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Histopathological features predict metastatic potential in locally advanced colon carcinomas.

Jayasinghe C, Simiantonaki N, Kirkpatrick CJ - BMC Cancer (2015)

Bottom Line: Metastatic dissemination can exist before a pathologically and clinically detectable manifestation.In the multivariate analysis, with the exception of large vessel density, these pathomorphological features were independent risk factors for lymphogenous metastasis (p = 0.023, p = 0.017, p = 0.037, p = 0.012, respectively) with a good discrimination ability (AUC of 0.853).Features associated with distant metastasis in the univariate analysis included high tumor budding (p = 0.002), low intratumoral small vessel density (p = 0.013), absent lymphocellular intratumoral inflammation (p = 0.048) and abundant necrosis (p = 0.073).

View Article: PubMed Central - PubMed

Affiliation: Institute of Pathology, Johannes Gutenberg University, Langenbeckstr. 1, 55101, Mainz, Germany. c.jayasinghe@gmx.de.

ABSTRACT

Background: Metastatic dissemination can exist before a pathologically and clinically detectable manifestation. The structural heterogeneity of colon cancer (CC) in histological sections with respect to the morphology of tumor aggressiveness and composition of the tumor microenvironment raises the question of whether the microscopical tumor architecture enables a discrimination of groups with different metastatic potential. This would result in an assessment of the prognosis and provision of an ancillary tool for the therapeutic management after surgery, beside the estimation of the local tumor extent.

Methods: In order to identify predictive biomarkers for metastasis of locally advanced CC, which can easily be integrated into the pathologist's daily routine diagnostic activity, we determined tumor budding, peritumoral inflammation, extent of desmoplasia and necrosis, density of macro- and microvascular blood vessels and functional state of lymphatics in the tumor center, invasive margin and tumor-free surrounding tissue in 86 non-metastatic, lymphogenous-metastatic and haematogenous-metastatic, subserosa-invasive CC.

Results: Features influencing nodal metastasis in the univariate analysis included high tumor budding (p = 0.004), high large vessel density in the subserosa (p = 0.043), abundant desmoplasia (p = 0.049), non-finger-like desmoplastic pattern (p = 0.051) and absent lymphocellular intratumoral inflammation (p = 0.084). In the multivariate analysis, with the exception of large vessel density, these pathomorphological features were independent risk factors for lymphogenous metastasis (p = 0.023, p = 0.017, p = 0.037, p = 0.012, respectively) with a good discrimination ability (AUC of 0.853). Features associated with distant metastasis in the univariate analysis included high tumor budding (p = 0.002), low intratumoral small vessel density (p = 0.013), absent lymphocellular intratumoral inflammation (p = 0.048) and abundant necrosis (p = 0.073). In the multivariate analysis only tumor budding was an independent predictor for haematogenous metastasis (p = 0.007) with a good discrimination ability (AUC of 0.829).

Conclusions: Thus, mainly tumor budding but also the described structural characteristics of the peritumoral tissue appears to reflect the metastatic potential of locally advanced CC and therefore should be stated in pathological reports.

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Related in: MedlinePlus

Desmoplastic pattern in CC. Pushing (A), finger-like (B) and net-like (C) pattern of desmoplasia in CC (H.E., x12,5).
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Fig1: Desmoplastic pattern in CC. Pushing (A), finger-like (B) and net-like (C) pattern of desmoplasia in CC (H.E., x12,5).

Mentions: Desmoplasia showed three different patterns, pushing, finger-like and net-like (Figure 1). The pushing pattern dominated in lymphogenous-metastatic patients whereas the finger-like pattern was commonest in non-metastatic cases (Table 1). In both groups 46% of the cases expressed the respective phenotype of peritumoral stromal reaction, so that a strong tendency just below statistical significance was observed (p = 0.051) (Table 2). The net-like pattern was seen most frequently in haematogenous-metastatic cases.Figure 1


Histopathological features predict metastatic potential in locally advanced colon carcinomas.

