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Mucinous neoplasm of the appendix:A case report and review of literature

World Journal of Gastrointestinal Surgery 2024年第3期16卷 944-954页

作者： Hao-Cheng Chang Jung-Cheng Kang Ta-Wei Pu Ruei-Yu Su Chao-Yang Chen je-ming hu Department of Surgery Tri-Service General HospitalTaipei 114TaiwanChina Division of Colon and Rectal Surgery Department of SurgeryTaiwanChina Adventist HospitalTaipei 105TaiwanChina Division of Colon and Rectal Surgery Department of SurgeryTri-Service General Hospital Songshan BranchNational Defense Medical CenterTaipei 105TaiwanChina Division of Colon and Rectal Surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114TaiwanChina Department of Pathology Tri-Service General HospitalNational Defense Medical CenterTaipei 105TaiwanChina Department of Pathology and Laboratory Medicine Taoyuan Armed Forces General HospitalTaoyuan 325TaiwanChina

BACKGROUND Appendiceal mucinous neoplasms(AMNs),although not classified as rare,are relatively uncommon tumors most often discovered incidentally during colorectal *** identification of AMNs is difficult due to non-specific sym-ptoms,overlapping tumor markers with other conditions,and the potential for *** underscores the urgent need for precision in diagnosis to pre-vent severe *** SUMMARY This case report describes the unexpected discovery and treatment of a low-grade AMN(LAMN)in a 74-year-old man undergoing laparoscopic hemicolectomy for transverse colon adenocarcinoma(AC).Preoperatively,non-specific gastroin-testinal symptoms and elevated tumor markers masked the presence of *** tumor,presumed to be an AMN peritoneal cyst intraoperatively,was con-firmed as LAMN through histopathological *** neoplasm exhibited mucin accumulation and a distinct immunohistochemical profile:Positive for Ho-meobox protein CDX-2,Cytokeratin 20,special AT-rich sequence-binding protein 2,and Mucin 2 but negative for cytokeratin 7 and Paired box gene *** profile aids in distinguishing appendiceal and ovarian mucinous *** recovery was uncomplicated,and the patient initiated adjuvant chemotherapy for the colon *** This case highlights the diagnostic complexity of AMNs,emphasizing the need for vigilant identification to avert potential complications,such as pseudomyxoma peritonei.

关键词： Adenocarcinoma Appendiceal neoplasms Low-grade appendiceal mucinous neoplasm Peritoneal neoplasms Pseudomyxoma peritonei Case report

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Stercoral perforation of the cecum:A case report

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World Journal of Gastrointestinal Surgery 2024年第4期16卷 1189-1194页

作者： hung-Chun Yu Ta-Wei Pu Jung-Cheng Kang Chao-Yang Chen je-ming hu Ruei-Yu Su Department of Surgery Taichung Armed Forces General HospitalTaichung 411228Taiwan Department of Surgery Tri-Service General HospitalNational Defense Medical CenterTaipei 11490Taiwan Division of Colon and Rectal Surgery Department of SurgeryTri-Service General Hospital Songshan BranchNational Defense Medical CenterTaipei 105Taiwan Division of Colon and Rectal Surgery Department of SurgeryTaiwan Adventist HospitalTaipei 105Taiwan Division of Colon and Rectal Surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Department of Pathology Tri-Service General HospitalNational Defense Medical CenterTaipei 105Taiwan Department of Pathology and Laboratory Medicine Taoyuan Armed Forces General HospitalTaoyuan 325Taiwan

BACKGROUND With less than 90 reported cases to date,stercoral perforation of the colon is a rare *** ulceration is thought to occur due to ischemic pressure necrosis of the bowel wall,which is caused by the presence of a stercoraceous *** underscore this urgent surgical situation concerning clinical presentation,surgical treatment,and results,we present the case of a 66-year-old man with a stercoral *** SUMMARY A 66-year-old man with a history of hypertension,hyperlipidemia,and gout presented at the emergency department with lower abdominal pain and a low-grade fever lasting for a few *** computed tomography indicated a suspected bezoar(approximately 7.6 cm)in the dilated cecum,accompanied by pericolic fat stranding,mild proximal dilatation of the ileum,pneumoperitoneum,and minimal ***,feculent peritonitis with isolated cecal perforation were ***,a right hemicolectomy with peritoneal lavage was performed.A histopathological examination supported the intraoperative *** In stercoral perforations,a diagnosis should be diligently pursued,especially in older adults,and prompt surgical intervention should be implemented.

