title: Circulating APRIL levels are correlated with advanced disease and prognosis in rectal cancer patients.
abstract: We have previously shown that the tumor necrosis factor family member a proliferation-inducing ligand (APRIL) enhances intestinal tumor growth in various preclinical tumor models. Here, we have investigated whether APRIL serum levels at time of surgery predict survival in a large cohort of colorectal cancer (CRC) patients. We measured circulating APRIL levels in a cohort of CRC patients (n=432) using a novel validated monoclonal APRIL antibody (hAPRIL.133) in an enzyme-linked immunosorbent assay (ELISA) setup. APRIL levels were correlated with clinicopathological features and outcome. Overall survival was examined with Kaplan-Meier survival analysis, and Cox proportional hazards ratios were calculated. We observed that circulating APRIL levels were normally distributed among CRC patients. High APRIL expression correlated significantly with poor outcome measures, such as higher stage at presentation and development of lymphatic and distant metastases. Within the group of rectal cancer patients, higher circulating APRIL levels at time of surgery were correlated with poor survival (log-rank analysis P-value 0.008). Univariate Cox regression analysis for overall survival in rectal cancer patients showed that patients with elevated circulating APRIL levels had an increased risk of poor outcome (hazard ratio (HR) 1.79; 95% confidence interval (CI) 1.16-2.76; P-value 0.009). Multivariate analysis in rectal cancer patients showed that APRIL as a prognostic factor was dependent on stage of disease (HR 1.25; 95% CI 0.79-1.99; P-value 0.340), which was related to the fact that stage IV rectal cancer patients had significantly higher levels of APRIL. Our results revealed that APRIL serum levels at time of surgery were associated with features of advanced disease and prognosis in rectal cancer patients, which strengthens the previously reported preclinical observation of increased APRIL levels correlating with disease progression.
authors.affiliation: LEXOR (Lab of Experimental Oncology and Radiobiology), Center for Experimental Molecular Medicine, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: V
authors.initials: V
authors.lastname: Lascano
authors.affiliation: 1] LEXOR (Lab of Experimental Oncology and Radiobiology), Center for Experimental Molecular Medicine, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands [2] Institut de Génétique Moléculaire (IGMM), CNRS UMR5535, Montpellier, France [3] Université Montpellier Sud de France, Montpellier, France.
authors.forename: M
authors.initials: M
authors.lastname: Hahne
authors.affiliation: 1] Institut de Génétique Moléculaire (IGMM), CNRS UMR5535, Montpellier, France [2] Université Montpellier Sud de France, Montpellier, France.
authors.forename: L
authors.initials: L
authors.lastname: Papon
authors.affiliation: LEXOR (Lab of Experimental Oncology and Radiobiology), Center for Experimental Molecular Medicine, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Cameron
authors.affiliation: Institute for Experimental Cancer Research, University Clinic Schleswig-Holstein (UKSH), Kiel, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Röeder
authors.affiliation: Clinic for General Surgery, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, UKSH, Kiel, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Schafmayer
authors.affiliation: BioNovion B.V., Oss, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Driessen
authors.affiliation: BioNovion B.V., Oss, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: van Eenennaam
authors.affiliation: Institute for Experimental Cancer Research, University Clinic Schleswig-Holstein (UKSH), Kiel, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Kalthoff
authors.affiliation: LEXOR (Lab of Experimental Oncology and Radiobiology), Center for Experimental Molecular Medicine, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: J P
authors.initials: JP
authors.lastname: Medema