Tumor Characteristics and Their Relationship to Colorectal Cancer Relapse

Poster template by ResearchPosters.co.za • Small number of patients – short time interval and selection criteria – further large scale studies are necessary; • None of the pathology related factors could be correlated to the type of relapse at a statistical significance level of 0,05 or under; • Logodds ratio correlates well with all other lymph node based scores, with the number of positive lymph nodes (p<0,001) and with the number of harvested lymph nodes (p=0,011, when Logodds is treated as a continuous variable), whereas LNR only correlates with the number of positive nodes (p<0,001), but not with the total number of harvested nodes (p= 0,235); • Logodds could be used to stratify patients in terms of relapse free survival time as shown by the Kaplan- Meier survival analysis; • In a Cox proportional hazard model we show that Logodds ratio (p=0,002) togheter with the presence of a mucionous component (p=0,008) can be used to asses the aggressivness of the tumor in terms of how fast a relapse can occur; • Longer ICU stay was positively correlated with advanced age (p = 0,024); • Hospital stay was longer for patients presenting as emergency (p = 0,002) and was inversely correlated to the disease free interval (p = 0,024); • 39 patients – 14 metastases (35,9%), 25 loco-regional relapses (64,1%); • Gender distribution – 17 (43,6%) males and 22 (56,4%) females, respectively 12 (48%) males and 13 (52%) females in the group of patients selected for multivariate analysis; • Age distribution – between 31 and 83 years old, with a mean of 62,28 years, a standard deviation of 14,45 years and a median of 66 years; • Site of primary tumor – 9(23,07%) right colon tumors (caecum, ascending and transverse colon) 17(43,6%) left colon tumors (descending colon and sigma) 13(33,3%) rectal tumors (including recto-sigmoid tumors); • 12(30,76%) cases presented as emergencies; • Retrospective study – 2007 to 2011 – 39 patients - 14 metastases and 25 loco-regional relapses after curative surgical procedure for colorectal cancer; • Aim – to explore various clinical and pathological parameters that could be used to predict if a tumor is more aggressive (defined by how fast it relapses) and what kind of relapse is more likely to appear(local vs. distant); • Exclusion criteria: • Previous radiotherapy or chemotherapy; • Previous neoplasia; • Synchronous neoplastic lesions; • Autoimmune disease; • Inflammatory bovel disease; • Infectious disease present at the time of the first surgical procedure; • Patients who underwent the first procedure in another clinic; • Comparison between different prognostic factors was possible in only 25 out of 39 patients because of missing data; • Statistical analysis – SPSS (20th edition) for Windows: • correlations between variables – Spearman`s rank correlation; • multivariate analysis – Cox proportional hazard model – variabiles were simultaneously introduced in the model (enter method)– significance level for exclusion of variables 0,2; • p≤0,05 – statistically significant; Tumor Characteristics and their Relationship to Colorectal Cancer Relapse Makkai-Popa, S.-T. 1,2 , Zugun, F. 3 , Georgescu, St.-O. 1,2 , Popa, Paula 2 , Carasevici, E. 1,3 , Tarcoveanu, E. 1,2 1 ”Gr. T. Popa” University of Medicine and Pharmacy Iasi, 2 ”Sf. Spiridon” University Hospital – First Surgical Clinic, 3 ”Sf. Spiridon” University Hospital – Genetics and Immunology Laboratory Introduction • Colorectal cancer incidence in Romania – 23,57 cases / 100000 people. (Trifan et al, 2006) • Most commonly used prognostic classification – TNM staging correlated with the tumor grading; • New prognostic markers: • Lymph node based ratios: • Ratio between lymph nodes containing metastases and the total number of resected lymph nodes – Sun et al, 2010, Jung Wook Huh et al, 2012; • Logodds ratio – Wang et al, 2008; Persiani et al, 2012; • Pathology based markers: • Abundance of peritumoral inflammatory infiltrate – Jass and Klintrup criteria – Jass et al, 2005; Klintrup et al, 2009; • Type of inflammatory infiltrate – Treg cells, cytotoxic T-cells – Katsuhiko et al, 2010; • The abundance of necrosis - Richards et al, 2011; • Systemic markers: • Systemic inflammation – Glasgow prognostic score -McMillan et al, 2007; Roxburgh et al, 2009; • Serum level of tumor markers - CEA – Jung Wook Huh et al, 2012; Results Pathology findings and their correlation with the relapse prognosis Conclusions Clinical characteristics and their correlation with the relapse prognosis Materials and methods Type