Postoperative Colorectal Cancer Patients Research Articles

Clinical distribution and molecular profiling on postoperative colorectal cancer patients with different traditional Chinese medicine syndromes

Clinical distribution and molecular profiling on postoperative colorectal cancer patients with different traditional Chinese medicine syndromes

The Value of Geriatric Nutritional Risk Index in Evaluating Postoperative Complication Risk and Long-Term Prognosis in Elderly Colorectal Cancer Patients.

PurposeThe geriatric nutritional risk index (GNRI) has been reported as a useful tool for predicting the prognosis of many diseases; however, there is currently little research on the relationship between GNRI and outcomes in elderly colorectal cancer (CRC) patients. This study aimed to explore the value of GNRI in evaluating postoperative complication risk and long-term prognosis in elderly CRC patients.Patients and MethodsThe medical records of 230 CRC patients aged≥65 years who underwent surgery between January 2012 and December 2014 were retrospectively analyzed. Patients were divided into abnormal and normal GNRI groups by modified binary classification. Logistic regression analysis was used to evaluate the correlation between GNRI and complication risk. The Kaplan–Meier method with log-rank test was used to construct survival curves. The Cox proportional hazard model was used for univariate, multivariate and subgroup survival analyses to assess the relationship between GNRI and long-term prognosis.ResultsMultivariate logistic regression analysis showed that GNRI (p = 0.009, HR 2.280, 95% CI: 1.224–4.247) was an independent risk factor for postoperative complications in elderly CRC patients. Kaplan–Meier survival curves revealed that the abnormal GNRI group had significantly lower disease-free survival (DFS; p = 0.005) and overall survival (OS; p=0.007) than the normal GNRI group had, especially in TNM I stage. In multivariate survival analysis, GNRI was an independent prognostic factor for DFS (p = 0.003, HR 1.842, 95% CI: 1.229–2.760) and OS (p = 0.003, HR 1.852, 95% CI: 1.231–2.787).ConclusionGNRI is a simple and effective tool for predicting the risk of postoperative complications and the long-term prognosis of postoperative elderly CRC patients and can provide a scientific basis for early nutrition interventions in elderly CRC patients.

DNA methylation of SFRP1, SFRP2, and WIF1 and prognosis of postoperative colorectal cancer patients

BackgroundAs biomarkers, DNA methylation is used to detect colorectal cancer (CRC) and make assessment of CRC prognosis. The published findings showed the association between the methylation of SFRP1, SFRP2, and WIF1, located in the Wnt signaling pathway, and the prognosis of CRC were not consistent. Our study aimed to explore the potential possibility of SFRP1, SFRP2, and WIF1 concomitant promoter methylation as prognostic biomarkers of postoperative CRC patients.MethodsAs a total of 307 sporadic postoperative CRC patients were followed up, we detected SFRP1, SFRP2, and WIF1 methylation obtained from tumor tissues and adjacent non-tumor tissues respectively on the basis of methylation-sensitive high resolution melting analysis. Univariate and multivariate Cox regressions were carried out so as to assess the potential possibility of SFRP1, SFRP2, and WIF1 promoter methylation as predictors of prognosis. Confounders in our study were controlled by Propensity Score (PS) analysis.ResultsThe SFRP1, SFRP2, and WIF1 methylation levels in tumor tissues were significantly higher than that in adjacent non-tumor tissues (P < 0.001). SFRP2 hypermethylation was significantly associated with a favorable clinical outcome at the hazard ratio (HR) of 0.343 [95% confidence intervals (CI): 0.164–0.718, P = 0.005] and 0.410 (95% CI: 0.200–0.842, P = 0.015) in multivariate Cox regression and PS analysis, respectively. Co-hypermethylation of SFRP1 and SFRP2 was significantly associated with a favorable clinical outcome at the HR of 0.333 (95% CI: 0.159–0.694, P = 0.003) and 0.398 (95% CI: 0.192–0.821, P = 0.013) in multivariate Cox regression and PS analysis, respectively. Co-hypermethylation of SFRP1, SFRP2 and WIF1 was significantly associated with a favorable clinical outcome at the HR of 0.326 (95% CI: 0.117–0.908, P = 0.032) and 0.401 (95% CI: 0.146–1.106, P = 0.077) in multivariate Cox regression and PS analysis, respectively.ConclusionsSFRP1, SFRP2, and WIF1 were frequently hypermethylated in CRC tumor tissues. It was apparent that the promoter hypermethylation of SFRP2 and co-hypermethylation of SFRP1 and SFRP2 might be considered as independent prognostic predictors for survival advantage of postoperative CRC patients.

