Prevalence Of Colorectal Cancer Research Articles

Histopathological Outcome of Colonoscopic Biopsies in a Tertiary Hospital in Southwestern Nigeria: A 7-Year Retrospective Study.

Colonoscopy with histopathological analysis of mucosal biopsy samples remains the gold standard procedure for diagnosing lower gastrointestinal disorders. This study aimed to determine the pattern of histopathological findings of mucosal biopsies obtained at colonoscopy over a 7-year period and to correlate the histological findings with the clinical profile of the patients. This was a retrospective study conducted in a healthcare facility in southwestern Nigeria. The Histology reports from January 1, 2016, to December 31, 2022, were retrieved from the histopathology department of the institution to obtain the following information for analysis: age, gender, year of the test, presenting complaint, provisional clinical diagnosis, colonoscopy diagnosis, and histological diagnosis. The data of a total number of 81 patients were analyzed; 51 males (63.0%) and 30 females (37.0%) with a male-to-female ratio of 1.7-1. The age range of the patients was 30-86 years with a mean (±standard deviations) age of 59.87 ± 14.44. The most common indication for colonoscopy was hematochezia (23 (28.4%)) followed by change in bowel habit (16 [19.8%]), constipation (11 [13.6%]), and tenesmus (10 [12.3%]). Large bowel masses suggestive of cancers were the most common colonoscopy finding in the study subjects (36 [44.4%]). Colorectal cancer was the most common histologic abnormality in the study subjects (26 [32.1%]) followed by chronic nonspecific colitis (8 [9.9%]), polyps (7 [8.6%]), adenomas (5 [6.2%]) and acute on chronic colitis (5 [6.2%]). Twenty-two (27.2%) patients had normal histologic findings. Patients aged between 45 and 64 years had the highest prevalence of colorectal cancer (13 [50.0%]). Colorectal cancer was the most common histopathological finding in this study and the patients were mostly within the middle-age group. Early screening colonoscopy is therefore recommended and histopathological analysis of the mucosal specimens obtained is essential for early detection of premalignant lesions.

Incorporating faecal haemoglobin measurement using the faecal immunochemical test (FIT) in the referral, triage and prioritisation pathway for patients with colorectal symptoms.

To derive a colorectal symptom pathway incorporating standard clinical and FIT data to guide referral, triage, and prioritisation of cases in New Zealand. Diagnostic accuracy of FIT to rule out colorectal cancer (CRC) was determined by meta-analysis. Thereafter, the risk of CRC after FIT was estimated for common clinical presentations by Bayesian methodology, using a specifically collated retrospective cohort of symptomatic cases. A symptom/FIT pathway was developed iteratively following multi-disciplinary engagement. Eighteen studies were included in meta-analysis. The sensitivity and specificity for CRC were 89.0% (95%CI 87.0-90.9%) and 80.1% (95%CI 77.7-82.4%) respectively, at a FHb threshold of >10mcg haemoglobin per gram stool, and 95.7% (95%CI 93.2-97.7%) and 60.5% (95%CI 53.8-67.0%) respectively, at the limit of detection. The final pathway was 97% sensitive for CRC, compared with 90% for the current direct access criteria, and requires 47% fewer colonoscopies. Estimated prevalence of CRC among those declined investigation was 0.23%. Incorporating FIT in the new patient symptomatic pathway as presented appears feasible, safe, and allows for resources to be targeted to those at greatest risk of disease. Further work is needed to ensure equity for Māori if this pathway were introduced nationally.

Genetic variants of MUC4 are associated with susceptibility to and mortality of colorectal cancer and exhibit synergistic effects with LDL-C levels.

As a disease with high mortality and prevalence rates worldwide, colorectal cancer (CRC) has been thoroughly investigated. Mucins are involved in the induction of CRC and the regulation of intestinal homeostasis but a member of the mucin gene family MUC4 has a controversial role in CRC. MUC4 has been associated with either decreased susceptibility to or a worse prognosis of CRC. In our study, the multifunctional aspects of MUC4 were elucidated by genetic polymorphism analysis in a case-control study of 420 controls and 464 CRC patients. MUC4 rs1104760 A>G polymorphism had a protective effect on CRC risk (AG, AOR = 0.537; GG, AOR = 0.297; dominant model, AOR = 0.493; recessive model, AOR = 0.382) and MUC4 rs2688513 A>G was associated with an increased mortality rate of CRC (5 years, GG, adjusted HR = 6.496; recessive model, adjusted HR = 5.848). In addition, MUC4 rs1104760 A>G showed a high probability of being a potential biomarker for CRC patients with low-density lipoprotein cholesterol (LDL-C) in the risk range while showing a significant synergistic effect with the LDL-C level. This is the first study to indicate a significant association between MUC4 genetic polymorphisms and CRC prevalence, suggesting a functional genetic variant with the LDL-C level, for CRC prevention.

