Establishing Criteria for Tumor Necrosis as Prognostic Indicator in Colorectal Cancer
Kastinen, Meeri; Sirniö, Päivi; Elomaa, Hanna; Äijälä, Ville K; Karjalainen, Henna; Tapiainen, Vilja V; Pohjanen, Vesa-Matti; Kemppainen, Janette; Sliashynskaya, Katja; Ahtiainen, Maarit; Rintala, Jukka; Meriläinen, Sanna; Rautio, Tero; Saarnio, Juha; Mattila, Taneli T; Lindgren, Outi; Wirta, Erkki-Ville; Helminen, Olli; Seppälä, Toni T; Böhm, Jan; Mecklin, Jukka-Pekka; Tuomisto, Anne; Mäkinen, Markus J; Väyrynen, Juha P (2024-07-15)
Lippincott Williams & Wilkins
15.07.2024
Kastinen, M., Sirniö, P., Elomaa, H., Äijälä, V. K., Karjalainen, H., Tapiainen, V. V., Pohjanen, V.-M., Kemppainen, J., Sliashynskaya, K., Ahtiainen, M., Rintala, J., Meriläinen, S., Rautio, T., Saarnio, J., Mattila, T. T., Lindgren, O., Wirta, E.-V., Helminen, O., Seppälä, T. T., … Väyrynen, J. P. (2024). Establishing criteria for tumor necrosis as prognostic indicator in colorectal cancer. American Journal of Surgical Pathology, 48(10), 1284–1292. https://doi.org/10.1097/PAS.0000000000002286
https://creativecommons.org/licenses/by/4.0/
© 2024 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
https://creativecommons.org/licenses/by/4.0/
© 2024 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
https://creativecommons.org/licenses/by/4.0/
Julkaisun pysyvä osoite on
https://urn.fi/URN:NBN:fi:oulu-202408125320
https://urn.fi/URN:NBN:fi:oulu-202408125320
Tiivistelmä
Abstract
Tumor necrosis has been reported to represent an independent prognostic factor in colorectal cancer, but its evaluation methods have not been described in sufficient detail to introduce tumor necrosis evaluation into clinical use. To study the potential of tumor necrosis as a prognostic indicator in colorectal cancer, criteria for 3 methods for its evaluation were defined: the average percentage method (tumor necrosis percentage of the whole tumor), the hotspot method (tumor necrosis percentage in a single hotspot), and the linear method (the diameter of the single largest necrotic focus). Cox regression models were used to calculate cancer-specific mortality hazard ratios (HRs) for tumor necrosis categories in 2 colorectal cancer cohorts with more than 1800 cases. For reproducibility assessment, 30 cases were evaluated by 9 investigators, and Spearman’s rank correlation coefficients and Cohen’s kappa coefficients were calculated. We found that all 3 methods predicted colorectal cancer-specific survival independent of other prognostic parameters, including disease stage, lymphovascular invasion, and tumor budding. The greatest multivariable HRs were observed for the average percentage method (cohort 1: HR for ≥ 40% vs. <3% 3.03, 95% CI, 1.93-4.78; cohort 2: HR for ≥ 40% vs. < 3% 2.97; 95% CI, 1.63-5.40). All 3 methods had high reproducibility, with the linear method showing the highest mean Spearman’s correlation coefficient (0.91) and Cohen’s kappa (0.70). In conclusion, detailed criteria for tumor necrosis evaluation were established. All 3 methods showed good reproducibility and predictive ability. The findings pave the way for the use of tumor necrosis as a prognostic factor in colorectal cancer.
Tumor necrosis has been reported to represent an independent prognostic factor in colorectal cancer, but its evaluation methods have not been described in sufficient detail to introduce tumor necrosis evaluation into clinical use. To study the potential of tumor necrosis as a prognostic indicator in colorectal cancer, criteria for 3 methods for its evaluation were defined: the average percentage method (tumor necrosis percentage of the whole tumor), the hotspot method (tumor necrosis percentage in a single hotspot), and the linear method (the diameter of the single largest necrotic focus). Cox regression models were used to calculate cancer-specific mortality hazard ratios (HRs) for tumor necrosis categories in 2 colorectal cancer cohorts with more than 1800 cases. For reproducibility assessment, 30 cases were evaluated by 9 investigators, and Spearman’s rank correlation coefficients and Cohen’s kappa coefficients were calculated. We found that all 3 methods predicted colorectal cancer-specific survival independent of other prognostic parameters, including disease stage, lymphovascular invasion, and tumor budding. The greatest multivariable HRs were observed for the average percentage method (cohort 1: HR for ≥ 40% vs. <3% 3.03, 95% CI, 1.93-4.78; cohort 2: HR for ≥ 40% vs. < 3% 2.97; 95% CI, 1.63-5.40). All 3 methods had high reproducibility, with the linear method showing the highest mean Spearman’s correlation coefficient (0.91) and Cohen’s kappa (0.70). In conclusion, detailed criteria for tumor necrosis evaluation were established. All 3 methods showed good reproducibility and predictive ability. The findings pave the way for the use of tumor necrosis as a prognostic factor in colorectal cancer.
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