Differences in gene expression profiles and carcinogenesis pathways between colon and rectal cancer

OBJECTIVE: Colon cancer is more common in the USA and Europe than that in China, for reasons that are unclear. The aim of this study was to investigate the differences in gene expression profiles and carcinogenesis pathways between colon and rectal cancer. METHODS: Expression profiling of primary tumor tissues from 12 colon and 12 rectal cancers was performed using oligonucleotide microarray analysis. All samples were strictly matched by clinical features. Bioinformatic analyses such as the Kyoto Encyclopedia of Genes and Genomes were used to identify genes and pathways specifically associated with colon or rectal cancers. RESULTS: A total of 824 genes were differentially expressed in colon and rectal cancers. All differential gene interactions in the Signal‐Net were analyzed. More genes were differentially expressed and included in the Signal‐Net for rectal than colon cancer. Of the genes differentially expressed between colon and rectal cancer, S100P, the Reg family, ACTN1, CAMK2G and ACAT1 were the most significantly altered. Genes involved in the cell cycle pathway were present in rectal and colon cancers, but were more important in rectal cancer. The p53 and metabolic signaling pathways were significantly different in colon and rectal cancers. Gene expression profiles differed between colon and rectal cancer, with metabolic pathways being more important in rectal cancer. CONCLUSION: The oncogenesis of rectal cancer may be more complex than that of colon cancer. Some genes could be new biomarkers for distinguishing between these two cancers.     

Pelvic resection of recurrent rectal cancer

PURPOSE: Pelvic recurrence of rectal cancer is an ominous event for the patient and a formidable challenge to the managing surgeon. We reviewed the results of abdominosacral resection to manage these patients and correlated outcome (survival and recurrence) with known prognostic factors. METHODS: An abdominosacral resection was performed on 61 patients with pelvic recurrence (53 with curative intent and 6 for palliation; 2 had extended pelvic resection). Of the 53 patients (32 males; average age, 59 years) previous resection included abdominoperineal resection in 27 patients, abdominoperineal resection plus hepatic lobectomy in 2 patients, low anterior resection in 19 patients, plus trisegmentectomy in 1 patient, and advanced primary cancers in 4 patients. Initial primary stage was Dukes B (64 percent) and Dukes C (36 percent). All had been irradiated (3,000–6,500 in 50 patients, 8,300 and 11,000 in 2 patients, and unknown dose in 3 patients). Preoperative carcinoembryonic antigen was elevated (>5 ng/ml) in 54 percent. Extent of resection: high sacral resection S-1–S-2 was done in 32 patients, midsacrum in 14 patients, and low S-4–S-5 in 6 patients. Twenty-eight patients (60 percent) required partial or complete bladder resection with or without adjacent viscera, and all had internal iliac and obturator node dissection. RESULTS: There were four postoperative (within 60 days) deaths, 8 percent in curative groups (5.4 percent overall). Major complications included prolonged intubation (20 percent), sepsis (34 percent), posterior wound infection or flap separation (38 percent). The survival rate in the curative group (49 postoperative survivors) was 31 percent at five years, with 13 patients surviving beyond five years. Seven of these patients survived from 5 to 21 years, whereas six patients recurred again and died within 5.5 to 7.5 years after abdominosacral resection. Disease-free survival rate at five years was 23 percent. Recent reconstruction with large composite myocutaneous gluteal flaps in 5 patients permitted complete sacral wound coverage, resulting in earlier ambulation and reduced hospital stay. CONCLUSIONS: Abdominosacral resection permits removal of pelvic recurrence of rectal cancer that is fixed to the sacrum and is associated with long-term survival in 31 percent of patients. Recent technical advances have improved the short-term outcome and have made the procedure more feasible for surgical teams familiar with these techniques.Presented at the meeting of The American Society of Colon and Rectal Surgeons, San Antonio, Texas, May 2 to 7, 1998.     

