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Ruiz-Belmonte LM, Carrera-Lasfuentes P, Cebollada-Solanas A, Scarpignato C, Lanas A, Gargallo-Puyuelo CJ. Predictive Score for Advanced Colorectal Neoplasia Based on Cardiovascular and Colorectal Cancer Risk Factors. J Clin Med 2024; 13:2887. [PMID: 38792429 DOI: 10.3390/jcm13102887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/04/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Background and Aims: Cardiovascular disease and colorectal cancer (CRC) are significant health problems and share some risk factors. The aim of our study was to develop and validate a predictive score for advanced colorectal neoplasia (CRN) based on risk factors for cardiovascular disease and CRC. Materials and Methods: A cross-sectional study comprising a derivation cohort and an external validation cohort of 1049 and 308 patients, respectively. A prediction score for advanced CRN (CRNAS: Colorectal Neoplasia Advanced Score) was developed from a logistic regression model, comprising sex, age, first-degree family history for CRC, systolic and diastolic blood pressure, total cholesterol, HDL cholesterol, body mass index, diabetes, smoking, and antihypertensive treatment. Other cardiovascular risk scores (Framingham-Wilson, REGICOR, SCORE, and FRESCO) were also used to predict the risk of advanced CRN. The discriminatory capacity of each score was evaluated using the area under the curve (AUC). Results: CRN were found in 379 subjects from the derivation cohort (36%), including 228 patients (22%) with an advanced CRN. Male sex, age, diabetes, and smoking were identified as independent risk factors for advanced CRN. The newly created score (CRNAS) showed an AUC of 0.68 (95% CI: 0.64-0.73) for advanced CRN, which was better than cardiovascular risk scores (p < 0.001). In the validation cohort, the AUC of CRNAS for advanced CRN was 0.67 (95% CI: 0.57-0.76). Conclusions: The newly validated CRNAS has a better discriminatory capacity to predict advanced CRN than cardiovascular scores. It may be useful for selecting candidates for screening colonoscopy, especially in those with cardiovascular risk factors.
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Affiliation(s)
- Lara M Ruiz-Belmonte
- Department of Gastroenterology, Miguel Servet University Hospital, Paseo Isabel La Católica, 1-3, 50009 Zaragoza, Spain
| | | | - Alberto Cebollada-Solanas
- Unidad de Biocomputación, Instituto Aragonés de Ciencias de la Salud (IACS/IIS Aragón), Centro de Investigación Biomédica de Aragón (CIBA), 50009 Zaragoza, Spain
| | - Carmelo Scarpignato
- Department of Health Sciences, United Campus of Malta, MSD 2080 Msida, Malta
| | - Angel Lanas
- Department of Gastroenterology, Lozano Blesa University Clinical Hospital, Av: San Juan Bosco, 15, 50009 Zaragoza, Spain
- Institute of Health Research Aragon (IIS Aragon), 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| | - Carla J Gargallo-Puyuelo
- Department of Gastroenterology, Lozano Blesa University Clinical Hospital, Av: San Juan Bosco, 15, 50009 Zaragoza, Spain
- Institute of Health Research Aragon (IIS Aragon), 50009 Zaragoza, Spain
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Ahmed N, Bechara R. Endoscopic submucosal dissection and JNET classification for colorectal neoplasia: A North American academic center experience. DEN Open 2024; 4:e322. [PMID: 38023663 PMCID: PMC10681000 DOI: 10.1002/deo2.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023]
Abstract
Objectives Endoscopic submucosal dissection (ESD) enables minimally invasive resection of superficial gastrointestinal neoplasms en bloc regardless of size. The Japan narrow band imaging expert team (JNET) classification utilizes optical magnification and narrow band imaging (NBI) to predict pathology. In North America, ESD is far from ubiquitous, and regional outcomes are not widely described. To date there are no North American studies describing the application and yield of the JNET classification as applied in the practice of ESD. Methods A retrospective, single-center, cohort analysis was performed on a prospectively maintained database of ESD procedures. Between July 2016 and February 2023, all consecutive patients treated with ESD for colorectal lesions were identified and stratified by lesion location, JNET, NBI International Colorectal Endoscopic, lateral spreading tumors, and Paris classifications. Univariate analysis was used for clinicopathological data. p < 0.05 was considered statistically significant. Results A total of 112 patients were identified. One lesion, a lipoma, was excluded. Overall, 49.5% (55/111) of lesions were colonic and 50.5% (56/111) rectal. Most lesions were lateral spreading tumors (60.4%, 67/111). Overall, 96.4% (107/111) ESDs were successfully completed, 98.1% (105/107) en bloc, and 87.9% (94/107) R0. Adverse events occurred in 1.8% (2/111) of procedures. The median diameter was 4.0 cm and resected in a median time of 62.0 min. Overall, 70.1% (47/67) lesions were upstaged from pre-ESD biopsy. JNET 2B showed 80.2% (95% CI 71.5-87.1) accuracy for high-grade dysplasia or sm1. All JNET type 3 were ≥sm2 (p < 0.001). Conclusions ESD permits safe and effective resection of superficial colorectal neoplasms. JNET classification was more accurate than pre-resection biopsy at predicting histology in this series.
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Affiliation(s)
- Nabeel Ahmed
- Faculty of Medicine and Health SciencesMcGill UniversityMontrealCanada
| | - Robert Bechara
- Department of GastroenterologyKingston Health Sciences CenterKingstonCanada
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Rogers CR, Korous KM, De Vera MA, Shaukat A, Brooks E, Rifelj KK, Henley C, Johnson W, Rogers TN. "It's Probably Just Hemorrhoids": A Qualitative Exploration of the Lived Experiences and Perceptions of Long-term Survivors of Early-Onset Colorectal Cancer. Cancer Epidemiol Biomarkers Prev 2023; 32:1617-1624. [PMID: 37619592 PMCID: PMC10873071 DOI: 10.1158/1055-9965.epi-23-0443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/24/2023] [Accepted: 08/22/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Colorectal cancer among adults aged <50 years [early-onset colorectal cancer (EOCRC)] is projected to be the leading cause of cancer-related death by 2030. Although evidence-based guidelines for colorectal cancer screening now recommend beginning screening at age 45, the needs of many at-risk young adults are potentially being overlooked. Unanswered questions also remain regarding the effects of EOCRC on quality-of-life and psychosocial outcomes. This qualitative study explored the lived experiences and perceptions of a sample of adult EOCRC survivors in the United States through one-on-one interviews. METHODS An EOCRC advocate survivor team member led 27 structured virtual interviews using a 10-question interview guide. Data were analyzed using a 9-step inductive approach. RESULTS Participants were geographically diverse. Most were women (66.6%) who self-identified as non-Hispanic White (85.2%). The mean age at interview was 40.19 ± 5.99; at diagnosis, 33.93 ± 5.90. Six overarching themes emerged: signs and symptoms, risk factors, system-level factors, quality of life, social support, and reflection. CONCLUSIONS The specific needs of individuals in this younger population of patients with colorectal cancer should be considered during treatment and future interventions and throughout survivorship. IMPACT While the reasons for the increasing incidence of EOCRC are currently unknown, the lived experiences and perceptions of EOCRC survivors noted in this study highlight specific needs of this population that can inform educational materials, comprehensive care, future research, and policy change.
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Affiliation(s)
- Charles R. Rogers
- Medical College of Wisconsin, Institute for Health & Equity, Milwaukee, Wisconsin, United States of America
| | - Kevin M. Korous
- Medical College of Wisconsin, Institute for Health & Equity, Milwaukee, Wisconsin, United States of America
| | - Mary A. De Vera
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Aasma Shaukat
- New York University, Grossman School of Medicine, Department of Medicine, New York, New York, United States of America
| | - Ellen Brooks
- University of Utah School of Medicine, Department of Family & Preventive Medicine, Salt Lake City, Utah, United States of America
| | - Kelly Krupa Rifelj
- Medical College of Wisconsin, Institute for Health & Equity, Milwaukee, Wisconsin, United States of America
| | - Candace Henley
- The Blue Hat Foundation, Chicago, Illinois, United States of America
| | - Wenora Johnson
- Patient-Centered Outcomes Research Institute, Chicago, Illinois, United States of America
| | - Tiana N. Rogers
- University of Utah, Eccles School of Business, Sorenson Impact Center, Salt Lake City, Utah, United States of America
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Patel F, Dilly C, Fayad N, Marri S, Eckert GJ, Kahi C. Long-Term Follow-Up of Colonoscopy Quality Monitoring. Clin Transl Gastroenterol 2023; 14:e00608. [PMID: 37436181 PMCID: PMC10522096 DOI: 10.14309/ctg.0000000000000608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/02/2023] [Indexed: 07/13/2023] Open
Abstract
INTRODUCTION High-quality colonoscopy is paramount for colorectal cancer prevention. Since 2009, endoscopists at our institution have received quarterly report cards summarizing individual colonoscopy quality indicators. We have previously shown that implementing this intervention was associated with short-term improvement in adenoma detection rate (ADR). However, the long-term effect of continued monitoring on colonoscopy quality is unclear. METHODS We conducted a retrospective study of prospectively administered quarterly colonoscopy quality report cards at the Roudebush Veteran's Affairs Medical Center between April 1, 2012, and August 31, 2019. The anonymized reports included individual endoscopists' ADRs, cecal intubation rates, and withdrawal times. Analyses were performed to determine slopes over time for each quality metric by physician and assess for differences based on whether ADRs were calculated quarterly or yearly. RESULTS Data from the report cards of 17 endoscopists who had performed 24,361 colonoscopies were included. The mean quarterly ADR (±SD) was 51.7% (±11.7%) and mean yearly ADR was 47.2% (±13.8%). There was a small increase in overall ADR based on quarterly and yearly measurements (slope + 0.6%, P = 0.02; and slope +2.7%, P < 0.001, respectively), but no significant change in individual ADRs, cecal intubation rates, or withdrawal times. Analysis of SD of ADRs showed no significant difference between yearly and quarterly measurements ( P = 0.064). Individual endoscopists' ADR SD differences between yearly and quarterly measurements ranged from -4.7% to +6.8%. DISCUSSION Long-term colonoscopy quality monitoring paralleled stable improvements in overall ADR. For endoscopists with baseline high ADR, frequent monitoring and reporting of colonoscopy quality metrics may not be necessary.
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Affiliation(s)
- Feenalie Patel
- Department of Medicine, Division of Gastroenterology and Hepatology, Indianapolis, Indiana, USA
| | - Christen Dilly
- Department of Medicine, Division of Gastroenterology and Hepatology, Indianapolis, Indiana, USA
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Nabil Fayad
- Department of Medicine, Division of Gastroenterology and Hepatology, Indianapolis, Indiana, USA
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Smitha Marri
- Department of Medicine, Division of Gastroenterology and Hepatology, Indianapolis, Indiana, USA
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - George J. Eckert
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Charles Kahi
- Department of Medicine, Division of Gastroenterology and Hepatology, Indianapolis, Indiana, USA
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
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Fábián A, Bor R, Szepes Z. The use of ultrasound in colonic and perianal diseases. Curr Opin Gastroenterol 2023; 39:50-56. [PMID: 36504036 PMCID: PMC9799033 DOI: 10.1097/mog.0000000000000891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW To revise recent literature findings regarding the use of ultrasound in colonic and perianal diseases by focusing particularly on its feasibility in inflammatory bowel diseases (IBD), colorectal neoplastic lesions, and perineal diseases, with further highlight on interventional capabilities. RECENT FINDINGS Treat-to-target approach in IBD raised an interest in intestinal ultrasound (IUS) for monitoring bowel activity considering its noninvasive nature, low costs, and well tolerability. New IUS indices have been developed with ever better methodologies and are at various stage of validation. A standardized over-the-wire technique for colonic US using a flexible overtube enables endoscopic ultrasound (EUS)-guided tissue sampling beyond the rectum, and forward-viewing radial-array echoendoscopes can assist identification of early neoplastic lesions in proximal colon. Intraoperative ultrasound and contrast-enhanced ultrasound carry an additional diagnostic value compared to conventional preoperative imaging modalities in detecting colorectal cancer liver metastases (CRLM). SUMMARY The feasibility of IUS in monitoring IBD activity is supported by growing evidence, but uniform IUS indices are still lacking. Recent advancements in EUS are expanding capabilities for determining depth of invasion of colorectal neoplasms, tissue sampling, and EUS-guided interventions to the entire colon. Ultrasonography can be a valuable tool in CRLM diagnostics as well.
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Affiliation(s)
- Anna Fábián
- Department of Internal Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Szeged, Hungary
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Bosák J, Kohoutová D, Hrala M, Křenová J, Morávková P, Rejchrt S, Bureš J, Šmajs D. Escherichia coli from biopsies differ in virulence genes between patients with colorectal neoplasia and healthy controls. Front Microbiol 2023; 14:1141619. [PMID: 37125208 PMCID: PMC10133476 DOI: 10.3389/fmicb.2023.1141619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/27/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Pathogenic strains of Escherichia coli have been clearly identified as the causative agents of extraintestinal and diarrheal infections; however, the etiopathogenic role of E. coli in other conditions, including colorectal cancer, remains unclear. Methods This study aimed to characterize mucosal E. coli isolates (n = 246) from 61 neoplasia patients and 20 healthy controls for the presence of 35 genetic determinants encoding known virulence factors. Results Virulence determinants encoding invasin (ibeA), siderophore receptor (iroN), S-fimbriae (sfa), and genotoxin (usp) were more prevalent among E. coli isolated from patients with neoplasia compared to the control group (p < 0.05). In addition, the prevalence of these virulence determinants was increased in more advanced neoplasia stages (p adj < 0.0125). Compared to patients with advanced colorectal adenoma and carcinoma, the ibeA gene was rarely found in the control group and among patients with non-advanced adenoma (p < 0.05), indicating its potential as the advanced-neoplasia biomarker. Patients with neoplasia frequently had E. coli strains with at least one of the abovementioned virulence factors, whereby specific combinations of these virulence factors were found. Discussion These findings suggest that E. coli strains isolated from patients with colorectal neoplasia possess several virulence factors, which could contribute to the development of neoplastic processes in the large intestine.
