Mucinous and signet-ring cell colorectal cancers differ from classical adenocarcinomas in tumor biology and prognosis.
Mucinous and signet-ring cell colorectal cancers differ from classical adenocarcinomas in tumor biology and prognosis.
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DOI：
10.1097/sla.0b013e3182a69f7e
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发表时间：
2013-11
影响因子：
9
通讯作者：
Bader FG
中科院分区：
文献类型：
--
作者：
Nitsche U;Zimmermann A;Späth C;Müller T;Maak M;Schuster T;Slotta-Huspenina J;Käser SA;Michalski CW;Janssen KP;Friess H;Rosenberg R;Bader FG
粘液腺癌是一种少见的腺癌，印戒细胞癌是结直肠癌的一种罕见的组织学亚型，其临床病理和预后与经典腺癌不同。特别是，印戒细胞癌，可以考虑到个人的风险估计，因为他们明显不同的行为。探讨不同组织学亚型结直肠癌的预后价值。大多数结直肠癌是典型的腺癌（AC）。较不常见的亚型包括粘液腺癌（MAC）和印戒细胞癌（SC）。与已建立的预后因素（如TNM和分级）相反，组织学亚型迄今没有治疗结果，尽管它可能反映了不同的生物学行为。在1982年至2012年期间，共有3479名连续患者接受了原发性结直肠癌（AC，MAC或SC）手术。分析了临床、组织病理学和生存数据。在所有3479例患者中，组织学亚型为AC 3074例（88%），MAC 375例（11%）和SC 30例（0.9%）。右侧肿瘤中MAC（51%，P < 0.001）和SC（50%，P = 0.029）的发生率高于AC（28%）。与AC相比，MAC和SC的肿瘤分期和组织学分级较高（均P < 0.001）。MAC组血管侵犯率低于AC组（5%vs9%，P = 0.011）。SC的淋巴管浸润率高于AC（67%比25%，P < 0.001）。AC、MAC和SC的5年病因特异性生存率分别为67 ± 1%、61 ± 3%和21 ± 8%（组间差异P < 0.001）。在多变量分析中，校正肿瘤分期后，AC和MAC之间的生存率没有显著差异。然而，SC仍然是与较差生存相关的独立预后因素（风险比= 2.5，95%可信区间= 1.6-3.8，P < 0.001）。MAC和SC是结直肠癌的组织学亚型，具有与经典AC不同的特征。两者都是在更晚期的肿瘤阶段被诊断出来的，但SC的预后不佳似乎是由其内在的肿瘤生物学引起的。
Mucinous adenocarcinomas are uncommon and signet-ring cell carcinomas are rare histological subtypes of colorectal cancer, which differ from classical adenocarcinomas in clinicopathology and prognosis. In particular, signet-ring cell carcinomas could be taken into account for individual risk estimation because of their clearly different behavior. To define the prognostic value of different histological subtypes of colorectal cancer. Most colorectal cancers are classical adenocarcinomas (AC). Less frequent subtypes include mucinous adenocarcinomas (MAC) and signet-ring cell carcinomas (SC). In contrast to established prognostic factors such as TNM and grading, the histological subtype has no therapeutical consequences so far, although it may reflect different biological behavior. Between 1982 and 2012, a total of 3479 consecutive patients underwent surgery for primary colorectal cancer (AC, MAC, or SC). Clinical, histopathological, and survival data were analyzed. Of all 3479 patients, histological subtype was AC in 3074 cases (88%), MAC in 375 cases (11%), and SC in 30 cases (0.9%). MAC (51%, P < 0.001) and SC (50%, P = 0.029) occurred more frequently in right-sided tumors than AC (28%). Compared with AC, tumor stages and histological grading were higher in MAC and SC (P < 0.001 for each). Rates of angioinvasion were lower in MAC than in AC (5% vs 9%, P = 0.011). Rates of lymphatic invasion were higher in SC than in AC (67% vs 25%, P < 0.001). Five-year cause-specific survival was 67 ± 1% for AC, 61 ± 3% for MAC, and 21 ± 8% for SC (P < 0.001 for difference between the groups). In multivariable analysis, survival did not differ significantly between AC and MAC after correction for tumor stage. However, SC remained an independent prognostic factor associated with worse survival (hazard ratio = 2.5, 95% confidence interval = 1.6–3.8, P < 0.001). MAC and SC are histological subtypes of colorectal cancer with different characteristics than classical AC. Both are diagnosed in more advanced tumor stages, but the dismal prognosis of SC seems to be caused by its intrinsic tumor biology.