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Multicenter Study
. 2022 May 2;22(1):486.
doi: 10.1186/s12885-022-09615-z.

Clinical impact of primary tumor sidedness and sex on unresectable post-recurrence survival in resected pathological stage II-III colorectal cancers: a nationwide multicenter retrospective study

Shinya Abe  1 , Kazushige Kawai  2 , Hiroaki Nozawa  2 , Kazuhito Sasaki  2 , Koji Murono  2 , Shigenobu Emoto  2 , Tsuyoshi Ozawa  2 , Yuichiro Yokoyama  2 , Yuzo Nagai  2 , Hiroyuki Anzai  2 , Hirofumi Sonoda  2 , Shinichi Yamauchi  3 , Kenichi Sugihara  3 , Soichiro Ishihara  2
Affiliations
Multicenter Study

Clinical impact of primary tumor sidedness and sex on unresectable post-recurrence survival in resected pathological stage II-III colorectal cancers: a nationwide multicenter retrospective study

Shinya Abe et al. BMC Cancer. .

Abstract

Background: Several studies have demonstrated that right-sided tumors have poorer prognosis than left-sided tumors in patients with unresectable colorectal cancer (CRC). The predictive ability of the tumor sidedness in CRC treated with chemotherapy in each sex is unclear.

Methods: Subjects were 964 unresectable recurrent patients treated with chemotherapy with stage II-III CRC after curative resection between 2004 and 2012. Post-recurrence cancer-specific survival (CSS) for each sex was examined.

Results: Patients were 603 males (222 right-side tumors (cecum to transverse colon) and 381 left-sided tumors (descending colon to rectum)), and 361 females (167 right-side tumors and 194 left-sided tumors). Right-sided tumors developed peritoneal recurrences in males and females. Left-sided tumors were associated with locoregional recurrences in males and with lung recurrences in females. Right-sided tumors were associated with shorter post-recurrence CSS in both sexes. In males, multivariate analyses showed that right-sided tumors were associated with shorter post-recurrence CSS (HR: 1.53, P < 0.0001) together with the presence of regional lymph node metastasis histopathological type of other than differentiated adenocarcinoma, the recurrence of liver only, the recurrence of peritoneal dissemination only, and relapse-free interval less than one-year. In females, multivariate analyses showed that right-sided tumors were associated with shorter post-recurrence CSS (HR: 1.50, P = 0.0019) together with advanced depth of invasion, the presence of regional lymph node metastasis, and recurrence of liver only.

Conclusions: Primary tumor sidedness in both sexes in unresectable recurrent CRC patients treated with chemotherapy may have prognostic implications for post-recurrence CSS.

Keywords: Chemoradiotherapy; Colorectal cancer; Outcome; Primary tumor location; Prognostic marker.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study cohort selection process. The Japanese Study Group for Follow-Up of Colorectal Cancer collected clinicopathological data from 22,638 patients with pathological stage II-III colorectal cancer who underwent radical surgery between January 2004 and December 2012 at 24 Japanese referral hospitals. A total of 964 patients with unresectable recurrent colorectal cancer treated with chemotherapy were included in the final study population. Patients treated with palliative chemotherapy were excluded
Fig. 2
Fig. 2
Correlation among left-sided and right-sided tumors and overall survival (OS) and post-recurrence cancer-specific survival (CSS) according to sex. a OS curves in males stratified according to tumor sidedness (5-year OS for left-sided tumors 45.8%, right-sided tumors 30.0%). b Post-recurrence CSS curves in males stratified according to tumor sidedness (5-year post-recurrence CSS for left-sided tumors 27.7%, right-sided tumors 14.2%). c OS curves in females stratified according to tumor sidedness (5-year OS for left-sided tumors 43.6%, right-sided tumors 31.8%). d Post-recurrence CSS curves in females stratified according to tumor sidedness (5-year post-recurrence CSS for left-sided tumors 31.8%, right-sided tumors 17.8%)
Fig. 3
Fig. 3
Correlation among left-sided and right-sided tumors and post-recurrence cancer-specific survival (CSS) in males according to single organ recurrence in: (a) liver, (b) lung, (c) peritoneum, (d) extra-regional lymph node, (f) locoregional or anastomotic site, and (g) bone metastasis. Kaplan-Meier curves in the liver (a), lung (b), locoregional or anastomotic site (e), and bone (f) metastasis were significantly stratified according to tumor sidedness. Tumor-sidedness did not stratify other Kaplan-Meier curves in peritoneal (c) and extra-regional lymph node (d) metastasis
Fig. 4
Fig. 4
Correlation among left-sided and right-sided and post-recurrence cancer-specific survival in females according to single organ recurrence in (a) liver, (b) lung, (c) peritoneum, (d) extra-regional lymph node, (f) locoregional or anastomotic site, and (g) bone metastasis. According to tumor sidedness, Kaplan-Meier curves in the liver (a) and locoregional or anastomotic site (e) metastasis were significantly stratified. Tumor-sidedness did not stratify other Kaplan-Meier curves in the lung (b), peritoneum (c), extra-regional lymph node (d), and bone (f) metastasis
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