Does sidedness predict risk of perforation with chemotherapy in colon cancer? Results from the National Inpatient Samples Database (NISD).
Authors: Jasmeet Kaur, Waqas Qureshi, Namrata Vijayvergia
Journal: Journal of Clinical Oncology (2024)

e15591 Background: Perforation is a life-threatening complication of colon cancer (CC) and can be seen even after the initiation of therapy in a metastatic setting. There is a lack of understanding of the factors affecting colon perforation (CP) risk in relation to left versus right anatomical locations. Herein, we evaluated the predictors and outcomes for colon cancer perforation, drawing comparisons between right (R) and left (L)-sided CC. Methods: A national representative cohort of 33,010 colon cancer patients admitted with CP was included for the years 2016–2020 from the national inpatient sample database. We used the International Classification of Diseases, 10th revision, diagnostic codes to identify patients with CC and CP. The patients were stratified as colon cancer perforation patients with R versus L sided. Descriptive statistics were performed for demographics and comorbidities. Survey statistics were used to calculate weighted analysis and compared using Pearson’s chi-square test for categorical variables and the t-test for continuous variables. Calculated the odds ratio and 95% confidence interval in multivariate logistic regression for the association of CP. Results: Among 33,010 hospitalized CC patients with perforation, 11,920 had R colon cancer, and 21,090 had L-CC. Notably, right-sided cases exhibited a significantly higher median age (69 vs. 63; p &lt; 0.001), a greater proportion of females (50.2% vs. 44%; p &lt; 0.001), and a higher rate of metastases at diagnosis (54% vs. 49%, p &lt; 0.001) compared to left-sided cases. A history of (hx) chemotherapy was more common in L-CC (11.5% vs. 4.87%; p &lt; 0.001). In-hospital mortality did not differ between the two groups (10.3% for R vs. 11% for L; p = 0.37). Surgical bypass was more frequent in L cases (38.3% vs. 5.75%; p &lt; 0.001), while colectomy was more common in R cases (59% vs. 26.8%; p &lt; 0.001). Interestingly, in adjusted analysis, intestinal obstruction decreased the odds of perforation in R-CC (OR: 0.82, 95% CI: 0.70 to 0.96, p = 0.02) while increasing it in L-sided tumors (OR: 1.22, 95% CI: 1.04 to 1.44, p = 0.01). In L-CC, hx chemotherapy was significantly associated with higher odds of perforation (OR: 2.25, 95% CI: 1.80 to 2.81; p &lt; 0.001), whereas in R-CC cancer, hx chemotherapy was associated with lower odds of perforation (OR: 0.45, 95% CI: 0.36 to 0.56; p &lt; 0.001). Metastasis was not significantly associated with CP in either R or L-CC. Conclusions: The study reveals distinct clinical profiles regarding perforated R-CC, including age and gender differences, comorbidities, and surgical approaches. An association between chemotherapy use and perforation risk by sidedness is an important finding, especially when considering therapies that are known to cause colon perforation. Further validation of these early findings in similar datasets is warranted to help develop a more personalized treatment approach for patients.