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Mizuuchi Y, Tanabe Y, Sada M, Tamura K, Nagayoshi K, Nagai S, Watanabe Y, Tamiya S, Ohuchida K, Nakata K, Nakano T, Nakamura M. Relationship between prognostic impact of N3 lymph node metastasis at the root of the feeding artery and location of colon cancer. Langenbecks Arch Surg 2023; 408:31. [PMID: 36645515 DOI: 10.1007/s00423-023-02778-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 12/12/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE To determine whether N3 nodal involvement predicts outcomes and whether its prognostic implications vary with tumor location in patients with Stage III colon cancer (CC). METHODS We defined N3 as lymph node metastases near the bases of the major feeding arteries. We retrospectively examined recurrence rates and patterns by tumor location and sites of lymph node metastases in 57 patients with N3 CC who had undergone curative resections between January 2000 and March 2019. Survival analysis was performed to compare the prognoses of patients with and without N3 lymph node metastasis. RESULTS Most N3 patients had large tumors (T ≥ 3); five had T2 disease. Recurrence occurred quickly in one patient with T2N3M0 disease. Multivariate survival analysis demonstrated that N3 lymph node metastasis is an independent predictor of poor prognosis in Stage III CC patients (P < 0.001). Categorizing N3 patients according to UICC-TNM staging system does not stratify risk of recurrence (P = 0.970). To investigate the impact of tumor location on recurrence risk, we classified N3 CC into two subtypes according to tumor location: metastasis at the base of the superior mesenteric artery in right-sided CC and inferior mesenteric artery in left-sided CC. The former was found to have a statistically significant poorer prognosis than the latter (P = 0.091). CONCLUSION N3 is a robust prognostic marker in CC patients. Recurrence risk varies by tumor location. N3 right-sided CCs with lymph node metastasis at the base of the superior mesenteric artery have poorer prognoses than do N3 left-sided CCs.
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Bairi KE, Trapani D, Page CL, Saad A, Jarroudi OA, Afqir S. Exploring the prognostic impact of tumor sidedness in ovarian cancer: A population-based survival analysis of over 10,000 patients. Cancer Treat Res Commun 2022; 33:100625. [PMID: 36057142 DOI: 10.1016/j.ctarc.2022.100625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 12/14/2022]
Abstract
Very recently, emerging evidence demonstrated that laterality might be an independent prognostic factor in patients with advanced ovarian cancer (OC). Based on preliminary provocative observations, our study aimed to investigate the prognostic impact of sidedness in a large cohort of women with OC. Survival was estimated based on Kaplan-Meier method and survival curves were compared using Log-rank test. Cox proportional-hazards model was used to study the association between survival and covariates. A total of 10,177 women with OC were included. Mean age at diagnosis was 59.58 years (±13.5); 36.7% OC right-sided, 36.9% were left- sided, and 26.4% had bilateral OC. The median overall survival (OS) for the entire population was 77 months, with the lowest median OS observed in bilateral OC (median OS: 34 months). The prognostic value of OC sidedness was not confirmed at the univariable analysis (HR = 0.958; 95% CI: 0.888-1.033, p = 0.268). However, women with bilateral OC has a 45% higher risk of death as compared with unilateral diagnosis (HR = 1.453; 95% CI: 1.410-1.497; p< 0.001). The independent prognostic value was further confirmed on multivarible analysis after adjusting for covariates including age, marital status, histological type, CA-125 at diagnosis, grade, stage, chemotherapy and surgery (HR = 1.087; 95% CI: 1.043-1.136, p = 0.02). However, the ultimate prognostic significance appeared less prominent, with bilateral OC conferring a relative increase of 8.7% of mortality. Our real-world study demonstrated that impact of tumor sidedness has no prognostic implication (right vs left OC) but bilateral OCs might be marginally more prognostically unfavorable. Prospective validation might be warranted, to confirm the prognostic significance of OC sidedness, including for the presence of key genetic alterations and lymph nodes asymmetry, to better stratify patients with OC and predict outcomes according to tumor sidedness at diagnosis.
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Affiliation(s)
- Khalid El Bairi
- Department of Medical Oncology, Mohammed VI University Hospital, Oujda, Morocco; Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.
