Bill Walsh Translational Research Laboratories, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia.
Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
PLoS One. 2019 Jun 12;14(6):e0218207. doi: 10.1371/journal.pone.0218207. eCollection 2019.
Recent literature has suggested that tumor sidedness in colorectal cancer (CRC) is an independent prognostic and potentially predictive marker of survival. The aims of the study were to determine the prognostic significance of tumor sidedness in colorectal cancer patients undergoing primary tumor resection and to assess associated tumor biology.
A total of 3281 consecutive patients who underwent surgical resection of their primary CRC from January 1998 to December 2012 were analyzed for association with tumor biologic factors and with overall survival. Metastatic patients were excluded from analysis.
Left sided CRCs were associated with a number of additional key prognostic markers including BRAFV600E wildtype status (P<0.001), mismatch repair proficiency (p<0.001), absence of peritumoral lymphocytic response (p = 0.001), high lymphocyte-to-monocyte ratio (p<0.001) and low neutrophil-to-lymphocyte ratio (p<0.001). In primary analysis with 3067 patients, there was no statistical difference in sidedness in the univariate analysis (p = 0.291). Three further subgroup analyses were performed. In the first subgroup, only stage III patients were analyzed. In the second, patients with mismatch repair deficiency were removed. In the third, additional clinicopathologic variables known to be independently prognostic were added into analysis. In all three subgroup analyses tumor sidedness was not an independent prognostic marker.
Tumor sidedness was not an independent prognostic marker of CRC. However, right sided CRCs were associated with several key independent prognostic markers supporting a hypothesis that tumor sidedness is a surrogate for other biomarkers.
最近的文献表明，结直肠癌（CRC）的肿瘤侧别是独立的预后和潜在的生存预测标志物。本研究的目的是确定肿瘤侧别在接受原发肿瘤切除术的结直肠癌患者中的预后意义，并评估相关的肿瘤生物学。
对 1998 年 1 月至 2012 年 12 月期间接受原发性 CRC 手术切除的 3281 例连续患者进行分析，以评估其与肿瘤生物学因素和总生存的相关性。转移性患者不纳入分析。
左半结肠癌与许多其他关键预后标志物相关，包括 BRAFV600E 野生型状态（P<0.001）、错配修复功能完整（p<0.001）、缺乏肿瘤周围淋巴细胞反应（p = 0.001）、高淋巴细胞与单核细胞比值（p<0.001）和低中性粒细胞与淋巴细胞比值（p<0.001）。在对 3067 例患者进行的主要分析中，单侧性在单因素分析中无统计学差异（p = 0.291）。进行了三项进一步的亚组分析。在第一亚组中，仅分析了 III 期患者。在第二个亚组中，排除了错配修复缺陷的患者。在第三个亚组中，加入了已知具有独立预后意义的其他临床病理变量。在所有三个亚组分析中，肿瘤侧别均不是独立的预后标志物。
肿瘤侧别不是结直肠癌的独立预后标志物。然而，右半结肠癌与几个关键的独立预后标志物相关，支持肿瘤侧别是其他生物标志物的替代标志物的假说。
