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Annals of Oncology Advance Access originally published online on April 27, 2005
Annals of Oncology 2005 16(8):1305-1310; doi:10.1093/annonc/mdi244
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© 2005 European Society for Medical Oncology

Mucinous histology predicts for reduced fluorouracil responsiveness and survival in advanced colorectal cancer

F. V. Negri1, A. Wotherspoon2, D. Cunningham1,*, A. R. Norman3, G. Chong1 and P. J. Ross1

1 Department of Medicine, 2 Department of Histopathology, 3 Department of Computing and Information, Royal Marsden Hospital, London and Sutton, Surrey, UK

* Correspondence to: Prof. D. Cunningham, Department of Medicine, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, UK. Tel: +44-208-661-3156; Fax: +44-208-643-9414; Email: david.cunningham{at}icr.ac.uk

Background:: Mucinous carcinoma of the colon and rectum (mucinous CRC) is a histological subtype of colorectal adenocarcinoma for which there is little data on chemotherapy responsiveness. The purpose of this study was to investigate specifically the efficacy of fluorouracil-based first-line chemotherapy in patients with advanced mucinous CRC.

Patients and methods:: All patients with advanced mucinous CRC enrolled in three prospective randomized trials evaluating infused 5-fluorouracil as first-line treatment were compared with patients with non-mucinous subtypes enrolled in the same trials in a case–control study. Prognostic factors associated with overall response rate (ORR), progression-free survival (PFS) and overall survival (OS) were identified using univariate and multivariate logistic and/or Cox proportional hazards analyses.

Results:: The study included 135 patients (45 cases and 90 controls). The response rates for cases and controls were 22% [95% confidence interval (CI), 11% to 38%] and 47% (95% CI, 36.1% to 58.2%), respectively (P=0.0058). Median OS for the mucinous CRC patients was 11.8 months (95% CI, 8.87–14.8) compared with 17.9 months (95% CI, 13.38–22.39) in the control group (univariate analysis, P=0.056); after correcting for significant prognostic factors by multivariate Cox regression analysis, P=0.0372 and hazard ratio (HR)=1.497 (1.02–2.19).

Conclusion:: Patients with advanced mucinous CRC have a poorer response to fluorouracil-based first-line chemotherapy and reduced survival compared with patients with non-mucinous CRC.

Key words: colorectal cancer, 5-fluorouracil, mucinous


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