Identification of Serum Exosomal hsa-circ-0004771 as a Novel Diagnostic Biomarker of Colorectal Cancer.

Background: Exosomal circular RNAs (circRNAs) in peripheral blood are considered as emerging diagnostic biomarkers of cancers. Owing to the lack of sensitive and specific biomarkers, a large number of colorectal cancer (CRC) patients were diagnosed in advanced stages leading to high mortality. This study aimed to identify circulating exosomal circRNAs as novel diagnostic biomarkers of CRC.Materials and Methods: Candidate circRNA was selected by integrating analysis of Gene Expression Omnibus (GEO) database with online program GEO2R. A total of 170 patients and 45 healthy controls were enrolled to assess the diagnostic value of circRNAs for CRC. Exosomes isolated from the serum of participants and cell cultured media were confirmed by transmission electron microscope (TEM), Nanoparticle Tracking Analysis and western blot. The expression and the diagnostic utility of circRNA were tested by qRT-PCR and receiver operating characteristic (ROC) analysis, respectively.Results: The circulating exosomal hsa-circ-0004771 with most abundant among the top ten differentially expressed circRNAs (fold change ≥1.5) was selected for further study based on the results of GEO dataset analysis. The up-regulated exosomal hsa-circ-0004771 was verified in serum of CRC patients compared to healthy controls (HCs) and patients with benign intestinal diseases (BIDs) by qRT-PCR. The area under the ROC curves (AUCs) of circulating exosomal hsa-circ-0004771 were 0.59 (95%CI, 0.457–0.725), 0.86 (95%CI, 0.785–0.933) and 0.88 (95%CI, 0.815–0.940) to differentiate BIDs, stage I/II CRC patients and CRC patients from HCs, respectively. The AUC was 0.816 (95%CI, 0.728–0.9) to differentiate stage I/II CRC patients from patients with BIDs. In addition, the elevated expression of exosomal hsa-circ-0004771 in the serum of CRC patients was tumor-derived. It was found that the expression of exosomal hsa-circ-0004771 was down-regulated expression of in the serum of postoperative CRC patients as well as cultured media of CRC cells treated with GW4869.Conclusions: Circulating exosomal hsa-circ-0004771 was significantly up-regulated in CRC patients and served as a novel potential diagnostic biomarker of CRC.

DNA hypermethylation of MAL gene may act as an independent predictor of favorable prognosis in patients with colorectal cancer

Background: Aberrant DNA methylation could be used as biomarkers for colorectal cancer (CRC) detection and assessment of prognosis. The aim of our study was to investigate the potential possibility of MAL methylation as a prognostic biomarker for postoperative CRC patients. Methods: We followed up 298 sporadic postoperative CRC patients and detected MAL methylation in tumor tissues and adjacent non-tumor tissues by methylation-sensitive high resolution melting (MS-HRM) analysis. Univariate, multivariate Cox regressions were performed to evaluate the potential possibility of MAL methylation as a predictor of prognosis. Propensity score (PS) analysis was used to control confounders. Results: The MAL methylation level in adjacent non-tumor tissues was significantly lower than that in tumor tissues (P<0.001). The MAL methylation had no significant correlation with clinicopathologic characteristics. MAL hypermethylation was detected in 63.4% (189/298) tumor tissues. The overall 5-year survival rates in hypermethylation and hypomethylation group were 70.78% and 55.69% (P=0.007). MAL hypermethylation was significantly associated with a favorable clinical outcome, the hazard ratio (HR) were 0.650 [95% confidence interval (CI): 0.454–0.929, P=0.018], 0.613 (95% CI: 0.422–0.889, P=0.010) and 0.692 (95% CI: 0.481–0.996, P=0.047) in univariate, multivariate Cox and PS method, respectively. The subgroup analysis showed that MAL hypermethylation in CRC patients with lower diagnosis age (<60) and colon cancer had a lower risk of death than MAL hypomethylation patients. Conclusions: MAL was frequently hypermethylated in CRC tumor tissues. MAL hypermethylation might act as an independent prognostic predictor of survival advantage in postoperative patients with CRC.

