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Neoadjuvant chemotherapy improves survival in patients with oesophageal mucinous adenocarcinoma: Post-hoc analysis of the UK MRC OE02 and OE05 trials. Eur J Cancer 2022; 170:140-148. [PMID: 35635935 DOI: 10.1016/j.ejca.2022.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/08/2022] [Accepted: 04/16/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Adenocarcinoma with more than 50% extracellular mucin is a relatively rare histological subtype of gastrointestinal adenocarcinomas. The clinical impact of extracellular mucin in oesophageal adenocarcinoma (OeAC) has not been investigated in detail. We hypothesised that patients with mucinous OeAC (OeACmucin) do not benefit from neoadjuvant chemotherapy. METHODS OeAC patients either treated by surgery alone in the OE02 trial (S-patients) or by neoadjuvant chemotherapy followed by surgery (CS-patients) in OE02 or OE05 trials were included. Cancers from 1055 resection specimens (OE02 [test cohort]: 187 CS, 185 S; OE05 [validation cohort]: 683 CS) were classified as either mucinous (more than 50% of the tumour area consists of extracellular mucin, OeACmucin) or non-mucinous adenocarcinoma (OeACnon-mucin). The relationship between histological phenotype, clinicopathological characteristics, survival and treatment was analysed. RESULTS Overall, 7.3% and 9.6% OeAC were classified as OeACmucin in OE02 and OE05, respectively. In OE02, the frequency of OeACmucin was similar in S and CS-patients. Patients with OeACmucin treated with surgery alone had a poorer overall survival compared with OeACnon-mucin patients (hazard ratio: 2.222, 95% confidence interval: 1.08-4.56, P = 0.025). Patients with OeACmucin treated with neoadjuvant chemotherapy and surgery had similar survival as OeACnon-mucin patients in test and validation cohort. CONCLUSIONS This is the first study to suggest in a post-hoc analysis of material from two independent phase III clinical trials that the poor survival of patients with mucinous OeAC can be improved by neoadjuvant chemotherapy. Future studies are warranted to identify potential underlying biological, biochemical or pharmacokinetic interactions between extracellular mucin and chemotherapy.
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CT and 3 Tesla MRI in the TN Staging of Colon Cancer: A Prospective, Blind Study. Curr Oncol 2022; 29:1069-1079. [PMID: 35200590 PMCID: PMC8870524 DOI: 10.3390/curroncol29020091] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/26/2022] [Accepted: 02/08/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Computer tomography (CT) scanning is currently the standard method for staging of colon cancer; however, the CT based preoperative local staging is far from optimal. The purpose of this study was to investigate the sensitivity and specificity of magnetic resonance imaging (MRI) compared to CT in the T- and N-staging of colon cancer. (2) Methods: Patients underwent a standard contrast-enhanced CT examination. For the abdominal MRI scan, a 3 Tesla unit was used, including diffusion weighted imaging (DWI). Experienced radiologists reported the CT and MRI scans blinded to each other and the endpoint of the pathological report. (3) Results: From 2018 to 2021, 134 patients received CT and MRI scans. CT identified 118 of the 134 tumors, whereas MRI identified all tumors. For discriminating between stage T3ab and T3cd, the sensitivity of CT was 51.1% and of MRI 80.0% (p = 0.02). CT and MRI showed a sensitivity of 21.4% and 46.4% in detecting pT4 tumors and a specificity of 79.0% and 85.0%, respectively. (4) Conclusion: Compared to CT, the sensitivity of MRI was statistically significantly higher in staging advanced T3cd and T4 tumors. MRI has the potential to be used in the treatment planning of colon cancer.
