Clinicopathological and Molecular Features of Colorectal Cancer Patients With Mucinous and Non-Mucinous Adenocarcinoma

Yuan-Tzu Lan; Shih-Ching Chang; Pei-Ching Lin; Chun-Chi Lin; Hung-Hsin Lin; Shen-Chieh Huang; Chien-Hsing Lin; Wen-Yi Liang; Wei-Shone Chen; Jeng-Kai Jiang; Jen-Kou Lin; Shung-Haur Yang

doi:10.3389/fonc.2021.620146

Clinicopathological and Molecular Features of Colorectal Cancer Patients With Mucinous and Non-Mucinous Adenocarcinoma

Front Oncol. 2021 Mar 2:11:620146. doi: 10.3389/fonc.2021.620146. eCollection 2021.

Authors

Yuan-Tzu Lan^{1

2}, Shih-Ching Chang^{1

2}, Pei-Ching Lin^{3

4}, Chun-Chi Lin^{1

2}, Hung-Hsin Lin^{1

2}, Shen-Chieh Huang^{1

2}, Chien-Hsing Lin⁵, Wen-Yi Liang⁶, Wei-Shone Chen^{1

2}, Jeng-Kai Jiang^{1

2}, Jen-Kou Lin^{1

2}, Shung-Haur Yang^{1

2

7}

Affiliations

¹ Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
² Department of Surgery, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
³ Department of Clinical Pathology, Taipei City Hospital, Taipei, Taiwan.
⁴ Department of Health and Welfare, University of Taipei, Taipei, Taiwan.
⁵ Division of Genomic Medicine, National Health Research Institutes, Zhunan, Taiwan.
⁶ Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan.
⁷ Department of Surgery, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan.

Abstract

Background: The prognosis of mucinous adenocarcinoma (MAC) and non-mucinous adenocarcinoma (NMAC) in colorectal cancer (CRC) is controversial, and the molecular differences between them are unclear.

Methods: Between 2000 and 2010, a total of 1,483 CRC patients were included. Among them, 73 patients (4.9%) were diagnosed with MAC. The clinicopathological features and genetic alterations were compared between MAC and NMAC.

Results: After propensity score matching to balance age and sex between MAC and NMAC patients, 292 CRC patients (73 MAC and 219 NMAC) were enrolled in the analysis at a 1:3 ratio. In right-sided colon cancer, patients with MAC were more likely to have Borrmann types 3 and 4 tumors, poor differentiation, and advanced T category and tumor, node, metastasis (TNM) stage, chemotherapy, and a similar 5-year overall survival (OS) rate compared with patients with NMAC. In left-sided colon cancer and rectal cancer, patients with MAC were more likely to have Borrmann types 3 and 4 tumors, poor differentiation, lymphovascular invasion, advanced T and N categories and TNM stages, chemotherapy, and a worse 5-year OS rate than patients with NMAC. Regarding genetic alterations, for NMAC, right-sided colon cancer had more BRAF mutations than left-sided colon cancer and rectal cancer. For MAC, right-sided colon cancer was associated with more microsatellite instability-high tumors and more AKT1 mutations than left-sided colon cancer and rectal cancer.

Conclusion: The genetic alterations are distinct between MAC and NMAC in CRC. Tumor location may have an impact on genetic alterations and patient prognosis in MAC and NMAC.

Keywords: MAC; NMAC; colorectal cancer; genetic alteration; prognostic factor.