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Evaluation of primary rectal cancer specimens places the pathologist in a unique position relative to peers, as it is one of the few specimens where the report influences not just patient outcomes but also the quality of the surgical technique itself. With ever-increasing data indicating that the completeness of the mesorectal excision and adequate resection margins are critical for reduced local recurrence rates and improved clinical outcome, the pathologist is faced with the challenge of implementing methods to optimize the evaluation of primary rectal cancers.

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Patólogos , Neoplasias del Recto/patología , Neoplasias del Recto/cirugía , Humanos , Recurrencia Local de Neoplasia , Estadificación de Neoplasias

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BACKGROUND: Survival rates from colorectal cancer (CRC) are highly variable in Europe. This variability could potentially be explained by differences in healthcare system delays in diagnosis. However, even when such delays are reduced, the relationship of the diagnostic interval (time from presentation with symptoms to diagnosis) with outcome is uncertain. METHODS: A total of 795 patients with CRC from 5 regions of Spain were retrospectively examined in this population-based multicenter study. Consecutive incident cases of CRC were identified from pathology services. The total diagnostic interval (TDI) was defined as the time from the first presentation with symptoms to diagnosis based on 3 different sources of information: (i) patient-recorded data (PR-TDI) by interview, (ii) hospital-recorded data (HR-TDI), and (iii) general practitioner-recorded data (GPR-TDI). Concordance correlation coefficients (CCCs) were used to estimate the agreement of 3 different TDIs. The TDIs of patients with different stages of CRC were also compared using the Kruskal-Wallis test. RESULTS: The median TDI was 131days based on patient interview data, 91days based on HR data, and 111days based on GPR data. Overall, the agreement of these TDIs was poor (CCCPRvsHR=0.399, CCCPRvsGPR=0.518, CCCHRvsGPR=0.383). Univariate analysis indicated that the TDI was greater in those with less advanced CRC for all 3 methods of calculation, but this association was only statistically significant for the HR-TDI (p=0.021). CONCLUSION: There is no evidence that patients with more advanced CRC have longer TDIs. In fact, we found an inverse relationship between the TDI and CRC stage, an example of the "waiting time paradox". This association may likely be due to the presence of unmeasured confounders as the stage when symptoms appear or the tumour aggressiveness.

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Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/mortalidad , Diagnóstico Tardío , Estadificación de Neoplasias , Anciano , Neoplasias Colorrectales/epidemiología , Atención a la Salud , Femenino , Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , España/epidemiología , Tasa de Supervivencia , Factores de Tiempo

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Objective To investigate the expression pattern of carbonic anhydrase 1 (CA1) in different clinical stages of color ectal cancers and the correlation between CA1 expression and pathologic characteristics of colorectal cancer.Methods The expression of CA1 in genetic level was detected by real-time quantitative polymerase chain reaction (PCR) and the expression of CA1 in protein level was detected by Western blot and immunohistochemical staining.Results The expression pattern of CA1 in the protein level was very similar to the genetic level.It had a very low expression level in carcinoma tissue,especially at stages Ⅲ and Ⅳ (P ＜0.01),CA1 had significantly lower expression level in the colorectal patients with metastasis (P ＜0.01).CA1 was gradually decreased from well-differentiation tissue to poorly-differentiation tissue with a significant difference between well-differentiated adenocarcinoma and poorly-differentiated adenocarcinoma (P ＜ 0.01).Kaplan-Meier survival analysis showed that the expression of CA1 was extremely related to colorectal carcinoma (CRC) prognosis.The 5-year survival rate was only 8％ in the CA1 negative expression group,and the 5-year survival rate of the patients with CA1 positive expression was 92.86％ (P ＜ 0.01).Conclusions CA1 had the similar expression patterns at genetic and protein levels.In the colorectal cancer tissue,the expression of CA1 was downregulated and even missing.CA1 had significantly lower expression level in the advanced colorectal cancers with metastasis and poorly differentiated colorectal cancer tissues.The patients with lower CA1 expression level had the worse prognosis.

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Objective To investigate the expressions of signal transducer and activator of transcription factor 3 (STAT3),Bcl-2,and matrix metalloproteinase 2 (MMP2) in colorectal adenomas and adenocarcinomas,and the relationship of those factors with the colorectal clinicopathological features and prognosis of intestinal adenocarcinomas,and explore their roles in invasion,metastasis,and prognosis of a colorectal cancer.Methods The samples were selected from Dongyang City People's Hospital from January 2011 to January 2012,including 50 cases of paraffin-coded colorectal mucosas with chronic inflammation,50 cases of paraffincoded colorectal adenomas,and 100 cases of paraffin-coded colorectal adenocarcinomas (35 cases with metastasis and 65 cases without distant metastasis).Envison two method was used to detect the expressions of STAT3,Bcl-2,and MMP2 in each sample.Results The expressions of STAT3,Bcl-2,and MMP2 in colorectal adenomas and adenocarcinomas were significantly higher than those in colorectal mucosas with chronic inflammation (P ＜ 0.05).The expressions of STAT3 and MMP2 in colorectal adenocarcinomas with distant metastasis were significantly higher than that those without distant metastasis (P ＜ 0.05).The expression of BCL-2 had no significant difference between colorectal adenocarcinomas with and without distant metastasis (P ＞ 0.05).Conclusions STAT3,Bcl-2 and MMP2 were associated with occurrence and development of colorectal carcinoma.STAT3 was associated with distant metastasis of colorectal carcinoma and might indicate a poor prognosis.STAT3 might be used as a candidate clinical sign for recurrence,metastasis,and poor survival prognosis of colorectal adenocarcinoma.

