Parastomal hernia (PSH) is one of the most frequent long-term complications following abdominoperineal resection (APR) for rectal cancer. The optimal colostomy route to minimize PSH remains controversial. This study aimed to compare PSH risk between extraperitoneal colostomy (EPC) and transperitoneal colostomy (TPC) after laparoscopic APR. A retrospective cohort study was conducted including patients who underwent laparoscopic APR for rectal cancer between 2014 and 2017. Patients were categorized according to colostomy route (EPC vs. TPC). The primary endpoint was PSH, and secondary endpoints included other short- and long-term stoma-related complications and perioperative outcomes. Propensity score matching (1:3) was applied to balance baseline characteristics. Risk factors for PSH were further analyzed using logistic regression. A total of 464 patients were included. After matching, 102 patients in the EPC group and 243 in the TPC group were analyzed. Perioperative outcomes and overall stoma-related complication rates were comparable between groups. However, PSH occurred less frequently in the EPC group than in the TPC group (10/102 [9.8

BACKGROUND:Parastomal hernia (PSH) is a frequent complication of abdominoperineal resection (APR), yet large-scale studies characterizing its long-term incidence and tools for individualized risk stratification remain lacking. To determine the long-term incidence, independent risk factors, and develop a clinical prediction model for PSH after APR in rectal cancer patients. METHODS:We conducted a retrospective cohort study of 836 patients with rectal adenocarcinoma who underwent APR and permanent end colostomy at a high-volume tertiary center (2014-2018). PSH was diagnosed according to the European Hernia Society criteria. Independent risk factors were identified using Cox regression, and a nomogram was developed to predict 1- to 5-year PSH probabilities. Model discrimination was assessed using time-dependent AUC. RESULTS:During a median follow-up period of 85 months, 207 patients (24.8%) developed PSH, with a cumulative incidence of 26.2% at 5 years. Independent risk factors included female sex (HR = 2.28, 95% CI: 1.73-3.01), age ≥ 60 years (HR = 5.17, 95% CI: 3.72-7.18), BMI ≥ 24 kg/m2 (HR = 2.10, 95% CI: 1.57-2.80), and transperitoneal stoma route (HR = 4.11, 95% CI: 2.63-6.41; all P < 0.001). The nomogram demonstrated strong discrimination with 1-, 2-, 3-, 4-, and 5-year AUCs of 0.65, 0.70, 0.76, 0.80, and 0.83, respectively. CONCLUSION:This study provides evidence on PSH incidence and risk factors, introducing a nomogram for personalized risk stratification. The nomogram allows clinicians to identify high-risk patients and tailor preventive strategies, such as extraperitoneal stoma creation or prophylactic mesh placement, to reduce PSH burden.

Randomized controlled trials have revealed that abdominoperineal resection leads to inferior oncological outcomes compared with low anterior resection, especially regarding local recurrence rates (LRRs). While neoadjuvant chemoradiotherapy can lower LRRs, it is linked to potential short- and long-term radiation-induced adverse effects. Consequently, meticulous patient selection for neoadjuvant chemoradiotherapy is imperative to balance benefits and risks. This research encompassed individuals with rectal cancer (RC) who underwent abdominoperineal resection (APR) from January 2006 to December 2017. The cohort was categorized into two cohorts on the basis of tumor location: the anterior cohort and the nonanterior cohort. Propensity score matching (PSM) was employed to mitigate selection bias, and this resulted in 767 patients in both cohorts. The primary endpoint assessed was survival without local recurrence (LR). Of the 2025 cases examined, 1806 were deemed eligible for inclusion. In the entire cohort, the incidence of LR was 9.9

