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Braz. j. biol ; 83: e248746, 2023. graf
Article in English | MEDLINE, LILACS, VETINDEX | ID: biblio-1339351


Abstract Colorectal cancer (CRC) is one of the most common cancers leading to comorbidities and mortalities globally. The rational of current study was to evaluate the combined epigallocatechin gallate and quercetin as a potent antitumor agent as commentary agent for therapeutic protocol. The present study investigated the effect of epigallocatechin Gallate (EGCG) (150mg) and quercetin (200mg) at different proportions on proliferation and induction of apoptosis in human colon cancer cells (HCT-116). Cell growth, colonogenic, Annexin V in addition cell cycle were detected in response to phytomolecules. Data obtained showed that, the colony formation was inhibited significantly in CRC starting from the lowest concentration tested of 10 µg/mL resulting in no colonies as visualized by a phase-contrast microscope. Data showed a significant elevation in the annexin V at 100 µg/mL EGCG(25.85%) and 150 µg/mL quercetin (48.35%). Moreover, cell cycle analysis showed that this combination caused cell cycle arrest at the G1 phase at concentration of 100 µg/mL (72.7%) and 150 µg/mL (75.25%). The combined effect of epigallocatechin Gallate and quercetin exert antiproliferative activity against CRC, it is promising in alternative conventional chemotherapeutic agent.

Resumo O câncer colorretal (CCR) é um dos cânceres mais comuns, levando a comorbidades e mortalidade em todo o mundo. O racional do presente estudo foi avaliar a combinação de galato de epigalocatequina e quercetina como um agente antitumoral potente como agente de comentário para protocolo terapêutico. O presente estudo investigou o efeito de galato de epigalocatequina (EGCG) (150 mg) e quercetina (200 mg) em diferentes proporções na proliferação e indução de apoptose em células de câncer de cólon humano (HCT-116). O crescimento celular, colonogênico, anexina V, além do ciclo celular foram detectados em resposta a fitomoléculas. Os dados obtidos mostraram que a formação de colônias foi inibida significativamente no CRC a partir da concentração mais baixa testada de 10 µg/mL, resultando em nenhuma colônia conforme visualizado por um microscópio de contraste de fase. Os dados mostraram uma elevação significativa na anexina V a 100 µg/mL de EGCG (25,85%) e 150 µg/mL de quercetina (48,35%). Além disso, a análise do ciclo celular mostrou que essa combinação causou parada do ciclo celular na fase G1 na concentração de 100 µg/mL (72,7%) e 150 µg/mL (75,25%). O efeito combinado da epigalocatequina galato e quercetina exerce atividade antiproliferativa contra o CCR, é promissor como agente quimioterápico alternativo convencional.

Humans , Colorectal Neoplasms/drug therapy , Catechin/analogs & derivatives , Catechin/pharmacology , Quercetin/pharmacology , Cell Cycle , Annexin A5 , Cell Line, Tumor , Cell Proliferation
Säo Paulo med. j ; 140(2): 244-249, Jan.-Feb. 2022. tab
Article in English | LILACS | ID: biblio-1366048


ABSTRACT BACKGROUND: The coronavirus disease-19 (COVID-19) pandemic has changed the course of diseases that require emergency surgery. OBJECTIVE: To evaluate the effect of the COVID-19 pandemic on colorectal cancer disease stage. DESIGN AND SETTING: Retrospective analysis in the city of Rize, Turkey. METHODS: This was a comparative analysis on two groups of patients with various symptoms who underwent surgical colorectal cancer treatment. Group 1 comprised patients operated between March 11, 2019, and December 31, 2019; while group 2 comprised patients at the same time of the year during the COVID-19 pandemic. RESULTS: Groups 1 and 2 included 56 and 48 patients, respectively. The rate of presentation to the emergency service was higher in Group 2 (P < 0.02). The stage of the pathological lymph nodes and the rate of liver metastasis was higher in Group 2 (P < 0.004 and P < 0.041, respectively). The disease stage was found to be more advanced in Group 2 (P < 0.005). The rate of postoperative complications was higher in Group 2 (P < 0.014). CONCLUSION: The presentation of patients with suspicious findings to the hospital was delayed, due both to the fear of catching COVID-19 and to the pandemic precautions that were proposed and implemented by healthcare authorities worldwide. Among the patients who presented to the hospital with emergency complaints and in whom colorectal cancer was detected, their disease was at a more advanced stage and thus a higher number of emergency oncological surgical procedures were performed on those patients.

Humans , Colorectal Neoplasms/surgery , COVID-19/surgery , Retrospective Studies , Pandemics , SARS-CoV-2
Acta sci., Health sci ; 44: e56960, Jan. 14, 2022.
Article in English | LILACS-Express | LILACS | ID: biblio-1367539


Colorectal cancer is the 4thcause of cancer death; with considering the growth process of this cancer and the necessity of early diagnosis, the purpose of the research is to state the LncRNA 00970, LncRNA UCAI,and the Wntgene before and after the treatment by 5-Azacytidine epigenetic medicine, to reach the biomarker in the very first steps of colorectal cancer. In this experiment, the human colon cancer cell line (HT29) treated with different concentrations of 5-aza-2'-deoxycytidine (5-aza-dC) was utilized to induce DNA demethylation; Quantitative PCR (qPCR) was used to measure LncRNA UCA1and LncRNA LINC00970 and Wntexpression. There was a significant relationship between the expression of LncRNA 00970, LncRNA UCAI,and the Wntgene and its effects on colorectal (p < 0.05). The Wntgene was treated by 1 and 10 of 5-Azacytidine epigenetic medicine, which then experienced decreases. In LncRNA UCAI and LncRNA00970 in dose 1 micromolar of 5-Azacytidine had decrement and increment of expressionrespectively that explains their efficiency but in treatment by dose 10 mM of this medicine, no significant LncRNA expression difference was detected, 5-azacitidine has a direct impact on its target genes and LncRNAs.Therefore, it can be used in the early diagnosis of colorectal cancer.

