化疗后结直肠癌转移瘤钙化CT影像学表现与化疗反应之间的关系

OBJECTIVE

To investigate the relationship between CT features of metastatic calcification and the response to chemotherapy in colorectal cancer metastases.

METHODS

A total of 27 patients with 30 sites of calcified metastases who underwent chemotherapy combined with targeted therapy (cetuximab) between January 2011 and December 2016 comprised this retrospective study population. Two radiologists independently evaluated the occurrence of tumor calcification before and after treatment, and evaluated the tumor response after therapy. According to the response evaluation criteria in solid tumors (version 1.1), the best curative effect evaluation of the patients was recorded. The patients were divided into groups as below: (1) Patients who showed complete response (CR) and partial response (PR) were assigned to the response group, and the stable disease (SD) and progressive disease (PD) were assigned to the non-response group. (2) Patients showed CR or PR, or patients showed SD with longer progress free survival (PFS) were assigned to the benefit group, and the remaining patients were assigned to the no benefit group. The difference of different imaging calcification features (morphology, maximum density, and density-time slope) were analyzed.

RESULTS

The most common site of metastases calcification was liver (63.3%), followed by lymph nodes (26.7%). There were 12 cases in the response group, 15 cases in the non-response group; and 13 cases in the benefit group, 14 cases in the no benefit group. The density time growth slope was higher in the response group when compared with the non-response group (P=0.025). The proportion of thhe patients with increased number of calcified foci in the benefit group (61.5%) was higher than that in the no benefit group (14.3%), P=0.018. There was no significant difference in the maximum density between the groups. The calcification of liver metastases were all amorphous calcification, with central calcification (36.8%), eccentric calcification (36.8%), garland calcification (15.8%) and diffuse calcification (10.6%). The lymph node metastases could be diffuse (75.0%), and curve or eggshell calcification (25.0%). There was no statistical difference between the groups.

CONCLUSION

In patients with advanced colorectal cancer metastases treated with cetuximab combined chemotherapy, rapid growth of calcification density and increased calcification number may be valuable imaging features of therapeutic efficacy. The maximal calcification density and morphology of calcification are not related to the therapeutic efficacy.

[Differences in dielectric properties between mucosal and serosal surface of malignant colorectal tissues, adjacent tissues at 1 cm and 3 cm and normal colorectal tissues]

OBJECTIVE

To investigate the differences in dielectric properties (relative permittivity and conductivity) between the mucosal surface and serosal surface of malignant colorectal tissues, adjacent tissues at 1 cm and 3 cm from the tumor focus and normal colorectal tissues.

METHODS

The dielectric properties of the mucosal and serosal surface of malignant colorectal tissues, adjacent tissues (1 cm and 3 cm) and normal colorectal tissues from 39 patients with colorectal cancer were measured with an open-ended coaxial probe within the frequency range of 50 MHz-3 GHz, and the corresponding dielectric properties were analyzed respectively; statistical tests of the data were used to analyze the dielectric properties at 6 specific frequency points.

RESULTS

The dielectric properties were significantly higher in the malignant mucosa surface than in the adjacent tissues and normal colorectal tissues at the 6 specific frequency points (P<0.01). The dielectric properties decreased progressively in adjacent tissues at 1 cm and 3 cm and normal mucosa surface. The mucosal and serosal surface of malignant tissues showed significant differences in dielectric properties at 64 MHz, 128 MHz, 298 MHz, 433 MHz, and 915 MHz (P<0.01) but not at 2450 MHz (P>0.01), but such differences were not observed in normal tissues (P>0.01).

CONCLUSION

The dielectric properties of the mucosal surface of the mucosal decrease in the order of malignant colorectal tissue, adjacent tissues at 1 cm and 3 cm from the tumor foci and normal colorectal tissues. The dielectric properties are higher in the mucosal surface than in the serosal surface in the malignant tissue, but comparable in normal colorectal tissues.

[Spleen tyrosine kinase inhibits proliferation and promotes apoptosis of colorectal cancer cells in vitro via regulating Fra-1]

OBJECTIVE

To investigate the effects of spleen tyrosine kinase (SYK) overexpression on proliferation and apoptosis of colorectal cancer cells and explore the possible mechanism.

