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1.
Talanta ; 236: 122867, 2022 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-34635249

RESUMEN

Carcinoembryonic antigen (CEA) is one of the most widely used tumor marker around the world, it mainly used for gastrointestinal cancers, especially in colorectal malignancy. At present, the detection methods of CEA are mostly based on antigen-antibody binding, whereas these methods were limited by the high costs and long waiting times in massive population tumor screening. During the experiments, we interestingly found that the fluorescence signal would be dramatically altered when the secondary structure of fluorescent modified guanine-rich DNA changed. Then we explored the reasons and established a new method for CEA detection, this method brings a simple, fast and cheap sensing platform for detection of biomarkers. It has great potential in screening of tumors among the group and is expected to provide prospective effects for tumor treatment.


Asunto(s)
Aptámeros de Nucleótidos , Neoplasias Colorrectales , Antígeno Carcinoembrionario , Neoplasias Colorrectales/diagnóstico , Fluorescencia , Guanina , Humanos
2.
Estima (Online) ; 19(1): e1521, jan.-dez. 2021.
Artículo en Portugués | LILACS, BDENF - Enfermería | ID: biblio-1291477

RESUMEN

Objetivo:Analisar as percepções dos pacientes com câncer colorretal em uso de colostomia sobre os cuidados de enfermagem das unidades de internação em oncologia de um hospital do oeste de Santa Catarina. Métodos: Estudo descritivo-exploratório de abordagem qualitativa realizado nas unidades de internação em oncologia do Hospital Regional do Oeste, no período de janeiro a agosto de 2020, por meio de um questionário contendo dados sociodemográficos e entrevista semiestruturada, aplicado a 20 pacientes com câncer colorretal em uso de colostomia. Os dados foram analisados por meio da Análise de Conteúdo de Laurence Bardin. Resultados: Os resultados apontaram prevalência de colostomizados do sexo masculino, com idade média de 60,25 anos, casados, aposentados e com ensino fundamental incompleto. A partir da análise qualitativa das entrevistas surgiu a categoria: percepções dos pacientes sobre os cuidados de enfermagem, a qual foi subdividida em: cuidados de enfermagem com a bolsa e a estomia e cuidados de enfermagem na internação. Conclusão: Ao término da pesquisa, conclui-se que os colostomizados percebem que a equipe de enfermagem realiza os cuidados essenciais à bolsa e à estomia, incluindo sua troca e higiene durante a internação, atendendo às necessidades dos pacientes. Além disso, fornecem orientações importantes sobre o uso dos dispositivos, promovendo educação em saúde.


Asunto(s)
Colostomía , Neoplasias Colorrectales , Investigación Cualitativa , Estomaterapia , Oncología Médica , Atención de Enfermería
3.
Oncoimmunology ; 10(1): 1976953, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34595059

RESUMEN

Human microbiota influence the response of malignancies to treatment with immune checkpoint blockade; however, their impact on other forms of immunotherapy is poorly understood. This study explored the effect of blood microbiota on clinical efficacy, represented by progression-free survival (PFS) and overall survival (OS), of combined chemotherapy and adoptive cellular therapy (ACT) in advanced colon cancer patients. Plasma was collected from colorectal cancer patients (CRC) treated with either chemotherapy alone (oxaliplatin and capecitabine) (XELOX CT alone group, n = 19), or ACT with a mixed dendritic cell/cytokine-induced killer cell product (DC-CIK) + XELOX (ICT group, n = 20). Circulating microbiota analysis was performed by PCR amplification and next-generation sequencing of variable regions V3~V4 of bacterial 16S rRNA genes. The association of the blood microbial diversity with clinical response to the therapy as measured by RECIST1.1 and OS was evaluated. The baseline Chao index of blood microbial diversity predicted prolonged PFS and OS of DC/CIK immunotherapy. More diverse blood microbiota that included Bifidobacterium, Lactobacillus, and Enterococcus were identified among responders to DC/CIK compared with non-responders. The plasma bacterial DNA copy number is inversely correlated with the CD3-/CD16+/CD56+ NK cells in circulation and decreased following DC-CIK; however, the Chao index of plasma microbiota significantly increased after administration of the DC-CIK product and this subsequent change was correlated with the number of CD3-/CD16+/CD56+ and CD8+/CD28+ cells infused. The diversity of the blood microbiome is a promising predictive marker for clinical responses to chemotherapy combined with DC-CIK. Cellular immunotherapy can affect the plasma microbiota's diversity in a manner favorable to clinical responses.


Asunto(s)
Neoplasias Colorrectales , Microbiota , Neoplasias Colorrectales/terapia , Células Dendríticas , Humanos , Inmunoterapia , Inmunoterapia Adoptiva , ARN Ribosómico 16S/genética , Linfocitos T
4.
J Med Life ; 14(4): 462-467, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34621368

RESUMEN

After almost 50 years of data analysis, screening for colorectal cancer has proven to be an effective tool in reducing colorectal cancer mortality. However, implementing the optimal strategy represents a challenge for many healthcare facilities around the world. There is much discussion regarding how screening should be done, the optimal tools that should be used, and the proper timing for screening procedures. Another essential step is to maintain the adherence of patients to screening programs. Also, the recommendation for lowering the age to initiate screening is in progress, as there is an increase in colorectal incidence in people born after 1970.


