Clinical significance of cellular and acellular mucin pools in rectal carcinoma following preoperative chemoradiotherapy

Cienfuegos, Javier A.; Baixauli, Jorge; Rotellar, Fernando; Arredondo, Jorge; Sola, Jesús Javier; Arbea, Leire; Pastor, Carlos; Hernández-Lizoain, José Luís

doi:10.1007/s12094-015-1422-8

Cited by 16 publications

(18 citation statements)

References 33 publications

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“…In patients with a complete pathological response, 27% of patients present with acellular mucin pools [73], while in all stages this was between 12 and 35% [70,[74][75][76][77]. The presence of acellular mucin pools in pCR patients does not affect prognosis [73], while some studies suggest better outcome for all stages in the presence of mucin pools [70,74,75]. In contrast, presence of remaining tumour cells in mucin pools is associated with poor outcome [74].…”

Section: The Third Form Of Response: Mucin Pool Formationmentioning

confidence: 99%

“…The presence of acellular mucin pools in pCR patients does not affect prognosis [73], while some studies suggest better outcome for all stages in the presence of mucin pools [70,74,75]. In contrast, presence of remaining tumour cells in mucin pools is associated with poor outcome [74]. Some studies do not distinguish between cellular and acellular mucin pools, showing intermediate outcomes in this group [78].…”

Section: The Third Form Of Response: Mucin Pool Formationmentioning

confidence: 99%

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How to measure tumour response in rectal cancer? An explanation of discrepancies and suggestions for improvement

Nagtegaal

Glynne‐Jones

2020

Cancer Treatment Reviews

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Various methods categorize tumour response after neoadjuvant therapy, including down-staging and tumour regression grading. Response categories allow comparison of different treatments within clinical trials and predict outcome. A reproducible response categorization could identify subgroups with high or low risk for the most appropriate subsequent treatments, like watch and wait. Lack of standardization and interpretation difficulties currently limit the usability of these approaches. In this review we describe these difficulties for the evaluation of chemoradiation in rectal cancer. An alternative approach of tumour response is based on patterns of residual disease, including fragmentation. We summarise the evidence behind this alternative method of response categorisation, which explains a number of very relevant clinical discrepancies. These issues include differences between downstaging and tumour regression, high local regrowth in advanced tumours during watchful waiting procedures, the importance of resection margins, the limited value of post-treatment biopsies and the relatively poor outcome of patients with a near complete pathological response. Recognition of these patterns of response can allow meaningful development of novel biomarkers in the future.

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Section: The Third Form Of Response: Mucin Pool Formationmentioning

confidence: 99%

Section: The Third Form Of Response: Mucin Pool Formationmentioning

confidence: 99%

How to measure tumour response in rectal cancer? An explanation of discrepancies and suggestions for improvement

Nagtegaal

Glynne‐Jones

2020

Cancer Treatment Reviews

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“…A pCR was defined as the absence of any viable cancer cells in the primary tumor and nodes (ypT0N0) in resected specimens after neoadjuvant treatment. More than 10% of mucins in resection specimens were considered as the presence of mucin pools and lacking neoplastic epithelium in specimens was defined as acellular mucin [20].…”

Section: Surgery and Pathology Reviewmentioning

confidence: 99%

Predictive Value of FOLFOX-Based Regimen, Long Interval, Hemoglobin Levels and Clinical Negative Nodal Status, and Postchemoradiotherapy CEA Levels for Pathological Complete Response in Patients with Locally Advanced Rectal Cancer after Neoadjuvant Chemoradiotherapy

