Different treatment strategies and molecular features between right-sided and left-sided colon cancers
Different treatment strategies and molecular features between right-sided and left-sided colon cancers
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DOI：
10.3748/wjg.v21.i21.6470
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发表时间：
2015-06-07
影响因子：
4.3
通讯作者：
Yuan, Ying
中科院分区：
文献类型：
--
作者：
Shen, Hong;Yang, Jiao;Yuan, Ying
结肠分别来源于胚胎时期的中肠和后肠，其中右结肠和左结肠在解剖和生理上都具有不同的特征。根据其明显的解剖位置，位于右结肠和左结肠的癌症分别被称为右结肠癌（RCC）和左结肠癌（LCC）。越来越多的证据支持这样一种观点，即在处理RCC和LCC时，不仅存在治疗策略的差异，而且它们之间的分子特征也有所不同，更不用说不同的临床表现了。RCC和LCC根治性手术后的无病生存率相似。在RCC的治疗中，FOLFIRI辅助化疗的获益优于LCC，或至少与LCC相似，但如果采用FOLFOX方案，则不如LCC。另一方面，在姑息性化疗环境下，转移性LCC表现出比RCC更长的生存期。对于KRAS野生型癌症，西妥昔单抗治疗对LCC的益处大于RCC。此外，与晚期RCC相比，晚期LCC对贝伐单抗治疗的敏感性更高。RCC和LCC在分子水平上存在显著的差异，这可能是造成所有明显差异的原因。在致癌机制方面，RCC与已知基因类型相关，如MMR、KRAS、BRAF和miRNA-31，而LCC与CIN、p53、NRAS、miRNA-146a、miRNA-147b和miRNA-1288相关。在蛋白表达方面，RCC与GNAS、NQO1、端粒酶活性、P-PDH、膜联蛋白A10有关，LCC与Topo I、TS、EGFR有关。此外，在RCC和LCC中，分离的途径主导着进展到复发。因此，RCC和LCC应被视为两个异质性的实体，这种异质性被用来对患者进行分层，以便在临床实践中获得最佳的、当前的和新颖的治疗策略。需要进一步的研究来揭示RCC和LCC之间的进一步差异。
The colon is derived from the embryological midgut and hindgut separately, with the right colon and left colon having different features with regards to both anatomical and physiological characteristics. Cancers located in the right and left colon are referred to as right colon cancer (RCC) and left colon cancer (LCC), respectively, based on their apparent anatomical positions. Increasing evidence supports the notion that not only are there differences in treatment strategies when dealing with RCC and LCC, but molecular features also vary between them, not to mention the distinguishing clinical manifestations. Disease-free survival after radical surgery of both RCC and LCC are similar. In the treatment of RCC, the benefit gained from adjuvant FOLFIRI chemotherapy is superior, or at least similar, to LCC, but inferior to LCC if FOLFOX regimen is applied. On the other hand, metastatic LCC exhibits longer survival than that of RCC in a palliative chemotherapy setting. For KRAS wild-type cancers, LCC benefits more from cetuximab treatment than RCC. Moreover, advanced LCC shows a higher sensitivity to bevacizumab treatment in comparison with advanced RCC. Significant varieties exist at the molecular level between RCC and LCC, which may serve as the cause of all apparent differences. With respect to carcinogenesis mechanisms, RCC is associated with known gene types, such as MMR, KRAS, BRAF, and miRNA-31, while LCC is associated with CIN, p53, NRAS, miRNA-146a, miRNA-147b, and miRNA-1288. Regarding protein expression, RCC is related to GNAS, NQO1, telomerase activity, P-PDH, and annexin A10, while LCC is related to Topo I, TS, and EGFR. In addition, separated pathways dominate progression to relapse in RCC and LCC. Therefore, RCC and LCC should be regarded as two heterogeneous entities, with this heterogeneity being used to stratify patients in order for them to have the optimal, current, and novel therapeutic strategies in clinical practice. Additional research is needed to uncover further differences between RCC and LCC.