A retrospective cross-sectional study ： comparison of the clinicopathological features with schistosomal and non-schistosomal colorectal cancer in Central China

A retrospective cross-sectional study ： comparison of the clinicopathological features with schistosomal and non-schistosomal colorectal cancer in Central China | 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 A retrospective cross-sectional study ： comparison of the clinicopathological features with schistosomal and non-schistosomal colorectal cancer in Central China Yuanting Zhu, Xiaoxue Wu, Xiaoshan Ran, Chun Rao, Ping Gong This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4014735/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 25 Jul, 2024 Read the published version in BMC Infectious Diseases → Version 1 posted 4 You are reading this latest preprint version Abstract Aim To analyze the clinicopathological features of schistosomal and non-schistosomal colorectal cancer in Central China and compare them with other areas of the Yangtze River Basin. Method The 501 cases of CRC were retrospectively analyzed from 2020 to 2022. They were divided into two groups: 406 cases of colorectal cancer without schistosomiasis (CRC-NS) and 95 cases of colorectal cancer with schistosomiasis (CRC-S). The clinicopathological characteristics included the distribution of schistosomiasis eggs, patient age, sex, tumor differentiation, lymph node metastasis, and clinical stage, etc. By retrieving the database, we compared the clinicopathological differences of colorectal cancer with schistosomiasis in other areas of the Yangtze River basin. Results Colorectal cancer with schistosomiasis infection accounted for 18.9%. CRC-S patients were significantly older than CRC-NS patients (P < 0.05). There was a statistical difference in the location of occurrence (P 0.05). In other areas of the Yangtze River Basin, there were statistical differences in the age of occurrence and T stage (P < 0.05) between colorectal cancer with schistosomiasis and non-schistosomal colorectal cancer. Conclusion In Central China, colorectal cancer with chronic schistosomiasis infection occurs more in the rectum and sigmoid colon. It is more common in individuals over 60 years old, consistent with the findings in the Yangtze River Basin. Additionally, schistosomal colorectal cancer had a higher TNM stage in the Yangtze River Basin. This may be related to the malignant biological behavior of colorectal cancer and could result in a relatively poor prognosis. Therefore, the elderly population in schistosomiasis endemic areas should pay more attention to early screening and tumor prevention. Schistosomiasis colorectal cancer clinicopathological characteristics Central China Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Colorectal cancer ranks as the fourth most common cancer worldwide and stands as the second leading cause of death. The studies have shown that it is closely related to schistosomal infection [ 1 , 2 ] . Human schistosomiasis manifests in three main types: S.haematobium S.mansoni and S.japonicum [ 3 , 4 ] , mainly schistosomiasis japonica in China. It is a parasitic disease widely prevalent along the Yangtze River Basin. Since the mid-1980s, efforts to control schistosomiasis have evolved from population chemotherapy to infection source control, with notable progress observed post the completion of the Three Gorges Dam. In the past decade, the incidence of schistosomiasis has decreased by 88.46% from 2010 to 2021. As of the end of 2021 [ 5 ] , among the 451 schistosomiasis endemic counties (cities, districts) in China, 339 counties have achieved elimination standard, 100 counties have attained transmission-blocking standards, and 12 counties are in the stage of transmission control. Among them, the number of acute schistosomiasis cases has steeply declined [ 6 , 7 ] . The existing patients primarily consist of advanced schistosomiasis cases (29,037 cases), chiefly concentrated in five provinces in the lake area(Hunan, Hubei, Jiangxi, Anhui, Jiangsu) [ 8 ] . Although the prevention and treatment of schistosomiasis has achieved remarkable results, the eggs still exert adverse effects on various organs after chronic schistosomiasis infection, particularly in the liver and intestine. Calcified schistosomiasis eggs are commonly observed in tissue sections of radical resection specimens from colorectal cancer patients in central China, it is also the evidence of chronic schistosomiasis infection. However, there are rarely reports regarding the clinicopathological characteristics of colorectal cancer patients with schistosoma infection in the central region, especially in comparison with other areas in the Yangtze River basin.. Therefore, the author collected samples from colorectal cancer patients in the Jingzhou area, analyzed their clinicopathological characteristics, and and compared them to data from the broader Yangtze River Basin. This study aims to elucidate the impact of chronic schistosomiasis japonicum infection on the clinicopathological features of colorectal cancer in the Yangtze River Basin. Materials and methods 1.1 Patients and samples A retrospective analysis was conducted on clinicopathological data and HE-stained slides of individuals diagnosed with schistosomal and non-schistosomal colorectal cancer from January 2020 to August 2022. Two expert pathologists reviewed HE-stained slides to determine the diagnosis and re-stage the cases according to the eighth edition of American Joint Committee on Cancer (AJCC). Among the cases analyzed, there were 99 cases of colorectal cancer with schistosomiasis (CRC-S group), comprising 65 males and 31 females. The male-to-female ratio within this group was 2.10:1, with ages ranging from 46 to 88 years and an average age of 66.03. In contrast, the non-schistosomal colorectal cancer group (CRC-NS) included 406 cases, consisting of 234 males and 172 females. The male-to-female ratio in this group was 1.41:1, with ages ranging from 26 to 92 years and an average age of 61.84. All patients had no history of preoperative chemoradiotherapy and related immunotherapy. 1.2 Clinicopathological features Analysis The clinicopathological features of the collected cases were thoroughly analyzed, including the following characteristics: tumor growth pattern(ulcer type, uplift type, infiltration type), growth sites(transverse colon, ascending colon, sigmoid colon and rectum). The depth of infiltration was divided into mucosa / submucosa, superficial / deep muscle layer and serosa (fibrous membrane)/outside. Histological type included adenocarcinoma (including tubular adenocarcinoma) and mucinous adenocarcinoma. The degree of differentiation was mainly divided into: low, moderate and high, according to the 2017 eighth edition of AJCC TNM stage. To enhance the comprehensiveness of the study, a comparative analysis was conducted with colorectal cancer featuring schistosomiasis infection reported in the literature in other parts of the Yangtze River Basin. 