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Kim S, Huh JW, Lee WY, Yun SH, Kim HC, Cho YB, Park Y, Shin JK. Prognostic Impact of Mucinous Adenocarcinoma in Stage II and III Colon Cancer. Dis Colon Rectum 2023; 66:1473-1480. [PMID: 37260257 DOI: 10.1097/dcr.0000000000002733] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Mucinous adenocarcinoma is a rare histologic feature of colorectal cancer and is characterized by oncologic features that are different from those of adenocarcinoma. However, there are conflicting views regarding the prognostic impact of mucinous adenocarcinoma on colon cancer. OBJECTIVE This study aimed to evaluate the prognostic impact of mucinous adenocarcinoma in stage II and III colon cancer. DESIGN This was a retrospective cohort study. SETTINGS This study was conducted between January 2010 and December 2015. Patients were divided into the mucinous adenocarcinoma and nonmucinous adenocarcinoma groups. Disease-free survival and overall survival were assessed using propensity score matching. PATIENTS Overall, 2532 patients who underwent radical surgery for stage II and III colon cancer were included in the study. MAIN OUTCOME MEASURES The main outcome measures were disease-free survival and overall survival. RESULTS The median follow-up duration was 86 months. The disease-free survival and overall survival were significantly lower in the mucinous adenocarcinoma group than in the nonmucinous adenocarcinoma group. In subgroup analysis, there was no significant difference in the disease-free survival and overall survival between patients with and without mucinous adenocarcinoma with stage II colon cancer. In stage III colon cancer, the disease-free survival and overall survival were significantly lower in patients with mucinous adenocarcinoma than in those without mucinous adenocarcinoma. Multivariable analysis showed that mucinous adenocarcinoma was a poor prognostic factor for disease-free survival and overall survival. LIMITATION The study's limitations include those that are inherently associated with retrospective single-center studies. CONCLUSIONS Mucinous adenocarcinoma is a poor prognostic factor in stage III but not in stage II colon cancer. Therefore, mucinous adenocarcinoma might not be regarded as an independent risk factor requiring chemotherapy for favorable oncologic outcomes. However, for stage III colon cancer, patients with mucinous adenocarcinoma require close observation. IMPACTO PRONSTICO DEL ADENOCARCINOMA MUCINOSO EN LAS ETAPAS II Y III DE CNCER DE CLON ANTECEDENTES:El adenocarcinoma mucinoso es una característica histológica rara del cáncer colorrectal, se caracteriza por propiedades oncológicas que son diferentes a las del adenocarcinoma. Sin embargo, existen puntos de vista contradictorios con respecto al impacto pronóstico del adenocarcinoma mucinoso en el cáncer de colon.OBJETIVO:Este estudio tuvo como objetivo evaluar el impacto pronóstico del adenocarcinoma mucinoso en las etapas II y III de cáncer de cólon.DISEÑO Y CONFIGURACIONES:Este estudio de cohorte retrospectivo se realizó entre enero de 2010 y diciembre de 2015. Los pacientes se dividieron entre grupos de adenocarcinoma mucinoso y adenocarcinoma no mucinoso. La supervivencia libre de enfermedad y la supervivencia global se evaluaron utilizando emparejamiento por puntuación de propensión.PACIENTES:En general, 2,532 pacientes que se sometieron a cirugía radical para etapa II y III de cáncer de colon se incluyeron en el estudio.PRINCIPALES MEDIDAS DE RESULTADO:Las principales medidas de resultado fueron la supervivencia libre de enfermedad y la supervivencia general.RESULTADOS:La mediana de duración del seguimiento fue de 86 meses. La supervivencia libre de enfermedad y la supervivencia global fueron significativamente menores en el grupo de adenocarcinoma mucinoso que en el grupo de adenocarcinoma no mucinoso. En el análisis de subgrupos, no hubo diferencias significativas en la supervivencia libre de enfermedad y la supervivencia global entre los pacientes con o sin adenocarcinoma mucinoso con cáncer de cólon etapa II. En el cáncer de colon etapa III, la supervivencia libre de enfermedad y la supervivencia global fueron significativamente más bajas en pacientes con adenocarcinoma mucinoso que en aquellos sin adenocarcinoma mucinoso. El análisis multivariable mostró que el adenocarcinoma mucinoso era un factor de mal pronóstico para la supervivencia libre de enfermedad y la supervivencia global.LIMITACIONES:Las limitaciones del estudio incluyen aquellas que están inherentemente asociadas con estudios retrospectivos de un solo centro.CONCLUSIONES:El adenocarcinoma mucinoso es un factor de mal pronóstico en el cáncer de colon etapa III pero no en etapa II. Por lo tanto, el adenocarcinoma mucinoso podría no considerarse un factor de riesgo independiente que requiera quimioterapia para obtener resultados oncológicos favorables. Sin embargo, para el cáncer de colon etapa III, los pacientes con adenocarcinoma mucinoso requieren observación cercana. (Traducción-Dr. Aurian Garcia Gonzalez ).
