Comparison of Clinicopathological and Survival Features of Right and Left Colon Cancers: Experience of the Medical Oncology Department of Fez

Right-sided colon cancers (RCC) and left-sided colon cancers (LCC) have different epidemiological, physiological, pathological, genetic, and clinical characteristics, which result in differences in the course, prognosis, and outcome of disease. The objective of our study is to compare right-sided colon cancers and left-sided colon cancers regarding clinicopathological and survival characteristics. This is a retrospective study of 664 patients with colon cancer treated at the medical oncology department of Fez over a period from December 2009 to September 2020. Rectosigmoid, descending colon, and splenic flexure tumors were considered left-sided colon cancers, whereas ascending colon tumors were considered right-sided colon cancers. The Kaplan Meier method was used to estimate median survival. The study included 664 patients (female, 47%) having colon cancer with a median age of 60 years (23 - 83). Of the patients, 78.5% (n = 519) had LCC and 19.36 % (n = 128) had RCC. The rate of patients aged ≥ 65 years and the rate of patients with a family history of colon cancer was higher in the LCC patients. The proportion of poorly differentiated adenocarcinomas represented 3%, of which 63% had cancer of the right colon. There was a significantly higher proportion of higher T stage (T3-4: 62% vs 38%) in right sided tumors as compared to left sided tumors. The rate of metastatic patients was 64.1% in the RCC group and 43% in the LCC group. The median follow-up period was 14 months in the RCC group and 19 months in the LCC group with higher median overall survival in the LCC group (32 vs 21 months). We found histopathological differences between right and left sided colon cancer. Tumors on the right colon were found to be more aggressive, as expressed by poorer differentiation, higher T stage associated with a median overall survival better in left colon cancer.

Different treatment strategies and molecular features between right-sided and left-sided colon cancers

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 mi RNA-31,while LCC is associated with CIN,p53,NRAS,mi RNA-146 a,mi RNA-147 b,and mi RNA-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 progressionto 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.

Right and Left Colon Cancer: Clinico-Pathological Features and Treatment Results (South Egypt Cancer Institute Experience)

Background: Colon cancer (CC) ranks as the third most common cancer worldwide and is considered the second leading cause of cancer death. Recently, many international studies have made the observation that right and left colon cancer have many significant differences regarding clinico-pathological characteristics and primary tumor location has a crucial impact on treatment outcomes and overall survival. Our study was conducted to verify the presence of significant differences between right and left colon cancer. Patients and Methods: This study is a retrospective cohort study which aimed at comparing right and left colon cancer as regards clinico-pathological data and treatment results among patients with colon cancer receiving treatment at South Egypt Cancer Institute (SECI) during the period from 1/2008 to 12/2018. A sample size of 160 cases of colon cancer patients (80 diagnosed as right colon cancer and 80 diagnosed as left colon cancer) was randomly selected from our South Egypt Cancer Institute (SECI)’s tumor registry. Statistical analysis was done using SPSS program version 20. Difference was considered statistically significant at P-value < 0.05. Survival curves were conducted using the Kaplan-Meier methods and were compared with the log-rank test. Results: Right colon cancer occurred at an older age and was more commonly presented with abdominal pain while left colon cancer was more commonly presented with bleeding manifestations. More cases of the right side underwent curative surgeries whereas more palliative surgeries were performed to left-sided cases. Left sided cases were associated with a more advanced stage at diagnosis while right-sided cases were associated with a better response to first-line chemotherapy. More cases of the left side died due to metastatic disease. On the other hand, our findings demonstrated no differences between both sides regarding gender predilection, risk factors, sites of metastases, number of metastatic organs, histo-pathological examination and grading, response to second- or third-line chemotherapy, chemotherapy toxicity (hematological or non-hematological), overall survival, progression-free survival, or disease-free survival. Conclusion: Primary tumor location of colon cancer has a significant effect on clinico-pathological characteristics and treatment outcomes.

