Clinicopathological differences and correlations between right and left colon cancer

doi:10.12998/wjcc.v8.i8.1424

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World Journal of Clinical Cases

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World J Clin Cases. Apr 26, 2020; 8(8): 1424-1443
Published online Apr 26, 2020. doi: 10.12998/wjcc.v8.i8.1424

Table 1 Characteristics of right and left colon cancer patients

	LCC (n = 100)	RCC (n = 44)	P value
Male	64 (64.0%)	22 (50.0%)	P = 0.163
Female	36 (36.0%)	22 (50.0%)	P = 0.163
Age (mean ± SD) (yr)	65.4 (± 10.3)	65.5 (± 10.1)	P = 0.948
BMI (mean ± SD) (k/m²)	28.0 (± 4.4)	29.0 (± 6.6)	P = 0.225

RCC: Right colon cancer; LCC: Left colon cancer; BMI: Body mass index.

Table 2 Clinical presentation and comorbidities with statistically significant differences between left and right colon cancer patients

	LCC (n = 100), n (%)	RCC (n = 44), n (%)	P value
Anaemia	13 (13.1)	14 (31.8)	^aP = 0.008
Rectal bleeding	46 (46.5)	9 (20.5)	^aP = 0.003
Feeling of incomplete evacuation	26 (26.3)	5 (11.4)	^aP = 0.005
Coronary heart disease	9 (9.0)	9 (20.5)	^bP = 0.056
Diabetes mellitus	8 (8.2)	10 (13.6)	^aP = 0.016

^aStatistically significant at 0.05 level.

^bStatistically significant at 0.1 level. RCC: Right colon cancer; LCC: Left colon cancer.

Table 3 Disease stage, tumour size (T), infiltrated lymph nodes (N) and metastatic load (M) in right and left colon cancer patients at the time of diagnosis according to AJCC 8^th edition, 2017

		LCC (n = 100), n (%)	RCC (n = 44), n (%)	P value
Stage	I	7 (7.0)	0 (0)	P = 0.230
	II	13 (13.0)	8 (18.2)
	III	25 (25.0)	14 (31.8)
	IV	55 (55.0)	22 (50.0)
T	T₁-T₂	11 (11.0)	3 (6.8)	^bP = 0.088
	T₃	61 (61.0)	25 (56.8)
	T₄	13 (13.0)	13 (29.6)
	T_X	15 (15.0)	3 (6.8)
N	N₀	28 (28.0)	9 (20.5)	^aP = 0.039
	N₁	32 (32.0)	23 (52.3)
	N₂	24 (24.0)	5 (11.3)
	N_X	16 (16.0)	7 (15.9)
M	M₀	45 (45.0)	22 (50.0)	P = 0.446
	M_1a	40 (40.0)	13 (29.5)
	M_1b	15 (15.0)	9 (20.5)

^aStatistically significant at 0.05 level.

^bStatistically significant at 0.1 level. (P value = 0.039 refers to N₀-N₂). RCC: Right colon cancer; LCC: Left colon cancer.

Table 4 Histology, differentiation, and presence of necrosis, emboli (vascular and lymphatic) and perineural infiltration in patients with right and left colon cancer according to the World Health Organization 2019 classification

		LCC (n = 100), n (%)	RCC (n = 44), n (%)	P value
Histology	Adenocarcinoma	95 (95.0)	37 (84.1)	^aP = 0.046
	Mucinous	4 (4.0)	7 (15.9)
	Neuroendocrine	1 (1.0)	0 (0)
Differentiation	Low	19 (20.9)	19 (46.3)	^aP = 0.005
Differentiation	Moderate/High	72 (79.1)	22 (53.7)	^aP = 0.005
Necroses	No	53 (62.4)	24 (61.5)	P = 1.000
Necroses	Yes	32 (37.6)	15 (38.5)	P = 1.000
Emboli	No	68 (82.9)	34 (87.2)	P = 0.606
Emboli	Yes	14 (17.1)	5 (12.8)	P = 0.606
Perineural infiltration	No	71 (87.7)	36 (92.3)	P = 0.544
Perineural infiltration	Yes	10 (12.3)	3 (7.7)	P = 0.544

^aStatistically significant at 0.05 level. RCC: Right colon cancer; LCC: Left colon cancer.

