{"paper_id":"0133c3d1-2a08-4bb2-91be-2ba4446feba1","body_text":"Investigation and Analysis of Schistosomiasis-Associated Gastroenteric Tumor in Jiujiang Section of the Yangtze River Basin (Jiangxi Province, China) from 2014 to 2024 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Investigation and Analysis of Schistosomiasis-Associated Gastroenteric Tumor in Jiujiang Section of the Yangtze River Basin (Jiangxi Province, China) from 2014 to 2024 Nanhao Zhou, Minhao Zeng, Xiongchaun Pei, Youlong Li, Yanqing Shi, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7228920/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose This study retrospectively analyzes the prevalence of Schistosoma japonicum infection in Jiujiang City from 2014 to 2024 and its relationship with colorectal cancer. Additionally, the infection rate of S. japonicum in Jiujiang City was investigated, aiming to provide new insights into the relationship between schistosome infection and host diseases. Methods Clinical and pathological data from 1,309 Schistosoma infection cases at the Affiliated Hospital of Jiujiang University were collected, including patient demographics, egg deposition sites, cancer status, and staging. Epidemiological survey data (2022–2023) from the Jiujiang CDC were analyzed, encompassing questionnaires, serological testing, and stool examinations. Results A pathological examination of 1,309 cases revealed that schistosome egg deposition was primarily located in the colorectal region (72.64%), with a higher prevalence in males and individuals aged 61–70 years. Among 200 tumor cases, 192 were found near egg deposition sites, with colorectal, gastric, and hepatobiliary cancers being the most common. The incidence of schistosomiasis-associated colorectal cancer (SACRC) peaked in the 71–80 age group, approximately a decade later than non-schistosomiasis-associated colorectal cancer (CRC). Tumor differentiation and staging showed no significant differences between SACRC and CRC. As of 2023, 13 out of 14 districts in Jiujiang City are affected by S. japonicum schistosomiasis, with 1.66 million people at risk. Pengze and Duchang have the largest at-risk populations. High seroprevalence rates were observed along the Yangtze River and Poyang Lake. Conclusion The study highlights the high prevalence of colorectal cancer among individuals infected with S. japonicum and underscores the ongoing public health challenges of schistosomiasis in the Yangtze River Basin, despite low overall prevalence. Schistosomiasis Intestinal Diseases Colorectal cancer Risk assessment Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Background Schistosomiasis is a disease caused by parasitic trematodes of the genus Schistosoma . According to the World Health Organization (WHO), approximately one-tenth of the global population is at risk of Schistosomiasis[ 1 , 2 ]. It is conservatively estimated that at least 230 million people are infected with Schistosoma spp. around the world, causing 200,000 deaths per year[ 3 , 4 ]. Each female Schistosoma japonicum is capable of laying thousands of eggs daily, although only a small proportion are excreted from the host[ 5 ]. The deposited eggs can cause chronic intestinal diseases, including colorectal cancer (CRC)[ 6 ]. Among the six known Schistosoma species that can infect humans, S. japonicum is the most prevalent in China, which was once among the countries with the heaviest burden of Schistosomiasis[ 7 ]. In the 1950s, S. japonicum was widely prevalent in 12 provinces along the Yangtze River, with over 10 million infected individuals. Through more than 70 years of active control efferts, China has achieved significant success in controlling Schistosomiasis[ 8 ]. Although the prevalence of schistosomal infection has significantly decreased in China, a substantial number of individuals with chronic schistosomal infection and advanced schistosomiasis still persist. The human portal vein-mesenteric vein system provides an optimal environment for the survival of Schistosoma . During prolonged parasitism, the large number of eggs produced by the parasite alters the intestinal microenvironment, inducing chronic inflammatory responses that subsequently influence tumorigenesis and tumor progression. Increasing epidemiological and pathological evidence suggests that chronic infection with S. japonicum is associated with the development of various malignancies, particularly colorectal cancer and hepatocellular carcinoma[ 9 ]. The proportion of Schistosomiasis-associated CRC (SACRC) among all patients has also decreased from 79.2% during 1970–1979 to 8.1% during 2012–2018 [ 10 ]. Despite Schistosomiasis no longer being considered a public health issue in China as of 2015, a survey conducted in 2016 on a total of 3,924 individuals in Hunan and Jiangxi provinces revealed that the total combined baseline prevalence of S. japonicum , determined by qPCR, was 4.8%[ 11 , 12 ]. Additionally, the intermediate hosts snail ( Oncomelania hupensis ), are still widely distributed in China, including in Jiangxi Province[ 13 ]. Therefore, there is still a potential risk of the disease's resurgence in China, which could impact the life expectancy of the population[ 14 ]. This study describes the trends in CRC and SACRC in the historically endemic area of S. japonicum along the Jiujiang section of the Yangtze River. It also compares the differences between SACRC and non-schistosomiasis-associated CRC (CRC), aiming to provide new insights into the relationship between S. japonicum infection and host colorectal cancer. Methodology Clinical information sources, patients and eligibility criteria The study was conducted at the Affiliated Hospital of Jiujiang University, located near Poyang Lake in Jiangxi Province, China. Using \"Schistosomiasis\" as keywords, clinical patient data were collected from the Department of Pathology at the Affiliated Hospital of Jiujiang University from July 2013 to July 2024. An analysis was conducted on schistosomiasis-associated diseases. After identifying colorectal cancer as the primary intestinal disease, clinical data from colorectal cancer patients were further collected. Based on confirmed infection status of Schistosoma japonicum , patients diagnosed with colorectal cancer were divided into two groups: the SACRC group (colorectal cancer with S. japonicum infection) and the CRC group (colorectal cancer without S. japonicum infection). The inclusion and exclusion criteria for CRC patients are as follows: The inclusion criteria were as follows: patients hospitalized for colorectal tumors, confirmed by preoperative biopsy and postoperative pathology; clear pathological data of colorectal tumors; patients undergoing their first radical surgery for colorectal cancer. The exclusion criteria were as follows: patients with recurrent colorectal cancer; patients without postoperative pathological data; patients with secondary malignant tumors of the colorectum. Retrospective data were collected for both groups of patients, including the location of colorectal cancer, maximum tumor diameter (cm), gross morphology, pathological type, degree of tumor cell differentiation, number of bowel segments involved, presence of perineural invasion, presence of vascular invasion, and TNM staging. The clinicopathological characteristics of the two groups were compared. Risk assessment for schistosomiasis infection JiuJiang, located in Jiangxi Province, lies in the middle and lower reaches of the Yangtze River and along the shores of Poyang Lake, the largest freshwater lake in China. With its numerous rivers, lakes, and complex natural environment, the region is prone to both marshland and hilly types of schistosomiasis. This study conducted an epidemiological survey in 2023 in the schistosomiasis-endemic areas of Jiujiang, using the following methods: medical consultation among the population in endemic areas, where any contact with S. japonicum -infested water was considered a risk behavior. Including all individuals who have had risk behaviors, and additionally randomly selecting some individuals who were consulted for serological testing (ELISA/IHA). The diagnostic criteria are based on the national standard of China, Schistosomiasis Diagnostic Criteria (WS 261–2006). Briefly, a positive result in the IHA test occurs when an agglutination reaction is observed at a 1:10 serum dilution, and in the ELISA test, a positive result is indicated when the OD value of the test well is greater than or equal to 2.1 times that of the standard negative control well. Results Clinical Characteristics of Patients with Schistosomiasis Infection From November 2013 to July 2024, a total of 1,317 cases of schistosomiasis were collected. Except for the full-year cases not collected in 2013 and 2024, and possibly due to the impact of the COVID-19 pandemic in 2020, there have been over 100 cases of schistosomiasis seeking medical treatment each year (Fig. 1 A). The analysis of the age and gender distribution of the cases shows that there were 816 male patients (61.96%) and 501 female patients (38.04%), indicating a significantly higher infection rate among males compared to females. Additionally, in each age group, the number of male patients is greater than that of females. The highest number of patients is found in the 51–60 age group, followed by the 61–70 age group (Fig. 1 B). Statistical analysis of schistosome egg deposition sites revealed that the vast majority of cases exhibited egg localization within the digestive system. Notably, 956 cases (72.64%) showed egg deposition in the colon and rectum, 159 cases (12.08%) in the appendix, and 87 cases (6.61%) in the liver and biliary tract.(Fig. 2 A). Among all schistosomiasis patients, 221 were diagnosed with cancer. An analysis of the deposition sites of eggs in these patients in relation to the cancer sites showed that the colon and rectum, liver and biliary tract, and stomach are common areas for both egg depositions and cancer (Fig. 2 B). The number of cases treated each year is shown in Fig. 2 C, with the numbers being relatively stable except for the years 2020–2021, which were affected by the COVID-19 pandemic. The typical pathological results of the three most common schistosomiasis-related cancers, liver cancer, colorectal cancer, and gastric cancer are shown in Fig. 3 . Comparative Analysis of Clinical Characteristics Between Colorectal Cancer Patients With and Without Schistosomiasis Infection A total of 1,030 CRC (colorectal cancer without S. japonicum infection) cases were collected from the aforementioned hospital between June 2014 and August 2024. A comparative analysis was conducted between the CRC group (NSACRC) and the SACRC (colorectal cancer with S. japonicum infection) group, focusing on age groups, gender ratios, degrees of differentiation, and TNM staging. Similar to the age composition of schistosomiasis patients, the largest proportion of CRC patients was in the 61–70 age group, accounting for 30%. However, the age composition of SACRC differs from both schistosomiasis patients and CRC, with a higher proportion of older cases, with 52.17% of patients in the 71–80 age group (Fig. 4 A). In terms of gender distribution, the male-to-female ratio for CRC was 55.92–44.08%; the ratio for SACRC was similar to that of the schistosomiasis patients, with a higher male proportion of 68.42% (Fig. 4 B). Subsequently, a comparative analysis was conducted on cases that underwent differentiation degree testing. Both SACRC and CRC predominantly presented with moderate and moderately low differentiation, with no significant difference between the two groups (Fig. 4 C). Similarly, the distribution of TNM staging also showed a similar pattern in both groups (Fig. 4 D). When comparing the presence of lymphatic metastasis of cancer cells, CRC exhibited a greater tendency for