Colorectal adenosquamous carcinoma: Clinicopathologic analysis of two large cohorts and literature review confirm poor prognosis and reveal prognostic aspects Journal Article
| Authors: | Gonzalez, R. S.; Horton, R. K.; Zhang, X.; Graham, R. P.; Longacre, T. A.; Mehrotra, A.; Allende, D. S.; McHugh, K. E.; Shia, J.; Westerhoff, M.; Srivastava, A.; Chen, W.; Vazzano, J.; Swanson, P. E.; Chatterjee, D.; Cheema, H.; Ma, C.; Mannan, R.; Chetty, R.; Nowak, K. M.; Serra, S.; Agostini-Vulaj, D.; Kazemimood, R.; Henn, P.; Kakar, S.; Choi, W. T.; Adeyi, O.; Jenkins, S. M.; Nagtegaal, I. D. |
| Article Title: | Colorectal adenosquamous carcinoma: Clinicopathologic analysis of two large cohorts and literature review confirm poor prognosis and reveal prognostic aspects |
| Abstract: | Aims: We compiled two cohorts of colorectal adenosquamous carcinoma (ASC) to describe its histologic and molecular aspects using modern parameters to compare them with literature reports using meta-analysis of cohorts and individual case series. Methods and Results: We identified 53 colorectal ASC from 19 North American academic medical centres, in addition to national database reports on 94 Dutch cases. We analysed available clinical, histologic, and immunohistochemical features and patient outcome. ASC comprised 0.02% of colorectal cancers in the Dutch database. The median cohort patient ages at resection were 65 and 69 years (North American and Dutch cohorts, respectively), with a roughly equal male:female ratio. The squamous component represented between 5% and 95% of each tumour, with a median of 50%. Tumour-infiltrating lymphocytes (TILs) were generally low (66%), and tumour budding was often Bd1 (64%). Most cases were pT3 (55%) or pT4 (40%), with nodal metastases in more than half (58%). Twenty-three cases (43%) metastasized distantly, most commonly to the liver. Mismatch repair (MMR) deficiency was identified in 34% of the cases. Follow-up was available for 48 patients; 13 (27%) had recurrent disease and 29 (60%) died. A total of 31 patients progressed, with median time to progression of 18 months. Available data for the Dutch cohort revealed largely similar findings, as did review of cases in the literature. Conclusion: Colorectal ASC usually presents at an advanced stage. Despite high rates of MMR deficiency and low tumour budding, TILs were generally low, and there is a high recurrence rate and poor prognosis. © 2025 John Wiley & Sons Ltd. |
| Keywords: | immunohistochemistry; adult; human tissue; protein expression; treatment outcome; aged; aged, 80 and over; middle aged; cancer surgery; gene mutation; major clinical study; overall survival; clinical feature; histopathology; mortality; cancer localization; cancer recurrence; cancer growth; gastrointestinal hemorrhage; cancer adjuvant therapy; neoadjuvant therapy; follow up; lymph node metastasis; polymerase chain reaction; tumor associated leukocyte; lymphocytes, tumor-infiltrating; progression free survival; cohort studies; anemia; tumor volume; tumor differentiation; cohort analysis; obesity; smoking; calcium; calcium blood level; hypercalcemia; pathology; risk factor; cancer mortality; distant metastasis; sex ratio; abdominal pain; colorectal carcinoma; colorectal neoplasms; netherlands; liver metastasis; lung metastasis; colonoscopy; colorectal adenoma; colorectal tumor; mismatch repair; microsatellite instability; carcinoma; protein p63; adenosquamous carcinoma; ovary metastasis; incidental finding; cytokeratin 5; cytokeratin 6; k ras protein; peritoneum metastasis; lynch syndrome; protein msh6; b raf kinase; colon; mesentery; mismatch repair protein pms2; perineural invasion; adenomatous polyp; adrenal metastasis; protein p40; colorectal adenocarcinoma; bladder metastasis; adenosquamous; cell budding; carcinoma, adenosquamous; abdominal metastasis; inflammatory bowel disease; villous adenoma; cancer prognosis; abdominal wall musculature; lymph vessel metastasis; very elderly; humans; prognosis; human; male; female; article; uterine metastasis; north american; mutl protein homolog 1; dna mismatch repair protein msh2; gastrointestinal dysplasia; tumor margin; colorectal squamous cell carcinoma; traditional serrated adenoma |
| Journal Title: | Histopathology |
| Volume: | 86 |
| Issue: | 7 |
| ISSN: | 0309-0167 |
| Publisher: | Wiley Blackwell |
| Date Published: | 2025-06-01 |
| Start Page: | 1064 |
| End Page: | 1081 |
| Language: | English |
| DOI: | 10.1111/his.15412 |
| PUBMED: | 39887413 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
