Mucinous differentiation in colorectal cancer – indicator of poor prognosis?

Abstract

Langner C, Harbaum L, Pollheimer M J, Kornprat P, Lindtner R A, Schlemmer A, Vieth M & Rehak P (2012) Histopathology 60, 1060–1072 Mucinous differentiation in colorectal cancer – indicator of poor prognosis? Aims: To analyse the prognostic impact of mucinous differentiation in colorectal mucinous adenocarcinomas and adenocarcinomas with a mucinous component. Methods and results: A total of 381 tumours were reviewed for mucinous differentiation by two independent pathologists. Mismatch repair status was assessed by immunohistochemistry. Prognostic significance was assessed by univariate and multivariate analyses. Eighty‐one (21%) tumours were Union Internationale Contre le Cancer (UICC) Stage I, 120 (31%) Stage II, 126 (33%) Stage III and 54 (14%) Stage IV. Mucinous adenocarcinomas accounted for 12% and adenocarcinomas with a mucinous component for 19% of tumours. Mucinous differentiation was associated significantly with mismatch repair protein deficiency. The presence of extracellular mucin, regardless of extent, did not affect patients’ outcome, while tumour grade, vascular and perineural invasion, tumour border configuration and budding were associated significantly with outcome. Cox analysis proved venous invasion to be an independent predictor of outcome in mucinous adenocarcinomas and both venous invasion and tumour budding as independent predictors of outcome in adenocarcinomas with any amount of mucin. Conclusions: Mucinous adenocarcinomas and/or adenocarcinomas with mucinous component do not differ from conventional adenocarcinomas with respect to prognosis and histological predictors of outcome. Hence, recording of mucinous differentiation may be used as an indicator of mismatch repair deficiency, but not for prognostic stratification.

Prognostic Significance of the Mucin Component in Stage III Rectal Carcinoma Patients

“…Some studies had suggested that MUC had a worse prognosis compared with non-MUC (Kanemitsu et al, 2003;Verhulst et al, 2012;Biffi et al, 2013). Others reported no differences (Leopoldo et al, 2007;Farhat et al, 2008;Xie et al, 2009;Langner et al, 2012;Yamaguchi et al, 2012). In present study, we found patient with MUC had a worse prognosis than non-MUC (both adenocarcinomas containing mucin component and without mucin component) in all patients with stage Ⅲ rectal carcinoma.…”

“…Langner et al suggested that recording of mucinous differentiation should be used as an indicator of mismatch repair deficiency, but not for prognostic stratification (Langner et al, 2012). Patients with stage I-III were included in that study.…”

“…Some studies believed that mucinous histologic type itself is an important prognostic factor affecting the progression of tumor and outcome of patients with colorectal carcinoma. And the survival rate of patients with mucinous adenocarcinoma could be inferior to the patients with non-mucinous adenocarcinoma (NMC) (Kanemitsu et al, 2003;Verhulst et al, 2012;Biffi et al, 2013;Hugen et al, 2013), while some other studies did not find any adverse prognostic effect (Leopoldo et al, 2007;Farhat et al, 2008;Xie et al, 2009;Langner et al, 2012;Yamaguchi et al, 2012).…”

“…Chemotherapy, which is primarily based on 5-fluoruracil, has decreased tumour recurrence in American Joint Cancer Committee (AJCC) Stage III patients (Langner et al, 2012). This study aimed to analyze the prognostic impact of different mucin component in patients with stage Ⅲ rectal carcinoma in current treatment.…”

TNM Stages and Prognostic Features of Colorectal and Mucinous Adenocarcinoma Patients: a Meta Analysis

“…There are 3759 English literatures in original search, after exclusion and screening, 28 English literatures (Cusack et al, 1996;Sun et al, 1996;Wu et al, 1996;Enriquez et al, 1998;Cerottini et al, 1999;Consorti et al, 2000;Nozoe et al, 2000;Kanemitsu et al, 2003;Chen et al, 2004;Du et al, 2004;Papadopoulos et al, 2004;Kang et al, 2005;You et al, 2006;Grillo-Ruggieri et al, 2007;Hill et al, 2007;Lee et al, 2007;Farhat et al, 2008;Pande et al, 2008;Catalano et al, 2009;Min et al, 2009;Song et al, 2009;Xie et al, 2009;Sultan et al, 2010;Catalano et al, 2011;Jivapaisarnpong et al, 2011;Hyngstrom et al, 2012;Langner et al, 2012;Yamaguchi et al, 2012) and 2 Chinese literatures (Songqing et al, 2002;Miao et al, 2005) meet the requirements. In the 30 literatures, 21 literatures can be used for Meta analysis of the relationship of mucinous adenocarcinoma and TNM staging, including 444489 cases, in which mucinous adenocarcinoma were 45050 cases, accounting for 10.1% of all cases; 21 literatures can be used for Meta analysis of relationship of mucinous adenocarcinoma and prognosis, including 450804 cases, in which mucinous adenocarcinoma were 45354 cases, accounting for 10.1% of all cases.…”