The incidence and mortality of colorectal cancer significantly increase among the elderly population.However, prospective clinical trials specifically targeting elderly patients with colorectal cancer remain scarce.Consequently, there is limited evidence-based guidance for oncologists to rely on when formulating diagnostic and therapeutic strategies for this demographic.This review aims to provide a comprehensive evaluation of the overall management, treatment, and follow-up strategies for elderly patients with colorectal cancer, offering a theoretical basis for enhancing the prevention and treatment of this disease in older adults.

The incidence and mortality of colorectal cancer significantly increase among the elderly population.However, prospective clinical trials specifically targeting elderly patients with colorectal cancer remain scarce.Consequently, there is limited evidence-based guidance for oncologists to rely on when formulating diagnostic and therapeutic strategies for this demographic.This review aims to provide a comprehensive evaluation of the overall management, treatment, and follow-up strategies for elderly patients with colorectal cancer, offering a theoretical basis for enhancing the prevention and treatment of this disease in older adults.

Objective:To investigate the relationship between sarcopenia and the long-term prognosis of elderly patients with locally advanced colorectal cancer.Methods:A retrospective analysis was conducted on clinical data from 205 elderly colorectal cancer patients aged 70 years and above who underwent radical resection with TNM staging of stage Ⅱ to Ⅲ at Beijing Hospital between January 2014 and December 2018.The study utilized abdominal CT scans taken within 30 days before surgery to measure the skeletal muscle area(SMA)of the 3rd lumbar vertebrae cross-section.Sarcopenia was defined as a skeletal muscle index(SMI) of ≤52.4 cm 2/m 2 in men and ≤38.5 cm 2/m 2 in women(SMI=SMA/height 2).A comparison was made between the clinical and pathological conditions of patients with and without sarcopenia in the two groups, with an analysis of the impact of sarcopenia on the long-term prognosis of elderly postoperative colorectal cancer patients. Results:Among the 205 patients assessed, 63.4%(130/205)were diagnosed with sarcopenia.The group with sarcopenia had a higher percentage of individuals aged 80 years and older( χ2=6.420, P=0.011)compared to those without sarcopenia.Additionally, this group had a lower proportion of overweight or obese patients( χ2=9.366, P=0.009), fewer patients who underwent adjuvant chemotherapy, and a lower 5-year disease-free survival rate post-surgery( χ2=6.257, 7.347, P=0.012, 0.007).Kaplan-Meier analysis indicated that disease-free survival rate was better in elderly patients with locally advanced colorectal cancer who did not have sarcopenia compared to those with sarcopenia(Log-rank χ2=6.919, P=0.009).Moreover, in elderly patients without sarcopenia, those who received adjuvant chemotherapy had a more favorable disease-free survival outcome than those who did not receive such treatment(Log-rank χ2=4.745, P=0.029).Multifactorial Cox regression analysis showed that TNM stage Ⅲ( HR=1.634, 95% CI: 1.110-2.404, P=0.013)and the presence of sarcopenia( HR=1.509, 95% CI: 1.017-2.238, P=0.041)were significant factors influencing the poor long-term prognosis of elderly patients with locally advanced colorectal cancer. Conclusions:Sarcopenia is associated with aging and body mass index, and has been found to be a significant factor in the long-term prognosis of elderly colorectal cancer patients.Those with sarcopenia tend to have a poorer prognosis, while those without may experience benefits from adjuvant chemotherapy.

Objective:To construct a classification and regression tree which can be used to guide the tracheostomy for traumatic cervical spinal cord injury (TCSCI) based on the identification of the risk factors for TCSCI.Methods:The 498 patients with TCSCI were retrospectively analyzed who had been treated at Department of Orthopedics, The Second Hospital Affiliated to Army Medical University from January 2009 to December 2018. There were 403 males and 86 females, with an age of (50.2±13.6) years. Of the patients, 69 received tracheostomy and 420 did not. The gender, age, smoking history, injury cause, neurological level of injury (NLI), American Spinal Cord Injury Association (ASIA) grade, injury severity score (ISS), thoracic injuries, prior pulmonary diseases, prior basic diseases, and operative approaches of the patients were statistically analyzed by single factor analysis. After the independent risk factors for tracheostomy were analyzed by binary logistic regression, the classification and regression tree was developed which could be used to guide the tracheostomy.Results:The logistic regression analysis showed age>50 years ( OR=4.744, 95% CI: 1.802 to 12.493, P=0.002), NLI at C 4 and above ( OR=23.662, 95% CI: 8.449 to 66.268, P<0.001), ASIA grade A ( OR=40.007, 95% CI: 12.992 to 123.193, P<0.001), and ISS score>16 ( OR=10.502, 95% CI: 3.909 to 28.211, P<0.001) were the independent risk factors for the tracheotomy. The classification and regression tree revealed that ASIA grade A and NLI at C 4 and above were the first and second decision nodes, which had a strong predictive effect on tracheostomy. 86.84% of the patients with ASIA grade A and NLI at C 4 and above underwent tracheostomy. Conclusion:Our classification and regression tree shows that NLI at C 4 and above and ASIA grade A have a strong guiding effect on tracheotomy for TCSCI.

