Prognostic and predictive value of cathepsin X in serum from colorectal cancer patientsReport as inadecuate

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BMC Cancer

, 14:259

Translational oncology


BackgroundCathepsin X is a cysteine protease involved in mechanisms of malignant progression. It is secreted from tumour cells as a proenzyme and may serve to predict the disease status and risk of death for cancer patients. In a previous, pilot, study on 77 colorectal patients we demonstrated the correlation of higher serum levels with shorter overall survival.

Methods264 patients with colorectal cancer were included in a prospectively accrued multi-centre observational cohort study with the aim of testing novel biomarkers. Blood samples were collected before preoperative large bowel endoscopy and total cathepsin X was measured in sera by ELISA. As a control group we selected at random 77 subjects who had no findings at endoscopy and reported no co-morbidity.

ResultsThe mean level of cathepsin X in cancer patients did not differ from the control levels 23.4 ng-ml ± 6.4 SD vs. 18.8 ng-ml ± 11.4 SD, p > 0.05 and there was no association with age, gender, disease stage, tumour location or CEA. In univariate analysis no association between cathepsin X levels and overall survival was demonstrated for the entire set of patients, however, cathepsin X was associated with survival in a group of patients with local resectable disease stages I-III HR = 1.69, 95% CI: 1.03-2.75, p = 0.03. For this group, multivariate Cox regression analysis showed an association HR = 3.13, 95% CI: 1.37-7.18, p = 0.003 between high cathepsin X levels and shorter overall survival for patients who did not receive chemotherapy, whereas, for patients who received chemotherapy, there was no association between cathepsin X and survival HR = 0.51, 95% CI: 0.20-1.33, p = 0.88.

ConclusionsAssociation of cathepsin X levels with overall survival was not confirmed for an entire set of 264 colorectal patients, but for patients in stages I-III with local resectable disease. The significant association of cathepsin X with survival in a group of patients who received no chemotherapy and the absence of this association in the group who received chemotherapy, suggest the possible predictive value for response to chemotherapy. The results have to be confirmed in a further prospective study.

KeywordsCathepsin X Colorectal cancer Prognosis Predictive marker Serum biomarker AbbreviationsCat XCathepsin X

CEACarcinoembryonic antigen

CIConfidence interval

CRCColorectal cancer

CVCoefficient of variance

CXCL-12C-X-C motif chemokine 12


HRHazard ratio

PymTPolyomavirus middle T oncogene

SDStandard deviation.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2407-14-259 contains supplementary material, which is available to authorized users.

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Author: Tjaša Vižin - Ib Jarle Christensen - Michael Wilhelmsen - Hans Jørgen Nielsen - Janko Kos


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