Effect of metabolic syndrome and its components on recurrence and survival in colon cancer patients

Post-diagnosis physical activity and sedentary behaviour and colorectal cancer prognosis: A Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis

Low physical activity and high sedentary behaviour have been clearly linked with colorectal cancer development, yet data on their potential role in colorectal cancer survival is limited. Better characterisation of these relationships is needed for the development of post-diagnosis physical activity and sedentary behaviour guidance for colorectal cancer survivors. We searched PubMed and Embase through 28 February 2022 for studies assessing post-diagnosis physical activity, and/or sedentary behaviour in relation to all-cause and cause-specific mortality and recurrence after colorectal cancer diagnosis. Total and recreational physical activity were assessed overall and by frequency, duration, intensity, and volume using categorical, linear, and non-linear dose-response random-effects meta-analyses. The Global Cancer Update Programme (CUP Global) independent Expert Committee on Cancer Survivorship and Expert Panel interpreted and graded the likelihood of causality. We identified 16 observational studies on 82,220 non-overlapping patients from six countries. Physical activity was consistently inversely associated with colorectal cancer morbidity and mortality outcomes, with 13%-60% estimated reductions in risk. Sedentary behaviour was positively associated with all-cause mortality. The evidence had methodological limitations including potential confounding, selection bias and reverse causation, coupled with a limited number of studies for most associations. The CUP Global Expert panel concluded limited-suggestive evidence for recreational physical activity with all-cause mortality and cancer recurrence. Total physical activity and its specific domains and dimensions, and sedentary behaviour were all graded as limited-no conclusion for all outcomes. Future research should focus on randomised trials, while observational studies should obtain objective and repeated physical activity measures and better adjustment for confounders.

Analysis of Baseline Serum Lipid Profile for Predicting Clinical Outcomes of Patients with Extensive-Stage Small Cell Lung Cancer

Purpose

Serum lipids were reported to be the prognostic factors of various cancers, but their prognostic value in small cell lung cancer (SCLC) patients remains unclear. This study investigated the relationship between lipid profiles and clinical outcomes in extensive-stage (ES) SCLC by establishing a predictive risk classification model.

Patients and Methods

We retrospectively analyzed the prognostic values of pretreatment serum lipids and their derivatives in patients with a confirmed diagnosis ES-SCLC. Independent factors of progression-free survival (PFS) were determined by univariate and multivariate cox analysis. Then, prognostic nomograms were established, of which predictive performance was evaluated by concordance index (C-index), calibration curves, receiver operating characteristic (ROC) curves, and decision curve analyses (DCA).

Results

A total of 158 patients was included in this study. Four optimal PFS-related factors, total cholesterol (TC) ≥ 5.30, high-density lipoprotein cholesterol (HDL-C) > 1.30, triglycerides (TG)/HDL-C  > 2.18, and ki67 expression > 70%, were included to construct the predictive nomogram. The C-indexes in training and validation sets were 0.758 and 0.792, respectively. ROC curves, calibration plots, and DCA all suggested favorable discrimination and predictive ability. Besides, the nomogram also performed better predictive ability than ki67 expression. Nomogram-related risk score divided the patients into two groups with significant progression disparities.

Conclusion

The promising prognostic nomogram based on lipid parameters could help clinicians to conveniently and accurately evaluate the prognosis of ES-SCLC patients and identify high-risk groups, so as to formulate individualized therapeutic regimens and follow-up strategies in time.

Prognostic nomograms integrating preoperative serum lipid derivative and systemic inflammatory marker of patients with non-metastatic colorectal cancer undergoing curative resection

Background

Lipid metabolism and cancer-related inflammation are closely related to the progression and prognosis of colorectal cancer (CRC). Therefore, this study aims to establish novel nomograms based on the combined detection of preoperative blood lipids and systemic inflammatory indicators to predict the overall survival (OS) and cancer-specific survival (CCS) of CRC patients.

Methods

A total of 523 patients with stage I-III CRC in our institute were collected from 2014 to 2018. The independent predictors for OS and CCS were determined by forward stepwise Cox regression for the establishment of prognostic models. The superiorities of different models were compared by concordance index (C-index), Akaike information criterion (AIC) and integrated discrimination improvement analysis. The performance of the nomograms based on the optimal models was measured by the plotting time-dependent receiver operating characteristic curves, calibration curves, and decision curves, and compared with the tumor-node-metastasis (TNM) staging system. The cohort was categorized into low-risk, medium-risk and high-risk groups according to the risk points of the nomogram, and analyzed using Kaplan–Meier curves and log-rank test.

Results

Preoperative TG/HDL-C ratio (THR) ≥ 1.93 and prognostic nutritional index (PNI) ≥ 42.55 were independently associated with favorable outcomes in CRC patients. Six (pT stage, pN stage, histological subtype, perineural invasion, THR and PNI) and seven (pT stage, pN stage, histological subtype, perineural invasion, gross appearance, THR and PNI) variables were chosen to develop the optimal models and construct nomograms for the prediction of OS and CCS. The models had lower AIC and larger C-indexes than other models lacking either or both of THR and PNI, and improved those integrated discrimination ability significantly. The nomograms showed better discrimination ability, calibration ability and clinical effectiveness than TNM system in predicting OS and CCS, and these results were reproducible in the validation cohort. The three risk stratifications based on the nomograms presented significant discrepancies in prognosis.

Conclusion

Preoperative THR and PNI have distinct prognostic value in stage I-III CRC patients. The nomograms incorporated the two indexes provide an intuitive and reliable approach for predicting the prognosis and optimizing individualized therapy of non-metastatic CRC patients, which may be a complement to the TNM staging system.

The metabolic syndrome and its components as prognostic factors in colorectal cancer: A meta-analysis and systematic review

BACKGROUND AND AIM

Metabolic syndrome (MetS) increases the risk of colorectal cancer (CRC), and the impact of MetS on CRC prognosis remains controversial after the diagnosis of CRC has been established. This study aimed to explore the impact of the individual components and synergies of MetS on the prognosis of patients with CRC.

METHODS

We searched articles published before August 3, 2022, in four databases, including PubMed, Embase, Cochrane Library, and ScienceDirect. The random-effects model inverse variance method was used to estimate the summarized effect size.

RESULTS

Patients with CRC with MetS were 1.342 times more likely to experience all-cause mortality than those without MetS, and the 95% confidence interval (CI) of hazard ratio (HR) was 1.107-1.627 (P = 0.003). CRC-specific mortality in patients with CRC with MetS was 2.122 times higher than in those without MetS, and the 95% CI of HR was 1.080-4.173 (P = 0.029). CRC-specific mortality exhibited an increasing trend of risk with increased metabolic risk factors. The HR of CRC-specific mortality for one, two, and three metabolic risk factors was 1.206 (95% CI, 1.034-1.407; P = 0.017), 1.881 (95% CI, 1.253-2.824; P = 0.002), and 2.327 (95% CI, 1.262-4.291; P = 0.007), respectively.

CONCLUSIONS

Metabolic syndrome increased all-cause and CRC-specific mortality in patients with CRC. As a single component of MetS, diabetes mellitus increased overall mortality in patients with CRC, while obesity increased CRC-specific mortality in patients with CRC, with a significant difference from non-MetS. Moreover, the risk of CRC-specific mortality increased with increasing number of metabolic risk factors.

Comparison of Postoperative Outcome and Prognosis Among Laparoscopic Left Colectomy and Laparoscopic Sigmoidectomy in Sigmoid Colon Cancer Patients: A Propensity Score Matching Study

PURPOSE

The purpose of this study was to investigate the effect of laparoscopic left colectomy (LLC) and laparoscopic sigmoidectomy (LSD) on short-term outcomes and prognosis of sigmoid colon cancer (SCC) patients using propensity score matching (PSM).

METHODS

In this retrospective study, the SCC patients who underwent LLC or LSD surgery were collected from a single clinical center from Jan 2011 to Dec 2019. Short-term outcomes and prognosis were compared between patients who received LSD surgery and LLC surgery.

RESULTS

A total of 356 patients were included in this study. After 1:1 PSM analysis, there were 50 patients who underwent LLC surgery and 50 patients who underwent LSD surgery left in this study. No significant difference was found in baseline characteristics after PSM (P > .05). In comparison with the LLC surgery group, the LSD surgery group had shorter operation time (P = .003) after PSM. Moreover, the surgical procedure was not an independent predictor for overall survival (OS) (P = .918, 95% CI = .333-2.688) and disease-free survival DFS (P = .730, 95% CI = .335-2.150), but age (OS: P = .009, 95% CI = 1.010-1.075; DFS: P = .014, 95% CI = 1.007-1.061) and tumor stage (OS: P = .004, 95% CI = 1.302-3.844; DFS: P < .01, 95% CI = 1.572-4.171) were the independent risk factors for OS and DFS in SCC patients.

CONCLUSION

There was no significant difference between the two surgical procedures for prognosis of SCC patients. However, the possible reasons for changing the surgical procedures should be cautious by surgeons.

Impact of metabolic syndrome on the short- and long-term outcomes for the elderly patients with gastric cancer after radical gastrectomy

BACKGROUND

Metabolic syndrome (MetS) and gastric cancer are age-related diseases, and their incidence rates have risen in past decades. However, few studies have examined the relationship between MetS and the prognosis of elderly patients who underwent radical gastrectomy, and the conclusions remain controversial.

METHODS

We conducted a prospective study of elderly patients who underwent radical gastrectomy for gastric cancer from August 2014 to February 2018. MetS was defined based on visceral fat area (VFA) instead of BMI or waist circumference. Receiver operating characteristic curve analysis was used to determine the cutoff values for VFA.