1.3 Statistical analysis The data were analyzed using SPSS software for Windows (version 25.0; IBM Corp). Enumeration data (%), the rate of comparison with chi-square test, test level α = 0.05. Results 2.1 Morphological characteristics of schistosomiasis eggs in tissue slides Upon analyzing the pathological slides of 96 cases of CRC-S, the following characteristics were observed: schistosomiasis eggs can be deposited in various parts of the intestinal wall, mucosal layer (88 / 99), submucosa (96 / 99), muscular layer (8 / 99), and outer membrane layer (3 / 99) (Fig. 1 , 2 ). Notably, calcified schistosomiasis eggs were found in the submucosa of all lesions. Most of the calcified schistosomiasis eggs were morphologically intact, showing a basophilic oval nodule measuring 0.45 ~ 0.5 mm. However, a few eggs were damaged during the preparation of tissue slides. Vascular proliferation and lymphocyte aggregation were observed around nearly all eggs, although interstitial reactions were not common. Interestingly, interstitial reactions were more easily observed in eggs deposited around tumor cells. Microscopic examination revealed that different deposition sites of schistosomiasis eggs had diverse degrees of differentiation of tumors. The deeper the deposition site of schistosomiasis eggs, the lower the degree of differentiation(10/9); in the same specimen, diverse degrees of tumor differentiation can be observed in the presence or absence of schistosomiasis egg deposition (5/ 99). (Fig. 3 , 4 : Calcified schistosomal egg deposition can be seen in adenocarcinoma slides with different degrees of differentiation) 2.2 Clinicopathological features of colorectal cancer with schistosomiasis Infection The clinicopathological features of the cohort have been summarized in Table 1 . Table 1 Clinicopathological features of colorectal cancer with schistosome infection Clinicopathol-ogical features CRC(n = 406) n (%) CRC-SI(n = 95)n (%) χ 2 -value P-value Age(year) 60 228(56.2) 70(73.7) Patients Male 234(57.6) 65(68.4) 3.722 0.054 Female 172(42.4) 30(31.6) Location* Transverse colon 34(8.4) 14(14.7) 28.109 0.000 Ascending colon 114(28.1) 8(8.4) Descending colon 35(8.6) 21(22.1) Sigmoid 117(28.9) 29(30.5) Rectum 105(25.9) 23(24.2) Type Elevated type 174(42.8) 32(33.7) 2.834 0.242 Ulceration type 206(51.1) 57(60.0) Infiltrating type 26(6.5) 6(6.3) Histological type Mucinous carcinoma 31(7.6) 6(6.3) 0.196 0.654 Adenocarcinoma 375(92.4) 89(93.7) Infiltrative depth Mucosa / Submucosa 27(6.7) 5(5.3) 0.418 0.811 Superficial / deep muscle layer 57(14.0) 12(12.6) Fibrous/ membrane/outside 322(79.3) 78(82.1) Differentiation+ Well 46(11.3) 13(13.7) 0.355 0.837 Moderate 290(71.4) 67(70.5) Poor 39(9.6) 9(9.5) Lymph node metastasis 19(8.2) 6(10.3) 0.316 0.574 Intravascular tumor thrombus 174(42.9) 38(40.4) 0.150 0.698 T stage I + II 81(20.0) 15(15.8) 0.861 0.354 III + IV 325(80.0) 80(84.2) Annotation: *. There is 1 colorectal cancer with non-schistosome infection in total colon; +. mucinous carcinoma can not disdinguish difference differentiation degree . The results showed that the deposition of schistosomiasis eggs was mainly in the submucosa, which was not related to age. Colorectal cancer with schistosomiasis infection exhibited a higher prevalence in individuals older than 60 years, which was statistically significant compared with CRC group(P = 0.002). In terms of tumor location(P < 0.000), there was a statistically significant difference between the two groups. However, there was no significant difference between the two groups in tumor type, histological type, Infiltrative depth, degree of differentiation, lymph node metastasis, vascular tumor thrombus and TNM stage (P > 0.05). 2.3 Comparison of clinicopathological features of colorectal cancer with schistosomiasis infection in the Yangtze River Basin, China A comprehensive review of relevant literature using the keywords "colorectal cancer," "colon cancer," "rectal cancer," "clinicopathological features," and "schistosomiasis" was conducted by searching the CNKI, Wanfang, and PubMed databases. It was observed that the majority of research data originated from the lower reaches of the Yangtze River, while research in the middle and upper reaches remains scarce. The results of the researches are some differences, they are generalized in Table 2 . Table 2 Comparison of clinicopathological features of colorectal cancer with Schistosoma japonicum infection in the Yangtze River Basin of China Clinicopat-hological features 2023Wang el [ 9 ] 351/137 2017Liu JL el [ 10 ] 191/76 2020Wang ZJ el [ 11 – 12 ] 2885/253 2020Zhou WG el [ 13 ] 2885/253 2021Qin el [ 14 ] 992/248 Age < 60 P = 0.01 0.000 P = 0.002 P = 0.001 / Patients P = 0.008 0.173 P = 0.004 P = 0.0077 P = 0.017 Type / 0.087 / P = 0.6916 / Location P = 0.908 0.001 P = 0.349 / P < 0.001 Infiltrative depth / 0.000 / P = 0.0679 / Infiltrative depth / 0.205 / / / Differentiation P = 0.001 0.530 / P = 0.0349 / Lymph node metastasis P < 0.01 0.028 / P = 0.4734 / T stage P < 0.01 0.011 P = 0.001 P = 0.0403 / In terms of the age of tumor occurrence, existing statistically differences between colorectal cancer with schistosomiasis and non-schistosomiasis, aligning with the conclusions drawn in this paper. Both of them had statistical significance in T stage. Most of the literature advanced that schistosomal are deposited in the rectum and sigmoid colon, and this is related to the fact that colorectal cancer with schistosomal occurs more frequently in the rectum and sigmoid colon in text. Discussions 3.1 Clinical correlation analysis of schistosomiasis and colorectal cancer in the region The research is located in central China. Relative data indicates that the CRC-S group exhibits a minimum patient age of 46 years, while the CRC group shows a minimum age of only 26 years. This suggests that colorectal cancer with schistosomiasis infection is more likely to manifest in the elderly, consistent with ZB Liu et al [ 15 ] . A statistical distinction in the location of occurrence was observed between CRC-S and CRC-NS, with a higher likelihood of occurrence in the sigmoid colon and rectum, a trend consistent with the study conducted by Qin et al [ 14 ] . It may be relevant to the location of schistosomiasis egg deposition. Wang et al [ 16 ] brought to 7 studies by META analysis, indicating that there was no statistical difference between CRC-S and CRC in growth pattern and depth of invasion, which was consistent with the experimental data in this paper. Both are mainly moderately differentiated adenocarcinoma. However, Almoghrabi [ 17 ] studies suggested a close association between schistosomiasis infection and the high pathological stage and early lymph node metastasis of colorectal cancer in the elderly, indicating a distinct correlation. This study manifested that there were no statistical differences in pathological stage, lymph node metastasis and whether exist intravascular tumor thrombus. It is important to note that this study primarily focuses on the incidence of CRC-S patients in central China, thus there a certain geographical limitations. 