Faculty Bibliography

BACKGROUND/UNASSIGNED:Colonoscopy remains the predominant diagnostic modality for colorectal cancer (CRC), as the diagnostic performance of tumor markers in alone, particularly in the early stages of the disease, is limited. This study sought to develop a diagnostic model for CRC that integrated various laboratory parameters. METHODS/UNASSIGNED:One hundred patients with CRC were assigned to an experimental group while 114 with benign colorectal diseases and 101 healthy individuals were assigned to a control group. The clinical and laboratory data, including the tumor markers such as carcinoembryonic antigen (CEA), glycan carbohydrate antigen 19-9 (CA19-9), carbohydrate antigen 242 (CA242), blood count parameters, blood biochemical parameters, and coagulation parameters, were collected for each participant. Three machine-learning models [multilayered perceptron (MLP), eXtreme Gradient Boosting (XGBoost), and random forest (RF)] were used to construct CRC diagnostic models. The performance of each model was evaluated based on its area under the curve (AUC), sensitivity, and specificity. RESULTS/UNASSIGNED:There are 12 parameters: including CEA, CA19-9, CA242, absolute neutrophil value (NEUT), hemoglobin, the neutrophil/lymphocyte ratio, the platelet/lymphocyte ratio, alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, albumin, and prothrombin time, were selected to build the diagnostic model. For the validation set, the RF machine-learning model achieved the highest performance in identifying CRC [AUC: 0.902 (95% confidence interval: 0.812-0.989), accuracy: 0.803, sensitivity: 0.908, specificity: 0.772, positive predictive value: 0.664, negative predictive value: 0.890, and F1 score: 0.763]. The AUC, sensitivity, specificity, and Youden's index for the combined diagnosis of tumor markers CEA, CA19-9, and CA242 were 0.761, 0.486, 0.983, and 0.469, respectively. The RF diagnostic model showed better diagnostic efficacy than the combined diagnosis model of tumor markers CEA, CA19-9 and CA242. CONCLUSIONS/UNASSIGNED:The use of machine learning combined with multiple laboratory parameters effectively improved the diagnostic efficiency of CRC and provided more accurate results for clinical diagnosis.

Introduction: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths for the overall US population, with over 153,000 new cases annually. It is one the most diagnosed cancers in veterans and accounts for approximately 9 "‹% of all cancers in this population. Methods: This cross-sectional study used weighted data from the BRFSS 2021, a nationally representative US-telephone-based survey. We assessed the rate of endoscopic and stool-based colorectal cancer screening done in the VP compared to the NVP, stratified by age of screening, insurance, health status, primary care and marital status. We used backward stepwise multivariate logistic regression analyses to then assess for potentially predictive factors. Results: A total of 117,227,096 adults were included in the study of which 11.64 "‹% were veterans. We found that a higher proportion of veterans (78.44 "‹%) had endoscopic CRC screening compared to non-veterans (68.62 "‹%). VP were more likely to be screened compared to NVP (OR "‹= "‹1.32, (1.00"“1.74). Only 26.45 "‹% of VP in this study utilized military health coverage and are four-times likely to be screened (OR "‹= "‹3.64, (2.04"“6.52). Lastly, both VP and NVP who were actively followed by their primary care provider (OR "‹= "‹2.80, (2.02"“3.87) were more likely to be screened. Conclusion: A higher proportion of VP had endoscopic colorectal cancer screening, but a screening gap still exists. Active engagement with PCPs is associated with more frequent endoscopic CRC screening in veterans. We recommend more grassroots efforts to get veterans engaged with their PCPs to significantly improve screening coverage.

