【Abstract】ObjectiveTo investigate the role of PPARδ in the pathogenesis of colorectal cancer. MethodsLiteratures about PPARδ and the pathogenesis of colorectal cancer were reviewed and analyzed.ResultsPPARδ is expressed in the nucleuses of glandular epithelia lining colon and rectum. It is normally suppressed by wild-type adenomatous polyposis coli (APC) but is up-regulated by enhanced β-catenin/T cell factor-4 (TCF-4) binding to TCF-4-responsive elements in the PPAR promoter when an inactivating APC mutation occurs, which indicates PPAR is a potential downstream target of the APC/β-catenin/TCF-4 signaling pathway in colorectal cancer. Consistent with PPAR’s role as an APC/β-catenin/TCF-4 target, some studies reported that PPAR mRNA is frequently overexpressed in colorectal cancers of both humans and rodent animals, which indicates that PPAR is relevant to the tumorigenesis of colorectal cancer. ConclusionPPARδ is closely related with the pathogenesis of colorectal cancer.
Colorectal cancer is the third most frequently diagnosed cancer and the second leading cause of cancer death worldwide. In recent years, with the development and change of society and economy, the epidemiological characteristics of colorectal cancer related to geographic economy and health resources have caused its incidence to show a trend of regional differentiation. At present, the diagnosis, treatment, prevention and control of colorectal cancer in China are still facing great challenges, therefore, summarizing the risk factors related to the incidence of colorectal cancer in China from the global epidemiological characteristics of colorectal cancer can further guide the prevention, control and clinical diagnosis and treatment of colorectal cancer in China, and is of great significance to improve the heavy burden of colorectal cancer. Therefore, this paper discusses the epidemiological characteristics of colorectal cancer in recent years and the screening policies in different regions based on the report of the International Agency for Research on Cancer and related studies, so as to provide the relevant basis for the prevention and control of colorectal cancer in the new situation in the future.
ObjectiveTo analyze the risk factors for early mortality in patients with stage Ⅳ colorectal cancer, and further construct and validate Nomogram prediction model for early mortality in stage Ⅳ colorectal cancer. MethodsA retrospective analysis was conducted on the clinical and pathological data of stage Ⅳ colorectal cancer patients from the Surveillance, Epidemiology, and End Results (SEER) database in the United States from 2018 to 2020. The study data was randomly divided into a training cohort and a validation cohort at a ratio of 8∶2. Multivariate logistic regression analysis was performed in the training cohort to screen for risk factors for early mortality in stage Ⅳ colorectal cancer patients, and Nomogram prediction model was further constructed. Receiver operating characteristic curve (ROC), calibration curve, and clinical decision curve analysis (DCA) were plotted. ResultsAge (50–70 group, OR=1.984, P=0.007; >70 group, OR=1.997, P=0.008), unmarried (OR=1.342, P=0.025), primary tumor differentiation of G3+G4 (OR=1.817, P<0.001), T4 stage (OR=1.434, P=0.009), N2 stage (OR=1.621, P<0.001), M1c stage (OR=1.439, P=0.036), no chemotherapy (OR=21.820, P<0.001), bone metastasis (OR=2.000, P=0.042), brain metastasis (OR=6.715, P=0.001) and liver metastasis (OR=1.886, P<0.001) were risk factors for all-cause early death in stage Ⅳ colorectal cancer patients. Age（50–70 group, OR=2.025, P=0.008; >70 group, OR=1.925, P=0.017), primary tumor differentiation grade of G3+G4 (OR=1.818, P<0.001), T4 stage (OR=1.424, P=0.013), N2 stage (OR=1.637, P<0.001), M1c stage (OR=1.541, P=0.016), no chemotherapy (OR=21.832, P<0.001), brain metastasis (OR=6.089, P=0.001), liver metastasis (OR=2.100, P<0.001) were factors for cancer-specific early death of stages Ⅳ colorectal cancer patients. Based on these variables, we constructed two Nomogram prediction models for all-cause early death and cancer-specific early death in stage Ⅳ colorectal cancer patients. The area under curve (AUC) value of the all-cause early death prediction model in the training queue was 0.874 [95% CI (0.855, 0.893)], and the AUC value of the cancer specific early death prediction model was 0.874 [95%CI (0.855, 0.894)]; the AUC value of the all-cause early death prediction model in the validation queue was 0.868 [95%CI (0.829, 0.907)], and the AUC value of the cancer specific early death prediction model was 0.867 [95%CI (0.827, 0.907)], indicating that the model had good predictive ability. The calibration curve showed that the predictive models had good consistency with the actual results for predicting early mortality in stage Ⅳ colorectal cancer, and the DCA curve showed that the models could provide patients with higher clinical benefits. ConclusionThe predictive models established in this study have good predictive performance for early mortality in stage Ⅳ colorectal cancer patients, which is helpful for clinical physicians to identify high-risk patients in the early stage and develop personalized treatment plans in clinical practice.