关键词： Acute abdomen Colectomy Peritoneal lavage Pneumoperitoneum Bezoars Case report

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Cellular angiofibroma arising from the rectocutaneous fistula in an adult: A case report

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World Journal of Clinical Cases 2024年第10期12卷 1778-1784页

作者： Hao-En Chen Yu-Yang Lu Ruei-Yu Su Hong-Hau Wang Chao-Yang Chen je-ming hu Jung-Cheng Kang Kuan-Hsun Lin Ta-Wei Pu Department of Surgery Taichung Armed Forces General HospitalTaichung 411Taiwan Department of Surgery Tri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Department of Pediatrics Tri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Department of Pathology Tri-Service General HospitalNational Defense Medical CenterTaipei 105Taiwan Department of Pathology and Laboratory Medicine Taoyuan Armed Forces General HospitalTaoyuan 32551Taiwan Department of Radiology Tri-Service General Hospital Songshan BranchNational Defense Medical CenterTaipei 105Taiwan Division of Colon and Rectal Surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Division of Colon and Rectal Surgery Department of SurgeryTaiwan Adventist HospitalTaipei 105Taiwan Division of Thoracic Surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Division of Colon and Rectal Surgery Department of SurgeryTri-Service General Hospital Songshan BranchNational Defense Medical CenterTaipei 105Taiwan

BACKGROUND Rectocutaneous fistulae are *** infection originates within the anal glands and subsequently extends into adjacent regions,ultimately resulting in fistula *** angiofibroma(CAF),also known as an angiomy ofibroblastoma-like tumor,is a rare benign soft tissue neoplasm predominantly observed in the scrotum,perineum,and inguinal area in males and in the vulva in *** describe the first documented case CAF that developed within a rectocutaneous fistula and manifested as a perineal *** SUMMARY In the outpatient setting,a 52-year-old male patient presented with a 2-year history of a growing perineal mass,accompanied by throbbing pain and minor scrotal *** examination revealed a soft,well-defined,non-tender mass at the left buttock that extended towards the perineum,without a visible *** initial assessment identified a soft tissue tumor,and the laboratory data were within normal *** and pelvic computed tomography(CT)revealed swelling of the abscess cavity that was linked to a rectal cutaneous fistula,with a track-like lesion measuring 6 cm×0.7 cm in the left perineal region and attached to the left *** examination found no significant inner orifices.A left medial gluteal incision revealed a thick-walled mass,which was excised along with the extending tract,and curettage was *** examination confirmed CAF *** patient achieved total resolution during follow-up assessments and did not require additional *** CT imaging supports perineal lesion diagnosis and *** angiofibromas,even with a cutaneous fistula,can be excised transperineally.

关键词： Angiofibroma Perineal mass Rectocutaneous fistula Anorectal fistula Anal fistula Case report

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Treatment of benign rectal stricture caused by repeated anal insertion by endoscopy and balloon dilation:A case report

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World Journal of Gastrointestinal Endoscopy 2024年第2期16卷 91-97页

作者： Shih-hung Liu Jung-Cheng Kang je-ming hu Chao-Yang Chen Kuan-Hsun Lin Ta-Wei Pu Department of Surgery Tri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Division of Colon and Rectal Surgery Department of SurgeryTaiwan Adventist HospitalTaipei 105Taiwan Division of Colon and Rectal Surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Division of Thoracic Surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Division of Colon and Rectal Surgery Department of SurgerySongshan BranchTri-Service General HospitalNational Defense Medical CenterTaipei 105Taiwan

