Myc诱导的核抗原53在结直肠癌中的表达及其与病理特征的关系

目的探讨Myc诱导的核抗原53(mina53)在结直肠癌中的表达及其与病理特征的关系。方法选择初治的结直肠癌患者341例作为研究对象,取所有患者的病灶组织标本(病灶组)与癌旁正常结直肠黏膜组织(癌旁组),采用免疫组化法检测mina53表达水平,调查患者的病理特征、预后并进行相关性分析。结果病灶组mina53表达阳性率为55.1%,显著高于癌旁组的19.6%(P<0.05)。mina53表达阳性与结直肠癌患者年龄、性别、部位、直径无相关性(P>0.05),与分化程度、临床分期、浆膜浸润有相关性(P<0.05)。所有患者均随访到2020年7月1日,随访死亡48例,死亡率14.1%。多因素Cox比例风险回归分析显示:分化程度、临床分期、浆膜浸润、mina53表达阳性为导致患者预后死亡的主要因素(P<0.05)。结论mina53在结直肠癌中呈现高表达状况,与患者的分化程度、临床分期、浆膜浸润等病理特征显著相关,也是影响患者预后的重要因素。

腹腔镜在中低位结直肠癌姑息切除术中的应用效果分析

目的探讨腹腔镜姑息切除术在中低位结直肠癌患者中的应用效果。方法将42例Ⅳ期中低位结直肠癌患者随机分为两组,各21例。两组均给予结直肠癌姑息性切除术治疗,观察组采用腹腔镜治疗,对照组采用开腹治疗。观察两组手术及术后情况,患者均随访6个月,观察治疗期间并发症及治疗效果。结果观察组手术时间长于对照组(P<0.01),术中出血量少于对照组(P<0.01),术后肠道功能恢复时间及住院时间均短于对照组(P<0.01);观察组优良率高于对照组(P<0.05);观察组近期并发症发生率低于对照组(P<0.05),两组均未见远期并发症发生。结论中低位结直肠癌腹腔镜姑息切除术可有效减少出血量,缩短肠道功能恢复时间及住院时间,降低术后并发症,提高患者生活质量。

Changing patterns of colorectal cancer in China over a period of 20 years

AIM： To determine whether any changes have occurred on the patterns of colorectal cancer in China. METHODS： Data from 21 Chinese articles published from 1980 to 1999, were used to analyze the time trend of colorectal cancer according to the patients＇age at diagnosis, sex, the site of the tumor, stage, and the pathology. RESULTS： From 1980s to 1990s, the mean age of the colorectal cancer patients has increased. The percentage of the female patients rose. The distribution of colorectal carcinoma shows a predominance of rectal cancer. However, the proportion of proximal colon cancer （induding transverse and ascending colon） increased significantly accompanied by a decline in the percentage of rectal cancer. Similarity in the percentage of distal colon cancer between two decades was revealed. In the 1990s, statistically more Stage B patients were found than those in 1980s. In addition, databases show a significant decrease in the Stage D cases. The proportion of adenocarcinoma increased, but the mucinous adenocarcinoma decreased during two decades. CONCLUSION： These findings indicate that the pattern of colorectal cancer in China has been changing. Especially, a proximal shift due to the increasing proportion of ascending and transverse colon cancer has occurred in China.

Bevacizumab as a second- or later-line of treatment for metastatic colorectal cancer

AIM: To determine the efficacy of bevacizumab in patients with metastatic colorectal cancer (MCRC) who have failed prior chemotherapy without bevacizumab. METHODS: Between March 2002 and June 2010, 40 patients in South Korea with MCRC who were treated with bevacizumab plus chemotherapy as a second or later-line treatment were analyzed retrospectively for their overall response rate (ORR), overall survival (OS), and progression-free survival (PFS). The tumor responses were assessed using the RECIST (Response Evaluation Criteria in Solid Tumors) guidelines. RESULTS: All of the patients had progressed under prior chemotherapy without bevacizumab. Three patients (7.5%) exhibited an ORR, twenty one patients (52.5%) exhibited stable disease (SD), and fifteen patients (37.5%) exhibited disease progression. The median duration of the OS and PFS were 14.0 and 6.13 mo respectively. The median OSs were 16.60, 14.07 and 13.00 mo for second-line, third-line and fourth- or later-line treatments, respectively. The median PFSs were 7.23, 7.30 and 3.87 mo for the second-line, third-line and fourth- or later-line treatments, respectively. CONCLUSION: In patients with MCRC, bevacizumab combined chemotherapy may be beneficial during second- or later-line treatment.

