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Briggs NL, Ton M, Malen RC, Reedy AM, Cohen SA, Phipps AI, Burnett-Hartman AN, Newcomb PA. Colorectal cancer pre-diagnostic symptoms are associated with anatomic cancer site. BMC Gastroenterol 2024; 24:65. [PMID: 38317073 PMCID: PMC10845784 DOI: 10.1186/s12876-024-03152-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 01/29/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Signs and red flag symptoms in colorectal cancer (CRC) patients who are below the recommended screening age are often overlooked, leading to delayed diagnosis and worse prognosis. This study investigates how patient pre-diagnostic symptoms are associated with anatomic site of their cancer and whether the association varies by age at CRC diagnosis. METHODS We ascertained CRC patients' experienced symptoms and screening through medical abstractions from an ongoing population-based study of CRC patients identified through a SEER cancer registry (N = 626). We used logistic regression to estimate odds ratios and 95% confidence intervals for the association between symptoms and CRC anatomic site. Additional analyses were stratified by age at diagnosis. Early-onset was defined as less than 50 years of age at CRC diagnosis. RESULTS Participants who experienced blood in stool were more likely (odds ratio (95% confidence interval)) to have rectal (vs. colon) cancer (4.37 (3.02, 6.33)), as were patients who experienced changes to stool (1.78 (1.21, 2.60)). Patients diagnosed with colon cancer were more likely to present with abdominal pain (0.30 (0.19, 0.47)), anemia (0.40 (0.21, 0.75)), other symptoms (0.33 (0.19, 0.55)) and no symptoms (0.68 (0.44, 1.04)). When stratifying by age at diagnosis, we found that the association between blood in stool and rectal tumor location was particularly pronounced for patients with early-onset CRC (6.48 (2.73, 15.41)). CONCLUSIONS Common pre-diagnostic red flag symptoms are associated with CRC anatomic site. These findings can inform best practices for gastroenterologist triage of care and early evaluation of CRC and are of key importance given the rise of early-onset (pre-screening age) CRC. TRIAL REGISTRATION Not applicable to this study and analysis.
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Affiliation(s)
- Nicole L Briggs
- Department of Epidemiology, University of Washington School of Public Health, UW Box #351619, 3980 15th Ave NE, Seattle, WA, 98195, USA.
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA.
| | - Mimi Ton
- Department of Epidemiology, University of Washington School of Public Health, UW Box #351619, 3980 15th Ave NE, Seattle, WA, 98195, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
| | - Rachel C Malen
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
| | - Adriana M Reedy
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
| | - Stacey A Cohen
- Division of Oncology, University of Washington, 825 Eastlake Ave E, Seattle, WA, 98109, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
| | - Amanda I Phipps
- Department of Epidemiology, University of Washington School of Public Health, UW Box #351619, 3980 15th Ave NE, Seattle, WA, 98195, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
| | - Andrea N Burnett-Hartman
- Department of Epidemiology, University of Washington School of Public Health, UW Box #351619, 3980 15th Ave NE, Seattle, WA, 98195, USA
- Institute for Health Research, Kaiser Permanente, 2550 S Parker Rd, Aurora, CO, 80014, USA
| | - Polly A Newcomb
- Department of Epidemiology, University of Washington School of Public Health, UW Box #351619, 3980 15th Ave NE, Seattle, WA, 98195, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