3.2 C linicopathological features of colorectal cancer with S. japonicum infection in the Yangtze River Basin of China Up to 2003, five provinces (municipalities and autonomous regions) including Guangdong, Shanghai, Fujian, Guangxi and Zhejiang have declared the elimination of schistosomiasis [ 5 ] . More than half of counties(cities, districts)have reached the epidemic to block the spread, but there are still about 110 counties(cities, districts)are still in serious epidemic, accounting for 25.8% of the total [ 18 ] , mainly distributed in the lake area of 5 provinces along the lake beach and Sichuan, Yunnan provinces of the mountain. This paper integrates and summarizes relevant research on CRC-S in the Yangtze River Basin of China, incorporating findings from five selected articles. The majority of studies are concentrated in the lower reaches of the Yangtze River, including one article in Jiading District and Pudong District of Shanghai in the early years, as well as Wuhu area of Hubei Province representing the middle reaches of the Yangtze River. The area of Anhui Province is one of the most serious areas of schistosomiasis infection [ 8 ] . Therefore, most of the studies come from here. Contrasting conclusions emerge from various studies. Wang [ 11 , 12 ] and other studies have shown that chronic schistosomiasis infection is not correlated with the growth pattern, histological type, depth of invasion, or differentiation of colorectal cancer. Instead, it is linked primarily to age, gender, and pathological stage. Liu’s study [ 10 ] in Shanghai aligns with this, indicating a worse prognosis for colorectal cancer with schistosomiasis infection. Wang et al [ 9 ] showed that CRC-S had early lymph node metastasis and high pathological stage, while Liu et al [ 10 ] also indicate that it. They all suggest poor prognosis; there are also different conclusions in the two literatures. Liu et al [ 10 ] purported that CRC-SI is more likely to occur in the elderly over 60 years old, and it is more likely to occur in the rectum and sigmoid colon. Adenocarcinoma is more common, but there is no difference in the growth pattern between CRC-NS and CRC-S, which is contrary to the conclusion of Wang et al. However, Zhou Weigen et al [ 13 ] argue that schistosomiasis infection does not affect the pathological stage and lymph node metastasis of colorectal cancer but is associated with middle and low differentiation, which was different from the conclusions of previous studies. The presence of conflicting conclusions may stem from the influence the influence in the effectiveness of schistosomiasis prevention and control across different regions, or the impart of regional differences in epidemic control areas and epidemic blocking areas in the same region. In the middle reaches of the Yangtze River region, only one literature. Qin et al [ 14 ] studied the related intestinal lesions caused by schistosomiasis in Wuhan, Hubei Province, and finally concluded that female patients with schistosomiasis faced a higher risk of colorectal cancer. Across studies in the Yangtze River Basin, age consistently emerged as a crucial factor impacting colorectal cancer with schistosomiasis infection, aligning with the conclusions of this study. Different conclusions in clinicopathological features across studies may be attributed to geographical location, the amount of sample data studied, and the effect of schistosomiasis prevention and treatment. For example, there are variances between the epidemic control area and the epidemic blocking area in Wuhu, Anhui Province. Therefore, it remains to be further clarified whether chronic schistosomiasis infection affects the malignant biological behavior of colorectal cancer, so that the tumor has earlier lymph node metastasis and higher pathological stage, leading to poor prognosis in the Yangtze River Basin. 3.3 The relationship between schistosomiasis and colorectal cancer Similar to trends in other countries, the incidence and mortality of CRC are rising in China [19,20,21] . Controlling related risk factors can reduce mortality. However, as an infectious parasitic disease with specific local characteristics, the correlation between schistosomiasis and colorectal cancer is rarely studied [ 22 , 23 ] . In the study, the clinicopathological features of CRC-NS and CRC-S were studied in Central China and compared them with other schistosomiasis endemic areas of the Yangtze River Basin. The findings indicate that colorectal cancer patients with schistosomiasis infection are more likely to be elderly, aged over 60, and more common in the rectum and sigmoid colon in Central China, which may be related to the deposition of schistosomiasis eggs in colorectal cancer. Moreover, the longer the duration of schistosomiasis infection, the deeper the deposition of schistosomiasis eggs, thereby increasing the possibility of diverse tumor differentiations. This leads to the conclusion that CRC-S may be associated with the malignant biological behavior of tumors. However, it is still unclear whether affects schistosomiasis infection survival and prognosis. Further research needs multi-center big data analysis. Declarations Acknowledgements: Not applicable Funding: No funding was received Availability of data and materials: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate: Research performed on human subjects, materials or data must follow international and national regulations and be in agreement with the Declaration of Helsinki, or any other relevant set of ethical principles. This study was approved by the medical ethics committee of Jingzhou Hospital Affiliated to Yangtze University(ethical approval number 2023-106-01 ). Patient consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests, and all authors should confirm its accuracy. References Dekker E, Tanis PJ, Vleugels JLA, Kasi PM, Wallace MB:Colorectal cancer. Lancet 394:1467-1480,2019. Hatta MNA, Mohamad Hanif EA, Chin SF, Neoh HM:Pathogens and Carcinogenesis: A Review. Biology (Basel)10:533,2021. von Bülow V, Lichtenberger J, Grevelding CG, Falcone FH, Roeb E, Roderfeld M:Does Schistosoma Mansoni Facilitate Carcinogenesis? Cells10:1982, 2021. 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Cite Share Download PDF Status: Published Journal Publication published 25 Jul, 2024 Read the published version in BMC Infectious Diseases → Version 1 posted Editorial decision: Revision requested 22 Mar, 2024 Editor assigned by journal 22 Mar, 2024 Submission checks completed at journal 22 Mar, 2024 First submitted to journal 04 Mar, 2024 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. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-4014735","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":282800764,"identity":"4f1f3315-20ff-4d60-a7ec-b2bcafd62c0b","order_by":0,"name":"Yuanting Zhu","email":"","orcid":"","institution":"Jingzhou Hospital Affiliated to Yangtze University","correspondingAuthor":false,"prefix":"","firstName":"Yuanting","middleName":"","lastName":"Zhu","suffix":""},{"id":282800765,"identity":"9908e6bf-f78d-4c63-8326-f9381daa7609","order_by":1,"name":"Xiaoxue Wu","email":"","orcid":"","institution":"Jingzhou Hospital Affiliated to Yangtze 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submucosa.