Global, regional, and national burden of colorectal cancer and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Benzene exposure and risk of colorectal cancer by anatomical subsite in the Norwegian offshore petroleum workers cohort

OBJECTIVE

To investigate the association between low levels of benzene exposure (≤0.879 parts per million [ppm]-years) and risk of colorectal cancer (CRC) including its anatomical subsites.

METHODS

Among 25,347 male workers in the Norwegian Offshore Petroleum Workers (NOPW) cohort with offshore work history (1965-1998), 455 CRC cases were diagnosed 1999-2021. We compared these with a subcohort (n = 2031) drawn from the full cohort. Work histories were linked to a previously developed industry-specific benzene job-exposure matrix (JEM). Cox regression for case-cohort analyses was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for CRC, adjusted for age, body mass index, smoking, alcohol intake, red/processed meat intake, and physical activity.

RESULTS

Risks of CRC increased with increasing benzene exposure. For all CRC, the HRs (95% CI) for the most exposed [quartile 4] vs. the unexposed were 1.32 (0.96 to 1.81, [0.177-0.879 ppm-years]; p-trend = 0.085) for cumulative, 1.52 (1.11 to 2.07, [17-34 years]; p-trend = 0.032) for duration, and 1.56 (1.15 to 2.12, [0.015-0.046 ppm]; p-trend = 0.005) for average intensity of benzene exposure. For right-sided colon cancer, the association was most evident for exposure duration (HR = 2.25 (1.33 to 3.80), quartile 4 [17-34 years] vs. unexposed; p-trend = 0.007). Sensitivity analyses showed consistent associations.

CONCLUSION

This study found positive exposure-response associations between low-level benzene exposure and CRC risk in offshore petroleum workers. These findings add to emerging evidence that benzene can be associated with solid tumours including lung and bladder, which potentially has important occupational and public health implications.

Advancing minimally invasive surgery for elderly colorectal cancer patients: Bridging evidence to practice

The recent study by Min et al provides evidence supporting laparoscopic radical resection of colorectal cancer (LRRCC) as a superior surgical approach for elderly patients. Their retrospective analysis of 104 patients demonstrated that LRRCC offers higher therapeutic efficacy, reduced postoperative complications, faster recovery, and attenuated systemic inflammatory responses compared to open surgery. While the study underscores the clinical advantages of minimally invasive techniques, it also highlights critical gaps, such as single-center design and limited long-term follow-up. This editorial contextualizes these findings within the broader literature, emphasizing the role of LRRCC in enhancing postoperative quality of life for elderly patients. We further discuss the implications of inflammatory biomarker modulation, advocate for multidisciplinary care models, and call for prospective trials to validate long-term outcomes.

Collaborative Autoethnography of Cancer Patients' Dynamic Sense of Agency

Through collaborative autoethnography, we studied shifts in cancer patients' sense of agency and the meaning of cancer during the diagnostic and treatment phases. This article contributes to the illness management literature by adopting sense of agency perspective that provides new understanding of retrospective interpretation of cancer patients' agency. The authors' experiences of receiving cancer diagnoses and a related, collectively written story illustrate how relational and contextual elements facilitate rapid shifts in cancer patients' sense of agency and illness management. The findings illustrate shifts in the sense of agency as a collaborative and reflexive process between cognitive, emotional, and bodily constraints and adjustments. We demonstrate how shifts in patients' sense of agency and respective changes in meanings attached to cancer were shaped by near ones, healthcare actors, and other cancer patients, as well as the COVID-19 pandemic and the fear of military conflict due to Finland neighbor Russia's war on Ukraine. Furthermore, the study illustrates how shifts in sense of agency shape and are shaped by changes in the understanding of cancer as either a secondary issue, ambiguous stranger, travel companion, or enemy.

Outcomes of Elderly Patients With Node-Positive Colon Cancer: A Multicenter Population-Based Cohort Study

BACKGROUND

In this large population-based cohort study, we examined the prognostic significance of various clinical, pathological, and contextual variables for their correlation with survival in elderly patients with stage III colon cancer.

METHODS

Patients aged ≥ 70 years with stage III colon cancer, diagnosed in Saskatchewan during 2012-2018, were evaluated. A Cox proportional multivariate survival analysis was performed to determine factors correlated with overall survival (OS) and disease-free survival.

RESULTS

Overall, 404 eligible patients with a median age of 79 years and a male-to-female ratio of 1:1 were identified. Among them, 48% were aged ≥ 80 years, 66% had ≥ 1 major comorbid illness, 46% had high-risk disease, and 50% had a node-positive to node-harvested (NPNH) ratio of > 0.1. Forty-three percent of patients received adjuvant chemotherapy. The 5-year disease-free survival with chemotherapy was 49% versus 30% without chemotherapy (P < .001). The 5-year OS with adjuvant chemotherapy was 64% versus 49% without chemotherapy (P < .001). On multivariate analysis a past history of cancer, hazard ratio (HR) 1.47 (95% CI, 1.12-1.94); presence of an ostomy, HR 1.53 (1.16-2.03); NPNH ratio > 0.1, HR 1.51 (1.15-1.98); grade III tumor, HR 1.54 (1.16-2.04); WHO performance status > 1, HR 1.42 (1.06-1.90); no adjuvant chemotherapy, HR 1.82 (1.32-2.50); high-risk stage III disease, HR 1.60 (1.22-2.11), and baseline carcinoembryonic antigen > 5, HR 1.98 (1.50-2.61) were independently correlated with OS.

CONCLUSIONS

This study highlights the prognostic importance of several factors in elderly patients with stage III colon cancer, particularly the benefit of adjuvant chemotherapy on survival. Key predictors of poorer OS include a past history of cancer, presence pf an ostomy, and a higher NPNH ratio. These findings emphasize the need for personalized treatment approaches to improve outcomes in this vulnerable population.

Interaction between gut microbiota and T cell immunity in colorectal cancer

This review delves into the complex and multi-layered mechanisms that govern the interaction between gut microbiota and T cells in the context of colorectal cancer (CRC), revealing a novel "microbiota-immune regulatory landscape" within the tumor microenvironment. As CRC progresses, the gut microbiota experiences a significant transformation in both its composition and metabolic patterns. On one hand, specific microbial entities within the gut microbiota can directly engage with T cells, functioning as "immunological triggers" that shape T-cell behavior. Simultaneously, microbial metabolites, such as short-chain fatty acids and bile acids, serve as "molecular regulators" that intricately govern T-cell function and differentiation, fine-tuning the immune response. On the other hand, the quorum-sensing mechanism, a recently recognized communication network among bacteria, also plays a pivotal role in orchestrating T-cell immunity. Additionally, the gut microbiota forms an intriguing connection with the neuro-immune regulatory axis, a largely unexplored "territory" in CRC research. Regarding treatment strategies, a diverse array of intervention approaches-including dietary modifications, the utilization of probiotics, bacteriophages, and targeted antibiotic therapies-offer promising prospects for restoring the equilibrium of the gut microbiota, thereby acting as "ecosystem renovators" that impede tumor initiation and progression. Nevertheless, the current research landscape in this field is fraught with challenges. These include significant variations in microbial composition, dietary preferences, and tumor microenvironments among individuals, a lack of large-scale cohort studies, and insufficient research that integrates tumor mutation analysis, gut microbiota investigations, and immune microenvironment evaluations. This review emphasizes the necessity for future research efforts to seamlessly incorporate multiple factors and utilize bioinformatics analysis to construct a more comprehensive "interactive map" of the gut microbiota-T cell relationship in CRC. The aim is to establish a solid theoretical basis for the development of highly effective and personalized treatment regimens, ultimately transforming the therapeutic approach to CRC.

The role of Adiponectin and Leptin in Colorectal Cancer and Adenoma: a systematic review and meta-analysis

BACKGROUND

Colorectal cancer ranks as the third most frequently diagnosed cancer globally. Adipokines, including adiponectin and leptin, are believed to play a vital role in the development and progression of tumors. This study aimed to clarify the association between circulating adiponectin and leptin concentrations and the risk of colorectal cancer and adenoma.

METHODS

A detailed literature review was conducted in different databases, including Google Scholar, Web of Science, Scopus, and PubMed. Articles measuring serum concentrations of adiponectin and leptin in colorectal adenoma or cancer patients were analyzed. Pooled odds ratios (ORs) and their related 95% confidence intervals (CIs) were estimated through a random-effects meta-analysis.

RESULTS

In total, 30 articles were analyzed. According to the meta-analysis, higher adiponectin concentrations were inversely linked to a reduced CRC risk (OR: 0.85, 95% CI: 0.74-0.96), particularly in men. However, no notable connection was detected between higher leptin concentrations and risk of CRC (OR: 1.12, 95% CI: 0.96-1.31). In subgroup analyses, BMI adjustment reinforced the negative association between higher adiponectin levels and risk of CRC, while insulin adjustment yielded non-significant results. Additionally, higher leptin levels revealed a meaningful relationship with colorectal adenoma risk (OR: 1.39, 95% CI: 1.06-1.84), whereas higher levels of adiponectin were not significantly linked to adenoma (OR: 0.79, 95% CI: 0.46-1.36).

CONCLUSION

According to this meta-analysis, elevated adiponectin concentrations may play a protective role against CRC, while leptin could potentially contribute to an elevated colorectal adenoma risk. Further studies are required to explore the potential mechanisms underlying adipokine-mediated colorectal carcinogenesis.

Pterostilbene as a Multifaceted Anticancer Agent: Molecular Mechanisms, Therapeutic Potential and Future Directions

Pterostilbene (PT), a natural dimethoxy analogue of resveratrol, exhibits enhanced bioavailability and lipophilicity, making it a more effective therapeutic candidate than resveratrol. These pharmacokinetic advantages improve its cellular uptake and metabolic stability, positioning PT as a promising compound in cancer treatment. PT has shown significant anticancer activity in several malignancies, including melanoma, breast, colorectal, and ovarian cancers. Its mechanisms of action include induction of apoptosis through caspase activation, cell cycle arrest, and inhibition of angiogenesis and metastasis via downregulation of matrix metalloproteinase-9 and vascular endothelial growth factor. PT also modulates epigenetic processes such as DNA methylation and histone modifications, and targets cancer stem cells by reducing the expression of stemness markers like CD44 and c-Myc. Additionally, PT enhances the efficacy of standard chemotherapeutic agents such as cisplatin, doxorubicin, and 5-fluorouracil, with preclinical studies showing synergistic effects and reversal of drug resistance. A Phase II clinical trial (NCT03671811) in endometrial cancer patients has confirmed the safety of PT and revealed its ability to modulate immune-related gene expression and suppress mechanistic target of rapamycin (mTOR) signaling. Despite promising results, several challenges remain particularly low water solubility, limited systemic bioavailability, lack of large-scale human studies, and undefined therapeutic protocols. Future research should focus on advanced formulation strategies, rigorous clinical trials across cancer types, and identification of patient-specific therapeutic responses to support PT's integration into oncology practice.

