中国结直肠癌预防共识意见(2016年，上海)

无论是遗传性（约占5％）还是散发性结直肠癌（colorectal cancer），环境因素均是影响其发生和进展的重要因素。因散发性结直肠癌（或称大肠癌）的发生途径大致分为腺瘤-腺癌途径（含锯齿状腺瘤引起的锯齿状途径）、炎-癌途径、de novo途径，结直肠癌的主要癌前疾病为结直腺瘤（colorectal adenoma，占全部结直肠癌癌前疾病的85％～90％，甚至更高）和溃疡性结肠炎（ulcerative colitis，UC）等炎症性肠病（inflammatory bowel disease，IBD）。尽管结直肠可发生间质瘤和神经内分泌肿瘤等，但临床上通常将结直肠癌和腺瘤统称为结直肠肿瘤。多数结直肠癌确诊时已届中晚期，疗效不佳，故结直肠癌的早期发现和及早预防至关重要。有鉴于此，应重视结直肠癌的预防。结直肠癌的预防包括对上述癌前疾病的预防和治疗。结直肠腺瘤的一级预防即预防结直肠腺瘤的发生，结直肠腺瘤的二级预防即结直肠腺瘤摘除后预防再发（recurrence，或称复发，包括原处复发和他处再发）或恶变。上述两者应归属于结直肠癌的一级预防。结直肠癌的二级预防包括早期结直肠癌的内镜下处理和内镜随访以防止复发。70％的散发性结直肠癌与生活习惯有关，且66％～78％的结直肠癌可通过健康的生活习惯而避免。

中国结直肠癌预防共识意见（2016年，上海）

不论是遗传性（约占5%）还是散发性结直肠癌（或称大肠癌，colorectal cancer）,环境因素均是影响其发生和进展的重要因素。因为散发性结直肠癌发生的途径大致分为腺瘤（adenoma）→腺癌途径（含锯齿状腺瘤引起的锯齿状途径）、炎→癌途径和De Novo途径3种，故结直肠癌的主要癌前疾病是腺瘤（占全部结直肠癌癌前疾病的85%～90%，甚至更高）和UC等IBD。尽管结直肠可发生间质瘤和神经内分泌肿瘤等，但临床上通常将结直肠癌和腺瘤统称为结直肠肿瘤。多数结直肠癌确诊时已届中晚期，疗效不佳，故结直肠癌的早期发现和尽早预防至关重要。

结直肠癌预防及治疗10年进展研讨会在沪召开

近日，赛诺菲一安万特集团在上海成功举办了结直肠癌预防及治疗10年进展研讨会。受人们生活方式改变等因素的影响。我国年均新发结直肠癌（俗称大肠癌）病例达13万，并以年均4％增幅不断攀升。在癌症发病排名中由第6位上升至第2位，发病率已接近西方发达国家。

结直肠癌治疗10年的重大进展--含乐沙定~的治疗方案可降低患者死亡风险20%

近10年来，随着肿瘤治疗方案的不断进步，结直肠癌（俗称：大肠癌）患者的生命不断得以延长，并且早期患者可以治愈。其中含有乐沙定。的治疗方案在近10年中，使得超过4万的结直肠癌患者得到治愈。2009年3月21日，全球医疗健康领域的领导者赛诺菲一安万特集团于在上海成功举办了结直肠癌预防及治疗10年进展研讨会。广东中山肿瘤医院的徐瑞华教授，上海肿瘤医院的蔡三军教授以及北京肿瘤医院的沈琳教授参加了此次会议。

世界顶级研究机构发布肠癌预防指南

世界顶级研究机构哈钦森癌症研究中心等机构联合发布最新报告，提出结直肠癌预防建议：1．峨持运动，心结直肠癌的风险降低20％。运动会降低腆岛索抵抗和炎症反应，而这两个现象都是结随肠癌的高风险因素。运动还能刺激消化，加快肠道蠕动，减少了致癌物和肠道黏膜的接触，降低诱发癌症的概率。建议每周锻炼5天。

