Characteristics of Differently Located Colorectal Cancers Support Proximal and Distal Classification: A Population-Based Study of 57,847 Patients

Jiao, Yang; Du, Xianglin L.; Li, Shu Ting; Wang, Bi Yuan; Wu, Yin; Chen, Zhe Ling; Lv, Meng; Shen, Yan; Wang, Xin; Dong, Dan; Li, Dan; Wang, Fan; Li, En Xiao; Yi, Min

doi:10.1371/journal.pone.0167540

Cited by 61 publications

(72 citation statements)

References 37 publications

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“…While incomplete colonoscopy was reported in some studies on interval CRC to be > 15%, the cecal intubation rate or complete colonoscopy rate of our center was more than 95% according to our latest colonoscopy registry (unpublished data). It is also important to know that distal cancer is still more prevalent than proximal cancer in Chinese patients (56.5% vs 43.5%) that may account for the higher proportion of distal PCCRC‐3y as well . As for our center, distal CRC constituted 68.6% of all CRC cases in 2017 (unpublished data).…”

Section: Discussionmentioning

confidence: 86%

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Epidemiology, characteristics, and survival of post‐colonoscopy colorectal cancer in Asia: A population‐based study

Cheung

Chen

Seto

et al. 2019

J of Gastro and Hepatol

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Background and Aim Population‐based studies on post‐colonoscopy colorectal cancer (CRC) from Asia are sparse. We aimed to determine the characteristics and predictive factors and survival of post‐colonoscopy CRC in Hong Kong. Methods This is a territory‐wide retrospective cohort study. Patients aged ≥ 40 years with colonoscopies performed between 2005 and 2013 without history of CRCs, inflammatory bowel disease, and prior colectomy were included. Post‐colonoscopy colorectal cancer for an interval of 3 years (PCCRC‐3y) was defined as CRC diagnosed between 6 and 36 months after index colonoscopy, whereas CRC diagnosed within 6 months of index colonoscopy was regarded as “detected CRC.” We used multivariable logistic regression to derive adjusted odds ratio (aOR) of PCCRC‐3y and Cox model for adjusted hazard ratio (aHR) of cancer‐specific mortality after CRC diagnosis. Results Of the 197 902 eligible patients, 10 005 (92.1%) were detected CRC and 854 (7.9%) PCCRC‐3y. The median age at PCCRC‐3y diagnosis was 75.9 years (interquartile range: 65.5–83.8)—a delay of 1.2 years (interquartile range: 0.8–1.9) from index colonoscopy—and 60.1% were male. Predictive factors for PCCRC‐3y included older age (aOR: 1.07), male sex (aOR: 1.45), history of colonic polyps (aOR: 1.31), polypectomy/biopsy at index colonoscopy (aOR: 3.97), surgical endoscopists (aOR: 1.53), and a higher center annual endoscopy volume. Independent predictive factors for cancer‐specific mortality after CRC diagnosis included PCCRC‐3y (aHR: 1.32), proximal cancer location (aHR: 1.80), and certain patient factors. Conclusion The PCCRC‐3y rate was 7.9% in Hong Kong, with a high proportion (> 80%) of distal cancers and a higher cancer‐specific mortality compared with detected CRC.

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Section: Discussionmentioning

confidence: 86%

“…It is also important to know that distal cancer is still more prevalent than proximal cancer in Chinese patients (56.5% vs 43.5%) that may account for the higher proportion of distal PCCRC-3y as well. 32 As for our center, distal CRC constituted 68.6% of all CRC cases in 2017 (unpublished data).…”

Section: Discussionmentioning

confidence: 88%

Epidemiology, characteristics, and survival of post‐colonoscopy colorectal cancer in Asia: A population‐based study

Cheung

Chen

Seto

et al. 2019

J of Gastro and Hepatol

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“…However, the subgroup analysis showed a significant better survival in stage III LCC (HR, 1.12; 95% CI, 1.06‐1.18; P < 0.001), but worse survival in stage II LCC (HR, 0.92; 95% CI, 0.87‐0.97; P = 0.001) compared with RCC . The discrepancy in the survival by stage was reported recently in both Eastern and Western countries . Despite variation in the reported results, most authors observed a poor survival for RCC in stage III cases.…”

Section: Discussionmentioning

confidence: 82%

“…For the reasons, many authors have indicated RCC as a disease distinct from LCC. Most studies have shown that survival with RCC is poorer than that with LCC for either primary lesions or cancer with metastasis . However, these previous studies mainly analyzed patients with primary colon cancer undergoing resection or patients with metastatic colorectal cancer.…”

Section: Introductionmentioning

confidence: 99%

“…Most studies have shown that survival with RCC is poorer than that with LCC for either primary lesions or cancer with metastasis. [7][8][9][10][13][14][15][16][17][18][19][20][21][22][23][24] However, these previous studies mainly analyzed patients with primary colon cancer undergoing resection or patients with metastatic colorectal cancer. In this study, we analyzed patients with stage III colon cancer who underwent curative-intent surgery to determine whether a difference exists between RCC and LCC in the prognostic value of the primary tumor location.…”

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confidence: 99%

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Primary tumor location in stage III colon cancer has prognostic impact on subsequent liver metastasis

