Case Control Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Nov 15, 2022; 14(11): 2208-2223
Published online Nov 15, 2022. doi: 10.4251/wjgo.v14.i11.2208
Oxidative imbalance increases the risk for colonic polyp and colorectal cancer development
Dimitrios Tsounis, Vassiliki Villiotou, Angeliki Melpidou, Chara Pantsiou, Alexandra Argyrou, Charis Giannopoulou, Adriani Grigoratou, Dimitra Rontogianni, Gerassimos J Mantzaris, George Papatheodoridis
Dimitrios Tsounis, Alexandra Argyrou, Department of Gastroenterology, 251 General Hospital of Hellenic Air Force, Athens 11525, Greece
Vassiliki Villiotou, Department of Biochemistry, Metaxa Anticancer Hospital, Piraeus 18537, Greece
Angeliki Melpidou, Chara Pantsiou, Adriani Grigoratou, Department of Biochemistry, Evangelismos Hospital, Athens 10676, Greece
Charis Giannopoulou, Department of Nuclear Medicine and Positron Emission Tomography Computed Tomography, Evangelismos Hospital, Athens 10676, Greece
Dimitra Rontogianni, Department of Pathology, Evangelismos Hospital, Athens 10676, Greece
Gerassimos J Mantzaris, Department of Gastroenterology, Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals, Athens 10676, Greece
George Papatheodoridis, Academic Department of Gastroenterology, Athens University Medical School, Laikon General Hospital, Athens 11527, Greece
Author contributions: All authors equally contributed to this paper with the conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Institutional review board statement: The study was approved by the ethics committee of Evangelismos Hospital (Athens, Greece).
Informed consent statement: All patients gave informed consent.
Conflict-of-interest statement: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
Data sharing statement: Technical appendix, statistical code and dataset available from the corresponding author at dim.tsoun69@gmail.com.
STROBE statement: The authors have read the STROBE Statement and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dimitrios Tsounis, FEBG, MD, MSc, Chief Doctor, Consultant Physician-Scientist, Department of Gastroenterology, 251 General Hospital of Hellenic Air Force, P. Kanellopoulou Avenue 3, Athens 11525, Greece. dim.tsoun69@gmail.com
Received: May 4, 2022
Peer-review started: May 4, 2022
First decision: July 13, 2022
Revised: August 19, 2022
Accepted: September 21, 2022
Article in press: September 21, 2022
Published online: November 15, 2022
Processing time: 195 Days and 4.5 Hours
Abstract
BACKGROUND

The role of oxidative stress in the pathogenesis of colorectal carcinoma (CRC) has garnered considerable interest recently. Specific oxidative factors have been implicated in the pathogenesis of adenomatous polyps and ultimately adenocarcinoma.

AIM

To evaluate the effect of oxidative imbalance as quantified by specific serological markers in the development of sporadic colon adenocarcinoma.

METHODS

A total of 170 patients that underwent endoscopy of the lower gastrointestinal tract in a tertiary center within 3 years were included in the study. They were allocated in three groups; those with sporadic colon adenocarcinoma (n = 56, 32.9%), those with colonic polyps (n = 33, 19.4%) and healthy controls (n = 81, 47.7%). All patients were evaluated for oxidant activity and antioxidant capacity with serum measurements of specific markers such as vitamins A, 25(OH) D3, E, C, B12, folic acid, glutathione, selenium (Se), zinc (Zn), free iron (Fe2+), and malondialdehyde and results were compared between groups.

RESULTS

Serum levels of vitamins C, E, D, Se, Zn, vitamin B12 and total antioxidant capacity were significantly lower in the combined neoplasia/polyp group than in the control group (P = 0.002, P = 0.009, P < 0.001, P < 0.001, P < 0.001, P = 0.020 and P < 0.001, correspondingly). Increased levels of vitamin E (P = 0.004), vitamin D (P < 0.001), Se (P < 0.001) and Zn (P < 0.001) seem to bestow a protective effect on the development of CRC. For vitamin D (P < 0.001) and Zn (P = 0.036), this effect seems to extend to the development of colon polyps as well. On the other hand, elevated serum levels of malondialdehyde are associated with a higher risk of CRC (OR = 2.09 compared to controls, P = 0.004). Regarding colonic polyp development, increased concentrations of vitamin Α and Fe2+ are associated with a higher risk, whereas lower levels of malondialdehyde with a lower risk.

CONCLUSION

Increased oxidative stress may play an important role in the pathogenesis and progression of CRC. Antioxidants’ presence may exert a protective effect in the very early stages of colon carcinogenesis.

Keywords: Oxidative imbalance; Reactive oxygen species; Colorectal adenocarcinoma; Colonic polyps; Antioxidant capacity

Core Tip: The role of oxidative stress in the pathogenesis of colorectal carcinoma (CRC) has garnered considerable interest recently. Here, we evaluated oxidant activity and antioxidant capacity of the patients with serum measurements of specific markers. Increased levels of vitamin E, vitamin D, selenium and zinc seem to bestow a protective effect regarding the development of CRC, whereas elevated serum levels of malondialdehyde are associated with a higher risk of CRC. Increased oxidative stress may play an important role in the pathogenesis and progression of CRC. Antioxidants’ presence may exert a protective effect in the very early stages of colon carcinogenesis.