Prevalence Of Colorectal Cancer Research Articles

Overweight and obesity significantly increase colorectal cancer risk: a meta-analysis of 66 studies revealing a 25-57% elevation in risk.

The incidence of colorectal cancer (CRC) has been steadily rising, and obesity has been identified as a significant risk factor. Numerous studies suggest a strong correlation between excess body weight and increased risk of CRC, but comprehensive quantification through pooled analysis remains limited. This study aims to systematically review and meta-analyze the existing literature to evaluate the association between obesity and CRC risk, considering variations across sex and study designs. A systematic literature search was conducted in PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science to identify randomized controlled trials and human clinical trials from 1992 to 2024. Statistical analysis was performed using the https://metaanalysisonline.com web application using a random effects model to estimate the pooled hazard rates (HR). Forest plots, funnel plots, and Z-score plots were utilized to visualize results. We identified 52 clinical trials and 14 case-control studies, encompassing a total of 83,251,050 and 236,877 subjects, respectively. The pooled analysis indicated that obesity significantly increased the prevalence of CRC (HR = 1.36, 95% CI = 1.24-1.48, p < 0.01). This effect was consistent across sexes, with HRs of 1.57 (95% CI = 1.38-1.78, p = 0.01) for males and 1.25 (95% CI = 1.14-1.38, p < 0.01) for females. Case-control studies specifically showed an effect, but with marginal significance only (HR = 1.27, 95% CI = 0.98-1.65, p = 0.07). The Z-score plot indicated the need for additional analysis in the case-control group. A significant heterogeneity was observed across studies in all four settings. This meta-analysis provides robust evidence that obesity is a significant risk factor for colorectal cancer, with an overall hazard rate indicating a 36% increased risk. The effect is pronounced across both sexes, with males showing a slightly higher risk compared to females. Although case-control studies showed a weaker association, the overall trend supports the link between obesity and CRC. These results underscore the importance of public health interventions aimed at reducing obesity to potentially lower the risk of colorectal cancer.

Risk of metachronous colorectal cancer associated with polypectomy during endoscopic diagnosis of colorectal cancer

Background and aimThere are conflicting reports regarding the risk of metachronous colorectal cancer (CRC) subsequent to colonoscopy with polypectomy or biopsy performed concurrently with diagnostic biopsies for CRC. We aimed to establish the 5-year risk of CRC in patients who had synchronous polypectomy or biopsies during the colonoscopy at which CRC was diagnosed.MethodsThis is a single-centre retrospective case–control study of adults who underwent surgical resection for CRC over a 2-year period (January 2016 to December 2017). Colonoscopy details of interest were the location of the CRC, polypectomy and non-CRC biopsy sites. In patients with CRC at index colonoscopy, we sought associations between the occurrence of metachronous CRC and the sites from which endoscopic specimens had been obtained.ResultsOur study population comprised 225 patients with a median (IQR) age of 71 (60–77) years. Polypectomy or biopsy at a non-CRC site had been performed during the index colonoscopy in 108 patients (48%), including 83 (37%) polypectomies outside the surgical resection field. There were 8 (3.6%) metachronous CRCs: 1 (0.4%) at the site of endoscopic mucosal resection for a 15-mm sessile serrated lesion, 3 (1.3%) anastomotic site CRCs and 4 (1.8%) at other sites within the colon. There was no significant difference in the prevalence of metachronous CRC in patients who underwent polypectomy/biopsy at the index colonoscopy compared with those who did not (1.9% vs. 5.1%, p = 0.283).ConclusionThere was no significant increased risk of metachronous CRC subsequent to synchronous polypectomy or biopsy during the colonoscopy at which CRC was diagnosed.

Integration of big data analytics in the investigation of the relationship between acromegaly and cancer

