ArticleClinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico2026
Rethinking mucinous colorectal adenocarcinoma classification: evidence from histopathology and RAS mutations.
Article in Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeMucinous adenocarcinoma (MAC) is a distinct and aggressive subtype of colorectal cancer (CRC), traditionally defined by > 50% mucinous component. However, evidence suggests tumors with lower mucin content may behave similarly. This study investigated clinicopathological and molecular differences between mucinous and non-mucinous CRC, and evaluated the prognostic relevance of the current mucin threshold.
methodsWe retrospectively analyzed 1716 CRC cases (2017-2021) from the Institut Pasteur de Tunis. Tumors were classified as NMAC (0-5% mucin), ACMC1 (5-50%), or MAC (> 50%). .RAS mutation status was determined using Lightmix (TibMolBiol). Clinical, histological, and metastatic features comparison across groups and survival analysis were assessed using SPSS v26.
resultsTumors with any mucinous component (5-100%) were significantly associated with right-sided location (p < 0.001), signet-ring cells (p < 0.001), synchronous peritoneal metastasis (p = 0.002-0.02), and KRAS mutations (p = 0.031) versus NMAC. Importantly, ACMC1 (5-50%) shared aggressive features with MAC, including lymphovascular invasion (p = 0.027) and distinct metastatic patterns.
conclusionsOur findings debate the WHO 50% mucin threshold, showing that tumors with 5-50% mucin exhibit comparable aggressiveness to classical MAC. Integrating molecular profiling with histology may improve risk stratification and guide tailored therapeutic strategies for mucinous CRC, regardless of mucin proportion.
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