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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

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"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:
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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]. 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]. 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
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