Colorectal cancer is the third most common malignant tumor worldwide. Early diagnosis can significantly improve patient prognosis and survival rates, but current screening and diagnostic methods have limitations, necessitating the search for new alternatives. Exosomes, as key mediators of intercellular communication and information carriers, play a crucial role in tumor development and progression and can serve as potential sources of diagnostic biomarkers. In recent years, circulating exosome-related biomarkers have been extensively studied. This non-invasive detection method analyzes exosome-related contents derived from tumor cells in peripheral circulation, such as nucleic acids, proteins, lipids, and metabolites, to comprehensively reflect information about the primary tumor. It enables simple, precise, and real-time monitoring of tumor progression, showing promise for clinical application and providing new insights for the early screening and accurate diagnosis of colorectal cancer.
To analyze the long-term change trend of colorectal mortality in China from 1990 to 2021, and to provide scientific recommendations for the prevention and control of colorectal cancer in China.
Methods
The mortality burden data of colorectal cancer in China from 1990 to 2021 were obtained from GBD2021. The trend of mortality was analyzed by Joinpoint regression model, Using age-period-queue model assessment age, period and cohort effects.
Results
From 1990 to 2021, the overall colorectal population and the standardized mortality rate of females in China showed a downward trend, while that of males showed an upward trend, and the change rates were -11.94%, 2.10% and -29.40%, respectively. APC model analysis showed that from 1990 to 2021, the colorectal age mortality rate in China increased with the increase of age, from 0.51/100 000 to 224.02/100 000 for the total population, from 0.48/100 000 to 525.14/100 000 for males, and from 0.62/100 000 to 107.38/100 000 for females. The period effect showed an overall downward trend, with the risk of death decreasing from 1.17 in 1992 to 0.96 in 2021 in the general population, from 1.03 to 1.00 in men, and from 1.42 to 0.89 in women. All the cohort effects showed a decreasing trend. The risk of death in the general population decreased from 1.42 in the 1897~1904 birth cohort to 0.48 in the 1997~2006 birth cohort, from 1.03 to 0.67 in men, and from 2.20 to 0.25 in women. It is important to note that APC models show a slow upward trend in mortality risk between about 2011 and 2021.
Conclusion
From 1990 to 2021, the total population and the death burden of females decreased, while the death burden of males increased. However, in recent years, the death burden of colorectal cancer in Chinese population of different genders showed a slow upward trend, suggesting that the death burden is still severe. More attention should be paid to middle-aged and elderly males, to reduce the mortality burden of colorectal cancer, effective intervention measures should be strengthened in the high-risk population.
To carry out the health economic evaluation between Changhai-AL-Prediction model after anterior resection for rectal cancer and the operator's decision-making preventive stoma plan in order to provide a best preventive stoma plan.
Methods
A prospective investigation of 200 rectal adenocarcinoma patients with low anterior resection in the First Affiliated Hospital of Naval Medical University was carried out from June 2023 to December 2023. The therapeutic effects of the two groups were compared and a decision tree model was constructed for cost-effectiveness analysis.
Results
The expected cost for the surgeon's decision-making group was 8 639 053.19 RMB, and the expected cost for the Changhai-AL-Prediction model after anterior resection for rectal cancer group was 7 133 715.92 RMB. The decision accuracy of the operator decision-making group is 36.5%, and the accuracy of the model decision-making group is 70.0%. The incremental cost-effectiveness ratio is -44 935.44. The cost of the model group is 44 935.44 RMB less than that of the surgeon's decision-making group for every 1% improvement in prediction accuracy.
Conclusion
Changhai-AL-Prediction model after anterior resection for rectal cancer can make more accurate preventive stoma decisions and has more economic advantages than the operator's decision plan.
To explore the clinical value of carbon nanocomposite suspension injection in TNM staging of colorectal cancer.
Methods
A prospective, randomized, controlled clinical trial was conducted in July 2021 in the Department of Colorectal Surgery, Nanjing Drum Tower Hospital. After the patients were qualified, they were randomly assigned to study group and control group, and 200 evaluable cases were planned to be included in each group. The patients in the study group underwent colonoscopy and were injected with carbon nanocomposite suspension. The patients in the control group were treated with routine operation, and no carbon nano-suspension was injected before operation. The number of lymph nodes detected, the number of positive lymph nodes detected and the lymph stages were compared between the two groups.
