四种血清肿瘤标志物在结直肠癌患者中的诊断体会

探究四种血清肿瘤标志物用于结直肠癌疾病诊断的临床价值。方法:随机抽取本院60例结直肠癌患者为研究组,60例健康体检人员为对照组,两组患者均使用四种血清肿瘤标志物检验,对比分析析两组的检验结果。结果:经检验,研究组患者CEA、CA125、CA199、CA72-4等肿瘤标记物与对照组均有显著差异,P<0.05。结论:对肝硬化患者实施生化检验,具有显著价值。

循证护理应用于结直肠癌病患术后管路护理中的临床效果

探讨结直肠癌患者在术后接受管路护理时,应用循证护理干预措施的临床效果。方法 本次临床实践研究,共选取结直肠癌病患者68例,于2019.02开始收集资料,结束时间为2020.02,共计1年期限。对这一时间段内的患者进行随机分组,运用数字表法可将入选患者均分为研究组、对照组,每组各有34例患者。在实施护理干预期间,对照组沿用常规术后管理护理方法,研究组患者在常规护理基础上,联合应用循证护理。对比患者分组干预后的各项指标,如满意度指标、负性情绪评分、并发症发生率、生活质量评分等。结果 干预后,研究组患者的平均满意度指标,相对高于对照组(P<0.05);研究组患者的焦虑、抑郁等平均分值,均低于对照组(P<0.05);研究组经干预后其并发症发生率,低于对照组(P<0.05);统计研究组生活质量各维度平均分,相对高于对照组患者(P<0.05)。结论 循证护理干预方法,在结直肠癌患者术后的管路护理中,能够发挥良好优势,有助于提升患者满意度、降低焦虑及抑郁等评分、减少并发症出现、切实提升患者生活质量水平,值得推广和应用。

中医辨证维持治疗晚期结直肠癌的临床研究

目的:为了进一步研究中医辨证维持治疗方法在晚期结直肠癌中的临床效果与作用。方法:现择取2018年7月-2019年7月来济宁市中西医结合医院接受治疗的110例晚期结直肠癌患者作为本次试验的研究对象,按照随机分组法将患者分为试验组与对照组,每组患者有55例。对照组患者采用常规的药物治疗方法,试验组采用中医辨证维持治疗方法,在两组患者结束治疗后,收集患者的治疗临床数据,并开展回顾性分析。结果:经过药物治疗后,两组晚期结直肠癌患者都产生了较为显著的临床效果,其中试验组患者的中位无疾病进展时间(Progression Free Survival,PFS)明显优于对照组,差异具有统计学意义(P<0.05);试验组患者的治疗总有效率明显优于对照组;试验组患者在结束治疗后各项免疫指标也明显优于对照组,差异具有统计学意义(P<0.05)。结论:在医院临床治疗晚期结直肠癌疾病中,使用中医辨证维持治疗方法的临床效果要明显优于使用常规药物治疗的效果。患者结束治疗后的各项免疫指标也有明显改善,这为提高患者疾病治疗、改善身体机体免疫功能、提升生命质量都起着积极的促进作用。

Aberrant expression of ether à go-go potassium channel in colorectal cancer patients and cell lines

AIM: To study the expression of ether à go-go (Eag1) potassium channel in colorectal cancer and the relation- ship between their expression and clinico-pathological features. METHODS: The expression levels of Eag1 protein were determined in 76 cancer tissues with paired non- cancerous matched tissues as well as 9 colorectal adenoma tissues by immunohistochemistry. Eag1 mRNA expression was detected in 13 colorectal cancer tissues with paired non-cancerous matched tissues and 4 colorectal adenoma tissues as well as two colorectal cancer cell lines (LoVo and HT-29) by reverse transcription PCR. RESULTS: The frequency of positive expression of Eag1 protein was 76.3% (58/76) and Eag1 mRNA was 76.9% (10/13) in colorectal cancer tissue. Expression level of Eag1 protein was dependent on the tumor size, lymphatic node metastasis, other organ metastases and Dukes’ stage (P < 0.05), while not dependent on age, sex, site and degree of differentiation. Eag1 protein and mRNA were negative in normal colorectal tissue, and absolutely negative in colorectal adenomas except that one case was positively stained for Eag1 protein. CONCLUSION: Eag1 protein and mRNA are aberrantly expressed in colorectal cancer and occasionally expressed in colorectal adenoma. The high frequency of expression of Eag1 in tumors and the restriction of normal expression to the brain suggest the potential of this protein for diagnostic, prognostic and therapeutic purposes.

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.

