Abstract
BackgroundHuman evaluation of pathological slides cannot accurately predict lymph node metastasis (LNM), although accurate prediction is essential to determine treatment and follow-up strategies for colon cancer. We aimed to develop accurate histopathological features for LNM in colon cancer.MethodsWe developed a deep convolutional neural network model to distinguish the cancer tissue component of colon cancer using data from the tissue bank of the National Center for Tumor Diseases and the pathology archive at the University Medical Center Mannheim, Germany. This model was applied to whole-slide pathological images of colon cancer patients from The Cancer Genome Atlas (TCGA). The predictive value of the peri-tumoral stroma (PTS) score for LNM was assessed.ResultsA total of 164 patients with stages I, II, and III colon cancer from TCGA were analyzed. The mean PTS score was 0.380 (± SD = 0.285), and significantly higher PTS scores were observed in patients in the LNM-positive group than those in the LNM-negative group (P < 0.001). In the univariate analyses, the PTS scores for the LNM-positive group were significantly higher than those for the LNM-negative group (P < 0.001). Further, the PTS scores in lymphatic invasion and any one of perineural, lymphatic, or venous invasion were significantly increased in the LNM-positive group (P < 0.001 and P < 0.001).ConclusionWe established the PTS score, a simplified reproducible parameter, for predicting LNM in colon cancer using computer-based analysis that could be used to guide treatment decisions. These findings warrant further confirmation through large-scale prospective clinical trials.
Highlights
Colon cancer is a major cause of morbidity and mortality worldwide, and its occurrence is expected to increase significantly over the few years [1, 2]
The presence of lymph node metastasis (LNM) is a crucial prognostic factor to determine whether patients with early-stage colon cancer should undergo additional surgery after local endoscopic treatment and whether adjuvant chemotherapy is necessary after surgical resection for those in the advanced stages [5,6,7]
Micro-metastasis [8, 9], the presence of minimal cancer cells in regional lymph nodes that pathological examination cannot detect, is observed through immunohistochemistry and molecular genetic evaluation in up to 50% of patients with nodenegative colon cancer even after radical surgery, aside from local endoscopic treatment being unable to provide an accurate status of regional lymph nodes [10,11,12]
Summary
Colon cancer is a major cause of morbidity and mortality worldwide, and its occurrence is expected to increase significantly over the few years [1, 2]. The presence of lymph node metastasis (LNM) is a crucial prognostic factor to determine whether patients with early-stage colon cancer should undergo additional surgery after local endoscopic treatment and whether adjuvant chemotherapy is necessary after surgical resection for those in the advanced stages [5,6,7]. Micro-metastasis [8, 9], the presence of minimal cancer cells in regional lymph nodes that pathological examination cannot detect, is observed through immunohistochemistry and molecular genetic evaluation in up to 50% of patients with nodenegative colon cancer even after radical surgery, aside from local endoscopic treatment being unable to provide an accurate status of regional lymph nodes [10,11,12]. We aimed to develop accurate histopathological features for LNM in colon cancer
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