Results
A total of 361 patients were enrolled in the clinical study, including 179 patients in the study group and 182 patients in the control group. The total number of lymph nodes obtained in the study group was 20.2±5.9, which was significantly higher than that in the control group (15.0±5.5) (t=8.584, P<0.001). The total number of positive lymph nodes in the study group was 1.6±3.9, which was significantly higher than that in the control group (0.8±1.9)(t=2.852, P=0.005). In the study group, 97 patients (54.2%) were N0, 56 patients (31.3%) were N1, and 26 patients (14.5%) were N2. In the control group, 115 patients (63.2%) were N0, 57 patients (31.3%) were N1, and 10 patients (5.5%) were N2. There was significant difference in lymph staging between the two groups (χ2=8.624, P=0.013).
Conclusion
The application of nano-carbon in lymph node tracing navigation for colorectal cancer can obtain more lymph nodes and positive lymph nodes, and thus obtain more accurate and objective lymph node staging, judge prognosis and guide follow-up treatment plan.
This study investigates the feasibility of circMFSD12 as a potential therapeutic target by analyzing its expression in colorectal cancer and its impact on tumor cell proliferation, migration, invasion, and sensitivity to 5-fluorouracil (5-FU), aiming to provide new insights for the treatment of colorectal cancer.
Methods
Human RNA datasets (GSE172229, GSE166973, GSE147597) from colorectal cancer tissues, normal colonic tissues, and normal intestinal tissues were retrieved from public databases to screen for downregulated circRNAs in colorectal cancer. The expression level of circMFSD12 in colorectal cancer cell lines was analyzed using quantitative real-time PCR (qRT-PCR). Overexpression plasmids of circMFSD12 were constructed and transfected into colorectal cancer cell lines LoVo and SW620 to evaluate their effects on cell proliferation, migration, and invasion through EdU staining, wound healing assays, and Transwell assays. Additionally, the effects on 5-FU sensitivity were assessed using CCK8 assays and flow cytometry experiments, and the potential molecular mechanisms were further investigated through bioinformatics analysis and miRNA pull-down experiments.
Results
Data analysis indicated that circMFSD12 is downregulated in colorectal cancer tissues (selection criteria: logFC<-0.5) and cells (expression in normal colonic epithelial cells NCM460: 1.00±0.14, and in colorectal cancer cells: HCT116: 0.72±0.08, LoVo: 0.42±0.10, SW480: 0.72±0.04, SW620: 0.48±0.07) (P<0.05). In vitro experiments showed that overexpression of circMFSD12 significantly inhibited colorectal cancer cell proliferation (LoVo: 52%±5.3% vs. 22%±3.7%, P<0.001; SW620: 56%±10% vs. 26%±4.0%, P<0.001), migration (LoVo: 75%±5.5% vs. 34%±5.7%, P<0.001; SW620: 54%±7.5% vs.22%±5.6%, P<0.001), and invasion (LoVo: 104±18.6 vs. 41.7±10.2, P<0.01; SW620: 86.7±16.5 vs. 34.7±4.9, P<0.01), and enhanced cellular sensitivity to 5-FU (LoVo: Control: 2.5±0.7 vs.7.4±1.0, P<0.01, 5-FU: 11.8±1.9 vs. 28.6±1.9, P<0.001; SW620: Control: 2.2±0.4 vs. 8.1±1.3, P<0.01, 5-FU: 10.2±1.4 vs. 23.4±2.3, P<0.001). Bioinformatics analysis and experimental validation suggest that circMFSD12 suppresses colorectal cancer cell behaviors by regulating the expression of miR-887-3p and PPP1R12B.
Conclusion
circMFSD12 regulates miR-887-3p/PPP1R12B, significantly affecting the biological behavior of colorectal cancer cells, indicating that it has good prospects as a novel molecular biomarker and potential therapeutic target.
