BackgroundNeoadjuvant PD-1/PD-L1 combined with chemoradiotherapy (CRT) has shown encouraging complete response (CR) rates in proficient mismatch repair (pMMR) or microsatellite-stable (MSS) locally advanced rectal cancer (LARC), yet immunotherapy duration varies widely across trials and its interaction with radiotherapy fractionation remains unclear.MethodsPubMed, Embase, and Cochrane Library were searched through October 8, 2025 for prospective trials of PD-1/PD-L1 inhibitors plus CRT in pMMR/MSS LARC. Random-effects models pooled CR (cCR+pCR) rates, with subgroup analyses and study-level meta-regression conducted to explore sources of heterogeneity. A linear probit model and an interactive quadratic probit model were applied to assess associations between treatment duration and response (PROSPERO number CRD420251253156).ResultsEighteen trials (972 patients; 10 LCRT-based and 8 SCRT-based) were included. Pooled CR and pCR rates were 44% (95% CI 0.38–0.49) and 40% (95% CI 0.36–0.45). CR was higher with SCRT plus ICI than LCRT plus ICI (50% vs 39%; P = 0.03), and pCR similarly favored SCRT (47% vs 34%; P < 0.01). Meta-regression identified radiotherapy fractionation and immunotherapy duration as study-level factors associated with CR. In analyses restricted to randomized controlled trials (RCTs), longer immunotherapy duration was positively associated with response. Exploratory quadratic models using all eligible studies suggested an inverted U-shaped pattern for LCRT (modeled peak at approximately 4.4 months) and a U-shaped pattern for SCRT (modeled trough at approximately 2.5 months).ConclusionAmong the included RCTs, longer immunotherapy duration was associated with higher response rates. The nonlinear patterns observed in the combined dataset were exploratory, may reflect heterogeneity between studies, and require prospective validation before informing treatment duration.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261348026, identifier CRD420251253156.

INTRODUCTION:Colon cancer (CC) is a malignant tumor commonly found in the intestines with high incidence and mortality rates. Oxaliplatin (OXA) is a platinum-based chemotherapy drug widely used to treat CC. However, frequent drug resistance in patients results in suboptimal treatment outcomes. Though kinesin family member 4A (KIF4A) has been reported to be upregulated in various cancers and linked with poor prognosis in patients, its regulatory mechanism in cellular metabolism remains unclear. METHODS:The human CC/OXA-resistant cell line (HCT116-R) was constructed. CCK-8 assay was employed to calculate the half-maximal inhibitory concentration (IC50) of CC cells. The level of cell stemness was assessed by cell sphere formation assay. The enrichment of KIF4A in signaling pathways of CC was analyzed through Gene Set Enrichment Analysis (GSEA). The bioinformatics analysis was applied to reveal the differential expression of KIF4A in CC and its correlation with genes related to stemness or glycolysis. The assessment of lactate in the supernatant was finished by utilizing the lactate detection kit. The oxidative phosphorylation and glycolysis levels in cells were measured by a Seahorse analyzer. The mRNA expression level of KIF4A was detected by quantitative real-time PCR. Furthermore, the Western blot (WB) was employed to determine the protein expression of glycolysis-related enzymes in cells. A mouse OXA-resistant CC xenograft tumor model was established, with changes in tumor volume and final weight recorded. TUNEL was utilized to detect the apoptosis level in tissues and immunohistochemistry to examine the distribution of KIF4A and ki-67 in tissues. The levels of stemness-related proteins in tissues were detected through WB. RESULTS:KIF4A was upregulated in CC, exhibiting a positive association with OXA resistance. High expression of KIF4A promoted cancer cell survival and cancer stemness. In GSEA prediction, KIF4A in CC may be linked with the glycolysis pathway. Correspondingly, the expression of KIF4A in CC was positively correlated with the expression of glycolysis-related proteins. Tests for lactate content and glycolysis/oxidative phosphorylation levels revealed that knocking down KIF4A repressed glycolytic function in the drug-resistant strain but reinforced mitochondrial oxidative phosphorylation. Furthermore, KIF4A overexpression effectively boosted the OXA resistance and stemness of cells, which was reversed by glycolysis inhibitor. The mouse model validated the above results. CONCLUSION:KIF4A is significantly upregulated in CC to reinforce the glycolysis of cancer cells, thus facilitating cell stemness and resistance to OXA-based therapy.

