Colorectal cancer statistics, 2023

Investigation of changes in planning target volume and regression probability of rectal boost using in-silico cone-beam computed tomography-guided online-adaptive radiotherapy

Background and purpose

Radiotherapy boost to the primary tumour may enable organ preservation in locally advanced rectal cancer (LARC). This study evaluated cone-beam computed tomography (CBCT)-guided online-adaptive radiotherapy (ART) to reduce rectal boost planning target volume (PTVBoost) margins and allow dose escalation.

Materials and methods

Eleven LARC patients were included in this in silico study. Population-based PTVBoost margins were computed for non-adaptive and online-ART using van Herk's formalism. Dose/volume results were compared between: non-adaptive RT with a 25 x 2.16 Gy boost (Non-ART54Gy), ART with a 25 x 2.16 Gy boost (ART54Gy), and ART with an escalated boost of 25 x 2.4 Gy (ART60Gy). Tumour regression probability was compared between each plan using a dose-response model.

Results

PTVBoost margins for non-adaptive vs. online-ART were 14.2 vs. 3.3 mm in the antero-posterior, 5.0 vs. 3.2 mm in the left-right, and 12.3 vs. 8.7 mm in the supero-inferior axes. PTVBoost and pelvic lymph node PTV coverage (V95%) were significantly improved with ART54Gy and ART60Gy compared to Non-ART54Gy (p < 0.001). High-priority organ-at-risk constraints (priority 1&2) were violated in 26.8 % of cases for Non-ART54Gy, 21.2 % of cases for ART54Gy, and 20.8 % of cases for ART60Gy. Tumour regression probability was superior for ART60Gy (20.8 %) compared to ART54Gy (17.0 %, p < 0.001) and Non-ART54Gy (16.9 %, p < 0.001).

Conclusions

Online-ART significantly reduce rectal boost PTV margin. It allows better target volume coverage with a similar risk of radiation-induced toxicities, even when escalating the dose. Therefore, online-ART should be considered to perform dose-escalation in LARC patients with the objective of organ preservation.

Unraveling Early Onset Disparities and Determinants: An Analysis of Colorectal Cancer Outcomes and Trends in Texas

Introduction Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the U.S., with disparities in incidence, survival, and age at diagnosis across racial, ethnic, and socioeconomic groups. The rising incidence of early-onset CRC (<50 years) has amplified concerns regarding access to care, screening disparities, and outcomes, particularly among minorities. This study examines the impact of race, ethnicity, socioeconomic status (SES), and sex on CRC survival and age at diagnosis in Texas from 1995 to 2016. Methods This retrospective cohort study utilized Texas Cancer Registry (TCR) data, including 235,076 CRC cases diagnosed between 1995 and 2016. Kaplan-Meier analysis and log-rank tests assessed 10-year survival by race and ethnicity and time period (1995-2005 vs. 2006-2016). Kruskal-Wallis tests with Bonferroni correction were used to compare survival years between racial/ethnic groups within each period. Age at diagnosis was analyzed by race and ethnicity, and SES using Welch ANOVA and Games-Howell post hoc testing. Welch's t-tests compared intra-race changes across decades. Sex-based differences in diagnosis age were assessed using Mann-Whitney U tests. Results Significant racial, ethnic, and socioeconomic disparities were observed in CRC outcomes. Black: Non-Hispanic and Black: Hispanic patients exhibited some of the lowest median survival times, with minimal overall improvement between the two time periods. Although Black: Hispanic patients exhibited the lowest median survival, the difference was not statistically significant in the 2006-2016 cohort (p = 0.12). Hispanic and Black patients were diagnosed at younger ages compared to White: Non-Hispanic patients. Lower SES was associated with younger age at diagnosis and worse survival. Male patients were consistently diagnosed earlier than female patients across both decades. Despite some improvement in survival for certain groups, disparities persisted, particularly for Black: Non-Hispanic and Black: Hispanic patients. Conclusion Disparities in CRC survival and diagnosis age persist across racial, ethnic, SES, and sex lines in Texas. These findings underscore the need for tailored screening efforts, improved healthcare access, and targeted interventions for high-risk populations. Persistent sex-based differences highlight a need for further research into biological and systemic factors. Addressing social determinants of health may help reduce these disparities.

County socioeconomic status and premature mortality from cancer in the United States

INTRODUCTION

There are consistent data demonstrating socioeconomic status (SES) is associated with cancer survivorship among older adults, but research on the relationship between area-level SES and risk of premature mortality from cancer remains not well understood. This study investigated the association between county-level SES and premature mortality from cancer.

METHODS

Demographic characteristics and causes of death were ascertained from the national death certificate data for years 2016-2020. Premature cancer death was defined as cancer mortality between ages 25-64. County SES was calculated using the Yost Index and categorized into distribution-based quintiles (1 =lowest SES, 5=highest SES). To calculate the mortality-adjusted rate ratios (aRR) and corresponding 95 % confidence intervals (95 %CI) for the associations between county SES and cancer, we performed multivariable linear mixed models, adjusting for confounders.

RESULTS

A total of 3143 counties were included. The age-adjusted mortality rates of all cancers combined were 107.6, 98.4, 88.6, 81.1, and 66.7 per 100,000 population for the 5 SES quintiles, respectively. Compared with high SES counties, low SES counties had a 58 % greater premature cancer mortality rate (aRRquintile 1 vs.5 =1.58, 95 %CI: 1.55-1.60). Similar associations were observed when stratified by sex, though risk was greatest among men ([aRRwomen=1.48, 95 %CI: 1.45-1.52]; [aRRmen=1.66, 95 %CI: 1.62-1.70]). Among leading cancer types, the association was greatest for lung cancer mortality for the lowest SES counties (aRR=2.03; 95 %CI: 1.98-2.08).

CONCLUSION

Our findings demonstrate that lower SES counties are at greater risk of premature mortality from cancer. Place-based interventions should target the socioeconomic environment across the cancer control continuum.

Understanding the impact of early onset colorectal cancer on quality of life: a qualitative analysis of online forum data

PURPOSE

Early onset colorectal cancer (EOCRC) is rising. The profile of health-related quality of life (HRQOL) impacts may differ in this younger cohort. Online forums are a source of unfiltered information regarding patient experience. This study used a qualitative analysis of online forum messages to elicit the unique HRQOL impacts of EOCRC.

METHODS

Messages were extracted from an online EOCRC UK forum. Inductive coding (with 10% dual-coding) and thematic analysis were used to describe the impact of diagnosis and treatment on HRQOL.

RESULTS

Data extraction and analyses were performed over one month; 463 messages (dated 01/04/2019 to 31/03/2024) were included. There was 100% concordance on dual-coding for main themes. Eight themes emerged: (1) diagnostic pathway and barriers; (2) parenthood and effect on children; (3) employment and finances; (4) fertility and early menopause; (5) stoma implications; (6) support systems, relationships and isolation; (7) sport and exercise and (8) mental health.

CONCLUSIONS

Qualitative thematic analysis of online forum data is a novel and efficient methodology for understanding the impact of cancer on HRQOL. Identified themes overlapped with those published in previous systematic reviews. This study offers new insights into the impact of isolation, early menopause, benefits of parenthood, psychological impact on children and practical and psychological implications of potential infertility in EOCRC. Current understanding of the diagnostic challenges and unique HRQOL impacts of EOCRC raises future research questions regarding how colorectal cancer services should evolve to provide support more in keeping with the needs of this growing younger cohort.

Isatin-modified Calixarene derivatives: A comprehensive study on synthesis, enzyme inhibition, antioxidant, antimicrobial, and Antiproliferative activities

In this article, a series of calix[4]arenes derivatized with isatin derivatives at the phenolic-O position were synthesized as potential theranostic molecules for antitumor therapy. The cytotoxic mechanism of action of the synthesized compounds was determined by Alamar Blue assay and flow cytometry using MCF-7, MDA-MB-231, DLD1, HeLa and A549 human cancer cell lines and their ability to penetrate into PNT1A healthy epithelial cells. To detect DNA damage, the Comet test was applied after the synthesized compounds interacted with the cells. As a result, it was found that treated cells had abnormal tail nuclei and damaged DNA structures compared with untreated cells. Within the scope of enzyme inhibition experiments, studies were carried out on aromatase and COX-2 enzymes and it was determined that the compounds in the series showed inhibitory activity at varying rates. Especially compounds CLX-A3, CLX-A4, CLX-B3 and CLX-B5 attract attention with their enzyme inhibitor potential. Also, the antioxidant activities of the compounds whose synthesis was completed were also investigated and it was observed that the examined derivatives also had antioxidant activity potential. As a result of the antibacterial and antifungal test performed with broth microdilution, it was observed that the compounds had significant antibacterial and antifungal activity. The lowest MIC values were recorded as 0.006 mg/ml against Sarcina lutea and 0.048 against Candida albicans. In addition, the compound CLX-B3was observed to be effective against all strains including, Klebsiella pneumoniae and Salmonella enteritidis (Gram-negative pathogenic bacteria).

Efficacy and safety of fruquintinib combined with PD-1 inhibitors in the treatment of refractory metastatic colorectal cancer: a systematic review and meta-analysis

BACKGROUND

Fruquintinib, a VEGFR1-3 tyrosine kinase inhibitor, is approved for treating refractory metastatic colorectal cancer. Recent clinical practice has shown that combining fruquintinib with programmed cell death protein 1 (PD-1) inhibitors can achieve better efficacy.The objective of this study is to assess the efficacy and safety of combining PD-1inhibitors with fruquintinib.

METHODS

We systematically searched PubMed, Cochrane Library, Embase, Wanfang, and CNKI up to 28 August 2024 for studies comparing fruquintinib combined with PD-1 inhibitors to fruquintinib alone. RevMan software was used to perform meta-analyses of survival data for the included studies.

