Histological categorisation of the desmoplastic reaction is a predictor of patient prognosis in oesophageal squamous cell carcinoma

Abstract

Histological categorisation of the desmoplastic reaction is a predictor of patient prognosis in oesophageal squamous cell carcinoma Aims: Histological categorisation of the desmoplastic reaction (DR) is an independent prognostic factor in colorectal cancer. However, it is unknown whether DR categorisation is predictive of oesophageal squamous cell carcinoma (OSCC) outcomes. This study aimed to evaluate the prognostic value of DR categorisation in OSCC patients. Methods and results: Data were collected from 118 patients with OSCC who underwent a curative oesophagectomy with T2 or deeper wall invasion. The DR in each tumour was classified as mature, intermediate or immature based on the presence or absence of keloid-like collagen and myxoid stroma. We identified 49 mature DR tumours, 41 intermediate DR tumours and 28 immature DR tumours. The 5-year overall survival (OS) rate was highest in the mature DR group (42.8%), followed by the intermediate DR group (25.0%) and the immature DR group (19.9%) (P = 0.022, log-rank test; P = 0.006, log-rank trend test). The 5-year disease-specific survival (DSS) rate was also highest in the mature DR group (48.5%), followed by the intermediate DR group (30.8%) and the immature DR group (26.8%) (P = 0.031, log-rank test; P = 0.010, log-rank trend test, respectively). Multivariate analysis revealed that an immature DR was an independent poor prognostic factor of OS and DSS (P = 0.002 and P = 0.004). Conclusions: DR categorisation of OSCC stroma following oesophagectomy is a useful diagnostic tool and an independent prognostic marker.

Combined assessment of tumour cell nest size and desmoplastic reaction as an excellent prognostic predictor in oesophageal squamous cell carcinoma

“…11 DR was categorized into three types (mature, intermediate, and immature) based on keloid-like collagen and myxoid stroma at the advancing edge of the tumour. Consistent with a previous study in ESCC, 19 DR was referred to as mature when fine collagenous fibres were arranged in multiple layers without any myxoid stroma or keloid-like collagen observed (Figure 1G); intermediate when keloid-like collagen (i.e. fragmented bands of collagen with remarkable eosinophilic hyalinization) was present (Figure 1H); and immature when fibrotic stroma intermingled with myxoid changes more than a microscopic field of one HPF at the invasive front (Figure 1I).…”

“…TB, CNS, and DR were scored according to previously established criteria. [11][12][13][14][17][18][19] TB was defined as single tumour cells or clusters of less than five cells protruding into the tumour stroma, measured by the highest budding activity. TB activity was denoted low if detectable budding nests ranged from 1 to 14 in 10 high-power fields (HPFs) (Figure 1A), and high if ≥15 (Figure 1B).…”

“…11,15 In addition, desmoplastic reaction (DR), a histological parameter to assess the stromal components in the invasive frontal area, namely, keloid-like collagen and myxoid stroma, has proven to be closely correlated with tumour biological behaviour in colorectal cancer, gastric adenocarcinoma, breast cancer, and ESCC. [16][17][18][19] DR can be histologically divided into three groups (mature, intermediate, and immature). Previous studies found that patients with ESCC with immature DR display the most invasive clinical aggressiveness and bears inferior prognosis.…”

“…Previous studies found that patients with ESCC with immature DR display the most invasive clinical aggressiveness and bears inferior prognosis. 19 Nevertheless, the relationship between TB/CNS and DR in ESCC have not been elucidated yet. To our knowledge, there are also limited data on the prognostic significance of combined assessment of the extent of cellular dissociation and tumour stroma in ESCC.…”

Development and Validation of a Novel Prognostic Nomogram Combined With Desmoplastic Reaction for Synchronous Colorectal Peritoneal Metastasis

“…DR classification as a prognostic factor has been validated not only in different stages of colorectal cancer but also in pancreatic ductal carcinoma ( 38 ), cervical squamous cell carcinoma ( 39 ), intrahepatic cholangiocarcinoma ( 40 ), and esophageal squamous cell carcinoma ( 41 ). In particular, a recent retrospective phase III clinical trial concluded that DR might be a valuable prognostic indicator to identify patients who will benefit from postoperative chemotherapy in stage II colorectal cancer ( 22 ).…”