Correlation between differentiation grade and lymphovascular invasion in colorectal adenocarcinoma
Abstract
Colorectal carcinoma is the third most common malignant tumor worldwide. It is a heterogeneous disease with diverse clinicopathological and prognostic characteristics. The TNM (tumor, node, metastasis) staging system is currently used as a prognostic predictor. However, its predictive value is limited, as approximately 30% of patients with lymph node-negative disease die due to metastasis progression. It is suspected that other prognostic factors other than TNM staging system, may play a significant role. Differentiation grade and lymphovascular invasion have been proposed as essential prognostic factors for lymph node-negative colorectal carcinoma. This study aimed to evaluate the correlation between differentiation grade and lymphovascular invasion in colorectal carcinoma. It was an observational study with a cross-sectional design. Samples were collected from 4 Anatomical Pathology laboratories in West Sumatera in 2018. A total of 97 paraffin blocks of colorectal adenocarcinoma met the inclusion criteria. Differentiation grade and lymphovascular invasion were evaluated according to the 2019 World Health Organization (WHO) classification. The correlation between differentiation grade and lymphovascular invasion was analyzed using Fisher's Exact test. A p value <0.05 considered statistically significant. The most prevalent age group for cases of colorectal adenocarcinoma was 51–60 yr (36.1%). Low-grade differentiation was the most common grade of differentiation (72.2%). Lymphovascular invasion in small vessels was commonly encountered (73.3%). High-grade differentiation adenocarcinomas had 100% lymphovascular invasion. A significant correlation between differentiation grade and lymphovascular invasion was observed (p = 0.031). This study confirms that lymphovascular invasion is a valuable predictor of colorectal carcinoma progressiveness.
References
Bray F, Ferlay J, Soerjomataram I. Global Cancer Statistics 2018 : GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. 2018; 68:394-424.
https://doi.org/10.3322/caac.21492
International Agency for Research on Cancer WHO. Cancer today. IARC Web site. https://gco.iarc.fr/today/. Accessed April 21, 2020.
van Wyk HC, Roxburgh CS, Horgan PG, Foulis AF, McMillan DC. The detection and role of lymphatic and blood vessel invasion in predicting survival in patients with node negative operable primary colorectal cancer. Crit Rev Oncol Hematol 2014; 90(1):77-90.
https://doi.org/10.1016/j.critrevonc.2013.11.004
Yuan H, Dong Q, Zheng B, Hu X, Xu JB, Tu S. Lymphovascular invasion is a high risk factor for stage I/II colorectal cancer: a systematic review and meta-analysis. Oncotarget 2017; 8(28):46565-79.
https://doi.org/10.18632/oncotarget.15425
Downs-Kelly E, Rubin BP, Goldblum JR. Odze and goldblum surgical pathology of the GI tract, liver, biliary tract, and pancreas. 3rd ed. Robert D. Odze JRG, editor. Philadelphia: Saunders; 2015. 822-9 p.
ID Nagtegaal, MJ Arends, M Salto-Tellez. Colorectal Carcinoma. In: the WHO Classification of Tumors Editorial Board, ed. WHO Classification of Tumours digestive system tumors. 5th ed. IARC; 2019. 177-87 p.
Ashwini K, Padmavathi R. A study on expression of vascular endothelial growth factor in colorectal malignancies and its correlation with various clinicopathological parameters. JCDR 2018; 12(1):1-4.
https://doi.org/10.7860/JCDR/2018/28992.11033
Washington MK, Berlin J, Branton P, Burgart LJ, Carter DK, Fitzgibbons PL, et. al. Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum. Arch Pathol Lab Med 2009; 133(10):1539-51.
https:// doi: 10.5858/133.10.1539.
Syukri SA, Tofrizal, Asri A, Agus S. Profil klinikopatologik karsinoma kolorektal di Laboratorium Patologi Anatomik di Sumatera Barat periode Juli 2016 sampai Juni 2017, reevaluasi subtipe histopatologik berdasarkan klasifikasi WHO 2010. [Laporan Penelitian]. Fakultas Kedokteran Universitas Andalas. 2018.
Gunasekaran V, Ekawati NP, Sumadi IWJ. Karakteristik klinikopatologi karsinoma kolorektal di RSUP Sanglah, Bali, Indonesia tahun 2013-2017. ISM 2019; 10(3):552-6.
https://doi.org/10.15562/ism.v10i3.458
IARC Handbooks of Cancer Prevention-17. Colorectal cancer screening. Lyon: IARC; 2019. 27-50.
Kumar V, Abbas AK, Aster JC. Small and Large Intestine. Robbins Basic Pathology.10th ed. Philadelphia: Elsevier; 2018. 630-34 p.
