Clinical, anatomopathological and molecular characteristics of colorectal cancer by tumor location and degree of differentiation
Keywords:
Colorectal neoplasms, Neoplasm grading, Neoplasm staging, Neoplasms by location, Biological markersAbstract
Aims: Colorectal cancer (CRC) has a high incidence and mortality, with different pat- terns depending on anatomical location and other pathological characteristics that appear linked to changes in exposure risk factors exposure as well as the diagnosis. All these make it essential to determine the source of the tumour to properly assess the effect of these factors in the development, diagnosis and progression of the disease. The aim was to describe the clinical and anatomical-pathological characteristics of patients diagnosed with CRC in the Health Area of Leon (A5L) based on their location and degree of tumour differentiation.
Methods: Information was collected on the clinical and pathological characteristics, including biological markers analysed in clinical routine of 408 patients between 25 and 85 years with a confirmed diagnosis of CRC, and residents in ASL at least six months before diagnosis. Univariate and bivariate analyses were performed according to the degree of differentiation and tumour location.
Results: Tumour size decreases from the colon to the rectum from location decline proximal colon to the rectum (Proximal Colon=5.13cm; Distal Colon=4.09cm; Rectum=3.17cm, P< 0.001), with the TNM stage also being higher in proximal areas. Mucinous adenocarcinomas are more frequent in poorly differentiated than in well differentiated tumours (23.1% vs 5.5%). Lymphatic, venous and peri-tumour invasions are more common in poorly differentiated tumours.
Conclusions: The distribution in accordance with the location has more advanced TNM stages in the proximal areas, which could be related to the poorer early diagnosis in proximal areas. The association between venous and lymphatic invasion with the degree of differentiation is poorly understood, and requires studies to clarify their possible prognostic interest.
Author Biographies
Laura Vilorio-Marqués, Universidad de León
Grupo de Investigación en Interacción Gen-Ambiente-Salud, Universidad de León, León, España
Antonio José Molina, Universidad de León
Grupo de Investigación en Interacción Gen-Ambiente-Salud, Universidad de León, León, España
Cristina Diez Tascón, Complejo Asistencial Universitario de León
Servicio de Anatomía Patológica, Complejo Asistencial Universitario de León (CAULE), León, España
Begoña Álvarez Cuenllas, Complejo Asistencial Universitario de León
Servicio de Digestivo, Complejo Asistencial Universitario de León, León, España
Concepción Álvarez Cañas, Complejo Asistencial Universitario de León
Servicio de Anatomía Patológica, Complejo Asistencial Universitario de León (CAULE), León, España
Mercedes Hernando Martín, Complejo Asistencial Universitario de León
Servicio de Anatomía Patológica, Complejo Asistencial Universitario de León (CAULE), León, España
Tania Fernández Villa, Universidad de León
Grupo de Investigación en Interacción Gen-Ambiente-Salud, Universidad de León, León, España
Tomás Elosua, Complejo Asistencial Universitario de León
Servicio de Cirugía, Complejo Asistencial Universitario de León (CAULE), León, España
Vicente Martín, CIBERESP
Centro de Investigación Biomédica en Red Epidemiología y Salud Pública, CIBERESP, Madrid, España
References
International Agency for Research on Cancer. World Cancer Report 2008. Lyon: IARC; 2008.
López-Abente G, Ardanaz E, Torrella-Ramos A, Mateos A, Delgado-Sanz C, Chirlaque MD, et al. Changes in colorectal cancer incidence and mortality trends in Spain. Ann Oncol. 2010;21 Suppl 3:iii76-82.
https://doi.org/10.1093/annonc/mdq091
Naveiro JC, Peral A, Diez AE, González FA, Burón JL. Incidencia y riesgo de cáncer en el área sanitaria de León. Oncología. 2001;24:21-8.
