SIDE in metastatic colon cancer: SEER Database analysis.

753 Background: Recent data suggests side of colon cancer is a prognostic factor and a potential predictive factor for biologic therapy. We sought to analyze SEER database to study impact of colon cancer side. Methods: The SEER database (version 8.3.4) was reviewed for patients with Stage IV colon cancer from 2004-2014. We only included patients with labeled primary site, and excluded appendiceal, rectal or unlabeled cases. Variables included were: age, race, gender, stage, grade and side of the tumor. Primary outcome was overall survival and disease specific survival. Cox proportional hazard regression model was employed to test the association between survival and side of cancer. Results: 48,306 patients met the inclusion criteria, median age was 67 years (range 20-108), 51% were male, and 77% patients were white. 19831 (41%) patients had left colon cancer (LCC). Right colon cancer (RCC) was associated with inferior OS and DSS compared to LCC. The median overall survival was 15 months (mo) for left side and 9 months for right colon cancer (p<0.0001). Estimated 3-year OS for RCC was 14% and 24% for LCC (p <0.0001). RCC was associated with poor outcome across different variables, among patients < 60 years of age median OS was 23 mo for LCC, and 16 mo for RCC (p .0001). In the age group ≥ 60 years, 10 mo for left side and 7 mo for RCC (p < 0.0001). Among male patients RCC had 10 mo median OS vs 16 mo for LCC (p <0.0001), women 15mo for LCC vs 9mo for RCC (<0.0001). Cox regression model suggested age (<0.001), race (<0.0001), year of diagnosis (<0.0001) and grade (<0.0001) correlate with outcome. Conclusions: Right side colon cancer is associated with poor outcome compared to left colon cancer. These findings are consistent with other recent reports.

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Metastatic pattern and tumor sidedness in colorectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e15147 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e15147-e15147

Author(s):

Mahvish Muzaffar ◽

Abdul Rafeh Naqash ◽

Darla K. Liles ◽

Sumyra Kachru

Keyword(s):

Colorectal Cancer ◽

Colon Cancer ◽

Regression Model ◽

Predictive Factor ◽

Primary Tumor ◽

Left Colon ◽

Cancer Site ◽

Metastatic Colon Cancer ◽

Metastatic Pattern ◽

Left Colon Cancer

e15147 Background: Tumor side has emerged as an important prognostic and predictive factor in metastatic colon cancer. We sought to study its impact on the metastatic pattern of colorectal cancer. Methods: The SEER database (version 8.3.5) was reviewed for patients with Stage IV colorectal cancer diagnosed between 2004-2015. We only included patients with labeled primary site, and excluded appendiceal, unlabeled and autopsy alone cases. Variables included in the analysis were: age, race, gender, grade, primary tumor side and sites of metastasis at diagnosis. Primary outcome analyzed was overall survival and disease specific survival.Cox proportional hazard regression model was employed to test the association between survival and side of cancer/ site of metastasis. Results: A total of 74,768 cases were identified who met the eligibility criteria. The mean age was 68.5 yrs. for right colon cancer (RCC),64.0 yrs. for left colon cancer (LCC). and 62.9 yrs. for rectal cancer. White race was predominant group for RCC, LCC and rectum. More females were vs men in RCC (52% vs 48%), LCC (44% vs 56%) and rectum (60% vs 40%). (The cox regression model suggested inferior outcome for black race HR 1.05(1.03-1.07) (<0.001), high grade HR 1.32(1.30-1.35) p<.0001, right side tumors HR 1.23(1.21-1.250, p <.0001 (table). Conclusions: Over last few years tumor sidedness has emerged as an important prognostic and predictive factor in colon cancer. Our study also highlights the impact of sidedness on survival irrespective of distant metastatic pattern. This analysis contributes to the ongoing discussion that right and left colon cancer are two distinct disease entities. Impact of primary tumor side and metastatic site on survival in colorectal cancer. [Table: see text]

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Predictive Value of Body Composition Analysis for the Prognosis of Patients with Advanced Gastrointestinal Tumors

journal of nutritional oncology ◽

10.34175/jno202004005 ◽

2020 ◽

Vol 5 (4) ◽

pp. 182-188

Author(s):

Hai Mei Yang ◽

◽

Yi Zhuo Wang ◽

Xiang Liang Liu ◽

Wei Ji ◽

...

