Top

International Journal of Colorectal Disease

Published in:

01-03-2012 | Original Article

Tumor location is a prognostic factor in poorly differentiated adenocarcinoma, mucinous adenocarcinoma, and signet-ring cell carcinoma of the colon

Authors: Soichiro Ishihara, Toshiaki Watanabe, Takuya Akahane, Ryu Shimada, Atsushi Horiuchi, Hajime Shibuya, Tamuro Hayama, Hideki Yamada, Keijiro Nozawa, Keiji Matsuda, Koutarou Maeda, Kenichi Sugihara

Published in: International Journal of Colorectal Disease | Issue 3/2012

Abstract

Purpose

Cancers which arise in the proximal and distal colon are suggested to be different clinically, pathologically, and genetically. The aim of this study is to clarify whether clinical behavior of colonic poorly differentiated adenocarcinoma, mucinous adenocarcinoma, and signet-cell carcinoma (Por/Muc/Sig cancers), minor and aggressive subpopulation in colonic cancers, differs in accordance with the tumor location.

Methods

A total of 3,175 patients with curatively resected colonic cancers were studied. Clinical and pathological features were compared between Por/Muc/Sig cancers and well or moderately differentiated adenocarcinomas (Wel/Mod cancers) and between proximal and distal cancers in each histologic type.

Results

Por/Muc/Sig cancers (n = 213) were more advanced in the TNM stage and showed worse disease-specific survival than Wel/Mod cancers (n = 2,692). In Por/Muc/Sig cancers, but not in Wel/Mod cancers, proximal cancers showed significantly better disease-specific survival than distal cancers (88.9% vs. 76.5%, p = 0.0234), and a multivariate analysis showed that proximal tumor location was an independent predictor of fair prognosis (hazard ratio (HR), 0.458; 95% confidence interval (CI), 0.218–0.961; p = 0.0390). In addition, female gender also was an independent predictor of fair prognosis in Por/Muc/Sig cancers (HR, 0.373; 95% CI, 0.151–0.922) and not in Wel/Mod cancers.

Conclusions

Proximal Por/Muc/Sig cancers were suggested to be a distinct subpopulation with a favorable oncologic outcome. Tumor location and gender might be helpful in the risk stratification after curative surgery for Por/Muc/Sig cancers.

Gervaz P, Bucher P, Morel P (2004) Two colons-two cancers: paradigm shift and clinical implications. J Surg Oncol 88:261–266. doi:10.1002/jso.20156 PubMedCrossRef

Azzoni C, Bottarelli L, Campanini N, Di Cola G, Bader G, Mazzeo A, Salvemini C, Morari S, Di Mauro D, Donadei E, Roncoroni L, Bordi C, Sarli L (2007) Distinct molecular patterns based on proximal and distal sporadic colorectal cancer: arguments for different mechanisms in the tumorigenesis. Int J Colorectal Dis 22:115–126. doi:10.1007/s00384-006-0093-x PubMedCrossRef

Bufill JA (1990) Colorectal cancer: evidence for distinct genetic categories based on proximal or distal tumor location. Ann Intern Med 113:779–788PubMed

Nawa T, Kato J, Kawamoto H, Okada H, Yamamoto H, Kohno H, Endo H, Shiratori Y (2008) Differences between right- and left-sided colon cancer in patient characteristics, cancer morphology and histology. J Gastroenterol Hepatol 23:418–423. doi:10.1111/j.1440-1746.2007.04923.x PubMedCrossRef

Ponz de Leon M, Sacchetti C, Sassatelli R, Zanghieri G, Roncucci L, Scalmati A (1990) Evidence for the existence of different types of large bowel tumor: suggestions from the clinical data of a population-based registry. J Surg Oncol 44:35–43PubMedCrossRef

Lengauer C, Kinzler KW, Vogelstein B (1997) Genetic instability in colorectal cancers. Nature 386:623–627. doi:10.1038/386623a0 PubMedCrossRef

Haydon AM, Jass JR (2002) Emerging pathways in colorectal-cancer development. Lancet Oncol 3:83–88. doi:S1470204502006496[pii] PubMedCrossRef

Kim H, Jen J, Vogelstein B, Hamilton SR (1994) Clinical and pathological characteristics of sporadic colorectal carcinomas with DNA replication errors in microsatellite sequences. Am J Pathol 145:148–156PubMed

Jass JR, Do KA, Simms LA, Iino H, Wynter C, Pillay SP, Searle J, Radford-Smith G, Young J, Leggett B (1998) Morphology of sporadic colorectal cancer with DNA replication errors. Gut 42:673–679PubMedCrossRef

10.

