Introduction

Malnutrition is a highly prevalent condition in patients with cancer that has a negative impact on clinical outcomes. The GLIM criteria for malnutrition aim to standardize its diagnosis. In colorectal cancer, poor nutritional status is associated with increased morbidity and mortality and reduce tolerance to treatment.

Aims & Methods

We aimed to assess the prevalence of malnutrition base on the GLIM criteria and to correlate this with patient outcomes and survival in colorectal cancer.
Patients with colorectal cancer diagnosed from January 2015 to December 2022 were included. All of them were screened for malnutrition using the GLIM criteria.
The relationships between GLIM-malnutrition and suvival were analyzed.

Results

Sixty patients were included. The mean age was 54 years [35 - 82] with a sex ratio of 1.8 (M/F). Tumors were located in the right colon in 20 patients (33%), the left colon in 22 patients (36%), and the rectum in 15 patients (25%). According to TNM classification, patients were predominantly classified in stages II and III. In terms of treatment, 20 patients received neoadjuvant chemotherapy (30%), 15 patients received neoadjuvant radiotherapy (25%), and 45 patients underwent surgery (75%). Malnutrition, according to GLIM criteria, was present in 40% of patients. It was classified as mild, moderate, and severe in 40%, 45%, and 15% of cases, respectively.
Regarding survival, the difference between the two Kaplan-Meier curves of patients fulfilling GLIM malnutrition criteria versus patients without malnutrition was statistically significant (Log-rank test p = 0.001), [HR = 4.35 (95% CI = 2 - 9)], with a mean survival period of 18 ± 4.7 versus 32 ± 5.2 months, respectively (p = 0.028). Mild malnutrition was associated with better survival compared to moderate and severe malnutrition: 20 ± 2.3 versus 17 ± 3.2 months, respectively (p = 0.003).

Conclusion

Pretherapeutic screening for malnutrition seems to be mandatory due to its negative prognostic impact in patients with colorectal cancer, allowing for better pre-therapeutic stratification.

References

Cederholm T, Jensen GL, Correia MITD, et al. GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community. Clin Nutr. 2019;38(1):1-9.

Introduction

Colorectal cancer (CRC) ranks as the second leading cause of cancer-related deaths worldwide. Although first-line chemotherapy can prolong survival in CRC patients, around 40% do not experience a beneficial response to these therapeutic regimens. Currently, no clinically validated biomarkers capable of predicting patient response to chemotherapy are available. MicroRNAs (miRs) are small non-coding RNAs involved in various oncogenic processes. Their differential expression across distinct clinical conditions, along with their high stability and ease of detection, make them promising predictive biomarkers to overcome this challenge.

Aims & Methods

Thus, we aimed at systematically reviewing the current state of knowledge regarding miRs as predictive biomarkers of therapeutic response in colorectal cancer patients. A systematic search on PubMed/MEDLINE and Scopus databases was performed on published articles reporting the role of microRNAs detected in blood and tissue as biomarkers for predicting the therapeutic outcome in colorectal cancer patients. 2673 records were retrieved by December 2024. After removal of duplicate records 2568 abstracts were screened, and 40 full texts included in this review. The different outcomes to predict treatment response were extracted from the studies, namely response to chemeotherapy, progression free survival (PSF), disease free survival, overall survival, and recurrence of the disease.

Results

Among the 111 miRs reported in the 40 articles, circulating miR-4772-3p demonstrated a good ability to predict the response of CRC stage I–III patients to FOLFOX, the most used first-line therapy in this group of patients (sensitivity: 79%, AUC: 0.72, 95% CI: 0.59–0.85). Additionally, PFS is commonly used to assess treatment response. In this context, decreased levels of miR-4772-3p are associated with poor PFS, demonstrating a lower response to FOLFOX. In addition, a combination of three miRs (miR-17-5p, miR-92b-3p, and miR-98-5p) in tissue samples was indicative of a complete or partial response to FOLFOX combined with anti-VEGF therapy, namely bevacizumab, in metastatic CRC patients (AUC: 0.85, 95% CI: 0.72–0.91). Notably, miR-17-5p was the most frequently reported miR associated with FOLFOX response prediction in tissue samples, and its high expression levels were linked to poor PFS, indicating treatment inefficiency and consequently progression of disease. Regarding to the specific group of patients with locally advanced rectal cancer (LARC) that are mainly submitted to neoadjuvant chemoradiotherapy (nCRT), a panel composed of eight circulating microRNAs (miR-30e-5p, miR-33a-5p, miR-130a-5p, miR-210-3p, miR-214-3p, miR-320a, miR-338-3p, and miR-1260a) showed a higher accuracy for predicting patients response to nCRT, with a sensitivity of 80% (AUC: 0.89, 95% CI: 0.81 to 0.94). Furthermore, the miR-125b-5p detected in tissue samples, was also associated with the nCRT response (AUC: 0.90, 95% CI: 0.7818-1.043). These miRs could increase the response to nCRT for LARC patients, considering that currently only around 40% achieve a partial response and as few as 20% reach a complete response to treatment.

