Kang C M, Lim S-B, Hong S-M, Yu C S, Hong Y S, Kim T W, Park J-H, Kim J H, Kim J C
Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
Department of Pathology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
Colorectal Dis. 2016 Jan;18(1):O10-6. doi: 10.1111/codi.13169.
The frequent presence of acellular mucin in specimens showing pathological complete response to preoperative chemoradiotherapy (CRT) and the poor response to preoperative CRT in mucinous rectal cancer have been reported. However, the prevalence and prognostic significance of cellular and acellular mucin have not been evaluated in resected specimens from patients with mucinous rectal cancer who undergo preoperative CRT.
We retrospectively evaluated the clinicopathological features and prognostic significance of mucin in resected specimens from 59 consecutive patients with mucinous rectal cancer who underwent long-course CRT followed by resection between January 2000 and December 2009. Patients were categorized according to the presence of mucin, as identified by pathological analysis. The clinicopathological findings and oncological results were compared.
Mucin was identified in 25 of 59 patients with mucinous rectal cancer (42.4%). Mucin was more frequent in men (hazard ratio = 23.94, 95% confidence interval = 1.875-305.504, P = 0.015) and in specimens showing a good tumour response grade (hazard ratio = 64.26, 95% confidence interval = 6.940-595.045, P < 0.001). With a median follow-up of 67.7 (range 8.6-133.2) months, the 5-year overall survival (60.7% without mucin vs 51.4% with mucin, P = 0.898) and disease-free survival (59.9% without mucin vs 56.9% with mucin, P = 0.813) did not differ between the groups.
The presence of mucin in rectal cancer with mucinous differentiation after preoperative CRT and resection is associated with male gender and a good tumour response grade, without significant impact on oncological outcome.
有报道称，在对术前放化疗（CRT）呈现病理完全缓解的标本中经常出现无细胞黏液，且黏液性直肠癌对术前CRT反应较差。然而，尚未对接受术前CRT的黏液性直肠癌患者切除标本中细胞性和无细胞黏液的发生率及预后意义进行评估。
我们回顾性评估了2000年1月至2009年12月期间连续59例接受长程CRT后行切除术的黏液性直肠癌患者切除标本中黏液的临床病理特征及预后意义。根据病理分析确定的黏液存在情况对患者进行分类。比较临床病理结果和肿瘤学结果。
59例黏液性直肠癌患者中有25例（42.4%）检测到黏液。黏液在男性中更常见（风险比=23.94，95%置信区间=1.875 - 305.504，P = 0.015），且在肿瘤反应分级良好的标本中更常见（风险比=64.26，95%置信区间=6.940 - 595.045，P < 0.001）。中位随访67.7（范围8.6 - 133.2）个月，两组间5年总生存率（无黏液组为60.7%，有黏液组为51.4%，P = 0.898）和无病生存率（无黏液组为59.9%，有黏液组为56.9%，P = 0.813）无差异。
术前CRT及切除术后的黏液性分化直肠癌中黏液的存在与男性性别及良好的肿瘤反应分级相关，但对肿瘤学结局无显著影响。
