Colon Cancer Mortality Research Articles

Association Between Very Small Tumor Size and Increased Cancer-Specific Mortality in Node-Positive Colon Cancer.

Larger tumor size and lymph node involvement are traditionally associated with increased colon cancer-specific mortality. We sought to determine whether patients with very small tumors associated with lymph node involvement are at paradoxically increased risk of colon cancer-specific mortality in comparison with those who have larger tumors and lymph node involvement. This is a retrospective cohort study using the Surveillance, Epidemiology, and End Results database. Geographic areas included in one of the 18 Surveillance, Epidemiology, and End Results registries were used. We identified 99,594 patients with nonmetastatic colon adenocarcinoma treated with surgery between 1988 and 2001. The primary predictor variables were regional lymph node involvement and primary tumor size by longest dimension, grouped into the following predetermined strata: <5 mm, 5 to 19 mm, 20 to 39 mm, 40 to 59 mm, ≥ 60 mm. We used competing risks regression to determine differences in the risk of colon cancer-specific mortality between strata after controlling for T stage, tumor grade, age, year of diagnosis, race, and number of dissected lymph nodes. Median follow-up among censored patients was 12.9 years. We found a significant interaction between lymph node involvement and tumor size (p < 0.05). Among those with node-negative disease, colon cancer-specific mortality increased monotonically with tumor size. In contrast, among those with node-positive disease, patients with the smallest tumors (<5 mm) were at increased risk of 10-year colon cancer-specific mortality compared with those with tumors sized 5 to 19 mm, 20 to 39 mm, 40 to 59 mm, and ≥60 mm (53.3% vs. 30.1%, 37.5%, 39.2%, and 39.7%; adjusted hazard ratios, 1.63-2.24; p < 0.05 in all cases). The main limitations are the retrospective design and information available in the study database. In the setting of lymph node involvement, very small tumor size may predict for increased colon cancer-specific mortality compared with larger tumors. Smaller tumors associated with lymph node involvement may represent more aggressive malignancies with a distinct biology that merits further investigation.

What is the Best Colonoscopy Surveillance for Lynch Syndrome Patients?

Lynch syndrome is the most common form of hereditary colorectal cancer. Screening programs have reduced colon cancer mortality. Despite intensive surveillance, the cumulative risk of developing colorectal cancer is substantial. Identification of modifiable factors has the potential to improve outcome of surveillance. Our article will review current guidelines for Lynch syndrome and how to perform colonoscopy. High-quality surveillance colonoscopy should be performed in an experimented center every 1–2 years, starting at the age of 20–25 years. Colonoscopy should include meticulous inspection and precise removal of all polyps, with special attention to the right colon especially of flat lesions. News endoscopic techniques, such as chromoendoscopy, were developed and recommended to improve the detection of adenomas, particularly of flat adenomas, and minimize the risk of developing interval cancer. Finally, educational intervention in a surveillance program is essential for optimizing screening including adherence.

Inhibition of Growth and Metastasis of Colon Cancer by Delivering 5-Fluorouracil-loaded Pluronic P85 Copolymer Micelles.

Hepatic metastasis is the leading cause of mortality of colon cancer, which is still lack of an effective therapy. A new delivery system, pluronic P85 block copolymers, conveying chemotherapeutic agent 5-fluorouracil (5-Fu) for inhibiting growth and metastasis of colon cancer was designed and developed. In this study, we demonstrated that 5-Fu produce strong pesticide effect at lower doses in the present of pluronic P85 compared with control groups. The migration and invasion of HCT116 cells and RKO cells were examined and the results showed that migration and invasion capacities of HCT116 cells and RKO cells were reduced by administering 5-Fu/P85 copolymer micelles in vitro and in vivo which indicating an effectively activity. Interestingly, the content of CD133 + CXCR4+ cells in HCT116 cancer cells and RKO cells treated by 5-Fu/P85 copolymer micelles was decreased. Importantly, the epithelial-mesenchymal transition (EMT) of CD133 + CXCR4+ cells, which was strongly associated with liver metastasis of colon cancer, was also suppressed by giving 5-Fu/P85 copolymer micelles. The results indicated that 5-Fu/P85 copolymer micelles could inhibit the growth and metastasis of colon cancer, which could be attributed to the decrease of the content of CD133 + CXCR4+ cells and suppression of EMT of CD133 + CXCR4+ cells.

