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Gholamalizadeh H, Zafari N, Velayati M, Fiuji H, Maftooh M, Ghorbani E, Hassanian SM, Khazaei M, Ferns GA, Nazari E, Avan A. Prognostic value of primary tumor location in colorectal cancer: an updated meta-analysis. Clin Exp Med 2023; 23:4369-4383. [PMID: 37405571 DOI: 10.1007/s10238-023-01120-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/12/2023] [Indexed: 07/06/2023]
Abstract
The clinical, histological, and molecular differences between right-sided colon cancer (RCC) and left-sided colon cancer (RCC) have received considerable attention. Over the past decade, many articles have been published concerning the association between primary tumor location (PTL) of colorectal cancer and survival outcomes. Therefore, there is a growing need for an updated meta-analysis integrating the outcomes of recent studies to determine the prognostic role of right vs left-sidedness of PTL in patients with colorectal cancer. We conducted a comprehensive database review using PubMed, SCOPUS, and Cochrane library databases from February 2016 to March 2023 for prospective or retrospective studies reporting data on overall survival (OS) and cancer-specific survival (CSS) of RCC compared with LCC. A total of 60 cohort studies comprising 1,494,445 patients were included in the meta-analysis. We demonstrated that RCC is associated with a significantly increased risk of death compared with LCC by 25% (hazard ratio (HR), 1.25; 95% confidence interval (CI), 1.19-1.31; I2 = 78.4%; Z = 43.68). Results showed that patients with RCC have a worse OS compared with LCC only in advanced stages (Stage III: HR, 1.275; 95% CI 1.16-1.4; P = 0.0002; I2 = 85.8%; Stage IV: HR, 1.34; 95% CI 1.25-1.44; P < 0.0001; I2 = 69.2%) but not in primary stages (Stage I/II: HR, 1.275; 95% CI 1.16-1.4; P = 0.0002; I2 = 85.8%). Moreover, a meta-analysis of 13 studies including 812,644 patients revealed that there is no significant difference in CSS between RCC and LCC (HR, 1.121; 95% CI 0.97-1.3; P = 0.112). Findings from the present meta-analysis highlight the importance of PTL in clinical decision-making for patients with CRC, especially in advanced stages. We provide further evidence supporting the hypothesis that RCC and LCC are distinct disease entities that should be managed differently.
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Affiliation(s)
- Hanieh Gholamalizadeh
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nima Zafari
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahla Velayati
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Fiuji
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mina Maftooh
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Basic Sciences Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elnaz Ghorbani
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Mahdi Hassanian
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Basic Sciences Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Khazaei
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Basic Sciences Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon A Ferns
- Division of Medical Education, Brighton and Sussex Medical School, Falmer, Brighton, Sussex, BN1 9PH, UK
| | - Elham Nazari
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
- Basic Sciences Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Amir Avan
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
- College of Medicine, University of Warith Al-Anbiyaa, Karbala, Iraq.
- School of Mechanical, Medical and Process Engineering, Science and Engineering Faculty, Queensland University of Technology, 2 George St, Brisbane, QLD, 4000, Australia.
- Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia.
