The colorectal cancer epidemic: challenges and opportunities for primary, secondary and tertiary prevention

Effectiveness of health promotion interventions to increase faecal occult blood test uptake rates among older adults with an average-risk of colorectal cancer: A systematic review and meta-analysis

Objective

This review aims to examine the effectiveness of interventions in increasing faecal occult blood test (FOBT) uptake rates among older adults with an average-risk of colorectal cancer (CRC) and to identify essential components of such interventions based on current evidence.

Methods

Five databases were included in a systematic literature search for studies reporting randomized controlled trials (RCT) and interventions aimed at increasing FOBT uptake rates among average-risk individuals aged 50-75. Review Manager 5.4.1 was used for conducting meta-analyses and subgroup analyses.

Results

A meta-analysis of the 20 included studies demonstrated that health promotion interventions led to significant increases in FOBT uptake rates (odds ratio [OR] ​= ​1.55, 95% confidence interval (CI) ​= ​1.30-1.85; I 2 ​= ​95%). Provision of information, mailing of FOBT outreach, and reminders were identified as core components of promotion interventions to increase FOBT uptake rates. Among the different significant reminder strategies, a digital message (via text) plus telephone calls (automated and navigator-initiated) had a larger effect size than a telephone call alone. In addition, there was no significant evidence that financial incentives were associated with FOBT uptake. Most studies included a diverse mixture of components, but only a few studies utilized theoretical framework-based interventions.

Conclusions

Future studies with rigorous methodologies are warranted to examine the effectiveness and understand the mechanisms of theoretical framework-based multi-component educational programmes aimed at increasing FOBT uptake rates.

Systematic review registration

PROSPERO CRD42024520859.

Fueling the fire: colonocyte metabolism and its effect on the colonic epithelia

Colonic permeability is a major consequence of dysbiosis and diseases affecting the colon, further contributing to inflammation and extraintestinal diseases. Recent advances have shed light on the association between colonocyte energy utilization and the mechanisms that support epithelial function and homeostasis. One unifying theme is the induction of colonocyte hypoxia, driven by the aerobic oxidation of microbial-derived butyrate, as a critical factor promoting multiple cellular processes that support intestinal barrier function, mucus secretion, and the maintenance of synergistic luminal microbes. Particular attention will be focused on experimental evidence supporting beta-oxidation via activation of peroxisome proliferators-activated receptor-γ (PPAR) and upregulation and activation of processes that promote barrier function by hypoxia-inducible factor (HIF) signaling. Growing evidence suggests that colonocyte energy utilization is tightly regulated and switches between beta-oxidation of butyrate and anaerobic glycolysis, the latter being associated with several disease states. As most of the primary literature associated with colonocyte energy utilization has focused on adult models, evidence supporting butyrate oxidation in the neonatal gut is lacking. Thus, this review details the current state of knowledge linking colonocyte substrate utilization to mechanisms supporting gut health, but also highlights the counterindications of colonic butyrate availability and utilization in developmental periods.

Biomimetic modification of macrophage membrane-coated prussian blue nanoparticles loaded with SN-38 to treat colorectal cancer by photothermal-chemotherapy

SN-38 is the active metabolite of irinotecan and acts as an effective topoisomerase I inhibitor with therapeutic effects on many malignant tumors, including some drug-resistant cancers. However, the poor solubility, low bioavailability, and severe dose-dependent toxicity limits the clinical application of SN-38. Currently, emerging macrophage membrane-coated nanoparticles provide an efficient biomimetic approach to develop novel SN-38 formulations for the reduction of its side effects. Photothermal therapy (PTT) is a promising methods in tumor treatment to thermally ablate tumors using various materials such Prussian blue nanoparticles (NPs) and can combined with chemotherapy to synergistically work. There is no report that combined SN38 and photothermal therapy for the treatment of colorectal cancer (CRC). SN38-PB@CM NPs were constructed by loading SN-38 into macrophage cell membrane-coated hollow mesoporous Prussian blue (PB) NPs. The morphology, size and zeta potential were evaluated by transmission microscopy and dynamic light scatter (DLS). Coomassie bright blue staining was performed to assess total protein profile. The photothermal properties of it were also investigated via near-infrared imaging. CCK8 and calcein-AM/PI staining were used to evaluate cell viability. Flow cytometry was performed to assess cell apoptosis. The fluorescent microscopy was used to observe cellular uptake of SN38-PB@CM NPs to assess its internalization in vitro. The biodistribution, tumor-targeting efficacy, antitumor efficacy and safety of SN38-PB@CM NPs in vivo were assessed in CT26 tumor-bearing mice via In Vivo Imaging System. SN38-PB@CM NPs were successfully constructed and exhibited a uniform size distribution (140.5 ± 4.3 nm) and an excellent drug-loading capacity (5.61 ± 0.64%). SN38-PB@CM NPs showed stable release properties within 72 h. It can also enhance the selective intracellular delivery of SN38 in vitro and showed good near-infrared (NIR) photothermal properties. And the NPs showed excellent tumor targeting, effective photothermal therapy, improved biosafety and antitumor efficacy on CT26-bearing mice. Multifunctional SN38-PB@CM NPs could achieve improved biosafety, great tumor-targeting, high-efficiency PTT and excellent antitumor efficacy, which provided a promising and attractive combination therapy for the treatment of CRC.

Assessing awareness of colorectal cancer symptoms, risk factors and screening barriers among eligible adults in Jordan: a cross-sectional study

BACKGROUND

Colorectal cancer (CRC) is the second most prevalent malignancy in Jordan. Because early detection can greatly improve treatment outcomes, it is crucial to increase awareness of signs and symptoms, risk factors, and the significance of routine CRC screenings. In this study, we aimed to assess awareness levels regarding CRC symptoms and risk factors among adults in Jordan and to identify barriers to CRC screening.

METHODS

This web-based cross-sectional study was conducted in Jordan from March 5, 2024 to July 9, 2024, and targeted people aged 50-75 years who had no history of CRC. The sample size was calculated via a convenience sampling method. Data were collected via a validated, culturally adapted survey. Descriptive analysis was used when appropriate. Analytic statistics were performed to predict participants' awareness of CRC symptoms and risk factors.

RESULTS

The study included 400 participants, with a mean age of 58.42 years (SD = 6.511). More than half of the respondents were females (56.5%). The mean awareness score of CRC symptoms among the study participants was 4.97/9 (SD = 1.18), whereas that of risk factors was 5.21/10 (SD = 1.53). The overall mean awareness score was 10.18/19 (SD = 2.65). The top three reported barriers to CRC screening were: not at risk due to absence of symptoms (61.8%), not at risk due to adopting a healthy lifestyle (56.8%), not at risk due to absence of family history (51.8%).

CONCLUSION

Colorectal cancer awareness among the population was relatively low, with significant symptoms and risk factors being overlooked by the participants. In addition to that, notable barriers to screening, especially fear and embarrassment of the screening test, have surfaced. This prompts the need for more cancer education and healthcare provider involvement to overcome screening barriers and promote participation in screening programs to enable early detection.

Development and validation of survival prediction tools in early and late onset colorectal cancer patients

This study aims to develop online calculators using machine learning models to predict survival probabilities for early- and late-onset colorectal cancer (EOCRC and LOCRC) over a 1- to 8-year period. We extracted data on 117,965 CRC patients from the published database spanning 2010 to 2021, divided into training and internal testing datasets. The data of 200 CRC patients from Chongqing Hospital of Jiangsu Province Hospital was used as the external testing dataset. We conducted univariate and multivariate regression analyses on the training dataset to identify key survival factors and develop predictive machine learning models. The models were evaluated using internal and external testing datasets based on AUC, accuracy, precision, recall, and F1 score. Web-based calculators were subsequently developed to predict survival curves for EOCRC and LOCRC patients under different treatment strategies. In the multivariate Cox regression analysis, 16 and 18 variables were independently significant survival factors for EOCRC and LOCRC, respectively. In the EOCRC group, the machine learning models achieved AUC values of 0.880 and 0.804 in the internal and external testing cohorts. For the LOCRC group, the machine learning models exhibited AUC values of 0.857 and 0.823 in the internal and external testing cohorts. The online calculators, powered by trained machine learning models, are accessible at https://eocrc-surv.streamlit.app/ and https://locrc-surv.streamlit.app/ . These tools estimate survival probabilities for EOCRC and LOCRC patients under various treatment strategies and display the corresponding survival curves post-treatment over the 1- to 8-year period. This study successfully developed online calculators using machine learning algorithms to predict 1- to 8-year survival probabilities for EOCRC and LOCRC patients under various treatment strategies.

DIVERT-Ca: unveiling the hidden link between acute diverticulitis and colorectal cancer risk-multicentre retrospective study

INTRODUCTION

Colorectal cancer (CRC) is the third most common cancer worldwide, accounting for approximately 10% of all malignancies. Emerging trends of association with risk factors such as diverticulitis highlight the need for updated screening and follow-up protocols. We aimed to examine risk factors associated with the development of CRC within 12 months following an episode of acute diverticulitis, and identify areas to streamline follow-up.

METHODS

We performed a retrospective multicentre study of adult patients admitted in 2022 with computed tomography (CT) confirmed acute diverticulitis across four large NHS Trusts in the UK. Patient demographics, comorbidities, clinical presentation, vital signs, laboratory results, details of in-patient stay, and follow-up investigations were collected and analysed. Our primary outcome was the incidence of CRC within 12 months of index presentation with acute diverticulitis. Analysed secondary outcomes were potential patient risk factors associated with a diagnosis of CRC and follow-up protocols. All statistical analysis was performed using R (version 4.4) and P-values of < 0.05 were considered statistically significant.

RESULTS

A total of 542 patients with acute diverticulitis over the study period were included. The median age of our cohort was 62 (51-73) years, and 204 (37.6%) were male. Ten (1.8%) patients were diagnosed with CRC within the 12-month period. Hinchey grade Ib was significantly associated with CRC (OR 4.51, P = 0.028). Colonoscopic follow-up requests were associated with age between 40 and 60 years, mild white cell count (WCC) elevation, and a hospital stay of 3-7 days. Male gender, age between 18 and 40 years, and elevated C-reactive protein (CRP) were all strongly associated with CRC but not statistically significant. Follow-up was inconsistent with 53.7% of the cohort having luminal investigations.

