Modern Treatment of Rectal Cancer Closes the Gap Between Common Adenocarcinoma and Mucinous Carcinoma

Hugen, Niek; Velde, Cornelis Jh van de; Bosch, Steven L.; Fütterer, Jurgen J.; Elferink, M.A.G.; Marijnen, Corrie A.M.; Rutten, H.J.T.; Wilt, Johannes H. de; Nagtegaal, Irıs D.

doi:10.1245/s10434-014-4339-5

Cited by 55 publications

(42 citation statements)

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“…The latter is in accordance with a recent study from our group that reported on outcomes in LARC patients with mucinous AC and AC. This study demonstrated that pCR was not observed in any mucinous AC patient compared with over 16 % in AC patients, which did not affect survival 29. In the current cohort, pCR rates were again significantly lower in mucinous AC patients without an effect on OS.…”

Section: Discussionsupporting

confidence: 41%

Treatment Interval between Neoadjuvant Chemoradiotherapy and Surgery in Rectal Cancer Patients: A Population-Based Study

et al. 2016

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Background Neoadjuvant chemoradiation therapy (CRT) has been widely implemented in the treatment of rectal cancer patients, but optimal timing of surgery after neoadjuvant therapy is unclear. The purpose of this study was to evaluate the effects of prolonged intervals between long-course CRT and surgery in rectal cancer patients.MethodsData on all rectal cancer patients diagnosed between 2006 and 2011 were retrieved from the population-based Netherlands Cancer Registry; the main outcome parameters were pathologic complete response (pCR) and overall survival (OS). Outcomes were reported separately for patients with early tumors (ETs; N = 217) and locally advanced rectal cancer (LARC; N = 1073). Patients were divided into 2-week interval groups according to treatment interval, ranging from 5–6 to 13–14 weeks. Kaplan–Meier curves, and logistic regression and Cox regression models were used for data analysis.ResultsNo significant difference in pCR rate was observed for ET patients according to treatment interval. Compared with a treatment interval of 7–8 weeks, pCR rates in LARC patients were higher after 9–10 weeks (18.4 %; odds ratio [OR] 1.56, 95 % CI 1.03–2.37) and 11–12 weeks of treatment interval (20.8 %; OR 1.94, 95 % CI 1.15–3.26). Treatment interval did not influence OS in ET or LARC patients.ConclusionsTreatment intervals of 9–12 weeks between surgery and CRT seem to improve the chances of pCR in LARC patients, without an effect on OS. The length of treatment interval did not affect outcomes in patients with ET. The ongoing search for minimally invasive surgery drives the need for exploration of factors that improve pathologic response.Electronic supplementary materialThe online version of this article (doi:10.1245/s10434-016-5294-0) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 41%

Treatment Interval between Neoadjuvant Chemoradiotherapy and Surgery in Rectal Cancer Patients: A Population-Based Study

et al. 2016

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“…Some researchers tried to ascribe this poor PRT response to radiation resistance. Hugen N et al 16. found that mutated KRAS as a biomarker was strongly associated with poor response to chemoradiotherapy in MC.…”

Section: Discussionmentioning

confidence: 99%

“…Many oncologists considered RC patients with stage II–III as an indication for preoperative radiotherapy (PRT), and recommend to add chemotherapy for patients with locally advanced RC in which the mesorectal fascia is threatened41415. The efficacy of neo-adjuvant therapy including PRT for RC has been described in many literatures161718. SRCC was prone to extensive lymphatic spread and peritoneal metastases leading to poor survival.…”

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confidence: 99%

Prognosis and value of preoperative radiotherapy in locally advanced rectal signet-ring cell carcinoma

Chen

Wang

et al. 2017

Sci Rep

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As well known, signet-ring cell carcinoma (SRCC) is a rare histological subtype of colorectal adenocarcinoma, which has been associated with poor prognosis and resistant to non-surgery therapy compared with common adenocarcinoma. In this study, we assessed the effect of preoperative radiotherapy (PRT) for locally advanced rectal SRCC in a large patient group from the Surveillance, Epidemiology, and End Results program (SEER, 1988–2011) database. SRCC was found in 0.9% (n = 622) rectal cancer (RC) patients in our study. In the PRT setting, SRCC had significantly worse cancer-specific survival than mucinous adenocarcinoma and nonmucinous adenocarcinoma patients (log-rank, P < 0.001). In terms of SRCC, stage III RC patients benefited from PRT (log-rank, P < 0.001) while stage II did not (P = 0.095). The multivariate Cox proportional hazard model showed that PRT was an independent benefit factor in stage III rectal SRCC patients (HR, 0.611; 95% CI, 0.407–0.919; P = 0.018). In conclusion, SRCC was an independent predictor of poor prognosis in stage III RC patients, but not in stage II. In the PRT setting of locally advanced RC, SRCC patients had significantly worse prognosis. PRT was an independent prognostic factor associated with improved survival in stage III rectal SRCC.

