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Chambers AC, Dixon SW, White P, Williams AC, Thomas MG, Messenger DE. Demographic trends in the incidence of young-onset colorectal cancer: a population-based study. Br J Surg 2020; 107:595-605. [PMID: 32149386 PMCID: PMC7155067 DOI: 10.1002/bjs.11486] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/18/2019] [Accepted: 11/27/2019] [Indexed: 12/13/2022]
Abstract
Background Evidence is emerging that the incidence of colorectal cancer is increasing in young adults, but the descriptive epidemiology required to better understand these trends is currently lacking. Methods A population‐based cohort study was carried out including all adults aged 20–49 years diagnosed with colorectal cancer in England between 1974 and 2015. Data were extracted from the National Cancer Registration and Analysis Service database using ICD‐9/10 codes for colorectal cancer. Temporal trends in age‐specific incidence rates according to sex, anatomical subsite, index of multiple deprivation quintile and geographical region were analysed using Joinpoint regression. Results A total of 56 134 new diagnoses of colorectal cancer were analysed. The most sustained increase in incidence rate was in the group aged 20–29 years, which was mainly driven by a rise in distal tumours. The magnitude of incident rate increases was similar in both sexes and across Index of Multiple Deprivation quintiles, although the most pronounced increases in incidence occurred in the southern regions of England. Conclusion Colorectal cancer should no longer be considered a disease of older people. Changes in incidence rates should be used to inform future screening policy, preventative strategies and research agendas, as well as increasing public understanding that younger people need to be aware of the symptoms of colorectal cancer.
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Affiliation(s)
- A C Chambers
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK.,Department of Colorectal Surgery, University Hospitals Bristol, Bristol Royal Infirmary, Bristol, UK
| | - S W Dixon
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - P White
- Department of Engineering Design and Mathematics, University of West of England, Bristol, UK
| | - A C Williams
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - M G Thomas
- Department of Colorectal Surgery, University Hospitals Bristol, Bristol Royal Infirmary, Bristol, UK
| | - D E Messenger
- Department of Colorectal Surgery, University Hospitals Bristol, Bristol Royal Infirmary, Bristol, UK
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Yu W, Wang Y, Liu L, Li S, Zhu K. LOC101060264 Silencing Suppresses Invasion and Metastasis of Human Colon Cancer. Med Sci Monit 2020; 26:e920270. [PMID: 32077446 PMCID: PMC7045723 DOI: 10.12659/msm.920270] [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] [Indexed: 01/16/2023] Open
Abstract
Background We explored the regulatory effects of long noncoding RNA (lncRNA) LOC101060264 silencing mediated by shRNA on invasion and metastasis of human colon cancer. Material/Methods Initially, 2 shRNA plasmids for LOC101060264 silencing – shRNA1 and shRNA2 – were introduced into LoVo cells. Following transfection, the expressions of LOC101060264, E-cadherin, and vimentin were determined. Next, to explore the regulatory effects of LOC101060264 silencing on cell growth, cell cycle, invasion, and migration abilities of LoVo cells, we performed MTT, flow cytometry, Transwell assay, and scratch assay, respectively. Furthermore, in nude mice with xenografted tumors, the tumor volume and weight were measured, and the expressions of PCNA, E-cadherin, vimentin, and MMP-9 in tumor tissues were determined by immunohistochemistry. Results The level of E-cadherin increased and the level of vimentin decreased after LOC101060264 silencing mediated by shRNA1 and shRNA2 in LoVo cells. Silencing LOC101060264 repressed the migration, invasion, and proliferation of LoVo cells in vitro and inhibited tumor growth in nude mice in vivo. We also studied the expression of these proteins and found reduced expression of PCNA, vimentin, and MMP-9 protein, and found enhanced expression of E-cadherin protein. Moreover, the inhibitory effect of shRNA2 on the above cell behaviors was stronger than that of shRNA1. Conclusions In summary, LOC101060264 silencing decreased LoVo cell invasiveness via suppressing ETM and attenuated tumor metastasis, which provides a novel therapeutic target for patients with colon cancer.
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Affiliation(s)
- Weihua Yu
- Department of Gastroenterology, The Second Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Yunxia Wang
- Department of Gastroenterology, The Second Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Lan Liu
- Department of Gastroenterology, The Second Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Shuai Li
- Department of Gastroenterology, The Second Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Kongxi Zhu
- Department of Gastroenterology, The Second Hospital of Shandong University, Jinan, Shandong, China (mainland)
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Moskalev AS, Barysheva EM, Soldatov VO, Frolova OG, Bobyntseva OV, Samgina TA, Churnosov MI, Ivanov VP, Polonikov AV, Bushueva OY. Association of C3435T (rs1045642) Polymorphism of the MDR1 Gene with the Increased Risk of Colorectal Cancer in Russian Females from Central Russia. RUSS J GENET+ 2020. [DOI: 10.1134/s1022795419120093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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54
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Löwenberg M, Van Der Vlugt M. Risk of Progression of Low-Grade Dysplasia to Advanced Neoplasia in Inflammatory Bowel Disease. J Crohns Colitis 2019; 13:1483-1484. [PMID: 31314882 DOI: 10.1093/ecco-jcc/jjz118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Mark Löwenberg
- Amsterdam UMC, University of Amsterdam, Department of Gastroenterology and Hepatology, Meibergdreef, Amsterdam, The Netherlands
| | - Manon Van Der Vlugt
- Amsterdam UMC, University of Amsterdam, Department of Gastroenterology and Hepatology, Meibergdreef, Amsterdam, The Netherlands
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55
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De Jong ME, Van Tilburg SB, Nissen LHC, Kievit W, Nagtegaal ID, Horjus CS, Römkens TEH, Drenth JPH, Hoentjen F, Derikx LAAP. Long-term Risk of Advanced Neoplasia After Colonic Low-grade Dysplasia in Patients With Inflammatory Bowel Disease: A Nationwide Cohort Study. J Crohns Colitis 2019; 13:1485-1491. [PMID: 31175827 PMCID: PMC6903794 DOI: 10.1093/ecco-jcc/jjz114] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS The long-term risk of high-grade dysplasia [HGD] and colorectal cancer [CRC] following low-grade dysplasia [LGD] in inflammatory bowel disease [IBD] patients is relatively unknown. We aimed to determine the long-term cumulative incidence of advanced neoplasia [HGD and/or CRC], and to identify risk factors for advanced neoplasia in a nationwide IBD cohort with a history of LGD. METHODS This is a nationwide cohort study using data from the Dutch National Pathology Registry [PALGA] to identify all IBD patients with LGD between 1991 and 2010 in the Netherlands. Follow-up data were collected until January 2016. We determined the cumulative incidence of advanced neoplasia and identified risk factors via multivariable Cox regression analysis. RESULTS We identified 4284 patients with colonic LGD with a median follow-up of 6.4 years after initial LGD diagnosis. The cumulative incidence of subsequent advanced neoplasia was 3.6, 8.5, 14.4 and 21.7%, after 1, 5, 10 and 15 years, respectively. The median time to develop advanced neoplasia after LGD was 3.6 years. Older age [≥ 55 years] at moment of LGD (hazard ratio [HR] 1.73, 95% confidence interval [CI] 1.44-2.06), male sex [HR 1.33, 95% CI 1.10-1.60], and follow-up at an academic [vs non-academic] medical centre [HR 1.37, 95% CI 1.07-1.76] were independent risk factors for advanced neoplasia following LGD. CONCLUSIONS In a large nationwide cohort with long-term follow-up of IBD patients with LGD, the cumulative incidence of advanced neoplasia was 21.7% after 15 years. Older age at LGD [≥55 years], male sex and follow-up by a tertiary IBD referral centre were independent risk factors for advanced neoplasia development after initial LGD.
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Affiliation(s)
- Michiel E De Jong
- Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands,Corresponding author: Michiel E. de Jong, MD, Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology, Radboud University Medical Centre, PO Box 9101, code 455, 6500 HB Nijmegen, The Netherlands. Tel: 31 621980519; Fax: 31 243540103;
| | - Sanne B Van Tilburg
- Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Loes H C Nissen
- Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands
| | - Wietske Kievit
- Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Carmen S Horjus
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Tessa E H Römkens
- Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands
| | - Joost P H Drenth
- Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Frank Hoentjen
- Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Lauranne A A P Derikx
- Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands,Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands
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Stracci F, Gili A, Naldini G, Gianfredi V, Malaspina M, Passamonti B, Bianconi F. Geospatial analysis of the influence of family doctor on colorectal cancer screening adherence. PLoS One 2019; 14:e0222396. [PMID: 31584952 PMCID: PMC6777754 DOI: 10.1371/journal.pone.0222396] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 08/29/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Despite the well-recognised relevance of screening in colorectal cancer (CRC) control, adherence to screening is often suboptimal. Improving adherence represents an important public health strategy. We investigated the influence of family doctors (FDs) as determinant of CRC screening adherence by comparing each FDs practice participation probability to that of the residents in the same geographic areas using the whole population geocoded. METHODS We used multilevel logistic regression model to investigate factors associated with CRC screening adherence, among 333,843 people at their first screening invitation. Standardized Adherence Rates (SAR) by age, gender, and socioeconomic status were calculated comparing FDs practices to the residents in the same geographic areas using geocoded target population. RESULTS Screening adherence increased from 41.0% (95% CI, 40.8-41.2) in 2006-2008 to 44.7% (95% CI, 44.5-44.9) in 2011-2012. Males, the most deprived and foreign-born people showed low adherence. FD practices and the percentage of foreign-born people in a practice were significant clustering factors. SAR for 145 (21.4%) FDs practices differed significantly from people living in the same areas. Predicted probabilities of adherence were 31.7% and 49.0% for FDs with low and high adherence, respectively. DISCUSSION FDs showed a direct and independent effect to the CRC screening adherence of the people living in their practice. FDs with significantly high adherence level could be the key to adherence improvement. IMPACT Most deprived individuals and foreigners represent relevant targets for interventions in public health aimed to improve CRC screening adherence.
