149 results on '"Tsai, Wen-Sy"'
Search Results
102. Prospective clinical study of circulating tumor cells for colorectal cancer screening.
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Tsai, Wen-Sy, primary, Nimgaonkar, Ashish, additional, Segurado, Oscar, additional, Chang, Ying, additional, Hsieh, Ben, additional, Shao, Hung-Jen, additional, Wu, Jen-chia, additional, Lai, Jr-Ming, additional, Javey, Mana, additional, Watson, Drew, additional, and Mei, Rui, additional
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- 2018
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103. circlncRNAnet: An integrated web-based resource for mapping functional networks of long or circular forms of non-coding RNAs
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Wu, Shao-Min, primary, Liu, Hsuan, additional, Huang, Po-Jung, additional, Chang, Ian Yi-Feng, additional, Lee, Chi-Ching, additional, Yang, Chia-Yu, additional, Tsai, Wen-Sy, additional, and Tan, Bertrand Chin-Ming, additional
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- 2017
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104. Acquired somatic TP53 or PIK3CA mutations are potential predictors of when polyps evolve into colorectal cancer
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Chang, Pi-Yueh, primary, Chen, Jinn-Shiun, additional, Chang, Shih-Cheng, additional, Wang, Mei-Chia, additional, Chang, Nai-Chung, additional, Wen, Ying-Hao, additional, Tsai, Wen-Sy, additional, Liu, Wei-Hsiu, additional, Liu, Hsiu-Ling, additional, and Lu, Jang-Jih, additional
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- 2017
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105. ADAR1-mediated 3′ UTR editing and expression control of antiapoptosis genes fine-tunes cellular apoptosis response
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Yang, Chang-Ching, primary, Chen, Yi-Tung, additional, Chang, Yi-Feng, additional, Liu, Hsuan, additional, Kuo, Yu-Ping, additional, Shih, Chieh-Tien, additional, Liao, Wei-Chao, additional, Chen, Hui-Wen, additional, Tsai, Wen-Sy, additional, and Tan, Bertrand Chin-Ming, additional
- Published
- 2017
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106. Site-specific antibody modification and immobilization on a microfluidic chip to promote the capture of circulating tumor cells and microemboli
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Lai, Chian-Hui, primary, Choon Lim, Syer, additional, Wu, Liang-Chun, additional, Wang, Chien-Fang, additional, Tsai, Wen-Sy, additional, Wu, Han-Chung, additional, and Chang, Ying-Chih, additional
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- 2017
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107. The impact of kidney function on colorectal cancer patients with localized and regional diseases: An observational study from Taiwan.
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Sum-Fu Chiang, Jinn-Shiun Chen, Reiping Tang, Chien-Yuh Yeh, Pao-Shiu Hsieh, Wen-Sy Tsai, Jeng-Fu You, Hsin-Yuan Hung, Cheng-Chou Lai, Jr-Rung Lin, Jy-Ming Chiang, Chiang, Sum-Fu, Chen, Jinn-Shiun, Tang, Reiping, Yeh, Chien-Yuh, Hsieh, Pao-Shiu, Tsai, Wen-Sy, You, Jeng-Fu, Hung, Hsin-Yuan, and Lai, Cheng-Chou
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COLORECTAL cancer ,CANCER patients ,PROPORTIONAL hazards models ,RECEIVER operating characteristic curves - Abstract
Background: Impaired kidney function is associated with different diseases. However, its impact on colorectal cancer has not been clarified. In order to understand the effect of preoperative kidney function on the outcome of patients with cancer, we analyzed colorectal cancer patients with localized or regional diseases.Materials and Methods: In total, 3731 stage I to III colorectal cancer (CRC) patients were analyzed in Chang Gung Memorial Hospital. Modification of Diet in Renal Disease (MDRD) formula was used for estimated glomerular filtration rate (eGFR). Receiver operating characteristic (ROC) analysis for kidney function cut-off value; Chi-square method, independent t test, or analysis of variance (ANOVA) method for clinicopathological factors; Kaplan-Meier method for disease-free survival (DFS); Cox proportional hazard model for multivariate analysis.Results: Among colon cancer patients, low eGFR (MDRD <70) was associated with more male patients, T2 stage, patients without adjuvant chemotherapy, and patients with elevated creatinine level. Low eGFR is a significant risk factor only for stage III colon cancer (hazard ratio 1.70, 95% CI: 1.28-2.26; P < 0.001). Furthermore, postoperative adjuvant chemotherapy did not significantly increase 5-year DFS for both high and low eGFR groups in stage II patients (5 yrs DFS, 94.8% vs. 84.1%, P = 0.098 for high eGFR subgroup; and 75.0% vs. 75.8%, P = 0.379 for low eGFR subgroup). However, significant improvement of 5-yrs DFS after chemotherapy was found in low eGFR stage III colon cancer patients (64.7% vs. 39.4%, P < 0.001 for low eGFR subgroup). In contrast, no significant DFS difference was caused by chemotherapy for high eGFR stage III subgroup (70.5% vs. 63.9%, P = 0.110).Conclusions: Although low eGFR is an independent risk factor for stage III colon cancer. However, the adjuvant chemotherapy impacts on stage III colon cancer patients differently according to eGFR status. [ABSTRACT FROM AUTHOR]- Published
- 2019
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108. Elderly Adults with Late-Onset Ulcerative Colitis Tend to Have Atypical, Milder Initial Clinical Presentations but Higher Surgical Rates and Mortality: A Taiwan Society of Inflammatory Bowel Disease Study
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Lin, Wei-Chen, primary, Tung, Chien-Chih, additional, Lin, Hung-Hsin, additional, Lin, Chun-Chi, additional, Chang, Chen-Wang, additional, Yen, Hsu-Heng, additional, Chuang, Chiao-Hsiung, additional, Hsu, Wen-Hung, additional, Tsai, Wen-Sy, additional, Wang, Horng-Yuan, additional, Lin, Jen-Kou, additional, Wei, Shu-Chen, additional, and Wong, Jau-Min, additional
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- 2016
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109. NRAS germline variant G138R and multiple rare somatic mutations on APC in colorectal cancer patients in Taiwan by next generation sequencing
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Chang, Pi-Yueh, primary, Chen, Jinn-Shiun, additional, Chang, Nai-Chung, additional, Chang, Shih-Cheng, additional, Wang, Mei-Chia, additional, Tsai, Shu-Hui, additional, Wen, Ying-Hao, additional, Tsai, Wen-Sy, additional, Chan, Err-Cheng, additional, and Lu, Jang-Jih, additional
- Published
- 2016
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110. Circulating Tumor Cell Count Correlates with Colorectal Neoplasm Progression and Is a Prognostic Marker for Distant Metastasis in Non-Metastatic Patients
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Tsai, Wen-Sy, primary, Chen, Jinn-Shiun, additional, Shao, Hung-Jen, additional, Wu, Jen-Chia, additional, Lai, Jr-Ming, additional, Lu, Si-Hong, additional, Hung, Tsung-Fu, additional, Chiu, Yen-Chi, additional, You, Jeng-Fu, additional, Hsieh, Pao-Shiu, additional, Yeh, Chien-Yuh, additional, Hung, Hsin-Yuan, additional, Chiang, Sum-Fu, additional, Lin, Geng-Ping, additional, Tang, Reiping, additional, and Chang, Ying-Chih, additional
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- 2016
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111. Mutations of KRAS/NRAS/BRAF predict cetuximab resistance in metastatic colorectal cancer patients
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Hsu, Hung-Chih, primary, Thiam, Tan Kien, additional, Lu, Yen-Jung, additional, Yeh, Chien Yuh, additional, Tsai, Wen-Sy, additional, You, Jeng Fu, additional, Hung, Hsin Yuan, additional, Tsai, Chi-Neu, additional, Hsu, An, additional, Chen, Hua-Chien, additional, Chen, Shu-Jen, additional, and Yang, Tsai-Sheng, additional
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- 2016
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112. Sensitive and Specific Biomimetic Lipid Coated Microfluidics to Isolate Viable Circulating Tumor Cells and Microemboli for Cancer Detection
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Chen, Jia-Yang, primary, Tsai, Wen-Sy, additional, Shao, Hung-Jen, additional, Wu, Jen-Chia, additional, Lai, Jr-Ming, additional, Lu, Si-Hong, additional, Hung, Tsung-Fu, additional, Yang, Chih-Tsung, additional, Wu, Liang-Chun, additional, Chen, Jinn-Shiun, additional, Lee, Wen-Hwa, additional, and Chang, Ying-Chih, additional
- Published
- 2016
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113. MicroRNA-223 and microRNA-92a in stool and plasma samples act as complementary biomarkers to increase colorectal cancer detection
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Chang, Pi-Yueh, primary, Chen, Chia-Chun, additional, Chang, Yu-Sun, additional, Tsai, Wen-Sy, additional, You, Jeng-Fu, additional, Lin, Geng-Ping, additional, Chen, Ting-Wen, additional, Chen, Jinn-Shiun, additional, and Chan, Err-Cheng, additional
- Published
- 2016
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114. Identifying cancer origin using circulating tumor cells
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Lu, Si-Hong, primary, Tsai, Wen-Sy, additional, Chang, Ying-Hsu, additional, Chou, Teh-Ying, additional, Pang, See-Tong, additional, Lin, Po-Hung, additional, Tsai, Chun-Ming, additional, and Chang, Ying-Chih, additional
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- 2016
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115. Concurrent colonic mucosa-associated lymphoid tissue lymphoma and adenoma diagnosed after a positive fecal occult blood test: a case report