ObjectiveTo evaluate the association between acromegaly and cancer and different types of cancer by using natural language processing systems and big data analytics. Material and methodsWe conducted an observational, retrospective study utilizing data from the electronic health records (EHRs) of Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain. Information from the EHRs was extracted using artificial intelligence techniques and analyzed using Savana Manager 4.0 software. ResultsOut of a total of 708,047 registered patients (54.7% females), 544 patients (0.08%; 330 women, 60.7%; mean age at diagnosis 53.0±15.8 yr) were diagnosed with acromegaly. The incidence of cancer was higher in patients with acromegaly vs those without this condition (7.7% vs 3.9%, p<0.001; OR, 2.047, 95%CI, 1.493–2.804). Male acromegalic patients had a higher prevalence of cancer vs females (57.1% vs 42.9%, p=0.012). A significantly higher prevalence of colorectal cancer (2.9% vs 1.4%, p=0.006), bladder cancer (1.1% vs 0.3%, p=0.005), and lymphoma (1.1% vs 0.3%, p=0.009) was observed in patients with acromegaly vs those without the condition. Acromegalic men had significantly higher prevalence rates of colorectal cancer (4.7% vs 1.3%, p=0.001), bladder cancer (2.8% vs 0.4%, p<0.001), breast cancer (0.9% vs 0.2%, p=0.042), gastric cancer (0.9% vs 0.1%, p=0.011), lymphoma (1.4% vs 0.3%, p=0.037), and liver cancer (0.9% vs 0.1%, p=0.012) vs non-acromegalic men. On the other hand, acromegalic women showed a higher prevalence of thyroid cancer (1.2% vs 0.4%, p=0.043) vs non-acromegalic women. ConclusionOur study, based on artificial intelligence techniques and analysis of real-world data and information, revealed a significant association between acromegaly and cancer in our hospital population, mainly acromegalic men, with a higher frequency of colorectal cancer, bladder cancer and lymphoma in particular.

Circulating exosomal PCAT1 as a complement of carcinoembryonic antigen for early colorectal cancer diagnosis

BackgroundsGiven the global prevalence of colorectal cancer (CRC), advancements in prompt and accurate diagnosis are crucial. Long non-coding RNAs (lncRNAs) in serum exosomes are emerging as potential diagnostic biomarkers. This study evaluated the feasibility of using serum exosomal lncRNAs for early-stage CRC diagnosis in clinical practice. MethodsCandidate serum exosomal lncRNAs were identified through an integrated analysis of two GEO datasets (GSE100206 and GSE100063) containing non-coding RNA expression profiles in serum exosomes. Exosomes isolated from participants' serum were validated using transmission electron microscopy (TEM) and immunoblotting. The expression levels of serum exosomal PCAT1 were measured by quantitative real-time polymerase chain reaction (qRT-PCR). Diagnostic accuracy was assessed using receiver operating characteristic (ROC) analysis. ResultsSerum exosomal PCAT1 levels were evaluated in 150 CRC patients, 66 patients with benign colorectal lesions, and 128 healthy controls. ROC analysis demonstrated high diagnostic efficacy of serum exosomal PCAT1 for CRC. Notably, the predictive performance was sufficient to distinguish early-stage CRC patients. Additionally, the diagnostic value was significant for CRC patients with low serum carcinoembryonic antigen (CEA) levels. Measuring serum exosomal PCAT1 could complement CEA assessment, enhancing CRC diagnostic accuracy. ConclusionsSerum exosomal PCAT1 can complement CEA assessment, aiding in early CRC diagnosis and helping to differentiate the disease, especially in patients with low CEA levels.

Prognostic Study of Colorectal Cancer: Differences between Screen-Detected and Symptom-Diagnosed Patients

Abstract: Background and objective: Colorectal cancer (CRC) is the leading cause of mortality in Spain, with screening programs, such as the faecal occult blood test and colonoscopy, having shown effectiveness in reducing CRC incidence and mortality. Despite these advancements, CRC screening uptake remains low in Spain, highlighting the need for studies comparing outcomes between screening-diagnosed and symptom-diagnosed patients to better understand the impact on overall survival and to quantify the clinical benefit in prognosis at diagnosis and at the end of follow-up. Methods: We conducted a retrospective cohort study with the following objectives: to compare stage at diagnosis, all-cause mortality, and disease-specific mortality among people diagnosed with CRC based on screening and based on symptoms; to identify the risk factors associated with mortality in this population; and to evaluate the effectiveness of screening on survival and early detection. Our study included people diagnosed with CRC in the public hospital of Elda (Spain) from 2014 to 2018; follow-up was until 2023 or death. Our primary outcome was all-cause mortality, which we analysed using Kaplan–Meier curves. We also investigated CRC-specific mortality and other-cause mortality. Results: Our sample included 315 people (186 with symptom-based diagnoses, 129 with screening-based diagnoses). The mean length of follow-up was 62.8 months. The screening group had a higher prevalence of a family history of CRC (p = 0.008), a distal tumour location (p = 0.002), and a cancer stage of 0 or I (p &lt; 0.001). The symptoms group had a higher prevalence of a proximal CRC (p = 0.002), other chronic diseases (p &lt; 0.001), and stages II, III, and IV (p &lt; 0.001). Two variables were associated with mortality: stage IV at diagnosis and previous cancers. People with a symptom-based diagnosis had a higher prevalence of stage IV at diagnosis and a higher cumulative incidence of CRC mortality and all-cause mortality at the end of follow-up (p &lt; 0.05). The Kaplan–Meier curves also showed a higher rate of all-cause mortality in the symptoms group throughout the follow-up. Conclusion: CRC screening enables an earlier diagnosis and improves survival. These findings support public health policies that promote accessible and effective screening.