Article in Chinese | WPRIM | ID: wpr-923114


@#[Abstract] Objective: To investigate the expression of long non-coding RNA (lncRNA) small nucleolar RNA host gene 10 (SNHG10) in colorectal cancer tissues and cells and its effect on the invasion and migration of colorectal cancer cells and the underlying mechanism. Methods: From January 2018 to December 2019, 78 pairs of colorectal cancer tissue and para-cancerous tissues from the patients who had radical colorectal cancer resection in Henan Provincial People's Hospital were collected. Quantitative PCR (qPCR) was performed to quantify the levels of lncRNA SNHG10 and miR-532-3p in colorectal cancer tissues, colorectal cancer cell lines (SW480, SW620, HT-29 and LoVo) and human normal colorectal mucosal FHC cells; and their correlations with the clinicopathological features of colorectal cancer patients were further analyzed. Dual-luciferase reporter gene assay was used to validate the targeted relationship between lncRNA SNHG10 and miR-532-3p. After transfection with si-SNHG10 or miR-532-3p mimic or co-transfection of si-SNHG10 and miR-532-3p inhibitor, the invasion and migration of SW620 cells were detected by Transwell assay, and the protein expression of E-cadherin, N-cadherin and vimentin were detected by WB. Results: SNHG10 was highly expressed in colorectal cancer tissues and cells (all P<0.05), and its expression was related to TNM stage and distant metastasis (all P<0.05). miR-532-3p was lowly expressed in colorectal cancer tissues and cells, and its expression was correlated with TNM stage, lymphonode metastasis and distant metastasis (all P<0.05). The expression of SNHG10 and miR-532-3p in colorectal cancer tissues was negatively correlated (r=-0.225, P=0.048). Dual-luciferase reporter gene assay confirmed that SNHG10 targetedly regulated miR-532-3p. Both down-regulation of SNHG10 and up-regulation of miR-532-3p significantly inhibited the invasion and migration of SW620 cells (all P<0.05), up-regulated the expression of E-cadherin (P<0.05), while down-regulated the expression of N-cadherin and vimentin (all P<0.05). After transfection with miR-532-3p inhibitor, the inhibitory effect of knocking down the expression of lncRNA SNHG10 on the invasion and migration of colorectal cancer cells was reversed (all P<0.05). Conclusions: LncRNA SNHG10 is highly expressed in colorectal cancer and is associated with TNM stage and distant metastasis. LncRNA SNHG10 affects the invasion and metastasis of colorectal cancer cells by targeting miR-532-3p and regulating EMT.

Acta Pharmaceutica Sinica ; (12): 343-352, 2022.
Article in Chinese | WPRIM | ID: wpr-922910


Colorectal cancer (CRC) is a common malignancy burdening people globally, with increasing morbidity and mortality nowadays, due to the alternation in the diet type and lifestyle in modern society. Berberine, a type of benzylisoquinoline alkaloid, is widely present in numerous medicinal plants, particularly including Coptidis Rhizoma. Mounting evidence reveals that berberine possesses an array of pharmacological effects, such as anti-inflammation, anti-bacterium, anti-cancer, anti-diabetes mellitus and so on. In particular, berberine exhibits substantial inhibition on various types of cancers including CRC. Hereby, we sought to systematically review the suppressive effect of berberine on CRC through the diminishment of the proliferation and metastasis, induction of apoptosis, arrest of cell cycle, regulation of inflammatory reaction, the reverse of chemotherapeutic resistance and restoration of gut microbiota in CRC, so as to shed light on the in-depth mechanisms underlying the treatment of CRC with berberine in the clinical setting.

Journal of Preventive Medicine ; (12): 147-150, 2022.
Article in Chinese | WPRIM | ID: wpr-920568


Objective@#To investigate the factors affecting the depressive symptoms among patients with colorectal cancer in Chengdu City, so as to provide insights into mental health improvement among colorectal cancer patients.@*Methods@#Patients with colorectal cancer were enrolled from three hospitals in Chengdu City using the convenient sampling method. The basic information, life styles and cancer diagnosis and therapy were collected, and the depressive symptoms were evaluated using the Zung Self-Rating Depression Scale ( SDS ). In addition, factors affecting the depressive symptoms were identified using the multivariable logistic regression analysis.@*Results@#A total of 384 patients with colorectal cancer were enrolled, including 247 men ( 64.32% ), and the subjects had a mean age of ( 57.47±11.39 ) years and a mean SDS score of 37.73±9.15. The detection rate of depressive symptoms was 15.36%. Multivariable logistic regression analysis showed that colorectal cancer patients with a history of radiotherapy had a high risk of developing depressive symptoms ( OR=0.468, 95%CI: 0.245-0.895 ), while patients with alcohol consumption ( OR=0.407, 95%CI: 0.172-0.963 ) and drinking tea ( OR=0.470, 95%CI: 0.244-0.904 ) had a low risk of developing depressive symptoms.@*Conclusions@#The detection of depressive symptoms is 15.36% among patients with colorectal cancer in Chengdu City, and a history of radiotherapy, alcohol consumption and drinking tea affect the development of depressive symptoms among patients with colorectal cancer.

