Center for Colorectal Cancer

Goyang, South Korea

Center for Colorectal Cancer

Goyang, South Korea
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Lee J.,Seoul National University | Shin A.,Seoul National University | Oh J.H.,Center for Colorectal Cancer
World Journal of Gastroenterology | Year: 2017

AIM To investigate the relationship between the colors of vegetables and fruits and the risk of colorectal cancer in Korea. METHODS A case-control study was conducted with 923 colorectal cancer patients and 1846 controls recruited from the National Cancer Center in Korea. We classified vegetables and fruits into four groups according to the color of their edible parts (e.g. , green, orange/ yellow, red/purple and white). Vegetable and fruit intake level was classified by sex-specific tertile of the control group. Logistic regression models were used for estimating the odds ratios (OR) and their 95% confidence intervals (CI). RESULTS High total intake of vegetables and fruits was strongly associated with a reduced risk of colorectal cancer in women (OR = 0.32, 95%CI: 0.21-0.48 for highest vs lowest tertile) and a similar inverse association was observed for men (OR = 0.60, 95%CI: 0.45-0.79). In the analysis of color groups, adjusted ORs (95%CI) comparing the highest to the lowest of the vegetables and fruits intake were 0.49 (0.36-0.65) for green, and 0.47 (0.35-0.63) for white vegetables and fruits in men. An inverse association was also found in women for green, red/purple and white vegetables and fruits. However, in men, orange/yellow vegetables and fruits (citrus fruits, carrot, pumpkin, peach, persimmon, ginger) intake was linked to an increased risk of colorectal cancer (OR = 1.61, 95%CI: 1.22-2.12). CONCLUSION Vegetables and fruits intake from various color groups may protect against colorectal cancer. © The Author(s) 2017.


Shin D.W.,Seoul National University | Cho J.,Sungkyunkwan University | Kim S.Y.,National Cancer Control Research Institute | Guallar E.,Johns Hopkins Medical Institutions | And 7 more authors.
Annals of Surgical Oncology | Year: 2013

Background: Surgery for cancer is often delayed due to variety of patient-, provider-, and health system-related factors. However, impact of delayed surgery is not clear, and may vary among cancer types. We aimed to determine the impact of the delay from cancer diagnosis to potentially curative surgery on survival. Methods: Cohort study based on representative sample of patients (n = 7,529) with colorectal, breast, lung and thyroid cancer with local or regional disease who underwent potentially curative surgery as their first therapeutic modality within 1 year of cancer diagnosis. They were diagnosed in 2006 and followed for mortality until April 2011, a median follow-up of 4.7 years. Results: For colorectal and breast cancers, the adjusted hazard ratios (95 % confidence intervals) for all-cause mortality comparing a surgical delay beyond 12 weeks to performing surgery within weeks 1-4 after diagnosis were 2.65 (1.50-4.70) and 1.91 (1.06-3.49), respectively. No clear pattern of increased risk was observed with delays between 4 and 12 weeks, or for any delay in lung and thyroid cancers. Concordance between the area of the patient's residence and the hospital performing surgery, and the patient's income status were associated with delayed surgery. Conclusions: Delays to curative surgery beyond 12 weeks were associated with increased mortality in colorectal and breast cancers, suggesting that health provision services should be organized to avoid unnecessary treatment delays. Health care systems should also aim to reduce socioeconomic and geographic disparities and to guarantee equitable access to high quality cancer care. © 2013 Society of Surgical Oncology.


Zhang B.,Vanderbilt University | Jia W.-H.,Sun Yat Sen University | Matsuda K.,University of Tokyo | Kweon S.-S.,Chonnam National University | And 43 more authors.
Nature Genetics | Year: 2014

Known genetic loci explain only a small proportion of the familial relative risk of colorectal cancer (CRC). We conducted a genome-wide association study of CRC in East Asians with 14,963 cases and 31,945 controls and identified 6 new loci associated with CRC risk (P = 3.42 × 10 ̂'8 to 9.22 × 10 â ̂'21) at 10q22.3, 10q25.2, 11q12.2, 12p13.31, 17p13.3 and 19q13.2. Two of these loci map to genes (TCF7L2 and TGFB1) with established roles in colorectal tumorigenesis. Four other loci are located in or near genes involved in transcriptional regulation (ZMIZ1), genome maintenance (FEN1), fatty acid metabolism (FADS1 and FADS2), cancer cell motility and metastasis (CD9), and cell growth and differentiation (NXN). We also found suggestive evidence for three additional loci associated with CRC risk near genome-wide significance at 8q24.11, 10q21.1 and 10q24.2. Furthermore, we replicated 22 previously reported CRC-associated loci. Our study provides insights into the genetic basis of CRC and suggests the involvement of new biological pathways. © 2014 Nature America, Inc.


