Diagnosis Of Colorectal Adenocarcinoma Research Articles

Profile of Colorectal Adenocarcinoma in Dr. Soetomo Hospital Surabaya Period 2018-2022

Background: The incidence of colorectal cancer is increasing every year by about 8% with most patients in men. This cancer mostly occurs in old age above 50 years. Most colorectal cancers are of the adenocarcinoma type, which is most common on the left side of the colon. One of the determinant prognosis factors of colorectal adenocarcinoma is the depth of invasion, the deeper the correlate with invasion, the worse the prognose. Method: Descriptive research with a retrospective approach. The sample used data from histopathological examination results with a diagnosis of colorectal adenocarcinoma from surgery and biopsy material at the Anatomy Pathology Laboratory of Dr. Soetomo General Academic Hospital Surabaya for the period 2018-2022. Result: The total sample size was 143 cases with the most patients being male (60.84%) and the most age group being 51-60 (41.26%). The most common location was rectum (13.29%) with T stage (the most invasion depth was T3 (19.58%). The most common degree of differentiation was low degree (58.04%) with stage N (metastasis to lymph node) which was N0 (23.78%). Discussion: Age and lifestyle (drinking alcohol and smoking) are two of the many risk variables that affect the occurrence of colorectal cancer. The right-sided colon is the most typical site of adenocarcinoma, and it is linked to both KRAS and NRAS variables. The degree of differentiation can affect survival, although the depth of invasion and metastatic variables also affect prognosis. Conclusion: Colorectal adenocarcinoma is mostly found in men over 50 years of age with low differentiation and is most commonly located in the rectum.

PD-L1 Expression in Colorectal Adenocarcinoma Is Associated With the Tumor Immune Microenvironment and Epithelial-Mesenchymal Transition.

Colorectal carcinomas are the third-most common tumors in the world, and colorectal cancer ranks second in cancer-related deaths. Our aim in this study was to investigate the correlation between programmed cell death ligand 1 (PD-L1) expression and clinicopathologic parameters in colorectal carcinomas and their relationship to the tumor immune microenvironment, epithelial-mesenchymal transition (EMT), and microsatellite instability. We also investigated the predictive and prognostic role of PD-L1. One hundred patients with a diagnosis of colorectal adenocarcinoma who did not receive neoadjuvant therapy were included in the study. The relationships among the altered expression of PD-L1; vimentin; E-cadherin; mismatch repair status; and pathologic microenvironmental features, including the presence of tumor budding and CD8-positive tumor infiltrating lymphocytes (TILs), were assessed. Increased PD-L1 expression in tumor cells was associated with increased TILs (P = .013), high histologic grade (P = .011), advanced pathologic T stage (P = .007), lymph node metastasis (P = .002), distant metastasis (P < .001), perineural invasion (P = .009), high bud score (P = .023), EMT (P < .001), and shorter disease-free survival (P = .029). Overall, PD-L1 expression in colorectal carcinoma tumor cells is a marker of poor prognosis, and the positive correlation detected between EMT status and PD-L1 expression suggests that patients with the mesenchymal phenotype may be more likely to benefit from programmed cell death 1 protein/PD-L1 immunotherapy.

Prognostic Factors for Survival of Colorectal Adenocarcinoma Patients in Uganda.

BackgroundIn Uganda, similar to other countries in East Africa, the incidence of colorectal cancer (CRC) has been steadily increasing. This increase in incidence is accompanied by a poor prognosis. There is limited knowledge on factors responsible for the poor outcome of patients with CRC in Uganda. Cancer survival analysis is one way of determining some of these prognostic factors. The aim of this study was to determine prognostic factors associated with CRC survival in Ugandan patients.MethodsThis was a retroprospective cohort study involving patients with linked data in the Kampala cancer registry and medical records from hospitals in Uganda. Participants with a diagnosis of colorectal adenocarcinoma between 1st January 2008 and 31st December 2018 were included. Variables included patients’ demographic data, grade, stage and location of CRC, data on whether a patient was operated on, type of operation, treatment modalities and date of diagnosis. Our outcome variable was time to death after diagnosis. We computed and compared survival using the Log rank test and used Cox proportional hazards regression to determine factors associated with survival.ResultsA total of 247 patients were included in the study with a mean (SD) age of 53.3 (15.7) years and a female: male ratio of 1.14:1. The proportions of patients surviving at 1, 2 and 3 years were 65.2% (95% CI: 58.8–70.9), 42.0% (95% CI:35.6–48.3) and 33.3% (95% CI:27.3–39.4) respectively. In multivariate analysis, factors associated with increased mortality included clinical stage II (aHR = 2.44, 95% CI: 1.10–5.41, p=0.028), stage III (aHR=2.65, 95% CI: 1.31–5.39, p=0.007) and stage IV (aHR=5.47, 95% CI: 2.40–12.48, p<0.001). Curative surgery alone (aHR=0.63, 95% CI: 0.39–1.01, p=0.057) and curative surgery with chemotherapy (aHR=0.53, 95% CI: 0.32–0.88, p=0.015) were associated with a better survival.ConclusionThe survival rate among CRC patients in Uganda is low. Advanced stage CRC accelerates mortality, while surgery alone or in combination with chemotherapy improves survival. Implementation of national screening programmes for early diagnosis of CRC and increasing surgery and oncology infrastructure is recommended to improve the CRC survival rate in the Ugandan population.