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Fernández Montes A, Alonso Orduña V, Asensio Martínez E, Rodríguez Salas N, Torres E, Cacho Lavín D, Rodríguez Alonso RM, Falcó E, Oliva JC, Cirera L, García Gómez J, Pericay C. The Frequency of Specific KRAS Mutations, and Their Impact on Treatment Choice and Survival, in Patients With Metastatic Colorectal Cancer. Oncologist 2023; 28:e902-e909. [PMID: 37141400 PMCID: PMC10546812 DOI: 10.1093/oncolo/oyad117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/17/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Patients with metastatic colorectal cancer (mCRC) and KRAS mutations have a poor prognosis, seemingly dependent on the location of the mutation. This multicenter, retrospective, cohort study assessed the frequency and prognostic value of specific KRAS mutation codon locations in mCRC patients, and survival outcomes in relation to treatment. MATERIALS AND METHODS Data from mCRC patients treated in 10 Spanish hospitals between January 2011 and December 2015 were analyzed. The main objective was to investigate (1) the impact of KRAS mutation location on overall survival (OS), and (2) the effect of targeted treatment plus metastasectomy and primary tumor location on OS in patients with KRAS mutations. RESULTS The KRAS mutation location was known for 337/2002 patients. Of these, 177 patients received chemotherapy only, 155 received bevacizumab plus chemotherapy, and 5 received anti-epidermal growth factor receptor therapy plus chemotherapy; 94 patients underwent surgery. The most frequent KRAS mutation locations were G12A (33.8%), G12D (21.4%), and G12V (21.4%). Compared with other locations, patients with a G12S mutation had the shortest median OS (10.3 [95% CI, 2.5-18.0] months). OS was longer in patients who underwent surgery versus those who did not, with a trend toward prolonged survival with bevacizumab (median OS 26.7 [95% CI, 21.8-31.7] months) versus chemotherapy alone (median OS 23.2 [95% CI, 19.4-27.0] months). CONCLUSION These findings confirm that KRAS mutation location may predict survival outcomes in patients with mCRC, and suggest that pre-/post-operative bevacizumab plus metastasectomy provides survival benefits in patients with KRAS mutations.
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Affiliation(s)
- Ana Fernández Montes
- Servicio de Oncología Médica, Complexo Hospitalario Universitario de Ourense, Calle Ramón Puga Noguerol, Ourense, Spain
| | - Vicente Alonso Orduña
- Servicio de Oncología Médica, Hospital Universitario Miguel Servet, Instituto de Investigacion Sanitaria de Aragon, Paseo Isabel la Católica, Zaragoza, Spain
| | - Elena Asensio Martínez
- Servicio de Oncología Médica, Hospital General Universitario de Elche, Carrer Almazara, Elche, Alicante, Spain
| | - Nuria Rodríguez Salas
- Servicio de Oncología Médica, Hospital Universitario La Paz, Paseo de la Castellana, Madrid, Spain
| | - Esperanza Torres
- UGC intercentros de Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria and Instituto de Investigación Biomédica de Málaga (IBIMA), Campus de Teatinos, Málaga, Spain
| | - Diego Cacho Lavín
- Servicio de Oncología Médica, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Rosa María Rodríguez Alonso
- Servicio de Oncología Médica, Hospital Universitario Reina Sofía-Córdoba, Avenida Menéndez Pidal, Córdoba, Spain
| | - Esther Falcó
- Servicio de Oncología Médica, Hospital de Son Llàtzer, Carretera de Manacor, Palma de-Mallorca, Illes Balears, Spain
| | - Joan Carles Oliva
- Institut d’Investigació I Innovació I3PT, Fundació Parc Taulí, Plaça Taulí, Sabadell, Barcelona, Spain
| | - Lluis Cirera
- Servicio de Oncología Médica, Hospital Universitario Mútua Terrassa, Plaça del Doctor Robert, Terrassa, Barcelona, Spain
| | - Jesus García Gómez
- Servicio de Oncología Médica, Complexo Hospitalario Universitario de Ourense, Calle Ramón Puga Noguerol, Ourense, Spain
| | - Carles Pericay
- Servicio de Oncología Médica, Hospital Universitari Parc Taulí, Plaça Taulí, Sabadell, Barcelona, Spain
