General epidemiologic colorectal cancer profile in Oncologos del Occidente from Colombia, South America.

e14693 Background: The Colorectal Cancer is one of the most common cancer in the US and the fourth cancer for the developing countries like in our area. Methods: This is a preliminary and partial report of a retrospective analysis from our cancer records in Oncologos del Occidente a Private Oncologic Cancer Center from Colombia. Results: 663 patients (50% of final report) from January 1997 to June 2012 with Colon Cancer 306(46%), Rectal Cancer 309(47%) y Anal Cancer (7%); 51% female; median age 60(range 16-92. sd:13.929); Urban Area 91%. Clinical stage I (7%), IIA (19%), IIB (3%), IIIA (5%), IIIB (13%) and IIIC (10%), IV (11%), Adenocarcinoma 81%, Mucinous (8%); Well differentiated (63%), Poorly differentiated (7%); pretreatment Carcino-embryonic antigen mean 32.778 ng/ml (range 0.18-550.0), Adverse prognostic factors were Obstruction (39%), Ulceration (31%), Lymph Vascular Invasion (10%), T4 Stage (5%), Perforation (4%), Positive Surgical Margin (2%) with two factors 21% and three factors 7%; Low rectal cancer was 90%, Non-Surgical treatment was Chemotherapy (CT) (37%), CT/Radiotherapy (RT) (35%), CT and RT (8%), RT (3%), None (16%); preoperative treatment 37%, First line CT was based on 5FU/LV (52%); 20% relapsed and the main recurrence pattern was Local-marginal (25%), Liver (17%), Pelvic peritoneal (3%), Carcinomatosis (8%) and Lung (23); Rescue treatment was CT (10%), Surgery+CT (1%), CT+RT (1%) and Surgery (1%); the main rescue CT was Folfox 2%, 5FU/LV (3%), Capecitabine (3%), Mixed 6%; Surgical Lymph nodes mean excised was 10.037 (0-38 SD.7.554) and positive nodes mean was 1.972(0-29 SD 3.503); Overall Survival at 5 years for Colon cancer is 63% and 53% to 10 years and Rectal cancer to 5 and 10 years is 45% and 36% respectively (p=0.001). Conclusions: These results reflect the colorectal cancer behavior in a specific area of Colombia and the importance of a multidisciplinary work.

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Artificial Intelligence in Decision-Making for Colorectal Cancer Treatment Strategy: An Observational Study of Implementing Watson for Oncology in a 250-Case Cohort

Frontiers in Oncology ◽

10.3389/fonc.2020.594182 ◽

2021 ◽

Vol 10 ◽

Author(s):

Batuer Aikemu ◽

Pei Xue ◽

Hiju Hong ◽

Hongtao Jia ◽

Chenxing Wang ◽

...

Keyword(s):

Artificial Intelligence ◽

Colorectal Cancer ◽

Rectal Cancer ◽

Colon Cancer ◽

Treatment Strategy ◽

Colorectal Cancer Patient ◽

Treatment Recommendations ◽

Learning Ability ◽

Cancer Center ◽

Colorectal Cancer Patients

BackgroundPersonalized and novel evidence-based clinical treatment strategy consulting for colorectal cancer has been available through various artificial intelligence (AI) supporting systems such as Watson for Oncology (WFO) from IBM. However, the potential effects of this supporting tool in cancer care have not been thoroughly explored in real-world studies. This research aims to investigate the concordance between treatment recommendations for colorectal cancer patients made by WFO and a multidisciplinary team (MDT) at a major comprehensive gastrointestinal cancer center.MethodsIn this prospective study, both WFO and the blinded MDT’s treatment recommendations were provided concurrently for enrolled colorectal cancers of stages II to IV between March 2017 and January 2018 at Shanghai Minimally Invasive Surgery Center. Concordance was achieved if the cancer team’s decisions were listed in the “recommended” or “for consideration” classification in WFO. A review was carried out after 100 cases for all non-concordant patients to explain the inconsistency, and corresponding feedback was given to WFO’s database. The concordance of the subsequent cases was analyzed to evaluate both the performance and learning ability of WFO.ResultsOverall, 250 patients met the inclusion criteria and were recruited in the study. Eighty-one were diagnosed with colon cancer and 189 with rectal cancer. The concordances for colon cancer, rectal cancer, or overall were all 91%. The overall rates were 83, 94, and 88% in subgroups of stages II, III, and IV. When categorized by treatment strategy, concordances were 97, 93, 89, 87, and 100% for neoadjuvant, surgery, adjuvant, first line, and second line treatment groups, respectively. After analyzing the main factors causing discordance, relative updates were made in the database accordingly, which led to the concordance curve rising in most groups compared with the initial rates.ConclusionClinical recommendations made by WFO and the cancer team were highly matched for colorectal cancer. Patient age, cancer stage, and the consideration of previous therapy details had a significant influence on concordance. Addressing these perspectives will facilitate the use of the cancer decision-support systems to help oncologists achieve the promise of precision medicine.

