Early Treatment Of Colorectal Cancer Research Articles

Chinese national clinical practice guidelines on prevention, diagnosis and treatment of early colorectal cancer.

The incidence and mortality of colorectal cancer (CRC) in China are increasing in recent years. The clarified pathogenesis and detectable precancerous lesions of CRC make it possible to prevent, screen, and diagnose CRC at an early stage. With the development of endoscopic and surgical techniques, the choice of treatment for early CRC is also worth further discussion, and accordingly, a standard follow-up program after treatment needs to be established. This clinical practice guideline (CPG) was developed following the recommended process of the World Health Organization, adopting Grading of Recommendations Assessment, Development and Evaluation (GRADE) in assessing evidence quality, and using the Evidence to Decision framework to formulate clinical recommendations, thereby minimizing bias and increasing transparency of the CPG development process. We used the Reporting Items for practice Guidelines in HealThcare (RIGHT) statement and Appraisal of Guidelines for Research and Evaluation II (AGREE II) as reporting and conduct guides to ensure the guideline's completeness and transparency. This CPG comprises 46 recommendations concerning prevention, screening, diagnosis, treatment, and surveillance of CRC. In these recommendations, we have indicated protective and risk factors for CRC and made recommendations for chemoprevention. We proposed a suitable screening program for CRC based on the Chinese context. We also provided normative statements for the diagnosis, treatment, and surveillance of CRC based on existing clinical evidence and guidelines. The 46 recommendations in this CPG are formed with consideration for stakeholders' values and preferences, feasibility, and acceptability. Recommendations are generalizable to resource-limited settings with similar CRC epidemiology pattern as China.

ENDOSCOPIC TREATMENT FOR EARLY COLORECTAL CANCER

Relevance: In recent years, significant breakthroughs have occurred in the endoscopic treatment of cancerous and precancerous lesions of the gastrointestinal tract. Endoscopic mucosal resection (EMR) is a simple and effective method of treating most benign gastrointestinal tract lesions. However, with the introduction of endoscopic submucosal dissection (ESD) and full-thickness endoscopic resection (EFTR), the volume of lesions subject to endoscopic treatment has significantly expanded even in the colon. Currently, these methods are regularly used not only for the treatment of benign tumors but also for complex resection of early stages of colorectal cancer. For the first time in Kazakhstan, the presented article analyzed the cases of endoscopic removal of epithelial formations of the large intestine performed at an oncological clinic from 2020 to 2023.
 The aim was to evaluate the use of endoscopic treatment of early colorectal cancer.
 Methods: The article presents a retrospective analysis of 68 cases of endoscopic removal of epithelial formations of the colon performed from 2020 to 2023 at the Center of Expert Endoscopy and Interventional Radiology of the National Scientific Cancer Center (Astana, Kazakhstan).
 Results: In 2020-2023, 68 endoscopic extractions of colon tumors were performed, including 25 outpatient and 43 inpatient manipulations. Out of 43 inpatient cases, endoscopic dissection in the submucosal layer was performed in 9 cases, and endoscopic mucosal resection of tumors of the large intestine was performed in 34 cases. Morphologically, we found hyperplastic polyps in 11 cases, lipomas in 2 cases, tubulovillous adenomas with mild dysplasia – 43 cases, tubulovillous adenomas with severe dysplasia – 11 cases, carcinoma in situ – 3 cases, and adenocarcinoma with invasion – 3 cases.
 Conclusion: When detecting benign neoplasms with dysplasia and early colorectal cancer, minimally invasive technologies (EMR, ESD, EFTR) should be the first preferred treatment method and only if they cannot be performed and there is a high risk of invasion into the underlying layers, and therefore, if endoscopic treatment is not radical, clinicians should choose surgical radical treatment. Patients should be informed about the availability of the latest methods of local treatment in the Republic through the financing of the Compulsory Medical Insurance Fund (CMIF).

