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Hu XJ, Sun Y, Liu GJ, Zhang J, Zhang LX, Peng YH. Cystathionine- β-synthase expression correlates with tumour progression and adverse prognosis in patients with colon cancer. J Int Med Res 2024; 52:3000605241263726. [PMID: 39324183 PMCID: PMC11439173 DOI: 10.1177/03000605241263726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/30/2024] [Indexed: 09/27/2024] Open
Abstract
OBJECTIVE To investigate the levels of cystathionine-β-synthase (CBS) in colon cancer tissues compared with adjacent control tissues; and to examine the relationship between CBS level and clinical characteristics and prognosis. METHODS This retrospective study enrolled patients with primary colon cancer. Paraffin-embedded specimens were used to create pathological tissue microarrays. Immunohistochemistry was performed on the microarray to detect the levels of CBS in colon cancer tissues and normal adjacent tissues. Analyses were undertaken to examine the relationship between the level of CBS and clinical characteristics and prognosis. RESULTS A total of 216 patients (107 males and 109 females) were included in the study. The level of CBS in cancer tissues was found to be significantly increased compared with normal adjacent control tissues. There were significant differences in tumour location, tumour-node-metastasis stage and survival rate between the CBS-negative and CBS-positive groups. Positive CBS immunostaining was associated with decreased survival in colon cancer patients. The results of multivariate Cox regression analysis revealed that tumour location and positive CBS immunostaining were independent prognostic factors for survival. CONCLUSION Positive CBS immunostaining was closely associated with colon cancer and high levels of CBS might accelerate tumour development and affect patient prognosis in colon cancer.
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Affiliation(s)
- Xiao-Jie Hu
- Department of Surgery, Hebei Medical University, Shijiazhuang, Hebei Province, China
- Department of Gastrointestinal Surgery, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Yun Sun
- Department of Gastrointestinal Surgery, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Guang-Jie Liu
- Department of Thoracic Surgery, The Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Juan Zhang
- Department of Epidemiology and Statistics, Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Li-Xiao Zhang
- Department of Gastrointestinal Surgery, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Yan-Hui Peng
- Department of Surgery, Hebei Medical University, Shijiazhuang, Hebei Province, China
- Department of Hepatobiliary, Pancreatic and Splenic Surgery, Hebei General Hospital, Shijiazhuang, Hebei Province, China
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Kagawa Y, Wang C, Piao Y, Jin L, Tanizawa Y, Cai Z, Sunakawa Y. Real-World Evidence of FOLFIRI Combined with Anti-Angiogenesis Inhibitors or Anti-EGFR Antibodies for Patients with Early Recurrence Colorectal Cancer After Adjuvant FOLFOX/CAPOX Therapy: A Japanese Claims Database Study. Target Oncol 2024; 19:575-585. [PMID: 38691296 PMCID: PMC11231005 DOI: 10.1007/s11523-024-01063-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Oxaliplatin-containing adjuvant regimens (folinic acid, fluorouracil, and oxaliplatin/capecitabine and oxaliplatin [FOLFOX/CAPOX]) are used after curative resection of colorectal cancer (CRC). However, real-world evidence regarding treatment sequences and outcomes in patients with early recurrence CRC after adjuvant chemotherapy is limited. OBJECTIVE We aimed to describe the patient characteristics, treatment sequence, and overall duration of second-line (2L) therapy in patients with early recurrence CRC who received adjuvant chemotherapy (FOLFOX/CAPOX) followed by folinic acid, fluorouracil, and irinotecan (FOLFIRI) + anti-angiogenesis drugs (AA) or FOLFIRI + anti-epidermal growth factor receptor (EGFR) antibodies. METHODS This retrospective study analyzed Japanese administrative data from November 2014 to March 2023 of adult patients who underwent CRC resection surgery, started FOLFOX/CAPOX ≤3 months (mo) after surgery, and had early CRC recurrence. Early recurrence was defined as initiation of FOLFIRI+AA or FOLFIRI+anti-EGFR antibodies as 2L therapy, ≤12 mo of discontinuing adjuvant chemotherapy. Patient characteristics, treatment sequence, median time to treatment discontinuation (mTTD), i.e., duration between the start and end dates of 2L therapy (Kaplan-Meier method), and factors associated with 2L time to treatment discontinuation constituted the study outcomes (Cox regression model). Subgroup analyses were performed for timing of early CRC recurrence (≤6 mo and 6-12 mo) and tumor sidedness. RESULTS Among the 832 selected patients (median age [minimum-maximum] 67 (24-86) years, 56.4% male), CAPOX (71.3%) was more commonly used than FOLFOX (28.7%) as adjuvant therapy. FOLFIRI+AA (72.5%) was used more commonly than FOLFIRI+anti-EGFR antibodies (27.5%) in 2L. AA and anti-EGFR antibodies groups had similar mTTD: 6.2 mo (95% confidence interval 5.8, 6.9) and 6.1 mo (95% confidence interval 5.2, 7.4). Age ≥70 years showed significant association with shorter 2L treatment duration (hazard ratio 1.2, 95% confidence interval 1.0, 1.4; p = 0.03). The AA cohort's mTTD was numerically shorter in the ≤6 mo recurrence subgroup compared with the 6-12 mo recurrence subgroup (6.1 mo vs 8.1 mo); the anti-EGFR antibodies cohort had similar mTTD (5.8 mo vs 6.2 mo). The AA and anti-EGFR antibodies cohorts also had similar mTTD in the left-sided CRC subgroup (6.5 mo vs 6.2 mo), but not in the right-sided subgroup (5.6 mo vs 3.9 mo). CONCLUSIONS This is the first administrative data-based real-world evidence on treatment sequence and outcomes for patients with early recurrence CRC treated with FOLFIRI+AAs or FOLFIRI+ anti-EGFR antibodies after adjuvant FOLFOX/CAPOX therapy in Japan. Both regimens had similar TTD, but relapse timing and tumor sidedness may influence their efficacy.
