Differences in Cancer-Specific Mortality of Right- Versus Left-Sided Colon Adenocarcinoma: A Surveillance, Epidemiology, and End Results Database Analysis

Abstract

PURPOSE Studies have shown an increased risk for all-cause mortality with right-sided colon cancer (RCC) as compared with left-sided colon cancer (LCC). However, these studies were unable to directly account for mortality events unrelated to cancer, known as other-cause mortality. We investigated the difference in cancer-specific mortality (CSM) between RCC and LCC at localized, regional, and metastatic stages, according to the Fine and Gray proportional hazards model, while accounting for other-cause mortality as a competing risk. METHODS Using the SEER database, we identified 90,635 patients with LCC (ie, involving the splenic flexure, descending, sigmoid, and rectosigmoid colon) and 112,679 patients with RCC (ie, involving the cecum, ascending, hepatic flexure, and transverse colon) diagnosed from 1998 to 2013. We performed a competing risk analysis for CSM using the Fine and Gray proportional hazard model, adjusting for age, sex, race, tumor grade, surgery status, year of diagnosis, and tumor laterality, with two-sided testing and a statistical significance threshold of 0.05. RESULTS Compared with LCC, RCC demonstrated statistically significant decreased CSM at the localized stage (adjusted hazards ratio [AHR], 0.865; P < .001), equivalent CSM at the regional stage (AHR, 0.990; P = .440), and increased CSM at the metastatic stage (AHR, 1.175; P < .001). CONCLUSION Using a competing risk model, we have shown that RCC, compared with LCC, is associated with lower CSM at the localized stage, equivalent CSM at the regional stage, and higher CSM at the metastatic stage. This pattern may correlate with variation in genetic factors, including known decreased prevalence of microsatellite instability in RCC with regional and metastatic disease.