BACKGROUND Benign rectal strictures can be categorized as primary(disease-related)and secondary(surgical anastomosis-related).Secondary strictures arise from surgical complications,whereas primary strictures have diverse etiologies,including various inflammatory *** strictures are usually managed by surgery and *** present an unusual etiology of benign rectal stricture caused by the repeated insertion of foreign objects into the rectum for sexual purposes,resulting in rectal injury and subsequent chronic *** SUMMARY A 53-year-old man presented to the outpatient clinic of the Colorectal Surgery Department with symptoms of chronic constipation and bloody *** patient previously experienced rectal injury due to foreign object insertion for sexual *** revealed benign circumferential narrowing of the *** underwent treatment by endoscopic argon plasma coagulation and balloon dilation and follow-up as an outpatient for 4 months.A colonoscopy at the end of the follow-up period revealed no evidence of rectal stricture *** A history of rectal injury,followed by chronic inflammation,should be considered in patients with benign rectal *** with endoscopic argon plasma coagulation and balloon dilation can prevent the need for surgical resection of benign rectal strictures.

关键词： Chronic rectal inflammation Colonoscopy Benign rectal stricture Foreign body insertion Rectal injury Case report

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Risk factors predict microscopic extranodal tumor deposits in advanced stage Ⅲ colon cancer patients

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World Journal of Gastroenterology 2023年第11期29卷 1735-1744页

作者： Yi-Han Jhuang Yu-Ching Chou Yu-Chun Lin je-ming hu Ta-Wei Pu Chao-Yang Chen Division of Cardiovascular Surgery Tri-Service General HospitalNational Defense Medical CenterTaipei 114TaiwanChina School of Public Health National Defense Medical CenterTaipei 114TaiwanChina Department of Pathology Tri-Service General HospitalNational Defense Medical CenterTaipei 114TaiwanChina Division of Colorectal Surgery Tri-Service General HospitalNational Defense Medical CenterTaipei 114TaiwanChina Division of Colorectal Surgery Tri-Service General Hospital Song-shan BranchNational Defense Medical CenterTaipei 114TaiwanChina

BACKGROUND Colorectal cancer is a frequent cause of cancer-related mortality in patients with lymph node or distant *** tumor deposits(TDs)are considered prognostically distinct from lymph node *** To investigate risk factors for extranodal TDs in stage III colon *** This was a retrospective cohort *** selected 155 individuals diagnosed with stage III colon cancer from the database of the Cancer Registry of the Tri-Service General *** patients were allocated into the groups with/without *** Cox regression analysis and Kaplan-Meier method were *** primary outcomes investigate the association between the covariates and extranodal TDs,and prognostic significance of the covariates regarding the *** There were 136 individuals in the non-N1c group and 19 individuals in the N1c *** with lymphovascular invasion(LVI)had a higher risk of *** survival rates of patients with and without LVI were 6.64 years and 8.61 years,respectively(P=0.027).The N1c patients without LVI had higher overall survival than those who with LVI(7.73 years vs 4.42 years,P=0.010).CONCLUSION Patients having stage III colon cancer with LVI have a higher probability of having TDs than those with stage III colon cancer without *** III colon cancer patients with TDs and LVI could have poor prognosis and outcome.

关键词： Colon cancer Tumor deposits Lymphovascular invasion Risk factor

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Repair of a giant inguinoscrotal hernia with herniation of the ileum and sigmoid colon:A case report

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World Journal of Clinical Cases 2023年第2期11卷 401-407页

作者： Shih-hung Liu Ching-Hen Yen Hsu-Ping Tseng je-ming hu Ching-Han Chang Ta-Wei Pu Department of Surgery Tri-Service General HospitalNational Defense Medical CenterTaipei 11490Taiwan Division of Urological Surgery Department of SurgerySongshan BranchTri-Service General HospitalNational Defense Medical CenterTaipei 10581Taiwan Division of Colon and Rectal Surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 11490Taiwan Department of Surgery Kaohsiung Armed Forces General HospitalKaohsiung 802Taiwan Division of Colon and Rectal Surgery Department of SurgerySongshan BranchTri-Service General HospitalNational Defense Medical CenterTaipei 10581Taiwan