Cancer surveillance in ulcerative colitis and Crohn's disease: new strategies.

Inflammatory bowel disease (IBD) patients have a higher incidence of colon cancer than the general population. Colon cancer surveillance has traditionally involved taking numerous random biopsies to provide sufficient yield to detect dysplasia. Recently, consensus guidelines have been published which promote the use of chromoendoscopy for IBD colon cancer surveillance. This presents a new set of opportunities and challenges in the evaluation and management of dysplasia in IBD. Dysplasia, previously thought to be 'invisible' to the endoscopist, is now considered to be 'visible' in the majority of cases with the advent of the use of high-definition endoscopy and chromoendoscopy. This changes how we manage dysplastic lesions, providing the patient options for endoscopic resection rather than promoting total proctocolectomy. Implemention of chromoendoscopy may require additional training for endoscopists unfamiliar with the technique. However, if this proves to be cost-effective and provides a higher sensitivity in dysplasia detection, then widespread education and implementation will be well worth the efforts. To do so, future studies will need to prove its benefits in preventing or reducing colon cancer morbidity and mortality in this high-risk patient population.

FICE vs Narrow Band Imaging for In Vivo Histologic Diagnosis of Polyps.

Background and Objectives:Gastrointestinal cancers are the most frequently occurring cancers worldwide. Diagnosis and removal of polyps during screening endoscopy decreases the prevalence of colon cancer and cancer-related mortality, and it is considered to be the gold standard in gastrointestinal system cancer prevention. Technological innovations in endoscopy have led to revolutionary developments in many areas. Flexible spectral imaging color enhancement (FICE) and narrow-band imaging (NBI) are forms of digital chromoendoscopy and enhance the endoscopic images without the need for a dye. This study seeks to evaluate the efficacy of FICE and NBI on polyp screening and real-time histologic diagnosis with endoscopy and to compare them.Methods:A total of 134 patients (male/female = 72/62) and 161 polyps were evaluated with FICE or NBI, and real-time histologic diagnosis predictions were classified as neoplastic or nonneoplastic, according to Kudo's pit pattern classification. Pathological results and real-time endoscopic diagnoses were statistically interpreted for both FICE and NBI. Positive predictive value, negative predictive value, sensitivity, specificity, and accuracy rates were calculated and compared for both modalities.Results:When both systems were compared, the negative predictive value of NBI was found to be higher than that of FICE statistically (P < .001). Specificity and positive predictive value in the FICE group were higher than in the NBI group, but the difference was not statistically significant (P = .082 and P = .153, respectively).Conclusions:Aside from being safe in polyp detection, digital chromoendoscopy also helps the endoscopist in selecting the type of simultaneous intervention (eg, polypectomy, endomucosal resection, or submucosal dissection) by enabling endoscopic histologic diagnosis.

The Majority of Myeloma Patients Are Vitamin D Deficient, Unrelated to Survival or Cytogenetics

