Mucinous Adenocarcinoma Patients Research Articles

Risk of Second Primary Malignancies Based on the Histological Subtypes of Colorectal Cancer.

Background: Previous studies have revealed an increased risk of second primary malignancies (SPMs) after colorectal cancer (CRC); however, no previous investigation has quantified differences in the risk of SPMs based on the histological subtypes of first primary CRC.Methods: Patients diagnosed with first primary CRC between 2000 and 2011 were identified from the Surveillance, Epidemiology, and End Results cancer registries. The patients were divided into three cohorts: classical adenocarcinoma (CA), mucinous adenocarcinoma (MA), and signet-ring cell carcinoma (SRCC). Standardized incidence ratios were calculated to assess the risk of SPMs among the patients.Results: Overall risk of SPMs was significantly higher among patients with three histological subtypes of CRC than in the general population. The risk of esophagus cancer was significantly increased in SRCC. The risk of small intestine, colon and rectum, and corpus uteri cancers was high in three histological subtypes, with the highest risk observed in SRCC, followed by MA. Increased risks of second stomach, uterus, urinary bladder, kidney, and thyroid cancers were only observed in CA patients, while increased risk of second renal pelvis cancer was limited to MA patients. Furthermore, the high overall risk of SPMs in CA patients persisted regardless of clinicopathological factors. After surgery combined with chemotherapy treatment, CA patients were more prone to developing second small intestine, colon and rectum cancers than those treated with surgery only. A lower second prostate cancer risk was observed in rectal CA patients treated with surgery combined with radiotherapy than in patients treated with surgery only.Conclusion: The present study revealed that the risk of developing SPMs after CRC varied based on the histological subtypes of the first primary CRC. Although the mechanisms underlying the observed patterns of SPM risk remain unknown, the study provided insights into future cancer surveillance based on the histological subtypes of CRC.

Clinicopathological and Molecular Features of Colorectal Cancer Patients With Mucinous and Non-Mucinous Adenocarcinoma.

BackgroundThe prognosis of mucinous adenocarcinoma (MAC) and non-mucinous adenocarcinoma (NMAC) in colorectal cancer (CRC) is controversial, and the molecular differences between them are unclear.MethodsBetween 2000 and 2010, a total of 1,483 CRC patients were included. Among them, 73 patients (4.9%) were diagnosed with MAC. The clinicopathological features and genetic alterations were compared between MAC and NMAC.ResultsAfter propensity score matching to balance age and sex between MAC and NMAC patients, 292 CRC patients (73 MAC and 219 NMAC) were enrolled in the analysis at a 1:3 ratio. In right-sided colon cancer, patients with MAC were more likely to have Borrmann types 3 and 4 tumors, poor differentiation, and advanced T category and tumor, node, metastasis (TNM) stage, chemotherapy, and a similar 5-year overall survival (OS) rate compared with patients with NMAC. In left-sided colon cancer and rectal cancer, patients with MAC were more likely to have Borrmann types 3 and 4 tumors, poor differentiation, lymphovascular invasion, advanced T and N categories and TNM stages, chemotherapy, and a worse 5-year OS rate than patients with NMAC. Regarding genetic alterations, for NMAC, right-sided colon cancer had more BRAF mutations than left-sided colon cancer and rectal cancer. For MAC, right-sided colon cancer was associated with more microsatellite instability-high tumors and more AKT1 mutations than left-sided colon cancer and rectal cancer.ConclusionThe genetic alterations are distinct between MAC and NMAC in CRC. Tumor location may have an impact on genetic alterations and patient prognosis in MAC and NMAC.

Clinicopathological characteristics and survival in lung signet ring cell carcinoma: a population-based study.