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Shilo Yaacobi D, Berger Y, Shaltiel T, Bekhor EY, Khalifa M, Issa N. Excision of malignant and pre-malignant rectal lesions by transanal endoscopic microsurgery in patients under 50 years of age. World J Gastrointest Surg 2023; 15:1892-1900. [PMID: 37901725 PMCID: PMC10600772 DOI: 10.4240/wjgs.v15.i9.1892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/24/2023] [Accepted: 07/29/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND The most common technique for treating benign and early malignant rectal lesions is transanal endoscopic microsurgery (TEM). Local excision is an acceptable technique for high-risk and elderly patients, but there are hardly any data regarding young patients. AIM To describe TEM outcomes in patients under 50 years of age. METHODS We collected demographic, clinical, and pathological data from all patients under the age of 50 years who underwent the TEM procedure at Hasharon Rabin Medical Center from January 2005 to December 2018. RESULTS During the study period, a total of 26 patients under the age of 50 years underwent TEM procedures. Their mean age was 43.3 years. Eleven (42.0%) were male. The mean operative time was 67 min, and the mean tumor size was 2.39 cm, with a mean anal verge distance of 8.50 cm. No major intraoperative or postoperative complications were recorded. The median length of stay was 2 d. Seven (26.9%) lesions were adenomas with low-grade dysplasia, four (15.4%) were high-grade dysplasia adenomas, two were T1 carcinomas (7.8%), and three were T2 carcinomas (11.5%). No residual disease was found following endoscopic polypectomy in two patients (7.8%), but four (15.4%) had other pathologies. Surgical margins were negative in all cases. Local recurrence was detected in one patient 33 mo following surgery. CONCLUSION Among young adult patients, TEM for benign rectal lesions has excellent outcomes. It may also offer a balance between the efficacy of complete oncologic resection and postoperative quality of life in the treatment of rectal cancer. In some cases, it may be considered an alternative to radical surgery.
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Affiliation(s)
- Dafna Shilo Yaacobi
- Department of Plastic Surgery & Burns, Rabin Medical Center, Petah Tikva 4941492, Israel
| | - Yael Berger
- Department of Surgery, Rabin Medical Center-Hasharon Hospital, Petah Tikva 4941492, Israel
| | - Tali Shaltiel
- Department of Surgery, Rabin Medical Center-Hasharon Hospital, Petah Tikva 4941492, Israel
| | - Eliahu Y Bekhor
- Department of Surgery, Rabin Medical Center-Hasharon Hospital, Petah Tikva 4941492, Israel
| | - Muhammad Khalifa
- Department of Surgery, Rabin Medical Center-Hasharon Hospital, Petah Tikva 4941492, Israel
| | - Nidal Issa
- Department of Surgery, Rabin Medical Center-Hasharon Hospital, Petah Tikva 4941492, Israel
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Taku N, Yi-Qian YN, Chang GJ, Ludmir EB, Raghav KPS, Rodriguez-Bigas MA, Holliday EB, Smith GL, Minsky BD, Overman MJ, Messick C, Boyce-Fappiano D, Koong AC, Skibber JM, Koay EJ, Dasari A, Taniguchi CM, Bednarski BK, Morris VK, Kopetz S, Das P. Benchmarking Outcomes for Definitive Treatment of Young-Onset, Locally Advanced Rectal Cancer. Clin Colorectal Cancer 2022; 21:e28-e37. [PMID: 34794903 PMCID: PMC8917971 DOI: 10.1016/j.clcc.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE There has been an increase in the incidence of rectal cancer diagnosed in young adults (age < 50 years). We evaluated outcomes among young adults treated with pre-operative long course chemoradiation (CRT) and total mesorectal excision (TME). METHODS The medical records of 219 patients, age 18-49, with non-metastatic, cT3-4, or cN1-2 rectal adenocarcinoma treated from 2000 to 2017 were reviewed for demographic and treatment characteristics, as well as pathologic and oncologic outcomes. The Kaplan-Meier test, log-rank test, and Cox regression analysis were used to evaluate survival outcomes. RESULTS The median age at diagnosis was 44 years. CRT followed by TME and post-operative chemotherapy was the most frequent treatment sequence (n = 196), with FOLFOX (n = 115) as the predominant adjuvant chemotherapy. There was no difference in sex, stage, MSS/pMMR, or pCR by age (< 45 years [n = 111] vs. ≥ 45 years [n = 108]). The 5-year rates of DFS were 77.2% for all patients, 69.8% for age < 45 years and 84.7% for age ≥ 45 years (P = .01). The 5-year rates of OS were 89.6% for all patients, 85.1% for patients with age < 45 years and 94.3% for patients with age ≥ 45 years (P = .03). Age ≥ 45 years was associated with a lower risk of disease recurrence or death on multivariable Cox regression analysis (HR = 0.55, 95% CI 0.31-0.97, P = .04). CONCLUSION Among young adults, patients with age < 45 years had lower rates of DFS and OS, compared to those with age ≥ 45 years. These outcomes could serve as a benchmark by which to evaluate newer treatment approaches.
