Skip to main content

Advertisement

SpringerLink
Log in

Tumor location is a prognostic factor in poorly differentiated adenocarcinoma, mucinous adenocarcinoma, and signet-ring cell carcinoma of the colon

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Cancers which arise in the proximal and distal colon are suggested to be different clinically, pathologically, and genetically. The aim of this study is to clarify whether clinical behavior of colonic poorly differentiated adenocarcinoma, mucinous adenocarcinoma, and signet-cell carcinoma (Por/Muc/Sig cancers), minor and aggressive subpopulation in colonic cancers, differs in accordance with the tumor location.

Methods

A total of 3,175 patients with curatively resected colonic cancers were studied. Clinical and pathological features were compared between Por/Muc/Sig cancers and well or moderately differentiated adenocarcinomas (Wel/Mod cancers) and between proximal and distal cancers in each histologic type.

Results

Por/Muc/Sig cancers (n = 213) were more advanced in the TNM stage and showed worse disease-specific survival than Wel/Mod cancers (n = 2,692). In Por/Muc/Sig cancers, but not in Wel/Mod cancers, proximal cancers showed significantly better disease-specific survival than distal cancers (88.9% vs. 76.5%, p = 0.0234), and a multivariate analysis showed that proximal tumor location was an independent predictor of fair prognosis (hazard ratio (HR), 0.458; 95% confidence interval (CI), 0.218–0.961; p = 0.0390). In addition, female gender also was an independent predictor of fair prognosis in Por/Muc/Sig cancers (HR, 0.373; 95% CI, 0.151–0.922) and not in Wel/Mod cancers.

Conclusions

Proximal Por/Muc/Sig cancers were suggested to be a distinct subpopulation with a favorable oncologic outcome. Tumor location and gender might be helpful in the risk stratification after curative surgery for Por/Muc/Sig cancers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Gervaz P, Bucher P, Morel P (2004) Two colons-two cancers: paradigm shift and clinical implications. J Surg Oncol 88:261–266. doi:10.1002/jso.20156

    Article  PubMed  Google Scholar 

  2. Azzoni C, Bottarelli L, Campanini N, Di Cola G, Bader G, Mazzeo A, Salvemini C, Morari S, Di Mauro D, Donadei E, Roncoroni L, Bordi C, Sarli L (2007) Distinct molecular patterns based on proximal and distal sporadic colorectal cancer: arguments for different mechanisms in the tumorigenesis. Int J Colorectal Dis 22:115–126. doi:10.1007/s00384-006-0093-x

    Article  PubMed  Google Scholar 

  3. Bufill JA (1990) Colorectal cancer: evidence for distinct genetic categories based on proximal or distal tumor location. Ann Intern Med 113:779–788

    PubMed  CAS  Google Scholar 

  4. Nawa T, Kato J, Kawamoto H, Okada H, Yamamoto H, Kohno H, Endo H, Shiratori Y (2008) Differences between right- and left-sided colon cancer in patient characteristics, cancer morphology and histology. J Gastroenterol Hepatol 23:418–423. doi:10.1111/j.1440-1746.2007.04923.x

    Article  PubMed  Google Scholar 

  5. Ponz de Leon M, Sacchetti C, Sassatelli R, Zanghieri G, Roncucci L, Scalmati A (1990) Evidence for the existence of different types of large bowel tumor: suggestions from the clinical data of a population-based registry. J Surg Oncol 44:35–43

    Article  PubMed  CAS  Google Scholar 

  6. Lengauer C, Kinzler KW, Vogelstein B (1997) Genetic instability in colorectal cancers. Nature 386:623–627. doi:10.1038/386623a0

    Article  PubMed  CAS  Google Scholar 

  7. Haydon AM, Jass JR (2002) Emerging pathways in colorectal-cancer development. Lancet Oncol 3:83–88. doi:S1470204502006496[pii]

    Article  PubMed  CAS  Google Scholar 

  8. Kim H, Jen J, Vogelstein B, Hamilton SR (1994) Clinical and pathological characteristics of sporadic colorectal carcinomas with DNA replication errors in microsatellite sequences. Am J Pathol 145:148–156

    PubMed  CAS  Google Scholar 

  9. Jass JR, Do KA, Simms LA, Iino H, Wynter C, Pillay SP, Searle J, Radford-Smith G, Young J, Leggett B (1998) Morphology of sporadic colorectal cancer with DNA replication errors. Gut 42:673–679

    Article  PubMed  CAS  Google Scholar 

  10. Kakar S, Smyrk TC (2005) Signet ring cell carcinoma of the colorectum: correlations between microsatellite instability, clinicopathologic features and survival. Mod Pathol 18:244–249. doi:10.1038/modpathol.3800298

