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Jun SY, Cho S, Kim MJ, Park JW, Ryoo SB, Jeong SY, Park KJ, Shin A. Glycemic traits and colorectal cancer survival in a cohort of South Korean patients: A Mendelian randomization analysis. Cancer Med 2024; 13:e7084. [PMID: 38477501 DOI: 10.1002/cam4.7084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 02/13/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Clinical diabetic traits have been reported to be associated with increased colorectal cancer (CRC) risk in observational studies. Using the Mendelian randomization (MR) analysis method, we examined the causal association between glycemic traits, such as fasting glucose (FG), fasting insulin (FI), and glycosylated hemoglobin A1c (HbA1c), and survival in a cohort of CRC patients. METHODS We conducted a two-sample MR analysis among a cohort of patients with locally advanced CRC at Seoul National University Hospital. Single-nucleotide polymorphisms robustly associated (p < 5 × 10-8 ) with the three glycemic traits were obtained from the Meta-Analyses of Glucose and Insulin-related traits Consortium, Asian Genetic Epidemiology Network, and Korea Biobank Array. Three-year and 5-year overall survival (OS) and progression-free survival (PFS) were used as outcomes. Survival analysis was conducted using subgroup analysis by cancer stage and subsite in a multivariate Cox proportional hazards model adjusted for age and sex to examine whether glycemic traits affected survival. RESULTS A total of 509 patients were included in our final analysis. MR analysis showed that HbA1c levels were associated with poor 3-year OS (β = 4.20, p = 0.02). Sensitivity analyses did not show evidence of any violations of the MR assumptions. In the cancer subgroup analysis of the Cox proportional hazards model, pooled hazard ratios for FG were significantly associated with poor 3-year OS and PFS regardless of cancer stage. FI was not significantly associated with any 3-year survival endpoints. Among Stage III patients, three glycemic traits were significantly associated with both 5-year OS and PFS. Location-specific subgroup analysis showed a significant association between three glycemic traits and 5-year PFS in patients with left-sided colon cancer. FG was associated with poor 3-year survival for colon cancer but not rectal cancer. CONCLUSIONS Our results suggest that FG and HbA1c could be used to predict prognosis in CRC patients. Lifestyle and/or pharmacological interventions targeting glycemic traits could help improve survival for CRC patients.
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Affiliation(s)
- So Yon Jun
- Department of Preventative Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sooyoung Cho
- Department of Preventative Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Medical Research Center, Genomic Medicine Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Min Jung Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Ji Won Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Seung-Bum Ryoo
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Yong Jeong
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Kyu Joo Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Aesun Shin
- Department of Preventative Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
- Medical Research Center, Genomic Medicine Institute, Seoul National University College of Medicine, Seoul, South Korea
- Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul, South Korea
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2
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Liu Z, Song M. Prevalence of colorectal cancer and breast cancer screening according to history of diabetes in 2010-2019. J Med Screen 2023; 30:156-158. [PMID: 37259533 DOI: 10.1177/09691413231175724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
As cancer is overtaking cardiovascular disease as the leading cause of death among diabetics, improved cancer prevention efforts are needed for individuals with diabetes. In this research letter, we used data from the US National Health Interview Survey to examine the use of screening for two major diabetes-related cancers, colorectal cancer, and breast cancer, in individuals with and without diabetes. We found that individuals with diabetes had slightly higher use of colorectal cancer screening and similar use of breast cancer screening compared to those without diabetes in the US. Besides, despite the increasing use of colorectal cancer and breast cancer screening over the past 10 years, screening uptake remains suboptimal. We believe that these findings provide important data to inform policymaking and cancer prevention efforts.
