Cytochrome P450 Family 46 Subfamily A Member 1 Promotes the Progression of Colorectal Cancer by Inducing Tumor Cell Proliferation and Angiogenesis.

BACKGROUND/AIM: Cytochrome P450 family 46 subfamily A member 1 (CYP46A1) has been implicated in the development and progression of various cancers. This study aimed to analyze the expression of CYP46A1, examining its relationship with oncogenic behaviors, and determining its prognostic implications in colorectal cancer (CRC). MATERIALS AND METHODS: A total of 225 patients with CRC who underwent curative surgical resection were examined using paraffin-embedded tissue blocks and subjected to tumor-specific survival analysis. The expression of CYP46A1 was assessed in CRC tissues through reverse transcription-polymerase chain reaction, western blotting, and immunohistochemistry. The CRC cells' apoptosis, proliferation, angiogenesis, and lymphangiogenesis were analyzed using terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling assays, alongside immunohistochemical staining for Ki-67, CD34, and D2-40 antibodies. RESULTS: CYP46A1 expression was found to be up-regulated in CRC tissues compared to normal colorectal mucosa. Such expression was significantly associated with advanced stage, deeper tumor invasion, lymph node metastasis, distant metastasis, and decreased survival. Furthermore, the mean Ki-67 labeling index and microvessel density values in CYP46A1-positive tumors were significantly elevated compared to CYP46A1-negative tumors. However, there was no discernible correlation between CYP46A1 expression and either the apoptotic index or lymphatic vessel density value. CONCLUSION: CYP46A1 promotes CRC progression, specifically through the induction of tumor cell proliferation and angiogenesis. The insights provided may hold potential implications for future therapeutic interventions targeting CYP46A1.

Do Laparoscopic Approaches Ensure Oncological Safety and Prognosis for Serosa-Exposed Colon Cancer? A Comparative Study against the Open Approach.

The adoption of laparoscopic surgery in the management of serosa-exposed colorectal cancer has raised concerns. This study aimed to investigate whether laparoscopic surgery is associated with an increased risk of postoperative recurrence in patients undergoing resection for serosa-exposed colon cancer. A retrospective analysis was conducted on a cohort of 315 patients who underwent curative resection for pathologically confirmed T4a colon cancer without distant metastases at the Asan Medical Center between 2006 and 2015. Patients were categorized according to the surgical approach method: laparoscopic surgery (MIS group) versus open surgery (Open group). Multivariate analysis was employed to identify risk factors associated with overall survival (OS) and disease-free survival (DFS). The MIS group included 148 patients and the Open group had 167 patients. Of the total cohort, 106 patients (33.7%) experienced recurrence during the follow-up period. Rates, patterns, and time to recurrence were not different between groups. The MIS group (55.8%) showed more peritoneal metastasis compared to the Open group (44.4%) among recurrence sites, but it was not significant (p = 0.85). There was no significant difference in the five-year OS (73.5% vs. 78.4% p = 0.374) or DFS (62.0% vs. 64.6%; p = 0.61) between the Open and MIS groups. Age and the pathologic N stage were independently associated with OS, and the pathologic N stage was the only associated risk factor for DFS. The laparoscopic approach for serosa-exposed colon cancer did not compromise the DFS and OS. This study provides evidence that laparoscopic surgery does not compromise oncologic outcomes of patients with T4a colon cancer although peritoneal seeding is the most common type of disease failure of serosa-exposed colon cancer.

Expression of an oxysterol-metabolizing enzyme in colorectal cancer and its relation to tumor cell behavior and prognosis.