BACKGROUND Giant inguinoscrotal hernias are huge inguinal hernias that extend below the midpoint of the inner thigh in the standing *** inguinoscrotal hernias are rare in developed countries because of their better medical resources and early ***,they can develop in patients who refuse surgery or ignore their *** is inevitable because strangulation and organ perforation can occur,leading to peritonitis and *** surgical approaches include open abdominal and inguinal approaches or a combination of *** SUMMARY We present the case of a 73-year-old man who visited our emergency department with a huge mass in his left scrotum and septic *** computed tomography revealed a large left inguinoscrotal hernia that contained small bowel loops and the *** surgical intervention was performed immediately because intestinal strangulation was highly *** operative repair was performed using a combination of mini-exploratory laparotomy and the inguinal *** incarcerated organs,which included the ileum and sigmoid colon,had relatively good intestinal perfusion without perforation or ischemic *** were successfully reduced into the abdomen,and bowel resection was not necessary.A tension-free prosthetic mesh was used for the hernia *** weeks after the initial surgery,and with adequate antimicrobial therapy,the patient recovered and was discharged from our *** evidence of hernia relapse was noted during the outpatient follow-up examination 3 mo after *** Emergency surgery involving combined mini-exploratory laparotomy and the inguinal approach should be performed for serious incarcerated giant inguinoscrotal hernias.

关键词： Inguinal hernia Ileum Sigmoid colon Sepsis Hernia repair Case report

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Cecocutaneous fistula diagnosed by computed tomography fistulography:A case report

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World Journal of Gastrointestinal Surgery 2022年第10期14卷 1161-1168页

作者： Tung-Yen Wu Kuang-hua Lo Chao-Yang Chen je-ming hu Jung-Cheng Kang Ta-Wei Pu Department of Surgery Tri-Service General Hospital Songsang BranchTaipei 105Taiwan Department of Surgery Taipei Veterans General HospitalTaipei 112Taiwan Division of Colon and Rectal Surgery Department of SurgeryTri-Service General HospitalTaipei 114Taiwan Division of Colon and Rectal Surgery Department of SurgeryTaiwan Adventist HospitalTaipei 105Taiwan Division of Colon and Rectal Surgery Department of SurgeryTri-Service General Hospital Songsang BranchNational Defense Medical CenterTaipei 105Taiwan

BACKGROUND Enterocutaneous fistula(ECF) is an abnormal communication between the skin and the gastrointestinal tract and is associated with considerable morbidity and mortality. To diagnose ECF, X-ray fistulography and abdominal computed tomography(CT) with intravenous or oral contrast are generally used. If the anatomic details obtained from CT are insufficient, CT fistulography may help diagnose and determine the extent of the abnormal channel. However, CT fistulography is seldom performed in patients with insufficient evidence of a *** SUMMARY A 35-year-old man with a prior appendectomy presented with purulence over the abdominal wall without gastrointestinal tract symptoms or a visible opening on the abdominal surface. His history and physical examination were negative for nausea, diarrhea, muscle guarding, and bloating. Local abdominal tenderness and redness over a purulent area were noted, which led to the initial diagnosis of cellulitis. He was admitted to our hospital with a diagnosis of cellulitis. We performed a minimal incision on the carbuncle to collect the pus. The bacterial culture of the exudate resulted positive for Enterococcus sp. ECF was thus suspected, and we arranged a CT scan for further investigation. CT images before intravenous contrast administration showed that the colon was in close contact with the abdominal wall. Therefore, we conducted CT fistulography by injecting contrast dye into the carbuncle during the CT scan. The images showed an accumulation of the contrast agent within the subcutaneous tissues, suggesting the formation of an abscess. The contrast dye tracked down through the muscles and peritoneum into the colon, delineating a channel connecting the subcutaneous abscess with the colon. This evidence confirmed cecocutaneous fistula and avoided misdiagnosing ECF without gastrointestinal tract symptoms as cellulitis. The patient underwent laparoscopic right hemicolectomy with re-anastomosis of the ileum and transverse c