▪Introduction: Since a link between solar radiation, vitamin D production, and decreased colon cancer mortality was established in 1980, there has been increasing interest in vitamin D and cancer, suggesting that higher vitamin D levels improve overall survival, specifically in breast and colorectal cancer (Maalmi H et al, Eur J Canc, May-2014, PMID 24582912), but also in follicular lymphoma (Kelly JL, J Clin Onc, 1-May-2015, PMID 25823738). In myeloma, largest published series is from the Mayo Clinic reporting on 148 newly diagnosed MM patients for which no survival association was found, but there were associations between low 25-OH-Vit D (<20 ng/mL) and higher serum CRP, serum creatinine, and ISS stage (Ng AC, Am J. Heme, Jul-2009, PMID 19415724); we wanted to expand on their trailblazing analysis. Cytogenetically high risk myeloma characterized by the amplification of 1q21 is associated with increased serum levels of soluble IL-6 receptor (sIL-6r) (Stephens OW, Blood, 2012, PMID 22072558) which may be associated with other markers of inflammation, e.g. CRP, creatinine, and b2microglobulin.Methods: The Buckeye Myeloma Registry (OSU 10115) opened in 2011 to enroll any patient with a plasma cell dyscrasia. Serum total 25-OH-Vitamin D was measured at the time of the initial clinic visit to the myeloma group at Ohio State.Results: Of a total of 843 patients, 115 (13.6%), 53 (6.3%) with SMM, and 675 (80.1%) with MM. In the 675 MM patients, the median age was 64 y.o. (range 28-95), 14.5% African-American and the remainder Caucasian, with 28.6% ISS stage 1, 48.7% ISS stage 2, 21.9% ISS stage 3, and 24.5% unknown. At diagnosis for the MM patients, 67% presented with lytic bone disease.Out of 675 MM patients, there were 52 (7.7%) patients with < 10 ng/mL 25-OH-Vit D, 394 (51%) with low vit D (10-30 ng/mL), and 229 (39%) for 25-OH-Vit D 30-100 ng/mL. There was no correlation between 25-OH-Vit D and BMI or creatinine, but there was a strong correlation with race (r=0.18, p<0.000026).Among the MM patients, log-rank [Mantel-Cox] analysis of overall survival with serum 25-OH-Vit D including all groups demonstrated no significant differences (p=0.9725) with only 101 events. There was no correlation between 25-OH-Vit D and the presence on CD138-selected FISH of 1q21 amplification (p=0.196), 17p (p53) deletion (p=0.68), or 13q deletion (p=0.812).Conclusion: The majority of myeloma patients are vitamin D deficient, but this was not associated with worsened overall survival or with high risk cytogenetics. Cox proportional hazards analyses of survival adjusted for significant univariate covariates will be presented at the meeting. Correlations with presence or absence of diffuse lytic bone disease, severity of renal insufficiency, and race will also be presented at the meeting. DisclosuresNo relevant conflicts of interest to declare.

MicroRNA-26a and -584 inhibit the colorectal cancer progression through inhibition of the binding of hnRNP A1-CDK6 mRNA

While the progress of chemotherapy and molecular targeted therapy has improved the outcome of colorectal cancer patients, the mortality of colon cancer remains high, indicating the need to develop novel therapeutic targets for improving the outcome of colon cancer. Heterogeneous ribonucleoprotein A1 (hnRNP A1) is highly expressed in colorectal cancer and its expression correlates with malignant transformation. In this study, we performed a microarray analysis with the RNA immunoprecipitation (RNA-IP) method and identified hnRNP A1-interacting miRs, including miR-26a and -584, in a colorectal cancer cell line, SW620. A SRB assay revealed the tumor suppressive effect of miR-26a and -584, and the tumor suppressive effect of these miRs was diminished by the downregulation of hnRNP A1. The combined method of a transcriptome analysis and RNA-IP revealed hnRNP A1-interacting mRNAs, including cyclin dependent kinase 6 (CDK6). A Western blot analysis revealed the downregulation of CDK6 in miR-26a and -584 overexpression cells, as well as hnRNP A1 knockdown cells. The binding assay indicated that the binding of hnRNP A1-CDK6 mRNA was reduced by transfection of miR-26a and -584. The expression of cleaved caspase-3 was induced in miR-26a and -584 overexpression cells. These data indicate that miR-26a and -584 inhibit the binding of hnRNP A1-CDK6 mRNA and induce colorectal cancer cell apoptosis.

Endoscopic resection of colorectal lesions: The narrowing divide between East and West.

