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Poster display session: Basic science, Endocrine tumours, Gastrointestinal tumours - colorectal & non-colorectal, Head and neck cancer (excluding thyroid), Melanoma and other skin tumours, Neuroendocrine tumours, Thyroid cancer, Tumour biology & pathology

3892 - Influence of primary tumour sidedness on survival after upfront primary tumour resection (PTR) in synchronous metastatic colon cancer (mCC)


21 Oct 2018


Poster display session: Basic science, Endocrine tumours, Gastrointestinal tumours - colorectal & non-colorectal, Head and neck cancer (excluding thyroid), Melanoma and other skin tumours, Neuroendocrine tumours, Thyroid cancer, Tumour biology & pathology


Tumour Site

Colon and Rectal Cancer


Karlijn van Rooijen


Annals of Oncology (2018) 29 (suppl_8): viii150-viii204. 10.1093/annonc/mdy281


K.L. van Rooijen1, S.A. Kurk1, D.E..W. van der Kruijssen1, S. Elias2, A.M. May3, A. Cats4, G.M. Creemers5, F.L..G. Erdkamp6, O.J. Loosveld7, C.J. Rodenburg8, P.J. Tanis9, G.R. Vink10, J.H.W. de Wilt11, C.J.A. Punt12, M. Koopman1

Author affiliations

  • 1 Medical Oncology, University Hospital Utrecht, 3508 GA - Utrecht/NL
  • 2 Epidemiolgy, Julius Center of Health Academy, 3584 CG - Utrecht/NL
  • 3 Julius Center, University Hospital Utrecht, 3508 GA - Utrecht/NL
  • 4 Gi Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, 1066 CX - Amsterdam/NL
  • 5 Department Of Medical Oncology, Catharina Hospital, 5602 ZA - Eindhoven/NL
  • 6 Medical Oncology, Zuyderland Medical Center-Sittard-Geleen, 6130 MB - Sittard/NL
  • 7 Medical Oncology, Amphia Ziekenhuis-location Molengracht, 4818 CK - Breda/NL
  • 8 Medical Oncology, Meander Medical Center, 3813 TZ - Amersfoort/NL
  • 9 Surgical oncology, Academic Medical Center, 1105 AZ - Amsterdam/NL
  • 10 General Oncology, Netherlands Comprehensive Cancer Organisation, 3511 DT - Utrecht/NL
  • 11 Surgical oncology, University Medical Center St Radboud, 6525 GA - Nijmegen/NL
  • 12 Medical Oncology, Academic Medical Center, University of Amsterdam, 1100 DD - Amsterdam/NL


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Abstract 3892


Retrospective data suggest a survival benefit for PTR in synchronous mCC, which is the topic of ongoing prospective trials. Whether outcome after PTR varies by primary tumour sidedness, an important prognostic factor in colorectal cancer (CRC), is currently unknown. We investigated the impact of upfront PTR followed by systemic treatment in synchronous mCC according to sidedness within two randomized phase 3 trials (CAIRO and CAIRO2).


A total of 408 synchronous mCC patients, with available data on both PTR status and sidedness, were included (CAIRO n = 279; CAIRO2 n = 129, excluding patients treated with both bevacizumab and cetuximab). We used mixed effect Cox regression models to study the association between PTR and overall survival (OS) and to estimate hazard ratios (HR). Models were adjusted for age, treatment arm, WHO performance status (PS), serum lactate dehydrogenase (LDH) and year of enrollment as potential confounders. To analyze whether PTR effect was modified by sidedness, we tested the interaction term of PTR status and sidedness.


A total of 191 patients (46.8%) had right-sided mCC and 217 patients (53.2%) had left-sided mCC. The rate of PTR was comparable in right-sided (69.1%) and left-sided (65.0%) mCC. Patients who underwent PTR had better PS and LDH level compared to patients without PTR. Univariable and multivariable analyses demonstrated significant and comparable (pinteraction >0.05) survival benefits after upfront PTR for both right-sided and left-sided mCC (Table).Table: 530P

HR (95%CI) for OS after PTR versus no PTR
Right-sided mCC (n = 191)Left-sided mCC (n = 217)pinteractionOverall effect (n = 408)
Univariable0.53 (0.38-0.73)0.66 (0.49-0.87)0.310.61 (0.50-0.76)
Multivariable0.60 (0.42-0.84)0.72 (0.53-0.96)0.430.69 (0.55-0.87)


The previously reported better survival after PTR among synchronous mCRC patients included in the CAIRO and CAIRO2 trials was significant for all mCC patients in our analysis, independent of sidedness. Prospective randomized trials on the prognostic effect of PTR in synchronous mCC, i.e. the CAIRO4 trial, remain valid for mCC patients with both right- and left-sided primary tumours.

Clinical trial identification

CAIRO: NCT00312000, published: July 14, 2007 (Lancet) CAIRO2: NCT00208546, published: February 5, 2009 (N Engl J Med).

Legal entity responsible for the study

University Medical Center Utrecht, Utrecht, The Netherlands.


Has not received any funding.

Editorial Acknowledgement


All authors have declared no conflicts of interest.

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