title: Prognosis of mucinous and signet-ring cell colorectal cancer in a population-based cohort.
abstract: OBJECTIVE
  Besides classical colorectal adenocarcinomas (AC), mucinous adenocarcinomas (MAC) and signet-ring cell carcinomas (SC) occur. Controversy remains regarding their prognostic role. Aim of this study was to define prognostic and histopathological specifications of mucinous and signet-ring cell colorectal cancer.
  
  
  METHODS
  A total of 28,056 patients with AC, MAC, and SC between 1998 and 2012 in the catchment area of the Munich Cancer Registry were analyzed. Time to locoregional recurrence and distant recurrence was calculated by cumulative incidence. Survival was analyzed by the Kaplan-Meier method, calculation of relative survival, and Cox proportional hazards regression.
  
  
  RESULTS
  AC occurred in 25,172 patients (90 %), MAC in 2724 (9.7 %), and SC in 160 (0.6 %). AC were less frequently localized in the proximal colon (34 %) compared to MAC (57 %, p < 0.001) and SC (76 %, p < 0.001). Both, MAC and SC had higher T, N, and M categories, lymphatic invasion, and worse grading (p < 0.001 for each). There were significant differences regarding the 10-year cumulative incidence of locoregional recurrence (p < 0.001), and distant recurrence (p < 0.001). For AC, the 5-year overall survival was 59 % (95 % confidence interval 58.0; 59.3), for MAC 52 % (50.2; 54.2), and for SC 40 % (32.1; 48.5; p < 0.001). However, MAC or SC did not remain independent prognostic factors for overall survival compared to AC upon multivariable analysis (p = 0.981).
  
  
  CONCLUSIONS
  This large cohort reveals specific histopathological and recurrence patterns for patients with colorectal AC, MAC, and SC. MAC and SC are diagnosed at more advanced tumor stages and therefore entail reduced survival rates.
authors: Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, Munich, Germany. ulrich.nitsche@tum.de.
authors: Ulrich
authors: http://orcid.org/0000-0002-8501-5652
authors: U
authors: Nitsche
authors: Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, Munich, Germany.
authors: Helmut
authors: H
authors: Friess
authors: Klinik für Allgemein-, Viszeral-, Gefäß- und Thoraxchirurgie, Klinikum München-Bogenhausen, Englschalkinger Str. 77, 81925, Munich, Germany.
authors: Ayman
authors: A
authors: Agha
authors: Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany.
authors: Martin
authors: M
authors: Angele
authors: Tumorregister München (TRM) des Tumorzentrums München (TZM), Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Klinikum der Universität München (KUM), Marchioninistr. 15, 81377, Munich, Germany.
authors: Renate
authors: R
authors: Eckel
authors: Klinik für Allgemein-, Viszeral- und Minimalinvasive Chirurgie, Isarklinikum, Sonnenstraße 24-26, 80331, Munich, Germany.
authors: Wolf
authors: W
authors: Heitland
authors: Klinikum der Universität München, Ärztliche Direktion, Marchioninistr. 15, 81377, Munich, Germany.
authors: Karl-Walter
authors: KW
authors: Jauch
authors: Abteilung für Allgemein-, Gefäß-, Schilddrüsen- und Thoraxchirurgie, Klinikum Dritter Orden, Menzinger Str. 44, 80638, Munich, Germany.
authors: Detlef
authors: D
authors: Krenz
authors: Klinik für Allgemein- und Viszeralchirurgie, Klinikum München-Neuperlach, Oskar-Maria-Graf-Ring 51, 81737, Munich, Germany.
authors: Natascha C
authors: NC
authors: Nüssler
authors: Abteilung für Viszeral-, Thorax- und Gefäßchirurgie, Klinikum Dachau, Krankenhausstr. 15, 85221, Dachau, Germany.
authors: Horst-Günter
authors: HG
authors: Rau
authors: Klinik für Allgemein- und Viszeralchirurgie, Klinikum München-Neuperlach, Oskar-Maria-Graf-Ring 51, 81737, Munich, Germany.
authors: Reinhard
authors: R
authors: Ruppert
authors: Tumorregister München (TRM) des Tumorzentrums München (TZM), Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Klinikum der Universität München (KUM), Marchioninistr. 15, 81377, Munich, Germany.
authors: Gabriele
authors: G
authors: Schubert-Fritschle
authors: Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, Munich, Germany.
authors: Dirk
authors: D
authors: Wilhelm
authors: Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany.
authors: Jens
authors: J
authors: Werner
authors: Tumorregister München (TRM) des Tumorzentrums München (TZM), Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Klinikum der Universität München (KUM), Marchioninistr. 15, 81377, Munich, Germany.
authors: Jutta
authors: J
authors: Engel
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D000368:Aged; D018279:Carcinoma, Signet Ring Cell / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries
keywords: Colorectal neoplasms; Mucinous adenocarcinoma; Prognosis; Signet-ring cell carcinoma