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Affiliation(s)
- Juraj Bosák
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Darina Kohoutová
- Center of Biomedical Research, University Hospital Hradec Králové, Hradec Králové, Czechia
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Matěj Hrala
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jitka Křenová
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Paula Morávková
- Second Department of Internal Medicine - Gastroenterology, Charles University, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové, Hradec Králové, Czechia
| | - Stanislav Rejchrt
- Center of Biomedical Research, University Hospital Hradec Králové, Hradec Králové, Czechia
| | - Jan Bureš
- Center of Biomedical Research, University Hospital Hradec Králové, Hradec Králové, Czechia
| | - David Šmajs
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czechia
- *Correspondence: David Šmajs,
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Kim CE, Yoon LS, Michels KB, Tranfield W, Jacobs JP, May FP. The Impact of Prebiotic, Probiotic, and Synbiotic Supplements and Yogurt Consumption on the Risk of Colorectal Neoplasia among Adults: A Systematic Review. Nutrients 2022; 14. [PMID: 36432622 DOI: 10.3390/nu14224937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/09/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022] Open
Abstract
Prebiotic and probiotic supplementation and yogurt consumption (a probiotic food) alter gut microbial diversity, which may influence colorectal carcinogenesis. This systematic review evaluates the existing literature on the effect of these nutritional supplements and yogurt consumption on colorectal neoplasia incidence among adults. We systematically identified ten randomized controlled trials and observational studies in adults age ≥ 18 without baseline gastrointestinal disease. Prebiotics included inulin, fructooligosaccharides, galactooligosaccharides, xylooligosaccharides, isomaltooligosaccharides, and β-glucans. Probiotics included bacterial strains of Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus, Bacillus, Pediococcus, Leuconostoc, and Escherichia coli. Synbiotic supplements, a mixture of both prebiotic and probiotic supplements, and yogurt, a commonly consumed dietary source of live microbes, were also included. We defined colorectal neoplasia as colorectal adenomas, sessile serrated polyps, and colorectal cancer (CRC). Overall, findings suggest a moderate decrease in risk of adenoma and CRC for high levels of yogurt consumption compared to low or no consumption. Prebiotic supplementation was not associated with colorectal neoplasia risk. There was some evidence that probiotic supplementation may be associated with lower risk of adenomas but not with CRC incidence. Higher yogurt consumption may be associated with lower incidence of colorectal neoplasia. We found little evidence to suggest that prebiotic or probiotic supplements are associated with significant decreases in CRC occurrence.
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Gil Vazquez E, Nasreddin N, Valbuena GN, Mulholland EJ, Belnoue-Davis HL, Eggington HR, Schenck RO, Wouters VM, Wirapati P, Gilroy K, Lannagan TR, Flanagan DJ, Najumudeen AK, Omwenga S, McCorry AM, Easton A, Koelzer VH, East JE, Morton D, Trusolino L, Maughan T, Campbell AD, Loughrey MB, Dunne PD, Tsantoulis P, Huels DJ, Tejpar S, Sansom OJ, Leedham SJ. Dynamic and adaptive cancer stem cell population admixture in colorectal neoplasia. Cell Stem Cell 2022; 29:1213-1228.e8. [PMID: 35931031 PMCID: PMC9592560 DOI: 10.1016/j.stem.2022.07.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/01/2022] [Accepted: 07/19/2022] [Indexed: 12/13/2022]
Abstract
Intestinal homeostasis is underpinned by LGR5+ve crypt-base columnar stem cells (CBCs), but following injury, dedifferentiation results in the emergence of LGR5-ve regenerative stem cell populations (RSCs), characterized by fetal transcriptional profiles. Neoplasia hijacks regenerative signaling, so we assessed the distribution of CBCs and RSCs in mouse and human intestinal tumors. Using combined molecular-morphological analysis, we demonstrate variable expression of stem cell markers across a range of lesions. The degree of CBC-RSC admixture was associated with both epithelial mutation and microenvironmental signaling disruption and could be mapped across disease molecular subtypes. The CBC-RSC equilibrium was adaptive, with a dynamic response to acute selective pressure, and adaptability was associated with chemoresistance. We propose a fitness landscape model where individual tumors have equilibrated stem cell population distributions along a CBC-RSC phenotypic axis. Cellular plasticity is represented by position shift along this axis and is influenced by cell-intrinsic, extrinsic, and therapeutic selective pressures.
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Affiliation(s)
- Ester Gil Vazquez
- Wellcome Centre Human Genetics, Roosevelt Drive, University of Oxford, Oxford, UK
| | - Nadia Nasreddin
- Wellcome Centre Human Genetics, Roosevelt Drive, University of Oxford, Oxford, UK
| | - Gabriel N. Valbuena
- Wellcome Centre Human Genetics, Roosevelt Drive, University of Oxford, Oxford, UK
| | - Eoghan J. Mulholland
- Wellcome Centre Human Genetics, Roosevelt Drive, University of Oxford, Oxford, UK
| | | | - Holly R. Eggington
- Wellcome Centre Human Genetics, Roosevelt Drive, University of Oxford, Oxford, UK
| | - Ryan O. Schenck
- Wellcome Centre Human Genetics, Roosevelt Drive, University of Oxford, Oxford, UK
| | - Valérie M. Wouters
- Laboratory for Experimental Oncology and Radiobiology, Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers, Meibergdreef 9, 1105 Amsterdam, the Netherlands,Oncode Institute, Meibergdreef 9, 1105 Amsterdam, the Netherlands
| | - Pratyaksha Wirapati
- Swiss Institute for Bioinformatics, University of Lausanne, Lausanne, Switzerland
| | | | | | | | | | - Sulochana Omwenga
- Wellcome Centre Human Genetics, Roosevelt Drive, University of Oxford, Oxford, UK
| | - Amy M.B. McCorry
- Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, UK
| | - Alistair Easton
- Department of Oncology, Old Road Campus Research Building, Roosevelt Drive, University of Oxford, Oxford, UK
| | - Viktor H. Koelzer
- Department of Pathology and Molecular Pathology, University and University Hospital Zürich, Rämistrasse 100, 8006 Zürich, Switzerland
| | - James E. East
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, and Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Dion Morton
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - Livio Trusolino
- Candiolo Cancer Institute FPO IRCCS, 10060 Candiolo, Torino, Italy
| | - Timothy Maughan
- Department of Oncology, Old Road Campus Research Building, Roosevelt Drive, University of Oxford, Oxford, UK
| | | | - Maurice B. Loughrey
- Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, UK
| | - Philip D. Dunne
- Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, UK
| | - Petros Tsantoulis
- University of Geneva and Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - David J. Huels
- Laboratory for Experimental Oncology and Radiobiology, Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers, Meibergdreef 9, 1105 Amsterdam, the Netherlands,Oncode Institute, Meibergdreef 9, 1105 Amsterdam, the Netherlands
| | - Sabine Tejpar
- Molecular Digestive Oncology Unit, KU Leuven, Leuven, Belgium
| | - Owen J. Sansom
- Cancer Research UK Beatson Institute, Glasgow, UK,Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Glasgow, UK
| | - Simon J. Leedham
- Wellcome Centre Human Genetics, Roosevelt Drive, University of Oxford, Oxford, UK,Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, and Oxford NIHR Biomedical Research Centre, Oxford, UK,Corresponding author
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Jeong SJ, Lee J, Kim E, Hwang JS, Lee J, Choi JH, Heo NY, Park J, Park SH, Kim TO, Park YE. Prevalence and risk of colorectal polyps among the Korean population under 50 years. Medicine (Baltimore) 2022; 101:e29493. [PMID: 35801765 PMCID: PMC9259151 DOI: 10.1097/md.0000000000029493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Colorectal cancer is a common cancer; generally, adults aged ≥ 50 years are screened using stool occult blood tests and colonoscopy. However, colorectal adenoma and cancer have been found in patients under the aged of 50, and studies on characteristics and risk factors in young patients are lacking. We evaluated the prevalence and risk factors of colorectal adenoma and cancer in young adults aged under 50 years. We retrospectively analyzed 570 individuals aged under 50 years who underwent colonoscopy at the Haeundae Paik Hospital, Korea, from January to June 2018. Logistic regression model was used to identify the risk factors for colorectal adenoma and colorectal cancer. The prevalence of colorectal adenoma in group of 19-29 years was 3.2% (1 of 31), 30-39 years was 13.8% (30 of 217) and in the group of 40-49 years was 21.1% (68 of 322) (P = .009). In multivariable analysis, age over 45 years (adjusted odds ratio [OR], 1.941; 95% confidence interval [CI], 1.187-3.172; P = .008) and male sex (adjusted OR, 1.711; 95% CI, 1.044-2.806; P = .033) were independent risk factors for colorectal neoplasia including cancer. The prevalence of colorectal adenoma increases as the age increased in young adults under 50 years of age, especially after the age of 45 years, the risk of colorectal neoplasia increases; hence, early screening should be considered before the age of 50 years.
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Affiliation(s)
- Su Jin Jeong
- Division of Gastroenterology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jinho Lee
- Division of Gastroenterology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Eunju Kim
- Division of Gastroenterology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jun Seong Hwang
- Division of Gastroenterology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jin Lee
- Division of Gastroenterology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Joon Hyuk Choi
- Division of Gastroenterology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Nae-Yun Heo
- Division of Gastroenterology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jongha Park
- Division of Gastroenterology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Seung Ha Park
- Division of Gastroenterology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Tae Oh Kim
- Division of Gastroenterology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Yong Eun Park
- Division of Gastroenterology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
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Kobayashi N, Takeuchi Y, Ohata K, Igarashi M, Yamada M, Kodashima S, Hotta K, Harada K, Ikematsu H, Uraoka T, Sakamoto N, Doyama H, Abe T, Katagiri A, Hori S, Michida T, Yamaguchi T, Fukuzawa M, Kiriyama S, Fukase K, Murakami Y, Ishikawa H, Saito Y. Outcomes of endoscopic submucosal dissection for colorectal neoplasms: Prospective, multicenter, cohort trial. Dig Endosc 2022; 34:1042-1051. [PMID: 34963034 DOI: 10.1111/den.14223] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/07/2021] [Accepted: 12/27/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Endoscopic mucosal resection (EMR) is the gold standard for the treatment of noninvasive large colorectal lesions, despite challenges associated with nonlifting lesions and a high rate of local recurrence. Endoscopic submucosal dissection (ESD) offers the possibility of overcoming these EMR limitations. However, a higher risk of complications and longer procedure time prevented its dissemination. As ESD now provides more stable results because of standardized techniques compared with those used earlier, this study aimed to quantify the rates of en bloc and curative resections, as well as ESD complications, in the present situation. METHODS A multicenter, large-scale, prospective cohort trial of ESD was conducted at 20 institutions in Japan. Consecutive patients scheduled for ESD were enrolled from February 2013 to January 2015. RESULTS ESD was performed for 1883 patients (1965 lesions). The mean procedure time was 80.6 min; en bloc and curative resections were achieved in 1759 (97.0%) and 1640 (90.4%) lesions, respectively, in epithelial lesions ≥20 mm. Intra- and postprocedural perforations occurred in 51 (2.6%) and 12 (0.6%) lesions, respectively, and emergency surgery for adverse events was performed in nine patients (0.5%). CONCLUSIONS This trial conducted after the standardization of the ESD technique throughout Japan revealed a higher curability, shorter procedure time, and lower risk of complications than those reported previously. Considering that the target lesions of ESD are more advanced than those of EMR, ESD can be a first-line treatment for large colorectal lesions with acceptable risk and procedure time. (Clinical Trial Registration: UMIN000010136).
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Affiliation(s)
- Nozomu Kobayashi
- Department of Gastroenterology, Tochigi Cancer Center, Tochigi, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Ken Ohata
- Department of Gastroenterology, NTT Medical Center, Tokyo, Japan
| | - Masahiro Igarashi
- Division of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Masayoshi Yamada
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Shinya Kodashima
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Keita Harada
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Hiroaki Ikematsu
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Toshio Uraoka
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan.,Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Naoto Sakamoto
- Department of Gastroenterology, Juntendo University Hospital, Tokyo, Japan
| | - Hisashi Doyama
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
| | - Takashi Abe
- Department of Gastroenterology, Hanwa Sumiyoshi General Hospital, Osaka, Japan.,Department of Gastroenterology, Takarazuka Municipal Hospital, Hyogo, Japan
| | - Atsushi Katagiri
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Shinichiro Hori
- Department of Gastroenterology, NHO Shikoku Cancer Center, Ehime, Japan
| | - Tomoki Michida
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.,Department of Internal Medicine, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
| | - Takehito Yamaguchi
- Department of Gastroenterology, Chiba Cancer Center, Chiba, Japan.,Department of Internal Medicine, Japan Community Healthcare Organization Funabashi Central Hospital, Chiba, Japan
| | - Masakatsu Fukuzawa
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | | | - Kazutoshi Fukase
- Department of Internal Medicine, Yamagata Prefectural Central Hospital, Yamagata, Japan.,Department of Internal Medicine, Yamagata Prefectural Kahoku Hospital, Yamagata, Japan
| | | | - Hideki Ishikawa
- Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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11
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Mascarenhas M, Afonso J, Ribeiro T, Cardoso H, Andrade P, Ferreira JPS, Saraiva MM, Macedo G. Performance of a Deep Learning System for Automatic Diagnosis of Protruding Lesions in Colon Capsule Endoscopy. Diagnostics (Basel) 2022; 12:1445. [PMID: 35741255 DOI: 10.3390/diagnostics12061445] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/05/2022] [Accepted: 06/07/2022] [Indexed: 12/18/2022] Open
Abstract
Background: Colon capsule endoscopy (CCE) is an alternative for patients unwilling or with contraindications for conventional colonoscopy. Colorectal cancer screening may benefit greatly from widespread acceptance of a non-invasive tool such as CCE. However, reviewing CCE exams is a time-consuming process, with risk of overlooking important lesions. We aimed to develop an artificial intelligence (AI) algorithm using a convolutional neural network (CNN) architecture for automatic detection of colonic protruding lesions in CCE images. An anonymized database of CCE images collected from a total of 124 patients was used. This database included images of patients with colonic protruding lesions or patients with normal colonic mucosa or with other pathologic findings. A total of 5715 images were extracted for CNN development. Two image datasets were created and used for training and validation of the CNN. The AUROC for detection of protruding lesions was 0.99. The sensitivity, specificity, PPV and NPV were 90.0%, 99.1%, 98.6% and 93.2%, respectively. The overall accuracy of the network was 95.3%. The developed deep learning algorithm accurately detected protruding lesions in CCE images. The introduction of AI technology to CCE may increase its diagnostic accuracy and acceptance for screening of colorectal neoplasia.
