Overexpression of G protein-coupled receptor 31 as a poor prognosticator in human colorectal cancer

AIM To investigate the expression of G protein-coupled receptor 31 (GPR31) and its clinical significance in human colorectal cancer (CRC).METHODS To determine the association between the GPR31 expression and the prognosis of patients, we obtained paraffin-embedded pathological specimens from 466 CRC patients who underwent initial resection. A total of 321 patients from the First Affiliated Hospital of Sun Yat-sen University from January 1996 to December 2008 were included as a training cohort, whereas 145 patients from the Sixth Affiliated Hospital of Sun Yat-sen University from January 2007 to November 2008 were included as a validation cohort. We examined GPR31 expression levels in CRC tissues from two independent cohorts via immunohistochemical staining. All patients were categorized into either a GPR31 low expression group or a GPR31 high expression group. The clinicopathological factors and the prognosis of patients in the GPR31 low expression group and GPR31 high expression group were compared.RESULTS We compared the clinicopathological factors and the prognosis of patients in the GPR31 low expression group and GPR31 high expression group. Significant differences were observed in the number of patients in pM classification between patients in the GPR31 low expression group and GPR31 high expression group (P = 0.007). The five-year survival and tumor-free survival rates of patients were 84.3% and 82.2% in the GPR31 low expression group, respectively, and both rates were 59.7% in the GPR31 high expression group (P < 0.05). Results of the Cox proportional hazard regression model revealed that GPR31 upregulation was associated with shorter overall survival and tumor-free survival of patients with CRC (P < 0.05). Multivariate analysis identified GPR31 expression in colorectal cancer as an independent predictive factor of CRC patient survival (P < 0.05).CONCLUSION High GPR31 expression levels were found to be correlated with pM classification of CRC and to serve as an independent predictive factor of poor survival of CRC patients.

Male gender is associated with an increased risk of anastomotic leak in rectal cancer patients after total mesorectal excision

Background:The impact of a patient’s gender on the development of anastomotic leak(AL)in rectal cancer patients following total mesorectal excision(TME)remains controversial.The aim of this study was to evaluate the association between patients’gender and the risk of AL.Methods:All rectal cancer patients following TME with a primary anastomosis during the study period from 2010 to 2014 were examined.Comparisons of the post-operative AL incidence rate between male and female patients were performed.Results:Of all patients examined(n¼956),587(61.4%)were males and 369(38.6%)were females.Male patients were more likely to have a history of smoking and drinking alcohol,but less likely to have a history of abdominal surgery compared to female patients.A higher incidence rate of pre-operative bowel obstruction and larger tumor volume in male patients was observed in our study.Of all the patients,81(8.5%)developed post-operative AL.More male patients(n¼62,10.6%)suffered from AL than females(n¼19,5.1%)(P¼0.003).Multivariate logistic regression analyses confirmed the association between male gender and AL[odds ratio(OR):2.41,95%confidence interval(CI):1.37–4.23,P¼0.002].Similar results were also obtained in patients who underwent laparoscopic TME(OR:2.11,95%CI:1.15–3.89,P¼0.016).Conclusions:Male patents were found to have an increased risk for AL following TME with a primary anastomosis.A temporary protecting stoma may help to protect the anastomosis and lessen the risk for AL especially in male patients.

Nomogram for predicting overall survival time of patients with stageⅣcolorectal cancer

Background Prognosis varies among stageⅣcolorectal cancer(CRC).Our study aimed to build a robust prognostic nomogram for predicting overall survival(OS)of patients with stageⅣCRC in order to provide evidence for individualized treatment.Method We collected the information of 16,283 patients with stageⅣCRC in the Surveillance,Epidemiology,and End Results(SEER)database and then randomized these patients in a ratio of 7:3 into a training cohort and an internal validation cohort.In addition,501 patients in the Sixth Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)database were selected and used as an external validation cohort.Univariate and multivariate Cox analyses were used to screen out significant variables for nomogram establishment.The nomogram model was assessed using time-dependent receiveroperating characteristic curve(time-dependent ROC),concordance index(C-index),calibration curve,and decision curve analysis.Survival curves were plotted using the Kaplan–Meier method.Result The C-index of the nomogram for OS in the training,internal validation,and external validation cohorts were 0.737,0.727,and 0.655,respectively.ROC analysis and calibration curves pronounced robust discriminative ability of the model.Further,we divided the patients into a high-risk group and a low-risk group according to the nomogram.Corresponding Kaplan–Meier curves showed that the prediction of the nomogramwas consistent with the actual practice.Additionally,model comparisons and decision curve analysis proved that the nomogram for predicting prognosis was significantly superior to the tumor-node-metastasis(TNM)staging system.Conclusions We constructed a nomogram to predict OS of the stageⅣCRC and externally validate its generalization,which was superior to the TNM staging system.

Endoscopic management of delayed bleeding after polypectomy of small colorectal polyps:two or more clips may be safe

Background:The resection of small colorectal polyps(≤10mm)is routine for endoscopists.However,the management of one of its main complications,namely delayed(within 14 days)postpolypectomy bleeding(DPPB),has not been clearly demonstrated.We aimed to assess the role of coloscopy in the management of DPPB from small colorectal polyps and identify the associated factors for initial hemostatic success.Methods:We conducted a retrospective study of 69 patients who developed DPPB after the removal of colorectal polyps of≤10mmand underwent hemostatic colonoscopy at the Sixth Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between April 2013 and June 2021.Demographics,clinical variables,and colonoscopic features were collected independently.We applied univariate and multivariate analyses to assess factors associated with initial hemostatic success.Results:General colonoscopy without oral bowel preparation was successfully performed in all the patients,with a median duration of 23.9(12.5–37.9)minutes.Among 69 patients,62(89.9%)achieved hemostasis after initial hemostatic colonoscopy and 7(10.1%)rebled 2.761.1 days after initial colonoscopic hemostasis and had rebleeding successfully controlled by one additional colonoscopy.No colonoscopy-related adverse events occurred.Multivariate analysis showed that management with at least two clips was the only independent prognostic factor for initial hemostatic success(odds ratio,0.17;95%confidence interval,0.03–0.91;P=0.04).All the patients who had at least two clips placed at the initial hemostatic colonoscopy required no further hemostatic intervention.Conclusions:Colonoscopy is a safe,effective,and not too time-consuming approach for the management of patients with DPPB of small colorectal polyps and management with the placement of at least two hemoclips may be beneficial.