| | - Dario Trapani
- Division of Early Drug Development for Innovative Therapies, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Cécile Le Page
- Research Institute of McGill University Health Center (RI-MUHC), Montréal, QC, Canada
| | - Anas Saad
- Cleveland Clinic Foundation, Cleveland, Ohio, United States of America
| | - Ouissam Al Jarroudi
- Department of Medical Oncology, Mohammed VI University Hospital, Oujda, Morocco; Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco
| | - Said Afqir
- Department of Medical Oncology, Mohammed VI University Hospital, Oujda, Morocco; Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco
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Ito T, Takashima A, Yamazaki K, Yukami H, Uetake H, Tsuda M, Suto T, Moriwaki T, Sugimoto N, Ojima H, Takii Y, Yasui H, Esaki T, Tsuji A, Goto M, Saruta M, Otsu S, Shinozaki K, Fujiwara T, Tamura T, Baba E, Shiozawa M, Denda T, Ueno H, Nagashima K, Shimada Y. Primary tumor location as a predictor of survival in patients with RAS wild-type colorectal cancer who receive molecularly targeted drugs as first-line therapy: a multicenter real-world observational study by the Japanese Society for Cancer of the Colon and Rectum. Int J Clin Oncol 2022. [PMID: 35861943 DOI: 10.1007/s10147-022-02208-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/08/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Primary tumor location is considered a predictor of overall survival (OS) in RAS wild-type (WT) metastatic colorectal cancer (mCRC) treated with bevacizumab (BEV) or an anti-epidermal growth factor antibody (cetuximab or panitumumab [CET/PAN]) as first-line molecularly targeted therapy. BEV is recommended for right-sided mCRC and CET/PAN for left-sided mCRC based on post-hoc analyses of clinical trial data, but real-world evidence is lacking. METHODS We retrospectively collected data of patients who started BEV or CET/PAN plus 5-fluorouracil-based doublet chemotherapy between January 2013 and December 2016 as first-line treatment for RAS WT mCRC at any of 24 Japanese institutions. OS was compared between the BEV and CET/PAN groups according to primary tumor location by Cox multivariate regression analysis in the full cohort and in a propensity score-matched cohort. RESULTS In total, 935 patients were enrolled. Median OS was 24.6 months with BEV and 20.9 months with CET/PAN in right-sided mCRC (n = 213; adjusted hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.50-1.06) and 35.7 months and 30.0 months, respectively, in left-sided mCRC (n = 722; adjusted HR 0.92, 95% CI 0.74-1.13). In the propensity score-matched cohort, OS was significantly better in the BEV group than in the CET/PAN group in right-sided mCRC (HR 0.52, 95% CI 0.28-0.96) but was not significantly different in left-sided mCRC (HR 0.78, 95% CI 0.53-1.07). CONCLUSION Real-world data showed that OS was better with BEV than with CET/PAN in right-sided mCRC. However, there was no significant difference in OS in left-sided mCRC.
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Simões P, Fernandes G, Costeira B, Machete M, Baptista C, N Silva D, Leal-Costa L, Prazeres G, Correia J, Albuquerque J, Padrão T, Gomes C, Godinho J, Faria A, Casa-Nova M, Lopes F, Teixeira JA, F Pulido C, Oliveira H, Mascarenhas-Lemos L, Albergaria D, Maio R, Passos-Coelho JL. Lymph node yield in the pathological staging of resected nonmetastatic colon cancer: The more the better? Surg Oncol 2022; 43:101806. [PMID: 35841744 DOI: 10.1016/j.suronc.2022.101806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/31/2022] [Accepted: 07/03/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Guidelines recommend regional lymphadenectomy with a lymph node yield (LNY) of at least 12 lymph nodes (LN) for adequate colon cancer (CC) staging. LNY ≥22LN may improve survival, especially in right-sided CC [Lee et al., Surg Oncol, 27(3), 2018]. This multicentric retrospective cohort study evaluated the impact of LNY and tumor laterality on CC staging and survival. MATERIALS AND METHODS Patients with stage I-III CC that underwent surgery from 2012 to 2018 were grouped according to LNY: <22 and ≥ 22. Primary outcomes were LN positivity (N+ rate) and disease-free survival (DFS). Overall survival (OS) was the secondary outcome. Exploratory analyses were performed for laterality and stage. RESULTS We included 795 patients (417 < 22LN, 378 ≥ 22LN); 53% had left-sided CC and 29%/37%/38% had stage I/II/III tumors. There was no association between LNY ≥22LN and N+ rate after adjustment for grade, T stage, lymphovascular invasion (LVI) and perineural invasion; a trend for a higher N+ rate in left-sided CC was identified (interaction p = 0.033). With a median follow-up of 63.6 months for DFS and 73.2 months for OS, 254 patients (31.9%) relapsed and 207 (26.0%) died. In multivariate analysis adjusted for age, ASA score, laparoscopic approach, T/N stage, mucinous histology, LVI and adjuvant chemotherapy, LNY ≥22LN was significantly associated with both DFS (HR 0.75, p = 0.031) and OS (HR 0.71, p = 0.025). Restricted cubic spline analysis showed a more significant benefit for right-sided CC. CONCLUSION LNY ≥22LN was associated with longer DFS and OS in patients with operable CC, especially for right-sided CC.
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Affiliation(s)
- Pedro Simões
- Medical Oncology, Hospital Beatriz Ângelo, Av. Carlos Teixeira 3, 2674-514, Loures, Portugal.
| | - Gonçalo Fernandes
- Medical Oncology, Hospital da Luz Lisboa, Av. Lusíada 100, 1500-650, Lisbon, Portugal.
| | - Beatriz Costeira
- General Surgery, Hospital Beatriz Ângelo, Av. Carlos Teixeira 3, 2674-514, Loures, Portugal.
| | - Madalena Machete
- Medical Oncology, Hospital Beatriz Ângelo, Av. Carlos Teixeira 3, 2674-514, Loures, Portugal.
| | - Carlota Baptista
- Medical Oncology, Hospital Beatriz Ângelo, Av. Carlos Teixeira 3, 2674-514, Loures, Portugal.
| | - Diana N Silva
- Medical Oncology, Hospital Beatriz Ângelo, Av. Carlos Teixeira 3, 2674-514, Loures, Portugal.
| | - Luísa Leal-Costa
- Medical Oncology, Hospital Beatriz Ângelo, Av. Carlos Teixeira 3, 2674-514, Loures, Portugal.
| | - Gil Prazeres
- Medical Oncology, Hospital da Luz Lisboa, Av. Lusíada 100, 1500-650, Lisbon, Portugal.
| | - Jorge Correia
- Medical Oncology, Hospital da Luz Lisboa, Av. Lusíada 100, 1500-650, Lisbon, Portugal.
