Colorectal Adenosquamous Carcinoma: Demographics, Tumor Characteristics, and Survival Benefits of Surgery with Chemoradiation

Asad Ullah; Guirshney Samarah Kenol; Kue Tylor Lee; Abdul Qahar Khan Yasinzai; Agha Wali; Abdul Waheed; Saleh Heneidi; Bhavishya U Ramamoorthy; Nabin R Karki; Andrew M Blakely

doi:10.1007/s12029-024-01052-4

Colorectal Adenosquamous Carcinoma: Demographics, Tumor Characteristics, and Survival Benefits of Surgery with Chemoradiation

J Gastrointest Cancer. 2024 Apr 12. doi: 10.1007/s12029-024-01052-4. Online ahead of print.

Authors

Affiliations

¹ Department of Pathology, Texas Tech University Center, Lubbock, TX, 79430, USA. drasadkhankakar@gmail.com.
² Medical College of Georgia, Augusta, GA, 30912, USA.
³ Department of Medicine, Bolan Medical College, Quetta, 83700, Pakistan.
⁴ Department of Surgery, San Joaquin General Hospital, French Camp, CA, 95231, USA.
⁵ Department of Pathology, Kaiser Permanente Medical Center, Los Angeles, USA.
⁶ Department of Surgical Oncology, National Cancer Institute, Bethesda, MD, USA.
⁷ Division of Medical Oncology, Mitchel Cancer Institute, University of South Alabama, Mobile, AL, USA.

PMID: 38607504
DOI: 10.1007/s12029-024-01052-4

Abstract

Background: Colorectal adenosquamous carcinoma (ASC) is a rare subtype of colorectal carcinoma. This study presents findings from a large database query to highlight the demographic, clinical, and pathological factors, prognosis, and survival of colorectal ASC.

Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients with colorectal ASC diagnosed between 2000 and 2020 and assess factors associated with overall survival (OS) and cause-specific survival (CSS).

Results: Among 284 identified cases, the median age of diagnosis was 64 years. The majority of patients were White (69.0%), with income ≤ $70,000 ( 62.3%), and lived in metropolitan areas (85.6%). Regarding tumor characteristics, the majority of tumors were poorly differentiated (49.6%), regional stage (39.8%), size of > 4.0 cm ( 41.5%), and had a negative lymph node status (47.2%). Primary sites were the rectum (35.2%) and colon ( 64.8%). In patients with primary site to the rectum, the majority of treatment modality was multimodal therapy (40.0%). The main treatment modality for the primary site to the colon was surgery only (46.2%), followed by surgery + chemotherapy (34.2%). The overall 5-year survival was 31.3 (95% C.I. 28.4-34.2) and the 5-year cause-specific survival (CSS) was 40.1% (95% C.I. 36.9-43.3). Multivariate analysis showed age ≥ 60 years, regional stage, and distant stage were negative prognostic factors. An income of > $70,000, multimodal therapy, and surgery with chemotherapy were positive prognostic factors.

Conclusion: Colorectal adenosquamous carcinomas are more common in the non-Hispanic White populations and appear more frequently later in life (based on the median age of diagnosis at 64). Factors that contributed to a worse prognosis were an age of diagnosis ≥ 60 years, regional stage, and distant stage.

Keywords: Chemotherapy; Demographics; Distant metastasis; Prognosis; SEER.