Benedix Frank, Kube Rainer, Meyer Frank, Schmidt Uwe, Gastinger Ingo, Lippert Hans
Department of General, Visceral and Vascular Surgery, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
Dis Colon Rectum. 2010 Jan;53(1):57-64. doi: 10.1007/DCR.0b013e3181c703a4.
There is a growing amount of data suggesting that carcinomas of the right and left colon should be considered as different tumor entities. Using the data and analysis compiled in the German multicentered study "Colon/Rectum Cancer," we aimed to clarify whether the existing differences influence clinical and histological parameters, the perioperative course, and the survival of patients with right- vs left-sided colon cancer.
During a 3-year period data on all patients with colon cancer were evaluated. Right- and left-sided cancers were compared regarding the following parameters: demographic factors, comorbidities, and histology. For patients who underwent elective surgery with curative intent, the perioperative course and survival were also analyzed.
A total of 17,641 patients with colon carcinomas were included; 12,719 underwent curative surgery. Patients with right-sided colon cancer were significantly older, and predominantly women with a higher rate of comorbidities. Mortality was significantly higher for this group. Final pathology revealed a higher percentage of poorly differentiated and locally advanced tumors. Rate of synchronous distant metastases was comparable. However, hepatic and pulmonary metastases were more frequently found in left-sided, peritoneal carcinomatosis in right-sided carcinomas. Survival was significantly worse in patients with right-sided carcinomas on an adjusted multivariate model (odds ratio, 1.12).
We found that right- and left-sided colon cancers are significantly different regarding epidemiological, clinical, and histological parameters. Patients with right-sided colon cancers have a worse prognosis. These discrepancies may be caused by genetic differences that account for distinct carcinogenesis and biological behavior. The impact of these findings on screening and therapy remains to be defined.
越来越多的数据表明，右半结肠癌和左半结肠癌应被视为不同的肿瘤实体。利用德国多中心研究“结肠癌/直肠癌”汇编的数据和分析，我们旨在阐明现有的差异是否会影响临床和组织学参数、围手术期过程以及右半结肠癌与左半结肠癌患者的生存率。
在3年期间，对所有结肠癌患者的数据进行了评估。比较了右半结肠癌和左半结肠癌在以下参数方面的情况：人口统计学因素、合并症和组织学。对于接受根治性择期手术的患者，还分析了围手术期过程和生存率。
共纳入17641例结肠癌患者；12719例接受了根治性手术。右半结肠癌患者年龄明显更大，且以女性为主，合并症发生率更高。该组患者的死亡率明显更高。最终病理显示低分化和局部晚期肿瘤的比例更高。同时性远处转移率相当。然而，左侧结肠癌更常发生肝转移和肺转移，右侧结肠癌更常发生腹膜种植转移。在调整后的多变量模型中，右半结肠癌患者的生存率明显更差（优势比，1.12）。
我们发现右半结肠癌和左半结肠癌在流行病学、临床和组织学参数方面存在显著差异。右半结肠癌患者的预后更差。这些差异可能是由导致不同致癌机制和生物学行为的基因差异引起的。这些发现对筛查和治疗的影响仍有待确定。
