Evaluation of risk factors for recurrence after potentially curative surgery for colorectal carcinoma using cDNA array

在可能治愈的结直肠癌手术后，标准的辅助治疗是使用5-氟尿嘧啶和亚叶酸碱进行化疗。根据TNM分期确定适应症；III期疾病或有淋巴结转移的患者是辅助化疗的候选者。因此，由于缺乏确定术后复发危险因素的精确方法，许多没有隐匿性转移的患者接受了不必要的化疗。另一方面，隐匿性转移但无淋巴结转移的患者则不被认为是术后化疗的指征。本研究旨在建立一种精确的方法，利用印迹550个肿瘤相关基因的cDNA阵列来确定明显治愈性切除后的隐匿性转移患者。通过cDNA阵列检测基因表达谱，比较行根治性切除后5年无复发的结直肠癌患者（A组）和肝转移患者（B组）。与a组相比，我们发现B组患者中有9个基因表达较高，22个基因表达较低，使用这种基因表达谱可以确定肝脏复发的风险，准确率为80%，远远优于传统的TNM分期相关决策。

Standard adjuvant therapy after potentially curative surgery for colorectal cancer is chemotherapy using 5-fluorouracil and leucovorine. The indication have been determined according to TNM stage ; Patients with stage III disease, or with lymph node metastasis, are candidates for adjuvant chemotherapy. Therefore, many patients without occult metastasis have been received unnecessary chemotherapy due to the lack of precise method for determine the risk factors for postoperative recurrence. On the other hand, patients with occult metastasis, but without lymph node metastasis, were not considered to be indicated for postoperative chemotherapy.This study was conducted to develop precise method to determine patients with occult metastasis after apparently curative resection using cDNA array on which 550 cancer-related genes were blotted.Patients with colorectal carcinoma who had undergone potentially curative resection and survived without recurrence for 5 years (Group A) and those with hepatic metastasis (Group B) were compared in terms of gene expression profile determined by cDNA array.We found 9 genes with higher and 22 genes with lower expression in patients in Group B compared to those in Group A.Using this gene expression profile, the risk of hepatic recurrence can be determined with the accuracy of 80%, which is much better than conventional TNM stage-related decision making.