Prognostic impact of mucinous histology in stage II colon cancer: a retrospective clinicopathological analysis

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Mucinous adenocarcinoma (MAC) exhibits aggressive clinicopathological features, yet its prognostic significance in stage II colon cancer remains controversial, and current guidelines do not regard mucinous histology as a high-risk feature (HRF). We compared mucinous and non-mucinous (NMAC) stage II colon adenocarcinomas with respect to clinicopathological characteristics and cumulative HRF burden. In this retrospective single-center cohort, patients who underwent curative resection for stage II colon cancer between January 2023 and October 2025 were included. MAC was defined as greater than 50% extracellular mucin. Clinicopathological variables, cumulative HRFs, and postoperative outcomes were compared. DFS was evaluated exploratorily using Kaplan–Meier estimation and the log-rank test. Of 47 patients, 32 (68.1%) had NMAC and 15 (31.9%) had MAC. MAC tumors tended to be larger than 6 cm (47% vs. 16%, p = 0.073) and MSI-positive (27% vs. 13%, p = 0.20), whereas grade 3 histology was more common in NMAC (44% vs. 20%; overall grade distribution, p = 0.12). The distribution of pT3, pT4a, and pT4b disease was similar between groups ( p = 0.875), and postoperative outcomes did not differ significantly. Among 45 patients with evaluable DFS data, five DFS events occurred, including four in the NMAC group and one in the MAC group. Estimated 24-month DFS was 87.2% for NMAC and 90.0% for MAC, with no statistically significant between-group difference (log-rank p = 0.423). In this small retrospective cohort, MAC and NMAC showed heterogeneous clinicopathological patterns, and no statistically detectable difference in DFS was identified. These findings are exploratory and do not establish mucinous histology as either an adverse or favorable prognostic factor in stage II colon cancer. Validation in larger cohorts with longer follow-up is required.

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