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12
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Lu L, Koo S, McPherson S, Hull MA, Rees CJ, Sharp L. Systematic review and meta-analysis: Associations between metabolic syndrome and colorectal neoplasia outcomes. Colorectal Dis 2022; 24:681-694. [PMID: 35156283 DOI: 10.1111/codi.16092] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/26/2021] [Accepted: 01/12/2022] [Indexed: 12/13/2022]
Abstract
AIM Metabolic syndrome (MetS) is a cluster of factors including obesity, hypertension, diabetes, hypercholesterolemia and hyperlipidaemia. It has been associated with an increased risk of colorectal neoplasia. This systematic review and meta-analysis assessed the association between MetS and (i) recurrence of adenomas or occurrence of CRC in patients with prior adenomas, and (ii) survival in patients with CRC. METHOD MEDLINE, Embase, Scopus and Web of Science were searched up to 22 November 2019. Two authors independently conducted title and abstract screening; full text of eligible studies was evaluated. Where ≥3 studies reported effect measures for a specific outcome, meta-analysis using random effects model was conducted. I2 was used to assess between-study heterogeneity. Quality appraisal was undertaken with the Newcastle-Ottawa Score. RESULTS The search identified 1,764 articles, 55 underwent full text screening, resulting in a total of 15 eligible studies. Five studies reported on metachronous neoplasia, with differing outcomes precluded a meta-analysis. No consistent relationship between MetS and metachronous neoplasia was found. Ten studies reported on survival outcomes. MetS was associated with poorer CRC-specific survival (HR = 1.8, 95% CI: 1.04-3.12, I2 = 92.7%, n = 3). Progression-free survival was also worse but this did not reach statistical significance (HR = 1.12, 95% CI: 0.89-1.42, I2 = 85.6%, n = 3). There was no association with overall survival (HR = 1.04, 95% CI: 0.94-1.15, I2 = 43.7%, n = 7). Significant heterogeneity was present but subgroup analysis did not account for this. CONCLUSION MetS is associated with poorer CRC-specific survival, but evidence is inconsistent on metachronous neoplasia. Further research is warranted to better understand the impact of MetS on the adenoma-carcinoma pathway.
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Affiliation(s)
- Liya Lu
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Sara Koo
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle, UK.,South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
| | - Stuart McPherson
- Newcastle Upon Tyne NHS Foundation Trust and Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Mark A Hull
- Leeds Institute of Medical Research, St James's University Hospital, University of Leeds, Leeds, UK
| | - Colin J Rees
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle, UK.,South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
| | - Linda Sharp
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle, UK
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13
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Fennell L, Kane A, Liu C, McKeone D, Hartel G, Su C, Bond C, Bettington M, Leggett B, Whitehall V. Braf mutation induces rapid neoplastic transformation in the aged and aberrantly methylated intestinal epithelium. Gut 2022; 71:1127-1140. [PMID: 34230216 PMCID: PMC9120393 DOI: 10.1136/gutjnl-2020-322166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/30/2021] [Indexed: 12/08/2022]
Abstract
OBJECTIVE Sessile serrated lesions (SSLs) are common across the age spectrum, but the BRAF mutant cancers arising occur predominantly in the elderly. Aberrant DNA methylation is uncommon in SSL from young patients. Here, we interrogate the role of ageing and DNA methylation in SSL initiation and progression. DESIGN We used an inducible model of Braf mutation to direct recombination of the oncogenic Braf V637E allele to the murine intestine. BRAF mutation was activated after periods of ageing, and tissue was assessed for histological, DNA methylation and gene expression changes thereafter. We also investigated DNA methylation alterations in human SSLs. RESULTS Inducing Braf mutation in aged mice was associated with a 10-fold relative risk of serrated lesions compared with young mice. There were extensive differences in age-associated DNA methylation between animals induced at 9 months versus wean, with relatively little differential Braf-specific methylation. DNA methylation at WNT pathway genes scales with age and Braf mutation accelerated age-associated DNA methylation. In human SSLs, increased epigenetic age was associated with high-risk serrated colorectal neoplasia. CONCLUSIONS SSLs arising in the aged intestine are at a significantly higher risk of spontaneous neoplastic progression. These findings provide support for a new conceptual model for serrated colorectal carcinogenesis, whereby risk of Braf-induced neoplastic transformation is dependent on age and may be related to age-associated molecular alterations that accumulate in the ageing intestine, including DNA methylation. This may have implications for surveillance and chemopreventive strategies targeting the epigenome.
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Affiliation(s)
- Lochlan Fennell
- The Conjoint Gastroenterology Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Alexandra Kane
- The Conjoint Gastroenterology Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
- Conjoint Internal Medical Laboratory, Chemical Pathology, Health Support Queensland Pathology Queensland, Herston, Queensland, Australia
| | - Cheng Liu
- The Conjoint Gastroenterology Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Diane McKeone
- The Conjoint Gastroenterology Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Gunter Hartel
- Statistics Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Chang Su
- The Conjoint Gastroenterology Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Catherine Bond
- The Conjoint Gastroenterology Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Mark Bettington
- Envoi Specialist Pathologists, Brisbane, Queensland, Australia
| | - Barbara Leggett
- The Conjoint Gastroenterology Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
- Department of Gastroenterology and Hepatology, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Vicki Whitehall
- The Conjoint Gastroenterology Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
- Conjoint Internal Medical Laboratory, Chemical Pathology, Health Support Queensland Pathology Queensland, Herston, Queensland, Australia
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14
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Tourne-Garcia C, Perez-Riquelme F, Monteagudo-Piqueras O, Fraser CG, Yepes-Garcia P. One or two faecal immunochemical tests in an organised population-based colorectal cancer screening programme in Murcia (Spain). J Med Screen 2022;:9691413221094919. [PMID: 35578555 DOI: 10.1177/09691413221094919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Roll-out of population-based colorectal cancer (CRC) screening with faecal immunochemical test (FIT) is limited by availability of further investigations, particularly colonoscopy and examination of excised lesions. Our objective was to assess whether variation in number of faecal samples and threshold adjustment can optimise resource utilisation and CRC detection rate. METHODS Three different screening strategies were compared for the same FIT threshold using a quantitative FIT system: one FIT, positive when >20 µg Hb/g faeces; two FIT, positive when either was >20 µg Hb/g faeces; and two FIT, positive when the mean was >20 µg Hb/g faeces. We calculated changes in the size of population the provider could invite to screening for an equal number of screening positive results, and CRC and adenoma detected. RESULTS In our setting, Region of Murcia, south of Spain (not fully rolled out screening programme), changing the usual strategy of two FIT, positive when either to positive when the mean was >20 µg Hb/g faeces, would increase population invited by 37.81% with the same number of positive results (which would generate a CRC detection rate of 19.2%). In a fully rolled out programme, changing the strategy from one to two FIT (positive when the mean is >20 µg Hb/g faeces), would increase CRC detection rate by 4.64% with an increase of only 13.34% in positive FIT. CONCLUSIONS In a population-based CRC screening programme, smart use of number of FITs and positivity threshold can increase population invited and CRC detection without increasing the number of colonoscopies and pathological examinations needed.
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15
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Tan X, Quante M, Chen Z, Chen Z, Königsrainer A, Wichmann D. Impact of Salvage Surgery following Colonic Endoscopic Polypectomy for Patients with Invasive Neoplasia. Curr Oncol 2022; 29:3138-3148. [PMID: 35621645 PMCID: PMC9139913 DOI: 10.3390/curroncol29050255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Invasive neoplasia (Tis-T1) are increasingly being encountered in the daily routine of endoscopic polypectomy. However, the need for salvage surgery following endoscopic therapy for invasive neoplasia is controversially discussed. PATIENTS AND METHODS Patients with endoscopic removal of invasive neoplasia were identified from the national Surveillance Epidemiology and End Results (SEER) Database 2005 to 2015. Survival analysis and Cox proportional hazard regression analysis in cancer-specific mortality and overall survival rate was used, which were stratified by T stage and polyp size. RESULTS A total of 5805 patients with endoscopic removal of invasive neoplasia were included in the analysis, of whom 1214 (20.9%) underwent endoscopic treatment alone and 4591 (79.1%) underwent endoscopic resection plus surgery. The survival analysis revealed that patients undergoing salvage surgery had a significantly better cancer-specific survival (97.4% vs. 95.8%, p-value = 0.017). In patients with T1 stage, additional salvage surgery led to a significantly higher cancer-specific survival (92.1% vs. 95.0%, p value = 0.047). CONCLUSION Salvage surgery following endoscopic polypectomy may improve the oncological survival of patients with invasive neoplasia, especially in patients with T1 stage. Furthermore, the T stage, size, and localization of polyps, as well as the level of CEA, could be identified as significant predictors for lymphonodal and distant metastases.
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Affiliation(s)
- Xiangzhou Tan
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha 410008, China; (X.T.); (Z.C.); (Z.C.)
- Interdisciplinary Endoscopy Unit, Department of General, Visceral and Transplantation Surgery, University Hospital Tübingen, 72076 Tübingen, Germany; (M.Q.); (A.K.)
| | - Markus Quante
- Interdisciplinary Endoscopy Unit, Department of General, Visceral and Transplantation Surgery, University Hospital Tübingen, 72076 Tübingen, Germany; (M.Q.); (A.K.)
| | - Zihua Chen
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha 410008, China; (X.T.); (Z.C.); (Z.C.)
| | - Zhikang Chen
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha 410008, China; (X.T.); (Z.C.); (Z.C.)
| | - Alfred Königsrainer
- Interdisciplinary Endoscopy Unit, Department of General, Visceral and Transplantation Surgery, University Hospital Tübingen, 72076 Tübingen, Germany; (M.Q.); (A.K.)
| | - Dörte Wichmann
- Interdisciplinary Endoscopy Unit, Department of General, Visceral and Transplantation Surgery, University Hospital Tübingen, 72076 Tübingen, Germany; (M.Q.); (A.K.)
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16
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Zhou E, Wang L, Santiago CN, Nanavati J, Rifkin S, Spence E, Hylind LM, Gills JJ, La Luna L, Kafonek DR, Cromwell DM, Drewes JL, Sears CL, Giardiello FM, Mullin GE. Adult-Attained Height and Colorectal Cancer Risk: A Cohort Study, Systematic Review, and Meta-Analysis. Cancer Epidemiol Biomarkers Prev 2022; 31:783-792. [PMID: 35247904 PMCID: PMC8983463 DOI: 10.1158/1055-9965.epi-21-0398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 10/09/2021] [Accepted: 02/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The influence of anthropometric characteristics on colorectal neoplasia biology is unclear. We conducted a systematic review and meta-analysis to determine if adult-attained height is independently associated with the risk of colorectal cancer or adenoma. METHODS We searched MEDLINE, EMBASE, the Cochrane Library, and Web of Science from inception to August 2020 for studies on the association between adult-attained height and colorectal cancer or adenoma. The original data from the Johns Hopkins (Baltimore, MD) Colon Biofilm study was also included. The overall HR/OR of colorectal cancer/adenoma with increased height was estimated using random-effects meta-analysis. RESULTS We included 47 observational studies involving 280,644 colorectal cancer and 14,139 colorectal adenoma cases. Thirty-three studies reported data for colorectal cancer incidence per 10-cm increase in height; 19 yielded an HR of 1.14 [95% confidence interval (CI), 1.11-1.17; P < 0.001), and 14 engendered an OR of 1.09 (95% CI, 1.05-1.13; P < 0.001). Twenty-six studies compared colorectal cancer incidence between individuals within the highest versus the lowest height percentile; 19 indicated an HR of 1.24 (95% CI, 1.19-1.30; P < 0.001), and seven resulting in an OR of 1.07 (95% CI, 0.92-1.25; P = 0.39). Four studies reported data for assessing colorectal adenoma incidence per 10-cm increase in height, showing an overall OR of 1.06 (95% CI, 1.00-1.12; P = 0.03). CONCLUSIONS Greater adult attained height is associated with an increased risk of colorectal cancer and adenoma. IMPACT Height should be considered as a risk factor for colorectal cancer screening.
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Affiliation(s)
- Elinor Zhou
- Johns Hopkins University School of Medicine, Department of Gastroenterology and Hepatology, Baltimore, MD
- Mercy Medical Center, Institute for Digestive Health and Liver Disease, Baltimore, MD
| | - Lin Wang
- Johns Hopkins University Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD
| | | | - Julie Nanavati
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Samara Rifkin
- University of Michigan, Department of Gastroenterology and Hepatology, Ann Arbor, MI
| | - Emma Spence
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Linda M. Hylind
- Johns Hopkins University School of Medicine, Department of Gastroenterology and Hepatology, Baltimore, MD
| | - Joell J. Gills
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - David R. Kafonek
- Johns Hopkins Health Care & Surgery Center, Department of Gastroenterology and Hepatology, Green Spring Station Endoscopy Center, Lutherville, MD
| | - David M. Cromwell
- Johns Hopkins Health Care & Surgery Center, Department of Gastroenterology and Hepatology, Green Spring Station Endoscopy Center, Lutherville, MD
| | - Julia L. Drewes
- Johns Hopkins University School of Medicine, Department of Medicine, Division of Infectious Diseases, Baltimore, MD
| | - Cynthia L. Sears
- Johns Hopkins University School of Medicine, Department of Medicine, Division of Infectious Diseases, Baltimore, MD
| | - Francis M. Giardiello
- Johns Hopkins University School of Medicine, Department of Gastroenterology and Hepatology, Baltimore, MD
| | - Gerard E. Mullin
- Johns Hopkins University School of Medicine, Department of Gastroenterology and Hepatology, Baltimore, MD
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Piper TB, Nielsen HJ, Christensen IJ. Serological cancer-associated protein biomarker levels at bowel endoscopy: Increased risk of subsequent primary malignancy. Tumour Biol 2022; 44:1-16. [PMID: 35180141 DOI: 10.3233/tub-211501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND It was previously shown in three subpopulations that subjects not identified with colorectal cancer (CRC) at bowel endoscopy, but with increased serological cancer-associated protein biomarker levels had an increased risk of being diagnosed with subsequent malignant diseases. OBJECTIVE The aim of the present study was to perform a pooled analysis of subjects from the three subpopulations and subsequently validate the results in an independent study. The study population denoted the training set includes N = 4,076 subjects with symptoms attributable to CRC and the independent validation set N = 3,774 similar subjects. METHODS Levels of CEA, CA19-9, TIMP-1 and YKL-40 were determined in blood samples collected prior to diagnostic bowel endoscopy. Follow-up of subjects not diagnosed with CRC at endoscopy, was ten years and identified subjects diagnosed with primary intra- or extra-colonic malignant diseases. The primary analysis was time to a newly diagnosed malignant disease and was analyzed with death as a competing risk in the training set. Subjects with HNPCC or FAP were excluded. The cumulated incidence was estimated for each biomarker and in a multivariate model. The resulting model was then validated on the second study population. RESULTS In the training set primary malignancies were identified in 515 (12.6%) of the 4,076 subjects, who had a colorectal endoscopy with non-malignant findings. In detail, 33 subjects were subsequently diagnosed with CRC and 482 subjects with various extra-colonic cancers. Multivariate additive analysis of the dichotomized biomarkers demonstrated that CEA (HR = 1.50, 95% CI:1.21-1.86, p < 0.001), CA19-9 (HR = 1.41, 95% CI:1.10-1.81, p = 0.007) and TIMP-1 (HR = 1.25 95% CI: 1.01-1.54, p = 0.041) were significant predictors of subsequent malignancy. The cumulated incidence at 5 years landmark time was 17% for those subjects with elevated CEA, CA19-9 and TIMP-1 versus 6.7% for those with low levels of all. When the model was applied to the validation set the cumulated 5-year incidence was 10.5% for subjects with elevated CEA, CA19-9 and TIMP-1 and 5.6% for subjects with low levels of all biomarkers. Further analysis demonstrated a significant interaction between TIMP-1 and age in the training set. The age dependency of TIMP-1 indicated a greater risk of malignancy in younger subjects if the biomarker was elevated. This observation was validated in the second set. CONCLUSION Elevated cancer-associated protein biomarker levels in subjects with non-malignant findings at large bowel endoscopy identifies subjects at increased risk of being diagnosed with subsequent primary malignancy. CEA, CA19-9 and TIMP-1 were significant predictors of malignant disease in this analysis. TIMP-1 was found dependent on age. The results were validated in an independent symptomatic population.