Colon cancer (CC) remains a significant global health burden, and the search for novel prognostic biomarkers and therapeutic targets is crucial. This study comprehensively analyzed the role of SIX2 (Sine Oculis Homeobox Homolog 2) in CC. Utilizing data from TCGA, GTEx, and CCLE databases, differential expression of SIX2 was observed in multiple cancers, with significant upregulation in many tumors compared to normal tissues. In CC, SIX2's differential expression was notable. Cox regression analysis revealed its prognostic significance, with overexpression associated with poor survival outcomes. SIX2 was strongly associated with gene alterations and correlated with key signaling pathways like WNT and TGF-β. In the tumor microenvironment, SIX2 was related to immune cell infiltration and immune-related molecules. Notably, in CC, it was associated with immunosuppressive cells and checkpoint molecules. Additionally, ABT737 was found to sensitize tumor immunotherapy in the context of SIX2. Animal experiments demonstrated that ABT737 effectively restricted the growth of CC in mice, and its combination with antiPD-1 immunotherapy was more effective. It could reduce the infiltration of CD163+ tumor-associated macrophages but without significantly increasing the infiltration of CD8+ T cells. Our findings suggest that SIX2 is a potential key player in CC, offering insights into future research and the development of targeted therapies.

TPS3641 Background: Total neoadjuvant chemoradiotherapy is the standard of care for locally advanced rectal cancer (LARC) to control local recurrence and achieve organ preservation. However, for proficient mismatch repair (pMMR) or microsatellite stable (MSS) LARC, which accounts for nearly 90% of rectal cancers, conventional chemoradiotherapy has limited efficacy and is associated with significant side effects. Recent studies have shown that combining radiotherapy with immunochemotherapy can improve pathological complete response (pCR) rates, but the inclusion of tumor-draining lymph nodes (TDLNs) in the conventional irradiation field may impair T-cell immunity and reduce response to immunotherapy. Our previous phase II trial demonstrated that node-sparing modified short-course radiotherapy combined with chemotherapy and PD-1 blockade could achieve a high pCR rate of 78.8% in pMMR LARC 1 . Building on these findings, we initiated this phase III trial to compare this novel treatment regime with conventional short-course chemoradiotherapy in improving pCR rates. Methods: This is a phase III, open-label, multicenter, randomized trial conducted across 17 hospitals in China. A total of 170 eligible MSS/pMMR middle or low rectal cancer patients (cT3-4N0/+M0) will be recruited and randomly assigned (5:5:1) to three groups: control group (conventional short-course chemoradiotherapy), experimental group (node-sparing modified short-course chemoradiotherapy plus PD-1 blockade), and exploratory group (conventional short-course chemoradiotherapy plus PD-1 blockade). The innovative node-sparing modified short-course radiotherapy targets only the primary tumor bed, excluding TDLNs. Following randomization, patients will receive short-course radiotherapy (conventional or node-sparing) followed by four cycles of CAPOX ± tislelizumab: tislelizumab 200 mg IV on day 1, oxaliplatin 130 mg/m² IV on day 1, and capecitabine 1000 mg/m² orally on days 1-14, and Total mesorectal excision (TME) will be performed at weeks 14-15. The primary endpoint is pCR rate, while secondary endpoints include organ preservation rate, disease-free survival, overall survival, adverse effects, and quality of life. As of January 2025, 46 of the planned 170 patients have been enrolled. The Data Monitoring Committee (DMC) reviewed the trial in December 2024 and recommended continuing as planned. Reference: Annals of Oncology (2024) 24 (suppl_1): 1-20. 10.1016/iotech/iotech100744. Clinical trial information: NCT06507371 .

