Comparison of Clinicopathological Features and Prognosis of Mucinous Gastric Carcinoma and other Gastric Cancers: A Retrospective Study of 4,417 Patients.
Gastric cancer
Mucinous gastric carcinoma
Nomogram
Prognosis
Journal
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
ISSN: 1873-4626
Titre abrégé: J Gastrointest Surg
Pays: Netherlands
ID NLM: 9706084
Informations de publication
Date de publication:
11 2023
11 2023
Historique:
received:
28
06
2023
accepted:
29
09
2023
medline:
27
11
2023
pubmed:
18
10
2023
entrez:
17
10
2023
Statut:
ppublish
Résumé
Mucinous gastric carcinoma (MGC) is a distinct histologic subtype of gastric cancer (GC) that is often diagnosed at an advanced stage. The clinicopathological characteristics and prognosis of MGC, when compared to adenocarcinoma and signet-ring cell carcinoma (SRCC), are currently subjects of debate and require further investigation. In this study, we conducted an investigation on 4,417 patients who were hospitalized with GC at Zhejiang Cancer Hospital between April 2008 and December 2019. The objective was to compare the prognosis and clinicopathological characteristics of MGC with other types of GC. In comparison to adenocarcinoma, MGC patients exhibited more advanced tumor infiltration (p < 0.001), lower tumor differentiation (p < 0.001), and higher rates of preoperative tumor marker positivity (except for AFP and CA125) (all p < 0.05). However, after propensity score matching (PSM) to eliminate confounding factors, MGC patients surprisingly exhibited a better prognosis than adenocarcinoma patients (p = 0.008), and the results in multifactorial COX regression were similar (HR = 0.792, 95% CI 0.629-0.997, p = 0.047). Among patients with MGC, age, pN stage, as well as preoperative levels of CA125 and CA724 (all p < 0.05), emerged as independent prognostic markers. While overall survival did not significantly differ between MGC and SRCC (p = 0.196), significant survival disparities emerged in advanced-stage patients (p = 0.009), with MGC showing better survival rates. Furthermore, a nomogram was developed to predict 1-, 3-, and 5-year survival in gastric cancer patients based on various factors, achieving a C-index of 0.772 (95% CI: 0.745-0.799). While the poorer prognosis associated with MGC may be linked to its advanced stage and lower degree of differentiation, its biological behavior could contribute to improved survival.
Sections du résumé
BACKGROUND
Mucinous gastric carcinoma (MGC) is a distinct histologic subtype of gastric cancer (GC) that is often diagnosed at an advanced stage. The clinicopathological characteristics and prognosis of MGC, when compared to adenocarcinoma and signet-ring cell carcinoma (SRCC), are currently subjects of debate and require further investigation.
METHODS
In this study, we conducted an investigation on 4,417 patients who were hospitalized with GC at Zhejiang Cancer Hospital between April 2008 and December 2019. The objective was to compare the prognosis and clinicopathological characteristics of MGC with other types of GC.
RESULTS
In comparison to adenocarcinoma, MGC patients exhibited more advanced tumor infiltration (p < 0.001), lower tumor differentiation (p < 0.001), and higher rates of preoperative tumor marker positivity (except for AFP and CA125) (all p < 0.05). However, after propensity score matching (PSM) to eliminate confounding factors, MGC patients surprisingly exhibited a better prognosis than adenocarcinoma patients (p = 0.008), and the results in multifactorial COX regression were similar (HR = 0.792, 95% CI 0.629-0.997, p = 0.047). Among patients with MGC, age, pN stage, as well as preoperative levels of CA125 and CA724 (all p < 0.05), emerged as independent prognostic markers. While overall survival did not significantly differ between MGC and SRCC (p = 0.196), significant survival disparities emerged in advanced-stage patients (p = 0.009), with MGC showing better survival rates. Furthermore, a nomogram was developed to predict 1-, 3-, and 5-year survival in gastric cancer patients based on various factors, achieving a C-index of 0.772 (95% CI: 0.745-0.799).
CONCLUSIONS
While the poorer prognosis associated with MGC may be linked to its advanced stage and lower degree of differentiation, its biological behavior could contribute to improved survival.
