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(searched for: doi:10.3816/ccc.2011.n.003)
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, Sau Har Lee, Fengjun Qiu, Li Zhou, Xiaoling Wang, Tingjie Ye, Xudong Hu
Published: 28 May 2021
PLoS ONE, Volume 16; doi:10.1371/journal.pone.0250634

Abstract:
Background Drug resistance frequently led to the failure of chemotherapy for malignant cancers, hence causing cancer relapse. Thus, understanding mechanism of drug resistance in cancer is vital to improve the treatment efficacy. Here, we aim to evaluate the association between SMAD4 expression and the drug resistance in cancers by performing a meta-analysis. Method Relevant studies detecting SMAD4 expression in cancer patients treated with chemo-drugs up till December 2020 were systematically searched in four common scientific databases using selected keywords. The pooled hazard ratio (HR) was the ratio of hazard rate between SMAD4neg population vs SMAD4pos population. The HRs and risk ratios (RRs) with 95% confidence intervals (CIs) were used to explore the association between SMAD4 expression losses with drug resistance in cancers. Result After an initial screening according to the inclusion and exclusion criteria, eleven studies were included in the meta-analysis. There were a total of 2092 patients from all the included studies in this analysis. Results obtained indicated that loss of SMAD4 expression was significantly correlated with drug resistance with pooled HRs (95% CI) of 1.23 (1.01–1.45), metastasis with pooled RRs (95% CI) of 1.10 (0.97–1.25) and recurrence with pooled RRs (95% CI) of 1.32 (1.06–1.64). In the subgroup analysis, cancer type, drug type, sample size and antibody brand did not affect the significance of association between loss of SMAD4 expression and drug resistance. In addition, there was no evidence of publication bias as suggested by Begg’s test. Conclusion Findings from our meta-analysis demonstrated that loss of SMAD4 expression was correlated with drug resistance, metastasis and recurrence. Therefore, SMAD4 expression could be potentially used as a molecular marker for cancer resistance.
Seung-Yeon Yoo, Ji-Aee Lee, Yunjoo Shin, Nam-Yun Cho, ,
Journal of Pathology and Translational Medicine, Volume 53, pp 289-297; doi:10.4132/jptm.2019.06.07

Abstract:
SMAD family member 4 (SMAD4) has gained attention as a promising prognostic factor of colorectal cancer (CRC) as well as a key molecule to understand the tumorigenesis and progression of CRC. We retrospectively analyzed 1,281 CRC cases immunohistochemically for their expression status of SMAD4, and correlated this status with clinicopathologic and molecular features of CRCs. A loss of nuclear SMAD4 was significantly associated with frequent lymphovascular and perineural invasion, tumor budding, fewer tumor-infiltrating lymphocytes, higher pT and pN category, and frequent distant metastasis. In contrast, tumors overexpressing SMAD4 showed a significant association with sporadic microsatellite instability. After adjustment for TNM stage, tumor differentiation, adjuvant chemotherapy, and lymphovascular invasion, the loss of SMAD4 was found to be an independent prognostic factor for worse 5-year progression-free survival (hazard ratio [HR], 1.27; 95% confidence interval [CI], 1.01 to 1.60; p=.042) and 7-year cancerspecific survival (HR, 1.45; 95% CI, 1.06 to 1.99; p=.022). We confirmed the value of determining the loss of SMAD4 immunohistochemically as an independent prognostic factor for CRC in general. In addition, we identified some histologic and molecular features that might be clues to elucidate the role of SMAD4 in colorectal tumorigenesis and progression.
, Walid K. Chatila, Francisco Sanchez‐Vega, Jashodeep Datta, Louise C. Connell, , Azfar Basunia, Taryn M. Boucher, Haley Hauser, Isaac Wasserman, et al.
Published: 10 September 2019
by Wiley
Cancer Medicine, Volume 8, pp 6538-6548; doi:10.1002/cam4.2415

