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The incidence of small bowel tumors is low and accounts for 5% of digestive tract tumors and 2% of malignant digestive tract tumors. Small bowel tumors are most common in middle-aged people aged 30–59 years with a male to female ratio of 1.5–2.4:1. According to the literatures at home and abroad, most small bowel tumors are malignant. Adenocarcinomas, neuroendocrine tumors, stromal tumors, and lymphomas are the main malignant tumors. The clinical manifestations of small bowel tumors are nonspecific. At present, surgical resection is the main treatment method for small bowel tumors. The surgical methods include laparotomy, endoscopic surgery, laparoscopic surgery, combined endoscopic and laparoscopic surgery, etc. Laparoscopic small bowel tumor resection has been widely used in the clinical practice, but auxiliary incision has to be made for specimen extraction and digestive tract reconstruction. Laparoscopic small bowel tumor resection with specimen extraction through the natural orifice has been rarely reported. With the gradual popularization of the minimally invasive concept of NOSES and the improvement of surgeons’ operating skills in NOSES, the technique of NOSES can be applied for the treatment of small bowel tumors. Specimen extraction through the natural orifice can avoid auxiliary incision in the abdominal wall and only leave a few tiny trocar scars on the abdominal wall after the surgery. NOSES exhibits perfect minimally invasive effect. As a technique that’s easy to operate, replicate, and promote, NOSES exhibits great vitality. In this chapter, the laparoscopic resection of small bowel tumors with transvaginal specimen extraction is introduced.

At present, with the increasing incidence of colorectal cancer, the incidence and diagnosis rates of multiple primary colorectal cancer (MPCRC) are also increasing. Patients with right colon cancer complicated with sigmoid colon cancer need to receive radical resection for both right colon cancer and sigmoid colon cancer, which involve many organs. In addition, since the right colon has many adjacent organs, complicated vasculature, and high incidence of anatomical variations, this procedure is a very difficult technique in NOSES. When NOSES is performed in the right colon alone, the vagina is the preferred route of specimen extraction. When the patient is complicated with cancer in other parts of the colon, the specimen can be extracted along with the right colon specimen through the vagina. The main operating features of right colon cancer resection include complete dissection and transection of the right hemicolon in the abdominal cavity, totally laparoscopic functional end-to-end anastomosis between the terminal ileum and transverse colon, and transvaginal specimen extraction. The specimen extraction methods for sigmoid colon resection vary based on the different tumor sizes, but the principles of CME should be strictly followed. Anatomy and dissection should be performed at the correct operating plane, which is a prerequisite for the rapid and safe operation. The operating difficulties of this procedure mainly involve three aspects. Firstly, the laparoscopic technical difficulties include the correct identification of anatomical landmarks, reasonable surgical approach and complete mesentery resection, ligation of vessels at the root of the mesentery and dissection of lymph nodes, and the exposure and protection of important tissues and organs. Secondly, the technical difficulty of NOSES in the right colon cancer and sigmoid colon cancer is totally laparoscopic digestive tract reconstruction for twice, which is more difficult than other procedures. Thirdly, this procedure requires surgeons and assistants to have better cooperation. In the process of specimen extraction, the precise application of aseptic and tumor-free techniques is crucial.

BackgroundAlthough radiation therapy (RT) improves local control for rectal cancer (RC), the long-term risks from RT, including development of a secondary malignancy, are controversial. The risk and prognosis of secondary bladder cancer (SBC) in RC patients undergoing RT have not been adequately studied. Our goal is to investigate the impact of RT on the risk of developing SBC and assess their survival outcomes.MethodsThis large population-based study included RC patients as their initial primary cancer from nine registries of the Surveillance, Epidemiology and End Results (SEER) database between 1973 and 2015. The cumulative incidence of SBC was assessed by using Fine and Gray’s competing risk regression. The standardized incidence ratio (SIR) was used to compare the incidence of SBC in RC survivors to the US general population. The Kaplan-Meier method was used to evaluate the 10-year overall survival (OS) and 10-year cancer specific survival (CSS) for patients with SBC.ResultsOf 74,646 RC patients, 24,522 patients were treated with surgery and RT and 50,124 patients were treated with surgery alone. The incidence of SBC was 1.85% among patients who received RT and 1.24% among patients who did not. The incidence of SBC in RC patients who received RT was higher than the US general population (SIR, 1.35; 95% CI, 1.19-1.53, PConclusionRadiation was associated with an increased risk of developing SBC in RC patients, and special attention should be paid to the surveillance of these patients.

NOSES VII is mainly applicable to female patients with larger tumors located at the left-sided colon. The main operating features of this procedure include totally laparoscopic dissection and transection of the left colon, specimen extraction from the vagina, and totally laparoscopic end-to-end anastomosis between the transverse colon and rectum. Compared with NOSES VI, this procedure has a broader indication because the specimen extraction from the vagina is easier to be performed, however the vaginal incision should be sutured properly. The operating difficulties of NOSES VII mainly involve laparoscopic technical difficulties and the challenges of NOSES. Specifically, the laparoscopic technical difficulties include the complete mesocolon excision of left-sided colon, dissection of lymph nodes at the root of mesenteric vessels, and the mobilization of the splenic flexure. The NOSES technical difficulties include the transvaginal specimen extraction, totally laparoscopic digestive tract reconstruction, the suturing of vaginal incision, and the strict maintenance of aseptic and tumor-free operation, etc.

NOSES ID is mainly applicable to patients with small tumors located in the lower and ultralow rectum. As with conventional laparoscopic radical resection of rectal cancer, the laparoscopic operation should strictly follow the principles of total mesorectal excision (TME). Anatomy and dissection should be performed in the correct plane, and the dissection of the pelvic floor should be more adequate to facilitate transperineal operation in the intersphincteric space, which is the key to the accurate completion of the procedure. The operating characteristics of NOSES ID are Intersphincteric transection of bowel in the anal canal after adequate laparoscopic dissection, extraction of the specimen through a natural orifice, and anastomosis of the proximal sigmoid colon to the anal canal. The operating characteristics of NOSES I are: (1) intraperitoneal transection and closure of intended resection line of sigmoid colon; (2) adequate dissection of mesorectum at the pelvic floor to the intersphincteric sulcus; (3) accurate searching of the approach to intersphincteric space at the perineum. This procedure requires excellent cooperation between the surgeon and assistant for the ultralow operation in the narrow space of the pelvic cavity. In addition, the aseptic and tumor-free principles must be strictly practiced. NOSES ID can not only ensure the radical resection of small tumors located in the lower and ultra-low rectum, but also preserve the anal function to the maximum extent, and avoid the auxiliary incision in the abdominal wall. Therefore, this procedure fully satisfies the requirements of functional surgery and minimally invasive surgery.

Preoperative preparation, especially bowel preparation, is a routine procedure before colorectal examinations and surgeries. Bowel preparation aims to clean the bowel and facilitate surgeries. With the popularization of Enhanced Recovery After Surgery (ERAS), the contents of preoperative preparation are constantly adjusted and improved. However, due to the particularity in the surgical procedures of NOSES, preoperative preparation is still vitally important. It involves many aspects including bowel preparation, vaginal preparation for females, and psychological preparation for patients. The most satisfactory surgical effects cannot be achieved without a comprehensive preoperative preparation.

