Impact of Primary Tumor Location on Demographics, Resectability, Outcomes, and Quality of Life in Finnish Metastatic Colorectal Cancer Patients (Subgroup Analysis of the RAXO Study)
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Sonja Aho
1,2,3,4
,
Emerik Osterlund
5,6,
Ari Ristimäki
7,8,
Lasse Nieminen
9,10,
Jari Sundström
11,12,
Markus J. Mäkinen
13,14,15,
Teijo Kuopio
16,17,
Soili Kytölä
18,19,
Annika Ålgars
20,
Raija Ristamäki
20,
Eetu Heervä
20,
Raija Kallio
21,22,
Päivi Halonen
23,24,
Leena-Maija Soveri
24,25,
Arno Nordin
6,26,
Aki Uutela
6,26,
Tapio Salminen
1,2,
Hanna Stedt
27,28,
Annamarja Lamminmäki
27,28,
Timo Muhonen
24,29,
Juha Kononen
30,31,
Bengt Glimelius
5
,
Helena Isoniemi
6,26,
Juho T. Lehto
3,4,
Kaisa Lehtomäki
1,2,† and
Pia Osterlund
1,2,23,24,32,33,*,†add
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1
Department of Oncology, Tays Cancer Centre, Tampere University Hospital, Elämänaukio 2, 33520 Tampere, Finland
2
Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 23, 33520 Tampere, Finland
3
TUNI Palliative Care Research Group, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 23, 33520 Tampere, Finland
4
Palliative Care Centre, Tampere University Hospital, Elämänaukio 2, 33520 Tampere, Finland
5
Department of Immunology, Genetics and Pathology, Uppsala University, 75185 Uppsala, Sweden
6
Department of Transplantation and Liver Surgery, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
7
Department of Pathology, HUSLAB, HUS Diagnostic Center, Helsinki University Hospital, Haartmaninkatu 3, 00290 Helsinki, Finland
8
Applied Tumor Genomics Research Program, Research Programs Unit, Faculty of Medicine, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland
9
Department of Pathology, FIMLAB, Tampere University Hospital, Elämänaukio 2, 33520 Tampere, Finland
10
Department of Pathology, University of Tampere, Arvo Ylpön katu 23, 33520 Tampere, Finland
11
Department of Pathology, Turku University Hospital, Kiinanmyllynkatu 4-8, 20520 Turku, Finland
12
Institute of Biomedicine, University of Turku, Kiinanmyllynkatu 10, 20520 Turku, Finland
13
Department of Pathology, Oulu University Hospital, Kajaanintie 50, 90220 Oulu, Finland
14
Translational Medicine Research Unit, Department of Pathology, University of Oulu, Pentti Kaiteran katu 1, 90570 Oulu, Finland
15
Medical Research Center Oulu, Pentti Kaiteran katu 1, 90570 Oulu, Finland
16
Department of Pathology, Hospital Nova, Hoitajantie 3, 40620 Jyväskylä, Finland
17
Department of Biological and Environmental Science, University of Jyväskylä, Seminaarinkatu 15, 40014 Jyväskylän yliopisto, Finland
18
Department of Genetics, HUSLAB, HUS Diagnostic Center, Helsinki University Hospital, Haartmaninkatu 3, 00290 Helsinki, Finland
19
Department of Genetics, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland
20
Department of Oncology, Turku University Hospital and University of Turku, Hämeentie 11, 20520 Turku, Finland
21
Department of Oncology, Oulu University Hospital, Kajaanintie 50, 90220 Oulu, Finland
22
Department of Oncology, University of Oulu, Pentti Kaiteran katu 1, 90570 Oulu, Finland
23
Department of Oncology, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
24
Department of Oncology, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland
25
Home Care, Joint Municipal Authority for Health Care and Social Services in Keski-Uusimaa, Sairaalakatu 1, 05850 Hyvinkää, Finland
26
Department of Surgery, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland
27
Department of Oncology, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
28
Faculty of Health Sciences, University of Eastern Finland, Yliopistonranta 1A, 70210 Kuopio, Finland
29
Department of Oncology, South Carelia Central Hospital, Valto Käkelän Katu 1, 53130 Lappeenranta, Finland
30
Docrates Cancer Centre, Docrates Hospital, Saukonpaadenranta 2, 00180 Helsinki, Finland
31
Department of Oncology, Hospital Nova, Hoitajankatu 3, 40620 Jyväskylä, Finland
32
Department of Gastrointestinal Oncology, Karolinska Universitetssjukhuset, Eugeniavägen 3, 17176 Solna, Sweden
33
Department of Oncology/Pathology, Karolinska Institutet, Solnavägen 1, 17177 Solna, Sweden
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Cancers 2024, 16(5), 1052; https://doi.org/10.3390/cancers16051052
Submission received: 7 February 2024
/
Revised: 23 February 2024
/
Accepted: 27 February 2024
/
Published: 5 March 2024
(This article belongs to the Special Issue Advance in Colorectal Cancer: A Themed Issue in Honor of Prof. Bengt Glimelius)
Simple Summary
The location of the primary tumor in the right colon, left colon, or rectum affects the efficacy of biological drugs used in the treatment of metastatic colorectal cancer, but how? We examined how the primary tumor location affects disease characteristics, treatability, quality of life, and outcome in a real-life study population of 1080 Finnish patients in the RAXO study. The primary tumor location correlates with the location of metastases, the frequency of gene mutations, how often metastases can be operated upon, long-term survival after curative surgery or palliative chemotherapy, and the quality of life during the disease trajectory. The primary tumor location is a helpful surrogate for clinicians working with metastatic colorectal cancer patients in estimating the clinical course of the disease. This study cannot identify the reasons for the associations, i.e., whether it is the primary location per se, the different mutations, or other reasons.
Abstract
The primary tumor location (PTL) is associated with the phenotype, metastatic sites, mutations, and outcomes of metastatic colorectal cancer (mCRC) patients, but this has mostly been studied according to sidedness (right vs. left sided). We studied right colon vs. left colon vs. rectal PTL in a real-life study population (n = 1080). Health-related quality of life (HRQoL) was assessed multi-cross-sectionally with QLQ-C30, QLQ-CR29, EQ-5D, and 15D. A chi-square, Kaplan–Meier, and Cox regression were used to compare the groups. The PTL was in the right colon in 310 patients (29%), the left colon in 396 patients (37%), and the rectum in 375 patients (35%). The PTL was associated with distinct differences in metastatic sites during the disease trajectory. The resectability, conversion, and resection rates were lowest in the right colon, followed by the rectum, and were highest in the left colon. Overall survival was shortest for right colon compared with left colon or rectal PTL (median 21 vs. 35 vs. 36 months), with the same trends after metastasectomy or systemic therapy only. PTL also remained statistically significant in a multivariable model. The distribution of symptoms varied according to PTL, especially between the right colon (with general symptoms of metastases) and rectal PTL (with sexual- and bowel-related symptoms). mCRC, according to PTL, behaves differently regarding metastatic sites, resectability of the metastases, outcomes of treatment, and HRQoL.