Izzaty AH. Hubungan antara faktor usia dengan kejadian kanker kolorektal di RSUD Moewardi Surakarta Tahun 2010-2013 [Thesis]. Surakarta: Universitas Muhammadiyah Surakarta; 2015.
Chacko L, Macaron C, Burke CA. Colorectal cancer screening and prevention in women. Dig Dis Sci 2015; 60(3):698-710.
https://doi.org/10.1007/s10620-014-3452-4
Clendenen TV, Koenig KL, Shore RE, Levitz M, Arslan AA, Zeleniuch-Jacquotte A. Postmenopausal levels of endogenous sex hormones and risk of colorectal cancer. Cancer Epidemiol Biomarkers Prev 2009; 18(1):275-81.
https://doi.org/10.1158/1055-9965.EPI-08-0777
Walsh SV, Carey FA. Malignant epithelial neoplasms of the large bowel. In: Shepherd NA, Warren BF, William GT, Greenson JK, Lauwers GY, Novelli MR. Morson and Dawson's Gastrointestinal Pathology. 5th ed. United Kingdom: Blackwell; 2013. 685-712 p.
https://doi.org/10.1002/9781118399668.ch38
Ratnasari D, Mughni A, Yudhanto E, Budijitno S. Differences in the degree of differentiation of colorectal adenocarcinoma in the young, middle and old age groups at RSUP Dr. Kariadi Semarang [Thesis]. Semarang: Universitas Diponegoro; 2012.
Anggunan. Hubungan antara usia dan jenis kelamin dengan derajat diferensiasi adenokarsinoma kolon melalui hasil pemeriksaan histopatologi di RSUD Dr. H. Abdul Moeloek Provinsi Lampung. J Medika Malahayati 2015; 1(4):161–8
Jayadi T, Harjadi, Tirtoprodjo P. Hubungan ekspresi protein NM23-H1, densitas limfovaskuler peritumoral dan invasi limfovaskuler dengan stadium dan diferensiasi histopatologi adenokarsinoma kolorekta. Maj Patol 2013; 22(2).
Devianti L, Agus S. Hubungan antara beberapa faktor prognostik klinikopatologik karsinoma kolorektal di RSUD Dr. Achmad Mochtar Bukittinggi Tahun 2015-2017. J Kes Andalas 2109; 8(2):269-74.
Pai RK, Gonzalo DH, Schaeffer DF. Epithelial Neoplasms of the Colon. In : Noffsinger AE, Ed. Fenoglio-Preiser's Gastrointestinal Pathology. 4th ed. Philadelphia: Wolter Kluwer; 2017. 886-927 p.
Betge J, Pollheimer MJ, Lindtner RA, Kornprat P, Schlemmer A, Rehak P, et. al. Intramural and extramural vascular invasion in colorectal cancer: prognostic significance and quality of pathology reporting. Cancer 2012; 118(3):628-38.
https://doi.org/10.1002/cncr.26310
Betge J, Langner C. Vascular invasion, perineural invasion, and tumour budding: predictors of outcome in colorectal cancer. Acta Gastroenterol Belg 2011; 74(4):516-29.
Aktekin A, Özkara S, Gürleyik G, Odabaşi M, Müftüoğlu T, Sağlam A. The factors effecting lymphovascular invasion in adenocarcinoma of the colon and rectum. Indian J Surg 2015; 77(Suppl 2):314-8.
https://doi.org/10.1007/s12262-013-0816-5
Kim BH, Kim JM, Kang GH, Chang HJ, Kang DW, Kim JH, et al. Standardized pathology report for colorectal cancer, 2nd Edition. J Pathol Transl Med 2020; 54(1):1-19.
https://doi.org/10.4132/jptm.2019.09.28
Schneider NI, Langner C. Prognostic stratification of colorectal cancer patients: current perspectives. Cancer Manag Res 2014; 6:291-300.
https://doi.org/10.2147/CMAR.S38827
Marzouk O, Schofield J. Review of histopathological and molecular prognostic features in colorectal cancer. Cancers (Basel) 2011; 3(2):2767-810.
https://doi.org/10.3390/cancers3022767
Al-Sukhni E, Attwood K, Gabriel EM, LeVea CM, Kanehira K, Nurkin SJ. Lymphovascular and perineural invasion are associated with poor prognostic features and outcomes in colorectal cancer: A retrospective cohort study. Int J Surg 2017; 37:42-9.
https://doi.org/10.1016/j.ijsu.2016.08.528
Minhajat R, Benyamin AF, Miskad UA. The relationship between histopathological grading and metastasis in colorectal carcinoma patients. Nusantara Med Scie J 2020; 5(2):51-60.
