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From Dukes through Jass: pathological prognostic indicators in rectal cancer
J C Harrison1, P J Dean, F el-Zeky
1Department of Pathology, Baptist Memorial Hospital, Memphis, TN 38146.
Human Pathology
|May 1, 1994
Summary
The Jass staging system for rectal cancer was evaluated, finding the Crohn's-like lymphoid reaction to be a significant new prognostic indicator. While some Jass features correlated with others, depth of invasion and lymph node metastasis remain key staging elements.
Area of Science:
- Oncology
- Pathology
- Surgical Oncology
Background:
- The Jass staging system for resected rectal adenocarcinoma incorporates peritumoral lymphocytic infiltration and tumor growth pattern alongside traditional prognostic factors.
- Evaluating novel prognostic indicators is crucial for refining rectal cancer staging and improving patient outcomes.
Purpose of the Study:
- To test the applicability and prognostic value of the Jass staging system in a cohort of 348 resected rectal cancers.
- To identify independent prognostic variables for rectal cancer survival, including newly recognized features like Crohn's-like lymphoid reaction and tumor nodules in pericolic fat.
Main Methods:
- Retrospective review of 348 resected rectal cancer cases.
- Analysis of 12 pathological variables, including Jass system components and novel features.
- Univariate and Cox stepwise proportional hazards analyses to determine prognostic significance.
Main Results:
- Univariate analysis identified several factors associated with improved survival, including specific tumor types, grades, growth patterns, prominent lymphocytic infiltration, absence of extramural vein invasion, limited invasion depth, Crohn's-like lymphoid reaction, and absence of nodal metastasis or pericolic fat nodules.
- Cox analysis revealed depth of tumor invasion, lymph node metastasis, Crohn's-like lymphoid reaction, and extramural venous invasion as independent prognostic factors.
- Peritumoral lymphocytic infiltration and tumor growth pattern from the Jass system did not independently predict prognosis in the Cox model, likely due to correlations with other significant variables.
Conclusions:
- Depth of invasion and lymph node metastasis remain fundamental to rectal cancer staging.
- The Crohn's-like lymphoid reaction is a significant, novel independent prognostic indicator for rectal cancer survival.
- While the Jass system introduced potentially valuable features, the Crohn's-like lymphoid reaction and extramural vein invasion demonstrated greater independent prognostic power in this study, highlighting complex interrelationships among prognostic factors.