Colorectal cancer(CRC)is a leading cause of cancer-related morbidity and mortality globally,and its management in the emergency setting presents distinct challenges.In addition to its advantages in elective CRC surger...Colorectal cancer(CRC)is a leading cause of cancer-related morbidity and mortality globally,and its management in the emergency setting presents distinct challenges.In addition to its advantages in elective CRC surgery,studies have demonstrated that minimally invasive surgery(MIS)can provide benefits in CRC emergencies,such as reduced morbidity and a shorter length of hospitalization.However,the applicability of MIS in the emergency setting is limited by factors such as compromised patient physiology,resource constraints,and the need for technical expertise.As an alternative to emergency MIS,endoscopic interventions have also been increasingly supported by emerging evidence as a bridge to surgery.This article appraises contemporary guidelines and the evidence behind their recommendations for MIS surgery in CRC emergencies,whilst highlighting the challenges to implementation and the strategies to overcome them.展开更多
BACKGROUND The combination of anti-epidermal growth factor receptor(EGFR)therapy and chemotherapy is currently a preferred first-line treatment for patients with unre-sectable,RAS and BRAF wild-type,left-sided metasta...BACKGROUND The combination of anti-epidermal growth factor receptor(EGFR)therapy and chemotherapy is currently a preferred first-line treatment for patients with unre-sectable,RAS and BRAF wild-type,left-sided metastatic colorectal cancer(mCRC).Several studies have also demonstrated the benefit of anti-EGFR therapy in sub-sequent line settings for this patient population.However,direct evidence com-paring the effectiveness of frontline vs subsequent anti-EGFR therapy remains limited,leaving a crucial gap in guiding optimal treatment strategies.AIM To compare overall survival(OS)between frontline and subsequent anti-EGFR treatment in patients with unresectable,RAS and BRAF wild-type,left-sided mCRC.METHODS We retrospectively reviewed the medical records of mCRC patients treated at The King Chulalongkorn Memorial Hospital and Songklanagarind Hospital,Thailand,between January 2013 and April 2023.Patients were classified into two groups based on the sequence of their anti-EGFR treatment.The primary endpoint was OS.RESULTS Among 222 patients with a median follow-up of 29 months,no significant difference in OS was observed between the frontline and subsequent-line groups(HR 1.03,95%CI:0.73-1.46,P=0.878).The median OS was 35.53 months(95%CI:26.59-44.47)for the frontline group and 31.60 months(95%CI:27.83-35.37)for the subsequent-line group.In the subsequent-line group,71 patients(32.4%)who ultimately never received anti-EGFR therapy had a significantly worse median OS of 19.70 months(95%CI:12.87-26.53).CONCLUSION Frontline and subsequent-line anti-EGFR treatments provide comparable OS in unresectable,RAS/BRAF wild-type,left-sided mCRC patients,but early exposure is vital for those unlikely to receive subsequent therapy.展开更多
Colorectal cancer(CRC)is the third most common cancer worldwide and the second leading cause of cancer-related mortality.While early-stage CRC patients generally exhibit favorable overall survival(OS)rates,the prognos...Colorectal cancer(CRC)is the third most common cancer worldwide and the second leading cause of cancer-related mortality.While early-stage CRC patients generally exhibit favorable overall survival(OS)rates,the prognosis for metastatic CRC(mCRC)remains poor,with a survival rate<15%.Targeted combination therapy remains the main treatment strategy for mCRC,with a median OS(mOS)of only 25-30 months.展开更多
In this editorial,we reviewed the article by Fadlallah et al that was recently published in the World Journal of Clinical Oncology.The article provided a comprehensive and in-depth view of the management and treatment...In this editorial,we reviewed the article by Fadlallah et al that was recently published in the World Journal of Clinical Oncology.The article provided a comprehensive and in-depth view of the management and treatment of colorectal cancer(CRC),one of the leading causes of cancer-related morbidity and mortality worldwide.The article analyzed the therapeutic modalities and their sequencing,focusing on total neoadjuvant therapy for locally advanced rectal cancer.It highlighted the role of immunotherapy in tumors with high microsatellite instability or deficient mismatch repair,addressing recent advances that have improved prognosis and therapeutic response in localized and metastatic CRC.Innovations in surgical techniques,advanced radiotherapy,and systemic agents targeting specific mutational profiles are also discussed,reflecting on how they revolutionized clinical management.Circulating tumor DNA has emerged as a promising tool for detecting minimal residual disease,prognosis,and therapeutic monitoring,solidifying its role in precision oncology.This review emphasized the importance of technological and therapeutic advancements in improving clinical outcomes and personalizing CRC treatment.展开更多
BACKGROUND Adenomatous polyposis confers an increased risk of developing colorectal cancer.APC and MUTYH are the major genes investigated in patients suspected of having polyposis.In addition to APC and MUTYH genes,ot...BACKGROUND Adenomatous polyposis confers an increased risk of developing colorectal cancer.APC and MUTYH are the major genes investigated in patients suspected of having polyposis.In addition to APC and MUTYH genes,other genes,such as POLE,POLD1,NTHL1,MBD4,MSH3 and MLH3,have recently been associated with polyposis phenotypes,conferring heterogeneity in terms of the clinical,etiological and heritable aspects of patients with polyposis.AIM To investigate the underlying variant landscape in patients with suspected polyposis who lack variants in the APC and MUTYH genes using whole-exome sequencing.METHODS Twenty-seven participants were included in the study and subjected to germline whole-exome sequencing.In addition,their clinical-pathological,personal,and family history data were collected.RESULTS The mean age at diagnosis was 51 years,and most participants had attenuated forms of polyposis(88.9%),with 63.0%diagnosed with a primary tumor,mostly colorectal cancer(76.5%).Among the variants identified,17 were classified as pathogenic or likely pathogenic(in 12 participants),including variants in genes involved in the Wnt/β-catenin signaling pathway,such as ST7 L,A1CF,and DKK4,and variants in DNA-repair genes,such as NTHL1,PNKP,and PMS2,as well as a variant found at the FRK gene identified in a patient with classic polyposis at age 19 and with a family history of polyps.CONCLUSION This study identified novel genes potentially associated with polyposis in patients lacking germline pathogenic variants in the APC and MUTYH genes.These findings support the use of next-generation sequencing for screening,expanding the scope of polyposis-related variants beyond these two genes.展开更多
Colorectal cancer(CRC)is the most frequently diagnosed malignancy of the digestive system and the second leading cause of cancer-related deaths worldwide(1).In China,CRC ranks as the second most common cancer with inc...Colorectal cancer(CRC)is the most frequently diagnosed malignancy of the digestive system and the second leading cause of cancer-related deaths worldwide(1).In China,CRC ranks as the second most common cancer with incidence and mortality rates continuing to rise(2).The Chinese Society of Clinical Oncology(CSCO)first introduced its guidelines in 2017,and since then,they have been updated annually to incorporate the latest clinical research findings,drug availability,and expert consensus(3-8).This article presents the key updates in the 2025 edition compared to the 2024 version.展开更多