Identifiants
pubmed: 37848685
doi: 10.1007/s11605-023-05853-z
pii: S1091-255X(24)00081-7
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2352-2364Subventions
Organisme : National Natural Science Foundation of China
ID : 82074245
Organisme : National Natural Science Foundation of China
ID : 81973634
Organisme : National Natural Science Foundation of China
ID : 82204828
Organisme : National Natural Science Foundation of China
ID : 81502603
Organisme : National Key R&D Program of China
ID : 2021YFA0910100
Organisme : Chinese Postdoctoral Science Foundation
ID : 2022M713203
Organisme : Collaborative Innovation Center for Modern Science and Technology and Industrial Development of Jiangxi Traditional Medicine
ID : ZYYCXTD-C-202208
Organisme : Medical Science and Technology Project of Zhejiang Province
ID : 2022KY114
Organisme : Medical Science and Technology Project of Zhejiang Province
ID : WKJ-ZJ-2104
Organisme : Zhejiang Provincial Research Center for Upper Gastrointestinal Tract Cancer
ID : JBZX-202006
Organisme : Science Natural Science Foundation of Zhejiang Province
ID : HDMY22H160008
Organisme : Natural Science Foundation of Zhejiang Province
ID : TGY23H160038
Organisme : Medicine and Health Science Fund of Zhejiang Province
ID : 2023KY073
Informations de copyright
© 2023. The Society for Surgery of the Alimentary Tract.
Références
Sung H, Ferlay J, Siegel RL, et al.: Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 71: 209-249, 2021.
doi: 10.3322/caac.21660
pubmed: 33538338
Hong S, Won YJ, Park YR, et al.: Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2017. Cancer Res Treat 52: 335-350, 2020.
doi: 10.4143/crt.2020.206
pubmed: 32178489
pmcid: 7176962
Nagtegaal ID, Odze RD, Klimstra D, et al.: The 2019 WHO classification of tumours of the digestive system. Histopathology 76: 182-188, 2020.
doi: 10.1111/his.13975
pubmed: 31433515
Lee JE, Choi YY, An JY, Kim KT, Shin SJ and Cheong JH: Clinicopathologic and genomic characteristics of mucinous gastric adenocarcinoma. Gastric Cancer 25: 697-711, 2022.
doi: 10.1007/s10120-022-01295-9
pubmed: 35534656
Xie GD, Liu YR, Jiang YZ and Shao ZM: Epidemiology and survival outcomes of mucinous adenocarcinomas: A SEER population-based study. Sci Rep 8: 6117, 2018.
doi: 10.1038/s41598-018-24540-7
pubmed: 29666453
pmcid: 5904162
Shimada M, Kigawa J, Ohishi Y, et al.: Clinicopathological characteristics of mucinous adenocarcinoma of the ovary. Gynecol Oncol 113: 331-334, 2009.
doi: 10.1016/j.ygyno.2009.02.010
pubmed: 19275957
Guo R, Chen B and Erickson LA: Mucinous Carcinoma of the Breast. Mayo Clin Proc 95: 2049-2050, 2020.
doi: 10.1016/j.mayocp.2020.07.008
pubmed: 32861349
Kim M, Hwang J, Kim KA, et al.: Genomic characteristics of invasive mucinous adenocarcinoma of the lung with multiple pulmonary sites of involvement. Mod Pathol 35: 202-209, 2022.
doi: 10.1038/s41379-021-00872-0
pubmed: 34290355
Tseng CH, Fang WL, Huang KH, et al.: The clinicopathological characteristics and genetic alterations of mucinous carcinoma of the stomach. J Chin Med Assoc 83: 141-147, 2020.
doi: 10.1097/JCMA.0000000000000232
pubmed: 32015267
Zhang M, Zhu GY, Zhang HF, Gao HY, Han XF and Xue YW: Clinicopathologic characteristics and prognosis of mucinous gastric carcinoma. J Surg Oncol 102: 64-67, 2010.
doi: 10.1002/jso.21533
pubmed: 20578080
Choi MG, Sung CO, Noh JH, et al.: Mucinous gastric cancer presents with more advanced tumor stage and weaker beta-catenin expression than nonmucinous cancer. Ann Surg Oncol 17: 3053-3058, 2010.
doi: 10.1245/s10434-010-1184-z
pubmed: 20645013
Pozos-Ochoa LI, Lino-Silva LS, Leon-Takahashi AM and Salcedo-Hernandez RA: Prognosis of Signet Ring Cell Carcinoma of the Colon and Rectum and their Distinction of Mucinous Adenocarcinoma with Signet Ring Cells. A Comparative Study. Pathol Oncol Res 24: 609-616, 2018.
