Effect of Primary Tumor Location on Postmetastasectomy Survival in Patients with Colorectal Cancer Liver Metastasis
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ORIGINAL ARTICLE
Effect of Primary Tumor Location on Postmetastasectomy Survival in Patients with Colorectal Cancer Liver Metastasis Tien-Hua Chen 1,2 & Wei-Shone Chen 1,3 & Jeng-Kai Jiang 1,3 & Shung-Haur Yang 1,3,4 & Huann-Sheng Wang 1,3 & Shih-Ching Chang 1,3 & Yuan-Tzu Lan 1,3 & Chun-Chi Lin 1,3 & Hung-Hsin Lin 1,3 & Sheng-Chieh Huang 1,3 & Hou-Hsuan Cheng 1,3 & Gar-Yang Chau 1,5 & Cheng-Yuan Hsia 1,5 & Hao-Jan Lei 1,5 & Shu-Cheng Chou 1,5 & Yee Chao 1,2 & Hao-Wei Teng 1,2,6 Received: 15 July 2020 / Accepted: 31 October 2020 # 2020 The Society for Surgery of the Alimentary Tract
Abstract Background The effects of primary tumor location on colorectal liver metastasis (CRLM) and post-hepatic-metastasectomy overall survival (OS) are controversial. This study evaluated the difference in post-hepatic-metastasectomy OS among rightsided colon, left-sided colon, and rectal cancer groups. Methods In total, 381 patients who underwent curative-intent CRLM resection were enrolled. Patients were grouped based on the primary tumor location (right-sided, left-sided, and rectum). The Kaplan–Meier analysis and log-rank test were performed for survival analysis. The univariate and multivariate analyses of clinical and pathological factors were performed using the Cox proportional hazards model. Results Significant OS difference was noted among the three groups (log-rank, p = 0.014). The multivariate analysis revealed a 32% lower death risk in left-sided colon cancer compared with right-sided colon cancer (hazard ratio [HR] 0.68, p = 0.042), whereas no OS difference was noted between the rectal cancer and right-sided colon cancer groups. The left- versus right-sided OS advantage was noted only in the KRAS wild-type subgroup (HR 0.46, p = 0.002), and a rectal versus right-sided OS disadvantage was noted in the KRAS mutant subgroup (HR 1.78, p = 0.03). Conclusions The CRLM post-hepatic-metastasectomy OS was superior in left-sided colon cancer than in right-sided colon cancer and was similar in rectal and right-sided colon cancer. The OS difference in different primary tumor locations is dependent on KRAS mutation status, with a decreased left- versus right-sided death risk noted only in KRAS wild-type colon cancer and an increased rectal versus right-sided death risk noted only in KRAS mutant colon cancer. Keywords Colorectal neoplasms . Neoplasm metastasis . KRAS protein . BRAF protein
* Hao-Wei Teng [email protected] 1
Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
2
Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City, Taiwan
3
Division of Colon and Rectum Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
4
Department of Surgery, National Yang-Ming University Hospital, Yilan, Taiwan
5
Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
6
Institute of Clinical Medicine, National Yang-Ming University, Taip
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