Skip to main content

Advertisement

SpringerLink
Log in

Clinicopathology and Outcomes for Mucinous and Signet Ring Colorectal Adenocarcinoma: Analysis from the National Cancer Data Base

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

We evaluated clinical features and survival outcomes among patients with signet ring and mucinous histologies of colorectal adenocarcinoma by using data from the National Cancer Data Base (NCDB).

Methods

Patients aged 18–90 years with colorectal adenocarcinoma diagnosed between 1998 and 2002 were identified from the NCDB. Site-stratified (colon vs. rectum) survival analysis was performed by multivariate relative survival adjusted for multiple clinicopathologic and treatment variables.

Results

The study included 244,794 patients: 25,546 (10%) with mucinous, 2,260 (1%) with signet ring, and 216,988 (89%) with nonmucinous, non–signet ring adenocarcinoma. Mucinous and signet ring cancers were more frequently right-sided (60% and 62%, respectively) than were nonmucinous, non–signet ring adenocarcinomas (42%, P < 0.001). Signet ring histology was associated with a higher stage (P < 0.001), and 77.2% of signet ring tumors were high-grade lesions, compared with 20% of mucinous and 17% of non–signet ring, nonmucinous adenocarcinomas (P < 0.001). After adjustment for covariates, signet ring histology was independently associated with higher risk of death [hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.33–1.51, and HR 1.57, CI 1.38–1.77, for tumors located in the colon and rectum, respectively]. Mucinous tumors of the rectum (HR 1.22, CI 1.16–1.29), but not the colon (HR 1.03, CI 1.00–1.06), were associated with increased risk of death.

Conclusions

Signet ring cell adenocarcinomas of the colon and rectum and mucinous adenocarcinomas of the rectum are associated with poorer survival. These aggressive histologic variants of colorectal adenocarcinoma should be targeted for research initiatives to improve outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60:277–300.

    Article  PubMed  Google Scholar 

  2. Kang H, O’Connell JB, Maggard MA, et al. A 10-year outcomes evaluation of mucinous and signet-ring cell carcinoma of the colon and rectum. Dis Colon Rectum. 2005;48:1161–8.

    Article  PubMed  Google Scholar 

  3. Borger ME, Gosens MJ, Jeuken JW, et al. Signet ring cell differentiation in mucinous colorectal carcinoma. J Pathol. 2007;212:278–86.

    Article  PubMed  CAS  Google Scholar 

  4. Messerini L, Palomba A, Zampi G. Primary signet-ring cell carcinoma of the colon and rectum. Dis Colon Rectum. 1995;38:1189–92.

    Article  PubMed  CAS  Google Scholar 

  5. Symonds DA, Vickery AL. Mucinous carcinoma of the colon and rectum. Cancer. 1976;37:1891–900.

    Article  PubMed  CAS  Google Scholar 

  6. Parham D. Colloid carcinoma. Ann Surg. 1923;77:90–105.

    PubMed  CAS  Google Scholar 

  7. Mizushima T, Nomura M, Fujii M, et al. Primary colorectal signet-ring cell carcinoma: clinicopathological features and postoperative survival. Surg Today. 2010;40:234–8.

    Article  PubMed  Google Scholar 

  8. Pande R, Sunga A, Levea C, et al. Significance of signet-ring cells in patients with colorectal cancer. Dis Colon Rectum. 2008;51:50–5.

    Article  PubMed  Google Scholar 

  9. Song W, Wu SJ, He YL, et al. Clinicopathologic features and survival of patients with colorectal mucinous, signet-ring cell or non-mucinous adenocarcinoma: experience at an institution in southern China. Chin Med J (Engl). 2009;122:1486–91.

    Google Scholar 

  10. Sung CO, Seo JW, Kim KM, et al. Clinical significance of signet-ring cells in colorectal mucinous adenocarcinoma. Mod Pathol. 2008;21:1533–41.

    Article  PubMed  Google Scholar 

  11. Berg JW, Godwin JD 2nd. The epidemiologic pathology of carcinomas of the large bowel. J Surg Oncol. 1974;6:381–400.

    Article  PubMed  CAS  Google Scholar 

  12. Boland CR, Goel A. Microsatellite instability in colorectal cancer. Gastroenterology. 2010;138:2073–87.

    Article  PubMed  CAS  Google Scholar 

  13. Connelly JH, Robey-Cafferty SS, Cleary KR. Mucinous carcinomas of the colon and rectum. An analysis of 62 stage B and C lesions. Arch Pathol Lab Med. 1991;115:1022–5.

    PubMed  CAS  Google Scholar 

  14. Consorti F, Lorenzotti A, Midiri G, Di Paola M. Prognostic significance of mucinous carcinoma of colon and rectum: a prospective case-control study. J Surg Oncol. 2000;73:70–4.

