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Background/aim: This study aimed to clarify the potential of modified Glasgow Prognostic Score (mGPS) as a prognostic biomarker and reveal the significance of fish oil (FO)-enriched nutrition in colorectal cancer (CRC)., Patients and Methods: A total of 738 CRC patients from three different patient cohorts, including 670 patients in the biomarker study and 68 patients in the nutrition-intervention study, were analyzed., Results: High preoperative mGPS was significantly correlated with well-recognized disease progression factors and advanced UICC stage classification. In addition, high mGPS was an independent prognostic factor in both cohorts, especially in stage III and IV patients. These statuses were maintained in postoperative course and correlated with sarcopenia. Furthermore, FO-enriched nutrition suppressed systemic inflammatory reaction and improved skeletal muscle mass and prognosis, especially in CRC patients with mGPS 1 or 2., Conclusion: Assessment of mGPS could identify patients with high-risk CRC, who might be candidates for FO-enriched nutrition., (Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background/aim: This study was designed to evaluate the clinical significance of the C-reactive protein-to-albumin ratio (CAR) in patients with rectal cancer undergoing preoperative chemoradiotherapy (CRT) followed by surgery., Patients and Methods: This retrospective study evaluated the correlation between CAR and prognosis in 115 patients with locally advanced rectal cancer. We also carried out subgroup analyses limited to patients with low modified Glasgow prognosis score (mGPS) (score 0) or pathological TNM stage I-II [ypN(-)]., Results: CAR exhibited significant relationships with sex, tumor invasion, recurrence, serum carcinoembryonic antigen, and mGPS. Elevated CAR was an independent prognostic factor for overall survival (OS) and disease-free survival (DFS) among all patients. Elevated CAR also predicted poor OS and DFS in patients with pathological TNM stage I-II [ypN(-)] and low mGPS score., Conclusion: CAR is a promising predictor of survival and recurrence in patients with rectal cancer treated by CRT., (Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Aim: To identify predictors of poor prognosis of patients with colon cancer (CC) who underwent surgery with curative intent, we investigated the association between the albumin to globulin ratio (AGR) with clinicopathological findings such as overall (OS) and disease-free (DFS) survival., Patients and Methods: We conducted a retrospective study of clinicopathological findings, including preoperative laboratory data, for 248 patients with stage I-III CC., Results: Patients with low AGR had shorter DFS and OS compared to those with high AGR. Multivariate analyses identified low AGR as an independent variable independently associated with recurrence and poor prognosis of patients with CC who underwent surgery with curative intent regardless of lymphnode metastasis., Conclusion: The preoperative AGR was an independent predictor of recurrence and poor prognosis of patients with CC who underwent surgery with curative intent. The AGR indicates that these patients may benefit from intensive adjuvant therapy., (Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background: In palliative care, prediction of life expectancy is one of the most crucial issues for patients, family and medical staff, in order to provide appropriate end-of-life care. The aim of this study was to formulate a new objective score to predict life expectancy within 1 week for terminally ill patients with cancer., Patients and Methods: Medical records were obtained from 187 terminally-ill patients with cancer who were admitted for palliative care. The biomarkers for a potential 'Objective Predictive Score' were assessed., Results: Profiling of blood parameters demonstrated that elevated levels of alanine aminotransferase (ALT), total bilirubin (T-bil), blood urea nitrogen (BUN), creatinine (Cr) and a decreased platelet count were significantly correlated with death within 1 week in a training cohort. Our formulated Objective Predictive Score was able to predict death within 1 week with high accuracy in a training and a validation cohort., Conclusion: Our scoring system might enable the assessment of prognostication with higher accuracy in a terminal care setting., (Copyright© 2017 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

