Right and Left Colorectal Cancer: Differences in Post-Surgical-Care Outcomes and Survival in Elderly Patients

Fernández, Irene Mirón; Velasco, Santiago Mera; Luque, Jesús Damián Turiño; Poveda, Iván González; Lopez, M.; Santoyo, Julio Santoyo

doi:10.3390/cancers13112647

Cited by 8 publications

(5 citation statements)

References 27 publications

(39 reference statements)

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“…Multiple studies have suggested that the PTL influenced the prognosis of patients with advanced CRC, and patients with left-sided colon cancer (L-CC) had a better OS compared with that of patients with R-CCs (26)(27)(28). However, whether PTL was associated with long-term survival in patients with CRC liver metastases after radical resection of the primary tumor and metastatic tumor remains inconclusive.…”

Section: Discussionmentioning

confidence: 99%

Primary tumor location impacts survival in colorectal cancer patients after primary resection: a population‑based propensity score matching cohort study

Yin¹,

Li²,

Xu³

et al. 2023

J Gastrointest Oncol

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Background: Right-sided colon cancers (R-CCs) are associated with worse outcomes compared to leftsided colon cancers (L-CCs). This study aimed to investigate whether a difference in survival existed among R-CC, L-CC, and rectal cancer (ReC) and subsequent liver metastasis.Methods: Data from the Surveillance, Epidemiology, and End Results (SEER) database for 2010-2015 was used to identify colorectal cancer (CRC) patients who underwent surgical resection of primary disease.Propensity score adjustment and Cox regression models were used to identify risk factors and prognostic factors of primary tumor location (PTL). Kaplan-Meier curve analysis and the log-rank test were used to evaluate overall survival (OS) of CRC patients.Results: Our results showed that among the 73,350 included patients, 49% were R-CC, 27.6% L-CC, and 23.1% ReC. Before propensity score matching (PSM), the OS of the R-CC group was significantly lower than that of the L-CC and ReC groups (P<0.05). However, the clinicopathological characteristics, including gender, tumor grade, tumor size, marital status, tumor (T) stage, node (N) stage, and carcinoembryonic antigen (CEA), were significantly unbalanced among the 3 groups (P<0.05). After 1:1 PSM, 8670 patients were effectively screened out in each group. The differences in clinicopathological characteristics among the 3 groups were significantly reduced, and baseline distribution characteristics such as gender, tumor size, and CEA were significantly improved after matching (P>0.05). Survival was higher in the left-side group when evaluated by tumor sidedness, and ReC patients had the highest median survival (114.3 months). Right-sided cancer patients had the worst prognosis in both PTL and sidedness analyses, with a median survival of 76.6 months.Among CRC patients with synchronous liver metastases, adjustment by inverse propensity weight and propensity score and analysis of OS yielded similar results and had more significant stratification results. Conclusions:In conclusion, R-CC has a worse survival prognosis compared to L-CC and ReC, and they are fundamentally different tumors that have distinct effects on CRC patients with liver metastases.

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Section: Discussionmentioning

confidence: 99%

Primary tumor location impacts survival in colorectal cancer patients after primary resection: a population‑based propensity score matching cohort study

Yin¹,

Li²,

Xu³

et al. 2023

J Gastrointest Oncol

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“…Patients with LCC benefit more from chemotherapy and targeted therapy and also experienced a better prognosis, while patients with RCC showed more promising results in immunotherapy 29 . Mirón Fernández et al 30 pointed out that there were significant differences between RCC and LCC in terms of evolution, progression, complications, and survival. Compared with LCC, RCC had a more advanced N stage, a larger tumor volume, lower tumor differentiation, and a higher positive rate of lymphatic vascular invasion.…”

Section: Discussionmentioning

confidence: 99%

Prediction values of tertiary lymphoid structures in the prognosis of patients with left- and right-sided colon cancer: a multicenter propensity score-matched study

