Risk Factors of Colorectal Cancer

Study on the reduction of heterocyclic amines by marinated natural materials in pork belly

This study was conducted to determine the effect of natural ingredient seasoning on the reduction of heterocyclic amine (HCA) production that may occur when pork belly is cooked at a very high temperature for a long time. Pork belly seasoned with natural ingredients, such as natural spices, blackcurrant, and gochujang, was cooked using the most common cooking methods, such as boiling, pan fry, and barbecue. HCAs in pork belly were extracted through solid-phase extraction and analyzed via high-performance liquid chromatography. For short-term toxicity, a mouse model was used to analyze weight, feed intake, organ weight, and length; hematology and serology analysis were also performed. Results revealed that HCAs formed only when heating was performed at a very high temperature for a long time, not under general cooking conditions. Although the toxicity levels were not dangerous, the method showing the relatively highest toxicity among various cooking methods was barbecue, and the natural material with the highest toxicity reduction effect was blackcurrant. Furthermore, seasoning pork belly with natural materials containing a large amount of antioxidants, such as vitamin C, can reduce the production of toxic substances, such as HCAs, even if pork belly is heated to high temperatures.

Prevalence and risk of colorectal polyps among the Korean population under 50 years

Colorectal cancer is a common cancer; generally, adults aged ≥ 50 years are screened using stool occult blood tests and colonoscopy. However, colorectal adenoma and cancer have been found in patients under the aged of 50, and studies on characteristics and risk factors in young patients are lacking. We evaluated the prevalence and risk factors of colorectal adenoma and cancer in young adults aged under 50 years. We retrospectively analyzed 570 individuals aged under 50 years who underwent colonoscopy at the Haeundae Paik Hospital, Korea, from January to June 2018. Logistic regression model was used to identify the risk factors for colorectal adenoma and colorectal cancer. The prevalence of colorectal adenoma in group of 19-29 years was 3.2% (1 of 31), 30-39 years was 13.8% (30 of 217) and in the group of 40-49 years was 21.1% (68 of 322) (P = .009). In multivariable analysis, age over 45 years (adjusted odds ratio [OR], 1.941; 95% confidence interval [CI], 1.187-3.172; P = .008) and male sex (adjusted OR, 1.711; 95% CI, 1.044-2.806; P = .033) were independent risk factors for colorectal neoplasia including cancer. The prevalence of colorectal adenoma increases as the age increased in young adults under 50 years of age, especially after the age of 45 years, the risk of colorectal neoplasia increases; hence, early screening should be considered before the age of 50 years.

Association Between Height and Clinical Outcome in Metastatic Colorectal Cancer Patients Enrolled Onto a Randomized Phase 3 Clinical Trial: Data From the FIRE-3 Study

BACKGROUND

Previous studies have found significant relationships between height and colorectal cancer (CRC) risk. Increased growth has been associated with activated pathways such as insulin-like growth factor 1. This study examined the impact of height on outcomes in metastatic CRC patients enrolled onto the FIRE-3 study, a randomized phase 3 clinical trial.

PATIENTS AND METHODS

A total of 695 patients with metastatic CRC were studied and height was measured in centimeters. Male patients were grouped as ≤ 165, 166-175, 176-185, and ≥ 186 cm in height; female patients were grouped as ≤ 154, 155-164, 165-174, and ≥ 175 cm in height. Primary end point was overall survival (OS); secondary end point was progression-free survival.

RESULTS

When patients' heights were categorized into 4 groups, the tallest group showed a worse OS compared to the shortest group; however, there was no linear relationship between height and OS. To investigate this, we showed the association between height as a continuous variable and OS. Patients shorter than 172 cm had a worse OS as their height decreased. Patients taller than 172 cm had a worse OS as their height increased. Moreover, patients with heights between 165 and 179 cm had a better OS compared to other patients (P = .05). This effect was independent of treatment arm and gender.

CONCLUSION

Patients shorter than 165 cm and taller than 179 cm have a worse OS, while those between 165 and 179 cm have a better OS. Hence, clinicians should consider height as an important prognostic factor when treating metastatic CRC patients. Future prospective studies are warranted to shed light on the mechanisms underlying the worse OS in taller patients.

Mitochondrial UQCRB as a new molecular prognostic biomarker of human colorectal cancer

Ubiquinol cytochrome c reductase binding protein (UQCRB) is important for mitochondrial complex III stability, electron transport, cellular oxygen sensing and angiogenesis. However, its potential as a prognostic marker in colorectal cancer (CRC) remains unclear. The aim of this study was to determine whether UQCRB can be used as a diagnostic molecular marker for CRC. The correlation between the expression of three genes (UQCRB, UQCRFS1 and MT-CYB) in the mitochondrial respiratory chain complex III and clinico-pathological features was determined. Compared to non-tumor tissues, UQCRB gene expression was upregulated in CRC tissues. Gene and protein expression of the genes were positively correlated. Copy number variation (CNV) differences in UQCRB were observed in CRC tissues (1.32-fold) compared to non-tumor tissues. The CNV of UQCRB in CRC tissues increased proportionally with gene expression and clinical stage. Single-nucleotide polymorphisms in the 3′-untranslated region of UQCRB (rs7836698 and rs10504961) were investigated, and the rs7836698 polymorphism was associated with CRC clinical stage. DNA methylation of the UQCRB promoter revealed that most CRC patients had high methylation levels (12/15 patients) in CRC tissues compared to non-tumor tissues. UQCRB overexpression and CNV gain were correlated with specific CRC clinico-pathological features, indicating clinical significance as a prognostic predictor in CRC. Gene structural factors may be more important than gene transcription repression factors with respect to DNA methylation in UQCRB overexpression. Our results provide novel insights into the critical role of UQCRB in regulating CRC, supporting UQCRB as a new candidate for the development of diagnostics for CRC patients.