Oxysterols and oxysterol-metabolizing enzymes have been implicated in the pathogenesis of various cancers. However, the distinct function of the oxysterol-metabolizing enzyme cytochrome P450 family 39 Subfamily A Member 1 (CYP39A1) in colorectal cancer (CRC) remains unclear. The aims of the current study were to evaluate whether CYP39A1 affects the oncogenic behaviors of CRC cells and to investigate the prognostic value of its expression in CRC. A CYP39A1 small-interfering RNA was used to block CYP39A1 gene expression in DLD1 and SW480 cells. The expression of CYP39A1 in CRC tissues was investigated by immunohistochemistry. Tumor angiogenesis and lymphangiogenesis were assessed by CD34 and D2-40 immunohistochemical staining, respectively. CYP39A1 knockdown inhibited tumor cell migration and invasion in DLD1 and SW480 cells. Angiogenesis was also inhibited through the decreased expression of vascular endothelial growth factor (VEGF)-A and hypoxia-inducible factor (HIF)-1α, and angiostatin and endostatin expression increased. In addition, CYP39A1 knockdown inhibited the lymphangiogenesis by decreasing the expression of VEGF-C. CYP39A1 expression was increased in CRC tissues compared with normal colorectal mucosa. CYP39A1 expression was associated with tumor stage, depth of invasion, lymph node metastasis, distant metastasis, and poor survival. The microvessel and lymphatic vessel density values of CYP39A1-positive tumors were significantly higher than those of CYP39A1-negative tumors. These results indicate that CYP39A1 is associated with tumor progression by influencing tumor cell angiogenesis and lymphangiogenesis in CRC.

Expression of Apurinic/Apyrimidinic Endonuclease 1 in Colorectal Cancer and its Relation to Tumor Progression and Prognosis.

BACKGROUND/AIM: Over-expression of apurinic/apyrimidinic endonuclease 1 (APE1) has been demonstrated to be associated with cancer progression, chemo- and radioresistance in various cancers. This study examined the expression of APE1 and its relation to tumor progression and prognosis in patients with colorectal cancer (CRC). MATERIALS AND METHODS: We investigated 193 patients with CRC who received curative surgery for whom formalin-fixed and paraffin-embedded blocks were available, and long-term tumor-specific survival rate analysis was possible. The expression of APE1 was investigated by reverse transcription-polymerase chain reaction, western blotting, and immunohistochemistry in CRC and lymph node tissues. The apoptosis, proliferation, and angiogenesis of CRC cells were determined using terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling assay, and immunohistochemical staining for Ki-67 and CD34 antibodies. RESULTS: APE1 was over-expressed in CRC and metastatic lymph node tissues compared with normal colorectal mucosa and non-metastatic lymph node tissues. Over-expression of APE1 was significantly associated with advanced stage, lymphovascular invasion, perineural invasion, deeper tumor invasion, lymph node metastasis, distant metastasis, and poor survival. Multivariate analysis demonstrated that APE1, perineural invasion, and lymph node metastasis were the independent prognostic factors associated with overall survival. The mean Ki-67 labeling index value of APE1-positive tumors was significantly higher than that of APE1-negative tumors. However, there was no significant association between APE1 expression and the apoptotic index or microvessel density. CONCLUSION: Over-expression of APE1 is significantly associated with tumor progression and poor survival in patients with CRC. Therefore, APE1 may be a novel biomarker and present a potential prognostic factor for CRC.

Robotic right versus left colectomy for colorectal neoplasia: a systemic review and meta-analysis.

Previous studies comparing right and left colectomies have shown variable short-term outcomes. Despite the rapid adoption of robotics in colorectal operations, few studies have addressed outcome differences between robotic right (RRC) and left (RLC) colectomies. Therefore, we sought to compare the short-term outcomes of RRC and RLC for neoplasia. This is a systematic review and meta-analysis of articles published from the time of inception of the datasets to May 1, 2022. The electronic databases included English publications in Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, and Scopus. A total of 13,514 patients with colon neoplasia enrolled in 9 comparative studies were included. The overall mean age was 64.1 years (standard deviation [SD] ± 9.8), and there was a minor female predominance (52% female vs. 48% male). 8656 (64.0%) underwent RRC and 4858 (36.0%) underwent RLC. The ASA score 1 of - 2 in the LRC group was 37% vs. 21% in the R. Whereas the ASA score 3-4 was 62% in the LRC vs. 76% in RRC. Moreover, the mean of the Charlson Comorbidity Score in the LRC was 4.3 (SD 1.9) vs. 3.1 (SD 2.3) in the RRC. Meta-analysis revealed a significantly higher rate of ileus in RRC (10%) compared to RLC (7%) (OR 1.46, 95% CI 1.27-1.67). Additionally, operative time was significantly shorter by 22.6 min in RRC versus LRC (95% CI - 37.4-7.8; p < 0.001). There were no statistically significant differences between RRC and RLC in conversion to open operation, estimated blood loss, wound infection, anastomotic leak, reoperation, readmission, and hospital length of stay. In this only meta-analysis comparing RRC and LRC for colon neoplasia, we found that RRC was independently associated with a shorter operative time but increased risk of ileus.