metastasis, with 35.75% of cases showing lymphatic metastasis of cancer cells, while the proportion of SACRC cases with metastasis was 28.42%. Epidemiological Trends and Distribution of Schistosomiasis in the Jiujiang Section of the Yangtze River Basin in 2023 According to the census report published by the Jiujiang City Government and the survey data from the Jiujiang City Center for Disease Control and Prevention, as of 2023, out of the 14 districts/counties under the jurisdiction of Jiujiang City, 13 had areas where S. japonicum is prevalent. Among the city's population of 4.56 million, 1.66 million people live in village-level units or residential areas where the disease was prevalent, and these residents were at a higher risk of infection. Among the 13 districts, Pengze had the largest number of people at risk, with 302.7 thousand people; followed by Duchang and Xunyang-Development zone, with 256.9 thousand and 236.8 thousand people, respectively. Five districts had the prevalence population that accounts for more than half of their total population, namely Pengze (79.08%), Lushan (61.18%), Chaisang (54.96%), Hukou (54.57%), and Gongqingcheng (52.72%). In addition, the prevalence population in the core urban area of Xunyang-Development zone also accounted for a high proportion (49.93%). In the endemic areas across various districts, we conducted medical consultation with a total of 400,958 individuals to investigate whether they had exposed to S. japonicum -infested water. The results showed that Pengze, Lushan, Duchang, and Ruichang all had more than 10,000 people who had engaged in risky behaviors in 2023, with 29,884, 27,149, 16,289, and 11,515 individuals respectively. These numbers represent 42.49%, 52.35%, 17.18%, and 21.64% of the consulted population in their respective districts. Furthermore, we conducted serological testing on some of the surveyed individuals (excluding those from Lushan and DeAn, all others with risky behaviors were included). The results showed that in Pengze, 1,145 subjects tested seropositive, accounting for 3.82% of those surveyed serologically and 1.63% of all those consulted. Followed by Duchang, with 952 seropositive individuals, representing 3.37% of the serologically tested subjects and 1% of all those consulted. All subjects in Xunyang-Development zone tested seronegative, and additionally, there were relatively few seropositive cases in DeAn and Wuning, with less than 10 individuals. Particularly noteworthy is that we conducted fecal examinations on some individuals who were interviewed, and most areas reported negative results. However, in Duchang, 18 cases tested positive in 1590 fecal examinations ( Table 1 ) . Based on the proportion of seropositive subjects among all those consultations surveyed and the proportion of consultation surveyed individuals among the epidemic population, it is estimated that Pengze, Duchang, Lushan, and Chaisang may have more than a thousand potential seropositive cases, with a total potential seropositive population in the city reaching 12,752. From the seropositivity rate of subjects in each district obtained from the investigation and the total potential seropositive population in the city, it can be seen that the seropositivity rate and the number of potential seropositive individuals are relatively high in the districts along the Yangtze River, and also high in the districts surrounding the waterway from the estuary to the Poyang Lake (Fig. 5 ). Table 1 The survey on the prevalence of S. japonicum in Jiujiang section of the Yangtze River basin. District Total Population (Thousands) Epidemic Area Population Thousands) Medicinal Consultation Count 1 Risk Behavior Count 2 Serological Tested Count 3 Serological Positive Count 4 Serological Positive Rate 5 Potential Serological Positive Cases 6 LianXi 225.3 50.4 10175 690 5192 78 0.77% 387 ChaiSang 281.1 154.5 21931 2660 17540 195 0.89% 1374 WuNing 402.3 18.0 2095 0 1027 8 0.38% 69 YongXiu 316.4 98.4 32523 635 18877 174 0.54% 526 DeAn 180.0 21.2 5040 58 802 6 0.12% 25 DuChang 703.2 256.9 94813 16289 28213 952 1.00% 2579 HuKou 227.4 124.1 20658 8177 8177 24 0.12% 144 PengZe 382.8 302.7 70332 29884 30012 1145 1.63% 4928 RuiChang 452.3 203.0 53217 11515 26039 93 0.17% 355 GongQingCheng 180.0 94.9 30299 9 15025 145 0.48% 454 LuShan 265.6 162.5 51865 27149 30026 610 1.18% 1911 XunYang-Development Zone 7 474.3 236.8 8010 167 1026 0 0.00% 0 1 The people who were consulted all come from epidemic areas. 2 Cases that have been exposed to S. japonicum -infested water and have not undergone any form of examination or diagnosis are considered risky behavior. 3 The serological testing included all cases with risk behaviors. Except for only 2 individuals with risk behaviors in DeAn who were tested, and 11 people with risk behaviors in LuShan who were not. 4 Serological testing methods include ELISA and IHA. 5 The ratio of positive serological test results to the number of individuals who underwent consultation. 6 The potential number is calculated by dividing the number of serologically positive individuals by the ratio of the number of consultations to the population in the epidemic area. 7 The surveys in the Development Zone and XunYang district were conducted separately, but since the two districts were once a single district, the data were merged to avoid confusion. Discussion Schistosomiasis is a category of tropical diseases caused by parasitic flatworms of the genus Schistosoma . In China, the prevalent species is S. japonicum . Historically, Schistosomiasis japonica has ravaged China, particularly in the waterways of the Yangtze River region, with Jiangxi Province being one of the endemic areas. The initial control campaigns for S. japonicum also began in Jiangxi Province [ 15 ]. Although China has made significant progress in controlling the prevalence of S. japonicum through extensive and prolonged management efforts, attention must still be given to the global epidemic situation. It is important to respond to the World Health Organization's 'One Health' initiative and focus on the large number of late-stage schistosomiasis patients in order to achieve comprehensive elimination of the disease [ 16 – 18 ]. The pathogenesis of schistosomiasis is multifaceted, involving the migration of eggs through the host's tissues, which can lead to significant immunopathological reactions. The eggs of Schistosoma species, especially when deposited in the intestinal tissues, are known to induce chronic inflammation, granuloma formation, and fibrosis, which are key pathological changes associated with the disease [ 19 ]. These pathological changes are not only a result of the eggs' physical presence but also due to the host's immune response to the eggs, which can lead to genetic instability and potentially promote carcinogenesis [ 20 ]. The cohort analysis in this study highlights the persistent challenge of schistosomiasis in the Jiujiang section of the Yangtze River Basin. From 2014 to 2023, the consistent annual incidence of over 100 schistosomiasis cases, with some exceptions due to data collection gaps and the COVID-19 pandemic, underscores the need for vigilant surveillance systems to monitor the disease's prevalence and assess the effectiveness of control measures [ 3 ]. The gender disparity observed in the incidence of schistosomiasis, with a significantly higher rate among males, suggests that infection risk is not evenly distributed across populations. The gender distribution of patients with schistosome egg deposition over the years predominantly shows a higher proportion of males, ranging from 56.21–80.77%. Consistent with previous research findings, more males are infected than females. This discrepancy may be attributed to differences in social and occupational roles, which provide males with more opportunities to come into contact with S. japonicum-infested water and become infected with cercariae [ 4 , 21 ]. During S. japonicum infections, adult worms typically reside in the mesenteric veins of the definitive host, releasing eggs that travel via the portal vein to the liver and subsequently enter the digestive system through the biliary tract and gallbladder. The deposition of these eggs in these areas can lead to granuloma formation, and chronic inflammation may potentially induce carcinogenesis. This process involves significant immunopathological reactions as the eggs migrate through the host's tissues [ 22 ]. Particularly when eggs are deposited in intestinal tissues, they induce chronic inflammation, granuloma formation, and fibrosis, which are key pathological changes associated with schistosomiasis [ 23 ]. These pathological changes are not only a consequence of the physical presence of the eggs but also related to the host's immune response to the eggs, potentially leading to genetic instability and promoting carcinogenesis. The deposition of eggs in the intestines and liver, along with the subsequent immune responses and inflammatory processes, are central to the pathogenesis of schistosomiasis [ 19 ]. Despite potential biases that may arise from data collected by pathology departments, we were surprised to find that hepatobiliary deposition accounted for only 6.61% of all cases. Typically, individuals infected with schistosomes have a significant deposition of eggs in the liver and gallbladder, which leads to the formation of granulomas and liver fibrosis, hallmarking schistosomiasis [ 24 ]. This implies that a considerable number of potential or chronic infection patients do not exhibit relatively obvious symptoms due to egg deposition in the liver and gallbladder. In this study, the highest number of cases with egg deposition in the digestive system was observed, with the colon and rectum accounting for 72.64%, followed by the appendix (12.08%), jejunum-ileum-cecum (3.19%), and stomach (2.96%). Deposition in the small intestine, pancreas, esophagus, respiratory system, and reproductive system was rare (< 1%). This findings are consistent with previous studies, which have shown that in patients with Schistosoma japonicum , extrahepatic egg deposition is most commonly observed in the rectum, sigmoid colon, and descending colon, with the highest number of eggs in the digestive tract when parasitizing in large animals [ 25 , 26 ]. We conducted a statistical analysis of patients who had both malignant tumors and deposition of schistosome eggs within their bodies. Among the 1,309 cases with egg deposition, 221 had cancer. The most common type was colorectal cancer (142 cases, 64.25%), followed by gastric cancer (29 cases, 13.12%) and liver cancer (28 cases, 12.67%). These findings are not entirely consistent with another survey conducted in Shanghai, China, but colorectal and gastric cancers remain very common malignant tumors among patients with schistosomiasis [ 27 ]. Although it is surprising that there are so few cases of liver-gallbladder egg deposition, among the 87 patients, 19 had cancer in the gallbladder, and the cancer rate of 21.84% indicates the inducing capacity of S. japonicum for cancer in liver-gallbladder. Although only 29 cases of gastric cancer combined with gastric schistosome egg deposition were collected, there were only 39 cases of gastric deposition among all collected schistosome egg deposition cases. Additionally, cases of colorectal cancer combined with colorectal egg deposition accounted for only 14.85% of the egg deposition cases. It can also be observed that from 2013 to 2024, colorectal cancer has consistently been the most common type of cancer among patients with chronic schistosomiasis patients. In the International Agency for Research on Cancer classification, S. japonicum was identified as a Group 2B (possibly carcinogenic) for the liver and colorectum as early as 1994, and this classification has remained unchanged ever since. However, the