Expression of cyclin-dependent kinase 9 is positively correlated with the autophagy level in colon cancer

BACKGROUND Cyclin-dependent kinase 9(CDK9)expression and autophagy in colorectal cancer(CRC)tissues has not been widely studied.CDK9,a key regulator of transcription,may influence the occurrence and progression of CRC.The expression of auto-phagy-related genes BECN1 and drug resistance factor ABCG2 may also play a role in CRC.Under normal physiological conditions,autophagy can inhibit tumorigenesis,but once a tumor forms,autophagy may promote tumor growth.Therefore,understanding the relationship between autophagy and cancer,partic-ularly how autophagy promotes tumor growth after its formation,is a key motivation for this research.AIM To investigate the relationship between CDK9 expression and autophagy in CRC,assess differences in autophagy between left and right colon cancer,and analyze the associations of autophagy-related genes with clinical features and prognosis.METHODS We collected tumor tissues and paracarcinoma tissues from colon cancer patients with liver metastasis to observe the level of autophagy in tissues with high levels of CDK9 and low levels of CDK9.We also collected primary tissue from left and right colon cancer patients with liver metastasis to compare the autophagy levels and the expression of BECN1 and ABCG2 in the tumor and paracarcinoma tissues.RESULTS The incidence of autophagy and the expression of BECN1 and ABCG2 were different in left and right colon cancer,and autophagy might be involved in the occurrence of chemotherapy resistance.Further analysis of the rela-tionship between the expression of autophagy-related genes CDK9,ABCG2,and BECN1 and the clinical features and prognosis of colorectal cancer showed that the high expression of CDK9 indicated a poor prognosis in colorectal cancer.CONCLUSION This study laid the foundation for further research on the combination of CDK9 inhibitors and autophagy inhibitors in the treatment of patients with CRC.

达芬奇机器人辅助右半结肠癌根治术的学习曲线分析

目的:分析达芬奇机器人辅助右半结肠癌根治术的学习曲线。方法:选择2016年3月至2022年6月在郑州大学第一附属医院接受达芬奇机器人辅助右半结肠癌根治术的70例患者。手术由同一组具备丰富结直肠手术经验的团队连续开展。采用累积和分析法拟合该手术的学习曲线。结果:拟合的学习曲线方程为Y=-0.003 X^(3)-0.003 X^(2)+12.849 X-130.951,R^(2)=0.771,P<0.05。第41例时曲线达到峰值,据此将学习曲线分为学习提高与稳定掌握两个阶段。与学习提高阶段相比,稳定掌握阶段手术时间缩短(P=0.005),术中出血量减少(P=0.048),术后并发症减少(P=0.039)。结论:41例为有丰富结直肠手术经验的临床医师稳定掌握达芬奇机器人辅助右半结肠癌根治术所需最小手术例数。

基于TCGA研究左右半结肠癌基因表达差异及苦参-大血藤-半枝莲作用机制

【目的】探讨左半结肠癌与右半结肠癌的基因表达差异及大肠癌核心药对苦参-大血藤-半枝莲作用于左右半结肠癌的机制差异。【方法】下载134例左半结肠癌及194例右半结肠癌患者癌症基因组图谱(TCGA)的转录组数据,应用R软件实现2组差异基因分析及京都基因与基因组百科全书(KEGG)通路富集分析;通过BATMAN-TCM数据库获取苦参-大血藤-半枝莲药对的活性成分及靶点,基于左右半结肠癌差异基因,分别进行药对-左/右半结肠癌KEGG富集分析、蛋白质互作(PPI)网络构建,比较药对治疗左、右半结肠癌富集的生物信号通路差异及关键靶点差异。【结果】左半结肠癌与右半结肠癌相对于正常癌旁组织共同的差异表达基因共6051个,左半结肠癌特异性的差异表达基因共1958个,右半结肠癌特异性的差异表达基因共1739个;左半结肠癌特异性KEGG富集通路14条,右半结肠癌特异性KEGG富集通路23条。苦参-大血藤-半枝莲药对活性化合物共85个,对应的靶点合计469个,药对-左半结肠癌靶点富集于10条KEGG信号通路,关键靶点为DRD2、CACNA1C、HTR3A、COMT、TH,药对-右半结肠癌靶点富集于1条KEGG信号通路,核心靶点为HTR3A、DRD2、TH、AGT、GRIN2B。【结论】左半结肠癌与右半结肠癌存在基因表达差异:左半结肠癌与免疫功能异常、AMPK信号通路异常等机制有关,右半结肠癌与中性粒细胞外陷阱形成、酒精中毒、Hippo信号通路异常等机制有关。除调控细胞周期及必需氨基酸代谢等机制外,苦参-大血藤-半枝莲药对对调节左半结肠癌肠道内分泌功能、抑制右半结肠癌炎症反应具有特异性作用,亦可能对结肠癌患者具有情绪调控作用。

