Pattern Of Colorectal Cancer Research Articles

Loss of programmed cell death 4 expression marks adenoma‐carcinoma transition, correlates inversely with phosphorylated protein kinase B, and is an independent prognostic factor in resected colorectal cancer

Programmed cell death 4 (Pdcd4) inhibits malignant transformation, and initial studies of Pdcd4 suggested the regulation of Pdcd4 localization by protein kinase B (Akt). However, supporting patient tissue data are missing, and the diagnostic/prognostic potential of Pdcd4 rarely has been studied. The objectives of the current were 1) to determine Pdcd4 as a diagnostic marker in the adenoma-carcinoma sequence, 2) to support phosphorylated Akt (pAkt)-mediated Pdcd4 regulation in vivo, and 3) to obtain the first prognostic evidence of Pdcd4 in colorectal cancer. Tumor samples and normal tissues from 71 patients with colorectal cancer who were followed prospectively (median follow-up, 36 months) and 42 adenomas were analyzed for Pdcd4, Akt, and pAkt in immunohistochemical and Western blot analyses. A significant reduction in Pdcd4 was observed between normal mucosa and adenomas and between adenomas and tumor samples (P < .01 and P < .01, respectively). Normal mucosa demonstrated strong nuclear Pdcd4, which was reduced significantly in adenomas (P < .01) and almost was lost in tumors (P < .01). pAkt was correlated inversely with Pdcd4 and with the transition of Pdcd4 from nucleus to cytoplasm (P < .01). Kaplan-Meier analysis (using the Mantel-Cox log-rank test) indicated a significant correlation between the loss of total and nuclear Pdcd4 in tumors and overall survival (P < .05 and P < .02, respectively) and disease-specific survival (P < .01 and P < .01, respectively). In multivariate analysis, loss of total or nuclear Pdcd4 was an independent predictor of disease-specific or overall survival. To the authors' knowledge, this is the first study to demonstrate an independent prognostic impact of Pdcd4 and its expression pattern in colorectal cancer. Data from this study support the regulation of Pdcd4 localization by pAkt in vivo. Pdcd4 immunohistochemistry may be useful as a supportive diagnostic tool for the transition between normal, adenoma, and tumor tissues.

Bleeding patterns in colorectal cancer: the effect of aspirin and the implications for faecal occult blood testing.

Faecal occult blood testing for 3 consecutive days is recommended for the detection of colorectal cancer. Is this adequate? Haemoccult tests were performed for 6 days on the faeces of 50 patients with colorectal cancer. Enteric-coated aspirin was given during the final 3 days to see if its systemic effect on coagulation would increase tumour bleeding. In 25 patients blood loss was quantified by radiochromium assay. Bleeding was slight and intermittent with large daily fluctuations in individual patients. Median daily loss before aspirin was 1.2 ml and after aspirin 2.5 ml. Thirty per cent of the tumours were Haemoccult negative using the standard 3-day regimen and 18 per cent were negative after aspirin. Over the 6-day period, 10 per cent were persistently negative. We conclude that new methods are required to improve the diagnostic yield from faecal occult blood tests.

Inflammation and prognosis in colorectal cancer

Aim of the study Previous work has indicated that quantification of inflammatory cell reaction is of prognostic value in colorectal cancer. We evaluated the prognostic significance of inflammatory cell reaction patterns in colorectal cancer and developed a grading method which could be used in the routine assessment of tumours. Methods The intensity of overall inflammatory cell reaction, numbers of neutrophilic and eosinophilic granulocytes, lymphoid cells and macrophages in both the central region and the invasive margin were estimated in 386 colorectal cancer patients. Prognostic significance was analysed by uni- and multivariate analysis. Results Our method for classification of inflammatory reaction was reliable. High-grade inflammation at the invasive margin in Dukes’ stage A and B cancers (pT1-2N0 and pT3N0, respectively) was associated with better 5-year-survival (87.6%) than low-grade inflammation (47.0%). Conclusions Inflammatory cell response at the invasive border is a relevant prognostic indicator and could be easily incorporated into the routine evaluation of histopathological specimens.

