Abstract
ObjectivesThe aims of this study were to evaluate the associations between peritoneal elastic lamina invasion (ELI) and the clinicopathological prognostic factors of colon cancer, to evaluate the feasibility of ELI with use of an elastic stain to help diagnose serosal invasion of colon cancer in routine practice, so as to help us to provide a more accurate estimate for prognosis and stage of patients and a marker for postoperative treatment.Methods254 cases with colon cancer were included in the study. According to the presence of elastic lamina (EL) and elastic lamina invasion (ELI), all cases were divided into four groups: pT3 EL negative (pT3 EL (-)), pT3 ELI positive (pT3 ELI (+)), pT3 ELI negative (pT3 ELI (-)) and pT4a. Statistical analysis was used to analyze the relationship between elastic lamina invasion and other established adverse histologic features.ResultsThe EL and ELI positive rates were 81.5% and 42.1% respectively. There were significant differences in mph node metastasis, venous invasion and tumor buds between pT3 ELI (-) and pT3 ELI (+), pT3 ELI (-) and pT4a. There was no significant difference in same factors between pT3 ELI (+) and pT4a. In pT3 stage, there were significant differences in lymph node metastasis, perineural invasion and tumor buds between EL (-) and ELI (+). There were no significant differences in same factors between EL (-) and ELI (-). EL was detected less frequently in right-sided tumors compared with left-sided tumors.ConclusionsELI might be the prognostic factors of colon cancer with II stage and might be the marker of postoperative adjuvant chemotherapy. Patients with pT3 ELI (+) might have similar prognosis to patients with pT4a. For patients with pT3 colon cancer, EL(-) might have similar prognosis as ELI (-) and might take the same therapy. In addition, the right half colon EL positive rate was lower than the left colon. Elastic staining might be a useful tool to help determine the invasive depth and stage of colon cancer.
Highlights
Peritoneal involvement was an important adverse prognostic factor in colorectal cancer (CRC)
There was no significant difference in same factors between pT3 elastic lamina invasion (ELI) (+) and pT4a
There were no significant differences in same factors between elastic lamina (EL) (-) and ELI (-)
Summary
Peritoneal involvement was an important adverse prognostic factor in colorectal cancer (CRC). Serosal invasion could distinguish between T3 and T4a stage colon cancer and may prompt consideration of adjuvant chemotherapy in stage II disease. The methods could help to confirm serosal invasion including cytological examination and Immunohistochemistry. It should be noted that the presence of malignant cells in peritoneal fluid could be a consequence of tumor metastases to lymph nodes or other sites and would not necessarily be the result of direct trans-serosal spread by the primary tumor. As for Immunohistochemistry, because of damage of the surface of serosa caused by the fibrous and inflammatory, the diagnostic positive rate of this method is not high. These techniques were not universally applied in routine histopathological analysis
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