The clinicopathological spectrum and treatment outcomes in metastatic colorectal cancer in the KwaZulu-Natal province of South Africa.

In high-income countries (HICs) 17-20% of colorectal cancer (CRC) patients have metastatic CRC (mCRC) at the time of diagnosis, of which 10-25% are or become resectable, and a further 4-11% of patients will develop metachronous metastases. The study aimed to establish the prevalence and pattern of metastatic CRC to document treatment outcomes in KwaZulu-Natal (KZN), and to compare results to international norms. The study population comprised patients with mCRC presenting between 2000 and 2019. Demographics, primary tumour site, spectrum of metastatic disease and resection rate were assessed. MCRC occurred in 33% of the CRC patient population. Eight hundred and thirty-six patients had metastatic disease, comprising Africans (325, 38.8%), Indians (312, 37.3%), Coloureds (37, 4.4%) and Whites (161, 19.2%). Six hundred and fifty-four patients (79%) had synchronous metastases and 182 patients had metachronous metastases (21%). Single organ metastases occurred in 596 patients (71.2%) (M1A) and multiple organ metastasis occurred in 240 patients (28.7%) (M1B). Metastases occurred in the liver (613), lung (240) and peritoneum (85). Fifty-two patients (6.2%) underwent resection of their metastases. The prevalence of stage IV CRC in our setting is at the upper limit of international norms. mCRC occurred in 33%, with similar proportions in all races. Resection rate for metastases is low.

Zearalenone attenuates colitis associated colorectal tumorigenesis through Ras/Raf/ERK pathway suppression and SCFA-producing bacteria promotion

The high prevalence of colorectal cancer (CRC) and its leading death causing rate have placed a considerable burden on patients and healthcare providers. There is a need for a therapy that has fewer adverse effects and greater efficiency. Zearalenone (ZEA), an estrogenic mycotoxin, has been demonstrated to exert apoptotic properties when administrated in higher doses. However, it is unclear whether such apoptotic effect remains valid in an in vivo setting. The current study aimed to investigate the effect of ZEA on CRC and its underlying mechanisms in the azoxymethane/ dextran sodium sulfate (AOM/DSS) model. Our results revealed that ZEA significantly lowered the total number of tumours, colon weight, colonic crypt depth, collagen fibrosis and spleen weight. ZEA suppressed Ras/Raf/ERK/cyclin D1 pathway, increasing the expression of apoptosis parker, cleaved caspase 3, while decreasing the expression of proliferative marker, Ki67 and cyclin D1. The gut microbiota composition in ZEA group showed higher stability and lower vulnerability in the microbial community when compared to AOM/DSS group. ZEA increased the abundance of short chain fatty acids (SCFAs) producing bacteria unidentified Ruminococcaceae, Parabacteroidies and Blautia, as well as the faecal acetate content. Notably, unidentified Ruminococcaceae and Parabacteroidies were substantially correlated with the decrease in tumour count. Overall, ZEA demonstrated a promising inhibitory effect on colorectal tumorigenesis and exhibited the potential for further development as a CRC treatment.