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Affiliation(s)
- Nicolette Taku
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Y Nancy Yi-Qian
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - George J Chang
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ethan B Ludmir
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kanwal Pratap Singh Raghav
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Emma Brey Holliday
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Grace L Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bruce D Minsky
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael J Overman
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Craig Messick
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David Boyce-Fappiano
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Albert C Koong
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - John Michael Skibber
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eugene Jon Koay
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Arvind Dasari
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cullen M Taniguchi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brian K Bednarski
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Van K Morris
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Scott Kopetz
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Prajnan Das
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Jia Z, Wu H, Xu J, Sun G. Development and validation of a nomogram to predict overall survival in young non-metastatic rectal cancer patients after curative resection: a population-based analysis. Int J Colorectal Dis 2022; 37:2365-2374. [PMID: 36266551 PMCID: PMC9640402 DOI: 10.1007/s00384-022-04263-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE This study aimed to establish and validate a nomogram for predicting overall survival (OS) in young non-metastatic rectal cancer (RC) patients after curative resection. METHODS Young RC patients (under 50 years of age) from 2010 to 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Those patients randomly assigned to a training cohort and a validation cohort at a ratio of 7:3. The independent prognostic factors for OS were identified by univariate and multivariate Cox regression analysis. A nomogram model was built based on the independent prognostic variables and was evaluated by concordance index (C-index), receiver operating characteristics (ROC) curves, calibration plot, and decision curve analysis (DCA). RESULTS A total number of 3026 young RC patients were extracted from SEER database. OS nomogram was constructed based on race, histological type, tumor grade, T stage, N stage, carcinoembryonic antigen (CEA) level, and number of lymph nodes (LN) examined. C-index, ROC curves, calibration plot, and DCA curves presented satisfactory performance of the above nomogram in predicting the prognosis of young non-metastatic RC patients after curative resection. The nomogram can identify three subgroups of patients at different risks, which showed different prognostic outcomes both in the training cohort and validation cohort. CONCLUSION We successfully established a reliable and insightful nomogram to predict OS for young non-metastatic RC patients after curative resection. The nomogram may provide accurate prognosis prediction to guide individualized follow-up and treatment plans.