Hong Y.S.,University of Ulsan | Park Y.S.,Sungkyunkwan University | Lim H.Y.,Sungkyunkwan University | Lee J.,Sungkyunkwan University | And 14 more authors.
The Lancet Oncology | Year: 2012

Background: Capecitabine plus oxaliplatin (CapeOX) is one of the reference doublet cytotoxic chemotherapy treatments for patients with metastatic colorectal cancer. We aimed to compare the efficacy and safety of CapeOX with that of S-1 plus oxaliplatin (SOX), a promising alternative treatment for patients with metastatic colorectal cancer. Methods: In this open-label, multicentre, randomised phase 3 trial, we randomly assigned patients (1:1) from 11 institutions in South Korea to receive either CapeOX (capecitabine 1000 mg/m2 twice daily on days 1-14 and oxaliplatin 130 mg/m2 on day 1) or SOX (S-1 40 mg/m2 twice daily on days 1-14 and oxaliplatin 130 mg/m2 on day 1). Treatment was repeated every 3 weeks and continued for as many as nine cycles of oxaliplatin-containing chemotherapy, except in instances of disease progression, unacceptable toxicity, or a patient's refusal. Maintenance chemotherapy with S-1 or capecitabine was allowed after discontinuation of oxaliplatin. Randomisation was done with a computer-generated sequence (stratified by primary sites, previous adjuvant or neoadjuvant treatment, and the presence of measurable lesions). The primary endpoint was to show non-inferiority of SOX relative to CapeOX in terms of progression-free survival (PFS). The primary analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00677443. Findings: Between May 14, 2008, and Sept 23, 2009, we randomly assigned 168 patients to receive SOX and 172 to receive CapeOX. Median PFS was 8·5 months (95% CI 7·6-9·3) in the SOX group and 6·7 months (6·2-7·1) in the CapeOX group (hazard ratio, 0·79 [95% CI 0·60-1·04]; pnon-inferiority<0·0001, plog-rank=0·09). The upper limit of the CI was below the predefined margin of 1·43, showing the non-inferiority of SOX to CapeOX. We recorded a higher incidence of grade 3-4 neutropenia (49 [29%] vs 24 [15%]), thrombocytopenia (37 [22%] vs 11 [7%]), and diarrhoea (16 [10%] vs seven [4%]) in the SOX group than in the CapeOX group. The frequency of any grade of hand-foot syndrome was greater in the CapeOX group than it was in the SOX group (51 [31%] vs 23 [14%]). Interpretation: The SOX regimen could be an alternative first-line doublet chemotherapy strategy for patients with metastatic colorectal cancer. Further investigation is needed to explore its potential when used together with other targeted agents or as adjuvant chemotherapy. Funding: Korea Healthcare Technology Research and Development Project, Ministry of Health and Welfare, South Korea. © 2012 Elsevier Ltd.


Salah S.,King Hussein Cancer Center | Watanabe K.,Tohoku University | Watanabe K.,The Surgical Center | Park J.S.,Sungkyunkwan University | And 10 more authors.
Annals of Surgical Oncology | Year: 2013

Background: Repeated resection of colorectal cancer pulmonary metastasis is associated with long-term survival. Nevertheless, very limited data addressing the best candidates for repeated pulmonary resection is available. Patients and Methods: We searched the PubMed database for retrospective studies evaluating lung metastasectomy for metastatic colorectal cancer (CRC). We included studies with available data about repeated pulmonary metastasectomy. Potential prognostic factors were analyzed for possible impact on survival following the second metastasectomy through univariate and multivariate analysis. Results: Between 1983 and 2008, 944 lung metastasectomies were carried out on 759 patients. Of those, 148 patients had a second metastasectomy. The 5-year survival rate was 52 % for patients who had 1 metastasectomy and 57.9 % from the second metastasectomy for patients who had repeated resection. More than 2 metastatic pulmonary nodules and maximum diameter of largest pulmonary nodule ≥3 cm were the only independent factors associated with inferior survival following repeated pulmonary resection. Conclusions: In selected patients with metastatic CRC, repeated pulmonary metastasectomy offers an excellent chance for long-term survival and is associated with a quite low operative mortality. Patients with more than 2 metastatic nodules and a maximum diameter of the largest metastatic lung nodule of ≥3 cm have a significantly inferior survival. © 2013 Society of Surgical Oncology.


Salah S.,King Hussein Cancer Center | Watanabe K.,Tohoku University | Watanabe K.,The Surgical Center | Welter S.,Ruhrlandklinik | And 11 more authors.
Annals of Oncology | Year: 2012

Background: Although resecting colorectal cancer (CRC) pulmonary metastasis is associated with long-term survival, identification of prognostic groups is needed for future randomized trials, and construction of a lung metastasectomy prognostic model (LMPM) is warranted. Patients and methods: We searched the PubMed database for retrospective studies evaluating prognostic factors following resecting CRC lung metastasis. Individual patient data were analyzed. Independent prognostic factors were used to construct an LMPM. Results: Between 1983 and 2008, 1112 metastasectomies were carried out on 927 patients included in eight studies. Five-year survival rate was 54.3% following the first lung resection. Multivariate analysis identified three independently poor prognostic factors: pre-thoracotomy carcinoembryonic antigen ≥5 ng/ml, disease-free interval <36 months, and more than one metastatic lesion. Patients with good-, intermediate-, and high-risk groups according to the LMPM had a 5-year survival of 68.2%, 46.4%, and 26.1%, respectively (P < 0.001). Perioperative chemotherapy and previously resected liver metastasis had no influence on survival. Conclusions: The low- and intermediate-risk groups have a good chance of long-term survival following metastasectomy. However, more studies are needed to investigate whether surgery offers any advantage over systemic therapy for the poor-risk group. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.


