title: Quantitative investigation of desmoplasia as a prognostic indicator in colorectal cancer.
abstract: BACKGROUND
  The role of desmoplastic reaction (DR) in colorectal cancer invasion is still an open question. The presence of fibrous connective tissue may represent a barrier against cancer diffusion or a stroma to build up and support the tumor. Aims of the present study were to evaluate the influence of DR on long-term survival and to validate a reliable quantitative method to measure the desmoplastic tissue.
  
  
  METHODS
  This retrospective study included 86 patients who underwent radical colorectal resection for cancer, from a database of 429 patients. To achieve a quantitative histochemical measurement of DR, digital images were analyzed by a computerized image analysis program. DR was related to the overall survival and the quantitative method was related to the traditional one.
  
  
  RESULTS
  By using the Kaplan-Meier analysis, DR was found to be significantly associated with overall survival. Patients with a higher value of DR survived longer than those with smaller DR and the quantitative results were in accordance with those obtained by using the traditional methods.
  
  
  CONCLUSIONS
  Desmoplasia seems to be a protective factor for survival in patients with colorectal carcinoma. The quantitative technique is easily standardized and can be routinely performed, so that DR may be a useful prognostic indicator. Notwithstanding, the conflicting outcomes reported in literature about DR need further biological and molecular studies to achieve definitive conclusions.
authors.affiliation: Department of Surgery Pietro Valdoni, University of Rome Sapienza, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Caporale
authors.forename: Stefano
authors.initials: S
authors.lastname: Amore Bonapasta
authors.forename: Massimo
authors.initials: M
authors.lastname: Scarpini
authors.forename: Antonio
authors.initials: A
authors.lastname: Ciardi
authors.forename: Annarita
authors.initials: A
authors.lastname: Vestri
authors.forename: Mariangela
authors.initials: M
authors.lastname: Ruperto
authors.forename: Andrea
authors.initials: A
authors.lastname: Giuliani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D005355:Fibrosis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies