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Introduction: Colorectal cancer (CRC) is one of the most common cancers worldwide. This study was designed to evaluate biological patterns, explore molecular classification and correlate with survival outcome in treatment naïve CRC patients. Methods: Over 11 years consecutive series of 435 CRC patients were operated on as primary surgical therapy. A total of 201 CRC patients were included, whose complete set of clinical information was available, and their good quality tumour blocks were retrieved. Immunohistochemistry was used for tumour analysis, and partitional clustering was performed using R software for cluster analysis. Results: The median age was 43 (range 10-85) years; adenocarcinoma was the most commonly seen histological type. The great majority had positive CK20, CEA, E-Cadherin, Ki67, CDX2, and p53 expression. There were four distinct molecular classes found, whereas Ki67, CDX2, and p53 play the main role in partitioning. Younger age negatively impacted survival; overall and disease-specific survival was 26 months only with 50 months' longest survival. Conclusion: Colorectal cancer is a biologically heterogeneous disease with at least four distinct molecular patterns, where cell proliferation and gene repair mechanisms appear to play the key role.
RESUMO
OBJECTIVE: To evaluate the pattern of tumour infiltrating lymphocytes in colorectal cancers, and to correlate them with nuclear protein Ki67, vascular endothelial growth factor and clinical outcome. METHODS: The retrospective study was conducted at the Nuclear Institute of Medicine and Radiotherapy and the Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan, and comprised data of colorectal cancer patients from January 1, 2008, to December 31, 2018. Whole tumour sections of colorectal cancer were used with haematoxylin and eosin staining, Histological type, grade and infiltrated lymphocytes within the tumour block were assessed. Ki67 and vascular endothelial growth factor were evaluated by immunohistochemistry, while the staining of these biomarkers was assessed by the percentage of cells stained. Data was analysed using SPSS 22. RESULTS: Of the 201 patients, 110(54.7%) were males and 91(45.3%) were females. Overall median age was 43 years (range 10-85 years). Majority of the tumours 132(65.7%) showed mild to moderate tumour infiltrating lymphocytes, 30(14.9%) had severe tumour infiltrating lymphocytes, while 39(19.4%) did not show any infiltrating lymphocytes. Tumour infiltrating lymphocytes did not show significant association with the histological grade (p>0.05), but high tumour infiltrating lymphocytes were associated with poor survival without being significantly associated with Ki67 pattern and vascular endothelial growth factor (p>0.05). CONCLUSIONS: Majority of colorectal cancer cases showed varying levels of lymphocyte infilteration, and tumour infiltrating lymphocytes were associated with poor survival, without having significant association with Ki67 pattern and vascular endothelial growth factor.