RESULTS

A total of 9 retrospective cohort studies and 1 randomized controlled trial were included, involving a total of 716 patients. Compared with the monotherapy group, the combination therapy group had a greater Overall Response Rate [RR = 2.45,95% CI (1.83, 3.56), p < 0.00001], Disease Control Rate [RR = 1.37,95% CI (1.64,4.79), p = 0.0002], and progression-free survival [HR = 0.64,95% CI (0.49, 0.84), p = 0.001]. However, there was no significant difference in overall survival between the two groups. The incidence of adverse effects was identical in both groups.

CONCLUSION

Fruquintinib combined with PD-1 inhibitors was more effective than fruquintinib alone in the treatment of advanced colorectal cancer, with acceptable safety.

REGISTRATION

PROSPERO (registration number CRD42024583116).

Deep Learning Algorithm‑Based MRI Radiomics and Pathomics for Predicting Microsatellite Instability Status in Rectal Cancer: A Multicenter Study

RATIONALE AND OBJECTIVES

To develop and validate multimodal deep-learning models based on clinical variables, multiparametric MRI (mp-MRI) and hematoxylin and eosin (HE) stained pathology slides for predicting microsatellite instability (MSI) status in rectal cancer patients.

MATERIALS AND METHODS

A total of 467 surgically confirmed rectal cancer patients from three centers were included in this study. Patients from center 1 were randomly divided into a training set (242 patients) and an internal validation (invad) set (105 patients) in a 7:3 ratio. Patients from centers 2 and 3 (120 patients) were included in an external validation (exvad) set. HE and immunohistochemistry (IHC) staining were analyzed, and MSI status was confirmed by IHC staining. Independent predictive factors were identified through univariate and multivariate analyses based on clinical evaluations and were used to construct a clinical model. Deep learning with ResNet-101 was applied to preoperative MRI (T2WI, DWI, and contrast-enhanced T1WI sequences) and postoperative HE-stained images to calculate deep-learning radiomics score (DLRS) and deep-learning pathomics score (DLPS), respectively, and to DLRS and DLPS models. Receiver operating characteristic (ROC) curves were plotted, and the area under the curve (AUC) was used to evaluate and compare the predictive performance of each model.

RESULTS

Among all rectal cancer patients, 82 (17.6%) had MSI. Long diameter (LD) and pathological T stage (pT) were identified as independent predictors and were used to construct the clinical model. After undergoing deep learning and feature selection, a final set of 30 radiomics features and 30 pathomics features were selected to construct the DLRS and DLPS models. A nomogram combining the clinical model, DLRS, and DLPS was created through weighted linear combination. The AUC values of the clinical model for predicting MSI were 0.714, 0.639, and 0.697 in the training, invad, and exvad sets, respectively. The AUCs of DLPS and DLRS ranged from 0.896 to 0.961 across the training, invad, and exvad sets. The nomogram achieved AUC values of 0.987, 0.987, and 0.974, with sensitivities of 1.0, 0.963, and 1.0 and specificities of 0.919, 0.949, and 0.867 in the training, invad, and exvad sets, respectively. The nomogram outperformed the other three models in all sets, with DeLong test results indicating superior predictive performance in the training set.

CONCLUSION

The nomogram, incorporating clinical data, mp-MRI, and HE staining, effectively reflects tumor heterogeneity by integrating multimodal data. This model demonstrates high predictive accuracy and generalizability in predicting MSI status in rectal cancer patients.

Predicting bone metastasis risk of colorectal tumors using radiomics and deep learning ViT model

Background

Colorectal cancer is a prevalent malignancy with a significant risk of metastasis, including to bones, which severely impacts patient outcomes. Accurate prediction of bone metastasis risk is crucial for optimizing treatment strategies and improving prognosis.

Purpose

This study aims to develop a predictive model combining radiomics and Vision Transformer (ViT) deep learning techniques to assess the risk of bone metastasis in colorectal cancer patients using both plain and contrast-enhanced CT images.

Materials and methods

We conducted a retrospective analysis of 155 colorectal cancer patients, including 81 with bone metastasis and 74 without. Radiomic features were extracted from segmented tumors on both plain and contrast-enhanced CT images. LASSO regression was applied to select key features, which were then used to build traditional machine learning models, including Support Vector Machine (SVM), K-Nearest Neighbors (KNN), Random Forest, LightGBM, and XGBoost. Additionally, a dual-modality ViT model was trained on the same CT images, with a late fusion strategy employed to combine outputs from the different modalities. Model performance was evaluated using AUC-ROC, accuracy, sensitivity, and specificity, and differences were statistically assessed using DeLong's test.

Results

The ViT model demonstrated superior predictive performance, achieving an AUC of 0.918 on the test set, significantly outperforming all traditional radiomics-based models. The SVM model, while the best among traditional models, still underperformed compared to the ViT model. The ViT model's strength lies in its ability to capture complex spatial relationships and long-range dependencies within the imaging data, which are often missed by traditional models. DeLong's test confirmed the statistical significance of the ViT model's enhanced performance, highlighting its potential as a powerful tool for predicting bone metastasis risk in colorectal cancer patients.

Conclusion

The integration of radiomics with ViT-based deep learning offers a robust and accurate method for predicting bone metastasis risk in colorectal cancer patients. The ViT model's ability to analyze dual-modality CT imaging data provides greater precision in risk assessment, which can improve clinical decision-making and personalized treatment strategies. These findings underscore the promise of advanced deep learning models in enhancing the accuracy of metastasis prediction. Further validation in larger, multicenter studies is recommended to confirm the generalizability of these results.

Gene expression profiling to uncover prognostic and therapeutic targets in colon cancer, combined with docking and dynamics studies to discover potent anticancer inhibitor

Drug resistance poses a major obstacle to the efficient treatment of colorectal cancer (CRC), which is one of the cancers that kill people most often in the United States. Advanced colorectal cancer patients frequently pass away from the illness, even with advancements in chemotherapy and targeted therapies. Developing new biomarkers and therapeutic targets is essential to enhancing prognosis and therapy effectiveness. My goal in this study was to use bioinformatics analysis of microarray data to find possible biomarkers and treatment targets for colorectal cancer. Using an ArrayExpress database, I examined a dataset on colon cancer to find genes that were differentially expressed (DEGs) in tumor versus healthy tissues. Integration of advanced bioinformatics tools provided robust insights into the identification and analysis of EGFR as a key player. STRING and Cytoscape enabled the construction and visualization of protein-protein interaction networks, highlighting EGFR as a hub gene due to its centrality and interaction profile. Functional enrichment analysis through DAVID revealed EGFR's involvement in critical biological pathways, as identified in GO and KEGG analyses. This underscores the power of combining computational tools to uncover significant biomarkers like EGFR. Autodock Vina screening of the NCI diversity dataset identified two potential EGFR inhibitors, ZINC13597410 and ZINC04896472. MD simulation data revealed that ZINC04896472 could be potential anticancer inhibitor. These findings serve as a basis for the creation of novel therapeutic approaches that target EGFR and other discovered pathways in CRC. The suggested strategy may improve the efficacy of CRC therapy and advance personalized medicine.

Outcomes of Postchemoradiotherapy Watch-and-Wait Strategy in Patients With Rectal Cancer: A 20-Year, Single-Center Study

BACKGROUND AND OBJECTIVES

The watch-and-wait (WW) strategy is a nonsurgical alternative for patients with rectal cancer exhibiting an excellent response to chemoradiotherapy. Studies on the WW strategy have primarily investigated 5-year oncological outcomes; few have focused on longer-term outcomes or the optimal patient selection approach for this therapeutic strategy.

METHODS

This retrospective study enrolled patients with locally advanced rectal adenocarcinoma who had achieved complete response after chemoradiotherapy. Patients who achieved pathological complete response were categorized into a control group (n = 95) and those who achieved clinical complete response and were managed using the WW strategy were categorized into a case group (n = 33). Kaplan-Meier estimates were calculated for the between-group comparison of survival.

RESULTS

The median follow-up duration was 89 months. Compared with the control group, the case group exhibited improved long-term sphincter preservation, particularly for low-lying tumors (p = 0.032), and inferior nonlocal-regrowth disease-free survival (p = 0.007). Within the case group, patients achieving a complete response by positron emission tomography exhibited 5-year survival rates similar to those achieving a complete endoscopic response.

CONCLUSION

The WW strategy is associated with improved sphincter preservation but worse nonlocal-regrowth disease-free survival. The potential of PET in patient selection for this strategy deserves further investigation.

Isoegomaketone improves radiotherapy efficacy and intestinal injury by regulating apoptosis, autophagy and PI3K/AKT/mTOR signaling in a colon cancer model

The current study aimed to investigate the effect of isoegomaketone (IK) as a radiosensitizer for colon cancer and its effect on intestinal injury, and to verify its potential mechanism. A total of 40 BALB/c nude mice were selected to construct a HT‑29 tumor‑bearing mice model with T lymphocyte deficiency. Tumor size was measured every other day, and the survival of mice was counted. Intestinal and tumor tissues of mice were harvested when the experiment ended. The levels of inflammatory factors and markers of oxidative stress in intestinal tissues of different groups of mice were analyzed by ELISA. Western blotting was used to examine the expression of apoptosis‑ and autophagy‑related proteins, and the phosphorylation levels of the PI3K/AKT/mTOR signaling pathway in HT‑29 cells and tumor tissues. Radiotherapy (RT) combined with IK significantly reduced the viability of HT‑29 cells. The optimal dose proportion of RT combined with IK was 8 Gy and 100 µg/ml, and the combination index was <1, suggesting a strong combination effect. In addition, IK could further promote radiation DNA damage in HT‑29 cells by inhibiting the PI3K/AKT/hypoxia inducible factor 1α (HIF‑1α) signaling pathway, while upregulating the expression of proapoptotic and autophagy‑related proteins in HT‑29 cells. In HT‑29 tumor‑bearing mice, RT in combination with IK significantly inhibited the growth of xenografts and improved mouse survival. In addition, the combination of RT and IK significantly upregulated BAX and Beclin‑1 expression, downregulated BCL‑2 expression, and promoted the conversion of LC3 I to LC3 II. Radiation induced an increase in inflammatory cytokine levels as well as oxidative stress marker levels in intestinal tissue. Western blot analysis showed that the combination of RT and IK significantly inhibited the phosphorylation level of the PI3K/AKT/mTOR signaling pathway compared with the control and monotherapy groups. IK could significantly enhance the efficacy of RT by regulating the apoptosis and autophagy of colon cancer tumors, and alleviate inflammation and oxidative stress by regulating the PI3K/AKT/mTOR signaling pathway to alleviate intestinal injury. The present findings suggest that IK can be used as a promising sensitizer and has the potential to enhance the efficacy and safety of RT for colon cancer.