Clinical Usefulness of Ultrasound Elastography in Colonic Diseases: A Narrative Review.

Ultrasound elastography is an innovation of ultrasound technology that has developed since the 1990s. It has been successfully applied for many organs, such as the thyroid, breast, liver, prostate, and muscle systems, providing qualitative and quantitative information about tissue stiffness for clinical diagnoses. For colorectal tumors, ultrasound elastography can distinguish colon adenoma from colon adenocarcinoma and predict the chemotherapeutic effects of colon cancer by monitoring the stiffness changes of cancer tissue. In Crohn's disease, ultrasound elastography helps assess the stages of the course and guides further treatment strategies. Compared with colonoscopy, ultrasound elastography frees patients from the fears of uncomfortable procedures and enables operators to comprehensively observe the bowel wall and the surrounding structures. In this review, we introduced the principles and the pathological basis of ultrasound elastography and compared the diagnostic efficacies of colonoscopy with colonic ultrasound elastography. Meanwhile, we summarized the ultrasonography of colonic diseases and reviewed the clinical usefulness of ultrasound elastography in colonic diseases.

CD47 mediates the progression of colorectal cancer by inducing tumor cell apoptosis and angiogenesis.

CD47 is an immunoregulatory protein that is found on the cell surface and plays significant roles in cellular functions such as proliferation, apoptosis, migration, and immune homeostasis. CD47 is overexpressed in various human cancers and is associated with tumor development, progression, and poor prognosis. In this study, we analyzed the expression of CD47 to determine whether it affected the oncogenic behavior of colorectal cancer (CRC) and investigated the prognostic value of CD47 expression in patients with CRC. We investigated 468 patients with CRC who underwent curative surgery and examined the expression of CD47 in tumor and lymph node tissues by performing RT-PCR and immunohistochemistry. Apoptosis, proliferation, angiogenesis, and lymphangiogenesis were determined via a TUNEL assay and immunohistochemical staining for Ki-67, CD34, and D2-40. CD47 expression was increased in human CRC tumors and metastatic lymph nodes compared with normal colorectal mucosa and non-metastatic lymph node tissues. CD47 expression was significantly associated with perineural invasion, lymphovascular invasion, cell differentiation, cancer stage, depth of invasion, lymph node metastasis, distant metastasis, and poor survival. The mean apoptotic index and microvessel density value of CD47-positive tumors were significantly higher than those of CD47-negative tumors. However, no significant difference was observed between CD47 expression and Ki-67 labeling index or lymphatic vessel density. These results indicate that CD47 mediated the progression of CRC by inducing tumor cell apoptosis and angiogenesis.

Effectiveness of Multiple Consecutive Fecal Immunohistochemical Testing for Colorectal Cancer Screening.

