J Pathol Transl Med.  2018 Mar;52(2):98-104. 10.4132/jptm.2017.12.27.

Prognostic Utility of Histological Growth Patterns of Colorectal Lung Oligometastasis

• Yeong SJ
• Pak MG
• Lee HW
• Ha SY
• Roh MS

• KMID: 2408510
• DOI: http://doi.org/10.4132/jptm.2017.12.27

Abstract

BACKGROUND
Patients with resectable colorectal lung oligometastasis (CLOM) demonstrate a heterogeneous oncological outcome. However, the parameters for predicting tumor aggressiveness have not yet been fully investigated in CLOM. This study was performed to determine the prognostic value of histological growth patterns in patients who underwent surgery for CLOM.
METHODS
The study included 92 patients who were diagnosed with CLOM among the first resection cases. CLOMs grow according to three histological patterns: aerogenous, pushing, and desmoplastic patterns. The growth patterns were evaluated on archival hematoxylin and eosin-stained tissue sections.
RESULTS
The aerogenous pattern was found in 29.4% (n=27) of patients, the pushing pattern in 34.7% (n=32), the desmoplastic pattern in 6.5% (n=6), and a mix of two growth patterns in 29.4% (n=27). The size of the aerogenous pattern was significantly smaller than that of metastases with other patterns (p=.033). Kaplan-Meier analysis demonstrated that patients showing an aerogenous pattern appeared to have a poorer prognosis, which was calculated from the time of diagnosis of the CLOM (p=.044). The 5-year survival rate from the diagnosis of colorectal cancer tended to be lower in patients with an aerogenous pattern than in those who had a non-aerogenous pattern; however, the difference was marginally significant (p=.051). In the multivariate Cox analysis, the aerogenous pattern appeared as an independent predictor of poor overall survival (hazard ratio, 3.122; 95% confidence interval, 1.196 to 8.145; p=.020).
CONCLUSIONS
These results suggest that the growth patterns may play a part as a histology-based prognostic parameter for patients with CLOM.

Keyword

Colorectal neoplasms; Lung; Oligometastasis; Growth pattern; Prognosis

MeSH Terms

Colorectal Neoplasms
Diagnosis
Hematoxylin
Humans
Kaplan-Meier Estimate
Lung*
Neoplasm Metastasis
Prognosis
Survival Rate
Hematoxylin

Figure

• 

  Fig. 1. Representative histologic features of the three different growth patterns of lung oligometastasis from colorectal adenocarcinoma. (A, B) In the aerogenous pattern, tumor clusters, nests, or single tumor cells spread into the air spaces of the lung parenchyma surrounding the edge of the tumor without destruction of the lung architecture, desmoplastic stroma, or inflammatory infiltrate. (C, D) In the pushing pattern, the metastasis grows by compression of the lung parenchyma, running parallel to the tumor-lung interface without desmoplastic stroma, and with only a mild inflammatory infiltrate. (E, F) In the desmoplastic pattern, the metastatic tumor is separated from the lung parenchyma by a desmoplastic rim infiltrated with lymphocytes. There is no direct contact between the tumor cells and lung parenchyma.

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  Fig. 2. Kaplan-Meier curves illustrating the overall survival of patients with colorectal lung oligometastasis (CLOM) in relation to growth patterns. (A) The overall survival rate calculated from the diagnosis of CLOM shows a shorter survival time in patients with CLOM having an aerogenous pattern than in those with CLOM having a non-aerogenous pattern (p=.044). (B) Although the difference was marginally significant (p=.051), the overall survival rate calculated from the time of diagnosis of colorectal cancer tends to show a shorter survival length in patients with CLOM having an aerogenous pattern than in those with CLOM with a non-aerogenous pattern.

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