CONCLUSION

The incidence of CRC was in-keeping with published literature. Hinchey grade 1b was significantly associated with a subsequent CRC diagnosis. These findings emphasise the need for specialised radiological review of CT scans to detect underlying malignancy. Moreover, standardised follow-up protocols following an episode of acute diverticulitis are needed to avoid missing malignant lesions.

What is the current state of anxiety and its related factors in Chinese patients undergoing colonoscopy? A cross-sectional study

BACKGROUND

Anxiety in patients undergoing colonoscopy may also result in adverse effects, including altered vital signs such as elevated heart rate and blood pressure, exacerbation of symptoms like bloating and gastrointestinal discomfort, a decline in cooperation and satisfaction, and even colonoscopy failure. However, limited studies have explored the level of anxiety, factors that influence it, and its specific causes.

METHODS

A cross-sectional study was conducted, recruiting 825 patients undergoing colonoscopy in Hunan Province between January and July 2023 using stratified sampling. The Spielberger State-Trait Anxiety Inventory (STAI), a self-designed demographic characteristics questionnaire, and a colonoscopy patient anxiety influencing factor questionnaire were used. The data were analyzed in SPSS (version 26) using Mann-Whitney U, Kruskal-Wallis, and multiple regression analysis tests.

RESULTS

The final study included 825 participants, of whom 19.8% exhibited mild anxiety, 37.0% exhibited moderate anxiety, and 43.2% exhibited severe anxiety. The results indicated that insomnia (β=-0.080, p = 0.013), no comorbidities (β=-0.147, p < 0.001), not smoking or drinking (β=-0.158, p < 0.001), and poor health (moderate: β=-0.183, p < 0.001; poor: β=-0.164, p < 0.001) were negatively associated with anxiety levels. In contrast, marital status (β = 0.177, p < 0.001), education level (β = 0.204, p < 0.001), age (β = 0.114, p = 0.007), medical insurance (Basic Medical Insurance for Urban Residents β = 0.204, p < 0.001; Commercial medical insurance: β = 0.112, p < 0.001), care provided by relatives (β = 0.102, p = 0.002), diarrhoea (β = 0.089, p = 0.005), occupation (farmers: β = 0.099, p = 0.009; self-employed: β = 0.082, p = 0.014), and paternal upbringing (β = 0.067, p = 0.034) were positively correlated with anxiety. Several factors had a greater impact on the anxiety level of the patients: education level (β = 0.204), health status (moderate: β=-0.183; not good: β=-0.164), and marital status (β = 0.177). It probably because higher education levels may increase awareness of potential risks associated with colonoscopy, contributing to greater anxiety. The five common reasons for anxiety included the presence of bloody faeces, enemas, need for further treatment, lack of timely feedback from the physician, lack of an accurate diagnosis.

CONCLUSION

The level of anxiety experienced by patients during the colonoscopy phase was more severe and should be alleviated with targeted interventions based on the cause of anxiety, such as pre-procedural counseling, patient education materials, and enhanced communication with healthcare providers.

"If I Start [Primary Prevention] Now, I Can Prevent [Cancer]": College Students Endorse Cancer Prevention Education

Early onset colorectal cancer has been linked to lifestyle-related risk factors. Emerging adulthood (ages 18-25) has the greatest changes to lifestyle health behaviors with implications for health outcomes. College students have moderate consideration of future cancer risk (CFC-CA) when navigating current health behavior choices. This study explored cancer prevention knowledge, attitudes and behavioral intentions in a subset of students with low, medium and high CFC-CA. Qualitative interviews were used to explore cancer prevention among a sample of college students. We identified a stratified sample (N = 43) of high CFC-CA (n = 16), medium CFC-CA (n = 14), and low CFC-CA (n = 13) students who agreed to complete a 60-min interview on Zoom. Interviews were transcribed verbatim, and transcripts were coded using an iterative, line-by-line approach. Group comparisons were completed after coding was complete. Students exhibited greatest awareness of highly publicized cancers including the lung, breast, and skin. Fifty-four percent of those with low CFC-CA and 87% with high CFC-CA believe that their current health behavioral intentions are protective against cancer. Most students want more cancer education regardless of CFC-CA level to know how they can reduce their cancer risk. Differences in preferred information sources (indirect vs direct) were identified for low versus higher CFC-CA, respectively. Students' preferences for cancer education were related to their CFC-CA scores. This could be used to tailor information content and delivery modality. Delivering cancer prevention education through means that facilitate internal reflection may be more effective for improving risk reduction behaviors.

Cost-effectiveness analysis of sequential two-step screening versus direct colonoscopy screening for colorectal cancer: a large-scale survey in Eastern China

Objectives

Despite the implementation of colorectal cancer (CRC) screening programs in many regions worldwide over the past few decades, the cost-effectiveness of these programs has been questioned owing to their acceptance rates. In this study, we evaluated the cost-effectiveness of screening strategies, quantified the impact of colonoscopy acceptance rates, and analyzed the underlying factors driving individual preferences.

Methods

The cost-effectiveness of three strategies-no screening, sequential two-step screening (fecal immunochemical test and risk assessment, followed by colonoscopy), and colonoscopy screening-was evaluated from a societal perspective. This assessment was conducted using a decision-tree Markov model with the incremental cost-effectiveness ratio as the primary evaluation criterion.

Results

Sequential screening was more cost-effective than colonoscopy screening (19,335 vs. 27,379 United States dollars per quality-adjusted life year). Ideal sequential screening could prevent 32.2%(691/2147) CRC deaths, whereas colonoscopy screening at the same colonoscopy acceptance rate (20.3%) could prevent 17.6%(377/2147) CRC deaths. When the acceptance rate of direct colonoscopy surpasses the threshold of 37.2%, the resulting health benefits likely outweigh those achieved using a the sequential two-step screening approach.

Conclusions

Sequential screening is recommended for individuals in areas with constrained screening resources or during the early stages of regional screening program implementation. However, once screening habits are established, transitioning to direct colonoscopy screening becomes more favorable. Notably, reducing colonoscopy costs is the principal factor for enhancing an individual's willingness to undergo the procedure.

Targeting the SIRT3/MnSOD and JNK/HMGB1/Beclin 1 Axes: Role of Apigenin in Multifaceted Metabolic Intervention in Colorectal Cancer

Colorectal cancer (CRC) is the third most prevalent cancer worldwide. While chemotherapy remains the standard treatment approach, natural products have emerged as a promising alternative. Among these, apigenin, a natural flavonoid, has garnered significant attention due to its pro-oxidant and antioxidant properties in various types of cancer. This study aimed to assess the potential impact of apigenin in CRC treatment by targeting mitochondrial SIRT3, HMGB1, and beclin 1-mediated autophagy in a mouse model of CRC. We administered 20 mg/kg of dimethyl hydrazine (DMH) intraperitoneally once weekly for 20 weeks to induce CRC in C57BL/6 mice. After 6 weeks of initiating the study, apigenin was intragastrically co-administered by oral gavage at 25 and 50 mg/kg until the end of week 20. The results revealed significant weight loss, shortening of the colon, and diarrhea in DMH-induced CRC, which are considered the marks of CRC. In addition, histopathological examination revealed dysplastic changes in the DMH-treated group, while no dysplasia was found in the apigenin-treated CRC groups. Importantly, the administration of apigenin to DMH-treated animals has led to a significant reduction of SIRT3 and MnSOD expression levels with a significant increase in LC3-II at either dose and a significant dose-dependent increase in the levels of MDA, c-JNK, HMGB1, and beclin 1 compared to the DMH-treated group. In conclusion, apigenin may have a promising role in suppressing DMH-induced CRC. It elicits a pro-oxidant activity by suppressing the gene expression of SIRT3 and subsequently, its target MnSOD, resulting in increased reactive oxygen species (ROS) and lipid peroxidation. The released ROS, in turn, activates JNK-mediated autophagy by enhancing HMGB1, beclin 1, and LC3-II protein levels.

Effects of high-quality nursing on surgical site wound infections after colostomy in patients with colorectal cancer

BACKGROUND

Colostomy is important in the treatment of colorectal cancer. However, surgical site wound infections after colostomy seriously affect patients' physical recovery and quality of life.

AIM

To investigate the ability of high-quality nursing care to prevent surgical site wound infections and reduce post-colostomy complications in patients with colorectal cancer.

METHODS

Eighty patients with colorectal cancer who underwent colostomy at our hospital between January 2023 and January 2024 were selected as research subjects. The random number table method was used to divide the participants into control and research groups (n = 40 each). The control group received routine nursing care, while the research group received high-quality nursing care. The differences in indicators were compared between groups.

RESULTS

The baseline characteristics did not differ between the research (n = 40) and control (n = 40) groups (P > 0.05). The incidences of wound infection, inflammation, and delayed wound healing were significantly lower in the research (5.00%) vs control (25.00%) group (P = 0.028). The incidence of postoperative complications, including fistula stenosis, fistula hemorrhage, fistula prolapse, peristome dermatitis, urinary retention, pulmonary infection, and intestinal obstruction, was significantly lower in the research (5.00%) vs control (27.50%) group (P = 0.015). In addition, the time to first exhaust (51.40 ± 2.22 vs 63.80 ± 2.66, respectively; P < 0.001), time to first bowel movement (61.30 ± 2.21 vs 71.80 ± 2.74, respectively; P < 0.001), and average hospital stay (7.94 ± 0.77 vs 10.44 ± 0.63, respectively; P < 0.001) were significantly shorter in the research vs control group. The mean Newcastle satisfaction with nursing scale score was also significantly higher in the research (91.22 ± 0.96) vs control (71.13 ± 1.52) group (P < 0.001).

CONCLUSION

High-quality nursing interventions can effectively reduce the risk of wound infections and complications in patients undergoing colostomy, promote their postoperative recovery, and improve their satisfaction with the nursing care received.