Asunto(s)
Colonoscopía , Neoplasias Colorrectales , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/epidemiología , Atención a la Salud , Detección Precoz del Cáncer , Humanos , Incidencia , Tamizaje Masivo
5.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(3): 191-197, 2021 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-34645160

RESUMEN

Colorectal cancer is one of the malignant tumors with the highest morbidity and mortality in China. With the research of precision medicine concept and tumor-related molecular markers, appropriate detection and application of colorectal cancer-related molecular markers has become an important part of current clinical practice. In order to effectively solve the current clinical problems and improve clinicians' understanding and application of molecular markers on colorectal cancer, the Chinese Society of Clinical Oncology(CSCO) Colorectal Cancer Expert Committee organized experts in related fields to write an expert consensus on molecular markers of colorectal cancer based on recent domestic and international clinical trial and clinical experience. The consensus mainly provides guidance on testing specimens, molecular markers and testing methods, and interpretation of testing results. It aims to provide clinicians with standardized clinical reference for diagnosis and treatment, and standard and effective treatment for patients with colorectal cancer.


Asunto(s)
Neoplasias Colorrectales , China , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/genética , Consenso , Humanos
6.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(3): 208-213, 2021 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-34645163

RESUMEN

Peritoneum is a common metastatic site of colorectal cancer and has worse prognosis compared with other metastatic sites. Peritoneal metastasis was previously considered as a terminal state of the disease, and palliative treatment with systemic chemotherapy was the main treatment method. With the gradual acceptance of the cytoreductive surgery (CRS) + hyperthermic intraperitoneal chemotherapy (HIPEC) treatment model by surgeons and the application of targeted and immunotherapeutic drugs, the prognosis of patients with colorectal cancer peritoneal metastasis has been greatly improved. However, the diagnosis and treatment of peritoneal metastasis still face many challenges and controversies. Based on the evolution of the understanding of colorectal cancer peritoneal metastasis, the possible mechanisms of peritoneal metastasis are discussed, including the theory of "oligometastases" and the theory of "seed and soil". Besides, we further investigate the diagnosis and treatment strategies of colorectal cancer peritoneal metastasis and the facing challenges, including the limitations of imaging examination, the controversy of laparoscopic exploration, the difficulty in assessing peritoneal metastatic load, the limited means of postoperative recurrence monitoring and efficacy evaluation, and the significant variation in the diagnosis and treatment level among different regions of China. Meanwhile, we emphasize the importance of multidisciplinary perioperative management of CRS+HIPEC, and propose that the basic and clinical transformation research of peritoneal metastasis should be strengthened, and the promotion of standardized diagnosis and treatment of peritoneal metastasis is the key to improve the prognosis of patients with colorectal cancer peritoneal metastasis.


Asunto(s)
Neoplasias Colorrectales , Hipertermia Inducida , Neoplasias Peritoneales , Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/terapia , Terapia Combinada , Procedimientos Quirúrgicos de Citorreducción , Humanos , Recurrencia Local de Neoplasia , Neoplasias Peritoneales/tratamiento farmacológico , Neoplasias Peritoneales/terapia , Peritoneo , Pronóstico , Tasa de Supervivencia
7.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(3): 220-224, 2021 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-34645165

RESUMEN

Peritoneal carcinomatosis (PC) is one of the difficult problems in the treatment of colorectal cancer (CRC). Based on several retrospective analyses of large samples and prospective randomized controlled studies (RCTs), NCCN and PSOGI recommend cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) for selected CRC patients with mild to moderate PC. There are two important controversial issues in this field: the survival benefit of second-look surgery plus HIPEC for the patients with high risk of PC, and the specific benefit of HIPEC added to CRS for patients with PC. PROPHYLOCHIP found that second-look surgery plus HIPEC in patients at high risk of PC does not result in increased survival. PRODIGE 7 showed that overall survival (OS, 41.7 months vs. 41.2 months, P=0.99) and recurrence-free survival (RFS, 13.1 months vs. 11.1 months, P=0.43) were similar between the HIPEC group and non-HIPEC group, and suggested that HIPEC is not necessary for patients who underwent complete CRS. However, due to a series of problems in the design and implementation of this trial, the conclusion has caused great controversy and has not been widely recognized. Through detailed analysis and in-depth discussion, we believe that the benefit of HIPEC could not be denied according to PRODIGE 7. CRS + HIPEC is the embodiment and model of the concept of "Solid tumor treatment is surgery-based integrated treatment". CRS is the cornerstone of therapeutic strategies with curative intent for CRC PC and complete CRS is the key to improve the prognosis. Furthermore, HIPEC is an effective supplement to CRS.


