Colorectal cancer statistics, 2023

Comprehensive analysis of the critical role of the epithelial mesenchymal transition subtype - TAGLN-positive fibroblasts in colorectal cancer progression and immunosuppression

Epithelial-mesenchymal transition (EMT) plays a pivotal role in tumor metastasis and immune suppression in colorectal cancer (CRC). However, the specific mechanisms of EMT and its relationship with the clinical prognosis and immunotherapy response in CRC patients remain unclear. In this study, we identified TAGLN-positive fibroblasts (TAGLN⁺Fib) as a cancer-associated fibroblast (CAF) subtype within the tumor microenvironment (TME) that promotes tumor metastasis and immune evasion. High EMT scores, strongly associated with TAGLN expression, were correlated with advanced tumor stages, poor prognosis, and resistance to immunotherapy. Functional experiments demonstrated that TAGLN knockdown significantly reduced CRC cell proliferation, migration, and EMT phenotypes in vitro and suppressed tumor growth in vivo. Furthermore, TAGLN⁺Fib closely interacted with MMP7-positive tumor epithelial cells and SPP1-positive macrophages, forming a pro-metastatic and immunosuppressive network. An EMT-TME risk model constructed using TAGLN⁺Fib exhibited robust predictive power for CRC prognosis and immunotherapy response. This study reveals the association of EMT scores with CRC prognosis and immunotherapy response, highlights TAGLN⁺Fib's critical role in tumor progression, and develops an EMT-TME risk model, offering insights for personalized CRC treatment and precision medicine.

Combined therapy with DR5-targeting antibody-drug conjugate and CDK inhibitors as a strategy for advanced colorectal cancer

Targeted therapies for advanced microsatellite stable (MSS) subtype colorectal cancer (MSS-CRC) remain a clinical challenge. Here, we show that death receptor 5 (DR5) is elevated in both MSS and microsatellite instability-high (MSI-H) colorectal cancer (CRC) cohorts, highlighting its potential as a clinical target. Oba01, a clinical-stage DR5-targeting antibody-drug conjugate (ADC) delivering the microtubule-disrupting agent monomethyl auristatin E (MMAE), shows superior efficacy in CRC cell lines, patient-derived xenografts and their corresponding organoids, irrespective of MSS or MSI-H status. Importantly, our functional multi-omics analysis reveals that the cell cycle pathway and cyclin-dependent kinases (CDKs) are key synergistic targets of Oba01's tumor-killing activity. We further show that Oba01 synergizes with the Food and Drug Administration (FDA)-approved CDK inhibitor abemaciclib in clinically relevant in vivo models. This synergy is also observed with other CDK inhibitors, underscoring the potential of combining Oba01 with CDK inhibition as a therapeutic strategy for advanced CRC, particularly the refractory MSS subtype.

The efficacy of retrograde and antegrade enemas in the management of low anterior resection syndrome in patients undergoing rectal resection: a systematic review and meta-analysis

BACKGROUND

Rectal resection could potentially cause low anterior resection syndrome (LARS). Although recent studies have reported the efficacy of enema against LARS, no systematic review and meta-analysis has been conducted.

METHODS

A systematic search was conducted in PubMed, EMBASE, MEDLINE, CINAHL Complete, Cochrane library and Web of Science. Eligible studies that quantified the effect of enema vs. other approaches on LARS following rectal resection were selected. Meta-analysis was conducted by using RevMan 5.4 software and StataMP 17. Where meta-analysis was not possible, vote counting was performed.

RESULTS

This study comprised five RCTs with 159 participants and meta-analysis was performed in 4 studies. Compared with the control group, enema reduced LARS score with mean differences of -10.84 (95% CI: -16.71 to -4.98, P = 0.0003). Subgroup analysis based on the type of enema were performed, with three European studies using retrograde enema and one Asian study using antegrade enema, with mean differences of -13.77 (95% CI: -17.97 to -9.57, P < 0.00001) and -4.86 (95% CI: -9.26 to -0.46, P = 0.03), respectively. According to follow-up period, two trials reported short-term effects and the other two investigated medium/long-term effects with mean differences of -14.22 (95% CI: -20.05 to -8.38, P = 0.23) and -7.59 (95% CI: -14.47 to -0.71, P = 0.13), respectively. One study that used antegrade enema was key contributor to the substantial interstudy heterogeneity by the leave-one-out sensitivity analysis. After exclusion of this study, no heterogeneity was found (t2 = 0.00; χ2 = 1.63, df = 2, p = 0.44; I2 = 0%). Vote counting also showed positive effects of enema on LARS.

CONCLUSIONS

Enema, particularly retrograde enema, is effective in managing LARS. However, the effectiveness of antegrade enema deserves further investigation. The short-term effects of enema are more pronounced compared to long-term outcomes. Due to the limited number of included studies, these findings should be taken cautiously. More RCTs on other continents are needed to validate the impact of enema on LARS, as well as to develop standardised protocols to facilitate clinical practice.

PROSPERO REGISTRATION

CRD42024539973.

Fusobacterium nucleatum enhances cholesterol biosynthesis in colorectal cancer via miR-130a-3p-mediated AMPK inhibition, a process counteracted by butyrate

Fusobacterium nucleatum (Fn) has been implicated in various diseases, including colorectal cancer (CRC). This study elucidates Fn's contribution to cholesterol synthesis and the underlying link with CRC, as well as butyrate's counteracting effects in this process. Cells and mouse models were treated with Fn followed/accompanied by butyrate treatments to investigate the interplay between butyrate and Fn's oncogenic properties. Transcriptomics analysis pinpointed Fn's profound impact on cholesterol biosynthesis genes and pathways. Fn treatment upregulated the expression of genes involved in cholesterol synthesis (FDPS, FDFT1, and SQLE) and increased SREBF2 activity in cells and mouse intestines, elevating cholesterol levels in cells, intestines, and sera. Fn upregulated miR-130a-3p, identified through transcriptomics and target prediction, through nuclear factor-κB activation. miR-130a-3p subsequently downregulated AMPKα/β1 expression to activate SREBF2 and upregulate cholesterol biosynthesis genes. These effects were predominantly mitigated by butyrate. Notably, analysis of TCGA data revealed that fusobacterial abundance correlated significantly with the expression of FDPS, FDFT1, SQLE, and AMPKα/β1 in CRC. Fn abundance and miRNA expression in human stools were quantified using qPCR and RT-qPCR. Fecal miR-130a-3p levels increased progressively from normal subjects through adenoma patients to CRC patients, correlating significantly with fecal Fn abundance. Additionally, heightened fecal Fn abundance was associated with an increased incidence of hypercholesterolemia in CRC patients. Fn promotes cholesterol biosynthesis by upregulating miR-130a-3p, which downregulates AMPK proteins and activates SREBF2. This study highlights the influence of gut bacteria on host cholesterol synthesis. Targeted modulation of gut microbiota to reduce cholesterol may represent a promising preventive strategy for CRC.

Experimental toolkit to study the oncogenic role of WNT signaling in colorectal cancer

Colorectal cancer (CRC) is linked to the WNT/β-catenin signaling as its primary driver. Aberrant activation of WNT/β-catenin signaling is closely correlated with increased incidence, malignancy, poorer prognosis, and even higher cancer-related death. Research over the years has postulated various experimental models that have facilitated an understanding of the complex mechanisms underlying WNT signaling in CRC. In the present review, we have comprehensively summarized the in vitro, in vivo, patient-derived, and computational models used to study the role of WNT signaling in CRC. We discuss the use of CRC cell lines and organoids in capturing the molecular intricacies of WNT signaling and implementing xenograft and genetically engineered mouse models to mimic the tumor microenvironment. Patient-derived models, including xenografts and organoids, provide valuable insights into personalized medicine approaches. Additionally, we elaborated on the role of computational models in simulating WNT signaling dynamics and predicting therapeutic outcomes. By evaluating the advantages and limitations of each model, this review highlights the critical contributions of these systems to our understanding of WNT signaling in CRC. We emphasize the need to integrate diverse model systems to enhance translational research and clinical applications, which is the primary goal of this review.

Associations of pretreatment emotional distress with adherence to therapy for patients with locally advanced rectal cancer: a post hoc analysis of the Chinese FOWARC phase 3 randomized clinical trial

BACKGROUND

Non-adherence in advanced rectal cancer therapy is common and severely impairs clinical outcomes. Although behavioral research suggests emotional factors influence adherence, limited evidence links pretreatment emotional distress (PED) to treatment adherence in rectal cancer patients.

METHODS

This post hoc analysis of a phase 3 randomized clinical trial was conducted from June 9, 2010, to February 15, 2015, involving 219 patients (assigned to receive neoadjuvant therapy with fluorouracil plus radiotherapy [group A, 67 patients], modified fluorouracil, leucovorin, and oxaliplatin [mFOLFOX6] plus radiotherapy [group B, 66 patients], or mFOLFOX6 alone [group C, 86 patients] followed by TME resection and postoperative adjuvant chemotherapy) with locally advanced rectal cancer from the main center. The PED of patients was measured through the emotional dimension items in the Quality of Life Questionnaire-Core Questionnaire (QLQ-C30). The primary outcome was adherence to therapy, with non-adherence defined as patients in groups A and B receiving fewer than ten cycles of chemotherapy or less than 37 Gy of radiotherapy, and patients in group C receiving fewer than ten cycles of chemotherapy. Multivariable logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for adherence by PED levels. Additionally, the structural equation model (SEM) was utilized to analyze the impact pathways of PED on adherence.

RESULTS

Among the 219 patients (142 men; mean age, 53.4 years) who completed the QLQ-C30 scale, 27.8% (61/219) demonstrated non-adherence to the treatment regimen. Multivariable analyses showed that each 1-point increase in PED score raised non-adherence risk by 4.37 times (OR: 4.37, 95% CI: 1.92-9.96, P < 0.001). The SEM analysis revealed that PED score was positively correlated with the risk of non-adherence (standardized regression coefficients [β] = 0.25, 95% CI: 0.11 to 0.28), while economic burden was positively correlated with PED (β = 0.17, 95% CI: 0.11 to 0.28), and could indirectly affect adherence through PED (β = 0.04, 95% CI: 0.01 to 0.09).

CONCLUSIONS

Higher levels of pretreatment emotional distress were associated with an increased risk of treatment non-adherence, thereby highlighting the potential significance of addressing emotional distress in cancer management.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT01211210.