The special anatomical location of lower rectal cancer makes anus preserving surgery more challenging. At present, the double stapling technique is usually used in the anastomosis for rectal cancer, which increases the chance of anus preservation. However, due to the limitation of the size of stapler, it is difficult for the stapler to transect and close the rectum at the level of the pelvic floor muscle surface for obese patients or patients with a narrow pelvis. Parks proposed transabdominal resection for rectal cancer with transanal coloanal anastomosis in 1982. Many scholars have confirmed that this approach provides anus preserving opportunity for more rectal cancer patient without affecting the long-term efficacy. It also makes up for the deficiency of double stapling technique in anus preserving surgery for lower rectal cancer. NOSES IC, i.e., laparoscopic ultralow rectal cancer resection with transanal specimen extraction and single-layer sigmoid-anal anastomosis, is not only a sublimation of the traditional Parks procedure but also an improvement of the theoretical system of NOSES for the lower rectum. The characteristics of this procedure are distinct: (1) Under the premise of ensuring the radical resection of rectal cancer, this procedure gives full play to the minimally invasive advantage of NOSES with small postoperative injury, light pain, and quick recovery; (2) In the transanal specimen extraction and manual single-layer sigmoid-anal anastomosis, both ends are sutured with absorbable sutures. The good tissue compatibility of absorbable suture reduces the disadvantage of poor tissue compatibility of the staple, thereby reduce the anastomotic inflammatory reaction and reduce the possibility of anastomotic stenosis. (3) This procedure can protect the internal and external anal sphincter to the greatest extent to preserve the anal function and ensure the postoperative bowel control function.

With the rapid development of surgical techniques and the widespread acceptance of minimal invasiveness, minimally invasive surgery has become the focal point of new medical technology. In most cases, laparoscopic surgery has replaced the conventional open surgery as a regular treatment procedure. Meanwhile, more recently, robotic surgery has been enthusiastically adopted by patients and surgeons alike. Moreover, natural orifice transluminal endoscopic surgery (NOTES) has overturned the conventional concept and pushed minimally invasive technique to the extreme of “no incision.” Furthermore, various minimally invasive techniques, and the evolved modalities of the surgical armamentarium of many different laparoscopic techniques, including 3D laparoscopic surgery, single-port laparoscopic surgery, hand-assisted laparoscopic surgery, and transanal minimally invasive surgery, are widely being used in the clinical practice. From here, we can see that the field of surgery has fully entered a new era with multiple surgical techniques and a wide variety of academic perspectives.

NOSES I is mainly applicable to patients with small tumors located in the lower rectum. NOSES I has no differences regarding the extent of resection and lymph node dissection when compared with the conventional laparoscopic radical resection of rectal cancer. The main differences between conventional laparoscopic surgery and NOSES I are digestive tract reconstruction and specimen extraction. The main operating procedures of NOSES I include transanal rectal eversion, extra-corporeal specimen removal, and totally laparoscopic end-to-end anastomosis between sigmoid colon and rectum. In addition, this technique may facilitate to determine the distance from the distal edge of the tumor to the dentate line under direct vision and avoid positive distal resection margin, thereby greatly improve the possibility of ultralow anastomosis. At present, NOSES I mainly includes two approaches of digestive tract reconstruction, namely NOSES IA and NOSES IB. There are some slight differences between these two approaches. NOSES IA involves the application of non-touch technique, but NOSES IB does not. Therefore, the indication of NOSES IB is wider than NOSES IA, but both of the approaches achieve the same surgical outcome. On the basis of ensuring the radical resection, NOSES I has obvious advantages such as less trauma, faster recovery, better cosmetic effect, etc., which is a worthy technique to be mastered and popularized by surgeons.

For patients with tumors located at the splenic flexure or left transverse colon, specimen extraction through the sigmoid colon is often difficult because the tumor is located far from the anus. For such patients, specimen extraction can be performed after opening the rectum. The main operating features of this procedure include complete dissection and resection of the left colon in the abdominal cavity, specimen extraction from a longitudinal incision in the upper rectum, totally laparoscopic side-to-side anastomosis between the transverse colon and sigmoid colon, and closing the incision of the upper rectum. The operating difficulties of this procedure mainly involve laparoscopic technical difficulties and the challenges of NOSES. Specifically, the laparoscopic technical difficulties include the complete mesocolon resection of the left colon, dissection of lymph nodes at the root of the mesentery, and the mobilization of the splenic flexure. The NOSES technical difficulties include the specimen extraction after opening the rectum, totally laparoscopic digestive tract reconstruction, and application of aseptic and tumor-free operation. These are the challenges the surgeons need to face and overcome.

Background: Cancer stem cells (CSCs), which are characterized by self-renewal and plasticity, are highly correlated with tumor metastasis and drug resistance. To fully understand the role of CSCs in colorectal cancer (CRC), we evaluated the stemness traits and prognostic value of stemness-related genes in CRC. Methods: In this study, the data from 616 CRC patients from The Cancer Genome Atlas (TCGA) were assessed and subtyped based on the mRNA expression-based stemness index (mRNAsi). The correlations of cancer stemness with the immune microenvironment, tumor mutational burden (TMB) and N6-methyladenosine (m6A) RNA methylation regulators were analyzed. Weighted gene co-expression network analysis (WGCNA) was performed to identify the crucial stemness-related genes and modules. Furthermore, a prognostic expression signature was constructed using Lasso-penalized Cox regression analysis. The signature was validated via multiplex immunofluorescence staining of tissue samples in an independent cohort of 48 CRC patients. Results: This study suggests that high mRNAsi scores are associated with poor overall survival in stage IV CRC patients. Moreover, the levels of TMB and m6A RNA methylation regulators were positively correlated with mRNAsi scores, and low mRNAsi scores were characterized by increased immune activity in CRC. The analysis identified 2 key modules and 34 key genes as prognosis-related candidate biomarkers. Finally, a 3-gene prognostic signature (PARPBP, KNSTRN and KIF2C) was explored together with specific clinical features to construct a nomogram, which was successfully validated in an external cohort. Conclusions: There is a unique correlation between CSCs and the prognosis of CRC patients, and the novel biomarkers related to cell stemness could accurately predict the clinical outcomes of these patients. Funding: None Declaration of Interest: The authors declare no conflict of interest. Ethical Approval: This study was approved by Institutional Review Board of National Cancer Center (NCC), Chinese Academy of Medical Sciences (approval no. 2017–20). All the patients’ samples used in this study have obtained necessary consent.

The right colon has many adjacent organs, complicated vasculature, and large anatomical variations. Therefore, NOSES VIII is one of the most difficult techniques in NOSES. Right colon cancer resection with transvaginal specimen extraction is limited to women. Extraction of the right colon specimen through the transverse colon, descending colon, sigmoid colon, rectum, and anus is theoretically feasible, but the actual operation is extremely difficult and impractical. The main operating features of NOSES VIII include complete dissection and transection of the right colon in the abdominal cavity, specimen extraction from the vagina, and totally laparoscopic functional end-to-end anastomosis between the terminal ileum and transverse colon. The main difficulties of this surgical procedure include the technical difficulties in laparoscopic right hemicolectomy and transvaginal specimen extraction. Specifically, the laparoscopic technical difficulties include the correct identification of anatomical landmarks, reasonable surgical approach and complete mesocolon resection, ligation of vessels, and dissection of lymph nodes at the root of the mesentery, and the exposure and protection of important tissues and organs. The NOSES technical difficulties include totally laparoscopic digestive tract reconstruction, which is more difficult than other procedures, and requires the surgeon and assistant to be more skillful. In the process of transvaginal specimen extraction, the application of aseptic and tumor-free techniques is crucial.

NOSES III is mainly applicable to female patients with slightly larger rectal tumors. The main operating procedures of NOSES III include transvaginal rectal extraction, extra-corporeal specimen removal, and totally laparoscopic end-to-end anastomosis between sigmoid colon and rectum. Compared with NOSES II, the main features of NOSES III are as follows: (1) there is no need to open the bowel intracorporeally, which better meets the requirements of aseptic principle; (2) more stringent vaginal preparation is needed before operation; (3) because of the strong vaginal extensibility, the indications of NOSES III are wider, but this procedure is limited to female patients. Although there is difference between NOSES III and conventional laparoscopic rectal resection, this technology is entirely reasonable, safe, and feasible as long as surgeons have clear anatomic understanding and solid operating skills.

NOSES II is mainly applicable to patients with the long sigmoid colon and small tumors located in the middle rectum. As with conventional laparoscopic radical resection of rectal cancer, NOSES II should strictly follow the principles of total mesorectal excision (TME). Anatomy and dissection should be performed at the correct operating plane, which is a prerequisite for rapid and safe operation. The operating procedures of conventional NOSES II include transanal extraction of the rectal lesion under the protection of self-made protective sleeve, extracorporeal resection of tumor, purse-string suture, and insertion of anvil, as well as totally laparoscopic end-to-end anastomosis between the sigmoid colon and rectum. In the conventional NOSES II, attention has been paid to the aseptic and tumor-free operation, but this is an approach still has some drawbacks. The surgical procedure of a modified NOSES II, which is more in line with the aseptic and tumor-free principle, is presented as follows

Objective: Stage II colorectal cancer (CRC) manifests various treatment responses and outcomes. To assess the recurrence risk, we established a molecular subtype classification for stage II CRC. Methods: We developed a novel molecular subtyping clustering algorithm CRC-MSC for determining molecular subtypes in stage II CRC using only whole exome sequencing (WES). It utilized a specified distance estimate, calculated according to the shared alterations among samples. CRC-MSC was qualified for classification and risk stratification on samples from National Cancer Center (NCC) and The Cancer Genome Atlas (TCGA). To facilitate application to individual management decision, this algorithm was simplified by a decision tree classifier (CRC-MDTC). Phylogenetic analysis was conducted to clarify the mutated genes constituting the decision tree. Results: Using CRC-MSC successfully subtyped 60 stage II CRC samples from NCC into three groups, favorable prognosis (S-I), unfavorable prognosis (S-II) and intermediate (S-III) groups, which was verified in TCGA dataset. These subtypes feature unique molecular, clinicopathological phenotypes and clinical outcomes, especially immune traits.A simplified version of decision tree classifier (CRC-MDTC), TMB, PRKDA and KRAS alterations are three top classification indications, could also reliably categorize samples into three groups. It was validated in an independent cohort with an accuracy of 74.7%. CRC-MSC and CRC-MDTC were available at https://bioinfo.org/crcmsc. Conclusions: In addition to the initial risk evaluation, we developed a framework for the classification of stage II CRC subtypes based on genome profiling, which may shed new light on the management of patients with stage II CRC, especially with regarded to individualized chemotherapy and immunotherapy. Funding: This work was supported by National Program Project for Precision Medicine in National Research and Development Plan of China (2016YFC0905300), and CAMS Innovation Fund for Medical Sciences (CIFMS) (2019-I2M-2-002). Declaration of Interest: None to declare. Ethical Approval: The ethical approval of this study was granted by the Institutional Review Board of Chinese Academy of Medical Sciences (CHCAMS, Beijing, China)/National Cancer Center (NCC, Beijing, China).

The relative low incidence of left colon cancer (only accounting for 5–6% of colon cancer), with some cases of sclerotic type accompanied by obstructive symptoms, leads to a lower amount of experience in NOSES VI. Compared with conventional laparoscopic left hemicolectomy, the main operating features of NOSES VI A include complete dissection and transection of left colon in abdominal cavity, specimen extraction from the rectum and anus, and totally laparoscopic end-to-end anastomosis between transverse colon and rectum. The operating difficulties of NOSES VI A mainly involve the laparoscopic technical difficulties and the challenges of NOSES. Specifically, the laparoscopic technical difficulties include the complete mesocolon resection of left colon, dissection of lymph nodes at the root of mesentery, and the mobilization of splenic flexure. The NOSES technical difficulties include the specimen extraction from the rectum and anus, totally laparoscopic digestive tract reconstruction, and application of aseptic and tumor-free operation. These are the challenges the surgeons need to face and overcome.

Background Our understanding in prognosis of bone metastasis (BM) from colorectal cancer (CRC) is limited. We aimed to establish a clinical risk stratification for individually predicting the survival of CRC patients with BM. Methods A total of 200 CRC patients with BM were included in this study. Survival time from BM diagnosis was estimated using the Kaplan-Meier method. The multivariable COX regression model identified the risk factors on cancer specific survival (CSS). Based on weighted scoring system, the stratification model was constructed to classify patients with BM according to prognostic risk. Discrimination power and calibration ability of risk stratification were measured. Results The median CSS time was 11 months after BM diagnosis. Lymph node metastasis, Carbohydrate antigen 199 (CA199) levels, bone involvement, Karnofsky Performance Status (KPS) scores, primary tumor resection, bisphosphonates therapy and radiotherapy were identified as predictors of CSS. Four risk groups were stratified according to weighted scoring system, including low risk, medium risk, medium-high risk and high risk group, with 35, 16, 9 and 5 months of median CSS, respectively (P=0.000). The risk stratification displayed good accuracy in predicting CSS, with acceptable discrimination and calibration. Conclusions This novel risk stratification predicts CSS in CRC patient with BM using easily accessible clinicopathologic factors, which is recommended for use in individualized clinical decision making in patient with BM.

Wei Pei,1,* Sicheng Zhou,1,* Jing Zhang,2 Haitao Zhou,1 Haipeng Chen,1 Jianjun Bi,1 Zhaoxu Zheng,1 Zheng Liu,1 Zheng Jiang,1 Zheng Wang,1 Qian Liu,1 Xishan Wang,1 Jianwei Liang,1 Qiang Feng1 1Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People’s Republic of China; 2Department of Abdominal Surgery, Huanxing Cancer Hospital, Beijing 100122, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jianwei Liang; Qiang Feng Email Liangjw1976@163.com; 190977026@qq.comObjective: This study aimed to evaluate the safety and efficacy of lobaplatin in hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with peritoneal metastasis (PM) arising from colorectal or appendiceal cancer.Materials and Methods: Patients with synchronous or metachronous PM who underwent cytoreductive surgery (CRS) with HIPEC were systematically reviewed at the China National Cancer Center and Huanxing Cancer Hospital from June 2017 to June 2019. All enrolled patients were grouped into either lobaplatin or nonlobaplatin groups depending on the different chemotherapeutic agents used during HIPEC. Clinical characteristics, pathological features, perioperative parameters, and prognostic data were collected and analyzed.Results: A total of 100 patients were enrolled, with 48 patients in the lobaplatin group and 52 in the nonlobaplatin group. The two groups were well balanced in terms of clinicopathological characteristics. The two groups had comparable perioperative outcomes. However, more patients in the lobaplatin group than in the nonlobaplatin group developed abnormal platelet levels on postoperative day (POD)3 and abnormal ALT levels on POD5. Moreover, the average platelet count in the lobaplatin group was significantly lower than that in the nonlobaplatin group on POD5. There were no significant differences in the 3-year overall survival (OS) rates (48.4% vs 35.1%, P=0.298) and the 3-year progression-free survival (PFS) rates (34.9% vs 21.0%, P=0.470) of the two groups.Conclusion: Lobaplatin-based HIPEC is safe and feasible for the treatment of patients with PM arising from colorectal or appendiceal cancer with comparable low mortality and acceptable morbidity.Keywords: peritoneal metastasis, HIPEC, lobaplatin, morbidity, safety, survival

Introduction: Neoadjuvant chemoradiotherapy (nCRT) followed by operation has become the standard treatment for locally advanced rectal cancer (LARC). However, considering the possible toxicity and complications of radiochemotherapy, nCRT is seldom used for the elderly. The purpose of this study was to assess the safety and long-term effect of nCRT combined with TME in elderly patients with LARC. Method: Four-hundred-fourteen LARC patients were divided into 2 groups: 108 patients were in the elderly group (≥ 65 years old) and 306 patients were in the non-elderly group (Results: The data comprised 103 patients in the elderly group and 292 patients in the non-elderly group who completed nCRT sessions following operation. The treatment-completion rates of the elderly and non-elderly groups were 95.37% and 95.42%, respectively. Twenty-two patients developed radiotherapy complications (grade III) in the elderly group and 37 such cases developed in the non-elderly group. Diarrhea, skinulcer, and perianal pain were ranked as the top 3 most common complications. The incidence of infection, anastomotic leakage, and intestinal obstruction was 0.97% in the elderly group. The 5-year DFS and 5-year OS rate were 70.7% and 80.8% in the elderly group, 67.3% and 81.6% in the non-elderly group respectively. Conclusions: nCRT are safe and effective for elderly patients, and it does not increase the risk of postoperative complications for the elderly. Hence, nCRT should not be withheld based on age alone.

Background The liver is the most frequent site for metastatic spread in colorectal cancer (CRC) patients, and these patients have much poorer prognosis than those without metastasis. Previous studies have shown that IgG Fc binding protein (FCGBP) plays important roles in tumorigenesis, progression, and prognosis, but its role in CRC metastasis remains unclear. Purpose In this study, we are aimed to explore the significance of FCGBP in liver metastatic CRC (LMCRC) patients. Methods We analyzed the expression of FCGBP RNA between CRC primary samples and liver metastatic samples in the Gene Expression Omnibus (GEO) database and The Cancer Genome Atlas (TCGA). Next, we assessed the expression of FCGBP protein in 135 paired primary CRC (PC) samples and LMCRC samples. Finally, we explored the relationship between the expression features and clinicopathological characteristics. Results The expression data of FCGBP were obtained from the GEO and TCGA databases. FCGBP RNA expression was evaluated between primary lesions (PC) and liver metastatic lesions (LM). FCGBP RNA was down-regulated in PC and LM, and especially lower in LM (p

Background This study aimed to evaluate the impact of postoperative complications on long-term survival in patients with peritoneal metastasis (PM) arising from colorectal cancer (CRC) treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Methods Patients with PM arising from CRC treated with CRS and HIPEC were systematically reviewed at the China National Cancer Center and Huanxing Cancer Hospital from June 2017 to June 2019. High-grade complications that occurred within 30 days were defined as grade 3 to 4 events according to the Common Terminology Criteria for Adverse Events (CTCAE) classification. Univariate and multivariable Cox regression models for overall survival were created. Predictors of high-grade postoperative complications were evaluated with univariate and multivariate logistic regression analyses. Results In all, 86 consecutive cases were included in this study. Forty-one patients (47.7%) developed postoperative complications, while 22 patients (25.6%) experienced high-grade complications. No mortality occurred during the postoperative period. The median survival of all patients was 25 months, and the estimated 3-year overall survival (OS) rate was 35.0%. In the multivariable Cox regression analysis, a high peritoneal carcinomatosis index (PCI) score (HR, 1.07, 95% CI, 1.01–1.14; P=0.015) and grade 3–4 postoperative complications (HR, 1.86, 95% CI, 1.22–3.51; P=0.044) correlated with worse overall survival. High estimated blood loss (OR, 1.01, 95% CI, 1.01–1.02; P Conclusion Careful patient selection, high levels of technical skill and improved perioperative management are crucial to ensure patient survival benefits after CRS+HIPEC.

Background and purpose: Abdominal desmoid tumors (ADTs) are rare soft-tissue neoplasms that have a relatively high local recurrence rate. The purpose of the present study was to delineate the clinicopathologic features and explore the prognostic factors of ADTs.Methods: From January 2000 to January 2019, patients with ADTs who underwent macroscopically complete resection at the China National Cancer Center were included in the study. The clinicopathologic characteristics and follow-up data were carefully collected and reviewed. Prognostic factors such as age at presentation, sex, tumor location, tumor size and tumor proximity to nerves or vasculature were analyzed, and recurrence-free survival was analyzed with these factors.Results: A total of 113 patients with ADTs were assigned to the abdominal wall group (n = 66) or abdominal cavity group (n = 47) according to the tumor site. Abdominal wall DTs and intra-abdominal DTs demonstrated distinct clinicopathological features and prognoses. During a median 61-month follow-up period, twelve (10.2%) patients had local recurrence. According to the univariate and multivariate analyses, intra-abdominal tumors, large tumors, and positive margins were independent risk factors for poor prognosis.Conclusion: Compared with intra-abdominal DTs, abdominal wall DTs demonstrate different clinicopathological features and a better prognosis. Under the premise of ensuring negative margins during the first surgical procedure, patients with abdominal wall DTs can obtain satisfactory prognoses through radical resection.

Background: Liver is the most frequent metastatic spread sites for CRC patients and these patients have much poorer prognosis compared to those without metastasis. Previous studies have shown that IgG Fc binding protein (FCGBP) plays important roles in tumorigenesis, progression and prognosis. In this study, we are aimed to explore the significance of FCGBP in liver metastatic CRC (LMCRC) patients. Methods: The expression data of FCGBP was obtained from GEO and TCGA database, FCGBP RNA expression was evaluated between primary lesions (PC) and liver metastatic lesion (LM). 135 paired specimens including normal mucosa, primary tumor and liver metastasis tissues were all collected from CRC patients and adopted in Tissue microarrays (TMAs). Immunohistochemical staining was performed on the TMAs slides with FCGBP and the immunohistochemistry score (SI) was calculated by the staining intensity multiplied by the positive rate of stained cells. Survival curves were calculated by Kaplan–Meier method and the log-rank test was used to compare the overall survival (OS) and disease-free survival (DFS). Univariate and multivariate analysis for prognosis were using Cox proportional hazards regression model.Results: FCGBP RNA was down-regulated in PC and LM, and especially lower in LM in database. We also found FCGBP protein was down-regulated in primary lesion and metastatic lesion, especially in metastatic lesion in 135 paired tumor tissues. According to immunohistochemistry score (SI), each cohort (primary lesion and metastatic lesion) was divided into FCGBP-positive (SI=4-12) and FCGBP-negative (SI=0-3) group. In both groups, the level of CEA (PC group, 3.880 vs 77.049, pp=0.008) and CA19-9 (PC group, 8.610 vs 111.700, pp=0.037) was lower than those in FCGBP-negative group. FCGBP-positive in LM cohort was an independent risk factor both in OS (HR 1.573, 95% Cl [1.017-2.433], p=0.042) and DFS (HR 1.869, 95% Cl [1.256-2.781], p=0.002). Conclusions: This study has found the relationship between FCGBP and clinical information of LMCRC patients. FCGBP expression was much lower in liver metastasis tumor tissues compared with primary tumor tissues in liver metastatic CRC patients and associated with the OS and PFS. Our works illustrate that FCGBP can be a promising prognostic factor for LMCRC.

Background Lobectomy is not advocated for papillary thyroid carcinoma (PTC) with high-risk features, although there is no high-level evidence showing that this is an inferior strategy. This study aimed to examine the association between the extent of surgery and survival of patients with PTC and high-risk features. Methods Consecutive patients with PTC and at least one high-risk feature treated in 2000–2012 were included in the study. High-risk features were defined as: primary tumour larger than 4 cm, gross extrathyroidal extension, macroscopic multifocality, and confirmed nodal metastasis including pathological lateral neck metastasis (pN1b) or more than five central lymph node metastases. Cox proportional hazards models were employed to measure the association between the extent of surgery and disease-specific survival (DSS) in the whole cohort and in a matched-pair analysis. Results Among a total of 2059 patients with high-risk features, 1224 underwent lobectomy and 835 had total thyroidectomy. Patients who underwent total thyroidectomy had significantly higher rates of bilateral cancer than those who had a lobectomy (79.4 versus 2.7 per cent respectively), macroscopic multifocality (80.8 versus 32.8 per cent) and bilateral neck metastasis (30.9 versus 3.3 per cent) (all P Conclusion Lobectomy was not associated with significantly worse outcomes for patients with PTC and high-risk features.

Background: The impact of the timing of bone metastasis (BM) diagnosis on colorectal cancer (CRC) patients is unclear. Our study aimed to explore the differences in clinicopathological characteristics, treatments and prognosis between synchronous BM (SBM) and metachronous BM (MBM) from CRC.Methods: We retrospectively investigated clinical data of CRC patients with SBM or MBM from 2008 to 2017 at Chinese National Cancer Center. Cancer specific survival (CSS) after BM diagnosis was estimated using the Kaplan-Meier method. The multivariable COX regression model identified the prognostic factors of CSS.Results: Finally, 63 CRC patients with SBM and 138 CRC patients with MBM were identified. Compared to SBM from CRC, MBM significantly was more involving multiple bone lesions (63.0 vs. 7.9%; p < 0.001), and more frequently originated from rectal cancer (60.9 vs. 41.3%; p = 0.033). The therapeutic strategies in SBM and MBM group were contrasted including systemic treatment, bisphosphonates, radiotherapy and metastasectomy for BM. 85.5% of patients in MBM group and 25.4% of patients in SBM group underwent primary tumor resection at initial diagnosis (p < 0.001). The median CSS was 11 months in both SBM and MBM group (p = 0.556), yet MBM patients developed from CRC in early AJCC stage presented obviously longer survival than those from advanced stage. Furthermore, patients could have improved CSS from primary tumor resection while there might be no survival benefit from targeted therapy in both SBM and MBM groups. Bisphosphonates was associated with a better CSS for patients with SBM, while radiotherapy for BM was related to a better CSS for patients with MBM.Conclusion: The CRC patients in SBM and MBM group represented different clinicopathological characteristics and treatment modalities, which affected the prognosis in different ways. Distinct consideration for CRC patients with SBM and MBM in clinical decision making is required.

Background: To evaluate the feasibility and safety of a new surgical method, complete laparoscopic extended right hemicolectomy with preserving the ileocecal junction in right-transverse colon cancer.Methods: We retrospectively analyzed and compared the data of consecutive patients with right-transverse colon cancer who underwent complete laparoscopic extended right hemicolectomy with preserving the ileocecal junction (n=23) and conventional complete laparoscopic extended right hemicolectomy (n=34) in our hospital between October 2017 to May 2019, respectively.Results: The overall operation time of the ileocecal junction-preserved group was significantly shorter than that of the control group (p=0.024). There was no difference in the number of harvested lymph nodes, metastatic lymph nodes and rate of metastatic lymph nodes (p＞0.05). The ileocecal junction-preserved group showed shorter time of first flatus, lower frequency of postoperative diarrhea and shorter duration of postoperative hospitalization. Furthermore, it also showed that the defecation frequency was lower in the ileocecal junction-preserved group than control group on the 1st, 3rd and 6th month (p＜0.05), and the number of patients who defecated at night or defecated four times or more a day were less in the ileocecal junction-preserved group than control group on the 1st month (p＜0.05).Conclusion: The complete laparoscopic extended right hemicolectomy with preserving the ileocecal junction promises as a safe and feasible surgical procedure for right-transverse colon cancer, associated with earlier recovery of bowel function, shorter operation time and similar pathological outcomes when compared to the conventional laparoscopic procedure.

Highlights Triage strategies to keep suspected and confirmed cases in isolation Virtual consultations and limiting all out patient activity Screening asymptomatic patients with nucleic acid test, antibody testing & CT chest Designated staff and operating areas for COVID 19 infected patients Careful use of laparoscopy with precautions Limited operating on cancer patients with consideration of alternatives treatment strategies Precaution and protocol are needed after the epidemic

The study aimed to identify chemoradiotherapy (CRT)-sensitive biomarkers in colorectal cancer (CRC) patients. The GSE15781 dataset used in this study contains 42 samples: 22 CRC tissues (non-CRT: n = 13; CRT: n = 9) and 20 normal colorectal tissues (non-CRT: n = 10; CRT: n = 10). Following pretreatment, differentially expressed genes were selected using the limma package. Potential CRT-sensitive genes were identified with Venn analysis and then enriched in function and pathway clusters using the DAVID online tool. Moreover, protein-protein interaction (PPI) network analysis was implemented using the STRING database. The TRRUST database was used to establish a transcription factor (TF)-target transcriptional network. A miRNA-mRNA network was constructed based on relevant databases. miRNA and mRNA expression levels were analyzed using real-time quantitative PCR. A group of 259 candidate CRT-sensitive genes were identified that were mainly enriched in cell cycle regulation, adhesion-associated processes, and the p53 signaling pathway. A PPI network was established that contained striking nodes, including ITGA2, MYC, ESR1, and dihydropyrimidine dehydrogenase (DPYD), among which ESR1 was linked to MYC, and the two nodes were also highlighted in the TF-target regulation network. SRY-box 9 (SOX9) was another key TF. Hsa-miR-590-3p, hsa-miR-495, hsa-miR-320c, and hsa-miR-320d were predominant in the miRNA-mRNA network. Expression levels of SOX9, DPYD mRNA, miR-495, and miR-590-3p were clearly reduced after X-ray treatment in irradiated HT-29 cells, whereas that of miR-320d was notably enhanced. SOX9 may be a CRT-sensitive gene in CRC patients, and hsa-miR-590-3p, hsa-miR-495, and hsa-miR-320d may be CRT-sensitive microRNAs in CRC patients. Therefore, SOX9, hsa-miR-590-3p, hsa-miR-495, and hsa-miR-320d may be used as sensitive biomarkers in CRC patients.

Backgroud: Our understanding in prognosis of bone metastasis (BM) from colorectal cancer (CRC) is limited. We aimed to establish a clinical risk stratification for individually predicting the survival of CRC patients with BM.Methods: A total of 200 CRC patients with BM were included in this study. Survival time from BM diagnosis was estimated using the Kaplan-Meier method. The multivariable COX regression model identified the risk factors on cancer specific survival (CSS). Based on weighted scoring system, the stratification model was constructed to classify patients with BM according to prognostic risk. Discrimination power and calibration ability of risk stratification were measured.Results: The median CSS time was 11 months after BM diagnosis. Lymph node metastasis, CA199 levels, bone involvement, KPS scores, primary tumor resection, bisphosphonates therapy and radiotherapy were identified as predictors of CSS. Four risk groups were stratified according to weighted scoring system, including low risk, medium risk, medium-high risk and high risk group, with 35, 16, 9 and 5 months of median CSS, respectively (P = 0.000). The risk stratification displayed good accuracy in predicting CSS, with acceptable discrimination and calibration.Conclusion: This novel risk stratification predicts CSS in CRC patient with BM using easily accessible clinicopathologic factors, which is recommended for use in individualized clinical decision making in patient with BM.

BACKGROUND: Claudin 7 is often abnormally expressed in cancers and promotes the progression of some malignancies. However, the role of claudin 7 in stage II colorectal cancer (CRC) has not been studied. AIM: To assess the expression and prognostic value of claudin 7 in stage II CRC. METHODS: We retrospectively studied 231 stage II CRC patients who underwent radical surgery at our hospital from 2013 to 2014. The protein expression level of claudin 7 was assessed and its relationship with clinicopathological features and prognosis was statistically analyzed. The independent prognostic factors were identified by Cox proportional hazards models. A prognostic grading system was constructed to stratify the survival of CRC patients. RESULTS: The expression of claudin 7 was significantly reduced in cancer tissues compared with normal tissues (P < 0.001), and its low expression was closely related to recurrence of the disease (P = 0.017). Multivariate analysis confirmed that claudin 7 low expression (claudin 7-low) (P = 0.028) and perineural invasion positivity (PNI+) (P = 0.026) were independent predictors of poor disease-free survival (DFS). A prognostic grading system based on the status of claudin 7 and PNI classified the patients into three prognostic grades: grade A (claudin 7-high and PNI-), grade B (claudin 7-low and PNI-, claudin 7-high and PNI+), and grade C (claudin 7-low and PNI+). The DFS was significantly different among the three grades (grade B vs grade A, P = 0.032; grade C vs grade A, P < 0.001; grade C vs grade B, P = 0.040). CONCLUSION: Claudin 7 can be used as a new prognostic marker to predict the DFS of patients with stage II CRC. The prognostic grading system with the addition of claudin 7 can further improve prognosis stratification of patients.

We first describe the application of natural orifice specimen extraction surgery in the treatment of a rectal implantation metastasis tumor from ovarian cancer. One patient diagnosed with recurrent rectal implantation metastasis 1 year after the removal of ovarian cancer successfully underwent transanal specimen extraction via laparoscopic rectectomy without an abdominal incision at the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College in March 2017. The operation time was 118 minutes, and the intraoperative blood loss was 5 mL. The specimen was extracted via the anus during the operation, and the resection margin was negative. The patient recovered well without complications. Anal function was normal, and the stoma and abdominal incision were well healed after 1 month of follow-up. This study supports the idea that the application of natural orifice specimen extraction surgery for rectal implantation metastasis from ovarian cancer is safe and feasible and can achieve satisfactory outcomes.

Background and objective The benefit from adjuvant chemotherapy for patients treated with neoadjuvant chemoradiotherapy (NCRT) and curative surgery remains controversial, particularly among those responding well to NCRT. This retrospective study aimed to clarify the benefits of adjuvant chemotherapy in terms of the oncological outcomes of patients with ypT0–2N0 rectal cancer after NCRT and curative surgery. Methods All patients with ypT0–2N0 rectal cancer after NCRT and curative resection between 2005 and 2014 were examined. The oncological outcomes between patients treated with adjuvant chemotherapy and those without any chemotherapy were compared. Results The clinicopathological characteristics of 110 patients were reviewed in this study; one patient was excluded due to lack of follow-up. Of the 109 patients included, 58 (53.2%) underwent adjuvant chemotherapy (chemo group), whereas the remaining 51 (46.8%) did not receive any chemotherapy (non-chemo group). After a median follow-up of 50 months, there were no significant differences in the 5-year overall survival (OS) or recurrence-free survival (RFS) rates between the groups (OS: 92.1 vs 86.3%, P = 0.375; RFS: 80.9 vs 74.7%, P = 0.534). Subgroup analysis also demonstrated no significant differences in 5-year OS and RFS rates between patients with ypT0N0 rectal cancer (P = 0.712 and P = 0.599, respectively) and those with ypT1–2N0 disease (P = 0.255 and P = 0.278, respectively). Conclusions These results indicate that patients with ypT0–2N0 rectal cancer after NCRT followed by curative surgery may not derive significant benefit from adjuvant chemotherapy. However, further prospective randomized trials, with larger sample sizes, are warranted to confirm this conclusion.

This abstract was not presented at the symposium.

