Published online Mar 26, 2023. doi: 10.12998/wjcc.v11.i9.1963
Peer-review started: November 22, 2022
First decision: February 7, 2023
Revised: February 12, 2023
Accepted: March 3, 2023
Article in press: March 3, 2023
Published online: March 26, 2023
Colorectal cancer (CRC) is the third most common cancer worldwide, with the fourth highest mortality among all cancers. Reportedly, in addition to adenomas, serrated polyps, which account for 15%-30% of CRCs, can also develop into CRCs through the serrated pathway. Sessile serrated adenomas/polyps (SSAs/Ps) are a type of serrated polyps that are easily misdiagnosed under endoscopy.
Traditional Chinese medicine is based on syndrome differentiation and treatment. Whether the Wnt signaling pathway through β-catenin, adenomatous polyposis coli (APC), and mutated CRC (MCC) protein expression are different in SSAs/Ps patients with different syndrome types warrants research.
We aimed to observe the difference in the Wnt signaling pathway expression in SSA/P patients with different syndrome types.
Thirty cases each of large intestine damp-heat (Da-Chang-Shi-Re, DCSR) syndrome and spleen-stomach weakness (Pi-Wei-Xu-Ruo) syndrome were reported. Baseline comparison of general data, typical tongue coatings, colonoscopic findings, the hematoxylin and eosin findings, and the β-catenin, APC, and MCC protein expression in the colonic mucosa of each group were analyzed.
Significant differences were observed between the two groups of patients with different syndrome types (P = 0.001) with respect to the SSA/P size. The other aspects did not differ between the groups. The Wnt signaling pathway was activated in patients with SSAs/Ps belonging to both groups, which was manifested as β-catenin protein translocation into the nucleus. However, SSA/P patients with DCSR syndrome had more nucleation, higher β-catenin expression, and decreased negative regulatory factor (APC and MCC) expression (P < 0.0001) than SSA/P patients with Pi-Wei-Xu-Ruo syndrome. In addition, the SSA/P size was linearly correlated with the related protein expression.
Patients with DCSR syndrome had a more obvious Wnt signaling pathway activation and a higher risk of carcinogenesis.
A high-quality colonoscopic diagnosis was essential. The thorough assessment of clinical diseases can be improved by combining the diseases of Western medicine with the syndromes of traditional Chinese medicine.