Mochizuki Kenichi, Kudo Shin-Ei, Ichimasa Katsuro, Kouyama Yuta, Matsudaira Shingo, Takashina Yuki, Maeda Yasuharu, Ishigaki Tomoyuki, Nakamura Hiroki, Toyoshima Naoya, Mori Yuichi, Misawa Masashi, Ogata Noriyuki, Kudo Toyoki, Hayashi Takemasa, Wakamura Kunihiko, Sawada Naruhiko, Ishida Fumio, Miyachi Hideyuki
Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki, Yokohama, 224-8503, Japan.
Int J Colorectal Dis. 2020 Oct;35(10):1911-1919. doi: 10.1007/s00384-020-03668-x. Epub 2020 Jun 16.
Although some studies have reported differences in clinicopathological features between left- and right-sided advanced colorectal cancer (CRC), there are few reports regarding early-stage disease. In this study, we aimed to compare the clinicopathological features of left- and right-sided T1 CRC.
Subjects were 1142 cases with T1 CRC undergoing surgical or endoscopic resection between 2001 and 2018 at Showa University Northern Yokohama Hospital. Of these, 776 cases were left-sided (descending colon to rectum) and 366 cases were right-sided (cecum to transverse colon). We compared clinical (patients age, sex, tumor size, morphology, initial treatment) and pathological features (invasion depth, histological grade, lymphatic invasion, vascular invasion, tumor budding) including lymph node metastasis (LNM).
Left-sided T1 CRC showed significantly higher rates of LNM (left-sided 12.0% vs. right-sided 5.4%, P < 0.05) and lymphatic invasion (left-sided 32.7% vs. right-sided 23.2%, P < 0.05). Especially, the sigmoid colon and rectum showed higher rates of LNM (12.4% and 12.1%, respectively) than other locations. Patients with left-sided T1 CRC were younger than those with right-sided T1 CRC (64.9 years ±11.5 years vs. 68.7 ± 11.6 years, P < 0.05), as well as significantly lower rates of poorly differentiated carcinoma/mucinous carcinoma than right-sided T1 CRC (11.6% vs. 16.1%, P < 0.05).
Left-sided T1 CRC, especially in the sigmoid colon and rectum, exhibited higher rates of LNM than right-sided T1 CRC, followed by higher rates of lymphatic invasion. These results suggest that tumor location should be considered in decisions regarding additional surgery after endoscopic resection.
This study was registered with the University Hospital Medical Network Clinical Trials Registry ( UMIN 000032733 ).
尽管一些研究报告了左、右侧晚期结直肠癌（CRC）在临床病理特征上的差异，但关于早期疾病的报告却很少。在本研究中，我们旨在比较左、右侧T1期CRC的临床病理特征。
研究对象为2001年至2018年在昭和大学北横滨医院接受手术或内镜切除的1142例T1期CRC患者。其中，776例为左侧（降结肠至直肠），366例为右侧（盲肠至横结肠）。我们比较了临床特征（患者年龄、性别、肿瘤大小、形态、初始治疗）和病理特征（浸润深度、组织学分级、淋巴侵犯、血管侵犯、肿瘤芽生），包括淋巴结转移（LNM）。
左侧T1期CRC的LNM发生率（左侧12.0% vs.右侧5.4%，P < 0.05）和淋巴侵犯发生率（左侧32.7% vs.右侧23.2%，P < 0.05）显著更高。特别是，乙状结肠和直肠的LNM发生率（分别为12.4%和12.1%）高于其他部位。左侧T1期CRC患者比右侧T1期CRC患者更年轻（64.9岁±11.5岁 vs. 68.7±11.6岁，P < 0.05），且低分化癌/黏液癌的发生率也显著低于右侧T1期CRC（11.6% vs. 16.1%，P < 0.05）。
左侧T1期CRC，尤其是在乙状结肠和直肠，LNM发生率高于右侧T1期CRC，其次是淋巴侵犯发生率更高。这些结果表明，在内镜切除术后决定是否进行额外手术时应考虑肿瘤位置。
本研究已在大学医院医学网络临床试验注册中心注册（UMIN 000032733）。
