Colon cancer survival differs from right side to left side and lymph node harvest number matter.
Colon cancer survival differs from right side to left side and lymph node harvest number matter.
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DOI：
10.1186/s12889-021-10746-4
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发表时间：
2021-05-12
影响因子：
4.5
通讯作者：
Rossi PG
中科院分区：
文献类型：
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作者：
Mangone L;Pinto C;Mancuso P;Ottone M;Bisceglia I;Chiaranda G;Michiara M;Vicentini M;Carrozzi G;Ferretti S;Falcini F;Hassan C;Rossi PG
右侧结直肠癌（CRC）的生存率低于左侧结直肠癌。本研究的目的是进一步评估右侧位置对生存的影响以及淋巴结切除术范围的作用。纳入2000年至2012年在意大利艾米利亚-罗马涅大区诊断的所有crc。收集分期、分级、组织学、筛查史和淋巴结切除数等数据。多变量Cox回归模型用于估计右结肠与左结肠的风险比（HR），以及按肿瘤部位切除< 12、12 - 21或bbb21个淋巴结的风险比（HR），其相对可信区间为95% ci。在研究期间，共有29358例患者登记（右结肠8828例，左结肠18852例，横结肠1678例）。右侧癌患者多为高龄、女性、晚期和高分级，且切除的ln数量较多。右侧结肠的5年生存率低于左侧结肠（55.2% vs 59.7%）。在多变量分析中，调整年龄、性别和筛查状态后，右结肠显示较低的生存率（HR 1.12, 95%CI 1.04-1.21）。与左结肠（HR 0.89, 95%CI 0.76-1.06和HR 0.83, 95%CI 0.69-1.01）相比，右结肠（HR 0.54, 95%CI 0.40 - 0.72和HR 0.40, 95%CI 0.30-0.55）的淋巴结切除数分层（12-21或> - 21）与更好的生存率相关。本研究证实右侧结直肠癌生存率较差；这种联系不是由于筛查状况。适当的淋巴结切除与更好的生存率相关，尽管在因果关系方面的关联方向尚不清楚。在线版本包含补充材料，可在10.1186/s12889-021-10746-4获得。
Right-sided colorectal cancer (CRC) has worse survival than does left-sided CRC. The objective of this study was to further assess the impact of right-side location on survival and the role of the extent of lymphadenectomy. All CRCs diagnosed between 2000 and 2012 in Emilia-Romagna Region, Italy, were included. Data for stage, grade, histology, screening history, and number of removed lymph nodes (LN) were collected. Multivariable Cox regression models were used to estimate hazard ratios (HR), with relative 95% confidence intervals (95%CI), of right vs. left colon and of removing < 12, 12–21 or > 21 lymph nodes by cancer site. During the study period, 29,358 patients were registered (8828 right colon, 18,852 left colon, 1678 transverse). Patients with right cancer were more often older, females, with advanced stage and high grade, and higher number of removed LNs. Five-year survival was lower in the right than in the left colon (55.2% vs 59.7%). In multivariable analysis, right colon showed a lower survival when adjusting for age, sex, and screening status (HR 1.12, 95%CI 1.04–1.21). Stratification by number of lymph nodes removed (12–21 or > 21) was associated with better survival in right colon (HR 0.54, 95%CI 0.40–0.72 and HR 0.40, 95%CI 0.30–0.55, respectively) compared to left colon (HR 0.89, 95%CI 0.76–1.06 and HR 0.83, 95%CI 0.69–1.01, respectively). This study confirms that right CRC has worse survival; the association is not due to screening status. An adequate removal of lymph nodes is associated with better survival, although the direction of the association in terms of causal links is not clear. The online version contains supplementary material available at 10.1186/s12889-021-10746-4.