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. 2016 Dec 9;11(12):e0167540.
doi: 10.1371/journal.pone.0167540. eCollection 2016.

Characteristics of Differently Located Colorectal Cancers Support Proximal and Distal Classification: A Population-Based Study of 57,847 Patients

Jiao Yang  1 , Xiang Lin Du  2 , Shu Ting Li  1 , Bi Yuan Wang  1 , Yin Ying Wu  1 , Zhe Ling Chen  1 , Meng Lv  1 , Yan Wei Shen  1 , Xin Wang  1 , Dan Feng Dong  1 , Dan Li  1 , Fan Wang  1 , En Xiao Li  1 , Min Yi  1   3 , Jin Yang  1
Affiliations

Characteristics of Differently Located Colorectal Cancers Support Proximal and Distal Classification: A Population-Based Study of 57,847 Patients

Jiao Yang et al. PLoS One. .

Abstract

Background: It has been suggested that colorectal cancer be regarded as several subgroups defined according to tumor location rather than as a single entity. The current study aimed to identify the most useful method for grouping colorectal cancer by tumor location according to both baseline and survival characteristics.

Methods: Cases of pathologically confirmed colorectal adenocarcinoma diagnosed from 2000 to 2012 were identified from the Surveillance, Epidemiology, and End Results database and categorized into three groups: right colon cancer (RCC), left colon cancer (LCC), and rectal cancer (ReC). Adjusted hazard ratios for known predictors of disease-specific survival (DSS) in colorectal cancer were obtained using a Cox proportional hazards regression model.

Results: The study included 57847 patients: 43.5% with RCC, 37.7% with LCC, and 18.8% with ReC. Compared with LCC and ReC, RCC was more likely to affect old patients and women, and to be at advanced stage, poorly differentiated or un-differentiated, and mucinous. Patients with LCC or ReC had better DSS than those with RCC in subgroups including stage III or IV disease, age ≤70 years and non-mucinous adenocarcinoma. Conversely, patients with LCC or ReC had worse DSS than those with RCC in subgroups including age ˃70 years and mucinous adenocarcinoma.

Conclusions: RCC differed from both LCC and ReC in several clinicopathologic characteristics and in DSS. It seems reasonable to group colorectal cancer into right-sided (i.e., proximal) and left-sided (i.e., distal) ones.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. The frequency distribution of age at diagnosis by tumor location.
Right colon cancer (RCC), left colon cancer (LCC), rectal cancer (ReC).
Fig 2
Fig 2. Comparison of disease-specific survival by tumor locations.
Kaplan–Meier curves showing the comparisons of disease-specific survival among right colon cancer (RCC), left colon cancer (LCC) and rectal cancer (ReC), with significant difference (P<0.0001).
Fig 3
Fig 3. Comparison of disease-specific survival among differently located colorectal cancers stratified by stage.
Kaplan–Meier curves showing the comparisons of disease-specific survival among right colon cancer (RCC), left colon cancer (LCC) and rectal cancer (ReC) within each stage, all with significant differences (all P<0.0001).
Fig 4
Fig 4. Comparison of disease-specific survival among differently located colorectal cancers stratified by histology type.
Kaplan–Meier curves showing the comparisons of disease-specific survival among right colon cancer (RCC), left colon cancer (LCC) and rectal cancer (ReC) within mucinous and non-mucinous adenocarcinoma, both with significant differences (both P<0.0001).
See this image and copyright information in PMC

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