Risk of Colorectal Cancer among Patients with One or Multiple Metabolic Syndrome Components

Background/Objectives: Dysfunctions of metabolic syndrome (MetS) have been identified as a significant risk factor for colorectal cancer (CRC). However, current colon cancer guidelines do not classify patients with MetS as high risk, thereby leaving these individuals vulnerable. Consequently, we explored the relationship between MetS, its individual components, and the development of CRC in a cohort of patients with MetS to assess the necessity for CRC screening in these individuals. Methods: This study included patients ages 18 and older that received a service from the Marshall-Health (MH) practice plan, Cabell-Huntington Hospital (CHH), MU/JCESOM’s Edwards Comprehensive Cancer Center (ECCC), or the University of Kentucky HealthCare (UKHC) system between 2010 and 2018. We implemented log-binomial regression models to assess the individual and collective effects of MetS components after adjusting other CRC risk factors. Results: Given that CRC prevalence increases in the older population (aged 65 years and above), and that multiple components of MetS are observed within the same population, we analyzed the concurrent impact of all MetS components on CRC. Log-binomial regression models were implemented to assess the risk of CRC due to MetS components after adjusting other risk factors. Conclusions: We identified specific components that markedly increased CRC risk, suggesting that individuals with these components should be prioritized for early screening. These findings could significantly influence early CRC screening protocols, with the ultimate aim to reduce mortality associated with the disease.

Discovery of novel MLK4 inhibitors against colorectal cancer through computational approaches

Colorectal cancer (CRC) is a significant health issue globally, affecting approximately 10 % of the world's population. The prevalence of CRC highlights the need for effective treatments and prevention strategies. The current therapeutic option, such as chemotherapy, has significant side effects. Thus, this study investigated the anticancer properties of Sanguinarine derivatives, an alkaloid found in traditional herbs via chemoinformatic approaches. Six Sanguinarine derivatives were discovered through virtual screening and molecular docking to determine their binding affinities against the mixed lineage kinase (MLK4) protein which is responsible for CRC. All the compounds were found to be more effective than standard drug used for colorectal cancer treatment, with Sanguinarine derivative 11 showing the highest affinity. The stability of the drug was confirmed through molecular dynamics simulations at 500 ns. This suggests that compound 11 has a higher chance of replacing 5-Fluorouracil, which is currently a widely used chemotherapy drug. Before molecular dynamics simulations, the pharmacokinetic and chemical properties of Sanguinarine derivatives were determined using pkCSM server and DFT method, respectively. The results support that compound 11 is a good drug candidate, as evidenced by Lipinski's Rule of Five. Therefore, compound 11 is recommended for further analysis via in vivo and in vitro studies to confirm its efficacy and safety.

Colorectal cancer prevalence in faecal immunochemical test non-returners: potential for health inequality in symptomatic referral pathways.