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Affiliation(s)
- Thomas B Piper
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
| | - Hans J Nielsen
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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18
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Affiliation(s)
| | - Hiroyasu Saiga
- Medical AI Research Depaetment, NEC Corporation, Tokyo, Japan
| | - Naoto Maeda
- Medical AI Research Depaetment, NEC Corporation, Tokyo, Japan
| | - Ejaz Hossain
- Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Hitoshi Ikeda
- Medical AI Research Depaetment, NEC Corporation, Tokyo, Japan
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Puzzono M, Mannucci A, Grannò S, Zuppardo RA, Galli A, Danese S, Cavestro GM. The Role of Diet and Lifestyle in Early-Onset Colorectal Cancer: A Systematic Review. Cancers (Basel) 2021; 13:5933. [PMID: 34885046 DOI: 10.3390/cancers13235933] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/16/2021] [Accepted: 11/24/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary This systematic review sifted through the exogenous dietary and lifestyle risk factors associated with early-onset colorectal cancer, going through the putative involvement of these exogenous risk factors in epigenetic and microbiota modifications. Given the burden of early-onset colorectal cancer and its globally increasing trend with scant literature on its pathogenesis, we believe it would be of benefit to highlight the importance of further systematic and large studies. Indeed, dietary and lifestyle modification could complement colorectal screening for early-onset colorectal cancer prevention. Abstract The incidence of early-onset colorectal cancer, defined as colorectal cancer occurring in young adults under the age of 50, is increasing globally. Knowledge of the etiological factors in young adults is far from complete. Questionable eoCRCs’ exogenous factors are represented by processed meat, sugary drinks, alcohol, Western dietary pattern, overweight and obesity, physical inactivity, and smoking, though with heterogeneous results. Therefore, we performed a systematic review to summarize the current evidence on the role of diet and lifestyle as eoCRC risk factors. We systematically searched PubMed, Scopus, and EMBASE up to July 2021, for original studies evaluating diet, alcohol, physical activity, BMI, and smoking in eoCRC and included twenty-six studies. Indeed, the exogenous factors could represent modifiable key factors, whose recognition could establish areas of future interventions through public health strategies for eoCRC primary prevention. Additionally, we discussed the role of additional non-modifiable risk factors, and of epigenetic regulation and microbiota as mediators of the eoCRC triggered by diet and lifestyle.
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Iwasaki M, Kanehara R, Yamaji T, Katagiri R, Mutoh M, Tsunematsu Y, Sato M, Watanabe K, Hosomi K, Kakugawa Y, Ikematsu H, Hotta K, Kunisawa J, Wakabayashi K, Matsuda T. Association of Escherichia coli containing polyketide synthase in the gut microbiota with colorectal neoplasia in Japan. Cancer Sci 2021; 113:277-286. [PMID: 34779109 PMCID: PMC8748232 DOI: 10.1111/cas.15196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/13/2021] [Accepted: 10/19/2021] [Indexed: 01/19/2023] Open
Abstract
Escherichia coli containing polyketide synthase in the gut microbiota (pks+ E coli) produce a polyketide-peptide genotoxin, colibactin, and are suspected to play a role in the development of colorectal neoplasia. To clarify the role of pks+ E coli in the early stage of tumorigenesis, we investigated whether the pks status of E coli was associated with the prevalence of colorectal neoplasia. This cross-sectional analysis of data from a prospective cohort in Izu Oshima, Japan included asymptomatic residents aged 40-79 years who underwent screening colonoscopy and provided a stool sample. We identified 543 participants with colorectal neoplasia (22 colorectal cancer and 521 adenoma) as cases and 425 participants with normal colon as controls. The pks status of E coli was assayed using stool DNA and specific primers that detected pks+ E coli. The proportion of pks+ E coli was 32.6% among cases and 30.8% among controls. Compared with those with pks- E coli, the odds ratio (OR) (95% confidence interval) for participants with pks+ E coli was 1.04 (0.77-1.41) after adjusting for potential confounders. No statistically significant associations were observed regardless of tumor site or number of colorectal adenoma lesions. However, stratified analyses revealed increased ORs among participants who consumed cereals over the median intake or vegetables under the median intake. Overall, we found no statistically significant association between pks+ E coli and the prevalence of colorectal adenoma lesions among this Japanese cohort. However, positive associations were suggested under certain intake levels of cereals or vegetables.
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Affiliation(s)
- Motoki Iwasaki
- Division of Epidemiology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Rieko Kanehara
- Division of Epidemiology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Taiki Yamaji
- Division of Epidemiology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Ryoko Katagiri
- Division of Epidemiology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Michihiro Mutoh
- Division of Prevention, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Yuta Tsunematsu
- Department of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Michio Sato
- Department of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Kenji Watanabe
- Department of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Koji Hosomi
- Laboratory of Vaccine Materials, Center for Vaccine and Adjuvant Research, and Laboratory of Gut Environmental System, National Institutes of Biomedical Innovation, Health and Nutrition (NIBIOHN), Ibaraki, Japan
| | - Yasuo Kakugawa
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroaki Ikematsu
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Jun Kunisawa
- Laboratory of Vaccine Materials, Center for Vaccine and Adjuvant Research, and Laboratory of Gut Environmental System, National Institutes of Biomedical Innovation, Health and Nutrition (NIBIOHN), Ibaraki, Japan
| | - Keiji Wakabayashi
- School of Food and Nutritional Sciences, University of Shizuoka, Shizuoka, Japan
| | - Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan
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21
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Pereira C, Mohan J, Gururaj S, Chandrashekhara P. Predictive Ability of Neutrophil-Lymphocyte Ratio in Determining Tumor Staging in Colorectal Cancer. Cureus 2021; 13:e19025. [PMID: 34722011 PMCID: PMC8547368 DOI: 10.7759/cureus.19025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 01/05/2023] Open
Abstract
Introduction Tumor staging plays an important role in determining treatment in colorectal cancer. In the recent past, the neutrophil-lymphocyte ratio (NLR) has been used as a predictive marker of inflammation for different types of clinical entities. Our study aims to determine if NLR can predict tumor staging in patients with colorectal cancer. Materials and methods We retrospectively analyzed all cases that underwent surgical treatment for colorectal cancer from 2014 to 2020. The NLR, tumor stage, and histology report for all patients were reviewed. Recommended cut-off values for NLR for tumor stage (T), lymph node stage (N), and metastatic stage (M) were determined using receiver operating characteristic (ROC) analysis. Results NLR was found to be significantly higher in patients with T3-T4 tumors as compared to T1-T2 tumors (mean: 5.8 vs. 2.6, respectively p < 0.001). The NLR values were higher in cases of N1-N2 groups as compared to N0 groups (mean: 5.7 vs. 3.5, p = 0.07). The NLR was also higher in M1 patients as compared to M0 patients (32.1 vs. 4.5, respectively, p = 0.24) but failed to show a statistical significance. Conclusion NLR is a useful predictor of colorectal cancer which can give us some information about the type of tumor we may encounter during surgery.
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Affiliation(s)
- Chirag Pereira
- General Surgery, Father Muller Medical College and Hospital, Mangalore, IND
| | - Jiju Mohan
- General Surgery, Father Muller Medical College and Hospital, Mangalore, IND
| | - Shankar Gururaj
- General Surgery, Father Muller Medical College and Hospital, Mangalore, IND
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22
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Martinez JA, Skiba MB, Chow HS, Chew WM, Saboda K, Lance P, Ellis NA, Jacobs ET. A Protective Role for Arachidonic Acid Metabolites against Advanced Colorectal Adenoma in a Phase III Trial of Selenium. Nutrients 2021; 13:3877. [PMID: 34836131 DOI: 10.3390/nu13113877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 12/11/2022] Open
Abstract
Oxylipins derived from arachidonic acid (ARA) have been implicated in the development of colorectal adenomas and colorectal cancer. The primary purpose of this work was to determine the relationship between plasma levels of oxylipins and colorectal adenoma characteristics at study entry, as well as with the development of a new adenoma during follow-up within a Phase III adenoma prevention clinical trial with selenium (Sel). Secondarily, we sought to determine whether the selenium intervention influenced plasma oxylipin levels. Four oxylipins were quantified in stored plasma samples from a subset of Sel study subjects (n = 256) at baseline and at 12-months. There were significantly lower odds of an advanced adenoma at baseline with higher prostaglandin E2 (PGE2), with an OR (95% CI) of 0.55 (0.33–0.92), and with 5-hydroxyeicosatetraenoic acid (5-HETE) ((0.53 (0.33–0.94)); and of a large adenoma with higher PGE2 ((0.52 (0.31–0.87)). In contrast, no associations were observed between any oxylipin and the development of a new adenoma during follow-up. Selenium supplementation was associated with a significantly smaller increase in 5-HETE after 12 months compared to the placebo, though no other results were statistically significant. The ARA-derived oxylipins may have a role in the progression of non-advanced adenoma to advanced, but not with the development of a new adenoma.
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23
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Pai RK, Hartman DJ, Leighton JA, Pasha SF, Rivers CR, Regueiro M, Binion DG, Pai RK. Validated Indices for Histopathologic Activity Predict Development of Colorectal Neoplasia in Ulcerative Colitis. J Crohns Colitis 2021; 15:1481-1490. [PMID: 33687061 DOI: 10.1093/ecco-jcc/jjab042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS To correlate histologic activity in surveillance colonoscopies with the development of colorectal neoplasia in ulcerative colitis [UC]. METHODS Colorectal biopsies during surveillance [N = 764] from 52 UC patients with colorectal neoplasia were compared to 122 patients without neoplasia enrolled in a prospective natural history registry. All biopsies were scored using validated histologic scoring systems (Geboes score, Nancy histopathologic index [NHI], and Robarts histopathologic index [RHI]). Clinical, endoscopic, and histologic data were correlated with the development of colorectal neoplasia. RESULTS In multivariable analysis, mean RHI (hazard ratio [HR] 1.07 for each 1-unit increase in RHI, 95% confidence interval [CI] 1.03-1.12, p = 0.002) and mean NHI [HR 1.89 for each 1-unit increase in NHI, 95% CI 1.34-2.67, p = 0.002] for the entire surveillance period were significantly associated with colorectal neoplasia development. Shorter surveillance interval and increasing age were associated with increased risk of neoplasia development whereas mean Mayo endoscopic score was not significant. To generate a clinically useful measure of neoplasia risk, mean histologic activity in the preceding 5 years before the study endpoint was correlated with neoplasia development. In the preceding 5 years of surveillance, a mean RHI ≥ 8 had a 7.53-fold increased risk [95% CI 2.56-12.16, p < 0.001] and mean NHI ≥ 1.9 had a 5.89-fold increased risk [95% CI 2.18-15.92, p < 0.001] of developing colorectal neoplasia. CONCLUSIONS Persistent histologic activity during multiple surveillance episodes is an independent predictor of colorectal neoplasia. Mean RHI and mean NHI during a 5-year colonoscopic surveillance period can be used to assess risk for colorectal neoplasia and optimize UC surveillance.
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Affiliation(s)
- Rish K Pai
- Department of Pathology and Laboratory Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Douglas J Hartman
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jonathan A Leighton
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Shabana F Pasha
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Claudia Ramos Rivers
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Miguel Regueiro
- Division of Gastroenterology, Cleveland Clinic, Cleveland, OH, USA
| | - David G Binion
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Reetesh K Pai
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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24
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Kandiah K, Subramaniam S, Thayalasekaran S, Chedgy FJQ, Longcroft-Wheaton G, Fogg C, Brown JF, Smith SCL, Iacucci M, Bhandari P. Multicentre randomised controlled trial on virtual chromoendoscopy in the detection of neoplasia during colitis surveillance high-definition colonoscopy (the VIRTUOSO trial). Gut 2021; 70:1684-1690. [PMID: 33214162 PMCID: PMC8355878 DOI: 10.1136/gutjnl-2020-320980] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 09/19/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Longstanding colonic IBD increases the risk of developing colorectal cancer. The utility of chromoendoscopy with standard-definition white light technology has been established. However, the use of high-definition virtual chromoendoscopy (HDV) in colitis surveillance remains undefined. OBJECTIVE To compare the performance of HDV (i-scan OE mode 2) with high-definition white light (HDWL) for detection of neoplasia in patients with IBD undergoing surveillance colonoscopy. Additionally, we assessed the utility of protocol-guided quadrantic non-targeted biopsies. DESIGN A multioperator randomised controlled trial was carried out in two centres in the UK. Total of 188 patients (101 men, mean age 54) with longstanding ulcerative or Crohn's colitis were randomised, prior to starting the surveillance colonoscopy, to using either HDV (n=94) or HDWL (n=94) on withdrawal. Targeted and quadrantic non-targeted biopsies were taken in both arms per-randomisation protocol. The primary outcome was the difference in neoplasia detection rate (NDR) between HDV and HDWL. RESULTS There was no significant difference between HDWL and HDV for neoplasia detection. The NDR was not significantly different for HDWL (24.2%) and HDV (14.9%) (p=0.14). All intraepithelial neoplasia (IEN) detected contained low-grade dysplasia only. A total of 6751 non-targeted biopsies detected one IEN only. The withdrawal time was similar in both arms of the study; median of 24 min (HDWL) versus 25.5 min (HDV). CONCLUSION HDV and HDWL did not differ significantly in the detection of neoplasia. Almost all neoplasia were detected on targeted biopsy or resection. Quadrantic non-targeted biopsies have negligible additional gain. TRIAL REGISTRATION NUMBER Clinical Trial.gov ID NCT02822352.