Abstract:
Resection of colorectal liver metastases (CLM) can cure disease, but many patients with extensive disease cannot be fully resected and others recur following surgery. Hepatic arterial infusion (HAI) chemotherapy can convert extensive liver disease to a resectable state or decrease recurrence risk, but response varies and no biomarkers currently exist to identify patients most likely to benefit. We performed a retrospective cohort study of CLM patients receiving HAI chemotherapy whose tumors underwent MSK-IMPACT sequencing. The frequency of oncogenic alterations and their association with overall survival (OS) and objective response rate were analyzed at the individual gene and signaling pathway levels. Three hundred and seventy patients met inclusion criteria: 189 (51.1%) who underwent colorectal liver metastasectomy followed by HAI + systemic therapy (Adjuvant cohort), and 181 (48.9%) with unresectable CLM (Metastatic cohort) who received HAI + systemic therapy, consisting of 63 (34.8%) with extrahepatic disease and 118 (65.2%) with liver-restricted disease. Genomic alterations were similar in each cohort, and no individual gene or pathway was significantly associated with objective response. Patients in the adjuvant cohort with concurrent Ras/B-Raf alteration and SMAD4 inactivation had worse prognosis while in the metastatic cohort patients with co-alteration of Ras/B-Raf and TP53 had worse OS. Similar findings were observed in a validation cohort. Concurrently altered Ras/B-Raf and SMAD4 mutations were associated with worse survival in resectable patients, while concurrent Ras/B-Raf and TP53 alterations were associated with worse survival in unresectable patients. The mutual exclusivity of Ras/B-Raf, SMAD4, and TP53 may have prognostic value for CLM patients receiving HAI.
Geng Qin, Guo Zhen Wang, Dan Dan Guo, Ru Xue Bai, Miao Wang,
Published: 25 April 2018
by Wiley
Journal of Digestive Diseases, Volume 19, pp 301-313; doi:10.1111/1751-2980.12599

The publisher has not yet granted permission to display this abstract.
Tao Jiang, Ling Ye, Zhongbo Han, Yuan Liu, , ,
Journal of Experimental & Clinical Cancer Research, Volume 36, pp 1-14; doi:10.1186/s13046-017-0602-5

Abstract:
As a disease with extremely complex molecular mechanisms, many deregulated miRNAs have been identified in colon cancer. Few studies have been performed by using Ingenuity Pathways Analysis (IPA) to predict miRNAs specifically expressed in colon cancer. A characteristic microRNA-target network of colon cancer was explored using IPA. Then the clinical significance of miR-19b-3p was evaluated in 211 colon cancer patients. The roles of miR-19b-3p and its candidate target gene, SMAD4, in colon cancer progression were examined both in vitro and in vivo. Bioinformatics analysis showed that 15 microRNAs screened by IPA were significantly correlated with malignant biological behaviors of colon cancer. miR-19b-3p was the most significantly upregulated candidate based on the validation experiment using 211 colon cancer samples. High expression of miR-19b-3p was significantly associated with high N stage (P < 0.001), high AJCC stage (P < 0.001), poor histologic grade (P = 0.032), frequent venous and lymphatic invasion (P = 0.027), and liver metastasis (P < 0.001). Survival analysis revealed that miR-19b-3p was an independent prognostic factor associated with colon cancer patient’s overall survival (OS) and disease-free survival (DFS). miR-19b-3p promoted proliferation and chemoresistance of colon cancer cells, but had no effect on invasion in vitro, along with tumorigenesis in vivo. In addition, we confirmed that miR-19b-3p mediates resistance to oxaliplatin-based chemotherapy via SMAD4. Our findings demonstrate the role of miR-19b-3p-SMAD4 axis in colon cancer progression, which may become a potential therapeutic target against chemotherapy resistance.
Binhao Zhang, Chao Leng, Chao Wu, Zhanguo Zhang, Lei Dou, Xin Luo, , Xiaoping Chen
Published: 8 December 2015
Oncology Reports, Volume 35, pp 1807-1815; doi:10.3892/or.2015.4479

The publisher has not yet granted permission to display this abstract.
Published: 1 February 2015
Translational Oncology, Volume 8, pp 18-24; doi:10.1016/j.tranon.2014.11.003

