Association of tumor budding with clinicopathological features and prognostic value in stage III-IV colorectal cancer

Preoperative CT-derived sarcopenia as a predictor of postoperative complications in patients undergoing laparoscopic radical resection for non-metastatic colorectal cancer: a retrospective study

PURPOSE

Sarcopenia is increasingly recognized as a risk factor for postoperative complications in gastrointestinal cancer surgery. This study aimed to assess the association between sarcopenia and postoperative complications following laparoscopic radical resection of non-metastatic colorectal cancer (CRC).

METHODS

In this retrospective study, 387 non-metastatic CRC patients undergoing laparoscopic radical resection were categorized into a sarcopenic group and a non-sarcopenic group based on preoperative skeletal muscle index (SMI, cm2/m2). Logistic regression analysis was performed to identify independent predictors for postoperative complications.

RESULTS

Sarcopenia was present in 156 (40.31%) patients. The incidence of postoperative complications was 32.3%, with a serious complication (Clavien-Dindo III-V) rate of 12.1%. Compared with non-sarcopenic patients, sarcopenic patients had significantly higher incidences of total complications (P < 0.001) and severe complications (P = 0.026). Multivariable analysis identified sarcopenia as an independent risk factor for total postoperative complications (OR = 3.42, 95%CI 1.85-6.31). Further analysis of specific types of postoperative complications revealed that anastomotic leakage (P = 0.001), surgical site infection (P = 0.002), and surgical site adverse events (P = 0.001) rates were higher in sarcopenic patients. In multivariable analysis, sarcopenia was independently associated with anastomotic leakage (OR = 3.36, 95%CI = 1.12-10.12) and surgical site adverse events (OR = 3.02, 95%CI = 1.55-5.90).

CONCLUSIONS

Preoperative CT-derived sarcopenia can predict postoperative complications in patients with non-metastatic CRC undergoing laparoscopic radical resection, particularly anastomotic leakage and surgical site adverse events.

Prognostic role of tertiary lymphatic structures and their modulation by adjuvant FOLFOX in stage III colon cancer: a retrospective cohort study

Background

Stage III colon cancer (CC) presents a critical therapeutic challenge due to its high recurrence risk. Identifying robust prognostic biomarkers to guide adjuvant therapy decisions is urgently needed in clinical practice. Tertiary lymphoid structures (TLSs), as immune aggregates within the tumor microenvironment, have emerged as potential indicators of immunological activity and treatment response. The objective of this study is to evaluate the role of TLSs in stage III CC, focusing on their potential as prognostic markers and their influence on patient outcomes, particularly in relation to chemotherapy response.

Methods

This retrospective cohort study enrolled 613 patients with pathologically confirmed stage III CC from two cohorts: 374 from Harbin Medical University and 239 from The Cancer Genome Atlas Colon Adenocarcinoma (TCGA-COAD) external validation cohort. Overall survival (OS) was the primary outcome, with a median follow-up period of 62 months. TLSs were assessed via immunohistochemistry and categorized by density and location [intratumoral (T score), peritumoral (P score)]. Prognostic significance was evaluated using multivariate Cox regression. A murine model was used to assess the immunomodulatory effects of folinic acid, oxaliplatin, and 5-fluorouracil (FOLFOX) chemotherapy on TLS formation.

Results

TLSs were present in 54.0% and 50.2% of patients in Cohorts 1 and 2, respectively. TLSs enriched with CD8+ T cells and CD20+ B cells were associated with improved OS. Multivariate analysis identified TLS presence as an independent predictor of better survival [hazard ratio (HR) =0.256, 95% confidence interval (CI): 0.093-0.707; P=0.009]. Higher intratumoral TLS density (T score) correlated with lower mortality risk (T2 vs. T0: HR =0.173, P=0.003), whereas higher peritumoral TLS density (P3) predicted worse prognosis (HR =5.887, P=0.04). In vivo experiments confirmed that FOLFOX treatment enhanced TLS formation and increased infiltration of immune cells including B cells, CD4+/CD8+ T cells, and dendritic cells.

