Impact of laterality and mucinous histology on relapse-free and overall survival in a registry-based colon cancer series

Francesca Negri,Matteo Goldoni,Cinzia Azzoni,Laura Manotti,Guido Rindi,Stefano Cascinu,Annalisa Gilli,Letizia Gnetti,Lorena Bottarelli,Enrico Maria Silini,Paolo Sgargi,Annamaria De Giorgi,Maria Michiara,Francesco Leonardi

doi:10.1038/s41598-019-40096-6

Abstract

Recent data suggest that tumor laterality and mucinous histology may be clinically relevant. We investigated how both variables impact on the prognosis and the response to therapies in a large population-based cohort of cancer patients. Incidence data, clinical and pathological features, and outcome were systematically collected from the Tumor Registry of Parma over the years 2004–2009. Survival data were modeled by multivariable analysis. 1358 patients affected by stage I–IV colon cancer were considered; 661 (49%) had right-sided and 697 (51%) left-sided tumors. 144 (11%) had mucinous (MAC) and 1214 (89%) non-mucinous (NMAC) histology. MACs and NMACs of the right colon showed no difference in stage distribution, whereas left colon MACs were more frequently in an advanced stage (stage IV) (p = 0.008). Stage IV right colon tumors had a poorer overall survival than stage IV left-sided colon cancers (75th percentile 20 vs 34 months, p < 0.001). At relapse, MACs were less responsive to systemic therapy and had worse survival compared with NMACs regardless of tumor side (7.1 vs 13.1 months, p = 0.018). Right-sided colon cancers had poorer survival compared to left-sided tumors; the effect was mainly attributable to NMACs. At relapse, MACs had unfavorable prognosis regardless of the primary tumor-side.

Highlights

Recent data suggest that tumor laterality and mucinous histology may be clinically relevant
Mucinous adenocarcinomas (MACs) is a predictor of poor outcome[16,17,18], but it is contentious whether histology exerts an independent effect or it is dependent on site, stage or genetic features such as MSI19,20
Right-sided Colorectal cancer (CRC) had a worse OS compared with left-sided tumors (75th percentile 20 vs 34 months, p < 0.001; Fig. 1A)

Summary

Introduction

Recent data suggest that tumor laterality and mucinous histology may be clinically relevant. We investigated how both variables impact on the prognosis and the response to therapies in a large population-based cohort of cancer patients. Right-sided colon cancers had poorer survival compared to left-sided tumors; the effect was mainly attributable to NMACs. At relapse, MACs had unfavorable prognosis regardless of the primary tumor-side. Clinical behavior and prognosis of CRC depend mainly on tumor stage, grade, age, gender, molecular and pathological features[2]. A dichotomy between right-sided (proximal to the splenic flexure) and left-sided CRC (distal to the splenic flexure) is supported by embryological, epidemiological, clinical, pathological and molecular data[5]. The study included pathological revision of all cases with an original diagnosis of MAC and the analysis of the effect of therapy on both primary and recurrent tumors

Methods

Results

Conclusion