Clinicopathological Features of Serrated Adenocarcinoma Defined by Mäkinen in Dukes’ B Colorectal Carcinoma

Abstract

Objective: Serrated adenocarcinoma (SAC), proposed as a new pathologic type, arises predominantly in the right side of the colon and has a poorer prognosis than conventional colorectal carcinoma. The prognosis of colorectal carcinoma is variable in Dukes’ B, so the aim of this study was to determine whether or not SAC has a poor prognosis in Dukes’ B. Methods: The study group comprised 64 patients who underwent surgery for colorectal carcinoma. We undertook a statistical analysis of the association of SAC and non-SAC with sex, age, histologic type, depth of tumor, location of tumor, venous invasion and lymphatic invasion. Results: SACs were encountered in 17.5% of cases (n = 11). SAC had a less favorable 5-year survival than non-SAC (p = 0.0396 log-rank, Kaplan-Meier). The factors that achieved statistical significance in the univariate analysis were subsequently included in a multivariate analysis and we found that SAC was an independent factor (p = 0.027). Conclusions: SAC has a poor prognosis and is not affected by other factors confirming that SAC is an independently less favorable prognostic factor.

Serrated adenocarcinoma morphology in colorectal mucinous adenocarcinoma is associated with improved patient survival

“…In contrast with previous conventional CRC findings (most are non-MAC) [18, 19], patients in our study who had colorectal MACs with SAC morphology exhibited improved relapse-free survival, and this was significant in AJCC stage III MAC patients. SAC morphology was associated with proximal cancer location and CIMP-positive status, which were favorable prognostic factors in our analyses.…”

“…First, we did not include non-MACs for comparison, as our findings on the prognostic implications of SAC morphology contradicted results from studies of conventional, mostly non-MAC, CRC [18, 19]. Second, to avoid the effect of neoadjuvant therapy in histological analyses, we excluded low rectal cancer cases, which had often undergone neoadjuvant concurrent chemoradiotherapy.…”

“…A previous study using these criteria found that SACs constituted 9.1% of the CRC cohort (n=927), and approximately half of these SACs contained a residual serrated adenoma precursor [18]. SACs are more often located in the proximal colon than conventional adenocarcinomas, and are associated with a lower 5-year survival [18, 19]. …”

Prognostic stratification of colorectal cancer patients: current perspectives

“…Serrated morphology has been associated with poor prognosis, particularly when occurring in left-sided tumors 30,31. Adenosquamous carcinoma has features of both squamous cell carcinoma and adenocarcinoma, either mixed or separate 5,32,33.…”

Invasive Mucinous Adenocarcinoma Associated with Adjacent Sessile Serrated Lesion of the Appendix Vermiform: A Case Report

“…Although it has been generally accepted that adenoma-carcinoma sequence [2] is an important pathway in colonic carcinogenesis, recent studies revealed that DNA hypermethylation and/or BRAF mutations also play important roles in the tumor progression especially in right-sided colon carcinomas and that SSL morphologically represents a characteristic feature of a newly postulated cancerization pathway, coined “serrated neoplasia pathway” [3, 4]. Moreover, some investigators suggested that neoplastic SSL closely associated with mucinous adenocarcinoma [5], and others reported that the outcome of patients with colorectal carcinomas that featured serrated architecture was worse than that of patients with nonserrated carcinomas [6]. …”