The value of laparoscopic simultaneous resection for synchronous left-sided colorectal cancer liver metastases / 中华肝胆外科杂志

Objective:To investigate the value of total laparoscopic simultaneous resection for left-sided colorectal cancer (CRC) and synchronous liver metastases (SLM).Methods:A retrospective analysis of the clinical data of patients with left-sided CRC and SLM who underwent simultaneous resection in the Shanghai Cancer Center, Fudan University from March 2014 to December 2017. The patients were divided into laparoscopy group, open surgery group and hybrid surgery group. The intraoperative information, postoperative short-term outcome and long-term survival were analyzed among the three groups.Results:A total of 96 patients were enrolled. The total laparoscopic group enrolled 29 patients, including 21 males and 8 females, aged (57.8±1.6) years old; the open surgery group enrolled 28 patients, including 18 males and 10 females, aged (57.3±2.0) years old; 39 cases were included in the hybrid surgery group, including 27 males and 12 females, aged (55.3±1.8) years old. The distribution ratio of the two lobes of liver metastases in the open surgery group was higher than that in the total laparoscopic group and hybrid surgery group (all P<0.05), and there was no significant difference in the other clinical baseline characteristics between the three groups (all P>0.05). In laparoscopy group, open surgery group and hybrid surgery group, the mean operative time was (241.5±12.9) min, (209.3±10.7) min and (234.9±12.4) min, respectively. The median intraoperative blood loss was 200.0 ml, 300.0 ml and 200.0 ml, respectively. The median postoperative hospital stay was 8.0 days, 9.0 days and 9.0 days, respectively. There were no statistical differences in these indicators (all P>0.05). The patients in the open surgery group had a longer initial defecation time than those in the other two groups ( P<0.05). The incidence of postoperative complications was 31.0% (9/29), 39.3% (11/28) and 35.9% (14/39), respectively, with no difference among the three groups ( P>0.05). In laparoscopy group, open surgery group and hybrid surgery group, 1-year overall survival were 93.0%, 85.0% and 94.0%; 3-year overall survival were 72.0%, 81.0% and 74.0%, respectively ( P>0.05). One-year disease free survival were 70.0%, 52.0% and 55.0%; 3-year disease free survival were 36.0%, 30.0% and 39.0%, respectively ( P>0.05). Conclusion:Laparoscopic simultaneous resection for left-sided CRC and SLM shows slight advantages in the safety and short-term outcome, and does not affect the long-term survival.

Adjuvant and perioperative neoadjuvant therapy for colorectal cancer / 中华胃肠外科杂志

Colorectal cancer is one of the most common malignant tumors in the world, threatening human health. The treatment strategy of stage II and stage III colorectal cancer has changed from surgery alone to multidisciplinary mode emphasizing perioperative treatment. The indication of adjuvant chemotherapy for stage II colon cancer is still defined by high-risk factors, but only microsatellite status and BRAF gene mutation can help predict efficacy of chemotherapy. Combined chemotherapy is the main adjuvant therapy for stage III colon cancer. The recommended course of adjuvant chemotherapy is 6 months. Based on the results of the IDEA study, the three-month CapeOX regimen (oxaliplatin and capecitabine) is recommended for the treatment of patients with T1-3 and N1 tumors. Neoadjuvant chemotherapy for locally advanced colon cancer is still in the exploratory stage of clinical trials. The difference between the treatment of rectal cancer and colon cancer lies in the application of radiotherapy. Chemoradiotherapy combined with TME (total mesorectal excision) surgery and adjuvant chemotherapy has become the standard treatment for locally advanced rectal cancer. Nowadays, the research hotspots in neoadjuvant therapy of rectal cancer include neoadjuvant chemotherapy and total neoadjuvant therapy (TNT). This article will review the progress of perioperative treatment for colorectal cancer.

Long non-coding RNAs in Colorectal Cancer: Progression and Future Directions.

