Abstract
Background Prior studies have shown a better prognosis with medullary colon cancer (MCC) compared to nonmedullary colon carcinomas (NMC); however, data are inconsistent and lacking the evaluation of treatments received. As we did not see similar survival outcomes, we aimed to retrospectively examine survival and receipt of treatment differences between MCC and NMC within the Geisinger Health System. Methods The Cancer Registry was retrospectively reviewed for MCC and NMC from 2006 to 2017. Demographics and treatments were compared using T-test and chi-squared analyses, also comparing MCC to poorly differentiated (PD) or undifferentiated (UD) NMC. Overall survival was analyzed using Kaplan–Meier curves and log-rank tests. Results 33 MCC and 1775 NMC patients were identified and 31 (93.9%) MCC and 1433 (87.0%) NMC underwent resection. MCC were older (p=0.0002), had a higher Charlson Comorbidity Index (p=0.013) and were more likely right sided (p=0.013). Seven patients (22.6%) with MCC vs. 149 (10.4%) NMC underwent resection of contiguous organs. Overall median survival was significantly worse for MCC as compared to NMC (19.6 vs. 60.5 months, p=0.0002). Only stage 3 patients had a significantly worse median survival when compared to PD/UD NMC (9.6 vs. 47.2 months, p < 0.001). Contiguous organ resection and failure to receive chemotherapy were not found as contributing factors to decreased survival. Conclusion Multiple previous studies showed a better prognosis for MCC compared to PD/UD NMC. We, however, found stage 3 patients had a worse prognosis which may be secondary to higher comorbidities, increased stage, and higher rate of UD.
Highlights
Medullary colon cancer (MCC) was differentiated from nonmedullary colon cancer (NMC) as a subtype of adenocarcinoma by the World Health Organization (WHO) and is described as poorly differentiated or undifferentiated tumors with solid sheets of cells lacking glandular formation [1]. is variant is commonly mismatch repair deficient with microsatellite instability and is characterized by prominent eosinophilic cytoplasm, a pushing type border, marked lymphocytic infiltration, small nuclei, and prominent nucleoli [2].While data regarding histologic differences between MCC versus nonmedullary colon carcinomas (NMC) are prominent, literature regarding differences in treatment and survival for MCC compared to NMC with poor or undifferentiated pathology appear to be limited and conflicting
Multiple previous studies showed a better prognosis for MCC compared to poorly differentiated (PD)/UD NMC
Prognosis for MCC is thought to be better compared to NMC since it rarely presents with nodal metastases or metastatic disease [2, 3]
Summary
Medullary colon cancer (MCC) was differentiated from nonmedullary colon cancer (NMC) as a subtype of adenocarcinoma by the World Health Organization (WHO) and is described as poorly differentiated or undifferentiated tumors with solid sheets of cells lacking glandular formation [1]. is variant is commonly mismatch repair deficient with microsatellite instability and is characterized by prominent eosinophilic cytoplasm, a pushing type border, marked lymphocytic infiltration, small nuclei, and prominent nucleoli [2].While data regarding histologic differences between MCC versus NMC are prominent, literature regarding differences in treatment and survival for MCC compared to NMC with poor or undifferentiated pathology appear to be limited and conflicting. Prior studies showed MCC patients have a better prognosis than undifferentiated (UD) NMC [3,4,5]. One study showed UD MCC typically present at stage 3 may have a worse prognosis than NMC of the same stage [3]. Since these tumors more commonly occur in elderly, it is possible that the inconsistent survival outcomes may be secondary to increased surgical morbidity or limited adjuvant treatments. Prior studies have shown a better prognosis with medullary colon cancer (MCC) compared to nonmedullary colon carcinomas (NMC); data are inconsistent and lacking the evaluation of treatments received. Found stage 3 patients had a worse prognosis which may be secondary to higher comorbidities, increased stage, and higher rate of UD
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