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Affiliation(s)
- Seijong Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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2
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YÜZBAŞIOĞLU MF, BOZ A, ACAR H, CENGİZ E, TOPUZ S, PEKER O. Appendiküler Müsinöz Kistadenom ve Peritoneal Adenomüsinozis. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2020. [DOI: 10.17517/ksutfd.654724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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3
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Lee MA, Kang J, Lee HY, Kim W, Shon I, Hwang NY, Kim HK, Choi YS, Kim J, Zo JI, Shim YM. Spread through air spaces (STAS) in invasive mucinous adenocarcinoma of the lung: Incidence, prognostic impact, and prediction based on clinicoradiologic factors. Thorac Cancer 2020; 11:3145-3154. [PMID: 32975379 PMCID: PMC7606017 DOI: 10.1111/1759-7714.13632] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/02/2020] [Accepted: 08/03/2020] [Indexed: 12/11/2022] Open
Abstract
Background Spread through air spaces (STAS) has recently been demonstrated to exhibit a negative impact on lung adenocarcinoma prognosis. However, most of these studies investigated STAS in nonmucinous adenocarcinoma. Here, we investigated the incidence of STAS in invasive mucinous adenocarcinoma (IMA) of the lung and evaluated whether tumor STAS was a risk factor of disease recurrence in IMA. We also examined clinicoradiologic factors in patients with IMA harboring STAS. Methods We reviewed pathologic specimens and imaging characteristics of primary tumors from 132 consecutive patients who underwent surgical resection for IMA to evaluate STAS. Patients with and without STAS were compared with respect to clinical characteristics as well as computed tomography (CT) imaging using logistic regression. The relationships between all variables including STAS and survival were analyzed. Results Among a total of 132 patients, full pathologic specimens were available for 119 patients, and STAS was observed in 86 (72.3%). IMA patients with STAS were significantly associated with older age, presence of lobulated and spiculated margins on CT scan (P = 0.009, P = 0.006, and P = 0.027). In multivariate analysis for overall survival (OS), STAS was a borderline independent poor prognostic predictor (P = 0.028). Older age, history of smoking, higher T stage, presence of lymph node metastasis, and consolidative morphologic type remained independent predictors for OS. Conclusions STAS was associated with reduced OS and was a borderline independent poor prognostic factor in IMA. IMA with STAS was associated with older age and presence of lobulated and spiculated margins on CT scan. Key points Significant findings of the study Compared with other subtypes, IMA shows a higher incidence of STAS, which is an independent poor prognostic predictor even in IMA. Lobulated and spiculated margins on CT are associated with STAS. What this study adds Considering that STAS can carry the potential for aerogenous metastasis, predicting STAS using preoperative surrogate CT imaging is desirable to avoid limited resection.
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Affiliation(s)
- Min A Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jun Kang
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ho Yun Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Wooil Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Insuk Shon
- Samsung Cancer Research Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Na Young Hwang
- Samsung Cancer Research Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Hong Kwan Kim
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong Soo Choi
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jhingook Kim
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Ill Zo
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Mog Shim
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Pseudomyxoma Peritonei Originating from Transverse Colon Mucinous Adenocarcinoma: A Case Report and Literature Review. Gastroenterol Res Pract 2020; 2020:5826214. [PMID: 32714388 PMCID: PMC7354658 DOI: 10.1155/2020/5826214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/13/2020] [Accepted: 06/20/2020] [Indexed: 02/08/2023] Open
Abstract
Background Pseudomyxoma peritonei (PMP) is a rare neoplasm involving the peritoneum. Most PMPs are low-grade appendicular mucinous neoplasms (LAMNs). There have been no reports of PMP originating from a transverse colonic mucinous adenocarcinoma and causing metastatic mucinous adenocarcinoma. Case Presentation. We report a 46-year-old woman who presented with a right abdominal mass of more than 4-month duration. Transverse colonic mucinous adenocarcinoma, PMP, and ovarian metastatic mucinous adenocarcinoma were diagnosed. The patient's diet was normal, and she had no abdominal pain or bloating. The abdomen mass increased in the month before treatment. After chemotherapy, the transverse colon mass and ovarian giant cyst were resected and about 2000 mL of gelatinous tumor tissue was removed. Postoperative histology confirmed PMP from the transverse colonic mucinous adenocarcinoma, ovarian metastatic mucinous adenocarcinoma, and mesocolon metastatic cancer. Multiple lung metastases appeared 8 months after surgery. The patient died 29 months after surgery because of an inability to eat and poor nutrition. A systematic literature review of the management and outcome of all known similar cases is also presented. Conclusions This is the first report of PMP originating from a transverse colonic mucinous adenocarcinoma. It was diagnosed during resective surgery, involved ovarian metastasis, and survival was short. We did an extensive literature review in order to describe the clinical characteristics, histopathological findings, genetic profile, and potential treatments of PMP caused by nonappendiceal mucinous adenocarcinoma.