Martín Sánchez V, Muinelo Voces MI, Jorquera Plaza F, Molina De La Torre AJ, De Abajo Olea S, Tamames Gómez S, et al. Tendencia y distribución municipal de la incidencia de cáncer colorrectal en el área de salud de León (1994-2008). Gastroenterol Flepatol. 2012;35(5):299-308.
https://doi.org/10.1016/j.gastrohep.2012.01.004
Chauvenet M, Cottet V, Lepage C, Jooste V, Faivre J, Bouvier AM. Trends in colorectal cancer incidence: a period and birth-cohort analysis in a well-defined French population. BMC Cancer. 2011;11:282.
https://doi.org/10.1186/1471-2407-11-282
Flemminki K, Santi I, Weires M, Thomsen H, Sundquist J, Bermejo JL. Tumor location and patient characteristics of colon and rectal adenocarcinomas in relation to survival and TNM classes. BMC Cancer. 2010;10:688.
https://doi.org/10.1186/1471-2407-10-688
Kaemmerer E, Klaus C, Jeon MK, Gassier N. Molecular classification of colorectal carcinomas: the genotype-to-phenotype relation. World J Gastroenterol. 2013;19(45):8163-7.
https://doi.org/10.3748/wjg.v19.i45.8163
Sobin LH. TNM: evolution and relation to other prognostic factors. Semin Surg Oncol. 2003;21(1):3-7.
https://doi.org/10.1002/ssu.10014
Carmona FJ, Esteller M. Epigenomics of human colon cancer. Mutat Res. 2010;693:53-60.
https://doi.org/10.1016/j.mrfmmm.2010.07.007
Perea J, Lomas M, Hidalgo M. Molecular basis of colorrectal cancer: towards an individualized management? Rev Esp Enferm Dig. 2011; 103(1 ):29-35.
https://doi.org/10.4321/S1130-01082011000100006
AJCC: Colon and rectum.Edge SB, Byrd DR, Compton CC, editores. AJCC Cancer Staging Manual. 7th ed. New York: Springer; 2010. p. 143-64.
https://doi.org/10.1007/978-0-387-88441-7_14
Minoo P, Zlobec I, Peterson M, Terraciano L, Lugli A. Characterization of rectal, proximal and distal colon cancers based on clinicopathological, molecular and protein profiles. Int J Oncol. 2010;37(3):707-18.
https://doi.org/10.3892/ijo_00000720
Ogino S, Chan AT, Fuchs CS, Giovannucci E. Molecular pathological epidemiology of colorectal neoplasia: an emerging transdisciplinary and interdisciplinary field. Gut. 2011;60(3):397-411.
https://doi.org/10.1136/gut.2010.217182
Caldarella A, Crocetti E, Messerini L, Paci E. Trends in colorectal incidence by anatomic subsite from 1985 to 2005: a population- based study. Int J Colorectal Dis. 2013;28(5):637-41.
https://doi.org/10.1007/s00384-013-1672-2
Thelwell N, Millington S, Solinas A, Booth J, Brown T. Mode of action and application of Scorpion primers to mutation detection. Nucleic Acids Res. 2000;28(19):3752-61.
https://doi.org/10.1093/nar/28.19.3752
Whitcombe D, Theaker J, Guy SP, Brown T, Little S. Detection of PCR products using self-probing amplicons and fluorescence. Nat Biotechnol. 1999;17(8):804-7.
Zlobec I, Baker K, Minoo P, Hayashi S, Terracciano L, Lugli A. Tumor border configuration added to TNM staging better stratifies stage II colorectal cancer patients into prognostic subgroups. Cancer. 2009;115(17):4021-9.
https://doi.org/10.1002/cncr.24450
Krzystek-Korpacka M, Diakowska D, Grabowski K, Gamian A. Tumor location determines midkine level and its association with the disease progression in colorectal cancer patients: a pilot study. Int J Colorectal Dis. 2012;27(10):1319-24.
https://doi.org/10.1007/s00384-012-1476-9
Zlobec I, Bihl M, Schwarb H, Terracciano L, Lugli A. Clinicopathological and protein characterization of BRAF- and K-RAS-mutated colorectal cancer and implications for prognosis. Int J Cancer. 2010;127(2):367-80.
https://doi.org/10.1002/ijc.25042
Song W, Wu SJ, He YL, Cai SR, Zhang CH, Zhang XH, et al. Clinicopathological features and survival of patients with colorectal mucinous, signet-ring cell or non-mucinous adenocarcinoma: experience at an institution in southern china. Chin Med. 2009; 122(13): 1486-91.