Identification of the colorectal adenoma-carcinoma sequence with its corresponding genetic and epigenetic alterations has significantly increased our knowledge of the etiopathogenesis of colorectal cancer (CRC). However, the molecular mechanisms of colorectal carcinogenesis and metastasis haven't been clearly elucidated. Long non-coding ribonucleic acids (lncRNAs) are key participants of gene regulations rather than "noises". Accumulative studies have implicated that the aberrant expressions of lncRNAs are tightly corelated to CRC screening, diagnosis, prognosis and therapeutic outcomes. Our review focuses on recent findings on the involvement of lncRNAs in CRC oncogenesis and the lncRNA-based clinical implications in patients with CRC.

Colorectal cancer heterogeneity: genotype, phenotype and clinical manifestation / 中华胃肠外科杂志

Colorectal cancer is the third high-incidence of malignant tumors in the world, and also a kind of tumor with good biological behavior and good efficacy. Colorectal cancer heterogeneity is a very important trait of its biological behavior, which can be reflected in many different aspects, including tumor type, pathogenesis, molecular phenotyping and time-space heterogeneity. Different pathogenesis produces different tumor phenotypes, which are generated in the process of natural evolution and intervention. Various phenotypes show the difference among different individuals of colorectal cancer, in terms of clinical characteristics, treatment response and prognosis. Understanding the heterogeneity of colorectal cancer has important clinical value for individualized treatment.

Recognition of Anterior Peritoneal Reflections and Their Relationship With Rectal Tumors Using Rectal Magnetic Resonance Imaging.

Our goal was to explore the factors influencing the visualization of anterior peritoneal reflections (APRs) using rectal MRI. We evaluated the usefulness of rectal MRI in measuring the distance from the anal verge to the APR and determining the relationship between the APR and the rectal tumor. Clinical and imaging data from 319 patients who underwent surgery after MRI examination between October 2010 and December 2013 were retrospectively analyzed. The distance from the anal verge to the APR and the relationship between the APR and the location of the rectal tumor was evaluated. analysis of variance, logistic regression, independent samples t tests, and Kappa tests were used for statistical analysis. The APR was visible in 283 of 319 cases using rectal MRI. The APR was more readily observed in patients who were older than 58 years (P = 0.046), in patients whose subcutaneous fat thicknesses were >22.2 mm (P = 0.004), in patients with nondistended bladders (P = 0.001), and in those with an anteversion of the uterus (P = 0.001). There was a significant difference between the distance from the anal verge to the APR between females (10.4 ±â€Š1.1 cm) and males (10.0 ±â€Š1.2 cm; P = 0.014). The accuracy in predicting tumor location with respect to the APR was 70%, 50%, 98.2%, respectively for patients with tumors located above, at, and below the APR (compared with the location determined during surgery). Most of the APRs were visible using rectal MRI, whereas certain internal factors influence visualization. Rectal MRI could be a useful tool for evaluating the distance from the anal verge to the APR and relationship between rectal tumors and the APR.

Present status and future of multi-disciplinary treatment for colorectal cancer / 中华胃肠外科杂志

Multi-disciplinary treatment (MDT) is an effective pattern to implement the standardized and individualized treatment for cancer. Under the pattern of MDT which integrates the surgery, chemotherapy, radiotherapy, interventional therapy, targeted therapy and immune therapy, there has been a landmark progress in the diagnosis and treatment of colorectal cancer. Curative resection followed by adjuvant chemotherapy has been established as a standard treatment for stage III( colon cancer, but it is still controversial about whether patients with stage II( colon cancer should receive adjuvant chemotherapy and which regimen is preferred. Decision making regarding the use of adjuvant therapy for stage II( patients should not only depend upon the clinicopathological features but also individualized discussion between patients and physicians about the biological behavior of the disease, evidence supporting the efficacy, and possible toxicity. Radical operation following neoadjuvant chemoradiotherapy is currently the standard modality for locally advanced rectal cancer, but the strategy of 'Wait and See' is proposed by some researchers for those achieving complete response after chemoradiotherapy, although there is no sufficient supportive data yet. Patients with metastatic colorectal cancer should undergo an upfront evaluation and discussion by a multidisciplinary team before the initial treatment. Achieving a negative surgical margin with adequate remanent liver reserve is the criteria for determining the resectability of liver metastasis. Both adjuvant and neoadjuvant chemotherapy are two alternatives for initially resectable liver metastasis. Concomitant with the progress of medicine, the MDT is moving toward a precise treatment system oriented by genes and being able to predict the prognosis, efficacy and side effects exactly.