Objective:To explore the application value of three-dimensional visualization technique based on CT data in the analysis of renal vascular anatomical variation.Methods:The clinical data of 210 patients with renal tumors, adrenal tumors and renal cysts who underwent renal enhanced CT from October 2020 to June 2021 were retrospectively analyzed. Among the patients, there were 114 males and 96 females with an average age of (56.5±13.2) years. The CT data were reconstructed by 3D slicer software. According to the three-dimensional visualization model, the renal vascular anatomy was analyzed from the perspective of whether it needs to be treated during laparoscopic radical nephrectomy and laparoscopic partial nephrectomy. The variation of renal artery can be divided into multiple renal arteries, premature branches of renal artery and the mixed type with the above two variations. Renal vein variation can be divided into multiple renal veins, late confluence of renal veins and mixed type with the above two variations.Results:Among the 210 patients in this study, there were no statistically significant differences in anatomical variations of renal arteries and veins between males and females ( P=0.914 and P=0.121). Among 420 kidneys, renal artery variation (174/420, 41.4%) was more common than renal vein variation (121/420, 28.8%) ( P<0.01). 32 (7.6%) right kidneys and 38 (9.0%) left kidneys have multiple renal arteries ( P=0.432). Eighty-nine cases (42.4%) had premature branches in the right renal artery, while 37 cases (17.6%) in the left kidney ( P<0.01). 24 kidneys (5.7%) showed mixed renal artery variation. 53 (12.6%) right kidneys and 3 (0.7%) left kidneys had multiple renal veins ( P<0.01). Late confluence of renal veins was found in 41 right kidneys (9.8%) and 33 left kidneys (7.9%), respectively ( P=0.306). 8 (1.9%) mixed renal vein variants were all right kidneys.. From the perspective of laparoscopic renal surgery, there were 71 cases (33.8%) of the left kidney to deal with ≥ 2 renal arteries, as well as 103 cases (49.1%) of the right kidney ( P<0.01). There were 44 cases (21.0%) of the left kidney to deal with ≥ 2 renal veins, as well as 78 cases (37.1%) of the right kidney ( P<0.01). Conclusions:The three-dimensional visualization technique based on renal CT data is helpful to accurately evaluate the renal vascular anatomy before operation. Right renal vascular variants are more common.

Objective:To analyze the dosing, efficacy and safety of Regorafenib in elderly patients with metastatic colorectal cancer.Methods:Clinical data of 40 elderly patients with advanced colorectal cancer treated with regorafenib from June 2018 to October 2019 at Beijing Hospital were collected.The dosing, effectiveness and safety of regorafenib were retrospectively analyzed.The primary endpoint was overall survival(OS).Results:A total of 40 elderly patients were enrolled in this study, including 25 males and 15 females, with a median age of 66 years.The initial dose of Regorafenib was 80 mg, and the maintenance dose was 80 mg in 14(35.0%)patients, 120 mg in 20(50.0%)patients and 160 mg in 6(15.0%)patients.Thirty-one patients were treated with Regorafenib and 9 patients were given a combination therapy including Regorafenib.The objective response rate(ORR)was 2.5%(1 case), and the disease control rate(DCR)was 45.0%(18 cases). The median progression free survival(PFS)was 2.2 months(95% CI: 2.1-4.0)and the median OS was 8.8 months(95% CI: 7.1-11.2). There was no significant difference in PFS or OS in different maintenance dose groups( P<0.05). Patients who received 120 mg Regorafenib as a maintenance dose showed longest survival with a median OS of 9.8 months(95% CI: 6.9-14.0). There was no difference in median OS between the Regorafenib group and the combination therapy group( χ2=0.1, P>0.05). Grade 3 and 4 adverse reactions occurred in 11 patients(27.5%). Common adverse reactions were hand-foot skin reaction, fatigue, hypertension, diarrhea, elevated transaminase levels and proteinuria. Conclusions:Regorafenib offers a good survival benefit for elderly patients with advanced colorectal cancer who failed to respond to standard therapy.The dosing strategy, starting with a low dose of Regorafenib and escalating gradually as tolerance builds up, is recommended for elderly patients, when both efficacy and safety are considered.The proportion of patients who can tolerate 120 mg Regorafenib as a maintenance dose is high with relatively long overall survival, indicating it is appropriate for the elderly.

