Risk Factors for Recurrence of Radically Resected Mucinous Colorectal Adenocarcinoma

Qing Huang; Min-Hong Zou; Jian-Chang Wei; Ye Jiang; Zhuan-Peng Chen; Qiang Wang; Wang-Lin Li; Jie Cao

doi:10.2147/CMAR.S313627

Risk Factors for Recurrence of Radically Resected Mucinous Colorectal Adenocarcinoma

Cancer Manag Res. 2021 Jun 17:13:4777-4790. doi: 10.2147/CMAR.S313627. eCollection 2021.

Authors

Qing Huang^#¹, Min-Hong Zou^#², Jian-Chang Wei^#¹, Ye Jiang³, Zhuan-Peng Chen¹, Qiang Wang¹, Wang-Lin Li¹, Jie Cao¹

Affiliations

¹ Department of Gastrointestinal Surgery, Guangzhou Digestive Disease Center, Guangzhou First People's Hospital, The Second Affiliated Hospital of South China University of Technology, Guangzhou, Guangdong, People's Republic of China.
² Department of Ultrasound, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China.
³ Department of Pathology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China.

^# Contributed equally.

Abstract

Background: Mucinous adenocarcinoma (MA) is a subtype of colorectal cancer (CRC) associated with a higher incidence of local extension and worse survival compared to non-mucinous adenocarcinoma, but few studies have investigated surgery-related predictors for recurrence of MA. Therefore, we aimed to elucidate the predictors for local recurrence and remote metastasis of MA after surgery.

Patients and methods: This study retrospectively analyzed 162 patients with mucinous colorectal adenocarcinoma (MAC) after radical resection. Analysis variables included demographics, clinical indicators, pathologic stage, surgical procedure, adjuvant therapy, and recurrence. Univariate and multivariate analyses were performed to investigate the risk factors for local and distant tumor relapse.

Results: A total of 162 patients (86 male) with a mean age of 58.26 years were included; 70.37% of patients had colonic tumors, and 29.63% had rectal tumors. The 5-year disease-free survival (DFS) rates for these patients were as follows: 100% for TNM stage I, 71.2% for stage II, and 47.8% for stage III. Five-year DFS rates of MAC, colonic and rectal MA were 62.0%, 65.8%, and 51.7%, respectively. Local recurrence occurred in 38 patients and distant metastasis in 33 patients. In univariate analysis, predictors for local recurrence of MAC were intraoperative blood loss, intraoperative transfusion, and N2 stage; and predictors for distant metastasis were male sex, CA199, CEA, intraoperative blood loss, T4 stage, and N2 stage. In multivariate analysis, predictors for local recurrence of MAC were intraoperative transfusion (P=0.04, OR=4.175) and N2 stage (P=0.000, OR=5.291), and predictors for distant metastasis were male sex (P=0.049, OR=2.410), CA199 (P=0.02, OR=1.003), and T4 stage (P=0.007, OR=4.006).

Conclusion: Intraoperative transfusion and N2 stage were significant predictors for local recurrence. Male sex, CA199, and T4 stage were significant predictors for distant metastasis. Knowledge of the risk factors for postoperative recurrence provides a basis for logical approaches to treatment and follow-up of MAC.

Keywords: colorectal cancer; local and distant recurrence; mucinous adenocarcinoma.

Grants and funding

This research is supported by Medical Science and Technology Research Fund Project of Guangdong (A2019526), National Natural Science Foundation of China (81871943), Natural Science Foundation of Guangdong Province (2017A030311035), Guangzhou Planned Project of Science and Technology(202102010024) .