Table 5 KRAS, NRAS, BRAF and MSI-related genes in right and left colon cancer patients

	LCC (n = 100), n (%)	RCC (n = 44), n (%)	Total, n (%)	P value
KRAS wild type	60 (63.8)	17 (42.5)	77 (57.5)	^aP = 0.036
KRAS mutant	34 (36.2)	23 (57.5)	57 (42.5)	^aP = 0.036
NRAS wild type	80 (95.2)	29 (100.0)	109 (96.5)	P = 0.571
NRAS mutant	4 (4.8)	0 (0)	4 (3.5)	P = 0.571
RAS wild type	56 (59.6)	17 (42.5)	73 (54.5)	P = 0.104
RAS mutant	38 (40.4)	23 (57.5)	61 (45.5)	P = 0.104
BRAF wild type	60 (93.8)	23 (82.1)	83 (90.2)	P = 0.125
BRAF mutant	4 (6.2)	5 (17.9)	9 (9.8)	P = 0.125
MSS	51 (94.4)	29 (93.5)	80 (94.1)	P = 1.000
MSI-H	3 (5.6)	2 (6.5)	5 (5.9)	P = 1.000

^aStatistically significant at 0.05 level. RCC: Right colon cancer; LCC: Left colon cancer; MSI: Microsatellite instability.

Table 6 Adjuvant and perioperative therapy across disease stages and locations

Stage	Location	FOLFOX	XELOX	RT-capecitabine	RT-capecitabine-XELOX	Total
II	LCC	3	5	5	-	13
II	RCC	3	5	-	-	8
III	LCC	3	11	-	11	25
III	RCC	2	12	-	-	14
Total	LCC	6	16	5	11	38
Total	RCC	5	17	-	-	22
	Total	11	33	5	11	60

RCC: Right colon cancer; LCC: Left colon cancer.

Table 7 Cox regression analysis of disease recurrence

	P value	HR	95%CI
KRAS wild-type/NRAS mutant (Ref cat)
KRAS mutant	^aP = 0.002	3.731	1.635-8.513
Presence of emboli	^aP = 0.025	3.221	1.161-8.938
Location	0.286
Histology	0.339
Sex	0.797
Age	0.336
Lymph node involvement	0.465
Grade	0.533
Necroses	0.911
Initial stage	0.216

^aStatistically significant at 0.05 level. HR: Hazard ratio; CI: Confidence interval.

Table 8 Administered chemotherapy regimens in the first-line setting according to primary tumour location

	FOLFOX, n (%)	FOLFIRI, n (%)	Cisplatin-etoposide (%)	Total, n (%)
LCC	61 (53.0)	21 (18.3)	1 (0.9)	83 (72.2)
RCC	19 (16.5)	13 (11.3)	-	32 (27.8)
Total	80 (69.5)	34 (29.6)	1 (0.9)	115 (100)

RCC: Right colon cancer; LCC: Left colon cancer.

Table 9 Administered antibodies in the first-line setting according to RAS mutation status and progression-free survival time

	RAS status	Bevacizumab, n (%)	PFS	Panitumumab, n (%)	PFS	Total, n (%)	PFS
LCC	RAS wild type	20 (17.6)	12.3	27 (23.7)	15.8	47 (41.3)	14.0
	RAS mutant	35 (30.7)	11.6	-	-	35 (30.7)	11.6
	Total	55 (48.3)	11.6	27 (23.7)	15.8	82 (72.0)	12.2
RCC	RAS wild type	4 (3.4)	22.2	8 (7.0)	5.5	12 (10.4)	13.8
	RAS mutant	20 (17.6)	10	-	-	20 (17.6)	10
	Total	24 (21.0)	12.6	8 (7.0)	5.5	32 (28.0)	12.5
Total		79 (69.3)	12	35 (30.7)	14.5	114 (100.0)	12.3

RCC: Right colon cancer, LCC: Left colon cancer, PFS: Progression free survival.

