Akce Mehmet, Zakka Katerina, Jiang Renjian, Williamson Shayla, Alese Olatunji B, Shaib Walid L, Wu Christina, Behera Madhusmita, El-Rayes Bassel F
Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, United States.
Department of Internal Medicine, Wellstar Health System, Atlanta Medical Center, Atlanta, GA, United States.
Front Oncol. 2021 Mar 30;11:592351. doi: 10.3389/fonc.2021.592351. eCollection 2021.
Tumor sidedness as a prognostic factor in advanced stage colon cancer (CC) is well established. The impact of tumor sidedness on the clinical outcomes of stage II and III CC has not been well studied.
The National Cancer Database (NCDB) was utilized to identify patients with pathological stage II and III primary adenocarcinoma of the colon from 2010 to 2015 using ICD-O-3 morphology and topography codes: 8140-47, 8210-11, 8220-21, 8260-63, 8480-81, 8490 and C18.0, 18.2,18.3, 18.5,18.6, 18.7. Univariate (UVA) and multivariable (MVA) survival analyses and Kaplan-Meier Curves with Log-rank test were utilized to compare overall survival (OS) based on tumor location and treatment received.
A total of 35,071 patients with stage II (n = 17,629) and III (n = 17,442) CC were identified. 51.3% female; 81.5% Caucasian; median age 66 (range, 18-90). Majority of stage II and III tumors were right sided, 61.2% (n = 10,794) and 56.0% (n = 9,763). Microsatellite instability high (MSI-H) was more common in stage II compared to III, 23.3% (n = 4,115) 18.2% (n = 3,171) (p < 0.0001). In stage II MSI-H CC right was more common than left, 78.3% (n = 3223) 21.7% (n = 892). There was no significant difference in survival between stage II MSI-H left right (5-year OS 76.2 74.7%, p = 0.1578). Stage II MSS CC right was more common than left, 56.0% (n = 7571) 44.0% (n = 5943), and survival was better in the left right (5-year OS 73.2 70.8%, p = 0.0029). Stage III MSI-H CC was more common in the right than in the left, 75.6% (n = 2,397) vs 24.4% (n = 774) and survival was better in the left (5-year OS 62.5 56.5%, p = 0.0026). Stage III MSS CC was more common in the right than in the left, 51.6% (n = 7,366) 48.4% (n = 6,905), and survival was better in the left right (5-year OS 67.0 54.4%, p < 0.001).
Survival was better in left sided tumors compared to right in stage II MSS, stage III MSS, and stage III MSI-H CC.
肿瘤部位作为晚期结肠癌（CC）的一个预后因素已得到充分证实。肿瘤部位对II期和III期CC临床结局的影响尚未得到充分研究。
利用国家癌症数据库（NCDB），通过ICD - O - 3形态学和部位编码：8140 - 47、8210 - 11、8220 - 21、8260 - 63、8480 - 81、8490以及C18.0、18.2、18.3、18.5、18.6、18.7，识别2010年至2015年患有病理II期和III期原发性结肠腺癌的患者。采用单因素（UVA）和多因素（MVA）生存分析以及带有对数秩检验的Kaplan - Meier曲线，根据肿瘤位置和接受的治疗来比较总生存期（OS）。
共识别出35071例II期（n = 17629）和III期（n = 17442）CC患者。女性占51.3%；白种人占81.5%；中位年龄66岁（范围18 - 90岁）。II期和III期肿瘤大多位于右侧，分别为61.2%（n = 10794）和56.0%（n = 9763）。微卫星高度不稳定（MSI - H）在II期比III期更常见，分别为23.3%（n = 4115）和18.2%（n = 3171）（p < 0.0001）。在II期MSI - H CC中，右侧比左侧更常见，分别为78.3%（n = 3223）和21.7%（n = 892）。II期MSI - H左侧和右侧的生存率无显著差异（5年总生存率76.2%对74.7%，p = 0.1578）。II期微卫星稳定（MSS）CC右侧比左侧更常见，分别为56.0%（n = 7571）和44.0%（n = 5943），左侧的生存率优于右侧（5年总生存率73.2%对70.8%，p = 0.0029）。III期MSI - H CC右侧比左侧更常见，分别为75.6%（n = 2397）对24.4%（n = 774），左侧的生存率更好（5年总生存率62.5%对56.5%，p = 0.0026）。III期MSS CC右侧比左侧更常见，分别为51.6%（n = 7366）和48.4%（n = 6905），左侧的生存率优于右侧（5年总生存率67.0%对54.4%，p < 0.001）。
在II期MSS、III期MSS和III期MSI - H CC中，左侧肿瘤的生存率优于右侧。
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