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Clinical lymph node staging by imaging in colorectal cancer: A flip of the coin?

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e15160 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e15160-e15160 ◽

Cited By ~ 1

Author(s):

Nelleke Pietronella Maria Brouwer ◽

Rutger Carel Hubert Stijns ◽

Lemmens Valery ◽

Iris D. Nagtegaal ◽

Regina GH Beets-Tan ◽

...

Keyword(s):

Colorectal Cancer ◽

Rectal Cancer ◽

Colon Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Neoadjuvant Therapy ◽

Cancer Patients ◽

Lymph Node Staging ◽

Preoperative Treatment ◽

Positive Lymph Nodes

e15160 Background: Clinical lymph node staging by MRI and CT is important in stratification for neoadjuvant therapy in colorectal cancer. Overstaging may result in unnecessary neoadjuvant therapy, but understaging may refrain patients from adequate preoperative treatment. This study aims to provide insight in current daily practice in clinical lymph node staging in CRC in the Netherlands. Methods: All patients with primary CRC, diagnosed between 2003-2014, who underwent lymph node dissection were selected from the nationwide population-based Netherlands Cancer Registry (n=100,211). Trends in patient- and tumor-characteristics, and lymph node staging were analyzed. For the years 2011-2014, sensitivity, specificity, positive (PPV) and negative predictive value (NPV) were calculated for clinical lymph node staging, with histology as the gold standard. Only patients without preoperative treatment were analyzed. Since prospective studies have shown that 5x5 Gy radiotherapy (RT) followed by total mesorectal excision within 10 days does not lead to nodal downstaging, an additional analysis was performed in this group. Results: The proportion clinically positive lymph nodes increased significantly between 2003-2014; from 7% to 22% for colon cancer and from 7% to 53% for rectal cancer. The proportion histological positive lymph nodes remained fairly stable over time (±35% colon, ±33% rectum). During 2011-2014, clinical lymph node staging was available in the registry in 86% of colon cancer patients, 92% of rectal cancer patients without neoadjuvant treatment and 95% of rectal cancer patients with 5x5 Gy RT. The parameters based on data from this period are presented in table 1. Conclusions: With a sensitivity and PPV of approximately 50%, clinical lymph node staging is about as accurate as flipping a coin. This leads to overtreatment in patients with rectal cancer with neoadjuvant RT. Acceptable specificity and NPV limit the risk of undertreatment. [Table: see text]

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Disparities in stage at presentation and treatment of colorectal cancer among Hispanic and non-Hispanic white patients.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.433 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 433-433 ◽

Cited By ~ 1

Author(s):

Rodrigo Rodriguez ◽

Melissa Gonzalez ◽

Bridget N. Fahy ◽

Anita Kinney ◽

Ashwani Rajput

Keyword(s):