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Liu W, Liu L, Wang R, Gong G, Ding X, Yang B, Bao Y, Wang Z, Zhang B, Zhao D, Wu F, Ding Y. Bevacizumab Combined With Oxaliplatin/Capecitabine in Patient With Refractory and Recurrent Mucinous Adenocarcinoma of the Appendix: A Case Report. Front Oncol 2019; 9:55. [PMID: 30792968 PMCID: PMC6374296 DOI: 10.3389/fonc.2019.00055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 01/21/2019] [Indexed: 12/31/2022] Open
Abstract
Primary appendiceal adenocarcinoma with peritoneal pseudomyxoma (PPM) has a high recurrence rate and refractory to medical interventions such as repetitive debulking surgery and systemic chemotherapy. Genome-based targeted therapy for such cases has not been well-documented. Here we present a 63-years-old women, who was diagnosed with recurrent mucinous adenocarcinoma of the appendix with local invasions and peritoneal carcinomatosis, was refractory to systemic chemotherapy after surgery. We used a regime developed using whole exome sequencing. Somatic mutations in the genes encoding VEGFR2, FGFR1, FGFR2, FGFR3, and KRAS were identified in the patient's tumor tissue. The patient was then treated with bevacizumab plus oxaliplatin. After 4 months of treatment, pelvic CT showed dramatic reduction of pseudomyoma and a decline of CA199 level from 5436.7 to 1121.4 U/ml. Continual treatment with bevacizumab-capecitabine remained effective and the patient's CA199 level further decreased to 401.26 U/ml according to the follow-up examination on Aug 15th, 2018. Results from this study show the evidence of gene mutations involving VEGF signal activation in the recurrence of appendiceal adenocarcinoma. Our results also suggest the association of these mutations with the effectiveness of anti-VEGF treatment using bevacizumab. Therefore, the screening of gene mutations involved in VEGF signaling and targeted therapy with anti-VEGF drugs may provide a new option to manage refractory/recurrent advanced-stage appendiceal adenocarcinoma.
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Affiliation(s)
- Wenzhi Liu
- The Institute for Translational Medicine, The Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Lili Liu
- Department of Oncology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ruoyu Wang
- The Institute for Translational Medicine, The Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Guanyu Gong
- The Institute for Translational Medicine, The Affiliated Zhongshan Hospital of Dalian University, Dalian, China.,Genomic Future Inc., Lexington, MA, United States
| | - Xinjia Ding
- Department of Neurosurgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Bin Yang
- Genomic Future Inc., Lexington, MA, United States.,Department of Pediatrics, Children's Hospital of Boston, Harvard Medical School, Boston, MA, United States
| | - Yun Bao
- The Institute for Translational Medicine, The Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Zhiqiang Wang
- The Institute for Translational Medicine, The Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Bo Zhang
- Department of Neurosurgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Dewei Zhao
- The Institute for Translational Medicine, The Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Fei Wu
- The Institute for Translational Medicine, The Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Yan Ding
- The Institute for Translational Medicine, The Affiliated Zhongshan Hospital of Dalian University, Dalian, China.,Department of Pediatrics, Children's Hospital of Boston, Harvard Medical School, Boston, MA, United States
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7
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Pasquali S, Sommariva A, Mahteme H, Suo T, Ma H, Tropea S, Steenberg JL, Mocellin S. Cytoreductive surgery alone or combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for pseudomyxoma peritonei. Hippokratia 2018. [DOI: 10.1002/14651858.cd005659.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Sandro Pasquali
- Fondazione IRCCS Istituto Nazionale dei Tumori; Sarcoma Service; Via G. Venezian 1 Milano Italy 20133
| | - Antonio Sommariva
- Istituto Oncologico Veneto, IOV-IRCCS; Surgical Oncology Unit; Via Gattamelata 64 Padova Veneto Italy 35128
| | - Haile Mahteme
- Uppsala Cancer Clinic; Uppsala Cancer Clinic; Box 833 Uppsala Sweden 75108
| | - Tao Suo
- Zhongshan Hospital, Fudan University; Department of General Surgery, Institute of General Surgery; 180 Fenglin Road, Xuhui District Shanghai Shanghai China 200032
| | - Huaixing Ma
- Anhui Provincial Cancer Hospital, the First Affiliated Hospital of University of Science and Technology of China (The Western Area); Department of Medical Oncology; Hefei Anhui China
| | - Saveria Tropea
- Istituto Oncologico Veneto, IOV-IRCCS; Surgical Oncology Unit; Via Gattamelata 64 Padova Veneto Italy 35128
| | - Josephine L Steenberg
- Bispebjerg Hospital, Region H; Cochrane Colorectal Cancer Group; Bispebjerg Bakke 23 Building 39N Copenhagen NV Denmark 2400
| | - Simone Mocellin
- Istituto Oncologico Veneto, IOV-IRCCS; Surgical Oncology Unit; Via Gattamelata 64 Padova Veneto Italy 35128
- University of Padova; Department of Surgery Oncology and Gastroenterology; Padova Veneto Italy 35128
