Clinical and prognostic differences between surgically resected right-sided and left-sided colorectal cancer

Fukata, Koji; Yuasa, Norihiro; Takeuchi, Eiji; Miyake, Hideo; Nagai, Hidemasa; Yoshioka, Yuichiro; Miyata, Kanji

doi:10.1007/s00595-019-01889-4

Cited by 15 publications

(8 citation statements)

References 31 publications

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“…We found that the incidence of postoperative recurrence for left colon cancer was higher than that of right, and left colon is one of the independent risk factors of poorer DFS, which was consistent with some reports [13,14]. The majority of the literature differs, reporting that there is no difference [15] or that the right colon has a relatively poor prognosis [16][17][18][19]. The inclusion of the rectum in the left colon is the biggest difference between these reports.…”

Section: Discussionsupporting

confidence: 89%

Left colon as a novel high-risk factor for postoperative recurrence of stage II colon cancer

et al. 2020

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Background: It is not clear whether stage II colon and rectal cancer have the same risk factors for recurrence. Thus, the purpose of this study was to identify the risk factors for postoperative recurrence in stage II colorectal cancer. Patients and methods: We retrospectively analyzed the data of 990 patients who had undergone radical surgery for stage II colorectal cancer. Patients' pathological features and characteristics including age, sex, family history, body mass index, tumor diameter, gross type of tumor, infiltration degree (T3/T4), tumor grade, perineural invasion, vascular invasion, lymphatic invasion, pathologic examination of lymph node number, and preoperative carcinoembryonic assay (CEA) level was compared between patients with and without recurrence. Finally, the prediction of the left and right colons was analyzed. Results: The mean ages of the colon cancer and rectal cancer patients were 69.5 years and 66.4 years, respectively. In total, 508 (82.1%) and 285 (76.8%) patients were treated laparoscopically for colon cancer and rectal cancer, respectively, with median follow-up periods of 42.2 months and 41.8 months, respectively. Forty-four recurrences occurred in both the colon cancer (7.1%) and rectal cancer (11.9%) groups. The preoperative serum CEA level and T4 infiltration were significantly higher in recurrent colorectal cancer patients. The postoperative recurrence rate of left colon cancer (descending colon, sigmoid colon) was higher than that of right colon cancer (cecum, ascending colon, transverse colon) (OR 2.191, 95% CI 1.091-4.400, P = 0.027). In COX survival factor analysis of colon cancer, the left colon is one of the independent risk factors (risk ratio 5.377, 95% CI 0.216-0.88, P = 0.02). In disease-free survival (DFS), the left colon has a relatively poor prognosis (P = 0.05). However, in the COX analysis and prognosis analysis of OS, no difference was found between the left colon and the right colon. Conclusion: Preoperative CEA and depth of infiltration (T4) are high-risk factors associated with recurrence and are prognostic factors in stage II colorectal cancer. Left colon is also a risk factor for postoperative recurrence of stage II colon cancer.

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Section: Discussionsupporting

confidence: 89%

Left colon as a novel high-risk factor for postoperative recurrence of stage II colon cancer

et al. 2020

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“…On the other hand, right-sided CRC may have a better prognosis in early stage disease [ 158 , 192 , 194 , 195 ]. This may be due to a higher incidence of immunogenic MSI-H CRC on the right side.…”

Section: Pathological Featuresmentioning

confidence: 99%

“…A large population-based study in 2017 by Wang et al examining 33,789 stage II CRC patients showed that overall cancer specific survival was higher in right-sided CRC compared to left-sided CRC and rectal cancer in both univariate (86.5% vs. 83.8% and 78.7% respectively, p < 0.001) and multivariate analysis (HR 0.642 vs. 0.760, p < 0.0001) [ 195 ]. An analysis of 899 stage II and III CRC patients by Fukata et al showed improved RFS in patients with stage II right-sided CRC [ 194 ]. In a population study of 53,801 CRC patients, Weiss et al found that right-sided stage II CRC had lower mortality than left-sided stage II CRC (HR 0.92, p = 0.001) but higher mortality in stage III disease (HR 1.12, p < 0.001) [ 196 ].…”

