Miltflexuurcarcinoom toont slechtere overleving dan colon descendens-kanker: SEER-TCGA-analyse

BACKGROUND: The survival differences between splenic flexure cancer (SFC) and descending colon cancer (DCC) are unclear due to their distinct anatomical and molecular features. This study compares their survival outcomes and genetic differences using data from the Surveillance, Epidemiology, and End Results (SEER) and The Cancer Genome Atlas (TCGA) databases. METHODS: This study used SEER data (2000-2022) to compare postoperative patients with splenic flexure cancer (SFC) and descending colon cancer (DCC). Propensity score matching (PSM) was performed to balance baseline characteristics. Overall survival (OS) and cancer-specific survival (CSS) were assessed using the Kaplan-Meier method, and competing-risk analysis with a multivariable Fine-Gray model was applied to evaluate cancer-specific death (CSD). TCGA transcriptomic data were analyzed to identify differentially expressed genes (DEGs) and enriched pathways between SFC and DCC. RESULTS: A total of 7,579 patients were identified from SEER, including 2,636 with SFC and 4,943 with DCC. After PSM, DCC remained associated with significantly better OS and CSS than SFC. Competing-risk analysis showed that SFC had higher cumulative incidences of both CSD and OCD, and multivariable Fine-Gray analysis further demonstrated that DCC was independently associated with a lower risk of CSD than SFC (sHR=0.73, P=0.019). Younger age and adequate nodal evaluation were protective, whereas advanced tumour burden, particularly T4 and N2 disease, remained strongly adverse. TCGA analysis further demonstrated distinct transcriptional profiles between the two subsites, with SNHG4 upregulated and AHCYL2 downregulated in SFC, alongside subsite-associated differences in fatty acid metabolism, spliceosome-related signalling, and ribosome-associated processes. CONCLUSION: SFC is associated with worse survival than DCC, and transcriptomic profiles are distinct between the two subsites in TCGA.