Abstract 4921: Plasma proteomics for the discovery of biomarkers of incisional hernia in colorectal cancer patients in the ColoCare Study
Authors: Böhm Jürgen , Pianka Frank , Stüttgen Nina , Gigic Biljana , Zhang Yuzheng , Schrotz-King Petra , Habermann Nina , Ulrich Alexis , Schneider Martin , Lampe Paul , Diener Markus , Ulrich Cornelia M. 
Published: July 2016

Abstract
Background
Incisional hernia is the most common long-term complication after laparotomy for colorectal cancer resection with an incidence of 9-20%. Predisposing factors have been identified. Nevertheless, there are limited approaches to precisely predict individual risk, creating a need for predictive biomarkers of incisional hernia development.
Methods
We utilized pre-operative plasma samples of patients with newly diagnosed colorectal cancer [n = 72; (stage I-IV)] from the ColoCare Study in Heidelberg, Germany, who underwent laparoscopic tumor resection between 2010 and 2013. Patient questionnaires and telephone-interviews were used to assess the incidence of an incisional hernia, and demographic and clinical-surgical data were abstracted from medical records. 21 patients with incisional hernia occurrence were matched with 51 patients without an incisional hernia ( = controls) by gender, age, and BMI with at least 18 months follow-up. To assess predictive markers of incisional hernia risk we screened the plasma proteome for 3061 proteins using a well-validated antibody microarray test. Paired t-tests were used to compare protein levels between cases and controls. A gene-set-enrichment analysis (Gene Ontology and KEGG) was applied to test for differences in signaling pathways between the two groups.
Results
The proteome screen identified 27 proteins that showed elevated or reduced plasma levels in the hernia group compared to the control group (nominal p-values &lt;0.05). Most of these proteins were connected to cell adhesion and inflammation, e.g. the encoding genes CCL21, IL12A, EPCAM and CDH3. The gene-set-enrichment analysis identified several pathways of extracellular matrix receptor interaction or cell proliferation that differed significantly between the hernia and control group.
Conclusion
To date no predictive blood-based biomarkers of incisional hernia risk are available. We discovered several candidate protein biomarkers which, after validation in further studies, could be incorporated into a multifactorial risk model to guide clinical decision making. This could enable the initiation of prophylactic treatments such as a mesh implantation and individualized patient recommendations to prevent incisional hernia occurrence in high-risk patients.
Citation Format: Jürgen Böhm, Frank Pianka, Nina Stüttgen, Biljana Gigic, Yuzheng Zhang, Petra Schrotz-King, Nina Habermann, Alexis Ulrich, Martin Schneider, Paul Lampe, Markus Diener, Cornelia M. Ulrich. Plasma proteomics for the discovery of biomarkers of incisional hernia in colorectal cancer patients in the ColoCare Study. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 4921.