OBJECTIVE: The fecal immunohistochemical test (FIT) is a simple colorectal-cancer screening test. There are no recent studies evaluating the benefits of doing more than one a year. Our study aimed to evaluate the effectiveness of performing the test for 3 consecutive days in terms of detecting cancer and advanced adenomas. METHODS: This was a single-center retrospective review of records of patients who had daily tests for 3 consecutive days and had at least one positive during the period from 2009-2011. RESULTS: A total of 456 records were reviewed, 410 met the inclusion criteria. Most of the participants were men (95.9%), with the mean age of all the participants being 64.3 (±7.8) years. Regarding the FIT results, 18.8% had positive results on all 3 tests, 20.2% had 2 positive tests, and 61.0% had 1 positive FIT. There were 16 (3.9%) patients in the studied sample that had colon cancer. Their lesions were located predominantly in the distal colon (ratio of distal to proximal: 2:1). The patients with 3 positive FITs had a higher prevalence of advanced adenomas (33.3% vs. 13.4%, respectively; P < .05). DISCUSSION: Our study showed a low concordance between daily consecutive tests results. those patients with more than 1 positive FIT had a higher prevalence of advanced adenoma or adenocarcinoma than patients who had only one. Fewer than 4% of the patients in our study had colon cancer. Prospective studies would be needed to determine the effectiveness of more than 1 annual FIT in colon cancer prevention.

Comment on "Artificial intelligence in gastroenterology: A state-of-the-art review".

Colon capsule endoscopy (CCE) was introduced nearly two decades ago. Initially, it was limited by poor image quality and short battery time, but due to technical improvements, it has become an equal diagnostic alternative to optical colonoscopy (OC). Hastened by the coronavirus disease 2019 pandemic, CCE has been introduced in clinical practice to relieve overburdened endoscopy units and move investigations to out-patient clinics. A wider adoption of CCE would be bolstered by positive patient experience, as it offers a diagnostic investigation that is not inferior to other modalities. The shortcomings of CCE include its inability to differentiate adenomatous polyps from hyperplastic polyps. Solving this issue would improve the stratification of patients for polyp removal. Artificial intelligence (AI) has shown promising results in polyp detection and characterization to minimize incomplete CCEs and avoid needless examinations. Onboard AI appears to be a needed application to enable near-real-time decision-making in order to diminish patient waiting times and avoid superfluous subsequent OCs. With this letter, we discuss the potential and role of AI in CCE as a diagnostic tool for the large bowel.

Short-term clinical and oncological outcomes after single-incision plus one-port laparoscopic surgery for rectosigmoid cancer: a retrospective clinical analysis of 30 cases.

OBJECTIVE: To evaluate the safety and feasibility of single-incision laparoscopic surgery+1 (SILS+1) radical resection of sigmoid and upper rectal cancer. METHODS: The clinical data of 30 consecutive patients with sigmoid and upper rectal cancer who underwent SILS+1 radical resection between October 2018 and January 2020 in our hospital were retrospectively analyzed. An initial 5-cm periumbilical transverse incision was made. Then, a multiport device was placed in the umbilical incision. Two 10-mm ports were used for laparoscope insertion, and the other two ports were used for laparoscope device insertion. A 12-mm trocar was placed in the right lower abdominal quadrant under laparoscopic view and served as the surgeon's dominant operating channel. RESULTS: All operations were performed successfully without conversion to conventional laparoscopic surgery or open operation. Three patients developed postoperative complications: one patient developed ileus, one developed postoperative bleeding, and one developed wound infection. There were no perioperative deaths. CONCLUSIONS: The safety and feasibility of SILS+1 radical resection of sigmoid and upper rectal cancer was established by experienced surgeons in our study. However, further studies are needed to demonstrate the advantages of this procedure compared with the benefits of conventional laparoscopic surgery.

Impact of physical activity and diet on colorectal cancer survivors' quality of life: a systematic review.

BACKGROUND: Post-treatment management is essential for improving the health and quality of life of colorectal cancer (CRC) survivors. The number of cancer survivors is continually increasing, which is causing a corresponding growth in the need for effective post-treatment management programs. Current research on the topic indicates that such programs should include aspects such as physical activity and a proper diet, which would form the basis of lifestyle change among CRC survivors. Therefore, this study aimed to identify the impact of physical activity and diet on the quality of life of CRC survivors. METHODS: We performed a systematic literature review regarding CRC survivors. We searched the Embase, PubMed, and EBSCOhost databases, considering papers published between January 2000 and May 2017 in any language, using a combination of the following subject headings: "colorectal cancer," "colorectal carcinoma survivor," "survivorship plan," "survivorship care plan," "survivorship program," "lifestyle," "activities," "exercise," "diet program," and "nutrition." RESULTS: A total of 14,036 articles were identified, with 35 satisfying the eligibility criteria for the systematic review. These articles were grouped by the study questions into physical activity and diet: 24 articles were included in the physical activity group and 11 in the diet group. CONCLUSIONS: The research showed that an effective survivorship program can significantly help CRC survivors maintain good health and quality of life for long periods. However, there is a lack of consensus and conclusive evidence regarding how the guidelines for such a program should be designed, in terms of both its form and content.