    Article  PubMed  CAS  Google Scholar 

  11. Bjerkeset T, Morild I, Mork S, Soreide O (1987) Tumor characteristics in colorectal cancer and their relationship to treatment and prognosis. Dis Colon Rectum 30:934–938

    Article  PubMed  CAS  Google Scholar 

  12. Mulcahy HE, Skelly MM, Husain A, O’Donoghue DP (1996) Long-term outcome following curative surgery for malignant large bowel obstruction. Br J Surg 83:46–50

    Article  PubMed  CAS  Google Scholar 

  13. Nissan A, Guillem JG, Paty PB, Wong WD, Cohen AM (1999) Signet-ring cell carcinoma of the colon and rectum: a matched control study. Dis Colon Rectum 42:1176–1180

    Article  PubMed  CAS  Google Scholar 

  14. Papadopoulos VN, Michalopoulos A, Netta S, Basdanis G, Paramythiotis D, Zatagias A, Berovalis P, Harlaftis N (2004) Prognostic significance of mucinous component in colorectal carcinoma. Tech Coloproctol 8(Suppl 1):s123–s125. doi:10.1007/s10151-004-0131-z

    Article  PubMed  Google Scholar 

  15. Ward R, Meagher A, Tomlinson I, O’Connor T, Norrie M, Wu R, Hawkins N (2001) Microsatellite instability and the clinicopathological features of sporadic colorectal cancer. Gut 48:821–829

    Article  PubMed  CAS  Google Scholar 

  16. Gafa R, Maestri I, Matteuzzi M, Santini A, Ferretti S, Cavazzini L, Lanza G (2000) Sporadic colorectal adenocarcinomas with high-frequency microsatellite instability. Cancer 89:2025–2037. doi:10.1002/1097-0142(20001115)89:10<2025::AID-CNCR1>3.0.CO;2-S[pii]

    Article  PubMed  CAS  Google Scholar 

  17. Winn B, Tavares R, Fanion J, Noble L, Gao J, Sabo E, Resnick MB (2009) Differentiating the undifferentiated: immunohistochemical profile of medullary carcinoma of the colon with an emphasis on intestinal differentiation. Hum Pathol 40:398–404. doi:10.1016/j.humpath.2008.08.014

    Article  PubMed  CAS  Google Scholar 

  18. Wick MR, Vitsky JL, Ritter JH, Swanson PE, Mills SE (2005) Sporadic medullary carcinoma of the colon: a clinicopathologic comparison with nonhereditary poorly differentiated enteric-type adenocarcinoma and neuroendocrine colorectal carcinoma. Am J Clin Pathol 123:56–65

    Article  PubMed  Google Scholar 

  19. Lanza G, Gafa R, Matteuzzi M, Santini A (1999) Medullary-type poorly differentiated adenocarcinoma of the large bowel: a distinct clinicopathologic entity characterized by microsatellite instability and improved survival. J Clin Oncol 17:2429–2438

    PubMed  CAS  Google Scholar 

  20. Leopoldo S, Lorena B, Cinzia A, Gabriella DC, Angela Luciana B, Renato C, Antonio M, Carlo S, Cristina P, Stefano C, Maurizio T, Luigi R, Cesare B (2008) Two subtypes of mucinous adenocarcinoma of the colorectum: clinicopathological and genetic features. Ann Surg Oncol 15:1429–1439. doi:10.1245/s10434-007-9757-1

    Article  PubMed  Google Scholar 

  21. Hamilton SR, Aaltonen LA (eds) (2000) Pathology and genetics of tumours of the digestive system. World Health Organization classification of tumours. IARC Press, Lyon

    Google Scholar 

  22. Kazama Y, Watanabe T, Kanazawa T, Tada T, Tanaka J, Nagawa H (2005) Mucinous carcinomas of the colon and rectum show higher rates of microsatellite instability and lower rates of chromosomal instability: a study matched for T classification and tumor location. Cancer 103:2023–2029. doi:10.1002/cncr.21022

    Article  PubMed  CAS  Google Scholar 

  23. Kanemitsu Y, Kato T, Hirai T, Yasui K, Morimoto T, Shimizu Y, Kodera Y, Yamamura Y (2003) Survival after curative resection for mucinous adenocarcinoma of the colorectum. Dis Colon Rectum 46:160–167. doi:10.1097/01.DCR.0000044721.76711.6D

    Article  PubMed  Google Scholar 

  24. Vasen HF, Moslein G, Alonso A, Bernstein I, Bertario L, Blanco I, Burn J, Capella G, Engel C, Frayling I, Friedl W, Hes FJ, Hodgson S, Mecklin JP, Moller P, Nagengast F, Parc Y, Renkonen-Sinisalo L, Sampson JR, Stormorken A, Wijnen J (2007) Guidelines for the clinical management of Lynch syndrome (hereditary non-polyposis cancer). J Med Genet 44:353–362. doi:jmg.2007.048991[pii]

