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Is the Effect of Tumor Localization on Prognosis Compatible with Real-life Data in Metastatic Colon Cancer? Single-Center Experience: A Retrospective Analysis

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Abstract

Aim

In recent years, the prognostic and predictive value of primary tumor localization in colon cancer has become increasingly important. This study aimed to retrospectively analyze the effect of colon cancer tumor localization on progression-free survival, overall survival, and response to treatments and present real-life data.

Method

Retrospective evaluation was made of 465 patients who were diagnosed with metastatic colorectal carcinoma between 2010 and 2015 in our clinic. The effect of primary tumor localization on progression-free survival, overall survival, and response to therapy was investigated.

Results

The right colon cancer (RCC) was determined in 66 patients, 14.2% of the whole group, and left colorectal cancer (LCRC) in 399 patients which is 85.8% of patients. Mucinous adenocarcinoma was 16.7% in RCC; however, only 6.4% of LCRC had a mucinous tumor (p < 0.05). Nodal involvement in any stage (N1 and N2) was 46.9% in right colon cancer whereas in LCRC, it was 41.2% (p < 0.05). Primary tumor surgery (74.2% vs. 70.2%) and metastasectomy (33.3% vs. 19.4%) were also more common in RCC(p < 0.05). k-ras mutation status was similar in both groups (28.8% in RCC vs 26.8% in LCRC, p > 0.05). Median progression-free survival was 12.6 months in RCC, and 15.5 in LCRC (p > 0.05). Median overall survival was 28.4 months in RCC and 33.5 months in LCRC (p > 0.05). In k-ras wild-type patients, the median overall survival was 32.3 months (95% CI 25.2–39.5) in the anti-VEGF antibody treatment group and 55.1 months (95% CI 36.5–73.7) in the anti-EGFR antibody treatment group (p < 0.05).

Conclusion

Although tumors located in the right colon have been considered to be worse in terms of progression-free and overall survival in clinical trials, the results of this study showed that in daily practice, there was no difference between left and right colon localized tumors in progression-free and overall survival. Further, in k-ras wild-type colon cancers, tumor localization predicts the treatment response. This study is important with the presentation of real-life data and compatibility with the data of the studies to daily life.

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References

  1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359–86. Epub 2014/09/16. https://doi.org/10.1002/ijc.29210. PubMed PMID: 25220842.

  2. Siegel RL, Miller KD, Fedewa SA, Ahnen DJ, Meester RGS, Barzi A, et al. Colorectal cancer statistics, 2017. CA Cancer J Clin. 2017;67(3):177–93. Epub 2017/03/02. https://doi.org/10.3322/caac.21395. PubMed PMID: 28248415.

  3. Zacharakis M, Xynos ID, Lazaris A, Smaro T, Kosmas C, Dokou A, et al. Predictors of survival in stage IV metastatic colorectal cancer. Anticancer Res. 2010;30(2):653–60 (Epub 2010/03/25 PubMed PMID: 20332485).

    CAS  PubMed  Google Scholar 

  4. Brenner H, Kloor M, Pox CP. Colorectal cancer. The Lancet. 2014;383(9927):1490–502. https://doi.org/10.1016/s0140-6736(13)61649-9.

    Article  Google Scholar 

  5. Goldman L, Schafer AI. Goldman’s cecil medicine E-book: Elsevier Health Sciences; 2011.

  6. Elez E, Argiles G, Tabernero J. First-line treatment of metastatic colorectal cancer: interpreting FIRE-3, PEAK, and CALGB/SWOG 80405. Curr Treat Options Oncol. 2015;16(11):52. Epub 2015/09/17. https://doi.org/10.1007/s11864-015-0369-x. PubMed PMID: 26374340.

  7. Tejpar S, Stintzing S, Ciardiello F, Tabernero J, Van Cutsem E, Beier F, et al. Prognostic and predictive relevance of primary tumor location in patients with RAS wild-type metastatic colorectal cancer. JAMA Oncology. 2017;3(2). https://doi.org/10.1001/jamaoncol.2016.3797.