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Affiliation(s)
- Zhenya Jia
- Department of Medical Oncology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022 People’s Republic of China
| | - Huo Wu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022 People’s Republic of China
| | - Jing Xu
- Department of Medical Oncology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022 People’s Republic of China
| | - Guoping Sun
- Department of Medical Oncology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022 People’s Republic of China
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Zeiderman MR, Nuño M, Sahar DE, Farkas LM. Trends in flap reconstruction of pelvic oncologic defects: Analysis of the national inpatient sample. J Plast Reconstr Aesthet Surg 2021; 74:2085-2094. [PMID: 33455867 DOI: 10.1016/j.bjps.2020.12.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/07/2020] [Accepted: 12/19/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Flap reconstruction of radiated pelvic oncologic defects decreases perineal wound-healing complications. How widely and how often reconstructions are performed, and how technical mastery and improved perioperative care has affected outcomes, is unknown. Our objective is to 1) provide a comprehensive evaluation of national trends in flap reconstruction of pelvic oncologic defects and 2) compare complications and length of stay (LOS) in patients with/without reconstruction. METHODS The National Inpatient Sample (NIS) database was queried (1998-2014) for patients diagnosed with cancer, primarily of the rectum and anus, who underwent abdominoperineal resection (APR) or pelvic exenteration (PE). Differences in complications and LOS were compared between patients with flap reconstruction versus primary closure. Regional and hospital outcomes were also analyzed. RESULTS The cohort included 117,923 adult patients; 3,673 (3.1%) underwent flap reconstruction. Flap reconstruction rates increased from 0.8% in 1998 to 9.8% in 2014. Extirpative procedures decreased 37.4% from 1998 to 2014. Flap reconstruction decreased risk of wound breakdown (OR 0.87; p = 0.0029) and need for secondary closure of dehiscence (OR 0.82; p = 0.0023) between periods 1998-2009 and 2010-2014. Median LOS was higher for flap patients (median [IQR] of 9.8 [7.2,14.8] vs. 7.9 [6.1-11.0; p < 0.0001) and decreased over time. CONCLUSIONS The use of flap reconstruction for pelvic oncologic defects increased from 1998 to 2014, with a reduction in LOS. Following flap reconstruction, overall complications are higher, but wound breakdown and dehiscence requiring reclosure are decreasing, suggesting technique maturation. We anticipate flap reconstruction rates will increase with further improvement in patient outcomes.
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Affiliation(s)
- Matthew R Zeiderman
- Department of Surgery, Division of Plastic & Reconstructive Surgery, University of California, Davis USA; Department of Surgery, Division of Colon & Rectal Surgery, University of California, Davis USA.
| | - Miriam Nuño
- Department of Surgery, Division of Plastic & Reconstructive Surgery, University of California, Davis USA; Department of Surgery, Division of Colon & Rectal Surgery, University of California, Davis USA; Department of Public Health Sciences, Division of Biostatistics, University of California, Davis USA
| | - David E Sahar
- Department of Surgery, Division of Plastic & Reconstructive Surgery, University of California, Davis USA
| | - Linda M Farkas
- Department of Surgery, Division of Colon & Rectal Surgery, University of California, Davis USA; Department of Surgery, Division of Colon and Rectal Surgery, University of Texas Southwestern Medical Center USA.
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Liu LL, Sun JD, Xiang ZL. A nomogram to predict the prognosis of patients with unresected rectal adenocarcinoma undergoing chemoradiotherapy: a population-based study. J Cancer 2021; 12:4745-4761. [PMID: 34234846 PMCID: PMC8247370 DOI: 10.7150/jca.61642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/29/2021] [Indexed: 02/02/2023] Open
Abstract
Background: Chemotherapy combined with radiotherapy is the main treatment strategy for unresectable rectal cancer. However, the prognostic factors of patients with unresectable rectal cancer treated with radiotherapy and chemotherapy have not been systematically studied. Therefore, this study investigated the prognostic factors and prognosis based on surveillance, epidemiology and final results of the SEER medical insurance database. Methods: Primary rectum patients were selected from the SEER database. The independent prognostic factors associated with overall survival (OS), cancer-specific survival (CSS) and noncancer-related death were evaluated using the Kaplan-Meier method and log-rank test, a competing risk model, and the Cox proportional hazards regression model. Two nomograms were established for predicting