Early-onset colorectal cancer (EOCRC) shows a different epidemiological trend compared to later-onset colorectal cancer, with its incidence rising in most regions and countries worldwide. However, the reasons behind this trend remain unclear. The etiology of EOCRC is complex and could involve both genetic and environmental factors. Apart from Lynch syndrome and Familial Adenomatous Polyposis, sporadic EOCRC exhibits a broad spectrum of pathogenic germline mutations, genetic polymorphisms, methylation changes, and chromosomal instability. Early-life exposures and environmental risk factors, including lifestyle and dietary risk factors, have been found to be associated with EOCRC risk. Meanwhile, specific chronic diseases, such as inflammatory bowel disease, diabetes, and metabolic syndrome, have been associated with EOCRC. Interactions between genetic and environmental risk factors in EOCRC have also been explored. Here we present findings from a narrative review of epidemiological studies on the assessment of early-life exposures, of EOCRC-specific environmental factors, and their interactions with susceptible loci. We also present results from EOCRC-specific genome-wide association studies that could be used to perform Mendelian randomization analyses to ascertain potential causal links between environmental factors and EOCRC.
Humans ; Colorectal Neoplasms/etiology* ; Risk Factors ; Genome-Wide Association Study ; Genetic Predisposition to Disease/genetics*

The incidence and mortality rates of early-onset colorectal cancer (EOCRC) among people under 50 years old are showing an upward trend. Although traditional epidemiological studies have conducted relatively deep research and screened out environmental factors related to EOCRC, our understanding of the causes, mechanisms, and treatment of this disease is still far from sufficient. In this review, we clarify the current progress of EOCRC, with a particular focus on epidemiology, screening status, clinical symptoms, and prognosis. This provides new evidence for secondary prevention, including precision screening, and offers new ideas for improving the diagnosis and treatment of EOCRC.

Objective:To explore the differences in distribution of colorectal cancer-related risk factors between patients with early-onset colorectal cancer (EOCRC) and those with late-onset colorectal cancer (LOCRC) in a Chinese cohort, and to provide reference and guidance for the prevention, diagnosis, and treatment of EOCRC.Methods:Using data from the National Colorectal Cancer Cohort study cohort, 5377 patients with newly diagnosed colorectal cancer (CRC) attending the Department of Colorectal Surgery and Oncology of the Second Affiliated Hospital, Zhejiang University School of Medicine from June 2018 to February 2023 were included in the study cohort. Questionnaires capturing epidemiological features, including lifestyle and dietary habits, were administered. The patients were divided into two groups, the cut-off age being 50 years. Those aged ≥50 years were defined as having LOCRC and those aged <50 years as having EOCRC. Wilcoxon (continuous variates) or χ 2 tests (categorical variates) were performed to compare differences in epidemiological features. Results:A total of 3799 people who had completed the questionnaire were included in this study, 491 of whom had EOCRC and 3308 LOCRC. The response rate to the questionnaire was 70.7%. The median ages of patients in the EOCRC and LOCRC groups were 43 and 66 years, respectively. There was a higher proportion of female patients (48.5% [253/491] vs. 35.8% [1184/3308], χ 2=28.8, P<0.001) in the EOCRC than the LOCRC group. Patients with EOCRC and lower body mass index (medium 22.1 kg/m 2 vs. 22.9 kg/m 2, W=744 793, P=0.005) and lower proportion of abdominal obesity (87.2% [428/491] vs. 93.8% [3103/3308], χ 2=38.3, P<0.001). Patients with EORC significantly less commonly reported a history of hypertension (5.9% [29/491] vs. 41.6% [1375/3308], χ 2=231.8, P<0.001), diabetes (1.4% [7/491] vs. 14.4% [476/3308], χ 2=63.6, P<0.001) and cardiovascular and cerebrovascular diseases (0.8% [4/491] vs. 7.3% [241/3308], χ 2=28.6, P<0.001). However, the proportion of patients with a family history of CRC was significantly higher ( P<0.05) in the EOCRC group (10.2% [50/491] vs. 6.9% [227/3 308], χ 2=6.5, P=0.010]. In terms of lifestyle, patients with EOCRC had shorter sleep duration (median: 8.0 hours vs. 8.5 hours, W=578 989, P<0.001), and were less likely to participate in physical exercise (29.5% [145/491] vs. 38.7% [1281/3308] χ 2=15.0, P<0.001) or engage in physical work (65.2% [320/491] vs. 74.1% [2450/3308], χ 2=16.7, P<0.001). Meanwhile, in the EOCRC group a lower percentage of patients were smokers (29.3% [144/491] vs. 42.7% [1411/3308], χ 2=46.9, P<0.001) and they smoked less (median 17.6 pack/year vs. 30.0 pack/year,W=55 850, P<0.001). Fewer patients in the EOCRC group habitually drank alcohol (21.0% [103/491] vs. 38.0% [1257/3308], χ 2=57.5, P<0.001) or tea (17.5% [86/491] vs. 28.7% [948/3308], χ 2=26.2, P<0.001) than in the LOCRC group. Compared with the LOCRC group, patients with EOCRC had a higher frequency of intake of fresh meat, fresh fruit, eggs, and dairy products and a lower frequency of intake of preserved meat and pickled vegetables; these differences are statistically significant (all P<0.05). There was no statistically significant difference in consumption of fresh vegetables or a high-sugar diet between the two groups (both P>0.05). Conclusions:This study highlights disparities in adverse lifestyle and dietary habits between patients in China with EOCRC versus LOCRC.