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Objective To evaluate the expression of Yes-associated protein (YAP) in colorectal carcinoma and analyze its influence on tumor cell proliferation.Methods The expressions of YAP in 94paired colorectal carcinomas and pericancerous normal tissues were detected by using immunohistochemistry method.The expressions of YAP in colorectal carcinoma cell line HCT116 were inhibited with a YAP-spe-cific siRNA.Cell proliferation was then determined by methyl thiazolyl diphenyl-tetrazolium bromide (MTT) assay.Results The positive rate of YAP in colorectal carcinomas was significantly higher than that in pericancerous normal tissues [69.1％ (65/94) vs 22.3 ％ (21/94),P ＜ 0.001].The expression of YAP was associated with tumor Node Metastasis(TNM) stage and lymph node metastasis(P ＜0.05),but not associated with gender,age,tumor location and histological grade(P ＞0.05).After YAP-specific siR-NA was transfected into HCT116 using lipofectamine,the expression of YAP mRNA and protein in the experimental group were reduced by (78.2 ±2.1)％ and (81.7 ± 1.5)％,respectively,with a statistically significant difference (t =67.55,91.601,P ＜0.01).The growth of HCT116 was significantly inhibited and the reduced rate of cell proliferation was (28.1 ± 1.6) ％,(34.7 ± 2.4) ％ and (24.7 ± 1.2) ％ at the time point of 48 h,72 h and 96 h,respectively.Conclusions Expression of YAP was upregulated in colorectal carcinomas and downregulation of YAP expression could inhibit growth of colorectal carcinoma cells.YAP can be used as a new candidate target for diagnosis and treatment of a colorectal carcinoma.

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(0.05)). Multivariate analysis revealed that adjuvant radiotherapy and histology of tumor significantly affected the prognosis(P=(0.045) and P=(0.009), respectively). Whereas loco-regional control was only significantly affected by adjuvant radiotherapy(P=(0.000)). CONCLUSION: Adjuvant radiotherapy and histology of tumor are the important prognostic factors in the rectal cancer patients after treatment with multimodality therapy based on surgery.

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Objective To investigate the expression and clinical significance of ?-catenin and COX-2 in human colorectal carcinoma. Methods [WTBZ]The expression of ?-catenin and COX-2 in 153 colorectal tissue specimens was examined by immunohistochemical technique, and their clinical significance and correlation were statistically analyzed. Results In colorectal adenocarcinoma, the loss of ?-catenin in the cytomembrane was significantly correlated with the differentiated degree, lymph node metastasis and Dukes' stages, while COX-2 overexpression was associated with the Dukes' stages,lymph node metastasis and infiltrating depth. The ectopic expression of ?-catenin was not associated with the COX-2 overexpression. [WTHZ] Conclusion COX-2 and ?-catenin may play a role in the pathogenesis of colorectal adenocarcinoma. The ectopic expression of ?-catenin may be not the main reason of the COX-2 overexpression in colorectal adenocarcinoma. Detection of ?-catenin and COX-2 expression may be helpful for Dukes' staging and evaluating the risk of lymph node metastasis in colorectal adenocarcinoma.

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AIM: To evaluate the clinical significance of endocrine-like tumor cells in human colorectal carcinomas. METHODS: The immunohistochemistry method (ABC) using a rabbit polyclonal antibody against human chromogranin A (CGA) was employed to determine changes in endocrine-like tumor cells from the surgically resected colorectal carcinoma tissues of patients (35 males and 27 females, aged from 19 to 78 years, with a mean age of 50.3 years). Of the 62 specimens, 44 were from rectal carcinomas, 18 from colonic carcinomas, 14 from lymph nodes and 48 from non-involvement. Dukes classification revealed 19 of the cases were in stage A, 29 cases were in stage B and 14 cases were in stage C. All of the specimens were fixed with 10% formalin, embedded with paraffin and cut into 5 µm sections. Additionally, the correlations among CGA-positive tumor cells, as well as the clinicopathologic data, age and sex of the patients, were also investigated. RESULTS: CGA-positive tumor cells were found in 35.5% of the patients with colorectal cancers, representing 20.0% (5 of 25) and 45.9% (17 of 37) of the aged and non-aged, respectively. These differences were significant (χ(2) test, P < 0.05). Nevertheless, no significant correlations were found between the CGA-positive tumor cells and the sex, Dukes stages, tumor location, degree of histological differentiation or presence of lymph node metastasis. CONCLUSION: The low incidence of endocrine-like tumor cells found in the aged patients may be a new pathological feature for colorectal carcinomas, which could explain why the aged patients usually had a better prognosis. The exact significance of these findings requires further characterization.