Asunto(s)
Neoplasias Colorrectales , Hipertermia Inducida , Neoplasias Peritoneales , Protocolos de Quimioterapia Combinada Antineoplásica , Quimioterapia del Cáncer por Perfusión Regional , Neoplasias Colorrectales/terapia , Terapia Combinada , Procedimientos Quirúrgicos de Citorreducción , Humanos , Neoplasias Peritoneales/tratamiento farmacológico , Estudios Retrospectivos , Tasa de Supervivencia
8.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(3): 230-239, 2021 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-34645167

RESUMEN

Objective: Peritoneal carcinomatosis refers to a group of heterogeneous (primary or secondary) malignancies in the surface of the peritoneum. Cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is a comprehensive treatment strategy aiming at peritoneal carcinomatosis. This study analyzed the efficacy and safety of CRS+HIPEC in patients with peritoneal carcinomatosis, and explored prognostic factors. Methods: In this descriptive case-series study, the clinicopathological data of 1384 consecutive patients with peritoneal carcinomatosis treated in Zhongnan Hospital of Wuhan University (330 patients) and Shijitan Hospital of Capital Medical University (1054 patients) from January 2004 to January 2020 were collected retrospectively. Treatment patterns of CRS+HIPEC characteristics (operative time, number of resected organs, number of stripped peritoneum, number of anastomosis, and HIPEC regimens), safety [blood loss volume, postoperative severe adverse event (SAE) and treatment outcome], survival time and prognostic factors influencing survival were analyzed. The SAE was defined as grade III-IV adverse event according to the Peritoneal Surface Oncology Group International Textbook. Perioperative period was defined from the day of CRS+HIPEC to postoperative 30th day. OS was calculated from the day of CRS+HIPEC to the date of death or the last follow-up. Kaplan-Meier method was used for survival analysis, and log-rank test was used for comparison between groups. Cox regression model was used to identify the prognostic factors. Results: Among 1384 peritoneal carcinomatosis patients, 529 (38.2%) were male; median age was 55 (10-87) years old; median body mass index (BMI) was 22.6 kg/m(2); peritoneal carcinomatosis of 164 (11.8%) patients were from gastric cancer, 287 (20.7%) from colorectal cancer, 356 (25.7%) from pseudomyxoma peritonei, 90 (6.5%) from malignant peritoneal mesothelioma, 300 (21.7%) from gynecological cancer or primary peritoneal carcinoma, and 187 (13.5%) from retroperitoneal sarcoma, lung cancer, breast cancer, and other rare tumors. The median duration of CRS+HIPEC was 595 (90-1170) minutes, median number of resected organs was 2 (0-10), median number of resected peritoneal area were 4 (0-9), median peritoneal cancer index (PCI) was 21(1-39). Completeness of cytoreduction (CC) score of 0-1 was observed in 857 cases (61.9%). Regarding HIPEC regimens, there were 917 cases (66.3%) with cisplatin plus docetaxel, 183 cases (13.2%) with cisplatin plus mitomycin, 43 cases (3.1%) with adriamycin plus ifosfamide, and the other 240 cases (17.3%) with modified regimens. Perioperative SAE developed in 331 peritoneal carcinomatosis patients (23.9%) with 500 cases, of whom 21 patients (1.5%) died during the perioperative period due to ineffective treatment, while the others recovered after active treatment. During median follow-up time of 8.6 (0.3-82.7) months, there were 414 deaths (29.9%). The median OS was 38.2 months (95% CI: 30.6-45.8), and the 1-, 3-, 5-year survival rate was 73.5%, 50.4% and 39.3%, respectively. The median OS of peritoneal carcinomatosis patients from gastric cancer, colorectal cancer, pseudomyxoma peritonei, malignant peritoneal mesothelioma and female genital cancer or primary peritoneal carcinomatosis was 11.3 months (95% CI: 8.9-13.8), 18.1 months (95% CI: 13.5-22.6), 59.7 months (95% CI: 48.0-71.4), 19.5 months (95% CI: 6.0-33.0) and 51.7 months (95% CI: 14.6-88.8), respectively, and the difference among groups was statistically significant (P<0.001). Univariate and multivariate analyses revealed that the primary gastric cancer (HR=4.639, 95% CI: 1.692-12.724), primary colorectal cancer (HR=4.292, 95% CI: 1.957-9.420), primary malignant peritoneal mesothelioma (HR=2.741, 95% CI: 1.162-6.466), Karnofsky performance status (KPS) score of 60 (HR=4.606, 95% CI: 2.144-9.895), KPS score of 70 (HR=3.434, 95% CI: 1.977-5.965), CC score of 1 (HR=2.683, 95% CI: 1.440~4.999), CC score of 2-3 (HR=3.661,95% CI: 1.956-6.852) and perioperative SAE (HR=2.588, 95% CI: 1.846-3.629) were independent prognostic factors influencing survival with statistically significant differences (all P<0.05). Conclusions: CRS+HIPEC is an effective integrated treatment strategy for patients with peritoneal carcinomatosis, which can prolong survival with acceptable safety. Preoperative evaluation of patients' general condition is necessary and CRS+HIPEC should be carefully considered to perform for patients with preoperative KPS score <80. During the operation, the optimal CRS should be achieved on condition that safety is granted. In addition, it is necessary to prevent perioperative SAE to reduce the risk of death in peritoneal carcinomatosis patients.