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8
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Kasprzak A, Siodła E, Andrzejewska M, Szmeja J, Seraszek-Jaros A, Cofta S, Szaflarski W. Differential expression of mucin 1 and mucin 2 in colorectal cancer. World J Gastroenterol 2018; 24:4164-4177. [PMID: 30271081 PMCID: PMC6158483 DOI: 10.3748/wjg.v24.i36.4164] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/15/2018] [Accepted: 08/24/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To determine tissue expression (mRNA, protein) of two types of mucins [mucin 1 (MUC1) and mucin 2 (MUC2)] in patients with colorectal cancer (CRC). METHODS Expression of membrane-bound mucin (MUC1) and secretory mucin (MUC2) in CRC (mRNA, protein) were analyzed in tissue material including fragments of tumors obtained from CRC patients (n = 34), and fragments of normal colorectal tissue from the same patients (control). The analysis was conducted using real-time quantitative polymerase chain reaction (RT-qPCR) (transcripts), immunohistochemistry (IHC) (apomucins), and the modern approach for morphometric analysis of IHC reaction (HSV filter software). Results on tissue expression of both mucins (mRNA, protein) were compared to histological alterations in colorectal cancer samples and correlated with selected clinical data in the patients. The statistical analysis was conducted using Statistica PL v. 12.0 software. RESULTS Significantly higher expression of the MUC1 mRNA in the CRC, compared with the control and the borderline correlation of mRNA expression with MUC1 protein levels in colorectal samples was observed. The expression of apomucins concerned cell membranes (MUC1) and cytoplasm (MUC2) and occurred both in control tissues and in most cancerous samples. There were no significant relationships between MUC1 (mRNA, protein) and the clinicopathological data of patients. MUC2 protein expression was significantly lower as compared to the control, while MUC2 mRNA expression was comparable in both groups. The MUC1/MUC2 ratio was significantly higher in CRC tissues than in the control. The higher expression of MUC2 was a feature of mucinous CRC subtypes, and characterized higher histological stage of tumors. Negative correlations have been obtained between MUC2 and the Ki-67 antigen, as well as between MUC2 and p53 protein expressions in CRC. CONCLUSION A combination of tissue overexpression of MUC1, reduced MUC2 expression, and high ratio of MUC1/MUC2 is a factor of poor prognosis in CRC patients. MUC2 tissue expression allows to differentiate mucinous and nonmucinous CRC subtypes.
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Affiliation(s)
- Aldona Kasprzak
- Department of Histology and Embryology, Poznan University of Medical Sciences, Poznan 60-781, Poland
| | - Elżbieta Siodła
- Department of Histology and Embryology, Poznan University of Medical Sciences, Poznan 60-781, Poland
| | - Małgorzata Andrzejewska
- Department of Histology and Embryology, Poznan University of Medical Sciences, Poznan 60-781, Poland
| | - Jacek Szmeja
- Chair and Department of General Surgery, Endocrinological and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan 60-355, Poland
| | - Agnieszka Seraszek-Jaros
- Department of Bioinformatics and Computational Biology, Chair of Clinical Pathomorphology, Poznan University of Medical Sciences, Poznan 60-529, Poland
| | - Szczepan Cofta
- Department of Pulmonology, Allergology and Respiratory Oncology, Poznan University of Medical Science, Poznan 60-569, Poland
| | - Witold Szaflarski
- Department of Histology and Embryology, Poznan University of Medical Sciences, Poznan 60-781, Poland
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Pasquali S, Sommariva A, Mahteme H, Suo T, Ma H, Tropea S, Steenberg JL, Mocellin S. Cytoreductive surgery alone or combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for pseudomyxoma peritonei. Hippokratia 2018. [DOI: 10.1002/14651858.cd005659.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Sandro Pasquali
- Fondazione IRCCS Istituto Nazionale dei Tumori; Sarcoma Service; Via G. Venezian 1 Milano Italy 20133
| | - Antonio Sommariva
- Istituto Oncologico Veneto, IOV-IRCCS; Surgical Oncology Unit; Via Gattamelata 64 Padova Veneto Italy 35128
| | - Haile Mahteme
- Uppsala Cancer Clinic; Uppsala Cancer Clinic; Box 833 Uppsala Sweden 75108
| | - Tao Suo
- Zhongshan Hospital, Fudan University; Department of General Surgery, Institute of General Surgery; 180 Fenglin Road, Xuhui District Shanghai Shanghai China 200032
| | - Huaixing Ma
- Anhui Provincial Cancer Hospital, the First Affiliated Hospital of University of Science and Technology of China (The Western Area); Department of Medical Oncology; Hefei Anhui China
| | - Saveria Tropea
- Istituto Oncologico Veneto, IOV-IRCCS; Surgical Oncology Unit; Via Gattamelata 64 Padova Veneto Italy 35128
| | - Josephine L Steenberg
- Bispebjerg Hospital, Region H; Cochrane Colorectal Cancer Group; Bispebjerg Bakke 23 Building 39N Copenhagen NV Denmark 2400
| | - Simone Mocellin
- Istituto Oncologico Veneto, IOV-IRCCS; Surgical Oncology Unit; Via Gattamelata 64 Padova Veneto Italy 35128
- IOV-IRCCS; Istituto Oncologico Veneto; Padova Italy 35100