Impact of Multidisciplinary Team Management on Survival and Recurrence in Stage I-III Colorectal Cancer: A Population-Based Study in Northern Italy

This study aimed to assess whether multidisciplinary team (MDT) management improves outcomes in patients with stage I-III colorectal cancer (CRC) compared to non-MDT care. This study included 460 CRC patients diagnosed from 2017 to 2018 in a northern Italian province, of whom 300 (65%) were managed by MDT. MDT patients were younger, more frequently had rectal cancers, were diagnosed at earlier stages, and were more likely to undergo surgery and chemotherapy. Disease-free survival (DFS) and overall survival (OS) were significantly better in the MDT group. The recurrence rate was 8.5%, with no significant differences between MDT and non-MDT patients, although MDT patients exhibited lower recurrence rates for early-stage tumors. A multivariable analysis showed that DFS and OS were adversely affected by older age, advanced stage, and lack of MDT management. Kaplan-Meier estimates demonstrated a 3-year DFS of 78% in the MDT group versus 65% in the non-MDT group, as well as an OS of 83% versus 69%, respectively. The MDT approach was associated with improved treatment adherence and better management of recurrences. While limited by a small sample size, this population-based study highlights the beneficial impact of MDT care on CRC outcomes. Further research with extended follow-up is warranted to confirm these findings.

Identification and biological evaluation of fused tetrahydroisoquinoline derivatives as Wnt/β-catenin signaling inhibitors to suppress colorectal cancer

Colorectal cancer (CRC) has been becoming one of the most common causes of cancer mortality worldwide. Accumulating studies suggest that the progressive up-regulation of Wnt/β-catenin signaling is a crucial hallmark of CRC, and suppressing it is a promising strategy to treat CRC. Herein, we reported our latest efforts in the discovery of novel fused tetrahydroisoquinoline derivatives with good anti-CRC activities by screening our in-house berberine-like library and further structure-activity relationship (SAR) studies, in which we identified compound 10 is a potent lead compound with significant antiproliferation potencies. By the biotinylated probe and LC-MS/MS study, Hsp90 was identified as its molecular target, which is a fully different mechanism of action from what we reported before. Further studies showed compound 10 directly engaged the N-terminal site of Hsp90 and promoted the degradation of β-catenin, thereby suppressing the Wnt/β-catenin signaling. More importantly, compound 10 exhibits favorable pharmacokinetic parameters and significant anti-tumor efficacies in the HCT116 xenograft model. Taken together, this study furnished the discovery of candidate drug compound 10 possessing a novel fused tetrahydroisoquinoline scaffold with excellent in vitro and in vivo anti-CRC activities by targeting Hsp90 to disturb Wnt/β-catenin signaling pathway, which lay a foundation for discovering more effective CRC-targeted therapies.

Clinicopathological and molecular landscape in colorectal cancer associated with colorectal polyps and inflammatory bowel disease

Although inflammatory bowel disease (IBD) and colorectal polyps are considered as significant risk factors of colorectal cancer (CRC), the molecular mechanism associated with colorectal carcinogenesis is still explored. Unlike sporadic CRC, local persistent inflammation in IBD induces genetic and epigenetic alterations, leading to tumor development. Moreover, cumulative data indicate that colorectal polyps display a significant malignant potential. In this context, our study aimed to investigate the clinicopathological features of CRC associated with IBD and/or colorectal neoplastic polyps in a retrospective group of CRC cases. The clinical data and histopathological features of CRC cases have been collected from our files. Immunohistochemical examination of mismatch repair (MMR) proteins has been performed in a selected case. The study group comprised 40 patients, 72.5% men and 27.5% women, with a median age of 64.73±9.09 years. Out of the cases with double association, 62.5% of CRC cases displayed colorectal polyps, while 32.5% of patients were diagnosed with both CRC and IBD, which encompassed both ulcerative colitis (UC) and Crohn's disease (CD). Two patients included in our study group exhibited a triple association of IBD, colorectal polyps, and CRC, one of them showing defective MMR (dMMR) phenotype. Although our results provide significant data on the relationship between IBD, colorectal polyps, and colorectal carcinogenesis, future cohort studies are needed to improve our understanding on the complex mechanism of colorectal carcinogenesis, ultimately guiding improved prevention, diagnosis, and treatment strategies for these patients.

Machine learning applications in preventive healthcare: A systematic literature review on predictive analytics of disease comorbidity from multiple perspectives

Artificial intelligence is constantly revolutionizing biomedical research and healthcare management. Disease comorbidity is a major threat to the quality of life for susceptible groups, especially middle-aged and elderly patients. The presence of multiple chronic diseases makes precision diagnosis challenging to realize and imposes a heavy burden on the healthcare system and economy. Given an enormous amount of accumulated health data, machine learning techniques show their capability in handling this puzzle. The present study conducts a review to uncover current research efforts in applying these methods to understanding comorbidity mechanisms and making clinical predictions considering these complex patterns. A descriptive metadata analysis of 791 unique publications aims to capture the overall research progression between January 2012 and June 2023. To delve into comorbidity-focused research, 61 of these scientific papers are systematically assessed. Four predictive analytics of tasks are detected: disease comorbidity data extraction, clustering, network, and risk prediction. It is observed that some machine learning-driven applications address inherent data deficiencies in healthcare datasets and provide a model interpretation that identifies significant risk factors of comorbidity development. Based on insights, both technical and practical, gained from relevant literature, this study intends to guide future interests in comorbidity research and draw conclusions about chronic disease prevention and diagnosis with managerial implications.

Robot-assisted vs. laparoscopic right hemicolectomy in octogenarians and nonagenarians: an analysis of the US nationwide inpatient sample 2005-2018

BACKGROUND

Colorectal cancer (CRC) is a significant health concern, particularly among older adults. Outcomes between laparoscopic and robot-assisted surgeries for right-sided colon cancers in the oldest old population have yet to be evaluated despite increased use of these surgeries.

AIM

This study aimed to compare clinical outcomes after robot-assisted right hemicolectomy (RARH) versus laparoscopic right hemicolectomy (LRH) in octogenarian and nonagenarian patients.

METHODS

This population-based, retrospective and observational study analyzed the data of adults ≥ 80 years old diagnosed with right-side colon cancer who received RARH or LRH. All data were extracted from the US National Inpatient Sample (NIS) database 2005-2018. Associations between type of surgery and in-hospital outcomes were determined using univariate and multivariable logistic regression and linear regression analysis.

RESULTS

Data of 7,550 patients (representing 37,126 hospitalized patients in the U.S.) were analyzed. Mean age of the study population was 84.8 years, 61.4% were females, and 79.1% were non-smokers. After adjusting for relevant confounders, regression analysis showed that patients undergoing RARH had a significantly shorter LOS (adjusted Beta (aBeta), -0.24, 95% CI: -0.32, -0.15) but greater total hospital costs (aBeta, 26.54, 95% CI: 24.64, 28.44) than patients undergoing LRH. No significant differences in mortality, perioperative complications, and risk of unfavorable discharge were observed between the two procedures (p > 0.05). Stratified analyses by frailty status revealed consistent results.

CONCLUSIONS

RARH is associated with a significantly shorter LOS but higher total hospital costs than LRH among octogenarians and nonagenarians. Other short-term outcomes for this population are similar between the two procedures, including in-hospital mortality, perioperative complications, and unfavorable discharge. These findings also apply to frail patients.

Exploiting branched-chain amino acid metabolism and NOTCH3 expression to predict and target colorectal cancer progression

Background

The interplay between colon adenocarcinoma (COAD) and branched-chain amino acid (BCAA) metabolism is not fully understood, presenting a crucial area for investigation.

Methods

We developed a prognostic model based on BCAA metabolism using the least absolute shrinkage and selection operator (LASSO) regression algorithm. We employed qRT-PCR and Western blot analyses to examine NOTCH3 expression in COAD tissues versus adjacent non-cancerous tissues and various cell lines. We also investigated the impact of NOTCH3 on COAD cell proliferation, invasion, and migration through in vitro and in vivo experiments.

Results

Our BCAA metabolism-related signature (BRS) distinguished between different immune features, tumor mutation burdens, responses to immunotherapy, and drug sensitivity among COAD patients. NOTCH3 was found to be overexpressed in COAD, promoting tumor growth as verified through various assays. The model effectively predicted COAD prognosis and patient responses to treatments, underscoring the potential of BCAA pathways as therapeutic targets.

Conclusion

The BRS is instrumental in predicting the prognosis and therapeutic response in COAD, with NOTCH3 playing a significant role in the proliferation, invasion and migration of COAD. These findings suggest that targeting BCAA metabolism and NOTCH3 could advance COAD treatment strategies.

Utilization of colorectal cancer screening tests: a systematic review and time trend analysis of nationally representative data

Background

The substantial and increasing global burden of colorectal cancer (CRC) underscores the imperative to enhance implementation and utilization of effective CRC screening offers. Therefore, we examined the lifetime and up-to-date use of CRC screening tests across various countries, and described utilization trends over time.

Methods

We conducted a systematic review on the extent and recent trends of utilization of CRC screening tests among people 45 years or older in different countries around the globe. PubMed/Medline, Web of Science, and Embase electronic databases were screened for eligible studies from inception to June 30, 2024. The study protocol was registered with international prospective register of systematic reviews (PROSPERO) (CRD42023391344).

Findings

A total of 50 studies, based on nationally-representative data, were finally included - 27 from the United States (US) and 23 from other countries. The overall utilization of CRC screening has steadily increased over time in many countries, reaching 74.9% in Denmark in 2018-2020, 64% in Korea in 2020, and 72% in the US in 2021. Nevertheless, the utilization rates remain far below the national or continental targets in most countries. In contrast to European and Asian countries, where screening was predominantly fecal test-based, the approach in the US was primarily driven by colonoscopy, and the uptake of fecal tests and sigmoidoscopy gradually declined in the past two decades.

Interpretation

Despite ongoing progress in CRC screening offers and utilization, there remains large potential for enhanced roll-out and utilization of effective CRC screening programs for enhanced control of CRC incidence and mortality in the years ahead.

Funding

There was no funding source for this study.

