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Clinicopathological differences and survival outcomes with first-line therapy in patients with left-sided colon cancer and rectal cancer: pooled analysis of 2879 patients from AGITG (MAX), COIN, FOCUS2, OPUS, CRYSTAL and COIN-B trials in the ARCAD database

Salem, Mohamed E., Yin, Jun, Weinberg, Benjamin A., Renfro, Lindsay A., Pederson, Levi D., Maughan, Timothy S., Adams, Richard A., Van Cutsem, Eric, Falcone, Alfredo, Tebbutt, Niall C., Seymour, Matthew T., Díaz-Rubio, Eduardo, Aranda, Enrique, Bokemeyer, Carsten, Heinemann, Volker, Wasan, Harpreet, de Gramont, Aimery, Grothey, Axel, Shi, Qian, Sargent, Daniel J. and Marshall, John L. 2018. Clinicopathological differences and survival outcomes with first-line therapy in patients with left-sided colon cancer and rectal cancer: pooled analysis of 2879 patients from AGITG (MAX), COIN, FOCUS2, OPUS, CRYSTAL and COIN-B trials in the ARCAD database. European Journal of Cancer 103 , pp. 205-213. 10.1016/j.ejca.2018.08.020

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Abstract

Purpose Patients with left-sided colon tumours have better survival and respond differently to biologics compared with patients with right-sided tumours. Left-sided colon tumours and rectal cancers are often grouped together. Herein, we examined the clinicopathological differences and outcomes between left-sided colon and rectal cancers. Patients and methods Data from 2879 metastatic colorectal cancer patients enrolled on six first-line clinical trials during 2004–2010 were pooled. Patients were included if the primary tumour origin was clearly defined. Progression-free survival (PFS) and overall survival (OS) were compared in the two groups after adjusting for patient and tumour characteristics, metastatic sites and the first-line regimen. Results In total, 1374 patients with metastatic left-sided colon cancer and 1505 patients with metastatic rectal cancers were evaluated. Left-sided colon cancer patients were more likely to be female (40.1% versus 32.6%; P < 0.0001) and older (31.0% ≥ 70 years versus 25.8%; P = 0.0033) compared with rectal cancers patients. Patients with left-sided colon cancer had higher rates of liver metastases (80.9% versus 72.3%, P < 0.0001) but lower rates of lung metastases (34.2% versus 53.8%, P < 0.0001). KRAS mutations were slightly less frequent among left-sided tumours (34.8% versus 40.5%; P = 0.0103). Patients with left-sided tumours had approximately similar PFS (median 7.4 versus 6.9 months; hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.87–1.03; P = 0.1998) and OS (median 17.4 versus 16.6 months; HR 0.99, 95% CI 0.91–1.07; P = 0.7597) compared with rectal cancer patients. Conclusion The site of tumour origin within the left side was not prognostic of outcomes. Moreover, neither bevacizumab nor cetuximab impacted, differently, the findings of the comparisons in outcomes between patients with left-sided colon tumours or rectal cancers.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Centre for Trials Research (CNTRR)
Publisher: Elsevier
ISSN: 0959-8049
Date of Acceptance: 22 August 2018
Last Modified: 25 May 2021 14:00
URI: https://orca.cardiff.ac.uk/id/eprint/141046

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