淋巴结转移度预测老年结直肠癌患者术后远处转移的价值

目的探讨淋巴结转移度(LNR)对老年结直肠癌患者术后远处转移的预测价值。方法选取2011年1月至2015年1月于该院普通外科行根治性手术的老年结直肠癌患者96例,按照有无术后远处转移将入组患者分为实验组(转移组,36例)和对照组(非转移组,60例),按照LNR水平高低将入组患者分为HLNR组和LLNR组,统计分析LNR的相关临床病理因素,单因素及多因素分析影响老年结直肠癌出现术后远处转移的临床病理因素,总结分析LNR与老年结直肠癌患者出现术后远处转移相关性。结果 HLNR组和低LLNR组在年龄、大体类型和分化程度等方面均有统计学差异(均P<0.05);Logistic多因素分析结果显示,大体类型及分化程度与老年结直肠癌LNR水平独立相关(均P<0.05)。实验组和对照组在大体类型、分化程度、淋巴结检出总数(ELN)及LNR等方面均有统计学差异(均P<0.05),Logistic多因素分析结果显示:LNR、分化程度及大体类型与老年结直肠癌患者术后远处转移独立相关(RR:2.098;CI%:1.050~4.192;P<0.05)。结论 LNR、分化程度及大体类型与老年结直肠癌术后远处转移独立相关,可联合预测老年结直肠癌术后远处转移情况。     

术前血清碱性磷酸酶及乳酸脱氢酶检测水平对结直肠癌患者病情评估的临床价值

[目的]探讨术前血清碱性磷酸酶(ALP)及乳酸脱氢酶(LDH)水平对结直肠癌患者病情评估的临床价值。[方法]选取2012年8月～2018年12月在本院确诊为结直肠癌并住院接受手术治疗的228例患者和81例健康对照组作为研究对象,收集健康对照组及结直肠癌患者术前血清ALP和LDH水平及结直肠癌组术后病理学资料。比较正常对照组与结直肠癌组患者术前血清ALP及LDH水平,并分析术前血清ALP水平LDH水平与临床病理特征之间的相关性。[结果]结直肠癌组术前血清ALP及LDH水平明显高于对照组(均P0.05);有淋巴结转移、有远处转移的结直肠癌患者术前血清ALP水平均比无淋巴结转移、无远处转移的患者更高(均P0.05)。肿瘤浸润较深的T3～T4期、有淋巴结转移、远处转移,CEA≥5μg/L的结直肠癌患者术前血清LDH水平均比肿瘤浸润深度较浅的T1～T2期、无淋巴结转移、远处转移、CEA5μg/L的患者更高(均P0.05)。不同TNM分期,不同分化程度的结直肠癌患者术前血清ALP和LDH水平不同,分期越高,分化程度越低,ALP及LDH水平越高,差异具有统计学意义(均P0.05)。[结论]术前结直肠癌患者血清ALP及LDH水平越高,提示肿瘤浸润程度越深,分期越高,越易出现淋巴结及远处转移。术前ALP及LDH水平可作为评价结直肠癌患者临床预后的辅助指标。     

Ⅰ期结直肠癌局部复发与转移18例患者的临床病理特征分析

目的探讨早期结直肠癌复发与转移的高危因素、诊断与治疗现状,以期改善预后。 方法回顾性总结2005年3月至2008年5月中国医学科学院肿瘤医院收治的18例Ⅰ期、无脉管瘤栓与神经侵犯但出现复发及转移的结直肠癌患者临床病理资料。 结果18例Ⅰ期局部复发与远处转移的结直肠癌患者中,男性12例（66.7%）,女性6例（33.3%）,术前便血15例（83.3%）,无体重减轻11例（64.7%）,T1肿瘤2例（11.1%）,T2肿瘤16例（88.9%）,局部复发7例（38.9%）,远处转移9例（50.0%）,淋巴结转移2例（11.1%）。11例患者（61.11%）的复发与转移没有临床症状。复发转移后中位生存期为57.6个月。 结论Ⅰ期结直肠癌患者必须常规进行定期复查,要重视复发与转移的早期症状。     

