Mucinous Content-A Vital Predictor For Postoperative Survival Time In Patients With Stage Ⅰ To Ⅲ Colorectal Cancer

Objective:Colorectal cancer has serious impacts on human health due to its high morbidity,high mortality,and high heterogeneity.Predicting colorectal cancer patients’prognoses accurately could conduce patients’management and improve their overall life qualities and prognoses.This study aims to elucidate the value of mucinous content as a predictor for stage Ⅰ to Ⅲ colorectal cancer patients’postoperative survival times,so as to provide a reference for colorectal cancer patients’diagnosis and treatment.Methods:This study retrospectively collected the clinicopathological data of 3,852 patients with stage Ⅰ to Ⅲ colorectal cancer who underwent curative surgery in the Affiliated Hospital of Qingdao University from September 2001 to October 2020,and divided patients into adenocarcinoma group,adenocarcinoma with mucus composition group,and mucinous adenocarcinoma group according to cancers’mucinous content in the tumor slices（from low to high,1%and 50%were the cut-off）.Patients’survival times were elucidated by the Kaplan-Meier survival curve and differences among curves were evaluated by the log-rank test.The Cox proportional hazard regression model was used to further explore the predictive value of mucinous content,perineural invasion,lymphovascular invasion,tumor node metastasis stage,and the other indicators of stage Ⅰ to Ⅲ colorectal cancer patients overall and disease-free survival times.Akaike information criterion values were obtained to compare indictors’predictive value,andχ² test/Fisher’s exact test was selected to compare patients baseline characteristics.Converted patients’postoperative survival times into classified outcomes（3-and 5-years were the cut-off）to further show the prognostic value of mucinous content and used variable screening algorithms to find the adverse prognostic risk factors of patients.Results:There were 3,852 patients with stage Ⅰ to Ⅲ colorectal cancer in this study,the male to female ratio was 1.76:1,and patients average age was 61.4 years old.The mucinous content positive rate was 15.7%.The proportions of different mucinous content group were adenocarcinoma group 84.3%,adenocarcinoma with mucus content group 7.3%,and mucinous adenocarcinoma8.5%,the average overall survival time of each group was 156.003,75.069,and 61.672 months,and the average disease-free survival time of each group was 148.452,81.117,and 95.779months,respectively.Mucinous content（adjusted HR adenocarcinoma with mucus content=1.351,P adenocarcinoma with mucus content（27）0.001;adjusted HR mucinous adenocarcinoma=4.142,P mucinous adenocarcinoma=0.013;P total（27）0.001）,age（adjusted HR=1.321,P（27）0.001）,serum carcinoembryonic antigen level（adjusted HR=1.319,P（27）0.001）,tumor differentiation grade（adjusted HR=2.508,P（27）0.001）,perineural invasion（adjusted HR=1.441,P（27）0.001）,lymphovascular invasion（adjusted HR=1.595,P（27）0.001）invasion and TNM stage(adjusted HR _{Stage Ⅲ}=2.431,P _{Stage Ⅲ}（27）0.001;P _total（27）0.001)can independently predict patients’overall survival time,and mucinous content ranked 2^th in the comparation of indicators predictive performance.As for patients’disease-free survival time,mucinous content(adjusted HR _{mucinous adenocarcinoma}=1.968,P _{mucinous adenocarcinoma}=0.001;P _total（27）0.001),serum carcinoembryonic antigen level（adjusted HR=1.358,P（27）0.001）,lymphovascular invasion（adjusted HR=1.450,P（27）0.001）and TNM stage(adjusted HR _{Stage Ⅱ}=1.675,P _{Stage Ⅱ}（27）0.001;adjusted HR _{Stage Ⅲ}=3.312,P _{Stage Ⅲ}（27）0.001;P _total（27）0.001)are independent predictors,moreover,the predictive performance of mucinous content ranked 5^th.Conclusion:1.Mucinous content is an independently prognostic predictor for patients with stage Ⅰ to Ⅲ colorectal cancer.2.Mucinous content could be taken as one of the reliable references for the hierarchical management of stage Ⅰ to Ⅲ colorectal cancer patients.