Liao

Chiang

Tsai

et al. 2018

Journal of Surgical Oncology

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Background and Objectives We aim to investigate whether a difference exists between right‐sided and left‐sided colon cancer at the same disease stage and subsequent liver metastasis and identify whether tumor location can independently influence survival. Methods Right‐sided colon cancer was defined as malignancy arising from the cecum to the transverse colon; left‐sided colon cancer was defined as malignancy arising from the splenic flexure to the sigmoid colon. Clinicopathological features and survival data were collected for analysis. Results Overall, 1442 patients were included for analysis. The median follow‐up time was 58.2 months. Patients with left‐sided colon cancer had better 5‐year overall survival (75.2% vs 61.7%, P = 0.005), 5‐year cancer‐specific survival (81.6% vs 73.4%, P = 0.001), and 5‐year recurrence‐free survival (70.9% vs 66.5%, P = 0.033) compared with patients having right‐sided colon cancer. After the presentation of subsequent liver metastasis, patients with primary left‐sided colon cancer had better 3‐year cancer‐specific survival ( P < 0.001). In the multivariate analysis, cancer location was an independent prognostic factor for cancer‐specific survival (right vs left, HR: 1.276, 95% CI: 1.002‐1.625). Conclusions The primary tumor location can serve as a prognostic factor for treatment outcomes either in primary stage III colon cancer or subsequent liver metastasis.

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Trends in Incidence of Early-Onset Colorectal Cancer in the United States Among Those Approaching Screening Age

Abualkhair

Zhou

Ahnen³

et al. 2020

JAMA Netw Open

111

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IMPORTANCE Early-onset colorectal cancer incidence rates among patients aged 45 to 49 years have been considered much lower compared with the rates among patients aged 50 to 54 years, prompting debate about earlier screening benefits at 45 years. However, the observed incidence rates in the Surveillance, Epidemiology, and End Results (SEER) registries may underestimate colorectal cancer case burdens in those younger than 50 years compared with those older than 50 years because average-risk screening is generally not performed to detect preclinical cases of colorectal cancer. Finding steep incidence increases of invasive stage (beyond in situ) cases of colorectal cancer from age 49 to 50 years would be consistent with high rates of preexisting, undetected cancers in younger patients ultimately receiving a diagnosis of colorectal cancer after undergoing screening at 50 years.OBJECTIVE To assess the preclinical burden of colorectal cancer by analyzing its incidence in 1-year age increments, focusing on the transition between ages 49 and 50 years. DESIGN, SETTING, AND PARTICIPANTSData from the SEER 18 registries, representing 28% of the US population, were used to conduct a cross-sectional study of colorectal cancer incidence rates from January 1, 2000, to December 31, 2015, in 1-year age increments (ages 30-60 years) stratified by US region (South, West, Northeast, and Midwest), sex, race, disease stage, and tumor location. Statistical analysis was conducted from November 1, 2018, to December 15, 2019. MAIN OUTCOMES AND MEASURES Incidence rates of colorectal cancer. RESULTS A total of 170 434 cases of colorectal cancer were analyzed among 165 160 patients (92 247 men [55.9%]; mean [SD] age, 51.6 [6.7] years). Steep increases in the incidence of colorectal cancer in the SEER 18 registries were found from 49 to 50 years of age (46.1% increase: 34.9 [95% CI, 34.1-35.8] to 51.0 [95% CI, 50.0-52.1] per 100 000 population). Steep rate increases from 49 to 50 years of age were also seen in all US regions, men and women, white and black populations, and in colon and rectal cancers. The rate ratio incidence increase in the SEER 18 registries from 49 to 50 years of age (1.46 [95% CI, 1.42-1.51]) was significantly higher than earlier 1-year age transitions. Steep rate increases in the SEER 18 registries were found from 49 to 50 years of age in localized-stage (75.9% increase: 11.2 [95% CI, 10.7-11.7] to 19.7 [95% CI, 19.0-20.3] per 100 000) and regional-stage (30.3% increase: 13.2 [95% CI, 12.7-13.8] to 17.2 [95% CI, 16.7-17.8] per 100 000) colorectal cancers. A total of 8799 of the 9474 cases (92.9%) of colorectal cancer in the SEER 18 registries from 2000 to 2015 that were diagnosed among individuals aged 50 years were invasive. CONCLUSIONS AND RELEVANCE Steep incidence increases between 49 and 50 years of age are consistent with previously undetected colorectal cancers diagnosed via screening uptake at 50 years. These cancers are not reflected in observed rates of colorectal cancer in the SEER registries among individuals y...

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Characteristics of Differently Located Colorectal Cancers Support Proximal and Distal Classification: A Population-Based Study of 57,847 Patients

Cited by 61 publications

References 37 publications

Epidemiology, characteristics, and survival of post‐colonoscopy colorectal cancer in Asia: A population‐based study

Epidemiology, characteristics, and survival of post‐colonoscopy colorectal cancer in Asia: A population‐based study

Primary tumor location in stage III colon cancer has prognostic impact on subsequent liver metastasis

Trends in Incidence of Early-Onset Colorectal Cancer in the United States Among Those Approaching Screening Age

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