Top

Published in:

Open Access 01-12-2024 | Colorectal Cancer | Research

Clinicopathological and molecular characteristics of colorectal adenosquamous carcinoma in an Asian population

Authors: Fujin Ye, Mian Chen, Xiaobin Zheng, Pinzhu Huang, Chao Wang, Huashan Liu, Hao Xie, Wei Xiao, Qin Guo, Liang Huang

Published in: BMC Gastroenterology | Issue 1/2024

Abstract

Background

Adenosquamous carcinoma is a rare sub-type of colorectal cancer with a poor prognosis. Little is known about its clinicopathological and molecular characteristics in Asian populations. This study aimed to investigate these features in a cohort of patients with adenosquamous carcinoma in the colorectum.

Methods

Tumor cases pathologically diagnosed with colorectal adenosquamous carcinoma were retrieved from the Sixth Affiliated Hospital, Sun Yat-sen University tissue archive between December 2012 and June 2020. Clinicopathological features, molecular characteristics, and oncology outcomes were analyzed.

Results

Among 18,139 cases of colorectal cancer, 11 were diagnosed with adenosquamous carcinoma, providing an incidence rate of 0.061%. The median overall survival (OS) was 14 months, and the expected 3-year OS rate was 29.6%. As of October 14, 2022, four cases had local recurrence and five had distant metastasis. KRAS gene mutations were found in four of seven patients (57.1%), and three out of eleven (27.3%) patients had mismatch repair-deficient (dMMR) tumors.

Conclusions

Adenosquamous carcinoma is associated with a poor prognosis. Compared to other sub-types of colorectal cancer, a higher proportion of patients with dMMR and KRAS mutations were observed. These findings suggested that more patients with adenosquamous carcinoma could benefit from targeted therapies, such as immunotherapy.

Xie Y, Shi L, He X, Luo Y. Gastrointestinal cancers in China, the USA, and Europe. Gastroenterol Rep. 2021;9(2). https://doi.org/10.1093/gastro/goab010.

Khan AH, Gao X, Goffredo P, et al. Presentation, treatment, and prognosis of colorectal adenosquamous carcinoma: a contemporary analysis of the surveillance, epidemiology, and end results database. Am J Surg. 2022;223(5):957–62. https://doi.org/10.1016/j.amjsurg.2021.09.004.CrossRefPubMed

Masoomi H, Ziogas A, Lin BS, et al. Population-based evaluation of adenosquamous carcinoma of the colon and rectum. Dis Colon Rectum. 2012;55(5):509–14. https://doi.org/10.1097/DCR.0b013e3182420953.CrossRefPubMedPubMedCentral

Cagir B, Nagy MW, Topham A, Rakinic J, Fry RD. Adenosquamous carcinoma of the colon, rectum, and anus: epidemiology, distribution, and survival characteristics. Dis Colon Rectum. 1999;42(2):258–63. https://doi.org/10.1007/BF02237138.CrossRefPubMed

Nasseri Y. Adenosquamous carcinoma: an aggressive histologic sub-type of colon cancer wth poor prognosis.:5.

Lan YT, Huang KH, Liu CA, et al. A nation-wide Cancer Registry-Based study of Adenosquamous Carcinoma in Taiwan. PLoS ONE. 2015;10(10):e0139748. https://doi.org/10.1371/journal.pone.0139748.CrossRefPubMedPubMedCentral

von Elm E, Altman DG, Egger M, et al. Strengthening the reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806–8. https://doi.org/10.1136/bmj.39335.541782.AD.CrossRef

Uehara K, Nakanishi Y, Shimoda T, Taniguchi H, Akasu T, Moriya Y. Clinicopathological significance of microscopic abscess formation at the invasive margin of advanced low rectal cancer. Br J Surg. 2007;94(2):239–43. https://doi.org/10.1002/bjs.5575.CrossRefPubMed

Ling YH, Chen JW, Wen SH, Huang CY, Li P, Lu LH, et al. Tumor necrosis as a poor prognostic predictor on postoperative survival of patients with solitary small hepatocellular carcinoma. BMC Cancer. 2020;20(1):607.CrossRefPubMedPubMedCentral

10.

de Campos-Lobato LF, Dietz DW, StocchiL, 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

11.

Comer TP, Beahrs OH, Dockerty MB. Primary squamous cell carcinoma and adenoacanthoma of the colon. Cancer. 1971;28(5):1111–7. https://doi.org/10.1002/1097-0142(1971)28:5%3C1111::AID-CNCR2820280504%3E3.0.CO;2-V.CrossRefPubMed

12.

Links M, Ho H, Clingan P, Diamond T. Hypercalcaemia in a patient with fatal adenosquamous carcinoma of the colon. Med J Aust. 1994;160(5):286–7.CrossRefPubMed

13.

Berkelhammer CH, Baker AL, Block GE, Bostwick DG, Michelassi F. Humoral hypercalcemia complicating adenosquamous carcinoma of the proximal colon. Dig Dis Sci. 1989;34(1):142–7. https://doi.org/10.1007/BF01536171.CrossRefPubMed

14.

Moll UM, Ilardi CF, Zuna R, Phillips ME. A biologically active parathyroid hormone-like substance secreted by an adenosquamous carcinoma of the transverse colon. Hum Pathol. 1987;18(12):1287–90. https://doi.org/10.1016/s0046-8177(87)80415-x.CrossRefPubMed

15.

Thompson JT, Paschold EH, Levine EA. Paraneoplastic hypercalcemia in a patient with adenosquamous cancer of the colon. Am Surg. 2001;67(6):585–8.CrossRefPubMed

16.

