A National Cancer Database (NCDB) analysis of the impact of nonmetastatic colon cancer sidedness on survival.

139 Background: Differences in embryological origin and tumor biology distinguish right-sided colon cancer (RCC) from left-sided colon cancer (LCC). Previous studies characterizing the prognostic impact of colon cancer laterality on clinical outcomes in non-metastatic colon cancer have been conflicting, thus closer examination is needed. Methods: Using the NCDB, patients with stage I-III colon cancer between 2004-2014 were stratified according to tumor location; RCC vs. LCC. Patient (pt) and tumor characteristics were compared in univariate analysis, survival (OS) was estimated by Kaplan-Meier (KM) curves and Cox proportional hazards modeling. Binomial logistic regression analysis was utilized to identify variables associated with colon cancer laterality. Results: Of the 342,735 pts who met inclusion criteria, 210,343 (61.4%) were diagnosed with RCC, and 132,392 (38.6%) with LCC. Pts with RCC were older (mean 71.6 vs. 66.4 years, p< 0.001) and predominantly female (65% vs. 35%, p< 0.001) compared to those with LCC. A trend towards poorer OS was seen in pts with RCC (mean 91.0 mos [95% CI: 90.2-91.8]) compared to LCC (112.2 mos [95% CI: 110.9-113.6]) in unadjusted analysis. On Cox multivariable adjusted analyses there was a significant but minimal impact on OS and laterality (hazard ratio or HR [LCC as ref] 0.978, 95% CI 0.967-0.989 p< 0.0001). Multiple unadjusted KM survival analyses showed RCC with T4 disease, high-grade, LVI/PNI, positive margins, N0-N2 disease, tumor deposits, and receipt of adjuvant chemotherapy had poorer OS than those features in LCC (all p < 0.0001). Binomial logistic regression showed RCCs were significantly more likely to be higher grade (odds ratio or OR 2.024) and MSI-H (OR 2.010) with trends (nonsignificant) towards more likely having N1-2 positive disease, LVI, less receipt of adjuvant chemotherapy, and fewer tumor deposits. Conclusions: The impact of sidedness on prognosis in stage I-III colon cancer is complex. In this large, population-based study, RCC tends to be associated with more adverse prognostic features than LCC. More investigation into the biologic differences between RCC and LCC is warranted and how they impact phenotype and survival.

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Prognostic impact of preoperative albumin to globulin ratio in curative colon cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.647 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 647-647

Author(s):

Yuji Toiyama ◽

Hiroyuki Fujikawa ◽

Yasuhiro Inoue ◽

Hiroki Imaoka ◽

Masato Okigami ◽

...

Keyword(s):