DNA hypermethylation of MAL gene may act as an independent predictor of favorable prognosis in patients with colorectal cancer

BackgroundAberrant DNA methylation could be used as biomarkers for colorectal cancer (CRC) detection and assessment of prognosis. The aim of our study was to investigate the potential possibility of MAL methylation as a prognostic biomarker for postoperative CRC patients.MethodsWe followed up 298 sporadic postoperative CRC patients and detected MAL methylation in tumor tissues and adjacent non-tumor tissues by methylation-sensitive high resolution melting (MS-HRM) analysis. Univariate, multivariate Cox regressions were performed to evaluate the potential possibility of MAL methylation as a predictor of prognosis. Propensity score (PS) analysis was used to control confounders.ResultsThe MAL methylation level in adjacent non-tumor tissues was significantly lower than that in tumor tissues (P<0.001). The MAL methylation had no significant correlation with clinicopathologic characteristics. MAL hypermethylation was detected in 63.4% (189/298) tumor tissues. The overall 5-year survival rates in hypermethylation and hypomethylation group were 70.78% and 55.69% (P=0.007). MAL hypermethylation was significantly associated with a favorable clinical outcome, the hazard ratio (HR) were 0.650 [95% confidence interval (CI): 0.454–0.929, P=0.018], 0.613 (95% CI: 0.422–0.889, P=0.010) and 0.692 (95% CI: 0.481–0.996, P=0.047) in univariate, multivariate Cox and PS method, respectively. The subgroup analysis showed that MAL hypermethylation in CRC patients with lower diagnosis age (<60) and colon cancer had a lower risk of death than MAL hypomethylation patients.ConclusionsMAL was frequently hypermethylated in CRC tumor tissues. MAL hypermethylation might act as an independent prognostic predictor of survival advantage in postoperative patients with CRC.

Dehydrogenase/reductase SDR family member2 silencing sensitizes an oxaliplatin‑resistant cell line to oxaliplatin by inhibiting excision repair cross‑complementing group 1 protein expression.

Oxaliplatin (Oxa)-based chemotherapy is widely used as the first-line treatment for colorectal cancer (CRC). However, Oxa-resistance is common for many postoperative CRC patients. To explore drug resistance in CRC, an Oxa-resistant cell line, HCT116/Oxa, was established from parental HCT116 cells. These Oxa-resistant cells exhibited characteristics of epithelial-mesenchymal transition (EMT) and a higher migratory capacity than parental cells. Protein profiles of HCT116/Oxa and HCT116 cells were compared using a tandem mass tag-based quantitative proteomics technique. The protein dehydrogenase/reductase SDR family member 2 (DHRS2) was revealed to be highly expressed in HCT116/Oxa cells. Silencing of DHRS2 in HCT116/Oxa cells effectively restored Oxa-sensitivity by suppressing the expression of excision repair cross-complementing group 1 protein via a p53-dependent pathway, and reversed the EMT phenotype. Overall, the suppression of DHRS2 expression may be a promising strategy for the prevention of Oxa-resistance in CRC.

Development process of an evidence-based exercise program for post-operative colorectal cancer patients.

