Department of Surgery, Colorectal Section, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan, Taiwan.
J Surg Oncol. 2018 Dec;118(8):1301-1310. doi: 10.1002/jso.25270. Epub 2018 Nov 8.
We aim to investigate whether a difference exists between right-sided and left-sided colon cancer at the same disease stage and subsequent liver metastasis and identify whether tumor location can independently influence survival.
Right-sided colon cancer was defined as malignancy arising from the cecum to the transverse colon; left-sided colon cancer was defined as malignancy arising from the splenic flexure to the sigmoid colon. Clinicopathological features and survival data were collected for analysis.
Overall, 1442 patients were included for analysis. The median follow-up time was 58.2 months. Patients with left-sided colon cancer had better 5-year overall survival (75.2% vs 61.7%, P = 0.005), 5-year cancer-specific survival (81.6% vs 73.4%, P = 0.001), and 5-year recurrence-free survival (70.9% vs 66.5%, P = 0.033) compared with patients having right-sided colon cancer. After the presentation of subsequent liver metastasis, patients with primary left-sided colon cancer had better 3-year cancer-specific survival ( P < 0.001). In the multivariate analysis, cancer location was an independent prognostic factor for cancer-specific survival (right vs left, HR: 1.276, 95% CI: 1.002-1.625).
The primary tumor location can serve as a prognostic factor for treatment outcomes either in primary stage III colon cancer or subsequent liver metastasis.
本研究旨在探讨同一疾病分期的右半结肠癌和左半结肠癌在发生肝转移后的差异，并确定肿瘤位置是否能独立影响生存。
将右半结肠癌定义为发生于盲肠至横结肠的恶性肿瘤；左半结肠癌定义为发生于脾曲至乙状结肠的恶性肿瘤。收集分析了两组患者的临床病理特征和生存数据。
共纳入 1442 例患者进行分析。中位随访时间为 58.2 个月。左半结肠癌患者的 5 年总生存率（75.2% vs 61.7%，P=0.005）、5 年癌症特异性生存率（81.6% vs 73.4%，P=0.001）和 5 年无复发生存率（70.9% vs 66.5%，P=0.033）均优于右半结肠癌患者。出现肝转移后，原发左半结肠癌患者的 3 年癌症特异性生存率更高（P<0.001）。多因素分析显示，肿瘤位置是癌症特异性生存的独立预后因素（右 vs 左，HR：1.276，95%CI：1.002-1.625）。
原发肿瘤位置可作为 III 期结肠癌原发灶或后续肝转移的治疗结局的预后因素。