Colon Cancer ◽

Adjuvant Chemotherapy ◽

Cancer Patients ◽

Poor Prognosis ◽

Early Recurrence ◽

Stage I ◽

Stage Iii ◽

Prognostic Impact ◽

Stage Iii Colon Cancer ◽

Albumin To Globulin Ratio

647 Background: Albumin to globulin ratio (AGR) has been reported to predict long term mortality in patients with several cancers. However, prognostic impact of preoperative AGR in colon cancer patients with curative intent has not yet been fully addressed. Therefore, we, for the first time, investigated the association between AGR and clinico-pathological findings including overall survival (OS) and disease free survival (DFS) in stage I-III colon cancer patients. Methods: Clinicopathological findings including preoperative laboratory data (carcinoembryonic antigen [CEA] and AGR) from 251 curative colon cancer patients were assessed as indicators of early recurrence and poor prognosis in this retrospective study. AGR was calculated as [AGR = albumin/ (total protein - albumin)]. The cut-off value of AGR was 1.32 in current study. Results: Several clinicopathological categories related with tumor progression such as lymph node metastasis, T4 tumor, large tumor size, undifferentiated tumor, venous and lymphatic invasion, and high CEA were significantly associated with low AGR level. The patients with low AGR were significantly poorer OS (P = 0.001) and DFS (P = 0.003) than those with high AGR, respectively. In addition, multivariate analyses demonstrated that low AGR was independently associated with early recurrence (HR = 2.87, P = 0.007) and poor prognosis (HR = 2.56, P = 0.008), respectively. On the other hand, sub analysis of survival curves revealed that stage III colon cancer patients with low AGR were significantly poorer OS (P = 0.007) and DFS (P = 0.02) than those with high AGR, respectively. Furthermore, significantly poorer OS and DFS were also shown in stage I-II colon cancer patients with low AGR, respectively (OS: P = 0.02, DFS: P = 0.01). Conclusions: Preoperative AGR was an independent predictor of early recurrence and poor prognosis in curative colon cancer patients. AGR may represent a simple, potentially useful predictive biomarker for selecting stage I-II colon cancer patients who might need adjuvant chemotherapy. Furthermore, AGR may select candidates who are better to introduce more intensive adjuvant chemotherapy after curative operation in stage III colon cancer patients.

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Loss of proapoptotic Bax protein expression-prognostic impact in primary stage I to III (UICC) colon cancer either treated or not treated with adjuvant chemotherapy

Gastroenterology ◽

10.1016/s0016-5085(03)82313-2 ◽

2003 ◽

Vol 124 (4) ◽

pp. A457

Author(s):

Thomas Okech ◽

Oliver Nehls ◽

Chih-Jen Hsieh ◽

M. Sabia ◽

Rainer Porschen ◽

...

Keyword(s):

Colon Cancer ◽

Adjuvant Chemotherapy ◽

Protein Expression ◽

Stage I ◽

Prognostic Impact ◽

Primary Stage ◽

Bax Protein

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Impact of BRAF mutations on prognosis and immunotherapy response in microsatellite instability/mismatch repair deficient metastatic colorectal cancer: A systematic review and meta-analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.3557 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 3557-3557

Author(s):

Robin Park ◽

Laércio Lopes da Silva ◽

Sunggon Lee ◽

Anwaar Saeed

Keyword(s):

Colorectal Cancer ◽

Systematic Review ◽

Braf Mutation ◽

Meta Analysis ◽

Stage Iv ◽

Stage I ◽

Prognostic Impact ◽

Braf Mutations ◽

Mutation Status ◽

The Impact

3557 Background: Mismatch repair deficient/microsatellite instability high (dMMR/MSI-H) colorectal cancer (CRC) defines a molecular subtype with distinct clinicopathologic characteristics including an excellent response to immunotherapy. Although BRAF mutations are established as a negative prognostic marker in CRC, whether they retain their negative prognostic impact in or alter the response to immunotherapy in dMMR/MSI-H CRC remains unknown. Herein, we present a systematic review and meta-analysis of the impact of BRAF mutations on the overall survival (OS) and immune checkpoint inhibitor (ICI) response in dMMR/MSI-H CRC. Methods: Studies published from inception to 26 January 2021 were searched in PubMed, Embase, and major conference proceedings (AACR, ASCO, and ESMO). Eligible studies included the following: 1) observational studies reporting outcomes based on BRAF mutation status in dMMR/MSI-H CRC patients and 2) experimental studies of ICI reporting outcomes based on BRAF mutation status in dMMR/MSI-H CRC patients. A summary hazard ratio (HR) was calculated for OS in BRAF mutated ( BRAFmut) vs. BRAF wild type ( BRAFwt) patients (pts) with the random effects meta-analysis (REM). A summary odds ratio (OR) was calculated for objective response rate (ORR) in BRAFmut vs. BRAFwt pts treated with ICI with the REM. Results: Database search conducted according to PRISMA guidelines found 4221 studies in total. Initial screening identified 30 studies and after full-text review, 9 studies (N = 4158 pts) were included for the meta-analysis of prognosis (analysis A) and 3 studies (N = 178 pts) were included for the meta-analysis of ICI response (analysis B). The outcome measures are summarized in the table below. Analysis A showed that in stage I-IV dMMR/MSI-H CRC pts, BRAFmut was associated with worse OS than BRAFwt (HR 1.57, 1.23-1.99). The heterogeneity was low (I2 = 21%). Subgroup analysis showed no significant difference in the prognostic impact of BRAF mutation status between stage IV only and stage I-IV CRC pts. Analysis B showed no difference in ORR (OR 1.04, 0.48-2.25) between BRAFmut vs. BRAFwt dMMR/MSI-H pts who received ICI. The heterogeneity was low (I2 = 0%). Conclusions: BRAF mutations retain their negative prognostic impact in dMMR/MSI-H stage I-IV and stage IV CRC but are not associated with differential ICI response. Limitations include the following: analysis A was based on retrospective studies; also, the impact of BRAF status on the survival outcome of ICI could not be assessed due to limited number of studies.[Table: see text]

