Tissue classification and diagnosis of colorectal cancer histopathology images using deep learning algorithms. Is the time ripe for clinical practice implementation?

Early Colon Cancer Prediction from Histopathological Images Using Enhanced Deep Learning with Confidence Scoring

Colon Cancer (CC) arises from abnormal cell growth in the colon, which severely impacts a person's health and quality of life. Detecting CC through histopathological images for early diagnosis offers substantial benefits in medical diagnostics. This study proposes NalexNet, a hybrid deep-learning classifier, to enhance classification accuracy and computational efficiency. The research methodology involves Vahadane stain normalization for preprocessing and Watershed segmentation for accurate tissue separation. The Teamwork Optimization Algorithm (TOA) is employed for optimal feature selection to reduce redundancy and improve classification performance. Furthermore, the NalexNet model is structured with convolutional layers and normal and reduction cells, ensuring efficient feature representation and high classification accuracy. Experimental results demonstrate that the proposed model achieves a precision of 99.9% and an accuracy of 99.5%, significantly outperforming existing models. This study contributes to the development of an automated and computationally efficient CC classification system, which has the potential for real-world clinical implementation, aiding pathologists in early and accurate diagnosis.

A fusion model to predict the survival of colorectal cancer based on histopathological image and gene mutation

Colorectal cancer (CRC) is a prevalent gastrointestinal tumor worldwide with high morbidity and mortality. Predicting the survival of CRC patients not only enhances understanding of their life expectancies but also aids clinicians in making informed decisions regarding suitable adjuvant treatments. Although there are many clinical, genomic, and transcriptomic studies on this hot topic, only a few studies have explored the direction of integrating advanced deep learning algorithms and histopathological images. In addition, it is still unclear if combining histopathological images and molecular data can better predict patients' survival. To fill in this gap, we proposed in this study a novel multimodal deep learning computational framework using Multimodal Compact Bilinear Pooling (MCBP) to predict the 5-year survival of CRC patients from histopathological images, clinical information, and molecular data. We applied our framework to the cancer genome atlas (TCGA) CRC data, consisting of 84 samples with histopathological images, clinical information, mRNA sequencing data, and gene mutation data all available. Under the 5-fold cross-validation, the model using only histopathological images achieved an area under the curve (AUC) of 0.743. Whereas, the model combining image and clinical information and the model combining image and gene mutation information achieved AUCs of 0.771 and 0.773 respectively, better than that of the image solely. Our study demonstrates that histopathological images can reasonably predict the 5-year survival of CRC patients, and that the appropriate integration of these images with clinical or molecular data can further enhance predictive performance.

MRI-based radiomics for predicting pathological complete response after neoadjuvant chemoradiotherapy in locally advanced rectal cancer: a systematic review and meta-analysis

Purpose

To evaluate the value of MRI-based radiomics for predicting pathological complete response (pCR) after neoadjuvant chemoradiotherapy (NCRT) in patients with locally advanced rectal cancer (LARC) through a systematic review and meta-analysis.

Methods

A systematic literature search was conducted in PubMed, Embase, Proquest, Cochrane Library, and Web of Science databases, covering studies up to July 1st, 2024, on the diagnostic accuracy of MRI radiomics for predicting pCR in LARC patients following NCRT. Two researchers independently evaluated and selected studies using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool and the Radiomics Quality Score (RQS) tool. A random-effects model was employed to calculate the pooled sensitivity, specificity, and diagnostic odds ratio (DOR) for MRI radiomics in predicting pCR. Meta-regression and subgroup analyses were performed to explore potential sources of heterogeneity. Statistical analyses were performed using RevMan 5.4, Stata 17.0, and Meta-Disc 1.4.

Results

A total of 35 studies involving 9,696 LARC patients were included in this meta-analysis. The average RQS score of the included studies was 13.91 (range 9.00-24.00), accounting for 38.64% of the total score. According to QUADAS-2, there were risks of bias in patient selection and flow and timing domain, though the overall quality of the studies was acceptable. MRI-based radiomics showed no significant threshold effect in predicting pCR (Spearman correlation coefficient=0.119, P=0.498) but exhibited high heterogeneity (I2≥50%). The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and DOR were 0.83, 0.82, 5.1, 0.23 and 27.22 respectively, with an area under the summary receiver operating characteristic (sROC) curve of 0.91. According to joint model analysis, publication year, country, multi-magnetic field strength, multi-MRI sequence, ROI structure, contour consistency, feature extraction software, and feature quantity after feature dimensionality reduction were potential sources of heterogeneity. Deeks' funnel plot suggested no significant publication bias (P=0.69).

Conclusions

MRI-based radiomics demonstrates high efficacy for predicting pCR in LARC patients following NCRT, holding significant promise for informing clinical decision-making processes and advancing individualized treatment in rectal cancer patients.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42024611733.