膜解剖指导腹腔镜尾侧入路右半结肠癌根治术治疗结肠癌患者的临床效果观察

目的:观察分析膜解剖指导腹腔镜右半结肠癌根治术尾侧入路治疗结肠癌患者的临床效果。方法:将2021年9月—2023年12月收治的86例右半结肠癌患者纳入研究,随机分为实验组和对照组,实验组行膜解剖指导腹腔镜尾侧入路右半结肠癌根治术,对照组行腹腔镜中间入路右半结肠癌根治术,比较两组手术指标和术后恢复指标。结果:实验组患者手术进行时间以及出血量均低于对照组(P<0.05),两组淋巴结清扫数、中转开腹率对比无差异(P>0.05)。实验组术后肛门排气、进食流质、住院时间低于对照组(P<0.05),实验组术后并发症发生率显著低于对照组(P<0.05)。结论:膜解剖指导腹腔镜尾侧入路右半结肠癌根治术治疗右半结肠癌优势显著,可提高临床疗效,促进康复,值得推广。

贝伐珠单抗联合FOLFIRI方案治疗微卫星稳定型晚期复发左、右半结直肠癌的疗效对比

目的探讨应用贝伐珠单抗联合FOLFIRI方案治疗微卫星稳定(MSS)型晚期复发左、右半结直肠癌的疗效差异。方法回顾性分析徐州医科大学附属医院2018年9月—2021年12月收治的58例一线应用贝伐珠单抗联合FOLFIRI方案治疗的MSS型晚期复发左、右半结直肠癌患者的临床资料,比较MSS型左、右半结直肠癌患者的临床特征、总生存时间(OS)、无进展生存时间(PFS)、疾病控制率(DCR)、客观缓解率(ORR)及1、2年生存率。结果MSS型晚期右半结肠癌患者合并不完全肠梗阻所占比例更高(P<0.05),MSS型晚期右半结肠癌患者较左半结直肠癌患者更易合并贫血及体重下降>5 kg(均P<0.05),肿瘤最大直径≥5 cm的右半结肠癌患者所占比例较左半结直肠癌患者高(P<0.05);左半结直肠癌患者中男性患者占比小于右半结肠癌患者(P<0.05)。2组治疗后癌胚抗原(CEA)和糖类抗原199(CA199)较治疗前明显下降(均P<0.05)。右半结肠癌组发生肝转移患者所占比例高于左半结直肠癌组(P<0.05)。左半结直肠癌组与右半结肠癌组ORR分别为14.8%和29.0%(P<0.05),DCR分别为74.1%和87.1%,差异无统计学意义(P>0.05)。左半结直肠癌组的1、2年生存率分别为92.6%、81.4%,右半结肠癌组分别为83.8%、61.3%,差异有统计学意义(P<0.05)。左半结直肠癌组的中位PFS长于右半结肠癌组(13.7个月vs 10.1个月,P<0.05),左半结直肠癌组的中位OS也明显长于右半结肠癌组(35.3个月vs 27.2个月,P<0.05),预后相对较好。结论应用贝伐珠单抗联合FOLFIRI方案治疗MSS型晚期复发结直肠癌患者,左、右半结直肠癌患者的临床特征、转移部位及生存状况存在差异。