Braz. j. med. biol. res ; 55: e11832, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1364556


The human gut microbiota is a complex and dynamic community of microorganisms living in our intestines and has emerged as an important factor for colorectal adenocarcinoma (CRC). The purpose of our study was to investigate the microbiota composition in Brazilian CRC patients compared with a local control population (CTL) to find out which changes could be considered universal or regional features in CRC microbiota. Fecal samples were obtained from 28 CRC and 23 CTL individuals. The 16S rRNA gene was used for metagenomic analysis. In addition to the anthropometric variables, the clinical stage (TNM 2018) was considered. Patients with CRC had a significant increase in alpha diversity and a higher percentage of genus Prevotella and a decreased proportion of Megamonas and Ruminococcus. Additionally, the proportion of Faecalibacterium prausnitzii was associated with a better prognosis in the first stages of CRC, and Fusobacterium nucleatum proved to be an important marker of colorectal carcinogenesis and tumor aggressiveness. Although regional differences influence the composition of the microbiota, in the case of CRC, the microhabitat created by the tumor seems to be a major factor. Our results contribute to a better understanding of the carcinogenic process, and even in different environments, some factors appear to be characteristic of the microbiota of patients with CRC.

J. coloproctol. (Rio J., Impr.) ; 41(4): 393-405, Out.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1356431


Background: Anatomopathological staging is the primary method to determine the prognosis of patients with colorectal carcinoma (CRC). However, new tools have been developed that can complement it, such as the analysis of the elevation of systemic inflammatory markers. Objective: To evaluate the impact of the elevation of scores based on inflammatory markers (the neutrophil-to-lymphocyte ratio [NLR], the Glasgow Prognostic Score [GPS], and isolated C-reactive protein [CRP]) in the prognosis of patients diagnosed with CRC and submitted to potentially curative surgery in Hospital de Braga, Portugal, between January 1st, 2005, and December 31st, 2010. Methods: A retrospective analysis of the data of 426 patients was performed, with a collection of several clinico-pathological variables, as well as the levels of lymphocytes, neutrophils, albumin and CRP, in the pre- and postoperative periods, to apply the different scores to the sample. Results: From the analysis of the survival curves, we concluded that patients with increased NLR in the pre- and postoperative periods present a lower cancer-related survival than patients with normal NLR (preoperative period: 93.7 versus 122 months; p<0.001; postoperative period: 112 versus 131 months; p=0.002). Patients with increased NLR in the pre- and postoperative periods also had a lower disease-free survival (preoperative period: 88.0 versus 122 months; p<0.001; postoperative period: 111 versus 132 months; p=0.002). In addition, increased pre- and postoperative NLR was associatedwith a higher risk of death due to CRC (preoperatively: hazard ratio [HR]=2.25; p<0.001; postoperatively: HR=2.18; p=0.003). However, the multivariate analysis shows that only postoperative NLR (ajusted HR =2.66; p=0.002) does so independently of the remaining variables. Conclusion: Regarding the scores applied to the sample, the NLR was the one that most consistently related to the prognosis of the patients. However, it would be useful to develop a prospective study that could confirm this relationship. (AU)

Humans , Male , Female , Prognosis , Colorectal Neoplasms/mortality , C-Reactive Protein/analysis , Colorectal Neoplasms/therapy , Survival Rate , Disease-Free Survival , NLR Proteins/analysis
An. Fac. Cienc. Méd. (Asunción) ; 54(3): 33-40, Dec. 2021.
Article in Spanish | LILACS | ID: biblio-1352903


El estado mutacional del KRAS ha sido considerado como biomarcador para tratamientos biológicos tras varios ensayos clínicos realizados en pacientes con cáncer colorrectal metastásico. Reportes recientes indican que las frecuencias de mutación del gen KRAS en pacientes con CCR de Asia, Europa y Latinoamérica están entre el 24%, 36% y 40%, respectivamente. Paraguay no cuenta con este tipo de informes, a pesar de registrar anualmente en promedio 75 nuevos casos de pacientes diagnosticados con CCR sólo en el Servicio de Cirugía General del Hospital Central del Instituto de Previsión Social (IPS). El presente trabajo ha implementado este análisis de rutina, prerrequisito obligatorio para la administración de fármacos basados en anticuerpos terapéuticos, y revelado una frecuencia de mutación del gen KRAS del 34% en pacientes paraguayos con CCR que acuden a los Servicios del Hospital Central del IPS

The mutational status of the KRAS has been consider as a biomarker for biological treatments after several clinical trials carried out in patient with metastatic colorectal cancer. Recent reports indicate that the KRAS gene mutation frequencies in CRC patients from Asia, Europe, and Latin America are between 24%, 36%, and 40%, respectively. Paraguay does not have this kind of reports, despite registering an average of 75 new cases of patients diagnosed with CRC per year only in the General Surgery Service of the "Central Hospital - Instituto de Prevision Social (IPS)". The present work has implemented this routine analysis, a mandatory prerequisite for the administration of drugs based on therapeutic antibodies and revealed a KRAS gene mutation frequency of 34% in Paraguayan patients with CRC who attend the IPS Central Hospital Services

Colorectal Neoplasms , Mutation , Cross-Sectional Studies , Determination , Genes
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1353151


Objetivo: Avaliar a custo-efetividade da trifluridina/cloridrato de tipiracila (FTD/TPI) em comparação ao melhor cuidado de suporte (sigla em inglês BSC, best supportive care) e ao regorafenibe para o tratamento em pacientes com câncer colorretal metastático (CCRm) politratados (terceira linha ou linhas posteriores) sob a perspectiva de pagadores privados no Brasil. Métodos: Foi construído um modelo de sobrevida particionado considerando três estados de saúde. A efetividade foi medida em anos-vida ganhos e Quality-Adjusted Life Years (QALY). Os custos foram obtidos a partir da perspectiva do sistema de saúde privado brasileiro considerando um horizonte temporal de cinco anos. Também foram realizadas análises de sensibilidade univariada e probabilística para avaliar a robustez do modelo. Resultados: A utilização de FTD/TPI pode gerar melhores desfechos clínicos versus BSC e economia de recursos versus regorafenibe. FTD/TPI proporcionou mais 0,098 anos de vida por paciente e uma qualidade de vida incremental de 0,072, comparada ao BSC. Já em relação ao regorafenibe, a FTD/TPI apresentou redução de R$ 2.088,49 nos custos por paciente e benefícios clínicos com incremento marginal. Conclusão: FTD/TPI representa uma opção de tratamento de CCRm custo-efetiva, comparada ao regorafenibe, na perspectiva de pagadores privados no Brasil

