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1.
Ann Palliat Med ; 9(2): 420-427, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32233640

RESUMEN

BACKGROUND: To analyze whether face-to-face education before colonoscopy improves the quality of bowel preparation and increases the detection of adenomas. METHODS: A retrospective cross-sectional study of adult patients with colorectal polyps identified by colonoscopy as outpatients was performed. The patients underwent an added colonoscopy inpatient for resection of colorectal polyps. As outpatients, we gave the patients written bowel preparation instructions; however, when they were inpatients, we supplied face-to-face education. We analyzed the data from the two colonoscopies of the same group of patients out- and in-patients, including the quality of the intestinal preparation, the time to reach the ileocecal region, and the detection of adenomas. RESULTS: A total of 260 patients {age 63 [56, 68] years old, male/female (169/91)} were retrospectively included in our study. Two hundred fifty-two patients with a total of 685 adenomas were detected, 94 patients with 179 adenomas overlooked in the first colonoscopy. The BBPS Score during inpatient was higher than that during outpatient, {9 [8, 9] vs. 7 [6, 9]}, P<0.05, the Bubble Score during inpatient was lower than that during outpatient [0 (0.00, 0.00) vs. 0 (0.00, 1.00)], P<0.05. The time to reach the ileocecal region during inpatient is shorter than that during outpatient {6 [5, 9] vs. 7.5 [5, 11] min}, P<0.05. Poor bowel preparation, flat adenoma morphology, and adenoma diameter lower than 5mm were related adenoma misdiagnoses, P<0.05. CONCLUSIONS: Face-to-face patient education can improve the quality of bowel preparation, then shorten the time to reach the ileocecal region, and increase detection of colorectal adenomas.


Asunto(s)
Colonoscopía/métodos , Aceptación de la Atención de Salud/psicología , Educación del Paciente como Asunto/métodos , Irrigación Terapéutica/métodos , Adenoma/diagnóstico , Adulto , Anciano , Colonoscopía/psicología , Neoplasias Colorrectales/diagnóstico , Estudios Transversales , Errores Diagnósticos/prevención & control , Detección Precoz del Cáncer/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios/métodos , Estudios Retrospectivos
2.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(2): 267-272, 2020 Feb 10.
Artículo en Chino | MEDLINE | ID: mdl-32164140

RESUMEN

Objective: To establish the key question list for the development of evidence- based guideline in China according to the content and limitation of current evidence-based guidelines around the world. Methods: First, we introduced the evidence-based guidelines in detail which met the criteria based on World Health Organization guideline development handbook and then formulated the draft list of key questions for the development of evidence-based guidelines. At last, the Delphi method was used to determine the list of key questions in developing evidence-based guidelines of colorectal cancer screening. Results: Totally, 34 questionnaires were collected, with experts from clinical and epidemiological fields. The average experts' authority coefficient was 0.81, indicating a high degree of authority. The concentration of opinions on all items in the questionnaire was relatively high, with the full score ratio greater than 75% and the coefficient of variation less than 0.3. The list of key questions on evidence-based guidelines for colorectal cancer screening has been divided into six parts: epidemiological problems, risk classification, screening age, screening tools, implementation and selection of steering group members, which covers the issues that need to be considered in the development of evidence-based colorectal cancer screening guidelines in China. Conclusion: The key question list for evidence-based guideline development in our study can be applied to the development of evidence-based guidelines for colorectal cancer screening in the future, as well as the development of evidence-based guidelines for other cancer screening in China.


Asunto(s)
Neoplasias Colorrectales/diagnóstico , Detección Precoz del Cáncer , Práctica Clínica Basada en la Evidencia , Guías de Práctica Clínica como Asunto , China , Técnica Delfos , Humanos
3.
Zhonghua Yi Xue Za Zhi ; 100(10): 767-770, 2020 Mar 17.
Artículo en Chino | MEDLINE | ID: mdl-32192290

