Highlights
- •We used the National Cancer Database to identify metastatic colon cancer patients.
- •We found differential metastatic patterns between left versus right colon cancer.
- •Right colon metastases are associated with worse overall survival.
- •Implications in how we treat future patients and clinical trial design.
Abstract
Background
The role of laterality for patients with synchronous metastatic colon cancer (SMCC)
is not well-defined.
Methods
Using the National Cancer Database (2010–2015), we compared patients with metastatic
right- (RCC) versus left-sided colon cancer (LCC). We performed Kaplan-Meier analysis
to compare overall survival (OS) for each metastatic site and utilized adjusted Cox
proportional hazard analysis to identify predictors of OS.
Results
Patients with RCCs were more likely to be older, female, and have more comorbidities.
LCCs were more likely to metastasize to liver and lung, whereas RCCs were more likely
to metastasize to peritoneum and brain. There was equal likelihood to metastasize
to bone. OS was significantly longer for LCCs for all metastatic sites. After controlling
for multiple variables, RCC (HR 1.426, p < 0.001) remained an independent predictor
of worse OS compared to LCC.
Conclusions
Laterality of the primary tumor plays an important role in outcomes for patients with
SMCC.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cancer Facts & Figures. American Cancer Society, 2018
- Pattern of distant metastases in colorectal cancer: a SEER based study.Oncotarget. 2015; 6: 38658-38666
- Patterns of metastasis in colon and rectal cancer.Sci Rep. 2016; 6: 1-9https://doi.org/10.1038/srep29765
- Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases.Ann Surg. 2005; 241: 715-724https://doi.org/10.1097/01.sla.0000160703.75808.7d
- Liver histology and surgical outcomes after preoperative chemotherapy with fluorouracil plus oxaliplatin in colorectal cancer liver metastases.J Clin Oncol. 2006; 24: 4983-4990https://doi.org/10.1200/jco.2006.05.8156
- Improved survival in metastatic colorectal cancer is associated with adoption of hepatic resection and improved chemotherapy.J Clin Oncol. 2009; 27: 3677-3683https://doi.org/10.1200/JCO.2008.20.5278
- Prognostic significance of TP53 gene mutation in 995 cases of colorectal carcinoma influence of tumour site, stage, adjuvant chemotherapy and type of mutation.Eur J Cancer. 2000; 36: 2053-2060https://doi.org/10.1016/S0959-8049(00)00285-9
- The number of intraepithelial T cells decreases from ascending colon to rectum [1].J Clin Pathol. 2003; 56: 158https://doi.org/10.1136/jcp.56.2.158
- Differences between right- and left-sided colon cancer in patient characteristics, cancer morphology and histology.J Gastroenterol Hepatol. 2008; 23: 418-423https://doi.org/10.1111/j.1440-1746.2007.04923.x
- Right versus left colon cancer biology: integrating the consensus molecular subtypes.J Natl Compr Cancer Netw. 2017; 15: 411-419https://doi.org/10.6004/jnccn.2017.0038
- Association between prognosis and tumor laterality in early-stage colon cancer.JAMA Oncol. 2017; 3: 1386-1392https://doi.org/10.1001/jamaoncol.2017.1016
- Mortality by stage for right- versus left-sided colon cancer: analysis of surveillance, epidemiology, and end results-medicare data.J Clin Oncol. 2011; 29: 4401-4409https://doi.org/10.1200/JCO.2011.36.4414
- Better survival in right-sided versus left-sided stage I - III colon cancer patients.BMC Canc. 2016; 16: 6-13https://doi.org/10.1186/s12885-016-2412-0
- The worse prognosis of right-sided compared with left-sided colon cancers: a systematic review and meta-analysis.J Gastrointest Surg. 2016; 20: 648-655https://doi.org/10.1007/s11605-015-3026-6
- Prognostic survival associated with left-sided vs right-sided colon cancer a systematic review and meta-analysis.JAMA Oncol. 2017; 3: 211-219https://doi.org/10.1001/jamaoncol.2016.4227
- The prognostic implications of primary colorectal tumor location on recurrence and overall survival in patients undergoing resection for colorectal liver metastasis.J Surg Oncol. 2016; 114: 803-809https://doi.org/10.1002/jso.24425
- Embryonic origin of primary colon cancer predicts pathologic response and survival in patients undergoing resection for colon cancer liver metastasis.Ann Surg. 2018; 267 (Natural): 514-520https://doi.org/10.1007/s10741-014-9462-7