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Affiliation(s)
- Fabrizio Stracci
- Department of Experimental Medicine, Public Health Section, University of Perugia, Perugia, Italy
- Umbria Cancer Registry, Perugia, Italy
- * E-mail:
| | | | - Giulia Naldini
- School of Specialization in Hygiene and Preventive Medicine, University of Perugia, Perugia, Italy
| | - Vincenza Gianfredi
- School of Specialization in Hygiene and Preventive Medicine, University of Perugia, Perugia, Italy
| | - Morena Malaspina
- Azienda USL Umbria 1,Laboratorio Unico di Screening, Perugia, Italy
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Kelty E, Ward SV, Cadby G, McCarthy NS, O'Leary P, Moses EK, Ee HC, Preen DB. Familial and non-familial risk factors associated with incidence of colorectal cancer in young and middle-aged persons in Western Australia. Cancer Epidemiol 2019; 62:101591. [PMID: 31494463 DOI: 10.1016/j.canep.2019.101591] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/17/2019] [Accepted: 08/21/2019] [Indexed: 12/11/2022]
Abstract
AIMS The aim of this study was to examine factors including family history, medical history and comorbidities associated with the risk of colorectal cancer (CRC) in young (18-49 years) and middle-age (50-69 years) individuals. METHODS State records were used to identify individuals born in Western Australia between 1945 and 1996, and their first-degree relatives. Individuals in the cohort and their relatives were linked to State cancer registry, hospital and mortality data to identify diagnoses of CRC and other risk factors. The associations between CRC and identified risk factors were examined using multivariable logistic regression. RESULTS For both young and middle-aged patients, family history of CRC, and a history of smoking, inflammatory bowel disease, liver disease and non-CRC cancer were associated with a significant increase in odds of CRC. In middle-aged patients, having a colonoscopy in the previous 10 years was associated with a reduced odds of CRC regardless of the detection of polyps. However, in young patients only the absence of polyps as confirmed by colonoscopy was associated with a decreased risk of CRC (OR: 0.38, 95%CI: 0.26 - 0.54, p < 0.001). CONCLUSIONS Many of the risk factors associated with CRC were similar in young and middle-aged persons, and should be used to identify high risk young patients for screening. The association between colonoscopy and polyps with CRC was modified by age, likely as the result of routine screening in middle-aged patients.
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Affiliation(s)
- Erin Kelty
- School of Population and Global Health, The University of Western, Australia.
| | - Sarah V Ward
- Centre for Genetic Originals of Health and Disease, School of Biomedical Sciences, The University of Western, Australia; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gemma Cadby
- Centre for Genetic Originals of Health and Disease, School of Biomedical Sciences, The University of Western, Australia
| | - Nina S McCarthy
- Centre for Genetic Originals of Health and Disease, School of Biomedical Sciences, The University of Western, Australia
| | - Peter O'Leary
- School of Pharmacy and Biomedical Sciences, Curtin University, Australia
| | - Eric K Moses
- Centre for Genetic Originals of Health and Disease, School of Biomedical Sciences, The University of Western, Australia; School of Pharmacy and Biomedical Sciences, Curtin University, Australia
| | - Hooi C Ee
- Department of Gastroenterology, Sir Charles Gairdner Hospital, Australia
| | - David B Preen
- School of Population and Global Health, The University of Western, Australia
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van de Veerdonk W, Hoeck S, Peeters M, Van Hal G. Towards risk-stratified colorectal cancer screening. Adding risk factors to the fecal immunochemical test: Evidence, evolution and expectations. Prev Med 2019; 126:105746. [PMID: 31173802 DOI: 10.1016/j.ypmed.2019.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/28/2019] [Accepted: 06/03/2019] [Indexed: 12/24/2022]
Abstract
With increasing incidence and mortality, colorectal cancer (CRC) is a growing health problem worldwide. An effective way to address CRC is by screening for fecal (occult) blood by the fecal immunochemical test (FIT). However, there is room for improvement since precursor lesions and CRC bleed intermittent and can therefore be missed by the FIT (false negatives) or, the detected blood did not result from precursor lesions or CRC (false positives). This review provides the latest evidence on risk prediction models using FIT combined with additional risk factors before colonoscopy, which risk factors to include and if these models will better discriminate between normal findings and CRC compared to the FIT-only. Many prediction models are known for CRC, but compared to the FIT, these are less effective in detecting CRC. The literature search resulted in 645 titles where 11 papers matched the inclusion criteria and were analyzed. Comparing the FIT-only with the risk prediction models for detecting CRC resulted in a significantly increased discrimination for the models. In addition, 2 different risk-stratification categories before colonoscopy were distinguished, namely the 1-model approach which combined risk factors with FIT results in a prediction model while the 2 step approach used risk factors apart from the FIT. Finally, combining FIT with CRC risk factors by means of a model before colonoscopy seems effective regarding discriminative power, however, more research is needed for validation combined with transparent and standardized reporting to improve quality assessment, for which suggestions are reported in this study.
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Affiliation(s)
- Wessel van de Veerdonk
- Faculty of Medicine and Health Sciences, Department of Social Epidemiology and Health Policy (SEHPO), University of Antwerp, Belgium.
| | - Sarah Hoeck
- Faculty of Medicine and Health Sciences, Department of Social Epidemiology and Health Policy (SEHPO), University of Antwerp, Belgium; Centre for Cancer Detection, Bruges, Antwerp, Belgium
| | - Marc Peeters
- Department of Oncology, Antwerp University Hospital, Antwerp, Belgium; Molecular Imaging, Pathology, Radiotherapy & Oncology (MIPRO), University of Antwerp, Belgium
| | - Guido Van Hal
- Faculty of Medicine and Health Sciences, Department of Social Epidemiology and Health Policy (SEHPO), University of Antwerp, Belgium; Centre for Cancer Detection, Bruges, Antwerp, Belgium
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Escolà-Vergé L, Peghin M, Givone F, Pérez-Rodríguez MT, Suárez-Varela M, Meije Y, Abelenda G, Almirante B, Fernández-Hidalgo N. Prevalence of colorectal disease in Enterococcus faecalis infective endocarditis: results of an observational multicenter study. ACTA ACUST UNITED AC 2019; 73:711-717. [PMID: 31444092 DOI: 10.1016/j.rec.2019.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/22/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES The aim of this study was to determine the prevalence of colorectal disease in Enterococcus faecalis infective endocarditis (EFIE) patients. METHODS An observational, retrospective, multicenter study was performed at 4 referral centers. From the moment that a colonoscopy was systematically performed in EFIE in each participating hospital until October 2018, we included all consecutive episodes of definite EFIE in adult patients. The outcome was an endoscopic finding of colorectal disease potentially causing bacteremia. RESULTS A total of 103 patients with EFIE were included; 83 (81%) were male, the median age was 76 [interquartile range 67-82] years, and the median age-adjusted Charlson comorbidity index was 5 [interquartile range 4-7]. The presumed sources of infection were unknown in 63 (61%), urinary in 20 (19%), gastrointestinal in 13 (13%), catheter-related bacteremia in 5 (5%), and others in 2 (2%). Seventy-eight patients (76%) underwent a colonoscopy, and 47 (60%) had endoscopic findings indicating a potential source of bacteremia. Thirty-nine patients (83%) had a colorectal neoplastic disease, and 8 (17%) a nonneoplastic disease. Of the 45 with an unknown portal of entry who underwent a colonoscopy, gastrointestinal origin was identified in 64%. In the subgroup of 25 patients with a known source of infection and a colonoscopy, excluding those with previously diagnosed colorectal disease, 44% had colorectal disease. CONCLUSIONS Performing a colonoscopy in all EFIE patients, irrespective of the presumed source of infection, could be helpful to diagnose colorectal disease in these patients and to avoid a new bacteremia episode (and eventually infective endocarditis) by the same or a different microorganism.
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Affiliation(s)
- Laura Escolà-Vergé
- Servicio de Enfermedades Infecciosas, Hospital Universitari Vall d'Hebron, Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Maddalena Peghin
- Clinica di Malattie Infettive, Dipartimento de Medicina, Università di Udine e Ospedale Santa Maria della Misericordia, Udine, Italy
| | - Filippo Givone
- Clinica di Malattie Infettive, Dipartimento de Medicina, Università di Udine e Ospedale Santa Maria della Misericordia, Udine, Italy
| | - María Teresa Pérez-Rodríguez
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Complexo Hospitalario Universitario de Vigo, Instituto de Investigación Biomédica Galicia-Sur, Vigo, Pontevedra, Spain
| | - Milagros Suárez-Varela
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Complexo Hospitalario Universitario de Vigo, Instituto de Investigación Biomédica Galicia-Sur, Vigo, Pontevedra, Spain
| | - Yolanda Meije
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Gabriela Abelenda
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Benito Almirante
- Servicio de Enfermedades Infecciosas, Hospital Universitari Vall d'Hebron, Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nuria Fernández-Hidalgo
- Servicio de Enfermedades Infecciosas, Hospital Universitari Vall d'Hebron, Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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Sasieni P. Equality and equity in medical screening: what is fair? Lancet Gastroenterol Hepatol 2019; 4:578-580. [PMID: 31292068 DOI: 10.1016/s2468-1253(19)30185-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/08/2019] [Accepted: 04/10/2019] [Indexed: 01/26/2023]
Affiliation(s)
- Peter Sasieni
- King's College London, Guy's Hospital, London SE1 9RT, UK.
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Mannucci A, Zuppardo RA, Rosati R, Leo MD, Perea J, Cavestro GM. Colorectal cancer screening from 45 years of age: Thesis, antithesis and synthesis. World J Gastroenterol 2019; 25:2565-2580. [PMID: 31210710 PMCID: PMC6558439 DOI: 10.3748/wjg.v25.i21.2565] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/15/2019] [Accepted: 04/20/2019] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer incidence and mortality in patients younger than 50 years are increasing, but screening before the age of 50 is not offered in Europe. Advanced-stage diagnosis and mortality from colorectal cancer before 50 years of age are increasing. This is not a detection-bias effect; it is a real issue affecting the entire population. Three independent computational models indicate that screening from 45 years of age would yield a better balance of benefits and risks than the current start at 50 years of age. Experimental data support these predictions in a sex- and race-independent manner. Earlier screening is seemingly affordable, with minimal impediments to providing younger adults with colonoscopy. Indeed, the American Cancer Society has already started to recommend screening from 45 years of age in the United States. Implementing early screening is a societal and public health problem. The three independent computational models that suggested earlier screening were criticized for assuming perfect compliance. Guidelines and recommendations should be derived from well-collected and reproducible data, and not from mathematical predictions. In the era of personalized medicine, screening decisions might not be based solely on age, and sophisticated prediction software may better guide screening. Moreover, early screening might divert resources away from older individuals with greater biological risks. Finally, it is still unknown whether early colorectal cancer is part of a continuum of disease or a biologically distinct disease and, as such, it might not benefit from screening at all. The increase in early-onset colorectal cancer incidence and mortality demonstrates an obligation to take actions. Earlier screening would save lives, and starting at the age of 45 years may be a robust screening option.
