Jian-Min Xu’s research while affiliated with Fudan University and other places

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Publications (87)


Patient demographics, tumor characteristics and surgeon specialization
Pattern of colorectal surgery and long-term survival: 10-year experience from a single center
  • Article
  • Full-text available

November 2024

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9 Reads

World Journal of Gastrointestinal Oncology

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Miao Chen

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Dong-Hao Xu

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Jian-Min Xu

BACKGROUND The incidence of colorectal cancer (CRC) has increased in recent decades, and ranks fourth among males and third among females in China. Surgical resection remains the most important treatment modality for curative intent in CRC. Several studies found that surgeon volumes and specialization appeared to be associated with improved overall survival (OS). Moreover, numerous reports have suggested that specialization and minimally invasive surgery have gained increased popularity in CRC surgery. However, few studies have specifically examined the role and long-term survival of all stage CRC in a real-world study. AIM To evaluate the effect of surgeon specialization on survival changes and minimally invasive surgery utilization in a real world study. METHODS A retrospective analysis on the association between surgeon specialization and OS between 2008 and 2013 in Zhongshan Hospital CRC database was performed. Standard demographic, clinicopathologic, surgical and follow-up data were obtained from the CRC database. Surgeon specialty was categorized as colorectal surgeon (CS) and general surgeon (GS). CRC patients who underwent primary surgical resection were enrolled. RESULTS A total of 5141 CRC patients who underwent primary surgical resection between 2008 and 2013 were evaluated, 1748 (34.0%) of these by CS. The percentage of minimally invasive procedures in the CS group showed an increasing trend. There was no benefit associated with surgeon specialization for stage I, II and IV patients. Surgeon specialization exhibited a significant association with OS solely among stage III patients, with 5-year OS rates of 76% and 67% for the CS and GS groups, respectively (P < 0.01). Further analyses found that surgeon specialization was significantly associated with survival only in stage III rectal patients, and the 5-year OS rate in the CS group and GS group was 80% and 67%, respectively (P < 0.01). CONCLUSION Surgeon specialization is associated with improved OS after primary surgery in stage III rectal patients. An appropriate surgical technique, perioperative program and adjuvant therapy may contribute to survival benefit in these patients.

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Cox regression analyses for overall survival of colorectal cancer patients in this study
High patatin like phospholipase domain containing 8 expression as a biomarker for poor prognosis of colorectal cancer

March 2024

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9 Reads

World Journal of Gastrointestinal Oncology

BACKGROUND Patatin like phospholipase domain containing 8 (PNPLA8) has been shown to play a significant role in various cancer entities. Previous studies have focused on its roles as an antioxidant and in lipid peroxidation. However, the role of PNPLA8 in colorectal cancer (CRC) progression is unclear. AIM To explore the prognostic effects of PNPLA8 expression in CRC. METHODS A retrospective cohort containing 751 consecutive CRC patients was enrolled. PNPLA8 expression in tumor samples was evaluated by immunohistochemistry staining and semi-quantitated with immunoreactive scores. CRC patients were divided into high and low PNPLA8 expression groups based on the cut-off values, which were calculated by X-tile software. The prognostic value of PNPLA8 was identified using univariate and multivariate Cox regression analysis. The overall survival (OS) rates of CRC patients in the study cohort were compared with Kaplan-Meier analysis and Log-rank test. RESULTS PNPLA8 expression was significantly associated with distant metastases in our cohort (P = 0.048). CRC patients with high PNPLA8 expression indicated poor OS (median OS = 35.3, P = 0.005). CRC patients with a higher PNPLA8 expression at either stage I and II or stage III and IV had statistically significant shorter OS. For patients with left-sided colon and rectal cancer, the survival curves of two PNPLA8-expression groups showed statistically significant differences. Multivariate analysis also confirmed that high PNPLA8 expression was an independent prognostic factor for overall survival (hazard ratio HR = 1.328, 95%CI: 1.016-1.734, P = 0.038). CONCLUSION PNPLA8 is a novel independent prognostic factor for CRC. These findings suggest that PNPLA8 is a potential target in clinical CRC management.


