Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City, Taiwan.
J Gastrointest Surg. 2021 Mar;25(3):650-661. doi: 10.1007/s11605-020-04855-5. Epub 2020 Nov 17.
The effects of primary tumor location on colorectal liver metastasis (CRLM) and post-hepatic-metastasectomy overall survival (OS) are controversial. This study evaluated the difference in post-hepatic-metastasectomy OS among right-sided colon, left-sided colon, and rectal cancer groups.
In total, 381 patients who underwent curative-intent CRLM resection were enrolled. Patients were grouped based on the primary tumor location (right-sided, left-sided, and rectum). The Kaplan-Meier analysis and log-rank test were performed for survival analysis. The univariate and multivariate analyses of clinical and pathological factors were performed using the Cox proportional hazards model.
Significant OS difference was noted among the three groups (log-rank, p = 0.014). The multivariate analysis revealed a 32% lower death risk in left-sided colon cancer compared with right-sided colon cancer (hazard ratio [HR] 0.68, p = 0.042), whereas no OS difference was noted between the rectal cancer and right-sided colon cancer groups. The left- versus right-sided OS advantage was noted only in the KRAS wild-type subgroup (HR 0.46, p = 0.002), and a rectal versus right-sided OS disadvantage was noted in the KRAS mutant subgroup (HR 1.78, p = 0.03).
The CRLM post-hepatic-metastasectomy OS was superior in left-sided colon cancer than in right-sided colon cancer and was similar in rectal and right-sided colon cancer. The OS difference in different primary tumor locations is dependent on KRAS mutation status, with a decreased left- versus right-sided death risk noted only in KRAS wild-type colon cancer and an increased rectal versus right-sided death risk noted only in KRAS mutant colon cancer.
原发肿瘤位置对结直肠癌肝转移（CRLM）和肝转移切除术后总体生存（OS）的影响存在争议。本研究评估了右半结肠癌、左半结肠癌和直肠癌患者肝转移切除术后 OS 的差异。
共纳入 381 例接受根治性 CRLM 切除术的患者。根据原发肿瘤位置（右半结肠、左半结肠和直肠）将患者分为不同组别。采用 Kaplan-Meier 分析和对数秩检验进行生存分析。采用 Cox 比例风险模型对临床和病理因素进行单因素和多因素分析。
三组间 OS 差异有统计学意义（log-rank，p=0.014）。多因素分析显示，与右半结肠癌相比，左半结肠癌死亡风险降低 32%（风险比 [HR] 0.68，p=0.042），而直肠癌与右半结肠癌患者间 OS 无差异。仅在 KRAS 野生型亚组中观察到左半结肠癌 OS 优于右半结肠癌（HR 0.46，p=0.002），而在 KRAS 突变亚组中观察到直肠癌 OS 劣于右半结肠癌（HR 1.78，p=0.03）。
与右半结肠癌相比，左半结肠癌 CRLM 肝转移切除术后 OS 更好，与右半结肠癌相似。不同原发肿瘤位置的 OS 差异取决于 KRAS 突变状态，仅在 KRAS 野生型结肠癌中观察到左半结肠癌死亡风险降低，而仅在 KRAS 突变型结肠癌中观察到直肠癌死亡风险升高。
