Colorectal Cancer pp 247-265 | Cite as
Surgical Pathology of Colorectal Cancer
Abstract
From initial diagnosis through definitive treatment, pathologic evaluation plays a central role in the care of patients with colorectal cancer. The pathologic stage of a surgically resected colorectal carcinoma is widely recognized as the most accurate predictor of survival and it typically determines the appropriateness of adjuvant treatment as well. Numerous additional pathologic factors have been shown by multivariate analyses to have prognostic significance that is independent of stage, and these may help to further substratify tumors. In this chapter, the pathologic features of colorectal cancers that predict outcome after surgical resection and have direct bearing on patient care are reviewed.
Keywords
Colorectal Cancer Rectal Cancer Colorectal Carcinoma Circumferential Resection Margin Mucinous CarcinomaPreview
Unable to display preview. Download preview PDF.
References
- 1.Sherlock P and Winawer SJ. Are there markers for the risk of colorectal cancer? N. Engl. J. Med., 311 (1984) 118–119.PubMedCrossRefGoogle Scholar
- 2.Itzkowitz SH. Gastrointestinal adenomatous polyps. Semin. Gastrointest. Dis., 7 (1996) 105–116.PubMedGoogle Scholar
- 3.Muto T, Bussey HJR, and Morson BC. The evolution of cancer of the colon and rectum. Cancer, 36 (1975) 2251–2270.PubMedCrossRefGoogle Scholar
- 4.Jass JR. Malignant colorectal polyps. Gastroenterology, 109 (1995) 2034–2035.PubMedCrossRefGoogle Scholar
- 5.Morson BC, Whiteway JE, Jones EA, et al. Histopathology and prognosis of malignant colorectal polyps treated by endoscopic polypectomy. Gut, 25 (1984) 437–444.PubMedCrossRefGoogle Scholar
- 6.Wolff WI and Shinya H. Definitive treatment of “malignant” polyps of the colon. Ann. Surg., 182 (1975) 516–525.PubMedCrossRefGoogle Scholar
- 7.Wilcox GM, Anderson PB, and Colacchio TA. Early invasive carcinoma in colonic polyps: a review of the literature with emphasis on the assessment of the risk of metastasis. Cancer, 57 (1986) 160–171.PubMedCrossRefGoogle Scholar
- 8.Cooper HS, Deppisch LM, Gourley WK, et al. Endoscopically removed malignant colorectal polyps: clinicopathologic correlations. Gastroenterology, 108 (1995) 1657–1665.PubMedCrossRefGoogle Scholar
- 9.Cranley JP, Petras RE, Carey WD, et al. When is endoscopic polypectomy adequate therapy for colonic polyps containing invasive carcinoma? Gastroenterology, 91 (1986) 419–427.PubMedGoogle Scholar
- 10.Cooper HS. Surgical pathology of endoscopically removed malignant polyps of the colon and rectum. Am. J. Surg. Pathol., 7 (1983) 613–623.PubMedCrossRefGoogle Scholar
- 11.Cooper HS. The role of the pathologist in the management of patients with endoscopically removed malignant colorectal polyps. Pathol. Annu., 23 (1988) 25–43.PubMedGoogle Scholar
- 12.Cooper HS, Deppisch LM, Kahn EI, et al. Pathology of the malignant colorectal polyp. Hum. Pathol., 29 (1998) 15–26.PubMedCrossRefGoogle Scholar
- 13.Cunningham KN, Mills LR, Schuman BM, et al. Long-term prognosis of well-differentiated adenocarcinoma in endoscopically removed colorectal adenomas. Dig. Dis. Sci., 39 (1994) 2034–2037.PubMedCrossRefGoogle Scholar
- 14.Haggitt RC, Glotzbach RE, Soffer EE, et al. Prognostic factors in colorectal carcinomas arising in adenomas: implications for lesions removed by endoscopic polypectomy. Gastroenterology, 89 (1985) 328–336.PubMedGoogle Scholar
- 15.Lipper S, Kahn LB, and Ackerman LV. The significance of microscopic invasive cancer in endoscopically removed polyps of the large bowel. A clinicopathologic study of 51 cases. Cancer, 52 (1983) 1691–1699.PubMedCrossRefGoogle Scholar
