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The presence of poorly differentiated clusters predicts survival in stage II colorectal cancer

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Abstract

In stage II colorectal carcinoma (CRC), adjuvant chemotherapy is reserved to cases at high risk of adverse outcome. This study aims to investigate the prognostic value of tumor budding (TB) and poorly differentiated clusters (PDC) in this setting. In a cohort of 149 patients with surgically resected stage II CRC not undergoing neoadjuvant or adjuvant treatments, we assessed the prognostic value of several clinical-pathological variables, including PDC and TB, on cancer-specific survival (CSS). Rectal location, lymphovascular invasion, and a number of lymph nodes < 12 confirmed to be significant and independent predictors of shorter CSS. A total of 117 CRCs were graded as PDC-G1 (0–4 PDCs), 19 as PDC-G2 (5–9 PDCs), and 13 as PDC-G3 (> 9 PDCs). Ninety-eight cases had PDC absent. TB foci were found in 91 CRCs; 121 were classified Bd1, 16 were Bd2, and 12 were Bd3. PDC-G2/G3 was significantly prognostic of shorter CSS (P < 0.0001). Among PDC-G1 cases, the presence of PDC was significantly associated with reduced CSS (P < 0.0001). Moreover, in the whole 149 CRCs, it had higher sensitivity and specificity to identify high-risk patients, compared to PDC grade, and it was independently associated with shorter CSS at multivariate analysis. High TB grade (Bd3) was significantly associated with shorter CSS (P = 0.0001), but it lost prognostic value at multivariate analysis. These findings suggest that the presence of PDC in stage II CRCs might be added to the pool of high-risk factors, warranting the use of adjuvant chemotherapy.

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Data will be available upon request to corresponding author.

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Funding

FUR 2019, University of Verona, Italy, to VB.

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Authors and Affiliations

  1. Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy

    Serena Ammendola, Irene Marconi, Giulia Burato & Valeria Barresi

  2. Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University of Verona, Verona, Italy

    Giulia Turri, Cristian Conti & Corrado Pedrazzani

  3. Department of Pathology and Diagnostics, Hospital Trust of Verona, Verona, Italy

    Sara Pecori & Anna Tomezzoli

Authors
  1. Serena Ammendola
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Contributions

Draft of the paper: SA, IM, GB, VB.

Collection and analysis of histological data: SA, IM, GB, SP, AT, VB.

Collection and analysis of clinical data: GT, CC, CP.

Statistical analyses: GB, VB.

Revision of the paper: SP, AT, CP, VB.

Corresponding author

Correspondence to Valeria Barresi.

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Ethical issues

All methods used in this study were performed in accordance with the relevant ethical guidelines and regulations of the University Hospital of Verona, where the investigation was carried out. The study was approved by the Verona University Hospital Ethics Committee (ID number: 42763-CRINF-1034 CESC). Informed consent was obtained from all patients enrolled in the study.

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The authors declare that they have no conflict of interest.

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Verona University Hospital Ethics Committee (ID number: 42763-CRINF-1034 CESC).

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Ammendola, S., Turri, G., Marconi, I. et al. The presence of poorly differentiated clusters predicts survival in stage II colorectal cancer. Virchows Arch 478, 241–248 (2021). https://doi.org/10.1007/s00428-020-02880-y

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  • DOI: https://doi.org/10.1007/s00428-020-02880-y

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