Abstract
Background. The effect of colorectal cancer (CRC) histological subtypes on the prognosis is still a controversial issue. We aimed to compare clinical findings, histopathologic data, and survival outcomes in CRC patients with classical and mucinous subtypes.
Methods. Patients who were operated on for CRC between 2010 and 2017 were included in the study. Patients were classified into two groups according to the presence of a mucinous component: mucinous adenocarcinoma (MAC) - mucinous component > 50% and classical adenocarcinoma (CAC). Clinical and histopathologic findings, recurrence, metastasis, and survival rates were compared.
Results. Data of the 484 CRC patients were documented. Sixty-nine patients (14.3%) were in the MAC group and 415 (85.7%) patients were in the CAC group. The mean age of patients with MAC and CAC was 63.4 ± 13.5 and 68.5 ± 12.7 years, respectively (p = 0.002). Proximal colon localization was found in 30 (43.5%) MAC patients and 123 (29.6%) CAC patients (p = 0.029). The number of patients with metastatic lymph nodes was higher in the MAC group (58% vs. 41.2%, p = 0.03). Nevertheless, there was no significant difference between the CAC and MAC groups in terms of disease-free survival (63.1% vs. 69.6%, p = 0.37) and disease-related mortality (23.6% vs. 23.2%, p = 0.94) over the follow-up period. Multivariate analysis showed that the presence of perineural invasion, patient’s age, and disease stage were associated with mortality in CRC patients.
Conclusions. MACs occurred at a younger age than CACs and were more likely localized in the proximal colon as compared to CACs. Despite increased lymph node metastasis in MAC patients, no statistical significance was detected in overall survival or disease-free survival. Multivariate analysis revealed that age, perineural invasion, and disease stage were relevant to mortality in CRC patients.
References
Huang L, Luo S, Lai S, Liu Z, Hu H, Chen M, et al. Survival after curative resection for stage I colorectal mucinous adenocarcinoma. BMC Gastroenterology. 2022;22:192. Available from: https://doi.org/10.1186/s12876-022-02276-z
Xu J, Sun Z, Ju H, Xie E, Mu Y, Xu J, et al. Construction of novel prognostic nomogram for mucinous and signet ring cell colorectal cancer patients with a survival longer than 5 years. International Journal of General Medicine. 2022;15:2549–2573. Available from: https://doi.org/10.2147/IJGM.S353523
Yu F, Huang L, Shen F, Wu S, Chen J. Prognostic implications of mucinous histology in stage III colon cancer with the receipt of adjuvant chemotherapy. Journal of Gastrointestinal Oncology. 2020;11(5):858–869. Available from: https://doi.org/10.21037/jgo-20-160
Huang Y, Alzahrani NA, Liauw W, Arrowaili A, Morris DL. Survival difference between mucinous vs. non-mucinous colorectal cancer following cytoreductive surgery and intraperitoneal chemotherapy. International Journal of Hyperthermia. 2018;35(1):298–304. Available from: https://doi.org/10.1080/02656736.2018.1496486
Reynolds IS, Furney SJ, Kay EW, McNamara DA, Prehn JHM, Burke JP. Meta-analysis of the molecular associations of mucinous colorectal cancer. British Journal of Surgery. 2019;106(6):682–691. Available from: https://doi.org/10.1002/bjs.11142
Catalano V, Loupakis F, Graziano F, Torresi U, Bisonni R, Mari D, et al. Mucinous histology predicts for poor response rate and overall survival of patients with colorectal cancer and treated with first-line oxaliplatin- and/or irinotecan-based chemotherapy. British Journal of Cancer. 2009;100(6):881–887. Available from: https://doi.org/10.1038/sj.bjc.6604955
Park JS, Huh JW, Park YA, Cho YB, Yun SH, Kim HC, et al. Prognostic comparison between mucinous and nonmucinous adenocarcinoma in colorectal cancer. Medicine. 2015;94(15):e658. Available from: https://doi.org/10.1097/MD.0000000000000658
Luo C, Cen S, Ding G, Wu W. Mucinous colorectal adenocarcinoma: clinical pathology and treatment options. Cancer Communications. 2019;39(1):13. Available from: https://doi.org/10.1186/s40880-019-0361-0
Fadel MG, Malietzis G, Constantinides V, Pellino G, Tekkis P, Kontovounisios C. Clinicopathological factors and survival outcomes of signet-ring cell and mucinous carcinoma versus adenocarcinoma of the colon and rectum: a systematic review and meta-analysis. Discover Oncology. 2021;12:5. Available from: https://doi.org/10.1007/s12672-021-00398-6