Chevinsky AH, Berelowitz M, Hoover HCJ. Adenosquamous carcinoma of the colon presenting with hypercalcemia. Cancer. 1987;60(5):1111–6. https://doi.org/10.1002/1097-0142(19870901)60:5%3C1111::aid-cncr2820600532%3E3.0.co;2-1.CrossRefPubMed

17.

Elmas N, Killi RM, Sever A. Colorectal carcinoma: radiological diagnosis and staging. Eur J Radiol. 2002;42(3):206–23. https://doi.org/10.1016/S0720-048X(02)00036-0.CrossRefPubMed

18.

Okabayashi K, Hasegawa H, Ishii Y, Endo T, Kitagawa Y. Adenosquamous carcinoma of the sigmoid colon treated by the less invasive procedures of endoscopy and laparoscopy: report of a case. Surg Today. 2009;39(11):994–7. https://doi.org/10.1007/s00595-009-3961-5.CrossRefPubMed

19.

Akahoshi S, Yamamura K, Komohara Y, et al. A Case Report of Metachronous multiple adenosquamous carcinoma of the Colon over-expressing PD-L1 and a literature review. Anticancer Res. 2021;41(11):5847–54. https://doi.org/10.21873/anticanres.15404.CrossRefPubMed

20.

Hirsch D. Clinical responses to PD-1 inhibition and their molecular characterization in six patients with mismatch repair-deficient metastatic cancer of the digestive system. J Cancer Res Clin Oncol. 11.

21.

Le DT, Kim TW, Van Cutsem E, et al. Phase II open-label study of Pembrolizumab in Treatment-Refractory, microsatellite Instability–High/Mismatch repair–deficient metastatic colorectal Cancer: KEYNOTE-164. J Clin Oncol. 2020;38(1):11–9. https://doi.org/10.1200/JCO.19.02107.CrossRefPubMed

22.

Overman MJ, Lonardi S, Wong KYM, et al. Durable clinical benefit with Nivolumab Plus Ipilimumab in DNA Mismatch Repair–Deficient/Microsatellite instability–high metastatic colorectal Cancer. J Clin Oncol. 2018;36(8):773–9. https://doi.org/10.1200/JCO.2017.76.9901.CrossRefPubMed

23.

Chalabi M, Fanchi LF, Dijkstra KK, et al. Neoadjuvant immunotherapy leads to pathological responses in MMR-proficient and MMR-deficient early-stage colon cancers. Nat Med. 2020;26(4):566–76. https://doi.org/10.1038/s41591-020-0805-8.CrossRefPubMed

24.

Evert K, Stiegler C, Schäfer C, et al. [Successful pembrolizumab therapy in metastasized adenosquamous carcinoma of the colon]. Pathol. 2019;40(5):540–5. https://doi.org/10.1007/s00292-018-0546-3.CrossRef

25.

Dienstmann R, Connor K, Byrne AT, et al. Precision Therapy in RAS Mutant Colorectal Cancer. Gastroenterology. 2020;158(4):806–11. https://doi.org/10.1053/j.gastro.2019.12.051.CrossRefPubMed

26.

Lu SB, Ge FS, Liu C, Hua YW. Adenosquamous carcinoma of sigmoid colon in an adolescent: a case report and literature review. Asian J Surg. 2022;45(4):1055–6. https://doi.org/10.1016/j.asjsur.2022.01.055.CrossRefPubMed

27.

Jia XL, Chen G. EGFR and KRAS mutations in chinese patients with adenosquamous carcinoma of the lung. Lung Cancer Amst Neth. 2011;74(3):396–400. https://doi.org/10.1016/j.lungcan.2011.04.005.CrossRef

28.

Lal N, White BS, Goussous G, et al. KRAS Mutation and Consensus Molecular Subtypes 2 and 3 are independently Associated with reduced Immune Infiltration and Reactivity in Colorectal Cancer. Clin Cancer Res. 2018;24(1):224–33. https://doi.org/10.1158/1078-0432.CCR-17-1090.CrossRefPubMed

29.

Zhu G, Pei L, Xia H, Tang Q, Bi F. Role of oncogenic KRAS in the prognosis, diagnosis and treatment of colorectal cancer. Mol Cancer. 2021;20(1):143. https://doi.org/10.1186/s12943-021-01441-4.CrossRefPubMedPubMedCentral

30.

Lenkiewicz E, Malasi S, Hogenson TL, et al. Genomic and epigenomic landscaping defines new therapeutic targets for Adenosquamous Carcinoma of the pancreas. Cancer Res. 2020;80(20):4324–34. https://doi.org/10.1158/0008-5472.CAN-20-0078.CrossRefPubMedPubMedCentral

Title: Clinicopathological and molecular characteristics of colorectal adenosquamous carcinoma in an Asian population
Authors: Fujin Ye
Mian Chen
Xiaobin Zheng
Pinzhu Huang
Chao Wang
Huashan Liu
Hao Xie
Wei Xiao
Qin Guo
Liang Huang
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Colorectal Cancer
Colorectal Cancer
Published in: BMC Gastroenterology / Issue 1/2024
Electronic ISSN: 1471-230X
DOI: https://doi.org/10.1186/s12876-023-02989-9

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2024

Characterization of primary small intestinal lymphoma: a retrospective study based on double balloon endoscopy

Correlation of alanine aminotransferase levels and a histological diagnosis of steatohepatitis with ultrasound-diagnosed metabolic-associated fatty liver disease in patients from a centre in Nigeria

Comparison of vonoprazan and proton pump inhibitors for the treatment of gastric endoscopic submucosal dissection-induced ulcer: an updated systematic review and meta-analysis

Medical radiation exposure in inflammatory bowel disease: an updated meta-analysis

Evaluating the efficacy of different volume resuscitation strategies in acute pancreatitis patients: a systematic review and meta-analysis

Prediction of injury localization in preoperative patients with gastrointestinal perforation: a multiomics model analysis

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials