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Variations in Metastasis Site by Primary Location in Colon Cancer
*Ramzi Amri, Liliana G Bordeianou, *Patricia Sylla, David L Berger
Massachusetts General Hospital, Harvard Medical School, Boston, MA

Objective: To determine whether sites of distant recurrence are associated with specific locations of primary disease in colon cancer.
Design: Retrospective review of a cohort of surgically treated colon cancer patients.
Setting: Tertiary care center.
Patients: All patients undergoing a one-sided segmental colonic resection for colon cancer at our center (2004-2011) were included in an institutional review board-approved data repository (N=947).
Main outcomes measures: overall and site-specific metastatic presentation and recurrence rates, subdivided into right-sided, left-sided, and sigmoid resections.
Results: Baseline AJCC staging did not differ significantly between resection regions (P=0.14). However, significant variations were measured in region-specific overall rates of metastatic disease to the liver (P=0.040) and lung (P<0.001).
In fact, right-sided colectomies had a significantly lower overall rate of metastatic disease (24.8% vs. 31.8%; P=0.017), in large part due to significantly lower long-term occurrence of pulmonary metastasis (2.7% vs. 9%; P<0.001). Conversely, left colectomies had significantly higher rates of liver metastasis during follow-up (9.4% vs. 4.8%; P=0.029), while sigmoid resections had higher rates of liver metastasis at baseline (17.1% vs. 11.3%; P=0.015), and higher long-term rates of lung (9.9% vs. 3.5% P<0.001) and brain metastases (2.3% vs. 0.6%; P=0.033). Other sites of metastasis, including (retro)peritoneum, omentum, ovary, and bone did not yield significant differences.
Conclusions: Important variations in site-specific rates of metastatic disease exist within major resection regions of colon cancer. These variations may be important to consider when evaluating options for adjuvant treatment and surveillance after resection of the primary disease.
RightLeftSigmoidP
N=557N=127N=238
All Metastasis24.8%*31.5%31.9%0.059
At Baseline15.8%16.5%20.2%0.30
In follow-up9.0%15.0%11.8%0.11
Liver15.6%21.3%22.4%0.040
At Baseline11.1%11.8%17.1%*0.054
In follow-up4.5%9.4%*5.3%0.082
Lung4.7%***8.7%12.2%***<0.001
At Baseline2.0%1.6%2.3%0.89
In follow-up2.7%***7.1%9.9%***<0.001
Peritoneal6.8%7.9%6.5%0.87
At Baseline3.2%0.8%2.7%0.31
In follow-up3.6%7.1%3.8%0.19
Brain0.7%0%2.3%*0.057
At Baseline0%0%0%-
In follow-up0.7%0%2.3%*0.057
*/**/***: Denotes values significantly different from the remaining resection regions:
*: P<0.05; **: P<0.01***: P<0.001. Statistically significant differences are shown in bold


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