| | - Joana Albuquerque
- Medical Oncology, Hospital da Luz Lisboa, Av. Lusíada 100, 1500-650, Lisbon, Portugal.
| | - Teresa Padrão
- Medical Oncology, Hospital da Luz Lisboa, Av. Lusíada 100, 1500-650, Lisbon, Portugal.
| | - Catarina Gomes
- Gastroenterology, Hospital Beatriz Ângelo, Av. Carlos Teixeira 3, 2674-514, Loures, Portugal.
| | - João Godinho
- Medical Oncology, Hospital Beatriz Ângelo, Av. Carlos Teixeira 3, 2674-514, Loures, Portugal.
| | - Ana Faria
- Medical Oncology, Hospital Beatriz Ângelo, Av. Carlos Teixeira 3, 2674-514, Loures, Portugal.
| | - Mafalda Casa-Nova
- Medical Oncology, Hospital Beatriz Ângelo, Av. Carlos Teixeira 3, 2674-514, Loures, Portugal.
| | - Fábio Lopes
- Medical Oncology, Hospital Beatriz Ângelo, Av. Carlos Teixeira 3, 2674-514, Loures, Portugal.
| | - José A Teixeira
- Medical Oncology, Hospital Beatriz Ângelo, Av. Carlos Teixeira 3, 2674-514, Loures, Portugal.
| | - Catarina F Pulido
- Medical Oncology, Hospital da Luz Lisboa, Av. Lusíada 100, 1500-650, Lisbon, Portugal.
| | - Helena Oliveira
- Pathology, Hospital Beatriz Ângelo, Av. Carlos Teixeira 3, 2674-514, Loures, Portugal.
| | - Luís Mascarenhas-Lemos
- Pathology, Hospital Beatriz Ângelo, Av. Carlos Teixeira 3, 2674-514, Loures, Portugal; Pathology, Hospital da Luz Lisboa, Av. Lusíada 100, 1500-650, Lisbon, Portugal.
| | - Diogo Albergaria
- General Surgery, Hospital Beatriz Ângelo, Av. Carlos Teixeira 3, 2674-514, Loures, Portugal.
| | - Rui Maio
- General Surgery, Hospital Beatriz Ângelo, Av. Carlos Teixeira 3, 2674-514, Loures, Portugal; General Surgery, Hospital da Luz Lisboa, Av. Lusíada 100, 1500-650, Lisbon, Portugal.
| | - José L Passos-Coelho
- Medical Oncology, Hospital Beatriz Ângelo, Av. Carlos Teixeira 3, 2674-514, Loures, Portugal; Medical Oncology, Hospital da Luz Lisboa, Av. Lusíada 100, 1500-650, Lisbon, Portugal.
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Engbersen MP, Nerad E, Rijsemus CJV, Buffart T, Beets-Tan RGH, Aalbers AGJ, Kok NFM, Lahaye MJ. Differences in the distribution of peritoneal metastases in right- versus left-sided colon cancer on MRI. Abdom Radiol (NY) 2022; 47:530-537. [PMID: 34894278 DOI: 10.1007/s00261-021-03366-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Right-sided colon tumors with peritoneal metastases (PM) are associated with a poorer prognosis than left-sided tumors. We hypothesized that a different pattern of spread could be characterized with abdominopelvic MRI. The objective of this study was to explore the spread of PM in relation to the primary tumor location on MRI. METHODS This is a retrospective cohort study of patients with PM from colon cancer referred to be considered for CRS-HIPEC at a single tertiary referral center. Patients with colon cancer were eligible if they had undergone an abdominopelvic MRI scan following a clinical diagnosis of PM. The frequency of affected PCI regions on MRI (MRI-PCI) was assessed and compared between tumor sidedness. RESULTS One hundred eighteen patients were included with a median age of 65 (IQR: 56-72). 46% percent were male. The median MRI-PCI was 10 (IQR: 5-16) and 8 (IQR: 4-11) for right- and left-sided tumors, respectively (p = 0.39), and the median number of affected regions was 4 (IQR: 2-7 for right-sided and IQR 2-5 for left-sided tumors). PM was most frequently found close to the primary tumor. The odds ratio of patients with PM of left sided to be affected with PM in the upper abdominal regions was 0.42 (95% CI: 0.20-0.90) and with PM on the small bowels or mesentery was 0.42 (95% CI: 0.19-0.92) over a patient with PM of right-sided colon cancer. CONCLUSION MRI can help to assess the spread of PM in colonic cancer. In right-sided tumors, the small bowel and upper abdominal regions are more frequently affected.
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Affiliation(s)
- Maurits P Engbersen
- Department of Radiology, Antoni Van Leeuwenhoek-Netherlands Cancer Institute, PO Box 900203, 1006 BE, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Elias Nerad
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Charlotte J V Rijsemus
- Department of Radiology, Antoni Van Leeuwenhoek-Netherlands Cancer Institute, PO Box 900203, 1006 BE, Amsterdam, The Netherlands
- Department of Surgery, Antoni Van Leeuwenhoek-Netherlands Cancer Institute, PO Box 900203, 1006 BE, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tineke Buffart
- Department of Gastrointestinal Oncology, Antoni Van Leeuwenhoek-Netherlands Cancer Institute, PO Box 900203, 1006 BE, Amsterdam, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, Antoni Van Leeuwenhoek-Netherlands Cancer Institute, PO Box 900203, 1006 BE, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Arend G J Aalbers
- Department of Surgery, Antoni Van Leeuwenhoek-Netherlands Cancer Institute, PO Box 900203, 1006 BE, Amsterdam, The Netherlands
| | - Niels F M Kok
- Department of Surgery, Antoni Van Leeuwenhoek-Netherlands Cancer Institute, PO Box 900203, 1006 BE, Amsterdam, The Netherlands
| | - Max J Lahaye
- Department of Radiology, Antoni Van Leeuwenhoek-Netherlands Cancer Institute, PO Box 900203, 1006 BE, Amsterdam, The Netherlands.