- 16.Kyzer S, Begin LR, Gordan PH, et al. The care of patients with colorectal polyps that contain invasive adenocarcinoma. Cancer, 70 (1992) 2044–2050.PubMedCrossRefGoogle Scholar
- 17.Muller S, Chesner IM, Egan MJ, et al. Significance of venous and lymphatic invasion in malignant polyps of the colon and rectum. Gut, 30 (1989) 1385–1391.PubMedCrossRefGoogle Scholar
- 18.Volk EE, Goldblum JR, Petras RE, et al Management and outcome of patients with invasive carcinoma arising in colorectal polyps. Gastroenterology, 109 (1995) 1801–1807.PubMedCrossRefGoogle Scholar
- 19.Coverlizza S, Risio M, Ferrari A, et al. Colorectal adenomas containing invasive carcinoma: pathologic assessment of lymph node metastatic potential. Cancer, 64 (1989) 1937–1947.PubMedCrossRefGoogle Scholar
- 20.Nivatvongs S and Goldberg SM. Management of patients who have polyps containing invasive carcinoma removed via colonoscope. Dis. Colon Rectum, 21 (1978) 8–11.PubMedCrossRefGoogle Scholar
- 21.Nivatvongs S, Rojanasakul A, Reiman HM, et al. The risk of lymph node metastasis in colorectal polyps with invasive adenocarcinoma. Dis. Colon Rectum, 34 (1991) 323–328.PubMedCrossRefGoogle Scholar
- 22.Wilcox GM, Anderson PB, and Colacchio TA. Early invasive carcinoma in colonic polyps: a review of the literature with emphasis on the assessment of the risk of metastasis. Cancer, 57 (1986) 160–171.PubMedCrossRefGoogle Scholar
- 23.Wilcox GM and Beck JR. Early invasive cancer in adenomatous colonic polyps (“malignant polyps”). Evaluation of the therapeutic options by decision analysis. Gastroenterology, 92 (1987) 1159–1168.PubMedGoogle Scholar
- 24.Fleming ID, Cooper JS, Henson DE, et al. (eds.). AJCC Manual for Staging of Cancer. 5th ed. Philadelphia, Lippincott-Raven, 1997.Google Scholar
- 25.Fielding LP, Arsenault PA, Chapuis PH, et al. Clinicopathological staging for colorectal cancer: an International Documentation System (IDS) and an International Comprehensive Terminology (ICAT). J. Gastroenterol. Hepatol., 6 (1991) 325–344.PubMedCrossRefGoogle Scholar
- 26.Wittekind C, Henson DE, Hutter RVP, Sobin LH, eds. TNM Supplement. A Commentary on Uniform Use. 2nd ed. Wiley-Liss, New York, 2001.Google Scholar
- 27.Chapuis PH, Dent OF, Fisher R, et al. A multivariate analysis of clinical and pathological variables in prognosis after resection of large bowel cancer. Br. J. Surg., 72 (1985) 698–702.PubMedCrossRefGoogle Scholar
- 28.D’Eredita G, Serio G, Neri V, et al. A survival regression analysis of prognostic factors in colorectal cancer. Aust. NZ J. Surg., 66 (1996) 445–451.CrossRefGoogle Scholar
- 29.Frank R, Saclarides T, Leurgans S, et al. Tumor angiogenesis as a predictor of recurrence and survival in patients with node-negative colon cancer. Ann. Surg., 222 695–699.Google Scholar
- 30.Griffin M, Bergstralh E, Coffey R, et al. Predictors of survival after curative resection of carcinoma of the colon and rectum. Cancer, 60 (1987) 2318–2324.PubMedCrossRefGoogle Scholar
- 31.Mulcahy HE, Skelly MM, Husain A, et al. Long-term outcome following curative surgery for malignant large bowel obstruction. Br. J. Surg., 83 (1996) 46–50.PubMedCrossRefGoogle Scholar
- 32.Newland R, Dent O, Lyttle M, et al. Pathologic determinants of survival associated with colorectal cancer with lymph node metastases. A multivariate analysis of 579 patients. Cancer, 73 (1994) 2076–2082.PubMedCrossRefGoogle Scholar
- 33.Roncucci L, Fante R, Losi L, et al. Survival for colon and rectal cancer in a population-based cancer registry. Fur. J. Cancer, 32A (1996) 295–302.Google Scholar