老年结直肠癌组织中miR-182表达及其与临床病理参数的关系

目的探讨老年结直肠癌组织中微小RNA(miR)-182的表达及其与临床病理参数的关系。方法选择绍兴市人民医院2010年1月至2011年12月70岁以上老年结直肠癌患者120例结直肠癌组织及其相应的癌旁组织标本。采用实时荧光定量聚合酶链反应(PCR)测定结直肠癌组织和癌旁组织中miR-182水平。结果结直肠癌组织中miR-182水平明显高于癌旁组织(P0.05)。结直肠癌组织中miR-182水平与结直肠癌TNM分期、淋巴结转移和远处转移明显相关(P0.05),TNM分期Ⅲ～Ⅳ期、有淋巴结转移、有远处转移患者结直肠癌组织中miR-182水平明显高于Ⅰ～Ⅱ期、无淋巴结转移、无远处转移患者(P0.05);结直肠癌组织中miR-182水平与结直肠癌患者年龄、性别、肿瘤部位、肿瘤浸润深度、癌胚抗原(CEA)水平无关(P0.05)。结直肠癌组织中miR-182水平诊断结直肠癌的受试者工作特征(ROC)曲线下面积为0.812,95%CI为0.809～0.815,miR-182水平界值为1.623,灵敏度为86.34%,特异度为77.16%。miR-182低表达患者的生存率明显高于高表达者(P=0.009)。结论老年结直肠癌组织中miR-182水平升高,miR-182水平与结直肠癌的临床分期、淋巴结转移、远处转移有关,有望成为结直肠癌诊断和预后预测的潜在指标。     

老年结直肠癌患者手术风险及预后

目的分析老年结直肠癌患者的临床病理特点及影响手术预后因素。方法手术治疗的结直肠癌患者300例,分析不同年龄结直肠癌患者的临床及病理资料,采用多因素COX分析评价影响老年组术后复发的危险因素及3、5年生存率和无病生存率。结果≥70岁组高中分化腺癌比例、TNM分期Ⅲ~Ⅳ期、区域淋巴结转移、腹腔及远处转移发生率均显著高于70岁组(P0.05)。COX多因素分析提示,TNM分期、组织类型、区域淋巴结转移、腹腔及远处转移均为影响≥70岁结直肠癌患者预后的相关因素。≥70岁组3年生存率为57.66%(79/137),3年无病生存率为48.91%(67/137);5年生存率为24.82%(34/137),5年无病生存率为21.17%(29/137)。结论应对TNM分期高、组织类型为高中分化腺癌、存在区域淋巴结转移、腹腔及远处转移的≥70岁结直肠癌患者加强术后监测,以降低术后复发率,提升患者术后生存率。     

Hsa-miR-9在结直肠癌组织中的表达水平及意义

目的观察Hsa-miR-9在结直肠癌组织中的表达水平及其临床意义。方法收集结直肠癌患者手术标本66例,应用qRT-PCR检测癌组织中Hsa-miR-9的表达水平,并观察其与结直肠癌临床病理参数及临床分期之间的关系。结果结直肠癌组织中Hsa-miR-9的表达水平与肿瘤分化及浸润程度、肿瘤有无淋巴结及远处转移和临床分期相关,高分化与中低分化比较、(T1+T2)期与(T3+T4)期比较、有淋巴结转移与无淋巴结转移比较、有远处转移与无远处转移比较以及(Ⅰ+Ⅱ)期与(Ⅲ+Ⅳ)期比较均有显著差异(P<0.05)。结论 Hsa-miR-9与结直肠癌的发生、发展与转移密切相关,可成为结直肠癌指导治疗、判断预后的生物学指标。     

高龄结直肠癌肝转移Ⅰ期手术切除患者的围手术期处理

结直肠癌是常见的消化道肿瘤.对于结直肠癌肝转移患者许多人主张对原发灶和转移灶分次切除[1].但有研究表明,结直肠癌肝转移患者积极Ⅰ期切除原发肿瘤和肝脏转移癌的手术并发症少,在死亡率方面与分次切除无显著差异;     