Background:The incidence of colorectal cancer (CRC) has been escalating, with a concurrent rise in early-onset colon cancer (EOCC). Despite this alarming trend, the prognosis of EOCC has been understudied. Our study aims to identify risk factors associated with EOCC and develop nomograms for predicting overall survival (OS) and cancer-specific survival (CSS), with the goal of choosing suitable therapy for various patient subgroups. Methods:Utilizing data from the Surveillance, Epidemiology, and End Results (SEER) database, we conducted a comprehensive analysis to elucidate risk factors in EOCC patients. We developed and validated nomograms to predict OS and CSS, stratifying patients into left-sided and right-sided groups and further categorizing them into distinct risk categories. After propensity score matching, we assessed therapeutic benefits of various interventions across subgroups. Results:We identified T stage, tumor histology, grade, size, N stage, carcinoembryonic antigen (CEA) levels, perineural invasion, tumor deposits, and race as independent risk factors for the left-sided group through univariate and multivariate Cox regression analyses. Those factors were integrated into the survival nomograms for this group. For the right-sided group, tumor histology, grade, N stage, CEA levels, perineural invasion, tumor deposits, radiation, and chemotherapy were identified as independent prognostic factors and were similarly incorporated into the survival nomograms. The concordance index (C-index) for our nomograms was significantly higher than that of the American Joint Committee on Cancer (AJCC) 7th edition staging system across all cohorts. Receiver operating characteristic (ROC) curve analysis demonstrated area under the curve (AUC) values of 0.72, 0.71, and 0.71 for 1-, 3-, and 5-year OS in the development cohort of the left-sided group, with comparable results in the validation cohort. The right-sided groups exhibited similarly favorable AUC outcomes. Calibration plots indicated a strong correlation between predicted and actual outcomes. Decision curve analysis (DCA) revealed the clinical utility of our nomograms to be superior to the AJCC 7th edition staging system. Analyses for CSS yielded analogous results. Kaplan-Meier curves highlighted significant differences in OS and CSS between low and high-risk groups. Notably, the right-sided groups derived greater benefits from adjuvant chemotherapy compared to the left-sided groups, whereas radiation therapy provided no discernible benefits across all subgroups. Conclusions:Our study provides a comprehensive prognostic evaluation of EOCC patients and uses nomograms for predicting OS and CSS in left-sided and right-sided groups. Subgroup analyses underscore the potential advantages of adjuvant chemotherapy in high-risk groups of both cohorts and the low-risk group of the right-sided cohort. These findings may inform the optimization of therapeutic strategies for EOCC patients.

Background:Locally advanced rectosigmoid junction cancer (LARSJC) presents unique challenges in prognosis and treatment due to its anatomical ambiguity between the colon and rectum. Current staging systems may not sufficiently capture the heterogeneity of LARSJC, highlighting a clinical need for more accurate prognostic tools to guide treatment decisions and improve patient outcomes. This study aimed to investigate risk factors and develop nomograms for LARSJC patients to improve clinical outcomes across diverse patient subgroups. Methods:We developed and validated nomograms to predict overall survival (OS) and cancer-specific survival (CSS) in LARSJC patients using data from the Surveillance, Epidemiology, and End Results (SEER) database (2010-2017). Patients with stage II and III LARSJC were included, excluding those with multiple primary cancers or incomplete data. Potential predictors, including age, sex, tumor stage, grade, size, carcinoembryonic antigen (CEA) levels, and perineural invasion, were assessed. OS and CSS were measured from diagnosis to death or last follow-up. The dataset was randomly split into a 7:3 ratio for training and validation. Predictive accuracy was assessed using C-index, receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA). Results:T stage, N stage, poor tumor grade, larger tumor size, age, tumor histology, positive CEA level, tumor deposits, perineural invasion, chemotherapy, and therapy sequence were selected as independent risk factors by univariate and multivariate Cox regression analyses and included in the OS nomogram model. The C-index of the OS nomogram in the training set (0.74; 95% CI: 0.72-0.76) and testing set (0.75; 95% CI: 0.73-0.77) were significantly higher than that of the American Joint Committee on Cancer (AJCC) 7th staging system (0.63; 95% CI: 0.61-0.66). The ROC curve with the calculated area under the curve (AUC) in the development cohort was 0.790, 0.782, and 0.762 for 1-, 3-, and 5-year OS, respectively. The AUC in the validation cohort was 0.752, 0.742, and 0.703 for 1-, 3-, and 5-year OS, respectively. The calibration plots for both cohorts demonstrated good agreement between actual clinical observations and predicted outcomes for 1-, 3-, and 5-year OS. In the training cohort, DCA showed that the nomogram prediction model was more advantageous for clinical application than the AJCC 7th staging system. Kaplan-Meier curves in the low and high groups showed significant differences in OS. Similar results were observed for CSS. Conclusions:This study provided a comprehensive prognostic analysis of LARSJC patients, developing nomograms that may assist in personalizing treatment plans. Limitations included the retrospective nature of the study and potential missing data in the SEER database. Future researches should focus on validating these models in prospective studies and incorporating additional biomarkers to enhance prognostic accuracy. These findings could guide clinical decision-making, identifying high-risk patients for targeted interventions and improving overall patient management.