Figure 1 was a flow chart of the trial design and procedures. Between September 2019 and April 2021, 4372 consecutive patients were considered for inclusion, and 91 were excluded because they were < 18 or > 80 years of age or had previously unresected colorectal polyps (Figure 1). The remaining 4281 patients were randomized to the IEE (n = 2140) or WLI (n = 2141) groups. 70 patients failed cecal intubation because of poor bowel preparation, technical difficulties, or intolerance. A total of 4211 patients were included in the analysis, with 2113 in the IEE group and 2098 in the WLI group. No adverse events related to endoscopy occurred. The baseline characteristics of the patients in the two groups were similar (Table 1). The mean age, number of men, colorectal surgery history, and colonoscopy history of IEE and WLI were 56.7 ± 12.9 years and 56.8 ± 13.0 years, 1002 (47.7%) and 982 (46.8%), 149 (7.1%) and 134 (6.4%), 892 (42.2%) and 879 (41.9%), respectively. Between-group differences were not significant (all P > 0.05). The most common colonoscopy indication in both groups was diagnostic, 880(41.6%) patients in the IEE group and 876 (41.8%) in the WLI group (P > 0.05).
Overall adenoma detection rate in patients of the two group
All polyps analysis of both group
Overall adenoma detection rate in patients of the subgroup
Efficacy of image-enhanced endoscopy for colorectal adenoma detection: A multicenter, randomized trial

May 2023

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25 Reads

World Journal of Gastrointestinal Oncology

Background: Improved adenoma detection at colonoscopy has decreased the risk of developing colorectal cancer. However, whether image-enhanced endoscopy (IEE) further improves the adenoma detection rate (ADR) is controversial. Aim: To compare IEE with white-light imaging (WLI) endoscopy for the detection and identification of colorectal adenoma. Methods: This was a multicenter, randomized, controlled trial. Participants were enrolled between September 2019 to April 2021 from 4 hospital in China. Patients were randomly assigned to an IEE group with WLI on entry and IEE on withdrawal (n = 2113) or a WLI group with WLI on both entry and withdrawal (n = 2098). The primary outcome was the ADR. The secondary endpoints were the polyp detection rate (PDR), adenomas per colonoscopy, adenomas per positive colonoscopy, and factors related to adenoma detection. Results: A total of 4211 patients (966 adenomas) were included in the analysis (mean age, 56.7 years, 47.1% male). There were 2113 patients (508 adenomas) in the IEE group and 2098 patients (458 adenomas) in the WLI group. The ADR in two group were not significantly different [24.0% vs 21.8%, 1.10, 95% confidence interval (CI): 0.99-1.23, P = 0.09]. The PDR was higher with IEE group (41.7%) than with WLI group (36.1%, 1.16, 95%CI: 1.07-1.25, P = 0.01). Differences in mean withdrawal time (7.90 ± 3.42 min vs 7.85 ± 3.47 min, P = 0.30) and adenomas per colonoscopy (0.33 ± 0.68 vs 0.28 ± 0.62, P = 0.06) were not significant. Subgroup analysis found that with narrow-band imaging (NBI), between-group differences in the ADR, were not significant (23.7% vs 21.8%, 1.09, 95%CI: 0.97-1.22, P = 0.15), but were greater with linked color imaging (30.9% vs 21.8%, 1.42, 95%CI: 1.04-1.93, P = 0.04). the second-generation NBI (2G-NBI) had an advantage of ADR than both WLI and the first-generation NBI (27.0% vs 21.8%, P = 0.01; 27.0% vs 21.2.0%, P = 0.01). Conclusion: This prospective study confirmed that, among Chinese, IEE didn't increase the ADR compared with WLI, but 2G-NBI increase the ADR.