Colon cancer in rectal bladder

Received: April 7, 2000 / Accepted: October 20, 2000     

Clinical outcome of intersphincteric resection for ultra-low rectal cancer

AIM:To analyze oncological outcome of intersphinctericresection(ISR)in ultra-low rectal cancer with intent tospare colostoma.METHODS:From 1995 to 1998,patients with a non-fixed rectal adenocarcinoma(tumor stage T2)preserving thelower margin at 1-3 cm above the dentate line withoutdistant metastasis was enrolled(period Ⅰ).ISR was prac-ticed in eight patients,and their postoperative follow-up was at least 5 years.In addition,from 1999 to 2003,another 10 patients having the same tumor locationas period Ⅰ underwent ISR(period Ⅱ).Among those,6patients with T3-4-staged tumor received preoperativechemoradiotherapy.RESULTS:All patients received ISR with curative inten-tion and no postoperative mortality.In these case seriesat period Ⅰ,local recurrence rate was 12.5% and me-tastasis rate 25.0%;the 5-year survival rate was 87.5%and disease-free survival rate 75.0%.There was no localrecurrence or distant metastases in 10 patients with amedian follow-up of 30(range,18-47)mo at period Ⅱ.CONCLUSION:As to ultra-low rectal cancer,inter-sphincteric resection could provide acceptable localcontrol and cancer-related survival with no permanentstoma in early-staged tumor(tumor stage T2);more-over,preoperative concurrent chemoradiotherapy wouldmake ISR feasible with surgical curative intent in moreadvanced tumors(tumor stages T3-4).     

The utilization of intraluminal formalin for intractable rectal haemorrhage in advanced rectal cancer: a case report

Abstract A patient with a metastatic fixed low rectal carcinoma presented severe rectal bleeding requiring massive transfusion over with a 36-hour period. Bleeding was controlled with the instillation of a 4% intrarectal formalin solution permitting the completion of a course of neoadjuvant chemoradiotherapy. This technique has been reserved for intractable transfusion-dependent radiation proctitis and is presented as a primary alternative in severe rectal bleeding from inoperable rectal cancer.     

Quality of life and cost effectiveness analysis of therapy for locally recurrent rectal cancer

PURPOSE: This study was performed to determine the quality of life and cost-effectiveness of therapeutic options for patients with locally recurrent rectal carcinoma, determined from the perspectives of patients and health care providers. METHODS: We reviewed the records of patients (N=68) with locally recurrent rectal carcinoma evaluated from 1992 through 1995. We constructed a decision-analytic model incorporating outcomes, survival, and costs. Utilities were elicited from convenience samples of health care providers and patients using the standard gamble technique. RESULTS: The median survival for patients undergoing surgical resection (n=40) was 42 months, compared with 16.8 months for patients undergoing diagnostic or palliative surgery (n=16) and 18.3 months for patients treated nonoperatively (n=12;P<0.005). The mean cost of treatment per patient was $19,283 for the nonoperative group, $45,647 for the diagnostic or palliative surgery group, and $70,878 for the surgical resection group. The diagnostic or palliative surgical strategy was dominated by the nonoperative strategy because the former had greater costs with fewer health benefits. The incremental cost-utility ratio of surgical resection compared with nonoperative management using health care provider utilities was $109,777 per quality-adjusted life year gained; it was reduced to $56,698 using per quality-adjusted life year using mean patient utilities. CONCLUSIONS: Patients with recurrent rectal carcinoma view surgery and morbidity to be less severe than health care providers. Diagnostic or palliative surgery is expensive and affects quality-adjusted survival adversely compared with nonoperative therapy. Surgical resection may be a cost-effective use of resources, particularly when cost-effectiveness is calculated using patient preferences.Presented in part at the Annual Clinical Congress of the American College of Surgeons, Chicago, Illinois, October 12 to 17, 1997, and at the Annual Meeting of the American Society of Clinical Oncology, Los Angeles, California, May 16 to 19, 1998.     