Exercise is generally accepted to be beneficial for colorectal cancer patients; however, very few studies have investigated the effects of exercise on patient care and health outcomes during the immediate post-operative recovery period. Furthermore, very few studies have investigated the safety, feasibility, and efficacy of exercise on post-operative cancer patients. Although intervention programs should be based on solid evidence from clinical trials, the majority of previous studies have not presented the development process of the intervention programs. This paper describes a ten-step development process of an inpatient exercise program for colorectal cancer patients after colectomy. The development process is composed of the following ten steps: systematic literature review, understanding patient characteristics via patient survey, first expert group discussion, development of the first draft exercise program, pretest, focus group interview, second expert group discussion, pilot study, randomized controlled trial, and the final exercise program development. The exercise program developed through the ten-step process was divided into three phases according to the patients' condition. For all three phases, patients performed the exercises two times a day, once under supervision. Any specific exercises that caused pain on a given day were excluded from the exercise program for that day. The exercise program reduced the length of hospital stay and time to flatus in colorectal cancer patients after surgery. This study reports a safe and effective means to develop an evidence-based exercise program not only for colorectal cancer patients but also for other population groups.

Rabeprazole intake does not affect systemic exposure to capecitabine and its metabolites, 5'-deoxy-5-fluorocytidine, 5'-deoxy-5-fluorouridine, and 5-fluorouracil.

Several retrospective studies have shown that the antitumor efficacy of capecitabine-containing chemotherapy decreases when co-administered with a proton pump inhibitor (PPI). Although a reduction in capecitabine absorption by PPIs was proposed as the underlying mechanism, the effects of PPIs on capecitabine pharmacokinetics remain unclear. We prospectively examined the effects of rabeprazole on the pharmacokinetics of capecitabine and its metabolites. We enrolled patients administered adjuvant capecitabine plus oxaliplatin (CapeOX) for postoperative colorectal cancer (CRC) patients and metastatic CRC patients receiving CapeOX with/without bevacizumab. Patients receiving a PPI before registration were allocated to the rabeprazole group, and the PPI was changed to rabeprazole (20mg/day) at least 1week before the initiation of capecitabine treatment. On day 1, oral capecitabine (1000mg/m2) was administered 1h after rabeprazole intake. Oxaliplatin (and bevacizumab) administration on day 1 was shifted to day 2 for pharmacokinetic analysis of the first capecitabine dose. Plasma concentrations of capecitabine, 5'-deoxy-5-fluorocytidine, 5'-deoxy-5-fluorouridine, and 5-fluorouracil were analyzed by high-performance liquid chromatography. Effects of rabeprazole on inhibition of cell proliferation by each capecitabine metabolite were examined with colon cancer cells (COLO205 and HCT116). Five and 9 patients enrolled between September 2017 and July 2018 were allocated to rabeprazole and control groups, respectively. No significant effects of rabeprazole on area under the plasma concentration-time curve divided by capecitabine dose for capecitabine and its three metabolites were observed. Rabeprazole did not affect the proliferation inhibition of colon cancer cells by the respective capecitabine metabolites. Rabeprazole does not affect capecitabine pharmacokinetics.

Association and diagnostic value of serum SPINK4 in colorectal cancer.

The role of serum serine peptidase inhibitor, Kazal type 4 (SPINK4), in colorectal cancer (CRC) is largely unknown. This study aimed to explore the association and diagnostic value of serum SPINK4 in CRC. A total of 70 preoperative CRC patients, 30 postoperative CRC patients, 30 gastric cancer patients, and 30 healthy controls were enrolled. Using enzyme-linked immunosorbent assays, we found that the serum SPINK4 level was significantly increased in preoperative CRC compared with postoperative CRC patients, gastric cancer patients, and healthy controls (p < 0.05). The serum SPINK4 level was remarkably elevated in colon cancer compared with rectal cancer and was enhanced in the M1 stage compared with the M0 stage (p < 0.05). The area under the receiver operating characteristic curve of serum SPINK4 level in the diagnosis of CRC was 0.9186, with a sensitivity and specificity of 0.886 and 0.900, respectively, and a cut-off value of 2.065. There was no significant difference between high and low expression of serum SPINK4 regarding the overall survival time and disease-free survival (p > 0.05). This study demonstrated that the serum SPINK4 level increased in CRC and was associated with the location and distant metastasis of CRC. It had a high diagnostic value in CRC but was not associated with the survival of CRC patients.

