Surgical Oncology Program, National Cancer Institute, Bethesda, MD, USA.
Department of Computational and Quantitative Medicine, City of Hope National Medical Center, Duarte, CA, USA.
Sci Rep. 2021 Oct 14;11(1):20481. doi: 10.1038/s41598-021-99848-y.
Colon medullary adenocarcinoma (MAC) is a rare histologic subtype. Clinical presentation and cancer outcomes of MAC, compared to colon adenocarcinoma (AC), remain incompletely described. Annual age-adjusted incidence rates were computed using Surveillance, Epidemiology, and End Results (2002-2017). A cohort analysis using the National Cancer Database (2010-2016) compared patient characteristics in an unmatched dataset and prognostic characteristics in a 1:1 matched subset. Reported annual age-adjusted incidence of MAC has significantly increased, with an average annual percent change (APC) increase of 23.8% (95% CI: 19.2-28.6); concurrent AC incidence declined (APC: - 2.8, 95% CI: - 3.1 to - 2.8). Analyses of 1018 MAC and 210,784 AC unmatched patients showed that MAC patients were more often older, female, and white, with higher disease stage, poorly-differentiated tumors, right-sided laterality, and lymphovascular invasion (all p < 0.0001). Among those with known microsatellite status, instability was more prevalent among MAC than AC patients (82% vs. 24%, p < 0.0001). Multivariate analyses of the matched dataset revealed that MAC histology was not independently associated with overall survival. However, when stratifying by laterality, left-sided MAC was associated with shorter survival when compared to right-sided MAC (HR 1.66, 95% CI 1.16-2.38) and right-sided AC (HR 1.54, 95% CI 1.12-2.12). The reported incidence of MAC is increasing, in contrast to the declining incidence of AC. MAC clinical and molecular features are distinct from AC and likely account for outcome differences. Overall, left-sided MAC was associated with the shortest OS. Molecular profiling may improve treatment guidelines for MAC.
结肠髓质腺癌（MAC）是一种罕见的组织学亚型。与结肠腺癌（AC）相比，MAC 的临床表现和癌症结局仍不完全清楚。使用监测、流行病学和最终结果（2002-2017 年）计算了每年年龄调整后的发病率。使用国家癌症数据库（2010-2016 年）进行的队列分析在未匹配数据集和 1:1 匹配子集中比较了患者特征和预后特征。报告的 MAC 年年龄调整发病率显著增加，平均年百分比变化（APC）增加 23.8%（95%CI：19.2-28.6）；同时 AC 的发病率下降（APC：-2.8%，95%CI：-3.1 至-2.8）。对 1018 例 MAC 和 210784 例 AC 未匹配患者的分析表明，MAC 患者年龄更大、女性、白人、疾病分期更高、分化程度较差、右侧、血管淋巴管侵犯（均 p<0.0001）。在已知微卫星状态的患者中，MAC 患者比 AC 患者更普遍存在不稳定性（82% vs. 24%，p<0.0001）。匹配数据集的多变量分析显示，MAC 组织学与总生存无关。然而，当按侧别分层时，与右侧 MAC 相比，左侧 MAC 与较短的生存相关（HR 1.66，95%CI 1.16-2.38）和右侧 AC（HR 1.54，95%CI 1.12-2.12）。报告的 MAC 发病率正在增加，而 AC 的发病率正在下降。MAC 的临床和分子特征与 AC 不同，可能导致结果不同。总体而言，左侧 MAC 的 OS 最短。分子谱分析可能会改善 MAC 的治疗指南。