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Affiliation(s)
- Kesavan Kandiah
- Department of Gastroenterology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK,Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sharmila Subramaniam
- Department of Gastroenterology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | | | - Fergus JQ Chedgy
- Department of Gastroenterology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK,Digestive Diseases Centre, Brighton and Sussex University Hospitals, Brighton, UK
| | | | - Carole Fogg
- Department of Gastroenterology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - James F Brown
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Samuel CL Smith
- Institute of Immunology and Immunotherapy, NIHR Wellcome Trust Clinical Research Facilities, University of Birmingham, Birmingham, UK
| | - Marietta Iacucci
- Institute of Immunology and Immunotherapy, NIHR Wellcome Trust Clinical Research Facilities, University of Birmingham, Birmingham, UK,National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
| | - Pradeep Bhandari
- Department of Gastroenterology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
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25
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Niedermaier T, Heisser T, Gies A, Guo F, Amitay EL, Hoffmeister M, Brenner H. To what extent is male excess risk of advanced colorectal neoplasms explained by known risk factors? Results from a large German screening population. Int J Cancer 2021; 149:1877-1886. [PMID: 34278571 DOI: 10.1002/ijc.33742] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/28/2021] [Accepted: 07/14/2021] [Indexed: 12/31/2022]
Abstract
Colorectal cancer (CRC) incidence and prevalence of its precursors are substantially higher among males than among females in most countries but the reasons for the male excess risk are incompletely understood. We aimed to assess to what extent it is explained by known risk factors. Prevalence of advanced neoplasia (AN, ie, CRC or advanced adenoma) and CRC risk and preventive factors were ascertained among 15 985 participants of screening colonoscopy aged 55-79 years in Germany. Logistic regression was used to calculate odds ratios (ORs) for the association between male sex and AN with and without adjustment for known risk and preventive factors. In age-adjusted comparisons, men had 2-fold increased risk for AN compared to women (OR = 1.98, 95% confidence interval [CI] 1.79-2.19). After comprehensive adjustment for medical, lifestyle and dietary factors, the OR was reduced to 1.52 (95% CI 1.30-1.77), suggesting that these factors accounted for 47% of male excess risk. Male excess risk increased from proximal colon to distal colon and rectum, with age-adjusted ORs (95% CI) of 1.63 (1.38-1.91), 2.13 (1.85-2.45) and 2.36 (1.95-2.85), respectively, and with the proportion of excess risk explained by covariates being lower for AN in the rectum (26%) than for AN in the proximal (52%) or distal colon (46%). Male excess risk was somewhat lower (age-adjusted OR 1.87) and explained excess risk was smaller (36%) when men were compared to women who never used hormone replacement therapy. In conclusion, most of the male excess risk and the potential to overcome it remain to be explored by further research.
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Affiliation(s)
- Tobias Niedermaier
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Heisser
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Anton Gies
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Feng Guo
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Efrat L Amitay
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
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26
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Rasmussen L, Nielsen HJ, Christensen IJ. Evaluation of a 92 multiplex protein panel in detection of colorectal cancer and high-risk adenoma in 784 symptomatic individuals. Cancer Biomark 2021; 32:73-84. [PMID: 34092616 DOI: 10.3233/cbm-203211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Blood-based protein biomarkers for detection of colorectal cancer (CRC) have been submitted to intense research to improve the full potential in screening for CRC. OBJECTIVE The aim was to explore the diagnostic performance of 92 proteins related to inflammation and carcinogenesis in detection of CRC or precancerous lesions. METHODS Blood-samples were collected from 4,698 individuals undergoing colonoscopy. An explorative unmatched case-control study was designed with 294 cases (individuals with CRC or high-risk colorectal adenoma) and 490 controls (individuals with low-risk colorectal adenoma, non-malignant findings or clean colorectum at colonoscopy). Protein profiling was performed by multiplex proximity extension assay. Statistical analyses were performed as univariate and multivariate logistic regression analyses. RESULTS Univariably, CSF-1, MMP12 and IL8 demonstrated superior performance in discrimination of individuals with CRC. Recurrently, IL8 was included as contributor in majority of multivariate models discriminating individuals with CRC. The multivariate evaluation in discrimination of individuals with CRC demonstrated AUC=ROC 0.82, sensitivity = 0.39 at specificity = 0.80. Discrimination of individuals with late stage CRC from individuals with clean colorectum demonstrated AUC=ROC 0.90, sensitivity = 0.58 at specificity = 0.80. CONCLUSIONS A subset of biomarker candidates, specifically IL8, investigated in the present study suggest a potential as blood-based biomarkers in screening of CRC.
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27
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Lui RN, Kyaw MH, Lam TYT, Ching JYL, Chan VCW, Wong MCS, Sung JJY. Prevalence and risk factors for sessile serrated lesions in an average risk colorectal cancer screening population. J Gastroenterol Hepatol 2021; 36:1656-1662. [PMID: 33617148 DOI: 10.1111/jgh.15368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 12/01/2020] [Accepted: 12/05/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIM The reported prevalence and risk factors for sessile serrated lesions (SSLs) show significant variation. We aimed to specifically study the prevalence and potential risk factors of SSLs in an average risk colorectal cancer (CRC) screening population of Chinese subjects. METHODS This is a case-control study of prospectively collected data from a territory-wide colorectal screening program in Hong Kong. Information on risk factors was obtained from questionnaires completed prior to screening colonoscopy. We compared subjects with SSLs against controls without these lesions to identify potential risk factors using multivariable logistic regression. RESULTS Of 12 039 asymptomatic screening subjects, 6011 subjects received a screening colonoscopy with 2214 subjects (36.8%) having conventional adenomas, 486 subjects (8.1%) having hyperplastic polyps, and 85 subjects (1.4%) having SSLs only. Of these subjects, three had synchronous advanced adenomas and were excluded from the analysis. More than 60% of these lesions were in the proximal colon. We compared these 82 subjects with SSLs only and 3226 controls without any polyps. After multivariable logistic regression, age ≥ 66 years, smoking, and diabetes mellitus (DM) were significant independent risk factors for SSLs. CONCLUSION In this study, we report the prevalence of SSLs to be 1.4%. Age ≥ 66 years, smoking, and DM were independent risk factors for these lesions. Our findings provide relevant new data that should be taken into consideration when designing region-specific surveillance programs for SSLs with the ultimate goal of reducing the risk of CRC.
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Affiliation(s)
- Rashid N Lui
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Moe H Kyaw
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Thomas Y T Lam
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Jessica Y L Ching
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Victor C W Chan
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Martin C S Wong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Joseph J Y Sung
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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28
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Rutter MD, Evans R, Hoare Z, Von Wagner C, Deane J, Esmaily S, Larkin T, Edwards R, Yeo ST, Spencer LH, Holmes E, Saunders BP, Rees CJ, Tsiamoulos ZP, Beintaris I. WASh multicentre randomised controlled trial: water-assisted sigmoidoscopy in English NHS bowel scope screening. Gut 2021; 70:845-852. [PMID: 32895334 PMCID: PMC8040154 DOI: 10.1136/gutjnl-2020-321918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The English Bowel Cancer Screening Programme invites 55 year olds for a sigmoidoscopy (Bowel Scope Screening (BSS)), aiming to resect premalignant polyps, thus reducing cancer incidence. A national patient survey indicated higher procedural pain than anticipated, potentially impacting on screening compliance and effectiveness. We aimed to assess whether water-assisted sigmoidoscopy (WAS), as opposed to standard CO2 technique, improved procedural pain and detection of adenomatous polyps. DESIGN The WASh (Water-Assisted Sigmoidoscopy) trial was a multicentre, single-blind, randomised control trial for people undergoing BSS. Participants were randomised to either receive WAS or CO2 from five sites across England. The primary outcome measure was patient-reported moderate/severe pain, as assessed by patients on a standard Likert scale post procedure prior to discharge. The key secondary outcome was adenoma detection rate (ADR). The costs of each technique were also measured. RESULTS 1123 participants (50% women, mean age 55) were randomised (561 WAS, 562 CO2). We found no difference in patient-reported moderate/severe pain between WAS and CO2 (14% in WAS, 15% in CO2; p=0.47). ADR was 15% in the CO2 arm and 11% in the WAS arm (p=0.03); however, it remained above the minimum national performance standard in both arms. There was no statistical difference in mean number of adenomas nor overall polyp detection rate. There was negligible cost difference between the two techniques. CONCLUSION In the context of enema-prepared unsedated screening sigmoidoscopies performed by screening-accredited endoscopists, no difference in patient-reported pain was seen when using either a CO2 or WAS intubation technique. TRIAL REGISTRATION NUMBER ISRCTN81466870.
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Affiliation(s)
- Matthew D Rutter
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK .,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rachel Evans
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | | | - Jill Deane
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
| | - Shiran Esmaily
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
| | | | - Rhiannon Edwards
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | - Seow Tien Yeo
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | - Llinos Haf Spencer
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | - Emily Holmes
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | | | - Colin J Rees
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK,Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, UK
| | | | - Iosif Beintaris
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
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29
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Masi AC, Koo S, Lamb CA, Hull MA, Sharp L, Nelson A, Hampton JS, Rees CJ, Stewart CJ. Using faecal immunochemical test (FIT) undertaken in a national screening programme for large-scale gut microbiota analysis. Gut 2021; 70:429-431. [PMID: 32430347 DOI: 10.1136/gutjnl-2020-321594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/01/2020] [Indexed: 12/08/2022]
Affiliation(s)
- Andrea C Masi
- Gastroenterology, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Sara Koo
- Gastroenterology, South Tyneside General Hospital, South Shields, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher A Lamb
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mark A Hull
- Leeds Institute of Biomedical & Clinical Sciences, St James's University Hospital, Leeds, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Nelson
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - James S Hampton
- Gastroenterology, South Tyneside General Hospital, South Shields, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Colin J Rees
- Gastroenterology, South Tyneside General Hospital, South Shields, UK .,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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30
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Bagshaw P, Cox B, Frizelle FA, Church JM. Guidelines for completion colonoscopy after polyps are found at flexible sigmoidoscopy for investigation of haemorrhoidal-type rectal bleeding. Gut 2021; 70:441-442. [PMID: 32487718 DOI: 10.1136/gutjnl-2020-321655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 12/08/2022]
Affiliation(s)
- Philip Bagshaw
- Canterbury Charity Hospital Trust, Christchurch, New Zealand .,Surgery, University of Otago Christchurch, Christchurch, New Zealand
| | - Brian Cox
- Department of Preventive and Social Medicine, University of Otago Dunedin School of Medicine, Dunedin, New Zealand
| | | | - James M Church
- Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Peterova E, Bures J, Moravkova P, Kohoutova D. Tissue mRNA for S100A4, S100A6, S100A8, S100A9, S100A11 and S100P Proteins in Colorectal Neoplasia: A Pilot Study. Molecules 2021; 26:molecules26020402. [PMID: 33466593 PMCID: PMC7828666 DOI: 10.3390/molecules26020402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/03/2021] [Accepted: 01/11/2021] [Indexed: 11/16/2022] Open
Abstract
S100 proteins are involved in the pathogenesis of sporadic colorectal carcinoma through different mechanisms. The aim of our study was to assess tissue mRNA encoding S100 proteins in patients with non-advanced and advanced colorectal adenoma. Mucosal biopsies were taken from the caecum, transverse colon and rectum during diagnostic and/or therapeutic colonoscopy. Another biopsy was obtained from adenomatous tissue in the advanced adenoma group. The tissue mRNA for each S100 protein (S100A4, S100A6, S100A8, S100A9, S100A11 and S100P) was investigated. Eighteen biopsies were obtained from the healthy mucosa in controls and the non-advanced adenoma group (six individuals in each group) and thirty biopsies in the advanced adenoma group (ten patients). Nine biopsies were obtained from advanced adenoma tissue (9/10 patients). Significant differences in mRNA investigated in the healthy mucosa were identified between (1) controls and the advanced adenoma group for S100A6 (p = 0.012), (2) controls and the non-advanced adenoma group for S100A8 (p = 0.033) and (3) controls and the advanced adenoma group for S100A11 (p = 0.005). In the advanced adenoma group, differences between the healthy mucosa and adenomatous tissue were found in S100A6 (p = 0.002), S100A8 (p = 0.002), S100A9 (p = 0.021) and S100A11 (p = 0.029). Abnormal mRNA expression for different S100 proteins was identified in the pathological adenomatous tissue as well as in the morphologically normal large intestinal mucosa.
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Affiliation(s)
- Eva Peterova
- 2nd Department of Internal Medicine–Gastroenterology, Charles University, Faculty of Medicine in Hradec Kralove, University Hospital, Sokolska 581, 500 05 Hradec Kralove, Czech Republic; (E.P.); (P.M.); (D.K.)
- Department of Medical Biochemistry, Charles University, Faculty of Medicine in Hradec Kralove, Simkova 870, 500 01 Hradec Kralove, Czech Republic
| | - Jan Bures
- 2nd Department of Internal Medicine–Gastroenterology, Charles University, Faculty of Medicine in Hradec Kralove, University Hospital, Sokolska 581, 500 05 Hradec Kralove, Czech Republic; (E.P.); (P.M.); (D.K.)
- Correspondence: ; Tel.: +420-495-834-240
| | - Paula Moravkova
- 2nd Department of Internal Medicine–Gastroenterology, Charles University, Faculty of Medicine in Hradec Kralove, University Hospital, Sokolska 581, 500 05 Hradec Kralove, Czech Republic; (E.P.); (P.M.); (D.K.)
| | - Darina Kohoutova
- 2nd Department of Internal Medicine–Gastroenterology, Charles University, Faculty of Medicine in Hradec Kralove, University Hospital, Sokolska 581, 500 05 Hradec Kralove, Czech Republic; (E.P.); (P.M.); (D.K.)
