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Prognostic value of primary tumor location in colorectal cancer: an updated meta-analysis

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Abstract

The clinical, histological, and molecular differences between right-sided colon cancer (RCC) and left-sided colon cancer (RCC) have received considerable attention. Over the past decade, many articles have been published concerning the association between primary tumor location (PTL) of colorectal cancer and survival outcomes. Therefore, there is a growing need for an updated meta-analysis integrating the outcomes of recent studies to determine the prognostic role of right vs left-sidedness of PTL in patients with colorectal cancer. We conducted a comprehensive database review using PubMed, SCOPUS, and Cochrane library databases from February 2016 to March 2023 for prospective or retrospective studies reporting data on overall survival (OS) and cancer-specific survival (CSS) of RCC compared with LCC. A total of 60 cohort studies comprising 1,494,445 patients were included in the meta-analysis. We demonstrated that RCC is associated with a significantly increased risk of death compared with LCC by 25% (hazard ratio (HR), 1.25; 95% confidence interval (CI), 1.19–1.31; I2 = 78.4%; Z = 43.68). Results showed that patients with RCC have a worse OS compared with LCC only in advanced stages (Stage III: HR, 1.275; 95% CI 1.16–1.4; P = 0.0002; I2 = 85.8%; Stage IV: HR, 1.34; 95% CI 1.25–1.44; P < 0.0001; I2 = 69.2%) but not in primary stages (Stage I/II: HR, 1.275; 95% CI 1.16–1.4; P = 0.0002; I2 = 85.8%). Moreover, a meta-analysis of 13 studies including 812,644 patients revealed that there is no significant difference in CSS between RCC and LCC (HR, 1.121; 95% CI 0.97–1.3; P = 0.112). Findings from the present meta-analysis highlight the importance of PTL in clinical decision-making for patients with CRC, especially in advanced stages. We provide further evidence supporting the hypothesis that RCC and LCC are distinct disease entities that should be managed differently.

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Author notes

  1. Hanieh Gholamalizadeh and Nima Zafari have equally contributed as first author.

Authors and Affiliations

  1. Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

    Hanieh Gholamalizadeh, Nima Zafari, Mahla Velayati, Hamid Fiuji, Mina Maftooh, Elnaz Ghorbani, Seyed Mahdi Hassanian, Majid Khazaei, Elham Nazari & Amir Avan

  2. Basic Sciences Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran

    Mina Maftooh, Seyed Mahdi Hassanian, Majid Khazaei & Elham Nazari

  3. Division of Medical Education, Brighton and Sussex Medical School, Falmer, Brighton, Sussex, BN1 9PH, UK

    Gordon A. Ferns

  4. College of Medicine, University of Warith Al-Anbiyaa, Karbala, Iraq

    Amir Avan

  5. School of Mechanical, Medical and Process Engineering, Science and Engineering Faculty, Queensland University of Technology, 2 George St, Brisbane, QLD, 4000, Australia

    Amir Avan

  6. Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia

    Amir Avan

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Contributions

HG, MV, and EG wrote the main manuscript text. NZ, HF, and MM performed the data extraction and data analysis. SMH and MK prepared figures. Gordon A Ferns performed the language editing. AA and EN supervised all steps of our work. All authors reviewed the manuscript.

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Correspondence to Elham Nazari or Amir Avan.

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Hanieh Gholamalizadeh: None Declared; Nima Zafari: None Declared; Mahla Velayati: None Declared; Hamid Fiuji: None Declared; Mina Maftooh: None Declared; Elnaz Ghorbani: None Declared; Seyed Mahdi Hassanian: None Declared; Majid Khazaei: None Declared; Gordon A Ferns: None Declared; Elham Nazari: None Declared; Amir Avan: None Declared.

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Gholamalizadeh, H., Zafari, N., Velayati, M. et al. Prognostic value of primary tumor location in colorectal cancer: an updated meta-analysis. Clin Exp Med 23, 4369–4383 (2023). https://doi.org/10.1007/s10238-023-01120-2

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