Objective: To determine the cost-effectiveness analysis of trifluridine/tipiracil chloridrate (FTD/TPI) compared to best supportative care (BSC) and regorafenib for the treatment of polytreated metastatic colorectal carcinoma (mCRC) (3rd line or later lines) in the private payer perspective in Brazil. Methods: A partitioned survival model was developed based on three health states. Effectiveness was measured in life-years gained and Quality-Adjusted Life Years (QALYs). Costs were obtained from the perspective of the supplementary healthcare system in Brazil considering a time horizon of five years. Univariate and probabilistic sensitivity analyses were performed to evaluate the robustness of the model. Results: The use of FTD/TPI may generate better clinical outcomes versus BSC and resource savings versus regorafenib. FTD/TPI provided more 0,098 years of life per patient and an incremental quality of life of 0,072 compared to BSC. Regarding regorafenib, FTD/TPI provided a cost reduction of R$ 2.088,49 per patient and similar clinical benefits. Conclusion: FTD/TPI represents a cost-effective treatment option for mCRC compared to regorafenib from the perspective of the supplementary healthcare system in Brazil

Arq. gastroenterol ; 58(3): 359-363, July-Sept. 2021. tab, graf
Article in English | LILACS | ID: biblio-1345304


ABSTRACT BACKGROUND: The gold standard test for colorectal cancer screening the colonoscopy. Although this is the test of choice, colonoscopy misses a significant number of lesions, mainly in the proximal colon. With the purpose of reducing the number of lesions missed, new techniques have been studied, amongst them, retroflexed view in the right side of the colon and the second direct forward view. OBJECTIVE: Assessing the safety of the retroview in the proximal colon (cecum and ascending colon), its impact on the detection of lesions in the proximal colon and its advantage over the double right forward view using adenoma detection rate and adenoma miss rate. METHODS: Three hundred and ninety-three patients who came to Hospital Mater Dei to undergo colonoscopy from March to July 2017, prospectively. Out of these, 372 were included in the study based on the following exclusion criteria: being under 18 years of age, inadequate bowel preparations (Boston scale <7), history of colectomy, inflammatory bowel disease or polypoid diseases. First, an endoscopist inserted the colonoscope into the cecum and examine the cecum and the ascending colon with a forward view twice. In the third insertion into the cecum, retroflexed view was performed, cecal mucosa was examined until the hepatic flexure in search of polyps missed on forward view. All lesions found were resected and sent for histological analysis. RESULTS: In 334 (89.8%) patients, retroflexed view was performed successfully, 65.8% of failures were attributed to the loops of the device which prevented the maneuver. The direct view identified 175 polyps in the proximal colon in 102 people. Retroflexed view detected 26 polyps missed by the direct view in 24 (6.5%) people, with a missing rate of 12.9% in the test with only the forward view. Out of the 26 polyps found in retroview, 21 (80.76%) were adenomas, one of them with a high-grade dysplasia. Eleven patients had polyps seen only in retroflexed view. Retroview has increased the polyp detection rate from 27.41% to 31.72% and the adenoma detection rate from 21.77% to 25%. The adenoma miss rate by the double direct view was 12.8%. Without the retroview, one polyp in every 13.91 colonoscopies would be missed (number needed to treat - NNT=13.91). There was no adverse event. CONCLUSION: The retroflexed view technique in the proximal colon was shown to be safe, fast and feasible in most cases. It increased the adenoma detection rate and was shown to be advantageous in this study wit benefit beyond the double direct view.

RESUMO CONTEXTO: O exame padrão ouro para rastreamento de câncer colorretal é a colonoscopia. Apesar de ser o exame de escolha, a colonoscopia perde um número não desprezível de lesões, principalmente no cólon proximal. Com a intenção de reduzir a perda de lesões, novas técnicas são estudadas, dentre elas, a retroflexão em cólon direito e a segunda visão frontal direta. OBJETIVO: Avaliar a segurança da retrovisão no cólon proximal (ceco e cólon ascendente), o seu impacto na detecção de lesões em cólon proximal e sua superioridade sobre a dupla visão frontal direta usando taxa de detecção de adenoma e taxa de adenoma perdido. MÉTODOS: Foram avaliados 393 pacientes de forma prospectiva que procuraram o Hospital Mater Dei para realizar colonoscopia entre março e julho de 2017. Desses, 372 foram incluídos baseados nos critérios de exclusão: menores de 18 anos, preparos intestinais inadequados (escala de Boston <7), com antecedente de colectomia, doença inflamatória intestinal ou síndromes polipoides. Primeiramente um endoscopista realizou a inserção do colonoscópio até o ceco e examinou o ceco e o cólon ascendente em visão frontal por duas vezes. Na terceira reinserção até o ceco era realizada a retroflexão e inspeção da mucosa do ceco até a flexura hepática em busca de pólipos perdidos à visão frontal. Todas lesões encontradas foram ressecadas e enviadas para análise histológica. RESULTADOS: Em 334 (89,8%) pacientes a retroflexão foi realizada com sucesso, 65,8% dos insucessos foram atribuídos a alças no aparelho que impediram a manobra. A visão direta identificou 175 pólipos no cólon proximal em 102 pessoas. A retroflexão detectou 26 pólipos perdidos pela visão direta em 24 (6,5%) pessoas, com uma taxa de perda de 12,9% no exame apenas em visão frontal. Dos 26 pólipos encontrados em retrovisão, 21 (80,76%) eram adenomas, um deles com displasia de alto grau. Onze pacientes tinham pólipos vistos apenas em retroflexão. A realização da retrovisão aumentou a taxa de detecção de pólipo de 27,41% para 31,72% e a taxa de detecção e adenomas de 21,77% para 25%. A taxa de adenoma perdido pela dupla visão direta foi de 12,8%. Se a retrovisão não fosse realizada, um pólipo a cada 13,91 colonoscopias seria perdido (NNT=13,91). Não houve nenhum evento adverso. CONCLUSÃO: A técnica de retroflexão em cólon proximal mostrou-se segura, rápida e factível na maioria dos casos. Ela aumentou a taxa de detecção de adenomas e mostrou-se soberana neste estudo com benfeitorias além da dupla visão direta.

