Sidedness is prognostic in locoregional colon cancer: an analysis of 9509 Australian patients

Abstract

Background/AimRight sided colon cancer (RsCC) is proposed to be a distinct disease entity to left sided colon cancer (LsCC). We seek to confirm primary tumour location as an independent prognostic factor in locoregional colorectal cancer.MethodsAll patients with stage I – III primary adenocarcinoma of colon were identified from the New South Wales (NSW) clinical cancer registry (2006–2013). Primary tumour location (RsCC vs LsCC) survival analyses were conducted using the Kaplan-Meier method, and adjusted hazard ratios for 5-year all-cause mortality (OS) and 5-year cancer specific mortality (CSS) were obtained using Cox proportional hazards regression.ResultsWe identified 9509 patients including 5051 patients with RsCC and 4458 with LsCC. Patients with RsCC were more likely to be older, female, have a higher Charlson comorbidity index, and have worse tumour prognostic factors. In univariate analysis of all stages combined, those patients with RsCC had a worse overall survival (OS, HR 1.20 95% CI 1.11–1.29, p < 0.0001), although this was not significant in the multivariate analysis (HR 0.96 95% CI 0.89–1.04, p = 0.35). Stage I patients with RsCC had a trend to improved OS (multivariate HR 0.84 95% CI 0.69–1.01, p = 0.07) and a significantly improved CSS (multivariate HR 0.51 95% CI 0.35–0.75, p = 0.0006). In stage II patients with RsCC there was a significantly improved OS (multivariate HR 0.85 95% CI 0.75–0.98, p = 0.02) and CSS (multivariate HR 0.59 95% CI 0.45–0.78, p = 0.0002) compared to LsCC. In stage III patients, those with RsCC had a worse OS (multivariate HR 1.13 95% CI 1.01–1.26, p = 0.032) and a trend to worse CSS (multivariate HR 1.12 95% CI 0.94–1.33, p = 0.22).ConclusionsPrimary tumour location is an important prognostic factor in locoregional colon cancer with an effect that varies by stage. RsCC is associated with lower all-cause mortality in stage II, and higher all-cause mortality in stage III.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-017-3255-z) contains supplementary material, which is available to authorized users.

Is primary sidedness a prognostic factor in patients with resected colon cancer liver metastases (CLM)?

“…These authors included patients with nonmetastatic colon tumors in the analysis and observed that patients with right‐sided colon tumors and clinical stages (CS) III and IV had worse survival whereas those with right‐sided colon tumors at CS I and II did not have significant differences in survival. A large Australian case series (9509 patients) included only nonmetastatic disease and had similar findings, with lower survival among patients with right‐sided colon tumors and CS III . Other studies that included patients with nonmetastatic disease obtained different results for patients with CS I and II.…”

“…A large Australian case series (9509 patients) included only nonmetastatic disease and had similar findings, with lower survival among patients with right-sided colon tumors and CS III. 10 Other studies that included patients with nonmetastatic disease obtained different results for patients with CS I and II. However, these studies have consistently demonstrated the negative impact of rightsided colon tumors in patients with CS III.…”

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

“…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.…”

“…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.…”

“…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.…”