This study aimed to describe the faecal immunochemical test non-return rate of those referred with high-risk symptoms of colorectal cancer from primary care, and the clinical outcomes of the 'non-returners'. From January 2019 to July 2021, patients referred to secondary care with symptoms suspicious of colorectal cancer and a referral priority of urgent or urgent suspicion of cancer were sent a faecal immunochemical test. All patients were investigated regardless of faecal immunochemical test return or result. Demographics and clinical outcomes such as colorectal cancer prevalence were compared between those who returned a faecal immunochemical test and non-returners. Of 7345 patients included in the study, 874 (11.9%) did not return a faecal immunochemical test. Non-returner characteristics included male sex (P = 0.040), younger age (median age 57 versus 65 years, P < 0.001), per rectal bleeding (P < 0.001) and lower socioeconomic status (median Scottish Index of Multiple Deprivation, 6 versus 7, P < 0.001) compared with those who returned a faecal immunochemical test. Of 6294 patients undergoing colorectal investigation, there was a greater prevalence of colorectal cancer (5.4% versus 3.6% P = 0.032) and significant bowel pathology than in the non-returners (15.3% versus 9.8%, P < 0.001). With a median follow-up of 25 months, the colorectal cancer prevalence for the entire 7345 cohort was equal between those who returned and did not return a faecal immunochemical test (3.2% versus 3.8%, P = 0.108). Of note, the non-returners diagnosed with colorectal cancer were younger (median age 64 versus 73 years, P < 0.001) and from a lower socioeconomic area (median Scottish Index of Multiple Deprivation 4 versus 7, P = 0.015) than faecal immunochemical test returners. Patients referred to secondary care, with symptoms suspicious of colorectal cancer, that did not return a faecal immunochemical test had a similar colorectal cancer prevalence to those that returned the test.

Association Between Vitamin Intake and Colorectal Cancer: Evidence from NHANES Data.

This study aims to investigate the associations between vitamins and colorectal cancer (CRC) based on a national sample of US adults. A total of 6200 samples were collected from the National Health and Nutrition Examination Survey to explore the relationship between vitamins (specifically, A, C, and D) and CRC. Logistic regression models were employed to assess the associations between dietary vitamin intake and CRC. Our findings indicate a negative association between vitamin C intake and CRC. However, the associations of vitamin A and vitamin D with CRC were not statistically significant. For vitamin C, compared to the first tertile, the odds ratios (ORs) and 95% confidence intervals (CIs) were 0.91 (0.76-0.97) for the second tertile and 0.81 (0.64-0.95) for the third tertile (P < 0.01). Conversely, for vitamin A, compared to the first tertile, the odds ratios (ORs) and 95% confidence intervals (CIs) were 1.02 (0.82-1.22) for the second tertile and 1.04 (0.75-1.25) for the third tertile (P < 0.01). For vitamin D, compared to the first tertile, the odds ratios (ORs) and 95% confidence intervals (CIs) were 0.96 (0.84-1.06) for the second tertile and 1.01 (0.83-1.15) for the third tertile (P < 0.01). Additionally, the negative association between vitamin C and CRC was more pronounced among females (0.76, 0.67-0.92), individuals aged 60 and above (0.75, 0.69-0.95), and those with a BMI > 30 (0.78, 0.67-0.93). Our findings suggest that higher vitamin C intake is associated with a reduced prevalence of CRC. However, further large-scale prospective cohort studies are warranted to validate our results.

Pattern of Colorectal Cancer in Karbala Province of Iraq: Data from Developing Country

Background: Globally, there are differences in the prevalence of colorectal cancer (CRC) depending on environmental and demographic factors. Objective: Our study’s objective was to analyze the CRC pattern in the Iraqi province of Karbala, comparing and identifying probable variations with another people. Methods: In Iraq, at the Al-Hussein Cancer Center in Karbala, retrospective descriptive research was conducted on 524 patients who diagnosed with CRC from January 2012 to December 2020. Results: The incidence rate of CRC increased from 3.83 per 100,000 in 2012 to 5.69 per 100,000 in 2020. Among our patients, median age was 55 years. The proportion of males was (54.96%) while the proportion of females was (45.04%) with a M:F ratio of (1.22:1). The most affected anatomical site was colon in (64.89%) and adenocarcinoma was the most frequent histopathology in (67.18%). Unfortunately, more than 46% of cases presented as stage III &amp; IV. Conclusion: This statistical analysis of CRC could be a fundamental knowledge source to analyze epidemiological pattern, to assess development in the last few years and to improve treatment plans.