Shikonin Derivative Suppresses Colorectal Cancer Cells Growth via Reactive Oxygen Species-Mediated Mitochondrial Apoptosis and PI3K/AKT Pathway

Colorectal cancer (CRC) is one of the deadliest cancers globally, ranking as the third most prevalent and second most lethal malignancy worldwide. The standard treatment for CRC typically involves a combination of surgery, radiotherapy, and chemotherapy. Despite advancements in CRC treatment, the prognosis remains unsatisfactory, primarily due to unclear mechanisms underlying tumorigenesis and the aggression of CRC. The aberrant activation of the PI3K/AKT pathway is frequently implicated in the initiation, progression, and metastasis of CRC. Studies have demonstrated that shikonin (SK) exerts anti-cancer effects. In this study, we evaluated the anti-tumor activities of a series of semi-synthesized SK derivatives against CRC cells. Our findings revealed that the SK derivative (M12) significantly inhibited the proliferation and colony formation of CRC cells, reduced cell migration, and induced apoptosis. Mechanistically, M12 enhanced the production of reactive oxygen species and downregulated the mitochondrial membrane potential, ultimately leading to mitochondrial apoptosis. Furthermore, M12 exhibited anti-CRC effects by modulating the PI3K/AKT signaling pathway and significantly suppressed tumorigenicity without causing notable adverse effects in mice. Therefore, targeting the PI3K/AKT pathway could be a promising treatment for CRC. M12 appears to be a promising candidate for the effective and safe treatment of CRC.

Robotic-assisted surgery for locally advanced rectal cancer beyond total mesorectal excision planes: the Mayo Clinic experience

BACKGROUND

The purpose of this study was to evaluate the surgical and oncological outcomes of robotic-assisted beyond-TME surgery for locally advanced rectal cancer.

METHODS

Consecutive adult (≥ 18 years old) patients who underwent a robotic-assisted proctectomy beyond-TME planes for primary or recurrent rectal cancer at three Mayo Clinic (USA) hospitals from 2017-2023 were included. Patient demographics and tumor and disease characteristics were obtained by review of the electronic health record. Outcomes of interest included postoperative complications, hospital length of stay, and pathologic and oncologic outcomes.

RESULTS

In total, 72 patients were included in the final cohort. Thirty-five (48.6%) patients underwent an extended resection without exenteration, while 22 (30.6%) underwent a multi-visceral en bloc exenteration; 20 (36.1%) patients underwent a lateral pelvic lymph node dissection, with or without a concomitant extended resection. Most cases had an advanced T-stage and an involved mesorectal fascia on pre-treatment MRI. The median operative time was 425.0 min (340.5-504.0) and the median estimated blood loss was 150.0 mL (75.0-277.5). Conversion to open surgery was needed in two (2.8%) cases. Nearly half the cohort (48.3%) experienced a postoperative complication and the median postoperative length of stay was 3.5 (3.0-7.0) days. Five cases had a positive margin, resulting in an R0 rate of 93.1%. None of the exenteration cases had a positive margin. After a median follow-up of 22.0 (13.0-45.7) months, 10 patients experienced a local recurrence (13.8%).

CONCLUSION

Robotic-assisted beyond-TME surgery can be performed safely with favorable postoperative clinical and oncologic outcomes.

Rectal Cancer Disparities Among the American Indian/Alaskan Native Populations

PURPOSE

Recent work noted lower overall survival (OS) in American Indian/Alaskan Native (AI/AN) individuals diagnosed with colon cancer compared with non-Hispanic White (NHW) individuals. Rectal cancer demographic profiles at diagnosis and survival outcomes have not been reported. We sought to identify differences in rectal cancer diagnosis and outcomes between AI/AN and White populations.

METHODS

White and AI/AN patients aged 18 or older, diagnosed between 2004 and 2020 with rectal adenocarcinoma were identified within the National Cancer Database (NCDB). Unadjusted and adjusted analyses were used to evaluate demographic and clinical standardized differences (stddiff) between AI/AN and White patients. Survival analyses of those diagnosed with locally advanced rectal cancer (Stage II/III) were performed using the Kaplan-Meier methods and multivariate Cox-proportional hazards modeling.

RESULTS

176,341 eligible cases were identified: 0.6% were AI/AN (N = 992) and 99.4% White (N = 175,349). Compared to the White population, AI/AN patients were younger at diagnosis (mean age 59.9 vs. 64.5 years; stddiff = 0.36) and had more advanced stage disease (44.8% vs. 43.7%; stddiff = 0.15). A higher percentage of AI/AN resided in the areas of the lowest median income (35.5% vs. 15.1%; stddiff = 0.62) per zip code, rural (9.9% vs. 2.2%; stddiff = 0.65), and used Medicaid as their primary payor (14.3% vs. 6.2%; stddiff = 0.63). Adjusted analyses suggest the AI/AN group has an increased hazard of death compared with the White population (HR, 1.14; 95% CI, 1.05-1.25; p = 0.003).

CONCLUSIONS

AI/AN patients with rectal cancer have a younger age and a more advanced stage at diagnosis. AI/AN race is associated with lower OS compared to White patients in multivariable analyses. Future efforts should focus on increasing colorectal cancer screening and access to treatment for AI/AN populations in an attempt to improve survival outcomes.

Association of non-gain-of-function alterations in exportin-1 with improved overall survival in colorectal cancer

BACKGROUND

Upregulation of nuclear export protein exportin-1 (coded by gene XPO1) has been previously demonstrated in multiple cancer subtypes, contributing to pharmacotherapy resistance and increased recurrence rates. This study aimed to explore the effect of non-gain-of-function (GOF) XPO1 alterations in patients with colorectal cancer (CRC).

METHODS

Patients with colon/rectal/colorectal adenocarcinoma were identified from the Memorial Sloan Kettering Clinicogenomic, Harmonized Oncologic Real-World Dataset using cBioPortal. A subpopulation with alterations in XPO1 was identified. Patients with known amplifications and GOF E571K and R749Q alterations were excluded, as were patients with in situ and stage IV disease. Survival analysis was performed via Kaplan-Meier and Cox proportional hazards analyses, adjusted for patient age and disease stage.

RESULTS

Among 5543 patients with CRC, 83 (1.5%) had alterations in the XPO1 locus, and 5460 patients (98.5%) did not. Of patients with XPO1 alteration, 66 (79.5%) had non-GOF alterations, and 17 (21.5%) had GOF point mutations or amplifications. Patients with non-GOF XPO1 alteration had a mortality hazard ratio of 0.601 (95% CI, 0.463-0.805; P =.011). When adjusted for patient age and disease stage, XPO1 co-alteration was associated with improved overall survival (OS) in patients with alterations in TP53, APC, FBXW7, SMAD4, and BRAF genes (all P <.01).

CONCLUSION

XPO1 alterations were associated with improved OS in patients with CRC. Associated survival benefits persisted when co-alterations were present, particularly in co-alterations with intranuclear tumor suppressor proteins.

Efficacy and safety of oral sulfate solution versus polyethylene glycol for colonoscopy: A systematic review and meta-analysis of randomized controlled trials

Background

Colonoscopy is the gold standard for early detection and monitoring of colorectal cancer. Procedural effectiveness is dependent on optimal bowel preparation. Traditional polyethylene glycol (PEG) solutions are difficult to tolerate, whereas newer low-volume alternatives, including PEG with ascorbic acid and oral sulfate solutions (OSS), offer improved efficacy and tolerability. The meta-analysis was performed to evaluate the efficacy and safety of OSS compared to PEG for bowel preparation in colonoscopy.

Methods

Studies were identified by searching PubMed, Embase, Cochrane CENTRAL, and clinicaltrials.gov from inception until June 2024. Only randomized controlled trials comparing OSS with PEG were included. Data was analyzed using R version 4.4.0 using a random effects model to calculate risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs).

Results

Twenty-one studies with 6346 participants met the inclusion criteria. OSS significantly improved adenoma detection (RR, 1.13; 95% CI, 1.04-1.22; p-value <0.01; I2 = 0%) and polyp detection rates (RR, 1.16; 95% CI, 1.06-1.26; p-value <0.01; I2 = 0%), and had a higher Boston Bowel Preparation Scale (BBPS) score (MD, 0.31; 95% CI, 0.13-0.50; p-value <0.01; I2 = 81%). PEG was associated with more sleep disturbances (RR, 0.45; 95% CI, 0.25-0.82; p-value = 0.03; I2 = 0%). However, other adverse effects were similar between both solutions.

Conclusion

OSS demonstrated superior adenoma and polyp detection rates. When compared to PEG, patients utilizing OSS achieved higher BBPS scores. Data gleaned support enhanced cleansing efficacy and safety of OSS as a bowel preparation regimen.

Fact or Myth? Black Patients Do Not Want to Participate in Clinical Trials

INTRODUCTION

To assess strategies for optimizing participation of underserved minorities in a blood-based early colorectal cancer detection test study (PREEMPT CRC; NCT04369053) at a hospital serving primarily Black individuals.