Alterations in expression of miRNA 497 and long non-coding RNAS (XIST-TSIX) and its significant role in colorectal cancer prediction

Colorectal cancer (CRC) is a common type of malignancy in Western nations with high incidence related to different factors as genetic, foods and pollution. Long non-coding RNAs (LncRNAs) play a significant role in cellular processes, oncogensis and can be used as biomarkers for cancer progression. The rationale of this study was to quantify the expression levels of miRNA 497 and LncRNAs (XIST-TSIX) as a sensitive and accurate markers for CRC diagnosis and correlated with serum FOXK1, CA19.9 and CEA compared with normal subjects. This study was carried outon100 participants, they were divided into two equal groups: Group (1): Patients were diagnosed with CRC and Group (2): Normal subjects as control. Tumor size, type, TNM staging, differentiation, levels of FOXK1and, CEA, CA19.9 were evaluated in serum. The RNA was extracted from the tissue of CRC patients for quantification expression of miRNA 497 and LncRNAs (XIST and TSIX) using qRT-PCR. Data obtained showed that, the expression levels of tissue miRNA 497, XIST, TSIX in combination with serum FOXK1, CA19.9 and CEA are good confirmatory non-invasive markers for CRC diagnosis. Sensitivity and specificity tests showed higher AUC values of miRNA 497 + XIST + TSIX + FOXK1 significantly than those of CA19.9 + CAE. It was concluded that, a rigorous assessment of these parameters could facilitate the discovery of non-invasive biomarkers for the early detection and prognosis of CRC, ultimately enhancing the protocols for early treatment decision-making.

Breaking surgical barriers: ERAS in action in Romania

Implementing Enhanced Recovery After Surgery (ERAS) protocols presents challenges for healthcare systems, particularly for patients undergoing complex surgeries. Though ERAS effectively reduces postoperative complications and hospital stays, its implementation varies. Our hospital adopted the ERAS protocol in 2020. This study details specific ERAS components implemented in our clinic, emphasizing surgical and anesthetic strategies. We describe preoperative, intraoperative, and postoperative phases and analyze the evidence for each component's integration. Additionally, we highlight the specific challenges faced in Romania, such as funding limitations, resource constraints, and reluctance among healthcare professionals. We conducted a prospective study of 147 patients with colorectal cancer treated from 2020 to 2023, detailing the perioperative care phases and supporting evidence for protocol components. The methodology was refined to account for potential confounding factors by ensuring consistency in patient selection criteria and perioperative management. Despite ERAS's advantages, patients and staff resisted its implementation. In Romanian hospitals, colorectal surgery uses ERAS only in limited cases due to inadequate funding, insufficient medical personnel, logistical challenges, and a lack of awareness or skepticism among healthcare professionals and patients. The study presents specific clinical outcomes, including length of hospital stay (LOS), postoperative complications, and readmission rates among ERAS patients. We recommend expanding medical networks and utilizing advanced technologies like telemedicine services and home-based care to improve ERAS protocol adherence. Furthermore, educational programs are essential to increase awareness and compliance with ERAS principles among patients and healthcare providers.

Bibliometric analysis of preoperative radiotherapy for locally advanced rectal cancer: evolution and future

Background

Preoperative radiotherapy of rectal cancer has been a hot topic of research in recent years with the introduction of total neoadjuvant therapies and immunotherapeutic agents. We utilized bibliometrics and visualization analysis to examine studies in this field, aiming to identify current hotspots and research trends.

Method

We searched the Web of Science database for all publications related to preoperative radiotherapy of rectal cancer in the past 10 years. Using bibliometric analysis software, such as VOSviewer, CiteSpace and R-studio, we extracted and analyzed the data, summarizing the publication output of countries, institutions, authors, and journals in this field, and analyzing their relationships. We also summarized the keywords, burst words, and most cited articles, and analyzed the relationships among them.

Results

We found 794 publications in the field, sourced from 217 journals or books, involving 5,805 authors from various organizations and countries. Through bibliometric analysis, we observed a growing trend in the number of publications in preoperative radiotherapy of rectal cancer over the past 10 years. China, United States and Italy were the top countries in terms of publication output. Sun Yat-sen University, Fujian University, and Fudan University were the top three medical centers in terms of publication output, while Leiden University from Netherlands led globally in terms of citation impact. Professor Zhen Zhang, Sanjun Cai, and Ji Zhu were the top three authors with the highest publication output. The most highly cited journals in this field includes "The Lancet Oncology," "J Clinical Oncology," and "Annals of Oncology." Journals such as "Radiotherapy and Oncology," "Frontiers in Oncology," and "BMC Cancer" have the highest number of articles published. Based on the analysis of keywords and burst words, we found that "preoperative chemoradiation" and "oral capecitabine" were the research hotspots before 2016, while the focus shifted to "short-course radiotherapy" and "long-term outcomes" after 2017. Currently, the most frequently cited publications mainly summarize multicenter clinical studies and total neoadjuvant treatment models and immunotherapy.

Conclusion

Research on preoperative radiotherapy of rectal cancer is increasing year by year, and attracting attention from high-cited journals such as "The Lancet Oncology," "JCO," and "Annals of Oncology." Based on current data, the total neoadjuvant treatment models and radiation combined with immunotherapy are the research trends.

DMMR status and synchronous lesions predicts metachronous lesions after curative resection for rectal cancer

Background

There are no established standard colonoscopy surveillance protocols for patients after curative rectal cancer resection. We investigated the predictive factors for colorectal neoplasms during surveillance colonoscopies to identify patients who are at risk of developing metachronous neoplasms in the residual colorectum.

Methods

This was a single-center, retrospective study that included patients with diagnosis of rectal carcinoma who had undergone curative resection from October 2012 to June 2018. Clinicopathological variables were analyzed by logistic regression analysis to identify risk factors independently associated with metachronous neoplasms in patients that underwent curative rectal cancer surgery.

Results

In all, 554 patients were included in the analysis. Deficient mismatch repair (dMMR) status was recorded in 20 (3.6%) patients. At the surveillance colonoscopies, 118 patients (21.3%) had metachronous neoplasms while 169 patients (30.5%) had metachronous polyps. The median time interval between index colonoscopy and the last surveillance colonoscopy was 736.5 (476.75-1,082.25) days. Univariable and multivariable analysis showed dMMR status, synchronous adenomas/polyps, surveillance time > 3, and longer surveillance period patients were significant risk factors for development of metachronous lesions; in subgroup analysis, we also found that among rectal cancer patients with synchronous adenomas, adenomas located in the left colon and rectum, and longer surveillance period were independent risk factors for detecting metachronous adenomas.

Conclusions

This study underscored the importance of extended follow-up protocols and targeted surveillance for identifying and managing metachronous lesions in dMMR rectal cancer patients, especially with synchronous adenomas. Further prospective, multicenter studies are needed to validate these results.

Underwater endoscopic mucosal resection is superior to conventional endoscopic mucosal resection for medium-sized colorectal sessile polyps: a randomized controlled trial

The comparison of underwater endoscopic mucosal resection (UEMR) and conventional endoscopic mucosal resection (CEMR) in the treatment of medium-sized (10 mm ≤ diameter ≤ 20 mm) colorectal sessile polyps is unknown. This randomized controlled trial (RCT) was designed to compare the efficacy and safety of UEMR and CEMR in the treatment of medium-sized colorectal sessile polyps. 200 patients with medium-sized colorectal sessile polyps were randomly divided into UEMR group and CEMR group equally. The resection rates, patient tolerance and complications of the two groups were evaluated. The R0 resection rate (73.3% vs. 56.3%, P = 0.011) and the En bloc resection rate (91.1% vs. 80.6%, P = 0.032) of the UEMR group were significantly higher than those of the CEMR group; The mean abdominal pain score of the UEMR group was significantly lower than that of the CEMR group [(3.2 ± 1.9) vs. (4.1 ± 2.1), P = 0.006]; There was no significant difference in the intraoperative bleeding rate between the two groups (4.0% vs. 6.1%, P = 0.516). There was no delayed bleeding and perforation in both groups. UEMR was effective in the treatment of medium-sized sessile colorectal polyps with few complications, and patient tolerance was good, which is worthy of clinical promotion.The study was registered at the Chinese Clinical Trial Registry (ChiCTR2400082051) on 19/03/2024 and can be accessed at www.chictr.org.cn .

Total neoadjuvant therapy followed by total mesorectal excision for rectal cancer in older patients real world data and proof of concept

Background

Rectal cancer (RC) commonly affects older patients. Total Neoadjuvant Therapy (TNT) has been introduced to improve local and systemic control of RC. The aim was to present real-world data of older patients receiving TNT followed by surgery after a frailty assessment and verify feasibility and safety of this approach.

Methods

This was a single-center retrospective study which enrolled all patients ≥70 years of age with RC who underwent TNT followed by surgery between November 2017 and April 2022. Data regarding cancer characteristics, neoadjuvant chemoradiotherapy (CRT), and toxicity were recorded. All patients underwent surgery 12-16 weeks after the end of therapy. Intra- and postoperative outcomes were recorded. Pre- and postoperative functional evaluation was carried out.

Results

Fifteen patients were enrolled. Mean age was 74 (70-81) years. Mean distance of the tumor from the anal verge was 5.2 cm. Fourteen patients had positive nodes (93.3%), 11 (73.3%) showed involvement of the circumferential margin (CRM+) and 10 (66.6%) had extramural vascular invasion (EMVI+). Ten patients (66.6%) received mFOLFOX-6 and 5 CAPOX (33.3%) followed by CRT. After CRT, positive nodes were reported in 4 cases (26.6%), CRM+ in 4 (26.6%), and EMVI+ in 1 (6.6%). Transanal total mesorectal excision (taTME) was performed in all cases. Median operative time was 280 min (110-420). Median length of stay was 4 days (3-29). One Clavien-Dindo grade 4 complication, no readmissions, and no variations in pre- and postoperative functional status within 30 days from surgery were reported. No positive distal or CRMs were detected. Three pathologic complete responses were reported (20%).

Conclusions

TNT followed by TME is feasible and safe in older patients, with good clinical and oncologic outcomes. Patient evaluation is crucial for maximizing cancer care in fit older patients.

Retrospective analysis of immediate and long-term results of NOSES technique and conventional laparoscopic-assisted resection in patients with colorectal cancer

Introduction

The aim of research was to study the feasibility and safety of surgery providing specimen extraction through natural orifices in patients with colorectal cancer.

Materials and methods

This study is a comparative retrospective analysis of findings obtained from 265 patients who underwent surgical treatment using NOSES technique and 275 patients who underwent laparoscopic-assisted (LA) resection. Data included preoperative patients' information, intraoperative findings, results of postoperative pathological examination of surgical specimens, early postoperative period analysis, and follow-up.

Results

Both groups were comparable in terms of gender, age and BMI. The duration of surgery was similar in both groups (p = 0.94). Intraoperative blood loss under NOSES interventions was slightly lower than in laparoscopic-assisted surgeries (p < 0.001). There was no significant difference in the number of lymph nodes removed and anal function scores between the two groups (p > 0.05). It was revealed that in the NOSES group, the function of the gastrointestinal tract normalized at an earlier time, slightly the time to start liquid food intake and the duration of postoperative hospital stay were reduced (p < 0.001). A statistically significant difference between groups was found in complications, such as pneumonia (p = 0.03). The absolute number of complications was observed more often in the LA surgery group (10.4%) than in the NOSES group (5.8%). Local recurrence was less common in the NOSES group (p = 0.01). There were no statistically significant differences in disease progression (p = 0.16). When analyzing disease-free and overall survival rate in this study, there was no statistically significant difference between the two surgical techniques in terms of their effect on postoperative survival (p > 0.05).

