Different treatment strategies and molecular features between right-sided and left-sided colon cancers
Open Access
- 1 January 2015
- journal article
- review article
- Published by Baishideng Publishing Group Inc. in World Journal of Gastroenterology
- Vol. 21 (21), 6470-8
- https://doi.org/10.3748/wjg.v21.i21.6470
Abstract
The colon is derived from the embryological midgut and hindgut separately, with the right colon and left colon having different features with regards to both anatomical and physiological characteristics. Cancers located in the right and left colon are referred to as right colon cancer (RCC) and left colon cancer (LCC), respectively, based on their apparent anatomical positions. Increasing evidence supports the notion that not only are there differences in treatment strategies when dealing with RCC and LCC, but molecular features also vary between them, not to mention the distinguishing clinical manifestations. Disease-free survival after radical surgery of both RCC and LCC are similar. In the treatment of RCC, the benefit gained from adjuvant FOLFIRI chemotherapy is superior, or at least similar, to LCC, but inferior to LCC if FOLFOX regimen is applied. On the other hand, metastatic LCC exhibits longer survival than that of RCC in a palliative chemotherapy setting. For KRAS wild-type cancers, LCC benefits more from cetuximab treatment than RCC. Moreover, advanced LCC shows a higher sensitivity to bevacizumab treatment in comparison with advanced RCC. Significant varieties exist at the molecular level between RCC and LCC, which may serve as the cause of all apparent differences. With respect to carcinogenesis mechanisms, RCC is associated with known gene types, such as MMR, KRAS, BRAF, and miRNA-31, while LCC is associated with CIN, p53, NRAS, miRNA-146a, miRNA-147b, and miRNA-1288. Regarding protein expression, RCC is related to GNAS, NQO1, telomerase activity, P-PDH, and annexin A10, while LCC is related to Topo I, TS, and EGFR. In addition, separated pathways dominate progression to relapse in RCC and LCC. Therefore, RCC and LCC should be regarded as two heterogeneous entities, with this heterogeneity being used to stratify patients in order for them to have the optimal, current, and novel therapeutic strategies in clinical practice. Additional research is needed to uncover further differences between RCC and LCC.Keywords
This publication has 57 references indexed in Scilit:
- Regulation of microRNA-1288 in colorectal cancer: Altered expression and its clinicopathological significanceMolecular Carcinogenesis, 2013
- Specific Mutations inKRASCodons 12 and 13, and Patient Prognosis in 1075BRAFWild-Type Colorectal CancersClinical Cancer Research, 2012
- Assessment of colorectal cancer molecular features along bowel subsites challenges the conception of distinct dichotomy of proximal versus distal colorectumGut, 2012
- Addition of cetuximab to oxaliplatin-based first-line combination chemotherapy for treatment of advanced colorectal cancer: results of the randomised phase 3 MRC COIN trialThe Lancet, 2011
- Defective Mismatch Repair As a Predictive Marker for Lack of Efficacy of Fluorouracil-Based Adjuvant Therapy in Colon CancerJournal of Clinical Oncology, 2010
- Outcome of right- and left-sided colonic and rectal cancer following surgical resectionColorectal Disease, 2010
- Hypermethylator Phenotype in Sporadic Colon Cancer: Study on a Population-Based Series of 582 CasesCancer Research, 2008
- Is There a Difference in Survival Between Right- Versus Left-Sided Colon Cancers?Annals of Surgical Oncology, 2008
- Association of tumour site and sex with survival benefit from adjuvant chemotherapy in colorectal cancerThe Lancet, 2000
- Regression analysis of prognostic factors in colorectal cancer after curative resectionsDiseases of the Colon & Rectum, 1988