    Article  PubMed  CAS  Google Scholar 

  25. Lynch HT, de la Chapelle A (1999) Genetic susceptibility to non-polyposis colorectal cancer. J Med Genet 36:801–818

    PubMed  CAS  Google Scholar 

  26. Graham DM, Appelman HD (1990) Crohn’s-like lymphoid reaction and colorectal carcinoma: a potential histologic prognosticator. Mod Pathol 3:332–335

    PubMed  CAS  Google Scholar 

  27. Soreide K, Nedrebo BS, Soreide JA, Slewa A, Korner H (2009) Lymph node harvest in colon cancer: influence of microsatellite instability and proximal tumor location. World J Surg. doi:10.1007/s00268-009-0255-4

  28. Watanabe T, Kobunai T, Toda E, Yamamoto Y, Kanazawa T, Kazama Y, Tanaka J, Tanaka T, Konishi T, Okayama Y, Sugimoto Y, Oka T, Sasaki S, Muto T, Nagawa H (2006) Distal colorectal cancers with microsatellite instability (MSI) display distinct gene expression profiles that are different from proximal MSI cancers. Cancer Res 66:9804–9808. doi:10.1158/0008-5472.CAN-06-1163

    Article  PubMed  CAS  Google Scholar 

  29. Kim YH, Min BH, Kim SJ, Choi HK, Kim KM, Chun HK, Lee H, Kim JY, Chang DK, Son HJ, Rhee PL, Rhee JC, Kim JJ (2010) Difference between proximal and distal microsatellite-unstable sporadic colorectal cancers: analysis of clinicopathological and molecular features and prognoses. Ann Surg Oncol. doi:10.1245/s10434-009-0888-4

  30. Koo JH, Leong RW (2009) Sex differences in epidemiological, clinical and pathological characteristics of colorectal cancer. J Gastroenterol Hepatol. doi:10.1111/j.1440-1746.2009.05992.x

  31. Hsu HH, Cheng SF, Wu CC, Chu CH, Weng YJ, Lin CS, Lee SD, Wu HC, Huang CY, Kuo WW (2006) Apoptotic effects of over-expressed estrogen receptor-beta on LoVo colon cancer cell is mediated by p53 signalings in a ligand-dependent manner. Chin J Physiol 49:110–116

    PubMed  CAS  Google Scholar 

Download references

Acknowledgment

This study is based on the data from 18 hospitals which are members of the Japanese Study Group for Postoperative Follow-up of Colorectal Cancer: First Department of Surgery, Sapporo Medical University; Department of Surgery, Hirosaki University; Division of Digestive and General Surgery, Niigata University; Department of Surgery, National Defense Medical College; Department of Surgery, Tochigi Cancer Center; Department of Surgery, Tokyo Metropolitan Komagome Hospital; Department of Surgery II, Tokyo Women’s Medical University; Department of Surgery, International Medical center of Japan; Department of Surgery, Keio University; Department of Surgery, Teikyo University; Department of Surgery, Fujita Health University; Department of Gastroenterological Surgery, Aichi Cancer Center Research Institute; Department of Surgery, Kyoto University; Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases; Department of Surgery, Kurume University; Department of Surgery, Hyogo College of Medicine; Department of Surgery, Kyorin University; and Department of Surgical Oncology, Tokyo Medical and Dental University.

Author information

Authors and Affiliations

  1. Department of Surgery, Teikyo University, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan

    Soichiro Ishihara, Toshiaki Watanabe, Takuya Akahane, Ryu Shimada, Atsushi Horiuchi, Hajime Shibuya, Tamuro Hayama, Hideki Yamada, Keijiro Nozawa & Keiji Matsuda

  2. Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake Aichi, Japan

    Koutarou Maeda

  3. Department of Surgical Oncology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan

    Kenichi Sugihara

Authors
  1. Soichiro Ishihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Toshiaki Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takuya Akahane
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ryu Shimada
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Atsushi Horiuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hajime Shibuya
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tamuro Hayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hideki Yamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Keijiro Nozawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Keiji Matsuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Koutarou Maeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Kenichi Sugihara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Soichiro Ishihara.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ishihara, S., Watanabe, T., Akahane, T. et al. Tumor location is a prognostic factor in poorly differentiated adenocarcinoma, mucinous adenocarcinoma, and signet-ring cell carcinoma of the colon. Int J Colorectal Dis 27, 371–379 (2012). https://doi.org/10.1007/s00384-011-1343-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-011-1343-0

Keywords

Search

Navigation