Objective To analyse the causes of missed diagnosis in colorectal cancers and improve the early diagnosis. Methods A retrospective analysis was made to investigate the cause of missed diagnosis in 380 cases suffering from colorectal cancers.Results Of the 1 020 patients treated in our hospital in the past ten years (1984-1993), 380 patients were missed diagnosed, with the missed diagnosis rate of 37.3%. The main causes included: ①lacking attention to the early symptoms of colorectal cancers, neglecting the need to conduct certain tests such digital rectal examination and stool occult blood examination, ②delaying of seeking medical advice on the part of the patients, ③being satisfied with the diagnosis and treatment of benign disease, and ④neglecting certain special tests such as enteroscopy and barium enema examination of colon.Conclusion Routine use of rectal touch, occult blood examination and necessary use of special tests such as enteroscopy, barium enema examination of colon in patients suffering from stool change will increase the rate of accurate diagnosis of colorectal cancer.
Hyperthermic intraperitoneal chemotherapy (HIPEC) has been used in clinical setting, and is one of the optional treatment for peritoneal surface tumors. It can be used as adjuvant therapy to prevent peritoneal recurrence after gastric or colorectal cancer resection, or to treat those diseases with peritoneal metastasis alone through cytoreductive surgery +HIPEC or HIPEC alone, based on a multidisciplinary model. The updates of European HIPEC-related clinical trials, GASTRIPEC, GASTRICHIP, PRODIGE 7, PROPHYLOCHIP, COLOPEC, COMBATAC, were reported at the 11th International Workshop on Peritoneal Surface Malignancy. In those trials, there was no definitive result surporting that HIPEC treatment might bring survival benefits to patients with gastric or colorectal cancer. However, long-term follow-up results remain to be seen, and some studies are still recruiting. Although several studies were designed as phase Ⅲ trials, the overall sample size was small-scaled. In addition, in the trials, diagnostic laparoscopy were widely used in gastric or colorectal cancer patients, which was helpful to improve staging accuracy and optimizing treatment strategies. The indications for HIPEC therapy (peritoneal cancer index) and technical issues (duration, temperature, approach, and agents) need further investigate.
ObjectiveTo study the expression of apoptosissuppressing gene (bcl2) and apoptosispromoting gene (bax) in colorectal cancerous tissue and transitional mucosas. MethodsColorectal cancerous tissue, transitional mucosas (3 cm from the cancerous tissue) and normal tissue were taken respectively in thirtyone cases. Immunohistochemical technique SP method was used to detect the expression in those tissues. ResultsThe positive expression rate of bcl2 protein in cancerous tissue and transitional mucosa were 64.5%and 60.0% respectively and significantly higher than that in normal tissue (P＜0.05). The positive expression rate of bcl2 protein in normal tissue was 35.0%. The positive expression rate of bax protein in cancerous tissue and transitional mucosa were 45.2%and 45.0% respectively and significantly lower than that in normal mucosa (P＜0.05). The positive expression rate of bax protein in normal tissue was 60.0%. There was no obvious difference in the positive rate of bax and bcl2 protein between cancerous tissue and transitional mucosa (Pgt;0.05). The expression rate of bax and bcl2 protein in colorectal cancer was irrelative to clinical pathological gradation and clinical stage (Pgt;0.05). ConclusionThere is over expression of bcl2 protein and low expression of bax protein in colorectal cancer and transitional mucosa. bcl2 protein and bax protein can affect the generation of colorectal cancer by participating in the regulation of apoptosis. But it is irrelative to clinical pathological gradation and clinical stage. Transitional mucosas should be viewed as precancerous lesion and resected during operation.
ObjectiveTo review the research progress of the relationship between the insulin resistance, insulin-like growth factor-Ⅰ(IGF-Ⅰ), insulin-like growth factor-Ⅱ(IGF-Ⅱ), and colorectal cancer, and to explore the future research trends. MethodsThe related literatures in recent 5 years from abroad databases (PubMed, Web of Science, and EMBASE)and domestic databases (CNKI, WANFANG, and WEIPU)were collected and reviewed. ResultsThe research on the correlation between the changes and colorectal cancer with insulin resistance and IGF-Ⅰand IGF-Ⅱlevels, epidemiological studies and the mechanism research, indicates that there are complex and close relationship between them. ConclusionsThe research about the relationship between the insulin resistance, IGF-Ⅰ, IGF-Ⅱ, and colorectal cancer is promising.However, many issues need to be further investigated.
