Pathologic factors are more important than tumor location in long-term survival in colon cancer
Proximal and distal colon cancers differ in terms of epidemiology, clinical presentation, and pathologic features. The aim of our study was to evaluate the impact of right-sided (RC), transverse (TC), and left-sided (LC) colon cancer on morbidity rates and oncological outcomes.
A retrospective analysis of patients with resected colon cancer between 2004 and 2014 was conducted. Cox proportional hazard models were used to assess predictors of overall (OS), and disease-specific survival (DSS), as well as disease-free survival (DFS).
A total of 1189 patients were included. RC patients (n = 618) were older, predominantly women, and had a higher comorbidity rate. LC (n = 454) was associated with symptomatic presentation and increased rates of laparoscopic surgery. Multivisceral resections were more frequently performed in TC tumors (n = 117). This group was admitted 1 day longer and had a higher complication rate (RC 35.6% vs. TC 43.6% vs. LC 31.1%, P0.032). Although the incidence of abscess/leak was similar between the groups, the necessity of readmission and subsequent reoperation for a leak was significantly higher in LC patients. Pathology revealed more poorly differentiated tumors and microsatellite instability in RC. Kaplan-Meier curves demonstrated worse 5-year OS for right-sided tumors (RC 73.0%; TC 76.2%. LC 80.8%, P0.023). However, after adjustment, no differences were found in OS, DSS, and DFS between tumor location. Only pathological features were independently correlated with prognosis, as were baseline characteristics for OS.
Tumor location in colon cancer was not associated with survival or disease recurrence. Pathological differences beyond tumor stage were significantly more important.
KeywordsColon cancer Sidedness Morbidity Disease recurrence Survival
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Edwards BK, Ward E, Kohler BA, Eheman C, Zauber AG, Anderson RN, Jemal A, Schymura MJ, Lansdorp-Vogelaar I, Seeff LC, van Ballegooijen M, Goede SL, Ries LA (2010) Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer 116:544–573CrossRefPubMedPubMedCentralGoogle Scholar
- 2.Vogelaar I, van Ballegooijen M, Schrag D, Boer R, Winawer SJ, Habbema JD, AGl Z (2006) How much can current interventions reduce colorectal cancer mortality in the US? Mortality projections for scenarios of risk-factor modification, screening, and treatment. Cancer 107:1624–1633CrossRefPubMedGoogle Scholar
- 7.Benedix F, Kube R, Meyer F, Schmidt U, Gastinger I, Lippert H (2010) Colon/rectum carcinomas (primary tumor) study group. Comparison of 17,641 patients with right- and left-sided colon cancer: differences in epidemiology, perioperative course, histology, and survival. Dis Colon Rectum 53:57–64CrossRefPubMedGoogle Scholar
- 8.Azzoni C, Bottarelli L, Campanini N, Di Cola G, Bader G, Mazzeo A, Salvemini C, Morari S, Di Mauro D, Donadei E, Roncoroni L, Bordi C, Sarli L (2007) Distinct molecular patterns based on proximal and distal sporadic colorectal cancer: arguments for different mechanisms in the tumorigenesis. Int J Color Dis 22:115–126CrossRefGoogle Scholar