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Affiliation(s)
- Alessandro Mannucci
- Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
| | - Raffaella Alessia Zuppardo
- Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
| | - Riccardo Rosati
- Department of Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
| | - Milena Di Leo
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Department of Biomedical Science, Humanitas University, Milan 20090, Italy
| | - José Perea
- Surgery Department, “Fundación Jiménez Díaz” University Hospital, Madrid 28040, Spain
- Health Research Institute-Fundación Jiménez Díaz University Hospital, Madrid 28040, Spain
| | - Giulia Martina Cavestro
- Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
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Chen C, Stock C, Hoffmeister M, Brenner H. Optimal age for screening colonoscopy: a modeling study. Gastrointest Endosc 2019; 89:1017-1025.e12. [PMID: 30639539 DOI: 10.1016/j.gie.2018.12.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 12/29/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Recent guidelines on colorectal cancer (CRC) screening recommend starting screening earlier than before. We performed a simulation study to examine and compare the optimal ages to have once-only screening colonoscopy and repeated colonoscopies. METHODS A Markov model was set up using data from the German national screening colonoscopy registry to simulate the natural history of the adenoma-carcinoma process. CRC deaths and years of potential life lost (YPLL) for a hypothetical unscreened 50-year-old German population were estimated for a single screening colonoscopy or 2 or 3 screening colonoscopies with 10-year intervals at various ages. RESULTS One single screening colonoscopy performed between 50 and 65 years of age was expected to reduce CRC death by 49% to 69% and YPLL by 51% to 68%. An inverted U-shaped association was found between screening age and proportion of CRC deaths or YPLL prevented. The optimal age for once-only colonoscopy that yielded the highest reductions in YPLL was around 54 years for men and 56 years for women. Estimates were approximately 6 to 8 years higher when proportions of CRC deaths prevented were examined. For 2 or 3 screening colonoscopies, the optimal starting age fell to around 50 years or even younger for both genders. CONCLUSIONS Based on the YPLL estimates, in a high CRC incidence and high life expectancy country like Germany, the optimal age for once-only screening colonoscopy is around 55 years and possibly slightly younger for men than for women. When 2 or more screening colonoscopies are offered with 10-year intervals, screening should start at age 50 at the latest or possibly even younger for both genders.
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Affiliation(s)
- Chen Chen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Christian Stock
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
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Robertson DJ, Ladabaum U. Opportunities and Challenges in Moving From Current Guidelines to Personalized Colorectal Cancer Screening. Gastroenterology 2019; 156:904-917. [PMID: 30593801 DOI: 10.1053/j.gastro.2018.12.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 12/09/2018] [Accepted: 12/10/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Douglas J Robertson
- Department of Veterans Affairs Medical Center, White River Junction, Vermont; Geisel School of Medicine at Dartmouth and The Dartmouth Institute, Hanover, New Hampshire.
| | - Uri Ladabaum
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California
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64
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Rim CH, Kim CY, Yang DS, Yoon WS. Clinical Significance of Gender and Body Mass Index in Asian Patients with Colorectal Cancer. J Cancer 2019; 10:682-688. [PMID: 30719166 PMCID: PMC6360425 DOI: 10.7150/jca.28495] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 12/05/2018] [Indexed: 12/21/2022] Open
Abstract
Objective: Colorectal cancer is a disease closely associated with anthropometric values. This study aimed to evaluate the clinical relevance of gender and body mass index (BMI) with colorectal cancer using a Korean nationwide cohort. Methods: Data of colorectal cancer cohorts between 2012 and 2013 were acquired from the Health Insurance Review and Assessment Service. All patients underwent surgery due to colorectal cancers. Stage IV patients were excluded due to possible clinical heterogeneity. BMI was classified with the World Health Organization criteria. Results: A total of 31,756 patients were analyzed. The underweight group had 33% higher risk of stage III disease (p<0.001). The overweight and obese groups had 20% and 19% lower risk of stage III (p<0.001 and p=0.002, respectively). The underweight and obese groups had higher risk of longest hospitalization period quartile (≥19 days), with odds ratio of 2.26 (p<0.001) and 1.33 (p<0.001), respectively. The overweight group had a 22% lower risk of the longest hospitalization period quartile (p=0.002). Females had 12% lower risk of distal cancer than males (p<0.001). There was no significant relationship between cancer stage and gender. The proportions of patients who were <50 years and ≥70 years old were higher in the females, and the proportions of patients in their 50s and 60s were higher in the males. Conclusions: Cancer stages and hospitalization period varied depending on BMI. Disease location and the age distribution were affected by gender.
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Affiliation(s)
- Chai Hong Rim
- Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Ansan, Gyeonggi-do, Republic of Korea
| | - Chul Yong Kim
- Department of Radiation Oncology, Anam Hospital, Korea University Medical College, Seoul, Republic of Korea
| | - Dae Sik Yang
- Department of Radiation Oncology, Guro Hospital, Korea University Medical College, Seoul, Republic of Korea
| | - Won Sup Yoon
- Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Ansan, Gyeonggi-do, Republic of Korea
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Nikolaou S, Qiu S, Fiorentino F, Rasheed S, Tekkis P, Kontovounisios C. The prognostic and therapeutic role of hormones in colorectal cancer: a review. Mol Biol Rep 2018; 46:1477-1486. [PMID: 30535551 DOI: 10.1007/s11033-018-4528-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 11/23/2018] [Indexed: 02/06/2023]
Abstract
Colorectal cancer (CRC) is one of the commonest cancers in Western society with a poor prognosis in patients with advanced disease. Targeted therapy is of increasing interest and already, targeted hormone treatment for breast and prostate cancer has improved survival. The aim of this literature review is to summarise the role of hormones in CRC prognosis and treatment. A literature review of all human and animal in vivo and in vitro studies in the last 20 years, which assessed the role of hormones in CRC treatment or prognosis, was carried out. The hormones described in this review have been subdivided according to their secretion origin. Most of the studies are based on in vitro or animal models. The main findings point to adipokines, insulin and the insulin growth factor axis as key players in the link between obesity, type 2 diabetes mellitus and a subset of CRC. Gut-derived hormones, especially uroguanylin and guanylin are being increasingly investigated as therapeutic targets, with promising results. Using hormones as prognostic and therapeutic markers in CRC is still in the preliminary stages for only a fraction of the hormones affecting the GIT. In light of the increasing interest in tailoring treatment strategies, hormones are an important area of focus in the future of CRC management.
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Affiliation(s)
- Stella Nikolaou
- Department of Colorectal Surgery, Chelsea & Westminster Hospital, London, UK. .,Department of Colorectal Surgery, Royal Marsden Hospital, London, UK. .,Department of Surgery and Cancer, Imperial College, London, UK. .,Department of Surgery and Cancer, Imperial College London, Royal Marsden Hospital, Fulham Road & Chelsea and Westminster Campus, 369 Fulham Road, London, SW10 9NH, UK.
| | - Shengyang Qiu
- Department of Colorectal Surgery, Chelsea & Westminster Hospital, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | | | - Shahnawaz Rasheed
- Department of Colorectal Surgery, Chelsea & Westminster Hospital, London, UK.,Department of Colorectal Surgery, Royal Marsden Hospital, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - Paris Tekkis
- Department of Colorectal Surgery, Chelsea & Westminster Hospital, London, UK.,Department of Colorectal Surgery, Royal Marsden Hospital, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - Christos Kontovounisios
- Department of Colorectal Surgery, Chelsea & Westminster Hospital, London, UK.,Department of Colorectal Surgery, Royal Marsden Hospital, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
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Participant-Related Risk Factors for False-Positive and False-Negative Fecal Immunochemical Tests in Colorectal Cancer Screening: Systematic Review and Meta-Analysis. Am J Gastroenterol 2018; 113:1778-1787. [PMID: 30158713 PMCID: PMC6768609 DOI: 10.1038/s41395-018-0212-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/29/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Colorectal cancer (CRC) screening using fecal immunochemical tests (FIT) may reduce CRC-related mortality but its effectiveness is influenced by the limited accuracy of FIT. Identifying individuals at increased risk of a false FIT result could improve screening, but the available evidence is conflicting. We performed a systematic review and meta-analysis on risk factors for false-positive and false-negative FIT results in CRC screening. METHODS A systematic search in MEDLINE, EMBASE, and Cochrane Library identified publications (before 29 January 2017) on risk factors (known at time of FIT invitation) associated with false FIT results (presence/absence of advanced neoplasia) in a CRC screening setting. Risk of bias was assessed using QUIPS. In meta-analysis, summary relative risk ratios and corresponding 95% confidence intervals were calculated for each risk factor. RESULTS Of 518 records identified, 14 studies with 54,499 participants in total were included for analysis. In meta-analysis, male sex was associated with a significantly lower risk of false-positivity (RR 0.84, CI 0.74-0.94), whereas participants using non-steroidal anti-inflammatory drugs (NSAIDs) had a higher risk (RR 1.16, CI 1.06-1.27). The use of anticoagulants was most frequently studied, without a significant effect on FIT positivity. Males (RR 1.83, CI 1.53-2.19), participants with a family history for CRC (RR 1.61, CI 1.19-2.15), hyperglycemia (RR 1.29, CI 1.02-1.65), hypertension (RR 1.50, CI 1.14-1.98), obesity (RR 1.38, CI 1.11-1.71), and (former) smokers (RR 1.93, CI 1.52-2.45) were all at significantly higher risk for false-negative results. Age was not found to have a systematic effect on either FIT false-positivity or false-negativity in meta-analysis. CONCLUSIONS Multiple risk factors, known at time of FIT invitation, are associated with false FIT results in CRC screening. This information can be used to identify populations risking false reassurance after a negative result or unnecessary colonoscopy after a positive result, and to further optimize CRC screening effectiveness.
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Koskenvuo L, Malila N, Pitkäniemi J, Miettinen J, Heikkinen S, Sallinen V. Sex differences in faecal occult blood test screening for colorectal cancer. Br J Surg 2018; 106:436-447. [PMID: 30460999 PMCID: PMC6587743 DOI: 10.1002/bjs.11011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 08/16/2018] [Accepted: 09/05/2018] [Indexed: 02/06/2023]
Abstract
Background This analysis of patients in a randomized population‐based health services study was done to determine the effects of faecal occult blood test (FOBT) screening of colorectal cancer (CRC) in outcomes beyond mortality, and to obtain explanations for potential sex differences in screening effectiveness. Methods In the Finnish FOBT screening programme (2004–2011), people aged 60–69 years were randomized into the screening and control arms. Differences in incidence, symptoms, tumour location, TNM categories, non‐vital outcomes and survival in the screening and control arms were analysed. Results From 321 311 individuals randomized, 743 patients with screening‐detected tumours and 617 control patients with CRC were analysed. CRC was less common in women than in men (0·34 versus 0·50 per cent; risk ratio (RR) 0·82, 95 per cent c.i. 0·74 to 0·91) and women were less often asymptomatic (16·7 versus 22·0 per cent; RR 0·76, 0·61 to 0·93). Women more often had right‐sided tumours (32·0 versus 21·3 per cent; RR 1·51, 1·26 to 1·80). Among men with left‐sided tumours, those in the screening arm had lower N (RR 1·23, 1·02 to 1·48) and M (RR 1·57, 1·14 to 2·17) categories, as well as a higher overall survival rate than those in the control arm. Furthermore among men with left‐sided tumours, non‐radical resections (26·2 versus 15·7 per cent; RR 1·67, 1·22 to 2·30) and postoperative chemotherapy sessions (61·6 versus 48·2 per cent; RR 1·28, 1·10 to 1·48) were more frequent in the control arm. Similar benefits of screening were not detected in men with right‐sided tumours or in women. Conclusion Biennial FOBT screening seems to be effective in terms of improving several different outcomes in men, but not in women. Differences in incidence, symptoms and tumour location may explain the differences in screening efficacy between sexes. Only of benefit in men
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Affiliation(s)
- L Koskenvuo
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - N Malila
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - J Pitkäniemi
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - J Miettinen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - S Heikkinen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - V Sallinen
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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68
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Shaukat A, Church TR. Long-Term Effectiveness of Sigmoidoscopy Screening in Women and Men. Ann Intern Med 2018; 169:663. [PMID: 30398635 DOI: 10.7326/l18-0511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Aasma Shaukat
- Minneapolis VA Health Care System, Minneapolis, Minnesota (A.S.)