BACKGROUND:Endoscopic polypectomy could be an appropriate, definitive treatment for pathologic T1 (pT1) colon polyps without high-risk features. Prior studies suggested worse prognosis for proximal versus distal advanced-stage colon cancers following curative treatment. However, there is limited evidence on the prognostic impact of tumor location for pT1s. PATIENTS AND METHODS/METHODS:This was a retrospective cohort study using the Surveillance, Epidemiology, and End Results database to identify adults with T1NxMx or T1N0-3M0/x colon adenocarcinoma from 2000 to 2019. RESULTS:A total of 3398 patients underwent endoscopic polypectomy (17% proximal) and 28,334 had a partial colectomy (49% proximal) for pT1 adenocarcinoma. Following endoscopic polypectomy, 5-year overall and cancer-specific survival rates were 64% and 91% for proximal versus 83% and 96% for distal polyps, compared with 82% and 95% for proximal versus 88% and 97% for distal tumors after colectomy. In multivariable models, there was a greater difference in overall survival between proximal and distal polyps for those who underwent endoscopic versus surgical resection [hazard ratio (HR) 1.73, 95% confidence interval (CI) 1.49-2.02 vs. HR 1.13, 95% CI 1.08-1.18]. Patients with proximal versus distal polyps who underwent polypectomy also exhibited increased cancer-specific mortality (HR 1.94, 95% CI 1.37-2.75). However, cancer-specific survival variations based on tumor location were no longer observed in patients undergoing partial colectomy (HR 1.09, 95% CI 0.98-1.21). CONCLUSIONS:Proximal tumor location was independently associated with worse overall and cancer-specific survival following endoscopic polypectomy. However, after colectomy, the cancer-specific disparity based on tumor laterality was mitigated. These findings suggest that proximal location may be considered a high-risk feature in endoscopic polypectomy.

BACKGROUND AND AIMS/OBJECTIVE:Resection of colorectal polyps has been shown to decrease the incidence and mortality of colorectal cancer. Large non-pedunculated colorectal polyps are often referred to expert centres for endoscopic resection, which requires relevant information to be conveyed to the therapeutic endoscopist to allow for triage and planning of resection technique. The primary objective of our study was to establish minimum expected standards for the referral of LNPCP for potential ER. METHODS:A Delphi methodology was employed to establish consensus on minimum expected standards for the referral of large colorectal polyps among a panel of international endoscopy experts. The expert panel was recruited through purposive sampling, and three rounds of surveys were conducted to achieve consensus, with quantitative and qualitative data analysed for each round. RESULTS:A total of 24 international experts from diverse continents participated in the Delphi study, resulting in consensus on 19 statements related to the referral of large colorectal polyps. The identified factors, including patient demographics, relevant medications, lesion factors, photodocumentation and the presence of a tattoo, were deemed important for conveying the necessary information to therapeutic endoscopists. The mean scores for the statements ranged from 7.04 to 9.29 out of 10, with high percentages of experts considering most statements as a very high priority. Subgroup analysis by continent revealed some variations in consensus rates among experts from different regions. CONCLUSION/CONCLUSIONS:The identified consensus statements can aid in improving the triage and planning of resection techniques for large colorectal polyps, ultimately contributing to the reduction of colorectal cancer incidence and mortality.

AIM/OBJECTIVE:Primary sclerosing cholangitis (PSC) increases the risk of colorectal cancer (CRC) in inflammatory bowel disease (IBD) patients; however, there is a paucity of literature to suggest PSC alone as an independent risk factor for CRC. We aimed to determine if PSC is an independent risk factor for CRC in a large tertiary care medical center. Optimizing screening intervals is of great importance, given the burden and risks associated with a lifetime of colonoscopy screening. METHODS:This retrospective cohort study consists of patients diagnosed with PSC preceding IBD (PSC-IBD) and PSC-only before January 6, 2023 from a large, tertiary, academic medical center. Patients diagnosed with IBD concurrently or before PSC were excluded to reduce IBD's impact on CRC risk. Demographic data and colonoscopy findings were collected and assessed. RESULTS:Overall, 140 patients from all NYU Langone Health clinical settings were included. Patients with PSC-IBD were more likely to be diagnosed with CRC (23.3% vs. 1.8%, p < 0.01) and either low-grade or uncharacterized dysplasia (16.7% vs. 0.0%, p < 0.01) compared with those with PSC-only. Among PSC-only patients, the estimated CRC risk was significantly elevated compared with that expected of the standard NYU Langone population (SIR 9.2, 95% CI 1.1, 33.2). CONCLUSIONS:Our study revealed a significantly heightened CRC risk in PSC-IBD patients compared with those with PSC-only. Importantly, individuals with PSC-only also face a greater CRC risk compared with the general population. Individuals with PSC-alone may require extended screening and surveillance colonoscopy intervals compared with those with PSC-IBD, yet still require more frequent monitoring than screening guidelines recommend for the general population.