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Lin, Pei-Chiang, primary, Chen, Jinn-Shiun, additional, Deng, Po, additional, Wang, Chih-Wei, additional, Huang, Chiung-Huei, additional, Tang, Reiping, additional, Chiang, Jy-Ming, additional, Yeh, Chien-Yuh, additional, Hsieh, Pao-Shiu, additional, Tsai, Wen-Sy, additional, and Chiang, Sum-Fu, additional
- Published
- 2016
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116. A retrospective analysis of 20-year data of the surgical management of ulcerative colitis patients in Taiwan: a study of Taiwan Society of Inflammatory Bowel Disease
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Lin, Chun-Chi, primary, Wei, Shu-Chen, additional, Lin, Been-Ren, additional, Tsai, Wen-Sy, additional, Chen, Jinn-Shiun, additional, Hsu, Tzu-Chi, additional, Lin, Wei-Chen, additional, Huang, Tien-Yu, additional, Chao, Te-Hsin, additional, Lin, Hung-Hsin, additional, Wong, Jau-Min, additional, and Lin, Jen-Kou, additional
- Published
- 2016
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117. Bone Marrow Stromal Antigen 2 Is a Novel Plasma Biomarker and Prognosticator for Colorectal Carcinoma: A Secretome-Based Verification Study
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Chiang, Sum-Fu, primary, Kan, Chih-Yen, additional, Hsiao, Yung-Chin, additional, Tang, Reiping, additional, Hsieh, Ling-Ling, additional, Chiang, Jy-Ming, additional, Tsai, Wen-Sy, additional, Yeh, Chien-Yuh, additional, Hsieh, Pao-Shiu, additional, Liang, Ying, additional, Chen, Jinn-Shiun, additional, and Yu, Jau-Song, additional
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- 2015
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118. Membrane Proteins as Potential Colon Cancer Biomarkers: Verification of 4 Candidates from a Secretome Dataset
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Chiang, Sum-Fu, primary, Tsai, Ming-Hung, additional, Tang, Reiping, additional, Hsieh, Ling-Ling, additional, Chiang, Jy-Ming, additional, Yeh, Chien-Yuh, additional, Hsieh, Pao-Shiu, additional, Tsai, Wen-Sy, additional, Liu, Ya-Ping, additional, Liang, Ying, additional, Chen, Jinn-Shiun, additional, and Yu, Jau-Song, additional
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- 2014
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119. Anorectal Melanoma: Review of 22 Consecutive Cases
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Yen, Cheng-I, primary, Chen, Hong-Hwa, additional, Chiang, Sum-Fu, additional, Yeh, Chien-Yuh, additional, Chen, Jinn-Shiun, additional, Hsieh, Pao-Shiu, additional, Chiang, Jy-Ming, additional, Tsai, Wen-Sy, additional, Tang, Reiping, additional, Changchien, Chung-Rong, additional, and Wang, Jeng-Yi, additional
- Published
- 2012
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120. Immunohistochemical Study of Vascular Endothelial Growth Factor (VEGF) and Matrilysin (MMP-7) in T1 Adenocarcinoma of the Colon and Rectum to Predict Lymph Node Metastases or Distant Metastases
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Yeh, Chien-Yuh, primary, Chiang, Jy-Ming, additional, Hsieh, Pao-Shiu, additional, Tsai, Wen-Sy, additional, Tang, Reiping, additional, Changchien, Chung-Rong, additional, Chen, Jinn-Shiun, additional, Wang, Jeng-Yi, additional, Wu, Ren-Chin, additional, and Hung, Hsin-Yuan, additional
- Published
- 2011
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121. Clinical significance of signet ring cell rectal carcinoma
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Yeh, Chien-Yuh, primary, Wang, Jeng-Yi, additional, Chen, Jinn-Shiun, additional, Hsieh, Pao-Shiu, additional, Hung, Shin-Yuan, additional, Tang, Reiping, additional, Tsai, Wen-Sy, additional, Changchien, Chung-Rong, additional, and Lin, Paul-Yann, additional
- Published
- 2004
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122. Detection of Enterobius vermicularis eggs in the submucosa of the transverse colon of a man presenting with colon carcinoma.
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Lee, Sai-Cheong, primary, Tsai, Wen-Sy, additional, Hwang, Kao-Pin, additional, Lee, Ning, additional, and Lin, Chin-Yew, additional
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- 2002
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123. Differential effects of polyunsaturated fatty acids on chemosensitivity of NIH3T3 cells and its transformants
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Tsai, Wen-Sy, primary, Nagawa, Hirokazu, additional, and Muto, Tetsuichiru, additional
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- 1997
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124. Decreasing Postoperative Pulmonary Complication Following Laparoscopic Surgery in Elderly Individuals with Colorectal Cancer: A Competing Risk Analysis in a Propensity Score–Weighted Cohort Study.
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Chern, Yih-Jong, You, Jeng-Fu, Cheng, Ching-Chung, Jhuang, Jing-Rong, Yeh, Chien-Yuh, Hsieh, Pao-Shiu, Tsai, Wen-Sy, Liao, Chun-Kai, and Hsu, Yu-Jen
- Subjects
PREVENTION of surgical complications ,LUNG disease prevention ,EVALUATION of medical care ,LENGTH of stay in hospitals ,OPERATIVE surgery ,LAPAROSCOPIC surgery ,RETROSPECTIVE studies ,COLORECTAL cancer ,RISK assessment ,SURVIVAL analysis (Biometry) ,LONGITUDINAL method ,OLD age - Abstract
Simple Summary: As the effect of laparoscopic surgery on elderly patients with colorectal cancer (CRC) remains unclear, this propensity score–weighted cohort study revealed that laparoscopic surgery is a favorable method for elderly patients with CRC than open surgery in terms of less pulmonary-related postoperative morbidity and mortality, less hospital stay and similar oncological outcomes. Advanced age is a risk factor for major abdominal surgery due to a decline in physical function and increased comorbidities. Although laparoscopic surgery provides good results in most patients with colorectal cancer (CRC), its effect on elderly patients remains unclear. This study aimed to compare the short- and long-term outcomes between open and laparoscopic surgeries in elderly patients with CRC. Total 1350 patients aged ≥75 years who underwent curative resection for stage I–III primary CRC were enrolled retrospectively and were divided into open surgery (846 patients) and laparoscopy (504 patients) groups. After propensity score weighting to balance an uneven distribution, a competing risk analysis was used to analyze the short-term and long-term outcomes. Postoperative mortality rates were lower in the laparoscopy group, especially due to pulmonary complications. Postoperative hospital stay was significantly shorter in the laparoscopy group than in the open surgery group. Overall survival, disease-free survival, and competing risk analysis showed no significant differences between the two groups. Laparoscopic surgery for elderly patients with CRC significantly decreased pulmonary-related postoperative morbidity and mortality in this large cohort study. Laparoscopic surgery is a favorable method for elderly patients with CRC than open surgery in terms of less hospital stay and similar oncological outcomes. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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125. Comparative analysis of short- and long-term outcomes in laparoscopic versus open surgery for colorectal cancer patients undergoing hemodialysis.
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Hung, Hsin-Yuan, Huang, Shu-Huan, Tsai, Tzong-yun, You, Jeng-Fu, Hsieh, Pao-Shiu, Lai, Cheng-Chou, Tsai, Wen-Sy, and Tsai, Kun-Yu
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HEMODIALYSIS , *PROCTOLOGY , *COLORECTAL cancer , *CANCER patients , *MINIMALLY invasive procedures , *HEMODIALYSIS patients - Abstract
Purpose: Although minimally invasive colorectal surgery has been proven to have a shorter hospital stay and fewer short-term complications than open surgery, the advantages of laparoscopic surgery for colorectal cancer patients undergoing hemodialysis have not been validated. This study compared the outcomes of open and laparoscopic approaches in these patients. Materials and methods: Between January 2007 and December 2020, we retrospectively analyzed the clinical data of 78 hemodialysis patients who underwent curative-intent, elective colorectal surgery. Patients were divided into two groups according to the surgical method: open and laparoscopic. Results: Postoperative morbidity (p = 0.480) and mortality (p = 0.598) rates and length of hospital stay (28.8 vs. 27.5 days, p = 0.830) were similar between the groups. However, laparoscopic surgery patients had a shorter return to clear liquid, full liquid, or soft food time than open surgery patients (p < 0.001, p = 0.007, and p = 0.002, respectively). Disease-free survival and long-term cancer-specific survival rates were also similar between the two groups (p = 0.353 and p = 0.201, respectively). Multivariate analysis revealed that intraoperative blood transfusion was a risk factor for severe complications and mortality (OR 6.055; p = 0.046), and the odds ratio (OR) of laparoscopic surgery was not significantly greater than that of open surgery (OR = 0.537, p = 0.337). Conclusion: Although laparoscopic surgery did not result in hemodialysis patients having a shorter postoperative hospital stay, our results suggest that the laparoscopic approach is as safe as open surgery for hemodialysis patients and may be beneficial for shortening the return time to food intake. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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126. The prognostic and predictive significance of perineural invasion in stage I to III colon cancer: a propensity score matching-based analysis.