(HE×200)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4014735/v1/cf1d985c647a3dca4f51b5bd.png"},{"id":53581692,"identity":"7584a82c-5c13-4bbc-914e-152fc3adf442","added_by":"auto","created_at":"2024-03-27 17:37:07","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":336937,"visible":true,"origin":"","legend":"\u003cp\u003eSchistosomal ova in muscle layer:Schistosomal ova in the distal normal tissues after radical surgery of colorectal cancer,located in the muscle；In the slice,several Schistosomal ova shaped cavity because of calcification.(HE×200)\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4014735/v1/f0109e8209c47236529ad04e.png"},{"id":53581694,"identity":"58e0371c-e8fb-45b7-b649-153bc5851c15","added_by":"auto","created_at":"2024-03-27 17:37:07","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":347994,"visible":true,"origin":"","legend":"\u003cp\u003eSchistosomal ova in highly differentiated tumors:In conventional paraffin sections of the highly differentiated colorectal cancer,showed old calcified Schistosomal ova.(HE×200)\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4014735/v1/7df08aff89192fd2761ed835.png"},{"id":53581691,"identity":"545cf46e-0ba6-4dd9-adde-28f5f580524a","added_by":"auto","created_at":"2024-03-27 17:37:06","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":344969,"visible":true,"origin":"","legend":"\u003cp\u003eSchistosomal ova in poor differentiated tumors:In conventional paraffin sections of the poorly differentiated colorectal cancer,calcification Schistosomal ova surrounded the tumor tissue, with promoting fibrous connective tissue reaction and inflammatory cell infiltration such as eosinophils.(HE×200)\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-4014735/v1/caf957348d4a7762821f0d0b.png"},{"id":61596545,"identity":"aff8a980-2a64-48bf-8ad4-7dcabb0e542f","added_by":"auto","created_at":"2024-08-01 17:28:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1894696,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4014735/v1/cd6059a8-b7e7-484d-a11f-66101da46b68.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A retrospective cross-sectional study ： comparison of the clinicopathological features with schistosomal and non-schistosomal colorectal cancer in Central China","fulltext":[{"header":"Introduction","content":"\u003cp\u003eColorectal cancer ranks as the fourth most common cancer worldwide and stands as the second leading cause of death. The studies have shown that it is closely related to schistosomal infection \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Human schistosomiasis manifests in three main types: S.haematobium S.mansoni and S.japonicum \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e, mainly schistosomiasis japonica in China. It is a parasitic disease widely prevalent along the Yangtze River Basin. Since the mid-1980s, efforts to control schistosomiasis have evolved from population chemotherapy to infection source control, with notable progress observed post the completion of the Three Gorges Dam. In the past decade, the incidence of schistosomiasis has decreased by 88.46% from 2010 to 2021. As of the end of 2021 \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e, among the 451 schistosomiasis endemic counties (cities, districts) in China, 339 counties have achieved elimination standard, 100 counties have attained transmission-blocking standards, and 12 counties are in the stage of transmission control. Among them, the number of acute schistosomiasis cases has steeply declined \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. The existing patients primarily consist of advanced schistosomiasis cases (29,037 cases), chiefly concentrated in five provinces in the lake area(Hunan, Hubei, Jiangxi, Anhui, Jiangsu) \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAlthough the prevention and treatment of schistosomiasis has achieved remarkable results, the eggs still exert adverse effects on various organs after chronic schistosomiasis infection, particularly in the liver and intestine. Calcified schistosomiasis eggs are commonly observed in tissue sections of radical resection specimens from colorectal cancer patients in central China, it is also the evidence of chronic schistosomiasis infection. However, there are rarely reports regarding the clinicopathological characteristics of colorectal cancer patients with schistosoma infection in the central region, especially in comparison with other areas in the Yangtze River basin..\u003c/p\u003e \u003cp\u003eTherefore, the author collected samples from colorectal cancer patients in the Jingzhou area, analyzed their clinicopathological characteristics, and and compared them to data from the broader Yangtze River Basin. This study aims to elucidate the impact of chronic schistosomiasis japonicum infection on the clinicopathological features of colorectal cancer in the Yangtze River Basin.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Patients and samples\u003c/h2\u003e \u003cp\u003eA retrospective analysis was conducted on clinicopathological data and HE-stained slides of individuals diagnosed with schistosomal and non-schistosomal colorectal cancer from January 2020 to August 2022. Two expert pathologists reviewed HE-stained slides to determine the diagnosis and re-stage the cases according to the eighth edition of American Joint Committee on Cancer (AJCC).\u003c/p\u003e \u003cp\u003eAmong the cases analyzed, there were 99 cases of colorectal cancer with schistosomiasis (CRC-S group), comprising 65 males and 31 females. The male-to-female ratio within this group was 2.10:1, with ages ranging from 46 to 88 years and an average age of 66.03. In contrast, the non-schistosomal colorectal cancer group (CRC-NS) included 406 cases, consisting of 234 males and 172 females. The male-to-female ratio in this group was 1.41:1, with ages ranging from 26 to 92 years and an average age of 61.84. All patients had no history of preoperative chemoradiotherapy and related immunotherapy.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e1.2 Clinicopathological features Analysis\u003c/h2\u003e \u003cp\u003eThe clinicopathological features of the collected cases were thoroughly analyzed, including the following characteristics: tumor growth pattern(ulcer type, uplift type, infiltration type), growth sites(transverse colon, ascending colon, sigmoid colon and rectum). The depth of infiltration was divided into mucosa / submucosa, superficial / deep muscle layer and serosa (fibrous membrane)/outside. Histological type included adenocarcinoma (including tubular adenocarcinoma) and mucinous adenocarcinoma. The degree of differentiation was mainly divided into: low, moderate and high, according to the 2017 eighth edition of AJCC TNM stage. To enhance the comprehensiveness of the study, a comparative analysis was conducted with colorectal cancer featuring schistosomiasis infection reported in the literature in other parts of the Yangtze River Basin.