International Journal of Colorectal Disease最新文献

Purpose: The study aims to evaluate the correlation between visceral adiposity, fatty liver, and survival in patients with metastatic colorectal cancer (mCRC).

Methods: The study included 131 adult patients with treatment-naive mCRC. The visceral and liver fat content was measured using baseline computed tomography (CT) images. The analysis used the 50th percentile (131.80 HU) visceral adiposity value as a cutoff. The visceral and liver fat content association with patient characteristics and outcomes was assessed.

Results: In the overall cohort, neither visceral adiposity (median OS 37.8 vs 36.7 months, HR = 0.83; p = 0.428) nor liver steatosis (median OS 46.0 vs 33.9 months, HR = 0.81; p = 0.370) showed significant association with OS. However, in patients with BMI ≥ 25 kg/m², liver steatosis was associated with significantly shorter survival (median OS 35.2 vs 59.5 months; adjusted HR = 0.49; p = 0.040). Visceral adiposity remained non-significant across BMI subgroups.

Conclusion: We observed a possible association between liver steatosis and OS in patients with mCRC in the high BMI subgroup. Prospective studies are essential to validate these findings and the role of liver steatosis in the prognostic assessment of mCRC patients.

Purpose: Current diagnostic modalities lack sufficient sensitivity for detecting omental metastasis (OM), often underestimating metastatic burden. Unlike traditional statistical model, machine learning (ML) model is designed to detect subtle variable interactions and model nonlinear patterns that traditional statistics overlook, enhancing the reliability of OM risk evaluation in clinical practice. The aim of the study was to build a ML model in preoperatively predicting OM in right-sided colon cancer (RCC) patients using a multicenter dataset.

Methods: This retrospective multicenter study included 1798 RCC patients: 1206 from Zhejiang Cancer Hospital (training set n = 804, test set n = 402) and 592 from the Second Affiliated Hospital of Harbin Medical University (validation set). OM status, tumor location, preoperative CEA level, preoperative CA199 level, Grade, histology, tumor size and age of patients were recorded. Six ML models including extreme gradient boosting (XGB), artificial neural network (ANN), logistic regression (LR), random forest (RF), support vector machine (SVM) and decision tree (DT) were developed for the OM prediction in RCC. The area under the receiver operator characteristic (ROC) curve (AUC), accuracy, sensitivity, specificity, precision, F1 score and decision curve analysis (DCA) were analyzed for judging predictive performance.

Results: The OM rates in training set, test set and validation set were 10.4%, 9.5% and 10.0%, respectively. The XGB model outperforming five other algorithms (ANN, RF, LR, SVM, and DT) across training set (AUC = 0.924, 0.096 gain vs LR), internal test (AUC = 0.868, 0.038 gain vs LR) and validation set (AUC = 0.766, 0.065 gain vs LR). The comparison of accuracy, sensitivity, specificity, precision and F1 score revealed the XGB model exhibited the best performance. The DCA curve also suggested that XGB had better clinical decision-making capability than the other five models. Feature importance analysis highlighted preoperative CEA level and tumor location as key predictors.

Conclusion: Our study developed and validated an XGB-based machine learning model that could accurately predict OM in RCC patients using routine preoperative variables. This model demonstrates strong discriminative ability and clinical utility, assisting personalized risk stratification and appropriate treatment decisions.

Purpose: Treatment strategies for early and locally advanced rectal cancer are evolving, particularly with the increasing use of non-operative management and multidisciplinary decision-making. The aim of this study is to establish an expert-based consensus on the preferred treatment strategies for early and locally advanced rectal cancer.

Methods: A 12-member steering committee was established to conduct a modified Delphi consensus process on rectal cancer management. The committee performed a systematic literature review (2014-2024) to inform survey development. A 49-question survey, including open-ended and multiple-choice items, was developed and refined. A panel of 44 colorectal surgery experts was selected based on academic contributions, and two Delphi rounds were conducted anonymously. Consensus was defined as ≥ 70% agreement. Based on panel responses, 29 consensus statements were formulated.

