الملخص
Colorectal cancer is the third most common neoplasm and the second most lethal worldwide. The most common histological type is adenocarcinoma, characterized by its glandular pattern. Medullary colon carcinoma is a rare histological variant of colorectal cancer, characterized by a predominantly solid architecture, poorly di?erentiated or undifferentiated morphology, often associated with an anomalous immunophenotype and microsatellite instability. The present study reports a case in an academic service of general surgery of a 74-year-old patient who presented with a tumor of the ascending colon, histologically with an exuberant lymphocytic in?ltrate, suggestive of large cell lymphoma, but which was revealed by subsequent immunohistochemistry to be medullary carcinoma of the colon with microsatellite instability.
O câncer colorretal é a terceira neoplasia mais comum e a segunda mais letal no mundo. O adenocarcinoma é o tipo histológico mais comum, caracterizado pelo seu padrão glandular. O carcinoma medular do cólon é uma variante histológica rara do câncer colorretal, caracterizada por uma arquitetura predominantemente sólida, morfologia pouco diferenciada ou indiferenciada, frequentemente associada a um imunofenótipo anômalo e instabilidade de microssatélites. O presente estudo relata um caso em um serviço acadêmico de cirurgia geral de um paciente de 74 anos que apresentou tumor de cólon ascendente, histologicamente com infiltrado linfocitário exuberante, sugestivo de linfoma de grandes células, mas que foi revelado através de exame subsequente imunohistoquímico como carcinoma medular do cólon com instabilidade de microssatélites.
الموضوعات
Male , Aged , Carcinoma, Medullary , Colon, Ascending , Surgical Oncology , Colonic Neoplasmsالملخص
RESUMEN El schwannoma de colon es una entidad sumamente rara que puede debutar como lesión subepitelial con signos ulcerativos de melena y anemia. El estudio de imágenes nos orienta a la localización mientras que la biopsia colonoscópica no es de ayuda. Muchas veces el diagnóstico y tratamiento se efectúa con la resección de la lesión en tanto que el diagnóstico final se realiza en el posoperatorio por histopatología y por la inmunohistoquímica, la cual muestra positividad intensa para S100 y vimentina en las células tumorales con un índice de proliferación KI67 menor al 1%, por lo que se concluye que se trata de una lesión benigna. Presentamos el siguiente caso por su dificultad diagnóstica pre e intraoperatoria, clínica inespecífica y diagnóstico definitivo por inmunohistoquímica.
ABSTRACT Colon schwannoma is an extremely rare entity that may debut as a subepithelial lesion with ulceration signs, such as melena and anemia. Imaging studies guide us to localization, while a colonoscopy biopsy is not helpful. Many times, the diagnosis and treatment are made with lesion resection, and the final diagnosis is postoperatively made with histopathology and immunohistochemistry, which shows intense positivity for S100 and vimentin in tumor cells with a KI67 proliferation index of less than 1%, therefore, it is concluded that this is a benign lesion. We present this case due to its pre- and intraoperative diagnostic difficulty, non-specific symptoms, and its definitive diagnosis that was achieved with immunohistochemistry.
الملخص
Objective:To analyze the risk factors of postoperative infection in patients with colon cancer, and construct a nomogram model.Methods:The clinical data of 220 patients with colon cancer in Anhui Cancer Hospital from May 2019 to June 2022 were retrospectively analyzed. Among them, 55 patients developed postoperative infection (infection group), and 165 patients did not develop postoperative infection (non-infection group). The receiver operating characteristic (ROC) curve was used to analyze the efficacy of each index in predicting postoperative infection in patients with colon cancer. Multivariate Logistic regression analysis was used to analyze the independent risk factors of postoperative infection in patients with colon cancer. R language 3.5.2 software was used to construct a nomogram model for predicting postoperative infection in patients with colon cancer, and it was verified and evaluated.Results:There were no significant differences in gender composition, body mass index, tumor stage, intraoperative blood transfusion, hypertension, smoking history, alcohol consumption history, tumor diameter and hemoglobin between the two groups ( P>0.05); the age, diabetes mellitus ratio, operation time and exhaust time in the infection group were significantly higher than those in the non-infection group: (49.60 ± 4.40) years old vs. (47.20 ± 4.12) years old, 63.64% (35/55) vs. 30.30% (50/165), (197.80 ± 12.55) min vs. (192.23 ± 12.05) min and (3.42 ± 1.18) d vs. (2.60 ± 0.80) d, the albumin was significantly lower than that in the non-infected group: (28.29 ± 3.02) g/L vs. (32.80 ± 3.21) g/L, and there were statistical differences ( P<0.01). ROC curve analysis result showed that the area under the curve of age, operation time, exhaust time and albumin for predicting postoperative infection in patients with colon cancer were 0.672, 0.610, 0.706 and 0.846, and the optimal cut-off values were 49 years old, 184 min, 3 d and 30 g/L, respectively. Multivariate Logistic regression analysis result showed that age (>49 years old), diabetes mellitus, operation time (>184 min), exhaust time (>3 d) and albumin (≤30 g/L) were independent risk factors of postoperative infection in patients with colon cancer ( OR = 2.131, 1.758, 1.449, 1.841 and 2.325; 95% CI 1.269 to 2.696, 1.354 to 3.059, 1.201 to 1.965, 1.018 to 2.365 and 1.582 to 3.051; P<0.01). A nomogram model was constructed with age, diabetes mellitus, operation time, exhaust time, and albumin as predictors for predicting postoperative infection in patients with colon cancer. The correction curve of the nomogram model for predicting postoperative infection in patients with colon cancer was close to the ideal curve (C-index = 0.764, 95% CI 0.657 to 0.834); decision curve analysis result showed that the nomogram model provided clinical net benefit when the risk threshold was > 0.07; and the clinical net benefit of the model was higher than that of age, diabetes mellitus, operation time, exhaust time and albumin. Conclusions:The age (>49 years old), diabetes mellitus, operation time (>184 min), exhaust time (>3 d) and albumin (≤30 g/L) are the independent risk factors of postoperative infection in patients with colon cancer, and the nomogram model based on the above variables could predict postoperative infection.
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Objective:To investigate the correlation between preoperative incomplete intestinal obstruction and the risk of perioperative reflux and aspiration assessed by preoperative bedside ultrasonography in patients with colon cancer.Methods:A prospective case series study was conducted. A total of 300 patients with colon cancer who underwent elective surgery from March 2020 to January 2022 in the First Hospital of Shanxi Medical University were prospectively selected for the study. According to whether there was incomplete intestinal obstruction before operation, the patients were divided into obstruction group and non-obstruction group. All patients underwent preoperative ultrasound examination of the gastric antrum, measuring the cross-sectional area of the gastric antrum in the right lateral position, and calculating the gastric volume and unit body mass gastric volume (GV/W), which were all expressed as M ( Q1, Q3). The differences in cross-sectional area of the gastric antrum, gastric volume and GV/W in the right lateral position between the two groups were compared, as well as the risk of reflux and aspiration (the risk of reflux and aspiration was extremely low at GV/W<0.8 ml/kg, the risk was low at GV/W 0.8-1.5 ml/kg, and the risk was high at GV/W >1.5 ml/kg). Multivariate logistic regression was used to analyze the influencing factors of high risk of reflux and aspiration. Results:Of 300 patients, 7 patients were excluded because of blurred images on ultrasonography, and a total of 293 patients were finally included. The age [ M ( Q1, Q3)] of obstruction group (146 cases) was 58.0 years old (55.0 years old, 67.0 years old), including 80 males and 66 females; the age of non-obstruction group (147 cases) was 55.0 years old (53.5 years old, 64.0 years old), including 64 males and 83 females. The age and body mass index (BMI) of the patients in the obstructin group were higher than those in the non-obstruction group, and the differences were statistically significant (both P < 0.05), and there were no significant differences in gender, duration of dietary abstinence, comorbid hypertension, comorbid diabetes mellitus, smoking status, sedentariness, and alcoholism between the two groups (all P > 0.05). Compared with the non-obstruction group, patients in the obstruction group had a higher cross-sectional area of the gastric antrum [5.83 cm 2 (5.25 cm 2, 6.70 cm 2) vs. 5.13 cm 2 (4.43 cm 2, 5.79 cm 2), P < 0.001], gastric volume [43.00 ml (37.07 ml, 52.74 ml) vs. 32.78 ml (25.52 ml, 39.85 ml), P < 0.001] and GV/W [0.70 ml/kg (0.65 ml/kg, 0.82 ml/kg) vs. 0.55 ml/kg (0.46 ml/kg, 0.62 ml/kg), P < 0.001] in the right lateral position. The proportion of patients at high risk of reflux and aspiration in the obstruction group was higher than that in the non-obstruction group [22.6% (33/146) vs. 12.2% (18/147), χ2 = 4.59, P = 0.032]. Multivariate logistic regression analysis showed that combination of incomplete intestinal obstruction (combined vs. uncombined, OR = 2.145, 95% CI: 1.096-4.198, P = 0.026), and males (females vs. males, OR = 0.415, 95% CI: 0.199-0.867, P = 0.019) were the independent risk factors for a high risk of perioperative reflux and aspiration assessed by preoperative bedside ultrasonography. Conclusions:Colon cancer patients combined with incomplete intestinal obstruction have significantly larger preoperative cross-sectional area of the gastric antrum, gastric volume and GV/W in the right lateral position, and have gastric retention, which may contribute to a higher risk of perioperative reflux and aspiration.
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ABSTRACT Background: Colorectal cancer is the most frequent gastrointestinal malignancy worldwide. The value of adjuvant treatment is controversial in Stages I and II. Objective: The aim of this study was to construct post-operative prognostic models applicable to patients with stages I-II colon carcinoma (CC). Methods: This is a retrospective cohort study of patients with Stage I-II CC treated over a 25-year period. Exposure was defined as clinical, histopathological, and immunohistochemical factors (including CDX2 and MUC2 expression). Patients were randomly allocated to either a "modeling set" or a "validation set". Factors associated with recurrence, disease-free survival (DFS), and overall survival (OS) were defined in the "modeling set". Their performances were tested in the "validation set". Results: From a total of 556 recruited patients, 339 (61%) were allocated to the "modeling set" and 217 (39%) to the "validation set". Three models explaining recurrence, DFS, and OS were described. Tumor location in the left colon (Hazards ratio [HR] = 1.57; 95% Confidence interval [CI] 0.99-2.48), lymphocyte (HR = 0.46; 96% CI 0.27-0.88) and monocyte (HR = 0.99; 95% CI 0.99-1) counts, neutrophil/platelet ratio (HR = 1.3; 95% CI 0.74-2.3, and HR = 2.3; 95% CI 1.3-4.1; for second and third category, respectively), albumin/monocyte ratio (HR = 0.43; 95% CI 0.21-0.87), and microscopic residual disease after surgery (HR = 8.7; 95% CI 3.1-24) were independently associated with OS. T classification and expression of CDX2 and/or MUC2 were not independently associated with recurrence or prognosis. Conclusion: These models are simple and readily available, and distinguish the risk and prognosis in patients with CC stages I and II; these models require cheaper processes than the use of more sophisticated molecular biology techniques. They may guide either the need for adjuvant therapy versus post-operative surveillance only, as well as aid in the design of clinical trials.
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ABSTRACT We report an unusual case of fulminant endogenous Clostridium septicum panophthalmitis. A 74-year-old male patient presented with sudden amaurosis in the right eye, which in a few hours, evolved into an orbital cellulitis, endophthalmitis, anterior segment ischemia, and secondary perforation of the eye. A complete diagnostic study, which included cranial and orbital contrast-enhanced computed tomography scan, contrast-enhanced magnetic resonance imaging, blood cultures, and complete blood work, were performed. No causal agent was identified. Clostridium septicum infection caused fulminant gaseous panophthalmitis. Despite broad-spectrum antibiotic treatment, evisceration of the eyeball was necessary. The extension study showed a colon adenocarcinoma as the origin of the infection. Clostridium septicum panophthalmitis is a rare but aggressive orbital infection. This infection warrants the identification of a neoplastic process in the gastrointestinal tract in many cases not previously described.