relationship between S. japonicum infection and cancer has always been a matter of debate [ 28 , 29 ]. In a 2005 study conducted in Sichuan Province, China, it was found that among all cases, 24% of colorectal cancer and 27% of liver cancer could be attributed to schistosomiasis infection [ 30 ]. In this study, the proportion of SACRC cases accounted for 11.04% (129/1168) of all CRC cases. This proportion is higher than the 8.1% found in a survey conducted in Wuhu City, Anhui Province, which is also located along the Yangtze River [ 31 ]. However, it was surprising to find that in two surveys conducted in Shanghai, the proportion of SACRC was unusually high, at 17.3% [ 32 ] and 39.0% [ 33 ], respectively. Although high-level hospitals may treat more SACRC patients from various regions, the number of CRC patients would also increase. Subsequently, a comparative analysis was conducted on the age distribution, gender distribution, degree of differentiation, pathological staging, and metastatic status of SACRC and CRC. Due to the deposition of schistosome eggs in the colon and rectum, which can cause inflammation, fibrosis, and other pathological changes, we anticipated that within the same region, the age of onset for SACRC might be earlier than that for CRC, and the degree of tumor differentiation and pathological staging of SACRC might be more severe than that of CRC [ 9 ]. However, the results we observed showed that the proportion of SACRC before the age of 60 was significantly lower than that of CRC, suggesting that the onset age of SACRC was \"delayed,\" or possibly that schistosomiasis \"delayed\" the time when CRC was detected. This is consistent with some previous research findings, with the peak age of onset for SACRC being around 61–70 years old [ 10 , 34 ]. The gender ratio of CRC cases is relatively balanced, at 1.27:1 (Male: Female), while SACRC continues the gender ratio characteristic of S. japonicum infection, which is 2.17:1. Additionally, the degree of differentiation and the level of pathological staging showed similar patterns, with no significant differences observed. Surprisingly, the proportion of metastatic cases in SACRC (28.42%) was also lower than that in CRC (35.75%). Due to the observed risks for potential late-stage schistosomiasis patients, as well as the ongoing need for prevention and control, in 2023 we conducted a survey on the infection status of Japanese schistosomiasis among residents in various districts and counties of Jiujiang City from multiple perspectives. A fecal examination was conducted on 11,425 individuals, with only 18 positive cases detected in DuChang. This indicates that the schistosomiasis control in Jiujiang City has achieved good results, with fewer high-risk areas. However, 42.13% of the population in Jiujiang City still resides in village-level units with risk areas. Only Xiushui County, with its well-developed water network, has no risky waters, despite its abundant water resources. Pengze County, located by the Yangtze River and not in the core urban area, has a high-risk population of 79.08% and contributes the most to the potential seropositive population. The areas surrounding the waterways from the Yangtze River to Poyang Lake, including DuChang, YongXiu, LuShan, GongQingCheng, and even the core urban areas of ChaiSang and LianXi, have higher seropositivity rates and a greater number of potential seropositive individuals. This means that the Poyang Lake and Yangtze River basins, historically areas where schistosomiasis was prevalent, still pose significant risks. The infection rate among residents in Hubei Province was 0 from 2016 to 2018, the infection rate among livestock was also 0 from 2013 to 2018, and the infection rate of snails was 0 in 2018 [ 35 ]. However, from 2016 to 2020, 660 seropositive cases were identified among residents in XiaoGan City, Hubei Province, and the transmission risk in JiangLing County, Hubei Province, has been on the rise [ 36 , 37 ]. In 2018, an investigation of schistosome infection rates in wild rats in Shitai County, Anhui Province, was conducted. Out of 376 wild rats examined, 91 tested positive in fecal examinations, with a positive rate of 24.2% [ 38 ]. These findings indicate that the risk of a resurgence of infection still exists. The continuous identification of positive cases in both humans and wild animals suggests that the parasite’s transmission cycle remains active in some regions. Additionally, the persistence of schistosomiasis in animal reservoirs, such as wild rats, poses a significant challenge to controlling the disease and eliminating it from endemic areas. Conclusion In summary, our study indicates that among clinical cases collected from the Affiliated Hospital of Jiujiang University, the incidence of liver-gallbladder cancer, gastric cancer, and colorectal cancer (CRC) is very high among patients infected with S. japonicum. Specifically, patients with Schistosoma japonicum-associated colorectal cancer (SACRC) have a higher average age than those with non-Schistosoma-associated colorectal cancer (CRC), and lymphatic metastasis is more common in SACRC patients. Additionally, we conducted a survey on the prevalence of schistosomiasis in Jiujiang City. Although the overall prevalence is low, there are still a large number of individuals at high risk, including potential seropositive patients, and some patients tested positive in fecal examinations. This suggests that in the Yangtze River Basin, a historically endemic area for schistosomiasis, there will be significant public health pressure in the future due to the treatment needs of patients with late-stage schistosomiasis. Declarations Ethics approval and consent to participate The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Declaration of Helsinki. Written informed consent was obtained from all participants prior to their participation in the study. All procedures involving human subjects/patients were approved by IRB of the Affiliated Hospital of Jiujiang University (NO. jumer-b-2024-0301). Consent for publication Not Applicable Data availability The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare no competing interests. Funding National Natural Science Foundation of China (32360888) , Jiujiang Science and Technology Program project (S2024ZDYFN0004) and Science and Technology Project of Health Commission of Jiangxi Province (202510481). Authors’ contributions Nanhao Zhou and Minhao Zeng: Conceptualization, Visualization, Writing original draft. Shan Li: Funding acquisiton, edited and revised the article . Yanqing Shi and Ting Li: Provided clinical data and performed relevant diagnosis and surgery. Youlong Li: Provision of data from the Centers for Disease Control and Prevention (CDC) along with analytical guidance. Ting Li: Provided clinical data and performed relevant diagnosis and revised the manuscript. Minhao Zeng, Nanhao Zhou and Xuguang Sun: Collected and analysis the clinical data. * These authors contributed equally. All Authors read and approved the final manuscript. Acknowledgements We thank the patient for his participation in this study. We have obtained the patient’s support and informed consent form. Authors' information Corresponding Author Ting Li: Affiliated Hospital of Jiujiang University, Jiujiang 332005, Jiangxi, China; Email: [email protected] Shan Li: Jiangxi Provincial Key Laboratory of Cell Precision Therapy, School of Basic Medical Sciences, Jiujiang University, Jiujiang 332005, Jiangxi, China; Email: [email protected] , ORCID: 0000-0002-0824-251X Present Addresses Nanhao Zhou : Jiangxi Provincial Key Laboratory of Cell Precision Therapy, School of Basic Medical Sciences, Jiujiang University, Jiujiang 332005, Jiangxi, China; [email protected] Minhao Zeng: School of Biotechnology, Jiangsu University of Science and Technology, Zhenjiang 212100,Jiangsu, China; Email: [email protected] Xiongchaun Pei : Jiangxi Provincial Key Laboratory of Cell Precision Therapy, School of Basic Medical Sciences, Jiujiang University, Jiujiang 332005, Jiangxi, China; [email protected] Youlong Li: Center for Disease Control and Prevention of Jiujiang, Jiujiang 332005, Jiangxi, China; Email: [email protected] Yanqing Shi: Affiliated Hospital of Jiujiang University, Jiujiang 332005, Jiangxi, China; Email: [email protected] Xuguang Sun: Jiangxi Provincial Key Laboratory of Cell Precision Therapy, School of Basic Medical Sciences, Jiujiang University, Jiujiang 332005, Jiangxi, China; Email: [email protected] , ORCID: 0009-0001-4126-7428 References Perera Dilhan J, Koger-Pease C, Paulini K, Daoudi M, Ndao M: Beyond schistosomiasis: unraveling co-infections and altered immunity. 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Xu J, Li SZ, Zhang LJ, Bergquist R, Dang H, Wang Q, Lv S, Wang TP, Lin DD, Liu JB et al: Surveillance-based evidence: elimination of schistosomiasis as a public health problem in the Peoples' Republic of China. Infectious diseases of poverty 2020, 9(1):63. Gordon CA, Williams GM, Gray DJ, Clements ACA, Zhou X-N, Li Y, Utzinger J, Kurscheid J, Forsyth S, Addis Alene K et al: Schistosomiasis in the People's Republic of China – down but not out. Parasitology 2022, 149(2):218-233. Lv C, Li YL, Deng WP, Bao ZP, Xu J, Lv S, Li SZ, Zhou XN: The Current Distribution of Oncomelania hupensis Snails in the People's Republic of China Based on a Nationwide Survey. Tropical medicine and infectious disease 2023, 8(2). Jiang H, Zhou J, Xia M, Li G, Di J, Mao F, Yu L, Cai Y, Wang Z, Xiong Y et al: Life expectancy and healthy life expectancy of patients with advanced schistosomiasis in Hunan Province, China. Infectious diseases of poverty 2023, 12(1):4. Li Y, He T, Xie J, Lv S, Li Z, Yuan M, Hu F, Lin D: Trend of Human Schistosomiasis Japonica Prevalence in China from 1990 to 2019. Tropical medicine and infectious disease 2023, 8(7). Xu J, Hu W, Yang K, Lv S, Li S-Z, Zhou X-N: Key points and research priorities of schistosomiasis control in China during the 14th Five-Year Plan Period. Chinese Journal of Schistosomiasis Control 2021, 33(01):1-6 (In Chinese). Li Q, Li Y, Guo S, Li S-Z, Wang Q, Lin W-N, Zhang L-j, Li S-Z, Zhou X-N, Xu J: Schistosomiasis in Humans, 1990-2041: Findings from the Global Burden of Disease 2021 Study and Predictions by Bayesian Age-Period-Cohort Analysis. In: medRxiv: 2024; 2024. Hong Z, Li L, Zhang L, Wang Q, Xu J, Li S, Zhou XN: Elimination of Schistosomiasis Japonica in China: From the One Health Perspective. China CDC weekly 2022, 4(7):130-134. Costain AH, MacDonald AS, Smits HH: Schistosome Egg Migration: Mechanisms, Pathogenesis and Host Immune Responses. Frontiers in immunology 2018, 9:3042. Salim OEH, Hamid HKS, Mekki SO, Suleiman SH, Ibrahim SZ: Colorectal carcinoma associated with schistosomiasis: a possible causal relationship. World Journal of Surgical Oncology 2010, 8(1):68. Ayabina DV, Clark J, Bayley H, Lamberton PHL, Toor J, Hollingsworth TD: Gender-related differences in prevalence, intensity and associated risk factors of Schistosoma infections in Africa: A systematic review and meta-analysis. PLoS neglected tropical diseases 2021, 15(11):e0009083. McManus DP, Bergquist R, Cai P, Ranasinghe S, Tebeje BM, You H: Schistosomiasis-from immunopathology to vaccines. Seminars in immunopathology 2020, 42(3):355-371. Hams E, Aviello G, Fallon PG: The schistosoma granuloma: friend or foe? Frontiers in immunology 2013, 4:89. Ewuzie A, Wilburn L, Thakrar DB, Cheng H, Reitzug F, Roberts N, Malouf R, Chami GF: Association of current Schistosoma mansoni, Schistosoma japonicum, and Schistosoma mekongi infection status and intensity with periportal fibrosis: a systematic review and meta-analysis. The Lancet Global health 2025, 13(1):e69-e80. Yang Y, Wang X-Y, Duan C, Wang Z-J, Sheng H-Y, Xu X-L, Wang W-J, Yang J-H: Clinicopathological characteristics and its association with digestive system tumors