138 Background: Anlotinib is an oral multi-target tyrosine kinase inhibitor, mainly targeting VEGFR1-3, FGFR 1-4, PDGFR a/b and c-kit. Previous trial had demonstrated that anlotinib monotherapy was effective and safe in advanced colorectal cancer. ALTER-C002 trial is an open-label, single-arm, phase II study, aimed to evaluate the efficacy and safety of anlotinib plus CAPEOX as first-line therapy in patients with RAS/ BRAF wild-type unresectable metastatic colorectal cancer (mCRC). Preliminary results demonstrated significant antitumor activity and manageable toxicity. Here we reported the updated results at the data cutoff of August 19, 2022. Methods: RAS/BRAF wild-type unresectable mCRC patients with no prior systemic treatment received anlotinib (12 mg p.o. qd, d1-d14, q3w), capecitabine (850 mg/m2 p.o., bid, d1-d14, q3w) and oxaliplatin (130 mg/m2 i.v., d1, q3w) for 6 cycles followed by anlotinib and capecitabine as maintenance therapy until disease progression. Tumor response was assessed every 6 weeks according to RECIST v1.1 by investigator. The primary endpoint was ORR, and secondary endpoints included safety, DCR, DOR and PFS. Results: From Nov 2019 to February 2021, 30 eligible patients were enrolled, of whom, median age was 60y (range, 32-72y), 26 (86.7%) had left colon or rectal cancer, and 25 (83.3%) had liver metastases. The ORR was 76.7% (95% CI, 57.7-90.1%) with 2 patient achieved a complete response (CR); DCR was 93.3% (95% CI, 77.9-99.2%). At the data cutoff date, the median DOR was 7.9 months (95% CI, 4.3–11.4) and the median DOT was 8.38 months (95%CI, 5.9-10.9). The median OS has not reached yet, the 24-month OS rate was 72.8% (95%CI, 50.7-86.3%) and the 30-month OS rate was 58.3% (95%CI:25.5-80.8%). Grade 3-4 treatment-emergent adverse events (TEAEs) occurred in 25 (83.3%) patients; the most common grade 3 or 4 TEAEs ( > 10%) were hypertension (50%, 15/30 pts), neutropenia (26.7%, 8/30 pts) and diarrhea (13.3%, 4/30 pts). No grade 5 treatment-related events occurred. Conclusions: Anlotinib combined with CAPEOX exhibited promising ORR in the first-line treatment of mCRC compared to those of previous treatment. A longer follow-up is needed for a more complete assessment, and we launched a phase III, multicenter, open-label trial to assess the efficacy of this regimen comprehensively. Clinical trial information: NCT04080843 .

TPS233 Background: Neoadjuvant chemoradiotherapy followed by total mesorectal excision is a standard treatment for locally advanced rectal cancer. Mismatch repair-deficient locally advanced rectal cancer was highly sensitive to PD-1 blockade. However, most rectal cancers are mismatch repair-proficient or microsatellite stable subtypes for which PD-1 blockade is ineffective. Radiation can trigger the activation of CD8+ T cells, further enhancing the responses of microsatellite stable rectal cancer to PD-1 blockade. Radioimmunotherapy offers a promising therapeutic modality for rectal cancer. Progenitor T exhausted cells are abundant in tumour-draining lymph nodes and play an important role in immunotherapy. Conventional irradiation fields include the mesorectum and regional lymph nodes, which might cause considerable damage to T lymphocytes and radiation-induced fibrosis, ultimately leading to a poor response to immunotherapy and rectal fibrosis. This study investigated whether node-sparing modified short-course irradiation combined with chemotherapy and PD-1 blockade could be effective in patients with microsatellite stable locally advanced rectal cancer. Methods: Our clinical trial investigates the safety and efficacy of node-sparing modified short-course radiotherapy combined with CAPOX and tislelizumab for microsatellite stable locally advanced middle and low rectal cancer. This phase II study will recruit 32 patients to receive node-sparing modified short-course radiotherapy (the irradiated planned target volume only included the primary tumour bed but not the tumour-draining lymph nodes, 25 Gy/5f, 5 Gy/f) followed by CAPOX and tislelizumab. 2 of planned 32 patients have been enrolled. CAPOX and tislelizumab will be started two days after the completion of radiotherapy: oxaliplatin 130 mg/m2 intravenous infusion, day 1; capecitabine 1000 mg/m2 oral administration, days 1-14; and tislelizumab 200 mg, intravenous infusion, day 1. There will be three 21-day cycles. TME will be performed at weeks 11-12. We will collect blood, tumour, and lymphoid specimens; perform flow cytometry and in situ multiplexed immunofluorescence detection; and analyse the changes in various lymphocyte subsets. The primary endpoint is the rate of pathological complete response. The organ preservation rate, tumour regression grade, local recurrence rate, disease-free survival, overall survival, adverse effects, and quality of life will also be analysed. Clinical trial information: NCT05972655 .