Inflammatory diet and risk for colorectal cancer: A population-based case-control study in Newfoundland, Canada

OBJECTIVE

Chronic inflammation is implicated in causing cancer. Diet plays an important role in regulating chronic inflammation by altering circulating levels of inflammatory biomarkers. Effect of single food or nutrient on cancer often is inconclusive; perhaps due to dietary interactions and multicolinearity. The aim of this study was to determine prediagnostic inflammatory potential of overall diet in relation to risk for colorectal cancer (CRC).

METHODS

In all, 547 patients with CRC from Newfoundland Familial Colorectal Cancer Registry and 685 controls from the general population were identified. Data on sociodemographic, medical history, lifestyle, and a 169-item food frequency questionnaire were collected retrospectively from both groups. Energy-adjusted Dietary Inflammatory Index (DII) score was calculated and used as both categorical and continuous variables for analysis. Odds ratio was estimated using multivariable logistic regression after adjusting potential confounders. A linear test for trend was performed using the median value in each quartile.

RESULTS

Overall energy-adjusted mean DII score was -0.81 (range -5.19 to 6.93). Cases (-0.73 ± 1.5) had slightly higher DII scores than controls (-0.89 ± 1.6; P = 0.04). After adjusting the potential confounders, a statistically significant association was found between DII score and CRC risk. Using DII as a continuous variable (odds ratio [OR]_continuous 1.10, 95% confidence interval [CI] 1.01-1.20) and categorical variable (OR_{quartile 1 versus 4} 1.65, 95% CI 1.13-2.42; P_trend = 0.02).

CONCLUSION

Our findings indicate that proinflammatory diets are associated with an increased risk for CRC in the Newfoundland population.

Anti-inflammatory effect of lycopene in SW480 human colorectal cancer cells

BACKGROUND/OBJECTIVES

Although the antioxidative effects of lycopene are generally known, the molecular mechanisms underlying the anti-inflammatory properties of lycopene are not fully elucidated. This study aimed to examine the role and mechanism of lycopene as an inhibitor of inflammation.

METHODS/MATERIALS

Lipopolysaccharide (LPS)-stimulated SW 480 human colorectal cancer cells were treated with 0, 10, 20, and 30 µM lycopene. The MTT assay was performed to determine the effects of lycopene on cell proliferation. Western blotting was performed to observe the expression of inflammation-related proteins, including nuclear factor-kappa B (NF-κB), inhibitor kappa B (IκB), mitogen-activated protein kinase (MAPK), extracellular signal-related kinase (ERK), c-jun NH2-terminal kinase (JNK), and p38 (p38 MAP kinase). Real-time polymerase chain reaction was performed to investigate the mRNA expression of tumor necrosis factor α (TNF-α), interleukin-1 beta (IL-1β), interleukin-6 (IL-6), inducible nitric oxide synthase (iNOS), and cyclooxygenase-2 (COX-2). Concentrations of nitric oxide (NO) and prostaglandin E₂ (PGE₂) were determined via enzyme-linked immunosorbent assays.

RESULTS

In cells treated with lycopene and LPS, the mRNA expression of TNF-α, IL-1β, IL-6, iNOS, and COX-2 were decreased significantly in a dose-dependent manner (P < 0.05). The concentrations of PGE₂ and NO decreased according to the lycopene concentration (P < 0.05). The protein expressions of NF-κB and JNK were decreased significantly according to lycopene concertation (P < 0.05).

CONCLUSIONS

Lycopene restrains NF-κB and JNK activation, which causes inflammation, and suppresses the expression of TNF-α, IL-1β, IL-6, COX-2, and iNOS in SW480 human colorectal cancer cells.

Targeting FGF receptors in colorectal cancer: from bench side to bed side

Successful management of advanced colorectal cancer has been a challenging job for practicing oncologists as well as a priority for the oncology research community. The better understanding of the underlying patho-biology and critical pathway targets in this disease has contributed to major developments in that direction. In this review, we will revise the different biological and clinical aspects related to the use of FGFR pathway-targeted therapies in advanced colorectal cancer with particular focus on future perspectives in that regard.

The potential usefulness of (18)F-FDG PET/CT for detecting colorectal carcinoma and adenoma in asymptomatic adults

OBJECTIVE

The aim of this study was to evaluate the potential usefulness of (18)F-FDG PET/CT for detecting colorectal carcinoma and adenoma in asymptomatic adults.

