Prognostic and survival analysis of 837 Chinese colorectal cancer patients

Mortality rate and predictors of colorectal cancer patients in Ethiopia: a systematic review and meta-analysis

INTRODUCTION

The incidence of colorectal cancer (CRC) has been increasing in Sub-Saharan countries, including Ethiopia. However, the real mortality rate for CRC patients in Ethiopia has not been established. Therefore, this systematic review and meta-analysis aimed to determine the overall mortality rate and identify predictors among CRC patients in Ethiopia.

METHODS

PubMed, EMBASE, Web of Science, Scopus, Science Direct, and Google Scholar were searched to identify relevant articles. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) were followed. The quality of the included studies was assessed using the Newcastle-Ottawa Scale Critical Appraisal checklist. A random effect model was used to estimate the pooled mortality rate and adjusted hazard ratio (AHR). Publication bias was assessed using funnel plots and Egger's regression test, while heterogeneity was evaluated through the Cochran Q test and I2 statistics.

RESULTS

After reviewing 74 articles, only 7 studies met the criteria and were included in the analysis. The analysis revealed that the overall mortality rate among CRC patients in Ethiopia was 40.5% (95% confidence interval [CI]: 32.05, 48.87) while the survival rates at 1 year, 3 years, and 5 years were 82.3% (95% CI: 73.33, 91.31), 48.8% (95% CI: 43.35, 54.32), and 26.6% (95% CI: 21.26, 31.91) respectively. Subgroup analysis indicated that studies conducted after 2017 had higher mortality rates compared to those studied earlier (43.0% vs. 38.2%). Older age (AHR: 1.89, 95% CI: 1.27, 2.82); being married (AHR: 2.53, 95% CI: 1.79, 3.57); having comorbidities (AHR: 1.84, 95% CI: 1.45, 2.35); having high CEA levels (AHR: 2.06, CI: 1.35, 3.13); being in stage II (AHR: 4.13, 95% CI: 1.85, 9.22), III (AHR: 8.62, 95% CI: 3.88, 19.15), and IV (AHR: 8.06, CI: 2.89, 22.49) were the most important predictors.

CONCLUSION

In Ethiopia, the mortality rate among individuals diagnosed with CRC is high, with two out of five patients dying from this disease. Age, marital status, CEA level, comorbidities, and cancer stage were identified as predictors of mortality in CRC patients. Therefore, early detection and screening should be prioritized, particularly for older patients, those who are married, have comorbidities, elevated CEA levels, and advanced cancer stages.

Imaging segmentation mechanism for rectal tumors using improved U-Net

OBJECTIVE

In radiation therapy, cancerous region segmentation in magnetic resonance images (MRI) is a critical step. For rectal cancer, the automatic segmentation of rectal tumors from an MRI is a great challenge. There are two main shortcomings in existing deep learning-based methods that lead to incorrect segmentation: 1) there are many organs surrounding the rectum, and the shape of some organs is similar to that of rectal tumors; 2) high-level features extracted by conventional neural networks often do not contain enough high-resolution information. Therefore, an improved U-Net segmentation network based on attention mechanisms is proposed to replace the traditional U-Net network.

METHODS

The overall framework of the proposed method is based on traditional U-Net. A ResNeSt module was added to extract the overall features, and a shape module was added after the encoder layer. We then combined the outputs of the shape module and the decoder to obtain the results. Moreover, the model used different types of attention mechanisms, so that the network learned information to improve segmentation accuracy.

RESULTS

We validated the effectiveness of the proposed method using 3773 2D MRI datasets from 304 patients. The results showed that the proposed method achieved 0.987, 0.946, 0.897, and 0.899 for Dice, MPA, MioU, and FWIoU, respectively; these values are significantly better than those of other existing methods.

CONCLUSION

Due to time savings, the proposed method can help radiologists segment rectal tumors effectively and enable them to focus on patients whose cancerous regions are difficult for the network to segment.

SIGNIFICANCE

The proposed method can help doctors segment rectal tumors, thereby ensuring good diagnostic quality and accuracy.

Rectal cancer survival and prognostic factors in Iranian population: A retrospective cohort study

BACKGROUND

Rectal cancer (RC) poses a significant global health challenge, causing substantial morbidity and mortality. This study aims to investigate the survival rates of RC patients and identify the factors that influence their survival. The study considers demographic characteristics, tumor features, and treatment received as the factors under consideration.

METHODS

A retrospective analysis was conducted on the medical records of 593 RC patients. Data were collected through a comprehensive review of medical records and conducting telephone interviews. Survival rates were estimated using the life table method, and subgroup comparisons were performed using the log-rank test. Cox regression analysis was utilized to assess the independent associations between RC survival time and various covariates.

RESULTS

The study cohort comprised 593 RC patients, with a predominantly male representation. The mean age at diagnosis was 58.18 years, and the majority of patients (78.6 %) underwent surgical interventions. The median age at symptom onset and diagnosis were 58 and 59 years, respectively. Survival rates at 1st, 3rd, 5th, and 10th years were estimated to be 85 %, 59 %, 47 %, and 36 %, respectively. Statistical analysis revealed several significant prognostic factors, including age, education, symptoms, and cancer stage. In the multivariate Cox proportional-hazards analysis, advanced regional stage (HR = 1.54, 95 % CI, 1.13-2.08), presence of metastasis (HR = 3.73, 95 % CI, 2.49-5.58), and age over 70 (HR = 1.65) were associated with a higher risk of mortality.

CONCLUSION

Given the alarming prognosis of RC observed in the study area and the significant delay between symptom onset and diagnosis, it is crucial to address this issue and potentially improve the survival rates of RC patients.

Preliminary data on cytotoxicity and functional group assessment of a herb-mineral combination against colorectal carcinoma cell line

OBJECTIVES

The invasive screening methods and the late stage diagnosis of colorectal carcinoma (CRC) are contributing for the devastative prognosis. The gradual shift of the disease pattern among younger generations requires the implementation of phytochemicals and traditional medicines. Arkeshwara rasa (AR) is a herb-mineral combination of Tamra bhasma/incinerated copper ashes and Dwigun Kajjali/mercury sulphide levigated with Calotropis procera leaf juice, Plumbago zeylanica root decoction and the decoction of three myrobalans (Terminalia chebula, Terminalia bellerica, Emblica Officinalis decoction)/Triphala decoction.

METHODS

The SW-480 cell line was checked for the cytotoxicity and the cell viability criteria with MTT(3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide) assay. The acridine orange/ethidium bromide (AO/EtBr) assay revealed the depth of apoptosis affected cells in the fluorescent images. The FTIR analysis exhibited the graphical spectrum of functional groups within the compound AR.

RESULTS

The IC50 from the 10-7 to 10-3 concentrations against SW-480 cells was 40.4 μg/mL. The staining of AO/EtBr was performed to visualize live and dead cells and it is evident from the result that number of apoptotic cells increases at increasing concentration of AR. The single bond with stretch vibrations of O-H and N-H are more concentrated in the 2,500-3,200 cm-1 and 3,700-4,000 cm-1 of the spectra whereas, the finger print region carries the O-H and S=O type peaks.

CONCLUSIONS

The AR shows strong cyto-toxicity against the SW-480 cells by inducing apoptosis. It also modulates cellular metabolism with the involvement of functional groups which antagonizes the strong acids. Moreover, these effects need to be analyzed further based in the in vivo and various in vitro models.

Finding the minimum number of retrieved lymph nodes in node-negative colorectal cancer using Real-world Data and the SEER database

BACKGROUND

Current clinical guidelines recommend the removal of at least 12 lymph nodes (LNs) in resectable colorectal cancer (CRC). With advancements in lymphadenectomy technologies, the number of retrieved lymph nodes (rLNs) has markedly increased. This study aimed to investigate the lowest number of rLNs in node-negative patients.

MATERIALS AND METHODS

A total of 1103 N0 and 208 N1a stage patients were enrolled in our cohort, while 8503 N0 and 1276 N1a patients from the Surveillance, Epidemiology, and End Results CRC database were included. Propensity score matching and multivariate Cox regression analyses were performed to mitigate the influence of selection bias and control for potential confounding variables.

RESULTS

The median number of rLNs in N0 patients increased from 13.5 (interquartile range [IQR]: 9-18) in 2013 to 17 (IQR: 15-20) in 2019. The restrictive cubic spline illustrated a nonlinear relationship between rLNs and prognosis (nonlinearity, P =0.009), with a threshold ( N =16) influencing clinical outcomes. Patients at either N0 or N1a stage with sufficient rLNs (≥16) demonstrated superior prognoses to those with a limited rLNs (<16). After adjusting for clinical confounders, similar prognoses were observed in N0 limited and N1a adequate populations. Furthermore, Kaplan-Meier curves revealed that N0 limited patients who received chemotherapy exhibited better outcomes than those who did not.