  8. Loupakis F, Yang D, Yau L, Feng S, Cremolini C, Zhang W, et al. Primary tumor location as a prognostic factor in metastatic colorectal cancer. J Natl Cancer Inst. 2015;107(3). Epub 2015/02/26. https://doi.org/10.1093/jnci/dju427. PubMed PMID: 25713148; PubMed Central PMCID: PMCPMC4565528.

  9. Venook AP, Niedzwiecki D, Innocenti F, Fruth B, Greene C, O’Neil BH, et al. Impact of primary (1º) tumor location on overall survival (OS) and progression-free survival (PFS) in patients (pts) with metastatic colorectal cancer (mCRC): analysis of CALGB/SWOG 80405 (Alliance). Journal of Clinical Oncology. 2016;34(15_suppl):3504-. https://doi.org/10.1200/JCO.2016.34.15_suppl.3504.

  10. Douillard J, Siena S, Cassidy J, Tabernero J, Burkes R, Barugel ME, et al. Randomized phase 3 study of panitumumab with FOLFOX4 compared to FOLFOX4 alone as 1st-line treatment (tx) for metastatic colorectal cancer (mCRC): the PRIME trial. Eur J Cancer. 2009;7(6).

  11. von Einem JC, Heinemann V, von Weikersthal LF, Vehling-Kaiser U, Stauch M, Hass HG, et al. Left-sided primary tumors are associated with favorable prognosis in patients with KRAS codon 12/13 wild-type metastatic colorectal cancer treated with cetuximab plus chemotherapy: an analysis of the AIO KRK-0104 trial. J Cancer Res Clin Oncol. 2014;140(9):1607–14. Epub 2014/05/13. https://doi.org/10.1007/s00432-014-1678-3. PubMed PMID: 24816724; PubMed Central PMCID: PMCPMC4131148.

  12. Sinicrope FA, Mahoney MR, Yoon HH, Smyrk TC, Thibodeau SN, Goldberg RM, et al. Analysis of molecular markers by anatomic tumor site in stage III colon carcinomas from adjuvant chemotherapy trial NCCTG N0147 (Alliance). Clin Cancer Res. 2015;21(23):5294–304. Epub 2015/07/19. https://doi.org/10.1158/1078-0432.CCR-15-0527. PubMed PMID: 26187617; PubMed Central PMCID: PMCPMC4668228.

  13. Hemminki K, Santi I, Weires M, Thomsen H, Sundquist J, Bermejo JL. Tumor location and patient characteristics of colon and rectal adenocarcinomas in relation to survival and TNM classes. BMC Cancer. 2010;10:688. Epub 2010/12/24. https://doi.org/10.1186/1471-2407-10-688. PubMed PMID: 21176147; PubMed Central PMCID: PMCPMC3022888.

  14. Qin Q, Yang L, Sun YK, Ying JM, Song Y, Zhang W, et al. Comparison of 627 patients with right- and left-sided colon cancer in China: differences in clinicopathology, recurrence, and survival. Chronic Dis Transl Med. 2017;3(1):51–9. Epub 2017/10/25. https://doi.org/10.1016/j.cdtm.2017.02.004. PubMed PMID: 29063056; PubMed Central PMCID: PMCPMC5627696.

  15. Huang CW, Tsai HL, Huang MY, Huang CM, Yeh YS, Ma CJ, et al. Different clinicopathologic features and favorable outcomes of patients with stage III left-sided colon cancer. World J Surg Oncol. 2015;13:257. Epub 2015/08/28. https://doi.org/10.1186/s12957-015-0640-4. PubMed PMID: 26311139; PubMed Central PMCID: PMCPMC4551706.

  16. Lim DR, Kuk JK, Kim T, Shin EJ. Comparison of oncological outcomes of right-sided colon cancer versus left-sided colon cancer after curative resection: which side is better outcome? Medicine (Baltimore). 2017;96(42):e8241. Epub 2017/10/20. https://doi.org/10.1097/MD.0000000000008241. PubMed PMID: 29049212; PubMed Central PMCID: PMCPMC5662378.