Kakar S, Smyrk TC (2005) Signet ring cell carcinoma of the colorectum: correlations between microsatellite instability, clinicopathologic features and survival. Mod Pathol 18:244–249. doi:10.1038/modpathol.3800298 PubMedCrossRef

11.

Bjerkeset T, Morild I, Mork S, Soreide O (1987) Tumor characteristics in colorectal cancer and their relationship to treatment and prognosis. Dis Colon Rectum 30:934–938PubMedCrossRef

12.

Mulcahy HE, Skelly MM, Husain A, O’Donoghue DP (1996) Long-term outcome following curative surgery for malignant large bowel obstruction. Br J Surg 83:46–50PubMedCrossRef

13.

Nissan A, Guillem JG, Paty PB, Wong WD, Cohen AM (1999) Signet-ring cell carcinoma of the colon and rectum: a matched control study. Dis Colon Rectum 42:1176–1180PubMedCrossRef

14.

Papadopoulos VN, Michalopoulos A, Netta S, Basdanis G, Paramythiotis D, Zatagias A, Berovalis P, Harlaftis N (2004) Prognostic significance of mucinous component in colorectal carcinoma. Tech Coloproctol 8(Suppl 1):s123–s125. doi:10.1007/s10151-004-0131-z PubMedCrossRef

15.

Ward R, Meagher A, Tomlinson I, O’Connor T, Norrie M, Wu R, Hawkins N (2001) Microsatellite instability and the clinicopathological features of sporadic colorectal cancer. Gut 48:821–829PubMedCrossRef

16.

Gafa R, Maestri I, Matteuzzi M, Santini A, Ferretti S, Cavazzini L, Lanza G (2000) Sporadic colorectal adenocarcinomas with high-frequency microsatellite instability. Cancer 89:2025–2037. doi:10.1002/1097-0142(20001115)89:10<2025::AID-CNCR1>3.0.CO;2-S[pii] PubMedCrossRef

17.

Winn B, Tavares R, Fanion J, Noble L, Gao J, Sabo E, Resnick MB (2009) Differentiating the undifferentiated: immunohistochemical profile of medullary carcinoma of the colon with an emphasis on intestinal differentiation. Hum Pathol 40:398–404. doi:10.1016/j.humpath.2008.08.014 PubMedCrossRef

18.

Wick MR, Vitsky JL, Ritter JH, Swanson PE, Mills SE (2005) Sporadic medullary carcinoma of the colon: a clinicopathologic comparison with nonhereditary poorly differentiated enteric-type adenocarcinoma and neuroendocrine colorectal carcinoma. Am J Clin Pathol 123:56–65PubMedCrossRef

19.

Lanza G, Gafa R, Matteuzzi M, Santini A (1999) Medullary-type poorly differentiated adenocarcinoma of the large bowel: a distinct clinicopathologic entity characterized by microsatellite instability and improved survival. J Clin Oncol 17:2429–2438PubMed

20.

Leopoldo S, Lorena B, Cinzia A, Gabriella DC, Angela Luciana B, Renato C, Antonio M, Carlo S, Cristina P, Stefano C, Maurizio T, Luigi R, Cesare B (2008) Two subtypes of mucinous adenocarcinoma of the colorectum: clinicopathological and genetic features. Ann Surg Oncol 15:1429–1439. doi:10.1245/s10434-007-9757-1 PubMedCrossRef

21.

Hamilton SR, Aaltonen LA (eds) (2000) Pathology and genetics of tumours of the digestive system. World Health Organization classification of tumours. IARC Press, Lyon

22.

Kazama Y, Watanabe T, Kanazawa T, Tada T, Tanaka J, Nagawa H (2005) Mucinous carcinomas of the colon and rectum show higher rates of microsatellite instability and lower rates of chromosomal instability: a study matched for T classification and tumor location. Cancer 103:2023–2029. doi:10.1002/cncr.21022 PubMedCrossRef

23.

