Evaluation of Somatic Mutation Spectrum as Biomarker for Survival Outcome in Chinese CRC

Study Overview
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Brief Summary
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By analyse the tissue/blood variant spectrum model using NGS, the present clinical trial aims to elucidate the genetic basis of CRC in Chinese; to establish of CRC genetic map in Chinese patients; to identification new genetic biomarkers, drug and pathways; and to subtyping for precision treatment and management for Chinese CRC patients.

Detailed Description
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Colorectal cancer (CRC), as one of the common malignant tumors with high morbidity and mortality, is a major health threat in China. Surgical resection is the conventional treatment for early and intermediate stage CRC, chemotherapy is the main treatment for late stage CRC. Circulating tumor DNA (ctDNA) is tumor-derived fragmented DNA with an average size of 170bp, mixed with cell free DNA (cfDNA) of other sources in blood circulation. Although the mechanisms of its release have not been fully addressed, apoptosis and/or necrosis of tumor cells and serum exosome are considered as its main source, which makes it a genomic reservoir of different tumor clones. Also, as its half-life is up to hours, ctDNA is reflecting the most up-to-date status of tumor genome. Hence, it allows for noninvasive molecular characterization of tumors,which can be qualitative, quantitative and used for disease monitoring. The possibility of that ctDNA could be used to detect micrometastatic disease in patients received surgical resection was suggested in several studies. Using Next Generation Sequencing (NGS), Newman et al. have shown that the serum level of ctDNA was correlated with tumor progress and prognosis in NSCLC. Isaac et al. demonstrated the postoperative ctDNA level was associated with breast cancer progression, and it was more sensitive compared to CT scan for predicting the early relapse. Tie et al. examined the postoperative ctDNA level of 1046 plasma samples from a prospective cohort of 230 patients with resected stage II CRC by NGS, and their results demonstrated that recurrence happened in 79% of the patients with positive postoperative ctDNA at median follow-up of 27 months, versus 9.8% in the negative postoperative ctDNA group.

Official Title
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A Cohort Study Evaluating the Effectiveness of the Somatic Mutation Spectrum Model in CRC Prognosis and Prediction Stratification

Conditions
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Colorectal Cancer

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Retrospective cohort: The patient had no previous history of tumor prior to the diagnosis of colorectal cancer. The tissue samples of patients were obtained from the radical(stage I-III) or palliative (stage IV) resection of colorectal cancer. The clinical data of patients are complete. The treatment record of the patients after surgery are complete, and the fellow-up data are available. Prospective cohort: Patients who were diagnosed as stage IV colorectal cancer and planed to received palliative systematic chemotherapy. Paired 10 ml blood and tissue samples should be available The clinical informations of patients and definite pathological diagnosis of colorectal cancer should be obtained Patients agree with the group to follow-up them and provide follow-up informations Performance status ECOG（Eastern Cooperative Oncology Group） score ≤2 Informed consent must be obtained from the patient Exclusion Criteria: Retrospective cohort: The patient had previous history of tumor prior to colorectal cancer surgery The clinical data of patients are not available 4. The date of treatment after surgery are not integrity, outcome data are not available Prospective cohort: The patient received a blood transfusion within three months; The patient has active HIV, hepatitis B or hepatitis C infection; pregnant patients; Alcohol or drug users; Other situation that researchers considered might affect the results of the experiment or violate the ethics.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Retrospective cohort<br>Whole exome sequencing of 2500 retrospective tissue sample. | |
| Prospective cohort<br>Whole exome sequencing of 500 prospectively collected tissue samples. Panel sequencing of 451 genes of prospectively collected blood samples. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| prediction accuracy of survival rate | We will use the gene mutation data and follow-up data of the patients to construct a prediction model,the accuracy of model to anticipating the 5 year survival rate of patients is the primary endpoint | through study completion, an average of 5 years | 
| prediction accuracy of recurrent rate | We will use the gene mutation data and follow-up data of the patients to construct a prediction model,the accuracy of model to anticipating the 3 year recurrent rate of patients is the primary endpoint | through study completion, an average of 3 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mutation Consistency of tissue and blood sample | We do NGS sequencing of both the tissue sample and blood sample of the CRC patients. The gene mutation data will be analysis, and the percentage of same and different mutation of tissue and blood sample will be reported. | through study completion, an average of 3 years |