Bioengineered Tumor-Derived Extracellular Vehicles Suppressed Colorectal Cancer Liver Metastasis and Bevacizumab Resistance

Antiangiogenic therapies, such as bevacizumab, are among the causes of cancer-related death in patients with colorectal cancer (CRC) with liver metastasis. Delivering siRNAs via primary cell originating from primary cells is a promising method for targeting CRC liver metastasis and drug resistance. Here, it is found that the expression of CCL24 is significantly upregulated in tumor tissues at the CRC liver metastasis site. In addition, CCL24 is significantly upregulated in tumor tissues from bevacizumab-resistant patients. CCL24 promotes the formation of inflammatory tumor-associated fibroblast subsets in the CRC liver metastasis microenvironment and induces resistance to bevacizumab therapy. Based on these results, a primary cell-derived extracellular vehicle delivery system is designed for the simultaneous delivery of siRNAs targeting CCL24 in the tumor microenvironment (TME). Downregulation of CCL24 in the TME by delivering bioengineered extracellular vehicles significantly increased sensitivity to antiangiogenic therapy in a CRC mouse model. A novel therapeutic target is identified for patients with CRC with liver metastasis and suggested a possible therapeutic alternative for patients with CRC with resistance to antiangiogenic therapy and distant metastasis.

Gut microbiome and colorectal cancer: From pathogenesis to treatment

Colorectal cancer (CRC) continues to rank among the most prevalent cancers worldwide. A growing body of research indicates that the microbiome significantly influences the onset, development, and progression of CRC, in addition to affecting the efficacy of various systemic therapies. The composition of the microbiome, shaped by factors such as bacterial strains, geography, ethnicity, gender, and dietary habits, provides essential information for CRC screening, early diagnosis, and the prediction of treatment responses. Modulating the microbiome presents a highly promising medical strategy for improving individual health. This review aims to present a thorough overview of recent research concerning the interplay between host microbiota and CRC, along with its implications for screening and the immune response against tumors in the context of cancer treatment.

Immunotherapy in microsatellite-stable colorectal cancer: Strategies to overcome resistance

Colorectal cancer (CRC) is among the foremost causes of cancer-related mortality worldwide; however, individuals with microsatellite-stable (MSS) disease-who constitute most CRC diagnoses-derive limited benefit from existing immunotherapeutic approaches. Here, we outline emerging methods designed to address the inherent resistance of MSS CRC to immune checkpoint inhibitors (ICIs). Recent findings emphasize how the immunosuppressive tumor microenvironment (TME) in MSS CRC, marked by diminished immunogenicity and high levels of regulatory T cells and myeloid-derived suppressor cells, restricts effective antitumor immune activity. Combination regimens that merge ICIs with chemotherapy, anti-angiogenic agents, or targeted blockade of pathways such as TGF-β and VEGF have shown encouraging early outcomes, including enhanced antigen presentation and T-cell penetration. Novel immunomodulatory platforms-such as epigenetic modifiers, oncolytic viruses, and engineered probiotic vaccines-are under assessment to further reprogram the TME and boost therapeutic efficacy. Concurrently, progress in adoptive cell therapies (for example, chimeric antigen receptor (CAR) T cells) and the development of cancer vaccines targeting tumor-associated and neoantigens promise to extend immune control over MSS CRC. In parallel, improving patient selection through predictive biomarkers-from circulating tumor DNA (ctDNA) to gene expression signatures and specific molecular subtypes-could refine individualized treatment strategies. Finally, interventions that alter the gut microbiome, including probiotics and fecal transplantation, serve as complementary tools to strengthen ICI responses. Taken together, these insights and combined treatment strategies lay the foundation for more successful immunotherapeutic interventions in MSS CRC, ultimately aiming to provide sustained clinical benefits to a broader spectrum of patients.

Pre-diagnostic Demographic, Lifestyle, and Health History Factors in Association with Secreted Protein Acidic and Rich in Cysteine (SPARC) Expression in Colorectal Cancer Tissue

Background

Demographic, health history, and lifestyle factors have been associated with prognosis of colorectal cancer (CRC), but mechanisms underlying these associations remain poorly understood. A compelling mechanism involves changes in expression of tumor markers that influence treatment outcomes, such as secreted protein acidic and rich in cysteine (SPARC), lower levels of which have previously been associated with poorer CRC prognosis.

Objective

We explored the association of factors that have been previously associated with CRC prognosis with expression of SPARC in tumor tissues.

Design

We conducted a prospective evaluation of 50 participants of a longitudinal cohort study that went on to develop CRC.

Methods

Tumor and normal tissue cores were taken from formalin-fixed paraffin-embedded (FFPE) blocks of incident CRC cases and were used to create tissue microarrays (TMAs). Slides created from the TMAs were stained with SPARC antibodies and analyzed to calculate H-scores for both epithelial and non-epithelial components of tumor and normal tissues. H-scores were ln-transformed and analyzed in association with demographic, lifestyle, and health history factors assessed before cancer diagnosis using linear regression models.

Results

In CRC tumor epithelium, smoking was associated with a 0.53-fold lower level of SPARC expression (P = .054). Higher income was associated with a 1.33-fold greater level of SPARC expression in tumor non-epithelial tissue (P = .041). Higher cancer stage was associated with a 0.74-fold lower level of non-epithelial tumor SPARC expression (P = .040). In the epithelial component of normal colorectal tissues, higher fruit consumption was associated with a 2.74-fold greater SPARC H-score (P = .002).

Conclusions

The associations we observed for smoking, income, and cancer stage with SPARC in tumor tissue are consistent with previously established associations of these factors with CRC prognosis. Larger studies with prognostic data are needed, but our results suggest that differences in SPARC expression may contribute to previously observed impacts of various factors on CRC prognosis.

A Digital Score Based on Circulating-Tumor-Cells-Derived mRNA Quantification and Machine Learning for Early Colorectal Cancer Detection

Circulating tumor cells (CTCs) serve as valuable biomarkers in tumor circulation, carrying essential primary tumor information. The purification of CTCs from peripheral blood samples and the analysis of their characteristic molecules enable the detection of tumors at an early stage. The noninvasive, continuous, real-time dynamic monitoring provides a promising solution for the timely diagnosis of colorectal cancer (CRC). In this study, we developed a minimally invasive method for CRC early detection to enable accurate screening in a friendly manner for individuals who generally require colonoscopy. The dual-antibody (i.e., anti-EpCAM and anti-EGFR) modified antifouling hydrogel-coated magnetic nanoparticles (pSBMA-MNPs) were prepared for efficient and specific CTC purification. Then, the quantification of 6 RNA transcripts in purified CRC CTCs was performed via droplet digital PCR (ddPCR), and a CRC score was calculated using an extreme gradient boosting model to distinguish CRC from colon polyps and adenomas. A pilot study was conducted to evaluate the clinical potential of the CRC CTC RNA assay in a training cohort (n = 101) and an independent test cohort (n = 65), achieving a diagnostic accuracy of 91.0% in the whole cohort, significantly outperforming serum CEA, CA125, and CA199. Subgroup analysis across CRC stage, age, and tumor location of patients was also performed, and the CRC score exhibited robust performance, demonstrating commendable diagnostic efficacy for CRC detection and promising application in friendly screening individuals that really require colonoscopy.

Patterns of care in patients with asymptomatic stage IV colon cancer: A population-based analysis

BACKGROUND

Currents guidelines recommend chemotherapy with or without biologic agents for asymptomatic stage IV colon cancer treatment, whereas primary tumor resection is reserved for symptomatic tumors or resectable metastases. However, US treatment patterns are understudied. Our study aims to identify real-world treatment patterns for asymptomatic metastatic colon cancer.

METHODS

Adults with asymptomatic metastatic colon cancer were identified in the 2014 Surveillance, Epidemiology, and End Results Patterns of Care database and categorized into 6 groups: chemotherapy with or without biologic agents, chemotherapy with or without biologic agents with primary tumor resection and metastasectomy, chemotherapy with or without biologic agents and primary tumor resection alone, primary tumor resection only, no treatment, or other treatments. Multinomial logistic regression was used to examine factors associated with receiving each treatment modality. Cox proportional hazard models were used to assess the relationships between treatments and survival.

RESULTS

Among 1,717 weighted patient cases, 28% received chemotherapy with or without biologic agents, 23% chemotherapy with or without biologic agents with primary tumor resection, 12% chemotherapy with or without biologic agents with primary tumor resection and metastasectomy, 12% primary tumor resection only, 23% no treatment, and 2% other treatment. Younger patients were more likely to receive chemotherapy with or without biologic agents with primary tumor resection and metastasectomy than chemotherapy with or without biologic agents alone (odds ratio, 3.32; 95% confidence interval, 1.3-8.6) and less likely to undergo no treatment (odds ratio, 0.05; 95% confidence interval, 0.02-0.17). Patients treated by chemotherapy with or without biologic agents with primary tumor resection and metastasectomy had the greatest median survival of 61 months, whereas those with no treatment had a 1-month median survival.

CONCLUSION

Almost one quarter of patients with asymptomatic stage IV colon cancer received no treatment. Meanwhile, 12% of patients underwent curative systemic and surgical treatment, which was associated with a median survival of 5 years, validating reported outcomes of this approach by institutional studies. These data provide an important benchmark for future interventions pertaining to asymptomatic patients with stage IV colon cancer.

Norcantharidin promotes M1 macrophage polarization and suppresses colorectal cancer growth

Colorectal cancer (CRC) is characterized by an immunosuppressive and inflammatory microenvironment, thus responds poorly to therapy. Previous studies show that norcantharidin (NCTD), a demethylated cantharidin (CTD) derived from Mylabris, exerts high efficacy in treating various cancers. In this study we investigated the antitumor effects of NCTD against CRC and the underlying mechanisms. Subcutaneous CRC models were established in balb/c mice using mouse colorectal cancer cell line CT26 and in balb/c nude mice using human colorectal cancer cell line HCT116. The mice were administered NCTD (2 or 4 mg·kg-1·d-1, i.p.) for 14 days. We showed that NCTD dose-dependently reduced the tumor growth in both the CRC models. Furthermore, NCTD markedly increased M1 macrophage infiltration in tumor tissue in both the CRC models. NCTD-induced macrophage M1 polarization was confirmed by flow cytometry and qPCR assays in both THP-1 cell-derived and RAW264.7 macrophage models in vitro. We demonstrated that NCTD (20, 40 μM) dose-dependently increased CSF2 secretion from CRC cells and macrophages, and suppressed the JAK2/STAT3 signaling pathway in CRC cells. Concurrently, NCTD (10-40 μM) dose-dependently inhibited CRC cell proliferation, invasion and migration in vitro. In conclusion, this study provides new evidence for the effects of NCTD against CRC and elucidates its antitumor mechanisms through remodeling the inflammatory microenvironment via CSF2-mediated macrophage M1 polarization and inhibiting JAK2/STAT3 phosphorylation in CRC cells.

