Purpose

Sidedness has emerged as a prognostic factor for metastatic colorectal cancer treated with modern systemic therapies. This study investigates whether it is also relevant for an unselected patient cohort including all stages.

Methods

All consecutive patients admitted with colon cancer between 1995 and 2018 were retrieved from an institution-held database. Patients were divided into two cohorts. The first cohort included patients without distant metastases who were able to undergo curative resection. The second cohort presented with distant metastases (stage IV). Potentially prognostic factors were subjected to multivariate Cox Regression analysis.

Results

Overall, 1,606 patients met the inclusion and exclusion criteria. An R0-resection was achieved in 1,222 patients without distant metastases. Five-year cause-specific survival rate was 89.3% for this group. There was no difference between right- and left-sided cancers (88.2% vs. 90.1%, p = 0.220). However, prognosis of caecal carcinoma was significantly worse than that of all other sites combined (83.5% vs. 90.2%, p = 0.007). In multivariate analysis, pT-category, pN-category, grading, vascular invasion, emergency operation, adjuvant chemotherapy, and caecal carcinoma remained as independent prognostic factors. In the 384 patients with stage IV-disease, 3-year overall survival for right- vs. left-sided cancers differed only in univariate analysis (17.7% vs. 28.6%, p = 0.013).

Conclusion

In non-metastatic colon cancer, location in the caecum is an independent prognostic factor. In unselected patients with stage IV colon cancer, sidedness was not found to be a prognostic factor. Differentiation into right- and left-sided tumors may be simplistic, and further studies on the biological behavior of different colonic sites are warranted.

中文翻译：

---

在未经选择的结肠癌患者队列中，单侧性不是预后因素，但盲肠癌的预后更差 – 对大型单一机构数据库的多变量分析

目的

单侧性已成为采用现代全身疗法治疗的转移性结直肠癌的预后因素。这项研究调查了它是否也与包括所有阶段在内的未选择的患者队列相关。

方法

1995 年至 2018 年间所有连续入院的结肠癌患者均从机构持有的数据库中检索。患者被分为两组。第一个队列包括能够接受根治性切除的无远处转移的患者。第二组出现远处转移（IV 期）。对潜在的预后因素进行多变量Cox回归分析。

结果

总体而言，1,606 名患者符合纳入和排除标准。 1,222 名无远处转移的患者实现了 R0 切除。该组的五年病因特异性生存率为 89.3%。右侧和左侧癌症之间没有差异（88.2% vs. 90.1%，p = 0.220）。然而，盲肠癌的预后明显比所有其他部位的预后差（83.5% vs. 90.2%，p = 0.007）。在多变量分析中，pT类、pN类、分级、血管侵犯、急诊手术、辅助化疗和盲肠癌仍然是独立的预后因素。在 384 名 IV 期疾病患者中，右侧癌症与左侧癌症的 3 年总生存率仅在单变量分析中存在差异（17.7% 与 28.6%，p = 0.013）。

结论

在非转移性结肠癌中，盲肠中的位置是一个独立的预后因素。在未经选择的 IV 期结肠癌患者中，未发现单侧性是预后因素。区分右侧和左侧肿瘤可能过于简单化，有必要对不同结肠部位的生物学行为进行进一步研究。