Colorectal cancer remains a major health concern,with colorectal polyps as key precursors.Endoscopic mucosal resection(EMR)is a common treatment,but recurrence rates remain high.Traditional surveillance strategies rel...Colorectal cancer remains a major health concern,with colorectal polyps as key precursors.Endoscopic mucosal resection(EMR)is a common treatment,but recurrence rates remain high.Traditional surveillance strategies rely on polyp characteristics and completeness of the resection potentially missing key risk factors.Machine learning(ML)offers a transformative approach by integrating patient-specific data to refine risk stratification.Recent studies highlight ML models,such as Extreme Gradient Boosting,which outperform conventional methods in predicting polyp recurrence within one-year post-EMR.These models incorporate factors like age,smoking status,family history,and pathology,optimizing follow-up recommendations and minimizing unnecessary procedures.Artificial intelligence(AI)-driven tools and web-based calculators enhance clinical workflow by providing real-time,personalized risk assessments.However,challenges remain in external validation,model interpretability,and clinical integration.Future surveillance strategies should combine expert judgment with AI insights to optimize patient outcomes.As gastroenterology embraces AI,MLdriven surveillance represents a paradigm shift,advancing precision medicine in colorectal polyp management.This editorial explores AI’s role in transforming post-EMR follow-up,addressing benefits,limitations,and future directions.展开更多
BACKGROUND Macrophages play a crucial role in the tumor microenvironment,displaying remarkable plasticity that allows them to either suppress or promote tumor progression.Their polarization into M1 or M2 phenotypes co...BACKGROUND Macrophages play a crucial role in the tumor microenvironment,displaying remarkable plasticity that allows them to either suppress or promote tumor progression.Their polarization into M1 or M2 phenotypes could have significant prognostic implications,and manipulating this polarization may offer a novel approach to controlling colorectal neoplasms.AIM To evaluate the infiltration rates of M1 and M2 macrophages in colorectal neoplasia,specifically comparing cases with and without metalloproteinase mutations.Additionally,it sought to explore potential prognostic factors as-sociated with the disease.展开更多
BACKGROUND Colorectal cancer(CRC)is the third most prevalent form of cancer worldwide.Among patients with CRC,colorectal liver metastasis(CRLM)is the foremost direct contributor to mortality.In recent years,immunother...BACKGROUND Colorectal cancer(CRC)is the third most prevalent form of cancer worldwide.Among patients with CRC,colorectal liver metastasis(CRLM)is the foremost direct contributor to mortality.In recent years,immunotherapy has swiftly risen to prominence as a vital approach for treating a range of solid tumors,including CRC.We present a unique case of a patient suffering from CRLM,with the goal of offering an insightful example and relevant references for the treatment of CRLM.CASE SUMMARY We report a patient who experienced liver metastasis after undergoing successful surgical removal of CRC,with the postoperative pathological stage identified as pT4N2aM0.The patient has been receiving a combination treatment of Western and Traditional Chinese Medicine.Regular assessments of the patient’s condition have been conducted,encompassing evaluations of serum carcinoembryonic antigen levels,carbohydrate antigen 199,and observations of the tongue complexion and its coating.The patient achieved clinical remission after anti-programmed death-1 immunotherapy when various systemic therapies failed.Since the diagnosis of CRLM,the patient has survived for more than 6 years,surpassing the expected survival time for those with advanced CRC.CONCLUSION This case illustrates the considerable promise of anti-programmed death-1 immunotherapy in managing CRLM,especially in scenarios of drug resistance and disease progression.展开更多
Colorectal cancer(CRC),ranking as the third most common malignant tumor globally,continues to have high incidence and mortality rates.In China,the incidence of CRC has been increasing in recent years,imposing a heavy ...Colorectal cancer(CRC),ranking as the third most common malignant tumor globally,continues to have high incidence and mortality rates.In China,the incidence of CRC has been increasing in recent years,imposing a heavy economic burden on society[1].Low prevalence of early screening leads to the majority of patients being diagnosed at an advanced stage.Current main treatment methods,such as surgery,chemotherapy,targeted therapy,and immunotherapy,have limited effectiveness for these patients and are prone to recurrence and metastasis.Moreover,the interplay of various pathogenic factors including genetic,environmental,and lifestyle factors increases the difficulty of CRC prevention and treatment[1].展开更多
Lynch syndrome(LS),also known as hereditary non-polyposis colorectal cancer(HNPCC),is an inherited condition associated with a higher risk of colorectal cancer(CRC)and other cancers.It is caused by germline mutations ...Lynch syndrome(LS),also known as hereditary non-polyposis colorectal cancer(HNPCC),is an inherited condition associated with a higher risk of colorectal cancer(CRC)and other cancers.It is caused by germline mutations in DNA mismatch repair(MMR)genes,including MLH1,MSH2,MSH6 and PMS2.These mutations lead to microsatellite instability(MSI)and defective DNA repair mechanisms,resulting in increased cancer risk.Early detection of LS is crucial for effective management and cancer prevention.Endoscopic surveillance,particularly regular colonoscopy,is recommended for individuals with LS to detect CRC at early stages.Additionally,universal screening of CRC for MMR deficiency can help identify at-risk individuals.Genetic counseling plays a valuable role in LS by guiding patients and their families in understanding the genetic basis,making informed decisions regarding surveillance and prevention,and offering reproductive options to reduce the transmission of pathogenic variants of the offspring.The aim of this review is to outline current strategies for the diagnosis,surveillance,and management of LS,with a focus on the role of genetic counseling,endoscopic screening,and emerging therapeutic approaches to mitigate cancer risk in affected individuals.展开更多
BACKGROUND The use of an ultrasound-guided quadratus lumborum block(QLB)combined with general anesthesia for patients undergoing colorectal cancer surgery serves as a model for reducing the postoperative stress respon...BACKGROUND The use of an ultrasound-guided quadratus lumborum block(QLB)combined with general anesthesia for patients undergoing colorectal cancer surgery serves as a model for reducing the postoperative stress response,preserving metabolic stability,protecting renal function,and alleviating postoperative pain.AIM To compare QLB combined with general anesthesia vs general anesthesia alone in the perioperative stress response,metabolic and renal function,postoperative pain,and recovery outcomes among patients undergoing colorectal cancer surgery.METHODS Clinical data of 116 patients who underwent colorectal cancer surgery at our hospital between July 2023 and August 2024 were collected for retrospective analysis.According to the anesthesia protocol,the patients were divided into the control(general anesthesia,n=58)and experimental groups(QLB combined with general anesthesia,n=58).Physiological indicators such as blood glucose(GLU),lactic acid(LAC),blood urea nitrogen(BUN),and creatinine(CRE)were measured at T0(pre-surgery),T1(post-surgery),T2(6 hours post-surgery),T3(24 hours post-surgery),and T4(48 hours post-surgery).The differences between the two groups for each indicator were evaluated using repeated-measures analysis of variance.RESULTS The GLU levels from T1 to T4 in the experimental group were significantly lower than those in the control group(P<0.001),and the LAC levels were also significantly reduced(P<0.001).The experimental group exhibited superior renal protection based on postoperative BUN and CRE levels(P<0.05).Furthermore,the postoperative pain score in the experimental group was significantly lower than that in the control group[visual analogue scale(VAS)]scores differed significantly from T2 to T4,P<0.05.CONCLUSION Research has shown that QLB combined with general anesthesia can decrease postoperative GLU and LAC by 8%-15%and 10%-20%(P<0.001),respectively.It also enhances renal function markers(BUN,CRE,P<0.05)and lowers VAS scores by 15%-30%(P<0.05).Ultrasound-guided lumbar muscle block with general anesthesia outperforms general anesthesia alone in diminishing stress response,preserving metabolic balance and renal function,and alleviating postoperative pain.This approach offers a more efficient perioperative management strategy for patients undergoing colorectal cancer surgery.It is particularly advantageous for individuals with stress sensitivity,renal impairment,and heightened pain susceptibility.展开更多
