Importance of tumor pathology and morphology in patients with surgically resected colon cancer. Findings from the gastrointestinal tumor study group

Abstract

Previous analyses of findings from the Gastrointestinal Tumor Study Group (GITSG) study G I 6175, a four-arm randomized trial of patients with adjuvant colon cancer, have revealed no efficacy for chemotherapy or immunotherapy, but Dukes' Stage was found to have prognostic significance in both survival and disease-free survival. In this study, the exophytic tumor as primary type, maximal tumor dimension, and degree of differentiation were examined for prognostic importance. In a model simultaneously including treatment effects, significance levels for prognosis in total survival were: Dukes' stage (P < O.OOOl), exophytic tumors (P = 0.05), maximal dimension (P = 0.005) ' and well versus poor differentiated tumors (P = 0.06). This observation about tumor length, adjusted for stage and morphology, provides evidence that size is prognostic in colonic tumors. In addition, an interaction between tumor morphology and immunotherapy, adjusted for Dukes' stage, was noted. In 100 patients with exophytic tumors, significant survival and disease-free survival benefit (P < 0.02) from immunotherapy occurred. Tumor morphology is found to be an important prognostic variable and should be carefully considered in the construction of future trials in this disease site. and was terminated in 1979 when the goal of 130 evaluable patients per arm was achieved. Median follow-up now exceeds 5.5 years. No significant effects were attributable to any individual treatment arm. When patients were grouped by "chemotherapy versus no chemotherapy" or "immunotherapy versus no immunotherapy" again no definitive differences attributable to therapy could be defined. To investigate the importance of tumor morphology and pathology in these study patients, the effects of exophytic primary tumors (those with a polypoid morphology extending into the luminal space), maximal tumor dimension, venous and lymphatic invasion, and the degree of tumor differentiation were evaluated as prognostic factors.

Expression of Vitamin D Receptor and 25-Hydroxyvitamin D3-1α-Hydroxylase in Normal and Malignant Human Colon

“…2 and 3). Because colorectal cancer is heterogeneously differentiated (12,17,18), we also could assess the expression of these proteins as a function of tumor cell differentiation, again with all evaluation done in the same patient. Overall, the 10 colorectal cancers studied contained 53 separate and distinct regions of well-differentiated tumor, 66 that were moderately differentiated, and 32 that were poorly differentiated.…”

“…Clinically, the most important implication of tumor differentiation relates to the fact that it predicts the development of metastases for most solid tumors (36,37). In contrast, colon cancers are unusual and differ from most other solid tumors, including even rectal cancers (17), insofar they tend to be heterogeneously differentiated (12,18). Thus, assessing an entire colon cancer's ''differentiation,'' as is usually done by clinical pathologists when assessing tumor ''grade,'' does not provide information useful for predicting a patient's outcome or survival.…”

Expression of angiopoietin-like 4 (ANGPTL4) in human colorectal cancer: ANGPTL4 promotes venous invasion and distant metastasis

“…However, the detailed mechanisms of Angptl4 protein in human colorectal cancer requires further investigation. (1)(2)(3)(4)(5)(6) and human colorectal cancer cell lines (7)(8)(9)(10)(11)(12) …”

“…the occurrence and progression of cancer are considered to be a series of genetic events affecting the structure and/or expression of a number of oncogenes, tumour suppressors, and growth factors (2,3). the deep invasive carcinomas, such as colorectal cancer, have higher rates of lymph duct and venous invasions, and lymph node metastasis (3).…”

Expression of the ets-1 Proto-Oncogene in Human Colorectal Carcinoma

“…Usually, these parameters can be determined by microscopic examination of tissue sections from the primary neoplasm and lymph nodes (1). However, only histopathological examination of primary colorectal carcinoma specimens cannot always elucidate the prognosis (1).…”