Relationship Between Aspirin Use and Site-Specific Colorectal Cancer Risk Among Individuals With Metabolic Comorbidity

BACKGROUND

The relationship between aspirin usage and the risk of colorectal cancer (CRC) among individuals with both hypertension (HTN) and diabetes mellitus (DM) remains unclear. This study aims to explore the impact of aspirin use on the site-specific CRC risk in patients with metabolic comorbidity.

METHODS

A case-control study was conducted among 1,331 CRC patients and 2,771 controls recruited from the Nation Cancer Center in Korea. Multinomial logistic regression analyses were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for the association between aspirin use, metabolic disease status, and site-specific CRC risk.

RESULTS

Among the 4,102 participants, 1,191 individuals had neither HTN nor DM, 2,044 were diagnosed with HTN, 203 with DM, and 664 presented with HTN and DM comorbidity. An increasing number of HTN and DM was associated with an increased risk of overall CRC (HTN or DM: OR, 1.70; 95% CI, 1.39-2.07; HTN and DM: OR, 8.43; 95% CI, 6.37-11.16), while aspirin use was associated with a decreased risk of overall CRC (OR, 0.31; 95% CI, 0.21-0.46). These results remained consistent across anatomical sites. Among individuals with HTN and DM comorbidity, aspirin use notably associated with lower risk of overall CRC (OR, 0.39; 95% CI, 0.21-0.72), proximal colon (OR, 0.32; 95% CI, 0.13-0.71) and rectal cancer (OR, 0.27; 95% CI, 0.08-0.97), but not distal colon cancer (OR, 0.58; 95% CI, 0.27-1.24).

CONCLUSION

This study showed that aspirin use is negatively associated with overall and site-specific CRC, even among individuals with HTN and DM comorbidity.

The association between ferroptosis-related patterns and tumor microenvironment in colorectal cancer

Ferroptosis, a form of regulated cell death (RCD), exhibits distinct characteristics such as iron-dependence and lipid peroxidation accumulation (ROS), setting it apart from other types of cell death like apoptosis and necrosis. Its role in cancer biology is increasingly recognized, particularly its potential interaction with tumor microenvironment (TME) and CD8 T cells in cancer immunotherapy. However, the impact of ferroptosis on TME cell infiltration remains unclear. In this study, we conducted unsupervised clustering analysis on patient data from public databases, identifying three ferroptosis patterns with distinct TME cell infiltration characteristics: immune-inflamed, immune-excluded, and immune-desert phenotypes. We developed a ferroptosis score based on differentially expressed genes (DEGs) among these patterns, which correlated with various biological features including chemotherapy-resistance and immune cells infiltration. Despite patients with high ferroptosis scores exhibiting worse prognosis, they showed increased likelihood of benefiting from immunotherapy. Our findings highlight the importance of ferroptosis-related patterns in understanding TME cell infiltration and suggest novel strategies for drug combinations and immune-related therapies.

Metabolic Heterogeneity of Tumor Cells and its Impact on Colon Cancer Metastasis: Insights from Single-Cell and Bulk Transcriptome Analyses

Background: Metabolic reprogramming plays a crucial role in the development of colorectal cancer (CRC), influencing tumor heterogeneity, the tumor microenvironment, and metastasis. While the interaction between metabolism and CRC is critical for developing personalized treatments, gaps remain in understanding how tumor cell metabolism affects prognosis. Our study introduces novel insights by integrating single-cell and bulk transcriptome analyses to explore the metabolic landscape within CRC cells and its mechanisms influencing disease progression. This approach allows us to uncover metabolic heterogeneity and identify specific metabolic genes impacting metastasis, which have not been thoroughly examined in previous studies. Methods: We sourced microarray and single-cell RNA sequencing datasets from the Gene Expression Omnibus (GEO) and bulk sequencing data for CRC from The Cancer Genome Atlas (TCGA). We employed Gene Set Variation Analysis (GSVA) to assess metabolic pathway activity, consensus clustering to identify CRC-specific transcriptome subtypes in bulkseq, and rigorous quality controls, including the exclusion of cells with high mitochondrial gene expression in scRNA seq. Advanced analyses such as AUCcell, infercnvCNV, Non-negative Matrix Factorization (NMF), and CytoTRACE were utilized to dissect the cellular landscape and evaluate pathway activities and tumor cell stemness. The hdWGCNA algorithm helped identify prognosis-related hub genes, integrating these findings using a random forest machine learning model. Results: Kaplan-Meier survival curves identified 21 significant metabolic pathways linked to prognosis, with consensus clustering defining three CRC subtypes (C3, C2, C1) based on metabolic activity, which correlated with distinct clinical outcomes. The metabolic activity of the 13 cell subpopulations, particularly the epithelial cell subpopulation with active metabolic levels, was evaluated using AUCcell in scRNA seq. To further analyze tumor cells using infercnv, NMF disaggregated these cells into 10 cellular subpopulations. Among these, the C2 subpopulation exhibited higher stemness and tended to have a poorer prognosis compared to C6 and C0. Conversely, the C8, C3, and C1 subpopulations demonstrated a higher level of the five metabolic pathways, and the C3 and C8 subpopulations tended to have a more favorable prognosis. hdWGCNA identified 20 modules, from which we selected modules primarily expressed in high metabolic tumor subgroups and highly correlated with clinical information, including blue and cyan. By applying variable downscaling of RF to a total of 50 hub genes, seven gene signatures were obtained. Furthermore, molecules that were validated to be protective in GEO were screened alongside related molecules, resulting in the identification of prognostically relevant molecules such as UQCRFS1 and GRSF1. Additionally, the expression of GRSF1 was examined in colon cancer cell lines using qPCR and phenotypically verified by in vitro experiments. Conclusion: Our findings emphasize that high activity in specific metabolic pathways, including pyruvate metabolism and the tricarboxylic acid cycle, correlates with improved colon cancer outcomes, presenting new avenues for metabolic-based therapies. The identification of hub genes like GRSF1 and UQCRFS1 and their link to favorable metabolic profiles offers novel insights into tumor neovascularization and metastasis, with significant clinical implications for targeting metabolic pathways in CRC therapy.

Receipt of follow-up care plans on colorectal cancer screening among breast, prostate, and lung cancer survivors

PURPOSE

Our study aimed to examine whether receipt of follow-up care plans is associated with greater guideline-concordant CRC screening stratified by breast, prostate, and lung cancer survivors.

METHODS

We used data from years 2016, 2018, and 2020 of the Behavioral Risk Factor Surveillance System on 3339 eligible treatment-utilizing cancer survivors with complete treatment. We performed descriptive statistics and multivariable logistic regression to examine the mentioned association.

RESULTS

We observed that 83.9% of breast and 88.2% of prostate cancer survivors with follow-care plans received CRC screening (p-value < 0.001). The lowest CRC screening use was observed among lung cancer (70.8%). In multivariable analysis, receipt of follow-up care plans was strongly associated with greater odds of receiving CRC screening in breast (OR, 2.67; 95% CI: 1.71-4.16) and prostate (OR, 3.81; 95% CI: 2.30-6.31) cancer survivors. Regardless of provider type, 84 to 88% reduced likelihood of receipt of CRC screening when they received follow-up care plans among lung cancer survivors. Among those without follow-up care plans, breast (OR, 0.29; 95% CI: 0.09-0.92) and lung (OR, 0.05; 95% CI: 0.01-0.25) cancer survivors who received care from general practices were less likely to receive CRC screening compared to those who received care from non-general practices.

CONCLUSIONS

Receipt of follow-up care plans was associated with greater CRC screening use in breast and prostate cancers. Lung cancer survivors demonstrated lower screening use despite receipt of follow-up care plans.

IMPLICATION FOR CANCER SURVIVORS

Patient and provider communication regarding CRC screening recommendation should be included in their follow-up care plans.

Identification of EGR4 as a prospective target for inhibiting tumor cell proliferation and a novel biomarker in colorectal cancer

EGR4 (Early Growth Response 4) is a member of the EGR family, involving in tumorigenesis. However, the function and action mechanism of EGR4 in the pathogenesis of colorectal cancer (CRC) remain unclear. To address this, we assessed the prognosis of CRC based on EGR4 using the Kaplan-Meier plotter tool and tissue microarray. The abundance of immunoinfiltration was evaluated through ssGSEA, TISIDB, and TIMER. In vitro experiments involving knockdown or overexpression of EGR4 were performed, and RNA-sequencing was conducted to explore potential mechanisms. Furthermore, we used oxaliplatin and 5-fluorouracil to validate the impact of EGR4 on chemo-resistance. Pan-cancer analysis and tissue microarray showed that EGR4 was highly expressed in CRC and significantly correlated with an unfavorable prognosis. Moreover, EGR4 expression was associated with immunoinfiltration and cancer-associated fibroblasts in the CRC microenvironment. Functional enrichment demonstrated that high-expressional EGR4 were involved in chromatin and nucleosome assembly. Additionally, EGR4 promoted the proliferation of CRC cells. Mechanistically, EGR4 upregulated TNFα to activate the NF-κB signaling pathway, and its knockdown reduced p65 nuclear translocation. Importantly, combining shEGR4 with oxaliplatin and 5-fluorouracil significantly inhibited CRC proliferation. Taken together, these findings provide new insights into the potential prognosis and therapeutic targets of EGR4 in CRC.

Colorectal cancer screening: The value of early detection and modern challenges

The screening of colorectal cancer (CRC) is pivotal for both the prevention and treatment of this disease, significantly improving early-stage tumor detection rates. This advancement not only boosts survival rates and quality of life for patients but also reduces the costs associated with treatment. However, the adoption of CRC screening methods faces numerous challenges, including the technical limitations of both noninvasive and invasive methods in terms of sensitivity and specificity. Moreover, socioeconomic factors such as regional disparities, economic conditions, and varying levels of awareness affect screening uptake. The coronavirus disease 2019 pandemic further intensified these cha-llenges, leading to reduced screening participation and increased waiting periods. Additionally, the growing prevalence of early-onset CRC necessitates innovative screening approaches. In response, research into new methodologies, including artificial intelligence-based systems, aims to improve the precision and accessibility of screening. Proactive measures by governments and health organizations to enhance CRC screening efforts are underway, including increased advocacy, improved service delivery, and international cooperation. The role of technological innovation and global health collaboration in advancing CRC screening is undeniable. Technologies such as artificial intelligence and gene sequencing are set to revolutionize CRC screening, making a significant impact on the fight against this disease. Given the rise in early-onset CRC, it is crucial for screening strategies to continually evolve, ensuring their effectiveness and applicability.