CORRELATION OF FIBROBLAST ACTIVATION PROTEIN (FAP) IMMUOHISTOCHEMICAL EXPRESSION WITH HISTOPATHOLOGICAL GRADING AND TUMOR-STROMA RATIO (TSR) IN COLORECTAL ADENOCARCINOMA

Background: Colorectal adenocarcinoma is a malignancy of the large intestine (colon and rectum) of epithelial origin, ranks third in the world, and the second leading cause of cancer death. The prognosis can be assessed based on the reaction of the tumor microenvironment that plays a role in the stage of cancer development. Immunohistochemical examination of Fibroblast Activation Protein (FAP) as well as an assessment of grading and how the ratio between the extent of tumor and stroma (Tumor-Stroma Ratio) has recently been one of the prognostic predictors of colorectal adenocarcinoma. Objective: To analyze the relationship of immunohistochemical expression of Fibroblast Activation Protein (FAP) with histopathological grading and Tumor-Stroma Ratio (TSR) in colorectal adenocarcinoma. Materials and Methods: 32 samples in the form of histopathological slides from surgical tissue with a diagnosis of colorectal adenocarcinoma, reviewed slides and assessed for grading and TSR scores, then performed immunohistochemical staining of Fibroblast Activation Protein (FAP) and assessed the expression, then analyzed for correlation between variables using the Somers'd correlation test. Results: The most histopathological grading distribution was low grade, the highest TSR was TSR-High, and the highest FAP expression found was strong expression. Based on the Somer's d correlation test, it was found that there was a significant correlation between FAP expression and grading (p=0.037) and there was no significant correlation between FAP expression and TSR (p=0.244). Conclusion: The tumor microenvironment is one of the prognostic predictor factors in colorectal adenocarcinoma patients, should be reported in the routine pathology report and further investigated how the stromal component and the role of FAP expression to open the possibility of other targeted therapies. Keywords: Fibroblast Activation Protein, Tumor-Stroma Ratio, colorectal prognosis

Fecal Bacteria as Non-Invasive Biomarkers for Colorectal Adenocarcinoma.

Colorectal adenocarcinoma (CRC) ranks one of the five most lethal malignant tumors both in China and worldwide. Early diagnosis and treatment of CRC could substantially increase the survival rate. Emerging evidence has revealed the importance of gut microbiome on CRC, thus fecal microbial community could be termed as a potential screen for non-invasive diagnosis. Importantly, few numbers of bacteria genus as non-invasive biomarkers with high sensitivity and specificity causing less cost would be benefitted more in clinical compared with the whole microbial community analysis. Here we analyzed the gut microbiome between CRC patients and healthy people using 16s rRNA sequencing showing the divergence of microbial composition between case and control. Furthermore, ExtraTrees classifier was performed for the classification of CRC gut microbiome and heathy control, and 13 bacteria were screened as biomarkers for CRC. In addition, 13 biomarkers including 12 bacteria genera and FOBT showed an outstanding sensitivity and specificity for discrimination of CRC patients from healthy controls. This method could be used as a non-invasive method for CRC early diagnosis.