Asunto(s)
Neoplasias Colorrectales , Hipertermia Inducida , Neoplasias Peritoneales , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Niño , Terapia Combinada , Procedimientos Quirúrgicos de Citorreducción , Femenino , Humanos , Quimioterapia Intraperitoneal Hipertérmica , Masculino , Persona de Mediana Edad , Neoplasias Peritoneales/tratamiento farmacológico , Estudios Retrospectivos , Tasa de Supervivencia , Adulto Joven
9.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(3): 248-255, 2021 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-34645169

RESUMEN

Objective: To compare the survival outcome in patients with synchronous colorectal cancer liver metastasis receiving neoadjuvant chemotherapy followed by hepatic surgery versus upfront surgery strategies. Methods: A retrospective cohort study was carried out. Data of patients undergoing surgery at the Department of Hepatopancreatobiliary Surgery Unit I of Peking University Cancer Hospital from January 2008 to December 2018 for initially resectable synchronous colorectal liver metastasis were retrospectively collected. A total of 282 cases were enrolled, including 244 in the neoadjuvant chemotherapy group, 38 in the upfront surgery first group. The overall survival (OS) and progression-free survival (PFS) of the two groups were compared. A propensity score risk adjustment was used to eliminate potential bias between groups, and the covariates including sex, age, location of primary tumor, T stage, clinical risk score (CRS), RAS gene status, adjuvant chemotherapy, and resection margin status were included for adjustment. Results: In the neoadjuvant chemotherapy group, 244 cases received 4 (1-15) cycles of chemotherapy before hepatic resection, among whom 207 cases received oxaliplatin-based regimens, 37 cases received irinotecan-based regimens, and 90 cases received combined targeted agents in the first line treatment. The median follow-up time was 30 (5-134) months, and loss of follow-up was 1%. Before adjustment, Kaplan-Meier survival analysis showed that the 1-year and 3-year OS rates in the neoadjuvant chemotherapy group (95.1% and 66.4%) were better than those in the upfront surgery first group (94.7% and 51.5%, P=0.026); 1-year and 3-year PFS rates in neoadjuvant chemotherapy group (51.0% and 23.4%) were also better than those in surgery first group (39.5% and 11.5%, P=0.039). After propensity score risk adjustment, Cox multivariate analysis indicated that neoadjuvant chemotherapy was an independent protective factor of PFS (HR=0.664, 95% CI: 0.449-0.982, P=0.040), however, neoadjuvant chemotherapy was not an independent protective factor of OS (HR=0.651, 95% CI: 0.393-1.079, P=0.096). Subgroup analysis showed that the 1-year and 3-year OS rates in the patients with response to the first line treatment (194, including complete remission, partial remission and reduction but not partial remission) (96.9% and 67.1%) were better than those in the upfront surgery group (94.7% and 51.5%, P=0.026) after adjustment. However, the 1-year and 3-year OS rates in the patients without response to the first line treatment (50, including tumor progression or enlargement) were 90.0% and 63.3%, respectively, which were not significantly different with 94.7% and 51.5% in the upfront surgery group (P=0.310) after adjustment. Conclusions: For patients with resectable synchronous colorectal cancer liver metastasis, liver resection after neoadjuvant chemotherapy can provide longer PFS than upfront surgery. Although the whole OS benefit is not significant, patients with effective neoadjuvant first-line chemotherapy have better OS than those undergoing upfront surgery.


Asunto(s)
Neoplasias Colorrectales , Neoplasias Hepáticas , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioterapia Adyuvante , Neoplasias Colorrectales/tratamiento farmacológico , Humanos , Neoplasias Hepáticas/tratamiento farmacológico , Terapia Neoadyuvante , Pronóstico , Estudios Retrospectivos , Resultado del Tratamiento
10.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(3): 256-263, 2021 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-34645170

RESUMEN

Objective: To explore whether the cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) can improve the survival rate of colorectal cancer patients with peritoneal metastasis. Methods: The relevant studies were systematically retrieved from PubMed, Embase, Cochrane Library, CNKI, Wanfang, VIP database, and the study of French Elias' team on peritoneal metastasis was retrieved manually. Inclusion criteria: (1) The patients were colorectal cancer peritoneal metastasis. (2) There were CRS+HIPEC treatments (treatment group) and other treatments (control group). (3) Survival analysis data of treatment group and control group were available. (4) Types of studies were randomized controlled trials, cohort studies, or case-control studies. (5) The literature was in Chinese or English. Exclusion criteria: (1) studies without full-text; (2) studies without complete data. The literature screening and data extraction were carried out by two people independently, and the third person decided on the literature with differences. The extracted data included authors, year of publication, number of patients, time of enrollment, time of follow-up, studies design, treatment regimen, hazard ratio (HR) and 95% CI of treatment group and control groups. If the HR and 95% CI of the treatment group and control group were not provided in the literature, Engauge Digitizer 11.1 software was used to extract the time of follow-up and the survival rate at the corresponding time point from the survival curves of both groups, and the HR and 95% CI of both groups were calculated by combining the number of both groups. The quality of study was evaluated by Newcastle-Ottawa scale (NOS) or Cochrane collaboration's tool for assessing risk bias. STATA 15.1 software was used for statistical analysis. HR and 95% CI of both groups were pooled and analyzed. Inter-trial heterogeneity was assessed by Q test and I(2) statistics. When there was no significant heterogeneity (Q test: P≥0.10), fixed-effect model was used for pooled analysis. When significant heterogeneity existed (Q test: P<0.10), random effect model was used for pooled analysis, and subgroup analysis was used to find out the source of heterogeneity. Sensitivity analysis was used to evaluate the stability of the pooled results. Publication bias was assessed by Egger's test and Begg's test (P<0.05 indicated publication bias) and it is reflected by the visual symmetry of Begg's funnel plot on the natural logarithm of HR. Results: A total of 10 studies were enrolled in the meta-analysis, including 1 randomized controlled trial and 9 cohort studies. The risk of bias in 1 randomized controlled trial was uncertain, and 9 cohort studies were all higher than 7 points, indicating high quality literatures. There were 781 patients in treatment group receiving CRS+HIPEC and 2452 patients in control group receiving other treatment, including tumor cytoreductive surgery (CRS), palliative chemotherapy (PC) and intraperitoneal chemotherapy (IPC). The results of pooled analysis by random effect model showed that the OS rate in treatment group was significantly higher than that in control group (HR=0.43, 95% CI: 0.34-0.54), but the heterogeneity of the study was high (P=0.024, I(2)=52.9%). The subgroup analysis of different control treatments showed that the OS rate in treatment group was significantly higher than that in CRS control group (HR=0.63, 95% CI: 0.44-0.90), in PC control group (HR=0.37, 95% CI: 0.32-0.43), in CRS+ IPC control group (HR=0.60, 95% CI: 0.37-0.96), and the heterogeneity of each subgroup was low (CRS control group: P=0.255, I(2)=22.9%; PC control group: P=0.222, I(2)=29.9%; CRS+IPC control group: P=0.947, I(2)=0). Due to the low heterogeneity of subgroups, fixed-effect models were used to pool and analysis. The results of sensitivity analysis revealed that there was little difference between the pooled analysis results after each study was deleted, suggesting that the pooled analysis results were more reliable. Publication bias detection of each study showed Begg's test (P=0.088) >0.05 and Egger's test (P=0.138)>0.05. According to the Begg's funnel plot, the scatter point distribution was basically symmetric, indicating that there was no publication bias in the included study. Conclusion: CRS+HIPEC can improve the OS of patients with colorectal cancer peritoneal metastasis.