RESUMEN

Objective: To investigate the significance of quantitative fecal immunochemical test (FIT) for opportunistic screening of colorectal neoplasia, and to propose the most optimal thresholds to improve the screening level of early colorectal neoplasia. Methods: The opportunistic screening participants were recruited from the Department of Gastroenterology & GI Endoscopy Center of the Seventh Medical Center of PLA General Hospital, and stool sample was collected before colonoscopy and the quantitative FIT was analyzed by OC-MICRO analysator for each patient. We assessed test performance in detecting colorectal neoplasia (advanced adenoma and CRC)with different thresholds on sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results: A total of 1 448 objects were enrolled in this study, including 714 male (49.3%)and 734 female (50.7%).All participants were classified according to the result of colonoscopy and pathology, and 242 cases of colorectal neoplasia were found, containing 157 advanced adnoma and 85 colorectal cancer. The FIT threshold increased from 50 µg/L to 200 µg/L, while the positivity rate dropped from 11.5% to 8.6% and the sensitivity in detecting colorectal neoplasia dropped from 47.9% to 38.8%. However, the specificity increased from 96.8% to 98.2% and the positive predictive value increased from 82.3% to 87.0%.The miss rate of colorectal cancer increased from 11.8% (n=10) to 17.6% (n=15) along with the increase in FIT thresholds, but the miss rate of 100 µg/L and 150 µg/L was the same as 12.9% (n=11). Conclusions: Quantitative FIT,which is simple and fast,with the threshold of 100 µg/L for opportunistic screening, has a high sensitivity and specificity for the diagnosis of colorectal neoplasia,and is an important index in screening and diagnosis of colorectal neoplasia.


Asunto(s)
Neoplasias Colorrectales , Detección Precoz del Cáncer , Colonoscopía , Neoplasias Colorrectales/diagnóstico , Heces , Femenino , Humanos , Masculino , Tamizaje Masivo , Sangre Oculta
4.
Magy Onkol ; 64(1): 32-37, 2020 Mar 17.
Artículo en Húngaro | MEDLINE | ID: mdl-32181760

RESUMEN

Inherited colorectal cancer syndromes account for 6-10% of all cases. The diagnosis of the polypoid forms is easier due to their phenotypes, compared to the non-polypoid cases. The evaluation of the MSI/MMR status of the already developed colorectal cancer cases could help in the recognition and screening of the latter forms. This screening method is much more sensitive than that solely based on family anamnestic data. The MSI/MMR status of the tumor also could help in adjuvant or palliative treatment planning, therefore it is recommended in all colorectal cancer cases. Here we review the available information regarding the inherited colorectal cancer syndromes, and the role of MSI/MMR status in the management of colorectal cancers.


Asunto(s)
Neoplasias Colorrectales/terapia , Neoplasias Colorrectales/diagnóstico , Humanos , Tamizaje Masivo , Síndrome
5.
Anticancer Res ; 40(3): 1651-1659, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32132070

RESUMEN

BACKGROUND/AIM: The purpose of this study was to investigate the clinical, pathological, and prognostic differences between adenocarcinoma (ADC) and mucinous adenocarcinoma (MUC) in colorectal cancer (CRC). PATIENTS AND METHODS: This was a retrospective study of a Japanese high-volume cancer Center over a 10-year period. From April 2007 to December 2016, a total of 3,296 patients with primary CRC were included in the study. The clinical characteristics of MUC and ADC were compared. Then, propensity score matching was performed according to a 1:2 ratio. Multivariate analysis was used for independent risk factors related to prognosis. The overall survival (OS) and disease-free survival (DFS) of 126 cases of MUC and 256 cases of ADC were studied, as well as the survival rate of each stage. RESULTS: MUC accounts for 3.82% of the total CRC. Compared to ADC, MUC is more common in female patients (47.62% vs. 38.77%; p=0.045), with higher carcinoembryonic antigen levels (56.35% vs. 34.95%; p<0.001), more ulcerative and infiltrative types (82.54% vs. 72.93%; p=0.016), higher incidence of perineural infiltration (51.59% vs. 41.04%; p=0.018), deeper infiltration (T3-T4: 90.48% vs. 65.84%; p<0.001), and more advanced cancer (stage III-IV: 59.52% vs. 44.79%; p=0.001). MUC is also more likely to recur (24.6% vs. 14.32%; p=0.001). Regarding the long-term survival rate, the OS (p<0.001) and DFS (p=0.05) is consequently worse. After propensity score matching, multivariate analysis showed that MUC was a common independent risk factor for DFS [odds ratio (OR)=4.277; 95% confidence interval (CI), 0.327-0.97; p=0.039], and also for OS (OR= 6.836; 95% CI, 0.274-0.831; p=0.009). In MUC, OS and DFS were still relatively worse (OS: p=0.017; DFS: p=0.038). However, only significant statistical differences were shown in stage II (OS: p=0.003; DFS: p=0.007). No significant differences were noted in the stages I, III, or IV. CONCLUSION: MUC is a high-risk factor for stage II CRC. Adjuvant chemotherapy should be routinely recommended for patients with MUC stage II, and special attention should be paid during their follow-up.