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“…In some of the patients, however, MLs are induced by nCRT in rectal cancer tissue (5)(6)(7)(8)(9)(10)(11)(12). In patients who receive nCRT, the incidence of mucinous carcinoma is relatively high, ranging from 13% to 24% (6,8,11).…”

Section: Discussionmentioning

confidence: 99%

“…Patients with mucinous carcinoma have been reported to have a poor response to nCRT, as well as poor outcomes. In some patients, however, nCRT may induce the formation of mucin lakes (MLs) in rectal cancer tissue (5)(6)(7)(8)(9)(10)(11)(12). The ability to determine whether MLs are induced or originally exist in resected specimens would be of great clinical significance.…”

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confidence: 99%

Chemoradiotherapy-induced Changes in Mucinous Components in Rectal Cancer Tissue: Evaluation on High Iron Diamine-alcian Blue and Mucin 1 Staining

et al. 2018

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Abstract. Background Total mesorectal excision (TME) after neoadjuvant chemoradiotherapy (nCRT) is the standard treatment for rectal cancer (1-4). Patients with mucinous carcinoma have been reported to have a poor response to nCRT, as well as poor outcomes. In some patients, however, nCRT may induce the formation of mucin lakes (MLs) in rectal cancer tissue (5-12). The ability to determine whether MLs are induced or originally exist in resected specimens would be of great clinical significance.Sialomucin and sulphomucin are included in intracytoplasmic mucin of cancer cells and MLs in patients with colorectal cancer and can be identified by high iron diamine-Alcian blue (HID-AB) staining (13). Mucin 1 (MUC1), a transmembrane mucin and a membrane-bound glycoprotein, exists in cancer cells and in MLs in colorectal cancer tissue and has been reported to be related to outcomes (14-17).HID-AB staining and MUC1 immunohistochemical staining was, therefore, performed in resected specimens of rectal cancer obtained from patients who received nCRT and those who did not, to evaluate mucinous components in cancer cells and MLs in cancer tissue and examine whether nCRT induces changes in mucinous components. Patients and MethodsSubjects. From 2005 through 2015, a total of 293 patients with rectal cancer underwent curative surgery. Among the 205 patients who received nCRT, the ML formation which occupied at least 20% of the area of the maximum cut surface of the resected specimens was found in 20 patients. These patients were designated as the CRT-MC group. Among the 88 patients who did not receive CRT, 9 patients were histologically diagnosed with mucinous carcinoma on the resected specimens in which ML formation was remarkable (non-CRT-MC group), and 18 patients were diagnosed with well-or moderately differentiated adenocarcinoma but had apparent ML formation in less than 50% of the area ratios of the tumors. These patients were designated as the non-CRT-AC group. A total of 47 patients were studied. This study was approved by the institutional review board of our University (17R-238), and all patients gave their written informed consent.HID-AB staining, MUC1 staining, and evaluations. To perform HID-AB staining, the sections were deparaffinized and then stained with HID solution, prepared using N, N-dimethyl-m-phenylenediamine dihydrochloride (120 mg) and N,N-dimethyl-p-phenylenediamine 4783

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Modern Treatment of Rectal Cancer Closes the Gap Between Common Adenocarcinoma and Mucinous Carcinoma

Abstract: Modern treatment of RC has benefited MC patients, leading to equal survival for MC and AC patients. Enhancements in the fields of imaging and quality of surgery have improved outcome and preoperative therapies should be recommended for both histological subtypes.

Cited by 55 publications

References 42 publications

Treatment Interval between Neoadjuvant Chemoradiotherapy and Surgery in Rectal Cancer Patients: A Population-Based Study

Treatment Interval between Neoadjuvant Chemoradiotherapy and Surgery in Rectal Cancer Patients: A Population-Based Study

Prognosis and value of preoperative radiotherapy in locally advanced rectal signet-ring cell carcinoma

Chemoradiotherapy-induced Changes in Mucinous Components in Rectal Cancer Tissue: Evaluation on High Iron Diamine-alcian Blue and Mucin 1 Staining

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