Objective To investigate clinical outcomes of complete video-assisted thoracoscopic lobectomy and summarize our preliminary experience. Methods Clinical data of 60 consecutive patients who underwent complete video-assisted thoracoscopic lobectomy in General Hospital of Chengdu Military Command from March 2010 to August 2011 were retrospectively reviewed. There were 37 male patients and 23 female patients with their median age of 52.1 （17-77） years. There were 7 patients undergoing left upper lobectomy， 19 patients undergoing left lower lobectomy， 12 patients undergoing right upper lobectomy， 3 patients undergoing right middle lobectomy， 17 patients undergoing right lower lobectomy， and 2 patients undergoing combined right middle and lower lobectomy. Results The average operation time was 161 （50-270） minutes， average intra-operative blood loss was 310 （50-800） ml， average number of lymph node dissection was 13.4 （6-29）， average postoperative thoracic drainage was 950 （250-2 800） ml， average duration of thoracic drainage was 4.6 （3-11） days， average intensive care unit stay was 1.2 （1-3） days， and average postoperative hospital stay was 7.7（4-14） days. None of the patients had any severe postoperative complication. Fifty-two patients were followed up for 7 to 24 months， and 8 patients were lost during follow-up. During follow-up， 5 patients had lung cancer metastases， including 2 patients with mediastinal lymph node metastases and 3 patients with distant metastases. After chemoradiotherapy，3 patients lived well but 2 patients died. None of the other patients had any severe complication during follow-up. Conclusion Complete video-assisted thoracoscopic lobectomy is a safe and effective surgical strategy for patients with benign or malignantpulmonary disease.
Objective To investigate the role of peroxisome proliferator activated receptor α （PPARα） in the pathogenesis of colorectal cancer. Method The literatures about PPARα and the pathogenesis of colorectal cancer were reviewed and analyzed. Result The relationships of PPARα to the proliferation， apoptosis， and differentiation of colorectal cancer cells in the pathogenesis of colorectal cancer were controversial. Conclusions PPARα might be involved in the regulation of proliferation， differentiation， apoptosis of colorectal cancer cells， but the pathogenesis and the up- and down-stream signal pathways are not elucidated. In additional， PPARα might partly be involved in the mechanism of drug resistance of chemotherapy drugs for colorectal cancer， but the role is not very clear yet. So more research works need to be done about the relationship of PPARα to pathogenesis of colorectal cancer.
Objective To evaluate the adoption of carbon nano-particle in the pathologic examination of lymph node for lower rectal cancer. Methods Sixty consecutive patients with rectal cancers located at or below the peritoneal reflection were randomly allocated to the routine method group or the group using carbon nano-particle. Resultsof pathologic examination were compared. Results Altogether, 1 070 lymph nodes were examined from the 2 study groups. The average examined number of the carbon nano-particle group was (20.2±4.9)/case, which was significantly higher than the other group 〔(15.4±6.8)/case〕, P=0.003. More tiny lymph nodes were examined in the nano-particle group (P=0.029) and more metastases were proved from the lymph nodes dyed by nano-particle (P=0.000). The majority of examined lymph nodes were located along the superior rectal vessel and its branches. ConclusionAdoption of nano-particle in pathologic examination of rectal cancer surgery can increase the examined number of lymph nodes, while detect small nodes harboring cancer, thus ensuring the correctness of pathologic report. The distribution of mesorectal lymph nodes underlines the execution of TME principle in dissection.
ObjectiveTo evaluate the safety and short-term outcome of laparoscopic total mesorectal excision (TME) for the middle-lower rectal cancer in municipal hospital.MethodsThe pathological data of 94 patients with middle-lower rectal cancer (49 cases underwent laparoscopic TME, while 45 cases received open TME), who treated in The First People’s Hospital of Ziyang from Jan. 2015 to Jun. 2017, were retrospectively collected and analyzed.ResultsTwo patients (4.1%) in laparoscopy group were converted to open surgery. Compared with the laparotomy group, the laparoscopic group had significantly less volume of intraoperative bleeding, shorter abdominal incision, earlier time to the first flatus and liquid diet, and lower rate of 30-day postoperative complication (P<0.05), but had longer operative time (P=0.033). While there were no significant difference on postoperative stay, the specimen length, distal margin, and number of harvested lymph nodes between the 2 groups (P>0.05).ConclusionLaparoscopic TME is a feasible, safe, and minimally invasive technique for middle-lower rectal cancer, and produce more favourable short-term outcome than open surgery in municipal hospital.
