Shehara Mendis1, Sophie Beck2, Belinda Lee2,3,4, Margaret Lee1,2,3,4,5, Rachel Wong2,5,6, Suzanne Kosmider1, Jeremy Shapiro7, Desmond Yip8,9, Simone Steel10, Louise Nott11, Ross Jennens12, Lara Lipton1,7, Matthew Burge13, Kathryn Field3,4, Sumitra Ananda1, Hui-Li Wong2, Peter Gibbs1,2,3,4,14. 1. Footscray Hospital, Western Health, Footscray, Victoria, Australia. 2. Walter & Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia. 3. Royal Melbourne Hospital, Parkville, Victoria, Australia. 4. Faculty of Medicine & Health Sciences, University of Melbourne, Melbourne, Victoria, Australia. 5. Box Hill Hospital, Eastern Health, Box Hill, Victoria, Australia. 6. Faculty of Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia. 7. Cabrini Health, Malvern, Victoria, Australia. 8. Canberra and Calvary Hospitals, Garran, Australian Capital Territory, Australia. 9. ANU Medical School, The Canberra Hospital, Garran, Australian Capital Territory, Australia. 10. Peninsula Private Hospital, Frankston, Victoria, Australia. 11. Royal Hobart Hospital, Hobart, Tasmania, Australia. 12. Epworth Hospital, Richmond, Victoria, Australia. 13. Royal Brisbane Hospital, Herston, Queensland, Australia. 14. BioGrid Australia, Melbourne, Australia.
Abstract
BACKGROUND: Metastatic colorectal cancer (mCRC) patients with a right-sided primary (RC) have an inferior survival to mCRC arising from a left-sided primary (LC). Previous analyses have suggested multiple factors contribute. METHODS: The Treatment of Recurrent and Advanced Colorectal Cancer (TRACC) Registry prospectively captured data on consecutive mCRC patients. RC were defined as tumors proximal to the splenic flexure; LC were those at and distal to the splenic flexure and included rectal cancers. Patient, tumor, treatment, and survival data were analyzed stratified by side. RESULTS: Of 2306 patients enrolled from July 2009-March 2018, 747 (32%) had an RC. Patients with RC were older, more likely to be female and have a Charlson score ≥3. RC were more frequently BRAF mutated, deficient in mismatch repair, associated with peritoneal metastases, and less likely to receive chemotherapy. Progression-free survival on first-line systemic therapy was inferior for RC patients (8.1 vs. 10.8 months, hazard ratio [HR] for progression in RC 1.38, P < 0.001). Median overall survival for all RC patients was inferior (19.6 vs. 27.5 months, HR for death in RC 1.44, P < 0.001), and inferior within the treated (21 vs. 29.5 months, HR 1.52, P < 0.001) and untreated subgroups (5.9 vs. 10.3 months, HR 1.38, P = 0.009). Primary side remained a significant factor for overall survival in multivariate analysis. CONCLUSION: Our data from a real-world population confirms the poorer prognosis associated with RC. Primary tumor location remains significantly associated with overall survival even when adjusting for multiple factors, indicating the existence of further side-based differences that are as yet undefined.
BACKGROUND:Metastatic colorectal cancer (mCRC) patients with a right-sided primary (RC) have an inferior survival to mCRC arising from a left-sided primary (LC). Previous analyses have suggested multiple factors contribute. METHODS: The Treatment of Recurrent and Advanced Colorectal Cancer (TRACC) Registry prospectively captured data on consecutive mCRC patients. RC were defined as tumors proximal to the splenic flexure; LC were those at and distal to the splenic flexure and included rectal cancers. Patient, tumor, treatment, and survival data were analyzed stratified by side. RESULTS: Of 2306 patients enrolled from July 2009-March 2018, 747 (32%) had an RC. Patients with RC were older, more likely to be female and have a Charlson score ≥3. RC were more frequently BRAF mutated, deficient in mismatch repair, associated with peritoneal metastases, and less likely to receive chemotherapy. Progression-free survival on first-line systemic therapy was inferior for RC patients (8.1 vs. 10.8 months, hazard ratio [HR] for progression in RC 1.38, P < 0.001). Median overall survival for all RC patients was inferior (19.6 vs. 27.5 months, HR for death in RC 1.44, P < 0.001), and inferior within the treated (21 vs. 29.5 months, HR 1.52, P < 0.001) and untreated subgroups (5.9 vs. 10.3 months, HR 1.38, P = 0.009). Primary side remained a significant factor for overall survival in multivariate analysis. CONCLUSION: Our data from a real-world population confirms the poorer prognosis associated with RC. Primary tumor location remains significantly associated with overall survival even when adjusting for multiple factors, indicating the existence of further side-based differences that are as yet undefined.
Authors: Lucy Gately; Katharine Drummond; Mark Rosenthal; Rosemary Harrup; Anthony Dowling; Andrew Gogos; Zarnie Lwin; Ian Collins; David Campbell; Elizabeth Ahern; Claire Phillips; Hui K Gan; Iwan Bennett; Oliver M Sieber; Peter Gibbs Journal: BMC Cancer Date: 2022-06-02 Impact factor: 4.638
Authors: Christine Koulis; Raymond Yap; Rebekah Engel; Thierry Jardé; Simon Wilkins; Gemma Solon; Jeremy D Shapiro; Helen Abud; Paul McMurrick Journal: Cancers (Basel) Date: 2020-03-28 Impact factor: 6.639