Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Medical Oncology, Western Health, Footscray, VIC, Australia; Medical Oncology, Eastern Health, Box Hill, VIC, Australia.
IBM Research, Australia Research Laboratory, Melbourne, VIC, Australia.
Clin Colorectal Cancer. 2018 Sep;17(3):e569-e577. doi: 10.1016/j.clcc.2018.05.008. Epub 2018 May 26.
Multiple studies have defined the prognostic and potential predictive significance of the primary tumor side in metastatic colorectal cancer (CRC). However, the currently available data for early-stage disease are limited and inconsistent.
We explored the clinicopathologic, treatment, and outcome data from a multisite Australian CRC registry from 2003 to 2016. Tumors at and distal to the splenic flexure were considered a left primary (LP).
For the 6547 patients identified, the median age at diagnosis was 69 years, 55% were men, and most (63%) had a LP. Comparing the outcomes for right primary (RP) versus LP, time-to-recurrence was similar for stage I and III disease, but longer for those with a stage II RP (hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.52-0.90; P < .01). Adjuvant chemotherapy provided a consistent benefit in stage III disease, regardless of the tumor side. Overall survival (OS) was similar for those with stage I and II disease between LP and RP patients; however, those with stage III RP disease had poorer OS (HR, 1.30; 95% CI, 1.04-1.62; P < .05) and cancer-specific survival (HR, 1.55; 95% CI, 1.19-2.03; P < .01). Patients with stage IV RP, whether de novo metastatic (HR, 1.15; 95% CI, 0.95-1.39) or relapsed post-early-stage disease (HR, 1.35; 95% CI, 1.11-1.65; P < .01), had poorer OS.
In early-stage CRC, the association of tumor side and effect on the time-to-recurrence and OS varies by stage. In stage III patients with an RP, poorer OS and cancer-specific survival outcomes are, in part, driven by inferior survival after recurrence, and tumor side did not influence adjuvant chemotherapy benefit.
多项研究已经确定了转移性结直肠癌（CRC）原发肿瘤侧的预后和潜在预测意义。然而，目前早期疾病的数据有限且不一致。
我们从 2003 年至 2016 年探索了澳大利亚多站点 CRC 登记处的临床病理、治疗和结局数据。脾曲处及以下的肿瘤被认为是左侧原发肿瘤（LP）。
对于确定的 6547 名患者，中位诊断年龄为 69 岁，55%为男性，大多数（63%）有 LP。比较右侧原发肿瘤（RP）与 LP 的结果，I 期和 III 期疾病的复发时间相似，但 RP 为 II 期的患者复发时间更长（风险比 [HR]，0.68；95%置信区间 [CI]，0.52-0.90；P<0.01）。辅助化疗在 III 期疾病中提供了一致的获益，而与肿瘤侧无关。LP 和 RP 患者的 I 期和 II 期疾病的总生存期（OS）相似；然而，III 期 RP 疾病患者的 OS 较差（HR，1.30；95%CI，1.04-1.62；P<0.05）和癌症特异性生存期（HR，1.55；95%CI，1.19-2.03；P<0.01）。无论是否为初发性转移性（HR，1.15；95%CI，0.95-1.39）或早期疾病后复发（HR，1.35；95%CI，1.11-1.65；P<0.01），RP 期 IV 患者的 OS 较差。
在早期 CRC 中，肿瘤侧与复发时间和 OS 之间的关联因分期而异。RP 期 III 患者的 OS 和癌症特异性生存结果较差，部分原因是复发后的生存情况较差，而肿瘤侧并不影响辅助化疗的获益。