Global Epidemiology of Early-Onset Digestive System Malignancy: A Systematic Analysis for the Global Burden of Disease Study 2021

BACKGROUND AND AIM

The researches on the global burden of digestive system malignancy in young populations were limited. This study aimed to comprehensively investigate the burden of early-onset digestive system malignancy (often defined as cancers diagnosed below the age of 50) based on the Global Burden of Disease 2021.

METHODS

Data of incidence, prevalence, deaths, disability-adjusted life years (DALYs), and risk factors for the five major early-onset digestive system malignancies, including early-onset esophageal cancer (EOEC), early-onset gastric cancer (EOGC), early-onset liver cancer (EOLC), early-onset pancreatic cancer (EOPC), and early-onset colorectal cancer (EOCRC), were extracted from GBD 2021. The average annual percent change (AAPC) was calculated using joinpoint regression analysis. The Bayesian age-period-cohort (BAPC) model was utilized to predict the burden up to 2030.

RESULTS

From 1990 to 2021, the age-standardized incidence rate (ASIR) of early-onset digestive system malignancies, except for EOCRC (AAPC, 0.37), showed a decreasing pattern. Meanwhile, the age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) of early-onset digestive system malignancy presented a downward trend. Notably, high-middle sociodemographic index (SDI) countries experienced higher disease burdens. Dietary risk factors, tobacco, alcohol consumption, and metabolic factors were the main risk factors. The ASIR of EOEC and EOCRC was projected to increase in 2030, whereas the trend for EOGC, EOLC, and EOPC was projected to decrease.

CONCLUSIONS

Early-onset digestive system malignancy presented notable heterogeneity across gender, geography, and cancer types. This emphasizes the urgency of addressing the public health challenge of early-onset digestive system malignancy.

Rising colorectal cancer burden attributable to high body mass index in China from 1990 to 2021: a comprehensive analysis using the global burden of disease study

Background

Colorectal cancer (CRC) attributable to high body mass index (BMI) has become a significant public health issue in China. This study analyzes the burden of CRC attributable to high BMI from 1990 to 2021, exploring trends in mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs).

Methods

Data were obtained from the Global Burden of Disease Study (GBD) database. Age- and sex-specific mortality, DALYs, YLDs, and YLLs rates were analyzed for 2021, and temporal trends were examined from 1990 to 2021. Joinpoint and age-period-cohort (APC) analyses were conducted to identify shifts in burden and contributing factors. Decomposition analysis was applied to assess the impact of aging, population growth, and epidemiological changes.

Results

In 2021, 19,418 CRC deaths were attributable to high BMI in China, with a higher burden observed in males. The total DALYs reached 507,316, and YLLs accounted for 482,925. From 1990 to 2021, age-standardized mortality rates increased by 2.43-fold, while DALYs and YLLs increased by 2.33-fold and 2.24-fold, respectively. The most dramatic increase was seen in YLDs, with a 5.17-fold rise. Epidemiological changes contributed most to the increases in deaths and DALYs, followed by aging, while population growth had the least impact.

Conclusions

The burden of CRC attributable to high BMI in China has grown significantly over the past three decades, with males disproportionately affected. Aging and epidemiological changes are the main drivers of this trend, underscoring the need for targeted interventions to reduce the CRC burden.

Personalized surveillance in colorectal cancer: Integrating circulating tumor DNA and artificial intelligence into post-treatment follow-up

Given the growing burden of colorectal cancer (CRC) as a global health challenge, it becomes imperative to focus on strategies that can mitigate its impact. Post-treatment surveillance has emerged as essential for early detection of recurrence, significantly improving patient outcomes. However, intensive surveillance strategies have shown mixed results compared to less intensive methods, emphasizing the necessity for personalized, risk-adapted approaches. The observed suboptimal adherence to existing surveillance protocols underscores the urgent need for more tailored and efficient strategies. In this context, circulating tumor DNA (ctDNA) emerges as a promising biomarker with significant potential to revolutionize post-treatment surveillance, demonstrating high specificity [0.95, 95% confidence interval (CI): 0.91-0.97] and robust diagnostic odds (37.6, 95%CI: 20.8-68.0) for recurrence detection. Furthermore, artificial intelligence and machine learning models integrating patient-specific and tumor features can enhance risk stratification and optimize surveillance strategies. The reported area under the receiver operating characteristic curve, measuring artificial intelligence model performance in predicting CRC recurrence, ranged from 0.581 and 0.593 at the lowest to 0.979 and 0.978 at the highest in training and validation cohorts, respectively. Despite this promise, addressing cost, accessibility, and extensive validation remains crucial for equitable integration into clinical practice.

An interplay between human genetics and intratumoral microbiota in the progression of colorectal cancer

Intratumoral microbiota plays a crucial role in cancer progression. However, the relationship between host genetics and intratumoral microbiota, as well as their interaction in colorectal cancer (CRC) progression, remains unclear. With 748 Chinese CRC patients enrolled from three cohorts, we find that the single nucleotide polymorphism (SNP) rs2355016, located in the intron of ATP-sensitive inward rectifier potassium channel 11 (KCNJ11), is significantly associated with the abundance of Fusobacterium. Compared with the rs2355016 GG genotype, patients carrying the A allele exhibit downregulation of KCNJ11 and enrichment of Fusobacterium, which corresponds to accelerated proliferation and progression. Low expression of KCNJ11 can increase the level of galactose-N-acetyl-d-galactosamine (Gal-GalNAc) on the surface of CRC cells, thereby facilitating the binding of the Fap2 protein from F. nucleatum to Gal-GalNAc. This further enhances the adhesion and invasion of F. nucleatum and promotes CRC growth. Our study explores the interaction between intratumoral microbiota and SNPs in CRC patients, which will enhance our understanding of CRC proliferation.

Exploring metabolomics for colorectal cancer risk prediction: evidence from the UK Biobank and ESTHER cohorts

BACKGROUND

While metabolic pathway alterations are linked to colorectal cancer (CRC), the predictive value of pre-diagnostic metabolomic profiling in CRC risk assessment remains to be clarified. This study evaluated the predictive performance of a metabolomics risk panel (MRP) both independently and in combination with established risk factors.

METHODS

We derived, internally validated (IV), and externally validated (EV) a metabolomics risk panel (MRP) for CRC from data of the UK Biobank (UKB) and the German ESTHER cohort. Baseline blood samples were assessed for 249 metabolites using nuclear magnetic resonance spectroscopy analysis. We applied LASSO Cox proportional hazards regression to identify metabolites for inclusion in the MRP and evaluated the model performance using the concordance index (C-index). We compared the performance of the MRP to an environmental risk panel (ERP; sex, age, body mass index, smoking status, and alcohol consumption) and a genetic risk panel (GRP; polygenic risk score).

RESULTS

The study included 154,892 participants of the UKB cohort (mean age at baseline 54.5 years; 55.5% female) with 1879 incident CRC and 3242 participants of the ESTHER cohort (mean age 61.5 years; 52.2% female) with 103 CRC cases. Twenty-three metabolites, primarily amino acid and lipid-related metabolites, were selected for the MRP, showing moderate predictive performance (C-index 0.60 [IV] and 0.54 [EV]). The ERP and GRP showed superior performance, with C-index values of 0.73 (IV) and 0.69 (EV). Adding the MRP to these risk models did not change the C-indices in both cohorts.

CONCLUSIONS

Genetic and environmental risk information provided strong predictive accuracy for CRC risk, with no improvements from adding metabolomics data. These findings suggest that metabolomics data may have limited impact on enhancing established CRC risk models in clinical practice.

Temporal trend and attributable risk factors of cardiovascular disease burden for adults 55 years and older in 204 countries/territories from 1990 to 2021: an analysis for the Global Burden of Disease Study 2021

AIMS

The ageing global population and overall population growth have significantly increased the burden of cardiovascular diseases (CVDs). This study aims to examine global temporal trends in the incidence, disability-adjusted life years (DALYs), and mortality rates of both overall and type-specific CVDs among adults aged 55 and older from 1990 to 2021, with a focus on identifying changes over time, regional disparities, and the key risk factors contributing to this burden.

METHODS AND RESULTS

We analysed data from the Global Burden of Disease Study 2021, covering 204 countries and territories. Trends in age-standardized rates of incidence, DALY, and mortality for both overall and specific types of CVDs were assessed, alongside the impact of key risk factors. Between 1990 and 2021, global age-standardized incidence, DALY, and mortality rates showed a declining trend, with estimated annual percentage changes of -0.39, -1.30, and -1.11, respectively. However, due to overall population growth and ageing, the absolute number of CVD cases continued to rise. Regions with high-middle socio-demographic index (SDI) exhibited the highest incidence and mortality rates, while high SDI regions saw the greatest declines. Men had higher age-standardized rates of CVD incidence, DALY, and mortality compared with women. The burden increased with age, with the oldest age groups (80+ years) showing the highest rates. High systolic blood pressure was the leading modifiable risk factor, contributing to more than half of the CVD-related DALY globally. Other major risk factors included high LDL cholesterol, smoking, and ambient particulate matter pollution.

CONCLUSION

While age-standardized rates of CVD incidence, DALY, and mortality have declined over the past three decades, the total burden of CVDs continues to rise due to population ageing and growth. These findings highlight the need for targeted prevention strategies in regions with high CVD burden, particularly those with lower socioeconomic status.

