Colon Cancer Sidedness, Presentation, and Survival at Different Stages

Abstract

Background. Several prognostic factors have been used to guide therapy for colon cancer (CC). However, the relationship between CC laterality (sidedness) and prognosis remains under investigation. Objectives. To assess the effect of laterality on CC presentation and survival, using a Surveillance, Epidemiology, and End Results (SEER) population-based cohort. Methods. A retrospective cohort study using data from the SEER program (2007-2015). Results. Of the 163,980 patients with CC, 85,779 (52.3%) presented with right-sided CC (RCC) and 78,201 (47.7%) with left-sided CC (LCC). Stage distributions were as follows: stage I, 24.1%; stage II, 27.3%; stage III, 28.2%; and stage IV, 20.4%. In an adjusted modified Poisson regression approach for risk ratio (RR), patients with LCCs were more likely to be male (RR = 1.14; 95% CI 1.12-1.15, p<0.001). As compared to stage I, stage II cancers (RR = 0.88, 95% CI 0.87-0.90, p<0.001) were less likely to be LCC. Stage IV CC was slightly less likely to be left-sided (RR = 0.98, 95% CI 0.98, 0.96-1.00, p = 0.028). The median overall survival (OS) for RCC was 87 months. The median OS for LCC was not established, as more than half of the patients diagnosed with LCC were still living at the time of the analysis. In adjusted Cox proportional Hazard model, individuals with stage I, III, and IV LCCs had superior OS as compared to those with matched-stage RCC (adjusted HR = 0.87; 95% CI 0.85-0.88, p<0.001). However, OS was worse among those with stage II disease who presented with LCC (adjusted Hazard ratio [aHR] = 1.06; 95% CI 1.02-1.11, p = 0.004). CC-specific survival (CSS) was superior for LCC versus RCC for stages III and IV but worse for II. Conclusions. In this population-cohort study, LCC is associated with superior OS and CSS survival. The overall survival advantage was attributed to stage I, III, and IV disease. Individuals presenting with stage II disease exhibit superior survival if the CC is right-sided.

The Prognostic Value of the Detection of Microbial Translocation in the Blood of Colorectal Cancer Patients

“…It was observed that patients with right-sided tumors presented a significantly decreased OS compared to left-sided tumors. This phenomenon has also been described previously [39][40][41][42]. Baran B et al reported that treatment response differed among the left and right-sided tumors.…”

“…Finally, Ulanja MB et al, in a retrospective analysis of 163,980 patients with colon cancer, concluded that tumor sidedness might affect presentation and survival rates at different stages of the disease. They reported that patients with left-sided tumors presented better overall survival rates in stages I, III/IV; whereas, patients with right-sided tumors presented better survival rates only in stage II disease [42]. The results from our study and the studies mentioned above could be explained by the findings of Dejea CM et al The authors examined 36 tissues from the right (15 CRC and 4 adenomas) and left-sided tumors (15 CRC and 2 adenomas) and demonstrated the association of bacterial aggregates (biofilms) in the colon with CRC.…”

Right and Left Colon Cancer: Clinico-Pathological Features and Treatment Results (South Egypt Cancer Institute Experience)

“…As for stage at diagnosis, our study demonstrated that most right-sided cases were stage III while left-sided cases were stage IV and these results were in agreement with the results of the study by Paul J Ross et al [24]. Conversely, these results did not agree with the study by Mark B. Ulanja et al which reported that right-sided colon cancer was more significantly associated with a more advanced stage when compared to left-sided colon cancer [25]. This can be due to the more advanced tumor (T) and lymph node (N) stages in right colon cancer versus the more potential for metastases (M stage) in left colon cancer in our study group.…”

Body composition measured by computed tomography is associated with colorectal cancer survival, also in early-stage disease

“…Tumor genetic and anthropomorphic features, as well as survival estimates, varies depending on right-or left-sided tumor localization. Compared to left-sided colon cancer, rightsided colon cancer is associated with female sex, older age and a higher proportion of mutations in the KRAS and BRAF oncogenes, and left-sided colon cancer generally has worse prognosis [33,34]. Furthermore, in some cohorts, e.g.…”