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Aomatsu N, Maeda K, Uchima Y, Matsutani S, Tsujio G, Miyamoto H, Okada T, Kurihara S, Nishii T, Tachimori A, Ikeda K, Takeuchi K. Multiple stage IV colorectal cancers in a patient who received multidisciplinary treatment, including chemotherapy and Japanese Kampo medicine: A case report. Neuropeptides 2021; 88:102160. [PMID: 34004454 DOI: 10.1016/j.npep.2021.102160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/05/2021] [Accepted: 05/09/2021] [Indexed: 10/21/2022]
Abstract
FOLFOXIRI (fluorouracil, leucovorin, oxaliplatin, and irinotecan) plus bevacizumab is the preferred first-line treatment for right-sided metastatic colorectal cancer with RAS mutation. However, severe adverse events are common in Japanese patients. We report the successful management of multiple stage IV colorectal cancers in a patient who received multidisciplinary treatment, including chemotherapy and Japanese Kampo medicine. A 68-year-old man presented with epigastralgia and appetite loss and was diagnosed with multiple stage IV colorectal cancers. Colonoscopy identified type II tumors in the ascending colon, sigmoid colon, and upper rectum. Histopathological examination of a biopsy specimen revealed well- to moderately differentiated tubular adenocarcinoma. Enhanced computed tomography of the thorax and abdomen showed multiple pulmonary nodules and para-aortic lymph node swelling. Laparoscopic loop-ileostomy was performed to avoid bowel obstruction due to severe stenosis of ascending colon cancer. Intraoperative observation revealed two white nodules suggestive of metastasis in the lateral area of the liver. Therefore, we diagnosed multiple stage IV colorectal cancers with multiple metastases (lung, liver, and distant lymph nodes). His postoperative course was uneventful, and chemotherapy was started. Since the cancer cells harbored a RAS mutation, he received FOLFOXIRI plus bevacizumab. Japanese Kampo medicine consisting of Hangeshashinto and Juzen-taiho-to, to prevent diarrhea and fatigue, was administered daily. After 12 courses of chemotherapy, though circumferential stenosis still existed in the ascending colon, the tumors in the sigmoid colon and upper rectum were unclear. Enhanced computed tomography showed shrinkage of the pulmonary nodules and para-aortic lymph node; therefore, laparoscopic-assisted ileocecal resection was performed. The postoperative histopathological examination revealed moderately differentiated adenocarcinoma. The patient recovered uneventfully, and Kampo medicine consisting of Ninjin'yoeito was administered for postoperative weakness. Administration of adjuvant chemotherapy in this patient led to a near complete response that has been maintained without recurrence for 2 years and 8 months without reduced quality of life.
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Affiliation(s)
- Naoki Aomatsu
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan.
| | - Kiyoshi Maeda
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
| | | | | | - Gen Tsujio
- Department of Surgery Center, Fuchu Hospital, Osaka, Japan
| | | | - Takuma Okada
- Department of Surgery Center, Fuchu Hospital, Osaka, Japan
| | | | - Takafumi Nishii
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
| | - Akiko Tachimori
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
| | - Katsumi Ikeda
- Department of Breast Surgical Oncology, Osaka City General Hospital, Osaka, Japan
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Oytun MG, Bulut G, Gökmen E. Is the Effect of Tumor Localization on Prognosis Compatible with Real-life Data in Metastatic Colon Cancer? Single-Center Experience: A Retrospective Analysis. J Gastrointest Cancer 2021. [PMID: 33665720 DOI: 10.1007/s12029-021-00615-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Abstract
AIM In recent years, the prognostic and predictive value of primary tumor localization in colon cancer has become increasingly important. This study aimed to retrospectively analyze the effect of colon cancer tumor localization on progression-free survival, overall survival, and response to treatments and present real-life data. METHOD Retrospective evaluation was made of 465 patients who were diagnosed with metastatic colorectal carcinoma between 2010 and 2015 in our clinic. The effect of primary tumor localization on progression-free survival, overall survival, and response to therapy was investigated. RESULTS The right colon cancer (RCC) was determined in 66 patients, 14.2% of the whole group, and left colorectal cancer (LCRC) in 399 patients which is 85.8% of patients. Mucinous adenocarcinoma was 16.7% in RCC; however, only 6.4% of LCRC had a mucinous tumor (p < 0.05). Nodal involvement in any stage (N1 and N2) was 46.9% in right colon cancer whereas in LCRC, it was 41.2% (p < 0.05). Primary tumor surgery (74.2% vs. 70.2%) and metastasectomy (33.3% vs. 19.4%) were also more common in RCC(p < 0.05). k-ras mutation status was similar in both groups (28.8% in RCC vs 26.8% in LCRC, p > 0.05). Median progression-free survival was 12.6 months in RCC, and 15.5 in LCRC (p > 0.05). Median overall survival was 28.4 months in RCC and 33.5 months in LCRC (p > 0.05). In k-ras wild-type patients, the median overall survival was 32.3 months (95% CI 25.2-39.5) in the anti-VEGF antibody treatment group and 55.1 months (95% CI 36.5-73.7) in the anti-EGFR antibody treatment group (p < 0.05). CONCLUSION Although tumors located in the right colon have been considered to be worse in terms of progression-free and overall survival in clinical trials, the results of this study showed that in daily practice, there was no difference between left and right colon localized tumors in progression-free and overall survival. Further, in k-ras wild-type colon cancers, tumor localization predicts the treatment response. This study is important with the presentation of real-life data and compatibility with the data of the studies to daily life.