- 34.Takebayashi Y, Akiyama S, Yamada K, et al. Angiogenesis as an unfavorable prognostic factor in human colorectal carcinoma. Cancer, 78 (1996) 226–231.PubMedCrossRefGoogle Scholar
- 35.Crucitti F, Sofo L, Doglietto G, et al. Prognostic factors in colorectal cancer: current status and new trends. J. Surg. Oncol., 2 (1991) 76–82.CrossRefGoogle Scholar
- 36.Deans G, Heatley M, Anderson N, et al. Jass’ Classification revisited. J. Am. Coll. Surg., 179 (1994) 11–17.PubMedGoogle Scholar
- 37.Freedman L, Macaskill P, and Smith A. Multivariate analysis of prognostic factors for operable rectal cancer. Lancet, II (1984) 733–736.CrossRefGoogle Scholar
- 38.Michelassi F, Ayala J, Balestracci T, et al. Verification of a new clinicopathologic staging system for colorectal adenocarcinoma. Ann. Surg., 214 (1991) 11–18.PubMedGoogle Scholar
- 39.Michelassi F, Block GE, Vannucci L, et al. A 5- to 21-year follow-up and analysis of 250 patients with rectal adenocarcinoma. Ann. Surg., 208 (1988) 379–387.PubMedCrossRefGoogle Scholar
- 40.Hobday TJ and Erlichman C. Colorectal cancer. In Prognostic Factors in Cancer. Gospodarowicz MK, Henson DE, Hutter RVP, O’Sullivan B, Sobin LH, Wittekind C, eds. Wiley-Liss, New York, 2001, pp. 311–332.Google Scholar
- 41.Compton CC. Updated protocol for the examination of specimens removed from patients with carcinomas of the colon and rectum excluding carcinoid tmors, lymphomas, sarcomas, and tumors of the vermiform appendix. A basis for checklists. Arch. Pathol. Lab. Med., 124 (2000) 1016–1025.PubMedGoogle Scholar
- 42.Hamilton SR, Rubio CA, Vogelstein B, et al. Carcinoma of the colon and rectum. In World Health Organization Classification of Tumours. Tumours of the Digestive System. IARC Press, Lyon France, 2000, pp. 101–119.Google Scholar
- 43.Carlon C, Fabris G, Arslan-Pagnini C, et al. Prognostic correlations of operable carcinoma of the rectum. Dis. Colon Rectum, 28 (1985) 47–50.PubMedCrossRefGoogle Scholar
- 44.Green J, Timmcke A, Mitchell W, et al. Mucinous carcinoma just another colon cancer? Dis. Colon Rectum, 36 (1993) 49–54.PubMedCrossRefGoogle Scholar
- 45.Hermanek P, Guggenmoos-Holzmann I, and Gall FP. Prognostic factors in rectal carcinoma. A contribution to the further development of tumor classification. Dis. Colon Rectum, 32 (1989) 593–599.PubMedCrossRefGoogle Scholar
- 46.Jass J, Atkin W, Cuzick J, et al. The grading of rectal cancer: historical perspectives and a multivariate analysis of 447 cases. Histopathology, 10 (1986) 437–459.PubMedCrossRefGoogle Scholar
- 47.Jass J, Love S, and Northover J. A new prognostic classification of rectal cancer. Lancet, I (1987) 1303–1306.CrossRefGoogle Scholar
- 48.Robey-Cafferty SS, el-Naggar AK, Grignon DJ, et al. Histologic parameters and DNA ploidy as predictors of survival in stage B adenocarcinoma of colon and rectum. Mod. Pathol., 3 (1990) 261–266.PubMedGoogle Scholar
- 49.Spratt J and Spjut H. Prevalence and prognosis of individual clinical and pathologic variables associated with colorectal carcinoma. Cancer, 20 (1967) 1976–1985.PubMedCrossRefGoogle Scholar
- 50.Umpleby HC and Williamson RC. Carcinoma of the large bowel in the first four decades. Br. J. Surg., 71 (1984) 272–277.PubMedCrossRefGoogle Scholar
- 51.Jesserun J, Romero-Guadarrama M, and Manivel JC. Medullary adenocarcinoma of the colon: clinicopathologic study of 11 cases. Hum. Pathol., 30 (1999) 843–848.CrossRefGoogle Scholar
- 52.Minsky B, Mies C, Rich T, et al. Colloid carcinoma of the colon and rectum. Cancer, 60 (1987) 3103–3112.PubMedCrossRefGoogle Scholar
- 53.Secco G, Fardelli R, Campora E, et al. Primary mucinous adenocarcinomas and signet-ring cell carcinomas of colon and rectum. Oncology, 51 (1994) 30–34.PubMedCrossRefGoogle Scholar
