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Annals of Surgical Oncology

, Volume 26, Issue 5, pp 1421–1427 | Cite as

Does Primary Tumor Side Matter in Patients with Metastatic Colon Cancer Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy?

  • Kaitlyn J. KellyEmail author
  • Masumah Alsayadnasser
  • Florin Vaida
  • Jula Veerapong
  • Joel M. Baumgartner
  • Sameer Patel
  • Syed Ahmad
  • Robert Barone
  • Andrew M. Lowy
Gastrointestinal Oncology
  • 240 Downloads

Abstract

Background

Primary tumor location has been shown to be prognostic of overall survival (OS) in patients with both locally advanced and metastatic colorectal cancer. The impact of sidedness on prognosis has not been evaluated in the setting of peritoneal-only metastases treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

Methods

A retrospective review of prospectively maintained databases of patients with peritoneal surface malignancy undergoing CRS/HIPEC from three high-volume centers was performed.

Results

A total of 115 patients with metastatic colon cancer to the peritoneum who underwent CRS/HIPEC with mitomycin C were identified. Fifty-one patients (45%) had left-sided primary tumors, and 64 (55%) had right-sided primary tumors. Patients with right-sided tumors were more likely to be older (median age 56 vs. 49 years, p = 0.007) and to have signet ring cell histology (17% vs. 4%, p = 0.026). Patients with right-sided tumors had median disease-free survival (DFS) and OS of 14 months (95% confidence interval [CI] 10.5–17.5) and 36 months (95% CI 27.4–44.6), respectively, versus 16 months (95% CI 11.0–21.0) and 69 months (95% CI 24.3–113.7) for those patients with left-sided tumors. On multivariate analysis, primary tumor side was an independent predictor of both DFS and OS.

Conclusions

In this study, there was a dramatic, clinically significant difference in OS between patients with right- and left-sided tumors, and primary tumor side was an independent predictor of DFS and OS. Primary tumor side should be considered in patient selection for CRS with or without HIPEC.

Notes

Acknowledgment

The authors would like to acknowledge and thank Shirley Tejidor, our Regional Therapies Program Manager, for her outstanding work.

