• Annals of surgery · Feb 2024

    Prognostic Relevance of Primary Tumor Sidedness in Early-Stage Colorectal Cancer: An Integrated Analysis of Four Randomized Controlled Trials (JCOG2003A).

    • Akira Ouchi, Ryo Sadachi, Tetsuya Hamaguchi, Shunsuke Tsukamoto, Yasuhiro Shimada, Masafumi Inomata, Yasumasa Takii, Koji Komori, Akio Shiomi, Manabu Shiozawa, Masayuki Ohue, Jun Watanabe, Masaaki Ito, Yoshiyuki Kawashima, Takaya Kobatake, Hiroaki Souda, Yoshihisa Saida, Tadayoshi Hashimoto, Yusuke Sano, Yukihide Kanemitsu, and JCOG Colorectal Cancer Study Group.
    • Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Aichi, Japan.
    • Ann. Surg. 2024 Feb 1; 279 (2): 283289283-289.

    ObjectiveThe aim of this study was to determine the genuine prognostic relevance of primary tumor sidedness (PTS) in patients with early-stage colorectal cancer (CRC).BackgroundThe prognostic relevance of PTS in early-stage CRC remains a topic of debate. Several large epidemiological studies investigated survival only and did not consider the risk of recurrence so far.MethodsPatients with stage II/III adenocarcinoma of the colon and upper rectum from 4 randomized controlled trials were analyzed. Survival outcomes were compared according to the tumor location: right-sided (cecum to transverse colon) or left-sided (descending colon to upper rectum).ResultsA total of 4113 patients were divided into a right-sided group (N=1349) and a left-sided group (N=2764). Relapse-free survival after primary surgery was not associated with PTS in all patients and each stage [hazard ratio (HR) adjusted =1.024 (95% CI: 0.886-1.183) in all patients; 1.327 (0.852-2.067) in stage II; and 0.990 (0.850-1.154) in stage III]. Also, overall survival after primary surgery was not associated with PTS in all patients and each stage [HR adjusted =0.879 (95% CI: 0.726-1.064) in all patients; 1.517 (0.738-3.115) in stage II; and 0.840 (0.689-1.024) in stage III]. In total, 795 patients (right-sided, N=257; left-sided, N=538) developed recurrence after primary surgery. PTS was significantly associated with overall survival after recurrence (HR adjusted =0.773, 95% CI: 0.627-0.954).ConclusionsPTS had no impact on the risk of recurrence for stage II/III CRC. Treatment stratification based on PTS is unnecessary for early-stage CRC.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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