Objectives To determine the relationship between chemotherapy dose delay/reduction with progression-free survival (PFS) and overall survival (OS) in colorectal cancer patients treated with FOLFIRI based first-line chemotherapy in real-world retrospectively study. Methods We identified 144 eligible patients with advanced CRC who received FOLFIRI as first-line based treatment. The study protocol was submitted to the institutional review board and was exempted. Dose delay was defined as an average delay of more than 3 days (>3 days vs. ≤3 days) from the intended date. Dose reduction (actual dose/standard dose * 100%) ≤85% was considered as chemotherapy reduction in the chemotherapy dose relative to the standard (mg/m2) regimen for all cycles. Relative dose intensity (RDI) ≤80% was described as chemotherapy reduction. OS and PFS were measured using Kaplan–Meier and Cox proportional hazard models. Results There were 114 patients with chemotherapy dose delay (dose delay >3 days). PFS of patients without dose delay had better survival than patients with dose delay (p = 0.002). There were 28.47% patients treated with dose reduction of 5-Fu. PFS and OS were better in patients without 5-Fu dose reduction than in patients with 5-Fu dose reduction with p values of 0.024 and <0.001, respectively. Patients with high 5-FU RDI had better PFS than patients with low 5-FU RDI (p < 0.001). While, there was no statistical difference in OS between the two groups. Then we stratified the analysis by age. In <65 years cohort, both PFS and OS were better in patients with high 5-Fu RDI than in those with low 5-Fu RDI (p < 0.001, p = 0.005, respectively). But, in ≥65 years cohort, OS were better in patients with low 5-Fu RDI than in those with high 5-Fu RDI (p = 0.025). Moreover, both dose reduction and RDI of irinotecan had no statistically significant difference in both PFS and OS. Conclusion In the advanced colorectal cancer patients who received FOLFIRI based treatment as first-line regimen, chemotherapy dose delay and reduction dose of 5-Fu were associated with worse survival, especially among patients younger than 65 years.

Objective: Preoperative chemoradiotherapy (CRT) is a standard option for patients with advanced rectal cancer (RC) located in the lower part of the rectum. Besides, some early stage RC patients may be over-treated, due to imprecise preoperative staging. The aim this study was to explore the value of hypoxia-inducible factor 1 alpha (HIF-1 alpha) as a predictor of benefit from preoperative CRT for locally advanced RC patients in terms of pathologic complete response (pCR) and clinical outcomes.Methods: Colonoscopic biopsy specimens from 114 RC patients were subjected to immunohistochemistry method for analysis of HIF-1 alpha expression, followed by analyzing clinicopathological characteristics. Independent factors associated with pCR were analyzed using univariate and logistic multivariate regression. Cox proportional hazard models were utilized to analyze param-eters independently related to overall survival (OS) and recurrence-free survival (RFS) of RC patients.Results: HIF-1 alpha was observed to be highly expressed in 52.6% patients (60/114). Tumor size was significantly larger in the HIF-1 alpha high expression group than in the low expression group (p = 0.027). The proportion of patients who achieved pCR in the high expression group, was significantly lower than the low expression group (p = 0.001). Besides, HIF-1 alpha was identified as the only predictor of pCR in the multivariate regression analysis (p = 0.006). In terms of prognosis, the 3-year RFS rate and OS rate were significantly lower in the high-expression HIF-1 alpha group than those in the low-expression HIF-1 alpha group (p = 0.015 & p = 0.027). HIF-1 alpha level was significantly related to RFS and OS based on univariate and multivariate analyses.Conclusions: HIF-1 alpha expression is a potential predictor for pCR and an independent prognostic factor for RC patients with preoperative CRT.

