title: Adjuvant chemotherapy improves overall survival after TME surgery in mucinous carcinoma of the rectum.
abstract: BACKGROUND
  Mucinous tumours of the rectum are characterised by an abundance of extracellular mucin within the tumour complex. They are known to have a poor prognosis compared to non-mucinous adenocarcinomas. The effect of adjuvant chemotherapy on the survival outcomes of patients with mucinous cancer remains unclear. This study evaluated the 5-year overall survival of patients with mucinous rectal cancer following optimal TME surgery to determine whether adjuvant chemotherapy conferred a survival benefit.
  
  
  METHODS
  An analysis of a prospectively-maintained database was conducted of patients presenting with mucinous rectal cancer between 2000 and 2010. Patients with mucinous tumours were identified from final pathology reports of the surgical resection specimens. The primary outcome was 5-year overall survival; univariate and multivariate analysis was performed using Cox proportional hazards regression models.
  
  
  RESULTS
  A total of 191 patients were included for analysis with mean age of presentation 64.6 years (36-88 ± 11). On the fully adjusted multivariate model, EMVI status (HR 1.853, 95% CI 1.081-3.175) and not being given adjuvant chemotherapy (HR 2.888, 95% CI 1.801-4.633) were significant for disease recurrence. The 5-year overall survival for patients that had undergone adjuvant chemotherapy was 66.1% compared with 35.2% (Mantel Cox log-rank test - p < 0.0001).
  
  
  CONCLUSIONS
  This study demonstrates that adjuvant chemotherapy is an independent factor for improvement in overall survival in patients with mucinous adenocarcinoma. Therefore, patients who have undergone TME surgery for mucinous carcinoma of the rectum should be offered adjuvant chemotherapy even in the absence of other high-risk features for poor outcomes.
authors.affiliation: Royal Marsden Hospital, Fulham Road, London, United Kingdom; Croydon University Hospital, London Road, Croydon, United Kingdom; Imperial College, Department of Cancer and Surgery, London, United Kingdom. Electronic address: manish.chand@rmh.nhs.uk.
authors.forename: M
authors.initials: M
authors.lastname: Chand
authors.affiliation: Royal Marsden Hospital, Fulham Road, London, United Kingdom; Imperial College, Department of Cancer and Surgery, London, United Kingdom. Electronic address: shahnawaz.rasheed@rmh.nhs.uk.
authors.forename: S
authors.initials: S
authors.lastname: Rasheed
authors.affiliation: Royal Marsden Hospital, Fulham Road, London, United Kingdom; Imperial College, Department of Cancer and Surgery, London, United Kingdom. Electronic address: aneel.bhangu@rmh.nhs.uk.
authors.forename: A
authors.initials: A
authors.lastname: Bhangu
authors.affiliation: Royal Marsden Hospital, Fulham Road, London, United Kingdom; Imperial College, Department of Cancer and Surgery, London, United Kingdom. Electronic address: Gordon.stamp@rmh.nhs.uk.
authors.forename: G W H
authors.initials: GW
authors.lastname: Stamp
authors.affiliation: Croydon University Hospital, London Road, Croydon, United Kingdom. Electronic address: ian.swift@croydonhealth.nhs.uk.
authors.forename: R I
authors.initials: RI
authors.lastname: Swift
authors.affiliation: Royal Marsden Hospital, Fulham Road, London, United Kingdom; Imperial College, Department of Cancer and Surgery, London, United Kingdom. Electronic address: paris.tekkis@rmh.nhs.uk.
authors.forename: P P
authors.initials: PP
authors.lastname: Tekkis
authors.affiliation: Royal Marsden Hospital, Fulham Road, London, United Kingdom. Electronic address: gina.brown@rmh.nhs.uk.
authors.forename: G
authors.initials: G
authors.lastname: Brown
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Chemotherapy; Mucin; Mucinous; Rectal cancer; TME