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Prognosis of mucinous and signet-ring cell colorectal cancer in a population-based cohort

  • Original Article – Clinical Oncology
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Abstract

Purpose

Besides classical colorectal adenocarcinomas (AC), mucinous adenocarcinomas (MAC) and signet-ring cell carcinomas (SC) occur. Controversy remains regarding their prognostic role. Aim of this study was to define prognostic and histopathological specifications of mucinous and signet-ring cell colorectal cancer.

Methods

A total of 28,056 patients with AC, MAC, and SC between 1998 and 2012 in the catchment area of the Munich Cancer Registry were analyzed. Time to locoregional recurrence and distant recurrence was calculated by cumulative incidence. Survival was analyzed by the Kaplan–Meier method, calculation of relative survival, and Cox proportional hazards regression.

Results

AC occurred in 25,172 patients (90 %), MAC in 2724 (9.7 %), and SC in 160 (0.6 %). AC were less frequently localized in the proximal colon (34 %) compared to MAC (57 %, p < 0.001) and SC (76 %, p < 0.001). Both, MAC and SC had higher T, N, and M categories, lymphatic invasion, and worse grading (p < 0.001 for each). There were significant differences regarding the 10-year cumulative incidence of locoregional recurrence (p < 0.001), and distant recurrence (p < 0.001). For AC, the 5-year overall survival was 59 % (95 % confidence interval 58.0; 59.3), for MAC 52 % (50.2; 54.2), and for SC 40 % (32.1; 48.5; p < 0.001). However, MAC or SC did not remain independent prognostic factors for overall survival compared to AC upon multivariable analysis (p = 0.981).

Conclusion

This large cohort reveals specific histopathological and recurrence patterns for patients with colorectal AC, MAC, and SC. MAC and SC are diagnosed at more advanced tumor stages and therefore entail reduced survival rates.

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Acknowledgments

We thank all the hospitals, departments, and practitioners that participated in the documentation of the presented data. In particular, we thank the following 50 surgical hospitals and departments that participated in the documentation of over 90 % of the presented surgically treated cohort.

Author contributions

Städt. Klinikum München-Neuperlach, Klinik für Allgemein- und Viszeralchirurgie, endokrine Chirurgie und Coloproktologie: Prof. N. Nüssler, Dr. R. Ruppert; Städt. Klinikum München-Bogenhausen, Klinik für Allgemein-, Viszeral-, Gefäß- und Thoraxchirurgie: Prof. A. Agha; Klinikum der Ludwig-Maximilians-Universität – Großhadern, Chirurgische Klinik und Poliklinik: Prof. J. Werner; Klinikum rechts der Isar der Technischen Universität, Chirurgische Klinik und Poliklinik: Prof. H. Friess; Klinikum Dachau, Abteilung für Viszeral- und Thoraxchirurgie: Prof. H.-G. Rau; Klinikum Dritter Orden, Klinik für Allgemein-, Viszeral-, Gefäß- und Thoraxchirurgie: Dr. D. Krenz; Klinikum Rosenheim, Klinik für Allgemein-, Gefäß- und Thoraxchirurgie: Prof. P. Wagner; Krankenhaus Barmherzige Brüder München, Allgemein- und Viszeralchirurgie: PD Dr. H. Spatz; Klinikum Traunstein, Abteilung für Allgemein-, Viszeral- und Minimalinvasive Chirurgie: PD Dr. R. J. Schauer; Klinikum Landshut, Chirurgische Klinik I: Prof. F. Löhe; Kreisklinikum Altötting, Abteilung für Allgemein-, Viszeral- und Thoraxchirurgie: Prof. J. Roder; Städt. Klinikum München-Harlaching, Klinik für Allgemein- und Viszeralchirurgie und Coloproktologie: Dr. R. Schmid; Chirurgische Klinik Seefeld: Dr. R. Hahn; Maria-Theresia-Klinik, Chirurgische Abteilung: Prof. T. F. Hoffmann; Kreisklinik Prien am Chiemsee, Chirurgische Abteilung: Prof J. Stadler; Helios Klinikum München West (Pasing), Allgemein- und Viszeralchirurgie: Dr. E. Bielesch; Rotkreuzkrankenhaus, Chirurgische Abteilung: Prof. W. Thasler; Klinikum Erding, Abteilung für Viszeral-, Thorax- und endokrine Chirurgie: Dr. H. Bödeker; Klinikum Freising, Abteilung für Allgemein-, Thorax- und Gefäßchirurgie: Dr. F. Zeller; Städt. Klinikum München-Schwabing, Klinik für Viszeralmedizin: Prof. H. Waldner; Klinikum Ingolstadt, Chirurgische Klinik I: Prof. S. B. Hosch; Klinikum Garmisch-Partenkirchen, Fachabteilung Allgemein-, Viszeral-, Thorax- und endokrine Chirurgie: PD Dr. H. Vogelsang; Kreisklinik Ebersberg, Abteilung für Allgemein-, Viszeral und Gefäßchirurgie: Dr. P. Kreissl; Krankenhaus Landshut-Achdorf, Chirurgische Klinik I, Allgemein- und Viszeralchirurgie: Prof. J. Schmidt; Klinik Mühldorf am Inn, Allgemein-, Viszeral und Thoraxchirurgie: Dr. W. Richter; Klinikum der Ludwig-Maximilians-Universität – Innenstadt, Chirurgische Klinik für Allgemein-, Viszeral, Transplantations- und Thoraxchirurgie: Prof. J. Werner; Asklepios Stadtklinik Bad Tölz, Abteilung für Allgemein-, Viszeral und Gefäßchirurgie: Dr. C. Kiehling; Klinikum Fürstenfeldbruck, Abteilung für Allgemein-, Viszeral und Gefäßchirurgie: Dr. F. Spelsberg; Kreisklinik Trostberg, Allgemein- und Viszeralchirurgie: Dr. J. Deuble; Kreisklinik Bad Reichenhall, Chirurgische Abteilung: Prof. E. Pratschke; Chirurgische Klinik Dr. Rinecker, Allgemein- und Viszeralchirurgie: Dr. E. Shang; Krankenhaus Martha-Maria, Klinik für Allgemein-, Viszeral und Thoraxchirurgie: Prof. H. Fürst; Ilmtalklinik Pfaffenhofen, Abteilung für Allgemein- und Viszeralchirurgie: PD Dr. R. Lange; Klinikum Starnberg, Chirurgische Klinik: Prof. A. Trupka; Privatklinik Josephinum, Abteilung für Chirurgie: Dr. R. Hahn; RoMed Klinik Bad Aibling, Chirurgische Abteilung: PD Dr. Thalheimer; Kliniken St. Elisabeth Neuburg, Abteilung für Allgemein-, Viszeralchirurgie und Thoraxchirurgie: Dr. E. Brunner; Kliniken im Naturpark Altmühltal Kösching, Chirurgische Klinik I: Dr. N. Hüllebrand; Triamed Kreisklinik Wasserburg, Chirurgische Abteilung: Dr. C. Bitter; Krankenhaus Vilsbiburg, Chirurgische Klinik I: Dr. N. Steigemann; Helios Klinik München Perlach, Viszeralchirurgie: Dr. N. Demmel; Chirurgische Klinik München-Bogenhausen, Chirurgische Abteilung: PD Dr. T. Hüttl; Krankenhaus Penzberg Chirurgische Abteilung: Dr. R. Miksch; Benedictus Krankenhaus Tutzing, Chirurgische Abteilung: Dr. D. Mündel; Kreisklinik Wolfratshausen, Chirurgische Abteilung: Dr. S. Schmidbauer; Krankenhaus Weilheim, Abteilung für Allgemein- und Viszeralchirurgie: PD Dr. R. Lang; Klinikum Landsberg am Lech, Abteilung für Chirurgie: Dr. H. Tigges; Kreiskrankenhaus Schrobenhausen, Chirurgische Abteilung: Dr. P. Haupt, Dr. A. Limberger; Wolfartklinik, Abteilung für Allgemein- und Viszeralchirurgie: PD Dr. G. Meyer; Krankenhaus Schongau, Abteilung für Unfallchirurgie: Dr. R. Welser.