ENDOSCOPIC TREATMENT FOR EARLY COLORECTAL CANCER

Relevance: In recent years, significant breakthroughs have occurred in the endoscopic treatment of cancerous and precancerous lesions
 of the gastrointestinal tract. Endoscopic mucosal resection (EMR) is a simple and effective method of treating most benign gastrointestinal
 tract lesions. However, with the introduction of endoscopic submucosal dissection (ESD) and full-thickness endoscopic resection (EFTR), the
 ЛЕЧЕНИЕ
 38 Онкология и Радиология Казахстана, №4 (70) 2023
 volume of lesions subject to endoscopic treatment has significantly expanded even in the colon. Currently, these methods are regularly used
 not only for the treatment of benign tumors but also for complex resection of early stages of colorectal cancer. For the first time in Kazakhstan,
 the presented article analyzed the cases of endoscopic removal of epithelial formations of the large intestine performed at an oncological clinic
 from 2020 to 2023.
 The aim was to evaluate the use of endoscopic treatment of early colorectal cancer.
 Methods: The article presents a retrospective analysis of 68 cases of endoscopic removal of epithelial formations of the colon performed from
 2020 to 2023 at the Center of Expert Endoscopy and Interventional Radiology of the National Scientific Cancer Center (Astana, Kazakhstan).
 Results: In 2020-2023, 68 endoscopic extractions of colon tumors were performed, including 25 outpatient and 43 inpatient manipulations.
 Out of 43 inpatient cases, endoscopic dissection in the submucosal layer was performed in 9 cases, and endoscopic mucosal resection of tumors
 of the large intestine was performed in 34 cases. Morphologically, we found hyperplastic polyps in 11 cases, lipomas in 2 cases, tubulovillous
 adenomas with mild dysplasia – 43 cases, tubulovillous adenomas with severe dysplasia – 11 cases, carcinoma in situ – 3 cases, and adenocarcinoma with invasion – 3 cases.
 Conclusion: When detecting benign neoplasms with dysplasia and early colorectal cancer, minimally invasive technologies (EMR, ESD,
 EFTR) should be the first preferred treatment method and only if they cannot be performed and there is a high risk of invasion into the underlying layers, and therefore, if endoscopic treatment is not radical, clinicians should choose surgical radical treatment. Patients should
 be informed about the availability of the latest methods of local treatment in the Republic through the financing of the Compulsory Medical
 Insurance Fund (CMIF)

Risk factors for residual cancer or lymph node metastasis after endoscopic noncurable resection of early colorectal cancer

Objective: Risk factors related to residual cancer or lymph node metastasis after endoscopic non-curative resection of early colorectal cancer were analyzed to predict the risk of residual cancer or lymph node metastasis, optimize the indications of radical surgical surgery, and avoid excessive additional surgical operations. Methods: Clinical data of 81 patients who received endoscopic treatment for early colorectal cancer in the Department of Endoscopy, Cancer Hospital, Chinese Academy of Medical Sciences from 2009 to 2019 and received additional radical surgical surgery after endoscopic resection with pathological indication of non-curative resection were collected to analyze the relationship between various factors and the risk of residual cancer or lymph node metastasis after endoscopic resection. Results: Of the 81 patients, 17 (21.0%) were positive for residual cancer or lymph node metastasis, while 64 (79.0%) were negative. Among 17 patients with residual cancer or positive lymph node metastasis, 3 patients had only residual cancer (2 patients with positive vertical cutting edge). 11 patients had only lymph node metastasis, and 3 patients had both residual cancer and lymph node metastasis. Lesion location, poorly differentiated cancer, depth of submucosal invasion ≥2 000 μm, venous invasion were associated with residual cancer or lymph node metastasis after endoscopic (P<0.05). Logistic multivariate regression analysis showed that poorly differentiated cancer (OR=5.513, 95% CI: 1.423, 21.352, P=0.013) was an independent risk factor for residual cancer or lymph node metastasis after endoscopic non-curative resection of early colorectal cancer. Conclusions: For early colorectal cancer after endoscopic non-curable resection, residual cancer or lymph node metastasis is associated with poorly differentiated cancer, depth of submucosal invasion ≥2 000 μm, venous invasion and the lesions are located in the descending colon, transverse colon, ascending colon and cecum with the postoperative mucosal pathology result. For early colorectal cancer, poorly differentiated cancer is an independent risk factor for residual cancer or lymph node metastasis after endoscopic non-curative resection, which is suggested that radical surgery should be added after endoscopic treatment.

