Abstract
Sidedness, mutations, and survival in stage IV colon cancer: A U.S. population-based study
Journal of clinical oncology, Vol.36(4_suppl), pp.742-742
02/01/2018
DOI: 10.1200/JCO.2018.36.4_suppl.742
Abstract
742 Background: Despite recent diagnostic and therapeutic advances in colon cancer (CC), it remains one of the leading causes for cancer-related deaths worldwide. At time of diagnosis, 20% of CC patients (PTS) present with de novo stage IV. In recent years, clinical trials have identified sidedness and several molecular biomarkers (MBM), such as microsatellite instability high (MSI-H), KRAS and BRAF mutations, as prognostic and predictive factors for treatment response in stage IV CC. However, their impact and interactions in the population-based setting remain elusive. Methods: The National Cancer Institute’s 2014 Patterns of Care study included a sample of 1,444 stage IV CC PTS from Surveillance, Epidemiology, and End Results registries, and captured MSI, BRAF and detailed chemotherapy information not available in the public-use dataset. Demographic, tumor, molecular and treatment data were compared using chi-square tests. Cox proportional hazards models were used to compare overall survival (OS) across subgroups of demographic, tumor, MBM and treatment characteristics. Results: Compared to left-sided (L) CC, PTS diagnosed with right-sided (R) CC tend to be older (median age: 65 vs 60, respectively; p < 0.001), more females (54% vs 44%, p = 0.001), African Americans (25% vs 22%, p = 0.001), have poorly or undifferentiated tumors (27% vs 15%, p = 0.001), and harbor MSI-H (14% vs 7%, p = 0.018), KRAS (52% vs 36%, p < 0.001) or BRAF (29% vs 11%, p = 0.001) mutations. FOLFOX, with or without bevacizumab, accounted for > 50% of the first-line regimens. Multivariable Cox proportional hazards models revealed the following poor risk factors: right-sidedness, poorly or undifferentiated tumor, no surgery, no chemotherapy, no cetuximab/panitumumab or no bevacizumab therapy. In separate models for LCC and RCC among those tested for KRAS (n = 689), treatment with bevacizumab was associated with lower odds of death in both models (p < 0.05). Cetuximab/panitumumab were nearly significantly associated with lower odds of death in LCC (p = 0.06) but not RCC (0.35). Conclusions: Right-sidedness is a poor prognostic factor in stage IV CC. Regardless of sidedness, stage IV CC PTS can benefit from surgery, chemotherapy, or bevacizumab.
Details
- Title: Subtitle
- Sidedness, mutations, and survival in stage IV colon cancer: A U.S. population-based study
- Creators
- Albert Y Lin - VA Palo Alto Health Care System, Palo Alto, CAAmanda Kahl - University of Iowa College of Public Health, Iowa City, IAIrena Gribovskaja-Rupp - University of Iowa Carver College of Medicine, Iowa City, IAMichele West - University of Iowa College of Public Health, Iowa City, IACharles F Lynch - University of Iowa, Iowa City, IAMary E Charlton - University of Iowa College of Public Health, Iowa City, IA
- Resource Type
- Abstract
- Publication Details
- Journal of clinical oncology, Vol.36(4_suppl), pp.742-742
- DOI
- 10.1200/JCO.2018.36.4_suppl.742
- ISSN
- 0732-183X
- eISSN
- 1527-7755
- Language
- English
- Date published
- 02/01/2018
- Academic Unit
- Epidemiology; Surgery
- Record Identifier
- 9984216622402771
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