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The Impact of KRAS Mutation on the Presentation and Prognosis of Non-Metastatic Colon Cancer: an Analysis from the National Cancer Database

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-020-04543-4 ◽

2020 ◽

Vol 24 (6) ◽

pp. 1402-1410 ◽

Cited By ~ 3

Author(s):

Aaron Scott ◽

Paolo Goffredo ◽

Timothy Ginader ◽

Jennifer Hrabe ◽

Irena Gribovskaja-Rupp ◽

...

Keyword(s):

Colon Cancer ◽

Kras Mutation ◽

Metastatic Colon Cancer ◽

National Cancer Database ◽

The Impact

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Tumor sidedness influences prognostic impact of lymph node metastasis in colon cancer patients undergoing curative surgery

Scientific Reports ◽

10.1038/s41598-019-56512-w ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Hsin-Wu Lai ◽

James Cheng-Chung Wei ◽

Hung-Chang Hung ◽

Chun-Che Lin

Keyword(s):

Colon Cancer ◽

Proportional Hazards ◽

Stage I ◽

Prognostic Impact ◽

Curative Surgery ◽

Node Metastasis ◽

Specific Mortality ◽

Cancer Specific Mortality ◽

High Level ◽

Worse Prognosis

AbstractThis study aimed to evaluate prognostic impacts of the number of lymph nodes (LNs) examined and LN ratio on cancer-specific mortality after surgery in patients with right-sided colon cancer (RCC) or left-sided colon cancer (LCC) using the Surveillance, Epidemiology, and End Results database. Number of LNs examined and LN ratio were treated as categorical and/or continuous. Competing risks proportional hazards regressions adjusted by propensity score were performed. All included patients had stage I, II, or III disease, and 45.1% of them had RCC. RCC and LCC patients with high level of LNs examined had better prognosis after segmental resection or hemicolectomy. RCC and LCC patients with higher LN ratio had worse prognosis regardless of surgery. Survival benefit of having high level of LNs examined was observed in RCC patients with stage I, II, or III disease, but only in LCC patients with stage II disease. Both higher LN ratio and high level of LN were negative prognostic factors for cancer-specific mortality in stage III patients regardless of tumor sidedness. In conclusion, RCC patients in various conditions had worse or comparable prognosis compared to their LCC counterparts, which reflected the severity of LN metastasis.

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941 – The Impact of Kras Mutation on the Presentation and Prognosis of Non-Metastatic Colon Cancer: An Analysis from the National Cancer Database

Gastroenterology ◽

10.1016/s0016-5085(19)40607-0 ◽

2019 ◽

Vol 156 (6) ◽

pp. S-1421-S-1422

Author(s):

Paolo Goffredo ◽

Xiang Gao ◽

Timothy Ginader ◽

Jennifer Hrabe ◽

Irena Gribovskaja-Rupp ◽

...

