Clinical colorectal cancer最新文献

Background: Blood-based biomarkers could be an alternative method to increase compliance in population-based screening programs for early detection of colorectal cancer (CRC). We aimed to identify blood-based biomarkers that can identify patients with early-stage asymptomatic CRC for use in national screening programs.

Materials and methods: In a nested cohort of 1982 participants with a positive fecal immunochemical test (FIT, with > 100 ng Hemoglobin/mL) from the Danish CRC screening program, serum levels of 18 blood-based biomarkers (including GDF-15, hepsin, IL-8, keratin 1/10, L1CAM, MIA, MCP-1, NSE, OPG, AFP, CD44, CATD, TWEAK, YKL-40, CEA, midkine, osteonectin and ferritin) were measured. Biomarkers associated to CRC after adjusting for various possible confounders were combined with age and sex in a predictive multivariable model for CRC.

Results: Complete biomarker and clinical data were collected from 1959 subjects, including 237 (12.1%) with CRC and 623 (31.8%) with advanced adenomas. IL-8 was unaffected by confounders, increased across the adenoma-carcinoma progression, and associated to CRC (OR: 1.83, 95% CI, 1.59-2.11, P < .01) even when restricting analyses to early-stage CRC (OR: 1.41, 95% CI, 1.15-1.73, P < .01). Combining IL-8, OPG, CEA, ferritin, and age resulted in an AUC of 0.717 (0.682-0.751) for discriminating subjects with and without CRC.

Conclusion: Application of blood-based biomarker panels consisting of colorectal neoplasia-associated proteins seem to be potential predictors for early detection of CRC. Especially IL-8 could have a significant impact on future screening models, though further testing in true screening cohorts is needed.

Background: Circulating tumor DNA (ctDNA) has emerged as a promising biomarker for minimal residual disease (MRD) detection and recurrence risk stratification in colorectal cancer (CRC). However, its prognostic significance in stage III CRC remains incompletely defined. This meta-analysis aimed to evaluate the association between postoperative ctDNA positivity and recurrence risk in patients with stage III CRC.

Methods: PubMed, Embase, and the Cochrane Library were searched for potentially eligible studies published up to April 2025. Pooled risk ratio (RR) and pooled hazard ratio (HR) were calculated to evaluate recurrence rate and the prognosis of recurrence-free survival (RFS) following CRC surgery and ACT. Meta-analysis was performed using a random-effects model.

Results: A total of ten studies involving 2461 stage III CRC patients were included. Postoperative ctDNA positivity was significantly associated with an increased risk of recurrence (RR = 4.39, 95% CI, 3.45-5.58, P < .00001) and a poorer RFS (HR = 6.56, 95% CI, 4.80-8.98, P < .00001). The pooled analysis showed that ctDNA-positive patients had a significantly higher risk of recurrence following ACT (RR = 4.80, 95% CI, 3.17-7.26, P < .00001) and a worse RFS (HR = 10.00, 95% CI, 4.84-20.66, P < .00001).

Conclusion: Postoperative ctDNA positivity is a strong prognostic marker of recurrence in patients with stage III CRC and could guide individualized surveillance and adjuvant therapy decisions. Further prospective studies are warranted to validate its routine clinical use.

Background: The prognostic and predictive relevance of primary tumor sideness in colorectal cancer (CRC) has garnered growing interest. While clinical and molecular differences between right-sided (RS), left-sided (LS) and rectal (RT) tumors are well established in metastatic disease, their impact in non-metastatic, surgically treated patients remains less clear. This study aims to evaluate whether tumor location influences recurrence patterns and post-recurrence survival (PRS) following curative-intent resection for CRC. Patients and Methods We conducted a retrospective cohort study including 1,425 patients with histologically confirmed stage I-III colorectal adenocarcinoma who underwent R0 resection.

Results: Tumor recurrence was observed in 22.4% of patients. However, recurrence site differed significantly by tumor location: RS tumors were more likely to develop peritoneal metastases (9.5% vs. 6.6% LS and 5.3% RT; p=0.044), whereas RT tumors had a higher incidence of pulmonary metastases (12.4% vs. 6.3% RS and 7.4% LS; p=0.004). PRS differed markedly: 36-month PRS was 21% for RS, 41% for LS, and 32% for RT (p=0.005). Multivariate analysis confirmed primary tumor location as an independent prognostic factor for PRS. RS tumors conferred a significantly higher risk of death post-recurrence compared to LS and RT tumors. Although tumor sidedness does not appear to influence overall recurrence rates after curative resection, it is associated with distinct metastatic patterns and significantly worse post-recurrence outcomes.

Conclusion: These findings highlight the need to incorporate tumor location into prognostic stratification and post-surgical surveillance strategies in CRC. Personalized follow-up protocols, based on tumor biology and recurrence risk, may improve long-term outcomes.

