BACKGROUND Inflammatory bowel disease (IBD) patients with post-inflammatory polyps (PIPs) may carry an increased risk of colorectal neoplasia (CRN) including dysplasia and cancer. Current guidelines recommend active colonoscopy follow-up for these patients. However, the evidence for guidelines is still poor. In addition, some recent high-quality reports present a different view, which challenges the current guidelines. We hypothesize that IBD patients with PIPs are at increased risk of CRN. AIM To evaluate the risk of CRN in IBD patients with and without PIPs. METHODS A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was performed to identify studies that compared the risk of CRN in IBD patients with and without PIPs. In addition, we screened the reference lists and citation indices of the included studies. Quality assessment was performed using the Newcastle–Ottawa Scale. Pooled odds ratio (OR) was calculated using the random-effects model to explore the final pooled effect size of the included studies and determine whether PIPs increase the risk of CRN. Sensitivity analysis, subgroup analysis, and assessment of publication bias were performed to examine the sources of heterogeneity. RESULTS Twelve studies with 5819 IBD patients, including 1281 (22.01%) with PIPs, were considered eligible for this meta-analysis. We found that IBD patients with PIPs were at an increased risk of CRN as compared to those without PIPs [OR 2.01; 95% confidence interval (CI): 1.43–2.83]. The results were similar when colorectal cancer was used as the study endpoint (OR 2.57; 95%CI: 1.69–3.91). Furthermore, the risk of CRN was still increased (OR 1.80; 95%CI: 1.12–2.91) when restricted to ulcerative colitis patients. Heterogeneity was high among the included studies ( I ² = 75%). Subgroup analysis revealed that the high heterogeneity was due to the study design. Sensitivity analysis showed that the main statistical outcomes did not essentially change after excluding any one of the included studies. No significant publication bias was found in the funnel plots. CONCLUSION IBD patients with PIPs have an increased risk of CRN as compared with those without PIPs, which support the current guidelines. However, a high-quality randomized controlled trial is warranted.

Background Prognosis varies among stage IV colorectal cancer (CRC). Our study aimed to build a robust prognostic nomogram for predicting overall survival (OS) of patients with stage IV CRC in order to provide evidence for individualized treatment. Method We collected the information of 16,283 patients with stage IV CRC in the Surveillance, Epidemiology, and End Results (SEER) database and then randomized these patients in a ratio of 7:3 into a training cohort and an internal validation cohort. In addition, 501 patients in the Sixth Affiliated Hospital of Sun Yat-sen University (Guangzhou, China) database were selected and used as an external validation cohort. Univariate and multivariate Cox analyses were used to screen out significant variables for nomogram establishment. The nomogram model was assessed using time-dependent receiver-operating characteristic curve (time-dependent ROC), concordance index (C-index), calibration curve, and decision curve analysis. Survival curves were plotted using the Kaplan–Meier method. Result The C-index of the nomogram for OS in the training, internal validation, and external validation cohorts were 0.737, 0.727, and 0.655, respectively. ROC analysis and calibration curves pronounced robust discriminative ability of the model. Further, we divided the patients into a high-risk group and a low-risk group according to the nomogram. Corresponding Kaplan–Meier curves showed that the prediction of the nomogram was consistent with the actual practice. Additionally, model comparisons and decision curve analysis proved that the nomogram for predicting prognosis was significantly superior to the tumor-node-metastasis (TNM) staging system. Conclusions We constructed a nomogram to predict OS of the stage IV CRC and externally validate its generalization, which was superior to the TNM staging system.

Background The prognostic significance of primary tumor size in patients with stage IV colorectal cancer (CRC) has not been established. This study aimed to evaluate the prognostic value of tumor size in stage IV CRC. Methods We retrospectively analyzed the data of patients with stage IV CRC in the Surveillance, Epidemiology and End Results (SEER) database and patients with stage IV CRC treated at the Sixth Affiliated Hospital of Sun Yat-sen University (SYSU). The optimal cutoff value for tumor size was determined using the X-Tile program. Multivariable Cox regression analysis were used to examine whether tumor size was an independent predictor of prognosis. Results There were 16,283 patients in the SEER cohort and 462 in the SYSU cohort. With the help of the X-Tile program, we selected 60mm as the optimal tumor size cutoff. Multivariate analysis confirmed that tumor size (HR = 1.17, 95%CI: 1.13–1.22) was an independent prognostic factor in stage IV CRC. Across all subgroups in the SEER cohort, survival probability was significantly lower in patients with tumor size ≥ 60 mm than in patients with tumor size < 60 mm. Conclusions Tumor size appears to be an independent predictor of survival in patients with stage IV CRC. Patients with tumor size ≥ 60 mm have poor prognosis.

Background: α-Fetoprotein-positive colorectal cancer (AFPP-CRC) is a rare type of colorectal cancer (CRC), and there have been no comprehensive investigations on prognostic factors of AFPP-CRC. The aim of this study was to elucidate the prognostic factors of AFPP-CRC. Method: During the years of 2010 to 2020, 127 CRC patients with preoperative elevated serum AFP level were collected, after excluding the diagnosis of hepatitis, hepatocirrhosis and hepatocarcinoma. The AFPP-CRC group was matched by 1:2 to the AFPN(α-Fetoprotein-negative)-CRC group after propensity score matching (PSM) analysis. Prognostic factors were investigated using univariate and multivariate Cox regression model. Kaplan-Meier curves were performed among the concerned prognostic factors as well. Logistic regression was used in studying associated factors between good and poor prognosis groups of AFPP-CRC. Result: After adjusting for other confounding factors by PSM, AFP positivity and tumor stage were shown to be associated with poorer disease-free survival (DFS). The median of overall survival (OS) was 26.4 months versus 30.3 months when comparing AFPP-CRC group versus AFPN-CRC group (P=0.09). The median of DFS was 23.3 months in the AFPP-CRC group, as compared to 26.0 months in the AFPNCRC group (HR:1.77, 95%CI:1.22-2.57, P=0.003). Among AFPP-CRC patients, those who also had poor prognosis were characterized by microsatellite stability even after considering other confounding factors (OR, 0.18; 95%CI, 0.04-0.63; P=0.01). Conclusion: We found higher serum AFP level before surgery was associated with worse DFS in patients with CRC, even adjusting for tumor stage. Besides, AFPP-CRC with microsatellite stability might had a worse prognosis.