Asunto(s)
Neoplasias Colorrectales , Hipertermia Inducida , Neoplasias Peritoneales , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioterapia del Cáncer por Perfusión Regional , Neoplasias Colorrectales/terapia , Terapia Combinada , Procedimientos Quirúrgicos de Citorreducción , Humanos , Quimioterapia Intraperitoneal Hipertérmica , Neoplasias Peritoneales/tratamiento farmacológico , Pronóstico , Ensayos Clínicos Controlados Aleatorios como Asunto , Tasa de Supervivencia
11.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(3): 279-282, 2021 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-34645173

RESUMEN

Surgery is recognized as the core treatment for colorectal liver metastasis (CRLM), while its recurrence rate remains relatively high, even for resectable CRLM. This hints that the efficacy of treatment involves not only technological factors of surgery, but also biological behavior of tumor. For resectable CRLM, neoadjuvant therapy is beneficial to eliminate the micro-metastasis, reduce postoperative recurrence rate, screen tumor biological behavior and improve prognosis. However, questions about which kind of CRLM patients fits for neoadjuvant therapy and what regimen should be used are still debatable. This paper reviews stratified management of resectable CRLM, choice of neoadjuvant regimen, especially the application value of targeted therapy, based on the latest guidelines and studies.


Asunto(s)
Neoplasias Colorrectales , Neoplasias Hepáticas , Neoplasias Colorrectales/cirugía , Hepatectomía , Humanos , Neoplasias Hepáticas/cirugía , Terapia Neoadyuvante , Recurrencia Local de Neoplasia/cirugía
12.
World J Surg Oncol ; 19(1): 297, 2021 Oct 13.
Artículo en Inglés | MEDLINE | ID: mdl-34645481

RESUMEN

BACKGROUND: Inflammation markers have an important effect on tumor proliferation, invasion, and metastasis. Oligometastatic disease (OMD) is an intermediate state between widespread metastases and locally confined disease, where curative strategies may be effective for some patients. We aimed to explore the predictive value of inflammatory markers in patients with oligometastatic colorectal cancer (OMCC) and build a nomogram to predict the prognosis of these patients. METHODS: Two hundred nine patients with OMCC were retrospectively collected in this study. The Kaplan-Meier survival curves and Cox regression analysis were used to estimate overall survival (OS) and progression-free survival (PFS). A multivariate Cox analysis model was utilized to establish the nomogram. The concordance index (C-index), calibration curve, and receiver operating characteristics (ROC) were established to verify the validity and accuracy of the prediction model. RESULTS: According to the multivariate analysis, decreased platelet-to-lymphocyte ratio (PLR) might independently improve OS in patients with OMCC (HR = 2.396, 95% CI 1.391-4.126, P = 0.002). Metastases of extra-regional lymph nodes indicated poor OS (HR = 2.472, 95% CI 1.247-4.903, P = 0.010). While the patients with early N stage had better OS (HR = 4.602, 95% CI 2.055-10.305, P = 0.001) and PFS (HR = 2.100, 95% CI 1.364-3.231, P = 0.007). Primary tumor resection (HR = 0.367, 95% CI 0.148-0.908, P = 0.030) and lower fibrinogen (HR = 2.254, 95% CI 1.246-4.078, P = 0.007) could significantly prolong the OS in patients with OMCC. PLR, metastases of extra-regional lymph nodes, N stage, primary tumor resection, and fibrinogen were used to make up the nomogram. The C-index and area under the curve (AUC) of the ROC in nomogram were 0.721 and 0.772 respectively for OS, showed good consistency between predictive probability of OS and actual survival. CONCLUSIONS: Decreased PLR could predict a good prognosis in patients with OMCC. The nomogram including inflammatory factors and clinicopathological markers was credible and accurate to predict survivals in patients with OMCC.