Colonic polypectomy is an effective way of reducing colon cancer mortality. Multiple techniques now exist for the resection of polyps, and the endoscopist must decide on the appropriate resection approach for individual patients and lesions. This decision should maximize efficacy, safety and cost-effectiveness and provide optimal oncological outcomes while minimizing unnecessary surgical treatment. Advances in endoscopic imaging technology are improving the accuracy of endoscopic diagnosis and allowing more precise risk assessment of colonic lesions. Resection technique can be tailored to the endoscopic findings. Diminutive (≤5 mm) and small polyps (≤9 mm) are best resected primarily by snare techniques. Cold snare polypectomy has proven safety, but efficacy and technique require further study. There is variation in techniques used for polyps 6-20 mm in size and incomplete resection rates for conventional polypectomy may be considerable. Endoscopic mucosal resection (EMR) is well established, safe and effective for lesions without submucosal invasion (SMI); however, recurrence is a key limitation. Endoscopic submucosal dissection (ESD) is well established in the East; however, it is resource intensive and its role in lesions with a low risk of SMI is questionable. ESD in the West remains incompletely defined and is associated with high adverse event rates, but it is becoming increasingly available and successful as experience grows. Emerging full-thickness resection technologies are still in their infancy and remain experimental as a result of the absence of reliable closure devices and techniques. Patient-focused outcomes should guide technique selection.

Noncommunicable Diseases: Three Decades Of Global Data Show A Mixture Of Increases And Decreases In Mortality Rates.

Noncommunicable diseases are the leading health concerns of the modern era, accounting for two-thirds of global deaths, half of all disability, and rapidly growing costs. To provide a contemporary overview of the burdens caused by noncommunicable diseases, we compiled mortality data reported by authorities in forty-nine countries for atherosclerotic cardiovascular diseases; diabetes; chronic respiratory diseases; and lung, colon, breast, cervical, liver, and stomach cancers. From 1980 to 2012, on average across all countries, mortality for cardiovascular disease, stomach cancer, and cervical cancer declined, while mortality for diabetes, liver cancer, and female chronic respiratory disease and lung cancer increased. In contrast to the relatively steep cardiovascular and cancer mortality declines observed in high-income countries, mortality for cardiovascular disease and chronic respiratory disease was flat in most low- and middle-income countries, which also experienced increasing breast and colon cancer mortality. These divergent mortality patterns likely reflect differences in timing and magnitude of risk exposures, health care, and policies to counteract the diseases. Improving both the coverage and the accuracy of mortality documentation in populous low- and middle-income countries is a priority, as is the need to rigorously evaluate societal-level interventions. Furthermore, given the complex, chronic, and progressive nature of noncommunicable diseases, policies and programs to prevent and control them need to be multifaceted and long-term, as returns on investment accrue with time.

Aspirin and salicylic acid decrease c-Myc expression in cancer cells: a potential role in chemoprevention.

Epidemiological studies have demonstrated a significant correlation between regular aspirin use and reduced colon cancer incidence and mortality; however, the pathways by which it exerts its anti-cancer effects are still not fully explored. We hypothesized that aspirin's anti-cancer effect may occur through downregulation of c-Myc gene expression. Here, we demonstrate that aspirin and its primary metabolite, salicylic acid, decrease the c-Myc protein levels in human HCT-116 colon and in few other cancer cell lines. In total cell lysates, both drugs decreased the levels of c-Myc in a concentration-dependent fashion. Greater inhibition was observed in the nucleus than the cytoplasm, and immunofluorescence studies confirmed these observations. Pretreatment of cells with lactacystin, a proteasome inhibitor, partially prevented the downregulatory effect of both aspirin and salicylic acid, suggesting that 26S proteasomal pathway is involved. Both drugs failed to decrease exogenously expressed DDK-tagged c-Myc protein levels; however, under the same conditions, the endogenous c-Myc protein levels were downregulated. Northern blot analysis showed that both drugs caused a decrease in c-Myc mRNA levels in a concentration-dependent fashion. High-performance liquid chromatography (HPLC) analysis showed that aspirin taken up by cells was rapidly metabolized to salicylic acid, suggesting that aspirin's inhibitory effect on c-Myc may occur through formation of salicylic acid. Our result suggests that salicylic acid regulates c-Myc level at both transcriptional and post-transcription levels. Inhibition of c-Myc may represent an important pathway by which aspirin exerts its anti-cancer effect and decrease the occurrence of cancer in epithelial tissues.