Kanemitsu Y, Kato T, Hirai T, Yasui K, Morimoto T, Shimizu Y, Kodera Y, Yamamura Y (2003) Survival after curative resection for mucinous adenocarcinoma of the colorectum. Dis Colon Rectum 46:160–167. doi:10.1097/01.DCR.0000044721.76711.6D PubMedCrossRef

24.

Vasen HF, Moslein G, Alonso A, Bernstein I, Bertario L, Blanco I, Burn J, Capella G, Engel C, Frayling I, Friedl W, Hes FJ, Hodgson S, Mecklin JP, Moller P, Nagengast F, Parc Y, Renkonen-Sinisalo L, Sampson JR, Stormorken A, Wijnen J (2007) Guidelines for the clinical management of Lynch syndrome (hereditary non-polyposis cancer). J Med Genet 44:353–362. doi:jmg.2007.048991[pii] PubMedCrossRef

25.

Lynch HT, de la Chapelle A (1999) Genetic susceptibility to non-polyposis colorectal cancer. J Med Genet 36:801–818PubMed

26.

Graham DM, Appelman HD (1990) Crohn’s-like lymphoid reaction and colorectal carcinoma: a potential histologic prognosticator. Mod Pathol 3:332–335PubMed

27.

Soreide K, Nedrebo BS, Soreide JA, Slewa A, Korner H (2009) Lymph node harvest in colon cancer: influence of microsatellite instability and proximal tumor location. World J Surg. doi:10.1007/s00268-009-0255-4

28.

Watanabe T, Kobunai T, Toda E, Yamamoto Y, Kanazawa T, Kazama Y, Tanaka J, Tanaka T, Konishi T, Okayama Y, Sugimoto Y, Oka T, Sasaki S, Muto T, Nagawa H (2006) Distal colorectal cancers with microsatellite instability (MSI) display distinct gene expression profiles that are different from proximal MSI cancers. Cancer Res 66:9804–9808. doi:10.1158/0008-5472.CAN-06-1163 PubMedCrossRef

29.

Kim YH, Min BH, Kim SJ, Choi HK, Kim KM, Chun HK, Lee H, Kim JY, Chang DK, Son HJ, Rhee PL, Rhee JC, Kim JJ (2010) Difference between proximal and distal microsatellite-unstable sporadic colorectal cancers: analysis of clinicopathological and molecular features and prognoses. Ann Surg Oncol. doi:10.1245/s10434-009-0888-4

30.

Koo JH, Leong RW (2009) Sex differences in epidemiological, clinical and pathological characteristics of colorectal cancer. J Gastroenterol Hepatol. doi:10.1111/j.1440-1746.2009.05992.x

31.

Hsu HH, Cheng SF, Wu CC, Chu CH, Weng YJ, Lin CS, Lee SD, Wu HC, Huang CY, Kuo WW (2006) Apoptotic effects of over-expressed estrogen receptor-beta on LoVo colon cancer cell is mediated by p53 signalings in a ligand-dependent manner. Chin J Physiol 49:110–116PubMed

Title: Tumor location is a prognostic factor in poorly differentiated adenocarcinoma, mucinous adenocarcinoma, and signet-ring cell carcinoma of the colon
Authors: Soichiro Ishihara
Toshiaki Watanabe
Takuya Akahane
Ryu Shimada
Atsushi Horiuchi
Hajime Shibuya
Tamuro Hayama
Hideki Yamada
Keijiro Nozawa
Keiji Matsuda
Koutarou Maeda
Kenichi Sugihara
Publication date: 01-03-2012
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 3/2012
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-011-1343-0

At a glance: The STEP trials

Springer Medicine

Tumor location is a prognostic factor in poorly differentiated adenocarcinoma, mucinous adenocarcinoma, and signet-ring cell carcinoma of the colon

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2012

Pleiotrophin is a potential colorectal cancer prognostic factor that promotes VEGF expression and induces angiogenesis in colorectal cancer

Dukes C colorectal cancer: is the metastatic lymph node ratio important?

Ultrastaging of colon cancer by sentinel node biopsy using fluorescence navigation with indocyanine green

Trimodal endoscopic imaging for the detection and differentiation of colorectal adenomas: a prospective single-centre clinical evaluation

The effects of tacrolimus on colonic anastomotic healing in rats

Determinants of short- and long-term outcome in patients undergoing simultaneous resection of colorectal cancer and synchronous colorectal liver metastases