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Annals of Oncology Advance Access published online on April 27, 2005
Annals of Oncology, doi:10.1093/annonc/mdi244
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© 2005 European Society for Medical Oncology
Received December 24, 2004
Revised March 10, 2005
Accepted March 11, 2005

Original article

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

F. V. Negri 1, A. Wotherspoon 2, D. Cunningham 1*, A. R. Norman 3, G. Chong 1, and P. J. Ross 1

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

* To whom correspondence should be addressed.
D. Cunningham, E-mail: david.cunningham{at}icr.ac.uk


  Abstract

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.

Keywords: colorectal cancer; 5-fluorouracil; mucinous.
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