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Choi, Lee, Won, Lee, Si, Lee, Kang, Park, Ahn, Kim, and Oh: Analysis of Prognosis in Colorectal Mucinous Adenocarcinoma: A Retrospective Analysis with Peritoneal Fluid
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2010; 79(6): 474-480.

Published online: 31 December 2010

DOI: https://doi.org/10.4174/jkss.2010.79.6.474

Analysis of Prognosis in Colorectal Mucinous Adenocarcinoma: A Retrospective Analysis with Peritoneal Fluid

Seung Bong Choi, M.D., In Kyu Lee, M.D., Dae Youn Won, M.D., Yoon Suk Lee, M.D., Yoon Si, M.D., Sang Chul Lee, M.D., Won Kyung Kang, M.D., Jong Kyung Park, M.D., Chang Hyeok Ahn, M.D., Jun-Gi Kim, M.D., Seong Taek Oh, M.D.

Department of Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea.

Corresponding author (cmcgslee@catholic.ac.kr)

Received 18 April 2010       Accepted 13 July 2010

Copyright © 2010 The Korean Surgical Society

Abstract

Purpose

Although many papers have reported poor prognosis of colorectal mucinous adenocarcinoma, the underlying cause for its unfavorable outcome is yet to be elucidated. In the peritoneal fluid studies, we observed that peritoneal recurrences and cytology positive cases were many times mucinous cancers. On the basis of these observations, mucinous and non-mucinous adenocarcinomas were compared and prognostic factors were studied.

Methods

Five hundred and forty-six patients who underwent surgery for colorectal adenocarcinomas from January 2004 to December 2008 were included.

Results

Among the 546 patients, mucinous adenocarcinomas were 30 (5.5%) and non-mucinous adenocarcinomas were 516 (94.5%). Mean age was 55.0 years, which was younger than 63.2 years in non-mucinous colon cancers. They tend to develop in the right colon. Mucinous adenocarcinomas were more advanced in depth of invasion and distant metastasis, but no significant difference in lymph node (LN) metastasis. Peritoneal CEA, CA19-9, and positive cytology were more apparent. Liver and peritoneal metastasis did not show significant increases. Five year survival rates were 82.9% and 91.7% and cancer free survival rates were 42.7% and 68.5% each, respectively, for mucinous and non-mucinous cancers. According to stage, only stage III and IV patients showed differences in cancer free survival and overall survival (P=0.001, 0.040).

Conclusion

Mucinous adenocarcinomas showed worse prognoses and significant differences in recurrences, but had similar prognoses in early cancers. Although no significant differences were in LN metastasis, dissimilarities were in infiltration depth. Infiltrations led to the increase in free cancer cells and peritoneal fluid tumor markers: ultimately cancer recurrences developed.

Keywords: Colorectal cancer, Mucinous adenocarcinoma, Peritoneal cytology, Tumor marker

Figures and Tables

Fig. 1
Cancer free survival and overall survival curve of patients by histologic type in whole patients (A, D); patients with stage I, II (B, E); patients with stage III, IV (C, F).
jkss-79-474-g001
Table 1
Clinical characteristics of mucinous adenocarcinoma
jkss-79-474-i001
Table 2
Pathologic features of mucinous adenocarcinoma
jkss-79-474-i002
Table 3
Comparison of recurrence according to histologic type
jkss-79-474-i003
Table 4
Comparison of peritoneal fluid cytology and tumor markers according to histologic type
jkss-79-474-i004

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