Short-term Outcomes of Laparoscopy-Assisted vs Open Surgery for Patients With Low Rectal Cancer The LASRE Randomized Clinical Trial Supplemental content

September 2022

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58 Reads

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54 Citations

JAMA Oncology

Importance The efficacy of laparoscopic vs open surgery for patients with low rectal cancer has not been established. Objective To compare the short-term efficacy of laparoscopic surgery vs open surgery for treatment of low rectal cancer. Design, Setting, and Participants This multicenter, noninferiority randomized clinical trial was conducted in 22 tertiary hospitals across China. Patients scheduled for curative-intent resection of low rectal cancer were randomized at a 2:1 ratio to undergo laparoscopic or open surgery. Between November 2013 and June 2018, 1070 patients were randomized to laparoscopic (n = 712) or open (n = 358) surgery. The planned follow-up was 5 years. Data analysis was performed from April 2021 to March 2022. Interventions Eligible patients were randomized to receive either laparoscopic or open surgery. Main Outcomes and Measures The short-term outcomes included pathologic outcomes, surgical outcomes, postoperative recovery, and 30-day postoperative complications and mortality. Results A total of 1039 patients (685 in laparoscopic and 354 in open surgery) were included in the modified intention-to-treat analysis (median [range] age, 57 [20-75] years; 620 men [59.7%]; clinical TNM stage II/III disease in 659 patients). The rate of complete mesorectal excision was 85.3% (521 of 685) in the laparoscopic group vs 85.8% (266 of 354) in the open group (difference, −0.5%; 95% CI, −5.1% to 4.5%; P = .78). The rate of negative circumferential and distal resection margins was 98.2% (673 of 685) vs 99.7% (353 of 354) (difference, −1.5%; 95% CI, −2.8% to 0.0%; P = .09) and 99.4% (681 of 685) vs 100% (354 of 354) (difference, −0.6%; 95% CI, −1.5% to 0.5%; P = .36), respectively. The median number of retrieved lymph nodes was 13.0 vs 12.0 (difference, 1.0; 95% CI, 0.1-1.9; P = .39). The laparoscopic group had a higher rate of sphincter preservation (491 of 685 [71.7%] vs 230 of 354 [65.0%]; difference, 6.7%; 95% CI, 0.8%-12.8%; P = .03) and shorter duration of hospitalization (8.0 vs 9.0 days; difference, −1.0; 95% CI, −1.7 to −0.3; P = .008). There was no significant difference in postoperative complications rate between the 2 groups (89 of 685 [13.0%] vs 61 of 354 [17.2%]; difference, −4.2%; 95% CI, −9.1% to −0.3%; P = .07). No patient died within 30 days. Conclusions and Relevance In this randomized clinical trial of patients with low rectal cancer, laparoscopic surgery performed by experienced surgeons was shown to provide pathologic outcomes comparable to open surgery, with a higher sphincter preservation rate and favorable postoperative recovery. Trial Registration ClinicalTrials.gov Identifier: NCT01899547


Low ferroptosis score predicts chemotherapy responsiveness and immune‐activation in colorectal cancer

July 2022

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125 Reads

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13 Citations

Background: Existing studies for ferroptosis and prognosis in colorectal cancer (CRC) were limited. In this study, we aim to investigate the prognostic role of ferroptosis markers in patients with CRC and exploration of its micro-environmental distributions. Methods: Immunohistochemical staining was performed for CRC patients' tissue microarray. Selection and prognostic validation of markers were based on mRNA data from the cancer genome atlas (TCGA) database. Gene Set Enrichment Analysis (GSEA) was performed to indicate relative immune landmarks and hallmarks. Ferroptosis and immune contexture were examined by CIBERSORT. Survival outcomes were analyzed by Kaplan-Meier analysis and cox analysis. Results: A panel of 42 genes was selected. Through mRNA expression difference and prognosis analysis, GPX4, NOX1 and ACSL4 were selected as candidate markers. By IHC, increased GPX4, decreased NOX1 and decreased FACL4 indicate poor prognosis and worse clinical characteristics. Ferroptosis score based on GPX4, NOX1 and ACSL4 was constructed and validated with high C-index. Low ferroptosis score can also demonstrate the better progression free survival and better adjuvant chemotherapy (ACT) responsiveness. Moreover, tumor with low ferroptosis score tend to be infiltrated with more CD4+ T cells, CD8+ T cells and less M1 macrophage. Finally, we found that IFN-γ was potentially the central molecule at the crossroad between ferroptosis and onco-immune response. Conclusion: Ferroptosis plays important role on CRC tumor progression, ACT response and prognosis. Ferroptosis contributes to immune-supportive responses and IFN-γ was the central molecule for this process.