Gut microbiota in patients after surgical treatment for colorectal cancer.

SummaryColorectal cancer (CRC) is a common disease worldwide that is strongly associated with the gut microbiota. However, little is known regarding the gut microbiota after surgical treatment. 16S rRNA gene sequencing was used to evaluate differences in gut microbiota among colorectal adenoma patients, CRC patients, CRC postoperative patients and healthy controls by comparing gut microbiota diversity, overall composition and taxonomic signature abundance. The gut microbiota of CRC patients, adenoma patients and healthy controls developed in accordance with the adenoma‐carcinoma sequence, with impressive shifts in the gut microbiota before or during the development of CRC. The gut microbiota of postoperative patients and CRC patients differed significantly. Subdividing CRC postoperative patients according to the presence or absence of newly developed adenoma which based on the colonoscopy findings revealed that the gut microbiota of newly developed adenoma patients differed significantly from that of clean intestine patients and was more similar to the gut microbiota of carcinoma patients than to the gut microbiota of healthy controls. The alterations of the gut microbiota between the two groups of postoperative patients corresponded to CRC prognosis. More importantly, we used the different gut microbiota as biomarkers to distinguish postoperative patients with or without newly developed adenoma, achieving an AUC value of 0.72. These insights on the changes in the gut microbiota of CRC patients after surgical treatment may allow the use of the microbiota as non‐invasive biomarkers for the diagnosis of newly developed adenomas and to help prevent cancer recurrence in postoperative patients.

The influence of Thymidine Phosphorylase genetic variation on clinical outcomes and safety of colorectal cancer patients received adjuvant chemotherapy after R0 resection

Objective: To study the association between Thymidine Phosphorylase (TYMP) genetic variation and clinical outcomes and safety of postoperative colorectal cancer (CRC) patients. Methods: A total of 235 patients with colorectal cancer underwent surgical treatment were included in this retrospective analysis. Peripheral blood and the postoperative tissue specimen of the CRC patients were collected for the genotyping of polymorphism and TYMP mRNA expression, respectively. The correlation between polymorphism and clinical outcomes and safety of postoperative CRC patients were analysed. Results: Located in the upstream, 5633C>T was of clinical significance. The prevalence of 5633C>T in TYMP among the CRC patients were as follows: CC genotype 149 cases (63.40%), CT genotype 73 cases (31.06%), TT genotype 13 cases (5.54%), minor allele frequency of 5633C>T is 0.21. The distribution of three genotypes was in accordance with Hardy-Weinberg Equilibrium (P=0.313). CT genotype and TT genotype patients were merged in the comparison of prognosis. The survival analysis of patients with different genotypes found that the median Overall Survival (OS) of CT/TT genotype and CC genotype were 5.8 and 4.5 year, which was statistically significant (P=0.009). Adjusted in multivariate Cox regression analysis, CT/TT genotype was an independent favorable factor for OS (HR=0.67, P=0.015). Additionally, of the 87 postoperative tissue specimens, the results showed that the expression of TYMP in cancer tissues of the patients with CT or TT genotypes were significantly higher than those of the wild type CC genotype patients (P=0.019). And the safety analysis showed that the incidence of grade 3 hand-foot syndrome among CT/TT genotype patients were higher than that of CC genotype patients (33.72% vs 20.13%, OR=1.68, P=0.021). Conclusion: The polymorphism 5633C>T of TYMP may impact the prognosis of CRC patients received adjuvant chemotherapy by influencing the mRNA expression of TYMP.