Asunto(s)
Adenocarcinoma Mucinoso/complicaciones , Neoplasias Colorrectales/diagnóstico , Adenocarcinoma Mucinoso/patología , Anciano , Estudios de Cohortes , Neoplasias Colorrectales/patología , Femenino , Humanos , Japón , Masculino , Estadificación de Neoplasias , Puntaje de Propensión , Estudios Retrospectivos , Factores de Riesgo
6.
Anticancer Res ; 40(3): 1705-1709, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32132078

RESUMEN

BACKGROUND/AIM: To investigate factors that affect colorectal polyp or colorectal cancer (CRC) detection amongst patients referred urgently to colorectal services for suspected bowel cancer. PATIENTS AND METHODS: This was a prospective observational study at a UK colorectal centre (2017-2018). Logistic regression determined odds ratios for colorectal polyp or CRC according to age, gender, previous polyp or cancer, and the 6 NICE referral (NG12) categories. RESULTS: A total of 605 patients were included in the study; median age 66 (IQR=54-76); 47.9% male. Nineteen (3.1%) patients had CRC and 64 (10.6%) had polyps. No individual variable increased the likelihood of CRC detection, but male patients had a higher likelihood of having either polyp or CRC (OR=1.72; 95%CI=1.07-2.80; p<0.05). CONCLUSION: At the point of an urgent referral to a colorectal clinic, the likelihood of CRC detection appears to be unaffected by age, gender, or any individual referral criterion. However, overall disease detection may be more likely amongst male patients.


Asunto(s)
Neoplasias Colorrectales/diagnóstico , Anciano , Pólipos del Colon/etiología , Pólipos del Colon/patología , Detección Precoz del Cáncer , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos
7.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(3): 211-216, 2020 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-32192296

RESUMEN

Corona virus disease 2019 (COVID-19) is currently raging in China. It has been proven that COVID-19 can be transmitted from human to human and cause hospital infection, which seriously threatens surgical staffs and inpatients. Although colorectal surgery is not a front-line subject in the fight against the epidemic, but in this special situation, it is a difficult task to provide the highest quality medical services and ensure the orderly clinical work, on the premise of maximizing the protection for patients and their families, health of medical staff, and the safety of wards and hospitals, We summarize how to carry out the clinical practice of colorectal surgery under the situation of the prevention and control of the COVID-19 epidemiology, including the procedures of diagnose and treatment for emergency patients with colorectal tumor, and share the experiences of the diagnosis of colorectal tumor, the management of patients with colorectal cancer who are scheduled to be admitted for surgery, the protection of wards, the perioperative management. More importantly, we introduce in detail the operative management and perioperative management of colorectal surgery patients suspected or diagnosed with new coronary pneumonia, including prevention and control measures for medical staff, operating rooms and surgical instruments. The main points are as follows: (1) Multidisciplinary team (MDT) must be run through the diagnosis and treatment of colorectal cancer. The members include not only routine departments, but also respiratory department and infectious department. (2) Colonoscopy examination may cause cross infection of COVID-19 to patients and doctors. Therefore, it is prior to examine the emergency cases and life-threatening patients (bleeding, obstruction, gastrointestinal foreign bodies, etc.). If the emergent patients (intestinal obstruction) with suspected or confirmed COVID-19, the surgeons must perform emergency surgery, and intestinal decompressive tube through colonoscopy is not recommended. (3) The colorectal cancer patients with suspected or confirmed COVID-19 should be placed in the isolated room with separate medical devices, and the operative room with negative pressure (under -5 Pa) must be separated. All disposable medical items, body fluids and feces of the patients in perioperative periods must be unified disposed according to the medical waste standard. (4) The surgical medical workers who process colorectal cancer patients with COVID-19 must be protected by three-level. After operation, the medical workers must receive medical observation and be isolated for 14 days. We hope our "Renji experience" will be beneficial to colleagues.


Asunto(s)
Neoplasias Colorrectales , Infecciones por Coronavirus/complicaciones , Neumonía Viral/complicaciones , China , Neoplasias Colorrectales/complicaciones , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/terapia , Brotes de Enfermedades , Humanos
8.
Am J Public Health ; 110(4): 587-594, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32078353