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Authors and Affiliations

  1. Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, Munich, Germany

    Ulrich Nitsche, Helmut Friess & Dirk Wilhelm

  2. Klinik für Allgemein-, Viszeral-, Gefäß- und Thoraxchirurgie, Klinikum München-Bogenhausen, Englschalkinger Str. 77, 81925, Munich, Germany

    Ayman Agha

  3. Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany

    Martin Angele & Jens Werner

  4. Tumorregister München (TRM) des Tumorzentrums München (TZM), Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Klinikum der Universität München (KUM), Marchioninistr. 15, 81377, Munich, Germany

    Renate Eckel, Gabriele Schubert-Fritschle & Jutta Engel

  5. Klinik für Allgemein-, Viszeral- und Minimalinvasive Chirurgie, Isarklinikum, Sonnenstraße 24-26, 80331, Munich, Germany

    Wolf Heitland

  6. Klinikum der Universität München, Ärztliche Direktion, Marchioninistr. 15, 81377, Munich, Germany

    Karl-Walter Jauch

  7. Abteilung für Allgemein-, Gefäß-, Schilddrüsen- und Thoraxchirurgie, Klinikum Dritter Orden, Menzinger Str. 44, 80638, Munich, Germany

    Detlef Krenz

  8. Klinik für Allgemein- und Viszeralchirurgie, Klinikum München-Neuperlach, Oskar-Maria-Graf-Ring 51, 81737, Munich, Germany

    Natascha C. Nüssler & Reinhard Ruppert

  9. Abteilung für Viszeral-, Thorax- und Gefäßchirurgie, Klinikum Dachau, Krankenhausstr. 15, 85221, Dachau, Germany

    Horst-Günter Rau

Authors
  1. Ulrich Nitsche
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  2. Helmut Friess
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  3. Ayman Agha
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  4. Martin Angele
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  5. Renate Eckel
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  6. Wolf Heitland
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  7. Karl-Walter Jauch
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  8. Detlef Krenz
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  9. Natascha C. Nüssler
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  10. Horst-Günter Rau
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  11. Reinhard Ruppert
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  12. Gabriele Schubert-Fritschle
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  13. Dirk Wilhelm
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  14. Jens Werner
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  15. Jutta Engel
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Correspondence to Ulrich Nitsche.

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Nitsche, U., Friess, H., Agha, A. et al. Prognosis of mucinous and signet-ring cell colorectal cancer in a population-based cohort. J Cancer Res Clin Oncol 142, 2357–2366 (2016). https://doi.org/10.1007/s00432-016-2224-2

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  • DOI: https://doi.org/10.1007/s00432-016-2224-2

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