Ott C, Gerken M, Hirsch D, Fest P, Fichtner-Feigl S, Munker S, et al. Advanced mucinous colorectal cancer: epidemiology, prognosis and efficacy of chemotherapeutic treatment. Digestion. 2018;98(3):143–152. Available from: https://doi.org/10.1159/000487710
Zhao K, Wu L, Huang Y, Yao S, Xu Z, Lin H, et al. Deep learning quantified mucus-tumor ratio predicting survival of patients with colorectal cancer using whole-slide images. Precision Clinical Medicine. 2021;4(1):17–24. Available from: https://doi.org/10.1093/pcmedi/pbab002
Kim SH, Shin SJ, Lee KY, Kim H, Kim TI, Kang DR, et al. Prognostic value of mucinous histology depends on microsatellite instability status in patients with stage III colon cancer treated with adjuvant FOLFOX chemotherapy: a retrospective cohort study. Annals of Surgical Oncology. 2013;20(11):3407–3413. Available from: https://doi.org/10.1245/s10434-013-3169-1
Kang H, O’Connell JB, Maggard MA, Sack J, Ko CY. A 10-year outcomes evaluation of mucinous and signet-ring cell carcinoma of the colon and rectum. Diseases of the Colon & Rectum. 2005;48(6):1161–1118. Available from: https://doi.org/10.1007/s10350-004-0932-1
Song B-R, Xiao C-C, Wu Z-K. Predictors of lymph node metastasis and prognosis in pT1 colorectal cancer patients with signet-ring cell and mucinous adenocarcinomas. Cellular Physiology and Biochemistry. 2017;41(5):1753–1765. Available from: https://doi.org/10.1159/000471868
de Gramont A, Hubbard J, Shi Q, O’Connell MJ, Buyse M, Benedetti J, et al. Association between disease-free survival and overall survival when survival is prolonged after recurrence in patients receiving cytotoxic adjuvant therapy for colon cancer: simulations based on the 20,800 patient ACCENT data set. Journal of Clinical Oncology. 2010;28(3):460–465. Available from: https://doi.org/10.1200/JCO.2009.23.1407
Nitsche U, Friess H, Agha A, Angele M, Eckel R, Heitland W, et al. Prognosis of mucinous and signet-ring cell colorectal cancer in a population-based cohort. Journal of Cancer Research and Clinical Oncology. 2016;142(11):2357–2366. Available from: https://doi.org/10.1007/s00432-016-2224-2
Hogan J, Burke JP, Samaha G, Condon E, Waldron D, Faul P, et al. Overall survival is improved in mucinous adenocarcinoma of the colon. International Journal of Colorectal Disease. 2014;29(5):563–569. Available from: https://doi.org/10.1007/s00384-013-1826-2
Hu X, Li Y-Q, Li Q-G, Ma Y-L, Peng J-J, Cai S. Mucinous Adenocarcinomas histotype can also be a high-risk factor for stage II colorectal cancer patients. Cellular Physiology and Biochemistry. 2018;47(2):630–640. Available from: https://doi.org/10.1159/000490018
Feng H, Lyu Z, Zheng J, Zheng C, Wu D qing, Liang W, et al. Association of tumor size with prognosis in colon cancer: a Surveillance, Epidemiology, and End Results (SEER) database analysis. Surgery. 2021;169(5):1116–1123. Available from: https://doi.org/10.1016/j.surg.2020.11.011
Enblad M, Hammarström K, Folkesson J, Imam I, Golubovik M, Glimelius B. Mucinous rectal cancers: clinical features and prognosis in a population-based cohort. BJS Open. 2022;6(2):zrac039. Available from: https://doi.org/10.1093/bjsopen/zrac039
Acharya A, Markar SR, Matar M, Ni M, Hanna GB. Use of tumor markers in gastrointestinal cancers: surgeon perceptions and cost-benefit trade-off analysis. Annals of Surgical Oncology. 2016;24(5):1165–1173. Available from: https://doi.org/10.1245/s10434-016-5717-y
Rao H, Wu H, Huang Q, Yu Z, Zhong Z. Clinical value of serum CEA, CA24-2 and CA19-9 in patients with colorectal cancer. Clinical Laboratory. 2021;67(04/2021):200828. Available from: https://doi.org/10.7754/Clin.Lab.2020.200828
Gao Y, Wang J, Zhou Y, Sheng S, Qian SY, Huo X. Evaluation of serum CEA, CA19-9, CA72-4, CA125 and ferritin as diagnostic markers and factors of clinical parameters for colorectal cancer. Scientific Reports. 2018;8:2732. Available from: https://doi.org/10.1038/s41598-018-21048-y
Cheng H-H, Lin J-K, Chen W-S, Jiang J-K, Yang S-H, Chang S-C. Clinical significance of the BRAFV600E mutation in Asian patients with colorectal cancer. International Journal of Colorectal Disease. 2018;33(9):1173–1181. Available from: https://doi.org/10.1007/s00384-018-3095-6
Okamura R, Hasegawa S, Hida K, Hoshino N, Kawada K, et al. The role of periodic serum CA19-9 test in surveillance after colorectal cancer surgery. International Journal of Clinical Oncology. 2016;22(1):96–101. Available from: https://doi.org/10.1007/s10147-016-1027-4

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.