RESUMEN

Objectives. To compare usual care, inreach consisting of one-on-one education, mailed outreach offering a fecal immunochemical test (FIT), and a combination of outreach and inreach for promoting colorectal cancer (CRC) screening.Methods. We conducted a 4-arm randomized controlled trial from 2015 to 2018 at a US federally qualified health center near the California-Mexico border primarily serving low-income Hispanics/Latinos. A total of 673 individuals aged 50 to 75 years not up to date with screening were assigned to 1 of the 4 intervention groups. The primary outcome was CRC screening through 6 months follow-up.Results. A total of 671 patients were included in intention-to-screen analyses. Their mean age was 59.9 years, 48.9% were male, and 86.3% were primarily Spanish-speaking. Screening was 27.5% for usual care (95% confidence interval [CI] = 0.21, 0.34), 52.7% for inreach (95% CI = 0.45, 0.60), 77.2% for outreach (95% CI = 0.71, 0.83), and 78.9% for combination of inreach and outreach (95% CI = 0.73, 0.85; P < .001 for all comparisons except P = .793 for outreach vs combination).Conclusions. Among individuals at high risk for noncompletion, inreach with one-on-one education nearly doubled, and outreach offering mailed FIT alone or in combination with inreach nearly tripled screening compared with usual care. Mailed FIT outreach was superior to inreach for promoting screening.


Asunto(s)
Neoplasias Colorrectales/diagnóstico , Detección Precoz del Cáncer/estadística & datos numéricos , Cooperación del Paciente/estadística & datos numéricos , Educación del Paciente como Asunto/métodos , Anciano , California , Femenino , Hispanoamericanos , Humanos , Inmunoquímica , Masculino , Persona de Mediana Edad , Sangre Oculta
9.
PLoS One ; 15(2): e0228795, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32040530

RESUMEN

BACKGROUND: Colorectal cancer incidence in Spain increased considerably between the early nineties and 2010. To reverse this tendency, screenings were progressively implemented starting the year 2001, targeting the population aged 50 to 69 years. OBJECTIVES: This study aimed to update colorectal cancer incidence and mortality trends in Spain and provide a detailed analysis of disease management and risk factors involved in in-hospital mortality. METHODS: To this aim, anonymised primary and specialised care admission records from 2011 to 2016 were extracted from a Spanish claims database representative of all Spanish regions. RESULTS: Primary care files from 37,317 patients and specialised care files from 192,048 patients were obtained, in which males represented the 56.17% and 60.70% of patients respectively. In-hospital mortality rate was 10.07% and remained stable during the study period, similarly to colorectal cancer incidence within the hospitalised population, which was 106 per 10,000 patients. Patients deceased during the hospitalisation presented an increased presence of metastatic tumours. Mean length of hospital stay decreased significantly over the study period from 13.43 days to 11.67 days (p<0.001), similarly to patients' 30-day readmission rate, which registered a decrease from the 15.29% to 13.58% (p<0.001). In consequence, the direct medical cost measured per patient, of €10,992, decreased over time. The implementation of colorectal cancer screening programmes caused a significant decrease in the number of new diagnoses in patients aged 75 to 79 years that may be attributable to the implementation of colorectal cancer screening programmes; however, in-hospital mortality was not reduced. Metastatic tumours and other conditions as anaemia are associated with higher in-hospital mortality rates.


Asunto(s)
Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/mortalidad , Mortalidad Hospitalaria , Tamizaje Masivo , Anciano , Neoplasias Colorrectales/epidemiología , Detección Precoz del Cáncer , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , España/epidemiología
10.
Anticancer Res ; 40(2): 575-581, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32014898

RESUMEN

Previous randomized studies suggest that fecal occult blood test (FOBT) screening can reduce mortality from colorectal cancer (CRC). Our aim was to review the current status of FOBTs in CRC screening. FOB is measured using either the traditional guaiac-based tests or more recently introduced fecal immunochemical tests (FITs). FITs have several advantages over guaiac-based FOBTs, including higher sensitivity and specificity, resulting in improved clinical performance and higher efficiency. Another advantage in population screening according to European Guidelines for quality assurance in CRC screening is that FITs can be automated and user can adjust the cut-off at which a positive result is reported. In population-based screening, all those testing positively with any FOBT should be referred for colonoscopy. Conclusion: Although a plethora of FOBTs are available on the market, relatively few have been extensively tested for clinical sensitivity and specificity in CRC screening. Current data imply that new FITs have superior test characteristics as compared with guaiac-based FOBTs. The latest development in the field is represented by the proteomic-based tests that may further reduce false-negative rates in CRC screening. Simple stool sample preservation and automatic analysis are other important issues in population-based screening for CRC.