早期结直肠癌局部切除与根治性术后生存比较

目的:研究早期结直肠癌局部切除术与根治性术后患者生存期的差异.方法:回顾性分析1998/2008年SEER数据库中符合筛选条件的患者,根据手术方式分为局部切除组和根治性手术组,并根据肿瘤部位分为结肠癌亚组和直肠癌亚组,通过绘制Kaplan-Meier生存曲线,比较两组患者的生存期差异及独立预后因素.结果:本研究共入组13795例患者,根治性切除的共13647例,其中结肠癌10389例,直肠癌3258例;局部切除的共148例,其中结肠癌62例,直肠癌86例.T1期更倾向于接受局部切除,而T2期则更倾向于接受根治性切除(P0.001).单因素生存分析结果显示:T1期结肠癌根治性手术组与局切手术组患者的5年和10年生存率有统计学差异(P=0.0069);T2期两组并无统计学差异(P=0.278).T1和T2期直肠癌根治性手术组与局切手术组患者的5年和10年生存率均无统计学差异(P=0.253,0.975).多生存因素分析结果显示:性别、年龄、种族、肿瘤大小、肿瘤分化程度和手术方式是影响预后的独立因素,但结直肠癌有各自的特点.结论:对于T1、T2期直肠癌,行局部切除可以达到根治性手术的效果,获得同等的生存率;T1期结肠癌,根治性切除比局部切除能获得更好的生存率;T2期结肠癌有待增加样本量后进一步对比分析.     

LINC02363在结直肠癌组织中的表达及其临床意义

背景:LncRNA与结直肠癌的发生、发展密切相关,其在肿瘤中表达和调控异常具有较高的特异性。目的:利用Cancer LncRNome数据库筛选结直肠癌中差异表达的lncRNA,并探讨LINC02363在结直肠癌中的表达及其临床意义。方法:提取Cancer LncRNome数据库和TCGA数据库中结直肠癌患者芯片数据,筛选结直肠癌差异表达的lncRNA。以实时荧光定量PCR法检测结直肠癌细胞株和上海交通大学医学院附属仁济医院53例结直肠癌组织中LINC02363表达。分析基于TCGA数据库的LINC02363表达与结直肠癌患者生存期和临床病理特征的相关性。结果:共筛选出与结直肠癌预后相关的2条表达上调的lncRNA和12条表达下调的lncRNA。与正常肠上皮细胞相比,LINC02363在结直肠癌细胞中表达下调。LINC02363在结直肠癌组织中表达显著降低。LINC02363低表达组生存期显著短于LINC02363高表达组,LINC02363低表达与结直肠癌远处转移呈正相关。结论:LINC02363在结直肠癌组织中表达下调,低表达LINC02363的结直肠癌患者预后差、转移可能性大。提示LINC02363有可能作为评估结直肠癌发生、发展以及远处转移的新型肿瘤标志物。     

外周血CK20 mRNA表达与结直肠癌临床病理和预后的关系

目的:探讨外周静脉血中CK20 mRNA表达及其与结直肠癌临床病理及预后的关系.方法:选取结直肠癌术前患者61例、健康志愿者20例和结直肠息肉患者10例,采用RT-PCR法检测其外周静脉血中CK20 mRNA的表达,并结合其临床病理特点和随访资料进行综合分析.结果:61例结直肠癌患者术前外周血CK20 mRNA阳性率为41.0%(25/61);其表达与肿瘤TNM分期、浸润深度、远处转移和区域淋巴结转移有关(P<0.05).20例健康志愿者和10例结直肠息肉患者外周血均无CK20 mRNA表达.在61例结直肠癌患者中,术后46mo完整随访的有37例,其中有17例死亡,有10例外周血CK20 mRNA表达阳性.结论:外周静脉血中CK20 mRNA的表达与结直肠癌患者的肿瘤分期和浸润转移有关.血液中CK20是反映结直肠癌患者发生肿瘤微转移较为特异的肿瘤标志物,外周血液中CK20 mRNA的表达可作为评估患者预后的指标.     