RNA binding protein CUGBP1 mediates the liver metastasis of colorectal cancer by regulating the ErbB signal pathway

July 2021

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34 Reads

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5 Citations

Translational Cancer Research

Background: The CUGBP1 (CELF1) is differentially expressed in liver metastasis and no liver metastasis colorectal cancers (CRC) tissues and the function of CUGBP1 in CRC is still unclear. Methods: Five cases of colorectal adenocarcinoma and 6 cases of liver metastatic CRC lesions were collected and subjected to cDNA microarray and bioinformatical analyses. The quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was used to confirm the result. Cell function assays were used to study the function of CUGBP1, and the western blot was used to discover the change of the downstream molecules. Results: CUGBP1 was significantly elevated in liver metastatic CRC lesions. Besides, the CUGBP1 can promote proliferation, colony formation, invasion, metastasis abilities as well as increase the apoptosis rates of CRC cells. ERBB2 was positively related to the CUGBP1. Western blot results found that silence of CUGBP1 decreased the protein level of p-AKT and p-ERK without influence the expression level of total protein of AKT and ERK. Conclusions: CUGBP1 can promote liver metastasis of CRC by promoting the phosphorylation of AKT and ERK through the ErbB signaling pathway. CUGBP1 is a potential biomarker for early detection of CRC and maybe a novel therapeutic target of CRC treatment, especially in liver metastasis.



Self-expandable metallic stenting as a bridge to elective surgery versus emergency surgery for acute malignant right-sided colorectal obstruction

December 2020

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26 Reads

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15 Citations

BMC Surgery

Background The use of a self-expandable metallic stent (SEMS) as a bridge to surgery has increased for patients with obstructing colorectal cancer. However, relatively few reports have compared SEMS as a bridge to elective surgery for acute malignant obstruction of the right-sided colon (MORC) vs. emergency surgery (ES). This study aimed to evaluate the benefits of elective surgery after SEMS placement vs. ES for patients (including stage IV cases) with acute MORC. Methods Patients with acute MORC who underwent radical resection for a primary tumour from July 2008 to November 2016 at Zhongshan Hospital of Fudan University were retrospectively enrolled. Postoperative short-term outcomes, progression-free survival (PFS), and overall survival (OS) were compared between the SEMS and ES groups. Results In total, 107 patients with acute MORC (35 in the SEMS group and 72 in the ES group) were included for analysis. The Intensive Care Unit admission rate was lower (11.4% vs. 34.7%, P = 0.011), the incidence of complications was reduced (11.4% vs. 29.2%, P = 0.042), and the postoperative length of hospitalisation was significantly shorter (8.23 ± 6.50 vs. 11.18 ± 6.71 days, P = 0.033) for the SEMS group. Survival curves showed no significant difference in PFS ( P = 0.506) or OS ( P = 0.989) between groups. Also, there was no significant difference in PFS and OS rates between patients with stage II and III colon cancer. After colectomy for synchronous liver metastases among stage IV patients, the hepatectomy rates for the SEMS and ES groups were 85.7% and 14.3%, respectively ( P = 0.029). The hazard ratio for colectomy alone vs. combined resection was 3.258 (95% CI 0.858–12.370; P = 0.041). Conclusion Stent placement offers significant advantages in terms of short-term outcomes and comparable prognoses for acute MORC patients. For synchronous liver metastases, SEMS placement better prepares the patient for resection of the primary tumour and liver metastasis, which contribute to improved survival.



