MOR-1 Expression in Colorectal Cancer and Disease-free Survival Relationship. Five-year Follow-up.

Study Overview
=================
Brief Summary
-----------------
Colorectal cancer (CRC) is a global burden and one of the most frequent types of cancer. Colorectal cancer therapy is complex and surgery remains the cornerstone for its treatment, combined with chemotherapy and radiotherapy. At diagnosis time, stage II / III is the predominant . There is a growing interest on the potential effect of perioperative anesthetic management on cancer growth and spread. Preclinical studies suggest that opioids could promote direct tumor growth, angiogenesis, metastasis and immunosuppression of cellular and humoral responses, mainly mediated by Mu opioid receptor 1 (MOR-1) activation. Association between increased expression of MOR-1and or perioperative opioids use and shorter DFS or OS has been demonstrated in lung, prostate, gastric and esophagus cancers. Furthermore a pooled analysis suggested that methylnaltrexone, a peripherally acting Mu-opioid receptor antagonist (PAMORA) was associated with increased survival in patients with advanced cancer. Thus, the expression of the MOR-1 is an indicator of poor prognosis in some cancer types, but its relevance in colon cancer is unknown. The hypothesis of this study is that the increased MOR-1expression in tumor samples from colorectal cancer could be associated to poor disease free survival. These findings would be of great clinical relevance in order to avoid perioperative opioid use in oncological patients. Moreover PAMORAs could be a valuable tool in perioperative antitumor treatment, since currently these drugs are currently used with confirmed tolerability and low adverse effects in the management of opioid-induced constipation (Opioid Induced Constipation-OIC). Besides MOR 1 expression could constitute a biomarker that guide the investigators to perform neoadjuvant therapy.

Detailed Description
-----------------
PRIMARY OBJECTIVES: To evaluate the association between Mu opioid receptor 1 (MOR-1) expression in patients with colorectal cancer stage II / III submitted to scheduled curative surgery and disease-free survival (DFS) five years follow up after surgery. SECONDARY OBJECTIVES: To evaluate the association between the MOR-1 expression in patients with colorectal cancer stage II / III undergoing scheduled curative surgery and overall survival (OS) five years follow up after surgery. To evaluate the association between MOR-1 expression in patients with colorectal cancer stage II / III submitted to scheduled curative surgery and perioperative complications until postoperative day 28th after surgery. To evaluate the association between perioperative opioids dose (morphine equivalents) and disease-free survival/overall survival until five years after surgery. To evaluate MOR-1 expression differences in paraffin samples from patients with colorectal cancer stage II / III submitted scheduled colorectal surgery between the tumor tissue and the adjacent nontumorous tissue.

Official Title
-----------------
Mu Opioid Receptor 1 Expression in Colorectal Cancer and Disease-free Survival Relationship (Morocco). Five-year Follow-up.

Conditions
-----------------
Colorectal Cancer

Intervention / Treatment
-----------------
* Other: ELISA for MOR-1 expression


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients older than 18 years. Colorectal scheduled surgery between January 2010- December 2013. Colon / rectum neoplasia Stage II / III (T3 / T4 N + M0). Exclusion Criteria: Stage I or Stage IV Non-oncological colorectal surgery Non-elective surgery

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| TT<br>Tumor Tissue. Colon or rectum neoplasia stage II and III tumor tissue. | Other: ELISA for MOR-1 expression<br>* To evaluate MOR-1 expression differences by immunohistochemical analysis (ELISA - semiquantitative) in paraffin samples from patients with colorectal cancer stage II / III submitted scheduled colorectal surgery between the tumor tissue and the adjacent nontumorous tissue.<br>|
| NTT<br>Nontumorous Tissue. Colon or rectum neoplasia stage II and III adjacent nontumorous tissue. | Other: ELISA for MOR-1 expression<br>* To evaluate MOR-1 expression differences by immunohistochemical analysis (ELISA - semiquantitative) in paraffin samples from patients with colorectal cancer stage II / III submitted scheduled colorectal surgery between the tumor tissue and the adjacent nontumorous tissue.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Expression of MOR1. | Immunohistochemical analysis (ELISA - semiquantitative) to asses expression of MOR1 in tumor tissue and adjacent nontumorous tissue. | Six months | 
| Disease free survival. | Disease free survival 5 years after surgery. | Five years. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Local recurrence. | Five years follow up after surgery. | Five years. | 
| Lymphatic relapse. | Five years follow up after surgery. | Five years. | 
| Metastasis. | Reproduction or extension of the tumor to another part of the body. Five years follow up after surgery. | Five years. | 
| Type of recurrence (local, regional or distant). | Five years follow up after surgery. | Five years. | 
| Overall Survival. | Five years follow up after surgery. | Five years. | 
| Morphine equivalents. | Morphine equivalents consumption during perioperative period. | During surgery and up to 96 hours during the perioperative period. | 
| Perioperative complications. | Perioperative complications until postoperative day 28th. | 28 days. | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
CANCER, COLON, OPIOIDS, MOR-1