左右半结肠癌患者临床病理特征的比较

Clinicopathological differences between left-sided and right-sided colon cancer

目的探讨左右半结肠癌患者临床病理特征的差异。方法回顾性分析广西医科大学附属肿瘤医院2004—2019年收治的2163例结直肠癌患者的临床资料,根据肿瘤部位的不同将患者分为左半结肠癌组(n=1634,LCC组)与右半结肠癌组(n=529,RCC组),比较两组一般资料、临床表现、分子生物学特征及病理资料的差异。结果两组性别、年龄比较差异均无统计学意义(均P>0.05),LCC组BMI高于RCC组(P<0.05)。LCC组出现黏液血便、排粪习惯改变、肛门坠胀感的比例高于RCC组,RCC组出现腹痛、腹部肿块的比例高于LCC组(均P<0.05)。LCC组T3~4期、M1期比例低于RCC组,两组TNM分期比较差异有统计学意义(均P<0.05);两组N分期、肿瘤分化程度比较差异均无统计学意义(均P>0.05)。在特征明确的患者中,RCC组NRAS突变比例更低、微卫星不稳定比例更高、有血管浸润的比例更低(均P<0.05);两组KRAS突变比例、神经侵犯、淋巴管浸润比例比较差异均无统计学意义(均P>0.05)。结论LCC患者与RCC患者相比,两者存在BMI、临床表现、肿瘤分期及血管浸润方面的差异,且后者微卫星不稳定比例更高、NRAS突变比例更低。

Objectives To compare the clinicopathological differences between left-sided and right-sided colon cancer.Methods We retrospectively analyzed 2,163 colorectal cancer patients who underwent treatment at Guangxi Medical University Affiliated Tumor Hospital between 2004 and 2019.Patients were divided into left-sided colon cancer group(LCC,n=1,634)and rightsided colon cancer group(RCC,n=529).Demographics,clinical characteristics,molecular characteristics,and pathological characteristics were compared between the two groups.Results The two groups did not differ in sex and age(P>0.05).Body mass index(BMI)was significantly higher in the LCC group than in the RCC group(P<0.05).Patients in the LCC group had significantly higher proportions of existing mucousy and bloodly stool,changes in bowel movement,and rectal distension,while patients in the RCC group had significantly higher proportions of appearing abdominal pain and abdominal mass(P<0.05).Patients in the LCC group had a significantly lower rate of T3~4 staging and M1 staging than in the RCC group(P<0.05).The two groups differed significantly in TNM staging(P<0.05).The N staging and degree of differentiation did not differ between the two groups(P>0.05).Among representative cases,patients in the RCC group had a significantly lower rate of NRAS mutation,a higher rate of microsatellite instability,and a lower rate of vascular infiltration(P<0.05).The two groups were similar in the rate of KRAS mutation,neural infiltration,and lymphatic infiltration(P>0.05).Conclusion Compared with RCC,LCC is different in BMI,clinical presentations,staging,and vascular infiltration.RCC is also more likely to have microsatellite instability but less likely to have NRAS mutation.