Fecoflowmetric analysis of anorectal motor function in postoperative anal-preserving surgery patients with low rectal cancer comparison with the wexner score and anorectal manometry.

The aim of this study was to elucidate whether fecoflowmetry (FFM) could evaluate more detailed evacuative function than anorectal manometry by comparing between FFM or anorectal manometric findings and the clinical questionnaires and the types of surgical procedure in the patients who received anal-preserving surgery. Fifty-three patients who underwent anal-preserving surgery for low rectal cancer were enrolled. The relationships between FFM or the manometric findings and the clinical questionnaires and the types of procedure of anal-preserving surgery were evaluated. There were significant differences between FFM markers and the clinical questionnaire and the types of the surgical procedure, whereas no significant relationship was observed between the manometric findings and the clinical questionnaire and the types of the surgical procedure. FFM might be feasible and useful for the objective assessment of evacuative function and may be superior to manometry for patients undergoing anal-preserving surgery.

Expression of monocarboxylate transporter (MCT)-4 in colorectal cancer and its role: MCT4 contributes to the growth of colorectal cancer with vascular endothelial growth factor.

BACKGROUND: In tumor cells, monocarboxylate transporter (MCT)-4 regulates the excretion of lactate produced by glycolysis from the cell. MCT4 has also been reported to be involved in tumor growth and infiltration. Similarly, vascular endothelial growth factor (VEGF) is known to be involved in the growth, infiltration, and metastasis of tumors. In this study, we clinically evaluated the relationship between MCT4 and VEGF in colorectal cancer. MATERIALS AND METHODS: A prospective study was conducted in 210 patients with colorectal cancer who underwent surgical treatment. The clinicopathological data were correlated with the expression of MCT4 and VEGF obtained from immunohistochemical analysis. RESULTS: MCT4 and VEGF were expressed in tumors of 102 (49%) and 129 (61%) patients, respectively. A maximum tumor diameter of 45 mm or more (p<0.0001) and a tumor invasion depth of T1 or less (p<0.0119) were factors independently correlated with the expression of MCT4 and VEGF, respectively. The tumor size was significantly smaller (p=0.0031), and the disease was significantly less advanced (p=0.0017), in MCT4-negative/VEGF-positive than MCT4-positive/VEGF-negative cases. CONCLUSION: We suspect that in colorectal cancer, VEGF is involved in the early stages of tumor growth and MCT4 expression appears as the tumor enlarges and contributes to its further infiltration and growth.

Decreased expression of claudin-1 in rectal cancer: a factor for recurrence and poor prognosis.

AIM: To investigate the potential involvement of claudin-1 (CL-1) in the tumorigenesis of rectal cancer by analyzing the correlation between CL-1 expression, clinicopathological factors and prognosis. PATIENTS AND METHODS: Rectal cancer tissue specimens from 306 patients that had undergone surgical treatment were evaluated using immunohistochemical analysis for expression of CL-1 and correlated with clinicopathological factors. RESULTS: A reduced expression of CL-1 (less than 30% of tumor cells strongly, positively stained) correlated significantly with poor prognosis in stage II and III rectal cancer. Moreover, the expression levels of CL-1 correlated significantly with tumor differentiation and perineural invasion (p=0.037 and 0.009, respectively). However, no significant differences were detected between the expression levels of CL-1 and other clinicopathological factors. CONCLUSION: Loss of claudin-1 expression is a strong predictor of disease recurrence and poor patient survival in stage II and III rectal cancer.

Expression of IGF-1 and IGF-1R and their relation to clinicopathological factors in colorectal cancer.

BACKGROUND: Expression of insulin-like growth factor-1 (IGF-1) and IGF-1 receptor (IGF-1R) has been shown to increase in colorectal cancer. We examined the correlation between expression of IGF-1 and IGF-1R and clinicopathological factors in colorectal cancer. PATIENTS AND METHODS: A prospective study was conducted of 210 colorectal cancer patients that underwent resection from January 2002 to December 2004. The clinicopathological data was correlated to expression of IGF-1 and IGF-1R obtained from immunohistochemical analysis. Statistical analysis was carried using univariate and multivariate analysis. RESULTS: IGF1 and IGF-1R staining was positive in 169 (80%) and 139 (66%) cases, respectively. Univariate and multivariate analyses showed significant correlation between expression of IGF-1 and tumor size (p=0.0024), and depth of invasion (p=0.0147). While IGF-1R was significantly correlated to tumor size and depth of invasion in univariate analysis, only tumor size (p=0.0658) had a strong association in multivariate analysis. CONCLUSION: Expression of IGF-1 and IGF-1R seems to increase with tumor size in colorectal cancer.