Colorectal Cancer ◽

Rectal Cancer ◽

Colon Cancer ◽

Locally Advanced ◽

Incidence Rates ◽

Cancer Center ◽

Advanced Stage ◽

Stage Of Disease ◽

Nccn Guidelines ◽

Significant Difference

433 Background: Although incidence rates for colorectal cancer (CRC) for Hispanics are similar to non-Hispanic whites (NHW) in New Mexico, the cause-specific mortality is higher among the Hispanic population. Hispanics have also been shown to be less likely to be current with colorectal cancer screening guidelines as compared to NHW. The purpose of this study was to determine if there was a difference between Hispanics and NHW in stage at presentation and if the care provided was concordant with NCCN guidelines at our NCI designated cancer center. Methods: A prospective data base of all patients who presented with colorectal cancer between June 2009 and July 2013 was queried. A total of 197 patients were identified. Data was extracted that included: demographics, stage of CRC at first diagnosis, treatments given, and pathology results. Frequencies of stage at presentation and NCCN guideline concordance (meeting the 12 lymph node metric, receipt of adjuvant therapy for stage III disease and radiation therapy for locally advanced rectal cancer) were recorded. Results: The Table shows the results. There were 107 (55%) males. There was not a statistical difference in the stage of presentation for Hispanics and NHW for patients with colon cancer. Hispanic patients with rectal cancer, however, presented with more advanced stage of disease as compared to NHW (p<0.05). There was no statistically significant difference in concordance with NCCN guidelines for the three metrics analyzed. Conclusions: Hispanics and NHW with colon cancer presented with similar stage of disease and were concordant with NCCN guideline metrics. Hispanics with rectal cancer, however, presented at a more advanced stage of disease as compare to NHW patients. The reason for this disparity remains to be elucidated. Future studies to include outreach, education, screening and molecular profiling of these disparate populations are planned. [Table: see text]

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Predictors of pathological upgrading and upstaging in patients eligible for active surveillance submitted to radical prostatectomy (RARP).

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.7_suppl.59 ◽

2015 ◽

Vol 33 (7_suppl) ◽

pp. 59-59

Author(s):

Ana Maria Autran-Gomez ◽

Fernando P. Secin ◽

Arjun Sivaraman ◽

Rafael Sanchez-Salas ◽

Juan I Monzo ◽

...

Keyword(s):

Radical Prostatectomy ◽

Active Surveillance ◽

Clinical Stage ◽

Surgical Margin ◽

Cancer Center ◽

Positive Surgical Margin ◽

Cox's Regression ◽

Positive Core ◽

Study Population

59 Background: To evaluate the pathological outcomes in patients who were suitable for Active Surveilance (AS) and underwent Radical Prostatectomy (RP) and to explore the potential predictive factors to identify Gleason upgrading and upstaging. Methods: A prospectively maintained database was used to evaluate 1,552 consecutive patients who underwent RP [Laparoscopic / Robotic] at our institution between 1998 and 2012. We identified 405 RP patients fulfilling the Memorial Sloan-Kettering Cancer Center criteria for AS (PSA ≤10 ng/ml, clinical stage ≤2a, Gleason≤6, ≤2 + cores and less 50% cancer in any one core). In the final RP specimen, upgrading was defined as identification of Gleason >6 and upstaging as presence of ≥ pT3. The clinical and the pathological features of upstaged/upgraded patients were compared with the remaining patients and the cox’s regression model was applied to identify potential predictors. Kaplan Meir curve was used to identify Biochemical Recurrence Free Survival (BCR-FS) at 5 years. Results: We noticed upstaging in 195 (48%) patients and Gleason upgrading in 55 (13%) at RP specimen. Multivariate analysis showed percent of positive core had significant association with upstaging/upgrading. Positive Surgical Margin (PSM) was noted in 66(16%) patients, and the PSM rate was significantly higher in upstaged patients. The mean follow-up of the study population was 28 months and the predicted BCR-FS at 5 years was 92% and 88% in the patients who were not and were upstaged/upgraded. Conclusions: Percentage of positive cores in patients subjected to Active Surveillance appears to predict pathological upstaging/upgrading at radical prostatectomy. [Table: see text]

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Cost Analysis of Endoscopic Submucosal Dissection for the Treatment of Colorectal Lesions in China

BioMed Research International ◽

10.1155/2019/6983896 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Ning Cui ◽

Yu Zhao ◽

Honggang Yu

Keyword(s):