Conclusion

The results of this study demonstrate that NOSES technique is a relatively safe and effective surgical option in patients with colorectal cancer. It has high surgical efficiency providing no increased risk of surgical intervention, reducing total number of postoperative complications, reducing duration of postoperative hospital stay, reducing the time for gastrointestinal function recovery and the start of food intake. This study supports that NOSES has clear advantages over conventional laparoscopic-assisted surgery.

Exploring the influence of anemia and inflammation indices on colorectal cancer: analysis of the national health and nutrition examination survey From 2011 to 2018

Purpose

Patients with colorectal cancer (CRC) frequently present with anemia and signs of infection. However, the relationships between these factors remain unclear. This study investigated the potential association between anemia, inflammatory indices, and CRC.

Methods

We analyzed data from the 2011-2018 National Health and Nutrition Examination Survey to investigate links between anemia, inflammation, and CRC. Inflammatory indices, including the neutrophil-percentage-to-albumin ratio, neutrophil-to-lymphocyte ratio, and eosinophil-to-lymphocyte ratio, were analyzed. Following rigorous inclusion criteria, 14,114 participants were included. Statistical methods such as logistic regression and subgroup analyses were employed. Moreover, survival analysis was performed.

Results

Among the 14,114 participants, 0.6% had CRC and 11.0% were diagnosed with anemia. Anemia and inflammatory indices were associated with CRC, suggesting an increased risk (OR range: 2.03-2.50, P<0.05). Patients with CRC had lower red blood cell counts, reduced hemoglobin levels, and higher inflammatory indices. This is accompanied by an increase in the inflammatory indices, which is also a risk factor for CRC (OR range: 1.12-7.00, P<0.05). Survival analyses indicated that anemia was associated with lower survival rates, impacting all-cause, cancer, and CRC mortality.

Conclusion

Our results indicate that anemia and inflammatory indices are correlated with CRC. Patients with CRC tend to exhibit increased inflammatory indices and decreased red blood cell count and albumin levels, potentially impacting survival.

An efficient colorectal cancer detection network using atrous convolution with coordinate attention transformer and histopathological images

The second most common type of malignant tumor worldwide is colorectal cancer. Histopathology image analysis offers crucial data for the clinical diagnosis of colorectal cancer. Currently, deep learning techniques are applied to enhance cancer classification and tumor localization in histopathological image analysis. Moreover, traditional deep learning techniques might loss integrated information in the image while evaluating thousands of patches recovered from whole slide images (WSIs). This research proposes a novel colorectal cancer detection network (CCDNet) that combines coordinate attention transformer with atrous convolution. CCDNet first denoises the input histopathological image using a Wiener based Midpoint weighted non-local means filter (WMW-NLM) for guaranteeing precise diagnoses and maintain image features. Also, a novel atrous convolution with coordinate attention transformer (AConvCAT) is introduced, which successfully combines the advantages of two networks to classify colorectal tissue at various scales by capturing local and global information. Further, coordinate attention model is integrated with a Cross-shaped window (CrSWin) transformer for capturing tiny changes in colorectal tissue from multiple angles. The proposed CCDNet achieved accuracy rates of 98.61% and 98.96%, on the colorectal histological image and NCT-CRC-HE-100 K datasets correspondingly. The comparison analysis demonstrates that the suggested framework performed better than the most advanced methods already in use. In hospitals, clinicians can use the proposed CCDNet to verify the diagnosis.

Phase angle is a predictor for postoperative complications in colorectal cancer

Aim

The aim of this study was to develop a validated nomogram to predict the risk of postoperative complications in colorectal cancer (CRC) patients by analyzing the factors that contribute to these complications.

Methods

We retrospectively collected clinical information on patients who underwent CRC surgery at a single clinical center from January 2021 to December 2021. Univariate and multivariate logistic regression analysis to identify independent risk factors for postoperative complications and to develop a predictive model. A receiver operating characteristic (ROC) curve was used to calculate the area under the curve (AUC) to assess the predicted probability. Calibration curve was drawn to compare the predicted probability of the nomogram with the actual probability, and decision curve analysis (DCA) was employed to evaluate the clinical utility of the nomogram.

Results

A total of 190 CRC patients were included in this study. We retrospectively collected baseline information, clinical information, surgical information, and nutrition-related indicators for all patients. Through multivariate logistic regression analysis, preoperative albumin (p = 0.041, OR = 0.906, 95% CI = 0.824-0.996), surgical time (p = 0.009, OR = 1.006, 95% CI = 1.001-1.010), waistline (p = 0.049, OR = 1.011, 95% CI = 1.002-1.020) and phase angle (PA) (p = 0.022, OR = 0.615, 95% CI = 0.405-0.933) were identified as independent risk factors for postoperative complications in CRC, and a nomogram prediction model was established using the above four variables. The AUC of 0.706 for the ROC plot and the high agreement between predicted and actual probabilities in the calibration curves suggested that the prediction model has good predictive power. The DCA also confirmed the good clinical performance of the nomogram.

Conclusion

This study developed a nomogram to predict the risk of postoperative complications in CRC patients, providing surgeons with a reliable reference to personalized patient management in the perioperative period and preoperative nutritional interventions.