  17. Weiss JM, Pfau PR, O'Connor ES, King J, LoConte N, Kennedy G, et al. Mortality by stage for right- versus left-sided colon cancer: analysis of surveillance, epidemiology, and end results--Medicare data. J Clin Oncol. 2011;29(33):4401–9. Epub 2011/10/05. https://doi.org/10.1200/JCO.2011.36.4414. PubMed PMID: 21969498; PubMed Central PMCID: PMCPMC3221523.

  18. Hussain M, Waqas O, Hassan U, Loya A, Akhtar N, Mushtaq S, et al. Right-sided and left-sided colon cancers are two distinct disease entities: an analysis of 200 cases in Pakistan. Asian Pac J Cancer Prev. 2016;17(5):2545–8 (Epub 2016/06/09 PubMed PMID: 27268627).

    PubMed  Google Scholar 

  19. J AC, Baixauli J, Arredondo J, Pastor C, Martinez Ortega P, Zozaya G, et al. Clinico-pathological and oncological differences between right and left-sided colon cancer (stages I-III): analysis of 950 cases. Rev Esp Enferm Dig. 2018;110(3):138–44. Epub 2017/12/23. https://doi.org/10.17235/reed.2017.5034/2017. PubMed PMID: 29271228.

  20. Ribic CM, Sargent DJ, Moore MJ, Thibodeau SN, French AJ, Goldberg RM, et al. Tumor microsatellite-instability status as a predictor of benefit from fluorouracil-based adjuvant chemotherapy for colon cancer. N Engl J Med. 2003;349(3):247–57. Epub 2003/07/18. https://doi.org/10.1056/NEJMoa022289. PubMed PMID: 12867608; PubMed Central PMCID: PMCPMC3584639.

  21. Malesci A, Laghi L, Bianchi P, Delconte G, Randolph A, Torri V, et al. Reduced likelihood of metastases in patients with microsatellite-unstable colorectal cancer. Clin Cancer Res. 2007;13(13):3831–9. Epub 2007/07/04. https://doi.org/10.1158/1078-0432.CCR-07-0366. PubMed PMID: 17606714.

  22. Weisenberger DJ, Siegmund KD, Campan M, Young J, Long TI, Faasse MA, et al. CpG island methylator phenotype underlies sporadic microsatellite instability and is tightly associated with BRAF mutation in colorectal cancer. Nat Genet. 2006;38(7):787–93. https://doi.org/10.1038/ng1834.

    Article  CAS  PubMed  Google Scholar 

  23. Hurwitz HI, Yi J, Ince W, Novotny WF, Rosen O. The clinical benefit of bevacizumab in metastatic colorectal cancer is independent of K-ras mutation status: analysis of a phase III study of bevacizumab with chemotherapy in previously untreated metastatic colorectal cancer. Oncologist. 2009;14(1):22–8. Epub 2009/01/16. https://doi.org/10.1634/theoncologist.2008-0213. PubMed PMID: 19144677.

  24. Bufill JA. Colorectal cancer: evidence for distinct genetic categories based on proximal or distal tumor location. Ann Intern Med. 1990;113(10):779–88. Epub 1990/11/15. https://doi.org/10.7326/0003-4819-113-10-779. PubMed PMID: 2240880.

  25. Modest DP, Schulz C, von Weikersthal LF, Quietzsch D, von Einem JC, Schalhorn A, et al. Outcome of patients with metastatic colorectal cancer depends on the primary tumor site (midgut vs. hindgut): analysis of the FIRE1-trial (FuFIRI or mIROX as first-line treatment). Anticancer Drugs. 2014;25(2):212–8. Epub 2013/11/10. https://doi.org/10.1097/CAD.0000000000000041. PubMed PMID: 24201305.

  26. Stintzing S, Tejpar S, Gibbs P, Thiebach L, Lenz HJ. Understanding the role of primary tumour localisation in colorectal cancer treatment and outcomes. Eur J Cancer. 2017;84:69–80. Epub 2017/08/09. https://doi.org/10.1016/j.ejca.2017.07.016. PubMed PMID: 28787661.