METHODS

Culturally sensitive, racially congruent research staff approached individuals undergoing average-risk screening colonoscopy. Consent/study procedures were synchronized with clinical appointments. Enrolled and not-enrolled patient characteristics were compared. Recruitment was compared with other study sites.

RESULTS

In total, 247 of 509 eligible individuals were enrolled; most were identified as Black (88.7%). No baseline characteristics were associated with participation. Recruitment was high compared with other sites (11th centile).

DISCUSSION

Recruitment barriers for Black individuals can be overcome when easy, culturally sensitive access is facilitated.

Extrachromosomal circular DNA as a novel biomarker for the progression of colorectal cancer

BACKGROUND

Extrachromosomal circular DNA (eccDNA) has potential in tumor diagnosis, particularly for improving diagnostic accuracy and early cancer detection; however, many challenges remain in its application to clinical practice.

METHODS

We conducted a Circle-Seq analysis on clinical samples at different stages of colorectal cancer progression to examine the dynamic changes of eccDNA during the progression of colorectal cancer. We used breakpoint-specific PCR to verify candidate eccDNAs identified by Circle-Seq. The results were further validated using the AOM/DSS-induced colorectal cancer model.

RESULTS

There was an increase in the abundance of eccDNA with the progression of colorectal cancer. The genes associated with these eccDNA molecules were primarily related to signaling pathways involved in tumor development and metastasis. Our analysis also revealed that eccDNA abundance positively correlates with gene expression, and eccDNA derived from specific genes has potential value for the early diagnosis of tumors.

CONCLUSIONS

This study revealed a connection between eccDNA and colorectal cancer progression and highlights the clinical potential of eccDNA for the early diagnosis of colorectal cancer.

Gender Differences in Quality of Bowel Preparation for Colonoscopy: Post Hoc Analysis of a Randomized Controlled Trial

OBJECTIVE

Bowel cleansing is a key element for a quality colonoscopy. Despite recent advances, not all predictors of successful cleansing are fully known. This post hoc analysis of an RCT aims to explore gender differences in bowel cleansing quality.

METHODS

The "OVER" trial was a multicenter phase-4 RCT including 478 patients randomized 1:1 to receive split-dose 1L polyethylene glycol plus ascorbate (PEG+ASC) or 4L-PEG. In this post hoc analysis, multivariable logistic regression models were designed to assess predictors of cleansing success (CS) and adenoma detection rate (ADR) by gender.

RESULTS

Of the 478 randomized patients, 50.2% were males and 49.8% females.Overall, CS was comparable between females and males (87.1% vs 88.4, P = 0 .6), whereas CS in the right (95.7% vs 90.9, P = 0.049) and transverse colon (98.6% vs 93.9, P =0.011) was significantly higher in females.At multivariable regression analysis for CS outpatient setting (OR = 5.558) and higher withdrawal time (OR = 1.294) were independently associated with CS in females, whereas screening/surveillance indication (OR = 6.776) was independently associated with CS in males.At multivariable regression analysis for ADR, running time <5 hours (OR = 3.014) and higher withdrawal time (OR = 1.250) were independently associated with ADR in females, whereas older age (OR = 1.040) and higher withdrawal time (OR = 1.093) were independently associated with ADR in males.

CONCLUSIONS

This study showed different results in bowel preparation quality and different predictors of CS and ADR by gender. These findings suggest the need for further research to explore gender-specific approaches for bowel preparation.

Colon and rectal peritoneal carcinomatosis: are we mixing apples with oranges? A propensity score-matched analysis

Rectal cancer is universally considered a different disease entity as compared to colon cancer, except when dealing with colorectal peritoneal carcinomatosis (PC), in which the two cancers are deemed as the same one. The present study aims to investigate the influence of primary tumor location (colon vs. rectum) on oncologic outcomes in patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal peritoneal metastases. Data from three referral centers undergoing CRS plus HIPEC for PC of colorectal origin were prospectively collected. The primary outcomes were overall survival (OS) and disease-free survival (DFS) according to primary tumor location (colic vs. rectal). Univariate and multivariate analyses were performed using the Cox proportional hazard model first on the total number of patients. Then, a propensity score matching using the nearest-neighbour method with a 1:1 ratio was performed. The study included 167 patients: 126 colic and 41 rectal PC. After propensity score matching, rectal primary tumor location was independently predictive of a lower DFS (HR 1.91; 95%CI 1.06-3.45; p = 0.031) but not of a lower OS (HR 1.12; 95%CI 0.57-2.21; p = 0.73). Post-matching 3-year DFS rates were 49.2% (95%CI 34,3-70,5%) and 19.4% (95%CI 9,4-40,2%) for colic and rectal PC, respectively. The present study shows a significantly worse DFS for rectal cancer PC undergoing CRS and HIPEC compared to colon cancer PC, suggesting a possible need for dedicated pathways for rectal PC patients and posing a question for rectal PC to be considered as a unique disease entity.

Dumbbell probe-bridged CRISPR/Cas13a and nicking-mediated DNA cascade reaction for highly sensitive detection of colorectal cancer-related microRNAs

Colorectal cancer (CRC) is a leading cause of cancer-related deaths globally, necessitating the development of sensitive and minimally invasive diagnostic approaches. In this study, we present a novel diagnostic strategy by integrating dumbbell probe-mediated CRISPR/Cas13a with nicking-induced DNA cascade reaction (DP-bridged Cas13a/NDCR) for highly sensitive microRNA (miRNA) detection. Target miRNA triggers Cas13a-mediated cleavage of the dumbbell probe, releasing an intermediate strand that hybridizes with a methylene blue-labeled hairpin probe on the electrode surface. Nicking enzyme cleaves the formed duplex DNA, triggering a cascade reaction that amplifies the electrochemical signal. Under optimized conditions, the method demonstrates a detection limit of 8.26 fM for miRNA-21, with reliable specificity and long-term stability. Furthermore, integration with machine learning models using multiple miRNA markers improved diagnostic accuracy, differentiating CRC from colorectal polyps and healthy controls with 100% accuracy in clinical validation cohorts. This study highlights the potential of DP-bridged Cas13a/NDCR as a sensitive and accurate diagnostic tool for CRC.

Innovative Therapeutic Approach Targeting Colon Cancer Stem Cells: Transitional Cold Atmospheric Plasma

Transitional cold atmospheric plasma (TCAP) represents a novel technique for generating plasma remotely from a primary source. It consists of a partially nonthermal ionized gas mixture containing charged and neutral particles, photons, and free radicals. In recent years, TCAP has attracted considerable attention in biomedical applications. In order to evaluate colon cancer stem cells' (CCSCs) proliferation, apoptotic induction, inflammatory response, and survival, TCAP was utilized both directly and indirectly in this study. Using argon and helium gases, TCAP was continuously delivered in two stages during the experiment. For direct state, TCAP was irradiated onto CCSCs for 3 and 5 min. In the indirect technique, Matrigel was treated with TCAP for 5 min before the introduction of cells. In vitro assays demonstrated that TCAP exposure significantly reduced the viability of CCSCs; helium gas and direct application had greater impacts than argon. Numerous investigations confirmed the induction of apoptosis, showing that the treated groups had more apoptotic cells and altered cellular structures than controls (****p < 0.0001). A substantial increase in the Bax/Bcl-2 ratio was found by analyzing the expression of the Bax and Bcl-2 genes, indicating increased susceptibility to apoptosis (*p = 0.0177 and ***p = 0.0004). The higher efficacy of the direct helium mode was further highlighted by inflammatory marker analysis, which showed a significant reduction in interleukin-6 and interleukin-8 expression in cells directly treated with TCAP-helium compared to TCAP-argon (**p = 0.0015 and ***p = 0.0007). Lastly, the proliferation test, which relies on K i-67 expression, demonstrated a noteworthy decline in all TCAP-treated groups, with the direct helium group exhibiting the most robust impact (**p = 0.0014). Overall, the findings highlight the potential of TCAP, particularly with helium, as a promising approach for selectively targeting CCSCs and providing insights into its therapeutic mechanisms for cancer treatment. TCAP, therefore, emerges as a unique therapeutic strategy with potential applications in cancer stem cell-targeted therapies.

Targeting NUCKS1 with a fragment of tRNAAsn(GUU) of Chinese yew for the treatment of colorectal cancer

Despite the discovery of numerous oncogenes in colorectal cancer (CRC), the development of associated drugs is limited, posing a significant challenge for CRC treatment. Identification of novel druggable targets is therefore crucial for the therapeutic development of CRC. Here, we report the first investigation on therapeutics targeting the potent oncogene NUCKS1 to suppress cancer progression. NUCKS1-orientated bioinformatics screening of NUCKS1 inhibitors from our library of tRNA fragments originated from medicinal plants identified tRF-T36, a 5' tRNA fragment of tRNAAsn(GUU) of Chinese yew (Taxus chinensis), exhibiting stronger inhibitory effects than taxol against CRC progression. Mechanistically, tRF-T36 binds directly to the 3' UTR of NUCKS1 mRNA to downregulate its expressions via RNAi pathway. High-throughput RNA sequencing indicated that the downregulated NUCKS1 induced by tRF-T36 further inhibits PI3K/Akt pathway, as verified by the significantly efficacy decrease of tRF-T36 mimic in co-treatment with 740Y-P, an agonist of PI3K/Akt pathway. Collectively, our findings emphasize the importance of NUCKS1 as a promising druggable target for CRC. Furthermore, the present study provides the first siRNA sequence, tRF-T36 mimic, as small RNA drug candidate, thereby shedding light on CRC therapeutics.

