title: Inclusion of cytological features in tumor grading improves prognostic stratification of patients with colorectal cancer.
abstract: OBJECTIVE
  Tumor grade is a traditional prognostic parameter in colorectal cancer. Remarkably, however, there is still no generally accepted consensus how to perform tumor grading. In this study, we systematically compared the prognostic value of traditional grading based upon histological features, that is, gland formation alone with grading based upon both histological and cytological features, such as nuclear pleomorphism and anaplasia ("alternative grade").
  
  
  METHODS
  Three hundred eighty-one tumors of randomly selected patients were retrospectively reviewed. Traditional and alternative tumor grades were related to various clinicopathological features and to progression-free and cancer-specific survival applying both univariate and multivariate testing.
  
  
  RESULTS
  Traditional and alternative tumor grades were significantly associated with T and N classification, tumor size, lymphovascular invasion, as well as both progression-free and cancer-specific survival. In Cox's proportional hazards regression models, the alternative grade was superior to the traditional tumor grade and was significantly associated with progression-free survival (hazard ratio 1.57, 95% confidence interval 1.04-2.35; p = 0.031), independent of patients' age and gender, T and N classification, and lymphovascular invasion. Likewise, patients with tumors with high alternative grade were more likely to die of disease (hazard ratio 1.30, 95% confidence interval 0.85-2.00), but this difference was not statistically significant (p = 0.22).
  
  
  CONCLUSIONS
  Tumor grade based upon both histological and cytological features was superior to grade based upon histological features alone and proved to be an independent prognostic parameter. Thus, tumor grade based upon both histological and cytological features may help to improve prognostic stratification and may thereby affect clinical decision-making and patient management.
authors.affiliation: Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, A-8036, Graz, Austria.
authors.forename: Annika
authors.initials: A
authors.lastname: Resch
authors.affiliation: Department of Oncology, Haematology, BMT with Section Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Harbaum
authors.affiliation: Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, A-8036, Graz, Austria.
authors.forename: Marion J
authors.initials: MJ
authors.lastname: Pollheimer
authors.affiliation: Department of Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Kornprat
authors.affiliation: Department of Surgery, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Lindtner
authors.affiliation: Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, A-8036, Graz, Austria. cord.langner@medunigraz.at.
authors.forename: Cord
authors.initials: C
authors.lastname: Langner
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D060787:Neoplasm Grading; D011379:Prognosis
keywords: Cancer-specific survival; Colorectal cancer; Histology; Progression-free survival; Tumor grade
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