RESUMO Este é o relato de um caso incomum de panoftalmite endógena fulminante por Clostridium septicum. Um paciente do sexo masculino, 74 anos, apresentou amaurose súbita no olho direito, que em poucas horas evoluiu para celulite orbitária, endoftalmite, isquemia do segmento anterior e perfuração secundária do olho. Foi realizado um estudo diagnóstico completo, que incluiu uma tomografia computadorizada com contraste cranial e orbital, um exame de ressonância magnética, hemocultura e hemograma completo. Nenhum agente causal foi identificado. A infecção por Clostridium septicum causou uma panoftalmite gasosa fulminante. Apesar do tratamento com antibióticos de amplo espectro, foi necessário eviscerar o globo ocular. O estudo de seguimento mostrou um adenocarcinoma de cólon como a origem da infecção. A panoftalmite por Clostridium septicum é um tipo raro, mas muito agressivo de infecção orbitária. Essa infecção deve sugerir a busca por um processo neoplásico no trato gastrointestinal, em muitos casos não diagnosticado anteriormente.
الموضوعات
Humans , Aged , Adenocarcinoma , Colonic Neoplasms , Clostridium septicum , Adenocarcinoma/complications , Adenocarcinoma/diagnostic imagingالملخص
Colorectal cancer (CRC) is one of the most common gastrointestinal cancers. The incidence and mortality of CRC are still rising in China. It is of great importance to explore the molecular mechanisms of the development and progression of CRC. Microsatellites are short tandem repeats that are distributed throughout the genome. Detection of microsatellite instability (MSI) is of great value in the diagnosis and treatment of CRC. MSI detection is an important method for Lynch syndrome screening. For patients with stage Ⅱ CRC, MSI status is an influencing factor for post-operative recurrence and an important reference for adjuvant therapy. For patients with stage Ⅳ CRC, MSI status is an important indicator for screening potential patients suitable for treatment of immune checkpoint inhibitors. However, there are still problems concerning the application of MSI. The detection methods of MSI have not been fully unified. The requirement of MSI detection in CRC patients are universal but not precise. MSI is not a valid predictor for the prognosis of CRC patients, and it could not effectively predict the efficacy of chemotherapy and immunotherapy. Moreover, with the application of other molecular markers, such as programmed death-1, programmed death-ligand 1, tumor mutation burden and immunoscore, the value of MSI in CRC is being challenged and remains to be unveiled with more studies. The authors investigate the problems in MSI detection and application, in order to provide reference for clinical practice.
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Objective:To analyze the application effect of nano-carbon lymphatic tracer technology in laparoscopic colon cancer (CC) radical resection based on propensity matching.Methods:Retrospective case-control study was performed in this study. From January 2016 to April 2021, 714 cases of CC patients who underwent laparoscopic CC radical resection in Kunshan Second People′s Hospital were divided into groups according to whether or not the nano-carbon lymphatic tracing technique was applied. Seventy-eight cases in group A were applied with nano-carbon lymphatic tracing technique, while 636 cases in group B were not applied with nano-carbon lymphatic tracing technique. The initial data were matched 1∶3 by the propensity score matching method, and finally group A (73 cases) and group B (219 cases) were obtained. The detection of lymph nodes in the two groups after propensity score matching was compared.Results:By comparing the baseline data of the two groups after propensity score matching, it was found that there were no significant differences in gender, height, weight, body mass index, tumor T stage, tumor N stage, tumor TNM stage, preoperative chemotherapy, or tumor location ( P>0.05). The total number of lymph nodes in group A was higher than that in group B: (22.24 ± 7.08) pieces vs. (19.03 ± 6.29) pieces, and the difference was statistically significant ( t = 3.66, P<0.05); the number of positive lymph nodes and the degree of lymph node metastasis in group A were not significantly different from those in group B ( P>0.05). Tumor T stage T 3, tumor N stage N 0, tumor TNM stage Ⅱ, and preoperative chemotherapy, the total number of lymph nodes in group A was higher than that in group B: 23 (6, 60) pieces vs. 19 (4, 54) pieces , 20 (3, 62) pieces vs. 18 (3, 75) pieces, 23 (6, 59) pieces vs. 20 (7, 54) pieces, 22 (5, 45) pieces vs. 14 (4, 46) pieces, and the difference was statistically significant ( Z = 2.43, 2.70, 2.64 and 3.32; P<0.05); the number of positive lymph nodes and the degree of lymph node metastasis of tumor N stage N 2 in group A were lower than those in group B: 4 (4, 9) pieces vs. 6 (4, 25) pieces , 16 (10, 42) pieces vs. 32 (19, 100) pieces, and the difference between groups was statistically significant ( Z = -2.53 and -2.87, P<0.05). Followed up to April 2022, among the 292 patients, 5 were lost to follow-up, the 3-year disease-free survival rates of 72 patients in group A and 215 patients in group B were 83.33% (60/72) and 91.16% (196/215) respectively, there was no significant difference between two groups ( P>0.05). Conclusions:The number of lymph nodes detected in laparoscopic CC radical resection increases after the application of nano-carbon lymphatic tracing technology.