Background:The incidence of colorectal cancer (CRC) has been rising in recent years, with a concurrent increase in early-stage rectal cancer (ESRC) cases. This study aimed to investigate risk factors and developed nomograms to predict overall survival (OS) and cancer-specific survival (CSS) in ESRC patients in order to improve clinical outcomes across diverse patient subgroups. Methods:Risk factors were investigated in ESRC patients by analyzing data from the Surveillance, Epidemiology, and End Results (SEER) database. We developed and validated nomograms to predict OS and CSS after dividing patients into two risk groups. Then we assessed the potential benefits of various therapies across subgroups after propensity score-matching (PSM). Results:T stage, tumor grade, age, carcinoembryonic antigen (CEA) levels, tumor size, and surgical options emerged as independent risk factors through univariate and multivariate Cox regression analyses, contributing to the OS nomogram; while for CSS, the identified risk factors were tumor grade, age, elevated CEA levels and surgical options. The Concordance-index of the nomogram surpassed that of the American Joint Committee on Cancer (AJCC) 7th staging system, with values of 0.69 (C-index, 0.64-0.74) in the training set and 0.65 (C-index, 0.62-0.68) in the testing set. The receiver operating characteristic (ROC) analysis revealed area under the curve (AUC) values of 0.70, 0.70, and 0.67 for 1-, 3-, and 5-year OS in the development cohort, with comparable results in the validation cohort. Calibration plots demonstrated strong alignment between predicted and observed outcomes. Decision curve analysis (DCA) confirmed the nomogram's superior clinical utility relative to the AJCC 7th staging system, with similar findings for CSS. Kaplan-Meier curves illustrated significant differences in OS and CSS between low- and high-risk groups. Notably, radiation and chemotherapy conferred no benefit, while low-risk patients, especially younger individuals, may benefit from local resection. Conclusions:This study presents a comprehensive prognostic analysis of patients with ESRC and developed predictive nomograms for OS and CSS. Subgroup analyses highlight the potential benefits of local resection in younger patients with low risk.

In the context of surgical treatment for rectal cancer, the dentate line is acknowledged as a critical anatomical landmark. However, the prognostic implications of dentate line invasion (DLI) remain elusive and warrant further investigation. This study aims to evaluate and compare the outcomes of patients with rectal cancer who underwent abdominoperineal resection (APR), distinguishing between those with and without DLI. Between January 2006 and December 2017, this study enrolled 1854 patients with rectal cancer who underwent APR. The cohort was divided into two groups, namely the DLI group (n = 340) and the non-DLI group (n = 1514). The primary endpoints were distant relapse-free survival (DRFS) and local recurrence-free survival (LRFS). Univariate and multivariate analyses were conducted to assess the impact of DLI on DRFS, LRFS, overall survival (OS), and disease-free survival (DFS). The median follow-up duration for the patients was 92.9 months, with a 5-year OS rate of 92.0

Background Randomized studies have demonstrated that laparoscopic abdominoperineal resection is not inferior to open abdominoperineal resection for rectal cancer. Aims Evaluate the immediate and extended results of laparoscopic abdominoperineal resection versus open abdominoperineal resection for rectal cancer. Methods From January 2006 to December 2017, a total of 1852 patients with rectal cancer who had undergone abdominoperineal resection were enrolled in this investigation. The groups were matched in a 1:1 ratio using propensity score matching. The primary endpoints were overall survival and disease-free survival. The secondary endpoints were pathology and short-term postoperative outcomes. Results Compared to the open abdominoperineal resection group, the laparoscopic abdominoperineal resection group exhibited a higher rate of positive circumferential resection margins (P < 0.001) and fewer postoperative complications (P < 0.001). 5-year disease-free survival (P = 0.449) and overall survival rates (P = 0.664) were comparable. Age (P < 0.001), comorbidity (P = 0.040), (y)pT (P = 0.024), (y)pN (P < 0.001), lymphovascular invasion (P = 0.003) and positive circumferential resection margins (P = 0.014) were independent prognostic risks for overall survival. Conclusion The pathological outcomes of laparoscopic abdominoperineal resection are inferior compared to open abdominoperineal resection. However, they demonstrate comparable long-term oncological outcomes, and laparoscopic abdominoperineal resection offers certain short-term advantages over the open approach.