腹腔镜左半结肠癌根治术中采用IMA-CMA技术对淋巴结清扫的影响分析

目的 探讨腹腔镜左半结肠癌根治术中采用肠系膜下动脉优先解剖联合完全内侧入路(Priority Anatomy of the Inferior Mesenteric Artery Combined with Complete Medial Approach,IMA-CMA)技术对淋巴结清扫的影响。方法 回顾性选取2019年5月-2023年5月南平第一医院治疗的81例腹腔镜左半结肠癌根治术患者的临床资料,根据手术方法不同分为IMA-CMA组和对照组,其中IMA-CMA组44例,对照组37例。对照组采用传统入路技术,IMA-CMA组采用IMA-CMA技术,比较两组患者的手术相关指标、淋巴结清扫情况、术后肠功能恢复情况、并发症发生情况及复发率和转移率。结果 同对照组相比较,IMA-CMA组手术时间较短,术中出血量较低,253组淋巴结清扫数目较多,差异有统计学意义(P均<0.05)。同对照组相比较,IMA-CMA组腹痛腹胀持续时间、术后排便时间及术后排气时间均较短,差异有统计学意义(P均<0.05)。IMA-CMA组并发症发生率为4.55%,低于对照组的18.92%,差异有统计学意义(χ^(2)=4.204,P<0.05)。术后1年,IMA-CMA组和对照组复发率、转移率比较,差异无统计学意义(P均>0.05)。结论 腹腔镜左半结肠癌根治术中采用IMA-CMA技术能够缩短手术时间,减少术中出血量,对淋巴结的清扫情况更佳,且可以改善术后肠功能恢复情况及并发症发生情况,不增加复发和转移风险。

Short and long-term outcomes of laparoscopic colectomy in obese patients

AIM:To investigate the impact of laparoscopic colectomy on short and long-term outcomes in obese patients with colorectal diseases.METHODS:A total of 98 obese(body mass index>30kg/m2)patients who underwent laparoscopic(LPS)right or left colectomy over a 10 year period were identified from a prospective institutionally approved database and manually matched to obese patients who underwent open colectomy.Controls were selected to match for body mass index,site of primary disease,American Society of Anesthesiologists score,and year of surgery(±3 year).The parameters analyzed included age,gender,comorbid conditions,American Society of Anaesthesiologists class,diagnosis,procedure,and duration of operation,operative blood loss,and amount of homologous blood transfused.Conversion rate,intra and postoperative complications as were as reoperation rate,30 d and long-term morbidity rate were also analyzed.For continuous variables,the Student’s t test was used for normally distributed data the Mann-Whitney U test for nonnormally distributed data.The Pearson’sχ2tests,or the Fisher exact test as appropriate,were used for proportions.RESULTS:Conversion to open surgery was necessary in 13 of 98 patients(13.3%).In the LPS group,operative time was 29 min longer and blood loss was 78 mL lower when compared to open colectomy(P=0.03,P=0.0001,respectively).Overall morbidity,anastomotic leak and readmission rate did not significantly differ between the two groups.A trend toward a reduction of wound complications was observed in the LPS when compared to open group(P=0.09).In the LPS group,an earlier recovery of bowel function(P=0.001)and a shorter length of stay(P=0.03)were observed.After a median follow-up of 62(range 12-132)mo 23patients in the LPS group and 38 in the open group experienced long-term complications(LPS vs open,P=0.03).Incisional hernia resulted to be the most frequent long-term complication with a significantly higher occurrence in the open group when compared to the laparoscopic one(P=0.03).CONCLUSION:Laparoscopic colectomy in obese patients is safe,does not jeopardize postoperative complications and resulted in lower incidence of long-term complications when compared with open cases.

LRPPRC的表达与结肠癌临床指标和预后的相关性研究

目的研究LRPPRC表达与结肠癌临床指标和预后的相关性。方法采用免疫组化技术检测LRPPRC在结肠癌组织的表达,实验数据和临床指标及预后的相关性分析使用SPSS软件,P<0.05为差异有统计学意义。结果LRPPRC在结肠癌组织的表达显著高于癌旁组织。LRPPRC蛋白表达和患者的原发肿瘤数量显著正相关,而和预后显著负相关,且是结肠癌预后的独立预测因素。统计学分析显示,右半结肠癌亚组的T分期、临床分期和总生存期均显著更差。同时,LRPPRC的异常高表达和右半结肠癌组患者更多的原发肿瘤数量及更差的总生存期显著相关,但其与左半结肠癌亚组的各项临床指标及预后均无关。结论LRPPRC的过表达促进了右半结肠癌的进展,它可能是右半结肠癌预后和治疗的重要标记物。

