Division of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
Division of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan.
Anticancer Res. 2020 Mar;40(3):1651-1659. doi: 10.21873/anticanres.14115.
BACKGROUND/AIM: The purpose of this study was to investigate the clinical, pathological, and prognostic differences between adenocarcinoma (ADC) and mucinous adenocarcinoma (MUC) in colorectal cancer (CRC). PATIENTS AND METHODS: This was a retrospective study of a Japanese high-volume cancer Center over a 10-year period. From April 2007 to December 2016, a total of 3,296 patients with primary CRC were included in the study. The clinical characteristics of MUC and ADC were compared. Then, propensity score matching was performed according to a 1:2 ratio. Multivariate analysis was used for independent risk factors related to prognosis. The overall survival (OS) and disease-free survival (DFS) of 126 cases of MUC and 256 cases of ADC were studied, as well as the survival rate of each stage. RESULTS: MUC accounts for 3.82% of the total CRC. Compared to ADC, MUC is more common in female patients (47.62% vs. 38.77%; p=0.045), with higher carcinoembryonic antigen levels (56.35% vs. 34.95%; p<0.001), more ulcerative and infiltrative types (82.54% vs. 72.93%; p=0.016), higher incidence of perineural infiltration (51.59% vs. 41.04%; p=0.018), deeper infiltration (T3-T4: 90.48% vs. 65.84%; p<0.001), and more advanced cancer (stage III-IV: 59.52% vs. 44.79%; p=0.001). MUC is also more likely to recur (24.6% vs. 14.32%; p=0.001). Regarding the long-term survival rate, the OS (p<0.001) and DFS (p=0.05) is consequently worse. After propensity score matching, multivariate analysis showed that MUC was a common independent risk factor for DFS [odds ratio (OR)=4.277; 95% confidence interval (CI), 0.327-0.97; p=0.039], and also for OS (OR= 6.836; 95% CI, 0.274-0.831; p=0.009). In MUC, OS and DFS were still relatively worse (OS: p=0.017; DFS: p=0.038). However, only significant statistical differences were shown in stage II (OS: p=0.003; DFS: p=0.007). No significant differences were noted in the stages I, III, or IV. CONCLUSION: MUC is a high-risk factor for stage II CRC. Adjuvant chemotherapy should be routinely recommended for patients with MUC stage II, and special attention should be paid during their follow-up.
背景/目的：本研究旨在探讨结直肠癌（CRC）中腺癌（ADC）和黏液腺癌（MUC）的临床、病理和预后差异。
方法：这是一项对日本一家大容量癌症中心的回顾性研究，时间跨度为 10 年（2007 年 4 月至 2016 年 12 月）。共纳入 3296 例原发性 CRC 患者。比较 MUC 和 ADC 的临床特征。然后，按照 1:2 的比例进行倾向评分匹配。采用多变量分析确定与预后相关的独立危险因素。研究了 126 例 MUC 和 256 例 ADC 的总生存期（OS）和无病生存期（DFS），以及各期的生存率。
结果：MUC 占 CRC 的 3.82%。与 ADC 相比，MUC 更常见于女性患者（47.62% vs. 38.77%；p=0.045），癌胚抗原水平更高（56.35% vs. 34.95%；p<0.001），溃疡型和浸润型更多（82.54% vs. 72.93%；p=0.016），神经周围浸润发生率更高（51.59% vs. 41.04%；p=0.018），浸润程度更深（T3-T4：90.48% vs. 65.84%；p<0.001），且癌症分期更晚（III-IV 期：59.52% vs. 44.79%；p=0.001）。MUC 也更有可能复发（24.6% vs. 14.32%；p=0.001）。关于长期生存率，OS（p<0.001）和 DFS（p=0.05）的结果更差。进行倾向评分匹配后，多变量分析显示 MUC 是 DFS 的独立危险因素（优势比[OR]=4.277；95%置信区间[CI]，0.327-0.97；p=0.039），也是 OS 的独立危险因素（OR=6.836；95%CI，0.274-0.831；p=0.009）。在 MUC 中，OS 和 DFS 仍然相对较差（OS：p=0.017；DFS：p=0.038）。然而，仅在 II 期观察到统计学显著差异（OS：p=0.003；DFS：p=0.007）。在 I 期、III 期或 IV 期没有观察到显著差异。
结论：MUC 是 CRC II 期的高危因素。对于 MUC II 期的患者，应常规推荐辅助化疗，并在随访期间特别关注。
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