Can the weekday of surgery influence the prognosis of colorectal cancer patients? A retrospective study based on a single-center of large sample / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the impact of the weekday of surgery on the prognosis of patients with colorectal cancer.</p><p><b>METHODS</b>A retrospective analysis was conducted in patients with colorectal cancer who underwent radical resection in Fudan University Shanghai Cancer Center(FUSCC) between January 2007 and December 2013, and 4 971 patients were identified eligible. Statistical analyses were carried out between patients who received surgery on Monday to Thursday and those who received surgery on Friday. Chi-square test was used to analyze the relationship between clinicopathological parameters and day of surgery. T test was used to compare continuous variables between groups. The 5-year overall survival (OS) and disease-free survival (DFS) were calculated by the Kaplan-Meier method, and compared by log-rank test.</p><p><b>RESULTS</b>There were no statistically significant differences between two groups in age, gender and pathological grade et al (all P>0.05). However, the number of dissected lymph node was higher in patients who received surgery on Monday to Thursday (median 16) compared with patients who received surgery on Friday (median 14), with statistically significant difference (P=0.038). The 5-year OS and DFS in all eligible patients were 78.0% and 55.0%, respectively. 5-year OS of patients in Monday to Thursday surgery group and Friday surgery group was 79.6% and 77.2%, while 5-year DFS in two groups was 57.8% and 50.4%. There were no significant differences in OS and DFS between two group, with P=0.882 and P=0.210, respectively. Subgroup analyses were conducted according to different pathological stages. 5-year OS of patients at stage I( in Monday to Thursday surgery group and Friday surgery group was 94.7% and 90.6% (P=0.742) and 5-year DFS was 85.1% and 78.2% (P=0.765). 5-year OS of patients at stage II( in two groups was 85.5% and 83.7% (P=0.496) and 5-year DFS was 72.7% and 62.8% (P=0.121). 5-year OS of patients at stage III( in two groups was 69.7% and 69.4%(P=0.354) and 5-year DFS was 41.8% and 37.4% (P=0.976). No statistically significant differences manifested in subgroup analyses.</p><p><b>CONCLUSION</b>Patients with colorectal cancer undergoing surgery on Monday to Thursday have similar long-term prognosis with those on Friday.</p>

Value of dynamic contrast-enhanced MRI in predicting response to neoadjuvant chemoradiation in locally advanced rectal cancer / 中华放射学杂志