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Objective:To study the expression and clinical significance of microRNA-574-3p (miR-574-3p) in colon cancer.Methods:A total of 106 colon cancer patients who were admitted to the First Hospital of Qinhuangdao and Shijiazhuang Hospital of Traditional Chinese Medicine from June 2012 to June 2015 were selected as the research objects. Real-time fluorescent quantitative polymerase chain reaction (qRT-PCR) was used to detect the expression level of miR-574-3p in colon cancer tissues and normal adjacent tissues. The relationship between the expression of miR-574-3p and the clinicopathological characteristics and prognosis of patients with colon cancer was analyzed. Immunohistochemical staining was used to detect the relationship between the expression of miR-574-3p and the expression of CyclinA2 or E-cadherin.Results:Compared with normal tissues adjacent to cancer, the expression level of miR-574-3p in 106 cases of colon cancer was significantly lower ( P<0.01). The decreased expression of miR-574-3p was related to tumor diameter, Dukes stage, histological grade and lymph node metastasis (all P<0.05), but not to age and tumor location (all P>0.05). The patients with low expression of miR-574-3p, high Dukes stage and histological grade, and lymph node metastasis had poor survival (all P<0.05). The 5-year overall survival rate of patients with decreased miR-574-3p expression in cancer tissue was significantly lower than that of patients without decreased miR-574-3p expression ( P=0.007 6). Compared with patients with no decreased miR-574-3p expression, patients with decreased miR-574-3p expression had higher CyclinA2 protein integrated optical density (IOD) value and lower E-cadherin protein IOD value in colon cancer tissues (all P<0.05). Conclusions:The decreased expression of miR-574-3p is related to the poor prognosis of colon cancer patients, which may affect tumor recurrence and metastasis by regulating the expression of CyclinA2 and E-cadherin proteins.
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Objective:To explore the relationship between the abnormal adipose tissue around the primary tumor of colon cancer and the prognosis.Methods:From January 2015 to December 2017, 448 patients with colon cancer in Peking University Cancer Hospital were retrospectively and consecutively collected. The scores were assigned to the severity, horizontal and vertical ranges of peritumoral adipose tissue (PAT) abnormalities, and the cumulative scores were calculated to establish the PAT grades from 1 to 3. We defined a score of 0 or 1 as PAT grade 1, a score of 2 as PAT grade 2, a score of 3 as PAT grade 3. The patients were followed up, and the overall survival (OS) and metastasis-free survival (MFS) were recorded. The Kaplan-Meier curve, log-rank test and Cox regression analysis were used to evaluate its impact on prognosis, and the hazard ratio (HR) and 95% confidence interval (CI) were calculated.Results:Among the 448 patients, patients with PAT grade 1, 2, and 3 accounted for 70.1% (314/448), 18.1% (81/448), and 11.8% (53/448), respectively. The Kaplan-Meier survival curve showed that patients with PAT grade 1 had the best OS, patients with grade 3 had the worst OS, and patients with grade 2 were in between, and the difference was statistically significant (χ 2=27.38, P<0.001). There were statistically significant differences between the grades in pairs ( P<0.05). There was no significant difference in MFS between different PAT grades (χ 2=2.85, P=0.240). The results of Cox regression analysis showed that PAT grade was an independent factor affecting the OS. Compared with PAT grade 1, the risk of death in patients with PAT grade 2 and 3 was significantly increased (HR 2.563, 95%CI 1.181-5.561; HR 2.269, 95%CI 1.005-5.121; P=0.034). PAT grade was not an independent factor of MFS ( P=0.253). Conclusion:The PAT grade established based on the degree and scope of abnormal PAT in colon cancer is an independent factor for poor prognosis of colon cancer.
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Objective:To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative pulmonary function in the patients undergoing robot-assisted radical resection of colon cancer.Method:Ninety-four patients of either sex, aged 50-80 yr, with body mass index of 18-25 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, with ARISCAT grade of medium risk, undergoing elective robot-assisted radical resection of colon cancer, were enrolled in this study. The patients were divided into TEAS group (group T, n=47) and sham-TEAS group (group S, n=47) using a random number table method. In group T, patients received 30 min of TEAS at Hegu (LI4), Quchi (LI11), Zusanli (ST36) and Feishu (BL13) between 5: 00 and 7: 00 a. m. from 1st day before operation to 3rd day after operation, with disperse-dense wave 2/100 Hz, and the stimulation intensity was the maximum intensity that the patient could tolerate. Patients in group S were also connected to the device without electrical stimulation. Both groups adopted lung-protective ventilation strategy during operation. The oxygenation index was calculated at the time of entering the operating room (T 0), 5 min after anesthesia induction (T 1), 5 min of pneumoperitoneum (T 2), 5 min after changing to Trendelenburg position (T 3) and immediately after the end of pneumoperitoneum (T 4). Peak airway pressure, plateau airway pressure, driving pressure and dynamic lung compliance were recorded at T 0-T 4. The serum concentration of lung Clara cell 16 kDa protein was recorded using enzyme-linked immunosorbent assay at T 0, T 4 and 2 h after extubation (T 5). On 1 day before operation and 1, 3 and 7 days after operation, the forced expiratory volume in the first second (FEV 1) and forced vital capacity (FVC) were measured, and the FEV 1/FVC was calculated, and the concentrations of serum tumor necrosis factor-alpha, interleukin-6 and cardiopulmonary resuscitation were simultaneously determined using enzyme-linked immunosorbent assay. The occurrence of pulmonary complications within 7 days after operation was recorded. Results:There was no significant difference in pH values, PaCO 2, oxygenation index, peak airway pressure, plateau airway pressure, driving pressure, and dynamic lung compliance at each time point between the two groups ( P>0.05). Compared with S group, the serum Clara cell 16 kDa protein concentrations were significantly decreased at T 5, FEV 1 and FVC were increased at 3 and 7 days after operation, the serum tumor necrosis factor-alpha, interleukin-6 and cardiopulmonary resuscitation concentrations were decreased at 1, 3 and 7 days after operation, the incidence of unexpected oxygen supply and total incidence of postoperative pulmonary complications were decreased ( P<0.05), and no significant change was found in FEV 1/FVC at each time point in T group ( P>0.05). Conclusions:TEAS can improve lung function in the patients undergoing robot-assisted radical resection of colon cancer.