METHODS

The mRNA expressions of SYK and Fra?1 in 10 clinical specimens of colorectal cancer and 10 adjacent tissues were measured with qRT?PCR, and their protein expressions were detected with Western blotting. The recombinant plasmid pcDNA.3.1?SYK was constructed and transfected into colorectal cancer cells to induce SYK overexpression, and the cell viability and proliferation were assessed using by MTT assay and BrdU assay, respectively; caspase?3 activity in the cells was evaluated with a commercial kit and the cell apoptosis was analyzed with Annexin?V FITC/PI assay.

RESULTS

The expressions of SYK were significantly decreased in colorectal cancer tissues and colorectal cancer cell lines. Transfection of pcDNA.3.1?SYK into the colorectal cancer cells induced obviously upregulated mRNA and protein expressions of SYK, which caused a significant suppression of the cell viability and proliferation and enhancement of the cell apoptosis along with a significant inhibition of Fra?1 expression.

CONCLUSION

s SYK overexpression inhibits the proliferation and promotes apoptosis of colorectal cancer cells, and these effects are possibly mediated by the regulation of Fra?1 expression by SYK.

[Role of aquaporin-5 in regulating colorectal cancer cell growth in vitro]

OBJECTIVE

To study the role of aquaporin 5(AQP5) in regulating the cell proliferation and apoptosis of human colorectal cancer cells and explore the possible mechanism.

METHODS

A small interfering RNA (siRNA) targeting AQP5 was used to suppress endogenous AQP5 expression in the human colorectal cancer cell lines COLO 205 and SW480, and the transfection efficiency of AQP5 siRNA was determined using immunofluorescence assay and PCR. The changes in the proliferation of the transfected cells was evaluated with MTT assay, and the cell apoptosis was analyzed using Annexin V-FITC/PI and TUNEL assays; the changes of Bax and Bcl2 expressions in the cells were determined using RTPCR and Western blotting.

RESULTS

Transfection with AQP-5-siRNA resulted in a significant reduction (up to 90%) of AQP-5 expression in COLO 205 and SW480 cells. MTT assay showed that AQP-5-siRNA transfection significantly inhibited the cell proliferation compared NS siRNA transfection (P<0.05). Flow cytometric analysis revealed significantly increased apoptotic rate of cells following AQP-5-siRNA transfection compared with NS?siRNA transfection(P<0.05). Real-time quantitative RT-PCR and Western blotting demonstrated that AQP-5-siRNA transfection significantly increased Bax and Bcl-2 expressions at both mRNA and protein levels in the cells.

CONCLUSION

AQP5-siRNA can promote apoptosis of colorectal cancer cells in vitro possibly in relation to its effects on Bax and Bcl expressions.

SHP-2在结直肠癌组织中的表达及临床意义

目的

探讨SHP-2蛋白在结直肠癌中的表达情况及其与病理特征的关系.

方法

采用免疫组织化学法和Western blot方法检测SHP-2蛋白在人结直肠癌组织中的表达情况, 分析其与患者临床病理因素的关系.

结果

结直肠癌组织中SHP-2阳性表达率为25.6%(43/168), 与正常结直肠组织比较, 差异有统计学意义(P<0.05). 结直肠癌组织中SHP-2的蛋白水平为0.2396±0.0655, 与配对正常结直肠组织比较(0.7665±0.1133), 差异有统计学意义(P<0.0001). SHP-2蛋白的低表达与分化程度和淋巴结转移有关, 与性别、年龄、浸润程度、远处转移、TNM分期无关.

结论

SHP-2可能在结直肠癌的发生发展过程中起抑制作用, 并可能成为潜在的治疗靶点.

MicroRNAs在结直肠癌中的研究进展

结直肠癌在我国恶性肿瘤中的发病率较高, 且其死亡率居高不下. 目前, 越来越多的学者十分关注微小RNAs(microRNAs, miRNAs)与结直肠癌的关系. miRNAs是普遍存在于生物体内的一类小分子非编码RNA, miRNAs的异常表达与结直肠癌的发生和进展密切相关. miRNAs可以通过转录后基因调控的方式, 来影响肿瘤细胞的增殖、调亡以及对化疗的敏感性等. 在这里, 我们回顾了近年来关于miRNAs与结直肠癌的相关文献, 了解miRNAs在结直肠癌中的表达、结直肠癌化疗耐药以及其与预后的关系, 从而更好的了解结直肠癌进展的生物学过程, 有助于结直肠癌的诊断与治疗, 提高结直肠癌患者的预后.