The growing trend for no primary surgery in colorectal cancer

AbstractAimIn colorectal cancer (CRC), surgery of the primary site is commonly curative. Our aim was to determine estimates of ‘no surgery’ for primary CRC while identifying common reasons for no surgery.MethodWe identified all patients with a diagnosis of colorectal adenocarcinoma from the National Cancer Database between January 2004 and December 2016. Then, we identified patients who did not undergo surgery on the primary tumour and their demographic, tumour and institutional characteristics. Kaplan–Meier and logistic regression analyses were used to evaluate specific factors associated with overall survival as related to no surgery and recommendations against operative management.ResultsA total of 1,208,878 patients with CRC were identified, 14.5% of whom had no surgery of the primary cancer. No surgery was more common in rectal cancer than in colon cancer. Despite a steady incidence of CRC diagnoses, the likelihood of no surgery grew by 170% over the study period. Metastatic disease was noted in 53.7% of the no surgery cohort. Nine per cent of the no surgery patient cohort received a recommendation against surgery despite the absence of metastatic disease, 7.5% refused surgery and only 2% underwent palliative surgery. On multivariable analysis, patients who were not recommended to have surgery were more likely to be older, uninsured, comorbid and receive care at a single hospital. The no surgery patients had significantly lower overall survival.ConclusionA substantial proportion of patients with CRC do not have surgery. Interventions aimed at expanding access and promoting second opinions at other cancer hospitals might reduce the growing rate of no surgery in CRC.

Anatomopathological characteristics and determination of KRAS/NRAS in patients of 20-35 years with diagnosis of colorectal adenocarcinoma in the Hospital General de México from 2011 to 2015

Anatomopathological characteristics and determination of KRAS/NRAS in patients of 20-35 years with diagnosis of colorectal adenocarcinoma in the Hospital General de México from 2011 to 2015

Features of CDH1, CTNNB1 genes transcriptional activity and expression levels of E-cadherin, β-catenin proteins coded by these genes on the I, II, III, IV stages of colorectal adenocarcinoma development

Aim – analysis of CDH1 and CTNNB1 genes mRNA expression levels and expression levels of E-cadherin, β-catenin proteins coded by these genes, and also their correlations with KRAS gene transcriptional activity level on the I, II, III, IV stages (pTNM) of colorectal adenocarcinoma (CRA) development. Materials and methods. Parallel immunohistochemical and molecular-genetic, pathohistological studies of operational material of CRA from 40 patients (4 study groups – I, II, III, IV stages according to pTNM classification – 10 cases in each group) with diagnosis of colorectal adenocarcinoma, and sectional material of 10 fragments of distal colonic wall with normal histological structure were conducted. Results. In comparison with unchanged mucosa of distal colon CRA is characterized by the decreased CDH1 gene transcriptional activity. There is the tendency to reducing of CDH1 gene mRNA expression in the study groups – from the I to the IV stages of the tumor development. CRA is characterized by the low E-cadherin expression level, which also has the tendency to reducing in the study groups. Moreover, in comparison with unchanged mucosa of distal colon CRA is characterized by the increased CTNNB1 gene transcriptional activity and the high β-catenin expression level. There aren’t statistically significant differences between the CTNNB1 gene mRNA, β-catenin expression levels in the study groups. There are direct correlations between the expression levels of the studied genes and the molecules, coded by these genes, and also reverse correlations between the KRAS and CDH1 genes mRNA expression levels, the KRAS gene mRNA expression level and the E-cadherin expression level, direct correlation between the KRAS gene mRNA expression level and the β-catenin expression level. Conclusions. CRA is characterized by the decreased CDH1 gene transcriptional activity that correlates with the low E-cadherin expression level, and by the increased CTNNB1 gene transcriptional activity that correlates with the high β-catenin expression level. The CDH1 gene transcriptional activity and the expression level of E-cadherin, which is coded by this gene, decrease during the CRA progression from the I to the IV stages. CRA is characterized by reverse correlations between the KRAS and CDH1 genes mRNA expression levels, the KRAS gene mRNA expression level and the E-cadherin expression level, direct correlation between the KRAS gene mRNA expression level and the β-catenin expression level.