Abstract Background Anlotinib, an oral small molecule tyrosine kinase inhibitor targeting VEGFR 1/2/3, FGFR 1-4, PDGFR a/β, and c-kit, had demonstrated prolonged progression-free survival (PFS) in refractory metastatic colorectal cancer (mCRC). This multicenter, single-arm, phase II, exploratory study was conducted to evaluate the efficacy and safety of anlotinib combined with capecitabine and oxaliplatin as first-line treatment for unresectable RAS/BRAF wild-type mCRC. Methods Patients aged 18–75 with RAS/BRAF wild-type unresectable mCRC, without prior systemic treatment, and ECOG performance status ≤1 were enrolled. Eligible patients received capecitabine (850 mg/m2, p.o., bid, on day 1–14 every 21 days), oxaliplatin (130 mg/m2, i.v., on day 1 every 21 days), and anlotinib (12 mg, p.o., qd, on days 1–14 every 21 days) as induction therapy. Following 6 cycles of therapy, patients who achieved response or stable disease received capecitabine and anlotinib as maintenance therapy until tumor progression. The primary endpoint was objective response rate (ORR) according to RECIST (version: 1.1), and the secondary endpoints were PFS, disease control rate (DCR), duration of response (DOR), and safety. Results Between November 2019 and February 2021, 31 patients were enrolled. One patient was excluded for refusing treatment. The primary endpoint of ORR was 76.7% (95% CI, 57.7–90.1) with 1 patient achieving a complete response and 22 patients partial response. DCR was 93.3% (95% CI, 77.9–99.2). At a median follow-up of 14.1 months (95% CI, 9.9–18.3), median PFS was 11.3 months (95% CI, 7.1–14.1), and DOR was 7.9 months (95% CI, 5.5–12.7). Twenty-five (83.3%) patients experienced grade 3 or 4 treatment-emergent adverse events (TEAEs). No grade 5 TEAE was reported. The most common grade 3 or 4 TEAEs (>10%) were hypertension (15/30; 50%), neutrophil count decreased (8/30; 26.7%), and diarrhea (4/30; 13.3%). A total of 18 (60%) patients had TEAEs that resulted in dose reduction, interruptions, or delays. Conclusions Anlotinib combined with capecitabine and oxaliplatin showed considerable ORR, DCR, PFS, and DOR in the first-line therapy of mCRC with manageable toxicity profiles. Trial registration ClinicalTrials.gov : NCT04080843

目的 研究生物反馈联合舒肛汤中药坐浴治疗功能性肛门直肠痛的效果,旨在探讨临床治疗该病的有效疗法.方法 根据现状调查自2018年9月-2019年8月收集金华市中心医院门诊功能性肛门直肠痛的患者100例,采用随机数字表法分为观察组与对照组,各50例,对照组采用单纯的生物反馈疗法,观察组在生物反馈疗法基础上联合舒肛汤中药温水坐浴治疗,对比2组患者的治疗效果,包括疼痛视觉模拟评分(VAS)、肛门直肠压力、盆底功能、症状积分以及临床疗效.结果 观察组治疗后的VAS评分为(1.6±1.0)分,低于对照组的(2.5±1.3)分(t =3.880,P＜0.001);观察组治疗后的直肠静息压、肛管静息压、最大缩榨压均小于对照组(均P＜0.05);观察组治疗后的放松状态AVG、快速收缩AVG Peak、间断收缩AVG、肌电变异性CV均优于对照组(均P＜0.05);观察组治疗后的症状积分为(14.6±7.0)分,低于对照组的(18.2±7.6)分(t=2.464,P=0.016);观察组的总有效率(92.0％)高于对照组(74.0％),x2=5.741,P=0.017.结论 生物反馈联合舒肛汤中药坐浴治疗功能性肛门直肠痛的效果显著,可明显减轻患者疼痛,降低肛门直肠压力,提高盆底功能,减少症状积分,值得临床推行.