ABSTRACTLung signet-ring cell carcinoma (LSRCC) is a very rare type of lung cancer, the clinical characteristics, and prognosis of which remain to be clarified. In order to explore the clinicopathological and survival-related factors associated with LSRCC, we performed a large population-based cohort analysis of data included in the Surveillance, Epidemiology, and End Results (SEER) registry from 2001 to 2015. A total of 752 LSRCC and 7518 lung mucinous adenocarcinoma (LMAC) patients were incorporated into our analysis, with respective mean ages of 63.8 and 67.5 years at the time of diagnosis. LSRCC patients were significantly more likely than LMAC patients to have distant-stage disease (72.1% vs. 45.8%, p < 0.0001), tumors of a high pathological grade (40.6% vs. 10.8%, p < 0.0001), have undergone chemotherapy (62.1% vs. 39.9%, p<0.0001), be male (52.7% vs. 48.5%, p = 0.03), and be < 40 years old (3.3% vs. 1.3%, p = 0.022), whereas they were less likely to have undergone surgical treatment (52.4% vs. 77.0%, p < 0.0001). LSRCC and LMAC patients exhibited median overall survival (OS) duration of 8 and 18 months (p < 0.0001), respectively, although these differences were not significant after adjusting for confounding variables. Independent factors associated with a favorable patient prognosis included a primary site in the middle or lower lung lobe, underwent surgery, and underwent chemotherapy. However, age ≥80 years, higher grade, distant summary stage disease, and T4 stage disease were linked to poor prognosis. Patient age, tumor grade, primary tumor site, summary stage, T stage, surgery, and chemotherapy were all significantly associated with LSRCC patient prognosis.

Application of liver acquisition with volume acceleration enhanced sequence in improving the accuracy of reassessing organ-invasive rectal mucinous adenocarcinoma after chemoradiation

ObjectivesTo explore the ability of liver acquisition with volume acceleration contrast-enhanced sequence (LAVA-ce) to improve the accuracy of reassessing adjacent organ involvement by rectal mucinous adenocarcinoma (MC) after neoadjuvant therapy (NAT). MethodsThis study retrospectively enrolled twenty-five patients with MC who underwent pre- and post-NAT MRI, were staged as T4b using pre-NAT T2 weighted imaging, received NAT and underwent radical resection. All MR images were divided into two schemes, T2 weighted plus diffusion weighted imaging (T2Dw protocol) and plus LAVA-ce (T2DwLce protocol). All patients were scored on a 0−4 scale to reassess organ-invasive mucus components. Postoperative pathology was used to identify the involvement of surrounding organs (ypT4b). The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the consistency of the results with pathology after adding fs-CE sequence. ResultsAmong 25 MC patients (15 males and 10 females, aged 21–89 years), 21 were restaged as yT4b after NAT by using T2Dw, with an accuracy of 44.0 % (11/25), which was lower than the accuracy of staging patients with non-mucinous rectal adenocarcinoma (94.1 %, 96/102). The accuracy of MC restaging was improved by using T2DwLce (23/25). The AUC of T2DwLce was 0.857 (95 % CI, 0.660∼0.964), which was higher than that of T2Dw (AUC, 0.611 [95 % CI, 0.397∼0.798]) (P = 0.019). ConclusionThe LAVA-ce sequence can improve the accuracy of reevaluation and should be included in the MRI protocol for MC patients.

Prognosis of early stage pulmonary mucinous adenocarcinoma with different treatments.

BackgroundThe effects of surgical approach and adjuvant chemotherapy (AC) of early stage pulmonary mucinous adenocarcinoma (MAD) have not been thoroughly studied yet. This study intends to clarify whether AC provides clinical benefit to the early stage MAD patients and the survival difference between surgical approaches.MethodsAll cases of stage I MAD were identified from the SEER database during the period of 2009–2014. The primary cohort was divided into AC and surgery (S) groups. Meanwhile, the patients with tumor ≤1 cm were divided into lobectomy and sublobar resection group. Clinical characteristics, treatments and survival data including overall survival (OS) and cancer-specific survival (CSS) were analyzed.ResultsA total of 1,816 patients were included in the final cohort. Referring to surgical procedure, 140 patients received lobectomy and 75 patients received sublobar resection. AC showed worse survival outcomes than surgery alone (OS: 71.2 vs. 93.4 months; CSS: 74.9 vs. 101.1 months). No significant difference was observed between lobectomy group and sublobar resection group (OS: 97.3 vs. 93.1 months; CSS: 103.7 vs. 101.3 months). Consistent results were also shown after the propensity score matching analysis (PSM) was applied.ConclusionsEarly stage of MAD has an ideal prognosis. AC may bring adverse effects which would lower OS and CSS of stage I MAD patients. No significant difference is observed in the comparison of prognosis between lobectomy and sublobar resection in tumor size ≤1 cm MAD patients.