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Reif de Paula T, Simon HL, Profeta da Luz MM, Keller DS. Right sided colorectal cancer increases with age and screening should be tailored to reflect this: a national cancer database study. Tech Coloproctol 2021; 25:81-9. [PMID: 32852630 DOI: 10.1007/s10151-020-02329-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 08/10/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND In the United States, colorectal cancer (CRC) screening and surveillance is recommended until age 75. However, rates of surgery for CRC are greatest in the elderly, questioning current guidelines. Tumor sidedness is an emerging prognostic marker that may help guide screening and treatment decisions, with specific benefit evaluating CRC anatomic distribution in the elderly. Our objective was to investigate the anatomical distribution of CRC in the elderly and factors associated with right-sidedness. METHODS The National Cancer Database (2004-2016) was used to identify elderly patients with CRC. Cases were stratified by tumor sidedness and elderly subgroups: 65-74, 75-84, and ≥ 85 years of age, and further categorized by primary site. Multivariate analysis identified factors associated with CRC right-sidedness. The outcomes were CRC sidedness in the elderly, the anatomic distribution by age group, and factors associated with right-sidedness. RESULTS There were 508,219 colorectal cancer patients aged over 65 years identified, 54% of whom had a right-sided cancer. The right-sided incidence rates by age group were 49% (65-74 years), 58.2% (75-84 years), and 65.9% (≥ 85 years) (p < 0.001). Variables associated with right-sidedness were age (OR 1.032; 95% CI 1.031-1.033; p < 0.001), female sex (OR 1.541; 95% CI 1.522-1.561; p < 0.001), Medicare (OR 1.023, 95% CI 1.003-1.043; p = 0.027), year of diagnosis ≥ 2010 (OR 1.133; 95% CI 1.119-1.147; p < 0.001), tumor size > 5 cm (OR 1.474; 95% CI 1.453-1.495; p < 0.001), pathologic stage IV (OR 1.036; 95% CI 1.012-1.060; p = 0.003). CONCLUSIONS We found higher rates of right-sided colon cancer in the 75 and above age group. This is a population who would benefit greatly from a high-quality and complete colonoscopy for early diagnosis. As screening and surveillance for this age group are not currently recommended, our findings question the lack of universal recommendation of colonoscopy in patients over 75 years old. Guidelines for CRC screening and surveillance should consider the colon cancer right-shift in the elderly population. Based on these results, we recommend thorough assessment of the proximal colon in the elderly.
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Salem ME, Battaglin F, Goldberg RM, Puccini A, Shields AF, Arguello D, Korn WM, Marshall JL, Grothey A, Lenz H. Molecular Analyses of Left- and Right-Sided Tumors in Adolescents and Young Adults with Colorectal Cancer. Oncologist 2020; 25:404-413. [PMID: 31848314 PMCID: PMC7216442 DOI: 10.1634/theoncologist.2019-0552] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 09/13/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The incidence of colorectal cancer (CRC), particularly left-sided tumors (LT), in adolescents and young adults (AYA) is rising. Epigenetic events appear to play an important role in tumorigenesis and cancer progression, especially in younger patients. We compared molecular features of LT to right-sided tumors (RT) in AYA. MATERIALS AND METHODS A total of 246 LT and 56 RT were identified in a cohort of 612 AYA with primary CRC. Tumors were examined by next-generation sequencing (NGS), protein expression, and gene amplification. Tumor mutational burden (TMB) and microsatellite instability (MSI) were determined based on NGS data. RESULTS RT showed higher mutation rates compared with LT in several genes including BRAF (10.3% vs. 2.8%), KRAS (64.1% vs. 45.5%), PIK3CA (27% vs. 11.2%), and RNF43 (24.2% vs. 2.9%). Notably, additional mutations in distinct genes involved in histone modification and chromatin remodeling, as well as genes associated with DNA repair and cancer-predisposing syndromes, were characteristic of RT; most frequently KMT2D (27.8% vs. 3.4%), ARID1A (53.3% vs. 21.4%), MSH6 (11.1% vs. 2.3%), MLH1 (10.5% vs. 2.3%), MSH2 (10.5% vs. 1.2%), POLE (5.9% vs. 0.6%), PTEN (10.8% vs. 2.3%), and BRCA1 (5.4% vs. 0.6%). MSI was seen in 20.8% of RT versus 4.8% of LT. RT had a higher frequency of TMB-high regardless of MSI status. CONCLUSION Molecular profiling of AYA CRC revealed different molecular characteristics in RT versus LT. Epigenetic mechanisms and alteration in DNA repair genes warrant further investigation and may be a promising treatment target for CRC in AYA. IMPLICATIONS FOR PRACTICE Colorectal cancer (CRC) in adolescents and young adults (AYA) comprises a distinct entity with different clinicopathologic features and prognosis compared with older patients. Molecular profiling of right- and left-sided tumors in AYA is needed to gain novel insight into CRC biology and to tailor targeted treatment in this age group. This study found that right- and left-sided CRC show distinct molecular features in AYA, overall and in subgroups based on microsatellite instability status. Alterations in DNA double-strand break repair and homologous recombination repair, as well as epigenetic mechanisms, appear to play a critical role. The present molecular profiling data may support the development of personalized treatment strategies in the AYA population.
