Clinical significance of mucinous component in colorectal adenocarcinoma: a propensity score-matched study

Abstract

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.

Establishment and validation of a postoperative predictive model for patients with colorectal mucinous adenocarcinoma

“…The present study showed that chemotherapy is a protective factor for CRMA patients, suggesting that CRMA patients can benefit from chemotherapy. Therefore, chemotherapy is still effect of mucin on survival may be associated with its proportion in the lesion, and mucous component >70% may serve as a biomarker for poor prognosis [44]. We found that OS has a lower predictive accuracy than CSS because of the competitive risk.…”

“…SUMA et al reported that the percentage of mucus components was significantly associated with tumor aggressive behavior and poor prognosis in colorectal mucinous adenocarcinoma [ 43 ]. What is more, Yan et al reported that the effect of mucin on survival may be associated with its proportion in the lesion, and mucous component >70% may serve as a biomarker for poor prognosis [ 44 ]. We found that OS has a lower predictive accuracy than CSS because of the competitive risk.…”

Risk stratification of stage II rectal mucinous adenocarcinoma to predict the benefit of adjuvant chemotherapy following neoadjuvant chemoradiation and surgery

“…Rectal mucinous adenocarcinoma (RMA) is a distinct pathological subtype of rectal cancer, characterized by the presence of extracellular mucinous components comprising more than 50% of the tumor volume ( 3 ). Numerous studies have indicated that RMA is associated with poor prognosis ( 4 , 5 ), which is closely associated with a higher proportion of lymph node infiltration, peritoneal implantation, and larger tumor volumes ( 6 , 7 ). Nonetheless, the treatment strategies for RMA and rectal cancer are similar, advocating for neoadjuvant chemoradiation (NCR) before total mesorectal excision (TME) surgery, followed by standard adjuvant chemotherapy (AC) ( 8 ).…”

Identification and validation of a novel six-gene signature based on mucinous adenocarcinoma-related gene molecular typing in colorectal cancer

“…In colorectal MAC, MUC1 and MUC13 are transmembrane mucins, while MUC2 and MUC5AC are secreted gell-forming mucins resistant to tumor cell death and form an immune infiltrating barrier [ 12 ]. In comparison to non-mucinous adenocarcinoma (NMAC), MAC is more common in women, and it has more advanced T or N stage, proximal location, worse differentiation, and a higher ratio of peritoneal implant, microsatellite instability-H (MSI-H) or BRAF mutation [ 15 – 18 ]. Due to the inherent characteristics of MAC, it often responds poorly to conventional therapy [ 14 , 19 , 20 ].…”