Changing patterns of colorectal cancer in China over a period of 20 years

To determine whether any changes have occurred on the patterns of colorectal cancer in China. Data from 21 Chinese articles published from 1980 to 1999, were used to analyze the time trend of colorectal cancer according to the patients' age at diagnosis, sex, the site of the tumor, stage, and the pathology. From 1980s to 1990s, the mean age of the colorectal cancer patients has increased. The percentage of the female patients rose. The distribution of colorectal carcinoma shows a predominance of rectal cancer. However, the proportion of proximal colon cancer (including transverse and ascending colon) increased significantly accompanied by a decline in the percentage of rectal cancer. Similarity in the percentage of distal colon cancer between two decades was revealed. In the 1990s, statistically more Stage B patients were found than those in 1980s. In addition, databases show a significant decrease in the Stage D cases. The proportion of adenocarcinoma increased, but the mucinous adenocarcinoma decreased during two decades. These findings indicate that the pattern of colorectal cancer in China has been changing. Especially, a proximal shift due to the increasing proportion of ascending and transverse colon cancer has occurred in China.

Pattern of colorectal cancer at two hospitals in the western region of Saudi Arabia

Data of all patients with CRC treated at two hospitals in the Western region of the Kingdom of Saudi Arabia (KSA), between 1993 and 2002, were collected and analyzed. Out of the 121 patients evaluated, ten were excluded because of incomplete data. Out of 111 patients, 59 (53.2%) were males, with a male to female ratio of 1.13: 1 and 49 (44.1 %) were Saudis. Thirty-three patients (29.7%) were 40 years or less and 78 (70.3%) were more than 40 years. Colon cancer was found in 69 patients (62.2%) and rectal cancer in 42 (37.8%). Stages at presentation were; stage 0 (2.7%), stage I (11.7%), stage II (23.4%), stage III (20.7%), stage IV (22.5%) and the staging was unknown in 18.9% of the patients. The most common tumor grade was moderately differentiated (38.7%), followed by poorly differentiated (20.7%) and well differentiated 19.8% of the patients. Forty-four patients (39.6%) were alive at the time of data collection, 43 (38.7%) expired and 24 (21.6%) were lost to follow up. Correlation between age groups revealed that young patients had more advanced stage and poorly differentiated tumors than > 40 years old (p= 0.005 and 0.024 respectively). Compared to data from Western countries, colorectal cancer in this population is more common in younger patients. It presents more commonly in a more advanced stage and poorly differentiated type than in older patients.

Relation of E-cadherin and β-catenin expression to pit pattern in colorectal cancer

To investigate the usefulness of pit pattern to estimate depth of submucosal invasion and the mechanism of change in pit pattern by tumor character in colorectal cancer, we investigated the relation between pit pattern and immuno-histochemical E-cadherin and beta-catenin expression. Fifty-seven colorectal tumors including 37 submucosal invasive carcinomas, 10 high-grade adenomas and 10 cases of advanced carcinomas invading into the muscularis propria were divided into a non-VN and VN group according to a modification of the Kudo classification system. In addition, distance between the invasive front and muscularis mucosae was measured, and histological and immunohistochemical expression of E-cadherin and beta-catenin in the superficial portion and invasive portion were examined. Many tumors with deep invasion were classified in the VN group. Among the submucosal invasive carcinomas in the VN group, there was a significantly higher number with deep invasion than with slight invasion. All submucosal invasive cancers with lymphatic invasion also had deep submucosal invasion. Immunohistochemical analysis revealed significant loss of normal membrano-cytoplasmic beta-catenin expression in the superficial area of cancers in the VN group. Submucosal carcinoma with deep invasion also had significant loss of membrano-cytoplasmic expression of beta-catenin in the superficial area. Pit pattern is useful not only to predict tumor character but also to estimate depth of invasion. Change in pit pattern may be associated with abnormality of beta-catenin expression.