An examination of colorectal cancer burden by socioeconomic status: evidence from GLOBOCAN 2018

Who should be screened for colorectal cancer and how can it be prevented more effectively?

In this editorial, we comment on the article published by Agatsuma et al in a recent issue of the World J Gastroenterol (2024; 30: 1368-1376). We firmly concur with Agatsuma et al regarding the vital significance of colorectal cancer (CRC) screening as a public health strategy to diminish disease burden. Individuals exposed to risk factors for CRC, those with comorbid conditions, and those with limited health literacy should undergo screening. However, we believe that more regular screenings should be accompanied by a greater focus on primary prevention (PP) of CRC. CRC remains a significant global health challenge, and its incidence is strongly linked to age, lifestyle, and socioeconomic factors. It is particularly noteworthy that the majority of CRC patients are diagnosed outside of established screening pathways and frequently at an advanced stage of the disease, and the majority of patients possess inadequate or even nonexistent knowledge regarding CRC, which significantly impacts the prognosis and imposes a substantial economic burden. This study revealed that CRC identified during hospital visits for comorbid conditions was typically diagnosed at an earlier stage than detected via symptomatic pathways. Remarkably, early incidental detection of CRC aligns closely with the timing of discovery through routine cancer screenings. This suggests that by adopting more inclusive screening protocols that combine opportunistic testing with traditional screening methods, health care systems can create a more comprehensive safety net for individuals at risk of CRC. However, before maximizing the health benefits of screening programs, it is essential to make additional efforts prior to screening, such as raising awareness via public education, risk assessment, and personalized recommendations, enhancing the knowledge and skills of health care professionals, optimizing the accessibility and convenience of screening processes, ensuring the quality and safety of screening services, strengthening follow-up and support systems, and providing policy support and financial investment. The establishment of a comprehensive screening system often requires substantial investment in human, material, and financial resources, which can be challenging to achieve in regions with limited health care resources. Strengthening PP strategies can reduce the disease burden by targeting the cause, representing a more cost-effective and impactful approach. Establishing a comprehensive cancer PP service platform that integrates authoritative public education on malignant tumor PP, individualized malignant tumor risk assessment, and self-health management assistance accessible to the entire population will significantly enhance the overall effectiveness of CRC PP strategies.

Disparities in 36 cancers across 185 countries: secondary analysis of global cancer statistics

Cancer is a major public health problem and represents substantial disparities worldwide. This study reported estimates for 36 cancers across 185 countries by incidence, mortality, 5-year prevalence, mortality-to-prevalence ratio (MPR), and mortality-to-incidence ratio (MIR) to examine its association with human development index (HDI) and gross national income (GNI). Data were collected from the GLOBOCAN 2020. MPR and MIR were calculated by sex, age group, country, and cancer type and then summarized into totals. Segi's population and global cancer spectrum were used to calculate age- and type-standardized ratios. Correlation analyses were conducted to assess associations. Results showed that breast cancer was the most diagnosed cancer globally. Low- and middle-income countries had high MPR and MIR. Cancers of esophagus, pancreas, and liver had the highest ratios. Males and the older population had the highest ratios. HDI and GNI were positively correlated with incidence and mortality but negatively correlated with MPR/MIR. Substantial disparities in cancer burden were observed among 36 cancer types across 185 countries. Socioeconomic development may contribute to narrowing these disparities, and tailored strategies are crucial for regional- and country-specific cancer control.

Targeted variant prevalence of FBXW7 gene mutation in colorectal carcinoma propagation. The first systematic review and meta-analysis

FBXW7 is a tumour suppressor gene that functions as E3-ubiquitin-ligase, targeting numerous oncoproteins for degradation, i.e., Cyclin-E, c-Myc, and Notch. FBXW7 performs a pivotal role in regulating cell cycle progression. FBXW7 mutation is frequently implicated in various cancers.

Methodology

A systematic review and meta-analysis done on several studies using "Preferred Reporting Items for Systemmatic Reviews and Meta-Analysis (PRISMA)" criteria and registered with PROSPERO (registration-number-CRD42023388845). The preliminary search comprises 1182 articles; however, 58 studies were subsequently chosen after eliminating non-eligible studies. To explore the prevalence of FBXW7 mutation among colorectal cancer patients, data were analysed using "OpenMeta Analyst and comprehensive meta-analysis-3.0 (CMA-3.0)" software.

Results

This meta-analysis involves 13,974 respondents; most were males 7825/13,974, (56.0 %). Overall prevalence of FBXW7 mutations was 10.3 %, (95%CI: 8.6-12.4), I2 = 90.5 %, (P < 0.001). The occurrence of FBXW7 mutations was highest in Russia [19.0 %, (95%CI: 9.8-33.7)] and Taiwan [18.8 %, (95%CI: 8.7-35.9)], P-values< 0.05 while the least prevalence was reported in Netherland (4 %) and Italy (5 %), both P-values< 0.001. Overall prevalence of FBXW7 abberation was greatest amongst male gender: "53.9 %, (95%CI: 8.3-62.0 %)", Tumour location (colon): 59.8 %, (95%CI: 53.9-65), tumour site (left): 61.6 %, (95%CI: 53.8-68.9), Tumour-grade (Moderate): 65.9 %, (95%CI: 54.9-75.4 %), and Tumour late-stage: 67.9 %, (95%CI: 49.7-84.3 %), all P-values< 0.001. When stratified according to study-period, an increasing trend was noted from 2018 till present with the highest mutation rate recorded in 2022 (15.3 %).

Conclusion

Overall prevalence of FBXW7 mutations was 10.3 % with male gender, left side, and late-stage being most mutated, and these outcomes conform with severally published articles on FBXW7 mutation.

Procyanidin C1 inhibits tumor growth and metastasis in colon cancer via modulating miR-501-3p/HIGD1A axis

INTRODUCTION

Although colon (COAD) and rectal adenocarcinoma (READ) combined to refer to colorectal cancer (CRC), substantial clinical evidence urged that CRC should be treated as two different cancers due to compared with READ, COAD showed higher morbidity and worse 5-year survival.

OBJECTIVES

This study has tried to screen for the crucial gene that caused the worse prognosis and investigate its mechanism for mediating tumor growth and metastases in COAD. Meanwhile, the potential anti-COAD compound implicated in this mechanism was identified and testified from 1,855 food-borne chemical kits. This study aims to bring a new perspective to the development of new anti-COAD drugs and personalized medicine for patients with COAD.

METHODS AND RESULTS

The survival-related hub genes in COAD and READ were screened out from The Cancer Genome Atlas (TCGA) database and the results showed that HIGD1A, lower expressed in COAD than in READ, was associated with poor prognosis in COAD patients, but not in READ. Over-expressed HIGD1A suppressed CRC cell proliferation, invasion, and migration in vitro and in vivo. Meanwhile, the different expressed microRNA profiles between COAD and READ showed that miR-501-3p was highly expressed in COAD and inhibited HIGD1A expression by targeting 3'UTR of HIGD1A. MiR-501-3p mimics promoted cell proliferation and metastasis in CRC cells. In addition, Procyanidin C1 (PCC1), a kind of natural polyphenol has been verified as a potential miR-501-3p inhibitor. In vitro and in vivo, PCC1 promoted HIGD1A expression by suppressing miR-501-3p and resulted in inhibited tumor growth and metastasis.

CONCLUSION

The present study verified that miR-501-3p/HIGD1A axis mediated tumor growth and metastasis in COAD. PCC1, a flavonoid that riched in food exerts anti-COAD effects by inhibiting miR-501-3p and results in the latter losing the ability to suppress HIGD1A expression. Subsequently, unfettered HIGD1A inhibited tumor growth and metastasis in COAD.

Risk factors affecting patients survival with colorectal cancer in Morocco: survival analysis using an interpretable machine learning approach

The aim of our study was to assess the overall survival rates for colorectal cancer at 3 years and to identify associated strong prognostic factors among patients in Morocco through an interpretable machine learning approach. This approach is based on a fully non-parametric survival random forest (RSF), incorporating variable importance and partial dependence effects. The data was povided from a retrospective study of 343 patients diagnosed and followed at Hassan II University Hospital. Covariate selection was performed using the variable importance based on permutation and partial dependence plots were displayed to explore in depth the relationship between the estimated partial effect of a given predictor and survival rates. The predictive performance was measured by two metrics, the Concordance Index (C-index) and the Brier Score (BS). Overall survival rates at 1, 2 and 3 years were, respectively, 87% (SE = 0.02; CI-95% 0.84-0.91), 77% (SE = 0.02; CI-95% 0.73-0.82) and 60% (SE = 0.03; CI-95% 0.54-0.66). In the Cox model after adjustment for all covariates, sex, tumor differentiation had no significant effect on prognosis, but rather tumor site had a significant effect. The variable importance obtained from RSF strengthens that surgery, stage, insurance, residency, and age were the most important prognostic factors. The discriminative capacity of the Cox PH and RSF was, respectively, 0.771 and 0.798 for the C-index while the accuracy of the Cox PH and RSF was, respectively, 0.257 and 0.207 for the BS. This shows that RSF had both better discriminative capacity and predictive accuracy. Our results show that patients who are older than 70, living in rural areas, without health insurance, at a distant stage and who have not had surgery constitute a subgroup of patients with poor prognosis.

Temporal patterns of cancer burden in Asia, 1990-2019: a systematic examination for the Global Burden of Disease 2019 study

Background

Cancers represent a challenging public health threat in Asia. This study examines the temporal patterns of incidence, mortality, disability and risk factors of 29 cancers in Asia in the last three decades.