BACKGROUND The degree of obstruction plays an important role in decision-making for obstructive colorectal cancer(OCRC).The existing assessment still relies on the colorectal obstruction scoring system(CROSS)which is ...BACKGROUND The degree of obstruction plays an important role in decision-making for obstructive colorectal cancer(OCRC).The existing assessment still relies on the colorectal obstruction scoring system(CROSS)which is based on a comprehensive analysis of patients’complaints and eating conditions.The data collection relies on subjective descriptions and lacks objective parameters.Therefore,a scoring system for the evaluation of computed tomography-based obstructive degree(CTOD)is urgently required for OCRC.AIM To explore the relationship between CTOD and CROSS and to determine whether CTOD could affect the short-term and long-term prognosis.METHODS Of 173 patients were enrolled.CTOD was obtained using k-means,the ratio of proximal to distal obstruction,and the proportion of nonparenchymal areas at the site of obstruction.CTOD was integrated with the CROSS to analyze the effect of emergency intervention on complications.Short-term and long-term outcomes were compared between the groups.RESULTS CTOD severe obstruction(CTOD grade 3)was an independent risk factor[odds ratio(OR)=3.390,95%confidence interval(CI):1.340-8.570,P=0.010]via multivariate analysis of short-term outcomes,while CROSS grade was not.In the CTOD-CROSS grade system,for the non-severe obstructive(CTOD 1-2 to CROSS 1-4)group,the complication rate of emergency interventions was significantly higher than that of non-emergency interventions(71.4%vs 41.8%,P=0.040).The postoperative pneumonia rate was higher in the emergency intervention group than in the non-severe obstructive group(35.7%vs 8.9%,P=0.020).However,CTOD grade was not an independent risk factor of overall survival and progression-free survival.CONCLUSION CTOD was useful in preoperative decision-making to avoid unnecessary emergency interventions and complications.展开更多
BACKGROUND Certain subgroups are at an increased risk of false fecal immunochemical test(FIT)results;however,related studies are limited,and the available evidence is conflicting.AIM To evaluate factors associated wit...BACKGROUND Certain subgroups are at an increased risk of false fecal immunochemical test(FIT)results;however,related studies are limited,and the available evidence is conflicting.AIM To evaluate factors associated with false-positive and false-negative FIT results.METHODS This retrospective study was based on the database of the Tianjin Colorectal Cancer Screening Program from 2012 to 2020.A total of 4129947 residents aged 40-74 years completed at least one FIT.Of these,24890 asymptomatic participants who underwent colonoscopy examinations and completed lifestyle questionnaires were included in the analysis.Multivariable logistic regression was performed to identify the factors associated with false FIT results.RESULTS Among the overall screening population,88687(2.15%)participants tested positive for FIT.The sensitivity,specificity,positive predictive value,and negative predictive value of FIT for advanced neoplasms were 58.2%,44.8%,9.7%,and 91.3%,respectively.Older age,female sex,smoking,alcohol consumption,higher body mass index,and hemorrhoids were significantly associated with increased odds of false-positive and lower odds of falsenegative FIT results.Moreover,features of high-grade dysplasia or villous for advanced adenoma and the presence of cancer were also associated with lower odds of false-negative results,while irregular exercise and diverticulum were associated with higher odds of false-positive results.CONCLUSION FIT results may be inaccurate in certain subgroups.Our results provide important evidence for further individualization of screening strategies.展开更多
BACKGROUND Designing a feasible risk prediction model for advanced colorectal neoplasia(ACN)can enhance colonoscopy screening efficiency.Abdominal obesity is associated with colorectal cancer development.AIM To propos...BACKGROUND Designing a feasible risk prediction model for advanced colorectal neoplasia(ACN)can enhance colonoscopy screening efficiency.Abdominal obesity is associated with colorectal cancer development.AIM To propose and evaluate a modified scoring model incorporating waist-hip ratio for the prediction of ACN.METHODS A total of 6483 patients who underwent their first screening or diagnostic colonoscopy in our center between 2020 and 2023 were recruited,in which 4592 were in the derivation cohort and 1891 formed a validation cohort.Multivariate logistic regression was used to investigate the risk factors of ACN in the derivation cohort based on endoscopic findings,and a new scoring model for ACN prediction was developed.The discriminatory capability of the scoring model was validated by the validation cohort.RESULTS Age,male gender,smoking,and wait-to-hip ratio were identified as independent risk factors for ACN,and a 7-point scoring model was developed.The prevalence of ACN was 3.3%,9.3%and 18.5%in participants with scores of 0-2[low risk(LR)],3–4[moderate risk(MR)],and 5–7[high risk(HR)],respectively,in the derivation cohort.With the scoring model,49.9%,38.4%,and 11.7%of patients in the validation cohort were categorized as LR,MR,and HR,respectively.The corresponding prevalence rates of ACN were 5.0%,10.3%,and 17.6%,respectively.The C-statistic of the new scoring model was 0.66,which was higher than that of the Asia-Pacific Colorectal Screening model(0.63).CONCLUSION A modified scoring model incorporating waist-hip ratio has an improved predictive performance in the prediction of ACN.展开更多
Colorectal cancer is a major cause of cancer-related mortality worldwide,under-scoring the importance of early and effective colorectal cancer screening to im-prove survival rates.Traditional colorectal cancer screeni...Colorectal cancer is a major cause of cancer-related mortality worldwide,under-scoring the importance of early and effective colorectal cancer screening to im-prove survival rates.Traditional colorectal cancer screening methods include non-invasive tests,such as the fecal immunochemical test(FIT),as well as diagnostic procedures like colonoscopy.Colonoscopy remains the gold standard for detec-ting and treating precancerous polyps and early-stage cancer,regardless of whe-ther it is used as the first screening test or the second test following a positive FIT.However,its effectiveness can be affected by factors such as operator skill,patient variability,and limited lesion visibility,resulting in a significant rate of missed lesion rates and highlighting the need for more efficient and accurate screening techniques.This review is aimed to assess the current challenges of traditional screening methods with the impact of artificial intelligence(AI)in the diagnostic flow.The literature on AI-powered tools for colorectal cancer screening,including novel applications,emerging programs,and recent guidelines,has been reviewed to highlight both the advantages and limitations of implementing this technology in healthcare.Recent advances in AI have introduced soft AI colonoscopy,with the purpose of improving lesion recognition(computer-aided detection)and/or improving optical diagnosis(computer-aided diagnosis).AI-powered colono-scopy systems employ deep learning algorithms to analyze real-time endoscopic images,enhancing detection rates for adenomas,serrated lesions and cancer by reducing human error.AI-assisted colonoscopy enhances adenoma detection,enabling earlier intervention and improved patient outcomes.The benefits are particularly pronounced for less-experienced practitioners,as the detection rates for AI-assisted colonoscopy are similar to experts.AI integration also helps in the teaching process,in developing standardized procedures,and improving screening procedure accuracy and efficiency across different healthcare providers.However,there are challenges and limitations,such as the cost of AI implementation,data privacy concerns,and the need for extensive clinical validation.As AI technology continues to evolve,its transformation of the colorectal cancer screening system could revolutionize the field,making early detection more accessible and reducing mortality,on the condition that the above issues are addressed before widespread use.展开更多