Molecular and clinicopathological features of appendiceal mucinous neoplasms

Appendiceal mucinous tumors (AMTs) include low-grade mucinous appendiceal neoplasms (LAMNs), high-grade mucinous appendiceal neoplasms (HAMNs), and mucinous adenocarcinomas (MACs). We collected 51 AMT samples (LAMN: 34, HAMN: 8, MAC: 9). Three of the eight HAMN cases contained LAMN components, and four out of nine MAC cases contained LAMN and/or HAMN components within the tumor. A next-generation sequencing (NGS) cancer hotspot panel was used to analyze 11 pure LAMN, 4 HAMN, and 3 MAC cases. The results revealed KRAS and GNAS as the most frequently mutated genes. Sanger sequencing was then performed to detect KRAS, GNAS, and TP53 mutations in the remaining 31 cases and RNF43 mutations in all cases. KRAS/GNAS and TP53 mutations occurred exclusively in pure LAMNs; however, five LAMN cases had mutations in both KRAS and GNAS. RNF43 mutations almost exclusively occurred with KRAS/GNAS mutations in pure LAMNs. In MAC and HAMN, KRAS/GNAS mutation status was nearly preserved between lower-grade areas. Most of the detected RNF43 mutations was missense type. RNF43 mutations were detected in both components of MAC with lower-grade area; however, RNF43 mutations detected in these two lesions were entirely different. RNF43 mutations were detected in only one of the eight HAMN patients, which was the sole case without pseudomyxoma peritonei (PMP). None of the four MAC patients with RNF43 mutation showed PMP. These findings suggest that RNF43 mutations occur at a later stage of MAC development and do not associate with PMP. Furthermore, a gradual transition from LAMN to MAC via HAMN could be considered.

The Impact of Histologic Subtype on Receipt of Adjuvant Chemotherapy and Overall Survival in Stage III Colon Cancer: a Retrospective Cohort Analysis.

The impact of adjuvant chemotherapy (AT) on resected colon adenocarcinoma based on histologic subtype is poorly defined and extrapolated from patients with advanced disease. We evaluated the receipt and effect of AT on overall survival stratified by histologic subtype-mucinous, non-mucinous, and signet ring adenocarcinomas. A retrospective cohort study from 2004 to 2015 was conducted using the National Cancer Database. Patients with colon adenocarcinoma who underwent curative resection with pathologic stage III were included. Appendiceal and rectal tumors were excluded. The predictor variable was histologic subtype, and outcome variables were overall survival and receipt of AT. Absolute survival was increased for mucinous, non-mucinous, and signet ring tumors with receipt of AT (88.1, 108.9, and 38.1months, respectively). In multivariable analysis, there was no difference in overall survival for mucinous patients relative to non-mucinous patients. In subgroup analysis, a modest survival advantage for non-mucinous patients relative to the mucinous patients was observed (HR, 0.92; 95% CI, 0.89-0.95). In multivariable modeling, non-mucinous and signet ring adenocarcinoma had decreased odds of receipt of AT relative to mucinous adenocarcinoma patients. Histologic subtype is an important prognostic factor for overall survival for stage III colon adenocarcinoma. Although the magnitude of the benefit of AT may vary in stage III curatively resected patients, it has a substantial survival benefit across all histologic subtypes. Based on these observations, there is no indication that patients with stage III mucinous adenocarcinoma of the colon should not receive AT. All patients with resected stage III colon cancer should be referred for AT regardless of histologic subtype.

