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Review
. 2014 Jul 2:6:291-300.
doi: 10.2147/CMAR.S38827. eCollection 2014.

Prognostic stratification of colorectal cancer patients: current perspectives

Nora I Schneider  1 , Cord Langner  1
Affiliations
Review

Prognostic stratification of colorectal cancer patients: current perspectives

Nora I Schneider et al. Cancer Manag Res. .

Abstract

Tumor staging according to the American Joint Committee on Cancer/Union for International Cancer Control tumor, node, metastasis (TNM) system is currently regarded as the standard for staging of patients with colorectal cancer. This system provides the strongest prognostic information for patients with early stage disease and those with advanced disease. For patients with intermediate levels of disease, it is less able to predict disease outcome. Therefore, additional prognostic markers are needed to improve the management of affected patients. Ideal markers are readily assessable on hematoxylin and eosin-stained tumor slides, and in this way are easily applicable worldwide. This review summarizes the histological features of colorectal cancer that can be used for prognostic stratification. Specifically, we refer to the different histological variants of colorectal cancer that have been identified, each of these variants carrying distinct prognostic significance. Established markers of adverse outcomes are lymphatic and venous invasion, as well as perineural invasion, but underreporting still occurs in the routine setting. Tumor budding and tumor necrosis are recent advances that may help to identify patients at high risk for recurrence. The prognostic significance of the antitumor inflammatory response has been known for quite a long time, but a lack of standardization prevented its application in routine pathology. However, scales to assess intra- and peritumoral inflammation have recently emerged, and can be expected to strengthen the prognostic significance of the pathology report.

Keywords: blood-vessel invasion; colorectal cancer; lymphatic invasion; perineural invasion; tumor budding; tumor necrosis.

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Figures

Figure 1
Figure 1
(A–D) Histopathological variants of colorectal cancer. (A) Mucinous adenocarcinoma characterized by abundant extracellular mucin production; (B) signet ring-cell carcinoma with prominent intracytoplasmic mucin deposition, causing displacement and molding of tumor-cell nuclei; (C) medullary carcinoma characterized by sheets of malignant cells with vesicular nuclei with prominent nucleoli and abundant eosinophilic cytoplasm (note prominent lymphocytic infiltration of the tumor tissue); (D) micropapillary adenocarcinoma with characteristic small papillary and trabecular tumor-cell clusters within stromal spaces mimicking vascular channels.
Figure 2
Figure 2
(A–D) Major prognostic variables in colorectal cancer. (A) Lymphatic invasion is diagnosed when tumor cells are present in vessels with an unequivocal endothelial lining, yet lacking a thick (muscular) wall; (B) blood vessel invasion refers to the involvement of veins, and is characterized histologically by the presence of tumor cells in vessels with a thick (muscular) wall or in vessels containing red blood cells; (C) perineural invasion is defined by tumor-cell invasion of nerves and/or spread along nerve sheaths; (D) tumor budding is characterized by the presence of isolated single cells or small clusters of cells composed of less than five cells scattered in the stroma at the invasive tumor margin.
Figure 3
Figure 3
(A–D) Additional prognostic variables in colorectal cancer. (A) Coagulative tumor necrosis reflecting chronic ischemic injury due to rapid tumor growth. Assessing the anti-tumoral inflammatory response is another novel prognostic tool which commonly indicates favorable outcome. (B) Marked overall inflammation at the tumor margin, characterized by a mixed inflammatory infiltrate with destruction of cancer-cell islets. (C) Antitumor immune response, characterized by dense peritumoral lymphocytic infiltration; (D) Eosinophilic infiltration of the tumor area (tumor-associated tissue eosinophilia).
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