Disease knowledge, medical experience, health-related quality of life and health-care costs among patients with advanced colorectal cancer in China: protocol for a nationwide multicentre survey

Comparative characteristics of early-onset vs. late-onset advanced colorectal cancer: a nationwide study in China

BACKGROUND

The incidence of early-onset colorectal cancer (EOCRC, diagnosed in patients under the age of 50 years) has been increasing around the world. Here, we aimed to systematically identify distinctive features of EOCRC.

METHODS

From 2020 to 2021, we conducted a nationwide survey in 19 hospitals, collecting data on advanced CRC patients' demographics, clinical features, disease knowledge, medical experiences, expenditures, and health-related quality of life (HRQOL). We compared these features between EOCRC and late-onset colorectal cancer (LOCRC, ≥ 50 years old) groups and analyzed the association between EOCRC and HRQOL using multivariate linear regression.

FINDINGS

In total, 991 patients with EOCRC and 3581 patients with LOCRC were included. Compared to the LOCRC group, the EOCRC group had higher levels of education, were more informed about the risk factors for CRC, were more likely to have widespread metastases throughout the body, were more inclined to undergo gene testing, and were more likely to opt for targeted therapy, radiotherapy, and chemotherapy. However, HRQOL in the EOCRC group was similar to that of the LOCRC group, and no significant association was observed between EOCRC and HRQOL (beta: -0.753, P value: 0.307).

INTERPRETATION

In Chinese patients, EOCRC patients had more aggressive features. Despite undergoing more intensified treatments and gene testing, they had similar HRQOL compared with LOCRC. These findings advocate for a more tailored approach to treatment, especially for young CRC patients with advanced TNM stages and metastasis.

Real-World Utilization, Barriers, and Factors Associated With the Targeted Treatment of Metastatic Colorectal Cancer Patients in China: A Multi-Center, Hospital-Based Survey Study

Objectives: To explore the utilization, barriers, and factors associated with the targeted treatment of Chinese metastatic colorectal cancer (mCRC) patients. Methods: A total of 1,688 mCRC patients from 19 hospitals in 14 cities were enrolled from March 2020 to March 2021 using stratified, multistage cluster sampling. The use of targeted therapy and any barriers patients experienced were collected. Logistic regression analyses were conducted to identify the factors associated with initiating targeted treatment. Results: About 51.6% of the patients initiated targeted therapy, of whom 44.5%, 20.2%, and 35.2% started first-, second-, and third-line treatment, respectively. The most reported barriers were high medical costs and a lack of belief in the efficacy of targeted therapy. Patients treated in the general hospital, diagnosed at an older age, less educated, and who had a lower family income, no medical insurance, poor health-related quality of life, metastasis outside the liver/lung or systemic metastasis, a shorter duration of mCRC were less likely to initiate targeted therapy. Conclusion: Reduced medical costs and interventional education to improve public awareness could facilitate the use of targeted treatment for mCRC.

Circular RNA PGPEP1 induces colorectal cancer malignancy and immune escape

OBJECTIVE

Colorectal cancer (CRC) is a prevalent gastrointestinal tumor globally. Circular RNAs (circRNAs) have been identified as regulatory players in the pathogenesis of CRC. However, it is unclear whether hsa_circ_0050102 (circPGPEP1) affects the malignant progression and immune escape in CRC.

METHODS

Bioinformatics analysis and circRNA in vivo precipitation experiments were performed to analyze and identify circRNAs that mediate immune escape in CRC. Using luciferase reporter assay, RIP, RNA pull-down assay, and FISH, the interaction between circPGPEP1, miR-515-5p, and nuclear factor of activated T-cell 5 (NFAT5) was identified. The functional role of circPGPEP1/miR-515-5p/NFAT5 axis in CRC anti-tumor immunity was investigated by co-culture assay, CFSE assay, and flow cytometry of CRC cells and T cells.

RESULTS

circPGPEP1 was a stable circRNA that was highly expressed in CRC. Functionally, circPGPEP1 silencing not only effectively inhibited CRC cell proliferation, migration, EMT, and immune escape and promoted apoptosis in vitro, but also inhibited CRC tumor growth and immune escape in vivo. In terms of the regulatory mechanism, circIGF2BP3 competitively upregulated NFAT5 expression by sponging miR-515-5p. Furthermore, functional rescue experiments showed that circPGPEP1 acted in CRC by regulating the miR-515-5p/NFAT5 axis.

CONCLUSION

Collectively, circPGPEP1 exerts an oncogene role in CRC by regulating the miR-515-5p/NFAT5 axis.