POINT PREVALENCE OF COLORECTAL CANCER IN A MEGA CITY OF PAKISTAN, KARACHI – A CROSS SECTIONAL STUDY

Background and Objective: Globally, Colorectal Cancers are also third most common cancers and fourth leading cause of death due to carcinoma. Burden of Colorectal Cancers is also high in Pakistan. The main risk factor for Colorectal Cancer is age, however, other risk factors are e.g. family history, irritable bowel disease, sedentary life-style, high visceral adipose tissues, smoking and alcohol. Hence; the main objective of current study was to determine point prevalence of Colorectal Cancers in a mega city of Pakistan, Karachi; a representative population of Pakistan. It is hypothesized that incidences of Colorectal Cancers would be higher in Karachi than rest of the country. Materials and Methods: The retrospective cross-sectional study was conducted in Karachi. Duration of study was from January-2015 to October-2019. Data has been collected from two state-owned and four private hospitals of Karachi. Precision analysis technique was used to determine the sample size of study. Study is approved by Board of Advanced Studies & Research, University of Karachi (Reference Number: BASR/01046/Pharm.). Objective of study was explained to patients before initiation the study; informed consent was taken from each patient. S.P.S.S (Statistical-Package-for-Social-Sciences) software version 22 was used to analyze the data. Results: Among 1,617 patients: male 54.35% (N=879); female 45.64% (N=738). Mean age of diagnosis of colorectal cancer: male 49.51±14.72 years; female 45.28±13.52 years. Significantly higher point prevalence was found in ethnicity speaking Sindhi compared with ethnicity speaking Balochi (p=0.001), Pashto (p=0.0001), Punjabi (p=0.001) and Siraiki (p=0.0001); Urdu speaking compared with Balochi speaking (p=0.0001), Pashto speaking (p=0.0001), Punjabi speaking (p=0.0001) and Siraiki speaking (p=0.0001) in male. In female; Sindhi speaking point prevalence is significantly higher than Siraiki speaking (p=0.028); Urdu speaking point prevalence is significantly higher than patients speaking Balochi (p=0.012), Pashto (p=0.002), Punjabi (p=0.002) and Siraiki (p=0.0001). Conclusion: Allocation of resources are required at governmental and non-governmental level for early screening. National cancer registry program should also be initiated to support health policy makers for the development of counter strategies. Peer Review History: Received: 26 February 2023; Revised: 13 March; Accepted: 27 April 2023, Available online: 15 May 2023 Academic Editor: Prof. Cyprian Ogbonna ONYEJI, Obafemi Awolowo University, Ile-Ife, Nigeria, conyeji@oauife.edu.ng Received file: Reviewer's Comments: Average Peer review marks at initial stage: 5.5/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. Bilge Ahsen KARA, Ankara Gazi Mustafa Kemal Hospital, Turkey, ahsndkyc@gmail.com Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, amaka_mgbahurike@yahoo.com

Effects of prebiotic supplement on gut microbiota, drug bioavailability, and adverse effects in patients with colorectal cancer at different primary tumor locations receiving chemotherapy: study protocol for a randomized clinical trial

BackgroundThe prevalence of colorectal cancer (CRC) worldwide is a huge challenge to human health. Primary tumor locations found to impact prognosis and response to therapy. The important role of gut microbiota in the progression and treatment of CRC has led to many attempts of alleviating chemotherapy-induced adverse effects using microecologics. However, the underlying mechanism of the difference in the prognosis of different primary tumor locations and the synergistic effect of prebiotics on chemotherapy need to be further elucidated. This study aims to explore the differences in tumor microbiota and examine the effectiveness of xylooligosaccharides (XOS) on gut microbiota, adverse effects, and bioavailability of chemotherapy drugs in CRC patients at different primary tumor locations.MethodsThis is a double-blinded, randomized, parallel controlled clinical trial. Participants with left-sided CRC (LSCRC, n = 50) and right-sided CC (RSCC, n = 50) will randomly allocated to prebiotic group (n = 25) or control group (n = 25) and will receive either a daily XOS (3 g/day) or placebo, respectively, for 12 weeks. The primary outcomes will be the differences in the mucosa microbiota composition at different tumor locations and differences in gut microbiota composition, adverse effects, and blood concentration of capecitabine posttreatment. The secondary outcomes will include other blood indicators, short-chain fatty acids (SCFAs) concentration, quality of life, and mental health.DiscussionThis study will reveal the potential benefits of prebiotic for improving the gut microbiota composition, alleviating the adverse effects, and improving the efficacy of chemotherapy in patients with CRC. In addition, this study will provide data on the different distribution of tumor microbiota and the different changes of gut microbiota during treatment in LSCRC and RSCC, which may provide novel insights into personalized cancer treatment strategies based on primary tumor locations and gut microbiota in the future.Trial registrationChinese Clinical Trial Registry (www.chictr.org.cn): ChiCTR2100046237. Registered on 12 May 2021.

Prevalence of colorectal cancer in 2020: a comparative analysis between China and the world

