Mucinous rectal cancers : clinical features and prognosis in a population-based cohort

Purpose Mucinous rectal cancers are generally associated with poor prognosis. This study aimed to clinically characterize mucinous rectal cancers in a defined region of Sweden. Methods All patients with rectal cancer in Uppsala and Dalarna, Sweden, between 2010 and 2018, were identified using the Swedish Colorectal Cancer Registry. Data were verified and updated by way of medical, radiology, and histopathology reports. Patients were selected if magnetic resonance imaging, biopsy, and/or surgical specimen were mucinous. Primary outcomes were overall survival (OS), time to recurrence (TTR), pattern of metastatization, and downstaging. Risk factors for recurrence were analysed with univariable and multivariable analyses. Results Of 1220 patients with rectal cancer, 263 (22 per cent) had a mucinous specimen, median (interquartile range; i.q.r.) age was 71 (63-77) years, and 152 (58 per cent) were men. Most were localized in the low-middle rectum (76 per cent) and were stage III (53 per cent), or stage IV (28 per cent). The 5-year OS was 55 per cent (95 per cent c.i. 49 to 62); after total mesorectal excision (n = 164), 5-year OS was 75 per cent (95 per cent c.i. 68 to 83), and 5-year TTR was 68 per cent (95 per cent c.i. 60 to 77). In those with complete response (pCR), pStage I, pStage II, and pStage III, 5-year TTR was 93 per cent, 85 per cent, 74 per cent, and 44 per cent respectively. Synchronous metastasis was most common in the liver (64 per cent) and metachronous in the lungs (58 per cent). pCR was achieved in 14 patients, (13 per cent); whereas T and N category downstaging was achieved in 31 (28 per cent) and 67 patients (61 per cent) respectively. Perineural invasion had the strongest association with recurrence (hazard ratio 6.34, 95 per cent c.i. 2.50 to 16.10). Conclusion Mucinous rectal cancers have high recurrence rates, but pCR rate is more than 10 per cent. Perineural invasion is the main feature associated with recurrence. Mucinous rectal has been associated with a more aggressive disease course and this study aimed to clinically characterize all mucinous rectal cancers in a defined region of Sweden. Primary outcomes were overall survival, time to recurrence, pattern of metastatization, and downstaging; mucinous rectal cancer was found to have higher recurrence rates than rectal cancer in general, but complete responses were uncommon. Perineural invasion was associated with recurrence, which most commonly occurs in the lungs, whereas synchronous metastases are most common in the liver