Background: Tumor sidedness in colon cancer has been linked to biological and clinical differences, but its impact on survival and prognostic factors remains unclear. This study aimed to find the predictors of overall survival (OS) in patients with right-sided colon cancer (RCC) and left-sided colon cancer (LCC) undergoing surgical treatment. Methods: A retrospective single-center study was conducted on 247 patients with colon cancer, including 117 with RCC and 130 with LCC. Clinical, surgical, and pathological variables were analyzed. Cox regression and ROC curve analyses were used to identify independent predictors of OS in the overall cohort and tumor-side subgroups. Results: RCC patients were older (69 vs. 68 years,p= 0.03), had lower hemoglobin levels (11.7 vs. 12.95 g/dL,p< 0.01), and more often presented with anemia (34.18% vs. 11.48%,p< 0.001). LCC patients more frequently underwent emergency surgery (13.74% vs. 5.69%,p= 0.03). Mucinous adenocarcinomas were more frequent in RCC (12.82% vs. 5.38%,p= 0.03), whereas distant metastases (15.38% vs. 6.84%,p= 0.03) and liver metastases (14.61% vs. 6.84%,p= 0.04) were more common in LCC. The one-year overall survival was similar between LCC and RCC before (88.09% vs. 91.52%,p= 0.15) and after propensity score matching (89.32% vs. 91.87%,p= 0.60) In multivariate Cox regression, independent predictors of lower OS included advanced AJCC stage (HR = 34.54,p< 0.001) in RCC, while, in LCC, AJCC stage (HR = 31.14,p= 0.001 and stoma (HR = 5.86,p= 0.01) were significant. Tumor location itself was not associated with OS (p= 0.18). Conclusions: Prognostic factors in colon cancer vary with tumor location. Side-specific risk stratification may improve outcome prediction and guide personalized management.
背景：结肠癌的肿瘤侧向性与生物学及临床差异相关，但其对生存及预后因素的影响尚不明确。本研究旨在探究接受手术治疗的右半结肠癌（RCC）与左半结肠癌（LCC）患者总生存期（OS）的预测因素。方法：本研究为回顾性单中心研究，纳入247例结肠癌患者，其中RCC 117例，LCC 130例。分析临床、手术及病理学变量，采用Cox回归与ROC曲线分析确定整体队列及肿瘤侧向亚组中OS的独立预测因素。结果：RCC患者年龄更大（69岁 vs. 68岁，p=0.03），血红蛋白水平更低（11.7 g/dL vs. 12.95 g/dL，p<0.01），贫血发生率更高（34.18% vs. 11.48%，p<0.001）。LCC患者更常接受急诊手术（13.74% vs. 5.69%，p=0.03）。黏液腺癌在RCC中更常见（12.82% vs. 5.38%，p=0.03），而远处转移（15.38% vs. 6.84%，p=0.03）与肝转移（14.61% vs. 6.84%，p=0.04）在LCC中更常见。倾向评分匹配前后，LCC与RCC的一年总生存率均无显著差异（匹配前：88.09% vs. 91.52%，p=0.15；匹配后：89.32% vs. 91.87%，p=0.60）。多变量Cox回归分析显示，RCC中较低的OS独立预测因素为晚期AJCC分期（HR=34.54，p<0.001）；LCC中AJCC分期（HR=31.14，p=0.001）与造口术（HR=5.86，p=0.01）为显著预测因素。肿瘤位置本身与OS无显著关联（p=0.18）。结论：结肠癌的预后因素因肿瘤位置而异。基于肿瘤侧向性的风险分层可能改善预后预测，并指导个体化治疗。
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