nach oben

Erschienen in:

16.10.2015 | Research Article

Clinical significance of cellular and acellular mucin pools in rectal carcinoma following preoperative chemoradiotherapy

verfasst von: J. A. Cienfuegos, J. Baixauli, F. Rotellar, J. Arredondo, J. J. Sola, L. Arbea, C. Pastor, J. L. Hernández-Lizoáin

Erschienen in: Clinical and Translational Oncology | Ausgabe 7/2016

Einloggen, um Zugang zu erhalten

Abstract

Background and objectives

The standard treatment for locally advanced rectal cancer (LARC) is neoadjuvant chemoradiotherapy (CRT) followed by surgery. Pathological findings remain the most significant prognostic factor. The presence of mucin pools and their prognostic significance is a controversial issue. The aim of this study was to analyze the incidence of cellular and acellular mucin pools and their clinical significance.

Methods

Four-hundred and forty-six consecutive prospectively collected specimens from patients with LARC treated with long-course preoperative CRT and surgery were analyzed. Kaplan–Meier analysis was performed.

Results

Mucin pools were present in 182 specimens (40.8 %); 66 (14.7 %) were acellular, and viable tumor cells were identified in 116 (26 %). The complete pathological response rate was 13.5 % (60 of 446). With a median follow-up of 79.0 months, the 5- and 10-year disease-free survivals for patients with acellular and cellular mucin pools were 81.5, 78.1, 63.7 and 61.2 %, respectively (p ≤ 0.026). The presence of cells in the colloid response to treatment was associated with a 17.8 and 16.9 % decrease in 5- and 10-year disease survival vs. acellular colloid response.

Conclusions

Our results suggest that cellular mucin pools are an indicator of an aggressive phenotype and harbingers of a worse prognosis.

Julien LA, Thorson AG. Current neoadjuvant strategies in rectal cancer. J Surg Oncol. 2010;101(321):326.

Reynold M, Niland J, ter Veer A, Milne D, Bekaii-Saab T, Cohen SJ, et al. Neoadjuvant radiotherapy use in locally advanced rectal cancer at NCCN member institutions. J Natl Compr Cancer Netw. 2014;12:235–43.

Mamon HJ, Tepper JE. Combination chemoradiation therapy: the whole is more than the sum of the parts. J Clin Oncol. 2014;32:367–9.CrossRefPubMed

Heald R, MacFarlane JK. Surgical management of rectal cancer. Br J Surg. 1995;82:1704–5.CrossRefPubMed

Gerard JP, Conroy T, Bonnetain F, Bouche O, Chapet O, Closon-Dejardin MT, et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3–4 rectal cancers: results of FFCD 9203. J Clin Oncol. 2006;24:4620–5.CrossRefPubMed

Sauer R, Liersch T, Merkel S, Fietkau R, Hohenberger W, Hess C, et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol. 2012;30:1926–33.CrossRefPubMed

Fokas E, Liersch T, Fietkau R, Hohenberger W, Beissbarth T, Hess C, et al. Tumor regression grading after preoperative chemoradiotherapy for locally advanced rectal carcinoma revisited: updated results of the CAO/ARO/AIO-94 trial. J Clin Oncol. 2014;32:1554–62.CrossRefPubMed

Shia J, Guillem JG, Moore HG, Tickoo SK, Qin J, Ruo L, et al. Patterns of morphologic alteration in residual rectal carcinoma following preoperative chemoradiation and their association with long-term outcome. Am J Surg Pathol. 2004;28:215–23.CrossRefPubMed

Quah HM, Chou JF, Gonen M, Shia J, Schrag D, Saltz LB, et al. Pathologic stage is most prognostic of disease-free survival in locally advanced rectal cancer patients after preoperative chemoradiation. Cancer. 2008;113:57–64.CrossRefPubMed

10.

Bouzourene H, Bosman FT, Matter M, Coucke P. Predictive factors in locally advanced rectal cancer treated with preoperative hyperfractionated and accelerated radiotherapy. Hum Pathol. 2003;34:541–8.CrossRefPubMed

11.