CONCLUSIONS

Among patients with node-negative CRC, it is crucial to remove 16 or more LNs effectively. Fewer than 16 rLNs should be regarded as an independent risk factor, implying the need for adjuvant chemotherapy.

Clinical presentation, treatment patterns, and outcomes of colorectal cancer patients at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia: A prospective cohort study

BACKGROUND

Colorectal cancer (CRC) is the third most common cause of cancer death in both genders worldwide.

AIMS

This study aimed to evaluate the outcomes and prognostic factors of CRC patients at Tikur Anbessa Specialized Hospital in Ethiopia.

METHODS AND RESULTS

A prospective cohort study was conducted on 209 patients from January 2020 to September 2022. Kaplan-Meier curves and bivariate and multivariate Cox regression analyses were used to analyze overall and progression-free survival, with a significance value of P < .05. Results showed an overall mortality rate was 67.46% (95% confidence interval [CI]: 61.0-74.0), while the 1-year overall survival (OS) rate was 63.16% (95% CI: 56.23-69.29), with a median follow-up duration of 20 months. The median OS and progression-free survival times were 17 and 11 months, respectively. Age above 40 years (hazard ratio [HR] = 1.53, 1.02-2.29, p < .040), lower educational level (high school and below) (HR = 2.20, 1.24-3.90, p < .007), poor performance status (HR = 1.60, 1.03-2.48, p < .035), Hgb ≤12.5 g/dL (HR = 1.55, 1.03-2.08, p < .035), T-4 disease (HR = 6.05, 2.28-16.02, p < .000), and metastases at diagnosis (HR = 8.53, 3.77-19.25, p < .000) were all associated with poorer survival.

CONCLUSION

These findings suggest that poor survival of CRC patients in Ethiopia is largely due to advanced stage of the disease and lack of timely treatment, and highlight the urgent need for improved access to cancer treatment in the region.

A nomogram for predicting cause-specific mortality among patients with cecal carcinoma: a study based on SEER database

OBJECTIVE

Classical Cox proportional hazard models tend to overestimate the event probability in a competing risk setup. Due to the lack of quantitative evaluation of competitive risk data for colon cancer (CC), the present study aims to evaluate the probability of CC-specific death and construct a nomogram to quantify survival differences among CC patients.

METHODS

Data on patients diagnosed with CC between 2010 and 2015 were collected from the Surveillance, Epidemiology, and End Results Program (SEER) database. Patients were divided into a training dataset for the establishment of the model and a validation dataset to evaluate the performance the model at a ratio of 7:3. To evaluate the ability of multiple variables to predict cause-specific death in CC patients, univariate and multivariate analyses with Fine-Gray models were performed to screen the predictors of cause-specific death, and a nomogram for predicting cause-specific mortality was constructed. Then, the receiver operating characteristic (ROC) curve and the calibration curve were plotted to evaluate the prognostic performance of the nomogram.

RESULTS

The dataset was randomly divided into a training (n = 16,655) dataset and a validation (n = 7,139) dataset at a ratio of 7:3. In the training dataset, variables including pathological subtypes of tumors, pathological grading (degree of differentiation), AJCC staging, T-staging, surgical type, lymph node surgery, chemotherapy, tumor deposits, lymph node metastasis, liver metastasis, and lung metastasis were identified as independent risk factors for cause-specific death of CC patients. Among these factors, the AJCC stage had the strongest predictive ability, and these features were used to construct the final model. In the training dataset, the consistency index (C-index) of the model was 0.848, and the areas under the receiver operating characteristic curve (AUC) at 1, 3, and 5 years was 0.852, 0.861, and 0.856, respectively. In the validation dataset, the C-index of the model was 0.847, and the AUC at 1 year, 3 years, and 5 years was 0.841, 0.862, and 0.852, respectively, indicating that this nomogram had an excellent and robust predictive performance.

CONCLUSION

This study can help clinical doctors make better clinical decisions and provide better support for patients with CC.

Neutrophil to lymphocyte ratio can predict overall survival in patients with stage II to III colorectal cancer

The neutrophil-to-lymphocyte ratio (NLR) is a prognostic inflammatory marker in colorectal cancer (CRC), however, little is known for its prognostic role in stage II to III CRC patients underwent curative resection. This study was aimed to investigate prognostic role of NLR in stage II to III CRC patients underwent surgery. Medical records of 1378 newly diagnosed CRC patients between June 2006 and March 2020 were reviewed. Data were collected by using electronic medical record software. Survival rate were analyzed using the Kaplan-Meier method. The cutoff values of NLR in stage II to III CRC patients were defined by maximally selected log-rank statistics. Multivariable cox proportional-hazard models were performed to find risk factors associated with overall survival (OS) in stage II to III CRC patients underwent surgery. Among 1378 CRC patients enrolled, 910 patients underwent surgery. In entire surgical cohort, age, body mass index (BMI), CEA, carbohydrate antigen 19-9 (CA 19-9), lymphatic invasion, NLR, and albumin-to-globulin ratio (AGR) were found to be risk factors associated with OS (all P < .05). In stage II to III CRC patients underwent curative resection (n = 623), age, BMI, lymphatic invasion, AGR, and NLR were found to be risk factors associated with OS (all P < .05). In the multivariable analysis, CA 19-9 and lymphatic invasion were independent risk factors for OS in entire surgical cohort. In the multivariable analysis for the stage II to III CRC patients, age, BMI, lymphatic invasion and NLR (Hazard ratio = 2.41, 95% confidential interval [CI]: 1.04-5.595, P = .041) were independent risk factors for OS. NLR can be used as a clinically simple and useful parameter for predicting OS in stage II to III CRC patients undergoing curative resection, however, its optimal cutoff value should be further evaluated.

Survival rate of colorectal cancer in China: A systematic review and meta-analysis

Background

This study aims to comprehensively summarize the colorectal survival rate in China. Method: In PubMed and Web of Science, keywords such as "colorectal cancer", "survival" and "China" were used to search literatures in the past 10 years. Random effect models were selected to summarize 1-year, 3-year, and 5-year survival rates, and meta-regression and subgroup analyses were performed on the included studies.

Results

A total of 16 retrospective and prospective studies providing survival rates for colorectal cancer in China were included. The 1-year, 3-year, and 5-year survival rates of colorectal cancer in China were 0.79, 0.72 and 0.62, respectively. In the included studies, the 5-year survival rates of stage I (5474 cases), stage II (9215 cases), stage III (8048 cases), and stage IV (4199 cases) colorectal cancer patients were 0.85, 0.81, 0.57 and 0.30, respectively. Among them, the 5-year survival rates of colorectal cancer were 0.82, 0.76, 0.71, 0.67, 0.66, 0.65 and 0.63 in Tianjin, Beijing, Guangdong, Shandong, Liaoning, Zhejiang and Shanghai, respectively.

Conclusion

The 5-year survival rate in China is close to that of most European countries, but still lower than Japan and South Korea, and the gap is gradually narrowing. Region, stage, differentiation, pathological type, and surgical approach can affect 5-year survival in colorectal cancer.

Systematic review registration

https://www.crd.york.ac.uk/prospero/ identifier, CRD42022357789.

Prognostic Impact of Extramural Lymphatic, Vascular, and Perineural Invasion in Stage II Colon Cancer: A Comparison With Intramural Invasion

BACKGROUND

Lymphatic invasion, vascular invasion, and perineural invasion are prognostic factors for colon cancer. However, the prognostic significance of those factors according to the location of permeation (intramural and extramural invasion) in stage II colon cancer is still unclear.

OBJECTIVE

This study aimed to clarify whether the location of lymphatic invasion, vascular invasion, and perineural invasion could affect the survival of patients with stage II colon cancer.

DESIGN

This was a retrospective cohort study.

SETTINGS

This study took place at a university teaching hospital.

PATIENTS

A total of 1130 patients with stage II colon cancers who underwent radical surgery at the Seoul National University Hospital between July 2003 and December 2015 were included.

MAIN OUTCOME MEASURES

Patients were classified according to the location of lymphatic invasion, vascular invasion, and perineural invasion. Survival outcomes were compared among those without invasion and those with intramural and extramural invasion. Primary end point is overall survival and secondary end point is disease-free survival.

RESULTS

Disease-free survival and overall survival of patients with extramural invasion were worse than those of patients without invasion and those with intramural invasion. Multivariate analysis for survival outcomes confirmed that extramural invasion was a significant independent prognostic factor. However, both disease-free survival and overall survival were not significantly different between patients without invasion and those with intramural invasion.

LIMITATIONS

This study was limited by its retrospective design.

CONCLUSIONS

Extramural invasion was associated with worse prognosis in stage II colon cancer, but intramural invasion was not. Therefore, pathologic reports about the location of lymphatic invasion, vascular invasion, and perineural invasion might be helpful for predicting prognosis and for determining the need of adjuvant chemotherapy in stage II colon cancers. See Video Abstract at http://links.lww.com/DCR/B939 .