Mounting evidences have indicated that long noncoding RNAs (lncRNAs) play pivotal roles in human diseases, especially in cancers. Recently, TINCR was proposed to be involved in tumor progression. However, its role in colorectal cancer (CRC) remains elusive. In our study, we found that SP1-induced TINCR was significantly upregulated in CRC tissues and cell lines. Moreover, cox multivariate survival analysis revealed that high TINCR was an independent predictor of poor overall survival (OS). Functionally, knockdown of TINCR obviously suppressed CRC cells proliferation, migration and invasion in vitro, and inhibited CRC cells growth and metastasis in vivo. Mechanistically, we identified TINCR could act as a miR-7-5p sponge using RNA pull down, luciferase reporter and RIP assays. Furthermore, we showed that TINCR might promote CRC progression via miR-7-5p-mediated PI3K/Akt/mTOR signaling pathway. Lastly, we revealed that plasma TINCR expression was upregulated in CRC when compared to healthy controls and could be a promising diagnostic biomarker for CRC. Based on above results, our data indicated that TINCR might serve as a potential diagnostic and prognostic biomarker for CRC.

Objective: This study was performed to identify a reasonable cutoff age for defining older patients with colorectal cancer (CRC) and to examine whether old age was related with increased colorectal cancerspecific death (CSD) and poor colorectal cancer-specific survival (CSS).Methods: 76,858 eligible patients from the Surveillance, Epidemiology and End Results (SEER) database were included in this study.The Cox proportional hazards regression model and the Chow test were used to determine a suitable cutoff age for defining the older group.Furthermore, a propensity score matching analysis was performed to adjust for heterogeneity between groups.A competing risk regression model was used to explore the impact of age on CSD and non-colorectal cancer-specific death (non-CSD).Kaplan-Meier survival curves were plotted to compare CSS between groups.And a Cox regression model was used to validate the results.External validation was performed on data from 1998 to 2003 retrieved from the SEER database.Results: Based on a cutoff age of 70 years, the examined cohort of patients was classified into a younger group (n =51,915, <70 years of old) and an older group (n =24,943, ≥70 years of old).Compared with younger patients, older patients were more likely to have fewer lymph nodes sampled and were less likely to receive chemotherapy and radiotherapy.When adjusted for other covariates, agedependent differences of 5-year CSD and 5-year non-CSD were significant in the younger and older groups (15.84% and 22.42%, P < 0.001; 5.21% and 14.21%, P < 0.001).And an age of ≥70 years remained associated with worse CSS comparing with younger group (subdistribution hazard ratio [SHR], 1.51 [95% confidence interval [CI], 1.45-1.57],P < 0.001).The Cox regression model as a sensitivity analysis had a similar result.External validation also supported an age of 70 years as a suitable cutoff, and this older group was associated with having reduced CSS and increased CSD. Conclusions:Seventy is a suitable cutoff age to define those considered as having elderly CRC.Elderly CRC was associated with not only increased non-CSD but also with increased CSD.Further research is needed to provide evidence of whether cases of elderly CRC should receive stronger treatment if possible.

