B0086 - Rectal Bleeding as a Symptom of Advanced Colorectal Cancer Is Associated With Left-Sided Colorectal Cancer and Improved Survival

Jun Song, MD¹, Neil Sood, MD¹, Navneet Goraya, MD¹, Rebecca Moon, MD², Butros Toro, MD³, Jonathan Gotfried, MD⁴, Frank Friedenberg, MD, MS⁵, Adam C. Ehrlich, MD, MPH^5
1Temple University Hospital, Philadelphia, PA; ²Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA; ³Lourdes Digestive Care, Binghamton, NY; ⁴Bryn Mawr Hospital/Main Line Health, Bryn Mawr, PA; ⁵Lewis Katz School of Medicine at Temple University, Philadelphia, PA

Introduction: Rectal bleeding (RB) is a symptom of colorectal cancer (CRC) that often prompts endoscopic investigation. The outcomes of RB in the setting of CRC have not been well described. We investigated the outcomes of patients diagnosed with stage IV CRC after presenting with RB.

Methods: We retrospectively analyzed patients ages 18 years and older diagnosed with Stage IV CRC from 2011 to 2017 in our academic, safety-net hospital. Patients were excluded if they were not diagnosed via diagnostic colonoscopy. Patients were stratified based on RB at presentation. Location of tumors were categorized as right-sided colorectal cancer (RCRC) and left-sided colorectal cancer (LCRC). RCRC included those located from the cecum to the proximal two-thirds of the transverse colon. LCRC included those located from the distal one-third of the transverse colon to the rectum.

Results: Sixty-nine patients met the inclusion criteria. General characteristics are shown in Table 1. Those without RB had significantly higher Charlson Comorbidity Index (CCI) scores (p < 0.05). The average time from presentation to endoscopy in those with RB compared to those without RB were 0.9 + 1.5 months and 1.2 + 3.3 months, respectively (p = 0.53). All thirty-five patients with RB had LCRC. For those without RB, eighteen had RCRC and sixteen had LCRC. There were no differences in times to surgery (p = 0.09), systemic therapy (p = 0.27), or any treatment (p = 0.14). Median survival in those with RB was 1377 days and those without RB was 358 days. Using the Cox proportional hazards model with CCI, gender, and race as covariates for multivariate analysis, the average length of survival remained significantly higher in patients with RB (p < 0.01, HR 0.43, 95% CI 0.23-0.80) [Figure 1].

Discussion: RCRC and LCRC have been documented to have different morphological and molecular characteristics, with RCRC often being described as more aggressive than LCRC. In our study, all patients who presented with RB had LCRC and more than half of the patients without RB had RCRC. The absence of RB was associated with increased mortality after controlling for age, comorbidities, gender, and race. Furthermore, there were no differences in time to either endoscopy or treatment. In conclusion, RB in CRC may be more indicative of left-sided disease which may be associated with a less aggressive disease course. However, more research is required to fully understand the association between RB and clinical outcomes.




Disclosures:


Jun Song, MD¹, Neil Sood, MD¹, Navneet Goraya, MD¹, Rebecca Moon, MD², Butros Toro, MD³, Jonathan Gotfried, MD⁴, Frank Friedenberg, MD, MS⁵, Adam C. Ehrlich, MD, MPH⁵. B0086 - Rectal Bleeding as a Symptom of Advanced Colorectal Cancer Is Associated With Left-Sided Colorectal Cancer and Improved Survival, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.