Low rectal cancer

INTRODUCTION: The aim of this study was to evaluate the impact of combined radiotherapy and chemotherapy (leucovorin and 5-fluorouracil) on the treatment of potentially resectable low rectal cancer using the following end points: 1) toxicity of this combined modality regimen; 2) clinical and pathologic response rate and local control; 3) downstaging of the tumor and its influence on the number of sphincter-saving operations; 4) disease-free interval, patterns of relapse, and overall survival. METHODS: From 1991 to 1996, 118 patients with potentially resectable cases of histologically proven adenocarcinoma and no distant metastases were enrolled into this protocol. All patients were evaluated by clinical and proctologic examination, abdominal computed tomography, transrectal ultrasound, and chest radiography. Therapy consisted of 5,040 cGy (6 weeks) and concurrent leucovorin (20/mg/m²/day) with bolus doses of 5-fluorouracil administered intravenously at 425 mg/m²/day for three consecutive days on the first and last three days of radiation therapy. After two months, all patients underwent repeat evaluation and biopsy of any suspected residual lesions or scar tissue. RESULTS: Median follow-up was 36 months. Toxicity of chemotherapy regimen was minimum. Thirty-six patients (30.5 percent) were classified as being complete responders. In six of these patients, complete response was confirmed by the absence of tumor in the surgical specimens (3 abdominoperineal resections and 3 proctosigmoidectomies with coloanal anastomosis). In the remaining 30 patients, confirmation of a complete response was made by the absence of symptoms, negative findings on physical examination, and biopsy, transrectal ultrasound, and pelvic computed tomographic test results during follow-up. Eighty-two patients (69.4 percent) were considered incomplete responders. Residual lesions had already been identified during the first examination in 74 patients. In the other eight patients, residual tumor was only identified after 3 to 14 months. All patients underwent surgical treatment, except one patient who refused surgery. Eighty-seven patients underwent 90 surgical procedures: local excision, 9; coloanal anastomosis, 36; abdominoperineal resection, 4; Hartmann's procedure, 1. Isolated local recurrences occurred in five patients (4.3 percent) and combined local and distant failure in eight patients (6.7 percent). Ninety patients are alive and disease-free at a median follow-up of 36 months. CONCLUSIONS: Combined up-front chemoradiotherapy was associated with tolerable and acceptable side effects. A significant number of patients had complete disappearance of their tumors (30.5 percent) within a median follow-up of 36 months. This regimen spared 26.2 percent of patients from surgical treatment and allowed sphincter-saving management in 38.1 percent of patients who may have required abdominoperineal resection. Preliminary results of this trial suggests a reduction in the number of local recurrences and reinforces the concept that infiltrative low rectal cancer may be initially treated by chemoradiotherapy.Read at the meeting of The American Society of Colon and Rectal Surgeons, Philadelphia, Pennsylvania, June 22 to 26, 1997.     

黑色素瘤抗原基因MAGE-A1在直肠癌组织的表达

[目的]检测黑色素瘤抗原基因MAGE-A1在直肠癌组织中的表达,探索其与直肠癌临床病理的关系及其在直肠癌免疫治疗中的应用价值。[方法]采用RT-PCR法,对66例直肠癌患者的癌组织、癌旁"正常"黏膜组织和手术切缘组织(乙状结肠端)以及3例直肠息肉标本(无瘤)的MAGE-A1的表达情况进行检测,并对RT-PCR扩增产物中的目的基因片段进行DNA测序验证。[结果]66例直肠癌患者的直肠癌组织、癌旁"正常"黏膜组织、手术切缘组织MAGE-A1基因的表达阳性率分别为30.30%(20/66)、12.12%(8/66)、12.12%(8/66),3例直肠息肉标本未见MAGE-A1表达。肿瘤组织MAGE-A1基因表达阳性率均显著高于癌旁"正常"黏膜组织、手术切缘组织(P0.05);而与年龄、性别、组织学类型、Dukes分期及淋巴结转移无关(P0.05)。[结论]基于MAGE-A1基因在直肠癌中的高表达率,MAGE-A1表达蛋白可以作为一种有前途的靶点用于免疫治疗,同时有望成为一种筛查和随访指标。     

104例直肠癌患者淋巴结转移情况及其相关因素分析

目的探讨影响直肠癌患者淋巴结转移的相关因素,为临床诊断、治疗和预后评估提供参考。方法回顾性分析104例手术治疗的直肠腺癌患者的临床病理资料,对可能与其淋巴结转移有关的因素进行单因素和多因素Logistic回归分析。结果本组淋巴结转移率为45.19%;肿瘤分化程度低、浸润程度深及第二号人表皮生长因子受体（C-erbB-2）表达阳性者淋巴结转移率显著升高（P〈0.05）,三者均为影响直肠癌患者淋巴结转移的重要因素,尤以C-erbB-2表达为著（P〈0.05）。结论直肠癌淋巴结转移与肿瘤浸润深度、分化程度和C-erbB-2表达密切相关,尤以C-erbB-2表达为著;临床对相关患者应于术中尽可能彻底清除引流区域内的淋巴结、术后进行积极辅助性治疗,以减少术后复发、提高生存率。     