Objective This study was performed to identify a reasonable cutoff age for defining older patients with colorectal cancer (CRC) and to examine whether old age was related with increased colorectal cancer-specific death (CSD) and poor colorectal cancer-specific survival (CSS). Methods A total of 76,858 eligible patients from the surveillance, epidemiology, and end results (SEER) database were included in this study. The Cox proportional hazard regression model and the Chow test were used to determine a suitable cutoff age for defining the older group. Furthermore, a propensity score matching analysis was performed to adjust for heterogeneity between groups. A competing risk regression model was used to explore the impact of age on CSD and non-colorectal cancer-specific death (non-CSD). Kaplan–Meier survival curves were plotted to compare CSS between groups. Also, a Cox regression model was used to validate the results. External validation was performed on data from 1998 to 2003 retrieved from the SEER database. Results Based on a cutoff age of 70 years, the examined cohort of patients was classified into a younger group (n = 51,915, <70 years of old) and an older group (n = 24,943, ≥70 years of old). Compared with younger patients, older patients were more likely to have fewer lymph nodes sampled and were less likely to receive chemotherapy and radiotherapy. When adjusted for other covariates, age-dependent differences of 5-year CSD and 5-year non-CSD were significant in the younger and older groups (15.84% and 22.42%, P < 0.001; 5.21% and 14.21%, P < 0.001). Also an age of ≥70 years remained associated with worse CSS comparing with younger group (subdistribution hazard ratio, 1.51 95% confidence interval (CI) [1.45–1.57], P < 0.001). The Cox regression model as a sensitivity analysis had a similar result. External validation also supported an age of 70 years as a suitable cutoff, and this older group was associated with having reduced CSS and increased CSD. Conclusions A total of 70 is a suitable cutoff age to define those considered as having elderly CRC. Elderly CRC was associated with not only increased non-CSD but also with increased CSD. Further research is needed to provide evidence of whether cases of elderly CRC should receive stronger treatment if possible.

PurposeAnal adenocarcinoma (AA) represents a rare condition, and little is known about the predictive factors of the outcomes or the optimal TNM staging system for curable AA. Using population-based data, we preliminarily sought to determine the prognostic factors and evaluate the existing T and N staging criteria of AA.MethodsWe analyzed the Surveillance, Epidemiology, and End Results 18 database to identify patients 20-80 years old who were diagnosed with AA or rectal adenocarcinoma (RA) and underwent abdominal perineal resection between 2004 and 2012. The difference between Kaplan-Meier survival curves was estimated by a log-rank test. A Cox proportional hazard regression model was used to adjust the effects of other covariates on survival in the propensity score-matched cohort, including age, gender, race, marital status, histology, grade of differentiation, tumor size, number of positive lymph nodes, radiotherapy, and chemotherapy.ResultsCompared to patients with RA, patients with AA had a worse CSS after controlling for other covariates (hazard ratio [HR], 1.96; 95% confidence interval [CI], 1.25-3.07; P<0.01). For AA, the increasing tumor size (2-5 cm: HR, 0.62; 95% CI, 0.29-1.32; P>0.05; >5 cm: HR, 1.01; 95% CI, 0.49-2.07; P>0.05) had no significant influence on survival. The number of positive lymph nodes (1-3: HR, 2.93; 95% CI, 1.55-5.53; P<0.01; ≥4: HR, 4.24; 95% CI, 2.08-8.62; P<0.01) significantly influenced survival.ConclusionsAA confers a worse prognosis than RA does. The T staging criteria of anal carcinoma, dominated by tumor size, seem to be invalid for AA, while the number of positive lymph nodes is a prognostic factor.

BACKGROUND:Transverse colostomy is commonly performed to create temporary stoma in rectal cancer patients after neoadjuvant chemoradiotherapy. Conventional methods are either difficult to implement or to care for. To resolve these problems, we herein describe a modified transverse colostomy method.MATERIAL AND METHODS:Two sutures of peritoneum were made as "bridges" to support the stoma. Absorbable sutures were utilized to reinforce the stoma. Once the stoma was created, the stoma bag was immediately placed on the skin. 120 patients who received conventional or modified transverse colostomy between 2008 and 2014 were selected. Then, the two groups of patients were compared for stoma-related complications.RESULTS:The operation time of stoma construction was 34±10 minutes for the conventional method and 28±7 minutes for the modified method (P= 0.009). There were no significant differences between the two groups with respect to postoperative bleeding, bowel obstruction or stoma retraction. Patients with conventional transverse colostomy were remarkably more likely to experience parastoma hernia (P= 0.048) and stoma prolapse (P= 0.038).CONCLUSION:In comparison with conventional methods, the modified transverse colostomy is a safe and effective diverting technique. It can be readily performed by all kinds of surgeons, especially those in underdeveloped areas. The technique represents a preferred method for constructing temporary stoma in rectal cancer patients treated with neoadjuvant chemoradiotherapy.