Methods

The age, sex and year-wise estimates of incidence, mortality, and disability-adjusted life years (DALYs) of 29 cancers for 49 Asian countries from 1990 through 2019 were generated as a part of the Global Burden of Disease, Injuries and Risk Factors 2019 study. Besides incidence, mortality and DALYs, we also examined the cancer burden measured in terms of DALYs and deaths attributable to risk factors, which had evidence of causation with different cancers. The development status of countries was measured using the socio-demographic index. Decomposition analysis was performed to gauge the change in cancer incidence between 1990 and 2019 due to population growth, aging and age-specific incidence rates.

Findings

All cancers combined claimed an estimated 5.6 million [95% uncertainty interval, 5.1-6.0 million] lives in Asia with 9.4 million [8.6-10.2 million] incident cases and 144.7 million [132.7-156.5 million] DALYs in 2019. The age-standardized incidence rate (ASIR) of all cancers combined in Asia was 197.6/100,000 [181.0-214.4] in 2019, varying from 99.2/100,000 [76.1-126.0] in Bangladesh to 330.5/100,000 [298.5-365.8] in Cyprus. The age-standardized mortality rate (ASMR) was 120.6/100,000 [110.1-130.7] in 2019, varying 4-folds across countries from 71.0/100,000 [59.9-83.5] in Kuwait to 284.2/100,000 [229.2-352.3] in Mongolia. The age-standardized DALYs rate was 2970.5/100,000 [2722.6-3206.5] in 2019, varying from 1578.0/100,000 [1341.2-1847.0] in Kuwait to 6574.4/100,000 [5141.7-8333.0] in Mongolia. Between 1990 and 2019, deaths due to 17 of the 29 cancers either doubled or more, and 20 of the 29 cancers underwent an increase of 150% or more in terms of new cases. Tracheal, bronchus, and lung cancer (both sexes), breast cancer (among females), colon and rectum cancer (both sexes), stomach cancer (both sexes) and prostate cancer (among males) were among top-5 cancers in most Asian countries in terms of ASIR and ASMR in 2019 and cancers of liver, stomach, hodgkin lymphoma and esophageal cancer posted the most significant decreases in age-standardized rates between 1990 and 2019. Among the modifiable risk factors, smoking, alcohol use, ambient particulate matter (PM) pollution and unsafe sex remained the dominant risk factors between 1990 and 2019. Cancer DALYs due to ambient PM pollution, high body mass index and fasting plasma glucose has increased most notably between 1990 and 2019.

Interpretation

With growing incidence, cancer has become more significant public health threat in Asia, demanding urgent policy attention and guidance. Its heightened risk calls for increased cancer awareness, preventive measures, affordable early-stage detection, and cost-effective therapeutics in Asia. The current study can serve as a useful resource for policymakers and researchers in Asia for devising interventions for cancer management and control.

Funding

The GBD study is funded by the Bill and Melinda Gates Foundation.

Elevated colorectal cancer incidence among American Indian/Alaska Native persons in Alaska compared to other populations worldwide

Colorectal cancer (CRC) is a leading cancer worldwide; incidence varies greatly by country and racial group. We compared 2018 American Indian/Alaska Native (AI/AN) CRC incidence rates in Alaska to other Tribal, racial, and international population rates. AI/AN persons in Alaska had the highest CRC incidence rate among US Tribal and racial groups (61.9/100,000 in 2018). AI/AN persons in Alaska also had higher rates than those reported for any other country in the world in 2018 except for Hungary, where males had a higher CRC incidence rate than AI/AN males in Alaska (70.6/100,000 and 63.6/100,000 respectively). This review of CRC incidence rates from populations in the United States and worldwide showed that AI/AN persons in Alaska had the highest documented incidence rate of CRC in the world in 2018. It is important to inform health systems serving AI/AN persons in Alaska about policies and interventions that can support CRC screening to reduce the burden of this disease.

Predictive biomarkers for colorectal cancer: a state-of-the-art systematic review

INTRODUCTION

Colorectal cancer (CRC) poses a substantial health burden, with early detection paramount for improved prognosis. This study aims to evaluate potential CRC biomarkers and detection techniques.

MATERIALS AND METHODS

This systematic review, reported in adherence to PRISMA Statement 2020 guidelines, collates the latest research on potential biomarkers and detection/prognosis methods for CRC, spanning the last decade.

RESULTS

Out of the 38 included studies, diverse biomarkers and detection methods emerged, with DNA methylation markers like SFRP2 and SDC2, microRNAs including miR-1290, miR-506, and miR-4316, and serum and plasma markers such as NTS levels and U2 snRNA fragments standing out. Methylated cfDNA and m5C methylation alteration in immune cells of the blood, along with circular RNA, showed promise as diagnostic markers. Meanwhile, techniques involving extracellular vesicles and lateral flow immunoassays exhibited potential for swift and effective CRC screening.

DISCUSSION

Our state-of-the-art review identifies potential biomarkers, including SFRP2, SDC2, miR-1290, miR-506, miR-4316, and U2 snRNA fragments, with significant potential in enhancing CRC detection. However, comprehensive validation studies and a rigorous evaluation of clinical utility and cost-effectiveness remain necessary before integration into routine clinical practice.

CONCLUSION

The findings emphasize the need for continued research into biomarkers and detection methods to improve patient outcomes.

From Omic Layers to Personalized Medicine in Colorectal Cancer: The Road Ahead

Colorectal cancer is a major health concern since it is a highly diagnosed cancer and the second cause of death among cancers. Thus, the most suitable biomarkers for its diagnosis, prognosis, and treatment have been studied to improve and personalize the prevention and clinical management of colorectal cancer. The emergence of omic techniques has provided a great opportunity to better study CRC and make personalized medicine feasible. In this review, we will try to summarize how the analysis of the omic layers can be useful for personalized medicine and the existing difficulties. We will discuss how single and multiple omic layer analyses have been used to improve the prediction of the risk of CRC and its outcomes and how to overcome the challenges in the use of omic layers in personalized medicine.

Colorectal cancer in Tanzania: the current status and future directions

Introduction

Globally, colorectal cancer (CRC) is the third most common malignancy and the second most common cause of cancer death. By 2030, the incidence is expected to increase to reach 2.2 million cases and 1.1 million deaths. In Sub-Saharan Africa, accurate cancer incidence data is limited, but anecdotally, clinicians note a significant rise in the incidence of CRC in the past decade. To educate clinicians on the growing burden of CRC, the Tanzanian Surgical Association hosted a 4-day CRC symposium from 3rd to 6th October 2022. Following the meeting, a group of multidisciplinary stakeholders created a working group whose first task was to assess the epidemiology, presentation and available resources for CRC care in Tanzania. The findings of that assessment are described in this article.

Findings

The true incidence of CRC in Tanzania is currently unknown. However, individual high-volume centres have noted a dramatic rise in cases of colon and rectal cancer on their wards. A review of the published data on CRC in Tanzania showed that most patients present with CRC late and the limited availability of endoscopic and diagnostic services poses a challenge for accurately staging these patients prior to treatment. Multidisciplinary care, including surgery, chemotherapy and radiation, is available for the treatment of CRC in Tanzania, although the capacity and quality of these services vary throughout the country.

Conclusion

There is a substantial burden of CRC in Tanzania that appears to be increasing. While there is capacity in the country to provide all aspects of multidisciplinary care, late presentation, limited access to diagnostic and treatment services and poor coordination continue to be significant barriers to providing optimal treatment to these patients.

Development of a prognostic model based on ferroptosis-related genes for colorectal cancer patients and exploration of the biological functions of NOS2 in vivo and in vitro

Background

Ferroptosis is involved in many malignant tumors and has been implicated in important mechanisms of colorectal cancer (CRC) suppression. However, the prognostic and predictive values of the ferroptosis activation pattern in CRC patients have not been noted. Here, we aimed to construct and validate a prediction model based on ferroptosis-related genes (FRGs) for CRC patients and investigated the expression pattern and biological function of the most significantly altered gene.

Methods

A total of 112 FRGs were obtained from the FerrDb website, and the clinical characteristics of 545 CRC patients and their global gene expression profiles were downloaded from The Cancer Genome Atlas (TCGA) database. Survival-related FRGs were identified by Cox proportional hazards regression analysis. Finally, the expression pattern and biological function of NOS2, the most implicated gene was explored in vitro and in vivo.

Results

The prediction model was established based on 8 FRGs. Patients in the high- or low-risk group were stratified based on the median risk value calculated by our model, and patients in the high-risk group experienced poor overall survival (p<0.01). Further validation demonstrated that the FRG model acted as an independent prognostic indicator for CRC patients (HR=1.428, 95% CI, 1.341-1.627; p<0.001). The area under the receiver operating characteristic (ROC) curve (AUC) for 5-year survival was 0.741. NOS2 was one of the most significantly affected FRGs and was highly expressed in malignant tissue, but it inhibited tumor growth and induced tumor cell death in vitro and in vivo, possibly by repressing the NF-κB pathway.

Conclusion

Our study revealed that FRGs have potential prognostic value in CRC patients and that NOS2 suppresses tumor progression, providing a novel therapeutic target for CRC treatment based on ferroptosis.

Integrative Proteomic and Pharmacological Analysis of Colon Cancer Reveals the Classical Lipogenic Pathway with Prognostic and Therapeutic Opportunities

Despite recent advancements, the high mortality rate remains a concern in colon cancer (CAC). Identification of therapeutic markers could prove to be a great asset in CAC management. Multiple studies have reported hyperactivation of de novo lipogenesis (DNL), but its association with the pathology is unclear. This study aims to establish the importance as well as the prognostic and therapeutic potential of DNL in CAC. The key lipogenic enzymes fatty acid synthase along with ATP citrate lyase were quantified using an LC-MS/MS-based targeted proteomics approach in the samples along with the matched controls. The potential capacity of the proteins to distinguish between the tumor and controls was demonstrated using random forest-based class prediction analysis using the peptide intensities. Furthermore, in-depth proteomics of DNL inhibition in the CAC cell line revealed the significance of the pathway in proliferation and metastasis. DNL inhibition affected the major signaling pathways, including DNA repair, PI3K-AKT-mTOR pathway, membrane trafficking, proteasome, etc. The study revealed the upregulation of 26S proteasome machinery as a result of the treatment with subsequent induction of apoptosis. Again, in silico molecular docking-based drug repurposing was performed to find potential drug candidates. Furthermore, we have demonstrated that blocking DNL could be explored as a therapeutic option in CAC treatment.