关键词： Cecocutaneous fistula Enterocutaneous fistula Computed tomography fistulography Laparoscopy Hemicolectomy Case report

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Benefits of laparoscopy-assisted ileostomy in colorectal cancer patients with bowel obstruction

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世界临床病例杂志 2023年第24期11卷 5660-5665页

作者： Yi-Jie Wang Kuan-Hsun Lin Jung-Cheng Kang je-ming hu Chao-Yang Chen Ta-Wei Pu Department of Surgery Tri Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Division of Thoracic Surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Division of Colon and Rectal Surgery Department of SurgeryTaiwan Adventist HospitalTaipei 105Taiwan Division of Colon and Rectal Surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Division of Colon and Rectal Surgery Department of SurgerySongshan branchTri-Service General HospitalNational Defense Medical CenterTaipei 105Taiwan

BACKGROUND Ileostomies are commonly performed after colon and rectal ***-assisted ileostomy with adhesion lysis may have potential benefits over conventional open *** To compare the outcomes of laparoscopy-assisted and conventional *** Data from 48 consecutive patients who underwent ileostomy at our institution between May 2021 and May 2022 were retrospectively *** groups comprised 26 and 22 patients who underwent laparoscopic ileostomy(laparoscopic group)and conventional ileostomy(conventional group),respectively,performed by a single *** demographics,operative characteristics,postoperative outcomes,and 30-d morbidities and mortality rates were *** The two groups had comparable mean ages,sex distributions,American Society of Anesthesiologists scores,and body mass ***,the laparoscopic group showed similar operative time,better visualization for adhesion lysis,and lower visual analog scale scores than the conventional *** Laparoscopy-assisted ileostomy is a safe and efficient method that produces lower visual analog scale scores,better intraoperative visualization for effective adhesion lysis,and similar operative time compared with conventional ileostomy.

关键词： Laparoscopy Ileostomy Colorectal cancer Bowel obstruction Tissue adhesion Retrospective study

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Is anoplasty superior to scar revision surgery for posthemorrhoidectomy anal stenosis?Six years of experience

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World Journal of Clinical Cases 2022年第22期10卷 7698-7707页

作者： Yu-Tse Weng Kuan-Jung Chu Kuan-Hsun Lin Chun-Kai Chang Jung-Cheng Kang Chao-Yang Chen je-ming hu Ta-Wei Pu Division of Plastic and Reconstructive Surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan National Defense Medical Center Taipei 114Taiwan Division of Thoracic Surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Division of Plastic and Reconstructive Surgery Department of SurgeryZuoying BranchKaohsiung Armed Forces General HospitalKaohsiung 813Taiwan Division of Colon and Rectal Surgery Department of SurgeryTaiwan Adventist HospitalTaipei 105Taiwan Division of Colon and Rectal Surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Division of Colon and Rectal Surgery Department of SurgerySongshan branchTri-Service General HospitalNational Defense Medical CenterTaipei 105Taiwan

BACKGROUND Anal stenosis is a rare but frustrating condition that usually occurs as a complication of *** severity of anal stenosis can be classified into three categories:mild,moderate,and *** are two main surgical treatments for this condition:scar revision surgery and anoplasty;however,no studies have compared these two approaches,and it remains unclear which is preferrable for stenoses of different *** To compare the outcomes of scar revision surgery and double diamond-shaped flap *** Patients with mild,moderate,or severe anal stenosis following hemorrhoidectomy procedures who were treated with either scar revision surgery or double diamond-shaped flap anoplasty at our institution between January 2010 and December 2015 were investigated and *** severity of stenosis was determined via anal examination performed digitally or using a Hill-Ferguson *** explored patient characteristics included age,sex,preoperative severity of anal stenosis,preoperative symptoms,and preoperative adjuvant therapy;moreover,their postoperative quality of life was measured using a 10-point *** underwent proctologic follow-up examinations one,two,and four weeks after *** We analyzed 60 consecutive patients,including 36 men(60%)and 24 women(40%).The mean operative time for scar revision surgery was significantly shorter than that for double diamondshaped flap anoplasty(10.14±2.31[range:7-15]min vs 21.62±4.68[range:15-31]min;P<0.001).The average of length of hospital stay was also significantly shorter after scar revision surgery than after anoplasty(2.1±0.3 vs 2.9±0.4 d;P<0.001).Postoperative satisfaction was categorized into four groups:45 patients(75%)reported excellent satisfaction(scores of 8-10),13(21.7%)reported good satisfaction(scores of 6-7),two(3.3%)had no change in satisfaction(scores of 3-5),and none(0%)had scores indicating poor satisfaction(1-2).As such,most patients were satisfied wi