Effect of extended nursing care on quality of life in postoperative patients with colorectal cancer

Objective To explore the effect of extended nursing service on quality of life of postoperative colorectal cancer patients. Methods A total of 150 patients with colorectal cancer who underwent colorectal cancer surgery from May 2013 to October 2016 were randomly divided into observation group and control group, 75 cases of each group.The patients were followed up for 3 months, 6 months and 1 year after discharge.The patients of the observation group were extended nursing services such as family follow-up, telephone follow-up and fellowship activities.Patients were assessed with QLQ-C30 quality of life questionnaire(QLQ-C30). Results The physical function, role function, emotional function, cognitive function, social function and overall health of the observation group were significantly higher than those of the control group after extended nursing intervention for 3 months, 6 months and 1 year, and the differences were statistically significant(P<0.05). Conclusion Extended nursing care for postoperative colorectal cancer patients can improve their knowledge and social communication ability, and improve the quality of life of patients. Key words: Extended care; Colorectal cancer; Postoperative stoma; Quality of life

Plasma metabolic profiling on postoperative colorectal cancer patients with different traditional Chinese medicine syndromes

ObjectivesThis study aims to investigate the metabolic profiles of postoperative colorectal cancer (PCRC) patients with different traditional Chinese medicine (TCM) syndromes and to discuss the metabolic mechanism under PCRC progression and TCM syndrome classification. MethodsFifty healthy controls (HC) and 70 PCRC patients, including 10 Dampness and heat syndrome (DHS), 33 Spleen deficiency syndrome (SDS), 19 Liver and kidney Yin deficiency syndrome (LKYDS) and 8 with non-TCM syndrome (NS) were enrolled. Plasma metabolic profiles were detected by Gas chromatography-mass spectrometry (GC–MS) and analyzed by principal component analysis (PCA) and partial least squares-discriminate analysis (PLS-DA). Furthermore, pathway enrichment was analyzed based on KEGG and DAVID databases and metabolic network was constructed via metaboanalyst and cytoscape. ResultsThe top-3 metabolites with higher abundance in PCRC compared with HC were terephthalic acid (165.417-fold), ornithine (24.484-fold) and aminomalonic acid (21.346-fold). And the cholesterol (0.588-fold) level was decreased in PCRC. l-Alanine, 1, 2-ethanediamine, urea, glycerol, glycine, aminomalonic acid, creatinine and palmitic acid were specifically altered in the DHS, while d-tryptophan was exclusively changed in SDS, and l-proline, 1, 2, 3-propanetricarboxylic acid, d-galactose and 2-indolecarboxylic acids in LKYDS. ConclusionsThe plasma metabolic profiles were perturbed in PCRC patients. Increased levels of terephthalic acid might indicate high risk of relapse and elevated ornithine may contribute to the post-operational recovery or may raise the susceptibility to PCRC recurrence. The metabolic profiles of DHS, SDS, LKYDS and NS were almost separately clustered, indicating the possibility of explaining TCM syndromes classification using metabolomics. Furthermore, creatinine and aminomalonic acid alternation might correlate with the formation of DHS, while d-tryptophan may associate with SDS and d-galactose and 1, 2, 3-propanetricarboxylic acid may relate to LKYDS. As numbers of patients in each TCM syndrome are small, further study is needed to verify those results.

Characteristic proteins in the plasma of postoperative colorectal and liver cancer patients with Yin deficiency of liver-kidney syndrome.

Systems biology and bioinformatics provide the feasibility for the basic research associated with “same traditional Chinese medicine (TCM) syndrome in different diseases”. In this study, the plasma proteins in postoperative colorectal (PCC) and postoperative liver cancer (PLC) patients with YDLKS (Yin deficiency of liver-kidney syndrome) were screened out using iTRAQ combined with LC-MS/MS technology. The results demonstrated that, KNG1, AMBP, SERPING1, etc, were all differentially expressed in both PCC and PLC patients with YDLKS, and associated closely with complement and coagulation cascades pathway. C7 and C2 were another two representative factors involving in former pathway. Further validation showed that, the C7 levels were increased significantly in PLC (P < 0.05) and PCC (P < 0.05) with YDLKS group compared to those of NS (no obvious TCM syndromes) group. The AMBP levels were down-regulated significantly in PLC with YDLKS group compared to those of PCC with YDLKS group (P < 0.05). The significant differences of SERPING1 levels (and C2 levels) were shown between YDLKS and NS in PCC (P < 0.01). There were also significant differences of C2 levels between PCC and PLC patients with YDLKS (P < 0.05). Moreover, significant differences of C2 levels were also found between PLC and PCC patients with YDLKS (P < 0.01). ROC curves indicated that, C7 and SERPING1 independently had a potential diagnostic value in distinguishing YDLKS from NS in PLC and PCC, providing the evidences for the material basis of “same TCM syndrome in different diseases” in PCC and PLC patients with YDLKS.

