Inflammatory infiltration, fibrosis, necrosis and mucinous content in relation to clinicopathological and molecular factors in rectal cancers with or without preoperative radiotherapy

Abstract

The association between inflammatory infiltration, fibrosis, necrosis and mucinous content in rectal cancers, and their relationship to preoperative radiotherapy (RT) clinicopathological and biological factors (p53, apoptosis and Cox-2) is not fully characterised. We analysed these histopathological parameters and their relationships in rectal cancer patients who participated in a clinical trial of preoperative RT. One hundred and forty-eight preoperative biopsies and 153 surgically resected tumours were examined. Of the surgical specimens, 81 had surgery alone and 72 received RT before surgery. A higher grade of inflammatory infiltration was related to favourable survival in the whole group of patients (p=0.004, for multivariate analysis p=0.01) as well as in the subgroups of patients with (p=0.04) or without RT (p=0.01). After RT, tumours showed a decreased infiltration (p=0.0003) and increased necrosis (p=0.006), strong necrosis was related to favourable survival (p=0.046). Necrosis (p=0.054) and fibrosis (p=0.06) tended to be increased in p53-negative tumours after RT. Inflammatory infiltration was a strong prognostic factor in rectal cancer patients, regardless of RT. RT tended to induce necrosis and fibrosis in p53-negative tumours.

Tumor necrosis is a new promising prognostic factor in colorectal cancer

“…Data regarding CRC, however, are scarce and appear to be restricted to 2 singlecenter experiences from Ireland [34] and Sweden [35]. Our data proved presence of "extensive tumor necrosis" to be an independent predictor of disease progression and cancerspecific survival in a model including a variety of established prognosticators, such as T and N classification, angioinvasion, as well as tumor grade.…”

Prognostic value of tumour necrosis and host inflammatory responses in colorectal cancer

“…Previously, tumour necrosis has shown prognostic value in a variety of solid organ tumours including renal7, breast8, lung9 pancreatic15 and colorectal6, 16–18 malignancy. It is apparent from these and similar studies that necrosis is not an isolated pathological feature but is strongly related to other aggressive characteristics including tumour size, grade and pathological stage.…”

The Prognostic Value of Histological Tumor Necrosis in Solid Organ Malignant Disease: A Systematic Review

“…In a study of 153 patients with rectal cancer, the authors reported a higher rate of recurrence in patients with extensive necrosis. However, the authors also observed an association with preoperative radiotherapy that may partly explain why necrosis did not have i ndependent prognostic value [56].…”

“…One study linked tumor necrosis with the local inflammatory response as assessed by COX-2 expression [56], while another study reported that tumors with a strong inflammatory cell infiltrate had less necrosis [53]. …”