Abstract:
AIM: SMAD4 immunohistochemistry is considered a valuable prognostic marker in colorectal cancer, but individual studies have often been small and the results variable. A meta-analysis could potentially clarify these findings. METHODS: In September 2014, a Pubmed and Google Scholar search was conducted to find publications that reported the prognostic value of SMAD4 expression. A meta-analysis was performed to clarify the association between SMAD4 expression and survival outcomes. RESULTS: 137 studies were found, of which 13 were considered eligible. The studies consisted of a total of 3800 patients. Three different endpoints were taken into account, namely, overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS). In addition, the studies were divided into univariate and multivariate analyses. The pooled hazard ratios were given as follows: univariate CSS = 1.75 [95% confidence interval (CI): 0.93-3.32; z= 1.69; P= .09]; multivariate CSS = 2.17 (95% CI: 1.56-3.01; z= 4.65; P= .000); univariate DFS = 2.11 (95% CI: 1.36-3.28; z= 3.32; P= .001); multivariate DFS = 2.15 (95% CI: 1.56-3.01; z= 4.65; P= .000); univariate OS and DFS = 2.30 (95% CI: 1.41-3.73; z= 3.36; P= .001); univariate OS = 2.28 (95% CI: 1.30-4.00; z= 2.89; P= .004). CONCLUSION: The results of the presented meta-analyses indicate that SMAD4 expression status using immunohistochemistry is a prognostic marker for patient survival.
Bin Zhang, Xingjie Chen, Sukang Bae, K K Singh, Mary Kay Washington,
British Journal of Cancer, Volume 110, pp 946-957; doi:10.1038/bjc.2013.789

Abstract:
Higher frequency of Smad4 inactivation or loss of expression is observed in metastasis of colorectal cancer (CRC) leading to unfavourable survival and contributes to chemoresistance. However, the molecular mechanism of how Smad4 regulates chemosensitivity of CRC is unknown. We evaluated how the loss of Smad4 in CRC enhanced chemoresistance to 5-fluorouracil (5-FU) using two CRC cell lines in vitro and in vivo. Immunoblotting with cell and tumour lysates and immunohistochemical analyses with tissue microarray were performed. Knockdown or loss of Smad4 induced tumorigenicity, migration, invasion, angiogenesis, metastasis, and 5-FU resistance. Smad4 expression in mouse tumours regulated cell-cycle regulatory proteins leading to Rb phosphorylation. Loss of Smad4 activated Akt pathway that resulted in upregulation of anti-apoptotic proteins, Bcl-2 and Bcl-w, and Survivin. Suppression of phosphatidylinositol-3-kinase (PI3K)/Akt pathway by LY294002 restored chemosensitivity of Smad4-deficient cells to 5-FU. Vascular endothelial growth factor-induced angiogenesis in Smad4-deficient cells might also lead to chemoresistance. Low levels of Smad4 expression in CRC tissues correlated with higher levels of Bcl-2 and Bcl-w and with poor overall survival as observed in immunohistochemical staining of tissue microarrays. Loss of Smad4 in CRC patients induces resistance to 5-FU-based therapy through activation of Akt pathway and inhibitors of this pathway may sensitise these patients to 5-FU.
Lara Lipton, Michael Christie,
Cancer Genomics pp 131-162; doi:10.1007/978-94-007-5842-1_5

The publisher has not yet granted permission to display this abstract.
Aneel Bhangu, Gemma Wood, Alex Mirnezami, Ara Darzi, Paris Tekkis,
Published: 1 December 2012
Surgical Oncology, Volume 21, pp 316-323; doi:10.1016/j.suronc.2012.08.003

The publisher has not yet granted permission to display this abstract.
, U. Sommer, G. B. Baretton
Published: 1 September 2012
Annals of Oncology, Volume 23; doi:10.1093/annonc/mds346

Abstract:
In recent years, colorectal cancer (CRC), once a uniform disease with well-understood carcinogenesis, has been divided into at least five different subgroups with distinct precursor lesions, pathways of carcinogenesis, morphological, and molecular characteristics. Moreover, new therapeutic concepts with ‘targeted’ substances have added to the complexity of the management of CRC patients. The clinical value of biomarkers in advanced CRC is indisputable ever since activating mutations of the KRaS oncogene have been shown to predict resistance to anti-epidermal growth factor receptor antibodies. Prognostic biomarkers predicting patient outcomes and predictive biomarkers forecasting response to a certain therapy may help us to improve therapeutic agent selection and patient management with the ultimate goal of maximizing the benefit of treatment and minimizing toxicity. Biomarkers with known implications in advanced CRC will be discussed in this paper.
Laura H. Rosenberger, Timothy Newhook, David M. Mauro, Sara A. Hennessy,
Published: 31 March 2012
Gastrointestinal Endoscopy, Volume 75, pp 683-687; doi:10.1016/j.gie.2011.10.009

Kimberly Long, Toaa Abuelenen, Libia Pava, Maya Bastille,
Published: 1 October 2011
Genes & Cancer, Volume 2, pp 927-931; doi:10.1177/1947601911436200

The publisher has not yet granted permission to display this abstract.
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