[Association of RAS mutations in circulating cell-free DNA in the plasma with clinicopathological features of colorectal cancer]

OBJECTIVE

To detect RAS mutations in the circulating cell-free DNA (cfDNA) in the plasma and explore the their correlation with the clinicopathological features in patients with colorectal cancer.

METHODS

Real-time PCR was used to detect RAS mutations in plasma cfDNA and matched tumor tissue DNA samples from 71 colorectal cancer patients. The correlation of RAS mutations with the clinicopathological features of the patients were analyzed.

RESULTS

Of the 71 patients with colorectal cancer, 23 (32.39%) showed RAS mutations in the cfDNA and 36 (50.7%) showed RAS mutations in tumor tissue DNA, with a concordance rate of 76.06% in the results between the two samples (Kappa=0.523). RAS mutations in the cfDNA were not related to the patients' age (P=0.072), gender (P=0.320), tumor stage (IVa and IVb, P=0.450), primary tumor position (P=0.324), lung metastasis (P=0.237), CEA level (P=0.284) or CA199 level (P=0.427). The positivity rate of RAS mutations in plasma cfDNA was significantly higher in patients with liver metastasis than those without liver metastasis (P=0.045).

CONCLUSION

Plasma cfDNA can be a reliable source of diagnostic DNA to replace the tumor tissue DNA for diagnosis of RAS mutations. RAS mutations in plasma cfDNA occur more frequently in colorectal cancer patients with liver metastasis.

免疫检查点抑制剂在结直肠癌中的应用以及未来发展方向

结直肠癌(colorectal cancer, CRC)是消化系最常见的恶性肿瘤之一, 在我国, 其发病率及死亡率处于逐年上升趋势, 且总体预后相对较差. 近年来, 免疫治疗的基础和临床研究都获得了快速发展, 已成为肿瘤研究的热点. 其中, 免疫检查点抑制剂已经被批准用于包括CRC在内的多种实体肿瘤的临床治疗. 本文将重点阐述免疫检查点的作用、机制和免疫检查点抑制剂在CRC中应用的最新进展, 以及影响其抗肿瘤疗效的因素. 已经完成和正在进行的临床试验肯定了免疫检查点抑制剂在CRC的治疗中的潜力, 尽管部分患者仍对免疫检查点治疗无应答. 因此, 探究免疫检查点抑制剂治疗CRC患者的敏感因素, 对实现个体化精准治疗至关重要. 未来, 免疫检查点抑制剂有望和其他多种治疗方法相联合, 提高患者反应率, 延长患者的生存期.

局部治疗手段在结直肠癌肝转移治疗中的价值

结直肠癌肝转移患者全身治疗是标准治疗, 应该作为每一种治疗策略的初始, 但局部治疗也发挥着重要价值. 手术完全切除肝转移灶仍是目前能治愈结直肠癌和胃肠道神经内分泌肿瘤肝转移的最佳方法. 射频消融主要应用于那些不可切除或术后复发的局限性病灶, 但受转移灶大小、数量和解剖位置的制约. 立体定向放射治疗作为一种非手术的局部治疗是安全、有效的. 微波消融、冷冻消融、高能聚焦超声刀、经皮穿刺瘤内注射无水乙醇、肝动脉栓塞或肝动脉化疗栓塞、肝动脉灌注化疗等也是重要的局部治疗手段, 在患者的综合治疗中发挥重要作用. 本文就以上内容作一综述.

[Expression of cAMP-dependent protein kinase inhibitor beta in colorectal carcinoma and its clinical significance]

OBJECTIVE

To investigate the expression of cAMP-dependent protein kinase inhibitor beta (PKIB) in colorectal carcinoma (CRC) and its association with the clinicopathological factors of the patients.

METHODS

The expression of PKIB mRNA was detected with quantitative real-time PCR in 34 CRC tissues and paired adjacent tissues. Immunohistochemistry was used to detect the expression of PKIB protein in 72 CRC tissue specimens, and the relationship between PKIB protein expression and the clinicopathological features of the patients was analyzed.

