Relationship between metalloproteinase-9 (MMP-9) expression and clinicopathology in colorectal cancer: a cross-sectional study

Introduction

According to the WHO's GLOBOCAN database, ~1,931,590 new colorectal cancer (CRC) cases and 915,607 CRC-related deaths occurred in 2020. The incidence of CRC in Indonesia is 8.6%, making it the fourth most common cancer. With CRC, matrix metalloproteinase-9 (MMP-9) has a role in tumour development and progression, such that patients with a higher MMP-9 expression had poorer survival. This study aimed to analyze the relationship between MMP-9 expression and clinicopathology in CRC patients.

Methods

This was an analytic observational study with a cross-sectional research design. It was conducted from November 2021 to June 2022 with 52 patient tissue samples: these were subjected to MMP-9 immunohistochemistry stain, with the GeneTex (Irvine) MMP-9 monoclonal antibody. Patient data were collected with clinical variables based on medical records and histopathological examination by anatomy pathologists.

Results

Primary tumour location, cancer staging, and histopathology grading were associated with MMP-9 (P=0.016, P=0.001, P=0.049). The more proximal to the primary tumour, the higher the stage of cancer, and the higher the histopathological grade, thus the greater the expression of MMP-9.

Conclusion

A significant relationship existed of primary tumour location, cancer staging, and histopathology grading with MMP-9 expression in CRC patients. MMP-9 expression could be a useful indicator for the clinical assessment of tumour biologic behaviour and prognosis in CRC patients.

The Mutation Portraits of Oncogenes and Tumor Supressor Genes in Predicting the Overall Survival in Pancreatic Cancer: A Bayesian Network Meta-Analysis

INTRODUCTION

In pancreatic cancer, the carcinogenesis can not be separated from genetics mutations. The portraits of genes alterations majorily including oncogenes (KRAS, HER2, PD-L1) and tumor supressor genes (P53, CDKN2A, SMAD4). Besides being notorious a screening marker, the genetic mutations were related to the prognosis of pancreatic cancer. The aim of this study is to determine the genetic mutations portrait in predicting the overall survival in pancreatic cancer.

METHODS

The network meta analysis (NMA) was registered in PROSPERO (CRD42023397976) and conducted in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) in addition of NMA extension guidance. Comprehensive searches were done including all studies which reported the overall survival of pancreatic cancer subjects with KRAS, HER2, PD-L1, P53, CDKN2A, SMAD4. Data were collected and analysis will be done based on Bayesian method, Markov Chain Monte Carlo algorithm, using BUGSnet package in R studio. Transivity was controlled by methods and consistency of the NMA will be fitted by deviance information criterion. Data analysis in NMA were presented in Sucra plot, league table, and forest plot.

RESULTS

Twenty-four studies were included in this NMA with 4613 total subjects. The NMA was conducted in random-effects, consistent, and convergence model. Relative to control, the genetic mutation of SMAD4 (HR 1.84; 95%CI 1.39-2.46), HER2 (HR 1.76; 95%CI 1.14-2.71), and KRAS (HR 1.7; 95%CI 1.19-2.48) were significant to have worse survival. The mutations of PD-L1, P53, and CDKN2A also showed poor survival, but not statistically significant compared to control.

CONCLUSION

In pancreatic cancer, the mutation of SMAD4 predicted the worst overall survival, compared to control, also mutation of HER2, KRAS, PD-L1, P53, and CDKN2A.

Gallbladder adenocarcinoma with upper abdominal pain: A case report

Introduction

The most prevalent malignancy of the biliary system and the fifth most common cancer of the gastrointestinal tract is gallbladder cancer. This cancer is extremely aggressive with a 19 % 5-year survival rate. Herein, we report a case of gallbladder cancer with an ambiguous symptom of upper abdominal pain.

Presentation of case

A 51-year-old woman presented with abdominal pain persisting for 3 months. On examination, a lump on the right abdomen measuring 7 × 5 cm was found. Ultrasound showed a gallbladder mass measuring 8 cm, and magnetic resonance imaging showed an infiltrating gallbladder mass suggestive of segment VI liver malignancy. The patient underwent radical cholecystectomy with en bloc hepatectomy and lymph node dissection. Histopathology revealed poorly differentiated gallbladder adenocarcinoma that metastasized to the liver. The postoperative course was uneventful, and the patient was discharged on postoperative day 5.

Discussion

In our case, we performed radical (extended or margin-clearing) cholecystectomy to remove the gallbladder with a margin of normal liver tissue along with regional lymphadenectomy. This procedure is used to improve staging and decrease the risk of recurrence.

Conclusion

Although gallbladder cancer is rare in Indonesian populations, it has a high mortality rate because of the frequently advanced stage of the disease at the time of diagnosis. Radiography may determine its degree and malignancy features. Regardless of the tumor size, the prognosis of gallbladder cancer depends on its stage and removability.

•

Gallbladder cancer is a rare type of malignancy in Indonesian populations.