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e1.3 Statistical analysis\u003c/h2\u003e \u003cp\u003eThe data were analyzed using SPSS software for Windows (version 25.0; IBM Corp). Enumeration data (%), the rate of comparison with chi-square test, test level α\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Morphological characteristics of schistosomiasis eggs in tissue slides\u003c/h2\u003e \u003cp\u003eUpon analyzing the pathological slides of 96 cases of CRC-S, the following characteristics were observed: schistosomiasis eggs can be deposited in various parts of the intestinal wall, mucosal layer (88 / 99), submucosa (96 / 99), muscular layer (8 / 99), and outer membrane layer (3 / 99) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e,\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Notably, calcified schistosomiasis eggs were found in the submucosa of all lesions.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eMost of the calcified schistosomiasis eggs were morphologically intact, showing a basophilic oval nodule measuring 0.45\u0026thinsp;~\u0026thinsp;0.5 mm. However, a few eggs were damaged during the preparation of tissue slides. Vascular proliferation and lymphocyte aggregation were observed around nearly all eggs, although interstitial reactions were not common. Interestingly, interstitial reactions were more easily observed in eggs deposited around tumor cells.\u003c/p\u003e \u003cp\u003eMicroscopic examination revealed that different deposition sites of schistosomiasis eggs had diverse degrees of differentiation of tumors. The deeper the deposition site of schistosomiasis eggs, the lower the degree of differentiation(10/9); in the same specimen, diverse degrees of tumor differentiation can be observed in the presence or absence of schistosomiasis egg deposition (5/ 99). (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e,\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e: Calcified schistosomal egg deposition can be seen in adenocarcinoma slides with different degrees of differentiation)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Clinicopathological features of colorectal cancer with schistosomiasis Infection\u003c/h2\u003e \u003cp\u003eThe clinicopathological features of the cohort have been summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\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\u003eClinicopathological features of colorectal cancer with schistosome infection\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinicopathol-ogical features\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCRC(n\u0026thinsp;=\u0026thinsp;406)\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCRC-SI(n\u0026thinsp;=\u0026thinsp;95)n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e178(43.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25(26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e9.912\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e228(56.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70(73.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e234(57.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65(68.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3.722\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e172(42.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30(31.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocation*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransverse colon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34(8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14(14.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e28.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAscending colon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e114(28.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8(8.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDescending colon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35(8.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21(22.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSigmoid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e117(28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29(30.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRectum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e105(25.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23(24.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElevated type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e174(42.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32(33.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2.834\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.242\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUlceration type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e206(51.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57(60.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfiltrating type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26(6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(6.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistological type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMucinous carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31(7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.654\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e375(92.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89(93.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfiltrative depth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMucosa / Submucosa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27(6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5(5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.418\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.811\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuperficial / deep muscle layer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57(14.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12(12.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFibrous/ membrane/outside\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e322(79.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78(82.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifferentiation+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWell\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e46(11.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13(13.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.355\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.837\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e290(71.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67(70.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39(9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9(9.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymph node metastasis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19(8.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.316\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.574\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntravascular tumor thrombus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e174(42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38(40.