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Mucinous Rectal Cancer: Effectiveness of Preoperative Chemoradiotherapy and Prognosis

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

Abstract

Background

This study investigated the effects of preoperative chemoradiotherapy (PCRT) and the prognoses of patients with mucinous rectal cancer compared with those with nonmucinous cancer.

Methods

We retrospectively reviewed the medical records of 368 patients who underwent curative resection after PCRT, between 2000 and 2006, for midrectal to lower-rectal adenocarcinoma. Mucinous cancers were present in 23 patients (6.3%) and nonmucinous cancers in 345. In each patient, clinical stage before chemoradiotherapy was compared with pathologic stage to evaluate the extent of downstaging. Survival and multivariate analyses were performed using clinicopathologic variables. The median follow-up period was 42 months (range, 4–105 months).

Results

There was no difference in clinical stage between the groups. Although 58 patients (16.8%) in the nonmucinous group achieved pathologic complete responses (pCR), no mucinous group patient showed such a response. T-downstaging was more frequently observed in the nonmucinous than in the mucinous group (189 vs 7 [54.9% vs 30.4%], P = .03), but N-downstaging was similar in the 2 groups. The 5-year overall survival rate (OS) was significantly lower in the mucinous than in the nonmucinous group (64.8% vs 79.8%, P = .049). Multivariate analysis revealed that mucinous histotype was an independent (negative) prognostic factor for survival (hazard ratio, 2.36; 95% confidence interval, 1.05–5.3; P = .04).

Conclusions

Patients with mucinous rectal cancer experienced a lower rate of T-downstaging after PCRT and had a poorer prognosis than did patients with nonmucinous cancer.

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References

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

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  3. American Joint Committee on Cancer. Colon and rectum. In: Greene FL, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG, et al., editors. AJCC cancer staging manual. 6th ed. New York: Springer, 2002:127–38.

    Google Scholar 

  4. Odone V, Chang L, Caces J, George SL, Pratt CB. The natural history of colorectal carcinoma in adolescents. Cancer. 1982;49:1716–20.

    Article  PubMed  CAS  Google Scholar 

  5. Umpleby HC, Ranson DL, Williamson RC. Peculiarities of mucinous colorectal carcinoma. Br J Surg. 1985;72:715–8.

    Article  PubMed  CAS  Google Scholar 

  6. Hanski C, Tiecke F, Hummel M, Hanski ML, Ogorek D, Rolfs A, et al. Low frequency of p53 gene mutation and protein expression in mucinous colorectal carcinomas. Cancer Lett. 1996;103:163–70.

    Article  PubMed  CAS  Google Scholar 

  7. Lanza G, Jr., Maestri I, Dubini A, Gafa R, Santini A, Ferretti S, et al. p53 expression in colorectal cancer: relation to tumor type, DNA ploidy pattern and short-term survival. Am J Clin Pathol. 1996;105:604–12.

    PubMed  Google Scholar 

  8. Messerini L, Vitelli F, De Vitis LR, Mori S, Calzolari A, Palmirotta R, et al. Microsatellite instability in sporadic mucinous colorectal carcinomas: relationship to clinico-pathological variables. J Pathol. 1997;182:380–4.

    Article  PubMed  CAS  Google Scholar 

  9. Bazan V, Migliavacca M, Zanna I, Tubiolo C, Grassi N, Latteri MA, et al. Specific codon 13 K-ras mutations are predictive of clinical outcome in colorectal cancer patients, whereas codon 12 K-ras mutations are associated with mucinous histotype. Ann Oncol. 2002;13:1438–46.

    Article  PubMed  CAS  Google Scholar 

  10. 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 

  11. 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 

  12. Adell R, Marcote E, Segarra MA, Pellicer V, Gamon R, Bayon AM, et al. [Is mucinous colorectal adenocarcinoma a distinct entity?]. Gastroenterol Hepatol. 2002;25:534–40.

    PubMed  CAS  Google Scholar 

  13. Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351:1731–40.

    Article  PubMed  CAS  Google Scholar 

  14. Grann A, Minsky BD, Cohen AM, Saltz L, Guillem JG, Paty PB, et al. Preliminary results of preoperative 5-fluorouracil, low-dose leucovorin, and concurrent radiation therapy for clinically resectable T3 rectal cancer. Dis Colon Rectum. 1997;40:515–22.