Metastatic potential in T1 and T2 colorectal cancer

BACKGROUND/AIMS: Survival of patients with colorectal cancer confined to the muscularis propria (stage I) is excellent after curative resection. However, some patients are likely to develop lymph node and distant metastasis that can ultimately cause death. The purpose of this study was to identify the possible predictors of lymph node and distant metastasis in T1 and T2 colorectal cancers. METHODOLOGY: In total 208 patients with T1 and T2 colorectal cancers who underwent surgical resection in Taipei Veterans General Hospital from July 1996 to December 2001 were enrolled. The clinicopathological variables including age, gender, tumor location (rectum/colon), preoperative carcinoembryonic antibody level, depth of tumor invasion, lymphovascular invasion, and unfavored histology corresponding to the metastasis assessed pathologically were analyzed. Categorical variables were analyzed using Chi-square with Yates' correction. The independent predictor of lymph node and distant metastasis was determined with multivariate binary logistic regression. RESULTS: Of the 208 T1 and T2 colorectal cancer patients, 36 (17.3%) had lymph node metastasis and 5 (2.4%) had distant metastasis at surgery. The risk of lymph node metastasis was 14.3% (8/56) in T1 and 18.4% (28/52) in T2 colorectal cancer. The tumors with evidence of lymphovascular invasion had a significantly higher incidence of lymph node metastasis than those without lymphovascular invasion (43.6% vs. 9.4%; p<0.001). The independent risk factor for lymph node metastasis was lymphovascular invasion only (95% confidence interval, 3.37-19.97; p<0.001), whereas that for distant metastasis was preoperative carcinoembryonic antibody level >5ng/mL only (95% confidence interval, 0.03-0.21; p<0.001). The negative predictive value of possible adverse risk factors including preoperative carcinoembryonic antibody level >5ng/mL, lymphovascular invasion, and unfavored differentiation for metastasis was 93.5%. CONCLUSIONS: Considering the negative predictive value of combined possible adverse risk factors, the risk of metastasis still was 6.5%. Therefore radical surgery was recommended for all T1 and T2 stage colorectal cancer patients except if the patient had a very high surgical risk.     

Clinicopathological study of colorectal mucinous carcinoma in Taiwan: A multivariate analysis

The clinicopathological significance of colorectal mucinous carcinoma is controversial, although some authors feel mucinous carcinoma has a worse prognosis than that of non-mucinous carcinoma. To clarify the significance of this type of carcinoma in Taiwan, a retrospective review of patients with colorectal carcinoma treated at Chang Gung Memorial Hospital between 1984 and 1988 was undertaken. During this period, 53 mucinous carcinomas and 401 non-mucinous carcinomas fulfilling the inclusion criteria were analysed. Mucinous carcinomas were more common in patients 39 years of age or under (P < 0.005). Most mucinous carcinomas were located in the rectum/rectosigmoid, followed by the right colon; however, the right colon had a higher relative incidence (38 vs 8%, respectively; P < 0.005). Mucinous carcinomas presented at a significantly more advanced stage (23 vs 8%, respectively, stage D disease; P < 0.005) and had a markedly lower curative resection rate (68 vs 84%, respectively; P < 0.05). Following curative resection, mucinous carcinomas tended to have an increased incidence of subsequent distant metastasis (27.8 vs 18.8%, respectively; P < 0.005). The overall survival rate of patients with mucinous carcinoma was worse than that of non-mucinous carcinoma (P < 0.005). Multivariate analysis showed that clinically important predictive factors were stage of disease on diagnosis and subsequent distant metastasis. The mucinous histological type itself was not an independent prognostic factor in colorectal cancer.     

Aggressive surgery for stage IV gallbladder carcinoma; what are the contraindications?

Background/Purpose

Advanced gallbladder carcinoma with paraaortic lymph node metastasis or distant metastasis is normally considered a contraindication for surgery. Our latest analyses suggest otherwise.

Methods

Records of 166 patients who underwent surgery for stage IV gallbladder carcinoma were reviewed retrospectively. Predictors of hospital mortality and long-term survival were analyzed. Long-term survival in patients with paraaortic lymph node metastasis and/or distant metastasis was also determined.