the 1- and 3-year OS and CSS of patients. Results: A total of 3,998 rectal adenocarcinoma cancer patients who received chemoradiotherapy but had not undergone surgery were included in this study and divided into training (n = 3559) and validation cohorts (n = 439). Patients in the training cohort had a 1-year OS rate of 65.7±0.8%, a 3-year OS rate of 26.6±0.8%, a 5-year OS rate of 1.6±0.8%, and a median survival rate of 20.0 months (range, 19.22-20.8 months). The following factors were significant prognostic factors of OS: age (p< 0.001); tumour grade (p< 0.001); T stage (p< 0.001); M stage (p< 0.001); bone metastasis (p<0.001); brain metastases (p<0.001); liver metastases (p<0.001); lung metastases (p<0.001); marital status (p<0.001) and insurance status (p=0.005). Age (p< 0.001), tumour grade (p< 0.001), T stage (p< 0.001), M stage (p< 0.001), bone metastasis (p<0.001), brain metastases (p<0.001), liver metastases (p<0.001), lung metastases (p<0.001) and race (p=0.034) were independent prognostic factors of CSS. Age (p< 0.001), T stage (p< 0.001), N stage (p=0.007), M stage (p<0.001), liver metastases (p<0.001), lung metastases (p<0.001), marital status (p<0.001) and insurance status (p=0.019) were independently associated with noncancer-related death. Conclusion: Age, tumour grade, T and M stage, bone, brain, liver and lung metastases, marital status and insurance status are independent risk factors for the OS of rectal adenocarcinoma patients who have undergone chemoradiotherapy but have not undergone surgery. Age, tumour grade, T stage, M stage, bone, brain, liver, lung metastases and race were independent prognostic factors of CSS. Age, T, N and M stage, liver and lung metastases, marital status and insurance status, were independently associated with noncancer-related death. Interestingly, the earlier the T stage was, the higher the rate of noncancer-related death. Two nomograms were developed to predict OS and CSS, and the C-indexes were 0.6776 and 0.6744, respectively. Rectal cancer screening is strongly recommended for patients under the age of 50.
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Affiliation(s)
- Lin-Lin Liu
- Department of Radiation Oncology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, China
| | - Jun-Die Sun
- Department of Radiation Oncology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, China
| | - Zuo-Lin Xiang
- Department of Radiation Oncology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, China
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Simpson G, Hopley P, Wilson J, Day N, Haworth A, Montazeri A, Smith D, Titu L, Anderson J, Agbamu D, Walsh C. Long-term outcomes of real world 'watch and wait' data for rectal cancer after neoadjuvant chemoradiotherapy. Colorectal Dis 2020; 22:1568-1576. [PMID: 32686268 DOI: 10.1111/codi.15177] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/13/2020] [Indexed: 12/27/2022]
Abstract
AIM A 'watch and wait' (W&W) strategy after neoadjuvant long-course chemoradiotherapy (NACRT) remains controversial. Whilst encouraging short-term data exist, the strategy will be judged on long-term data. We present long-term, real-world UK data from a single National Health Service trust. METHODS An analysis was performed of a prospectively maintained W&W database over 9 years between 2010 and 2018. Outcome measures include incidence and time to regrowth and overall and disease-free survival. RESULTS We diagnosed 563 rectal cancers in 9 years. In all, 283 patients underwent rectal resection (50.3%). NACRT was used in 155 patients for margin-threatened tumours on staging MRI. Forty-nine patients (31.6%) experienced either a 'near complete' or a complete clinical response (cCR) at their 10 weeks post-NACRT assessment (MRI and endoscopy). The median age was 69 years (range 44-83), and the male to female ratio was 32:17. The median follow-up was 38 months (range 12-96). The median tumour distance from the anal verge was 7 cm (1-15 cm). Twenty-two patients had a cCR on initial assessment and 27 patients had a 'near' cCR. Of those 27 who experienced a 'near' cCR, 17 (63%) progressed to cCR on repeat assessment and 10 (37%) did not. Of these 10 patients, seven underwent standard surgical resection and three were unfit for surgery. R0 for the seven with delayed resection was 100%. Of 39 patients (22 cCR and 17 'near' cCR who progressed to cCR) (25.2% of those receiving NACRT), six patients experienced local regrowth (15.4%). The median time to local regrowth was 29 months (15-60 months). One of these six patients underwent salvage abdominoperineal resection, one was advised to have contact radiotherapy and four opted against surgery and also had contact radiotherapy. The overall survival was 100% at 2 years and 90% at 5 years. Disease-free survival was 90.47% at 2 years and 74.8% at 5 years. CONCLUSION A W&W treatment strategy was employed safely in this patient cohort with acceptable rates of local regrowth and survival.