Objective To determine the value of dynamic contrast enhanced (DCE?MRI) in predicting treatment response before preoperative chemoradiotherapy in locally advanced rectal cancer. Methods A cohort of consecutive patients with histologically confirmed rectal adenocarcinoma treated with preoperative chemoradiotherapy followed by total mesorectal excision (TME) surgery was enrolled in a prospective, pilot trial. All enrolled patients were examined using DCE?MRI at two time points: 2 to 5 days before neoadjuvant chemoradiation, 1 to 4 days before surgery. The following perfusion parameters (Ktrans, Kep, Ve) were measured for tumor. The patients were classified into pathological complete response (pCR) and non?pCR group according to the pathological results after operation. Those perfusion parameters were compared between the pCR and the non?pCR group and between before and after CRT in pCR and the non?pCR group with the t test. Receiver?operating curves (ROC) were constructed to further investigate the predictive value of Ktrans, Kep, Ve before neoadjuvant chemoradiation and were used to determine a threshold value at which patents with pCR could be distinguished from patients without complete response. Results The final study population consisted of 38 patients. There were 12 patients with a pCR and 26 patients with non?pCR. Before neoadjuvant chemoradiation, the mean tumor Ktrans, Kep and Ve for pCR group were (1.25 ± 0.56)/min, (2.10 ± 1.61)/min and 0.73 ± 0.34, respectively, for non?pCR group they were (0.46 ± 0.39)/min, (1.15 ± 0.77)/min and 0.32±0.12, respectively. All perfusion parameters showed significant difference between those two groups(t values were 3.45,5.67 and 6.23 respectively, all P0.05), as well as the changes before and after neoadjuvant chemoradiation in those groups(P>0.05). ROC analysis for Ktrans pre?treatment revealed that Ktrans had an AUC of 0.837 in predicting pCR. A Ktrans of 0.66/min was emerged as the optimal cut?off for distinguishing pCR from non?pCR and for Ktrans>0.66/min, the sensitivity and specificity for predicting pCR were 75.0% (9/12) and 96.2% (25/26). Kep and Ve showed an AUC of 0.655 and 0.654 in predicting pCR. Conclusions In locally advanced rectal cancer, DCE?MRI can aid in predicting treatment response before preoperative chemoradiotherapy. Ktrans may become a better predictor to classify which patients will benefit from neoadjuvant chemoradiation.

Multidisciplinary treatment of colorectal cancer peritoneal metastasis / 中国癌症杂志

Peritoneum is one of the common site of colorectal cancer metastasis. Traditionally, peritoneal carcinomatosis is associated with a poor prognosis without effective surgical treatment. Recently, the attitude towards the treatment strategies for colorectal peritoneal metastasis has changed significantly with advances in surgical techniques, hyperthermic intraperitoneal chemotherapy and multi-disciplinary treatment. As to the prognosis, colorectal peritoneal metastasis has an inferior outcome to non-peritoneal metastasis under the palliative systemic treatment. However, the complete peritoneal cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy can achieve a long-term survival in selective patients with colorectal peritoneal metastasas. The prognostic factors include peritoneal carcinomatosis index, completeness of cytoreduction, the presence of extra-peritoneal metastasis (liver etc), peritoneal surface disease severity score and Japanese peritoneal staging. In terms of the treatment, complete peritoneal cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy and systemic treatment (including chemotherapy and targeted therapy) may be the best modality of multi-disciplinary treatment for colorectal peritoneal metastasis.

Efficacy of high-resolution MRI in the prediction of tumor complete response after neoadjuvant chemoradiation therapy for T3 rectal cancer / 中华消化外科杂志

Objective To explore the efficacy of high-resolution MRI in the prediction of tumor complete response after neoadjuvant chemoradiation therapy for T3 rectal cancer.Methods The clinical data of 108 patients with T3 rectal cancer who were admitted to Shanghai Cancer Center of Fudan University from 2010 to 2012 were retrospectively analyzed.The TNM stage of tumor,extramural depth of tumor invasion (mrT3 stage),involvement of mesorectum and rectal fascia,tumor diameter and distance from anal edge to lower edge of tumor were the main items of evaluation using the high-resolution MRI.A total of 108 patients underwent surgical resection of tumor after neoadjuvant chemoradiation therapy.The tumor complete response after neoadjuvant chemoradiation therapy was evaluated by tumor node metastasis (TNM) stage and tumor regression grade (TRG).The categorical data and multivariate analysis were done by the single factor analysis of variance (ANOVA) and Logistic regression analysis.Results The positive response rate of the T3a,T3b and T3c in the patients were 61.5％ (16/26),36.9％ (24/65) and 11.8％ (2/17) after neoadjuvant chemoradiation therapy,respectively.The mrT3,mrN and tumor diameter were the potential factors affecting response of neoadjuvant chemoradiation therapy by the univariate analysis of pathological restaging (x2 =50.474,30.985,8.318,P ＜ 0.05).The mrT3 was an independent risk factor affecting response of neoadjuvant chemoradiation therapy by the multivariate analysis of pathological restaging (OR =4.473,95 ％ confidence interval:2.003-9.991,P ＜ 0.05).There was no significant difference between the mrT3 stage,N stage,involvement of mesorectum and rectal fascia,tumor diameter and distance from anal edge to lower edge of tumor before therapy and the response after neoadjuvant chemoradiation therapy based on the tumor regression grade(TRG) (x2 =6.264,6.159,2.949,2.189,6.335,P ＞ 0.05).Conclusion The mrT3 in patients undergoing high-resolution MRI before neoadjuvant chemoradiation therapy could predict the tumor complete response after neoadjuvant chemoradiation therapy for T3 rectal cancer.