Humans , Adolescent , Colonic Polyps/diagnostic imaging , Colonic Neoplasms/diagnostic imaging , Colonoscopy , Tertiary Care Centers
Arq. gastroenterol ; 58(3): 316-321, July-Sept. 2021. tab
Article in English | LILACS | ID: biblio-1345286


ABSTRACT BACKGROUND AND OBJECTIVE: Considering the association between colorectal cancer (CRC) and both insulin resistance and obesity, and the prominent role of ghrelin in these metabolic disorders, we explored whether plasma levels of ghrelin were associated with CRC. Moreover, in the patients with CRC the possible correlations between ghrelin and insulin, insulin resistance, and body mass index (BMI) as an indicator of obesity were examined. METHODS: A total of 170 subjects, including 82 cases with CRC and 88 controls were enrolled in this study. Plasma levels of ghrelin, insulin, and glucose were measured in all the subjects using ELISA and glucose oxidase methods. Furthermore, insulin resistance was assessed by calculating HOMA-IR index. RESULTS: The cases with CRC had decreased ghrelin levels (P<0.001) and a higher HOMA-IR index (P<0.001) than controls. Interestingly, when CRC patients were stratified based on tumor site, lower ghrelin levels and a higher HOMA-IR index were observed in the patients with either colon or rectal cancer vs. controls too. Additionally, there were an age and BMI-independent negative correlation between ghrelin levels and HOMA-IR (r=-0.365, P<0.05), and an age-independent negative correlation between ghrelin levels and BMI (r=-0.335, P<0.05) in the rectal subgroup. CONCLUSION: Our findings support a role for ghrelin in connection with insulin resistance and obesity in CRC susceptibility; however, it needs to be corroborated by further studies.

RESUMO CONTEXTO E OBJETIVO: Considerando a associação entre câncer colorretal (CCR), a resistência à insulina, à obesidade e o papel proeminente da grelina nessas doenças metabólicas, foi explorado se os níveis plasmáticos de grelina estavam associados ao CCR. Além disso, nos pacientes com CCR foram pesquisadas as possíveis correlações entre a grelina, insulina, resistência insulínica e índice de massa corporal (IMC) como indicadores de obesidade. MÉTODOS: Foram incluídos neste estudo 170 indivíduos, sendo 82 com CRC e 88 controles. Os níveis plasmáticos de grelina, insulina e glicose foram medidos em todos os sujeitos utilizando métodos ELISA e glicose oxidase. Além disso, a resistência à insulina foi avaliada pelo cálculo do índice HOMA-IR. RESULTADOS: Os pacientes com CRC apresentaram redução dos níveis de grelina (P<0,001) e maior índice HOMA-IR (P<0.001) do que os controles. Curiosamente, quando os pacientes com CRC foram estratificados com base no local do tumor, níveis mais baixos de grelina e maior índice de HOMA-IR foram observados nos indivíduos com câncer de cólon ou retal versus controles também. Além disso, houve uma correlação negativa entre idade e IMC independente entre os níveis de grelina e HOMA-IR (r=-0,365, P<0,05) e uma correlação negativa independente da idade entre os níveis de grelina e IMC (r=-0,335, P<0,05) no subgrupo retal. CONCLUSÃO: Nossos achados apoiam o papel da grelina em relação à resistência à insulina e à obesidade na suscetibilidade do CRC; no entanto, ela precisa ser corroborada por estudos posteriores.

Humans , Insulin Resistance , Colorectal Neoplasms , Body Mass Index , Ghrelin , Obesity/complications
Rev. gastroenterol. Perú ; 41(3): 150-155, jul.-sep 2021. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1357339


RESUMEN Introducción: El cáncer de colon y recto (CCR) es el tercer cáncer más frecuente y la cuarta causa de muerte por cáncer en el mundo. En Colombia, es la tercera causa de muerte por cáncer. La recomendación más aceptada es hacer tamización con colonoscopia en personas de 50 a 75 años. Sin embargo, recientemente la Asociación Americana de Cáncer (ACS) ha recomendado iniciar la tamización a partir de los 45 años. En nuestro medio no hay estudios sobre prevalencia de pólipos adenomatosos en menores de 50 años. Objetivo: Comparar la prevalencia de pólipos adenomatosos durante colonoscopia de tamización en personas de 45-49 años (casos) y compararla con la de personas de 50 a 75 años (control). Materiales y métodos: Estudios de casos y controles. Los datos se recolectaron de forma prospectiva durante el periodo de enero 2018 hasta noviembre de 2019 en el centro de gastroenterología y endoscopia digestiva de Bogotá Colombia. Resultados: Se incluyeron 490 pacientes, 119 casos y 371 controles, relación casos:control fue 1:3. La prevalencia de pólipos en los casos 36,7% y en los controles (42,5%) p=0,279. Los pólipos adenomatosos se detectaron en 18,5% (IC 95% 12,4-26,6) de los casos y 32,4% (IC 95% 27,7-37,2) de los controles (p=0,004). Conclusión: La prevalencia de pólipos durante la colonoscopia de tamización en personas de 45-49 años es similar a la esperada en colonoscopias de tamización de personas entre los 50-75 años. Este hallazgo favorecería colonoscopia de tamización a partir de los 45 años.