RESULTS

A total of 585 patients were included in this study. The optimal cutoff values for VFA were 96.1 cm² for men and 105.2 cm² for women, and 212 patients were diagnosed with MetS. The patients with MetS suffered significantly more postoperative complications than those without MetS (37.3% versus 21.4%, P < 0.001). The multivariable logistic regression analysis demonstrated that MetS (OR 2.923, P < 0.001), BMI < 18.5 kg/m² (OR 2.086, P = 0.045), cardiac tumor (OR 1.865, P = 0.013), and Nutritional Risk Screening 2002 scores ≥ 3 (OR 1.654, P = 0.015) were independent risk factors for postoperative complications. During a median follow-up period of 56.4 months, the MetS group and the non-MetS group had comparable overall survival and disease-specific survival.

CONCLUSIONS

MetS was an independent risk factor for complications of the elderly patients after radical gastrectomy, but had no influence on long-term survival.

Impact of obesity and white adipose tissue inflammation on the omental microenvironment in endometrial cancer

BACKGROUND

A complex relationship between adipose tissue and malignancy, involving an inflammatory response, has been reported. The goal of this work was to assess the prevalence of white adipose tissue (WAT) inflammation in patients with endometrial cancer (EC), and the association with circulating inflammation markers. Furthermore, the aim was to characterize the pathways activated in and the cell type composition of adipose tissue in patients with EC.

METHODS

Adipose tissue and blood samples were prospectively collected from 101 patients with EC at initial surgery. WAT inflammation was determined based on adipocytes surrounded by macrophages forming crown-like structures. Circulating levels of metabolic syndrome-associated and inflammatory markers were quantified. RNA-sequencing was performed on adipose samples (n = 55); differential gene expression, pathway, and cellular decomposition analyses were performed using state-of-the-art bioinformatics methods.

RESULTS

WAT inflammation was identified in 46 (45.5%) of 101 EC patients. Dyslipidemia, hypertension, and diabetes mellitus were significantly associated with WAT inflammation (p < .05). WAT inflammation was associated with greater body mass index (p < .001) and higher circulating levels of leptin, high-sensitivity C-reactive protein, and interleukin-6, as well as lower levels of adiponectin and sex hormone-binding globulin (p < .05). Transcriptomic analysis demonstrated increased levels of proinflammatory and pro-neoplastic-related gene expression in inflamed omental adipose tissue.

CONCLUSIONS

WAT inflammation is associated with metabolic syndrome, obesity, and inflammatory markers, as well as increased expression of proinflammatory and proneoplastic genes.

Systematic review and meta-analysis: Associations between metabolic syndrome and colorectal neoplasia outcomes

AIM

Metabolic syndrome (MetS) is a cluster of factors including obesity, hypertension, diabetes, hypercholesterolemia and hyperlipidaemia. It has been associated with an increased risk of colorectal neoplasia. This systematic review and meta-analysis assessed the association between MetS and (i) recurrence of adenomas or occurrence of CRC in patients with prior adenomas, and (ii) survival in patients with CRC.

METHOD

MEDLINE, Embase, Scopus and Web of Science were searched up to 22 November 2019. Two authors independently conducted title and abstract screening; full text of eligible studies was evaluated. Where ≥3 studies reported effect measures for a specific outcome, meta-analysis using random effects model was conducted. I² was used to assess between-study heterogeneity. Quality appraisal was undertaken with the Newcastle-Ottawa Score.

RESULTS

The search identified 1,764 articles, 55 underwent full text screening, resulting in a total of 15 eligible studies. Five studies reported on metachronous neoplasia, with differing outcomes precluded a meta-analysis. No consistent relationship between MetS and metachronous neoplasia was found. Ten studies reported on survival outcomes. MetS was associated with poorer CRC-specific survival (HR = 1.8, 95% CI: 1.04-3.12, I²  = 92.7%, n = 3). Progression-free survival was also worse but this did not reach statistical significance (HR = 1.12, 95% CI: 0.89-1.42, I²  = 85.6%, n = 3). There was no association with overall survival (HR = 1.04, 95% CI: 0.94-1.15, I²  = 43.7%, n = 7). Significant heterogeneity was present but subgroup analysis did not account for this.

CONCLUSION

MetS is associated with poorer CRC-specific survival, but evidence is inconsistent on metachronous neoplasia. Further research is warranted to better understand the impact of MetS on the adenoma-carcinoma pathway.

A Nomogram for Predicting Survival in Patients With Colorectal Cancer Incorporating Cardiovascular Comorbidities

Background

Cardiovascular comorbidities (CVCs) affect the overall survival (OS) of patients with colorectal cancer (CRC). However, a prognostic evaluation system for these patients is currently lacking.

Objectives

This study aimed to develop and validate a nomogram, which takes CVCs into account, for predicting the survival of patients with CRC.

Methods

In total, 21,432 patients with CRC were recruited from four centers in China between January 2011 and December 2017. The nomogram was constructed, based on Cox regression, using a training cohort (19,102 patients), and validated using a validation cohort (2,330 patients). The discrimination and calibration of the model were assessed by the concordance index and calibration curve. The clinical utility of the model was measured by decision curve analysis (DCA). Based on the nomogram, we divided patients into three groups: low, middle, and high risk.

Results

Independent risk factors selected into our nomogram for OS included age, metastasis, malignant ascites, heart failure, and venous thromboembolism, whereas dyslipidemia was found to be a protective factor. The c-index of our nomogram was 0.714 (95% CI: 0.708–0.720) in the training cohort and 0.742 (95% CI: 0.725–0.759) in the validation cohort. The calibration curve and DCA showed the reliability of the model. The cutoff values of the three groups were 68.19 and 145.44, which were also significant in the validation cohort (p < 0.001).

Conclusion

Taking CVCs into account, an easy-to-use nomogram was provided to estimate OS for patients with CRC, improving the prognostic evaluation ability.

Preoperative Metabolic Syndrome and HDL-C Level Predict the Prognosis of Patients Following Radical Cystectomy: A Propensity Score Matching Study

Objective

To investigate the prognostic significance of metabolic syndrome (MetS) and its components in patients with bladder cancer (BCa) treated with radical cystectomy (RC).

Methods

A total of 335 BCa patients who underwent RC between 2004 and 2019 at Peking University Third Hospital (PUTH) were analyzed retrospectively. The Kaplan-Meier method with the log-rank test was performed to assess overall survival (OS) and progression-free survival (PFS). Univariate and multivariate Cox proportional hazard models were conducted to identify the prognostic factors of OS and PFS before and after propensity score matching (PSM).

Results

Enrolled patients were allocated into two groups according to the presence or absence of MetS (n=84 MetS vs n=251 non-MetS), and 82 new matched pairs were identified to balance the baseline characteristics after 1:1 PSM. In the Kaplan-Meier analysis, MetS was associated with better OS (P=0.031) than the group without MetS. In addition, a body mass index (BMI) ≥ 25 was associated with better OS (P=0.011) and PFS (P=0.031), while low high-density lipoprotein cholesterol (HDL-C) was associated with worse OS (P=0.033) and PFS (P=0.010). In all patients, multivariate Cox analysis showed that hemoglobin, pathologic tumor stage and lymph node status were identified as independent prognostic factors for both OS and PFS, while age, MetS and HDL-C were independent prognostic factors only for OS. Reproducible results of multivariate analysis can still be observed in propensity matched patients. The results of further subgroup analysis revealed that the association of MetS with increased OS (P=0.043) and BMI ≥25 with increased OS (P=0.015) and PFS (P=0.029) was observed in non-muscle invasive bladder cancer (NMIBC) patients.

Conclusions

MetS was independently associated with better OS in BCa patients after RC, and HDL-C was the only component of MetS that was independently associated with worse OS. MetS and HDL-C may become reliable prognostic biomarkers of OS in BCa patients after RC to provide individualized prognostication and assist in the formulation of clinical treatment strategies.

Association of secondhand smoke exposure with cardiometabolic health in never-smoking adult cancer survivors: a population-based cross-sectional study

BACKGROUND

Little is known about the association of secondhand smoke (SHS) exposure with cardiometabolic health in adult cancer survivors, especially those who have never smoked. This study aimed to investigate the association of SHS exposure and cardiometabolic health in never-smoking adult cancer survivors.

METHODS

Cross-sectional data of 830 adult cancer survivors aged more than 19 years who were never-smokers were identified from the Korea National Health and Nutrition Survey (KNHANES) 2013-2018, a nationally representative sample of the noninstitutionalized Korean population. SHS exposure was defined from self-reported survey and cardiometabolic outcomes (hypertension, general and abdominal obesity, hyperlipidemia, hypertriglyceridemia, reduced high-density lipoprotein, and impaired fasting glucose) were determined according to relevant criteria and data from the KNHANES. We used multiple logistic regression to compute odds ratio (OR) and 95% confidence intervals (95% CI) comparing those with and without SHS exposure for each outcome adjusted for potential confounders.

RESULTS

Compared with the never-smoking adult cancer survivors without SHS exposure, those with SHS exposure had significantly higher odds for hypertriglyceridemia (OR = 1.63; 95% CI: 1.07-2.48). However, the other outcomes showed nonsignificant associations with SHS exposure (hypertension [OR = 1.33; 95% CI: 0.90-1.96]. general obesity [OR = 1.47; 95% CI: 1.47: 0.97-2.22], abdominal obesity [OR = 1.20; 95% CI: 0.82-1.75], hyperlipidemia [OR = 1.03; 95% CI: 0.68-1.55], reduced HDL-cholesterol [OR = 1.01; 95% CI: 0.70-1.45], and impaired fasting glucose [OR = 1.07; 95% CI: 0.72-1.58].