- Author
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Chu, Chun-Hui, Lai, I-Li, Jong, Bor-Kang, Chiang, Sum-Fu, Tsai, Wen-Sy, Hsieh, Pao-Shiu, Yeh, Chien-Yuh, and You, Jeng-Fu
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COLON cancer , *CHEMOTHERAPY complications , *ADJUVANT chemotherapy , *PROPENSITY score matching , *OVERALL survival - Abstract
Background: Colorectal cancer (CRC) presents with varying prognoses, and identifying factors for predicting metastasis and outcomes is crucial. Perineural invasion (PNI) is a debated prognostic factor for CRC, particularly in stage I-III patients, but its role in guiding adjuvant chemotherapy for node-positive colon cancer remains uncertain. Methods: We conducted a single-center study using data from the Colorectal Section Tumor Registry Database at Chang Gung Memorial Hospital, Taiwan. This prospective study involved 3,327 CRC patients, 1,536 of whom were eligible after application of the exclusion criteria, to investigate the prognostic value of PNI in stage I-III patients and its predictive value for node-positive/negative cancer patients receiving adjuvant chemotherapy. Propensity score matching (PSM) was used to minimize selection bias, and follow-up was performed with standardized procedures. Results: PNI-positive (PNI+) tumors were associated with higher preoperative CEA levels and more frequent adjuvant chemotherapy. After PSM, PNI + tumors were associated with marginally significantly lower 5-year disease-free survival (DFS) and significantly lower overall survival (OS) rates in stages III CRC. However, no significant differences were observed in stages I and II. Subgroup analysis showed that among PNI + tumors, only poorly differentiated tumors had higher odds of recurrence. PNI did not predict outcomes in node-negative colon cancer. Adjuvant chemotherapy benefited PNI + patients with node-positive but not those with node-negative disease. Conclusions: Our study indicates that PNI is an independent poor prognostic factor in stage III colon cancer but does not predict outcomes in node-negative disease. Given the potential adverse effects of adjuvant chemotherapy, our findings discourage its use in node-negative colon cancer when PNI is present. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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127. Comprehensive functional genomic analyses link APC somatic mutation and mRNA-miRNA networks to the clinical outcome of stage-III colorectal cancer patients
- Author
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Chiang, Sum-Fu, Huang, Heng Hsuan, Tsai, Wen-Sy, Chin-Ming Tan, Bertrand, Yang, Chia-Yu, Huang, Po-Jung, Yi-Feng Chang, Ian, Lin, Jiarong, Lu, Pei-Shan, Chin, En, Liu, Yu-Hao, Yu, Jau-Song, Chiang, Jy-Ming, Hung, Hsin-Yuan, You, Jeng-Fu, and Liu, Hsuan
- Abstract
Colorectal cancer (CRC) is a major health concern globally, but exhibits regional and/or environmental distinctions in terms of outcome especially for patients with stage III CRC.
- Published
- 2021
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128. The oncologic outcome and prognostic factors for solitary colorectal liver metastasis after liver resection.
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Hsu, Yu-Jen, Chern, Yih-Jong, Wu, Zhong-En, Yu, Yen-Lin, Liao, Chun-Kai, Tsai, Wen-Sy, You, Jeng-Fu, and Lee, Chao-Wei
- Abstract
Studies on prognostic factors for patients undergoing surgery to treat solitary liver metastases originating from colorectal cancer (CRC) are limited. This study aimed to analyze significant prognostic factors associated with tumor recurrence and long-term survival after liver resection for solitary colorectal liver metastasis. Data from 230 patients with solitary liver metastases from CRC who received liver resection between 2010 and 2019 were retrospectively analyzed. Recurrence-free survival (RFS) and overall survival (OS) were accessed with the Kaplan–Meier method and log-rank test. Cox regression multivariate analysis identified independent variables associated with RFS and OS. Nomograms were developed to predict patient outcomes after surgery. The 3- and 5-year OS rates were 72.3% and 59.8%, respectively. The 3- and 5-year RFS rates were 40.0% and 27.1%, respectively. Multivariate analysis revealed age ≥ 70 years, resection margin width < 10 mm, initial N2 stage, hypoalbuminemia before surgery, and neutrophil-to-lymphocyte ratio (NLR) ≥ 3 after surgery as independent prognostic factors for OS. For RFS, initial N2 stage, hypoalbuminemia before surgery, NLR ≥ 3 after surgery, elevated carcinoembryonic antigen (CEA) levels after surgery, and CEA ratio (after/before liver resection) < 0.3 were identified as independent prognostic factors. This study demonstrated that initial N2 stage, hypoalbuminemia before liver resection, and NLR ≥ 3 after liver resection exert a significant association on the RFS and OS of patients undergoing surgery for solitary liver metastases from CRC. Thus, upfront chemotherapy, prompt postoperative chemotherapy, and intensive postoperative surveillance are mandatory for patients having these adverse factors. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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129. Comparison of clinical outcomes of stoma reversal during versus after chemotherapy for rectal cancer patients.
- Author
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Tsai, Kun-Yu, You, Jeng-Fu, Huang, Shu-Huan, Tsai, Tzong-yun, Hsieh, Pao-Shiu, Lai, Cheng-Chou, Tsai, Wen-Sy, and Hung, Hsin-Yuan
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RECTAL cancer , *CANCER chemotherapy , *SURGICAL stomas , *CANCER patients , *COLOSTOMY , *TREATMENT effectiveness - Abstract
Purpose: The optimal timing of stoma closure during or after adjuvant chemotherapy for rectal cancer patients undergoing sphincter-preserving surgery remains unknown. This study aimed to investigate the influence of clinical and oncological outcomes depending on the timing of stoma closure. Methods: Between January 2006 and December 2015, we enrolled 244 consecutive rectal cancer patients who underwent curative-intent sphincter-preserving surgery with diverting transverse colostomy and adjuvant chemotherapy. Patients with stoma closure during (During group) adjuvant chemotherapy were compared to those who had stoma closure after adjuvant chemotherapy (After group). Results: Parastomal hernia occurred more frequently in the after group than in the during group. (10% vs. 2.9%, p = 0.028). Overall, no significant difference was observed in overall survival (OS) or disease-free survival (DFS) between the two groups (p = 0.911 for OS, p = 0.505 for DFS). However, an inferior OS occurred if reopen surgery was performed within 30 days of stoma closure in the during group, as compared with the after group (p = 0.004). In addition, a marginally poor DFS was observed in the group of patients who received further operations due to 30-day stoma closure complications compared to the other patients (p = 0.07). Conclusions: For rectal cancer patients who underwent sphincter-preserving surgery, attention should be given to avoid 30-day major complications after stoma reversal because patients who require reoperation during adjuvant chemotherapy may have poor long-term survival. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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130. Upfront primary tumor resection versus upfront systemic therapy for metastatic colorectal cancer: a systematic review and meta-analysis.
- Author
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Lo, Shih-Jung, Huang, Shu-Huan, Lai, I-Li, Chern, Yih-Jong, Hsu, Yu-Jen, Liao, Chun-Kai, Cheng, Ching-Chung, Tsai, Wen-Sy, Hsieh, Pao-Shiu, and You, Jeng-Fu
- Subjects
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COLORECTAL cancer , *METASTASIS , *PROPENSITY score matching , *SURVIVAL rate ,TUMOR surgery - Abstract
Purpose: The standard initial treatment for metastatic colorectal cancer (mCRC) remains debated. This study investigated whether upfront primary tumor resection (PTR) or upfront systemic therapy (ST) provides better survival outcomes for patients with mCRC. Methods: The PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases were searched for studies published at any time from January 1, 2004, to December 31, 2022. Randomized controlled trials (RCTs) and prospective or retrospective cohort studies (RCSs) utilizing propensity score matching (PSM) or inverse probability treatment weighting (IPTW) were included. We evaluated overall survival (OS) and short-term (60-day) mortality in these studies. Results: After reviewing 3,626 articles, we identified 10 studies including a total of 48,696 patients. OS differed significantly between the upfront PTR and upfront ST arms (hazard ratio [HR] 0.62; 95% CI: 0.57–0.68; p < 0.001). However, a subgroup analysis identified no significant difference in OS in RCTs (HR 0.97; 95% CI: 0.7–1.34; p = 0.83), whereas significant difference in OS occurred between the treatment arms in RCSs with PSM or IPTW (HR 0.59; 95% CI: 0.54–0.64; p < 0.001). Short-term mortality was analyzed in three RCTs, and 60-day mortality differed significantly between the treatment arms (risk ratio [RR] 3.52; 95% CI: 1.23–10.10; p = 0.02). Conclusions: In RCTs, upfront PTR for mCRC did not improve OS and enhanced the risk of 60-day mortality. However, upfront PTR seemed to increase OS in RCSs with PSM or IPTW. Therefore, whether upfront PTR should be used for mCRC remains unclear. Further large RCTs are required. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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131. Comparison of short-term and medium-term outcomes between intracorporeal anastomosis and extracorporeal anastomosis for laparoscopic left hemicolectomy.
