Hu Xiang, Li Ya-Qi, Li Qing-Guo, Ma Yan-Lei, Peng Jun-Jie, Cai Sanjun
Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Cell Physiol Biochem. 2018;47(2):630-640. doi: 10.1159/000490018. Epub 2018 May 22.
BACKGROUND/AIMS: Colorectal mucinous adenocarcinoma (MA) has been associated with a worse prognosis than adenocarcinoma (AD) in advanced stages. Little is known about the prognostic impact of a mucinous histotype on the early stages of colorectal cancer with negative lymph node (LN) metastasis. In contrast to the established prognostic factors such as T stage and grading, the histological subtype is not thought to contribute to the therapeutic outcome, although different subtypes can potentially represent different entities. In this study, we aimed to define the prognostic value of mucinous histology in colorectal cancer with negative LNs.
Between 2006 and 2017, a total of 4893 consecutive patients without LN metastasis underwent radical surgery for primary colorectal cancer (MA and AD) in Fudan University Shanghai Cancer Center (FUSCC). Clinical, histopathological, and survival data were analyzed.
The incidence of MA was 11% in 4893 colorectal cancer patients without LN metastasis. The MA patients had a higher T category, a greater percentage of LN harvested, larger tumor size and worse grading than the AD patients (p < 0.001 for each). We found that MA histology was correlated with a poor prognosis in terms of relapse in node-negative patients, and MA histology combined with TNM staging may be a feasible method for predicting the relapse rate. Additionally, MA presented as a high-risk factor in patients with negative perineural or vascular invasion and well/moderate-differentiation and showed a more dismal prognosis for stage II patients. Meanwhile, the disease-free survival was identical in MA and AD patients after neo- and adjuvant chemotherapy.
MA histology is an independent predictor of poor prognosis due to relapse in LN-negative colorectal cancer patients. Mucinous histology can suggest a possible high risk in early-stage colorectal carcinoma.
背景/目的：在晚期，结直肠黏液腺癌（MA）的预后较腺癌（AD）更差。关于黏液组织学类型对淋巴结（LN）转移阴性的早期结直肠癌预后的影响，人们了解甚少。与已确定的预后因素如T分期和分级不同，尽管不同的组织学亚型可能代表不同的实体，但组织学亚型一般不被认为会影响治疗结果。在本研究中，我们旨在确定黏液组织学在LN阴性的结直肠癌中的预后价值。
2006年至2017年间，复旦大学附属肿瘤医院（FUSCC）共有4893例无LN转移的连续患者接受了原发性结直肠癌（MA和AD）根治性手术。对临床、组织病理学和生存数据进行了分析。
在4893例无LN转移的结直肠癌患者中，MA的发生率为11%。与AD患者相比，MA患者的T分期更高、清扫的LN比例更大、肿瘤尺寸更大且分级更差（每项p<0.001）。我们发现，就LN阴性患者的复发而言，MA组织学与预后不良相关，并且MA组织学与TNM分期相结合可能是预测复发率的一种可行方法。此外，MA在无神经周或血管侵犯且高/中分化的患者中表现为高危因素，并且II期患者的预后更差。同时，新辅助化疗和辅助化疗后，MA和AD患者的无病生存期相同。
MA组织学是LN阴性结直肠癌患者因复发导致预后不良的独立预测因素。黏液组织学可提示早期结直肠癌可能存在高风险。