Evaluation of the "Burgenland PREvention trial of colorectal cancer Disease with ImmunologiCal Testing" (B-PREDICT)-a population-based colorectal cancer screening program

BACKGROUND

The colorectal cancer (CRC) screening program B-PREDICT is a population based invited two stage screening project using a faecal immunochemical test (FIT) for initial screening followed by a colonoscopy for those with a positive FIT. B-PREDICT was compared with the opportunistic screening colonoscopy (OPP-COL), performed in course of the nationwide screening program.

METHODS

Within B-PREDICT all residents of the Austrian federal state Burgenland, aged between 40 and 80 are annually invited to FIT testing. All individuals who underwent initial colonoscopy in Burgenland between 01/2003 and 12/2014, were included in this study. Individuals from the FIT-triggered invited screening program B-PREDICT were compared with those from the non-FIT triggered OPP-COL.

RESULTS

15 133 individuals from B-PREDICT were compared to 10 045 individuals with OPP-COL. CRC detection rates were 1.34% (CI-95%, [1.15; 1.52]) in B-PREDICT compared to 0.54% in OPP-COL (95%-CI, [0.39; 0.68] p < 0.001). The decrease in the age standardized incidence rates of CRC was more pronounced in the population screened with FIT than in the general population screened with colonoscopy. Changes in incidence rates per year were -4.4% (95%-CI, [-5.1; -3.7]) vs. -1.8% (95%-CI, [-1.9; -1.6] p < 0.001).

CONCLUSIONS

B-PREDICT shows a two-fold higher detection rate of CRC as well as HRA compared to OPP-COL.

Multilevel analysis of social determinants of advanced stage colorectal cancer diagnosis

The advanced stage at diagnosis of colorectal cancer (CRC) may be related to individual factors, socioeconomic conditions, and healthcare service availability. The objective of the study was to analyze the prevalence of advanced stage CRC at the time of diagnosis and its association with individual, contextual, socioeconomic, and healthcare service indicators. An observational, cross-sectional study was conducted, analyzing cases of malignant neoplasms of the colon and rectum in individuals of both sexes, aged between 18 and 99 years, diagnosed between 2010 and 2019 in Brazil (n = 69,047). Data were collected from the Hospital Cancer Registry (HCR), Atlas of Human Development in Brazil, and from the National Registry of Health Institutions (NRHI). A Multilevel Poisson Regression model with random intercept was used. The prevalence of advanced stage CRC at diagnosis was 65.6%. Advanced stage was associated with older age groups prevalence ratio (PR) 4.40 and younger age groups (PR 1.84), low Human Development Index (HDI) (PR 1.22), and low density of family health strategy teams (PR 1.10). The study highlights the unequal distribution of social determinants of health in the diagnosis CRC in Brazil, revealing the need to evaluate and redirect public policies aimed at improving early detection and prevention of CRC in the country.

Pharmacodynamic components and mechanisms of ginger (Zingiber officinale) in the prevention and treatment of colorectal cancer

ETHNOPHARMACOLOGICAL RELEVANCE

Ginger is a "medicine-food homology" natural herb and has a longstanding medicinal background in treating intestinal diseases. Its remarkable bioactivities, including anti-inflammatory, antioxidant, immunoregulatory, flora regulatory, intestinal protective, and anticancer properties, make it a promising natural medicine for colorectal cancer (CRC) prevention and treatment.

AIM OF THE REVIEW

The purpose is to review the relevant literature on ginger and pharmacodynamic components for CRC prevention and treatment, summarize the possible mechanisms of ginger from clinical studies and animal and in vitro experiments, to provide theoretical support for the use of ginger preparations in the daily prevention and clinical treatment of CRC.

MATERIALS AND METHODS

Literatures about ginger and CRC were searched from electronic databases, such as PubMed, Web of Science, ScienceDirect, Google Scholar and China National Knowledge Infrastructure (CNKI).

RESULTS

This article summarizes the molecular mechanisms of ginger and its pharmacodynamic components in the prevention and treatment of CRC, including anti-inflammatory, antioxidant, immunoregulatory, flora regulatory, intestinal protective, inhibit CRC cell proliferation, induce CRC cell cycle blockage, promote CRC cell apoptosis, suppress CRC cell invasion and migration, enhance the anticancer effect of chemotherapeutic drugs.

CONCLUSIONS

Ginger has potential for daily prevention and clinical treatment of CRC.

Prognostic and predictive value of tumor deposits in advanced signet ring cell colorectal cancer: SEER database analysis and multicenter validation

BACKGROUND

Colorectal signet-ring cell carcinoma (SRCC) is a rare cancer with a bleak prognosis. The relationship between its clinicopathological features and survival remains incompletely elucidated. Tumor deposits (TD) have been utilized to guide the N staging in the 8th edition of American Joint Committee on Cancer (AJCC) staging manual, but their prognostic significance remains to be established in colorectal SRCC.

PATIENTS AND METHODS

The subjects of this study were patients with stage III/IV colorectal SRCC who underwent surgical treatment. The research comprised two cohorts: a training cohort and a validation cohort. The training cohort consisted of 631 qualified patients from the SEER database, while the validation cohort included 135 eligible patients from four independent hospitals in China. The study assessed the impact of TD on Cancer-Specific Survival (CSS) and Overall Survival (OS) using Kaplan-Meier survival curves and Cox regression models. Additionally, a prognostic nomogram model was constructed for further evaluation.

RESULTS

In both cohorts, TD-positive patients were typically in the stage IV and exhibited the presence of perineural invasion (PNI) (P < 0.05). Compared to the TD-negative group, the TD-positive group showed significantly poorer CSS (the training cohort: HR, 1.87; 95% CI, 1.52-2.31; the validation cohort: HR, 2.43; 95% CI, 1.55-3.81; all P values < 0.001). This association was significant in stage III but not in stage IV. In the multivariate model, after adjusting for covariates, TD maintained an independent prognostic value (P < 0.05). A nomogram model including TD, N stage, T stage, TNM stage, CEA, and chemotherapy was constructed. Through internal and external validation, the model demonstrated good calibration and accuracy. Further survival curve analysis based on individual scores from the model showed good discrimination.

CONCLUSION

TD positivity is an independent factor of poor prognosis in colorectal SRCC patients, and it is more effective to predict the prognosis of colorectal SRCC by building a model with TD and other clinically related variables.

Bakar A, Hj Jobli NM, Sararaks S. Study protocol for a mixed methods approach to optimize colorectal cancer screening in Malaysia: Integrating stakeholders insights and knowledge-to-action framework

INTRODUCTION

Colorectal cancer is a growing global health concern and the number of reported cases has increased over the years. Early detection through screening is critical to improve outcomes for patients with colorectal cancer. In Malaysia, there is an urgent need to optimize the colorectal cancer screening program as uptake is limited by multiple challenges. This study aims to systematically identify and address gaps in screening service delivery to optimize the Malaysian colorectal cancer screening program.

METHODS

This study uses a mixed methods design. It focuses primarily on qualitative data to understand processes and strategies and to identify specific areas that can be improved through stakeholder engagement in the screening program. Quantitative data play a dual role in supporting the selection of participants for the qualitative study based on program monitoring data and assessing inequalities in screening and program implementation in healthcare facilities in Malaysia. Meanwhile, literature review identifies existing strategies to improve colorectal cancer screening. Additionally, the knowledge-to-action framework is integrated to ensure that the research findings lead to practical improvements to the colorectal cancer screening program.

DISCUSSION

Through this complex mix of qualitative and quantitative methods, this study will explore the complex interplay of population- and systems-level factors that influence screening rates. It involves identifying barriers to effective colorectal cancer screening in Malaysia, comparing current strategies with international best practices, and providing evidence-based recommendations to improve the local screening program.

Colorectal cancer screening utilization among breast, cervical, prostate, skin, and lung cancer survivors

PURPOSE

To examine whether sociodemographic characteristics, access to care, risk behavior factors, and chronic health conditions were associated with colorectal cancer (CRC) screening utilization among breast, cervical, prostate, skin, and lung cancer survivors.

METHODS

We analyzed the 2020 Behavioral Risk Factor Surveillance System (BRFSS) data on 9780 eligible cancer survivors. Descriptive statistics and multivariable logistic regression models were applied to assess the association between guideline-concordant CRC screening and the mentioned characteristics.

RESULTS

Overall, 81.9%, 65%, 88%,78.1%, and 80.1% of breast, cervical, prostate, skin, and lung cancer survivors received CRC screening, respectively (p-value < 0.001). In multivariable analysis, breast, cervical, and skin cancer survivors aged 60 years or older were associated with higher odds of receiving CRC screening. Respondents that had their recency of routine checkup two or more years before had lower odds of having CRC screening among cervical (OR = 0.06; 95% CI, 0.02-0.22), prostate (OR = 0.26; 95% CI, 0.14-0.49), and skin cancer (OR = 0.50; 95% CI, 0.36-0.70) survivors. The presence of chronic diseases was also associated with guideline-concordant CRC screening among breast, prostate, and skin cancer survivors.

CONCLUSIONS

Our findings provide important evidence on potential factors that are associated with guideline-concordant CRC screening utilization across different cancer survivors, which include older age, recency of routine checkup, and multiple chronic diseases. Moreover, variation in CRC screening utilization across cancer survivors may highlight missed opportunities for secondary cancer prevention.

IMPLICATIONS FOR CANCER SURVIVORS

Establishing clear CRC screening guidelines and including patient-provider communication on recommendation in cancer survivorship care may increase adherence to CRC screening.

