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Clinical and prognostic significance of pathological and inflammatory markers in the surgical treatment of locally advanced colorectal cancer.

Sokolov M, Angelov K, Vasileva M, Atanasova MP, Vlahova A, Todorov G - Onco Targets Ther (2015)

Bottom Line: However, where there were high-risk pathological characteristics according to the Petersen Index, survival was similar to that for node-positive disease (P=0.702).Our data also showed a significant difference in survival between groups divided according to whether they had a modified Glasgow Prognostic Score of 1 or 2 (P=0.031).In order to maintain a reasonable balance between an aggressive approach and so-called meaningless "surgical exorbitance", we should focus on certain histopathological and inflammatory markers that can be identified as additional factors for planning the type and volume of surgical treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Medical University of Sofia, Sofia, Bulgaria.

ABSTRACT

Background: Locally advanced colorectal cancer (CRC) may vary in its clinical and pathological appearance. It is now accepted that progression of disease in patients with locally advanced CRC is determined not only by local tumor characteristics but also by the immune system and inflammatory response in the body.

Methods: We investigated patients with confirmed CRC who were treated in the surgical clinic at the University Hospital Alexandrovska over a 10-year period and retrospectively evaluated the histological features of the preoperative biopsies and operative specimens removed during radical multivisceral resections. We also collected prospective data for serum C-reactive protein levels and Jass-Klintrup score, Petersen Index score, and Glasgow Prognostic Score in patients with locally advanced CRC.

Results: Of 1,105 patients with CRC, 327 (29.6%) were diagnosed with locally advanced disease. In total, 108 combined multivisceral resections (79 for primary tumors and 29 for recurrent tumors) were performed. Overall survival was 34 months for pR0 cases and 12 months for pR1 cases (P<0.05). Our data confirmed that C-reactive protein is a prognostic marker of overall survival. Data for 48 patients with histologically confirmed locally advanced tumors showed significantly increased survival with a higher Jass-Klintrup score (P=0.037). In patients with node-negative disease, 5-year survival was 49%. However, where there were high-risk pathological characteristics according to the Petersen Index, survival was similar to that for node-positive disease (P=0.702). Our data also showed a significant difference in survival between groups divided according to whether they had a modified Glasgow Prognostic Score of 1 or 2 (P=0.031).

Conclusion: In order to maintain a reasonable balance between an aggressive approach and so-called meaningless "surgical exorbitance", we should focus on certain histopathological and inflammatory markers that can be identified as additional factors for planning the type and volume of surgical treatment.

No MeSH data available.


Related in: MedlinePlus

Comparison of the modified PI in the study population (A) with pT4N0/1 (one positive lymph node) and survival depending on number of metastatic (N+) lymph nodes (B).Abbreviation: PI, Petersen index.
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f7-ott-8-2329: Comparison of the modified PI in the study population (A) with pT4N0/1 (one positive lymph node) and survival depending on number of metastatic (N+) lymph nodes (B).Abbreviation: PI, Petersen index.

Mentions: Additional clinically relevant prognostic criteria were identified by postoperative histological examination of the removed specimens. These specimens provided important information regarding resected node-negative locally advanced CRCs, including peritoneal involvement (P+, P−), venous invasion (submucosal, extramural; V0/V1), involvement of resection margins (R0/R1), and tumor perforation. We added perineural invasion (PN+, PN−), thereby modifying the PI score and combining these five factors in a scoring system as follows: 0–5 (0, absence of any positive factors; 1–4, presence of 1–4 positive factors, respectively; and 5, presence of all factors). Thus, in the group with node-negative disease, which accounted for 44% of our patients with cT4 carcinoma, 5-year survival was 49%. In patients with a high PI score, survival was similar to that for node-positive disease (P=0.702). The PI identified patients at high risk of tumor recurrence who would benefit from aggressive adjuvant treatment and had cT4 tumors (Dukes’ stage B or C, with a positive node) as shown in Figure 7.