We aimed to identify for macrophage-2 (M2) characteristic genes with hub prognostic value through machine learning combined with bioinformatics techniques, and to explore their relationship with the immune microenvironment and tumor immunotherapy.
Methods
This study collected the TCGA-COAD dataset and the dataset (GSE39582) from the GEO database. The CIBERSORT method was used to calculate the levels of M2-type macrophages in tumor samples, and characteristic genes were screened through correlation analysis, univariate and multivariate Cox regression analysis, and the random survival forest algorithm. The ESTIMATE algorithm was employed to calculate the immune microenvironment scores (stromal score and immune score) of tumor samples, and to study the characteristic genes and their relationships, finally validating in an immunotherapy cohort.
Results
This study identified PPM1M and MRAS as core prognostic genes determined by machine learning. In the TCGA data, populations with high expression levels of MRAS had shorter progression-free survival (P=0.0013). In the GEO data, high expression of PPM1M gene (P=0.031) and MRAS gene (P=0.002) were both associated with recurrence. Both PPM1M and MRAS genes were positively correlated with tumor immune score and stromal score, and positively correlated with the levels of suppressive regulatory T cells (Treg). Finally, in the evaluation of immunotherapy, patients with high expression of PPM1M and MRAS had better prognosis after receiving immunotherapy.
Conclusion
Characteristic genes of M2-type macrophages determined by machine learning are related to survival, recurrence, and progression. In the immune microenvironment, PPM1M and MRAS are both positively correlated with suppressive tumor immune components and stromal components. Furthermore, PPM1M and MRAS may serve as novel biomarkers for the efficacy of immunotherapy.
To retrospectively analyze the data of rectal high-resolution magnetic resonance examination before radical resection in patients with rectal cancer, observe the structure of lateral mesorectum and analyze its influence on the prognosis of patients combined with clinical data.
Methods
Data of patients who underwent radical resection at the First Affiliated Hospital of Naval Medical University between January 2017 and December 2018 were retrospectively analyzed. The imaging data of patients undergoing rectal high-resolution magnetic resonance imaging (MRI) before surgery were collected. The bilateral structures of the mesorectal fascia (MRF) and the middle rectal artery (MRA) were observed based on MRI, and measured its relevant parameters, including the width of the lateral mesorectum, the type of MRA and maximum diameter of MRA. Cox regression analysis was performed by combining the clinical data with the patient's disease-free survival (DFS) data. The preoperative prediction model was constructed and Nomogram and receiver operating characteristic (ROC) curves were plotted.
Results
This study included 258 patients. The interruption of MRF and the MRA through were observed bilaterally in all patients on preoperative rectal high-resolution MRI. MRA could be divided into 4 types: anterolateral type, lateral type, posterolateral type, and small branches type. Patients were divided into two groups according to whether local recurrence and distant metastasis occurred. Multivariate Cox regression analysis showed the maximum diameter of the right MRA (HR: 3.042, 95%CI: 1.928~4.798, P<0.001) and mrT stage (HR: 3.618, 95%CI: 1.223~10.705, P=0.021) and the width of right MRF (HR: 1.001, 95%CI: 1.000~1.001, P=0.012) were predictors of postoperative recurrence and metastasis. The C-index of the Nomogram prediction model was 0.733 (95%CI: 0.686~0.781). The AUC for 1-, 3- and 5-year DFS was 0.784, 0.808 and 0.888, respectively.
Conclusion
The inherent presence of the MRF and the MRA could be observed by high-resolution rectal MRI. The width of the right MRF and the maximum diameter of the right MRA were prognostic factors for postoperative recurrence and metastasis. Better intraoperative management of the MRF may lead to better outcomes for patients, and further research is still needed in the future.
Colorectal cancer is one of the most common malignant tumors worldwide. In recent years, Natural orifice specimen extraction surgery (NOSES) has gained widespread use as a minimally invasive technique in the treatment of colorectal cancer. However, there has not been a systematic bibliometric analysis of the current international research status on NOSES surgery.