Autofluorescence Imaging Reflects the Nuclear Enlargement of Tumor Cells as well as the Cell Proliferation Ability and Aberrant Status of the p53, Ki-67, and p16 Genes in Colon Neoplasms.

BACKGROUND: Autofluorescence imaging (AFI) is useful for diagnosing colon neoplasms, but what affects the AFI intensity remains unclear. This study investigated the association between AFI and the histological characteristics, aberrant methylation status, and aberrant expression in colon neoplasms. METHODS: Fifty-three patients with colorectal neoplasms who underwent AFI were enrolled. The AFI intensity (F index) was compared with the pathological findings and gene alterations. The F index was calculated using an image analysis software program. The pathological findings were assessed by the tumor crypt density, cell densities, and N/C ratio. The aberrant methylation of p16, E-cadherin, Apc, Runx3, and hMLH1 genes was determined by a methylation-specific polymerase chain reaction. The aberrant expression of p53 and Ki-67 was evaluated by immunohistochemical staining. RESULTS: An increased N/C ratio, the aberrant expression of p53, Ki-67, and the altered methylation of p16 went together with a lower F index. The other pathological findings and the methylation status showed no association with the F index. CONCLUSIONS: AFI reflects the nuclear enlargement of tumor cells, the cell proliferation ability, and the altered status of cell proliferation-related genes, indicating that AFI is a useful and practical method for predicting the dysplastic grade of tumor cells and cell proliferation.

Prognostic value of inferior mesenteric artery lymph node metastasis in cancer of the descending colon, sigmoid colon and rectum.

AIM: This study aimed to analyse the potential significance of metastasis to the inferior mesenteric artery lymph node (IMA-LN) in patients with malignancy of the left colon and rectum. METHOD: A retrospective analysis of a cohort of 890 patients collected prospectively who underwent radical resection of a primary tumour of the descending colon, sigmoid colon and rectum in our department from 1 January 2009 to 31 December 2015 was performed. Patients were divided into an IMA-LN metastasis (IMA-LN (+)) group (n = 51) and a non IMA-LN metastasis (IMA-LN (-)) group (n = 839). A total of 801 patients were followed by a designated member of the study staff. Clinical features, pathological characteristics, recurrence patterns and survival rates were compared between the two groups. RESULTS: In the IMA-LN (+) group, the risk ratio of overall recurrence and tumour related death was 7.786 (95% CI 4.142-14.637) and 7.756 (95% CI 4.142-14.525) respectively. Significant differences were found in overall survival (log-rank: χ2  = 69.06, P < 0.0001) and disease-free survival (log-rank: χ2  = 69.06, P < 0.0001) between the two groups. Furthermore, there were significant differences in overall survival (log-rank: χ2  = 18.47, P < 0.0001) and disease-free survival (log-rank: χ2  = 16.99, P < 0.0001) between the IMA-LN (-) and IMA-LN (+) subgroups of patients with Stage N2 disease. Multivariate survival analysis indicated that IMA-LN (+) was an independent risk factor of poor prognosis. There was no difference in the prognosis between high tie and low tie with IMA-LN dissection. CONCLUSION: Inferior mesenteric artery lymph node metastasis was an independent predictive factor for high systemic recurrence. Low ligation of the IMA with IMA-LN dissection was not inferior to high ligation.

Adenoma Detection Rate in Asymptomatic Patients with Positive Fecal Immunochemical Tests.