RESULTS

The expression of PKIB mRNA was significantly higher in CRC tissues than in the paired asjacent tissues (P<0.0001). The expression of PKIB protein in CRC patients was closely related with tumor infiltration (T stage) (P=0.038) but not with age, gender, tumor size, location, lymph node metastasis (N stage) or distant metastasis (M stage) (P>0.05). The survival time of patients with high PKIB expressions was significantly shorter than that of patients with low PKIB expressions (70.532∓6.190 vs 93.500∓5.847 months, P=0.023).

CONCLUSION

A high expression of PKIB in CRC is positively correlated with tumor infiltration (T stage) and a poor prognosis, suggesting an important role of PKIB in the development of CRC and its value as an indicator for prognostic evaluation of CRC patients.

[C-reactive protein/albumin ratio as a novel inflammation-based prognostic index for predicting outcomes of patients with colorectal cancer]

OBJECTIVE

To evaluate the association of C-reactive protein/albumin ratio (CAR) with the prognosis of patients with colorectal cancer and compare the prognostic value of CAR with other inflammation-based prognostic scoring systems.

METHODS

We retrospectively evaluated 163 newly diagnosed colorectal cancer patients in Nanfang Hospital between January, 2007 and December, 2014. All recommended cutoff values of the clinicopathological factors were defined using receiver- operating characteristic (ROC) curve analyses. We evaluated the prognostic value of CAR in comparison with Glasgow Prognostic Score (GPS) and neutrophil lymphocyte ratio (NLR) with the area under the ROC curve. Univariate and multivariate analyses using the Cox proportional hazards model were performed to identify the factors closely associated with overall survival of the patients. Kaplan-Meier analysis was used to compare overall survival curves between patients with a high CAR and those with a low CAR.

RESULTS

The recommended cutoff value of CAR was 0.132. Kaplan-Meier analysis and log rank test demonstrated a significant difference in the overall survival between patients with a low CAR (<0.132) and those with a high CAR (≥0.132) (2157.0∓395.3 vs 1661.0∓136.4 days, P<0.001). The area under the ROC curve of CAR, NLR and GPS was 0.656, 0.550 and 0.642, respectively, indicating a better prognostic value of CAR. Univariate analyses showed that age, C-reactive protein, albumin, CAR, NLR, GPS, platelet, TMN stage, Dukes stage and chemotherapy regimens were associated with the overall survival of the patients (P<0.05). Multivariate analyses showed that TMN stage [HR=1.689 (95%CI: 1.146-2.488), P=0.008] and Dukes stage [HR=2.447 (95%CI: 1.349-4.441), P=0.003] were associated with the overall survival of the patients.

CONCLUSIONS

Similar to the previously reported inflammation-based prognostic systems (GPS and NLR), CAR is useful for predicting the survival of patients with colorectal cancer and can be complementary to the two prognostic scoring systems.

[Role of Beclin 1 gene in autophagy and apoptosis of SW620 cells]

OBJECTIVE

To study the role of Beclin1 gene in autophagy and apoptosis of SW620 cells.

METHODS

RNA interference was used to knockdown the expression of Beclin 1 in SW620 cells, and the cell viability was measured by MTT assays. The autophagic activity in serum-starved SW620 CRC cells was evaluated by assessing endogenous microtubule-associated protein 1 light chain 3 (LC3) protein levels using immunofluorescence assay. Flow cytometry was used to measure the apoptosis rate of SW620 cells treated with serum deprivation, staurosporine or etoposide, and the protein expression of Beclin1 was detected using Western blotting.

RESULTS

The viability of cells in pSUPER-Becl group was significantly reduced after serum deprivation (P<0.05). Serum deprivation for 24 h resulted in a stronger apoptotic resistance in cells in the control and pSUPER-non groups than in pSUPER-Becl group (P<0.05). Treatment with staurosporine the most significantly increased the cell apoptosis in pSUPER-Becl group (P<0.05), and similar effect was observed with etoposide treatment (P<0.05). As the time of serum deprivation extended, the expression of Beclin 1 in control group and pSUPER-non group increased progressively (P<0.05), which was consistent with the changes in LC3 expression; LC3 expression in pSUPER-Becl group decreased significantly with a prolonged serum starvation (P<0.05).

CONCLUSION

Beclin 1 is a crucial regulator of autophagy and apoptosis in colorectal cancer cells to maintain the balance between autophagy and apoptosis. Beclin 1 may serve as a protective mechanism to protect colorectal cancer cells from injury caused by low nutrition and chemotherapy byregulating cell autophagy.