The differences between three distinct locations of colorectal cancers based on clinicopathological characteristics and molecular features / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the differences of clinical characteristics and molecular features among colorectal cancer subsides and provide evidence for colorectal cancer protection, diagnosis and treatment.</p><p><b>METHODS</b>All of 4 316 colorectal patients from Shanghai cancer center were selected for clinical character analysis, among which, 2 224 subjects for molecular feature analysis. Clinic pathological characteristics like age, gender, tumor types, histological types, differentiation and T-stage, as well as molecular features like hMLH1, hMSH2, CD44, p21, p53, COX2,E-cadherin, Her2 and Ki-67, were involved into this research.</p><p><b>RESULTS</b>It showed that compared with left-sided colon and rectal cancers, right-sided cancers occurred more in women (46.0% (541/1 176); 39.2% (424/1 083); 41.2% (848/2 057), respectively, χ² = 11.85, P < 0.01), had more mucinous or signet-ring carcinoma (12.0% (128/1 064), 5.8% (56/960), 4.0% (75/1 859), respectively, χ² = 31.27, P < 0.01), poor differentiated carcinoma (32.1% (343/1 069), 19.5% (201/1 033), 19.3% (380/1 967), respectively, χ² = 72.66, P < 0.01) , and advanced T stage (87.9% (992/1 129), 83.2% (869/1 045), 72.2% (1 486/2 057), respectively, χ² = 121.44, P < 0.01). Meanwhile, the rates of hMLH1 were higher in right-sided colon cancers when compared with rectal cancers (13.4% (59/439) vs 8.5% (88/1 035), OR (95%CI): 1.67 (1.18-2.37)), as well as the rates of hMSH2 negative expression (4.9% (22/452) vs 2.4% (26/1 083), OR (95% CI): 2.08(1.17-3.71)). The rates of p53 positive expression were higher in right-sided colon cancers when compared with rectal cancers (76.2% (321/421) vs 68.4%, (776/1 134), OR (95% CI): 0.68 (0.52-0.87)). Compared with right-sided colon cancers, the rates of Her2 positive expression were higher in rectal cancers (19.3% (176/913) vs 13.2% (45/340), OR (95% CI): 1.57 (1.10-2.23)) , as well as the rates of Ki-67 expression which was positive in more than 50% cells (73.6% (840/1 141) vs 65.6% (299/456), OR (95% CI): 0.68 (0.54-0.86)).</p><p><b>CONCLUSION</b>There are specific characteristics in right-sided colon cancers. The difference of molecular features between right-sided colon and rectal cancers are more significant.</p>