Results: The panel reached consensus on the importance of multidisciplinary evaluation and surgical expertise in total mesorectal excision. Structured MRI reporting was recommended. Total neoadjuvant therapy was preferred for high-risk tumors. Non-operative management was recommended in cases of clinical complete response, with defined surveillance strategies. The role of biopsy in near-complete responders was also addressed.

Conclusions: This international consensus provides structured guidance on the management of rectal cancer, emphasizing multidisciplinary planning, the role of total neoadjuvant therapy in organ preservation, and rigorous surveillance protocols in non-operative management. These recommendations aim to standardize care and support evidence-informed clinical decision-making.

Background: Colorectal cancer (CRC) is a prevalent and deadly malignancy, often characterized by cellular heterogeneity and resistance to therapy. CD133, a proposed cancer stem cell marker, has been implicated in poor clinical outcomes, but its prognostic value remains controversial, particularly in diverse populations.

Objective: This study aimed to evaluate the relationship between CD133 expression and overall survival (OS) in patients with colorectal adenocarcinoma treated at Mousavi Hospital in Zanjan, Iran.

Methods: This retrospective cohort study analyzed 55 patients who underwent surgical resection for histologically confirmed colorectal adenocarcinoma between 2012 and 2017. CD133 expression was assessed using immunohistochemistry (IHC) and categorized as positive or negative. Associations with clinicopathological features and 5-year survival were examined using logistic regression and Cox proportional hazards (PH) models.

Results: CD133 expression was detected in 47.3% of tumors. It was significantly more prevalent in high-grade tumors (83.1% vs 18.7%, p = 0.001) and in female patients (66.7% vs 32.2%, p = 0.015). Five-year survival was significantly lower in CD133-positive patients (19.2%) compared to CD133-negative individuals (75.9%, p < 0.001). In multivariable Cox regression adjusted for tumor grade and age, CD133 positivity was associated with increased hazard of death (adjusted hazard ratio(HR) = 5.03; 95% confidence interval (CI) 1.66-15.25; p = 0.004). Because of the modest sample size and wide confidence intervals, this association should be considered preliminary. In crude analyses, tumor grade impacted survival; in the adjusted model, only CD133 remained remarkable, while age, sex, and tumor location showed no significant associations.

Conclusions: CD133 expression is significantly associated with high tumor grade and poor survival in Iranian CRC patients, but findings should be interpreted with caution, given the small cohort. Its evaluation could aid in identifying high-risk individuals and guiding personalized treatment strategies in larger confirmatory studies.

Background: Colorectal cancer (CRC) significantly impacts health-related quality of life (HRQoL) and sexual function (SF) in patients, with these effects potentially varying by gender. Despite the growing prevalence of CRC in Iran, the gender-specific relationship between HRQoL and SF remains underexplored. This study aims to investigate the association between HRQoL and SF in CRC patients in Iran.

Methods: A descriptive-correlational study was conducted among 256 CRC patients recruited from oncology centers in Iran through convenience sampling. Participants were assessed using validated and reliable instruments, including a researcher-developed demographic questionnaire, the Short Form-36 (SF-36) for HRQoL, the Female Sexual Function Index (FSFI) for women, and the International Index of Erectile Function (IIEF) for men. The normality of the data was evaluated using kurtosis and skewness indices. Pearson's correlation coefficients and partial correlation analyses were employed to examine the associations between HRQoL and SF, adjusting for potential confounders. Data were collected and subsequently coded using Stata software (version 17, StataCorp, College Station, TX).

Results: In this study, 256 colorectal cancer patients (50.4% male, 49.6% female) were analyzed, with a mean age of 50.2 ± 20.4 years. Significant associations between HRQoL and sexual function were primarily observed in female patients. In women, strong positive correlations were found between the physical functioning domain of HRQoL and both sexual satisfaction (r = 0.78, p < 0.001) and sexual pain (r = 0.87, p < 0.001). Additional significant correlations included HRQoL physical functioning and sexual desire (r = 0.53), mental stimulation (r = 0.53), lubrication (r = 0.59), orgasm (r = 0.59), and the total FSFI score (r = 0.69) (all p < 0.001). In contrast, no comparable correlations were found in male patients. Energy levels were positively correlated with sexual function in females but negatively in males (e.g., energy/fatigue and sexual satisfaction, r =  - 0.67, p < 0.001), further underscoring gender-specific differences. Social functioning was positively associated with sexual pain (r = 0.54, p < 0.001) and other FSFI domains in women. General HRQoL was also positively correlated with sexual function in women (e.g., total HRQoL and sexual satisfaction, r = 0.56, p < 0.001) but not in men. These findings highlight a clear gender disparity in the interplay between HRQoL and sexual function.

