Clinicopathology and outcomes for mucinous and signet ring colorectal adenocarcinoma: analysis from the National Cancer Data Base.
Clinicopathology and outcomes for mucinous and signet ring colorectal adenocarcinoma: analysis from the National Cancer Data Base.
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DOI：
10.1245/s10434-012-2321-7
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发表时间：
2012-09
影响因子：
3.7
通讯作者：
Chang GJ
中科院分区：
文献类型：
--
作者：
Hyngstrom JR;Hu CY;Xing Y;You YN;Feig BW;Skibber JM;Rodriguez-Bigas MA;Cormier JN;Chang GJ
我们使用国家癌症数据库（NCDB）的数据，评估了结直肠腺癌印戒和粘液组织学患者的临床特征和生存结局。1998年至2002年诊断为结直肠腺癌的18-90岁患者来自NCDB。采用多变量相对生存率对多个临床病理学和治疗变量进行校正，进行分层（结肠与直肠）生存分析。该研究包括244，794例患者：25，546例（10%）粘液腺癌，2，260例（1%）印戒腺癌，216，988例（89%）非粘液非印戒腺癌。粘液癌和印戒癌发生在右侧的比例（分别为60%和62%）高于非粘液癌和非印戒腺癌（42%，P <0.001）。印戒组织学与较高分期相关（P < .001），77.2%的印戒肿瘤为高级别病变，而粘液腺癌为20%，非印戒非粘液腺癌为17%（P < .001）。校正协变量后，印戒组织学与较高的死亡风险独立相关（结肠和直肠肿瘤的HR分别为1.42，95%置信区间[CI] 1.33-1.51和1.57，CI 1.38-1.77）。直肠粘液性肿瘤（HR 1.22，CI 1.16-1.29）与死亡风险增加相关，而结肠粘液性肿瘤（HR 1.03，CI 1.00-1.06）与死亡风险增加无关。结肠和直肠的印戒细胞腺癌和直肠的粘液腺癌与较差的生存率相关。这些侵袭性的结直肠腺癌组织学变异应该作为研究的目标，以改善预后。
We evaluated clinical features and survival outcomes among patients with signet ring and mucinous histologies of colorectal adenocarcinoma using data from the National Cancer Data Base (NCDB). Patients aged 18–90 years with colorectal adenocarcinoma diagnosed between 1998 and 2002 were identified from the NCDB. Site-stratified (colon vs rectum) survival analysis was performed using multivariate relative survival adjusted for multiple clinicopathologic and treatment variables. The study included 244,794 patients: 25,546 (10%) with mucinous, 2,260 (1%) with signet ring, and 216,988 (89%) with nonmucinous, non–signet ring adenocarcinoma. Mucinous and signet ring cancers were more frequently right-sided (60% and 62%, respectively) than were nonmucinous, non–signet ring adenocarcinomas (42%, P < .001). Signet ring histology was associated with a higher stage (P < .001), and 77.2% of signet ring tumors were high-grade lesions, compared with 20% of mucinous and 17% of non–signet ring, nonmucinous adenocarcinomas (P < .001). After adjustment for covariates, signet ring histology was independently associated with higher risk of death (HR 1.42, 95% confidence interval [CI] 1.33-1.51, and HR 1.57, CI 1.38-1.77, for tumors located in the colon and rectum, respectively). Mucinous tumors of the rectum (HR 1.22, CI 1.16-1.29), but not the colon (HR 1.03, CI 1.00-1.06), were associated with increased risk of death. Signet ring cell adenocarcinomas of the colon and rectum and mucinous adenocarcinomas of the rectum are associated with poorer survival. These aggressive histologic variants of colorectal adenocarcinoma should be targeted for research initiatives to improve outcomes.
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