Advanced Mucinous Colorectal Cancer: Epidemiology, Prognosis and Efficacy of Chemotherapeutic Treatment

Abstract

Background: The clinicopathological significance of the mucinous subtype of colorectal cancer (CRC) remains controversial. As of today, none of the current guidelines differentiate treatment with respect to mucinous or nonmucinous cancer. Due to the lack of substantiated data, best treatment remains unclear and the mucinous subtype of CRC is usually treated along the lines of recommendations for adenocarcinoma of the colon. Methods: We investigated an East-Bavarian cohort of 8,758 patients with CRC. These included 613 (7.0%) patients with a mucinous subtype, who were analyzed for assessing their characteristics in clinical course and for evaluating the efficacy of common chemotherapy protocols. Results and Conclusion: Mucinous CRC was predominantly located in the right hemicolon; it was diagnosed at more advanced stages and occurred with preponderance in women. A higher rate of G3/4 grading was observed at diagnosis (all p < 0.001). An association of mucinous CRC with younger age at initial diagnosis, previously reported by other groups, could not be confirmed. Patients with mucinous stage IV colon cancer demonstrated poorer survival (p = 0.006). In contrast, no differences in survival were observed for specific stages I–III colon cancer. Stage-dependent analysis of rectal cancer stages I–IV also showed no differences in survival. However, univariable overall analysis resulted in significant poorer survival of mucinous compared to nonmucinous rectal cancer (p = 0.029). Also, combined analysis of all patients with mucinous CRC revealed poorer overall survival (OS) of these patients compared to nonmucinous CRC patients (median 48.4 vs. 60.2 months, p = 0.049) but not in multivariable analysis (p = 0.089). Chemotherapeutic treatment showed comparable efficacy regarding OS for mucinous and nonmucinous cancers in both an adjuvant and palliative setting for colon cancer patients (p values comparing mucinous and nonmucinous cancers < 0.001–0.005).

Potential prognostic factors for predicting the chemotherapeutic outcomes and prognosis of patients with metastatic colorectal cancer

“…Moreover, the univariate analysis showed that PFS was significantly related to CA19‐9, hemoglobin, histological type, metachronous cancer, peritoneal dissemination, and the number of organs affected by metastasis. After adjusting for the effects of these parameters in the multivariate analysis, pretreatment CA19‐9, hemoglobin, and histological type were independent predictors for PFS, which was consistent with the findings of previous research (Table ).…”

Treatment and Outcomes of Colorectal Cancer in Armenia: A Real-World Experience From a Developing Country

“…Various studies are concordant with our findings showing patients with signet ring cell CRC to have worse survivability, 33 whereas there is discrepancy regarding mucinous subtype. There are several reports that patients with mucinous histology had lower survival, 34 while others failed to show any correlation with prognosis. 35 …”

Mucinous colorectal adenocarcinoma: clinical pathology and treatment options

“…Further, there is a persisting debate in regard to the prognosis of mucinous colorectal adenocarcinoma as compared to its non-mucinous counterpart. Some studies have found that patients with mucinous colorectal adenocarcinoma have a lower progression-free survival (PFS) rate (3-year PFS rate, 79.2% vs. 56.9%, respectively) and a shorter median OS (60.2 months vs. 48.4 months, respectively) [22, 23]. However, others have shown that the mucinous colorectal adenocarcinoma histology itself had no correlation with prognosis.…”