The incidence and mortality rates of early-onset colorectal cancer (EOCRC) among people under 50 years old are showing an upward trend. Although traditional epidemiological studies have conducted relatively deep research and screened out environmental factors related to EOCRC, our understanding of the causes, mechanisms, and treatment of this disease is still far from sufficient. In this review, we clarify the current progress of EOCRC, with a particular focus on epidemiology, screening status, clinical symptoms, and prognosis. This provides new evidence for secondary prevention, including precision screening, and offers new ideas for improving the diagnosis and treatment of EOCRC.

Objective:To explore the differences in distribution of colorectal cancer-related risk factors between patients with early-onset colorectal cancer (EOCRC) and those with late-onset colorectal cancer (LOCRC) in a Chinese cohort, and to provide reference and guidance for the prevention, diagnosis, and treatment of EOCRC.Methods:Using data from the National Colorectal Cancer Cohort study cohort, 5377 patients with newly diagnosed colorectal cancer (CRC) attending the Department of Colorectal Surgery and Oncology of the Second Affiliated Hospital, Zhejiang University School of Medicine from June 2018 to February 2023 were included in the study cohort. Questionnaires capturing epidemiological features, including lifestyle and dietary habits, were administered. The patients were divided into two groups, the cut-off age being 50 years. Those aged ≥50 years were defined as having LOCRC and those aged <50 years as having EOCRC. Wilcoxon (continuous variates) or χ 2 tests (categorical variates) were performed to compare differences in epidemiological features. Results:A total of 3799 people who had completed the questionnaire were included in this study, 491 of whom had EOCRC and 3308 LOCRC. The response rate to the questionnaire was 70.7%. The median ages of patients in the EOCRC and LOCRC groups were 43 and 66 years, respectively. There was a higher proportion of female patients (48.5% [253/491] vs. 35.8% [1184/3308], χ 2=28.8, P<0.001) in the EOCRC than the LOCRC group. Patients with EOCRC and lower body mass index (medium 22.1 kg/m 2 vs. 22.9 kg/m 2, W=744 793, P=0.005) and lower proportion of abdominal obesity (87.2% [428/491] vs. 93.8% [3103/3308], χ 2=38.3, P<0.001). Patients with EORC significantly less commonly reported a history of hypertension (5.9% [29/491] vs. 41.6% [1375/3308], χ 2=231.8, P<0.001), diabetes (1.4% [7/491] vs. 14.4% [476/3308], χ 2=63.6, P<0.001) and cardiovascular and cerebrovascular diseases (0.8% [4/491] vs. 7.3% [241/3308], χ 2=28.6, P<0.001). However, the proportion of patients with a family history of CRC was significantly higher ( P<0.05) in the EOCRC group (10.2% [50/491] vs. 6.9% [227/3 308], χ 2=6.5, P=0.010]. In terms of lifestyle, patients with EOCRC had shorter sleep duration (median: 8.0 hours vs. 8.5 hours, W=578 989, P<0.001), and were less likely to participate in physical exercise (29.5% [145/491] vs. 38.7% [1281/3308] χ 2=15.0, P<0.001) or engage in physical work (65.2% [320/491] vs. 74.1% [2450/3308], χ 2=16.7, P<0.001). Meanwhile, in the EOCRC group a lower percentage of patients were smokers (29.3% [144/491] vs. 42.7% [1411/3308], χ 2=46.9, P<0.001) and they smoked less (median 17.6 pack/year vs. 30.0 pack/year,W=55 850, P<0.001). Fewer patients in the EOCRC group habitually drank alcohol (21.0% [103/491] vs. 38.0% [1257/3308], χ 2=57.5, P<0.001) or tea (17.5% [86/491] vs. 28.7% [948/3308], χ 2=26.2, P<0.001) than in the LOCRC group. Compared with the LOCRC group, patients with EOCRC had a higher frequency of intake of fresh meat, fresh fruit, eggs, and dairy products and a lower frequency of intake of preserved meat and pickled vegetables; these differences are statistically significant (all P<0.05). There was no statistically significant difference in consumption of fresh vegetables or a high-sugar diet between the two groups (both P>0.05). Conclusions:This study highlights disparities in adverse lifestyle and dietary habits between patients in China with EOCRC versus LOCRC.

