Clinicopathological differences and correlations between right and left colon cancer

Doctoral Dissertation uoadl:2920868 102 Read counter

Unit:
Faculty of Medicine
Library of the School of Health Sciences
Deposit date:
2020-07-30
Year:
2020
Author:
Kalantzis Ioannis
Dissertation committee:
Παυλάκη Αικατερίνη, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ, Επιβλέπουσα
Γακιοπούλου Χαρίκλεια, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Νόννη Αφροδίτη, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Λάζαρης Ανδρέας, Καθηγήτης, Ιατρική Σχολή, ΕΚΠΑ
Καβαντζάς Νικόλαος, Καθηγήτης, Ιατρική Σχολή, ΕΚΠΑ
Κορκολοπούλου Πηνελόπη, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Τσελένη Σοφία, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Κλινικοπαθολογοανατομικές διαφορές και συσχετίσεις μεταξύ καρκίνου του δεξιού και αριστερού τμήματος του παχέος εντέρου
Languages:
Greek
Translated title:
Clinicopathological differences and correlations between right and left colon cancer
Summary:
Background

The differences in histopathology and molecular biology between right colon cancer (RCC) and left colon cancer (LCC) were first reported in the literature by Bufill in 1990. Since then, a large number of studies have confirmed their differences in epidemiology, clinical presentation, comorbidities and biological behaviour, which may be related to the difference in prognosis and overall survival (OS) between the two groups.

Aim

To investigate statistically significant differences between Greek patients with LCC and RCC in terms of epidemiology, clinical manifestation, histopathology and molecular biology, taking into consederaration the response rates in targeted regimens in first and second line chemotherapy and overall survival.

Methods

The present observational study included 144 patients diagnosed with colon cancer of any stage who received chemotherapy in a Greek tertiary oncology hospital during a 2.5-year period. Clinical information, comorbidities, histopathologic characteristics and molecular biomarkers were collected from the patients’ medical records retrospectively, while administered chemotherapy regimens, targeted agents, progression-free survival (PFS) periods with first- and second-line chemotherapy and OS were recorded retroactively and prospectively. Data analysis was performed with the SPSS statistical package.

Results

Eighty-six males and 58 females participated in the study. One hundred (69.4%) patients had a primary lesion in the left colon, and 44 (30.6%) patients had a primary lesion in the right colon. Patients with RCC were more likely to display anaemia than patients with LCC (OR = 3.09), while LCC patients were more likely to develop rectal bleeding (OR = 3.37) and a feeling of incomplete evacuation (OR = 2.78). Considering comorbidities, RCC patients were more likely to suffer from diabetes (OR = 3.31) and coronary artery disease (p = 0.056) than LCC patients. The mucinous differentiation rate was higher in the right-sided group than in the left-sided group (OR = 4.49), as was the number of infiltrated lymph nodes (p = 0.039), while the percentage of high-grade differentiation was higher in the group of patients with left-sided colon cancer (OR = 2.78). RAS wild-type patients who received anti-EGFR treatment experienced greater benefit (PFS: 16.5 mo) than those who received anti-VEGF treatment (PFS: 13.7 mo) (p = 0.05), while among RAS wild-type patients who received anti-EGFR treatment, LCC patients experienced greater benefit (PFS: 15.8 mo) than the RCC subgroup (PFS: 5.5 mo) in the first-line chemotherapy setting (p = 0.034). BRAF-mutant patients had shorter PFS (9.3 mo) than BRAF wild-type patients (14.5 mo) (p = 0.033). RCC patients showed a shorter tumour recurrence period (7.7 mo) than those with LCC (14.5 mo) (p < 0.001), as well as shorter overall survival (58.4 mo for RCC patients; 82.4 mo for LCC patients) (p = 0.018).

Conclusion

RCC patients present more comorbidities, worse histological and molecular characteristics and a consequently higher probability of tumour recurrence, poor response to targeted therapy and shorter overall survival than LCC patients.
Main subject category:
Health Sciences
Keywords:
Colorectal neoplasm, Epidermal growth factor, Vascular endothelial growth factor, Histology, Molecular biology, Metabolic syndrome
Index:
No
Number of index pages:
0
Contains images:
Yes
Number of references:
204
Number of pages:
185
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