Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2020; 8(8): 1424-1443
Published online Apr 26, 2020. doi: 10.12998/wjcc.v8.i8.1424
Clinicopathological differences and correlations between right and left colon cancer
Ioannis Kalantzis, Afroditi Nonni, Kitty Pavlakis, Eumorphia-Maria Delicha, Konstantinos Miltiadou, Christos Kosmas, Nikolaos Ziras, Konstantinos Gkoumas, Harikleia Gakiopoulou
Ioannis Kalantzis, Konstantinos Gkoumas, Department of Gastroenterology, Korgialenio-Mpenakeio Hellenic Red Cross Hospital, Athens 11526, Greece
Ioannis Kalantzis, Konstantinos Miltiadou, Christos Kosmas, Nikolaos Ziras, Department of Oncology, Metaxa Anticancer Hospital, Piraeus 18537, Greece
Afroditi Nonni, Kitty Pavlakis, Harikleia Gakiopoulou, First Department of Pathology, National and Kapodistrian University of Athens, Medical School, Athens 11527, Greece
Eumorphia-Maria Delicha, Independent Biostatistical Consultant, ASTAT, Statistics in Clinical Research, Glyfada 16675, Greece
Konstantinos Miltiadou, Hepatogastroenterology Unit, Second Department of Internal Medicine, Attikon University General Hospital, Athens 12462, Greece
Author contributions: Kalantzis I designed the study, collected the data and wrote the manuscript. Nonni A and Pavlakis K provided critical revision. Eumorphia-Maria Delicha performed the statistical analysis. Miltiadou K collected the data and contributed to data interpretation. Kosmas C provided critical revision. Ziras N conceived the study aim and design. Gkoumas K contributed to manuscript development and interpretation of results. Gakiopoulou H designed and coordinated the study.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Metaxa Anticancer Hospital (Piraeus, Greece).
Informed consent statement: All study participants, or their legal guardians, provided informed written consent prior to study enrolment.
Conflict-of-interest statement: The authors declare no financial support, funding resources or conflicts of interest.
Data sharing statement: The datasets generated during for the purposes of the current study are not publicly available. The authors are committed to sharing with qualified external researchers’ access to patient level data. Such requests are reviewed and approved on the basis of scientific merit. All data provided is anonymised and in line with applicable laws and regulations. The data may be requested from the corresponding author of the manuscript.
STROBE statement: The authors have read the STROBE statement checklist of items, and the manuscript was prepared and revised according to the STROBE statement checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ioannis Kalantzis, MD, MSc, Doctor, Department of Gastroenterology, Korgialenio-Mpenakeio Hellenic Red Cross Hospital, 2 Athanasaki Street, Athens 11526, Greece. johnkalantzis@hotmail.com
Received: December 27, 2019
Peer-review started: December 27, 2019
First decision: February 18, 2020
Revised: February 28, 2020
Accepted: April 17, 2020
Article in press: April 17, 2020
Published online: April 26, 2020
Processing time: 118 Days and 19 Hours
Abstract
BACKGROUND

The differences in histopathology and molecular biology between right colon cancer (RCC) and left colon cancer (LCC) were first reported in the literature by Bufill in 1990. Since then, a large number of studies have confirmed their differences in epidemiology, clinical presentation, comorbidities and biological behaviours, which may be related to the difference in prognosis and overall survival (OS) between the two groups.

AIM

To investigate statistically significant differences between Greek patients with LCC and RCC.

METHODS

The present observational study included 144 patients diagnosed with colon cancer of any stage who received chemotherapy in a Greek tertiary oncology hospital during a 2.5-year period. Clinical information, comorbidities, histopathologic characteristics and molecular biomarkers were collected from the patients’ medical records retrospectively, while administered chemotherapy regimens, targeted agents, progression-free survival (PFS) periods with first- and second-line chemotherapy and OS were recorded retroactively and prospectively. Data analysis was performed with the SPSS statistical package.

RESULTS

Eighty-six males and 58 females participated in the study. One hundred (69.4%) patients had a primary lesion in the left colon, and 44 (30.6%) patients had a primary lesion in the right colon. Patients with RCC were more likely to display anaemia than patients with LCC [odds ratio (OR) = 3.09], while LCC patients were more likely to develop rectal bleeding (OR = 3.37) and a feeling of incomplete evacuation (OR = 2.78) than RCC patients. Considering comorbidities, RCC patients were more likely to suffer from diabetes (OR = 3.31) and coronary artery disease (P = 0.056) than LCC patients. The mucinous differentiation rate was higher in the right-sided group than in the left-sided group (OR = 4.49), as was the number of infiltrated lymph nodes (P = 0.039), while the percentage of high-grade differentiation was higher in the group of patients with left-sided colon cancer than in RCC patients (OR = 2.78). RAS wild-type patients who received anti-epidermal growth factor receptor (EGFR): Treatment experienced greater benefit (PFS: 16.5 mo) than those who received anti-vascular endothelial growth factor treatment (PFS: 13.7 mo) (P = 0.05), while among RAS wild-type patients who received anti-EGFR treatment, LCC patients experienced greater benefit (PFS: 15.8 mo) than the RCC subgroup (PFS: 5.5 mo) in the first-line chemotherapy setting (P = 0.034). BRAF-mutant patients had shorter PFS (9.3 mo) than BRAF wild-type patients (14.5 mo) (P = 0.033). RCC patients showed a shorter tumour recurrence period (7.7 mo) than those with LCC (14.5 mo) (P < 0.001), as well as shorter (OS) (58.4 mo for RCC patients; 82.4 mo for LCC patients) (P = 0.018).

CONCLUSION

RCC patients present more comorbidities, worse histological and molecular characteristics and a consequently higher probability of tumour recurrence, poor response to targeted therapy and shorter OS than LCC patients.

Keywords: Colorectal neoplasm; Epidermal growth factor; Vascular endothelial growth factor; Histology; Molecular biology; Metabolic syndrome

Core tip: Primary tumour location in colon cancer plays a significant role in disease behaviour. Left colon cancer and right colon cancer present different pathogenic mechanisms, probably related to the differences in histology and molecular pathways between them. The higher tumour recurrence rate, poor response to targeted therapy and shorter overall survival of right compared to left colon cancer patients reflects the heterogeneity between the two diseases and dictates different therapeutic approaches.