Influence of primary site on metastatic distribution and survival in stage <scp>IV</scp> colorectal cancer

Suthananthan, Arul; Bhandari, Mayank; Platell, Cameron

doi:10.1111/ans.13969

Cited by 20 publications

(16 citation statements)

References 32 publications

(39 reference statements)

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“…Considering the primary tumor location of SCLM patients, SCLM patients with right-sided tumor location were associated with obviously poorer prognosis than those with other tumor sites. Similar results had been reported by some previous studies ( 13 , 14 , 16 , 17 ). Compared with left-sided colorectal tumors, the liver metastatic area of right-sided tumors seemed to be more extensive, indicating that these patients had significantly worse prognoses ( 18 ).…”

Section: Discussionsupporting

confidence: 93%

Predictive Risk Factors and Online Nomograms for Synchronous Colon Cancer With Liver Metastasis

Zhu

Chen

et al. 2020

Front. Oncol.

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Objectives To develop and validate predictive nomograms of cancer specific survival (CSS) and overall survival (OS) for synchronous colon cancer with liver metastasis (SCLM) patients. Methods Patients with pathologically diagnosed colon cancer with liver metastasis were retrieved from the SEER database between 2010 and 2015. Only SCLM patients were included. Univariate and multivariate cox regression analyses were conducted to identify the potential predictors of patients’ survival outcomes. The selected variables were integrated to create predictive nomograms via R tools. Furthermore, the concordance index Harrell’s C statistic (C-index) was calculated to describe the discrimination of nomograms. Calibration (1000 bootstrap resamples) curves were plotted to compare the predictions of nomograms with the observed outcomes. Decision curve analysis (DCA) and clinical impact curves were performed to evaluate the clinical effects of nomograms. Results A total of 22,378 SCLM patients were included. The median time of OS and CSS was 13 and 17 months, respectively. The 1-, 2-, and 3-year rate of OS was 50.6, 28.1, and 14.8%, respectively. While the 1-, 2-, and 3-year rate of CSS was 58.7, 36.8, and 22.5%, respectively. SCLM patients with increased age, left primary tumor location, AJCC IVb stage, and no chemotherapy were associated with an obviously reduced OS and CSS. Variables including age, histological grade, T/N/M stage, tumor size, bone/lung metastasis, CEA, surgery of primary site, and chemotherapy were closely related to the prognoses of SCLM patients. Nomograms of OS and CSS were built and displayed online for convenient utilization. The C-index of OS and CSS monograms were 0.74 and 0.73, respectively, indicating relatively good discrimination of the nomograms. The calibration curves suggested a good agreement between the actual observation and the nomogram prediction. DCAs and clinical impact curves reflected favorable potential clinical effects of predictive nomograms. Conclusion Chemotherapy, surgery of primary site, and age were important independent risk factors for the CSS and OS of SCLM patients. We built and validated two reliable nomograms of OS and CSS to predict the prognoses of SCLM patients, which can be accessed online at ( https://predictive-tool.shinyapps.io/CSS-DynNomapp/ ; https://predictive-tool.shinyapps.io/OS-DynNomapp/ ).

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Section: Discussionsupporting

confidence: 93%

Predictive Risk Factors and Online Nomograms for Synchronous Colon Cancer With Liver Metastasis

Zhu

Chen

et al. 2020

Front. Oncol.

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“…The prevalent association, observed in the current study, between primary tumor location and the three subcategories of stage IV mCRC could also represent an explanation for the higher survival observed in left-sided mCRC than in rightsided tumors [1][2][3]. Thus, patients with metastatic RCC have the highest probability of developing stage IVC disease and the lowest probability for stage IVA disease.…”

Section: Discussionsupporting

confidence: 58%

“…Until the last years, CRC was considered a unitary entity, but quite recently, some studies have demonstrated that there are differences in the prognosis of patients with Abbreviations: AJCC: American Joint Committee on Cancer; BRAF: v-raf murine sarcoma viral oncogene homolog B; CRC: colorectal cancer; CT: computed tomography; DW-MRI: diffusion-weighted -magnetic resonance imaging; IQR: interquartile range; LCC: left colon cancer; M1a: metastasis to one organ/site, excluding peritoneum; M1b: two or more metastatic sites without peritoneal involvement ; M1c: peritoneal metastases; mCRC: metastatic CRC; OS: overall survival; PET: positron emission tomography; RCC: right colon cancer; RC: rectal cancer; RR: relative risk; SD: standard deviation. metastatic colorectal cancer (mCRC), depending on the location of the primary tumor (between the right colon vs. the left colon and the rectum) [1][2][3]. During recent years, some explanations have emerged, such as the different embryological origin of the right colon versus the left colon and the rectum, the distinct pattern of somatic mutations in adenocarcinomas located on the right side versus left-sided CRC and the differences in the microbiota [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

“…metastatic colorectal cancer (mCRC), depending on the location of the primary tumor (between the right colon vs. the left colon and the rectum) [1][2][3]. During recent years, some explanations have emerged, such as the different embryological origin of the right colon versus the left colon and the rectum, the distinct pattern of somatic mutations in adenocarcinomas located on the right side versus left-sided CRC and the differences in the microbiota [1][2][3]. However, these explanations revealed some dissimilarities between the right colon tumors, on one hand, and the left colon and rectal tumors (altogether), on the other hand.…”

