Background: Colon cancer (CC) ranks as the third most common cancer worldwide and is considered the second leading cause of cancer death. Recently, many international studies have made the observation that right and left colon cancer have many significant differences regarding clinico-pathological characteristics and primary tumor location has a crucial impact on treatment outcomes and overall survival. Our study was conducted to verify the presence of significant differences between right and left colon cancer. Patients and Methods: This study is a retrospective cohort study which aimed at comparing right and left colon cancer as regards clinico-pathological data and treatment results among patients with colon cancer receiving treatment at South Egypt Cancer Institute (SECI) during the period from 1/2008 to 12/2018. A sample size of 160 cases of colon cancer patients (80 diagnosed as right colon cancer and 80 diagnosed as left colon cancer) was randomly selected from our South Egypt Cancer Institute (SECI)’s tumor registry. Statistical analysis was done using SPSS program version 20. Difference was considered statistically significant at P-value < 0.05. Survival curves were conducted using the Kaplan-Meier methods and were compared with the log-rank test. Results: Right colon cancer occurred at an older age and was more commonly presented with abdominal pain while left colon cancer was more commonly presented with bleeding manifestations. More cases of the right side underwent curative surgeries whereas more palliative surgeries were performed to left-sided cases. Left sided cases were associated with a more advanced stage at diagnosis while right-sided cases were associated with a better response to first-line chemotherapy. More cases of the left side died due to metastatic disease. On the other hand, our findings demonstrated no differences between both sides regarding gender predilection, risk factors, sites of metastases, number of metastatic organs, histo-pathological examination and grading, response to second- or third-line chemotherapy, chemotherapy toxicity (hematological or non-hematological), overall survival, progression-free survival, or disease-free survival. Conclusion: Primary tumor location of colon cancer has a significant effect on clinico-pathological characteristics and treatment outcomes.
KeywordsColon CancerRightLeftTumor Location
Bray, F., Ferlay, J., Soerjomataram, I., Siegel, R.L., Torre, L.A. and Jemal, A. (2018) Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians, 68, 394-424. https://doi.org/10.3322/caac.21492
Tejpar, S., Stintzing, S., Ciardiello, F., Tabernero, J., Van, E., Beier, F., Esser, R., Lenz, H.-J. and Heinemann, V. (2017) Prognostic and Predictive Relevance of Primary Tumor Location in Patients with RAS Wild-Type Metastatic Colorectal Cancer: Retrospective Analyses of the CRYSTAL and FIRE-3 Trials. JAMA Oncology, 3, 194-201. https://doi.org/10.1001/jamaoncol.2016.3797
Ahmed, A.-Z., Wael, K., Deya, M., Alaa, A., Mostafa, I. and Ela, M.A. (2015) Colorectal Cancer in Egypt. Diseases of the Colon & Rectum, 45, 1255-1260. https://doi.org/10.1007/s10350-004-6401-z
Venook, A.P., Niedzwiecki, D., Innocenti, F., et al. (2016) Impact of Primary Tumor Location on Overall Survival and Progression-Free Survival in Patients with Metastatic Colorectal Cancer: Analysis of CALGB/SWOG 80405 (Alliance). 2016 ASCO Annual Meeting.
Watson, A.J. and Collins, P.D. (2014) Colon Cancer: A Civilization Disorder. Digestive Diseases, 29, 222-228. https://doi.org/10.1159/000323926
Arhi, C.S., Ziprin, P., Bottle, A., Burns, E.M., Aylin, P. and Darzi, A. (2019) Colorectal Cancer Patients under the Age of 50 Experience Delays in Primary Care Leading to Emergency Diagnoses: A Population-Based Study. Colorectal Disease, 21, 1270-1278. https://doi.org/10.1111/codi.14734
Beart, R.W., Melton 3rd, L.J., Maruta, M., Dockerty, M.B., Frydenberg, H.B. and O’Fallon, W.M. (1983) Trends in Right and Left-Sided Colon Cancer. Diseases of the Colon & Rectum, 26, 393-398.
Salvatore, L., Aprile, G., Arnoldi, E., et al. (2017) Management of Metastatic Colorectal Cancer Patients: Guidelines of the Italian Medical Oncology Association (AIOM). ESMO Open, 2, e000147. https://doi.org/10.1136/esmoopen-2016-000147
Rosen, M., Chan, L., Beart Jr., R.W., Vukasin, P. and Anthone, G. (2018) Follow-Up of Colorectal Cancer: A Meta-Analysis. Diseases of the Colon & Rectum, 41, 1116-1126.