of 1111 patients with Schistosomiasis japonica. Scientific reports 2023, 13(1):15115. Nation CS, Da'dara AA, Marchant JK, Skelly PJ: Schistosome migration in the definitive host. PLoS neglected tropical diseases 2020, 14(4):e0007951. Liu XF, Ju S, Wang KY, Li Y, Qiang JW: The prevalence rate, mortality, and 5-year overall survival of Schistosoma japonicum patients with human malignancy. Frontiers in oncology 2023, 13:1288197. Jain S, Rana M, Choubey P, Kumar S: Schistosoma japonicum Associated Colorectal Cancer and Its Management. Acta parasitologica 2023, 68(4):723-734. Cogliano VJ, Baan R, Straif K, Grosse Y, Lauby-Secretan B, El Ghissassi F, Bouvard V, Benbrahim-Tallaa L, Guha N, Freeman C et al: Preventable exposures associated with human cancers. Journal of the National Cancer Institute 2011, 103(24):1827-1839. Qiu DC, Hubbard AE, Zhong B, Zhang Y, Spear RC: A matched, case-control study of the association between Schistosoma japonicum and liver and colon cancers, in rural China. Ann Trop Med Parasitol 2005, 99(1):47-52. Wang Z, Du Z, Liu Y, Wang W, Liang M, Zhang A, Yang J: Comparison of the clinicopathological features and prognoses of patients with schistosomal and nonschistosomal colorectal cancer. Oncology letters 2020, 19(3):2375-2383. Rong Z, Huang C: Research advance in colorectal cancer with schistosomiasis. Modern Oncology 2019, 27(2):335-339 (In Chinese). Wang W, Lu K, Wang L, Jing H, Pan W, Huang S, Xu Y, Bu D, Cheng M, Liu J et al: Comparison of non-schistosomal colorectal cancer and schistosomal colorectal cancer. World J Surg Oncol 2020, 18(1):149. Zhu Y, Wu X, Ran X, Rao C, Gong P: A retrospective cross-sectional study: comparison of the clinicopathological features of schistosomal and non-schistosomal colorectal cancer in Central China. BMC infectious diseases 2024, 24(1):732. Zhu H, Liu JB, Xiao Y, Tu ZW, Shan XW, Li B, Wu JL, Zhou XR, Sun LC, Xia J et al: Efforts to eliminate schistosomiasis in Hubei province, China: 2005-2018. Acta tropica 2022, 231:106417. Feng J, Zhang X, Hu H, Gong Y, Luo Z, Xue J, Cao C, Xu J, Li S: Spatiotemporal distribution of schistosomiasis transmission risk in Jiangling County, Hubei Province, P.R. China. PLoS neglected tropical diseases 2023, 17(5):e0011265. Cheng B, Wu JY: [Surveillance of schistosomiasis in Xiaogan City from 2016 to 2020]. Zhongguo xue xi chong bing fang zhi za zhi = Chinese journal of schistosomiasis control 2021, 33(4):420-423 (In Chinese). He JC, Chen XF, Wang TP, Gao FH, Tao W, Dai B, Ding SJ, Liu T, Li Y, Wang H et al: [Investigation on prevalence of Schistosoma japonicum infections in wild mice in Shitai County, Anhui Province, 2018]. Chinese journal of schistosomiasis control 2022, 34(6):622-625 (In Chinese). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-7228920\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":505509503,\"identity\":\"3020450a-41be-4d62-9b22-fa0daa1978ca\",\"order_by\":0,\"name\":\"Nanhao Zhou\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Jiujiang University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Nanhao\",\"middleName\":\"\",\"lastName\":\"Zhou\",\"suffix\":\"\"},{\"id\":505509504,\"identity\":\"2aacf5a2-58df-4f8c-b9a5-27aa222f353b\",\"order_by\":1,\"name\":\"Minhao Zeng\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Jiangsu University of Science and Technology\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Minhao\",\"middleName\":\"\",\"lastName\":\"Zeng\",\"suffix\":\"\"},{\"id\":505509505,\"identity\":\"fae8c09b-5338-43da-baab-3dc42aa4c43c\",\"order_by\":2,\"name\":\"Xiongchaun Pei\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Jiujiang University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Xiongchaun\",\"middleName\":\"\",\"lastName\":\"Pei\",\"suffix\":\"\"},{\"id\":505509506,\"identity\":\"c72b326c-1c63-411a-a9fd-2298a42a3b3b\",\"order_by\":3,\"name\":\"Youlong Li\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Center for Disease Control and Prevention of Jiujiang\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Youlong\",\"middleName\":\"\",\"lastName\":\"Li\",\"suffix\":\"\"},{\"id\":505509507,\"identity\":\"d7f193b2-4268-44e7-ac43-81f6bcdbfe3f\",\"order_by\":4,\"name\":\"Yanqing Shi\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Affiliated Hospital of Jiujiang University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Yanqing\",\"middleName\":\"\",\"lastName\":\"Shi\",\"suffix\":\"\"},{\"id\":505509508,\"identity\":\"b8c36dd1-7e12-48a1-85ed-ec60b2f30efe\",\"order_by\":5,\"name\":\"Xuguang Sun\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Jiujiang University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Xuguang\",\"middleName\":\"\",\"lastName\":\"Sun\",\"suffix\":\"\"},{\"id\":505509509,\"identity\":\"a9b2a05d-fb13-4e51-a00f-c7f252441fde\",\"order_by\":6,\"name\":\"Ting Li\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Affiliated Hospital of Jiujiang University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Ting\",\"middleName\":\"\",\"lastName\":\"Li\",\"suffix\":\"\"},{\"id\":505509510,\"identity\":\"f765c897-789d-4ee2-a728-1e174e3d817f\",\"order_by\":7,\"name\":\"Shan Li\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyklEQVRIiWNgGAWjYDACdhBhwMbDz97Y+PADUVqYQUQFn5xkz+FmYwnitZyRMza4kd4mwEOMDvlm5mMSH9vMEmfOfNjGIMFgJ6fbQECLwWG2NMmZbWmJ/dKJbQ8KGJKNzQ4Q0sLMY2zM23YscebsxHYDCYYDidsIaZFvBmr52/Y/ccPNg20SPMRoYTjMY/iY4Qwb0PuMRGoB+iXxYU8FGzCQE4GBbECEX+Tbmw8c+AGOyuMPH36osJMjqAXdUtKUj4JRMApGwSjAAQBTN0DE9qbDrgAAAABJRU5ErkJggg==\",\"orcid\":\"\",\"institution\":\"Jiujiang University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Shan\",\"middleName\":\"\",\"lastName\":\"Li\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2025-07-28 02:08:19\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-7228920/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-7228920/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":90198931,\"identity\":\"ff497bdf-2860-4856-8e2a-a4bf3be88d6d\",\"added_by\":\"auto\",\"created_at\":\"2025-08-29 18:01:10\",\"extension\":\"jpg\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":335750,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eThe prevalence of \\u003cem\\u003eS. japonicum\\u003c/em\\u003e infection at the Affiliated Hospital of Jiujiang University from 2013 to 2024. A, Number of \\u003cem\\u003eS. japonicum\\u003c/em\\u003e infection cases by Year; B, Age Group distribution of \\u003cem\\u003eS. japonicum\\u003c/em\\u003e infection cases by Year.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure1.tiff.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7228920/v1/df9732af0113bba6e01e0502.jpg\"},{\"id\":90198934,\"identity\":\"8234c3a5-b8df-44b5-864d-df87daf0ecf1\",\"added_by\":\"auto\",\"created_at\":\"2025-08-29 18:01:10\",\"extension\":\"jpg\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":785606,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eDistribution and correlation of \\u003cem\\u003eS. japonicum\\u003c/em\\u003e egg deposition and cancer cases. A, Egg deposition percentage pie chart; B, Sankey diagram showing the relationship between the location of egg deposition and the number of cancer cases in the corresponding parts among cancer patients with egg deposition; C, The trend in the number of cases of three types of cancer over different years.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure2.tiff.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7228920/v1/3488e0292f1484d6dcbfe491.jpg\"},{\"id\":90199618,\"identity\":\"be97cedd-bbae-4ce4-80c2-0f72bd32d7c6\",\"added_by\":\"auto\",\"created_at\":\"2025-08-29 18:09:10\",\"extension\":\"jpg\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":1555878,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eAnalysis of HE-stained pathological tissue sections shows the presence of \\u003cem\\u003eS. japonicum\\u003c/em\\u003eeggs in liver (A, 20×), colorectal (B, 20×) and stomach (B, 20×) tumor tissues.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure3.tiff.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7228920/v1/4a6dae9df87483e5410e0b4d.jpg\"},{\"id\":90198933,\"identity\":\"367a56e0-376e-4133-9346-9f496a0665cf\",\"added_by\":\"auto\",\"created_at\":\"2025-08-29 18:01:10\",\"extension\":\"jpg\",\"order_by\":4,\"title\":\"Figure 4\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":2231111,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eStatistics of CRC cases complicated with \\u003cem\\u003eS. japonicum\\u003c/em\\u003e infection. A, The distribution of SACRC and CRC cases across different age groups; B, Gender distribution of SACRC and CRC patients; C, Distribution of the differentiated in SACRC and CRC; D,: Distribution proportion of TNM staging in SACRC and CRC patients.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure4.tiff.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7228920/v1/b2c7f7a9b77173160ac3dcc2.jpg\"},{\"id\":90198938,\"identity\":\"10d6b474-ceff-4c6f-909f-6f823e7d6f83\",\"added_by\":\"auto\",\"created_at\":\"2025-08-29 18:01:10\",\"extension\":\"jpg\",\"order_by\":5,\"title\":\"Figure 5\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":1276874,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eDistribution map of seropositivity rate (A) and cases (B) of \\u003cem\\u003eS. japonicum\\u003c/em\\u003e for residents in each district. 1. XiuShui; 2. WuNing; 3. RuiChang; 4. DeAn; 5. YongXiu; 6. GongQingCheng; 7. ChaiSang; 8. LuShan; 9. DuChang; 10. XuYang-Development Zone; 11. LianXi; 12. HuKou; 13. PengZe; 14. Yangtze River\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure5.tiff.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7228920/v1/6596ae3ddd80fa3f8405c261.jpg\"},{\"id\":90286146,\"identity\":\"7b5ee7ea-505b-490a-b0a1-a4cf966dde0f\",\"added_by\":\"auto\",\"created_at\":\"2025-09-01 06:17:40\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":7073816,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7228920/v1/e0cd7d67-7be8-48f8-ad33-5f579223a28b.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Investigation and Analysis of Schistosomiasis-Associated Gastroenteric Tumor in Jiujiang Section of the Yangtze River Basin (Jiangxi Province, China) from 2014 to 2024\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003eSchistosomiasis is a disease caused by parasitic trematodes of the genus \\u003cem\\u003eSchistosoma\\u003c/em\\u003e. According to the World Health Organization (WHO), approximately one-tenth of the global population is at risk of Schistosomiasis[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. It is conservatively estimated that at least 230\\u0026nbsp;million people are infected with \\u003cem\\u003eSchistosoma\\u003c/em\\u003e spp. around the world, causing 200,000 deaths per year[\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. Each female \\u003cem\\u003eSchistosoma japonicum\\u003c/em\\u003e is capable of laying thousands of eggs daily, although only a small proportion are excreted from the host[\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. The deposited eggs can cause chronic intestinal diseases, including colorectal cancer (CRC)[\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eAmong the six known \\u003cem\\u003eSchistosoma\\u003c/em\\u003e species that can infect humans, \\u003cem\\u003eS. japonicum\\u003c/em\\u003e is the most prevalent in China, which was once among the countries with the heaviest burden of Schistosomiasis[\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]. In the 1950s, \\u003cem\\u003eS. japonicum\\u003c/em\\u003e was widely prevalent in 12 provinces along the Yangtze River, with over 10\\u0026nbsp;million infected individuals. Through more than 70 years of active control efferts, China has achieved significant success in controlling Schistosomiasis[\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. Although