Completeness of pathology reports in stage II colorectal cancer

Bettina E. Hansen,Rolf Torenbeek,Ruth E. M. Fleischeuer,Peter Paul L. O. Coene,Stefan Büttner,J. H. Carel Meijers,David D. E. Zimmerman,Mike Kliffen,Jan Willem T. Dekker,Jan N. M. IJzermans,Michael Doukas,Wietske W. Vrijland,Robert R. J. Coebergh van den Braak,Wouter J. Vles,Geert W. M. Tetteroo,Anneke A. M. van der Wurff,Zarina S. Lalmahomed

doi:10.1080/00015458.2017.1279872

Abstract

Introduction: The completeness of the pathological examination of resected colon cancer specimens is important for further clinical management. We reviewed the pathological reports of 356 patients regarding the five factors (pT-stage, tumor differentiation grade, lymphovascular invasion, tumor perforation and lymph node metastasis status) that are used to identify high-risk stage II colon cancers, as well as their impact on overall survival (OS).Methods: All patients with stage II colon cancer who were included in the first five years of the MATCH study (1 July 2007 to 1 July 2012) were selected (n = 356). The hazard ratios of relevant risk factors were calculated using Cox Proportional Hazards analyses.Results: In as many as 69.1% of the pathology reports, the desired information on one or more risk factors was considered incomplete. In multivariable analysis, age (HR: 1.07, 95%CI 1.04–1.10, p < .001), moderately- (HR: 0.35, 95%CI 0.18–0.70, p = .003) and well (HR 0.11, 95%CI 0.01–0.89, p = .038) differentiated tumors were significantly associated with OS.Conclusions: Pathology reports should better describe the five high-risk factors, in order to enable proper patient selection for further treatment. Chemotherapy may be offered to stage II patients only in select instances, yet a definitive indication is still unavailable.

Highlights

The completeness of the pathological examination of resected colon cancer specimens is important for further clinical management
In the 44 Nx patients, the pathology report did not comment on this total yield as being a risk factor
In 62.8% of all cases, no statement regarding presence or absence of lymphovascular invasion (LVI) was recorded; tumor differentiation grade was not reported in 2.3%

Summary

Introduction

The completeness of the pathological examination of resected colon cancer specimens is important for further clinical management. We reviewed the pathological reports of 356 patients regarding the five factors (pT-stage, tumor differentiation grade, lymphovascular invasion, tumor perforation and lymph node metastasis status) that are used to identify high-risk stage II colon cancers, as well as their impact on overall survival (OS). Conclusions: Pathology reports should better describe the five high-risk factors, in order to enable proper patient selection for further treatment. The risk of developing metastases as well as survival can be estimated more accurately for the individual patient by taking into consideration the American Joint Committee on Cancer (AJCC) TNM classification [7]. Curatively resectable tumors are divided into AJCC stage I to III, with stage III necessitating adjuvant chemotherapy in addition to watchful waiting strategies.

Methods

Results

Conclusion