新疆维吾尔自治区二级医院结直肠癌平均风险人群的结肠镜筛查情况

2014年，美国结直肠癌发病率和病死率在不同性别的恶性肿瘤中均居第3位［1］。结直肠癌在中国的发展趋势同样迅猛，尤以长江三角洲地区为甚。结肠镜检查对控制结直肠癌发病率有重要作用，并可将其病死率降低53%［2］。对平均风险人群进行结肠镜筛查是最为有效的预防结直肠癌的手段，被强烈推荐，并在一些国家获得医疗保险支持［3-5］。我国早期结直肠癌及癌前病变筛查共识于2015年初发布，势必会使我国结直肠癌预防工作更正规和深入［6］。然而本土数据的不足为评估结直肠癌的预防工作带来困难。我国疾病的地域分布差异明显，医疗资源分配极不均衡，既往国内研究多为经济较发达地区的大型医院完成，对偏远地区和少数民族群体相对缺少关注。本研究对新疆维吾尔自治区二级医院的数据进行回顾性分析，尤其关注结肠镜检查的质量控制指标和维吾尔族受检者的情况。

Overall expression of beta-catenin outperforms its nuclear accumulation in predicting outcomes of colorectal cancers

AIM： To examine the expression of beta-catenin in colorectal cancer and look for association with other dinico-pathological parameters. METHODS;： Tumor samples from 163 cases of colorectal cancer （CRC） who had undergone primary colectomy between May, 1998 and November, 2002 with complete follow-up data for either 5 years or until death were recruited for a beta-catenin immunohistochemical study. The percentage of immunoreacted tumor cells was defined as overall staining density （OSD） and percentage of cells having nuclear localization was counted as nuclear staining density （NSD）. Univariate exploration used log-rank test and multivariate survival analysis used Cox＇s hazard regression model. RESULTS： Beta-catenin immunoreactivity was detected in 161 samples （98.8%）, of which 131 cases had nuclear staining. High OSD （≥ 75%）, detected in 123 cases （75.5%）, was significantly associated with earlier clinical staging （P 〈 0.01）, lower nodal status （P = 0.02）, non-metastatic status （P 〈 0.01） and better differentiation （P = 0.02）. Multivariate analysis found that high OSD was independently associated with better survival [Cox＇s hazard ratio 0.51, 95% confidence interval （CI） 0.31-0.83]. Although high NSD （≥ 75%） was correlated with high pre-operative serum CEA （P = 0.03）, well differentiation （P 〈 0.01）, and increased staining intensity（P 〈 0.01）, the parameter was not significantly associated with survival. CONCLI3SIOM： Unlike previous reports, the study did not find a predictive value of nuclear beta-catenin in CRC. Instead, the overall expression of beta-catenin in CRC showed an association with better differentiation and earlier staging. Moreover, the parameter also independently predicted superior survival.

Molecular basis of the potential of mesalazine to prevent colorectal cancer

Patients with ulcerative colitis (UC) and Crohn's disease (CD) are at increased risk for developing colorectal cancer (CRC), and this is believed to be a result of chronic inflammation. Although conclusive evidence is still missing, both epidemiological and experimental observations suggest that certain drugs used to treat inflammation, such as mesalazine, can reduce the incidence of colitis-associated CRC. Therefore, in recent years, several studies have been conducted to dissect the mechanisms by which mesalazine interferes with CRC cell growth and survival. This review summarizes the current information on the molecular mechanisms that underlie the antineoplastic action of mesalazine.

Extraprofessional and Occupational Risk Factors for Colorectal Cancer

Colorectal cancers （CRC） account for frequent and serious cancers which result from the interaction between individual genetic factors and environmental factors, and in particular widely studied nutritional ones. The role of other occupational factors remains a controversial subject. The objective of this study is to evaluate the possible impact of occupational factors on the risk of developing CRC. Materials and Methods： This is a retrospective case-control study. The cases and the control group were enlisted in the general surgical ward of Farhat Hached Teaching Hospital of Sousse （Tunisia） during the period extending from 2004 to 2008, and they were age and gender-matched. The data were analyzed using SPSS 11.0 software with a signification threshold fixed at 5%. A univariate analysis was carried out as well as a multiple binary logistical regression. Results： During the period of the study, 40 cases of colorectal cancers have been colligated including 28 men and 12 women with a sex ratio of 0.43. The average age of the cases was 61.55 ± 13.3 years and 60.40 ± 12.84 years for the control group, with a non significant difference （P = 0.69）. The univariate analysis has objectivized significant associations between colorectal cancer and the housing conditions, the neoplastic and digestive family history, the occupational activity sector, exposure to pesticides, and lack of periodic medical supervision. After logistical regression, the occurrence risk of CRC was significantly associated with： alcohol and smoking （ORa = 3.43; Pa = 0.05）, meat consumption （ORa = 3.34; Pa = 0.03）, exposure to pesticides （ORa = 20.44; Pa = 0.012） and lack of periodic medical supervision （OR = 7.45; P = 0.004）. Conclusion： The occupational risk factors might play a role in the etiopathogenesis of colorectal cancers. With regard to our study, pesticides seem to be most implicated and necessitate suitable preventive measures. Nevertheless, it seems useful to multiply the studies to a much larger scale in order to further explore such relationship and to further reinforce the prevention of such serious disease.