the prevalence of schistosomal infection has significantly decreased in China, a substantial number of individuals with chronic schistosomal infection and advanced schistosomiasis still persist. The human portal vein-mesenteric vein system provides an optimal environment for the survival of \\u003cem\\u003eSchistosoma\\u003c/em\\u003e. During prolonged parasitism, the large number of eggs produced by the parasite alters the intestinal microenvironment, inducing chronic inflammatory responses that subsequently influence tumorigenesis and tumor progression. Increasing epidemiological and pathological evidence suggests that chronic infection with \\u003cem\\u003eS. japonicum\\u003c/em\\u003e is associated with the development of various malignancies, particularly colorectal cancer and hepatocellular carcinoma[\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]. The proportion of Schistosomiasis-associated CRC (SACRC) among all patients has also decreased from 79.2% during 1970–1979 to 8.1% during 2012–2018 [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eDespite Schistosomiasis no longer being considered a public health issue in China as of 2015, a survey conducted in 2016 on a total of 3,924 individuals in Hunan and Jiangxi provinces revealed that the total combined baseline prevalence of \\u003cem\\u003eS. japonicum\\u003c/em\\u003e, determined by qPCR, was 4.8%[\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. Additionally, the intermediate hosts snail (\\u003cem\\u003eOncomelania hupensis\\u003c/em\\u003e), are still widely distributed in China, including in Jiangxi Province[\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. Therefore, there is still a potential risk of the disease's resurgence in China, which could impact the life expectancy of the population[\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eThis study describes the trends in CRC and SACRC in the historically endemic area of \\u003cem\\u003eS. japonicum\\u003c/em\\u003e along the Jiujiang section of the Yangtze River. It also compares the differences between SACRC and non-schistosomiasis-associated CRC (CRC), aiming to provide new insights into the relationship between \\u003cem\\u003eS. japonicum\\u003c/em\\u003e infection and host colorectal cancer.\\u003c/p\\u003e\"},{\"header\":\"Methodology\",\"content\":\"\\u003cp\\u003e\\u003cb\\u003eClinical information sources, patients and eligibility criteria\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eThe study was conducted at the Affiliated Hospital of Jiujiang University, located near Poyang Lake in Jiangxi Province, China. Using \\\"Schistosomiasis\\\" as keywords, clinical patient data were collected from the Department of Pathology at the Affiliated Hospital of Jiujiang University from July 2013 to July 2024. An analysis was conducted on schistosomiasis-associated diseases. After identifying colorectal cancer as the primary intestinal disease, clinical data from colorectal cancer patients were further collected. Based on confirmed infection status of \\u003cem\\u003eSchistosoma japonicum\\u003c/em\\u003e, patients diagnosed with colorectal cancer were divided into two groups: the SACRC group (colorectal cancer with \\u003cem\\u003eS. japonicum\\u003c/em\\u003e infection) and the CRC group (colorectal cancer without \\u003cem\\u003eS. japonicum\\u003c/em\\u003e infection).\\u003c/p\\u003e\\u003cp\\u003eThe inclusion and exclusion criteria for CRC patients are as follows:\\u003c/p\\u003e\\u003cp\\u003eThe inclusion criteria were as follows: patients hospitalized for colorectal tumors, confirmed by preoperative biopsy and postoperative pathology; clear pathological data of colorectal tumors; patients undergoing their first radical surgery for colorectal cancer.\\u003c/p\\u003e\\u003cp\\u003eThe exclusion criteria were as follows: patients with recurrent colorectal cancer; patients without postoperative pathological data; patients with secondary malignant tumors of the colorectum.\\u003c/p\\u003e\\u003cp\\u003eRetrospective data were collected for both groups of patients, including the location of colorectal cancer, maximum tumor diameter (cm), gross morphology, pathological type, degree of tumor cell differentiation, number of bowel segments involved, presence of perineural invasion, presence of vascular invasion, and TNM staging. The clinicopathological characteristics of the two groups were compared.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eRisk assessment for schistosomiasis infection\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eJiuJiang, located in Jiangxi Province, lies in the middle and lower reaches of the Yangtze River and along the shores of Poyang Lake, the largest freshwater lake in China. With its numerous rivers, lakes, and complex natural environment, the region is prone to both marshland and hilly types of schistosomiasis. This study conducted an epidemiological survey in 2023 in the schistosomiasis-endemic areas of Jiujiang, using the following methods: medical consultation among the population in endemic areas, where any contact with \\u003cem\\u003eS. japonicum\\u003c/em\\u003e-infested water was considered a risk behavior. Including all individuals who have had risk behaviors, and additionally randomly selecting some individuals who were consulted for serological testing (ELISA/IHA). The diagnostic criteria are based on the national standard of China, Schistosomiasis Diagnostic Criteria (WS 261–2006). Briefly, a positive result in the IHA test occurs when an agglutination reaction is observed at a 1:10 serum dilution, and in the ELISA test, a positive result is indicated when the OD value of the test well is greater than or equal to 2.1 times that of the standard negative control well.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003e\\u003cb\\u003eClinical Characteristics of Patients with Schistosomiasis Infection\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eFrom November 2013 to July 2024, a total of 1,317 cases of schistosomiasis were collected. Except for the full-year cases not collected in 2013 and 2024, and possibly due to the impact of the COVID-19 pandemic in 2020, there have been over 100 cases of schistosomiasis seeking medical treatment each year (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003eA). The analysis of the age and gender distribution of the cases shows that there were 816 male patients (61.96%) and 501 female patients (38.04%), indicating a significantly higher infection rate among males compared to females. Additionally, in each age group, the number of male patients is greater than that of females. The highest number of patients is found in the 51\\u0026ndash;60 age group, followed by the 61\\u0026ndash;70 age group (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003eB).\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cp\\u003eStatistical analysis of schistosome egg deposition sites revealed that the vast majority of cases exhibited egg localization within the digestive system. Notably, 956 cases (72.64%) showed egg deposition in the colon and rectum, 159 cases (12.08%) in the appendix, and 87 cases (6.61%) in the liver and biliary tract.(Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003eA). Among all schistosomiasis patients, 221 were diagnosed with cancer. An analysis of the deposition sites of eggs in these patients in relation to the cancer sites showed that the colon and rectum, liver and biliary tract, and stomach are common areas for both egg depositions and cancer (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003eB). The number of cases treated each year is shown in Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003eC, with the numbers being relatively stable except for the years 2020\\u0026ndash;2021, which were affected by the COVID-19 pandemic. The typical pathological results of the three most common schistosomiasis-related cancers, liver cancer, colorectal cancer, and gastric cancer are shown in Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eComparative Analysis of Clinical Characteristics Between Colorectal Cancer Patients With and Without Schistosomiasis Infection\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eA total of 1,030 CRC (colorectal cancer without \\u003cem\\u003eS. japonicum\\u003c/em\\u003e infection) cases were collected from the aforementioned hospital between June 2014 and August 2024. A comparative analysis was conducted between the CRC group (NSACRC) and the SACRC (colorectal cancer with \\u003cem\\u003eS. japonicum\\u003c/em\\u003e infection) group, focusing on age groups, gender ratios, degrees of differentiation, and TNM staging. Similar to the age composition of schistosomiasis patients, the largest proportion of CRC patients was in the 61\\u0026ndash;70 age group, accounting for 30%. However, the age composition of SACRC differs from both schistosomiasis patients and CRC, with a higher proportion of older cases, with 52.17% of patients in the 71\\u0026ndash;80 age group (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003eA). In terms of gender distribution, the male-to-female ratio for CRC was 55.92\\u0026ndash;44.08%; the ratio for SACRC was similar to that of the schistosomiasis patients, with a higher male proportion of 68.42% (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003eB).\\u003c/p\\u003e\\u003cp\\u003eSubsequently, a comparative analysis was conducted on cases that underwent differentiation degree testing. Both SACRC and CRC predominantly presented with moderate and moderately low differentiation, with no significant difference between the two groups (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003eC). Similarly, the distribution of TNM staging also showed a similar pattern in both groups (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003eD). When comparing the presence of lymphatic metastasis of cancer cells, CRC exhibited a greater tendency for metastasis, with 35.75% of cases showing lymphatic metastasis of cancer cells, while the proportion of SACRC cases with metastasis was 28.42%.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eEpidemiological Trends and Distribution of Schistosomiasis in the Jiujiang Section of the Yangtze River Basin in 2023\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eAccording to the census report published by the Jiujiang City Government and the survey data from the Jiujiang City Center for Disease Control and Prevention, as of 2023, out of the 14 districts/counties under the jurisdiction of Jiujiang City, 13 had areas where \\u003cem\\u003eS. japonicum\\u003c/em\\u003e is prevalent. Among the city's population of 4.56\\u0026nbsp;million, 1.66\\u0026nbsp;million people live in village-level units or residential areas where the disease was prevalent, and these residents were at a higher risk of infection. Among the 13 districts, Pengze had the largest number of people at risk, with 302.7 thousand people; followed by Duchang and Xunyang-Development zone, with 256.9 thousand and 236.8 thousand people, respectively. Five districts had the prevalence population that accounts for more than half of their total population, namely Pengze (79.08%), Lushan (61.18%), Chaisang (54.96%), Hukou (54.57%), and Gongqingcheng (52.72%). In addition, the prevalence population in the core urban area of Xunyang-Development zone also accounted for a high proportion (49.93%).\\u003c/p\\u003e\\u003cp\\u003eIn the endemic areas across various districts, we conducted medical consultation with a total of 400,958 individuals to investigate whether they had exposed to \\u003cem\\u003eS. japonicum\\u003c/em\\u003e-infested water. The results showed that Pengze, Lushan, Duchang, and Ruichang all had more than 10,000 people who had engaged in risky behaviors in 2023, with 29,884, 27,149, 16,289, and 11,515 individuals respectively. These numbers represent 42.49%, 52.35%, 17.18%, and 21.64% of the consulted population in their respective districts.