Asunto(s)
Neoplasias Colorrectales , Linfocitos , Plaquetas , Humanos , Nomogramas , Pronóstico , Estudios Retrospectivos
13.
BMC Health Serv Res ; 21(1): 1032, 2021 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-34592971

RESUMEN

BACKGROUND: Multidisciplinary team meetings (MDTMs) are part of the standard cancer care process in many European countries. In France, they are a mandatory condition in the authorization system for cancer care administration, with the goal to ensure that all new patients diagnosed with cancer are presented in MDTMs. AIM: Identify the factors associated with non-presentation or unknown presentation in MDTMs, and study the impact of presentation in MDTMs on quality of care and survival in patients diagnosed with colorectal cancer (CRC). METHODS: 3999 CRC patients diagnosed between 2005 and 2014 in the area covered by the "Calvados Registry of Digestive Tumours" were included. Multivariate multinomial logistic regression was used to assess the factors associated with presentation in MDTMs. Univariate analyses were performed to study the impact of MDTMs on quality of care. Multivariate Cox model and the Log-Rank test were used to assess the impact of MDTMs on survival. RESULTS: Non-presentation or unknown presentation in MDTMs were associated with higher age at diagnosis, dying within 3 months after diagnosis, unknown metastatic status, non-metastatic cancer and colon cancer. Non-presentation was associated with a diagnosis after 2010. Unknown presentation was associated with a diagnosis before 2007 and a longer travel time to the reference care centres. Presentation in MDTMs was associated with more chemotherapy administration for patients with metastatic cancer and more adjuvant chemotherapy for patients with stage III colon cancer. After excluding poor prognosis patients, lower survival was significantly associated with higher age at diagnosis, unknown metastatic status or metastatic cancer, presence of comorbidities, rectal cancer and non-presentation in MDTMs (HR = 1.5 [1.1-2.0], p < 0.001). CONCLUSIONS: Elderly and poor prognosis patients were less presented in MDTMs. Geriatric assessments before presentation in MDTMs were shown to improve care plan establishment. The 100% objective is not coherent if MDTMs are only to discuss diagnosis and curative cares. They could also be a place to discuss therapeutic limitations. MDTMs were associated with better treatment and longer survival. We must ensure that there is no inequity in presentation in MDTMs that could lead to a loss of chance for patients.


Asunto(s)
Neoplasias Colorrectales , Neoplasias , Anciano , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/terapia , Humanos , Grupo de Atención al Paciente , Probabilidad , Modelos de Riesgos Proporcionales , Sistema de Registros
14.
BMC Gastroenterol ; 21(1): 360, 2021 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-34600484

RESUMEN

BACKGROUND: Synchronous colorectal cancer (SCRC) is featured by the presence of multiple primary tumor lesions in a single patient at initial diagnosis. It is less common with the prevalence of approximately 3.5% among colorectal cancer (CRC). Some studies of SCRC have been performed in patients with two tumor lesions. However, SCRC cases with three or more tumor lesions were rare and remained to be investigated. CASE PRESENTATION: In this case report, we presented a 56-year-old male SCRC case with quadruple tumor lesions which is rarely seen in clinical practice. After laparoscopic radical resection of sigmoid carcinoma and partial rectum resection, the four tumor samples were subjected to pathological evaluation and next-generation sequencing (NGS) based genetic profiling. The four tumor lesions included two adenocarcinomas with moderate differentiation at sigmoid colon and rectum respectively, a grade 1 neuroendocrine tumor (NET) at rectum and a high-grade intraepithelial neoplasia at ascending colon. Each tumor exhibited distinct histology types and mutation profiles. After surgical resection, the patient remained disease-free after four cycles of chemotherapy with oxaliplatin and capecitabine (XELOX). CONCLUSIONS: The tumor lesions in this case showed different pathological and genetic features which indicats the heterogeneity of SCRC. The genomic profilling might provide novel insights to understand SCRC at molecular level.


Asunto(s)
Adenocarcinoma , Neoplasias Colorrectales , Neoplasias Primarias Múltiples , Adenocarcinoma/genética , Adenocarcinoma/cirugía , Neoplasias Colorrectales/genética , Genómica , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Primarias Múltiples/genética , Estudios Retrospectivos
15.
BMC Res Notes ; 14(1): 385, 2021 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-34600575

RESUMEN

OBJECTIVE: The objective of this study was to employ ensemble clustering and tree-based risk model approaches to identify interactions between clinicogenomic features for colorectal cancer using the 100,000 Genomes Project. RESULTS: Among the 2211 patients with colorectal cancer (mean age of diagnosis: 67.7; 59.7% male), 16.3%, 36.3%, 39.0% and 8.4% had stage 1, 2, 3 and 4 cancers, respectively. Almost every patient had surgery (99.7%), 47.4% had chemotherapy, 7.6% had radiotherapy and 1.4% had immunotherapy. On average, tumour mutational burden (TMB) was 18 mutations/Mb and 34.4%, 31.3% and 25.7% of patients had structural or copy number mutations in KRAS, BRAF and NRAS, respectively. In the fully adjusted Cox model, patients with advanced cancer [stage 3 hazard ratio (HR) = 3.2; p < 0.001; stage 4 HR = 10.2; p < 0.001] and those who had immunotherapy (HR = 1.8; p < 0.04) or radiotherapy (HR = 1.5; p < 0.02) treatment had a higher risk of dying. The ensemble clustering approach generated four distinct clusters where patients in cluster 2 had the best survival outcomes (1-year: 98.7%; 2-year: 96.7%; 3-year: 93.0%) while patients in cluster 3 (1-year: 87.9; 2-year: 70.0%; 3-year: 53.1%) had the worst outcomes. Kaplan-Meier analysis and log rank test revealed that the clusters were separated into distinct prognostic groups (p < 0.0001). Survival tree or recursive partitioning analyses were performed to further explore risk groups within each cluster. Among patients in cluster 2, for example, interactions between cancer stage, grade, radiotherapy, TMB, BRAF mutation status were identified. Patients with stage 4 cancer and TMB ≥ 1.6 mutations/Mb had 4 times higher risk of dying relative to the baseline hazard in that cluster.