Clinical value of circulating tumor cells detection in patients with colorectal cancer

Objective To investigate the association between the positive rate of circulating tumor cells (CTC) and clinicopathological parameters, recurrence and metastasis in patients with colorectal cancer. Methods 7.5 ml peripheral blood of 138 cases of newly diagnosed colorectal cancer who met inclusion criteria, 82 post-operative cases of colorectal cancer and 34 healthy controls were collected. The CTC was enriched by beads which packaged the anti epithelial cell adhesion molecule and counting the CTC (CK+ DAPI+ CD45-). To investigate the association between the preoperative positive rate of CTC and clinicopathological parameters, and the relationship between the positive rate of CTC and recurrence and metastasis in post-operative colorectal cancer patients who have not accepted any therapy more than one month. Results The positive rate of CTC in patients with colorectal cancer and healthy controls were 47.1% (65/138), and 0 (0/34) respectively, and the difference was statistically significant (χ 2= 25.743, P 0.05); The significant association between the positive rate of CTC and N or M staging was found. CTC positive rates in N0, N1, N2 stage were 38.3% (23/60), 37.9% (11/29), and 63.9% (23/36) respectively (χ 2= 6.819, P= 0.033); CTCs positive rates of M0, M1 stage were 38.0% (38/100) and 71.1% (27/38) respectively, and there was a statistical difference (χ 2= 12.074, P= 0.001). In 82 post-operative cases of colorectal cancer, the positive rates of CTC were 51.6% (32/62) and 90.0% (18/20) in non-recurrence and recurrence, respectively, and the difference was statistically significant (χ 2= 9.365, P= 0.002). Conclusion CTC detection may assess the occurrence of metastasis and recurrence in colorectal cancer patients. Key words: Colorectal neoplasms; Circulating tumor cells; Clinical value

Effect of Probiotic Giving on Digestive Function in Patients Post-Perforated Colorectal Cancer surgery

Background: One of the goals of colorectal cancer surgery is to facilitate the digestive tract to function properly. Surgery performed can lead new problems such as infection, sepsis, postoperative pain, and nausea vomiting. Modulation of perioperative nutrition of intestinal microbiota such as probiotics is more and more applied as a strategy to reduce complications of elective surgical infection and accelerate the improvement of gastrointestinal symptoms such as flatus and defecation. The purpose of this study was to analyze the effect of giving probiotics on digestive function in patients after colorectal cancer surgery. Subjects and Methods: The subjects of this study were postoperative patients with colorectal cancer, with a total sample of 20. The sampling technique used non-random sampling. This type of the study is quasi experimental design with Post-test Only Control Design method. In this design, the sample is divided into two groups namely, group I was given probiotics and group II was not given probiotics then the follow up treatmen was conducted to assess the effect on the digestive function of patients after colorectal cancer surgery. Results: The majority of post-operative colorectal cancer patients were> 50 years (85%). The sex of post operative patients with colorectal cancer balanced between men and women, which was equally 50%. There was a significant difference between intestinal bowel surgery after colorectal cancer surgery which was given probiotics with no probiotics given (p <0.05). Similarly, post operative flatus colorectal cancer patients also had significant differences with the values (p <0.05). As for the defecation patients of post-surgery colorectal cancer , there was also a significant difference between the defecation patients of post-surgery of colorectal cancer surgery given probiotics and those not given probiotics with values (p <0.05). Conclusion: statistically, there was an effect of giving probiotics to digestive function including bowel sound, flatus, and defecation of post-surgery patient of colorectal cancer. Keywords: Probiotics, digestive function, colorectal cancer Corespondence: Impol Hutapea. Masters Program in Family Medicine, Sebelas Maret University. Email: papihamora@gmail.com Indonesian Journal of Medicine (2017), 2(2): 107-115 https://doi.org/10.26911/theijmed.2017.02.02.05