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Affiliation(s)
- Zechen Liu
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - Mingyang Song
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
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3
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Susan M, Macasoi I, Pinzaru I, Dehelean C, Ilia I, Susan R, Ionita I. In Vitro Assessment of the Synergistic Effect of Aspirin and 5-Fluorouracil in Colorectal Adenocarcinoma Cells. Curr Oncol 2023; 30:6197-6219. [PMID: 37504320 PMCID: PMC10377900 DOI: 10.3390/curroncol30070460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/22/2023] [Accepted: 06/25/2023] [Indexed: 07/29/2023] Open
Abstract
Although remarkable progress has been made, colorectal cancer remains a significant global health issue. One of the most challenging aspects of cancer treatment is the resistance of tumor cells to classical chemotherapy. Conventional therapy for colorectal cancer often involves the use of 5-fluorouracil as a chemotherapeutic agent. Aspirin, a drug used primarily to prevent cardiovascular complications, became a focus of attention due to its potential use as an antitumor agent. The purpose of the study was to evaluate the potential synergistic cytotoxic effects of aspirin and 5-fluorouracil on colorectal adenocarcinoma cells. The viability of cells, the impact on the morphology and nuclei of cells, the potential antimigratory effect, and the impact on the expression of the major genes associated with cell apoptosis (Bcl-2, Bax, Bad), as well as caspases 3 and 8, were evaluated. The results indicated that the two compounds exerted a synergistic effect, causing a reduction in cell viability accompanied by changes characteristic of the apoptosis process-the condensation of nuclei and the reorganization of actin filaments in cells, the reduction in the expression of the Bcl-2 gene, and the increase in the expression of Bax and Bad genes, along with caspases 3 and 8. Considering all these findings, it appears that aspirin may be investigated in depth in order to be used in conjunction with 5-fluorouracil to increase antitumor activity.
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Affiliation(s)
- Monica Susan
- Faculty of Medicine, "Victor Babeș" University of Medicine and Pharmacy from Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Ioana Macasoi
- Faculty of Pharmacy, "Victor Babes" University of Medicine and Pharmacy from Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
- Research Center for Pharmaco-Toxicological Evaluations, Faculty of Pharmacy, "Victor Babes" University of Medicine and Pharmacy from Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Iulia Pinzaru
- Faculty of Pharmacy, "Victor Babes" University of Medicine and Pharmacy from Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
- Research Center for Pharmaco-Toxicological Evaluations, Faculty of Pharmacy, "Victor Babes" University of Medicine and Pharmacy from Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Cristina Dehelean
- Faculty of Pharmacy, "Victor Babes" University of Medicine and Pharmacy from Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
- Research Center for Pharmaco-Toxicological Evaluations, Faculty of Pharmacy, "Victor Babes" University of Medicine and Pharmacy from Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Iosif Ilia
- Faculty of Medicine, "Victor Babeș" University of Medicine and Pharmacy from Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Razvan Susan
- Faculty of Medicine, "Victor Babeș" University of Medicine and Pharmacy from Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Ioana Ionita
- Faculty of Medicine, "Victor Babeș" University of Medicine and Pharmacy from Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
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Grigorean VT, Erchid A, Coman IS, Liţescu M. Colorectal Cancer-The "Parent" of Low Bowel Obstruction. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050875. [PMID: 37241107 DOI: 10.3390/medicina59050875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/29/2023] [Accepted: 04/30/2023] [Indexed: 05/28/2023]
Abstract
Introduction: Despite the improvement of early diagnosis methods for multiple pathological entities belonging to the digestive tract, bowel obstruction determined by multiple etiologies represents an important percentage of surgical emergencies. General data: Although sometimes obstructive episodes are possible in the early stages of colorectal cancer, the most commonly installed intestinal obstruction has the significance of an advanced evolutionary stage of neoplastic disease. Development of Obstructive Mechanism: The spontaneous evolution of colorectal cancer is always burdened by complications. The most common complication is low bowel obstruction, found in approximately 20% of the cases of colorectal cancer, and it can occur either relatively abruptly, or is preceded by initially discrete premonitory symptoms, non-specific (until advanced evolutionary stages) and generally neglected or incorrectly interpreted. Success in the complex treatment of a low neoplastic obstruction is conditioned by a complete diagnosis, adequate pre-operative preparation, a surgical act adapted to the case (in one, two or three successive stages), and dynamic postoperative care. The moment of surgery should be chosen with great care and is the result of the experience of the anesthetic-surgical team. The operative act must be adapted to the case and has as its main objective the resolution of intestinal obstruction and only in a secondary way the resolution of the generating disease. Conclusions: The therapeutic measures adopted (medical-surgical) must have a dynamic character in accordance with the particular situation of the patient. Except for certain or probably benign etiologies, the possibility of colorectal neoplasia should always be considered, in low obstructions, regardless of the patient's age.