关键词： Anal canal Anoplasty Scar revision Stenosis Surgery-induced tissue adhesions Surgical flaps

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Differential DNA methylation analysis of SUMF2,ADAMTS5,and PXDN provides novel insights into colorectal cancer prognosis prediction in Taiwan

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World Journal of Gastroenterology 2022年第8期28卷 825-839页

作者： Jing-Quan Su Pin-Yu Lai Pei-Hsuan hu je-ming hu Pi-Kai Chang Chao-Yang Chen Jia-Jheng Wu Yu-Jyun Lin Chien-An Sun Tsan Yang Chih-Hsiung Hsu hua-Ching Lin Yu-Ching Chou School of Medicine National Defense Medical CenterTaipei 114TaiwanChina School of Public Health National Defense Medical CenterTaipei 114TaiwanChina Division of Colorectal Surgery Department of surgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114TaiwanChina Graduate Institute of Medical Sciences National Defense Medical CenterTaipei 114TaiwanChina Department of Public Health College of MedicineFu-Jen Catholic UniversityNew Taipei City 242TaiwanChina Big Data Research Center College of MedicineFu-Jen Catholic UniversityNew Taipei City 242TaiwanChina Department of Health Business Administration Meiho UniversityPingtung County 912TaiwanChina Division of Colorectal Surgery Department of SurgeryCheng-Hsin General HospitalTaipei 112TaiwanChina

BACKGROUND Patients with colorectal cancer(CRC)undergo surgery,as well as perioperative chemoradiation or adjuvant chemotherapy primarily based on the tumor–node–metastasis(TNM)cancer staging ***,treatment responses and prognostic outcomes of patients within the same stage vary *** potential use of novel biomarkers can improve prognostication and shared decision making before implementation into certain *** To investigate whether SUMF2,ADAMTS5,and PXDN methylation status could be associated with CRC *** We conducted a Taiwan region cohort study involving 208 patients with CRC recruited from TriService General Hospital and applied the candidate gene approach to identify three genes involved in oncogenesis pathways.A methylation-specific polymerase chain reaction(MS-PCR)and Epi TYPER DNA methylation analysis were employed to detect methylation status and to quantify the methylation level of candidate genes in tumor tissue and adjacent normal tissue from *** evaluated SUMF2,ADAMTS5,and PXDN methylation as predictors of prognosis,including recurrence-free survival(RFS),progression-free survival(PFS),and overall survival(OS),using a Cox regression model and Kaplan–Meier *** We revealed various outcomes related to methylation and *** shorter PFS and OS were associated with the CpG_3+CpG_7 hypermethylation of SUMF2 from tumor tissue compared with CpG_3+CpG_7 hypomethylation[hazard ratio(HR)=2.24,95%confidence interval(CI)=1.03-4.85 for PFS,HR=2.56 and 95%CI=1.08-6.04 for OS].By contrast,a significantly longer RFS was associated with CpG_2 and CpG_13 hypermethylation of ADAMTS5 from normal tissue compared with CpG_2 and CpG_13 hypomethylation[HR(95%CI)=0.15(0.03-0.71)for CpG_2 and 0.20(0.04-0.97)for CpG_13].The relationship between the methylation status of PXDN and the prognosis of CRC did not reach statistical *** Our study found that CpG_3+CpG_7 hypermethylation o

关键词： DNA methylation Biomarkers Tumor tissue Adjacent normal tissue Prognosis prediction Colorectal cancer

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