Long-term trend of colorectal cancer survival rate in Qidong, 1972-2016

Objective: The survival of colorectal cancer in Qidong City, Jiangsu Province from 1972 to 2016 was analyzed to provide a basis for the evaluation of prognosis and the formulation of prevention and control measures. Methods: Colorectal cancer data were obtained from the Qidong Cancer Registration and Reporting System, and the follow-up was up to December 31, 2021. The observed survival rate (OSR) and relative survival rate (RSR) were calculated by SURV 3.01 software, and the trend test was performed by Hakulinen's likelihood ratio test. The Joinpoint regression model was used to calculate the average annual percentage change (AAPC) of survival, and the ARIMA model was used to predict the trend of colorectal cancer survival. Results: There were 8 637 new cases of colorectal cancer in Qidong from 1972 to 2016. Dividing 1972-2016 into 9 periods at 5-year intervals, the 5-year OSR from 1972-1976 to 2012-2016 increased from 21.86% to 48.86%, and the 5-year RSR increased from 26.45% to 59.91%. The increasing trend of RSR was statistically significant (χ(2)=587.47, P<0.001). From 1972 to 2016, the survival rates of colorectal cancer in different sexes in Qidong were similar, and the 5-year RSR was 44.63% for men and 44.07% for women. Since the 1990s, the 5-year OSR and RSR for men have been lower than those for women. From 1972 to 2016, the 5-year RSR of colorectal cancer in Qidong was significantly improved in the 65-74 and ≥75-year-old groups, but the survival rate of the ≥75-year-old group was still the lowest (36.78%), followed by the 35-44-year-old group ( 43.04%). The time trend showed that the overall AAPC of colorectal cancer 5-year RSR in Qidong from 1972 to 2016 was 2.50% (t=16.45, P<0.001). The upward trend of different sexes was consistent, and the increase was greater in women (AAPC for males=2.18%, AAPC for females=2.54%, both P<0.05). The 5-year RSR of colorectal cancer in each age group showed an upward trend, and the AAPCs of the 35-44, 45-54, 55-64, 65-74, and ≥75-year-old groups were 1.54%, 1.83%, 2.00%, 3.51% and 4.35%, respectively (all P<0.05). The prediction results of colorectal cancer survival rate showed that the 5-year RSR of colorectal cancer in Qidong will increase to 71.62% by 2026. Conclusions: The overall survival rate of colorectal cancer patients in Qidong has been greatly improved, but there is still room for improvement. We should continue to pay attention to the early diagnosis and early treatment of colorectal cancer.

Endoscopic diagnosis and treatment of early colorectal cancer and precancerous lesions: current status and future prospects

Early detection of colorectal cancer and precursor lesions under colonoscopy, and timely and optimal treatment remain the crucial means for reducing colorectal cancer-related deaths. In this article, we focused on the hot spots in recent years, reviewed the progress of endoscopic diagnosis and treatment of serrated lesions and inflammatory bowel disease (IBD)-related dysplasia, the application of endocytoscopy and the management of early colorectal cancer/precancerous lesions, and provided new prospects for future studies.

Long-term prognosis of curative endoscopic submucosal dissection for early colorectal cancer according to submucosal invasion: a multicenter cohort study

BackgroundEndoscopic submucosal dissection (ESD) can provide a high en bloc resection rate and has been widely applied as curative treatment for early colorectal cancer (ECC). However, surgical treatment is occasionally required, and reports on the long-term prognosis of ESD are insufficient. This study aimed to investigate the long-term outcomes of ECC removal by ESD, including local recurrence and metastasis.MethodsThis multicenter study was conducted retrospectively on 450 consecutive patients with ECC who were treated with ESD between November 2003 and December 2013. Clinical, pathological, and endoscopic data were collected to determine tumor depth, resection margin, lymphovascular invasion, and recurrence.ResultsThe median follow-up period was 53.8 (12–138 months). The en bloc resection rate was 85.3% (384) and in intramucosal cancer being 84.1% and in superficial submucosal invasion (SM1) cancer being 89.8% (p = 0.158). The curative resection rate was 76.0% (n = 342), and there was no statistical difference between the two groups (77.3% vs. 71.4%, p = 0.231). The overall recurrence free survival rate (RFS) was 98.7% (444/450). In patients with curative resection, there was no statistically significant difference in RFS according to invasion depth (intramucosal: 99.3% vs. SM1: 97.1%, p = 0.248).ConclusionsPatients with curatively resected ECC treated with ESD showed favorable long-term outcomes. Curatively resected SM1 cancer has a RFS similar to that of intramucosal cancer.