Section: Introductionmentioning

confidence: 99%

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Influence of the Primary Tumor Location on the Pattern of Synchronous Metastatic Spread in Patients with Stage IV Colorectal Carcinoma, According to the 8 th Edition of the AJCC Staging System

Alexandrescu

Anastase

Grigorie

et al. 2020

JGLD

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Background and Aims: The correlations between primary tumor location (right colon cancer – RCC, left colon cancer – LCC and rectal cancer – RC) and the incidence of metastatic sites are scarce and divergent. The current study is the first which compares the pattern of metastatic distribution (M1a: metastasis to one organ/site, excluding peritoneum; M1b: two or more metastatic sites; M1c: peritoneal metastases) between RCC, LCC and RC, respectively. Methods: All patients operated for colorectal cancer (CRC) between January 2006 and December 2015 were analyzed to assess the primary tumor location, the presence and site of synchronous metastases. Univariate analysis determined the statistical significance of association between each CRC location and the metastatic pattern. Multinomial logistical regression model compared the prevalence of each metastatic pattern for each CRC location. Results: Out of 5,107 patients, 1,318 (25.80%) had metastases on the moment of CRC diagnosis. There were no statistically significant association between the metastatic pattern and the patients’ gender (M1a, p=0.321; M1b, p=0.539; M1c, p=0.417, Chi-square) or patients’ age (p=0.616 Mann–Whitney U-test). RC had a significant higher relative risk for M1a (RR of 1.437, p=0.014) and a lower relative risk for M1c (RR of 0.564, p=0.001), compared to LCC. On the contrary, compared with LCC, the RCC showed a significant lower relative risk for M1a (RR of 0.673, p=0.006) and a higher relative risk for M1c (RR of 1.834, p=0.0001). Conclusion. There is a strong correlation between the primary location of CRC and the pattern of the metastatic spread, with potential prognostic implications.

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“…Previously the suggestion has been made that the typically more indolent course of presentation of right CRC, might in part be responsible for inferior outcome with resulting liver metastases[ 10 ]. The notion here is that delayed diagnosis of primary tumour results in an increased risk of developing synchronous metastases which are then incurable[ 51 ]. This would mean potentially fewer curative-intent resections offered to these patients, resulting in observed abbreviated survival.…”

Section: Discussionmentioning

confidence: 99%

Impact of primary tumour location on colorectal liver metastases: A systematic review

Bingham¹,

Shetye²,

Suresh³

et al. 2020

WJCO

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BACKGROUND Colorectal cancer (CRC) is the third most common cause of cancer-related death worldwide. Despite significant advances in screening, surgical management and adjuvant therapies, average 5-year survival seldom exceeds 60% in most developed nations. Metastatic disease represents the primary cause of mortality in patients with CRC, and the liver is the most common location for distant tumour spread. Up to 25% of patients are found to have synchronous liver metastases at the time of diagnosis and a further 30%-40% will develop metachronous disease in the course of follow-up. It has been suggested that primary tumour location [right side versus left side, primary tumour location (PTL)] can influence oncological outcomes in this patient group and that this should be considered in prognostic models and therapeutic decision-making algorithms. This suggestion is not universally accepted and there have been conflicting reports in the literature to date. AIM To provide a comprehensive summary of the available evidence regarding the impact of PTL on oncological outcomes in patients with colorectal cancer liver metastases (CRCLM). METHODS MEDLINE, EMBASE and COCHRANE were searched for relevant publications using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. Data on oncological outcomes was then extracted from full text articles that met the predefined inclusion criteria. RESULTS A total of 41 studies were identified that met predefined inclusion criteria for this review. In 21 out of 38 studies that provided data on overall survival, a statistically significant improvement in overall survival was reported in patients with left sided primary tumours. These studies included a total of 13897 patients compared with 4306 patients in the studies that did not show a significant difference. Eight studies noted a similar trend towards improved disease-free or progression-free survival. Several authors observed distinct patterns of relapse after treatment of hepatic metastases according to PTL; for example hepatic recurrence after treatment of CRCLM appears to occur more aggressively with right-sided CRC. CONCLUSION Taken together, the findings of the present review indicate that PTL may have a role as an independent prognostic factor when determining treatment and disease surveillance strategies in CRC. The mechanisms responsible for this variation remain poorly understood, but are likely to relate to molecular, histological and embryological differences, as well as inherent differences in therapeutic sensitivity.

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Influence of primary site on metastatic distribution and survival in stage IV colorectal cancer

Abstract: Rectal cancers have a higher chance of recurring, with a higher metastatic rate to the lung, yet demonstrate better survival outcomes in metastatic colorectal cancer, reflecting the benefit of intervention for metastases.

Cited by 20 publications

References 32 publications

Predictive Risk Factors and Online Nomograms for Synchronous Colon Cancer With Liver Metastasis

Predictive Risk Factors and Online Nomograms for Synchronous Colon Cancer With Liver Metastasis

Influence of the Primary Tumor Location on the Pattern of Synchronous Metastatic Spread in Patients with Stage IV Colorectal Carcinoma, According to the 8 th Edition of the AJCC Staging System

Impact of primary tumour location on colorectal liver metastases: A systematic review

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