AIM To analyze the efficacy of laparoscopic radical resection of CRC(LRRCC)in treating older patients with CRC and the effect of this procedure on inflammatory factors.METHODS The study included 104 older patients wit...AIM To analyze the efficacy of laparoscopic radical resection of CRC(LRRCC)in treating older patients with CRC and the effect of this procedure on inflammatory factors.METHODS The study included 104 older patients with CRC admitted from August 2022 to August 2024.Participants undergoing open radical resection of CRC were categorized as the control group(50 patients),whereas those receiving LRRCC were classified as the research group(54 patients).Subsequently,comparative analyses involved data on efficacy,postoperative complications(ileus,incision infection,anastomotic fistula,and pulmonary infection),surgery-related parameters(operation duration and intraoperative bleeding volume),postoperative recoveryrelated indicators(time to first postoperative passage of flatus and defecation and length of hospital stay),and inflammatory factors(tumor necrosis factor-α,highsensitivity C-reactive protein,and interleukin-6).RESULTS Data revealed markedly superior therapeutic efficacy and a lower overall postoperative complication rate in the research group compared to the control group.The research group demonstrated substantially less intraoperative bleeding,less time to first postoperative passage of flatus and defecation,and a shorter length of hospital stay despite a notably longer operation duration compared to the control group.Further,tumor necrosis factor-α,high-sensitivity C-reactive protein,and interleukin-6 levels in the research group were significantly reduced 3 days postoperatively compared to both the preoperative and control group values.CONCLUSION LRRCC for older patients with CRC exhibited superior therapeutic efficacy compared to open radical resection and significantly suppressed postoperative stress-related inflammatory responses,which merits clinical application and promotion.展开更多
BACKGROUND Metastatic colorectal cancer(mCRC)is a global health challenge with a poor prognosis.Prognostic markers are critical for survival prediction.METHODS This multicenter,retrospective study measured baseline ca...BACKGROUND Metastatic colorectal cancer(mCRC)is a global health challenge with a poor prognosis.Prognostic markers are critical for survival prediction.METHODS This multicenter,retrospective study measured baseline carcinoembryonic antigen and carbohydrate antigen 19-9 levels to calculate a TMI as the geometric mean of values normalized to their upper limits of normal.Receiver operating characteristic curve analysis assessed TMI’s prognostic accuracy,and patients were stratified into high-TMI(≥1.39)and low-TMI(<1.39)groups.The primary endpoint was overall survival(OS),with progression-free survival and treatment response as secondary endpoints.RESULTS The study included 305 mCRC patients with a median follow-up of 22.9 months.The median OS for high-TMI patients was 29.5 months,significantly lower than the 45.6 months observed in the low-TMI group(P=0.02).The 2-year OS rates for the high-and low-TMI groups were 59.4%and 72.9%,respectively.Median progression-free survival was also shorter for the high-TMI group(14.0 vs 16.0 months,P=0.84).High TMI is an independent prognostic factor for worse OS.CONCLUSION TMI is a simple,cost-effective prognostic tool for mCRC,with high TMI associated with poorer survival outcomes.展开更多
Colorectal cancer (CRC) is the third most common cancer globally, with 20%-25%of patients diagnosed at stage IV, significantly affecting overall survival (OS).Only 14% of stage IV patients survive for 5 years with pal...Colorectal cancer (CRC) is the third most common cancer globally, with 20%-25%of patients diagnosed at stage IV, significantly affecting overall survival (OS).Only 14% of stage IV patients survive for 5 years with palliative chemotherapy.However, the role of liver transplantation (LT) in the management of CRC livermetastasis (CRCLM) is an evolving area of interest. Recent advancements inoncologic outcomes and clinical understanding have prompted the re-evaluationof LT as a viable treatment option for CRCLM. A promising result from someprospective pilot studies reported a 5-year OS rate of 60% after LT for patientswith CRCLM. Key factors influencing eligibility include tumor biology, absence ofextrahepatic disease, and the patient's performance status. By synthesizing thelatest research findings, we aim to provide a comprehensive overview that summarizesthe most relevant data related to the clinical outcomes of patients whounderwent LT for CRCLM. We aim to provide a comprehensive overview by synthesizingthe latest research findings. This review discusses the inclusion criteriaand eligibility for LT in CRCLM, which are of great importance to patient outcomes.展开更多
BACKGROUND Colorectal polyps are commonly observed in patients with chronic liver disease(CLD)and pose a significant clinical concern because of their potential for malignancy.AIM To explore the clinical characteristi...BACKGROUND Colorectal polyps are commonly observed in patients with chronic liver disease(CLD)and pose a significant clinical concern because of their potential for malignancy.AIM To explore the clinical characteristics of colorectal polyps in patients with CLD,a nomogram was established to predict the presence of adenomatous polyps(AP).METHODS Patients with CLD who underwent colonoscopy at Tianjin Second People’s Hospital from January 2020 to May 2023 were evaluated.Clinical data including laboratory results,colonoscopy findings,and pathology reports were collected.Key variables for the nomogram were identified through least absolute shrinkage and selection operator regression,followed by multivariate logistic regression.The performance of the model was evaluated using the area under the receiver area under curve,as well as calibration curves and decision curve analysis.RESULTS The study enrolled 870 participants who underwent colonoscopy,and the detection rate of AP in patients with CLD was 28.6%.Compared to individuals without polyps,six risk factors were identified as predictors for AP occurrence:Age,male sex,body mass index,alcohol consumption,overlapping metabolic dysfunction-associated steatotic liver disease,and serum ferritin levels.The novel nomogram(AP model)demonstrated an area under curve of 0.801(95%confidence interval:0.756-0.845)and 0.785(95%confidence interval:0.712-0.858)in the training and validation groups.Calibration curves indicated good agreement among predicted and actual probabilities(training:χ^(2)=11.860,P=0.157;validation:χ^(2)=7.055,P=0.530).The decision curve analysis underscored the clinical utility of the nomogram for predicting the risk of AP.CONCLUSION The AP model showed reasonable accuracy and provided a clinical foundation for predicting the occurrence of AP in patients with CLD,which has a certain predictive value.展开更多
文摘Colorectal cancer(CRC)is a leading cause of cancer-related morbidity and mortality globally,and its management in the emergency setting presents distinct challenges.In addition to its advantages in elective CRC surgery,studies have demonstrated that minimally invasive surgery(MIS)can provide benefits in CRC emergencies,such as reduced morbidity and a shorter length of hospitalization.However,the applicability of MIS in the emergency setting is limited by factors such as compromised patient physiology,resource constraints,and the need for technical expertise.As an alternative to emergency MIS,endoscopic interventions have also been increasingly supported by emerging evidence as a bridge to surgery.This article appraises contemporary guidelines and the evidence behind their recommendations for MIS surgery in CRC emergencies,whilst highlighting the challenges to implementation and the strategies to overcome them.