Coffee Intake, Recurrence, and Mortality in Stage III Colon Cancer: Results From CALGB 89803 (Alliance).

Observational studies have demonstrated increased colon cancer recurrence in states of relative hyperinsulinemia, including sedentary lifestyle, obesity, and increased dietary glycemic load. Greater coffee consumption has been associated with decreased risk of type 2 diabetes and increased insulin sensitivity. The effect of coffee on colon cancer recurrence and survival is unknown. During and 6 months after adjuvant chemotherapy, 953 patients with stage III colon cancer prospectively reported dietary intake of caffeinated coffee, decaffeinated coffee, and nonherbal tea, as well as 128 other items. We examined the influence of coffee, nonherbal tea, and caffeine on cancer recurrence and mortality using Cox proportional hazards regression. Patients consuming 4 cups/d or more of total coffee experienced an adjusted hazard ratio (HR) for colon cancer recurrence or mortality of 0.58 (95% CI, 0.34 to 0.99), compared with never drinkers (Ptrend = .002). Patients consuming 4 cups/d or more of caffeinated coffee experienced significantly reduced cancer recurrence or mortality risk compared with abstainers (HR, 0.48; 95% CI, 0.25 to 0.91; Ptrend = .002), and increasing caffeine intake also conferred a significant reduction in cancer recurrence or mortality (HR, 0.66 across extreme quintiles; 95% CI, 0.47 to 0.93; Ptrend = .006). Nonherbal tea and decaffeinated coffee were not associated with patient outcome. The association of total coffee intake with improved outcomes seemed consistent across other predictors of cancer recurrence and mortality. Higher coffee intake may be associated with significantly reduced cancer recurrence and death in patients with stage III colon cancer.

Cancer care coordinators in stage III colon cancer: a cost-utility analysis.

BackgroundThere is momentum internationally to improve coordination of complex care pathways. Robust evaluations of such interventions are scarce. This paper evaluates the cost-utility of cancer care coordinators for stage III colon cancer patients, who generally require surgery followed by chemotherapy.MethodsWe compared a hospital-based nurse cancer care coordinator (CCC) with ‘business-as-usual’ (no dedicated coordination service) in stage III colon cancer patients in New Zealand. A discrete event microsimulation model was constructed to estimate quality-adjusted life-years (QALYs) and costs from a health system perspective. We used New Zealand data on colon cancer incidence, survival, and mortality as baseline input parameters for the model. We specified intervention input parameters using available literature and expert estimates. For example, that a CCC would improve the coverage of chemotherapy by 33 % (ranging from 9 to 65 %), reduce the time to surgery by 20 % (3 to 48 %), reduce the time to chemotherapy by 20 % (3 to 48 %), and reduce patient anxiety (reduction in disability weight of 33 %, ranging from 0 to 55 %).ResultsMuch of the direct cost of a nurse CCC was balanced by savings in business-as-usual care coordination. Much of the health gain was through increased coverage of chemotherapy with a CCC (especially older patients), and reduced time to chemotherapy. Compared to ‘business-as-usual’, the cost per QALY of the CCC programme was $NZ 18,900 (≈ $US 15,600; 95 % UI: $NZ 13,400 to 24,600). By age, the CCC intervention was more cost-effective for colon cancer patients < 65 years ($NZ 9,400 per QALY). By ethnicity, the health gains were larger for Māori, but so too were the costs, meaning the cost-effectiveness was roughly comparable between ethnic groups.ConclusionsSuch a nurse-led CCC intervention in New Zealand has acceptable cost-effectiveness for stage III colon cancer, meaning it probably merits funding. Each CCC programme will differ in its likely health gains and costs, making generalisation from this evaluation to other CCC interventions difficult. However, this evaluation suggests that CCC interventions that increase coverage of, and reduce time to, effective treatments may be cost-effective.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0970-5) contains supplementary material, which is available to authorized users.