•

The mortality rate is high owing to the frequently advanced stage at diagnosis.

•

Radiography may determine the degree and malignancy features of the disease.

•

Radical cholecystectomy removes the gallbladder with a margin of normal liver tissue.

•

Regional lymphadenectomy improves staging and decreases recurrence.

The relationship between glycine levels in collagen in the anterior rectus sheath tissue and the onset of indirect inguinal hernia: A cross-sectional study

Introduction

An inguinal hernia is a protrusion of abdominal-cavity contents through the inguinal canal. Protection against an inguinal hernia depends on the integrity of fascial tissue, which is maintained by collagen. Collagen is a structural protein consisting of amino acids, the most common of which is glycine. This study aimed to determine the relationship between glycine and the appearance of lateral inguinal hernias. To this end, the researchers examined the profile of collagen and glycine levels in the tissue of the sheath of the rectus femoris in patients with lateral inguinal hernia (indirect inguinal hernia).

Methods

The study used a cross-sectional design to determine glycine levels in rectus anterior sheath tissue in patients with indirect inguinal hernia. Examination of collagen glycine levels was conducted using the ELISA (Enzyme-Linked immunosorbent assay) method. Data were analyzed using the Statistical Package for the Social Science (SPSS) program. An ANOVA test, Pearson's correlation test, and Spearman's correlation test were also performed. A p-value <0.05 was said to be significant.

Results

Across 72 samples, the mean body mass index (BMI) was 22.5 kg/m2 and, the mean clinical onset was 28.02 months. Correlation tests showed a correlation between glycine levels and clinical onset (p = 0.026). The ANOVA test showed a difference between glycine levels with age group (p = 0.025) and BMI (p = 0.015). The correlation between glycine levels and clinical-grade (p = 0.416) was not statistically significant.

Conclusion

There is a significant relationship between glycine levels and age, BMI, and clinical onset of indirect inguinal hernia.

•

The stability of the abdominal wall depends on the integrity of muscle and fascial tissue.

•

Collagen is a structural protein that helps tissues maintain their mechanical characteristics, structure, and shape.

•

The collagen structure contains amino acids such as glycine, proline, hydroxyproline, alanine, and hydroxylysine.

•

The high glycine content of collagen is vital to promoting collagen turnover, as its deficiency reduces collagen turnover.

•

There is a relationship between glycine levels and age, body mass index, and clinical onset of indirect inguinal hernia.

Adult Hirschsprung disease as acute intestinal obstruction: a case report

Most cases of Hirschsprung disease (HD) cases are known in newborns or infants. Nevertheless, some cases with mild symptoms are not identified until acute presentations, such as bowel obstruction present in adolescence or adulthood. We reported a 25-year-old male with a history of chronic constipation from childhood presenting with bowel obstruction due to HD. As an emergency operation, the Hartmann procedure was performed to overcome the obstruction. The histological result showed an aganglionic segment, confirming HD. We plan a definitive Duhamel endorectal pull-through surgery three to six months in the future. Adult HD is uncommon, and clinicians should be aware when patients with histories of chronic constipation from a young age present with intestinal obstruction.

Profile of collagen prolines level of anterior rectus sheath tissue in indirect inguinal hernia: A cross-sectional study

Introduction

A hernia is a protrusion of an organ or tissue through an abnormal anatomical channel or opening. Epidemiological data indicated an increased prevalence of inguinal hernias in patients with connective tissue diseases. The biomechanical strength of connective tissue is highly dependent on the constituent of the matrix, including collagen. Fibroblasts produce and secrete procollagen containing high concentrations of proline and lysine. Collagen integrity plays an essential role in preventing hernia formation in the abdominal wall. To investigate the relationship between collagen proline levels of the anterior rectus sheath tissue in patients with lateral inguinal hernias (indirect inguinal hernia).

Methods

The study participants consisted of 67 inguinal hernia patients. A sample of anterior rectus tissue was obtained at the time of surgery, then being washed in a PBS buffer (pH 7.4). The measurement of collagen proline levels was subsequently carried out with enzyme linked immunosorbent assay (ELISA).

Results

All study participants were male with mean age of 44 years, mean body mass index of 22.6 kg/m² and mean onset of events of 27 months. Study subjects with reducible, irreducible, and incarcerated hernias were 45.7% (44/67 cases), 14.9% (10/67) and 19.4% (13/67), respectively. The mean proline level of the study subjects was 9.20. Correlation tests showed a correlation of proline levels and age (p = 0.001), body mass index (p = 0.006), and the onset of events (p = 0.023). Meanwhile, correlation of proline levels and occupation (p = 0.235) and clinical degree (p = 0.164) were not statistically significant.

Conclusion

Presence if relationship between proline levels with age, and onset of incidence among indirect inguinal hernia patients.

•

Collagen is the main structural protein in the muscle wall layer.

•

Defects in collagenases will result in abnormal collagen synthesis leading to pathological collagen degradation.