Background Many pre-menopausal patients faced an unclear status of menstruation after chemotherapy, which makes it difficult for oncologists to determine the endocrinotherapy plan. This study aimed to establish a model that predicts and classifies the menstruation status of patients with CIA (chemotherapy-induced amenorrhea). Methods This is a hospital-based prospective study of female breast cancer patients. Inclusion criteria included patients diagnosed with breast cancer with a complete medical record of menses. Multivariate models were adjusted for established and potential confounding factors including age, serum concentration of estradiol (E2) and follicle-stimulating hormone (FSH), feeding, pregnancy, parity, abortions, and body mass index (BMI). The hazard ratios and 95% confidence intervals of different risk factors were estimated. Results From 2013 to 2016, 1,796 breast cancer patients were included in this study. Among them, 1,175 (65.42%) were pre-menopausal and 621 (34.58%) were post-menopause. The average age of natural menopause was 49.99 ± 3.24. 550 patients were included in CIA analysis, and 449 patients (81.64%) had CIA. As patients older than 60 years were defined as post-menopausal and low proportion of post-menopausal patients among people under 45 years old (4.83%), the target population of menopausal status estimation of patients focused on 1,142 patients aged 45 to 60 years old in this study. Age was found to be associated with menopausal status (OR: 1.856, 95% CI: 1.732-1.990). Other factors included, serum concentrations of E2 (OR: 0.976, 95% CI: 0.972-0.980) and FSH (OR: 1.060, 95% CI: 1.053-1.066), menarche age (OR: 1.074, 95% CI: 1.009-1.144) and number of abortions (OR: 0.829, 95% CI: 0.736-0.933). According to multivariate analysis, menopausal status was correlated with age, serum concentration of E2 and FSH. The model is: Logit (p) = -28.396+0.536Age-0.014E2+0.032FSH. When P is greater than 0.5, then the patient's menstrual state will be classified as post-menopausal. The areas under the ROC curve (AUC) were 0.9220, 0.8561 and 0.8769, respectively for the single factors of age, E2 and FSH, but the comprehensive model's AUC reached 0.9678. To examine the performance of this model, sensitivity analyses and model validation were conducted using external validation cohort (n=3,073), Leave-One-Out Cross Validation test, 10%, 20%, 30%- fold cross validation check, and Back substitution check. The results show that the sensitivities for different methods were about 85%, and the specificities were higher than 89%. According to the estimation of National Center Cancer Registry of China and the result of a national-wide Chinese retrospective study, about 137.7 thousands newly diagnosed female breast cancer aged 45-60 each year. Among them, 30.72% was hormone receptor positive, and 41.4 thousands (14.85%) patients annually probably be influenced by chemotherapy and decisions regarding endocrine therapy must be concerned. Conclusions The discriminative model obtained from this study for predicting menstrual state is important for pre-menopausal breast cancer patients with CIA. This model has high levels of specificity and sensitivity. A large numbers of patients probably be benefited from this study. Citation Format: Zhang B, Zheng R, Zhang Q, Wang X. Evaluation of menopausal status among breast cancer patients with chemotherapy-induced amenorrhea: A prospective study in China [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-15-07.

Metadherin (MTDH) is an oncoprotein and is expressed at high levels in a wide variety of human carcinomas, which represents an important genetic determinant and regulates multiple events in tumorigenesis. MTDH promotes breast cancer cell proliferation and tumorigenesis through the activation of numerous signaling pathways. Currently, the mecha- nism regulating MTDH expression is poorly understood. Here we identified that FBXW7, a component of E3 ubiquitin ligase, targets MTDH for ubiquitin-mediated degradation. Forced overexpression of FBXW7 could decrease the level of MTDH protein, and inhibition of endogenous FBXW7 expression remarkably increases the MTDH protein abundance. More importantly, overexpression of FBXW7 could lead to proliferation arrest and apoptosis in breast cancer cells through targeting MTDH degradation. These data suggest that FBXW7, a tumor suppressor, inhibits breast cancer cell prolifera- tion and promotes apoptosis at least partially through targeting MTDH for proteolysis. This new regulatory mechanism of MTDH by FBXW7 represents a new pathway for malignant phenotype turnover in human breast cancer.

// Qian Zhang 1 ,2, Yufu Wang 1, 2 , Hanqing Hu 1, 2 , Rui Huang 1, 2 , Lei Xie 1, 2 , Enrui Liu 1, 2 , Ying-Gang Chen 1, 2 , Guiyu Wang 1, 2 and Xishan Wang 1, 2, 3 1 Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, PR China 2 Colorectal Cancer Institute of Harbin Medical University, Harbin, Heilongjiang 150086, PR China 3 Department of Colorectal Surgery, Cancer Hospital of Chinese Academy Sciences, Beijing, 100021, PR China Correspondence to: Xishan Wang, email: wxshan1208@126.com Guiyu Wang, email: guiywang@163.com Ying-Gang Chen, email: chygang777@126.com Keywords: socioeconomic, SEER, colorectal cancer, survival, adverse Received: October 17, 2016 Accepted: May 29, 2017 Published: September 13, 2017 ABSTRACT Socioeconomic status (SES) has an impact on the survival of various cancers, but it has not been fully understood in colorectal cancer (CRC).The Surveillance, Epidemiology and End Results database was adopted to detect the role of SES in the survival outcomes of CRC. A total of 184,322 eligible patients were included and SES status was analyzed. The multivariable analysis showed that Non-Hispanic Black (HR, 1.20; 95% CI, 1.15–1.24), being widowed (HR, 1.04; 95% CI, 1.01–1.07), any Medicaid (HR, 1.36; 95% CI, 1.33–1.39) and the lowest education level group patients had relative poorer prognosis. Besides, sex, tumor location, age, differentiation level and American Joint Committee on Cancer stage also had significant effects on overall survival of CRC. The individuals were further divided into five groups according to the number of survival-adverse factors. All of the four groups containing adverse factors showed impaired survival outcomes compared with the group containing no adverse factor.

Due to special tumor location and technical difficulty of transverse colon cancer (TCC), partial colectomy (PC) is being widely applied in selected TCC patients, instead of extended hemicolectomy (HC). However, the oncological safety of this less aggressive surgical approach is not well studied. Here, we identified 10344 TCC patients from Surveillance, Epidemiology, and End-Results (SEER) database. The surgical treatment for those patients included PC and HC. Firstly, we compared lymph nodes evaluations between patients treated with HC and PC, including median number of nodes, the rate of nodes ≥ 12 and the rate of node positivity. Then, 5-year cancer specific survival (CSS) was obtained. Kaplan-Meier methods and Cox regression models were performed to assess the correlations between prognostic factors and long-term survival. Despite of less node examined by PC, the rate of node positivity was equal between PC and HC, suggesting node retrieval under PC was adequate to tumor stage. In addition, the 5-year CSS for patients who underwent PC were 67.5%, which was similar to patients who received HC (66.5%). The result after propensity score matching also confirmed the equivalent survival outcome between HC and PC. However, subgroup analyses showed that patients with tumor size ≥ 5 cm could not obtain survival benefit from PC. Furthermore, surgical approach was not considered as independent prognostic factor for TCC patients. Therefore, although PC is a less aggressive surgical approach, it should be a safe and feasible option for selected TCC patients.