Detection of hMSH2 and hMLH1 mutations in Chinese hereditary non-polyposis colorectal cancer kindreds

AIM： To establish and validate the mutation testing for identification and characterization of hereditary non-polyposis colorectal cancer （HNPCC） in suspected Chinese patients. METHODS： Five independent Chinese kindreds with HNPCC fulfilling the classical Amsterdam criteria were collected. Genomic DNA was extracted after informed consent was obtained. The coding region of hMSH2 and hMLH1 genes was detected by polymerase chain reaction （PCR） and denaturing high-performance liquid chromatography （DHPLC）. Mutations identified in the proband by DHPLC were directly sequenced using a 377 DNA sequencer, analyzed with a basic local alignment tool （BLAST）, and tested in the corresponding family members by direct DNA sequencing. RESULTS： Mutations were identified in two Chinese HNPCC kindreds. One was the missense mutation of hMSH2 c.1808A→G resulting in Asp 603 Gly identified in the proband of the fifth HNPCC （HNPCCS） kindred. In the HNP5 kindred, three family members were found to have this mutation and two of them had colorectal cancer. The other mutation of hMLH1 c.1882A→G was identified in the HNP2 kindred＇s proband, which might be the nonsense mutation analyzed by BLAST. CONCLUSION： Pedigree investigation and mutation testing of hMSH2 and hMLH1 are the practical methods to identify high-risk HNPCC patients in China.

Pharmacological intervention of traditional Chinese medicine for the quality of life in patients with colorectal cancer： a systematic review and meta-analysis

Objective： The objective of this study is to evaluate the impact of various traditional Chinese medicine （TCM）approaches on the quality of life in patients with colorectal cancer. Methods： In this study, we systematically performedthe screening of randomized controlled trials from Cochrane Library, Pubmed, Embase, Medline, and Web of Science.The data were extracted by two reviewers independently, and then risk assessment was performed. All the analyses wereconducted using Review Manager 5.3. Results： A total of 18 eligible studies containing 1312 patients were included.Experimental group were treated with TCM combined with Western medicine or TCM alone （N = 688） and controlgroup were treated with Western medicine treatment alone （N = 624）. The results showed that the recent clinicalefficiency between the two groups was not statistically significant （P = 0.06）. KPS scores of the experimental group werehigher than those in the control group [P 〈 0.001, WMD = 9.60, 95%CI = （5.62, 13.57）]. The toxicity comparisonshowed that the occurrence of toxicities, such as leucopenia, thrombocytopenia, nausea and vomiting, diarrhea, andneurotoxicity in the experimental group was lower than that in the control group [P 〈 0.001, OR = 0.31, 95%CI = （0.19,0.50）], [P = 0.003, OR = 0.49, 95%CI = （0.31, 0.78）], [P 〈 0.001, OR = 0.30, 95%CI = （0.16, 0.54）], [P 〈 0.001, OR =0.40, 95%CI = （0.27, 0.58）], and [P 〈 0.001, OR = 0.43, 95%CI = （0.30, 0.61）]. The immunological test comparisondemonstrated that the immunological parameters （CD3, CD4, and CD4/CD8） showed higher values in the experimentalgroup than those in the control group [P 〈 0.001, MD = 5.55, 95%CI = （4.83, 6.28）], [P 〈 0.0001, MD = 6.75, 95%CI =（5.25, 8.26）], and [P = 0.001, MD = 0.26, 95%CI = （0.10, 0.41）]. Conclusions： TCM did not show significant recentclinical efficiency. However, treatment with TCM showed increase in KPS scores in patients with colorectal cancer,alleviation of toxicity associated with chemotherapy, regulation of autoimmunity, and improvement in the quality of lifeof patients.

