Separation of Low-Versus High-grade Crohn's Disease-associated Small Bowel Carcinomas is Improved by Invasive Front Prognostic Marker Analysis

G. Arpa, F. Grillo, P. Giuffrida, G. Nesi, C. Klersy, C. Mescoli, M.V. Lenti, G. Lobascio, M. Martino, G. Latella, D. Malvi, M.C. MacCiomei, P. Fociani, V. Villanacci, A. Rizzo, S. Ferrero, F. Sessa, A. Orlandi, G. Monteleone, L. BianconeL. Cantoro, F. Tonelli, A. Ciardi, G. Poggioli, F. Rizzello, S. Ardizzone, G. Sampietro, G. Solina, B. Oreggia, C. Papi, R. D'Incà, M. Vecchi, F. Caprioli, R. Caronna, A. D'Errico, R. Fiocca, M. Rugge, G.R. Corazza, O. Luinetti, M. Paulli, E. Solcia, A. Di Sabatino, A. Vanoli

Research output: Contribution to journalArticlepeer-review

Abstract

Background and Aims: Crohn's disease-associated small bowel carcinoma is a rare event, usually reported to have a severe prognosis. However, in previous investigations we have found a minority of cases displaying a relatively favourable behaviour, thus outlining the need to improve the histopathological prediction of Crohn's disease-associated small bowel carcinoma prognosis. 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.

Original languageEnglish
Pages (from-to)295-302
Number of pages8
JournalJournal of Crohn's and Colitis
Volume14
Issue number3
DOIs
Publication statusPublished - 2020

Keywords

  • Adenocarcinoma
  • grading
  • poorly differentiated cluster
  • tumour budding
  • adult
  • aged
  • Article
  • cancer grading
  • cancer mortality
  • cancer prognosis
  • cancer staging
  • clinical article
  • Crohn disease
  • female
  • follow up
  • histopathology
  • human
  • human tissue
  • male
  • priority journal
  • prognostic assessment
  • retrospective study
  • small intestine carcinoma
  • tumor differentiation
  • tumor growth
  • tumor invasion

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