Prognostic Significance and Molecular Features of Colorectal Mucinous Adenocarcinomas
نویسندگان
چکیده
Mucinous adenocarcinoma (MC) is a special histology subtype of colorectal adenocarcinoma. The survival of MC is controversial and the prognostic biomarkers of MC remain unclear. To analyze prognostic significance and molecular features of colorectal MC. This study included 755,682 and 1001 colorectal cancer (CRC) patients from Surveillance, Epidemiology, and End Results program (SEER, 1973– 2011), and Linköping Cancer (LC, 1972–2009) databases. We investigated independently the clinicopathological characteristics, survival, and variety of molecular features from these 2 databases. MC was found in 9.3% and 9.8% patients in SEER and LC, respectively. MC was more frequently localized in the right colon compared with nonmucinous adenocarcinoma (NMC) in both SEER (57.7% vs 37.2%, P< 0.001) and LC (46.9% vs 27.7%, P< 0.001). Colorectal MC patients had significantly worse cancer-specific survival (CSS) than NMC patients (SEER, P< 0.001; LC, P1⁄4 0.026), prominently in stage III (SEER, P< 0.001; LC, P1⁄4 0.023). The multivariate survival analysis showed that MC was , MD, Hong Zhan nd Xiao-Feng Sun, MD, PhD features showed that that strong expression of PINCH (HR, 3.954; 95% CI, 1.493–10.47; P1⁄4 0.013) and weak expression of RAD50 (HR 0.348, 95% CI, 0.106–1.192; P1⁄4 0.026) were significantly associated with poor CSS of colorectal MC patients. In conclusion, the colorectal MC patients had significantly worse CSS than NMC patients, prominently in stage III. MC was an independent prognostic factor associated with worse survival in rectal cancer patients. The PINCH and RAD50 were prognostic biomarkers for colorectal MC patients. (Medicine 94(51):e2350) Abbreviations: CI = confidence intervals, CRC = colorectal cancer, CSS = cancer-specific survival, HR = hazard ratios, LC = Linköping Cancer, MC = mucinous adenocarcinoma, NMC = nonmucinous adenocarcinoma, PINCH = particularly interesting new cysteine-histidine-rich protein, SEER = Surveillance Epidemiology and End Results program. INTRODUCTION C olorectal cancer (CRC) is the third most common cancer and a major cause of cancer mortality worldwide. As a special histology subtype of adenocarcinoma, mucinous adenocarcinoma (MC) is defined by the World Health Organization (WHO) containing more than 50% extracellular mucin within the tumor and accounts for 1.6% to 25.4% CRCs. There were several consistent findings concerning differences between MC and nonmucinous adenocarcinoma (NMC) in the colorectum. Most notable of these differences were that MC more often affected young and female patients, frequently located on the proximal colon and had more later-stage presentations. However, the findings about the survival of colorectal MC patients were constantly inconsistent. Some studies reported that MC had a poorer prognosis compared with NMC, while others did contradict results. Parts of results were not stratified analyzed stage by stage. A recent meta-analysis of 44 articles showed a 2% to 8% significantly increased hazard of death of MC compared with NMC in the colorectum, which persisted after correction for stage. Nevertheless, they did not further analyze the prognostic impact of MC on different tumor locations. Furthermore, there were a limited number of literatures on molecular features showing that MC is associated with increased BRAF mutation rate, microsatellite instability (MSI), CpG island methylator phenotype, decreased APC mutation rate, and p53 expression. The prognostic biomarkers of MC remain unclear. One of the important reasons s was that signet-ring cell carcinoma ing factor existed in some studies. on feature of overproduction of mucin www.md-journal.com | 1 (intracellular) with MC (extracellular), SRCC had different biological behaviors and survival outcomes. In the present study, we analyzed clinicopathological characteristics and their survival significance of colorectal MC patients with exclusion of SRCC from 2 databases in the United States and Sweden. Furthermore, we assessed the molecular features of MC and their prognostic value of the patients from Sweden.
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