Mucinous Adenocarcinomas Histotype Can Also be a High-Risk Factor for Stage II Colorectal Cancer Patients

Hu, Xiang; Li, Ya Qi; Li, Qing Guo; Yan, Lei; Peng, Jun; Cai, Sanjun

doi:10.1159/000490018

Cited by 16 publications

(18 citation statements)

References 23 publications

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“…Mucinous carcinoma is a relatively rare pathological type of colorectal cancer, accounting for approximately 10-15% of all colorectal cancer cases [18]. As a distinct subtype, mucinous carcinoma has been reported to be associated with higher risks of lymph node involvement in stage I and II colorectal cancer [19,20]. Our population-based analysis consistently revealed that patients with mucinous carcinoma of the colon had a higher risk of LNM.…”

Section: Discussionsupporting

confidence: 60%

Population-based analysis on predictors for lymph node metastasis in T1 colon cancer

Zhang

et al. 2019

Surg Endosc

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Background In this study, we aimed to identify independent predictive factors for lymph node metastasis (LNM) in T1 colon cancer. Methods Data of 8056 eligible patients were retrospectively collected from the Surveillance, Epidemiology, and End Results (SEER) database during 2004-2012. We performed logistic regression analysis to identify predictive factors for LNM. Both unadjusted and adjusted Cox regression analyses were used to determine the association between LNM and patient survival. Finally, we used competing risks analysis and the cumulative incidence function (CIF) to further confirm the prognostic role of LNM in cancer-specific survival (CSS). Results The overall risk of LNM in patients with T1 colon cancer was 12.0% (N = 967). Adjusted logistic regression models revealed that mucinous carcinoma [odds ratio (OR) = 2.26, P < 0.001], moderately differentiated (OR 1.74, P < 0.001), poorly differentiated (OR 5.16, P < 0.001), and undifferentiated carcinoma (OR 3.01, P = 0.003); older age (OR 0.66, P < 0.001 for age 65-79 years, OR 0.44, P < 0.001 for age over 80 years); and carcinoma located in the ascending colon (OR 0.77, P = 0.018) and sigmoid colon (OR 1.24, P = 0.014) were independent predictive factors for LNM. Adjusted Cox regression analysis showed that positive lymph node involvement was significantly associated with CSS [hazard ratio (HR) = 3.02, P < 0.001], which was further robustly confirmed using a competing risks model and the CIF. Conclusions This population-based study showed that mucinous carcinoma, tumor grade, age, and primary tumor location were independent predictive factors for LNM in T1 colon cancer. The risk of LNM should be carefully evaluated in patients with T1 colon cancer, before clinical management. Keywords Colon cancer • Lymph node metastasis • Independent predictive factors • SEER database Colorectal cancer is among the leading causes of cancerrelated mortality in both western countries and China [1, 2]. Colorectal cancer is mainly divided into colon cancer and rectal cancer based on primary tumor location, with colon cancer accounting for approximately 70% of colorectal cancers [1, 3]. Early colon cancer refers to carcinoma with invasion limited to the submucosa [4, 5], which can be designated T1N X M0 based on the TNM classification system.

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Section: Discussionsupporting

confidence: 60%

Population-based analysis on predictors for lymph node metastasis in T1 colon cancer

Zhang

et al. 2019

Surg Endosc

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“…Most currently studies comparing CRC with MAC use this criterion, nevertheless, their impact on patients' prognosis has remained controversial. The present results do not agree with some previous reports [3,10] but support those of a recent study by Gonzalez et al [5] and Chen et al [2], in which they state that the proportion of mucinous component of MAC has no signi cant in uence on patient prognosis. While mucinous features should still be mentioned, utilizing criteria such as a 50% cut off is not supported by our data.…”

Section: Discussioncontrasting

confidence: 99%

“…Despite several studies comparing underlying clinicopathological differences between MAC and conventional CRC. Still, controversial results relating prognostic value of mucinous histology have been reported [2][3][4][5][6][7]. Till present, the prognostic value of MAC remains undetermined when the locations of the tumor, molecular alterations, population characteristics or different treatment plans are taken into account.…”

Section: Introductionmentioning

confidence: 99%

Clinicopathological characteristics, molecular alterations and prognosis of mucinous histology in colorectal adenocarcinoma patients