ML210 Antagonizes ABCB1- Not ABCG2-Mediated Multidrug Resistance in Colorectal Cancer

Objectives: ABCB1-mediated multidrug resistance (MDR) compromises chemotherapy efficacy in colorectal cancer (CRC). Despite decades of research, no selective ABCB1 inhibitor has achieved clinical success. This study investigates ML210 as a novel ABCB1-specific inhibitor to reverse ABCB1-driven MDR. Methods: Cytotoxicity assays (MTT) were performed on ABCB1-overexpressing HCT-8/V and ABCG2-overexpressing S1-M1-80 CRC cells. Drug accumulation (doxorubicin/mitoxantrone) was quantified via flow cytometry, and cell cycle effects were analyzed using propidium iodide staining. Molecular docking utilized the ABCB1 crystal structure. Results: ML210 selectively reversed ABCB1-mediated resistance to doxorubicin and vincristine in HCT-8/V cells, enhancing intracellular drug accumulation without affecting ABCG2 activity. It induced cell cycle arrest in ABCB1-overexpressing cells and did not alter ABCB1 protein expression. Molecular docking revealed stable binding of ML210 within the ABCB1 substrate pocket through hydrophobic interactions and hydrogen bonding. Conclusions: ML210 is a selective ABCB1 inhibitor that circumvents MDR via direct transport blockade, offering a targeted strategy against ABCB1-mediated chemoresistance in CRC. Its specificity for ABCB1 over ABCG2 highlights potential clinical advantages.

Targeted Therapy and Immunotherapy in Elderly Patients with Metastatic Colorectal Cancer

OPINION STATEMENT

At initial diagnosis, over half of the patients with metastatic colorectal cancer (mCRC) are aged 65 years or older. In this population, age-related declines in organ reserve and the presence of comorbidities can significantly weaken drug tolerance and affect treatment outcomes. However, existing clinical guidelines, largely based on clinical trials involving younger, fitter adults, may not be fully applicable to older patients, particularly those are vulnerable. Moreover, chronologic age and commonly used performance assessment tools, such as the Eastern Cooperative Oncology Group and Karnofsky Performance Status scores, are insufficient for accurate evaluation of physiological fitness in older adults. To provide evidence-based references for clinicians, this review summarizes advances in targeted therapy and immunotherapy for elderly patients with mCRC over the past five years, with a focus on vascular endothelial growth factor (VEGF) targeting agents, epidermal growth factor receptor (EGFR) inhibitors, multi-targeted tyrosine kinase inhibitors (TKIs) and single-agent immunotherapy. Overall, for elderly patients assessed as fit, first-line treatment may include dose-reduced doublet chemotherapy combined with VEGF targeting agents, or alternatively, single-agent chemotherapy plus VEGF targeting agents. For vulnerable elderly patients with mCRC, single-agent chemotherapy with VEGF targeting agents remains the preferred first-line strategy, while RAS wild-type left-sided tumors may benefit from single-agent chemotherapy plus EGFR inhibitors. Although multi-targeted TKIs have shown positive outcomes in elderly patients who are intolerant to other therapies. There is currently no evidence supporting their use in first-line treatment or combination therapy. In terms of immunotherapy, similar to the general mCRC population, single-agent immunotherapy is recommended as a first-line option for elderly microsatellite instability-high/mismatch repair-deficient patients. Notably, integrating comprehensive geriatric assessment into clinical practice can facilitate personalized treatment strategies, particularly for vulnerable and frail patients.

Deciphering the interaction between the expression of LRP2 served as a mitochondrial metabolism-related gene and prognosis in colon cancer integrating multi-omics analysis

BACKGROUND

Colon adenocarcinoma (COAD) is increasingly prevalent among patients under 50 years old, and the 5-year survival rate for patients with metastasis is less than 20%. Identifying significant biomarkers and therapeutic targets is crucial. We investigated the expression of LRP2 in COAD and its prognostic value utilizing single-cell sequencing and transcriptomics datasets, which was conducted preliminary validation at the patient samples and cellular levels as well.

METHODS

Based on differential gene expression of tumor samples and normal tissues in The Cancer Genome Atlas (TCGA), we performed consensus clustering, univariate and multivariate Cox regression analysis applying 1,234 mitochondrial metabolism-related genes (MMRGs) to identify some essential genes associated with poor prognosis in COAD patients. We validated survival outcome and biological function of the target gene leveraging single-cell sequencing and transcriptomics datasets from Gene Expression Omnibus (GEO), and evaluated the value of the target gene in the clinical pathology stage of COAD patients. Simultaneously, the expression levels of critical gene were detected in the diverse tissues of COAD by immunohistochemistry (IHC) staining. Transcriptomics data was continuously implemented to compare the discrepancy between the expression levels of the target gene and somatic mutation burden, inspecting the key pathways of the target gene by gene set enrichment analysis (GSEA) and examining its drug sensitivity synthetically in the CellMiner databases. The proliferative capacity augmented in LRP2-overexpressed colon cancer cells was determined employing cell counting kit-8 (CCK-8) and flow cytometry assays.

RESULTS

LRP2 served as a key mitochondrial metabolism-related gene was assessed clinical prognosis in COAD patients according to the TCGA database. High expression of LRP2 was prominently associated with poor prognosis in COAD patients (P < 0.05), which was validated by GEO databases, and the expression levels of LRP2 were positively related to clinical pathological stage simultaneously (P < 0.05). Some specific cell types were clustered and proliferation pathways were immensely enriched, which were correlated with LRP2 in two single-cell sequencing datasets. The mutation profiles displayed remarkable differences in two levels of LRP2, we also observed high expressions of LRP2 were immensely correlated with high tumor mutation burden (TMB) and unfavorable prognosis in these patients (P < 0.05). LRP2 was significantly enriched in multiple cancer proliferation-related pathways, and the noteworthy correlation between LRP2 and the sensitivity to various drugs was identified (P < 0.05). The expression levels of LRP2 were multifarious in different COAD patients based on IHC staining. LRP2-overpression could stimulate the proliferation capability of HCT116 and SW480 cell lines markedly (P < 0.05).

CONCLUSION

The expression levels of LRP2 were intimately correlated with gene mutations, prognosis, pathological stage and the sensitivity to anticancer drugs in COAD. Augmented levels of LRP2 would manifest poor prognosis, which furnished novel insights for clinical diagnosis and treatment in COAD. LRP2 could extensively facilitate the proliferation ability of colon cell lines.

Recurrence risk following rectal cancer surgery: a survival analysis of key predictors

BACKGROUND

Identifying predictors of postsurgical recurrence in patients with rectal cancer is critical for optimizing postoperative management and improving patient outcomes. We aimed to assess the effects of demographic, clinical, and pathological factors on recurrence risk after rectal cancer surgery.

METHODS

We conducted a secondary analysis of data from patients who underwent curative rectal cancer surgery between 2004 and 2018. A Cox proportional hazards regression model was applied to examine the influence of variables on recurrence risk. Kaplan-Meier curves were used to visualize cumulative hazards.

RESULTS

Among 961 patients (62.7% male, mean age 63.1 years), 127 (13.2%) experienced recurrence over a median follow-up of 60 months. Based on the Cox model (C-index = 0.770, likelihood ratio test χ2(19) = 127.5, P < 0.001), significant predictors of increased recurrence risk included pathologic node stage N1 (hazard ratio 2.92, 95% CI: 1.84-4.63, P < 0.001) and N2 (4.05, 2.36-6.94, P < 0.001), as well as fewer than 12 harvested lymph nodes (1.95, 1.31-2.90, P = 0.001). Moderately differentiated histology reduced recurrence risk (0.49, 0.27-0.89, P = 0.018), and age (0.98, 0.96-0.99, P = 0.004) was inversely correlated with recurrence risk. Sex, chemotherapy, pathologic tumor stage, and lymphovascular invasion were not significant predictors of recurrence.

CONCLUSION

This study identified key factors associated with recurrence risk after rectal cancer surgery, highlighting the importance of pathologic node stage, lymph node metrics, and histological differentiation. These findings provide a foundation for personalized postoperative management strategies and improving long-term outcomes in rectal cancer patients.

Revealing New Patterns in Colorectal Cancer Screening with a Focus on a Younger Patient Population

Colorectal cancer (CRC) continues to impart a significant mortality burden in the United States, with a growing number of cases affecting younger individuals. In this study, we set out to characterize predictors of missed colorectal cancer screening in a general and age-stratified population. Methods: We analyzed a patient population of over 85,000 patients who presented to a large outpatient network in the Baltimore, Maryland area and were due for CRC screening. We analyzed different characteristics, including race, occupation, relationship status, tobacco smoking status, and body mass index, of patients up to date and overdue on their CRC screening. The majority (over 99%) of our patient population was insured. We performed this analysis on the patient population as a whole and as an age-stratified patient population. Results: In our overall patient population, all of the aforementioned characteristics were significantly different between patients up to date and those overdue on CRC screening. Races with the highest up-to-date CRC screening proportion were Pacific Islanders, East Asian, and White patients, while Asian Indian patients had the lowest up-to-date percentage. Non-employed patients (including patients with disabilities and students), single patients, and current or past tobacco smokers were all found to have significantly lower percentages of up-to-date patients as compared to other groups within these categories. BMI was significantly lower in up-to-date patients. In our age-stratified analysis, younger patients had a significantly lower percentage of up-to-date patients. Notably, younger patients had a significantly higher proportion of patients electing for noninvasive screening modalities. Conclusions: These disparities in CRC screening warrant targeted interventions to minimize future risk of heightened mortality in certain patient populations.

Profile of colorectal polyps in young patients: A retrospective study

There is an increased incidence of colorectal cancer in young patients, however, the relationship between polyp characteristics and histology is not clearly understood. This study aimed to investigate the prevalence of different histological types of polyps in young patients and risk factors associated with advanced histology. Young patients (aged <45) who underwent polypectomy at Sir Run Run Shaw Hospital (2015-2017, Zhejiang, China) and West China Xiamen Hospital (2023-2024, Xiamen, China) were included. A database of endoscopes was accessed to classify polyps according to endoscopic features. The distribution of polyps and the risk factors associated with advanced histology were reported. The detection rate of polyps among the young adults was 20%, with 47.6% of adenoma. Hyperplastic polyps were second only to tubular adenomas in frequency. Of the 2776 polyps, nearly 85% were sessile, 29.4% were located in the sigmoid colon, and 25.4% were located in the rectum. Among polyps, 87.3% were <10 mm in diameter. Histological features of advanced adenoma were found in 5.3% of patients. Of these, 30.4% occurred in polyps <10 mm. Furthermore, 69.6% were distributed in the distal colorectum. Multivariate logistic regression analysis demonstrated that polyp size and morphology were independent predictors of advanced adenomas. In young patients, polyps are mainly located in the distal colorectum, with tubular adenoma being the predominant type. Large size and pedunculated morphology were independent predictors of advanced polyp histology in young patients. Nearly one-third of the advanced histology cases were associated with small polyps. It is recommended that endoscopists resect all neoplastic polyps found during colonoscopy, especially pedunculated polyps, and submit them for histology.