Colorectal Cancer ◽

Cost Analysis ◽

Endoscopic Submucosal Dissection ◽

Transverse Colon ◽

Surgical Margin ◽

Positive Surgical Margin ◽

Labor Costs ◽

Positive Surgical Margins ◽

Submucosal Dissection ◽

Treatment Medication

Aim. The aim of the study was to evaluate costs associated with colonic endoscopic submucosal dissection (ESD) for treatment of colorectal cancer. Methods. The study is a retrospective analysis of data on 395 patients treated by colonic ESD. Results. The operation, consumable items, and medication accounted for 71% of the total costs for colonic ESD treatment. Medication and consumable items’ costs were higher if lesions occurred in the transverse colon and right hemicolon compared to the left hemicolon. Medication, consumable items, and total costs were higher for larger lesions. Lesion numbers and carcinoma were associated with higher medication, consumable items, operation, and total costs. Positive surgical margins and complications of hemorrhage or perforation were positively correlated with higher costs for medication, consumable items, and total costs. Conclusion. Labor costs for doctors and nurses remain low in China. Costs for medication and consumable items were higher for treatment involving the transverse colon or right hemicolon (vs. the left hemicolon), larger lesions, carcinoma, and a positive surgical margin. A benchmark cost estimate for ESD treatment including 4 days of postoperative hospitalization was determined to be approximately 5400 USD.

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Clinical and demographical factors associated with fertility counseling in colorectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e24047 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e24047-e24047

Author(s):

Chengwei Peng ◽

Lena Masri ◽

Stefanie Roman ◽

Scott Sherman ◽

Daniel Jacob Becker

Keyword(s):

Colorectal Cancer ◽

Rectal Cancer ◽

Univariate Analysis ◽

Cancer Center ◽

Survivorship Care ◽

Demographic Shift ◽

Curative Intent ◽

Younger Patients ◽

Future Fertility ◽

Fertility Counseling

e24047 Background: The incidence of colorectal cancer in patients younger than 50 has been increasing over the past 2 decades. This demographic shift has important implications for survivorship care, in particular regarding issues of future fertility especially in light of USPSTF’s recommendation for colorectal cancer screening to begin at 45. Although ASCO has longstanding recommendations for fertility counseling in patients with cancer, the rates of fertility counseling in younger patients with colorectal cancer are unknown. Methods: Records for new patient visits for colorectal cancer in patients younger than age 55 in a large academic cancer center between 2012 and 2019 were queried for patient demographics, disease characteristics, and documentation of fertility counseling. Associations between demographic/clinical characteristics and fertility counseling were explored. Univariate and multivariable logistical regression analyses were performed using SAS v9.4. Results: Among 194 patients who met inclusion criteria, 39.2% of patients were female, 10.4% were African American, 31.4% had rectal cancer, and 69.6% were treated with curative intent. Approximately 14.5% of patients had Medicaid insurance. Age ranged from 22-55. The overall rate of fertility counseling among all patients was 15.5%. Of these patients, 43.3% were male. In univariate analysis, age less than or equal to 40 (p < 0.01), female gender (p = 0.03) and curative intent therapy (p = 0.03) were associated with fertility counseling. These factors were again statistically significant in multivariate analysis: age < 40, female, and curative intent therapy (Table). Race, stage of cancer, insurance status, prior exposure to chemotherapy, year of diagnosis and colon vs rectal cancer were not associated with counseling. Conclusions: The rate of fertility counseling was very low among patients with colorectal cancer, and exceptionally low among men. Despite changes in the demographics of colorectal cancer, it does not appear that appropriate changes have been made in fertility counseling. Increases in fertility counseling were not seen in more recent years despite recognition of increasing incidence in younger patients. Additional studies to identify barriers to counseling and strategies to improve survivorship care are urgently needed.[Table: see text]

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Differences in the outcomes of adjuvant chemotherapy for colon cancer prescribed by physicians in different disciplines: a population-based study in Taiwan

BMJ Open ◽

10.1136/bmjopen-2017-021341 ◽

2018 ◽

Vol 8 (12) ◽

pp. e021341

Author(s):

Cheng-I Hsieh ◽

Raymond Nien-Chen Kuo ◽

Chun-Chieh Liang ◽

Hsin-Yun Tsai ◽

Kuo-Piao Chung

Keyword(s):

