Mucinous Rectal Cancer: Effectiveness of Preoperative Chemoradiotherapy and Prognosis

Shin, Ui Sup; Yu, Chang Sik; Kim, Jong Hoon; Kim, Tae Won; Lim, Seok-Byoung; Yoon, Sang Nam; Yoon, Yong Sik; Kim, Chan Wook; Kim, Jin Cheon

doi:10.1245/s10434-011-1612-8

Cited by 78 publications

(62 citation statements)

References 21 publications

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“…MSI tumours have been associated with less responsiveness to 5-fluorouracil (5-FU) chemotherapeutic treatment [169], but this does not explain the discrepancy between the adjuvant and palliative setting. In rectal cancer, resistance of MC to radiotherapy or chemoradiotherapy is suspected, given the poorer rate of tumour downstaging [170,171]. Also, the metastatic pattern is different between MC and NMC patients [8].…”

Section: Discussionmentioning

confidence: 99%

The molecular background of mucinous carcinoma beyond MUC2

Hugen

Simons²,

Halilović³

et al. 2014

Clin J Pathol

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The increasing interest of the oncology community in tumour classification and prediction of outcome to targeted therapies has put emphasis on an improved identification of tumour types. Colorectal mucinous adenocarcinoma (MC) is a subtype that is characterized by the presence of abundant extracellular mucin that comprises at least 50% of the tumour volume and is found in 10-15% of colorectal cancer patients. MC development is poorly understood, however, the distinct clinical and pathological presentation of MC suggests a deviant development and molecular background. In this review we identify common molecular and genetic alterations in colorectal MC. MC is characterized by a high rate of MUC2 expression. Mutation rates in the therapeutically important RAS/RAF/MAPK and PI3K/AKT pathways are significantly higher in MC compared with non-mucinous adenocarcinoma. Furthermore, mucinous adenocarcinoma shows higher rates of microsatellite instability and is more frequently of the CpG island methylator phenotype. Although the majority of MCs arise from the large intestine, this subtype also develops in other organs, such as the stomach, pancreas, biliary tract, ovary, breast and lung. We compared findings from colorectal MC with tumour characteristics of MCs from other organs. In these organs, MCs show different mutation rates in the RAS/RAF/MAPK and PI3K/ AKT pathways as well, but a common mucinous pathway cannot be identified. Identification of conditions and molecular aberrations that are associated with MC generates insight into the aetiology of this subtype and improves understanding of resistance to therapies.

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Section: Discussionmentioning

confidence: 99%

The molecular background of mucinous carcinoma beyond MUC2

Hugen

Simons²,

Halilović³

et al. 2014

Clin J Pathol

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“…Tumors are defined as MC when a minimum of 50.0% mucin-to-tumor volume is determined (4). Interestingly, MCs have limited response to oncological treatments (5,6). Therefore, it is important to differentiate MC from AC.…”

Section: Introductionmentioning

confidence: 99%

Mean ADC values discriminate rectal mucinous carcinomafrom rectal nonmucinous adenocarcinoma

Er¹,

Erden²

2017

Turk J Med Sci

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IntroductionColorectal carcinoma is a major cause of cancer-related mortality. Rectal cancer comprises approximately onethird of the cases of colorectal cancer. Adenocarcinomas comprise 96% of colorectal cancers (1). Mucinous adenocarcinoma (MC) is a specific rectal cancer subtype, encompassing 10.0% of all cases, and it is associated with a poorer prognosis than nonmucinous adenocarcinoma (AC) (2,3). Tumors are defined as MC when a minimum of 50.0% mucin-to-tumor volume is determined (4). Interestingly, MCs have limited response to oncological treatments (5,6). Therefore, it is important to differentiate MC from AC.Diffusion-weighted imaging (DWI) is a version of MRI based on fluid dynamics and the molecular mechanics of water mobility (7). The signal intensity increases when water mobility is restricted, such as in cases of dense cellularity lesions and poor interstitium (8). The apparent diffusion coefficient (ADC) is used to quantitate diffusivity based on the fluid restrictions described above compared to the surrounding tissues. The measurable data obtained by DWI can clarify the nature of the lesions in various parts of the body (9).Our goal was to investigate the usefulness of ADC values in order to distinguish MC from AC. Materials and methods PatientsThis was a retrospective study. We subjected 64 patients diagnosed with rectal carcinoma to pelvic MRI to determine the local staging baseline for rectal tumors. The patients were included in the study based on histopathologically Background/aim: This study aimed to differentiate rectal mucinous carcinoma (MC) from nonmucinous rectal adenocarcinoma (AC) using mean apparent diffusion coefficient (mADC) values obtained with diffusion-weighted imaging.Materials and methods: Sixty-two pathologically confirmed rectal AC (n = 44) and MC (n = 18) patients were included in this study. The two groups underwent pelvic MRI to determine the local staging baseline for rectal tumors. Once the region of interest (ROI) was determined, a border was drawn around each hyperintense tumor (b = 1000 s/mm 2 images). Following a repeat of this procedure for each patient, the ROIs were recorded to apparent diffusion coefficient (ADC) maps, and mADC values were measured. The mADC was determined per slice, followed by a calculation of whole tumor volume ADC mean using the individual mADC values. The Mann-Whitney test was performed to compare mADCs for the two groups. A receiver operating characteristic (ROC) curve was generated to determine the differentiating capacity of ADCs from MC to AC. Results:The mADC was higher in MC (1.631 ± 0.375 × 10 -3 mm 2 /s) (range: 0.95-2.36 × 10 -3 mm 2 /s) than in AC (0.921 ± 0.157 × 10 -3 mm 2 /s) (range: 0.6-1.48 × 10 -3 mm 2 /s) (P < 0.001). mADCs were effective in distinguishing MC from AC (area under the ROC curve, 0.972 (95% CI : 0.928-1.00)). A threshold of 1.27 × 10 -3 mm 2 /s was set that corresponded with high sensitivity (94.4%) and specificity (97.7%). Twelve MCs (67%) were predominantly hypointense, and 6 MCs (33%) were seen as mixed si...

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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.…”

mentioning

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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Mucinous Rectal Cancer: Effectiveness of Preoperative Chemoradiotherapy and Prognosis

Abstract: Patients with mucinous rectal cancer experienced a lower rate of T-downstaging after PCRT and had a poorer prognosis than did patients with nonmucinous cancer.

Cited by 78 publications

References 21 publications

The molecular background of mucinous carcinoma beyond MUC2

The molecular background of mucinous carcinoma beyond MUC2

Mean ADC values discriminate rectal mucinous carcinomafrom rectal nonmucinous adenocarcinoma

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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