Asunto(s)
Neoplasias Colorrectales , Oncología por Radiación , Análisis por Conglomerados , Neoplasias Colorrectales/genética , Neoplasias Colorrectales/terapia , Femenino , Humanos , Masculino , Pronóstico , Análisis de Supervivencia
16.
Arkh Patol ; 83(5): 5-12, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-34609798

RESUMEN

OBJECTIVE: To assess the risk of recurrence after surgical treatment is an integral part of the management of patients with colorectal cancer. The AJCC/UICC TNM staging system, in which the risk is identified by grouping the patients on the basis of anatomical elements, is commonly used. Despite the simplicity of implementation, significant heterogeneity remains within each stage group. A better tool for predicting a recurrence is needed in the era of multimodal treatment. SUBJECTS AND METHODS: A total of 1350 archival colorectal cancer cases during 2012 to 2015 were retrospectively analyzed; among which the investigators identified 3 patient groups: 1) 53 patients with non-metastatic colon cancer for at least 5 years; 2) 45 patients with metachronous metastases detected during the same period; and 3) 53 patients with synchronous metastases. Among the estimated 31 parameters, the investigators used a multidimensional analysis to select 6 most significant prognostic factors that were included in the final model based on a logistic regression analysis. The resulting model was applied to assess the risk of metastasis after cytoreductive surgery. It was internally and externally validated in an examination group (n=25). RESULTS: The model has a sensitivity of 97.78% and a specificity of 96.23%, improving the risk stratification for metastatic colon cancer. The factors in the model include extramural venous invasion, the severity of budding, the expression of E-cadherin and ß-catenin, the proportion of cytotoxic CD8+ lymphocytes of the total number of T lymphocytes in the microenvironment, and the ratio of newly formed vessels to tumor stromal microvessel density. CONCLUSION: Using morphopathological factors, the resulting model allows better consideration of tumor specificity in a particular patient, thereby providing a more individual prediction of outcome than that provided by the AJCC/UICC TNM staging system. By identifying patients at both high- and low-risk for metastasis, the model can be useful to plan treatment and to choose clinical management tactics for patients with colorectal cancer.


Asunto(s)
Neoplasias del Colon , Neoplasias Colorrectales , Neoplasias del Colon/patología , Neoplasias Colorrectales/patología , Humanos , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Microambiente Tumoral
17.
Acta Gastroenterol Belg ; 84(3): 401-405, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34599562

RESUMEN

Patients and methods: A prospective registration of patients with colorectal cancer and a colonoscopy within the last 10 years. We tried to classify these post-colonoscopy colorectal cancers (PCCRCs) by most reasonable explanation and into subcategories suggested by the World Endoscopy Organization (WEO) and calculated the unadjusted PCCRC rate. Results: 47 PCCRCs were identified. The average age at diagnosis of PCCRC was 73 years. PCCRCs were more located in the right colon with a higher percentage of MSI-positive and B-RAF mutated tumours. The average period between index colonoscopy and diagnosis of PCCRC was 4.2 years. Sixty-eight % of all PCCRCs could be explained by procedural factors. The mean PCCRC-3y of our department was 2.46%. Conclusions: The data of our centre are in line with the data of the literature from which can be concluded that most postcolonoscopy colorectal cancers are preventable. The PCCRC-3y is an important quality measure for screening colonoscopy. Ideally all centres involved in the population screening should measure the PCCRC-3 y annually, with cooperation of the cancer registry and reimbursement data provided by the Intermutualistic Agency (IMA).


Asunto(s)
Neoplasias Colorrectales , Colonoscopía , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/epidemiología , Humanos , Estudios Prospectivos , Factores de Riesgo , Factores de Tiempo
18.
J Coll Physicians Surg Pak ; 31(10): 1174-1178, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34601837

