Annals of Coloproctology

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Colorectal cancer

Are the width, length, depth, and area of submucosal invasion predictive of lymph node metastasis in pT1 colorectal cancer?: Olga Maynovskaia, Evgeny Rybakov, Stanislav Chernyshov, Evgeniy Khomyakov, Sergey Achkasov; Ann Coloproctol. 2023;39(6):484-492. Published online December 26, 2023; DOI: https://doi.org/10.3393/ac.2023.00087.0012

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Purpose
Submucosa-limited (pathological T1, pT1) colorectal cancers (CRCs) pose a continuing challenge in the choice of treatment options, which range from local excision to radical surgery. The aim of this study was to evaluate the morphometric and morphologic risk factors associated with regional lymph node metastasis (LNM) in pT1 CRC.
Methods
We performed a histological review of patients who underwent oncological resection between 2016 and 2022. Tumor grade, budding, poorly differentiated clusters (PDCs), cancer gland rupture, lymphovascular invasion (LVI), and presence of deep submucosal invasion (DSI), as well as width, length, total area, and area of DSI, were evaluated as potential risk factors for LNM.
Results
A total of 264 cases of colon and rectal carcinomas with invasion into the submucosal layer (pT1) were identified. LNM was found in 46 of the 264 cases (17.4%). All morphometric parameters, as well as DSI (P=0.330), showed no significant association with LNM. High grade adenocarcinoma (P=0.050), budding (P=0.056), and PDCs (P<0.001) were associated with LNM. In the multivariate analysis, LVI presence remained the only significant independent risk factor (odds ratio, 15.7; 95% confidence interval, 8.5–94.9; P<0.001).
Conclusion
The DSI of T1 CRC, as well as other morphometric parameters of submucosal tumor spread, held no predictive value in terms of LNM. LVI was the only independent risk factor of LNM.

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The results of randomized controlled trial comparing effectiveness of transanal endoscopic microsurgery versus endoscopic submucosal dissection
Evgeny Rybakov, Stanislav Chernyshov, Aleksey Likutov, Evgeny Khomiakov, Oleg Yugai, Mikhail Alekseev, Olga Maynovskaia, Mikhail Tarasov, Sergei Achkasov
Surgical Endoscopy.2026; 40(1): 469. CrossRef
Calibrated Absolute Risk of Lymph-Node-Metastasis After Non-curative Endoscopic Resection of pT1 Colorectal Cancer
Jung Kyong Shin, Hee Cheol Kim, Woo Yong Lee, Seong Hyeon Yun, Yong Beom Cho, Jung Wook Huh, Yoon Ah Park
Annals of Surgical Oncology.2026;[Epub] CrossRef
IMMUNOREACT 8: Immune markers of local tumor spread in patients undergoing transanal excision for clinically N0 rectal cancer
Giulia Becherucci, Cesare Ruffolo, Melania Scarpa, Federico Scognamiglio, Astghik Stepanyan, Isacco Maretto, Andromachi Kotsafti, Ottavia De Simoni, Pierluigi Pilati, Boris Franzato, Antonio Scapinello, Francesca Bergamo, Marco Massani, Tommaso Stecca, An
Surgery.2025; 178: 108902. CrossRef
Long-term outcomes and lymph node metastasis following endoscopic resection with additional surgery or primary surgery for T1 colorectal cancer
Pin-Chun Chen, Yi-Kai Kao, Po-Wen Yang, Chia-Hung Chen, Chih-I Chen
Scientific Reports.2025;[Epub] CrossRef
Management strategies for pT1 rectal cancer following local excision: Insights from a national survey by the AIRO gastrointestinal study group
Elena Galofaro, Paola De Franco, Federico Barbaro, Roberta Menghi, Silvia Pecere, Angela Romano, Silvia Di Franco, Rita Marina Niespolo, Mariantonietta Gambacorta, Giuditta Chiloiro
Journal of Radiation Research and Applied Sciences.2025; 18(4): 101955. CrossRef
Problems and prospects of using morphological risk factors for lymph node metastasis in T1 colorectal cancer (review)
O. A. Mainovskaya
Koloproktologia.2025; 24(4): 177. CrossRef

Incidence and Multiplicities of Adenomatous Polyps in TNM Stage I Colorectal Cancer in Korea: Young-Sang Hong, Eun-Joo Jung, Chun-Geun Ryu, Gang-Mi Kim, Su-Ran Kim, Sung-Noh Hong, Dae-Yong Hwang; J Korean Soc Coloproctol. 2012;28(4):213-218. Published online August 31, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.4.213

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Abstract PDF

Purpose

In recent years, the incidence of early-stage colorectal cancer (CRC) has markedly increased in the population within the Republic of Korea. The aim of this study was to evaluate the clinicopathologic features of adenomatous polyps in TNM stage I CRC patients and in the general population.

Methods

Between March 2003 and September 2009, 168 patients with stage I CRC were enrolled in this study. In addition, the records of 4,315 members of the general population without CRC, as determined by colonoscopy during a health check-up, were reviewed.