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

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

KRAS mutations in colorectal cancer: impacts on tumor microenvironment and therapeutic implications

INTRODUCTION

Despite decreasing trends in incidence, colorectal cancer (CRC) is still a major contributor to malignancy-related morbidities and mortalities. Groundbreaking advances in immunotherapies and targeted therapies benefit a subset of CRC patients, with sub-optimal outcomes. Hence, there is an unmet need to design and manufacture novel therapies, especially for advanced/metastatic disease. KRAS, the most highly mutated proto-oncogene across human malignancies, particularly in pancreatic adenocarcinoma, non-small cell lung cancer, and CRC, is an on-off switch and governs several fundamental cell signaling cascades. KRAS mutations not only propel the progression and metastasis of CRC but also critically modulate responses to targeted therapies.

AREAS COVERED

We discuss the impacts of KRAS mutations on the CRC's tumor microenvironment and describe novel strategies for targeting KRAS and its associated signaling cascades and mechanisms of drug resistance.

EXPERT OPINION

Drug development against KRAS mutations has been challenging, mainly due to structural properties (offering no appropriate binding site for small molecules), critical functions of the wild-type KRAS in non-cancerous cells, and the complex network of its downstream effector pathways (allowing malignant cells to develop resistance). Pre-clinical and early clinical data offer promises for combining KRAS inhibitors with immunotherapies and targeted therapies.

Associations between FOXO1 expression in tissue, the pathological characteristics of colorectal cancer, and patient survival

BACKGROUND

The transcription factor Forkhead box O1 (FOXO1) plays key roles in many biological processes, including metabolic regulation and apoptosis. However, any role in colorectal cancer (CRC) remains to be elucidated.

METHODS

An immunohistochemical tissue microarray was used to measure the expression levels of FOXO1 in cancerous tissues from 76 colorectal cancer patients and 28 paracancerous tissues. The difference in expression in the two tissues was statistically compared, and correlations were sought between FOXO1 concentrations and CRC pathological parameters and prognosis.

RESULTS

FOXO1 positivity was significantly lower in CRC tissues than in paracancerous tissues (59.2% vs 85.7%, P = 0.011). The FOXO1 level of CRC tissues was not significantly correlated with sex, tumour size, pathological or TNM stage, Duke stage for cancer and severity, lymph node metastasis, or vascular invasion. However, low FOXO1 expression predicted poorer differentiation (P = 0.033) and higher nerve invasion (P < 0.001). Kaplan-Meier survival analysis revealed that the 5-year survival rate was significantly higher in patients expressing FOXO1 (75.6%; 34/45) than not (54.8%; 17/31). In the multivariable Cox proportional hazards model analysis, high FOXO1 expression remained independently associated with better overall survival (HR = 0.46, 95% CI 0.25-0.86, P = 0.016).

CONCLUSION

FOXO1 expression is significantly correlated with the pathological features of CRC and patient prognosis.

Global burden of colon and rectal cancer and attributable risk factors in 204 countries and territories from 1990 to 2021

OBJECTIVE

Colon and rectal cancers (CRCs) are among the most common malignancies worldwide. While previous studies have examined the disease burden and risk factors of CRC at regional levels, they lack the granularity needed for country-specific policy development. Using updated data from the Global Burden of Disease (GBD) 2021 study, this research explores the national-level spatial distribution of CRC burdens linked to key risk factors and analyzes temporal trends in their contributions. The findings aim to support the formulation of precise public health policies to effectively reduce CRC incidence.

METHODS

Based on data from the GBD study 2021, we examined CRC-related incidence, prevalence, mortality, disability-adjusted life years (DALYs), and associated risk factors. Age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and DALY rate (ASDR) were obtained and analyzed from 1990 to 2021. We used regression analysis and stratification across the four World Bank regions to assess geographical variations and the effect of economic development levels. We further assessed the contribution of various risk factors to CRC-related deaths and DALYs, while analyzing the distribution and temporal trends of the top three contributing risk factors.

RESULTS

On a global scale, the ASDR for CRC declined from 357.33 per 100,000 in 1990 to 283.24 per 100,000 in 2021 (95% confidence interval [CI]: -0.82 to -0.64). In 2021, the regions classified by the World Bank as high income exhibited the highest ASDR in 2021, at 347.35 per 100,000, while the lower-middle-income regions reported the lowest ASDR, at 179.48 per 100,000. During this period, the global ASMR fell from 15.56 to 12.40 per 100,000, while the ASIR rose from 24.04 to 25.60 per 100,000. However, these trends were not consistent across different World Bank income regions. Key risk factors contributing to CRC included high red meat consumption, obesity, insufficient calcium intake, and alcohol consumption, with variations observed among the World Bank income groups.

CONCLUSION

Although the global burden of colorectal cancer (CRC) has declined from 1990 to 2021, particularly in high-income regions, the incidence rate continues to rise. The increase is more pronounced among individuals aged 50 years and older, who also bear a higher absolute incidence than younger populations. High red meat consumption, high body mass index (BMI), and low calcium intake remain the leading global risk factors for CRC. Effective weight management and the promotion of healthy lifestyles are essential strategies for reducing CRC risk across sexes, while smoking and alcohol control are particularly critical for alleviating the burden among males.

Global, regional, and national burden of disease attributable to a diet low in milk, 1990-2021: An updated analysis of the Global Burden of Disease study 2021

Diet low in milk has been linked to various chronic diseases and cancer. To better understand the global health effect of a diet low in milk, this study analyzed the latest data from the Global Burden of Disease study 2021. Our findings revealed that the number of deaths and disability-adjusted life years (DALY) of colon and rectum cancer (CRC) attributable to a diet low in milk increased from 1990 to 2021. The age-standardized mortality rates (ASMR) and age-standardized DALY rates (ASDR) for CRC due to low milk intake declined slightly over this period, with a faster decline observed among females. Predictive analysis shows similar tendency, even higher ASMR and ASDR in CRC associated with a diet low in milk in males than in females by 2050. In contrast, the rate of prostate cancer attributable to a diet low in milk remained relatively stable. Regionally, southern Latin America exhibited the highest ASMR and ASDR for CRC associated with a diet low in milk in 2021, whereas western sub-Saharan Africa had the most notable changes in these rates for prostate cancer. The largest decrease in ASMR and ASDR of CRC due to a diet low in milk was observed in the high socio-demographic index (SDI) region. In addition, the low SDI region exhibited the highest change rates for prostate cancer attributable to a diet low in milk. In summary, our study provides valuable insights into trends for the global burden of CRC and prostate cancer attributable to a diet low in milk, emphasizing the importance of considering gender, age, regional, and national differences in dietary habits and disease risk when formulating public health policies and dietary recommendations.

Risk of ischemic stroke in korean patients with Cancer: Insights from national health insurance data

OBJECTIVES

This study aimed to compare the cumulative incidence of ischemic stroke between patients with and without cancer, estimate the hazard ratio of stroke in patients with cancer compared to those without cancer, and compare our results with those of other nationwide studies.

MATERIALS AND METHODS

We recruited 91,424 patients diagnosed with cancer from the Korean National Health Insurance Service database between 2011 and 2015 and enrolled 182,848 controls. These participants were followed up for 5 years. We estimated the hazard ratios for ischemic stroke occurrence in the patient groups for all cancer types and nine specific cancer types during follow-up at 6 months and 1, 3, and 5 years.

RESULTS

For all cancer types, except colorectal, gallbladder, bile duct, and head and neck cancers, the slope of the cumulative increase in ischemic stroke in the early period was higher than that in longer follow-up durations. Ischemic stroke risk was elevated after the 6-month follow-up in patients with cancer compared to patients without cancer (95% confidence interval [CI]: 1.56-1.94). Over 3-5 years, Ischemic stroke risk increased in patients with lung (CI: 1.56-2.04), pancreatic (CI: 1.33-1.95), and liver cancers (CI: 1.07-1.39), compared to cancer-free individuals, whereas no significant increase was observed in patients with thyroid (CI: 0.79-1.13), stomach (CI: 0.92-1.17), colorectal (CI: 0.69-1.48), gallbladder (CI: 0.91-9.89), bile duct (CI: 0.39-3.50), and head and neck (CI: 0.26-74.30) cancers.

CONCLUSION

Our findings regarding stomach, colorectal, and liver cancers differ from the results of Western studies. Conducting a nationwide study within each country, rather than applying findings from other countries, is preferable for predicting and preventing ischemic stroke development in patients with cancer when using insurance-based data.

Burden of colorectal cancer attributable to high body-mass index in 204 countries and territories, 1990-2021: Results from the Global Burden of Disease Study 2021

OBJECTIVES

A strong association between high Body Mass Index (BMI) and Colorectal Cancer (CRC) has been well established. However, the global burden of CRC attributable to high BMI remains underexplored. This study aims to examine and analyze the burden of CRC linked to high BMI at global, regional, and national levels from 1990 to 2021.

STUDY DESIGN

A descriptive analysis of the Global Burden of Disease (GBD) Study 2021.

METHODS

Data on the number of deaths and disability-adjusted life years (DALYs), as well as age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR), were extracted from the GBD 2021. Average annual percentage change (AAPC) was calculated to evaluate the temporal change in ASDR and ASMR using Joinpoint regression analysis. The Population Attributable Fractions (PAF) were used to analyze the CRC burden attributed to risk factors.

RESULTS

In 2021, the global deaths and DALYs of CRC attributed to high BMI were 99,270 deaths and 2,364,660 years respectively, more than double the figures from 1990. High SDI regions bore the greatest burden while low-middle and middle SDI regions experienced a faster rise, with individuals over 60 and males being the most affected. East Asia, particularly China, had the heaviest burden globally. ASMR and ASDR were correlated with SDI. The top five risk factors for CRC burden were a diet low in whole grains (17.72 %), a diet low in milk (15.10 %), a diet high in red meat (14.55 %), high BMI (9.69 %) and a diet low in calcium (8.20 %) in 2021.

CONCLUSION

High BMI is a significant risk factor for CRC, with aging, population growth, gender, and SDI contributing to geographic and temporal variations in the burden. These findings highlight the urgent need for targeted prevention strategies, especially in high-risk populations, and emphasize the role of obesity prevention, early screening, lifestyle and dietary modifications, and interventions such as AI-driven technologies to reduce the CRC burden.

Temporal trends, disease burden and attributable risk factors of stomach and colorectal cancers among 31 countries and territories in Western Pacific region, 20002021

Objective

This study aimed to describe the updated disease burden and temporal trends of stomach cancer (SC) and colorectal cancer (CRC), and to explore potential influence factors of the two cancers in the Western Pacific region (WPR).