Fearon, E.R. and Vogelstein, B. (1990) A Genetic Model for Colorectal Tumorigenesis. Cell, 61, 759-767. https://doi.org/10.1016/0092-8674(90)90186-I
Boland, C.R. and Goel, A. (2010) Microsatellite Instability in Colorectal Cancer. Gastroenterology, 138, 2073-2087. https://doi.org/10.1053/j.gastro.2009.12.064
Van Allen, E.M., Miao, D., Schilling, B., Shukla, S.A., Blank, C., Zimmer, L., Sucker, A., et al. (2015) Genomic Correlates of Response to CTLA-4 Blockade in Metastatic Melanoma. Science, 350, 207-211. https://doi.org/10.1126/science.aad0095
Qiu, M.-Z., Pan, W.-T., Lin, J.-Z., Wang, Z.-X., et al. (2018) Comparison of Survival between Right-Sided and Left-Sided Colon Cancer in Different Situations. Cancer Medicine, 7, 1141-1150. https://doi.org/10.1002/cam4.1401
Saltzstein, S.L. and Behling, C.A. (2007) Age and Time as Factors in the Left-to-Right Shift of the Subsite of Colorectal Adenocarcinoma: A Study of 213,383 Cases from the California Cancer Registry. Journal of Clinical Gastroenterology, 41, 173-177. https://doi.org/10.1097/01.mcg.0000225550.26751.6a
Kandula, R., Gundeti, S., Rajesh, K., Ravishankar, A., et al. (2017) Clinicopathological and Outcome Differences between Right and Left Colon Cancer: An Institutional Experience from South India. Annals of Oncology, 28, 50-51. https://doi.org/10.1093/annonc/mdx659.029
Cienfuegos, J.-A., Baixauli, J., Arredondo, J., et al. (2018) Clinico-Pathological and Oncological Differences between Right and Left-Sided Colon Cancer (Stages I-III): Analysis of 950 Cases. Revista Espanola de Enfermedades Digestivas, 110, 138-144. https://doi.org/10.17235/reed.2017.5034/2017
Kim, Y.-Z., Kim, J.-H., Lee, J.-Y., et al. (2013) Symptoms and initial Diagnostic Test in Colorectal Cancer Patients. The Korean Academy of Family Medicine, 3, 58-64.
Dixon, S. and Paul, D. (2019) Symptoms of Colon Cancer.
Hsu, Y.-L., Lin, C.-C., Jiang, J.-K., Lin, H.-H., et al. (2019) Clinicopathological and Molecular Differences in Colorectal Cancer According to Location. The International Journal of Biological Markers, 34, 47-53. https://doi.org/10.1177/1724600818807164
Brule, S.Y., Jonker, D.J., Karapetis, C.S., et al. (2015) Location of Colon Cancer (Right-Sided Versus Left-Sided) as a Prognostic Factor and a Predictor of Benefit from Cetuximab in NCIC CO.17. European Journal of Cancer, 51, 1405-1414. https://doi.org/10.1016/j.ejca.2015.03.015
Kumar, S., Kafle, P., Patowary, B.N., Belbase, N., et al. (2013) Surgical Outcome and Clinical Profile of Emergency versus Elective Cases of Colorectal Cancer in College of Medical Sciences, Nepal. Journal of College of Medical Sciences, 9, 25-30. https://doi.org/10.3126/jcmsn.v9i2.9684
Hansen, I.O. and Jess, P. (2012) Possible Better Long-Term Survival in Left versus Right-Sided Colon Cancer—A Systematic Review. Danish Medical Journal, 59, A4444.
Bustamante-Lopez, L.A., Nahas, S.C., Nahas, C.S.R., et al. (2019) Is There a Difference between Right- versus Left-Sided Colon Cancers? Does Side Make Any Difference in Long-Term Follow-Up? Arquivos Brasileiros de Cirurgia Digestiva, 32, e1479. https://doi.org/10.1590/0102-672020190001e1479
Ross, P.J., Srikandarajah, K. and De Naurois, J. (2018) Right versus Left-Sided Colon Cancer: Is It Time to Consider These as Different Diseases? AIMS Medical Science, 5, 303-315. https://doi.org/10.3934/medsci.2018.3.303
Ulanja, M.B., Rishi, M., Beutler, B.D., Sharma, M., et al. (2019) Colon Cancer Sidedness, Presentation, and Survival at Different Stages. Journal of Oncology, 2019, Article ID: 4315032. https://doi.org/10.1155/2019/4315032
Peng, J.H., Li, C., Wang, F.L., Zhang, H.Z., et al. (2018) Right- and Left-Sided Stage III Colon Cancers Present Different Prognostic Outcomes of Oxaliplatin-Based Adjuvant Chemotherapy after Curative Resection. Cancer Management and Research, 10, 2095-2103. https://doi.org/10.2147/CMAR.S163520
You, X.-H., Wen, C., Xia, Z.-J., Sun, F., et al. (2019) Primary Tumor Sidedness Predicts Bevacizumab Benefit in Metastatic Colorectal Cancer Patients. Frontiers in Oncology, 9, 723. https://doi.org/10.3389/fonc.2019.00723
Wang, F., Bai, L., Liu, T.-S., Yu, Y.-Y., et al. (2015) Right and Left-Sided Colorectal Cancers Respond Differently to Cetuximab. Chinese Journal of Cancer, 34, Article No. 24. https://doi.org/10.1186/s40880-015-0022-x
Boeckx, N., Koukakis, R., De Beeck, K.O., Rolfo, C., et al. (2018) Effect of Primary Tumor Location on Second- or Later-Line Treatment Outcomes in Patients with RAS Wild-Type Metastatic Colorectal Cancer and All Treatment Lines in Patients with RAS Mutations in Four Randomized Panitumumab Studies. Clinical Colorectal Cancer, 17, 170-178. https://doi.org/10.1016/j.clcc.2018.03.005
Qiu, M.-Z., Hu, J.M., Yang, D.J., Cosgrove, D.P. and Xu, R.H. (2015) Pattern of Distant Metastases in Colorectal Cancer: A SEER Based Study. Oncotarget, 6, 38658-38666. https://doi.org/10.18632/oncotarget.6130
Christodoulidis, G., Spyridakis, M., Symeonidis, D., et al. (2010) Clinicopathological Differences between Right- and Left-Sided Colonic Tumors and Impact upon Survival. Techniques in Coloproctology, 14, 45-47. https://doi.org/10.1007/s10151-010-0622-z