Abstract 2093: Regulation of c-Myc expression by aspirin and salicylic acid in colon cancer cells through a novel pathway

Abstract Epidemiological studies have demonstrated a significant correlation between regular aspirin use and reduced colon cancer incidence and mortality; however, the exact pathway has not been identified. We hypothesized that aspirin's anti-cancer effect may occur through modulation of c-Myc gene expression. Being a transcription factor, c-Myc controls nearly 15% of the expression of all genes and its activity is highly regulated in normal cells. In many cancers including colon cancer, c-Myc is mutated and constitutively activated which leads to uncontrolled cell proliferation. In the present study, we demonstrate that aspirin and its primary metabolite, salicylic acid, significantly decrease the c-Myc protein levels in colon cancer cells. In total cell lysates, both drugs decreased the levels of c-Myc in a concentration dependent (250 μM to 2500 μM) fashion (up to 70%). Interestingly, greater inhibition was observed in the nucleus than the cytoplasm, and immuno-fluorescence studies further confirmed these observations. Pre-treatment of cells with lactacystin partially reversed the inhibitory effect of both aspirin and salicylic acid, suggesting that 26S proteasomal pathway is involved. Transfection of HCT-116 cells with DDK-tagged c-Myc produced abundant c-Myc protein; but, it was unaffected by aspirin and salicylic acid. In the same lysates, the endogenous c-Myc level were significantly decreased. HPLC analysis showed that aspirin taken up by cells was metabolized to salicylic acid in a time-dependent fashion. This further supports the finding aspirin's inhibitory effect on c-Myc occurs through formation of salicylic acid. Our result suggests that aspirin and salicylic acid regulate c-Myc level at both transcriptional and post-transcription level. Inhibition of c-Myc levels may represent an important pathway by which aspirin exerts its anti-cancer effect and decrease the occurrence of cancer in epithelial tissues. Citation Format: Guoqiang Ai, Rakesh Dachineni, Pratik Muley, Hemachand Tummala, Jayarama B. Gunaje. Regulation of c-Myc expression by aspirin and salicylic acid in colon cancer cells through a novel pathway. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 2093. doi:10.1158/1538-7445.AM2015-2093

Observational methods to assess the effectiveness of screening colonoscopy in reducing right colon cancer mortality risk: SCOLAR.

Screening colonoscopy's effectiveness in reducing risk of death from right colon cancers remains unclear. Methodological challenges of existing observational studies addressing this issue motivated the design of 'Effectiveness of Screening for Colorectal Cancer in Average-Risk Adults (SCOLAR)'. SCOLAR is a nested case-control study based on two large integrated health systems. This affords access to a large, well-defined historical cohort linked to integrated data on cancer outcomes, patient eligibility, test indications and important confounders. We found electronic data adequate for excluding ineligible patients (except family history), but not the detailed information needed for test indication assignment. The lessons of SCOLAR's design and implementation may be useful for future studies seeking to evaluate the effectiveness of screening tests in community settings.

Race and Insurance Differences in the Receipt of Adjuvant Chemotherapy Among Patients With Stage III Colon Cancer.