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Affiliation(s)
- G Simpson
- Wirral University Teaching Hospital, Wirral, UK
| | - P Hopley
- Wirral University Teaching Hospital, Wirral, UK
| | - J Wilson
- Wirral University Teaching Hospital, Wirral, UK
| | - N Day
- Wirral University Teaching Hospital, Wirral, UK
| | - A Haworth
- Wirral University Teaching Hospital, Wirral, UK
| | | | - D Smith
- Wirral University Teaching Hospital, Wirral, UK
| | - L Titu
- Wirral University Teaching Hospital, Wirral, UK
| | - J Anderson
- Wirral University Teaching Hospital, Wirral, UK
| | - D Agbamu
- Wirral University Teaching Hospital, Wirral, UK
| | - C Walsh
- Wirral University Teaching Hospital, Wirral, UK
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Abstract
Despite the steady decline in the incidence of colorectal cancer (CRC) and cancer-related mortality in Americans of 50 years and older over the last few decades, there has been a disturbing trend of steadily rising incidence in early-onset colorectal cancer (EOCRC), defined as CRC in those younger than 50 years. With the incidence of EOCRC increasing from 4.8 per 100,000 in 1988 to 8.0 per 100,000 in 2015, and with the decreased rates in those older than 50 years largely attributed to improved screening in the older population, new screening recommendations have recently lowered the age for screening average-risk individuals from 50 to 45. EOCRC has been found to present differently from late-onset CRC, with a higher proportion of patients presenting with left-sided and rectal cancer, more aggressive histological features, and more advanced stage at the time of diagnosis. This article reviews the most recent evidence from population-based studies and institutional series, as well as the newest screening guidelines, and provides an up-to-date summary of our current understanding of EOCRC, from clinical presentation to tumor biology and prognosis, and future directions in treatment and prevention.
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Affiliation(s)
- Blake Read
- Department of Surgery, Mills-Peninsula Medical Center, Palo Alto Medical Foundation, Burlingame, California
| | - Patricia Sylla
- Division of Colon and Rectal Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Yan WX, Qi XZ, Sun YS, Lin JX, Zhou HZ, Chen L. LncRNA DCST1-AS1 regulates proliferation and apoptosis of rectal cancer cells by targeting miR-874-3p. Shijie Huaren Xiaohua Zazhi 2020; 28:401-409. [DOI: 10.11569/wcjd.v28.i11.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Some long non-coding RNAs (lncRNAs) have been demonstrated to be abnormally expressed in rectal cancer (RC) and may be involved in tumorigenesis and development. The expression of lncRNA DCST1-AS1 is upregulated in tumors, but its mechanism of action in the development and progression of RC has not been elucidated. It was hypothesized that the expression level of DCST1-AS1 is increased in RC cells and it may promote tumorigenesis and development.
AIM To investigate the effects of DCST1-AS1 on the proliferation and apoptosis of RC cells and the potential mechanism.
METHODS The levels of DCST1-AS1 and miR-874-3p in 30 RC tissues and adjacent tissues were measured by quantitative real-time polymerase chain reaction. RC SW1463 cells were divided into different groups and transfected with si-NC, si-DCST1-AS1, miR-NC, miR-874-3p, pcDNA, pcDNA-DCST1-AS1, si-DCST1-AS1 + anti-miR-NC, and si-DCST1-AS1 + anti-miR-874-3p, respectively. The proliferation and apoptosis of SW1463 cells in each group were measured by MTT assay and flow cytometry, respectively. Western blot analysis was carried out to measure the expression levels of CyclinD1, p21, B-cell lymphoma-2 (Bcl-2), and Bcl-2-associated X protein (Bax) proteins in SW1463 cells. The targeting relationship between DCST1-AS1 and miR-874-3p was validated using a dual-luciferase reporter assay system.
