Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2025; 17(3): 101325
Published online Mar 15, 2025. doi: 10.4251/wjgo.v17.i3.101325
Assessment of new pathological markers in early stage colon cancer: Insights and limitations
Bulent Erdogan, Fatma Elif Usturalı Keskin, Erkan Özcan, Ahmet Küçükarda, Ali Kaan Güren, Osman Köstek, Bekir Muhammet Hacioglu, Hilmi Kodaz
Bulent Erdogan, Department of Medical Oncology, Division of Medical Oncology, Department of Internal Medicine, Trakya University School of Medicine, Edirne 22000, Türkiye
Fatma Elif Usturalı Keskin, Department of Pathology, Trakya University School of Medicine, Trakya University, Edirne 22000, Türkiye
Erkan Özcan, Division of Medical Oncology, Trakya University School of Medicine, Edirne 22000, Türkiye
Ahmet Küçükarda, Bekir Muhammet Hacioglu, Division of Medical Oncology, Department of Internal Medicine, Trakya University School of Medicine, Edirne 22000, Türkiye
Ali Kaan Güren, Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Marmara University, Istanbul 34000, Türkiye
Osman Köstek, Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul 34000, Türkiye
Hilmi Kodaz, Department of Medical Oncology, Acibadem Eskisehir Hospital, Eskisehir 26130, Türkiye
Author contributions: Erdogan B conceptualized the study; Özcan E, Küçükarda A, Güren AK provided study material or patients; Köstek O, Kodaz H curated the data; Kodaz H performed formal analysis; Erdogan B, Hacioglu BM developed the methodology; Usturalı Keskin FE contributed to the pathological analysis; Erdogan B, Kodaz H contributed to revision of the manuscript.
Institutional review board statement: Approved by Trakya University Ethics Committee, No. TUTF-BAE2020/336.
Informed consent statement: Since this is a retrospective study, informed consent was not required from the patients.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The datasets used and/or analyzed during the present study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hilmi Kodaz, Professor, Department of Medical Oncology, Acibadem Eskisehir Hospital, Hosnudiye District, Eskibaglar Street, No. 19 Tepebası, Eskisehir 26130, Türkiye. hilmikodaz@hotmail.com
Received: September 10, 2024
Revised: November 9, 2024
Accepted: December 12, 2024
Published online: March 15, 2025
Processing time: 156 Days and 13.9 Hours
Abstract
BACKGROUND

The decision to administer adjuvant chemotherapy to patients with local stage depends on specific high-risk features that are T4 tumor stage, presence of perineural invasion, lymphovascular invasion, poorly differentiated tumor histology, inadequate lymph node sampling (fewer than 12 lymph nodes), and evidence of tumor perforation or obstruction. Tumor-stroma ratio, tumor infiltrating lymphocytes (TIL), Crohn-like reaction (CLR), desmoid reaction, poorly differentiated clusters (PDC) are new pathological markers that are being studied.

AIM

To examine the relationship between new pathological markers and defined high risk factors, in early stage colorectal cancer.

METHODS

We evaluated 155 patients with the diagnosis stage I and II colorectal cancer between the years 2007 and 2021 who were treated at Trakya University Hospital, Department of Medical Oncology. We divided those with and without high-risk factors into two groups. We examined the relationship of new pathological markers with these groups and with pathological markers in risk factors.

RESULTS

There was no statistically significant correlation between presence of TIL, presence of PDC, presence of tumor budding, presence of CLR, presence of desmoid reaction and low and high-risk groups according to the degree of those with PDC (P = 0.82, P = 0.51, P = 0.77, P = 0.37, P = 0.83, respectively). In addition, no statistically significant correlation was found between the tumor-stroma ratio and low and high risk groups (P = 0.80). We found a statistically significant correlation between the presence of PDC and the presence of PDC grade 3 and T stage (P = 0.001, P = 0.001, respectively). It was determined that the presence of PDC and the frequency of grade 3 PDC increased with the advanced T stage.

CONCLUSION

No relationship was found between the presence of new pathological markers and high-low risk groups. When we examined the relationship between new and old pathological markers, only the frequency of detection of PDC and PDC grade 3 was found to be correlated with advanced T stage.

Keywords: Colon cancer; Early stage; Risk factors; New pathological markers; Tumor-stroma ratio; Tumor infiltrating lymphocytes; Crohn-like reaction; Desmoid reaction; Poorly differentiated clusters

Core Tip: When their associations with the pathological marker in the risk group were evaluated, it was found that there was a significant correlation between the presence of poorly differentiated clusters (PDC) and the presence of PDC grade 3 and advanced T stage. This showed us that PDC is one of the markers to be used in cases where these risk factors are insufficient.