The effect of the primary tumor location on the survival of colorectal cancer patients after radical surgery

683 Background: There is currently no consensus about whether bevacizumab effectiveness is associated with the primary tumor location of metastatic colorectal cancer (mCRC). The aim of this study was to assess whether the primary tumor location was a predictor for bevacizumab treatment. Methods: From 2004 to 2013, 740 patients with mCRC treated with oxaliplatin / 5-FU / leucovorin (mFOLFOX6) or irinotecan / 5-FU / leucovorin (FOLFIRI) (CT group) and 244 patients treated with bevacizumab plus mFOLFOX6 or FOLFIRI (CT + B group) as first-line setting were included from Sun yat-sen university cancer center. Right-side colon cancers included those occurring in the cecum, ascending colon or transverse colon. Left-side colon cancers included those from descending or sigmoid colon. The primary outcome was overall survival (OS). Kaplan-Meier curves with log-rank tests were used to detect difference. All statistical tests were two sided. Results: 222 right-side colon, 259 left-side colon and 259 rectal cancer patients were included in CT group while 78 right-side colon, 86 left-side colon and 80 rectal cancer patients were included in CT + B group. Patients in CT + B group had similar OS compare with CT group only when the primary tumor located at right-side colon (median OS was 19.6 months for CT + B group versus 19.5 months for CT group, P = 0.269). For left-side colon cancer, significantly longer OS were observed in CT + B than CT group (22.3 months versus 21.9 months, P = 0.014). For rectal cancer patients, those in CT + B group also had longer OS than CT group (25.9 months versus 21.1 months, P = 0.005). Conclusions: Our data suggested that patients with right-side colon cancer could not get survival benefit from the addition of bevacizumab to first-line chemotherapy. Further data from randomized trials are needed to test our hypothesis. [Table: see text]

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The Impact of Primary Tumor Location in Synchronous Metastatic Colorectal Cancer: Differences in Metastatic Sites and Survival

Annals of Surgical Oncology ◽

10.1245/s10434-019-08100-5 ◽

2019 ◽

Vol 27 (5) ◽

pp. 1580-1588 ◽

Cited By ~ 5

Author(s):

Nelleke P. M. Brouwer ◽

Dave E. W. van der Kruijssen ◽

Niek Hugen ◽

Ignace H. J. T. de Hingh ◽

Iris D. Nagtegaal ◽

...

Keyword(s):

Colorectal Cancer ◽

Rectal Cancer ◽

Metastatic Colorectal Cancer ◽

Cancer Patients ◽

Primary Tumor ◽

Relative Survival ◽

Tumor Location ◽

Primary Tumor Location ◽

Metastatic Sites ◽

The Impact

Abstract Purpose We explored differences in survival between primary tumor locations, hereby focusing on the role of metastatic sites in synchronous metastatic colorectal cancer (mCRC). Methods Data for patients diagnosed with synchronous mCRC between 1989 and 2014 were retrieved from the Netherlands Cancer registry. Relative survival and relative excess risks (RER) were analyzed by primary tumor location (right colon (RCC), left colon (LCC), and rectum). Metastatic sites were reported per primary tumor location. Survival was analyzed for metastatic sites combined and for single metastatic sites. Results In total, 36,297 patients were included in this study. Metastatic sites differed significantly between primary tumor locations, with liver-only metastases in 43%, 54%, and 52% of RCC, LCC, and rectal cancer patients respectively (p < 0.001). Peritoneal metastases were most prevalent in RCC patients (33%), and lung metastases were most prevalent in rectal cancer patients (28%). Regardless of the location of metastases, patients with RCC had a worse survival compared with LCC (RER 0.81, 95% CI 0.78–0.83) and rectal cancer (RER 0.73, 95% CI 0.71–0.76). The survival disadvantage for RCC remained present, even in cases with metastasectomy for liver-only disease (LCC: RER 0.66, 95% CI 0.57–0.76; rectal cancer: RER 0.84, 95% CI 0.66–1.06). Conclusions This study showed significant differences in relative survival between primary tumor locations in synchronous mCRC, which can only be partially explained by distinct metastatic sites. Our findings support the concept that RCC, LCC and rectal cancer should be considered distinct entities in synchronous mCRC.

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Primary Tumor Resection With Or Without Metastasectomy For Left- And Right-Sided Stage IV Colorectal Cancer: An Instrumental Variable Analysis

10.21203/rs.3.rs-864779/v1 ◽

2021 ◽

Author(s):

Ling Yin ◽

Jun-Quan Chen ◽

Yi-Chen Yao ◽

Wu-Hao Lin ◽

Jian-Hong Peng ◽

...

Keyword(s):

Colorectal Cancer ◽

Primary Tumor ◽

Tumor Resection ◽

Stage Iv ◽

Tumor Location ◽

Instrumental Variable Analysis ◽

Primary Tumor Location ◽

Stage Iv Colorectal Cancer ◽

Colorectal Cancer Patients ◽

Variable Analysis

Abstract Background Whether primary tumor location (PTL) is predictive of survival benefits following primary tumor resection plus metastasectomy (PMTR) and primary tumor resection (PTR) alone in stage IV colorectal cancer patients is not known. We sought to address this issue by employing instrumental variable analysis to evaluate the efficacy of PMTR and PTR with stratification for primary tumor location in stage IV colorectal cancer patients.Patients and Methods Stage IV colorectal cancer patients diagnosed between January 1, 2005 and December 31, 2015 were identified from the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute. To account for both measured and unmeasured confounders, the efficacy of PMTR and PTR in the left- and right-sided subgroups was evaluated using instrumental variable analysis, with the health service area as the instrument variable. Overall survival (OS) was the primary outcome of interest.Results A total of 50333 eligible patients were analyzed (left-sided, n=29402 and right-sided, n=20931). OS was significantly better with PMTR than with other treatments (PTR, metastasectomy only, or no surgery) in patients with left-sided tumors (hazard ratio [HR]=0.37 [95% CI, 0.24-0.58], P<0.001), but not in patients with right-sided tumors (HR=0.98 [95% CI, 0.65-1.47], P = 0.910; interaction test P<0.001). OS was comparable in patients treated with PTR and those treated with no surgery in both the left-sided (HR=1.11 [95% CI, 0.68-1.81], P=0.690) and right-sided (HR=0.85 [95% CI, 0.50-1.43], P=0.530; interaction test P=0.466) subgroups.Conclusions PMTR appears to only benefit patients with left-sided stage IV colorectal cancer but not those with right-sided tumors. PTR does not improve OS, regardless of primary tumor location. When selecting patients for PMTR, primary tumor location should be considered. Overuse of PTR should be avoided.

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