Self-expandable metallic stenting as a bridge to elective surgery versus emergency surgery for acute malignant right-sided colorectal obstruction

June 2020

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42 Reads

Background Data are limited regarding the advantages of a self-expandable metal stent (SEMS) as a bridge to elective surgery for acute malignant obstruction of the right-sided colon (MORC), as most studies concentrated on this technique used in left-sided colon. This study aimed to evaluate the outcomes of patients (including stage IV cases) with acute MORC treated by initial SEMS placement vs emergency surgery (ES). Methods Patients with acute MORC who underwent radical resection for a primary tumour from July 2008 to November 2016 at Zhongshan Hospital of Fudan University were retrospectively enrolled. Postoperative short-term outcomes, progression-free survival (PFS), and overall survival (OS) were compared between the SEMS and ES groups. Results In total, 107 patients with acute MORC (35 in the SEMS group and 72 in the ES group) were included for analysis. The Intensive Care Unit admission rate was lower (11.4% vs. 34.7%, P = 0.011), the incidence of complications was reduced (11.4% vs. 29.2%, P = 0.042), and the postoperative length of hospitalisation was significantly shorter (8.23 ± 6.50 vs. 11.18 ± 6.71 days, P = 0.033) for the SEMS group. Survival curves showed no significant difference in PFS (P = 0.506) or OS (P = 0.989) between groups. 29.0% (27/93) of the patients with stage II and III disease experienced disease progression, when the distant metastasis rates for the SEMS and ES groups were 21.4% (6/28) and 18.5% (12/65), respectively (P = 0.740) and local site relapse presented in 2 (7.1%) patients of the SEMS group and in 7 (10.8%) patients of the ES group (P = 0.719). After colectomy for synchronous liver metastases, the hepatectomy rates for the SEMS and ES groups were 85.7% and 14.3%, respectively (P = 0.029). The hazard ratio for colectomy alone vs combined resection was 3.258 (95% CI 0.858–12.370; P = 0.041). Conclusion Stent placement offers significant advantages in terms of short-term outcomes and comparable prognoses for acute MORC patients. For synchronous liver metastases, SEMS placement better prepares the patient for resection of the primary tumour and liver metastasis, which contribute to improved survival.


Citations (55)


... with obesity which can make it difficult to achieve a high quality TME. Nevertheless, a randomized clinical trial by Jiang et al. demonstrated comparable pathologic outcomes including comparable TME, negative circumferential margins, distal resection margins, and number of lymph nodes retrieved when laparoscopy was compared to open techniques [69]. Colorectal surgery can be technically challenging in patients with obesity [70]. ...

Reference:

A Review Article: The Relationship Between Obesity and Colorectal Cancer
Short-term Outcomes of Laparoscopy-Assisted vs Open Surgery for Patients With Low Rectal Cancer The LASRE Randomized Clinical Trial Supplemental content

JAMA Oncology

... Therefore, the ferroptosis inhibitory protein FSP1 blocks lipid oxidation by reducing CoQ 10 (31).Finally, the GCH1-BH4 pathway. Tetrahydrobiopterin (BH4) is a redox-active cofactor that participates in the metabolism of NO, a neurotransmitter (32).In the production of BH4, GTP cyclohydrolase-1 (GCH1) is an essential enzyme (33).The research group of Kraft et al. identified GCH1-BH4 as a novel pathway regulating ferroptosis by CRISPR-Cas9 screening (34,35). Overexpression of GCH1 not only eliminated lipid peroxidation, but also prevented the occurrence of ferroptosis in cells (36). ...