Implications of the initial Braidwood v. Becerra ruling for colorectal cancer outcomes: a modeling study

The Affordable Care Act (ACA) eliminated patient cost-sharing for United States Preventive Service Task Force (USPSTF) recommended services. However, if the US Court of Appeals for the Fifth Circuit fully upheld a US District Court ruling in Braidwood Management v. Becerra, 666 F. Supp. 3d 613 (N.D. Tex 2023), cost-sharing for USPSTF recommendations made after ACA passage would have been reinstated for more than 150 million people. The case would have reinstated cost-sharing for colorectal cancer (CRC) screening for ages 45-49 years and for polyp removal during (diagnostic) colonoscopy across all ages. Using the MISCAN-Colon model, we simulated the potential impact on CRC outcomes, assuming early-onset CRC trends and lower screening participation. An 8-percentage-point decline in screening participation could increase CRC incidence by 5.1% and CRC mortality by 9.1%, with slightly lower costs due to increased cost-sharing. Larger decreases in screening participation can result in higher costs from increased incidence and delayed diagnoses.

UGT8 mediated sulfatide synthesis modulates BAX localization and dictates apoptosis sensitivity of colorectal cancer

Elevated de novo lipid synthesis is a remarkable adaptation of cancer cells that can be exploited for therapy. However, the role of altered lipid metabolism in the regulation of apoptosis is still poorly understood. Using thermal proteome profiling, we identified Manidipine-2HCl, targeting UGT8, a key enzyme in the synthesis of sulfatides. In agreement, lipidomic analysis indicated that sulfatides are strongly reduced in colorectal cancer cells upon treatment with Manidipine-2HCl. Intriguingly, this reduction led to severe mitochondrial swelling and a strong synergism with BH3 mimetics targeting BCL-XL, leading to the activation of mitochondria-dependent apoptosis. Mechanistically, Manidipine-2HCl enhanced mitochondrial BAX localization in a sulfatide-dependent fashion, facilitating its activation by BH3 mimetics. In conclusion, our data indicates that UGT8 mediated synthesis of sulfatides controls mitochondrial homeostasis and BAX localization, dictating apoptosis sensitivity of colorectal cancer cells.

Low CXCL11 expression is indicative of poor prognosis in rectal cancer patients undergoing preoperative chemoradiotherapy: a retrospective cohort study

INTRODUCTION

Neoadjuvant concurrent chemoradiotherapy (CCRT) is routinely used before surgery in patients with locally advanced rectal cancer to reduce tumor size and decrease the risk of local recurrence. However, the disease-specific survival has not improved in most cases due to distant metastases. In selected individuals exhibiting a clinical complete response, non-operative management may be allowed; however, those who presented no or little response tend to have an inferior prognosis. Consequently, refined molecular characterization could aid in predicting which patients would benefit from neoadjuvant chemoradiotherapy.

METHODS

The mRNA level (by transcriptomic profiling) and protein expression (by immunohistochemical staining) of C-X-C motif chemokine ligand 11 (CXCL11) were integrated to predict neoadjuvant chemoradiotherapy efficacy. For survival analysis, clinicopathological features and CXCL11 immunoreactivity that were statistically significant in univariate analysis were included in multivariate analysis using the Cox proportional hazards regression model.

RESULTS

We identified that the CXCL11 level exhibits the most significant downregulation among neoadjuvant chemoradiotherapy non-responders. Using tumor samples from our rectal cancer cohort (n = 343) with immunohistochemistry validation, we demonstrated that low CXCL11 immunoexpression shows significant correlations with advanced disease and positive lymph nodes both prior to and following CCRT (all p < 0.001), vascular and perineural invasion (p < 0.001 and p = 0.006), and poor response to CCRT (p < 0.001). Moreover, low CXCL11 immunoexpression was an independent adverse prognostic factor significantly associated with patient survival. Additionally, we further identified pyroptotic cell death as an unrevealed role of CXCL11 in rectal cancer through bioinformatic analysis.

CONCLUSION

CXCL11 expression may serve as an early predictor of clinical outcomes and aid in therapeutic decision-making by identifying individuals likely to respond to neoadjuvant chemoradiotherapy in rectal cancer.

CircSATB1 Promotes Colorectal Cancer Liver Metastasis through Facilitating FKBP8 Degradation via RNF25-Mediated Ubiquitination

Colorectal cancer (CRC) is one of the most common cancers worldwide and liver metastasis is the leading reason for its mortality. Circular RNAs (circRNAs) are conclusively associated with the progression of various cancers, rendering the exploration of its specific mechanisms in colorectal cancer liver metastasis(CRLM) highly valuable. Combined with GEO (Gene Expression Omnibus) databases and clinical data in our center, we found that high expression of circSATB1 is closely related to the progression of CRLM. Functionally, circSATB1 could significantly promote the metastatic ability of CRC cells in vitro and in vivo. Mechanistically, circSATB1 facilitated the RNF25-mediated ubiquitylation and degradation of FKBP8, releasing its inhibitory effects on mTOR signaling. In this process, circSATB1 acted as a scaffold for RNF25-FKBP8 complexes. Additionally, circSATB1 could be packaged in exosomes and secreted from the CRC primary tumors into plasma. In conclusion, this study uncovered a new circSATB1 that acts as a potent promoter of CRLM and offers novel insights into the precision therapeutic strategies for CRLM.

Gastric Cancer Screening in the United States: A Review of Current Evidence, Challenges, and Future Perspectives

Gastric cancer remains a leading cause of cancer-related mortality worldwide. In the United States, gastric cancer incidence and mortality are substantially higher among non-White racial and ethnic groups and new immigrants from high-incidence countries. This is in large part related to the higher prevalence of Helicobacter pylori -associated gastric premalignant changes in these populations. Apart from primary prevention, early detection of gastric cancer is the principal strategy to reduce gastric cancer mortality and improve survival. Extensive evidence in Asian countries has demonstrated the benefits of endoscopic screening in detecting early-stage gastric cancer and reducing gastric cancer-related mortality. By contrast, direct, high-quality US-based data, such as from large clinical trials or observational studies, on important outcomes of gastric cancer screening are still lacking. In this review, we evaluate and summarize the latest global evidence on the epidemiology and predisposing factors of gastric cancer as well as the efficacy, benefits vs. risks, and cost-effectiveness of gastric cancer screening. We further discuss the critical knowledge gaps and challenges in promoting gastric cancer screening in the United States. Dedicated research is urgently needed to enrich the US-based data on gastric cancer primary and secondary prevention to inform clinical practice and reduce gastric cancer-related morbidity and mortality in a cost and resource efficient manner.

Household income is independently associated with overall and cancer-specific survival after proctectomy for rectal cancer: A surveillance, epidemiology, and end results-based analysis

BACKGROUND

We assessed association among household income, overall survival (OS), and cancer-specific survival (CSS) after proctectomy for rectal cancer.

METHODS

Population-based cohort study included stage I-III rectal adenocarcinoma patients who underwent proctectomy (2010-2020), subdivided by household income at diagnosis [low (<$50,000), average ($50,000-74,999), above-average (≥$75,000)] and compared.

RESULTS

Of 39,185 patients (59 ​% male; mean age 60.4), 12.5 ​% had low, 48.1 ​% had average, and 39.4 ​% had above-average income. Low-income patients were more often Black, rural dwellers, and undergone total proctectomy (OR: 1.49, p ​< ​0.001). Income <$50,000 patients had shorter restricted mean OS (p ​< ​0.001) and CSS (p ​< ​0.001) than the other groups. 5-year ​OS ​(70.5 ​% ​vs. ​73.6 ​% ​vs. ​82.3 ​%, ​p ​< ​0.001) ​and ​CSS (78.3 ​% ​vs. ​80.6 ​% ​vs. ​87.2 ​%, ​p ​< ​0.001) ​were ​significantly ​lower ​in the ​low-income ​group ​than ​the ​average ​and ​above-average ​income groups. ​Adjusted for other factors, low-income was an independent predictor of OS (HR: 1.31, 95%CI: 1.22-1.41) and CSS (HR: 1.31, 95%CI: 1.21-1.43), compared to above-average.

CONCLUSIONS

Black patients and rural dwellers more often had <$50,000 income. Low-income increased odds of undergoing non-restorative surgery for rectal cancer and reduced OS and CSS.

Polysaccharide-based drug delivery targeted approach for colon cancer treatment: A comprehensive review

Colon cancer is a leading cause of cancer-related morbidity and mortality worldwide, necessitating advancements in therapeutic strategies to improve outcomes. Current treatment modalities, including surgery, chemotherapy, and radiation, are limited by systemic toxicity, low drug utilization rates, and off-target effects. Colon-targeted drug delivery systems (CDDS) offer a promising alternative by leveraging the colon's unique physiology, such as near-neutral pH and extended transit time, to achieve localized and controlled drug release. Polysaccharide-based CDDS, utilizing natural polymers like chitosan, cyclodextrin, pectin, guar gum, alginate, hyaluronic acid, dextran, chondroitin sulfate, and inulin, have emerged as innovative approaches for improving the specificity and efficacy of colon cancer treatments. These biocompatible and biodegradable polymers enable site-specific drug delivery, enhance tumor apoptosis, reduce systemic side effects, and improve patient compliance. This review evaluates recent advancements in polysaccharide-based CDDS, detailing their drug release mechanisms, therapeutic potential, and challenges in overcoming gastrointestinal transit and pH variability. Studies highlight the successful formulation of nanoparticles, microspheres, and other delivery systems, demonstrating targeted drug delivery, improved bioavailability, and enhanced cytotoxicity against colon cancer cells in-vitro and in-vivo. The review underscores the need for continued research on polysaccharide-based CDDS for colon cancer treatment, offering a path toward more effective, patient-centered oncological care.