Table 10 Cox regression analysis of first-line chemotherapy

	P value	HR	95%CI
BRAF wild type		(Ref cat)
BRAF mutant	^aP = 0.040	2.454	1.044-5.772
KRAS/NRAS	0.202
Location	0.166
Histology	0.636
Sex	0.405
Age	0.906
Antibody	0.748
Initial stage	0.217

^aStatistically significant at 0.05 level. HR: Hazard ratio; CI: Confidence interval.

Table 11 Administered chemotherapy regimens in the second-line setting according to primary tumour location

	FOLFOX, n (%)	FOLFIRI, n (%)	Total, n (%)
LCC	19 (19.4)	55 (56.1)	74 (75.5)
RCC	8 (8.2)	16 (16.3)	24 (24.5)
Total	27 (27.6)	71 (72.4)	98 (100.0)

RCC: Right colon cancer; LCC: Left colon cancer.

Table 12 Administered antibodies in the second-line setting according to RAS mutation status and time to progression-free survival

	RAS status	Bevacizumab, n (%)	PFS	Panitumumab, n (%)	PFS	Aflibercept, n (%)	PFS	Total, n (%)	PFS
LCC	RAS wild type	16 (16.5)	7.4	20 (20.6)	8.1	10 (10.3)	6.8	46 (47.4)	7.9
	RAS mutant	9 (9.3)	9	-	-	19 (19.6)	9.3	28 (28.9)	9.0
	Total	25 (25.8)	7.4	20 (20.6)	8.1	29 (29.9)	8.2	74 (76.3)	8.2
RCC	RAS wild type	2 (2.1)	4.4	6 (6.2)	12.3	1 (1.0)	7.7	9 (9.3)	9.0
	RAS mutant	7 (7.3)	10.4	-	-	7 (7.3)	7.0	14 (14.4)	12.3
	Total	9 (9.3)	10.4	6 (6.2)	12.3	8 (8.3)	7.1	23 (23.4)	8.6
		34 (34.5)	9.0	26 (26.8)	9.7	37 (38.1)	7.6	97 (100)	8.6

RCC: Right colon cancer; LCC: Left colon cancer; PFS: Progression free survival.

Table 13 Overall survival depending on the combination of administered antibodies in first- and second-line chemotherapy

First line	Second line	Median OS (mo)	P value
Bevacizumab	Bevacizumab	58.4	P = 0.693
Panitumumab	Bevacizumab	44.9
Bevacizumab	Panitumumab	51.7
Panitumumab	Panitumumab	46.7
Bevacizumab	Aflibercept	44.0
Panitumumab	Aflibercept	62.3

OS: Overall survival.

Table 14 Cox regression analysis of overall survival

	P value	HR	95%CI
KRAS wild type/NRAS wild type		(Ref cat)
KRAS mutant	^aP = 0.017	2.313	1.162-4.605
Initial stage I-III		(Ref cat)
Initial stage IV	^aP < 0.001	4.036	1.922-8.475
BRAF	0.373
Location	0.937
Histology	0.259
Sex	0.602
Age	0.250
Lymph nodes	0.407
Differentiation grade	0.142
Presence of necrosis	0.375
Presence of emboli	0.783

^aStatistically significant at 0.05 level. HR: Hazard ratio; CI: Confidence interval.

Citation: Kalantzis I, Nonni A, Pavlakis K, Delicha EM, Miltiadou K, Kosmas C, Ziras N, Gkoumas K, Gakiopoulou H. Clinicopathological differences and correlations between right and left colon cancer. World J Clin Cases 2020; 8(8): 1424-1443
URL: https://www.wjgnet.com/2307-8960/full/v8/i8/1424.htm
DOI: https://dx.doi.org/10.12998/wjcc.v8.i8.1424