Objective: To demonstrate the disease burden and epidemiological characteristics of colorectal cancer in different regions by analyzing the incidence and mortality data in China and worldwide in 2020. Methods: Estimation of the incidence and mortality data of colorectal cancer were obtained from the GLOBOCAN 2020 database. The incidence, death, age standardized incidence rate (ASIR) and age standardized mortality rate (ASMR) of colorectal cancer in China and 20 regions in the world were compared. The correlation between the Human Development Index (HDI) and ASIR/ASMR was analyzed. Results: In 2020, the number of new cases of colorectal cancer in the world reached 1 931 600, and the number of deaths reached 935 200. The incidence and mortality in all regions of the world continued to rise in the age group above 50 years old. The morbidity and mortality in male were higher than those in female. East Asia ranked the highest number of incidence cases and deaths in the world, which were 740 000 and 360 100 respectively. There were significant differences in incidence and mortality among regions in the world. The highest ASIR and ASMR were observed in Northern Europe (33.61/100 000) and Eastern Europe (14.53/100 000), whereas the lowest ASIR and ASMR were both observed in South-Central Asia (5.46/100 000 and 3.16/100 000). HDI had significant exponential relationship with ASIR (r(2)=0.59, P<0.001) and ASMR (r(2)=0.38, P<0.001). There were 555 500 new cases and 286 200 death cases of colorectal cancer in China, accounting for about 30% of the world and more than 75% of East Asia. The ASIR of China was 24.07/100 000, ranking at the medium level, while the ASMR was 12.07/100 000, ranking at the high level of world. Conclusion: The incidence and mortality of colorectal cancer are highly correlated with HDI. China is one of the countries with the heaviest disease burden of colorectal cancer in the world.

Медико-географический анализ заболеваемости колоректальным раком

The article discusses the issues of territorial prevalence of colorectal cancer in Saratov. A statistical analysis of morbidity and an oncogeographical analysis of urban landscape sites were carried out. The study of the regional features of the spread of this pathology, taking into account risk factors, will help in the development of the direction for the active search for patients.

Knowledge of Colorectal Cancer Among Syrians: A Cross-Sectional Study

Background: The incidence of colorectal cancer is the second highest among women and the third highest among males. Screening for the disease has resulted in a significant decrease in both the prevalence and death rate of colorectal cancer (CRC) during the last two decades. Research has indicated that people unaware of the dangers of colorectal cancer may not participate in diagnostic procedures, which delays detection and reduces the likelihood of survival. Aim: This cross-sectional research seeks to examine the level of knowledge of CRC risk factors in Syria and the variables correlated with a greater level of awareness. Methods: An online cross-sectional study was conducted from 1 to 25 August 2022 to assess the Syrians' degree of awareness of Colorectal Cancer risk factors in Syria and the characteristics associated with a high level of understanding. The survey is based on another study, and the sample inclusion criteria of study participants were Syrian nationals aged 18 or older from all Syrian governorates. The questionnaire included 35 questions divided into 3 sections, sociodemographic variables such as (age, sex, marital status, educational level, occupation…etc.), evaluation of participant knowledge of colorectal cancer risk factors such as (alcohol consumption, Red meat consumption, lack of fiber in the diet, obesity, and old age), and symptoms such as (blood in stool, abdominal pain, constipation, change in defecation habits, general tiredness, unexplained weight loss). Results: Among 702 Syrian national participants, (n=430, 61.3%) were females, and (n=272, 38.7%) males. Only (n=67, 9.5%) participants have a chronic disease. Most participants have shown good knowledge of colorectal cancer symptoms (n=301, 42.9%), and (n=297, 42.3%) participants have shown moderate knowledge of colorectal cancer symptoms. Only (n=123, 17.6%) participants have shown a good understanding of colorectal cancer risk factors, whereas (n=293, 41.7%) have demonstrated poor knowledge. Educational level was related to greater knowledge of colorectal cancer risk factors (P-value 0.05). No correlation was found between other variables and a good awareness of colorectal cancer symptoms and risk factors (P-value &gt; 0.05). Ph.D. degree of educational level (OR = 15.41, 95% CI: 1.211–196.16; P-value&lt;0.05) was associated with good awareness of colorectal cancer symptoms and Widowers' marital status (OR = 7.351, 95% CI: 1.22–44.285; P-value&lt;0.05) was associated with good awareness of colorectal cancer risk factors. Most participants were somewhat confident in their ability to recognize colorectal cancer symptoms (43.60%), whereas just 4.60 % of people were highly confident in their ability to recognize them. Only (24.10%) The participants were not confident in identifying colorectal cancer symptoms. Conclusion: According to our findings, there is insufficient understanding of the colorectal cancer symptoms and risk factors that contribute to the disease's development in patients and its detection in its late stages. Consequently, there is a greater need to increase colorectal cancer awareness and education programs on the disease's signs and symptoms and its risk factors. It may be possible to minimize the frequency of advanced cases of colorectal cancer by increasing the number of screening programs for colorectal cancer in Syria.

The Consumption of Animal and Plant Foods in Areas of High Prevalence of Stroke and Colorectal Cancer.