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Ono Y, Cates JMM, Gonzalez RS. Can histologic features predict neoadjuvant therapy response in rectal adenocarcinoma? Pathol Res Pract 2021; 226:153608. [PMID: 34530256 DOI: 10.1016/j.prp.2021.153608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 02/07/2023]
Abstract
Current standard therapy for locally advanced rectal cancer (LARC) is neoadjuvant therapy followed by surgical resection; however, treatment response is variable among patients. This study aimed to identify histologic features that predict tumor response. This retrospective study included 105 patients with LARC, all of whom underwent biopsy followed by neoadjuvant therapy and subsequent surgical resection. Each patient's initial biopsy was evaluated for tumor grade, tumor budding, intraepithelial lymphocytes, intraepithelial neutrophils, desmoplasia, apoptosis, adjacent stromal lymphocytes, signet ring cells, mucinous features, tumoral Paneth cells, dirty necrosis, microscopic ulceration, and prominent lymphoid aggregates. These histologic features, along with patient age at diagnosis and tumor microsatellite status, were compared to tumor regression grades from the respective resection specimens. No histologic factors in tumor biopsies predictive of treatment response in post-therapy resection specimens were identified. Histologic features in pre-therapy biopsy samples of LARC do not predict subsequent response to neoadjuvant therapy. Effective and reliable methods to predict response to neoadjuvant therapy in rectal cancer remain elusive.
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Affiliation(s)
- Yuho Ono
- Beth Israel Deaconess Medical Center, Department of Pathology, 330 Brookline Avenue, Boston, MA 02215, United States
| | - Justin M M Cates
- Vanderbilt University Medical Center, Department of Pathology, Microbiology, and Immunology, 1161 21st Avenue South, Nashville, TN 37232, United States
| | - Raul S Gonzalez
- Beth Israel Deaconess Medical Center, Department of Pathology, 330 Brookline Avenue, Boston, MA 02215, United States.
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O’Connell E, Reynolds IS, McNamara DA, Burke JP, Prehn JHM. Resistance to Cell Death in Mucinous Colorectal Cancer-A Review. Cancers (Basel) 2021; 13:cancers13061389. [PMID: 33808549 PMCID: PMC8003305 DOI: 10.3390/cancers13061389] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/07/2021] [Accepted: 03/10/2021] [Indexed: 12/14/2022] Open
Abstract
Mucinous colorectal cancer (CRC) is estimated to occur in approximately 10-15% of CRC cases and is characterized by abundant extracellular mucin. Mucinous CRC is frequently associated with resistance to apoptosis. Inferior prognosis is observed in mucinous CRC, particularly in rectal cancer and metastatic cases. Mucins are heavily glycosylated secretory or transmembrane proteins that participate in protection of the colonic epithelium. MUC2 overexpression is a hallmark of mucinous CRCs. Mucinous CRC is associated with KRAS and BRAF mutation, microsatellite instability and the CpG island methylator phenotype. Mutations of the APC gene and p53 mutations which are characteristic non-mucinous colorectal adenocarcinoma are less common in mucinous CRC. Both physical and anti-apoptotic properties of mucin provide mechanisms for resistance to cell death. Mucin glycoproteins are associated with decreased expression of pro-apoptotic proteins, increased expression of anti-apoptotic proteins and increased cell survival signaling. The role for BCL-2 proteins, including BCL-XL, in preventing apoptosis in mucinous CRC has been explored to a limited extent. Additional mechanisms opposing cell death include altered death receptor expression and altered mutation rates in genes responsible for chemotherapy resistance. The roles of alternate cell death programs including necroptosis and pyroptosis are not well understood in mucinous CRC. While the presence of MUC2 is associated with an immunosuppressive environment, the tumor immune environment of mucinous CRC and the role of immune-mediated tumor cell death likewise require further investigation. Improved understanding of cell death mechanisms in mucinous CRC may allow modification of currently used regimens and facilitate targeted treatment.
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Affiliation(s)
- Emer O’Connell
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland; (E.O.); (I.S.R.); (D.A.M.); (J.P.B.)
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Ian S. Reynolds
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland; (E.O.); (I.S.R.); (D.A.M.); (J.P.B.)
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Deborah A. McNamara
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland; (E.O.); (I.S.R.); (D.A.M.); (J.P.B.)
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - John P. Burke
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland; (E.O.); (I.S.R.); (D.A.M.); (J.P.B.)
