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Multicenter Study
. 2022 Mar 3;17(3):e0264652.
doi: 10.1371/journal.pone.0264652. eCollection 2022.

Impact of histological subtype on prognosis in stage IV colorectal cancer: A population-based cohort study

Teppei Miyakawa  1   2 , Hidetaka Kawamura  1   2 , Michitaka Honda  1   2 , Yoshinao Takano  2 , Shunji Kinuta  3 , Takahiro Kamiga  4 , Shigeru Yamazaki  5 , Atsushi Muto  6 , Satoru Shiraso  7 , Naoyuki Yamashita  8 , Toshiyasu Iwao  9 , Koji Kono  10 , Shinichi Konno  11
Affiliations
Multicenter Study

Impact of histological subtype on prognosis in stage IV colorectal cancer: A population-based cohort study

Teppei Miyakawa et al. PLoS One. .

Abstract

Background: There are a few established prognostic factors for stage IV colorectal cancer. Thus, this study aimed to evaluate the impact of histological subtypes on prognosis and metastatic patterns in patients with stage IV colorectal cancer.

Methods: This was a population-based, multicenter, cohort study. We included consecutive patients diagnosed with stage IV colorectal cancer between 2008 and 2015 at all designated cancer hospitals in Fukushima prefecture, Japan. Patients were classified into two groups according to histological subtypes as follows: poorly differentiated adenocarcinoma (Por), mucinous adenocarcinoma (Muc), or signet-ring cell carcinoma (Sig) and well (Wel) or moderately differentiated adenocarcinoma (Mod). We evaluated the relationship between these histological groups and survival time. After adjusting for other clinical factors, we calculated the hazard ratio for Por/Muc/Sig.

Results: A total of 1,151 patients were enrolled, and 1,031 and 120 had Wel/Mod and Por/Muc/Sig, respectively. The median overall survival was 19.2 and 11.9 months for Wel/Mod and Por/Muc/Sig, respectively (p < 0.001). The adjusted hazard ratio for Por/Muc/Sig with regard to survival time was 1.42 (95% confidence interval: 1.13-1.77). Por/Muc/Sig had a lower incidence of liver and lung metastases and a higher incidence of peritoneal dissemination and metastasis to rare organs, such as the bone and brain.

Conclusions: The Por/Muc/Sig histological subtype was an independent prognostic factor for poor prognosis among patients with stage IV colorectal cancer. The histological subtype may be useful for predicting the prognosis of patients with stage IV colorectal cancer and designing the treatment strategy.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Patient enrollment flow.
Fig 2
Fig 2. Overall survival according to histological subtype.
a) All patients b) Patients with metastasectomy c) Patients with doublet chemotherapy d) Patients with best supportive care.
See this image and copyright information in PMC

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