Clinicopathological features and prognosis of rare carcinomas of the breast: A comparative analysis from the NCDB.

e19256 Background: A comparative analysis of the clinicopathological features, immunohistochemistry, and overall (OS) for rare ( &lt; 10%) of all breast cancers (BCs) has not been widely explored. Methods: The National Cancer Database (NCDB) was reviewed for patients with a confirmed diagnoses of the following rare BC tumors: Mucinous adenocarcinoma (MuC), tubular adenocarcinoma (TuC), intraductal micropapillary (IMP), papillary carcinoma (PaC), and intraductal papillary adenocarcinoma (IPA) between 2010 and 2016. Patients with an unknown stage were excluded. Univariate analyses &amp; multivariable Cox-regression models were performed in SAS v. 9.4. Results: Analysis included 70,341 patients. MuC was the most common histologic type seen among the rare tumors in our cohort n = 30,087 (43%), compared with 9,681 (13.8%) TuC, 12,735 (18.1%) IMP, 435 ( &lt; 1%) PaC, &amp; 17,403 (24.7%) IPA. TuC &amp; IMP both presented earlier in life, with a median age of 60 versus 69 years for MuC patients and 67 years for both PaC &amp; IPA. The majority of carcinomas were ER+/PR+/HER2- (MuC 88.6%, TuC 89.9%, IMP 67.3%, PaC 76.8%, &amp; IPA 79.6%); ER+/PR+/HER2+ were noted in 3.5% of Muc and 13.2 % of IMP, and ER-/PR-/HER2- were seen in PaC 8.7% and IPA 7.3%. Two highly significant factors for inferior outcome were stage (III &amp; IV) and metastasis to the brain. Stage ≥3 at diagnosis conferred a worse prognosis for MuC patients (HR 3.1, p &lt; 0.0001), IPA patients (HR 3.5, p &lt; 0.0001), &amp; IMP patients (HR 4.8; p &lt; .0001) when compared to patients with stage 0 &amp; 1. Brain metastasis was an adverse mortality indicator for MuC patients (HR 2.4, p &lt; .0003), IPA patients (HR 6.8, p &lt; 0.0001), &amp; IMP patients (HR 10.4, p &lt; .0001). For MuC, age ≥60 was also prognostic (HR 2.7; p &lt; .0001). The 5-year OS was 92.2% for patients with MuC, 94.7% for TuC patients, 93.1% for IMP patients, 81% for PaC &amp; 90% for IPA overall (p-values &lt; 0.0001). Conclusions: The rare BC tumors analyzed in this large database confirm that these tumors are typically seen at an older age, are commonly ER+/PR+/HER2 -, and rarely HER2 + or Triple negative. Mucinous adenocarcinoma being the most common type. They have an overall good prognosis, with papillary carcinoma having inferior OS. Other poor prognostic factors include older age, brain metastasis and advanced stages at diagnosis.

Clinicopathological characteristics and prognosis of colorectal mucinous adenocarcinoma and nonmucinous adenocarcinoma: a surveillance, epidemiology, and end results (SEER) population-based study

BackgroundMucinous adenocarcinoma (MC) is a rare histological subtype of colorectal adenocarcinoma. Previous studies investigating the prognosis of MC have conflicting results and the proper treatment of MC remains unclear.MethodsThis retrospective study presents the clinicopathological characteristics and prognosis of MC. This cohort study collected data from April 1 through August 01, 2018. This study used data on 107,735 patients with nonmucinous adenocarcinoma (NMC) and 9,494 with MC between 2009 and 2013 from the Surveillance, Epidemiology, and End Results program (SEER). Clinicopathological features were analyzed by chi-square test and survival curves by the Kaplan-Meier method. We used propensity score matching (PSM) to account for potential bias. Logistic regression and Cox proportional hazards models were used to compare and calculate adjusted risks of MC death.ResultsMC was more frequent in patients with older age, large tumor size and moderate tumor grade compared with NMC (P<0.001). Five-year survival was lower for MC patients than NMC patients (P<0.001). Older age, later tumor node metastasis (TNM) stage and multiple tumors indicated a poorer prognosis while surgery gave better survival outcomes [hazard ratio (HR) =0.38; 95% confidence interval (CI), 0.33 to 0.44; P<0.001]. Younger age, left-side colon location and early disease stage were associated with better survival after surgery (P<0.001).ConclusionsAge, TNM stage, tumor number and treatment were indicators of prognosis and surgery gave better survival for MC patients compared with those without surgery. Our study contributes to their clinical treatment.

