The Clinical Utility of the Combination of T Stage and Venous Invasion to Predict Survival in Patients Undergoing Surgery for Colorectal Cancer

Roxburgh, Campbell S.D.; McMillan, Donald C.; Richards, Colin H.; Atwan, Manal; Anderson, John H.; Harvey, Tim; Horgan, Paul G.; Foulis, Alan K.

doi:10.1097/sla.0000000000000229

Cited by 60 publications

(68 citation statements)

References 27 publications

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“…Additional pathologic data were taken from reports issued following resection. Since 2003, elastica staining has been used in our institution for the detection of venous invasion, with tumors before 2003 stained retrospectively (5). Both intramural and extramural invasion were considered as evidence of venous invasion.…”

Section: Clinicopathologic Characteristicsmentioning

confidence: 99%

“…Although several high-risk pathologic characteristics, such as venous invasion or serosal involvement, are now recognized as important determinants of survival, particularly in node negative disease (4,5), it is now clear that other host and tumor characteristics may similarly determine oncologic outcome. Indeed, alongside the intrinsic properties of tumor cells, components of the tumor microenvironment, such as tumor-infiltrating immune cells (6), and the tumor-associated stroma (7), may also determine disease progression and the outcome of patients with colorectal cancer.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of a Tumor Microenvironment–Based Prognostic Score in Primary Operable Colorectal Cancer

Park

McMillan

Powell

et al. 2015

Clinical Cancer Research

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Purpose: The tumor microenvironment is recognized as an important determinant of progression and outcome in colorectal cancer. The aim of the present study was to evaluate a novel tumor microenvironment-based prognostic score, based on histopathologic assessment of the tumor inflammatory cell infiltrate and tumor stroma, in patients with primary operable colorectal cancer.Experimental Design: Using routine pathologic sections, the tumor inflammatory cell infiltrate and stroma were assessed using Klintrup-M€ akinen (KM) grade and tumor stroma percentage (TSP), respectively, in 307 patients who had undergone elective resection for stage I-III colorectal cancer. The clinical utility of a cumulative score based on these characteristics was examined.Results: On univariate analysis, both weak KM grade and high TSP were associated with reduced survival (HR, 2.42; P ¼ 0.001 and HR, 2.05; P ¼ 0.001, respectively). A cumulative score based on these characteristics, the Glasgow Microenvironment Score (GMS), was associated with survival (HR, 1.93; 95% confidence interval, 1.36-2.73; P < 0.001), independent of TNM stage and venous invasion (both P < 0.05). GMS stratified patients in to three prognostic groups: strong KM (GMS ¼ 0), weak KM/ low TSP (GMS ¼ 1), and weak KM/high TSP (GMS ¼ 2), with 5-year survival of 89%, 75%, and 51%, respectively (P < 0.001). Furthermore, GMS in combination with node involvement, venous invasion, and mismatch repair status further stratified 5-year survival (92% to 37%, 93% to 27%, and 100% to 37%, respectively).Conclusions: The present study further confirms the clinical utility of assessment of the tumor microenvironment in colorectal cancer and introduces a simple, routinely available prognostic score for the risk stratification of patients with primary operable colorectal cancer.

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Section: Clinicopathologic Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of a Tumor Microenvironment–Based Prognostic Score in Primary Operable Colorectal Cancer

Park

McMillan

Powell

et al. 2015

Clinical Cancer Research

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“…As with nearly every other malignant entity, the exact staging and grading of these tumors receive high priority for the choice of the most appropriate therapy [2]. Furthermore, these facts have strongly influenced patients' overall survival/mortality and morbidity, as well as tumor recurrence rates [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Lymph node hypoplasia is associated with adverse outcomes in node-negative colon cancer using advanced lymph node dissection methods

Mayr

Aumann

Schaller

et al. 2016

Langenbecks Arch Surg

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“…There have been multiple attempts to improve on patient prognosis and to identify novel clinical targets through molecular biomarker analysis and novel histopathologic grading systems, where the invasive margin of CRC is of particular significance [10–12]. Although these features may have prognostic value they have not been adopted into routine clinical practice for several reasons, including observer variability and non-standardized quantification [13–15]; both of which might be overcome using automated image analysis.…”

Section: Introductionmentioning

confidence: 99%

Novel histopathologic feature identified through image analysis augments stage II colorectal cancer clinical reporting

et al. 2016

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A number of candidate histopathologic factors show promise in identifying stage II colorectal cancer (CRC) patients at a high risk of disease-specific death, however they can suffer from low reproducibility and none have replaced classical pathologic staging. We developed an image analysis algorithm which standardized the quantification of specific histopathologic features and exported a multi-parametric feature-set captured without bias. The image analysis algorithm was executed across a training set (n = 50) and the resultant big data was distilled through decision tree modelling to identify the most informative parameters to sub-categorize stage II CRC patients. The most significant, and novel, parameter identified was the ‘sum area of poorly differentiated clusters’ (AreaPDC). This feature was validated across a second cohort of stage II CRC patients (n = 134) (HR = 4; 95% CI, 1.5– 11). Finally, the AreaPDC was integrated with the significant features within the clinical pathology report, pT stage and differentiation, into a novel prognostic index (HR = 7.5; 95% CI, 3–18.5) which improved upon current clinical staging (HR = 4.26; 95% CI, 1.7– 10.3). The identification of poorly differentiated clusters as being highly significant in disease progression presents evidence to suggest that these features could be the source of novel targets to decrease the risk of disease specific death.

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The Clinical Utility of the Combination of T Stage and Venous Invasion to Predict Survival in Patients Undergoing Surgery for Colorectal Cancer

Abstract: The results of the present study have prompted the development of a novel tumor staging system based on TVI. The TVI has clinical utility, especially in node-negative disease, in predicting outcome following curative resection for CRC.

Cited by 60 publications

References 27 publications

Evaluation of a Tumor Microenvironment–Based Prognostic Score in Primary Operable Colorectal Cancer

Evaluation of a Tumor Microenvironment–Based Prognostic Score in Primary Operable Colorectal Cancer

Lymph node hypoplasia is associated with adverse outcomes in node-negative colon cancer using advanced lymph node dissection methods

Novel histopathologic feature identified through image analysis augments stage II colorectal cancer clinical reporting

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