Relationship between ulcerative colitis patients treated with leukocytapheresis and ulcerative colitis-associated colorectal cancer.

BACKGROUND: Leukocytapheresis (LCAP) is a recent modality for treatment of patients with ulcerative colitis (UC). This study aimed to assess whether LCAP changed the development of colorectal cancer (CRC) in patients with UC. PATIENTS AND METHODS: A total of 42 patients with UC underwent surgical treatment from January 2001 until October 2010 at Kurume University Hospital. The patient details, preoperative therapy, operative indication and complications were obtained from our prospective database. Univariate, multivariate analysis and tree model were used for statistical analysis. RESULTS: In patients who received LCAP before surgery, CRC was significantly less frequent (p=0.0321). CRC incidence following LCAP increased when the disease period from diagnosis of UC exceeded 133 months. Multivariate analysis showed that the odds for undergoing LCAP were significantly higher (p=0.0305) in those cases with a total dose of steroid more than 2.57 g. CONCLUSION: LCAP may suppress CRC in UC patients.

Clinicopathological study on poorly differentiated adenocarcinoma of the colon.

Clinicopathological characteristics and grading of poorly differentiated colon adenocarcinoma (Por) were discussed. A total of 1074 patients with colon cancer underwent surgical treatment at Kurume University Hospital in Fukuoka, between 1985 and 2005. Clinicopathological characteristics of 88 cases (8%) of Por and 986 cases (92%) of well differentiated tubular adenocarcinoma/moderately differentiated tubular adenocarcinoma (Tub1/Tub2) were studied. A multiple classification analysis showed that Por was more frequently observed in the right colon than Tub1/Tub2, and that the ratio of macroscopic types 3 and 4 was significantly higher in Por. Significant differences were also observed with regard to lymph vessel and perineural invasion. There were no significant differences between recurrence-free survivals of Por and Tub1/Tub2 after radical resection in Stages II and III. Recurrence of Por was significantly higher in peritonea and lymph nodes. These findings indicate that Por, which is generally considered to have a poor prognosis, has a similar recurrence rate to that of Tub1/Tub2 after the performance of radical surgery.

Increased claudin-1 protein expression contributes to tumorigenesis in ulcerative colitis-associated colorectal cancer.

BACKGROUND: The molecular and morphological alterations of the tight junctions in ulcerative colitis (UC)-associated colorectal cancer are still poorly understood. The possible involvement of claudin-1 (CL-1), one of the major tight junctional proteins, was investigated in the tumorigenesis of UC-associated CRC. PATIENTS AND METHODS: A total of 39 patients with UC underwent surgical treatment from January 2001 until October 2009 at Kurume University Hospital in Fukuoka. CRC tissue specimens were analyzed to determine whether the expression of CL-1 correlates with clinicopathological factors and to determine the role of CL-1 and ß-catenin in the alteration of tight junctions during tumorigenesis. RESULTS: The operations were 30 of elective surgery and 9 of emergency surgery. Colectomy was performed in five patients (12.8%) because of UC-associated CRC, and in another patient (2.6 %) because of high-grade dysplasia. The immunostaining pattern of the high-grade dysplasia and UC-associated CRC for CL-1 showed much stronger and more diffuse staining in comparison to the normal or UC colonic mucosa. The expression of ß-catenin was also positive or up-regulated in all of the UC-associated CRC and high-grade dysplasia tissue specimens. CONCLUSION: These observations suggested that CL-1 plays a pivotal role in the regulation of cellular morphology and behavior in UC. We speculate that increased CL-1 expression may be involved in the early stages of transformation in UC-associated neoplasia. CL-1 protein may therefore be a good candidate for surveillance of patients with UC.

Challenges in staging systems for colorectal cancer: clinical significance of metastatic lymph node number in colorectal cancer and mesorectal extension in rectal cancer.

In many countries, treatment for cancer is performed based on staging systems in which the degree of cancer development is defined objectively. A common staging system is thus needed to compare outcomes. The staging system for colorectal cancer in Japan has been made to enhance consistency with the TNM classification, and the categorization of metastatic lymph nodes and depth of invasion have been revised in recent years. Although these are important factors that determine disease stage, relationships between each factor and recurrence have shown differing prognoses. In our retrospective study, the prognosis of a group with only one metastatic lymph node was significantly better compared to a group with > or = 2 metastatic lymph nodes. In addition, rectal cancer with mesorectal extension >5 mm showed low relapse-free survival rates and high recurrence rates. The validity of staging systems should thus be inspected from various perspectives.