Objective To summarize the key roles of cancer-associated fibroblasts (CAFs) in the pathogenesis, development, therapeutic resistance, and immune microenvironment modulation of colorectal cancer (CRC). MethodsThrough a systematic review of existing literature, this article summarizes the origin and heterogeneity of CAFs, their mechanisms of action in CRC occurrence and progression, and reviews potential CAFs-targeting therapeutic strategies. ResultsCAFs are heterogeneous with respect to both origin and function. As a critical ingredient in tumor microenvironment, CAFs drive CRC progression by promoting tumor proliferation, invasion, metastasis, angiogenesis. CAFs can mediate therapy resistance by regulating cancer stem cell properties and suppress antitumor immunity by regulating immune checkpoint molecules. Targeting specific CAFs subsets or their key signaling pathways demonstrat tumor-suppressive effects. ConclusionsCAFs are key regulators of CRC progression. Developing targeted therapeutic strategies against their origins, heterogeneity, and functional mechanisms holds the potential to providing new directions in CRC treatment.
ObjectiveTo compare the outcomes following emergency surgery or conservative treatment for patients with acute type A aortic intramural hematoma (IMH).MethodsClinical data of consecutive patients diagnosed with acute type A aortic IMH in our hospital from September 2014 to December 2018 were retrospectively analyzed. The patients who met our surgical indications received surgery (an operation group) and other patients received strict conservative treatment (a conservative treatment group).ResultsFinally 127 patients were enrolled, including 112 males and 15 females with an average age of 53.6±13.0 years. Of 127 patients, 85 (66.9%) patients accepted emergency surgery and 42 (33.1%) patients accepted strict conservative treatment. There was no difference between the two groups in early mortality or complications (P＞0.05). The 5-year survival rate was 90.4% in the operation group and 74.3% in the conservative treatment group (P=0.010). A maximum aortic diameter in the ascending aorta and aortic arch≥45 mm and maximum thickness of IMH in the same section≥8 mm were risk factors for IMH-related death in patients undergoing conservative treatment (P＜0.001).ConclusionThe mortality associated with emergency surgery for patients with acute type A aortic IMH is satisfactory. In clinical centers with well-established surgical techniques and postoperative management, emergency surgical treatment may provide a better outcome than conservative treatment for patients with acute type A aortic IMH.