- Author
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Wang, Li-Ming, Jong, Bor-Kang, Liao, Chun-Kai, Kou, Ya-Ting, Chern, Yih-Jong, Hsu, Yu-Jen, Hsieh, Pao-Shiu, Tsai, Wen-Sy, and You, Jeng-Fu
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HEMICOLECTOMY , *SURGICAL anastomosis , *PROGRESSION-free survival , *BLOOD proteins , *OVERALL survival , *IMMUNOADSORPTION - Abstract
Background: Few studies have evaluated the feasibility and safety of intracorporeal anastomosis (IA) for left hemicolectomy. Here, we aimed to investigate the potential advantages and disadvantages of laparoscopic left hemicolectomy with IA and compare the short- and medium-term outcomes between IA and extracorporeal anastomosis (EA). Methods: We retrospectively analyzed 133 consecutive patients who underwent laparoscopic left hemicolectomies from July 2016 to September 2019 and categorized them into the IA and EA groups. Patients with stage 4 disease and conversion to laparotomy or those lost to follow-up were excluded. Postoperative outcomes between IA and EA groups were compared. Short-term outcomes included postoperative pain score, bowel function recovery, complications, duration of hospital stay, and pathological outcome. Medium outcomes included overall survival and disease-free survival for at least 2 years. Results: After excluding ineligible patients, the remaining 117 underwent IA (n = 40) and EA (n = 77). The IA group had a shorter hospital stay, a shorter time to tolerate liquid or soft diets, and higher serum C-reactive protein level on postoperative day 3. There was no difference between two groups in operative time, postoperative pain, specimen length, or nearest margin. A 2-year overall survival (IA vs. EA: 95.0% vs. 93.5%, p = 0.747) and disease-free survival (IA vs. EA: 97.5% vs. 90.9%, p = 0.182) rates were comparable between two groups. Conclusions: Laparoscopic left hemicolectomy with IA was technically feasible, with better short-term outcomes, including shorter hospital stays and shorter time to tolerate liquid or soft diets. The IA group had higher postoperative serum C-reactive protein level; however, no complications were observed. Regarding medium-term outcomes, the overall survival and disease-free survival rates were comparable between IA and EA procedures. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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132. EV-miRome-wide profiling uncovers miR-320c for detecting metastatic colorectal cancer and monitoring the therapeutic response.
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Yang, Chan-Keng, Hsu, Hung-Chih, Liu, Yu-Hao, Tsai, Wen-Sy, Ma, Chung-Pei, Chen, Yi-Tung, Tan, Bertrand Chin-Ming, Lai, Ying-Yu, Chang, Ian Yi-Feng, Yang, Chi, Yang, Chia-Yu, Yu, Jau-Song, and Liu, Hsuan
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METASTASIS , *COLORECTAL cancer , *NON-coding RNA , *CIRCULATING tumor DNA , *CELL transformation , *RNA sequencing - Abstract
Purpose: Molecular composition of circulating small extracellular vesicles (EVs) does not merely reflect the cells of origin, but also is enriched in specific biomolecules directly associated with the cellular transformation. However, while most of the currently identified EV-miRs are only geared towards one-dimensional disease detection, their application for long-term tracking and treatment response monitoring has been largely elusive. Methods: We established and optimized a rapid, sensitive and robust liquid biopsy sampling method, and further used small RNA sequencing to comprehensively catalogue EV-miRomes in association with the progression and outcome of metastatic colorectal cancer (mCRC). Results: By cross-comparison of EV-miRomes (n = 290) from multi-stage and longitudinal cohorts, we uncovered a 15-EV-miR signature with dual detection and long-term monitoring of tumor size progression for mCRC. From this panel, EV-miR-320c was uncovered as a strong clinical marker – aside from its diagnostic power and a therapeutic monitoring performance superior to carcinoembryonic antigen (CEA), its high expression has also been linked to lower overall survival and a greater likelihood of disease recurrence. Further, integrative analyses of tissue transcriptomic and liquid biopsy implicated this 15-EV-miR signature in programming the mesenchymal–epithelial transition (MET) for distant localization of the metastasized cells and also in creating a tumor-favoring metastatic niche. Conclusion: Our clinically-oriented delineation of the mCRC-associated circulating EV-miRomes systematically revealed the functional significance of these liquid biopsy markers and further strengthen their translational potential in mCRC therapeutic monitoring. [ABSTRACT FROM AUTHOR]
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- 2022
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133. Preoperative risk stratification of permanent stoma in patients with non-metastatic mid and low rectal cancer undergoing curative resection and a temporary stoma.
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Huang, Shu-Huan, Tsai, Kun-Yu, Tsai, Tzong-yun, You, Jeng-Fu, Yeh, Chien-Yuh, Hsieh, Pao-Shiu, Tang, Reiping, Chiang, Jy-Ming, and Tsai, Wen-Sy
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SURGICAL stomas , *RECTAL cancer , *PREOPERATIVE risk factors , *ILEOSTOMY , *RECTAL surgery , *DISEASE risk factors ,RECTUM tumors - Abstract
Background: Although a temporary stoma can mitigate the severity of anastomotic leakage, some rectal cancer patients retain a permanent stoma after sphincter-preserving surgery. Therefore, this study aimed to identify independent preoperative risk factors for permanent stoma and establish a prediction model for mid-and low-rectal cancer patients who underwent sphincter-preserving surgery and temporary stoma. Methods: We retrospectively reviewed consecutive patients with non-metastatic rectal cancer between 2000 and 2015. The risk factors for permanent stomas were collected and analyzed. Results: A total of 1020 rectal cancer patients with temporary stoma were included. The overall rate of permanent stoma was 17.5% (n = 179). Cancer progression and anastomotic complications are major causes of permanent stomas. Multivariate analysis showed that preoperative risk factors such as advanced age, male sex, preoperative CEA ≥ 10 ng/ml, T4 stage, N stage, low rectal tumor, and ASA ≥ III were independent preoperative risk factors after adjustment. The ROC curve of the risk factors and permanent stoma showed an AUC of 0.689, a cut-off value of 2.5, a sensitivity of 0.689, and a specificity of 0.622. The permanent stoma rates were significantly higher between risk scores ≤ 2 and > 2 (29.9% vs. 11.3%, p < 0.001). Conclusion: Preoperative CEA ≥ 10 ng/ml, T4 stage, N stage, low rectal tumor, advanced age, ASA ≥ III, and male sex were independent preoperative prognostic factors for a permanent stoma. The risk was higher with a score greater than two. Therefore, the risk of subsequent permanent stoma should be evaluated and informed to the patient prior to the primary surgery. [ABSTRACT FROM AUTHOR]
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- 2022
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134. Smoking cessation for less than 10 years remains a risk factor of anastomotic leakage in mid-to-low rectal cancer patients undergoing sphincter-preserving surgery.
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Tsai, Kun-Yu, Huang, Shu-Huan, You, Jeng-Fu, Tang, Reiping, Chiang, Jy-Ming, Yeh, Chien-Yuh, Hsieh, Pao-Shiu, Tsai, Wen-Sy, Chiang, Sum-Fu, and Lai, Cheng-Chou
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RECTAL surgery , *SMOKING cessation , *RECTAL cancer , *CANCER patients , *RECEIVER operating characteristic curves , *LEAKAGE - Abstract
Purpose: Although cigarette smoking is a well-known risk factor for anastomotic leakage during rectal surgery, the proper duration of smoking cessation that can decrease anastomotic leakage in patients undergoing sphincter-preserving surgery is unclear. This study aimed to investigate the optimal duration of smoking cessation that can reduce this complication. Methods: Between January 1, 2000, and December 31, 2012, we enrolled 1246 consecutive patients who underwent curative-intent sphincter-preserving surgery without preventive stoma at the Division of Colorectal Surgery of a tertiary referral center in Taiwan. Questionnaires were used to record their pre-surgical smoking status. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off duration of smoking cessation. Multivariate analysis was used to verify the effect of cigarette cessation on anastomotic leakage. Results: The ROC curve showed a cut-off value of 10.5 years of cessation duration. Therefore, the former-smoker group was further divided using a cessation duration of 10 years. The overall anastomotic leakage rate was 5.29%. However, the anastomotic leakage rate in current smokers (9.3%) and in those who quit for < 10 years (12.9%) was significantly higher than that in non-smokers (3.3%) and those who quit for ≥ 10 years (4.5%). On multivariate analysis, current smokers (p = 0.022), former smokers with < 10 years of smoking cessation (OR 2.725; p = 0.029), male sex (p = 0.015), and low rectal cancer (p < 0.001) were all independently related to the development of anastomotic leakage. Conclusion: Smoking cessation for < 10 years remains a risk factor for anastomotic leakage in patients with mid-to-low rectal cancer undergoing sphincter-preserving surgery. [ABSTRACT FROM AUTHOR]
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- 2022
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135. The risk factors of local recurrence and distant metastasis on pT1/T2N0 mid-low rectal cancer after total mesorectal excision.