ObjectiveBased on the latest version of the Database from Colorectal Cancer(DACCA), this study analyzed the long-term effect of neoadjuvant therapy combined with intersphincteric resection (ISR) in patients with rectal cancer. MethodsAccording to the established screening criteria, clinical data of 944 patients with rectal cancer admitted from January 2009 to December 2020 were collected from the DACCA updated on March 21, 2022, to explore the influencing factors for overall survival (OS) and disease specific survival (DSS) of rectal cancer treated with neoadjuvant therapy combined with ISR, by Cox proportional hazard regression model. Results① The 3-year OS and DSS survival rates of neoadjuvant therapy combined with ISR for rectal cancer were 89.2% and 90.4%, respectively, and the 5-year OS and DSS survival rates were 83.9% and 85.4%, respectively. ② For different ISR surgical methods and neoadjuvant therapy plans, there were no significant differences in OS and DSS (P>0.05), but there were significant differences in OS and DSS among different ypTNM stage groups (P<0.001), patients with ypTNM 0–Ⅱ had better OS and DSS. ③ BMI, ypTNM stage and R0 resection were influencing factors for OS and DSS (P<0.05). ④ The overall incidence of postoperative complications was low, including 6.4% (60/944) within 30 days, 7.5% (71/944) within half a year and 3.3% (31/944) over half a year after operation. ConclusionsIn the comprehensive treatment of patients with low/ultra-low rectal cancer, neoadjuvant therapy combined with ISR can achieve relatively stable and good long-term oncological efficacy, and the incidence of short-term postoperative complications is not high, which is one of the options.
ObjectiveTo explore the security and feasibility of simultaneous laparoscopic surgery for synchronous colorectal cancer liver metastasis (SCRLM). MethodThe data of 36 patients underwent simultaneous surgery for SCRLM in the Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital of Sichuan University from March 2015 to December 2021 were retrospectively collected, and the perioperative outcomes, postoperative morbidity and survival were analyzed. ResultsThe surgical procedure of all 36 enrolled patients were accomplished. The operation time was (328.9±85.8) min. The intraoperative blood loss was 100 (50, 150) mL and 4 cases (11.1%) needed intraoperative transfusion. The time to first flatus was (2.9±0.8) d and the time to liquid diet was (3.2±1.0) d. The average postoperative VAS score was 1.9±0.3. The postoperative length of stay was (6.8±4.3) d, 5 (13.9%) cases developed postoperative complications, which were cured by conservative treatment. No severe complications and death occurred within 30 days after surgery. After a median follow-up of 24.7 months, 15 cases (41.7%) experienced recurrence or metastasis and 1 case (2.8%) died. The 1-, 2- and 3-year disease-free survival rates were 89.8%, 55.0%, 29.2%, respectively. The 1-, 2- and 3-year overall survival rates were 100.0%, 100.0%, 87.5%, respectively. There was no significant differences in disease-free survival rates (χ2=1.675, P=0.196) and OS (χ2=0.600, P=0.439) between patients with (n=26) or without (n=10) neoadjuvant. ConclusionsSimultaneous laparoscopic surgery seems to be a secure and feasible strategy for patients with SCRLM, with considerable survival benefits and short-term outcomes including small incision, little bleeding, quick recovery and low complication rate. More high-quality clinical studies are desirable in the future to further confirm the efficacy and safety of this operation.
Objective To prospectively evaluate the health-related quality of life (HRQOL) outcomes in patients undergoing laparoscopic total mesorectal excision (LTME) with anal sphincter preservation (ASP) for low rectal cancers. Methods From June 2001 to March 2004, 125 patients undergoing LTME and 103 patients undergoing OTME were included in this study. The international standard questionnaires (QLQ-C30 and QLQ-CR38) were used to evaluate the conditions of patients at 3 periods after surgery respetively: 3-6 months, 12-18 months, gt;24 months. Results In contrast to OTME patients, the LTME ones showed significantly better physical function during 3-6 months after surgery, less micturition problems within 12-18 months, less male sexual problems and better sexual function during 12-18 months after surgery, with better sexual enjoyment after postoperative 24 months. Both groups showed significant improvement in most subscales from the first to the second assessment, and improvement in sexual enjoyment from the second to the third assessment. The sexual function, micturition problems and male sexual problems in LTME group significantly improved from the first to the second assessment, whereas the sexual function in OTME group improved from the second to the third assessment.Conclusion Patients undergoing LTME for low rectal cancers have bette postoperative HRQOL than patients undergoing OTME, with better physical function, micturition function, overall sexual and male sexual functions in short term, and better sexual enjoyment in the long term. The HRQOL of both LTME and OTME patients may be expected to improve over time, particularly in the first postoperative year.