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69
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White A, Ironmonger L, Steele RJC, Ormiston-Smith N, Crawford C, Seims A. A review of sex-related differences in colorectal cancer incidence, screening uptake, routes to diagnosis, cancer stage and survival in the UK. BMC Cancer 2018; 18:906. [PMID: 30236083 PMCID: PMC6149054 DOI: 10.1186/s12885-018-4786-7] [Citation(s) in RCA: 186] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/30/2018] [Indexed: 02/07/2023] Open
Abstract
Background Colorectal cancer (CRC) is an illness strongly influenced by sex and gender, with mortality rates in males significantly higher than females. There is still a dearth of understanding on where sex differences exist along the pathway from presentation to survival. The aim of this review is to identify where actions are needed to improve outcomes for both sexes, and to narrow the gap for CRC. Methods A cross-sectional review of national data was undertaken to identify sex differences in incidence, screening uptake, route to diagnosis, cancer stage at diagnosis and survival, and their influence in the sex differences in mortality. Results Overall incidence is higher in men, with an earlier age distribution, however, important sex differences exist in anatomical site. There were relatively small differences in screening uptake, route to diagnosis, cancer staging at diagnosis and survival. Screening uptake is higher in women under 69 years. Women are more likely to present as emergency cases, with more men diagnosed through screening and two-week-wait. No sex differences are seen in diagnosis for more advanced disease. Overall, age-standardised 5-year survival is similar between the sexes. Conclusions As there are minimal sex differences in the data from routes to diagnosis to survival, the higher mortality of colorectal cancer in men appears to be a result of exogenous and/or endogenous factors pre-diagnosis that lead to higher incidence rates. There are however, sex and gender differences that suggest more targeted interventions may facilitate prevention and earlier diagnosis in both men and women.
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Affiliation(s)
- Alan White
- Institute of Health & Wellbeing, Leeds Beckett University, Civic Quarter, Leeds, LS1 3HE, UK.
| | - Lucy Ironmonger
- Cancer Research UK, Angel Building, 407 St John Street, London, EC1V 4A, UK
| | - Robert J C Steele
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening (CRiPS), University of Dundee, Dundee, DD1 9SY, UK
| | - Nick Ormiston-Smith
- Department of Health, 15 Butterfield Street, Herston, Brisbane, 4006, QLD, Australia
| | - Carina Crawford
- Cancer Research UK, Angel Building, 407 St John Street, London, EC1V 4A, UK
| | - Amanda Seims
- Institute of Health & Wellbeing, Leeds Beckett University, Civic Quarter, Leeds, LS1 3HE, UK
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70
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Hasakova K, Vician M, Reis R, Zeman M, Herichova I. Sex-dependent correlation between survival and expression of genes related to the circadian oscillator in patients with colorectal cancer. Chronobiol Int 2018; 35:1423-1434. [PMID: 29953268 DOI: 10.1080/07420528.2018.1488722] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Recent evidence supports the important role of the circadian system in cancer progression in humans. The aim of the present study is to evaluate clock (cry1, cry2 and per2) and clock-controlled (vascular endothelial growth factor-a, early growth response protein 1 and estrogen receptor β) gene expression in colorectal cancer and adjacent tissue and identify a possible link between survival of patients and expression of above mentioned genes. The study includes 64 patients of both sexes with previously diagnosed colorectal cancer. RNA was extracted from the tumor tissue and adjacent parts of the resected colon, and real-time PCR was used for detection of clock gene expression. Expression of cry2 and per2 was significantly downregulated in tumor tissue compared to adjacent tissues. After splitting of the cohort according to sex, we detected downregulated levels of cry2 and per2 in male patients, but not in females. Splitting of male and female sub-cohorts according to presence of metastases revealed significant donwregulation of cry2 expression in female patients without distant metastasis. Better survival rate was associated with low expression of cry2 in female patients. Moreover, we observed an increase in cry1 expression in female patients with distant metastases in tumor compared to adjacent tissue. Accordingly, women with high expression of cry1 in tumor tissue displayed worse survival, which was not observed in men. Taken together, expression of clock and clock-controlled genes in tumors of males and females clustered according to presence of distant metastases correlated with survival analysis. Studied clock-controlled genes also showed sex-dependent changes. Low expression of vegf-a in tumor correlated with better survival in men but not in women. High expression of estrogen receptor β mRNA was related to better survival in women but not in men. Low expression of vegf-a, egr1 and estrogen receptor β was associated with worse survival in women compared to men. Our data indicate sex-dependent associations between clock and clock-controlled gene expression in cancer tissue and patient's survival prognosis.
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Affiliation(s)
- Kristina Hasakova
- a Department of Animal Physiology and Ethology, Faculty of Natural Sciences , Comenius University Bratislava , Bratislava , Slovak Republic
| | - Marian Vician
- b Fourth Surgery Department , University Hospital, Comenius University Bratislava , Bratislava , Slovak Republic
| | - Richard Reis
- c First Surgery Department , University Hospital, Comenius University Bratislava , Bratislava , Slovak Republic
| | - Michal Zeman
- a Department of Animal Physiology and Ethology, Faculty of Natural Sciences , Comenius University Bratislava , Bratislava , Slovak Republic
| | - Iveta Herichova
- a Department of Animal Physiology and Ethology, Faculty of Natural Sciences , Comenius University Bratislava , Bratislava , Slovak Republic
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71
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Ji J, Sundquist J, Sundquist K. Use of hormone replacement therapy improves the prognosis in patients with colorectal cancer: A population-based study in Sweden. Int J Cancer 2018; 142:2003-2010. [PMID: 29270993 DOI: 10.1002/ijc.31228] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 12/05/2017] [Accepted: 12/13/2017] [Indexed: 12/26/2022]
Abstract
The association between hormone therapy (estrogen, with or without progesterone) and colorectal cancer (CRC) has received considerable scientific interest but previous research has generated inconsistent results. We aimed to examine whether post-diagnostic use of hormone therapy might protect against CRC mortality and all-cause mortality. Women diagnosed with CRC between January 2007 and December 2012 were identified from the Swedish Cancer Registry and linked to the Swedish Prescribed Drug Register to retrieve hormone therapy users after CRC diagnosis. A total of 1,109 patients were diagnosed with CRC and used hormone therapy post-CRC diagnosis. Time-dependent Cox regression with 1-year lag was used to calculate the hazard ratio (HR) of CRC mortality and all-cause mortality associated with post-diagnostic use of hormone therapy. Use of hormone therapy after CRC diagnosis was associated with a 26% risk reduction in CRC mortality (HR = 0.67, 95%CI 0.56-0.79) and a 30% risk reduction in all-cause mortality (HR = 0.68, 95%CI 0.59-0.77). The risk reduction was even stronger if women also used hormone therapy before the diagnosis of CRC and for women with higher cumulative doses of hormone therapy. The risk reduction was largely consistent irrespective of CRC severity. Our data suggests that use of hormone therapy after CRC diagnosis is associated with a decreased risk of cancer-related mortality and all-cause mortality.
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Affiliation(s)
- Jianguang Ji
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden.,Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden.,Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York
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72
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Significance of intratissue estrogen concentration coupled with estrogen receptors levels in colorectal cancer prognosis. Oncotarget 2017; 8:115546-115560. [PMID: 29383180 PMCID: PMC5777792 DOI: 10.18632/oncotarget.23309] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 12/05/2017] [Indexed: 12/17/2022] Open
Abstract
Dysregulation of estrogen related pathways is implicated colorectal cancer (CRC) development. However, significance of intratissue concentration of estrone (E1) and 17β-estradiol (E2) in relation to estrogen receptor (ESR) expression level was not addressed so far. Herein, we measured E1 and E2 intratissue concentration using liquid chromatography electrospray ionization tandem mass spectrometry (ESI LC/MS) and mRNA levels of ESR1 and ESR2 using RT-qPCR in cancerous and histopathologically unchanged tissue from 75 and 110 CRC patients, respectively. The obtained results were associated with clinicopathological factors, expression of estrogen dependent genes (CTNNB1, CCND1) and prognostic significance. We found no statistically significant differences in E1 or E2 concentration between cancerous tissue and histopathologically unchanged counterparts. Moreover, mRNA levels of ESR1 and ESR2 were significantly decreased in cancerous tissue compared with histopathologically unchanged (p=0.00001). Log rank analysis revealed no benefit of low E1 to E2 ratio, high E1, E2 concentration or ESR1, ESR2 mRNA level for patients’ overall (OS) and disease free survival (DFS). Interestingly, we have observed that patients with low ESR1 mRNA level coupled with low E1 intratissue concentration had a significant decrease in DFS compared with group of patients with high ESR1 mRNA level and high E1 concentration (HR=0.16, 95% CI 0.02-1.05; p=0.06). Furthermore, patients with low E1 concentration and low ESR1 transcript had significantly higher CTNNB1 and CCND1 mRNA level compare with subgroup with high level of both grouping factors. Our study indicates a potential value of estrogen intratissue concentration and its receptor expression level for CRC patients’ prognosis.
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73
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Silva JM, Pinho E, Monteiro E, Silva JF, Costa C. Controlled searching in reversibly de-identified medical imaging archives. J Biomed Inform 2017; 77:81-90. [PMID: 29224856 DOI: 10.1016/j.jbi.2017.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/22/2017] [Accepted: 12/04/2017] [Indexed: 11/17/2022]
Abstract
Nowadays, digital medical imaging in healthcare has become a fundamental tool for medical diagnosis. This growth has been accompanied by the development of technologies and standards, such as the DICOM standard and PACS. This environment led to the creation of collaborative projects where there is a need to share medical data between different institutions for research and educational purposes. In this context, it is necessary to maintain patient data privacy and provide an easy and secure mechanism for authorized personnel access. This paper presents a solution that fully de-identifies standard medical imaging objects, including metadata and pixel data, providing at the same time a reversible de-identifier mechanism that retains search capabilities from the original data. The last feature is important in some scenarios, for instance, in collaborative platforms where data is anonymized when shared with the community but searchable for data custodians or authorized entities. The solution was integrated into an open source PACS archive and validated in a multidisciplinary collaborative scenario.