To assess the relationship of C-reactive protein/albumin ratio (CAR) to outcomes and surgical site infection (SSI) in gastric cancer (GC) treated with curative intent, we retrospectively assessed 384 patients with GC for CAR, SSIs, disease-free survival (DFS), overall survival (OS) and other factors. We found SSIs in 42 patients (10.9%). Pathological T-stage, TNM classification, body mass index, duration of surgery, blood loss and preoperative CAR were significantly associated with SSIs; in multivariate analyses, CAR [hazard ratio (HR)=2.98, p=0.003] and duration of surgery (HR=2.34, p=0.029) independently predicted SSI. Age, sex, T-and N-stages, tumor size and serum carcinoembryonic antigen (CEA) were associated with high CAR, and high CAR, CEA and CA19-9 combined was associated with shorter OS (p=0.0001) and DFS (p=0.0001). Multivariate analyses also linked high CAR to early recurrence (HR=2.21, p=0.011) and poor prognosis (HR=1.82, p=0.038). We show, for the first time to our knowledge, that a high CAR predicts SSI, early recurrence and poor prognosis in patients with GC treated with curative intent., (Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Dysregulation pattern of microRNA-7 (miR-7) and the clinical significance of its expression in colorectal cancer (CRC) are unresolved. Here, we investigated the relationship between clinicopathological factors, including prognostic outcome, and miR-7 expression in CRC tissues. We analyzed miR-7 expression levels by real-time reverse transcription polymerase chain reaction in 210 colorectal tissues (196 CRCs and 14 normal mucosae from healthy volunteers). miR-7 expression levels were significantly up-regulated in CRC tissues compared to normal colorectal mucosae. Elevated miR-7 expression was significantly correlated with tumour depth, venous invasion, lymphatic invasion, lymph node metastasis, and liver metastasis. High miR-7 expression was significantly associated with poor overall survival in patients with CRC (p=0.010). Moreover, miR-7 expression was an independent prognostic factor in patients with CRC (hazard ratio=1.854, 95% confidence interval=1.016-3.540; p=0.044). miR-7 acts as an oncogene in CRC and is significantly associated with tumour progression and poor prognosis., (Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Aim: The aim of this study was to investigate the correlations between clinicopathological findings, laboratory data and survival outcome in patients undergoing curative laparoscopic surgery for colorectal cancer (CRC)., Patients and Methods: Clinicopathological findings and laboratory data, including tumor markers carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) and systemic inflammatory response indicators, neutrophil-to-lymphocyte ratio (NLR) and modified Glasgow prognosis score (mGPS), for 204 patients (tumor stage I-III) undergoing laparoscopic curative surgery for CRC were collected., Results: Elevated CA19-9 and mGPS, and body mass index (BMI) <20 kg/m(2) were significant indicators of poorer overall survival, while CA19-9 and BMI were validated as independent predictors of overall survival. In addition, BMI <20 kg/m(2) was a significant independent factor predictive of poorer disease-free survival. BMI significantly negatively correlated with NLR, which reflects the patients' immune response., Conclusion: Lower BMI is a promising predictor of recurrence and poor prognosis in patients treated by laparoscopic surgery for CRC with curative intent., (Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Background: Angiopoietin-like protein-2 (ANGPTL2) mediates chronic inflammation. Tumor cell-derived ANGPTL2 promotes tumor invasion and angiogenesis. ANGPTL2 expression has not been fully investigated in gastric cancer (GC)., Materials and Methods: ANGPTL2 expression in 354 patients with GC was assessed by immunohistochemistry (IHC). IHC scores were calculated, and the association of ANGPTL2 with clinicopathological factors and patient outcomes was evaluated., Results: Immunoreactive ANGPTL2 protein was expressed mainly in GC cell cytoplasm. Kaplan-Meier analysis showed that high expression of ANGPTL2 indicated significantly poorer overall disease-free survival (DFS). Among patients with curatively resected GC, multivariate analysis for DFS revealed that high ANGPTL2 expression (p<0.01), advanced T-stage (p=0.015), lymph node metastasis (p<0.01), and advanced Unio Internationalis Contra Cancrum (UICC) stage (p<0.01) were independent risk factors for poor DFS., Conclusion: High cytoplasmic ANGPTL2 expression in GC tissue was associated with tumor progression, invasion, metastasis, and poor prognosis. ANGPTL2 may be a useful marker for detecting early postoperative recurrence in patients with GC., (Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Aim: The aim of the present study was to investigate whether serum markers and clinical