Objective To assess the value of hypoxia-inducible factor 1α (HIF-1α) for predicting pathological response and clinical outcomes in rectal cancer patients treated with neoadjuvant chemoradiotheray (nCRT).Methods One hundred and fourteen patients with rectal cancer receiving nCRT before surgery from January 2010 to December 2015 were enrolled in the study.The expression of HIF-1α in tumor tissue was examined with immunohistochemistry.The predictive factors of pathological complete response (pCR),3-year recurrence-free survival and 3-year overall survival were analyzed.Results The high expression of HIF-1α was detected in 60 cases (52.6％).The expression of HIF-1α was correlated with tumor diameter before treatment and pCR(P＜0.05),not correlated to gender,age,BMI,distance from tumor to anus,T stage and N stage(all P ＞0.05).Multivariate logistic regression analysis showed that HIF-1α expression was correlated with pCR (P＜0.05).HIF-1α expression and ypTNM staging were correlated with 3-year recurrence free survival rate and 3-year overall survival rate (P＜0.05).Cox proportional risk regression model showed that the expression of HIF-1α was an independent predictor for recurrence free survival and overall survival (all P＜0.05).Conclusion HIF-1α can predict the efficacy of nCRT,and the prognosis of patients with rectal cancer.

目的 调查重症加强护理病房(ICU)危重症患者的心理健康状态并分析其影响因素,为ICU危重症患者的临床护理提供参考.方法 采用随机抽样法抽取2015年8月-2017年5月金华市中心医院ICU危重症患者88例,运用一般资料调查表和症状自评量表90(SCL-90)评价患者的心理健康情况,采用单因素分析和多元线性回归分析影响患者心理健康的因素.结果 ICU危重症患者SCL-90总分(152.44±40.28分)及部分因子(躯体化、焦虑、抑郁、恐惧、偏执)评分均低于国内常模,差异有统计学意义(P＜0.05).ICU住院天数、机械通气天数、插管数量及是否使用镇静药物可影响患者的心理健康状态;其中,主要影响因素为机械通气天数、插管数量及是否使用镇静药物(均P＜0.05).结论 ICU危重症患者心理健康状况不理想,主要受机械通气天数、插管数量及是否使用镇静药物影响.

BACKGROUND:To investigate the role of interleukin (IL)-17 in tissue and peripheral blood of perianal abscess and anal fistula.METHODS:Patients with primary perianal abscess (n = 50) admitted to Jinhua Municipal Central Hospital between March 2003 and August 2004 were enrolled. Fifty patients with mixed haemorrhoids, who showed no perianal abscess or anal fistula, were also recruited as the control. After surgery, patients were followed up for 6 months. Protein and gene expression of IL-17 was determined in surgically harvested anal tissues and peripheral blood, respectively. The relationship between IL-17 and clinical pathological features were analysed.RESULTS:As shown by immunohistochemistry of anorectal tissues, the positive rate of IL-17 protein was higher in the perianal abscess group than in the control group. In patients with perianal abscess, the expression of IL-17 significantly correlated with the diameter of the abscess (P = 0.013), the wound surface healing time (P = 0.010) and the progression into anal fistula (P = 0.003). For the gene expression of IL-17 in peripheral blood cells, the level was significantly higher in patients with perianal abscess comparing to the control group (0.4350 ± 0.1190 versus 0.1785 ± 0.1230, P ≤ 0.001). Comparing to the recovery group, patients with their perianal abscess progressed to anal fistula showed higher levels of IL-17 gene expression (P = 0.014).CONCLUSIONS:Expression of IL-17 was increased in the anorectal tissues and peripheral blood of patients with perianal abscess and anal fistula. IL-17 may play an important role in the pathogenesis of perianal abscess and anal fistula.