Prediction of efficacy of neoadjuvant radiochemotherapy based on depth of invasion in T3 rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the association of mesorectal invasion depth before neoadjuvant radiochemotherapy with pathological outcome and to provide evidence for individualized treatment in T3 rectal cancer.</p><p><b>METHODS</b>Retrospective analysis was performed on the clinical records of 73 consecutive rectal cancer patients treated with neoadjuvant radiochemotherapy and radical surgery in the Shanghai Cancer Center from January 2010 to December 2012. All the patients underwent high-resolution MRI and the depth of mesorectal invasion, lymph node status, tumor length, and mesorectal fascia status were evaluated. The category T3 was subdivided according to the measurement of the maximal tumor invasion beyond the outer border of the muscularis propria: T3a(<5 mm), T3b(5-10 mm) and T3c(>10 mm). The association of mesorectal invasion depth,other MRI and clinical features with short-term efficacy was analyzed,especially with pathological complete response(pCR).</p><p><b>RESULTS</b>T3a, T3b and T3c accounted for 19.2%, 64.4% and 16.4% in 73 rectal cancer patients who underwent high resolution MRI, respectively. There were 42.9% of T3a patients achieved pathological complete response,significantly higher than those of T3b(14.9%)and T3c(0%) (P=0.017).</p><p><b>CONCLUSIONS</b>T3a rectal cancer patients are more likely to achieve pCR than those of T3b and T3c after neoadjuvant radiochemotherapy. The maximal tumor invasion beyond the outer border of the muscularis propria less than 5 mm may act as a predictive factor and guide the follow-up treatment of T3 rectal cancer.</p>

BRCA1 and ERCC1 mRNA levels are associated with lymph node metastasis in Chinese patients with colorectal cancer.

BACKGROUND: Although both excision repair cross-complementing group 1 (ERCC1) and breast cancer susceptibility gene 1 (BRCA1) can be effective biomarkers for chemosensitivity in primary malignant tumors, their applicability to metastases is poorly understood. Here, ERCC1 and BRCA1, which are linked to lymph node metastasis (LNM) in colorectal cancer (CRC), were evaluated in primary CRC samples from Chinese patients with LNM (LNM CRC) or without LNM (non-LNM CRC). mRNA levels of ERCC1 and BRCA1 in CRC samples, and their relationships to primary CRC and LNM, were also examined. METHODS: Differences in BRCA1 and ERCC1 gene expression between primary CRC with or without LNM were assessed in CRC samples from 120 Chinese patients, using real-time polymerase chain reaction. Relationships between ERCC1 and BRCA1 expression and clinicopathological parameters and prognoses were also examined. RESULTS: ERCC1 and BRCA1 were significantly down-regulated in LNM CRC compared with non-LNM CRC. Down-expression of ERCC1 and BRCA1 was significantly associated with LNM (P < 0.001), advanced TNM stage (P < 0.001), and decreased 5-year overall survival rate (P < 0.001). Univariate and multivariate analyses showed ERCC1 and BRCA1 expression as independent predictors of recurrence and survival in CRC patients (P < 0.05). CONCLUSIONS: ERCC1 and BRCA1 mRNA expression levels correlate inversely to CRC metastasis. ERCC1 and BRCA1 might serve as biomarkers for LNM and as prognostic indicators for CRC; their down-expressions are predictors of poor outcome in CRC patients.

The microRNA of advanced colorectal cancer predict efifcacy of ifrst-line chemotherapy / 中国癌症杂志

Background and purpose: Colorectal cancer (CRC) is the most frequently occurring primary malignant tumor. Chemotherapy can reduce the risk of local and distant relapse. Therefore, it is very important to ifnd new biomarkers that can predict chemoresistant and help in treatment decisions. Methods:In this study, we examined the expression levels of 1 200 human miRNAs in 6 CRC tissues, using miRNA proifling assay arrays. A validation study was done to corroborate a subset of the results, including expression levels of miR-4299, miR-196b, miR-324-5p, miR-455-3p and miR-939, by analyzing 100 specimens of stageⅣcolorectal adenocarcinoma (not respond and respond to the chemotherapy) to quantitative real-time PCR. We modeled the relationship between the expression levels of these miRNAs and the survival rate of 100 CRC patients by Kaplan-Meier method. Results:Expression proifles in CRCs suggested that 5 miRNAs were candidate markers associated with the chemoresistance of colorectal cancer. We found that miR-4299 and-196b had signiifcant diagnostic value for chemoresistance CRC. miR-4299 yielded an AUC (the areas under the ROC curve) of 0.784 and miR-196b yielded an AUC of 0.647 in discriminating CRC from controls. Combined ROC analysis using these 2 miRNAs revealed an elevated AUC of 0.848 with 67.9%sensitivity and 90.9%speciifcity in discriminating chemoresistance CRC. The low level of miR-4299 expression and the high level of-196b expression are signiifcantly correlated with the good survival of CRC patients. Conclusion:These data suggest that miR-4299 and-196b have strong potential as novel biomarkers for chemoresistant detection of colorectal cancer.