Diets of red and processed meat have been reported as important risk factors for developing colorectal cancer. Given the racial and ethnic differences in the incidence of colorectal cancer, patterns of food consumption, and areas of residence, particularly in the South, more data is needed on the relationship between residing in a high stroke area, colorectal cancer incidence levels, and red meat and processed meat consumption. We created online surveys to ascertain meat, red meat, and healthy food consumption levels. We used OLS regression to evaluate the association between residence in Stroke Belt states and colorectal cancer incidence quartiles with food consumption. We further used path analysis using structural equation modeling to evaluate if age, sex, race/ethnicity, income, and comorbidity index mediated the association between residence in the eight-state Stroke Belt, colorectal cancer incidence groups, and meat consumption. Our sample included 923 participants, with 167 (18.1%) residing in the Stroke Belt and 13.9% being in the highest colorectal cancer incidence group. The findings show that residing in a Stroke Belt state is predictive of the consumption of overall meat 0.93 more days per week or red meat 0.55 more days per week compared to those not residing in a Stroke Belt state. These data can be used to develop future diet interventions in these high-risk areas to reduce rates of colorectal cancer and other negative health outcomes.

Posttraumatic growth in colorectal cancer survivors: A systematic review.

The diagnosis of cancer is an adverse event; nevertheless, it can also exert positive changes on survivors, such as posttraumatic growth (PTG). This review aims to integrate researches on PTG in colorectal cancer (CRC) survivors, including manifestations and prevalence of PTG, factors associated with PTG and interventions on PTG. A systematic search was implemented on six databases to identify studies on PTG in CRC survivors published in English or Chinese from October 1995 to May 2022. We also performed a manual search for additional studies from the article reference lists. Thirty-one studies were included. The results were integrated based on the PTG theoretical framework and PTG affective-cognitive processing model. PTG manifests in CRC survivor-caregiver dyads in five domains, including personal growth, appreciation of life, relating to others, new possibilities and spiritual change. Factors correlated with PTG can be integrated into levels of personality, event cognitions, appraisal mechanisms, emotional states, coping and social environmental context. Elements of interventions can be integrated according to the affective-cognitive processing PTG model. Existing interventions are effective in promoting PTG in CRC survivors. We provide a systematic perspective on studies targeting PTG in CRC survivors. PTG manifested in survivor-caregiver dyads. Factors associated with PTG in CRC survivors are significant, and the interventions are effective. An intervention programme based on the affective-cognitive processing model and focused on CRC survivor-caregiver dyads would be significant for the dyads facing cancer.

Prevalence of irritable bowel syndrome and its association with colorectal cancer: a systematic review and meta-analysis.

This study evaluates the risk of colorectal cancer (CRC) in patients with Irritable Bowel Syndrome (IBS). A literature search was performed on MEDLINE, EMBASE, SCOPUS, and Google Scholar from inception to 31st January 2020 without any limitations on article type or language for studies reporting data on CRC on patients with IBS. A meta-analysis was performed to estimate the prevalence of CRC among patients with IBS. Data extraction was according to the PRISMA guidelines. The quality of the included studies was assessed according to the Newcastle Ottawa Scale. Twenty-one articles were eligible for data extraction and quantitative analysis. Of them, 11 were included in the meta-analysis (IBS n=284 366, no-IBS n=8 390 509). The pooled prevalence of CRC in patients with IBS was 0.96% (95% CI-0.184%-2.344%). The prevalence was lowest in the constipation-predominant IBS (pooled prevalence 1.126%. Patients with IBS-D and IBS-U had an equal pooled prevalence of CRC (2.49%). Eleven studies compared the prevalence of CRC in patients with IBS with a control population. The pooled OR was 2.8 (CI 2.305-3.294). There was an increased risk of CRC among patients diagnosed with IBS, primarily in the first year after IBS diagnosis. The review was registered on PROSPERO (CRD42021236707).

Trends of Colorectal Cancer Incidence, Prevalence and Mortality in Worldwide From 1990 to 2017.

Colorectal cancer is a major health problem both in developing and developed countries. This cancer is among the top three commonly diagnosed cancers in males and females. In this context, assessing the Incidence, Prevalence and Mortality Rate trend of this cancer is of great importance. We used the data from the GBD 2017 study to assess the global trend of 3 important indicators of colorectal cancer burden and to examine the relationship between trends of these indicators with Human Development Index (HDI). We used the multivariate mixed effects modeling framework with time and HDI as the covariates. Trend analysis of colorectal cancer burden indicators showed a rather steady trend for mortality rate, while it revealed increasing slopes for both the incidence and prevalence rates. In addition, our findings showed a direct relationship between prevalence and incidence rates of this cancer and HDI level and indirect association between mortality rate and level of HDI. There were significant changes in indicators of colorectal cancer during the study period. The inverse relationship between mortality due to this cancer and socio-economic status of the countries indicated an urgent need for screening the patients and promoting the level of care in countries with lower levels of HDI.