Jia W.-H.,Sun Yat Sen University | Zhang B.,Vanderbilt University | Matsuo K.,Aichi Cancer Center Research Institute | Shin A.,National Cancer Center | And 28 more authors.
Nature Genetics | Year: 2013

To identify new genetic factors for colorectal cancer (CRC), we conducted a genome-wide association study in east Asians. By analyzing genome-wide data in 2,098 cases and 5,749 controls, we selected 64 promising SNPs for replication in an independent set of samples, including up to 5,358 cases and 5,922 controls. We identified four SNPs with association P values of 8.58 × 10 -7 to 3.77 × 10 -10 in the combined analysis of all east Asian samples. Three of the four were replicated in a study conducted in 26,060 individuals of European descent, with combined P values of 1.22 × 10 -10 for rs647161 (5q31.1), 6.64 × 10 -9 for rs2423279 (20p12.3) and 3.06 × 10 -8 for rs10774214 (12p13.32 near the CCND2 gene), derived from meta-analysis of data from both east Asian and European-ancestry populations. This study identified three new CRC susceptibility loci and provides additional insight into the genetics and biology of CRC. © 2013 Nature America, Inc. All rights reserved.


Telem D.A.,Massachusetts General Hospital | Han K.S.,Center for Colorectal Cancer | Kim M.-C.,Seoul National University | Ajari I.,Massachusetts General Hospital | And 7 more authors.
Surgical Endoscopy and Other Interventional Techniques | Year: 2013

Background: The authors' group has previously described successful transanal rectosigmoid resection via natural orifice translumenal endoscopic surgery (NOTES) in both porcine and cadaveric models using the transanal endoscopic microsurgery platform. This report describes the largest cadaveric series to date as optimization of this approach for clinical application continues. Methods: Between December 2008 and September 2011, NOTES transanal rectosigmoid resection with total mesorectal excision (TME) was successfully performed in 32 fresh human cadavers using transanal dissection alone (n = 19), with transgastric endoscopic assistance (n = 5), or with laparoscopic assistance (n = 8). The variables recorded were gender, body mass index (BMI), operative time, length of the mobilized specimen, integrity of the mesorectum and the resected specimen, and complications. Univariate statistical analysis was performed. Results: Of the 32 cadavers, 22 were male with a mean BMI of 24 kg/m2 (range 16.3-37 kg/m2). The mean operative time was 5.1 h (range 3-8 h), and the mean specimen length was 53 cm (range 15-91.5 cm). After the first five cadavers, specimen length significantly improved, and a trend toward decreased operative time was demonstrated. The mesorectum was intact in 100 % of the specimens. In nine cadavers, endoscopic dissection was complicated by organ injury. Evaluation by the operative approach demonstrated a significantly longer specimen with laparoscopic assistance (67.7 cm) than with transgastric assistance (45.4 cm) or transanal dissection alone (49.2 cm) (p = 0.013). Comparison of the technique used for inferior mesenteric pedicle division demonstrated both significantly decreased operative time (4.8 vs 6 h; p = 0.024) and increased specimen length (57.7 vs 39.6 cm; p = 0.025) when a stapler was used in lieu of a bipolar cautery device. Conclusion: Transanal NOTES rectosigmoid resection with TME is feasible and demonstrates improvement in specimen length and operative time with experience. Transitioning to clinical application requires laparoscopic assistance to overcome limitations related to NOTES instrumentation, as well as procedural training with fresh human cadavers. © 2012 Springer Science+Business Media, LLC.


PubMed | National Cancer Center, Center for Colorectal Cancer and Seoul National University
Type: | Journal: Scientific reports | Year: 2017

Common genetic risk variants for colorectal cancer (CRC) have been identified at approximately 40 loci by genome-wide association studies (GWAS). We investigated the association of these risk variants by age at onset of CRC using case-only and case-control analysis. A total of 1,962 CRC cases and 2,668 controls from two independent case-control studies conducted by Koreas National Cancer Center were included in this study. We genotyped 33 GWAS-identified single-nucleotide polymorphisms (SNPs) associated with CRC risk. The risk allele in SNP rs704017, located at 10q22.3 in the ZMIZ1-AS1 gene, was consistently less frequent among CRC patients aged <50 years than among CRC patients aged 50 years in the case-only analysis (odds ratio (OR)=0.78, 95% confidence interval (CI)=0.66-0.92, P=2.710

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