愚愚学园
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2016年6月3-7日，一年一度的美国临床肿瘤学会（American Society of Clinical Oncology，ASCO）年会在芝加哥举办。6月5日上午的消化系统（结直肠）肿瘤口头报告专场上，一项摘要号为3505的数据分析，对原发肿瘤位置与结直肠癌预后之间的关系进行了评估，整理如下：
包括CALGB/SWOG 80405的临床试验显示以原始肿瘤位置为基础的结直肠癌患者的总生存期存在差异，然而这一信息尚未常规纳入研究设计中。这项研究的目的是在特定分期的结直肠癌患者队列中评估原始肿瘤位置对预后的影响。
SEER（Surveillance Epidemiology and End Results Program）追踪原发结直肠癌的位置。研究人员采用SEER数据对原始位置特征进行描述，右半原始位置=盲肠到横结肠；左半原始位置=脾曲到乙状降结肠；直肠原始位置=直肠乙状结肠和直肠。研究人员于2007年到2011年之间在SEER区域确认了原发性结直肠癌诊断的患者，并对他们随访至2013年以确定诊断分期。研究人员对中位和3-年存活率进行测量，同时采用Kaplan-Meier曲线和Cox回归用于比较不同群组之间的OS。在调整的Cox模型中，纳入年龄，性别，种族，民族，和确诊年龄以评估相对于左半肿瘤，直肠和右半肿瘤死亡的危险比（HR）。
右半原发性结直肠癌预后差于左半原发性癌和直肠癌，在调整其他临床和人口统计学特征差异后这种差异仍然存在。这种相关性在I期和II期癌症中不太一致。
在以人群为基础的III期和IV期结直肠癌患者中，右半原发性肿瘤患者的表现出较差的生存期。这种异质性论证了原始位置报告的一致性，为了更好地理解这种机制为预后表型差异垫下的基础，需要开展下一步包括分子分型的研究。
原文摘要：
The relationship between primary tumor sidedness and prognosis in colorectal cancer.(Abstract3505)
Authors：Deborah Schrag, Shicheng Weng,et al
Session Type：Oral Abstract Session
Background: Clinical trials including CALGB/SWOG 80405 reveal differences in overall survival for patients with colorectal cancer based on the location of the 1° tumor yet this information is not routinely included in study design, reporting or patient counseling. Objective: To evaluate the impact of 1° tumor location on prognosis among stage-specific cohorts of patients with colorectal cancer.
Methods: The Surveillance Epidemiology and End Results Program (SEER) tracks sidedness of primary colorectal cancers. We characterized the 1° site using SEER data as R-sided 1° = cecum to transverse colon; L-sided 1° = splenic flexure to sigmoid descending colon; 1° rectum = rectosigmoid and rectal. We identified patients with diagnoses of primary colorectal cancer in a SEER region between 2007 and 2011 and followed through 2013 by stage at diagnosis. We measured median and3-year survival and used Kaplan-Meier plots and Cox regression used to compare OS across groups. Age, gender, race, ethnicity, and year of diagnosis were included in adjusted Cox models to estimate the hazard ratio (HR) for death of rectal and right-sided relative to left-sided tumors.
Results: Right sided 1° CRC had inferior prognosis to both left-sided and rectal cancers and this difference persisted after adjusting for differences in other clinical and demographic characteristics. The association was less consistent for stage I and II cancers.
Conclusions: In a population-based series of patients with stage III and IV CRC, patients with R-sided tumors had inferior survival. This heterogeneity argues for consistent reporting of 1° site and further research including molecular sub-typing to better understand the mechanis underpinning this phenotypic difference in prognosis.
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