Precision medicine is to customize the treatment options for individual patient based on the personal genome information. Colorectal cancer (CRC) is one of the most common cancer worldwide. Molecular heterogeneity of CRC, which includes the MSI phenotype, hypermutation phenotype, and their relationship with clinical preferences, is believed to be one of the main factors responsible for the considerable variability in treatment response. The development of powerful next-generation sequencing (NGS) technologies allows us to further understand the biological behavior of colorectal cancer, and to analyze the prognosis and chemotherapeutic drug reactions by molecular diagnostic techniques, which can guide the clinical treatment. This paper will introduce the new findings in this field. Meanwhile we integrate the new progress of key pathways including EGFR, RAS, PI3K/AKT and VEGF, and the experience in selective patients through associated molecular diagnostic screening who gain better efficacy after target therapy. The technique for detecting circulating tumor DNA (ctDNA) is introduced here as well, which can identify patients with high risk for recurrence, and demonstrate the risk of chemotherapy resistance. Mechanism of tumor drug resistance may be revealed by dynamic observation of gene alteration during treatment.
Colorectal Neoplasms ; Drug Resistance, Neoplasm ; Humans ; Molecular Diagnostic Techniques ; Mutation ; Patient Selection ; Phenotype ; Phosphatidylinositol 3-Kinases ; Precision Medicine ; Prognosis ; Recurrence

With the development of tumor molecular diagnosis and the administration of targeted drugs, cancer treatment has gradually entered a new era of precision medicine. The diagnosis and treatment of gastrointestinal stromal tumor (GIST) is a full embodiment of the concept of precision medicine, but there are still many problems needed to be solved in the clinical diagnosis and treatment of GIST (such as the correlation between the gene mutation and prognosis, the treatment strategy of wild type GIST and the drug resistance phenomenon).
Evidence-Based Medicine ; Gastrointestinal Neoplasms ; Gastrointestinal Stromal Tumors ; Humans ; Mutation ; Precision Medicine ; Prognosis

The development of evidence-based medicince should be an important milestone from the empirical medicine to the evidence-driving modern medicine. With the outbreak in biomedical data, the rising big data analysis can efficiently solve exploratory questions or decision-making issues in biomedicine and healthcare activities. The current problem in China is that big data analysis is still not well conducted and applied to deal with problems such as clinical decision-making, public health policy, and should not be a debate whether big data analysis can replace evidence-based medicine or not. Therefore, we should clearly understand, no matter whether evidence-based medicine or big data analysis, the most critical infrastructure must be the substantial work in the design, constructure and collection of original database in China.
China ; Decision Making ; Evidence-Based Medicine ; Humans

China has entered a period of high incidence of colorectal cancer. The year of 2015 is the start of precision medicine. Colorectal cancer "precision medicine" is based on the analysis of the cancer genome sequencing and information analysis, interprets the mechanism of the occurrence, development, invasion, metastasis and recurrence of colorectal cancer, and helps to implement targeted individual treatment. The experts of the world's Colorectal Cancer Subtyping Consortium, integrated the past genetic testing based on the classification of colorectal cancer subtypes, refered to the indices of gene mutation, copy number, methylation, microRNA and proteomics, and coalesce the types of colorectal cancer into four consensus molecular subtypes(CMSs) with distinguishing features. CMSs may be the most powerful classification system of colorectal cancer because of its clear biological interpretation, and is expected to provide a reference basis for the establishment of clinical precision treatment system.
China ; Colorectal Neoplasms ; Humans ; Mutation ; Precision Medicine ; Proteomics ; Recurrence

Crohn's disease (CD) is a chronic inflammatory disorder affecting any part of the digestive tract which relapses and remits throughout the disease course. It occurs in individuals with genetic susceptibility and involves an abnormal response of the immune system to the external environment. Besides, improved hygiene, abuse of antibiotics, westernization of diet with high sugar and fat are thought to be associated with rapidly increasing incidence of CD. Certain components of foods may influence gut inflammation through antigen presentation and alteration of the microflora. This article aims mainly to review diet-related clinical studies to outline its roles in the pathogenesis and progress of disease, and then give some evidence-based suggestions.
Crohn Disease ; Diet ; Genetic Predisposition to Disease ; Humans