Jia

Yan

2020

Preprint

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Background Mucinous adenocarcinoma (MAC) is conventionally diagnosed by WHO definition when the extracellular mucin is more than 50% of the tumour area. The study is aimed at analyzing the clinicopathological characteristics, mutation spectrum, and prognosis of the colorectal adenocarcinoma (CRC) with any mucinous proportion or feature. Methods Clinical and pathological information for 50 patients were reviewed and recorded. Mutation analyses for exon 2–4 of KRAS gene and exon 15 of BRAF gene were performed by Sanger sequencing. Expression of DNA mismatch repairs (MMRs) and P53 proteins was evaluated by immunohistochemistry (IHC). Density of tumour infiltrating lymphocyte (TIL) status was scored. We also evaluated the percentage of glands producing mucin and the morphology of the different tumor cells types in mucin pools. We retrospectively analyzed prognosis of 43 patients with Stage II-III MAC. The primary outcome was progression-free survival (PFS). Results The overall frequencies of KRAS and BRAF mutations were 37.9% and 4.4%, respectively. Patients with MAC exhibiting high levels of mucin were related to the increase of tumor diameter (P = 0.038), but were not associated with any of the other clinicopathological parameters. The proportion or variable morphology of mucinous component did not stratify PFS in Stage II-III tumours. It is interesting to note that male patients had lower TIL compared with female patients (P = 0.018). TIL-low tumors were also correlated with advanced stage (P = 0.041). TIL status was a strong independent predictor of PFS in stage II-III mucinous component tumours (p < 0.001). All four IV stage patients were also classified into TIL-low case. No parameters were independently associated with outcome after adjusting for tumour stage in multivariate analysis. Conclusions TIL status could more accurately determine the biology of the MAC feature for appropriate management, irrespective of quantity or morphology of mucinous component.

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“…In 2011, a study involved 1,025 unselected patients from Italy showed that the OS of stage II colon cancer with MUA was not significantly different from those with NMUA (P = 0.206) (19). Later, in 2018, a study also found that the cancerspecific survival difference between MUA and NMUA was not statistically significant (P = 0.597) (20). Recently, Fields et al (21) conducted a retrospective analysis and reported that the 5year survival rates of patients with stage II NMUA and MUA were 65.1 and 63.5%, respectively, and the survival difference achieved statistical significance (P = 0.002).…”

Section: Discussionmentioning

confidence: 99%

Mucinous Histology Might Be an Indicator for Enhanced Survival Benefit of Chemotherapy in Stage II Colon Cancer

Huang

et al. 2020

Front. Med.

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Background: It was a difficult question to identify candidates who would benefit most from adjuvant chemotherapy in stage II colon cancer because of the paucity of relevant conclusive clinical trial results. We aimed to assess if mucinous adenocarcinoma (MUA) could be an indicator for the efficacy of adjuvant chemotherapy in stage II colon cancer. Methods: Using SEER * Stat software V.8.3.5, eligible patients were then recruited from the SEER database. A χ 2 test was applied to compare the distribution of different categorical variables between nonmucinous adenocarcinoma (NMUA) and MUA groups. We then used the Kaplan-Meier method to analyze overall survival (OS) of different histological types in stage II colon cancer, and the log-rank test was then used to assess the OS differences. The Cox proportional regression risk models were also built in our analyses to eliminate potential crossed bias from other prognostic factors. Results: A total of 50,065 patients diagnosed with stage II colon cancer were recruited from the SEER database from 2004 to 2011; all the patients were divided into two groups, including NMUA (n = 44,785) and MUA (n = 5,280). The Cox analysis of the histological type indicated that the survival difference between MUA and NMUA failed to reach statistical significance in stage II colon cancer (P = 0.360). In NMUA, patients treated with adjuvant chemotherapy were independently associated with 37.2% decreased risk of overall mortality compared with those not [hazard ratio (HR) = 0.628, 95% confidence interval (CI) = 0.601-1.656, P < 0.001]; in MUA, the number increased to 41.5% (HR = 0.585, 95% CI = 0.515-0.665, P < 0.001). Conclusions: Our study showed that the survival difference between MUA and NMUA failed to reach statistical significance in stage II colon cancer. More importantly, our study had provided the first evidence that chemotherapy would offer higher survival improvement in MUA compared with NMUA in stage II colon cancer; mucinous histology might be an indicator for enhanced survival benefit of chemotherapy in stage II colon cancer.

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Mucinous Adenocarcinomas Histotype Can Also be a High-Risk Factor for Stage II Colorectal Cancer Patients

Cited by 16 publications

References 23 publications

Population-based analysis on predictors for lymph node metastasis in T1 colon cancer

Population-based analysis on predictors for lymph node metastasis in T1 colon cancer

Clinicopathological characteristics, molecular alterations and prognosis of mucinous histology in colorectal adenocarcinoma patients

Mucinous Histology Might Be an Indicator for Enhanced Survival Benefit of Chemotherapy in Stage II Colon Cancer

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