ABSTRACT Introduction: Colon and rectal cancer (CRC) is the third most frequent cancer and the fourth cause of cancer death in the world. In Colombia, it is the third leading cause of death from cancer. The most accepted recommendation is to do colonoscopy screening in people 50 to 75 years old. However, recently the American Cancer Association (ACS) has recommended starting screening from the age of 45. In our environment there are no studies on the prevalence of adenomatous polyps in children under 50 years of age. Objective: To compare the prevalence of adenomatous polyps during screening colonoscopy in people aged 45-49 years (cases) and compare it with that of people aged 50 to 75 years (control). Materials and methods: Case-control studies. The data were collected prospectively during the period from January 2018 to November 2019 at the gastroenterology and digestive endoscopy center of Bogotá Colombia. Results: 490 patients were included, 119 cases and 371 controls, case: control ratio was 1: 3. The prevalence of polyps in cases 36.7% and in controls (42.5%) p=0.279. Adenomatous polyps were detected in 18.5% (95% CI 12.4-26.6) of the cases and 32.4% (95% CI 27.7-37.2) of the controls (p=0.004). Conclusion: The prevalence of polyps during screening colonoscopy in people aged 45-49 years is similar to that expected in screening colonoscopies of people between 50-75 years. This finding would favor screening colonoscopy from 45 years of age.

Rev. gastroenterol. Perú ; 41(3): 156-163, jul.-sep 2021. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1357340


RESUMEN Introducción : El cáncer colorrectal (CCR) es un problema mundial de salud pública y se origina principalmente a partir de pólipos. Hace 25 años se ha considerado una estrategia denominada quimioprevención que consiste en el consumo de alimentos como maíz morado y cúrcuma o sustancias químicas como ácido acetilsalicílico (AAS) y anti inflamatorios no esteroideos (AINEs) que previenen la carcinogénesis efectivamente al reducir el riesgo de desarrollo de pólipos. Objetivo : Determinar la eficacia y seguridad del concentrado liofilizado Zea mays morado 200 mg en la prevención de formación de pólipos colónicos en la práctica gastroenterológica privada. Material y métodos : aleatorizamos 112 pacientes (casos) para recibir este producto y 112 pacientes (controles) para recibir placebo, durante 3 años. Ambos grupos de similares características demográficas, clínicas y antecedentes patológicos. Resultados : Hallamos que los casos al final del estudio desarrollaron 83% menos pólipos que los controles (p<0,001). Los casos que desarrollaron pólipos fueron menores en número, tamaño e histología que al inicio del ensayo. Los eventos adversos que presentaron los casos fueron 4,5% similar a los controles, principalmente petequias. Conclusiones : Concluimos que el concentrado liofilizado de Zea mays morado 200 mg es eficaz y seguro en la prevención del desarrollo de pólipos colónicos.

ABSTRACT Introduction : Colorectal cancer (CRC) is a worldwide problem of public health and arises mainly from polyps. In last 25 years, a strategy called chemoprevention that consists of food intake like purple corn and turmeric or chemical substances like acetyl salicylic acid (ASA) and non-steroidal anti-inflammatory drugs (NSAIDs) that prevent effectively carcinogenesis reducing the risk of polyp development. Objective : To determine the efficacy and safety of lyophilized concentrate of purple corn (Zea mays L.) 200 mg in the prevention of colonic polyps development in private gastroenterological practice Methods : we randomly assigned 112 patients (cases) to receive this product and 112 patients (controls) to receive placebo, during 3 years. Both groups had similar demographic, clinical and medical history characteristics. Results : we found that cases developed 83% less polyps than controls (p<0.001). The cases that developed polyps were smaller in number, size and histology than at the beginning of the trial. The adverse events that cases presented were 4.5% similar to controls, mainly petechiae. Conclusion : We conclude that the lyophilized concentrate of purple corn (Zea mays L.) 200 mg was effective and safe in preventing the development of colonic polyps.

J. coloproctol. (Rio J., Impr.) ; 41(3): 301-307, July-Sept. 2021.
Article in English | LILACS | ID: biblio-1346416


Over the past decade, there has been a great interest in postcolonoscopy colorectal cancer (PCCRC). Its etiology is complex and multifactorial. Monitoring for PCCRC is even more complex. The strategies to decrease the incidence of PCCRC start by defining the problem, identifying the factors contributing to its development, followed by an attempt to define methods to decrease its incidence.We believe that the quality of the colonoscopy and the endoscopist's expertise are the key factors in decreasing the incidence of PCCRC. (AU)

Humans , Colorectal Neoplasms/diagnosis , Colonoscopy , Colitis, Ulcerative/complications , Colorectal Neoplasms, Hereditary Nonpolyposis/complications , Clinical Competence , Early Detection of Cancer
J. coloproctol. (Rio J., Impr.) ; 41(3): 228-233, July-Sept. 2021. tab, ilus
Article in English | LILACS | ID: biblio-1346421


Objectives: To evaluate the serrated lesion detection rate in colonoscopy at a specialized clinic and its role as quality criteria for endoscopic examination. Methods: This is an observational cross-sectional study with all patients that underwent colonoscopy between October 2018 and May 2019, performed by an experimented physician. A questionnaire was answered before the examination by the patient, and another questionnaire after the colonoscopy was answered by themedical team. All polyps identified were removed and sent to the same pathologist for analysis. Results: A total of 1,000 colonoscopies were evaluated. The average age of the patients was 58.9 years old, and most of them were female (60.6%). In 62.5% of the procedures, polyps were removed, obtaining a total of 1,730 polyps, of which 529 were serrated lesions, being 272 sessile serrated lesions (SSL). This data resulted in a serrated lesion detection rate (SDR) of 29.2%, and of 14% when considering only the SSL detection rate (SSLDR). The right colon had higher rates, with 22.3% SDR and 15.3% SSLDR. Screening colonoscopies also presented a higher serrated detection rate, of 20%, followed by diagnostics and follow-up exams. Smoking was the only risk factor associated with higher serrated detection rate. Conclusions: The serrated lesion detection rate is higher than the ones already previously suggested and the have the higher rates were stablished in the right colon and on screening exams. (AU)