The understanding of rectoanal inhibitory reflex (RAIR) is progressing for the latest 100 years. From the discovery of its important role in diagnosis of Hirschsprung's disease to all aspects of its development, reflex pathways, neural regulation and physiological functions, there have been more in-depth explorations. It is now recognized that a number of other diseases also have a more specific performance of RAIR. It has become an important and indispensable part to anorectal manometry. Research progress of rectoanal inhibitory reflex is reviewed in this article.
Hirschsprung Disease ; Humans ; Physical Examination ; Rectum ; Reflex

OBJECTIVETo analyze the impact of platelet count on the prognosis of stage II-III colorectal cancer receiving adjuvant chemotherapy.

METHODSClinical and follow-up data of 286 patients with stage II-III colorectal cancer receiving adjuvant FOLFOX chemotherapy from March 2003 to October 2011 were analyzed retrospectively. Associations of baseline blood platelet count before chemotherapy and nadir blood platelet count during chemotherapy with relapse and death after adjuvant chemotherapy were analyzed by ROC curve and the optimal cutoff was selected. The association of the blood platelet count and the prognosis was analyzed by Kaplan-Meier and Cox regression model.

RESULTSROC curve showed the baseline blood platelet count was associated with recurrence (AUC=0.588, P=0.034). The optimal cutoff affecting recurrence was 276×10(9)/L. Kaplan-Meier showed those with baseline platelet count >276×10(9)/L receiving adjuvant chemotherapy had worse disease free survival (DFS) than those with baseline platelet count ≤276×10(9)/L, whose 5-year disease free survival(DFS) was 66% and 80% respectively (P=0.013). Cox regression analysis revealed baseline platelet count >276×10(9)/L was an independent unfavorable factor for DFS of adjuvant chemotherapy in colorectal cancer (HR=1.865, 95% CI: 1.108-3.141, P=0.019).

CONCLUSIONColorectal cancer patients receiving adjuvant chemotherapy with baseline platelet count >276×10(9)/L have worse prognosis.

Antineoplastic Combined Chemotherapy Protocols ; Chemotherapy, Adjuvant ; Colonic Neoplasms ; Colorectal Neoplasms ; Disease-Free Survival ; Fluorouracil ; Humans ; Leucovorin ; Neoplasm Staging ; Organoplatinum Compounds ; Platelet Count ; Prognosis ; Recurrence ; Retrospective Studies

OBJECTIVETo investigate the impact of preoperative oral liquid carbohydrate on postoperative insulin resistance (IR) in gastric cancer patients undergoing elective resection, and to examine the association of IR index (homeostasis model assessment, HOMA-IR) with tumor necrosis factor-α (TNF-α).

METHODSBetween January 2013 and September 2013, 35 patients undergoing elective resection for gastric cancer were prospectively enrolled and randomized into two groups. Patients in trial group (n=18) received oral 500 ml of 10% glucose solution two hours before surgery. Patients in control group (n=17) were asked to fast for 8-12 hours before operation. About 300 mg of rectus abdominis and subcutaneous fatty tissues was removed before the closure of abdominal wall. Blood samples were collected to measure the serum concentration of TNF-α with double antibody sandwich ELISA in perioperative period (3-hour before operation, end of operation, 1-day and 3-day after operation). HOMA-IR was calculated on preoperative 3-hour and postoperative 1-day. Western blotting was used to detect protein expression of TNF-α. Correlation of HOMA-IR with TNF-α was examined.

RESULTSHOMA-IR on the first day after surgery was not different from that at 3-hour before surgery in trial group (P=0.090), which was significantly lower than that in control group (P=0.000). In trial group, serum TNF-α at the end of operation was higher than that at 3-hour before surgery, which declined rapidly on the first day after surgery and had no significant difference compared with that on the third day after surgery. In control group, serum TNF-α at the end of operation was also higher than that before surgery, which rose to the peak on the first day after surgery and was still higher than that at 3-hour before surgery. The TNF-α protein expression in muscle tissues of trial group was higher than that of control group (P=0.001), while no significant difference was observed between two groups in adipose tissues (P=0.987). Correlation analysis showed that HOMA-IR was positively correlated with TNF-α on the first day after surgery (r=0.832, P=0.000).