ObjectiveTo detect expression of DTX2 molecule in colorectal cancer (CRC) tissues and investigate its clinical significances.MethodsOncomine and GEPIA databases were used to analyze the expression of DTX2 gene in CRC tissues and normal colorectal tissues, and online data of human protein atlas (HPA) was used to analyze the relationship between DTX2 protein expression and survival prognosis of patients with CRC. The expressions of DTX2 mRNA and protein were detected in the 55 cases of CRC tissues and corresponding paracancerous normal (PN) tissues by using qRT-PCR, Western blot, and immunohistochemistry methods, respectively. The correlations between the expression of DTX2 and the clinicopathologic characteristics were analyzed.Results① The data from Oncomine and GEPIA databases showed that the expression levels of DTX2 mRNA in the CRC tissues were significantly higher than those in the normal colorectal tissues (P<0.05); HPA online data analysis showed that the overall survival of CRC patients with low expression of DTX2 was better than that with high expression of DTX2 (P=0.009 8). ② The results of qRT-PCR and Western blot showed that the expression levels of DTX2 mRNA and protein in the CRC tissues were higher than those in the PN tissues (t=0.722, P<0.001; t=1.314, P<0.001); The results of immunohistochemical staining showed that the positive rate of DTX2 protein expression in the CRC tissues was higher than that in the PN tissues (χ2=0.899, P<0.001). The positive rate of DTX2 protein expression and the expression levels of DTX2 mRNA and protein were related to the depth of tumor invasion, lymph node metastasis, and TNM stage of CRC patients, that was, the deeper depth of tumor invasion, the more lymph node metastasis, and the later TNM stage, the higher positive rate of DTX2 protein expression, the higher expression levels of DTX2 mRNA and protein (P<0.05).ConclusionsDTX2 protein may be a novel biomarker for estimating progression of CRC. However, prognosis evaluation of DTX2 protein on CRC needs further clinical research.
【Abstract】 Objective To investigate the effect of NG-nitro-L-arginine methyl ester (L-NAME), an inhibitor of nitric oxide synthase, on the growth of colorectal cancer xenografts in vivo and on tumor-associated neovascularization. Methods Twenty BALB/c nude mice were randomly divided into control group and study group equally. Human colorectal cancer cell line SL174T was inoculated subcutaneously into nude mice to form transplantation tumors. Saline 0.2 ml was intragastric-administrated to mice in control group and L-NAME （4 mg toties guoties) was administrated orally to mice in study group three times per week for four weeks. The changes of tumors in both groups were recorded and the microvessel density (MVD) was also measured by immunohistochemistry assay. Results L-NAME significantly inhibited the growth of colorectal cancer xenografts in nude mice. The weight of transplantation tumor reduced with the inhibitory rate of 41.36%, and the inhibitory rate of tumor volume was 43.48% in study group. MVD in the study group and control group were 14.83±2.10 and 21.04±3.11, respectively, which showed that the former was significantly lower than that of the control group （P＜0.05）. Conclusion L-NAME may inhibit the growth of colorectal cancer via the suppression of tumor neovascularization.
ObjectiveTo investigate the effectiveness of sublobar resection and lobectomy via uniportal video-assisted thoracoscopic surgery (U-VATS) for lung metastases from colorectal cancer.MethodsRetrospective research was conducted on 42 colorectal cancer patients with lung metastases who underwent U-VATS sublobar resection and lobectomy at the Tongji Hospital, Huazhong University of Science and Technology between April 2016 and May 2019, including 24 males and 18 females with an average age of 58.0±9.9 years. Among them 17 patients received U-VATS sublobar resection and 25 patients received lobectomy. The operation time, intraoperative blood loss, postoperative pulmonary infection, drainage tube indwelling time, drainage volume on the first day after surgery, postoperative hospital stay were analyzed between the two groups, and the relationship between the prognosis and clinical characteristics of the two groups was compared.ResultsSublobar resection patients had less lung metastases (P=0.043) and shorter operation time (P=0.023) compared with the lobectomy patients. There was no significant difference between the lobectomy and sublobar resection groups in intraoperative blood loss (P=0.169), rate of postoperative infection (P=0.982), postoperative drainage duration (P=0.265), drainage volume on the first day after surgery (P=0.402) and postoperative hospital stay (P=0.612). The progression-free survival of the two groups was 25.19 months and 23.63 months (P=0.721), and their overall survival was 29.09 months and 30.64 months (P=0.554).ConclusionConsidering guantity and locations of lung metastases, U-VATS sublobar resection can achieve a similar prognosis to lobectomy for lung metastases from colorectal cancer. Further efficacy of this surgical strategy remains to be proved by longer follow-up.