Development of a Brief Online Mindfulness-Based Intervention to Reduce Patient Anxiety Before a First-Time Screening Colonoscopy

To describe the development of an online mindfulness-based intervention (MBI) to reduce anxiety before a first-time screening colonoscopy among average-risk patients. A qualitative study used an iterative process guided by health behavior and mindfulness theories and feedback from a convenience sample of patients, endoscopy medical staff, and community members. Patient and medical staff (n = 18) were included in formative interviews (30-45 min), eight helped during intervention development sessions (15-90 min), and four community members reviewed the MBI in individual sessions (60 min). Interviews and sessions were recorded, transcribed verbatim, and analyzed using NVivo qualitative data software. Two themes emerged from the study: (1) both patients and medical staff reported that average-risk patients have pre-procedural anxiety before a first-time screening colonoscopy, and (2) using stakeholder-engaged strategies in an iterative process with both patients and medical staff is important so the developed intervention is acceptable to the priority population and to ensure medical accuracy and avoid disruption of workflow. Using an iterative process with key stakeholders is essential to develop interventions that are feasible and acceptable. The MBI developed through this process is being compared to usual care in a pilot randomized controlled trial to determine intervention feasibility and patient acceptability and to collect preliminary efficacy data. If efficacious, the developed MBI has the potential to reduce pre-procedural anxiety which may improve patient behaviors (e.g., bowel prep adherence and quality), patient satisfaction, and clinic workflow by reducing cancellation/no-shows, the amount of sedation required, and procedural time.

Discovering biomarkers associated with infiltration of CD8+ T cells and tumor-associated fibrosis in colon adenocarcinoma using single-cell RNA sequencing and gene co-expression network

Background

Colorectal adenocarcinoma (COAD) is a prevalent malignant tumor associated with a high mortality rate. Within the tumor microenvironment, CD8+ T cells play a pivotal role in the anti-tumor immune response within the human body. Fibrosis directly and indirectly affects the therapeutic response of tumor immunotherapy. However, the significance of regulatory genes associated with tumor-associated fibrosis and CD8+ T cell infiltration remains uncertain. Therefore, it is imperative to identify biomarkers with prognostic value and elucidate the precise role of CD8+ T cells and tumor-associated fibrosis.

Methods

We performed a single-cell transcriptome analysis of COAD samples from the GEO database. To evaluate immune infiltration in COAD samples, we utilized CIBERSORT and ESTIMATE. Furthermore, we analyzed the correlation between CD8+ T cells and immune infiltration. To analyze COAD expression's quantitative immune cell composition data, we conducted a Weighted Gene Correlation Network Analysis and utilized a deconvolution algorithm. The data for these analyses were obtained from the GEO database. We utilized univariate Cox regression and LASSO analysis to create a prognostic model. The predictive model was assessed through Kaplan-Meier analysis, and a survival prediction nomogram was created. Additionally, we analyzed the correlation between the prognostic model and chemotherapy drug sensitivity. To estimate the expression of hub genes, we employed immunohistochemistry, real-time PCR, and western blot techniques.

Results

Single-cell transcriptome analysis has indicated a higher prevalence of CD8+ T cells in COAD tumor samples. The connection between COAD and CD8+ T cells was further confirmed by WGCNA and deconvolution analysis using the GEO database. The Protein-Protein Interaction network analysis revealed three hub genes: LARS2, SEZ6L2, and SOX7. A predictive model was subsequently created using LASSO and univariate COX regression, which included these three genes. Two of these hub genes (LARS2 and SEZ6L2) were found to be upregulated in COAD cell lines and tissues, while SOX7 was observed to be downregulated. The prognostic model demonstrated a significant association with CD8+ T cells, suggesting that these genes could serve as potential biomarkers and targets for gene therapy in treating COAD.

Conclusion

This study has identified three key genes associated with CD8+ T cells and the prognosis of COAD, providing new prognostic biomarkers for diagnosing and treating COAD.

Acidosis overrides molecular heterogeneity to shape therapeutically targetable metabolic phenotypes in colon cancers

Colorectal cancer (CRC) represents a prototypical example of a cancer type for which inter- and intra-tumor heterogeneities remain major challenges for the clinical management of patients. Besides genotype-mediated phenotypic alterations, tumor microenvironment (TME) conditions are increasingly recognized to promote intrinsic diversity and phenotypic plasticity and sustain disease progression. In particular, acidosis is a common hallmark of solid tumors, including CRC, and it is known to induce aggressive cancer cell phenotypes. In this study, we report that long-term adaptation to acidic pH conditions is associated with common metabolic alterations, including a glycolysis-to-respiration switch and a higher reliance on the activity of phosphoglycerate dehydrogenase (PHGDH), in CRC cells initially displaying molecularly heterogeneous backgrounds. Pharmacological inhibition of PHGDH activity or mitochondrial respiration induces greater growth-inhibitory effects in acidosis-exposed CRC cells in 2D and 3D culture conditions, and in patient-derived CRC organoids. These data pave the way for drugs targeting the acidic tumor compartment as a "one-size-fits-all" therapeutic approach to delay CRC progression.

Bevacizumab-Insights from EudraVigilance Database on the Assessments of the Safety Profile of Monoclonal Antibodies Used as Targeted Cancer Treatment

Background/Objectives: Worldwide, colon cancer is a major cause of cancer-related mortality, with an increasing incidence influenced by genetic, environmental, and lifestyle factors. Despite advances in diagnosis and personalized treatments, challenges remain in improving patient prognosis, particularly in metastatic colorectal cancer (mCRC). Bevacizumab (BEV), a monoclonal antibody, is widely used in colorectal cancer treatment. This study aimed to analyze adverse events associated with BEV compared with other therapies based on data from the EudraVigilance (EV) database. Methods: A descriptive and disproportionality analysis was conducted on signals reported in the EV database related to BEV. The study included comparisons with other antineoplastic treatments, such as chemotherapy, targeted therapy, and immunotherapy. Patient demographics, severity of adverse drug reactions (ADRs), and distribution patterns were analyzed to assess the safety profile of BEV in colorectal cancer treatment. Results: The majority of the signals for BEV were from patients aged 18-64 years (39.42%) and 65-85 years (34.08%). Hypertension, thromboembolism, proteinuria, and gastrointestinal disorders have been the most frequently reported. Serious ADRs, including gastrointestinal perforations, hemorrhage, and arterial thromboembolism, were observed in 93.74% of Individual Case Safety Reports. BEV was associated with a higher likelihood of vascular and endocrine disorders compared with chemotherapy and other targeted therapies. Immunotherapy was linked to increased immunological ADRs, while BEV demonstrated fewer immune-related toxicities. Conclusions: Continuous monitoring is necessary to optimize patient management, particularly in elderly patients or those with cardiovascular comorbidities. Understanding BEV's safety profile allows for better personalization of treatment strategies, minimizing risks while enhancing therapeutic outcomes.

Discovery of Daraxonrasib (RMC-6236), a Potent and Orally Bioavailable RAS(ON) Multi-selective, Noncovalent Tri-complex Inhibitor for the Treatment of Patients with Multiple RAS-Addicted Cancers

Oncogenic RAS mutations are among the most common in human cancers. To target the active, GTP-bound state of RAS(ON) directly, we employed an innovative tri-complex inhibitor (TCI) modality. Formation of a complex with an intracellular chaperone protein CypA, an inhibitor, and a target protein RAS blocks effector binding, inhibiting downstream RAS signaling and tumor cell proliferation. Herein, we describe the structure-guided SAR journey that led to the discovery of daraxonrasib (RMC-6236), a noncovalent, potent tri-complex inhibitor of multiple RAS mutant and wild-type (WT) variants. This orally bioavailable bRo5 macrocyclic molecule occupies a unique composite binding pocket comprising CypA and SWI/SWII regions of RAS(ON). To achieve broad-spectrum RAS isoform activity, we deployed an SAR campaign that focused on interactions with residues conserved between mutants and WT RAS isoforms. Concurrent optimization of potency and drug-like properties led to the discovery of daraxonrasib (RMC-6236), currently in clinical evaluation in RAS mutant advanced solid tumors (NCT05379985; NCT06040541; NCT06162221; NCT06445062; NCT06128551).

The Potential Benefits of Curcumin-Enriched Diets for Adults with Colorectal Cancer: A Systematic Review

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths worldwide. Conventional treatments such as chemotherapy and radiotherapy are often associated with severe side effects and limited effectiveness. Curcumin, a polyphenol derived from Curcuma longa, has demonstrated anti-inflammatory and anticancer properties. A systematic review of the recent scientific literature followed PRISMA guidelines to evaluate the benefits of a curcumin-enriched diet for adults with colorectal cancer. Articles published between 2018 and 2024 were retrieved from PubMed, SciELO, Google Scholar, and Scopus. Studies meeting the inclusion criteria focused on curcumin, adults, and colorectal cancer outcomes. The administration of curcumin-containing products was associated with improved survival rates, enhanced quality of life, tumor reduction, and anti-inflammatory effects. A curcumin-enriched diet shows potential as an effective adjunct therapy for CRC patients, though its limited bioavailability and potential side effects, such as gastrointestinal discomfort, pose challenges. Addressing these limitations through larger cohorts, extended study durations, and improved formulations to enhance bioavailability is essential. Such efforts could enable the development of personalized dietary recommendations for CRC management.

Migrasome-Related Genes as Potential Prognosis and Immunotherapy Response Predictors for Colorectal Cancer

Background: Studies highlight the role of migrasomes as mediators of intercellular communication and signaling, critical in influencing tumorigenesis and progression. Yet migrasome-related genes and their potential role in colorectal cancer prognosis remain unexplored. Methods: Differentially expressed gene set A (DEG set A) was identified in the TCGA-CRC dataset, and Weighted Gene Co-expression Network Analysis (WGCNA) was performed to identify the most important modules associated with migrasome-related gene (MRG) scores. Single-cell RNA-seq dataset GSE231559 DEG set B was determined. Candidate migrasome-related genes were filtered by intersecting DGE set A, key module genes, and DEG set B. Prognostic genes were subsequently screened through regression analysis, and a risk model was developed. Patients with CRC in the TCGA cohort were stratified into high- and low-risk groups based on the optimal cutoff of the risk score. Immunotherapy response-related analyses were then performed. Finally, cell-to-cell communication analysis was carried out for key cells identified based on prognostic gene expression analysis in annotated cells. Results: The six candidate migrasome-related genes were identified through the overlap of 5158 DEG set A, 1960 key module genes, and 146 DEG set B. Further screening led to the selection of T1MP1, CXCL8, and MGP as potential prognostic biomarkers. Immune-related analysis indicated that the high-risk group exhibited a better response to immunotherapy. Notably, the prognostic genes showed elevated expression levels in monocytes and tissue stem cells, thereby designating them as key cell types. Conclusions: We conducted bioinformatic analysis of migrasome-related genes and identified significant involvement of T1MP1, CXCL8, and MGP in influencing CRC prognosis and immunotherapy response. Our research provides novel insights into the role of migrasomes in CRC biology.