Methods
For this study, we utilized the Web of Science Core Collection database to search for articles published between 2000 and 2023 related to NOSES surgery for colorectal tumors. We applied the Bibliometrix method to analyze data on countries, institutions, journals, authors, and keywords.
Results
A total of 316 articles were included in our study. The highest number of publications occurred in 2022, with 44 articles. China emerged as a major contributor in this field, particularly the Chinese Academy of Medical Sciences & Peking Union Medical College, which published 50 articles. Additionally, the journal of Surgical Endoscopy and Other Interventional Techniques from the United States had the highest publication volume. Through cluster analysis, we found that the research hotspots remain focused on the application of NOSES technology in colorectal cancer surgery, and China continues to be the main center for NOSES research.
Conclusion
Our study provides a comprehensive summary of research on NOSES surgery for colorectal tumors from 2000 to 2023. It describes global research trends, highlighting Chinese pivotal role in advancing this field. Future research should emphasize technical advancements and clinical applications of NOSES.
To investigate the feasibility and safety of specimen extraction surgery (NOSES) performed in ambulatory surgery for rectal cancer.
Methods
The clinical data of 20 patients with rectal cancer performed by ambulatory surgery from Nov. 1, 2023 to Mar. 31, 2024 admitted to the National Cancer Regional Medical Center-Liaoning Hospital of Cancer Hospital of Chinese Academy of Medical Sciences/the First Affiliated Hospital of China Medical University were retrospectively analyzed and the surgery-related indexes and postoperative complications were collected and analyzed.
Results
In this study, we summarized and analyzed 20 patients with rectal cancer that had been carried out in ambulatory surgery, with no delayed discharge, only one readmission patient, no serious postoperative complications, and patient satisfaction rate was more than 95%.
Conclusion
NOSES combined with ERAS strategy in ambulatory surgery could reduce the surgical incision, stress response and postoperative pain, which is safe and feasible.
The low anterior resection syndrome (LARS), a common postoperative complication of rectal cancer, has a relatively high incidence and seriously affects the quality of patient survival, and there are few systematic research studies addressing risk prediction and treatment of LARS. For clinicians, knowledge of the occurrence and progression of LARS and effective treatments are helpful for early clinical intervention and treatment. This article provides a review of research advances in the prediction and treatment related to LARS.
As a branch field of pelvic floor diseases, benign anorectal diseases are common and frequently-occurring diseases in clinical practice, including hemorrhoids, anal fistula, anal fissure, rectal prolapse and so on. With the westernization of people 's lifestyle and dietary structure, the incidence of benign anorectal diseases has gradually increased, and the treatment of moderate to severe benign anorectal diseases is still based on surgery. Finite element method (FEM) is a research hotspot in the field of mechanics in recent years and has been widely used in the biomedical field. Scholars at home and abroad have introduced it into the study of pelvic floor diseases. By constructing a finite element model of pelvic floor structure and simulating the pelvic floor tissue stress under various physiological states, they try to elucidate the pathogenesis of pelvic floor diseases, which is of great significance for improving surgical methods, reducing postoperative recurrence and reducing postoperative complications. In this paper, we search the relevant literature reports in recent years, summarize the research progress of finite element method in benign anorectal diseases, and analyze and elaborate its advantages, limitations and future optimization directions in order to provide a reference for the basic research of benign anorectal diseases in the direction of medical workers.
Rectal cancer is a common malignant tumor of digestive tract. Operation is the main treatment method. The surgery brings less invasive with the use of equipment and technology such as laparoscopy and the Da Vinci robot, but still requires an auxiliary incision in the abdominal wall for specimen extraction and the placement of the anvil. The natural orifice specimen extraction(NOSES) procedure is an advanced minimally invasive surgical technique that uses the natural orifice to remove gastrointestinal specimens and complete laparoscopic enterostomy. This technique has demonstrated significant clinical advantages, particularly in the treatment of rectal cancer, including reduced postoperative pain, shorter hospital stays, avoidance of scarring, and improved the quality of patient's life. This paper describes a case of laparoscopic radical rectal cancer resection without auxiliary abdominal incision (CRC NOSES ⅠB), and discusses the feasibility and technical points of this procedure.