Objective:To investigate clinical features, diagnosis and treatment of angioimmunoblastic T-cell lymphoma(AITL)in middle and old age patients.Methods:This was a retrospective study.A total of 33 middle-aged and elderly patients(a median age of 64 years, range 47~85 years)with AITL admitted to our hospital from May 2008 to March 2017, including 54.5% male(18 cases), were enrolled in this study.Clinical manifestations, pathology, imaging and survival data of patients were collected.The objective response rate(ORR)of patients with different therapeutic regimens was analyzed.The survival analysis was conducted by using the Kaplan-Meier method, the survival rate was analyzed by using the Log-rank method, and multivariate analysis was conducted by using the proportional hazards regression model.Results:The median overall survival(OS)was 26.0 months(8.5-43.5 months). The 1-year, 3-year and 5-year OS rate was 66.7%(22 cases), 45.5%(15 cases)and 24.2%(8 cases), respectively.The ORR of first-line chemotherapy with CHOP-like regimens(cyclophosphamide, doxorubicin, vincristine, prednisone)was 65.5%(19/29)and the incidence of serious adverse reactions was 64.5%(20/31). Single-factor chi-square testing showed that age ≥60 years, Barthel score ≥90, Eastern Cooperative Oncology Group performance status score(ECOG-PS)≥2, anemia, International prognostic index(IPI)score of 4~5, receiving chidamide treatment were influncing factors for the prognosis in middle-aged and elderly patients with AITL( χ2=5.103, 4.306, 6.004, 4.030, 6.348 and 4.080, P<0.05). Cox multivariate analysis showed that age ≥60 years and receiving chidamide treatment were independent prognostic factors affecting the 5-year survival rate of middle-aged and elderly AITL patients( OR=0.313 and 4.964, P<0.05). That the OS was better in the group receiving chidamide treatment than in the group without chidamide treatment( P<0.05). Conclusions:Clinical features of AITL are diverse and lack of specificity.Most patients present with advanced stage AITL at the initial diagnosis.The 5-year OS rate is low.AITL patients aged over 60 years have a poor prognosis.Chidamide can improve the OS rate.

Objective:To investigate the characteristics of gene mutations in colorectal cancer(CRC)patients by using next-generation generation sequencing(NGS).Methods:Blood and tissue samples were collected from 90 CRC patients admitted to Beijing Hospital between August 5, 2016 and December 29, 2020.Analysis of driver gene mutations was performed by using a 1021-gene NGS panel.Results:There were 43 tissue samples and 83 blood samples.Also, 36 patients had both tissue and blood samples.The frequency rates of KRAS and BRAF mutations were 51.2%(22/43)and 20.9%(9/43)in tissue samples, and 3 rare concomitant KRAS/ BRAF mutations were detected.The frequency rates of KRAS and BRAF mutations were 26.5%(22/83)and 10.8%(9/83)in blood samples.In patients with tissue and blood samples, the rates of KRAS and BRAF mutations were 52.8%(19/36)and 10.8%(8/36). Conclusions:The rate of KRAS mutations in tissue samples from colorectal cancer patients is similar to rates reported in the literature, but the rate of BRAF mutation and the rate of rare KRAS and BRAF co-mutations are higher than those reported from other countries.

