Analysis of the anatomic subsites, gender and age in unresectable advanced colorectal carcinomas in Tochigi, Japan suggests a shift in location towards the right side colon in elderly patients treated with cetuximab
Analysis of the anatomic subsites, gender and age in unresectable advanced colorectal carcinomas in Tochigi, Japan suggests a shift in location towards the right side colon in elderly patients treated with cetuximab
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DOI：
10.3892/mco.2013.62
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发表时间：
2013-03-01
影响因子：
1.2
通讯作者：
Fujimori, Takahiro
中科院分区：
文献类型：
--
作者：
Tanaka, Toshio;Ichikawa, Kazuhito;Fujimori, Takahiro
结直肠癌是一种常见的恶性肿瘤，近年来发病率呈明显上升趋势。此外，已确定老年患者的右侧结肠增加。因此，我们对49例不能手术切除的晚期结直肠癌患者进行了临床病理研究，以阐明临床病理特征与K-ras突变的关系。在本研究纳入的49例患者中，24例年龄≥ 60岁，M/F比值为16/9。在年龄≥ 65岁的患者中，15例患者作为对照组入组，M/F比值为9/6。结果表明，就癌的亚部位而言，不能切除的晚期大肠癌发生在右半结肠13例，左半结肠19例，直肠17例。右半结肠癌常见于≥ 65岁的老年患者，女性患者有明显的趋势（P=0.024）。对40例患者进行表皮生长因子受体（EGFR）抗体免疫染色，以确定K-ras基因是否会产生阳性结果。K-ras基因突变率为20%（8/8），低于正常大肠癌。抗EGFR抗体（西妥昔单抗）被认为是治疗不能切除的晚期结直肠癌的分子靶向药物。右侧结肠癌发病率的增加以及结直肠癌患者数量的增加意味着这个问题应该得到解决。无蒂锯齿状腺瘤/息肉（SSA/P）伴b-raf突变和CIMP CpG岛甲基化表型）异常作为右侧结肠癌的前体病变是常见的，并且由于西妥昔单抗难治性野生型K-ras/突变型b-raf结直肠癌可能在老年患者和右侧结肠癌患者中增加，对于使用抗EGFR抗体（西妥昔单抗）治疗结肠直肠癌，同时检查K-ras和b-raf基因异常是至关重要的。此外，关于此类治疗效果的多学科评估可能基于累积结果（如患者生存期）来确定。
Colorectal cancer is a frequently occurring cancer whose incidence has shown a marked increase in recent years. Additionally, an increase in right side colon in elderly patients has been identified. Therefore, a clinicopathological study was conducted in 49 patients with unresectable advanced colorectal carcinomas to elucidate the association of clinicopathological characteristics and K-ras mutation. Of the 49 patients included in this study, 24 were aged = 60 years with a M/F ratio of 16/9. Of the patients aged >= 65 years, 15 patients were enrolled as controls and the M/F ratio was 9/6. Results revealed that with regard to the subsite of cancer, unresectable advanced colorectal carcinomas developed in the right-sided colon in 13 patients, left-sided colon in 19 patients and rectum in 17 patients. Right-sided colon carcinomas were commonly identified in the elderly patients aged >= 65 years, with a marked tendency in the female patients (P=0.024). Immunostaining was performed for the epidermal growth factor receptor (EGFR) antibody in 40 patients to determine whether the K-ras gene would yield positive results. The mutant K-ras gene was identified in 8 patients (20%) and the frequency was lower compared with that of the normal colorectal carcinomas. Anti-EGFR antibody (cetuximab) is considered to be a molecularly targeted agent for unresectable advanced colorectal carcinomas. The increase in incidence of right-sided colon carcinomas as well as the increase in the number of patients presenting with colorectal carcinomas means this issue should be addressed. Sessile serrated adenoma/polyp (SSA/P) with b-raf mutation and CIMP (CpG island methylator phenotype) abnormality as a precursor lesion of right-sided colon carcinoma is common and since cetuximab refractory wild-type K-ras/mutant b-raf colorectal carcinoma may increase in elderly patients and patients with right-sided colon carcinoma, a simultaneous examination for the K-ras and b-raf gene abnormalities for the treatment of colorectal cancer using anti-EGFR antibody (cetuximab) is crucial. In addition, the multidisciplinary assessments regarding the effect of such treatments is likely to be determined based on cumulative results, such as the duration of patient survival.