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. 2016 Jul 28:16:554.
doi: 10.1186/s12885-016-2412-0.

Better survival in right-sided versus left-sided stage I - III colon cancer patients

Rene Warschkow  1   2 , Michael C Sulz  3 , Lukas Marti  1 , Ignazio Tarantino  4 , Bruno M Schmied  1 , Thomas Cerny  5 , Ulrich Güller  6   7   8
Affiliations

Better survival in right-sided versus left-sided stage I - III colon cancer patients

Rene Warschkow et al. BMC Cancer. .

Abstract

Background: The distinction between right-sided and left-sided colon cancer has recently received considerable attention due to differences regarding underlying genetic mutations. There is an ongoing debate if right- versus left-sided tumor location itself represents an independent prognostic factor. We aimed to investigate this question by using propensity score matching.

Methods: Patients with resected, stage I - III colon cancer were identified from the Surveillance, Epidemiology, and End Results (SEER) database (2004-2012). Both univariable and multivariable Cox regression as well as propensity score matching were used.

Results: Overall, 91,416 patients (51,937 [56.8 %] with right-sided, 39,479 [43.2 %] with left-sided colon cancer; median follow-up 38 months) were eligible. In univariable analysis, patients with right-sided cancer had worse overall (hazard ratio [HR] = 1.32, 95 % CI:1.29-1.36, P < 0.001) and cancer-specific survival (HR = 1.26, 95 % CI:1.21-1.30, P < 0.001) compared to patients with left-sided cancer. After propensity score matching, the prognosis of right-sided carcinomas was better regarding overall (HR = 0.92, 95 % CI: 0.89 - 0.94, P < 0.001) and cancer-specific survival (HR = 0.90, 95 % CI:0.87 - 0.93, P < 0.001). In stage I and II, the prognosis of right-sided cancer was better for overall (HR = 0.89, 95 % CI:0.84-0.94 and HR = 0.85, 95 % CI:0.81-0.89) and cancer-specific survival (HR = 0.71, 95 % CI:0.64 - 0.79 and HR = 0.75, 95 % CI:0.70-0.80). Right- and left-sided colon cancer had a similar prognosis for stage III (overall: HR = 0.99, 95 % CI:0.95-1.03 and cancer-specific: HR = 1.04, 95 % CI:0.99-1.09).

Conclusions: This population-based analysis on stage I - III colon cancer provides evidence that the prognosis of localized right-sided colon cancer is better compared to left-sided colon cancer. This questions the paradigm from previous research claiming a worse survival in right-sided colon cancer patients.

Keywords: Colon cancer; Left-sided; Right-sided; SEER; Survival.

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Figures

Fig. 1
Fig. 1
Flow chart of patients’ cohort definition. Data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute in the United States, covering approximately 28 % of cancer cases in the United States were used for the present population-based analysis. Primary cancer site and histology were coded according to criteria in the third edition of the International Classification of Diseases for Oncology (ICD-O-3) and used to identify 246,390 patients with colon cancer diagnosed between 2004 and 2012. The figure shows the selection process leaving 51,937 patients with right-sided and 39,479 patients with left-sided colon cancer for analysis
Fig. 2
Fig. 2
Kaplan-Meier curves for overall and cancer-specific survival. Panel (a and b) depict the overall and cancer-specific survival in the original data set and panel (c and d) the overall and cancer-specific survival after propensity score matching. The number of colon cancer patients at risk are given below each plot
Fig. 3
Fig. 3
Kaplan-Meier curves for overall and cancer-specific survival after stratified propensity score matching. Panels (a, c, and e) depict the overall survival and panels (b, d, and f) depict the cancer-specific survival for stage I (panels a and b), stage II (panels c and d), and stage III (panels e and f). The number of colon cancer patients at risk are given below each plot
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