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74
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Detection Rate, Anatomic Sites, and Pathologic Types of Colorectal Cancer During Colonoscopy Procedures. Surg Laparosc Endosc Percutan Tech 2017; 27:394-399. [DOI: 10.1097/sle.0000000000000456] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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76
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Melo-Peñaloza MA. Results of total colonoscopy in the diagnosis of polyps. Case studies in Villavicencio, Colombia. REVISTA DE LA FACULTAD DE MEDICINA 2017. [DOI: 10.15446/revfacmed.v65n3.49484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. Cualquier levantamiento por encima del plano normal de la mucosa colónica es considerada proyección polipoidea. A mayor edad es más probable encontrar pólipos; además, los >1 cm de diámetro tienen mayor potencial de desarrollar neoplasia maligna.Objetivo. Establecer la frecuencia de lesiones polipósicas del colon, su tamaño, su localización y los grupos de edades donde están presentes en pacientes a quienes se les realizó colonoscopia en el Hospital Departamental de Villavicencio en el periodo 2009-2014.Materiales y métodos. Se analizaron los resultados de 411 colonoscopias diagnósticas. La recolección de datos y descripción estadística se hizo con el software SPPSS 2011.Resultados. Del total de la muestra, 43 (10.46%) pólipos fueron ≤1cm de diámetro, 16 (4% 3.89%) estuvieron entre 1cm y 2cm, no se encontraron pólipos >2cm y en el resto de resultados no se hallaron estas anomalías. En el grupo de edad de 41 a 50 años se presentaron pólipos en todos los segmentos del colon, pero el de mayor porcentaje (11%) fue el de 71 a 80 años. En el colon izquierdo se presentó el 69% de los pólipos >1cm y el 67% de los <1cm.Conclusión. En grupos de poblaciones <40 años de edad, los hallazgos de pólipos son bajos en colon izquierdo y muy bajos en colon derecho.
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77
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Mortality trends and risk of dying from colorectal cancer in the seven socioeconomic regions of Mexico, 2000-2012. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2017. [DOI: 10.1016/j.rgmxen.2017.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Baghestani AR, Moamer S, Pourhoseingholi MA, Khadem Maboudi AA, Ghoreshi B, Zali MR. Demographic and Pathological Predictors of Colorectal Cancer Survival in Competing Risk Model, Using Generalized Weibull Distribution. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2017; 10. [DOI: 10.5812/ijcm.7352] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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79
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Application of the Parametric Regression Model with the Four-Parameter Log-Logistic Distribution for Determining of the Effecting Factors on the Survival Rate of Colorectal Cancer Patients in the Presence of Competing Risks. IRANIAN RED CRESCENT MEDICAL JOURNAL 2017. [DOI: 10.5812/ircmj.55609] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Quyn AJ, Fraser CG, Stanners G, Carey FA, Carden C, Shaukat A, Steele RJ. Uptake trends in the Scottish Bowel Screening Programme and the influences of age, sex, and deprivation. J Med Screen 2017; 25:24-31. [PMID: 29183246 DOI: 10.1177/0969141317694065] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective Age, sex, and deprivation are known factors influencing colorectal (bowel) cancer screening uptake. We investigated the influence of these factors on uptake over time. Methods Data from the Scottish Bowel Screening Programme (SBoSP) were collected between 2007 and 2014. End-points for analysis were uptake, faecal occult blood test positivity, and disease detection, adjusted for age, sex, deprivation, and year of screening. Results From 5,308,336 individual screening episodes documented, uptake gradually increased with increasing age up to 65-69 and was lower in men than women (52.4% vs. 58.7%, respectively). Deprivation had a significant effect on uptake by men and women of all age groups, with the most deprived least likely to complete a screening test. Uptake has increased with time in both sexes and across the deprivation gradient. The number needed to screen to detect significant neoplasia was significantly lower in men than women overall (170 vs. 365), and this held over all age and deprivation groups. The number needed to screen was also lower in the more deprived population. Conclusions Although lower age, male sex, and increased deprivation are associated with lower bowel cancer screening uptake in Scotland, uptake has increased since SBoSP introduction in all age groups, both sexes, and across the deprivation gradient. Despite a lower uptake, the number needed to screen to find significant disease was lower in men and in those with higher levels of deprivation.
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Affiliation(s)
- Aaron J Quyn
- 1 Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
| | - Callum G Fraser
- 1 Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
| | - Greig Stanners
- 2 Information Services Division, NHS National Services Scotland, Glasgow, UK
| | - Francis A Carey
- 3 Department of Pathology, Ninewells Hospital and Medical School, Dundee, UK
| | - Claire Carden
- 1 Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
| | - Aasma Shaukat
- 4 University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Robert Jc Steele
- 1 Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
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81
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Sánchez-Barriga JJ. Mortality trends and risk of dying from colorectal cancer in the seven socioeconomic regions of Mexico, 2000-2012. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2017; 82:217-225. [PMID: 28320550 DOI: 10.1016/j.rgmx.2016.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 09/07/2016] [Accepted: 10/06/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND In Mexico, there has been an upward trend in mortality rates from colorectal cancer (CRC) over the past three decades. This tumor is ranked among the ten most prevalent causes of morbidity from malignancies in Mexico. AIMS To determine the mortality trends by socioeconomic region and by state, and to establish the relative risk between both educational level and socioeconomic region with mortality from CRC within the time frame of 2000-2012. MATERIALS AND METHODS Records of mortality associated with colorectal cancer were obtained. Rates of mortality by state and by socioeconomic region were calculated, along with the strength of association (obtained through the Poisson regression) between both socioeconomic region and educational level and the mortality from CRC. RESULTS A total of 45,487 individuals died from CRC in Mexico from 2000 to 2012. Age-adjusted mortality rates per 100,000 inhabitants increased from 3.9 to 4.8. Baja California, Baja California Sur, and Sonora had the highest mortality from CRC. Individuals with no school or incomplete elementary school had a higher risk of dying from this cancer (RR of 3.57, 95% CI: 3.46-3.68). Region 7 had the strongest association with mortality from CRC (Mexico City: RR was 2.84, 95% CI: 2.39-3.37 [2000] and 3.32, 95% CI: 2.89-3.82 [2012]). CONCLUSIONS In Mexico, the age-adjusted mortality rates per 100,000 inhabitants that died from CRC increased from 3.9 to 4.8 in the study period, using the world population age distribution as the standard. Baja California, Baja California Sur, and Sonora had the highest mortality from CRC. Mexico City, which was socioeconomic region 7, had the strongest association with mortality from CRC.
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Affiliation(s)
- J J Sánchez-Barriga
- Dirección de Investigación Operativa de Epidemiología, Dirección General de Epidemiología, Secretaría de Salud, Ciudad de México, México.
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82
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Fachiroh J, Gravitiani E, Husodo AH. Nitrate in drinking water and risk of colorectal cancer in Yogyakarta, Indonesia. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2017; 80:120-128. [PMID: 28095125 DOI: 10.1080/15287394.2016.1260508] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Nitrate concentration in well water in Yogyakarta, Indonesia, and its surroundings tended to increase rapidly from time to time, and it may be associated with an elevated risk for several types of cancer. The purpose of this study was to examine the association between nitrate in drinking water and colorectal cancer (CRC) risk occurrence. A case-control study was conducted in Yogyakarta Special Province. Pathologically confirmed 75 CRC patients and 75 controls were consulted and their individual well water was sampled and examined for nitrate concentrations. Logistic regression analysis was conducted to establish the association between nitrate and CRC risk development. There was a significant correlation between nitrate in drinking water and CRC occurrence, and this value was relatively stable after being adjusted for protein intake, smoking history, age, and family history of cancer. These findings demonstrated that the risk of CRC development was fourfold among those with >10 years of nitrate exposure from well water compared with those with ≤10 years of nitrate exposure. Consequently, a significant association between nitrate in drinking water and occurrence of CRC in Yogyakarta was established.
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Affiliation(s)
- Jajah Fachiroh
- c Department of Histology and Cell Biology , Faculty of Medicine, Universitas Gadjah Mada , Yogyakarta , Indonesia
| | - Evi Gravitiani
- d Faculty of Economics and Business , Universitas Sebelas Maret , Surakarta , Indonesia
| | - Adi Heru Husodo
- f Department of Public Health , Faculty of Medicine Universitas Gadjah Mada , Yogyakarta , Indonesia
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83
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Moamer S, Baghestani A, Pourhoseingholi MA, Hajizadeh N, Ahmadi F, Norouzinia M. Evaluation of prognostic factors effect on survival time in patients with colorectal cancer, based on Weibull Competing-Risks Model. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2017; 10:54-59. [PMID: 28331565 PMCID: PMC5346825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM The aim of this study was to assess the association between survival of patients with colorectal cancer and prognostic factors in a competing risk parametric model using Weibull distribution. BACKGROUND The prognosis of colorectal cancer is relatively good in terms of survival time. In many prognostic studies, patients may be exposed to several types of competing events. These different causes of death are called competing risks. METHODS Data was recorded from 372 patients with colorectal cancer who registered in the Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences (Tehran, Iran) from 2004 to 2015 in a retrospective study. Analysis was performed using competing risks model and Weibull distribution. Software used for data analysis was R, and significance level was regarded as 0.05. RESULTS The result indicated that, at the end of follow-up, 111 (29.8%) deaths were from colorectal cancer and 14 (3.8%) deaths were due to other diseases. The average body mass index (BMI) was 24.61(SD 3.98). The mean survival time for a patient in 372 was 62.05(SD 48.78) month with median equals to 48 months. According to competing-risks method, only stageIII (HR, 1.69; 95% CI, 1.246-2.315 ), stageIV( HR, 4.51; 95% CI,2.91-6.99 ) and BMI( HR, 0.96; 95% CI, 0.96-0.975) have a significant effect on patient's survival time. CONCLUSION This study indicated pathologic stage (III,IV) and BMI as the prognosis, using a Weibull model with competing risks analysis, while other models without the competing events lead to significant predictors which may be due to over-estimation.