USP14/S100A11 axis promote colorectal cancer progression by inhibiting cell senescence

The aberrant expression of S100A11 has been identified in various malignancies but its functional roles and underlying mechanisms in colorectal cancer (CRC) have not been fully elucidated. Therefore, this study was designed to investigate the expression of S100A11 and its functional significance in CRC, indicating that S100A11 is significantly upregulated and correlates with poor survival outcomes in CRC. Functionally, S100A11 knockdown in CRC cell lines inhibited cell proliferation, invasion, and migration, leading to decreased tumour growth and metastasis in vivo. Mechanistic investigations revealed that S100A11 promotes cell proliferation and invasion by suppressing cell senescence. In addition, USP14 interacts with and mediates S100A11 deubiquitination. More importantly, the overexpression of S100A11 was able to partially counteract the reduction in cell proliferation caused by the knockdown of USP14. In summary, the novel regulatory axis involving USP14 and S100A11 modulates the malignant biological behavior of CRC cells through inhibiting cell senescence, therefore the interaction between USP14 and S100A11 represents a promising therapeutic target in CRC.

Long noncoding RNA SNHG5 promotes 5-fluorouracil resistance in colorectal cancer by regulating miR-26b/p-glycoprotein axis

BACKGROUND

Colorectal cancer (CRC) is the second most prevalent cause of cancer-related mortality and is increasing in younger individuals. Chemotherapy, a crucial adjuvant systemic therapy for CRC management, often leads to resistance through poorly characterized underlying molecular mechanisms. The long noncoding RNA SNHG5 is highly expressed in CRC and promotes tumor proliferation and invasion, prompting us to hypothesize that SNHG5 may play a crucial role in the chemotherapeutic agent 5-fluorouracil (5-Fu) resistance in CRC.

AIM

To identify the function and mechanism of SNHG5 in 5-Fu resistance in CRC.

METHODS

Quantitative real-time polymerase chain reaction was performed to examine the expression of SNHG5 in CRC tissues from 22 5-Fu-sensitive patients and 14 5-Fu-resistant patients and in CRC cells and 5-Fu-resistant CRC cells. Cell viability and apoptosis were assessed in SNHG5-overexpressing CRC cells and SNHG5-knockdown 5-Fu-resistant CRC cells. SNHG5 function in 5-Fu resistance in CRC was further analyzed using a xenograft mouse model. SNHG5 interactions with microRNAs were predicted by bioinformatics analysis. Luciferase reporter and RNA immunoprecipitation assays were performed to verify the binding between SNHG5 and miR-26b. Rescue experiments were performed to validate the functional interaction between SNHG5 and the miR-26b/p-glycoprotein (Pgp) axis.

RESULTS

SNHG5 expression was upregulated in 5-Fu-resistant CRC tissues and 5-Fu-resistant CRC cells. In vitro functional experiments demonstrated that SNHG5 overexpression significantly reduced cell apoptosis and enhanced cell viability, whereas SNHG5 knockdown in 5-Fu-resistant CRC cells increased cell apoptosis and decreased cell viability upon 5-Fu treatment. In a xenograft mouse model, we confirmed that SNHG5 overexpression led to a reduction in 5-Fu sensitivity in CRC in vivo. Mechanistically, SNHG5 acted as a molecular sponge for miR-26b. Rescue experiments validated that SNHG5 conferred 5-Fu resistance in CRC by regulating the miR-26b/Pgp axis.

CONCLUSION

SNHG5/miR-26b/Pgp regulates CRC chemosensitivity, providing potential therapeutic targets for the treatment of 5-Fu-resistant CRC.

ZuoJin Pill intervention in HCT116 tumor-bearing mice: Modulation of tumor growth, intestinal barrier integrity and microbial composition

BACKGROUND

The progression of colorectal cancer (CRC) disrupts the intestinal mucosal barrier, and impacting patient prognosis. Traditional chemotherapy often induces gastrointestinal toxicity by damaging this barrier. ZJP offers protection to the barrier and suppresses tumor growth. Nonetheless, its impact on tumors and the intestinal microbiota remains inadequately elucidated. This study delved into the interventional effects and the intervention mechanism of ZJP across different stages of CRC, unraveling its mechanisms in sustaining intestinal mucosal integrity amidst cancer progression and its impact on the gut microbiota.

METHODS

The regulatory impact of ZJP on tumor growth and the intestinal mucosal barrier at various CRC stages was comprehensively explored in HCT116 tumor-bearing mice. Western blot analyses was performed to investigate the effects of ZJP on the tumor polyamine pathway and glycolysis-related proteins. High-performance liquid chromatography (HPLC) facilitated the quantification of tumor and mucosal polyamine content, while 16 S rRNA analysis discerned the modulatory effects of ZJP on the intestinal microbiota.

RESULTS

ZJP emerged as a potent inhibitor of tumor growth, prominently preserving the intestinal mucosal barrier during the early stages of treatment. Mechanistically, ZJP suppressed HIF1α and c-Myc and disrupted tumor glycolysis. Additionally, ZJP downregulated polyamine synthesis, metabolism and transport proteins. Microbiota analysis unveiled enrichment in Oscillospira, Ruminococcus, and Akkermansia during the initial treatment phase. Correlation analyses spotlighted an intricate microbial network influencing tumor progression, mucosal barrier integrity, and polyamine regulation.

CONCLUSION

ZJP exerted dual efficacy by inhibiting tumor growth and protecting the intestinal mucosal barrier. This multifaceted intervention involved glycolysis inhibition and modulation of polyamine-associated proteins. The potential efficacy of ZJP intervention in early-stage tumors as opposed to advanced stages may be linked to gut microbiota alterations during tumor development. This study offers novel insights into prospective microbiota-driven personalized anticancer approaches.

KLRG1 expression induces functional exhaustion of NK cells in colorectal cancer patients

BACKGROUND

Natural killer (NK) cells are a subset of innate lymphoid cells that possess cytotoxic properties, playing a pivotal role in immune surveillance against tumor cells. However, it remains unclear whether there are any alterations in the quantity and functional status of NK cells in colorectal cancer (CRC).

METHODS

In this study, we collected peripheral blood samples from both CRC patients and age- and sex-matched healthy controls (HCs). The distribution characteristics, phenotypic changes, functional status, apoptosis susceptibility, and proliferative capacity of circulating NK cells were detected and analyzed by flow cytometry. An in vitro study was performed to investigate the blocking effect of KLRG1 antibody on peripheral blood NK cells in CRC patients.

RESULTS

The frequency and absolute number of circulating NK cells were significantly decreased in CRC patients compared to those in HCs. Meanwhile, the function of NK cells from CRC patients was compromised, as shown by the reduced production of IFN-γ, TNF-α, and CD107a, with this impairment becoming increasingly significant as neural invasion progressed and tumor invasion advanced. We further found that the expression of activating receptors NKp30 and NKp46 were reduced, while the expression of inhibitory receptor KLRG1 was remarkably increased. The increased proportion of KLRG1 on NK cells was associated with CRC progression, and KLRG1+ NK cells showed impaired production of IFN-γ, TNF-α, and CD107a and were more susceptible to apoptosis. Importantly, blockade of the KLRG1 pathway could restore the cytokine production and degranulation ability of NK cells from CRC patients.

CONCLUSIONS

The present study demonstrates that NK cells in CRC patients exhibit functional exhaustion, and KLRG1 blockade restores the effector function of NK cells, indicating that targeting KLRG1 represents a promising strategy for immunotherapy in patients with CRC.

Could the HALP score indicate poor prognosis in colorectal cancer patients?

Objective

Colorectal cancer (CRC) is a major health problem worldwide. According to estimates for the year 2030, cancer will be the number one cause of death for both genders. CRC is the third most common type of cancer and the second most common cause of cancer-related deaths. Various parameters are needed to provide information about the course and prognosis of the disease.

Material and Methods

The study included 103 patients diagnosed with CRC between 2017 and 2023. The patients' HALP scores were retrospectively analyzed together with clinical data. The relationship between survival times, disease stage, and treatment response was examined.

Results

The obtained data showed that low HALP scores were associated with worse overall survival. Although the HALP score cut-off value was found to be different in various studies conducted on benign or malignant diseases, a low HALP score indicates a poor prognosis. In our study, a HALP score below 23 was found to be associated with low overall survival.

Conclusion

This study suggests that a low HALP score is associated with poor prognosis and could serve as a valuable prognostic marker in the clinical management of CRC patients. However, certain limitations must be considered. While albumin is a marker of systemic inflammation and nutritional status, its specificity is limited in acute and chronic inflammatory conditions, which may impact the prognostic value of the HALP score. Further investigation into the biological mechanisms underlying this relationship and the potential of the HALP score in predicting treatment response would enhance its clinical applicability.

Evaluation and Bias Analysis of Large Language Models in Generating Synthetic Electronic Health Records: Comparative Study

BACKGROUND

Synthetic electronic health records (EHRs) generated by large language models (LLMs) offer potential for clinical education and model training while addressing privacy concerns. However, performance variations and demographic biases in these models remain underexplored, posing risks to equitable health care.

OBJECTIVE

This study aimed to systematically assess the performance of various LLMs in generating synthetic EHRs and to critically evaluate the presence of gender and racial biases in the generated outputs. We focused on assessing the completeness and representativeness of these EHRs across 20 diseases with varying demographic prevalence.

METHODS

A framework was developed to generate 140,000 synthetic EHRs using 10 standardized prompts across 7 LLMs. The electronic health record performance score (EPS) was introduced to quantify completeness, while the statistical parity difference (SPD) was proposed to assess the degree and direction of demographic bias. Chi-square tests were used to evaluate the presence of bias across demographic groups.