RESULTS Compared with tumor adjacent tissues, the level of lncRNA DCST1-AS1 in RC tissues was remarkably increased (P < 0.05), while the level of miR-874-3p was significantly decreased (P < 0.05). Compared with the si-NC and miR-NC groups, cell proliferation and CyclinD1 and Bcl-2 protein levels were reduced in the si-DCST1-AS1 group and miR-874-3p group, while the apoptosis rate and levels of p21 and Bax were increased. LncRNA DCST1-AS1 targeted and negatively regulated the expression of miR-874-3p. Compared with the si-DCST1-AS1 + anti-miR-NC group, cell proliferation and CyclinD1 and Bcl-2 protein levels in the si-DCST1-AS1 + anti-miR-874-3p group were increased, while cell apoptosis rate and p21 and Bax protein levels were decreased.
CONCLUSION LncRNA DCST1-AS1 regulates the proliferation and apoptosis of SW1463 cells by targeting miR-874-3p. DCST1-AS1 may be a potential molecular target for RC.
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Affiliation(s)
- Wang-Xin Yan
- Department of Colorectal and Anal Surgery, Wenzhou People's Hospital, Wenzhou 325000, Zhejiang Province, China
| | - Xiao-Zhe Qi
- Department of Colorectal and Anal Surgery, Wenzhou People's Hospital, Wenzhou 325000, Zhejiang Province, China
| | - Yue-Sheng Sun
- Department of General Surgery, Wenzhou People's Hospital, Wenzhou 325000, Zhejiang Province, China
| | - Ji-Xu Lin
- Department of Colorectal and Anal Surgery, Wenzhou People's Hospital, Wenzhou 325000, Zhejiang Province, China
| | - Hui-Zhen Zhou
- Department of Colorectal and Anal Surgery, Wenzhou People's Hospital, Wenzhou 325000, Zhejiang Province, China
| | - Liang Chen
- Department of Colorectal and Anal Surgery, Wenzhou People's Hospital, Wenzhou 325000, Zhejiang Province, China
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Ning S, Zeller MP. Management of iron deficiency. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:315-322. [PMID: 31808874 PMCID: PMC6913441 DOI: 10.1182/hematology.2019000034] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Iron deficiency (ID) affects billions of people worldwide and remains the leading cause of anemia with significant negative impacts on health. Our approach to ID and iron deficiency anemia (IDA) involves three steps (I3): (1) identification of ID/IDA, (2) investigation of and management of the underlying etiology of ID, and (3) iron repletion. Iron repletion options include oral and intravenous (IV) iron formulations. Oral iron remains a therapeutic option for the treatment of ID in stable patients, but there are many populations for whom IV iron is more effective. Therefore, IV iron should be considered when there are no contraindications, when poor response to oral iron is anticipated, when rapid hematologic responses are desired, and/or when there is availability of and accessibility to the product. Judicious use of red cell blood transfusion is recommended and should be considered only for severe, symptomatic IDA with hemodynamic instability. Identification and management of ID and IDA is a central pillar in patient blood management.
