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Mucinous subtype as prognostic factor in colorectal cancer: a systematic review and meta-analysis

Johanna Verhulst, Liesbeth Ferdinande UGent, Pieter Demetter and Wim Ceelen UGent (2012) JOURNAL OF CLINICAL PATHOLOGY. 65(5). p.381-388
abstract
Background : Mucinous adenocarcinoma (MAC) of the colorectum has been known and studied for many years. The prognostic significance of this histological subtype remains controversial. The authors reviewed the prognostic significance of mucinous differentiation in colorectal cancer. Materials and methods : A systematic web-based search was performed using Web of Knowledge and Medline. Articles published in English, German or French which used the WHO definition of MAC and described cohort studies, case-control studies or cross-sectional studies comparing survival in patients with MAC and adenocarcinoma (AC) not otherwise specified were included. Data on first author, year of publication, country, number of patients included, prevalence of MAC, % stage IV disease, % disease located in the proximal colon, mean age at presentation, % male patients and 5-year overall survival were extracted from individual studies. A fixed-effects meta-analysis model was used for analysis. The primary outcome was survival, expressed as the HR. Differences between categorical outcome parameters were quantified using the RR and corresponding 95% CI. Results : 44 studies and 222 256 patients were included. The RR for proximal disease versus distal disease was 1.55 (95% CI 1.53 to 1.58). Mucinous differentiation was less frequent in male subjects (RR 0.93 (95% CI 0.91 to 0.94)). Interestingly, the prevalence of stage IV disease was similar in MAC and AC (RR 0.99 (95% CI 0.96 to 1.02)). Thirty-five articles were included in the survival analysis. A worse survival in MAC versus AC was demonstrated (HR 1.05 (95% CI 1.02 to 1.08)). Conversely, three out of four studies reported a better survival in MAC with microsatellite instability (MSI). Due to heterogeneity a meta-analysis on the effect of MSI was not possible. Conclusion : MAC more often originates from the right colon and is less frequent in male subjects. The authors did not identify a difference in the proportion of stage IV patients at presentation. Mucinous differentiation results in a 2-8% increased hazard of death, which persists after correction for stage. More research is needed to define the interaction between mucinous differentiation, MSI and outcome.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (review)
publication status
published
subject
keyword
CURATIVE RESECTION, HISTOLOGY PREDICTS, GENETIC-CHARACTERISTICS, MULTIVARIATE-ANALYSIS, CLINICOPATHOLOGICAL FEATURES, SIGNET-RING CELL, MICROSATELLITE INSTABILITY, RECTAL-CARCINOMA, COLON-CANCER, ADENOCARCINOMA
journal title
JOURNAL OF CLINICAL PATHOLOGY
J. Clin. Pathol.
volume
65
issue
5
pages
381 - 388
Web of Science type
Review
Web of Science id
000303863000001
JCR category
PATHOLOGY
JCR impact factor
2.439 (2012)
JCR rank
26/77 (2012)
JCR quartile
2 (2012)
ISSN
0021-9746
DOI
10.1136/jclinpath-2011-200340
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
3086988
handle
http://hdl.handle.net/1854/LU-3086988
date created
2013-01-09 19:28:11
date last changed
2016-12-19 15:39:07
@article{3086988,
  abstract     = {Background : Mucinous adenocarcinoma (MAC) of the colorectum has been known and studied for many years. The prognostic significance of this histological subtype remains controversial. The authors reviewed the prognostic significance of mucinous differentiation in colorectal cancer. 
Materials and methods : A systematic web-based search was performed using Web of Knowledge and Medline. Articles published in English, German or French which used the WHO definition of MAC and described cohort studies, case-control studies or cross-sectional studies comparing survival in patients with MAC and adenocarcinoma (AC) not otherwise specified were included. Data on first author, year of publication, country, number of patients included, prevalence of MAC, \% stage IV disease, \% disease located in the proximal colon, mean age at presentation, \% male patients and 5-year overall survival were extracted from individual studies. A fixed-effects meta-analysis model was used for analysis. The primary outcome was survival, expressed as the HR. Differences between categorical outcome parameters were quantified using the RR and corresponding 95\% CI. 
Results : 44 studies and 222 256 patients were included. The RR for proximal disease versus distal disease was 1.55 (95\% CI 1.53 to 1.58). Mucinous differentiation was less frequent in male subjects (RR 0.93 (95\% CI 0.91 to 0.94)). Interestingly, the prevalence of stage IV disease was similar in MAC and AC (RR 0.99 (95\% CI 0.96 to 1.02)). Thirty-five articles were included in the survival analysis. A worse survival in MAC versus AC was demonstrated (HR 1.05 (95\% CI 1.02 to 1.08)). Conversely, three out of four studies reported a better survival in MAC with microsatellite instability (MSI). Due to heterogeneity a meta-analysis on the effect of MSI was not possible. 
Conclusion : MAC more often originates from the right colon and is less frequent in male subjects. The authors did not identify a difference in the proportion of stage IV patients at presentation. Mucinous differentiation results in a 2-8\% increased hazard of death, which persists after correction for stage. More research is needed to define the interaction between mucinous differentiation, MSI and outcome.},
  author       = {Verhulst, Johanna and Ferdinande, Liesbeth and Demetter, Pieter and Ceelen, Wim},
  issn         = {0021-9746},
  journal      = {JOURNAL OF CLINICAL PATHOLOGY},
  keyword      = {CURATIVE RESECTION,HISTOLOGY PREDICTS,GENETIC-CHARACTERISTICS,MULTIVARIATE-ANALYSIS,CLINICOPATHOLOGICAL FEATURES,SIGNET-RING CELL,MICROSATELLITE INSTABILITY,RECTAL-CARCINOMA,COLON-CANCER,ADENOCARCINOMA},
  language     = {eng},
  number       = {5},
  pages        = {381--388},
  title        = {Mucinous subtype as prognostic factor in colorectal cancer: a systematic review and meta-analysis},
  url          = {http://dx.doi.org/10.1136/jclinpath-2011-200340},
  volume       = {65},
  year         = {2012},
}

Chicago
Verhulst, Johanna, Liesbeth Ferdinande, Pieter Demetter, and Wim Ceelen. 2012. “Mucinous Subtype as Prognostic Factor in Colorectal Cancer: a Systematic Review and Meta-analysis.” Journal of Clinical Pathology 65 (5): 381–388.
APA
Verhulst, J., Ferdinande, L., Demetter, P., & Ceelen, W. (2012). Mucinous subtype as prognostic factor in colorectal cancer: a systematic review and meta-analysis. JOURNAL OF CLINICAL PATHOLOGY, 65(5), 381–388.
Vancouver
1.
Verhulst J, Ferdinande L, Demetter P, Ceelen W. Mucinous subtype as prognostic factor in colorectal cancer: a systematic review and meta-analysis. JOURNAL OF CLINICAL PATHOLOGY. 2012;65(5):381–8.
MLA
Verhulst, Johanna, Liesbeth Ferdinande, Pieter Demetter, et al. “Mucinous Subtype as Prognostic Factor in Colorectal Cancer: a Systematic Review and Meta-analysis.” JOURNAL OF CLINICAL PATHOLOGY 65.5 (2012): 381–388. Print.