title: Morphofunctional malignancy grading is a valuable prognostic factor for colorectal cancer.
abstract: BACKGROUND
  Novel strategies are needed to identify more efficient biomarkers to accurately diagnose prognose and improve the treatment outcome of colorectal cancer.
  
  
  OBJECTIVE
  To analyze the functional and morphological features of colorectal cancer to identify the neoplastic patterns that affect patient survival.
  
  
  METHODS
  Forty-five patients with colorectal cancer were followed for a minimum of 3 years. Blood levels of carcinoembryonic antigen (CEA) were measured by chemiluminescence and immunohistochemical analysis of tissue expression followed by computer-assisted image processing. Tumors were assigned to three morphofunctional classes. The morphofunctional classification was based on combination between histological differentiation and cell polarization. The functional characterization was based on the CEA cell polarization. The tissue polarization of CEA was classified in well-polarized, moderately polarized or nonpolarized cells. Morphofunctional staging was defined by the association between morphofunctional class (polarization and histological differentiation) and TNM by score given to each one classification.
  
  
  RESULTS
  There was an association between increased CEA tissue expression and loss of histological differentiation (P = 0.01) or loss of polarization capacity (P = 0.03). There was a progressive increase in tissue CEA quantities in accordance with the proposed morphofunctional grading system. Plasma levels of CEA were increased in advanced tumor stages. Blood levels of CEA were increased in advanced morphofunctional stages (P = 0.001). There was a relationship between survival outcome and morphofunctional staging (P = 0.005).
  
  
  CONCLUSIONS
  Morphofunctional staging is a valuable prognostic factor for colorectal cancer and it correlates with plasma CEA levels.
authors.affiliation: Universidade São Francisco, Bragança Paulista, SP, Brazil. depriolli@terra.com.br
authors.forename: Denise Gonçalves
authors.initials: DG
authors.lastname: Priolli
authors.forename: Carlos Augusto Real
authors.initials: CA
authors.lastname: Martinez
authors.forename: Helenice
authors.initials: H
authors.lastname: Piovesan
authors.forename: Izilda Aparecida
authors.initials: IA
authors.lastname: Cardinalli
authors.forename: Nelson Fontana
authors.initials: NF
authors.lastname: Margarido
authors.forename: Jaques
authors.initials: J
authors.lastname: Waisberg
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis*; D002272:Carcinoembryonic Antigen / Q000032:analysis*; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007150:Immunohistochemistry; D049449:Luminescence; D009367:Neoplasm Staging / Q000379:methods; D011379:Prognosis; D016019:Survival Analysis
chemical_list: D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen