The use of histological subtype as a classiﬁcation system
for colorectal cancer was introduced by the World Health
Organization in 1979. Carcinomas are categorized as tra-
ditional adenocarcinomas, mucinous adenocarcinomas
(MA), signet- ring cell carcinomas (SC), and other, more
infrequent, types [1, 2]. MA is a histological subtype of
colon cancer in which the neoplastic cells secrete extensive
extracellular mucins that form more than 50% of the tumor
volume . SC tumors are comprised of more than 50%
signet- ring cells in which the nucleus is pushed to the
The differences on efﬁcacy of oxaliplatin in locally
advanced colon cancer between mucinous and nonmucinous
, Peng Gao
, Yongxi Song
, Yuchong Yang
, Xiaowan Chen
, Yu Sun
, Ailin Li
Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, 155 North Nanjing Street, Heping District,
Shenyang City 110001, China
Department of Radiation Oncology, The First Hospital of China Medical University, 155 North Nanjing Street, Heping District, Shenyang City
© 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use,
distribution and reproduction in any medium, provided the original work is properly cited.
Chemotherapy, colon neoplasms, mucinous
adenocarcinoma, SEER program
Zhenning Wang, Department of Surgical
Oncology and General Surgery, The First
Hospital of China Medical University,
Shenyang 110001, China.
Tel: +86 24 83283556;
Fax: +86 24 22703578;
This work was supported by National Science
Foundation of China (No. 81372549,
81402520) and Clinical Capability
Construction Project for Liaoning Provincial
Hospitals (LNCCC- A01- 2014).
Received: 7 September 2017; Revised: 14
December 2017; Accepted: 18 December
Cancer Medicine 2018; 7(3):600–615
Dehao Yu and Peng Gao contributed equally
to this work.
Until now, it remains unclear how to best use the histological subtype in clini-
cal practice. This study aimed to compare differences in the efﬁcacy of post-
operative chemotherapy among different histological subtypes of colon adeno-
carcinomas. Using the Surveillance, Epidemiology, and End Results- Medicare
database, 51,200 patients with stage II or III primary colon carcinomas who
underwent resection for curative intent between 1992 and 2008 were included.
The survival beneﬁt was evaluated using a Cox proportional hazards model,
interaction analyses, and propensity score- matched techniques. There was no
signiﬁcant difference in survival for low- risk stage II mucinous adenocarcinoma
(MA) or nonmucinous adenocarcinoma (NMA) between 5- FU and oxaliplatin-
treated groups (P = 0.387 for MA, P = 0.629 for NMA). Patients with high- risk
stage II NMA who received the oxaliplatin chemotherapy regimen had signiﬁ-
cantly improved cancer- speciﬁc survival (CSS) compared with the 5- FU group
(P = 0.004), while those with MA saw no improvement (P = 0.690). For stage
III tumors, patients with NMA who received the oxaliplatin chemotherapy regi-
men had signiﬁcantly improved CSS compared with the 5- FU group (P < 0.001),
while those with MA saw no improvement (P = 0.300). There were signiﬁcant
interactions between chemotherapy regimen and histological subtype. For patients
with resected colon cancer who received 5- FU- based postoperative chemotherapy,
oxaliplatin chemotherapy prolongs CSS for stage III and high- risk stage II NMA.
Conversely, there was no similar improvement with addition of oxaliplatin for
patients with stage III or stage II MA.