Association of county-level food deserts and food swamps on postoperative outcomes among patients undergoing colorectal surgery

BACKGROUND

Although malnutrition has been linked to worse healthcare outcomes, the broader context of food environments has not been examined relative to surgical outcomes. We sought to define the impact of food environment on postoperative outcomes of patients undergoing resection for colorectal cancer (CRC).

METHODS

Patients who underwent surgery for CRC between 2014 and 2020 were identified from the Medicare database. Patient-level data were linked to the United States Department of Agriculture data on food environment. Multivariable regression was used to examine the association between food environment and the likelihood of achieving a textbook outcome (TO). TO was defined as the absence of an extended length of stay (≥75th percentile), postoperative complications, readmission, and mortality within 90 days.

RESULTS

A total of 260,813 patients from 3017 counties were included in the study. Patients from unhealthy food environments were more likely to be Black, have a higher Charlson Comorbidity Index, and reside in areas with higher social vulnerability (all P < .01). Patients residing in unhealthy food environments were less likely to achieve a TO than that of patients residing in the healthiest food environments (food swamp: 48.8% vs 52.4%; food desert: 47.9% vs 53.7%; P < .05). On multivariable analysis, individuals residing in the unhealthy food environments had lower odds of achieving a TO than those of patients living in the healthiest food environments (food swamp: OR, 0.86; 95% CI, 0.83-0.90; food desert: OR, 0.79; 95% CI, 0.76-0.82); P < .05).

CONCLUSION

The surrounding food environment of patients may serve as a modifiable sociodemographic risk factor that contributes to disparities in postoperative CRC outcomes.

Screening for Colorectal Cancer

Colorectal cancer (CRC) is the second leading cause of cancer death. Screening has been proven to reduce both cancer incidence and cancer-related mortality. Various screening tests are available, each with their own advantages and disadvantages and varying levels of evidence to support their use. Clinicians should offer CRC screening to average-risk persons aged 50 to 75 years; starting screening at age 45 years remains controversial. Screening may be beneficial in select persons aged 76 to 85 years, based on their overall health and screening history. Offering a choice of screening tests or sequentially offering an alternate test for those who do not complete screening can significantly increase participation.

Assessment of salivary miRNA, clinical, and demographic characterization in colorectal cancer diagnosis

AIM

Colorectal cancer (CRC), as the third most frequent malignancy in the world, is the fourth major cause of cancer-related mortality. Its early detection contributes significantly to a reduction in mortality. The objective of this case-control research was to analyze the salivary expression of microRNA-29a (miR-29a) and microRNA-92a (miR-92a), and also to consider demographic, clinical, and nutritional habits for differentiation between CRC patients and healthy controls, especially in the early stages.

METHOD

A standard checklist was used to obtain the demographic information, clinical features, and dietary habits of the case and control groups. Samplings of whole unstimulated saliva samples were obtained from 33 healthy persons and 42 CRC patients. Through real-time PCR, statistical analyses, and machine learning analyses, miR-29a and miR-92a salivary expression levels were evaluated.

RESULTS

The mean salivary expression of miR-92a and miR-29a in CRC patients was significantly higher than in healthy controls (p < 0.001). The area under the receiver operating characteristic curve for miR-92a and miR-29a salivary biomarkers was 0.947 and 0.978, respectively. The sensitivity and specificity values for miR-92a were 95.24 % and 84.85 %, respectively, whereas sensitivity and specificity for miR-29a were equal to 95.20 % and 87.88 %, respectively. Multiple logistic regressions considering demographics, clinical features, and nutritional habits led to values of 95.35 % and 96.88 % as sensitivity and specificity, respectively, and machine learning analysis led to values of 88.89 % and 86.67 % as sensitivity and specificity, respectively.

CONCLUSION

CRC could be accurately diagnosed based on miR-92a and miR-29a levels in saliva. Statistical analysis and machine learning might develop cost-effective models for the distinction of CRC using a noninvasive technique.

Whole-transcriptome defines novel glucose metabolic subtypes in colorectal cancer

Colorectal cancer (CRC) is the most prevalent malignancy of the digestive system. Glucose metabolism plays a crucial role in CRC development. However, the heterogeneity of glucose metabolic patterns in CRC is not well characterized. Here, we classified CRC into specific glucose metabolic subtypes and identified the key regulators. 2228 carbohydrate metabolism-related genes were screened out from the GeneCards database, 202 of them were identified as prognosis genes in the TCGA database. Based on the expression patterns of the 202 genes, three metabolic subtypes were obtained by the non-negative matrix factorization clustering method. The C1 subtype had the worst survival outcome and was characterized with higher immune cell infiltration and more activation in extracellular matrix pathways than the other two subtypes. The C2 subtype was the most prevalent in CRC and was characterized by low immune cell infiltration. The C3 subtype had the smallest number of individuals and had a better prognosis, with higher levels of NRF2 and TP53 pathway expression. Secreted frizzled-related protein 2 (SFRP2) and thrombospondin-2 (THBS2) were confirmed as biomarkers for the C1 subtype. Their expression levels were elevated in high glucose condition, while their knockdown inhibited migration and invasion of HCT 116 cells. The analysis of therapeutic potential found that the C1 subtype was more sensitive to immune and PI3K-Akt pathway inhibitors than the other subtypes. To sum up, this study revealed a novel glucose-related CRC subtype, characterized by SFRP2 and THBS2, with poor prognosis but possible therapeutic benefits from immune and targeted therapies.

Colon and rectal cancer: An emergent public health problem

Colorectal cancer ranks third globally, with a high mortality rate. In the United States, and different countries in Europe, organized population screenings exist and include people between 50 and 74 years of age. These screenings have allowed an early diagnosis and consequently an improvement in health indicators. Colon and rectal cancer (CRC) is a disease of particular interest due to the high global burden associated with it and the role attributed to prevention and early diagnosis in reducing morbidity and mortality. This study is a review of CRC pathology and includes the most recent scientific evidence regarding this pathology, as well as a diagnosis of the epidemiological situation of CRC. Finally, the recommendation from a public health perspective will be discussed in detail taking into account the context and the most current recommendations.

Would initiating colorectal cancer screening from age of 45 be cost-effective in Germany? An individual-level simulation analysis

Background

Colorectal cancer (CRC) screening has been shown to be effective and cost-saving. However, the trend of rising incidence of early-onset CRC challenges the current national screening program solely for people ≥50 years in Germany, where extending the screening to those 45-49 years might be justified. This study aims to evaluate the cost-effectiveness of CRC screening strategies starting at 45 years in Germany.

Method

DECAS, an individual-level simulation model accounting for both adenoma and serrated pathways of CRC development and validated with German CRC epidemiology and screening effects, was used for the cost-effectiveness analysis. Four CRC screening strategies starting at age 45, including 10-yearly colonoscopy (COL), annual/biennial fecal immunochemical test (FIT), or the combination of the two, were compared with the current screening offer starting at age 50 years in Germany. Three adherence scenarios were considered: perfect adherence, current adherence, and high screening adherence. For each strategy, a cohort of 100,000 individuals with average CRC risk was simulated from age 20 until 90 or death. Outcomes included CRC cases averted, prevented death, quality-adjusted life-years gained (QALYG), and total incremental costs considering both CRC treatment and screening costs. A 3% discount rate was applied and costs were in 2023 Euro.

Result

Initiating 10-yearly colonoscopy-only or combined FIT + COL strategies at age 45 resulted in incremental gains of 7-28 QALYs with incremental costs of €28,360-€71,759 per 1,000 individuals, compared to the current strategy. The ICER varied from €1,029 to €9,763 per QALYG, and the additional number needed for colonoscopy ranged from 129 to 885 per 1,000 individuals. Among the alternatives, a three times colonoscopy strategy starting at 45 years of age proves to be the most effective, while the FIT-only strategy was dominated by the currently implemented strategy. The findings remained consistent across probabilistic sensitivity analyses.

Conclusion

The cost-effectiveness findings support initiating CRC screening at age 45 with either colonoscopy alone or combined with FIT, demonstrating substantial gains in quality-adjusted life-years with a modest increase in costs. Our findings emphasize the importance of implementing CRC screening 5 years earlier than the current practice to achieve more significant health and economic benefits.

Frailty worsens long-term survival in patients with colorectal cancer: a systematic review and meta-analysis

Background

Colorectal cancer (CRC) is the 3rd most common cancer in men and 2nd most common malignancy in females across the globe leading to high mortality rates. Frailty is an age-related syndrome that has been associated with high morbidity and mortality. This systematic review aimed to examine if frailty can predict long-term (>1 year) outcomes of patients with CRC.

Methods

This PROSPERO registered review examined the databases of PubMed, Embase, and Web of Science till 4th September 2023 for cohort studies assessing the association between frailty and long-term outcomes of CRC.

Results

15 studies with 45288 patients were included. 6573 patients (14.5%) were frail. Meta-analysis demonstrated that frailty was associated with statistically significant poor overall survival (OS) (HR: 2.11 95% CI: 1.44, 3.08 I2 = 94%) (14 studies), cancer-specific survival (CSS) (HR: 4.59 95% CI: 2.75, 7.67 I2 = 38%) (2 studies), and disease-free survival (DFS) (HR: 1.46 95% CI: 1.28, 1.66 I2 = 0%) (5 studies) after CRC. Subgroup analysis for OS based on study type, location, sample size, stage of cancer, percentage with frailty, treatment, adjustment for CRC stage and comorbidities, and follow-up did not change the results. These results were not altered in significance on sensitivity analysis.

Conclusion

Our results show that frail CRC patients have poor OS and DFS as compared to non-frail patients. Variations in frailty measurement tools and high inter-study heterogeneity are major limitations of the review.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, PROSPERO, CRD42023450586.