RESULTS

Larger models exhibited superior performance but heightened biases. The Yi-34B achieved the highest EPS (96.8), while smaller models (Qwen-1.8B: EPS=63.35) underperformed. Sex polarization emerged: female-dominated diseases (eg, multiple sclerosis) saw amplified female representation in outputs (Qwen-14B: 973/1000, 97.3% female vs 564,424/744,778, 75.78% real; SPD=+21.50%), while balanced diseases and male-dominated diseases skewed the male group (eg, hypertension Llama 2-13 B: 957/1000, 95.7% male vs 79,540,040/152,466,669, 52.17% real; SPD=+43.50%). Racial bias patterns revealed that some models overestimated the representation of White (eg, Yi-6B: mean SPD +14.40%, SD 16.22%) or Black groups (eg, Yi-34B: mean SPD +14.90%, SD 27.16%), while most models systematically underestimated the representation of Hispanic (average SPD across 7 models is -11.93%, SD 8.36%) and Asian groups (average SPD across 7 models is -0.77%, SD 11.99%).

CONCLUSIONS

Larger models, such as Yi-34B, Qwen-14B, and Llama 2 to 13 B, showed improved performance in generating more comprehensive EHRs, as reflected in higher EPS values. However, this increased performance was accompanied by a notable escalation in both gender and racial biases, highlighting a performance-bias trade-off. The study identified 4 key findings as follows: (1) as model size increased, EHR generation improved, but demographic biases also became more pronounced; (2) biases were observed across all models, not just the larger ones; (3) gender bias closely aligned with real-world disease prevalence, while racial bias was evident in only a subset of diseases; and (4) racial biases varied, with some diseases showing overrepresentation of White or Black populations and underrepresentation of Hispanic and Asian groups. These findings underline the need for effective bias mitigation strategies and the development of benchmarks to ensure fairness in artificial intelligence applications for health care.

Jacalin Attenuates Colitis-Associated Colorectal Carcinogenesis by Inhibiting Tumor Cell Proliferation and Intestinal Inflammation

BACKGROUND

Colorectal cancer (CRC) remains a significant cause of morbidity and mortality worldwide. In patients with inflammatory bowel disease, who have twice the risk of developing CRC, chronic inflammation has been recognized to contribute to colitis-associated cancer (CAC) development. Jacalin, a lectin extracted from jackfruit seeds, has been shown to recognize altered glycosylation and to exert antiproliferative and cytotoxic effects in CRC. However, its activity in CAC remains unknown. Herein, we sought to investigate the effects of jacalin in CAC progression using the dextran sulfate sodium (DSS) and azoxymethane (AOM) mouse model.

METHODS

Colitis-associated cancer induction was performed in male C57BL/6 mice by an intraperitoneal injection of AOM, followed by 3 cycles of 2.5% DSS diluted in drinking water for 7 days, intercalated by 2 weeks of normal drinking water. After 1 week of daily pretreatment, mice were orally treated with phosphate-buffered saline (control group), 100 or 500 µg of jacalin three times a week for an additional 11 weeks.

RESULTS

We showed that jacalin-treated mice presented tumors with reduced volumes and mean size compared to the control group. In addition, both doses of jacalin reduced the number of proliferating cells (Ki-67 positive cells) in tumor tissues, while the higher dose (500 µg) showed also a similar effect in "normal-appearing" colonic crypts. Jacalin treatment attenuated the clinical scores of inflammations, which was accompanied by a reduction of intestinal and/or tumoral production of IL-1β, IL-23, and IL-17.

CONCLUSIONS

Collectively, our findings demonstrated that jacalin suppresses CAC development, highlighting its anti-inflammatory and antitumoral role in the AOM/DSS-induced model.

Interdependence of health between patients with colorectal cancer and family caregivers: a cross-sectional study

BACKGROUND

Despite numerous shared health challenges during treatment and recovery, the interdependence of health between patients with colorectal cancer and their family caregivers remains underexplored. This study applied the actor-partner interdependence model (APIM) to examine this dyadic relationship.

METHODS

This descriptive correlational survey involved patients with colorectal cancer who visited the outpatient department for postoperative follow-up, along with their family caregivers. From 343 consenting participants, responses from 100 matched patient-caregiver pairs were analyzed. Data collection occurred at J Hospital from August 2023 to May 2024. Key variables included the psychological health and quality of life (QoL) of both patients and caregivers, patient self-care, and caregiver contribution to self-care. Statistical analysis was performed using Stata 16.1, with structural equation modeling.

RESULTS

The mean age of patients was 65.57 years; 51% were male, 66% had colon cancer, and 34% rectal cancer. The caregivers' mean age was 56.11 years; 55% were female, and 66% were spouses. The analysis of actor effects showed that the psychological health and QoL of both patients and caregivers independently influenced their respective outcomes. The analysis of partner effects revealed mutual influences between the psychological health of patients and caregivers; moreover, the psychological health of caregivers impacted patients' self-care. While there was a correlation between the QoL of patients and caregivers, it was not statistically significant in the structural equation modeling.

CONCLUSIONS

This study underscores the profound interdependence of health between patients with colorectal cancer and their caregivers, revealing significant mutual impacts on psychological health and, to a lesser extent, self-care. These insights suggest the need for targeted interventions to improve both patient recovery and caregiver support, even where some correlations lack statistical significance.

TRIAL REGISTRATION

Prospectively registered with the Clinical Research Information Service (CRIS) under the Clinical Trial Number KCT0008743 (Registration Date: 2023.08.25).

Phillyrin from Forsythia suspensa suppresses the proliferation, angiogenesis, and metastasis of colorectal cancer via targeting CD147

ETHNOPHARMACOLOGICAL RELEVANCE

Forsythia suspensa (Thunb.) Vahl, a traditional Chinese herbal medicine, is widely used in clinical practice. Phillyrin (PHN), a major bioactive component of Forsythia suspensa, exhibits significant anti-inflammatory, neuroprotective, and antibacterial properties, offering potential for colorectal cancer (CRC) prevention and treatment.

AIM OF THE STUDY

This study aimed to clarify the effects of PHN on CRC progression, focusing on epithelial-mesenchymal transition (EMT) and angiogenesis, to elucidate the underlying molecular mechanisms involving CD147.

MATERIALS AND METHODS

In vitro, cell viability and colony formation were conducted to detect the inhibition of PHN on CRC cells. Wound healing and Transwell assays were used to detect the migration and invasion. PCR, Western blot and ELISA were performed to clarify the relevant molecular levels. Overexpression plasmids were constructed to regulate the target molecule for mechanism research. In vivo, subcutaneous xenograft and lung metastasis models evaluated PHN's anti-cancer effects including histological and immunohistochemical (IHC) analysis.

RESULTS

PHN inhibited CRC cell proliferation, migration, and invasion in vitro, downregulating CD147 expression, while CD147 overexpression reversed the effects of PHN. In vivo, PHN significantly suppressed tumor growth and lung metastasis, reducing VEGFA, N-Cadherin, Snail1, and MMP-9 expression, and increasing E-Cadherin levels.

CONCLUSION

These findings indicated that PHN suppressed the proliferation and metastasis of CRC via regulating CD147-mediated EMT and angiogenesis. PHN may be a promising therapeutic agent for CRC treatment in clinic, and CD147 may be a potential target for drug development.

SOX17: a new therapeutic target for immune evasion of colorectal cancer

Despite advances in cancer immunotherapies across various cancers, survival outcomes in colorectal cancer (CRC) with these agents remain largely unsatisfactory despite the high tumour burden. Colorectal stem cells (CSCs), especially LGR5+ CSCs, are the significant drivers in CRC initiation, progression and resistance to conventional therapies. Although native immune surveillance is sufficient to combat early tumour formation, CRC evades early immune detection with its well-documented adenoma-to-carcinoma sequence. The exact mechanism underlying this phenomenon still needs to be better understood. SRY-related HMG box gene 17 (SOX17), a transcription factor that specifies embryonic gut formation, is increasingly recognised as a significant factor in CRC tumourigenesis. However, its role as a tumour suppressor or oncogene is still debated. Evidence from a recent study highlighted the critical role of SOX17 in reshaping the tumour immune ecosystem through the simultaneous inhibition of CD8+ T cells and selective suppression of LGR5 expression in CSCs through transcriptional repression, thereby facilitating disease progression. Given its role in immune evasion, SOX17 could be a promising marker in personalised therapy. Additionally, SOX17 could play a role in the diagnostic arena, potentially identifying dysplasia in the gastrointestinal tract. Future clinical, basic and genetic studies focusing on SOX17 are needed to ascertain its mechanistic role in tumour immunomodulation in CRC and diagnosing preneoplastic lesions in the gastrointestinal tract.

The potential of CT colonography for colorectal cancer screening in Japan

Colorectal cancer remains a leading cause of mortality worldwide, and early detection is essential for improving outcomes. CT colonography (CTC) has emerged as a promising alternative to optical colonoscopy for colorectal cancer screening. This article explores the potential of CTC in Japan, focusing on quality control, patient acceptability, complications, and its role in screening programs. CTC has demonstrated high sensitivity and specificity for detecting colorectal polyps, with its diagnostic performance comparable to colonoscopy for lesions ≥ 10 mm. Techniques such as fecal tagging and dual-position imaging significantly enhance diagnostic accuracy. However, the variability in diagnostic outcomes underscores the need for rigorous interpretation training and quality control. The American College of Radiology recommends training with at least 50 cases verified by colonoscopy. Despite its advantages, the adoption of CTC in Japan remains limited due to low awareness among medical professionals, a shortage of trained radiologists, and the absence of specific guidelines endorsing its use. Patient acceptability for CTC is high due to its non-invasive nature, shorter examination time, and reduced bowel preparation requirements compared to colonoscopy. Nonetheless, complications such as bowel perforation, albeit rare, necessitate careful risk assessment. While CTC has been recognized in the U.S. and Europe for screening and diagnostic follow-up, its integration into Japan's colorectal cancer screening guidelines is crucial to expand its utilization. To maximize the benefits of CTC, efforts must focus on standardizing methodologies, establishing quality indicators, and generating robust evidence on mortality reduction and cost-effectiveness.

CS-6-induced p62 accumulation exacerbates DNA damage in colorectal cancer

Background

Gamabufotalin (CS-6), a bufadienolide derived from Chansu, has been reported to exhibit anti-tumor effects in various cancers, including glioblastoma, nonsmall cell lung cancer, and breast cancer. However,its role in colorectal cancer (CRC) remains unexplored.

Objective

Our study aimed to evaluate the inhibition of CS-6 to CRC cells by cell viability assay, colony formation assay, comet assay, and cell cycle analysis firstly. And its molecular mechanism was studied by immunofluorescence (IF) assay, western blot (WB) assay, siRNA transfection, protein-protein interaction (PPI) network and co-immunoprecipitation (Co-IP) assay. Finally, the in vivo antitumor assessments of CS-6 on colorectal cancer was validated through an transplant colorectal cancer model.