Racial differences in the anatomical distribution of colorectal cancer:a study of differences between American and Chinese patients

AIM: To compare the racial differences of anatomical distribution of colorectal cancer (CRC) and determine the association of age, gender and time with anatomical distribution between patients from America (white) and China (oriental).METHODS: Data was collected from 690 consecutive patients in Cleveland Clinic Florida, U.S.A. and 870consecutive patients in Nan Fang Hospital affiliated to the First Military Medical University, China over the past 11years from 1990 to 2000. All patients had colorectal adenocarcinoma diagnosed by histology and underwent surgery.RESULTS: The anatomical subsite distribution of tumor,age and gender were significantly different between white and oriental patients. Lesions in the proximal colon (P＜0.001) were found in 36.3 % of white vs 26.0 % of oriental patients and cancers located in the distal colon and rectum in 63.7 % of white and 74 % of oriental patients (P＜0.001). There was a trend towards the redistribution from distal colon and rectum to proximal colon in white males over time, especially in older patients (＞80 years).No significant change of anatomical distribution occurred in white women and Oriental patients. The mean age at diagnosis was 69.0 years in white patients and 48.3 years in Oriental patients (P＜0.001).CONCLUSION: This is the first study comparing the anatomical distribution of colorectal cancers in whites and Chinese patients. White Americans have a higher risk of proximal CRC and this risk increased with time. The proportion of white males with CRC also increased with time.Chinese patients were more likely to have distal CRC and developed the disease at a significantly earlier age than white patients. These findings have enhanced our understanding of the disease process of colorectal cancer in these two races.

Clinical and molecular analysis of hereditary non-polyposis colorectal cancer in Chinese colorectal cancer patients

AIM： To analyze the frequency of hereditary non-polyposis colorectal cancer （HNPCC） in Chinese colorectal cancer （CRC） patients, and to discuss the value of microsatellite instability （MSI） and/or immunohistochemistry （IHC） for MSH2/MLH1 protein analysis as pre-screening tests in China. METHODS： The Amsterdam criteria Ⅰ and Ⅱ （clinical diagnosis） and/or germline hMLHI/hMSH2 mutations （genetic diagnosis） were used to classify HNPCC families. Genetic tests, including microsatellite instability, immunohistochemistry for MSH2/MLH1 proteins and hMSH2/hMLH1 genes, were performed in each proband. RESULTS： From July 2000 to June 2004, 1988 patients with colorectal cancer were analysed and 114 CRC patients （5.7%） from 48 families were categorized as having HNPCC, including 76 from 26 families diagnosed clinically and 38 from the other 22 families diagnosed genetically. The sensitivity and specificity of high MSI and IHC for predicting mutations were 100% and 54%, and 79% and 77%, respectively. CONCLUSION： The frequency of HNPCC is approximately 10% among all Chinese CRC cases. The MSI and IHC detections for hMSH2/hMLH1 proteins are reliable prescreening tests for hMLHI/hMSH2 germline mutations in families suspected of having HNPCC.

Study on the Early Detection and Clinico—pathologic Staging of Colorectal Cancer in China

Objective To confirm an effective and practicable screening model for early detection of colorectal cancer (CRC) , and to modify an acceptable and reasonable staging of CRC for predicting prognosis and to define the therapeutic strategy.Methods Data from 3 case-control studies have been used for selecting the high risk factors of CRC to optimize Sequencing Screening Model (SSM) . The fieldwork recalls have been utilized to compare the sensitivity, specificity and Youden Index between the SSM and the optimized one. The 1722 individuals have been used to evaluate the Optimized Sequencing Screening Model (OPSM). From 1980 to 1995, 1334 cases of CRC pathologically confirmed have been analyzed for 3-, 5- and 10-year survival rates. All tests were performed at the 0.05 level of significances. Statistical analysis was conducted by using the SPSS 10.0 statistic software.Results A simple questionnaire and RPHA-FOB test as the screening model for early detecting CRC had been proved as an optimized screening model. The sensitivity, specificity and Youden Index of the optimized model were higher than those of SSM. From the 1722 individuals 4 Dukes A and 5 Dukes B CRC were screened out. Analysis of the 3-, 5- and 10-year survival rates revealed that there were statistically significant differences between serosa and extraserosa. The 3-, 5- and 10-year survival rates were 0.91?