IMPACTO PRONSTICO DE LA INVASION EXTRAMURAL LINFTICA, VASCULAR Y PERINEURAL EN EL CNCER DE COLON ESTADO II ESTUDIO COMPARATIVO CON RELACIN A LA INVASIN INTRAMURAL

ANTECEDENTES:La invasión linfática, vascular y perineural son factores pronósticos para el cáncer de colon. Sin embargo, la importancia pronóstica de estos factores de acuerdo con la ubicación de la permeabilidad (invasión intramural y extramural) del cáncer de colon en estadío II aún no está aclarada.OBJETIVO:El presente estudio tiene por objetivo, el de aclarar si la localización de la invasión linfática, vascular y perineural podría afectar la sobrevida en los pacientes con cáncer de colon en estadío II.DISEÑO:Estudio de cohortes de caracter retrospectivo.AJUSTES:Nuestro estudio se llevó a cabo en un hospital docente universitario.PACIENTES:Se incluyeron un total de 1130 pacientes diagnosticados con cáncer de colon en estadío II, los cuales fueron sometidos a cirugía radical en el Hospital Universitario Nacional de Seúl, entre julio de 2003 y diciembre de 2015.PRINCIPALES MEDIDAS DE RESULTADO:Los pacientes fueron clasificados según la localización de la invasión linfática, vascular y perineural. Los resultados de la sobrevida fueron comparados con aquellos sin invasión y los otros con invasión intramural y extramural. El objetivo final primario fué la sobrevida global, el objetivo final secundario fué la sobrevida libre de enfermedad.RESULTADOS:La sobrevida libre de enfermedad y la sobrevida global de los pacientes con invasión extramural fueron mucho peores en relacion a las de los pacientes sin invasión y aquellos con invasión intramural. El análisis multivariado de los resultados de la sobrevida confirmaron que la invasión extramural es un factor pronóstico independiente muy significativo. Sin embargo, tanto la sobrevida libre de enfermedad, como la sobrevida global no fueron significativamente diferentes entre los pacientes sin invasión y aquellos con invasión intramural.LIMITACIONES:Estudio limitado por su diseño con caracter retrospectivo.CONCLUSIONES:La invasión extramural fué asociada con un peor pronóstico en el cáncer de colon en estadío II, pero la invasión intramural no lo fué. Por tanto, los informes anatomopatológicos sobre la ubicación de la invasión linfática, vascular y perineural, podrían ser útiles para predecir el pronóstico y determinar el menester de la quimioterapia adyuvante en los cánceres de colon en estadío II. Consulte Video Resumen en http://links.lww.com/DCR/B939 . (Traducción-Dr. Xavier Delgadillo ).

Survival pattern of colorectal cancer in Sub-Saharan Africa: A systematic review and meta-analysis

Cancer incidence is relatively low in sub-Saharan Africa (SSA), however, prognosis is expected to be poor in comparison with high-income countries. Comprehensive evidence is limited on the survival pattern of colorectal cancer patients in the region. We conducted a systematic review and meta-analysis to investigate the pattern of colorectal cancer survival in the region and to identify variation across countries and over time. We searched international databases MEDLINE, Scopus, Embase, Web of Science, ProQuest, CINAHL, and Google Scholar to retrieve studies that estimated survival from colorectal cancer in SSA countries from inception to December 31, 2021 without language restriction. Due to between-study heterogeneity, we performed a random-effects meta-analysis to pool survival rates. To identify study-level sources of variation, we performed subgroup analysis and meta-regression. Results are reported in line with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 guideline and the protocol was registered in PROSPERO database (CRD42021246935). 23 studies involving 10,031 patients were included in the review, of which, 20 were included in the meta-analysis. The meta-analysis results showed that the pooled 1-, 2-, 3-, 4-, and 5-year survival rates in SSA were 0.74 (95% CI, 0.66-0.81), 0.50 (95% CI, 0.41-0.58), 0.36 (95% CI, 0.27-0.47), 0.31 (95% CI, 0.22-0.42), and 0.28 (95% CI, 0.19-0.38) respectively. Subgroup analyses indicated that the survival rate varied according to year of study, in which those conducted in recent decades showed relatively better survival. The 5-year survival was higher in middle-income SSA countries (0.31; 95%CI: 0.17-0.49) than low-income countries (0.20; 95%CI: 0.11-0.35), however, the difference was not statistically significant. In conclusion, survival from colorectal cancer is low in sub-Saharan Africa compared to other regions. Thus, intervention strategies to improve screening, early diagnosis and treatment of colorectal cancer should be developed and implemented to improve survival in the region.

Gene Mutational Clusters in the Tumors of Colorectal Cancer Patients With a Family History of Cancer

Introduction

Family history is a high-risk factor for colorectal cancer (CRC). The risk comes not only from known germline mutations but also from the other family-related mechanisms. Uncovering them would be an important step to improve the diagnosis and treatment of these patients.

Method

Samples from 168 patients with advanced CRC were collected and applied to next-generation sequencing of 624 pan-cancer genes. Genomic mutations and significantly mutated genes were identified. Significantly mutated genes and co-mutated genes were used to cluster patients. For each cluster of patients, mutational signatures were extracted. The identified mutational signatures were further validated in the other independent cohort.

Result

Significantly mutated genes including TP53, APC, KRAS, and SMAD4 were found associated with tumor mutational burden and microsatellite instability. LRP1, ACVR2A, and SETBP1 were found co-mutated. Patients with mutations in LRP1, ACVR2A, and SETBP1 tend to have a family history of cancer. Those patients tended to have right-sided tumors with high tumor mutational burden and microsatellite instability. Among them, signature analysis identified two possible etiologies, SBS10a (defective polymerase epsilon exonuclease domain) and SBS6 (defective DNA mismatch repair and microsatellite unstable tumors). These signatures were also found in another independent cohort.

Conclusion

The gene cluster (LRP1, ACVR2A, and SETBP1) could be a good biomarker of these patients with a family risk, which was characterized by right-sidedness, high tumor mutational burden, and high microsatellite instability.

Report of 13-year survival of patients with colon and rectal cancers; lessons from Shiraz colorectal cancer surgery registry system of a level three medical center

Background

Colorectal cancer (CRC) is the second most common cancer in women and the third most common cancer in men worldwide, with an increasing trend in its incidence in Asian countries. In the present study, we aimed to describe the 13-year results of patients with CRC based on the Shiraz Colorectal Cancer Surgery (SCORCS) registry system in patients with a pathologically confirmed diagnosis of colon cancer (CC) and rectal cancer (RC) undergoing surgery.

Methods

Between 2007 and 2020, 811 patients, including 280 patients with CC and 531 patients with RC, registered in SCORCS, were included in the present study. The information collected for this study included demographic characteristics of the patients, primary clinical presentations, laboratory findings before surgery, radiologic and colonoscopy results, and surgical procedures. Death was confirmed by the physician as “CRC-related”. The data were analyzed by SPSS software version 21; life table and Kaplan-Meier curve were used for evaluating the overall survival, recurrence, and metastasis rates and Log-Rank test or Breslow test to check significant differences between the subgroups. The Cox proportional regression model was fitted to evaluate the prognostic factors of survival recurrence and metastasis.

Results

Laparoscopy was performed in 60% of patients (66% in RC and 51% in CC), laparotomy in 32% (27% in RC and 41% in CC), and 7% required conversion. The median time of follow-up was 29 months in all patients; 28 months in patients with RC, and 33 months in patients with CC; 1, 3, and 5 years’ survival rate was 90, 70, and 63% for all the patients, 89%, 67%, and 58% for RC and 90%, 74%, and 71% for CC, respectively (P = 0.009). The Cox regression analysis revealed tumor stages II, (P = 0.003, HR:2.45, 95% CI;1.34–4.49), III, (P ≤ 0.001, HR:3.46, 95% CI;1.88–6.36) and IV, (P ≤ 0.001, HR:6.28, 95% CI;2.73–14.42) in RC and stage IV, (P = 0.03, HR:9.33, 95% CI;1.1-76.37) in CC were the significant survival prognostic factors. The metastasis and recurrence of the tumors occurred earlier in patients with RC than CC (P = 0.001 and 0.03, respectively).

Conclusions

Long-term follow-up of patients with CRC in an Iranian population indicated the significance of screening for diagnosis of early stages and improved survival of the patients.

Ethical dilemma of colorectal screening: What age should a screening colonoscopy start and stop?

Many advanced age patients who are diagnosed with colorectal cancer are often not offered surgical treatment due to presumed high risks of the procedure. While there is data to support surgical treatment of colorectal cancer in advanced age patients, screening colonoscopy is not currently recommended for patients older than 85 years. Moreover, recent studies concluded that the incidence of colorectal cancer in patients 80 years and older is increasing. This raises the concern that the current guidelines are withholding screening colonoscopy for healthy elderly patients. Another concern contrary to this would be the new trend of growing incidence of advanced colorectal cancer in the younger patient population. Together they raise the ethical dilemma of how to best utilize colonoscopies as well as surgical intervention, as they are limited resources.