doi: 10.1007/s12253-017-0283-6
pubmed: 28785968
Tang CT, Chen Y and Zeng C: Prognostic analysis of gastric signet ring cell carcinoma and mucinous carcinoma: a propensity score-matched study and competing risk analysis. Aging (Albany NY) 12: 22059-22077, 2020.
doi: 10.18632/aging.104048
pubmed: 33130635
Sarriugarte Lasarte A, Garcia Alberdi E, Martinez Indart L, et al.: From Lauren's diffuse gastric cancer to WHO's poorly cohesive carcinoma. Clinicopathological and prognostic characteristics. Rev Esp Enferm Dig 113: 324-331, 2021.
Zhao X, Li Y, Yang Z, et al.: Adenocarcinoma with Mixed Subtypes in the Early and Advanced Gastric Cancer. Can J Gastroenterol Hepatol 2021: 8497305, 2021.
doi: 10.1155/2021/8497305
pubmed: 34746042
pmcid: 8570884
Bozkaya Y, Erdem GU, Ozdemir NY, et al.: Comparison of clinicopathological and prognostic characteristics in patients with mucinous carcinoma and signet ring cell carcinoma of the stomach. Curr Med Res Opin 33: 109-116, 2017.
doi: 10.1080/03007995.2016.1239192
pubmed: 27646639
Tang X, Zhang J, Che X, Lan Z, Chen Y and Wang C: The Clinicopathological Features and Long-Term Survival Outcomes of Mucinous Gastric Carcinoma: a Consecutive Series of 244 Cases from a Single Institute. J Gastrointest Surg 20: 693-699, 2016.
doi: 10.1007/s11605-015-3064-0
pubmed: 26733419
Lim SW, Kim DY, Kim YJ and Kim SK: Clinicopathologic features of mucinous gastric carcinoma. Dig Surg 19: 286-290, 2002.
doi: 10.1159/000064583
pubmed: 12207072
Takatsu Y, Hiki N, Nunobe S, et al.: Clinicopathological features of gastric cancer in young patients. Gastric Cancer 19: 472-478, 2016.
doi: 10.1007/s10120-015-0484-1
pubmed: 25752270
Kunisaki C, Akiyama H, Nomura M, et al.: Clinicopathologic characteristics and surgical outcomes of mucinous gastric carcinoma. Ann Surg Oncol 13: 836-842, 2006.
doi: 10.1245/ASO.2006.03.077
pubmed: 16604474
Choi JS, Kim MA, Lee HE, Lee HS and Kim WH: Mucinous gastric carcinomas: clinicopathologic and molecular analyses. Cancer 115: 3581-3590, 2009.
doi: 10.1002/cncr.24422
pubmed: 19479974
Zhao J, Ren G, Cai R, et al.: Mucinous adenocarcinoma and non-mucinous adenocarcinoma: differing clinicopathological characteristics and computed tomography features in gastric cancer. Oncotarget 8: 45698-45709, 2017.
doi: 10.18632/oncotarget.17389
pubmed: 28501848
pmcid: 5542219
Adachi Y, Yasuda K and Kitano S: Mucinous gastric carcinoma: is it more malignant? Gastric Cancer 4: 223-224, 2001.
doi: 10.1007/PL00011742
pubmed: 11846067
Kawamura H, Kondo Y, Osawa S, et al.: A clinicopathologic study of mucinous adenocarcinoma of the stomach. Gastric Cancer 4: 83-86, 2001.
doi: 10.1007/PL00011728
pubmed: 11706765
Niu W, Du X, Guo L, et al.: Adaptive immunity profiling associated with histological subtypes and postoperative survival in gastric cancer. J Gastrointest Oncol 12: 328-343, 2021.
doi: 10.21037/jgo-21-79
pubmed: 34012629
pmcid: 8107599
Ackermann CJ, Guller U, Jochum W, Schmied BM and Warschkow R: The prognostic value of signet ring cell histology in stage I/II colon cancer-a population-based, propensity score-matched analysis. Int J Colorectal Dis 33: 1183-1193, 2018.
doi: 10.1007/s00384-018-3096-5
pubmed: 29881972
Gronnier C, Messager M, Robb WB, et al.: Is the negative prognostic impact of signet ring cell histology maintained in early gastric adenocarcinoma? Surgery 154: 1093-1099, 2013.
doi: 10.1016/j.surg.2013.05.020
pubmed: 24075273