Role of androgen receptor expression in the metastatic potential of colorectal carcinoma

Background The prevalence of colorectal cancer (CRC) is widespread and associated with significant morbidity and deaths. In CRC, hormone receptors, such as androgen receptors (AR), are pathologically modified. Additional research is required to understand better its function and predictive and therapeutic value in CRC metastatic potential. Objective To assess the AR status in CRC primary tumors and metastatic lymph nodes. Methods Tissue microarray and immunohistochemical techniques were applied to 75 CRC cases with lymph node (LN) metastases. We correlate the results with all relevant clinicopathological indicators of prognostic relevance. Results and conclusion Out of the 75 cases that were analyzed, 16% of CRC primaries and 12% of LN metastases had nuclear AR that was focally positive. AR expression was significantly correlated with advanced age, conventional non-mucinous histology, lower grade, and arousal on top of adenoma. A deeper invasion was likewise linked to AR expression; however, this association was not statistically significant. AR expression has a positive prognostic influence since the median overall and disease-free survival of cases with positive AR expression in either primary carcinomas or LN metastases were significantly higher than that of cases with negative expression in both primary and LN metastases. We assume that AR expression in CRC has a positive prognostic influence.

Textbook Outcome in Colorectal Surgery for Cancer: An Italian Version.

Background/Objectives: The textbook outcome (TO) is a composite tool introduced to uniform surgical units and regulate surgical quality and outcomes. A patient is considered TO only if all predetermined items are met. In colorectal surgery, TO represents a new tool that can achieve important results given the prevalence of colorectal cancers. However, at present, there is a lack of uniformity in the TO's definition. This study utilized the Delphi process to define an Italian version of the TO in colorectal cancer. Methods: The survey consisted of two rounds of online questionnaires submitted to an expert panel in colorectal oncological surgery, renowned academic surgeons, who had attended multiple scientific conferences and who were authors of papers on this specific topic. Five main topics with 26 questions were investigated through an online modified Delphi method. Items with almost 75% agreement achieved consensus. Results: Twenty-eight Italian experts were selected and participated in the two rounds. The Italian version of the textbook outcome in colorectal surgery was defined as the presence of 90-day postoperative survival, negative margins and at least 12 lymph nodes, a minimally invasive approach, ostomy fashioning if preoperatively planned, postoperative complication < Clavien-Dindo 3b, at least 10 ERAS items, no readmission, proper CHT and RT regimens, complete colonoscopy after or before surgery and Tumor Board Evaluation. Conclusions: The textbook outcome in colorectal cancer patients is a quality instrument providing a complete overview of the care of such patients, from diagnosis to treatment. We hereby propose an Italian version of the TO with outcomes chosen by an expert panel.

A systematic review of the economic burden of colorectal cancer.

Colorectal cancer is the third most common cancer in the Western Hemisphere. It is the third most common cancer in men after prostate and lung cancers and the second most common cancer in women after breast cancer. According to some studies, the incidence and prevalence of colorectal cancer is increasing rapidly. In the present study, a systematic review of the articles related to the economic burden of colorectal cancer was carried out. The articles were taken from the following databases: SID, Medline/Pubmed, Embase, Scopus, Web of Science, NHS Economic Evaluation Database (EED), Econlit, and Google Scholar. Furthermore, the PICOTS model was used to select the inclusion criteria. The quality of the articles' methodologies was evaluated using Drummond's checklist. Then, some data were extracted from relevant articles, in terms of year, place of research, sample size, costing approach, type of measured costs, average direct medical costs, average direct nonmedical costs, and average indirect costs. The data from 37 studies dealing with the costs of patients with colorectal cancer were extracted. Most of the studies were conducted in the United States, and the social perspective was the most common perspective to measure the costs. According to the majority of the studies, direct medical costs were considered the greatest driver in causing the economic burden of colorectal cancer. The costs of hospitalization, medicine, surgery, chemotherapy, and radiotherapy accounted for the largest share of direct medical costs, and the costs of transportation, accommodation, and home care were the greatest share of direct nonmedical costs. Furthermore, the costs associated with disability, absenteeism, and premature death were identified as the main drivers of indirect costs. The findings of this study showed that colorectal cancer imposes great direct and indirect costs on families, the health system, and society. The best way to deal with this disease and, hence, to reduce its economic burden is to take comprehensive preventive measures and modify the lifestyle. In addition, health policymakers can limit the costs of this disease by expanding the screening program.

Adherence to the Mediterranean diet and its protective effects against colorectal cancer: a meta-analysis of 26 studies with 2,217,404 participants.

