title: Clinical significance of cellular and acellular mucin pools in rectal carcinoma following preoperative chemoradiotherapy.
abstract: OBJECTIVE
  The standard treatment for locally advanced rectal cancer (LARC) is neoadjuvant chemoradiotherapy (CRT) followed by surgery. Pathological findings remain the most significant prognostic factor. The presence of mucin pools and their prognostic significance is a controversial issue. The aim of this study was to analyze the incidence of cellular and acellular mucin pools and their clinical significance.
  
  
  METHODS
  Four-hundred and forty-six consecutive prospectively collected specimens from patients with LARC treated with long-course preoperative CRT and surgery were analyzed. Kaplan-Meier analysis was performed.
  
  
  RESULTS
  Mucin pools were present in 182 specimens (40.8 %); 66 (14.7 %) were acellular, and viable tumor cells were identified in 116 (26 %). The complete pathological response rate was 13.5 % (60 of 446). With a median follow-up of 79.0 months, the 5- and 10-year disease-free survivals for patients with acellular and cellular mucin pools were 81.5, 78.1, 63.7 and 61.2 %, respectively (p ≤ 0.026). The presence of cells in the colloid response to treatment was associated with a 17.8 and 16.9 % decrease in 5- and 10-year disease survival vs. acellular colloid response.
  
  
  CONCLUSIONS
  Our results suggest that cellular mucin pools are an indicator of an aggressive phenotype and harbingers of a worse prognosis.
authors.affiliation: Department of General Surgery, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Av. Pío XII, 36, 31008, Pamplona, Spain. fjacien@unav.es.
authors.forename: J A
authors.initials: JA
authors.lastname: Cienfuegos
authors.affiliation: Department of General Surgery, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Av. Pío XII, 36, 31008, Pamplona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Baixauli
authors.affiliation: Department of General Surgery, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Av. Pío XII, 36, 31008, Pamplona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Rotellar
authors.affiliation: Department of General Surgery, Complejo Hospitalario de León, León, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Arredondo
authors.affiliation: Department of Pathology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
authors.forename: J J
authors.initials: JJ
authors.lastname: Sola
authors.affiliation: Department of Radiation Oncology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Arbea
authors.affiliation: Department of General Surgery, Fundación Jiménez Díaz, The Autonomous University of Madrid, Madrid, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Pastor
authors.affiliation: Department of General Surgery, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Av. Pío XII, 36, 31008, Pamplona, Spain.
authors.forename: J L
authors.initials: JL
authors.lastname: Hernández-Lizoáin
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis*; D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009077:Mucins / Q000032:analysis / Q000096:biosynthesis*; D020360:Neoadjuvant Therapy; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology*
chemical_list: D014408:Biomarkers, Tumor; D009077:Mucins
keywords: Cellular mucin; Neoadjuvant chemoradiation; Outcome; Pathological response; Rectal cancer