Direction of diagnosis and treatment improvement in colorectal cancer

Background: Cancer is a major public health problem and the leading cause of death in Korea since 2000. Colorectal cancer is the third leading cause of cancer-related death. Therefore, early detection through screening, surgical techniques improvement, anticancer drugs, adjuvant treatment, and medical resources advancement is important to reduce colorectal cancer-related mortality.Current Concepts: In Korea, the 5-year relative survival rate of patients with colorectal cancer is approximately mid-70%, which is superior to other developed countries, such as the United States, United Kingdom, and Japan, with 60% to 68% because of the well performed screening program and technical improvement. Efforts are underway to conduct active endoscopic treatment for early colorectal cancer and identify cases requiring surgery. Minimally invasive surgery has evolved beyond conventional applications into disease-specific methods, and the robotic system has an important role for evolvement. Performing metastatic colorectal cancer efforts is necessary to improve the survival rate through active surgical treatment and gene therapy.Discussion and Conclusion: Eventually, the role of the patient’s genetic information in diagnosing and treating colorectal cancer is expected to increase. In some cases, diagnosing colorectal cancer using a non-invasive method is already realized. Active surgical treatment based on personal characteristics contributes in improving the treatment outcomes for difficult-to-treat metastatic colorectal cancer. After the period of overall colorectal cancer treatment results improvement, we will undertake the precision treatment era.

Endoscopic diagnosis and treatment of early colorectal cancer.

Early colorectal cancer refers to cancer in the colorectum that is confined to the mucosa or submucosa and does not invade the muscularis propria, irrespective of lymph node or distant metastasis. As the number of persons undergoing screening colonoscopy increases, the proportion of patients diagnosed with precancerous colorectal lesions and early colorectal cancer also increases. In the last decade, innovative optical technologies for endoscopic diagnosis have been introduced and endoscopic treatment techniques such as endoscopic submucosal dissection have provided major breakthroughs in the management of early colorectal cancer. With these remarkable developments, endoscopic treatment has established itself as an alternative to surgical resection in the treatment of early colorectal cancer. This review will discuss the endoscopic diagnosis and treatment of early colorectal cancer. Furthermore, the unmet needs in this field and the latest research addressing those issues will be summarized.

Minimally invasive treatments for early colorectal cancer: comparison of endoscopic resection and laparoscopic surgery.

Endoscopic treatment and laparoscopic surgery are minimally invasive options for early treatment of colorectal cancer, however, more evidence of the long-term outcomes between the two procedures is needed to guide clinical decisions. Therefore, this study aimed to compare the oncologic outcomes between endoscopic and laparoscopic treatment for early colorectal cancer. The study group included 60 patients who underwent endoscopic treatment and 38 patients who underwent laparoscopic surgery for early colorectal adenocarcinoma between January 2010 and December 2013 at a single study site. Histopathological diagnoses showed that 43 (78.3%) carcinomas in the endoscopic submucosal dissection group were mucosal to sm1, 13 (21.7%) were sm2 or deeper, and 17 high-risk cases (28.3%) in the endoscopic group underwent additional surgery. The median operation time, time to sips of water, and length of hospital stay were significantly shorter in the endoscopic group than in the laparoscopic group. The overall survival rates of patients in the endoscopic group and laparoscopic groups were 91.5% and 87.4%, respectively (P=0.391), and the disease-free survival rates were 90.4% and 87.4% (P=0.614), respectively. Systemic recurrences occurred in two patients (1.6%) in the endoscopic group and one patient (2.0%) in the laparoscopic group. Local recurrence combined with systemic recurrence in one patient (0.8%) in the endoscopic group. Endoscopic resection for early colorectal cancer can be performed safely with better short-term outcomes and comparable long-term oncological outcomes compared to laparoscopic surgery.

Use of Insoluble Dietary Fiber and Probiotics for Bowel Preparation Before Colonoscopy: A Prospective Study.

