Colorectal Neoplasms ; diagnosis ; epidemiology ; Humans ; Mass Screening ; methods

Colorectal cancer (CRC) is one of the most common malignant tumors in China. In recent years, the incidence and mortality of CRC in China have been on the rise. According to the China cancer statistics report in 2018, the incidence and mortality of CRC in China ranked the third and fifth among all malignant tumors, with 376,000 new cases and 191,000 deaths. China has become the country with the highest number of new cases and deaths of CRC every year in the world, which seriously threatens the health of Chinese residents. In 2010, the National Ministry of Health organized colorectal cancer expertise of the Chinese Medical Association to write the Chinese Protocol of Diagnosis and Treatment of Colorectal Cancer (2010 edition) and publish it publicly. Since 2010, the National Health and Family Planning Commission has organized experts to revise the protocol in 2015 and 2017, while the National Health Commission revised it in 2020. The revised part of Chinese Protocol of Diagnosis and Treatment of Colorectal Cancer (2020 edition) involves new progress in the field of imaging examination, pathological evaluation, surgery, chemotherapy and radiotherapy. The 2020 edition of the protocol not only referred to the contents of the international guidelines, but also combined with the specific national conditions and clinical practice in China, and also included many evidence-based clinical data in China recently. The 2020 edition of the protocol would further promote the standardization of diagnosis and treatment of CRC in China, improve the survival and prognosis of patients, and benefit millions of CRC patients and their families.
China ; epidemiology ; Colorectal Neoplasms ; diagnosis ; epidemiology ; therapy ; Humans ; Practice Guidelines as Topic

Colorectal cancer is one of the most common malignant tumors, and its incidence and mortality are increasing year by year in China. In 2018, for the first time, the FIT-DNA test was written into the expert consensus as the recommended screening technology in China. As the core technology of colorectal cancer screening, colonoscopy for right colon cancer is further supported. With the application of artificial intelligence technology in colonoscopy, the efficiency and accuracy of screening will be greatly improved. New screening technologies represented by circulating tumor cell (CTC) and individualized screening programs based on molecular genetics are future directions. As the core of colorectal cancer treatment, surgery has become quite mature. Traditional laparoscopic surgery has become an optimal choice for colorectal cancer surgery. Open surgery, robotic surgery and single-incision laparoscopic surgery have not been found superior to multiport laparoscopic surgery. The focus of surgical research is to precisely select surgical methods, and to protect normal physiological function of patients. For example, in order to reduce complications and improve quality of life in patients undergoing rectal cancer surgery after neoadjuvant radiotherapy, the "Tianhe surgery" was invented by the authors' team. Chemotherapy as the basis of colorectal cancer treatment has shown good results in many aspects: The PRODIGE-7 trial has confirmed that systemic chemotherapy is more important for colorectal peritoneal metastasis after high quality cytoreductive surgery (CRS). While the addition of hyperthermic intraperitoneal chemotherapy (HIPEC) with oxaliplatin does not result in the better overall survival (OS), but increases the risk of postoperative complications. The FOWARC study has found that the FOLFOX regimen (oxaliplatin and fluorouracil) achieved a 3-year disease-free survival (DFS) rate similar to that of neoadjuvant chemoradiotherapy, challenging the clinical value of radiotherapy. Although several studies have confirmed that total neoadjuvant therapy (TNT) can improve pathological complete response (pCR) rate and DFS of patients with colorectal cancer, we do not recommend unretricted expansion of chemotherapy. How to combine the clinical characteristics and molecular biological markers to select high-risk groups for chemotherapy, and how to use personalized medicine according to the genetic characteristics of patients, are also hot spots of current research. Immunotherapy is a game-changer in all aspects of colorectal cancer. In order to adapt to the immune therapy, the efficacy evaluation standard of solid tumors (iRECIST) has been revised. Immune score could redefine tumor clinical staging system. Both the Checkmate-142 study for advanced tumors and the NCT03026140 study on neoadjuvant treatment for early tumors showed promising results. Although no significant progress has been seen in the EGFR-targeted therapy and VEGFR-targeted therapy, new targeted drugs such as Eltanexor (ETLA, kpt -8602) and cobimetinib (MEK inhibitor) have been found to be effective in clinical studies. According to the detection results of tumor-related signaling pathways in patients, cross-guidance selection of targeted drug therapy is also the direction of research. Although the IWWD research results give a big blow to the "watch and wait" strategy, with the exploration of TNT plan, more accurate imaging efficacy evaluation and the application of immunotherapy, the "watch and wait" strategy will also receive new attention. In recent years, we have seen the rapid development of artificial intelligence technology. Although it is still in the exploratory stage in the field of medicine, it will certainly reshape all aspects of colorectal cancer diagnosis and treatment in the future, leading the research direction.
China ; epidemiology ; Clinical Trials as Topic ; Colorectal Neoplasms ; diagnosis ; epidemiology ; therapy ; Combined Modality Therapy ; Early Detection of Cancer ; methods ; Humans