\\u003c/p\\u003e\\u003cp\\u003eFurthermore, we conducted serological testing on some of the surveyed individuals (excluding those from Lushan and DeAn, all others with risky behaviors were included). The results showed that in Pengze, 1,145 subjects tested seropositive, accounting for 3.82% of those surveyed serologically and 1.63% of all those consulted. Followed by Duchang, with 952 seropositive individuals, representing 3.37% of the serologically tested subjects and 1% of all those consulted. All subjects in Xunyang-Development zone tested seronegative, and additionally, there were relatively few seropositive cases in DeAn and Wuning, with less than 10 individuals. Particularly noteworthy is that we conducted fecal examinations on some individuals who were interviewed, and most areas reported negative results. However, in Duchang, 18 cases tested positive in 1590 fecal examinations \\u003cb\\u003e(\\u003c/b\\u003eTable\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e\\u003cb\\u003e)\\u003c/b\\u003e.\\u003c/p\\u003e\\u003cp\\u003eBased on the proportion of seropositive subjects among all those consultations surveyed and the proportion of consultation surveyed individuals among the epidemic population, it is estimated that Pengze, Duchang, Lushan, and Chaisang may have more than a thousand potential seropositive cases, with a total potential seropositive population in the city reaching 12,752. From the seropositivity rate of subjects in each district obtained from the investigation and the total potential seropositive population in the city, it can be seen that the seropositivity rate and the number of potential seropositive individuals are relatively high in the districts along the Yangtze River, and also high in the districts surrounding the waterway from the estuary to the Poyang Lake (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig5\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eThe survey on the prevalence of \\u003cem\\u003eS. japonicum\\u003c/em\\u003e in Jiujiang section of the Yangtze River 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colname=\\\"c5\\\"\\u003e\\u003cp\\u003e16289\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e28213\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e952\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e1.00%\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e2579\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eHuKou\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e227.4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e124.1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e20658\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e8177\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e8177\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e24\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.12%\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e144\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePengZe\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e382.8\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e302.7\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e70332\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e29884\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e30012\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e1145\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e1.63%\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e4928\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eRuiChang\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e452.3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e203.0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e53217\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e11515\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e26039\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e93\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.17%\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e355\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eGongQingCheng\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e180.0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e94.9\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e30299\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e9\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e15025\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e145\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.48%\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e454\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eLuShan\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e265.6\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e162.5\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e51865\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e27149\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e30026\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e610\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e1.18%\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e1911\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eXunYang-Development Zone\\u003csup\\u003e7\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e474.3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e236.8\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e8010\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e167\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1026\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c8\\\"\\u003e\\u003cp\\u003e0.00%\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c9\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003csup\\u003e1\\u003c/sup\\u003eThe people who were consulted all come from epidemic areas. \\u003csup\\u003e2\\u003c/sup\\u003eCases that have been exposed to \\u003cem\\u003eS. japonicum\\u003c/em\\u003e-infested water and have not undergone any form of examination or diagnosis are considered risky behavior. \\u003csup\\u003e3\\u003c/sup\\u003eThe serological testing included all cases with risk behaviors. Except for only 2 individuals with risk behaviors in DeAn who were tested, and 11 people with risk behaviors in LuShan who were not. \\u003csup\\u003e4\\u003c/sup\\u003eSerological testing methods include ELISA and IHA. \\u003csup\\u003e5\\u003c/sup\\u003eThe ratio of positive serological test results to the number of individuals who underwent consultation. \\u003csup\\u003e6\\u003c/sup\\u003eThe potential number is calculated by dividing the number of serologically positive individuals by the ratio of the number of consultations to the population in the epidemic area. \\u003csup\\u003e7\\u003c/sup\\u003eThe surveys in the Development Zone and XunYang district were conducted separately, but since the two districts were once a single district, the data were merged to avoid confusion.\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eSchistosomiasis is a category of tropical diseases caused by parasitic flatworms of the genus \\u003cem\\u003eSchistosoma\\u003c/em\\u003e. In China, the prevalent species is \\u003cem\\u003eS. japonicum\\u003c/em\\u003e. Historically, Schistosomiasis japonica has ravaged China, particularly in the waterways of the Yangtze River region, with Jiangxi Province being one of the endemic areas. The initial control campaigns for \\u003cem\\u003eS. japonicum\\u003c/em\\u003e also began in Jiangxi Province [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. Although China has made significant progress in controlling the prevalence of S. japonicum through extensive and prolonged management efforts, attention must still be given to the global epidemic situation. It is important to respond to the World Health Organization's 'One Health' initiative and focus on the large number of late-stage schistosomiasis patients in order to achieve comprehensive elimination of the disease [\\u003cspan additionalcitationids=\\\"CR17\\\" citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eThe pathogenesis of schistosomiasis is multifaceted, involving the migration of eggs through the host's tissues, which can lead to significant immunopathological reactions. The eggs of \\u003cem\\u003eSchistosoma\\u003c/em\\u003e species, especially when deposited in the intestinal tissues, are known to induce chronic inflammation, granuloma formation, and fibrosis, which are key pathological changes associated with the disease [\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e]. These pathological changes are not only a result of the eggs' physical presence but also due to the host's immune response to the eggs, which can lead to genetic instability and potentially promote carcinogenesis [\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eThe cohort analysis in this study highlights the persistent challenge of schistosomiasis in the Jiujiang section of the Yangtze River Basin. From 2014 to 2023, the consistent annual incidence of over 100 schistosomiasis cases, with some exceptions due to data collection gaps and the COVID-19 pandemic, underscores the need for vigilant surveillance systems to monitor the disease's prevalence and assess the effectiveness of control measures [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eThe gender disparity observed in the incidence of schistosomiasis, with a significantly higher rate among males, suggests that infection risk is not evenly distributed across populations. The gender distribution of patients with schistosome egg deposition over the years predominantly shows a higher proportion of males, ranging from 56.21\\u0026ndash;80.77%. Consistent with previous research findings, more males are infected than females. This discrepancy may be attributed to differences in social and occupational roles, which provide males with more opportunities to come into contact with S. japonicum-infested water and become infected with cercariae [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eDuring \\u003cem\\u003eS. japonicum\\u003c/em\\u003e infections, adult worms typically reside in the mesenteric veins of the definitive host, releasing eggs that travel via the portal vein to the liver and subsequently enter the digestive system through the biliary tract and gallbladder. The deposition of these eggs in these areas can lead to granuloma formation, and chronic inflammation may potentially induce carcinogenesis. This process involves significant immunopathological reactions as the eggs migrate through the host's tissues [\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e]. Particularly when eggs are deposited in intestinal tissues, they induce chronic inflammation, granuloma formation, and fibrosis, which are key pathological changes associated with schistosomiasis [\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]. These pathological changes are not only a consequence of the physical presence of the eggs but also related to the host's immune response to the eggs, potentially leading to genetic instability and promoting carcinogenesis. The deposition of eggs in the intestines and liver, along with the subsequent immune responses and inflammatory processes, are central to the pathogenesis of schistosomiasis [\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e]. Despite potential biases that may arise from data collected by pathology departments, we were surprised to find that hepatobiliary deposition accounted for only 6.61% of all cases. Typically, individuals infected with schistosomes have a significant deposition of eggs in the liver and gallbladder, which leads to the formation of granulomas and liver fibrosis, hallmarking schistosomiasis [\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e]. This implies that a considerable number of potential or chronic infection patients do not exhibit relatively obvious symptoms due to egg deposition in the liver and gallbladder.