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Meta-Analysis
. 2024 Aug 13;24(1):263.
doi: 10.1186/s12876-024-03359-9.

Mucinous histology is a negative predictor of neoadjuvant chemoradiotherapy for locally advanced rectal adenocarcinoma

Xiangwen Tan  1 , Yiwei Zhang  2 , Xiaofeng Wu  2 , Qing Fang  2 , Yunhua Xu  2 , Shuxiang Li  3 , Jinyi Yuan  3 , Xiuda Peng  4 , Kai Fu  5 , Shuai Xiao  6   7
Affiliations
Meta-Analysis

Mucinous histology is a negative predictor of neoadjuvant chemoradiotherapy for locally advanced rectal adenocarcinoma

Xiangwen Tan et al. BMC Gastroenterol. .

Abstract

Background: Neoadjuvant chemoradiotherapy (NCRT) followed by total mesorectal excision (TME) is the standard treatment for locally advanced rectal cancer (LARC). Mucinous adenocarcinoma (MAC) is a potential poor prognosis subgroup of rectal cancer. However, the predictive value of MAC in NCRT treatment of LARC is controversial.

Methods: A comprehensive literature search of PubMed, Embase, and the Cochrane Library was performed. All studies examining the effect of MAC on CRT response in LARC were included. Outcomes of MAC were compared with non-specific adenocarcinoma (AC) by using random-effects methods. Data were presented as odds ratios (ORs) with 95% confidence intervals (CIs). The main outcomes were the rates of pathological complete response (pCR), tumor and nodal down-staging, positive resection margin rate, local recurrence, and overall mortality.

Results: Fifteen studies containing comparative data on outcomes in a total of 9,238 patients receiving NCRT for LARC were eligible for inclusion. MAC had a reduced rate of pCR (OR, 0.38; 95% CI, 0.18-0.78) and tumor down-staging (OR, 0.31; 95% CI, 0.22-0.44) following NCRT compared with AC. MAC did not significantly affect nodal down-staging (OR, 0.42; 95% CI, 0.16-1.12) after NCRT.

Conclusion: MAC of LARC was found to be a negative predictor of response to NCRT with lower rates of pCR and tumor down-staging for LARC. The nodal down-staging of MAC was relatively lower than that of AC, although the differences were not statistically significant.

Keywords: Meta-analysis; Mucinous adenocarcinoma; Neoadjuvant chemoradiotherapy; Rectal cancer.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The selection procedure for eligible studies was in accordance with the PRISMA guidelines
Fig. 2
Fig. 2
Meta-analysis of pathological complete response rate in mucinous and no mucinous rectal cancer patients following neoadjuvant chemoradiotherapy. Random-effects odds ratios (ORs) were calculated and plotted in the forest plot. The size of each marker varies according to the weight given to the specific study
Fig. 3
Fig. 3
Meta-analysis of tumor downstaging in mucinous and no mucinous rectal cancer patients following neoadjuvant chemoradiotherapy
Fig. 4
Fig. 4
Meta-analysis of nodal downstaging in mucinous and no mucinous rectal cancer patients following neoadjuvant chemoradiotherapy
See this image and copyright information in PMC

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