Background: Despite the documented technical advantages in terms of pelvis dissection and increased rate of sphincter-preserving procedures, the long-term oncological outcomes after transanal total mesorectal excision (TaTME) are still a matter of debate. This study aimed to report mid- and long-term survival outcomes of patients with rectal cancer treated with TaTME.

Methods: Patients with non-metastatic mid to low rectal adenocarcinoma who underwent double-team trans-anal/laparoscopic trans-abdominal total mesorectal excision between 2015 and 2020 were selected and reviewed. Three and 5-year overall survival (OS), 3 and 5-year disease-free survival (DFS), 3 and 5-year disease-specific survival (DSS), and 3 and 5-year local recurrence (LR) rate. Univariable and multivariable analyses were performed to correlate clinical and pathological variables with the outcomes of interest.

Results: Of 146 patients treated with TaTME during the study period, 114 non-metastatic patients were analyzed (M/F 1.7; mean age: 69.1 years). The mean follow-up time was 58.6 months. Sixty four percentage received neoadjuvant treatment before TaTME. Pathologic stages were documented as being stage 0-I in 62 (54.4%) and stage II-III in the remaining 52 patients (45.6%); 5 patients had a positive circumferential margin (4.4%), and overall, one-third of the cohort received adjuvant therapy. 3-year survival outcomes were: OS 89.4%, DFS 95.5%, DSS 85.5%, and LR 3.5%. The multivariable analysis of the 3-year outcomes showed a significant association between OS and age at the time of surgery and between DFS and pathological stages. A 5-year survival analysis was conducted on 68 patients. 5-year survivals were OS 75.0%, DFS 91.0%, and DSS 82.0%. Multivariate analysis showed that elderly age had a negative impact on 5-year OS.

Conclusions: When performed by experienced surgeons in a high-volume center, TaTME is a mini-invasive procedure with good mid/long-term oncological outcomes.

Background: Total neoadjuvant therapy (TNT) is the standard approach for locally advanced rectal cancer (LARC), yet pathological complete response (pCR) is achieved in only a subset. Systemic inflammation, nutritional status, and sarcopenia influence outcomes, yet integrated predictive models are lacking. We aimed to develop clinical, laboratory, and AI-based models to predict pathological response.

Methods: This retrospective study included stage II to III LARC patients treated at Ankara Etlik City Hospital (Nov 2022-Dec 2024). Eligible patients received ≥ 12 weeks of TNT followed by curative surgery. Sarcopenia was assessed using CT-based skeletal muscle area at the third lumbar vertebra (L3). C-reactive protein/albumin ratio (CAR) and systemic immune-inflammation index (SII) were used to assess inflammatory and nutritional status. Composite scores (CINR-pCR, CINR-Ryan) were calculated using z-transformed CAR and SII weighted by regression coefficients. Outcomes included pCR and good pathological response, defined as tumor regression grade (TRG) 0 to 1 per the modified Ryan grading system. Logistic regression and Random Forest (RF) models were used.

Clinicaltrials: gov: NCT07049627.

Results: Among 136 patients, 93 met the inclusion criteria. pCR and TRG 0 to 1 was achieved in 20 (21.5%) and 43 (46.2%) patients, respectively. Independent predictors of pCR included absence of post-TNT sarcopenia (OR 0.30, 95% CI, 0.09-0.95, P = .007), low CAR (OR 0.14, 95% CI, 0.03-0.70, P = .008), low SII (OR 0.28, 95% CI, 0.08-0.96, P = .042), low LDH (OR 0.10, 95% CI, 0.02-0.70, P = .020), and metformin use (OR 2.52, 95% CI, 1.40-3.78, P = .031). For TRG 0 to 1, significant predictors included low CAR (OR 0.42, 95% CI, 0.23-0.76, P = .005), low SII (OR 0.13, 95% CI, 0.03-0.56, P = .006), absence of ≥ 10% weight loss (OR 0.12, 95% CI, 0.02-0.66, P = .016), absence of post-TNT sarcopenia (OR 0.18, 95% CI, 0.05-0.70, P = .014), and shorter RT-to-surgery interval (OR 3.14, 95% CI, 1.17-6.43, P = .004). CINR scores showed strong predictive value (AUCs: 0.868 and 0.846), and RF models showed excellent performance (AUCs: 0.933 and 0.910, respectively).

Conclusions: Inflammatory, nutritional, and sarcopenia-based markers, including CINR scores and AI models, accurately predict pathological response in LARC. Importantly, the ROC-derived cut-off values (CINR-pCR: 1.58; CINR-Ryan: 0.45) stratified patients into low- and high-risk groups, supporting clinical decision-making in organ-preservation strategies and surgical timing. Prospective multicenter validation is warranted.