Methods

Estimates of incidence, deaths, and disability-adjusted life years (DALYs) for SC and CRC were obtained from the Global Burden of Disease Study 2021. Trends in age-standardized incidence rates (ASIR), age-standardized mortality rates (ASMR), and age-standardized DALY rates (ASDR) were assessed. A decomposition analysis was conducted to quantify the role of three factors (i.e., population aging, population growth, and epidemiological change) driving DALY changes between 2000 and 2021. Pearson correlation analysis was used to examine the association between cancer burden and Socio-demographic Index (SDI) at the national level in 2021.

Results

In 2021, the WPR accounted for 61.77% of global incident SC cases and 43.07% of global incident CRC cases. From 2000 to 2021, the ASIR, ASMR, and ASDR of SC and the ASMR and ASDR of CRC decreased, whereas the ASIR of CRC increased by an average of 1.32% per year. Among the 31 WPR countries and territories, China had the highest number of incident cases, deaths, and DALYs for both cancers in 2021. Epidemiology change was the primary driver to the reduction of DALYs for SC, while population aging and population growth contributed to the increase of DALYs for CRC. Additionally, ASMR (r=-0.37, P=0.041) and ASDR (r=-0.43, P=0.016) of SC were negatively correlated with SDI in 2021, whereas positive correlations were observed between SDI and ASIR (r=0.74, P<0.001), ASMR (r=0.47, P=0.008), and ASDR (r=0.36, P=0.044) for CRC.

Conclusions

SC and CRC continue to pose considerable public health threats in the WPR. Targeted prevention and control strategies should be prioritized, particularly in high-burden and resource-limited countries.

Relationship between apparent diffusion coefficient values and clinicopathologic features in rectal cancer: a cross-sectional study

Background

The prognosis of rectal cancer is closely related to its clinicopathologic features. Accurate preoperative assessment of these features is crucial for treatment planning and prognosis prediction. The apparent diffusion coefficient (ADC), derived from diffusion-weighted imaging (DWI), has shown potential as a noninvasive imaging biomarker for evaluating tumor characteristics. This study aimed to explore the relationship between ADC values and the clinicopathological features of rectal cancer.

Methods

We retrospectively recruited 97 eligible patients with rectal adenocarcinoma who underwent magnetic resonance imaging (MRI) and surgical resection at our institution between January 2023 and December 2023. Each patient was evaluated for the presence of extramural vascular invasion (EMVI) or circumferential resection margin (CRM) on MRI, and the mean (ADCmean), minimum (ADCmin), and maximum (ADCmax) ADC values were calculated. Moreover, the relationship between the ADC values and clinicopathological features, including tumor stage, histologic grade, lymphovascular invasion, perineural invasion, and lymph node metastasis, were statistically analyzed.

Results

Among 97 patients with rectal cancer, the mean age was 61.40±10.46 years and 60 (61.9%) were males. ADCmean, ADCmin, and ADCmax were significantly lower in patients with EMVI or CRM than in those without EMVI or CRM (P<0.05). Pathologic T1-2 staging exhibited higher ADCmean (0.79±0.26 vs. 0.61±0.22, P=0.001), ADCmin (0.71±0.26 vs. 0.55±0.22, P=0.002) and ADCmax (0.89±0.26 vs. 0.75±0.22, P=0.004) compared with T3-4 staging. Highly and moderately differentiated tumors had higher ADCmean, ADCmin, and ADCmax than less-differentiated tumors (P<0.05). Patients with lymphovascular invasion, perineural invasion, and lymph node metastasis showed significantly lower ADCmean, ADCmin, and ADCmax than those without these conditions (P<0.05). ADCmean, ADCmin and ADCmax were negatively correlated with EMVI (r=-0.334, -0.340, -0.302), CRM (r=-0.362, -0.414, -0.276), pathologic T-stage (r=-0.324, -0.313, -0.276), histologic grade (r=-0.353, -0.352, -0.289), lymphovascular invasion (r=-0.405, -0.384, -0.421), perineural invasion (r=-0.428, -0.407, -0.265), and lymph node metastasis (r=-0.347, -0.316, -0.268) in rectal cancer.

Conclusions

ADC values were negatively associated with different clinicopathological features of rectal cancer, suggesting their potential role as noninvasive imaging markers for preoperative tumor assessment.

Global, regional, and national burden of disease analysis on paralytic ileus and intestinal obstruction in adults aged 65 and over from 1990 to 2021, with projections for 2030: a Global Burden of Disease Study 2021 analysis

OBJECTIVE

This study aimed to evaluate the burden and trends of paralytic ileus and bowel obstruction in individuals aged ≥ 65 years, offering insights into prevention, treatment, and healthcare policy.

METHODS

Data from the Global Burden of Disease Study 2021 were used to analyze paralytic ileus and intestinal obstruction by demographics, year, country/region, and Socio-Demographic Index (SDI). The statistical methods included Joinpoint regression, decomposition analysis, and Bayesian Age-Period-Cohort modeling.

RESULTS

In 2021, the global age-standardized incidence of paralytic ileus and intestinal obstruction among the elderly was 643.45 cases per 100,000 individuals. The corresponding prevalence was 24.05 per 100,000 individuals, with disability-adjusted life years (DALYs) of 294.01 per 100,000 person-years and a mortality rate of 20.55 per 100,000 individuals. Between 1990 and 2021, the age-standardized incidence and prevalence of paralytic ileus and intestinal obstruction in the elderly gradually increased, while age-standardized DALYs and mortality consistently declined. Despite similar trends observed across both genders, the disease burden increased with age and was more pronounced in males than in females. Furthermore, the age-standardized incidence and prevalence of these conditions increased with SDI, whereas mortality and DALYs decreased. By 2030, the incidence and prevalence are expected to continue increasing, whereas mortality and DALYs are expected to decrease.

CONCLUSIONS

Despite the consistent decrease in mortality and DALYs associated with paralytic ileus and bowel obstruction in the elderly population aged ≥ 65 years, their incidence and prevalence continue to increase annually. This underscores the importance of improving preventive measures, early screening, and treatment efforts to address this pressing public health challenge.

Exercise-induced extracellular vesicles mediate apoptosis in human colon cancer cells in an exercise intensity-dependent manner

Regular exercise reduces the incidence and improves the prognosis of many cancer types, but the underlying mechanisms remain elusive. Evidence suggests that exercise exerts its therapeutic effects through extracellular vesicles (EVs), which are essential for cellular communication. Here, we hypothesized that exercise-induced EVs from serum of healthy individuals would exert anti-tumorigenic effects on human colon cancer HT-29 cells, in an exercise intensity-dependent manner. Ten healthy young active males participated in a randomized crossover trial, completing two workload-matched acute exercise bouts, moderate-intensity continuous exercise (MICE) and high-intensity interval exercise (HIIE), on a cycle ergometer. A control session of rest (PRE) was included. EVs were isolated from serum samples collected during PRE and immediately after each exercise session. EVs were co-incubated with HT-29 colon cancer cells, and the effects on cell viability, migration, and apoptosis were measured. EV treatment reduced cell viability in all groups (PRE, MICE, and HIIE) by 35%, 43% and 47%, respectively, vs. PBS. HIIE-EVs showed a significantly greater reduction in cell viability vs. PRE; therefore, only these groups were used for further analysis. PRE EVs reduced migration by 27%, and HIIE-EVs by 39%. HIIE-EVs increased expression of pro-apoptotic markers: Bax/Bcl-2 ratio by 56% and Caspase 3 by 30% vs. PBS, with no change observed in the PRE group. Further, 16% of cells in PRE and 28% of cells in HIIE were TUNEL-positive, indicating DNA fragmentation. To our knowledge, this is the first human study that illustrates the therapeutic potential of exercise-induced EVs in cancer treatment.

Death domain-associated protein (Daxx) impairs colon cancer chemotherapy by inhibiting the cGAS-STING pathway

Background

Colorectal cancer (CRC) holds the third position in global cancer prevalence mortality. Although chemotherapy is a conventional treatment, recent investigations have shed light on the therapeutic potential of the cGAS cyclic GMP-AMP synthase (cGAS)-stimulator of interferon genes (STING) pathway in CRC management. Despite the primary role of the death domain-associated protein (Daxx) in cellular apoptosis, its influence on the regulation of cGAS-STING activation remains elusive.

Methods

The Daxx degradation and speck formation were conducted using immunofluorescence and Western blotting. The Daxx knock-down and over-expression in CRC cells were performed to detect in vivo and in vitro migration, proliferation, cGAS-STING activation, and immune responses.

Results

Our study reveals that treatment with irinotecan (CPT-11) and oxaliplatin (OXA) significantly accelerated the Daxx degradation and diminished the formation of Daxx specks within the nucleus of CRC cells. Genetic elimination of Daxx enhanced the irinotecan and oxaliplatin-induced suppression of proliferation and migration in CRC cells, and overexpression of Daxx resulted in similar results. Mechanistically, Daxx overexpression reduced DNA damage repair by restraining homologous recombination (HR) over non-homologous end-joining (NHEJ), which suppressed TBK1 and IRF3 phosphorylation downstream of the cGAS-STING signal. In a murine model of CT-26 tumors, Daxx knockdown amplified the OXA-mediated tumor growth inhibition by promoting STING activation and immune responses.

Conclusions

Our findings show that the degradation of nuclear Daxx potentiates the cGAS-STING pathway, thereby bolstering the efficacy of chemotherapy.

Advancing Colorectal Cancer Diagnostics from Barium Enema to AI-Assisted Colonoscopy

Colorectal cancer (CRC) remains a major global health burden, necessitating continuous advancements in diagnostic methodologies. Traditional screening techniques, including barium enema and fecal occult blood tests, have been progressively replaced by more precise modalities, such as colonoscopy, liquid biopsy, and artificial intelligence (AI)-assisted imaging. Objective: This review explores the evolution of CRC diagnostic tools, from conventional imaging methods to cutting-edge AI-driven approaches, emphasizing their clinical utility, cost-effectiveness, and integration into multidisciplinary healthcare settings. Methods: A comprehensive literature search was conducted using the PubMed, Medline, and Scopus databases, selecting studies that evaluate various CRC diagnostic tools, including endoscopic advancements, liquid biopsy applications, and AI-assisted imaging techniques. Key inclusion criteria include studies on diagnostic accuracy, sensitivity, specificity, clinical outcomes, and economic feasibility. Results: AI-assisted colonoscopy has demonstrated superior adenoma detection rates (ADR), reduced interobserver variability, and enhanced real-time lesion classification, offering a cost-effective alternative to liquid biopsy, particularly in high-volume healthcare institutions. While liquid biopsy provides a non-invasive means of molecular profiling, it remains cost-intensive and requires frequent testing, making it more suitable for post-treatment surveillance and high-risk patient monitoring. Conclusions: The future of CRC diagnostics lies in a hybrid model, leveraging AI-assisted endoscopic precision with molecular insights from liquid biopsy. This integration is expected to revolutionize early detection, risk stratification, and personalized treatment approaches, ultimately improving patient outcomes and healthcare efficiency.

