| Background and ObjectiveColorectal cancer is the third most commonly diagnosed cancer and frequent cause of cancer-related death worldwide.As the concept of tumor-free survival is becoming mature,it is an important direction to improve the resection rate,reduce postoperative recurrence and prolong the survival time with combining chemotherapy,molecular targeted therapy and other comprehensive treatment methods of colorectal cancer.Chemotherapy and molecular targeted therapy are still the main therapeutic methods for patients who have lost their surgical opportunities.In recent years,immunotherapy has become one of the emerging strategies for colorectal cancer.However,there is heterogeneity in the treatment response and prognosis of colorectal cancer,the exploration of prognostic factors and the research of molecular markers are the key to achieve accurate treatment and individualized treatment of colorectal cancer.Collecting 1382 patients with colorectal cancer admitted in our hospital in recent years,divided into left colon cancer group and right colon cancer group according to the primary tumor location,studying the differences in epidemiological characteristics,clinical manifestations,pathological types and survival prognosis between the two groups,and analyzing the related factors that may have influence on the survival of colorectal cancer patients.At the same time,421 cases of advanced colorectal cancer with different MSI States were further analyzed in terms of clinical pathology and molecular characteristics,which provided detailed clinical data and research basis for the prevention and treatment of colon cancer and further in-depth study.Materials and MethodsCollecting 1382 patients with sporadic colorectal cancer who were admitted to the affiliated tumor hospital of Zhengzhou university from January 2012 to December2015 with complete data,including 962 patients with left colon cancer and 420 patients with right colon cancer;421 cases of advanced colorectal cancer.Collecting information about age,sex,clinical symptoms,pathological features,treatment plan and the like of patients by reading the patient's medical records and follow-up,and grasping the prognosis and survival situation of patients by telephone follow-up.The researchers classified and analyzed the data by unified collection,grouped the patients into groups,and statistically analyzed the data between groups respectively.? 2 test was used to test the composition ratio,Kaplan-Meier method was used to draw the survival curve,and log-rank analysis was used to compare the survival time,P< 0.05 showed that there was significant statistical difference.Results1?Left colon cancer is more common in male patients,and right colon cancer is higher in female patients,the difference is statistically significant(P < 0.05).The median age of patients in the study group was 58.7 years old,and the proportion of patients aged 60 years or older in right colon cancer was higher,with statistical significance between groups(P < 0.05).Among patients with sporadic colon cancer,patients with malignant family tumor history are more common in left colon cancer,and patients with smoking and alcoholism history are higher in left colon cancer,P<0.05.2?The main clinical manifestations of patients with left colon cancer are hematochezia(40 %),changes in stool traits and defecation habits(16.3 %),intestinal obstruction(18.6 %),while those with right colon cancer are abdominal pain,abdominal distension(45.8 %),abdominal mass(30.2 %).3?The differentiation degree of left colon cancer is high,the pathological classification is adenocarcinoma and TNM stage is early.The degree of low differentiation of right colon cancer is relatively low,and the pathological types are mostly mucinous adenocarcinoma and signet ring cell carcinoma with higher malignancy,and TNM stage is late.Compared with left colon cancer,right colon cancer is more prone to postoperative local recurrence and metastasis,and MSI-H and KRAS gene mutations are more common.However,there was no significant difference in distant metastasis between left and right colon cancer(P> 0.05).4?The median survival time of the patients in this study was 51 months,and the average survival time was 49.657 months.The average survival time of left colon cancer was 53.580 months,and that of right colon cancer was 43.906 months.The 5-year survival rate of left and right colon cancer was 36.2 % vs 20.4 %.There was no significant difference in the survival prognosis of left and right colon cancer in stage I and II,P> 0.05.The survival prognosis of right colon cancer in stage III?IV was worse than that of left colon cancer,P < 0.05.5?The results of multivariate analysis showed that age,tumor location,differentiation degree,TNM stage and KRAS gene mutation could be independent risk factors for survival and prognosis of colon cancer.6?Compared with chemotherapy alone,PFS(12.281 months vs 8.707 months,P= 0.017)and OS(40.382 months vs 26.337 months,P = 0.003)in the first line treatment of advanced colorectal cancer were significantly prolonged.In the right colon cancer,PFS(9.823 months vs 6.085 months,P = 0.058)and OS(28.987 months vs 20.357 months,P= 0.311)showed no significant difference.7?KRAS wild-type patients with left colon cancer received cetuximab combined chemotherapy compared with bevacizumab combined chemotherapy,they had longer PFS(11.478 months vs 9.314 months,P = 0.059)and OS(40.595 months vs 32.615 months,P = 0.048).Compared with cetuximab combined chemotherapy PFS(11.123 months vs 9.143 months,P= 0.347)and OS(31.462 months vs 23.375 months,P =0.068),right colon cancer patients received bevacizumab combined chemotherapy.8?There was no significant difference in survival between MSI-H group and MSS / MSI-L group of advanced colorectal cancer(24.340 months vs 29.963 months),P= 0.274.MSI-H is mostly related to right colon(P = 0.017),pathological type(P=0.047),metastasis type(liver-lung metastasis,P = 0.038,simple peritoneal metastasis,P= 0.003),operation method(P = 0.043),BRAF mutation(P = 0.032).The results of multivariate analysis showed that the metastasis pattern(simple peritoneal metastasis or liver-lung lymph node metastasis)could be an independent risk factor for the prognosis of MSI-H patients.9?The median survival time of MSI-H-HL group was significantly lower than that of MSS-HL group(17.610 months vs 32.418 months)and MSS-PM group(17.610 months vs 42.408 months).The median survival time in MSI-H-PM group was the longest(56.875 months),P < 0.001Conclusions1?There are significant differences in clinicopathological features,treatment options and survival prognosis between left and right colon cancer.2?There was no significant difference in survival between MSI-H group and MSS / MSI-L group of m CRC patients.Compared with MSS / MSI-L group,MSI-H group was more common in right colon,more malignant in pathological type,more common in simple peritoneal metastasis and higher BRAF mutation rate.3?The prognosis of MSI-H type m CRC is related to its metastasis mode,and MSI-H-PM type m CRC has a better prognosis than MSI-H-HL type. |
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