Growth patterns of colorectal cancer liver metastases and their impact on prognosis: a systematic review

Abstract

BackgroundColorectal cancer liver metastases (CRLM) grow in distinct histological patterns that have been associated with outcome after surgical resection. We conducted a systematic review to evaluate the frequency of different CRLM growth patterns and their impact on prognosis.MethodsWe searched Embase and MEDLINE databases from inception to 1 December 2017 to identify studies that reported CRLM growth pattern histopathology, their frequencies, and/or data related to outcome.ResultsWe included a total of 23 studies (2432 patients with CRLM) published between 1991 and 2017. There were variations in the terminology used to describe the growth patterns as well as in their histopathological definitions. A ‘desmoplastic’ pattern was most frequently considered, followed by ‘pushing’ and ‘replacement’ patterns. Data supported the presence of both intralesional and interlesional heterogeneity. There were no differences in growth pattern distribution stratified by chemotherapy. While heterogeneity of histopathology assessment precluded formal meta-analysis, the majority of articles found favourable outcomes for desmoplastic and unfavourable outcomes for replacement CRLM, independently of when the study was conducted.ConclusionsThe results suggest that CRLM growth patterns may have prognostic potential and that they may be considered for standardised routine histopathological reporting. Further understanding of the different growth patterns may provide important insights into the biological mechanisms that underlie metastatic growth in the liver.

Colorectal liver metastases: radiopathological correlation

“…Three types of growth patterns have been described in liver metastases on gross pathology: infiltrative, pushing, and capsulated [32]. With the infiltrative growth pattern, tumor cells invade the surrounding hepatic tissue, while liver cells are progressively displaced by the metastatic lesion with the pushing growth pattern.…”

<p>Prognostic Factors After Hepatectomy for Gastric Adenocarcinoma Liver Metastases: Desmoplastic Growth Pattern as the Key to Improved Overall Survival</p>

“…21 The growth pattern (GP) of metastases, reflecting distinct characteristics of the tumor microenvironment, also constitutes a potential prognostic factor. GP has shown to be relevant in CRLM [22][23][24][25] and seems to represent the path to pursue in the selection of patients for Hp. 10,26 In our study, we sought to investigate both clinical and histopathological factors, with emphasis on GCLM's GP, potentially associated with an improved outcome after Hp.…”

Framing cancer progression: influence of the organ‐ and tumour‐specific matrisome

“…In the clinical pathology assessment, patterns of metastatic colonisation can vary even within one cancer type. In particular, CRC cells were described to form either mixed or predominantly ‘pushing’, ‘infiltrating’ or ‘desmoplastic’ patterns, with only the last pattern being associated with the desmoplastic stroma on the border between metastasis and normal liver tissue . Several studies suggest that an ‘infiltrating’ pattern (diffusive replacement of hepatocytes by the cancer cells) is more unfavourable for patient prognosis than a ‘desmoplastic’ pattern, perhaps due to the more efficient expansion by co‐option with sinusoidal blood vessels .…”