The popularity of prostate-specific antigen screening has led to overdiagnosis and overtreatment of prostate cancer. Active surveillance can be used as a safe and reliable treatment option for some patients with localized prostate cancer. At the same time, compared with surgery and chemoradiotherapy, active surveillance can provide these patients with a better quality of life. A variety of new monitoring methods, including PSMA PET and biomarkers, can optimize the risk stratification of prostate cancer and reduce unnecessary puncture biopsies to further improve the quality of life of patients. However, there are still great controversies about the inclusion criteria, monitoring programs, and intervention indications for active surveillance of prostate cancer, and domestic doctors and patients still lack acceptance of it. This article reviews the research progress of active surveillance in prostate cancer.

Objective:To explore the epidemiological and pathological characteristics of multiple primary malignant tumors (MPMTs) accompanied with colorectal malignancies.Methods:The MPMTs patients with colorectal malignant tumors admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2013 to December 2019 were screened, and the data of gender, age, onset interval, lesion distribution, TNM stage, and pathological type were collected. Then we analyzed the epidemiological characteristics and clinicopathological characteristics.Results:A total of 235 MPMTs patients with colorectal malignancies were treated, accounting for 4.00% of the 5878 patients with colorectal malignancies during the same period. There were 154 males and 81 females, with a male-to-female ratio of 1.90∶1. The median age at diagnosis of the first primary cancer was 64 years. There were 90 synchronous multiple primary carcinomas (SC) patients (38.30%) and 145 metachronous multiple primary carcinomas (MC) patients (61.70%), and the age of first primary cancer diagnosis in SC patients was older than that in MC patients (65 and 62 years, respectively, P=0.022). The median onset interval was 13.25 months (95% CI: 19.61, 27.23 months), and the age at diagnosis of the first primary cancer was negatively correlated with the onset interval ( r=-0.224, P<0.001). There were 257 colorectal malignant tumor lesions in 235 patients, which were distributed in all intestinal segments. The TNM stages were mainly Ⅱ and Ⅲ, and the pathological type was mainly adenocarcinoma. There were no significant differences in the distribution of intestinal segments, TNM stages and pathological types of colorectal malignant tumors between the SC group and the MC group (all P>0.05). There were 234 extraintestinal lesions, mainly distributed in the lung (48), stomach (45), and liver and gallbladder (25). The proportion of extraintestinal lesions located in the stomach of SC patients was 32.18% (28/87), which was higher than that of MC patients [11.56% (17/147), P<0.001]; the proportion of extraintestinal lesions located in the thyroid of SC patients was 2.30% (2/87), lower than that of MC patients [10.20% (15/147), P=0.024]. Conclusions:Approximately 4% of patients with colorectal malignant tumors suffer from two or more malignant tumors, slightly higher in male than in female, and slightly higher in MC patients than in SC patients. The diagnosis age of the first and second primary malignant tumors is mainly concentrated among 55-75 years old, and the interval is inversely related to the diagnosis age of the first primary malignant tumor. The colorectal malignant tumors of SC and MC patients are distributed in all intestinal segments, and the pathological stages are mainly stage Ⅱ and Ⅲ, while the pathological types are mainly adenocarcinoma. Extraintestinal lesions are mostly located in the lungs and stomach.