Background:In screening colonoscopy, patients usually have to ingest large amounts of bowel-cleansing agents, including polyethylene glycol (PEG). This is difficult and has various side effects; thus, patients avoid undergoing a colonoscopy. We tested a novel bowel preparation method before colonoscopy using insoluble dietary fiber and probiotics (PB).Methods:This was a prospective clinical study conducted between October 2018 and March 2019 at a general hospital. Forty participants were randomly assigned to low-volume PEG solution diet (MoviPrep), wheat bran fiber (WBF) and probiotic Bifidobacterium animalis subsp. lactis GCL2505 (PB GCL2505), or standard-volume regimen (1.0 to 1.5 L of MoviPrep) (control group). The patient compliance and the quality of bowel preparation were evaluated.Results:Forty individuals aged 38 to 83 years were randomly assigned to the WBF with PB (n=20) and control (n=20) groups. All participants underwent bowel preparation before colonoscopy according to each protocol. The mean required volume of MoviPrep was significantly lower in the WBF with PB group than in the control group (582.5 vs. 1305 mL, P<0.0001). Successful bowel-cleansing rates were not significantly different between the 2 groups; however, the ratio of the Harefield Cleansing Scale grades C and D was significantly lower in the WBF with PB group than in the control group (P=0.0471).Conclusions:The intake of WBF and GCL2505 before colonoscopy reduces the required PEG quantities while maintaining bowel-cleansing quality. This novel, minimally invasive pretreatment method makes colonoscopy more accessible contributing to the prevention and early treatment of colorectal cancer.

Circulating nucleosomes for detection of colorectal cancer and high-risk advanced adenomas.

169 Background: Detection and treatment of early colorectal cancer (CRC) or advanced adenomas (AA) is the key for superior outcomes and fecal immunochemical testing (FIT)-based screening has proven effective in reducing CRC death and the risk of advanced-stage CRC but the discrepancy in the effectiveness was observed between proximal and distal cancers. On the other hand, false-positive results of FIT with 60 % of negative colonoscopy is another concern, considering the burden to the screening participants and the healthcare providers. A blood-based test as an alternative or supplement to FIT has the potential to concurrently enhance the detection of high-risk neoplasms and identify individuals at risk who should then be referred to colonoscopy. We investigated the levels of circulating free nucleosomes containing different epigenetic modifications in patients referred for colonoscopy. Methods: 10mls whole blood was obtained from 520 asymptomatic patients prior to colonoscopy at National Taiwan University Hospital. Patients were classified into 5 groups based on their colonoscopy reports: (i) patient with CRC (n = 33), (ii) patients with AA (n = 123, including 18 with AA &gt; 2cm); (iii) patients with non-AA (n = 168); (iv) patients with non-neoplastic polyps (n = 30); (vi) healthy controls with no endoscopic lesion (n = 166). Plasma samples were analyzed for nucleosome levels using 7 different quantitative immunoassays (Nu.Q assays; Belgian Volition SRL, Belgium) targeting H3.1-nucleosomes or different histone modifications (H3K27Me3-, H3K36Me3-, H3K9Me3-, H3K14Ac-, H3K27Ac- or H3R8Cit-nucleosomes). All study subjects were asked to collect a stool sample at home within 48-hours before the colonoscopy. The fecal samples were assayed with the Eiken OC-SENSOR FIT kit (Eiken Chemical Co., Ltd., Tokyo, Japan) for all study subjects. Results: At a cut-off of 20µg/g feces, the FIT test showed a sensitivity of 92,9% at 17.5% specificity for CRC +AA vs. Controls. All the CRC patients and 83.3% of the high-risk AA (&gt; 2cm) patients were FIT positive. A combination of 2 Nu.Q biomarkers: H3K27Me3 and H3R8Cit with FIT in a logistic regression model showed improved sensitivity of 95% at 20.6% specificity allowing the detection of all CRC patients and 94.3% of AA patients including all the high-risk adenomas. The FIT test detected 46 out of 55 proximal adenomas whereas the combined model could detect 50 proximal adenomas including 3 proximal AA &gt; 2cm not being detected by FIT (p &lt; 0.05). The same combination would reduce unnecessary colonoscopies by 21.8% of the control and 23.3% of the non-neoplastic polyps subgroups compared to 17.5% and 6.7%, respectively with the FIT test alone. Conclusions: Our results indicate that H3K27Me3 and H3R8Cit-nucleosome levels in combination with FIT could improve the detection of proximal high-risk AA and could also provide a non-invasive method to reduce unnecessary colonoscopy.

Endoscopic submucosal dissection for early colorectal cancer

The aim of the study was to evaluate the effectiveness of endoscopic submucosal dissection for early colorectal cancer. From 2014 to 2020 at the N.N. Petrov National Medical Research Centre of Oncology, 165 patients with stage cTis-T1N0M0 colorectal cancer were treated by endoscopic submucosal dissection, including 103 women and 62 men aged from 29 to 89 years (mean age 64 years). A single block resection was achieved in all cases, regardless of size and location. Intra- and early postoperative complications were observed in 14 (8.4%) patients, there was no postoperative mortality. In the presented study, endoscopic submucosal dissection showed technical success in 100% of cases, with a risk of postoperative complications of 4.2% and appeared curative in 80.7% of cases. Thus, this technique can be recommended for the treatment of early colorectal cancer due to its high efficiency and safety.

