Yang Jiao, Du Xiang Lin, Li Shu Ting, Wang Bi Yuan, Wu Yin Ying, Chen Zhe Ling, Lv Meng, Shen Yan Wei, Wang Xin, Dong Dan Feng, Li Dan, Wang Fan, Li En Xiao, Yi Min, Yang Jin
Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an city, Shaanxi Province, China.
Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas School of Public Health, Houston, TX, United States of America.
PLoS One. 2016 Dec 9;11(12):e0167540. doi: 10.1371/journal.pone.0167540. eCollection 2016.
It has been suggested that colorectal cancer be regarded as several subgroups defined according to tumor location rather than as a single entity. The current study aimed to identify the most useful method for grouping colorectal cancer by tumor location according to both baseline and survival characteristics.
Cases of pathologically confirmed colorectal adenocarcinoma diagnosed from 2000 to 2012 were identified from the Surveillance, Epidemiology, and End Results database and categorized into three groups: right colon cancer (RCC), left colon cancer (LCC), and rectal cancer (ReC). Adjusted hazard ratios for known predictors of disease-specific survival (DSS) in colorectal cancer were obtained using a Cox proportional hazards regression model.
The study included 57847 patients: 43.5% with RCC, 37.7% with LCC, and 18.8% with ReC. Compared with LCC and ReC, RCC was more likely to affect old patients and women, and to be at advanced stage, poorly differentiated or un-differentiated, and mucinous. Patients with LCC or ReC had better DSS than those with RCC in subgroups including stage III or IV disease, age ≤70 years and non-mucinous adenocarcinoma. Conversely, patients with LCC or ReC had worse DSS than those with RCC in subgroups including age ˃70 years and mucinous adenocarcinoma.
RCC differed from both LCC and ReC in several clinicopathologic characteristics and in DSS. It seems reasonable to group colorectal cancer into right-sided (i.e., proximal) and left-sided (i.e., distal) ones.
有人提出，应将结直肠癌视为根据肿瘤位置定义的几个亚组，而非单一实体。本研究旨在根据基线特征和生存特征确定按肿瘤位置对结直肠癌进行分组的最有效方法。
从监测、流行病学和最终结果数据库中识别出2000年至2012年期间病理确诊的结直肠腺癌病例，并分为三组：右半结肠癌（RCC）、左半结肠癌（LCC）和直肠癌（ReC）。使用Cox比例风险回归模型获得结直肠癌疾病特异性生存（DSS）已知预测因子的调整后风险比。
该研究纳入了57847例患者：43.5%为RCC，37.7%为LCC，18.8%为ReC。与LCC和ReC相比，RCC更易发生于老年患者和女性，且更易处于晚期、低分化或未分化以及黏液性状态。在包括III期或IV期疾病、年龄≤70岁和非黏液性腺癌的亚组中，LCC或ReC患者的DSS优于RCC患者。相反，在包括年龄＞70岁和黏液性腺癌的亚组中，LCC或ReC患者的DSS比RCC患者差。
RCC在几个临床病理特征和DSS方面与LCC和ReC均不同。将结直肠癌分为右侧（即近端）和左侧（即远端）两类似乎是合理的。