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Lai, I-Li, You, Jeng-Fu, Chern, Yih-Jong, Tsai, Wen-Sy, Chiang, Jy-Ming, Hsieh, Pao-Shiu, Hung, Hsin-Yuan, and Hsu, Yu-Jen
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METASTASIS , *SURGICAL margin , *CANCER relapse , *PREOPERATIVE risk factors , *CARCINOEMBRYONIC antigen , *RECTAL prolapse - Abstract
Background: Radical resection is associated with good prognosis among patients with cT1/T2Nx rectal cancer. However, still some of the patients experienced cancer recurrence following radical resection. This study tried to identify the postoperative risk factors of local recurrence and distant metastasis separately. Methods: This retrospective, single-center study comprised of 279 consecutive patients from Linkou branch of Chang Gung Memorial Hospital in 2005–2016 with rectal adenocarcinoma, pT1/T2N0M0 at distance from anal verge ≤ 8cm, who received curative radical resection. Results: The study included 279 patients with pT1/pT2N0 mid-low rectal cancer with median follow-up of 73.5 months. Nineteen (6.8%) patients had disease recurrence in total. Nine (3.2%) of them had local recurrence, and fourteen (5.0%) of them had distant metastasis. Distal resection margin < 0.9 (cm) (hazard ratio = 4.9, p = 0.050) was the risk factor of local recurrence. Preoperative carcinoembryonic antigen (CEA) ≥ 5 ng/mL (hazard ratio = 9.3, p = 0.0003), lymph node yield (LNY) < 14 (hazard ratio = 5.0, p = 0.006), and distal resection margin < 1.4cm (hazard ratio = 4.0, p = 0.035) were the risk factors of distant metastasis. Conclusion: For patients with pT1/pT2N0 mid-low rectal cancer, current multidisciplinary treatment brings acceptable survival outcome. Insufficient distal resection margin attracted the awareness of risk factors for local recurrence and distant metastasis as a foundation for future research. [ABSTRACT FROM AUTHOR]
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- 2021
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136. Sensitive and Specific Biomimetic Lipid Coated Microfluidics to Isolate Viable Circulating Tumor Cells and Microemboli for Cancer Detection
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Tsung-Fu Hung, Jia-Yang Chen, Liang-Chun Wu, Wen-Sy Tsai, Jr-Ming Lai, Wen-Hwa Lee, Hung-Jen Shao, Chih-Tsung Yang, Si-Hong Lu, Jen-chia Wu, Jinn-Shiun Chen, Ying-Chih Chang, Chen, Jia-Yang, Tsai, Wen-Sy, Shao, Hung-Jen, Wu, Jen-Chia, Lai, Jr-Ming, Lu, Si-Hong, Hung, Tsung-Fu, Yang, Chih-Tsung, Wu, Liang-Chun, Chen, Jinn-Shiun, Lee, Wen-Hwa, and Chang, Ying-Chih
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0301 basic medicine ,Male ,Pathology ,Colorectal cancer ,Physiology ,Microfluidics ,lcsh:Medicine ,02 engineering and technology ,Biochemistry ,Metastasis ,Circulating tumor cell ,Fluorescence Microscopy ,Lab-On-A-Chip Devices ,Medicine and Health Sciences ,lcsh:Science ,Early Detection of Cancer ,Whole blood ,Flow Rate ,Microscopy ,Multidisciplinary ,biology ,Physics ,Light Microscopy ,Classical Mechanics ,Hematology ,Middle Aged ,021001 nanoscience & nanotechnology ,Neoplastic Cells, Circulating ,Lipids ,Foam ,Body Fluids ,Multidisciplinary Sciences ,Blood ,Oncology ,Physical Sciences ,Engineering and Technology ,Female ,Fluidics ,Antibody ,Anatomy ,0210 nano-technology ,Colorectal Neoplasms ,Research Article ,Adult ,medicine.medical_specialty ,Materials by Structure ,Materials Science ,Fluid Mechanics ,Research and Analysis Methods ,Continuum Mechanics ,Antibodies ,03 medical and health sciences ,Antigen ,Antigens, Neoplasm ,medicine ,Cancer Detection and Diagnosis ,Humans ,Colorectal Cancer ,metastatic prostate-cancer ,lcsh:R ,colorectal-cancer ,Cancer ,Cancers and Neoplasms ,Biology and Life Sciences ,Fluid Dynamics ,medicine.disease ,HCT116 Cells ,030104 developmental biology ,biology.protein ,Cancer research ,lcsh:Q ,Ex vivo - Abstract
Here we presented a simple and effective membrane mimetic microfluidic device with antibody conjugated supported lipid bilayer (SLB) "smart coating" to capture viable circulating tumor cells (CTCs) and circulating tumor microemboli (CTM) directly from whole blood of all stage clinical cancer patients. The non-covalently bound SLB was able to promote dynamic clustering of lipid-tethered antibodies to CTC antigens and minimized non-specific blood cells retention through its non-fouling nature. A gentle flow further flushed away loosely-bound blood cells to achieve high purity of CTCs, and a stream of air foam injected disintegrate the SLB assemblies to release intact and viable CTCs from the chip. Human blood spiked cancer cell line test showed the similar to 95% overall efficiency to recover both CTCs and CTMs. Live/dead assay showed that at least 86% of recovered cells maintain viability. By using 2 mL of peripheral blood, the CTCs and CTMs counts of 63 healthy and colorectal cancer donors were positively correlated with the cancer progression. In summary, a simple and effective strategy utilizing biomimetic principle was developed to retrieve viable CTCs for enumeration, molecular analysis, as well as ex vivo culture over weeks. Due to the high sensitivity and specificity, it is the first time to show the high detection rates and quantity of CTCs in non-metastatic cancer patients. This work offers the values in both early cancer detection and prognosis of CTC and provides an accurate non-invasive strategy for routine clinical investigation on CTCs. Refereed/Peer-reviewed
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- 2016
137. Comparison of laparoscopic and open surgery for colorectal malignancy in obese patients: a propensity score-weighted cohort study.
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Hsu YJ, Yu YL, Jhuang JR, You JF, Liao CK, Tsai WS, Pan YP, and Chern YJ
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- Humans, Female, Male, Middle Aged, Aged, Retrospective Studies, Cohort Studies, Postoperative Complications epidemiology, Postoperative Complications etiology, Adenocarcinoma surgery, Adenocarcinoma pathology, Adult, Operative Time, Treatment Outcome, Laparoscopy adverse effects, Propensity Score, Colorectal Neoplasms surgery, Colorectal Neoplasms pathology, Obesity complications
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Background: Insufficient evidence exists to ascertain the long-term prognosis in patients with obesity undergoing laparoscopic surgery versus open surgery for colorectal cancer., Methods: Employing an institutional database from 2009 to 2019, we assessed individuals with a BMI of greater than or equal to 30 kg/m 2 who underwent surgery for primary stage I-III colorectal adenocarcinoma. The authors used propensity score-weighted analysis to compare short-term and oncologic outcomes between laparoscopic and open surgical approaches., Results: This study enrolled 473 patients (open vs. laparoscopic surgery: 220 vs. 253; median follow-up period, 60 months). The laparoscopy group showed a significantly longer operative time (252 vs. 212 min), a higher anastomotic-leakage rate (5.14% vs. 0.91%), and a greater proportion of Clavien-Dindo class greater than III complications (5.93% vs. 1.82%). The open group showed a higher wound infection rate (7.27% vs. 3.16%) and a higher readmission rate (6.36% vs. 2.37%). After propensity score weighting, laparoscopy was inferior to open surgery in terms of long-term overall survival (hazard ratio: 1.43), disease-free survival (1.39), and recurrence rate (21.1% vs. 14.5%). In the subgroup analysis, female patients, older individuals, stage III patients, patients with rectal cancer, and those who underwent surgery after 2014 showed inferior long-term outcomes after laparoscopy., Conclusions: Laparoscopic colorectal cancer surgery for patients with obesity requires significant caution. Despite good short-term outcomes, this procedure is associated with hidden risks and poor long-term prognoses. In female patients, older individuals, stage III patients, patients with rectal cancer, and those treated in the late surgery era subgroups, caution is advised when performing laparoscopic surgery., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2024
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138. Predictors for temporary stomas non-closure among non-metastatic rectal cancer patients undergoing curative resection: a retrospective analysis.