Objective:To investigate the influencing factors for the recurrence of TNM(T3~4N0M0)stage Ⅱ colorectal cancer in patients aged 75 years and over after radical resection.Methods:Clinicopathologic data of 161 colorectal cancer patients aged 75 years and over undergone radical resection in our hospital from January 2012 to August 2017 were retrospectively analyzed.They were followed up for 49 months(range: 2-84 months). Survival analysis was conducted by the Kaplan-Meier method and the survival rate was examined using the Log-rank method.Multivariate analysis was conducted by the proportional hazards regression model.Results:Univariate analysis showed that age≥80 years, preoperative comorbidities involving more than 1 system, weight loss≥10%, preoperative intestinal obstruction or perforation, preoperative CEA elevation, preoperative CA199 elevation, depth of primary tumor invasion T4, dissection of lymph nodes<12, vascular invasion, nerve invasion, deficient mismatch repair(dMMR), risk stratification and adjuvant chemotherapy were related factors for the prognosis in patients with TNM stage Ⅱ colorectal cancer aged 75 years and over after radical resection.Multivariate analysis showed that preoperative comorbidities involving more than 1 system, weight loss≥10%, preoperative intestinal obstruction or perforation, preoperative CEA elevation, depth of primary tumor invasion T4, dissection of lymph nodes<12 and vascular invasion were independent risk factors for poor prognosis, and adjuvant chemotherapy was an independent factor for favorable prognosis.The 5-year-disease-free survival(DFS)rate was 41.6% in all patients.The Kaplan-Meier curves indicated that disease-free survival(DFS)between the low-risk, middle-risk and high-risk groups had a statistically significant difference( χ2=14.632, P=0.001). Kaplan-Meier survival analysis showed that high-risk patients receiving Oxaliplatin combined with Capecitabine adjuvant chemotherapy had better DFS than those receiving Capecitabine or non-adjuvant chemotherapy( χ2=11.157, P=0.004). Conclusions:DFS is improved in strictly selected patients with stage Ⅱ colorectal cancer aged 75 years and over and at high risk who receive Oxaliplatin combined with Capecitabine adjuvant chemotherapy.

Objective:To investigate the effect of a tankyrase inhibitor NVP-TNKS656 on the growth of hepatocellular carcinoma(HCC)cell lines and the involved molecular mechanisms.Methods:Five HCC cell lines were treated with 0, 2.5, 5.0, 10.0 μmol/L of NVP-TNKS656.The cell lines of HLE and HLF were selected and divided into four groups: 0.0 μmol/L(control or DMSO), 2.5 μmol/L, 5.0 μmol/L, 10.0 μmol/L of NVP-TNKS656 groups.Cells were cultured for 48 h for subsequent experiments.Crystal violet staining was used to count the number of the newly formed cell clones.Western blotting was used to detect the protein expression levels of Yes-associated protein(YAP), angiomotin-like 1(AMOTL1)and AMOTL2.The real-time qRT-PCR was used to detect the mRNA expression of YAP and its downstream connective tissue growth factor(CTGF)and cysteine-rich 61(Cyr61). Dual luciferase reporter gene was used to detect the luciferase activity of transcriptional enhancer activator domain(TEAD)family.Results:NVP-TNKS656 inhibited the growth of 5 HCC cell lines in a dose-dependent manner in HLE, HLF, Huh7, MHCC97-H, and MHCC97-L cell lines.There were significant differences in the newly formed cell clone numbers between control(0 μM of NVP-TNKS656)and each of 2.5 μmol/L, 5.0 μmol/L, 10.0 μmol/L of NVP-TNKS656 groups in a dose-dependent manner( F=90.46, 68.58, 191.8, 114.6 and 201.4, all P<0.05). In HLE and HLF cell lines, NVP-TNKS656 significantly reduced the protein level of YAP in a dose-dependent manner and decreased the YAP target gene CTGF(HLE cells: 1.02±0.02, 0.90±0.03, 0.57±0.02, 0.38±0.03, HLF cells: 0.98±0.03, 0.86±0.02, 0.66±0.02, 0.43±0.01)and Cyr61(HLE cells: 1.00±0.01, 0.86±0.02, 0.74±0.03, 0.44±0.03 and HLF cells: 0.99± 0.02, 0.87±0.01, 0.72±0.02, 0.54±0.01)( P<0.05), and inhibited the activity of YAP/TEAD luciferase.At the same time, NVP-TNKS656 up-regulated two major negative regulators of YAP, namely AMOTL1 and AMOTL2 proteins, and promoted the apoptosis of HLE and HLF cells in a dose-dependent manner. Conclusion:NVP-TNKS656 can inhibit the proliferation of HCC by stabilizing AMOTL1/ AMOTL2 and down-regulating the YAP target gene.This study indicates that NVP-TNKS656 can be used as a potential drug for treating HCC.