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Plasma Inflammatory Markers and Risk of Advanced Colorectal Adenoma in Women

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Plasma Inflammatory Markers and Risk of Advanced Colorectal Adenoma in Women Published OnlineFirst October 28, 2015; DOI: 10.1158/1940-6207.CAPR-15-0307 Research Article Cancer Prevention Research Plasma Inflammatory Markers and Risk of Advanced Colorectal Adenoma in Women Mingyang Song1,2,3,4, Raaj S. Mehta1,2, Kana Wu3, Charles S. Fuchs5,6, Shuji Ogino4,6,7, Edward L. Giovannucci3,4,5, and Andrew T. Chan1,2,5 Abstract Evidence remains inconclusive about the association of 2.32) comparing extreme quintiles of MIC-1 after adjusting for systemic inflammatory markers with colorectal neoplasia. We colorectal cancer–risk factors and other inflammatory markers. investigated whether circulating inflammatory markers were Among cases, MIC-1 level was positively associated with the associated with risk of advanced colorectal adenoma. We mea- number of adenomas (P < 0.001) and gradually increased from sured plasma macrophage inhibitory cytokine-1 (MIC-1), C- adenomas located in the rectum, distal colon, and up to the reactive protein (CRP), interleukin-6 (IL6), and soluble TNF proximal colon. There was a strong positive association receptor 2 (sTNFR-2) in blood samples drawn from 32,826 between MIC-1 and risk of adenomas with multiplicity, 1 womenin1989to1990intheNurses'HealthStudy.Through cm size and location in the proximal colon (all Ptrend < 0.05). 2008, we documented 757 cases of advanced colorectal ade- CRP, IL6, or sTNFR-2 was not associated with adenoma risk. In nomas (1 cm or any size with advanced histology); each case conclusion, plasma MIC-1 was associated with higher risk of was matched by age and time of blood draw with one control colorectal adenoma, especially multiple, large, and proximal randomly selected from participants who underwent lower adenomas. Our results provide further support for a role for endoscopy and did not have neoplasia. Plasma MIC-1 was MIC-1 in carcinogenesis and the potential for MIC-1 as an associated with higher risk of advanced adenoma (Ptrend ¼ adjunctive biomarker for detection of advanced colorectal 0.04), with an OR of 1.55 (95% confidence interval, 1.03– adenoma. Cancer Prev Res; 9(1); 27–34. Ó2015 AACR. Introduction Despite the preponderance of evidence implicating chronic inflammation in colorectal carcinogenesis, epidemiologic data Colorectal cancer is the third most commonly diagnosed cancer remain inconclusive about the association between systemic and the fourth leading cause of cancer-related death in the world inflammatory markers and colorectal neoplasia. Circulating C- (1). Inflammation has been implicated in the initiation and reactive protein (CRP), a liver-derived acute phase protein that is progression of colorectal cancer (2). Patients with ulcerative elevated in chronic inflammatory conditions, has been associated colitis and Crohn's colitis demonstrate chronic inflammation in with an increased risk of colorectal cancer in 7 (9–15) of the 18 the gastrointestinal mucosa and are at increased risk of developing prospective studies that have been published to date (9–25). colorectal cancer (3). Conversely, regular use of anti-inflamma- Studies examining the association of other inflammatory cyto- tory medications such as aspirin has been associated with lower kines, such as interleukin-6 (IL6; refs. 10, 22–24, 26) and TNFa risk of colorectal cancer (4) as well as colorectal adenomas (5–8), (23, 26, 27), with colorectal cancer are limited and inconsistent. precursors of most colorectal cancer. Recently, macrophage inhibitory cytokine-1 (MIC-1, also known as growth differentiation factor 15, GDF15), a divergent member of the human TGFb superfamily and a mediator of the systemic 1Clinical and Translational Epidemiology Unit, Massachusetts General fl 2 in ammatory response (28), has been related to development of Hospital and Harvard Medical School, Boston, Massachusetts. Divi- – sion of Gastroenterology, Massachusetts General Hospital, Boston, cancers in various organs (29 32), including colorectal cancer Massachusetts. 3Department of Nutrition, Harvard T.H. Chan School of (33). We recently showed that elevated levels of plasma MIC-1 Public Health, Boston, Massachusetts. 