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Hsu CC, Tsai WS, Tsai TY, You JF, Yeh CY, Hsieh PS, Tang R, and Huang SH
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- Humans, Retrospective Studies, Female, Male, Middle Aged, Aged, Prognosis, Risk Factors, Follow-Up Studies, Anastomotic Leak etiology, Anastomotic Leak epidemiology, Neoplasm Recurrence, Local pathology, Neoplasm Recurrence, Local epidemiology, Neoplasm Recurrence, Local surgery, Postoperative Complications etiology, Postoperative Complications epidemiology, Adult, Proctectomy methods, Proctectomy adverse effects, Aged, 80 and over, Rectal Neoplasms surgery, Rectal Neoplasms pathology, Surgical Stomas adverse effects
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Background: The primary treatment for non-metastatic rectal cancer is curative resection. However, sphincter-preserving surgery may lead to complications. This study aims to develop a predictive model for stoma non-closure in rectal cancer patients who underwent curative-intent low anterior resection., Methods: Consecutive patients diagnosed with non-metastatic rectal cancer between January 2005 and December 2017, who underwent low anterior resection, were retrospectively included in the Chang Gung Memorial Foundation Institutional Review Board. A comprehensive evaluation and analysis of potential risk factors linked to stoma non-closure were performed., Results: Out of 956 patients with temporary stomas, 10.3% (n = 103) experienced non-closure primarily due to cancer recurrence and anastomosis-related issues. Through multivariate analysis, several preoperative risk factors significantly associated with stoma non-closure were identified, including advanced age, anastomotic leakage, positive nodal status, high preoperative CEA levels, lower rectal cancer presence, margin involvement, and an eGFR below 30 mL/min/1.73m2. A risk assessment model achieved an AUC of 0.724, with a cutoff of 2.5, 84.5% sensitivity, and 51.4% specificity. Importantly, the non-closure rate could rise to 16.6% when more than two risk factors were present, starkly contrasting the 3.7% non-closure rate observed in cases with a risk score of 2 or below (p < 0.001)., Conclusion: Prognostic risk factors associated with the non-closure of a temporary stoma include advanced age, symptomatic anastomotic leakage, nodal status, high CEA levels, margin involvement, and an eGFR below 30 mL/min/1.73m2. Hence, it is crucial for surgeons to evaluate these factors and provide patients with a comprehensive prognosis before undergoing surgical intervention., (© 2024. The Author(s).)
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- 2024
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139. Tumor Marker Trajectories and Survival Analysis in Patients With Normal Carcinoembryonic Antigen Ranges After Colorectal Cancer Resection.
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Chern YJ, Hsu HY, Hsu YJ, Hsu LY, Tsai WS, Liao CK, Jong BK, and You JF
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- Humans, Carcinoembryonic Antigen, Biomarkers, Tumor, Retrospective Studies, Cohort Studies, Survival Analysis, Neoplasm Staging, Adenocarcinoma surgery, Colorectal Neoplasms surgery, Rectal Neoplasms
- Abstract
Background: Evidence regarding postoperative CEA for predicting long-term outcomes of colorectal cancer remains controversial, especially in patients with normal postoperative CEA., Objective: To investigate the risk difference among different postoperative CEA trajectories in patients with normal postoperative CEA after curative colorectal cancer resection., Design: This cohort study was conducted at a comprehensive cancer center and included data retrieved from a prospectively collected database between January 2006 and December 2018., Settings: Retrospective cohort study., Patients: Patients with colorectal cancer who underwent surgery for primary stage I to III colorectal adenocarcinoma were included and those with postoperative CEA >5 ng/mL were excluded., Interventions: Standard curative radical resection was performed., Main Outcome Measures: Ten-year overall survival and disease-free survival were analyzed., Results: The study population (n = 8156) was categorized into 6 trajectories: persistent-ultralow (n = 2351), persistent-low (n = 2474), gradually decrease (n = 401), persistent-medium (n = 1727), slightly increase (n = 909), and around-upper-limit (n = 394). The median follow-up time was 7.8 years, and the median time frame in which CEA was measured to determine trajectory was 2.6 years. The persistent-ultralow group had the highest 10-year overall survival (85.1%) and disease-free survival (82.7%). The around-upper-limit group had the lowest 10-year overall survival (55.5%) and disease-free survival (53.4%). The adjusted HR trend was comparable to the crude HR of the persistent-ultralow group. Consequently, the higher initial serum CEA groups had higher HRs of overall survival and disease-free survival. The adjusted HR of overall survival was 2.96 (95% CI, 2.39-3.66) and of disease-free survival was 2.66 (95% CI, 2.18-3.69) for the around-upper-limit groups., Limitations: Retrospective design., Conclusions: The postoperative serum CEA trajectory is an independent factor associated with long-term outcomes. Although CEA levels were all within normal range, higher levels of postoperative serum CEA trajectory correlated with worse long-term oncological outcomes. See Video Abstract., Trayectorias De Marcadores Tumorales Y Anlisis De Supervivencia En Pacientes Con Rangos Normales De Antgeno Carcinoembrionario Posterior a Reseccin De Cncer Colorrectal: ANTECEDENTES:La evidencia sobre el CEA post operatorio para la predicción de los resultados a largo plazo del cáncer colorrectal sigue siendo controversial, especialmente en pacientes con CEA post quirúrgico normal.OBJETIVO:Investigar la diferencia de riesgo entre diferentes trayectorias postoperatorias del CEA en pacientes con CEA post quirúrgico normal tras la resección curativa del cáncer colorrectal.DISEÑO:Este estudio de cohorte se realizó en un centro oncológico integral e incluyó datos recuperados de una base de datos recopilada prospectivamente entre enero de 2006 y diciembre de 2018.AJUSTES:Estudio de cohorte retrospectivo.PACIENTES:Se incluyeron pacientes con el diagnostico de CCR que fueron sometidos a cirugía por adenocarcinoma colorrectal primario en estadio I-III. Se excluyeron pacientes con CEA postoperatorio >5 ng/mL.INTERVENCIONES:Se realizó una resección radical curativa estandarizada.PRINCIPALES MEDIDAS DE RESULTADO:Se analizaron la supervivencia general a diez años y la supervivencia libre de enfermedad.RESULTADOS:La población de estudio (n = 8156) fue clasificada en seis trayectorias, que incluyeron ultrabajo persistente (n = 2351), bajo persistente (n = 2474), disminución gradual (n = 401), medio persistente (n = 1727), aumento leve (n = 909) y alrededor del límite superior (n = 394). La mediana del tiempo de seguimiento fue de 7,8 años y la mediana del período de tiempo en el que el CEA fue medido para determinar la trayectoria fue de 2,6 años. El grupo ultrabajo persistente tuvo la mayor supervivencia general a 10 años (85,1 %) y supervivencia libre de enfermedad (82,7 %). El grupo alrededor del límite superior tuvo la supervivencia general a 10 años más baja (55,5 %) y la supervivencia libre de enfermedad (53,4 %). La tendencia del índice de riesgo ajustado fue comparable al índice de riesgo bruto del grupo ultrabajo persistente. En consecuencia, los grupos con CEA sérico iniciales más altos tenían índices de riesgos más altos de supervivencia general y supervivencia libre de enfermedad. Los índices de riesgos ajustados de supervivencia general/supervivencia libre de enfermedad fueron 2,96/2,66 (intervalo de confianza del 95 %: 2,39-3,66/2,18-3,69) para los grupos cercanos al límite superior.LIMITACIONES:El estudio estuvo limitado por su diseño retrospectivo.CONCLUSIONES:La trayectoria del CEA sérico postoperatorio es un factor independiente asociado con resultados a largo plazo. Aunque los niveles de CEA se encontraban todos dentro del rango normal, los niveles más altos de trayectoria del CEA en suero posoperatorio se correlacionaron con peores resultados oncológicos a largo plazo. (Traducción-Dr Osvaldo Gauto )., (Copyright © The ASCRS 2023.)
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- 2024
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140. The Longitudinal Trends of Care Needs, Psychological Distress, and Quality of Life and Related Predictors in Taiwanese Colorectal Cancer Survivors.
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Wang IY, Jane SW, Hsu HC, Lin YC, Tsai WS, Young CY, Beaton RD, and Huang HP
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- Humans, Quality of Life psychology, Survivors psychology, Stress, Psychological, Cancer Survivors psychology, Colorectal Neoplasms therapy, Psychological Distress
- Abstract
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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- 2023
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141. Metformin increases pathological responses to rectal cancers with neoadjuvant chemoradiotherapy: a systematic review and meta-analysis.