Conclusion: In conclusion, this study identifies complex, gender-specific associations between HRQoL and sexual function in colorectal cancer patients. Among female patients, better physical functioning and higher energy levels were associated with greater sexual satisfaction, whereas these associations were not observed in male patients, suggesting potential gender differences in sexual health outc

Background: It has been suggested that chemoradiotherapy may cause fibrosis of the internal anal sphincter, resulting in sclerosis. However, no report has quantitatively investigated this relationship by using real-time tissue elastography.

Objective: To clarify the relationship between fibrosis and elasticity of the internal anal sphincter in patients undergoing surgery for lower rectal cancer with or without preoperative chemoradiotherapy from a histological perspective.

Design: A single-center, prospective cohort study.

Settings: The surgical and pathological departments in a tertiary referral university hospital.

Patients: Eighteen patients with rectal cancer who underwent abdominoperineal resection between May 2019 and May 2022 were included in the study.

Main outcome measures: Real-time tissue elastography was performed before surgery to measure internal anal sphincter hardness as "elasticity" (hardest (0) to softest (255); decreased elasticity indicated sclerotic changes). Internal anal sphincter fibrosis was evaluated using Masson's trichrome and Elastica van Gieson staining. We evaluated internal anal sphincter elasticity after preoperative chemoradiotherapy and preoperatively in patients who did not undergo preoperative chemoradiotherapy and analyzed the correlation with the percentage of internal anal sphincter fibrosis in the resected specimens.

Results: Of the 18 patients, 10 underwent preoperative chemoradiotherapy. A significantly higher percentage of internal anal sphincter fibrosis was observed in the chemoradiotherapy group. Post-chemoradiotherapy elasticity was significantly lower in patients undergoing chemoradiotherapy compared to pre-chemoradiotherapy elasticity and that in patients not undergoing chemoradiotherapy. The analysis of the correlation between internal anal sphincter elasticity and fibrosis showed that elasticity decreased as the percentage of fibrosis increased.

Limitations: This study was conducted at a single institution, and the number of cases was small. The radiation dose to the anal canal may have differed depending on the location of the tumor, which may have affected internal anal sphincter elasticity.

Conclusions: Internal anal sphincter elasticity may reflect tissue sclerosis associated with fibrosis caused by chemoradiotherapy.

Background: Establishing statements backed by strong scientific evidence with the intention of standardizing and guiding Hemorrhoidal Disease (HD) diagnosis and treatment in both the general population and in specific patient groups is the aim of this consensus.

Methods: A consensus panel of 11 surgical specialists from the Taiwan Society of Colon and Rectal Surgeons was convened from July 2023 to October 2024. Using a modified Delphi methodology, the panel addressed the diagnosis, treatment, prevention, and special situations of HD. Experts responded to a pre-meeting survey, and a literature search of English-language studies on clinical judgment, pharmacologic treatments, and surgical interventions was conducted. Draft statements were developed, discussed, and refined during the first meeting in July 2023. In April 2024, the panel reviewed updated studies, finalized recommendations, and voted anonymously. An online meeting in October 2024 validated and approved the recommendations, which were graded using the GRADE system.

Results: A total of 9 consensus statements have been developed covering the diagnosis and management of HD. The general principle of this consensus statement is to follow most international guidelines. To tailor the local clinical practice, we also discussed the alternative treatment strategy for sclerotherapy, the use of traditional herbs/medicines, and the consideration of CRC screening test.

Conclusions: These suggestions may represent a positive start toward recognized guidelines for improved hemorrhoidal disease treatment for all Taiwan healthcare professionals. As the first point of contact with patients, general practitioners, family medicine physicians, young surgeons, and pharmacists will find them to be quite valuable.