Molecular-immunohistochemical characteristics of proliferation and apoptosis of tumor cells in colorectal adenocarcinoma

Aim – to study the features of K-RAS transcriptional activity gene, Ki-67 and TP53 mRNA genes expression levels in comparison with the immunohistochemical expression levels of Ki-67, p53 proteins and caspase-3 encoded by them in colorectal adenocarcinoma (CRA) with its progression from the I to the IV stage. Materials and methods. Parallel immunohistochemical and molecular-genetic, pathohistological studies of operational material of CRA from 40 patients (4 study groups – I, II, III, IV stages of the disease according to pTNM classification – 10 cases in each group) with diagnosis of colorectal adenocarcinoma, and also sectional material of 10 fragments of distal colonic wall with normal histological structure were conducted. Results. In comparison with unchanged mucosa of distal colon, CRA is characterized by the increased K-RAS gene and Ki-67 gene activity. As CRA progresses from the I to IV stages, there is an increase in the transcriptional activity of the K-RAS gene and a decrease in the transcriptional activity of the Ki-67 gene in the study groups. The tumor cells are characterized by the medium level of expression of Ki-67, which is the marker of cellular proliferation, herewith the reverse correlation between the Ki-67 expression level and the tumor invasion level is present. CRA is characterized by the increased TP 53 gene transcriptional activity with the tendency to elevation, which happens during the progression of the tumor from the I to the IV stage and correlates with the increased K-RAS gene transcriptional activity. CRA is also characterized by the medium p53 expression level and the low level of caspase-3 expression, which is the marker of apoptotic degradation process, which happens in the presence of the reverse correlation between the increased K-RAS gene transcriptional activity and the low level of apoptosis of the tumor cells. Conclusions. The K-RAS and TP53 genes transcriptional activity increases, but the Ki-67 gene transcriptional activity decreases during the process of CRA progression from the I to the IV stage. The inverse correlation between the level of transcription activity of the K-RAS, TP53 genes and apoptosis of tumor cells of the colorectal adenocarcinoma was determined. The decline of proliferation level of the tumor cells, that is observed during the process of CRA progression from the I to the IV stage, is mediated by the signal pathways, which don’t have connection with RAS-protein.

Racial Disparities in Clinical Presentation and Survival Times Among Young-Onset Colorectal Adenocarcinoma.

Recently published data indicate increasing incidence of colorectal adenocarcinoma (CRC) in young-onset (<50years) patients. This study examines racial disparities in presentation and survival times among non-Hispanic Blacks (NHB) and Hispanics compared with non-Hispanic Whites (NHW). A retrospective single-center cohort study was conducted from 2004 through 2014 using 96 patient medical charts with a diagnosis of young-onset CRC. Age, gender, primary site, and histological stage at the time of diagnosis were assessed for survival probabilities by racial group over a minimum follow-up period of 5years. Among subjects with CRC diagnosis before 50years of age, the majority of subjects were between 40 and 50years, with CRC presentation occurring among this age group for 51 (79.7%) of NHW, 18 (81.8%) of NHB, and 5 (50.0%) of Hispanics. The majority of all patients presented with advanced stages of CRC (31.3% with stage III and 27.1% with stage IV). NHB exhibited statistically significantly worse survival compared to NHW (adjusted hazard ratio for death=2.09; 95% confidence interval 1.14-3.84; P=0.02). A possible trend of worse survival was identified for Hispanics compared to NHW, but this group was low in numbers and results were not statistically significant. Disparities between racial groups among young-onset CRC cases were identified in overall survival and reflect growing concern in rising incidence and differentiated care management.

Advanced-Stage Colorectal Cancer in Persons Younger Than 50 Years Not Associated With Longer Duration of Symptoms or Time to Diagnosis.

The incidence of colorectal cancer (CRC) is increasing in the United States among adults younger than the age of 50 years. Studies of young-onset CRC have focused on outcomes and treatment patterns. We examined patient presentation, provider evaluation, and time to diagnosis, which can affect stage and prognosis. In a retrospective study, we collected data from patients with a diagnosis of colorectal adenocarcinoma, confirmed by pathologists, seen at the Stanford Cancer Institute from January 1, 2008, through December 31, 2014. We compared symptoms, clinical features, time to diagnosis, and cancer stage in patients with young-onset CRC (diagnosed at an age younger than 50 years; n= 253) with patients diagnosed with CRC at an age of 50 years or older (n= 232). A higher proportion of patients with young-onset CRC were diagnosed with advanced-stage tumors (72%) compared with older patients (63%) (P= .03). Larger proportions of patients with young-onset CRC also had a family history of CRC (25% vs 17% in older patients; P= .03), confirmed or probable hereditary cancer syndromes (7% vs 1% in older patients; P < .01), and left-sided disease (distal colon cancer in 41% vs 34% in older patients; P= .01; and rectal cancer in 40% vs 35% in older patients; P= .29). Patients with young-onset CRC had a significantly longer median time to diagnosis (128 vs 79 days for older patients; P < .05), symptom duration (60 vs 30 days for older patients; P < .01), and time of evaluation (31 vs 22 days; P < .05). In multivariable analyses, time to diagnosis was 1.4-fold longer for younger than for older patients (P < .01). Among younger patients, those with stage III or IV CRC had shorter durations of symptoms and evaluations than those with stage I or II CRC. In a retrospective analysis of patients with CRC, we found that greater proportions of patients younger than 50 years were diagnosed with advanced-stage tumors than older patients; this difference could not be explained simply by delays from symptom onset to diagnosis. Although tumor biology may be an important determinant of stage at diagnosis, clinicians should be aware of CRC alarm symptoms, family history, and genetic syndromes, to speed evaluation and diagnosis of younger patients and potentially improve outcomes. It remains to be determined whether subgroups of persons at risk for young-onset CRC who benefit from early screening can be identified.