Meta-analysis of postoperative incision infection risk factors in colorectal cancer surgery

Objective

To evaluate the risk factors for postoperative incision infection in colorectal cancer, this meta-analysis aimed to identify key variables impacting infection incidence following colorectal cancer surgery.

Methods

Utilizing a meta-analytical approach, studies published from January 2015 to December 2022 were systematically collected and analyzed through the assessment of factors like body mass index, diabetes, albumin levels, malnutrition, and surgical duration.

Results

The meta-analysis of eleven high-quality studies revealed that elevated BMI, diabetes, low albumin levels, malnutrition, and extended surgical duration were associated with increased infection risk, while laparoscopic procedures showed potential for risk reduction.

Conclusions

This study underscores the significance of preoperative risk assessment and management in mitigating postoperative incision infections in colorectal cancer patients. The findings present actionable insights for clinicians to enhance patient prognoses and overall quality of life.

Different impacts of adipose tissue dynamics on prognosis in patients with resectable locally advanced rectal cancer treated with and without neoadjuvant treatment

Background

Body composition is recognized to be associated with clinical outcomes in patients with locally advanced rectal cancer (LARC). This study aimed to determine the prognostic role of regional adipose tissue distribution in patients with resectable LARC treated with or without neoadjuvant chemoradiotherapy (nCRT).

Methods

This retrospective study included 281 consecutive patients who underwent radical surgery for LARC with or without preoperative nCRT between 2013 and 2019. Patients underwent contrast-enhanced CT scans before nCRT and before surgery. Visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue (aSAT), and gluteal subcutaneous adipose tissue (gSAT) were quantified on the CT images. The association of adipose tissue distribution with progression-free survival (PFS) was analyzed using Cox proportional hazards analysis.

Results

A total of 102 nCRT-treated and 179 primarily resected patients were included. During a median follow-up period of 24 months, 74 (26.3%) patients experienced local recurrence or metastasis. Multivariable analysis showed that VAT was associated with PFS in all patients (hazard ratio [HR] 1.28, 95% confidence interval [CI] 1.04-1.57; P = 0.021). This association was only maintained in primarily resected patients (HR 1.31, 95% CI 1.02-1.69; P = 0.037). For patients receiving preoperative nCRT, VAT was not significantly associated with PFS, while the dynamic change in gSAT (ΔgSAT) between nCRT and surgery was associated with PFS (HR 0.43, 95%CI 0.27-0.69, P = 0.001).

Conclusion

Visceral obesity is an adverse prognostic factor in patients with resectable LARC treated by primary resection, while increased gluteal subcutaneous adiposity during preoperative nCRT may indicate favorable clinical outcomes.

Identifying risk and prognostic factors for synchronous liver metastasis in small bowel adenocarcinoma: a predictive analysis using the SEER database

Background

Small bowel adenocarcinoma (SBA) is a rare gastrointestinal malignancy with an increasing incidence and a high propensity for liver metastasis (LM). This study aimed to investigate the risk factors for synchronous LM and prognostic factors in patients with LM.

Methods

Utilizing the Surveillance, Epidemiology, and End Results (SEER) database, this study analyzed data from 2,064 patients diagnosed with SBA between 2010 and 2020. Logistic regression was used to determine risk factors for synchronous LM. A nomogram was developed to predict the risk of LM in SBA patients, and its predictive performance was assessed through receiver operating characteristic (ROC) curves and calibration curves. Kaplan-Meier and Cox regression analyses were conducted to evaluate survival outcomes for SBA patients with LM.

Results

Synchronous LM was present in 13.4% of SBA patients (n = 276). Six independent predictive factors for LM were identified, including tumor location, T stage, N stage, surgical intervention, retrieval of regional lymph nodes (RORLN), and chemotherapy. The nomogram demonstrated good discriminative ability, with an area under the curve (AUC) of 83.8%. Patients with LM had significantly lower survival rates than those without LM (P < 0.001). Survival analysis revealed that advanced age, tumor location in the duodenum, surgery, RORLN and chemotherapy were associated with cancer-specific survival (CSS) in patients with LM originating from SBA.

Conclusions

This study highlights the significant impact of LM on the survival of SBA patients and identifies key risk factors for its occurrence. The developed nomogram aids in targeted screening and personalized treatment planning.

Global burden of five major types of gastrointestinal cancer

Gastrointestinal (GI) cancers cause major global morbidity and mortality, with over 5 million new cases and 3.5 million deaths in 2020. The most prevalent GI malignancies are colorectal, gastric, liver, oesophageal, and pancreatic cancers. Marked geographic variations exist, with high incidence in developed regions contrasting with high mortality in developing areas. These patterns reflect disparities in risk factors and cancer control capacities. However, GI cancer incidence is rising with economic growth and lifestyle changes. Poor prognosis and increasing burden underscore the critical need for expanded prevention and research. This review examines global epidemiology, risks, prevention, detection, treatment, and priorities for common GI cancers. Controlling the toll of GI malignancies requires coordinated global actions across prevention, screening, treatment access, and research. Key priorities include vaccination, reducing modifiable risks, improving screening, expanding care access, and advancing prevention/therapy research. Global commitments to evidence-based interventions and knowledge sharing are vital to curb the GI cancer epidemic.

Sign of Neck Mass as the Chief Complaint: A Case Report and Literature Review About Thyroid Metastasis of Colorectal Cancer

Background

Commonly, the thyroid gland is regarded as an organ with fewer metastatic diseases, and colorectal metastasis to the thyroid (CMT) is rarely reported, especially, with that the clinical sign of thyroid metastasis nidus is the chief complaint. The CMT occurs in advanced colorectal cancer and is associated with poor prognosis and short survival.