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Affiliation(s)
- Soraya Moamer
- Department of Biostatistics,Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmadreza Baghestani
- Physiotherapy Research Centre, Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohamad Amin Pourhoseingholi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nastaran Hajizadeh
- Department of Biostatistics,Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzaneh Ahmadi
- Department of Biostatistics,Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Norouzinia
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Tehran, Iran
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Pattern and Distribution of Colorectal Cancer in Tanzania: A Retrospective Chart Audit at Two National Hospitals. J Cancer Epidemiol 2016; 2016:3769829. [PMID: 27965709 PMCID: PMC5124659 DOI: 10.1155/2016/3769829] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 08/09/2016] [Indexed: 12/11/2022] Open
Abstract
Background. Colorectal cancer (CRC) is a growing public health concern with increasing rates in countries with previously known low incidence. This study determined pattern and distribution of CRC in Tanzania and identified hot spots in case distribution. Methods. A retrospective chart audit reviewed hospital registers and patient files from two national institutions. Descriptive statistics, Chi square (χ2) tests, and regression analyses were employed and augmented by data visualization to display risk variable differences. Results. CRC cases increased sixfold in the last decade in Tanzania. There was a 1.5% decrease in incidences levels of rectal cancer and 2% increase for colon cancer every year from 2005 to 2015. Nearly half of patients listed Dar es Salaam as their primary residence. CRC was equally distributed between males (50.06%) and females (49.94%), although gender likelihood of diagnosis type (i.e., rectal or colon) was significantly different (P = 0.027). More than 60% of patients were between 40 and 69 years. Conclusions. Age (P = 0.0183) and time (P = 0.004) but not gender (P = 0.0864) were significantly associated with rectal cancer in a retrospective study in Tanzania. Gender (P = 0.0405), age (P = 0.0015), and time (P = 0.0075) were all significantly associated with colon cancer in this study. This retrospective study found that colon cancer is more prevalent among males at a relatively younger age than rectal cancer. Further, our study showed that although more patients were diagnosed with rectal cancer, the trend has shown that colon cancer is increasing at a faster rate.
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85
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Steele RJC, Stanners G, Lang J, Brewster DH, Carey FA, Fraser CG. Interval cancers in a national colorectal cancer screening programme. United European Gastroenterol J 2016; 4:587-94. [PMID: 27536369 PMCID: PMC4971793 DOI: 10.1177/2050640615624294] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 11/29/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Little is known about interval cancers (ICs) in colorectal cancer (CRC) screening. OBJECTIVE The purpose of this study was to identify IC characteristics and compare these with screen-detected cancers (SCs) and cancers in non-participants (NPCs) over the same time period. DESIGN This was an observational study done in the first round of the Scottish Bowel Screening Programme. All individuals (772,790), aged 50-74 years, invited to participate between 1 January 2007 and 31 May 2009 were studied by linking their screening records with confirmed CRC records in the Scottish Cancer Registry (SCR). Characteristics of SC, IC and NPC were determined. RESULTS There were 555 SCs, 502 ICs and 922 NPCs. SCs were at an earlier stage than ICs and NPCs (33.9% Dukes' A as against 18.7% in IC and 11.3% in NPC), screening preferentially detected cancers in males (64.7% as against 52.8% in IC and 59.7% in NPC): this was independent of a different cancer site distribution in males and females. SC in the colon were less advanced than IC, but not in the rectum. CONCLUSION ICs account for 47.5% of the CRCs in the screened population, indicating approximately 50% screening test sensitivity: guaiac faecal occult blood testing (gFOBT) sensitivity is less for women than for men and gFOBT screening may not be effective for rectal cancer.
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Affiliation(s)
- Robert JC Steele
- Centre for Research into Cancer Prevention and Screening (CRiPS), University of Dundee, Dundee, UK
| | - Greig Stanners
- Information Services, National Services Scotland, Edinburgh, UK
| | - Jaroslaw Lang
- Information Services, National Services Scotland, Edinburgh, UK
| | | | - Francis A Carey
- Department of Pathology, Ninewells Hospital and Medical School, Dundee, UK
| | - Callum G Fraser
- Centre for Research into Cancer Prevention and Screening (CRiPS), University of Dundee, Dundee, UK
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86
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Ren J, Kirkness CS, Kim M, Asche CV, Puli S. Long-term risk of colorectal cancer by gender after positive colonoscopy: population-based cohort study. Curr Med Res Opin 2016; 32:1367-74. [PMID: 27050237 DOI: 10.1080/03007995.2016.1174840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Evidence for surveillance intervals of colonoscopy are primarily based on adenoma recurrence rate rather than on colorectal cancer (C.R.C.) incidence. Little is known about long-term risk of C.R.C. after positive colonoscopy. In view of men have significantly higher C.R.C. risk than women, we aimed to estimate the gender-specific C.R.C. incidence after positive colonoscopy (adenoma or malignant lesion) at follow-up colonoscopy. METHODS A retrospective cohort study was conducted using data from a database of colonoscopy screening and surveillance. Patients having had a colonoscopy (January 2010-March 2014) were selected as study subjects and the history of prior colonoscopies was reviewed. Multivariable Weibull regression models were used to estimate the incidence of C.R.C. at follow-up colonoscopy for subjects who were assigned a stratified risk level. The benchmark risk was defined according to a national survey. RESULTS The interval incidence of C.R.C. at a 10 year follow-up was 164 (95% C.I. 63-343) and 79 (95% C.I. 26-188) per 100,000 person-years for low-risk men and women respectively, which tallied with our benchmark risk. Men exceeded the benchmark risk in 3-5 years if they had an incomplete polyp removal, ≥3 adenomas during their last colonoscopy or a personal C.R.C. history, and in 7-8 years if they only had familial C.R.C. HISTORY Women had a lower risk of C.R.C., and reached a same risk level 3-5 years later than men. Coexisting above risk factors resulted in a sharp increase in the incidence of C.R.C. at follow-up exceeding the benchmark much earlier. CONCLUSION Surveillance intervals for men based on incidence of C.R.C. are in line with that recommended by the current guidelines for colonoscopy. However, an extension of 3-5 years may be appropriate for women. To target personalized medicine, a risk predictive model could be used to identify an appropriate surveillance interval for each individual in the future.
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Affiliation(s)
- Jinma Ren
- a Center for Outcomes Research, University of Illinois College of Medicine at Peoria , IL , USA
| | - Carmen S Kirkness
- a Center for Outcomes Research, University of Illinois College of Medicine at Peoria , IL , USA
- b University of Illinois College of Nursing at Chicago , IL , USA
| | - Minchul Kim
- a Center for Outcomes Research, University of Illinois College of Medicine at Peoria , IL , USA
| | - Carl V Asche
- a Center for Outcomes Research, University of Illinois College of Medicine at Peoria , IL , USA
- c University of Illinois College of Pharmacy at Chicago , IL , USA
| | - Srinivas Puli
- d Gastroenterology, O.S.F. Saint Francis Medical Center , Peoria , IL , USA
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87
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Grobbee EJ, Wieten E, Hansen BE, Stoop EM, de Wijkerslooth TR, Lansdorp-Vogelaar I, Bossuyt PM, Dekker E, Kuipers EJ, Spaander MC. Fecal immunochemical test-based colorectal cancer screening: The gender dilemma. United European Gastroenterol J 2016; 5:448-454. [PMID: 28507758 DOI: 10.1177/2050640616659998] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 06/01/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Despite differences between men and women in incidence of colorectal cancer (CRC) and its precursors, screening programs consistently use the same strategy for both genders. OBJECTIVE The objective of this article is to illustrate the effects of gender-tailored screening, including the effects on miss rates of advanced neoplasia (AN). METHODS Participants (age 50-75 years) in a colonoscopy screening program were asked to complete a fecal immunochemical test (FIT) before colonoscopy. Positivity rates, sensitivity and specificity for detection of AN at multiple cut-offs were determined. Absolute numbers of detected and missed AN per 1000 screenees were calculated. RESULTS In total 1,256 individuals underwent FIT and colonoscopy, 51% male (median age 61 years; IQR 56-66) and 49% female (median age 60 years; IQR 55-65). At all cut-offs men had higher positivity rates than women, ranging from 3.8% to 10.8% versus 3.2% to 4.8%. Sensitivity for AN was higher in men than women; 40%-25% and 35%-22%, respectively. More AN were found and missed in absolute numbers in men at all cut-offs. CONCLUSION More AN were both detected and missed in men compared to women at all cut-offs. Gender-tailored cut-offs could either level sensitivity in men and women (i.e., lower cut-off in women) or level the amount of missed lesions (i.e., lower cut-off in men).
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Affiliation(s)
- Esmée J Grobbee
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Els Wieten
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Bettina E Hansen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Esther M Stoop
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Thomas R de Wijkerslooth
- Department of Gastroenterology and Hepatology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Patrick M Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Manon Cw Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Abstract
Colorectal cancer is one of the leading causes of cancer-related morbidity and mortality. Main risk factors include advanced age, family history, male sex, and lifestyle factors. Screening can reduce incidence and death from colorectal cancer. Therefore, prevention and early detection are crucial in order to detect and remove pre-neoplastic adenomas and to detect cancers at early stages. Colonoscopy, flexible sigmoidoscopy, and fecal occult blood tests are established tools for screening. Newer fecal immunochemical tests reveal higher sensitivities for advanced adenoma and cancer than guaiac-based hemoccult tests. Molecular stool and blood tests as well as virtual colonoscopy and colon capsule endoscopy are promising new developments so far not established as routine instruments for the prevention and early detection of colorectal cancer. Colonoscopy is the method of choice for the diagnosis of colorectal cancer and for adenoma removal. Prognosis is essentially dependent on the tumor stage at the time of the initial diagnosis. Proper staging based on imaging prior to therapy is a prerequisite. In rectal cancer, local staging is an essential requirement for the identification of appropriate candidates for neoadjuvant therapy.
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Affiliation(s)
- Frank T Kolligs
- Department of Internal Medicine and Gastroenterology, HELIOS Klinikum Berlin-Buch, Berlin, Germany
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89
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Botteri E, Crosta C, Bagnardi V, Tamayo D, Sonzogni AM, De Roberto G, de Leone A, Lowenfels A, Maisonneuve P. Predictors of advanced colorectal neoplasia at initial and surveillance colonoscopy after positive screening immunochemical faecal occult blood test. Dig Liver Dis 2016; 48:321-6. [PMID: 26739617 DOI: 10.1016/j.dld.2015.11.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 11/12/2015] [Accepted: 11/19/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Characteristics such as gender and lifestyle are not taken in account in colorectal cancer screening and surveillance recommendations. AIMS To identify factors associated with advanced neoplasia at initial and surveillance colonoscopy. METHODS In this observational study, 750 individuals with positive faecal occult blood test, aged 50-74 years, underwent a first screening colonoscopy in 2007-2009. We collected anthropometric data as well as data on physical activity, smoking and drinking habits, fruit and vegetable consumption and low-dose aspirin use through a questionnaire. RESULTS At initial colonoscopy advanced neoplasia (n=399, 53.2%) was positively associated with age, male gender, smoking and alcohol drinking, and inversely associated with physical activity, fruit and vegetables consumption and long-term use of aspirin. These 7 factors were used to calculate a risk score, ranging from 0 (no unfavourable characteristics) to 7 (all unfavourable characteristics present), which was significantly associated with advanced neoplasia (odds ratio 1.55 for one point increase, P<0.01). Among the 372 adenoma patients who returned for follow-up surveillance colonoscopy, the score remained associated with advanced neoplasia (odds ratio 1.28 for one point increase, P=0.01). CONCLUSION Besides age and gender, modifiable factors such as lifestyle and aspirin use were associated with the risk of advanced neoplasia at initial and surveillance colonoscopy.