- 54.Symonds D and Vickery A. Mucinous carcinoma of the colon and rectum. Cancer, 37 (1976) 1891–1900.PubMedCrossRefGoogle Scholar
- 55.Heys S, Sherif A, Bagley J, et al. Prognostic factors and survival of patients aged less than 45 years with colorectal cancer. Br. J. Surg., 81 (1994) 685–688.PubMedCrossRefGoogle Scholar
- 56.Harrison J, Dean P, El-Zeky F, et al. From Dukes through Jass: pathological prognostic indicators in rectal cancer. Hum. Pathol., 25 (1994) 498–505.PubMedCrossRefGoogle Scholar
- 57.Sasaki O, Atkin WS, and Jass JR. Mucinous carcinoma of the rectum. Histopathology, 11 (1987) 259–272.PubMedCrossRefGoogle Scholar
- 58.Shepherd N, Saraga E, Love S, et al. Prognostic factors in colonic cancer. Histopathology, 14 (1989) 613–620.PubMedCrossRefGoogle Scholar
- 59.Halvorsen T and Seim E. Association between invasiveness, inflammatory reaction, desmoplasia and survival in colorectal cancer. J. Clin. Pathol., 42 (1989) 162–166.PubMedCrossRefGoogle Scholar
- 60.Öfner D, Riedmann B, Maier H, et al. Standardized staining and analysis of argyrophilic nucleolar organizer region associated proteins (AgNORs) in radically resected colorectal adenocarcinoma-correlation with tumour stage and long-term survival. J. Pathol., 75 (1995) 441–448.CrossRefGoogle Scholar
- 61.Staren ED, Gould VE, Warren WH, et al. Neuroendocrine carcinomas of the colon and rectum: a clinico-pathologic correlation. Surgery, 104 (1988) 1080–1089.PubMedGoogle Scholar
- 62.DeBruine A, Wiggers T, Beek C, et al. Endocrine cells in colorectal adenocarcinomas: incidence, hormone profile and prognostic relevance. Int. J. Cancer, 54 (1993) 765–771.CrossRefGoogle Scholar
- 63.Gaffey M, Mills S, and Lack E. Neuroendocrine carcinoma of the colon and rectum. A clinicopathologic, ultrastructural, and immunohistochemical study of 24 cases. Am. J. Surg. Pathol., 14 (1990) 1010–1023.PubMedCrossRefGoogle Scholar
- 64.Blenkinsopp WK, Stewart-Brown S, Blesovsky L, et al. Histopathology reporting in large bowel cancer. J. Clin. Pathol., 34 (1981) 509–513.PubMedCrossRefGoogle Scholar
- 65.Böttger TC, Potratz D, Stöckle M, et al. Prognostic value of DNA analysis in colorectal carcinoma. Cancer, 72 (1993) 3579–3587.PubMedCrossRefGoogle Scholar
- 66.Fisher E, Sass R, Palekar A, et al. Dukes’ classification revisited. Findings from the National Surgical Adjuvant Breast and Bowel Projects. Cancer, 64 (1989) 2354–2360.PubMedCrossRefGoogle Scholar
- 67.Jessup JM, Lavin PT, Andrews CW, et al. Sucrase-isomaltase is an independent prognostic marker for colorectal carcinoma. Dis. Colon Rectum, 38 (1995) 1257–1264.PubMedCrossRefGoogle Scholar
- 68.Jessup J, McGinnis L, Steele G, et al. The National Cancer Data Base Report on Colon Cancer. Cancer, 78 (1996) 918–926.PubMedCrossRefGoogle Scholar
- 69.Ruschoff J, Bittinger A, Neumann K, et al. Prognostic significance of nucleolar organizing regions (NORs) in carcinomas of the sigmoid colon and rectum. Pathol. Res. Pract., 186 (1990) 85–91.PubMedCrossRefGoogle Scholar
- 70.Scott NA, Wieand HS, Moertel CG, et al. Colorectal cancer. Dukes’ stage, tumor site, preoperative plasma CEA level, and patient prognosis related to tumor DNA ploidy pattern. Arch. Surg., 122 (1987) 1375–1379.PubMedCrossRefGoogle Scholar
- 71.Wiggers T, Arends J, Volovics A. Regression analysis of prognostic factors in colorectal cancer after curative resections. Dis. Colon Rectum, 31 (1988) 33–41.PubMedCrossRefGoogle Scholar
- 72.Compton CC, Fielding LP, Burgart LJ, et al. Prognostic factors in colorectal cancer: College of American Pathologists consensus statement 1999. Arch. Pathol. Lab. Med., 124 (2000) 979–994.PubMedGoogle Scholar
