Histopathological finding as a prognostic factor of the surgical treatment outcome in colorectal cancer

Abstract

Background/Aim. Adenocarcinomas of the colon are the most common malignant colorectal tumors. Macroscopic and histopahtological features of colorectal cancer significantly affect its outcome. The aim of this study was to analyze the impact of histopahological finding as a prognostic factor on the surgical treatment outcome and the course of the disease. Methods. In the first part of this study the distribution (numerical and proportional) of certain histopathological parameters in the examined groups of patients were reviewed; in the second part of the study the statistical significance of the impact of the certain elements of a histopahtological finding on the surgical treratment outcome was analyzed. The histopathological elements analyzed included: the hsitological tumor type grading according to Duke, ie Astler-Coller, and tumor, nodes, metastases (TNM) staging in the examined sample of 100 patients. Results. Statistically significant prognostic factors of the outcome of surgical treatment were selected after multivariant analysis. These factors comprise Astler-Coller-Dukes stage D (revealed in 77.78% patients died), stage IV according TNM classification (T1-4, N0-2, M1), histological structure (poorly diferentiated adenocarcinoma in 85.2% patents died) and type of tumor (mucynous adenocarcinoma was more often present in died, 77.78%). Since ? = 0.000 for four risk factors were formed using discriminant analysus, it was proved their significant influence on the outcome of surgical treatment. Discriminant coefficient showed that the greatest influence on surgical treatment were registred in patients with tumor of Astler-Coller-Dukes stage D (0.255), poorly differentiated adenocarcinoma (histological structure) (0.139), mucynous adenocarcinoma (type of tumor) (0.074) and stage IV according to the TNM elassification (T1-4, N0-2, M1) (0.39). Conclusion. The prognostic factors influencing the outcome of surgery for colorectal carcinoma were defined. Patients with pathohistological finding of Astler-Coller-Dukes stage D, stage IV according to the TNM classification (T1-4, N0-2, M1) and poorly differentiated adenocarcioma have statistically highly significant mortality during the perioperative course of the disease.Uvod/Cilj. Adenokarcinomi predstavljaju najcesce maligne tumore debelog creva. Makroskopske i patohistoloske karakteristike tumora uticu na ishod bolesti. Cilj rada bio je da se utvrdi predikivna vrednost patohistoloskog nalaza u proceni ishoda hirurskog lecenja bolesnika. Metode. U prvom delu studije prikazana je zastupljenost pojedinih patohistoloskih parametara ispitivanih bolesnika, a u drugom delu analizirana je statisticka znacajnost elemenata patohistoloskog nalaza za ishod operativnog lecenja. Analiza je sprovedena za patohistoloski tip tumora debelog creva, stepen diferentovanosti (grading) i stadijum bolesti po Dukesu, tj. Astler-Colleru i tumor, nodes, metastases (TNM) klasifikaciji (staging) na uzorku od 100 bolesnika. Rezultati. Nakon multivarijantne analize varijanse iz patohistoloskog nalaza izdvojeni su statisticki znacajni prognosticki faktori koji predvidjaju ishod operativnog lecenja: D stadijum bolesti po Astler-Coller-Dukesu (prisutan kod 77,78% umrlih), po TNM klasifikaciji IV stadijum bolesti (T1-4, N0-2, M1), histoloska gradja (slabo diferentovan tumor zastupljen kod 85,2% umrlih bolesnika) i tip tumora (mucinozni adenokarcinom znatno cesce prisutan kod umrlih, 77,78%). Kako je ? = 0,000 za cetiri faktora rizika sintetizovana iz patohistoloskog nalaza, diskriminativnom analizom dokazano je da postoji njihov znacajan uticaj na ishod operativnog lecenja. Koeficijent diskriminacije upucuje na to da je najveci uticaj na ishod operativnog lecenja imao: stadijum D (Astler-Coller- Dukes) (0,255), slabo diferentovan tumor (histoloska gradja) (0,130), mucinozni adenokarcinom (tip tumora) (0,074) i stadijum IV (T1-4, N0-2,M1) (TNM klasifikacija) (0,39). Zakljucak. Definisani su prognosticki faktori koji uticu na ishod hirurskog lecenja karcinoma debelog creva. Dokazano je da bolesnici sa patohistoloskim D stepenom tumora (Astler-Coller-Dukes), IV stadijumom bolesti (TNM, T1-4, N0-2, M1), slabo diferentovanim mucinoznim adenokarcinomom imaju statisticki visoko znacajno mortalitet u perioperativnom toku.