Fever as the only manifestation of hypersensitivity reactions associated with oxaliplatin in a patient with colorectal cancer Oxaliplatin-induced hypersensitivity reaction

Hypersensitivity reactions （HSR） to oxaliplatin in patients with colorectal cancer include facial flushing, erythema, pruritis, fever, tachycardia, dyspnea, tongue swelling, rash/hives, headache, chills, weakness, vomiting, burning sensations, dizziness, and edema. We report a patient with fever as the sole manifestation of initial HSR, review the literature and discuss the management of HSR. A 57-year-old female with T3N2M0 rectal adenocarcinoma received modified FOLFOX-6. She tolerated the first 8 cycles without any toxicities except grade 1 peripheral neuropathy and nausea. During 9th and 10th infusions, she developed fever to a maximum of 38.3℃ with stable hemodynamic status despite medications. During 11th infusion, she developed grade 3 HSR consisting of symptomatic bronchospasm, hypotension, nausea, vomiting, cough, and fever. On examination, she was pale, cyanotic, with a temperature of 38.8℃, BP dropped to 95/43 mm Hg, pulse of 116/min and O2 saturation of 88%-91%. She was hospitalized for management and recovered in 24 h. Fever alone is not a usual symptom of oxaliplatin HSR. It may be indicative that the patient may develop serious reactions subsequently, as did our patient who developed hypotension with the third challenge. Treatment and prevention consists of slowing the infusion rate, use of steroids and antagonists of Type 1 and 2 histamine receptor antagonists, whereas desensitization could help to provide the small number of patients who experience severe HSR with the ability to further receive an effective therapy for their colorectal cancer.

Clinical outcomes of lung metastasectomy in patients with colorectal cancer

AIM： To investigate prognostic factors of survival fol- lowing curative, non-palliative surgical removal of lung metastases secondary to colorectal cancer （CRC）.

How to select elderly colorectal cancer patients for surgery: a pilot study in an Italian academic medical center

Objective: Cancer is one of the most common diagnoses in elderly patients. Of all types of abdominal cancer, colorectal cancer(CRC) is undoubtedly the most frequent. Median age at diagnosis is approximately 70 years old worldwide. Due to the multiple comorbidities affecting elderly people, frailty evaluation is very important in order to avoid over- or undertreatment. This pilot study was designed to investigate the variables capable of predicting the long-term risk of mortality and living situation after surgery for CRC.Methods: Patients with 70 years old and older undergoing elective surgery for CRC were prospectively enrolled in the study. The patients were preoperatively screened using 11 internationally-validated-frailty-assessment tests. The endpoints of the study were long-term mortality and living situation. The data were analyzed using univariate Cox proportional-hazard regression analysis to verify the predictive value of score indices in order to identify possible risk factors.Results: Forty-six patients were studied. The median follow-up time after surgery was 4.6 years(range, 2.9-5.7 years) and no patients were lost to follow-up. The overall mortality rate was 39%. Four of the patients who survived(4/28, 14%) lost their functional autonomy. The preoperative impaired Timed Up and Go(TUG), Eastern Cooperative Group Performance Status(ECOG PS), Instrumental Activities of Daily Living(IADLs), Vulnerable Elders Survey(VES-13) scoring systems were significantly associated with increased long term mortality risk.Conclusion: Simplified frailty-assessing tools should be routinely used in elderly cancer patients before treatment in order to stratify patient risk. The TUG, ECOG-PS, IADLs and VES-13 scoring systems are potentially able to predict long-term mortality and disability. Additional studies will be needed to confirm the preliminary data in order to improve management strategies for oncogeriatric surgical patients.

Cetuximab plus irinotecan in pretreated metastatic colorectal cancer patients:The ELSIE study

AIM:To evaluate the efficacy and safety of cetuxim-ab plus irinotecan in irinotecan-refractory metastatic colorectal cancer (mCRC) patients from South-East Asia and Australia. METHODS:In this open-label,phase Ⅱ study,the main eligibility criteria were epidermal growth factor receptor-positive mCRC with progressive disease within 3 mo of an irinotecan-based regimen as the most recent chemotherapy. Patients received cetuximab 400 mg/m2 initially,then 250 mg/m2 every week,with the same regimen of irinotecan on which the patients had progressed (4 pre-defined regim-ens allowed). The prim-ary objective was evaluation of progression-free survival (PFS) at 12 wk. Secondary objectives included a further investigation of PFS,and an assessment of the overall response rate (ORR),duration of response,time to treatment failure (TTF),overall survival and the safety profile. RESULTS:One hundred and twenty nine patients were enrolled from-25 centers in the Asia-Pacific region and of these 123 received cetuximab plus irinotecan. The most common recent irinotecan regimen used was 180 mg/m2 every 2 wk which had been used in 93 patients (75.6%). The PFS rate at 12 wk was 50% (95% confidence interval (CI,41-59) and m-edian PFS tim-e was 12.1 wk (95% CI:9.7-17.7). The ORR was 13.8% (95% CI:8.3-21.2) and disease control rate was 49.6% (95% CI:40.5-58.8). Median duration of response was 31.1 wk (95% CI:18.0-42.6) and median overall survival was 9.5 mo (95% CI,7.5-11.7). The median TTF was 11.7 wk (95% CI:9.1-17.4). Treatment was generally well tolerated. The most common grade 3/4 adverse events were diarrhea (13.8%),neutropenia (8.9%),rash (5.7%) and vomiting (5.7%).CONCLUSION:In patients from Asia and Australia,this study confirm-s the activity and safety of cetuxim-ab plus irinotecan observed in previous studies in Europe and South America.

Is proliferative colonic disease presentation changing?

