切换至 "中华医学电子期刊资源库"
高级检索
中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2019, Vol. 08 ›› Issue (06) : 546 -552. doi: 10.3877/cma.j.issn.2095-3224.2019.06.002

所属专题： 文献；

青年专家论坛

"偏左，朝右"：基于原发部位结肠癌发生机制研究进展及临床治疗决策思辨
傅中懋1, 黄陈1,†()   
  1. 1. 201600　上海交通大学附属第一人民医院胃肠外科
  • 收稿日期:2019-09-25 出版日期:2019-12-25
  • 通信作者: 黄陈
  • 基金资助:
    国家自然科学基金面上项目(No.817725276); 上海交通大学医院高峰高原计划(No.20161425); 上海交通大学医工交叉项目(No.YG2017MS28); 上海松江科技攻关项目(No.18sjkjgg23)

″Left, right″: Research progress in pathogenesis of colon cancer based on primary site and clinical treatment decision

Zhongmao Fu1, Chen Huang1,†()   

  1. 1. Department of Gastrointestinal Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 201600, China
  • Received:2019-09-25 Published:2019-12-25
  • Corresponding author: Chen Huang
  • About author:
    Corresponding author: Huang Chen, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

傅中懋, 黄陈. "偏左，朝右"：基于原发部位结肠癌发生机制研究进展及临床治疗决策思辨[J/OL]. 中华结直肠疾病电子杂志, 2019, 08(06): 546-552.

Zhongmao Fu, Chen Huang. ″Left, right″: Research progress in pathogenesis of colon cancer based on primary site and clinical treatment decision[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2019, 08(06): 546-552.

结肠癌作为消化系统最常见的恶性肿瘤之一，大约有1/5的患者在首诊时就存在着远处器官转移，肿瘤发生在左半结肠或右半结肠被认为是判断患者预后的一个重要因素。目前通过对结肠癌临床表现、发病机制的系统研究，发现左半结肠癌（LCC）与右半结肠癌（RCC）存在着明显的差异，这种差异会直接影响对患者治疗方案的选择。因此，本文着重从复发转移机制，分子生物学及治疗预后方面着手，探讨并更好地理解其差异，为结肠癌患者的个体化、精准化治疗提供进一步理论依据。

关键词: 结肠肿瘤, 预后, 原发部位, 差异, 临床治疗决策

Colon cancer is one of the most common malignant tumor of digestive system, about 1/5 of colon cancer patients had distant organ metastasis at the first diagnosis, tumor occurrence in the left colon or right colon is considered to be an important factor in judging the prognosis of patients. At present, through systematic research on the clinical manifestations and pathogenesis of colon cancer, the results showed that there was a significant difference between left-sided colon cancer (LCC) and right-sided colon cancer (RCC), which will directly affect the choice of treatment plan for patients. Therefore, in this paper, we mainly study intestinal flora, the mechanism of recurrence and metastasis and prognosis to explore and better understand the differences between left and right colon cancer, providing further theoretical basis for individualized and precise treatment of colon cancer patients.

