Prognostic impact of primary tumor location in Stage III colorectal cancer-right-sided colon versus left-sided colon ver
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ORIGINAL ARTICLE–ALIMENTARY TRACT
Prognostic impact of primary tumor location in Stage III colorectal cancer-right-sided colon versus left-sided colon versus rectum: a nationwide multicenter retrospective study Dai Shida1 • Manabu Inoue1 • Taro Tanabe1 • Konosuke Moritani1 • Shunsuke Tsukamoto1 • Shinichi Yamauchi2 • Kenichi Sugihara2 • Yukihide Kanemitsu1
Received: 8 January 2020 / Accepted: 25 June 2020 Ó Japanese Society of Gastroenterology 2020
Abstract Background Previous studies investigating the impact of tumor location on colorectal cancer prognosis only compared two groups by location, e.g., ‘right-sided colon vs. left-sided colon,’ ‘colon vs. rectum,’ and ‘right-sided (right-sided colon) vs. left-sided (left-sided colon and rectum).’ This nationwide multicenter retrospective study aimed to clarify the prognostic impact of tumor location in patients with stage III colorectal cancer by classifying tumors into three groups: right-sided colon, left-sided colon, and rectum. Methods Subjects were 9194 patients with stage III colorectal cancer who underwent curative surgery from 1997 to 2012. Relapse-free survival (RFS) after primary surgery and overall survival (OS) after recurrence were examined. Results Rectal cancer (n = 2922) was associated with worse RFS compared to right-sided colon cancer (n = 2362) (hazard ratio (HR) 0.65; 95% CI 0.59–0.72; p \ 0.001) and left-sided colon cancer (n = 3910) (HR 0.72; 95% CI 0.66–0.78; p \ 0.001) after adjusting for key clinical factors (i.e., sex, age, histological type, CEA, adjuvant therapy, T category, and N category). Among patients with recurrence (n = 2823), rectal cancer was associated with better OS compared to right-sided colon
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00535-020-01706-7) contains supplementary material, which is available to authorized users. & Dai Shida [email protected] 1
Department of Colorectal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 1040045, Japan
2
Tokyo Medical and Dental University, Tokyo, Japan
cancer (HR 1.23; 95% CI 1.08–1.40; p = 0.002) and worse OS compared to left-sided colon cancer (HR 0.88; 95% CI 0.79–0.99; p = 0.029). Twenty percent of right-sided colon cancer recurrences exhibited peritoneal dissemination, 42% of left-sided colon cancer recurrences were liver metastases, and 33% of rectal cancer recurrences were local recurrences. Conclusions The three tumor locations (right-sided colon, left-sided colon, rectum) had different prognostic implications for recurrence after curative resection and overall mortality, suggesting that tumor location serves as a prognostic biomarker in stage III colorectal cancer. Keywords Right-sided colon cancer Left-sided colon cancer Rectal cancer Tumor location Sidedness Abbreviations CI Confidence interval CSS Cancer-specific survival dMMR Deficient mismatch repair HR Hazard ratio OS Overall survival RFS Relapse-free survival
Introduction In colorectal cancer, the prognostic value of primary
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