Prognostic impact of preoperative immunonutritional status in rectal mucinous adenocarcinoma.

Aim: To explore the impact of preoperative the albumin-to-globulin ratio (AGR) and the prognostic nutritional index (PNI) on prognosis in rectal mucinous adenocarcinoma (MAC). Methods: A total of 128 patients were included. Results: According to the X-tile analysis, cutoff values of AGR and PNI were 1.1 and 43.8. Preoperative AGR (p = 0.041), preoperative PNI (p = 0.036) and pTNM stage (p = 0.003) were independently associated with overall survival in rectal MAC patients. Distance from the anal verge (p = 0.005), preoperative AGR (p = 0.021), preoperative PNI (p = 0.007) and pTNM stage (p < 0.001) were significantly associated with disease-free survival in rectal MAC patients. Nomograms for overall survival and disease-free survival were developed (C-index: 0.739 and 0.764). Conclusion: Preoperative AGR and PNI can act as effective predictors for survival for rectal MAC patients.

Mucinous histology as a poor prognostic factor in young patients with Stage II rectal cancer: A population-based study.

Mucinous adenocarcinoma (MA) is a distinct histotype of rectal cancer, possibly having prognostic differences with adenocarcinoma (AD). We investigated the prognostic significance of mucinous histology in patients with Stage II rectal cancer. Eligible patients were retrieved from the Surveillance, Epidemiology, and End Results database from 2004 to 2017, and the survival difference between AD and MA patients in the overall and subgroup populations (divided by age) was compared. Multivariate Cox proportional hazard regression analysis was performed to assess whether the mucinous histotype was an independent prognostic factor. A total of 10, 910 patients with Stage II rectal cancer were enrolled and divided into a young group (≤55 years, n = 3248) and an old group (>55 years, n = 7662). Patients with MA exhibited a lower cancer-specific survival rate than those with common AD in the overall population and the young group, but not in the old group. The analysis revealed that the mucinous histotype was an independent prognostic factor in the young group, but not in the old group. Moreover, after excluding patients with risk factors (including poorly differentiated or undifferentiated tumor grade, T4 stage, <12 lymph nodes examined, and elevated preoperative carcinoembryonic antigen level), prognosis of the mucinous histotype was poorer in the young group than that in the old group. The mucinous histotype was an independent prognostic factor in young patients with Stage II rectal cancer. The presence of mucinous histology reflected poor prognosis, especially in the low-risk young population.

Clinical impact of first-line bevacizumab plus chemotherapy in metastatic colorectal cancer of mucinous histology: a multicenter, retrospective analysis on 685 patients.

In metastatic colorectal cancer (MCRC), mucinous histology has been associated with poor response rate and prognosis. We investigated whether bevacizumab combined with different chemotherapy regimens may have an impact on clinical outcomes of MCRC patients with mucinous histology. 685 MCRC patients were classified in mucinous adenocarcinoma (MC) and non-mucinous adenocarcinoma (NMC) and were treated with first-line bevacizumab plus fluoropyrimidine (FP)-based, oxaliplatin (OXA)-based, irinotecan (IRI)-based, or FOLFOXIRI. Ninety-four (13.7%) patients had MC. With a median follow-up of 50months, MC patients had a median overall survival (OS) of 28.2months compared with 27.7months for the NMC group [hazard ratio (HR) = 0.92; 95% confidence interval (CI) 0.70-1.19, P = 0.530]. The overall response rates for MC and NMC were 41.5% (95% CI 31.5-51.4) and 62.4% (95% CI 58.4-66.3), respectively (Chi-square test, P <0.003). After correcting for significant prognostic factors by multivariate Cox regression analysis, age, resection of the primary tumour, and number of metastatic sites were found to be associated with poorer OS, but not mucinous histology. Compared with NMC, MCRC patients with mucinous histology treated with bevacizumab plus chemotherapy had comparable OS despite lower overall response rate.

