Age- and sex-specific spatio-temporal patterns of colorectal cancer mortality in Spain (1975-2008)

Spatial Variation of Survival for Colorectal Cancer in Malaysia

A patient's survival may depend on several known and unknown factors and it may also vary spatially across a region. Socioeconomic status, accessibility to healthcare and other environmental factors are likely to contribute to survival rates. The aim of the study was to model the spatial variation in survival for colorectal cancer patients in Malaysia, accounting for individual and socioeconomic risk factors. We conducted a retrospective study of 4412 colorectal cancer (ICD-10, C18-C20) patients diagnosed from 2008 to 2013 to model survival in CRC patients. We used the data recorded in the database of the Malaysian National Cancer Patient Registry-Colorectal Cancer (NCPR-CRC). Spatial location was assigned based on the patients' central district location, which involves 144 administrative districts of Malaysia. We fitted a parametric proportional hazards model in which the spatially correlated frailties were modelled by a log-Gaussian stochastic process to analyse the spatially referenced survival data, which is also known as a spatial survival model. After controlling for individual and area level characteristics, our findings indicate wide spatial variation in colorectal cancer survival across Malaysia. Better healthcare provision and higher socioeconomic index in the districts where patients live decreased the risk of death from colorectal cancer, but these associations were not statistically significant. Reliable measurement of environmental factors is needed to provide good insight into the effects of potential risk factors for the disease. For example, a better metric is needed to measure socioeconomic status and accessibility to healthcare in the country. The findings provide new information that might be of use to the Ministry of Health in identifying populations with an increased risk of poor survival, and for planning and providing cancer control services.

Colorectal cancer mortality in Mato Grosso, Brazil: Spatiotemporal trends

Mortality due to colorectal cancer is increasing in Brazil, but an organised approach to screening and prevention is lacking. Considering the importance of this disease, the present study examines recent mortality trends of colorectal cancer mortality in the meso- and microregions in the state of Mato Grosso with the objective of analysing spatiotemporal trends to help guide the allocation of health services related to this type of cancer. Mortality data from the Brazilian national public health system from 1996 to 2015 were analysed investigating spatiotemporal trends using Conditional Autoregressive (CAR) models, a class of Bayesian hierarchical models that rely on Markov Chain Monte Carlo (MCMC) simulations. Convergence issues arose with several types of CAR models, but notably not with the linear variant, which models the mortality within each spatial region as a linear function of time. Men and women of all ages displayed higher and increasing mortality rates in the Cuiabá and Rondonópolis microregions. Additional regions of increasing mortality were found for specific age and gender strata. It was concluded that spatiotemporal modelling is a useful tool for the characterisation of diseases, including cancer, which are influenced by several factors and need to be monitored over space and time. The combination of spatial and temporal analyses of mortality shown in this paper unveils important information regarding the small areas dynamics, which may guide discussions, regulation and application of decentralised public health policies.

Spatial and temporal variations in Spain in the standardised ratio of in-hospital mortality due to colorectal cancer, 2008-2014

Background

Colorectal cancer (CRC) is the second cause of tumour mortality in Spain and Europe. To date, no studies have been conducted in Spain to evaluate the spatial and temporal distribution of the excess risk of death during hospitalisation for CRC.

Methods

A cohort was constructed of all episodes of hospitalisation in Spain due to CRC (codes 153 and 154 of the International Classification of Diseases, 9th edition, Clinical Modification) during the period 2008–2014, based on the minimum basic data set published by the Ministry of Health. Mortality ratios were calculated per region for each of the years analyzed (spatial or cross-sectional analysis) and during the overall study period, for each region independently (temporal or longitudinal analysis). In the first of these analyses, particular note was taken of the regions and years in which the limits of two and three standard deviations were exceeded.

Results

Two hundred and fifty eight thousand, nine hundred and twenty seven episodes of CRC were analysed. The patients were predominantly male (60.6%), with an average hospital stay of 13.16 days. Half underwent surgery during admission and on average presented more than six diagnoses at discharge. The spatial analysis revealed mortality ratios that deviated by at least three standard deviations in the following regions: Islas Canarias, Asturias, Valencia, Extremadura, País Vasco and Andalucía. The longitudinal analysis showed that most regions presented one or more years when CRC mortality was at least 15% higher than expected during the period; outstanding in this respect were Asturias, Navarra and La Rioja, where this excess risk was detected in at least 2 years.

Conclusions

Geographic and temporal patterns of the distribution of the excess risk of mortality from CRC in Spain are described using SMRs. We conclude that during the study period, the geographic pattern of mortality in Spain did not coincide with the excess risk of mortality calculated using the SMR method described by Jarman and Foster. This method of risk estimation can be a useful tool for the study of mortality risk and its spatial variations.

Curcumin combined with cis-platinum promote the apoptosis of human colorectal cancer HT29 cells and mechanism

Colorectal carcinoma is one of the common malignant carcinoma that severely harms the public health. Curcumin (Cur) exhibits anti-tumor, antioxidant, anti-inflammatory and antiviral effects, which result in the promotion of the apoptosis of cancer cells. The present study aimed to investigate the effect of cis-platinum (DDP) combined with Cur on the apoptosis of colorectal carcinoma cells, and to elucidate its underlying mechanism of action. The cell viability of human colorectal cancer HT29 cells was detected by MTT after DDP treatment. The effect of DDP/Cur co-treatment on cell proliferation and apoptosis were investigated using CCK-8 assay and flow cytometry assay. HT29 cells growth was significantly inhibited after DDP treatment and DDP combined with Cur treatment for 24 h. In our results, DDP in combination with Cur significantly promoted the apoptosis of HT29 colorectal carcinoma cell in a dose dependent manner. Bcl-2-associated X protein (Bax) expression was promoted and B-cell lymphoma-2 (Bcl-2) expression was suppressed, In addition, Notch1, Notch1 intracellular domain (NICD1) and hairy and enhancer of split 1 (Hes-1) were decreased dramatically in HT29 cells treated with Cur combined with DDP. The effect of Cur combined with DDP treatment was better than the effect of DDP treatment. It showed that DDP combined with Cur promote the apoptosis of HT29 cells via regulating the expression of related apoptotic genes and inhibiting the activation of Notch1 signaling pathway.

Factors Determining Colorectal Cancer: The Role of the Intestinal Microbiota

The gastrointestinal tract, in particular the colon, holds a complex community of microorganisms, which are essential for maintaining homeostasis. However, in recent years, many studies have implicated microbiota in the development of colorectal cancer (CRC), with this disease considered a major cause of death in the western world. The mechanisms underlying bacterial contribution in its development are complex and are not yet fully understood. However, there is increasing evidence showing a connection between intestinal microbiota and CRC. Intestinal microorganisms cause the onset and progression of CRC using different mechanisms, such as the induction of a chronic inflammation state, the biosynthesis of genotoxins that interfere with cell cycle regulation, the production of toxic metabolites, or heterocyclic amine activation of pro-diet carcinogenic compounds. Despite these advances, additional studies in humans and animal models will further decipher the relationship between microbiota and CRC, and aid in developing alternate therapies based on microbiota manipulation.