BACKGROUND AND AIMS: The adenoma detection rate (ADR) is a powerful measure of screening colonoscopy quality. Patients who undergo colonoscopy for the evaluation of a positive fecal immunochemical test (FIT) have increased prevalence of colorectal neoplasia, but it is not known whether separate quality benchmarks are required. The aim of this study was to compare the conventional ADR to the ADR of colonoscopies performed for the evaluation of positive FIT, in asymptomatic average-risk patients. METHODS: Patients ≥ 50 years old who underwent colonoscopy for the evaluation of a positive FIT between January 1, 2013, and July 31, 2014, at a tertiary Veterans Affairs Medical Center were identified. FIT performed for any indication other than average-risk screening was excluded. The comparison group included average-risk patients ≥ 50 years old undergoing screening colonoscopy during the same time frame. The two groups were compared for ADR, advanced neoplasm [adenoma ≥ 10 mm, tubulovillous, high-grade dysplasia, CRC, sessile serrated polyp (SSP) ≥ 10 mm], CRC, and SSP detection after propensity score adjustment using a logistic regression model adjusted for endoscopist. RESULTS: There were 207 patients in the FIT group and 601 in the screening colonoscopy comparison group. After propensity score adjustment, ADR (72.9 vs. 50.0%, p = 0.003), number of adenomas per colonoscopy (3.3 ± 3.6 vs. 1.4 ± 2.3, p = 0.033), and advanced neoplasm detection rate (32.4 vs. 11.0%, p < 0.0001) were significantly higher in the FIT group. There were no significant differences in the number of CRC and the SSP detection rate. CONCLUSIONS: In this cohort of average-risk Veterans, the ADR of colonoscopies performed for the evaluation of a positive FIT was higher than the ADR of screening colonoscopies. Patients with a positive FIT also had significantly more adenomas per colonoscopy and advanced neoplasms. These findings suggest that the quality of colonoscopies performed for a positive FIT is insufficiently assessed by the conventional ADR and requires additional quality metrics.

Comparison of Clinical Outcomes Between Laparoscopic-Assisted and Minilaparotomy Approaches for Colon Cancer.

BACKGROUND/AIMS: The minilaparotomy approach is feasible for the resection of colon cancer. This study aimed to compare the clinical and oncological outcomes of minilaparotomy and laparoscopic approaches in patients with colon cancer. METHODS: We performed a retrospective analysis of consecutive patients undergoing minilaparotomy or laparoscopic resection for colon cancer from January 2009 to December 2014. RESULTS: There were 376 patients with colon cancer. Seventy-one patients were excluded. The remaining 305 patients were allocated to the minilaparotomy (n = 146) group or laparoscopic group (n = 159). The demographic data of the two groups was similar except for body mass index. The time to first bowel movement (P = 0.000) and the hospital stay (P = 0.005) were less in the laparoscopic group. Compared with the minilaparotomy group, the mean operation time was longer and the costs higher for laparoscopic group (P = 0.000). The morbidity, mortality, and local recurrence were comparable between the two groups. The 5-year overall and disease-free survival rates were also similar (overall survival is 75.3 vs. 72.9%, P = 0.648; disease-free survival is 66.2 vs. 70.2%, P = 0.914). CONCLUSION: The minilaparotomy approach was safe and equivalent to laparoscopic approach for patients with colon cancer. It is an alternative to the laparoscopic approach in selected patients.

Fascitis necrosante clostridial asociada a neoplasia colónica perforada: importancia de un diagnóstico precoz / Necrotizing fasciitis following colon neoplasm perforation: the clue of an early detection

Introducción: La gangrena espontánea por Clostridium septicum es una entidad poco frecuente con una alta mortalidad que se asocia a pacientes neoplásicos y/o inmunodeprimidos. Caso clínico: Presentamos un caso de gangrena clostridial en un paciente con neoplasia de colon ascendente perforada a retroperitoneo. Discusión-conclusiones: Aunque es poco común deberemos pensar en una infección clostridial en pacientes sépticos y sospecha de neoplasia colónica. En ausencia de diagnóstico y tratamiento precoz, el pronóstico es fatal.