Prognostic Prediction Models for Colorectal Cancer Patients After Curative Resection

To develop a prediction tool for recurrence and survival in colorectal cancer (CRC) patients following surgically curative resections. We developed a reliable prediction model for CRC patients after surgically curative resections. Using clinicopathologic factors, novel prediction models were constructed with the area under the curve (AUC) of 0.841 and 0.876 for DFS and CSS, respectively. Between January 2004 and December 2007, 376 CRC patients were investigated at the Osaka Medical Center for Cancer and Cardiovascular Diseases. Patients with at least 1 of the following criteria were excluded: preoperative treatment, synchronous distant metastasis, noncurative resection, and incomplete follow-up after operation. All patients were retrospectively analyzed. A Cox proportional hazards model was used to develop a prediction model for disease-free survival (DFS) and cancer-specific survival (CSS). In univariate and multivariate analyses of clinicopathologic factors, the following factors had significant correlation with DFS and CSS: tumor location, preoperative serum carcinoembryonic antigen (CEA), pathologically defined tumor invasion, and lymph node metastasis. Using these variables, novel prediction models were constructed by the logistic regression model with AUC of 0.840 and 0.876 for DFS and CSS, respectively. The prediction models were validated by external datasets in an independent patient group. This study showed novel and reliable personalized prognostic models, integrating not only TNM factors but also tumor location and preoperative serum CEA to predict patient prognosis. These individualized prediction models could help clinicians in the treatment of postoperative CRC patients.

789 - Development of a deregulating MicroRNA panel for the detection of early relapse in postoperative colorectal cancer patients

789 - Development of a deregulating MicroRNA panel for the detection of early relapse in postoperative colorectal cancer patients

Development of a deregulating microRNA panel for the detection of early relapse in postoperative colorectal cancer patients.

BackgroundColorectal cancer (CRC) is the third leading cause of cancer mortality worldwide and is associated with high recurrence and mortality, despite recent advancements in therapeutic strategies. MicroRNA (miR) deregulation is associated with CRC development and recurrence; therefore, miRs may be reliable biomarkers for detecting early relapse postoperatively.MethodsIn this study ten candidates were identified using miR arrays: miR-7, miR-31, miR-93, miR-141, miR-195, miR-375, miR-429, miR-494, miR-650, and let-7b. Substantial differences were observed in their expression levels between early relapsed (recurrences within 12 months after surgery) and non-early relapsed CRC patients. The validation study, including 50 early relapsed and 54 non-early relapsed patients, confirmed miR expression alterations in cancer tissue samples.ResultsUsing a miR real-time quantitative polymerase chain reaction (RT-qPCR), we observed that expression levels of miR-93, miR-195, and let-7b were significantly decreased, whereas those of miR-7, miR-141 and miR-494 showed increases that were more significant in the CRC tissue samples from the early relapsed patients than in those from the non-early relapsed patients. Disease-free survival and overall survival were significantly worse in the high miR-7, miR-141, and miR-494 expression subgroups and the low miR-93 and miR-195 expression subgroups (all P < 0.05). A panel of 6 miRs (miR-7, miR-93, miR-195, miR-141, miR-494, and let-7b), at a cut-off value of 2 deregulated miRs, distinguished early relapsed CRC from non-early relapsed CRC, with a sensitivity of 76.6 % and a specificity of 71.4 %. By combining this 6-miRs panel with 6 clinicopathologic factors, at a cut-off value of 4, distinguished early relapsed CRC from non-early relapsed CRC, with a sensitivity of 89.4 % and a specificity of 88.9 %.ConclusionsThis study showed that the developed miR panel has the potential to improve predicting early relapse in CRC patients.