Intratumoral Fibrotic Features Are Associated With Lymph Node Metastasis and Recurrence in Patients With Advanced...

Area of Science:

• Oncology
• Pathology
• Digital Pathology

Background:

• Fibrosis is a key feature of advanced colon adenocarcinomas.
• Objective assessment of fibrosis signatures in colon cancer is underexplored.
• Fibrosis may indicate lymph node metastasis and predict recurrence.

Purpose of the Study:

• To evaluate phenotypic histologic features of fibrosis in colon cancer.
• To identify fibrosis signatures correlating with lymph node metastasis and recurrence.
• To assess the predictive value of fibrosis for patient outcomes.

Main Methods:

• Selected 38 patients with stage T3 colon adenocarcinoma from 499 colorectal cancer cases.
• Quantified fibrosis using Azan-Mallory staining and the FibroNest digital pathology platform.
• Developed a phenotypic fibrosis composite score (Ph-FCS) integrating collagen content, fiber morphology, and structure.

Main Results:

• Ph-FCS significantly differed between colon cancer groups with and without lymph node metastasis (89.5% sensitivity, 89.5% specificity, AUC 0.95).
• Kurtosis, a texture analysis parameter, was the most significant individual factor differentiating metastasis groups.
• Ph-FCS distinguished between recurrence and nonrecurrence groups post-chemotherapy (71.4% sensitivity, 100% specificity, AUC 0.88), with more fiber branches in the recurrence group.

Conclusions:

• The fibrotic histologic phenotype in advanced colon cancer differs significantly between patients with and without lymph node metastasis.
• Fibrosis analysis can predict recurrence in patients undergoing chemotherapy.
• Phenotypic collagen analysis in nontumor lesions shows promise for predicting colon cancer patient outcomes.