Upregulated NLGN1 predicts poor survival in colorectal cancer

Background

Neuroligin1 (NLGN1) is a main component of excitatory glutamatergic synapses complex and is important for synapse assembly and function. The clinical value of NLGN1 in colorectal cancer (CRC) is not clear.

Methods

We obtained the expression data of 1143 CRC patients from 3 independent Gene Expression Omnibus (GEO) datasets (GSE32323, GSE24551, GSE39582) and The Cancer Genome Atlas (TCGA) to make the comparison of the NLGN1 expression level between CRC tissues and matched noncancerous tissues, and to evaluate its value in predicting survival of CRC patients. At the protein level, these results were further confirmed by immunohistochemical staining of 52 CRC samples in our own centre. Finally, the function of NLGN1 was explored by gene set enrichment analysis (GSEA).

Results

Increased mRNA and protein levels of NLGN1 expression were associated with worse overall survival or recurrence-free survival in CRC patients from 2 GEO datasets, the TCGA database, and our cohort. In addition, multivariate regression analysis showed that NLGN1 was an independent poor prognostic factor of survival in patients with CRC in TCGA database (OR = 2.524, P = 0.010). Functional analysis revealed that NLGN1 was correlated with function involving the Hedgehog signaling pathway, mismatch repair process, and some material metabolism processes.

Conclusions

This study is the first to implicate and verify NLGN1 as a new poor prognostic marker for CRC.

Development of a Gene-Based Prediction Model for Recurrence of Colorectal Cancer Using an Ensemble Learning Algorithm

It is difficult to determine which patients with stage I and II colorectal cancer are at high risk of recurrence, qualifying them to undergo adjuvant chemotherapy. In this study, we aimed to determine a gene signature using gene expression data that could successfully identify high risk of recurrence among stage I and II colorectal cancer patients. First, a synthetic minority oversampling technique was used to address the problem of imbalanced data due to rare recurrence events. We then applied a sequential workflow of three methods (significance analysis of microarrays, logistic regression, and recursive feature elimination) to identify genes differentially expressed between patients with and without recurrence. To stabilize the prediction algorithm, we repeated the above processes on 10 subsets by bagging the training data set and then used support vector machine methods to construct the prediction models. The final predictions were determined by majority voting. The 10 models, using 51 differentially expressed genes, successfully predicted a high risk of recurrence within 3 years in the training data set, with a sensitivity of 91.18%. For the validation data sets, the sensitivity of the prediction with samples from two other countries was 80.00% and 91.67%. These prediction models can potentially function as a tool to decide if adjuvant chemotherapy should be administered after surgery for patients with stage I and II colorectal cancer.

Competitive Risk Analysis of Prognosis in Patients With Cecum Cancer: A Population-Based Study

Background:

The presence of competing risks means that the results obtained using the classic Cox proportional-hazards model for the factors affecting the prognosis of patients diagnosed with cecum cancer (CC) may be biased.

Objective:

The purpose of this study was to establish a competitive risk model for patients diagnosed with CC to evaluate the relevant factors affecting the prognosis of patients, and to compare the results with the classical COX proportional risk model.

Methods:

We extracted data on patients diagnosed with CC registered between 2004 and 2016 in the Surveillance, Epidemiology, and End Results (SEER) database. The univariate analysis utilized the cumulative incidence function and Gray’s test, while a multivariate analysis was performed using the Fine-Gray, cause-specific (CS), and Cox proportional-hazards models.

Results:

The 54463 eligible patients diagnosed with CC included 24387 who died: 12087 from CC and 12300 from other causes. The multivariate Fine-Gray analysis indicated that significant factors affecting the prognosis of patients diagnosed with CC include: age, race, AJCC stage, differentiation grade, tumor size, surgery, radiotherapy, chemotherapy and regional lymph nodes metastasis. Due to the presence of competitive risk events, COX model results could not provide accurate estimates of effects and false-negative results occurred. In addition, COX model misestimated the direction of association between regional lymph node metastasis and cumulative risk of death in patients diagnosed with CC. Competitive risk models tend to be more advantageous when analyzing clinical survival data with multiple endpoints.

Conclusions:

The present study can help clinicians to make better clinical decisions and provide patients diagnosed with CC with better support.

Treatment patterns and direct medical costs of metastatic colorectal cancer patients: a retrospective study of electronic medical records from urban China

Objectives: To describe direct medical costs associated with each line of treatment among metastatic colorectal cancer (mCRC) patients in China.Methods: Electronic medical records between 2011 and 2016 were extracted from 12 tertiary hospitals in China for adult patients who initiated third-line treatment at least nine months before the end of data collection. Direct medical costs included costs of wards, diagnostic tests, surgical procedures, special materials, drugs and others. Costs were assessed by line of treatment, and drug costs were further breakdown for patients receiving chemotherapy alone and those receiving chemo- and biologics-combined therapy.Results: Of the 404 mCRC patients, the mean age was 55 years old and 62% were male. Oxaliplatin- and irinotecan-based regimens dominated first- and second-line treatment, respectively (44 and 37%). From first- to second- to third-line, the proportion of patients receiving targeted biologics increased from 18% at first-line and 12% at second-line to 34% at third-line; median number of treatment cycles reduced from 6 to 4 and to 2. The corresponding mean direct medical costs per person per cycle increased from $2,514 to $2,678 to $5,121. Mean drug costs per cycle increased from $2,314 to $2,673 to $4,316 among patients receiving chemotherapy alone and from $3,245 to $2,717 to $6,533 among patients receiving chemo- and biologics-combined therapy.Conclusions: Before 2017, mCRC patients in China did not receive the maximum benefits of precision medicine breakthroughs. Reduced treatment cycles and increased costs per cycle from first- to third-line suggested poor healthcare resource utilization. With earlier initiation and more treatment cycles, targeted biologics may better demonstrate their effectiveness among Chinese patients. Our findings reflected the urgent need to increase drug accessibility in China before 2017 and underscore that including innovative biologics into Chinese health insurance plans can reduce patients' economic burden and improve the management of mCRC.

Survival Rate of Colorectal Cancer in Eastern Mediterranean Region Countries: A Systematic Review and Meta-Analysis

Colorectal cancer (CRC) is the second most common cause of cancer-related deaths worldwide. Survival rates are among the most important factors in quality control and assessment of treatment protocols. This study was aimed to assess the survival rate of colorectal cancer in Eastern Mediterranean Region Countries. In the present study we comprehensively searched 6 international databases including PubMed/Medline, ProQuest, Scopus, Embase, Web of Knowledge and Google Scholar for published articles until November 2018. The Newcastle-Ottawa Quality Assessment Form for Cohort Studies was applied to evaluate the quality of included studies. The heterogeneity of papers was assessed with the Cochran Test and I-Square statistics. Meta-regression test was performed based on publication year, sample size and Human Development Index (HDI) of each study. Among the total of 1023 titles found in the systematic search, 43 studies were eligible to be included in the present meta-analysis. According to the results, the 1-year, 3-year and 5-year survival rate of patients with Colorectal Cancer was 88.07% (95% CI, 83.22-92.92), 70.67% (95% CI, 66.40-74.93) and, 57.26% (95% CI, 50.43-64.10); respectively. Furthermore, Meta-regressions did not show significant correlations between survival rate and year, sample size or Human Development Index. Survival rates, especially the 5-year survival rate in the EMRO were less than European countries and the USA. Documented and comprehensive evidence-based findings of the present meta-analysis can be used to enhance policies and outcomes of different medical areas including prophylaxis, treatment and health related objectives in colorectal cancer.

Comparison of risk factors between colon cancer and rectum cancer in a single medical center hospital, Taiwan

INTRODUCTION

Colorectal cancer (CRC) is rapidly increasing in developed countries. In Taiwan, the incidence rate of CRC has increased during the past decade, but the 5-year survival has remained at approximately 63%. In this study, we sought to determine the 5-year survival rate of patients diagnosed with colon and rectum cancer and to determine factors affecting survival.

MATERIAL AND METHODS

All patients from the Taiwan Cancer Database of the medical center hospital in North Taiwan between 2007 and 2013 were identified. Survival analysis was performed using Kaplan-Meier curves, and differences between the curves were analyzed using the log-rank test. Cox proportional hazards regression models were used to analyze survival by each variable.

RESULTS

A total of 869 patients were included: 554 (63.8%) patients had colon cancer and 315 (36.2%) had rectum cancer. The mean survival time was 71.27 ±1.27 months (colon group: 71.90 ±1.58 months; rectum group: 67.88 ±1.95 months). There was no significant difference (p = 0.493) between patients who had colon or rectum cancer. The forward stepwise Cox regression analysis results indicated that perineural invasion, distant metastasis, age, pathological differentiation grade, and obstruction were statistically significant for patients who had CRC, colon cancer or rectum cancer.