- The impact of primary tumour location in patients undergoing hepatic resection for colorectal liver metastasis.Eur J Surg Oncol. 2018; 44: 771-777https://doi.org/10.1016/j.ejso.2018.02.210
- Colorectal cancer liver metastases - a population-based study on incidence, management and survival.BMC Canc. 2018; 18: 1-11https://doi.org/10.1186/s12885-017-3925-x
- NCCN Clinical Practice Guidelines in Oncology: Colon Cancer. 2008https://doi.org/10.1007/978-1-4020-6754-9_3356
- Comparison of 17,641 patients with right- and left-sided colon cancer: differences in epidemiology, perioperative course, histology, and survival.Dis Colon Rectum. 2010; 53: 57-64https://doi.org/10.1007/DCR.0b013e3181c703a4
- A relationship to survival is seen by combining the factors of mismatch repair status, tumor location and age of onset in colorectal cancer patients.PLoS One. 2017; 12: 1-11https://doi.org/10.1371/journal.pone.0172799
- Does the primary site of colorectal cancer impact outcomes for patients with metastatic disease?.Cancer. 2015; 121: 830-835https://doi.org/10.1002/cncr.29129
- C-KI-RAS activation and the biological behaviour of proximal and distal colonic adenocarcinomas.Eur J Cancer. 1996; 32: 491-497https://doi.org/10.1016/0959-8049(95)00567-6
- Metastatic pattern in colorectal cancer is strongly influenced by histological subtype.Ann Oncol. 2014; 25: 651-657https://doi.org/10.1093/annonc/mdt591
- Mucinous and signet ring cell differentiation affect patterns of metastasis in colorectal carcinoma and influence survival.Int J Surg Pathol. 2017; 25: 108-117https://doi.org/10.1177/1066896916664990
- Pathophysiology of colorectal peritoneal carcinomatosis: role of the peritoneum.World J Gastroenterol. 2016; 22: 7692-7707https://doi.org/10.3748/wjg.v22.i34.7692
- Difference between left-sided and right-sided colorectal cancer: a focused review of literature.Gastroenterol Res. 2018; 11: 264-273https://doi.org/10.14740/gr1062w
- Primary tumor sidedness is predictive of survival in colon cancer patients treated with cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy: a US HIPEC collaborative study.Ann Surg Oncol. 2019; 26: 2234-2240https://doi.org/10.1245/s10434-019-07373-0
- Variation in hospital treatment patterns for metastatic colorectal cancer.Cancer. 2015; 121: 1755-1761https://doi.org/10.1002/cncr.27633.Percutaneous
- The beneficial effect of palliative resection in metastatic colorectal cancer.Br J Canc. 2013; 108: 1425-1431https://doi.org/10.1038/bjc.2013.94
- Trends in treatment and sruvival in older patients presenting with stage IV colorectal cancer.J Gastrointest Surg. 2014; 18: 369-377https://doi.org/10.1371/journal.pone.0178059
- Adequacy of lymph node examination in colorectal surgery: contribution of the hospital versus the surgeon.Med Care. 2013; 51https://doi.org/10.1097/MLR.0b013e3182a53d72.Adequacy
- Number of lymph nodes examined and associated clinicopathologic factors in colorectal carcinoma.Arch Pathol Lab Med. 2009; 133: 781-786
- The impact of KRAS mutations on prognosis in surgically resected colorectal cancer patients with liver and lung metastases: a retrospective analysis.BMC Canc. 2016; 16: 1-8https://doi.org/10.1186/s12885-016-2141-4
- KRAS mutation is associated with worse prognosis in stage III or high-risk stage II colon cancer patients treated with adjuvant FOLFOX.Ann Surg Oncol. 2015; 22: 187-194https://doi.org/10.1245/s10434-014-3826-z
- Metastatic pattern of stage IV colorectal cancer with high-frequency microsatellite instability as a prognostic factor.Anticancer Res. 2017; 37: 239-248https://doi.org/10.21873/anticanres.11313
- Microsatellite instability in metastatic colorectal cancer: a review of pathology, response to chemotherapy and clinical outcome.Med Oncol. 2012; 29: 1796-1801https://doi.org/10.1007/s12032-011-0050-6
- The characteristics of bone metastasis in patients with colorectal cancer: a long-term report from a single institution.World J Surg. 2016; 40: 982-986https://doi.org/10.1007/s00268-015-3296-x
- Surgical resection of pulmonary metastases from colorectal cancer: a systematic review of published series.Ann Thorac Surg. 2007; 84: 324-338https://doi.org/10.1016/j.athoracsur.2007.02.093
Article info
Publication history
Published online: December 12, 2019
Accepted:
December 3,
2019
Received in revised form:
November 22,
2019
Received:
September 25,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
