title: Clinical and histopathological correlations of fecal calprotectin release in colorectal carcinoma.
abstract: OBJECTIVE
  To determine calprotectin release before and after colorectal cancer operation and compare it to tumor and histopathological parameters.
  
  
  METHODS
  The study was performed on patients with diagnosed colorectal cancer admitted for operation. Calprotectin was measured in a single stool sample before and three months after the operation using an enzyme-linked immunosorbent assay (ELISA). Calprotectin levels greater than or equal to 50 μg/g were considered positive. The compliance for collecting stool samples was assessed and the value of calprotectin was correlated to tumor and histopathological parameters of intra- and peri-tumoral inflammation. Surgical specimens were fixed in neutral buffered formalin and stained with hematoxylin and eosin. Staging was performed according to the Dukes classification system and the 7(th) edition tumor node metastasis classification system. Intra- and peri-tumoral inflammation was graded according to the Klintrup criteria. Immunohistochemical quantification was performed for MPO, CD45R0, TIA-1, CD3, CD4, CD8, CD57, and granzyme B. Statistical significance was measured using Wilcoxon signed rank test, Kruskal Wallis test and Spearman's rank correlation coefficient as appropriate.
  
  
  RESULTS
  Between March 2009 and May 2011, 80 patients with colorectal cancer (46 men and 34 women, with mean age of 71 ± 11.7 years old) were enrolled in the study. Twenty-six patients had rectal carcinoma, 29 had left-side tumors, 23 had right-side tumors, and 2 had bilateral carcinoma. In total, 71.2% of the patients had increased levels of calprotectin before the operation (median 205 μg/g, range 50-2405 μg/g) and experienced a significant decrease three months after the operation (46 μg/g, range 10-384 μg/g, P < 0001). The compliance for collecting stool samples was 89.5%. Patients with T3 and T4 tumors had significantly higher values than those with T1 and T2 cancers (P = 0.022). For all other tumor parameters (N, M, G, L, V, Pn) and location, no significant difference in calprotectin concentration was found. Furthermore, the calprotectin levels and histological grading of both peri- and intra-tumoral inflammation was not correlated. Additional testing with specific markers for lymphocytes and neutrophils also revealed no statistically significant correlation.
  
  
  CONCLUSIONS
  Fecal calprotectin decreases significantly after colorectal cancer operation. Its value depends exclusively on the individual T-stage, but not on other tumor or histopathological parameters.
authors.affiliation: Frank Serge Lehmann, Christoph Beglinger, Division of Gastroenterology and Hepatology, University Hospital, 4031 Basel, Switzerland.
authors.forename: Frank Serge
authors.initials: FS
authors.lastname: Lehmann
authors.affiliation: Frank Serge Lehmann, Christoph Beglinger, Division of Gastroenterology and Hepatology, University Hospital, 4031 Basel, Switzerland.
authors.forename: Francesca
authors.initials: F
authors.lastname: Trapani
authors.affiliation: Frank Serge Lehmann, Christoph Beglinger, Division of Gastroenterology and Hepatology, University Hospital, 4031 Basel, Switzerland.
authors.forename: Ida
authors.initials: I
authors.lastname: Fueglistaler
authors.affiliation: Frank Serge Lehmann, Christoph Beglinger, Division of Gastroenterology and Hepatology, University Hospital, 4031 Basel, Switzerland.
authors.forename: Luigi Maria
authors.initials: LM
authors.lastname: Terracciano
authors.affiliation: Frank Serge Lehmann, Christoph Beglinger, Division of Gastroenterology and Hepatology, University Hospital, 4031 Basel, Switzerland.
authors.forename: Markus
authors.initials: M
authors.lastname: von Flüe
authors.affiliation: Frank Serge Lehmann, Christoph Beglinger, Division of Gastroenterology and Hepatology, University Hospital, 4031 Basel, Switzerland.
authors.forename: Gieri
authors.initials: G
authors.lastname: Cathomas
authors.affiliation: Frank Serge Lehmann, Christoph Beglinger, Division of Gastroenterology and Hepatology, University Hospital, 4031 Basel, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Zettl
authors.affiliation: Frank Serge Lehmann, Christoph Beglinger, Division of Gastroenterology and Hepatology, University Hospital, 4031 Basel, Switzerland.
authors.forename: Pascal
authors.initials: P
authors.lastname: Benkert
authors.affiliation: Frank Serge Lehmann, Christoph Beglinger, Division of Gastroenterology and Hepatology, University Hospital, 4031 Basel, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Oertli
authors.affiliation: Frank Serge Lehmann, Christoph Beglinger, Division of Gastroenterology and Hepatology, University Hospital, 4031 Basel, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Beglinger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism*; D001706:Biopsy; D002277:Carcinoma / Q000378:metabolism* / Q000473:pathology / Q000601:surgery; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000378:metabolism* / Q000473:pathology / Q000601:surgery; D004797:Enzyme-Linked Immunosorbent Assay; D005243:Feces / Q000737:chemistry*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D039841:Leukocyte L1 Antigen Complex / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010349:Patient Compliance; D011237:Predictive Value of Tests; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D039841:Leukocyte L1 Antigen Complex
keywords: Calprotectin; Colorectal cancer; Granulocytes; Inflammation; Tumor size