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Affiliation(s)
- Edoardo Botteri
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
| | - Cristiano Crosta
- Division of Endoscopy, European Institute of Oncology, Milan, Italy
| | - Vincenzo Bagnardi
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy; Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology and Public Health, University of Milan-Bicocca, Milan, Italy
| | - Darina Tamayo
- Division of Endoscopy, European Institute of Oncology, Milan, Italy
| | | | | | | | - Albert Lowenfels
- Department of Surgery, New York Medical College, Valhalla, New York, United States
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
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90
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Niccum DE, Billings JL, Dunitz JM, Khoruts A. Colonoscopic screening shows increased early incidence and progression of adenomas in cystic fibrosis. J Cyst Fibros 2016; 15:548-53. [PMID: 26851188 DOI: 10.1016/j.jcf.2016.01.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 12/08/2015] [Accepted: 01/11/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Colorectal cancer is an emerging problem in cystic fibrosis (CF). The goal of this study was to evaluate adenoma detection by systematic colonoscopic screening and surveillance. METHODS We analyzed prospectively collected results of colonoscopies initiated at age 40years from 88 CF patients at a single Cystic Fibrosis Center. We also reviewed results of diagnostic colonoscopies from 27 patients aged 30-39years performed during the same time period at the Center. RESULTS The incidence of polyp detection increased markedly after age 40 in CF patients. Greater than 50% were found to have adenomatous polyps; approximately 25% had advanced adenomas as defined by size and/or histopathology; 3% were found to have colon cancer. Multivariate analysis demonstrated specific risk factors for adenoma formation and progression. CONCLUSIONS Early screening and more frequent surveillance should be considered in patients with CF due to early incidence and progression of adenomas in this patient population.
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Affiliation(s)
- David E Niccum
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, United States
| | - Joanne L Billings
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, United States
| | - Jordan M Dunitz
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, United States
| | - Alexander Khoruts
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, United States.
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91
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Keeler BD, Mishra A, Stavrou CL, Beeby S, Simpson JA, Acheson AG. A cohort investigation of anaemia, treatment and the use of allogeneic blood transfusion in colorectal cancer surgery. Ann Med Surg (Lond) 2015; 6:6-11. [PMID: 26909150 PMCID: PMC4735571 DOI: 10.1016/j.amsu.2015.12.052] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/18/2015] [Accepted: 12/19/2015] [Indexed: 01/17/2023] Open
Abstract
Introduction Preoperative identification and treatment of anaemia is advocated as part of Patient Blood Management due to the association of adverse outcome with the perioperative use of blood transfusion. This study aimed to establish the rate of anaemia identification, treatment and implications of this preoperative anaemia on ARBT use. Methods All patients who underwent elective surgery for colorectal cancer over 18 months at a single Tertiary Centre were reviewed. Electronic databases and patient casenotes were reviewed to yield required data. Results Complete data was available on 201 patients. 67% (n = 135) had haemoglobin tested at presentation. There was an inverse correlation between tumour size and initial haemoglobin (P < 0.01, Rs = −0.3). Initial haemoglobin levels were significantly lower in patients with right colonic tumours (P < 0.01). Patients who were anaemic preoperatively received a mean 0.91 units (95%CI 0–0.7) per patient which was significantly higher than non-anaemic patients (0.3 units [95%CI 0–1.3], P < 0.01). For every 1 g/dl preoperative haemoglobin increase, the likelihood of transfusion was reduced by approximately 40% (OR 0.57 [95%CI 0.458–0.708], P < 0.01). Laparoscopic surgery was associated with fewer anaemic patients transfused (P < 0.01). Conclusion Haemoglobin levels should be routinely checked at diagnosis of colorectal cancer, particularly those with large or right sided lesions. Early identification of anaemia allows initiation of treatment which may reduce transfusion risk even with modest haemoglobin rises. The correct treatment of this anaemia needs to be established. Exclusion of anaemia is underperformed during initial management of colorectal cancer. Anaemia is more frequently associated with larger diameter and right sided tumours. When identified, preoperative anaemia is undertreated. Reduction in severity of anaemia at surgery is associated with reduced transfusion requirements.
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Affiliation(s)
- Barrie D Keeler
- Division of Gastrointestinal Surgery, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK; Department of Gastrointestinal Surgery, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Amitabh Mishra
- Department of Gastrointestinal Surgery, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Christiana L Stavrou
- Division of Gastrointestinal Surgery, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - Sophia Beeby
- Division of Gastrointestinal Surgery, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - J Alastair Simpson
- Division of Gastrointestinal Surgery, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK; Department of Gastrointestinal Surgery, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Austin G Acheson
- Division of Gastrointestinal Surgery, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK; Department of Gastrointestinal Surgery, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, NG7 2UH, UK
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92
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Azimafoussé Assogba GF, Jezewski-Serra D, Lastier D, Quintin C, Denis B, Beltzer N, Duport N. Impact of subsequent screening episodes on the positive predictive value for advanced neoplasia and on the distribution of anatomic subsites of colorectal cancer: A population-based study on behalf of the French colorectal cancer screening program. Cancer Epidemiol 2015; 39:964-71. [DOI: 10.1016/j.canep.2015.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 09/14/2015] [Accepted: 09/15/2015] [Indexed: 12/22/2022]
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93
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Klein JL, Okcu M, Preisegger KH, Hammer HF. Distribution, size and shape of colorectal adenomas as determined by a colonoscopist with a high lesion detection rate: Influence of age, sex and colonoscopy indication. United European Gastroenterol J 2015; 4:438-48. [PMID: 27403311 DOI: 10.1177/2050640615610266] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 09/13/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Increasing attention is focused on polyp-related features that may contribute to the operator-dependent nature of colonoscopy. Few data on polyps are available from high-yield colonoscopies, which may serve as a benchmark for quality control. OBJECTIVES Describe regional distribution, histology, size and shape of polyps, and the influence of patient age and gender, in colonoscopies performed by a colonoscopist with high lesion detection rate. METHODS Analysis of 698 consecutive patients with diagnostic, screening or surveillance colonoscopies. RESULTS In 704 colonoscopies, 1908 polyps were removed (360 were protruded and 1548 flat; 1313 were hyperplastic, 562 adenomas, 5 serrated adenomas and 8 mixed). There were 232 adenomas in female patients and 343 in male patients; 39% of the adenomas were protruded and 61% were flat. The peak adenoma detection rate (ADR) was 51% in patients beyond age 79 years. Men older than 49 years had a higher ADR than women. In men and women, respectively: 40% and 32% of adenomas were in the right colon, 31% and 22% were in the transverse colon, and 30% and 47% were in the left colon. Beyond age 59 years, the majority of adenomas were in the proximal colon. CONCLUSIONS An excess of adenomas in the proximal colon started at age 60 and this was more pronounced in men than in women. In all colonic regions, the majority of adenomas had a shape that was flat and smaller than 6 mm.
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Affiliation(s)
- Johannes L Klein
- Department of Gastroenterology and Hepatology, Medical University Graz, Graz, Austria
| | - Murat Okcu
- Institut für morphologische Analytik und Humangenetik, Graz, Austria
| | - Karl H Preisegger
- Institut für morphologische Analytik und Humangenetik, Graz, Austria
| | - Heinz F Hammer
- Department of Gastroenterology and Hepatology, Medical University Graz, Graz, Austria; Privatklinik Kastanienhof, Graz, Austria
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94
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Nistal E, Fernández-Fernández N, Vivas S, Olcoz JL. Factors Determining Colorectal Cancer: The Role of the Intestinal Microbiota. Front Oncol 2015; 5:220. [PMID: 26528432 PMCID: PMC4601259 DOI: 10.3389/fonc.2015.00220] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 09/24/2015] [Indexed: 12/26/2022] Open
Abstract
The gastrointestinal tract, in particular the colon, holds a complex community of microorganisms, which are essential for maintaining homeostasis. However, in recent years, many studies have implicated microbiota in the development of colorectal cancer (CRC), with this disease considered a major cause of death in the western world. The mechanisms underlying bacterial contribution in its development are complex and are not yet fully understood. However, there is increasing evidence showing a connection between intestinal microbiota and CRC. Intestinal microorganisms cause the onset and progression of CRC using different mechanisms, such as the induction of a chronic inflammation state, the biosynthesis of genotoxins that interfere with cell cycle regulation, the production of toxic metabolites, or heterocyclic amine activation of pro-diet carcinogenic compounds. Despite these advances, additional studies in humans and animal models will further decipher the relationship between microbiota and CRC, and aid in developing alternate therapies based on microbiota manipulation.
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Affiliation(s)
- Esther Nistal
- Instituto de Biomedicina (IBIOMED), Universidad de León , León , Spain
| | | | - Santiago Vivas
- Instituto de Biomedicina (IBIOMED), Universidad de León , León , Spain ; Gastroenterología, Hospital Universitario de León , León , Spain
| | - José Luis Olcoz
- Gastroenterología, Hospital Universitario de León , León , Spain
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95
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Rawłuszko-Wieczorek AA, Horst N, Horbacka K, Bandura AS, Świderska M, Krokowicz P, Jagodziński PP. Effect of DNA methylation profile on OATP3A1 and OATP4A1 transcript levels in colorectal cancer. Biomed Pharmacother 2015; 74:233-42. [PMID: 26349991 DOI: 10.1016/j.biopha.2015.08.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 08/06/2015] [Indexed: 01/17/2023] Open
Abstract
Epidemiological studies indicate that 17β-estradiol (E2) prevents colorectal cancer (CRC). Organic anion transporting polypeptides (OATPs) are involved in the cellular uptake of various endogenous and exogenous substrates, including hormone conjugates. Because transfer of estrone sulfate (E1-S) can contribute to intra-tissue conversion of estrone to the biologically active form -E2, it is evident that the expression patterns of OATPs may be relevant to the analysis of CRC incidence and therapy. We therefore evaluated DNA methylation and transcript levels of two members of the OATP family, OATP3A1 and OATP4A1, that may be involved in E1-S transport in colorectal cancer patients. We detected a significant reduction in OATP3A1 and a significant increase in OATP4A1 mRNA levels in cancerous tissue, compared with histopathologically unchanged tissue (n=103). Moreover, we observed DNA hypermethylation in the OATP3A1 promoter region in a small subset of CRC patients and in HCT116 and Caco-2 colorectal cancer cell lines. We also observed increased OATP3A1 transcript following treatment with 5-aza-2-deoxycytidine and sodium butyrate. The OATP4A1 promoter region was hypomethylated in analyzed tissues and CRC cell lines and was not affected by these treatments. Our results suggest a potential mechanism for OATP3A1 downregulation that involves DNA methylation during colorectal carcinogenesis.