CONCLUSION

This cross-sectional study suggests the association of SHS exposure with hypertriglyceridemia and provides evidence for marginal associations with other cardiometabolic risk factors in never-smoking adult cancer survivors. More studies are needed to develop evidence-based public health policies to minimize SHS exposure in adult cancer survivors.

Prediction Model Using Readily Available Clinical Data for Colorectal Cancer in Chinese Population

BACKGROUND

In China, health screening has become common, although colonoscopy is not always available or acceptable. We sought to develop a prediction model of colorectal cancer (CRC) for health screening population based on readily available clinical data to reduce labor and economic costs.

METHODS

We conducted a cross-sectional study based on a health screening population in Karamay Central Hospital. By collecting clinical data and basic information from participants, we identified independent risk factors and established a prediction model of CRC. Internal and external validation, calibration plot, and decision curve analysis were employed to test discriminating ability, calibration ability, and clinical practicability.

RESULTS

Independent risk factors of CRC, which were readily available in basic public health institutions, included high-density lipoprotein cholesterol, male sex, total cholesterol, advanced age, and hemoglobin. These factors were successfully incorporated into the prediction model (AUC 0.740, 95% CI 0.713-0.767). The model demonstrated a high degree of discrimination and calibration, in addition to a high degree of clinical practicability in high-risk people.

CONCLUSIONS

The prediction model exhibits good discrimination and calibration and is pragmatic for CRC screening in rural areas and basic public health institutions.

Effect of diabetes mellitus comorbidity on outcomes in stages II and III colorectal cancer

AIM

The effects of diabetes mellitus (DM) on the outcomes of colorectal cancer (CRC) are controversial. This retrospective study evaluated the effects of DM on American Joint Committee on Cancer (AJCC, 7th) Stages II and III CRC patients who received curative surgery.

METHODS

We reviewed the records of CRC patients who were treated from January 2008 to December 2014 and identified the presence of DM and hypertension prior to CRC diagnosis. Cox proportional hazards analyses were used for prognostic factor determination, and survival was analyzed using the Kaplan-Meier method with the log-rank test.

RESULTS

Total of 1066 consecutive eligible patients with stage II/III CRC were enrolled. There were 326 (30.6%) patients diagnosed with DM, and 311 (29.2%) CRC patients had recurrence. Patients with DM did not have a higher recurrence risk (p = 0.183) but had higher mortality (adjusted hazard ratio [aHR] = 1.381; 95% conference interval [CI], 1.069-1.782). In addition, HbA1c (≥7 vs. <7) was not associated with recurrence (p = 0.365). Patients with DM had more hypertension than patients without DM (69.1% vs. 37.6%, p < 0.001). A lower recurrence risk was noted in patients with hypertension (p = 0.002), but the overall survival (OS) did not reach statistical significance (aHR = 0.910; 95% CI, 0.707-1.169).

CONCLUSION

In our study, DM was a poor prognostic factor for survival in curative CRC patients. More studies are required to elucidate the effects that DM and other metabolic disorders, such as hypertension, have on the prognosis of patients with CRC.

Effect of Metabolic Syndrome and Individual Components on Colon Cancer Characteristics and Prognosis

Metabolic syndrome (MS) is recognized as a risk factor for colon cancer (CC). However, whether the cluster of metabolic changes that define MS also influence CC prognosis remains unclear. Thus, our aim was to investigate whether the presence of MS or any of the MS individual components could provide prognostic information on tumor phenotype and survival outcomes. Clinical and pathological data from patients with CC (n = 300) who underwent surgical resection at a single tertiary hospital were retrospectively collected to evaluate presence of MS components and diagnostic criteria, CC phenotype and disease outcomes. Patients were allocated into two groups according to the presence or absence of MS (n = 85 MS vs n = 83 non-MS). The overall prevalence of MS individual components was 82.7% for increased waist-circumference (WC), 61.3% for high blood pressure (BP), 48.8% for low HDL-cholesterol, 39.9% for high fasting glucose, and 33.9% for hypertriglyceridemia. Patients in the MS group presented smaller tumors (p = 0.006) with lower T-stage (p = 0.002). High BP (p = 0.029) and hypertriglyceridemia (p = 0.044) were associated with a smaller tumor size, while low-HDL (p = 0.008) was associated with lower T-stage. After propensity score matching using age, tumor size and staging as covariates high-BP (p = 0.020) and WC (p = 0.003) were found to influence disease-free survival, but not overall survival. In conclusion, despite MS being an established risk factor for CC, our data does not support the hypothesis that MS components have a negative impact on disease extension or prognosis. Nevertheless, a protective role of BP and lipid lowering drugs cannot be excluded.

Evaluation of prognostic factors and clinicopathological patterns of recurrence after curative surgery for colorectal cancer

BACKGROUND

Colorectal cancer is a common tumor with a quite high-related mortality. Despite the used curative treatments, patients will develop cancer recurrence in up to 50% of the cases and/or other primary neoplasms. Although most of the recurrences are discovered within 3 years from the first treatment, a small percentage is found after 5 years. The early detection of recurrence is crucial to allow further therapies improving patients’ survival. Several follow-up programs have been developed but the optimal one is far from being established.

AIM

To evaluation of potential prognostic factors for timing and patterns of recurrence in order to plan tailored follow-up programs.

METHODS

Perioperative and long-term data of all consecutive patients surgically treated with curative intent, from January 2006 to June 2009, for colorectal adenocar-cinoma, were retrospectively reviewed to find potential prognostic factors associated with: (1) Recurrence incidence; (2) Incidence of an early (within 3 years from surgery) or late recurrence; and (3) Different sites of recurrence. In addition, the incidence of other primary neoplasms has been evaluated in a cohort of patients with a minimum potential follow-up of 10 years.

RESULTS

Our study included 234 patients. The median follow-up period has been 119 ± 46.2 mo. The recurrence rate has been 25.6%. Patients with a higher chance to develop recurrence had also the following characteristics: Higher levels of preoperative glycemia and carcinoembryonic antigen, highest anaesthesiologists Score score, occlusion, received a complex operation performed with an open technique, after a longer hospital stay, and showed advanced tumors. The independent prognostic factors for recurrence were the hospital stay, N stage 2, and M stage 1 (multivariate analysis). Younger ages were significantly associated with an early recurrence onset. Patients that received intermediate colectomies or segmental resections, having an N stage 2 or American Joint Committee on Cancer stage 3 tumors were also associated with a higher risk of liver recurrence, while metastatic diseases at diagnosis were linked with local recurrence. Neoadjuvant treatments showed lung recurrence. Finally, bigger tumors and higher lymph node ratio were associated with peritoneal recurrence (marginally significant). Thirty patients developed a second malignancy during the follow-up time.

CONCLUSION

Several prognostic factors should be considered for tailored follow-up programs, eventually, beyond 5 years from the first treatment.

Metabolic Syndrome and Risk of Upper Tract Urothelial Carcinoma: A Case-Control Study From Surveillance, Epidemiology and End Results-Medicare-Linked Database

Background

Metabolic syndrome (MetS) and its components are associated with increased risks of several cancers. However, the relationship between MetS and upper tract urothelial carcinoma (UTUC) has never been investigated before.

Methods

We identified 3,785 UTUC cases aged over 65 years old within the Surveillance, Epidemiology and End Results-Medicare database between 2007 and 2016. For comparison, non-cancer controls (n = 189,953) were selected from the 5% random sample of individuals residing within regions of SEER registries and matched with cases through diagnosis date and pseudo-diagnosis date. MetS and its components were all defined by using ICD-9-CM codes. Multivariate logistic regression models were conducted to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Time trends for MetS and its components were reported and we also performed dose-response effect analysis to test the concomitant effect of these components. The study was presented following the STROBE reporting checklist.

Results

UTUC risk was associated with metabolic syndrome (NCEP-III: OR: 1.669, 95% CI: 1.550–1.792; IDF: OR: 1.924, 95% CI: 1.676–2.172) and its component factors: elevated waist circumference/central adiposity (OR: 1.872, 95% CI: 1.693–2.055), impaired fasting glucose (OR: 1.306, 95% CI: 1.133–1.480), high blood pressure (OR: 1.295, 95% CI: 1.239–1.353), high triglycerides (OR: 1.280, 95% CI: 1.222–1.341), and low high-density lipoprotein cholesterol (OR: 1.354, 95% CI: 1.118–1.592). Consistent associations could also be observed in the subgroup analyses by tumor stages, grades, and tumor size. Additionally, the rates of MetS increased over time in both UTUC and control cohort (NCEP-III criterion; EAPC: +18.1%, P <0.001; EAPC: +16.1%, P <0.001, respectively). A significantly gradual increase in UTUC rates could be seen as the No. of the MetS components increase (χ² = 37.239, P_trend = 0.000).

Conclusions

Among people aged over 65, MetS and its components were significant risk factors for UTUC with consistent associations in different tumor stages, grades, and tumor size. Even if a subject who did not meet the criteria for MetS had only one of the components, he (she) still had an elevated risk for UTUC. Strategies to control the epidemic of MetS and its components might contribute to a reduction in the UTUC burden. The findings should be considered tentative until ascertained by more researches.