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Affiliation(s)
- Valentin Titus Grigorean
- General Surgery Department, "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, "Bagdasar-Arseni" Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania
| | - Anwar Erchid
- General Surgery Department, "Bagdasar-Arseni" Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania
| | - Ionuţ Simion Coman
- General Surgery Department, "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, "Bagdasar-Arseni" Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania
| | - Mircea Liţescu
- General Surgery Department, "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, "Sf. Ioan" Clinical Emergency Hospital, 13 Vitan-Bârzeşti Road, 042122 Bucharest, Romania
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Smith L, Von Wagner C, Kaushal A, Rafiq M, Lyratzopoulos G, Renzi C. The Role of Type 2 Diabetes in Patient Symptom Attribution, Help-Seeking, and Attitudes to Investigations for Colorectal Cancer Symptoms: An Online Vignette Study. Cancers (Basel) 2023; 15:1668. [PMID: 36980553 PMCID: PMC10045970 DOI: 10.3390/cancers15061668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 03/12/2023] Open
Abstract
OBJECTIVES Type 2 diabetes is associated with a higher risk of colorectal cancer (CRC) and advanced-stage cancer diagnosis. To help diagnose cancer earlier, this study aimed at examining whether diabetes might influence patient symptom attribution, help-seeking, and willingness to undergo investigations for possible CRC symptoms. METHODS A total of 1307 adults (340 with and 967 without diabetes) completed an online vignette survey. Participants were presented with vignettes describing new-onset red-flag CRC symptoms (rectal bleeding or a change in bowel habits), with or without additional symptoms of diabetic neuropathy. Following the vignettes, participants were asked questions on symptom attribution, intended help-seeking, and attitudes to investigations. RESULTS Diabetes was associated with greater than two-fold higher odds of attributing changes in bowel habits to medications (OR = 2.48; 95% Cl 1.32-4.66) and of prioritising diabetes-related symptoms over the change in bowel habits during medical encounters. Cancer was rarely mentioned as a possible explanation for the change in bowel habits, especially among diabetic participants (10% among diabetics versus 16% in nondiabetics; OR = 0.55; 95% CI 0.36-0.85). Among patients with diabetes, those not attending annual check-ups were less likely to seek help for red-flag cancer symptoms (OR = 0.23; 95% Cl 0.10-0.50). CONCLUSIONS Awareness of possible cancer symptoms was low overall. Patients with diabetes could benefit from targeted awareness campaigns emphasising the importance of discussing new symptoms such as changes in bowel habits with their doctor. Specific attention is warranted for individuals not regularly attending healthcare despite their chronic morbidity.
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Affiliation(s)
- Lauren Smith
- Research Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK; (L.S.)
| | - Christian Von Wagner
- Research Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK; (L.S.)
| | - Aradhna Kaushal
- Research Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK; (L.S.)
| | - Meena Rafiq
- Research Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK; (L.S.)
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne 3052, Australia
| | - Georgios Lyratzopoulos
- Research Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK; (L.S.)
| | - Cristina Renzi
- Research Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK; (L.S.)