Results

CS-6 treatment significantly inhibited CRC SW620 and DLD1 cell viability and colony formation in vitro. Furthermore, CS-6 treatment-induced DNA damage and cell cycle arrest in SW620 and DLD1 cells. The western blot assay revealed that CS-6 treatment upregulated p62 expression. Knockdown of p62 in this study significantly alleviated CS-6-induced DNA damage and the downregulation of cyclin expression in SW620 and DLD1 cells. Additionally, the results indicated increased expression of microtubuleassociated protein I/II light chain 3II (LC3II) and reduced binding between B-cell lymphoma-2 (Bcl2) and beclin-1, suggesting that CS-6 treatment activated early-stage autophagy in CRC cells. However, inhibition of latestage autophagy and autophagy-related protein 5 (ATG5) with chloroquine and si-ATG5, respectively, further indicated that CS-6-induced autophagy defects led to p62 accumulation, exacerbated cell proliferation inhibition, and aggravated DNA damage. Intraperitoneal injection with CS-6 inhibited tumor growth in nude mice with colorectal cancer, and promoted the protein expression of phosphorylated H2A histone family member X (γH2AX), p62, phosphorylated Ataxia-telangiectasia mutated kinase (p-ATM) and LC3 I/II.

Conclusion

This study suggests that CS-6 may exert its anti-tumor effects in CRC by inducing autophagy defects, resulting in p62 accumulation and DNA damage in vitro and in vivo.

Ligand-activated EGFR/MAPK signaling but not PI3K, are key resistance mechanisms to EGFR-therapy in colorectal cancer

Understanding mechanisms of resistance to active therapies is crucial for developing more effective treatments. Here, we investigate resistance to anti-EGFR and anti-VEGF plus chemotherapy treatment in colorectal cancer (CRC) patients from the IMblaze370 trial (NCT02788279). While anti-VEGF does not select for secondary mutations, anti-EGFR leads to simultaneous mutations in EGFR and MAPK, but not PI3K pathway genes. Notably, we observe frequent acquired mutations in the EGFR extracellular but not intracellular domain and that patients with higher baseline expression of EGFR-ligands are prone to acquire resistant mutations. This data reveals a ligand-activated EGFR/MAPK-signaling dependency in CRC. We also observe enrichment for 8q gains in anti-EGFR treated patients, potentially linked to MYC amplification, a finding further supported by baseline expression analysis. This work adds to the evidence supporting broader evaluation of EGFR and pan-KRAS inhibitor combinations in CRC patients. It also underscores the utility of EGFR ligands as anti-EGFR efficacy biomarkers and provides a rationale for developing ligand blockers to complement and/or improve conventional anti-EGFR therapies in CRC.

Safety and Efficacy of Regorafenib and 5-Fluorouracil Combination Therapy in Refractory Metastatic Colorectal Cancer After Third-Line Treatment: An Institutional Experience

Background: Colorectal carcinoma (CRC) is one of the most common cancer types along with breast, prostate, and lung cancer. Many patients with CRC present with metastatic disease despite receiving standard first- and second-line therapies; thus emerges the demand for implementing new therapies that could improve outcomes among CRC patients. This case series was conducted to assess the efficacy and safety of regorafenib plus 5-fluorouracil (5-FU) in patients with refractory metastatic CRC (mCRC). Methods: We conducted a retrospective analysis of data from adult patients aged 18 and above who were diagnosed with refractory mCRC and received regorafenib plus 5-FU combination therapy at Houston Methodist Hospital between November 2017 and October 2023. Our study focuses on assessing key outcomes, including Overall Survival [OS], Progression-Free Survival [PFS], and safety. Results: Among the 12 patients we included in this study who underwent regorafenib plus 5-FU combination therapy for refractory mCRC after receiving at least three prior lines of treatment, the best response for six patients (50%) was successfully achieved, with disease control within 7-12 weeks from therapy initiation. Patients had an overall good tolerance for this treatment regimen and reported only the most common adverse events, including Hand-Foot Syndrome (HFS), mucositis, and hypertension (HTN), which were mostly resolved with dose adjustment of medications. Conclusions: This study highlights that using a combination of regorafenib plus 5-FU can be a potential treatment option for patients with refractory mCRC. Additional research, including prospective clinical trials, is required to assess the effectiveness and safety of regorafenib and 5-FU combination therapy in comparison to other currently limited treatment options.

Novel non-curable resection prediction model for early colorectal cancer following endoscopic submucosal dissection based on inflammatory immune index

Backgrounds

Colorectal carcinoma represents one of the common malignant tumors of digestive tract in clinic. Systemic immune inflammation index (SII) has great potential in predicting prognosis of digestive tract tumors. We sought to explore the predictive ability of SII for non-curative resection of early colorectal cancer treated with ESD, and to establish a related predictive model.

Methods

A retrospective analysis was performed on data from patients with early-stage colorectal cancer who underwent ESD in our hospital between January 2019 and December 2022. To establish the optimal cut-off value for the SII, Receiver Operating Characteristic (ROC) curves were generated, correlating preoperative SII levels with postoperative resection outcomes. Patients were categorized into high SII and low SII groups, and their clinical characteristics were comparatively analyzed. Furthermore, patients were stratified according to the presence or absence of non-curative resection outcomes post-ESD, to identify independent risk factors associated with non-curative resection. A prognostic nomogram was subsequently developed to enhance predictive accuracy for non-curative resection, integrating identified risk variables.

Results

A total of 215 patients were enrolled in this study, all of whom successfully underwent ESD, achieving an en bloc resection rate of 96.7%. Based on surgical procedures and pathological resection characteristics, 181 cases were classified as curative resections, whereas 34 cases of non-curative resections. Postoperative complications occurred in 10 patients, resulting in a complication rate of 4.7%. The optimal cut-off value of SII was 629.2 × 10∧9/L (area under the curve: 0.762, P < 0.001), and the sensitivity and specificity was 64.7 and 85.6%, respectively. An optimal SII cut-off value for predicting non-curative resection was determined to be 1.56 (AUC: 0.571, 95% CI: 0.501-0.641). Multivariate analysis demonstrated that elevated SII (P = 0.002), a positive lifting sign (P = 0.003), increased tumor size (P = 0.034), and poor tumor differentiation (P < 0.001) were independent risk factors significantly associated with non-curative resection.

Conclusion

SII revealed well correlation in predicting non-curable resection in patients with early colorectal cancer treated by ESD. Meanwhile, the higher the patient's NLR, PLR, tumor diameter and infiltration depth, the more likely to occur postoperative non-curative resection.

The Association Between Health Literacy and Colorectal Cancer Screening: Findings Using a Three-Question Health Literacy Measure

PURPOSE

Health literacy (HL) can impact health behaviors including colorectal cancer (CRC) screening. Prior findings using extensive measures of HL suggested that low HL is associated with lower CRC screening rates. We hypothesized that low HL, when measured using a clinically applicable three-question measure, would also be associated with low CRC screening rates.

METHODS

Data collected from the 2016 Behavioral Risk Factor Surveillance System (BRFSS) was utilized from 17 states that included a three-question HL measure. Participants ages 50-75 were included. The HL scores were categorized as adequate, marginal, or limited HL. The primary outcome was United States Preventative Services Task Force (USPSTF) recommendation-concordant CRC screening. The relationship between HL and CRC screening was examined using multivariable logistic regression.

RESULTS

Among 38,044 participants who met inclusion criteria, 47.2% (n = 17,950), 49.9% (n = 18,989), and 2.9% (n = 1105) had adequate, marginal, and limited HL, respectively. Lower HL levels were associated with lower adherence to USPSTF CRC screening recommendations: 73.3% for adequate, 68.0% for marginal, and 48.9% for limited HL (p < 0.01). Respondents with limited HL were 45% less likely to undergo CRC screening (OR = 0.55; 95%CI: 0.48-0.63). A significant interaction (p < 0.01) between health literacy and sex was identified. CRC screening difference among HL levels was more pronounced for male (OR = 0.48; 95% CI: 0.40-0.79) than female respondents (OR = 0.63; 95% CI: 0.52-0.76).

CONCLUSION

Limited health literacy is associated with significantly lower rates of appropriate CRC screening, particularly for males. This three-question HL measure provides a clinically applicable tool to identify people at risk for lack of CRC screening.

Physiological drivers of pks+ E. coli in colorectal cancer

Colorectal cancer (CRC) is a significant global health challenge, with rising incidence, particularly among individuals under 50. Increasing evidence highlights the gut microbiota as key contributors to CRC development, with certain oncogenic bacteria influencing cancer initiation, progression, and therapy response. Among these is pks+ Escherichia coli, which produces colibactin, a genotoxic compound that induces DNA damage and leaves a distinct mutational signature in healthy individuals and CRC patients. While research has focused on its genotoxic effects, this review examines the kinetics of colibactin-induced mutations and the epithelial and environmental changes that promote E. coli expansion and colibactin exposure. We also explore the broader role of pks+ E. coli in cancer initiation and progression beyond genotoxicity, and discuss potential therapeutic approaches.

Curcumin exerts anti-tumor activity in colorectal cancer via gut microbiota-mediated CD8+ T Cell tumor infiltration and ferroptosis

Colorectal cancer (CRC), as a high-incidence malignancy, continues to present significant challenges in prevention, screening, and treatment. Curcumin (Cur) exhibits notable anti-inflammatory and anticancer properties. Despite its poor solubility in water and low bioavailability, high concentrations of Cur are detected in the gastrointestinal tract after oral administration, suggesting that it may directly interact with the gut microbiota and exert regulatory effects. This study aims to explore the mechanisms by which Cur improves CRC by modulating gut microbiota. Firstly, we evaluated the effect of Cur on CRC cell viability in vitro using the MTT assay, and the results showed a significant inhibitory effect on CRC cell growth. The IC50 values for Cur in CT26 and RKO cells were 23.52 μM, 16.11 μM, and 13.62 μM at 24, 48, and 72 hours, respectively, and 26.3 μM, 16.52 μM, and 14.22 μM at 24, 48, and 72 hours, respectively. Cur induced apoptosis and caused G2 phase cell cycle arrest in tumor cells. Subsequently, we established a CRC mouse model. Oral administration of Cur at 15 mg kg-1 and 30 mg kg-1 inhibited CRC progression, as evidenced by reduced tumor volume, histological analysis, immunohistochemistry, and an increased number of CD8+ T cells infiltrating the tumors. Ferroptosis in tumor cells was also observed. Cur partially restored the gut microbiota of CRC mice, altering the abundance and diversity of the gut microbiota and affecting serum metabolite distribution, with significant increases in the abundance of SCFA-producing microbes such as Lactobacillus and Kineothrix. To verify causality, we designed a fecal microbiota transplantation (FMT) experiment. Compared with CRC mice, the fecal microbiota from Cur-treated mice significantly alleviated CRC symptoms, including slowed tumor growth, enhanced CD8+ T cell tumor infiltration, and induced ferroptosis in tumor cells. Additionally, when gut microbiota was depleted with antibiotics, Cur's antitumor effects disappeared, suggesting that Cur mitigates CRC in a gut microbiota-dependent manner. These findings provide new insights into the mechanisms underlying CRC and propose novel therapeutic interventions, emphasizing the interaction between gut microbiota and immune responses within the tumor immune microenvironment (TIME).