Colorectal cancer (CRC) is a major global health concern and represents a significant public health challenge in Hungary, where it exhibits some of the highest morbidity and mortality rates in the European Union. The Mediterranean diet has been suggested to reduce the incidence of CRC, but comprehensive evidence from diverse study designs is needed to substantiate this effect. A systematic literature search was conducted in PubMed, ClinicalTrials.gov, CENTRAL, and the Web of Science to identify randomized controlled trials and human clinical trials from 2008 to 2024 to identify relevant studies. Statistical analysis was performed using the https://metaanalysisonline.com web application using a random effects model to estimate the pooled hazard rates (HRs). Forest plots, funnel plots, and Z-score plots were utilized to visualize results. We identified 15 clinical trials and 9 case-control studies, encompassing a total of 2,217,404 subjects. The pooled analysis indicated that adherence to the Mediterranean diet significantly reduced the prevalence of CRC (HR = 0.84, 95% CI = 0.78-0.91, p < 0.01). This protective effect was consistent across sexes, with HRs of 0.85 (95% CI = 0.75-0.97, p = 0.01) for males and 0.88 (95% CI = 0.79-0.99, p = 0.03) for females. Case-control studies specifically showed a substantial effect (HR = 0.51, 95% CI = 0.38-0.68, p < 0.01). Notable heterogeneity was observed across studies, yet the a priori information size was substantially below the cumulative sample size, ensuring sufficient data for reliable conclusions.The findings from this meta-analysis reinforce the protective role of the Mediterranean diet against CRC. The results of this meta-analysis will inform dietary interventions designed to mitigate CRC risk, which are conducted within the framework of the Semmelweis Study, an ongoing comprehensive cohort study at Semmelweis University, designed to explore the multifaceted causes of unhealthy aging in Hungary. These interventions aim to explore the practical application of Mediterranean dietary patterns in reducing CRC incidence among the Hungarian population.

Efficient colorectal polyp segmentation using wavelet transformation and AdaptUNet: A hybrid U-Net

The prevalence of colorectal cancer, primarily emerging from polyps, underscores the importance of their early detection in colonoscopy images. Due to the inherent complexity and variability of polyp appearances, the task stands difficult despite recent advances in medical technology. To tackle these challenges, a deep learning model featuring a customized U-Net architecture, AdaptUNet is proposed. Attention mechanisms and skip connections facilitate the effective combination of low-level details and high-level contextual information for accurate polyp segmentation. Further, wavelet transformations are used to extract useful features overlooked in conventional image processing. The model achieves benchmark results with a Dice coefficient of 0.9104, an Intersection over Union (IoU) coefficient of 0.8368, and a Balanced Accuracy of 0.9880 on the CVC-300 dataset. Additionally, it shows exceptional performance on other datasets, including Kvasir-SEG and Etis-LaribDB. Training was performed using the Hyper Kvasir segmented images dataset, further evidencing the model's ability to handle diverse data inputs. The proposed method offers a comprehensive and efficient implementation for polyp detection without compromising performance, thus promising an improved precision and reduction in manual labour for colorectal polyp detection.

Link between irritable bowel syndrome, depression, and colorectal cancer risk in young patients: Age-matched nationwide population-based study.

There exists a link between irritable bowel syndrome (IBS) and depression. Similarly, chronic depression is known to increase the risk of cancer in general. In this population-based analysis, we investigated the prevalence and the odds of colorectal cancer (CRC) in young-depressed patients with IBS. To investigate the relationship between IBS and CRC in young, depressed patients using a nationally representative United States inpatient sample. The 2019 National Inpatient Sample was used to identify young (18-44 years) patients admitted with comorbid depression in the presence vs absence of IBS using relevant International Classification of Diseases, Tenth Revision, Clinical Modification codes. Primary endpoint was the prevalence and odds of CRC in age matched (1:1) young-depressed cohort hospitalized with IBS (IBS+) vs without IBS (IBS-). Multivariable regression analysis was performed adjusting for potential confounders. Age-matched (1:1) young-depressed IBS+ (83.9% females, median age 36 years) and IBS- (65.8% females, median age 36 years) cohorts consisted of 14370 patients in each group. IBS+ cohort had higher rates of hypertension, uncomplicated diabetes, hyperlipidemia, obesity, peripheral vascular disease, chronic obstructive pulmonary disease, hypothyroidism, prior stroke, prior venous thromboembolism, anxiety, bipolar disorder, and borderline personality disorder (P < 0.005) vs the IBS- cohort. However, prior myocardial infarction, acquired immunodeficiency syndrome, dementia, smoking, alcohol abuse, and drug abuse (P < 0.005) are high in IBS- cohort. The rate of CRC was comparable in both cohorts [IBS+ n = 25 (0.17%) vs IBS- n = 35 (0.24%)]. Compared to the IBS- cohort, the odds ratio (OR) of developing CRC was not significantly higher [OR 0.71, 95% confidence interval (CI) 0.23-2.25)] in IBS+ cohort. Also, adjusting for baseline sociodemographic and hospital characteristics and relevant comorbidities, the OR was found to be non-significant (OR 0.89, 95%CI 0.21-3.83). This nationwide propensity-matched analysis revealed comparable prevalence and risk of CRC in young-depressed patients with vs without IBS. Future large-scale prospective studies are needed to evaluate the long-term effects of depression and its treatment on CRC risk and outcomes in IBS patients.