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Affiliation(s)
| | - Nikodem Horst
- Department of General and Colorectal Surgery, Poznań University of Medical Sciences, Poland
| | - Karolina Horbacka
- Department of General and Colorectal Surgery, Poznań University of Medical Sciences, Poland
| | - Artur Szymon Bandura
- Department of Biochemistry and Molecular Biology, Poznań University of Medical Sciences, Poland
| | - Monika Świderska
- Department of Biochemistry and Molecular Biology, Poznań University of Medical Sciences, Poland
| | - Piotr Krokowicz
- Department of General and Colorectal Surgery, Poznań University of Medical Sciences, Poland
| | - Paweł Piotr Jagodziński
- Department of Biochemistry and Molecular Biology, Poznań University of Medical Sciences, Poland.
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96
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Patel GS, Ullah S, Beeke C, Hakendorf P, Padbury R, Price TJ, Karapetis CS. Association of BMI with overall survival in patients with mCRC who received chemotherapy versus EGFR and VEGF-targeted therapies. Cancer Med 2015. [PMID: 26211512 PMCID: PMC4618617 DOI: 10.1002/cam4.490] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Although a raised body mass index (BMI) is associated with increased risk of colorectal cancer (CRC) and recurrence after adjuvant treatment, data in the metastatic setting is limited. We compared overall survival (OS) across BMI groups for metastatic CRC, and specifically examined the effect of BMI within the group of patients treated with targeted therapies (TT). Retrospective data were obtained from the South Australian Registry for mCRC from February 2006 to October 2012. The BMI at first treatment was grouped as underweight <18.5 kg/m2, Normal = 18.5 to <25 kg/m2, Overweight = 25 to <30 kg/m2, Obese I = 30 to <35 kg/m2, Obese II ≥35 kg/m2. Of 1174 patients, 42 were underweight, 462 overweight, 175 Obese I, and 77 Obese II. The OS was shorter for patients who were underweight and overweight compared to normal (OS 13.7 and 22.3 vs. 24.1 months, respectively, hazard ratio [HR] 2.21 and 1.23). The adjusted median OS was longer for normal versus overweight or obese I patients receiving chemotherapy + targeted therapy (35.7 vs 25.1 or 22.8 months, HR 1.59 and 1.63, respectively) with no difference in OS for chemotherapy alone. On breakdown by type of targeted therapy, overweight and obese I patients had a poorer outcome with Bevacizumab. The BMI is predictive of a poorer outcome for underweight and overweight patients in the whole population. Of those receiving chemotherapy and targeted therapy, BMI is an independent predictor for OS for overweight and obese I patients, specifically for those treated with Bevacizumab. Patients who are overweight or obese (group I) may be a target group for lifestyle and nutrition advice to improve OS with TT.
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Affiliation(s)
- Gargi S Patel
- Department of Medical Oncology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Shahid Ullah
- Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Carol Beeke
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia
| | - Paul Hakendorf
- Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Robert Padbury
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia.,Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Timothy J Price
- Department of Medical Oncology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Christos S Karapetis
- Department of Medical Oncology, Flinders Medical Centre, Adelaide, South Australia, Australia.,Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia
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97
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Cai B, Wang MY, Liao K, Xu YS, Wei WY, Zhuang Y, Zhang S. Distribution characteristics of 3,369 chinese colorectal cancer patients for gender, age, location and tumor size during colonoscopy. Asian Pac J Cancer Prev 2015; 15:8951-5. [PMID: 25374235 DOI: 10.7314/apjcp.2014.15.20.8951] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies have shown the existence of gender- and age-related differences in the incidence and anatomic distribution of colorectal cancers. The purposes of this study were to analyze the distribution characteristics of colorectal cancer patients regarding gender, age, location and tumor size in the course of colonoscopy. MATERIALS AND METHODS All colorectal cancer patients who underwent colonoscopy in the First Affiliated Hospital of Guangxi Medical University from 2003 to 2012 were included in our retrospective study. Demographic information (age and gender) and colonoscopy report information (tumor size and location) were collected and analyzed. To compare the gender differences in tumor location and tumor size, as well as the size differences in tumor location, the chi-square test was used. RESULTS A total of 3, 369 colorectal cancer patients (2, 007 men vs 1, 362 women) were included in our study. Statistical analysis showed there was no gender difference in the anatomic distribution of the tumors (p>0.05). However, there was a gender difference in tumor size (p>0.05). In addition, our study found there was a significant difference in tumor size between rectal and colon tumors (p>0.001). CONCLUSIONS There was no gender difference in the anatomic distribution of colorectal tumors. In addition, tumors observed in men were larger than in women.
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Affiliation(s)
- Bin Cai
- Department of Colorectal Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China E-mail :
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98
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Reproductive and hormonal factors and mortality among women with colorectal cancer in the NIH-AARP Diet and Health Study. Br J Cancer 2015; 113:562-8. [PMID: 26103572 PMCID: PMC4522633 DOI: 10.1038/bjc.2015.224] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/12/2015] [Accepted: 05/21/2015] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Although use of menopausal hormone therapy (MHT) and some reproductive factors have been associated with colorectal cancer (CRC) risk, relations between these factors and survival after CRC diagnosis are unclear. METHODS Among 2053 post-menopausal women diagnosed with incident CRC in the NIH-AARP Diet and Health Study, we calculated hazard ratios (HRs) and 95% confidence intervals (CIs) using multivariable Cox proportional hazards regression to test associations between oral contraceptive (OC) use, menarche age, age at first birth, parity, menopausal age, and MHT use with all-cause and CRC-specific mortality. RESULTS There were 759 deaths (332 CRC-related deaths) over a median follow-up of 7.7 years. We observed no statistically significant associations between OC use, menarche age, age at first birth, parity, menopausal age, and mortality. Compared with never MHT use, former use was not associated with mortality, but we found an inverse association among baseline current users, for both all-cause (HR=0.79, 95% CI 0.66-0.94) and CRC mortality (0.76, 0.59-0.99). CONCLUSION Future studies should further focus on the mechanisms by which exogenous oestrogen exposure might affect tumour progression and CRC survival.
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99
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Abstract
Colorectal cancer is one of the most common causes of cancer morbidity both in men and in women. However, females over 65 years old show higher mortality and lower 5-year survival rate of colorectal cancer compared to their age-matched male counterparts. The objective of this review is to suggest gender-based innovations to improve colorectal cancer outcomes in females. Women have a higher risk of developing right-sided (proximal) colon cancer than men, which is associated with more aggressive form of neoplasia compared to left-sided (distal) colon cancer. Despite differences in tumor location between women and men, most of scientific researchers do not consider sex specificity for study design and interpretation. Also, colorectal cancer screening guidelines do not distinguish females from male, which may explain the higher frequency of more advanced neoplasia when tumors are first detected and false negative results in colonoscopy in females. Moreover, socio-cultural barriers within females are present to delay screening and diagnosis. Few studies, among studies that included both men and women, have reported sex-specific estimates of dietary risk factors which are crucial to establish cancer prevention guidelines despite sex- and gender-associated differences in nutrient metabolism and dietary practices. Furthermore, anti-cancer drug use for colorectal cancer treatment can cause toxicity to the reproductive system, and gender-specific recurrence and survival rates are reported. Therefore, by understanding sex- and gender-related biological and socio-cultural differences in colorectal cancer risk, gender-specific strategies for screening, treatment and prevention protocols can be established to reduce the mortality and improve the quality of life.
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Affiliation(s)
- Sung-Eun Kim
- Sung-Eun Kim, Jung Eun Lee, Mi-Kyung Sung, Department of Food and Nutrition, Sookmyung Women's University, Seoul 140-742, South Korea
| | - Hee Young Paik
- Sung-Eun Kim, Jung Eun Lee, Mi-Kyung Sung, Department of Food and Nutrition, Sookmyung Women's University, Seoul 140-742, South Korea
| | - Hyuk Yoon
- Sung-Eun Kim, Jung Eun Lee, Mi-Kyung Sung, Department of Food and Nutrition, Sookmyung Women's University, Seoul 140-742, South Korea
| | - Jung Eun Lee
- Sung-Eun Kim, Jung Eun Lee, Mi-Kyung Sung, Department of Food and Nutrition, Sookmyung Women's University, Seoul 140-742, South Korea
| | - Nayoung Kim
- Sung-Eun Kim, Jung Eun Lee, Mi-Kyung Sung, Department of Food and Nutrition, Sookmyung Women's University, Seoul 140-742, South Korea
| | - Mi-Kyung Sung
- Sung-Eun Kim, Jung Eun Lee, Mi-Kyung Sung, Department of Food and Nutrition, Sookmyung Women's University, Seoul 140-742, South Korea
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100
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Kim SE, Paik HY, Yoon H, Lee JE, Kim N, Sung MK. Sex- and gender-specific disparities in colorectal cancer risk. World J Gastroenterol 2015; 21:5167-5175. [PMID: 25954090 PMCID: PMC4419057 DOI: 10.3748/wjg.v21.i17.5167] [Citation(s) in RCA: 283] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 02/26/2015] [Accepted: 03/31/2015] [Indexed: 02/07/2023] Open
Abstract
Colorectal cancer is one of the most common causes of cancer morbidity both in men and in women. However, females over 65 years old show higher mortality and lower 5-year survival rate of colorectal cancer compared to their age-matched male counterparts. The objective of this review is to suggest gender-based innovations to improve colorectal cancer outcomes in females. Women have a higher risk of developing right-sided (proximal) colon cancer than men, which is associated with more aggressive form of neoplasia compared to left-sided (distal) colon cancer. Despite differences in tumor location between women and men, most of scientific researchers do not consider sex specificity for study design and interpretation. Also, colorectal cancer screening guidelines do not distinguish females from male, which may explain the higher frequency of more advanced neoplasia when tumors are first detected and false negative results in colonoscopy in females. Moreover, socio-cultural barriers within females are present to delay screening and diagnosis. Few studies, among studies that included both men and women, have reported sex-specific estimates of dietary risk factors which are crucial to establish cancer prevention guidelines despite sex- and gender-associated differences in nutrient metabolism and dietary practices. Furthermore, anti-cancer drug use for colorectal cancer treatment can cause toxicity to the reproductive system, and gender-specific recurrence and survival rates are reported. Therefore, by understanding sex- and gender-related biological and socio-cultural differences in colorectal cancer risk, gender-specific strategies for screening, treatment and prevention protocols can be established to reduce the mortality and improve the quality of life.
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