Case Report

In this case, we reported a patient with the sign of neck mass as the first manifestation of CMT. The patient underwent a partial thyroidectomy in June 2019, immunohistochemical findings of thyroid carcinoma suggested the possibility of adenocarcinoma of gastrointestinal tract. The patient underwent a colonoscopy in July 2019 and a colonic mass was found. Pathological examination diagnosed rectal adenocarcinoma. The patient underwent neoadjuvant chemotherapy, surgical treatment, postoperative adjuvant chemotherapy and targeted therapy. The patient died in June 2022.

Conclusion

The metastasis disease would not be ignored at all, when a patient complains at signs of neck mass. Further, the possibility of metastasis cancer should be considered once thyroid nodules occur in patients with colorectal cancer. Even though the biological characteristics and stage of the primary tumor have an important impact on the prognosis, positive standardized treatments can also be helpful.

Comparison of the burden of digestive diseases between China and the United States from 1990 to 2019

INTRODUCTION

China has experienced unprecedented transformations unseen in a century and is gradually progressing toward an emerging superpower. The epidemiological trends of digestive diseases in the United States (the US) have significant prescient effects on China.

METHODS

We extracted data on 18 digestive diseases from the Global Burden of Diseases 2019 Data Resource. Linear regression analysis conducted by the JoinPoint software assessed the average annual percentage change of the burden. We performed subgroup analyses based on sex and age group.

RESULTS

In 2019, there were 836.01 and 180.91 million new cases of digestive diseases in China and the US, causing 1558.01 and 339.54 thousand deaths. The age-standardized incidence rates of digestive diseases in China and the US were 58417.87/100,000 and 55018.65/100,000 respectively, resulting in age-standardized mortality rates of 81.52/100,000 and 60.88/100,000. The rates in China annually decreased by 2.149% for mortality and 2.611% for disability-adjusted life of year (DALY). The mortality and DALY rates of the US, respectively, had average annual percentage changes of -0.219 and -0.251. Enteric infections and cirrhosis and other chronic liver diseases accounted for the highest incidence and prevalence in both counties, respectively. The burden of multiple digestive diseases exhibited notable sex disparities. The middle-old persons had higher age-standardized prevalence rates.

CONCLUSION

China bore a greater burden of digestive diseases, and the evolving patterns were more noticeable. Targeted interventions and urgent measures should be taken in both countries to address the specific burden of digestive diseases based on their different epidemic degree.

The efficacy and safety of neoadjuvant chemoradiotherapy combined with immunotherapy for locally advanced rectal cancer patients: a systematic review

Background

Several studies have explored the effectiveness of PD-1/PD-L1 inhibitors combined with neoadjuvant chemoradiotherapy (nCRT) in the treatment of locally advanced rectal cancer(LARC), particularly in microsatellite stable(MSS) or mismatch repair proficient(pMMR) LARC patients. We undertook a single-arm systematic review to comprehensively evaluate the advantages and potential risks associated with the use of PD-1/PD-L1 inhibitors in conjunction with nCRT for patients diagnosed with locally advanced rectal cancer.

Methods

The PubMed, Embase, Cochrane Library, ClinicalTrials.gov, ASCO and ESMO were searched for related studies. The main outcomes were pathologic complete response (pCR), major pathological response (MPR), anal preservation, and adverse effects (AEs).

Results

Fourteen articles including 533 locally advanced rectal cancer (LARC) patients were analyzed. The pooled pCR, MPR, and anal preservation rates were 36%, 66% and 86%. Grade ≥3 adverse events occurred in 20%. Subgroup analysis showed that; dMMR/MSI-H had a pooled pCR (100%) and MPR (100%), pMMR/MSS had a pooled pCR (38%) and MPR (60%); the short-course radiotherapy and long-course radiotherapy had pooled pCR rates of 51% and 30%, respectively. The rates of pCR for the concurrent and sequential immuno-chemoradiotherapy subgroups at 30% and 40%, mirroring pCR rates for the PD-L1 and PD-1 inhibitor subgroups were 32% and 40%, respectively.

Conclusion

In cases of locally advanced rectal cancer, PD-1/PD-L1 inhibitors combined with neoadjuvant chemoradiotherapy have shown promising response rates and acceptable toxicity profiles. PD-1/PD-L1 inhibitors combined with neoadjuvant chemoradiotherapy hence has a positive outcome even in MSS LARC patients.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/#myprospero, identifier CRD42023465380.

Determinants of survival and recurrence in patients with stage I colorectal cancer

Background

Due to the novel advanced screening methods, the number of patients diagnosed with stage I colorectal cancer (CRC) is increasing. This retrospective cohort study aimed to identify recurrence and survival risk factors of patients with stage I CRC after surgery.

Materials and methods

Patients with stage I CRC were evaluated, and their demographic and clinicopathologic variables were recorded. The log-rank test assessed the association of variables with overall survival (OS), recurrence-free survival (RFS), local recurrence, and distant metastasis.

Results

The median overall survival period was 51 months. The recurrence rate was 13.7%: 7.2% local and 9.3% distant recurrence. One-, two-, three-, and five-year RFS were 92%, 89%, 87%, and 83%, respectively, and OS were 96%, 93%, 90%, and 89%, respectively. Local and distant recurrence rates were higher in patients with higher tumor grades. Additionally, RFS and OS were worse in patients with higher tumor grades, and perforation was associated with worse OS.