Objective To evaluate branched-chain DNA (b-DNA) signal amplification and semi-quantitative (Sq) RT-PCR in detection of free cancer cells in peritoneal flushing fluid of colorectal cancer patients during surgery. Methods The CEA mRNA in peritoneal flushing fluid in 48 cases of colorectal cancer were detected by b-DNA and SqRT-PCR. Peritoneal flushing fluid cytology (PLC) was conformed simultaneously to detect the free cancer cells. The peritoneal flushing fluid of 12 cases with colorectal benign disease were taken as negative control, GAPDH mRNA as internal control. Results In colorectal cancer patients, positive rate of free cancer cells by bDNA and SqRT-PCR （43.8%, 31.3%） was higher than that by PLC （4.2%）. The relative quantitative expressions of CEA mRNA were related to the Dukes staging， depth invasion and differentiation degree (Plt;0.05)， but irrelevant to tumor size，the patients’ age and gender (Pgt;0.05).Conclusion Both b-DNA and SqRT-PCR technologies have advantages and disadvantages to detect free cancer cells in peritoneal flushing fluid， which are related to clinicopathological factors.
Objective To investigate the role of expression of T cell costimulatory molecule CD28 and variance of T cell subpopulations in the development and prognosis of gastric cancer and colorectal cancer. Methods The peripheral blood lymphocytes were tested for T cell subpopulations and T cell costimulatory molecule CD28 by flow cytometry in 38 patients with gastric cancer, 42 patient s with colorectal cancer , and 21 healthy peoples as control group . Results Expressions of T cell costimulatory molecule CD28 in patients with gastric cancer and colorectal cancer were (25. 80 ±10. 56) % and (28. 95 ±9. 29) % , and significantly higher than that of control group 〔(0. 82 ±0. 98) % , Plt; 0. 01〕. Expression percentage of total T cell (CD3 + ) in patient s with gastric cancer and colorectal cancer were significantly lower than that of control group 〔(53. 61 ±13. 84) % and (55. 96 ±10. 68) % vs (72. 07 ±7. 83) % , Plt; 0. 01〕. Expression percentage of CD4 + T cell (CD4 + CD3 + ) in patients with gastric cancer and colorectal cancer were significantly lower than that of control group 〔( 29. 84 ±9. 71) % and ( 33. 75 ±9. 04) % vs (38. 79 ±5. 08) %; Plt; 0. 01 , Plt; 0. 05〕; Expression percentage of CTL cell (CD8 + CD28 + CD3 + ) in patient s with gastric cancer and colorectal cancer were significantly higher than that of control group 〔( 1. 57 ±1. 99) % and (1. 93 ±2. 61) % vs (0. 02 ±0. 04) %; P lt; 0. 01〕; Expression percentage of CD8 + inhibitory T cell (CD8 + CD28 -CD 3 + ) and CD4 / CD8 ratio in patient s with gastric cancer were significantly lower than that of control group 〔(16. 06 ±6. 94) % vs (20. 56 ±6. 54) % , Plt; 0. 05 ; (1. 10 ±0. 51) % vs (1. 36 ±0. 31) % , P lt; 0. 05〕; Expression of regulatory T cell (CD4 + CD25 + CD3 + ) of patients with colorectal cancer was (19. 74 ±6. 89) % , which was significantly higher than that of control group 〔(13. 72 ±3. 08) % , Plt; 0. 01〕. No difference of expression was found in peripheral T cell subpopulations of postoperative patients with gastric cancer and colorectal cancer after one week ( Pgt; 0. 05) . Conclusion T cell number is fall ,T cell costimulatory molecule CD28 useless expression is increase in patient s with gastric cancer and colorectal cancer. CD4 + T cell subpopulation is significantly decreased in patient s with gast ric cancer. The regulatory T cell of patient s with colorectal cancer is significantly increased.
ObjectiveTo study the expression of Lumican in colorectal cancer tissues and investigate its role in the carcinogenesis and progression of colorectal cancer. MethodsLumican expression in 114 colorectal cancer and 43 normal tissues was detected by immunohistochemical SP method. ResultsLumican expression was negative in 43 normal colorectal tissues，while 79.82%（91/114） positive in cancer tissues, the difference of which was significant (Plt;0.05). The intensity of Lumican expression correlated conversely to the grade of differentiation for the colorectal cancer (Plt;0.05). So Lumican expression was statistically higher in Dukes A+B group than that in C+D group (Plt;0.05). There was no difference of Lumican expression in age and gender (Pgt;0.05). ConclusionsLumican didn’t express in normal colorectal tissues while expressed in cancer tissues, which suggests that Lumican may play a role in the carcinogenesis of colorectal cancer. The expression of Lumican is correlated with tumor differentiation grade and Dukes staging, which could be considered as an valuable index to biological features of colorectal cancer.