Prognostic significance of perioperative chemotherapy on resectable colorectal mucinous adenocarcinoma liver metastasis.

Mucinous adenocarcinoma (MAC) is an uncommon subtype of colorectal cancer (CRC). For colorectal cancer liver metastasis (CRLM), perioperative chemotherapy (PCT) has been developed to improve the rate of resection and reduce the rate of early recurrence; however, its impact on long-term outcomes in MAC is unclear. From 1999 to 2016, 442 patients with CRLM were retrospectively reviewed, all of whom underwent CRC resection and liver metastasis resection. Among them, 34 were MAC, and the others were non-MAC. A total of 102 non-MAC patients with CRLM who underwent surgery at the same period were matched with 34 MAC patients in a ratio of 3:1 by using a random number table for analysis. Clinicopathologic characteristics for the MAC group (n=34) and non-MAC group (n=102) had no statistical difference. Both recurrence free survival (RFS) and overall survival (OS) did not significantly differ between the two groups. Nevertheless, in the non-MAC group, OS was fundamentally prolonged in patients with PCT compared to those who didn't have PCT (P=0.031). In this study, PCT had a survival benefit on non-MAC patients with CRLM while MAC patients with resectable CRLM do not benefit from PCT. When developing treatment like PCT or surgery alone for CRLM, mucinous histology should be considered as an important influence factor.

Survival of patients with resected primary colorectal mucinous adenocarcinoma: A competing risk nomogram analysis.

The aim of the present study was to use a competing risk model to analyze the prognostic value of mucinous adenocarcinoma (MAC) in patients with colorectal cancer (CRC). An additional aim was to construct nomograms for estimating the 3- and 5-year overall survival (OS) and cancer specific survival (CSS) rates of patients with primary CRC with MAC. The data were extracted from the Surveillance, Epidemiology, and End Results database, and a Multivariate Cox model and competing risk model were applied to assess the OS and CSS. Cox-based and competing risk-based nomograms were constructed and internally validated by discrimination and calibration, using the bootstrapping method with 1,000 times replicates. A total of 13,035 MAC and 61,958 non-mucinous adenocarcinoma (NMAC) CRC patients were enrolled in the present study. Compared with NMAC, MAC patients had a poorer OS and CSS time in the overall population, and in subgroups that comprised metastatic, non-metastatic, male, site of sigmoid colon, rectosigmoid junction and rectal CRC cases (HR>1; P<0.05). The Cox and competing risk-based nomograms showed effective discrimination and calibration. In conclusion, MAC was associated with poor OS and CSS in patients with CRC of the distal colon and rectum. The nomograms of primary CRC patients with MAC may aid the identification of individual patients with a high risk of overall mortality and cancer-associated mortality within 3 or 5 years.

The role of adjuvant chemotherapy in stage II and III mucinous colon cancer.

Mucinous adenocarcinoma is a subtype of colonic adenocarcinoma associated with worse survival compared to nonmucinous adenocarcinoma. Prior studies on the effect of chemotherapy on survival in mucinous adenocarcinoma have shown mixed results. The aim of this study is to evaluate the effect of chemotherapy on the survival of patients with stage II and III mucinous adenocarcinoma. The National Cancer Database was used to identify patients diagnosed with stage II or III nonmucinous adenocarcinoma or mucinous adenocarcinoma between 2004 and 2016. The primary outcome was overall survival. Fourteen thousand and three hundred patients with stage II mucinous colon adenocarcinoma and 16 741 patients with stage III mucinous colon adenocarcinoma were identified. There was no significant difference in survival between nonmucinous adenocarcinoma and mucinous adenocarcinoma patients in adjusted analysis for stage II disease (HR:1.00, 95%CI:0.98-1.02, P = .99), but there was a significant difference for stage III disease (HR:1.05, 95%CI:1.03-1.07, P < .001). In propensity-matched cohorts of patients with mucinous adenocarcinoma, chemotherapy was significantly associated with survival in stage II (HR:0.79, 95%CI:0.69-0.90, P < .001) and stage III disease (HR:0.56, 95%CI:0.52-0.60, P < .001). Patients with stage II or stage III mucinous adenocarcinoma of the colon who are given adjuvant chemotherapy have significantly improved survival compared to patients not given chemotherapy.

