1 Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
2 National Yang-Ming University, School of Medicine, Taipei, Taiwan.
Int J Biol Markers. 2019 Mar;34(1):47-53. doi: 10.1177/1724600818807164. Epub 2019 Mar 10.
The incidence, pathogenesis, molecular pathways, and outcomes of colorectal cancer vary depending on the location of the tumor. This study aimed to compare the difference in tumor characteristics and the outcome between right-sided colon cancer and left-sided colorectal cancer (LCRC).
A total of 1503 patients with colorectal cancer who underwent surgery at the Taipei Veterans General Hospital between 2000 and 2010 were enrolled in this study. Right-sided colon cancer was defined as cancers in the cecum, ascending colon, and transverse colon, while LCRC was defined as cancers in the splenic flexure colon, descending colon, sigmoid colon, and rectum. The endpoint was overall survival. The mutations were detected via polymerase chain reaction and MASS array. The prognostic value was determined using the log-rank test and the Cox regression analysis.
A total of 407 and 1096 cases were classified as right-sided colon cancer and LCRC, respectively. Compared to patients with LCRC, those with right-sided colon cancer had more mucinous type cancer (7.4% vs. 3.5%), poorly differentiated tumor (11.5% vs. 3.6%), and advanced tumor-node-metastasis stage. The risk for peritoneal tumor seeding was higher in the right-sided colon cancer group (12.8% vs. 5.7%). Overall survival was better in LCRC than in right-sided colon cancer ( P=0.036).
In our study, right-sided colon cancer had a more advanced tumor stage, a higher risk of peritoneal metastasis, and a poorer outcome than LCRC. Moreover, right-sided colon cancer had more gene mutations in BRAF, KRAS, SMAD4, TGF-β, PIK3CA, PTEN, AKT1, and high microsatellite instability.
肿瘤位置的不同会导致结直肠癌的发病率、发病机制、分子途径和结局有所差异。本研究旨在比较右半结肠癌与左半结直肠癌（LCRC）之间肿瘤特征和结局的差异。
本研究共纳入 2000 年至 2010 年期间在台北荣民总医院接受手术治疗的 1503 例结直肠癌患者。右半结肠癌定义为盲肠、升结肠和横结肠癌，而 LCRC 定义为脾曲结肠癌、降结肠癌、乙状结肠癌和直肠癌。终点是总生存。通过聚合酶链反应和 MASS 阵列检测突变。使用对数秩检验和 Cox 回归分析确定预后价值。
407 例和 1096 例患者分别归类为右半结肠癌和 LCRC。与 LCRC 患者相比，右半结肠癌患者具有更多的黏液型癌症（7.4% vs. 3.5%）、低分化肿瘤（11.5% vs. 3.6%）和更晚期的肿瘤-淋巴结-转移分期。右半结肠癌组腹膜种植瘤的风险更高（12.8% vs. 5.7%）。LCRC 的总生存情况优于右半结肠癌（P=0.036）。
在我们的研究中，右半结肠癌的肿瘤分期更晚，腹膜转移的风险更高，预后比 LCRC 更差。此外，右半结肠癌在 BRAF、KRAS、SMAD4、TGF-β、PIK3CA、PTEN、AKT1 和高微卫星不稳定性方面具有更多的基因突变。