Cholecystectomy is associated with an increased risk of colorectal cancer, but little is known about the relationship between gallbladder disease and colorectal adenoma. Gallbladder polyps and colorectal neoplasia (CRN) share several risk factors such as obesity, diabetes and metabolic syndrome, which might account for their association. In this study, we investigated whether asymptomatic patients with gallbladder disease are at increased risk of CRN and identified the factors to their association. The study population consisted of 4,626 consecutive, asymptomatic individuals drawn from a prospective health check-up cohort who underwent both ultrasonography and colonoscopy screening. The prevalence of CRNs in patients with gallbladder polyps or gallstones was significantly higher than that in the control group (32.1% vs. 26.8%; P = 0.032, 35.8% vs. 26.9%; P = 0.020). A multivariate regression analysis showed that gallbladder polyps were an independent risk factor for CRN [adjusted odds ratio (OR): 1.29; 95% confidence interval (CI); 1.03-1.62] whereas gallstones were not (adjusted OR: 1.14; 95% CI: 0.79-1.63). The adjusted OR for the risk of CRN was 1.12 for gallbladder polyps < 5 mm (95% CI, 0.85-1.46) and 1.79 for gallbladder polyps > or = 5 mm (95% CI, 1.15-2.77). The prevalence of CRN increased with increasing polyp size (P trend = 0.022). Our results suggest that colorectal neoplasia is significantly related to gallbladder polyps, especially those > or = 5 mm.
Adult ; Age Distribution ; Causality ; Colorectal Neoplasms/*diagnosis/*epidemiology ; Comorbidity ; Female ; Gallbladder Diseases/*diagnosis/*epidemiology ; Humans ; Incidence ; Male ; Middle Aged ; Republic of Korea/epidemiology ; Risk Assessment ; Sex Distribution

OBJECTIVETo compare the performances of fecal occult blood quantitive testing instrument and colloidal gold strip method in colorectal cancer screening.

METHODSA representative random population of 9000 subjects aging between 40 and 74 years old were selected from Xuxiang, Haining city, Zhejiang province, by random cluster sampling method in year 2011. The fecal samples from each subject were separately detected by the two methods, namely fecal occult blood quantitive testing instrument and colloidal gold strip method. The positive result was standardized by hemoglobin concentration (HGB) ≥ 100 ng/ml under the application of quantitive testing instrument, or color-developing by colloidal gold strip method. The positive subjects from either method would be provided a further colonoscopy examination for pathological diagnosis. The positive rate and consistency of the two methods were compared, as well as the positive predictive value and population detecting rate of the colorectal cancer and adenoma.

RESULTSA total of 6475 (71.9%) subjects submitted their two fecal samples according to our requirement in 9000 subjects. There were separately 319 positive cases (4.9%) and 146 positive cases (2.3%) by the performances of fecal occult blood quantitive testing instrument and colloidal gold strip method, including 45 positive in both tests (Kappa = 0.168, 95%CI:0.119-0.217).184 out of the 319 positive cases (57.7%) in the test by quantitive testing instrument and 89 out of 146 positive cases (61.0%) in the test by colloidal gold strip method received the colonoscopy examination. There were no significant statistical differences between the two methods in the positive predictive value of colorectal cancer (P > 0.05) , developing adenoma and non-developing adenoma.However, the population detecting rate of the colorectal cancer and developing adenoma were higher in the test by quantitive testing instrument (26 cases, 0.402%) than it in the test by colloidal gold strip method (10 cases, 0.154%). The difference showed statistical significance (χ(2) = 7.131, P < 0.01).