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Cisło M, Filip AA, Arnold Offerhaus GJ, Ciseł B, Rawicz-Pruszyński K, Skierucha M, Polkowski WP. Distinct molecular subtypes of gastric cancer: from Laurén to molecular pathology. Oncotarget 2018; 9:19427-19442. [PMID: 29721214 PMCID: PMC5922408 DOI: 10.18632/oncotarget.24827] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 02/27/2018] [Indexed: 12/12/2022] Open
Abstract
In Western countries the majority of gastric cancers (GC) are usually diagnosed in advanced stages reporting a 5-year survival rate of only 26%. The Laurén classification of GC was most widely used in clinical practice since it reflects GC morphology, epidemiology, tumor biology, clinical management and outcome. Despite the initial promise of individualizing antitumor treatment, the management of GC still remains relatively broad and general. Apart from clinical staging, molecular profiling enables targeting of the identified underlying alterations, rather than histology. In contrast to breast carcinoma, molecular classification of GC does not yet imply treatment modality. Molecular classifications of GC and their therapeutic implications are therefore extensively studied. The current proposed molecular divisions of GC come from three different parts of the world where different standard treatment modalities for advanced GC are recommended. Wider use of GC molecular subtyping may solve problems, such as susceptibility to novel systemic therapy regimens or selection of patients for aggressive surgery and targeted adjuvant/conversion therapy. In any case, the rapid entry of novel molecular targeted therapies into routine oncology practice clearly underscores the urgent need for clinicians to be aware of these new possibilities.
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Affiliation(s)
- Magdalena Cisło
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Agata Anna Filip
- Department of Cancer Genetics and Cytogenetics Laboratory, Medical University of Lublin, Lublin, Poland
| | | | - Bogumiła Ciseł
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | | | - Małgorzata Skierucha
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
- Department of Human Anatomy, Medical University of Lublin, Lublin, Poland
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Gruenberger EH, Hassan M, Kratzke I. Long-tract ileocolic intussusception due to mucinous adenocarcinoma of the ileocecal valve: a case report and literature review. J Surg Case Rep 2017; 2017:rjx030. [PMID: 28458844 PMCID: PMC5400455 DOI: 10.1093/jscr/rjx030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 01/27/2017] [Indexed: 01/26/2023] Open
Abstract
Intussusception in adults lacks specific symptoms and is often diagnosed emergently when they present with obstruction. Though intussusception certainly varies in size and location, the increased likelihood of ischemia or obstruction make large intussusceptions very rare in the literature. A patient admitted to our facility for small bowel obstruction was found to have extensive intussusception from the right lower quadrant to the splenic flexure, where a lead point was identified. Histopathology revealed multiple satellite lesions surrounding the lead point tumor, which was found to be invasive mucinous adenocarcinoma of the ileocecal valve. While malignancy is found in 60% of lead point identifiable adult intussusceptions, a malignancy is always found in the case of an exceptionally large intussusception.
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Affiliation(s)
- E H Gruenberger
- Department of Surgery, SUNY Upstate Medical University,750 East Adams St, Syracuse, NY 13210, USA
| | - M Hassan
- Department of Surgery, SUNY Upstate Medical University,750 East Adams St, Syracuse, NY 13210, USA
| | - I Kratzke
- Department of Surgery, SUNY Upstate Medical University,750 East Adams St, Syracuse, NY 13210, USA
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Liu Y, Mizumoto A, Ishibashi H, Takeshita K, Hirano M, Ichinose M, Takegawa S, Yonemura Y. Should total gastrectomy and total colectomy be considered for selected patients with severe tumor burden of pseudomyxoma peritonei in cytoreductive surgery? Eur J Surg Oncol 2016; 42:1018-23. [DOI: 10.1016/j.ejso.2016.04.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 03/24/2016] [Accepted: 04/18/2016] [Indexed: 01/26/2023] Open
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Low RN. Preoperative and surveillance MR imaging of patients undergoing cytoreductive surgery and heated intraperitoneal chemotherapy. J Gastrointest Oncol 2016; 7:58-71. [PMID: 26941984 DOI: 10.3978/j.issn.2078-6891.2015.115] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
MR imaging provides considerable advantages for imaging patients with peritoneal tumor. Its inherently superior contrast resolution compared to CT allows MRI to more accurately depict small peritoneal tumors that are often missed on other imaging tests. Combining different contrast mechanisms including diffusion-weighted (DW) MRI and gadolinium-enhanced MRI provides a powerful tool for preoperative and surveillance imaging in patients being considered for cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC).