Humans , Male , Female , Colonoscopy , Colon/injuries , Colorectal Neoplasms/etiology , Smoking/adverse effects , Colonic Polyps/diagnosis , Endoscopy
J. coloproctol. (Rio J., Impr.) ; 41(3): 257-264, July-Sept. 2021. tab
Article in English | LILACS | ID: biblio-1346426


Introduction: The Covid-19 pandemic has had an important impact on colorectal cancer surgery, for hospital resources had to be redistributed in favour of Covid-19 patients. The aim of the present study is to analyze our results in colorectal oncologic surgery during the Covid-19 pandemic in patients with and without perioperative SARSCoV- 2 infection. Methods: In total, 32 patients (19 male and 13 female patients), with a mean age of 64 years (range: 57.2 to 69.5 years) with colorectal cancer underwent surgery under the recommendations of surgical societies included in a protocol. Data collection included clinical characteristics (gender, age, body mass index, American Society of Anesthesiologists score, tumor location, preoperative staging, lymphopenia), data related to SARS-CoV-2 infection (postoperative symptoms, diagnostic tests), operative details (surgical procedure, approach, duration, stoma), pathological outcomes (tumor stage, number of lymph nodes harvested, distal and circumferential radial margins, quality of the total mesorectal excision), and surgical outcomes (morbidity, mortality, hospital stay, and the rates of reoperation and readmission). Results: A total of 3 (9.4%) patients who underwent colorectal surgery during the Covid-19 pandemic were infected by SARS-CoV-2 in the postoperative period. Chronic obstructive pulmonary disease was associated with Covid-19 (6.2% versus 33.3%; p=0.042), and surgical morbidity was higher among Covid-19 patients (100% versus 37.9%; p=0.039). There were not significant differences between COVID-19 patients and non-COVID-19 patients in relation to the rest of the analyzed outcomes. Conclusion: During the Covid-19 pandemic, colorectal cancer surgery should be performed according to the recommendations of surgical societies. However, Covid- 19 patients could present a higher morbidity rate. (AU)

Humans , Male , Female , Middle Aged , Aged , Colorectal Neoplasms/surgery , Colorectal Neoplasms/therapy , Treatment Outcome , COVID-19
Rev. Assoc. Med. Bras. (1992) ; 67(7): 1015-1020, July 2021. tab, graf
Article in English | LILACS | ID: biblio-1346939


SUMMARY OBJECTIVE: Pulmonary metastasectomy for the treatment of metastatic colorectal cancer is essential, but high ranked evidence of survival benefit is lacking. Here, we aimed to examine the prognostic factors after pulmonary metastasectomy in patients with colorectal cancer. METHODS: This is a single-center, retrospective hospital-based observational case series study. We reviewed data for 607 patients with metastatic colorectal cancer (mCRC) who were treated and observed from 2012 to 2019. Of the 607 patients with mCRC, 87 were with solitary lung metastases. Of the 87 patients, 39 were not appropriate for metastasectomy, while 15 patients recognized as suitable candidates by the multidisciplinary thoracic tumor board rejected metastasectomy. Consequently, only 33 patients were included in the final analysis. RESULTS: Rectum was detected as the primary site in 16 (48.5%) patients. Over 80% of patients had metachronous lung metastases, with a median of 29.0 months from initial diagnosis. Video-assisted thoracic surgery with wedge resection was performed in 20 (60.6%) patients. Over 90% of patients had solitary metastasis resected, with 97% of R0 resection. Median tumor size was 23.0 mm (min: 10; max: 90). Adjuvant treatment was given to 31 (93.9%) patients, while neoadjuvant treatment was given only to 8 (25%) patients. Of the 33 patients, there were 25 (75.7%) relapses. The most frequent site of relapse was lung in 15 (45.5%) patients. Interestingly, there were only 4 (12.2%) patients who had a relapse in the liver after lung metastasectomy. We found that median disease-free survival (DFS) and overall survival (OS) were 43.0 (13.0-73.0) and 55.0 (31.6-78.4) months, respectively. CONCLUSIONS: Pulmonary metastasectomy was associated with significantly long-time survival rates in mCRC (43 months of DFS and 55 months of OS). The second relapse occurred in 25 (75.7%) patients, with isolated lung metastases in nearly half of the patients (45.5%). Therefore, lung metastases in mCRC were unique and a multidisciplinary team including a thoracic surgeon should manage these patients.

Humans , Colorectal Neoplasms/surgery , Metastasectomy , Lung Neoplasms/surgery , Prognosis , Survival Rate , Retrospective Studies , Disease-Free Survival , Thoracic Surgery, Video-Assisted , Neoplasm Recurrence, Local
J. coloproctol. (Rio J., Impr.) ; 41(2): 176-181, June 2021. ilus
Article in English | LILACS | ID: biblio-1286986