Immunohistochemical Expression Analysis of Caldesmon Isoforms in Colorectal Carcinoma Reveals Interesting Correlations with Tumor Characteristics.

Colorectal cancer is a notorious disease, with almost half of the patients succumbing to the disease. The prevalence and incidence rates of colorectal cancer are increasing in many parts of the world, highlighting the need to discover new biomarkers for diagnosis and therapy. Caldesmon (CaD), an actin-binding protein that plays a significant role in controlling cell motility, has emerged as a promising biomarker. The CALD1 gene encodes CaD as multiple transcripts that mainly encode two protein isoforms: High-molecular-weight (h-CaD), expressed in smooth muscle, and low-molecular-weight (l-CaD), expressed in nonsmooth muscle cells. Most studies have suggested an oncogenic role of CaD in colorectal cancer, but the exact subcellular localization of the two CaD isoforms in tumor cells and stroma have not been clarified yet. Here, we analyzed tissue samples from 262 colorectal cancer patients by immunohistochemistry analysis using specific antibodies for l-CaD and h-CaD. The results showed elevated cytoplasmic expression levels of l-Cad in 187/262 (71.4%) cases. l-Cad was expressed at low levels in the normal colon mucosa and was also consistently expressed in the cancer-associated stroma of all cases, suggesting that it could play a role in modulating the tumor microenvironment. l-CaD expression in cancer cells was associated with preinvasive stages of cancer. Survival analysis indicated that patients with high l-CaD expression in tumor cells could respond poorly to selective chemotherapeutic 5FU, but not combination chemotherapy. h-CaD was expressed in colonic and vascular smooth muscle cells as expected and to a lesser extent in the tumor-associated stroma, but it was not expressed in the cancer cells or normal colon mucosal epithelial cells. Collectively, these data clarify how the expression patterns of CaD isoforms in colorectal cancer can have applications in the management of colorectal cancer patients.

Clinical value of alarm features for colorectal cancer: a meta-analysis.

Colorectal cancer (CRC) is a common neoplasm in Western countries. Prioritizing access to colonoscopy appears of critical relevance. Alarm features are considered to increase the likelihood of CRC. Our aim was to assess the diagnostic performance of alarm features for CRC diagnosis. We performed a systematic review and meta-analysis of studies reporting the diagnostic accuracy of alarm features (rectal bleeding, anemia, change in bowel habit, and weight loss) for CRC, published up to September 2021. Colonoscopy was required as the reference diagnostic test. Diagnostic accuracy measures were pooled by a bivariate mixed-effects regression model. The number needed to scope (NNS; i. e. the number of patients who need to undergo colonoscopy to diagnose one CRC) according to each alarm feature was calculated. 31 studies with 45 100 patients (mean age 31-88 years; men 36 %-63 %) were included. The prevalence of CRC ranged from 0.2 % to 22 %. Sensitivity was suboptimal, ranging from 12.4 % for weight loss to 49 % for rectal bleeding, whereas specificity ranged from 69.8 % for rectal bleeding to 91.9 % for weight loss. Taken individually, rectal bleeding and anemia would be the only practical alarm features mandating colonoscopy (NNS 5.3 and 6.7, respectively). When considered independently, alarm features have variable accuracy for CRC, given the high heterogeneity of study populations reflected by wide variability in CRC prevalence. Rectal bleeding and anemia are the most practical to select patients for colonoscopy. Integration of alarm features in a comprehensive evaluation of patients should be considered.

Colorectal Cancer: A Systematic Review of the Current Situation and Screening in North and Central Asian Countries.

