A relationship to survival is seen by combining the factors of mismatch repair status, tumor location and age of onset in colorectal cancer patientsReport as inadecuate




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Background

The progression of colorectal cancer CRC may differ depending on the location of the tumor and the age of onset of the disease. Previous studies also suggested that the molecular basis of CRC varies with tumor location, which could affect the clinical management of patients. Therefore, we performed survival analysis looking at different age groups and mismatch repair status MMR of CRC patients according to primary tumor location in an attempt to identify subgroups of CRC that might help in the prognosis of disease.

Methods

A group of 2233 patients operated on to remove their CRC tumors were analyzed 521 with right colon cancer, 740 with left colon cancer and 972 with rectal cancer. The expression of four MMR genes was assessed by immunohistochemistry IHC, independent of clinical criteria. From the data collected, a predictive model for overall survival OS could be constructed for some associations of tumor location and age of onset using Kaplan-Meier, logistic and Cox regression analysis.

Results

When tumor location was considered as the lone factor, we found no statistical difference in overall survival OS between right cancer 68%, left cancer 67% or rectal cancer tumor locations 71% HR: 1.17, 95%CI confidence interval: 0.97–1.43, P = 0.057. When age of onset was considered, middle age 40–59 years and older 60–85 years patients were found to have higher OS than younger onset cancer 20–39 years patients 69% vs 71% vs 59%, HR: 1.07, 95% confidence interval CI: 0.91–1.25, P = 0.008. When both age of onset and tumor location were considered in combination as disease factors, we found that the subgroup of patients with left colon cancer from middle age 69% and older 67% aged patients had higher OS than younger 54% patients HR: 0.89, 95%CI: 0.68–1.16, P = 0.048. However in patients with right colon cancers, we found no statistical difference is OS between younger, middle age or older grouped patients 60% vs 71% vs 67%, HR: 0.84, 95% CI: 0.61–1.16, P = 0.194. With regard to rectal located cancers, we found that younger 62% and middle age 68 patients had lower OS than older 77% patients HR:1.46, 95%CI: 1.13–1.88, P = 0.004. The rates of deficient MMR dMMR was 10.4%. We found no statistical difference in OS stratified by tumor locations. However, right colon cancer patients with dMMR 86% had higher OS than those with proficient MMR pMMR 63% HR: 3.01, 95% CI: 1.82–4.97, P<0.001. Left colon cancer patients with dMMR 76% also had higher OS than those with pMMR 66% HR: 1.67, 95% CI: 0.95–2.92, P = 0.01. Oppositely, rectal cancer patients with dMMR 60% had lower OS than those pMMR 68% HR: 0.77, 95% CI: 0.51–1.17, P = 0.04.

Conclusions

These data demonstrate that primary tumor location can be an important factor when considered along with age of onset for the prognosis of CRC. Primary tumor location is also an important factor to evaluate the predictive effect of MMR status for the prognosis of CRC.



Author: Pan Li, Zhitao Xiao, Todd A. Braciak, Qingjian Ou, Gong Chen , Fuat S. Oduncu

Source: http://plos.srce.hr/



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