Poornima Sharma ,Aung Oakkar ,David Hanna ,Dorothy Boo ,Wendla Citron ,Randi Cohen ,Russell DeLuca ,Karl Kasamon ,Yudhishtra Markan ,Gayatri Nimmagadda ,Mitch OH ,Harvinder Singh ,Cherif Boutros *
Introduction: Colon adenocarcinoma, the most common gastrointestinal cancer, has three distinct histological types namely, non-mucinous, mucinous and signet cell type. To date, the clinical implication of mucinous histology is not completely elucidated. Most studies discussing the impact of mucinous pathology in colon cancer are retrospectives analyses from large tertiary centers and report non-concordant results. The aim of our study is to analyze the results of management of non appendicular mucinous and signet colorectal cancer in a community setting.
Methods: Under IRB approval, a prospectively maintained database of patients treated for colorectal cancer (1996-2013) at a university-affiliated community cancer center was accessed. Data was collected on excel documents and reported demographic data (age at initial diagnosis, sex), pathological data (site, stage, histological type of cancer) and management data (treatment modalities and survival). Two groups were created: Non mucinous, and mucinous - signet cell colorectal cancer. Differences between groups were analyzed using chi-square, fisher test and Kaplan Meier curves for survival analysis.
Results: 1595 patients were included. Of these, 91.7% were non-MSCA (non-mucinous signet cell adenocarcinoma), remaining 7.2% were MCA and 1.1% was SRCA (signet ring cell carcinoma). Mean age was 67 in the three groups and there was no difference in age distribution. Right colon cancer represented 38% of non-mucinous colorectal cancer (n=556), and 58% (n=77) of the mucinous signet cell type. 5 year survival was 92.8%, 89.9%, 72.3% and 19.8% for stage I-IV; respectively for non-mucinous cancer. 5 year survival for mucinous-signet cell was 67.1%, 79%, 55.4% and 0%; respectively for stage I-IV; p<0.05.
Conclusion: Mucinous and signet cell histology is a clinicopathological distinct type of colorectal cancer that carries a negative impact on patient survival. Despite multimodality management and advance in chemotherapy, stage IV mucinous-signet cell