Clinical and prognostic significance of pathological and inflammatory markers in the surgical treatment of locally advanced colorectal cancer.

Sokolov M, Angelov K, Vasileva M, Atanasova MP, Vlahova A, Todorov G - Onco Targets Ther (2015)

Comparison of the modified PI in the study population (A) with pT4N0/1 (one positive lymph node) and survival depending on number of metastatic (N+) lymph nodes (B).Abbreviation: PI, Petersen index.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4562718&req=5

f7-ott-8-2329: Comparison of the modified PI in the study population (A) with pT4N0/1 (one positive lymph node) and survival depending on number of metastatic (N+) lymph nodes (B).Abbreviation: PI, Petersen index.
Mentions: Additional clinically relevant prognostic criteria were identified by postoperative histological examination of the removed specimens. These specimens provided important information regarding resected node-negative locally advanced CRCs, including peritoneal involvement (P+, P−), venous invasion (submucosal, extramural; V0/V1), involvement of resection margins (R0/R1), and tumor perforation. We added perineural invasion (PN+, PN−), thereby modifying the PI score and combining these five factors in a scoring system as follows: 0–5 (0, absence of any positive factors; 1–4, presence of 1–4 positive factors, respectively; and 5, presence of all factors). Thus, in the group with node-negative disease, which accounted for 44% of our patients with cT4 carcinoma, 5-year survival was 49%. In patients with a high PI score, survival was similar to that for node-positive disease (P=0.702). The PI identified patients at high risk of tumor recurrence who would benefit from aggressive adjuvant treatment and had cT4 tumors (Dukes’ stage B or C, with a positive node) as shown in Figure 7.

Bottom Line: However, where there were high-risk pathological characteristics according to the Petersen Index, survival was similar to that for node-positive disease (P=0.702).Our data also showed a significant difference in survival between groups divided according to whether they had a modified Glasgow Prognostic Score of 1 or 2 (P=0.031).In order to maintain a reasonable balance between an aggressive approach and so-called meaningless "surgical exorbitance", we should focus on certain histopathological and inflammatory markers that can be identified as additional factors for planning the type and volume of surgical treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Medical University of Sofia, Sofia, Bulgaria.

ABSTRACT

Background: Locally advanced colorectal cancer (CRC) may vary in its clinical and pathological appearance. It is now accepted that progression of disease in patients with locally advanced CRC is determined not only by local tumor characteristics but also by the immune system and inflammatory response in the body.

Methods: We investigated patients with confirmed CRC who were treated in the surgical clinic at the University Hospital Alexandrovska over a 10-year period and retrospectively evaluated the histological features of the preoperative biopsies and operative specimens removed during radical multivisceral resections. We also collected prospective data for serum C-reactive protein levels and Jass-Klintrup score, Petersen Index score, and Glasgow Prognostic Score in patients with locally advanced CRC.

Results: Of 1,105 patients with CRC, 327 (29.6%) were diagnosed with locally advanced disease. In total, 108 combined multivisceral resections (79 for primary tumors and 29 for recurrent tumors) were performed. Overall survival was 34 months for pR0 cases and 12 months for pR1 cases (P<0.05). Our data confirmed that C-reactive protein is a prognostic marker of overall survival. Data for 48 patients with histologically confirmed locally advanced tumors showed significantly increased survival with a higher Jass-Klintrup score (P=0.037). In patients with node-negative disease, 5-year survival was 49%. However, where there were high-risk pathological characteristics according to the Petersen Index, survival was similar to that for node-positive disease (P=0.702). Our data also showed a significant difference in survival between groups divided according to whether they had a modified Glasgow Prognostic Score of 1 or 2 (P=0.031).

Conclusion: In order to maintain a reasonable balance between an aggressive approach and so-called meaningless "surgical exorbitance", we should focus on certain histopathological and inflammatory markers that can be identified as additional factors for planning the type and volume of surgical treatment.

No MeSH data available.


Related in: MedlinePlus