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Affiliation(s)
- Mohamed E. Salem
- Department of Medical Oncology, Levine Cancer Institute, Atrium HealthCharlotteNorth CarolinaUSA
| | - Francesca Battaglin
- Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | - Alberto Puccini
- Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, University of GenoaItaly
| | - Anthony F. Shields
- Department of Oncology, Karmanos Cancer Institute, Wayne State UniversityDetroitMichiganUSA
| | | | - W. Michael Korn
- Caris Life SciencesPhoenixArizonaUSA
- University of California at San FranciscoSan FranciscoCaliforniaUSA
| | - John L. Marshall
- The Ruesch Center and Georgetown Lombardi Comprehensive Cancer CenterWashingtonDCUSA
| | | | - Heinz‐Josef Lenz
- Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
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10
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Matsuda K, Tamura K, Iwamoto H, Mizumoto Y, Mitani Y, Nakamura Y, Murakami D, Sakanaka T, Yamaue H. Tumor Sidedness Is Associated with Survival in Patients with Synchronous Colorectal Peritoneal Carcinomatosis. Oncology 2020; 98:230-236. [PMID: 31962336 DOI: 10.1159/000505128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Synchronous colorectal peritoneal carcinomatosis (SCPC) is not a rare entity, and the prognosis is extremely poor compared to other metastatic sites such as the liver and lung. Therefore, optimal treatment based on tumor characteristics is needed. Recently, the tumor sidedness of colorectal cancer has been reported as one of the prognostic factors and also as a key factor for the treatment strategy. The purpose of this study was to assess the clinical impact of tumor sidedness in patients with SCPC. METHODS A total of 189 cases of SCPC were identified in a retrospective database at Wakayama Medical University Hospital (WMUH) between 1998 and 2014, and were analyzed with a special focus on tumor location. RESULTS In multivariate analysis, a right-sided location (p = 0.02) and the presence of liver metastases (p < 0.001) were found to be the worst prognostic factors. The median survival time (MST) with right-sided and with left-sided SCPC was 10 and 16 months, respectively. The right-sided SCPC group included more aged patients (p = 0.045) and fewer patients who received postoperative chemotherapy (p = 0.034). When we focused on patients with macroscopically complete resection (n = 39), the MST and disease-free survival in the right-sided SCPC group was significantly shorter than in the left-sided SCPC group (p = 0.030 and p = 0.043, respectively). The MST of the right-sided and the left-sided SCPC patients among the completely resected patients was 24 and 73 months, respectively. CONCLUSION Tumor sidedness may be a potent prognostic indicator for patients with SCPC. The survival time with right-sided SCPC is dramatically reduced compared to that with left-sided SCPC, especially among completely resected cases. We should change the treatment strategy according to the location of SCPC.
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Affiliation(s)
- Kenji Matsuda
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Koichi Tamura
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hiromitsu Iwamoto
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yuki Mizumoto
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yasuyuki Mitani
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yuki Nakamura
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Daisuke Murakami
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Toshihiro Sakanaka
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan,
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11
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Wu CC, Wang JH, Lin PC, Liang CA, Huang CY, Lien HC, Chen CY, Chou KJ, Su YC. Tumor sidedness and efficacy of first-line therapy in patients with RAS/BRAF wild-type metastatic colorectal cancer: A network meta-analysis. Crit Rev Oncol Hematol 2020; 145:102823. [PMID: 31783291 DOI: 10.1016/j.critrevonc.2019.102823] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/17/2019] [Accepted: 10/17/2019] [Indexed: 12/16/2022] Open
Abstract
We conducted a systemic search of several databases for randomized controlled trials (RCTs) that reported efficacy and safety outcomes of drugs for left-sided and right-sided metastatic colorectal cancer (mCRC), to identify the best available treatment. A network meta-analysis with mixed comparisons was created to interpret the best treatment option using the surface under the cumulative ranking curve. In the left-sided rat sarcoma (RAS) wild-type (WT) mCRC patients, bevacizumab, panitumumab, or cetuximab with chemotherapy groups showed a significantly better objective response rate than the chemotherapy alone group. The progression-free survival (PFS) and overall survival were better with panitumumab or cetuximab with chemotherapy than with chemotherapy alone. In the right-sided RAS WT mCRC patients, PFS for bevacizumab with chemotherapy was significantly better than that for cetuximab with chemotherapy. Cetuximab, closely followed by panitumumab, is the most effective treatment in left-sided RAS WT mCRC. Bevacizumab is more effective in right-sided mCRC.