In vitro and in vivo anti-colorectal cancer effect of the newly synthesized sericin/propolis/fluorouracil nanoplatform through modulation of PI3K/AKT/mTOR pathway

The present work aimed to assess the potential effect of sericin/propolis/fluorouracil nanoformula against colorectal cancer (CRC) (the fourth most common cause of cancer-related mortalities). A novel anti-cancerous formula of the synthesized sericin/propolis nanoparticles was developed and tested both in vitro (using Caco-2 cell line) and in vivo (in experimentally induced colorectal cancer animal models). The combination index of the prepared nanoformula proved that the combination between sericin/propolis nanoparticles and 5-fluorouracil demonstrated the highest synergistic effect (0.86), with dose reduction index (DRI) of the chemotherapeutic drug reaching 1.49. The mechanism of action of the prepared nanoformula revealed that it acts through the inhibition of the PI3K/AKT/mTOR signaling pathway and consequently inhibiting cancerous cells proliferation. Treatment and prophylactic studies of both sericin and propolis showed increased TBARS (Thiobarbituric Acid Reactive Substance) formation, downregulated BCL2 (B-cell lymphoma 2) and activated BAX, Caspase 9 and Caspase 3 expression. The prepared nanoformula decreased the ROS (Reactive Oxygen Species) production in vivo owing to PI3K/AKT/mTOR pathway inhibition and FOXO-1 (Forkhead Box O1) activation that resulted in autophagy/apoptosis processes stimulation. The potent anticancer effect of the prepared nanoformula was further emphasized through the in vivo histopathological studies of experimentally induced tumors. The newly formulated sericin/propolis/fluorouracil nanoparticles exhibited clear-cut cytotoxic effects toward tumor cells with provided evidence for the prophylactic effect.

Knowledge and Attitudes toward Colorectal Cancer among Healthcare Workers: A Pilot Cross-Sectional Survey in Thailand

BACKGROUND

Colorectal cancer is an important public health problem in Thailand. The health workforce is one of the key strategies to reduce the burden of cancer. They are not only involved in patient care, but they can improve public knowledge of cancer within their community. This study aimed to explore the knowledge and attitudes toward colorectal cancer among Thai healthcare workers.

METHODS

A cross-sectional pilot study was conducted from October 2021 to March 2022. Convenience sampling was used to recruit study participants who worked in selected primary healthcare units or hospitals located in different regions across the country. The data on demographics and health behavior, knowledge of using the Fecal Immunochemical Test (FIT), and knowledge and attitudes toward colorectal cancer were collected using self-administered questionnaires. Descriptive statistics were used for data analysis.

RESULTS

A total of 300 healthcare workers were recruited in the study. The majority of participants presented a healthy lifestyle: 74% were in the healthy weight range, 68% had never consumed alcohol, and 99.3% were never smokers. More than 70% of participants provided correct answers to questions about the use of a FIT kit. The mean score for knowledge of colorectal cancer was 12.16 + 2.16 (out of 14) and 240 (80%) participants were considered to have adequate knowledge. Also, colorectal cancer knowledge was associated with age of participants (p<0.05). Most of the participants (76.2-92.3%) had positive attitudes toward colorectal cancer screening, however about half of them thought that a colonoscopy could be painful, uncomfortable, and embarrassing.

CONCLUSIONS

Overall, the majority of participants had adequate knowledge of colorectal cancer and positive attitudes toward its screening. The present study provided overview information on practical guidance for undertaking a nationwide survey in the future.

Serum uric acid and the risk of colorectal cancer: a meta-analysis

BACKGROUND

A meta-analysis was performed in this study to evaluate the association between serum uric acid and the risk of colorectal cancer (CRC).

METHODS

Relevant observational studies observing the relationship between uric acid and the incidence of CRC were obtained by the search of electronic databases, including Medline, Embase, Cochrane Library and Web of Science . A randomized-effects model was selected to pool the data by incorporating the influence of potential heterogeneity.

RESULTS

Eight observational studies involving 1,226,379 adults were included. During a mean follow-up duration of 12.8 years, CRC was developed in 12349 (1.0%) participants. Pooled results showed that compared to those with the lowest category of serum uric acid at baseline, participants with the highest category of serum uric acid had an increased incidence of CRC during follow-up [risk ratio (RR), 1.28; 95% confidence interval (CI), 1.17-1.42; P  < 0.001; I2  = 0%]. Sensitivity analysis limited to prospective cohort studies retrieved similar results (RR, 1.32; 95% CI, 1.19-1.47; P  < 0.001; I2  = 0%). Subgroup analyses showed consistent results in men and women, in estimates of the incidence of colon cancer and rectal cancer and in studies with different follow-up durations and quality scores ( P for subgroup differences all > 0.05).

CONCLUSION

Although the cutoff for defining a high uric acid varied among the included studies, results of the meta-analysis suggest that a high serum uric acid may be associated with an increased risk of CRC in an adult population.

Focusing on colorectal cancer in young adults (Review)

Colorectal cancer (CRC) ranks as the third leading cause of cancer-related mortality worldwide. Recent years have witnessed an increase in the incidence of CRC among adults <50 years old on a global scale. The increased incidence is associated with several modifiable risk factors, including obesity, type II diabetes, physical inactivity and frequent antibiotic use. In younger individuals, haematochezia and abdominal pain are the most common symptoms, predominantly affecting the left-side colon. While certain cases of early-onset CRC (eoCRC) are associated with a genetic predisposition, the majority result from sporadic mutations in the genes APC, KRAS, BRAF and TP53, which trigger uncontrolled cell proliferation and tumour formation. Colorectal carcinogenesis involves three major pathways: The chromosomal instability (CIN), microsatellite instability and CpG island methylator phenotype pathways. Dysregulation of the CIN pathway accounts for 85% of sporadic cases of eoCRC. Notably, eoCRC exhibits a distinctive molecular profile, characterized by a decreased prevalence of BRAF mutations, an increased prevalence of KRAS mutations and LINE-1 hypomethylation, and involvement of the Microsatellite and Chromosomal Stable pathway. Prevention strategies for eoCRC primarily centre on lifestyle modifications and the development of screening programs targeting younger populations. Further exploration into the molecular mechanisms involved in the identification of novel risk factors associated with eoCRC is imperative. These efforts, in conjunction with the development of specific screening strategies, hold the potential to reduce morbidity and mortality in the future.

Modulating a prebiotic food source influences inflammation and immune-regulating gut microbes and metabolites: insights from the BE GONE trial

BACKGROUND

Accessible prebiotic foods hold strong potential to jointly target gut health and metabolic health in high-risk patients. The BE GONE trial targeted the gut microbiota of obese surveillance patients with a history of colorectal neoplasia through a straightforward bean intervention.

METHODS

This low-risk, non-invasive dietary intervention trial was conducted at MD Anderson Cancer Center (Houston, TX, USA). Following a 4-week equilibration, patients were randomized to continue their usual diet without beans (control) or to add a daily cup of study beans to their usual diet (intervention) with immediate crossover at 8-weeks. Stool and fasting blood were collected every 4 weeks to assess the primary outcome of intra and inter-individual changes in the gut microbiome and in circulating markers and metabolites within 8 weeks. This study was registered on ClinicalTrials.gov as NCT02843425, recruitment is complete and long-term follow-up continues.

FINDINGS

Of the 55 patients randomized by intervention sequence, 87% completed the 16-week trial, demonstrating an increase on-intervention in diversity [n = 48; linear mixed effect and 95% CI for inverse Simpson index: 0.16 (0.02, 0.30); p = 0.02] and shifts in multiple bacteria indicative of prebiotic efficacy, including increased Faecalibacterium, Eubacterium and Bifidobacterium (all p < 0.05). The circulating metabolome showed parallel shifts in nutrient and microbiome-derived metabolites, including increased pipecolic acid and decreased indole (all p < 0.002) that regressed upon returning to the usual diet. No significant changes were observed in circulating lipoproteins within 8 weeks; however, proteomic biomarkers of intestinal and systemic inflammatory response, fibroblast-growth factor-19 increased, and interleukin-10 receptor-α decreased (p = 0.01).

INTERPRETATION

These findings underscore the prebiotic and potential therapeutic role of beans to enhance the gut microbiome and to regulate host markers associated with metabolic obesity and colorectal cancer, while further emphasizing the need for consistent and sustainable dietary adjustments in high-risk patients.

FUNDING

This study was funded by the American Cancer Society.

Neurotransmitter receptor-related gene signature as potential prognostic and therapeutic biomarkers in colorectal cancer

Background: Colorectal cancer is one of the most common malignant tumors worldwide. A various of neurotransmitter receptors have been found to be expressed in tumor cells, and the activation of these receptors may promote tumor growth and metastasis. This study aimed to construct a novel neurotransmitter receptor-related genes signature to predict the survival, immune microenvironment, and treatment response of colorectal cancer patients. Methods: RNA-seq and clinical data of colorectal cancer from The Cancer Genome Atlas database and Gene Expression Omnibus were downloaded. Neurotransmitter receptor-related gene were collected from publicly available data sources. The Weighted Gene Coexpression Network Analysis (WGCNA), Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression, Support Vector Machine-Recursive Feature Elimination (SVM-RFE), and Random Forest (RF) algorithms were employed to construct the Neurotransmitter receptor-related gene prognostic signature. Further analyses, functional enrichment, CIBERSORTx, The Tumor Immune Single Cell Center (TISCH), survival analysis, and CellMiner, were performed to analyze immune status and treatment responses. Quantitative real-time polymerase chain reaction (qRT-PCR) assays were carried out to confirm the expression levels of prognostic genes. Results: By combining machine learning algorithm and WGCNA, we identified CHRNA3, GABRD, GRIK3, and GRIK5 as Neurotransmitter receptor-related prognostic genes signature. Functional enrichment analyses showed that these genes were enriched with cellular metabolic-related pathways, such as organic acid, inorganic acid, and lipid metabolism. CIBERSORTx and Single cell analysis showed that the high expression of genes were positively correlated with immunosuppressive cells infiltration, and the genes were mainly expressed in cancer-associated fibroblasts and endothelial cells. A nomogram was further built to predict overall survival (OS). The expression of CHRNA3, GABRD, GRIK3, and GRIK5 in cancer cells significantly impacted their response to chemotherapy. Conclusion: A neurotransmitter receptor-related prognostic gene signature was developed and validated in the current study, giving novel sights of neurotransmitter in predicting the prognostic and improving the treatment of CRC.