[Role of Beclin 1 gene in autophagy and apoptosis of SW620 cells]

OBJECTIVE

To study the role of Beclin1 gene in autophagy and apoptosis of SW620 cells.

METHODS

RNA interference was used to knockdown the expression of Beclin 1 in SW620 cells, and the cell viability was measured by MTT assays. The autophagic activity in serum-starved SW620 CRC cells was evaluated by assessing endogenous microtubule-associated protein 1 light chain 3 (LC3) protein levels using immunofluorescence assay. Flow cytometry was used to measure the apoptosis rate of SW620 cells treated with serum deprivation, staurosporine or etoposide, and the protein expression of Beclin1 was detected using Western blotting.

RESULTS

The viability of cells in pSUPER-Becl group was significantly reduced after serum deprivation (P<0.05). Serum deprivation for 24 h resulted in a stronger apoptotic resistance in cells in the control and pSUPER-non groups than in pSUPER-Becl group (P<0.05). Treatment with staurosporine the most significantly increased the cell apoptosis in pSUPER-Becl group (P<0.05), and similar effect was observed with etoposide treatment (P<0.05). As the time of serum deprivation extended, the expression of Beclin 1 in control group and pSUPER-non group increased progressively (P<0.05), which was consistent with the changes in LC3 expression; LC3 expression in pSUPER-Becl group decreased significantly with a prolonged serum starvation (P<0.05).

CONCLUSION

Beclin 1 is a crucial regulator of autophagy and apoptosis in colorectal cancer cells to maintain the balance between autophagy and apoptosis. Beclin 1 may serve as a protective mechanism to protect colorectal cancer cells from injury caused by low nutrition and chemotherapy byregulating cell autophagy.

[Claudin-3 expression in colorectal carcinoma and its significance]

OBJECTIVE

To investigate the expression of claudin-3 in colorectal carcinoma and its association with the occurrence, progression and prognosis of colorectal cancer.

METHODS

Forty surgical specimens of colorectal carcinoma and 22 adjacent normal tissues resected between October, 2010 and January, 2013 at Nanfang Hospital were examined for claudin-3 expression using immunohistochemistry, which was analyzed in association with the clinicopathological parameters and the survival of the patients.

RESULTS

Claudin-3 was expressed mainly on the cell membrane, and its positivity rate was significantly higher in cancer tissues than in normal tissues (92.50% vs 59.09%, P<0.05). In 13 cases claudin-3 expression was detected in both the cancer tissues and adjacent normal tissues with average expression scores of 4.538 and 3.269, respectively (P<0.05). In the cancer tissues, the strongly positive expression rate was significantly higher in poorly differentiated tissues (85.71%) than in well (21.43%) and moderately (36.48%) differentiated tissues (P<0.05), and was higher in cases with lymph node metastasis than in those without (61.11% vs 22.72%, P<0.05). The strongly positive expression rate of claudin-3 was not correlated with the patients'age, gender, tumor location or tumor size (P>0.05). Of the 33 cancer patients followed up, 14 had a postoperative survival time no longer than 3 years and 19 had longer survival time, and their average expression scores differed significantly (4.50 vs 3.526, P<0.05).

CONCLUSION

Claudin-3 is over-expressed in colorectal cancer tissues, and its high expression may promote the occurrence and progression of colorectal cancer. Claudin-3 may serve as a molecular biomarker for early diagnosis and prognostic evaluation.

结直肠癌术前区域动脉灌注化疗的临床价值

区域动脉灌注抗癌药物, 肿瘤组织中高浓度的抗癌药物高度抑制肿瘤细胞的活性, 最大限度的杀伤癌细胞, 除了提高肿瘤局部化疗药物浓度外, 较高浓度的化疗药经门静脉回流到肝脏, 对预防肝转移起到非常重要的作用. 结直肠经术前区域动脉灌注化疗, 肿瘤组织学疗效显著, 肿瘤细胞凋亡明显, 能提高手术根治切除率, 减少术后转移和复发, 提高长期生存率, 而且并发症少, 几无痛苦, 为一种微创和安全的治疗方法, 可以作为一种有效的结直肠癌综合治疗方案.