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Poster Display session 2

2992 - Clinical impact of mucinous and poorly differentiated tumors on the outcome of patients with stage II colon cancer: a TOSCA subgroup analysis


29 Sep 2019


Poster Display session 2


Tumour Site

Colon and Rectal Cancer


Gerardo Rosati


Annals of Oncology (2019) 30 (suppl_5): v198-v252. 10.1093/annonc/mdz246


G. Rosati1, F. Galli2, M. Cantore3, S. Lonardi4, M. Banzi5, M.G. Zampino6, R. Mattioli7, N. Pella8, M. Ronzoni9, M. Di Bartolomeo10, S. Tamberi11, P. Marchetti12, S. Bozzarelli13, D.C. Corsi14, A.M. Bochicchio15, F. Artioli16, R. Labianca17, F. Galli18, D. Bilancia19, G. Bregni20

Author affiliations

  • 1 Medical Oncology, Azienda Ospedaliera Regionale S. Carlo di Potenza, 85100 - Potenza/IT
  • 2 Statistics Unit, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano/IT
  • 3 Medical Oncology, Azienda USL 1 di Massa e Carrara, Carrara/IT
  • 4 Medical oncology 1 Unit, Istituto Oncologico Veneto IRCCS, 35128 - Padova/IT
  • 5 Medical Oncology, Azienda Ospedaliera Arcispedale Santa Maria Nuova - IRCCS, 42100 - Reggio Emilia/IT
  • 6 Medical Oncology, Istituto Europeo di Oncologia, 20141 - Milan/IT
  • 7 Oncologia Medica, Azienda Ospedaliera Marche Nord, 61032 - Fano/IT
  • 8 Oncologia Medica, Azienda Sanitaria Universitaria Integrata di Udine - Ospedale Santa Maria della Misericordia, 33100 - Udine/IT
  • 9 Oncologia Medica, IRCCS Ospedale San Raffaele, 20132 - Milan/IT
  • 10 Oncologia Medica, Istituto Nazionale dei Tumori di Milano - Fondazione IRCCS, 20133 - Milan/IT
  • 11 Oncologia Medica, Ospedale degli Infermi, 48018 - Faenza/IT
  • 12 Oncologia Medica, Azienda Ospedaliera St. Andrea, 00189 - Rome/IT
  • 13 Humanitas Cancer Center, Humanitas Clinical And Research Center, Istituto Clinico Humanitas, 20089 - Rozzano/IT
  • 14 Oncology, Ospedale San Giovanni Calibita - Fatebenefratelli, 00186 - Rome/IT
  • 15 Oncologia Medica, Centro di Riferimento Oncologico Basilicata IRCCS, 85020 - Rionero in Vulture/IT
  • 16 Ausl Modena, Ospedale Ramazzini, 41015 - Carpi/IT
  • 17 Oncologia Medica, Azienda Ospedaliera Papa Giovanni XXIII, 24127 - Bergamo/IT
  • 18 Statistics Unit, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano/IT
  • 19 Oncologia Medica, AZ. OSPEDALIERA SAN CARLO, 85100 - Potenza/IT
  • 20 Oncologia Medica 1, IRCCS AOU San Martino - IST-Istituto Nazionale per la Ricerca sul Cancro, 16132 - Genova/IT


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Abstract 2992


ASCO and ESMO guidelines have identified inadequate sampling of lymph nodes, pT4 primary tumors, obstruction or perforation, lymphovascular and perineural invasion, and poorly differentiated tumors as negative prognostic factors supporting the clinicians in treating their patients with stage II colon cancer (CC). However, the influence of histological subtypes on the risk of death or disease recurrence remains controversial.


The phase III, multicenter, randomized TOSCA trial compared 3 vs. 6 months of fluoropyrimidine-oxaliplatin adjuvant chemotherapy in 3,759 patients with high-risk stage II or stage III CC. Objective of this sub-study was to investigate the role of the histological subtype [(mucinous adenocarcinoma (MUC) or non-mucinous adenocarcinoma (NMUC)] on the impact of the treatment duration in terms of relapse-free survival (RFS) and overall survival (OS) in the subgroup of patients with high-risk stage II, grade 3 CC.


Out of 3,614 patients from 130 centres enrolled in the per-protocol population defined in the TOSCA trial, 85 MUC and 389 NMUC patients were included in this analysis. No statistical differences were found between 3 vs. 6 months groups in both histological subgroups in terms of baseline characteristics, except for tumor side. The proportion of patients with right-sided cancer was higher for patients with MUC than NMUC. A significant interaction between treatment duration and histology was observed on both RFS (p = 0.027) and OS (p = 0.017). In the subgroup of patients with MUC, worse RFS (adjusted hazard ratio [HR], 3.95; 95% confidence interval [CI], 1.03–15.17; p = 0.045) and OS (HR, 9.56; 95% CI, 1.14–79.98; p = 0.037) were detected for patients treated in the 3 months arm. No statistically significant differences were detected in the subgroup of patients with NMUC.


Both MUC and poorly differentiated subtypes have unfavorable clinical characteristics. Patients with MUC, grade 3, stage II CC require special attention and may need 6 months of oxaliplatin-based chemotherapy. Larger studies are required to clarify the possible negative effect of the histological subtype to improve the prognosis of these patients.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.


Has not received any funding.


All authors have declared no conflicts of interest.

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