错配修复蛋白在左、右半结肠癌组织中的表达差异及其临床意义

目的:探讨错配修复(mismatch repair,MMR)蛋白在左半结肠癌(left colon cancer,LCC)和右半结肠癌(right colon cancer,RCC)组织中的表达及其临床意义。方法:收集2014年01月至2017年12月间在我院接受手术治疗的368例结肠癌患者的临床病理资料,根据肿瘤原发部位分为LCC组与RCC组,分析MMR蛋白在LCC、RCC组织中的表达是否存在显著差异,同时探讨LCC、RCC的临床病理特征,并分析MMR蛋白对LCC、RCC预后的指导意义。结果:368例结肠癌组织中dMMR为25.8%。单因素分析结果显示,在不同肿瘤部位MMR蛋白的表达有显著性差异(P<0.05),RCC组中dMMR为17.4%,明显高于LCC组的8.4%;另外LCC、RCC在肿瘤直径、分化程度、组织学类型上存在统计学差异(均P<0.05)。进一步Logistic多因素分析发现:肿瘤直径≥5 cm(OR=1.762,95%CI:1.144~2.713,P=0.010)、dMMR(OR=2.672,95%CI:1.617~4.417,P=0.000)均为RCC的独立相关因素。Kaplan-Meier生存分析显示,dMMR组患者的OS显著高于pMMR组患者(P=0.035);经肿瘤部位分层分析发现,RCC组中dMMR患者的OS显著高于pMMR患者(P=0.004),但在LCC组中dMMR患者与pMMR患者的OS无显著性差异(P=0.951)。结论:RCC中dMMR发生率明显高于LCC,且仅在RCC中提示着较好的预后作用,而在LCC中无预后指示作用。

贝伐珠单抗序贯联合mFOLFOX或FOLFIRI方案治疗转移性结直肠癌的临床疗效观察

目的:探讨贝伐珠单抗联合mFOLFOX或FOLFIRI方案作为一线治疗,进展后相互转换为二线治疗在转移性结直肠癌治疗中的真实疗效对比。方法:选取我院于2017年01月至2021年06月收治的101例晚期结直肠癌患者,采取贝伐珠单抗联合mFOLFOX或FOLFIRI方案作为一线治疗,进展后相互转换为二线治疗,观察临床疗效及不良反应情况。结果:贝伐珠单抗先联合mFOLFOX后FOLFIRI组(以下称先mFOLFOX组/pre mFOLFOX)的一线ORR(objective response rate)为44.2%,DCR(disease control rate)为86.5%;二线ORR为24%,DCR为60%。贝伐珠单抗先联合FOLFIRI后mFOLFOX组(以下称先FOLFIRI组/pre FOLFIRI)的一线ORR为42.9%,DCR为81.6%;二线ORR为29.2%,DCR为62.5%。两组间的一/二线ORR及DCR差异均未达统计学意义。Kaplan-Meier分析显示先mFOLFOX6组与先FOLFIRI组的中位PFS(progression-free survival)-1(一线PFS)、中位PFS-2(二线PFS)及OS均未达统计学差异(P>0.05)。COX多因素分析结果显示两组在肿瘤原发部位(左、右半结肠)、BRAF基因状态的OS差异有统计学意义(P=0.017;P=0.021)。两组中血液学、非血液学和贝伐珠单抗相关不良事件的发生率分别为29%,24%和11%。两组中不良反应发生情况比较差异无统计学意义(P=0.53)。结论:贝伐珠单抗联合化疗治疗晚期转移性结直肠癌,一线为联合mFOLFOX或FOLFIRI,进展后相互转化为二线,患者临床获益均明显,二组无显著差异,且不良反应可控,并且BRAF基因野生型、左半结肠癌的患者OS更长,获益更明显。