Section: Pathological Featuresmentioning

confidence: 99%

Pathological Features and Prognostication in Colorectal Cancer

et al. 2021

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The prognostication of colorectal cancer (CRC) has traditionally relied on staging as defined by the Union for International Cancer Control (UICC) and American Joint Committee on Cancer (AJCC) TNM staging classifications. However, clinically, there appears to be differences in survival patterns independent of stage, suggesting a complex interaction of stage, pathological features, and biomarkers playing a role in guiding prognosis, risk stratification, and guiding neoadjuvant and adjuvant therapies. Histological features such as tumour budding, perineural invasion, apical lymph node involvement, lymph node yield, lymph node ratio, and molecular features such as MSI, KRAS, BRAF, and CDX2 may assist in prognostication and optimising adjuvant treatment. This study provides a comprehensive review of the pathological features and biomarkers that are important in the prognostication and treatment of CRC. We review the importance of pathological features and biomarkers that may be important in colorectal cancer based on the current evidence in the literature.

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“…In some previous studies, the authors have speculated that, in CRC, larger tumours might be less aggressive than smaller tumours, and thus larger tumours might indicate a lower incidence of lymph node metastases, lymphatic invasion and venous invasion. In contrast, newly arising tumours, due to their high vascularization, might cause relevant changes in serum BDNF levels after a resection (Fukata et al, 2020;Guzel et al, 2018;Baeten et al, 2009). That hypothesis suggested that the BDNF concentration might not depend on tumour tissue mass; rather, it might depend on the aggressiveness of a growing tumour.…”

Section: Discussionmentioning

confidence: 99%

Brain derived neurotrophic factor declines after complete curative resection in gastrointestinal cancer

Guzel

Mech

Iwanowska

et al. 2021

PeerJ

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Background Brain derived neurotrophic factor (BDNF) is a neurotrophin involved in neural and metabolic diseases, but it is also one of the crucial factors in cancer development and metastases. In the current study, we investigated serum BDNF concentrations in patients that underwent surgical treatment for colorectal cancer or pancreatic cancer. Methods Serum BDNF concentrations were measured with standard enzyme-linked immunosorbent assays, before and on the third day after the operation, in 50 consecutive patients with colorectal cancer and 25 patients with pancreatic cancer (tumours in the head of pancreas). We compared pre- and postoperative BDNF levels, according to the subsequent TNM stage, histologic stage, lymph node involvement, neuro- or angio-invasion, and resection range. Results In the pancreatic cancer group, BDNF concentrations fell significantly postoperatively (p = 0.011). In patients that underwent resections, BDNF concentrations fell (p = 0.0098), but not in patients that did not undergo resections (i.e., laparotomy alone). There were significant pre- and postoperative differences in BDNF levels among patients with (p = 0.021) and without (p = 0.034) distant metastases. Significant reductions in BDNF were observed postoperatively in patients with small tumours (i.e., below the median size; p = 0.023), in patients with negative angio- or lymphatic invasion (p = 0.028, p = 0.011, respectively), and in patients with lymph node ratios above 0.17 (p = 0.043). In the colon cancer group, the serum BDNF concentrations significantly fell postoperatively in the entire group (p = 0.0076) and in subgroups of patients with or without resections (p = 0.034, p = 0.0179, respectively). Significant before-after differences were found in subgroups with angioinvasions (p = 0.050) and in those without neuroinvasions (p = 0.049). Considering the TNM stages, the postoperative BDNF concentration fell in groups with (p = 0.0218) and without (p = 0.034) distant metastases and in patients with tumours below the median size (p = 0.018). Conclusion Our results suggested that BDNF might play an important role in gastrointestinal cancer development. BDNF levels were correlated with tumour volume, and with neuro-, angio- and lymphatic invasions. In pancreatic cancer, BDNF concentrations varied according to the surgical procedure and they fell significantly after tumour resections. Thus, BDNF may serve as a potential marker of complete resections in underdiagnosed patients. However, this hypothesis requires further investigation. In contrast, no differences according to the procedure was made in patients with colon cancer.

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Clinical and prognostic differences between surgically resected right-sided and left-sided colorectal cancer

Cited by 15 publications

References 31 publications

Left colon as a novel high-risk factor for postoperative recurrence of stage II colon cancer

Left colon as a novel high-risk factor for postoperative recurrence of stage II colon cancer

Pathological Features and Prognostication in Colorectal Cancer

Brain derived neurotrophic factor declines after complete curative resection in gastrointestinal cancer

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