Aim: To investigate the safety and efficacy of radical surgery in colon cancer patients over 80 years old. Methods: Data from colon cancer patients aged ≥80 years who underwent radical surgery at the Cancer Hospital of the Chinese Academy of Medical Sciences and affiliated Heji Hospital of Changzhi Medical College from January 2011 to December 2022 were retrospectively analysed. Data on clinical characteristics, pathological features, perioperative data, and long-term prognosis were collected. Severe complications were classified as grade III-V. Logistic regression models were used to identify the risk factors for severe postoperative complications, and a Cox regression model was used to determine prognostic variables. Results: A total of 403 eligible patients were included in the study. A total of 118 (29.3%) patients developed postoperative complications, of which 51 (12.7%) experienced grade 3-5 severe complications. Two (0.5%) patients died of pulmonary embolism and myocardial infarction during the perioperative period. The multivariate logistic regression analysis showed that preoperative albumin levels <35 g/L and right colon cancer were independent risk factors for grade 3-5 postoperative complications. In terms of prognosis, multivariate analysis revealed that overall survival was significantly affected by TNM stage III and grade 3-4 postoperative complications. In addition, TNM stage III and perineural invasion were the independent prognostic factors for disease-free survival. Conclusion: Radical surgery can be performed safely in elderly colon cancer patients aged over 80 years, with an acceptable morbidity and mortality. Patients with preoperative albumin levels <35 g/L or tumors in the right colon should be alerted to the development of severe postoperative complications. In addition, the occurrence of severe complications can significantly affect the prognosis of elderly colon cancer patients.

To investigate the impact of preoperative cardiovascular disease on the perioperative period of rectal cancer patients over 75 years old. The clinicopathological data of 625 elderly patients aged ≥ 75 years who underwent radical rectal cancer surgery in the Cancer Hospital of the Chinese Academy of Medical Sciences and affiliated Heji Hospital of Changzhi Medical College from January 2011 to December 2022 were retrospectively collected and analyzed. According to preoperative comorbidities, all patients were divided into cardiovascular disease group (n = 361) and non-cardiovascular disease group (n = 264). One hundred and ninety-two pairs were selected from each group through Propensity score-matched to further analysis. Perioperative indexes and postoperative complications were compared between the two groups. There were no significant differences in clinicopathological data between the two groups (P > 0.05). The proportion of elderly patients with cardiovascular disease who went to ICU after radical surgery was significantly higher than those without cardiovascular disease (19.3

Abstract Objective The prevalence of early-onset colon cancer (EOCC) among individuals below the age of 50 has shown a marked upward trend in recent years. The embryology, clinical symptoms, incidence, molecular pathways, and oncologic outcomes differ between right-sided and left-sided colon cancers. However, the differences have not been fully researched in EOCC. Our study aims to develop and validate prognostic nomograms predicting overall survival (OS) and cancer-specific survival (CSS) for EOCC in different tumor locations based on the Surveillance, Epidemiology, and End Results (SEER) database. Methods Using the SEER database, a total of 5,588 patients with EOCC were extracted and divided into development and validation cohorts in a random allocation ratio of 7:3 across three groups. Univariate and multivariate Cox regression analyses were performed to identify independent prognostic factors influencing OS and CSS outcomes. These factors were then utilized to construct nomogram models. The prognostic capabilities of the three models were assessed through various evaluation metrics, including the concordance index (C-index), receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA), and validation cohorts respectively. Additionally, survival curves of the low- and high-risk groups were calculated using the Kaplan–Meier method together with the log-rank test. Results Significant differences in clinical features were observed between right-sided and left-sided EOCCs, particularly in terms of OS (52 months vs 54 months) as demonstrated by Kaplan–Meier curves. Transverse-sided EOCCs exhibited clinical characteristics similar to right-sided EOCCs, suggesting a potential shared tumor microenvironment and therapeutic considerations. Advanced stage, liver metastasis, poor grade, elevated pretreatment carcinoembryonic antigen (CEA) level, chemotherapy, and perineural invasion were identified as independent prognostic factors across all three tumor locations and were incorporated into the nomogram model. Nomograms were constructed to predict the probability of 3- and 5-year OS and CSS. The C-index and calibration plots showed that the established nomograms had good consistency between actual clinical observations and predicted outcomes. ROC curves with calculated area under the curve (AUC) values exceeded 0.8 for all three groups in both the development and validation cohorts, indicating robust predictive performance for OS and CSS. Furthermore, decision curve analysis (DCA) plots revealed a threshold probability range of 0.1 to 0.9, within which the nomogram model exhibited maximum benefit. Kaplan–Meier curves exhibited significant differences between the low- and high-risk groups in EOCC for all three tumor locations in OS and CSS, further validating the prognostic value of the nomogram models. Conclusions We successfully developed three precise nomogram models for EOCCs in different tumor locations, providing valuable support for clinicians in guiding clinical treatments and facilitating further prospective follow-up studies.