Conclusion

This systematic review highlights the potential of microRNAs as predictive biomarkers of therapeutic response in CRC, with the ability to improve treatment outcome prediction and support personalized therapy. However, further validation is required for improving clinical decisions and to allow the clinical applicability of these biomarkers.

Introduction

NICE recommend FIT (faecal immunochemical test) in almost all suspected colorectal cancer (CRC) cases. FIT-based prediction models perform well [1], but it is unclear how levels change along the adenoma-carcinoma sequence and how lesion type and location affect results. We previously reported retrospective FIT data from CRC patients at a single site [2]. We have re-evaluated this two years later and, utilising our regional trainee network, have included five more sites.

Aims & Methods

Our aim was to evaluate FIT results at various time points and in different tumour types/locations.
This was a multicentre, retrospective evaluation involving 6 hospital sites. All patients diagnosed with a malignant lesion of colon, rectum or anus in a 6-month period were identified using cancer registries. Data were collected from medical records.

Results

856 CRC patients were included. Where histology was available, 90% were adenocarcinoma. Referrals were 85% symptomatic, 14% BCSP and 1% surveillance. 492 patients had ≥1 non-BCSP FIT prior to diagnosis. 530 individual results were recorded with a mean of 178 days pre-diagnosis. Overall, 11% were <10μg/g, however the proportion increased as time from diagnosis increased (≤30 days 5.2%; 31-90 days 7.4%; 91-180 days 22.2%; 181-365 days 21.7%; >366 days 47.2%). When limited to ≤90 days, 6.3% were <10μg/g. This reduced to 5.3% in proven adenocarcinoma. The proportion varied according to lesion location (Table 1).
Table 1: Results by lesion location

Conclusion

Time since FIT is relevant clinically and in research. FITs >90 days old may not be suitable for guiding clinical decisions, however our sample for this time point was small. Prospective, sequential testing would more accurately study the change in FIT along the adenoma-carcinoma sequence. Studies assessing the value of repeat testing at different time points would help guide clinicians. The highest proportion of results <10μg/g was in right colon lesions, consistent with existing literature. However, we identified more false negatives in rectal lesions compared to left colon and recommend further research assessing this.

References

1. Hampton JS, Kenny RPW, Rees CJ, et al. The performance of FIT-based and other risk prediction models for colorectal neoplasia in symptomatic patients: a systematic review. EClinicalMedicine 2023; 64. DOI:10.1016/j.eclinm.2023.102204.
2. Manning S, Maxfield D, Bragg R, et al. P241 Is a negative FIT falsely reassuring? A retrospective evaluation. 2022 DOI:10.1136/gutjnl-2022-BSG.295.

Introduction

It is known that there are sex differences in the characteristics of colorectal cancer (CRC), such as incidence and prognosis. However, there is still a lack of understanding on the underlying mechanisms of its sex difference.

Aims & Methods

The aim of this study was to investigate the correlation between the clinicopathological features and the molecular characteristics of CRC depending on sex. 1,068 patients diagnosed with CRC and treated (surgery, chemotherapy or supportive care) at Seoul National University Bundang Hospital were prospectively enrolled. Basic characteristics such as sex, age, and social history, clinical characteristics such as tumor location, stage, and survival were analyzed. In addition, molecular expressions of microsatellite instability (MSI), oncogenes including K-ras, N-ras and H-ras, and DNA mismatch repair genes including MLH-1, MSH-2, MSH-6 and PMS-2 were also investigated.

Results

There were 630 males and 438 females, with a sex ratio of 1.5:1. Risk behaviors for cancer occurrence, such as drinking and smoking, were much more common in males (p < 0.001, respectively). In females, right colon cancer was more frequent than in males (p = 0.022), which seems to be associated with the loss of MLH-1 (p < 0.001) and PMS-2 expression (p = 0.003) (Table). In multivariate regression analyses, older age (p = 0.001), lower BMI (p < 0.001), presence of symptoms (p = 0.048), advanced cancer stage (p < 0.001) and mutation of BRAF (p = 0.030) were significant risk factors for disease-related death. Females showed better overall survival (p = 0.031) as well as disease-specific survival than males (p = 0.088), and this difference was most pronounced in age 40-69 group (overall survival p = 0.024; disease-specific survival p = 0.104, respectively), while not evident in the younger and older age groups (Figure).

Conclusion

Colorectal cancer shows sex differences in various characteristics including incidence, tumor location and prognosis, which might be originated from sex hormone and molecular characteristics.