Results

Of the 168 patients with stage I CRC, 68 (40.5%) had coexisting colorectal adenomatous polyps and of the 4,315 members of the general population, 1,112 (26.0%) had coexisting adenomatous polyps (P = 0.006). The prevalences of adenomatous polyp multiplicity in early CRC and in the general population were 32% and 15%, respectively (P = 0.023). Patients with coexisting adenomatous polyps had a higher frequency of tubulovillous or villous adenomas than members of the general population with polyps (7.5% vs. 2.0%, P = 0.037). Furthermore, a subgroup analysis showed that the occurrence (44% vs. 34%, P = 0.006) and the multiplicity (32% vs. 15%, P = 0.023) of adenomatous polyps were greater for T2 than T1 cancer.

Conclusion

The prevalence and the multiplicity of adenomatous polyps in TNM stage I CRC is higher than it is in the general population. The findings of this study suggest that depth of invasion of early stage CRC affects the prevalence and the number of adenomatous polyps in the remaining colon and rectum.

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Treatment of cancer in tubular villous colorectal adenomas
O.I. Kit, Yu.A. Gevorkyan, N.V. Soldatkina, V.M. Legostaev, E.N. Kolesnikov, O.K. Bondarenko, E.N. Mironenko, D.S. Petrov
Pirogov Russian Journal of Surgery.2025; (9): 29. CrossRef
Risk factors of recurrence in TNM stage I colorectal cancer
Jin-Hee Paik, Chun-Geun Ryu, Dae-Yong Hwang
Annals of Surgical Treatment and Research.2023; 104(5): 281. CrossRef

Relation of the Expression of Cyclooxygenase-2 in Colorectal Adenomas and Adenocarcinomas to Angiogenesis and Prognosis: Yoon Dae Han, Young Ki Hong, Jung Gu Kang, Yoon Jung Choi, Chan Heun Park; J Korean Soc Coloproctol. 2010;26(5):339-346. Published online October 31, 2010; DOI: https://doi.org/10.3393/jksc.2010.26.5.339

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Abstract PDF

Purpose

Recent studies have shown that cyclooxygenase (COX)-2 may be involved in tumor growth, invasion and apoptosis in various carcinomas. Vascular endothelial growth factor (VEGF) has a potent angiogenic activity, and COX-2 promotes angiogenesis by modulating angiogenic factors, including VEGF. Endothelial growth factor receptor (EGFR) is considered as a factor of cell growth, maturation and cell death. The current study was designed to investigate the possible roles of COX-2 in colorectal tumor progression and angiogenesis.

Methods

Fifty colorectal adenomas and forty adenocarcinomas were investigated by using immunohistochemical staining for COX-2, VEGF and EGFR. The correlations of COX-2, VEGF and EGFR with the grade of dysplasia, the size of the adenoma, and various clinicopathologic factors were studied.

Results

The expressions of COX-2, VEGF and EGFR were each significantly correlated with carcinomatous transformation, and the expressions of COX-2 and VEGF were significantly correlated. COX-2 and EGFR showed correlations with adenomas rather than adenocarcinomas. However, no correlations of COX-2, VEGF and EGFR expression to other clinicopathologic factors, except tumor size in EGFR expression, were detected.

Conclusion

These results suggest that COX-2 may play an important role in carcinogenesis through interaction with VEGF and EGFR in human colorectal cancer.

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In Vitro Anticancer Effects of Unitein and Deep Seawater Salt Minerals on HT-29 Human Colon Carcinoma Cells
Kyunghwa Lee, WoonSeo Song, YeonJun Lee, Yanni Pan, Suk-Chan Hahm, Kun-Young Park
Journal of the Korean Society of Food Science and Nutrition.2023; 52(1): 8. CrossRef
Ocoxin® oral solution slows down tumor growth in an experimental model of colorectal cancer metastasis to the liver in Balb/c mice
JOANA MÁRQUEZ, JORGE MENA, IERA HERNANDEZ-UNZUETA, AITOR BENEDICTO, EDUARDO SANZ, BEATRIZ ARTETA, ELVIRA OLASO
Oncology Reports.2016; 35(3): 1265. CrossRef
In vivo molecular imaging of epidermal growth factor receptor in patients with colorectal neoplasia using confocal laser endomicroscopy
Jun Liu, Xiuli Zuo, Changqing Li, Tao Yu, Xiaomeng Gu, Chengjun Zhou, Zhen Li, Martin Goetz, Ralf Kiesslich, Yanqing Li
Cancer Letters.2013; 330(2): 200. CrossRef
Imunoexpressão das proteínas COX-2, p53 e caspase-3 em adenoma colorretal e mucosa não neoplásica
Renan Brito Nogueira, Andréa Rodrigues Cordovil Pires, Thélia Maria Santos Soares, Simone Rabello de Souza Rodrigues, Mariane Antonieta Menino Campos, Giovanna Canato Toloi, Jaques Waisberg
Einstein (São Paulo).2013; 11(4): 456. CrossRef
Oldhamianoside II, a New Triterpenoid Saponin, Prevents Tumor Growth via Inducing Cell Apoptosis and Inhibiting Angiogenesis
Feng-Ling Wang, Jing-Yong Sun, Yan Wang, Yan-Ling Mu, Yu-Ji Liang, Zhao-Zhong Chong, San-Hai Qin, Qing-Qiang Yao
Oncology Research Featuring Preclinical and Clinical Cancer Therapeutics.2013; 20(8): 369. CrossRef
Effects of Resveratrol on Migration and Proliferation in HT-29 Colon Cancer Cells
Sol Hwa Lee, Song Yi Park, In-Seop Kim, Ock Jin Park, Young Min Kim
KSBB Journal.2012; 27(5): 289. CrossRef
Anti-Proliferative Effects of Selenium in HT-29 Colon Cancer Cells via Inhibition of Akt
Song-Yi Park, In-Seop Kim, Se-Hee Lee, Sol-Hwa Lee, Da-Woon Jung, Ock-Jin Park, Young-Min Kim
Journal of Life Science.2012; 22(1): 55. CrossRef