Although the incidence and mortality of colon cancer in the United States has declined over the past two decades, blacks have worse outcomes than whites. Variations in treatment may contribute to mortality differentials. Patients diagnosed with stage III colon cancer were randomly sampled from the SEER program from the years 1990, 1991, 1995, 2000, 2005, and 2010. Patients were categorized as non-Hispanic white (n = 835) or black (n = 384). Treatment data were obtained from a review of the medical records, and these data were verified through contact with the original treating physicians. Log-binomial regression models were used to estimate the association between race and receipt of adjuvant chemotherapy. Effect modification by insurance was assessed with use of single referent models. Receipt of adjuvant chemotherapy among both white and black patients increased from the period encompassing the years 1990 and 1991 (white, 58%; black, 45%) to the year 2005 (white, 72%; black, 71%) and then decreased in the year 2010 (white, 66%; black, 57%). There were marked racial disparities in the time period of 1990 to 1991 and again in 2010, with black patients less likely to receive adjuvant chemotherapy as compared with white patients (risk ratio [RR], .82; 95% CI, .72 to .93). For black patients, receipt of adjuvant chemotherapy did not differ across insurance categories (RR for private insurance, .80; 95% CI, .69 to .93; RR for Medicare, .84; 95% CI, .69 to 1.02; and RR for Medicaid, .84; 95% CI, .69 to 1.02), although a larger proportion had Medicaid in all years of the study as compared with white patients. The chemotherapy differential narrowed after the time period of 1990 to 1991, but our findings suggest that the disparity reemerged in 2010. Recent decreases in chemotherapy use may be due, in part, to the economic downturn and an increase in Medicaid coverage.

PTH-288 Trends in colon and rectal cancer epidemiology in ukraine: incidence, mortality and surgical management in comparison to a us hospital

Introduction To describe the trends in colon and rectal cancer incidence, management and mortality in Ukraine. To compare the distribution of operations for colon and rectal cancer in the major referral hospital in Ukraine and a United States tertiary care centre. Method This is a population based study of colorectal cancer incidence, mortality and management in Ukraine over 14 years (1999–2012). The National Cancer Registry of Ukraine was queried for incidence, overall and 1 year mortality, stage at presentation and management. The distribution of operative interventions for colorectal cancer performed at the National Cancer Institute in Ukraine a 560-bed, major referral centre for oncologic surgery as compared to the Brigham and Women’s Hospital, 779-bed tertiary care centre in the US will be reported here. Results Over the last 14 years we noted an increase in incidence and mortality in colon and rectal cancer. Crude incidence rate increased from 17.7 cases per 100, 000 to 24.3 for colon cancer and 11.3 to 12.8 for rectal cancer. The distribution of stages at presentation remained constant: 52.6% presented with stage I and II, 21.6% with stage III and 19.5% with stage IV disease for colon cancer and 63.2% with stage I and II, 15.1% with stage III and 15.1 with stage IV for rectal cancer. Despite the majority of patients presenting with early stage disease, 40.6% of colon cancer patients and 33.8% of rectal cancer patients died within a year of diagnosis. This number improved with the increased use of combined therapy in management of colorectalcancer. (Figure1). A wide variety and number of cases were performed at the National Cancer Institute in Ukraine with similar distribution to Brigham and Women’s Hospital in 2013. 260 operations for colon and rectal cancer were performed at the National Cancer Institute and 268 at the Brigham and Women’s Hospital. Of them, 31% vs. 28% were hemicolectomies, 52% vs. 53% were anterior and low anterior resections, 12% vs. 13% were abdominoperineal resections respectively. Conclusion Despite some improvement in colorectal cancer care and 1 year mortality in Ukraine the prognosis is still poor. It is perplexing that even though the large number of patients are diagnosed with early disease the outcomes are still poor. Since the incidence of colorectal cancer in increasing more studies are needed to establish the feasibility of colon cancer screening, to confirm the accurate reporting of stage distribution and to characterise barriers to obtain adequate care for colorectal cancer in Ukraine. Disclosure of interest None Declared.

Clustering asian and north african countries according to trend of colon and rectum cancer mortality rates: an application of growth mixture models.

