Clinicopathological differences and correlations between right and left colon cancer

Kalantzis, Ioannis; Nonni, Afroditi; Pavlakis, Kitty; Delicha, Eumorphia-Maria; Miltiadou, Konstantinos; Kosmas, Christos; Ziras, Nikolaos; Gkoumas, Konstantinos; Gakiopoulou, Harikleia

doi:10.12998/wjcc.v8.i8.1424

Cited by 23 publications

(15 citation statements)

References 40 publications

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“…Since the right colon (midgut), left colon and rectum (hindgut) develop from different embryological origins, tumor biology varies between right-sided colon cancer (CC), leftsided CC, and rectal cancer (RC) [18]. Primary tumors originating from right-sided CC are associated with a higher frequency of rat sarcoma viral oncogene homolog (RAS) mutations, v-raf murine sarcoma viral oncogene homolog B (BRAF) mutations, and microsatellite instability (MSI) [19,20]. Furthermore, right-sided CC showed a worse prognosis in both non-metastatic [21] and metastatic setting [22].…”

Section: Introductionmentioning

confidence: 99%

Primary Tumor Sidedness, RAS and BRAF Mutations and MSI Status as Prognostic Factors in Patients with Colorectal Liver Metastases Treated with Surgery and Thermal Ablation: Results from the Amsterdam Colorectal Liver Met Registry (AmCORE)

et al. 2021

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The aim of this study was to assess primary tumor sidedness of colorectal cancer (CRC), rat sarcoma viral oncogene homolog (RAS) and v-raf murine sarcoma viral oncogene homolog B (BRAF) mutations and microsatellite instability (MSI) status as prognostic factors predicting complications, survival outcomes, and local tumor progression (LTP) following surgery and thermal ablation in patients with colorectal liver metastases (CRLM). This Amsterdam Colorectal Liver Met Registry (AmCORE) based study included 520 patients, 774 procedures, and 2101 tumors undergoing local treatment (resection and/or thermal ablation) from 2000 to 2021. Outcomes following local treatment were analyzed for primary tumor sidedness of CRC, RAS, and BRAF mutations and MSI status. The Kaplan–Meier method was used to estimate local tumor progression-free survival (LTPFS), local control (LC), distant progression-free survival (DPFS), and overall survival (OS). Uni- and multivariable analyses were performed based on Cox proportional hazards model. The chi-square test was used to analyze complications. Complications (p = 0.485), OS (p = 0.252), LTPFS (p = 0.939), and LC (p = 0.423) was not associated with tumor-sidedness. Compared to right-sided colon cancer (CC) (reference HR 1.000), DPFS was superior for left-sided CC and rectal cancer (p = 0.018) with an HR for left-sided CC of 0.742 (95% CI, 0.596–0.923) and for RC of 0.760 (95% CI, 0.597–0.966). Regarding RAS mutations, no significant difference was found in OS (p = 0.116). DPFS (p = 0.001), LTPFS (p = 0.039), and LC (p = 0.025) were significantly lower in the RAS mutation group. Though no difference in LTPFS was found between RAS wildtype and RAS mutated CRLM following resection (p = 0.532), LTPFS was worse for RAS mutated tumors compared to RAS wildtype following thermal ablation (p = 0.037). OS was significantly lower in the BRAF mutation group (p < 0.001) and in the MSI group (p < 0.001) following local treatment, while both did not affect DPFS, LTPFS, and LC. This AmCORE based study suggests the necessity of wider margins to reduce LTP rates in patients with RAS mutated CRLM, especially for thermal ablation. Upfront knowledge regarding molecular biomarkers may contribute to improved oncological outcomes.

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Section: Introductionmentioning

confidence: 99%

Primary Tumor Sidedness, RAS and BRAF Mutations and MSI Status as Prognostic Factors in Patients with Colorectal Liver Metastases Treated with Surgery and Thermal Ablation: Results from the Amsterdam Colorectal Liver Met Registry (AmCORE)

et al. 2021

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“…From the above results and the clinicopathological analysis of the right hemicolon by Chen Wei et al [37]., it is reasonable to believe that LCC and RCC may be tumors of different properties and have different carcinogenic mechanisms.Therefore, LCC and RCC were screened by differential genes and established relevant prognostic signature respectively.With |LogFC|>1 and FDR < 0.05,we obtained 360 differential genes(218 up genes in RCC and 142 up genes in LCC).By univariate COX regression and multivariate COX regression with noose penalty,We have constructed 4-mRNA LCC prognostic signature and 6-mRNA RCC prognostic signature.The model has been veri ed by internal testing set, complete set and external testing set.Also the model has been validated as an independent prognostic indicator.It is understood that we are the rst to establish prognostic signatures for both left-side and right-side colon cancers, which have been validated internally and externally.This provides the basis for personalized treatment of left and right colon cancer.…”

Section: Discussionmentioning

confidence: 83%

“…Because of the different prognosis, outcomes, and clinical response to chemotherapy between LCC and RCC, it has received increasing attention. In some investigations ,it has been reported that LCC is associated with a better prognosis compared with RCC [4]. A recent systematic review noted that many studies have identi ed their differences in epidemiology, clinical presentation, pathology, and genetic mutations through anatomical subsites [5].…”

