Comparison of 627 patients with right- and left-sided cancer of the colon in china: variations in clinicopathology, recurrence, and survival


Colorectal cancer (CRC) may be the third-most generally diagnosed cancer in males and also the second in females, by having an believed 1.4 million cases and 693,900 deaths occurring this year worldwide.1 In China, the incidence of CRC is growing quickly which is now rated fifth when it comes to morbidity and mortality of all malignancies.2 Research has proven that right-sided colon cancers have become more widespread, having a loss of the incidence of left-sided colon cancers.3   4 It’s been recommended that there might be two distinct groups of cancer: right- and left-sided colon cancers that arise proximally and distally towards the splenic flexure, correspondingly.5 Subsequently, several research has suggested explanations with this difference including genetic, ecological, and embryological factors.5 6   7 The main tumor location has prognostic importance that relates to targeted therapy response in patients with metastatic CRC.8   9 In 13 first-line randomized controlled trials and something prospective pharmacogenetic study, right-sided cancer of the colon is connected having a considerably worse prognosis when compared with left-sided cancer of the colon [hazard ratio (HR) for overall survival (OS) = 1.56, 95% confidence interval (CI): 1.43–1.70, P < 0.001)]. 8 A meta-analysis of fireside-3/AIO KRK0306, CALGB/SWOG 80405, and PEAK studies established that patients with RAS wild-type left-sided cancer of the colon were built with a considerably greater survival take advantage of the inclusion of anti-epidermal growth factor receptor (EGFR) treatment in contrast to anti-vascular endothelial growth factor (VEGF) treatment to plain chemotherapy (HR = .71, 95% CI: .58–0.85, P = .0003). 8

However, there’s been conflicting specifics of the connection between cancer location and prognosis in patients with stage I–III disease.10 11 12 13 14 15 16   17 Some studies established that right-sided cancer of the colon continues to be connected with worse survival than left-sided cancer of the colon.10   12 A meta-analysis of 66 studies (n = 1,437,846 patients) having a median follow-from 65 several weeks says left-sided primary tumor location was connected having a considerably reduced chance of dying (HR = .82, 95% CI: .79–0.84, P < 0.001) independent of the stage. 16 Weiss et al13 reported no overall improvement in 5-year mortality between right- and left-sided colon cancers but discovered that within stage II disease right-sided cancers had lower mortality while within stage III right-sided cancers had greater mortality. However, Moritani et al14 discovered that patients with stage I right-sided cancer of the colon were built with a considerably greater 5-year disease-free survival (DFS) rate than did individuals with left-sided disease however, there wasn’t any factor at stages II and III. A population-based analysis of stage I–III cancer of the colon provided evidence that in phases I and II, the prognosis of right-sided cancer was better for OS (HR = .89 95% CI: .84–0.94 and HR = .85, 95% CI: .81–0.89), along with a similar prognosis seemed to be observed for stage III (HR = .99 95% CI: .95–1.03). 17

Therefore, it’s unclear if the primary tumor location relates to DFS and OS among Chinese patients with stage II/III cancer of the colon. We used just one institutional Chinese database without racial diversity to look at the connection between tumor site (right- versus. left-side) and 5-year mortality. Particularly, we searched for to find out if the relationship is consistent across tumor stages.


Study population

All patients within this study went through curative resection for cancer of the colon between The month of january 2005 and December 2008 in the Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China. Histopathological staging was confirmed postoperatively with a talking to pathologist based on American Joint Committee on Melanoma-node-metastasis (TNM) staging system. To become qualified for that study, patients needed to be a minimum of 18 years old, with TNM stage II or III cancer of the colon, and sufficient organ function. The tumor location in the cecum towards the sigmoid colon was indexed by the seventh edition TNM criteria. The cecum and also the climbing and transverse colon were understood to be the best-sided colon, whereas the climbing down and sigmoid colon were understood to be the left-sided colon. We excluded patients receiving preoperative chemotherapy- or radiotherapy that may modify the postoperative survival. Patients over the age of 85 many individuals with multiple synchronous large bowel carcinomas or familial adenomatous polyposis were also excluded.

The research protocol was authorized by the Medical Ethics Committee of Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China. The research was conducted in compliance using the Helsinki Promise of 1975 as revised in 1983.


Left sided vs. Right sided heart failure