Colorectal cancer is the second most common cause of cancer death with half a million deaths per year. Incidence and mortality rates have demonstrated notable changes in Asian and African countries during the last few decades. In this study, we first aimed to determine the trend of colorectal cancer mortality rate in each Institute for Health Metrics and Evaluation (IHME) region, and then re-classify them to find more homogenous classes. Our study population consisted of 52 countries of Asia and North Africa in six IHME pre-defined regions for both genders and age-standardized groups from 1990 to 2010.We first applied simple growth models for pre-defined IHME regions to estimate the intercepts and slopes of mortality rate trends. Then, we clustered the 52 described countries using the latent growth mixture modeling approach for classifying them based on their colorectal mortality rates over time. Statistical analysis revealed that males and people in high income Asia pacific and East Asia countries were at greater risk of death from colon and rectum cancer. In addition, South Asia region had the lowest rates of mortality due to this cancer. Simple growth modeling showed that majority of IHME regions had decreasing trend in mortality rate of colorectal cancer. However, re-classification these countries based on their mortality trend using the latent growth mixture model resulted in more homogeneous classes according to colorectal mortality trend. In general, our statistical analyses showed that most Asian and North African countries had upward trend in their colorectal cancer mortality. We therefore urge the health policy makers in these countries to evaluate the causes of growing mortality and study the interventional programs of successful countries in managing the consequences of this cancer.

Incidence and natural course of inflammatory bowel disease in Korea, 2006-2012: a nationwide population-based study.

Although a rising trend in the incidence of inflammatory bowel disease (IBD) in Asia has been recognized, national-level, population-based studies are lacking. In this study, we investigate the epidemiological features and natural course of IBD in Korea, including incidence, bowel resection rates, survival, and cause of death. We analyzed the Rare Intractable Disease registration and Health Insurance Review and Assessment Services claims database, which include information on every patients with IBD diagnosed through uniform criteria from 2006 to 2012. Twenty-seven thousand four hundred nineteen patients with IBD newly diagnosed from 2006 to 2012 were traced to bowel resection, survival, and cause of death. During study period, mean annual incidence for ulcerative colitis was 4.6 per 10 and for Crohn's disease (CD) was 3.2 per 10. Bowel resection rates at 1 and 5 years for patients with ulcerative colitis were 0.8% and 2.1%, respectively, and for patients with CD were 5.0% and 9.1%, respectively. Survival of patients with CD was lower than that of the general population, whereas patients with ulcerative colitis had similar survival. In patients with CD, mortality for colon cancer, lung cancer, and gastrointestinal disease was significantly increased compared with general population. Incidence of IBD found in our study is the highest in East Asia. Lower bowel resection rates and higher survival compared to those of Western nations suggest that the natural course of IBD may be different between East Asia and the West.

The fate of unscreened women in colon cancer: impact on staging and prognosis

BackgroundSeveral nationwide reports show lower female participation in colon cancer screening. We therefore assessed for outcome differences in women of screening age presenting for surgical treatment of colon cancer patients. MethodsAll patients over 50 years undergoing surgery for first-onset colon cancer at Massachusetts General Hospital (2004 to 2011) were included. Differences between (unscreened) women and the remaining population in presentation characteristics and subsequent morbidity and mortality were assessed. ResultsWe included 919 patients (49.1% female). Women were less often diagnosed through screening (26.4 vs 32.7%, P = .036). Unscreened women were at significantly higher risk (all P < .001) for having high-grade tumors (Relative risk [RR] = 1.61), lymph node metastasis (RR = 1.36), and distant metastasis (RR = 2.26) on pathology, leading to higher colon cancer-related mortality (RR = 1.72). ConclusionUnscreened women present with more advanced colon cancer and higher mortality, confirming that disparities in screening lead to ever-increasing disparities in outcomes.

Novel recurrently mutated genes in African American colon cancers

We used whole-exome and targeted sequencing to characterize somatic mutations in 103 colorectal cancers (CRC) from African Americans, identifying 20 new genes as significantly mutated in CRC. Resequencing 129 Caucasian derived CRCs confirmed a 15-gene set as a preferential target for mutations in African American CRCs. Two predominant genes, ephrin type A receptor 6 (EPHA6) and folliculin (FLCN), with mutations exclusive to African American CRCs, are by genetic and biological criteria highly likely African American CRC driver genes. These previously unsuspected differences in the mutational landscapes of CRCs arising among individuals of different ethnicities have potential to impact on broader disparities in cancer behaviors.