    Article  PubMed  CAS  Google Scholar 

  15. Green JB, Timmcke AE, Mitchell WT, et al. Mucinous carcinoma—just another colon cancer? Dis Colon Rectum. 1993;36:49–54.

    Article  PubMed  CAS  Google Scholar 

  16. Kanemitsu Y, Kato T, Hirai T, et al. Survival after curative resection for mucinous adenocarcinoma of the colorectum. Dis Colon Rectum. 2003;46:160–7.

    Article  PubMed  Google Scholar 

  17. Nozoe T, Anai H, Nasu S, Sugimachi K. Clinicopathological characteristics of mucinous carcinoma of the colon and rectum. J Surg Oncol. 2000;75:103–7.

    Article  PubMed  CAS  Google Scholar 

  18. Purdie CA, Piris J. Histopathological grade, mucinous differentiation and DNA ploidy in relation to prognosis in colorectal carcinoma. Histopathology. 2000;36:121–6.

    Article  PubMed  CAS  Google Scholar 

  19. Sasaki O, Atkin WS, Jass JR. Mucinous carcinoma of the rectum. Histopathology. 1987;11:259–72.

    Article  PubMed  CAS  Google Scholar 

  20. Xie L, Villeneuve PJ, Shaw A. Survival of patients diagnosed with either colorectal mucinous or non-mucinous adenocarcinoma: a population-based study in Canada. Int J Oncol. 2009;34:1109–15.

    Article  PubMed  Google Scholar 

  21. Bilimoria KY, Stewart AK, Winchester DP, Ko CY. The National Cancer Data Base: a powerful initiative to improve cancer care in the United States. Ann Surg Oncol. 2008;15:683–90.

    Article  PubMed  Google Scholar 

  22. Ederer F, Axtell LM, Cutler SJ. The relative survival rate: a statistical methodology. Natl Cancer Inst Monogr. 1961;6:101–21.

    PubMed  CAS  Google Scholar 

  23. Hoel DG, Ron E, Carter R, Mabuchi K. Influence of death certificate errors on cancer mortality trends. J Natl Cancer Inst. 1993;85:1063–8.

    Article  PubMed  CAS  Google Scholar 

  24. Dickman PW, Sloggett A, Hills M, Hakulinen T. Regression models for relative survival. Stat Med. 2004;23:51–64.

    Article  PubMed  Google Scholar 

  25. Shin US, Yu CS, Kim JH, et al. Mucinous rectal cancer: effectiveness of preoperative chemoradiotherapy and prognosis. Ann Surg Oncol. 2011;18:2232–9.

    Article  PubMed  Google Scholar 

  26. Gunderson LL, Jessup JM, Sargent DJ, et al. Revised TN categorization for colon cancer based on national survival outcomes data. J Clin Oncol. 2010;28:264–71.

    Article  PubMed  Google Scholar 

  27. Shia J, Guillem JG, Moore HG, et al. Patterns of morphologic alteration in residual rectal carcinoma following preoperative chemoradiation and their association with long-term outcome. Am J Surg Pathol. 2004;28:215–23.

    Article  PubMed  Google Scholar 

  28. Smith KD, Tan D, Das P, et al. Clinical significance of acellular mucin in rectal adenocarcinoma patients with a pathologic complete response to preoperative chemoradiation. Ann Surg. 2010;251:261–4.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We acknowledge the Institute for Cancer Care Excellence at the University of Texas M. D. Anderson Cancer Center for additional support of this work. Supported by an American Society of Clinical Oncology Foundation Career Development Award (G.J.C.) and National Institutes of Health/National Cancer Institute grants K07-CA133187 (G.J.C.) and CA016672 (M. D. Anderson’s Cancer Center support grant).

Conflict of interest

We have no commercial interest in the subject of the study and have no conflicts of interest to declare.

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

    John R. Hyngstrom MD, Chung-Yuan Hu PhD, Yan Xing MD, PhD, Y. Nancy You MD, MHSc, Barry W. Feig MD, John M. Skibber MD, Miguel A. Rodriguez-Bigas MD, Janice N. Cormier MD, MPH & George J. Chang MD, MS

Authors
  1. John R. Hyngstrom MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chung-Yuan Hu PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yan Xing MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Y. Nancy You MD, MHSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Barry W. Feig MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. John M. Skibber MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Miguel A. Rodriguez-Bigas MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Janice N. Cormier MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. George J. Chang MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to George J. Chang MD, MS.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hyngstrom, J.R., Hu, CY., Xing, Y. et al. Clinicopathology and Outcomes for Mucinous and Signet Ring Colorectal Adenocarcinoma: Analysis from the National Cancer Data Base. Ann Surg Oncol 19, 2814–2821 (2012). https://doi.org/10.1245/s10434-012-2321-7

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-012-2321-7

Keywords

Search

Navigation