Prognostic Value of LC3A Protein Expression Patterns in Rectal Cancer Tumors

Background/Objectives: Autophagy is a conserved self-degradation process by which cells break down and recycle their cellular constituents. This process is activated by various stressors, including nutrient deprivation and DNA damage, and has also been associated with tumor progression. In the present study, we aimed to determine the expression patterns, clinicopathological significance, and prognostic value of the autophagy marker microtubule-associated protein 1 light chain 3 alpha (LC3A)-an essential component of autophagic vacuoles-in rectal cancer. Methods: LC3A reactivity was measured by immunohistochemistry in tumor samples from 243 patients who underwent surgery for rectal cancer. Results: Three distinct patterns of LC3A expression were identified: diffuse cytoplasmic, perinuclear, and stone-like structures (SLS). In Kaplan-Meier survival analyses, patients positive for the SLS pattern of LC3A staining in the tumor periphery (TP) had worse overall survival (OS; p = 0.001) and disease-free survival (DFS; p = 0.030) than those without SLSs in this region, as determined by the log-rank test. When patients were stratified by tumor stage, this result was significant in those with stage T3-T4 (OS, p < 0.001; DFS, p = 0.001) but not T1-T2 disease. Multivariate Cox regression analysis further showed an association between TP-localized LC3A SLS positivity and reduced OS for the overall cohort (hazard ratio [HR] = 2.6313, 95% confidence interval [CI]: 1.090-6.349, p = 0.031) and specifically those in the T3-T4 subgroup (HR = 3.347, 95% CI: 1.657-6.760, p = 0.001). Conclusions: Our findings suggest that positivity for SLSs in the TP may hold clinical value as a biomarker for survival prognosis in rectal cancer patients.

Oral microbiota signature predicts the prognosis of colorectal carcinoma

Emerging evidence links oral-derived gut microbes to colorectal cancer (CRC) development, but CRC prognosis-related microbial alterations in oral remain underexplored. In a retrospective study of 312 CRC patients, we examined the oral microbiota using 16S rRNA gene full-length amplicon sequencing to identify prognostic microbial biomarkers for CRC. Neisseria oralis and Campylobacter gracilis increased CRC progression risk (HR = 2.63 with P = 0.007, HR = 2.27 with P = 0.001, respectively), while Treponema medium showed protective effects (HR = 0.41, P = 0.0002). A microbial risk score (MRS) incorporating these species effectively predicted CRC progression risk (C-index = 0.68, 95% CI = 0.61-0.76). When compared to a model constructed solely from clinical factors, including tumor stage, lymphatic metastasis, and perineural invasion, the predictive accuracy significantly improved with the addition of the MRS, resulting in a C-index rising to 0.77 (P = 2.33 × 10-5). Our findings suggest that oral microbiota biomarkers may contribute to personalized CRC monitoring strategies, their implementation in clinical surveillance necessitates confirmatory studies.

Moxibustion regulates KDM4D expression and modulates lipid metabolism to inhibit tumor proliferation in CAC mice

BACKGROUND

Lysine demethylase 4D (KDM4D) and aberrant lipid metabolism are implicated in the development and progression of colitis-associated cancer (CAC). Moxibustion, a therapeutic approach in traditional Chinese medicine, can inhibit intestinal inflammation and improve the intestinal mucosa.

METHODS

Mice were intraperitoneally injected with AOM, and three cycles of 3-2-2% DSS-free drinking water were administered to establish a CAC mouse model. Moxibustion and KDM4D inhibitor 5-c-8HQ intervention were performed for 30 days after modeling was completed. IHC staining was used to observe the expression of the nuclear-associated antigen Ki67 (Ki67), proliferating cell nuclear antigen (PCNA), and IL-33 in the colon. The expression of colon KDM4D and β-Catenin was observed by immunofluorescence staining and RT‒qPCR. LC‒MS pseudotargeted metabolomic sequencing was used to semiquantitatively detect the expression levels of lipids.

RESULTS

Moxibustion inhibited the proliferation of colon tumors in CAC mice, improved histopathology, and reduced the expression of PCNA and Ki67 in the colon. Using kdm4d knockout technology, it was initially confirmed that kdm4d is a key gene affecting CAC tumor proliferation. The inhibition of colon tumor proliferation in CAC mice by moxibustion is associated with the suppression of abnormal activation of the colon KDM4D/β-Catenin signaling pathway. LC-MS-targeted metabolomics revealed abnormal lipid metabolism in the colons of CAC mice. Moxibustion may affect the cholinergic metabolism pathway in the colon of CAC mice and regulate lipids such as sphingomyelin SM (d18:1/26:0) and triacylglycerol TAG58:7 (18:0). After kdm4d knockout, lipid disorders in the colons of CAC mice were partially restored. The kdm4d gene may be involved in the mechanism underlying the effect of moxibustion on lipid metabolism in the CAC colon.

CONCLUSIONS

Moxibustion inhibited the proliferation of colon tumors in CAC mice, inhibited the activation of the tumor-promoting signaling pathway KDM4D/β-Catenin, and improved lipid metabolism disorders in the colon, thus providing a promising strategy for the clinical adjuvant treatment of colorectal cancer.

RBCs as a Bioinspired Drug Delivery System for Co-delivery of Irinotecan and Nanoalumina Enhances Colorectal Cancer Therapy

Colorectal cancer (CRC) is a malignant epithelial tumor with high morbidity and mortality. In CRC treatment, irinotecan (CPT-11) as a chemotherapeutic drug is widely applied. However, its half-life is short, leading to large dosages and severe side effects. Red blood cells (RBCs) are biocompatible drug carriers with high capacity, avoiding premature drug degradation and achieving slow drug release. Nanoalumina (AN) is an emerging immune adjuvant that can enhance the immune response. Here, we used RBCs as carriers and absorbed AN to construct AN-CPT-11-RBCs. CPT-11 would induce tumor cell death, releasing much tumor antigen, while AN would activate immune cells to recognize newly released antigens and induce lymphocyte proliferation, enhancing the antitumor effect simultaneously. With loading amounts of 4 mg of CPT-11 and 3 mg of AN per 109 RBCs, AN-CPT-11-RBCs had similar properties to natural RBCs. In vivo, AN-CPT-11-RBCs could circulate for 9 days and stimulate the proliferation of lymphocytes in the spleen and tumor tissue, having a higher tumor growth inhibition rate of 74.01% and a lower frequency of administration. In conclusion, AN-CPT-11-RBCs attain the co-delivery of CPT-11 and AN for the synergistic treatment of CRC.

Constructing a mitochondrial-related genes model based on machine learning for predicting the prognosis and therapeutic effect in colorectal cancer

The role of mitochondria in tumorigenesis and progression is has been increasingly demonstrated by numerous studies, but its prognostic value in colorectal cancer (CRC) remains unclear. To address this, we developed a mitochondrial-related gene prognostic model using 101 combinations of 10 machine learning algorithms. Patients in the high-risk group exhibited significantly shorter overall survival time. The high-risk group exhibited elevated tumor immune dysfunction and exclusion score, indicating diminished immunotherapy efficacy. To address the suboptimal treatment outcomes in these patients, we identified PYR-41 and pentostatin as potential therapeutic agents, which are anticipated to enhance therapeutic efficacy in the high-risk group. Additionally, four biomarkers (HSPA1A, CHDH, TRAP1, CDC25C) were validated by quantitative real-time PCR, with significant expression differences between normal intestinal epithelial cells and colon cancer cells. Our prognostic model provides accurate CRC outcome prediction and guides personalized therapeutic strategies.

Racial Differences in Colorectal Adenomas at Screening Colonoscopy in the United States

BACKGROUND

Black Americans experience a higher incidence of colorectal cancer than Whites despite undergoing prevention screenings similar to those of Whites since 2010. We compared the colorectal adenoma status of Black and White patients at screening colonoscopy, a measure of colorectal cancer risk.

METHODS

Using cross-sectional, observational data, we studied colorectal adenomas at first-time screening colonoscopy in average-risk patients aged 40 to 89 years, screened between September 2001 and July 2016 in South Carolina. We analyzed the age-adjusted odds of Black men and women (vs. White) having adenomas, advanced adenomas, ≥3 nonadvanced adenomas, and right hyperplastic polyps, and compared their total polyp burden (the sum of the diameters of all adenomas and right polyps detected).

RESULTS

Among 28,100 patients (58.4% Black and 53.8% women), we found that Black patients had lower age- and gender-adjusted odds than White patients of having adenoma (OR = 0.88, P < 0.01) and right hyperplastic polyp (OR = 0.74, P < 0.01), with a similar pattern within gender groups. Black and White patients were similar about advanced adenoma and 3+ nonadvanced adenoma. Among patients with lesions, mean polyp burden ranged from 8.5 mm (±7.2) for Black women aged 40 to 49 years to 12.3 mm (±7.4) for Black men aged more than 70 years. Age-adjusted polyp burden was 0.4 mm higher for Black men than for White men and 0.3 mm lower for Black women than for White women patient groups (P < 0.01).

CONCLUSIONS

In a large, racially balanced patient sample, Black and White patients showed similar polyp profiles.

IMPACT

Given similar adenoma status, other evidence-supported clinical factors associated with suboptimal polyp detection should be explored to understand the continuing colorectal cancer disparities affecting Black Americans.

Residential Segregation and Colorectal Cancer Screening in the United States, 2010 to 2018

BACKGROUND

Residential segregation limits the access to resources, primarily because of disinvestment. This study evaluated the association between residential segregation and colorectal cancer screening in the United States and whether findings differed by race and ethnicity.

METHODS

Restricted National Health Interview Survey data (2010-2018) were used to ascertain colorectal cancer screening adherence per US Preventive Services Task Force recommendations. Residential segregation was operationalized using the Index of Concentration at the Extremes (ICE), based on income, race, and ethnicity information obtained from the 2014 to 2018 American Community Survey estimates for counties. Multivariable logistic regression models with robust variance estimators accounting for within-county correlation were used. Analyses were stratified by race and ethnicity and weighted to represent the US population.