Keyword(s):

Gastric Cancer ◽

Skeletal Muscle ◽

Colon Cancer ◽

Body Composition ◽

Left Colon ◽

First Line ◽

Right Colon ◽

Right Colon Cancer ◽

Left Colon Cancer

Objective There is strong evidence that the body composition can affect the progression-free survival (PFS) and overall survival (OS) in patients with a variety of cancers. The main objective of this study was to investigate the effect of body composition on the prognosis of patients with advanced gastrointestinal and colorectal cancers who received first-line palliative chemotherapy. Methods Patients who were newly-diagnosed with advanced gastrointestinal or colorectal cancer and received standard first-line palliative chemotherapy from January 2017 to December 2018 were included in this retrospective study. An analysis of computed tomography images was performed to determine the skeletal muscle index (SMI), which reflects the skeletal muscle mass and skeletal muscle density (SMD) related to muscle strength. A Kaplan-Meier survival analysis and log-rank test were used to compare the survival relationships among groups stratified by the SMI, and a Cox proportional hazard model was used for a multivariate analysis. Results A total of 108 patients met the inclusion criteria, including 41 cases of gastric cancer, 46 cases of left colorectal cancer, and 21 cases of right colon cancer. In patients with gastric cancer, the OS of women was significantly shorter than that of men. The OS of patients with a low SMI, low SMD, and low phase angle (PA) was significantly shorter than that of patients with high values (P ≤ 0.05). In the multivariate analysis, the SMD was significantly associated with the patients' long-term survival [Hazard Ratio (HR) = 0.904, 95% CI: 0.840~0.974, P = 0.008]. For patients with a low SMI and PA, the PFS was significantly shorter than that of patients with high values (P ≤ 0.05). In patients with left colon cancer, the PA and SMD were both independent risk factors for a poorer long-term prognosis (HR = 0.375, 95% CI: = 0.167~0.840, P = 0.017; HR = 0.887, 95% CI: 0.824~0.954, P = 0.001). Among right colon cancer patients, the PFS and OS of those with a low SMD were significantly lower than those for patients with high values (P ≤ 0.05). Conclusion The PA is an independent risk factor for the OS of left colon cancer patients; the SMD is an independent risk factor for the survival of patients with gastric cancer, left colon cancer, and right colon cancer.

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Risk of tumor-related death in stage I-III colon cance based on gender and tumor location.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e14538 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e14538-e14538

Author(s):

Robert D. Ladner ◽

Michael Kahn ◽

Dongyun Yang ◽

Sebastian Stintzing ◽

Wu Zhang ◽

...

Keyword(s):

Colon Cancer ◽

Cancer Biology ◽

Tumor Location ◽

Left Colon ◽

Stage I ◽

Stage Ii ◽

Primary Data ◽

Metastatic Colon Cancer ◽

Seer Database ◽

Left Colon Cancer

e14538 Background: Survival of metastatic colon cancer has recently been linked to gender and location of the primary. Data on these factors in the stage I-III is still sparse. We aimed to demonstrate the influence of gender and tumor location of tumor related survival, using SEER database. Methods: 288,640 patients diagnosed with stage I-III colon cancer during 1988 through 2009 identified from SEER database were included in this study. Cox proportional hazards models were used to evaluate the effects of tumor site (left vs right-sided colon) on colorectal cancer specific survival. Age, race, T stage, N stage, histology (adenocarcinoma, mucinous tumor), grading, numbers of lymph nodes resected and type of surgery were used as covariates. Results: A total of 85,131 (stage I), 110,667 (stage II) and 92,842 (stage III) patients were identified to have data on all the factors to be looked at. In the total population female gender was statistically significant for longer TSS for all three stages (HR 0.82; HR 0.86 and HR 0.89). Furthermore, in UICC I and UICC III left side was favorable (HR 0.82 and HR 0.91) but in stage II, right sided colon cancer patients had a longer TSS (HR 1.2 for left side). This was independent of gender. Conclusions: Different prognoses of right versus left colon cancer reflect different biology. Furthermore the influence of gender points to an estrogen effect in female patients. As there is emerging knowledge about the differences in right versus left colon cancer biology, the modulating effect of SMAD4 on estrogen driven TGFß signaling might be one explanation to those differences.