CONCLUSIONS

The long-term survival from CRC, colon cancer and rectum cancer remains promising, as 68.66%, 69.11% and 67.90% of patients are alive 5 years after being diagnosed, respectively. Perineural invasion was found to be an important factor related to the survival of patients who have CRC. Thus, early detection of CRC may help improve survival.

Survival Rates and Associated Factors of Colorectal Cancer Patients in Brunei Darussalam

Background:

Colorectal cancer (CRC) is the third most common cancer in both men and women. In most Asian countries, both the incidence and mortality rates of CRC are gradually increasing. In Brunei Darussalam, CRC ranks first and second in lifetime risk among men and women respectively. This study aims to report the overall survival rates and associated factors of CRC in Brunei Darussalam.

Methods:

This is a retrospective study examining CRC data for the period 2007 to 2017 retrieved from a population based cancer registry in Brunei Darussalam. A total of 728 patients were included in the analysis. Kaplan Meier method was used to estimate survival rates. Univariate analysis using log-rank test was used to examine the differences in survival between groups. Multivariate analysis using Cox PH regression was used to estimate hazard of death and obtain significant predictors that influence CRC patients’ survival.

Results:

The median survival time for colorectal, colon and rectal cancer patients were 57.0, 85.8 and 40.0 months respectively. The overall 1-, 3- and 5- year survival rates for CRC patients were 78.0%, 57.7% and 49.6% respectively. In univariate analysis, age at diagnosis, ethnicity, cancer stage, tumour location and histology were found to have significant difference in CRC patients’ survival. In the Cox PH analysis, older age (≥70 years), cancer stage, ethnicity and other histological type were determined as associated factors of CRC patients’ survival.

Conclusion:

This study found the overall 5-year survival rate of CRC in Brunei Darussalam is similar to that in some Asian countries such as Singapore and Malaysia. However, more efforts need to be carried out in order to raise awareness of CRC and improve the survival of CRC patients.

Colorectal cancer: Parametric evaluation of morphological, functional and molecular tomographic imaging

Colorectal cancer (CRC) represents one of the leading causes of tumor-related deaths worldwide. Among the various tools at physicians’ disposal for the diagnostic management of the disease, tomographic imaging (e.g., CT, MRI, and hybrid PET imaging) is considered essential. The qualitative and subjective evaluation of tomographic images is the main approach used to obtain valuable clinical information, although this strategy suffers from both intrinsic and operator-dependent limitations. More recently, advanced imaging techniques have been developed with the aim of overcoming these issues. Such techniques, such as diffusion-weighted MRI and perfusion imaging, were designed for the “in vivo” evaluation of specific biological tissue features in order to describe them in terms of quantitative parameters, which could answer questions difficult to address with conventional imaging alone (e.g., questions related to tissue characterization and prognosis). Furthermore, it has been observed that a large amount of numerical and statistical information is buried inside tomographic images, resulting in their invisibility during conventional assessment. This information can be extracted and represented in terms of quantitative parameters through different processes (e.g., texture analysis). Numerous researchers have focused their work on the significance of these quantitative imaging parameters for the management of CRC patients. In this review, we aimed to focus on evidence reported in the academic literature regarding the application of parametric imaging to the diagnosis, staging and prognosis of CRC while discussing future perspectives and present limitations. While the transition from purely anatomical to quantitative tomographic imaging appears achievable for CRC diagnostics, some essential milestones, such as scanning and analysis standardization and the definition of robust cut-off values, must be achieved before quantitative tomographic imaging can be incorporated into daily clinical practice.

Association of Family History With Cancer Recurrence, Survival, and the Incidence of Colorectal Adenoma in Patients With Colorectal Cancer

Background

The influence of family history (FH) on cancer recurrence and survival among patients with established colorectal cancer (CRC) remains uncertain. This study aimed to evaluate the association of FH with cancer recurrence, survival, and the incidence of colorectal adenomas in patients with CRC.

Methods

Consecutive patients with stage III CRC diagnosed between 2004 and 2009 and followed-up in Severance Hospital were retrospectively enrolled and followed until December 2014. Overall survival (OS) and disease-free survival (DFS) according to FH of CRC or colorectal neoplasm were evaluated using Cox proportional hazards regression and Kaplan-Meier curve.

Results

Among analyzed 979 patients, 69 (7.0%) was identified as having a FH of CRC in a first-degree relative. During a median follow-up of 9.6 years, mortality occurred in 14 of 69 patients (20.3%) with a FH of CRC and 348 of 910 patients (38.2%) without a FH. Compared with patients without a FH, a first-degree FH of CRC, first or second-degree FH of CRC, and first-degree FH of colorectal neoplasm (CRC or polyps) were associated with a significant reduction in the risk of overall mortality, with adjusted hazard ratios (HRs) of 0.52 (95% CI, 0.29-0.92), 0.51 (95% CI, 0.30-0.88), and 0.48 (95% CI, 0.28-0.82), respectively. However, DFS improvement was significant only when the definition of FH was FH of colorectal neoplasm (adjusted HR 0.57; 95% CI, 0.36-0.89). The incidence of adenoma and advanced adenoma was not different according to the FH.

Conclusions

Among patients with stage III CRC receiving curative surgery, a FH of colorectal neoplasm was associated with a reduction in cancer recurrence and mortality. The larger scaled studies are needed.

Survival Rate of Colorectal Cancer in Iran: A Systematic Review and Meta-Analysis

Background: Different studies have been conducted to estimate the survival rate of colorectal cancer in Iran but there is no overall estimate of the survival rate. The aim of this study was to calculate the pooled 1, 3, and 5-year survival rate of the patients with colorectal cancer in Iran. Methods: To retrieve relevant studies, we conducted a systematic search in Iranian databases, including Iran Medex, Magiran, SID, and international databases such as Medlin/PubMed, Scopus, and Google scholar using “Colorectal Neoplasms” and “Survival Rate” as keywords up to December 1st, 2017. We used random effect model to estimate pooled 1, 3, and 5-year survival rates of the patients with colorectal cancer in Iran. To assess the heterogeneity, we used Chi-squared test at the 5 % significance level (p <0.05) and I2 Index. We used meta-regression and subgroup analysis to find a potential source of heterogeneity. Results: After a systematic search, 196 articles were found, of the 38 studies met the eligibility criteria and are included in our meta-analysis. The pooled 1, 3, and 5-year survival rates in patient with colorectal cancer were 0.84 (95% CI: 0.81-0.87), 0.64 (95%CI: 0.59-0.70), and 0.54 (95%CI: 0.49-0.58) respectively. The 5-year survival rate in the subgroup of women was 0.5 (0.44-0.56) and in male subgroup was 0.44 (0.40-0.48). In a subgroup of the tumor site, the 5-year survival rate in colon cancer was 0.6 (0.49-0.75) and rectum cancer was 0.54 (0.36-0.69). In multivariable models, there was a significant association between years of study and 5-year survival rate as a source of heterogeneity (β = 18.9, P=0.01). Conclusion: According to the results of this study, women had a better survival rate than men, and according to the tumor site, the 5-year survival rate in colon cancer was better than the rectum cancer.

Time trends of incidence and mortality in colorectal cancer in Changning District, Shanghai, 1975-2013

OBJECTIVE

To evaluate the incidence and mortality of colorectal cancer (CRC) and the estimated patient's age, diagnostic duration and birth cohort effects in patients of Changning District, Shanghai.

METHODS

Age-standardized rates (ASRs) of CRC over eight intervals of 5 years from 1975 to 2013 were determined. Joinpoint regression analysis was used to determine the changes in annual incidence and mortality trends. Age-period-cohort analysis was performed to investigate their effects on the incidence and mortality trends of CRC.

RESULTS

For incidence, the ASRs of 14.14 per 100 000 and 11.81 per 100 000 during 1975-1979 increased to 32.11 per 100 000 and 26.25 per 100 000 in men and women during 2008-2013. For mortality, ASRs of 9.40 per 100 000 and 8.76 per 100 000 increased to 14.80 per 100 000 and 11.92 per 100 000 in men and women, respectively, from 1975-1979 to 2010-2013. Joinpoint regression analysis found an increasing incidence (average annual percentage change [AAPC] 2.18% for men and 1.65% for women) and mortality (AAPC 1.47% for men and 0.97% for women) of CRC throughout the entire period. The incidence and mortality trends of CRC were significantly affected by birth cohorts.

CONCLUSIONS

The increasing incidence and mortality of CRC are largely affected by the effects of birth cohorts. The increased incidence of CRC may be attributed to changes in lifestyle and diet, while that in mortality trends may be resulted from increasing incidence, an aging population and changing lifestyles.

The Risk Factors Affecting Survival in Colorectal Cancer in Taiwan

BACKGROUND

Colorectal cancer is one of the most common malignancies in developed countries. The incidence of colorectal cancer (CRC) in Taiwan is rising. We aimed to determine the five-yr survival rate of patients diagnosed with CRC and determine factors affecting survival.

