Diez-Alonso Manuel, Mendoza-Moreno Fernando, Ortega Miguel A, Aguado Hector, Matías Belen, Vera Cristina, Soto Sonia, Quiroga Ana, Blazquez Silvestra Barrena, de Mon Melchor Alvarez, Gutierrez-Calvo Alberto
Department of General and Digestive Surgery, University Hospital Príncipe de Asturias, 28805 Madrid, Spain.
Departamento de Cirugia, Ciencias Medicas y Sociales. Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain.
J Cancer. 2023 Aug 6;14(13):2444-2454. doi: 10.7150/jca.85695. eCollection 2023.
The location of the primary tumor in colorectal cancer (CRC) could be a prognostic factor related to survival. However, its usefulness has not been sufficiently analyzed. The results in patients with tumors in initial stages are very limited, and there are descriptive parameters of survival that have not been analyzed in detail. In this study, the relationship between primary tumor location and survival in CRC patients was analyzed. This was a retrospective observational study. All patients treated consecutively for CRC between January 2005 and December 2019 in the same hospital center were included. Overall survival (OS), cancer-related survival (CRS), time to recurrence (TTR), relapse-free survival (RFS) and postrecurrence survival (PRS) were analyzed, and the results were classified by tumor stage. The results were compared among patients with right colon (RS), left colon (LS) and rectal tumors. In the entire cohort, patients with RS tumors had lower OS and lower CRS at 60 months after diagnosis than did patients with LS or rectal tumors. In the regression analysis, the localization of the primary tumor was an independent prognostic indicator for OS and CRS. Analysis by tumor stage showed that patients with RS stage III tumors had lower OS and lower CRS at 60 months than did patients with LS and rectal tumors (42%, 59% and 53%, respectively, p = 0.006; and 48%, 63% and 57%, respectively, p = 0.025). Additionally, patients with RS Stage IV tumors had lower OS and lower CRS at 36 months than did patients with LS and rectal tumors (9%, 24%, 24%, respectively, p < 0.001; and 10%, 24% and 24%, respectively, p < 0.001). No differences were found in TTR and RFS among patients with stage I and II RS, LS, and rectal tumors. In contrast, patients with stage RS III tumors had significantly poorer PRS (9% for RS tumors, 13% for LS tumors, and 22% for rectal tumors) (p < 0.001). The location of the primary tumor in patients with CRC is related to survival. The effect of laterality is more marked in patients with stage III and IV tumors. Patients with RS tumors had lower OS and CRS due to the lower survival of patients with stage IV RS tumors and lower PRS for patients with stage III tumors.
结直肠癌（CRC）中原发肿瘤的位置可能是一个与生存相关的预后因素。然而，其效用尚未得到充分分析。初始阶段肿瘤患者的相关结果非常有限，且一些生存描述参数尚未得到详细分析。在本研究中，分析了CRC患者中原发肿瘤位置与生存之间的关系。这是一项回顾性观察研究。纳入了2005年1月至2019年12月在同一医院中心连续接受CRC治疗的所有患者。分析了总生存期（OS）、癌症相关生存期（CRS）、复发时间（TTR）、无复发生存期（RFS）和复发后生存期（PRS），并根据肿瘤分期对结果进行分类。比较了右半结肠癌（RS）、左半结肠癌（LS）和直肠癌患者的结果。在整个队列中，RS肿瘤患者在诊断后60个月时的OS和CRS低于LS或直肠癌患者。在回归分析中，原发肿瘤的定位是OS和CRS的独立预后指标。按肿瘤分期分析显示，RS III期肿瘤患者在60个月时的OS和CRS低于LS和直肠癌患者（分别为42%、59%和53%，p = 0.006；以及分别为48%、63%和57%，p = 0.025）。此外，RS IV期肿瘤患者在36个月时的OS和CRS低于LS和直肠癌患者（分别为9%、24%、24%，p < 0.001；以及分别为10%、24%和24%，p < 0.001）。I期和II期RS、LS和直肠癌患者在TTR和RFS方面未发现差异。相比之下，RS III期肿瘤患者的PRS明显更差（RS肿瘤为9%，LS肿瘤为13%，直肠肿瘤为22%）（p < 0.001）。CRC患者中原发肿瘤的位置与生存相关。在III期和IV期肿瘤患者中，左右侧的影响更为明显。RS肿瘤患者的OS和CRS较低，这是由于IV期RS肿瘤患者的生存率较低以及III期肿瘤患者的PRS较低。