Conclusions

The determinants of survival and recurrence identified in the present study can be used to improve patient outcomes by early diagnosis and appropriate management of high-risk patients.

LGR6 is a prognostic biomarker for less differentiated tumors in lymph nodes of colon cancer patients

INTRODUCTION

The aim was to investigate whether the stem cell marker LGR6 has prognostic value in colon cancer, alone or in combination with the prognostic biomarkers CEA and CXCL16.

METHODS

LGR6 mRNA levels were determined in 370 half lymph nodes of 121 colon cancer patients. Ability to predict relapse after curative surgery was estimated by Kaplan-Meier survival model and Cox regression analyses.

RESULTS

Patients with high LGR6 levels [LGR6(+)] had a decreased mean survival time of 11 months at 5-year follow-up and 47 months at 12-year follow-up, respectively, with hazard ratios of 3.2 and 2.8. LGR6 mRNA analysis added prognostic value to CEA and CXCL16 mRNA analysis. In the poor prognosis groups CEA(+) and CXCL16(+), further division was achieved by LGR6 analysis. LGR6(+) patients had a very poor prognosis. LGR6 also identified a small number of CEA(-), TNM stage I patients who relapsed suggesting stem cell origin of these tumors. LGR6 and LGR5 levels correlated strongly in lymph nodes of stage I and IV patients but not in stage II patients, suggesting that these stem cell markers are differentially regulated.

CONCLUSION

This study highlights LGR6 as a useful prognostic biomarker independently and in combination with CEA, CXCL16 or LGR5 identifying different risk groups.

Case report: Successful treatment of advanced colon cancer in an eighty-year-old man with long-term and multi-stage endoscopic minimally invasive therapy

Background

No previous studies have reported on the use of minimally invasive endoscopic therapy for colon cancer in older patients.

Case presentation

An 80-year-old man was admitted to our hospital with haematochezia and diagnosed with advanced colon cancer in 2018. Traditional surgical care was rejected by his family. We successfully treated the patient with multiple minimally invasive endoscopic therapies, such as argon plasma coagulation, from 2018 to 2021.

Conclusion

Invasive endoscopic therapy is a feasible way to treat colon cancer in older patients.

Factors Affecting the Efficiency of Near-Infrared Indocyanine Green (NIR/ICG) in Lymphatic Mapping for Colorectal Cancer: A Systematic Review

As laparoscopy gained global popularity in oncologic surgery, the challenge of detecting lymph nodes spurred researchers to explore innovative techniques and approach the situation from a fresh perspective. While many proposed methods have faded into obscurity, the utilization of indocyanine green (ICG) in the surgical treatment of oncologic patients has continued to advance. The immense potential of this dye is widely acknowledged, yet its full extent and limitations in lymphatic mapping for colorectal cancer remain to be precisely determined. This article aims to assess the magnitude of its potential and explore the constraints based on insights from clinical studies published by pioneering researchers. A systematic review of the existing literature, comprising articles in English, was conducted using the Scopus, PubMed, and Springer Link databases. The search employed keywords such as "colorectal cancer" AND/OR "indocyanine green," "fluorescence" AND/OR "lymphatic mapping" AND/OR "lymph nodes." Initially identifying 129 articles, the application of selection criteria narrowed down the pool to 10 articles, which served as the primary sources of data for our review. Despite the absence of a standardized protocol for the application of ICG in colorectal cancer, particularly in the context of lymphatic mapping, the detection rates have exhibited considerable variation across studies. Nevertheless, all authors unanimously regarded this technique as beneficial and promising. Additionally, it is advocated as an adjunctive tool to enhance the accuracy of cancer staging. Near-infrared (NIR)-enhanced surgery holds the promise of transforming the landscape of oncologic surgery, emerging as a valuable tool for surgeons. However, the absence of a standardized technique and the subjective nature of result assessment impose limitations on the potential of this method. Consequently, it can be inferred that the establishment of a universally accepted protocol, encompassing parameters such as dose, concentration, technique, and site of administration of ICG, along with the optimal time needed for fluorescence visualization, would enhance the outcomes. Emphasizing the accurate selection of patients is crucial to prevent the occurrence of false-negative results.

Future of Artificial Intelligence in Surgery: A Narrative Review

Artificial intelligence (AI) is the capability of a machine to execute cognitive processes that are typically considered to be functions of the human brain. It is the study of algorithms that enable machines to reason and perform mental tasks, including problem-solving, object and word recognition, and decision-making. Once considered science fiction, AI today is a fact and an increasingly prevalent subject in both academic and popular literature. It is expected to reshape medicine, benefiting both healthcare professionals and patients. Machine learning (ML) is a subset of AI that allows machines to learn and make predictions by recognizing patterns, thus empowering the medical team to deliver better care to patients through accurate diagnosis and treatment. ML is expanding its footprint in a variety of surgical specialties, including general surgery, ophthalmology, cardiothoracic surgery, and vascular surgery, to name a few. In recent years, we have seen AI make its way into the operating theatres. Though it has not yet been able to replace the surgeon, it has the potential to become a highly valuable surgical tool. Rest assured that the day is not far off when AI shall play a significant intraoperative role, a projection that is currently marred by safety concerns. This review aims to explore the present application of AI in various surgical disciplines and how it benefits both patients and physicians, as well as the current obstacles and limitations facing its seemingly unstoppable rise.