\\u003c/p\\u003e\\u003cp\\u003eIn this study, the highest number of cases with egg deposition in the digestive system was observed, with the colon and rectum accounting for 72.64%, followed by the appendix (12.08%), jejunum-ileum-cecum (3.19%), and stomach (2.96%). Deposition in the small intestine, pancreas, esophagus, respiratory system, and reproductive system was rare (\\u0026lt;\\u0026thinsp;1%). This findings are consistent with previous studies, which have shown that in patients with \\u003cem\\u003eSchistosoma japonicum\\u003c/em\\u003e, extrahepatic egg deposition is most commonly observed in the rectum, sigmoid colon, and descending colon, with the highest number of eggs in the digestive tract when parasitizing in large animals [\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eWe conducted a statistical analysis of patients who had both malignant tumors and deposition of schistosome eggs within their bodies. Among the 1,309 cases with egg deposition, 221 had cancer. The most common type was colorectal cancer (142 cases, 64.25%), followed by gastric cancer (29 cases, 13.12%) and liver cancer (28 cases, 12.67%). These findings are not entirely consistent with another survey conducted in Shanghai, China, but colorectal and gastric cancers remain very common malignant tumors among patients with schistosomiasis [\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eAlthough it is surprising that there are so few cases of liver-gallbladder egg deposition, among the 87 patients, 19 had cancer in the gallbladder, and the cancer rate of 21.84% indicates the inducing capacity of \\u003cem\\u003eS. japonicum\\u003c/em\\u003e for cancer in liver-gallbladder. Although only 29 cases of gastric cancer combined with gastric schistosome egg deposition were collected, there were only 39 cases of gastric deposition among all collected schistosome egg deposition cases. Additionally, cases of colorectal cancer combined with colorectal egg deposition accounted for only 14.85% of the egg deposition cases. It can also be observed that from 2013 to 2024, colorectal cancer has consistently been the most common type of cancer among patients with chronic schistosomiasis patients. In the International Agency for Research on Cancer classification, \\u003cem\\u003eS. japonicum\\u003c/em\\u003e was identified as a Group 2B (possibly carcinogenic) for the liver and colorectum as early as 1994, and this classification has remained unchanged ever since. However, the relationship between \\u003cem\\u003eS. japonicum\\u003c/em\\u003e infection and cancer has always been a matter of debate [\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e]. In a 2005 study conducted in Sichuan Province, China, it was found that among all cases, 24% of colorectal cancer and 27% of liver cancer could be attributed to schistosomiasis infection [\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e]. In this study, the proportion of SACRC cases accounted for 11.04% (129/1168) of all CRC cases. This proportion is higher than the 8.1% found in a survey conducted in Wuhu City, Anhui Province, which is also located along the Yangtze River [\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e]. However, it was surprising to find that in two surveys conducted in Shanghai, the proportion of SACRC was unusually high, at 17.3% [\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e] and 39.0% [\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e], respectively. Although high-level hospitals may treat more SACRC patients from various regions, the number of CRC patients would also increase.\\u003c/p\\u003e\\u003cp\\u003eSubsequently, a comparative analysis was conducted on the age distribution, gender distribution, degree of differentiation, pathological staging, and metastatic status of SACRC and CRC. Due to the deposition of schistosome eggs in the colon and rectum, which can cause inflammation, fibrosis, and other pathological changes, we anticipated that within the same region, the age of onset for SACRC might be earlier than that for CRC, and the degree of tumor differentiation and pathological staging of SACRC might be more severe than that of CRC [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]. However, the results we observed showed that the proportion of SACRC before the age of 60 was significantly lower than that of CRC, suggesting that the onset age of SACRC was \\\"delayed,\\\" or possibly that schistosomiasis \\\"delayed\\\" the time when CRC was detected. This is consistent with some previous research findings, with the peak age of onset for SACRC being around 61\\u0026ndash;70 years old [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e]. The gender ratio of CRC cases is relatively balanced, at 1.27:1 (Male: Female), while SACRC continues the gender ratio characteristic of \\u003cem\\u003eS. japonicum\\u003c/em\\u003e infection, which is 2.17:1. Additionally, the degree of differentiation and the level of pathological staging showed similar patterns, with no significant differences observed. Surprisingly, the proportion of metastatic cases in SACRC (28.42%) was also lower than that in CRC (35.75%).\\u003c/p\\u003e\\u003cp\\u003eDue to the observed risks for potential late-stage schistosomiasis patients, as well as the ongoing need for prevention and control, in 2023 we conducted a survey on the infection status of Japanese schistosomiasis among residents in various districts and counties of Jiujiang City from multiple perspectives. A fecal examination was conducted on 11,425 individuals, with only 18 positive cases detected in DuChang. This indicates that the schistosomiasis control in Jiujiang City has achieved good results, with fewer high-risk areas. However, 42.13% of the population in Jiujiang City still resides in village-level units with risk areas. Only Xiushui County, with its well-developed water network, has no risky waters, despite its abundant water resources. Pengze County, located by the Yangtze River and not in the core urban area, has a high-risk population of 79.08% and contributes the most to the potential seropositive population. The areas surrounding the waterways from the Yangtze River to Poyang Lake, including DuChang, YongXiu, LuShan, GongQingCheng, and even the core urban areas of ChaiSang and LianXi, have higher seropositivity rates and a greater number of potential seropositive individuals. This means that the Poyang Lake and Yangtze River basins, historically areas where schistosomiasis was prevalent, still pose significant risks. The infection rate among residents in Hubei Province was 0 from 2016 to 2018, the infection rate among livestock was also 0 from 2013 to 2018, and the infection rate of snails was 0 in 2018 [\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e]. However, from 2016 to 2020, 660 seropositive cases were identified among residents in XiaoGan City, Hubei Province, and the transmission risk in JiangLing County, Hubei Province, has been on the rise [\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e]. In 2018, an investigation of schistosome infection rates in wild rats in Shitai County, Anhui Province, was conducted. Out of 376 wild rats examined, 91 tested positive in fecal examinations, with a positive rate of 24.2% [\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e]. These findings indicate that the risk of a resurgence of infection still exists. The continuous identification of positive cases in both humans and wild animals suggests that the parasite\\u0026rsquo;s transmission cycle remains active in some regions. Additionally, the persistence of schistosomiasis in animal reservoirs, such as wild rats, poses a significant challenge to controlling the disease and eliminating it from endemic areas.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eIn summary, our study indicates that among clinical cases collected from the Affiliated Hospital of Jiujiang University, the incidence of liver-gallbladder cancer, gastric cancer, and colorectal cancer (CRC) is very high among patients infected with S. japonicum. Specifically, patients with Schistosoma japonicum-associated colorectal cancer (SACRC) have a higher average age than those with non-Schistosoma-associated colorectal cancer (CRC), and lymphatic metastasis is more common in SACRC patients. Additionally, we conducted a survey on the prevalence of schistosomiasis in Jiujiang City. Although the overall prevalence is low, there are still a large number of individuals at high risk, including potential seropositive patients, and some patients tested positive in fecal examinations. This suggests that in the Yangtze River Basin, a historically endemic area for schistosomiasis, there will be significant public health pressure in the future due to the treatment needs of patients with late-stage schistosomiasis.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Declaration of Helsinki. Written informed consent was obtained from all participants prior to their participation in the study. All procedures involving human subjects/patients were approved by IRB of the Affiliated Hospital of Jiujiang University (NO. jumer-b-2024-0301).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot Applicable\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData availability\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNational Natural Science Foundation of China (32360888) , Jiujiang Science and Technology Program project (S2024ZDYFN0004) and Science and Technology Project of Health Commission of Jiangxi Province (202510481).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors’ contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNanhao Zhou and Minhao Zeng: Conceptualization, Visualization, Writing original draft. Shan Li: Funding acquisiton, edited and revised the article . Yanqing Shi and Ting Li: Provided clinical data and performed relevant diagnosis and surgery. Youlong Li: Provision of data from the Centers for Disease Control and Prevention (CDC) along with analytical guidance. Ting Li: Provided clinical data and performed relevant diagnosis and revised the manuscript. Minhao Zeng, Nanhao Zhou and Xuguang Sun: Collected and analysis the clinical data. \\u003csup\\u003e* \\u003c/sup\\u003eThese authors contributed equally. All Authors read and approved the final manuscript. \\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWe thank the patient for his participation in this study. We have obtained the patient’s support and informed consent form.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors' information\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCorresponding Author\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTing\\u003c/strong\\u003e\\u003cstrong\\u003e Li: \\u003c/strong\\u003eAffiliated Hospital of Jiujiang University, Jiujiang 332005, Jiangxi, China; Email: liting0088@163.com\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eShan Li:\\u003c/strong\\u003e Jiangxi Provincial Key Laboratory of Cell Precision Therapy, School of Basic Medical Sciences, Jiujiang University, Jiujiang 332005, Jiangxi, China; Email: slove0408@163.com, ORCID: 0000-0002-0824-251X\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003ePresent Addresses\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eNanhao Zhou\\u003c/strong\\u003e: Jiangxi Provincial Key Laboratory of Cell Precision Therapy, School of Basic Medical Sciences, Jiujiang University, Jiujiang 332005, Jiangxi, China; 20220207561@jju.edu.cn\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMinhao Zeng:\\u003c/strong\\u003e School of Biotechnology, Jiangsu University of Science and Technology, Zhenjiang 212100,Jiangsu, China; Email: zengminhao@stu.just.edu.cn\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eXiongchaun Pei\\u003c/strong\\u003e: Jiangxi Provincial Key Laboratory of Cell Precision Therapy, School of Basic Medical Sciences, Jiujiang University, Jiujiang 332005, Jiangxi, China; 2017204596@qq.com\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eYoulong Li:\\u003c/strong\\u003e Center for Disease Control and Prevention of Jiujiang, Jiujiang 332005, Jiangxi, China; Email: jjxxcbfzs@163.com\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eYanqing Shi: \\u003c/strong\\u003eAffiliated Hospital of Jiujiang University, Jiujiang 332005, Jiangxi, China; Email: 710327101@qq.com\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eXuguang Sun:\\u003c/strong\\u003e Jiangxi Provincial Key Laboratory of Cell Precision Therapy, School of Basic Medical Sciences, Jiujiang University, Jiujiang 332005, Jiangxi, China; Email: 6060140@jju.edu.cn, ORCID: 0009-0001-4126-7428\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003ePerera Dilhan J, Koger-Pease C, Paulini K, Daoudi M, Ndao M: Beyond schistosomiasis: unraveling co-infections and altered immunity. Clinical microbiology reviews 2024, 37(1):e00098-00023.