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Objective:To compare the lymph node tracing of indocyanine green (ICG) and nanocarbon in laparoscopic right hemicolectomy.Methods:Fifty-two patients with right colon cancer were randomly divided into two groups: ICG group and nanocarbon group at Peking University International Hospital between Oct 2020 and Jul 2022. Sentinel lymph node (SLN) mapping and standard oncologic resection was performed. The micrometastasis was to detect when the routine SLN pathological test was negative.Results:In ICG group, the detection rate of SLN was 100%, the sensitivity was 93%, the false negative rate was 7%, and the accuracy was 96%,which were better than nanocarbon group (92%,57%,43%,77%). The number of SLN and positive SLN detected in ICG group were significantly higher than nanocarbon group [(3.2±0.7) vs. (2.6±1.1), t=4.424, P=0.020; (1.2±1.2) vs.(0.5±0.8), t=15.176, P=0.013]. The SLN biopsy accuracy of patients with BMI ≥24 kg/m 2 and tumor diameter ≥3 cm in ICG group was significantly higher than nanocarbon group (90% vs. 44%, χ 2=7.935, P=0.005; 90% vs.57%, χ 2=4.309, P=0.038). The detection rate of micrometastasis in SLN of ICG group was significantly different from nanocarbon group (35% vs. 15%, χ 2=5.853, P=0.016). Conclusion:ICG fluorescence imaging is superior to nanocarbon in SLN biopsy during laparoscopic radical right hemicolectomy, especially when patients' BMI ≥24 kg/m 2 and tumor diameter ≥3 cm.
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Objective:To investigate the relationship between microsatellite instability (MSI) , and clinicopathological features ,prognosis in patients with stage Ⅱ and Ⅲ colon cancer.Methods:Patients undergoing surgical resection for stage Ⅱ and Ⅲ colonic tumor in the Affiliated Hospital of Qingdao University from Dec 2016 to Nov 2018 were enrolled. All the 292 patients were with stage Ⅱ and Ⅲ colon cancer and MSI status. Propensity score matching method was used to match the two groups of patients according to 1:1. χ 2 analysis, Logistic Regression and COX regression was used to analyse the relationship between MSI status, the clinicopathological features and prognosis. Results:The risk of MSI-H in young patients ( OR=0.340, 95% CI: 0.126~0.921, P=0.034), right-sided colon cancer ( OR=7.985, 95% CI: 3.040-20.973, P<0.001), mucinous adenocarcinoma ( OR=4.285, 95% CI: 1.495-12.284, P=0.007), poorer differentiation ( OR=4.848, 95% CI: 1.597-14.716, P=0.005), N0 staging ( OR=0.235 , 95% CI: 0.077-0.719, P=0.011) increased . The total OS of colon cancer patients in the MSS group (66.7%) and the MSI-H group (86.9%) were statistically different( P=0.003). The MSI status ( HR=0.367, 95% CI: 0.151-0.891, P=0.027) is an independent factor affecting the prognosis of patients. Conclusions:In stage Ⅱ and Ⅲ colon cancer, patients with MSI-H have a better prognosis. MSI status is prognosis relevant factor for colon cancer patients.
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Objective:To investigate the characteristics related to proliferation, migration and invasion of radiation-induced polyploid colon cancer SW1116 cells and their progeny.Methods:Colon cancer SW1116 cells were conventionally cultured in Leibovitz's L-15 medium containing 10% fetal bovine serum. SW1116 cells at logarithmic growth stage were irradiated with 7 Gy X-ray, and the morphological changes of the cells were observed by inverted microscope on days 3, 5, 10 and 19 after radiation induction. According to the morphological changes of the cells, the cells at day 3 after radiation induction were labeled as polyploid giant cancer cell (PGCC) group, and the cells at day 19 were recorded as PGCC progeny group. SW1116 cells without radiation induction were used as control group. Flow cytometry was used to detect cell ploidy in the control, PGCC and PGCC progeny groups, CCK-8 assay was used to detect the proliferation ability of the three groups, cell migration and invasion abilities of the three groups were detected by cell scratch assay and Transwell assay, and Western blotting was used to detect the expressions of cell cycle and proliferation-related proteins and epithelial-mesenchymal transition (EMT) marker N-cadherin (N-cad) in the three groups.Results:The volume of SW1116 cells gradually became larger on days 3, 5 and 10 after radiation induction, and returned to normal on day 19. The proportions of polyploid (DNA content >4N) cell subsets in the control group, PGCC group and PGCC progeny group were (2.3±1.1)%, (23.1±8.1)% and (3.2±0.5)%, the difference was statistically significant ( F = 18.52, P < 0.05), and the proportion of polyploid cell subpopulations in the PGCC group was higher than that in the control group ( t = 5.38, P < 0.01), but the differences between the PGCC progeny group and the control group were not statistically significant ( t = 0.22, P > 0.05). After 72 h of culture, the cell proliferation rates of the control, PGCC and PGCC progeny groups were (100.0±4.1)%, (73.5±0.7)% and (123.9±3.5)%, and the difference was statistically significant ( F = 190.27, P < 0.001). After 48 h of cell scratching, the scratch healing rates in the control, PGCC and PGCC progeny groups were (38.0±2.7)%, (41.5±4.0)% and (63.7±4.2)%, and the difference was statistically significant ( F = 43.05, P < 0.001). After 24 h of culture, the number of invasive cells in the control, PGCC and PGCC progeny groups was 12.9±1.2, 3.4±0.6 and 23.7±1.5, and the difference was statistically significant ( F = 63.64, P < 0.001). The expression levels of cell cycle-related proteins P-cdc25c, cdc25c and cdc2 in the PGCC group were lower than those in the control group (all P < 0.05), and the expression levels of transcription factor-related proteins E2F-2, E2F-3 and EMT marker N-cad were downregulated compared with the control group (all P < 0.05); the expression levels of P-cdc25c, cdc25c, cdc2, E2F-2, E2F-3 and N-cad proteins in the PGCC progeny group were higher than those in the control group (all P < 0.05). Conclusions:Radiation can induce colon cancer SW1116 cells to produce polyploid, which may then generate daughter cells through asymmetric mitosis and gain new life, and then promote the recurrence and metastasis of colon cancer.