Long noncoding HOXD-AS1: a crucial regulator of malignancy

Long non-coding RNAs (lncRNAs) play a crucial role in the occurrence and progression of various cancers. HOXD-AS1, an antisense RNA 1 of the lncRNA HOXD cluster, (also known as HAGLR, MIR7704HG, Mdgt, and STEEL), is located at human chromosome 2q31.1. Recent studies have demonstrated that the abnormal expression of HOXD-AS1 is significantly correlated with the clinicopathological features of patients with various tumors. The expression of HOXD-AS1 is abnormal in various tumors, affecting tumor cell proliferation, apoptosis, metastasis, invasion, metabolism, and drug resistance. HOXD-AS1 is important for cancer diagnosis and prognosis evaluation. Detecting its expression level helps judge cancer progression and predict patient survival. It is a therapeutic target and biomarker for early diagnosis and prognosis, with good clinical application prospects. This article reviews the role, molecular mechanisms, and potential clinical value of HOXD-AS1 in malignant tumor development.

Colorectal cancer cells-derived exosomal miR-188-3p promotes liver metastasis by creating a pre-metastatic niche via activation of hepatic stellate cells

BACKGROUND/AIM

Metastasis is the leading cause of mortality for colorectal cancer (CRC). Cancer-derived exosomes are widely recognized as the primary catalysts behind the development of pre-metastasis niche (PMN) in distal sites. However, the exact mechanism behind this process in CRC remains elusive. This study aimed to investigate the function and mechanisms underlying the role of exosomal miR-188-3p in activating hepatic stellate cells (HSCs) to develop the PMN and promote liver metastasis.

METHODS

We extracted exosomes from CRC cells using ultracentrifugation. Exosomes were identified using transmission electron microscopy, nanoparticle tracking analysis, and Western blot. Exosome uptake was assessed using fluorescence tracing, exosome PKH67 staining, and real-time quantitative PCR. The effects of CRC cell-derived exosomes on HSCs migration were evaluated using Transwell migration and wound healing assays. Key differentially expressed miRNAs were screened from the GEO database, and bioinformatics prediction along with dual-luciferase reporter assays were used to identify downstream target genes of miR-188-3p. Downstream related proteins of the target genes were detected by Western blot. In vivo, the distribution of exosomes and activation of HSCs in the liver were explored by tail vein injection of exosomes into nude mice. Further, the impact of exosomal miR-188-3p on liver metastasis was investigated using a spleen injection liver metastasis model. Finally, the expression levels of miR-188-3p in exosomes from CRC patient plasma were determined by real-time quantitative PCR, and the relationship between the expression of miR-188-3p in plasma exosomes and CRC prognosis was analyzed.

RESULTS

The expression level of miR-188-3p within plasma exosomes demonstrated a statistically significant increase in CRC with liver metastasis compared to those without liver metastases. We also demonstrated the transferability of miR-188-3p from CRC cells to HSCs cells via the exosomes. Exosomal miR-188-3p plays a pivotal role in orchestrating the establishment of PMN through targeting PHLPP2 to activate HSCs before tumor metastasis. Exosomal miR-188-3p was found to actively foster in vivo metastasis of CRC. Additionally, plasma exosomal miR-188-3p potentially serves as a viable blood-based biomarker for CRLM.

CONCLUSION

Exosomal miR-188-3p derived from CRC cells can promote liver metastasis by activating HSCs to form a PMN through targeting PHLPP2 to activate the AKT/mTOR pathway. These results offer a new perspective on the mechanisms driving CRLM.

Anticancer Potential, Phenolic Profile, and Antioxidant Properties of Synsepalum dulcificum (Miracle Berry) in Colorectal Tumor Cell Lines

Polyphenols, recognized for their antioxidant capacity, have shown potential in improving the response treatment of various diseases, including cancer. In this context, polyphenols have the ability to induce cytotoxicity in tumor cells, making them possible complementary agents to current treatments. The present study aims to evaluate the effect of the aqueous extract of Synsepalum dulcificum, using the commercial product DMB®, on the proliferation of colorectal tumor cells. An aqueous extract of DMB® was obtained, and 12 compounds were identified through high-performance liquid chromatography (HPLC), with protocatechuic acid, gallic acid, and catechin being the most prominent. Regarding cytotoxicity, the extracts reduced cell viability in the DLD-1, HT29, SW480, and SW620 cell lines, with IC50 values of 7, 11, 13, and 15 mg/mL, respectively. The combination of oxaliplatin with the DMB® extract reduced the resistant population by up to 50% in the DLD-1 and SW620 cell lines, affecting the G2/M and S phases of the cell cycle, respectively. Additionally, treatment with the DMB® extract induced an increase in the expression of BCL2, CASP3, and CASP9, suggesting a mechanism of action associated with apoptosis. The aqueous extract of Synsepalum dulcificum (DMB®) exhibited cytotoxicity in colorectal cancer cells, enhancing the effect of oxaliplatin and activating apoptotic pathways, suggesting its potential as an adjuvant in anticancer therapies.

HMBOX1 reverses autophagy mediated 5-fluorouracil resistance through promoting HACE1-induced ubiquitination and degradation of ATG5 in colorectal cancer

Chemotherapy remains the primary treatment for unresectable or advanced postoperative colorectal cancers. However, its effectiveness is compromised by chemoresistance, which adversely affects patient outcomes. Dysregulated macroautophagy/autophagy is a proposed mechanism behind this resistance, with ubiquitination playing a key regulatory role. In this study, we identify the transcription factor HMBOX1 (homeobox containing 1) as a critical regulator of chemoresistance in colorectal cancer. RNA sequencing revealed that HMBOX1 is downregulated in drug-resistant colorectal cancer cells and tissues, with its low expression linked to poor prognosis. An integrated analysis of genes associated with autophagy and 5-fluorouracil (5-FU) resistance was conducted, verified in the colorectal cancer tissues of patients by single-cell RNA sequencing and immunostaining. Mass-spectrometry-based proteomics and RNA sequencing were used to elucidate the underlying molecular mechanisms. Functionally, upregulation of HMBOX1 enhances the sensitivity of colorectal cancer cells to the first-line treatment with 5-FU by inhibiting autophagy. Mechanistically, HMBOX1 promotes the transcription of the E3 ubiquitin ligase HACE1, which in turn enhances ATG5 K63-ubiquitination and subsequent proteasome-mediated degradation. This results in decreased ATG5 levels, inhibiting autophagy and thus reducing 5-FU resistance in colorectal cancer cells both in vitro and in vivo. Furthermore, we confirm that HMBOX1 expression positively correlates with HACE1 expression and inversely correlates with autophagy levels in clinical colorectal cancer tissues. Our findings suggest that HMBOX1 downregulation drives 5-FU resistance through autophagy enhancement in colorectal cancer, highlighting HMBOX1 as a potential target for improving chemosensitivity and patient prognosis.Abbreviation: 3-MA: 3-methyladenine; 5-FU: 5-fluorouracil; ATG: autophagy related; CASP3: caspase 3; C-CASP3: cleaved caspase 3; C-PARP: cleaved PARP; CCK8: cell counting kit-8; ChIP: chromatin immunoprecipitation; CHX: cycloheximide; CNV: copy number variation; co-IP: co-immunoprecipitation; COAD: colorectal adenocarcinoma; CQ: chloroquine; CRC: colorectal cancer; CR: complete response; FHC: fetal human colon; GEO: Gene Expression Omnibus; HACE1: HECT domain and ankyrin repeat containing E3 ubiquitin protein ligase 1; HMBOX1: homeobox containing 1; IHC: immunohistochemistry; LC-MS/MS: liquid chromatography-tandem mass spectrometry; mIHC: multiplexed immunohistochemistry; MUT: mutant; NC: negative control; OS: overall survival; PBS: phosphate-buffered saline; PD: progressive disease; PFA: paraformaldehyde; PFS: progression-free survival; PR: partial response; qPCR: quantitative polymerase chain reaction; RAPA: rapamycin; SD: stable disease; TCGA: The Cancer Genome Atlas; TEM: transmission electron microscopy; TF: translation factor; USP22: ubiquitin specific peptidase 22; WT: wild type.

Survival analysis and prediction of early-onset colorectal cancer patients post-chemotherapy: an analysis based on the SEER database

BACKGROUND

The incidence of Early-Onset Colorectal Cancer (EOCRC) has risen markedly in recent years, garnering widespread attention due to its distinctive clinical and biological features. However, systematic research on prognostic risk factors and long-term survival prediction for EOCRC patients undergoing postoperative chemotherapy remains scarce. This study seeks to pinpoint critical prognostic factors for EOCRC patients receiving postoperative chemotherapy and to devise a survival prediction tool employing a Nomogram model.

METHODS

Patients diagnosed with EOCRC between 2010 and 2015, who underwent postoperative chemotherapy, were extracted from the SEER (Surveillance, Epidemiology, and End Results) database. Only those meeting the inclusion criteria were included. Univariate and multivariate Cox regression analyses were performed to determine independent risk factors influencing overall survival (OS). A Nomogram model was then developed using significant variables. The model's predictive accuracy and clinical utility were assessed through the concordance index (C-index), calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA).

