Molecular and biological aspects of forecasting the oncological efficiency of cytoreductive surgery in metastatic colon cancer

Through an immunohistochemical study, the molecular biological properties of adenocarcinoma in patients with stage IV colorectal cancer with synchronous unresectable liver metastases, who underwent cytoreductive interventions for volume removal of the primary tumor, were examined. This study clarified the criteria for selecting patients with stage IV colon cancer with unresectable synchronous metastases in the liver for cytoreductive surgery from the standpoint of the molecular biological properties of the tumor. The prognostic significance of immunohistochemical markers such as the index of proliferative activity of stem cancer cells (ALDH + Ki-67 +) and the receptor for chemokines CXCR4 was established. The level of their expression correlates with the life expectancy of patients who underwent cytoreductive surgery. Thus, the high proliferative activity of cancer stem cells (ALDH + Ki67 + > 50%) and the high expression of chemokine receptor (CXCR4 > 70%) correlate with the rapid disease progression after surgical treatment. A significant inverse relationship was traced between the expression level of the receptor for chemokine CXCR4 as well as the proliferative activity of cancer stem cells and life expectancy of patients with stage IV colon cancer after cytoreductive surgery. The expediency of immunohistochemical studies in patients with metastatic colon cancer has been substantiated. Its implementation provides important information about the potential for tumor aggressiveness, which makes it possible to clarify the indications for performing cytoreductive surgery and improve the results of surgical treatment of this category of patients.