The association of Metabolic Syndrome and its Components with the Incidence and Survival of Colorectal Cancer: A Systematic Review and Meta-analysis

Background: This meta-analysis was aimed to quantitatively assess the associations of metabolic syndrome (MetS) and its components with colorectal cancer (CRC). Methods: PubMed, EMBASE and Web of Science databases were systematically searched for eligible studies. A total of 18 studies for CRC incidence and 12 studies for CRC mortality were identified. Results: MetS was associated with an increased risk of CRC incidence and mortality in male (RR: 1.28, 95 % CI 1.16-1.39, and 1.24, 1.18-1.31, respectively) and correlated with an increased risk of CRC incidence in female (RR: 1.21, 1.13-1.30), but not with CRC mortality in female. MetS increased the risk of cancer-specific mortality (RR: 1.72, 1.03-2.42), but not overall mortality. The risk estimates of CRC incidence changed little depending on age, sex, cancer site, the type of studies, ethnicity, publication year, or definition of MetS. As for CRC mortality, further stratified analyses indicated statistical significance in studies with assessing cancer-specific survival outcome, in male, a cohort design, ethnicity of non-Chinese or with definition of MetS as ≥ 3 metabolic abnormalities. Obesity and hyperglycemia are risk factors of CRC incidence in both male and female. Only dysglycemia is the risk factor for CRC mortality. Conclusions: MetS is associated with an increased risk of CRC incidence and cancer-specific mortality, but not overall mortality. In addition, MetS may increase the CRC mortality in male rather than in female. However, since most of the studies on CRC mortality were conducted in Chinese, further studies are needed to clarify this connection.

Co-morbid risk factors and NSAID use among white and black Americans that predicts overall survival from diagnosed colon cancer

Black Americans (BA) have higher incidence and higher mortality rates for colorectal cancers (CRC) as compared to White Americans (WA). While there are several identified risk factors associated with the development of CRC and evidence that high levels of adequate screening can reduce differences in incidence for CRC between BA and WA, there remains little data regarding patient co-morbid contributions towards survival once an individual has CRC. Here we set out to identify patient risk factors that influenced overall survival in a cohort of 293 BA and 348 WA with colon cancer. Amid our cohort, we found that patients’ age, tobacco usage, and pre-diagnosed medical conditions such as hypertension and diabetes were associated with shorter overall survival (OS) from colon cancer. We identified pre-diagnosed hypertension and diabetes among BA were responsible for one-third of the colon cancer mortality disparity compared with WA. We also identified long-term regular use of non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin, was associated with shorter OS from colon cancer among WA >65 years of age, but not younger WA patients or any aged BA patients. Our results raise the importance of not only treating the colon cancer itself, but also taking into consideration co-morbid medical conditions and NSAID usage to enhance patient OS. Further evaluation regarding adequate treatment of co-morbidities and timing of NSAID continuance after cancer therapy will need to be studied.

Association Between Metabolic Syndrome and Endometrial Cancer Survival in a SEER-Medicare Linked Database

BACKGROUND

Metabolic syndrome has previously been linked to increased risk of endometrial cancer. This study examines the association between metabolic syndrome and cancer-specific survival (CSS) in early stage and locoregionally advanced endometrial cancer.

METHODS

The SEER-Medicare linked database was used to identify a cohort of patients with endometrial cancer between 1992 and 2011 who underwent hysterectomy. Patients with incomplete stage or grade information were excluded. Patients were stratified into early stage (stage I to II) or locoregionally advanced (stage III to IVa) disease. Metabolic syndrome status was determined through Medicare claims 1 year before diagnosis. The relationship between metabolic syndrome and CSS was evaluated using univariable and multivariable Cox proportional hazards regression analyses.

RESULTS

A total of 10,090 patients with endometrial cancer were identified. The mean age was 75 and the majority (91.5%) were white. At diagnosis, 86.6% of patients were early stage and 13.4% were locoregionally advanced. Sixteen percent of patients had metabolic syndrome. On stage stratified multivariable analysis, race, income quartile, year of diagnosis, histopathology, and adjuvant treatment were associated with CSS in early stage disease. Presence of metabolic syndrome was associated with worse CSS in early stage disease (hazard ratio=1.28, 95% confidence interval: 1.09-1.53); this difference did not exist for locoregionally advanced disease (hazard ratio=1.18, 95% confidence interval: 0.93-1.49).

CONCLUSIONS

In elderly early stage endometrial cancer patients, metabolic syndrome is associated with worse CSS. Control of metabolic syndrome through lifestyle and pharmacologic therapies may improve cancer prognosis in this population.

KRAS Status is Associated with Metabolic Parameters in Metastatic Colorectal Cancer According to Primary Tumour Location

Colorectal cancer (CRC) is characterized by complex interplay between macroenvironmental factors and tumour microenvironment, leading to variable outcomes in CRC patients. To date, there is still a need to identify macroenvironment/microenvironment factors that could define subgroup of patients that would benefit from specific anti-cancer treatment in order to improve patient selection for individualized targeted-based therapy. Aim of this study was to evaluate associations between metabolic parameters and KRAS status in metastatic CRC (mCRC) according to a new tumour site classification. Retrospective data were extracted from a total of 201 patients diagnosed with mCRC between 2012 and 2017 extracted from an established CRC database at our tertiary institute. Clinical-pathological data, including age, gender, BMI, hypertension, diabetes, pre-CRC diagnosis serum lipid levels and KRAS status were recorded. Categorical characteristics were compared using chi-squared test. Continuous characteristics were compared using Mann-Whitney U test. Log rank test was used to compare hazards for survival. In all comparisons, a two-sided P value <0.05 was considered statistically significant. Out of 201 patients, 170 patients with complete serum lipid profile were included in the analysis. In recto-sigmoid cancers there was a statistically significant association between high cholesterol:high-density lipoprotein (chol:HDL) ratio and KRAS mutation (OR 2.69, 95% CI 1.1–6.4, p = 0,02). In non recto-sigmoid cancers, high cholesterol was associated with KRAS WT (OR 0.39, CI 0.15–0.97, p = 0.04). In 22 patients with KRAS mutated recto-sigmoid cancer stage IV at diagnosis normal chol:HDL ratio was associated with a trend to better survival (p = 0.06). High chol:HDL ratio was significantly associated with KRAS mutated metastatic recto-sigmoid cancers. A subgroup of mCRC patients with KRAS mutated recto-sigmoid cancer may benefit from optimal lipid lowering treatment.

Prognostic significance of high triglyceride and apolipoprotein B levels in patients with stage III and high-risk stage II colorectal cancer undergoing curative surgery

Although epidemiologic studies suggest that dyslipidemia increases the risk of colorectal cancer (CRC), the prognostic value of blood lipid and apolipoprotein levels in CRC remains unclear. The aim of the present study was to investigate the impact of blood lipid and apolipoprotein levels on the prognosis of patients with stage III and high-risk stage II CRC undergoing curative surgery. Preoperative levels of total cholesterol, triglycerides (TG), high-density lipoprotein, low-density lipoprotein, very-low-density lipoprotein, apolipoprotein A1 and apolipoprotein B (APO-B) in patients with CRC undergoing surgery were evaluated. The cut-off values of these factors were determined by the maximal x² method and were used to classify patients into two prognostic groups: Poor and good prognosis groups. The patients prognostic values were assessed using the Kaplan-Meier curve and Cox regression analysis. In addition, the impact of these parameters on the prognosis and their predictive accuracy were evaluated using nomograms and Harrells concordance index, respectively. In total, 246 patients were included in this evaluation. Based on the cut-off points for TG (1.53 mmol/l in men and 1.58 mmol/l in women) and APO-B (0.73 mmol/l in men and women), the present study determined that both TG and APO-B were predictors of disease-free survival (DFS) and overall survival (OS). Multivariate analysis demonstrated that high TG (men, ≥1.53 mmol/l; women, ≥1.58 mmol/l) and high APO-B (≥0.73 mmol/l) levels were significantly associated with decreased DFS and OS. Nomograms that included values for TG and APO-B levels demonstrated higher predictive accuracy compared with that of nomograms without these values. These results indicated that TG and APO-B levels may be good independent prognostic biomarkers after radical CRC surgery. Therefore, adjusting these parameters to moderate levels may be beneficial.

Robust Machine Learning for Colorectal Cancer Risk Prediction and Stratification

While colorectal cancer (CRC) is third in prevalence and mortality among cancers in the United States, there is no effective method to screen the general public for CRC risk. In this study, to identify an effective mass screening method for CRC risk, we evaluated seven supervised machine learning algorithms: linear discriminant analysis, support vector machine, naive Bayes, decision tree, random forest, logistic regression, and artificial neural network. Models were trained and cross-tested with the National Health Interview Survey (NHIS) and the Prostate, Lung, Colorectal, Ovarian Cancer Screening (PLCO) datasets. Six imputation methods were used to handle missing data: mean, Gaussian, Lorentzian, one-hot encoding, Gaussian expectation-maximization, and listwise deletion. Among all of the model configurations and imputation method combinations, the artificial neural network with expectation-maximization imputation emerged as the best, having a concordance of 0.70 ± 0.02, sensitivity of 0.63 ± 0.06, and specificity of 0.82 ± 0.04. In stratifying CRC risk in the NHIS and PLCO datasets, only 2% of negative cases were misclassified as high risk and 6% of positive cases were misclassified as low risk. In modeling the CRC-free probability with Kaplan-Meier estimators, low-, medium-, and high CRC-risk groups have statistically-significant separation. Our results indicated that the trained artificial neural network can be used as an effective screening tool for early intervention and prevention of CRC in large populations.