The efficacy of bevacizumab in Chinese patients with metastatic colorectal cancer and its effect in different line setting

Objective: We aimed to evaluate the effect of bevacizumab in the palliative treatment of Chinese metastatic colorectal cancer(mCRC) and its efficacy in different lines. Methods: Patients of mCRC treated with bevacizumab or not at Sun Yat-sen University Cancer Center from 2005 to 2013 were recruited as the study group and control group. The endpoints were objective response rate(ORR), disease control rate(DCR), overall survival(OS) and progression free survival(PFS). The OS and PFS of first-, second- and third-line treatment groups were compared between study group and control group. Results: The median PFS of the study and the control group were 8.2 months(7.0–9.4 months), 5.7 months(4.7–6.6 months), P = 0.001; OS were 26 months(5.4–130.5 months), 18 months(16.6–19.4 months), P < 0.001, respectively. The ORR and DCR of first-, second- and third-line were 30.3%(20/66), 20%(6/30), 17.6%(3/17) and 97%(64/66), 86.7%(26/30), 100%(17/17). In the first-line chemotherapy group, the OS of the study group and the control group were 22.9(5.4–96.7) months and 18(16.6–19.4) months(P < 0.001); PFS were 9.4(8.4–10.4) months and 5.7(4.7–6.6) months(P < 0.001), respectively. While in the second- and third-line setting, only OS were statistically different, PFS had no significant difference. Conclusion: The combination of bevacizumab and chemotherapy had a promising short-term and long-term efficacy in Chinese mCRC patients than those without bevacizumab regimens, and the effect could be better reflected in the first-line treatment.

Therapeutic targets of Traditional Chinese Medicine for colorectal cancer

OBJECTIVE: To explore the role of Traditional Chinese Medicine(TCM) in the prevention and treatment of colorectal cancer and identify possible therapeutic targets of TCM to provide clues for the use of TCM for colorectal cancer prevention and treatment in the clinic and to find novel directions for new drug discovery for colorectal cancer.METHODS: We used Pub Med and Google to search for and collect scientific publications for a full evaluation of current evidence in the literature indicating the potential role of Chinese herbal medicines and their respective ingredients as effective candidatesforcolorectalcancerpreventionandtreatment.RESULTS: We extracted a detailed description of potential therapeutic Chinese herbal medicines and their constituent ingredients that target different mechanisms in colorectal cancer such as gene mutation, dysregulation of signaling pathways, metabolism disorders, and the inflammatory microenvironment, including both conventional and non-conventional approaches.CONCLUSION: TCM may be a promising complementary and alternative therapy for the treatment of colorectal cancer.

The association between weight stability and parenteral nutrition characteristics and survival in patients with colorectal cancer

Objective:Knowledge about the impact of metabolic disturbances and parenteral nutrition(PN)characteristics on the survival of cancer patients receiving PN is limited.We aimed to assess the association between clinical and PN characteristics and survival in colorectal-cancer patients receiving PN support.Methods:Our study included 572 consecutive colorectal-cancer patients who had received PN support between 2008 and 2013.Patient characteristics,body mass index,weight,medical/surgical history,indication for PN,PN data and survival were recorded.Associations between clinical and PN characteristics and survival were analysed with important confounding factors.Results:The final cohort included 437 evaluable patients,with a mean age of 57 years.Eighty-one percent of the study population had advanced stage of colorectal cancer.Unstable weight(weight change≥2.5%)prior to PN initiation[hazard ratio(HR)=1.41,P=0.023]was adversely associated with survival after adjusting for multiple factors including cancer stage.Bowel obstruction(HR=1.75,P=0.017)as a PN indication was associated with worse survival when compared with without bowel obstruction.Higher PN amino acid by ideal body weight(g•kg^(-1))(HR=0.59,P=0.029)was associated with longer survival,whereas a higher percentage of non-PN intravenous calories(HR=1.04,P=0.011)was associated with shorter survival independently of confounding factors.Conclusions:Body mass index and weight stability can be useful nutritional indices for survival prediction in cancer patients receiving PN.PN planning should take into account of non-PN calories to achieve optimal energy support and balance.Future research is needed to define optimal PN amino-acid requirement and energy balance.