腹腔镜直肠癌根治术的研究进展

随着腹腔镜直肠癌根治手术的改进,其应用也越来越广泛,其手术的安全性、可行性、远期疗效及根治性也逐渐得到认可。该文对其研究进展作一综述。     

Clinical outcome of neoadjuvant chemoradiation in rectal cancer treatment

To determine the clinical and pathological outcome of locally advanced rectal cancer patients treated with neoadjuvant chemoradiation (chemoradiotherapy [CRT]) followed by curative surgery and to identify predictive factors of pathological complete response (pCR).Locally advanced rectal cancer patients undergoing CRT followed by curative surgery from January 2012 to December 2017 were included. Patient''s demographic data, pretreatment tumor characteristics, type of CRT regimens, type of surgery, postoperative complications, pathological reports and follow up records were analyzed. Univariate and multivariate analyses were applied to identify predictive factors for pCR. Five-year disease free and overall survival were estimated by Kaplan–Meier method and compared between pCR and non-pCR groups.A total of 85 patients were analyzed. Eighteen patients (21.1%) achieved pCR. The sphincter-saving surgery rate was 57.6%. After univariate analyses, tumor length >4 cm (P = .007) and positive lymph nodes (P = .040) were significantly associated with decreased rate of pCR. Complete clinical response was significantly associated with higher rate of pCR (P = .015). Multivariate analyses demonstrated that tumor length >4 cm (P = .010) was significantly associated with decreased rate of pCR. After a median follow-up of 65 months (IQR 34–79), the calculated 5-year overall survival and disease-free survival rates were 81.4% and 69.7%, respectively. Patients who achieved pCR tend to had longer 5-year disease-free survival (P = .355) and overall survival (P = .361) than those who did not.Tumor length >4 cm was associated with decreased rate of pCR in locally advanced rectal cancer who had CRT followed by surgery. Longer waiting time or more intense adjuvant treatment may be considered to improved pCR and oncological outcomes.     

直肠癌诊疗模式转变的研究进展

直肠癌是普外科常见的疾病之一,居恶性肿瘤发病率及病死率前三位。近年来,随着临床研究和诊断技术的发展,发现距离肛门12 cm内的直肠癌与上段结直肠癌的解剖学、疾病发展、诊疗手段及治疗效果均有明显差异。直肠癌概念已经重新定义为传统中的中低位直肠癌,即距离肛门12 cm内的直肠癌。该文就直肠癌的诊疗模式发生变化的一些临床研究进行综述。     

Electrocoagulation of rectal cancer

Electrocoagulation is an effective treatment modality for localized cancer of the distal rectum. Proper selection remains the key to successful treatment. Of potentially curable patients with cancer of the rectum followed up for a median of five years, 69 per cent had no evidence of cancer at the end of the study period. Gross tumor morphology defined two distinct groups with regard to outcome after electrocoagulation. Ninety-two per cent of patients with polypoid/exophytic tumors as compared to 33 per cent of patients with ulcerative lesions had successful treatment. Based on these results, the authors believe that lesions that are exophytic represent early cancers with a low incidence of nodal spread and, as such, can be treated by electrocoagulation with confidence. As a palliative measure, the authors found electrocoagulation to yield equivocal results. Read at the meeting of the American Society of Colon and Rectal Surgeons, Colorado Springs, Colorado, June 7 to 11, 1981.     

Complete peritonectomy and intraperitoneal chemotherapy for recurrent rectal cancer with peritoneal metastasis

A 68-year-old man underwent laparoscopic low anterior resection for rectal carcinoma in December 2006. Nearly 19 mo after the operation, he developed recurrent rectal cancer with peritoneal metastasis. In September 2008, he subsequently underwent a laparotomy with a peritonectomy, omentectomy, splenectomy, and a Hartmann procedure. Hyperthermic intraperitoneal oxaliplatin 750 mg was administered. The patient was discharged with no postoperative complications and has been well with postoperative FOLFOX chemotherapy.     

