Evaluation of the left-to-right shift of colon tumors in Iran: Is the trend changing?

Abstract

Background: Colorectal cancer (CRC) is the second cause of cancer-related deaths worldwide. There have been several studies reporting the proximal tumor shift, especially in Western countries. In the present study, we investigated the clinicopathologic and anatomical distributions of colorectal tumors in Iranian CRC patients. Materials and Methods: In this retrospective cohort study,258 patients with CRC from 2008 to 2013 were evaluated. Comparison of variables was performed using Pearson’s chi-square test and Fisher’s exact test depending on the nature of the  data. Results: A total of 258 patients including 124 (48.1%) females and 134 (51.9%) males enrolled in this study. Th e majority of cancers were  detected in the rectosigmoid, i.e., 98 (38%) followed by the left colon,i.e., 84 (32.6%) and the right colon, i.e., 76 (29.5%). In the present study, we observed the signifi cant association between metastases,adjuvant  therapy, family history, and history of infl ammatory bowel disease (IBD) with tumor, node, and metastasis (TNM) staging (P < 0.001). In univariate analysis, there was a strong association between overall survival (OS) and stage II CRC (P = 0.03). However,the predictive value was lost in multivariate analysis (P = 0.145). Conclusion: Unlike the majority of previous studies on Iranian CRC patients, we observed a considerably higher occurrence of right-sided colon cancers (84 versus 76). Although this  phenomenon did not reach the statistical signifi cance rate, based on recent studies on Iranian population including the present one, the pattern of anatomical distribution of colorectal tumors has been changed toward the proximal colon. This requires an urgent need to provide other strategies and complementary detecting approaches in order to identify proximal tumors in Iranian CRC patients.

Key words: Colorectal cancer (CRC), Iran, proximal shift, survival