Association between red and processed meat consumption and colorectal cancer risk: a comprehensive meta-analysis of prospective studies

Increasing evidence suggests that red and processed meat consumption may elevate the risk of colorectal cancer (CRC), yet the magnitude and consistency of this association remain debated. This meta-analysis aims to quantify the relationship between red and processed meat intake and the risk of CRC, colon cancer, and rectal cancer using the most comprehensive set of prospective studies to date. We conducted a comprehensive search in PubMed, Web of Science, Cochrane Library, Embase, and Google Scholar databases from 1990 to November 2024, to identify relevant prospective studies examining red, processed, and total meat consumption in relation to colorectal, colon, and rectal cancer risk. Hazard ratios (HR) and 95% confidence intervals (CI) were extracted for each study and pooled using a random-effects model to account for variability among studies. Statistical evaluation was executed using the online platform MetaAnalysisOnline.com. A total of 60 prospective studies were included. Red meat consumption was associated with a significantly increased risk of colon cancer (HR = 1.22, 95% CI 1.15-1.30), colorectal cancer (HR = 1.15, 95% CI 1.10-1.21), and rectal cancer (HR = 1.22, 95% CI 1.07-1.39). Processed meat consumption showed similar associations with increased risk for colon cancer (HR = 1.13, 95% CI 1.07-1.20), colorectal cancer (HR = 1.21, 95% CI 1.14-1.28), and rectal cancer (HR = 1.17, 95% CI 1.05-1.30). Total meat consumption also correlated with an elevated risk of colon cancer (HR = 1.22, 95% CI 1.11-1.35), colorectal cancer (HR = 1.17, 95% CI 1.12-1.22), and rectal cancer (HR = 1.28, 95% CI 1.10-1.48). This meta-analysis provides robust evidence that high consumption of red and processed meats is significantly associated with an increased risk of colorectal, colon, and rectal cancers. These findings reinforce current dietary recommendations advocating for the limitation of red and processed meat intake as part of cancer prevention strategies.

Assessing the prognostic and therapeutic value of cuproptosis-related genes in colon adenocarcinoma patients

Background

Colon adenocarcinoma (COAD) remains a major global health challenge with poor prognosis despite advances in treatment, underscoring the need for new biomarkers. As a novel mode of cell death, cuproptosis is thought to be potentially involved in the development of cancer. However, the particularly as the role of cuproptosis-related genes (CRGs) in COAD prognosis and therapy remains unclear.

Methods

We analyzed RNA sequencing data from The Cancer Genome Atlas for COAD, focusing on CRG expression patterns and their clinicopathological correlations. Using the Weighted Gene Co-expression Network Analysis (WGCNA) method, we identified the gene module most strongly linked to cuproptosis and conducted functional enrichment analysis to explore the roles of genes within this module in COAD tumorigenesis. A novel prognostic risk model based on four CRGs (ORC1, PTTG1, DLAT, PDHB) was developed to stratify COAD patients into high-risk and low-risk groups, assessing overall survival, tumor microenvironment, and mutational landscape differences. We also evaluated the therapeutic effects of ferredoxin 1 (FDX1) and elesclomol in promoting cuproptosis in HCT116 and LoVo cell lines through various experiments, including cell proliferation, apoptosis assessment, mitochondrial membrane potential evaluation, and DLAT lipoylation detection via Western blot.

Results

Certain CRGs showed different expressions in COAD versus normal tissues. WGCNA identified a gene module linked to cuproptosis, crucial for pathways like cell cycle regulation, citrate cycle (TCA cycle), and DNA replication. The novel risk model stratified patients into high and low-risk groups based on risk scores, revealing that high-risk COAD patients had shorter overall survival and distinct immune cell infiltration, while low-risk patients were more sensitive to immunotherapy. Experimental results indicated that FDX1 exerted an inhibitory effect on COAD, and its combination with elesclomol significantly reduced proliferation, promoted apoptosis, increased DLAT lipoylation, and lowered mitochondrial membrane potential in COAD cells.

Conclusion

The findings of this study provided a new perspective for the research on biomarkers and therapeutic strategies in COAD, evaluated the prognostic and therapeutic value of CRGs in COAD patients, and laid a theoretical foundation for the future clinical application of CRGs.

Burden and Trends of Diet-Related Colorectal Cancer in OECD Countries: Systematic Analysis Based on Global Burden of Disease Study 1990-2021 with Projections to 2050

Background: An unhealthy diet is a major risk factor for colorectal cancer (CRC). This study assessed the diet-related CRC burden from 1990 to 2021 in Organisation for Economic Co-operation and Development (OECD) nations and estimated the burden until 2050. Methods: Data for OECD countries on diet-related CRC disability-adjusted life years (DALYs) and deaths were obtained from the Global Burden of Disease 2021 study. The estimated annual percent change (EAPC) was calculated to analyse the CRC burden attributable to dietary factors. A generalised additive model with a negative binomial distribution was used to predict the future burden of CRC attributable to dietary factors from 2021 to 2050. Results: In 2021, the age-standardised percentages of diet-related CRC DALYs and deaths were 39.1% (95% uncertainty interval (UI): 9.3, 61.3) and 39.0% (95% UI: 9.7, 60.9), respectively, in the OECD countries. Between 1990 and 2021, the age-standardised DALYs decreased from 185 to 129 per 100,000, and deaths decreased from 8 to 6 per 100,000 population for OECD countries. Similarly, the EAPC in the rates showed a downward trend (EAPCdeaths = -1.26 and EAPCDALYs = -1.20). The estimated diet-related CRC DALYs and deaths are projected to increase to 4.1 million DALYs and 0.2 million deaths by 2050. There is a downward trend in CRC deaths (EAPC = 1.33 for both sexes) and in DALYs (-0.90 for males and -1.0 for females) from 1990 to 2050. Conclusions: The diet-related CRC burden remains significant. Implementing nutrition intervention programmes is necessary to promote access to affordable and nutritious foods and raise awareness about the importance of a healthy diet in reducing CRC risk.

Treatment delay significantly increases mortality in colorectal cancer: a meta-analysis

Delaying the initiation of cancer treatment increases the risk of mortality, particularly in colorectal cancer (CRC), which is among the most common and deadliest malignancies. This study aims to explore the impact of treatment delays on mortality in CRC. A systematic literature search was conducted in PubMed, Web of Science, and Scopus for studies published between 2000 and 2025. Meta-analyses were performed using random-effects models with inverse variance method to calculate hazard ratios (HRs) for both overall and cancer-specific survival at 4-, 8-, and 12-week treatment delay intervals, with heterogeneity assessed through I2-statistics and publication bias evaluated using funnel plots and Egger's test. A total of 20 relevant studies were included in the meta-analysis. The analyses of all patients demonstrated a progressively increasing risk of 12-39% with longer treatment delays (4 weeks, HR = 1.12; 95% CI, 1.08-1.16; 8 weeks, HR = 1.24; 95% CI, 1.16-1.34; 12 weeks, HR = 1.39; 95% CI, 1.25-1.55). In particular, incrementally higher hazard ratios were observed for all-cause mortality at 4 weeks (HR = 1.14; 95% CI, 1.09-1.18), 8 weeks (HR = 1.29; 95% CI, 1.20-1.39), and 12 weeks (HR = 1.47; 95% CI, 1.31-1.64). In contrast, cancer-specific survival analysis showed a similar trend but did not reach statistical significance (4 weeks, HR = 1.07; 95% CI, 0.98-1.18; 8 weeks, HR = 1.15; 95% CI, 0.95-1.39; 12 weeks, HR = 1.23; 95% CI, 0.93-1.63). Treatment delays in colorectal cancer patients were associated with progressively worsening overall survival, with each 4-week delay increment leading to a substantially higher mortality risk. This study suggests that timely treatment initiation should be prioritized in clinical practice, as these efforts can lead to substantial improvements in survival rates.

Lifetime risk of developing and dying from cancer in Henan Province, China: current status, temporal trends, and disparities

Objective

To understand the current status and changing trends in the lifetime risk of residents in Henan Province, China to develop and die from cancer.

Methods

Lifetime risk was estimated using the Adjusted for Multiple Primaries (AMP) method, incorporating cancer incidence, mortality, and all-cause mortality data from 55 cancer registries in Henan Province, China. Estimates were calculated overall and stratified by gender and area. The annual percent change (APC) in lifetime risk from 2010 to 2020, stratified by gender and cancer site, was estimated using a log-linear model.

Results

In 2020, the lifetime risk of developing and dying from cancer was 30.19 % (95 % CI: 29.63 %-30.76 %) and 23.62 % (95 % CI: 23.28 %-23.95 %), respectively. These estimates were higher in men, with values of 31.22 % (95 % CI: 30.59 %-31.85 %) for developing cancer and 26.73 % (95 % CI: 26.29 %-27.16 %) for dying from cancer, compared with women, who had values of 29.02 % (95 % CI: 28.12 %-29.91 %) and 20.08 % (95 % CI: 19.51 %-20.64 %), respectively. There were also geographical differences, with higher estimates in urban areas compared with rural areas. Residents had the highest lifetime risk of developing lung cancer, with a rate of 6.94 %, followed by breast cancer (4.14 %), stomach cancer (3.95 %), esophageal cancer (3.75 %), and liver cancer (2.86 %). Similarly, the highest lifetime risk of dying from cancer was observed for the following sites: lung (5.99 %), stomach (3.60 %), esophagus (3.39 %), liver (2.78 %), and colorectum (1.55 %). Overall, the lifetime risk of developing cancer increased, with an APC of 0.75 % (P < 0.05). Varying trends were observed across different cancer sites. There were gradual decreases in nasopharynx, esophagus, stomach, and liver cancers. Conversely, increasing trends were noted for most other sites, with the highest APCs observed in thyroid, prostate, lymphoma, kidney, and gallbladder cancers.

Conclusion

The lifetime risks of developing and dying from cancer were 30.19 % and 23.62 %, respectively. Variations in cancer risk across different regions, genders, specific cancer sites, and over calendar years provide important information for cancer prevention and policy making in the population.

Cancer incidence and mortality estimates in 2022 in southeast Asia: a comparative analysis

BACKGROUND

Cancer is a leading cause of morbidity and mortality in southeast Asia. We aimed to present and interpret cancer incidence and mortality statistics in the 11 constituent countries of Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand, Timor-Leste, and Viet Nam to inform research priorities, health services, and cancer policy.

METHODS

The number of new incident cases and deaths for all cancers combined and for leading cancers were extracted from the GLOBOCAN 2022 database developed by the International Agency for Research on Cancer for the 11 countries in southeast Asia. For comparison, we extracted estimates from China, India, Japan, Pakistan, South Korea, and the USA. We estimated age-standardised incidence rates (ASIRs) and age-standardised mortality rates (ASMRs) per 100 000 person-years; projections to 2050 were also estimated by multiplying ASIR and ASMR estimates for 2022 by the expected population for 2050. Data on race or ethnicity were not collected.

FINDINGS

Data were extracted on Dec 5, 2024. For the 11 countries in southeast Asia for all cancers combined, 545 725 (47·6%) of a total of 1 146 810 incident cases were estimated in men and 601 085 (52·4%) incident cases were estimated in women in 2022. In the same period, 385 430 (53·8%) of a total of 716 116 deaths were estimated in men and 330 686 (46·2%) deaths were estimated in women. The total cancer ASIR in men and women was highest in Singapore (235·89 per 100 000 and 231·01 per 100 000 respectively), while the corresponding ASMR was greatest in Laos for men (132·91 per 100 000) and Brunei for women (104·20 per 100 000). Breast cancer was the most common cancer among women in all countries (highest ASIRs in Singapore [72·61 per 100 000] and the Philippines [60·34 per 100 000]), and the most common cause of cancer mortality among women in the Philippines (ASMR 21·47 per 100 000), Malaysia (19·30 per 100 000), Singapore (17·82 per 100 000), Viet Nam (14·67 per 100 000), Indonesia (14·35 per 100 000), and Timor-Leste (10·24 per 100 000). Among men, lung cancer was the most frequently diagnosed cancer in the Philippines (ASIR 37·66 per 100 000), Malaysia (23·23 per 100 000), Myanmar (21·59 per 100 000), and Indonesia (21·30 per 100 000), and the leading cause of death due to cancer in the Philippines (ASMR 33·59 per 100 000), Singapore (31·94 per 100 000), Brunei (23·84 per 100 000), Malaysia (20·42 per 100 000), Myanmar (19·91 per 100 000), Indonesia (18·96 per 100 000), and Timor-Leste (12·95 per 100 000). Liver cancer contributed the greatest incidence and mortality in men in Cambodia, Laos, Viet Nam, and Thailand, and was also the leading cause of death due to cancer among women in Laos (ASMR 13·49 per 100 000), Cambodia (13·34 per 100 000), and Thailand (12·14 per 100 000). Cervical cancer was the leading cause of death due to cancer in women in Myanmar (ASMR 13·37 per 100 000); colorectal cancer was the most common cancer in men in Singapore (ASIR 39·41 per 100 00) and Brunei (37·70 per 100 000). By 2050, 2·03 million new cases of cancer are anticipated in southeast Asia annually, an 89·2% increase in men and a 65·6% increase in women, relative to 2022.

INTERPRETATION

The current patterns of cancer incidence and mortality in southeast Asia are primarily driven by breast cancer in women and lung cancer in men, but infection-related cancers (liver and cervix) are common in some countries. Regional collaborations must be strengthened to improve cancer prevention, diagnosis, care, and research in southeast Asia.

FUNDING

National Cancer Institute and the Prostate Cancer Foundation.

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

Background

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

Methods

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

Results

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

Conclusion

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

Prevalence of colonoscopy-related adverse events in older adults aged over 65 years: a systematic review and meta-analysis

BACKGROUND

This study aims to assess the occurrence of colonoscopy-related adverse events (AEs) in adults aged over 65 years, as there has been a significant increase in the prevalence of colonoscopies among the elderly compared to two decades ago.

METHODS

A comprehensive search was conducted on 3 June 2024, using the PubMed, Embase, and Cochrane Library databases. Meta-analyses were performed using the generalized linear-mixed model, and the results were presented as pooled rates with relevant 95% confidence intervals (CIs).

RESULTS

We retrieved a total of 15 417 records and included 13 population-based studies. The overall rates of colonoscopy-related perforation and bleeding in the elderly population were 7.8 (95% CI 5.5-11.2; I2  = 94%) and 23.5 (95% CI 9.0-61.3; I2  = 100%) per 10 000 colonoscopies, respectively. The " > 80 years" group had a significantly higher risk of perforation (RR 2.55; 95% CI 1.15-5.66; I2  = 79%) and bleeding (RR 1.23; 95% CI 1.02-1.48; I2  = 0%) compared to the "65-80 years" group. For screening colonoscopies, the rates of perforation and bleeding were 8.5 (95% CI 7.1-10.2; I2  = 0%) and 27 (95% CI 9.0-81.0; I2  = 99%) per 10 000 colonoscopies, respectively. For diagnostic colonoscopies, the rates of perforation and bleeding were 18 (95% CI 16.2-20.0; I2  = 1%) and 16 (95% CI 8.1-31.3; I2  = 98%) per 10 000 colonoscopies, respectively. Compared to non-therapeutic colonoscopies, therapeutic procedures exhibited higher rates of both perforation (1.5 vs. 0.4 per 10 000 colonoscopies) and bleeding (7.1 vs. 0.5 per 10 000 colonoscopies). The prevalence of cardiopulmonary AEs in the elderly population is relatively high, although the definition used varies across different studies.

CONCLUSIONS

We conducted a comprehensive analysis on the prevalence of AEs related to colonoscopy in older adults. Overall, the AE rates remain low. However, we emphasize the importance of enhancing safety protocols to further minimize risks, ensuring that the benefits of colonoscopy continue to outweigh the risks, especially for patients over the age of 80.

Epidemiology of colorectal cancer: A review with special emphasis on India

Colorectal cancer (CRC) is a common malignancy and cause for death around the world. In India, it ranks as the fourth most incident cancer in both sexes, with 64,863 cases and 38,367 deaths in 2022. With such high mortality, CRC survival in India is way lesser than that of developed countries. While western countries are facing an overall decline in CRC incidence, various regions in India are seeing an increasing trend. Within India, urban regions have markedly higher incidence than rural. Risk factors include consumption of red and processed meat, fried and sugary food, smoking and alcohol, comorbidities such as obesity, diabetes and inflammatory bowel disease (IBD), family history of CRC, adenomas and genetic syndromes, radiation exposure, pesticides and asbestos. Consumption of nutrient-rich well-balanced diets abundant in vegetables, dairy products, whole grains, nuts and legumes combined with physical activity are protective against CRC. Besides these, metformin, aspirin and micronutrient supplements were inversely associated with the development of CRC. Since a considerable proportion of CRC burden is attributed to modifiable risk factors, execution of population level preventive strategies is essential to limit the growing burden of CRC. Identifying the necessity, in this review, we explore opportunities for primary prevention and for identifying high-risk populations of CRC to control its burden in the near future.

Preclinical and Molecular Docking Insights into the Chemopreventive Role of Fenugreek Seed Extract in a Murine Model of Colorectal Cancer

Background/Objectives: Colorectal cancer (CRC) remains a leading cause of cancer-related mortality, necessitating the development of effective preventive strategies. Fenugreek (Trigonella foenum-graecum) possesses well-documented pharmacological properties; however, its chemopreventive potential in colorectal cancer (CRC) remains unexplored. This study evaluates the efficacy of methanolic fenugreek seed extract (FSE) in an azoxymethane (AOM)-induced murine colorectal cancer (CRC) model, focusing on the modulation of oxidative stress, regulation of biomarkers, induction of apoptosis, and maintenance of epithelial integrity. Methods: FSE was extracted using cold maceration (yield: 24%) and analyzed by gas chromatography-mass spectrometry (GC-MS), identifying 13 bioactive compounds, including benzene, 1,3-dimethyl-; 1,3-cyclopentadiene, 5-(1-methylethylidene)-; o-Xylene; benzenepropanoic acid, 3,5-bis(1,1-dimethylethyl)-4-hydroxy-; and benzene, 1,2,3-trimethyl-. All 13 compounds identified were matched with the NIST library with high confidence. Molecular docking was used to assess the interactions of FSE bioactives with E-cadherin-β-catenin complexes. Swiss albino mice received an FSE pre-treatment before AOM induction and continued this treatment three times weekly for 21 weeks. Key assessments included survival analysis, body weight changes, serum biomarker levels (GGT, 5'-NT, LDH), antioxidant enzyme activities (SOD, CAT, GPx1, MDA), reactive oxygen species (ROS) quantification, apoptosis detection via flow cytometry, and immunofluorescence-based evaluation of E-cadherin dynamics. Results: FSE improved survival rates, mitigated AOM-induced weight loss, and dose-dependently reduced serum biomarker levels. Antioxidant enzyme activity was restored, while MDA levels declined. A dose-dependent increase in ROS facilitated apoptosis, as confirmed by flow cytometry (16.7% in the low-dose FSE group and 34.5% in the high-dose FSE group). Immunofluorescence studies revealed that FSE-mediated restoration of E-cadherin localization counteracted AOM-induced epithelial disruptions. Conclusions: FSE exhibits potent chemopreventive potential against CRC by modulating oxidative stress, regulating key biomarkers, inducing apoptosis, and restoring epithelial integrity. These findings support further investigations into its clinical relevance for CRC prevention.

