Jung Ho Kim1, Kyung-Ju Kim2, Jeong Mo Bae2, Ye-Young Rhee2, Nam-Yun Cho3, Hye Seung Lee4, Gyeong Hoon Kang5. 1. Department of Pathology, SMG-SNU Boramae Medical Centre, Seoul, Korea. 2. Department of Pathology, Seoul National University College of Medicine, Seoul, Korea. 3. Laboratory of Epigenetics, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. 4. Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea. 5. Department of Pathology, Seoul National University College of Medicine, Seoul, Korea Laboratory of Epigenetics, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Abstract
AIMS: Crohn-like lymphoid reaction (CLR) in colorectal carcinoma (CRC) is associated with a favourable prognosis and microsatellite instability-high (MSI-H) status. However, there is a lack of consensus on optimal criteria for CLR assessment. The aim of this study was to comparatively validate traditional and novel assessment criteria for CLR. METHODS: CLR status in 212 MSI-H CRCs was assessed independently by two pathologists using three different criteria: (1) traditional semiquantitative criteria (Graham-Appelman criteria), (2) the largest lymphoid aggregate (LA) size-based criteria (Ueno criteria) and (3) LA density-based criteria (Väyrynen-Mäkinen criteria). RESULTS: Among the three criteria, the Väyrynen-Mäkinen criteria-based CLR assessment showed the best interobserver agreement (κ value, 0.71; intraclass correlation coefficient, 0.76). Pathologically, intense CLR (grade 2) by Graham-Appelman criteria, active CLR (largest LA size ≥1 mm) by Ueno criteria and high-density CLR (≥0.38 LAs/mm) by Väyrynen-Mäkinen criteria significantly correlated with an early cancer stage (stage I/II). In Kaplan-Meier analysis, both CLR statuses determined by Ueno criteria and Väyrynen-Mäkinen criteria were associated with significant differences in disease-free survival in MSI-H CRC patients (p=0.005 and p=0.001, respectively). In multivariable analysis, both active CLR and high-density CLR proved to be independent favourable prognostic factors in MSI-H CRC (HR, 0.47; 95% CI 0.24 to 0.9 for active CLR and HR, 0.5; 95% CI 0.28 to 0.89 for high-density CLR). CONCLUSIONS: Our study confirms that the two recently suggested criteria (Ueno criteria and Väyrynen-Mäkinen criteria) for CLR assessment are fairly reproducible methods and can serve as superior prognosticators in CRC. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
AIMS: Crohn-like lymphoid reaction (CLR) in colorectal carcinoma (CRC) is associated with a favourable prognosis and microsatellite instability-high (MSI-H) status. However, there is a lack of consensus on optimal criteria for CLR assessment. The aim of this study was to comparatively validate traditional and novel assessment criteria for CLR. METHODS:CLR status in 212 MSI-H CRCs was assessed independently by two pathologists using three different criteria: (1) traditional semiquantitative criteria (Graham-Appelman criteria), (2) the largest lymphoid aggregate (LA) size-based criteria (Ueno criteria) and (3) LA density-based criteria (Väyrynen-Mäkinen criteria). RESULTS: Among the three criteria, the Väyrynen-Mäkinen criteria-based CLR assessment showed the best interobserver agreement (κ value, 0.71; intraclass correlation coefficient, 0.76). Pathologically, intense CLR (grade 2) by Graham-Appelman criteria, active CLR (largest LA size ≥1 mm) by Ueno criteria and high-density CLR (≥0.38 LAs/mm) by Väyrynen-Mäkinen criteria significantly correlated with an early cancer stage (stage I/II). In Kaplan-Meier analysis, both CLR statuses determined by Ueno criteria and Väyrynen-Mäkinen criteria were associated with significant differences in disease-free survival in MSI-H CRCpatients (p=0.005 and p=0.001, respectively). In multivariable analysis, both active CLR and high-density CLR proved to be independent favourable prognostic factors in MSI-H CRC (HR, 0.47; 95% CI 0.24 to 0.9 for active CLR and HR, 0.5; 95% CI 0.28 to 0.89 for high-density CLR). CONCLUSIONS: Our study confirms that the two recently suggested criteria (Ueno criteria and Väyrynen-Mäkinen criteria) for CLR assessment are fairly reproducible methods and can serve as superior prognosticators in CRC. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Entities:
Keywords:
COLORECTAL CANCER; GUT PATHOLOGY; HISTOPATHOLOGY; TUMOUR IMMUNITY
Authors: Tsuyoshi Konishi; Yoshifumi Shimada; Lik Hang Lee; Marcela S Cavalcanti; Meier Hsu; Jesse Joshua Smith; Garrett M Nash; Larissa K Temple; José G Guillem; Philip B Paty; Julio Garcia-Aguilar; Efsevia Vakiani; Mithat Gonen; Jinru Shia; Martin R Weiser Journal: Am J Surg Pathol Date: 2018-06 Impact factor: 6.394