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Right versus left sided metastatic colorectal cancer: Teasing out clinicopathologic drivers of disparity in survival.

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.

journal_name

Asia Pac J Clin Oncol

journal_title

Asia-Pacific journal of clinical oncology

authors

Mendis S,Beck S,Lee B,Lee M,Wong R,Kosmider S,Shapiro J,Yip D,Steel S,Nott L,Jennens R,Lipton L,Burge M,Field K,Ananda S,Wong HL,Gibbs P

doi

10.1111/ajco.13135

subject

Has Abstract

pub_date

2019-06-01 00:00:00

pages

136-143

issue

3

eissn

1743-7555

issn

1743-7563

journal_volume

15

pub_type

杂志文章

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