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.698\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI\u0026thinsp;+\u0026thinsp;II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e81(20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15(15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.861\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.354\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII\u0026thinsp;+\u0026thinsp;IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e325(80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80(84.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eAnnotation:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e*. There is 1 colorectal cancer with non-schistosome infection in total colon;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e+. mucinous carcinoma can not disdinguish difference differentiation degree .\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe results showed that the deposition of schistosomiasis eggs was mainly in the submucosa, which was not related to age. Colorectal cancer with schistosomiasis infection exhibited a higher prevalence in individuals older than 60 years, which was statistically significant compared with CRC group(P\u0026thinsp;=\u0026thinsp;0.002). In terms of tumor location(P\u0026thinsp;\u0026lt;\u0026thinsp;0.000), there was a statistically significant difference between the two groups. However, there was no significant difference between the two groups in tumor type, histological type, Infiltrative depth, degree of differentiation, lymph node metastasis, vascular tumor thrombus and TNM stage (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cb\u003e2.3 Comparison of clinicopathological features of colorectal cancer with schistosomiasis infection in the Yangtze River Basin, China\u003c/b\u003e \u003c/p\u003e \u003cp\u003e A comprehensive review of relevant literature using the keywords \"colorectal cancer,\" \"colon cancer,\" \"rectal cancer,\" \"clinicopathological features,\" and \"schistosomiasis\" was conducted by searching the CNKI, Wanfang, and PubMed databases. It was observed that the majority of research data originated from the lower reaches of the Yangtze River, while research in the middle and upper reaches remains scarce. The results of the researches are some differences, they are generalized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of clinicopathological features of colorectal cancer with Schistosoma japonicum infection in the Yangtze River Basin of China\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinicopat-hological features\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2023Wang el\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e351/137\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2017Liu JL el\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e191/76\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2020Wang ZJ el\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e2885/253\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2020Zhou WG el\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e2885/253\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2021Qin el\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e992/248\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u0026thinsp;\u0026lt;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.0077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.6916\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.908\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.349\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfiltrative depth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.0679\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfiltrative depth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifferentiation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.530\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.0349\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymph node metastasis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.4734\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.0403\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\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\u003eIn terms of the age of tumor occurrence, existing statistically differences between colorectal cancer with schistosomiasis and non-schistosomiasis, aligning with the conclusions drawn in this paper. Both of them had statistical significance in T stage. Most of the literature advanced that schistosomal are deposited in the rectum and sigmoid colon, and this is related to the fact that colorectal cancer with schistosomal occurs more frequently in the rectum and sigmoid colon in text.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussions","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Clinical correlation analysis of schistosomiasis and colorectal cancer in the region\u003c/h2\u003e \u003cp\u003eThe research is located in central China. Relative data indicates that the CRC-S group exhibits a minimum patient age of 46 years, while the CRC group shows a minimum age of only 26 years. This suggests that colorectal cancer with schistosomiasis infection is more likely to manifest in the elderly, consistent with ZB Liu et al \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. A statistical distinction in the location of occurrence was observed between CRC-S and CRC-NS, with a higher likelihood of occurrence in the sigmoid colon and rectum, a trend consistent with the study conducted by Qin et al \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. It may be relevant to the location of schistosomiasis egg deposition. Wang et al \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e brought to 7 studies by META analysis, indicating that there was no statistical difference between CRC-S and CRC in growth pattern and depth of invasion, which was consistent with the experimental data in this paper. Both are mainly moderately differentiated adenocarcinoma. However, Almoghrabi \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e studies suggested a close association between schistosomiasis infection and the high pathological stage and early lymph node metastasis of colorectal cancer in the elderly, indicating a distinct correlation. This study manifested that there were no statistical differences in pathological stage, lymph node metastasis and whether exist intravascular tumor thrombus.\u003c/p\u003e \u003cp\u003eIt is important to note that this study primarily focuses on the incidence of CRC-S patients in central China, thus there a certain geographical limitations.