RE: Primary Tumor Location as a Prognostic Factor in Metastatic Colorectal Cancer

JNCI: Journal of the National Cancer Institute, Sep 2015

Wen-zhuo, He, Liang-ping, Xia

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RE: Primary Tumor Location as a Prognostic Factor in Metastatic Colorectal Cancer

JNCI J Natl Cancer Inst ( correspondence RE: Primary Tumor Location as a Prognostic Factor in Metastatic Colorectal Cancer He Wen-zhuo 0 1 2 3 4 5 Xia Liang-ping 0 1 2 3 4 5 0 2. Frattini M , Balestra D, Suardi S, et al. Different genetic features associated 1 1. Loupakis F , Yang D, Yau L, et al. Primary tumor location as a prognostic 2 Affiliation of authors: VIP Region, Sun Yat-sen University Cancer Center , Guangzhou, Guangdong, 510060 , P. R. China, HWz, XLp 3 5. Venderbosch S, de Wilt JH, Teerenstra S, et al. Prognostic value of resection 4 4. Lee YC, Lee YL, Chuang JP, et al. Differences in survival between colon 5 3. Yamauchi M, Morikawa T, Kuchiba A, et al. Assessment of colorectal cancer Metastatic - Correspondence Colorectal cancer is a group of distinct diseases rather than a the impact of primary tumor location on patients who accepted homogeneous one. Fotios Loupakis et al. ( 1) published an interchemotherapy, as well as patients who accepted chemotherapy esting paper, which suggested that patients with left-sided colo plus bevacizumab. However, what they did not evaluate was the rectal cancers had more favorable prognosis than right side. impact of bevacizumab on survival among patients grouped What’s more, the authors also proposed that the efficacy of by the primary tumor location. We would like to suggest the bevacizumab was independent of tumor location. The study was authors compare survival between patients who accepted based on well-known clinical trials and described in reasonable chemotherapy alone and chemotherapy plus bevacizumab in detail. In our opinion, there are three points that might weaken patients with right-side colon cancer, as well as left-side colon the stringency of their study. First, in Fotios Loupakis’ study (1), left-side cancers were defined as those of origin from descending colon, sigmoid colon, or rectum. However, descending and sigmoid colon cancers are different from rectal cancer in molecular features, trea-t ment approaches, and prognosis ( 2–4). As a result, it may not be appropriate to mix left-side colon and rectum into one group. Second, although the number of metastatic sites was balanced between groups, some other important prognostic factors were unbalanced or unmentioned, including staging at diagnosis, carcinoembryonic antigen levels, number of patients who accepted R0 resection, and primary tumor resection 5( ). Last but not least, the author mentioned that the efficacy of bevacizumab was independent of tumor location, which in our opinion is an overambitious conclusion. In other words, the authors studied cancer and rectal cancer. 4021. 854. molecular features along bowel subsites challenges the conception of distinct dichotomy of proximal versus distal colorectum.Gut. 2012;61(6):847– rectal cancer from SEER data.PLoS One. 2013;8(11):e78709. of primary tumor in patients with stage IV colorectal cancer: retrospective analysis of two randomized studies and a review of the literature.Ann Surg Oncol . 2011 ; 18 ( 12 ): 3252 - 3260 .

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Wen-zhuo, He, Liang-ping, Xia. RE: Primary Tumor Location as a Prognostic Factor in Metastatic Colorectal Cancer, JNCI: Journal of the National Cancer Institute, 2015, DOI: 10.1093/jnci/djv207