CONCLUSIONThe performances of fecal occult blood quantitive testing instrument might be better than colloidal gold strip method in colorectal cancer screening. However, the results need to be further verified.

Adenoma ; diagnosis ; epidemiology ; prevention & control ; Adult ; Aged ; China ; epidemiology ; Colorectal Neoplasms ; diagnosis ; epidemiology ; prevention & control ; Feces ; Female ; Humans ; Male ; Mass Screening ; methods ; Middle Aged ; Occult Blood

OBJECTIVETo introduce the concept, methods for calculation and application of "number needed to be screened" (NNBS) in epidemiologic studies.

METHODSThe concept of "number needed to treat" (NNT) was extended for disease screening strategies. For the purpose of illustration, the values of number needed to invite for screening (NNI) and number needed to be screened (NNBS) were calculated on the basis of the results from two randomized controlled screening trials--Nottingham randomized controlled trial of faecal-occult-blood screening for colorectal cancer and Swedish mammographic screening trial for breast cancer in two counties.

RESULTSIn order to prevent one death from the colorectal cancer among local people aged from 45 to 74 during the 14 years of follow-up, the NNI and NNBS for faecal-occult-blood screening program were 1220 and 665, respectively. In addition, in order to prevent one death from breast cancer among local women aged 40-74 during 8 years of follow-up, the NNI and NNBS for mammographic screening program were 1961 and 1494, respectively.

CONCLUSIONCompared with the traditional indices, NNBS can evaluate the overall effectiveness of a screening program in an intuitively understandable manner so as to facilitate the communication among medical researchers, health workers, health policy makers and the public.

Breast Neoplasms ; diagnosis ; epidemiology ; prevention & control ; Colorectal Neoplasms ; diagnosis ; epidemiology ; prevention & control ; Epidemiologic Studies ; Humans ; Mass Screening ; statistics & numerical data ; Sample Size

OBJECTIVETo explore the prevalence, clinical features and prognosis of multiple primary neoplasms in patients with colorectal carcinoma (CRC).

METHODSData of colorectal cancer patients admitted to our hospital from June 1994 to June 2002 were analyzed retrospectively. Patients were divided into multiple-cancer group (MCG) and single- cancer group (SCG). Clinical features and prognosis were compared between two groups.

RESULTSThe incidence of multiple cancers was 7.4 % (83/ 1125). Forty- seven patients had multiple colorectal cancers metachronous CRC(S) in 12 and synchronous CRC(S) in 35. Thirty- six patients 5 patients with synchronous cancers had malignant tumors outside colorectal tract,12 of whom were gastric carcinomas. No significant differences were found between MCG and SCG regarding gender, onset age, Dukes stage and differentiation of index CRC. Cancer family history (P=0.002) and colorectal adenoma (P=0.036) were significantly more common in MCG than those in SCG. The local recurrence or distant metastasis in MCG was significantly higher than that in SCG (P=0.047), though there was no significant difference in survival between the two groups. Forty- one percent of index tumors were located in right colon in MCG, significantly higher than that in SCG (P=0.048). The secondary tumors were mainly adenoma cancerization in MCG.

CONCLUSIONCancer family history and colorectal adenoma seems to be at high risk for developing multiple cancers in CRC patients. Gastric cancer and colorectal adenoma cancerization were common secondary tumors of multiple primary neoplasms in patients with colorectal carcinoma.

Adenomatous Polyps ; genetics ; Adult ; Aged ; Colorectal Neoplasms ; diagnosis ; epidemiology ; pathology ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Neoplasms, Multiple Primary ; diagnosis ; epidemiology ; pathology ; Prognosis ; Retrospective Studies ; Risk Factors

BACKGROUNDColorectal serrated polyp is considered as histologically heterogeneous lesions with malignant potential in western countries. However, few Asian studies have investigated the comprehensive clinical features of serrated polyps in symptomatic populations. The aim of the study was to evaluate the features of colorectal serrated polyps in a Chinese symptomatic population.

METHODSData from all consecutive symptomatic patients were documented from a large colonoscopy database and were analyzed. Chi-square test or Fisher's exact test and logistic regression analysis were used for the data processing.