Clinicopathological study of rectal neuroendocrine tumors / 中华消化杂志

Objective To study the correlation between clinicopathological characteristics and lymph node metastasis and prognosis of rectal neuroendocrine tumors (NET),and try to explore the choice of surgical approach.Methods The clinicopathological data of 48 postoperative rectal NET patients were collected.The univariate and multivariate analysis of the correlation between clinicopathologic characteristics and lymph node metastasis were performed by chi-square test and Logistic regression.The prognosis single factor survival analysis was analyzed by Kaplan-Meier method.The survival rates were compared by Log-rank test.The prognosis multivariate survival analysis was performed by the use of Cox model.Results The results of univariate analysis indicated that clinicopathological characteristics related with lymph node metastasis were tumor distance from anal verge less than six cm,tumor diameter over two cm,muscularis invasion,distant metastasis and histological grade 3.The results of multivariate analysis showed that histological grade 3 was an independent risk factor of lymph node metastasis (OR=9.333,95 ％CI:1.054 to 82.635,P=0.045).The results of univariate survival analysis suggested that factors correlated with poor prognosis were tumor distance from anal verge less than six cm,tumor diameter over two cm,muscularis invasion,lymph node metastasis,distant metastasis and histological grade 3.The results of multivariate survival analysis indicated that tumor distance from anal verge less than six cm (HR=0.215,95 ％CI:0.047 to 0.980,P=0.047),distant metastasis (HR=8.788,95％CI:2.612 to 29.571,P＜0.01) and histological grade3 (HR=5.510,95％CI:1.692-17.944,P=0.005) were independent factors associated with poor prognosis.Conclusions For histological grade 1 and 2 rectal NET patients without distant metastasis,radical surgery is recommended when tumor diameter over two cm or muscularis invasion exists.For histological grade 3 rectal NET patients without distant metastasis,radical surgery is recommended.

Prognostic analysis of neuroendocrine component in colorectal adenocarcinoma / 中华消化杂志

Objective To investigate the differentiation of neuroendocrine component (NEC) in colorectal adenocarcinoma in relation to its significance by comparing the outcome between patients with or without NEC.Methods The paraffin sections from patients with pathologically confirmed colorectal adenocarcinoma were retrospectively collected and screened for those with NEC by morphological examination and immunohistochemistry with neuroendocrine markers.Control patients (n=54) without NEC were selected from colorectal cancer database and 2: 1 matched on the basis of clinical features with NEC positive patients (n=27).Relative analysis was performed between two groups.Results With a median follow-up of 72 months,the 5-year disease free survival was 58.0% (16/27) in NEC positive group and 79.1% (43/54) in control group (P=0.036).Similarly,the 5-year cancer-specific overall survival was significantly lower in NEC positive group than in control group (58.3% versus 81.1%,P=0.037).Cox regression showed that the 5-year cumulative risks of disease recurrence and cancer-caused death in NEC positive patients were 2.38 and 2.41 times higher than those in control patients,respectively.Conclusions NEC appears to bear a poor prognosis in patients with colorectal adenocarcinoma.