Colon Cancer ◽

Adjuvant Chemotherapy ◽

Cox Regression ◽

Surgical Margin ◽

Disease Free Survival ◽

Disease Stage ◽

Multiple Primary Cancers ◽

Positive Surgical Margin ◽

Recurrence Rates ◽

Significant Difference

ObjectivesOne feature unique to the Taiwanese healthcare system is the ability of physicians other than oncologists to prescribe systemic chemotherapy. This study investigated whether the care paths implemented by oncologists and non-oncologists differ with regard to patient outcomes.SettingData from the Taiwan Cancer Registry and National Health Insurance Database were linked to identify patients with colon cancer who underwent colectomy as first treatment within 3 months of diagnosis and adjuvant chemotherapy between 2005 and 2009.Participants and methodsPostoperative patients who underwent adjuvant chemotherapy were included in this study. The exclusion criteria included patients with stage IV disease, a positive surgical margin and early disease recurrence. Among the patients presenting with multiple primary cancers, we also excluded patients who were diagnosed with colon cancer but for whom this was not the first primary cancer. The variables included sex, age, comorbidities, disease stage, chemotherapy cycle and changes in treatment regimen as well as the specialty of treatment providers and their case volume. Cox regression models and Kaplan-Meier analysis were used to examine differences in outcomes in the matched cohorts.ResultsWe examined 3534 patients who were prescribed adjuvant chemotherapy by physicians from different disciplines. In terms of 5-year disease-free survival, no significant difference was observed between the groups of oncologists or surgeons among patients with stage II (90.02%vs88.99%) or stage III (77.64%vs79.99%) diseases. Patients who were subjected to changes in their chemotherapy regimens presented recurrence rates higher than those who were not.ConclusionsThe discipline of practitioners is seldom taken into account in most series. This is the first study to provide empirical evidence demonstrating that the outcomes of patients with colon cancer do not depend on the treatment path, as long as the selection criteria for adjuvant chemotherapy is appropriate. Further study will be required before making any further conclusions.

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Single-Cell Analysis Reveals Characterization of Infiltrating T Cells in Moderately Differentiated Colorectal Cancer

Frontiers in Immunology ◽

10.3389/fimmu.2020.620196 ◽

2021 ◽

Vol 11 ◽

Author(s):

Xi Yang ◽

Quan Qi ◽

Yuefen Pan ◽

Qing Zhou ◽

Yinhang Wu ◽

...

Keyword(s):

Colorectal Cancer ◽

Rectal Cancer ◽

Colon Cancer ◽

T Cells ◽

T Cell ◽

Single Cell ◽

Peripheral Blood ◽

Strong Correlation ◽

Tumor Tissue ◽

Cell Populations

ObjectiveThis study aimed to characterize the tumor-infiltrating T cells in moderately differentiated colorectal cancer.MethodsUsing single-cell RNA sequencing data of isolated 1632 T cells from tumor tissue and 1252 T cells from the peripheral blood of CRC patients, unsupervised clustering analysis was performed to identify functionally distinct T cell populations, followed by correlations and ligand-receptor interactions across cell types. Finally, differential analysis of the tumor-infiltrating T cells between colon cancer and rectal cancer were carried out.ResultsA total of eight distinct T cell populations were identified from tumor tissue. Tumor-Treg showed a strong correlation with Th17 cells. CD8+TRM was positively correlated with CD8+IEL. Seven distinct T cell populations were identified from peripheral blood. There was a strong correlation between CD4+TN and CD4+blood-TCM. Colon cancer and rectal cancer showed differences in the composition of tumor-infiltrating T cell populations. Tumor-infiltrating CD8+IEL cells were found in rectal cancer but not in colon cancer, while CD8+ TN cells were found in the peripheral blood of colon cancer but not in that of rectal cancer. A larger number of tumor-infiltrating CD8+ Tex (88.94%) cells were found in the colon cancer than in the rectal cancer (11.06%). The T cells of the colon and rectal cancers showed changes in gene expression pattern.ConclusionsWe characterized the T cell populations in the CRC tumor tissue and peripheral blood.