Diagnostic value of SATB2, CK7 and CK20 in colorectal cancer

To study the diagnostic value of SATB2, together with CK7 and CK20, in colorectal cancer. Immunohistochemical study for SATB2, CK7 and CK20 was carried out in 210 cases of colorectal cancer tissue, 100 cases of non-colorectal cancer tissue, 90 cases of lymph node metastases and 50 cases of normal colorectal mucosa. The sensitivity and specificity of CK20+/CK7- immunophenotype for diagnosis of colorectal adenocarcinoma were 78.1% and 92.0%, respectively. When triple markers were used, the immunophenotype CK20+/CK7-/SATB2+ had a sensitivity of 57.1% and a specificity of 98.0%. When combining the immunophenotype of SATB2+/CK7- or CK20+/CK7-, the sensitivity was 85.7% and specificity was 90.0%. A panel of immunohistochemical markers SATB2, CK7 and CK20 could increase the specificity for diagnosis of colorectal adenocarcinoma significantly. SATB2 is considered as a useful adjunct in this respect.

Abstracts and Case Studies From the College of American Pathologists 2014 Annual Meeting (CAP '14)

Abstracts and Case Studies From the College of American Pathologists 2014 Annual Meeting (CAP '14)

Bile Duct Adenoma with Oncocytic Features

Bile duct adenomas are benign bile duct proliferations usually encountered as an incidental finding. Oncocytic bile duct neoplasms are rare and the majority are malignant. A 61-year-old male with a diagnosis of colorectal adenocarcinoma was undergoing surgery when a small white nodule was discovered on the surface of the right lobe of his liver. This lesion was composed of cytologically bland cells arranged in tightly packed glands. These cells were immunopositive for cytokeratin 7, negative for Hep Par 1, contained mucin, and had a Ki67 proliferation index of 8%. The morphology, immunophenotype, presence of mucin, and normal appearing bile ducts, as well as the increased Ki67 proliferation rate, were consistent with a bile duct adenoma with oxyphilic (oncocytic) change. Oncocytic tumors in the liver are rare; the first described in 1992. Only two bile duct adenomas with oncocytic change have been reported and neither of them had reported mucin production or the presence of normal appearing bile ducts within the lesion.

Accuracy of Preoperative Biopsies Compared With Surgical Specimens in the Diagnosis of Colorectal Adenocarcinoma

Since the first data from a patient with colorectal adenocarcinoma are obtained by biopsy, this study evaluated the accuracy of diagnosis by biopsy as compared with the diagnostic potential of the surgical specimen, considering the histological type, grade of differentiation, and immunohistochemical expression of p53. The specimens were obtained from 80 patients assisted at Hospital São Paulo. The biopsy and surgical specimen sections were stained by hematoxylin-eosin and immunohistochemistry and compared by 3 pathologists blinded to the evaluations. The accuracy for the histological types was 88%. The grade of differentiation presented an accuracy of 70% with Kappa = .48. The expression of protein p53 exhibited an accuracy of 68% with Kappa = .22. The preoperative biopsy of colorectal adenocarcinoma presented good accuracy compared with histopathological examination of the surgical specimen, but with weak to moderate effective degree of agreement between the results.

Risk of colorectal cancer subsite in a prostate cancer cohort.