Objective:To explore the epidemiological and pathological characteristics of multiple primary malignant tumors (MPMTs) accompanied with colorectal malignancies.Methods:The MPMTs patients with colorectal malignant tumors admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2013 to December 2019 were screened, and the data of gender, age, onset interval, lesion distribution, TNM stage, and pathological type were collected. Then we analyzed the epidemiological characteristics and clinicopathological characteristics.Results:A total of 235 MPMTs patients with colorectal malignancies were treated, accounting for 4.00% of the 5878 patients with colorectal malignancies during the same period. There were 154 males and 81 females, with a male-to-female ratio of 1.90∶1. The median age at diagnosis of the first primary cancer was 64 years. There were 90 synchronous multiple primary carcinomas (SC) patients (38.30%) and 145 metachronous multiple primary carcinomas (MC) patients (61.70%), and the age of first primary cancer diagnosis in SC patients was older than that in MC patients (65 and 62 years, respectively, P=0.022). The median onset interval was 13.25 months (95% CI: 19.61, 27.23 months), and the age at diagnosis of the first primary cancer was negatively correlated with the onset interval ( r=-0.224, P<0.001). There were 257 colorectal malignant tumor lesions in 235 patients, which were distributed in all intestinal segments. The TNM stages were mainly Ⅱ and Ⅲ, and the pathological type was mainly adenocarcinoma. There were no significant differences in the distribution of intestinal segments, TNM stages and pathological types of colorectal malignant tumors between the SC group and the MC group (all P>0.05). There were 234 extraintestinal lesions, mainly distributed in the lung (48), stomach (45), and liver and gallbladder (25). The proportion of extraintestinal lesions located in the stomach of SC patients was 32.18% (28/87), which was higher than that of MC patients [11.56% (17/147), P<0.001]; the proportion of extraintestinal lesions located in the thyroid of SC patients was 2.30% (2/87), lower than that of MC patients [10.20% (15/147), P=0.024]. Conclusions:Approximately 4% of patients with colorectal malignant tumors suffer from two or more malignant tumors, slightly higher in male than in female, and slightly higher in MC patients than in SC patients. The diagnosis age of the first and second primary malignant tumors is mainly concentrated among 55-75 years old, and the interval is inversely related to the diagnosis age of the first primary malignant tumor. The colorectal malignant tumors of SC and MC patients are distributed in all intestinal segments, and the pathological stages are mainly stage Ⅱ and Ⅲ, while the pathological types are mainly adenocarcinoma. Extraintestinal lesions are mostly located in the lungs and stomach.

In recent years, due to changes in the epidemiology of colorectal cancer in the United States, the update of evidence-based medical evidence for screening, and the emergence of various new screening methods, various organizations in the United States, such as American College of Gastroenterology、Preventive Services Task Force, have updated guidelines for colorectal cancer screening in average-risk individuals. These guidelines have different recommendation levels in terms of starting and ending age, screening methods and frequency for colorectal cancer screening. A comprehensive understanding of the key points of these guideline updates and the similarities and differences recommended by different guidelines has important reference value for the colorectal cancer screening in China.
China ; Colorectal Neoplasms/epidemiology* ; Early Detection of Cancer ; Humans ; Mass Screening ; United States

The donor liver shortage is the bottles-neck limitation for clinical liver transplantation to save patients' life. Liver transplantation is a treatment option for end-stage liver diseases, like Cirrhosis and hepatocellular carcinoma, and acute liver failure; however, due to availability of donor liver, lots of patients never received such treatment option and passed way. Most recently, non-human primates after a liver transplantation with GTKO pigs survived for nearly 1 month indicates a promise of clinical use of liver xenotransplantation and could offer "a bridge transplantation" for fulminant liver failure patients. This review discussed and summarized the advancement and progress in the field, i.e., history of liver xenotransplantation research, model animals, clinical selection criteria, and future research directions and clinical trials.