Context: A 1990 National Institutes of Health Consensus Conference recommended that patients with stage III colon cancer receive adjuvant chemotherapy because survival was improved in clinical trials in patients who r...Context: A 1990 National Institutes of Health Consensus Conference recommended that patients with stage III colon cancer receive adjuvant chemotherapy because survival was improved in clinical trials in patients who received a 5-fluorouracil-based regimen. Objective: To determine whether adjuvant chemotherapy is used in the community as a standard of practice that improves outcome and whether it failed to benefit any specific sets of patients. Design, Setting, and Participants: Prospective data from 85 934 patients with stage III colon cancer from 560 hospital cancer registries were entered into the National Cancer Data Base between 1990 and 2002 and included standard clinical, pathological, and first course of treatment variables. Main Outcome Measures: Prevalence of adjuvant chemotherapy usage and 5-year survival in patients treated in US hospitals. Results: Adjuvant chemotherapy use increased from 39%in 1991 to 64%in 2002 but was lower in black, female, and elderly patients. It improved 5-year survival from almost 8%in 1991 to more than 16%in 1997 compared with surgery alone. Adjuvant chemotherapy increases survival in elderly patients as much as it does in younger patients. However, the benefit of adjuvant chemotherapy in blacks and those with hi gh-grade cancers is not as great. Conclusions: Adjuvant chemotherapy use has in creased from 1990 to 2002 for patients with stage III colon cancer with an assoc iated increase in 5-year survival of 16%. The benefit of adjuvant chemotherapy seems to be lower in black patients and highgrade cancers. Women have the same benefit but are less often treated. Elderly patients have the same benefit as yo unger patients but are less frequently treated. New options for adjuvant therapy in 2004-2005 may further improve the outcome of patients with stage III colon cancer.展开更多
The discovery that all cells secrete extracellular vesicles(EVs)to shuttle proteins and nucleic acids to recipient cells suggested they play an important role in intercellular communication.EVs are widely distributed ...The discovery that all cells secrete extracellular vesicles(EVs)to shuttle proteins and nucleic acids to recipient cells suggested they play an important role in intercellular communication.EVs are widely distributed in many body fluids,including blood,cerebrospinal fluid,urine and saliva.Exosomes are nano-sized EVs of endosomal origin that regulate many pathophysiological processes including immune responses,inflammation,tumour growth,and infection.Healthy individuals release exosomes with a cargo of different RNA,DNA,and protein contents into the circulation,which can be measured non-invasively as biomarkers of healthy and diseased states.Cancer-derived exosomes carry a unique set of DNA,RNA,protein and lipid reflecting the stage of tumour progression,and may serve as diagnostic and prognostic biomarkers for various cancers.However,many gaps in knowledge and technical challenges in EVs and extracellular RNA(exRNA)biology,such as mechanisms of EV biogenesis and uptake,exRNA cargo selection,and exRNA detection remain.The NIH Common Fund-supported exRNA Communication Consortium was launched in 2013 to address major scientific challenges in this field.This review focuses on scientific highlights in biomarker discovery of exosome-based exRNA in cancer and its possible clinical application as cancer biomarkers.展开更多
文摘Context: A 1990 National Institutes of Health Consensus Conference recommended that patients with stage III colon cancer receive adjuvant chemotherapy because survival was improved in clinical trials in patients who received a 5-fluorouracil-based regimen. Objective: To determine whether adjuvant chemotherapy is used in the community as a standard of practice that improves outcome and whether it failed to benefit any specific sets of patients. Design, Setting, and Participants: Prospective data from 85 934 patients with stage III colon cancer from 560 hospital cancer registries were entered into the National Cancer Data Base between 1990 and 2002 and included standard clinical, pathological, and first course of treatment variables. Main Outcome Measures: Prevalence of adjuvant chemotherapy usage and 5-year survival in patients treated in US hospitals. Results: Adjuvant chemotherapy use increased from 39%in 1991 to 64%in 2002 but was lower in black, female, and elderly patients. It improved 5-year survival from almost 8%in 1991 to more than 16%in 1997 compared with surgery alone. Adjuvant chemotherapy increases survival in elderly patients as much as it does in younger patients. However, the benefit of adjuvant chemotherapy in blacks and those with hi gh-grade cancers is not as great. Conclusions: Adjuvant chemotherapy use has in creased from 1990 to 2002 for patients with stage III colon cancer with an assoc iated increase in 5-year survival of 16%. The benefit of adjuvant chemotherapy seems to be lower in black patients and highgrade cancers. Women have the same benefit but are less often treated. Elderly patients have the same benefit as yo unger patients but are less frequently treated. New options for adjuvant therapy in 2004-2005 may further improve the outcome of patients with stage III colon cancer.
文摘The discovery that all cells secrete extracellular vesicles(EVs)to shuttle proteins and nucleic acids to recipient cells suggested they play an important role in intercellular communication.EVs are widely distributed in many body fluids,including blood,cerebrospinal fluid,urine and saliva.Exosomes are nano-sized EVs of endosomal origin that regulate many pathophysiological processes including immune responses,inflammation,tumour growth,and infection.Healthy individuals release exosomes with a cargo of different RNA,DNA,and protein contents into the circulation,which can be measured non-invasively as biomarkers of healthy and diseased states.Cancer-derived exosomes carry a unique set of DNA,RNA,protein and lipid reflecting the stage of tumour progression,and may serve as diagnostic and prognostic biomarkers for various cancers.However,many gaps in knowledge and technical challenges in EVs and extracellular RNA(exRNA)biology,such as mechanisms of EV biogenesis and uptake,exRNA cargo selection,and exRNA detection remain.The NIH Common Fund-supported exRNA Communication Consortium was launched in 2013 to address major scientific challenges in this field.This review focuses on scientific highlights in biomarker discovery of exosome-based exRNA in cancer and its possible clinical application as cancer biomarkers.