CONCLUSIONOral intake of liquid carbohydrate 2 hours before surgery can reduce the level of TNF-α, which is likely to improve the postoperative insulin resistance.

Carbohydrates ; Fasting ; Humans ; Insulin Resistance ; Postoperative Period ; Prospective Studies ; Stomach Neoplasms ; Tumor Necrosis Factor-alpha

OBJECTIVETo discuss the clinical characteristics of remnant gastric cancer (RGC).

METHODSClinical data of 163 patients with RGC admitted to our department from January 2005 to January 2015 were collected and reviewed.

RESULTSThe time duration of all the RGC patients between primary gastrectomy and occurrence of RGC ranged from 9 to 46 years (median 27.5 years). Among 163 patients, 112(68.7%) patients manifested as discomfort in the upper abdominal region, 47(28.8%) patients had hematemesis and melena, 38(23.3%) had vomiting, 17(10.4%) had swallowing difficulty and 12 (7.4%) had decreased weights. In pathology, 127 (77.9%) cases were median or low grade adenocarcinoma; 114(69.8%) patients were Borrmann type III( gastric cancer under endoscope; 145 (88.9%) patients were TNM III(-IIII( gastric cancer. A total of 106 patients underwent operation, including 75(70.8%) patients of radical resection and 31(29.3%) patients of palliative resection. Patients mainly received Billroth II( anastomosis (77.4%) as digestive tract reconstruction, while 57 cases did not receive surgical operation. The overall 1-, 3-, and 5-year survival rates of the patients were 76.1%, 43.4%, 25.8% respectively. The median survival time of patients receiving radical resection and those receiving palliative resection was 34.6 months and 16.4 months respectively, whereas patients who did not receive surgical operation died 3-8 months after initial diagnosis.

CONCLUSIONSRegular gastroscopy is necessary for patients undergoing gastrectomy for over 10 years. Radical resection is of great importance in the treatment of remnant gastric cancer.

Adenocarcinoma ; Adolescent ; Adult ; Child ; Deglutition Disorders ; Gastrectomy ; Gastric Stump ; Gastroenterostomy ; Gastroscopy ; Humans ; Middle Aged ; Reconstructive Surgical Procedures ; Stomach Neoplasms ; Young Adult

OBJECTIVETo investigate the differences of clinicopathological features and prognosis in patients with advanced gastric cancer in different locations after radical gastrectomy, and to provide optimized therapies.

METHODSClinicopathological data of 421 patients with advanced gastric cancer undergoing radical gastrectomy in our department from January to December 2011 were analyzed retrospectively. Patients were divided into 3 groups according to cancer locations, including 48 cases of upper gastric cancer, 74 cases of middle gastric cancer and 299 cases of lower gastric cancer. Clinicopathological features and prognosis were compared among groups.

RESULTSThere were significant differences among 3 groups in lesion size(P=0.001), subtypes(P=0.033), pT classification(P=0.010), TNM staging(P=0.019) and lymph node metastasis (P=0.000). Ratio of lesion size >5 cm, and T4, N3, stage III( patients was significantly higher in upper gastric cancer group as compared to middle and lower group (all P<0.05). The survival curves showed that the general prognosis of upper gastric cancer group was worse than that of middle and lower gastric cancer group (P<0.05), while no significant difference was found between middle and lower gastric cancer group (P=0.027). Multivariate analysis revealed that depth of invasion (P=0.034, HR=1.918) was independent prognostic factor of advanced upper gastric cancer, lymph node metastasis (P=0.022, HR=1.406) was independent prognostic factor of advanced middle gastric cancer, and depth of invasion (P=0.022, HR=1.359) and lymph node metastasis (P=0.000, HR=1.519) were independent prognostic factors of advanced lower gastric cancer.

CONCLUSIONAs compared to advanced middle and lower gastric cancer, advanced upper gastric cancer possesses bigger cancer lesion, deeper depth of invasion, easier metastasis of lymph nodes, later TNM staging, and worse prognosis.

Gastrectomy ; Humans ; Lymphatic Metastasis ; Multivariate Analysis ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Stomach Neoplasms