Portal de Periódicos da CAPES

The relationship between primary tumor sidedness and prognosis in colorectal cancer.

2016; Lippincott Williams & Wilkins; Volume: 34; Issue: 15_suppl Linguagem: Inglês

10.1200/jco.2016.34.15_suppl.3505

1527-7755

Deborah Schrag, Shicheng Weng, Gabriel A. Brooks, Jeffrey A. Meyerhardt, Alan P. Venook,

Multiple and Secondary Primary Cancers

3505 Background: Clinical trials including CALGB/SWOG 80405 reveal differences in overall survival for patients with colorectal cancer based on the location of the 1° tumor yet this information is not routinely included in study design, reporting or patient counseling. Objective: To evaluate the impact of 1° tumor location on prognosis among stage-specific cohorts of patients with colorectal cancer. Methods: The Surveillance Epidemiology and End Results Program (SEER) tracks sidedness of primary colorectal cancers. We characterized the 1° site using SEER data as R-sided 1° = cecum to transverse colon; L-sided 1° = splenic flexure to sigmoid descending colon; 1° rectum = rectosigmoid and rectal. We identified patients with diagnoses of primary colorectal cancer in a SEER region between 2007 and 2011 and followed through 2013 by stage at diagnosis. We measured median and3-year survival and used Kaplan-Meier plots and Cox regression used to compare OS across groups. Age, gender, race, ethnicity, and year of diagnosis were included in adjusted Cox models to estimate the hazard ratio (HR) for death of rectal and right-sided relative to left-sided tumors. Results: Right sided 1° CRC had inferior prognosis to both left-sided and rectal cancers and this difference persisted after adjusting for differences in other clinical and demographic characteristics. The association was less consistent for stage I and II cancers. Conclusions: In a population-based series of patients with stage III and IV CRC, patients with R-sided tumors had inferior survival. This heterogeneity argues for consistent reporting of 1° site and further research including molecular sub-typing to better understand the mechanisms underpinning this phenotypic difference in prognosis. Stage/location of primary tumor N Median survival 3-year survival probability % Unadjusted HR (95% CI) Adjusted HR (95% CI) Stage IV Left 4784 17.0 27 1.0 1.0 Right 7579 8.7 16 1.40 (1.35-1.46) 1.20 (1.15-1.25) Rectal 4392 17.4 26 0.99 (0.94-1.04) 1.02 (0.97-1.07) Stage III Left 6394 n/a 71 1.0 1.0 Right 13748 59 62 1.39 (1.32-1.46) 1.17 (1.11-1.23) Rectal 5745 n/a 70 1.02 (0.96-1.08) 1.10 (1.04-1.17)