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Affiliation(s)
- Yoshinori Kagawa
- Osaka General Medical Center, 3 Chome-1-56 Bandaihigashi, Sumiyoshi Ward, Osaka, 558-8558, Japan.
- Osaka International Cancer Institute, Osaka, Japan.
| | | | | | - Long Jin
- Eli Lilly Japan K.K., Kobe, Japan
| | | | | | - Yu Sunakawa
- St. Marianna University School of Medicine, Kawasaki, Japan
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Nakamura Y, Kawase M, Kawabata Y, Kanto S, Yamaura T, Kinjo Y, Ogo Y, Kuroda N. Impact of malnutrition on cancer recurrence, colorectal cancer-specific death, and non-colorectal cancer-related death in patients with colorectal cancer who underwent curative surgery. J Surg Oncol 2024; 129:317-330. [PMID: 37846204 DOI: 10.1002/jso.27488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/23/2023] [Accepted: 09/30/2023] [Indexed: 10/18/2023]
Abstract
AIM This study aimed to examine how malnutrition, as reflected by the Geriatric Nutritional Risk Index (GNRI), is associated with colorectal cancer (CRC) recurrence and cause of death. METHODS Consecutive stage I-III CRC patients (n = 601) were divided into two groups using GNRI 98 as the cutoff. The relationship of GNRI with overall survival (OS) and recurrence-free survival (RFS) was evaluated, followed by competing risk analysis to determine prognostic factors of non-CRC-related death, and hazard function analysis to examine changes in the risk of recurrence and death. RESULTS Median body mass index was lower in the low GNRI group than in the high GNRI group (19.8 vs. 23.5; p < 0.001). After adjusting for known prognostic factors, a low GNRI was independently associated with reduced OS/RFS, and was a significant predictor of non-CRC-related death. The risk of recurrence was higher and peaked earlier in the low GNRI group than in the high GNRI group, although after 3 years, both groups had a similar risk. Meanwhile, the low GNRI group had a higher risk of non-CRC-related death over the course of 5 years. CONCLUSION It is important to consider preoperative nutritional status along with the cancer stage when developing strategies to improve outcomes for CRC patients.