Molecular Spectrum of K-RAS Mutations in Colorectal Cancer Patients in Peshawar, Pakistan

Background: The global incidence of colorectal cancer (CRC) has surged, presenting a significant health challenge with an annual occurrence of 1.7 million cases. The American Cancer Society reports that KRAS and BRAF mutations contribute to 20-50% of CRC cases. This study addresses the gap in data on KRAS mutations in CRC patients in Peshawar, Pakistan. Objective: To determine the prevalence and types of KRAS mutations in colorectal cancer patients in Peshawar, Pakistan. Methods: This retrospective, cross-sectional study was conducted at the Nuclear Medicine, Oncology, and Radiotherapy Institute (NORI) Hospital in Islamabad from April to November 2022. DNA was extracted from formalin-fixed, paraffin-embedded tissue blocks of 58 CRC patients, regardless of age and gender, following informed verbal consent. KRAS mutation testing was performed using the Cobas Z480 Real-time thermal cycler. Results: Among the 58 CRC patients, 34 (58.6%) were females, and 24 (41.4%) were males. The highest CRC incidence (36.2%) was observed in the 11-25 years age group. KRAS mutations at codons 12 and 13 were found in 18% of cases, with all isolates carrying the G12D mutation. Kaplan-Meier analysis revealed a lower survival probability for patients with codon 12 mutations compared to those with codon 13 mutations. Conclusion: The study highlights the need for broader research on KRAS mutations across diverse ethnicities and geographical regions in Pakistan to better understand CRC prevalence and improve patient outcomes.

Exploring the Association between Benign Anorectal Conditions and Colorectal Cancer from the Analysis of Lower Gastrointestinal Endoscopies

Abstract Objective Patients experiencing hemorrhoids or fissures may overlook other gastrointestinal (GI) symptoms, assuming that they are linked solely to their existing condition. However, colon cancer, often asymptomatic, can coincide with benign pathologies detected during colonoscopy. This study investigates the prevalence of colorectal cancer (CRC) in patients undergoing lower GI endoscopy for hemorrhoids and elucidates the correlation between cancer and benign pathologies identified during colonoscopy. Highlighting its potential to reveal hidden cancers emphasizes the critical role of colonoscopy in comprehensive health care. Methods The primary objective was to thoroughly investigate the prevalence of CRC in patients who underwent lower GI endoscopy for hemorrhoids. A comprehensive analysis was conducted using a dataset spanning 7 years of lower GI endoscopy. The main focus of this investigation was to determine the incidence of cancer. Additionally, a meticulous examination of accompanying benign diagnoses was performed to provide a comprehensive evaluation. Results The study cohort, comprising 6,268 patients, revealed a noteworthy coexistence of malignancies with common conditions. The revelation was of paramount significance that the total number of malignant cases within this cohort was 440. Polyps emerged as the most frequently observed condition, constituting 55.2% (n = 243) of the cases. Diverticulosis was present in 6.6% (n: 29) of cases, while ulcerative colitis was detected in 8% (n: 2) of cases. Hemorrhoids were identified in 20.7% (n: 91) of cases. The findings indicated a substantial association between these common conditions and malignancy. Specifically, it was discovered that approximately 1 in 22 individuals with hemorrhoids, 1 in 52 individuals with fissures, and 1 in 5.7 individuals with polyps were diagnosed with malignancy. Conclusion This study highlights the pivotal role of colonoscopy in uncovering hidden cancers, especially in patients with hemorrhoids. The findings emphasize the significance of doctors and patients prioritizing colonoscopy, as it allows for early detection and intervention for potential malignancies, even in the presence of hemorrhoids.