Mao

Wang

Liu

et al. 2023

International Journal of Surgery

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Background: Tertiary lymphoid structures (TLS) are the lymphocyte aggregates that play a key role in the vast majority of solid tumors including colon cancer, displaying an antitumor effect under most circumstances. The heterogeneity between left- and right-sided colon cancer (LCC and RCC) encompasses various aspects, such as clinical manifestations, pathological features, and immune responses. However, the function and prognostic significance of TLS within LCC and RCC have yet to be fully understood. Methods: A retrospective analysis was performed on 2612 patients who underwent radical resection for LCC or RCC without distant metastasis in multiple medical centers. Utilizing propensity score matching, 121 patients with LCC and 121 patients with RCC were selected for the training set. An external validation set including 64 patients with LCC and 64 patients with RCC were also employed. Hematoxylin-eosin and immunohistochemical staining were used to assess TLS and the proportion of various immune cells. Clinical characteristics and prognostic values of TLS in patients with LCC and RCC were analyzed. Nomograms were constructed for LCC and RCC to predict 3-year and 5-year overall survival (OS), respectively. Results: For LCC and RCC patients, TLS was located in the interstitial region or outside the tumor tissue and mainly consisted of B cells and T cells. The TLS quantity and density in RCC were higher than those of LCC. In multivariate Cox regression analysis, TLS density (P=0.014), vascular invasion (P=0.019), and AJCC stage (P=0.026) were independent prognostic factors for 5-year OS of RCC. For LCC patients, AJCC stage (P=0.024), tumor differentiation (P=0.001), and tumor budding (P=0.040) emerged as independent prognostic factors for 5-year OS. Similar results were obtained in the external verification set. Separate nomograms for RCC and LCC were developed, displaying improved prediction performance compared to the AJCC 8th edition TNM staging system. Conclusions: Differences in TLS quantity and density were observed between LCC and RCC, suggesting that a nomogram based on TLS density could more effectively predict survival for RCC patients. Furthermore, a nomogram based on tumor budding was recommended for better prediction of LCC patient survival. Taken together, these results suggested that the immune and clinical characteristics of colon cancer at left and right side were substantially different, which may lead to the use of different prediction model and the development of individual treatment strategy.

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“…Compared with left-sided CRC (LCRC), right-sided CRC (RCRC) is usually associated with poor prognosis, and also presents more advanced N stage, larger tumor size, poorly differentiated tumors, as well as higher probability of lymphatic vascular invasion ( 48 ). In addition, RCRC also presented higher hypermethylation and higher microsatellite instability (MSI) frequency than LRCR ( 26 , 49 ).…”

Section: Discussionmentioning

confidence: 99%

Crosstalk of angiogenesis-related subtypes, establishment of a prognostic signature and immune infiltration characteristics in colorectal adenocarcinoma

Cui

Liu²,

Wang³

et al. 2022

Front. Immunol.

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BackgroundColorectal adenocarcinoma (COAD) is one of the most common malignancies and angiogenesis is vital to the development of cancer. Here, we explored the roles of angiogenesis-related genes (ARGs) that affect the prognosis of COAD and constructed risk models to assess patient prognosis, immune characteristics, and treatment outcomes.MethodsWe comprehensively characterized the transcriptional and genetic modifications of 48 ARGs in COAD and evaluated the expression patterns. We identified two ARG subgroups using the consensus clustering algorithm. Based on the differentially expressed genes (DEGs) of two ARG subtypes, we calculated risk score, namely ARG_scores, and calssified COAD patients into different risk groups. To investigate the expression of ARG_score-related genes, qRT-PCR was performed. Subsequently, we mapped the nomogram to visually and accurately describe the value of the application of ARG_score. Finally, the correlation between ARG_score and clinical features, immune infiltration along with drug sensitivity were explored.ResultsWe identified two ARG related subgroups and there were great differences in overall survival (OS) and tumor microenvironment. Then, we created an ARG_score for predicting overall survival based on eight DEGs and confirmed its reliable predictive power in COAD patients, with higher ARG_score associated with worse prognosis. Furthermore, eight ARG_score-related genes expression was investigated by qRT-PCR. To make the ARG_score clinically feasible, we created a highly reliable nomogram. We also found a higher proportion of microsatellite instability-high (MSI-H) and higher tumor mutational burden (TMB) in the high-risk group. In addition, ARG_score was notably correlated with cancer stem cell indices and drug sensitivity.ConclusionThis scoring model has potential clinical application value in the prognosis, immune microenvironment and therapeutic drug sensitivity of COAD, which provides new insights for personalized treatment.

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Right and Left Colorectal Cancer: Differences in Post-Surgical-Care Outcomes and Survival in Elderly Patients

Cited by 8 publications

References 27 publications

Primary tumor location impacts survival in colorectal cancer patients after primary resection: a population‑based propensity score matching cohort study

Primary tumor location impacts survival in colorectal cancer patients after primary resection: a population‑based propensity score matching cohort study

Prediction values of tertiary lymphoid structures in the prognosis of patients with left- and right-sided colon cancer: a multicenter propensity score-matched study

Crosstalk of angiogenesis-related subtypes, establishment of a prognostic signature and immune infiltration characteristics in colorectal adenocarcinoma

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