Role of desmoplasia in recurrence of stage II colorectal cancer within five years after surgery and therapeutic implication.
BACKGROUND
Colorectal cancer (CRC) metastasis is enhanced in patients with venous embolization increasing the risk of recurrence and therefore mortality rate. Several evidences indicate that stage II patients have an abrupt recurrence within five years from surgery. This fact, led us to investigate the role played by different histological variables on CRC invasiveness.


OBJECTIVE
To demonstrate if quantitative and qualitative desmoplastic response and lymphocytic infiltration are prognostic factor involved in the recurrence of CRC within five years from surgery, considering possible clinical and therapeutical implications.


METHODS
Thirty-four patients with CRC underwent colectomy and the UICC-TNM classification was applied for disease staging. Histological variables were semi-quantitatively evaluated. Qualitative evaluation of desmoplasia was obtained with the hematoxillin-eosin method.


RESULTS
Survival rate arose 88% at stage II, at five years of follow-up, and the 12% not treated with adjuvant chemotherapy developed metastasis. Desmoplasia is strongly associated with venous neoplastic invasiveness (OR: 21.93; 95%CI: 1.012-475.26, p = 0.02), and therefore, with mortality rate (OR: 14.33; 95%CI: 0.67-304, p = 0.04). Moreover, mortality rate was significantly higher in patients with immature desmoplasia compare to mature stromal tissue (OR: 15.61, 95%CI: 0.69-343.38, p = 0.04).


CONCLUSIONS
These observations should prompt a future evaluation of desmoplasia to extent more suitably the use of adjuvant chemotherapy in II stage patients. Further clinical trials are needed to determine if these findings will be able to reduce mortality rate, in stage II CRC patients.
Crispino
Pietro
P
Gastroenterology Unit, Department of Clinical Sciences, University La Sapienza of Rome, Italy.
De Toma
Giorgio
G
Ciardi
Antonio
A
Bella
Antonino
A
Rivera
Margherita
M
Cavallaro
Giuseppe
G
Polistena
Andrea
A
Fornari
Francesca
F
Unim
Hans
H
Pica
Roberta
R
Cassieri
Claudio
C
Mingazzini
Pietro Luigi
PL
Paoluzi
Paolo
P
D000230:Adenocarcinoma / Q000098:blood supply / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000098:blood supply / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006801:Humans; D016246:Lymphocytes, Tumor-Infiltrating / Q000473:pathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009360:Neoplastic Cells, Circulating; D012306:Risk; D013194:Staining and Labeling; D017154:Stromal Cells / Q000473:pathology; D016019:Survival Analysis; D015996:Survival Rate; D014680:Veins
D000970:Antineoplastic Agents