Introduction: Spontaneous gangrene due to Clostridium septicum is a low frequency pathology with a high mortality rate. It is related to neoplasic and/or immunodeficient patients. Case report: We present the case of a patient who presented clostridial gangrene associated with a perforated colon neoplasm. Discussion-conclusions: Although it is not very common it must supposed a clostridial infection in septic patients with colon neoplasm suspect. If diagnosis and treatment are delayed the prognostic of the patient is fatal.

Synchronous quintuple primary gastrointestinal tract malignancies: Case report.

Multiple primary malignancy is defined as two or more malignancies detected in an individual person. In particular, synchronous quintuple primary malignancy is extremely rare. A 52-year-old male with anal pain and intermittent blood-tinged stool was diagnosed with malignancies in the stomach, jejunum, ascending colon, transverse colon and rectum. He underwent a subtotal gastrectomy, segmental resection of the jejunum and total protocolectomy with end ileostomy. The postoperative pathologic findings were moderate differentiated gastric adenocarcinoma (pT1bN0M0, pStageIA), combined adenocarcinoma and neuroendocrine carcinoma of the jejunum (pT3N0M0, pStageIIA), three mucinous adenocarcinoma of the ascending colon (pT3N0M0, pStageIIA), transverse colon (pT1N0M0, pStageI) and rectum (pT3N1aM0, pStageIIIB). The tumors did not lack MLH-1 and MSH-2 expression, as the markers (bat26, D5S346, bat25, D2S123) suggest MSI-H presence. Adjuvant chemoradiotherapy was started according to regimen, FOLFOX 4 for advanced rectal cancer. Six years post-operation, the patient is currently attending regular follow-ups without recurrence or metastasis.

Classification of Colon Cancer Patients Based on the Methylation Patterns of Promoters.

Diverse somatic mutations have been reported to serve as cancer drivers. Recently, it has also been reported that epigenetic regulation is closely related to cancer development. However, the effect of epigenetic changes on cancer is still elusive. In this study, we analyzed DNA methylation data on colon cancer taken from The Caner Genome Atlas. We found that several promoters were significantly hypermethylated in colon cancer patients. Through clustering analysis of differentially methylated DNA regions, we were able to define subgroups of patients and observed clinical features associated with each subgroup. In addition, we analyzed the functional ontology of aberrantly methylated genes and identified the G-protein-coupled receptor signaling pathway as one of the major pathways affected epigenetically. In conclusion, our analysis shows the possibility of characterizing the clinical features of colon cancer subgroups based on DNA methylation patterns and provides lists of important genes and pathways possibly involved in colon cancer development.

Efficacy and adverse events of cold vs hot polypectomy: A meta-analysis.

AIM: To compare previously reported randomized controlled studies (RCTs) of cold and hot polypectomy, we systematically reviewed and clarify the utility of cold polypectomy over hot with respect to efficacy and adverse events. METHODS: A meta-analysis was conducted to evaluate the predominance of cold and hot polypectomy for removing colon polyps. Published articles and abstracts from worldwide conferences were searched using the keywords "cold polypectomy". RCTs that compared either or both the effects or adverse events of cold polypectomy with those of hot polypectomy were collected. The patients' demographics, endoscopic procedures, No. of examined lesions, lesion size, macroscopic and histologic findings, rates of incomplete resection, bleeding amount, perforation, and length of procedure were extracted from each study. A forest plot analysis was used to verify the relative strength of the effects and adverse events of each procedure. A funnel plot was generated to assess the possibility of publication bias. RESULTS: Ultimately, six RCTs were selected. No significant differences were noted in the average lesion size (less than 10 mm) between the cold and hot polypectomy groups in each study. Further, the rates of complete resection and adverse events, including delayed bleeding, did not differ markedly between cold and hot polypectomy. The average procedural time in the cold polypectomy group was significantly shorter than in the hot polypectomy group. CONCLUSION: Cold polypectomy is a time-saving procedure for removing small polyps with markedly similar curability and safety to hot polypectomy.