Survival trends for left and right sided colon cancer using the population-based SEER database: A 45-year analysis from 1975 to 2019.

Authors

null

Mark Bilinyi Ulanja

CHRISTUS Ochsner St. Patrick Hospital, Lake Charles, LA

Mark Bilinyi Ulanja , Kwabena Oppong Asafo-Agyei , Bryce D Buetler , Daniel Antwi-Amoabeng , Reginald N. Ulanja , Vijay Neelam , Tarig Mabrouk , Samuel B Governor , Millicent Amankwah , Ganiyu A. Rahman , Francis T. Djankpa , Olatunji B. Alese

Organizations

CHRISTUS Ochsner St. Patrick Hospital, Lake Charles, LA, CHRISTUS Highland Medical Center, Shreveport, LA, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana, Christus St Patrick Hospital, Lake Charles, LA, Washington University School of Medicine in St. Louis, Division of General Medical Sciences, St Louis, MO, Feist-Weiller Cancer Center at LSUHSC-Shreveport, Shreveport, LA, University of Cape Coast, Cape Coast, Ghana, Department of Physiology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana, Winship Cancer Institute of Emory University, Atlanta, GA

Research Funding

No funding received
None.

Background: Survival differences between left sided (LCC) and right sided colon cancer (RCC) have been previously reported with mixed results. Many used short study periods and did not account for "other cause of mortality" (OCM). The differences in survival may exist irrespective of modern therapeutic agents, with implications for future clinical trial designs. Methods: We sought to assess the trends in the cause- specific and overall survival of colon cancer based on sidedness, using competing risk analysis. A SEER database from 1975 to 2019 was used.Time interval chosen based on clinical adoption of modern chemotherapy (1975-1989 = period A, 1990-2004 = B, 2005-2019 = C). Cox model was used for overall survival (OS), and Fine-Gray competing risk analysis for cause-specific survival (CSS). Adenocarcinoma were included, and primary rectal cancers excluded. Results: Of the 227,637 colon cancer patients, 50.1% were female and 46.2% RCC. Racial distribution of LCC vs RCC; Black-48.5% vs 51.5%, White-53.1% vs 46.9%, API/AN-63.7% vs 36.3%; p < 0.001. Age ≥ 65 were more likely to have RCC vs LCC (51.4% vs 48.6%), LCC common for age 18-49 (64.6% vs 35.4%), 50-64 (62.3% vs 37.7%), p < 0.00l. Females more likely to have RCC (50.4%vs 41.9%; p < 0.001), and males to have LCC (58.1% vs 49.6%;p < 0.001). Median CSS for LCC and RCC was 19.3 and 16.7 years respectively for 1975-1989 but median CSS for period B and C did not reach during study period. Median OS increased over time for both LCC (A = 5.5 yrs.; B = 7.6yrs and C = 10.5 yrs.) and RCC (4.3, 5.8 and 7.5yrs respectively). CSS was better for LCC than RCC for period C (aHR 0.89; 0.86-0.92; p < 0.001). LCC consistently showed superior OS for all study periods. Stage stratification showed worse CSS for localized and regional LCC in the earlier study periods, but the risk attenuated over time. However, left sided distant disease had superior CSS for all periods. Overall survival was better for LCC irrespective of stage, with gradual improvement over time(table 1). Conclusions: Over the past four decades, LCC has shown superior survival over right sided tumors. Furthermore, prognosis between LCC and RCC became more divergent in favor of LCC with the adoption of modern chemotherapy. Clinical trials for colon cancer should consider sidedness when recruiting patients for intervention.

StageCSSOS
aHR(95%CI)p-valueaHR(95%CI)p-value
Localized
1975-19891.151.09-1.22< 0.0010.930.90-0.95< 0.001
1990-20041.061.00-1.120.0580.910.88-0.93< 0.001
2005-20190.950.877-1.030.2110.860.82-0.90< 0.001
Regional
1975-19891.121.08-1.15< 0.0010.990.97-1.020.662
1990-20041.091.05-1.13< 0.0010.980.96-1.010.178
2005-20190.970.92-1.020.2380.880.85-0.92< 0.001
Distant
1975-19890.820.79-0.85< 0.0010.790.76-0.81< 0.001
1990-20040.870.84-0.90< 0.0010.850.83-0.88< 0.001
2005-20190.820.79-0.86< 0.0010.780.75-0.81< 0.001

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Publication Only: Gastrointestinal Cancer—Colorectal and Anal

Track

Gastrointestinal Cancer—Colorectal and Anal

Sub Track

Colorectal Cancer–Advanced Disease

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr e15560)

DOI

10.1200/JCO.2023.41.16_suppl.e15560

Abstract #

e15560

Abstract Disclosures