Asunto(s)
Neoplasias Colorrectales/diagnóstico , Heces/citología , Inmunoquímica/métodos , Tamizaje Masivo/métodos , Detección Precoz del Cáncer , Humanos , Sangre Oculta
11.
Ann R Coll Surg Engl ; 102(4): 308-311, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32081023

RESUMEN

INTRODUCTION: Survival for colorectal cancer is improved by earlier detection. Rapid assessment and diagnostic demand have created a surge in two-week rule referrals and have subsequently placed a greater burden on endoscopy services. Between 2009 and 2014, a mean of 709 patients annually were referred to Royal Surrey County Hospital with a detection rate of 53 cancers per year giving a positive predictive value for these patients of 7.5%. We aimed to assess what impact the 2015 changes in National Institute for Health and Care Excellence referral criteria had on local cancer detection rate and endoscopy services. METHODS: A prospectively maintained database of patients referred under the two-week rule pathway for April 2017-2018 was sub-analysed and the data cross-referenced with all diagnostic reports. FINDINGS: There were 1,414 referrals, which is double the number of previous years; 80.6% underwent endoscopy as primary investigation and 62 cancers were identified, 51 being of colorectal and anal origin (positive predictive value 3.6%). A total of 88 patients were diagnosed, with other significant colorectal disease defined as high-risk adenomas, colitis and benign ulcers. Overall, a total of 10.6% of our two-week rule patients had a significant finding.Since the 2015 referral criteria, despite a dramatic rise in two-week rule referrals, there has been no increase in cancer detection. It has placed significant pressure on diagnostic services. This highlights the need for a less invasive, cheaper yet sensitive test to rule out cancer such as faecal immunochemical testing that can enable clinicians to triage and reduce referral to endoscopy in symptomatic patients.


Asunto(s)
Neoplasias Colorrectales/diagnóstico , Vías Clínicas/normas , Detección Precoz del Cáncer/normas , Sangre Oculta , Triaje/normas , Colonoscopía/estadística & datos numéricos , Neoplasias Colorrectales/epidemiología , Vías Clínicas/estadística & datos numéricos , Bases de Datos Factuales/estadística & datos numéricos , Detección Precoz del Cáncer/métodos , Humanos , Uso Excesivo de los Servicios de Salud/prevención & control , Uso Excesivo de los Servicios de Salud/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Valor Predictivo de las Pruebas , Prevalencia , Derivación y Consulta/normas , Derivación y Consulta/estadística & datos numéricos , Factores de Tiempo , Reino Unido/epidemiología
12.
PLoS One ; 15(2): e0227899, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32012174

RESUMEN

BACKGROUND: The Australian National Bowel Cancer Screening Program (NBCSP) provides biennial immunochemical faecal occult blood test (iFOBT) screening for people aged 50-74 years. Previous work has quantified the number of colorectal cancer (CRC) deaths prevented by the NBCSP and has shown that it is cost-effective. With a 40% screening participation rate, the NBCSP is currently underutilised and could be improved by increasing program participation, but the maximum appropriate level of spending on effective interventions to increase adherence has not yet been quantified. OBJECTIVES: To estimate (i) reductions in CRC cases and deaths for 2020-2040 attributable to, and (ii) the threshold for cost-effective investment (TCEI) in, effective future interventions to improve participation in the NBCSP. METHODS: A comprehensive microsimulation model, Policy1-Bowel, was used to simulate CRC natural history and screening in Australia, considering currently reported NBCSP adherence rates, i.e. iFOBT participation (∼40%) and diagnostic colonoscopy assessment rates (∼70%). Australian residents aged 40-74 were modelled. We evaluated three scenarios: (1) diagnostic colonoscopy assessment increasing to 90%; (2) iFOBT screening participation increasing to 60% by 2020, 70% by 2030 with diagnostic assessment rates of 90%; and (3) iFOBT screening increasing to 90% by 2020 with diagnostic assessment rates of 90%. In each scenario, we estimated CRC incidence and mortality, colonoscopies, costs, and TCEI given indicative willingness-to-pay thresholds of AUD$10,000-$30,000/LYS. RESULTS: By 2040, age-standardised CRC incidence and mortality rates could be reduced from 46.2 and 13.5 per 100,000 persons, respectively, if current participation rates continued, to (1) 44.0 and 12.7, (2) 36.8 and 8.8, and (3) 31.9 and 6.5. In Scenario 2, 23,000 lives would be saved from 2020-2040 vs current participation rates. The estimated scenario-specific TCEI (Australian dollars or AUD$/year) to invest in interventions to increase participation, given a conservative willingness-to-pay threshold of AUD$10,000/LYS, was (1) AUD$14.9M, (2) AUD$72.0M, and (3) AUD$76.5M. CONCLUSION: Significant investment in evidence-based interventions could be used to improve NBCSP adherence and help realise the program's potential. Such interventions might include mass media campaigns to increase program participation, educational or awareness interventions for practitioners, and/or interventions resulting in improvements in referral pathways. Any set of interventions which achieves at least 70% iFOBT screening participation and a 90% diagnostic assessment rate while costing under AUD$72 million annually would be highly cost-effective (