References

  1. 1.
    Benedix F, Meyer F, Kube R, et al. Influence of anatomical subsite on the incidence of microsatellite instability, and KRAS and BRAF mutation rates in patients with colon carcinoma. Pathol Res Pract. 2012;208:592–7.CrossRefGoogle Scholar
  2. 2.
    Gervaz P, Bucher P, Morel P. Two colons-two cancers: paradigm shift and clinical implications. J Surg Oncol. 2004;88:261–6.CrossRefGoogle Scholar
  3. 3.
    Lindblom A. Different mechanisms in the tumorigenesis of proximal and distal colon cancers. Curr Opin Oncol. 2001;13:63–9.CrossRefGoogle Scholar
  4. 4.
    Holch JW, Ricard I, Stintzing S, Modest DP, Heinemann V. The relevance of primary tumour location in patients with metastatic colorectal cancer: a meta-analysis of first-line clinical trials. Eur J Cancer. 2017;70:87–98.CrossRefGoogle Scholar
  5. 5.
    Stintzing S, Tejpar S, Gibbs P, Thiebach L, Lenz HJ. Understanding the role of primary tumour localisation in colorectal cancer treatment and outcomes. Eur J Cancer. 2017;84:69–80.CrossRefGoogle Scholar
  6. 6.
    Lee MM, MacKinlay A, Semira C, et al. Stage-based variation in the effect of primary tumor side on all stages of colorectal cancer recurrence and survival. Clin Colorectal Cancer. 2018;17(3):e569–77.CrossRefGoogle Scholar
  7. 7.
    Loupakis F, Yang D, Yau L, et al. Primary tumor location as a prognostic factor in metastatic colorectal cancer. J Natl Cancer Inst. 2015;107(3):pii:dju427.Google Scholar
  8. 8.
    Nitsche U, Stogbauer F, Spath C, et al. Right sided colon cancer as a distinct histopathological subtype with reduced prognosis. Dig Surg. 2016;33:157–63.CrossRefGoogle Scholar
  9. 9.
    Price TJ, Beeke C, Ullah S, et al. Does the primary site of colorectal cancer impact outcomes for patients with metastatic disease? Cancer. 2015;121:830–5.CrossRefGoogle Scholar
  10. 10.
    Wong HL, Lee B, Field K, et al. Impact of primary tumor site on Bevacizumab efficacy in metastatic colorectal cancer. Clin Colorectal Cancer. 2016;15:e9–15.CrossRefGoogle Scholar
  11. 11.
    Sinicrope FA, Mahoney MR, Yoon HH, et al. Analysis of molecular markers by anatomic tumor site in Stage III colon carcinomas from adjuvant chemotherapy trial NCCTG N0147 (Alliance). Clin Cancer Res. 2015;21:5294–304.CrossRefGoogle Scholar
  12. 12.
    Lim DR, Kuk JK, Kim T, Shin EJ. Comparison of oncological outcomes of right-sided colon cancer versus left-sided colon cancer after curative resection: Which side is better outcome? Medicine (Baltimore). 2017;96:e8241.CrossRefGoogle Scholar
  13. 13.
    Creasy JM, Sadot E, Koerkamp BG, et al. The impact of primary tumor location on long-term survival in patients undergoing hepatic resection for metastatic colon cancer. Ann Surg Oncol. 2018;25:431–8.CrossRefGoogle Scholar
  14. 14.
    Dupre A, Malik HZ, Jones RP, Diaz-Nieto R, Fenwick SW, Poston GJ. Influence of the primary tumour location in patients undergoing surgery for colorectal liver metastases. Eur J Surg Oncol. 2018;44:80–6.CrossRefGoogle Scholar
  15. 15.
    Franko J, Shi Q, Meyers JP, et al. Prognosis of patients with peritoneal metastatic colorectal cancer given systemic therapy: an analysis of individual patient data from prospective randomised trials from the Analysis and Research in Cancers of the Digestive System (ARCAD) database. Lancet Oncol. 2016;17:1709–19.CrossRefGoogle Scholar
  16. 16.
    Amin MB, American Joint Committee on Cancer, American Cancer Society. AJCC cancer staging manual. 8th ed. In: Edge SB, et al., editors. Chicago: American Joint Committee on Cancer, Springer; 2017.Google Scholar
  17. 17.
    Cashin PH, Mahteme H, Spang N, et al. Cytoreductive surgery and intraperitoneal chemotherapy versus systemic chemotherapy for colorectal peritoneal metastases: a randomised trial. Eur J Cancer. 2016;53:155–62.CrossRefGoogle Scholar
  18. 18.
    Elias D, Gilly F, Boutitie F, et al. Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric French study. J Clin Oncol. 2010;28:63-8.CrossRefGoogle Scholar
  19. 19.
    Glehen O, Kwiatkowski F, Sugarbaker PH, et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol. 2004;22:3284–92.CrossRefGoogle Scholar
  20. 20.
    Verwaal VJ, Bruin S, Boot H, van Slooten G, van Tinteren H. 8-year follow-up of randomized trial: cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. Ann Surg Oncol. 2008;15:2426–32.CrossRefGoogle Scholar
  21. 21.
    Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res. 1996;82:359–74.CrossRefGoogle Scholar
  22. 22.
    Quenet F, Elias D, Roca L, et al. A UNICANCER phase III trial of hyperthermic intra-peritoneal chemotherapy (HIPEC) for colorectal peritoneal carcinomatosis (PC): PRODIGE 7. J Clin Oncol. 2018;36 Suppl: abstract no. LBA3503.Google Scholar

Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Kaitlyn J. Kelly
    • 1
    Email author
  • Masumah Alsayadnasser
    • 1
  • Florin Vaida
    • 2
  • Jula Veerapong
    • 1
  • Joel M. Baumgartner
    • 1
  • Sameer Patel
    • 3
  • Syed Ahmad
    • 3
  • Robert Barone
    • 4
  • Andrew M. Lowy
    • 1
  1. 1.Department of Surgery, Division of Surgical Oncology, Moores Cancer CenterUniversity of California, San DiegoLa JollaUSA
  2. 2.Department of Family Medicine and Public Health, Division of Biostatistics and BioinformaticsUniversity of California, San DiegoSan DiegoUSA
  3. 3.Department of Surgery, Division of Surgical OncologyUniversity of CincinnatiCincinnatiUSA
  4. 4.Department of SurgerySharp Memorial HospitalSan DiegoUSA

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