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Tumor-Induced Stenosis Can Be Considered a Prognostic Factor in Colorectal Cancer
Ralf Steinert2, Frank Meyer*1, Henry Ptok1, Michael Vieth3, Ingo Gastinger4
1Dept. of General, Abdominal and Vascular Surgery, University Hospital at Magdeburg, Magdeburg, Germany; 2Dept. of General and Abdominal Surgery, St.-Josefs Hospital at Salzkotten, Salzkotten, Germany; 3Institute of Pathology, Municipal Hospital at Bayreuth, Bayreuth, Germany; 4Institute for Quality Assurance in operative Medicine, Otto-von-Guericke University at Magdeburg, Magdeburg, Germany
In addition to modern research in the fields of genomics & proteomics, analyses of macroscopic tumor characteristics & their prognostic relevance appear as “old fashion“. However, there is no sufficient molecular parameter or a set of markers on the horizon, which are suitable to assess appropriately the prognosis of colorectal cancer. Beside the genotype, there is also the phenotype of a tumor lesion, whereby almost no data on precisely structured patient cohorts has been published so far.
Aim: By systematic additional analysis in a formerly documented historical study cohort, impact of macroscopic tumor issues as alternative to the today’s rather molecularbiological characteristics onto tumor outcome was to be investigated.
Patients & Methods: Over a time period of 3 years, all consecutive patients with colorectal cancer at the Carl-Thiem Hospital of Cottbus (n=205) who had undergone an elective, oncologically adequate resection were documented, in particular, their parameters of a minimally residual tumor disease. Among the 140 items, established clinical & histopathological data (re-checked by an investigation called “reference pathology“) added by further parameters on macroscopic tumor characteristics (obtained from tumor specimens) such as growing types were evaluated. With regard to the occurrence of a stenosis, only a subjective yes-/no-option of response including data registration was possible. Median follow-up time period was 61 months. End point of the study was the tumor-related death.
Results: In 199 patients (97.1%), sufficient information on tumor stenosis was available. There were significant associations between tumor stenosis & i) pT stage (p<0.001), stage according to UICC classification (p=0.018), type of tumor growth (insular vs. circular, p<0.001), grading (p=0.044), preoperative serum CEA level (p<0.001), L status (p=0.007) & intraoperative mobility of tumor lesion (p<0.001). There was no significant correlation with nodal status, peritumorous tumor cell dissociation, tumor shape & tumor site. Cases with a tumor-based stenosis were associated with a significantly worse tumor-dependent survival in both univariate Kaplan-Meier assessment (p=0.001) & in multivariate Cox regression analysis (p=0.045).
Conclusion: In a controlled patient cohort, detection of a stenosing tumor growth is considered an independent prognostic parameter. Macroscopic tumor issues characterizing tumor phenotype & manifestation of genotype should be included in the overall prognostic assessment of a tumor disease.
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