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12
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Cannon E, Buechler S. Colon Cancer Tumor Location Defined by Gene Expression May Disagree With Anatomic Tumor Location. Clin Colorectal Cancer 2019; 18:149-158. [PMID: 30853326 DOI: 10.1016/j.clcc.2019.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/22/2019] [Accepted: 02/04/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Cancers of the right colon have been shown to differ from left-side colon cancers in prognosis, response to epithelial growth factor receptor inhibitors, microsatellite instability and BRAF mutation status, and other molecular characteristics. Clinical application of these differences will benefit from a deeper understanding of how tumor location defines and is defined by gene expression. MATERIALS AND METHODS This study was carried out using Affymetrix microarray datasets (Cohort A: training set, n = 352; validation set, n = 519) and samples from The Cancer Genome Atlas Colon Adenocarcinoma database (Cohort B: n = 408), in which tumor location was reported. Gene expression patterns characteristic of tumor side were identified in a manner unbiased by statistical classification method. RESULTS In the Cohort A validation set, the anatomic locations of 75% of tumors agree with the locations predicted by gene expression (so-called genomic location), whereas 8% of tumors had genomic locations discordant with their anatomic locations, and 17% of tumors had ambiguous genomic locations. Genomic location was a better predictor of microsatellite instability, CpG island methylator phenotype status, and BRAF mutation status than anatomic location. Tumors with ambiguous genomic location were significantly (P = 1.3 × 10-7) more likely to have the mesenchymal consensus molecular subtype (40%) than those with a specific genomic location (18%). A genomic signature to predict genomic location was defined. CONCLUSION Tumor location is increasingly considered in deciding treatment of a colon tumor. We showed that genomic location was superior to anatomic location as a predictor of molecular characteristics, suggesting that it may be a more accurate predictor of response.
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Affiliation(s)
- Emily Cannon
- Department of Applied and Computational Mathematics and Statistics, University of Notre Dame, Notre Dame, IN
| | - Steven Buechler
- Department of Applied and Computational Mathematics and Statistics, University of Notre Dame, Notre Dame, IN.
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13
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Sunakawa Y, Satake H, Ichikawa W. Considering FOLFOXIRI plus bevacizumab for metastatic colorectal cancer with left-sided tumors. World J Gastrointest Oncol 2018; 10:528-531. [PMID: 30595807 PMCID: PMC6304303 DOI: 10.4251/wjgo.v10.i12.528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 09/17/2018] [Accepted: 11/02/2018] [Indexed: 02/05/2023] Open
Abstract
A recent subgroup analysis of the TRIBE trial suggested that FOLFOXIRI plus bevacizumab may be a preferred option for the first-line treatment of only right-sided metastatic colorectal cancer (mCRC), regardless of RAS or BRAF status. Our subanalysis of a phase II trial of the FOLFOXIRI triplet regimen plus bevacizumab in patients with mCRC who had RAS mutant tumors showed that tumor shrinkage was better and the duration of treatment was longer in patients with left-sided tumors than in those with right-sided tumors, leading to a higher rate of conversion to surgery in mCRC patients with left-sided tumors. The early and deep responses to the triplet-regimen in patients with left-sided tumors might facilitate conversion treatment resulting in favorable survival. Our data suggest that the FOLFOXIRI plus bevacizumab might be a promising treatment for left-sided mCRC involving RAS mutant tumors.
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Affiliation(s)
- Yu Sunakawa
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Kanagawa 216-8511, Japan
| | - Hironaga Satake
- Cancer Treatment Center, Kansai Medical University Hospital, Hirakata-city, Osaka 573-1191, Japan
| | - Wataru Ichikawa
- Division of Medical Oncology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa 227-8501, Japan
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14
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Papaxoinis G, Kotoula V, Giannoulatou E, Koliou GA, Karavasilis V, Lakis S, Koureas A, Bobos M, Chalaralambous E, Daskalaki E, Chatzopoulos K, Tsironis G, Pazarli E, Chrisafi S, Samantas E, Kaklamanos IG, Varthalitis I, Konstantara A, Syrigos KN, Pentheroudakis G, Pectasides D, Fountzilas G. Phase II study of panitumumab combined with capecitabine and oxaliplatin as first-line treatment in metastatic colorectal cancer patients: clinical results including extended tumor genotyping. Med Oncol 2018; 35:101. [PMID: 29855806 DOI: 10.1007/s12032-018-1160-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 05/27/2018] [Indexed: 12/12/2022]
Abstract
This clinical trial assessed the efficacy and toxicity of panitumumab combined with oxaliplatin and capecitabine as first-line treatment in KRAS exon 2 wild-type metastatic colorectal cancer (mCRC) patients. Patients with exon 2 KRAS wild-type mCRC received panitumumab 9 mg/Kg, oxaliplatin 130 mg/m2, and capecitabine 2000 mg/m2 repeated every 3 weeks. The primary endpoint was objective response rate (ORR, minimum 42 responses). We retrospectively assessed mutations in genes implicated in CRC with massively parallel sequencing; ERBB2 and EGFR amplification with fluorescence in situ hybridization, and tumor-infiltrating lymphocyte density. Among 78 patients enrolled, 45 (57.7%) completed 6 cycles. Most common grade 3-4 toxicities were skin rash (19.2%), diarrhea (18%), and neuropathy (6.4%). Among 5 (6.4%) potentially treatment-related deaths, 2 (2.6%) were characterized toxic. Objective response occurred in 43 (55.1%) of the patients (complete 6.4% and partial response 48.7%; stable 17.9% and progressive disease 7.7%), while 3.8% were non-evaluable and 15% discontinued their treatment early. Additional mutations in KRAS/NRAS/BRAF were found in 11/62 assessable (18%) tumors. After 51 months median follow-up, median progression-free (PFS) was 8.1 and overall survival 20.2 months, independently of KRAS/NRAS/BRAF or PI3K-pathway mutation status. Patients with TP53 mutations (n = 34; 55%), as well as those with left colon primary tumors (n = 66; 85%), had significantly better PFS, also confirmed in multivariate analysis. Although the clinical trial met its primary endpoint, according to the current standards, the efficacy and tolerability of the drug combination are considered insufficient. Extended genotyping yielded interesting results regarding the significance of TP53 mutations.ClinicalTrials.gov identifier: NCT01215539, Registration date: Sep 29, 2010.
