Quantifying the relationship of HIV infection with clinicopathological spectrum and outcome among patients with colorectal cancer in a South African population

Introduction: Literature is limited on HIV and colorectal cancer (CRC) in sub-Saharan Africa despite it being the epicentre of the HIV epidemic, Purpose: To compare clinicopathological features and outcome of CRC in HIV-negative and HIV-positive patients. Methods: Retrospective analysis of a prospective CRC database. Demographic details, HIV status, anatomical site, disease stage, treatment and follow-up were documented. Results: Of 715 patients with CRC, 145 and 570 tested positive and negative respectively for HIV. Median age was 45 (IQR 36-53 and 57 (IQR 45-66) years among HIV-positive and HIV-negative patients respectively (p<0.0001). Tumour differentiation differed between the two groups (p=0.003) but staging was not different (p=0.6). Surgical resection rate was 52% for HIV-positive patients versus 59% for HIV-negative patients (p=0.07). Median follow-up was 9 (IQR 2-20.5) months for HIV-positive patients and 12 (IQR 6-29) months for HIV-negative patients (p=0.154). Recurrence rate was 14.7% among HIV positive patients and 6.8% in HIV negative patients (p=0.089). Conclusion: When compared with HIV-negative patients, HIV-positive patients with CRC presented at a younger age and tended to have lower surgical resection rates. There was no difference between the two groups with CRC in terms of anatomical sub-site distribution, disease staging and recurrence rates

Establishment of Serum Free Chemically Defined Culture Medium to Study the Interactions Between Colonic Myofibroblasts and Colorectal Cancer Cells

@#Introduction: A crucial factor in cell culture technology is the use of appropriate culture medium which can promote cell growth and cellular functions. Development of serum free chemically defined medium enables the researchers to conduct the experiment in a more controlled manner. Myofibroblasts of the tumour microenvironment drive the colorectal carcinogenesis. In vitro study of the tumour-myofibroblast interaction using serum free medium may give a better insight into potential treatment for colorectal cancer (CRC) in the future. This study aims to establish serum free chemically defined medium to study the interplay between myofibroblast and CRC cells. Methods: A myofibroblast-specific serum free culture medium named as M-CIL, was developed to study the interactions between myofibroblasts and CRC cell lines in vitro. The influence of substrate (collagen type I) and subculturing of cells under incubation with M-CIL medium were also analysed. The effect of M-CIL medium on CRC cell growth also was studied. Gene expression analysis using quantitative real time polymerase chain reaction on amine oxidase, copper containing 3 (AOC3) was conducted to investigate the effect of individual components of the medium on myofibroblasts. Results: M-CIL medium supports the proliferation of myofibroblasts and produce minimal effect on CRC cells’ growth. Our data also shows the influence of M-CIL components on gene expression in myofibroblasts. Conclusion: M-CIL culture medium, which was designed with known and defined components, proved to be a suitable alternative to complete medium (DMEM + 10% FBS) for co-culture experiments of myofibroblasts and CRC cell lines.

Eficacia y seguridad de la resección endoscópica en pacientes con pólipos colorrectales no pediculados grandes / Efficacy and safety of endoscopic resection in patients with large non-pedunculated colorectal polyps

Introducción: Los pacientes con pólipos colorrectales no pediculados grandes (PCNP-G) han sido tradicionalmente tratados quirúrgicamente. Los avances en la endoscopía terapéutica permiten que la resección endoscópica de estas lesiones pueda ser considerada como una alternativa a la cirugía. Objetivo: Evaluar la eficacia y seguridad de la resección endoscópica en pacientes con PCNP-G. Materiales y métodos: Cohorte prospectiva multicéntrica. Se incluyeron a todos los pacientes referidos para resección endoscópica de PCNP-G entre enero del 2012 y diciembre del 2015, seguidos hasta agosto del 2016. Se obtuvieron las tasas de resecciones exitosas, de recurrencia y de complicaciones. Se analizaron los factores predictivos asociados a resección no exitosa y a recurrencia. Resultados: Se incluyeron 107 pacientes con 115 PCNP-G. La tasa de resección exitosa fue de 92%. Las complicaciones más comunes fueron el sangrado (8,7%) y la perforación (2,6%). La tasa de recurrencia fue de 7%, todas tratadas endoscópicamente con éxito. Los factores predictivos de resección no exitosa fueron una medida >50 mm de la lesión resecada y la presencia de fibrosis; y el único factor predictivo de recurrencia fue una medida >50 mm del pólipo resecado. Conclusiones: La resección endoscópica de los PCNP-G es altamente eficaz y segura

