Assessing demographic and socioeconomic factors in patients with advanced colorectal cancer.

BACKGROUND: The aim of the study was to determine the socioeconomic and demographic factors associated with advanced colorectal cancer (CRC) presentation at our institution. METHODS: From January 2009 to January 2018, patients that underwent CRC surgery at our institution were included and retrospectively analyzed. Univariate and multivariate logistic regression were used to determine independent risk factors for presenting with advanced CRC. RESULTS: A total of 277 patients were included, 53.5% presented with advanced CRC. The multivariate analysis identified that living in a rural area (odds ratio [OR] = 5.25; 95% confidence interval [95% CI]: 2.27-12-10; p < 0.001), weight loss (OR = 2.33; 95% CI: 1.35-4.09; p = 0.002), needing emergency surgery (OR = 4.68; 95% CI: 1.25-17.49; p = 0.022), location in the rectum in comparison with colon (OR = 2.66; 95% CI: 1.44-4.91; p = 0.002), and location in the mid rectum (OR = 6.10; 95% CI: 2.31-16.12; p < 0.001) were associated with higher odds of advanced CRC stage at presentation. CONCLUSIONS: Patients with lower socioeconomic status, with symptoms, and needing emergency surgery were associated with advanced CRC stage at presentation. Special interventions to improve access to care in this population should be planned to enhance CRC outcomes.

INTRODUCCIÓN: El objetivo del presente estudio es determinar los factores socioeconómicos y demográficos asociados con la presentación de cáncer colorrectal (CCR) en etapas avanzadas en nuestra institución. MÉTODOS: De Enero 2009 a Enero 2018, aquellos pacientes operados por CCR fueron incluidos y analizados de forma retrospectiva. Se realizó análisis de regresión logística para determinar los factores de riesgo independientes para presentar CCR avanzado. RESULTADOS: Se incluyeron un total de 277 pacientes, de los cuales 53.5% se diagnosticaron con CCR avanzado. En el análisis multivariable: vivienda en zona rural (OR = 5.25; 95% CI: 2.27-12-10; p < 0.001), pérdida de peso (OR = 2.33; 95% CI: 1.35-4.09; p = 0.002), necesidad de cirugía de urgencia (OR = 4.68; 95% CI: 1.25-17.49; p = 0.022), tumores en recto (OR = 2.66; 95% CI: 1.44-4.91; p = 0.002), fueron factores asociados a mayor probabilidad de presentación avanzada del CCR. CONCLUSIONES: Pacientes con nivel socioeconómico bajo, aquellos que acuden sintomáticos, y los que requieren de inicio cirugía de urgencia, fueron factores asociados a presentaciones avanzadas de CCR. Se requieren intervenciones especiales para mejorar el acceso a un diagnóstico temprano y oportuno en estos grupos poblacionales.

Parkin protein expression and its impact on survival of patients with advanced colorectal cancer.

OBJECTIVE: Features of colorectal cancer such as natural history, molecular, chromosomal, and epigenetic alterations have been well described. However, there is still a lack of accurate prognostic markers, which is evident by the lower overall survival rates of patients with advanced cancer. Although alterations in parkin protein expression have been described in colorectal cancer, the functional significance of this protein remains unknown. The present study aimed to investigate the involvement of parkin expression in colorectal adenocarcinoma development and progression by evaluating the association between its expression, clinicopathological parameters, and expression of known proteins involved in colorectal cancer. METHODS: Tissue microarrays consisting of 73 tumor and 64 normal tissue samples were generated to examine parkin expression and localization by immunohistochemistry. RESULTS: A positive correlation of parkin and APC expression was observed in the superficial, intermediate, and profound regions of all cases (ρ = 0.37; P = 0.001). Parkin expression was also significantly associated with tumors in men (P = 0.049), those of the mucinous subtype (P = 0.028), and of advanced stage (III + IV, P = 0.041). In addition, increased parkin expression was observed in the invasive front tumor region (P = 0.013). More importantly, a positive correlation was found between parkin expression and the overall survival of patients with advanced colorectal cancer (P = 0.019). Multivariate analysis showed that parkin expression was independent of any of the clinicopathological parameters evaluated in relation to patient survival. CONCLUSIONS: These results suggest that parkin expression status can be used as a potential independent prognostic marker of survival in advanced colorectal cancer.

Relationship between the Asp1104His polymorphism of the nucleotide excision repair gene ERCC5 and treatment sensitivity to oxaliplatin in patients with advanced colorectal cancer in China

OBJECTIVES: To study the relationship between the Asp1104His polymorphism of the nucleotide excision repair gene ERCC5 and treatment sensitivity to oxaliplatin in patients with advanced colorectal cancer (CRC) in China. METHODS: A group of 226 patients in the Department of Gastrointestinal Oncology at Zhejiang Xiaoshan Hospital from July 2011∼December 2016 and a control group of 226 normal healthy individuals were involved in this study. All patients were first diagnosed with advanced CRC and were treated with oxaliplatin-based chemotherapy. The genotype of ERCC5 at the site of amino acid 1104 was determined by a TaqMan probe-based real-time PCR approach. RESULTS: There were no differences in age or gender between the groups, but the percentages of smokers and individuals with a family history of cancer were significantly higher in the patient group than in the control group. Analysis of the G/C polymorphism frequency among the patients and the healthy controls showed that the frequencies of the CC genotype and the CC+GC genotype were significantly related to CRC, but no significant difference in these frequencies was found between genders. The analysis of the relationship between the 5-year survival rate and different genotypes showed that in the total patient group, regardless of gender, the 5-year survival rate was significantly associated with the Asp1104His polymorphism of ERCC5. CONCLUSIONS: The Asp1104His polymorphism of ERCC5 was associated with the risk and 5-year survival rate of CRC as well as treatment sensitivity to oxaliplatin.