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Affiliation(s)
- Russell N Low
- Department of Radiology and Sharp and Children's MRI Center, Sharp Memorial Hospital, San Diego, CA 92123, USA
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14
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Bjersand K, Mahteme H, Sundström Poromaa I, Andréasson H, Graf W, Larsson R, Nygren P. Drug Sensitivity Testing in Cytoreductive Surgery and Intraperitoneal Chemotherapy of Pseudomyxoma Peritonei. Ann Surg Oncol 2015; 22 Suppl 3:S810-6. [PMID: 26193962 PMCID: PMC4686558 DOI: 10.1245/s10434-015-4675-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Indexed: 12/13/2022]
Abstract
Background
Cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) is an established therapy for pseudomyxoma peritonei (PMP). However, the role of IPC is unclear. By ex vivo assessment of PMP tumor cell sensitivity to cytotoxic drugs, we investigated the basis for IPC drug selection and the role of IPC in the management of PMP. Methods Tumor cells were prepared by collagenase digestion of tumor tissue from 133 PMP patients planned for CRS and IPC. Tumor cell sensitivity to oxaliplatin, 5FU, mitomycin C, doxorubicin, irinotecan, and cisplatin was assessed in a 72-h cell-viability assay. Drug sensitivity was correlated to progression-free survival (PFS) and overall survival (OS). Results
Samples from 92 patients were analyzed successfully. Drug sensitivity varied considerably between samples. Peritoneal mucinous carcinomatosis (PMCA), compared with PMCA intermediate or disseminated peritoneal adenomucinosis, was slightly more resistant to platinum and 5FU and tumor cells from patients previously treated with chemotherapy were generally less sensitive than those from untreated patients. Multivariate analysis showed patient performance status and completeness of CRS to be prognostic for OS. Among patients with complete CRS (n = 61), PFS tended to be associated with sensitivity to mitomycin C and cisplatin (p ≈ 0.06). At the highest drug concentration tested, the hazard ratio for disease relapse increased stepwise with drug resistance for all drugs. Conclusions Ex vivo assessment of drug sensitivity in PMP provides prognostic information. The results suggest a role for IPC as therapeutic adjunct to CRS and for individualization of IPC by pretreatment assessment of drug sensitivity. Electronic supplementary material The online version of this article (doi:10.1245/s10434-015-4675-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kathrine Bjersand
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Haile Mahteme
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Håkan Andréasson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Wilhelm Graf
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Rolf Larsson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Peter Nygren
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
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15
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Razenberg LGEM, van Gestel YRBM, Lemmens VEPP, de Wilt JHW, Creemers GJ, de Hingh IHJT. The Prognostic Relevance of Histological Subtype in Patients With Peritoneal Metastases From Colorectal Cancer: A Nationwide Population-Based Study. Clin Colorectal Cancer 2015; 14:e13-9. [PMID: 26140733 DOI: 10.1016/j.clcc.2015.05.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 05/26/2015] [Accepted: 05/29/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND With evolving treatment possibilities for peritoneal metastases (PM) from colorectal cancer (CRC), adequate prognostication and patient selection for treatment becomes increasingly important. We investigated the prognostic relevance of commonly identified histological subtypes in PM of CRC (adenocarcinoma [AC], mucinous AC [MC], and signet-ring cell carcinoma [SC]), which is currently unclear. PATIENTS AND METHODS This study involved 4277 patients diagnosed with synchronous PM from CRC between 2005 and 2012 in The Netherlands. Kaplan-Meier analysis and log-rank testing were performed to estimate survival. Subsequently a Cox proportional hazard model was used to calculate hazard ratios for the risk of death. RESULTS Most of the CRC patients were diagnosed with AC (n = 3008; 70%), whereas MC and SC were found in 958 (22%) and 311 (7%) patients, respectively. SC was associated with the highest risk of death in colon and rectal cancer, with median survival rates of respectively, 6.6 and 6.9 months. For MC, median survival varied from 10.9 months in colon and 9.8 months in rectal cancer (P > .05). In colon cancer, MC was associated with a significantly lower risk of death compared with AC (hazard ratio, 0.9; 95% confidence interval, 0.79-0.95). In rectal cancer, no such effect was observed. AC was associated with a significantly poorer survival rate in the case of primary colonic tumor localization (7.4 months in colon vs. 10.9 months in rectal cancer). CONCLUSION Histological subtype is an important prognostic factor in patients with synchronous PM of colorectal origin. This knowledge will aid clinicians in counseling of patients and clinical decision-making regarding possible treatment options.