Asunto(s)
Neoplasias del Colon/diagnóstico , Neoplasias Colorrectales/diagnóstico , Intestinos/patología , Sangre Oculta , Anciano , Australia/epidemiología , Neoplasias del Colon/economía , Neoplasias del Colon/epidemiología , Neoplasias del Colon/patología , Colonoscopía/economía , Neoplasias Colorrectales/economía , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/patología , Análisis Costo-Beneficio , Detección Precoz del Cáncer/economía , Heces/química , Femenino , Humanos , Masculino , Persona de Mediana Edad
13.
Lancet ; 395(10221): 350-360, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-32007170

RESUMEN

BACKGROUND: Improved markers of prognosis are needed to stratify patients with early-stage colorectal cancer to refine selection of adjuvant therapy. The aim of the present study was to develop a biomarker of patient outcome after primary colorectal cancer resection by directly analysing scanned conventional haematoxylin and eosin stained sections using deep learning. METHODS: More than 12 000 000 image tiles from patients with a distinctly good or poor disease outcome from four cohorts were used to train a total of ten convolutional neural networks, purpose-built for classifying supersized heterogeneous images. A prognostic biomarker integrating the ten networks was determined using patients with a non-distinct outcome. The marker was tested on 920 patients with slides prepared in the UK, and then independently validated according to a predefined protocol in 1122 patients treated with single-agent capecitabine using slides prepared in Norway. All cohorts included only patients with resectable tumours, and a formalin-fixed, paraffin-embedded tumour tissue block available for analysis. The primary outcome was cancer-specific survival. FINDINGS: 828 patients from four cohorts had a distinct outcome and were used as a training cohort to obtain clear ground truth. 1645 patients had a non-distinct outcome and were used for tuning. The biomarker provided a hazard ratio for poor versus good prognosis of 3·84 (95% CI 2·72-5·43; p<0·0001) in the primary analysis of the validation cohort, and 3·04 (2·07-4·47; p<0·0001) after adjusting for established prognostic markers significant in univariable analyses of the same cohort, which were pN stage, pT stage, lymphatic invasion, and venous vascular invasion. INTERPRETATION: A clinically useful prognostic marker was developed using deep learning allied to digital scanning of conventional haematoxylin and eosin stained tumour tissue sections. The assay has been extensively evaluated in large, independent patient populations, correlates with and outperforms established molecular and morphological prognostic markers, and gives consistent results across tumour and nodal stage. The biomarker stratified stage II and III patients into sufficiently distinct prognostic groups that potentially could be used to guide selection of adjuvant treatment by avoiding therapy in very low risk groups and identifying patients who would benefit from more intensive treatment regimes. FUNDING: The Research Council of Norway.


Asunto(s)
Neoplasias Colorrectales/diagnóstico , Aprendizaje Profundo , Anciano , Biomarcadores de Tumor/metabolismo , Estudios de Cohortes , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/terapia , Detección Precoz del Cáncer/métodos , Eosina Amarillenta-(YS)/metabolismo , Femenino , Hematoxilina/metabolismo , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos
15.
Crit Rev Oncol Hematol ; 147: 102882, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32106012

RESUMEN

Cancers of Unknown Primary Site (CUP) account for approximately 1-3 % of all malignant neoplasms. It represents a heterogeneous group of malignancies without a detectable primary and is characterized by aggressive clinical behavior. Patients with CUP are presumably categorized into prognostic subsets according to their clinical and pathological characteristics. The majority of these patients are chemoresistant and treated with empiric chemotherapy regimens which yield limited survival. Recent diagnostic advances have led to the identification of a higher percentage of culprit primaries among which colorectal, lung and renal tumors. The empiric CUP regimens may be suboptimal in these patients which explain in part their poor prognosis. In the absence of prospective randomized studies to prove the benefit of site-specific therapy in these subsets, we reviewed the literature to assess whether CUP with colorectal, lung and renal - profiles should be treated similarly to the correspondent primary tumors.