- Faculty of Medicine, University Vita-Salute San Raffaele, 20132 Milan, Italy
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6
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Rectal Cancer and Diabetes Relationship: An Evidence-Based Overview for Healthcare Providers. Intern Med 2022. [DOI: 10.2478/inmed-2022-0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abstract
As the third most frequently diagnosed cancer through the worldwide, colorectal cancer (CRC) is the fourth leading cause and account for around 8% of all cancer-related death. Diabetes mellitus (DM) is a complex metabolic disorder characterized by chronic hyperglycemia and inflammation due to deficiency in insulin secretion or dysregulation of the insulin action pathway, which further leads to dysfunction and failure of multiple organs. Many advances have been made in the diagnosis and management of rectal cancer. Although colorectal cancer survival is severely dependent on the stage of disease at diagnosis, it might also be influenced by several risk factors. The relationship between colorectal cancer and diabetes is a complex one and can raise problems in both diagnosis and the management of patients with both conditions. Metabolic pathways of the type II diabetes, glucose intolerance and obesity can be considered as a link to rectal cancer. This article provides not just an overview of the epidemiology, diagnosis and management of CRC and DM, but also highlights of CRC and DM relationship.
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7
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Garranzo-Asensio M, Solís-Fernández G, Montero-Calle A, García-Martínez JM, Fiuza MC, Pallares P, Palacios-Garcia N, García-Jiménez C, Guzman-Aranguez A, Barderas R. Seroreactivity Against Tyrosine Phosphatase PTPRN Links Type 2 Diabetes and Colorectal Cancer and Identifies a Potential Diagnostic and Therapeutic Target. Diabetes 2022; 71:497-510. [PMID: 35040477 DOI: 10.2337/db20-1206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 12/13/2021] [Indexed: 11/13/2022]
Abstract
Colorectal cancer (CRC) and diabetes are two of the most prevalent chronic diseases worldwide with dysregulated receptor tyrosine kinase signaling and strong co-occurrence correlation. Plasma autoantibodies represent a promising early diagnostic marker for both diseases before symptoms appear. In this study, we explore the value of autoantibodies against receptor-type tyrosine-protein phosphatase-like N (PTPRN; full-length or selected domains) as diagnostic markers using a cohort of individuals with type 2 diabetes (T2D), CRC, or both diseases or healthy individuals. We show that PTPRN autoantibody levels in plasma discriminated between patients with T2D with and without CRC. Consistently, high PTPRN expression correlated with decreased survival of patients with CRC. Mechanistically, PTPRN depletion significantly reduced invasiveness of CRC cells in vitro and liver homing and metastasis in vivo by means of a dysregulation of the epithelial-mesenchymal transition and a decrease of the insulin receptor signaling pathway. Therefore, PTPRN autoantibodies may represent a particularly helpful marker for the stratification of patients with T2D at high risk of developing CRC. Consistent with the critical role played by tyrosine kinases in diabetes and tumor biology, we provide evidence that tyrosine phosphatases such as PTPRN may hold potential as therapeutic targets in patients with CRC.