A Single-Center Retrospective Chart Review to Determine Whether the Presence of Comorbidities Affects Colon Cancer Screenings in African Americans

Colon cancer is the third leading cause of cancer-related death in African Americans. Although the rates of colon screenings have risen, African Americans remain to be underscreened, and are more likely to present with advanced lesions. This population has a higher prevalence of inflammatory comorbidities, and their effects on screenings have not been fully explored. Along with higher rates of comorbidities, the Southeastern United States is one region for the highest rates of colorectal cancer. The purpose of this study was to determine whether people with comorbidities were more likely to have a screening colonoscopy. Convenience sampling was used to procure 408 patients. The median age was 55 years, and the majority were females (52.2%), who were obese (29.2%), and nonsmokers (52.2%). The most common comorbidity was hypertension (70.3%), followed by osteoarthritis (39%), and diabetes (25.5%). There is a well-documented trend between certain inflammatory comorbidities and higher death rates in patients with colorectal cancer. Clarifying the relationship between comorbidities and cancer starts with screening as many patients as possible. Therefore, interventions that support increasing the number of colorectal cancer screenings are imperative in order to improve morbidity and mortality in this despaired population.

Colorectal cancer patients in western Saudi Arabia. Outcomes and predictors for survival over a 10-years period (2002-2014)

Objectives:

To determine the survival outcomes and to describe the epidemiological characteristics of patients with colorectal cancer (CRC) in western Saudi Arabia.

Methods:

Our study is a retrospective analysis of patients with CRC diagnosed between 2002 and 2014. We recruited 279 patients who were selected randomly and followed until the end of July 2017. A Kaplan-Meier curve was used to estimate the survival rate for CRC patients according to gender, histopathological pattern, tumor site, and mutation type, taking into consideration time factor, dropouts, and loss to follow-up.

Results:

The mean age of CRC patients was 57±13 years, and most of them were Saudi (87.5%). Regarding tumor epidemiology, 32.4% of the patients at Best American Joint Committee on Cancer (Best AJCC) stage 4; 28.9% were at stage 3; and 1.2% were at stage zero. The most frequent pathological variant was adenocarcinoma (77.4%); the most affected site was the rectum (40.5%). By Cox regression analysis, age at diagnosis, tumor stage, Kirsten Ras (KRAS) mutation, and lymphovascular invasion were significant prognostic factors for survival in CRC patients.

Conclusion:

Colorectal cancer patients presented to the hospital late in the disease course. This may call for lowering the screening age, increasing awareness programs, and establishing a national screening program.

Diabetes, Obesity, and the Metabolic Syndrome as Prognostic Factors in Stages I to III Colorectal Cancer Patients

BACKGROUND

Attempts to introduce prognostic factors for survival outcomes in localized colorectal cancer patients receiving surgical treatment with or without adjuvant therapies, beyond the classic staging parameters, have been met with limited success. Obesity and diabetes mellitus are among the conditions that predispose to colorectal cancer but their value as prognostic markers once the disease is diagnosed is controversial.

PATIENTS AND METHODS

This study examines the prognostic value of the components of metabolic syndrome in a retrospective series of colorectal cancer patients with stages I to III disease followed in a single center.

RESULTS

Among the four components of the metabolic syndrome, only diabetes was independently associated with progression-free survival (PFS) while obesity, hypertension, and dyslipidemia were not. No associations of the metabolic syndrome (MS) or its components with overall survival (OS) were observed in multivariate analysis.

CONCLUSION

These data pinpoint to diabetes mellitus (DM) as a possible prognostic factor for PFS in localized colorectal cancer and further cast doubt for the value of obesity as measured by body mass index (BMI) on local stage colorectal cancer prognosis.

Role of pre-existing type 2 diabetes in colorectal cancer survival among older Americans: a SEER-Medicare population-based study 2002-2011

PURPOSE

Type 2 diabetes mellitus (diabetes) is a common comorbid condition among older adult colorectal cancer (CRC) patients, yet its effects on CRC mortality have not been adequately examined. This study aims to investigate the association between pre-existing diabetes, with and without complications, and CRC mortality.

METHODS

Medicare beneficiaries 67 years and older diagnosed with CRC between 2002 and 2011 were studied using the Surveillance, Epidemiology, and End Results (SEER)-Medicare datasets. Pre-existing diabetes was ascertained using validated algorithms. Cox proportional hazards models were used to compare all-cause and CRC-cause-specific death risk differences in relation to prior diabetes diagnosis and diabetes severity (with and without complications) with adjustment for relevant patient demographics and disease characteristics.

RESULTS

Analyses included 93,710 CRC patients. Among the study population, 22,155 (24%) had diabetes prior to CRC diagnosis and 4% had diabetes-related complications (neuropathy, nephropathy, retinopathy, or peripheral circulatory disorders). All-cause CRC mortality was significantly higher among diabetic patients compared with non-diabetic patients (hazard ratio (HR) = 1.20; 95% confidence interval (CI) = 1.17-1.23). The results were more pronounced for diabetes with complications (HR = 1.47; 95% CI = 1.34-1.54). Diabetic patients with complications were 16% more likely to die of colorectal cancer compared with patients without diabetes (HR = 1.16; 95% CI = 1.08-1.25).

CONCLUSION

Pre-existing diabetes contributes to poorer all-cause mortality among CRC patients and increased mortality from CRC among those with diabetes and complications. Opportunities exist to incorporate diabetes prevention and management interventions during CRC treatment phases among older adults.

Impact of Metabolic Syndrome Diagnosis and Its Treatment on Survival of Colorectal Cancer Patients

Background

Epidemiologic findings on the effect of metabolic syndrome (MetS) and its treatment on colorectal cancer (CRC) survival have been inconsistent and have not been previously studied in an Arab population such as the Omani population.

Patients and Methods

Data from the hospital records of 301 CRC patients treated in Sultan Qaboos University (SQUH), Oman, from 2006 to 2014 were analyzed retrospectively to determine the effects of MetS and its treatment on CRC survival. Overall survival (OS) by MetS status and by medications for MetS components management was compared with Cox proportional models.

Results

Of the 301 patients, 76 (25.2%) had MetS, 20.3% were on insulin, 23.9% were on metformin, 25.6% took statins, 17.9% were on either angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blocker (ARB). Whereas metformin (HR, 0.46, 95% CI, 0.25-0.84) and statins (HR, 0.58; 95% CI, 0.35-0.96) had a protective effect on OS, insulin (HR 1.73, 95% CI, 1.02-2.97) had a detrimental effect. In subgroup analysis of diabetic subjects, a nonsignificant improvement in OS was observed in the metformin treated patients compared to those on other hypoglycemic agents (HR, 0.92, 95% CI, 0.55-1.55). Neither MetS nor antihypertensive drugs had any apparent effect on OS.

Conclusions

Our result suggests that, among CRC patients with MetS, taking metformin and statins may improve overall survival, whereas being on insulin may negatively impact CRC prognosis. Further studies are warranted to determine the exact mechanism through which metformin, statins, and insulin exert their effects on CRC survival.

Prediction of Metabolic Syndrome for the Survival of Patients With Digestive Tract Cancer: A Meta-Analysis

Background and Objectives: Growing evidence indicates that metabolic syndrome confers a differential risk for the development and progression of many types of cancer, especially in the digestive tract system. We here synthesized the results of published cohort studies to test whether baseline metabolic syndrome and its components can predict survival in patients with esophageal, gastric, or colorectal cancer.

Methods: Literature retrieval, publication selection and data extraction were performed independently by two authors. Analyses were done using STATA software (version 14.1).

Results: A total of 15 publications involving 54,656 patients were meta-analyzed. In overall analyses, the presence of metabolic syndrome was associated with a non-significant 19% increased mortality risk for digestive tract cancer (hazard ratio [HR]: 1.19; 95% confidence interval [CI]: 1.45 to 2.520.95 to 1.49, P = 0.130; I²: 94.8%). In stratified analyses, the association between metabolic syndrome and digestive tract cancer survival was statistically significant in prospective studies (HR: 1.64, 95% CI: 1.18 to 2.28), in studies involving postsurgical patients (HR: 1.42, 95% CI: 1.06 to 1.92), and in studies assessing cancer-specific survival (HR: 1.91, 95% CI: 1.45 to 2.52). Further meta-regression analyses indicated that age and smoking were potential sources of between-study heterogeneity (both P < 0.001). The shape of the Begg's funnel plot seemed symmetrical (Begg's test P = 0.945 and Egger's test P = 0.305).

Conclusions: Our findings indicate that metabolic syndrome is associated with an increased risk of postsurgical digestive tract cancer-specific mortality. Continued investigations are needed to uncover the precise molecule mechanism linking metabolic syndrome and digestive tract cancer.

The role of metabolic syndrome variant in the malignant tumors progression

Metabolic syndrome (MS) is one of the leading risk factors for the development of some common cancers (endometrial cancer, postmenopausal breast cancer, colorectal cancer). Currently, a drug-induced metabolic syndrome related with androgen deprivation therapy in patients with prostate cancer represents a serious medical problem. Not only MS, or its individual components, but MS variants with different levels of leptin, adiponectin, visfatin, resistin are associated with tumor invasion, metastasis and survival rates in patients with MS-associated malignancies.

The combined effect of non-alcoholic fatty liver disease and metabolic syndrome on colorectal carcinoma mortality: a retrospective in Chinese females

BACKGROUND

This research aimed to investigate whether metabolic syndrome (MetS) and non-alcoholic fatty liver disease (NAFLD) had both individual and synergistic effects on the prognosis for female colorectal carcinoma (CRC) patients.

METHODS

The relationship between CRC prognosis and NAFLD as well as MetS was evaluated in 764 female participants. Based on the NAFLD level, patients were divided into significant NAFLD (SNAFLD), "moderate" and "severe" level, and non-SNAFLD, "non" and "mild" level. All the patients were categorized into four subgroups according to the status of SNAFLD and MetS and then a comparison of CRC prognosis among those four groups was performed.

