RESUMEN
PURPOSE: Classification based on a combination of molecular and pathologic predictors had never been done using hierarchical cluster analysis. For this purpose, we identified prognostic classification based on molecular predictors, pathologic and molecular predictors, and compared their respective prognostic efficacy together with that of tumor-node-metastasis (TNM) stage. Moreover, we investigated the prognostic significance of molecular classification in different TNM stage. EXPERIMENTAL DESIGN: Six pathologic predictors (p) and 13 immunohistochemical predictors (m) were investigated in 221 colorectal carcinomas. Unsupervised hierarchical clustering analysis was done to group the data. Survival analysis was done by Kaplan-Meier method and log-rank test, and by multivariate COX proportional hazard model. RESULTS: Six pathologic predictors and four molecular predictors were of significant prognostic value (P Asunto(s)
Neoplasias Colorrectales/clasificación
, Adulto
, Anciano
, Anciano de 80 o más Años
, Análisis por Conglomerados
, Neoplasias Colorrectales/genética
, Neoplasias Colorrectales/mortalidad
, Neoplasias Colorrectales/patología
, Femenino
, Humanos
, Masculino
, Persona de Mediana Edad
, Análisis Multivariante
, Pronóstico
, Modelos de Riesgos Proporcionales
, Receptores CXCR4/análisis
RESUMEN
OBJECTIVE: To investigate the effects of clinical and pathomorphological parameters on the prognosis of colon carcinoma and rectal carcinoma. METHODS: Univariate and multivariate COX proportional hazard models were used to study the effects of the clinical and pathomorphological factors on the prognosis in 101 cases of colon carcinoma, 219 of rectal carcinoma and 137 of rectal carcinoma under curative resections. RESULT: By using univariate analysis, we identified that lymph node metastasis and distant metastasis were the common prognostic factors for both colon carcinoma and rectal carcinoma. Smoking, deep infiltration, chemotherapy and serum albumin concentration were the uncertain prognostic factors for colon carcinoma. Signet-ring cell carcinoma, larger tumor size (>6 cm), deep infiltration, lack of radical surgery, and advanced TNM stage were the exclusive adverse prognostic factors for rectal carcinoma. Further studies showed that the adverse prognostic factors for the rectal carcinoma under curative resection included deep infiltration, lymph node metastasis, vessel invasion, less of peritumoral lymphocyte infiltration, lack of Crohn's like reactivity, high level of tumor budding, advanced TNM stage and positive urine glucose. By using multivariate analysis based on a COX proportional hazard model, it was identified that smoking, lymph node metastasis and serum albumin concentration were independent prognostic factors for colon carcinoma; advanced TNM stage, distant metastasis and palliative surgery for rectal carcinoma; and vessel invasion, lymph node metastasis and urine glucose for rectal carcinoma under curative resections. CONCLUSION: The various clinical and pathomorphological parameters show different prognostic value for colon carcinoma, rectal carcinoma and rectal carcinoma under curative resections.
Asunto(s)
Neoplasias del Colon/patología , Neoplasias del Recto/patología , Adulto , Anciano , Carcinoma de Células en Anillo de Sello/patología , Carcinoma de Células en Anillo de Sello/cirugía , Neoplasias del Colon/cirugía , Femenino , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Pronóstico , Modelos de Riesgos Proporcionales , Neoplasias del Recto/cirugíaRESUMEN
OBJECTIVE: To study the influence of clinical and pathological-morphological parameters on the prognosis of colorectal carcinoma. METHODS: Univariate and multivariate Cox proportional hazard model were used to study the influence of clinical and pathological-morphological factors on the prognosis in 226 colorectal carcinoma cases. RESULTS: Using univariate analysis, data showed that the factors significantly related to disease prognosis would include: the depth of direct spread, vessel invasion, perineural invasion, tumor budding, peritumoral-lymphocytic infiltration, Crohn-like reaction, number of positive lymph nodes, distant metastasis, TNM stage and urine glucose. Multivariate Cox proportional hazard model showed that six factors were identified to be associated with higher relative-risk (RR), including: older age, advanced TNM stage, more severe budding, perineural invasion, less peritumoral-lymphocytic infiltration and urine glucose. CONCLUSION: Age, TNM stage, tumor budding, perineural invasive, peritumoral-lymphocytic infiltration and urine glucose were independent predictors to the prognosis of colorectal carcinoma.