This thesis highlights, firstly, the importance of early CRC detection by presenting results of a CRC diagnostic proteomic biomarker signature with high discriminative power. Secondly, a strong... Show moreThis thesis highlights, firstly, the importance of early CRC detection by presenting results of a CRC diagnostic proteomic biomarker signature with high discriminative power. Secondly, a strong robust, independent prognostic tumor stroma ratio (TSR) biomarker, which confirms to be of important clinical value. The TSR has the ability to stratify colon cancer patients according to their prognostic outcome in a highly reproducible and low-cost manner. It has shown to link patients with a high intra tumor stromal content and a worse prognosis. Literature shows a wealth of evidence that supports this prognostic value in CRC as well as in other cancers. This PhD research therefore concludes that it should be implemented in the official guidelines of the TNM classification to improve stratification for CRC patients in daily routine pathological evaluation. The prospective, international, multicentre UNITED study will hopefully overcome the last hurdle for this clinical implementation. Lastly, this thesis offers more insight in the elusiveness of the tumor microenvironment and stromatogenesis that contributes to the aggressiveness of some CRC tumors. The biological differences, interconnections and changes in the microenvironment presented give multiple leads for further research and new personalized treatment possibilities. Show less
Given the natural history of colorectal and breast cancer, early diagnosis appears to be the most appropriate tool to reduce disease-related mortality.[6;7] Currently, there is no early diagnostic... Show moreGiven the natural history of colorectal and breast cancer, early diagnosis appears to be the most appropriate tool to reduce disease-related mortality.[6;7] Currently, there is no early diagnostic test with high sensitivity, specificity and positive predictive value, which can be used as a routine screening tool. Therefore, there is a need for new biomarkers for both types of cancer that can improve early diagnosis, monitoring of disease progression and therapeutic response and detect disease recurrence. Proteomic expression profiles generated with mass spectrometry have been suggested as potential tools for the early diagnosis of cancer and other diseases. Because it is still in its infancy, many problems have to be overcome before clinical proteomics can be transferred form bench to bedside. Chapter 2 gives an insight in the different fields of translational research in colorectal cancer by our group. In chapter 3 reliability of human serum protein profiling using MALDI-TOF mass spectrometry is analysed. We present a pipeline for pre-processing, statistical data analysis and presentation of MALDI-TOF spectra. This novel analysis method was used to assess the effect of variable pre-analytical conditions on human serum protein profiles, and their effect on reproducibility. In line with the logistic conditions in a routine clinical setting, the effects of sample handling and storage, and also circadian rhythm factors on the serum protein profiles were analysed. In chapter 4 and 5 the feasibility of mass spectrometry based protein profiling for the discrimination of colorectal cancer patients from healthy individuals was assessed. In addition to standardizing technical factors and biological variations, we performed blinded tests and employed a randomised block design experimentation to minimize impact of potential confounding factors and to avoid bias. Especially, validation of our classifier, as a possible pitfall, was given much attention. Therefore, we performed a linear discriminant analysis with double cross-validation to separate cancer patients from healthy subjects. Chapter 6 reports on results from an identical designed protein profiling study for the detection of breast cancer. In chapter 7 a first validated study on the detection of breast cancer based on mass spectrometry generated protein profiles is described. In this study the same randomised blocked design and double cross validation is used, however the classifier was validated in an independent set of new patients and controls. Finally, the results and conclusions of all above mentioned studies and especially the current status of clinical proteomics in cancer are discussed in chapter 8. A Dutch summary of this thesis is written in chapter 9. Show less
