Department of Surgery, Roskilde Hospital, Roskilde, Denmark.
BMJ Open. 2013 May 28;3(5):e002608. doi: 10.1136/bmjopen-2013-002608.
The categorisation of colon cancer (CC) into right-sided (RCC) and left-sided (LCC) disease may not capture more subtle variances in aetiology and prognosis. In a nationwide study, we investigated differences in clinical characteristics and survival of RCC versus LCC and of the complete range of CC subsites.
Prospective nationwide cohort study.
The database of the Danish Colorectal Cancer Group (DCCG).
23 487 CC patients.
Overall survival (Kaplan-Meier plots) and mortality (HR from Cox proportional hazards regression analysis) according to CC localisation. For adjustment and stratification, we used age, sex, ASA score (the American Society of Anaesthesiologists score), tumour location and stage, number of lymph nodes harvested at operation, number of lymph nodes with metastases and presence of distant metastases.
Patients with RCC had a higher median age at diagnosis (74.3 years) than patients with LCC (71.8 years; p<0.0001). Overall, the proportion of patients who were women increased the closer the tumour site was to the small intestine. Although RCC patients had higher ASA scores than LCC patients (p<0.0001), the highest ASA scores were observed in patients with cancer in the transverse and descending colon and at both colon flexures. While RCCs overall were more advanced than LCCs (p<0.0001), the most advanced CCs were those of the descending colon, splenic flexure and caecum. RCC mortality was higher than LCC mortality only during the first 2 years (women: HR 1.13; 95% CI 1.06 to 1.20; men: HR 1.27; 95% CI 1.20 to 1.35), and relative to mortality from sigmoid CC, the highest mortality was observed from splenic flexure cancer (HR 1.75; 95% CI 1.54 to 2.00).
The present data challenge the simple categorisation of CC into RCC and LCC.
将结肠癌（CC）分为右侧（RCC）和左侧（LCC）疾病可能无法捕捉到发病机制和预后方面更细微的差异。在一项全国性研究中，我们研究了 RCC 与 LCC 以及 CC 所有亚部位之间的临床特征和生存差异。
前瞻性全国性队列研究。
丹麦结直肠癌组（DCCG）数据库。
23487 例 CC 患者。
根据 CC 定位的总体生存率（Kaplan-Meier 图）和死亡率（Cox 比例风险回归分析的 HR）。为了调整和分层，我们使用了年龄、性别、ASA 评分（美国麻醉师协会评分）、肿瘤位置和分期、手术时采集的淋巴结数量、有转移的淋巴结数量和远处转移的存在。
RCC 患者的诊断中位年龄（74.3 岁）高于 LCC 患者（71.8 岁；p<0.0001）。总体而言，肿瘤位置越靠近小肠，女性患者的比例越高。尽管 RCC 患者的 ASA 评分高于 LCC 患者（p<0.0001），但最高的 ASA 评分出现在横结肠和降结肠癌以及两个结肠弯曲处的患者中。虽然 RCC 总体上比 LCC 更晚期（p<0.0001），但最晚期的 CC 是降结肠癌、脾曲和盲肠。RCC 死亡率仅在最初 2 年内高于 LCC 死亡率（女性：HR 1.13；95%CI 1.06 至 1.20；男性：HR 1.27；95%CI 1.20 至 1.35），与乙状结肠癌的死亡率相比，脾曲癌的死亡率最高（HR 1.75；95%CI 1.54 至 2.00）。
目前的数据对将 CC 简单地分为 RCC 和 LCC 提出了挑战。