Integrative analyses of multi-omics data constructing tumor microenvironment and immune-related molecular prognosis model in human colorectal cancer

The increasing prevalence and incidence of colorectal cancer (CRC), particularly in young adults, underscore the imperative to comprehend its fundamental mechanisms, discover novel diagnostic and prognostic markers, and enhance therapeutic strategies. Here, we integrated multi-omics data, including gene expression, somatic mutation data and DNA methylation data, to unravel the intricacies of tumor microenvironment (TME) in CRC and search for novel prognostic markers. By calculating the immune score for each patient from the expression profile, we delineated the differential immune cell fraction, constructed an immune-related multi-omics atlas, and identified molecular characteristics. The entire colorectal dataset (n = 343) was randomly divided into training (n = 249) and testing datasets (n = 94). We screened 144 immune-related genes, 6 mutant genes, and 38 methylation probes associated with overall survival (OS). These makers were then incorporated into a 10-gene prognostic model using Lasso and Cox regression in the training dataset, and the model's performance was evaluated in an independent validation dataset. The model exhibited satisfactory results (average concordance index [C-index] = 0.77), with the average 1-year, 3-year, and 5-year AUCs being 0.79, 0.76, and 0.76 in the training dataset and 0.74, 0.80, and 0.90 in the testing dataset. Furthermore, the prognostic model demonstrated applicability in guiding chemotherapy for CRC patients and exhibited a degree of pan-cancer utility in risk stratification. In conclusion, our integrated analysis of multi-omics data revealed immune-related genetic and epigenetic characteristics of the TME. We propose an integrative prognostic model that can stratify risk and guide chemotherapy for CRC patients. The generalizability of the model in risk stratification across different cancer types was validated in Pan-Cancer cohort.

The impact of COVID-19 and missed diagnosis of colorectal cancer.

e15598 Background: To evaluate the impact of COVID-19 pandemic on colorectal cancer diagnosis based on sex, age, race, and regions within the US. Methods: Data on colorectal cancer incidence were obtained from the United States Cancer Statistics (USCS) program from 2001-2020. SEER*Stat 8.4.1.2 and Joinpoint regression program 5.0.2 were used to calculate estimated and actual incidence rates per 100,000 adults. Rates were age-adjusted as appropriate. We compared actual colorectal cancer incidence rates in the year 2020 to estimated rates based on trends from 2001-2019 with sub-analyses for sex, age, race, and region. Results: From 2001 to 2019, there were 2,627,565 identified cases of colorectal cancer in the United States. In 2019, prior to the pandemic, the incidence rate of colorectal cancer was the highest in males at 42.26 per 100,000 compared to 32.18 in females. The overall cancer incidence was 36.87 per 100,000 in both males and females in the US. Based on the data from 2001 to 2019, colorectal cancer decreased by 2.20% per year (p &lt; 0.001). Using these prior trends, it was expected that the incidence of colorectal cancer to be 36.44 per 100,000 adults (115,392 total cases) in 2020. However, the reported incidence was only 32.47 per 100,000 (102,798). Thus, there were 10.9% (12,594) less colorectal cancer cases than expected. The missed diagnosis rate was more pronounced in males compared to females, where 11.90% and 10.84% less colorectal cancer cases were detected compared to expected in 2020, respectively. Based on age, the cases missed were the highest amongst middle aged adults, with 13.56%, 13.49%, and 13.05% cases missed for the age groups between 50-54, 65-69, and 70-74 respectively. Based on racial and ethnic groups, we found that Non-Hispanic Asians and Pacific Islander (NHAPI) had the greatest number of missed cases at 14.38% compared to 11.98%, 11.36%, and 11.27% of Non-Hispanic Black (NHB), Non-Hispanic White (NHW), and Hispanic adults, respectively. The discrepancy between expected and actual number of cases by U.S. region ranged from the highest in the Southern (11.64%) to the lowest in the Western (10.92%) region. An intersectionality analysis showed that 40–44-year-old NHAPI females residing in the Western region had the largest discrepancy at 47.96%. Conclusions: The reported colorectal cancer cases significantly declined during the pandemic. Males, middle age, NHAPI and NHB race and ethnicity, and those residing in the Southern region had the most number of missing cases. Due to the widespread prevalence of colorectal cancers, more mitigating factors are needed to improve the access to care for patients in these at-risk groups to improve diagnosis and detection of colorectal cancer and its associated mortality.