Introduction: Patients with large non-pedunculated colorectal polyps (L-NPCP) have been traditionally treated with surgery. Advances in therapeutic endoscopy allow endoscopic resection of these lesions and can be considered as an alternative to surgery. Objective: To evaluate the efficacy and safety of endoscopic resection in patients with L-NPCP. Methods: A prospective multicentric cohort. All patients referred for endoscopic resection with L-NPCP between January 2012 and December 2015, followed until August 2016, were included. Rates of successful resection, recurrence and complications were obtained. Predictive factors associated with unsuccessful resection and recurrence were analyzed. Results: 115 L-NPCP in 107 patients were included. The rate of successful resection was 92%. The most common complications were bleeding (8.7%) and perforation (2.6%). The recurrence rate was 7%, all successfully treated with a new endoscopic session. Predictors of unsuccessful resection were a measure >50 mm of the lesion and the presence of fibrosis; and the only predictor of recurrence was a size of the polyp resected >50 mm. Conclusions: Endoscopic resection of L-NPCP is very efficacious and safe

Qualidade de vida relacionada à saúde do paciente com estoma intestinal secundária ao câncer cólon-retal / Health-related quality of life in patients with intestinal ostomies secondary to colorectal cancer

Resumen:

Objetivo: investigar la calidad de vida vinculada a la salud (QRVS) de los pacientes con estoma intestinal secundario a cáncer colorrectal en Aracaju-Sergipe. Método: fue utilizado un instrumento con tres partes: elementos sociodemográficos y clínicos, escala de calidad de vida de Flanagan (EQVF) y EORTC-QLQ-C30. Los resultados fueron: 38,9% tumor rectal, 33,3% colorrectal y 27,8% colon. El 83,3% tenía metástasis y el 16,7% no. El 72,2% tenía una colostomía permanente y el 27,8% temporal. Resultados: la calidad de vida en general es regular, más baja para la recreación y más alta para las relaciones con otras personas. Para la EORTC QLQ-C30, la salud general promedio se considera pobre, debido a la presencia de metástasis, complicaciones del estoma, dolor e insomnio. Conclusiones: esta valoración negativa se puede mejorar a través de una ubicación correcta de la adaptación del estoma, un abordaje psicológico adecuado, tratamiento especializado con el fin de buscar un nivel de satisfacción y/o adaptación que haga sentir "sano".

Abstract:

Purpose: to assess health-related quality of life (HRQoL) in patients with intestinal ostomies secondary to colorectal cancer in Aracaju-Sergipe. Methods: a three-part tool was used: socio-demographic and clinical components, Flanagan's Quality of Life Scale (QOLS) and EORTC-QLQ-C30. Findings were as follows: 38.9% rectal, 33.3% colorectal, and 27.8% colonic tumors. Metastases were present in 83.3%; no metastases were found in 16.7%. Colostomies were permanent in 72.2% and temporary in 27.8%. Results: overall quality of life is poor; it appears lower for recreation and higher for relationship with others. According to EORTC QLQ-C30, mean general health is poor, due to metastases, ostomy complications, pain, and insomnia. Conclusions: such a negative assessment could be improved by a right position for ostomy adjustment, appropriate psychological approach, specialized therapy aimed at reaching a high satisfaction level and/or adjustment to make the patient feel "healthy".

Objetivo: este estudo investigou a qualidade de vida relacionada à saúde de pacientes com estoma intestinal secundário ao câncer cólon-retal na cidade de Aracaju-Sergipe.

Método: trata-se de estudo descritivo-exploratório, transversal, quantitativa, utilizando-se dados sócio-demográficos e clínicos, Escala de Qualidade de Vida de Flanagan (EQVF), e EORTC-QLQ-C30. A amostra constou de 18 pacientes atendidos no Centro de Oncologia Dr Oswaldo Leite. 38,9% apresentaram tumor de reto, cólon-retal 33,3% e cólon 27,8%. 83,3% apresentavam metástase e 16,7% não. 72,2% com colostomia definitiva e 27,8% provisória. Resultados: a análise da QVRS indicou qualidade de vida geral regular, sendo a menor média para o domínio recreação e a maior, relações com outras pessoas. Para EORTC QLQ-C30, o estado geral de saúde foi considerado ruim, devido à presença de metástases, complicações do estoma, dor, insônia. Conclusões: esta avaliação negativa da QVRS pode ser melhorada através de: correta localização do estoma, adaptação psicológica adequada, acompanhamento especializado ao paciente e familiar.