METHODS

All patients were identified from the Taiwan Cancer Data Base of the Medical Center Hospital in North Taiwan from 2007 to 2013. Data were collected using medical records and the cancer database. In all, 869 patients with CRC were included. Survival analysis was performed using Kaplan-Meier curves, and differences between the curves were analyzed using the log-rank test. Cox proportional hazards regression models were used to analyze survival by each variable.

RESULTS

The five-yr survival rate and the mean survival time after cancer diagnosis were 68.7% and 71.27±1.27 months. Perineural nerve invasion, distant metastasis, age, pathological differentiation grade, obstruction and regional lymph node metastasis were found to be independent predictors of the survival and prognosis of patients with CRC.

CONCLUSION

Perineural nerve invasion was an important factor related to the survival of CRC patients. Thus, the earlier detection of CRC might help improve survival.

Comparison of Basic and Ensemble Data Mining Methods in Predicting 5-Year Survival of Colorectal Cancer Patients

INTRODUCTION

Colorectal cancer (CRC) is one of the most common malignancies and cause of cancer mortality worldwide. Given the importance of predicting the survival of CRC patients and the growing use of data mining methods, this study aims to compare the performance of models for predicting 5-year survival of CRC patients using variety of basic and ensemble data mining methods.

METHODS

The CRC dataset from The Shahid Beheshti University of Medical Sciences Research Center for Gastroenterology and Liver Diseases were used for prediction and comparative study of the base and ensemble data mining techniques. Feature selection methods were used to select predictor attributes for classification. The WEKA toolkit and MedCalc software were respectively utilized for creating and comparing the models.

RESULTS

The obtained results showed that the predictive performance of developed models was altogether high (all greater than 90%). Overall, the performance of ensemble models was higher than that of basic classifiers and the best result achieved by ensemble voting model in terms of area under the ROC curve (AUC= 0.96).

CONCLUSION

AUC Comparison of models showed that the ensemble voting method significantly outperformed all models except for two methods of Random Forest (RF) and Bayesian Network (BN) considered the overlapping 95% confidence intervals. This result may indicate high predictive power of these two methods along with ensemble voting for predicting 5-year survival of CRC patients.

Risk Factors Predicting Colorectal Cancer Recurrence Following Initial Treatment: A 5-year Cohort Study

Purpose:

Recurrence is one of the most important factors influencing survival of colorectal cancer patients.

Subjects and Methods:

In this cohort study, clinical and demographic characteristics of 561 patients with colorectal cancer were collected from 2010 to 2015. Medical records and telephone interviews were used to define the patient’s clinical status including the date of any recurrence during the study period. The multivariate Cox model was used as the main strategy for analyzing data.

Results:

Some 239 (42.6%) patients experienced cancer recurrence during the 5-year follow-up period. Those with an older age at diagnosis had a higher risk of cancer recurrence than their younger counterparts [Hazard Ratio (HR) >70 y /<50 y= 1.65, P=0.01]. Rectal cancer had a greater risk of disease recurrence compared with other tumor sites [HR colon/ rectum=1.53, P=0.02]. Stage 3 cancer had a higher risk than stage 1 cancer [HR stage 3/ stage 1=4.30, P<0.001], and positive lympho-vascular invasion was also a risk factor [HR yes/ no=2.03, P<0.001]. Finally, tumor size, number of dissected lymph nodes, proportion of positive lymph nodes, perineural invasion and type of treatment did not significantly predict recurrence.

Conclusion:

Access to enhanced medical services including cancer diagnosis at an early stage and optimal treatment is needed to improve the survival and quality of life of CRC patients.

[The possibilities to improve the outcomes in patients with colon cancer complicated by acute obstruction]

AIM

To improve the outcomes in patients with colon cancer complicated by acute obstruction via development of combined and complex treatment strategies.

MATERIAL AND METHODS

We observed 442 patients with colon cancer complicated with acute obstruction. Original classification and diagnostic algorithm were applied.

RESULTS

Time of preoperative opening-up, volume and type of surgery were defined using obtained data. Also we are able to perform delayed radical surgery after correction of metabolic disorders and comorbidities, to create the conditions for combined and complex methods of treatment, to decrease the incidence of postoperative complications and mortality rate.

CONCLUSION

Three-stage surgery with shortened time between interventions decreases the incidence of anastomosis failure, allows to refuse Hartmann's procedure and to avoid severe reconstructive surgical stage without prolongation of rehabilitation period.

Colorectal Cancer in Jordan: Survival Rate and Its Related Factors

Objectives. To estimate the survival rate of colorectal cancer (CRC) and determine its predictors among Jordanian patients who were diagnosed in the period of 2005–2010. Methods. This study was based on Jordan cancer registry. All CRC cases that were registered in cancer registry during 2005–2010 were analyzed using the survival analysis. The last date for follow-up was 1st Oct 2016. Results. A total of 3005 patients with CRC were registered during 2005–2010. The overall 5-year and 10-year survival rates for patients with CRC were 58.2% and 51.8%, respectively. The 5-year survival rate decreased significantly from 60.4% for the age <50 years to 49.3% for the age ≥70 years (p < 0.005). The 5-year survival rate was 72.1% for the localized stage, 53.8% for the regional stage, and 22.6% for the distant metastasis. In the multivariate analysis, the only factors that were significantly associated with survival were age, grade, stage, and location of tumor. Conclusions. The overall 5-year and ten-year survival rates for CRC were 58.2% and 51.8%, respectively. Increased age, poor differentiation, advanced cancer stage, and right-sided cancers were associated with lower survival rates. Screening strategies are needed for early detection of colon adenomas and colorectal cancer in Jordan.

Prognostic significance of vascular endothelial growth factor polymorphisms in colorectal cancer patients

AIM

To investigate the associations of the genetic polymorphisms of vascular endothelial growth factor A (VEGF-A) -1498C>T and -634G>C, with the survival of patients with colorectal cancer (CRC).

METHODS

A prospective cohort consisting of 131 Brazilians patients consecutively operated on with a curative intention as a result of sporadic colorectal carcinoma was studied. DNA was extracted from peripheral blood and its amplification and allelic discrimination for each genetic polymorphism was performed using the technique of polymerase chain reaction (PCR) in real-time. The real-time PCR technique was used to identify the VEGF-A -1498C>T (rs833031) and -634G>C (rs2010963) polymorphisms. Genotyping was validated for VEGF-A -1498C>T polymorphism in 129 patients and for VEGF-A -634G>C polymorphism in 118 patients. The analysis of association between categorical variables was performed using logistic regression, survival by Kaplan-Meier method and multivariate analysis by the Cox regression method.

RESULTS

In the univariate analysis there was a significant association (OR = 0.32; P = 0.048) between genotype CC of the VEGF-A -1498C>T polymorphism and the presence of CRC liver metastasis. There was no association between VEGF-A -1498C>T polymorphism and VEGF-A -634G>C polymorphism with further clinical or anatomopathologic variables. The genotype CC of the VEGF-A -1498C>T polymorphism was significantly correlated with the 5-year survival (P = 0.032), but not significant difference (P = 0.27) was obtained with the VEGF-A -634G>C polymorphism with the 5-year survival in the univariate analysis. The genotype CT (HR = 2.79) and CC (HR = 4.67) of the polymorphism VEGF-A -1498C>T and the genotype CC (HR = 3.76) of the polymorphism VEGF-A -634C>G acted as an independent prognostic factor for the risk of death in CRC patients.

CONCLUSION

The CT and CC genotypes of the VEGF-A -1498C>T and the CC genotype of the VEGF-A -634C>G polymorphisms are prognostic factors of survival in Brazilians patients with sporadic colorectal carcinoma.

The pathological behaviors and prognostic factors of Chinese and Japanese colorectal cancers from general hospitals: a comparative study of the inpatients with surgical operation

Here, we collected the information of 17304 and 2014 inpatients with colorectal cancer (CRC) from general hospitals of China and Japan respectively, and analyzed microscopic and macroscopic aspects, even stratified by the age and gender. It was found that Chinese CRC patients showed younger prone, more rectal and ascending cancers, less sigmoid and transverse cancers, larger size, less invasion into lymphatic system or metastasis into lymph node, and poorer differentiation than Japanese ones (p < 0.05). TNM staging was employed as an independent factor for the prognosis of the CRC patients regardless of the country (p < 0.05). Female patients showed larger tumor size, easier invasion and metastasis into lymphatic system, and worse differentiation than males (p < 0.05). The younger patients displayed frequent invasion and metastasis into lymphatic system, and poor differentiation in comparison to elder ones (p < 0.05). These findings demonstrated that Japanese patients seemed to have more invasion and metastasis due to standard and precise operation and pathological diagnosis accuracy. Actually, Chinese patients had more aggressive pathological characteristics and a poorer prognosis. Therefore, it is essential to establish a routine screening methodology, a standard treatment system and postoperative diagnosis protocol for the prevention and therapeutics of Chinese CRC patients, especially for female and young patients.

