Myxoid stroma is associated with postoperative relapse in patients with stage II colon cancer

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RESEARCH ARTICLE

Open Access

Myxoid stroma is associated with postoperative relapse in patients with stage II colon cancer Takashi Okuyama1* , Shinichi Sameshima1, Emiko Takeshita1, Takashi Mitsui1, Takuji Noro1, Yuko Ono2, Tamaki Noie1, Shinichi Ban2 and Masatoshi Oya1

Abstract Background: Fibrosis surrounding cancer cells has been shown to affect cancer cell metastatic behavior. The present study aimed to explore the utility of myxoid stroma as a predictive factor for postoperative relapse in patients with stage II colon cancer. Methods: The present study retrospectively investigated 169 patients who underwent curative surgical resection of stage II colon cancer. The fibrotic stroma was classified according to Ueno’s criteria, and the patients were divided into the myxoid (MY) group and the non-MY (NMY) group. We also recorded tumor budding (TB) and investigated the combination of MY and TB for postoperative relapse. Postoperative survival was also explored. Results: Thirty-two (18.9%) patients had MY. MY was significantly associated with tumor budding (TB) and postoperative relapse (p < 0.001 and p < 0.001, respectively). The 5-year RFS rates in MY group and NMY group were 52.1 and 94.6% (p < 0.0001), and the 5-year OS rates in MY group and NMY group were 74.6 and 93.3% (p = 0.001). Multivariate analysis showed that both MY and TB were significant risk factors for postoperative relapse (p < 0.001 and p = 0.02, respectively), and that only TB was a significant risk factor for OS (p = 0.043). Furthermore, compared with patients with either one of MY or TB, patients with both MY and TB had postoperative relapse more frequently (11.4% vs. 53.8%). Conclusions: The present study suggests that MY is a predictive marker for postoperative relapse in patients with stage II colon cancer. Keywords: Myxoid stroma, Desmoplastic reaction, Stage II colon cancer

Background The actual role of adjuvant chemotherapy (AC) in patients with stage II colon cancer remains unclear despite several clinical trials and meta-analyses [1–4]. However, surveillance, epidemiology, and end results analyses have shown that there are groups of patients having a higher risk of relapse than others [5]. International guidelines therefore recommend that patients with stage II colon cancer should be * Correspondence: [email protected] 1 Department of Surgery, Saitama Medical Center, Dokkyo Medical University, 〒 343-8555 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, Japan Full list of author information is available at the end of the article

divided into a high-risk group and a low-risk group for postoperative relapse, and that AC should be considered in patients with high-risk features, but high-level evidence including molecular and genetic factors is still lacking [6–12]. Current molecular and genetic studies have indicated that tumor progression, growth, and spread are determined by the interaction between a cancer and its surrounding stromal cells [13, 14]. The tumor stroma contains many different cells, including lymphocytes, macrophages, le