Formation of Polyploid Giant Cancer Cells Involves in the Prognostic Value of Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer.

We previously reported that polyploid giant cancer cells (PGCCs) exhibit cancer stem cell properties and can generate daughter cells with the epithelial-mesenchymal transition phenotype. This study investigated the role of PGCC formation in the prognostic value of neoadjuvant chemoradiation therapy (nCRT) in locally advanced rectal cancer (LARC). The morphological characteristics were observed in patients with LARC after nCRT. Colorectal cancer cell lines were treated with irradiation or chemotherapeutic drugs, and the metastasis-related proteins were detected. 304 nCRT cases and 301 paired non-nCRT cases were collected for analysis. More PGCCs and morphologic characteristics related to invasion and metastasis appeared in tumor tissue after nCRT. Irradiation or chemicals could induce the formation of PGCCs with daughter cells exhibiting strong migratory, invasive, and proliferation abilities. In patients after nCRT, pathologic complete remission, partial remission, stable disease, and progressive disease were observed in 29 (9.54%), 125 (41.12%), 138 (45.39%), and 12 (3.95%) patients, respectively. Mucinous adenocarcinomas (MCs) occurred more frequently in nCRT than in non-nCRT patients (χ2 = 29.352, P=0.001), and the prognosis in MC patients was worse than that in non-MC patients (χ2 = 24.617, P=0.001). The difference in survival time had statistical significance for 60 days (χ2 = 5.357, P=0.021) and 70 days (χ2 = 18.830, P=0.001) rest interval time. On multivariable analysis, 60 days rest interval, Duke's stage, and recurrence and/or distant metastasis remained significant predictors of survival. In conclusion, irradiation or chemicals induce the formation of PGCCs and PGCCs produce daughter cells with strong migration and invasion abilities after a long incubation period. Appropriate rest interval (incubation period) is very important for patients with LARC who will receive nCRT.

Using nomograms to predict prognostic factors in young colorectal mucinous and signet-ring cell adenocarcinoma patients.

Due to insufficient quantitative evaluation of the clinic-pathological features and prognosis of young colorectal cancer (CRC) with mucinous adenocarcinoma (MAC) and signet-ring cell carcinoma (SRC), the aim of our study was to develop a nomogram to identify the prognostic predictors for overall survival (OS) in this patient population. We retrospectively evaluated the patient records of MAC and SRC patients aged ≤ 40 years. Kaplan–Meier analysis and log-rank testing were performed to estimate OS. A nomogram predicting OS was created for risk quantitation and decision tree analysis was performed for patient grouping. With a median follow-up of 36.5 months, we included a total of 90 young CRC patients for analysis. The overall cumulate 5-year OS rate was 57.7% (95% confidence interval (CI): 45.1–68.5%). The estimated 5-year OS was 62.9% (95% CI: 48.5–74.3%) for MAC and 37.3% (95% CI: 14.4–61.2%) for SRC (P=0.021). The recurrence rate was significantly greater in the SRC group compared with the mucinous group (52.4 compared with 26.1%, P=0.047). In the multivariate Cox regression model, preoperative carcinoembryonic antigen (CEA) levels and cycles of adjuvant chemotherapy (CT) were found to be an independent prognostic factor for OS (hazard ratio (HR): 2.43; 95% CI: 1.13–5.62, P=0.024; HR: 0.21; 95% CI: 0.083–0.57, P=0.002, respectively). Nomograms predicting 3- and 5-year OS were established that performed well (concordance index (c-indexes) of 0.636, 95% CI: 0.549–723) for OS. For MAC and SRC disease, a greater proportion of young patients present with advanced disease, and the prognosis for young SRC patients is poorer than MAC. Furthermore, preoperative CEA levels and cycles of adjuvant CT seem to independently affect the OS in this patient population.