贝伐珠单抗联合化疗治疗KRAS突变型晚期左、右半结肠癌疗效的对比分析

目的:对比分析姑息一线应用贝伐珠单抗联合化疗治疗KRAS突变型晚期左、右半结肠癌的临床疗效。方法:回顾性分析我院于2016年09月至2020年09月收治的83例一线应用贝伐珠单抗联合化疗治疗KRAS突变型晚期左、右半结肠癌患者,比较KRAS突变型左、右半结肠癌患者的临床特征、客观缓解率(ORR)、疾病控制率(DCR)、无进展生存时间(PFS)、18个月生存率、总生存时间(OS)。结果:KRAS突变型晚期右半结肠癌(RSCC)患者合并不完全肠梗阻及体重减轻>5 kg所占比例更高(P=0.369、P=0.009),KRAS突变型晚期左半结肠癌(LSCRC)患者更易合并中重度以上的贫血(P=0.154)。KRAS突变型LSCRC患者发生腹腔种植转移及远处器官转移的患者比例高于RSCC患者(P>0.05)。KRAS突变型LSCRC患者与RSCC患者ORR分别为29.3%和28.6%(P=0.944),DCR分别为87.8%和90.5%(P=0.696)。18个月生存率LSCRC组为80.05%,RSCC组为76.2%,差异无统计学意义(P=0.635)。KRAS突变型LSCRC患者中位PFS差于RSCC患者(8个月vs 9.8个月,P=0.004),KRAS突变型LSCRC患者中位OS优于KRAS突变型RSCC患者中位OS(22.8个月vs 21个月,P=0.001)。结论:姑息一线应用贝伐珠单抗联合化疗治疗KRAS基因突变型mCRC患者,左、右半结肠癌的远期疗效存在差异。

腹腔镜右半结肠癌根治术三种不同手术入路的临床效果对比

目的:探讨腹腔镜右半结肠癌根治术采用尾侧联合中间入路、中间入路及完全头侧入路3种手术入路方式的效果。方法:回顾性分析2019年8月—2022年8月福建医科大学附属南平第一医院收治的84例择期实施腹腔镜右半结肠癌根治术的患者的临床资料,依据手术入路方式的不同实施分组,尾侧联合中间入路患者纳入A组,中间入路患者纳入B组,完全头侧入路患者纳入C组,各28例。比较三组术中情况、术后情况、炎症指标及并发症发生情况。结果:三组术中失血量及淋巴结清扫个数比较,差异无统计学意义(P>0.05);A组、B组手术时间短于C组,且A组短于B组,差异有统计学意义(P<0.05)。三组疼痛起始时间及术后引流量比较,差异无统计学意义(P>0.05)。A组、B组首次排气时间短于C组,且A组短于B组,差异有统计学意义(P<0.05)。术前、术后,三组白细胞计数及C反应蛋白水平比较,差异无统计学意义(P>0.05)。三组并发症总发生率比较,差异无统计学意义(P>0.05)。结论:腹腔镜右半结肠癌根治术采用尾侧联合中间入路、中间入路及完全头侧入路3种手术入路方式在安全性、短期疗效方面差异不明显,其中尾侧联合中间入路方式术中操作时间明显缩短,操作方法易于掌握,尤其适合开展腹腔镜右半结肠癌根治术经验较少的低年资医生。

晚期左右半结肠癌患者组织MSI、KRAS、BRAF状态与疗效的相关性

目的:探讨晚期左右半结肠癌患者组织微卫星不稳定型(MSI)、原癌基因(KRAS)、丝氨酸/苏氨酸蛋白激酶(BRAF)状态与疗效的相关性。方法:选取兴山县人民医院80例晚期结肠癌患者为研究对象,均接受贝伐珠单抗联合化疗,根据化疗4周期后疗效分为疾病控制组(DC组,n=57)和疾病进展组(PD组,n=23)。比较两组患者的性别、年龄、功能状态(KPS)评分、病理分型、肿瘤部位、MSI、KRAS及BRAF状态,采用多因素Logistic回归分析影响贝伐珠单抗联合化疗治疗晚期左右半结肠癌患者临床疗效的独立危险因素。结果:DC组与PD组的性别、年龄、功能状态(KPS)评分、病理分型、肿瘤部位、KRAS状态比较,差异无统计学意义(P>0.05);但PD组的低频微卫星不稳定型(MSI-L)+微卫星稳定型(MSS)、BRAF突变型占比高于DC组,差异有统计学意义(P<0.05);通过多因素Logistic回归分析结果显示,MSI-L+MSS(β=0.476,OR=1.610,95%CI=1.252~2.069)、BRAF突变型(β=0.863,OR=2.370,95%CI=1.432~3.922)是影响贝伐珠单抗联合化疗治疗晚期左右半结肠癌患者临床疗效的独立危险因素(P<0.05)。Pearson法分析结果显示,组织MSI-L+MSS、BRAF突变型与疗效呈明显负相关(P<0.05)。结论:联合检测组织MSI、BRAF基因状态可用于评估晚期左右半结肠癌患者临床疗效,MSI-L+MSS、BRAF突变型与疗效呈明显负相关。