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Yin J, Cohen R, Jin Z, Liu H, Pederson L, Adams R, Grothey A, Maughan TS, Venook A, Van Cutsem E, Punt C, Koopman M, Falcone A, Tebbutt NC, Seymour MT, Bokemeyer C, Rubio ED, Kaplan R, Heinemann V, Chibaudel B, Yoshino T, Zalcberg J, Andre T, De Gramont A, Shi Q, Lenz HJ. Prognostic and Predictive Impact of Primary Tumor Sidedness for Previously Untreated Advanced Colorectal Cancer. J Natl Cancer Inst 2021; 113:1705-1713. [PMID: 34061178 DOI: 10.1093/jnci/djab112] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/13/2021] [Accepted: 05/26/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Unplanned subgroup analyses from several studies have suggested primary tumor sidedness (PTS) as a potential prognostic and predictive parameter in metastatic colorectal cancer (mCRC). We aimed to investigate the impact of PTS on outcomes of mCRC patients. METHODS PTS data of 9277 mCRC patients from 12 first-line randomized trials in the ARCAD database were pooled. Overall survival (OS) and progression-free survival (PFS) were assessed using Kaplan-Meier and Cox models adjusting for age, sex, performance status, prior radiation/chemotherapy, and stratified by treatment arm. Predictive value was tested by interaction term between PTS and treatment (cetuximab plus chemotherapy vs chemotherapy alone). All statistical tests were 2-sided. RESULTS Compared with right-sided metastatic colorectal cancer patients (n = 2421, 26.1%), left-sided metastatic colorectal cancer patients (n = 6856, 73.9%) had better OS (median = 21.6 vs 15.9 months; adjusted hazard ratio [HRadj] = 0.71, 95% confidence interval [CI] = 0.67 to 0.76; P < .001) and PFS (median = 8.6 vs 7.5 months; HRadj = 0.80, 95% CI = 0.75 to 0.84; P < .001). Interaction between PTS and KRAS mutation was statistically significant (Pinteraction < .001); left-sidedness was associated with better prognosis among KRAS wild-type (WT) (OS HRadj = 0.59, 95% CI = 0.53 to 0.66; PFS HRadj =0.68, 95% CI = 0.61 to 0.75) but not among KRAS mutated tumors. Among KRAS-WT tumors, survival benefit from anti-EGFR was confirmed for left-sidedness (OS HRadj = 0.85, 95% CI = 0.75 to 0.97; P = .01; PFS HRadj = 0.77, 95% CI = 0.67 to 0.88; P < .001) but not for right-sidedness. CONCLUSIONS The prognostic value of PTS is restricted to the KRAS-WT population. PTS is predictive of anti-EGFR efficacy, with a statistically significant improvement of survival for left-sidedness mCRC patients. These results suggest treatment choice in mCRC should be based on both PTS and KRAS status.
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Affiliation(s)
- Jun Yin
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Romain Cohen
- Department of Medical Oncology, Saint-Antoine Hospital, Paris, France
| | - Zhaohui Jin
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Heshan Liu
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Levi Pederson
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Richard Adams
- Cardiff University and Velindre Cancer Centre, Cardiff, UK
| | - Axel Grothey
- West Cancer Center and Research Institute, OneOncology, Germantown, TN, USA
| | - Timothy S Maughan
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK
- St James's Hospital, University of Leeds, Leeds, UK
| | - Alan Venook
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Eric Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg Leuven, University of Leuven, Leuven, Belgium
| | - Cornelis Punt
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, the Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | | | - Niall C Tebbutt
- Department of Medical Oncology, Austin Health, Melbourne, Australia
| | - Matthew T Seymour
- NIHR Clinical Research Network, St James's Hospital, University of Leeds, Leeds, UK
| | - Carsten Bokemeyer
- Department of Oncology, Haematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eduardo Diaz Rubio
- Universidad Complutense Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos, Madrid, Spain
| | - Richard Kaplan
- MRC Clinical Trials Unit at UCL, University College London, London, UK
| | - Volker Heinemann
- University Hospital Grosshadern, Ludwig Maximilian University of Munich, Munich, Germany
| | | | | | - John Zalcberg
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | | | - Aimery De Gramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - Qian Shi
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Heinz-Josef Lenz
- Department of Gastrointestinal Oncology, Keck School of Medicine at USC, Los Angeles, CA, USA
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