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Subsite-Specific Dietary Risk Factors for Colorectal Cancer: A Review of Cohort Studies

Journal of Oncology ◽

10.1155/2013/703854 ◽

2013 ◽

Vol 2013 ◽

pp. 1-14 ◽

Cited By ~ 32

Author(s):

Anette Hjartåker ◽

Bjarte Aagnes ◽

Trude Eid Robsahm ◽

Hilde Langseth ◽

Freddie Bray ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Rectal Cancer ◽

Colon Cancer ◽

Cohort Studies ◽

Distal Colon ◽

Proximal Colon ◽

Risk Estimates ◽

Specific Risk ◽

Dietary Components

Objective. A shift in the total incidence from left- to right-sided colon cancer has been reported and raises the question as to whether lifestyle risk factors are responsible for the changing subsite distribution of colon cancer. The present study provides a review of the subsite-specific risk estimates for the dietary components presently regarded as convincing or probable risk factors for colorectal cancer: red meat, processed meat, fiber, garlic, milk, calcium, and alcohol.Methods. Studies were identified by searching PubMed through October 8, 2012 and by reviewing reference lists. Thirty-two prospective cohort studies are included, and the estimates are compared by sex for each risk factor.Results. For alcohol, there seems to be a stronger association with rectal cancer than with colon cancer, and for meat a somewhat stronger association with distal colon and rectal cancer, relative to proximal colon cancer. For fiber, milk, and calcium, there were only minor differences in relative risk across subsites. No statement could be given regarding garlic. Overall, many of the subsite-specific risk estimates were nonsignificant, irrespective of exposure.Conclusion. For some dietary components the associations with risk of cancer of the rectum and distal colon appear stronger than for proximal colon, but not for all.

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Clinicopathological Factors Influencing Lymph Node Yield in Colorectal Cancer: A Retrospective Study

Gastroenterology Research and Practice ◽

10.1155/2019/5197914 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Elena Orsenigo ◽

Giulia Gasparini ◽

Michele Carlucci

Keyword(s):

Colorectal Cancer ◽

Rectal Cancer ◽

Colon Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Cancer Patients ◽

Rank Test ◽

Lymph Node Yield ◽

Log Rank Test ◽

Lymph Node Retrieval

Many colorectal resections do not meet the minimum of 12 lymph nodes (LNs) recommended by the American Joint Committee on Cancer for accurate staging of colorectal cancer. The aim of this study was to investigate factors affecting the number of the adequate nodal yield in colorectal specimens subject to routine pathological assessment. We have retrospectively analysed the data of 2319 curatively resected colorectal cancer patients in San Raffaele Scientific Institute, Milan, between 1993 and 2017 (1259 colon cancer patients and 675 rectal cancer patients plus 385 rectal cancer patients who underwent neoadjuvant therapy). The factors influencing lymph node retrieval were subjected to uni- and multivariate analyses. Moreover, a survival analysis was carried out to verify the prognostic implications of nodal counts. The mean number of evaluated nodes was 24.08±11.4, 20.34±11.8, and 15.33±9.64 in surgically treated right-sided colon cancer, left-sided colon cancer, and rectal tumors, respectively. More than 12 lymph nodes were reported in surgical specimens in 1094 (86.9%) cases in the colon cohort and in 425 (63%) cases in the rectal cohort, and patients who underwent neoadjuvant chemoradiation were analysed separately. On univariate analysis of the colon cancer group, higher LNs counts were associated with female sex, right colon cancer, emergency surgery, pT3-T4 diseases, higher tumor size, and resected specimen length. On multivariate analysis right colon tumors, larger mean size of tumor, length of specimen, pT3-T4 disease, and female sex were found to significantly affect lymph node retrieval. Colon cancer patients with 12 or more lymph nodes removed had a significantly better long-term survival than those with 11 or fewer nodes (P=0.002, log-rank test). Rectal cancer patients with 12 or more lymph nodes removed approached but did not reach a statistically different survival (P=0.055, log-rank test). Multiple tumor and patients’ factors are associated with lymph node yield, but only the removal of at least 12 lymph nodes will reliably determine lymph node status.

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