Applications of proteomics in biomarker research for colorectal cancer / 中国癌症杂志

Proteomics is an emerging branch of bioscience which studies proteome. The main techniques in proteomics include sample preparation in proteomic, two-dimensional gel electrophoresis, two-dimensional difference gel electrophoresis, multidimensional protein identification technology, surface enhanced laser desorption/ionization time-of-flight mass spectrometry. Colorectal cancer is one of the most common cancers worldwide. During the last several years, many advances have been achieved in terms of applications of proteomics in biomarker research for colorectal cancer.

Evaluation of operative risk and suvival of colorectal cancer patients 80 years of age and older / 中华消化杂志

Objective To estimate the operative risk and outcomes of colorectal cancer patients 80 years of age and older. Methods Colorectal cancer resection was performed in 99 patients 80 years of age and older between Dec. 1987 and June 2005. The informations about clinical data, co-morbidity,complications, operative mortality and survival were retrospectively analyzed. The patients were followed-up for 45.12 months (range 1-136) months. Results Of 99 patients, co-morbidity was found in 43 patients (43.4% ) and complication in 10 patients (10.1%). No patient died of operation.Eighty patients completed the follow-up study. The overall 3-year survival rate and disease-free survival rate were 64.3% and 61.1%, respectively. Whereas the overall 5-year survival rate and disease-free survival rate were 52.8% and 52.1%, respectively. In univariate analysis, curative or palliative operation, tumor differentiation, cancer embolism in the vasculature, tumor staging and complications were proved to be significant prognostic factors. Multivariate survival analysis,however, showed that only the curative or palliative operation was independent factor for survival.Conclusions The high risk of co-morbidity for patients 80 years of age and older is not the obstacle to cancer resection.These patients will have satisfactory outcomes via optimal treatment and operation.

Colonoscopy surveillance in colorectal cancer after surgery / 中华消化内镜杂志

Objective To evaluate the colonoscopy surveillance in colorectal cancer patients after surgical removal of the tumor.Methods From June 1986 to June 2007,2762 asymptomatic patients who had underwent operation for colorectal cancer were put into colonoscopy surveillance.They had the first examination 3-6 months after the operation,and were re-examined once a year thereafter for 3 years.The follow-up findings were compared with those from the 218 symptomatic patients who had colorectal cancer surgery from September 1981 to May 1986.Results In 2762 asymptomatic patients,48 cases of multiple primary cancer were detected,in which 39 cases(1.4%) were found at one examination and 9 cases(0.3%)at different examination.The TNM staging of these lesions included stage Ⅰ in 6,stage Ⅱ in 31 and stage Ⅲ in 11.During the surveillance,583 cases(21.1%) of adenoma were detected and endoscopically resected,in which 17(3.2%) were invasive early cancer and 58(9.9%) were high grade dysplasia.In 218 patients with symptoms,29 cases(13.3%) of adenoma and 27 cases( 12.4%) of cancer were detected,including 4 cases of stage Ⅰ cancer,6 of stage Ⅱ and 16 of stage Ⅲ.Conclusion Colonoscopy surveillance in colorectal cancer patients after surgery is important in finding precancerous lesion and early stage cancer,and is recommended in all patients.

Advances in surgery of rectal cancer / 中国癌症杂志

To introduce the advances in surgery of rectal cancer and to discuss some of its critical issues. Preserving the anus, diminishing the damage of urinary and sexual function and reducing recurrence are the three major difficulties in surgery of rectal cancer. The surgical margin, the concept of TME, the indication of local surgery, the necessity of pelvic lymphonodectomy and the reconstruction of the colonic sack are important problems in the surgery of rectal cancer.The surgery for preserving the anal function should not go against the fundamental principle of radical surgery. The distal and circumferential margin must be enough. The impairment of urinary and sexual function can be reduced by protecting the pelvic autonomic nerves. There are many factors contributing to the relapse of rectal cancer. TME can reduce markedly recurrence of rectal cancer. The trend of either over-expanding or over-shrinking the indication of local surgery of rectal cancer should be avoided. The extensive dissection of pelvic lymph nodes should be selective. The reconstruction of the colonic sack is valuable to some extent.[