Department of Surgery, Teikyo University, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
Int J Colorectal Dis. 2012 Mar;27(3):371-9. doi: 10.1007/s00384-011-1343-0. Epub 2011 Nov 4.
Cancers which arise in the proximal and distal colon are suggested to be different clinically, pathologically, and genetically. The aim of this study is to clarify whether clinical behavior of colonic poorly differentiated adenocarcinoma, mucinous adenocarcinoma, and signet-cell carcinoma (Por/Muc/Sig cancers), minor and aggressive subpopulation in colonic cancers, differs in accordance with the tumor location.
A total of 3,175 patients with curatively resected colonic cancers were studied. Clinical and pathological features were compared between Por/Muc/Sig cancers and well or moderately differentiated adenocarcinomas (Wel/Mod cancers) and between proximal and distal cancers in each histologic type.
Por/Muc/Sig cancers (n = 213) were more advanced in the TNM stage and showed worse disease-specific survival than Wel/Mod cancers (n = 2,692). In Por/Muc/Sig cancers, but not in Wel/Mod cancers, proximal cancers showed significantly better disease-specific survival than distal cancers (88.9% vs. 76.5%, p = 0.0234), and a multivariate analysis showed that proximal tumor location was an independent predictor of fair prognosis (hazard ratio (HR), 0.458; 95% confidence interval (CI), 0.218-0.961; p = 0.0390). In addition, female gender also was an independent predictor of fair prognosis in Por/Muc/Sig cancers (HR, 0.373; 95% CI, 0.151-0.922) and not in Wel/Mod cancers.
Proximal Por/Muc/Sig cancers were suggested to be a distinct subpopulation with a favorable oncologic outcome. Tumor location and gender might be helpful in the risk stratification after curative surgery for Por/Muc/Sig cancers.
近端和远端结肠癌在临床上、病理学和遗传学上均有所不同。本研究旨在阐明结直肠分化不良腺癌、黏液腺癌和印戒细胞癌（Por/Muc/Sig 癌）、结直肠癌中较小和侵袭性亚群的临床行为是否因肿瘤位置而异。
共研究了 3175 例可治愈性切除的结直肠癌患者。比较了 Por/Muc/Sig 癌与分化良好或中等腺癌（Wel/Mod 癌）以及每种组织学类型近端和远端癌症之间的临床和病理特征。
Por/Muc/Sig 癌（n=213）在 TNM 分期中更为晚期，疾病特异性生存率较 Wel/Mod 癌（n=2692）差。在 Por/Muc/Sig 癌中，但不在 Wel/Mod 癌中，近端癌症的疾病特异性生存率显著优于远端癌症（88.9% vs. 76.5%，p=0.0234），多变量分析显示近端肿瘤位置是预后良好的独立预测因素（风险比（HR），0.458；95%置信区间（CI），0.218-0.961；p=0.0390）。此外，女性也是 Por/Muc/Sig 癌预后良好的独立预测因素（HR，0.373；95%CI，0.151-0.922），但不是在 Wel/Mod 癌中。
近端 Por/Muc/Sig 癌被认为是具有良好肿瘤学结局的一个独特亚群。肿瘤位置和性别可能有助于对 Por/Muc/Sig 癌进行根治性手术后的风险分层。