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Affiliation(s)
- Shuoyan Ning
- Division of Hematology and Thromboembolism and
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada; and
| | - Michelle P Zeller
- Division of Hematology and Thromboembolism and
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada; and
- Canadian Blood Services, Ancaster, ON, Canada
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Huang YJ, Kang YN, Huang YM, Wu ATH, Wang W, Wei PL. Effects of laparoscopic vs robotic-assisted mesorectal excision for rectal cancer: An update systematic review and meta-analysis of randomized controlled trials. Asian J Surg 2019; 42:657-666. [DOI: 10.1016/j.asjsur.2018.11.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/06/2018] [Accepted: 11/08/2018] [Indexed: 02/08/2023] Open
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Rising Proportion of Young Individuals With Rectal and Colon Cancer. Clin Colorectal Cancer 2019; 18:e87-e95. [DOI: 10.1016/j.clcc.2018.10.002] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 09/24/2018] [Accepted: 10/09/2018] [Indexed: 12/18/2022]
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Karsenti D, Tharsis G, Burtin P, Venezia F, Tordjman G, Gillet A, Samama J, Nahon-Uzan K, Cattan P, Cavicchi M. Adenoma and advanced neoplasia detection rates increase from 45 years of age. World J Gastroenterol 2019; 25:447-456. [PMID: 30700941 PMCID: PMC6350166 DOI: 10.3748/wjg.v25.i4.447] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/23/2018] [Accepted: 12/28/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colonoscopy is considered a valid primary screening tool for colorectal cancer (CRC). The decreasing risk of CRC observed in patients undergoing colonoscopy is correlated with the adenoma detection rate (ADR). Due to the fact that screening programs usually start from the age of 50, very few data are available on the risk of adenoma between 40 and 49 years. However, the incidence of CRC is increasing in young populations and it is not uncommon in routine practice to detect adenomas or even advanced neoplasia during colonoscopy in patients under 50 years.
AIM To compare the ADR and advanced neoplasia detection rate (ANDR) according to age in a large series of patients during routine colonoscopy.
METHODS All consecutive patients who were scheduled for colonoscopy were included. Exclusion criteria were as follows: patients scheduled for partial colonoscopy or interventional colonoscopy (for stent insertion or stenosis dilation). Colonoscopies were performed in our unit by a team of 30 gastroenterologists in 2016. We determined the ADR and ANDR in each age group in the whole population and in the population with an average risk of CRC (excluding patients with personal or family history of advanced adenoma or cancer).
RESULTS 6027 colonoscopies were performed in patients with a median age of 57 years (range, 15-96). The ADR and ANDR were 28.6% and 9.7%, respectively, in the whole population. When comparing patients aged 40-44 (n = 382) and 45-49 years (n = 515), a strong increase in all parameters from 45 years was observed, with the ADR rising from 9.7% in patients aged 40-44 to 21.2% between 45 and 49 (P < 0.001) and the ANDR increasing from 3.1% in patients aged 40-44 to 6.4% in those aged 45-49 years (P < 0.03). With regard to patients aged 50-54 (n = 849), a statistically significant increase in the ADR and ANDR was not observed between patients aged 45-49 and those aged 50-54 years. In the population with an average risk of CRC, the ADR and ANDR were still significantly higher in patients aged 45-49 compared with those aged 40-44 years.
CONCLUSION This study shows a significant two-fold increase in the ADR and ANDR in patients aged 45 years and over.
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Affiliation(s)
- David Karsenti
- Digestive Endoscopy Unit, Clinique Paris-Bercy, Charenton-le-Pont 94220, France
| | - Gaelle Tharsis
- Digestive Endoscopy Unit, Clinique Paris-Bercy, Charenton-le-Pont 94220, France
| | - Pascal Burtin
- Digestive Endoscopy Unit, Institut Gustave Roussy, Villejuif 94800, France
| | - Franck Venezia
- Digestive Endoscopy Unit, Clinique Paris-Bercy, Charenton-le-Pont 94220, France
| | - Gilles Tordjman
- Digestive Endoscopy Unit, Clinique Paris-Bercy, Charenton-le-Pont 94220, France
| | - Agnès Gillet
- Digestive Endoscopy Unit, Clinique Paris-Bercy, Charenton-le-Pont 94220, France
| | - Joelle Samama
- Digestive Endoscopy Unit, Clinique Paris-Bercy, Charenton-le-Pont 94220, France
| | - Karine Nahon-Uzan
- Digestive Endoscopy Unit, Clinique Paris-Bercy, Charenton-le-Pont 94220, France
| | - Philippe Cattan
- Digestive Endoscopy Unit, Clinique Paris-Bercy, Charenton-le-Pont 94220, France
| | - Maryan Cavicchi
- Digestive Endoscopy Unit, Clinique Paris-Bercy, Charenton-le-Pont 94220, France
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