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Affiliation(s)
- Lieke G E M Razenberg
- Department of Oncology, Catharina Hospital, Eindhoven, The Netherlands; Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | | | | | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
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16
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Araújo RLC, Lopes G, Aisen M. Role of Cytoreduction Surgery With HIPEC in the Management of Peritoneal Carcinomatosis From Colorectal Cancer and Pseudomyxoma Peritonei. CURRENT COLORECTAL CANCER REPORTS 2015. [DOI: 10.1007/s11888-015-0264-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Long-term results after proactive management for locoregional control in patients with colonic cancer at high risk of peritoneal metastases. Int J Colorectal Dis 2014; 29:1081-9. [PMID: 24980687 DOI: 10.1007/s00384-014-1929-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE A major problem in treating patients with peritoneal spread from colorectal cancer is that at diagnosis wide peritoneal involvement often precludes all curative attempts. A possible solution is to identify those patients at risk for peritoneal metastases and intervene early to prevent locoregional disease spread before it develops and, thus, to improve outcome. METHODS We analyzed long-term results from a previous study and compared outcomes in 25 patients with advanced colon cancer considered at high risk for peritoneal spread (pT3/pT4 and mucinous or signet ring cell histology) prospectively included and managed with a proactive surgical approach including target organ resection for peritoneal spread plus hyperthermic intraperitoneal chemotherapy (HIPEC) and in 50 retrospectively well-matched controls who underwent standard surgical resection during the same period and in the same hospital by different surgical teams. RESULTS At 48 months after the study closed, peritoneal metastases and local recurrence developed significantly less often in proactively managed patients than in controls (4 vs 28%) (p < 0.03). Patients in the proactive group also survived longer than control patients (median overall survival 59.5 vs 52 months). Despite similar morbidity, Kaplan-Meier survival curves disclosed significantly longer disease-free and overall survival in the proactive than in the control group (p < 0.05 and <0.04). CONCLUSIONS In patients with advanced colon cancer at risk for peritoneal recurrence, the proactive surgical approach plus HIPEC seems to achieve good locoregional control preventing peritoneal spread thus improving outcome without increasing morbidity. These advantages merit investigation in a multicentric randomized trial.
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18
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Wray CJ, Kao LS, Millas SG, Tsao K, Ko TC. Acute appendicitis: controversies in diagnosis and management. Curr Probl Surg 2013; 50:54-86. [PMID: 23374326 DOI: 10.1067/j.cpsurg.2012.10.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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19
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Low RN, Barone RM, Lee MJ. Surveillance MR Imaging is Superior to Serum Tumor Markers for Detecting Early Tumor Recurrence in Patients with Appendiceal Cancer Treated with Surgical Cytoreduction and HIPEC. Ann Surg Oncol 2013; 20:1074-81. [DOI: 10.1245/s10434-012-2788-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Indexed: 12/21/2022]
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20
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Preclinical antitumor activity of a nanoparticulate SN38. Invest New Drugs 2013; 31:871-80. [DOI: 10.1007/s10637-012-9919-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 12/19/2012] [Indexed: 01/20/2023]
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21
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Reu S, Neumann J, Kirchner T. [Mucinous neoplasms of the vermiform appendix, Pseudomyxoma peritonei, and the new WHO classification]. DER PATHOLOGE 2012; 33:24-30. [PMID: 22179200 DOI: 10.1007/s00292-011-1542-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Mucinous neoplasms of the appendix are rare tumors, some of them characterized by an enigmatic discrepancy between a benign morphologic appearance and an aggressive biologic potential, associated with a poor prognosis and high mortality. The clinical picture of pseudomyxoma peritonei is, with few exceptions, caused by mucinous appendiceal neoplasms and differs in many aspects from usual peritoneal carcinomatosis. The controversy regarding terminology, diagnostic criteria, classification and therapy of these tumors has lasted for decades. The revised edition of the World Health Organization Classification of Tumors of the Digestive System proposes a uniform reporting system for mucinous appendiceal neoplasms and the peritoneal disease associated with it, thereby creating a comparable basis for pathological diagnosis, clinical therapy and further scientific studies.
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Affiliation(s)
- S Reu
- Pathologisches Institut, Ludwig-Maximilians-Universität München, Thalkirchner Str. 36, 80337, München, Deutschland.