Key words: Colonic neoplasms, Prognosis, Primary site, Difference, Clinical decision-making
表1 左右半结肠癌临床特征
特征 右半结肠 左半结肠
年龄 年龄偏大 年龄偏小
性别 女性多见 男性多见
肿瘤大小 相对较大 相对较小
腹部包块的有无 不易触及腹部包块 易触及腹部包块
病理类型 黏液腺样癌、未分化癌、印戒细胞癌 腺癌，分化程度高
临床表现 贫血、乏力、体重下降等 肠梗阻，排便习惯改变，便血腹痛
转移方式 腹膜及远处淋巴结 肝、肺转移常见
图1 左右半结肠癌分子生物学特征性差异
表2 CALGB 80405、FIRE-3、PEAK关于结肠癌左半、右半患者治疗预后结果
文献 肿瘤位置 一线化疗方案＋bev（例）vs.一线化疗方案＋cet/pani（例） OS（月） P值 PFS（月） P值
FIRE-3 LCC 149 vs. 157 28.0 vs. 38.3 0.002 10.7 vs. 10.7 0.38
RCC 50 vs. 38 23.0 vs. 18.3 0.28 9.0 vs. 7.6 0.11
CALGB 80405 LCC 152 vs. 173 32.6 vs. 39.3 0.04 11.2 vs. 12.7 0.15
RCC 78 vs. 71 29.2 vs. 13.7 0.10 10.2 vs. 7.5 0.006
PEAK LCC 53 vs. 54 43.4 vs. 32.0 未报道 14.6 vs. 11.5 未报道
RCC 22 vs. 14 17.5 vs. 21.0 未报道 8.7 vs. 12.6 未报道
表3 FIRE-3、CALGB 80405、PEAK、CRYSTAL、PRIME、20050181中抗-EGFR对LCC、RCC患者治疗预后结果
文献 治疗方案 LCC（例） vs. RCC（数） OS（月） P值 PFS（月） P值
CRYSTAL FOLFIRI＋cet 142 vs. 33 28.7 vs. 18.5 0.003 12.0 vs. 8.1 0.02
FIRE-3 FOLFIRI＋cet 157 vs. 38 38.3 vs. 18.3 <0.001 10.7 vs. 7.6 <0.001
CALGB 80405 FOLFIRI/FOLFOX＋cet 173 vs. 71 39.3 vs. 13.6 <0.001 12.7 vs. 7.5 0.002
PRIME FOLFOX＋pani 169 vs. 39 30.3 vs. 11.1 0.04 12.9 vs. 7.5 0.40
PEAK FOLFOX＋pani 53 vs. 22 43.4 vs. 17.5 0.007 14.6 vs. 8.7 0.16
20050181 FOLFOX＋pani 150 vs. 31 20.1 vs. 10.3 0.002 8.0 vs. 4.8 0.12
[1]
Siegel R, Miller K, Jemal A. Cancer statistics, 2019 [J]. CA Cancer J Clin, 2019, 69: 7-34.
[2]
曹毛毛，陈万青. 中国恶性肿瘤流行情况及防控现状[J]. 中国肿瘤临床, 2019, 46(3): 145-148.
[3]
Cannon E, Buechler S. Colon Cancer Tumor Location Defined by Gene Expression May Disagree With Anatomic Tumor Location[J]. Clin Colorectal Cancer, 2019, 6, 18(2): 149-158.
[4]
黄陈，戎泽印. 结直肠癌诊治新进展[J]. 蚌埠医学院学报, 2018, 43(10): 1293-1297.
[5]
Son HJ, Sohn SH, Lee SM, et al. Effect of estradiol in an azoxymethane/dextran sulfate sodium-treated mouse model of colorectal cancer: implication for sex difference in colorectal cancer development [J]. Cancer Res Treat, 2019, 51(2): 632-648.
[6]
Menigatti M, Truninger K, Gebbers JO, et al. Normal colorectal mucosa exhibits sex-and segment-specific susceptibility to DNA methylation at the hMLH1 and MGMT promoters [J]. Oncogene, 2009, 28: 899-909.
[7]
于明珠，张修石，王洪伟, 等. MRI联合多层螺旋CT增强扫描对结肠癌术前T分期的应用价值[J]. 现代肿瘤医学, 2016, 24(18): 2967-2971.
[8]
方立挺，施剑斐，潘细根. MRI与多层螺旋CT诊断结肠癌致肠梗阻临床价值分析[J]. 医学影像学杂志, 2018, 28(1): 157-159.
[9]
Yu L, Eresen A, Lu Y, et al. Radiomics signature for the preoperative assessment of stage in advanced colon cancer [J]. Am J Cancer Res, 2019, 9(7): 1429-1438.
[10]
吴涵，余志龙，黄陈. 人工智能技术在结直肠癌中的应用与展望[J/CD]. 中华结直肠疾病电子杂志, 2019, 8(2): 115-119.
[11]
Hugen N, Nagtegaal ID. Distinct metastatic patterns in colorectal cancer patients based on primary tumour location [J]. Eur J Cancer, 2017, 4(75): 3-4.
[12]
Tie J, Lipton L, Desai J, et al. KRAS mutation is associated with lung metastasis in patients with curatively resected colorectal cancer [J]. Clin Cancer Res, 2011, 17: 1122-130.
[13]
Urosevic J, Garcia-Albéniz X, PlaNETs E, et al. Colon cancer cells colonize the lung from established liver metastases through p38 MAPK signalling and PTHLH [J]. Nat Cell Biol, 2014, 16: 685-694.
[14]
Yaeger R, Cercek A, Chou JF, et al. BRAF mutation predicts for poor outcomes after metastasectomy in patients with metastatic colorectal cancer [J]. Cancer, 2014, 8, 120(15): 2316-2324.
[15]
Yaeger R, Cowell E, Chou JF, et al. RAS mutations affect pattern of metastatic spread and increase propensity for brain metastasis in colorectal cancer [J]. Cancer, 2015, 121: 1195-1203.
[16]
Rungroj N, Sudtachat N, NETstuwakul C, et al. Association between human prothrombin variant (T165M) and kidney stone disease [J]. PLoS One, 2012, 7(9): e45533.
[17]
Yaeger R, Chatila WK, Lipsyc MD, et al. Clinical sequencing defines the genomic landscape of metastatic colorectal cancer [J]. Cancer Cell, 2018, 33(1): 125-136.e3.
[18]
Carethers JM, Jung BH. GeNETsics and geNETsic biomarkers in sporadic colorectal cancer [J]. Gastroenterology, 2015, 149: 1177-1190. e3.
[19]
