Comparison of 627 patients with right‐ and left‐sided colon cancer in China: Differences in clinicopathology, recurrence, and survival

Abstract

ObjectiveRecent studies have reported increased mortality for right-sided colon cancers; however, the results are conflicting for different stage tumors. We examined the differences in clinicopathology between right- and left-sided colon cancers and the relationships between colon cancer location (right- and left-side) and 5-year disease-free survival (DFS) and overall survival (OS).MethodsWe identified patients from 2005 to 2008 with stage II/III colon cancer who underwent surgery for curative intent. We explored the impact of the tumor location on the postoperative DFS and OS using univariate and multivariate analyses.ResultsOf 627 patients, 50.6% (317/627) had right-sided colon cancer. These patients were more likely to have weight loss, second primary tumor, elevated preoperative carbohydrate antigen 19-9 (CA19-9), increased incidence of non-adenocarcinoma, more poorly differentiated tumors, vascular invasion, defective mismatch repair, and a lighter smoking history (P < 0.05). Right-sided colon cancer had a higher recurrence incidence compared with left-sided cancer (30.6% vs. 23.2%, P = 0.037), particularly with multiple metastatic sites in the first recurrence (17.5% vs. 5.6%, P = 0.020). Kaplan–Meier survival curves demonstrated a significant difference in the 5-year DFS rate between right- and left-sided cancers across all stages (68.1% vs. 75.2%, P = 0.043). However, there was no significant difference in the 5-year OS rate between the two groups (73.8% vs. 79.0%, P = 0.103). Subgroup analysis demonstrated that patients with left-sided colon cancer had a significantly better 5-year DFS and OS rates compared with those with right-sided disease at stage III (64.3% vs. 46.8%, P = 0.002; 69.5% vs. 53.5%, P = 0.006, respectively); there were no significant differences in the 5-year DFS and OS rates at stage II (85.2% vs. 85.9%, P = 0.819; 89.8% vs. 88.5%, P = 0.803, respectively). Adjusted Cox regression analysis showed no significant differences in the 5-year OS and DFS rates for stage II [hazard ratio (HR) = 1.203, 95% confidence interval (CI): 0.605–2.391, P = 0.598; HR = 0.980, 95% CI: 0.542–1.774, P = 0.948, respectively] or all stages combined (HR = 0.867, 95% CI: 0.613–1.227, P = 0.421; HR = 0.832, 95% CI: 0.606–1.142, P = 0.255, respectively). However, stage III left-sided cancer had higher 5-year OS and DFS rates (HR = 0.626, 95% CI: 0.414–0.948, P = 0.027; HR = 0.630, 95% CI: 0.428–0.926, P = 0.019, respectively).ConclusionWe found that right- and left-sided colon cancers had significantly different clinicopathological characteristics. Right-sided colon cancer had a higher incidence of recurrence than left-sided disease. Patients with stage III right-sided colon cancer had a worse prognosis compared with those with stage III left-sided colon cancer.

The Prognostic Value of the Detection of Microbial Translocation in the Blood of Colorectal Cancer Patients

“…Moreover, a meta-analysis concluded that in the right-sided advanced CRC, chemotherapy plus bevacizumab was a treatment option [44,45]. Moreover, the higher antigenic load described in the right-sided tumors is more likely to be due to the defective mismatch repair mechanism because of the high frequency of mutations, thus increasing the possibility of immune recognition [46,47]. Lim DR et al described data from 414 patients under curative resection for right or left-sided colon cancer, suggesting that patients with left-sided tumors had a better survival outcome than those with right-sided tumors, especially in stage III patients [41].…”

A meta‑analysis of serological thymidine kinase 1 as a marker for colorectal benign and malignant tumor risk assessment

“…Right-sided location, female sex, T4 disease, lymph node metastasis, and perineural invasion are independent risk factors for the locoregional recurrence of colon cancer (60). Qin et al (61) found that right-and left-sided colon cancer had significantly different clinicopathological characteristics. Right-sided colon cancer had a higher incidence of recurrence than left-sided colon cancer.…”

The difference between left and right colon cancer patients’ characteristics - single center experience

“…Kaplan-Meier survival analysis of the patients divided according to localization shows an overall five-year survival rate of 62% in patients with right colon cancer compared to 72% in patients with left colon cancer. as opposed to these results, many studies prove that the right colorectal cancer is more often in an advanced stage, whereas the left colorectal cancer is diagnosed in earlier stages (3,4,8,9,12).…”

“…in 2012 the incidence rate of colorectal cancer was 44,2/100000 in men, and 24,7/100000 in women; the mortality rate in men was 26,7/100000, and in women 24,7/100000. colorectal cancer is among ten most common causes of death in osijek-Baranya county; it was ranked fourth with 158 deaths in 2016 (1,4,5,10,11).…”