Assessment of tumor location in adjuvant treatment decision for stage II colon cancer

Year 2024, Volume: 6 Issue: 5, 293 - 298, 30.09.2024

Şafak Yıldırım Dişli , Eyyüp Ayas , Ahmet Kürşad Dişli , Ender Dogan , Feyyaz Özdemir

https://doi.org/10.38053/acmj.1482701

Abstract

Aims: In stage II colon cancer, the aim is to evaluate the impact of tumor location and other clinicopathological factors on prognosis and survival.
Methods: The study included a total of 93 patients diagnosed with stage II colon cancer between January 2018 and December 2022, comprising 41 females and 52 males. Clinicopathological factors related to the patients were retrospectively investigated. Factors found to be significant in univariate analysis were further evaluated through multivariate analysis to identify independent factors.
Results: As a result of univariate analysis, variables such as tumor location (right-left colon), perineural invasion, surgical margin, intestinal obstruction, and lymph node dissection were found to be statistically significant for the risk of death (p<0.05). These variables, identified as significant in univariate analyses, were included in the multivariate cox regression model. According to the result of the multivariate cox regression model, individuals with intestinal obstruction were determined to have a 7.07 times higher risk of death (HR: 7.07; 95% CI: 2.42-20.62; p < 0.001).
Conclusion: We observed an association between left colon tumors in stage II patients and poorer survival, and we noted that intestinal obstruction has an independent prognostic effect on survival.

Keywords

Adjuvant chemotherapy, colon cancer, prognosis, tumor localization

References

• Iacopetta B. Are there two sides to colorectal cancer?. Int J Cancer. 2002;101(5):403-408.
• Schoenwolf GC, Bleyl SB, Brauer PR, West PH. Development of the gastrointestinal tract. Larsen’s Human Embryology. 2009;1(1):435-477.
• Flemer B, Lynch DB, Brown JMR, et al. Tumour-associated and non-tumour-associated microbiota in colorectal cancer. Gut. 2017;66(4):633-643.
• Glebov OK, Rodriguez LM, Nakahara K, et al. Distinguishing right from left colon by the pattern of gene expression. Cancer Epidemiol Biomarkers Prev. 2003;12(8):755-762.
• Kaz AM, Wong CJ, Dzieciatkowski S, Luo Y, Schoen RE, Grady WM. Patterns of DNA methylation in the normal colon vary by anatomical location, gender, and age. Epigenetics. 2014;9(4):492-502.
• Tol J, Nagtegaal ID, Punt CJA. BRAF mutation in metastatic colorectal cancer. N Engl J Med. 2009;361(1):98-99.
• Tran B, Kopetz S, Tie J, et al. Impact of BRAF mutation and microsatellite instability on the pattern of metastatic spread and prognosis in metastatic colorectal cancer. Cancer. 2011;117(20):4623-4632.
• Schell MJ, Yang M, Teer JK, et al. A multigene mutation classification of 468 colorectal cancers reveals a prognostic role for APC. Nat Commun. 2016;15(7):11743.
• Missiaglia E, Jacobs B, Ario G, et al. Distal and proximal colon cancers differ in terms of molecular, pathological, and clinical features. Ann Oncol. 2014;25(10):1995-2001.
• Lothe RA, Peltomäki P, Meling GI, et al. Genomic instability in colorectal cancer: relationship to clinicopathological variables and family history. Cancer Res. 1993;53(24):5849-5852.
• Ionov Y, Peinado MA, Malkhosyan S, Shibata D, Perucho M. Ubiquitous somatic mutations in simple repeated sequences reveal a new mechanism for colonic carcinogenesis. Nature. 1993;363(6429):558-561.
• Boland CR, Goel A. Microsatellite instability in colorectal cancer. Gastroenterology. 2010;138(6):2073-2087.
• Samowitz WS, Curtin K, Ma KN, et al. Microsatellite instability in sporadic colon cancer is associated with an improved prognosis at the population level. Cancer Epidemiol biomarkers Prev. 2001;10(9):917-923.
• Schrag D, Weng S, Brooks G, Meyerhardt JA, Venook AP. The relationship between primary tumor sidedness and prognosis in colorectal cancer. J Clin Oncol. 2016;34(15):3505.
• Sinicrope FA, Mahoney MR, Smyrk TC, et al. Prognostic impact of deficient DNA mismatch repair in patients with stage III colon cancer from a randomized trial of FOLFOX-based adjuvant chemotherapy. J Clin Oncol. 2013;31(29):3664-3672.
• Meguid RA, Slidell MB, Wolfgang CL, Chang DC, Ahuja N. Is there a difference in survival between right- versus left-sided colon cancers? Ann Surg Oncol. 2008;15(9):2388-2394.
• Weiss JM, Pfau PR, Connor ES, et al. Mortality by stage for right- versus left-sided colon cancer: analysis of surveillance, epidemiology, and end results-Medicare data. J Clin Oncol. 2011;29(33):4401-4409.
• Warschkow R, Sulz MC, Marti L, et al. Better survival in right-sided versus left-sided stage I-III colon cancer patients. BMC Cancer. 2016;28(16):554.
• Demir H, Çağlayan D, Kaman O, et al. Evaluating the effect of tumor size and sidedness on prognosis in stage 2 colon cancer: a retrospective population study. Eur Rev Med Pharmacol Sci. 2022;26(4):1328-1340.
• Benedix F, Kube R, Meyer F, et al. Comparison of 17,641 patients with right- and left-sided colon cancer: differences in epidemiology, perioperative course, histology, and survival. Dis Colon Rectum. 2010; 53(1):57-64.
• Popat S, Hubner R, Houlston RS. Systematic review of microsatellite instability and colorectal cancer prognosis. J Clin. 2005;23(3):609-618.
• Hemminki A, Mecklin JP, Järvinen H, Aaltonen LA, Joensuu H. Microsatellite instability is a favorable prognostic indicator in patients with colorectal cancer receiving chemotherapy. Gastroenterology. 2000; 119(4):921-928.
• Jernvall P, Mäkinen MJ, Karttunen TJ, Mäkelä J, Vihko P. Microsatellite instability: impact on cancer progression in proximal and distal colorectal cancers. Eur J Cancer. 1999;35(2):197-201.
• Niedzwiecki D, Bertagnolli MM, Warren RS, et al. Documenting the natural history of patients with resected stage II adenocarcinoma of the colon after random assignment to adjuvant treatment with edrecolomab or observation: results from CALGB 9581. J Clin Oncol. 2011;29(23):3146-3152.
• Liu ZH, Li C, Huang NQ, et al. No difference of complete or incomplete left-sided malignant colonic obstruction on both short- and long-term outcomes. Genet Mol Res. 2014;13(3):7965-7978.
• Steinberg SM, Barkin JS, Kaplan RS, Stablein DM. Prognostic indicators of colon tumors. The Gastrointestinal tumor study group experience. Cancer. 1986;57(9):1866-1870.