结肠镜检查腺瘤检出率及其影响因素和研究现状

结肠镜检查和结肠镜下腺瘤性息肉等癌前病变的早期切除是行之有效的结直肠癌预防手段。早期结直肠癌患者手术后5年生存率可达90％以上，而晚期者则低于10％。但结直肠癌患者中早期确诊者仅占5％，60％～70％的结直肠癌患者确诊时已发生区域淋巴结转移和（或）远处转移，且术后复发率高达30％。提高早期诊断率是提高结直肠癌患者生存率的关键[1]。

内镜磁性成像在结肠镜检查中的应用现状与前景

结直肠癌发病率近年来不断升高。鉴于结肠镜检查在结直肠癌预防方面的显著效果，全社会逐渐意识到其重要意义［1］。然而结肠镜检查是一项技术性较强的工作，在进镜过程中经常发生的成袢问题增加了患者的痛苦与盲肠进镜的难度。为应对此问题，临床上常用腹部压迫来减少镜袢的形成［2-3］。Shah 等［4］系统研究了腹部压迫和体位改变对于解除肠袢的效果，发现腹部压迫防袢成功率较低（37％）。在腹部压迫、改变体位等传统手段失效的情况下，X 光透视可以提高解袢的成功率［5-9］。有研究显示，X 光透视可提高盲肠进镜率（cecal intubation rate，CIR）并减轻患者的痛苦［10］。但设备笨重不便使用，加之进镜过程中的反复透视又增加了医患双方的健康风险［5-6，11］。内镜磁性成像（mag-netic endoscopic imaging，MEI）技术的出现恰好解决了上述问题，成为寻求结肠镜在体内形态客观证据的有效工具。观察者可直观了解结肠镜进镜及成袢情况，从而提高包括腹部压迫在内的内镜辅助技术手法（endoscopic techniques and maneuvers，ETM）的有效性。本文将就 MEI 在结肠镜检查中的应用现状进行综述，总结有益信息为临床工作提供指导，并对其未来应用前景进行展望。

吃出来的大肠癌，你了解多少

在日前举行的“2016浦江消化科医师论坛”上。上海市消化疾病研究所所长、上海交通大学医学院附属仁济医院消化科主任兼大内科主任房静远教授。作了《2016中国结直肠癌预防共识意见》报告，令人关注。多荤少素成为了直肠癌饮食上的风险因素。另外，便血、腹痛、长期腹泻或便秘等，成为了直肠癌的危险信号。

IC5, a dithiocarbamate derivative, inhibits colon cancer cell proliferation in vitro and colitis-associated colorectal carcinogenesis in vivo

Colorectal cancer （CRC） is one of the leading causes of cancer-related deaths, and inflammatory bowel diseases and dysregulated cell proliferation play important roles in colorectal carcinogenesis. Therefore, inhibition of inflammatory signaling and cell proliferation is used as a major strategy for chemoprevention of CRC. In the present study, it was found that IC5, a dithiocarbamate derivative, could inhibit the proliferation of LoVo human colon cancer cells in a concentration-dependent manner, with an IC50 of 22 gM. The anti-proliferation effect of IC5 was accompanied by a significant cell cycle arrest in G2/M phase. Further study revealed that IC5 significantly inhibited NF-~B signaling in LoVo cells, suggesting that IC5 could inhibit inflammatory responses. We then evaluated the in vivo efficacy of IC5 to inhibit colitis-associated colorectal carcinogenesis using an azoxymethane （AOM）/dextran sodium sulfate （DSS） mouse model. AOM/DSS treatment resulted in a CRC incidence of 58.3%, while the incidences were decreased to 37.5% and 25% in mice orally administered with 50 and 100 mg/kg IC5, respectively. In addition, IC5 also reduced the plasma levels of alanine aminotransferase and asparatate aminotransferase. Taken together, these results suggested that IC5 could prevent colitis-associated colorectal carcinogenesis, and more attention should be paid to it as a cancer chemopreventive agent in further investigation.