| Objective Through a retrospective study,to summarize the distribution of patients with recurrent metastatic colorectal cancer admitted from the General Hospital of Ningxia Medical University in recent 5 years.Investigating the general conditions,pathological features,metastatic sites,laboratory parameters,and the relationship between the curative effect of the first treatment and prognosis,and further explore the differences between the above mentioned factors in patients with left and right recurrent metastatic colorectal cancer.To provide theoretical reference for the prognostic factors and left and right differential studies of recurrent colorectal cancer patients in Ningxia.Methods Collecting 303 cases from January 2012 to January 2017 in Ningxia Medical University General Hospital who was diagnosed with recurrent and metastatic colorectal cancer as the study subjects.First of all,understanding the recurrent and metastatic colorectal cancers pathological features,metastatic sites,laboratory parameters,first-line treatment,and short-term efficacy.Then used to the Kaplan-Meier method and log-rank test to analyze the relationship between the above factors with its prognosis.Finally,303 patients were divided into LSCC and RSCC,Through differential studies,to analyze the differences between LSCC and RSCC.Results 1.General situation: the median age of patients with ecurrent metastatic colorectal cancer in our hospital is between 50 and 70 years old.Men is more than women(59.7%,40.3%);There were more Han people than Hui(270 cases of vs 29 cases),and other nationalities accounted for 4 cases.The rectum cancer was higher than the colon(165 cases ofvs138 cases),and the LSCC cancer was significantly higher than RSCC(245 cases vs 58cases).2.Tumor characteristics: The degree of differentiation of recurrent and metastatic colorectal cancers was mainly moderately differentiated(67.0%);among 303 patients,164 detected Ki67,of which 142 cases(86.6%)were ?50%;151 cases of MMR protein was detected,and the proportion of positive patients was significantly higher than that of negative patients(82.8% vs 17.2%).There were18 patients with KRAS,NRAS,and BRAF genes tested,including right colon cancer in 3 and left half 15 cases of rectal cancer.The former was wild-type 2 cases,the latter wild-type with 8 cases.3.Metastatic site: The site of distant metastasis was mainly liver metastasis and lung metastasis,accounting for 49.5%(150 cases)and 36.3%(110 cases)respectively,followed by peritoneal metastasis(38 cases,12.5%),and other sites metastases;121 cases(39.9%)of patients with oligopotential metastasis.4.Laboratory indicators: Among 303 patients,98 cases(32.3%)and 191 cases(63%)were associated with anemia and hypoproteinemia;39 cases(12.9%)were CEA?200ng/ml,among which LSCC has 34 patients(14.9%)were significantly higher than the right(5,8.6%);CA199>27U/ml were 111 patients(36.3%),and the proportion of left colorectal cancer was slightly higher than that of the right(91,37.3% vs20,34.48%).5.Treatment and short-term curative effect: There were 265 patients receiving chemotherapy,including 219(83.9%)patients with oxaliplatin as the first-line regimen,42 patients with irinotecan,and only 4 patients receiving oral fluorouracil chemotherapy(16.1%);LSCC 204 patients,evaluation of efficacy RR was 31.4%(64 patients),DCR was 69.1%(141patients);RSCC was 57 patients,RR was assessed 32.6%(18 patients),DCR was 63.2%(36cases).Of the 303 patients 62(20.5%)were treated with surgical treatment,36 cases with palliative surgery and 26 cases with radical resection;52 cases(31.5%)rectal cancer were treated with radiation;79 patients were treated with target treatment,59(24.08%)had leftcolorectal cancer and 20(34.48%)had right colorectal cancer.6.The median progression-free survival time was 6.23 months in 303 patients,and the median overall survival time was 24.77 months.Univariate analysis showed with multiple organ metastases,multiple metastases,combined anemia,hypoalbuminemia,CEA ?200 ng/ml,CA199>27 U/ml,lower degree of differentiation and no chemotherapy,patients have a worse prognosis.Multivariate analysis suggested that anemia,hypoproteinemia,poor differentiation,no chemotherapy,and more metastatic sites were independent risk factors for poor prognosis in patients with recurrent metastatic colorectal cancer.7.There was no difference between LSCC and RSCC in terms of age,sex,ethnicity,differentiation,expression of Ki67,MMR protein expression,number of metastatic sites,liver metastasis,peritoneal metastasis,CEA,CA199,anemia,etc.;LSCC was more prone to occur lung metastases,and hypoproteinemia(99,40.4% vs 13,22.4%)than RSCC.Left and right semi-colorectal cancer had no significant difference in the choice of chemotherapy,short-term efficacy and overall survival.Conclusions 1.The site of distant metastasis of recurrent metastatic colorectal cancer is mainly liver metastasis and lung metastasis.Left-sided colorectal cancer is more prone to lung metastasis than right-sided colon cancer.2.Anemia,hypoproteinemia,poorly differentiated,and non-chemotherapy are independent risk factors for poor prognosis in patients with recurrent metastatic colorectal cancer.3.Oxaliplatin-based chemotherapy is the main first-line treatment for metastatic colorectal cancer in our hospital and there is no difference in efficacy with irinotecan-based regimen.4.Patients with advanced colorectal cancer should routinely perform genetic testing to provide a theoretical basis for individualized treatment. |
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