1029 Evaluation of Significant Polyp and Early Colorectal Cancer (SPECC) MDT In A District General Hospital

Abstract Aim There is an increase in the number of complex SPECC cases presented at colorectal MDT meetings with a wide variation in the treatments offered to patients, many of whom undergo high-risk and life-changing surgical resection. This study aimed to evaluate the detection, diagnosis and treatment of early colorectal cancer since the introduction of a SPECC MDT. Method This was a retrospective audit of 108 patients, from the SPECC MDT database from January 2014 to December 2019. Primary outcome assessed the recognition of lesions using endoscopy and radiological evaluation to assess depth of invasion and lymph node involvement. Secondary outcomes included definite treatment, pathological reporting and recurrence. Results Overall, mean age of 72, 79% had one or more significant co-morbidity. Clinical presentation; 61 asymptomatic, 46 symptomatic and 31 referred from the national bowel cancer-screening programme. All patients (n = 108) had endoscopic assessment the lesions were, 53% sessile and 47% pedunculated; 78% of the lesions were found in the rectum. We observed surgical management in 31 cases, endoscopic in 28, chemo-radiotherapy in 12 and 3 cases were palliative. However, 17 (n = 108) underwent failed endoscopic resection and required surgical intervention. Recurrence was observed in 17.6% of cases and mortality in 4%. Conclusions Pathological reports provide a definitive answer to questions of malignancy but SPECC can be challenging in all areas. A specialist MDT allows for appropriate assessment and treatment of lesions and leads to better patient outcomes.

The impact of colorectal cancer screening on incidence and stage IV disease in the Netherlands.

3531 Background: Population-based screening for colorectal cancer (CRC) aims to decrease incidence and mortality due to precancerous polyp removal, early detection and early treatment of CRC. In the Netherlands, phased introduction of a biennial fecal immunochemical hemoglobin test started in 2014 for individuals aged 55-75. This evaluation of the national data focuses on the initial effect of CRC screening on incidence and stage distribution and the impact on stage IV disease. Methods: All CRC patients diagnosed in the Netherlands between 2009 and 2018 were selected from the Netherlands Cancer Registry (NCR). Patients were linked to the Dutch national pathology registry (PALGA) to identify screen-detected tumors. Results: The NCR identified 137,717 CRC patients between 2009 and 2018. The incidence within screening age (55-75 yr) of all CRC stages showed an initial peak after introduction of screening in 2014, followed by a continuous decrease for all stages. CRC incidence outside the screening age did not show these explicit changes between 2009 and 2018. In 2018, the incidence of stage IV CRC within screening age was lower than the level at the start of the screening program. Stage distribution within screening age shifted towards earlier stages in the screening period (2014-2018) compared to the period before screening (2009-2012) (stage I: 31% vs. 18%, stage II: 22% vs. 26%, stage III: 29% vs. 31%, Stage IV: 18% vs. 25%, respectively). In the period 2014-2018 and within screening age, the ratio of screen-detected and symptom-detected tumors was highest in stage I (47%:53%) and lowest in stage IV (9%:91%). Screen-detected compared to symptom-detected stage IV patients diagnosed in the period 2014-2018 and within screening age had more frequently single organ metastases (74.5% vs 57.4%, p &lt; 0.001), higher resection rate of the primary tumor (57.5% vs. 41.3%; p &lt; 0.001) and higher local treatment rate of metastases (40.0% vs. 23.4% p &lt; 0.001). The median overall survival of screen-detected stage IV patients was significantly longer than that of symptom-detected stage IV patients (31.0 months (95% CI: 27.7 – 34.3) vs. 15.0 months (95% CI: 14.5 – 15.5), p &lt; 0.001). Conclusions: The initial results of the introduction of CRC screening in the Netherlands showed a favorable trend on CRC incidence and stage distribution. Screen-detected patients with stage IV disease had less extensive disease, resulting in better treatment options and improved survival.