- 73.Steele G Jr, Mayer RJ, Podolsky DK, et al. Cancer of the colon, rectum, and anus. In Cancer Manual. 9th ed. Osteen RT (ed.). American Cancer Society, Farmington, MA, pp. 399–410.Google Scholar
- 74.Stower M and Hardcastle J. The results of 1115 patients with colorectal cancer treated over an 8-year period in a single hospital. Eur. J. Surg. Oncol., 11 (1985) 119–123.PubMedGoogle Scholar
- 75.Sobin LH and Wittekind C (eds.). TNM Classification of Malignant Tumours: International Union Against Cancer. 5th ed. Wiley, New York, 1997.Google Scholar
- 76.Compton CC, Fenoglio-Preiser CM, Pettigrew N, et al. American Joint Committee on Cancer Prognostic Factors consensus conference: Colorectal Working Group. Cancer, 88 (2000) 1739–1757.PubMedCrossRefGoogle Scholar
- 77.Shepherd N, Baxter K, and Love S. The prognostic importance of peritoneal involvement in colonic cancer: A prospective evaluation. Gastroenterology, 112 (1997) 1096–1102.PubMedCrossRefGoogle Scholar
- 78.Tominaga T, Sakabe T, Koyama Y, et al. Prognostic factors for patients with colon or rectal carcinoma treated with resection only. Five-year follow-up report. Cancer, 78 (1996) 403–408.PubMedCrossRefGoogle Scholar
- 79.Zeng Z, Cohen AM, Hajdu S, et al. Serosal cytologic study to determine free mesothelial penetration of intraperitoneal colon cancer. Cancer, 70 (1992) 737–740.PubMedCrossRefGoogle Scholar
- 80.Herrera-Omelas L, Justinian J, Castillo N, et al. Metastases in small lymph nodes from colon cancer. Arch. Surg., 122 (1987) 1253–1256.CrossRefGoogle Scholar
- 81.Scott KWM and Grace RH. Detection of lymph node metastases in colorectal carcinoma before and after fat clearance. Br. J. Surg., 76 (1989) 1165–1167.PubMedCrossRefGoogle Scholar
- 82.Goldstein NS and Turner JR. Pericolonic tumor deposits in patients with T3N+MO colon adenocarcinomas. Markers of reduced disease free survival and intra-abdominal metastases and their implications for TNM classification. Cancer, 88 (2000) 2228–2238.Google Scholar
- 83.Liefers G-J, Cleton-Jansen A-M, van de Velde CJ, et al. Micrometastases and survival in stage II colorectal cancer. N. Engl. J. Med., 339 (1998) 223–228.PubMedCrossRefGoogle Scholar
- 84.Jeffers MD, O’Dowd GM, Mulcahy H, et al. The prognostic significance of immunohistochemically detected lymph node micrometastases in colorectal carcinoma. J. Pathol., 172 (1994) 183–187.PubMedCrossRefGoogle Scholar
- 85.Hermanek P, Hutter RVP, Sobin LH, et al. Classification of isolated tumor cells and micrometastasis. Cancer, 86 (1999) 2668–2673.PubMedCrossRefGoogle Scholar
- 86.Cross SS, Bull AD, and Smith JHF. Is there any justification for the routine examination of bowel resection margins in colorectal adenocarcinoma? J. Clin. Pathol. 42 (1989) 1040–1042.PubMedCrossRefGoogle Scholar
- 87.Sloane JP, Ansell ID, Quirke P, and Underwood JCE. Standards and Minimum Datasets for Reporting Common Cancers. Minimum Dataset for Colorectal Cancer Histopathology Reports. The Royal College of Pathologists, London, UK, 1998.Google Scholar
- 88.Quirke P. Limitations of existing systems of staging for rectal cancer: the forgotten margin. In Rectal Cancer Research. Rajagopalan NT, ed. Springer-Verlag, New York, NY, 2001, pp. 63–81.Google Scholar
- 89.Adam IJ, Mohamdee MO, Martin IG, et al. Role of the circumferential margin involvement in the local recurrence of rectal cancer. Lancet, 344 (1994) 707–711.PubMedCrossRefGoogle Scholar
- 90.Chan K, Boey J, and Wong S. A method of reporting radial invasion and surgical clearance of rectal carcinoma. Histopathology, 9 (1985) 1319–1327.PubMedCrossRefGoogle Scholar