factors could be used for preoperative prediction of peritoneal metastasis in gastric cancer (GC) as an indicator for neoadjuvant treatment., Patients and Methods: We enrolled 493 patients with GC for whom preoperative serum tumor markers [carcinoembryonic antigen (CEA) and carbohydrate antigen (CA)19-9], systemic inflammatory marker C-reactive protein (CRP), host immune markers [neutrophil and lymphocyte counts and their ratio (NLR)], albumin as a nutritional marker, and objective preoperative clinical factors were available as indicators of postoperative peritoneal metastasis., Results: Specific clinical factors, including tumor size, histopathology of biopsy sample, and tumor morphology, were significantly correlated with peritoneal metastasis. CA19-9, lymphocyte count and NLR were also predictive factors for peritoneal metastasis. Multivariate analysis identified the clinical factors tumor morphology and histopathology, and laboratory markers CA19-9 and lymphocyte count as independent factors predictive for peritoneal metastasis. A combination of independent predictive factors achieved high predictive accuracy (0.882) for peritoneal metastasis preoperatively., Conclusion: A combination of specific factors is an alternative method to preoperatively discriminate patients with GC with peritoneal metastasis from those without., (Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Aim: We investigated whether serum markers and clinical factors could be used to preoperatively predict lymph node (LN) metastasis in colorectal cancer (CRC)., Patients and Methods: The present study enrolled 157 curative CRC patients for whom preoperative serum carcinoembryonic antigen (CEA), systemic inflammatory markers (C-reactive protein (CRP) and angiopoietin-like protein 2 (ANGPTL2)) and objective preoperative clinical factors were available as indicators of pathological LN status., Results: Specific clinical factors, including gender, tumor size, histopathology of biopsy sample and tumor morphology, were significantly correlated with LN metastases. Additionally, CEA, CRP and ANGPTL2 levels were also predictive factors for LN status. Multivariate analysis revealed that clinical factors, including gender, histopathology, tumor morphology and ANGPTL2, were identified as independent predictive factors for LN metastases. A combination of clinical factors reached high predictive accuracy of LN metastases and, combined with clinical factors, ANGPTL2 further improved the accuracy., Conclusion: Serum ANGPTL2 improves preoperative detection of LN metastasis in CRC., (Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Aim: This study investigated microRNA (miR)-503 expression levels and evaluated its clinical significance in patients with oesophageal cancer (EC)., Materials and Methods: miR-503 expression was quantified by quantitative reverse transcription-polymerase chain reaction in 49 EC tissue samples and 12 adjacent normal tissues from 49 patients with EC. The association between miR-503 expression and clinicopathological factors, including prognostic outcomes, were assessed., Results: miR-503 was found up-regulated in EC tissues compared to adjacent normal tissues. High miR-503 expression was significantly associated with large tumor size. Kaplan-Meier analysis showed that patients with high miR-503 expression had significantly poorer disease-free and overall survival than those with lower expression levels. High miR-503 expression was identified as an independent prognostic predictor in patients with EC according to multivariate analysis., Conclusion: miR-503 expression affects tumor cell proliferation in EC. Evaluation of miR-503 expression might thus help identify patients with EC with poor prognosis and higher risk of early recurrence., (Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Background: Vasohibin-1 (VASH1) is related to angiogenesis and poor prognosis in several types of cancers. However, the biological function and clinical significance of VASH1 in colorectal cancer (CRC) are not fully known., Materials and Methods: The associations between VASH1 expression and clinicopathological features were investigated by immunohistochemistry in 429 CRC tissues. To evaluate the function of VASH1 in vitro, small-interfering VASH1-targeting RNA was transfected into human CRC cell lines., Results: We found that VASH1 was highly expressed in the cytoplasm of CRC tissues. High VASH1 expression in the cytoplasm was significantly associated with tumor progression, such as larger tumor size, advanced T-stage, lymph node metastasis, distant metastasis and poor prognosis. Moreover, a significant positive correlation was detected between VASH1 