| Background:Invasive micropapillary carcinoma is considered to be a rare disease entity with aggressive tumors.However,few reports describe pathologic features of invasive micropapillary component in gastrointestinal adenocarcinoma,particularly in colorectal cancer.This rare histological type often shows aggressive tumor behavior with significant lymphatic invasion,leading to poor prognosis.Recent studies have shown that invasive micropapillary carcinoma similar to breast which has been reported to occur in various organs,including the bladder,ureter,lung and parotid glands.It has also been reported that invasive micropapillary carcinoma is also found in colon.Previous studies of adenocarcinoma with invasive micropapillary pattern due to colorectal cancer have been limited,and the study of this type has not been well resolved.Previous studies of primary invasive micropipillary component in gastrointestinal adenocarcinoma,have shown that down-regulation of E-cadherin expression,as in other organs,means that the differentiation of colorectal adenocarcinoma with invasive micropapillary pattern is a poor prognostic factor.Materials and Method:1.Retrospective analysis of 134 cases of routine surgical treatment of colorectal cancer between January 2007 and December 2009 in the Second Affiliated Hospital of Zhejiang University was carried out,in which 53 cases with invasive micropapillary component existed,and as control group,81 cases of ordinary adenocarcinoma without micropapillary component.2.The differences of EMA,CD10 and E-Cadherin expression between colorectal adenocarcinoma with invasive micropapillary pattern and that without invasive micropapillary pattern was analyzed.3.Using SPSS 16 software for statistical analysis was perfomed.Result:1.53 cases(39.5%)had histologically a variety of invasive micropapillary component,58 cases(43.3%)of well differentiated adenocarcinoma and 23 cases(17.2%)of poorly differentiated adenocarcinoma had no invasive micropapillary component.The median age of the experimental group and the control group was 62.1±11.2 years and 60.4±12.1 years(P=0.37),respectively.The male percentage of the experimental group and the control group were 60.4%and 60.5%(P<0.565).In anatomic location,36 cases(67.9%)of the experimental group were in the colon,17 cases(32.1%)of the experimental group were in the rectum,while 48 cases(59.3%)were in the colon and 33 cases(40.7%)were in the rectum in control group.The differences between two groups were not statistically significant(P=0.203).2.Clinicopathological features were compared between two groups.The gross type of colorectal adenocarcinomas with invasive micropapillary component was more commonly ulcerative type,accounting for 58.5%,while the control group was more commonly elevated type,accounting for 70.4%(P<0.001).The size of the primary tumor with invasive micropapillary component was smaller than that without micropapillary component(P<0.001).The depth of tumor invasion of colorectal carcinomas with invasive micropapillary component was deeper than that without micropapillary component(P=0.015).3.In the degree of invasion of tumor tissue,more lymphatic invasion,vascular invasion and nerve invasion was found in colorectal adenocarcinomas with invasive micropapillary component.The differences between the two groups were statistically significant.The percentage of positive vascular invasion,nerve invasion and lymph node metastasis was 13.2%,18.9%and 66%in colorectal adenocarcinomas with invasive micropapillary component,which all were significantly higher than those in the control group.In number of positive lymph node,the experimental group was 3.8±1.7 higher than that of the control group(P<0.001).In addition,12 cases(22.6%)of adenocarcinomas with invasive micropapillary component were found to have distant metastases,compared with 4 cases(4.9%)in the control group with distant metastasis(P<0.001).In the stage of the tumor,38 cases were in stage III-IV in the experimental group,accounting for 71.7%,which was significantly higher than that in the control group(P=0.023).4.In immunohistochemical results,48 cases(90.6%)were positive for EMA antibody in "inside-out" staining pattern in the adenocarcinoma with invasive micropapillary component,and 5 cases(9.4%)were negative.8 cases(15.1%)were positive for CD 10 in "inside-out"staining pattern in the adenocarcinoma with invasive micropapillary component.17 cases(32.1%)were positive in cytoplasm and 28 cases(52.8%)were negative.E-cadherin expression was decreased in adenocarcinoma with invasive micropapillary component.34 cases(64.2%)were positive,19(35.9%)cases were weakly positive or negative.While all the cases(100%)were positive in adenocarcinoma without invasive micropapillary component(P<0.001).5.The average survival time of adenocarcinoma with invasive micropapillary component was significantly shorter than that in the control group(31.9±16.5 months vs 37.8±14.7 months,P=0.032).In addition,the study found that patients' 3-year disease-free survival rate was 40.5%in the adenocarcinoma group with invasive micropapillary component,while the 3-year disease-free survival rate was 72.6%in control group(P=0.02).In addition,as shown in Figure 4,the 3-year overall survival rate for patients was 59.3%in the experimental group,and 80.6%in the control group(P=0.07).6.Univariate analysis showed that the following factors were important indicators of patient survival parameters:Micropapillary component(P=0.001),tumor invasion depth(P=0.015),tumor type(P<0.001),vascular invasion(P=0.02),nerve infiltration(P=0.004),lymph node metastasis(P=0.042),distant metastasis during surgery(P<0.001),tumor stage(P=0.023).To further assess the significance of these eight factors,multivariate analysis and Cox proportional hazards model was performed.Micropapillary component[OR:4.28,95%confidence interval(CI)1.493-12.320,P<0.01]or lymph node metastasis[OR:6.29,95%confidence interval(CI)1.749-22.686,P<0.01)]was an independent prognostic factor for disease-free survival,the degree of tumor invasion was not an independent prognostic factor for disease-free survival.Conclusion:1.colorectal adenocarcinoma with invasive micropapillary component had no significantly differences in the gender,age,tumor location compared with the control group.2.Colorectal adenocarcinoma with invasive micropapillary component had more vascular invasion,nerve invasion,lymph node metastasis,and worse prognosis.3.Some cases in adenocarcinoma with invasive micropapillary pattern had CD 10 expression in "inside-out" staining pattern,which was similar to characteristic of EMA expression pattern. |
PDF Full Text Request