ITGB5 is a prognostic factor in colorectal cancer and promotes cancer progression and metastasis through the Wnt signaling pathway

Integrin beta5 (ITGB5) expression levels are dysregulated in a variety of cancers. However, the mechanism and clinical value of ITGB5 in colorectal cancer (CRC) remain unclear. The Gene Expression Omnibus (GEO) database, real-time PCR, Western blotting and immunohistochemistry were utilized to evaluate ITGB5 expression levels in CRC tissue. Clinical data from the GEO database were obtained to further explore the associations of ITGB5 with clinical features and patient survival. Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis and gene set enrichment analysis (GSEA) were performed to explore the functions and signaling pathways of ITGB5. In addition, ITGB5 expression was inhibited by siRNA, and the roles of ITGB5 in SW480 and RKO cell growth, migration and invasion, as well as in the Wnt/β-catenin signaling pathway, were investigated. Pancancer studies have shown that ITGB5 is highly expressed in a variety of cancers. Moreover, ITGB5 expression is significantly increased in CRC tissues and is correlated with TNM stage, invasion depth, lymph node metastasis and distant metastasis stage. Kaplan-Meier analysis and meta-analysis of the GSE39582 and GSE17538 datasets indicated that a high level of ITGB5 is a high risk factor for overall survival (OS) and disease-free survival (DFS). In addition, receiver operating characteristic (ROC) curve analysis revealed the value of ITGB5 in predicting DFS, and univariate and multivariate analyses showed that ITGB5 may be an independent prognostic factor for DFS. GO and KEGG analyses indicated that many GO terms related to the extracellular matrix (ECM), focal adhesion and ECM-receptor interaction pathways were enriched. GSEA revealed focal adhesion, cancer pathways, ECM-receptor interactions and Wnt signaling pathways in the samples with high ITGB5 expression. Correlation analysis revealed that high ITGB5 expression is significantly correlated with the TGF-β/EMT pathway and WNT targets. Silencing of ITGB5 inhibited SW480 and RKO cell proliferation, invasion and migration. Mechanistically, downregulated ITGB5 expression blocked the Wnt/β-catenin signaling pathway and epithelial-mesenchymal transition (EMT) in CRC cells. Moreover, ITGB5 expression was related to M0 macrophages, M2 macrophages, neutrophils and plasma cell fractions. ITGB5 may be associated with poor prognosis and metastasis in patients with CRC. ITGB5 may hold promise as a prognostic biomarker and a new potential therapeutic target for CRC.

The influence of the microbiome on radiotherapy and DNA damage responses

Colorectal cancer (CRC) is one of the most prevalent cancers in terms of diagnosis and mortality. Radiotherapy (RT) remains a mainstay of CRC therapy. As RT relies on DNA damage to promote tumor cell death, the activity of cellular DNA damage repair pathways can modulate cancer sensitivity to therapy. The gut microbiome has been shown to influence intestinal health and is independently associated with CRC development, treatment responses and outcomes. The microbiome can also modulate responses to CRC RT through various mechanisms such as community structure, toxins and metabolites. In this review we explore the use of RT in the treatment of CRC and the molecular factors that influence treatment outcomes. We also discuss how the microbiome can promote radiosensitivity versus radioprotection to modulate RT outcomes in CRC. Understanding the molecular interaction between the microbiome and DNA repair pathways can assist with predicting responses to RT. Once described, these connections between the microbiome and RT response can also be used to identify actionable targets for therapeutic development.

Exosomal miR-92a-3p modulates M2 macrophage polarization in colorectal cancer: implications for tumor migration and angiogenesis

Colorectal cancer (CRC) is one of the most prevalent malignant neoplasms globally. Its development and metastasis are closely associated with the polarization of macrophages within the tumor microenvironment (TME). In particular, the polarization of M2-type macrophages has been demonstrated to be related to the promotion of tumor growth, migration, and angiogenesis. This study aims to investigate the role of miR-92a-3p in colon cancer-derived exosomes in regulating M2-type macrophage polarization by targeting EID2B and to elucidate the impact of this process on tumor migration and angiogenesis. MicroRNAs that were differentially expressed in plasma exosomes from CRC patients were initially identified through a search of the GEO database. The results were then verified by RT-qPCR using miR-92a-3p. The uptake of exosomes was observed via laser confocal microscopy, and the impact of miR-92a-3p on the polarization of exosomes and macrophages was examined through the use of RT-qPCR and WB. A bioinformatics analysis and a dual-luciferase reporter assay were employed to identify the downstream target of miR-92a-3p and to investigate its effect on the MAPK/ERK pathway. miR-92a-3p was upregulated in plasma exosomes of colon cancer patients and exhibited a positive correlation with lymph node metastasis. The results demonstrated that miR-92a-3p was capable of promoting M0 macrophage polarization toward the M2 phenotype, and of enhancing the migratory and invasive capacities of CRC cells, as well as their angiogenic potential in vitro. Bioinformatic analysis and experimental validation demonstrated that miR-92a-3p targeted EID2B and that this target gene was negatively correlated with M2-type macrophage polarization. The results demonstrated that miR-92a-3p promotes macrophage M2 polarization by activating the MAPK/ERK pathway. miR-92a-3p activates the MAPK/ERK pathway and induces macrophage M2 polarization by targeting EID2B, thereby promoting migration and angiogenesis in CRC. These findings offer new potential targets for the treatment of colon cancer.

Impact of PD1 blockade added to neoadjuvant chemoradiotherapy on rectal cancer surgery: post-hoc analysis of the randomized POLARSTAR trial

BACKGROUND

The addition of PD1 blockade to neoadjuvant chemoradiotherapy (CRT) has been shown to significantly increase pCR rates in locally advanced rectal cancer (LARC). Yet, its impact on total mesorectal excision (TME) remains unknown.

METHODS

A post-hoc analysis of the randomized POLARSTAR trial, which enrolled patients with LARC at eight major colorectal cancer centres in Beijing to compare neoadjuvant CRT plus PD1 blockade with CRT alone, was undertaken. Patients received one of three combinations of neoadjuvant treatments before TME surgery: CRT plus concurrent PD1 blockade (concurrent group), CRT plus sequential PD1 blockade (sequential group), and CRT alone (control group). Several parameters related to TME surgery were studied.

RESULTS

For the concurrent group, the sequential group, and the control group, 52, 46, and 45 patients respectively were included in this analysis. The proportion of patients undergoing sphincter-saving plus one-stage anastomosis surgery was 92% (48 of 52), 96% (44 of 46), and 87% (39 of 45) respectively. The proportion of patients without a stoma was 21% (11 of 52), 17% (8 of 46), and 11% (5 of 45) respectively. The grade 3/4 surgical complication rate was 4% (2 of 52), 7% (3 of 46), and 4% (2 of 45) respectively. Significant differences were observed between the sequential group and the control group with respect to the proportion of patients with TRG0 (37% versus 18% respectively; P = 0.040), ypT0/is ypN0 (39% versus 20% respectively; P = 0.046), and a low neoadjuvant rectal (NAR) score (54% versus 31% respectively; P = 0.025).

CONCLUSIONS

Neoadjuvant CRT plus PD1 blockade enhances pathological tumour regression and is beneficial to the successful implementation of TME in patients with LARC. Validations with larger sample sizes are warranted.

Impact of lifestyle and mental health on colorectal adenomas in China: a prospective cross-sectional survey

Background

Colorectal adenomas, which are precancerous lesions that can develop into colorectal cancer, present a significant challenge due to the lack of comprehensive early screening and clear identification of risk factors.

Objectives

We conduct a double-blind, prospective cross-sectional analysis to examine the relationship between lifestyle, mental health, and colorectal adenomas.

Methods

Between June 2023 and July 2024, we surveyed 246 participants at Hubei Provincial Hospital of Traditional Chinese Medicine in Wuhan using a self-administered online questionnaire.

Results

The majority of participants were over the age of 50 (49.6%), married or living with a partner (87.08%), and employed as office workers or technicians (44.3%). Among the total population, 435 individuals (53.5%) were diagnosed with colorectal adenomas. A significant positive association was observed between being a manager (OR = 2.340; 95% CI = 1.043-5.248) and the presence of colorectal adenomas, as well as having a BMI over 28 (OR = 6.000; 95% CI = 1.501-23.991). After adjusting for professional role and BMI, no significant associations were found between scores on the HADS-D (AOR = 1.031; 95% CI = 0.967-1.099) or PSS-10 (AOR = 0.971; 95% CI = 0.923-1.022) scales and colorectal adenomas. However, higher scores on the AUDIT (AOR = 1.001-1.144), CDS-12 (AOR = 1.028; 95% CI = 1.003-1.054), PSQI (AOR = 1.079; 95% CI = 1.003-1.161), and HADS-A (AOR = 1.156; 95% CI = 1.059-1.262) scales were significantly associated with an increased likelihood of colorectal adenomas.

Conclusion

The study highlights the significance of addressing alcohol consumption, smoking, sleep quality, and anxiety to reduce the risk of colorectal adenomas. Targeted mental health interventions may play a crucial role in alleviating this health burden and enhancing overall population health.

Deciphering the impact of dietary habits and behavioral patterns on colorectal cancer

Colorectal cancer (CRC) is a malignant tumor that originates from the epithelial cells of the colon and rectum. Global epidemiological data shows that in 2020, the incidence and mortality rate of CRC ranked third and second, respectively, posing a serious threat to people's health and lives. The factors influencing CRC are numerous and can be broadly categorized as modifiable and non-modifiable based on whether they can be managed or intervened upon. Non-modifiable factors include age, gender, family history, among others. Among the modifiable factors, dietary habits and behavioral practices are the main intervention measures that people can take to prevent CRC. Numerous studies indicate that a high intake of red and processed meats, fats, as well as habits such as smoking, alcohol consumption, and prolonged sitting, increase the risk of developing CRC. Conversely, consuming ample vegetables, fruits, high dietary fiber, and engaging in moderate regular exercise may reduce the risk of CRC. This article primarily discusses the impact of dietary habits and behavioral practices on the occurrence and development of CRC, along with possible mechanisms, laying the foundation and providing direction for the prevention and control of CRC occurrence and development.

