Survival rates and prognostic factors in right- and left-sided colon cancer stage I–IV: an unselected retrospective single-center trial

Purpose: Colorectal cancer revealed over the last decades a remarkable shift with an increasing proportion of a right- compared to a left-sided tumor location. In the current study, we aimed to disclose clinicopathological differences between right- and left-sided colon cancer (rCC and lCC) with respect to mortality and outcome predictors. Methods: In total, 417 patients with colon cancer stage I-IV were analyzed in the present retrospective single-center study. Survival rates were assessed using the Kaplan-Meier method and uni/multivariate analyses were performed with a Cox proportional hazards regression model. Results: Our study showed no significant difference of the overall survival between rCC and lCC stage I-IV (p = 0.354). Multivariate analysis revealed in the rCC cohort the worst outcome for ASA (American Society of Anesthesiologists) score IV patients (hazard ratio [HR]: 16.0; CI 95%: 2.1-123.5), CEA (carcinoembryonic antigen) blood level > 100 mu g/l (HR: 3.3; CI 95%: 1.2-9.0), increased lymph node ratio of 0.6-1.0 (HR: 5.3; CI 95%: 1.7-16.1), and grade 4 tumors (G4) (HR: 120.6; CI 95%: 6.7-2179.6) whereas in the lCC population, ASA score IV (HR: 8.9; CI 95%: 0.9-91.9), CEA blood level 20.1-100 mu g/l (HR: 5.4; CI 95%: 2.4-12.4), conversion to laparotomy (HR: 14.1; CI 95%: 4.0-49.0), and severe surgical complications (Clavien-Dindo III-IV) (HR: 2.9; CI 95%: 1.5-5.5) were identified as predictors of a diminished overall survival. Conclusion: Laterality disclosed no significant effect on the overall prognosis of colon cancer patients. However, group differences and distinct survival predictors could be identified in rCC and lCC patients

An outcome-oriented predictor analysis of patients undergoing surgery for colorectal cancer with special regards to tumor location