RESULTSA total of 9191 (31.7%) patients were detected with at least one colorectal polyp. The prevalence of serrated polyps was 0.53% (153/28,981). The proportions of hyperplastic polyp (HP), sessile serrated adenoma/polyp (SSA/P), and traditional serrated adenoma (TSA) of all serrated polyps were 41.2%, 7.2%, and 51.6%, respectively, which showed a lower proportion of HP and SSA/P and a higher proportion of TSA. Serrated polyps appeared more in males and elder patients while there was no significant difference in the subtype distribution in gender and age. The proportions of large and proximal serrated polyps were 13.7% (21/153) and 46.4% (71/153), respectively. In total, 98.9% (89/90) serrated adenomas were found with dysplasia. Moreover, 14 patients with serrated polyps were found with synchronous advanced colorectal neoplasia, and large serrated polyps (LSPs) (odds ratio: 3.446, 95% confidence interval: 1.010-11.750, P < 0.05), especially large HPs, might have an association with synchronous advanced neoplasia (AN).

CONCLUSIONSThe overall detection rate of colorectal serrated polyps in Chinese symptomatic patient population was low, and distribution pattern of three subtypes is different from previous reports. Moreover, LSPs, especially large HPs, might be associated with an increased risk of synchronous AN.

Adult ; Age Distribution ; Aged ; Chi-Square Distribution ; Colonic Neoplasms ; diagnosis ; epidemiology ; Colonoscopy ; Colorectal Neoplasms ; diagnosis ; epidemiology ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Prevalence

Gender difference in the incidence of colorectal cancer is well known and has been supported by various epidemiologic studies. In Korea, women have lower incidence of colorectal cancer and adenoma, and the incidence in men has recently increased. Hormone replacement therapy in menopausal women is preventive of colorectal cancer but can cause cardiovascular diseases and breast cancer. Estrogen exerts diverse effects through estrogen receptors, ERalpha and ERbeta. ERbeta is associated with anti-proliferation and apoptosis. The ratio of ERalpha/ERbeta is important in the protection and tumorigenesis of colorectal cancer. Therefore ERbeta modulation has been investigated for preventing or treating colorectal cancer and avoiding adverse effects of estrogen at the same time. In addition, the gender-difference in the incidence of colorectal cancer should be taken into account when making guidelines on colorectal surveillance for Korean population.
Adenoma/diagnosis/epidemiology/mortality ; Colorectal Neoplasms/*diagnosis/epidemiology/mortality ; Estradiol Dehydrogenases/metabolism ; Estrogen Receptor alpha/metabolism ; Estrogen Receptor beta/metabolism ; Estrogens/*metabolism ; Humans ; Sex Factors

Robust identification of genetic alterations is important for the diagnosis and subsequent treatment of tumors. Screening for genetic alterations using tumor tissue samples may lead to biased interpretations because of the heterogeneous nature of the tumor mass. Liquid biopsy has been suggested as an attractive tool for the non-invasive follow-up of cancer treatment outcomes. In this study, we aimed to verify whether the mutations identified in primary tumor tissue samples could be consistently detected in plasma cell–free DNA (cfDNA) by digital polymerase chain reaction (dPCR). We first examined the genetic alteration profiles of three colorectal cancer (CRC) tissue samples by targeted next-generation sequencing (NGS) and identified 11 non-silent amino acid changes across six cancer-related genes (APC, KRAS, TP53, TERT, ARIDIA, and BRCA1). All three samples had KRAS mutations (G12V, G12C, and G13D), which were well-known driver events. Therefore, we examined the KRAS mutations by dPCR. When we examined the three KRAS mutations by dPCR using tumor tissue samples, all of them were consistently detected and the variant allele frequencies (VAFs) of the mutations were almost identical between targeted NGS and dPCR. When we examined the KRAS mutations using the plasma cfDNA of the three CRC patients by dPCR, all three mutations were consistently identified. However, the VAFs were lower (range, 0.166% to 2.638%) than those obtained using the CRC tissue samples. In conclusion, we confirmed that the KRAS mutations identified from CRC tumor tissue samples were consistently detected in the plasma cfDNA of the three CRC patients by dPCR.
Bias (Epidemiology) ; Biopsy ; Colorectal Neoplasms ; Diagnosis ; DNA ; Follow-Up Studies ; Gene Frequency ; Humans ; Mass Screening ; Plasma ; Polymerase Chain Reaction