AIM:To compare the site,age and gender of cases of colorectal cancer(CRC) and polyps in a single referral center in Rome,Italy,during two periods.METHODS:CRC data were collected from surgery/pathology registers,and polyp data from colonoscopy reports.Patients who met the criteria for familial adenomatous polyposis,hereditary non-polyposis colorectal cancer syndrome or inflammatory bowel disease were excluded from the study.Overlap of patients between the two groups(cancers and polyps) was carefully avoided.Theχ 2 statistical test and a regression analysis were performed.RESULTS:Data from a total of 768 patients(352 and 416 patients,respectively,in periods A and B) who underwent surgery for cancer were collected.During the same time periods,a total of 1693 polyps were analyzed from 978 patients with complete colonoscopies(428 polyps from 273 patients during period A and 1265 polyps from 705 patients during period B).A proximal shift in cancer occurred during the latter years for both sexes,but particularly in males.Proximal cancer increased > 3-fold in period B compared to period A in males [odds ratio(OR) 3.31,95%CI:2.00-5.47;P < 0.0001).A similar proximal shift was observed for polyps,particularly in males(OR 1.87,95%CI:1.23-2.87;P < 0.0038),but also in females(OR 1.62,95%CI:0.96-2.73;P < 0.07).CONCLUSION:The prevalence of proximal proliferative colonic lesions seems to have increased over the last decade,particularly in males.

Clinical observation of treatment with Yiqi Jianpi decoction combined with FOLFOX4 for the postoperation patients of colorectal cancer

Objective: The aim of the study was to observe the clinical efficacy with Yiqi Jianpi decoction combination with FOLFOX4 for the postoperative patients of colorectal cancer (CRC). Methods: Eighty-five patients were randomly divided into two groups. The treated group (n = 41) received Yiqi Jianpi decoction combined with FOLFOX4 chemotherapy and the control group (n = 44) received FLOFOX4 chemotherapy alone. A treatment course of 6 months was applied to both groups. Results: The life quality, symptomatic improvement and adverse side effects reducing in the treated group were better than those of the control group. Conclusion: Yiqi Jianpi decoction combination with FOLFOX4 chemotherapy is effective in the treatment of the postoperative patients with colorectal cancer.

Common toxicities and objective response rate in metastatic colorectal cancer patients treated with irinotecan based regimens

Objective： The aim of our study was to investigate if common toxicities are correlated to objective response rate （ORR） in metastatic colorectal cancer （mCRC） patients treated by irinotecan based regimens. Methods： Univadate and multivariate logistic regression analyses were performed to evaluate correlations between common toxicities and binary ORR in 106 mCRC patients from a prospective cohort treated with irinotecan based regimens. Results： The most frequent severe toxicities （Grade 3/4） were as follows： neutropenia （27.4%）, diarrhea （16.9%）, leucopenia （12.6%）, vomiting （3.2%） and thrombocytopenia （2.1%）. Thrombocytosis was observed in 25 （26.3%） patients. ORR was 25.3%. Thrombocytopenia （P = 0.014）, line of chemotherapy （P = 0.028） and thrembocytosis （P = 0.033） were correlated with ORR in univariate analysis. In multivariate analysis, thrombocytopenia （odds ratio [OR] = 8.600, 95% confidence interval [CI] = 1.705-43.385, P = 0.009） and first line chemotherapy （OR = 5.155, 95% CI = 1.153-23.256, P = 0.032） positively related to ORR. Conclusion： Threm- bocytopenia may be an indicator of ORR in mCRC patients treated by irinotecan plus 5-fluorouracil/capecitabine. Evidence is not strong enough to prove that irinotecan based regimens-induced diarrhea, leucopenia, neutropenia or vomiting is associ- ated with ORR.

Second-line panitumumab as a triweekly dose for patients with wild-type KRAS exon 2 metastatic colorectal cancer:a single-institution experience

Objective: Panitumumab administered as monotherapy in colorectal cancer(CRC) has shown response and disease stabilization rates of approximately 30%. The current study aimed to evaluate the progression-free survival(PFS) and overall survival(OS) of patients with metastatic colorectal cancer(mCRC) treated with panitumumab every 3 weeks as a second line treatment.Methods: This study is a retrospective analysis of 18 patients, aged more than 18 years, with wild-type KRAS exon 2 mCRC treated with panitumumab as a second-line single agent after progression on first-line chemotherapy.Results: The median number of courses received was 10(range, 4-29), and the median duration of treatment was 30 weeks(range,12-96 weeks). After a median follow-up period of 13 months, the median PFS was 6 months(range, 4.3-7.7 months) and the median OS was 11 months(range, 7.4-14.5 months). The median PFS was 4 months for patients with < grade 2 skin toxicity and 6months(range, 4.5-7.5 months) for patients with ≥ grade 2 skin rash(P=0.05). The median OS was 9 months(range, 6.4-11.5months) and 14 months(range, 11.6-16.3 months) for the two groups of patients(P=0.002).Conclusions: Panitumumab given every 3 weeks is effective and well tolerated in patients with advanced CRC that progressed after standard chemotherapy.

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.