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22
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Low RN, Barone RM. Combined diffusion-weighted and gadolinium-enhanced MRI can accurately predict the peritoneal cancer index preoperatively in patients being considered for cytoreductive surgical procedures. Ann Surg Oncol 2012; 19:1394-1401. [PMID: 22302265 DOI: 10.1245/s10434-012-2236-3] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Indexed: 12/21/2022]
Abstract
PURPOSE To determine whether abdominal and pelvic magnetic resonance imaging (MRI) with diffusion-weighted and dynamic gadolinium-enhanced imaging can be used to accurately calculate the peritoneal cancer index (PCI) before surgery compared to the PCI tabulated at surgery. METHODS Thirty-three patients underwent preoperative MRI followed by cytoreductive surgery for primary tumors of the appendix (n = 25), ovary (n = 5), colon (n = 2), and mesothelioma (n = 1). MRIs were retrospectively reviewed to determine the MRI PCI. These scores were then compared to PCI tabulated at surgery. Patients were categorized as having small-volume tumors (PCI 0–9), moderate-volume tumors (PCI 10–20), and large-volume tumors (PCI > 20). The respective anatomic site scores for both MRI and surgery were compared. RESULTS There was no significant difference between the MRI PCI and surgical PCI for the 33 patients (P = 0.12). MRI correctly predicted the PCI category in 29 (0.88) of 33 patients. Compared to surgical findings, MRI correctly predicted small-volume tumor in 6 of 7 patients, moderate-volume tumor in 3 of 4 patients, and large-volume tumor in 20 of 22 patients. MRI and surgical PCI scores were identical in 8 patients (24%). A difference of <5 was noted in 16 patients (49%) and of 5–10 in 9 patients (27%). Compared to surgical-site findings, MRI depicted 258 truly positive sites of peritoneal tumor, 35 falsely negative sites, 35 falsely positive sites, and 101 truly negative sites, with a corresponding sensitivity of 0.88, specificity of 0.74, and accuracy of 0.84. CONCLUSIONS Combined diffusion-weighted and gadolinium-enhanced peritoneal MRI accurately predicts the PCI before surgery in patients undergoing evaluation for cytoreductive surgery.
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Affiliation(s)
- Russell N Low
- Department of Radiology, Sharp Memorial Hospital, San Diego, CA, USA.
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23
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Numata M, Shiozawa M, Watanabe T, Tamagawa H, Yamamoto N, Morinaga S, Watanabe K, Godai T, Oshima T, Fujii S, Kunisaki C, Rino Y, Masuda M, Akaike M. The clinicopathological features of colorectal mucinous adenocarcinoma and a therapeutic strategy for the disease. World J Surg Oncol 2012; 10:109. [PMID: 22703761 PMCID: PMC3407705 DOI: 10.1186/1477-7819-10-109] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 06/15/2012] [Indexed: 12/12/2022] Open
Abstract
Background The guidelines established by the National Comprehensive Cancer Network do not describe mucinous histology as a clinical factor that should influence the therapeutic algorithm. However, previous studies show conflicting results regarding the prognosis of colorectal mucinous adenocarcinoma. In this study, we described the clinicopathological features of mucinous adenocarcinoma in Japan, to identify optimal therapeutic strategies. Methods 144 patients with mucinous and 2673 with non-mucinous adenocarcinomas who underwent primary resection in two major centers in Yokohama, Japan were retrospectively evaluated for clinicopathological features and treatment factors. A multivariate analysis for overall survival followed by the comparison of overall survival using Cox proportional hazard model were performed. Results Patients with mucinous adenocarcinoma had larger primary lesions, higher preoperative CEA levels, a deeper depth of invasion, higher rates of nodal and distant metastasis, and more metastatic sites. A multivariate analysis for overall survival revealed a mucinous histology to be an independent prognostic factor. In the subgroup analysis stratified by stage, Patients diagnosed as StageIII and IV disease had a worse survival in mucinous adenocarcinoma than non-mucinous, while survival did not differ significantly in patients diagnosed as Stage0-II disease. In StageIII, local recurrence in rectal cases and peritoneal dissemination were more frequently observed in patients with a mucinous histology. Conclusions Our study indentified that mucinous adenocarcinoma was associated with a worse survival compared with non-mucinous in patients with StageIII and IV disease. In rectal StageIII disease with mucinous histology, additional therapy to control local recurrence followed by surgical resection may be a strategical alternative. Further molecular investigations considering genetic features of mucinous histology will lead to drug development and better management of peritoneal metastasis
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Affiliation(s)
- Masakatsu Numata
- Department of Gastroenterological Surgery, Kanagawa Cancer Center, 1-1-2 Nakao, Asahi-ku, Yokohama, Kanagawa, 241-0815, Japan.
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24
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Gamblin TC, Alexander HR, Edwards R, Bartlett DL. Concepts of regional therapies for advanced malignancy. Ann Surg Oncol 2012; 19:1371-2. [PMID: 22302272 DOI: 10.1245/s10434-012-2243-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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