RESULTS

NAFLD, SNAFLD, and MetS were independent factors for CRC-specific mortality with the adjustment of age and other confounders. The hazard ratio (HR) of CRC-specific mortality in MetS (+) SNAFLD (+) group was significantly higher than that in other three groups. Relative excess risk of interaction (RERI) was 2.203 with 95% CI ranged from 0.197 to 4.210, attributable proportion (AP) was 0.444 with range from 0.222 to 0.667, and synergy index (SI) of 2.256 with 95% CI from 1.252 to 4.065, indicating SNAFLD and MetS had a significant synergic effect on CRC-specific mortality.

CONCLUSIONS

SNAFLD and MetS are independent risk factors for CRC-specific mortality in females. Moreover, those two diseases have a synergistic effect on promoting CRC-specific mortality.

Type 2 diabetes and colorectal cancer survival: The multiethnic cohort

This analysis examined type 2 diabetes (T2D) as a predictor of colorectal cancer (CRC) survival within the Multiethnic Cohort Study. Registry linkages in Hawaii and California identified 5,284 incident CRC cases. After exclusion of cases with pre-existing cancer diagnosis within 1 year and systemic disease, the analytic dataset had 3,913 cases with 1,800 all-cause and 678 CRC-specific deaths after a mean follow-up of 9.3 ± 5.2 years. Among CRC cases, 707 were diagnosed with T2D 8.9 ± 5.3 years before CRC. Cox regression with age as time metric was applied to estimate hazard ratios (HR) and 95% confidence intervals (CI) for T2D status as predictor of CRC-specific and all-cause survival while adjusting for known confounders. Overall, CRC-specific survival was not associated with pre-existing T2D (HR = 0.84; 95% CI = 0.67-1.07). However, a significant interaction was seen for comorbidity (pinteraction  = 0.03) with better survival among those without pre-existing conditions (HR = 0.49; 95% CI = 0.25-0.96) while no association was seen in patients with comorbid conditions. All-cause mortality was also not related to pre-existing T2D (HR = 1.11; 95% CI = 0.98-1.27), but significantly elevated for individuals with T2D reporting comorbid conditions (HR = 1.36; 95% CI = 1.19-1.56). Stratification by T2D duration suggested higher CRC-specific and all-cause mortality among participants with a T2D history of ≥10 than <10 years. The findings were consistent across sex and ethnic subgroups. In contrast to previous reports, pre-existing T2D had no influence on disease-specific and all-cause survival among CRC patients. Only participants with additional comorbidity and possibly those with long T2D duration experienced higher mortality related to T2D.

Assessment of the awareness and knowledge of cancer survivors regarding the components of metabolic syndrome

This study aimed to assess the prevalence of metabolic syndrome and the level of knowledge and awareness of its related conditions in a sample of cancer survivor patients. In this cross-sectional survey, a self-reported questionnaire was administered to outpatients aged >20 years with a diagnosis of cancer. This self-reported questionnaire on patient demographic characteristics, disease characteristics, and knowledge and awareness of metabolic syndrome was used as an instrument to assess patient's knowledge of metabolic syndrome. A total of 88 participants were included; of these 34.1% had metabolic syndrome, although only 6.8% of participants were diagnosed with metabolic syndrome. Over half of the participants had heard about metabolic syndrome; however, 70% of the participants did not know about the blood tests for the diagnosis of metabolic syndrome although they were aware of the physical measurements, such as weight, blood pressure, and waist circumference. The highest proportion of correct answers for questions about metabolic syndrome was related to stroke, while the lowest was about cholesterol levels. The proportions of correct answers for selected parameters were as follows: diabetes, 39.1%; adiposity, 47.2%; hypertension, 46.8%; cholesterol levels, 36.7%; arteriosclerosis, 45.5%; myocardial infarction, 37.8%; and stroke, 62.8%. The results suggest that the level of knowledge of metabolic syndrome among the cancer survivors in our sample was poor, although more than one-third of them had metabolic syndrome. Thus, it is essential to educate cancer survivors about metabolic syndrome and its related conditions to improve their overall health and quality of life.

Adherence to colonoscopy at 1 year following resection of localized colon cancer: a retrospective cohort study

BACKGROUND

For patients with stages I-III colon cancer who have undergone surgical resection, guidelines recommend surveillance colonoscopy at 1 year. However, limited data exist on adherence and associated factors. We aimed to determine the rate of adherence to surveillance colonoscopy at 1 year among nonmetastatic colon cancer patients who underwent resection and factors associated with adherence.

METHODS

In this population-based retrospective cohort study, the Surveillance, Epidemiology, and End Results (SEER)-Medicare database was used. We identified patients with stages I-III colon cancer who underwent surgical resection and survived >3 years without recurrence (no chemotherapy after 8 months) from 2002-2011. Our primary outcome was a colonoscopy claim 10-15 months after resection. We used multivariable regression analysis to assess associations between sociodemographic and clinical factors and receipt of timely colonoscopy.

RESULTS

Among 28,732 patients who survived >3 years without recurrence, 7967 (28%) did not undergo colonoscopy; 12,033 (42%) had it at one year, with 3159 (11%) before 10 months and 5573 (19%) after 15 months. Decreased adherence was associated with older age; being male versus female; being black or Hispanic versus white; higher tumor stage; left-sided tumors versus right sided; and increased comorbidities. Chemotherapy receipt was associated with increased adherence (odds ratio 2.06; 95% confidence interval 1.88-2.24).

CONCLUSIONS

In a large population-based sample of individuals aged ⩾ 65 years, only 42% of colon cancer survivors underwent 1-year surveillance colonoscopy. Demographic and clinical factors were associated with adherence.

Baseline Metabolic Risk Score and Postsurgical Esophageal Cancer-Specific Mortality: The Fujian Prospective Investigation of Cancer (FIESTA) Study

Backgrounds: Compelling evidence has emerged to support a close relationship between metabolic syndrome and esophageal cancer (EC). Aims: Using five baseline metabolism-related markers, we constructed a metabolic risk score (MRS), aiming to test whether MRS can improve the prediction of postsurgical EC-specific mortality over traditional demographic and clinicopathologic characteristics. Methods: Total 2535 EC patients who received three-field lymphadenectomy were enrolled from January 2000 to December 2010, and they were followed up until December 2015. Results: All EC patients were randomly split into derivation group (n=1512, 60%) and validation group (n=1014, 40%). MRS was generated in derivation group by adopting the Framingham 'points' system and shrinkage method, and it ranged from -9 to 17. EC-specific mortality risk increased with the increase of MRS, and adjusted estimates were more obvious in patients with upper tertile (MRS>6) than patients with lower MRS (≤2) in either derivation (hazard ratio [HR]=2.28, 95% confidence interval [CI]: 1.90-2.73, P<0.001) or validation group (HR=2.11, 95% CI: 1.66-2.67, P<0.001) or both groups (HR=2.37, 95% CI: 1.95-2.88, P<0.001). In Kaplan-Meier curve, cumulative survival rates differed significantly across tertiles of MRS. Further analysis indicated that MRS can improve classification accuracy and discriminatory ability over clinicopathologic parameters. Conclusions: Our findings supported the usefulness of baseline MRS in predicting the prognosis of postsurgical EC-specific mortality.

Interaction of smoking and metabolic syndrome in increasing the recurrence risk of colorectal cancer in a Chinese male cohort: a retrospective study

Whether smoking and metabolic syndrome (MetS) can affect colorectal carcinoma (CRC) prognosis remains debatable. Therefore, the present study aimed to examine the individual and combined effects of smoking and MetS on the prognosis of patients with localized CRC, including stage I to III disease. The relationship among smoking status, MetS, and CRC was assessed in 838 Chinese male patients. Cox proportional hazards regression analysis was used to evaluate CRC prognosis adjusted for clinicopathological variables. Relative excess risk of interaction (RERI), attributable proportion (AP), and synergy index (SI) were used to evaluate additive interactions between smoking and MetS. The presence of MetS was an independent risk factor for low rates of recurrence-free survival (RFS) but not for overall survival (OS). However, smoking was independently associated with both poor RFS and OS. Furthermore, the recurrence risk for current smokers with MetS was 1.62 times as high as the sum of risks in patients exposed to each risk factor alone. In conclusion, current smoking habit is a risk factor for both recurrence and cancer-specific mortality in CRC patients, while MetS is an independent predictor for CRC recurrence. Furthermore, these two factors have an additive effect on the recurrence risk of CRC.

An in-depth prognostic analysis of baseline blood lipids in predicting postoperative colorectal cancer mortality: The FIESTA study

BACKGROUND

Dyslipidaemia is key to colorectal carcinogenesis, and the prediction of baseline triglycerides (TG), total cholesterol (TC), high- and low-density lipoprotein cholesterol (HDLC and LDLC) for postsurgical colorectal cancer mortality has not been researched.

OBJECTIVES

We attempted to re-analyse the FIESTA database to assess the prognostic value of three informative lipid derivatives - AI (atherogenic index: (TC - HDLC)/HDLC), THR (TG/HDLC) and LHR (LDLC/HDLC) in predicting colorectal cancer mortality.

METHODS

Based on the FIESTA database, 1318 patients received radical resection from 2000 to 2008, with the latest follow-up completed in December 2015. Median follow-up time was 58.6 months.

RESULTS

Total 1318 patients were randomly evenly divided into the derivation and validation groups. Overall, baseline AI and LHR were associated with the significantly increased risk of colorectal cancer mortality in both derivation (hazard ratio (HR): 1.41 and 1.35, respectively) and validation (HR: 1.37 and 1.32, respectively) groups (all P < 0.001). The predictive performance of AI and LHR was remarkably enhanced in patients with female gender, former/current smoking, colon cancer, early stage, positive vein tumor embolus, normal weight, preoperative hypertension or diabetes comorbidities. Calibration/discrimination analyses revealed that adding AI or LHR to the traditional model had a better fit in both groups. A prognostic nomogram was finally constructed with good predictive accuracy and discriminative capability (C-index = 0.814, P < 0.001).