404 Background: Epidemiological studies imply an association between sex hormonal related factors and the risk of colorectal cancer. Methods: A prostate cancer cohort was initiated from the Swedish Cancer Register among patients diagnosed during 1961-2008. The prostate cancer patients were followed up until a diagnosis of colorectal adenocarcinoma, death, emigration or end of study (December, 31, 2008). The cohort was stratified into a group as “estrogen exposed” who were diagnosed with prostate cancer before 1980, and a group as “estrogen less exposed” who were diagnosed after 1980. The reason for this grouping was estrogen therapy was the predominant treatment strategy in Sweden before 1980 while other treatment became more common after 1980. Standardized incidence ratios (SIRs) and 95% confidence interval (CI) were estimated as the measure of relative risk compared to the general population of the corresponding age and calendar year. SIRs were estimated for total colorectal cancer and for cancer of the proximal colon, distal colon, and rectum separately. Results: Among a total of 190,485 of prostate cancer patients contributing 708,019 person-years at risk, we identified 1493 colorectal adenocarcinoma. For those diagnosed with prostate cancer before 1980 (estrogen exposed group),almost all age groups showed a decreased risk of colorectal cancer, except for cancer of the distal colon, compared to the general population. Increased risk of colorectal cancer was instead found in almost all age groups for those diagnosed after 1980 (estrogen less exposed group). SIRs of adenocarcinoma in the proximal colon and distal colon showed different patterns. After 1980, the SIR of adenocarcinoma in the distal colon among patients followed up for &gt;10 years was 1.29, (95% CI 1.02-1.60). Conclusions: This study indicates that exposure to estrogens protect against colorectal cancer, while treatment after 1980 displayed a potential increased risk of colorectal adenocarcinoma, especially in the distal colon.

Carcinomas Associated With Lynch Syndrome: A Family History

Lynch syndrome is a rare and inherited defect disorder. People who have Lynch syndrome are strongly predisposed to develop colorectal cancer as well as several other types of cancer. The aim of this study was to explore features of ovarian cancers arising in families with Lynch syndrome. This study was a case report based on family history examining three patients with a new diagnosis of colorectal adenocarcinoma with ovarian cancer. Family members of carriers of the mutations were counseled, and those found to be at risk were offered mutation testing. The clinical criteria of the Amsterdam II guidelines for Lynch syndrome were used in this study. This is a maternal history of a 27-year-old woman sharing the destiny of her 48-year-old mother and 45-year-old aunt, both of which were suffering from Lynch syndrome associated with ovarian cancer. The maternal grandmother and maternal uncle of this young woman also suffered from colon cancer in their forties. The medical implications for the carrier relatives were considered as the maternal branch of the family.

Total de linfonodos identificados após a ressecção do câncer colorretal

RACIONAL: A base cirúrgica principal no tratamento do câncer colorretal é a remoção em bloco do tumor com adequadas margens proximal e distal, associada à remoção dos linfonodos mesentéricos. OBJETIVO: Avaliar fatores associados à quantidade de linfonodos encontrados em peças cirúrgicas de pacientes com câncer colorretal. MÉTODOS: Estudo retrospectivo, de pacientes consecutivos, operados com diagnóstico de adenocarcinoma colorretal. Foram excluídos aqueles submetidos ao tratamento cirúrgico paliativo. Os dados demográficos, operatórios e histopatológicos foram analisados utilizando os testes exato de Fisher, Qui-quadrado, Wilcoxon rank-sum e um modelo de regressão logística. RESULTADOS: No período de 2000 a 2008, foram operados 298 pacientes com câncer colorretal. Os dados incluídos na análise estavam disponíveis para 173 pacientes. Destes, 85 (49%) eram do sexo feminino e a idade mediana era de 65 (26-94) anos. A ressecção mais comum foi a colectomia esquerda (45%), seguida pela colectomia direita (23%). O número mediano de linfonodos isolados foi oito (0-67) e 33% dos pacientes tiveram 12 ou mais linfonodos identificados na peça cirúrgica. Os pacientes com idade menor que 50 anos e aqueles submetidos à coletomia direita obtiveram maior número de linfonodos isolados. CONCLUSÕES: A idade do paciente menor que 50 anos e o tipo de ressecção cirúrgica estão associados ao maior número de linfonodos encontrados nas peças cirúrgicas.

Abstract A47: Delayed stage colorectal adenocarcinoma diagnosis: Are we neglecting critical demographic information?

