Separation of Low- Versus High-grade Crohn's Disease-associated Small Bowel Carcinomas is Improved by Invasive Front Prognostic Marker Analysis.
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Arpa Giovanni, Grillo Federica, Giuffrida Paolo, Nesi Gabriella, Klersy Catherine, Mescoli Claudia, Lenti Marco Vincenzo, Lobascio Gessica, Martino Michele, Latella Giovanni, Malvi Deborah, Macciomei Maria Cristina, Fociani Paolo, Villanacci Vincenzo, Rizzo Aroldo, Ferrero Stefano, Sessa Fausto, Orlandi Augusto, Monteleone Giovanni, Biancone Livia, Cantoro Laura, Tonelli Francesco, Ciardi Antonio, Poggioli Gilberto, Rizzello Fernando, Ardizzone Sandro, Sampietro Gianluca, Solina Gaspare, Oreggia Barbara, Papi Claudio, D'Incà Renata, Vecchi Maurizio, Caprioli Flavio, Caronna Roberto, D'Errico Antonietta, Fiocca Roberto, Rugge Massimo, Corazza Gino Roberto, Luinetti Ombretta, Paulli Marco, Solcia Enrico, Di Sabatino Antonio, Vanoli Alessandro
Аннотация
METHODS: As in recent studies on colorectal cancer, a substantial improvement in prognostic evaluations has been provided by the histological analysis of the tumour invasive front; we therefore systematically analysed the tumour budding and poorly differentiated clusters in the invasive front of 47 Crohn's disease-associated small bowel carcinomas collected through the Small Bowel Cancer Italian Consortium.
RESULTS: Both tumour budding and poorly differentiated cluster analyses proved highly effective in prognostic evaluation of Crohn's disease-associated small bowel carcinomas. In addition, they retained prognostic value when combined with two other parameters, i.e. glandular histology and stage I/II, both known to predict a relatively favourable small bowel carcinoma behaviour. In particular, association of tumour budding and poorly differentiated clusters in a combined invasive front score allowed identification of a minor subset of cancers [12/47, 25%] characterised by combined invasive front low grade coupled with a glandular histology and a low stage [I or II] and showing no cancer-related death during a median follow-up of 73.5 months.
CONCLUSIONS: The improved distinction of lower- from higher-grade Crohn's disease-associated small bowel carcinomas provided by invasive front analysis should be of potential help in choosing appropriate therapy for these rare and frequently ominous neoplasms.