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Lai IL, You JF, Tsai WS, Hsu YJ, Chern YJ, and Wu MY
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- Humans, Neoadjuvant Therapy, Chemoradiotherapy, Treatment Outcome, Metformin therapeutic use, Rectal Neoplasms pathology, Diabetes Mellitus drug therapy
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Background: To summarize the chemo-radio effect of metformin in rectal cancers with neoadjuvant chemoradiotherapy on pathological response, tumor regression grade (TRG), and T/N downstaging., Methods: PubMed, MEDLINE, Embase, and Cochrane Database of collected reviews were searched up to June 30, 2022. This study conducted systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) sheet. Odds ratios (ORs) and confidence intervals (CIs) which calculated by random-effects models were displayed in forest plots. Newcastle-Ottawa scale was used to assess the risk of bias of the observational cohort studies., Results: This systematic review and meta-analysis comprised eight cohorts out of seven studies, with 2294 patients in total. We performed two-way comparison for metformin in diabetic patients vs (1) non-metformin drugs in diabetic patients and (2) nondiabetic patients. In diabetes patient studies, the metformin group had a significantly increased pathological response on TRG (OR: 3.28, CI: 2.01-5.35, I
2 = 0%, p < 0.001) and T downstaging (OR: 2.14, CI: 1.24-3.67, I2 = 14%, p = 0.006) in comparison with a non-metformin group. When compared with nondiabetic patients, the pathological response on TRG (OR: 2.67, CI: 1.65-4.32, I2 = 43%, p < 0.001) and T downstaging (OR: 1.96, CI: 1.04-3.71, I2 = 66%, p = 0.04) were also higher in metformin group. The limitation was that no randomized controlled trials were available based on current literature review. Small sample sizes for diabetic metformin or non-metformin users in rectal cancer patients reduced the power of the study., Conclusions: For patients with rectal cancer and treated with neoadjuvant chemoradiotherapy, metformin administration in diabetic patients increased the pathological response on tumor-regression grade and T downstaging. Further well-designed, high-quality randomized controlled trials are required to reveal the actual effect of metformin., (© 2023. The Author(s).)- Published
- 2023
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142. Potential short-term outcome advantage of low vs. high ligation of inferior mesenteric artery for sigmoid and rectal cancer: propensity score matching analysis.
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Hsu CC, Hsu YJ, Chern YJ, Jong BK, Liao CK, Hsieh PS, Tsai WS, and You JF
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- Humans, Colon, Sigmoid surgery, Anastomotic Leak epidemiology, Anastomotic Leak surgery, Mesenteric Artery, Inferior surgery, Propensity Score, Retrospective Studies, Lymph Node Excision methods, Ligation, Rectal Neoplasms surgery, Sigmoid Neoplasms surgery
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Background: Whether to ligate the inferior mesenteric artery at its root during anterior resection for sigmoid colon or rectal cancer is still under debate. This study compared the surgical outcomes, postoperative recovery, and anastomotic leakage between high and low ligation of the inferior mesenteric artery through a subgroup analysis., Methods: This was a retrospective analysis of prospectively collected data. All patients who underwent colorectal resection for rectosigmoid cancer between December 2016 and December 2019 were enrolled. According to the surgical ligation level of the inferior mesenteric artery, the patients were categorized into either the high or low ligation group. The investigated population was matched using the propensity score method., Results: Overall, 894 patients with sigmoid or rectal cancer underwent elective anterior resection with high (577 patients) or low (317 patients) ligation of the inferior mesenteric artery. After the propensity score matching, 245 patients in each group were compared. High ligation of the inferior mesenteric artery was associated with higher incidence of anastomotic leakage (14.9% vs. 5.6%, P = 0.041) for mid- to low-rectum tumors and a higher incidence of complications (8.6% vs. 3.3%, P = 0.013) of grades 1-2 according to the Clavien-Dindo classification system., Conclusion: Compared with high ligation, low ligation of the inferior mesenteric artery resulted in lower likelihood of morbidity and mortality in rectal and sigmoid cancers. Moreover, low ligation was less likely to result in anastomosis leakage in mid- to low-rectal cancers., (© 2023. The Author(s).)
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- 2023
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143. MicroRNA-based signature for diagnosis and prognosis of colorectal cancer using residuum of fecal immunochemical test.
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Chen CC, Chang PY, Chang YS, You JF, Chan EC, Chen JS, Tsai WS, Huang YL, Fan CW, Hsu HC, and Chiang JM
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- Humans, Prospective Studies, Prognosis, Logistic Models, MicroRNAs genetics, Colorectal Neoplasms diagnosis, Colorectal Neoplasms genetics, Colorectal Neoplasms pathology
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Background: Colorectal cancer (CRC) is still among the most lethal and prevalent malignancies in the world. Despite continuous efforts, the diagnosis and prognosis of CRC have never been satisfying, especially the non-invasive assays., Methods: Our study comprised three independent cohorts of 835 qualified stool samples. From 46 literature-identified miRNA candidates, four miRNA ratios were selected and developed into a miRNA-based signature after applied to the training and test sets. The clinical performances of this signature were further evaluated in the prospective cohorts., Results: Four miRNA ratios with significant alterations and the highest discriminating power between the CRC and control groups in the training set were successfully validated in the test set. In the training dataset, combining these four miRNA ratios using a logistic regression model improved the area under the curve value to 0.821 and obtained a sensitivity of 73.6% and specificity of 78.9%. This miRNA signature showed consistent performances in the other two sample cohorts, with the highest sensitivity of 85.7% in the prospective cohort. Additionally, the higher miRNA signature was associated with worse disease-free survival (hazard ratio = 2.27) and overall survival (hazard ratio = 1.83) of CRC patients. For fecal immunochemical test (FIT)-positive populations, the positive predictive value for CRC detection in miRNA-positive subjects was 3.43-fold higher in the prospective cohort, compared to FIT alone., Conclusion: This stool miRNA signature is highly associated with poor outcome of CRC and can be added to FIT tests to help identify the most at-risk group to receive prompt colonoscopy examination., Competing Interests: Conflicts of interest Each author that there is no conflict to disclose. The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication., (Copyright © 2022 Chang Gung University. Published by Elsevier B.V. All rights reserved.)
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- 2023
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144. Usefulness of close surveillance for rectal cancer patients after neoadjuvant chemoradiotherapy.
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Hsu YJ, Chern YJ, Lai IL, Chiang SF, Liao CK, Tsai WS, Hung HY, Hsieh PS, Yeh CY, Chiang JM, Yu YL, and You JF
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It is controversial whether patients who achieve clinical complete remission (cCR) of rectal cancer should be treated with the "watch and wait" (W&W) or radical resection (RR) strategy. Our study aimed to compare the survival outcomes and ostomy rate of the W&W and RR strategies. Between January 2008 and December 2015, we investigated 26 patients who achieved pathologic complete remission after undergoing RR and 36 patients who adopted the W&W strategy because of cCR. The tumor regrowth, salvage surgery, recurrence, disease-free, and overall survival (OS) rates were assessed. In our study, recurrences occurred in nine and two patients from the W&W and RR groups, respectively. Each patient in the RR group had a temporary or permanent ostomy, but only three (8.3%) had an ostomy in the W&W group. The 5-year recurrence rate was 25.0% in the W&W group and 7.7% in the RR group. Six patients (16.7%) had tumor regrowth in the W&W group, and all were resectable when regrowth. The 5-year OS rates between the two groups were nonsignificant. There is no specific risk factor for recurrence and OS. Under close surveillance, the W&W group achieved similar OS to the RR group and benefited from a lower ostomy rate., Competing Interests: Conflict of interest: There is no conflict of interest, use of off-label or unapproved drugs or products, and use of previously copyrighted material. None of the authors has any potential financial or non-financial conflicts of interest., (© 2022 Yu-Jen Hsu et al., published by De Gruyter.)
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- 2022
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145. circlncRNAnet: an integrated web-based resource for mapping functional networks of long or circular forms of noncoding RNAs.
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Wu SM, Liu H, Huang PJ, Chang IY, Lee CC, Yang CY, Tsai WS, and Tan BC
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- Computational Biology, Databases, Nucleic Acid, High-Throughput Nucleotide Sequencing, Humans, Internet, MicroRNAs genetics, MicroRNAs metabolism, RNA metabolism, RNA Processing, Post-Transcriptional, RNA, Circular, RNA, Long Noncoding metabolism, RNA, Messenger metabolism, Sequence Analysis, RNA, Transcription, Genetic, Epigenesis, Genetic, Gene Regulatory Networks, RNA genetics, RNA, Long Noncoding genetics, RNA, Messenger genetics, User-Computer Interface
- Abstract
Background: Despite their lack of protein-coding potential, long noncoding RNAs (lncRNAs) and circular RNAs (circRNAs) have emerged as key determinants in gene regulation, acting to fine-tune transcriptional and signaling output. These noncoding RNA transcripts are known to affect expression of messenger RNAs (mRNAs) via epigenetic and post-transcriptional regulation. Given their widespread target spectrum, as well as extensive modes of action, a complete understanding of their biological relevance will depend on integrative analyses of systems data at various levels., Findings: While a handful of publicly available databases have been reported, existing tools do not fully capture, from a network perspective, the functional implications of lncRNAs or circRNAs of interest. Through an integrated and streamlined design, circlncRNAnet aims to broaden the understanding of ncRNA candidates by testing in silico several hypotheses of ncRNA-based functions, on the basis of large-scale RNA-seq data. This web server is implemented with several features that represent advances in the bioinformatics of ncRNAs: (1) a flexible framework that accepts and processes user-defined next-generation sequencing-based expression data; (2) multiple analytic modules that assign and productively assess the regulatory networks of user-selected ncRNAs by cross-referencing extensively curated databases; (3) an all-purpose, information-rich workflow design that is tailored to all types of ncRNAs. Outputs on expression profiles, co-expression networks and pathways, and molecular interactomes, are dynamically and interactively displayed according to user-defined criteria., Conclusions: In short, users may apply circlncRNAnet to obtain, in real time, multiple lines of functionally relevant information on circRNAs/lncRNAs of their interest. In summary, circlncRNAnet provides a "one-stop" resource for in-depth analyses of ncRNA biology. circlncRNAnet is freely available at http://app.cgu.edu.tw/circlnc/., (© The Authors 2017. Published by Oxford University Press.)