文摘BACKGROUND The combination of anti-epidermal growth factor receptor(EGFR)therapy and chemotherapy is currently a preferred first-line treatment for patients with unre-sectable,RAS and BRAF wild-type,left-sided metastatic colorectal cancer(mCRC).Several studies have also demonstrated the benefit of anti-EGFR therapy in sub-sequent line settings for this patient population.However,direct evidence com-paring the effectiveness of frontline vs subsequent anti-EGFR therapy remains limited,leaving a crucial gap in guiding optimal treatment strategies.AIM To compare overall survival(OS)between frontline and subsequent anti-EGFR treatment in patients with unresectable,RAS and BRAF wild-type,left-sided mCRC.METHODS We retrospectively reviewed the medical records of mCRC patients treated at The King Chulalongkorn Memorial Hospital and Songklanagarind Hospital,Thailand,between January 2013 and April 2023.Patients were classified into two groups based on the sequence of their anti-EGFR treatment.The primary endpoint was OS.RESULTS Among 222 patients with a median follow-up of 29 months,no significant difference in OS was observed between the frontline and subsequent-line groups(HR 1.03,95%CI:0.73-1.46,P=0.878).The median OS was 35.53 months(95%CI:26.59-44.47)for the frontline group and 31.60 months(95%CI:27.83-35.37)for the subsequent-line group.In the subsequent-line group,71 patients(32.4%)who ultimately never received anti-EGFR therapy had a significantly worse median OS of 19.70 months(95%CI:12.87-26.53).CONCLUSION Frontline and subsequent-line anti-EGFR treatments provide comparable OS in unresectable,RAS/BRAF wild-type,left-sided mCRC patients,but early exposure is vital for those unlikely to receive subsequent therapy.
基金supported by grants from the National Natural Science Foundation of China(Nos.U22A20330 and 82373372)the Key Project of Research and Development Plan in Heilongjiang Province(Nos.2022ZX06C01 and JD2023SJ40)+1 种基金the Natural Science Funding of Heilongjiang(No.YQ2022H017)the Haiyan Foundation of Harbin Medical University Cancer Hospital(No.JJJQ 2024-02).
文摘Colorectal cancer(CRC)is the third most common cancer worldwide and the second leading cause of cancer-related mortality.While early-stage CRC patients generally exhibit favorable overall survival(OS)rates,the prognosis for metastatic CRC(mCRC)remains poor,with a survival rate<15%.Targeted combination therapy remains the main treatment strategy for mCRC,with a median OS(mOS)of only 25-30 months.
文摘In this editorial,we reviewed the article by Fadlallah et al that was recently published in the World Journal of Clinical Oncology.The article provided a comprehensive and in-depth view of the management and treatment of colorectal cancer(CRC),one of the leading causes of cancer-related morbidity and mortality worldwide.The article analyzed the therapeutic modalities and their sequencing,focusing on total neoadjuvant therapy for locally advanced rectal cancer.It highlighted the role of immunotherapy in tumors with high microsatellite instability or deficient mismatch repair,addressing recent advances that have improved prognosis and therapeutic response in localized and metastatic CRC.Innovations in surgical techniques,advanced radiotherapy,and systemic agents targeting specific mutational profiles are also discussed,reflecting on how they revolutionized clinical management.Circulating tumor DNA has emerged as a promising tool for detecting minimal residual disease,prognosis,and therapeutic monitoring,solidifying its role in precision oncology.This review emphasized the importance of technological and therapeutic advancements in improving clinical outcomes and personalizing CRC treatment.
基金Supported by the National Oncology Care Support Program,No.25000.056766/2015-64.
文摘BACKGROUND Adenomatous polyposis confers an increased risk of developing colorectal cancer.APC and MUTYH are the major genes investigated in patients suspected of having polyposis.In addition to APC and MUTYH genes,other genes,such as POLE,POLD1,NTHL1,MBD4,MSH3 and MLH3,have recently been associated with polyposis phenotypes,conferring heterogeneity in terms of the clinical,etiological and heritable aspects of patients with polyposis.AIM To investigate the underlying variant landscape in patients with suspected polyposis who lack variants in the APC and MUTYH genes using whole-exome sequencing.METHODS Twenty-seven participants were included in the study and subjected to germline whole-exome sequencing.In addition,their clinical-pathological,personal,and family history data were collected.RESULTS The mean age at diagnosis was 51 years,and most participants had attenuated forms of polyposis(88.9%),with 63.0%diagnosed with a primary tumor,mostly colorectal cancer(76.5%).Among the variants identified,17 were classified as pathogenic or likely pathogenic(in 12 participants),including variants in genes involved in the Wnt/β-catenin signaling pathway,such as ST7 L,A1CF,and DKK4,and variants in DNA-repair genes,such as NTHL1,PNKP,and PMS2,as well as a variant found at the FRK gene identified in a patient with classic polyposis at age 19 and with a family history of polyps.CONCLUSION This study identified novel genes potentially associated with polyposis in patients lacking germline pathogenic variants in the APC and MUTYH genes.These findings support the use of next-generation sequencing for screening,expanding the scope of polyposis-related variants beyond these two genes.