奥沙利铂、卡培他滨、氟尿嘧啶治疗左右半结肠癌患者的效果比较

目的:比较奥沙利铂、卡培他滨、氟尿嘧啶治疗对左、右半结肠癌的治疗效果。方法:选取百色市人民医院2021年1月—2022年12月左、右半结肠癌患者85例作为研究对象,根据病变部位分为左半组(左半结肠癌患者,n=41)和右半组(右半结肠癌患者,n=44)。两组均采用奥沙利铂、卡培他滨、氟尿嘧啶化疗。比较两组治疗效果、血清肿瘤标志物与炎性因子水平。结果:左半组疾病控制率高于右半组,差异有统计学意义(P=0.033);治疗后,左半组癌胚抗原、甲胎蛋白、糖类抗原199水平低于右半组,差异有统计学意义(P<0.001);治疗后,左半组白细胞介素-2、肿瘤坏死因子-α、γ-干扰素水平低于右半组,差异有统计学意义(P<0.001)。结论:奥沙利铂、卡培他滨、氟尿嘧啶治疗方案对左半结肠癌的治疗效果优于右半结肠癌,对左半结肠癌患者的血清肿瘤标志物与炎性因子的调节作用更强。

INHBA基因表达上调与左、右半结肠癌临床病理特征及预后的相关性

目的初步探讨左、右半结肠癌基因转录水平的分子差异,及其差异表达基因INHBA与结肠癌临床病理特征及预后的相关性。方法收集具有完整随访资料的结肠癌标本,分析左、右半结肠癌患者的生存情况,同时利用公共数据库中的结肠癌数据,筛选左、右半结肠癌组织的差异表达基因,并应用RT-PCR及免疫组化分析差异表达基因INHBA的表达水平与结肠癌临床病理特征及预后的相关性。结果结直肠癌公共数据库分析结果显示,左、右半结肠癌转录组水平差异表达基因在TGF-β、NF-κB等信号通路中显著富集,TGF-β通路中的相关差异表达基因INHBA在右半结肠癌组织中的mRNA及蛋白表达水平显著高于左半结肠癌(P <0. 05),并且INHBA高表达与右半结肠癌的脉管浸润、远处转移及不良预后呈正相关(P <0. 05)。结论 INHBA基因在右半结肠癌组织中的表达水平显著高于左半结肠癌,并且其表达与患者的恶性进展及不良预后密切相关,INHBA表达上调可能在右半结肠癌的发生和演进过程中发挥着重要作用。

不同发病部位结肠癌临床特征及预后分析

目的分析不同发病部位结肠癌的临床特征和预后。方法分析2007年1月-2010年6月在本院治疗的361例结肠癌患者资料,其中左半结肠癌194例,右半结肠癌167例。对患者发病年龄、性别、临床表现、组织学类型、有无脉管癌栓、淋巴结转移情况、远处转移、临床分期等进行分析。结果右半结肠癌患者与左半结肠癌相比,发病年龄较高(>60岁,31.1%vs 18.0%),女性居多(61.1%vs 41.8%)。右半结肠癌的首发症状主要表现为腹部疼痛(37.3%)、便血(22.8%),部分可扪及腹部包块(23.4%);左半结肠癌表现为便血(54.1%)、肠梗阻(11.3%)。右半结肠癌与左半结肠癌低分化率(24.5%vs12.9%)及脉管癌栓率(11.4%vs 6.7%)差异有统计学意义(P<0.05)。右半结肠癌5年生存率69.5%,低于左半结肠癌的77.3%(P<0.05)。结论左、右半结肠癌临床病理特征及预后不尽相同;右半结肠癌的发病年龄更大,女性发病率更高,低分化及脉管癌栓更多见,恶性程度更高,5年生存率更低。

左右半结肠癌的差异及临床治疗理念

结肠癌是常见的消化道恶性肿瘤之一,近年来左右半结肠癌治疗和预后的关系愈发受到临床重视。左、右半结肠癌在胚胎来源、解剖结构、生理功能、分子特征、致癌机制、临床特征、治疗疗效、复发转移模式、生存预后方面均存在差异,被认为是完全不同的疾病。在临床治疗和今后的研究中需充分考虑这些特点,才能使治疗更加个体化,研究更具有针对性。