Predictors and Risk Factors of Pathologic Complete Response Following Neoadjuvant Chemoradiotherapy for Rectal Cancer: A Population-Based Analysis.

Background: Patients with rectal cancer who achieve pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT) may have a better prognosis and may be eligible for non-operative management. The aim of this research was to identify variables for predicting pCR in rectal cancer patients after nCRT and to define clinical risk factors for poor outcome after pCR to nCRT and radical resection in rectal cancer patients.Methods: A retrospective review was performed using the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2013. Non-metastatic rectal cancer patients who received radical resection after neoadjuvant chemoradiotherapy were included in this study. Multivariate analysis of the association between clinicopathological characteristics and pCR was performed, and a logistic regression model was used to identify independent predictors for pCR. A nomogram based on the multivariate logistics regression was built with decision curve analyses to evaluate the clinical usefulness.Results: A total of 6,555 patients were included in this study. The proportion of patients with pCR was 20.5% (n = 1,342). The nomogram based on multivariate logistic regression analysis showed that clinical T4 and N2 stages were the most significant independent clinical predictors for not achieving pCR, followed by mucinous adenocarcinoma and positive pre-treatment serum CEA results. The 3-year overall survival rate was 92.4% for those with pCR and 88.2% for those without pCR. Among all the pCR patients, mucinous adenocarcinoma patients had the worst survival, with a 3-year overall survival rate of 67.5%, whereas patients with common adenocarcinoma had an overall survival rate of 93.8% (P < 0.001). Univariate and multivariate analyses showed that histology and clinical N2 stage were independent risk factors.Conclusion: Mucinous adenocarcinoma, positive pre-treatment serum CEA results, and clinical T4 and N2 stages may impart difficulty for patients to achieve pCR. Mucinous adenocarcinoma and clinical N2 stage might be indicative of a prognostically unfavorable biological tumor profile with a greater propensity for local or distant recurrence and decreased survival.

Signet ring cell component predicts aggressive behaviour in colorectal mucinous adenocarcinoma

Mucinous adenocarcinoma (MAC) is defined by the presence of extracellular mucin covering more than 50% of the tumour area; however, MAC is histologically heterogeneous and some cases exhibit signet ring cell components. The aim of this study was to determine the prognostic impact of such variable morphology. A total of 299 consecutive MAC patients who underwent curative surgery were included. MACs were classified into four categories according to the predominant pattern of floating tumour cells: strips (27.1%), clusters (51.8%), signet ring cells (6.7%), and mixed clusters and signet ring cells (14.4%). In addition, we categorised MACs according to the relative amount of mucin. MACs with signet ring cell component were clearly associated with poor overall and recurrence-free survivals. Moreover, MACs with more than 50% signet ring cell component showed particularly poor clinical outcome just like non-mucinous signet ring cell carcinoma. MACs with a greater amount of extracellular mucin were associated with poor recurrence-free survival, independent of the pathological stage. In addition, lymphovascular and perineural invasion, advanced pathological stage, and old age at diagnosis were also prognostic factors for poor overall survival. MACs with more than 50% signet ring cell component should be classified as signet ring cell carcinoma and the presence of signet ring cells should be included in the pathology report of MACs with 10-50% signet ring cell component.

Disseminated and massive tumor burden in a case of primary thymic mucinous adenocarcinoma

Primary thymic mucinous adenocarcinoma is an extremely rare type of thymic carcinoma that is resistant to radiation and chemotherapy. We present a case of primary thymic mucinous adenocarcinoma with disseminated metastases and rapid progression, after concurrent chemoradiation and platinum-based doublet chemotherapy. Case and literature review also revealed poor outcomes for primary thymic mucinous adenocarcinoma patients receiving surgery and adjuvant therapy. We concluded the poor response of either resectable or unresectable primary thymic mucinous adenocarcinoma.