China guideline for the screening, early detection and early treatment of colorectal cancer (2020, Beijing)

Colorectal cancer (CRC) is a major malignancy threatening the health of people in China, which also leads to heavy social burden. A large number of researches and practices have demonstrated that screening and early detection are effective in reducing the mortality of CRC. It is therefore imperative to design guidelines for the screening, early detection and early treatment of CRC that are in line with national conditions of China based on international guideline development standard. In 2020, under the leadership of the National Cancer Center of China, a multidisciplinary guideline development group was established. The development of the guideline followed the principles and methods recommended by the World Health Organization. The guideline provides detailed recommendations for thirteen key clinical questions to which the professionals who are involved in screening, early detection and early treatment of colorectal cancer paid close attention. The guideline is intended to serve as a tool for professionals providing best decision-making on screening, early detection and early treatment of CRC and to enhance the effectiveness of CRC prevention and control in China.

Relationship of DNMT3b expression and SEPT9 methylation in theprogression of colorectal carcinogenesis

Objective: To investigate the relationship between the expression of DNA methyltransferase 3b (DNMT3b) and the methylation of SEPT9 gene, and their application prospects in the diagnosis and treatment of colorectal cancer. Methods: Seventy-five cases of colorectal cancer and adjacent tissues, 68 cases of colorectal high-grade internal neoplasia tissues (referred to as precancerous tissues) and high-grade internal adjacent neoplasia tissues (referred to as adjacent precancerous tissues) were collected. Pyrosequencing was used to detect the methylationlevel of SETP9. Real-time quantitative polymerase chain reaction (RT-qPCR) was used to examine the mRNA expressionof SEPT9 and immunohistochemistry(IHC) was applied to detect the protein expressions of SETP9 and DNMT3b. Liposome-mediated method was used to transfect DNMT3b siRNA and negative control siRNA into HT-29 cells. Five groups including DNMT3b siRNA 15 nmol/L group, DNMT3b siRNA 30 nmol/L group, negative control siRNA 15 nmol/L group, negative control siRNA 30 nmol/L group and blank control group were set up. Pyrosequencing was applied to determine the methylation level of SEPT9 and mRNA expression of DNMT3b in each group. Results: The methylation rates of SEPT9 gene in colorectal cancer tissues, adjacent tissues, precancerous tissues and adjacent precancerous tissues were (76.8±6.5)%, (14.4±2.6)%, (34.6±5.0)% and (7.4±1.2)%, respectively, which was highest in colorectal cancer tissue (P<0.001). The relative expressions of SEPT9 mRNA were 0.18±0.03, 0.89±0.41, 0.69±0.41 and 1.01±0.21, respectively, which was lowest in colorectal cancer tissue (P<0.001), while there were no statistically significant differences in adjacent tissues, precancerous tissues and adjacent precancerous tissues (P>0.05). The positive rates of SEPT9 protein expression were 12.0% (9/75), 53.3% (40/75), 55.1% (38/69) and 62.3% (43/69), which was lowest in the colorectal cancer tissue (P<0.001), while there were no statistically significant differences in the adjacent group, precancerous group and adjacent precancerous group (P>0.016 7). The positive rates of DNMT3b protein expression were 56.3% (45/75), 26.7% (20/75), 46.4% (32/69) and 33.3% (23/69), respectively, which was highest in colorectal cancer tissue (P<0.001), while without statistically significant difference from the precancerous tissue (P>0.016 7). Experiments in vitro showed that DNMT3b mRNA expression was lowest in DNMT3b siRNA 30 nmol/L group among five groups and was statistically different from other groups (all P<0.05). Meanwhile, the methylationrate of SEPT9 gene was lowest in this group, but without statistically significant difference from the DNMT3b siRNA 15 nmol/L group (P>0.05). Conclusions: The expression of DNMT3b is significantly correlated with the methylation level of SEPT9 gene in different stages of colorectal cancer. The high expression of DNMT3b may be an important molecular event before SEPT9 gene methylation and it may have an important potential application value in the diagnosis and treatment of early colorectal cancer.

Is Piecemeal Endoscopic Resection Acceptable for Early Colorectal Cancers in Certain Situations? A Single-Center French Study.

