Clinical features and prognosis in colorectal cancer patients with different ethnicities in Northwest China

AIM:To compare the clinical factors and tumor characteristics that predict survival in colorectal cancer(CRC)patients with different ethnicities in Xin Jiang area.METHODS:A total of 1421 histopathologically confirmed sporadic CRC patients who were either Han/Chinese or Uyghur were identified and enrolled from a database of both diagnoses and operative procedures from Xin Jiang Tumor Hospital,which is affiliated to Xin Jiang Medical University between 2000 and 2007.Patients with family histories of CRC,hereditary nonpolyposis CRC,familial adenomatous polyposis,inflammatory bowel disease,carcinoid,squamous carcinoma or melanoma were excluded.The two ethnic groups were compared with regard to clinical features,tumor characteristics,disease stage,overall survival rate,diseasefree survival rate and cancer-specific survival rate.The factors predicting long-term survival were assessed via both univariate and multivariate analysis.RESULTS:Among the 1421 patients with CRC enrolled in this study,1210 patients were Han/Chinese(mean age,62.3±4.5 years;range,19-92 years),while 211patients were Uyghur(mean age,52.4±15.6 years;range,17-87 years).There were significant differences in proportions of gender,age,blood type,occupation and histopathological type between the Han/Chinese and Uyghur patients(P<0.05).The median overall,disease-free and cancer-specific survival time were 45,62and 65 mo for the Han/Chinese patients and 42,49 and61 mo for the Uyghur patients(P=0.000,P=0.005,P=0.007).The cumulative 5-year survival of the Uyghur patients was significantly worse than that of the Han patients(P=0.000).A multivariate analysis showed that age,ethnicity,histopathological type,differentiation,T(Infiltration depth),N(Lymph node metastasis),staging,postoperative metastasis and metastatic site(P<0.05)were found to be the prognostic factors.CONCLUSION:The Uyghur CRC patients are associated with significantly younger age,more aggressive histopathologic characteristics and have significantly worse prognosis than the Han/Chinese patients.

Expression of trefoil factors and TWIST1 in colorectal cancer and their correlation with metastatic potential and prognosis

AIM To detect the expression of trefoil factors (TFFs) and TWIST1 in colorectal cancer (CRC) and analyze their correlation with metastasis and survival. METHODS This study examined the expression of TFF1, TFF3 and TWIST1 in a total of 75 tumor samples, 47 matched normal samples (15 cm from the lesion margin), 30 metastatic lymph nodes, and 10 liver metastatic cancer samples from patients with CRC. The relationship was then analyzed between the protein expression and different clinical records. TFF1, TFF3, TWIST1, E-cadherin, vimentin and beta-catenin mRNA and protein expression levels were measured in colon cancer cell lines with different metastatic potentials (HIEC, HT29, SW620, and LoVo cells), and the correlation of the expression levels with epithelial-mesenchymal transition (EMT) was discussed. RESULTS It was found that 66.7% (50/75), 78.7% (59/75) and 54.7% (41/75) of tumor tissue samples exhibited positive staining for TFF1, TFF3 and TWIST1 and so did 27.3% (13/47), 100% (47/47) and 17% (8/47) of adjacent normal colorectal tissues. Compared with adjacent normal tissues, significant differences were found in the expression of all three proteins in different cancerous tissues (P < 0.05). Higher expression of TFF3 and TWIST1 was significantly correlated with lymph node metastasis (P = 0.034, P = 0.000), advanced stage (P = 0.031, P = 0.003), and poorer survival (P = 0.042 for the TFF3 group, P = 0.003 for the TWIST1 group). The expression of TFF3 and TWIST1 in cancer cell lines was higher than that in HIEC (a normal human intestinal epithelial cell line)(P < 0.05), and the expression intensity demonstrated a tendency to rise with increased metastatic potential both at the protein and mRNA levels. However, TFF1 expression demonstrated the opposite tendency. It was also observed that the expression of E-cadherin and beta-catenin tended to decrease while that of vimentin, TWIST1 and Snail tended to rise with the increase in metastatic potential. CONCLUSION The expression of TFF3 and TWIST1 might be associated with the survival of patients with CRC after curative resection and might be pivotal predictors of disease progression. TFF3 may be correlated to the invasiveness of CRC.