CONCLUSION

We consolidated the prognostic superiority of AI and LHR in predicting colorectal cancer mortality over TNM stage.

The influence of metabolic syndrome in the outcomes of colorectal cancer patients

AIMS

Determine the influence of metabolic syndrome and its different components in the outcomes of colorectal cancer surgery at 30days.

MATERIALS AND METHODS

Prospective study that included all patients submitted to elective colorectal cancer surgery between August 2015 and August 2016 at Hospital de Braga. Clinical and laboratory parameters evaluated pre-operatively were: central obesity, blood pressure, fasting glucose, triglycerides levels and HDL cholesterol levels. Any complications during the first 30-days after surgery were recorded (readmission, reintervention, anastomotic dehiscence, morbimortality).

RESULTS

One hundred and thirty-four patients were included. Metabolic syndrome was diagnostic in 40.7% of patients with the ATPIII definition, 67.5% with the AHA definition and 67.0% with the IDF definition. At 30days after colorectal cancer surgery, 73.1% patients don't have any complication, 15.7% have minor complications (grade I/II of Clavien-Dindo classification), 11.1% have major complications (grade III/IV/V of Clavien-Dindo classification) and 1.5% have died from surgical complications (grade V of Clavien-Dindo classification). The statistic analysis didn't reveal any association between MS, or it's different components, and surgical outcomes.

CONCLUSION

This study seems to indicate that metabolic syndrome don't have any influence in surgical outcomes of colorectal cancer surgery.

Comparison of Basic and Ensemble Data Mining Methods in Predicting 5-Year Survival of Colorectal Cancer Patients

INTRODUCTION

Colorectal cancer (CRC) is one of the most common malignancies and cause of cancer mortality worldwide. Given the importance of predicting the survival of CRC patients and the growing use of data mining methods, this study aims to compare the performance of models for predicting 5-year survival of CRC patients using variety of basic and ensemble data mining methods.

METHODS

The CRC dataset from The Shahid Beheshti University of Medical Sciences Research Center for Gastroenterology and Liver Diseases were used for prediction and comparative study of the base and ensemble data mining techniques. Feature selection methods were used to select predictor attributes for classification. The WEKA toolkit and MedCalc software were respectively utilized for creating and comparing the models.

RESULTS

The obtained results showed that the predictive performance of developed models was altogether high (all greater than 90%). Overall, the performance of ensemble models was higher than that of basic classifiers and the best result achieved by ensemble voting model in terms of area under the ROC curve (AUC= 0.96).

CONCLUSION

AUC Comparison of models showed that the ensemble voting method significantly outperformed all models except for two methods of Random Forest (RF) and Bayesian Network (BN) considered the overlapping 95% confidence intervals. This result may indicate high predictive power of these two methods along with ensemble voting for predicting 5-year survival of CRC patients.

Obesity and diabetes as prognostic factors in patients with colorectal cancer

Colorectal carcinoma is one of the most prevalent cancer types for both men and women. Prognosis of the disease is mostly defined by the stage. Localized disease has a better prognosis especially in earlier stages I and II. In addition most patients with more advanced localized stage III disease are expected to survive with a combination of surgery and adjuvant treatments. Progress in treatment of metastatic disease has led to median survivals exceeding 2 years and a minority of oligometastatic patients may survive even longer or be cured with multimodality therapy. Besides stage of the disease few prognostic factors are available to guide informative discussions with patients or guide therapeutic decisions. One area of research that may provide information in this direction is comorbidity conditions of the metabolic syndrome spectrum. Despite a significant body of literature investigating elements of the metabolic syndrome such as obesity and diabetes in isolation as risk and prognostic factors in colorectal cancer, a more restricted amount of research is dealing with the combination of these two factors as prognosticators of colorectal cancer. This paper will discuss published data on these factors and specifically their combination in the prognosis of colorectal cancer and will address some of their pathogenesis and therapy implications.

Racial differences in the effects of comorbidity on breast cancer-specific survival

PURPOSE

In an effort to explain racial disparities in breast cancer survival, this study aimed to investigate how comorbidity affects breast cancer-specific mortality by race.

METHODS

A retrospective cohort study was conducted using the Surveillance, Epidemiology and End Results-Medicare linked data including 68,090 women 66+ years, who were diagnosed with stage I-III breast cancer in the United States from 1994 to 2004. Hospital and outpatient claims from the year prior to breast cancer diagnosis were used to identify comorbid conditions and patients were followed for survival through 2010.

RESULTS

Competing risk survival analysis failed to demonstrate any negative comorbidity effects on breast cancer-specific survival for black women. An increased breast cancer-specific mortality hazard was observed for white women who had diabetes without complication relative to white women without this condition after adjusting for age and year of diagnosis (hazard ratio: 1.22, 95% confidence interval 1.13, 1.30). The Cochran-Armitage Test showed diabetes was associated with a later stage of diagnosis (p < 0.01) and a more aggressive tumor grade (p < 0.01) among white women in the study population.

CONCLUSION

Race specific comorbidity effects do not explain breast cancer-specific survival disparities. However, the relationship between diabetes and breast cancer, including the role of aggressive tumor characteristics, warrants special attention.

Impact of platelet to lymphocyte ratio and metabolic syndrome on the prognosis of colorectal cancer patients

Objective

The aim of this study was to evaluate the prognostic value of both platelet to lymphocyte ratio (PLR) and metabolic syndrome (MetS) in colorectal cancer (CRC) patients.

Patients and methods

We retrospectively enrolled 1,163 CRC patients. Preoperative values of PLR were stratified into three groups according to cut-off values of 120 and 220. The Kaplan–Meier analysis was used to calculate cumulative survival rate related to PLR and MetS. Cox proportional hazard regression models were used to analyze potential risk factors and the prognosis associated with PLR and MetS in CRC patients.

Results

PLR was significantly higher in the MetS(+) group as compared to MetS(−) group (P=0.039). An elevated PLR was significantly associated with mortality (P=0.014), but not the existence of MetS (P=0.235). In multivariate regression analysis, PLR was an independent risk factor for overall survival (OS) (P=0.046). For the subgroup with a PLR >220, MetS was an independent predictor for both OS and disease-free survival (P=0.039 and P=0.047, respectively) by multivariate analysis adjusting for confounding covariates. In addition, the presence of MetS was associated with a 2-fold increased risk of mortality and tumor recurrences (hazard ratio [HR] =2.0 and HR =1.9, P<0.05, respectively).

Conclusion

Preoperative PLR was associated with MetS in CRC patients. Testing for the combined presence of PLR and MetS could potentially improve the predictive accuracy of CRC prognosis.

The effect of metabolic comorbidities and commonly used drugs on the prognosis of patients with ovarian cancer

BACKGROUND

Diabetes mellitus is associated with an increased risk of recurrence in patients with ovarian cancer. Retrospective studies suggested that the use of statins, metformin and beta blockers is associated with improved prognosis in these patients. Patients with diabetes often suffer from hypertension and are usually treated concomitantly by several classes of drugs. Our aim was to assess the independent contribution of diabetes mellitus and hypertension and of the use of aspirin, statins, metformin and beta blockers on the risk of ovarian cancer recurrence and mortality.

METHODS

Files of ovarian cancer patients treated between 2000 and 2012 were retrospectively reviewed. Data regarding disease characteristics, presence of diabetes mellitus and hypertension, recurrence and death were extracted. The use of drugs was assessed using the Clalit Health Services (CHS) pharmacy records.

RESULTS

143 patients treated by debulking surgery and platinum based chemotherapy were included. Median age was 62.5, 22 (15.4%) had diabetes mellitus, 61 (42.7%) had chronic hypertension. Statins were used by 43 (30%) patients, 31 (21.7%) used aspirin, 25 (17.5%) used beta blockers and 12 (8.4%) used metformin. In multivariate analysis diabetes mellitus was associated with a shorter recurrence free survival (RFS) and the use of aspirin and metformin was associated with a prolonged RFS in this cohort. Overall survival (OS) was longer in patients using aspirin and shorter in patients with hypertension.

CONCLUSIONS

Our data suggests that metabolic comorbidities and commonly used drugs are associated with the prognosis of patients with ovarian cancer. Additional trials are needed to confirm these observations and test therapeutic interventions.

Preoperative serum lipid profile and outcome in nonmetastatic colorectal cancer

OBJECTIVE

A large portion of non-metastatic colorectal cancers (non-mCRCs) recur after curative surgery. In addition to the traditional tumor-related factors, host-related factors are also required to accurately predict prognosis. A few studies have shown an association between the serum lipid profile and the survival and treatment response of patients with colorectal cancer.

METHODS

We retrospectively evaluated the prognostic significance of the preoperative serum lipid profile [total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C)] in patients with non-mCRC treated with curative surgery. The Spearman rank correlation test was used to analyze associations between lipid levels and categorical variables. Lipid levels were modeled as four equal-sized quartiles based on the distribution among the whole cohort. Kaplan-Meier curves were used to estimate survival probabilities, and the log-rank test was used to detect differences between them. Multivariate fractional polynomial (MFP) analysis was used to model any non-linear effects and avoid categorization. To evaluate the added prognostic value of lipids, the predictive power of two models (with and without lipids as covariates) was compared by using Harrell's C-statistic and the Akaike information criterion (AIC).