- The Royal Marsden Hospital NHS Foundation Trust, Fulham Road, Chelsea, London SW3 6JJ, UK
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32
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Recinos LM, Mohapatra S, Broder A, Saeed I. Primary Squamous Cell Carcinoma of the Cecum Presenting as Spontaneous Perforation. Cureus 2020; 12:e10510. [PMID: 33094051 PMCID: PMC7571777 DOI: 10.7759/cureus.10510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Squamous cell carcinoma (SCC) of the colon is an extremely rare condition, and its pathogenesis is not fully understood. Bowel perforation is a very infrequent manifestation of colonic SCC, and only a few cases have been reported in the literature involving sigmoid and splenic flexure perforation. To the best of our knowledge, no cases of ileocecal perforation have been documented in the literature. Here we present a case of cecal SCC that presented with bowel perforation, necessitating emergent surgical intervention. Histopathological examination showed SCC with lymph node metastasis. This case reviews current knowledge and highlights the rare manifestation that these rare tumors can present.
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Affiliation(s)
- Luisa M Recinos
- Internal Medicine, Saint Peter's University Hospital - Rutgers Robert Wood Johnson School of Medicine, New Brunswick, USA
| | - Sonmoon Mohapatra
- Gastroenterology and Hepatology, Saint Peter's University Hospital - Rutgers Robert Wood Johnson School of Medicine, New Brunswick, USA
| | - Arkady Broder
- Gastroenterology and Hepatology, Saint Peter's University Hospital - Rutgers Robert Wood Johnson School of Medicine, New Brunswick, USA
| | - Imran Saeed
- Surgery, Saint Peter's University Hospital - Rutgers Robert Wood Johnson School of Medicine, New Brunswick, USA
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33
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Merli AM, Vieujean S, Massot C, Blétard N, Quesada Calvo F, Baiwir D, Mazzucchelli G, Servais L, Wéra O, Oury C, de Leval L, Sempoux C, Manzini R, Bluemel S, Scharl M, Rogler G, De Pauw E, Coimbra Marques C, Colard A, Vijverman A, Delvenne P, Louis E, Meuwis MA. Solute carrier family 12 member 2 as a proteomic and histological biomarker of dysplasia and neoplasia in ulcerative colitis. J Crohns Colitis 2020; 15:jjaa168. [PMID: 32920643 DOI: 10.1093/ecco-jcc/jjaa168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Ulcerative colitis (UC) patients have a greater risk of developing colorectal cancer through inflammation-dysplasia-carcinoma sequence of transformation. The histopathological diagnosis of dysplasia is therefore of critical clinical relevance, but dysplasia may be difficult to distinguish from inflammatory changes. METHODS A proteomic pilot study on 5 UC colorectal dysplastic patients highlighted proteins differentially distributed between paired dysplastic, inflammatory and normal tissues. The best candidate marker was selected and immunohistochemistry confirmation was performed on AOM/DSS mouse model lesions, 37 UC dysplasia, 14 UC cancers, 23 longstanding UC, 35 sporadic conventional adenomas, 57 sporadic serrated lesions and 82 sporadic colorectal cancers. RESULTS Differential proteomics found 11 proteins significantly more abundant in dysplasia compared to inflammation, including Solute carrier family 12 member 2 (SLC12A2) which was confidently identified with 8 specific peptides and was below the limit of quantitation in both inflammatory and normal colon. SLC12A2 immunohistochemical analysis confirmed the discrimination of preneoplastic and neoplastic lesions from inflammatory lesions in mice, UC and in sporadic contexts. A specific SLC12A2 staining pattern termed "loss of gradient" reached 89% sensitivity, 95% specificity and 92% accuracy for UC-dysplasia diagnosis together with an inter-observer agreement of 95.24% (multirater κfree of 0.90; IC95%: 0.78 - 1.00). Such discrimination could not be obtained by Ki67 staining. This specific pattern was also associated with sporadic colorectal adenomas and cancers. CONCLUSIONS We found a specific SLC12A2 immunohistochemical staining pattern in precancerous and cancerous colonic UC-lesions which could be helpful for diagnosing dysplasia and cancer in UC and non-UC patients.
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Affiliation(s)
- Angela-Maria Merli
- Laboratory of Translational Gastroenterology, University of Liège, Liège, Belgium
| | - Sophie Vieujean
- Laboratory of Translational Gastroenterology, University of Liège, Liège, Belgium
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Charlotte Massot
- Laboratory of Translational Gastroenterology, University of Liège, Liège, Belgium
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Noella Blétard
- Pathological Anatomy and Cytology, University Hospital CHU of Liège, Liège, Belgium
| | | | | | | | - Laurence Servais
- Laboratory of Cardiology, GIGA-Cardiovascular Sciences, University of Liège, Liège, Belgium
| | - Odile Wéra
- Laboratory of Cardiology, GIGA-Cardiovascular Sciences, University of Liège, Liège, Belgium
| | - Cécile Oury
- Laboratory of Cardiology, GIGA-Cardiovascular Sciences, University of Liège, Liège, Belgium
| | - Laurence de Leval
- Institute of Pathology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Christine Sempoux
- Institute of Pathology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Roberto Manzini
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sena Bluemel
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Scharl
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Gerhard Rogler
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Edwin De Pauw
- Laboratory of Mass Spectrometry, University of Liège, Liège, Belgium
| | - C Coimbra Marques
- Abdominal Surgery Department, University Hospital CHU of Liège, Liège, Belgium
| | - Arnaud Colard
- Department of Gastroenterology, CHC Clinique Saint-Joseph, Liège, Belgium
| | - Anne Vijverman
- Department of Gastroenterology, CHR Citadelle, Liège, Belgium
| | - Philippe Delvenne
- Pathological Anatomy and Cytology, University Hospital CHU of Liège, Liège, Belgium
| | - Edouard Louis
- Laboratory of Translational Gastroenterology, University of Liège, Liège, Belgium
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
- Equally contributed to this work
| | - Marie-Alice Meuwis
- Laboratory of Translational Gastroenterology, University of Liège, Liège, Belgium
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
- Equally contributed to this work
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Chen Y, Chen X, Wang X, Liu Z, Zhou H, Xu S. Association of Cardiovascular Risk Assessment with Early Colorectal Neoplasia Detection in Asymptomatic Population: A Systematic Review and Meta-Analysis. Clin Epidemiol 2020; 12:865-873. [PMID: 32848475 PMCID: PMC7429103 DOI: 10.2147/clep.s262939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/19/2020] [Indexed: 12/24/2022] Open
Abstract
Previous studies have shown a strong coexistence of colorectal neoplasia (CRN) and cardiovascular diseases (CVD). This study was aimed to summarize the available evidence on association of CVD risk with early CRN detection in asymptomatic populations. PubMed, Web of Science, and Embase were systematically searched for eligible studies published until Dec 20, 2019. Studies exploring the associations of recommended CVD risk assessment methods (e.g., risk scores, carotid artery plaque, and coronary artery calcium score [CACS]) with risk of CRN were included. Meta-analyses were conducted to determine the overall association of CVD risk with the CRN. A total of 12 studies were finally included. The association of carotid artery plaque with the risk of colorectal adenoma (AD) was weakest (pooled odds ratio [OR)] 1.27, 95% confidence interval [CI), 1.12, 1.45]. Participants with CACS>100 had about 2-fold increased risk of AD than those with CACS=0. The pooled ORs were 3.36 (95% CI, 2.15, 5.27) and 2.30 (95% CI, 1.69, 3.13) for the risk of advanced colorectal neoplasia (AN) and AD, respectively, in participants with Framingham risk score (FRS)>20%, when compared to participants at low risk (FRS<10%). FRS might help identify subgroups at increased risk for AN, but further studies are needed.
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Affiliation(s)
- Yanwei Chen
- Infection Control Department of Shenzhen Hospital of University of Chinese Academy of Sciences, Shenzhen, People’s Republic of China
| | - Xuechen Chen
- Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Xi Wang
- Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Zhunzhun Liu
- Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Haibo Zhou
- Institute of Pharmaceutical Analysis, College of Pharmacy, Jinan University, Guangzhou, People’s Republic of China
| | - Shu Xu
- Oncology Department of Shenzhen Hospital of University of Chinese Academy of Sciences, Shenzhen, People’s Republic of China
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35
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Faqih A, Singal AG, Fullington HM, Hewitt B, Burstein E, Gopal P, Wylie A, Abrams J, Murphy CC. Colorectal Neoplasia among Patients with and without Human Immunodeficiency Virus. Cancer Epidemiol Biomarkers Prev 2020; 29:1689-1691. [PMID: 32467350 PMCID: PMC7415639 DOI: 10.1158/1055-9965.epi-20-0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/27/2020] [Accepted: 05/19/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Increasing availability of highly active antiretroviral therapy (HAART) for human immunodeficiency virus (HIV) has led to prolonged survival and rising incidence of non-HIV-defining cancers among patients with HIV. Compared with the general population, risk of colorectal cancer may differ among those with HIV due to immunosuppression, oncogenic viral coinfections, and higher prevalence of risk factors. METHODS We identified patients (age ≥50 years) diagnosed with HIV, prescribed HAART for ≥6 months, and receiving care in two large health care systems in Dallas, TX. Patients received a first colonoscopy between January 2009 and December 2017. We calculated a standardized prevalence ratio as the ratio of observed to expected number of advanced neoplasia (high-risk adenoma or colorectal cancer) using an age- and sex-matched cohort of patients without HIV (n = 10,250). RESULTS Among patients with HIV (n = 839), about two thirds (60.1%) had normal findings at colonoscopy; 6.8% had hyperplastic polyps only, 20.4% had low-risk adenomas, 11.7% had high-risk adenomas, and 1.1% had colorectal cancer. Prevalence of advanced neoplasia was similar between patients with and without HIV, with a standardized prevalence ratio of 0.99 (95% confidence interval, 0.81-1.19). CONCLUSIONS There was no difference in the prevalence of colorectal neoplasia between patients with and without HIV. IMPACT Patients with HIV appear to have similar risk of colorectal neoplasia compared to those without HIV and can therefore follow average-risk colorectal cancer screening guidelines.
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Affiliation(s)
- Adil Faqih
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Amit G Singal
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - Hannah M Fullington
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Benjamin Hewitt
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ezra Burstein
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - Purva Gopal
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Annika Wylie
- Department of Cell Biology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - John Abrams
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
- Department of Cell Biology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Caitlin C Murphy
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
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36
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Hawa F, Al Hillan A, Catanzaro AT, Tworek JA, Gunaratnam NT. Endoscopic Management of a Tubulovillous Adenoma Within a Diverticulum: Report of a Case and Review of Literature. Cureus 2020; 12:e8668. [PMID: 32699668 PMCID: PMC7370691 DOI: 10.7759/cureus.8668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/17/2020] [Indexed: 02/07/2023] Open
Abstract
Adenomas or adenocarcinomas located within a colonic diverticulum are considered a rare phenomenon that has been described in the literature. These lesions are technically difficult to manage endoscopically and usually require surgical intervention for removal. There is also an increased risk of perforation upon endoscopic resection owing to the lack of a muscular layer within the diverticulum. We report a case and include a literature review to evaluate different endoscopic techniques and propose the most effective for management of adenomas within a diverticulum. This technique is potentially comprised of employing a combined approach using a suction banding device, an over-the-scope clip (OTSC; Ovesco Endoscopy AG, Tübingen, Germany) , and hyperthemic snare to successfully remove the polyp, ensure tissue retrieval, and reduce risk of iatrogenic colonic perforation.
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Affiliation(s)
- Fadi Hawa
- Internal Medicine, St. Joseph Mercy Ann Arbor Hospital, Ann Arbor, USA
| | - Alsadiq Al Hillan
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Andrew T Catanzaro
- Gastroenterology and Hepatology, St. Joseph Mercy Ann Arbor Hospital, Ann Arbor, USA
| | - Joseph A Tworek
- Pathology, St. Joseph Mercy Ann Arbor Hospital, Ann Arbor, USA
| | - Naresh T Gunaratnam
- Gastroenterology and Hepatology, St. Joseph Mercy Ann Arbor Hospital, Ann Arbor, USA
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37
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Troschel AS, Miks A, Hüsing-Kabar A, Heinzow HS, Schmidt HH, Troschel FM, Kabar I. Inflammation, etiologies and Model for End-stage Liver Disease score: What makes liver disease patients susceptible to developing colorectal neoplasia? Hepatol Res 2020; 50:342-352. [PMID: 31805606 DOI: 10.1111/hepr.13463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/28/2019] [Accepted: 11/03/2019] [Indexed: 02/08/2023]
Affiliation(s)
- Amelie S Troschel
- Department of Gastroenterology and Hepatology, University Hospital Münster, Albert-Schweitzer-Campus 1, Münster, Germany
| | | | - Anna Hüsing-Kabar
- Department of Gastroenterology and Hepatology, University Hospital Münster, Albert-Schweitzer-Campus 1, Münster, Germany
| | - Hauke S Heinzow
- Department of Gastroenterology and Hepatology, University Hospital Münster, Albert-Schweitzer-Campus 1, Münster, Germany
| | - Hartmut H Schmidt
- Department of Gastroenterology and Hepatology, University Hospital Münster, Albert-Schweitzer-Campus 1, Münster, Germany
| | - Fabian M Troschel
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Münster, Germany
| | - Iyad Kabar
- Department of Gastroenterology and Hepatology, University Hospital Münster, Albert-Schweitzer-Campus 1, Münster, Germany
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Kooyker AI, Toes-Zoutendijk E, Opstal-van Winden AWJ, Spaander MCW, Buskermolen M, van Vuuren HJ, Kuipers EJ, van Kemenade FJ, Ramakers C, Thomeer MGJ, Dekker E, Nagtegaal ID, de Koning HJ, van Leerdam ME, Lansdorp-Vogelaar I. The second round of the Dutch colorectal cancer screening program: Impact of an increased fecal immunochemical test cut-off level on yield of screening. Int J Cancer 2020; 147:1098-1106. [PMID: 31853977 PMCID: PMC7383838 DOI: 10.1002/ijc.32839] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 12/18/2022]
Abstract
The Dutch colorectal cancer (CRC) screening program started in 2014, inviting the target population biennially to perform a fecal immunochemical test (FIT). We obtained prospectively collected data from the national screening information‐system to present the results of the second round (2016) and evaluate the impact of increasing the FIT cut‐off halfway through the first round from 15 to 47 μg Hb/g feces on outcomes in the second round. Second round screening was done with a 47 μg Hb/g feces FIT cut‐off. Participants were classified based on first round participation status as either FIT (15,47) or FIT (47,47) participants, and previous nonparticipants. In total, 348,891 (75.9%) out of 459,740 invitees participated in the second round. Participation rates were 93.4% among previous participants and 21.0% among previous non‐participants. FIT(47,47) participants had a significantly higher detection rate of AN (15.3 vs. 10.4 per 1,000 participants) compared to FIT(15,47) participants in the second round, while their cumulative detection rate of AN over two rounds was significantly lower (45.6 vs. 52.6 per 1,000 participants). Our results showed that participation in the Dutch CRC screening program was consistently high and that second round detection rates depended on the first round FIT cut‐off. The cumulative detection over two rounds was higher among FIT(15,47) participants. These findings suggest that a substantial part of, but not all the missed findings in the first round due to the increased FIT cut‐off were detected in the subsequent round. What's new? In 2014, the Netherlands implemented colorectal cancer (CRC) screening based on non‐invasive fecal immunochemical testing (FIT), which offers a practical approach for population‐based CRC detection. In the Dutch program's first round, to match local resources, FIT cut‐off was increased, resulting in reduced positivity rates and reduced colonoscopy referrals, at the cost of missing advanced neoplasias. The current study shows that many of these missed advanced neoplasias were detected in subsequent screening, suggesting that increased FIT cut‐off had marginal impact on screening outcome. The findings could benefit other CRC screening programs in establishing effective FIT cut‐offs.