e15511 Background: As one of the most concerning world public health issue, cancer accounted for 21% of all deaths. Early cancer detection methods help reduce the chance of dying from cancer. The fragmentation patterns of plasma circulating cell-free DNA (cfDNA) in tumor patients and healthy people are different, which reflects aberrant gene-regulation in cancer patients. Measure cfDNA fragmentomics not only identify the biomarkers to detect cancer early, but also contribute to revealing the biological regulatory mechanism of cancer. In this study, a novel method, i.e. multi-fragmentomics early tumor detection method (METD) was developed, which combined multiple cfDNA fragmentation features and effectively predicted early stage cancer patients. Methods: Adapter sequences were removed from raw data which are then aligned to hg19 reference genome. Duplicated reads, low quality reads and reads aligned to sex chromosomes were removed. Fragment length were normalized through z-score and GC content were regressed out from each bin using GBM (Gradient Boosting Machine) regression tree. Using data from 100 healthy samples, the baseline were calculated. Six fragmentation features including FSD (fragment size distribution) that is a ratio of short/long fragment numbers, EM (end motif) which represent the frequency of 5’end 2-6bp sequence patterns, BPM (break-point motifs) that is the frequency of 5’ end break-point sequences, TFAS (transcription factor accessibility score) that is the rank of coverage at transcription factor binding sites, CFS (co-fragmentation score) which calculate the first principle component of the free-C correlation matrix, GES (gene expression score) that measures the predicted gene expression from cfDNA lp-WGS data were calculated for each sample. Then these 6 fragmentation features were fitted in a penalized logistic regression for cancer prediction. Data of each sample was also downsampled to 0.1x, 0.5x, 1x, 3x and 5x to test the minimum amount of data needed for this prediction model. Results: In training data set, 208 samples from gastrointestinal cancer patients and 100 samples from healthy individuals, our method METD detect tumor patients with a AUC of 0.98. The AUC is 0.95 when the training data were downsampled to 0.1x. This method was then tested in a validation data set containing 32 cancer patients and 32 healthy individuals, which showed a specificity of 0.9 and sensitivity of 0.88. Conclusions: In this study, we develop a new method for early cancer detection integrating different fragmentomics features and demonstrated that lp-WGS data even with 0.1x data can be used to distinguish cancer and healthy groups. Studies with larger cohorts is warranted to verify the performance of this method in future.

Abstract Objective Adjuvant chemoradiotherapy in early stage rectal cancer is still controversial. The purpose of this study was to access the survival benefits of chemoradiotherapy for overall survival (OS) and cancer-specific survival (CSS) in patients with early stage rectal cancer and find the optimal treatment for these patients. Methods The study analyzed data from patients diagnosed with T1-2N0M0 rectal cancer between 2010 and 2016, using the Surveillance, Epidemiology, and End Results (SEER) database. The researchers then divided the patients into low-risk and high-risk groups based on various prognostic factors. Kaplan-Meier analysis was employed to evaluate the impact of chemoradiotherapy on OS and CSS in these patient groups. Results The Kaplan-Meier analysis revealed that patients with T1 stage (T1N0M0) had better OS and CSS outcomes than the T2 stage (T2N0M0) groups. Furthermore, it was shown that both low-risk groups of T1 stage and T2 stage had better OS and CSS outcomes than the high-risk groups. No significant benefits was shown when adding chemoradiotherapy in T1 stage groups while it was observed significant improvements for OS and CSS in T2 stage groups. Furthermore, local excision alone in T1 stage groups and local excision with chemoradiotherapy in T2 stage shown no significant difference comparing to those treated with segmental resection. Conclusion In our study, we found that chemoradiotherapy was beneficial for T2N0M0 rectal cancer patients. What’s more, local excision alone was a feasible alternative for T1N0M0 rectal cancer patients and local excision with chemoradiotherapy was a promising alternative for T2N0M0 rectal cancer patients.