Significance of logistic regression scoring model based on natural killer cell-mediated cytotoxic pathway in the diagnosis of colon cancer

Background

The poor clinical accuracy to predict the survival of colon cancer patients is associated with a high incidence rate and a poor 3-year survival rate. This study aimed to identify the poor prognostic biomarkers of colon cancer from natural killer cell-mediated cytotoxic pathway (NKCP), and establish a logistical regression scoring model to predict its prognosis.

Methods

Based on the expressions and methylations of NKCP-related genes (NRGs) and the clinical information, dimensionality reduction screening was performed to establish a logistic regression scoring model to predict survival and prognosis. Risk score, clinical stage, and ULBP2 were used to establish a logistic regression scoring model to classify the 3-year survival period and compare with each other. Comparison of survival, tumor mutation burden (TMB), estimation of immune invasion, and prediction of chemotherapeutic drug IC50 were performed between low- and high-risk score groups.

Results

This study found that ULBP2 was significantly overexpressed in colon cancer tissues and colon cancer cell lines. The logistic regression scoring model was established to include six statistically significant features: S = 1.70 × stage - 9.32 × cg06543087 + 6.19 × cg25848557 + 1.29 × IFNA1 + 0.048 × age + 4.37 × cg21370856 - 8.93, which was used to calculate risk score of each sample. The risk scores, clinical stage, and ULBP2 were classified into three-year survival, the 3-year prediction accuracy based on 10-fold cross-validation was 80.17%, 67.24, and 59.48%, respectively. The survival time of low-risk score group was better than that of the high-risk score group. Moreover, compared to high-risk score group, low-risk score group had lower TMB [2.20/MB (log10) vs. 2.34/MB (log10)], higher infiltration score of M0 macrophages (0.17 vs. 0.14), and lower mean IC50 value of oxaliplatin (3.65 vs 3.78) (p < 0.05).

Conclusions

The significantly upregulated ULBP2 was a poor prognostic biomarker of colon cancer. The risk score based on the six-feature logistic regression model can effectively predict the 3-year survival time. High-risk score group demonstrated a poorer prognosis, higher TMB, lower M0 macrophage infiltration score, and higher IC50 value of oxaliplatin. The six-feature logistic scoring model has certain clinical significance in colon cancer.

Risk factors affecting patients survival with colorectal cancer in Morocco : Survival Analysis using an Interpretable Machine Learning Approach

The aim of our study was to assess the overall survival rates for colorectal patients in Morocco and to identify strong prognostic factors using a novel approach combining survival random forest and the Cox model. Covariate selection was performed using the variable importance based on permutation and partial dependence plots were displayed to explore in depth the relationship between the estimated partial effect of a given predictor and survival rates. The predictive performance was measured by two metrics, the Concordance Index (C-index) and the Brier Score (BS). Overall survival rates at 1, 2 and 3 years were, respectively, 87% (SE = 0.02; CI-95% = 0.84-0.91), 77% (SE = 0.02; CI-95% = 0.73-0.82) and 60% (SE = 0.03; CI-95% = 0.54-0.66). In the Cox model after adjustment for all covariates, sex, tumor differentiation had no significant effect on prognosis, but rather tumor site had a significant effect. The variable importance obtained from RSF strengthens that surgery, stage, insurance, residency, and age were the most important prognostic factors. The discriminative capacity of the Cox PH and RSF was, respectively, 0.771 and 0.798 for the C-index, while the accuracy of the Cox PH and RSF was, respectively, 0.257 and 0.207 for the Brier Score. This shows that RSF had both better discriminative capacity and predictive accuracy. Our results show that patients who are older than 70, living in rural areas, without health insurance, at a distant stage and who have not had surgery constitute a subgroup of patients with poor prognosis.

Construction and Validation of a Protein-associated Prognostic Model for Gastrointestinal Cancer

Background Gastrointestinal cancer (GIC) is a prevalent and lethal malignant tumor. It is obligatory to investigate innovative biomarkers for the diagnosis and prognosis. Proteins play a crucial role in regulating the occurrence and progression of GIC. However, the prognostic value of proteins is unclear in GIC.

OBJECTIVE

This paper aims to identify the hub prognosis-related proteins (PAPs) and construct a prognosis model for GIC patients for clinical application.

METHODS

Protein expression data of GIC was obtained from The Cancer Proteome Atlas (TCPA) and downloaded the clinicopathological data from The Cancer Genome Atlas database (TCGA). Besides, hub proteins were filtrated via univariate and multivariate Cox regression analysis. Moreover, survival analysis and nomogram were used to predict overall survival (OS). We used the calibration curves to assess the consistency of predictive and actual survival rates. The consistency index (C-index) was used to evaluate the prognostic ability of the predictive model. Furthermore, functional enrichment analysis and protein co-expression of PAPs were used to explore their roles in GIC.

RESULTS

Finally, a prognosis model was conducted based on ten PAPs (CYCLIND1, DVL3, NCADHERIN, SYK, ANNEXIN VII, CD20, CMET, RB, TFRC, and PREX1). The risk score calculated by the model was an independent prognostic predictor. Compared with the high-risk subgroup, the low-risk subgroup had better OS. In the TCGA cohort, the area under the curve value of the receiver operating characteristic curve of the prognostic model was 0.692. The expression of proteins and risk score had a significant association with the clinicopathological characteristics of GIC. Besides, a nomogram based on GIC clinicopathological features and risk scores could properly predict the OS of individual GIC patients. The C-index is 0.71 in the TCGA cohort and 0.73 in the GEO cohort.

CONCLUSION

The results indicate that the risk score is an independent prognostic biomarker and is related to the malignant clinical features of GIC patients. Besides, several PAPs associated with the survival and clinicopathological characteristics of GIC might be potential biomarkers for GIC diagnosis and treatment.

Small-Area Geographic and Socioeconomic Inequalities in Colorectal Cancer in Cyprus

Colorectal cancer (CRC) is one of the leading causes of death and morbidity worldwide. To date, the relationship between regional deprivation and CRC incidence or mortality has not been studied in the population of Cyprus. The objective of this study was to analyse the geographical variation of CRC incidence and mortality and its possible association with socioeconomic inequalities in Cyprus for the time period of 2000-2015. This is a small-area ecological study in Cyprus, with census tracts as units of spatial analysis. The incidence date, sex, age, postcode, primary site, death date in case of death, or last contact date of all alive CRC cases from 2000-2015 were obtained from the Cyprus Ministry of Health's Health Monitoring Unit. Indirect standardisation was used to calculate the sex and age Standardise Incidence Ratios (SIRs) and Standardised Mortality Ratios (SMRs) of CRC while the smoothed values of SIRs, SMRs, and Mortality to Incidence ratio (M/I ratio) were estimated using the univariate Bayesian Poisson log-linear spatial model. To evaluate the association of CRC incidence and mortality rate with socioeconomic deprivation, we included the national socioeconomic deprivation index as a covariate variable entering in the model either as a continuous variable or as a categorical variable representing quartiles of areas with increasing levels of socioeconomic deprivation. The results showed that there are geographical areas having 15% higher SIR and SMR, with most of those areas located on the east coast of the island. We found higher M/I ratio values in the rural, remote, and less dense areas of the island, while lower rates were observed in the metropolitan areas. We also discovered an inverted U-shape pattern in CRC incidence and mortality with higher rates in the areas classified in the second quartile (Q2-areas) of the socioeconomic deprivation index and lower rates in rural, remote, and less dense areas (Q4-areas). These findings provide useful information at local and national levels and inform decisions about resource allocation to geographically targeted prevention and control plans to increase CRC screening and management.

A GNAS Gene Mutation's Independent Expression in the Growth of Colorectal Cancer: A Systematic Review and Meta-Analysis

Globally, colorectal carcinoma CRC is the third most common cancer and the third most common reason for cancer-associated mortality in both genders. The GNAS mutations are significantly linked with poor prognosis and failed treatment outcomes in CRC. A systematic review and meta-analysis of multiple studies executed following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria and registered with PROSPERO (registration number: CRD42021256452). The initial search includes a total of 271 publications; however, only 30 studies that merit the eligibility criteria were eventually chosen. Data analysis via OpenMeta Analyst and comprehensive meta-analysis 3.0 (CMA 3.0) software were used to investigate the prevalence of GNAS gene mutation among CRC patients. The meta-analysis consisted of 10,689 participants with most being males 6068/10,689 (56.8%). Overall, prevalence of GNAS mutations was 4.8% (95% CI: 3.1−7.3) with I2 = 94.39% and (p < 0.001). In 11/30 studies, the frequency of GNAS gene mutations was majorly in codons R201C [40.7% (95% CI: 29.2−53.2%)] and in codon R201H [39.7% (95% CI = 27.1−53.8)]. Overall prevalence of GNAS mutations was highest among the male gender: 53.9% (95% CI: 48.2−59.5%: I2 = 94.00%, (p < 0.001), tumour location (colon): 50.5% (95% CI: 33.2−67.6%: I2 = 97.93%, (p < 0.001), tumour grade (Well): 57.5% (95% CI: 32.4−79.2%: I2 = 98.10%, (p < 0.001) and tumour late stage: 67.9% (95% CI: 49.7−84.3%: I2 = 98.%, (p < 0.001). When stratified according to study location, a higher prevalence was observed in Japan (26.8%) while Italy has the lowest (0.4%). Overall prevalence of GNAS gene mutations was 4.8% with codons R201C and R201H being the most mutated, and the results conformed with numerous published studies on GNAS mutation.

Meta-analysis of fecal viromes demonstrates high diagnostic potential of the gut viral signatures for colorectal cancer and adenoma risk assessment

INTRODUCTION

Viruses have been reported as inducers of tumorigenesis. Little studies have explored the impact of the gut virome on the progression of colorectal cancer. However, there is still a problem with the repeatability of viral signatures across multiple cohorts.

OBJECTIVES

The present study aimed to reveal the repeatable gut vial signatures of colorectal cancer and adenoma patients and decipher the potential of viral markers in disease risk assessment for diagnosis.

METHODS

1,282 available fecal metagenomes from 9 published studies for colorectal cancer and adenoma were collected. A gut viral catalog was constructed via a reference-independent approach. Viral signatures were identified by cross-cohort meta-analysis and used to build predictive models based on machine learning algorithms. New fecal samples were collected to validate the generalization of predictive models.

RESULTS

The gut viral composition of colorectal cancer patients was drastically altered compared with healthy, as evidenced by changes in some Siphoviridae and Myoviridae viruses and enrichment of Microviridae, whereas the virome variation in adenoma patients was relatively low. Cross-cohort meta-analysis identified 405 differential viruses for colorectal cancer, including several phages of Porphyromonas, Fusobacterium, and Hungatella that were enriched in patients and some control-enriched Ruminococcaceae phages. In 9 discovery cohorts, the optimal risk assessment model obtained an average cross-cohort area under the curve of 0.830 for discriminating colorectal cancer patients from controls. This model also showed consistently high accuracy in 2 independent validation cohorts (optimal area under the curve, 0.906). Gut virome analysis of adenoma patients identified 88 differential viruses and achieved an optimal area under the curve of 0.772 for discriminating patients from controls.

CONCLUSION

Our findings demonstrate the gut virome characteristics in colorectal cancer and adenoma and highlight gut virus-bacterial synergy in the progression of colorectal cancer. The gut viral signatures may be new targets for colorectal cancer treatment. In addition, high repeatability and predictive power of the prediction models suggest the potential of gut viral biomarkers in non-invasive diagnostic tests of colorectal cancer and adenoma.

XGBoost modeli ile gen dizileme verilerine dayalı kolorektal kanserin sınıflandırılması: Bir halk sağlığı bilişimi uygulaması

Amaç: Bu çalışma, bir makine öğrenmesi yöntemi olan XGBoost yöntemi ile açık erişimli kolorektal kanser gen verilerini sınıflandırmayı ve temel genleri tanımlamayı amaçlamaktadır. Gereç ve Yöntem: Çalışmada açık erişimli kolorektal kanser gen veri seti kullanıldı. Veri seti, sağlıklı kontrollerden 10 mukozanın ve kolorektal kanserli 12 hastanın kolon mukozasının gen dizileme sonuçlarını içeriyordu. Hastalığı sınıflandırmak için makine öğrenmesi yöntemlerinden biri olan XGboost kullanıldı. Model performansı için doğruluk, dengelenmiş doğruluk, duyarlılık, seçicilik, pozitif tahmin değeri ve negatif tahmin değeri performans metrikleri değerlendirildi. Bulgular: Değişken seçim yöntemine göre 17 gen seçilmiş ve bu girdi değişkenleri ile modelleme yapılmıştır. Modelleme sonuçlarından elde edilen doğruluk, dengeli doğruluk, duyarlılık, özgüllük, pozitif tahmin değeri, negatif tahmin değeri ve F1 puanı sırasıyla %95.5, %95.8, %91.7, %1, %1 ve %90.9 ve %95.7 idi. XGboost tekniği sonucundan elde edilen değişken önemliliklerine göre, CYR61, NR4A, FOSB ve NR4A2 genleri kolorektal kanser için biyolojik belirteçler olarak kullanılabilir. Sonuç: Bu araştırma sonucunda kolorektal kanserle bağlantılı olabilecek genlerin yanı sıra hastalığa yönelik genetik biyobelirteçler de belirlendi. Gelecekte, tespit edilen genlerin güvenilirliği doğrulanabilir, bu genlere dayalı olarak terapötik prosedürler oluşturulabilir ve klinik pratikteki yararları belgelenebilir.

Tumor-derived endomucin promotes colorectal cancer proliferation and metastasis

BACKGROUND

Endomucin (EMCN) is a type I transmembrane glycoprotein and a mucin-like component of the endothelial cell glycocalyx. The mechanism of EMCN action in colorectal cancer (CRC) remains unclear.

AIMS

Our aim was to explore the role of EMCN in the progression of CRC.

MATERIALS & METHODS

We examined EMCN expression in CRC tissues and normal para-carcinoma tissues. The function and mechanisms of EMCN were checked in CRC cell lines and in mouse xenograft. Additionally, we used co-immunoprecipitation and mass spectrometry to identify the potential EMCN-binding proteins. Functional annotation analysis showed where these genes were enriched.

RESULTS

We found that EMCN was overexpressed in tumor tissues compared with that in normal para-carcinoma tissues. We also found that overexpression of EMCN induced CRC proliferation and metastasis both in vitro and in vivo. EMCN knockdown prevents epithelial-mesenchymal transition in vitro. We identified 178 potential EMCN-binding partners. Furthermore, functional annotation analysis indicated that these genes were considerably enriched in carcinogenic-related functions and pathways. Collectively, the identification of EMCN-binding partners enhanced our understanding of the mechanism of EMCN-mediated malignant phenotypes, and this research may provide valuable insights into the molecular mechanisms underlying CRC.

CONCLUSION

Tumor-derived endomucin promotes colorectal cancer proliferation and metastasis. We identified 178 EMCN-binding proteins and initially screened three potential EMCN-interacting proteins: NALCN, and TPM2, ANKK1. Our study provides valuable insights into the molecular mechanisms underlying CRC development.

Global burden of gastric cancer in adolescents and young adults: estimates from GLOBOCAN 2020

OBJECTIVES

Gastric cancer in adolescents and young adults (GCAYA) has been ignored by both patients and physicians. We examined the disease burden of GCAYA and its secular trends in incidence and mortality.

STUDY DESIGN

A comprehensive analysis of the global burden of GCAYA based on data provided by GLOBOCAN 2020.

METHODS

Global, regional, sex, and country-specific data of the incidence and mortality of GCAYA were extracted from the GLOBOCAN, the Cancer in Five Continents Plus, and the World Health Organization mortality database, respectively. The associations between the Human Development Index (HDI) and GCAYA burden were also evaluated by Pearson correlation analysis.

RESULTS

The global incidence of GCAYA was 0.79 per 100,000, and the corresponding mortality was 0.45 per 100,000 in 2020. The mortality-to-incidence ratio (MIR) was lower in AYA (0.61) than in patients aged 40-64 years (0.65) and patients aged 65 years and older (0.75). The age-standardized incidence rates (ASIR) and age-standardized mortality rates (ASMR) were 0.84 and 0.53 per 100,000, respectively, in women, compared with 0.74 and 0.45 per 100,000, respectively, in men. The majority of new cases (17,934) and deaths (10,360) were estimated to occur in Asia. There has a significant negative correlation between the MIR of GCAYA and HDI level (R² = 0.2707, P < 0.0001). There was a decreasing trend of incidence and mortality in most countries.

CONCLUSIONS

The MIR of GCAYA is lower than that among older patients and exhibit a positive association with socio-economic status. The incidence and mortality of GCAYA show a decreasing trend in most countries.

Oral Cancer Incidence, Mortality, and Mortality-to-Incidence Ratio Are Associated with Human Development Index in China, 1990–2019

The burden of oral cancer (OC) is closely related to economic development. We aimed to evaluate the burden of OC at different stages of economic development in China in terms of incidence, mortality, and mortality-to-incidence ratio (MIR) from 1990 to 2019. Data on cancer in China from 1990 to 2019 were obtained from the Global Burden of Disease 2019. Based on human development index (HDI), Chinese economic development was divided into three stages: low, medium, and high HDI stages. Mann–Whitney U-test was used to evaluate the differences in age-standardised incidence rates (ASIR), age-standardised mortality rates (ASMR), and MIR at various stages of HDI. Correlation and regression tests were conducted to examine the association amongst ASIR, ASMR, MIR, and HDI in OC. The estimated annual percentage changes (EAPCs) were calculated to assess the trend of ASIR, ASMR, and MIR. Significant differences were observed in terms of ASIR, ASMR, and MIR between groups (P < 0.001). The values of both sexes in the low HDI stage were lower than those of the medium and high HDI stages, except for MIR, in which the low HDI stage was the highest (P < 0.05). ASIR and ASMR of OC in males at the medium HDI stage showed the fastest growth rate with EAPC values of 5.64 (95% confidence interval, 95% CI, 5.20 to 6.08) and 4.42 (95% CI, 4.01 to 4.82), respectively. A strong positive correlation exists between HDI and ASIR (r = 0.96) and ASMR (r = 0.91) in both sexes from 1990 to 2019. During the high HDI stage, the ASIR and ASMR of OC were at a high level, but the ASIR halted the uptrend trend and ASMR showed a decreasing trend. Therefore, the HDI index has been positively correlated with the ASIR and ASMR of OC in China in the past 30 years, but this relationship may not be sustained as the economy develops. The health department should continue to allocate additional resources for the prevention and treatment of OC.

Colorectal cancer mortality trend in Mato Grosso, Brazil, 2000 to 2019

OBJECTIVE

To analyze the time series of colorectal cancer (CRC) mortality, according to sex and age group, in Mato Grosso, Brazil, from 2000 to 2019.

METHODS

Ecological time series study, with standardized mortality rates from CRC (C18 to C21) among residents of Mato Grosso. Information on deaths was provided by the Mato Grosso State Health Department, comprising the Mortality Information System and demographic information obtained from the Brazilian Institute of Geography and Statistics. The joinpoint regression analysis was used in the analysis of temporal trend.

RESULTS

A total of 2,406 deaths from CRC were identified in Mato Grosso between 2000 and 2019. The highest rates were found among the age group from 60 to 79 years. There was an increasing trend in mortality rates among men due to CRC for almost all age groups, with the exception of those aged 40 to 49 years and 80 years and older. For women, there was a significant increase in the age groups from 50 to 59 years and 80 years and older.

CONCLUSION

The results showed an increase in mortality rates from CRC in the state of Mato Grosso, from 2000 to 2019, in certain age groups for both sexes, but especially for men. Knowledge about the evolution of mortality can provide data on the epidemiological situation of cancer at the local level and, thus, contribute to the development of actions to control and prevent this disease.

Circ_0085315 promotes cell proliferation, invasion, and migration in colon cancer through miR-1200/MAP3K1 signaling pathway

Colon cancer (CC) is a common malignant tumor of the digestive tract. Circular RNAs (circRNAs) play important roles in the progression of CC. This study aimed to explore the role and mechanism of circRNA_0085315 in CC. In this study, we used qRT-PCR and Western blot assays to analyze the expressions of circRNA, miRNA, and mRNA as well as the expression of the related proteins. Luciferase reporter, RNA pull-down, and qRT-PCR assays were used to prove the relationship among circRNA, miRNA, and mRNA. CCK-8, colony formation, and transwell assays were used to perform the analysis of cell proliferation, migration, and invasion. Our results showed that the higher circRNA_0085315 expression led to the poorer prognosis of CC patients. The function of circRNA_0085315 as a ceRNA in competing with MAP3K1 mRNA to sponge miR-1200. CircRNA_0085315 sponged miR-1200 to promote cell proliferation, migration, and invasion and affected the expression of Ki67, MMP2, E-cadherin, and N-cadherin, but not circRNA_0085315-mut without the binding site of miR-1200. MAP3K1-overexpression or miR-1200 mimics prevented the suppression on the enhanced cell proliferation, migration, and invasion caused by circRNA_0085315-overexpression. circRNA_0085315 increased the phosphorylation levels of JNK, p38, and ERK1/2 by stimulating MAP3K1 up-regulation caused by miR-1200 inhibition. In conclusion, circRNA_0085315 serves as a ceRNA and promotes CC progression through the activation of the MAPK signaling pathway mediated via the miR-1200/MAP3K1 axis, suggesting that circRNA_0085315 may be a promising diagnostic and therapeutic target for CC.

A comparative examination of colorectal cancer burden in European Union, 1990-2019: Estimates from Global Burden of Disease 2019 Study

AIM

This study examines the burden of colorectal cancer (CRC) in European Union (EU) countries in the last 3 decades.

METHODS

The data pertaining to CRC burden were procured from the Global Burden of Disease 2019 Study for 28 EU countries (including United Kingdom) for the period 1990-2019. The age-standardized rates of CRC were utilized to compare the country-wise burden and joinpoint regression models were applied to examine the trends.

RESULTS

In EU, CRC incident cases increased by 70.2% from 261,306 to 444,872 and deaths increased by 36.8% from 155,823 to 213,174 between 1990 and 2019. The age-standardized incidence rate (ASIR) increased by 11.9% from 37.8/100,000 to 42.3/100,000 between 1990 and 2019; in contrast, the age-standardized mortality rate (ASMR) decreased by 16.9% (1990: 22.4/100,000; 2019: 18.6/100,000) and age-standardized DALYs rate (ASDALR) decreased by 18.6% (1990: 472.9/100,000; 2019: 385.1/100,000) in the study period. In 2019, Hungary was the leading country in terms of ASMR (28.6/100,000) and ASDALR (630.3/100,000), and Lithuania (29.2/100,000) had the lowest ASIR, whereas Finland had the lowest ASMR (12.3/100,000) and ASDALR (253.6/100,000) in 2019.

CONCLUSION

CRC incidence is increasing in EU and mortality rates, although decreasing, are still unacceptably high. CRC control efforts must be focused around early detection using screening and prevention through reduction of modifiable risk factors. Increasing CRC incidence rates in young adults in recent years requires more research to pinpoint risk factors, and there must be more awareness of this recent development among general public and clinicians.

Luteolin impacts deoxyribonucleic acid repair by modulating the mitogen-activated protein kinase pathway in colorectal cancer

This study aimed to investigate the effects of luteolin on colorectal cancer (CRC) and explore its underlying mechanism. HCT-116 and HT-29 cells were treated with luteolin, cisplatin, or selumetinib. The cell survival, cell proliferation, apoptosis and cell cycle distribution, and DNA damage were detected using Cell Counting Kit-8, colony formation, flow cytometry, and immunofluorescence staining analysis, respectively. Western blotting was used to detect the expression of apoptosis-related, cycle-related, DNA-damage-related, and mitogen-activated protein kinase (MAPK) pathway-related proteins. Luteolin showed inhibitory effects on cellular growth by reducing cell survival and proliferation, inducing apoptosis and DNA damage, and arresting the cell cycle in a concentration-dependent manner in HCT-116 and HT-29 cells. Meanwhile, luteolin increased the expression of pro-apoptotic proteins, p-CHK1 (central to the induction of cell cycle arrest), and DNA excision repair protein and decreased anti-apoptotic proteins, G2-M phase-related proteins, and DNA repair proteins. The combination of cisplatin and luteolin significantly decreased cell survival and increased the apoptosis rate of HCT-116 and HT-29 cells compared with cisplatin alone. Bioinformatic analysis using the Comparative Toxicogenomics Database and STITCH and MalaCards databases showed that the MAPK pathway is involved in the pharmacology of luteolin. Furthermore, western blotting demonstrated that luteolin plays an inhibitory role by suppressing the MAPK signaling pathway in CRC, which is enhanced when combined with selumetinib. Luteolin can also prevent tumourigenesis in CRC in vivo. In conclusion, luteolin suppressed cell proliferation, blocked the cell cycle, and induced DNA damage and apoptosis progression in CRC cells by mediating the MAPK pathway

Berberine as a Potential Agent for the Treatment of Colorectal Cancer

Colorectal cancer (CRC) is one of the most commonly diagnosed and deadly malignancies worldwide. The incidence of CRC has been increasing, especially in young people. Although great advances have been made in managing CRC, the prognosis is unfavorable. Numerous studies have shown that berberine (BBR) is a safe and effective agent presenting significant antitumor effects. Nevertheless, the detailed underlying mechanism in treating CRC remains indistinct. In this review, we herein offer beneficial evidence for the utilization of BBR in the management and treatment of CRC, and describe the underlying mechanism(s). The review emphasizes several therapeutic effects of BBR and confirms that BBR could suppress CRC by modulating gene expression, the cell cycle, the inflammatory response, oxidative stress, and several signaling pathways. In addition, BBR also displays antitumor effects in CRC by regulating the gut microbiota and mucosal barrier function. This review emphasizes BBR as a potentially effective and safe drug for CRC therapy.

Long non-coding RNA LINC00511 facilitates colon cancer development through regulating microRNA-625-5p to target WEE1

The altered part of long non-coding RNA LINC00511 (LINC00511) is extensively discussed in malignancies. Finitely, the mechanism of LINC00511 in colon cancer (CC) development lacks thorough explorations. Hence, this work is started from the LINC00511-mediated microRNA (miR)-625-5p/WEE1 axis in the CC process. LINC00511, miR-625-5p, and WEE1 levels were tested in CC tissues and cells. Subcellular localization of LINC00511 was clarified. CC cells were transfected with oligonucleotides that altered LINC00511, and miR-625-5p expression to define their performance in CC cell progression. The tumorigenic ability of cells was verified in xenografted tumors. CC tissues and cells highly expressed LINC00511 and WEE1 and lowly expressed miR-625-5p. LINC00511 was mainly localized in the cytoplasm. Deleted LINC00511 or restored miR-625-5p delayed cellular growth in CC. LINC00511 sponged miR-625-5p to target WEE1. Silenced miR-625-5p mitigated the role of depleted LINC00511, while inhibited WEE1 rescued the effect of silenced miR-625-5p on the biological functions of CC cells. It is summarized that down-regulated LINC00511 obstructs tumorigenesis of CC through restoring miR-625-5p and silencing WEE1, consolidating a basal reference for CC-oriented therapy.

Efficacy and tolerability of colonoscopies in overweight and obese patients: Results from a national database on gastrointestinal endoscopic outcomes

Background and study aims  Gastroenterologists are encountering a rising number of obese patients requiring colonoscopy. Existing literature regarding colonoscopy outcomes in this population is scant and conflicting. We analyzed a nationwide cohort of patients to identify the effects of body mass index (BMI) on colonoscopy success, efficacy, and tolerability. Patients and methods  The Clinical Outcomes Research Initiative (CORI) endoscopic database was queried for all colonoscopies in adults between 2008-2014. Patients were stratified into four cohorts based on BMI classification for comparison. Multivariable analysis was performed to identify the effect of BMI on procedure outcome, efficacy and tolerability. Results  Of 41,401 procedures, 27,696 met study inclusion criteria. Of these, 49.4 % were performed for colorectal cancer screening, most commonly under anesthesia directed sedation. Patient discomfort was the reason for an incomplete colonoscopy in 18.7 % of all cases, and more frequent among the overweight and obese cohorts. An inadequate bowel preparation was most common in the class III obesity cohort. Compared to the normal BMI group, a BMI ≥ 30 and < 40 kg/m ² was associated with an increased odds of an incomplete colonoscopy ( P  = 0.001for overweight, P  = 0.0004 for class I/II obesity), longer procedure ( P  < 0.05 for all) and poorer tolerance ( P  < 0.0001 for class I/II obesity, P  = 0.016 for class III obesity). Anesthesia-administered sedation was more commonly used than endoscopist directed sedation amongst the obese cohort compared with the normal BMI cohort ( P  < 0.0001). Conclusions  Endoscopists should consider the increased odds of incomplete colonoscopy, longer procedures, and poorer tolerance when performing colonoscopy in obese patients to improve clinical management and procedural outcome.

A Web-Based Prediction Model for Cancer-Specific Survival of Elderly Patients With Clear Cell Renal Cell Carcinoma: A Population-Based Study

Background

Clear cell renal cell carcinoma (ccRCC) is expected in the elderly and poor prognosis. We aim to explore prognostic factors of ccRCC in the elderly and construct a nomogram to predict cancer-specific survival (CSS) in elderly patients with ccRCC.

Methods

Clinicopathological information for all elderly patients with ccRCC from 2004 to 2018 was downloaded from the Surveillance, Epidemiology, and End Results (SEER) program. All patients were randomly assigned to a training cohort (70%) or a validation cohort (30%). Univariate and multivariate Cox regression models were used to identify the independent risk factors for CSS. A new nomogram was constructed to predict CSS at 1-, 3-, and 5 years in elderly patients with ccRCC based on independent risk factors. Subsequently, we used the consistency index (C-index), calibration curves, and the area under the receiver operating curve (AUC) and decision curve analysis (DCA) to test the prediction accuracy of the model.

Results

A total of 33,509 elderly patients with ccRCC were enrolled. Univariate and multivariate Cox regression analyses results showed that age, sex, race, marriage, tumor size, histological grade, tumor, nodes, and metastases (TNM) stage, and surgery were independent risk factors for CSS in elderly patients with ccRCC. We constructed a nomogram to predict CSS in elderly patients with ccRCC. The C-index of the training cohort and validation cohort was 0.81 (95% CI: 0.802-0.818) and 0.818 (95% CI: 0.806-0.830), respectively. The AUC of the training cohort and validation cohort also suggested that the prediction model had good accuracy. The calibration curve showed that the observed value of the prediction model was highly consistent with the predicted value. DCA showed good clinical application value of the nomogram.

Conclusion

In this study, we explored prognostic factors in elderly patients with ccRCC. We found that age, sex, marriage, TNM stage, surgery, and tumor size were independent risk factors for CSS. We constructed a new nomogram to predict CSS in elderly patients with ccRCC with good accuracy and reliability, providing clinical guidance for patients and physicians.

Functional metabolome profiling may improve individual outcomes in colorectal cancer management implementing concepts of predictive, preventive, and personalized medical approach

Objectives

Colorectal cancer (CRC) is one of the most common solid tumors worldwide, but its diagnosis and treatment are limited. The objectives of our study were to compare the metabolic differences between CRC patients and healthy controls (HC), and to identify potential biomarkers in the serum that can be used for early diagnosis and as effective therapeutic targets. The aim was to provide a new direction for CRC predictive, preventive, and personalized medicine (PPPM).

Methods

In this study, CRC patients (n = 30) and HC (n = 30) were recruited. Serum metabolites were assayed using an ultra-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF/MS) technology. Subsequently, CRC cell lines (HCT116 and HCT8) were treated with metabolites to verify their function. Key targets were identified by molecular docking, thermal shift assay, and protein overexpression/inhibition experiments. The inhibitory effect of celastrol on tumor growth was also assessed, which included IC50 analysis, nude mice xenografting, molecular docking, protein overexpression/inhibition experiments, and network pharmacology technology.

Results

In the CRC group, 15 serum metabolites were significantly different in comparison with the HC group. The level of glycodeoxycholic acid (GDCA) was positively correlated with CRC and showed high sensitivity and specificity for the clinical diagnostic reference (AUC = 0.825). In vitro findings showed that GDCA promoted the proliferation and migration of CRC cell lines (HCT116 and HCT8), and Poly(ADP-ribose) polymerase-1 (PARP-1) was identified as one of the key targets of GDCA. The IC50 of celastrol in HCT116 cells was 121.1 nM, and the anticancer effect of celastrol was supported by in vivo experiments. Based on the potential of GDCA in PPPM, PARP-1 was found to be significantly correlated with the anticancer functions of celastrol.

Conclusion

These findings suggest that GDCA is an abnormally produced metabolite of CRC, which may provide an innovative molecular biomarker for the predictive identification and targeted prevention of CRC. In addition, PARP-1 was found to be an important target of GDCA that promotes CRC; therefore, celastrol may be a potential targeted therapy for CRC via its effects on PARP-1. Taken together, the pathophysiology and progress of tumor molecules mediated by changes in metabolite content provide a new perspective for predictive, preventive, and personalized medical of clinical cancer patients based on the target of metabolites in vivo.Clinical trials registration number: ChiCTR2000039410.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-021-00269-8.

Digestive cancer incidence and mortality among young adults worldwide in 2020: A population-based study

BACKGROUND

Digestive cancer has traditionally been thought of as a disease that mainly occurs in elderly individuals, and it has been ignored in young adults by both patients and physicians.

AIM

To describe the worldwide profile of digestive cancer incidence, mortality and corresponding trends among 20-39-year-olds, with major patterns highlighted by age, sex, development level, and geographical region.

METHODS

I performed a population-based study to quantify the burden of young adult digestive cancers worldwide. Global, regional, sex, and country-specific data estimates of the number of new cancer cases and cancer-associated deaths that occurred in 2020 were extracted from the GLOBOCAN Cancer Today database. To assess long-term trends in young adult digestive cancer, cancer incidence data and mortality data were obtained from the Cancer in Five Continents Plus database and the World Health Organization mortality database, respectively. The associations between the human development index (HDI) and digestive cancer burden in young adults were evaluated by linear regression analyses.

RESULTS

In 2020, there were an estimated 19292789 new cancer cases, resulting in 9958133 deaths worldwide, which equated to an age-standardized incidence rate (ASIR) of 5.16 and age-standardized mortality rate (ASMR) of 3.04, accounting for 12.24% of all new cancer cases and 25.26% of all cancer deaths occurring in young adults. The burden was disproportionally greater among males, with male: female ratios of 1.34 for incidence and 1.58 for mortality. The ASIRs were 2.1, 1.4, and 1.0 per 100000 people per year, whereas the ASMRs were 0.83, 1.1, and 0.62 per 100000 people per year for colorectal, liver, and gastric cancer, respectively. When assessed by geographical region and HDI levels, the cancer profile varied substantially, and a strong positive correlation between the mortality-to-incidence ratio of digestive cancer and HDI ranking was found (R 2 = 0.7388, P < 0.001).

CONCLUSION

The most common digestive cancer types are colorectal, liver and gastric cancer. The global digestive cancer burden among young adults is greater among males and exhibits a positive association with socioeconomic status. The digestive cancer burden is heavy in young adults, reinforcing the need for primary and secondary prevention strategies.

Tendência da mortalidade por câncer colorretal em Mato Grosso, Brasil, de 2000 a 2019

RESUMO: Objetivo: Analisar a tendência temporal da mortalidade por câncer colorretal (CCR) segundo sexo e faixa etária, em Mato Grosso, Brasil, de 2000 a 2019. Métodos: Estudo ecológico de série temporal das taxas ajustadas de mortalidade pelo CCR (C18 a C21) de residentes de Mato Grosso. As informações sobre os óbitos foram fornecidas pela Secretaria de Estado de Saúde de Mato Grosso e compõem o Sistema de Informações sobre Mortalidade, e as informações demográficas foram obtidas do Instituto Brasileiro de Geografia e Estatística. Para a tendência temporal, foi empregada a análise de regressão por joinpoint. Resultados: Foram identificados 2.406 óbitos por CCR em Mato Grosso no período de 2000 a 2019. As maiores taxas foram encontradas entre as faixas etárias de 60 e 79 anos. Para os homens, evidenciou-se tendência crescente das taxas de mortalidade por CCR para quase todas as faixas etárias, com exceção das de 40 a 49 anos e de 80 anos ou mais. Para as mulheres, houve aumento significativo nas faixas etárias de 50 a 59 anos e de 80 anos ou mais. Conclusão: Os resultados do estudo mostraram aumento das taxas de mortalidade por CCR no estado do Mato Grosso, no período de 2000 a 2019, em determinadas faixas etárias de ambos os sexos, mas sobretudo para os homens. O conhecimento sobre a evolução da mortalidade pode oferecer dados da situação epidemiológica do câncer em nível local e, assim, contribuir para a elaboração de ações de controle e prevenção desse agravo.

Genetic association of ARID5B with the risk of colorectal cancer within Jammu and Kashmir, India

Colorectal cancer (CRC), which includes the development of cancer from the colon or rectum, is one of the highly prevalent cancers in the populations of Jammu and Kashmir (J&K) in India. However, case-control genetic association studies on CRC are lacking in this population. Various genome-wide association studies have previously shown that single-nucleotide polymorphisms (SNPs) of the AT-rich interaction domain 5B (ARID5B) gene located on chromosome 10q21.2 contribute substantially to the development of colorectal cancer. The association between ARID5B and CRC risk in north Indian population groups is still unknown. To understand the role of ARID5B SNPs in CRC in the population of J&K, we designed a case-control study to investigate the association of the cancer susceptibility variant rs10740055 of ARID5B with CRC in the population of J&K. The study included 180 cases and 390 healthy controls. Genotyping of the rs10740055 variant was performed by RT-PCR using the TaqMan assay technique. Hardy-Weinberg equilibrium of the variant was assessed using the chi-squared test. The allele- and genotype-specific risks were estimated by odds ratios (ORs) with 95% confidence intervals (CIs). The rs10740055 variant showed a higher risk for colorectal cancer with an OR of 3.35 (1.99-5.65 at 95% CI) and P = 0.000005 corrected for age, gender, ethnicity, BMI, alcohol intake and smoking. Our results indicate that the A allele of rs10740055 imparts risk to the population and also that a larger sample size is needed for further statistical validation. The association of other variants in other ARID family genes should also be tested as their role cannot be ruled out.

Survival outcome of pulmonary metastasectomy among the patients with colorectal cancers

OBJECTIVE

Pulmonary metastasectomy for the treatment of metastatic colorectal cancer is essential, but high ranked evidence of survival benefit is lacking. Here, we aimed to examine the prognostic factors after pulmonary metastasectomy in patients with colorectal cancer.

METHODS

This is a single-center, retrospective hospital-based observational case series study. We reviewed data for 607 patients with metastatic colorectal cancer (mCRC) who were treated and observed from 2012 to 2019. Of the 607 patients with mCRC, 87 were with solitary lung metastases. Of the 87 patients, 39 were not appropriate for metastasectomy, while 15 patients recognized as suitable candidates by the multidisciplinary thoracic tumor board rejected metastasectomy. Consequently, only 33 patients were included in the final analysis.

RESULTS

Rectum was detected as the primary site in 16 (48.5%) patients. Over 80% of patients had metachronous lung metastases, with a median of 29.0 months from initial diagnosis. Video-assisted thoracic surgery with wedge resection was performed in 20 (60.6%) patients. Over 90% of patients had solitary metastasis resected, with 97% of R0 resection. Median tumor size was 23.0 mm (min: 10; max: 90). Adjuvant treatment was given to 31 (93.9%) patients, while neoadjuvant treatment was given only to 8 (25%) patients. Of the 33 patients, there were 25 (75.7%) relapses. The most frequent site of relapse was lung in 15 (45.5%) patients. Interestingly, there were only 4 (12.2%) patients who had a relapse in the liver after lung metastasectomy. We found that median disease-free survival (DFS) and overall survival (OS) were 43.0 (13.0-73.0) and 55.0 (31.6-78.4) months, respectively.

CONCLUSIONS

Pulmonary metastasectomy was associated with significantly long-time survival rates in mCRC (43 months of DFS and 55 months of OS). The second relapse occurred in 25 (75.7%) patients, with isolated lung metastases in nearly half of the patients (45.5%). Therefore, lung metastases in mCRC were unique and a multidisciplinary team including a thoracic surgeon should manage these patients.

Socioeconomic inequalities in colorectal cancer incidence in Canada: trends over two decades

PURPOSE

Colorectal cancer is the third most commonly diagnosed cancer in Canada. This study aimed to measure and examine trends in socioeconomic inequalities in the incidence of colorectal cancer in Canada.

METHODS

This study is a time trend ecological study based on Canadian Census Division level data constructed from the Canadian Cancer Registry, Canadian Census of Population, and National Household Survey. We assessed trends in income and education inequalities in colorectal cancer incidence in Canada from 1992 to 2010. The age-standardized Concentration index ([Formula: see text]), which measures inequality across all socioeconomic groups, was used to quantify socioeconomic inequalities in colorectal cancer incidence in Canada.

RESULTS

The average crude colorectal cancer incidence was found to be 61.52 per 100,000 population over the study period, with males having a higher incidence rate than females (males: 66.98; females: 56.25 per 100,000 population). The crude incidence increased over time and varied by province. The age-standardized C indicated a higher concentration of colorectal cancer incidence among lower income and less-educated neighborhoods in Canada. Income and education inequalities increased over time among males.

CONCLUSION

The concentration of colorectal cancer incidence in low socioeconomic neighborhoods in Canada has implications for primary prevention and screening.

Differential Expression of the Sphingolipid Pathway Is Associated with Sensitivity to the PP2A Activator FTY720 in Colorectal Cancer Cell Lines

Protein phosphatase 2A (PP2A) is a ubiquitously expressed intracellular serine/threonine phosphatase. Deregulation of PP2A is a common event associated with adenocarcinomas of the colon and rectum. We have previously shown that breast cancer cell lines are sensitive to the PP2A activator FTY720, and that sensitivity is predicted by high Aurora kinase A (AURKA) mRNA expression. In this study, we hypothesized that high relative AURKA expression could predict sensitivity to FTY720-induced apoptosis in colorectal cancer (CRC). The CRC cell lines NCI H716, COLO320DM, DLD-1, SW480, and HT-29 show a high relative AURKA expression as compared to LS411N, T84, HCT116, SW48, and LOVO. Following viability assays, LS411N, T84, HCT116, and SW480 were shown to be sensitive to FTY720, whereas DLD-1 and HT-29 were non-sensitive. Hence, AURKA mRNA expression does not predict sensitivity to FTY720 in CRC cell lines. Differentially expressed genes (DEGs) were obtained by comparing the sensitive CRC cell lines (LS411N and HCT116) against the non-sensitive (HT-29 and DLD-1). We found that 253 genes were significantly altered in expression, and upregulation of CERS4, PPP2R2C, GNAZ, PRKCG, BCL2, MAPK12, and MAPK11 suggests the involvement of the sphingolipid signaling pathway, known to be activated by phosphorylated-FTY720. In conclusion, although AURKA expression did not predict sensitivity to FTY720, it is evident that specific CRC cell lines are sensitive to 5 µM FTY720, potentially because of the differential expression of genes involved in the sphingolipid pathway.

Prognostic implications of ferroptosis-associated gene signature in colon adenocarcinoma

BACKGROUND

Colon adenocarcinoma (COAD) is one of the most common and fatal malignant tumors, which increases the difficulty of prognostic predictions. Thus, new biomarkers for the diagnosis and prognosis of COAD should be explored. Ferroptosis is a recently identified programmed cell death process that has the characteristics of iron-dependent lipid peroxide accumulation. However, the predictive value of ferroptosis-related genes (FRGs) for COAD still needs to be further clarified.

AIM

To identify some critical FRGs and construct a COAD patient prognostic signature for clinical utilization.

METHODS

The Cancer Genome Atlas database (TCGA) and Gene Expression Omnibus databases were the data sources for mRNA expression and corresponding COAD patient clinical information. Differentially expressed FRGs were recognized using R and Perl software. We constructed a multi-FRG signature of the TCGA-COAD cohort by performing a univariate Cox regression and least absolute shrinkage and selection operator Cox regression analysis. COAD patients from the Gene Expression Omnibus cohort were utilized for verification.

RESULTS

Our research showed that most of the FRGs (85%) were differentially expressed between the corresponding adjacent normal tissues and cancer tissues in the TCGA-COAD cohort. Seven FRGs were related to overall survival (OS) in the univariate Cox analysis (all P < 0.05). A model with five FRGs (AKR1C1, AKR1C3, ALOX12, CRYAB, and FDFT1) was constructed to divide patients into high- and low-risk groups. The OS of patients in the high-risk group was significantly lower than that of the low-risk group (all P < 0.01 in the TCGA and Gene Expression Omnibus cohorts). The risk score was an independent prognosticator of OS in the multivariate Cox analysis (hazard ratio > 1, P < 0.01). The predictive capacity of the model was verified by a receiver operating characteristic curve analysis. In addition, a nomogram based on the expression of five hub FRGs and risk score can precisely predict the OS of individual COAD cancer patients. Immune correlation analysis and functional enrichment analysis results revealed that immunology-related pathways were abundant, and the immune states of the high-risk group and the low-risk group were different.

CONCLUSION

In conclusion, a novel five FRG model can be utilized for predicting prognosis in COAD. Targeting ferroptosis may be a treatment option for COAD.

A global assessment of recent trends in gastrointestinal cancer and lifestyle-associated risk factors

Background

Gastrointestinal (GI) cancers were responsible for 26.3% of cancer cases and 35.4% of deaths worldwide in 2018. This study aimed to analyze the global incidence, mortality, prevalence, and contributing risk factors of the 6 major GI cancer entities [esophageal cancer (EC), gastric cancer (GC), liver cancer (LC), pancreatic cancer (PC), colon cancer, and rectal cancer].

Methods

Using the Global Cancer Observatory and the Global Health Observatory databases, we reviewed the current GI cancer incidence, prevalence, and mortality, analyzed the association of GI cancer prevalence with national human development indices (HDIs), identified the contributing risk factors, and estimated developing age‐ and sex‐specific trends in incidence and mortality.

Results

In 2020, the trend in age‐standardized rate of incidence of GI cancers closely mirrored that of mortality, with the highest rates of LC, EC, and GC in Asia and of colorectal cancer (CRC) and PC mainly in Europe. Incidence and mortality were positively, but the mortality‐to‐incidence ratio (MIR) was inversely correlated with the national HDI levels. High MIRs in developing countries likely reflected the lack of preventive strategies and effective treatments. GI cancer prevalence was highest in Europe and was also positively correlated with HDIs and lifestyle‐associated risk factors, such as alcohol consumption, smoking, obesity, insufficient physical activity, and high blood cholesterol level, but negatively correlated with hypertension and diabetes. Incidences of EC were consistently and those of GC mostly decreasing, whereas incidences of CRC were increasing in most countries/regions, especially in the younger populations. Incidences of LC and PC were also increasing in all age‐gender populations except for younger males. Mortalities were decreasing for EC, GC, and CRC in most countries/regions, and age‐specific trends were observed in PC and LC with a decrease in the younger but an increase in the older population.

Conclusions

On the global scale, higher GI cancer burden was accompanied, for the most part, by factors associated with the so‐called Western lifestyle reflected by high and very high national HDI levels. In countries/regions with very high HDI levels, patients survived longer, and increasing GI cancer cases were observed with increasing national HDI levels. Optimizing GI cancer prevention and improving therapies, especially for patients with comorbid metabolic diseases, are thus urgently recommended.

Right and Left Colorectal Cancer: Differences in Post-Surgical-Care Outcomes and Survival in Elderly Patients

Simple Summary

The objective of this investigation is to analyze the differences between right and left colon cancer survival and test if these differences have transcendental importance for assistance to improve the survival and quality care of these patients. The results show that both entities are significantly different in terms of evolution, progression, complications and survival. Patients with right colon cancer have a worse prognosis, even in the early stages of the disease, due to more advanced N stages, a larger tumor size, more frequently poorly differentiated tumors and a greater positivity of lymphovascular invasion than left colon cancer. Improvement of the prognosis can be implemented mainly by reducing the specific mortality of colon cancer by achieving early detection and also stratified and personalized by location and age of onset, as well as surgical and oncological treatment of these patients.

Abstract

(1) There is evidence of the embryological, anatomical, histological, genetic and immunological differences between right colon cancer (RCC) and left colon cancer (LCC). This research has the general objective of studying the differences in outcome between RCC and LCC. (2) A longitudinal analytical study with prospective follow-up of the case–control type was conducted from 1 January 2010 to 31 December 2017 including 398 patients with 1:1 matching, depending on the location of the tumor. Inclusion criteria: programmed colectomies, 15 cm above the anal margin, adults and R0 surgery. (3) Precisely 6.8% of the exitus occurred in the first 6 months of the intervention. At 6 months, patients with LCC presented a mean survival of 7 months higher than RCC (p = 0.028). In the first stages, it can be observed that most of the exitus are for patients with RCC (stage I p = 0.021, stage II p = 0.014). In the last stages, the distribution of the deaths does not show differences between locations (stage III p = 0.683, stage IV p = 0.898). (4) The results show that RCC and LCC are significantly different in terms of evolution, progression, complications and survival. Patients with RCC have a worse prognosis, even in the early stages of the disease, due to more advanced N stages, larger tumor size, more frequently poorly differentiated tumors and a greater positivity of lymphovascular invasion than LCC.

Post-diagnostic reliance on plant-compared with animal-based foods and all-cause mortality in omnivorous long-term colorectal cancer survivors

BACKGROUND

Plant-rich diets are associated with lower cardiometabolic risks and longer survival in the general population, but their association with mortality in cancer survivors is still unclear.

OBJECTIVES

We aimed to examine the associations of 3 postdiagnostic plant-based diet indices with all-cause mortality in omnivorous long-term colorectal cancer (CRC) survivors.

METHODS

Diet was assessed with FFQs at a median of 6 years after diagnosis in 1404 CRC survivors (56% male; median age, 69 years) in a Northern German prospective cohort study. An overall, a healthful plant-based, and an unhealthful plant-based diet index were derived by scoring intakes of animal foods reversely and intakes of healthy (whole grains, vegetables, fruits, legumes, nuts, oils, tea/coffee) and less healthy plant foods (refined grains, fruit juices, sugar-sweetened beverages, potatoes, sweets/desserts) positively or reversely, depending on the index. Vital status follow-up was conducted via population registries. Cox proportional hazards regression was applied to estimate HRs for all-cause mortality according to plant-based diet adherence.

RESULTS

Within 7 years (median) after diet assessment, 204 deaths occurred. The overall plant-based diet index displayed a significant, inverse association with all-cause mortality (HR per 10-point increase in diet index, 0.72; 95% CI, 0.57-0.91). Although not statistically significant, higher healthful plant-based diet scores showed a strong tendency towards lower mortality (HR, 0.82; 95% CI, 0.67-1.01). The unhealthful plant-based diet index was associated with higher mortality, but lost statistical significance after multivariable adjustment (HR, 1.19; 95% CI, 0.96-1.48). A subgroup analysis revealed that the tendency towards a positive association of the unhealthful plant-based diet with mortality was restricted to less physically active individuals (<95 metabolic equivalent of task hours/week).

CONCLUSIONS

An overall plant-based diet was inversely associated with all-cause mortality in long-term CRC survivors. However, more research is needed to further disentangle the impacts of different qualities of plant-based diets on cancer survivors' health.

Construction and validation of an RNA-binding protein-associated prognostic model for colorectal cancer

Colorectal cancer (CRC) is one of the most prevalent and fatal malignancies, and novel biomarkers for the diagnosis and prognosis of CRC must be identified. RNA-binding proteins (RBPs) are essential modulators of transcription and translation. They are frequently dysregulated in various cancers and are related to tumorigenesis and development. The mechanisms by which RBPs regulate CRC progression are poorly understood and no clinical prognostic model using RBPs has been reported in CRC. We sought to identify the hub prognosis-related RBPs and to construct a prognostic model for clinical use. mRNA sequencing and clinical data for CRC were obtained from The Cancer Genome Atlas database (TCGA). Gene expression profiles were analyzed to identify differentially expressed RBPs using R and Perl software. Hub RBPs were filtered out using univariate Cox and multivariate Cox regression analysis. We used functional enrichment analysis, including Gene Ontology and Gene Set Enrichment Analysis, to perform the function and mechanisms of the identified RBPs. The nomogram predicted overall survival (OS). Calibration curves were used to evaluate the consistency between the predicted and actual survival rate, the consistency index (c-index) was calculated, and the prognostic effect of the model was evaluated. Finally, we identified 178 differently expressed RBPs, including 121 up-regulated and 57 down-regulated proteins. Our prognostic model was based on nine RBPs (PNLDC1, RRS1, HEXIM1, PPARGC1A, PPARGC1B, BRCA1, CELF4, AEN and NOVA1). Survival analysis showed that patients in the high-risk subgroup had a worse OS than those in the low-risk subgroup. The area under the curve value of the receiver operating characteristic curve of the prognostic model is 0.712 in the TCGA cohort and 0.638 in the GEO cohort. These results show that the model has a moderate diagnostic ability. The c-index of the nomogram is 0.77 in the TCGA cohort and 0.73 in the GEO cohort. We showed that the risk score is an independent prognostic biomarker and that some RBPs may be potential biomarkers for the diagnosis and prognosis of CRC.

A Systematic Examination of Burden of Childhood Cancers in 183 Countries: Estimates from GLOBOCAN 2018

OBJECTIVE

Childhood cancers are a significant cause of child deaths worldwide. This study examines the burden of 33 childhood cancers in 183 countries.

METHODS

The estimates of age-, sex- and country-wise incidence and deaths due to 33 childhood cancers (below the age 15) for 183 countries were retrieved from GLOBOCAN 2018. The socioeconomic status of a country was measured by human development index (HDI).

RESULTS

Globally, an estimated 200 166 cases and 74 956 deaths were attributed to childhood cancers in 2018. The age-standardised incidence rate (ASIR) was 103 per million, whereas the age-standardised mortality rate (ASMR) stood at 38 per million. ASIR was highest in high-income regions (e.g. North America: 182 per million); ASMR, however, was elevated in low- and medium-income countries (e.g. south-east Asia: 62 per million; North Africa: 51 per million). Leukaemia and brain cancers were dominant cancer groups accounting for 45% of cases and 57% of deaths. The ASIRs exhibited a positive gradient with HDI ( R 2 = 0.46 ) .

CONCLUSION

The high burden of childhood cancers (>80% of total incidence) in low- and middle-income countries (LMICs) calls for increased cancer awareness, improvement in oncologic infrastructure, international collaborations and twinning programmes, equitable access to multi-modal treatment and financial coverage of treatment expenses.

GUCY2C as a biomarker to target precision therapies for patients with colorectal cancer

Introduction

Colorectal cancer (CRC) is one of the most-deadly malignancies worldwide. Current therapeutic regimens for CRC patients are relatively generic, based primarily on disease type and stage, with little variation. As the field of molecular oncology advances, so too must therapeutic management of CRC. Understanding molecular heterogeneity has led to a new-found promotion for precision therapy in CRC; underlining the diversity of molecularly targeted therapies based on individual tumor characteristics.

Areas covered

We review current approaches for the treatment of CRC and discuss the potential of precision therapy in advanced CRC. We highlight the utility of the intestinal protein guanylyl cyclase C (GUCY2C), as a multi-purpose biomarker and unique therapeutic target in CRC. Here, we summarize current GUCY2C-targeted approaches for treatment of CRC.

Expert opinion

The GUCY2C biomarker has multi-faceted utility in medicine. Developmental investment of GUCY2C as a diagnostic and therapeutic biomarker offers a variety of options taking the molecular characteristics of cancer into account. From GUCY2C-targeted therapies, namely cancer vaccines, CAR-T cells, and monoclonal antibodies, to GUCY2C agonists for chemoprevention in those who are at high risk for developing colorectal cancer, the utility of this protein provides many avenues for exploration with significance in the field of precision medicine.

Genetic Variants of ANGPT1, CD39, FGF2 and MMP9 Linked to Clinical Outcome of Bevacizumab Plus Chemotherapy for Metastatic Colorectal Cancer

Angiogenesis pathway genes show substantial genetic variability causing inter-individual differences in responses to anti-angiogenic drugs. We examined 20 single nucleotide polymorphisms (SNPs) in 13 of these genes to predict tumour response and clinical outcome measured as progression free survival (PFS) and overall survival (OS) in 57 patients with metastatic colorectal cancer (mCRC) given bevacizumab plus chemotherapy. SNPs were detected (iPLEX® Assay) in genomic DNA extracted from formalin-fixed paraffin-embedded tumour specimens. The variant allele CD39 rs11188513 was associated with a good tumour response (p = 0.024). Patients homozygous for the wild-type allele FGF2 rs1960669 showed a median PFS of 10.95 months versus 5.44 months for those with at least one variant allele-A (HR 3.30; 95% CI: 1.52–7.14; p = 0.001). Patients homozygous for wild-type MMP9 rs2236416 and rs2274755 showed a median PFS of 9.48 months versus 6 and 6.62 months, respectively, for those with at least one variant allele (p = 0.022, p = 0.043, respectively). OS was also lengthened to 30.92 months (p = 0.034) in carriers of wild-type ANGPT1 rs2445365 versus 22.07 months for those carrying at least one variant allele-A. These gene variants were able to predict clinical outcome and tumour response in mCRC patients given bevacizumab-based therapy.