Prognostic value of elastic lamina staining in patients with stage III colon cancer

Abstract

Objective: The objectives of this study were to analyze the difference between the preoperative radiological and postoperative pathological stages of colorectal cancer (CRC) and explore the feasibility of elastic lamina invasion (ELI) as a prognostic marker for patients with stage III colon cancer.

Methods: A total of 105 consecutive patients underwent radical surgery (R0 resection) for stage III colon cancer at the Cancer Hospital of China Medical University between January 2015 and December 2017. Clinicopathological features, including radiological stage and elastic lamina staining, were analyzed for prognostic significance in stage III colon cancer.

Results: A total of 105 patients with stage III colon cancer who met the criteria and had complete data available were included. The median follow-up period of survivors was 41 months. During the follow-up period, 33 (31.4%) patients experienced recurrence after radical resection, and the 3-year disease-free survival (DFS) rate was 64.8%. The consistency between preoperative radiological and postoperative pathological staging was poor (κ = 0.232, P < 0.001). The accuracy of ≤ T2 stage diagnoses was 97.1% (102/105), that of T3 stage was 60.9% (64/105), that of T4a stage was 68.6% (72/105) and that of T4b stage was 91.4% (96/105). The DFS rate of T3 ELI (+) patients was significantly lower than that of both T3 ELI (-) patients (P = 0.000) and pT4a patients (P = 0.013). The DFS rate of T3 ELI (-) patients was significantly higher than that of pT4b patients (P=0.018). T3 ELI (+) (HR (Hazard ratio), 8.444 [95% CI, 1.736-41.067]; P = 0.008), T4b (HR, 57.727[95% CI, 5.547-600.754]; P = 0.001), N2 stage (HR, 10.629 [95% CI, 3.858-29.286]; P < 0.001), stage III (HR, 0.136 [95% CI, 0.31-0.589]; P = 0.008) and perineural invasion (PNI) (HR, 8.393 [95% CI, 2.094-33.637]; P = 0.003) were independent risk factors for postoperative recurrence of stage III colon cancer.

Conclusions: The consistency between preoperative radiological and postoperative pathological staging was poor, especially for tumors located in the ascending colon and descending colon. Elastic lamina staining is expected to become a stratified indicator of recurrence risk for patients with stage III colon cancer and a guide for individualized adjuvant chemotherapy, thus improving patient prognosis.

Keywords: Colon cancer; Disease-free survival; Elastic lamina invasion; Elastic lamina staining; Recurrence risk.

Fig. 1

Elastic lamina staining of normal colon tissue (Fig. 1: × 100). Elastic lamina in the subserosal area; S: serosal surface. The black arrow indicates the elastic lamina

Fig. 2

Elastic lamina staining of patient tissue sections. A, B The elastic lamina showed a “ring pattern”, and tumor cells invaded the elastic lamina, evaluated as pT3 ELI (+). S: serosal; T: tumor. The black arrow indicates the elastic lamina; (A: × 40, B: × 100). C, D The tumor approached the serosa but did not penetrate the elastic lamina, evaluated as pT3 ELI (−); S: serosal; T: tumor. The black arrow indicates the elastic lamina; (C: × 40, D: × 100). E, F The tumor approached the serosa but showed no staining for the elastic lamina, evaluated as pT3 EI (−); S: serosal; T: tumor. The black arrow indicates the elastic lamina; (E: ×40, F: × 100)

Fig. 3

DFS based on the differences between preoperative radiology and postoperative pathology T stages

Fig. 4

Association between DFS and tumor infiltration depth