    Article  PubMed  CAS  Google Scholar 

  15. Janjan NA, Crane CN, Feig BW, Cleary K, Dubrow R, Curley SA, et al. Prospective trial of preoperative concomitant boost radiotherapy with continuous infusion 5-fluorouracil for locally advanced rectal cancer. Int J Radiat Oncol Biol Phys. 2000;47:713–8.

    Article  PubMed  CAS  Google Scholar 

  16. Grillo-Ruggieri F, Mantello G, Berardi R, Cardinali M, Fenu F, Iovini G, et al. Mucinous rectal adenocarcinoma can be associated to tumor downstaging after preoperative chemoradiotherapy. Dis Colon Rectum. 2007;50:1594–603.

    Article  PubMed  Google Scholar 

  17. Sengul N, Wexner SD, Woodhouse S, Arrigain S, Xu M, Larach JA, et al. Effects of radiotherapy on different histopathological types of rectal carcinoma. Colorectal Dis. 2006;8:283–8.

    Article  PubMed  CAS  Google Scholar 

  18. Jass, editor. World Health Organization international histological classification of tumors. Berlin: Springer; 1989.

    Google Scholar 

  19. Negri FV, Wotherspoon A, Cunningham D, Norman AR, Chong G, Ross PJ. Mucinous histology predicts for reduced fluorouracil responsiveness and survival in advanced colorectal cancer. Ann Oncol. 2005;16:1305–10.

    Article  PubMed  CAS  Google Scholar 

  20. Korean Cancer Registry Center, Ministry of Health & Welfare. Annual Report of Korean Central Cancer Registry. Goyang: Korean Cancer Registry Center, Ministry of Health & Welfare; 2002.

  21. Nagtegaal I, Gaspar C, Marijnen C, Van De Velde C, Fodde R, Van Krieken H. Morphological changes in tumour type after radiotherapy are accompanied by changes in gene expression profile but not in clinical behaviour. J Pathol. 2004;204:183–92.

    Article  PubMed  CAS  Google Scholar 

  22. Das P, Skibber JM, Rodriguez-Bigas MA, Feig BW, Chang GJ, Wolff RA, et al. Predictors of tumor response and downstaging in patients who receive preoperative chemoradiation for rectal cancer. Cancer. 2007;109:1750–5.

    Article  PubMed  CAS  Google Scholar 

  23. Rullier A, Laurent C, Vendrely V, Le Bail B, Bioulac-Sage P, Rullier E. Impact of colloid response on survival after preoperative radiotherapy in locally advanced rectal carcinoma. Am J Surg Pathol. 2005;29:602–6.

    Article  PubMed  Google Scholar 

  24. Compton CC, Fielding LP, Burgart LJ, Conley B, Cooper HS, Hamilton SR, et al. Prognostic factors in colorectal cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med. 2000;124:979–94.

    PubMed  CAS  Google Scholar 

  25. Habr-Gama A, Perez RO, Nadalin W, Nahas SC, Ribeiro U Jr, Silva E Sousa AH Jr, et al. Long-term results of preoperative chemoradiation for distal rectal cancer correlation between final stage and survival. J Gastrointest Surg. 2005;9:90–9; discussion 99–101.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Korea Institute of Radiological & Medical Sciences, Korea Cancer Center Hospital, Seoul, Korea

    Ui Sup Shin MD

  2. Department of Colon and Rectal Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

    Chang Sik Yu MD, Seok-Byoung Lim MD, Sang Nam Yoon MD, Yong Sik Yoon MD, Chan Wook Kim MD & Jin Cheon Kim MD

  3. Department of Radiation Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

    Jong Hoon Kim MD

  4. Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

    Tae Won Kim MD

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  1. Ui Sup Shin MD
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  2. Chang Sik Yu MD
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  3. Jong Hoon Kim MD
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  4. Tae Won Kim MD
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  5. Seok-Byoung Lim MD
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  6. Sang Nam Yoon MD
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  7. Yong Sik Yoon MD
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  9. Jin Cheon Kim MD
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Correspondence to Chang Sik Yu MD.

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Shin, U.S., Yu, C.S., Kim, J.H. et al. Mucinous Rectal Cancer: Effectiveness of Preoperative Chemoradiotherapy and Prognosis. Ann Surg Oncol 18, 2232–2239 (2011). https://doi.org/10.1245/s10434-011-1612-8

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  • DOI: https://doi.org/10.1245/s10434-011-1612-8

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