Abstract Objective The use of adjuvant chemoradiotherapy in the treatment of stage IIA (T3N0M0) rectosigmoid junction cancer remains a topic of debate. To address this issue, we conducted a study to evaluate the impact of chemoradiotherapy on cancer-specific survival (CSS) and overall survival (OS) in patients diagnosed with stage IIA rectosigmoid junction cancer patients. Methods The study analyzed data from patients diagnosed with stage IIA rectosigmoid junction cancer between 2010 and 2016, using the Surveillance, Epidemiology, and End Results (SEER) database. The researchers then divided the patients into low-risk and high-risk groups based on various prognostic factors. Kaplan-Meier analysis was employed to evaluate the impact of chemoradiotherapy on CSS and OS in these patient groups. Results Kaplan-Meier analysis revealed that chemotherapy was significantly beneficial for CSS in all patients with stage IIA rectosigmoid junction cancer, while it only had a significant impact on OS in the high-risk group. Furthermore, the addition of radiotherapy to chemotherapy didn’t demonstrate any significant improvement in OS or CSS in all patients with stage IIA rectosigmoid junction cancer. Conclusion In the treatment of IIA rectosigmoid junction cancer patients, chemotherapy is generally recommended. However, the addition of radiotherapy doesn’t appear to improve OS and CSS in these patients.

目的 探讨肿瘤细胞减灭术(cytoreductive surgery,CRS)及腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)治疗结直肠癌异时性腹膜转移(peritoneal metastasis,PM)的疗效及远期预后因素分析.方法 回顾性收集分析2017年6月至2019年6月在中国医学科学院北京协和医学院肿瘤医院(28例)与北京市朝阳区桓兴肿瘤医院(6例)行CRS+HIPEC治疗的34例结直肠癌异时性PM患者的临床资料.采用Kaplan-Meier法进行生存曲线绘制,采用log-rank法进行生存分析.采用Cox比例风险回归模型进行多因素预后分析.结果 34例结直肠癌异时性PM患者术后3～4级并发症发生率为23.5％(8/34).中位总生存期(overall survival,OS)为26个月,1、2和3年OS率分别为70.6％、53.6％和42.2％.多因素分析显示,原发肿瘤位于直肠(HR=10.85,95％CI:1.21～97.11,P=0.033)和腹膜癌指数(peritoneal carcinomatosis index,PCI)≥12分(HR=5.22,95％CI:1.13～42.16,P=0.042)为影响患者肿瘤特异性生存(cancer-specific survival,CSS)的独立危险因素.结论 CRS+HIPEC的开展应对患者进行详细的术前评估且严格遵循手术适应证.直肠起源和PCI≥12分的结直肠癌异时性PM患者通过CRS+HIPEC治疗生存获益的可能性较小,应谨慎选择.

Objective:To determine the efficacy and safety of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) combined with hepatectomy in the treatment of colorectal peritoneal metastases (CRPM) combined with liver metastasis (LM).Methods:Sixteen clinicopathological data of CRPM patients with isolated LM from June 2017 to June 2019 in Colorectal Surgery Department, Cancer Hospital Chinese Academy of Medical Sciences were collected retrospectively.Results:There were six men and ten women present, with a median age of 62 years. All patients underwent CRS+HIPEC with concurrent liver resection, and the LM was completely removed. The median disease-free survival time was 9 months, and the median overall survival time was 25 months. The 1-year and 3-year overall survival rates were 75.0 and 37.0 percent, respectively, as were the 1-year and 3-year disease-free survival rates of 50.0 and 9.4 percent. Six cases (37.5%) had minor complications (Clavien-Dindo I~II), and four cases (25.0%) had major complications (III~IV).Conclusions:CRS+HIPEC combined with simultaneous liver resection is safe and viable for patients with CRPM combined with isolated and totally resected LM, and it can also provide some survival improvements.

