Mohamed E Salem1, Jun Yin2, Benjamin A Weinberg3, Lindsay A Renfro2, Levi D Pederson2, Timothy S Maughan4, Richard A Adams5, Eric Van Cutsem6, Alfredo Falcone7, Niall C Tebbutt8, Matthew T Seymour9, Eduardo Díaz-Rubio10, Enrique Aranda11, Carsten Bokemeyer12, Volker Heinemann13, Harpreet Wasan14, Aimery de Gramont15, Axel Grothey16, Qian Shi2, Daniel J Sargent2, John L Marshall3. 1. Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA. Electronic address: Mohamed.Salem@carolinashealthcare.org. 2. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA. 3. Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA. 4. CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK. 5. Cardiff University, Cardiff, UK. 6. Digestive Oncology, University Hospitals Leuven and KU Leuven, Leuven, Belgium. 7. Department of Oncology, University of Pisa, Pisa, Italy. 8. Medical Oncology, Austin Health, Heidelberg, Australia. 9. Gastrointestinal Cancer Research Unit, Cookridge Hospital, Leeds, UK. 10. Department Oncology, Hospital Clínico San Carlos, CIBERONC, Madrid, Spain. 11. Reina Sofia Hospital, University of Cordoba, Maimonides Institute of Biomedical Research, CIBERONC, Avenida de Menendez Pidal, Cordoba, Spain. 12. Department of Oncology, Haematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 13. Comprehensive Cancer Center, Ludwig-Maximilians-University of Munich, Munich, Germany. 14. Imperial College Healthcare NHS Trust, London, UK. 15. Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France. 16. Medical Oncology, West Cancer Center, Germantown, TN, USA.
Abstract
PURPOSE: Patients with left-sided colon tumours have better survival and respond differently to biologics compared with patients with right-sided tumours. Left-sided colon tumours and rectal cancers are often grouped together. Herein, we examined the clinicopathological differences and outcomes between left-sided colon and rectal cancers. PATIENTS AND METHODS: Data from 2879 metastatic colorectal cancer patients enrolled on six first-line clinical trials during 2004-2010 were pooled. Patients were included if the primary tumour origin was clearly defined. Progression-free survival (PFS) and overall survival (OS) were compared in the two groups after adjusting for patient and tumour characteristics, metastatic sites and the first-line regimen. RESULTS: In total, 1374 patients with metastatic left-sided colon cancer and 1505 patients with metastatic rectal cancers were evaluated. Left-sided colon cancer patients were more likely to be female (40.1% versus 32.6%; P < 0.0001) and older (31.0% ≥ 70 years versus 25.8%; P = 0.0033) compared with rectal cancers patients. Patients with left-sided colon cancer had higher rates of liver metastases (80.9% versus 72.3%, P < 0.0001) but lower rates of lung metastases (34.2% versus 53.8%, P < 0.0001). KRAS mutations were slightly less frequent among left-sided tumours (34.8% versus 40.5%; P = 0.0103). Patients with left-sided tumours had approximately similar PFS (median 7.4 versus 6.9 months; hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.87-1.03; P = 0.1998) and OS (median 17.4 versus 16.6 months; HR 0.99, 95% CI 0.91-1.07; P = 0.7597) compared with rectal cancer patients. CONCLUSION: The site of tumour origin within the left side was not prognostic of outcomes. Moreover, neither bevacizumab nor cetuximab impacted, differently, the findings of the comparisons in outcomes between patients with left-sided colon tumours or rectal cancers.
PURPOSE:Patients with left-sided colon tumours have better survival and respond differently to biologics compared with patients with right-sided tumours. Left-sided colon tumours and rectal cancers are often grouped together. Herein, we examined the clinicopathological differences and outcomes between left-sided colon and rectal cancers. PATIENTS AND METHODS: Data from 2879 metastatic colorectal cancerpatients enrolled on six first-line clinical trials during 2004-2010 were pooled. Patients were included if the primary tumour origin was clearly defined. Progression-free survival (PFS) and overall survival (OS) were compared in the two groups after adjusting for patient and tumour characteristics, metastatic sites and the first-line regimen. RESULTS: In total, 1374 patients with metastatic left-sided colon cancer and 1505 patients with metastatic rectal cancers were evaluated. Left-sided colon cancerpatients were more likely to be female (40.1% versus 32.6%; P < 0.0001) and older (31.0% ≥ 70 years versus 25.8%; P = 0.0033) compared with rectal cancerspatients. Patients with left-sided colon cancer had higher rates of liver metastases (80.9% versus 72.3%, P < 0.0001) but lower rates of lung metastases (34.2% versus 53.8%, P < 0.0001). KRAS mutations were slightly less frequent among left-sided tumours (34.8% versus 40.5%; P = 0.0103). Patients with left-sided tumours had approximately similar PFS (median 7.4 versus 6.9 months; hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.87-1.03; P = 0.1998) and OS (median 17.4 versus 16.6 months; HR 0.99, 95% CI 0.91-1.07; P = 0.7597) compared with rectal cancerpatients. CONCLUSION: The site of tumour origin within the left side was not prognostic of outcomes. Moreover, neither bevacizumab nor cetuximab impacted, differently, the findings of the comparisons in outcomes between patients with left-sided colon tumours or rectal cancers.
Authors: Richard M Goldberg; Richard Adams; Marc Buyse; Cathy Eng; Axel Grothey; Thierry André; Alberto F Sobrero; Stuart M Lichtman; Al B Benson; Cornelis J A Punt; Tim Maughan; Tomasz Burzykowski; Dirkje Sommeijer; Everardo D Saad; Qian Shi; Elisabeth Coart; Benoist Chibaudel; Miriam Koopman; Hans-Joachim Schmoll; Takayuki Yoshino; Julien Taieb; Niall C Tebbutt; John Zalcberg; Josep Tabernero; Eric Van Cutsem; Alastair Matheson; Aimery de Gramont Journal: J Natl Cancer Inst Date: 2022-06-13 Impact factor: 11.816