Clinical impact of primary tumor sidedness and sex on unresectable post-recurrence survival in resected pathological stage II-III colorectal cancers: a nationwide multicenter retrospective study
Shinya Abe,
Kazushige Kawai,
Hiroaki Nozawa,
Kazuhito Sasaki,
Koji Murono,
Shigenobu Emoto,
Tsuyoshi Ozawa,
Yuichiro Yokoyama,
Yuzo Nagai,
Hiroyuki Anzai,
Hirofumi Sonoda,
Shinichi Yamauchi,
Kenichi Sugihara,
Soichiro Ishihara
Affiliations
Shinya Abe
Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo
Kazushige Kawai
Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo
Hiroaki Nozawa
Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo
Kazuhito Sasaki
Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo
Koji Murono
Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo
Shigenobu Emoto
Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo
Tsuyoshi Ozawa
Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo
Yuichiro Yokoyama
Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo
Yuzo Nagai
Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo
Hiroyuki Anzai
Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo
Hirofumi Sonoda
Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo
Shinichi Yamauchi
Department of Surgical Oncology, Graduate School of Medicine, The Tokyo Medical and Dental University
Kenichi Sugihara
Department of Surgical Oncology, Graduate School of Medicine, The Tokyo Medical and Dental University
Soichiro Ishihara
Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo
Abstract Background Several studies have demonstrated that right-sided tumors have poorer prognosis than left-sided tumors in patients with unresectable colorectal cancer (CRC). The predictive ability of the tumor sidedness in CRC treated with chemotherapy in each sex is unclear. Methods Subjects were 964 unresectable recurrent patients treated with chemotherapy with stage II-III CRC after curative resection between 2004 and 2012. Post-recurrence cancer-specific survival (CSS) for each sex was examined. Results Patients were 603 males (222 right-side tumors (cecum to transverse colon) and 381 left-sided tumors (descending colon to rectum)), and 361 females (167 right-side tumors and 194 left-sided tumors). Right-sided tumors developed peritoneal recurrences in males and females. Left-sided tumors were associated with locoregional recurrences in males and with lung recurrences in females. Right-sided tumors were associated with shorter post-recurrence CSS in both sexes. In males, multivariate analyses showed that right-sided tumors were associated with shorter post-recurrence CSS (HR: 1.53, P < 0.0001) together with the presence of regional lymph node metastasis histopathological type of other than differentiated adenocarcinoma, the recurrence of liver only, the recurrence of peritoneal dissemination only, and relapse-free interval less than one-year. In females, multivariate analyses showed that right-sided tumors were associated with shorter post-recurrence CSS (HR: 1.50, P = 0.0019) together with advanced depth of invasion, the presence of regional lymph node metastasis, and recurrence of liver only. Conclusions Primary tumor sidedness in both sexes in unresectable recurrent CRC patients treated with chemotherapy may have prognostic implications for post-recurrence CSS.