Abstract Background The impact of primary tumour location on the prognosis of patients with peritoneal metastasis (PM) arising from colorectal cancer (CRC) after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is rarely discussed, and the evidence is still limited. Methods Patients with PM arising from CRC treated with CRS and HIPEC at the China National Cancer Center and Huanxing Cancer Hospital between June 2017 and June 2019 were systematically reviewed. Clinical characteristics, pathological features, perioperative parameters, and prognostic data were collected and analysed. Results A total of 70 patients were divided into two groups according to either colonic or rectal origin (18 patients in the rectum group and 52 patients in the colon group). Patients with PM of a colonic origin were more likely to develop grade 3–4 postoperative complications after CRS+HIPEC (38.9% vs 19.2%, P = 0.094), but this difference was not statistically significant. Patients with colon cancer had a longer median overall survival (OS) than patients with rectal cancer (27.0 vs 15.0 months, P = 0.011). In the multivariate analysis, the independent prognostic factors of reduced OS were a rectal origin (HR 2.15, 95% CI 1.15–4.93, P = 0.035) and incomplete cytoreduction (HR 1.99, 95% CI 1.06–4.17, P = 0.047). Conclusion CRS is a complex and potentially life-threatening procedure, and we suggest that the indications for CRS+HIPEC in patients with PM of rectal origin be more restrictive and that clinicians approach these cases with caution.

Background Nowadays, colorectal cancer (CRC) is one of the most commonly diagnosed malignant tumors worldwide, the incidence rate of which is still increasing year by year. Herein, the objective of this study is to investigate whether CDC42EP3 has regulatory effects in CRC. Methods First, CDC42EP3 knockdown cell model based on HCT116 and RKO cell lines was successfully constructed, which was further used for constructing mouse xenotransplantation models. Importantly, effects of CDC42EP3 knockdown on proliferation, colony formation, apoptosis, and migration of CRC were accessed by MTT assay, EdU staining assay, colony formation assay, Flow cytometry, and Transwell assay. Results As the results, we showed that CDC42EP3 was significantly upregulated in CRC, and its high expression was associated with tumor progression. Furthermore, knockdown of CDC42EP3 could inhibit proliferation, colony formation and migration, and promote apoptosis of CRC cells in vitro. In vivo results further confirmed knockdown of CDC42EP3 attenuated tumor growth in CRC. Interestingly, the regulation of CRC by CDC42EP3 involved not only the change of a variety of apoptosis-related proteins, but also the regulation of downstream signaling pathway. Conclusion In conclusion, the role of CDC42EP3 in CRC was clarified and showed its potential as a target of innovative therapeutic approaches for CRC.

OBJECTIVE:The aim of our study was to analyze the factors affecting lymph node metastasis (LNM) and the prognosis of colorectal neuroendocrine tumors (NETs).PATIENTS AND METHODS:A retrospective analysis was conducted to collect the clinical data of 135 patients with colorectal NETs from January 2000 to December 2018, including clinical manifestations, pathological results, treatment methods, etc. Follow-up was regularly performed to observe the recurrence and metastasis of tumors and to identify the clinical and pathological features of colorectal NETs, risk factors for LNM and survival outcomes.RESULTS:Among 135 patients, there were 57 (42.2) patients with LNM, and the independent risk factors for LNM in the multivariable analyses were tumor diameter ≥2 cm (P= 0.040) and tumor grade G3 (P=0.001). Patients were followed up for 1 to 190 months, and of the 133 patients who were successfully followed up, the 5-year OS was 71.7%, and the 5-year PFS was 69.0%. The multivariate analysis for survival outcomes showed that age ≥65 years (P=0.002/<0.001) and lymph node metastasis (P=0.018/0.025) were independent risk factors affecting 5-year PFS and OS in colorectal neuroendocrine tumors. Tumors in the colon (P=0.022), moderately positive (++) CgA (P=0.010) and strongly positive (+++) CgA (P=0.007) were independent risk factors for poor 5-year PFS in patients with colorectal NETs.CONCLUSION:Rectal NETs have a better prognosis than colonic neuroendocrine tumors. Tumor diameter and tumor grade are independent risk factors for LNM in colorectal neuroendocrine tumors. Age, tumor location, lymph node status and a positive level of the neuroendocrine marker CgA are independent risk factors that affect the prognosis of colorectal NETs.

Objective 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.