Several bacterial taxa enriched in inflammatory bowel diseases and colorectal cancer (CRC) are found in the oral cavity. We conducted a pilot study nested within a six-week aspirin intervention in a randomized placebo-controlled trial to test their response to aspirin intervention. Fifty healthy subjects, 50-75 years old, were randomized to receive 325 mg aspirin (n = 30) or placebo (n = 20) orally once daily for six weeks. Oral tongue swabs were collected at baseline and week six. We estimated the association between aspirin use and the temporal changes in the relative abundance of pre-specified genus level taxa from pre- to post-treatment. The temporal change in relative abundance differed for eight genus level taxa between the aspirin and placebo groups. In the aspirin group, there were significant increases in the relative abundances of Neisseria, Streptococcus, Actinomyces, and Rothia and significant decreases in Prevotella, Veillonella, Fusobacterium, and Porphyromonas relative to placebo. The log ratio of Neisseria to Fusobacterium declined more in the aspirin group than placebo, signaling a potential marker associated with aspirin intervention. These preliminary findings should be validated using metagenomic sequencing and may guide future studies on the role of aspirin on taxa in various oral ecological niches.

INTRODUCTION/BACKGROUND:Colorectal cancer (CRC) screening is now recommended at the age of 45 years in the United States. However, information regarding the adenomas detection rate (ADR) and sessile serrated lesions (SSLs) in 45- to 49-year-old individuals is limited. In addition, the impact of lowering the screening age to 45 years on the ADR and the detection rate of SSLs is not well elucidated. This systematic review and meta-analysis aims to report the overall ADR and SSL detection rate in 45- to 49-year-old individuals undergoing colonoscopy. METHODS:We searched MEDLINE, EMBASE, SCOPUS, Web of Science, ClinicalTrials.gov , and the Cochrane database from inception through October 2022 to identify studies reporting on ADR and SSL detection rates in 45- to 49-year-old individuals undergoing colonoscopies for all indications. This approach acknowledges the possibility of including individuals undergoing diagnostic colonoscopies or those with increased risk factors for CRC. We also conducted a separate analysis examining ADR in average-risk individuals undergoing screening colonoscopy. The pooled rates with their corresponding 95% confidence intervals (CIs) were generated using the fixed-effects model. I2 was used to adjudicate heterogeneity. RESULTS:Sixteen studies met the inclusion criteria. All studies were retrospective except one; 3 had data from national/local registries. There were 41,709 adenomas detected across 150,436 colonoscopies. The pooled overall ADR was 23.1% (95% CI 19.7%-27.0%, I2 = 98.6%). The pooled ADR in individuals with average risk of CRC from 7 studies was 28.2% (95% CI 24.6%-32.0%, I2 = 96.5%). The pooled overall SSL detection rate from 6 studies was 6.3% (95% CI 3.8%-10.5%, I2 = 97%). The included studies were heterogeneous because of differences in the inclusion and exclusion criteria and patient population. DISCUSSION/CONCLUSIONS:In 45- to 49-year-old individuals undergoing a colonoscopy for any indication, the ADR and SSL detection rates were 23.1% and 6.3%, respectively. We conclude that these outcomes in 45- to 49-year-olds are comparable with individuals aged 50-54 years.