Jayasinghe C, Simiantonaki N, Kirkpatrick CJ - BMC Cancer (2015)

Desmoplastic pattern in CC. Pushing (A), finger-like (B) and net-like (C) pattern of desmoplasia in CC (H.E., x12,5).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4307171&req=5

Fig1: Desmoplastic pattern in CC. Pushing (A), finger-like (B) and net-like (C) pattern of desmoplasia in CC (H.E., x12,5).
Mentions: Desmoplasia showed three different patterns, pushing, finger-like and net-like (Figure 1). The pushing pattern dominated in lymphogenous-metastatic patients whereas the finger-like pattern was commonest in non-metastatic cases (Table 1). In both groups 46% of the cases expressed the respective phenotype of peritumoral stromal reaction, so that a strong tendency just below statistical significance was observed (p = 0.051) (Table 2). The net-like pattern was seen most frequently in haematogenous-metastatic cases.Figure 1

Bottom Line: Metastatic dissemination can exist before a pathologically and clinically detectable manifestation.In the multivariate analysis, with the exception of large vessel density, these pathomorphological features were independent risk factors for lymphogenous metastasis (p = 0.023, p = 0.017, p = 0.037, p = 0.012, respectively) with a good discrimination ability (AUC of 0.853).Features associated with distant metastasis in the univariate analysis included high tumor budding (p = 0.002), low intratumoral small vessel density (p = 0.013), absent lymphocellular intratumoral inflammation (p = 0.048) and abundant necrosis (p = 0.073).

View Article: PubMed Central - PubMed

Affiliation: Institute of Pathology, Johannes Gutenberg University, Langenbeckstr. 1, 55101, Mainz, Germany. c.jayasinghe@gmx.de.

ABSTRACT

Background: Metastatic dissemination can exist before a pathologically and clinically detectable manifestation. The structural heterogeneity of colon cancer (CC) in histological sections with respect to the morphology of tumor aggressiveness and composition of the tumor microenvironment raises the question of whether the microscopical tumor architecture enables a discrimination of groups with different metastatic potential. This would result in an assessment of the prognosis and provision of an ancillary tool for the therapeutic management after surgery, beside the estimation of the local tumor extent.

Methods: In order to identify predictive biomarkers for metastasis of locally advanced CC, which can easily be integrated into the pathologist's daily routine diagnostic activity, we determined tumor budding, peritumoral inflammation, extent of desmoplasia and necrosis, density of macro- and microvascular blood vessels and functional state of lymphatics in the tumor center, invasive margin and tumor-free surrounding tissue in 86 non-metastatic, lymphogenous-metastatic and haematogenous-metastatic, subserosa-invasive CC.

Results: Features influencing nodal metastasis in the univariate analysis included high tumor budding (p = 0.004), high large vessel density in the subserosa (p = 0.043), abundant desmoplasia (p = 0.049), non-finger-like desmoplastic pattern (p = 0.051) and absent lymphocellular intratumoral inflammation (p = 0.084). In the multivariate analysis, with the exception of large vessel density, these pathomorphological features were independent risk factors for lymphogenous metastasis (p = 0.023, p = 0.017, p = 0.037, p = 0.012, respectively) with a good discrimination ability (AUC of 0.853). Features associated with distant metastasis in the univariate analysis included high tumor budding (p = 0.002), low intratumoral small vessel density (p = 0.013), absent lymphocellular intratumoral inflammation (p = 0.048) and abundant necrosis (p = 0.073). In the multivariate analysis only tumor budding was an independent predictor for haematogenous metastasis (p = 0.007) with a good discrimination ability (AUC of 0.829).

Conclusions: Thus, mainly tumor budding but also the described structural characteristics of the peritumoral tissue appears to reflect the metastatic potential of locally advanced CC and therefore should be stated in pathological reports.

Show MeSH
Related in: MedlinePlus