基金supported by the National Natural Science Foundation of China(No.82373415)Beijing Xisike Clinical Oncology Research Foundation(No.Ytongshu2021/ms-0003)。
文摘Colorectal cancer(CRC)is the most frequently diagnosed malignancy of the digestive system and the second leading cause of cancer-related deaths worldwide(1).In China,CRC ranks as the second most common cancer with incidence and mortality rates continuing to rise(2).The Chinese Society of Clinical Oncology(CSCO)first introduced its guidelines in 2017,and since then,they have been updated annually to incorporate the latest clinical research findings,drug availability,and expert consensus(3-8).This article presents the key updates in the 2025 edition compared to the 2024 version.
基金Supported by Ministry of Science and Higher Education of the Russian Federation,No.FGMF-2025-0003.
文摘Colorectal cancer remains a major health concern,with colorectal polyps as key precursors.Endoscopic mucosal resection(EMR)is a common treatment,but recurrence rates remain high.Traditional surveillance strategies rely on polyp characteristics and completeness of the resection potentially missing key risk factors.Machine learning(ML)offers a transformative approach by integrating patient-specific data to refine risk stratification.Recent studies highlight ML models,such as Extreme Gradient Boosting,which outperform conventional methods in predicting polyp recurrence within one-year post-EMR.These models incorporate factors like age,smoking status,family history,and pathology,optimizing follow-up recommendations and minimizing unnecessary procedures.Artificial intelligence(AI)-driven tools and web-based calculators enhance clinical workflow by providing real-time,personalized risk assessments.However,challenges remain in external validation,model interpretability,and clinical integration.Future surveillance strategies should combine expert judgment with AI insights to optimize patient outcomes.As gastroenterology embraces AI,MLdriven surveillance represents a paradigm shift,advancing precision medicine in colorectal polyp management.This editorial explores AI’s role in transforming post-EMR follow-up,addressing benefits,limitations,and future directions.
文摘BACKGROUND Macrophages play a crucial role in the tumor microenvironment,displaying remarkable plasticity that allows them to either suppress or promote tumor progression.Their polarization into M1 or M2 phenotypes could have significant prognostic implications,and manipulating this polarization may offer a novel approach to controlling colorectal neoplasms.AIM To evaluate the infiltration rates of M1 and M2 macrophages in colorectal neoplasia,specifically comparing cases with and without metalloproteinase mutations.Additionally,it sought to explore potential prognostic factors as-sociated with the disease.
基金Supported by the National Key R and D Program of China,No.2022YFC3500200 and No.2022YFC3500204Innovation Team and Talents Cultivation Program of National Administration of Traditional Chinese Medicine,No.ZYYCXTD-C-202208+3 种基金NATCM’s Project of Highlevel Construction of Key TCM Disciplines,No.[2023]85Qing Lan Project of Jiangsu Higher Education Institutions,No.[2023]27Jiangsu Postgraduate Practice Innovation Plan,No.SJCX22_0706General Project of Universities’Philosophy and Social Science in Jiangsu Province,No.2024SJYB0564.
文摘BACKGROUND Colorectal cancer(CRC)is the third most prevalent form of cancer worldwide.Among patients with CRC,colorectal liver metastasis(CRLM)is the foremost direct contributor to mortality.In recent years,immunotherapy has swiftly risen to prominence as a vital approach for treating a range of solid tumors,including CRC.We present a unique case of a patient suffering from CRLM,with the goal of offering an insightful example and relevant references for the treatment of CRLM.CASE SUMMARY We report a patient who experienced liver metastasis after undergoing successful surgical removal of CRC,with the postoperative pathological stage identified as pT4N2aM0.The patient has been receiving a combination treatment of Western and Traditional Chinese Medicine.Regular assessments of the patient’s condition have been conducted,encompassing evaluations of serum carcinoembryonic antigen levels,carbohydrate antigen 199,and observations of the tongue complexion and its coating.The patient achieved clinical remission after anti-programmed death-1 immunotherapy when various systemic therapies failed.Since the diagnosis of CRLM,the patient has survived for more than 6 years,surpassing the expected survival time for those with advanced CRC.CONCLUSION This case illustrates the considerable promise of anti-programmed death-1 immunotherapy in managing CRLM,especially in scenarios of drug resistance and disease progression.
文摘Colorectal cancer(CRC),ranking as the third most common malignant tumor globally,continues to have high incidence and mortality rates.In China,the incidence of CRC has been increasing in recent years,imposing a heavy economic burden on society[1].Low prevalence of early screening leads to the majority of patients being diagnosed at an advanced stage.Current main treatment methods,such as surgery,chemotherapy,targeted therapy,and immunotherapy,have limited effectiveness for these patients and are prone to recurrence and metastasis.Moreover,the interplay of various pathogenic factors including genetic,environmental,and lifestyle factors increases the difficulty of CRC prevention and treatment[1].
文摘Lynch syndrome(LS),also known as hereditary non-polyposis colorectal cancer(HNPCC),is an inherited condition associated with a higher risk of colorectal cancer(CRC)and other cancers.It is caused by germline mutations in DNA mismatch repair(MMR)genes,including MLH1,MSH2,MSH6 and PMS2.These mutations lead to microsatellite instability(MSI)and defective DNA repair mechanisms,resulting in increased cancer risk.Early detection of LS is crucial for effective management and cancer prevention.Endoscopic surveillance,particularly regular colonoscopy,is recommended for individuals with LS to detect CRC at early stages.Additionally,universal screening of CRC for MMR deficiency can help identify at-risk individuals.Genetic counseling plays a valuable role in LS by guiding patients and their families in understanding the genetic basis,making informed decisions regarding surveillance and prevention,and offering reproductive options to reduce the transmission of pathogenic variants of the offspring.The aim of this review is to outline current strategies for the diagnosis,surveillance,and management of LS,with a focus on the role of genetic counseling,endoscopic screening,and emerging therapeutic approaches to mitigate cancer risk in affected individuals.
文摘BACKGROUND The use of an ultrasound-guided quadratus lumborum block(QLB)combined with general anesthesia for patients undergoing colorectal cancer surgery serves as a model for reducing the postoperative stress response,preserving metabolic stability,protecting renal function,and alleviating postoperative pain.AIM To compare QLB combined with general anesthesia vs general anesthesia alone in the perioperative stress response,metabolic and renal function,postoperative pain,and recovery outcomes among patients undergoing colorectal cancer surgery.METHODS Clinical data of 116 patients who underwent colorectal cancer surgery at our hospital between July 2023 and August 2024 were collected for retrospective analysis.According to the anesthesia protocol,the patients were divided into the control(general anesthesia,n=58)and experimental groups(QLB combined with general anesthesia,n=58).Physiological indicators such as blood glucose(GLU),lactic acid(LAC),blood urea nitrogen(BUN),and creatinine(CRE)were measured at T0(pre-surgery),T1(post-surgery),T2(6 hours post-surgery),T3(24 hours post-surgery),and T4(48 hours post-surgery).The differences between the two groups for each indicator were evaluated using repeated-measures analysis of variance.RESULTS The GLU levels from T1 to T4 in the experimental group were significantly lower than those in the control group(P<0.001),and the LAC levels were also significantly reduced(P<0.001).The experimental group exhibited superior renal protection based on postoperative BUN and CRE levels(P<0.05).Furthermore,the postoperative pain score in the experimental group was significantly lower than that in the control group[visual analogue scale(VAS)]scores differed significantly from T2 to T4,P<0.05.CONCLUSION Research has shown that QLB combined with general anesthesia can decrease postoperative GLU and LAC by 8%-15%and 10%-20%(P<0.001),respectively.It also enhances renal function markers(BUN,CRE,P<0.05)and lowers VAS scores by 15%-30%(P<0.05).Ultrasound-guided lumbar muscle block with general anesthesia outperforms general anesthesia alone in diminishing stress response,preserving metabolic balance and renal function,and alleviating postoperative pain.This approach offers a more efficient perioperative management strategy for patients undergoing colorectal cancer surgery.It is particularly advantageous for individuals with stress sensitivity,renal impairment,and heightened pain susceptibility.