Section: Introductionmentioning

confidence: 99%

Analysis of multi-omics differences in left-side and right-side colon cancer

Huang

Duanmu

Liu

et al. 2020

Preprint

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Background:Colon cancer is one of the common tumors of digestive tract. Studies of left-side colon cancer(LCC) and right-side colon cancer(RCC) show that these two subtypes had different prognosis, outcomes, and clinical response to chemotherapy. Therefore,it is necessary to explore the necessity of clinical classification of anatomic subtypes about colon cancer.Methods:We selected the transcriptome data, clinical information and somatic mutation data of colon cancer patients from the the Cancer Genome Atlas(TCGA )database portal.The transcriptome data included 390 colon cancer patients(172 LCC samples and 218 RCC samples),and the somatic mutation data included 142 LCC samples and 187 RCC samples.By conducting a multi-omics analysis of the LCC and RCC from the four aspects of clinical characteristics, immune microenvironment , transcriptomic differences and mutation differences, so as to compare the expression and prognosis difference of LCC and RCC.We are the first to construct prognostic signatures respectively for LCC and RCC respectively.The prognostic signatures is validated by internal testing set, complete set and external testing set(GSE39582).Additionally we also verified the independent prognostic value of the signature.Results:Clinical characteristics analysis results show that RCC had a significantly worse prognosis than LCC.Analysis the immune microenvironment analysis shows that RCC was more immune infiltration than LCC.The results of differential gene analysis showed that there were 360 differential expressed genes,with 142 up genes in LCC and 218 up genes in RCC.Correlation analysis of mutated genes showed that the expression of mutated genes in RCC was negatively correlated, while the expression of mutated genes in LCC was positively correlated, and the mutation frequency of RCC was generally higher than that of LCC.Meanwhile, our 4-mRNA LCC and 6-mRNA RCC prognostic signatures are highly predictive and can be used as independent prognostic factors.Conclusion:The clinical classification of anatomic subtypes of colon cancer is of great significance for its early diagnosis and prognostic risk assessment.Our study provides directions for individualized treatment of left and right colon cancer.

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“…However, for patients with KRAS WT, there was still controversy when choosing EGFR inhibitor or anti-VEGF combined with chemotherapy [ 98 – 101 ]. In addition, studies showed that the mutational status of patients with metastatic CRC was different in different primary tumor sites [ 102 – 104 ], which could directly affect the response of patients to perioperative chemotherapy and targeted drugs [ 105 , 106 ]. However, most previous studies focused on the mutational status from the perspective of left and right CRC [ 107 – 109 ].…”

Section: Discussionmentioning

confidence: 99%

Primary tumor resection improves prognosis of unresectable carcinomas of the transverse colon including flexures with liver metastasis: a preliminary population-based analysis

et al. 2021

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Purpose Studies on unresectable colorectal cancer liver metastasis(CRLM) rarely analyze the prognosis of the patients from the point of colonic subsites. We aimed to evaluate the effect of primary tumor resection (PTR) and different scope of colectomy on the prognosis of patients with unresectable transverse colon cancer liver metastasis (UTCLM), hepatic flexure cancer liver metastasis (UHFLM), and splenic flexure cancer liver metastasis (USFLM). Patients and methods The patients were identified from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. Cox proportional hazards regression models were used to identify prognostic factors of overall survival (OS) and cause-specific survival (CSS). Kaplan-Meier analyses and log-rank tests were conducted to assess the effectiveness of PTR on survival. Results In total, this study included a cohort of 1960 patients: 556 cases of UHFLM, 1008 cases of UTCLM, and 396 cases of USFLM. The median survival time of whole patients was 11.0 months, ranging from 7.0 months for UHFLM patients to 15.0 months for USFLM patients. USFLM patients had the best OS and CSS, followed by UTCLM patients. UHFLM patients had the worst OS and CSS (All P < 0.001). PTR could improve the OS and CSS of UTCLM, UHFLM, and USFLM (All P < 0.001). Subgroups analysis revealed that USFLM patients with tumor size≤5 cm and negative CEA had not demonstrated an improved OS and CSS after PTR. Multivariate analysis showed that PTR and perioperative chemotherapy were common independent prognostic factors for UHFLM, UTCLM, and USFLM patients. There was no difference between segmental colon resection and larger colon resection on CSS of UHFLM, UTCLM, and USFLM patients. Conclusions We confirmed the different survival of patients with UTCLM, UHFLM, and USFLM, and for the first time, we proved that PTR could provide survival benefits for patients with unresectable CRLM from the perspective of colonic subsites of transverse colon, hepatic flexure, and splenic flexure. Besides, PTR may not improve the prognosis of USFLM patients with CEA- negative or tumor size≤5 cm. For oncologic outcomes, we concluded that segmental colon resection seemed an effective surgical procedure for UTCLM, UHFLM, and USFLM.

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Clinicopathological differences and correlations between right and left colon cancer

Cited by 23 publications

References 40 publications

Primary Tumor Sidedness, RAS and BRAF Mutations and MSI Status as Prognostic Factors in Patients with Colorectal Liver Metastases Treated with Surgery and Thermal Ablation: Results from the Amsterdam Colorectal Liver Met Registry (AmCORE)

Primary Tumor Sidedness, RAS and BRAF Mutations and MSI Status as Prognostic Factors in Patients with Colorectal Liver Metastases Treated with Surgery and Thermal Ablation: Results from the Amsterdam Colorectal Liver Met Registry (AmCORE)

Analysis of multi-omics differences in left-side and right-side colon cancer

Primary tumor resection improves prognosis of unresectable carcinomas of the transverse colon including flexures with liver metastasis: a preliminary population-based analysis

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