Sidedness is prognostic in locoregional colon cancer: an analysis of 9509 Australian patients
Sidedness is prognostic in locoregional colon cancer: an analysis of 9509 Australian patients
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DOI：
10.1186/s12885-017-3255-z
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发表时间：
2017-04-08
期刊：
影响因子：
3.8
通讯作者：
Ranson, Marie
中科院分区：
文献类型：
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作者：
Brungs, Daniel;Aghmesheh, Morteza;Ranson, Marie
背景/目的：右侧结肠癌（RsCC）被认为是与左侧结肠癌（LsCC）不同的疾病实体。我们试图确认原发肿瘤位置作为局部区域结直肠癌的独立预后因素。方法：所有来自新南威尔士州（NSW）临床癌症登记处（2006-2013）的I - III期原发性结肠腺癌患者。采用Kaplan-Meier法进行原发肿瘤定位（RsCC vs LsCC）生存分析，并采用Cox比例风险回归获得5年全因死亡率（OS）和5年癌症特异性死亡率（CSS）的校正风险比。结果：我们确定了9509例患者，其中5051例为RsCC， 4458例为LsCC。RsCC患者更可能是年龄较大的女性，具有较高的Charlson合并症指数，并且具有较差的肿瘤预后因素。在所有分期合并的单因素分析中，RsCC患者的总生存期较差（OS, HR 1.20 95% CI 1.11-1.29, p < 0.0001），尽管在多因素分析中无显著性差异(HR 0.96 95% CI 0。89-1.04, p = 0.35)。一期RsCC患者的OS有改善的趋势（多变量HR 0.84 95% CI 0.69-1.01, p = 0.07）， CSS有显著改善的趋势（多变量HR 0.51 95% CI 0.35-0.75, p = 0.0006）。与LsCC相比，II期RsCC患者的OS（多变量HR 0.85 95% CI 0.75-0.98, p = 0.02）和CSS（多变量HR 0.59 95% CI 0.45-0.78, p = 0.0002）显著改善。在III期患者中，患有RsCC的患者有更差的OS（多变量风险比1.13 95% CI 1.01-1.26, p = 0.032）和更差的CSS（多变量风险比1.12 95% CI 0.94-1.33, p = 0.22）。结论：原发肿瘤位置是局部区域性结肠癌的重要预后因素，其影响因分期而异。RsCC与II期全因死亡率较低和III期全因死亡率较高相关。
Background/Aim: Right sided colon cancer (RsCC) is proposed to be a distinct disease entity to left sided colon cancer (LsCC). We seek to confirm primary tumour location as an independent prognostic factor in locoregional colorectal cancer.Methods: All patients with stage I - III primary adenocarcinoma of colon were identified from the New South Wales (NSW) clinical cancer registry (2006-2013). Primary tumour location (RsCC vs LsCC) survival analyses were conducted using the Kaplan-Meier method, and adjusted hazard ratios for 5-year all-cause mortality (OS) and 5-year cancer specific mortality (CSS) were obtained using Cox proportional hazards regression.Results: We identified 9509 patients including 5051 patients with RsCC and 4458 with LsCC. Patients with RsCC were more likely to be older, female, have a higher Charlson comorbidity index, and have worse tumour prognostic factors. In univariate analysis of all stages combined, those patients with RsCC had a worse overall survival (OS, HR 1.20 95% CI 1.11-1.29, p < 0.0001), although this was not significant in the multivariate analysis (HR 0.96 95% CI 0. 89-1.04, p = 0.35). Stage I patients with RsCC had a trend to improved OS (multivariate HR 0.84 95% CI 0.69-1.01, p = 0.07) and a significantly improved CSS (multivariate HR 0.51 95% CI 0.35-0.75, p = 0.0006). In stage II patients with RsCC there was a significantly improved OS (multivariate HR 0.85 95% CI 0.75-0.98, p = 0.02) and CSS (multivariate HR 0.59 95% CI 0.45-0.78, p = 0.0002) compared to LsCC. In stage III patients, those with RsCC had a worse OS (multivariate HR 1.13 95% CI 1.01-1.26, p = 0.032) and a trend to worse CSS (multivariate HR 1.12 95% CI 0.94-1.33, p = 0.22).Conclusions: Primary tumour location is an important prognostic factor in locoregional colon cancer with an effect that varies by stage. RsCC is associated with lower all-cause mortality in stage II, and higher all-cause mortality in stage III.