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Objective:To screen the differentially expressed genes (DEG) related to inflammatory response associated with the prognosis of colon cancer based on the bioinformatics approach, and to construct and validate a prognostic model for colon cancer.Methods:RNA sequencing and clinical data of 472 colon cancer patients and normal colon tissues of 41 healthy people were retrieved from the Cancer Genome Atlas (TCGA) database. Gene expression related to prognosis of colon cancer and clinical data were retrieved from the International Cancer Genome Consortium (ICGC) database. The retrieval time was all from the establishment of library to November 2022. A total of 200 genes associated with inflammatory response obtained from the Gene Set Enrichment Analysis (GSEA) database were compared with the RNA sequencing gene dataset of colon cancer and normal colon tissues obtained from the TCGA database, and then DEG associated with inflammatory response were obtained. The prognosis-related DEG in the TCGA database were analyzed by using Cox proportional risk model, and the inflammatory response-related DEG were intersected with the prognosis-related DEG to obtain the prognosis-related inflammatory response-related DEG. The prognostic model of colon cancer was constructed by using LASSO Cox regression. Risk scores were calculated, and colon cancer patients in the TCGA database were divided into two groups of low risk (< the median value) and high risk (≥the median value) according to the median value of risk scores. Principal component analysis (PCA) was performed on patients in both groups, and survival analysis was performed by using Kaplan-Meier method. The efficacy of risk score in predicting the overall survival (OS) of colon cancer patients in the TCGA database was analyzed based on the R software timeROC program package. Clinical data from the ICGC database were applied to externally validate the constructed prognostic model, and patients with colon cancer in the ICGC database were classified into high and low risk groups based on the median risk score of patients with colon cancer in the TCGA database. By using R software, single-sample gene set enrichment analysis (ssGESA), immunophenotyping difference analysis, immune microenvironment correlation analysis, and immune checkpoint gene difference analysis of immune cells and immune function were performed for prognosis-related inflammation response-related DEG in the TCGA database.Results:A total of 60 inflammatory response-related DEG and 12 prognosis-related DEG were obtained; and 6 prognosis-related inflammatory response-related DEG (CCL24, GP1BA, SLC4A4, SRI, SPHK1, TIMP1) were obtained by taking the intersection set. LASSO Cox regression analysis showed that a prognostic model for colon cancer was constructed based on 6 prognosis-related inflammatory response-related DEG, and the risk score was calculated as = -0.113×CCL24+0.568×GP1BA+ (-0.375)×SLC4A4+(-0.051)×SRI+0.287×SPHK1+0.345×TIMP1. PCA results showed that patients with colon cancer could be better classified into 2 clusters. The OS in the high-risk group was worse than that in the low-risk group in the TCGA database ( P < 0.001); the area of the curve (AUC) of the prognostic risk score for predicting the OS rates of 1-year, 3-year, 5-year was 0.701, 0.685, and 0.675, respectively. The OS of the low-risk group was better than that of the high-risk group in the ICGC database; AUC of the prognostic risk score for predicting the OS rates of 1-year, 2-year, 3-year was 0.760, 0.788, and 0.743, respectively. ssGSEA analysis showed that the level of immune cell infiltration in the high-risk group in the TCGA database was high, especially the scores of activated dendritic cells, macrophages, neutrophils, plasmacytoid dendritic cells, T helper cells, and follicular helper T cells in the high-risk group were higher than those in the low-risk group, while the score of helper T cells 2 (Th2) in the high-risk group was lower compared with that in the low-risk group (all P < 0.05); in terms of immune function, the high-risk group had higher scores of antigen-presenting cell (APC) co-inhibition, APC co-stimulation, immune checkpoint, human leukocyte antigen (HLA), promotion of inflammation, parainflammation, T-cell stimulation, type Ⅰ interferon (IFN) response, and type ⅡIFN response scores compared with those in the low-risk group (all P < 0.05). The results of immunophenotyping analysis showed that IFN-γ-dominant type (C2) had the highest inflammatory response score, and the differences were statistically significant when compared with trauma healing type (C1) and inflammatory response type (C3), respectively (all P < 0.05). Immune microenvironment stromal cells and immune cells were all positively correlated with prognostic risk scores ( r values were 0.35 and 0.21, respectively, both P < 0.01). The results of immune checkpoint difference analysis showed there was a statistically significant difference in programmed-death receptor ligand 1 (PD-L1) expression level between high-risk group and low-risk group ( P = 0.002), and PD-L1 expression level was positively correlated with prognostic risk score ( r = 0.23, P < 0.01). Conclusions:Inflammatory response-related genes may play an important role in tumor immunity of colon cancer and can be used in the prognostic analysis and immunotherapy of colon cancer patients.
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Objective:To explore the practical application and clinical significance of modified grading system for Gastrointestinal Symptom Rating Scale (GSRS) scores in evaluating long-term postoperative gastrointestinal dysfunction (PGID) in patients after colon cancer surgery.Methods:A retrospective analysis was conducted on the case data of 122 patients who underwent right hemicolectomy for colorectal cancer at Beijing Friendship Hospital, Capital Medical University from September 2021 to September 2022. Among these patients, 69 were males (56.6%), and 53 were females (43.4%). The median age was 66.5 years, and the body mass index was (24.4±3.3) kg/m 2. The main observe indiator was GSRS scores of patients. The measurement data of normal distribution were represented as mean±standard deviation( ± s), and intergroup comparisons were conducted using ANOVA. The measurement data of non-normal distribution were expressed as the median (interquartile distance) [ M( Q1, Q3)], the Kruskal-Wallis H test was employed. Unordered count data comparisons were performed using the χ2 test, while comparisons for ordered count data between groups were conducted using the Kruskal-Wallis H test. GSRS scores were represented using density plots, and the scores were categorized into five symptom groups, presented using radar charts to illustrate the distribution of each symptom group. Results:Among the 122 patients, the most common long-term PGID syndromes was dyspepsia, followed by abdominal pain, diarrhea, and constipation. GSRS score data in the study population exhibited a nearly trimodal trend. Based on the overall data trend, the GSRS scale was refined, with cut-off values of 20 and 30, categorizing patients with right-sided colon cancer into low-risk, moderate-risk, and high-risk groups for quantifying the severity of long-term PGID. In terms of gender distribution, the differences among the three groups was statistically significant ( P=0.031), suggesting that males may be more susceptible to long-term PGID. However, there were no significant differences among the three groups concerning age, tumor location, surgical approach, anastomotic technique, lymph node dissection, pathological staging, adjuvant chemotherapy, and other factors. Conclusions:The modified grading system for GSRS scores aligns with the distribution characteristics of postoperative gastrointestinal function in colorectal cancer patients. It can quantify the risk of long-term PGID, allowing for a graded management approach to improve the postoperative quality of life for patients.