Results

Fifteen patients were 5-year survivors, with a 5-year survival rate of 12% among the 166 patients investigated. Overall hospital mortality was 14%. Male sex and portal vein resection were independent predictors of hospital mortality. Multivariate analysis of long-term survival failed to identify independent predictors. Patients with distant metastasis were divided into two groups based on whether or not the metastases were distant from the liver. Patients with paraaortic lymph node metastasis who underwent curative resection or who had isolated liver metastasis survived longer than those with other distant metastasis or those with unresectable advanced cancer.

Conclusions

Patients with advanced gallbladder carcinoma can benefit from surgical resection even when paraaortic lymph node metastasis and/or liver metastasis are present. However, surgical indications in advanced disease should be determined on an individual basis, based on clinical status.     

癌基因C-erbB-2在结直肠癌中的表达及其与浸润转移的相关性

目的:探讨癌基因C-erbB-2在结直肠癌中的表达及其与局部浸润和淋巴结转移的相关性.方法:采用免疫组化SP法检测69例原发性结直肠癌患者根治性手术切除的癌组织及周围组织中C-erbB-2的表达.结果:C-erbB-2基因主要为细胞膜及胞质内表达.结直肠癌组织中C-erbB-2阳性表达率为65.2%(45/69),而在结直肠良性肿瘤中仅有2例表达(2/20),两者存在显著差异(P<0.01);其阳性表达率在结直肠癌组织(65.2%)及周围组织(系膜组织47.8%、癌旁组织30.4%、远端切缘组织13.0%)中有显著差异(P<0.05);其表达与肿瘤大体类型、肿瘤细胞分化程度、临床分期(Dukes分期)及淋巴结转移关系密切(P<0.05),而与结直肠癌患者年龄、性别、肿瘤部位及大小和远处转移无明显关系(P>0.05);C-erbB-2在系膜组织及癌旁组织中的表达证实免疫组织化学方法同常规病理检测比较有显著差异(P<0.05).结论:C-erbB-2在结直肠癌中阳性表达与肿瘤浸润转移密切相关,可作为预测预后的指标.     

Contemporary operative management of pulmonary metastases of colorectal origin

The management of patients with metastatic disease from primary carcinoma of the colon and rectum is still controversial. To evaluate the results of resection of pulmonary metastases from patients with colorectal primaries, a retrospective study of all patients who underwent such resection was carried out at the teaching hospitals of McGill University and Université de Montréal. A total of 345 patients admitted with pulmonary metastases; 27 of them underwent pulmonary resection with the extent of the resection varying from wedge excision of the metastatic nodule to pneumonectomy. In 25 of the 27 patients the resection was considered curative. Eight of the 27 patients had resection of two metastatic lesions while the remaining 19 patients had resection of solitary lesions. The interval between resection of the primary colorectal malignancy and the resection of the metastatic lesion (disease-free interval) varied from 2 to 77 months with a median interval of 35 months. The five-year survival following resection of pulmonary metastases was 21 percent. A prolonged interval between treatment of the primary and resection of the pulmonary metastasis was associated with a longer survival. This retrospective study demonstrates that prolonged survival can be achieved following resection of pulmonary metastases from colorectal carcinoma. Read at the meeting of the American Society of Colon and Rectal Surgeons, Washington, D.C., April 5 to 10, 1987.     

Prognostic factors following liver resection for hepatic metastases from colorectal cancer