RESULTS

In this cross-sectional study (n = 44,690), participants residing in less advantaged counties had lower colorectal cancer screening adherence than those residing in the most advantaged counties [Q1 vs. Q5, OR (95% confidence interval): ICE income, 0.77 (0.70-0.86); ICE race, 0.86 (0.77-0.96); ICE race + income, 0.75 (0.67-0.84)]. In analyses stratified by race and ethnicity, we observed that overall findings were mostly driven by White people and estimates were less precise with no clear gradients among racial and ethnic minoritized groups. Among Black participants, colorectal cancer screening did not vary across quintiles of economic segregation.

CONCLUSIONS

Residential segregation was associated with colorectal cancer screening.

IMPACT

Interventions aimed at improving colorectal cancer screening uptake in the United States should address structural barriers present in areas with higher concentrations of low-income minoritized racial and ethnic groups and how features of residential segregation might differentially affect racial and ethnic groups.

VSIG4 Promotes Tumour-Associated Macrophage M2 Polarization and Immune Escape in Colorectal Cancer via Fatty Acid Oxidation Pathway

BACKGROUND

V-set and immunoglobulin domain containing 4 (VSIG4) is a B7-family-related protein almost exclusively expressed on macrophages. The difference in its expression mediates the dynamic transformation of the polarization state of macrophages, but the underlying mechanism is still unclear. We sought to reveal the correlation between VSIG4 and the polarization of tumour-associated macrophages (TAMs) and the immune escape of tumour cells in colorectal cancer (CRC).

METHODS

THP-1 monocyte-derived macrophages expressing different levels of VSIG4 were used for in vitro investigations. In addition, the co-culture system was used to verify the effect of tumour cells on the expression of VSIG4 in macrophages, and the effect of VSIG4 expression level on tumour cells in turn. Subcutaneous xenograft models evaluated the tumour growth inhibition efficacy of VSIG4 blockade as monotherapy and combined with immune checkpoint inhibitors (ICIs).

RESULTS

CRC cells secreted lactate to promote VSIG4 expression in macrophages. On the contrary, VSIG4 promoted macrophage M2 polarization and induced malignant progression of tumour cells by promoting M2 macrophage secretion of heparin-bound epidermal growth factor. In vivo experiments confirmed that knockdown VSIG4 inhibited tumour growth and improved the efficacy of ICIs therapy. Mechanistically, lactate secreted by CRC cells promoted its expression by influencing the epigenetic modification of VSIG4 in macrophages. In addition, VSIG4 enhanced the fatty acid oxidation (FAO) of macrophages and upregulated PPAR-γ expression by activating the JAK2/STAT3 pathway, which ultimately induced M2 polarization of macrophages. Downregulation of VSIG4 or blocking of FAO reversed the M2 polarization process of macrophages.

CONCLUSIONS

Our findings provide a molecular basis for VSIG4 to influence TAMs polarization by regulating the reprogramming of FAO, suggesting that targeting VSIG4 in macrophages could enhance the ICIs efficacy and represent a new combination therapy strategy for immunotherapy of CRC.

KEY POINTS

Colorectal cancer cells secrete lactate to upregulate VSIG4 in macrophages via the H3K18la-METTL14-m6A axis. VSIG4 promotes fatty acid oxidation of macrophages and drives its M2-type polarization. These VSIG4-expressing M2 macrophages promote tumour progression and an immunosuppressive microenvironment. Inhibition of VSIG4 expression can synergistically enhance the therapeutic effect of anti-PD-1 antibody.

Incidence and Mortality of Colorectal Cancer in Asia in 2022 and Projections for 2050

BACKGROUND

Colorectal cancer is an escalating public health concern in Asia, characterized by unique epidemiological patterns.

METHODS

We analyzed colorectal cancer data from 47 Asian countries using GLOBOCAN 2022. Spearman's correlation assessed the relationship between the Human Development Index and cancer rates. Projections for 2050 incidence and mortality were based on demographic forecasts.

RESULTS

In 2022, Asia accounted for 50.2% of global colorectal cancer cases, with 966.4 thousand new cases and 462.3 thousand deaths, including 10% in younger individuals. Age-standardized rates of incidence and mortality were 15.6/100 000 and 7.1/100 000, respectively. Incidence rates were rising faster in younger and male individuals. A significant correlation was found between the Human Development Index and cancer rates. Japan had the highest incidence rate (45.5/100 000 males; 28.5/100 000 females), and Brunei Darussalam had the highest mortality rate (21/100 000 males; 13.9/100 000 females). China recorded the highest incidence and mortality counts, with 307.7 thousand new cases and 142.6 thousand deaths in males, and 209.4 thousand new cases and 97.4 thousand deaths in females. By 2050, 1.87 million new cases and 1.01 million deaths are expected to occur in Asia, with the largest relative increases occurring in low HDI countries.

CONCLUSIONS

These findings highlight the need for targeted policies in low HDI countries, focusing on public awareness, early detection, prevention, and improving healthcare infrastructure. Interventions for younger individuals and males are also essential to address rising incidence rates.

Five-Gene Expression Signature Associated With Acquired FOLFIRI Resistance and Survival in Metastatic Colorectal Cancer

FOLFIRI, a combination of folinic acid, 5-fluorouracil, and irinotecan, is one of the recommended first-line chemotherapeutic treatments for metastatic colorectal cancer. Unfortunately, acquired FOLFIRI resistance represents a common obstacle in the treatment of metastatic colorectal cancer patients. Thus, we aimed to identify mechanisms, gene alterations, and gene expression signatures contributing to acquired FOLFIRI resistance by mimicking this problem in a cell culture model and subsequent translation in clinical data sets. Three FOLFIRI-resistant colorectal cancer (CRC) cell lines were established by continuous FOLFIRI treatment. Comparative mutation screening (161 genes) and transcriptomics (pathway and differential expression analyses) were performed in parental and resistant cells. Data reconciliation was performed in GSE62322, a clinical FOLFIRI responder data set (intrinsic resistance). Relapse-free survival (RFS) associations of identified differentially expressed genes and potential gene signatures were investigated in 8 clinical CRC data sets. No mutual genetic alterations were found in FOLFIRI-resistant derivatives. Resistant cell lines displayed activation of mitogen-activated protein kinase, immune response, and epithelial-mesenchymal transition pathways. Twelve differentially expressed genes, significantly differentially expressed in at least 2 of the 3 resistant cell lines, were identified. Comparison with GSE62322 and subsequent survival analyses revealed a 5-gene FOLFIRI signature comprised of CAV2, TNC, TACSTD2, SERPINE2, and PERP that was associated with RFS in multiple data sets including the cancer genome atlas CRC (hazard ratio [HR] =2.634, P = 4.53 × 10-6), in pooled samples of all data sets (all stages [N = 1981]: HR = 1.852, P = 6.44 × 10-13; stage IV [N = 260]: HR = 2.462, P = 5.22 × 10-9). A multivariate Cox regression analysis identified the 5-gene signature as an independent prognostic factor in the cancer genome atlas data set (HR = 1.89, P = .0202). Our analyses revealed a 5-gene FOLFIRI resistance signature associated with RFS that may help predict FOLFIRI resistance and thus avoid unnecessary ineffective treatment. Signature members might also represent targets to fight FOLFIRI resistance.

Combined preoperative and post-adjuvant-chemotherapy carcinoembryonic antigen levels are prognostic for early recurrence and survival in stage III colon cancer

BACKGROUND

The definitive treatment of stage-III colon cancer is surgery and adjuvant chemotherapy. A combined assessment of pre-operative and post-adjuvant chemotherapy carcinoembryonic antigen (CEA) levels may better prognosticate early recurrence and survival.

METHODS

A cohort of patients who underwent surgery and adjuvant chemotherapy was assessed. The CEA-Square (CEA2) score was defined as the multiplication of preoperative and post-adjuvant chemotherapy CEA levels and was grouped as "≤25(ng/mL)2" and ">25(ng/mL)2.

RESULTS

Among the 432 patients,137 were eligible. CEA2 score (>25 vs ​≤ ​25 (ng/mL)2) was significantly prognostic for early recurrence (34.5 ​% vs. 14.3 ​%, log-rank, p ​< ​0.001). In the multivariable analysis, only the CEA2 score remained associated with early recurrence [HR:3.375, (95 ​% CI:1.488-7.655), p ​= ​0.004]. In a median follow-up of 37.5 months (2.5-101.0), a high CEA2 score [>25 (ng/mL)2] was significantly associated with a worse OS (log-rank, p ​< ​0.001).

CONCLUSION

CEA2 is a simple, practical score combining prognostic values of preoperative and post-adjuvant chemotherapy CEA levels.

The feasible role of soluble E‑cadherin in spheroidogenesis of HCT116 colorectal cancer cells, a candidate biomarker for liquid biopsy

Although E-cadherin is known as a tumor suppressor via its effects on cell to cell adhesion, the effects of E-cadherin on malignant transformation have not yet been thoroughly investigated. In the present study, after malignant transformation was induced by spheroid formation in a fetal bovine serum-supplemented environment, the effects of soluble E-cadherin on the spheroidogenesis of colorectal cancer cells were investigated. E-cadherin knock-out (KO) was performed in HCT116 cells, targeting exon 3 of the CDH1 gene. A cell viability assay was performed to determine the proliferation and viability of wild type and CDH1 KO HCT116 cells after treatment with anticancer drugs. Spheroidogenesis was compared with or without exogenous E-cadherin, antibody against the ectodomain of E-cadherin (DECMA-1) and PD98059 treatment. In addition, morphometry, immunocytochemistry and western blotting were performed. Soluble E-cadherin in culture media was measured using an enzyme-linked immunosorbent assay. Firstly, CDH1 KO was confirmed by western blotting. Notably, the proliferation and viability of cells following treatment with 5-fluorouracil, epidermal growth factor receptor inhibitor and src kinase inhibitor were similar between the cell lines. Exogenous E-cadherin or DECMA-1 treatment did not affect spheroidogenesis, although long-term maintenance was slightly disturbed in CDH1 KO spheroids compared with that in wild type spheroids. In addition, E-cadherin was increased in spheroid culture as compared with that in conventional culture. Soluble E-cadherin was increased in a time-dependent manner, particularly in wild type HCT116 cells. PD98059 inhibited ERK activation and enhanced E-cadherin expression in conventional culture without affecting spheroidogenesis. These results suggested that soluble E-cadherin may be considered as a biomarker for colorectal cancer, although exogenous E-cadherin might not have a further role in malignant transformation.