The prevalence of colorectal cancer (CRC) is increasing in the past few decades. A significant proportion of this increase is from low to middle income countries (LMIC). CRC prevalence is also increasing in North and Central Asian Countries (NCAC). Screening for colorectal cancer has decreased CRC mortality but data regarding screening practices in NCAC is limited. A literature search was conducted in PubMed/Medline, Embase and Cochrane for current colorectal cancer screening practices in NCAC. Incidence and mortality rates were derived from public health agency websites to calculate age-standardized CRC mortality-to-incidence ratios. Web-based online break-point testing defined as statistical major changes in CRC mortality trends was completed. Among the 677 screened studies, 37 studies met the criteria for inclusion for review. CRC screening in NCAC is not organized, although most countries have cancer registries. The data availability is scarce, and most data is prior to 2017. Most studies are observational. There is minimal data about colonoscopy preparations, adenoma detection and complications rates. The polyp detection rates (PDRs) and adenoma detection rates (ADRs) seem low to optimal in this region. Commonly measured outcomes include participation rate, fecal immunochemical tests (FIT) positivity rate and cost-benefit measures. Lower mortality-to-incidence ratios is seen in countries with screening programs. Kazakhstan and Lithuania with screening programs have achieved breakpoint suggesting major changes in CRC mortality trends. Data about CRC screening varies widely within NCAC. High human developmental index (HDI) countries like Lithuania and Estonia have higher incidence of CRC and mortality. Seven NCAC have CRC screening programs with most utilizing non-invasive methods for screening. Data collection is regional and not organized. The ADR and PDR are low to optimal in this region and cancer detection rates are comparable to other high-income countries (HIC).CRC detection rate is 0.05% for screening in Kazakhstan and 0.2% for screening in Lithuania. Very limited information is available on the actual cost and logistics of implementing a CRC screening program. All NCAC have a cancer registry, with some having a high-quality registry showing national coverage with good validity and completeness.Establishing guideline-based registries and increasing screening efficacy could improve CRC outcomes in NCAC.

The association of serum folate and homocysteine on venous thromboembolism in patients with colorectal cancer: a cross-sectional study.

Venous thromboembolism is a common complication in patients with colorectal cancer who exhibit high homocysteine and low folate levels. However, whether venous thrombosis is the result of a direct effect of folic acid or the presence of a homocysteine-mediated mediating effect cannot be determined. This study aimed to explore the association and mediating effects of serum folate and homocysteine on venous thromboembolism in patients with colorectal cancer. This study included patients with colorectal cancer who were admitted to the First Hospital of Shanxi Medical University from May 2020 to May 2022. The patients' medical records were reviewed to collect information on general demographic characteristics, the prevalence of venous thromboembolism on admission, laboratory blood indices, serum folate, and serum homocysteine. SPSS 26.0 software was used for data collation and statistical analysis; the χ2 test was utilized for univariate analysis and unconditional logistic regression was applied for multivariate analysis. R 4.1.2 was used to perform the mediating effect test. A total of 236 colorectal cancer patients were investigated. The prevalence of colorectal cancer combined with venous thromboembolism was 15.3%; serum folate was <10.75 nmol/L in 25.4% of patients; and serum homocysteine was ≥22 µmol/L in 30.5% of patients. After controlling for confounding factors, the risk of venous thromboembolism was 2.48 times greater [95% confidence interval (CI): 1.04 to 5.94] in patients with low serum folate (<10.75 nmol/L) than in those with high serum folate (≥10.75 nmol/L). Also, the risk of venous thromboembolism was greater in those with high serum homocysteine (≥22 µmol/L) [odds ratio (OR) =2.99. 95% CI: 1.11 to 8.08]. The mediating effect test showed no direct effect of serum folate on venous thromboembolism combined with colorectal cancer, and a full mediating effect of serum homocysteine between serum folate and venous thromboembolism combined with colorectal cancer, with a mediating effect value of 0.002 and a total effect value of 0.0054. Serum folate influences the formation of venous thromboembolism through serum homocysteine. It is recommended that the nutritional supplementation of patients be enhanced to control serum folate and serum homocysteine levels.

Endoscopic findings after CT proven acute diverticulitis: a systematic review and meta-analysis.

Traditionally, international guidelines recommend patients with acute diverticulitis should be followed up with a colonoscopy 6-8 weeks after discharge. However, the need for an interval colonoscopy has been increasingly challenged in the setting of computed tomography (CT). Previous meta-analyses have included studies which combined suspected rather than imaging confirmed diverticulitis and often without correlation with endoscopic findings. This meta-analysis aims to investigate endoscopic findings of patients with CT confirmed diverticulitis. An electronic search of Medline, PubMed, Cochrane Library, Embase, CINAHL, Web of Science, Scopus, Clinicaltrials.gov and WHO ICTRP was performed up to October 18, 2021. Studies which reported CT confirmed acute diverticulitis in adults and who underwent endoscopic follow-up with either a colonoscopy or flexible sigmoidoscopy were included. Studies were excluded if diverticulitis was diagnosed by clinical grounds alone, ultrasound, barium enema, or other non-CT forms of imaging. A total of 68 studies with 13 905 patients were included. Median age was 58 years and male to female ratio was 0.84. Cancer was detected in 2.0% and advanced adenoma in 3.8%. Complicated diverticulitis had 9.2 higher odds of cancer compared to uncomplicated diverticulitis (95% CI 4.42-19.08, P < 0.001). Adenomas were detected in 17%. Of those diagnosed with colorectal cancer, 85% were concordant with the site of the diverticulitis on CT while 15% were incidental findings. Routine colonoscopic follow up should be recommended in medically fit patients who have CT proven acute diverticulitis due to the higher than population prevalence of colorectal cancer and advanced adenomas.