Nanoparticles for imaging-guided photothermal therapy of colorectal cancer

Colorectal cancer (CRC) is one of the most common malignancies with a high mortality rate worldwide. While surgery, chemotherapy, and radiotherapy have shown some effectiveness in improving survival rates, they come with drawbacks such as side effects and harm to healthy tissues. The theranostic approach, which integrates the processes of cancer diagnosis and treatment, can minimize biological side effects. Photothermal therapy (PTT) is an emerging treatment method that usages light-sensitive agents to generate heat at the tumor site and induce thermal erosion. The development of nanotechnology for CRC treatment using imaging-guided PTT has garnered significant. Nanoparticles with suitable physical and chemical properties can enhance the efficiency of cancer diagnosis and PTT. This approach enables the monitoring of cancer treatment progress and safeguards healthy tissues. In this article, we concisely introduce the application of metal nanoparticles, polymeric nanoparticles, and carbon nanoparticles in imaging-guided PTT of colorectal cancer.

Early-Onset Colorectal Cancer: Prevalence, Risk Factors, and Clinical Features Among Commercially Insured Adults in the United States

BACKGROUND

 The incidence of colorectal cancer (CRC) in patients younger than 50 has been rising over the last several decades, accounting for up to 25% of total cases. Despite the screening age recently being lowered to 45, a significant proportion of cases would still arise at younger ages prior to screening. Nonfamilial early-onset CRC remains a particular concern. Identification of risk factors and clinical features in this age group is needed to improve detection.

METHODS

In this retrospective cohort analysis using claims data from the Truven Health MarketScan® Commercial Claims insurance database from 2007 to 2017, patients were identified with colon and rectal cancer, compared across three age groups (ages 18-40, 40-50, and >50), and analyzed for risk factors and clinical features.

RESULTS

Female sex was more prevalent in the younger age group compared to age >50 (54% and 51.9% vs. 49.6%), with little change noted between rectal cancer age groups by sex. A higher percentage of younger patients were in the obese age groups compared with older groups for colon cancer, particularly the morbidly obese with BMI >40 (24.94%, 25.75%, and 21.34% in the three age groups). Abdominal pain was a common presenting symptom identified in the age groups <50 compared with age >50 (25% and 19% vs. 14%), along with hematochezia, weight loss, and anemia.

CONCLUSIONS

Morbid obesity and female sex may be important risk factors among patients with early-onset CRC. The presence of abdominal pain was more common among the early-onset CRC cohort.

Genoprotective potential of Macaranga species phytochemical compounds on HT-29 human colorectal adenocarcinoma cell line

BACKGROUND

The species of genus Macaranga are widely found in Malaysian secondary forests and has been used as an alternative for treating varieties of illness. Studies have shown that the medicinal properties of this genus contain anti-inflammatory, antioxidant, and anti-cancer effects. This study aimed to determine the cytotoxicity of six isolated phytochemicals from Macaranga heynei (M. heynei), Macaranga lowii and Shorea leprosula on HT-29 human colorectal adenocarcinoma cell lines.

RESULTS

One out of six isolated phytochemical compounds, identified as "Laevifolin A", showed a cytotoxicity with an IC50 value of 21.2 µM following 48 h treatment as detected using Sulforhodamine B (SRB) assay. Additionally, no induction of apoptosis and oxidative stress were observed on Laevifolin A treated HT-29 cells as determined using Annexin V-FITC/PI assay and dihydroethidine (HE) staining, respectively. Additionally, no damage to the DNA were observed as measured using the Alkaline Comet assay. Further investigation on menadione-induced oxidative DNA damage showed the genoprotective potential of Laevifolin A on HT-29 cells.

CONCLUSIONS

In conclusion, this study indicated that only one compound (Laevifolin A) that extracted from M. heynei has the cytotoxicity potential to be developed as an anticancer agent in human colorectal adenocarcinoma. However, besides exhibiting cytotoxic effect, the compound also exhibits genoprotective capability that warrant further investigation.

Kinesin superfamily member KIFC2 as an independent prognostic biomarker of colon adenocarcinoma associated with poor immune response

Clinical outcomes of colon adenocarcinoma (COAD) exhibit heterogeneity among different patients, highlighting the need for novel prognostic biomarkers. Kinesin superfamily members have been shown to play a crucial role in tumors and can predict cancer diagnosis and prognosis. However, the role of kinesin family member C2 (KIFC2) in tumors, particularly its prognostic value in COAD, remains poorly understood. Our bioinformatics analysis of the cancer genome atlas and GEO databases revealed significantly higher expression of KIFC2 in COAD, correlating with a worse prognosis in the cancer genome atlas-COAD and GSE17536 cohorts. Additionally, differentially expressed genes in COAD were enriched in immune-related pathways, and patients with higher KIFC2 expression showed fewer activated CD4 + T cells. These findings suggest KIFC2 as a potential prognostic biomarker for COAD, warranting further validation in clinical studies.

National and subnational incidence, mortality and associated factors of colorectal cancer in China: A systematic analysis and modelling study

Background

Due to their known variation by geography and economic development, we aimed to evaluate the incidence and mortality of colorectal cancer (CRC) in China over the past decades and identify factors associated with CRC among the Chinese population to provide targeted information on disease prevention.

Methods

We conducted a systemic review and meta-analysis of epidemiolocal studies on the incidence, mortality, and associated factors of CRC among the Chinese population, extracting and synthesising data from eligible studies retrieved from seven global and Chinese databases. We pooled age-standardised incidence rates (ASIRs) and mortality rates (ASMRs) for each province, subregion, and the whole of China, and applied a joinpoint regression model and annual per cent changes (APCs) to estimate the trends of CRC incidence and mortality. We conducted random-effects meta-analyses to assess the effect estimates of identified associated risk factors.

Results

We included 493 articles; 271 provided data on CRC incidence or mortality, and 222 on associated risk factors. Overall, the ASIR of CRC in China increased from 2.75 to 19.39 (per 100 000 person-years) between 1972 and 2019 with a slowed-down growth rate (APC1 = 5.75, APC2 = 0.42), while the ASMR of CRC decreased from 12.00 to 7.95 (per 100 000 person-years) between 1974 and 2020 with a slight downward trend (APC = -0.89). We analysed 62 risk factors with synthesized data; 16 belonging to the categories of anthropometrics factors, lifestyle factors, dietary factors, personal histories and mental health conditions were graded to be associated with CRC risk among the Chinese population in the meta-analysis limited to the high-quality studies.

Conclusions

We found substantial variation of CRC burden across regions and provinces of China and identified several associated risk factors for CRC, which could help to guide the formulation of targeted disease prevention and control strategies.

Registration

PROSPERO: CRD42022346558.

Unraveling the Role of Molecular Profiling in Predicting Treatment Response in Stage III Colorectal Cancer Patients: Insights from the IDEA International Study

BACKGROUND

This study aimed to investigate the molecular profiles of 237 stage III CRC patients from the international IDEA study. It also sought to correlate these profiles with Toll-like and vitamin D receptor polymorphisms, clinicopathological and epidemiological characteristics, and patient outcomes.

METHODS

Whole Exome Sequencing and PCR-RFLP on surgical specimens and blood samples, respectively, were performed to identify molecular profiling and the presence of Toll-like and vitamin D polymorphisms. Bioinformatic analysis revealed mutational status.

RESULTS

Among the enrolled patients, 63.7% were male, 66.7% had left-sided tumors, and 55.7% received CAPOX as adjuvant chemotherapy. Whole exome sequencing identified 59 mutated genes in 11 different signaling pathways from the Kyoto Encyclopedia of Genes and Genomes (KEGG) CRC panel. On average, patients had 8 mutated genes (range, 2-21 genes). Mutations in ARAF and MAPK10 emerged as independent prognostic factors for reduced DFS (p = 0.027 and p < 0.001, respectively), while RAC3 and RHOA genes emerged as independent prognostic factors for reduced OS (p = 0.029 and p = 0.006, respectively). Right-sided tumors were also identified as independent prognostic factors for reduced DFS (p = 0.019) and OS (p = 0.043). Additionally, patients with tumors in the transverse colon had mutations in genes related to apoptosis, PIK3-Akt, Wnt, and MAPK signaling pathways.

CONCLUSIONS

Molecular characterization of tumor cells can enhance our understanding of the disease course. Mutations may serve as promising prognostic biomarkers, offering improved treatment options. Confirming these findings will require larger patient cohorts and international collaborations to establish correlations between molecular profiling, clinicopathological and epidemiological characteristics and clinical outcomes.

Laser-activatable oxygen self-supplying nanoplatform for efficiently overcoming colorectal cancer resistance by enhanced ferroptosis and alleviated hypoxic microenvironment

BACKGROUND

Colorectal cancer (CRC) is the second most deadly cancer worldwide, with chemo-resistance remaining a major obstacle in CRC treatment. Notably, the imbalance of redox homeostasis-mediated ferroptosis and the modulation of hypoxic tumor microenvironment are regarded as new entry points for overcoming the chemo-resistance of CRC.

METHODS

Inspired by this, we rationally designed a light-activatable oxygen self-supplying chemo-photothermal nanoplatform by co-assembling cisplatin (CDDP) and linoleic acid (LA)-tailored IR820 via enhanced ferroptosis against colorectal cancer chemo-resistance. In this nanoplatform, CDDP can produce hydrogen peroxide in CRC cells through a series of enzymatic reactions and subsequently release oxygen under laser-triggered photothermal to alleviate hypoxia. Additionally, the introduced LA can add exogenous unsaturated fatty acids into CRC cells, triggering ferroptosis via oxidative stress-related peroxidized lipid accumulation. Meanwhile, photothermal can efficiently boost the rate of enzymatic response and local blood flow, hence increasing the oxygen supply and oxidizing LA for enhanced ferroptosis.

RESULTS

This nanoplatform exhibited excellent anti-tumor efficacy in chemo-resistant cell lines and showed potent inhibitory capability in nude mice xenograft models.

CONCLUSIONS

Taken together, this nanoplatform provides a promising paradigm via enhanced ferroptosis and alleviated hypoxia tumor microenvironment against CRC chemo-resistance.