RESUMEN

OBJECTIVE: To detect the Kras gene through liquid biopsy, a less invasive technique in diagnosed colorectal cancer patients. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Department of Oncology, Dr. Ziauddin Hospital and Bait-us-Sukoon Cancer Hospital, Karachi, from 2019 to 2020. METHODOLOGY: Circulating tumor DNA (ctDNA) in colorectal cancer patients was extracted through magnetic bead technique using MagMAX cell free DNA kit (Thermofisher, Uk). The frequency of Kras gene was quantified using a real-time polymerase chain reaction (RT-PCR) assay (qPCR). ANOVA and Chi-square tests were utilised for statistical analysis. RESULTS: Mean threshold cycle (CT) of Kras gene showed significantly higher expression 15.6 ± 1.82 (p=0.001) in stage IV CRC cases compared to early stages (19.53 ± 18.223.7 ± 2.9 and 19.8 ± 2.69 of stage 1, 2 and 3, respectively. Similarly, ΔCT mean of Kras gene at stage IV showed significantly higher expression of 2.48 ± 1.40 (0.048), compared to 2.39 ± 0.6, 3.12 ± 0.68 and 3.15 ± 0.41 of stage 1, 2 and 3, respectively. Males (n=40, 55%) showed significant association (p=0.001) with CRC compared to females (n=33, 45%). Categorisation of tumor types within different age groups revealed that colon cancer was more frequent (n=11, 15.1%) in the 41-50 age group, while rectal cancer was more frequent (n= 11, 15.1%) in the 41-50 age group, while rectal cancer was more in the 51-60 age group (n=11, 15.1%). CONCLUSION: Kras gene was detected with significantly increased levels in plasma of CRC patients at advanced stages. This confirms that liquid biopsy can be used to detect Kras gene in ctDNA of CRC patients through a magnetic bead based technique. Key Words: Liquid biopsy, Circulating tumor DNA, KRAS, Colorectal cancer, Real-time polymerase chain reaction.


Asunto(s)
Neoplasias Colorrectales , Proteínas Proto-Oncogénicas p21(ras) , Neoplasias Colorrectales/genética , Análisis Costo-Beneficio , Estudios Transversales , Femenino , Humanos , Biopsia Líquida , Masculino , Mutación , Proteínas Proto-Oncogénicas p21(ras)/genética
19.
Anticancer Res ; 41(10): 4895-4905, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34593437

RESUMEN

BACKGROUND/AIM: The limited efficacy of immune checkpoint inhibitors in colorectal cancer (CRC) is likely due to immunosuppressive mechanisms including T cell exhaustion caused by inhibitory immune checkpoints in the tumor microenvironment. MATERIALS AND METHODS: We investigated the expression status of the inhibitory immune checkpoint receptors on tumor-infiltrating T cells and their ligands on tumor cells by flow cytometry and immunohistochemistry, using surgically-resected specimens of CRC. RESULTS: Flow cytometry analysis indicated that TIM-3, TIGIT, and PD-1 were expressed on tumor-infiltrating CD4+ (8.3%, 56.0%, 26.1%) and CD8+ T cells (8.2%, 51.6%, 23.5%), and CRC cells abundantly expressed PD-L1, CEACAM-1, and CD155 (2.2%, 77.0%, 46.8%). Immunohistochemical analysis revealed that the tumor proportional score of PD-L1, CEACAM-1, and CD155 was 42.4%, 54.2%, and 52.1%, respectively. CONCLUSION: PD-1, TIM-3, and TIGIT axes may reduce T cell function in the CRC tumor microenvironment.


Asunto(s)
Biomarcadores de Tumor/metabolismo , Neoplasias Colorrectales/patología , Proteínas de Punto de Control Inmunitario/metabolismo , Linfocitos Infiltrantes de Tumor/inmunología , Receptores Inmunológicos/metabolismo , Microambiente Tumoral/inmunología , Anciano , Anciano de 80 o más Años , Neoplasias Colorrectales/inmunología , Neoplasias Colorrectales/metabolismo , Femenino , Estudios de Seguimiento , Humanos , Ligandos , Masculino , Persona de Mediana Edad , Pronóstico
20.
Anticancer Res ; 41(10): 4907-4916, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34593438

RESUMEN

BACKGROUND: Interleukin-6 receptor antibody (IL6R) inhibits colony formation and invasion by colorectal carcinoma (CRC) in vitro. We examined the effect of IL6R antibody on tumor growth of CRC xenografts in vivo. MATERIALS AND METHODS: SW480 cells inoculated subcutaneously into NU/NU mice were treated with anti-IL6R and tumor histology and growth-related signaling were subsequently estimated by hematoxylin and eosin and immunohistochemical staining. RESULTS: Tumor growth was inhibited by anti-IL6R treatment at dosages of both 0.1 and 1.0 mg/kg. Tumor cells had invaded into surrounding tissues in untreated mice, while there was no invasion of tumors in the IL6R antibody-treated mice. The expression of Ki-67, signal transducer and activator of transcription protein 3 (STAT3) and phosphor-extracellular signal-regulated kinase 1 and 2 (ERK1/2) were suppressed in anti-IL6R-treated tumors. CONCLUSION: IL6R antibody inhibited tumor growth and invasiveness in vivo by suppressing the expression of Ki-67, STAT3 and phosphor-ERK1/2. The results imply that the anti-IL6R may be a promising targeted drug for CRC.


Asunto(s)
Anticuerpos Monoclonales/farmacología , Neoplasias Colorrectales/prevención & control , Neovascularización Patológica/prevención & control , Receptores de Interleucina-6/antagonistas & inhibidores , Animales , Apoptosis , Proliferación Celular , Neoplasias Colorrectales/inmunología , Neoplasias Colorrectales/metabolismo , Neoplasias Colorrectales/patología , Humanos , Masculino , Ratones , Ratones Desnudos , Neovascularización Patológica/inmunología , Neovascularización Patológica/metabolismo , Neovascularización Patológica/patología , Receptores de Interleucina-6/inmunología , Factor de Transcripción STAT3/genética , Factor de Transcripción STAT3/metabolismo , Células Tumorales Cultivadas , Ensayos Antitumor por Modelo de Xenoinjerto
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