title: Growth differentiation factor 15: a prognostic marker for recurrence in colorectal cancer.
abstract: BACKGROUND
  Growth differentiation factor 15 (GDF15) belongs to the transforming growth factor beta superfamily and has been associated with activation of the p53 pathway in human cancer. The aim of this study was to assess the prognostic value of GDF15 in patients with colorectal cancer (CRC).
  
  
  METHODS
  Immunohistochemistry and tissue microarrays were used to analyse GDF15 protein expression in 320 patients with CRC. In a subgroup of 60 patients, the level of GDF15 protein in plasma was also measured using a solid-phase proximity ligation assay.
  
  
  RESULTS
  Patients with CRC with moderate to high intensity of GDF15 immunostaining had a higher recurrence rate compared with patients with no or low intensity in all stages (stages I-III) (HR, 3.9; 95% CI, 1.16-13.15) and in stage III (HR, 10.32; 95% CI, 1.15-92.51). Patients with high plasma levels of GDF15 had statistically shorter time to recurrence (P=0.041) and reduced overall survival (P=0.002).
  
  
  CONCLUSIONS
  Growth differentiation factor 15 serves as a negative prognostic marker in CRC. High expression of GDF15 in tumour tissue and high plasma levels correlate with an increased risk of recurrence and reduced overall survival.
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, 2800 Medical Building, 2800 Chicago Avenue South, Suite 300, Minneapolis, MN, USA. ulrik.wallin@surgsci.uu.se
authors.forename: U
authors.initials: U
authors.lastname: Wallin
authors.forename: B
authors.initials: B
authors.lastname: Glimelius
authors.forename: K
authors.initials: K
authors.lastname: Jirström
authors.forename: S
authors.initials: S
authors.lastname: Darmanis
authors.forename: R Y
authors.initials: RY
authors.lastname: Nong
authors.forename: F
authors.initials: F
authors.lastname: Pontén
authors.forename: C
authors.initials: C
authors.lastname: Johansson
authors.forename: L
authors.initials: L
authors.lastname: Påhlman
authors.forename: H
authors.initials: H
authors.lastname: Birgisson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000096:biosynthesis*; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000378:metabolism* / Q000473:pathology; D005260:Female; D055436:Growth Differentiation Factor 15 / Q000096:biosynthesis*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000378:metabolism* / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis
chemical_list: D014408:Biomarkers, Tumor; D055436:Growth Differentiation Factor 15