[摘要] 目前，越来越多的证据表明结肠癌和直肠癌是截然不同的疾病，无论是疾病的流行病学、解剖与组织学、分子特征、转移模式，还是临床治疗方法及疗效、预后等方面都存在许多差异，在临床治疗上也不能笼统地认为是同一种疾病。通过对CALGB/SWOG 80405、CRYSTAL、FIRE-3 三大临床研究的回顾性分析发现，左、右半结肠癌使用西妥昔单抗和贝伐珠单抗的疗效存在明显差异，基于上述临床试验，2017 年美国国立综合癌症网络（NCCN）首次将原发部位对治疗结肠癌决策的影响写入指南。在当前倡导精准化、个体化治疗的时代，明确结肠癌和直肠癌的发病机制、组织学差异以及临床对药物的不同反应等，不仅可以减轻患者的经济负担，而且可以为逐步实现患者的精准治疗提供最科学的依据。

[Abstract] At present, more and more evidence shows that colon and rectal cancers are different diseases. There are many differences no matter in the epidemiology, anatomy and histology, molecular characteristics, transfer patterns, or clinical treatment methods, therapeutic effects and prognosis. In clinical treatment, it cann’t be considered as the same disease in general. Through the retrospective analysis of the three clinical studies of CALGB/SWOG 80405, CRYSTAL, and FIRE-3, it has been found that there were significant differences in the efficacy of cetuximab and bevacizumab in left and right colon cancer. Based on the above clinical trials, the National Cancer Institute for the United States (NCCN) for the first time includes the guidelines for the impact of primary sites on the treatment of colon cancer into guidelines in 2017. In the current era of advocating precision and individualized treatment, to clarify the pathogenesis,histological differences and clinical response to drugs in colon cancer and rectal cancer, can not only reduce the economic burden of patients,but also provide the most scientific basis for the precise treatment of patients gradually.

上海市自然科学基金资助项目（No. 10ZR1438100，No. 04ZR14003）；上海市自然科学基金重点资助项目（No.06DZ19505）