of relapse Chi- square p- value Metastasis Loco- regional relapse Gender Male 6 (54,5%) 5 (35,7%) 0,887 0,346 Female 5(45,5%) 9(64,3%) Age <66 5(45,5%) 7(50%) 0,051 0.821 ≥66 6(54,5%) 7(50%) Location of primary tumor Right colon 1(9,1%) 5(35,7%) 3,678 0,159 Left colon 7(63,6%) 4(28,6%) Rectum 3(27,3%) 5(35,7%) Emergency character of first admission Emergency 4(36,4%) 4(28,6%) 0,172 0,678 Elective 7(63,6%) 10(71,4%) Type of relapse p- value Metastasis Loco- regional relapse Tumor size < 50 mm 2 (18,2%) 5 (35,7%) 0,332 ≥ 50 mm 9(81,8%) 9(64,3%) Resection margins ≤ 30 mm 4(36,4%) 6(42,9%) 0,742 > 30 mm 7(63,6%) 8(57,1%) Presence of a perforated tumor Yes 2(18,2%) 2(14,3%) 0,792 No 9(81,8%) 7(85,7%) Infiltration of serosal layer Not infiltrated 3(27,3%) 2(14,3%) 0,623 Infiltrated 8(72,7%) 12(85,7%) Degree of tumor differentiation Well differentiated 1(9,1%) 4(28,6%) 0,395 Moderately differentiated 9(81,8%) 8(57,1%) Poorly differentiated 1(9,1%) 2(14,3%) Presence of a mucinous component Yes 4(36,4%) 4(28,6%) 0,678 No 7(63,6%) 10(71,4%) Presence of perineural invasion Yes 2(18,2%) 3(21,4%) 0,840 No 9(81,8%) 11(78,6%) Presence of intravascular tumor emboli Yes 6(54,5%) 3(21,4%) 0,087 No 5(45,5%) 11(78,6%) Degree of necrosis Abundant 5(45,5%) 10(71,4%) 0,188 Rare 6(54,5%) 4(28,6%) Correlation of pathology findings with the disease free interval Spearman`s rho p- value Size of the tumor -0,197 0,346 Vegetant character of the tumor 0,514 0,009 Perforated tumor 0,136 0,516 Stenotic tumor 0,055 0,792 Circumferential growth of the tumor 0,023 0,914 Resection margin -0,111 0,599 Infiltrated serosa 0,069 0,742 Inflammation 0,044 0,833 Acute inflammation 0,123 0,558 Chronic inflammation -0,085 0,685 Presence of a peritumoral abcess -0,104 0,621 Tumor differentiation 0,309 0,133 Tumor grading 0,208 0,318 Presence of a mucinous component 0,166 0,426 Presence of perineural invasion 0,305 0,138 Presence of intravascular tumor emboli 0,035 0,869 Presence of extensive necrosis 0,238 0,252 Lymph node based ratios and their correlation with the relapse prognosis Table 1. Relationship between clinical characteristics and type of relapse. Table 2. Relationship between pathology findings and type of relapse. Table 3. Correlation of pathology findings with the disease free interval. Number of invaded lymph nodes Number of harvested lymph nodes LNR LODDS LODDS12 LNR quartiles LODDS quartiles Lymph node ratio (LNR) rho ,945 -0,247 - ,938 ,990 ,949 ,899 p-value <0,001 0,235 - <0,001 <0,001 <0,001 <0,001 Logodds ratio (LODDS) rho ,872 -,498* ,938 - - ,898 ,961 p-value <0,001 0,011 <0,001 - - <0,001 <0,001 Logodds ratio for patients with ≥ 12 harvested lymph nodes (LODDS12) rho ,951 -0,517 ,990 - - ,847 ,917 p-value <0,001 0,07 <0,001 - - <0,001 <0,001 LNR categories defined by quartiles (LNR quartiles) rho ,848 -0,315 ,949 ,898 ,847 - ,892 p-value <0,001 0,126 <0,001 <0,001 <0,001 - <0,001 Logodds ratio categories defined by quartiles (LODDS quartiles) rho ,785 -,579 ,899 ,961 ,917 ,892 - p-value <0,001 0,002 <0,001 <0,001 <0,001 <0,001 - Table 4. Correlation of different lymph node ratios with the number of invaded lymph nodes, with the number of harvested lymph nodes and between different coefficients . Figure 1. Kaplan-Meier survival curves when clasifying the patients according to pN categories and Logdds categories and the p-values resulted from comparing the groups by using the log-rank test. p-value = 0,021. p-value = 0,049. B SE Wald df p-value Exp(B) 95,0% CI for Exp(B) Lower Upper Gender 0,906 0,73 1,53 1 0,216 2,47 0,59 10,375 Onset age category -2,235 0,82 7,32 1 0,007 0,10 0,021 0,54 Necrosis -0,898 1,1 0,62 1 0,431 0,40 0,044 3,808 Intravascular tumor emboli -0,903 1,05 0,73 1 0,391 0,40 0,052 3,187 Perineural invasion -0,006 1,01 0 1 0,995 0,99 0,137 7,204 Mucinous component -2,196 0,82 7,13 1 0,008 0,11 0,022 0,557 Resection margin 0,002 0,01 0,03 1 0,856 1,00 0,982 1,022 Tumor size -0,087 0,04 4,71 1 0,03 0,91 0,847 0,992 Logodds ratio 5,526 1,80 9,33 1 0,002 251,11 7,257 8689,516 Logodds ratio category quartiles 14,55 3 0,002 Logodds ratio category quartiles(1) 12,444 3,76 10,95 1 0,001 253824,5 159,93 402836977,7 Logodds ratio category quartiles(2) 5,252 2,17 5,85 1 0,016 190,97 2,715 13432,481 Logodds ratio category quartiles(3) 3,563 1,67 4,54 1 0,033 35,26 1,332 933,749 Table 5. Cox regression model for Logodds ratio and Logodds ratio categories after allowing for the effects of other significant variables. .

Tumor Characteristics and Their Relationship to Colorectal Cancer Relapse

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