Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Weifang Medical University, Key Laboratory of Metabolism and Gastrointestinal Tumor, the First Affiliated Hospital of Shandong First Medical University, Key Laboratory of Laparoscopic Technology, the First Affiliated Hospital of Shandong First Medical University, Shandong Medicine and Health Key Laboratory of General Surgery, Weifang, 261000, Shandong, China.
Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Key Laboratory of Metabolism and Gastrointestinal Tumor, the First Affiliated Hospital of Shandong First Medical University, Key Laboratory of Laparoscopic Technology, the First Affiliated Hospital of Shandong First Medical University, Shandong Medicine and Health Key Laboratory of General Surgery, Jinan, 250000, Shandong, China.
BMC Cancer. 2021 Dec 1;21(1):1286. doi: 10.1186/s12885-021-09031-9.
BACKGROUND: This study aims to investigate the clinical significance and prognostic value of mucinous component (MC) in colorectal adenocarcinoma (AC). METHODS: Patients with colorectal AC and AC with MC (ACMC) (1-100%) underwent surgical resection between January 2007 and February 2018 were retrospectively reviewed. Propensity score matching (PSM) was performed according to a 1:1 ratio. Receiver-operating characteristic (ROC) curve was used to identify the optimal cut-off value of MC ratio for prognostic prediction. The clinicopathological features and 3-year overall survival (OS) of AC patients, mucinous adenocarcinoma (MAC) (MC > 50%) patients, and ACMC (1-50%) patients were compared before and after matching. Multivariable analysis was used for analyzing independent risk factors related to prognosis. RESULTS: A total of 532 patients were enrolled in this study. Patients with AC, MAC, and ACMC (1-50%) exhibited different clinicopathological features. However, their 3-year OS rates were similar (82.00% vs. 74.11% vs. 81.48%, P = 0.38). After matching, ROC curve determined 70% as the optimal cut-off value. And patients with ACMC > 70% had a much poorer 3-year OS compared with ACMC (1-70%) patients and AC patients (47.37% vs. 86.15% vs. 79.76%, P < 0.001). In addition, ACMC > 70% was revealed as a risk factor for poor survival in univariate analysis (HR = 1.643, 95%CI = 1.025-2.635, P = 0.039), though not an independent risk factor in multivariable analysis (HR = 1.550, 95%CI = 0.958-2.507, P = 0.074). CONCLUSIONS: MAC is usually diagnosed at an advanced stage. MAC has a similar survival with AC and ACMC (1-50%) patients before and after matching. Patients with ACMC > 70% exhibited a much poorer OS, and should be given more clinical attention.
背景：本研究旨在探讨结直肠腺癌（AC）中黏液成分（MC）的临床意义和预后价值。
方法：回顾性分析 2007 年 1 月至 2018 年 2 月期间接受手术切除的结直肠 AC 患者和伴有 MC（ACMC）（1-100%）的患者。采用 1:1 比例进行倾向评分匹配（PSM）。使用受试者工作特征（ROC）曲线确定 MC 比值预测预后的最佳截断值。比较匹配前后 AC 患者、黏液性腺癌（MAC）（MC>50%）患者和 ACMC（1-50%）患者的临床病理特征和 3 年总生存率（OS）。采用多变量分析分析与预后相关的独立危险因素。
结果：本研究共纳入 532 例患者。AC、MAC 和 ACMC（1-50%）患者的临床病理特征不同，但 3 年 OS 率相似（82.00% vs. 74.11% vs. 81.48%，P=0.38）。匹配后，ROC 曲线确定 70%为最佳截断值。与 ACMC（1-70%）患者和 AC 患者相比，ACMC>70%患者的 3 年 OS 更差（47.37% vs. 86.15% vs. 79.76%，P<0.001）。此外，ACMC>70%在单因素分析中被揭示为不良生存的危险因素（HR=1.643，95%CI=1.025-2.635，P=0.039），但在多因素分析中不是独立的危险因素（HR=1.550，95%CI=0.958-2.507，P=0.074）。
结论：MAC 通常在晚期诊断。MAC 在匹配前后与 AC 和 ACMC（1-50%）患者的生存相似。ACMC>70%的患者 OS 更差，应给予更多的临床关注。
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