ASO Author Reflections: Prognostic Value of Tumor Border Configuration in Colon Cancer
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Prognostic Value of Tumor Border Configuration in Colon Cancer Yasmeen Z. Qwaider, MD, and David L. Berger, MD Department of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
PAST
FUTURE
Jass et al.1 initially described tumor border configuration (TBC, either infiltrating or pushing) while analyzing resected rectal tumors. Since then, TBC has been considered a poor prognostic factor in colorectal cancer.2–4 However, studies group colon and rectal cancers together in their analyses. This study aimed to assess the prognostic value of TBC in stages 2 and 3 colon cancer.
This study showed that infiltrating TBC is a poor prognostic factor in colon cancer. The authors believe the study results could challenge the approach to stages 2 and 3 colon tumors. Future studies should assess the benefit of adjuvant chemotherapy for patients with high-risk features (e.g., TBC) in stage 2 disease and potentially identify patients with stage 3 disease who might not require adjuvant chemotherapy.
PRESENT This study investigated 700 patients from the authors’ institution with surgically resected stage 2 or 3 colon cancer.5 Infiltrating TBC was associated with stage 3 tumors, extramural vascular invasion, likelihood of progression to metastasis, and lower overall and disease-free survival rates (p \ 0.05). Infiltrating TBC also was an independent prognostic factor in Cox regression analysis for overall survival (adjusted hazard ratio [aHR] 1.8; 95% confidence interval [CI], 1.4–2.4; p \ 0.001) and diseasefree survival (aHR 1.7; 95% CI 1.3–2.2; p \ 0.001). Pairwise comparisons showed no difference in overall or disease-free survival between the patients with stage 2 disease and infiltrating TBC and the patients with stage 3 disease and pushing TBC (aHR 1.1; 95% CI 0.7–1.7; p = 0.8) and (aHR 1.0; 95% CI 0.7–1.6; p = 0.9), respectively.
Ó Society of Surgical Oncology 2020 First Received: 21 October 2020 Accepted: 21 October 2020 D. L. Berger, MD e-mail: [email protected]
DISCLOSURES
The authors have no disclosures to report
REFERENCES 1. Jass JR, Atkin WS, Cuzick J, Bussey HJ, Morson BC, Northover JM, et al. The grading of rectal cancer: Historical perspectives and a multivariate analysis of 447 cases. Histopathology. 1986;10:437–59. https://doi.org/10.1111/j.1365-2559.1986.tb 02497. 2. Shepherd, NA, Saraga EP, Love SB, Jass JR. Prognostic factors in colonic cancer. Histopathology. 1989;14(6):613–20. 3. 3. Morikawa T, Kuchiba A, Qian ZR, et al. Prognostic significance and molecular associations of tumor growth pattern in colorectal cancer. Ann Surg Oncol. 2012;19:1944–53. 4. Zlobec I, Baker K, Minoom P, Hayashi S, Terracciano L, Lugli A, et al. Tumor border configuration added to TNM better stratifies stage II colorectal cancer patients into prognostic subgroups. Cancer. 2009;115(17):4021–9. 5. Qwaider YZ, Sell NM, Stafford CE, Kunitake H, Ricciardi R, Bordeianou LG, et al. Infiltrating tumor border configuration is a poor
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