Low ferroptosis score predicts chemotherapy responsiveness and immune‐activation in colorectal cancer

... CELF1 protein levels were demonstrated to be increased in CRC tissues and cell lines, and its elevated expression is correlated with the incidence of liver metastasis. CELF1 was also shown to promote the growth and spread of CRC cells and to be highly expressed in liver metastatic lesions [111]. ...

RNA binding protein CUGBP1 mediates the liver metastasis of colorectal cancer by regulating the ErbB signal pathway

Translational Cancer Research

... Meta-analysis studies showed a lower rate of stoma formation in the SEMS group of patients with right-sided obstructive colon cancer than in the emergency surgery (ES) group ( Supplementary Fig. 9) [129][130][131][132][133][134][135][136]. However, most studies had few cases of stoma formation in each group. ...

Self-expandable metallic stenting as a bridge to elective surgery versus emergency surgery for acute malignant right-sided colorectal obstruction

BMC Surgery

... Following the deliberation of each patient with colorectal liver metastasis, a consensus was reached on the treatment plan or the necessity for additional diagnostic work-up. 20 The general practice for surveillance included physical examination, serum carcinoembryonic antigen testing, computed tomography of the chest, abdomen with intravenous contrast, and MRI of abdomen, pelvis with intravenous contrast. These were carried out every 2-4 cycles of fruquintinib administration. ...

Benefits of multi‐disciplinary treatment strategy on survival of patients with colorectal cancer liver metastasis

... Considering data from 6 included comparative studies [8,11,13,14,22,34], patients undergoing hepatectomy for BRAF-mut CRLM significantly more frequently exhibited positive lymph nodes on primary CRC specimens (OR ¼ 0.50; 95% CI [0.30e0.83]; p ¼ 0.007; I 2 ¼ 38%) (Figs. 3 and 4C). ...

Prognostic impact of KRAS and BRAF mutations in patients who underwent simultaneous resection for initially resectable colorectal liver metastases
  • Citing Article
  • December 2018

International Journal of Clinical and Experimental Pathology

... The PNI parameter is a ratio indicating the mortality or prognosis of many diseases, which has been associated with prognostic nutrition in recent years. These include systemic diseases [10,11] and cancer [12][13][14] and high-mortality-level diseases. Systemic immune inflammation index (SII) is similar to the PNI, but the parameters have been used in recent years to predict diseases and mortality through systemic immune inflammation. ...

Combined test of third lumbar skeletal muscle index and prognostic nutrition index improve prognosis prediction power in resected colorectal cancer liver metastasis

Aging

... 3,4 Currently, these LNs are examined by specialist pathologists, with decisions about adjuvant therapy only possible after resection in patients without distant metastatic disease. 5 In clinical practice, knowledge of preoperative LN involvement is rarely used given that neoadjuvant chemotherapy is typically only administered in patients with stage IV disease. Recently, the Foxtrot trial revealed that neoadjuvant chemotherapy can be delivered safely with the potential for pathological downstaging. ...

Exploration of exact significance of lymph node ratio and construction of a novel stage in colon cancer with no distant metastasis

... The higher the expression of CD206, the lower the differentiation, the deeper the depth of invasion and the more likely vascular tumour thrombus and nerve invasion of colon cancer. The above factors are also the influencing factors of low disease-free survival and overall survival (OS), suggesting that a high expression of CD206 has a relatively bad prognosis [27]. ...

Tumor-associated Macrophages as Prognostic and Predictive Biomarkers for Postoperative Adjuvant Chemotherapy in Patients with Stage II Colon Cancer
  • Citing Article
  • April 2019

Clinical Cancer Research

... Acupuncture was administered by a skilled acupuncturist once a day for seven days. A self-made acupuncture needle cannula ( Figure 1C) and a metronome were used to control amplitude and frequency, respectively [25]. Rats in the control and CFA groups underwent the same fixation method as experimental groups without additional interventions. ...

Role of Acupoint Area Collagen Fibers in Anti-Inflammation of Acupuncture Lifting and Thrusting Manipulation

Evidence-based Complementary and Alternative Medicine