基金the Youth Foundation of Fujian Provincial Health Commission,No.2021QNA014the Construction Project of Fujian Province Minimally Invasive Medical Center,No.[2021]76.
文摘BACKGROUND The degree of obstruction plays an important role in decision-making for obstructive colorectal cancer(OCRC).The existing assessment still relies on the colorectal obstruction scoring system(CROSS)which is based on a comprehensive analysis of patients’complaints and eating conditions.The data collection relies on subjective descriptions and lacks objective parameters.Therefore,a scoring system for the evaluation of computed tomography-based obstructive degree(CTOD)is urgently required for OCRC.AIM To explore the relationship between CTOD and CROSS and to determine whether CTOD could affect the short-term and long-term prognosis.METHODS Of 173 patients were enrolled.CTOD was obtained using k-means,the ratio of proximal to distal obstruction,and the proportion of nonparenchymal areas at the site of obstruction.CTOD was integrated with the CROSS to analyze the effect of emergency intervention on complications.Short-term and long-term outcomes were compared between the groups.RESULTS CTOD severe obstruction(CTOD grade 3)was an independent risk factor[odds ratio(OR)=3.390,95%confidence interval(CI):1.340-8.570,P=0.010]via multivariate analysis of short-term outcomes,while CROSS grade was not.In the CTOD-CROSS grade system,for the non-severe obstructive(CTOD 1-2 to CROSS 1-4)group,the complication rate of emergency interventions was significantly higher than that of non-emergency interventions(71.4%vs 41.8%,P=0.040).The postoperative pneumonia rate was higher in the emergency intervention group than in the non-severe obstructive group(35.7%vs 8.9%,P=0.020).However,CTOD grade was not an independent risk factor of overall survival and progression-free survival.CONCLUSION CTOD was useful in preoperative decision-making to avoid unnecessary emergency interventions and complications.
基金Supported by Natural Science Foundation of Tianjin,No.21JCZDJC00060 and No.21JCYBJC00180Tianjin Health and Medical Science and Technology Project,No.TJWJ2023QN040National Key Research and Development Program,No.2017YFC1700606 and No.2017YFC1700604.
文摘BACKGROUND Certain subgroups are at an increased risk of false fecal immunochemical test(FIT)results;however,related studies are limited,and the available evidence is conflicting.AIM To evaluate factors associated with false-positive and false-negative FIT results.METHODS This retrospective study was based on the database of the Tianjin Colorectal Cancer Screening Program from 2012 to 2020.A total of 4129947 residents aged 40-74 years completed at least one FIT.Of these,24890 asymptomatic participants who underwent colonoscopy examinations and completed lifestyle questionnaires were included in the analysis.Multivariable logistic regression was performed to identify the factors associated with false FIT results.RESULTS Among the overall screening population,88687(2.15%)participants tested positive for FIT.The sensitivity,specificity,positive predictive value,and negative predictive value of FIT for advanced neoplasms were 58.2%,44.8%,9.7%,and 91.3%,respectively.Older age,female sex,smoking,alcohol consumption,higher body mass index,and hemorrhoids were significantly associated with increased odds of false-positive and lower odds of falsenegative FIT results.Moreover,features of high-grade dysplasia or villous for advanced adenoma and the presence of cancer were also associated with lower odds of false-negative results,while irregular exercise and diverticulum were associated with higher odds of false-positive results.CONCLUSION FIT results may be inaccurate in certain subgroups.Our results provide important evidence for further individualization of screening strategies.
基金Supported by The Guangdong Medical Research Foundation of China,No.A2020603.
文摘BACKGROUND Designing a feasible risk prediction model for advanced colorectal neoplasia(ACN)can enhance colonoscopy screening efficiency.Abdominal obesity is associated with colorectal cancer development.AIM To propose and evaluate a modified scoring model incorporating waist-hip ratio for the prediction of ACN.METHODS A total of 6483 patients who underwent their first screening or diagnostic colonoscopy in our center between 2020 and 2023 were recruited,in which 4592 were in the derivation cohort and 1891 formed a validation cohort.Multivariate logistic regression was used to investigate the risk factors of ACN in the derivation cohort based on endoscopic findings,and a new scoring model for ACN prediction was developed.The discriminatory capability of the scoring model was validated by the validation cohort.RESULTS Age,male gender,smoking,and wait-to-hip ratio were identified as independent risk factors for ACN,and a 7-point scoring model was developed.The prevalence of ACN was 3.3%,9.3%and 18.5%in participants with scores of 0-2[low risk(LR)],3–4[moderate risk(MR)],and 5–7[high risk(HR)],respectively,in the derivation cohort.With the scoring model,49.9%,38.4%,and 11.7%of patients in the validation cohort were categorized as LR,MR,and HR,respectively.The corresponding prevalence rates of ACN were 5.0%,10.3%,and 17.6%,respectively.The C-statistic of the new scoring model was 0.66,which was higher than that of the Asia-Pacific Colorectal Screening model(0.63).CONCLUSION A modified scoring model incorporating waist-hip ratio has an improved predictive performance in the prediction of ACN.