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Affiliation(s)
- Arthur I Kooyker
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Gastroenterology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Esther Toes-Zoutendijk
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maaike Buskermolen
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hanneke J van Vuuren
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Chris Ramakers
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maarten G J Thomeer
- Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers - Academic Medical Center, Amsterdam, The Netherlands
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Gómez-Moreno R, Martínez-Ramírez R, Roche-Lima A, Carrasquillo-Carrión K, Pérez-Santiago J, Baerga-Ortiz A. Hotspots of Sequence Variability in Gut Microbial Genes Encoding Pro-Inflammatory Factors Revealed by Oligotyping. Front Genet 2019; 10:631. [PMID: 31354787 PMCID: PMC6629961 DOI: 10.3389/fgene.2019.00631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/17/2019] [Indexed: 11/21/2022] Open
Abstract
The gut microbiota has been implicated in a number of normal and disease biological processes. Recent studies have identified a subset of gut bacterial genes as potentially involved in inflammatory processes. In this work, we explore the sequence variability for some of these bacterial genes using a combination of deep sequencing and oligotyping, a data analysis application that identifies mutational hotspots in short stretches of DNA. The genes for pks island, tcpC and usp, all harbored by certain strains of E. coli and all implicated in inflammation, were amplified by PCR directly from stool samples and subjected to deep amplicon sequencing. For comparison, the same genes were amplified from individual bacterial clones. The amplicons for pks island and tcpC from stool samples showed minimal levels of heterogeneity comparable with the individual clones. The amplicons for usp from stool samples, by contrast, revealed the presence of five distinct oligotypes in two different regions. Of these, the oligotype GT was found to be present in the control uropathogenic clinical isolate and also detected in stool samples from individuals with colorectal cancer (CRC). Mutational hotspots were mapped onto the USP protein, revealing possible substitutions around Leu110, Glu114, and Arg115 in the middle of the pyocin domain (Gln110, Gln114, and Thr115 in most healthy samples), and also Arg218 in the middle of the nuclease domain (His218 in the uropathogenic strain). All of these results suggest that a level of variability within bacterial pro-inflammatory genes could explain differences in bacterial virulence and phenotype.
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Affiliation(s)
- Ramón Gómez-Moreno
- University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico.,Molecular Sciences Research Center, San Juan, Puerto Rico
| | - Rachell Martínez-Ramírez
- University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico.,Molecular Sciences Research Center, San Juan, Puerto Rico
| | - Abiel Roche-Lima
- CCRHD-RCMI Program University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | | | | | - Abel Baerga-Ortiz
- University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico.,Molecular Sciences Research Center, San Juan, Puerto Rico
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40
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Boyuk B, Ozgur A, Atalay H, Celebi A, Ekizoglu I, Aykurt E. Helicobacter pylori infection coexisting with intestinal metaplasia is not associated with colorectal neoplasms. Prz Gastroenterol. 2019;14:133-139. [PMID: 31616528 PMCID: PMC6791137 DOI: 10.5114/pg.2019.85897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 11/21/2018] [Indexed: 12/14/2022]
Abstract
Introduction Colorectal cancer is one of the most common cancers and is a major cause of morbidity and mortality in the world and our country. Studies have indicated that there might be a relationship between Helicobacter pylori (Hp) and colorectal neoplasia (CN), although others have not found any relationship. Aim To determine whether there is a potential relationship between Hp and CN in our patients. Material and methods A total of 314 patients, aged 16–86 years, who underwent gastroscopy and colonoscopy at our department between 2015 and 2017 were evaluated retrospectively. The age, gender, endoscopy results, presence of Hp, complete blood count (CBC), vitamin B12, folic acid, C-reactive protein (CRP), and sedimentation levels of the patients were examined. Results CBC, ferritin, vitamin B12, and CRP measurements did not show statistical significance in terms of the presence of Hp (p > 0.05). Folate values of Hp-positive patients were significantly lower than Hp-negative patients (p = 0.007; p < 0.01). No significant relationship was detected between Hp and colon cancer (p > 0.05). Adenomatous polyps were not related to Hp (p > 0.05). Correlation between intestinal metaplasia (IM) and adenomatous polyps was insignificant. There was no statistically significant difference between colon and gastric pathology results. Conclusions In our study, no significant relationship was noted between Hp and CN. A few studies have been conducted in our country, and our results are consistent with some of these studies while it is contradictory to others. Large populational multicentre studies are needed in order to identify the relationship between Hp and CN.
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Abu-Sbeih H, Ali FS, Ge PS, Barcenas CH, Lum P, Qiao W, Bresalier RS, Bhutani MS, Raju GS, Wang Y. Patients with breast cancer may be at higher risk of colorectal neoplasia. Ann Gastroenterol 2019; 32:400-406. [PMID: 31263363 PMCID: PMC6595931 DOI: 10.20524/aog.2019.0387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 04/17/2019] [Indexed: 11/11/2022] Open
Abstract
Background The risk of colorectal neoplasia in breast cancer survivors is unclear. This study aimed to determine the colonic adenoma detection rate (ADR) in patients with breast cancer. Methods We conducted a retrospective study of patients with breast cancer who underwent a colonoscopy between 2000 and 2017. A control group (n=3295), comprising cancer-free patients undergoing their first screening colonoscopy, was used for comparison. Results Of 62,820 breast cancer patients, 3304 met the inclusion criteria. The mean age at the time of first colonoscopy was 59 years. ADR was 55%; 1803 patients had adenomas. High-grade dysplasia was evident in 28% of polyps and invasive adenocarcinoma was detected in 172 patients (5%). The median time from breast cancer diagnosis to adenoma detection was 3 years. The ADR was 21% in patients aged <40 years (n=63) and 39% in patients aged 40-50 years (n=314). The ADR was 26% in patients <50 years with a body mass index (BMI) lower than 30 kg/m2 or no family history of colorectal cancer. Multivariate logistic regression analysis revealed that the following independent factors were associated with a greater risk of colon adenoma: older age, higher BMI, family history of colorectal cancer, and personal history of breast cancer. Conclusions In patients with breast cancer, the ADR was higher than the reported rates for the general population. Screening colonoscopy should be considered soon after breast cancer diagnosis in patients <50 years of age. Further prospective studies investigating our findings are warranted.
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Affiliation(s)
- Hamzah Abu-Sbeih
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas (Hamzah Abu-Sbeih, Phillip S. Ge, Phillip Lum, Robert S. Bresalier, Manoop S. Bhutani, Gottumukkala S. Raju, Yinghong Wang)
| | - Faisal S Ali
- Department of Internal Medicine, Presence Saint Joseph Hospital, Chicago, IL (Faisal S. Ali)
| | - Phillip S Ge
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas (Hamzah Abu-Sbeih, Phillip S. Ge, Phillip Lum, Robert S. Bresalier, Manoop S. Bhutani, Gottumukkala S. Raju, Yinghong Wang)
| | - Carlos H Barcenas
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (Carlos H. Barcenas)
| | - Phillip Lum
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas (Hamzah Abu-Sbeih, Phillip S. Ge, Phillip Lum, Robert S. Bresalier, Manoop S. Bhutani, Gottumukkala S. Raju, Yinghong Wang)
| | - Wei Qiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (Wei Qiao), USA
| | - Robert S Bresalier
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas (Hamzah Abu-Sbeih, Phillip S. Ge, Phillip Lum, Robert S. Bresalier, Manoop S. Bhutani, Gottumukkala S. Raju, Yinghong Wang)
| | - Manoop S Bhutani
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas (Hamzah Abu-Sbeih, Phillip S. Ge, Phillip Lum, Robert S. Bresalier, Manoop S. Bhutani, Gottumukkala S. Raju, Yinghong Wang)
| | - Gottumukkala S Raju
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas (Hamzah Abu-Sbeih, Phillip S. Ge, Phillip Lum, Robert S. Bresalier, Manoop S. Bhutani, Gottumukkala S. Raju, Yinghong Wang)
| | - Yinghong Wang
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas (Hamzah Abu-Sbeih, Phillip S. Ge, Phillip Lum, Robert S. Bresalier, Manoop S. Bhutani, Gottumukkala S. Raju, Yinghong Wang)
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Verdon C, Aruljothy A, Lakatos PL, Bessissow T. Endoscopic surveillance strategies for dysplasia in ulcerative colitis. Frontline Gastroenterol 2019; 11:124-132. [PMID: 32133111 PMCID: PMC7043085 DOI: 10.1136/flgastro-2018-101056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 03/11/2019] [Accepted: 03/17/2019] [Indexed: 02/04/2023] Open
Abstract
Ulcerative colitis (UC) is a chronic inflammatory bowel disorder with an increased risk of colorectal cancer (CRC). This has led to the implementation of surveillance programmes to minimise this risk. Overall, these proactive programmes in association with better medical therapies have reduced the incidence of CRC in this population. Specific populations remain at increased risk, such as younger age at diagnosis, primary sclerosing cholangitis, colonic strictures and pseudopolyps. The majority of gastrointestinal international societies favour chromoendoscopy with targeted biopsies or random biopsies. The aim of this review is to present the current literature on dysplasia surveillance, the methodology and endoscopic technology available to assess dysplasia in UC.
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Affiliation(s)
- Christine Verdon
- Gastroenterology, McGill University Health Centre, Montreal, Québec, Canada
| | - Achuthan Aruljothy
- Gastroenterology, McGill University Health Centre, Montreal, Québec, Canada
| | - Peter L Lakatos
- Gastroenterology, McGill University Health Centre, Montreal, Québec, Canada,1st Department of Medicine, Semmelweis University, Budapest, Hungary
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Park CH, Kim NH, Park JH, Park DI, Sohn CI, Jung YS. Impact of family history of colorectal cancer on age-specific prevalence of colorectal neoplasia. J Gastroenterol Hepatol 2019; 34:537-543. [PMID: 30462856 DOI: 10.1111/jgh.14553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/02/2018] [Accepted: 11/14/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIM There are no established guidelines on screening strategies for persons with a family history of colorectal cancer (CRC) in Korea. We aimed to evaluate the age-specific risk of colorectal neoplasia according to family history of CRC. METHODS Participants who underwent screening colonoscopy were included. Age-specific prevalence of non-advanced adenoma (NAA) and advanced colorectal neoplasia (ACRN) was calculated according to family history of CRC. RESULTS Among 35 997 participants, 1339 (3.7%) had a family history of CRC in first-degree relatives. A family history of CRC was an independent risk factor for NAA (adjusted odds ratio [AOR] 1.33, 95% confidence interval [CI] 1.16-1.52). In the subgroup analysis by age, family history of CRC was a risk factor for NAA in the 50-59 and ≥ 60 years groups (AOR [95% CI]: 1.42 [1.04-1.91] and 2.33 [1.34-4.09], respectively), but not in the 30-39 and 40-49 years groups. In the curve of age-specific prevalence of NAA, the gap of the prevalence between the family history and non-family history groups began to widen after the mid-50s. In cases of ACRN, a family history of CRC was not a risk factor in the entire age group (AOR 1.16, 95% CI 0.75-1.70). In the curve of age-specific prevalence of ACRN, however, the gap of the prevalence between the family history and non-family history groups began to widen after the early 60s. CONCLUSION Although a family history of CRC is a risk factor for NAA, it may affect NAA development from the mid-50s and ACRN development from the early 60s.
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Affiliation(s)
- Chan Hyuk Park
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Nam Hee Kim
- Preventive Health Care, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Ho Park
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Il Park
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chong Il Sohn
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Suk Jung
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Choi CHR, Al Bakir I, Ding NSJ, Lee GH, Askari A, Warusavitarne J, Moorghen M, Humphries A, Ignjatovic-Wilson A, Thomas-Gibson S, Saunders BP, Rutter MD, Graham TA, Hart AL. Cumulative burden of inflammation predicts colorectal neoplasia risk in ulcerative colitis: a large single-centre study. Gut 2019; 68:414-422. [PMID: 29150489 PMCID: PMC6581019 DOI: 10.1136/gutjnl-2017-314190] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 09/20/2017] [Accepted: 10/12/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Ulcerative colitis (UC) is a dynamic disease with its severity continuously changing over time. We hypothesised that the risk of colorectal neoplasia (CRN) in UC closely follows an actuarial accumulative inflammatory burden, which is inadequately represented by current risk stratification strategies. DESIGN This was a retrospective single-centre study. Patients with extensive UC who were under colonoscopic surveillance between 2003 and 2012 were studied. Each surveillance episode was scored for a severity of microscopic inflammation (0=no activity; 1=mild; 2=moderate; 3=severe activity). The cumulative inflammatory burden (CIB) was defined as sum of: average score between each pair of surveillance episodes multiplied by the surveillance interval in years. Potential predictors were correlated with CRN outcome using time-dependent Cox regression. RESULTS A total of 987 patients were followed for a median of 13 years (IQR, 9-18), 97 (9.8%) of whom developed CRN. Multivariate analysis showed that the CIB was significantly associated with CRN development (HR, 2.1 per 10-unit increase in CIB (equivalent of 10, 5 or 3.3 years of continuous mild, moderate or severe active microscopic inflammation); 95% CI 1.4 to 3.0; P<0.001). Reflecting this, while inflammation severity based on the most recent colonoscopy alone was not significant (HR, 0.9 per-1-unit increase in severity; 95% CI 0.7 to 1.2; P=0.5), a mean severity score calculated from all colonoscopies performed in preceding 5 years was significantly associated with CRN risk (HR, 2.2 per-1-unit increase; 95% CI 1.6 to 3.1; P<0.001). CONCLUSION The risk of CRN in UC is significantly associated with accumulative inflammatory burden. An accurate CRN risk stratification should involve assessment of multiple surveillance episodes to take this into account.
