Abstract
The aim of our study was to assess the prognostic value of the two new grading systems based on the quantification of tumor budding - (GBd) and poorly differentiated clusters - (PDCs-G) in colorectal carcinomas (CRC). We performed a retrospective study on 71 CRC patients who underwent surgery at the Emergency County Hospital, Timişoara. CRC cases were classified based on hematoxylin-eosin slides, using the conventional grading system, GBd, and PDCs-G, respectively. We used two-tier and three-tier grading schemes for each system. Subsequently, we evaluated associations with other prognostic factors in CRC. Based on the three-tier GBd (GBd-3t) most cases (34/69, 49.27%) were classified as G3Bd-3t, while based on the conventional grading system, the majority of the cases (55/69, 79.71%) were considered G2. On the other hand, based on the three-tier PDCs-G system (PDCs-G-3t), most cases (31/69, 44.93%) were PDCs-G2-3t. We also noted a more significant association of GBd-3t with other prognostic parameters analyzed, as compared to the conventional grading system. Nodal status, tumor stage, and lymphovascular invasion were strongly correlated with GBd-3t (p=0.0001). Furthermore, we noted that PDCs-G-3t correlated more significantly than the conventional grading system with nodal status (p<0.0001), tumor stage (p=0.0003), lymphovascular invasion (p<0.0001), perineural invasion (p=0.005), and the tumor border configuration (p<0.0001). High GBd and PDCs-G grades correlate directly with other negative prognostic factors in CRC. Thus, these new parameters/classification methods could be used as additional tools for risk stratification in patients with CRC.
Highlights
And nationally, the incidence and mortality of colorectal cancer (CRC) are increasing [1]
We evaluated tumor budding (TB) for all of the cases included in the study on the invasive front of the tumor, according to the International Tumor Budding Consensus Conference (ITBCC) recommendation [11]
The cases we studied were classified according to the TNM AJCC staging system as follows: 10 cases (14.49%) were stage I, 27 cases (39.13 %) stage II, 27 cases (39.13%) stage III and 5 cases (7.25%) stage IV. 27 cases (39.13%) presented LVI+, in 23 cases (33.33%) we noted perineural invasion (PNI) and 58 cases (84.06%) presented tumor infiltrating lymphocytes (TILs)+
Summary
The incidence and mortality of colorectal cancer (CRC) are increasing [1]. By using the TNM AJCC staging system (The TNM staging system - Tumor, Node, Metastasis proposed by The American Joint Committee on Cancer) [6] for CRC, an optimum classification of CRC patients with regard to recurrence and/or metastasis risk cannot be obtained [7]. It has been shown in the literature that clinical behavior may vary significantly in patients with the same stage of the disease, because the current staging classification offers limited prognostic information and is not able to anticipate the response to treatment [8]
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