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Affiliation(s)
- Yuya Nakamura
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, 670-8520, Hyogo, Japan
| | - Makoto Kawase
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, 670-8520, Hyogo, Japan
| | - Yusuke Kawabata
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, 670-8520, Hyogo, Japan
| | - Satoshi Kanto
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, 670-8520, Hyogo, Japan
| | - Tadayoshi Yamaura
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, 670-8520, Hyogo, Japan
| | - Yousuke Kinjo
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, 670-8520, Hyogo, Japan
| | - Yasumasa Ogo
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, 670-8520, Hyogo, Japan
| | - Nobukazu Kuroda
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, 670-8520, Hyogo, Japan
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Zhu J, Lian J, Xu B, Pang X, Ji S, Zhao Y, Lu H. Neoadjuvant immunotherapy for colorectal cancer: Right regimens, right patients, right directions? Front Immunol 2023; 14:1120684. [PMID: 36949951 PMCID: PMC10026962 DOI: 10.3389/fimmu.2023.1120684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/20/2023] [Indexed: 03/08/2023] Open
Abstract
Neoadjuvant chemoradiotherapy (NACRT) or chemotherapy (NACT) followed by radical resection and then adjuvant therapy is considered the optimal treatment model for locally advanced colorectal cancer (LACRC). A recent total neoadjuvant therapy (TNT) strategy further improved the tumour regression rate preoperatively and reduced local-regional recurrence in locally advanced rectal cancer (LARC). However, distant metastasis was still high, and little overall survival benefit was obtained from these preoperative treatment models. According to mismatch repair protein expression, MSI-H/dMMR and non-MSI-H/pMMR statuses were defined in colorectal cancer (CRC) patients. Due to the special features of biologics in MSI-H/dMMR CRC patients, this subgroup of patients achieved little treatment efficacy from chemoradiotherapy but benefited from immune checkpoint inhibitors (ICIs). The KEYNOTE-177 trial observed favourable survival outcomes in metastatic CRC patients treated with one-line pembrolizumab with tolerable toxicity. Given the better systemic immune function, increased antigenic exposure, and improved long-term memory induction before surgery, neoadjuvant ICI (NAICI) treatment was proposed. The NICHE trial pioneered the use of NAICI treatment in LACRC, and recent reports from several phase II studies demonstrated satisfactory tumour downsizing in CRC. Preclinical rationales and preliminary early-phase human trials reveal the feasibility of NAICI therapy and the therapeutic efficacy provided by this treatment model. Better tumour regression before surgery also increases the possibility of organ preservation for low LARC. However, the optimal treatment strategy and effective biomarker identification for beneficiary selection remain unknown, and potential pitfalls exist, including tumour progression during neoadjuvant treatment due to drug resistance and surgery delay. Given these foundations and questions, further phase II or III trials with large samples need to be conducted to explore the right regimens for the right patients.
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Affiliation(s)
- Jiahao Zhu
- Department of Outpatient Chemotherapy, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, China
| | - Jie Lian
- Department of Outpatient Chemotherapy, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, China
| | - Benjie Xu
- Department of Outpatient Chemotherapy, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, China
| | - Xiangyi Pang
- Department of Outpatient Chemotherapy, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, China
| | - Shengjun Ji
- Department of Radiotherapy and Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Yutian Zhao
- Department of Radiotherapy and Oncology, The Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Haibo Lu
- Department of Outpatient Chemotherapy, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, China
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Lehtonen TM, Ilvesmäki A, Koskenvuo LE, Lepistö AH. The ability of magnetic resonance imaging to predict lymph node metastases and the risk of recurrence in rectal cancer. J Surg Oncol 2023; 127:991-998. [PMID: 36800203 DOI: 10.1002/jso.27216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/06/2023] [Indexed: 02/18/2023]
Abstract
AIM This study aimed to examine the diagnostic accuracy and prognostic value of magnetic resonance imaging (MRI) detected lymph nodes in rectal cancer. METHOD We evaluated 806 rectal cancer patients consecutively operated on between 2015 and 2018 at Helsinki University Hospital. In total, 485 patients met the inclusion criteria of presenting with stage I-III disease and were intended for curative treatment at the time of diagnosis. The effect of MRI-detected clinical lymph node status (cN) on cumulative overall survival (OS), disease-specific survival (DSS) and disease-free survival (DFS) was calculated using the Kaplan-Meier analysis. RESULTS Negative predictive value (NPV) of MRI-lymphnode negativity was 74.8%. Positive predictive value of lymph node metastasis was only 48.6%. In the Kaplan-Meier survival analysis, OS (p = 0.989), DSS (p = 0.911), and DFS (p = 0.109) did not significantly differ according to MRI nodal status. However, cumulative disease-free survival significantly (p < 0.001) differed according to the histopathological lymph node metastasis status (pN). CONCLUSIONS MRI detected lymph node positivity appears insufficiently precise and cannot predict disease recurrence or survival. Therefore, it should not serve as an independent risk factor when considering neoadjuvant treatment options for rectal cancer patients.