Conclusions

TLSs serve as a reliable, independent prognostic biomarker in stage III CC. Their spatial distribution carries distinct prognostic implications, and FOLFOX-induced TLS formation suggests a dual role in cytotoxicity and immune activation. Incorporating TLS assessment into clinical workflows may improve risk stratification and guide personalized treatment, especially in designing immunochemotherapy strategies.

KRAS Mutation Status in Relation to Clinicopathological Characteristics of Romanian Colorectal Cancer Patients

Our study's aim was to evaluate the clinicopathological profile of colorectal cancer (CRC) patients from North-East Romania in relation to the Kirsten rat sarcoma viral oncogene homolog (KRAS). We designed a retrospective study on 108 CRC patients using the fully automated real-time PCR-based molecular testing system, IdyllaTMKRAS Mutation Test (Biocartis, Mechelen, Belgium). Of the patients, 64 (59.3%) were men and 62 (57.4%) were older than the group average, with left bowel location in 38 cases (35.2%), adenocarcinoma NOS in 102 cases (94.4%), mixed histological pattern in 65 cases (60.2%), T3 in 60 patients (55.6%), N2 in 46 patients (42.6%), and 7-12 tumour buds registered in 58 tumours (53.7%). A total of 54 tumour samples (50%) showed KRAS mutation. Statistical comparative analyses associated KRAS mutations with the histopathological pattern (p = 0.018), tumour grade (p = 0.030), depth of invasion (pT) (p < 0.001), lymph node involvement (pN) (p < 0.001), venous vascular invasion (p = 0.048), and tumour buds' number (p = 0.007). Our results demonstrate the relationship between KRAS mutation and clinicopathological features, with possible impact in clinical tumour stratification and therapeutic management.

Editor-in-Chief articles of choice and comments from January to June 2024

As the Editor-in-Chief of the World Journal of Gastroenterology , I carefully review all articles every week before a new issue’s online publication, including the title, clinical and research importance, originality, novelty, and ratings by the peer reviewers. Based on this review, I select the papers of choice and suggest pertinent changes (e.g. , in the title or text) to the company editors responsible for publication. This process, while time-consuming, is essential for assuring the quality of publications and highlighting important articles that readers may revisit.

The Relationship between Tumor Budding and Tumor Deposits in Patients with Stage III Colorectal Carcinoma

Background/Objectives: Recently, some new morphological features of colorectal cancer have been discovered as important prognostic factors; in this paper, we study the relationship between tumor budding (TB) and tumor deposits (TDs). Methods: The retrospective cohort study included 90 patients with pathohistologically confirmed stage III CRC who were treated with radical surgical resection. All hematoxylin and eosin (H and E)-stained slides from each patient were reviewed, and histological parameters were recorded. The samples were divided into two groups with similar sizes: a group without TDs (N = 51) and a control group with TDs (N = 39). The presence and TB grade were further analyzed in these groups and compared with other clinical and histological features. Results: The prevalence of TB in the investigated cohort was unexpectedly high (94.4%). Overall, there were 23 (25.6%) Bd1, 20 (22.2%) Bd2, and 47 (52.2%) Bd3 cases. The presence of TDs was significantly associated with a higher number of TB (p < 0.001, OR 16.3) and, consequently, with a higher TB grade (p = 0.004, OR 11.04). A higher TB grade (p = 0.001, HR 2.28; 95% CI 1.93-4.76) and a growing number of TDs (p = 0.014, HR 1.52; 95% CI 1.09-2.1) were statistically significantly associated with shorter survival. Conclusions: TDs appear more often in patients with higher TB grades in stage III CRC. A higher TB grade and a growing number of TDs were statistically significantly associated with shorter overall survival. These results could give additional emphasis to the importance of TB as an adverse prognostic factor since a strong relationship with TDs has been demonstrated.