文摘Colorectal cancer is a major cause of cancer-related mortality worldwide,under-scoring the importance of early and effective colorectal cancer screening to im-prove survival rates.Traditional colorectal cancer screening methods include non-invasive tests,such as the fecal immunochemical test(FIT),as well as diagnostic procedures like colonoscopy.Colonoscopy remains the gold standard for detec-ting and treating precancerous polyps and early-stage cancer,regardless of whe-ther it is used as the first screening test or the second test following a positive FIT.However,its effectiveness can be affected by factors such as operator skill,patient variability,and limited lesion visibility,resulting in a significant rate of missed lesion rates and highlighting the need for more efficient and accurate screening techniques.This review is aimed to assess the current challenges of traditional screening methods with the impact of artificial intelligence(AI)in the diagnostic flow.The literature on AI-powered tools for colorectal cancer screening,including novel applications,emerging programs,and recent guidelines,has been reviewed to highlight both the advantages and limitations of implementing this technology in healthcare.Recent advances in AI have introduced soft AI colonoscopy,with the purpose of improving lesion recognition(computer-aided detection)and/or improving optical diagnosis(computer-aided diagnosis).AI-powered colono-scopy systems employ deep learning algorithms to analyze real-time endoscopic images,enhancing detection rates for adenomas,serrated lesions and cancer by reducing human error.AI-assisted colonoscopy enhances adenoma detection,enabling earlier intervention and improved patient outcomes.The benefits are particularly pronounced for less-experienced practitioners,as the detection rates for AI-assisted colonoscopy are similar to experts.AI integration also helps in the teaching process,in developing standardized procedures,and improving screening procedure accuracy and efficiency across different healthcare providers.However,there are challenges and limitations,such as the cost of AI implementation,data privacy concerns,and the need for extensive clinical validation.As AI technology continues to evolve,its transformation of the colorectal cancer screening system could revolutionize the field,making early detection more accessible and reducing mortality,on the condition that the above issues are addressed before widespread use.
基金Supported by the Medical Research Project of Jiangsu Health Commission,No.Z2021010.
文摘AIM To analyze the efficacy of laparoscopic radical resection of CRC(LRRCC)in treating older patients with CRC and the effect of this procedure on inflammatory factors.METHODS The study included 104 older patients with CRC admitted from August 2022 to August 2024.Participants undergoing open radical resection of CRC were categorized as the control group(50 patients),whereas those receiving LRRCC were classified as the research group(54 patients).Subsequently,comparative analyses involved data on efficacy,postoperative complications(ileus,incision infection,anastomotic fistula,and pulmonary infection),surgery-related parameters(operation duration and intraoperative bleeding volume),postoperative recoveryrelated indicators(time to first postoperative passage of flatus and defecation and length of hospital stay),and inflammatory factors(tumor necrosis factor-α,highsensitivity C-reactive protein,and interleukin-6).RESULTS Data revealed markedly superior therapeutic efficacy and a lower overall postoperative complication rate in the research group compared to the control group.The research group demonstrated substantially less intraoperative bleeding,less time to first postoperative passage of flatus and defecation,and a shorter length of hospital stay despite a notably longer operation duration compared to the control group.Further,tumor necrosis factor-α,high-sensitivity C-reactive protein,and interleukin-6 levels in the research group were significantly reduced 3 days postoperatively compared to both the preoperative and control group values.CONCLUSION LRRCC for older patients with CRC exhibited superior therapeutic efficacy compared to open radical resection and significantly suppressed postoperative stress-related inflammatory responses,which merits clinical application and promotion.
文摘BACKGROUND Metastatic colorectal cancer(mCRC)is a global health challenge with a poor prognosis.Prognostic markers are critical for survival prediction.METHODS This multicenter,retrospective study measured baseline carcinoembryonic antigen and carbohydrate antigen 19-9 levels to calculate a TMI as the geometric mean of values normalized to their upper limits of normal.Receiver operating characteristic curve analysis assessed TMI’s prognostic accuracy,and patients were stratified into high-TMI(≥1.39)and low-TMI(<1.39)groups.The primary endpoint was overall survival(OS),with progression-free survival and treatment response as secondary endpoints.RESULTS The study included 305 mCRC patients with a median follow-up of 22.9 months.The median OS for high-TMI patients was 29.5 months,significantly lower than the 45.6 months observed in the low-TMI group(P=0.02).The 2-year OS rates for the high-and low-TMI groups were 59.4%and 72.9%,respectively.Median progression-free survival was also shorter for the high-TMI group(14.0 vs 16.0 months,P=0.84).High TMI is an independent prognostic factor for worse OS.CONCLUSION TMI is a simple,cost-effective prognostic tool for mCRC,with high TMI associated with poorer survival outcomes.
基金Supported by the European Union-NextGenerationEU,through the National Recovery and Resilience Plan of the Republic of Bulgaria,No.BG-RRP-2.004-0008.
文摘Colorectal cancer (CRC) is the third most common cancer globally, with 20%-25%of patients diagnosed at stage IV, significantly affecting overall survival (OS).Only 14% of stage IV patients survive for 5 years with palliative chemotherapy.However, the role of liver transplantation (LT) in the management of CRC livermetastasis (CRCLM) is an evolving area of interest. Recent advancements inoncologic outcomes and clinical understanding have prompted the re-evaluationof LT as a viable treatment option for CRCLM. A promising result from someprospective pilot studies reported a 5-year OS rate of 60% after LT for patientswith CRCLM. Key factors influencing eligibility include tumor biology, absence ofextrahepatic disease, and the patient's performance status. By synthesizing thelatest research findings, we aim to provide a comprehensive overview that summarizesthe most relevant data related to the clinical outcomes of patients whounderwent LT for CRCLM. We aim to provide a comprehensive overview by synthesizingthe latest research findings. This review discusses the inclusion criteriaand eligibility for LT in CRCLM, which are of great importance to patient outcomes.
基金Supported by the National Natural Science Foundation of China,No.62375202Natural Science Foundation of Tianjin,No.23JCYBJC00950+1 种基金Tianjin Health Science and Technology Project Key Discipline Special,No.TJWJ2022XK034Research Project in Key Areas of Traditional Chinese Medicine in 2024,No.2024022.
文摘BACKGROUND Colorectal polyps are commonly observed in patients with chronic liver disease(CLD)and pose a significant clinical concern because of their potential for malignancy.AIM To explore the clinical characteristics of colorectal polyps in patients with CLD,a nomogram was established to predict the presence of adenomatous polyps(AP).METHODS Patients with CLD who underwent colonoscopy at Tianjin Second People’s Hospital from January 2020 to May 2023 were evaluated.Clinical data including laboratory results,colonoscopy findings,and pathology reports were collected.Key variables for the nomogram were identified through least absolute shrinkage and selection operator regression,followed by multivariate logistic regression.The performance of the model was evaluated using the area under the receiver area under curve,as well as calibration curves and decision curve analysis.RESULTS The study enrolled 870 participants who underwent colonoscopy,and the detection rate of AP in patients with CLD was 28.6%.Compared to individuals without polyps,six risk factors were identified as predictors for AP occurrence:Age,male sex,body mass index,alcohol consumption,overlapping metabolic dysfunction-associated steatotic liver disease,and serum ferritin levels.The novel nomogram(AP model)demonstrated an area under curve of 0.801(95%confidence interval:0.756-0.845)and 0.785(95%confidence interval:0.712-0.858)in the training and validation groups.Calibration curves indicated good agreement among predicted and actual probabilities(training:χ^(2)=11.860,P=0.157;validation:χ^(2)=7.055,P=0.530).The decision curve analysis underscored the clinical utility of the nomogram for predicting the risk of AP.CONCLUSION The AP model showed reasonable accuracy and provided a clinical foundation for predicting the occurrence of AP in patients with CLD,which has a certain predictive value.