Abstract Background: Colorectal cancer (CRC) is the second leading cause of cancer deaths in the United States. Poor survival for CRC is associated with delayed diagnosis. To remedy this problem, race and ethnicity are routinely used to target intensified CRC screening when information about health insurance is not available. We sought to distinguish roles of demographic variables and bowel segments as predictors of delayed (AJCC stage II-IV) vs. early (in situ and stage I) diagnosis of colorectal adenocarcinoma in the diverse California population. Methods: Demographic variables and right (C18.0-C18.4) vs. left (C18.5-C18.7, C19.9 &amp; C20.9) bowel origin for 66,806 CRC cases diagnosed in 2004-2008 were extracted from the California Cancer Registry and analyzed by logistic regression as delayed vs. early stage. Results: Of the CRC cases, 65% were non-Hispanic (NH) white, 15% Hispanic, 13% Asian/Other and 7% NH black. Logistic regression showed increased odds of delayed vs. early diagnosis (OR, 95% confidence limits) for age &amp;lt;40 (2.58,2.26-2.94), 40-49 (1.71,1.60-1.83) and 75+ (1.05,1.02-1.09) relative to 50-74 years. Contrast with NH whites, odds ratios for delayed vs. early stage were: 1.05,0.99-1.13 (NH blacks); 1.08,1.02-1.13 (Hispanics) and 1.05,1.00-1.11 (Asian/Others). Females had higher odds of delayed CRC diagnosis (1.09,1.06-1.13) than males. Lower odds ratios for delayed stage diagnosis were seen for successively lower to highest SES quintiles (OR4:5=1.08,1.03-1.14; OR3:5=1.13,1.08-1.19; OR2:5=1.18,1.12-1.24; and OR15=1.21,1.14-1.28; Trend p &amp;lt;0.0001). Origin in the right bowel vs. left showed higher odds of delayed vs. early diagnosis (1.68,1.63-1.74). No significant product interactions between race/ethnicity and SES were detected (p=0.47). Discussion: Our findings identify younger and older than age 50-74 at diagnosis, female gender, Hispanic ethnicity, right or proximal bowel, and lower SES as independent predictors of delayed CRC diagnosis. Low SES persists as the most robust predictor of delayed diagnosis, independent of race/ethnicity and other covariates. Consistent with other studies, females showed higher odds of delayed stage CRC than males. More than 70% of CRC (76% of delayed stage) cases were in race/ethnic groups not routinely classified as underserved that are neglected in many intensified screening recommendations. Findings for higher odds of delayed CRC diagnosis in the right bowel challenge current screening practices that favor FOBT over colonoscopy in underserved populations. Delayed stage diagnosis among persons younger than 50 can be partly remedied by screening that targets familial adenomatous polyposis (FAP) and hereditary nonpolyposis colorectal cancer (HNPCC) syndromes. Our findings show the value of including SES, together with Hispanic ethnicity, FAP and HNPCC syndromes, and female gender when targeting intensified and egalitarian CRC screening in the diverse California population where health insurance information is not available. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A47.

Anastomotic leakage after anterior resection for rectal cancer: risk factors

The study aimed to identify risk factors for clinical anastomotic leakage (AL) after anterior resection for rectal cancer in a consecutive national cohort. All patients with an initial first diagnosis of colorectal adenocarcinoma were prospectively registered in a national database. The register included 1495 patients who had had a curative anterior resection between May 2001 and December 2004. The association of a number of patient- and procedure-related factors with clinical AL after anterior resection was analysed in a cohort design. Anastomotic leakages occurred in 163 (11%) patients. In a multivariate analysis, the risk of AL was significantly increased in patients with tumours located below 10 cm from the anal verge if no faecal diversion was undertaken (OR 5.37 5 cm (tumour level from anal verge), 95% CI 2.10-13.7, OR 3.57 7 cm, CI 1.81-7.07 and OR 1.96 10 cm, CI 1.22-3.10), in male patients (OR 2.36, CI 1.18-4.71), in smokers (OR 1.88, CI 1.02-3.46), and perioperative bleeding (OR 1.05 for intervals of 100 ml blood loss, CI 1.02-1.07). Anastomotic leakage after anterior resection for low rectal tumours is related to the level, male gender, smoking and perioperative bleeding. Faecal diversion is advisable after total mesorectal excision of low rectal tumours in order to prevent AL.