Expression of RhoA in Colorectal Cancers and Its Clinicopathological Significance.: Jung, Hae Il , Choi, Yoon Young , Baek, Moo Jun , Bae, Sang Ho , Bae, Sang Byung , Jung, Dong Jun , Kim, Sung Yong , Lee, Moon Soo , Cho, Moo Sik , Kim, Chang Ho; J Korean Soc Coloproctol. 2008;24(6):460-466.; DOI: https://doi.org/10.3393/jksc.2008.24.6.460

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Abstract PDF

PURPOSE
The Rho family of GTPases are involved in actin cytoskeleton organization and are associated with carcinogenesis and progression of human cancers. The clinicopathological significance of RhoA is not yet well known in the case of colorectal cancer. To investigate the expression of RhoA protein in colorectal carcinoma and to evaluate the relationship between RhoA protein expression and invasion and metastasis of colorectal cancer, we examined the expression of RhoA protein by using Western blotting and immunohistochemistry.
METHODS
The protein levels of RhoA in colorectal carcinomas of surgical specimens were analyzed in 71 consecutive patients with colorectal cancers by using immunohistochemistry and Western blotting. The relationships between the protein levels of RhoA in tumor tissues and the clinicopathological features of the patients were also assessed.
RESULTS
RhoA was highly expressed in 48 colorectal carcinomas (67.6%). There was a significant association between RhoA expression and lymph nodal status. The expression of RhoA protein was related to lymph-node metastasis (P=0.032) and advanced TNM tumor staging (P=0.020). RhoA expression had a significant prognostic value for overall survival. Kaplan-Meier plots of survival in patients with high RhoA showed that high RhoA expression was associated with a shorter overall survival. However, no association was found between RhoA and other pathologic or clinical variables, including age, gender, degree of differentiation, and presence of perineural spread.
CONCLUSIONS
The RhoA protein may be related to malignant transformation and development of colorectal caricinomas and may play an important role in the invasion and the metastasis of colorectal carcinomas.

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Unraveling the Role of Molecular Profiling in Predicting Treatment Response in Stage III Colorectal Cancer Patients: Insights from the IDEA International Study
Ippokratis Messaritakis, Eleni Psaroudaki, Konstantinos Vogiatzoglou, Maria Sfakianaki, Pantelis Topalis, Ioannis Iliopoulos, Dimitrios Mavroudis, John Tsiaoussis, Nikolaos Gouvas, Maria Tzardi, John Souglakos
Cancers.2023; 15(19): 4819. CrossRef

Loss of E-cadherin Function is Suggested to be Associated with Peritoneal Seeding in Colorectal Cancer.: Kim, Hee Cheol , Roh, Seon Ae , Kim, Jung Sun , Yu, Chang Sik , Kim, Jin Cheon; J Korean Soc Coloproctol. 2003;19(1):20-25.

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Abstract PDF: PURPOSE
We investigated whether the loss of E-cadherin function was related to the peritoneal seeding in colorectal carcinomas.
METHODS
Eleven patients who had undergone a palliative resection for a colorectal carcinoma, with peritoneal seeding, were enrolled onto the study. The primary tumors and seeding nodules were analyzed with regarded to mutations in the expressions of the CDH1 and protein of E-cadherin using SSCP, direct sequencing and immunohistochemical staining.
RESULTS
In the primary tumors, the E-cadherin was normally expressed in 9 of the 11 cases, with 2 cases showing a reduced expression. In the seeding nodules, the E-cadherin was normally expressed in 6 of the 11 cases, with 5 cases showing a reduced expression. The degree of E-cadherin expression in the seeding nodules was significantly decreased comparing to that in the primary tumors (P<0.001). In the mutational analysis, there were no pathogenic mutations in either the primary tumors or the seeding nodules, with the exception of two silent changes in the ctgggt>ctaggt (intron 2) and GTG>GTA (codon 782).
CONCLUSION
The loss of E-cadherin expression might be related to peritoneal seeding. The functional derangement of E-cadherin in peritoneal seeding could possibly be caused by a mechanism, such as promoter methylation, rather than the mutation of the CDH1.

A Study on the Relationship between CEA Immunohistochemical Findings and Expression Rate of PCNA and Clinicopathologic Factors of Colorectal Cancers.: Hong, Kwan Hee , Jeon, Byeong Min , Kim, Jong Ik; J Korean Soc Coloproctol. 1998;14(4):725-734.