Shen H, Yang J, Huang Q, et al. Different treatment strategies and molecular features between right-sided and left-sided colon cancers [J]. World J Gastroenterol, 2015, 21(21): 6470-6478.
[20]
East JE, Atkin WS, Bateman AC, et al. British Society of Gastroenterology position statement on serrated polyps in the colon and rectum [J]. Gut, 2017, 66: 1181-1196.
[21]
Zlobec I, Bihl M, Foerster A, et al. Comprehensive analysis of CpG island methylator phenotype (CIMP)-high, -low, and-negative colorectal cancers based on protein marker expression and molecular features [J]. J Pathol, 2011, 225(3): 336-343.
[22]
周薇，毕嘉欣，冶亚平, 等. 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[J]. 临床与实验病理学杂志, 2018, 34(9): 953-956.
[23]
Heinemann V, von Weikersthal LF, Decker T, et al. FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3): a randomised, open-label, phase 3 trial [J]. Lancet Oncol, 2014, 15: 1065-1075.
[24]
von Einem JC, Heinemann V, von Weikersthal LF, et al. Left-sided primary tumors are associated with favorable prognosis in patients with KRAS cod on 1213 wild-type metastatic colorectal cancer treated with cetuximab plus chemotherapy: an analysis of the AIO KRK-0104 trial [J]. J Cancer Res Clin Oncol, 2014, 140(9): 1607-1614.
[25]
Ulivi P, Scarpi E, Chiadini E, et al. Right-vs. left-sided metastatic colorectal cancer: differences in tumor biology and bevacizumab efficacy [J]. Int J Mol Sci, 2017, 18(6): 1240-1251.
[26]
Diagnosis And Treatment Guidelines For Colorectal Cancer Working Group Chinese Society Of Clinical Oncology CSCO. Chinese Society of Clinical Oncology (CSCO) diagnosis and treatment guidelines for colorectal cancer 2018 [J]. Chinese Journal of Cancer Research, 2019, 31(1): 117-134.
[27]
王畅. 微卫星状态对结肠癌术后辅助化疗决策的影响[J/CD]. 中华结直肠疾病电子杂志, 2018, 7(3): 207-213.
[28]
杨琦，孔祥兴，丁克峰. 左、右半结肠癌的预后及分子生物学特征差异[J]. 世界华人消化杂志, 2016, 24(24): 3556-3563.
[29]
Cha Y, Kim KJ, Han SW, et al. Adverse prognostic impact of the CpG island methylator phenotype in metastatic colorectal cancer [J]. Br J Cancer, 2016, 115(2): 164-171.
[30]
Guinney J, Dienstmann R, Wang X, et al. The consensus molecular subtypes of colorectal cancer [J]. Nat Med, 2015, 21: 1350-1356.
[31]
Bauer KM, Hummon AB, Buechler S. Right-side and left-side colon cancer follow different pathways to relapse [J]. Mol Carcinog, 2012, 51(5): 411-421.
[32]
黄陈，章靖. 左半结肠癌梗阻外科治疗策略演变[J/CD]. 中华结直肠疾病电子杂志, 2017, 6(2):94-97.
[1] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[2] 高杰红, 黎平平, 齐婧, 代引海. ETFA和CD34在乳腺癌中的表达及与临床病理参数和预后的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 64-67.
[3] 李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[4] 梁孟杰, 朱欢欢, 王行舟, 江航, 艾世超, 孙锋, 宋鹏, 王萌, 刘颂, 夏雪峰, 杜峻峰, 傅双, 陆晓峰, 沈晓菲, 管文贤. 联合免疫治疗的胃癌转化治疗患者预后及术后并发症分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 619-623.
[5] 张志兆, 王睿, 郜苹苹, 王成方, 王成, 齐晓伟. DNMT3B与乳腺癌预后的关系及其生物学机制[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 624-629.
[6] 屈翔宇, 张懿刚, 李浩令, 邱天, 谈燚. USP24及其共表达肿瘤代谢基因在肝细胞癌中的诊断和预后预测作用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 659-662.
[7] 顾雯, 凌守鑫, 唐海利, 甘雪梅. 两种不同手术入路在甲状腺乳头状癌患者开放性根治性术中的应用比较[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 687-690.
[8] 付成旺, 杨大刚, 王榕, 李福堂. 营养与炎症指标在可切除胰腺癌中的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 704-708.
[9] 陈樽, 王平, 金华, 周美玲, 李青青, 黄永刚. 肌肉减少症预测结直肠癌术后切口疝发生的应用研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 639-644.
[10] 关小玲, 周文营, 陈洪平. PTAAR在乙肝相关慢加急性肝衰竭患者短期预后中的预测价值[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 841-845.
[11] 张润锦, 阳盼, 林燕斯, 刘尊龙, 刘建平, 金小岩. EB病毒相关胆管癌伴多发转移一例及国内文献复习[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 865-869.
[12] 陈晓鹏, 王佳妮, 练庆海, 杨九妹. 肝细胞癌VOPP1表达及其与预后的关系[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 876-882.
[13] 董晓斌, 张静, 苏莎莎, 莎比亚·沙吾提, 盛好. 溃疡性结肠炎患者相关环状RNA 差异表达谱分析及功能研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 499-509.
[14] 董佳, 王坤, 张莉. 预后营养指数结合免疫球蛋白、血糖及甲胎蛋白对HBV 相关慢加急性肝衰竭患者治疗后预后不良的预测价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 555-559.
[15] 王景明, 王磊, 许小多, 邢文强, 张兆岩, 黄伟敏. 腰椎椎旁肌的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 846-852.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号