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Oncogenic mutations in colorectal cancer, indications for anatomical sites, and targeted intervention.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e22037 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e22037-e22037

Author(s):

Giovanni Corso ◽

Valeria Pascale ◽

Giuseppe Flauti ◽

Daniele Marrelli ◽

Franco Roviello

Keyword(s):

Colorectal Cancer ◽

Colon Cancer ◽

Microsatellite Instability ◽

Cancer Patients ◽

Left Colon ◽

Targeted Intervention ◽

Right Colon ◽

Right Colon Cancer ◽

Oncogenic Mutations ◽

Colorectal Cancer Patients

e22037 Background: Oncogenic mutations, such as KRAS, in colorectal cancer patients are considered standard molecular biomarkers that predict the clinical benefit for the targeted intervention with EGFR inhibitors. In addition, these mutations are associated with specific anatomical area in the colon tumor development, as BRAF mutations with the microsatellite instability. Methods: In this translational study we aim to assess the mutation frequencies of the EGFR [hotspot area and polyadenine deletions (A13_del)], KRAS, BRAFV600E, and PIK3CA oncogenes in a series of 280 colorectal cancer patients. Microsatellite instability phenotype is considered in this series. All patients' clinicopathological data were considered for statistical analysis and associations. Results: In this study, we verified multiple associations between oncogenic mutations and specified clinicopathological tumor features. Respectively, we identified the following significant results: 1) EGFR A13_deletions are associated with right colon carcinoma (22.2% vs. 3.3%; p<0.005), mucinous histotype (16% vs. 7.8%; p=0.042), G3 grading (19% vs. 7.3%; p=0.024) and microsatellite instability status (p<0.005); 2) PIK3CA mutations are related mucinous histotype (12% vs. 4.4%; p=0.021) 3) KRASG12 and KRASG13mutations are correlated respectively with the left (91.4% vs. 59.3%) and right (40.7% vs. 8.6%) colon cancer development (p<0.005), and finally 4) microsatellite instability is associated with right colon tumors (28.4% vs. 5.5%; p<0.005). Conclusions: Mostly, we verified a high frequency rate of the KRASG13 and EGFR A13_del oncogene mutations in right colon cancer; whereas KRASG12 codon mutation occurs more frequently in left colon cancers. In particular, we assessed that right colon cancer is associated with specific molecular characteristics, in comparison to left colon tumors. These evidences, in association with specific clinicopathological data, can delineate novel approaches for the colorectal cancer classification and targeted intervention.

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PROGNOSTIC FACTORS FOR LEFT COLECTOMY FOR COLON CANCER: A TEN YEARS EXPERIENCE OF A SINGLE UNIVERSITY INSTITUTION

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-6720201700020006 ◽

2017 ◽

Vol 30 (2) ◽

pp. 103-107 ◽

Cited By ~ 1

Author(s):

Sergio Carlos NAHAS ◽

Caio Sergio NAHAS ◽

Leonardo Alfonso BUSTAMANTE-LOPEZ ◽

Rodrigo Ambar PINTO ◽

Carlos Frederico Sparapan MARQUES ◽

...

Keyword(s):

Colon Cancer ◽

Overall Survival ◽

Length Of Hospital Stay ◽

Cancer Staging ◽

Tumor Location ◽

Left Colon ◽

Term Survival ◽

Lymph Node Yield ◽

Left Colectomy ◽

Left Colon Cancer

ABSTRACT Background: Colorectal cancer is the third most common cancer in the world. In Brazil, it is the leading cause of cancer in the gastrointestinal tract. Aim: To evaluate the preoperative, perioperative, and postoperative risk factors for recurrence and overall survival of patients with left colon cancer operated during a ten-year period. Methods: Patients with left colon cancer surgically treated underwent clinical preoperative workout and cancer staging. The following factors were studied: gender, age, tumor location, T stage, lymph node yield, N stage, M stage, histological type, and tumor differentiation. It was analyzed the influence in five-year overall survival. Results: A total of 173 patients underwent left colectomy for colon cancer. There was a slight predominance of male gender with 50.9%. The mean age was 60.8 years old. Fifteen (8.7%) tumors were located at splenic flexure, 126 (72.8%) at sigmoid colon, and 32 (18.5%) at descending colon. The median length of hospital stay was seven days. Mean survival was 47.5 months. At 60 months seven patients (4%) lost follow-up, 38 patients (21.9%) deceased and 135 patients (78%) were alive. Overall survival time was 48 months. Conclusion: Advanced stages (T3-T4, N+ and M+) were the only factors associated with poor long term survival in left colon cancer.