الملخص
Objective:To explore the correlation between preoperative nutritional status and postoperative complications in elderly patients with right-sided colon cancer.Methods:A prospective registry database of 1, 196 patients undergoing curative surgery for right-sided colon cancer was collected from 52 top-tier hospitals nationwide between September 2021 and June 2022. The cohort included 627 males and 569 females, with an age range of 64(53, 71) years. Among these, 136 patients developed complications, while 1, 060 did not. Patients were divided into two groups based on age: the elderly group(≥65 years, n=571) and the middle-aged group(<65 years, n=625). Preoperative nutritional assessment indicators, clinical pathological data, and the incidence of complications within 30 days post-surgery were collected. For normally distributed quantitative data, mean ± standard deviation( ± s) was used, and the t-test was applied for intergroup comparisons. Non-normally distributed quantitative data were represented as M( Q1, Q3) and analyzed using the Wilcoxon rank-sum test; categorical data were compared using the chi-square test or Fisher′s exact test. In the analysis of risk factors for postoperative complications in elderly patients, univariate analysis was first conducted on all potential risk factors, followed by the inclusion of statistically significant variables from univariate regression into a multivariate logistic regression model. Results:The overall incidence of postoperative complications was 11.37%(136/1 196), with common complications includin wound infection(2.26%), intestinal obstruction (2.26%), anastomotic leakage(1.42%), deep vein thrombosis(1.42%), and chylous leakage(1.42%). In the elderly group, the proportion of patients with preoperative nutritional risk who developed complications was significantly higher than those without complications(66.20% vs. 53.40%, P=0.043). In the multivariate analysis, body mass index( OR=1.058, 95% CI: 1.005-1.117, P=0.031) and nutritional risk( OR=1.803, 95% CI: 1.066-3.126, P=0.031) were identified as independent risk factors for postoperative complications in elderly patients. Conclusions:There is a correlation between preoperative nutritional status and the occurrence of postoperative complications in elderly colon cancer patients, particularly with respect to body mass index and nutritional risk. These findings underscore the importance of preoperative nutritional assessment and intervention in elderly patients to reduce the risk of postoperative complications.
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Background:Early diagnosis and treatment can effectively improve the prognosis of colon cancer.Simple,effective and sensitive screening indicators are of great significance for identification of early cancer and precancerous lesions.L-selectin is a cell adhesion molecule,and podocalyxin(PODXL)is its ligand,both of them play key roles in the development of cancer.Aims:To investigate the expression and significance of L-selectin and its ligand PODXL in colon cancer.Methods:A total of 120 cases of pathological specimens(40 hyperplastic polyp,40 colon adenoma,and 40 colon cancer)from Nov.2020 to Nov.2022 at the Frist People's Hospital of Hangzhou Lin'an District and the First Affiliated Hospital of Zhejiang Chinese Medical University were collected,and 20 cases of normal intestinal mucosal tissue were served as controls.qRT-PCR and immunohistochemistry were used to detect the mRNA and protein expressions of L-selectin and PODXL,respectively.Western blotting was used to determine the expressions of L-selectin and PODXL,and their relations with different clinicopathological parameters of colon cancer were analyzed.In addition,60 serum specimens of colon cancer were collected.ELISA was used to detect serum concentrations of L-selectin and PODXL.Results:Expressions of L-selectin and PODXL mRNA and protein in colon adenoma group were significantly higher than those in normal controls and hyperplastic polyp group(P<0.05),and mRNA and protein expressions of L-selectin and PODXL in colon cancer group were significantly higher than those in normal controls,hyperplastic polyp group and colon adenoma group(P<0.05).Significant differences in protein expressions of L-selectin and PODXL were found in different pathological types,lymph node metastasis,Dukes staging in colon cancer(P<0.05).Expression of L-selectin was positive correlated with expression of PODXL in colon cancer(r=0.855,P<0.001).Serum concentrations of L-selectin and PODXL were significantly lower in the initial group than in the relapse group(P<0.05),and serum concentrations of L-selection and PODXL was significantly lower in the non-metastatic group than in the metastatic group(P<0.05).Serum concentrations of L-selectin and PODXL at 3 months after surgery was significantly lower than 3 days after surgery and before surgery(P<0.05).Conclusions:L-selectin and PODXL may be involved in the development and progression of colon cancer.They are carcinogenic proteins,and their detection could provide reference value for the prevention and early diagnosis of colon cancer,and through early screening of lesion could improve the prognosis of colon cancer to a certain extent.