Emerging Frontiers in Colorectal Cancer Therapy: From Targeted Molecules to Immunomodulatory Breakthroughs and Cell-Based Approaches

Colorectal cancer (CRC) is ranked as the second leading cause of cancer-related deaths globally, necessitating urgent advancements in therapeutic approaches. The emergence of groundbreaking therapies, including chimeric antigen receptor-T (CAR-T) cell therapies, oncolytic viruses, and immune checkpoint inhibitors, marks a transformative era in oncology. These innovative modalities, tailored to individual genetic and molecular profiles, hold the promise of significantly enhancing patient outcomes. This comprehensive review explores the latest clinical trials and advancements, encompassing targeted molecular therapies, immunomodulatory agents, and cell-based therapies. By evaluating the strengths, limitations, and potential synergies of these approaches, this research aims to reshape the treatment landscape and improve clinical outcomes for CRC patients, offering new found hope for those who have exhausted conventional options. The culmination of this work is anticipated to pave the way for transformative clinical trials, ushering in a new era of personalized and effective CRC therapy.

Global, regional, and national burden of asthma from 1990 to 2021: A systematic analysis of the global burden of disease study 2021

Background

Asthma is a prevalent non-communicable disease that affects individuals of all ages and has emerged as a significant global public health concern. This study aims to conduct a comprehensive assessment of the burden of asthma worldwide, as well as at regional and national levels, utilizing the Global Burden of Diseases (GBD) 2021 database for the years 1990 to 2021.

Methods

This study utilized the GBD 2021 database to report the prevalent cases and incident cases of asthma, alongside age-standardized prevalence rates (ASPR), age-standardized incidence rate (ASIR), the number of disability-adjusted life years (DALYs), age-standardized DALY rates (ASDR), the number of deaths, and age-standardized mortality rates (ASMR) at global, regional, and national levels for the year 2021. Additionally, it computed the estimated annual percentage change (EAPC) for these asthma burden indicators from 1990 to 2021. This study further analyzed the levels of the above indicators in different gender and age groups, and investigated the association between asthma ASDR/ASMR levels and socio-demographic index (SDI). It also provided an analysis of the contribution of four risk factors to the overall asthma burden.

Results

From 1990 to 2021, the global EAPC for asthma ASIR was -1.04 (95 % confidence interval [CI]:-1.18 to -0.89), the EAPC for ASPR was -1.59 (95 % CI:-1.74 to -1.43), the EAPC for ASDR was -1.91 (95 % CI:-1.98 to -1.84), and the EAPC for ASMR was -2.03 (95 % CI:-2.09 to -1.98). In 2021, the prevalent cases of asthma remained alarmingly high at 260.48 million (95 % UI: 227.21 million to 297.97 million). Developed countries, exemplified by the United States, exhibited elevated asthma ASPR. However, the burden of asthma-related mortality and DALYs predominantly afflicted low- and middle-income nations. In China, there has been a significant decline in ASIR, ASPR, ASDR and ASMR for asthma. In most age groups, the burden of asthma among women was markedly higher than that among men, particularly evident in prevalence and DALYs. Children and the elderly bore a heavier burden of asthma. In 2021, ASDR and ASMR levels varied across countries, generally exhibiting a negative correlation with SDI levels. A high body-mass index continued to be a primary risk factor for asthma on a global scale. Decomposition analysis reveals that population growth plays a significant role in exacerbating the burden of asthma-related deaths and DALYs.

Conclusions

From 1990 to 2021, the burden of asthma as measured by age-standardized rate (ASR) has shown a declining trend. However, the overall burden of asthma remains significantly high. Moreover, there is a notable inequality in the burden of asthma across different regions and populations worldwide. This highlights the urgent need for countries to prioritize asthma management and control strategies to address these disparities and improve health outcomes for affected individuals.

Global, regional, and national burden of gallbladder and biliary tract cancer, 1990 to 2021 and predictions to 2045: an analysis of the Global Burden of Disease study 2021

BACKGROUND

Identifying past, present, and future temporal trends in gallbladder and biliary tract cancer (GBTC) can increase public awareness and promote changes in prevention and treatment strategies.

METHODS

The incidence and death rates of GBTC between 1990 and 2021 were extracted from the Global Burden of Disease study 2021 and assessed according to country, region, year, age, and sex. Time trends were measured using the average annual percentage change (AAPC) and projections of the burden of disease for 2022 to 2045 were made using the Bayesian age-period-cohort model.

RESULTS

In 2021, there were 216,768.3 new cases (95% uncertainty interval [UI], 181,888.0-245,237.6) and 171,961.2 deaths (95% UI, 142,351.8-194,238.4) in GBTC globally. The increases in incidence and deaths were 101.09% and 74.26%, respectively, compared with 1990. The GBTC burden was higher in females and older adults. However, age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR) trended downward from 1990 to 2021, with AAPC at -0.39 (95% CI, -0.52 to -0.26) and -0.88 (95% CI, -0.96 to -0.79), respectively. Although the ASIR and ASDR for both sexes are projected to decline gradually from 2022 to 2045, the incidence and deaths are expected to increase steadily. In addition, the global proportion of GBTC deaths owing to high body mass index in 2021 was 12.66% for females and 10.48% for males, which did not change significantly from 1990.

CONCLUSION

GBTC is becoming a major global health burden, especially among females and older adults. Given the increasing burden of an aging population, there is a need to reduce the incidence of this disease by adopting effective strategies and measures targeting risk factors.

Integrated analysis of non‑coding RNAs (HOTAIR and miR‑130a) and their cross‑talk with TGF‑β1, SIRT1 and E‑cadherin as potential biomarkers in colorectal cancer

Molecular changes have a substantial impact on the onset of colorectal cancer (CRC). Complexes of HOTAIR and miRNAs disrupt several cellular functions during carcinogenesis, primarily by disrupting several carcinogenic signaling pathways. In the present study, the relationships between the serum levels of transforming growth factor-β1 (TGF-β1), sirtuin-1 (SIRT1) and E-cadherin and those of HOX transcript antisense intergenic RNA (HOTAIR) and microRNA-130a (miR-130a) in individuals with CRC were analyzed, including their correlations and diagnostic potential. Patients with colon cancer and healthy volunteers were enrolled in the study. Blood samples were collected from 70 patients with CRC and 30 age-matched healthy control volunteers and reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was used to determine the serum levels of HOTAIR and miR-130a. In addition, the levels of TGF-β1, SIRT1 and E-cadherin were determined utilizing enzyme-linked immunosorbent assays. Patients with CRC were found to have significantly higher TGF-β1, SIRT1, HOTAIR and miR-130a serum levels than those of healthy participants. In addition, patients with high-grade CRC had significantly higher levels of TGF-β1, SIRT1, HOTAIR and miR-130a compared with those of patients with low-grade CRC. A significant reduction in the serum levels of E-cadherin was observed in participants with CRC compared with healthy participants, but no significant difference was detected according to the grade of CRC. Positive correlations were found between HOTAIR and miR-130a, as well as TGF-β1 and SIRT1. By contrast, negative correlations were noted between E-cadherin and HOTAIR, miR-130a, TGF-β1 and SIRT1. Therefore, it may be concluded that the miR-130a/HOTAIR and TGF-β1/SIRT1/E-cadherin axes may serve as novel biomarkers for the early diagnosis of CRC.

Comparison analysis of the burden and attributable risk factors of early-onset and late-onset colorectal cancer in China from 1990 to 2019

OBJECTIVES

The project intended to analyze the impact of burden and related risk factors of late-onset colorectal cancer (LOCRC) and early-onset colorectal cancer (EOCRC) in China, thus offering essential references for optimizing prevention and control strategies.

METHOD

Global Burden of Disease Study was employed to describe burden changes of EOCRC and LOCRC in China during 1990-2019, containing the numbers of incidence, deaths, prevalence, and disability-adjusted life years (DALYs), and to compare attributable deaths and DALYs risk factors in varying age and sex segments.

RESULTS

The numbers and corresponding crude rates of incidence, deaths, prevalence, and DALYs of EOCRC and LOCRC in China during 1990-2019 demonstrated an upward trend across all age categories, with males being dramatically predominant. Overall, over time, the impact of a low-calcium diet and a low-fiber diet on mortality and DALY rates decreased, while the impact of other risk factors increased. In terms of gender, the risk factors affecting males changed greatly, with smoking, inadequate milk intake, and the low whole-grain diet being the main factors in 2019, while in 1990, the main factors were the low-calcium diet, smoking, and inadequate milk intake.

CONCLUSION

The burden of colorectal cancer in China is concerning. Patients grouped by diagnostic age exhibit different characteristics, indicating the need for high-quality research in the future to achieve personalized medicine tailored to different population characteristics.

The effectiveness of Evodia rutaecarpa hot compress on the recovery of gastrointestinal function after laparoscopic surgery for colorectal cancer: A propensity score-matched retrospective cohort study

BACKGROUND

Although the use of hot compresses with the herbal medicine Evodia rutaecarpa (ER) as a complementary and alternative therapy to promote recovery of postoperative gastrointestinal function is gradually increasing in clinical practice, there is still a lack of relevant empirical studies. Particularly, the role of ER hot compress therapy on gastrointestinal recovery post-laparoscopic surgery for colorectal cancer has not been well investigated. The purpose of this study is to evaluate the efficacy and applicability of ER hot compress therapy for the recovery of postoperative gastrointestinal function.

METHODS

This is a retrospective cohort study. Patients were divided into two cohorts, the ER group and the non-ER group. Propensity score matching(PSM) was introduced to limit confounding, and independent samples t-tests, non-parametric tests, or Chi-squared tests were used to compare these two cohorts.

RESULTS

A total of 454 patients were included, with 267 (59%) receiving ER hot compress therapy and 187 (41%) not. After 1:1 PSM, 320 patients were analyzed (160 in each group). Compared to the ER group, patients in the non-ER group had shorter times to return to a semi-liquid diet (p = 0.030) and hospital stay (p<0.001), as well as lower hospital costs (p<0.001). Subgroup analyses revealed no statistically significant differences in the length of hospital stay, hospital costs, postoperative time to return to full-liquid diet, or time to return to semi-liquid diet among stage I and II tumor patients. However, except for hospital costs, the means and standard deviations of the other indicators were generally lower in the ER group. Complication incidence showed no significant difference between the two cohorts before and after PSM.

CONCLUSIONS

The use of ER hot packs after laparoscopic surgery in patients with colorectal cancer has a non-significant effect on the recovery of the gastrointestinal function and, given the results of the study, it is likely that patients with early-stage tumors may benefit more. Therefore, healthcare providers need to consider the individualization, practicality, and economics of treatment options.