Abstract PR005: Outcomes in colitis-associated metastatic colorectal cancer and intersection with early-onset and signet ring cell carcinoma

Abstract Patients with inflammatory bowel disease (IBD) have a higher risk of developing colorectal cancer (CRC) and mortality from colitis-associated CRC (CA-CRC) is currently rising. Clinical and molecular differences between CA-CRC and sporadic-CRC (S-CRC) have been previously identified, however there are conflicting reports on outcomes of CA-CRC, especially for those with metastatic CRC (mCRC). Due to the earlier onset of CA-CRC, undiagnosed IBD has been speculated to be a contributing factor to the rising prevalence of early-onset CRC (EOCRC), but confirmatory studies are lacking. In this retrospective study, three independent CRC patient datasets from MDACC were used – the mATTACC discover cohort (n=32 CA-mCRC; n=425 S-mCRC), a tumor registry (n=1696, excluding MSI-High samples), and a real-world evidence (RWE) validation dataset (n=269 CA-mCRC; n=29,596 S-mCRC). These cohorts were analyzed in order to explore characteristics of patients with CA-mCRC, evaluate the amount of EOCRC attributable to CA-mCRC, and compare outcomes of patient populations with CA-mCRC. Median age at diagnosis for patients with CA-mCRC (48yo) was significantly lower compared to S-mCRC (58yo; p&amp;lt;0.001), and an association between CA-mCRC and EOCRC was confirmed (OR=4.04, p&amp;lt;0.001). Prevalence of signet ring cell and mucinous (SRC/M) histology, a rare subtype of CRC, was analyzed within CA-mCRC and EOCRC cases in our cohorts. SRC/M histology was present in 28%-39% of CA-mCRC and 13%-15% of EOCRC cases, thus confirming the strong association of SRC/M histology with both CA-mCRC (OR=3.13, p&amp;lt;0.001) and EOCRC (OR=1.35, p&amp;lt;0.001). Therefore, by comparing the frequency of SRC/M in EOCRC and late-onset CRC, and correcting by the proportion of CA-mCRC cases with SRC/M histology, we estimate between 8.3% to 10.2% of EOCRC may be due to undiagnosed or subclinical IBD. Median overall survival (mOS) for patients with CA-mCRC (31m) was lower relative to S-mCRC (39m; HR=1.26, 95%CI: 1.06-1.48). In EOCRC, patients with CA-mCRC had worse outcomes (mOS=25m) compared to S-mCRC (40m; HR=1.61, 95%CI: 1.23-2.11). Prevalence of SRC/M histology stratified by CA-mCRC or EOCRC status revealed an increasing trend of SRC/M occurrence specifically within CA-mCRC (1995-2015). Additionally, for patients with CA-mCRC the mOS for those with SRC/M (21m) was lower than those with mucinous (51m) histology, highlighting the poor prognosis of SRC/M in this patient population (HR=1.89, 95%CI: 1.06-3.33). Patients with CA-mCRC have worse outcomes than S-mCRC, and those with early-onset or SRC/M have lower survival rates. Tumor biology consistent with CA-CRC, including SRC/M histology, may be present in 8.3%–10.2% of patients with EOCRC without a clinical diagnosis of IBD. Although other confounding biology may be underlying this association, recognition of undiagnosed IBD in mCRC patients is important as it may impact prognosis and treatment strategies for this high-risk patient population. Citation Format: Oscar E. Villarreal, Fadl Zeineddine, Ray Chacko, Christine Parseghian, Benny Johnson, Jason Willis, Michael Lee, Van Karlyle Morris, Arvind Dasari, Kanwal Raghav, Michael Overman, Y. Nancy You, Yinghong Wang, Dipen Maru, John Paul Shen, Scott Kopetz. Outcomes in colitis-associated metastatic colorectal cancer and intersection with early-onset and signet ring cell carcinoma [abstract]. In: Proceedings of the AACR Special Conference on Colorectal Cancer; 2022 Oct 1-4; Portland, OR. Philadelphia (PA): AACR; Cancer Res 2022;82(23 Suppl_1):Abstract nr PR005.