Einleitung: Weltweit ist das kolorektale Karzinome das dritthäufigste Krebsleiden und hat die zweitmeisten tumorbedingten Todesfälle zu verbuchen. Trotz seines Auftretens in einem Organ zeigen sich je nach Tumorlokalisation Unterschiede in den Tumoreigenschaften. Auch für die Prognose spielt die Lokalisation offenbar eine entscheidende Rolle. Methodik: Es wurden Daten von 424 Patienten ausgewertet, die in einem Zeitraum von Februar 2009 bis Mai 2019 am Campus Benjamin Franklin der Charité kurativ operiert wurden. Die Kohorten wurden dann entsprechend des arteriellen Versorgungsgebietes in rechtsseitige und linksseitige Karzinome aufgeteilt und miteinander verglichen. Es wurden univariate und multivariate Überlebensanalysen der Gesamtkohorte und der nach Lokalisation aufgeteilten Kohorten durchgeführt, um relevante Unterschiede der untersuchten Faktoren auf das Gesamtüberleben zu ermitteln. Ergebnisse: 232 (54,7%) Patienten hatten rechtsseitige Karzinome, 192 (45,3%) linksseitige Karzinome. Es fanden sich signifikante Unterschiede hinsichtlich der Verteilung von Geschlecht (p<0,001), Tumorentität (p=0,025), N-Stadium (p=0,013), Grading (p=0,033) und Mikrosatelliteninstabilität (p<0,001). Das 5-Jahres-Gesamtüberleben unterschied sich nicht signifikant voneinander (rechtsseitige Karzinome 58% versus linksseitige Karzinome 65% [p=0,385]), jedoch zeigten sich Unterschiede bei den für das Gesamtüberleben relevanten Faktoren. So verblieben in der multivariaten Analyse für rechtsseitige Karzinome der präoperative CEA-Werte (p=0,021) und das Grading (p=0,005), für linksseitige Karzinome ebenfalls der präoperative CEA-Wert (p<0,001), das Auftreten postoperativer Komplikationen (p=0,019) und das Alter bei Diagnosestellung (p=0,042) als eigenständige Faktoren. Der Effekt relevanter Nebenerkrankungen war für beide Entitäten signifikant. Fazit: Insgesamt konnte in unserer Studie kein signifikanter Unterschied des Gesamtüberlebens zwischen rechtsseitigen und linksseitigen Kolonkarzinomen belegt werden. Es zeigten sich jedoch für beide Lokalisationen unterschiedliche prädiktive Faktoren, was die Vermutung unterstützt, dass Karzinome beider Lokalisationen als unabhängige Tumorerkrankungen betrachtet werden sollten. Weitere Studien sind notwendig, um Diagnostik und Therapie präziser an die demographischen und prognostischen Besonderheiten von Betroffenen der jeweiligen Tumorlokalisation anzupassen.Introduction: Colon cancer is the third most diagnosed cancer worldwide and is responsible for the second most cancer-related deaths. Despite its presentation in one single organ, tumor location has been shown to be responsible for numerous differences regarding the tumor’s properties and seems to have a direct effect on life expectancy. Methods: Clinical data of 424 patients who were being operated on their colon cancer in curative intend between February 2009 and May 2019 at the Campus Benjamin Franklin of the Charité has been accumulated and analyzed. Patients were then stratified into right-sided and left-sided cohorts according to the arterial supply of the corresponding location. Univariate and multivariate regressions were performed on all tumors and the respective location-dependent factors in order to quantify their effect on overall survival. Results: 232 (54.7%) patients were diagnosed with right-sided tumors, 192 (45.3%) patients had left-sided tumors. We identified significant differences in the distribution of patient characteristics for gender (p<0.001), tumor entity (p=0.025), tumor grading (p=0.033) and microsatellite instability (p<0.001). However, tumor location did not have a significant impact on 5-year survival rate (58% for right-sided versus 65% for left-sided tumors [p=0.385]), but we saw differences in the effect of several tumor characteristics regarding survival rates. Multivariate regression identified CEA-value (p=0.021) and tumor grading (p=0.005) for right-sided carcinoma in contrast to CEA-value (p<0.001), the incidence of postoperative complications (p=0.019) and age at time of diagnosis (p=0.042) for left-sided carcinoma as independent prognostic markers for overall survival. The effect of relevant secondary conditions on survival could be demonstrated for both tumor locations. Conclusion: We were not able to show significant differences in the effect of tumor location on overall survival rate. We were, however, able to demonstrate a significant difference in the effect of certain predictive tumor characteristics on prognosis with regards to their respective location, which supports the notion that tumors should be treated as uniquely different entities according to their origin. Additional studies are necessary to further improve diagnostic and therapeutic modalities for the specific demographical and prognostic implications of each tumor entity

Survival rates and prognostic factors in right- and left-sided colon cancer stage I–IV: an unselected retrospective single-center trial

Purpose!#!Colorectal cancer revealed over the last decades a remarkable shift with an increasing proportion of a right- compared to a left-sided tumor location. In the current study, we aimed to disclose clinicopathological differences between right- and left-sided colon cancer (rCC and lCC) with respect to mortality and outcome predictors.!##!Methods!#!In total, 417 patients with colon cancer stage I-IV were analyzed in the present retrospective single-center study. Survival rates were assessed using the Kaplan-Meier method and uni/multivariate analyses were performed with a Cox proportional hazards regression model.!##!Results!#!Our study showed no significant difference of the overall survival between rCC and lCC stage I-IV (p = 0.354). Multivariate analysis revealed in the rCC cohort the worst outcome for ASA (American Society of Anesthesiologists) score IV patients (hazard ratio [HR]: 16.0; CI 95%: 2.1-123.5), CEA (carcinoembryonic antigen) blood level &amp;gt; 100 µg/l (HR: 3.3; CI 95%: 1.2-9.0), increased lymph node ratio of 0.6-1.0 (HR: 5.3; CI 95%: 1.7-16.1), and grade 4 tumors (G4) (HR: 120.6; CI 95%: 6.7-2179.6) whereas in the lCC population, ASA score IV (HR: 8.9; CI 95%: 0.9-91.9), CEA blood level 20.1-100 µg/l (HR: 5.4; CI 95%: 2.4-12.4), conversion to laparotomy (HR: 14.1; CI 95%: 4.0-49.0), and severe surgical complications (Clavien-Dindo III-IV) (HR: 2.9; CI 95%: 1.5-5.5) were identified as predictors of a diminished overall survival.!##!Conclusion!#!Laterality disclosed no significant effect on the overall prognosis of colon cancer patients. However, group differences and distinct survival predictors could be identified in rCC and lCC patients