// Fei-Feng Li 1, 2, * , Zhi-Xun Zhao 3, * , Peng Yan 3 , Song Wang 3 , Zheng Liu 4 , Qiong Zhang 5 , Xiao-Ning Zhang 5 , Chang-Hao Sun 6 , Xi-Shan Wang 3,4 , Gui-Yu Wang 2, 3 and Shu-Lin Liu 1, 2, 7 1 Systemomics Center, College of Pharmacy, and Genomics Research Center (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China), Harbin Medical University, Harbin, China 2 Translational Medicine Research and Cooperation Center of Northern China, Heilongjiang Academy of Medical Sciences, Heilongjiang, China 3 Department of Colorectal Surgery of the Second Affiliated Hospital, Harbin Medical University, Harbin, China 4 Department of Colorectal Surgery, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China 5 Department of Antibiotics, Heilongjiang Province Food and Drug Inspection Testing Institute, Harbin, China 6 Department of Nutrition and Food Hygiene, Public Health College, Harbin Medical University, Harbin, China 7 Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Canada * These authors have contributed equally to this work Correspondance to: Gui-Yu Wang, email: guiywang@gmail.com Shu-Lin Liu, email: slliu@ucalgary.ca Xi-Shan Wang, email: wxshan1208@126.com Keywords: colorectal cancer, APC, mutation, Wnt/β-catenin signaling pathway, gene expression Received: May 04, 2017 Accepted: May 23, 2017 Published: August 05, 2017 ABSTRACT Colorectal cancer (CRC) is among the most common and fatal forms of solid tumors worldwide and more than two thirds of CRC and adenomas patients have APC gene mutations. APC is a key regulator in the Wnt/β-catenin signaling pathway but its roles in CRC remains to be elucidated. In this study, we compared APC genes between CRC patients and controls to determine possible associations of nucleotide changes in the APC gene with the pathways involved in CRC pathogenesis. All participants received physical and enteroscopic examinations. The APC gene was sequenced for 300 Chinese Han CRC patients and 411 normal controls, and the expression levels of genes in the signaling pathway were analyzed using Western Blotting. Statistical analyses were conducted using SPSS (version 19.0) software. We found that rs11954856 in the APC gene was associated with colorectal cancer and could increase the expression levels of APC , β-catenin , TCF7L1 , TCF7L2 and LEF1 genes in the pathway in the CRC patients, demonstrating the involvement of APC in the pathological processes leading to CRC.

// Xu Guan 1, 2, * , Hanqing Hu 1, * , Wei Chen 3 , Zheng Jiang 2 , Zheng Liu 2 , Zhixun Zhao 1 , Yinggang Chen 1 , Guiyu Wang 1 and Xishan Wang 1, 2 1 Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China 2 Department of Colorectal Surgery, Cancer Institute & Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China 3 Follow Up Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China * These authors have contributed equally to this work Correspondence to: Xishan Wang, email: wxshan1208@126.com Guiyu Wang, email: guiywang@163.com Yinggang Chen, email: chygang777@163.com Keywords: colon cancer, surgery, colectomy, elderly, survival Received: September 23, 2016 Accepted: February 21, 2017 Published: April 10, 2017 ABSTRACT Due to large progress has been achieved in surgical techniques, anesthesia and perioperative care, it is accepted that the very elderly colon cancer (CC) patient is not contraindication for surgery. However, it is a controversy that an extended or a less aggressive surgical approach should be performed for this population. Here, we identified 28110 CC patients aged ≥80 from Surveillance, Epidemiology, and End-Results (SEER) database. The surgical approaches included extended hemicolectomy (HC) and partial colectomy (PC). 5-year cancer specific survival (CSS) was obtained. Kaplan–Meier methods and Cox regression models were used to assess the correlations between prognostic factors and long-term survival. The 5-year CSS for patients treated with HC were 45.6%, which were similar to patients who received PC (44.8%), the survival difference has no statistical significance (P=0.087). The result following propensity score matching further confirmed long-term survival were equal between HC and PC. However, patients in AJCC T3/T4 stage and with tumor size ≥5cm could obtain survival benefit from the extended surgery. In conclusion, most of elderly CC patients could not obtain survival benefit from extended resection. Partial colectomy should also be considered as an alternative approach for this group of patients.

Recent reports suggest promises on using oncolytic Newcastle disease viruses (NDV) to treat different cancers, while the effects of a NDV-D90 strain on gastric cancer remain unknown. Here we showed that NDV-D90 induced gastric cancer cell apoptosis in a dose-dependent manner in 3 gastric cancer cell lines BGC-823, SGC-7901 and MKN-28. Pronounced reduction in cell invasion was detected in NDV-D90-treated BGC-823 and SGC-7901 cells, but not in MKN-28 cells. The increases in cell apoptosis and reduction in cell growth in NDV-D90-treated gastric cancer cells seemingly resulted from augmentation of p38 signaling and suppression of ERK1/2 and Akt signaling. In vivo, orthotopic injection of NDV-D90 impaired tumor growth and induced intratumoral necrosis. Tumor cells that had been pre-treated with NDV-D90 showed defect in development of implanted tumor. Moreover, NDV-D90 appeared to reduce gastric tumor vascularization, possibly through suppression of vascular endothelial growth factor A and Matrix Metallopeptidase 2. Together, our data suggest that NDV-D90 may have potential anti-cancer effects on gastric cancer.

Leptin acts as an adipocytokine functions via the leptin receptor, which stimulates growth, migration, and invasion of cancer cells. This study is aimed at identifying leptin as a prognostic factor in colorectal cancer (CRC). The differentially expressed genes with prognostic value in CRC tissues either with or without liver metastasis were assessed based on The Cancer Genomic Atlas (TCGA). Leptin was considered a candidate gene for further analysis. Its expression features of 206 CRC patients without liver metastasis and 201 patients with metastasis on tissue microarrays were assessed by immunochemical staining, and the effect of leptin on survival was assessed by Kaplan-Meier analyses. Overexpressed leptin indicated a poorer prognosis for CRC patients in overall survival (p<0.05, log-rank test) based on the TCGA database. The leptin expression significantly correlated with metastasis stage (p<.010) and lymph node involvement (p<.010). Multivariate analysis also indicated that strong leptin expression was an independent adverse prognosticator in CRC (p=.017). Leptin may be valued as a prognostic marker could contribute to predicting a clinical outcome for patients with CRC.

Background Colorectal cancer is common in elderly patients. Laparoscopy is widely used to approach this kind of disease. This study was to examine short-term outcomes and long-term survival for laparoscopic and open surgery in elderly patients with colorectal cancer. Methods From January 2007 to December 2018, patients with colorectal cancer older than 80 operated at China National Cancer Center were included in the study. Propensity score matching (PSM) was used to minimize the adverse effects. The clinical data between open and laparoscopic surgery was compared, and the effect of factors on overall survival (OS) and disease-free survival (DFS) was analyzed by Cox proportional hazard model. Results Ninety-three pairs were selected after PSM. Patients in laparoscopic group had less intraoperative blood loss, postoperative complications, time to first flatus, time to oral feeding, postoperative hospital stay, and higher retrieved lymph node (P P > 0.05), besides the CEA level, III/IV stage, and perineural invasion were independent predictors of survival (P Conclusion In elderly patients with colorectal cancer, laparoscopic surgery had better short-term outcomes than open surgery. CEA level, III/IV stage, and perineural invasion were reliable predictors for OS and DFS.

Background The early detection of synchronous bone metastasis (BM) in newly diagnosed colorectal cancer (CRC) affects its initial management and prognosis. A clinical model to individually predict the risk of developing BM would be attractive in current clinical practice. Methods A total of 55,869 CRC patients were identified from Surveillance, Epidemiology, and End Results (SEER) database, of whom 317 patients were diagnosed with synchronous BM. Risk factors for BM in CRC patients was identified using multivariable logistic regression. A weighted scoring system was built with beta-coefficients (P