[New prognostic parameters and categories of colorectal carcinoma--correlation with standards].
The proper staging of colorectal cancer was discussed with emphasis on the most relevant pathological parameters. Standard staging classifications i.e. Dukes', Astler-Coller's and international TNM classifications are defined by a few basic parameters, namely local invasion and lymph node metastasis, along with the histological grade of differentiation. Advances in diagnosis and treatment and modern aspects of tumor biology introduced other prognostic factors regarding proliferative activity of tumor, its local and systemic effects, host defense mechanisms and metastatic potential. Independent prognostic significance was shown and/or new criteria recommended for: resection margin and peritoneal involvement, vascular invasion, tumoral mucin production activity, presence of extranodal (micro) metastasis, extent of presented (extra) mural tumor spread, peritumoral lymphocytic infiltration, character of tumoral invasive margin and presence of peritumoral Crohn's-like lymphoid reaction. The se pathological parameters, discussed in detail, were partly contained in new revision of TNM or other classifications, not widely accepted, such as Jass', Japanese JSCCR, British UKCCCR classification, or new prognostic categories proposed by Harrison and coworkers. Our own first experiences and primary results showed variable agreement most of the mentioned parameters with special respect to reproducibility of Harrison's new prognostic categories. Many newly developed methods and novel tumor markers with some predictive values on clinical outcome are recently recognized, still uncertain for routine clinical usage. We reviewed in brief most important and/or most studied pathobiological predictors, such as: DNA ploidy, markers of proliferative activity, expression of tumor-specific and tumor-associated antigens or receptors. Among many of hereditary and genetic markers we stressed the importance of RER phenotype, mutations of tumor suppressor genes and some oncogenes, allelic loss of 18q, 17p and other chromosomal alleles as prognostic and screening tools or therapeutic targets. In conclusion, more new insights in carcinogenesis and new therapeutic agents will require new classification systems, never considered as definitive.
Micev
M
M
Sluzba za patohistologiju, Klinicki centar Srbije, Beograd.
Cosić-Micev
M
M
Krivokapić
Z
Z
Marković
V
V
Popović
M
M
D015179:Colorectal Neoplasms / Q000145:classification / Q000473:pathology*; D006801:Humans; D009367:Neoplasm Staging; D011379:Prognosis