Asunto(s)
Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Primarias Desconocidas/tratamiento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Colorrectales/diagnóstico , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Primarias Desconocidas/diagnóstico , Pronóstico
16.
Medicine (Baltimore) ; 99(7): e19066, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32049807

RESUMEN

Previous work suggests that the long noncoding RNA HCC associated long non-coding RNA (HANR) is associated with hepatocellular carcinoma (HCC) progression, but its significance in the context of colorectal cancer (CRC) remains to be determined. Therefore, in this study we assessed the prognostic and diagnostic value of HANR in patients suffering from CRC.The HANR expression in 165 pairs of CRC cancer and adjacent non-cancerous prostate tissues was measured by quantitative reverse transcription polymerase chain reaction (qRT-PCR) analysis. Student t test was conducted for intergroup comparison. Pearson correlation test was used for correlation analysis. Survival curves were carried out by the Kaplan-Meier method and evaluated using the log-rank test. Multivariable Cox proportional hazard risk regression model was performed to screen the independent factor affected the prognosis of CRC patients.In this study, levels of HANR were significantly higher in CRC tumor samples relative to adjacent normal tissue samples (P < .001). A ROC analysis suggested HANR expression could be reliably used to differentiate between normal and CRC tumor tissue. In addition, elevated HANR expression was positively correlated with more advanced and aggressive CRC features, such as a larger tumor size (P = .003), increased invasion depth (P = .012), and more advanced TNM stage (P = .011). Survival analyses revealed that elevated HANR expression was correlated with worse overall survival (P = .002) and disease-free survival (P = .003). A multivariate analysis further confirmed the relevance of HANR as an independent predictor of CRC patient outcomes.In summary, these results indicate that the lncRNA HANR is a promising prognostic indicator in CRC patients.


Asunto(s)
Biomarcadores de Tumor/genética , Neoplasias Colorrectales/diagnóstico , ARN Largo no Codificante/genética , Regulación hacia Arriba , Adulto , Anciano , Neoplasias Colorrectales/genética , Neoplasias Colorrectales/patología , Detección Precoz del Cáncer , Femenino , Regulación Neoplásica de la Expresión Génica , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estadificación de Neoplasias , Pronóstico , Análisis de Supervivencia
17.
Medicine (Baltimore) ; 99(7): e19243, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32049865

RESUMEN

D-dimer level is a direct measure of activated coagulation and has been used as a biomarker of hypercoagulability. In this study, we aimed to explore the associations between D-dimer level and the clinicopathological features and prognosis in metastatic colorectal cancer (mCRC) patients. One hundred seventy-eight patients diagnosed with mCRC from the Department of General Surgery, Jingmen First People's Hospital from September 2014 to December 2018 were collected. Data of coagulation index was evaluated and survival analysis was performed to identify the biomarker of mCRC. Among 178 cases of colorectal cancer, we found that the value of 0.55 mg/L, 5ng/ml and 40U/ml were cut-off values of D-Dimer, CEA and CA-199 for patients survival, respectively. hypercoagulability was much more frequent in patients aged ≥60 years than <60 years (P < .001) and also in patients with ECOG ≥2 points (P < .001). Moreover, those patients who have CEA >5ng/ml and CA-199>40U/ml had hypercoagulable state (P < .001). There was a significant difference in D-Dimer >0.55 mg/L and D-Dimer ≤0.55 mg/L among the number of metastatic sites (P < .01) and patients with comorbidities (P < .01). Survival analysis showed that patients with D-Dimer >0.55 mg/L have significantly unfavorable overall survival (P = .006) and progressive free survival (P = .011).


Asunto(s)
Neoplasias Colorrectales/sangre , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , China/epidemiología , Estudios de Cohortes , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trombofilia
18.
Med Care ; 58(2): 183-191, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31934958

RESUMEN

BACKGROUND: This study examines the expansion of health insurance coverage in Massachusetts under state health reform as a natural experiment to investigate whether expanded insurance coverage reduced the likelihood of advanced stage colorectal cancer (CRC) and breast cancer (BCA) diagnosis. METHODS: Our study populations include CRC or BCA patients aged 50-64 years observed in the Massachusetts Cancer Registry and Surveillance Epidemiology and End Results (SEER) registries for 2001-2013. We use difference-in-differences regression models to estimate changes in the likelihood of advanced stage diagnosis after Massachusetts health reform, relative to comparison states without expanded coverage (Connecticut, New Jersey, Georgia, Kentucky, and Michigan). RESULTS: We find some suggestive evidence of a decline in the proportion of advanced stage CRC cases. Approximately half of the CRC patients in Massachusetts and control states were diagnosed at advanced stages pre reform; there was a 2 percentage-point increase in this proportion across control states and slight decline in Massachusetts post reform. Adjusted difference-in-difference estimates suggest a 3.4 percentage-point (P=0.005) or 7% decline, relative to Massachusetts baseline, in the likelihood of advanced stage diagnosis after the reform in Massachusetts, though this result is sensitive to years included in the analysis. We did not find a significant effect of reform on BCA stage at diagnosis. CONCLUSIONS: The decline in the likelihood of advanced stage CRC diagnosis after Massachusetts health reform may suggest improvements in access to health care and CRC screening. Similar declines were not observed for BCA, perhaps due to established BCA-specific safety-net programs.


