Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan.
Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine.
Jpn J Clin Oncol. 2024 Jul 7;54(7):753-760. doi: 10.1093/jjco/hyae035.
The relationship of tumour site with post-recurrence course and outcome after primary surgery in resectable colorectal cancer is unclear. This study investigated the prognostic impact of primary tumour location following radical resection without preoperative treatment in Stage I-III colorectal cancer.
We analyzed 3770 patients with Stage I-III colorectal cancer who underwent curative resection at our hospital during 2000-15. We defined the right-sided colon as the cecum, ascending colon and transverse colon, and the left-sided colon as the descending colon, sigmoid and rectosigmoid junction. Patients were divided into three groups according to tumour site: right-sided colon, left-sided colon and rectum. Endpoints were overall survival, recurrence-free survival by stage and survival after recurrence, respectively.
The 5-year overall survival rates of patients with stage I left-sided colon cancer, right-sided colon cancer and rectal cancer were 98.2, 97.3 and 97.2%, respectively (P = 0.488). The 5-year overall survival rates of patients with Stage II left-sided colon cancer, right-sided colon cancer and rectal cancer were 96.2, 88.7 and 83.0, respectively (P = 0.070). The 5-year overall survival rates of patients with Stage III left-sided colon cancer, right-sided colon cancer and rectal cancer were 88.7, 83.0 and 80.2, respectively (P = 0.001). The 5-year recurrence-free survival rates of patients with Stage I left-sided colon cancer, right-sided colon cancer and rectal cancer were 95.1, 94.5 and 90.6% (P = 0.027). The 5-year recurrence-free survival rates of patients with Stage II left-sided colon cancer, right-sided colon cancer and rectal cancer were 85.2, 90.2 and 76.1%, respectively (P < 0.001). The 5-year recurrence-free survival rates of patients with Stage III left-sided colon cancer, right-sided colon cancer and rectal cancer were 75.3, 75.3 and 59.8%, respectively (P < 0.001). Right-sided colon cancer was significantly associated with better recurrence-free survival compared with left-sided colon cancer (HR 1.29, 95% CI 1.03-1.63; P = 0.025) and rectal cancer (HR 1.89, 95% CI 1.51-2.38; P < 0.001) after adjusting for clinical factors. Amongst patients with recurrence, right-sided colon cancer was significantly associated with poorer survival after recurrence compared with left-sided colon cancer (HR 0.68, 95% CI 0.48-0.97; P = 0.036), and showed a tendency towards poorer survival after recurrence compared with rectal cancer (HR 0.79, 95% CI 0.57-1.10; P = 0.164).
In Stage I-III colorectal cancer without preoperative treatment, our results suggest that the three tumour sites (right-sided colon, left-sided colon or rectum) may have prognostic significance for recurrence-free survival and survival after recurrence, rather than sidedness alone.
原发肿瘤部位与根治性手术后可切除结直肠癌的复发后病程和结局的关系尚不清楚。本研究旨在探讨未经术前治疗的Ⅰ-Ⅲ期结直肠癌根治性切除术后原发肿瘤位置对预后的影响。
我们分析了 2000 年至 2015 年期间在我院接受根治性手术治疗的 3770 例Ⅰ-Ⅲ期结直肠癌患者。我们将右侧结肠定义为盲肠、升结肠和横结肠，左侧结肠定义为降结肠、乙状结肠和直肠乙状结肠交界处。根据肿瘤部位将患者分为三组：右侧结肠癌、左侧结肠癌和直肠癌。终点分别为总生存、按分期的无复发生存和复发后的生存。
Ⅰ期左侧结肠癌、右侧结肠癌和直肠癌患者的 5 年总生存率分别为 98.2%、97.3%和 97.2%（P=0.488）。Ⅱ期左侧结肠癌、右侧结肠癌和直肠癌患者的 5 年总生存率分别为 96.2%、88.7%和 83.0%（P=0.070）。Ⅲ期左侧结肠癌、右侧结肠癌和直肠癌患者的 5 年总生存率分别为 88.7%、83.0%和 80.2%（P=0.001）。Ⅰ期左侧结肠癌、右侧结肠癌和直肠癌患者的 5 年无复发生存率分别为 95.1%、94.5%和 90.6%（P=0.027）。Ⅱ期左侧结肠癌、右侧结肠癌和直肠癌患者的 5 年无复发生存率分别为 85.2%、90.2%和 76.1%（P<0.001）。Ⅲ期左侧结肠癌、右侧结肠癌和直肠癌患者的 5 年无复发生存率分别为 75.3%、75.3%和 59.8%（P<0.001）。右侧结肠癌与左侧结肠癌（HR 1.29，95%CI 1.03-1.63；P=0.025）和直肠癌（HR 1.89，95%CI 1.51-2.38；P<0.001）相比，无复发生存率更好，调整临床因素后差异有统计学意义。在复发患者中，右侧结肠癌与左侧结肠癌（HR 0.68，95%CI 0.48-0.97；P=0.036）相比，复发后生存时间更差，与直肠癌（HR 0.79，95%CI 0.57-1.10；P=0.164）相比，复发后生存时间有下降趋势。
在未经术前治疗的Ⅰ-Ⅲ期结直肠癌中，我们的结果表明，三个肿瘤部位（右侧结肠、左侧结肠或直肠）可能对无复发生存和复发后生存具有预后意义，而不仅仅是肿瘤部位。
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