RESULTS

A cohort of 9,205 patients was analyzed, with 6,445 randomly allocated to the training group and 2,760 to the validation group from the SEER database. Independent prognostic factors, including gender, race, marital status, primary tumor location, histological type, TNM stage, CEA levels, bone metastasis, liver metastasis, and lung metastasis, were identified through univariate and multivariate Cox regression analyses. A Nomogram model constructed from these factors yielded a C-index of 0.76 (0.75, 0.77) in the training group and 0.76 (0.75, 0.78) in the validation group, reflecting robust discriminative ability and consistency. The area under the curve (AUC) for predicting 1-year OS was calculated as 0.84 (0.81, 0.86) in the training group and 0.82 (0.78, 0.85) in the validation group. For 3-year OS, AUCs were recorded at 0.83 (0.82, 0.84) and 0.82 (0.80, 0.84), respectively, while for 5-year OS, AUCs reached 0.81 (0.80, 0.82) and 0.82 (0.80, 0.84). Calibration curves demonstrated close alignment between predicted and observed survival rates. Additionally, DCA affirmed the model's clinical decision-making value.

CONCLUSION

Prognostic risk factors for EOCRC patients receiving postoperative chemotherapy were systematically evaluated in this study, leading to the development of a Nomogram-based survival prediction model. This tool offers a robust scientific foundation for tailoring individualized treatment and guiding follow-up strategies.

Integrated multi-omics unveils novel immune signature for predicting prognosis in colon cancer patients

Colon cancer, a prevalent malignancy, is subject to intricate immune modulation, which substantially affects both treatment efficacy and prognostic outcomes. Furthermore, colon cancer is highly heterogeneous, and our comprehensive understanding of its immune microenvironment has not yet been fully realized. There is still ample opportunity for in-depth investigation into the composition and interactions of immune cells within colon cancer, as well as their implications for disease prognosis. In this study, we employed single-cell data from colon cancer to distinguish immune cells from non-immune cells through cluster analysis. Furthermore, we conducted an in-depth analysis of myeloid and T cells, which were categorized into 20 distinct cell subpopulations. Functional enrichment analysis revealed T cells' active involvement in the Fatty Acid Metabolism and Adipogenesis pathways, while immune checkpoint-associated genes (ICGs) were notably upregulated in CD8+ T cells. Subsequent analysis involved calculating gene scores to characterize cell subpopulations, which, when combined with patient survival time analysis, revealed a significant association between the gene characterization score (referred to as "imm-score") and the survival of colon cancer patients. Specifically, the presence of CD8+-ANXA1hi-T cells was linked to shortened overall survival in the high imm-score subgroup. Subsequently, combined with genomic analysis, patients in the high imm-score subgroup exhibited elevated tumor mutation burden (TMB) and heightened activity in both the epithelial-mesenchymal transition (EMT) and Notch signaling pathway. Finally, according to our new algorithm, scores calculated predicted the effectiveness of immunotherapy for patients. The results revealed that patients with lower scores could achieve better therapeutic outcomes with immunotherapy. This study offers an extensive analysis of the interplay between T cells and myeloid cells within colon cancer tissues, exploring their impact on the survival and prognosis of colon cancer patients. Additionally, it unveils the potential significance of the imm-score in colon cancer, potentially indicating a poor prognosis and providing novel insights into the immune-regulatory mechanisms underlying the disease.

TPX2 knockdown mediates p53 activation to induce autophagy and apoptosis for anti-colorectal cancer effects

Colorectal cancer (CRC) exhibits high morbidity and mortality worldwide. Targeting protein for Xenopus kinesin-like protein 2 (TPX2) impacts various cancers; however, mechanism of TPX2 in CRC remains unclear. Xenograft nude mouse models were constructed by subcutaneous injection of HCT116 cells with sh-NC, sh-TPX2, OE-NC, and OE-TPX2 transfection. Following the test of tumor growth, immunohistochemistry and TUNEL staining were done. In vitro, HCT116, RKO, and SW480 cells were divided into sh-NC, sh-TPX2, and sh-TPX2 + 3-methyladenine (3-MA, autophagy inhibitor) groups. Further, sh-p53 and rapamycin (RA, autophagy agonist) were added in HCT116 cells. EdU staining, flow cytometry, transparent electron microscopy, and Western blot were performed. Comparing with sh-NC group, sh-TPX2 inhibited tumor growth and Ki67 expression, and increased LC3-II expression and apoptosis, whereas OE-TPX2 group presented an opposite trend. In vitro, HCT116 and RKO cells in sh-TPX2 group enhanced apoptosis and LC3 II/LC3 I expression, and inhibited proliferation and P62 expression, which were reversed after further 3-MA intervention. The above results were not found in SW480 cells. Moreover, compared to sh-TPX2 group, sh-TPX2 + RA group enhanced apoptosis and autophagy, and suppressed the proliferation of HCT116 cells, which were reversed following further sh-p53 intervention. Therefore, sh-TPX2 mediated p53 activation to induce autophagy for anti-CRC effects, providing new ideas for CRC treatment.

Juglone-Bearing Thiopyrano[2,3-d]thiazoles Induce Apoptosis in Colorectal Adenocarcinoma Cells

Colorectal cancer is a major global health challenge, with current treatments limited by toxicity and resistance. Thiazole derivatives, known for their bioactivity, are emerging as promising alternatives. Juglone (5-hydroxy-1,4-naphthoquinone) is a naturally occurring compound with known anticancer properties, and its incorporation into thiopyrano[2,3-d]thiazole scaffolds may enhance their therapeutic potential. This study examined the cytotoxicity of thiopyrano[2,3-d]thiazoles and their effects on apoptosis in colorectal cancer cells. Les-6547 and Les-6557 increased the population of ROS-positive HT-29 cancer cells approximately 10-fold compared with control cells (36.3% and 38.5% vs. 3.8%, respectively), potentially contributing to various downstream effects. Elevated ROS levels were associated with cell cycle arrest, inhibition of DNA biosynthesis, and reduced cell proliferation. A significant shift in the cell cycle distribution was observed, with an increase in S-phase (from 17.3% in the control to 34.7% to 51.3% for Les-6547 and Les-6557, respectively) and G2/M phase (from 24.3% to 39.9% and 28.8%). Additionally, Les-6547 and Les-6557 inhibited DNA biosynthesis in HT-29 cells, with IC50 values of 2.21 µM and 2.91 µM, respectively. Additionally, ROS generation may initiate the intrinsic apoptotic pathway. Les-6547 and Les-6557 activated both intrinsic and extrinsic apoptotic pathways, demonstrated by notable increases in the activity of caspase 3/7, 8, 9, and 10. This study provides a robust basis for investigating the detailed molecular mechanisms of action and therapeutic potential of Les-6547 and Les-6557.

Survival benefit and impact of adjuvant chemotherapy following neoadjuvant therapy in patients with locally advanced rectal cancer

The controversy surrounding the continuation of postoperative adjuvant chemotherapy (AC) for locally advanced rectal cancer patients who underwent neoadjuvant therapy (NAT) still existed. The study aimed to identify the individuals that would benefit from AC from those with stage ypII/III rectal cancer. Data for this retrospective study were obtained from the Surveillance, Epidemiology, and End Results (SEER) database and the local database. Subgroup differentiation of the beneficiary population by classification and regression tree analysis. The primary endpoint was overall survival (OS). 15,671 patients were included from the SEER database and 508 patients from local database. The proportions receiving AC were 41.9% in the SEER database and 77.6% in local database, respectively. Analysis results illustrated that the AC benefited population in the SEER database was characterized as: stage ypT4/N + patients (HR 0.75, 95% CI 0.69-0.82, p < 0.001); stage ypT3N0 patients aged 70 years or older (HR 0.69, 95% CI 0.56-0.83, p < 0.001). Moreover, stage ypT4/N + patients also significantly benefited from AC in local database (HR 0.48, 95% CI 0.31-0.74, p < 0.001). The analysis of the two databases showed that stage ypT3N0 patients aged < 70 years could not significantly benefit from AC (HR 0.90, p = 0.114 in the SEER database; HR 0.90, p = 0.960 in local database). Postoperative adjuvant chemotherapy provides a significant benefit in patients with stage ypT4/N + rectal cancer following neoadjuvant therapy. Our study discovered that locally advanced rectal cancer patients with aggressive tumors might benefit from postoperative adjuvant chemotherapy and prolonged the survival.

Bovine Meat and Milk Factor (BMMF) Protein Is Expressed in Macrophages Spread Widely over the Mucosa of Colorectal Cancer Patients

Red meat consumption is considered a risk factor for colorectal cancer (CRC) development and stimulated isolation of plasmid-like DNA molecules from bovine serum and milk, termed bovine meat and milk factors (BMMFs). BMMFs encode a conserved replication protein (Rep). Increased populations of Rep-expressing macrophages have been identified in the peritumor of CRC patients and pre-cancerous tissues when compared to the tissues of healthy individuals. This supports the concept that BMMFs increase cancer risk by indirect carcinogenesis, upon induction of chronic inflammation. However, the spread of Rep+ immune cells in tissues at greater distances from primary tumors has not yet been assessed. Here, we immunohistologically analyzed the presence of Rep+ immune cells in sets of tumor, peritumor and, additionally, distant tissues of CRC patients (n = 13). We identified consistently high numbers of BMMF-positive macrophages in mucosal tissues at distances of as much as 25 cm away from the primary tumors, at levels comparable to peritumors and associated with M2-like macrophage polarization. The broad distribution of BMMFs suggests that BMMF+ macrophages might already exist at stages of pre-cancerous dysplasia or before. Quantification of BMMF tissue expression during colonoscopy might help to preventively stratify individuals at risk of developing polyps/CRC and recommend them for enhanced surveillance and/or changes in dietary lifestyle.