Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, P.R. China.
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, P.R. China.
Cancer Res Commun. 2023 Jun 15;3(6):1057-1066. doi: 10.1158/2767-9764.CRC-23-0073. eCollection 2023 Jun.
Desmoplastic reaction (DR) is one of many tumor-host interactions and is associated with the overall survival (OS) of patients with colorectal cancer. However, the clinical significance of DR requires further study in large multicenter cohorts and its predictive value in adjuvant chemotherapy (ACT) response remains unclear. Here, a total of 2,225 patients with colorectal cancer from five independent institutions were divided into primary ( = 1,012 from two centers) and validation ( = 1,213 from three centers) cohorts. DR was classified as immature, middle, or mature depending on the presence of myxoid stroma and hyalinized collagen bundles at the invasive front of the primary tumor. OS among different subgroups were compared, and the correlations of DR type with tumor-infiltrating lymphocytes (TILs) within stroma, tumor stroma ratio (TSR), and Stroma AReactive Invasion Front Areas (SARIFA) were also analyzed. In the primary cohort, patients with mature DR had the highest 5-year survival rate. These findings were confirmed in validation cohort. In addition, for stage II colorectal cancer, patients classified as non-mature DR would benefit from ACT compared with surgery alone. Furthermore, immature and middle DR were more associated with high TSR, less distribution of TILs within stroma and positive SARIFA compared with mature. Taken together, these data suggest that DR is a robust-independent prognostic factor for patients with colorectal cancer. For patients with stage II colorectal cancer, non-mature DR could be a potential marker for recognizing high-risk patients who may benefit from ACT.
DR has the potential to identify patients with high-risk colorectal cancer and predict the efficacy of adjuvant chemotherapy in patients with stage II colorectal cancer. Our findings support reporting DR types as additional pathologic parameters in clinical practice for more precise risk stratification.
促结缔组织增生反应（DR）是众多肿瘤-宿主相互作用之一，与结直肠癌患者的总生存期（OS）相关。然而，DR 的临床意义需要在大型多中心队列中进一步研究，其在辅助化疗（ACT）反应中的预测价值仍不清楚。在这里，来自五个独立机构的 2225 例结直肠癌患者被分为原发组（= 1012 例，来自两个中心）和验证组（= 1213 例，来自三个中心）。DR 根据原发性肿瘤侵袭前沿的黏液样基质和玻璃样胶原束的存在情况分为不成熟、中等或成熟。比较不同亚组的 OS，并分析 DR 类型与基质内肿瘤浸润淋巴细胞（TILs）、肿瘤间质比（TSR）和基质反应性侵袭前缘面积（SARIFA）的相关性。在原发组中，成熟 DR 患者的 5 年生存率最高。这些发现在验证组中得到了证实。此外，对于 II 期结直肠癌患者，与单独手术相比，非成熟 DR 分类的患者从 ACT 中获益。此外，与成熟 DR 相比，不成熟和中等 DR 更与高 TSR、基质内 TILs 分布较少和阳性 SARIFA 相关。总之，这些数据表明 DR 是结直肠癌患者强有力的独立预后因素。对于 II 期结直肠癌患者，非成熟 DR 可能是识别高危患者的潜在标志物，这些患者可能从 ACT 中获益。
DR 有可能识别出患有高危结直肠癌的患者，并预测 II 期结直肠癌患者辅助化疗的疗效。我们的研究结果支持将 DR 类型作为临床实践中附加的病理参数进行报告，以实现更精确的风险分层。
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