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Abstract PDF: Immunohistochemical study was performed for CEA staining patterns and PCNA indices. And the relationship between immunohistochemical findings and well-known clinical prognostic factors on the purpose of the clinical usefulness was evaluated. In forty seven cases of surgically removed colorectal carcinomas, the results were as follows; CEA staining patterns were apical (17 cases) and cytoplasmic (30 cases) type. Carcinomas with cyto plasmic pattern for CEA revealed more advanced Dukes' stage and more undifferentiated type and higher incidence of lymph node metastasis and were correlated with increased serum CEA levels. But PCNA indices showed no correlation with the Dukes' stage, histologic grade and CEA staining patterns. The cytoplasmic pattern of CEA immunohistochemistry may be a useful marker suggesting more aggressive biologic behavior of the colorectal carcinomas.

The Prognostic Significance of Tumor Microvessel Density in Colorectal Carcinoma.: Lee, Jeong Kyun , Han, Weon Cheol; J Korean Soc Coloproctol. 1998;14(4):719-724.

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Abstract PDF: PURPOSE
This study was carried out to evaluate the relationship with other clinicopath ologic factors and prognostic significance of tumor microvessel density in colorectal car cinoma. MATERIAL AND METHODS: 71cases of primary colorectal carcinoma (Modified Astler-Coller stage B and C) were analysed retrospectively who underwent curative resection at Wonkwang university hospital from September, 1991 to September, 1993. Male was 39cases. Age under 60 years was 31cases. 5 year survival rates were 80% (50 cases) in stage B and 52.4% (21 cases) in stage C. Tumor microvessels were stained by immuno histochemical method using anti-CD31 on paraffine embedded tissues, and were counted within 10x objective field (about 0.74 mm2) in the area of the most intense neovascu larization.
RESULTS
Mean microvessel Density (MVD) was 56.3+/-18.0 (range 19~128). MVD was 55.2 in 11 cases of nonrecurrent group and 73.5 in 10 cases of recurrent group in stage C (p=0.012). There was no significant association between MVD and other parameters such as age, sex, tumor location and size, CEA, lymph node metastasis, and survival. The 5 year survival rates of 33 cases of MVD< or =56 and 38 cases of MVD>56 were 84.9 and 60.5% respectively(p<0.05). 5 year survival rates of MVD< or =56 groups adjusted for age, sex, tumor location, differentiation, and recurrence were higher than those of >56 groups. 5 year survival rates of MVD < or =56 and >56 groups in stage C were 100% (5 cases) and 37.5% (16 cases) (p<0.05).
CONCLUSION
Tumor microvessl density may have somewhat prognostic significance in colorectal carcinoma.

The Clinical Significance of Carcinoembryonic Antigen and CA72-4 Assays of Peritoneal Fluid in Colorectal Carcinomas.: Park, Jong Dae , Kim, Hee Cheol , Cho, Young Kyu , Yu, Chang Sik , Kim, Jin Cheon; J Korean Soc Coloproctol. 2002;18(5):330-336.

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Abstract PDF: PURPOSE
CEA and CA72-4 assays in peritoneal fluid offers the greatest advantage in increasing the sensitivity of cytologic diagnosis of carcinomas of the G-I tract. Actually, little investigations have been taken for the relations between CEA and CA72-4 levels in peritoneal fluid and the clinicopathologic characteristics of colorectal carcinomas. The intent of this study was to verify the usefulness of CEA and CA72-4 levels in peritoneal fluid for the treatment of colorectal carcinoma.
METHODS
Seventy-three colorectal cancer patients who were hospitalized in our colorectal division were prospectively investigated. Thirty-five out of 73 patients had ascites. Preoperatively, the levels of serum CEA and CA72-4 were measured. At the time of laparotomy, ascites or peritoneal washings were collected from all patients and the levels of carcinoembryonic antigen and CA72-4 were measured and submitted for the analysis to the cytology laboratory. We analyzed the results with the levels of serum CEA and CA72-4, histologic differentiation, location, stage of the tumor, and obstruction due to tumor.
RESULTS
The levels of serum CEA and CA72-4 were significantly correlated with those of peritoneal fluid. The elevated levels of CEA and CA72-4 of peritoneal fluid were also significantly correlated with advanced stages of colorectal carcinomas, respectively. But according to histologic differentiation, only CA72-4 levels of peritoneal fluid were elevated in poorly differentiated or mucinous carcinoma. No difference between the levels of CEA and CA72-4 of peritoneal fluid was present in accordance with the location of tumors.
CONCLUSIONS
The measurement of CEA and CA72-4 of peritoneal fluid may be valuable method in discriminating between the early-stage versus the late-stage colorectal carcinoma.

The Prognostic Value and Reciprocity of p53 and bcl-2 Expression in Colorectal Carcinoma.: Park, Sang Heon , Min, Young Don , Kim, Jeong Yong , Kim, Kweon Cheon , Kim, Seong Hwan , Lim, Seong Cheol; J Korean Soc Coloproctol. 1998;14(4):691-700.