Purim O, Gordon N, Brenner B. Cancer of the colon and rectum: potential effects of sex-age interactions on incidence and outcome. Med Sci Monit. 2013;19:203-9.
https://doi.org/10.12659/MSM.883842
Brenner H, Hoffmeister M, Arndt V, Haug U. Gender differences in colorectal cancer: implications for age at initiation of screening. Br J Cancer. 2007;96(5):828-31.
https://doi.org/10.1038/sj.bjc.6603628
Jacobs ET, Thompson PA, Martinez ME:. Diet, gender, and colorectal neoplasia. J Clin Gastroenterol. 2007;41(8):731-46.
https://doi.org/10.1097/MCG.0b013e3180338e56
Koo JH, Leong RW. Sex differences in epidemiological, clinical and pathological characteristics of colorectal cancer. J Gastroenterol Hepatol. 2010;25(1):33-42.
https://doi.org/10.1111/j.1440-1746.2009.05992.x
Chiang JM, Yeh CY, Changchien CR, Chen JS, Tang R, Chen JR. Mucinous adenocarcinoma showing different clinicopathological features and molecular characteristics in relation to different colorectal cancer subgroups. Int J Colorectal Dis. 2010;25(8):941-7.
https://doi.org/10.1007/s00384-010-0958-x
Yamauchi M, Morikawa T, Kuchiba A, Imamura Y, Qian ZR, Nis- hihara R, et al. Assessment of colorectal cancer molecular features along bowel subsites challenges the conception of distinct dichotomy of proximal versus distal colorectum. Gut. 2012;61(6):847-54.
https://doi.org/10.1136/gutjnl-2011-300865
Verhulst J, Ferdinande L, Demetter P, Ceelen W. Mucinous subtype as prognostic factor in colorectal cancer: a systematic review and meta-analysis. J Clin Pathol. 2012;65(5):381-8.
https://doi.org/10.1136/jclinpath-2011-200340
Derwinger K, Gustavsson B. A study of aspects on gender and prognosis in synchronous colorectal cancer. Clin Med Insights Oncol. 2011;5:259-64.
https://doi.org/10.4137/CMO.S7871
Du CZ, Xue WC, Cai Y, Li M, Gu J. Lymphovascular invasion in rectal cancer following neoadjuvant radiotherapy: a retrospective cohort study. World J Gastroenterol. 2009;15(30):3793-8.
https://doi.org/10.3748/wjg.15.3793
Andreyev HJ, Norman AR, Cunningham D, Oates J, Dix BR, laco- petta BJ, et al. Kirsten ras mutations in patients with colorectal cancer: the 'RASCAL II' study. Br J Cancer. 2001;85(5):692-6.
https://doi.org/10.1054/bjoc.2001.1964
Jenkins AAA, Hayashi S, O'Shea AM, Burgart LJ, Smyrk TC, Shimizu D, et al. Pathology features in Bethesda guidelines predict colorectal cancer microsatellite instability: a population-based study. Gastroenterology. 2007;133(1):48-56.
https://doi.org/10.1053/j.gastro.2007.04.044
Slattery ML, Curtin K, Wolff RK, Boucher KM, Sweeney C, Edwards S, et al. A comparison of colon and rectal somatic DNA alterations. Dis Colon Rectum. 2009;52(7):1304-11.
How to Cite
Downloads
Downloads
Published
Issue
Section
License
Todos los derechos reservados.