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IS THERE A DIFFERENCE BETWEEN RIGHT- VERSUS LEFT-SIDED COLON CANCERS? DOES SIDE MAKE ANY DIFFERENCE IN LONG-TERM FOLLOW-UP?

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-672020190001e1479 ◽

2019 ◽

Vol 32 (4) ◽

Cited By ~ 1

Author(s):

Leonardo Alfonso BUSTAMANTE-LOPEZ ◽

Sergio Carlos NAHAS ◽

Caio Sergio R. NAHAS ◽

Rodrigo Ambar PINTO ◽

Carlos Frederico S. MARQUES ◽

...

Keyword(s):

Colon Cancer ◽

Survival Time ◽

Right Colon ◽

Risk Of Death ◽

Colon Cancers ◽

Right Colon Cancer ◽

Long Term Follow Up ◽

Disease Entities ◽

Left Colon Cancer

ABSTRACT Background: Since 1990 it was proposed that distal and proximal location of colon cancer might follow different biological, epidemiology, pathology and prognosis, probably due to embryologic different development of the two segments of the colon, which may represent two separate disease entities. These differences might have consequences for the treatment of patients with colorectal cancer. Aim: To compare the characteristics between patients with right and left colon cancer, with severity and tumor characteristic that influence in the survival of these patients. Method: Were evaluated the outcomes of surgical treatment of patients with colon cancer with data collected retrospectively from prospectively collected database. Results: The tumor’s side did not influence survival time of patients with colon cancer (p=0.112) in the regression model. Only the diseases stage leads to influence on survival time; patients with right colon cancer have more advanced staging (III or IV) and present a risk of death greater in 3.23 times. Conclusion: This analysis provides evidence that the prognosis of localized left-sided colon cancer is better compared to right-sided colon cancer. Also, the patients with right colon cancer have more advanced stage, mucinous tumor and are older.

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Smoking-Related Risks of Colorectal Cancer by Anatomical Subsite and Sex

American Journal of Epidemiology ◽

10.1093/aje/kwaa005 ◽

2020 ◽

Vol 189 (6) ◽

pp. 543-553 ◽

Cited By ~ 2

Author(s):

Inger T Gram ◽

Song-Yi Park ◽

Lynne R Wilkens ◽

Christopher A Haiman ◽

Loïc Le Marchand

Keyword(s):

Colorectal Cancer ◽

Rectal Cancer ◽

Colon Cancer ◽

Cox Regression ◽

Left Colon ◽

Right Colon ◽

Right Colon Cancer ◽

Increased Risk ◽

The Right ◽

Incident Cases

Abstract The purpose of this study was to examine whether the increased risk of colorectal cancer due to cigarette smoking differed by anatomical subsite or sex. We analyzed data from 188,052 participants aged 45–75 years (45% men) who were enrolled in the Multiethnic Cohort Study in 1993–1996. During a mean follow-up period of 16.7 years, we identified 4,879 incident cases of invasive colorectal adenocarcinoma. In multivariate Cox regression models, as compared with never smokers of the same sex, male ever smokers had a 39% higher risk (hazard ratio (HR) = 1.39, 95% confidence interval (CI): 1.16, 1.67) of cancer of the left (distal or descending) colon but not of the right (proximal or ascending) colon (HR = 1.03, 95% CI: 0.89, 1.18), while female ever smokers had a 20% higher risk (HR = 1.20, 95% CI: 1.06, 1.36) of cancer of the right colon but not of the left colon (HR = 0.96, 95% CI: 0.80, 1.15). Compared with male smokers, female smokers had a greater increase in risk of rectal cancer with number of pack-years of smoking (P for heterogeneity = 0.03). Our results suggest that male smokers are at increased risk of left colon cancer and female smokers are at increased risk of right colon cancer. Our study also suggests that females who smoke may have a higher risk of rectal cancer due to smoking than their male counterparts.

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