Colon cancer survival differs from right side to left side and lymph node harvest number matter

Abstract

Background Right-sided colorectal cancer (CRC) has worse survival than does left-sided CRC. The objective of this study was to further assess the impact of right-side location on survival and the role of the extent of lymphadenectomy. Methods All CRCs diagnosed between 2000 and 2012 in Emilia-Romagna Region, Italy, were included. Data for stage, grade, histology, screening history, and number of removed lymph nodes (LN) were collected. Multivariable Cox regression models were used to estimate hazard ratios (HR), with relative 95% confidence intervals (95%CI), of right vs. left colon and of removing < 12, 12–21 or > 21 lymph nodes by cancer site. Results During the study period, 29,358 patients were registered (8828 right colon, 18,852 left colon, 1678 transverse). Patients with right cancer were more often older, females, with advanced stage and high grade, and higher number of removed LNs. Five-year survival was lower in the right than in the left colon (55.2% vs 59.7%). In multivariable analysis, right colon showed a lower survival when adjusting for age, sex, and screening status (HR 1.12, 95%CI 1.04–1.21). Stratification by number of lymph nodes removed (12–21 or > 21) was associated with better survival in right colon (HR 0.54, 95%CI 0.40–0.72 and HR 0.40, 95%CI 0.30–0.55, respectively) compared to left colon (HR 0.89, 95%CI 0.76–1.06 and HR 0.83, 95%CI 0.69–1.01, respectively). Conclusions This study confirms that right CRC has worse survival; the association is not due to screening status. An adequate removal of lymph nodes is associated with better survival, although the direction of the association in terms of causal links is not clear.

Race, age, and sex differences on the influence of obesity on colorectal cancer sidedness and mortality: A national cross‐sectional study

“…Other sociodemographic groups at increased risk of CRC include obese individuals, and in particular obese women, who are less likely to undergo screening as compared to their normal weight counterparts 13 . Although existing data show that RsCC disproportionately affects Black individuals and women, the relationship between obesity and CRC sidedness remains to be established 14–17 . We aimed to evaluate the influence of overweight and obesity on CRC sidedness.…”

Lymph node status and its impact on the prognosis of left‐sided and right‐sided colon cancer: A SEER population‐based study

“…The AJCC seventh edition recommends that lymph node status should be assessed by N staging system, patients were divided into N0, N1, N2 three stages according to the number of metastatic lymph nodes. However, on account of various factors such as tumor site, examination of lymph node status is not adequate in some patients, 9 which could disturb lymph node staging to predict patient prognosis. Michal found that examined lymph nodes was less in left‐sided colon cancer patients, which might result in incorrect lymph node staging and thus inaccurate prediction of long‐term outcomes 10 .…”

TRIM29 is differentially expressed in colorectal cancers of different primary locations and affects survival by regulating tumor immunity based on retrospective study and bioinformatics analysis

“…The difference in prognosis among RCC, LCC, and RECC patients is notable, with most studies confirming that RCC patients have poorer prognosis compared to patients with LCC and RECC (5,14,(18)(19)(20). Furthermore, the intestinal flora, clinical manifestations, and treatment responses of patients with RCC, LCC, and RECC vary considerably (18,19).…”