AIM: To determine the impact of prognostic factors on survival of patients with metastases from colorectal cancer that underwent liver resection. METHODS: The records of 28 patients that underwent liver resection for metastases from colorectal cancer between April 1992 and September 2001 were retrospectively analyzed. Thirty-eight resections were performed (more than one resection in eight patients and two patients underwent re-resections). The primary tumor was resected in all the patients. A screening protocol for liver metastases including clinical examinations every three months, ultrassonography and CEA level until 5 years of follow-up and after every 6 months, was applied. The prognostic factors analyzed regarding the impact on survival were: Dukes C stage of primary tumor, size of metastasis >5 cm, a disease-free interval from primary tumor to metastasis < 1 year, CEA level > 100 ng/mL, resection margins < 1 cm and extrahepatic disease. The Kaplan-Meier curves, log rank and Cox regression were used for the statistical analysis. RESULTS: Perioperative morbidity and mortality were 39.3% and 3.6%, respectively. The 5-year survival rate was 35%. The independent prognostic factors were: disease-free interval from primary tumor to metastasis < 1 year and extrahepatic disease. CONCLUSIONS: The liver resection for metastases from colorectal cancer is a safe procedure with more than 30% 5-year survival. Disease-free interval from primary tumor to metastasis < 1 year and extrahepatic disease were independent prognostic factors.     

Recurrent colorectal cancer after endoscopic resection when additional surgery was recommended

AIM: To evaluate the type of recurrence after endoscopic resection in colorectal cancer patients and whether rescue was possible by salvage operation.METHODS: Among 4972 patients who underwent surgical resection at our institution for primary or recurrent colorectal cancers from January 2005 to February 2015, we experienced eight recurrent colorectal cancers after endoscopic resection when additional surgical resection was recommended.RESULTS: The recurrence patterns were: intramural local recurrence(five cases), regional lymph node recurrence(three cases), and associated with simultaneous distant metastasis(three cases). Among five cases with lymphatic invasion observed histologically in endoscopic resected specimens, four cases recurred with lymph node metastasis or distant metastasis. All cases were treated laparoscopically and curative surgery was achieved in six cases. Among four cases located in the rectum, three cases achieved preservation of the anus. Postoperative complications occurred in two cases(enteritis).CONCLUSION: For high-risk submucosal invasive colorectal cancers after endoscopic resection, additional surgical resection with lymphadenectomy is recommended, particularly in cases with lymphovascular invasion.     

Indicators for Surgical Resection and Intraoperative Radiation Therapy for Pelvic Recurrence of Colorectal Cancer

PURPOSE: We retrospectively analyzed prognostic factors for surgical resection and intraoperative radiation therapy to identify indicators for this treatment strategy. METHODS: Thirty-nine consecutive patients with locally recurrent colorectal cancer who underwent surgical resection with intraoperative radiation therapy from January 1, 1987, to June 30, 1999, were analyzed. The mean electron energy was 10.5 MeV and the mean intraoperative radiation dose was 22.6 Gy. Kaplan-Meier survival estimates were obtained for the 37 patients who recovered postoperatively. Prognostic factors were analyzed univariately by log-rank test and multivariately by Coxs proportional hazards model. RESULTS: Three-year cumulative survival was 44 percent (standard error = 11) for 26 patients free of unresectable distant metastasis who underwent surgical resection and intraoperative radiation therapy for pelvic recurrence of colorectal cancer, but none of the 11 patients with unresectable distant metastasis survived 3 years. Preoperative prognostic factors which were significant on univariate and multivariate analysis were unresectable distant metastasis (P = 0.001) and elevated preoperative serum CA 19–9 (P = 0.02). Patients with synchronous resection of local recurrence and distant metastasis had a significant survival advantage over those without resection of metastases (P = 0.02). Univariate analysis in a subgroup of 26 patients without unresectable distant metastasis revealed pain (P = 0.0003) to be a useful preoperative prognostic indicator, whereas tumor fixation (P = 0.01) and amount of residual tumor after surgical resection (P = 0.01) were significant intraoperative and postoperative factors, respectively. Fluorouracil-based postoperative systemic chemotherapy produced a significant survival benefit (P = 0.04). CONCLUSIONS: Patients with unresectable distant metastasis are not suitable candidates for surgical resection and intraoperative radiation therapy, whereas those with resectable metastasis are potential candidates. Intraoperative radiation therapy may be less useful for patients with pain, elevated preoperative CA19–9, fixed tumors, or gross residual tumor after surgical resection. Multimodal treatment strategies combining preoperative and/or postoperative external beam radiation therapy and intraoperative radiation therapy with fluorouracil-based systemic chemotherapy are recommended for patients with these indicators.     