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Affiliation(s)
- María Garranzo-Asensio
- Departamento de Bioquímica y Biología Molecular, Facultad de Óptica y Optometría, Universidad Complutense de Madrid, Madrid, Spain
- Chronic Disease Programme (UFIEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Guillermo Solís-Fernández
- Chronic Disease Programme (UFIEC), Instituto de Salud Carlos III, Madrid, Spain
- Molecular Imaging and Photonics Division, Chemistry Department, Faculty of Sciences, KU Leuven, Leuven, Belgium
| | - Ana Montero-Calle
- Chronic Disease Programme (UFIEC), Instituto de Salud Carlos III, Madrid, Spain
| | - José Manuel García-Martínez
- Area of Physiology, Department of Basic Health Sciences, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Maria Carmen Fiuza
- Surgery Department, University Hospital Fundación Alcorcon, Madrid, Spain
| | - Pilar Pallares
- Central Units, Instituto de Salud Carlos III, Madrid, Spain
| | - Nuria Palacios-Garcia
- Endocrinology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Custodia García-Jiménez
- Area of Physiology, Department of Basic Health Sciences, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Ana Guzman-Aranguez
- Departamento de Bioquímica y Biología Molecular, Facultad de Óptica y Optometría, Universidad Complutense de Madrid, Madrid, Spain
| | - Rodrigo Barderas
- Chronic Disease Programme (UFIEC), Instituto de Salud Carlos III, Madrid, Spain
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Georgescu DE, Patrascu T, Georgescu TF, Tulin A, Mosoia L, Bacalbasa N, Stiru O, Georgescu MT. Diabetes Mellitus as a Prognostic Factor for Locally Advanced Rectal Cancer. In Vivo 2021; 35:2495-2501. [PMID: 34182536 DOI: 10.21873/invivo.12530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIM Currently, the impact of diabetes mellitus (DM) on rectal cancer patients is complex and just partly elucidated. The purpose of this study was to investigate the impact of diabetes mellitus on rectal cancer patients focusing on tumor differentiation grade, neoadjuvant chemoradiotherapy (NACRT) response, disease-free (DFS) and overall (OS) survival. PATIENTS AND METHODS Our study's population consisted of a group of 53 patients diagnosed with locally advanced rectal cancer, who underwent NACRT, followed by radical oncological surgery. This patient population was further divided into two groups according to diabetes presence. RESULTS Downstaging rates, local control, DFS, and OS were lower in the DM subgroup compared to the non-DM locally advanced rectal cancer patients. CONCLUSION The presence of DM at the time of diagnosis of locally advanced rectal cancer patients may be a negative predictive factor for response to neoadjuvant therapy, distant metastases, and local recurrences rates.
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Affiliation(s)
- Dragos Eugen Georgescu
- Department of General Surgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of General Surgery, "Dr. Ion Cantacuzino" Clinical Hospital, Bucharest, Romania
| | - Traian Patrascu
- Department of General Surgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of General Surgery, "Dr. Ion Cantacuzino" Clinical Hospital, Bucharest, Romania
| | - Teodor Florin Georgescu
- Department of General Surgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; .,Department of General Surgery, Bucharest Clinical Emergency Hospital, Bucharest, Romania
| | - Adrian Tulin
- Department of General Surgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of General Surgery, Clinical Emergency Hospital "Prof. Dr. Agrippa Ionescu", Bucharest, Romania
| | - Liviu Mosoia
- Department of General Surgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of General Surgery, Central Military Emergency Hospital "Dr. Carol Davila", Bucharest, Romania
| | - Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Visceral Surgery, Center of Excellence in Translational Medicine "Fundeni" Clinical Institute, Bucharest, Romania
| | - Ovidiu Stiru
- Emergency Institute for Cardiovascular Diseases Prof. Dr. C.C. Iliescu, Bucharest, Romania.,Department of Cardio-Thoracic Pathology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Mihai-Teodor Georgescu
- Department of Radiotherapy II, "Prof. Dr. Alex. Trestioreanu" Institute of Oncology, Bucharest, Romania.,Discipline of Oncology, Department 8 (Radiology, Oncology, Haematology), "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Birch RJ, Downing A, Finan PJ, Howell S, Ajjan RA, Morris EJA. Improving outcome prediction in individuals with colorectal cancer and diabetes by accurate assessment of vascular complications: Implications for clinical practice. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 47:999-1004. [PMID: 33168335 PMCID: PMC8117971 DOI: 10.1016/j.ejso.2020.10.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/21/2020] [Accepted: 10/28/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Diabetes is considered a risk factor for mortality following a diagnosis of cancer. We hypothesised that the risk will vary due to the heterogeneous nature of the population and accurate classification of vascular complications will improve prediction of clinical outcomes. METHODS The COloRECTal cancer data Repository (CORECT-R) was used to identify individuals with primary colorectal cancer, who underwent surgical resection in England (2005-2016). Diabetes was recorded using ICD10 codes (E10-E14) during inpatient hospital admission in the six years preceding cancer diagnosis, complication status was determined using the adapted Diabetes Complications Severity Index (aDCSI). Survival and post-operative outcomes were compared between groups. RESULTS Of 232,367 individuals, 28,642 (12.3%) were recorded as having diabetes, 49.2% of whom had complications according to the aDCSI. Patients with diabetes complications had increased incidence of adverse post-operative outcomes (90-day post-operative mortality (6.6% versus 3.2%) and death during the surgical episode (7.9% versus 3.6%)), compared to those without diabetes. Those without complications had rates comparable to the population without diabetes. The odds of death within a year of diagnosis were higher for those with complicated diabetes compared to those without diabetes [OR 1.58 (95%CI 1.51-1.66) p < 0.01], but no difference was observed between those with uncomplicated diabetes and those without diabetes [OR 1.05 (95%CI 0.99-1.11) p = 0.10]. CONCLUSIONS Prediction of outcome following surgery in colorectal cancer patients with diabetes relies on the accurate assessment of complications. This study suggests that the poor post-operative outcomes in diabetes patients may be associated with diabetes complication rather than diabetes itself.