Câncer ano-reto-cólico: aspectos atuais v: câncer de reto: tratamento cirúrgico / Anal canal and colorectal cancer: current features: v: rectal cancer: surgical management

O desenvolvimento tecnológico dos últimos anos proporcionou amplas conquistas aplicáveis à Medicina como pouco ocorreu em outras épocas e, no campo da Cirurgia, só teve paralelo na descoberta do controle e domínio da dor e no advento dos antibióticos. Por outro lado, é tão grande o universo do desenvolvimento técnico e tão rápido sua transformação, que nós não temos tempo para avaliar criteriosamente os efeitos de sua transposição para a área médica. A evolução técnica é mais rápida do que sua adequação e uso em benefício da saúde, sobretudo no campo da aplicação das ciências cirúrgicas. As mais otimistas previsões para o próximo futuro deixaram, um pouco de lado, a experiência dos últimos 100 anos em que o extraordinário desenvolvimento tecnológico não proporcionou a contundente revolução que poderia ser esperada. Por exemplo, no campo da Coloproctologia, mormente se nos referirmos ao tratamento e à cura do câncer cólon-retal, o maior benefício foi artesanal, decorrente da destreza cirúrgica na criação da excisão total do mesorreto (ETM), que proporcionou ao paciente menor recidiva local, mais longa expectativa de vida e a preservação da continência anal. Por outro lado, a atual esperança evolucionista para o campo da cirurgia cólon-retal e, provavelmente, para outras especialidades cirúrgicas, denominada de "um progresso sem precedente na história das operações cirúrgicas em que as salas cirúrgicas do futuro não lembrarão, em absolutamente nada, as atuais salas²", desdenha as ocorrências registradas no século passado. Não há dúvidas que esse progresso material há de vir, como ocorreu nos últimos 100 anos, contudo o que nos resta é a dúvida a respeito do custo-benefício e, nesses termos, que valor trará para os nossos pacientes com câncer cólon-retal quando o objetivo estabelecido for a cura da doença maligna?

Before laparoscopic treatment of colon and rectal cancer, the TME (total mesorectal excision) was "the standout technique" introduced in the past 100 years able to modify local recurrence, to increase life expectancy of patients with rectal cancer, and to preserve the continence with ultra-low anastomosis through sphincter-sparing procedures. Most all of patients with rectal cancer must be operated with TME technique and only those with malignant neoplasm invading the anal canal should be submitted an abdominoperineal resection.

Expression of MMP-2, HIF-1alpha and VEGF in Colon Adenoma and Colon Cancer / 대한소화기학회지

BACKGROUND/AIMS: This study was aimed to investigate the expression of matrix metalloproteinase-2 (MMP-2), hypoxia-inducible factor (HIF)-1alpha, and vascular endothelial growth factor (VEGF) in colonic adenoma-carcinoma sequence. METHODS: Thirty-two tissue samples of colon adenoma, 11 of early colon cancer and 36 of advanced colon cancer were collected by colonoscopic biopsy. Normal colonic tissues were also collected from the same subjects. The mRNA expression levels of MMP-2, HIF-1alpha, and VEGF were quantitated using semiquantitative reverse transcription polymerase chain reactions. The protein expressions of activated MMP-2 and HIF-1alpha were examined by gelatin zymography and by Western blot in surgically resected cases, respectively. RESULTS: The expression level of MMP-2 mRNA showed a progressive increase in the advance of the colorectal adenoma-carcinoma sequence (p<0.05). In colon cancer tissues, the expression level of MMP-2 mRNA showed an increasing trend according to differentiation, lymphatic invasion and Dukes' stage (p<0.05). The protein expression of activated MMP-2 was observed in 10 of 11 (91%) cases of cancer tissues. The mRNA expression levels of HIF-1alpha and VEGF were greater in tissues of early and advanced colon cancer compared with colon adenoma (p<0.05; p<0.001). The protein expression of HIF-1alpha was observed in 9 of 11 (82%) cases of cancer tissues. The mRNA expression level of HIF-1alpha showed a positive correlation with MMP-2 and VEGF, respectively (r=0.52, p<0.001; r=0.76, p<0.001). CONCLUSIONS: MMP-2, HIF-1alpha, and VEGF may be useful in detecting early carcinogenesis and progression of colon cancer.