RESULTS

A total of 266 patients with non-mCRC were enrolled in the present study. Spearman rank correlation test showed that TG levels inversely correlated with N stage (r = -0.20, P = 0.00) and Tumor-Node-Metastasis (TNM) stage (r = -0.19, P = 0.00). HDL-C levels positively correlated with perineural invasion (PNI) (r = 0.15, P = 0.02), and LDL-C levels inversely correlated with lymphovascular invasion (LVI) (r = -0.12, P = 0.04). None of the four lipids predicted overall survival (OS) in univariate or multivariate analyses adjusted for age, gender, T stage, N stage, TNM stage, histological grade, tumor deposits, LVI, PNI, and adjuvant treatment (all P > 0.05). In agreement, the Kaplan-Meier curves for OS according to the lipid quartiles were not significantly different, as confirmed by the log-rank test (all P > 0.05). MFP analysis also found no significant associations between lipid levels and OS (all P > 0.05). A prognostic model that included lipids had a higher Harrell's C-statistic and a lower AIC value than did a model that did not include lipids (for Harrell's C-statistic: 0.82 vs. 0.77; for AIC: 398 vs. 432).

CONCLUSION

Measuring preoperative serum lipid levels may be a simple and cost-effective way of increasing prognostic accuracy in patients with non-mCRC treated with curative surgery.

Metabolic Dysfunction, Obesity, and Survival Among Patients With Early-Stage Colorectal Cancer

PURPOSE

The effects of obesity and metabolic dysregulation on cancer survival are inconsistent. To identify high-risk subgroups of obese patients and to examine the joint association of metabolic syndrome (MetSyn) in combination with obesity, we categorized patients with early-stage (I to III) colorectal cancer (CRC) into four metabolic categories defined by the presence of MetSyn and/or obesity and examined associations with survival.

METHODS

We studied 2,446 patients diagnosed from 2006 to 2011 at Kaiser Permanente. We assumed MetSyn if patients had three or more of five components present at diagnosis: fasting glucose > 100 mg/dL or diabetes; elevated blood pressure (systolic ≥ 130 mm Hg, diastolic ≥ 85 mm Hg, or antihypertensives); HDL cholesterol < 40 mg/dL (men) or < 50 mg/dL (women); triglycerides ≥ 150 mg/dL or antilipids; and/or highest sex-specific quartile of visceral fat by computed tomography scan (in lieu of waist circumference). We then classified participants according to the presence (or absence) of MetSyn and obesity (BMI < 30 or ≥ 30 kg/m²) and assessed associations with overall and CRC-related survival using Cox proportional hazards models adjusted for demographic, tumor, and treatment factors and muscle mass at diagnosis.

RESULTS

Over a median follow-up of 6 years, 601 patients died, 325 as a result of CRC. Mean (SD) age was 64 (11) years. Compared with the reference of nonobese patients without MetSyn (n = 1,225), for overall survival the hazard ratios (HR) and 95% CIs were 1.45 (1.12 to 1.82) for obese patients with MetSyn (n = 480); 1.09 (0.83 to 1.44) for the nonobese with MetSyn (n = 417), and 1.00 (0.80 to 1.26) for obese patients without MetSyn (n = 324). Obesity with MetSyn also predicted CRC-related survival: 1.49 (1.09 to 2.02). The hazard of death increased with the number of MetSyn components present, independent of obesity.

CONCLUSION

Patients with early-stage CRC with obesity and MetSyn have worse survival, overall and CRC related.

Silencing vimentin expression decreases pulmonary metastases in a pre-diabetic mouse model of mammary tumor progression

Increased breast cancer risk and mortality has been associated with obesity and Type 2 diabetes (T2D). Hyperinsulinemia, a key factor in obesity, pre-diabetes and T2D, has been associated with decreased breast cancer survival. In the current study, a mouse model of pre-diabetes (MKR mouse) was used to investigate the mechanisms through which endogenous hyperinsulinemia promotes mammary tumor metastases. The MKR mice developed larger primary tumors and greater number of pulmonary metastases compared to wild type (WT) mice after injection with c-Myc/Vegf overexpressing MVT-1 cells. Analysis of the primary tumors showed significant increase in Vimentin protein expression in the MKR mice compared to WT. We hypothesized that Vimentin was an important mediator in the effect of hyperinsulinemia on breast cancer metastasis. Lentiviral shRNA knockdown of Vimentin led to a significant decrease in invasion of the MVT-1 cells and abrogated the increase in cell invasion in response to insulin. In the pre-diabetic MKR mouse, Vimentin knockdown led to a decrease in pulmonary metastases. In vitro, we found that insulin increased pAKT, prevented Caspase 3 activation, and increased Vimentin. Inhibiting the PI3K/AKT pathway, using NVP-BKM120, increased active Caspase 3 and decreased Vimentin levels. This study is the first to show that Vimentin plays an important role in tumor metastasis in vivo in the setting of pre-diabetes and endogenous hyperinsulinemia. Vimentin targeting may be an important therapeutic strategy to reduce metastases in patients with obesity, pre-diabetes or T2D.

Impact of metabolic syndrome on the survival of Chinese patients with resectable esophageal squamous cell carcinoma

Metabolic syndrome (MetS) is associated with the risk of esophageal squamous cell carcinoma (ESCC). However, the impact of MetS on survival has not been evaluated. A retrospective review was performed on 596 consecutive Chinese patients with esophageal squamous cell carcinoma who received surgery between January 2005 and October 2007. The clinical data and pretreatment information related to MetS were reviewed. The impact of MetS on overall survival (OS) was estimated by Kaplan-Meier and Cox proportional hazards analyses. MetS was a significant and independent predictor for better survival in patients with resectable ESCC. The 3-year OS and 5-year OS for patients with and without MetS were 75.0% versus 57.8% and 65.1% versus 44.6%, respectively (P = 0.005 in the univariate analysis, P = 0.010 in multivariate analysis). However, there was no apparent influence of any single component of MetS on OS. The other independent prognostic factors identified in the univariate analysis included the following: gender, smoking status, alcohol use, the extent of radical surgical resection, T and N stage, and tumor differentiation. The results of the multivariate analysis included the extent of radical surgery resection, T and N stage, and tumor differentiation. MetS was also associated with greater tumor cell differentiation (P = 0.036). There was no association found between MetS status and postoperative complications. MetS is an independent prognostic factor for OS in patients with ESCC and is associated with better tumor cell differentiation.

The impact of metabolic syndrome on outcome and response to neoadjuvant chemoradiation in locally advanced rectal cancer patients

BACKGROUND AND OBJECTIVES

Metabolic syndrome (MetS) is a constellation of cardiovascular risk factors shown to increase the risk of developing various malignancies, as well as diminish tumor response to conventional therapies. The effects of MetS and its individual components on therapeutic response and treatment-related outcomes were examined in patients with locally advanced rectal cancer (LARC).

METHODS

Data was retrospectively collected on LARC patients treated with neoadjuvant chemoradiation (nCRT) and surgery. Medical records were reviewed for patient characteristics, staging, treatment plan, and outcomes.

RESULTS

One hundred two patients were included in the study. Patients with HTN had a significantly decreased nCRT response and were four times more likely to experience a poor response to treatment compared to patients without HTN. Additionally, HTN was found to significantly increase the rate of surgical complications. Neither DM nor obesity exhibited any significant effect on therapeutic response or complication rates, either individually or in combination with another risk factor.

CONCLUSION

This study demonstrates the importance of considering underlying MetS risk factors, especially HTN, when predicting tumor response in LARC patients undergoing nCRT followed by radical surgery. The results provide support for an increased focus on pre-treatment risk factor control to optimize cancer therapy outcomes.

Metabolic syndrome contributes to an increased recurrence risk of non-metastatic colorectal cancer

Objectives

Epidemiological data suggests a close link between metabolic syndrome (MetS) and non-metastatic colorectal cancer (NMCRC). However, the relationship between MetS and the outcome of NMCRC is less well understood. We aim to evaluate the impact of MetS on the prognosis in NMCRC patients.

Methods

We performed a large cohort study of 1069 NMCRC patients. The Kaplan-Meier method was used to calculate the cumulative survival rate. Cox proportional hazard regression models were used to analyze the prognosis associated with MetS adjusting for clinicopathologic variables.

Results

MetS was identified in 20.7% of NMCRC patients. Patients with MetS were more likely to be older, higher levels of blood glucose, triglycerides, high density lipoprotein, and uric acid than patients without MS (P < 0.05 for all). During a mean period of 59.6 months follow-up, patients with MetS had a statistically significantly lower rate of disease-free survival (DFS) than the patients without MetS (P = 0.014), especially local recurrence (P = 0.040). However, there was no difference in overall survival (P = 0.116). Multivariate analysis showed that the presence of MetS was an independent risk factor for DFS (HR = 0.733, 95%CI 0.545–0.987, P = 0.041), but not for OS (P = 0.118).

Conclusions

MetS is associated with an increased recurrence risk of NMCRC.

Targeting dormant micrometastases: rationale, evidence to date and clinical implications

In spite of decades of research, cancer survival has increased only modestly. This is because most research is based on models of primary tumors. Slow recognition has begun that disseminated, dormant cancer cells (micrometastatic cells) that are generally resistant to chemotherapy are the culprits in recurrence, and until these are targeted effectively we can expect only slow progress in increasing overall survival from cancer. This paper reviews efforts to understand the mechanisms by which cancer cells can become dormant, and thereby identify potential targets and drugs either on the market or in clinical trials that purport to prevent metastasis. This review targets the most recent literature because several excellent reviews have covered the literature from more than two years ago. The paper also describes recent work in the authors' laboratories to develop a screening-based approach that does not require understanding of mechanisms of action or the molecular target. Success of this approach shows that targeting micrometastatic cells is definitely feasible.