Gatot Inbar, Chikman Bar, Shapira Zahar, Zandbank Judit, Halevy Ariel
Division of General Surgery, Assaf Harofeh Medical Center.
Institute of Pathology, Assaf Harofeh Medical Center.
Harefuah. 2018 May;157(5):292-295.
This study aimed to investigate the pathologic differences between right and left sided colonic cancer.
The incidence of right sided colon cancer during the past several decades is increasing as compared to left sided colon cancer. There are cumulative publications describing epidemiological, pathological and genetic differences between right and left sided colon cancer. A few studies have also shown a lower survival rate in patients with right sided colon cancer as compared to patients with left sided colon cancer.
A retrospective study based on the accumulated data on right and left sided colonic cancer.
Data on 823 patients was collected; 426 patients (52.8%) had colon cancer located on the right side and in 397 patients (48.2%) it was located on the left side. There were no statistically significant differences between right and left colon cancer regarding sex, lymph node metastases and lymphovascular invasion. However, there was a significantly higher proportion of poorly differentiated adenocarcinomas (19%vs.8.7%; p<.001) and a trend to higher T stage (T3-4:87.7%vs.82.8%; p<.049) in right sided tumors as compared to left sided tumors. The incidence of mucinous tumors and mucinous components was also significantly higher in right sided tumors (7.3%vs.2%; p<.001, 13.1%vs.7%; p<.001).
We found histopathological differences between right and left sided colon cancer. Tumors on the right colon were found to be more aggressive, as expressed by poorer differentiation, higher T stage and mucinous tumors. The reasons are unclear, either the existence of two distinct molecular pathways or simply a delay in the diagnosis of right sided colon cancer. Future studies are needed to better understand the true nature of these differences.
本研究旨在调查右半结肠癌和左半结肠癌之间的病理差异。
在过去几十年中，与左半结肠癌相比，右半结肠癌的发病率呈上升趋势。已有大量文献描述了右半结肠癌和左半结肠癌在流行病学、病理和遗传学方面的差异。一些研究还表明，与左半结肠癌患者相比，右半结肠癌患者的生存率较低。
基于右半结肠癌和左半结肠癌的累积数据进行回顾性研究。
收集了823例患者的数据；426例患者（52.8%）患有右半结肠癌，397例患者（48.2%）患有左半结肠癌。在性别、淋巴结转移和淋巴管侵犯方面，右半结肠癌和左半结肠癌之间无统计学显著差异。然而，与左半结肠癌相比，右半结肠癌中低分化腺癌的比例显著更高（19%对8.7%；p<0.001），且T分期有升高趋势（T3-4：87.7%对82.8%；p<0.049）。右半结肠癌中黏液性肿瘤及黏液性成分的发生率也显著更高（7.3%对2%；p<0.001，13.1%对7%；p<0.001）。
我们发现右半结肠癌和左半结肠癌之间存在组织病理学差异。右半结肠癌表现出更强的侵袭性，表现为分化较差、T分期较高和黏液性肿瘤。原因尚不清楚，可能存在两种不同的分子途径，也可能仅仅是右半结肠癌的诊断延迟。需要进一步研究以更好地理解这些差异的本质。
