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Prognostic impact of primary tumor location in Stage III colorectal cancer-right-sided colon versus left-sided colon versus rectum: a nationwide multicenter retrospective study

Journal of Gastroenterology volume 55, pages 958–968 (2020)Cite this article

Abstract

Background

Previous studies investigating the impact of tumor location on colorectal cancer prognosis only compared two groups by location, e.g., ‘right-sided colon vs. left-sided colon,’ ‘colon vs. rectum,’ and ‘right-sided (right-sided colon) vs. left-sided (left-sided colon and rectum).’ This nationwide multicenter retrospective study aimed to clarify the prognostic impact of tumor location in patients with stage III colorectal cancer by classifying tumors into three groups: right-sided colon, left-sided colon, and rectum.

Methods

Subjects were 9194 patients with stage III colorectal cancer who underwent curative surgery from 1997 to 2012. Relapse-free survival (RFS) after primary surgery and overall survival (OS) after recurrence were examined.

Results

Rectal cancer (n = 2922) was associated with worse RFS compared to right-sided colon cancer (n = 2362) (hazard ratio (HR) 0.65; 95% CI 0.59–0.72; p < 0.001) and left-sided colon cancer (n = 3910) (HR 0.72; 95% CI 0.66–0.78; p < 0.001) after adjusting for key clinical factors (i.e., sex, age, histological type, CEA, adjuvant therapy, T category, and N category). Among patients with recurrence (n = 2823), rectal cancer was associated with better OS compared to right-sided colon cancer (HR 1.23; 95% CI 1.08–1.40; p = 0.002) and worse OS compared to left-sided colon cancer (HR 0.88; 95% CI 0.79–0.99; p = 0.029). Twenty percent of right-sided colon cancer recurrences exhibited peritoneal dissemination, 42% of left-sided colon cancer recurrences were liver metastases, and 33% of rectal cancer recurrences were local recurrences.

Conclusions

The three tumor locations (right-sided colon, left-sided colon, rectum) had different prognostic implications for recurrence after curative resection and overall mortality, suggesting that tumor location serves as a prognostic biomarker in stage III colorectal cancer.

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Abbreviations

CI:

Confidence interval

CSS:

Cancer-specific survival

dMMR:

Deficient mismatch repair

HR:

Hazard ratio

OS:

Overall survival

RFS:

Relapse-free survival

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Acknowledgements

This study is based on data from 24 hospitals, which are members of the Japanese Study Group for Postoperative Follow-up of CRC, as follows: Ichiro Takemasa (Sapporo Medical University); Kenichi Hakamada (Hirosaki University); Hitoshi Kameyama (Niigata University); Yasukimi Takii (Niigata Cancer Center Hospital); Hideki Ueno (National Defense Medical College); Heita Ozawa (Tochigi Cancer Center); Soichiro Ishihara (the University of Tokyo); Keiichi Takahashi (Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital); Yukihide Kanemitsu (National Cancer Center Hospital); Michio Itabashi (Tokyo Women’s Medical University); Tomomichi Kiyomatsu (National Center for Global Health and Medicine); Yusuke Kinugasa (Tokyo Medical and Dental University); Koji Okabayashi (Keio University); Yojiro Hashiguchi (Teikyo University); Tadahiko Masaki (Kyorin University); Masahiko Watanabe (Kitasato University); Akio Shiomi (Shizuoka Cancer Center); Tsunekazu Hanai (Fujita Health University); Koji Komori (Aichi Cancer Center Hospital); Yoshiharu Sakai (Kyoto University); Masayuki Ohue (Osaka International Cancer Institute); Shingo Noura (Osaka Rosai Hospital); Naohiro Tomita (Hyogo College of Medicine); and Yoshito Akagi (Kurume University).

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Affiliations

  1. Department of Colorectal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan

    Dai Shida, Manabu Inoue, Taro Tanabe, Konosuke Moritani, Shunsuke Tsukamoto & Yukihide Kanemitsu

  2. Tokyo Medical and Dental University, Tokyo, Japan

    Shinichi Yamauchi & Kenichi Sugihara

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  1. Dai Shida
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  2. Manabu Inoue
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Correspondence to Dai Shida.

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Shida, D., Inoue, M., Tanabe, T. et al. Prognostic impact of primary tumor location in Stage III colorectal cancer-right-sided colon versus left-sided colon versus rectum: a nationwide multicenter retrospective study. J Gastroenterol 55, 958–968 (2020). https://doi.org/10.1007/s00535-020-01706-7

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Keywords

  • Right-sided colon cancer
  • Left-sided colon cancer
  • Rectal cancer
  • Tumor location
  • Sidedness