•

Decreases in hydroxyproline and collagen were observed in the fascia and muscle tissue of patients with inguinal hernias.

•

There are a relationship between proline levels with age, and onset of incidence among indirect inguinal hernia.

Association of clinicopathological features and gastric cancer incidence in a single institution

BACKGROUND

Stomach cancer is the fifth most common malignancy. In 2012, 952,000 cancers were diagnosed worldwide, which led to 723,000 deaths. Elderly men are the most frequently observed category of gastric cancer patients, mostly affecting the antrum. The objective of this study was to analyze the association of age with sex, tumor sites, types of surgical intervention, and diagnosed anatomical pathologies in cases of gastric cancer.

METHODS

This cross-sectional descriptive study analyzed the associations between age, sex, tumor sites, types of surgical intervention, and diagnosed anatomical pathologies among the total gastric cancer incidences during medical treatments from January 2016 to May 2019. The study samples were collected from the total gastric cancer respondents who met the inclusion criteria during medical treatments within the study period.

RESULTS

Gastric cancer was most frequently observed among females (56%) and those aged 50-70 years old (47%). Most respondents had advanced stages of gastric cancer at first enrollment at our institution. The most frequently found tumor site was the corpus (43%). The most frequently performed type of surgical intervention was jejunostomy feeding (26%), and the most frequently diagnosed anatomical pathology was adenocarcinoma with poorly differentiation (39%). Overall, age had statistically significant correlations with sex (p < 0.001), tumor sites (p < 0.001), types of surgical intervention (p < 0.001), and diagnosed anatomical pathologies (p < 0.001).

CONCLUSION

Gastric cancer was more common in males than females. In the older age group (>50 years old), gastric cancer was more prevalent in women than men, and the gastric tumor tended to be more distal. Non-cardia gastric cancers were more prevalent than cardia gastric cancers.

Correlation of interleukin-6 and C-reactive protein levels in plasma with the stage and differentiation of colorectal cancer: A cross-sectional study in East Indonesia

Introduction

Tumors most often develop due to inflammatory factors, including inflammatory cells that produce cytokines and cytotoxic mediators that can stimulate malignant transformation. Knowing that interleukin-6 (IL-6) and C-reactive protein (CRP) factor into the development of colorectal cancer (CRC), we aimed to assess IL-6 and CRP's relationship with the stage and differentiation of CRC.

Methods

In a sample of 46 patients with CRC, as confirmed by histopathological examination, plasma levels of IL-6 and CRP were measured from peripheral venous blood samples before surgery and examined using enzyme-linked immunosorbent assay.

Results

Most patients were male (63.0%) and at least 50 years old (73.9%). A positive correlation emerged between stage of CRC and both plasma IL-6 (r = 0.396, p = .003) and CRP (r = 0.376, p = .005) levels, which the Kruskal–Wallis test indicated were highest in stage IV (IL-6: median = 25.80, p = .019; CRP: median = 34.10, p = .040). Plasma IL-6 levels (median = 25.80, p = .019) were higher in well-differentiated CRC, whereas plasma CRP levels (median = 34.10, p = .040] were higher in poorly differentiated tissue. Linear plotting revealed a linear relationship between plasma IL-6 and plasma CRP levels in patients with CRC.

Conclusion

Because the stage of CRC significantly correlates with plasma IL-6 and CRP levels, IL-6 and CRP can serve as diagnostic factors in assessing the progress and prognosis of CRC.

•

Interleukin-6 (IL-6) and C-reactive protein (CRP) levels can indicate inflammation.

•

Chronic inflammation affects the progression of colorectal cancer (CRC).

•

An association exists between IL-6, CRP, and stage of CRC.

•

IL-6 and CRP can be diagnostic factors in assessing CRC's progression.

Association of superoxide dismutase enzyme with staging and grade of differentiation colorectal cancer: A cross-sectional study

Introduction

The increase of superoxide dismutase (SOD) level in colorectal cancer (CRC) patients based on the examination of staging and grade of differentiation still evidently represents a clinical problem. SOD level raises at a certain staging and reduce at a certain grade of differentiation. For that reason, this study aimed to assess the association between SOD and the variables analyzed in this study.

Materials and methods

This study was observational study using a cross-sectional research design aimed to measure the association between SOD and staging as well as grade of differentiation in CRC incidence. The study was conducted in our institution from January until March 2018.

Results

Statistical analyses of the data derived from the laboratory indicated that age and histopathological examination (TNM staging) had statistically significant correlation with SOD1 level. This significant correlation was proven from results of the statistical analyses of each variable at p = 0.039 (age) and p = 0.001 (TNM staging) respectively. Subsequent tests concerning the correlation between age and TNM staging on SOD1 level revealed that the study samples in the category of 30-49 age years old showed statistically significant correlation with SOD1 level with p = 0.009.

Conclusion

The increase of grade of differentiation was proportional to the increase of SOD1 level as antioxidant against cancer in CRC patients.