| | - Jochen H. M. Prehn
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- Correspondence:
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Cao W, Zou Q, Zhao Y, Zhou J, Li W, Ren D, Meng X, Hu B, Zhou Z. Application of liver acquisition with volume acceleration enhanced sequence in improving the accuracy of reassessing organ-invasive rectal mucinous adenocarcinoma after chemoradiation. Eur J Radiol 2020; 133:109368. [PMID: 33207287 DOI: 10.1016/j.ejrad.2020.109368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/08/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To explore the ability of liver acquisition with volume acceleration contrast-enhanced sequence (LAVA-ce) to improve the accuracy of reassessing adjacent organ involvement by rectal mucinous adenocarcinoma (MC) after neoadjuvant therapy (NAT). METHODS This study retrospectively enrolled twenty-five patients with MC who underwent pre- and post-NAT MRI, were staged as T4b using pre-NAT T2 weighted imaging, received NAT and underwent radical resection. All MR images were divided into two schemes, T2 weighted plus diffusion weighted imaging (T2Dw protocol) and plus LAVA-ce (T2DwLce protocol). All patients were scored on a 0-4 scale to reassess organ-invasive mucus components. Postoperative pathology was used to identify the involvement of surrounding organs (ypT4b). The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the consistency of the results with pathology after adding fs-CE sequence. RESULTS Among 25 MC patients (15 males and 10 females, aged 21-89 years), 21 were restaged as yT4b after NAT by using T2Dw, with an accuracy of 44.0 % (11/25), which was lower than the accuracy of staging patients with non-mucinous rectal adenocarcinoma (94.1 %, 96/102). The accuracy of MC restaging was improved by using T2DwLce (23/25). The AUC of T2DwLce was 0.857 (95 % CI, 0.660∼0.964), which was higher than that of T2Dw (AUC, 0.611 [95 % CI, 0.397∼0.798]) (P = 0.019). CONCLUSION The LAVA-ce sequence can improve the accuracy of reevaluation and should be included in the MRI protocol for MC patients.
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Affiliation(s)
- Wuteng Cao
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China
| | - Qi Zou
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China; Department of Gastrointestinal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Yandong Zhao
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China; Department of Pathology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Jie Zhou
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Wenli Li
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China
| | - Donglin Ren
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China; Department of Gastrointestinal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Xiaochun Meng
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China.
| | - Bang Hu
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China; Department of Gastrointestinal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China.
| | - Zhiyang Zhou
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China.
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Ayhan M, Turan N, Köstek O, Tufan G, Tataroğlu Özyükseler D, Odabas H, Sakin A, Turan M, Sürmeli H, Yıldırım ME. Does the efficacy of regorafenib differ in chemotherapy refractory metastatic colorectal cancer patients who had mucinous pathology compared to those who had non-mucinous pathology? Curr Probl Cancer 2020; 45:100670. [PMID: 33129567 DOI: 10.1016/j.currproblcancer.2020.100670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/29/2020] [Accepted: 10/15/2020] [Indexed: 12/09/2022]
Abstract
PURPOSE To investigate the importance of mucinous histopathology on the assessment of tumor response in patients with metastatic colorectal cancer (mCRC) receiving regorafenib. MATERIALS AND METHOD All patients diagnosed with histologically confirmed mCRC in 2 oncology centers between 2013 and 2018 were retrospectively analyzed. Among 678 patients diagnosed with mCRC, 103 patients were treated with regorafenib. Ninety-four of these patients who had used at least 2 cycles of regorafenib and evaluable for treatment response were included in the analysis. Histopathologically, 18 patients with mucinous adenocarcinoma and 76 patients with nonmucinous adenocarcinoma were compared in terms of response rate and survival durations. RESULTS Median follow-up duration of 6 months, median age of the patients was 61 (34-77) years. While 19.1% of the patients had mucinous histology, 80.9% had nonmucinous histology. The overall response rate was significantly lower in the mucinous subgroup than the nonmucinous subgroup (5.6% vs 43.4%, respectively, P = 0.003). Similarly, both progression-free survival (3.0 vs 4.0 months, respectively, P = 0.011) and overall survival duration were shorter in the mucinous subgroup (3.0 vs 7.0 months, P = 0.016, respectively) compared with the nonmucinous subgroup. CONCLUSION The histological subgroup may predict tumor response in mCRC patients receiving regorafenib. Its efficacy on nonmucinous histology had significantly more favorable than mucinous subtype.