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Affiliation(s)
- George Papaxoinis
- Oncology Section, Second Department of Internal Medicine, Hippokration Hospital, 11527, Athens, Greece.
| | - Vassiliki Kotoula
- Department of Pathology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Giannoulatou
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia.,The University of New South Wales, Kensington, NSW, Australia
| | | | - Vasilios Karavasilis
- Department of Medical Oncology, Faculty of Medicine, School of Health Sciences, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sotirios Lakis
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Koureas
- Department of Radiology, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Mattheos Bobos
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elpida Chalaralambous
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emily Daskalaki
- Department of Pathology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kyriakos Chatzopoulos
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Tsironis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Elisavet Pazarli
- Department of Pathology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sofia Chrisafi
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Epaminontas Samantas
- Third Department of Medical Oncology, Agii Anargiri Cancer Hospital, Athens, Greece
| | - Ioannis G Kaklamanos
- Department of Surgery, School of Health Sciences, General Oncologic Hospital of Kifisia, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Konstantinos N Syrigos
- Oncology Unit GPP, Sotiria General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | | | - Dimitrios Pectasides
- Oncology Section, Second Department of Internal Medicine, Hippokration Hospital, 11527, Athens, Greece
| | - George Fountzilas
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece.,Aristotle University of Thessaloniki, Thessaloniki, Greece
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15
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Sunakawa Y, Ichikawa W, Tsuji A, Denda T, Segawa Y, Negoro Y, Shimada K, Kochi M, Nakamura M, Kotaka M, Tanioka H, Takagane A, Tani S, Yamaguchi T, Watanabe T, Takeuchi M, Fujii M, Nakajima T. Prognostic Impact of Primary Tumor Location on Clinical Outcomes of Metastatic Colorectal Cancer Treated With Cetuximab Plus Oxaliplatin-Based Chemotherapy: A Subgroup Analysis of the JACCRO CC-05/06 Trials. Clin Colorectal Cancer 2016; 16:e171-e180. [PMID: 27856123 DOI: 10.1016/j.clcc.2016.09.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/12/2016] [Accepted: 09/22/2016] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Primary tumor location is a critical prognostic factor in metastatic colorectal cancer (mCRC); however, it remains unclear whether tumor location is a predictor of the response to cetuximab treatment. It is also uncertain if BRAF mutation contributes to the impact of tumor location on survival. We assessed the prognostic impact of tumor location on clinical outcomes in mCRC patients treated with first-line cetuximab chemotherapy. PATIENTS AND METHODS The associations of tumor location with overall survival and progression-free survival were evaluated in mCRC patients with KRAS exon 2 wild-type tumors who were enrolled onto 2 clinical trials: JACCRO CC-05 of cetuximab plus FOLFOX (n = 57, UMIN000004197) and CC-06 of cetuximab plus SOX (n = 61, UMIN000007022). Tumors proximal or from splenic flexure to rectum were defined as right-sided or left-sided, respectively. In addition, exploratory RAS and BRAF mutation analyses were performed. RESULTS A total of 110 patients were assessable for tumor location; 90 had left-sided tumors. Left-sided tumors were significantly associated with longer overall survival (36.2 vs. 12.6 months, hazard ratio = 0.28, P < .0001) and progression-free survival (11.1 vs. 5.6 months, hazard ratio = 0.47, P = .0041) than right-sided tumors; similar results were obtained in multivariate analysis. A subanalysis showed that the association was evident in the FOLFOX group and that tumor location was an independent prognostic factor irrespective of BRAF status in RAS wild-type patients. CONCLUSION Primary tumor location might be a predictor of survival independent of BRAF status in mCRC patients who receive first-line cetuximab combined with oxaliplatin-based chemotherapy.
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Affiliation(s)
- Yu Sunakawa
- Division of Medical Oncology, Department of Internal Medicine, Showa University Northern Yokohama Hospital, Kanagawa, Japan.
| | - Wataru Ichikawa
- Division of Medical Oncology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Akihito Tsuji
- Department of Clinical Oncology, Kagawa University Faculty of Medicine Cancer Center, Kagawa University Hospital, Kagawa, Japan
| | - Tadamichi Denda
- Division of Gastroenterology, Chiba Cancer Center, Chiba, Japan
| | - Yoshihiko Segawa
- Department of Medical Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Yuji Negoro
- Department of Gastroenterology, Kochi Health Sciences Center, Kochi, Japan
| | - Ken Shimada
- Division of Medical Oncology, Department of Internal Medicine, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Mitsugu Kochi
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Masato Nakamura
- Aizawa Comprehensive Cancer Center, Aizawa Hospital, Nagano, Japan
| | | | - Hiroaki Tanioka
- Department of Medical Oncology, Japan Labour Health and Welfare Organization Okayama Rosai Hospital, Okayama, Japan
| | - Akinori Takagane
- Department of Surgery, Hakodate Goryoukaku Hospital, Hokkaido, Japan
| | - Satoshi Tani
- Department of Internal Medicine, Konan Hospital, Hyogo, Japan
| | - Tatsuro Yamaguchi
- Department of Surgery, Tokyo Metropolitan Cancer and Infections Diseases Center Komagome Hospital, Tokyo, Japan
| | | | - Masahiro Takeuchi
- Department of Clinical Medicine (Biostatistics), Kitasato University School of Pharmacy, Tokyo, Japan
| | - Masashi Fujii
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
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