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JOURNAL OF MEDICAL AND SURGICAL RESEARCH - Special Issue "Pathology", March, 2023

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What prognostic impact of necrosis in colic adenocarcinoma ?

Author: H. Abdoulaye Biyou, S. El yaagoubi, M. Omari, L.Tahiri, N. Hammas, L. Chbani

Category: JMSR Pathology

Abstract:

Background: Colon cancer is a real public health problem. Tumor necrosis has been proposed as an independent prognostic marker for colon cancer following a number of similar studies reporting necrosis as a marker of poor prognosis in renal, breast and lung carcinomas. The mechanisms underlying the relationship between necrosis and cancer survival, however, are unclear.

The aim of this work is to analyze the prognostic value of tumor necrosis in colonic adenocarcinomas by comparing our results with those of the literature.

Methods: This is a retrospective study of 100 cases of colonic adenocarcinoma diagnosed in the pathological anatomy and cytology department of CHU Hassan II in FES. The diagnosis was made after histological study. Tumor sections were made and the presence of necrosis was split into 2 groups: more than 50% or less than

50%. Correlations have been made between the presence of necrosis and its extent and the various histoprognostic factors and patient survival.

Statistical analysis was performed using SPSS software and a correlation is considered significant if p<0.0.5. Overall survival was assessed using the Kaplan Meier method.

Resultats : 100 cases of colonic adenocarcinoma were included in our work. Average age: 57 (29 and 89). Gender: MlF: 1l17. Most common location: right colon. The most common histological type: moderately differentiated adenocarcinoma. The follow-up of our patients: 43 months and 5 months (average: 47 months). The extent of tumor necrosis: less than 50% (73%) and more than 50% (27%). 56% of patients with >50% necrosis also had vascular emboli.

Discussion: Previously, tumor necrosis has shown prognostic value in a variety of solid organ tumors including renal, breast, lung, pancreatic, and colorectal. It appears from these and similar studies that necrosis is not an isolated pathological feature but is strongly related to other aggressive features, including tumor size, grade, and pathological stage.

In our series, the presence of necrosis was associated with an advanced stage, weak differentiation and vascular invasion. The lack of a significant relationship between necrosis and survival may be explained by the limited numbers of patients in our sample.

Conclusion: Our results show that tumor necrosis has a negative impact on patient prognosis and survival and should be included as a histoprognostic factor in pathology reports.

Keywords: Necrosis, Carcinoma, Colon

Full Text:

What prognostic impact of necrosis in colic adenocarcinoma?

H. Abdoulaye Biyou (1), S. El yaagoubi (1), M. Omari (3), L.Tahiri (1.2), N. Hammas ( 1.2), L. Chbani (1.2).

(1) Department of Pathological Anatomy and Cytology, CHU Hassan II, Fez, Morocco,

(2) Faculty of Medicine and Pharmacy, (3) Laboratory of Epidemiology and clinical research, Sidi Mohamed Ben Abdallah University, Fez, Morocco.

Corresponding author:

Abdoulaye Biyou Habsatou,

Department of Pathological Anatomy and Cytology, CHU hassan II, Fez, Morocco,

Background: Colon cancer is a real public health problem.(1) Tumor necrosis has been proposed as an independent prognostic marker for colon cancer following a number of similar studies reporting necrosis as a marker of poor prognosis in renal, breast and lung carcinomas.(2,3) The mechanisms underlying the relationship between necrosis and cancer survival, however, are unclear(3).

The aim of this work is to analyze the prognostic value of tumor necrosis in colonic adenocarcinomas by comparing our results with those of the literature.

Methods: This is a retrospective study of 100 cases of colonic adenocarcinoma diagnosed in the pathological anatomy and cytology department of CHU Hassan II in FES. The diagnosis was made after histological study. Tumor sections were made and the presence of necrosis was split into 2 groups: more than 50% or less than

50%. Correlations have been made between the presence of necrosis and its extent and the various histoprognostic factors and patient survival.

Statistical analysis was performed using SPSS software and a correlation is considered significant if p<0.0.5. Overall survival was assessed using the Kaplan Meier method.

Resultats : 100 cases of colonic adenocarcinoma were included in our work. Average age: 57 (29 and 89). Gender: MlF: 1l17. Most common location: right colon. The most common histological type: moderately differentiated adenocarcinoma. The follow-up of our patients: 43 months and 5 months (average: 47 months). The extent of tumor necrosis: less than 50% (73%) and more than 50% (27%). 56% of patients with >50% necrosis also had vascular emboli.

Discussion: Previously, tumor necrosis has shown prognostic value in a variety of solid organ tumors including renal, breast, lung, pancreatic, and colorectal.(3,4) It appears from these and similar studies that necrosis is not an isolated pathological feature but is strongly related to other aggressive features, including tumor size, grade, and pathological stage.(3,5)

In our series, the presence of necrosis was associated with an advanced stage, weak differentiation and vascular invasion. The lack of a significant relationship between necrosis and survival may be explained by the limited numbers of patients in our sample.

Conclusion: Our results show that tumor necrosis has a negative impact on patient prognosis and survival and should be included as a histoprognostic factor in pathology reports.

Keywords: Necrosis, Carcinoma, Colon.

Competing interests: we declare no conflict of interest

References:

  1. Keum NN, Giovannucci E. Global burden of colorectal cancer: emerging trends, risk factors and prevention strategies. Nat Rev Gastroenterol Hepatol. 2019;16(5)
  2. Pollheimer, M. J., Kornprat, P., Lindtner, R. A., Harbaum, L., Schlemmer, A., Rehak, P., & Langner, C. (2010). Tumor necrosis is a new promising prognostic factor in colorectal cancer. Human pathology, 41(12), 1749-1757.
  3. Richards, C. H., Roxburgh, C. S. D., Anderson, J. H., McKee, R. F., Foulis, A. K., Horgan, P.G., & McMillan, D. C. (2012). Prognostic value of tumour necrosis and host inflammatory responses in colorectal cancer. Journal of British Surgery, 99(2), 287-294.
  4. Gong, K., Guo, G., Beckley, N., Zhang, Y., Yang, X., Sharma, M., & Habib, A. A. (2021).Tumor necrosis factor in lung cancer: Complex roles in biology and resistance to treatment. Neoplasia, 23(2), 189-196.
  5. Komori, K., Kanemitsu, Y., Kimura, K., Hattori, N., Sano, T., Ito, S., ... & Shimizu, Y. (2013).Tumor necrosis in patients with TNM stage IV colorectal cancer without residual disease (R0 Status) is associated with a poor prognosis. Anticancer research, 33(3), 1099-1105.