METHODS

614 subjects were enrolled in this retrospective study. They underwent both (18)F-FDG PET/CT and colonoscopy in the same day as part of a cancer-screening program. Small focal FDG accumulation along the colorectum on (18)F-FDG PET/CT images were compared with colonoscopy findings. Size of lesion was measured on colonoscopy and histology was determined by biopsy or polypectomy.

RESULTS

In 614 (18)F-FDG PET/CT images, 27 foci of FDG uptakes were observed in the colorectal area in 25 subjects. The overall sensitivity and specificity of (18)F-FDG PET/CT were 5.6 and 96.8 %, respectively, but sensitivity to detect lesions larger than or equal to 1 cm was 25.8 %. On the ROC analysis, the optimal cut-off value for differentiating premalignant and malignant lesions from other benign conditions was 5.0 (sensitivity = 50 %, specificity = 88 %, AUC = 0.643).

CONCLUSIONS

Colonoscopic evaluation could be recommended by presence of focal colonic FDG uptake on (18)F-FDG PET/CT, especially when SUVmax is over 5.

The Role of Surgery for Asymptomatic Primary Tumors in Unresectable Stage IV Colorectal Cancer

There are still debates regarding the appropriate primary treatment policy for asymptomatic primary colorectal lesions in cases of unresectable metastatic colorectal cancer. Even though there are patients with asymptomatic primary tumors when starting chemotherapy, those patients may still undergo surgery due to complications related to primary tumors in the middle of chemotherapy; therefore, controversy exists regarding surgical resection of primary colorectal lesions in cases where symptoms are absent when making a diagnosis. Thus, based on the published literature, we discuss opinions that prefer first-line surgery for primary tumors as well as opinions favoring first-line chemotherapy for treating unresectable synchronous metastatic colorectal cancer. Although the upfront chemotherapy including targeted agents is suggested as an effective treatment in recent years, the first line surgery has been a preferred treatment for decades. The first line surgery is beneficial to prolong the survival duration given the retrospective analysis of randomized trial data. So far, no prospective comparison study has only focused on the first-line treatment modality; thus, future clinical studies focusing on the survival duration and the quality of life should be performed as soon as possible. Furthermore, at this point, multidisciplinary team approaches would be helpful in finding the appropriate therapy. Regardless of symptoms, the performance status and the tumor burden should be taken into consideration as well. In case of surgical resection, minimally invasive surgery, such as laparoscopic surgery, is recommended.

Lack of human tissue-specific correlations for rodent pancreatic and colorectal carcinogens

To better understand the relationships between chemical exposures and human cancer causation, incidence data for human cancer types were identified and pancreatic and colorectal cancers were studied in-depth to assess whether data supporting the causation of pancreatic or colorectal tumors by chemicals in rodents is predictive of causation by the same chemicals of the same tumors in humans. A search of the Carcinogenic Potency Database, the National Toxicology Program (NTP) technical report database, and the published literature identified 38 and 39 chemicals reported to cause pancreatic and colorectal tumors, respectively, in mice or rats. For each of these chemicals, searches were conducted of the International Agency for Research on Cancer monographs, the NTP Report on Carcinogens, and the published literature for evidence of induction of the same tumors in humans. Based on this evaluation, no conclusive evidence was identified to suggest that chemicals reported to cause pancreatic or colorectal tumors in rodents also cause these tumors in humans. These findings suggest that pancreatic tumor data from mouse and rat bioassays are of limited utility with regard to predicting similar tumor induction in humans. For colorectal cancer, a lack of correlation was noted for the vast majority of chemicals.

Factors affecting insertion time for colonoscopy performed under intramuscular analgesia in patients with history of colorectal resection

BACKGROUND

Colonoscopy can detect both early intraluminal recurrence and metachronous neoplasia after colorectal cancer resection. Because colon length and location change after colorectal resection, factors affecting insertion time during colonoscopy also might be altered. The goal of this study was to examine whether colonoscope insertion time differs between left-sided resection and right-sided resection and to identify factors that impact the performance of colonoscopy after colorectal resection.

METHODS

We included consecutive patients who underwent colonoscopy between November 2005 and November 2009 after colorectal resection for colorectal cancer. We classified surgical methods into left-sided resection (left hemicolectomy, low anterior resection, anterior resection, Hartman, and Mile's operation) or right-sided resection (right hemicolectomy) and retrospectively evaluated the colonoscope insertion time. Moreover, we analyzed factors that might affect the insertion time.

RESULTS

A total of 1,260 patients underwent colonoscopy after colorectal resection during the study period. Of these, 1,248 patients (771 men) who underwent complete colonoscopy were evaluated in this study. The colonoscopy completion rate was 99%, and the mean insertion time was 6.5±5.1 min (median, 5 min; range, 0.3-61 min). Right-sided resection, female gender, poor quality of bowel preparation, lower endoscopist case volume, open laparotomy, and colonoscopy performed more than 1 year after colorectal resection were found to be independent factors associated with prolonged insertion time.

CONCLUSIONS

This large study identified six factors that affect colonoscope insertion time after colorectal resection. These findings have implications for the practice and teaching of colonoscopy after colorectal resection.