Huang

et al. 2020

Journal of Oncology

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We aimed to identify predictors of a pathological complete response (pCR) in patients with locally advanced rectal cancer (LARC) following a multimodality therapy. We retrospectively reviewed 236 patients with LARC treated with neoadjuvant chemoradiotherapy (CRT) followed by radical resection from January 2011 to December 2017. Patients were administered CRT, which comprised radiotherapy and chemotherapy with an oxaliplatin plus 5-fluorouracil- or fluoropyrimidine-based regimen. Clinical factors were correlated with treatment response. The multivariate logistic regression revealed that a negative nodal stage (odds ratio (OR) = 3.2, P=0.0135), a high hemoglobin level (>10 g/dL) during neoadjuvant CRT (OR = 3.067, P=0.0125), an oxaliplatin-containing neoadjuvant CRT (OR = 5.385, P=0.0044), a long interval (>8 weeks) between radiotherapy and surgery (OR = 1.135, P=0.0469), and a post-CRT CEA ≤2 ng/mL (OR = 2.891, P=0.0233) were the independent predictors of increased pCR rates. The prediction nomogram was developed according to the above independent variables. The concordance index was 0.74, and the calibration curve showed good agreement. In summary, negative nodal stages, high hemoglobin levels during treatment, oxaliplatin-containing neoadjuvant therapy, a long radiotherapy-surgery interval (>8 weeks), and post-CRT CEA levels ≤2 ng/mL were favorable predictors of a pCR. This prediction nomogram might be crucial for patients with LARC undergoing a multimodality therapy.

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“…However, the prognostic implications of acellular mucin pools for patients undergoing preoperative CRT remain controversial. A previous study reported that acellular mucin pools were indicative of aggressive biological behavior of the malignant tumor, which leads to worse prognosis, 11 while other results suggested that acellular mucin pools in rectal cancer after preoperative CRT were not associated with poor prognostic outcomes. 12 To date, although several studies have focused specifically on investigating the prognostic significance of acellular mucin pools of pCR specimens, results have failed to reach a unified agreement due to limited sample numbers.…”

Section: Introductionmentioning

confidence: 94%

Prognostic impact of acellular mucin pools towards the patients with locally advanced rectal cancer achieving pathological complete response after preoperative chemoradiotherapy

Zhang

Guan

Luo

et al. 2020

Therap Adv Gastroenterol

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Background: To date, the prognostic significance of acellular mucin pools in tumors from patients with locally advanced rectal cancer (LARC) undergoing preoperative chemoradiotherapy (CRT) and subsequently obtaining pathological complete response (pCR) has not been well determined. Our current study aimed to explore the prognostic impact on these patients of acellular mucin pools. Methods: We collected clinical data from 117 consecutive LARC patients who achieved pCR after preoperative CRT and then underwent radical resection. Two groups of patients were generated, according to the presence or absence of acellular mucin pools. The 5-year disease-free survival (DFS) and overall survival (OS) rates were compared between the two groups of patients. Results: A total of 27 (23.1%) patients presented with acellular mucin pools. At a median follow-up period of 64 months, patients with acellular mucin pool showed a 5-year DFS rate (96.3% versus 83.7%, p = 0.110) and 5-year OS rate (100% versus 87.5%, p = 0.054) statistically similar to those of patients without acellular mucin pools. In univariable and multivariable Cox regression analyses, the presence of acellular mucin pools was not determined as an independent risk factor for DFS [hazard ratio (HR): 0.222; 95% confidence interval (CI): 0.029–1.864; p = 0.145] or OS (HR: 0.033; 95% CI: 0.000–9.620; p = 0.238). Conclusions: Acellular mucin pools had no significant prognostic impact on LARC patients showing pCR after preoperative CRT.

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Clinical significance of cellular and acellular mucin pools in rectal carcinoma following preoperative chemoradiotherapy

Abstract: Our results suggest that cellular mucin pools are an indicator of an aggressive phenotype and harbingers of a worse prognosis.

Cited by 16 publications

References 33 publications

How to measure tumour response in rectal cancer? An explanation of discrepancies and suggestions for improvement

How to measure tumour response in rectal cancer? An explanation of discrepancies and suggestions for improvement

Predictive Value of FOLFOX-Based Regimen, Long Interval, Hemoglobin Levels and Clinical Negative Nodal Status, and Postchemoradiotherapy CEA Levels for Pathological Complete Response in Patients with Locally Advanced Rectal Cancer after Neoadjuvant Chemoradiotherapy

Prognostic impact of acellular mucin pools towards the patients with locally advanced rectal cancer achieving pathological complete response after preoperative chemoradiotherapy

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