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Effect of Primary Tumor Location on Postmetastasectomy Survival in Patients with Colorectal Cancer Liver Metastasis

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The effects of primary tumor location on colorectal liver metastasis (CRLM) and post-hepatic-metastasectomy overall survival (OS) are controversial. This study evaluated the difference in post-hepatic-metastasectomy OS among right-sided colon, left-sided colon, and rectal cancer groups.

Methods

In total, 381 patients who underwent curative-intent CRLM resection were enrolled. Patients were grouped based on the primary tumor location (right-sided, left-sided, and rectum). The Kaplan–Meier analysis and log-rank test were performed for survival analysis. The univariate and multivariate analyses of clinical and pathological factors were performed using the Cox proportional hazards model.

Results

Significant OS difference was noted among the three groups (log-rank, p = 0.014). The multivariate analysis revealed a 32% lower death risk in left-sided colon cancer compared with right-sided colon cancer (hazard ratio [HR] 0.68, p = 0.042), whereas no OS difference was noted between the rectal cancer and right-sided colon cancer groups. The left- versus right-sided OS advantage was noted only in the KRAS wild-type subgroup (HR 0.46, p = 0.002), and a rectal versus right-sided OS disadvantage was noted in the KRAS mutant subgroup (HR 1.78, p = 0.03).

Conclusions

The CRLM post-hepatic-metastasectomy OS was superior in left-sided colon cancer than in right-sided colon cancer and was similar in rectal and right-sided colon cancer. The OS difference in different primary tumor locations is dependent on KRAS mutation status, with a decreased left- versus right-sided death risk noted only in KRAS wild-type colon cancer and an increased rectal versus right-sided death risk noted only in KRAS mutant colon cancer.

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Funding

We give thanks for grants from the Taiwan Clinical Oncology Research Foundation and to the Taipei Veterans General Hospital Big Data Center.

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Authors and Affiliations

  1. Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Tien-Hua Chen, Wei-Shone Chen, Jeng-Kai Jiang, Shung-Haur Yang, Huann-Sheng Wang, Shih-Ching Chang, Yuan-Tzu Lan, Chun-Chi Lin, Hung-Hsin Lin, Sheng-Chieh Huang, Hou-Hsuan Cheng, Gar-Yang Chau, Cheng-Yuan Hsia, Hao-Jan Lei, Shu-Cheng Chou, Yee Chao & Hao-Wei Teng

  2. Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City, Taiwan

    Tien-Hua Chen, Yee Chao & Hao-Wei Teng

  3. Division of Colon and Rectum Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan

    Wei-Shone Chen, Jeng-Kai Jiang, Shung-Haur Yang, Huann-Sheng Wang, Shih-Ching Chang, Yuan-Tzu Lan, Chun-Chi Lin, Hung-Hsin Lin, Sheng-Chieh Huang & Hou-Hsuan Cheng

  4. Department of Surgery, National Yang-Ming University Hospital, Yilan, Taiwan

    Shung-Haur Yang

  5. Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan

    Gar-Yang Chau, Cheng-Yuan Hsia, Hao-Jan Lei & Shu-Cheng Chou

  6. Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan

    Hao-Wei Teng

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  1. Tien-Hua Chen
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Contributions

THC: Data analysis and manuscript writing. WSC, JKJ, SHY, HSW, SCC, YTL, CCL, HHL, SCH, HHC, GYC, CYH, HJL, SCC, and YC: Data collection or management. HWT: Project development, data analysis, and manuscript editing.

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Correspondence to Hao-Wei Teng.

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Chen, TH., Chen, WS., Jiang, JK. et al. Effect of Primary Tumor Location on Postmetastasectomy Survival in Patients with Colorectal Cancer Liver Metastasis. J Gastrointest Surg 25, 650–661 (2021). https://doi.org/10.1007/s11605-020-04855-5

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