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Affiliation(s)
- Rebecca J Birch
- Leeds Institute for Data Analytics, Level 11, Worsley Building, University of Leeds, Leeds, LS2 9JT, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
| | - Amy Downing
- Leeds Institute for Data Analytics, Level 11, Worsley Building, University of Leeds, Leeds, LS2 9JT, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Paul J Finan
- Leeds Institute for Data Analytics, Level 11, Worsley Building, University of Leeds, Leeds, LS2 9JT, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Simon Howell
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, UK
| | - Ramzi A Ajjan
- Leeds Teaching Hospitals NHS Trust, UK; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Eva J A Morris
- Nuffield Department of Population Health, Big Data Institute, Old Road Campus, University of Oxford, Headington, Oxford, OX3 7LF, UK
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10
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A Review of Colorectal Cancer in Terms of Epidemiology, Risk Factors, Development, Symptoms and Diagnosis. Cancers (Basel) 2021; 13:cancers13092025. [PMID: 33922197 PMCID: PMC8122718 DOI: 10.3390/cancers13092025] [Citation(s) in RCA: 305] [Impact Index Per Article: 101.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 02/07/2023] Open
Abstract
This review article contains a concise consideration of genetic and environmental risk factors for colorectal cancer. Known risk factors associated with colorectal cancer include familial and hereditary factors and lifestyle-related and ecological factors. Lifestyle factors are significant because of the potential for improving our understanding of the disease. Physical inactivity, obesity, smoking and alcohol consumption can also be addressed through therapeutic interventions. We also made efforts to systematize available literature and data on epidemiology, diagnosis, type and nature of symptoms and disease stages. Further study of colorectal cancer and progress made globally is crucial to inform future strategies in controlling the disease's burden through population-based preventative initiatives.