Matrix metalloproteinase-2 and tissue inhibitor of metallo-proteinase-2 in colorectal carcinoma invasion and metastasis

AIM: To explore the relationship between matrix metallopr- oteinase-2 (MMP-2) and tissue inhibitor of metallopr- oteinase-2 (TIMP-2) in the development of colorectal carcinoma and to provide a valuable marker for clinical diagnosis. METHODS: Twenty-five patients with colorectal carcinoma underwent surgical resection. Samples were taken from tumor sites and normal tissues. MMP-2 activity was determined by gelatin zymography. Western blot and ABC immunohist-ochemical staining were used to detect the expression levels of MMP-2 and TIMP-2 in normal and colorectal carcinoma tissues. Statistical analyses were performed using the Student's t test and one-way ANOVA. P<0.05 was considered statistically .significant. All the statistical analyses were performed using SPSS 10.0 software. RESULTS: MMP-2 activity could be detected in both normal and colorectal carcinoma tissues. MMP-2 activity in colorectal carcinoma tissues was much higher than that in normal tissues (P<0.05, t=3.916,4.227). MMP-2 activity was positively related to the colorectal carcinoma invasion depth, lymph node metastasis and Duke's stage. Western blot and ABC immunohistochemical staining demonstrated that the expression level of MMP-2 in colorectal carcinoma tissues was much higher than that in normal tissues (P<0.05, t = 9.429), but the expression level of TIMP-2 in colorectal carcinoma tissues was much lower than that in normal tissues (P<0.05, t = 7.329). The MMP-2/TIMP-2 ratio of colorectal carcinoma was much higher than that of normal tissues. With the progression of invasion depth, lymph node metastasis and tumor Duke's stage, the activity and expression level of MMP-2 and TIMP-2 gradually increased, but the MMP-2/TIMP-2 ratio gradually decreased. CONCLUSION: The balance between MMP-2 and TIMP-2 plays a crucial role in the process of colorectal carcinoma invasion and metastasis.     

Clinicopathologic and prognostic relevance of ARID1A protein loss in colorectal cancer

AIM: To explore the association between AT-rich interactive domain 1A (ARID1A) protein loss by immunohistochemistry and both clinicopathologic characteristics and prognosis in patients with colorectal cancer.METHODS: We retrospectively collected clinicopathologic data and archived paraffin-embedded primary colorectal cancer samples from 209 patients, including 111 patients with colon cancer and 98 patients with rectal cancer. The tumor stage ranged from stage I to stage IV according to the 7^th edition of the American Joint Committee on Cancer tumor-node-metastasis (TNM) staging system. All patients underwent resection of primary colorectal tumors. The expression of ARID1A protein in primary colorectal cancer tissues was examined by immunohistochemical staining. The clinicopathologic association and survival relevance of ARID1A protein loss in colorectal cancer were analyzed.RESULTS: ARID1A loss by immunohistochemistry was not rare in primary colorectal cancer tumors (25.8%). There were 7.4%, 24.1%, 22.2% and 46.3% of patients with ARID1A loss staged at TNM stage I, II, III and IV, respectively, compared with 20.0%, 22.6%, 27.7% and 29.7% of patients without ARID1A loss staged at TNM stage I, II, III and IV, respectively. In patients with ARID1A loss, the distant metastasis rate was 46.3%. However, only 29.7% of patients without ARID1A loss were found to have distant metastasis. In terms of pathologic differentiation, there were 25.9%, 66.7% and 7.4% with poorly, moderately and well differentiated tumors in patients with ARID1A loss, and 14.2%, 72.3% and 13.5% with poorly, moderately and well differentiated tumors in patients without ARID1A loss, respectively. ARID1A loss was associated with late TNM stage (P = 0.020), distant metastasis (P = 0.026), and poor pathological classification (P = 0.035). However, patients with positive ARID1A had worse overall survival compared to those with negative ARID1A in stage IV colorectal cancer (HR = 2.49, 95%CI: 1.13-5.51).CONCLUSION: ARID1A protein loss is associated with clinicopathologic characteristics in colorectal cancer patients and with survival in stage IV patients.