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Affiliation(s)
- Murat Ayhan
- Department of Medical Oncology, Health Science University Kartal Dr. LütfiKırdar Training and Research Hospital, İstanbul, Turkey.
| | - Nedim Turan
- Department of Medical Oncology, Health Science University Kartal Dr. LütfiKırdar Training and Research Hospital, İstanbul, Turkey
| | - Osman Köstek
- Department of Medical Oncology, Edirne Sultan 1. Murat State Hospital, Edirne, Turkey
| | - Gülnihal Tufan
- Department of Medical Oncology, Health Science University Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Deniz Tataroğlu Özyükseler
- Department of Medical Oncology, Health Science University Kartal Dr. LütfiKırdar Training and Research Hospital, İstanbul, Turkey
| | - Hatice Odabas
- Department of Medical Oncology, Health Science University Kartal Dr. LütfiKırdar Training and Research Hospital, İstanbul, Turkey
| | - Abdullah Sakin
- Department of Medical Oncology, YuzuncuYil University Faculty of Medicine, Van, Turkey
| | - Merve Turan
- Department of Medical Oncology, Health Science University Kartal Dr. LütfiKırdar Training and Research Hospital, İstanbul, Turkey
| | - Heves Sürmeli
- Department of Medical Oncology, Health Science University Kartal Dr. LütfiKırdar Training and Research Hospital, İstanbul, Turkey
| | - Mahmut Emre Yıldırım
- Department of Medical Oncology, Health Science University Kartal Dr. LütfiKırdar Training and Research Hospital, İstanbul, Turkey
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Cao W, Wu L, Zhao Y, Zhou J, Li W, Wang X, Xu J, Zhou Z, Liang C. A New MRI-Defined Biomarker for Rectal Mucinous Adenocarcinoma: Mucin Pool Patterns in Determining the Efficacy of Neoadjuvant Therapy. Front Oncol 2020; 10:1425. [PMID: 32974154 PMCID: PMC7468516 DOI: 10.3389/fonc.2020.01425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/06/2020] [Indexed: 12/28/2022] Open
Abstract
Background and Aim: This work aims to study the relationship between MRI-defined mucin pool (MP) patterns prior to treatment and the efficacy of neoadjuvant therapy (NAT) in locally advanced rectal mucinous adenocarcinoma (RMAC). Methods: This retrospective study included 278 RMAC patients evaluated between January 2012 and January 2019. After having been trained by using 118 cases with postoperative pathological images, radiologists distinguished MRI-defined MP status as mixed type (MTMP) and separate type (STMP) in a NAT cohort (160 patients) in addition to tumor characteristics, invasion of mesorectal facia, and nodal status. Reader reproducibility was determined using the κ coefficient. The main outcome was the accuracy of MP dichotomy in predicting whether patients had tumor responsiveness or not. Results: Among 278 cases, MTMP and STMP accounted for 49.6 and 50.4% of MPs, respectively. A total of 72 patients received neoadjuvant chemoradiotherapy and 88 received chemotherapy. The tumor responsiveness rate in the chemoradiotherapy group was higher than that in the chemotherapy group (58.3 vs. 21.6%, P < 0.001). In the chemotherapy group, the tumor responsiveness rate in patients with MTMPs was lower than that in patients with STMPs (4.9 vs. 25.5%, P = 0.002). The baseline MRI-defined MTMP was associated with lower responsiveness rates after NAT in the chemotherapy group (odds ratio, 11.050, with 95% CI, 2.368–51.571, P = 0.002). Conclusions: MP dichotomy can be reliably evaluated by using MRI. In the chemotherapy group, MTMP may be a dependent predictor to indicate a lower likelihood of tumor responsiveness after NAT.
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Affiliation(s)
- Wuteng Cao
- School of Medicine, South China University of Technology, Guangzhou, China.,Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, China
| | - Lei Wu
- School of Medicine, South China University of Technology, Guangzhou, China.,Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yandong Zhao
- Department of Pathology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, China
| | - Jie Zhou
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, China
| | - Wenli Li
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, China
| | - Xinhua Wang
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, China
| | - Jianbo Xu
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, China
| | - Zhiyang Zhou
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, China.,Guangzhou Universal Medical Imaging Diagnostic Center, Guangzhou, China
| | - Changhong Liang
- School of Medicine, South China University of Technology, Guangzhou, China.,Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Diffusion-weighted magnetic resonance imaging of mucin pools in locally advanced rectal mucinous adenocarcinoma predicts tumor response to neoadjuvant therapy. Eur J Radiol 2020; 125:108890. [DOI: 10.1016/j.ejrad.2020.108890] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/05/2020] [Accepted: 02/10/2020] [Indexed: 12/16/2022]
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