Tien-Hua Chen1,2, Wei-Shone Chen1,3, Jeng-Kai Jiang1,3, Shung-Haur Yang1,3,4, Huann-Sheng Wang1,3, Shih-Ching Chang1,3, Yuan-Tzu Lan1,3, Chun-Chi Lin1,3, Hung-Hsin Lin1,3, Sheng-Chieh Huang1,3, Hou-Hsuan Cheng1,3, Gar-Yang Chau1,5, Cheng-Yuan Hsia1,5, Hao-Jan Lei1,5, Shu-Cheng Chou1,5, Yee Chao1,2, Hao-Wei Teng6,7,8. 1. Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. 2. Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City, Taiwan. 3. Division of Colon and Rectum Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan. 4. Department of Surgery, National Yang-Ming University Hospital, Yilan, Taiwan. 5. Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan. 6. Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. hwteng1971@gmail.com. 7. Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City, Taiwan. hwteng1971@gmail.com. 8. Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan. hwteng1971@gmail.com.
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.
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.
Authors: Timothy J Price; Carol Beeke; Shahid Ullah; Robert Padbury; Guy Maddern; David Roder; Amanda R Townsend; James Moore; Amitesh Roy; Yoko Tomita; Christos Karapetis Journal: Cancer Date: 2014-11-06 Impact factor: 6.860
Authors: Robert A Meguid; Mark B Slidell; Christopher L Wolfgang; David C Chang; Nita Ahuja Journal: Ann Surg Oncol Date: 2008-07-12 Impact factor: 5.344
Authors: Mohamed E Salem; Benjamin A Weinberg; Joanne Xiu; Wafik S El-Deiry; Jimmy J Hwang; Zoran Gatalica; Philip A Philip; Anthony F Shields; Heinz-Josef Lenz; John L Marshall Journal: Oncotarget Date: 2017-09-21