The association between tumour sub-site and local nodal and/or distant metastasis at the time of resection of colorectal cancer: a prospective study of 3,360 consecutive cases

Ronald Newland; Kheng-Seong Ng; Pierre Chapuis; Charles Chan; Owen Dent

doi:10.1016/j.humpath.2022.05.006

The association between tumour sub-site and local nodal and/or distant metastasis at the time of resection of colorectal cancer: a prospective study of 3,360 consecutive cases

Hum Pathol. 2022 Aug:126:121-128. doi: 10.1016/j.humpath.2022.05.006. Epub 2022 May 9.

Authors

Ronald Newland¹, Kheng-Seong Ng², Pierre Chapuis³, Charles Chan⁴, Owen Dent⁵

Affiliations

¹ Division of Anatomical Pathology, Concord Repatriation General Hospital, Sydney, NSW 2139, Australia; Concord Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia. Electronic address: rcnewland@bigpond.com.
² Colorectal Surgical Unit, Concord Repatriation General Hospital, Sydney, NSW 2139, Australia; Concord Institute of Academic Surgery. Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia. Electronic address: k.s.ng@sydney.edu.au.
³ Colorectal Surgical Unit, Concord Repatriation General Hospital, Sydney, NSW 2139, Australia; Concord Institute of Academic Surgery. Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia. Electronic address: phchapuis@optusnet.com.au.
⁴ Division of Anatomical Pathology, Concord Repatriation General Hospital, Sydney, NSW 2139, Australia; Concord Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia. Electronic address: charles.chan2@health.nsw.gov.au.
⁵ Colorectal Surgical Unit, Concord Repatriation General Hospital, Sydney, NSW 2139, Australia; Concord Institute of Academic Surgery. Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia. Electronic address: owen.dent@netspeed.com.au.

PMID: 35550833
DOI: 10.1016/j.humpath.2022.05.006

Abstract

The concept that right and left sided colorectal cancer may be biologically different has led to a review of the pathology and molecular characteristics expressed by the two sides. The aim of this cross-sectional study was to examine the association between tumour sub-sites and the presence of any metastasis by multivariable modelling. Pathology data were drawn from a hospital series of 3360 consecutive patients who had their first cancer resected between 1995 and 2019 inclusive. A preliminary analysis of the distribution of sex, age and a range of routinely reported pathology features showed that the simple division of the bowel into right and left sides masks the considerable variation in pathology features which occurs between sub-sites within each side. Logistic regression adjusting for sex, age, a range of routinely reported pathology features and tumour sub-site showed that age ≤70, direct tumour spread (T3 and T4), high grade, venous invasion and perineural invasion all carried a significantly increased risk for the presence of metastatic spread. The only tumour sub-sites to show an increased risk were the sigmoid colon and rectum (adjusted odds ratio 1.72, P < 0.001 and 1.78, P < 0.001, respectively). These findings suggest that multivariable modelling could usefully be applied to identify associations between sub-sites and molecular characteristics.

Keywords: Colorectal cancer; Metastatic risk; Multivariable analysis; Pathology features; Sub-site.

Publication types

Review

MeSH terms

Colorectal Neoplasms* / pathology
Colorectal Neoplasms* / surgery
Cross-Sectional Studies
Humans
Neoplasm Staging
Prospective Studies
Rectum / pathology