Keyword(s):

Colon Cancer ◽

Kras Mutation ◽

Metastatic Colon Cancer ◽

National Cancer Database ◽

The Impact

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Hepatic artery ligation and portal vein infusion for liver metastases from colon cancer.

Journal of Clinical Oncology ◽

10.1200/jco.1984.2.12.1382 ◽

1984 ◽

Vol 2 (12) ◽

pp. 1382-1389 ◽

Cited By ~ 21

Author(s):

L R Laufman ◽

T A Nims ◽

J T Guy ◽

J F Guy ◽

S Courter

Keyword(s):

Colon Cancer ◽

Portal Vein ◽

Liver Metastases ◽

Hepatic Artery ◽

Objective Response ◽

Metastatic Colon Cancer ◽

Hepatic Artery Ligation ◽

Artery Ligation ◽

Prognostic Features ◽

Portal Vein Infusion

Localized treatment of liver metastases from colon cancer has yielded better results than has systemic therapy. We report 19 patients with metastatic colon cancer whose bulk disease was limited to the liver, but was not amenable to surgical resection. Many of these patients had poor prognostic features: 14 had greater than 30% replacement of the liver, five had poorly differentiated tumor, and five had previously failed to respond to systemic chemotherapy. All were treated with hepatic artery ligation and portal vein infusion of chemotherapy (mitomycin C and 5-fluorouracil). Two patients (10%) died within one month postoperatively. The remaining 17 patients all improved clinically and demonstrated a marked decrease in carcinoembryonic antigen (CEA) levels. Based on follow-up physical exam, liver function tests, computed tomographic scan, and/or laparotomy, there were two complete responses, ten partial responses, four improved, and one indeterminate, for an objective response rate of 63%. Median survival of all patients was 13 months after hepatic artery ligation, and 14 months after diagnosis of liver metastases, with four patients still alive at 13+, 16+, 41+, and 61+ months after hepatic artery ligation. We believe that this form of therapy is an effective, well-tolerated alternative for patients with unresectable liver metastases.

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The Impact of Comorbid Diabetes on Short-Term Postoperative Outcomes in Stage I/II Colon Cancer Patients Undergoing Open Colectomy

BioMed Research International ◽

10.1155/2020/2716395 ◽

2020 ◽

Vol 2020 ◽

pp. 1-11

Author(s):

Ko-Chao Lee ◽

Kuan-Chih Chung ◽

Hong-Hwa Chen ◽

Kung-Chuan Cheng ◽

Kuen-Lin Wu ◽

...

Keyword(s):

Colon Cancer ◽

Postoperative Complications ◽

Hospital Mortality ◽

Cancer Patients ◽

Surgical Outcomes ◽

Stage I ◽

Open Colectomy ◽

Short Term ◽

Patients With Diabetes ◽

The Impact

Purpose. This study aimed at evaluating the impact of comorbid diabetes on short-term postoperative outcomes in patients with stage I/II colon cancer after open colectomy. Methods. The data were extracted from the National Inpatient Sample database (2005-2010). Short-term surgical outcomes included in-hospital mortality, postoperative complications, and hospital length of stay. Results. A total of 49,064 stage I/II colon cancer patients undergoing open surgery were included, with a mean age of 70.35 years. Of them, 21.94% had comorbid diabetes. Multivariable analyses revealed that comorbid diabetes was significantly associated with a lower risk of in-hospital mortality and postoperative complications. Compared to patients without diabetes, patients with uncomplicated diabetes had lower percentages of in-hospital mortality and postoperative complications, but patients with complicated diabetes had a higher percentage of postoperative complications. In addition, patients with diabetes only, but not patients with diabetes and hypertension only, had a lower percentage of in-hospital mortality than patients without any comorbidity. Conclusion. The present results suggested the protective effects of uncomplicated diabetes on short-term surgical outcomes in stage I/II colon cancer patients after open colectomy. Further studies are warranted to confirm these unexpected findings and investigate the possible underlying mechanisms.

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