ABSTRACT
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Subject(s)
Humans , Male , Female , Middle Aged , Aged , Liver Cirrhosis/therapy , Fecal Microbiota Transplantation/methods , Clostridioides difficile/pathogenicity , Clostridium Infections/therapy , Recurrence , Treatment OutcomeABSTRACT
BACKGROUND: Two or more primary colorectal tumors coexisting at the time of diagnosis are considered to be synchronous tumors. It is estimated that synchronous colorectal cancer (SCRC) only accounts for 1.1% to 8.1% of all colorectal cancers (CRCs), and its molecular basis is still poorly understood. PATIENTS AND METHODS: We evaluated the microsatellite instability (MSI) and the CpG island methylator phenotype (CIMP) statuses in a series of 49 patients (98 tumors) diagnosed with sporadic SCRC at the 12 de Octubre University Hospital with the aim of improving the molecular characterization of this type of tumor. We considered Lynch syndrome, familial adenomatous polyposis, and MUTYH-associated polyposis (MAP) as exclusion criteria. RESULTS: Molecular subgrouping on the basis of MSI and CIMP enabled us to define 4 groups that corresponded to the molecular classification proposed for single-tumor CRC. We observed a significant predominance of MSI tumors at the right side regardless of the methylation pattern, and a significant prevalence of microsatellite-stable tumors either at the left side or throughout the entire colon (P = .026). Furthermore, we defined some molecular features frequently observed in sporadic SCRC such as a low-frequency of MSI (8.2%). We observed a high concordance in terms of MSI between simultaneous tumors (93.9%) and a lower concordance in terms of CIMP (51%) between such tumors. CONCLUSION: Our findings support the hypothesis that SCRC involves an environmental rather than a genetic component in which various etiologic factors might modify tumor progression. Further studies are required to refine the molecular characterization of SCRC.
Subject(s)
Adenocarcinoma/genetics , Colorectal Neoplasms/genetics , CpG Islands/genetics , DNA Methylation/genetics , Microsatellite Instability , Aged , Aged, 80 and over , Female , Humans , MaleABSTRACT
BACKGROUND: We identify the features of multiple primary colorectal cancer (MPCC), synchronous colorectal cancer (SCRC) and metachronous colorectal cancer (MCRC), and distinguish between the cases that require a more extensive surgery and those where the parameters of SCRC might be important to prevent the development of MCRC. METHODS: We gathered up consecutive individuals with MPCC, 50 for each category, and 100 consecutive individuals diagnosed with 'single' colorectal cancer. Clinical and familiar information was obtained. We classified both SCRC and MCRC according to locations. RESULTS: MPCC were associated with polyps, both in earlier stages and as sporadic forms. SCRC located in the right colon were most frequently of the mucinous type. MCRC developed SCRC in 24%, along the entire colon, with familiar cancer antecedents. SCRC patients undergoing a total colectomy were younger, with the cancer spread throughout the entire colon and a larger number of polyps, whereas MCRC were predominantly adenomatous polyps. We found 2 risk factors for SCRC that led to the development of MCRC: rectal location and higher number of polyps. CONCLUSIONS: SCRC possibly involves more than an environmental component. MCRC appears to be the producer of polyps that evolve into cancer at different times, emphasising the idea of a genetic predisposition. Studies are required to find biomarkers that define patients with higher risk of developing MCRC within SCRC.