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Abstract PDF: p53 is a tumor suppressor gene product identified in a wide range of tumor including colorectal carcinoma. Genetic alterations in the p53 tumor suppressor gene are common in human colorectal carcinoma. bcl-2 is a protooncogene that inhibits apoptosis. The products of mutant p53 gene and bcl-2 have been associated with prognosis in several malignancies including colorectal carcinomas. This study was undertaken to evaluate values of p53 and bcl-2 oncoproteins as prognostic factors relative to clinicopathological factors and correlation of their expression. Analyses were made on achieval pathologic tissues of 80 patients with colorectal carcinomas including 34 patients able to follow-up over 5 years. The oncoproteins were localized using commercially available monoclonal antibodies:DO-7 for p53, clone124 for bcl-2. Expression of bcl-2 was cytoplasmic, whereas nuclear p53 expression was localized in carcinoma cells. The patients were 17 to 83 years of age. The expression of p53 and bcl-2 was determined respectively in 30 (37.5%) and 21 (26.3%)cases. The expression of p53 nuclear expression was not correlated with tumor location, size, histologic grade, Duke's classification, regional lymph node metastasis and tumor recurrence. The cytoplasmic expression of bcl-2 was not correlated with tumor location, size, histologic grade, Duke's classification, regional lymph node metastasis and recurrence. Univariate analysis showed that patients with p53 nuclear expression were not associated with poorer overall survival than patients with p53 negative, and also showed in patients with bcl-2 expression. The expression of p53 did not affect to that of bcl-2. We concluded that the p53 nuclear and bcl-2 cytoplasmic expression were not independent prognostic factors in colorectal carcinomas. Evidence of reciprocity of bcl-2 and p53 expression was not found.

The Study on Comparing the Expression of the Collagen IV with different Histopathologic Features of the Colorectal Carcinomas.: Jung, Woo Yeong , Kim, Jong Ik , Lee, Seung Jae , Lee, Jong Kyi , Jeon, Byeong Min , Oh, Sang Hoon , Hong, Kwan Hee , Kim, Sang Hyo; J Korean Soc Coloproctol. 1998;14(4):681-690.

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Abstract PDF: The malignant potential of a tumor is related to its ability to dissociate invasion and seed other sites-metastasis. In either instance, the tumor cells are confronted with a barrier signif icantly composed of type IV collagen. This type IV collagen is a major structural protein of basement membranes. Using immunohistochemical method to detect type IV collagen, intensity of stain and continuity of basement membrane at the tumor-stromal border was studied in surgical specimens from 47 colorectal carcinomas at the Pusan Paik-Hospital. Immunoreactivity was evaluated semi-quantitatively as three categories; Type-1, thick or normal basement membrane with or without minimal discontinuity; Type-2, thin basement membrane with or without moderate discontinuity; Type-3, fragmented or absent basement membrane. Also, in each case the tumor morphologic features were identified. The histologic type, differentiated grade, desmoplastic response, lymphatic and vascular invasion, lymph node involvement, tumor size and modified Dukes' stage were estabilished. Type-1 immunoreactivity was significantly observed in well-differentiated, negative lymph node, Dukes' stage B1/B2 tumors, and Type-3 was in poorly differentiated, positive lymph node, Dukes' stage C2/D. The expres sion of collagen IV in basement membrane was statistically significant correlated with differentiated grade, lymph node metastasis and modified Dukes' stage. By contrast, no statistically significant correlation was found between paucity of type IV collagen and the other parameters. The result suggest that expression of type IV collagen in basement membrane may be a useful prognostic marker, and may play a part in the invasive and metastatic process of colorectal carcinomas.

Reappraisal of AJCC Staging System in Colorectal Cancer.: Yu, Chang Sik , Kim, Hee Cheol , Ryu, Jang Hak , Kim, Jung Rang , Cho, Young Kyu , Namgung, Whan , Kim, Jin Cheon; J Korean Soc Coloproctol. 2002;18(4):262-267.

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Abstract PDF: PURPOSE
The TNM classification for carcinoma of the colon and the rectum provides more detail than other staging systems. This study was performed to evaluate the effectiveness of AJCC staging system (5th ed., 1997) for the colorectal cancer in predicting prognosis.
METHODS
We analyzed a data base of 1,233 colorectal cancer patients (M:F=673:560) who underwent surgery in Asan Medical Center during July 1989-December 1996. Survival analysis was performed between the stages and the subgroups in same stage by using Kaplan-Meier method and log rank test. Borderline subgroup comparison between the stages was performed, also. Significance was assigned to a P value of <0.05.
RESULTS
Mean age of the patients was 57 (19-90) years old. Median follow-up period was 42 (6-129) months. The number of patients in each stage were 0: 15, I: 152, II: 390, III: 465, IV: 199. The 5 year overall & disease free survival rates of each stage were 100%, 100% (in stage 0), 96.4%, 93.6% (in stage I), 82.7%, 82.2% (in stage II), 59.9%, 55.3% (in stage III), and 7.3%, 24.9% (in stage IV), respectively (P=0.000). Subgroup analysis in stage I (T1N0 vs. T2N0) and II (T3N0 vs. T4N0) revealed no differences. However, in stage III, N1 (n=246) group showed better survival than N2 (n=219) group (70.3%, 65.5% vs. 49.2%, 44.6%: P=0.000). Borderline survival analysis between stage I and II (T2N0 vs. T3N0) was significantly different (96.6%, 95.7% vs 82.7%, 82.3%: P=0.006). However, between stage II and III (T4N0 vs. T1N1), appropriate analysis was impossible due to small number of cases.
CONCLUSIONS
AJCC staging system for colorectal cancer was reliable and effective in predicting prognosis. However, substages are needed in stage III.

Prognostic Significance of the Expression of MRP and p53 in Colorectal Carcinoma.: Chang, Ji Young , Min, Young Don , Kim, Kweon Cheon , Lim, Sung Chul; J Korean Soc Coloproctol. 1998;14(3):365-374.

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Abstract PDF: Although MDR was previously thought to be predominantly caused by the expression of the MDR1 gene, it is now increasingly believed to be caused by other mechanism. Recently, over-expression of the multidrug resistance-associated protein (MRP) was suggested a possible mechanism for non-Pgp mediated MDR. Recent studies showed that MRP can confer resistance to a wide spectrum of natural product drug, but the clinical relevance of MRP-mediated MDR in human cancer is poorly understood. p53 is the most widely known tumor suppressor gene. It has been suggested that mutant p53 is related to abnormal proliferation of cell and some what is been related to cellular apoptosis. To determine the clinical significance of MRP and/or p53 expression in colorectal carcinoma, the authors investigated the expression of the MRP and p53 in 81 cases of primary colorectal carcinoma, the relationship between the MRP and/or p53 expression and clinical parameters including 5-yr. survival rate, and the relationship between the expression of MRP and p53. The results were as follows: 1) Of the 81 colorectal carcinomas, 36 (42%) were MRP positive and 28 (34%) were p53 positive. 2) The expression of MRP and/or p53 was not significantly correlated with sex, age, histologic grades, tumor invasion, tumor location, tumor size, lymph node metastasis, TNM stage and survival of patients. In conclusion, these results suggest that expression of MRP and/or p53 is neither related to the known prognostic factors nor a prognostic factor by itself.

Surgery for Lung Metastases from Colorectal Cancer.: Paik, Hyo Chae , Maeng, Dae Hyeon , Song, Suk Suk , Kim, Kil Dong , Chung, Kyung Young; J Korean Soc Coloproctol. 2002;18(1):37-41.

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Abstract PDF: PURPOSE
The liver and lung are the most common site of metastases after curative resection of colorectal carcinoma, and only 10 months of median survival is achieved once metastases has occurred in the lung. About 10% of patients have a solitary pulmonary metastasis and surgical resection leads to a 5 year survival rate of 21~43%. We have tried to define ideal candidates for pulmonary resection in a patient with pulmonary metastases from colorectal carcinoma.
METHODS
Between March 1990 to Feb. 2001, 25 patients underwent pulmonary resection for metastatic colorectal carcinoma. 15 patients were male, and 10 were female with mean age of 60.0 (range, 36~73) years. The primary sites were colon in 7 patients and rectum in 18 patients.
RESULTS
The mean disease free interval was 30.04 19.79 (range, 1~84) months and 19 patients had single metastasis and 6 patients had multiple metastatic lesions. Twenty- one patients had unilateral lesion. Wedge resection was done in 10 patients, lobectomy in 7, pneumonectomy in 2, wedge resection with bilobectomy in 2, segmentectomy and wedge resection in 1, and segmentectomy and lobectomy in 1 patient. Six patients recurred mean 13.7 months after the first operation (range, 1~33 months) and they underwent wedge resection in 4 and one case each of lobectomy and segmentectomy. Seven patients died during follow up with 3 year survival rate of 70.8% and 5 year survival rate of 43.4%.
CONCLUSIONS
The disease free interval, number of metastases, type and location of pulmonary resection, level of carcinoembryonic antigen had no correlation with the survival rate. We conclude that surgical resection of colorectal lung metastases is safe and effective, and every patients should be evaluated as a surgical candidate.

Expression of p53, bcl-2 Protein in Colorectal Cancer and Its Relationship to Pathologic Factor.: Jun, Ho Jin , Park, Dong Kook , Lee, Chan Young , Kim, Jung Tak , Lee, Do Sun , Jung, Min , Park, Jong Kwon , Rhu, Jin Woo , Lee, Min Chol , Myeong, Na Hye; J Korean Soc Coloproctol. 1998;14(2):165-178.

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Abstract PDF: PURPOSE
This study was undertaken to evaluate the correlation between p53, bcl-2 expression and pathologic factors stage, anatomic location, histologic grade, gross pattern, lymph node metastasis of the colorectal cancer.
METHODS
Analysis were made on archival pathology tissue of 56 patients with colorectal cancer. The oncoproteins were localized using commerically available monoclonal antibodies : DO-7 for, p53 and clone 124 for bcl-2.
RESULTS
P53 protein was detected in 53 out of 56(94.6%) adenocarcinomas of the colorectal cancer and the most frequently expressed patterns of immunoreactivity of p53 were strong in intensity in 40 cases(71.4%) and were diffuse in pattern in 39 cases(69.6%). Bcl-2 protein was detected in 34 out of 56(60.7%) adenocarcinomas of the colorectal cancer and the most frequently expressed patterns of immunoreactivity of bcl-2 were weak in intensity in 17 cases(30.3%) and were diffuse in pattern in 16 cases(28.6%). There was no correlation between p53, bcl-2 expression and Dukes' stage, anatomic location ,histologic grade, gross pattern of tumor, lymph node metastasis of the colorectal cancer.
CONCLUSION
53 mutation and bcl-2 expression are frequent event in human colorectal carcinoma as shown in this study, but p53 and bcl-2 protein expression is not significant independent predicator of aggressiveness and progression of colorectal cancers.

