| [Background]Colorectal cancer has become one of the world's major health problems in recent years and one of the most common causes of cancer deaths in the world each year.In particular,in parts of Asia where low-income countries are developing,colonoscopy screening is not yet at the national policy level,the incidence and mortality of colorectal cancer are on the rise[1].The current methods of early cancer screening in China are not widely used,and some remote and impoverished regions are affected by ideological and economic pressure,so that they cannot be diagnosed and treated early or even in time,leading to persistently high levels of advanced colorectal cancer.The digestive tract of the human body is the longest organ in the human body;in the 1990s,Finnish scholars proposed that colon cancer can be divided into left colon cancer and right colon cancer.A large amount of clinical data indicate that in the case of colorectal cancer,the clinical manifestations and biological characteristics of colorectal cancer in different sites are significantly different.However,there are few studies on the difference of colorectal cancer in advanced patients.[Objective]This study aims to investigate the clinicopathological features,metastasis patterns,and the impact on survival prognosis of patients with advanced left and right colorectal cancer,so as to further guide the clinical choice of different treatment options,individualized treatment of different patients.And analyze the effect of intraperitoneal thermochemotherapy on the prognosis of patients in advanced patients.[Methods]This study retrospectively analyzed the data of patients with advanced colorectal cancer in Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2011 to March 2017.A total of 445 patients with advanced colorectal cancer were included in the statistical analysis.All statistical patients were divided into left colon cancer group,right colon cancer group,and rectal cancer group.There were three groups in total;the left colon cancer group included the tumor site in the descending colon.sigmoid colon,spleen region of transverse colon;patients with the right colon cancer group included the tumor site in ascending colon,cecum,appendix,and liver region of transverse colon;patients with rectal cancer were tumors in the rectum.Statistical methods were used to analyze the differences between clinicopathologic features and metastatic patterns among the three groups.In addition,32 patients with advanced colorectal cancer undergoing CPT-11 intraperitoneal thermochemotherapy and 88 patients without intraperitoneal thermochemotherapy were included.A telephone follow-up survey was conducted on the patients included in the statistical analysis to understand their progress and survival.SPSS software was used to plot the survival curve,and the differences in survival prognosis among the three groups were evaluated,also evaluating the different effect of histological type and metastasis on the prognosis of patients.[Results]Among the 445 patients with advanced disease in this study,there were 146 cases of left colon cancer,accounting for 32.8%of the total cases,133 cases of right colon cancer(29.9%),166 cases of rectum cancer(37.3%).Middle-aged patients between40 and 60 years old are more likely to have left-sided colon cancer,while right-sided colon cancer and rectal cancer are more common in elderly patients older than 60 years,with a statistically significant difference(P=0.035),The right colon cancer versus left colon cancer and rectum cancer was more prone to mucinous adenocarcinoma(25.6%VS 11.6%and 12%,P=0.001);and in the right colon cancer group,the tumor diameter was larger and the depth of invasion was deeper than the other two groups,and the P value was less than 0.001,with a statistically significant)difference;But between the three groups in the degree of gender and organizational differentiation(differentiation divided into three groups:high and medium-high-differentiated into a group,medium differentiation into a group,low and medium-low differentiation into another group)there was no significant statistical difference(P = 0.106 and P=0.093).There was no significant difference in lymph node metastasis and Ki67 proliferation index between the three groups(P=0.878 and P=0.088).However,for the number of lymph nodes detected during surgery,there was a statistically significant difference between the three groups(P<0.001),and the detection rate of lymph nodes larger than 12 in the right colon cancer was significantly greater than that in the left colon cancer and rectum cancer(79.7%VS 54.8%and 58.4%).In terms of metastasis,the analysis data showed that lung metastases were more likely to occur in the rectal cancer and left hemi-colon cancer groups than in the right colon cancer group(29.5%and 25.9%vs 16.5%,P=0.028);in this experiment,there was also a statistically significant difference between the three groups in the occurrence of only lung metastasis and the occurrence of other metastatic sites(including lungs)(P=0.034 and P=0.028),Further those in the left colon cancer were more likely to have abdominal metastases than the other two groups,with statistical differences(28.1%VS 18.0%and 16.9%(P=0.033),but there was no significant difference in liver metastases between the three groups(P=0.082).Kaplan-Meier survival analysis showed that tumor sites affected overall survival(P=0.024)and progression-free survival(P=0.028),the COX proportional hazards analysis showed that right-sided colon cancer was a poor prognostic factor for survival.Peripheral infusion chemotherapy in patients with PFS as the study endpoint,Kaplan-Meier survival analysis showed that the prognosis of patients undergoing intraperitoneal chemotherapy was significantly better than those without intraperitoneal chemotherapy(P=0.012),according to the tumor site group analysis showed right colon cancer patients in the group benefited from intraperitoneal infusion chemotherapy(P=0.009),but left colon cancer and rectal cancer patients did not benefit significantly from intraperitoneal infusion chemotherapy.[Conclusion]The incidence of rectal cancer in patients with advanced colorectal cancer is slightly higher than that in left and right colon cancer.Middle-aged people aged 40 to 60 years are more likely to develop left colon cancer.The incidence of right colon cancer in young people below 40 years is higher than other sites.The right colon is more prone to mucinous adenocarcinoma,larger tumor diameter,deeper invasion depth,and more lymph nodes detected by the doctor during surgery.However,in the metastasis,the left colon cancer is more likely to have lung metastasis and abdominal metastasis.The survival analysis showed that the tumor site affected the patient's OS and PFS.The tumor site,the maximum diameter of the tumor,the pathological type,the number of lymph nodes detected,and liver metastasis were prognostic factors.And the maximum diameter of the tumor,hepatic metastasis,and lymph node metastasis are independent prognostic factors.Intraperitoneal infusion thermochemotherapy with irinotecan benefits survival in patients with advanced right colon cancer.[Objective]The incidence of colorectal cancer(CRC)in young patients(<40 years of age)appears to be increasing.However,their clinicopathological characteristics and survival are controversial.This study was to compare the characteristics of colorectal cancer in different age group in order to understand the characteristics and prognosis of CRC in young patients.[Methods]We collected primary colorectal cancer patients from Nanjing Drum Tower Hospital from January 2011 to December 2015,and Surveillance,Epidemiology,and End Results program from January 2011 to December 2013.All patients were classified into two groups:the young group(<40 years of age),and the elderly group(>40 years of age).The characteristics and prognosis of the two groups were compared.[Results]A total of 97,3 69 CRC patients were included from our hospital and the SEER database.The young CRC patients tended to be at rectum and left colon,later stage,more mucinous carcinoma,poorer differentiation,more lymph nodes metastasis,more distant metastasis,higher vessel and nerve invasion.The cancer-specific survival(CCS)of young CRC patients was significantly better.[Conclusion]Young CRC patients present advanced tumors and more malignant pathological features,while they have a better prognosis. |
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