Asunto(s)
Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/patología , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/patología , Reforma de la Atención de Salud/estadística & datos numéricos , Detección Precoz del Cáncer/estadística & datos numéricos , Femenino , Humanos , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Masculino , Massachusetts/epidemiología , Persona de Mediana Edad , Estadificación de Neoplasias , Programa de VERF
19.
Gastroenterol. hepatol. (Ed. impr.) ; 43(1): 45-56, ene. 2020. ilus, tab
Artículo en Español | IBECS | ID: ibc-188294

RESUMEN

El cáncer colorrectal constituye un problema de salud importante. Se ha demostrado una mejoría de la supervivencia mediante la realización de colonoscopias de cribado y la extirpación de sus lesiones precursoras, los pólipos. Sin embargo, la colonoscopia no es infalible y se han propuesto múltiples estrategias dirigidas a mejorar la calidad de la misma. En esta revisión se describen los sistemas endoscópicos de que disponemos para mejorar la detección y caracterización de los pólipos, las diferentes clasificaciones utilizadas para la predicción histológica y las indicaciones actuales de las técnicas de diagnóstico endoscópico avanzado


Colorectal cancer is a major health problem. An improvement to its survival has been demonstrated by performing colonoscopy screenings and removing its precursor lesions: polyps. However, colonoscopy is not infallible and multiple strategies have been proposed aimed at improving the quality thereof. This report describes the endoscopic systems available to improve the detection and characterization of polyps, the different classifications for histological prediction and the current indications of advanced endoscopic diagnostic techniques


Asunto(s)
Humanos , Pólipos del Colon/diagnóstico , Colonoscopios , Colonoscopía/instrumentación , Neoplasias Colorrectales/diagnóstico , Detección Precoz del Cáncer/instrumentación , Adenoma/diagnóstico , Diseño de Equipo
20.
PLoS One ; 15(1): e0227294, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31940389

RESUMEN

BACKGROUND: Cell-free DNA detection is becoming a surrogate assay for tumor genotyping. Biological fluids often content a very low amount of cell-free tumor DNA and assays able to detect very low allele frequency mutant with a few quantities of DNA are required. We evaluated the ability of the fully-automated molecular diagnostics platform Idylla for the detection of KRAS, NRAS and BRAF hotspot mutations in plasma from patients with metastatic colorectal cancer (mCRC). MATERIALS AND METHODS: First, we evaluated the limit of detection of the system using two set of laboratory made samples that mimic mCRC patient plasma, then plasma samples from patients with mCRC were assessed using Idylla system and BEAMing digital PCR technology. RESULTS: Limits of detection of 0.1%, 0.4% and 0.01% for KRAS, NRAS and BRAF respectively have been reached. With our laboratory made samples, sensitivity up to 0.008% has been reached. Among 15 patients' samples tested for KRAS mutation, 2 discrepant results were found between Idylla and BEAMing dPCR. A 100% concordance between the two assays has been found for the detection of NRAS and BRAF mutations in plasma samples. CONCLUSIONS: The Idylla system does not reach as high sensitivity as assays like ddPCR but has an equivalent sensitivity to modified NGS technics with a lower cost and a lower time to results. These data allowed to consider the Idylla system in a routine laboratory workflow for KRAS, NRAS and BRAF mutations detection in plasma.


Asunto(s)
Biomarcadores de Tumor/genética , ADN Tumoral Circulante/aislamiento & purificación , Neoplasias Colorrectales/diagnóstico , Análisis Mutacional de ADN/instrumentación , Técnicas de Genotipaje/instrumentación , Línea Celular Tumoral , ADN Tumoral Circulante/genética , Ensayos Clínicos como Asunto , Neoplasias Colorrectales/genética , Análisis Mutacional de ADN/métodos , GTP Fosfohidrolasas/genética , Frecuencia de los Genes , Técnicas de Genotipaje/métodos , Humanos , Límite de Detección , Proteínas de la Membrana/genética , Técnicas Analíticas Microfluídicas/instrumentación , Técnicas Analíticas Microfluídicas/métodos , Mutación , Proteínas Proto-Oncogénicas B-raf/genética , Proteínas Proto-Oncogénicas p21(ras)/genética , Sensibilidad y Especificidad
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