Factors Affecting Survival in Patients with Colorectal Cancer in Shiraz, Iran

BACKGROUND

Colorectal cancer (CRC) is the third most common cancer in the world, and the fourth in Iran in both genders. The aim of this study was to find predictive factors for CRC survival.

MATERIALS AND METHODS

Medical records of 570 patients referred to the radiotherapy oncology department of Shiraz Namazi hospital from 2005 to 2010 were retrospectively analysed. Data were collected by reviewing medical records, and by telephone interviews with patients. Survival analysis was performed using the Cox's regression model with survival probability estimated with Kaplan-Meier curve. The log-rank test was used to compare survival between strata. Data was analyzed with Stata 12.

RESULTS

The five-year survival rate and the mean survival time after cancer diagnosis were 58.5% and 67±1.4 months. On multivariate analysis, age of diagnosis, disease stage and primary tumor site, lymphovascular invasion and type of treatment (in colon cancer) were significant factors for survival.

CONCLUSIONS

Age of diagnosis and type of treatment (adjuvant therapy in patients with colon cancer) were two modifiable factors related to survival of CRC patients. Therefore earlier diagnosis might help increase survival.

Comparison of survival and clinicopathologic features in colorectal cancer among African American, Caucasian, and Chinese patients treated in the United States: Results from the surveillance epidemiology and end results (SEER) database

African American patients of colorectal cancer (CRC) were found to have a worse prognosis than Caucasians, but it has not been fully understood about the survival difference among Chinese and these two races above. In this study, we used the Surveillance, Epidemiology and End Results database to analyze the survival difference among these three race/ethnicities in the United States. Adenocarcinoma patients of colorectal cancer with a race/ethnicity of Caucasian, Chinese and African American were enrolled for study. Patients were excluded if they had more than one primary cancer but the CRC was not the first one, had unknown cause of death or unknown survival months. The 5-year cause specific survival (CSS) was our primary endpoint. Totally, there were 585,670 eligible patients for analysis. Chinese patients had the best and African American patients had the worst 5-year CSS (66.7% vs 55.9%), P < 0.001. The 5-year CSS for Caucasian patients was 62.9%. Race/ethnicity was an independent prognostic factor in the multivariate analysis, P < 0.001. The comparison of clinicopathologic factors among these three race/ethnicities showed that the insurance coverage rate, income, percentage that completing high school and percentage of urban residence was lowest in the African American patients. Chinese patients had the highest percentage of married, while African American patients ranked lowest. More African American patients were diagnosed as stage IV and had high percentage of signet ring cell and mucinous adenocarcinoma. It is likely that biological differences as well as socioeconomic status both contribute to the survival disparity among the different race/ethnicities.

The number of metastatic lymph nodes exhibiting poorly differentiated clusters predicts survival in patients with pStage III colorectal cancer

PURPOSE

Many studies have proposed alternative designations for lymph node (LN) status in colorectal cancer (CRC); however, knowledge of histopathological features in metastatic lymph nodes (MLNs) is limited. This study investigated the clinicopathological significance of poorly differentiated clusters (PDCs) in MLNs.

METHODS

Slides from 159 patients with pathological Stage III CRC were reviewed. Those with <12 dissected LNs (DLNs) were ineligible. PDCs composed of ≥5 cancer cells lacking full glandular formation and ≥10 PDCs under ×20 objective lens were defined as positive, and the number of MLNs with positive PDCs (MLNs-PDCs) was counted. Results were correlated with patient survival and comparisons made with other indications of LN status.

RESULTS

The mean numbers of MLNs and MLNs-PDCs were 2.8 and 1.0, respectively, and were moderately and positively correlated with each other. Univariate analysis identified cutoffs of ≥5 MLNs (86 vs. 55%, p = 0.024), ≥2 MLNs-PDCs (85 vs. 63%, p = 0.008), and ≥30% LN ratio (85 vs. 44%, p = 0.036) to indicate a positive LN status. However, no cutoff for DLNs was obtained. MLNs-PDCs (≥2) were associated with pT4 tumor (p = 0.0035), open surgery (p = 0.016), greater number of MLNs (p < 0.0001), and positive-PDC primary tumor (p < 0.0001). In multivariate analysis, a prognostic model incorporating ≥2 MLNs-PDCs provided the lowest Akaike information criterion value; consequently, both pT4 tumors (p < 0.001) and ≥2 MLNs-PDCs (p = 0.038) were revealed to be significant prognosticators.

CONCLUSION

Results showed that applying the number of MLNs-PDCs could improve stratification in pStage III CRC and may be a valuable candidate for LN status.

Synchronous Resectable Metastatic Colorectal Cancer: Lymph Node Involvement Predicts Poor Outcome

To evaluate the value of lymph node status of primary tumors in predicting the prognosis of synchronous resectable metastatic colorectal cancer (mCRC).The characteristics of resectable mCRC are substantially different from other cancers, and the prognostic factors of resectable mCRC are still controversial.The data of 2007 patients with mCRC who received resection of the primary tumors and metastatic lesions synchronously were reviewed from the Surveillance, Epidemiology and End-Result database. The Kaplan-Meier method was used to evaluate the capacity of different prognostic factors. Univariate and multivariate logistic regression models were used to evaluate the relationship between the lymph node status and other factors. The mRNA profiles of primary resectable mCRC tumors were obtained by microarray at our center.The median survival times were 50, 36, 32, 27, and 19 months in the N0-stage, N1a-stage, N1b-stage, N2a-stage, and N2b-stage subgroups according to the 7th American Joint Committee on Cancer (AJCC) Tumor Lymph Node Metastasis (TNM) N-classification (P = 0.000), and 40, 29, 22, and 15 months in patients with metastatic lymph node ratio (LNR) <0.25, 0.25-0.49, 0.5-0.74, and ≥0.75 subgroups (P = 0.000). In the COX model, the 7th AJCC TNM N-stage and LNR were independent prognostic factors. The mRNA profile was not associated with lymph node involvement.Both the N-stage according to the 7th AJCC TNM staging system and LNR had the capacity to subclassify synchronous resectable mCRC with different prognoses. The lymph node might be integrated into the AJCC staging system as a diagnose-delay prognostic factor for stage IV disease.

Intestinal obstruction: predictor of poor prognosis in colorectal carcinoma?

OBJECTIVES

The goal of this study was to assess the relationship between intestinal obstruction and the prognosis of colorectal carcinoma.

METHODS

Data pertaining to 4,501 colorectal carcinoma patients were extracted from the national colorectal registry and analysed. Survival analysis was performed using the Kaplan-Meier method. The log-rank test was used to compare the survival rate between patients with intestinal obstruction and those without intestinal obstruction. The p-values<0.05 were considered to indicate statistical significance. Simple Cox proportional hazards regression analysis was used to estimate the crude hazard ratio of mortality from colorectal cancer.

RESULTS

Intestinal obstruction was reported in more than 13% of patients. The 3-year survival rate after treatment was 48.3% (95% confidence interval [CI], 43.9 to 52.8) for patients with intestinal obstruction (n=593) and 54.9% (95% CI, 53.1 to 56.6) for patients without intestinal obstruction (n=3,908). The 5-year survival rate for patients with intestinal obstruction was 37.3% (95% CI, 31.9 to 42.8), which was lower than that of patients without intestinal obstruction (45.6%; 95% CI, 43.5 to 47.7). After adjusting the hazard ratio for other prognostic variables, intestinal obstruction had a statistically significant negative correlation with the survival rate of colorectal cancer patients, with an adjusted hazard ratio of 1.22 (p=0.008).

CONCLUSIONS

The presence of intestinal obstruction is associated with a lower survival rate among colorectal cancer patients.

Neurokinin-2 receptor polymorphism predicts lymph node metastasis in colorectal cancer patients

To analyze the single nucleotide polymorphisms (SNPs) of two subtypes of neurokinin (NK) receptors, NK1R and NK2R (also known as TAC1R and TAC2R), in colorectal cancer (CRC), peripheral blood samples were collected from 199 CRC patients. Direct-sequencing was performed to identify the NK1R rs10198644 and NK2R rs4644560 SNPs. Genotype results were correlated with clinical factors. The allele frequencies of NK1R rs10198644 GC, CC and GG were 52, 17 and 31%, respectively, while that of NK2R rs4644560 GC, CC, and GG were 36, 50 and 14%, respectively. Patients with NK2R rs4644560 GC exhibited more positive lymph nodes than those with CC (mean, 2.2 vs. 1.3; P=0.016). Further analysis highlighted that the number of positive lymph nodes was also increased in the NK2R rs4644560 GC/NK1R rs10198644 GG group compared with the NK2R rs4644560 GG/NK1R rs10198644 GG group (mean, 2.2 vs. 0.9; P=0.04). These data suggested that the NK2R rs4644560 GC polymorphism alone or combination with NK1R rs10198644 GG may be a promising prognostic marker of lymph node metastasis in CRC patients.

Can composite performance measures predict survival of patients with colorectal cancer?

AIM: To assess the relationship between long-term colorectal patient survival and methods of calculating composite performance scores.

METHODS: The Taiwan Cancer Database was used to identify patients who underwent bowel resection for colorectal adenocarcinoma between 2003 and 2004. Patients were assigned to one of three cohorts based on tumor staging: cohort 1, colon cancer stage < III; cohort 2, colon cancer stage III; cohort 3, rectal cancer. A composite performance score (CPS) was calculated for each patient using five different aggregating methods, including all-or-none, 70% standard, equal weight, analytic hierarchy process (AHP), and principal component analysis (PCA) algorithms. The relationships between CPS and five-year overall, disease-free, and disease-specific survivals were evaluated by a Cox proportional hazards model. A goodness-of-fit analysis for all five methods was performed using Akaike’s information criterion.

RESULTS: A total of 3272 colorectal cancer patients (cohort 1, 1164; cohort 2, 790; cohort 3, 1318 patients) with a mean age of 65 years were enrolled in the study. Bivariate correlation analysis showed that CPS values from the equal weight method were highly correlated with those from the AHP method in all cohorts (all P < 0.05). Multivariate Cox hazards analysis showed that CPS values derived from equal weight and AHP methods were significantly associated with five-year survivals of patients in cohorts 1 and 2 (all P < 0.05). In these cohorts, higher CPS values suggested a higher probability of five-year survival. However, CPS values derived from the all-or-none method did not show any significant process-outcome relationship in any cohort. Goodness-of-fit analyses showed that CPS values derived from the PCA method were the best fit to the Cox proportional hazards model, whereas the values from the all-or-none model showed the poorest fit.

CONCLUSION: CPS values may highlight process-outcome relationships for patients with colorectal cancer in addition to evaluating quality of care performance.

Young patients (≤ 35 years old) with colorectal cancer have worse outcomes due to more advanced disease: a 30-year retrospective review

An appropriate cutoff of age and the impact of age on colorectal cancer outcomes remain unclear and need to be explored, particularly in China.In total, 2460 colorectal cancer patients were studied retrospectively. All patients were divided into 6 groups according to their ages at the time of diagnosis: ≤ 30, 31 to 35, 36 to 40, 41 to 45, 46 to 50, and ≥ 50 years. A suitable cutoff age for defining young adult colorectal cancer was explored according to the distribution of survival in each group. Clinical characteristics and prognosis between the young adult group and the older group were then compared.According to the survival curves for each group, 35 years old was considered a suitable cutoff age for defining young adult colorectal cancer. There were 140 (5.7%) and 2320 (94.3%) cases in the young adult and older groups, respectively. The proportion of stage III-IV tumors was significantly higher in the young adult group (69.3%) than in the older group (46.4%) (P  =  0.000). The univariate analysis showed that the 5-year overall survival (OS) rate and the 10-year OS rate in the young adult group were 48.9% and 38.6%, respectively, whereas in the older group, they were 63.6% and 56.9%, respectively. The young adult group had a worse prognosis (P  =  0.000). The multivariate analysis showed that age was not an independent prognostic factor (relative risk 0.787, P  =  0.062). After adjusting for tumor stage, the hazard proportion of death in the young adult group increased by 27.6%, but this difference was not significant (P  =  0.053). Stratified analyses showed that the young adults with stage IV tumors had a worse survival rate (P  =  0.046).Patients ≤ 35 years who were diagnosed with colorectal cancer had a worse prognosis because of a higher proportion of advanced stage tumors. When stage-to-stage analysis was performed, it was found that young adult colorectal cancer patients had a worse outcome only if they had stage IV tumors.

Effects of different Chinese medicine treatments on postoperative relapse and metastasis of colorectal cancer: A non-interventional clinical study

AIM: To analyze the effects of three different Chinese medicine treatments, Fuzheng, Quxie and Fuzhengquxie, on postoperative relapse and metastasis of colorectal cancer (CRC).

METHODS: The data were collected on the basis of non-interventional clinical research. Life-table, Wilcoxon (Gehan) test and Cox proportional hazard model (multivariate analysis) were used to reveal the effect of Chinese medicine treatments on relapse and metastasis of postoperative CRC.

RESULTS: The results of life-table analysis and Wilcoxon (Gehan) test showed that there were significant correlations between DFS and TNM stage (P = 0.000), age (P = 0.045), histopathologic differentiation (P = 0.000), radiotherapy (P = 0.000) and Chinese medicine treatment (P = 0.001). The differences between Fuzheng vs control, Quxie vs control and Fuzhengquxie vs control were all statistically significant (P = 0.000, 0.005, 0.019, respectively). Cox multivariate analysis showed that TNM stage, age, histopathologic differentiation, radiotherapy and Chinese medicine treatment were all independent influencing factors, among which Chinese medicine treatment was a protective one. Pairwise comparisons of Fuzheng, Quxie and Fuzhengquxie revealed that there were no statistical differences (P > 0.05 for all) in the 3- and 5-year accumulative survival rates (YDFSR), however, the 10-YDFSR and median DFS were longer in the Quxie group than in the other two groups (47.00% vs 33.00%, 32.00%; 91.28 mo vs 44.84 mo, 52.45 mo; P < 0.05 for all).

CONCLUSION: The Chinese medicine treatments directed by therapeutic guidance of Fuzheng, Quxie and Fuzhengquxie can all inhibit postoperative relapse and metastasis of CRC. In the prevention of postoperative relapse and metastasis of CRC with Chinese medicine therapy, we do not have to limit to any of the three Chinese medicine treatments, but should focus on treatment based on syndrome differentiation. After patients achieve 5-year DFS, the appropriate application of Fuzheng therapy on the basis of syndrome differentiation and treatment may contribute to better long-term DFS.

Smoothelin and caldesmon are reliable markers for distinguishing muscularis propria from desmoplasia: a critical distinction for accurate staging colorectal adenocarcinoma

An accurate distinction between deep muscularis propria invasion versus subserosal invasion by colonic adenocarcinoma is essential for the accurate staging of cancer and subsequent optimal patient management. However, problems may arise in pathologic staging when extensive desmoplasia blurs the junction between deep muscularis propria and subserosal fibroadipose tissue. To address this issue, forty-three (43) cases of colonic adenocarcinoma resections from 2007-2009 at The Methodist Hospital in Houston, TX were reviewed. These cases were selected to address possible challenges in differentiating deep muscularis propria invasion from superficial subserosal invasion based on H&E staining alone. Immunohistochemical staining using smooth muscle actin (SMA), smoothelin, and caldesmon were performed on 51 cases: 8 cases of pT1 tumors (used mainly as control); 12 pT2 tumors; and 31 pT3 tumors. All 51 (100%) had diffuse, strong (3+) immunoreactivity for caldesmon and smoothelin in the muscularis propria with a granular cytoplasmic staining pattern. However, the desmoplastic areas of these tumors, composed of spindled fibroblasts and myofibroblasts, showed negative immunostaining for caldesmon and smoothelin (0/35). SMA strongly stained the muscularis propria and weakly (1+) or moderately (2+) stained the spindled fibroblasts in the desmoplastic areas (the latter presumably because of myofibroblastic differentiation). Compared to SMA, caldesmon and smoothelin are more specific stains that allow better delineation of the muscularis propria from the desmoplastic stromal reaction which provides a critical aide for proper staging of colonic adenocarcinoma and subsequent patient care.

Insulin-like growth factor-1 induces lymphangiogenesis and facilitates lymphatic metastasis in colorectal cancer

AIM: To investigate the expression of insulin-like growth factor-1 (IGF-1)/insulin-like growth factor-1 receptor (IGF-1R) in colorectal cancer (CRC) tissues and to analyze their correlation with lymphangiogenesis and lymphatic metastasis.

METHODS: Immunohistochemistry was used to evaluate IGF-1 and IGF-1R expression and lymphatic vessel density (LVD) in 40 CRC specimens. The correlation between IGF-1/IGF-1R and LVD was investigated. Effects of IGF-1 on migration and invasion of CRC cells were examined using transwell chamber assays. A LoVo cell xenograft model was established to further detect the role of IGF-1 in CRC lymphangiogenesis in vivo.

RESULTS: Elevated IGF-1 and IGF-1R expression in CRC tissues was correlated with lymph node metastasis (r = 0.715 and 0.569, respectively, P < 0.05) and tumor TNM stage (r = 0.731 and 0.609, P < 0.05). A higher LVD was also found in CRC tissues and was correlated with lymphatic metastasis (r = 0.405, P < 0.05). A positive correlation was found between LVD and IGF-1R expression (r = 0.437, P < 0.05). Transwell assays revealed that IGF-1 increased the migration and invasion of CRC cells. In vivo mouse studies showed that IGF-1 also increased LVD in LoVo cell xenografts.

CONCLUSION: IGF-1/IGF-1R signaling induces tumor-associated lymphangiogenesis and contributes to lymphatic metastasis of CRC.