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Objective:To investigate the value of multi-stage dynamic contrast enhanced MRI (DCE-MRI) histogram in predicting survival of patients undergoing surgical treatment of colorectal cancer (CRC).Methods:The retrospective cohort study was conducted. The clinico-pathological data of 81 patients with CRC who were admitted to the Jiuquan City People′s Hospital from January 2018 to February 2019 were collected. There were 47 males and 34 females, aged (62±6)years. All patients underwent routine MRI and DCE-MRI examination to extract relevant imaging parameters. Observation indicators: (1) treatment, imaging examination and follow-up; (2) imaging factors influencing postoperative disease-free survival of patients with CRC. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Univariate and multivariate analyses were conducted using the COX proportional risk model. Pearson correlation test was used to analyze and exclude factors with correlation in univariate analysis, and the multi-variate analysis was conducted on the rest of factors. The Kaplan-Meier method was used to calculate survival rates, and Log-Rank test was used for survival analysis. Results:(1) Treatment, imaging examination and follow-up. All 81 patients underwent preoperative MRI plain scan, enhanced imaging, and diffusion weighted imaging. After complete examination, all patients underwent radical resection of CRC and received postoperative chemotherapy using the FOLFOX regimen. All 81 patients were followed up for 42(range, 11-61)months after surgery. The 1-, 3-, 5-year overall survival rate of 81 patients after surgery was 98.8%, 96.3%, 93.8%, respectively. During the follow-up period, 56 of the 81 patients survived from disease-free and 25 patients had disease progressed. (2) Imaging factors influencing postoperative disease-free survival of patients with CRC. Results of multivariate analysis showed that the kurtosis value and skewness value of positive enhancement integral (PEI) were independent imaging factors influencing postoperative disease-free survival of patients of CRC ( odds ratio=1.840, 1.243, 95% confidence interval as 1.403-2.412, 1.020-1.516, P<0.05). Taking the median values of kurtosis value and skewness value of PEI as 4.864 and 5.042 for further analysis. The postoperative 5-year disease-free survival rate of patients with kurtosis value of PEI <4.864 and ≥4.864 was 89.7% and 10.3%, showing a significant difference between them ( χ2=31.265, P<0.05). The postoperative 5-year disease-free survival rate of patients with skewness value of PEI<5.042 and ≥5.042 was 63.4% and 36.6%, showing a significant difference between them ( χ2=8.164, P<0.05). Conclusions:The kurtosis value and skewness value of PEI in DCE-MRI are independent imaging factors influencing postoperative disease-free survival of patients of CRC. The DCE-MRI histogram can effectively evaluate the postoperative prognosis of patients of CRC.
الملخص
Objective:To investigate the clinicopathological characteristics of early-onset colorectal cancer.Methods:The retrospective and descriptive study was conducted. The clincopatholo-gical data of 59 206 patients with colorectal cancer in the Surveillance, Epidemiology, and End Results Program of the United States of America From January 1,2010 to December 31,2019 were collected. There were 33 213 males, 25 993 males, aged (50±7)years. Observation indicators: (1) demographic and oncological characteristics of colorectal cancer patients; (2) comparison of clinico-pathological characteristics between early-onset and late-onset colorectal cancer. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison among groups was conducted using the Kruskal-Wallis H test. Count data were described as absolute numbers, and comparison among groups was conducted using the chi-square test. Comparison of ordinal data was conducted using the non-parameter H test. Patients with early-onset colorectal cancer were segmented by age, and missing data for categorical variables is set as unknown. Results:(1) Demographic and oncological characteristics of colorectal cancer patients. Of 59 206 patients, there were 23 104 cases with early-onset colorectal cancer and 36 102 cases with late-onset colorectal cancer, and cases aged 13-29 years, cases aged 30-34 years, cases aged 35-39 years, cases aged 40-44 years, cases aged 45-49 years, cases aged 55-59 years were 1 041, 1 740, 3 288, 6 050, 10 985, 15 303,20 799, respectively. (2) Comparison of clinicopathological charac-teristics between early-onset and late-onset colorectal cancer. ① There were significant differences in gender, tumor location, degree of tumor differentiation, tumor histological type, tumor TNM staging, tumor T staging, tumor N staging, tumor M staging, preoperative carcinoembryonic antigen (CEA), perineural invasion, cancer nodule, tumor diameter between patients with early-onset and late-onset colorectal cancer ( P<0.01). Results of further analysis showed that cases with tumor located in ileocecal region, ascending colon, colon liver region, transverse colon were 2 329, 2 139, 579, 1 303 in the 6 350 patients with early-onset right colon cancer. The above indicators were 4 563, 3 945, 902, 1 951 in the 11 361 patients with late-onset right colon cancer. There was a significant difference in the above indicators between the two groups of patients ( χ2=114.27, P<0.01). Cases with tumor located in splenic region of the colon, descending colon, sigmoid colon, rectum sigmoid junction were 553, 1 354, 6 404, 2 431 in the 10 742 patients with early-onset left colon cancer. The above indicators were 865, 1 798, 9 668, 3 610 in the 15 941 patients with late-onset left colon cancer. There was a significant difference in the above indicators between the two groups of patients ( χ2=35.60, P<0.01). ②Of 23 104 patients with early-onset colorectal cancer, cases aged 13-29 years, cases aged 30-34 years, cases aged 35-39 years, cases aged 40-44 years, cases aged 45-49 years were 1 041, 1 740, 3 288, 6 050, 10 985, respectively. There were significant differences in gender, degree of tumor differentiation, tumor histological type, tumor TNM staging, tumor T staging, tumor N staging, pre-operative CEA, perineural invasion, cancer nodule, tumor diameter among patients of different age groups ( P<0.01). Results of further analysis showed that cases with tumor located in ileocecal region, ascending colon, colon liver region, and transverse colon were 91, 117, 45, 69 in the 6 350 early-onset right colorectal cancer patients aged 13-29 years. The above indicators were 165, 136, 47, 115, 304, 313, 93,201, 614, 535, 151, 330, 1 155, 1 038, 243, 588 in early-onset right colorectal cancer patients aged 30-34, 35-39, 40-44, 45-49 years, respectively. There was a significant difference in the above indicators among the five groups of patients ( H=36.63, P<0.01). Cases with tumor located in splenic region of the colon, descending colon, sigmoid colon, rectum sigmoid junction were 32, 83, 260, 95 in the 10 742 early-onset left colorectal cancer patients aged 13-29 years. The above indica-tors were 53, 112, 452, 171, 95, 230, 867, 342, 149, 337, 1 702, 665, 224, 592, 3 123, 1 158 in the 10 742 early-onset left colorectal cancer patients aged 30-34, 35-39, 40-44, 45-49 years, respectively. There was a significant difference in the above indicators among the five groups of patients ( H=47.84, P<0.01). Conclusions:Compared with late-onset colorectal cancer, early-onset colorectal cancer are more likely to occur in the left colon and rectum, with poorly differentiated and undifferentiated tumors, histological type of mucinous adenocarcinoma, TNM staging of stage Ⅲ and Ⅳ, higher proportion of nerve infiltration and cancer nodules, and larger tumor diameter. There are significant differences in clinicopathological characteristics of tumors among patients with early-onset colorectal cancer of different age groups.