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Affiliation(s)
- Chang-Ho Ryan Choi
- St Mark's Hospital, London, UK
- Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Ibrahim Al Bakir
- St Mark's Hospital, London, UK
- Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | | | | | | | | | | | | | | | | | | | - Matthew D Rutter
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
| | - Trevor A Graham
- Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
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Gómez-Moreno R, González-Pons M, Soto-Salgado M, Cruz-Correa M, Baerga-Ortiz A. The Presence of Gut Microbial Genes Encoding Bacterial Genotoxins or Pro-Inflammatory Factors in Stool Samples from Individuals with Colorectal Neoplasia. Diseases 2019; 7:E16. [PMID: 30717148 DOI: 10.3390/diseases7010016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 01/23/2019] [Accepted: 01/28/2019] [Indexed: 12/21/2022] Open
Abstract
Gut bacterial toxins are thought to contribute to the development of colorectal cancer (CRC). This study examines the presence of specific gut bacterial toxin genes in stool samples from individuals with colorectal neoplasia (adenomas and/or CRC). The presence of bacterial genes encoding genotoxic or pro-inflammatory factors (pks, tcpC, gelE, cnf-1, AMmurB, and usp) was established by PCR of stool samples from individuals from mainland US (n = 30; controls = 10, adenoma = 10, CRC = 10) and from Puerto Rico (PR) (n = 33; controls = 13; adenomas = 8; CRC = 12). Logistic regression models and multinomial logistic regression models were used to estimate the magnitude of association. Distinct bacterial gene profiles were observed in each sample cohort. In individuals with CRC, AMmurB was detected more frequently in samples from the US and gelE in samples from PR. In samples from PR, individuals with ≥2 gut bacterial toxin genes in stool had higher odds of having colorectal neoplasia (OR = 11.0, 95%: CI 1.0–637.1): however, no significant association between bacterial genes and colorectal neoplasia was observed in the US cohort. Further analyses are warranted in a larger cohort to validate these preliminary findings, but these encouraging results highlight the importance of developing bacterial markers as tools for CRC diagnosis or risk stratification.
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Zhang Q, Xing TY, Wang Z. A snare combined with endoclips to assist in endoscopic submucosal dissection for intraepithelial neoplasia in the entire colon and rectum. Scand J Gastroenterol 2019; 54:114-121. [PMID: 30650310 DOI: 10.1080/00365521.2018.1549270] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The use of mucosal traction to assist in colonic and rectal endoscopic submucosal dissection (ESD), especially for deep colonic ESD, is challenging. We developed a method of inverse insertion of a snare into the endoscopic working channel to deliver it into the colon together with the endoscope. With this method, two types of mucosal traction, per-anal external traction (PET) and per-anal internal traction (PIT), could be achieved using a snare with endoclips to assist in ESD (ESD-SE). Here, we aimed to examine its safety and feasibility. METHODS From January 2017 to September 2018, 50 colonic and rectal intraepithelial neoplasias in 50 patients were treated with ESD-SE. Data on lesion location and size, operation time, en bloc resection and R0 resection rates, and operative complications were collected. RESULTS Among 50 lesions, 15 lesions were located in the deep colon/proximal colon, and 35 lesions were in the distal colon. The median (interquartile range) size of lesions, submucosal dissection time, and total operation time were 4.5 (3.0-5.0) cm, 32 (18-81) min, and 50 (33-108) min, respectively. All lesions were completely resected, with R0 resection rates of 100%. No intraoperative and postoperative complications occurred. Postoperative pathology revealed 40 and 10 cases of high-grade and low-grade intraepithelial neoplasia, respectively. CONCLUSIONS The approach using insertion of a selective snare into the colon together with the endoscope, especially into the deep colon, was safe and simple. Use of the snare combined with endoclips could effectively assist in total colonic ESD. Further research is warranted.
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Affiliation(s)
- Qiang Zhang
- a Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology , Nanfang Hospital, Southern Medical University , Guangzhou , China
| | - Tong-Yin Xing
- a Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology , Nanfang Hospital, Southern Medical University , Guangzhou , China
| | - Zhen Wang
- a Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology , Nanfang Hospital, Southern Medical University , Guangzhou , China
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Gargallo CJ, Lanas Á, Carrera‐Lasfuentes P, Ferrandez Á, Quintero E, Carrillo M, Alonso‐Abreu I, García‐Gonzalez MA. Genetic susceptibility in the development of colorectal adenomas according to family history of colorectal cancer. Int J Cancer 2018; 144:489-502. [PMID: 30194776 PMCID: PMC6587859 DOI: 10.1002/ijc.31858] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/30/2018] [Accepted: 08/29/2018] [Indexed: 12/25/2022]
Abstract
Our study aimed to evaluate the relevance of genetic susceptibility in the development of colorectal adenomas (CRA) and its relationship with the presence of family history of colorectal cancer (CRC). Genomic DNA from 750 cases (first degree relatives of patients with CRC) and 750 controls (subjects with no family history of CRC) was genotyped for 99 single nucleotide polymorphisms (SNPs) previously associated with CRC/CRA risk by GWAS and candidate gene studies by using the MassArray™ (Sequenom) platform. Cases and controls were matched by gender, age and histological lesion. Eight hundred and fifty‐eight patients showed no neoplastic lesions, whereas 288 patients showed low‐risk adenomas, and 354 patients presented high‐risk adenomas. Two SNPs (rs10505477, rs6983267) in the CASC8 gene were associated with a reduced risk of CRA in controls (log‐additive models, OR: 0.67, 95%CI:0.54–0.83, and OR:0.66, 95%CI:0.54–0.84, respectively). Stratified analysis by histological lesion revealed the association of rs10505477 and rs6983267 variants with reduced risk of low‐ and high‐risk adenomas in controls, being this effect stronger in low‐risk adenomas (log‐additive models, OR:0.63, 95%CI:0.47–0.84 and OR:0.64, 95%CI:0.47–0.86, respectively). Moreover, 2 SNPs (rs10795668, rs11255841) in the noncoding LINC00709 gene were significantly associated with a reduced risk of low‐risk adenomas in cases (recessive models, OR:0.22, 95%CI:0.06–0.72, and OR:0.08, 95%CI:0.03–0.61) and controls (dominant models, OR:0.50, 95%CI:0.34–0.75, and OR:0.52, 95%CI:0.35–0.78, respectively). In conclusion, some variants associated with CRC risk (rs10505477, rs6983267, rs10795668 and rs11255841) are also involved in the susceptibility to CRA and specific subtypes. These associations are influenced by the presence of family history of CRC. What's new? While numerous candidate gene variants have been associated with colorectal cancer, little is known about the relevance of genetic susceptibility or influence of family history in the development of precancerous colorectal adenomas. In the present study, certain genetic variants previously associated with colorectal cancer risk, including two variants in the CASC8 gene and two in the lnc‐RNA LINC00709 gene, were found to be also involved in susceptibility to colorectal adenomas. The associations were modified by family history of colorectal cancer. The results could have implications for colorectal cancer screening and the identification of individuals at increased risk of colorectal adenoma.
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Affiliation(s)
- Carla J. Gargallo
- Department of GastroenterologyHospital Clínico Universitario Lozano BlesaZaragozaSpain
- Aragon Health Research Institute (IIS Aragon)ZaragozaSpain
| | - Ángel Lanas
- Department of GastroenterologyHospital Clínico Universitario Lozano BlesaZaragozaSpain
- Aragon Health Research Institute (IIS Aragon)ZaragozaSpain
- University of Zaragoza School of MedicineZaragozaSpain
- CIBERehdZaragozaSpain
| | | | - Ángel Ferrandez
- Department of GastroenterologyHospital Clínico Universitario Lozano BlesaZaragozaSpain
- Aragon Health Research Institute (IIS Aragon)ZaragozaSpain
| | - Enrique Quintero
- University of La Laguna, School of MedicineCanary IslandsSpain
- Hospital Universitario de CanariasCanary IslandsSpain
| | | | | | - María Asunción García‐Gonzalez
- Aragon Health Research Institute (IIS Aragon)ZaragozaSpain
- CIBERehdZaragozaSpain
- Aragon Institute of Health Sciences (IACS)ZaragozaSpain
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Vermeer NCA, Bahadoer RR, Bastiaannet E, Holman FA, Meershoek-Klein Kranenbarg E, Liefers GJ, van de Velde CJH, Peeters KCMJ. Introduction of a colorectal cancer screening programme: results from a single-centre study. Colorectal Dis 2018; 20:O239-O247. [PMID: 29917325 DOI: 10.1111/codi.14313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 06/06/2018] [Indexed: 02/08/2023]
Abstract
AIM In 2014, a national colorectal cancer (CRC) screening programme was launched in the Netherlands. It is difficult to assess for the individual patients with CRC whether the oncological benefits of surgery will outweigh the morbidity of the procedure, especially in early lesions. This study compares patient and tumour characteristics between screen-detected and nonscreen-detected patients. Also, we present an overview of treatment options and clinical dilemmas when treating patients with early-stage colorectal disease. METHOD Between January 2014 and December 2016, all patients with nonmalignant polyps or CRC who were referred to the Department of Surgery of the Leiden University Medical Centre in the Netherlands were included. Baseline characteristics, type of treatment and short-term outcomes of patients with screen-detected and nonscreen-detected colorectal tumours were compared. RESULTS A total of 426 patients were included, of whom 240 (56.3%) were identified by screening. Nonscreen-detected patients more often had comorbidity (P = 0.03), the primary tumour was more often located in the rectum (P = 0.001) and there was a higher rate of metastatic disease (P < 0.001). Of 354 surgically treated patients, postoperative adverse events did not significantly differ between the two groups (P = 0.38). Of 46 patients with T1 CRC in the endoscopic resection specimen, 23 underwent surgical resection of whom only 30.4% had residual invasive disease at colectomy. CONCLUSION Despite differences in comorbidity, stage and surgical outcome of patients with screen-detected tumours compared to nonscreen-detected tumours were not significantly different. Considering its limited oncological benefits as well as the rate of adverse events, surgery for nonmalignant polyps and T1 CRC should be considered carefully.
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Affiliation(s)
- N C A Vermeer
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - R R Bahadoer
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - E Bastiaannet
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - F A Holman
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - G J Liefers
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - C J H van de Velde
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - K C M J Peeters
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
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Jung YS, Kim NH, Yang HJ, Park SK, Park JH, Park DI, Sohn CI. The impact of passive smoking on the risk of colorectal neoplasia in never, former, and current smokers. J Gastroenterol Hepatol 2018; 33:1023-1030. [PMID: 29048137 DOI: 10.1111/jgh.14023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/11/2017] [Accepted: 10/13/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND AIM Active smoking is well known to be a risk factor for colorectal neoplasia (CRN). However, it remains unclear whether passive smoking is also related to the risk of CRN. This study investigated the effect of passive smoking on the risk of CRN in never, former, and current smokers. METHODS A cross-sectional study was performed on asymptomatic examinees who underwent colonoscopy as part of a health check-up. RESULTS Of 136 707 participants, 33 052 (24.2%) were never passive smokers, and 103 655 (75.8%) were ever passive smokers. The mean age of the study population was 41.0 years. The proportion of never, former, and current smokers was 56.9%, 21.4%, and 24.8%, respectively, and the proportion of overall CRN and advanced CRN (ACRN) was 15.4% and 1.7%, respectively. Ever passive smoke exposure was associated with an increased risk of overall CRN in never smokers (adjusted odds ratio [AOR] 1.08; 95% confidence interval [CI] 1.02-1.13) and former smokers (AOR 1.08; 95% CI 1.00-1.17) but not in current smokers (AOR 1.02; 95% CI 0.94-1.11). Additionally, it significantly increased the risk of ACRN among never smokers (AOR 1.17; 95% CI 1.01-1.35) and tended to increase the risk of ACRN among former smokers (AOR 1.26; 95% CI 0.99-1.61). Moreover, the risk of CRN increased with increasing frequency and duration of passive smoking in never and former smokers. CONCLUSIONS Passive smoking was an independent risk factor for CRN in never and former smokers. Never and former smokers who are highly exposed to passive smoke as well as current smokers should be given priority for colonoscopy.
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Affiliation(s)
- Yoon Suk Jung
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Nam Hee Kim
- Preventive Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo-Joon Yang
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Kyung Park
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Ho Park
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Il Park
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chong Il Sohn
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Jung YS, Kwon MJ, Park DI, Sohn CI, Park JH. Association between natural killer cell activity and the risk of colorectal neoplasia. J Gastroenterol Hepatol 2018; 33:831-836. [PMID: 29055146 DOI: 10.1111/jgh.14028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/01/2017] [Accepted: 10/08/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Low activity of natural killer (NK) cells is known to be associated with higher risk of cancer, especially with poor prognosis and the presence of colorectal cancer (CRC). We investigated whether NK cells activity differs between subjects with and without colorectal neoplasia (CRN). METHODS A cross-sectional study was performed on 1818 asymptomatic examinees aged ≥ 30 years who underwent NK cell activity test (which quantitates the amount of interferon-γ secreted into the plasma by NK cells) and a colonoscopy as part of a health checkup. RESULTS The mean age of the study population was 41.4 years. The proportion of overall CRN and advanced CRN was 13.5% (n = 246) and 0.7% (n = 13), respectively. Only one subject was diagnosed with CRC. The median level of NK cell activity was lower in subjects with CRN than in those without CRN (1205 vs 1515 pg/mL, P = 0.009). It was also lower in subjects with non-advanced CRN than in those without CRN (1221 vs 1515 pg/mL; P = 0.036). Moreover, it was lower in subjects with advanced CRN than in those with non-advanced CRN (480 vs 1221 pg/mL; P = 0.028). Subjects with low levels of NK cell activity (< 250 pg/mL) had a higher prevalence of overall CRN (19.0% vs 12.9%, P = 0.024) and advanced CRN (3.4% vs 0.4%, P = 0.001) than those who demonstrated higher level (≥ 250 pg/mL). CONCLUSIONS Natural killer cell activity seemed to decrease along with CRC progression toward the later stages in the adenoma-carcinoma sequence. Its activity may be depressed in relation to progression of neoplasia, even at precancerous stage.
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Affiliation(s)
- Yoon Suk Jung
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min-Jung Kwon
- Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Il Park
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chong Il Sohn
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Ho Park
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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