- 91.Quirke P and Scott N. The pathologist’s role in the assessment of local recurrence in rectal carcinoma. Surg. Oncol. Clin. N. Amer., 3 (1992) 1–17.Google Scholar
- 92.Quirke P, Durdy P, Dixon MF, et al. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Lancet, II (1986) 996–999.CrossRefGoogle Scholar
- 93.Knudsen JB, Nilsson T, Sprechler M, et al. Venous and nerve invasion as prognostic factors in postoperative survival of patients with resectable cancer of the rectum. Dis. Colon Rectum, 26 (1983) 613–617.PubMedCrossRefGoogle Scholar
- 94.Horn A, Dahl O and Morild I. Venous and neural invasion as predictors of recurrence in rectal adenocarcinoma. Dis. Colon Rectum, 34 (1991) 798–804.PubMedCrossRefGoogle Scholar
- 95.Lee Y. Local and regional recurrence of carcinoma of the colon and rectum: I. Tumour-host factors and adjuvant therapy. Surg. Oncol., 4 (1995) 283–293.PubMedCrossRefGoogle Scholar
- 96.Talbot I, Ritchie S, Leighton MH, et al. The clinical significance of invasion of veins by rectal cancer. Br. J. Surg., 67 (1980) 439–442.PubMedCrossRefGoogle Scholar
- 97.Takahashi Y, Tucker S, Kitadai Y, et al. Vessel counts and expression of vascular endothelial growth factor as prognostic factors in node-negative colon cancer. Arch. Surg., 132 (1997) 541–546.PubMedCrossRefGoogle Scholar
- 98.Minsky B, Mies C, Recht A, et al. Resectable adenocarcinoma of the rectosigmoid and rectum. II. The influence of blood vessel invasion. Cancer, 61 (1988) 1417–1424.PubMedCrossRefGoogle Scholar
- 99.Minsky B, Mies C, Rich T, et al. Lymphatic vessel invasion in an independent prognostic factor for survival in colorectal cancer. Int. J. Radiat. Oncol. Biol. Phys., 17 (1989) 311–318.PubMedCrossRefGoogle Scholar
- 100.Ono M, Sakamoto M, Ino Y, et al. Cancer cell morphology at the invasive front and expression of cell adhesion-related carbohydrate in the primary lesion of patients with colorectal carcinoma with liver metastasis. Cancer, 78 (1996) 1179–1186.PubMedCrossRefGoogle Scholar
- 101.Sinicrope F, Hart J, Brasitus T, et al. Relationship of P-glycoprotein and carcinoembryonic antigen expression in human colon carcinoma to local invasion, DNA ploidy, and disease relapse. Cancer, 74 (1994) 2908–2917.PubMedCrossRefGoogle Scholar
- 102.Hase K, Shatney C, Johnson D, et al. Prognostic value of tumor “budding” in patients with colorectal cancer. Dis. Colon Rectum, 36 (1993) 627–635.PubMedCrossRefGoogle Scholar
- 103.Thynne GS, Weiland LH, Moertel CG, et al. Correlation of histopathologic characteristics of primary tumor and uninvolved regional lymph nodes in Dukes’ C colonic carcinoma with prognosis. Mayo Clin. Proc., 55 (1980) 243–245.PubMedGoogle Scholar
- 104.Shirouzu K, Isomoto H, and Kakegawa T. Prognostic evaluation of perineural invasion in rectal cancer. Am. J. Surg., 165 (1993) 233–237.PubMedCrossRefGoogle Scholar
- 105.Pihl E, Malahy MA, Khankhanian N, et al. Immunomorphological features of prognostic significance in Dukes’ class B colorectal carcinoma. Cancer Res., 37 (1977) 4145–4149.PubMedGoogle Scholar
- 106.Svennevig JL, Lunde OC, Holter J, et al. Lymphoid infiltration and prognosis in colorectal carcinoma. Br. J. Cancer, 49 (1984) 375–377.PubMedCrossRefGoogle Scholar
- 107.Zhou XG, Yu BM, and Shen YX. Surgical treatment and late results in 1226 cases of colorectal cancer. Dis. Colon Rectum, 26 (1983) 250–256.PubMedCrossRefGoogle Scholar
- 108.Jass JR, Do KA, Simms LA, et al. Morphology of sporadic colorectal cancer with DNA replication errors. Gut, 42 (1998) 673–679.PubMedCrossRefGoogle Scholar