Histopathologic factors affecting tumor recurrence after hepatic resection in colorectal liver metastases

Abstract

PurposeHepatic resection is a standard method of treatment for colorectal liver metastases (CRLM). However, the pathologic factors of metastatic lesions that affect tumor recurrence are less well defined in CRLM. The aim of this study was to evaluate the risk factors for recurrence of CRLM, focusing on histopathologic factors of metastatic lesions of the liver.MethodsFrom January 2003 to December 2008, 117 patients underwent curative hepatic resection for CRLM were reviewed. Tumor size and number, differentiation, tumor budding, angio-invasion, dedifferentiation and tumor infiltrating inflammation of metastatic lesions were investigated.ResultsThe mean number of hepatic tumors was 2 (range, 1-8). The mean size of the largest tumor was 2.9 cm (range, 0.3-18.5 cm) in diameter. The moderate differentiation of the hepatic tumor was the most common in 86.3% of the patients. Tumor budding, angio-invasion, and dedifferentiation were observed in 81%, 34%, and 12.8% of patients. Inflammation infiltrating tumor was detected in 6.8% of patients. Recurrence after hepatic resection appeared in 69 out of 117 cases (58.9%). Recurrence-free survival at 1, 2 and 5 years were 62.4%, 43.6%, and 34.3%. The multivariate analysis showed the number of metastases ≥3 (P = 0.007), the tumor infiltrating inflammation (P = 0.047), and presence of dedifferentiation (P = 0.020) to be independent risk factors for tumor recurrence.ConclusionHistopathological factors, i.e., dedifferentiation and tumor infiltrating inflammation of the metastatic lesion, could be one of the risk factors of aggressive behavior as well as the number of metastases even after curative resection for CRLM.

Pathological factors and prognosis of resected liver metastases of colorectal carcinoma: implications and proposal for a pathological reporting protocol

“…Vascular invasion can occur through portal or hepatic veins . Some studies differentiated between portal vein and hepatic vein invasion, whereas others did not establish a prognostic distinction . Shirabe et al .…”

“…17 Some studies differentiated between portal vein and hepatic vein invasion, 17,18,65 whereas others did not establish a prognostic distinction. 63,64,66 Shirabe et al 65 and Sasaki et al 17 studied portal vein invasion and hepatic vein invasion separately among patients with CRLMs who underwent liver resection, and noted that neither was a significant prognostic factor. In contrast, Yamamoto et al 18 analysed portal and hepatic vein invasion, and noted that both were independent factors associated with poor prognosis after liver resection.…”

CD4 T cells target colorectal cancer antigens upregulated by oxaliplatin

“…More than half of CRC patients will develop metastases during the course of the disease, and the quarter has distant metastases at diagnosis, mainly in the liver . Although liver surgery can cure metastatic colorectal cancer (mCRC) in some cases, tumor recurrence affects 50% to 75% of the patients within 2 years . The hypothetical mechanisms of recurrence include remaining cancer cells or occult micrometastases unseen at the time of surgery .…”

Prognostic significance of poorly differentiated clusters and tumor budding in colorectal liver metastases

“…As the liver is the most common metastatic site for CRC, many different histomorphological features have been examined and proposed to stratify patients with colorectal liver metastases (CLM) into distinct prognostic groups . The prognostic impact of a variety of factors including the presence of intrahepatic lymphatic vascular invasion, vascular invasion, infiltrative tumor border, the absence of tumor pseudocapsule, and peritumoral and intratumoral inflammatory infiltrate has been investigated . In contrast, while examined in primary CRC tumors, only one study on TB has been reported among patients with CLM, and the prognostic implications of PDC among patients with CLM has not been examined to date.…”

“…17,18 The prognostic impact of a variety of factors including the presence of intrahepatic lymphatic vascular invasion, vascular invasion, infiltrative tumor border, the absence of tumor pseudocapsule, and peritumoral and intratumoral inflammatory infiltrate has been investigated. 17,[19][20][21][22][23] In contrast, while examined in primary CRC tumors, only one study on TB has been reported among patients with CLM, 23 and the prognostic implications of PDC among patients with CLM has not been examined to date. Therefore, the objectives of the current study were to assess the presence and incidence of TB and PDC among CLM, as well as define the prognostic impact of TB and PDC.…”