Multivisceral resections for primary advanced rectal cancer

Fixation of the locally advanced rectal tumor at the time of operation is an important prognostic variable. It may be difficult to determine whether fixation is caused by inflammatory adhesions or by direct tumor extension tethering the tumor to the surrounding pelvic structures. Extended en bloc removal of the locally advanced rectal cancer with involved adjacent organ(s) increases the resectability rate. We examined the perioperative mortality and morbidity and the prognosis of patients undergoing multivisceral resections for advanced primary rectal cancers. Of 83 patients with rectal cancers 20 (24%) had locally advanced tumors. Cases were divided into Gunderson-Sosin stages B₃ and C₃ and were further stratified into those with histologically confirmed carcinomatous invasion of the adjacent organ and those with inflammatory adhesions. Perioperative mortality was 5%. Only five patients (24%) showed histopathological confirmation of carcinomatous adhesion into adjacent organ(s)/structure(s). Histological confirmation of contiguous tumor spread was higher in C₃ patients. There was no significant difference between patients with positive and negative histopathological confirmation of malignant spread in terms of survival rates. Multivisceral resections can be performed safely for locally advanced rectal cancers with acceptable mortality and morbidity rates. The presence of local tumor extension does not mean incurability, and sound surgical judgement should dictate that in the face of a tethered lesion one must extend the surgical intervention radically to resect any tumor en bloc. Accepted: 13 October 1999     

Long-term quality of life of postoperative rectal cancer patients

BACKGROUND: The long-term quality of life (QOL) of postoperative rectal cancer patients has not been previously investigated in Japan and may vary depending on the surgical technique used (i.e. with or without a stoma). METHODS: The Kanagawa Cancer Registry was used to select 348 rectal cancer patients who underwent surgery at the St Marianna University Hospital between 1978 and 1997. Of these, 164 surviving patients were sent a postal survey consisting of the Japanese EuroQol instrument with an additional questionnaire on present symptoms and lifestyle. RESULTS AND CONCLUSIONS: One hundred and ten responses were received, including 38 from stoma patients. The presence of a stoma did not affect the QOL of the male patients, while it did affect that of the female patients. The QOL of the long-term survival group was associated with several items concerning lifestyle, symptoms and usual activity, and the association did not depend on the presence of a stoma. The long-term QOL could be recognized according to the characteristics of rectal cancer patients, independent of the presence of a stoma.     

Endoscopic ultrasound staging of rectal cancer: diagnostic value before and following chemoradiation

BACKGROUND: Endoscopic ultrasound (EUS) has been shown to be a reliable tool for staging rectal cancer. Nevertheless, the accuracy of EUS after chemoradiation remains unclear; therefore the purpose of the present paper was to compare the accuracy of EUS staging for rectal cancer before and following chemoradiation. METHODS: Patients with rectal cancer undergoing EUS staging were stratified into two groups. Group I consisted of 66 patients who underwent surgery following EUS staging without preoperative chemoradiation. Group II consisted of 25 patients who had EUS evaluation following chemoradiation. The EUS staging was compared to surgical/pathological staging. RESULTS: The accuracy of the T staging for group I was 86% (57/66). Inaccurate staging was mainly associated with overstaging EUS T2 tumors. The accuracy of the N staging for group I was 71% (47/66). The accuracy of EUS for a composite T and N staging relevant to treatment decisions in group I was 91%. In group II, the accuracy of T and N staging was 72% (18/25) and 80% (20/25), respectively. Overstaging EUS T3 tumors accounted for most inaccurate staging. The EUS staging predicted post-chemoradiation T0N0 stage correctly in only 50% of cases. CONCLUSIONS: Preoperative staging of rectal cancer by EUS is a useful modality in determining the need for preoperative chemoradiation. The EUS T staging following chemoradiation appears to be less accurate. Detection of complete response may be insufficient for selecting patients for limited surgical intervention.     

直肠癌根治术中保护性肠造口相关问题探讨

直肠癌是发病率较高的恶性肿瘤之一,直肠癌根治术是治疗直肠癌的重要方法,保护性肠造口可以降低直肠癌根治术吻合口漏带来的不利影响,一定程度上挽救了患者的生命。本文将针对直肠癌根治术中保护性肠造口的相关问题进行总结与探讨,主要包括保护性肠造口的利弊、开放与还纳时机、转为永久性肠造口以及相关心理问题。