Abstract
BackgroundThe guidelines established by the National Comprehensive Cancer Network do not describe mucinous histology as a clinical factor that should influence the therapeutic algorithm. However, previous studies show conflicting results regarding the prognosis of colorectal mucinous adenocarcinoma. In this study, we described the clinicopathological features of mucinous adenocarcinoma in Japan, to identify optimal therapeutic strategies.Methods144 patients with mucinous and 2673 with non-mucinous adenocarcinomas who underwent primary resection in two major centers in Yokohama, Japan were retrospectively evaluated for clinicopathological features and treatment factors. A multivariate analysis for overall survival followed by the comparison of overall survival using Cox proportional hazard model were performed.ResultsPatients with mucinous adenocarcinoma had larger primary lesions, higher preoperative CEA levels, a deeper depth of invasion, higher rates of nodal and distant metastasis, and more metastatic sites. A multivariate analysis for overall survival revealed a mucinous histology to be an independent prognostic factor. In the subgroup analysis stratified by stage, Patients diagnosed as StageIII and IV disease had a worse survival in mucinous adenocarcinoma than non-mucinous, while survival did not differ significantly in patients diagnosed as Stage0-II disease. In StageIII, local recurrence in rectal cases and peritoneal dissemination were more frequently observed in patients with a mucinous histology.ConclusionsOur study indentified that mucinous adenocarcinoma was associated with a worse survival compared with non-mucinous in patients with StageIII and IV disease. In rectal StageIII disease with mucinous histology, additional therapy to control local recurrence followed by surgical resection may be a strategical alternative. Further molecular investigations considering genetic features of mucinous histology will lead to drug development and better management of peritoneal metastasis
Highlights
The guidelines established by the National Comprehensive Cancer Network (NCCN) do not describe mucinous histology as a clinical factor that should influence the therapeutic algorithm [15,16]
Of the 2,817 colorectal cancer patients, Mucinous adenocarcinoma (MA) accounted for 5.1% (144) of the colorectal cancer cases
The patients with MA had significantly larger primary lesions, higher preoperative serum carcinoembryonic antigen (CEA) levels, deeper invasion, higher nodal and distant metastasis rates, and a larger number of metastatic sites compared to the patients with non-mucinous adenocarcinoma (NMA)
Summary
The guidelines established by the National Comprehensive Cancer Network do not describe mucinous histology as a clinical factor that should influence the therapeutic algorithm. MA makes up 6 to 20% of all colorectal cancers [3,4,5,6,7,8], and differs from non-mucinous adenocarcinoma (NMA) with regard to its clinicopathological characteristics, distinct genetic profiles, and pathogenic pathways [9,10,11,12]. Mucinous histology was reported not to be an independent prognostic factor for survival [13,14]. The guidelines established by the National Comprehensive Cancer Network (NCCN) do not describe mucinous histology as a clinical factor that should influence the therapeutic algorithm [15,16]. In some studies, it is reported that MA is associated with worse clinicopathological characteristics [17,18,19] and a poorer prognosis than NMA [5,17,20,21,22,23]
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