- Published
- 2018
- Full Text
- View/download PDF
146. Anorectal melanoma: review of 22 consecutive cases.
- Author
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Yen CI, Chen HH, Chiang SF, Yeh CY, Chen JS, Hsieh PS, Chiang JM, Tsai WS, Tang R, Changchien CR, and Wang JY
- Subjects
- Adult, Aged, Aged, 80 and over, Anus Neoplasms mortality, Anus Neoplasms pathology, Female, Humans, Male, Melanoma mortality, Melanoma pathology, Middle Aged, Neoplasm Staging, Rectal Neoplasms mortality, Rectal Neoplasms pathology, Anus Neoplasms surgery, Melanoma surgery, Rectal Neoplasms surgery
- Abstract
Background/aims: To evaluate outcome and prognostic factors of patients with anorectal melanoma., Methodology: Twenty-two consecutive patients with anorectal melanoma received operation from 1993 through 2011 were reviewed. The definitions of stage I, II and III are local disease, locoregional lymphadenopathy and metastatic disease, respectively., Results: The patients included 8 men and 14 women, aged from 36 to 83 years (mean, 58.4 years). At the end of the follow-up period, 19 patients died of disease and only 3 patients were alive with disease. Only two patients were alive longer than 5 years after operation. For stage I and II tumors that underwent clinical curative resection (n=17), stage II (p=0.04), tumor size >3 cm (p=0.008) and invasion depth to muscle (p=0.021) all showed poorer prognosis in overall survival. Though wide local excision (WLE) were performed in the patients with earlier tumors, there was no statistical difference in overall (p=0.063) and disease-free survival (p=0.333) between WLE and radical surgery. Furthermore, patients with WLE had more chance of local recurrence than radical surgery (6/7 vs. 3/10, p=0.050). Four salvage radical operations could be performed after local recurrence in WLE group., Conclusions: WLE increases the chance of local recurrence more than radical surgery. Care should be taken to avoid microseeding during performed WLE.
- Published
- 2013
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147. Clinical outcome of signet ring cell carcinoma and mucinous adenocarcinoma of the colon.
- Author
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Chen JS, Hsieh PS, Chiang JM, Yeh CY, Tsai WS, Tang R, Changchien CR, and Wu RC
- Subjects
- Adenocarcinoma, Mucinous mortality, Adolescent, Adult, Aged, Aged, 80 and over, Carcinoma, Signet Ring Cell mortality, Colonic Neoplasms mortality, Female, Humans, Male, Middle Aged, Neoplasm Staging, Prognosis, Survival Rate, Adenocarcinoma, Mucinous pathology, Carcinoma, Signet Ring Cell pathology, Colonic Neoplasms pathology
- Abstract
Background: The purpose of this study was to evaluate the clinicopathologic features and prognosis of signet ring cell carcinoma (SCC) and non-SCC mucinous adenocarcinoma (MC) and to compare them with those of nonmucinous adenocarcinoma (NMC) of the colon., Methods: From January 1995 to December 2003, 45 patients with SCC and 332 with MC were identified from prospectively collected medical records. The clinical data and outcomes were compared with those of 2984 consecutive patients with NMC in the same period., Results: The mean age at onset of SCC was 54.3 years. This was significantly lower than those for MC (mean 59.5 years, p = 0.038) and NMC (62.4 years, MC vs. NMC, p < 0.01). The rate of spread of tumors in TNM stage IV via hematogenous routes (liver, lung, bone, and brain) was significantly lower in SCC patients (5/28, 17.9%) than in MC (40/104, 38.5%) and in NMC patients (417/694, 60.1%). The rate of tumor spread via lymphatic drainage (systemic node) or seeding to the peritoneum was higher in SCC (23/28, 82.1%) and MC patients (79/104, 76.0%), than in NMC patients (343/694, 49.4%, p < 0.001). There was a higher proportion of poorly differ-entiated tumors in SCC (32/42, 71.1%) than in MC (26/332, 7.8%) and NMC (203/2984, 6.8%). The 1-, 2-, and 5-year overall survival rates of patients with SCC were 77.8%, 26.7%, and 11.9%, of those with MC, 81.6%, 65.9%, and 49.4% and of those with NMC, 84.1%, 73.3%, and 58.7%, respectively., Conclusion: The prognosis of SCC is poorer than that of MC and NMC. SCC patients had more locally advanced and almost no early-detected tumors, less hematogenic spread, and very poor surgical outcomes. The role of resection for late stage SCC should be carefully evaluated.
- Published
- 2010
148. Effect of body mass index on the outcome of patients with rectal cancer receiving curative anterior resection: disparity between the upper and lower rectum.
- Author
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You JF, Tang R, Changchien CR, Chen JS, You YT, Chiang JM, Yeh CY, Hsieh PS, Tsai WS, Fan CW, and Hung HY
- Subjects
- Aged, Colectomy, Female, Humans, Male, Middle Aged, Overweight, Thinness, Treatment Outcome, Adenocarcinoma surgery, Body Mass Index, Neoplasm Recurrence, Local, Rectal Neoplasms surgery, Rectum surgery
- Abstract
Objective: The aim of this study was to investigate the effect of body mass index (BMI) on local recurrence of primary rectal cancer after open curative sphincter-saving resection., Background: Increasing BMI was reported to be associated with a higher likelihood of local recurrence in male patients with rectal cancer. However, it remained unclear whether BMI exerts the same effects on local recurrence of rectal cancer in the upper and lower rectum., Methods: Between January 1995 and December 2002, we investigated 1873 patients with well-documented body height and body weight who underwent curative anterior resection for primary rectal cancer in a single institution. The patients were assigned to 4 groups according to their BMI: underweight, normal, overweight, and obese., Results: The frequency of local recurrence increased with an increase in the BMI in patients with lower rectal cancer. The local recurrence rates were 2.5% (2 of 79), 6.1% (48 of 782), 9.2% (39 of 424), and 13.8% (9 of 65) in underweight, normal, overweight, and obese patients with lower rectal cancer, respectively. These results were different from those of patients with upper rectal cancer. Independent risk factors for local recurrence in the lower rectal cancer group were BMI, resection margin, histologic grade of differentiation, depth of tumor invasion, and status of lymph node metastases. In the upper rectal cancer group, the depth of tumor invasion and histologic grade of differentiation reached statistical significance., Conclusions: BMI exerted different effects on local recurrence of rectal cancer in the upper and lower rectum. Further, more aggressive adjuvant and/or neoadjuvant treatments should be considered for patients with tumor in the lower rectum and with higher BMI.
- Published
- 2009
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149. Clinical features of second other-site primary cancers among sporadic colorectal cancer patients--a hospital-based study of 3,722 cases.
- Author
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Chiang JM, Yeh CY, Changehien CR, Chen JS, Tang R, Tsai WS, and Fan CW
- Subjects
- Colectomy, Colorectal Neoplasms epidemiology, Colorectal Neoplasms pathology, Colorectal Neoplasms surgery, Cross-Sectional Studies, Female, Follow-Up Studies, Humans, Male, Neoplasm Staging, Neoplasms, Multiple Primary epidemiology, Neoplasms, Multiple Primary pathology, Neoplasms, Multiple Primary surgery, Postoperative Complications epidemiology, Postoperative Complications pathology, Postoperative Complications surgery, Probability, Registries statistics & numerical data, Risk, Sex Factors, Taiwan, Colorectal Neoplasms diagnosis, Neoplasms, Multiple Primary diagnosis, Postoperative Complications diagnosis
- Abstract
Background/aims: Although synchronous and metachronous colorectal cancers are now well known to all colorectal surgeons, second other-site primary cancers following colorectal cancer are unfamiliar to most colorectal physicians. Knowledge of the clinical characteristics of these second other-site primary cancers becomes important especially during their follow-up surveillance., Methodology: Information from a computer database was retrieved. Medical records were reviewed and all histopathological data were confirmed., Results: Forty-seven (1.26%) patients developed second other-site primary cancers. Of these patients, 22 (46.8%) patients were diagnosed concordantly while 25 (53.2%) patients were discordant cases. Twelve of 25 (45%) discordant cases were found within one year postoperatively. Regarding the clinical features of these 47 patients, male patients more frequently develop discordant cases (p=0.031). A significantly higher proportion of Dukes' B patients developed second other-site primary cancer than that of patients of other stages (p=0.017). Liver, 8 (17%) cases, was the most common site followed by the prostate, 6 (13%), stomach, 6 (13%), lung, 5 (11%), head and neck cancers, 5 (11%), and kidney, 3 (6.4%). However, there was not a significantly increased risk for these sporadic colorectal patients statistically., Conclusions: We described clinical features of second other-site primary cancers and emphasized that knowledge of these is important for their postoperative surveillance.
- Published
- 2004
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