4Department of Epidemiology, were associated with higher risk of incident colorectal cancer (34). Harvard T.H. Chan School of Public Health, Boston, Massachusetts. However, there are limited data about the association of 5Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts. 6Department of Med- inflammatory markers with colorectal adenomas. The 5 studies ical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts. that have prospectively assessed the relationship between circu- 7 Department of Pathology, Brigham and Women's Hospital and Har- lating CRP and colorectal adenomas have each reported null vard Medical School, Boston, Massachusetts. associations (35–38) except one study, which observed an inverse Note: Supplementary data for this article are available at Cancer Prevention association between serum CRP and risk of adenomas (39). In the Research Online (http://cancerprevres.aacrjournals.org/). Polyp Prevention Study, serum MIC-1 was associated with the Corresponding Author: Andrew T. Chan, Massachusetts General Hospital and presence of colorectal adenomas and their recurrence 3 years later. Harvard Medical School, 55 Fruit Street, Boston, MA 02114. Phone: 617-726-3212; However, this analysis was limited by the large variation in the Fax: 617-724-6832; E-mail: [email protected] time of MIC-1 measurement with respect to colonoscopy, which doi: 10.1158/1940-6207.CAPR-15-0307 compromises its ability to determine whether MIC-1 elevation Ó2015 American Association for Cancer Research. was a predisposing factor or consequence of colorectal adenoma www.aacrjournals.org 27 Downloaded from cancerpreventionresearch.aacrjournals.org on October 2, 2021. © 2016 American Association for Cancer Research. Published OnlineFirst October 28, 2015; DOI: 10.1158/1940-6207.CAPR-15-0307 Song et al. (40). For IL6 and TNFa, the only available study did not find any dren's Hospital (Boston, MA). We used ELISA (R&D Systems) to association with risk of recurrent adenomas (38). measure levels of MIC-1 (GDF15), IL6, and sTNFR-2, and a highly Given the sparse data, we prospectively examined measures of sensitive immunoturbidimetric assay (Denka Seiken Co.) to plasma MIC-1, CRP, IL6, and soluble TNF receptor 2 (sTNFR-2, measure CRP levels in the archived prediagnostic plasma speci- also known as TNF receptor superfamily member 1B, TNFRSF1B), mens. Samples from cases and their matched controls were a surrogate marker for TNFa, with the incidence of advanced analyzed in the same batch. Quality control samples were ran- colorectal adenomas in a case–control study nested within the domly interspersed among the case–control samples. Personnel Nurses' Health Study (NHS). blinded to quality control and case–control status conducted all assays. Materials and Methods The biomarkers were assayed in two batches over 6 years apart and drift samples were included to assess laboratory drift over Study population time. The intraclass correlation between measurements of the two The NHS included 121,701 U.S. registered female nurses who drift batches was 0.99 for MIC-1, 0.97 for CRP, 0.97 for IL6, and were of age 30to 55years in1976.Detailed description of the cohort 0.82 for sTNFR-2. To minimize the batch effect, we corrected has been provided elsewhere (41). Briefly, follow-up questionnaires biomarker concentrations for measurement batch using the aver- were administered biennially to collect and update medical, life- age batch correction method (43) with adjustment for age, body style, and other health-related information; validated food frequen- mass index (BMI), and case–control status. The mean intra-assay cy questionnaires (FFQ) were completed in 1980, 1984, 1986, and coefficient of variation from blinded quality control samples was every 4 years thereafter to update dietary information. The follow- 4.8% for MIC-1, 5.5% for CRP, 12.7% for IL6, and 15.9% for up rate had been 95.6% among participants who were alive up to sTNFR-2. 2008. Between 1989 and 1990, 32,826 women returned a blood specimen on ice packs by overnight courier. The procedures for Statistical analysis blood collection, handling and storage, have been previously We categorized plasma markers into quantiles on the basis of summarized (42). Written informed consent was obtained from their distributions among control participants. Conditional logis- all participants, and the study protocol was approved by the tic regression was used to estimate the ORs and 95% confidence Institutional Review Board at the Brigham and Women's Hospital intervals (95% CI) of advanced adenomas in relation to biomar- and the Harvard T.H. Chan School of Public Health. kers. Test for trend was performed using the median value for each quintile as a continuous variable in the regression models. We Selection of colorectal adenoma cases and control subjects assessed the potential nonlinear relationship between biomarkers Women were eligible for selection as either an adenoma case and adenoma risk using stepwise restricted cubic spline analysis subject or a control subject if they had provided a blood specimen (44), with a P ¼ 0.05 as the criteria for both inclusion and in 1989 to 1990 and reported having at least one sigmoidoscopy retention in the model. In the multivariable analyses, we adjusted or colonoscopy from 1990 through 2008 after blood donation. for several risk factors for colorectal neoplasia. Details regarding Women who
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