\u003c/p\u003e \u003cp\u003e3.2 C\u003cb\u003elinicopathological features of colorectal cancer with S. japonicum infection in the Yangtze River Basin of China\u003c/b\u003e\u003c/p\u003e \u003cp\u003eUp to 2003, five provinces (municipalities and autonomous regions) including Guangdong, Shanghai, Fujian, Guangxi and Zhejiang have declared the elimination of schistosomiasis \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. More than half of counties(cities, districts)have reached the epidemic to block the spread, but there are still about 110 counties(cities, districts)are still in serious epidemic, accounting for 25.8% of the total \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e, mainly distributed in the lake area of 5 provinces along the lake beach and Sichuan, Yunnan provinces of the mountain.\u003c/p\u003e \u003cp\u003eThis paper integrates and summarizes relevant research on CRC-S in the Yangtze River Basin of China, incorporating findings from five selected articles. The majority of studies are concentrated in the lower reaches of the Yangtze River, including one article in Jiading District and Pudong District of Shanghai in the early years, as well as Wuhu area of Hubei Province representing the middle reaches of the Yangtze River. The area of Anhui Province is one of the most serious areas of schistosomiasis infection \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. Therefore, most of the studies come from here.\u003c/p\u003e \u003cp\u003eContrasting conclusions emerge from various studies. Wang \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e and other studies have shown that chronic schistosomiasis infection is not correlated with the growth pattern, histological type, depth of invasion, or differentiation of colorectal cancer. Instead, it is linked primarily to age, gender, and pathological stage. Liu\u0026rsquo;s study \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e in Shanghai aligns with this, indicating a worse prognosis for colorectal cancer with schistosomiasis infection. Wang et al \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e showed that CRC-S had early lymph node metastasis and high pathological stage, while Liu et al \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e also indicate that it. They all suggest poor prognosis; there are also different conclusions in the two literatures. Liu et al \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e purported that CRC-SI is more likely to occur in the elderly over 60 years old, and it is more likely to occur in the rectum and sigmoid colon. Adenocarcinoma is more common, but there is no difference in the growth pattern between CRC-NS and CRC-S, which is contrary to the conclusion of Wang et al. However, Zhou Weigen et al \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e argue that schistosomiasis infection does not affect the pathological stage and lymph node metastasis of colorectal cancer but is associated with middle and low differentiation, which was different from the conclusions of previous studies.\u003c/p\u003e \u003cp\u003eThe presence of conflicting conclusions may stem from the influence the influence in the effectiveness of schistosomiasis prevention and control across different regions, or the impart of regional differences in epidemic control areas and epidemic blocking areas in the same region.\u003c/p\u003e \u003cp\u003eIn the middle reaches of the Yangtze River region, only one literature. Qin et al \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e studied the related intestinal lesions caused by schistosomiasis in Wuhan, Hubei Province, and finally concluded that female patients with schistosomiasis faced a higher risk of colorectal cancer. Across studies in the Yangtze River Basin, age consistently emerged as a crucial factor impacting colorectal cancer with schistosomiasis infection, aligning with the conclusions of this study.\u003c/p\u003e \u003cp\u003eDifferent conclusions in clinicopathological features across studies may be attributed to geographical location, the amount of sample data studied, and the effect of schistosomiasis prevention and treatment. For example, there are variances between the epidemic control area and the epidemic blocking area in Wuhu, Anhui Province. Therefore, it remains to be further clarified whether chronic schistosomiasis infection affects the malignant biological behavior of colorectal cancer, so that the tumor has earlier lymph node metastasis and higher pathological stage, leading to poor prognosis in the Yangtze River Basin.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.3 The relationship between schistosomiasis and colorectal cancer\u003c/h2\u003e \u003cp\u003eSimilar to trends in other countries, the incidence and mortality of CRC are rising in China \u003csup\u003e[19,20,21]\u003c/sup\u003e. Controlling related risk factors can reduce mortality. However, as an infectious parasitic disease with specific local characteristics, the correlation between schistosomiasis and colorectal cancer is rarely studied \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn the study, the clinicopathological features of CRC-NS and CRC-S were studied in Central China and compared them with other schistosomiasis endemic areas of the Yangtze River Basin. The findings indicate that colorectal cancer patients with schistosomiasis infection are more likely to be elderly, aged over 60, and more common in the rectum and sigmoid colon in Central China, which may be related to the deposition of schistosomiasis eggs in colorectal cancer. Moreover, the longer the duration of schistosomiasis infection, the deeper the deposition of schistosomiasis eggs, thereby increasing the possibility of diverse tumor differentiations. This leads to the conclusion that CRC-S may be associated with the malignant biological behavior of tumors. However, it is still unclear whether affects schistosomiasis infection survival and prognosis. Further research needs multi-center big data analysis.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003eNo funding was received\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003eResearch performed on human subjects, materials or data must follow international and national regulations and be in agreement with the Declaration of Helsinki, or any other relevant set of ethical principles. This study was approved by the medical ethics committee of Jingzhou Hospital Affiliated to Yangtze University(ethical approval number 2023-106-01 ).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient consent for publication:\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003eThe authors declare that they have no competing interests, and all authors should confirm its accuracy.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDekker E, Tanis PJ, Vleugels JLA, Kasi PM, Wallace MB:Colorectal cancer. Lancet 394:1467-1480,2019.\u003c/li\u003e\n\u003cli\u003eHatta MNA, Mohamad Hanif EA, Chin SF, Neoh HM:Pathogens and Carcinogenesis: A Review. Biology (Basel)10:533,2021. \u003c/li\u003e\n\u003cli\u003evon B\u0026uuml;low V, Lichtenberger J, Grevelding CG, Falcone FH, Roeb E, Roderfeld M:Does Schistosoma Mansoni Facilitate Carcinogenesis? Cells10:1982, 2021.\u003c/li\u003e\n\u003cli\u003eJain S, Rana M, Choubey P, Kumar S: Schistosoma japonicum Associated Colorectal Cancer and Its Management. Acta Parasitol.2023 \u003c/li\u003e\n\u003cli\u003ePan L, Zhu H, Qian Y, Deng Y, Yang K: Publication and citation analyses of Chinese Journal of Schistosomiasis Control from 2011 to 2020. Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi35:86-91,2023. \u003c/li\u003e\n\u003cli\u003eZhang LJ, Xu ZM, Yang F, He JY, Dang H, Li YL, Cao CL, Xu J, Li SZ, Zhou XN: Progress of schistosomiasis control in People\u0026apos;s Republic of China in 2021. Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi4:329-336,2022 . \u003c/li\u003e\n\u003cli\u003eXu J, Cao CL, L\u0026uuml; S, Li SZ, Zhou XN. 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World J Surg Oncol18:149,2020 .\u003c/li\u003e\n\u003cli\u003eLiu JL,Li J,Chen J el:Clinical pathological characteristics of colorectal carcinoma with schistosomiasis:Journal of Tropical Medicine17:1301-1303+1430,2017.\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. Oncol Lett19:2375-2383, 2020. \u003c/li\u003e\n\u003cli\u003eWang Z, Du Z, Sheng H, Xu X, Wang W, Yang J, Sun J, Yang J: Polarization of intestinal tumour-associated macrophages regulates the development of schistosomal colorectal cancer. Cancer12:1033-1041,2021. \u003c/li\u003e\n\u003cli\u003eZhou WG: Analysis of clinicopathological features of schistosomiasis ovum deposited colorectal cancer[D]:Wannan medical college,2021.\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 Gastroenterol 21:12,2021.\u003c/li\u003e\n\u003cli\u003eLiu ZB,Wang L,Yang Y:Colorectal carcinoma with schistosomiasis among elderly people in the district of petrochemical industry in Shanghai: Analysis of clinical pathological characteristics and prognosis.Chinese Journal of Geriatrics30:836-838,2011.\u003c/li\u003e\n\u003cli\u003eWang YB: Correlation between schistosomiasis and clinicopathological features of colorectal cancer[D].Nanchang college.2021.\u003c/li\u003e\n\u003cli\u003eAlmoghrabi A, Mzaik O, Attar B: Schistosoma japonicum Associated With Colorectal Cancer. ACG Case Rep8:e00572,2021 .\u003c/li\u003e\n\u003cli\u003eWang XN:Investigation Report on Schistosomiasis Control in the Yangtze River Basin of Anhui Province.China development22:46-50,2022.\u003c/li\u003e\n\u003cli\u003eSung H, Ferlay J, Siegel RL: Laversanne M, Soerjomataram I, Jemal A, Bray F:Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin71:209-249,2021. \u003c/li\u003e\n\u003cli\u003eErratum: Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin70:313,2020. \u003c/li\u003e\n\u003cli\u003eZhang Y, Rumgay H, Li M, Cao S, Chen W: Nasopharyngeal Cancer Incidence and Mortality in 185 Countries in 2020 and the Projected Burden in 2040: Population-Based Global Epidemiological Profiling. JMIR Public Health Surveill9:e49968, 2023. \u003c/li\u003e\n\u003cli\u003eHamid HKS：Schistosoma japonicum-Associated Colorectal Cancer: A Review. Am J Trop Med Hyg100:501-505，2019.\u003c/li\u003e\n\u003cli\u003eWang W, Zhang Y, Liu J, Jing H, Lu K, Wang L, Zhu T, Xu Y, Bu D, Cheng M, Liu J, Shen W, Yao J, Huang S: Comparison of the prognostic value of stromal tumor-infiltrating lymphocytes and CD3\u0026thinsp;+\u0026thinsp;T cells between schistosomal and non-schistosomal colorectal cancer. World J Surg Oncol21:31，2023. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Schistosomiasis, colorectal cancer, clinicopathological characteristics, Central China","lastPublishedDoi":"10.21203/rs.3.rs-4014735/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4014735/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eTo analyze the clinicopathological features of schistosomal and non-schistosomal colorectal cancer in Central China and compare them with other areas of the Yangtze River Basin.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eThe 501 cases of CRC were retrospectively analyzed from 2020 to 2022. They were divided into two groups: 406 cases of colorectal cancer without schistosomiasis (CRC-NS) and 95 cases of colorectal cancer with schistosomiasis (CRC-S). The clinicopathological characteristics included the distribution of schistosomiasis eggs, patient age, sex, tumor differentiation, lymph node metastasis, and clinical stage, etc. By retrieving the database, we compared the clinicopathological differences of colorectal cancer with schistosomiasis in other areas of the Yangtze River basin.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eColorectal cancer with schistosomiasis infection accounted for 18.9%. CRC-S patients were significantly older than CRC-NS patients (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There was a statistical difference in the location of occurrence (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) between the two groups. There were no significant differences between CRC-S and CRC-NS patients in other clinicopathological features (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). In other areas of the Yangtze River Basin, there were statistical differences in the age of occurrence and T stage (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) between colorectal cancer with schistosomiasis and non-schistosomal colorectal cancer.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIn Central China, colorectal cancer with chronic schistosomiasis infection occurs more in the rectum and sigmoid colon. It is more common in individuals over 60 years old, consistent with the findings in the Yangtze River Basin. Additionally, schistosomal colorectal cancer had a higher TNM stage in the Yangtze River Basin. This may be related to the malignant biological behavior of colorectal cancer and could result in a relatively poor prognosis. Therefore, the elderly population in schistosomiasis endemic areas should pay more attention to early screening and tumor prevention.\u003c/p\u003e","manuscriptTitle":"A retrospective cross-sectional study ： comparison of the clinicopathological features with schistosomal and non-schistosomal colorectal cancer in Central China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-27 17:37:01","doi":"10.21203/rs.3.rs-4014735/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-03-22T16:54:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-22T16:37:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-22T16:33:46+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2024-03-05T01:16:34+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"114e3dd7-692a-486e-a3cd-5610243e8f0a","owner":[],"postedDate":"March 27th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-08-01T17:11:40+00:00","versionOfRecord":{"articleIdentity":"rs-4014735","link":"https://doi.org/10.1186/s12879-024-09648-8","journal":{"identity":"bmc-infectious-diseases","isVorOnly":false,"title":"BMC Infectious Diseases"},"publishedOn":"2024-07-25 16:16:10","publishedOnDateReadable":"July 25th, 2024"},"versionCreatedAt":"2024-03-27 17:37:01","video":"","vorDoi":"10.1186/s12879-024-09648-8","vorDoiUrl":"https://doi.org/10.1186/s12879-024-09648-8","workflowStages":[]},"version":"v1","identity":"rs-4014735","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4014735","identity":"rs-4014735","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}