Department of Pathology, 64030Dokuz Eylul University School of Medicine, Izmir, Turkey.
Department of General Surgery, 64030Dokuz Eylul University School of Medicine, Izmir, Turkey.
Int J Surg Pathol. 2022 Dec;30(8):861-871. doi: 10.1177/10668969221095459. Epub 2022 May 2.
Various potential prognostic histopathologic factors for colorectal carcinoma liver metastasis have been proposed. However, there is still no consensus on pathological reporting of colorectal carcinoma liver metastasis resection materials. The aim of this study was to investigate the relation between selected tumoral and parenchymal histopathologic features and prognostic factors for better characterization and prognostic prediction of the patients with colorectal carcinoma liver metastasis. Hematoxylin-eosin stained slides from 100 patients who underwent hepatic resection were evaluated. Pathologic characteristics; including number of tumor nodules, largest tumor size, status of surgical margin, tumor distance to closest margin, tumor necrosis, the presence of tumor capsule, tumor differentiation, perineural and lymphovascular invasion, micrometastasis, tumor budding, peritumoral lymphocytic infiltrate and parenchymal features including steatosis, steatohepatitis, lobular inflammation, confluent necrosis, hepatocyte ballooning, portal inflammation were assessed. For 49 patients who were treated with preoperative chemotherapy, tumor regression grade and chemotherapy-related parenchymal changes such as sinusoidal damage, venous obstruction, nodular regenerative hyperplasia, steatosis and steatohepatitis were also evaluated. The presence of lymphovascular invasion (p < 0.001), micrometastasis (p=0.004), absent or mild peritumoral lymphocytic infiltration (p =0.013), high tumor budding score (p=0.033) and moderate/poor differentiation (p=0.022) were significantly associated with shorter overall survival. Lymphovascular invasion (p < 0.001) was an independent predictor of mortality in multivariate analysis. We conclude that tumor differentiation, lymphovascular invasion, micrometastasis, peritumoral lymphocytic reaction and tumor budding score are potential prognostic histopathological features and candidates for inclusion in pathology reports of colorectal carcinoma liver metastasis resections.
各种潜在的结直肠癌肝转移的预后组织病理学因素已经被提出。然而，对于结直肠癌肝转移切除标本的病理报告仍然没有共识。本研究的目的是研究选择的肿瘤和实质组织病理学特征与预后因素之间的关系，以便更好地对结直肠癌肝转移患者进行特征描述和预后预测。 对 100 例接受肝切除术的患者的苏木精-伊红染色切片进行评估。病理特征包括肿瘤结节数量、最大肿瘤大小、手术切缘状态、肿瘤与最近切缘的距离、肿瘤坏死、肿瘤包膜的存在、肿瘤分化、神经周围和血管侵犯、微转移、肿瘤芽生、肿瘤周围淋巴细胞浸润以及实质特征包括脂肪变性、脂肪性肝炎、小叶炎症、融合性坏死、肝细胞气球样变、门脉炎症。对于 49 例接受术前化疗的患者，还评估了肿瘤退缩分级和与化疗相关的实质变化，如窦状隙损伤、静脉阻塞、结节性再生性增生、脂肪变性和脂肪性肝炎。 存在脉管侵犯（p < 0.001）、微转移（p=0.004）、无或轻度肿瘤周围淋巴细胞浸润（p =0.013）、高肿瘤芽生评分（p=0.033）和中/低分化（p=0.022）与总生存期较短显著相关。多因素分析显示，脉管侵犯是死亡的独立预测因素。 我们得出结论，肿瘤分化、脉管侵犯、微转移、肿瘤周围淋巴细胞反应和肿瘤芽生评分是潜在的预后组织病理学特征，可能成为结直肠癌肝转移切除标本病理报告的内容。
