Cienfuegos J A, Baixauli J, Rotellar F, Arredondo J, Sola J J, Arbea L, Pastor C, Hernández-Lizoáin J L
Department of General Surgery, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Av. Pío XII, 36, 31008, Pamplona, Spain.
Department of General Surgery, Complejo Hospitalario de León, León, Spain.
Clin Transl Oncol. 2016 Jul;18(7):714-21. doi: 10.1007/s12094-015-1422-8. Epub 2015 Oct 16.
The standard treatment for locally advanced rectal cancer (LARC) is neoadjuvant chemoradiotherapy (CRT) followed by surgery. Pathological findings remain the most significant prognostic factor. The presence of mucin pools and their prognostic significance is a controversial issue. The aim of this study was to analyze the incidence of cellular and acellular mucin pools and their clinical significance.
Four-hundred and forty-six consecutive prospectively collected specimens from patients with LARC treated with long-course preoperative CRT and surgery were analyzed. Kaplan-Meier analysis was performed.
Mucin pools were present in 182 specimens (40.8 %); 66 (14.7 %) were acellular, and viable tumor cells were identified in 116 (26 %). The complete pathological response rate was 13.5 % (60 of 446). With a median follow-up of 79.0 months, the 5- and 10-year disease-free survivals for patients with acellular and cellular mucin pools were 81.5, 78.1, 63.7 and 61.2 %, respectively (p ≤ 0.026). The presence of cells in the colloid response to treatment was associated with a 17.8 and 16.9 % decrease in 5- and 10-year disease survival vs. acellular colloid response.
Our results suggest that cellular mucin pools are an indicator of an aggressive phenotype and harbingers of a worse prognosis.
局部晚期直肠癌（LARC）的标准治疗方法是新辅助放化疗（CRT）后行手术治疗。病理结果仍然是最重要的预后因素。黏液池的存在及其预后意义是一个有争议的问题。本研究的目的是分析细胞性和无细胞性黏液池的发生率及其临床意义。
对446例接受长疗程术前CRT和手术治疗的LARC患者连续前瞻性收集的标本进行分析。采用Kaplan-Meier分析。
182例标本（40.8%）存在黏液池；66例（14.7%）为无细胞性，116例（26%）发现有存活肿瘤细胞。完全病理缓解率为13.5%（446例中的60例）。中位随访79.0个月，无细胞性和细胞性黏液池患者的5年和10年无病生存率分别为81.5%、78.1%、63.7%和61.2%（p≤0.026）。胶体反应中有细胞存在与5年和10年疾病生存率分别比无细胞胶体反应降低17.8%和16.9%相关。
我们的结果表明，细胞性黏液池是侵袭性表型的指标和预后较差的预兆。
