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Guanylyl Cyclase C Messenger RNA Is a Biomarker for Recurrent Stage II Colorectal Cancer

Burt Cagir, MD; Alyssa Gelmann, MD; Jason Park, BS; Tracy Fava, BS; Alexander Tankelevitch, MD; Edwin W. Bittner, MD; Eric J. Weaver, MD, PhD; Juan P. Palazzo, MD; David Weinberg, MD, MSc; Robert D. Fry, MD; and Scott A. Waldman, MD, PhD
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Grant Support: By grants from the National Institutes of Health (CA75123, CA79663) and Targeted Diagnostics and Therapeutics, Inc. Dr. Gelmann and Mr. Park were supported by training grants from the National Institutes of Health (5T32 GM08562 and T32 DK07705, respectively). Dr. Waldman is the Samuel M.V. Hamilton Professor of Medicine at Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.

Requests for Reprints: Scott A. Waldman, MD, PhD, Division of Clinical Pharmacology, Department of Medicine, Jefferson Medical College, Thomas Jefferson University, 132 South 10th Street, 1170 Main, Philadelphia, PA 19107; e-mail, scott.waldman@mail.tju.edu. For reprint orders in quantities exceeding 100, please contact the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

Current Author Addresses: Drs. Cagir, Bittner, and Fry: Division of Colorectal Surgery, Department of Surgery, Thomas Jefferson University, 1100 Walnut Street, Philadelphia, PA 19107.

Dr. Gelmann, Mr. Park, Ms. Fava, Mr. Tankelevitch, and Dr. Waldman: Division of Clinical Pharmacology, Department of Medicine, Thomas Jefferson University, 132 South 10th Street, 1170 Main, Philadelphia, PA 19107.

Drs. Weaver and Palazzo: Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, 132 South 10th Street, 285 Main, Philadelphia, PA 19107.

Dr. Weinberg: Division of Gastroenterology, Department of Medicine, Thomas Jefferson University, 132 South 10th Street, 480 Main, Philadelphia, PA 19107.


Ann Intern Med. 1999;131(11):805-812. doi:10.7326/0003-4819-131-11-199912070-00002
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Stage at diagnosis is the most important prognostic determinant for patients with colorectal cancer (16), and it dictates the role of adjuvant chemotherapy in this disease (710). Given the prognostic and therapeutic importance of staging, accurate histopathologic evaluation of lymph nodes to detect invasion by tumor cells is crucial. However, conventional microscopic lymph node examination has methodologic limitations (6, 11). It can be difficult to differentiate single or even small clumps of tumor cells from other types of cells, which limits sensitivity. The standard practice of examining only a limited number of tissue sections from each lymph node can omit from review more than 99% of each specimen and can introduce sampling error. These limitations are evident when the frequency of disease recurrence in patients with stage I and stage II disease is considered. By definition, such patients do not have extraintestinal disease at the time of curative resection. However, recurrence rates of 10% to 30% have been reported for lesions confined to the mucosa (stage I disease), and rates of 30% to 50% have been reported for lesions confined to the bowel wall (stage II disease) (1213).

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Grahic Jump Location
Figure.
Algorithm for selecting patient biopsy samples for analysis.

TNM = tumor, node, metastasis classification system.

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Summary for Patients

A New Test for Recurrent Colon Cancer

The summary below is from the full report titled “Guanylyl Cyclase C Messenger RNA Is a Biomarker for Recurrent Stage II Colorectal Cancer.” It is in the 7 December 1999 issue of Annals of Internal Medicine (volume 131, pages 805-812). The authors are B. Cagir, A. Gelmann, J. Park, T. Fava, A. Tankelevitch, E.W. Bittner, E.J. Weaver, J.P. Palazzo, D. Weinberg, R.D. Fry, and S.A. Waldman.

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