Characteristics of Primary Colorectal Signet Ring Cell Carcinoma.: Kim, In Kyoung , Lee, Ryung Ah , Hwang, Dae Yong , Lee, Seung Sook , Noh, Woo Chul , Bang, Ho Yoon , Choi, Dong Wook , Lee, Jong Inn , Paik, Nam Sun , Moon, Nan Mo; J Korean Soc Coloproctol. 2001;17(5):267-272.

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Abstract PDF: PURPOSE
Primary colorectal signet ring cell carcinoma is a rare disease entity and there is little information compare to ordinary colorectal adenocarcinoma. The aim of this study was to acknowledge the differences of clinicopathological features between colorectal signet ring cell carcinoma and ordinary colorectal adenocarcinoma.
METHODS
The author analyzed clinicopathological aspects of 742 consecutive surgical patients with colorectal carcinoma operated at Korean Cancer Center Hospital between January 1993 and December 1999. 19 patients with primary colorectal signet ring cell carcinoma were identified. Clinicopathological features and survival data were evaluated in comparison with those of the ordinary colorectal adenocarcinoma in a retrospective study matched for age, gender, and stage.
RESULTS
19 (2.6%) cases of primary signet ring cell carcinoma were identified and 26 (3.5%) cases of mucinous adenocarcinoma were identified. Male-to-female ratio of the signet ring cell carcinoma was 1.4:1. Mean age was 44 16 years and median age was 41year (range, 22-73 year). No patient had Stage I disease. The majority of patients had an advanced tumor stage at the time of diagnosis (15.8 percents StageII, 68.4 percents Stage III, and 15.8 percents Stage IV). Median survival time was only 29months (P=0.0084). In a study matched for age, gender, and stage, a lower survival rate was found for patients with signet ring cell carcinoma (P=0.0021). In contrast to ordinary adenocarcinoma, signet ring cell carcinoma was characterized by a significantly higher incidence of locoregional recurrence (50%) and peritoneal tumor spread (30%), but a lower incidence of hematogenous metastases (10%).
CONCLUSIONS
Primary signet ring cell colorectal carcinoma represents a rare and is frequently diagnosed in an advanced tumor stage, thus showing an overall poorer prognosis than ordinary colorectal carcinoma. A high incidence of locoregional recurrence and peritoneal seeding and a low incidence of hematogenous metastasis are characteristics of signet-ring cell carcinoma. This different pattern of tumor biology would be justified to different management of primary colorectal signet ring cell carcinoma.

Case Report

Complete Rectal Prolapse Combined with Rectal Cancer: A Case Report.: Lee, Tae Soon , Bae, Ok Suk , Park, Sung Dae; J Korean Soc Coloproctol. 2005;21(3):178-180.

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Abstract PDF: Colorectal cancer and rectal prolapse occur more frequently in elderly patients. Although the relationship between complete rectal prolapse and colorectal cancer has not yet been clarified, when both diseases develop simultaneously in a patient, it may be due to just coincidence or to a promotion of prolapse due to accelerated constipation caused by cancer. Thus, patients with a sudden onset of rectal prolapse should be screened for colorectal cancer. We report a case of complete rectal prolapse combined with early rectal cancer in a 75 year-old woman who was successfully treated with a perineal rectosigmoidectomy.

Original Articles

Clinical Study of Mucinous Colorectal Carcinoma.: An, Chang Hyeok , Kang, Won Kyung , Park, Seung Chul , Hong, Min Kwang , Lee, Do Sang , Oh, Seong Taek , Jeon, Hae Myung; J Korean Soc Coloproctol. 2001;17(2):97-102.