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Affiliation(s)
- Taru M Lehtonen
- Department of Surgery, Helsinki University Hospital (HUS), University of Helsinki, Helsinki, Finland
| | - Anna Ilvesmäki
- Department of Surgery, Helsinki University Hospital (HUS), University of Helsinki, Helsinki, Finland
| | - Laura E Koskenvuo
- Department of Surgery, Helsinki University Hospital (HUS), University of Helsinki, Helsinki, Finland
| | - Anna H Lepistö
- Department of Surgery, Helsinki University Hospital (HUS), University of Helsinki, Helsinki, Finland.,Applied Tumour Genomics, Research Programmes Unit, University of Helsinki, Helsinki, Finland
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Hu C, Cai D, Zhong ME, Fan D, Li CH, Lv MY, Huang ZP, Wang W, Wu XJ, Gao F. Predicting prognosis and immunotherapy response among colorectal cancer patients based on a tumor immune microenvironment-related lncRNA signature. Front Genet 2022; 13:993714. [PMID: 36159987 PMCID: PMC9489948 DOI: 10.3389/fgene.2022.993714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Abstract
Long non-coding RNAs (lncRNAs) remodel the tumor immune microenvironment (TIME) by regulating the functions of tumor-infiltrating immune cells. It remains uncertain the way that TIME-related lncRNAs (TRLs) influence the prognosis and immunotherapy response of colorectal cancer (CRC). Aiming at providing survival and immunotherapy response predictions, a CRC TIME-related lncRNA signature (TRLs signature) was developed and the related potential regulatory mechanisms were explored with a comprehensive analysis on gene expression profiles from 97 immune cell lines, 61 CRC cell lines and 1807 CRC patients. Stratifying CRC patients with the TRLs signature, prolonged survival was observed in the low-risk group, while the patients in the high-risk group had significantly higher pro-tumor immune cells infiltration and higher immunotherapy response rate. Through the complex TRLs-mRNA regulation network, immunoregulation pathways and immunotherapy response pathways were found to be differently activated between the groups. In conclusion, the CRC TRLs signature is capable of making prognosis and immunotherapy response predictions, which may find application in stratifying patients for immunotherapy in the bedside.
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Affiliation(s)
- Chuling Hu
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Institute of Gastroenterology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Du Cai
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Institute of Gastroenterology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Min-Er Zhong
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Institute of Gastroenterology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dejun Fan
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Institute of Gastroenterology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Cheng-Hang Li
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Institute of Gastroenterology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Min-Yi Lv
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Institute of Gastroenterology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ze-Ping Huang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Institute of Gastroenterology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei Wang
- Department of Pathology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiao-Jian Wu
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Institute of Gastroenterology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Xiao-Jian Wu, ; Feng Gao,
| | - Feng Gao
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Institute of Gastroenterology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Xiao-Jian Wu, ; Feng Gao,
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Feng H, Zhu D, Zheng J, Lyu Z, Hu W, Jiang M, Pan Z, Hou T, Li Y. Identification of Candidate Antigens and Immune Subtypes in Colon Cancer for mRNA Vaccine Development. ADVANCED THERAPEUTICS 2022. [DOI: 10.1002/adtp.202200036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Huolun Feng
- Department of gastrointestinal surgery Guangdong Provincial People's Hospital; Guangdong Academy of Medical Sciences Guangzhou Guangdong 510080 China
- The Second School of Clinical Medicine Southern Medical University Guangzhou Guangdong 510515 China
| | - Dandan Zhu
- School of Medicine South China University of Technology Guangzhou Guangdong 510006 China
- Guangdong clinical laboratory center Guangdong Provincial People's Hospital Guangdong Academy of Medical Sciences Guangzhou Guangdong 510080 China
| | - Jiabin Zheng
- Department of gastrointestinal surgery Guangdong Provincial People's Hospital; Guangdong Academy of Medical Sciences Guangzhou Guangdong 510080 China
| | - Zejian Lyu
- Department of gastrointestinal surgery Guangdong Provincial People's Hospital; Guangdong Academy of Medical Sciences Guangzhou Guangdong 510080 China
| | - Weixian Hu
- Department of gastrointestinal surgery Guangdong Provincial People's Hospital; Guangdong Academy of Medical Sciences Guangzhou Guangdong 510080 China
| | - Meiyu Jiang
- Department of gastrointestinal surgery Guangdong Provincial People's Hospital; Guangdong Academy of Medical Sciences Guangzhou Guangdong 510080 China
| | - Zihao Pan
- Department of gastrointestinal surgery Guangdong Provincial People's Hospital; Guangdong Academy of Medical Sciences Guangzhou Guangdong 510080 China
| | - Tieying Hou
- The Second School of Clinical Medicine Southern Medical University Guangzhou Guangdong 510515 China
- School of Medicine South China University of Technology Guangzhou Guangdong 510006 China
- Guangdong clinical laboratory center Guangdong Provincial People's Hospital Guangdong Academy of Medical Sciences Guangzhou Guangdong 510080 China
- Medical Department Guangdong Provincial People's Hospital Guangdong Academy of Medical Sciences Guangzhou Guangdong 510080 China
| | - Yong Li
- Department of gastrointestinal surgery Guangdong Provincial People's Hospital; Guangdong Academy of Medical Sciences Guangzhou Guangdong 510080 China
- The Second School of Clinical Medicine Southern Medical University Guangzhou Guangdong 510515 China
- School of Medicine South China University of Technology Guangzhou Guangdong 510006 China
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