\\u003c/li\\u003e\\n\\u003cli\\u003eSchistosomiasis (Bilharzia) [https://www.who.int/health-topics/schistosomiasis#tab=tab_1]\\u003c/li\\u003e\\n\\u003cli\\u003eColley DG, Bustinduy AL, Secor WE, King CH: Human schistosomiasis. The Lancet 2014, 383(9936):2253-2264.\\u003c/li\\u003e\\n\\u003cli\\u003eKing CH: Parasites and poverty: the case of schistosomiasis. Acta tropica 2010, 113(2):95-104.\\u003c/li\\u003e\\n\\u003cli\\u003eMawa PA, Kincaid-Smith J, Tukahebwa EM, Webster JP, Wilson S: Schistosomiasis Morbidity Hotspots: Roles of the Human Host, the Parasite and Their Interface in the Development of Severe Morbidity. Frontiers in immunology 2021, 12:635869.\\u003c/li\\u003e\\n\\u003cli\\u003eQin X, Liu CY, Xiong YL, Bai T, Zhang L, Hou XH, Song J: The clinical features of chronic intestinal schistosomiasis-related intestinal lesions. BMC gastroenterology 2021, 21(1):12.\\u003c/li\\u003e\\n\\u003cli\\u003eDai S-M, Guan Z, Zhang L-J, Lv S, Cao C-L, Li S-Z, Xu J: Imported Schistosomiasis, China, 2010\\u0026ndash;2018. Emerging Infectious Disease journal 2020, 26(1):179.\\u003c/li\\u003e\\n\\u003cli\\u003eXu J, Yu Q, Tchuent\\u0026eacute; L-AT, Bergquist R, Sacko M, Utzinger J, Lin D-D, Yang K, Zhang L-J, Wang Q et al: Enhancing collaboration between China and African countries for schistosomiasis control. The Lancet Infectious Diseases 2016, 16(3):376-383.\\u003c/li\\u003e\\n\\u003cli\\u003eHamid HKS: Schistosoma japonicum-Associated Colorectal Cancer: A Review. 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Infectious diseases of poverty 2023, 12(1):4.\\u003c/li\\u003e\\n\\u003cli\\u003eLi Y, He T, Xie J, Lv S, Li Z, Yuan M, Hu F, Lin D: Trend of Human Schistosomiasis Japonica Prevalence in China from 1990 to 2019. Tropical medicine and infectious disease 2023, 8(7).\\u003c/li\\u003e\\n\\u003cli\\u003eXu J, Hu W, Yang K, Lv S, Li S-Z, Zhou X-N: Key points and research priorities of schistosomiasis control in China during the 14th Five-Year Plan Period. Chinese Journal of Schistosomiasis Control 2021, 33(01):1-6 (In Chinese).\\u003c/li\\u003e\\n\\u003cli\\u003eLi Q, Li Y, Guo S, Li S-Z, Wang Q, Lin W-N, Zhang L-j, Li S-Z, Zhou X-N, Xu J: Schistosomiasis in Humans, 1990-2041: Findings from the Global Burden of Disease 2021 Study and Predictions by Bayesian Age-Period-Cohort Analysis. In: medRxiv: 2024; 2024.\\u003c/li\\u003e\\n\\u003cli\\u003eHong Z, Li L, Zhang L, Wang Q, Xu J, Li S, Zhou XN: Elimination of Schistosomiasis Japonica in China: From the One Health Perspective. China CDC weekly 2022, 4(7):130-134.\\u003c/li\\u003e\\n\\u003cli\\u003eCostain AH, MacDonald AS, Smits HH: Schistosome Egg Migration: Mechanisms, Pathogenesis and Host Immune Responses. Frontiers in immunology 2018, 9:3042.\\u003c/li\\u003e\\n\\u003cli\\u003eSalim OEH, Hamid HKS, Mekki SO, Suleiman SH, Ibrahim SZ: Colorectal carcinoma associated with schistosomiasis: a possible causal relationship. World Journal of Surgical Oncology 2010, 8(1):68.\\u003c/li\\u003e\\n\\u003cli\\u003eAyabina DV, Clark J, Bayley H, Lamberton PHL, Toor J, Hollingsworth TD: Gender-related differences in prevalence, intensity and associated risk factors of Schistosoma infections in Africa: A systematic review and meta-analysis. PLoS neglected tropical diseases 2021, 15(11):e0009083.\\u003c/li\\u003e\\n\\u003cli\\u003eMcManus DP, Bergquist R, Cai P, Ranasinghe S, Tebeje BM, You H: Schistosomiasis-from immunopathology to vaccines. Seminars in immunopathology 2020, 42(3):355-371.\\u003c/li\\u003e\\n\\u003cli\\u003eHams E, Aviello G, Fallon PG: The schistosoma granuloma: friend or foe? Frontiers in immunology 2013, 4:89.\\u003c/li\\u003e\\n\\u003cli\\u003eEwuzie A, Wilburn L, Thakrar DB, Cheng H, Reitzug F, Roberts N, Malouf R, Chami GF: Association of current Schistosoma mansoni, Schistosoma japonicum, and Schistosoma mekongi infection status and intensity with periportal fibrosis: a systematic review and meta-analysis. The Lancet Global health 2025, 13(1):e69-e80.\\u003c/li\\u003e\\n\\u003cli\\u003eYang Y, Wang X-Y, Duan C, Wang Z-J, Sheng H-Y, Xu X-L, Wang W-J, Yang J-H: Clinicopathological characteristics and its association with digestive system tumors of 1111 patients with Schistosomiasis japonica. Scientific reports 2023, 13(1):15115.\\u003c/li\\u003e\\n\\u003cli\\u003eNation CS, Da\\u0026apos;dara AA, Marchant JK, Skelly PJ: Schistosome migration in the definitive host. PLoS neglected tropical diseases 2020, 14(4):e0007951.\\u003c/li\\u003e\\n\\u003cli\\u003eLiu XF, Ju S, Wang KY, Li Y, Qiang JW: The prevalence rate, mortality, and 5-year overall survival of Schistosoma japonicum patients with human malignancy. Frontiers in oncology 2023, 13:1288197.\\u003c/li\\u003e\\n\\u003cli\\u003eJain S, Rana M, Choubey P, Kumar S: Schistosoma japonicum Associated Colorectal Cancer and Its Management. Acta parasitologica 2023, 68(4):723-734.\\u003c/li\\u003e\\n\\u003cli\\u003eCogliano VJ, Baan R, Straif K, Grosse Y, Lauby-Secretan B, El Ghissassi F, Bouvard V, Benbrahim-Tallaa L, Guha N, Freeman C et al: Preventable exposures associated with human cancers. Journal of the National Cancer Institute 2011, 103(24):1827-1839.\\u003c/li\\u003e\\n\\u003cli\\u003eQiu DC, Hubbard AE, Zhong B, Zhang Y, Spear RC: A matched, case-control study of the association between Schistosoma japonicum and liver and colon cancers, in rural China. Ann Trop Med Parasitol 2005, 99(1):47-52.\\u003c/li\\u003e\\n\\u003cli\\u003eWang Z, Du Z, Liu Y, Wang W, Liang M, Zhang A, Yang J: Comparison of the clinicopathological features and prognoses of patients with schistosomal and nonschistosomal colorectal cancer. Oncology letters 2020, 19(3):2375-2383.\\u003c/li\\u003e\\n\\u003cli\\u003eRong Z, Huang C: Research advance in colorectal cancer with schistosomiasis. Modern Oncology 2019, 27(2):335-339 (In Chinese).\\u003c/li\\u003e\\n\\u003cli\\u003eWang W, Lu K, Wang L, Jing H, Pan W, Huang S, Xu Y, Bu D, Cheng M, Liu J et al: Comparison of non-schistosomal colorectal cancer and schistosomal colorectal cancer. World J Surg Oncol 2020, 18(1):149.\\u003c/li\\u003e\\n\\u003cli\\u003eZhu Y, Wu X, Ran X, Rao C, Gong P: A retrospective cross-sectional study: comparison of the clinicopathological features of schistosomal and non-schistosomal colorectal cancer in Central China. BMC infectious diseases 2024, 24(1):732.\\u003c/li\\u003e\\n\\u003cli\\u003eZhu H, Liu JB, Xiao Y, Tu ZW, Shan XW, Li B, Wu JL, Zhou XR, Sun LC, Xia J et al: Efforts to eliminate schistosomiasis in Hubei province, China: 2005-2018. Acta tropica 2022, 231:106417.\\u003c/li\\u003e\\n\\u003cli\\u003eFeng J, Zhang X, Hu H, Gong Y, Luo Z, Xue J, Cao C, Xu J, Li S: Spatiotemporal distribution of schistosomiasis transmission risk in Jiangling County, Hubei Province, P.R. China. PLoS neglected tropical diseases 2023, 17(5):e0011265.\\u003c/li\\u003e\\n\\u003cli\\u003eCheng B, Wu JY: [Surveillance of schistosomiasis in Xiaogan City from 2016 to 2020]. Zhongguo xue xi chong bing fang zhi za zhi = Chinese journal of schistosomiasis control 2021, 33(4):420-423 (In Chinese).\\u003c/li\\u003e\\n\\u003cli\\u003eHe JC, Chen XF, Wang TP, Gao FH, Tao W, Dai B, Ding SJ, Liu T, Li Y, Wang H et al: [Investigation on prevalence of Schistosoma japonicum infections in wild mice in Shitai County, Anhui Province, 2018]. Chinese journal of schistosomiasis control 2022, 34(6):622-625 (In Chinese).\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Schistosomiasis, Intestinal Diseases, Colorectal cancer, Risk assessment\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-7228920/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-7228920/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003ePurpose\\u003c/h2\\u003e\\u003cp\\u003eThis study retrospectively analyzes the prevalence of \\u003cem\\u003eSchistosoma japonicum\\u003c/em\\u003e infection in Jiujiang City from 2014 to 2024 and its relationship with colorectal cancer. Additionally, the infection rate of \\u003cem\\u003eS. japonicum\\u003c/em\\u003e in Jiujiang City was investigated, aiming to provide new insights into the relationship between schistosome infection and host diseases.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e\\u003cp\\u003eClinical and pathological data from 1,309 \\u003cem\\u003eSchistosoma\\u003c/em\\u003e infection cases at the Affiliated Hospital of Jiujiang University were collected, including patient demographics, egg deposition sites, cancer status, and staging. Epidemiological survey data (2022\\u0026ndash;2023) from the Jiujiang CDC were analyzed, encompassing questionnaires, serological testing, and stool examinations.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e\\u003cp\\u003eA pathological examination of 1,309 cases revealed that schistosome egg deposition was primarily located in the colorectal region (72.64%), with a higher prevalence in males and individuals aged 61\\u0026ndash;70 years. Among 200 tumor cases, 192 were found near egg deposition sites, with colorectal, gastric, and hepatobiliary cancers being the most common. The incidence of schistosomiasis-associated colorectal cancer (SACRC) peaked in the 71\\u0026ndash;80 age group, approximately a decade later than non-schistosomiasis-associated colorectal cancer (CRC). Tumor differentiation and staging showed no significant differences between SACRC and CRC. As of 2023, 13 out of 14 districts in Jiujiang City are affected by \\u003cem\\u003eS. japonicum\\u003c/em\\u003e schistosomiasis, with 1.66\\u0026nbsp;million people at risk. Pengze and Duchang have the largest at-risk populations. High seroprevalence rates were observed along the Yangtze River and Poyang Lake.\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e\\u003cp\\u003eThe study highlights the high prevalence of colorectal cancer among individuals infected with \\u003cem\\u003eS. japonicum\\u003c/em\\u003e and underscores the ongoing public health challenges of schistosomiasis in the Yangtze River Basin, despite low overall prevalence.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Investigation and Analysis of Schistosomiasis-Associated Gastroenteric Tumor in Jiujiang Section of the Yangtze River Basin (Jiangxi Province, China) from 2014 to 2024\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-08-29 18:01:06\",\"doi\":\"10.21203/rs.3.rs-7228920/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"15063173-67e0-4d06-a25f-ebdb5f14b228\",\"owner\":[],\"postedDate\":\"August 29th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-09-01T06:09:19+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-08-29 18:01:06\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-7228920\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-7228920\",\"identity\":\"rs-7228920\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}