Ulrich Nitsche1, Helmut Friess2, Ayman Agha3, Martin Angele4, Renate Eckel5, Wolf Heitland6, Karl-Walter Jauch7, Detlef Krenz8, Natascha C Nüssler9, Horst-Günter Rau10, Reinhard Ruppert9, Gabriele Schubert-Fritschle5, Dirk Wilhelm2, Jens Werner4, Jutta Engel5. 1. Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, Munich, Germany. ulrich.nitsche@tum.de. 2. Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, Munich, Germany. 3. Klinik für Allgemein-, Viszeral-, Gefäß- und Thoraxchirurgie, Klinikum München-Bogenhausen, Englschalkinger Str. 77, 81925, Munich, Germany. 4. Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany. 5. Tumorregister München (TRM) des Tumorzentrums München (TZM), Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Klinikum der Universität München (KUM), Marchioninistr. 15, 81377, Munich, Germany. 6. Klinik für Allgemein-, Viszeral- und Minimalinvasive Chirurgie, Isarklinikum, Sonnenstraße 24-26, 80331, Munich, Germany. 7. Klinikum der Universität München, Ärztliche Direktion, Marchioninistr. 15, 81377, Munich, Germany. 8. Abteilung für Allgemein-, Gefäß-, Schilddrüsen- und Thoraxchirurgie, Klinikum Dritter Orden, Menzinger Str. 44, 80638, Munich, Germany. 9. Klinik für Allgemein- und Viszeralchirurgie, Klinikum München-Neuperlach, Oskar-Maria-Graf-Ring 51, 81737, Munich, Germany. 10. Abteilung für Viszeral-, Thorax- und Gefäßchirurgie, Klinikum Dachau, Krankenhausstr. 15, 85221, Dachau, Germany.
Abstract
PURPOSE: Besides classical colorectal adenocarcinomas (AC), mucinous adenocarcinomas (MAC) and signet-ring cell carcinomas (SC) occur. Controversy remains regarding their prognostic role. Aim of this study was to define prognostic and histopathological specifications of mucinous and signet-ring cell colorectal cancer. METHODS: A total of 28,056 patients with AC, MAC, and SC between 1998 and 2012 in the catchment area of the Munich Cancer Registry were analyzed. Time to locoregional recurrence and distant recurrence was calculated by cumulative incidence. Survival was analyzed by the Kaplan-Meier method, calculation of relative survival, and Cox proportional hazards regression. RESULTS: AC occurred in 25,172 patients (90 %), MAC in 2724 (9.7 %), and SC in 160 (0.6 %). AC were less frequently localized in the proximal colon (34 %) compared to MAC (57 %, p < 0.001) and SC (76 %, p < 0.001). Both, MAC and SC had higher T, N, and M categories, lymphatic invasion, and worse grading (p < 0.001 for each). There were significant differences regarding the 10-year cumulative incidence of locoregional recurrence (p < 0.001), and distant recurrence (p < 0.001). For AC, the 5-year overall survival was 59 % (95 % confidence interval 58.0; 59.3), for MAC 52 % (50.2; 54.2), and for SC 40 % (32.1; 48.5; p < 0.001). However, MAC or SC did not remain independent prognostic factors for overall survival compared to AC upon multivariable analysis (p = 0.981). CONCLUSION: This large cohort reveals specific histopathological and recurrence patterns for patients with colorectal AC, MAC, and SC. MAC and SC are diagnosed at more advanced tumor stages and therefore entail reduced survival rates.
PURPOSE: Besides classical colorectal adenocarcinomas (AC), mucinous adenocarcinomas (MAC) and signet-ring cell carcinomas (SC) occur. Controversy remains regarding their prognostic role. Aim of this study was to define prognostic and histopathological specifications of mucinous and signet-ring cell colorectal cancer. METHODS: A total of 28,056 patients with AC, MAC, and SC between 1998 and 2012 in the catchment area of the Munich Cancer Registry were analyzed. Time to locoregional recurrence and distant recurrence was calculated by cumulative incidence. Survival was analyzed by the Kaplan-Meier method, calculation of relative survival, and Cox proportional hazards regression. RESULTS: AC occurred in 25,172 patients (90 %), MAC in 2724 (9.7 %), and SC in 160 (0.6 %). AC were less frequently localized in the proximal colon (34 %) compared to MAC (57 %, p < 0.001) and SC (76 %, p < 0.001). Both, MAC and SC had higher T, N, and M categories, lymphatic invasion, and worse grading (p < 0.001 for each). There were significant differences regarding the 10-year cumulative incidence of locoregional recurrence (p < 0.001), and distant recurrence (p < 0.001). For AC, the 5-year overall survival was 59 % (95 % confidence interval 58.0; 59.3), for MAC 52 % (50.2; 54.2), and for SC 40 % (32.1; 48.5; p < 0.001). However, MAC or SC did not remain independent prognostic factors for overall survival compared to AC upon multivariable analysis (p = 0.981). CONCLUSION: This large cohort reveals specific histopathological and recurrence patterns for patients with colorectal AC, MAC, and SC. MAC and SC are diagnosed at more advanced tumor stages and therefore entail reduced survival rates.
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