Purpose: We synthesized the evidence on the accuracy of Deep learning in detecting colorectal cancer microsatellite instability to contribute to the development and updating of intelligent detection tools.

Methods: A systematic search was conducted in PubMed, Web of Science, Embase, and Cochrane Library from their inception until December 1, 2024. The included studies were assessed for the risk of bias using the Quality Assessment of Diagnostic Accuracy Studies-2. Only the diagnostic fourfold tables in the validation set underwent meta-analyses.

Results: Thirty original studies were finally included. The pooled specificity, sensitivity and area under the summary receiver operating characteristic curve of pathology slice-based deep learning were 0.86 (95% CI, 0.80-0.90), 0.90 (95% CI, 0.85-0.93) and 0.94 (95% CI 0.30-1.00), respectively. For the external validation of pathology slice-based deep learning, the pooled specificity, sensitivity and summary receiver operating characteristic curve were 0.84 (95% CI, 0.76-0.89), 0.88 (95% CI, 0.83-0.92) and 0.93 (95% CI, 1.00-0.00), respectively. The number of included studies on MRI-, colonoscopy-, and Raman spectrum-based deep learning was extremely small.

Conclusions: Pathology slice-based deep learning is accurate for colorectal cancer microsatellite detection and has potential for future software development, but imaging image-based deep learning needs more validation.

Trial registration: This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020). The protocol was prospectively registered with PROSPERO (CRD42025629990).

Introduction: Cardiovascular disease (CVD) and cancer are the leading causes of chronic illness and mortality in Western societies. Colorectal cancer (CRC) is the third most prevalent cancer and shares some risk factors with CVD, which is the major cause of mortality in CRC survivors. The American Heart Association recommends Life's Simple 7 to define and measure ideal cardiovascular health (iCVH). This study aimed to detail the iCVH in CRC patients at diagnosis.

Methods: A cross-sectional study of a cohort of Spanish patients with CRC describes health and behavioral factors at diagnosis. Physical activity was monitored using accelerometers; Diet was assessed through adherence to Mediterranean diet, and anthropometry was assessed by the body mass index (BMI). Hypertension, diabetes, hypercholesterolemia, and smoking were collected from clinical records.

Results: Two hundred thirty-eight CRC patients participated (66.4% male, 64.7 years mean age), 153 (64.3%) had localized disease, and 85 (35.7%) had metastatic disease. 10% had a history of CVD. 10 patients (4.3%) met 7 components of iCVH. Non-smoking (89.5%) was the most prevalent healthy behaviour, whereas BMI < 25 was the least (39.1%). Hypertension (62%) was the most common risk factor.

Conclusions: There is still some room for decreasing the habit of smoking. Initiatives for keeping a healthy diet and body composition are needed during and after the treatment.

Implications for practice: Assessing iCVH at diagnosis, which is considered a teachable moment, would raise awareness among health practitioners and patients about the importance of cardiovascular health along CRC trajectory and about behaviours that can be improved and impact on both cardiovascular and cancer outcomes.

Background: Adults aged ≥ 70 years represent approximately half of all patients diagnosed with colon cancer, but undertreatment in this population persists. Recent guidelines have aimed to reduce age-related biases in the treatment of colon cancer. We evaluated the age-related disparities in the receipt of curative-intent surgical and medical treatment of colon cancer, and their changes over time.

Methods: This was a population-based cohort study of adult patients diagnosed with colon adenocarcinoma between 2010 and 2018 in Alberta, Canada. Surgery receipt was assessed in patients with stage I-III disease, while systemic therapy receipt was assessed in stage III to IV disease. Patients were stratified by age at diagnosis (< 70 and ≥ 70 years). Cox proportional hazard models were used to evaluate interactions between age and treatment status, and their associations with cancer-specific survival (CSS). Time trends associated with treatment receipt were identified with multivariable logistic regression.

Results: Among the 10,838 patients included, 48% were aged ≥ 70 years. For surgery recipients, 5-year CSS was 0.90 (95% CI, 0.88-0.91) and 0.79 (95% CI, 0.77-0.80) for patients < 70 and patients ≥ 70 years of age respectively. Systemic therapy recipients aged < 70 years had a 5-year CSS of 0.57 (95% CI, 0.55-0.60), while individuals aged ≥ 70 years had a 5-year CSS of 0.51 (95% CI, 0.49-0.55). The association between treatment receipt and CSS was independent of age for both treatment modalities (P = .17). Treatment receipt trends remained consistent between 2010 and 2018.

Conclusion: Despite evolving practice guidelines and non-age-dependent survival benefits, disparities persist in the receipt of treatment for older adults with colon adenocarcinoma.