肿瘤位置对结直肠癌组织病理学表现的影响。

The impact of tumor location on the histopathologic expression of colorectal cancer.

作者信息

Papagiorgis P, Oikonomakis I, Karapanagiotou I, Wexner S D, Nikiteas N

机构信息

Department of Surgery, Athens Medical Center, Athens, Greece.

出版信息

J BUON. 2006 Jul-Sep;11(3):317-21.

PMID:17309156

Abstract

PURPOSE

Cancer of the colon and rectum has been classically viewed as the same disease entity. However, there are some differences both in the clinical features and gross macroscopic pathology between right and left sided colonic malignancies. Furthermore, recent research has added much controversy on the issue by demonstrating quite a few differences, mostly in the field of molecular biology. Since tumor pathology and staging is the major determinant of the disease outcome, comparison of these parameters between right and left colon cancer is reasonably expected to contribute to a better understanding of the nature of the adenocarcinoma of the colon.

PATIENTS AND METHODS

A retrospective review of the charts of patients with colorectal cancer operated on at the Cleveland Clinic Florida from March 1996 to April 2000 was conducted. Patients were divided into two groups according to the location of the tumor (right or left colon) and pathology between the two groups was compared.

RESULTS

One hundred and eighty-four patients were included in the study. Sixty individuals had right colon cancer, while 124 subjects had left colon lesions. Dukes' A (stage I) colon cancer had statistically significant higher incidence in left colon lesions (p=0.0084). Conversely, Dukes' C(stage III) tumors presented more often in the right colon (p=0.029). Grade III lesions showed a clear superiority for the right colon (p=0.0014), while grade II lesions were more commonly found in the left colon (p=0.0201). Grade III lesions were more common in the right colon (p=0.0200) when early colonic cancers (stage 0,I and II pooled together) were compared.

CONCLUSION

A shift in severity towards the right colon has been documented both in terms of stage and grade. These results should be viewed in the light of recent research data suggesting a different molecular biology pattern between right and left colonic tumors. The clinical implications of these differences, if any, and their impact on the patient management remain to be determined.

摘要

目的

传统上认为结肠癌和直肠癌是同一疾病实体。然而，右侧和左侧结肠恶性肿瘤在临床特征和大体宏观病理学方面存在一些差异。此外，最近的研究通过揭示相当多的差异，主要是在分子生物学领域，给这个问题增添了诸多争议。由于肿瘤病理学和分期是疾病预后的主要决定因素，比较右侧和左侧结肠癌的这些参数有望有助于更好地理解结肠腺癌的本质。

患者与方法

对1996年3月至2000年4月在佛罗里达克利夫兰诊所接受手术的结直肠癌患者病历进行回顾性研究。根据肿瘤位置（右结肠或左结肠）将患者分为两组，并比较两组之间的病理学情况。

结果

184名患者纳入研究。60人患有右结肠癌，124人患有左结肠病变。Dukes' A（I期）结肠癌在左结肠病变中的发生率在统计学上显著更高（p = 0.0084）。相反，Dukes' C（III期）肿瘤在右结肠中更常见（p = 0.029）。III级病变在右结肠中表现出明显优势（p = 0.0014），而II级病变在左结肠中更常见（p = 0.0201）。在比较早期结肠癌（0期、I期和II期合并）时，III级病变在右结肠中更常见（p = 0.0200）。