Shen Hong, Yang Jiao, Huang Qing, Jiang Meng-Jie, Tan Yi-Nuo, Fu Jian-Fei, Zhu Li-Zhen, Fang Xue-Feng, Yuan Ying
Hong Shen, Jiao Yang, Qing Huang, Meng-Jie Jiang, Yi-Nuo Tan, Jian-Fei Fu, Li-Zhen Zhu, Xue-Feng Fang, Ying Yuan, Department of Medical Oncology, 2 Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China.
World J Gastroenterol. 2015 Jun 7;21(21):6470-8. doi: 10.3748/wjg.v21.i21.6470.
The colon is derived from the embryological midgut and hindgut separately, with the right colon and left colon having different features with regards to both anatomical and physiological characteristics. Cancers located in the right and left colon are referred to as right colon cancer (RCC) and left colon cancer (LCC), respectively, based on their apparent anatomical positions. Increasing evidence supports the notion that not only are there differences in treatment strategies when dealing with RCC and LCC, but molecular features also vary between them, not to mention the distinguishing clinical manifestations. Disease-free survival after radical surgery of both RCC and LCC are similar. In the treatment of RCC, the benefit gained from adjuvant FOLFIRI chemotherapy is superior, or at least similar, to LCC, but inferior to LCC if FOLFOX regimen is applied. On the other hand, metastatic LCC exhibits longer survival than that of RCC in a palliative chemotherapy setting. For KRAS wild-type cancers, LCC benefits more from cetuximab treatment than RCC. Moreover, advanced LCC shows a higher sensitivity to bevacizumab treatment in comparison with advanced RCC. Significant varieties exist at the molecular level between RCC and LCC, which may serve as the cause of all apparent differences. With respect to carcinogenesis mechanisms, RCC is associated with known gene types, such as MMR, KRAS, BRAF, and miRNA-31, while LCC is associated with CIN, p53, NRAS, miRNA-146a, miRNA-147b, and miRNA-1288. Regarding protein expression, RCC is related to GNAS, NQO1, telomerase activity, P-PDH, and annexin A10, while LCC is related to Topo I, TS, and EGFR. In addition, separated pathways dominate progression to relapse in RCC and LCC. Therefore, RCC and LCC should be regarded as two heterogeneous entities, with this heterogeneity being used to stratify patients in order for them to have the optimal, current, and novel therapeutic strategies in clinical practice. Additional research is needed to uncover further differences between RCC and LCC.
结肠分别起源于胚胎学上的中肠和后肠，右半结肠和左半结肠在解剖学和生理学特征方面具有不同特点。根据明显的解剖位置，位于右半结肠和左半结肠的癌症分别称为右半结肠癌（RCC）和左半结肠癌（LCC）。越来越多的证据支持这样一种观点，即不仅在处理RCC和LCC时治疗策略存在差异，而且它们之间的分子特征也有所不同，更不用说明显不同的临床表现了。RCC和LCC根治性手术后的无病生存期相似。在RCC的治疗中，辅助性FOLFIRI化疗带来的益处优于LCC，或至少与LCC相似，但如果应用FOLFOX方案则不如LCC。另一方面，在姑息化疗环境中，转移性LCC的生存期比RCC长。对于KRAS野生型癌症，LCC比RCC从西妥昔单抗治疗中获益更多。此外，与晚期RCC相比，晚期LCC对贝伐单抗治疗表现出更高的敏感性。RCC和LCC在分子水平上存在显著差异，这可能是所有明显差异的原因。关于致癌机制，RCC与已知基因类型相关，如错配修复（MMR）、KRAS、BRAF和miRNA - 31，而LCC与染色体不稳定（CIN）、p53、NRAS、miRNA - 146a、miRNA - 147b和miRNA - 1288相关。关于蛋白质表达，RCC与GNAS、NQO1、端粒酶活性、磷酸化丙酮酸脱氢酶（P - PDH）和膜联蛋白A10相关，而LCC与拓扑异构酶I（Topo I）、胸苷合成酶（TS）和表皮生长因子受体（EGFR）相关。此外，RCC和LCC进展至复发分别由不同的途径主导。因此，RCC和LCC应被视为两个异质性实体，利用这种异质性对患者进行分层，以便他们在临床实践中获得最佳的、当前的和新颖的治疗策略。还需要进一步的研究来揭示RCC和LCC之间的更多差异。