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11
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Del Puerto-Nevado L, Minguez P, Corton M, Solanes-Casado S, Prieto I, Mas S, Sanz AB, Gonzalez-Alonso P, Villaverde C, Portal-Nuñez S, Aguilera O, Gomez-Guerrero C, Esbrit P, Vivanco F, Gonzalez N, Ayuso C, Ortiz A, Rojo F, Egido J, Alvarez-Llamas G, Garcia-Foncillas J. Molecular evidence of field cancerization initiated by diabetes in colon cancer patients. Mol Oncol 2019; 13:857-872. [PMID: 30628165 PMCID: PMC6441931 DOI: 10.1002/1878-0261.12438] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/01/2018] [Accepted: 12/27/2018] [Indexed: 12/20/2022] Open
Abstract
The potential involvement of type 2 diabetes mellitus (T2DM) as a risk factor for colon cancer (CC) has been previously reported. While several clinical studies show a higher incidence of CC and a lower survival rate in diabetics, others report no association. Our own experience indicates that diabetes does not seem to worsen the prognosis once the tumor is present. Despite this controversy, there are no wide‐spectrum molecular studies that delve into the impact of T2DM‐related mechanisms in colon carcinogenesis. Here, we present a transcriptomic and proteomic profiling of paired tumor and normal colon mucosa samples in a cohort of 42 CC patients, 23 of which have T2DM. We used gene set enrichment and network approaches to extract relevant pathways in diabetics, referenced them to current knowledge, and tested them using in vitro techniques. Through our transcriptomics approach, we identified an unexpected overlap of pathways overrepresented in diabetics compared to nondiabetics, in both tumor and normal mucosa, including diabetes‐related metabolic and signaling processes. Proteomic approaches highlighted several cancer‐related signaling routes in diabetics found only in normal mucosa, not in tumors. An integration of the transcriptome and proteome analyses suggested the deregulation of key pathways related to colon carcinogenesis which converged on tumor initiation axis TEAD/YAP‐TAZ as a potential initiator of the process. In vitro studies confirmed upregulation of this pathway in nontumor colon cells under high‐glucose conditions. In conclusion, T2DM associates with deregulation of cancer‐related processes in normal colon mucosa adjacent to tissue which has undergone a malignant transformation. These data support that in diabetic patients, the local microenvironment in normal colon mucosa may be a factor driving field cancerization promoting carcinogenesis. Our results set a new framework to study links between diabetes and colon cancer, including a new role of the TEAD/YAP‐TAZ complex as a potential driver.
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Affiliation(s)
- Laura Del Puerto-Nevado
- Translational Oncology Division, Oncohealth Institute, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain
| | - Pablo Minguez
- Genetics Department, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain
| | - Marta Corton
- Genetics Department, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain.,Center for Biomedical Network Research on Rare Diseases (CIBERER), ISCIII, Madrid, Spain
| | - Sonia Solanes-Casado
- Translational Oncology Division, Oncohealth Institute, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain
| | - Isabel Prieto
- Radiation Oncology, Oncohealth Institute, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain
| | - Sebastian Mas
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundacion Jimenez Diaz-UAM, Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Ana Belen Sanz
- Nephrology and Hypertension Department, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain.,REDINREN, Madrid, Spain
| | | | - Cristina Villaverde
- Genetics Department, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain.,Center for Biomedical Network Research on Rare Diseases (CIBERER), ISCIII, Madrid, Spain
| | - Sergio Portal-Nuñez
- Bone and Mineral Metabolism Laboratory, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain.,Applied Molecular Medicine Institute, School of Medicine, Universidad San Pablo CEU, CEU Universities, Madrid, Spain
| | - Oscar Aguilera
- Translational Oncology Division, Oncohealth Institute, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain
| | - Carmen Gomez-Guerrero
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundacion Jimenez Diaz-UAM, Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Pedro Esbrit
- Bone and Mineral Metabolism Laboratory, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain
| | - Fernando Vivanco
- Immunoallergy and Proteomics Laboratory, Immunology Department, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain
| | - Nieves Gonzalez
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundacion Jimenez Diaz-UAM, Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Carmen Ayuso
- Genetics Department, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain.,Center for Biomedical Network Research on Rare Diseases (CIBERER), ISCIII, Madrid, Spain
| | - Alberto Ortiz
- Nephrology and Hypertension Department, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain.,REDINREN, Madrid, Spain
| | - Federico Rojo
- Pathology Department, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain
| | - Jesus Egido
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundacion Jimenez Diaz-UAM, Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Gloria Alvarez-Llamas
- REDINREN, Madrid, Spain.,Immunoallergy and Proteomics Laboratory, Immunology Department, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain
| | - Jesus Garcia-Foncillas
- Translational Oncology Division, Oncohealth Institute, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain
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- Translational Oncology Division, Oncohealth Institute, IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain
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