  27. Petrelli F, Tomasello G, Borgonovo K, Ghidini M, Turati L, Dallera P, et al. Prognostic survival associated with left-sided vs right-sided colon cancer: a systematic review and meta-analysis. JAMA Oncol. 2017;3(2):211–9. Epub 2016/10/28. https://doi.org/10.1001/jamaoncol.2016.4227. PubMed PMID: 27787550.

  28. Yahagi M, Okabayashi K, Hasegawa H, Tsuruta M, Kitagawa Y. The worse prognosis of right-sided compared with left-sided colon cancers: a systematic review and meta-analysis. J Gastrointest Surg. 2016;20(3):648–55.

    Article  Google Scholar 

  29. Meguid RA, Slidell MB, Wolfgang CL, Chang DC, Ahuja N. Is there a difference in survival between right- versus left-sided colon cancers? Ann Surg Oncol. 2008;15(9):2388–94. Epub 2008/07/16. https://doi.org/10.1245/s10434-008-0015-y. PubMed PMID: 18622647; PubMed Central PMCID: PMCPMC3072702.

  30. Benedix F, Kube R, Meyer F, Schmidt U, Gastinger I, Lippert H, et al. 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(1):57–64. Epub 2009/12/17. https://doi.org/10.1007/DCR.0b013e3181c703a4. PubMed PMID: 20010352.

  31. Li Y, Feng Y, Dai W, Li Q, Cai S, Peng J. Prognostic effect of tumor sidedness in colorectal cancer: a SEER-based analysis. Clin Colorectal Cancer. 2019;18(1):e104-e16. Epub 2018/11/19. https://doi.org/10.1016/j.clcc.2018.10.005. PubMed PMID: 30448100.

  32. Lin J, Qiu M, Xu R, Dobs AS. Comparison of survival and clinicopathologic features in colorectal cancer among African American, Caucasian, and Chinese patients treated in the United States: results from the surveillance epidemiology and end results (SEER) database. Oncotarget. 2015;6(32):33935–43. Epub 2015/09/17. https://doi.org/10.18632/oncotarget.5223. PubMed PMID: 26375551; PubMed Central PMCID: PMCPMC4741814.

  33. Helvaci K, Eraslan E, Yildiz F, Tufan G, Demirci U, Berna Oksuzoglu O, et al. Comparison of clinicopathological and survival features of right and left colon cancers. J buon. 2019;24(5):1845–51 (Epub 2019/12/02 PubMed PMID: 31786846).

    PubMed  Google Scholar 

  34. Missiaglia E, Jacobs B, D'Ario G, Di Narzo AF, Soneson C, Budinska E, et al. Distal and proximal colon cancers differ in terms of molecular, pathological, and clinical features. Ann Oncol. 2014;25(10):1995–2001. Epub 2014/07/25. https://doi.org/10.1093/annonc/mdu275. PubMed PMID: 25057166.

  35. Arnold D, Lueza B, Douillard JY, Peeters M, Lenz HJ, Venook A, et al. Prognostic and predictive value of primary tumour side in patients with RAS wild-type metastatic colorectal cancer treated with chemotherapy and EGFR directed antibodies in six randomized trials. Ann Oncol. 2017;28(8):1713–29. Epub 2017/04/14. https://doi.org/10.1093/annonc/mdx175. PubMed PMID: 28407110; PubMed Central PMCID: PMCPMC6246616.

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Authors and Affiliations

  1. Faculty of Medicine, Department of Internal Medicine, Ege University, Izmir, Turkey

    Merve Güner Oytun

  2. Faculty of Medicine, Department of Internal Medicine, Division of Medical Oncology, Ege University, Izmir, Turkey

    Gülcan Bulut & Erhan Gökmen

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Oytun, M., Bulut, G. & Gökmen, E. Is the Effect of Tumor Localization on Prognosis Compatible with Real-life Data in Metastatic Colon Cancer? Single-Center Experience: A Retrospective Analysis. J Gastrointest Canc 53, 7–15 (2022). https://doi.org/10.1007/s12029-021-00615-z

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