Role of Desmoplasia in Recurrence of Stage II Colorectal Cancer within Five Years after Surgery and Therapeutic Implication

• Published in: Cancer investigation 2008-01, Vol.26 (4), p.419-425
• Main Authors: Crispino, Pietro, De Toma, Giorgio, Ciardi, Antonio, Bella, Antonino, Rivera, Margherita, Cavallaro, Giuseppe, Polistena, Andrea, Fornari, Francesca, Unim, Hans, Pica, Roberta, Cassieri, Claudio, Mingazzini, Pietro Luigi, Paoluzi, Paolo
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - blood supply; Adenocarcinoma - drug therapy; Adenocarcinoma - epidemiology; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Aged; Antineoplastic Agents - therapeutic use; Chemotherapy, Adjuvant; Colectomy; Colorectal cancer; Colorectal Neoplasms - blood supply; Colorectal Neoplasms - drug therapy; Colorectal Neoplasms - epidemiology; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Combined Modality Therapy; Desmoplasia; Disease recurrence; Follow-Up Studies; Humans; Lymphocytes, Tumor-Infiltrating - pathology; Middle Aged; Mortality; Neoplasm Invasiveness; Neoplasm Metastasis; Neoplasm Staging; Neoplastic Cells, Circulating; Risk; Staining and Labeling; Stromal Cells - pathology; Survival Analysis; Survival Rate; Veins
• ISSN: 0735-7907; 1532-4192
• DOI: 10.1080/07357900701788155

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. Aim: 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 evaluted. 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 adiuvant 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.