Agarwal A, Chang GJ, Hu CY, Taggart M, Rashid A, Park IJ, et al. Quantified pathologic response assessed as residual tumor burden is a predictor of recurrence-free survival in patients with rectal cancer who undergo resection after neoadjuvant chemoradiotherapy. Cancer. 2013;119:4231–41.CrossRefPubMed

12.

Dworak O, Keilholz L, Hoffmann A. Pathological features of rectal cancer after preoperative radiochemotherapy. Int J Colorectal Dis. 1997;12:19–23.CrossRefPubMed

13.

Castro EB, Rosen PP, Quan SH. Carcinoma of large intestine in patients irradiated for carcinoma of cervix and uterus. Cancer. 1973;31:45–52.CrossRefPubMed

14.

Nagtegaal I, Gaspar C, Marijnen C, Van De Velde C, Fodde R, Van Krieken H. Morphological changes in tumour type after radiotherapy are accompanied by changes in gene expression profile but not in clinical behaviour. J Pathol. 2004;204:183–92.CrossRefPubMed

15.

Ooki A, Akagi K, Yatsuoka T, Asayama M, Hara H, Yamamoto G, et al. Inverse effect of mucinous component on survival in stage III colorectal cancer. J Surg Oncol. 2014;110:851–7.CrossRefPubMed

16.

von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbrouke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370:1453–7.CrossRef

17.

Compton CC, Byrd DR, Garcia-Aguilar J, Kurtzman SH, Olawaiye A, Washington MK. AJCC cancer staging atlas: A companion to the seventh Editions of the AJCC Cancer Staging Manual and Handbook. 2nd ed. New York: Springer; 2012.CrossRef

18.

Aristu JJ, Arbea L, Rodriguez J, Hernández-Lizoáin JL, Sola JJ, Moreno M, et al. Phase I–II trial of concurrent capecitabine and oxaliplatin with preoperative intensity-modulated radiotherapy in patients with locally advanced rectal cancer. Int J Radiat Oncol Biol Phys. 2008;71:748–55.CrossRefPubMed

19.

Arbea L, Martinez-Monge R, Diaz-Gonzalez JA, Moreno M, Rodríguez J, Hernández JL, et al. Four-week neoadjuvant intensity-modulated radiation therapy with concurrent capecitabine and oxaliplatin in locally advanced rectal cancer patients: a validation phase II trial. Int J Radiat Oncol Biol Phys. 2012;83:587–93.CrossRefPubMed

20.

Arredondo J, Baixauli J, Beorlegui C, Arbea L, Rodríguez J, Sola JJ, et al. Prognosis factors for recurrence in patients with locally advanced rectal cancer preoperatively treated with chemoradiotherapy and adjuvant chemotherapy. Dis Colon Rectum. 2013;56:416–21.CrossRefPubMed

21.

Jass JR, O’Brien J, Riddell RH, Snover DC. Association of Directors of Anatomic and Surgical Pathology. Recommendations for the reporting of surgically resected specimens of colorectal carcinoma: Association of Directors of Anatomic and Surgical Pathology. Am J Clin Pathol. 2008;129:13–23.CrossRefPubMed

22.

Ruo L, Tickoo S, Klimstra DS, Minsky BD, Saltz L, Mazumdar M, et al. Long-term prognostic significance of extent of rectal cancer response to preoperative radiation and chemotherapy. Ann Surg. 2002;236:75–81.CrossRefPubMedPubMedCentral

23.

Shia J, McManus M, Guillem JG, Leibold T, Zhou Q, Tang LH, et al. Significance of acellular mucin pools in rectal carcinoma after neoadjuvant chemoradiotherapy. Am J Surg Pathol. 2011;35:127–34.CrossRefPubMed

24.

Lim SB, Hong SM, Yu CS, Hong YS, Kim TW, Park JH, et al. Prevalence and clinical significance of acellular mucin in locally advanced rectal cancer patients showing pathologic complete response to preoperative chemoradiotherapy. Am J Surg Pathol. 2013;37:47–52.CrossRefPubMed

25.

Colon and rectum. In: American Joint Committee on Cancer, ed. AJCC cancer staging manual. 7th ed. New York: Springer; 2010. p. 145–61.

26.

Washington MK, Berlin J, Branton P, Burgart LJ, Carter DK, Fitzgibbons PL, et al. Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum. Arch Pathol Lab Med. 2009;133:1539–51.PubMedPubMedCentral

27.

Rullier A, Laurent C, Vendrely V, Le Bail B, Bioulac-Sage P, Rullier E. Impact of colloid response on survival after preoperative radiotherapy in locally advanced rectal carcinoma. Am J Surg Pathol. 2005;29:602–6.CrossRefPubMed

28.

Smith KD, Tan D, Das P, Chang GJ, Kattepogu K, Feig BW, et al. Clinical significance of acellular mucin in rectal adenocarcinoma patients with a pathologic complete response to preoperative chemoradiation. Ann Surg. 2010;251:261–4.CrossRefPubMed

29.

de Campos-Lobato LF, Dietz DW, Stocchi L, Vogel JD, Lavery IC, Goldblum JR, et al. Clinical implications of acellular mucin pools in resected rectal cancer with pathological complete response to neoadjuvant chemoradiation. Colorectal Dis. 2012;14:62–7.CrossRefPubMed

30.

Cienfuegos JA, Rotellar F, Baixauli J, Beorlegui C, Sola JJ, Arbea L, et al. Impact of perineural and lymphovascular invasion on oncological outcomes in rectal cancer treated with neoadjuvant chemoradiotherapy and surgery. Ann Surg Oncol. 2015;22:916–23.CrossRefPubMed

31.

Guillem JG, Chessin DB, Cohen AM, Shia J, Mazumdar M, Enker W, et al. Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer. Ann Surg. 2005;241:829–36 (discussion 836-8).CrossRefPubMedPubMedCentral

32.

Rodel C, Martus P, Papadoupolos T, Fuzesi L, Klimpfinger M, Fietkau R, et al. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol. 2005;23:8688–96.CrossRefPubMed

33.

Smith FM, Wiland H, Mace A, Pai RK, Kalady MF. Clinical criteria underestimate complete pathological response in rectal cancer treated with neoadjuvant chemoradiotherapy. Dis Colon Rectum. 2014;57:311–5.CrossRefPubMed

Titel: Clinical significance of cellular and acellular mucin pools in rectal carcinoma following preoperative chemoradiotherapy
verfasst von: J. A. Cienfuegos
J. Baixauli
F. Rotellar
J. Arredondo
J. J. Sola
L. Arbea
C. Pastor
J. L. Hernández-Lizoáin
Publikationsdatum: 16.10.2015
Verlag: Springer International Publishing
Erschienen in: Clinical and Translational Oncology / Ausgabe 7/2016
Print ISSN: 1699-048X
Elektronische ISSN: 1699-3055
DOI: https://doi.org/10.1007/s12094-015-1422-8

Neu im Fachgebiet Onkologie

25.04.2024 | Nierenkarzinom | Nachrichten

Springer Medizin

Clinical significance of cellular and acellular mucin pools in rectal carcinoma following preoperative chemoradiotherapy

Abstract

Background and objectives

Methods

Results

Conclusions

Neu im Fachgebiet Onkologie

Adjuvante Immuntherapie verlängert Leben bei RCC

Alectinib verbessert krankheitsfreies Überleben bei ALK-positivem NSCLC

Bei Senioren mit Prostatakarzinom auf Anämie achten!

ICI-Therapie in der Schwangerschaft wird gut toleriert

Update Onkologie

Springer Medizin

Abstract

Background and objectives

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 7/2016

Targeting the microenvironment of pancreatic cancer: overcoming treatment barriers and improving local immune responses

Overexpression of Cathepsin L is associated with gefitinib resistance in non-small cell lung cancer

Landscape of early clinical trials for childhood and adolescence cancer in Spain

CCR6 overexpression predicted advanced biological behaviors and poor prognosis in patients with gastric cancer

Clinical significance of ECT2 expression in tissue and serum of gastric cancer patients

Long noncoding RNAs in lung cancer: what we know in 2015

Neu im Fachgebiet Onkologie

Adjuvante Immuntherapie verlängert Leben bei RCC

Alectinib verbessert krankheitsfreies Überleben bei ALK-positivem NSCLC

Bei Senioren mit Prostatakarzinom auf Anämie achten!

ICI-Therapie in der Schwangerschaft wird gut toleriert

Update Onkologie