expression and microvessel density. VASH1 siRNA inhibited CRC cell proliferation, migration, and invasion, and promoted anoikis., Conclusion: Overexpression of VASH1 in CRC cells increased malignant potential and promoted metastasis., (Copyright© 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Aim: The present study investigated the clinical significance of tartrate-resistant acid phosphatase type-5 (ACP5) expression in gastric cancer., Materials and Methods: In 150 specimens of gastric cancer and adjacent normal mucosa, expression of ACP5 protein and mRNA and was determined by immunohistochemical staining and quantitative real-time polymerase chain reaction, respectively., Results: Expression of ACP5 mRNA was significantly higher in cancer tissues than in adjacent normal mucosa. Elevated ACP5 mRNA was associated with lymph node metastasis and peritoneal dissemination. Logistic regression analysis revealed that elevated ACP5 expression was an independent risk factor for peritoneal dissemination and was associated with shorter survival. Immunohistochemical staining of primary carcinomas showed ACP5 to be expressed mainly in the cytoplasm., Conclusion: ACP5 is predictive of peritoneal dissemination in patients with gastric cancer, and might play a crucial role in the establishment of peritoneal dissemination., (Copyright© 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Background: The clinical significance of the systemic inflammatory response (SIR) in patients with rectal cancer undergoing neoadjuvant chemoradiotherapy (CRT), to the best of our knowledge, has not been thus far investigated., Patients and Methods: The neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and C-Reactive protein (CRP) levels for 84 patients with rectal cancer undergoing CRT were available as indicators of SIR status. The impact of SIR status on the prognosis of these patients was assessed., Results: Elevated NLR, CRP, carcinoembryonic antigen (CEA) and pathological TNM stage III [ypN(+)] were identified as significant prognostic factors for poor overall survival (OS), with CRP and ypN(+) being validated as independent predictors of OS. Elevated CRP and CEA levels were significant predictive factors for poor disease-free survival (DFS), and an elevated CRP level was identified as the only independent predictive factor for DFS. In addition, an elevated CRP level predicted for poorer OS and DFS in patients with pathological TNM stage I-II [ypN(-)]., Conclusion: CRP is a promising predictor of recurrence and prognosis in patients with rectal cancer treated by CRT.

Aim: The aim of our study was to determine whether an inflammation-based prognostic score predicted tumor aggressiveness and disease-free survival (DFS)., Patients and Methods: We retrospectively reviewed 197 patients with locally advanced gastric cancer. The preoperative inflammation-based score was calculated as follows: patients with elevated C-reactive protein (>0.5 mg/dl) and hypoalbuminemia (<3.5 g/dl) were allocated a score of 2, and patients with one or no abnormal value were allocated a score of 1 or 0, respectively., Results: The inflammation-based prognostic score was significantly associated with tumor size and lymph node metastasis. The association between inflammation-based prognostic score and DFS was evaluated by univariate and multivariate Cox proportional hazard models. In multivariate analyses, an elevated inflammation-based prognostic score was associated with significantly worse DFS., Conclusions: Preoperative inflammation-based prognostic score is a potential marker for recurrence after curative gastrectomy.

Background: Metastasis associated in colon cancer 1 (MACC1) is a recently identified gene that plays a key role in regulating hepatocyte growth factor-MET signaling. In this study, we demonstrated the correlation and the clinical significance of MACC1 and MET expression in rectal cancer patients treated with chemoradiotherapy (CRT) followed by surgery., Materials and Methods: The expression of MACC1 and MET mRNA in residual cancer cells from 52 patients after CRT was determined by quantitative real-time polymerase chain reaction. Protein expression was also investigated by immunohistochemical staining., Results: MACC1 and MET expressions were positively correlated. Furthermore, these proteins were also co-expressed in immunohistochemical analyses. High expression of MACC1 or MET was associated with reduced relapse-free survival and the prognosis was worse when both genes were highly expressed., Conclusion: Evaluation of MACC1 and MET expression may be useful for predicting prognosis in patients with rectal cancer treated with CRT followed by surgery.