Introduction: Ovarian metastases of gastrointestinal origin, also called Krukenberg tumors, have a guarded prognosis. Physicians need to look for alternatives in diagnosis and treatment for this clinical condition in order to improve the outcome of the patients. Objectives: To report the experience of the authors in the treatment of these patients, and to perform a review of the literature on the epidemiology, clinical presentation, diagnosis, treatment, and prognosis for ovarian metastases from colorectal cancer. Methods: We collected clinical information regarding the patients treated for ovarian metastasis from colorectal adenocarcinoma at our coloproctology service, and performed a search on the PubMed database using the terms colorectal cancer, ovarian metastasis, Krukenberg tumor and surgery. Conclusion: Large abdominal tumors are the most frequent presentation of ovarian metastasis from colorectal cancer. The diagnosis is based on a histopathological analysis, levels of carcinoembryonic antigen (CEA) and cancer antigen 125 (CA-125), and immunohistochemical studies for the cytokeratin 20 (CK20), caudal-type homeobox 2 (CDX2) and vilina markers. Citoreductive surgical procedures are the most promising approach to treatment, with the highest impact on overall survival. The prognosis is negatively influenced by the extent of the metastasis, by citoreductive surgical procedures with persistence of macro- or microscopic foci of the disease, and by low scores on the general well-being index of the patient. (AU)

Introdução: As metástases ovarianas de tumores gastrointestinais, também chamadas de tumores de Krukenberg, são neoplasias de prognóstico reservado. Exigem conhecimento de alternativas diagnósticas e terapêuticas para garantir melhora da sobrevida das pacientes. Objetivos: Relatar a experiência dos autores no tratamento dessas pacientes, e fazer uma revisão da literatura sobre a epidemiologia, apresentação clínica, diagnóstico, tratamento e prognóstico das metástases ovarianas do câncer colorretal. Métodos: Foi realizada uma coleta de informações clínicas de pacientes tratados por metástases ovarianas de adenocarcinoma colorretal em nosso serviço de coloproctologia, em conjunto com uma pesquisa na base de dados PubMed com os termos colorectal cancer, ovarian metastasis, Krukenberg tumor, e surgery. Conclusão: Volumosas massas abdominais constituem a principal apresentação clínica da doença. As alternativas diagnósticas incluem a avaliação histopatológica, a identificação dos níveis de antígeno cárcino-embriônico (ACE) e de antígeno de câncer 125 (CA-125), e exame imunoistoquímico de espécimes cirúrgicos para os marcadores citoqueratina 20 (CK20), homeobox 2 do tipo caudal (CDX2), e vilina. O tratamento citorredutor completo demonstrou o maior impacto na sobrevida dos pacientes. O prognóstico é influenciado negativamente pela extensão da doença metastática, por cirurgia citorredutiva com persistência focos microscópicos ou macroscópicos da doença, e baixo escore de índice de bem-estar geral do paciente. (AU)

Humans , Female , Ovarian Neoplasms/etiology , Adenocarcinoma , Krukenberg Tumor , Neoplasm Metastasis , Ovarian Neoplasms/diagnosis , Ovarian Neoplasms/therapy , Colorectal Neoplasms/complications , Cytoreduction Surgical Procedures
J. coloproctol. (Rio J., Impr.) ; 41(2): 188-192, June 2021. tab, graf, ilus
Article in English | LILACS | ID: biblio-1286991


Abstract Objective The present study aimed to evaluate the relationship between UGT1A1*28 gene polymorphism and the prevalence of neutropenia in patients with colorectal cancer treated with irinotecan. Method Thirteen studies were included. These papers were selected from the Virtual Health Library, Scientific Electronic Library Online, International Health Sciences Literature and PubMed, and their data were collected and evaluated using the BioEstat 5.3 software (BioEstat, Belém, PA, Brazil). Results Three genotypes were analyzed, namely 6/6 (wild type), 6/7, and 7/7. In total, 2,146 patients were included in the present study; of these, 55.6% (n=1,193) had 6/6 genotype, 37.3% (n=801) were heterozygous (6/7), and 7.1% (n=152) had the 7/7 genotype. A total of 1,672 (77.9%) patients displayed mild neutropenia, whereas 474 (22.1%) had severe neutropenia. When contrasting the 6/7 and 7/7 genotypes with the 6/6 genotype using statistical tests for meta-analysis, patients with the 7 allele, either Conclusion The analysis of the UGT1A1*28 gene polymorphism can aid the choice of treatment for patients with colorectal cancer in personalized medicine, increasing the chances of therapeutic success.

Resumo Objetivo Avaliar a relação do polimorfismo do gene UGT1A1*28 com a prevalência de neutropenia em pacientes com câncer colorretal submetidos a tratamento com o irinotecano. Método Foram incluídos 13 estudos sobre o tema proposto, selecionados nas bases de dados da Biblioteca Virtual de Saúde, Scientific Electronic Library Online, International Health Sciences Literature e PubMed.Os dados foramcoletados dos artigos científicos selecionados e avaliados com o auxílio do software BioEstat 5.3 (BioEstat, Belém, PA, Brasil). Resultados Osgenótipos analisados foram6/6 (tipo selvagem), 6/7 e 7/7. Foramincluídos 2.146 pacientes. Destes, 55,6% (n=1.193) apresentaram genótipo 6/6, 37,3% (n=801) eramheterozigotos (6/7) e 7,1%(n=152) tinhamo genótipo 7/7.Umtotal de 1.672 (77,9%) pacientes apresentou neutropenia leve e 474 (22,1%) neutropenia severa. Ao contrastar os genótipos 6/7 e 7/7 como 6/6, percebeu-se, coma execução dos testes estatísticos demetaanálise, que os pacientes como alelo 7, emhomozigose ou heterozigose, tinhammaior risco de desenvolver neutropenia severa que pacientes com o genótipo 6/6 (razão de chances =1,559; intervalo de confiança de 95%=1,163-2,090; p=0,003). Conclusão A análise do polimorfismo do gene UGT1A1*28 pode auxiliar na escolha do tratamento do paciente comcâncer colorretal, no contexto da medicina personalizada, ampliando, assim, as chances de sucesso terapêutico.

Humans , Polymorphism, Genetic , Colorectal Neoplasms/drug therapy , Neutropenia/epidemiology , Prevalence , Irinotecan/adverse effects , Irinotecan/therapeutic use