Annals of Surgical Oncology

, Volume 19, Issue 6, pp 1944–1953

Prognostic Significance and Molecular Associations of Tumor Growth Pattern in Colorectal Cancer

  • Teppei Morikawa
  • Aya Kuchiba
  • Zhi Rong Qian
  • Mari Mino-Kenudson
  • Jason L. Hornick
  • Mai Yamauchi
  • Yu Imamura
  • Xiaoyun Liao
  • Reiko Nishihara
  • Jeffrey A. Meyerhardt
  • Charles S. Fuchs
  • Shuji Ogino
Gastrointestinal Oncology

Abstract

Background

Infiltrative growth pattern at the tumor margin has been associated with shorter patient survival. However, little is known about the prognostic significance of tumor growth pattern, independent of tumoral molecular alterations and other histologic features.

Methods

Utilizing a database of 1139 colon and rectal cancer patients in two prospective cohort studies, histologic features including tumor growth pattern, tumor differentiation, lymphocytic reaction, mucinous component, and signet ring cell component were recorded by a single pathologist. Cox proportional hazard model was used to compute mortality hazard ratio, adjusting for clinical, pathologic, and tumor molecular features, including microsatellite instability, the CpG island methylator phenotype, long interspersed nucleotide element 1 (LINE-1) methylation, and KRAS,BRAF, and PIK3CA mutations.

Results

Among 1139 colorectal cancers, we observed expansile growth pattern in 372 tumors (33%), intermediate growth pattern in 610 tumors (54%), and infiltrative growth pattern in 157 tumors (14%). Compared to patients with expansile growth pattern, those with infiltrative growth pattern experienced shorter cancer-specific survival (log rank P < 0.0001; multivariate hazard ratio 1.74; 95% confidence interval 1.22–2.47) and overall survival (log rank P < 0.0001; multivariate hazard ratio 1.78; 95% confidence interval 1.33–2.39). The prognostic association of infiltrative growth pattern was confined to patients with stage I–III disease (Pinteraction with stage = 0.0001).

Conclusions

Infiltrative growth pattern was associated with worse prognosis among stage I–III colorectal cancer patients, independent of other clinical, pathologic, and molecular characteristics.

Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Teppei Morikawa
    • 1
  • Aya Kuchiba
    • 1
  • Zhi Rong Qian
    • 1
  • Mari Mino-Kenudson
    • 2
  • Jason L. Hornick
    • 3
  • Mai Yamauchi
    • 1
  • Yu Imamura
    • 1
  • Xiaoyun Liao
    • 1
  • Reiko Nishihara
    • 1
  • Jeffrey A. Meyerhardt
    • 1
  • Charles S. Fuchs
    • 1
    • 4
  • Shuji Ogino
    • 1
    • 3
  1. 1.Department of Medical OncologyDana-Farber Cancer Institute and Harvard Medical SchoolBostonUSA
  2. 2.Department of PathologyMassachusetts General Hospital and Harvard Medical SchoolBostonUSA
  3. 3.Department of PathologyBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA
  4. 4.Channing Laboratory, Department of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA

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