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Abstract PDF: PURPOSE
The clinical influences of mucinous colorectal carcinomas are still controversial. Some previous reports have suggested that mucinous carcinomas of colorectum affect more young patients, involve the more proximal colon, are more advanced at diagnosis, show increased incidence of local and distant metastasis, and have a worse prognosis than adenocarcinoma. We evaluated the clinicopathological aspect of mucinous colorectal carcinoma.
METHODS
A retrospective review of colorectal cancer patients treated between January 1990 and December 1998 was undertaken. Eight-hundred-fifty patients were operated for colorectal cancer during the period, among them seven- hundred-eighty-two patient records were available for this study. Sixty-two patients (7%) could be classified as mucinous carcinoma as defined by more than 50% of mucin- secreting pattern on histological examination. The age and sex distribution, primary location of tumor, modified Dukes' classification at diagnosis, recurrence rates and 5-year survival of mucinous carcinoma patients were compared with those of adenocarcinoma patients. Survival was calculated according to Kaplan-Meyer, and the differences were compared using the log-rank test.
RESULTS
The sex ratio of mucinous carcinoma was 2.05: 1, whereas 1.32: 1 in adenocarcinoma. The age distribution of mucinous carcinoma showed orderly 60s (30.7%), 50s (17.7%), 40s (17.7%) similar to adenocarcinoma. The sites of the mucinous carcinoma were 22 (35.5%) in the rectum, 21 (33.9%) in the right colon, 6 (9.7%) in the transverse colon, whereas for adenocarcinoma 250 (37.0%) in the rectum, 137 (20.3%) in the sigmoid colon, 114 (16.9%) in the ascending colon. The stage of primary tumor at diagnosis was as follows: In mucinous carcinoma, 5 stage B1 (8.1%), 13 B2 (21.0%), 33 C2 (53.2%), 11 D (17.7%). In adenocarcinoma, 20 stage A (3.0%), 61 B1 (9.0%), 210 B2 (31.1%), 15 C1 (2.2%), 250 C2 (37.0%), 120 D (17.7%). Three-year and five-year disease free survival rates were similar, but slightly higher in patients with adenocarcinomas. Mean survival time was also similar, 45.5+/-38.1 months in the mucinous carcinoma group and 45.6+/-33.4 months in the adenocarcinoma. Five-year survival was 65.6% and 68.1% in patients with mucinous carcinomas and adenocarcinomas, respectively; but the difference was not statistically significant. The recurrence rates were 41.9% and 22.3% in patients with mucinous carcinoma and adenocarcinoma, respectively with statistical significance (P<0.005). Local recurrence was more frequent in the mucinous carcinoma than in the adenocarcinoma significantly.
CONCLUSIONS
Our study suggested that mucinous colorectal carcinoma showed decreased survival, although having no statistical significance and increased recurrence rates with statistical significance compared with those of adenocarcinoma. So, we recommend aggresive surgical treatment and careful follow-up in mucinous colorectal carcinoma.

Clinical Significance of PCNA and nm23 Expression in Invasive Colorectal Carcinoma.: Kang, Gu , Park, Chul Jae; J Korean Soc Coloproctol. 2001;17(1):47-52.

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Abstract PDF: PURPOSE
It is known that PCNA (proliferating cell nuclear antigen) is associated with cell proliferating activity and nm23 with so called 'anti-metastatic' activity. We tried to elucidate the relationships of PCNA labeling index and nm23 expression in carcinoma cells with survival rates of patients with invasive colorectal carcinoma.
METHODS
Immunohistochemical study was performed using monoclonal antibodies for PCNA and nm23 gene products on 45 cases of paraffin-embedded tissue made of invasive colorectal cancer.
RESULTS
Five-year survival rate was lower in the group with high PCNA labeling index than that with low one, but PCNA labeling index was not associated with the tumor stages. Expression of nm23 was not associated with survival rate, tumor stage, site, and PCNA labeling index.
CONCLUSIONS
Although PCNA labeling index was not associated with tumor stages, this study suggests that PCNA labeling index will be a good prognostic factors in invasive colorectal carcinoma.

Pulmonary Resection for Lung Metastases from Colorectal Cancer.: Choi, Hyo Seong , Youk, Eui Gon , Park, Young Jin , Park, Kyu Joo , Lee, Jae Woong , Kim, Joo Hyun , Park, Jae Gahb; J Korean Soc Coloproctol. 1999;15(2):113-119.

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Abstract PDF: Isolated lung metastasis occurs in about 1% of all colorectal cancer cases. As in the case of isolated liver metastasis, resection of isolated lung metastasis results in 5 year survival rate of about 30%. PURPOSE: This study was performed to evaluate the survival benefit after pulmonary resection for metastatic colorectal cancer.
METHODS
Between January, 1992 and March, 1998, twelve patients underwent lung metastatectomy from colorectal cancer at the Seoul National University Hospital. We evaluated the clinical characteristics of patients and analyzed the follow-up results in 10 patients whose medical records were available. Indications for resection of pulmonary metastasis were complete resection of the primary tumor, no other organ involvement except lung, completely resectable lung lesion, and tolerable general condition of patient for lung resection.
RESULTS
Two patients had their primary tumors located in colon and 8 in rectum. Synchronous lung metastases were observed in 3 patients, and 7 patients had metachronous metastases developing 9 to 121 months (median; 33 months) after primary tumor resection. Eight patients had solitary metastatic nodule in lung, while two patients had multiple lesions confined to unilateral lung. Five patients underwent wedge resections, 4 underwent pulmonary lobectomies, and one patient had both wedge resection and lobectomy in unilateral lung. Three patients were lost during the follow-up, but remaining 7 patients are alive after median follow-up of period of 32 months and 6 of these patients have no postoperative recurrence. In addition, four of these 7 patients are alive for more than 3 years after lung metastatectomy.
CONCLUSION
Pulmonary metastasis from colorectal cancer without other organ involvement may be a candidate for lung resection. However, further studies are needed to determine the survival benefits after pulmonary resection.

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