The use of endoscopic treatment for early colorectal cancer (ECC) is increasing. The European guidelines suggest performing piecemeal endoscopic resection (pmR) for benign lesions and en bloc resection for ECC, especially for patients with favorable lymph node involvement risk evaluations. However, en bloc resections for lesions larger than two centimeters require invasive endoscopic techniques. Our retrospective single-center study aimed to determine the clinical impact of performing pmR for ECC rather than traditional en bloc resection. A single-center study was performed between January 2012 and September 2017. All ECC patients were included. The main objective was to evaluate the number of patients who potentially underwent unnecessary surgery due to piecemeal resection. The secondary endpoints were as follows: disease-free survival (DFS), defined as the time from pmR to endoscopic failure (local recurrence not treatable by endoscopy), complication rate, number of patients who did not undergo surgery by default, and factors predictive of outcomes and complications. One hundred and forty-six ECC endoscopically treated patients were included. In total, 85 patients were excluded (71 who underwent en bloc resection, 14 with pending follow-up). Data from 61 patients (33 women and 28 men) were analyzed. Two patients underwent potentially unnecessary surgery [3.28% (0.9%- 11.2%)]. The DFS rate was 87% (75%-93%) at 6 months and 85% [72%-92%] at 12 months. The median follow- up time was 16.5 months (12.4-20.9). Three patients (4.9%) had complications. One patient did not undergo surgery by default. A Paris classification of 0-2c (HR=9.3 (2.4-35.9), p<0.001) and Vienna classification of 5 [HR=16.3 (3.3-80.4), p<0.001] were factors associated with poor DFS. Performing pmR in place of en bloc resection for ECC had a limited impact on patients. If the pathology (especially deep margins) is analyzable, careful monitoring could be acceptable in ECC patients who undergo pmR.

Is Additional Surgery Necessary After Non-Curative Endoscopic Submucosal Dissection for Early Colorectal Cancer?

Background Although endoscopic submucosal dissection (ESD) is considered to be a curative treatment for early colorectal cancer, additional surgery with lymph node dissection is routinely recommended for patients treated in non-curative ESD, owing to the risk of residual cancer and lymph node metastasis (LNM). However, in clinical practice, few patients are found to have either residual cancer or LNM after additional surgery. Therefore, we conducted this study to determine the risk factors associated with residual cancer and LNM. Methods Patients with early colorectal cancer after non-curative ESD and additional surgery from January 2015 to May 2019 were retrospectively identified. Clinicopathological characteristics were collected to determine the predictors of residual cancer and LNM. Results A total of 62 patients were enrolled for analysis in this study. After additional surgery, residual cancer and LNM was detected in 12 patients (19.35%). Clinicopathological comparison of patients with the presence or absence of residual cancer and LNM demonstrated that piecemeal resection (80% vs. 14.04%, P < 0.001), submucosal invasion greater than 2000 μm (26.09% vs. 0%, P = 0.026), lymphovascular infiltration (37.5% vs. 13.04%, P = 0.033), and perineuronal invasion (75% vs. 15.52%, P = 0.004) were more frequent in residual cancer and LNM cases. Multivariate analysis identified lymphovascular infiltration (P = 0.031) as the only significantly independent risk factor associated with residual cancer and LNM. Conclusions Additional surgery with lymphadenectomy should be performed after non-curative ESD owing to the high risk of residual cancer and LNM, especially in cases with lymphovascular infiltration.

Improving the Follow-Up Completion Rate of Community-Dwelling Individuals Who Screened Positive for Colorectal Cancer

Early screening and early treatment of colorectal cancer increases the 5-year-survival rate of early stage cancer by 90%. However, a lack of knowledge regarding screening opportunities among community residents affects their willingness to seek medical help and delays treatment. The World Health Organization estimated that deaths from colorectal cancer in the next 20 years will increase from 8.2 million people to 13 million people annually. However, systemic screening and follow-up services will promote early detection and treatment and should effectively decrease colorectal cancer-related mortality. The aim of this study is to increase the follow-up completion rate of community participants who tested positive during a screening for colorectal cancer. The resolution measure produced stool occult blood screening education leaflets, promoted health lectures on the topic of cancer screening, planned a training course for cancer-prevention education, constructed a participant tracking and notification system in the outpatient information system for positive participants, set up a procedure for positive participant follow-up, and designed a cooperative model for community health promotion. The follow-up completion rate of participants who tested positive during colorectal cancer screen tests increased to 74.1%, and the accuracy rate of colorectal screening knowledge rose to 93.9%. Implementation of the project increased the follow-up effectiveness of participants who tested positive during the screening. We hope that medical facilities cooperate with communities in order to facilitate health promotion and increase the number of residents with correct cancer-prevention concepts.