Diffusion-Weighted MRI as a Quantitative Imaging Biomarker in Colon Tumors

PURPOSE

To assess the use of quantitative diffusion-weighted MRI (DW-MRI) as a diagnostic imaging biomarker in differentiating between benign colon adenoma, early, and advanced cancer of the colon, as well as predicting lymph node involvement, and finally comparing mucinous-producing colon cancer with adenomas and non-mucinous colon cancer.

METHOD

Patients with a confirmed tumor on colonoscopy were eligible for inclusion in this study. Using a 3.0 Tesla MRI machine, the main tumor mean apparent diffusion coefficient (mADC) was obtained. Surgically resected tumor specimens served as an endpoint, except in mucinous colon cancers, which were classified based on T2 images.

RESULTS

A total of 152 patients were included in the study population. The mean age was 71 years. A statistically significant mADC mean difference of -282 × 10-6 mm2/s [-419--144 95% CI, p < 0.001] was found between colon adenomas and early colon cancer, with an AUC of 0.80 [0.68-0.93 95% CI] and an optimal cut off value of 1018 × 10-6 mm2/s. Only a small statistically significant difference (p = 0.039) in mADC was found between benign tumors and mucinous colon cancer. We found no statistical difference in mADC mean values between early and advanced colon cancer, and between colon cancer with and without lymph node involvement.

CONCLUSION

Quantitative DW-MRI is potentially useful for determining whether a colonic tumor is benign or malignant. Mucinous colon cancer shows less diffusion restriction when compared to non-mucinous colon cancer, a potential pitfall.

Lymph Node Molecular Analysis with OSNA Enables the Identification of pT1 CRC Patients at Risk of Recurrence: A Multicentre Study

Early-stage colorectal carcinoma (CRC)-pT1-is a therapeutic challenge and presents some histological features related to lymph node metastasis (LNM). A significant proportion of pT1 CRCs are treated surgically, resulting in a non-negligible surgical-associated mortality rate of 1.5-2%. Among these cases, approximately 6-16% exhibit LNM, but the impact on survival is unclear. Therefore, there is an unmet need to establish an objective and reliable lymph node (LN) staging method to optimise the therapeutic management of pT1 CRC patients and to avoid overtreating or undertreating them. In this multicentre study, 89 patients with pT1 CRC were included. All histological features associated with LNM were evaluated. LNs were assessed using two methods, One-Step Nucleic Acid Amplification (OSNA) and the conventional FFPE plus haematoxylin and eosin (H&E) staining. OSNA is an RT-PCR-based method for amplifying CK19 mRNA. Our aim was to assess the performance of OSNA and H&E in evaluating LNs to identify patients at risk of recurrence and to optimise their clinical management. We observed an 80.9% concordance in LN assessment using the two methods. In 9% of cases, LNs were found to be positive using H&E, and in 24.7% of cases, LNs were found to be positive using OSNA. The OSNA results are provided as the total tumour load (TTL), defined as the total tumour burden present in all the LNs of a surgical specimen. In CRC, a TTL ≥ 6000 CK19 m-RNA copies/µL is associated with poor prognosis. Three patients had TTL > 6000 copies/μL, which was associated with higher tumour budding. The discrepancies observed between the OSNA and H&E results were mostly attributed to tumour allocation bias. We concluded that LN assessment with OSNA enables the identification of pT1 CRC patients at some risk of recurrence and helps to optimise their clinical management.

A nomogram based on collagen signature for predicting the immunoscore in colorectal cancer

Objectives

The Immunoscore can categorize patients into high- and low-risk groups for prognostication in colorectal cancer (CRC). Collagen plays an important role in immunomodulatory functions in the tumor microenvironment (TME). However, the correlation between collagen and the Immunoscore in the TME is unclear. This study aimed to construct a collagen signature to illuminate the relationship between collagen structure and Immunoscore.

Methods

A total of 327 consecutive patients with stage I-III stage CRC were included in a training cohort. The fully quantitative collagen features were extracted at the tumor center and invasive margin of the specimens using multiphoton imaging. LASSO regression was applied to construct the collagen signature. The association of the collagen signature with Immunoscore was assessed. A collagen nomogram was developed by incorporating the collagen signature and clinicopathological predictors after multivariable logistic regression. The performance of the collagen nomogram was evaluated via calibration, discrimination, and clinical usefulness and then tested in an independent validation cohort. The prognostic values of the collagen nomogram were assessed using Cox regression and the Kaplan-Meier method.

Results

The collagen signature was constructed based on 16 collagen features, which included 6 collagen features from the tumor center and 10 collagen features from the invasive margin. Patients with a high collagen signature were more likely to show a low Immunoscore (Lo IS) in both cohorts (P<0.001). A collagen nomogram integrating the collagen signature and clinicopathological predictors was developed. The collagen nomogram yielded satisfactory discrimination and calibration, with an AUC of 0.925 (95% CI: 0.895-0.956) in the training cohort and 0.911 (95% CI: 0.872-0.949) in the validation cohort. Decision curve analysis confirmed that the collagen nomogram was clinically useful. Furthermore, the collagen nomogram-predicted subgroup was significantly associated with prognosis. Moreover, patients with a low-probability Lo IS, rather than a high-probability Lo IS, could benefit from chemotherapy in high-risk stage II and stage III CRC patients.

Conclusions

The collagen signature is significantly associated with the Immunoscore in the TME, and the collagen nomogram has the potential to individualize the prediction of the Immunoscore and identify CRC patients who could benefit from adjuvant chemotherapy.