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. 2024 Apr 12:12:goae028.
doi: 10.1093/gastro/goae028. eCollection 2024.

Unraveling the role of tumor sidedness in prognosis of stage II colon cancer

Yun Yang  1   2   3 , Xiaobao Yang  1   2   3 , Zhigang Bai  1   2   3 , Xiaozhe Gu  1   2   3 , Saloni Rameshchandra Shah  4 , Kenish Sirajbhai Salewala  4 , Mansi Pankajbhai Kevadiya  4 , Zhongtao Zhang  1   2   3
Affiliations

Unraveling the role of tumor sidedness in prognosis of stage II colon cancer

Yun Yang et al. Gastroenterol Rep (Oxf). .

Abstract

Background: Stage II colon cancer has varying risks for metastasis, and treatment strategies depend on molecular and clinicopathological features. While tumor-sidedness is a well-accepted prognostic factor for stage III/IV colon cancer, its role in stage II is controversial. Understanding its effect in stage II is crucial for improving treatment strategies.

Methods: We analyzed clinical and follow-up data of colon cancer from the Surveillance, Epidemiology, and End Results database (2004-2017). Patients were divided into a primary study cohort (2010-2017) and a validation cohort (2004-2009). The baseline characteristics between right-sided colon cancer (RCC) and left-sided colon cancer (LCC) groups were compared. Moreover, the effect of tumor size on cancer-specific survival (CSS) was evaluated using Kaplan-Meier analysis.

Results: The study involved 87,355 patients in the study cohort and 65,858 in the validation cohort. Of the study cohort, 52.3% were diagnosed with RCC. The median age was 64 years old, with 48.5% females and 76.8% of white people. In addition, stage II RCC showed better CSS compared with LCC (5-year CSS 88.0% vs 85.5%, P < 0.001), while stage III/IV RCC demonstrated poorer outcomes. Multivariate Cox regression analysis identified that the right-sidedness was a positive prognostic factor in stages I/II but negative in stages III (HR 1.10, P < 0.001) and IV (HR 1.26, P < 0.001). Chemotherapy rates decreased in RCC, particularly in stage II (RCC vs LCC: 16.2% vs 28.5%, P < 0.001). Subgroup analysis, stratified by T3/T4 stages and chemotherapy status, further highlighted better survival outcomes in RCC.

Conclusions: RCC is associated with a significantly better prognosis in stage II. The importance of considering tumor-sidedness in clinical decision-making and the design of future clinical trials should be emphasized.

Keywords: colonic neoplasms; right-sided colon cancer; stage II; survival; tumor-sidedness.

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Conflict of interest statement

None declared.

Figures

Figure 1.
Figure 1.
Kaplan-Meier curve of prognosis difference between right-sided and left-sided colon cancer across four stages for patients diagnosed between 2010 and 2017. (A) Stage I. (B) Stage II. (C) Stage III. (D) Stage IV.
Figure 2.
Figure 2.
Kaplan-Meier curve of prognosis difference between right-sided and left-sided colon cancer across four stages for patients diagnosed between 2004 and 2009. (A) Stage I. (B) Stage II. (C) Stage III. (D) Stage IV.
Figure 3.
Figure 3.
Subgroup survival analysis of stage II patients stratified by T stage and chemotherapy status. Kaplan-Meier survival curve comparing the prognosis of RCC and LCC in (A) T3N0M0, (B) T4N0M0 patients, Kaplan-Meier curve of prognosis of RCC and LCC stratified by chemotherapy status, in (C) T3N0M0, and (D) T4N0M0 patients. CSS = cancer-specific survival, RCC = right-sided colon cancer, LCC = left-sided colon cancer, Chemo. = chemotherapy.
See this image and copyright information in PMC

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