Document Detail

New criteria for histologic grading of colorectal cancer.
MedLine Citation:
PMID:  22251938     Owner:  NLM     Status:  MEDLINE    
Conventional tumor grading systems based on the degree of tumor differentiation may not always be optimal because of difficulty in objective assessment and insufficient prognostic value for decision making in colorectal cancer (CRC) treatment. This study aimed to determine the importance of assessing the number of poorly differentiated clusters as the primary criterion for histologic grading of CRC. Five hundred consecutive patients with curatively resected stage II and III CRCs (2000 to 2005) were pathologically reviewed. Cancer clusters of ≥5 cancer cells and lacking a gland-like structure were counted under a ×20 objective lens in a field containing the highest number of clusters. Tumors with <5, 5 to 9, and ≥10 clusters were classified as grade (G)1, G2, and G3, respectively (n=156, 198, and 146 tumors, respectively). Five-year disease-free survival rates were 96%, 85%, and 59% for G1, G2, and G3, respectively (P<0.0001). Poorly differentiated clusters affected survival outcome independent of T and N stages and could help in more effective stratification of patients by survival outcome compared with tumor staging (Akaike information criterion, 1086.7 vs. 1117.0; Harrell concordance index, 0.73 vs. 0.67). The poorly differentiated cluster-based grading system showed a higher weighted κ coefficient for interobserver variability (5 observers) compared with conventional grading systems (mean, 0.66 vs. 0.52; range, 0.55 to 0.73 vs. 0.39 to 0.68). Our novel histologic grading system is expected to be less subjective and more informative for prognostic prediction compared with conventional tumor grading systems and TNM staging. It could be valuable in determining individualized postoperative CRC treatment.
Hideki Ueno; Yoshiki Kajiwara; Hideyuki Shimazaki; Eiji Shinto; Yojiro Hashiguchi; Kuniaki Nakanishi; Kazunari Maekawa; Yuka Katsurada; Takahiro Nakamura; Hidetaka Mochizuki; Junji Yamamoto; Kazuo Hase
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of surgical pathology     Volume:  36     ISSN:  1532-0979     ISO Abbreviation:  Am. J. Surg. Pathol.     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-01-18     Completed Date:  2012-03-06     Revised Date:  2014-01-28    
Medline Journal Info:
Nlm Unique ID:  7707904     Medline TA:  Am J Surg Pathol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  193-201     Citation Subset:  IM    
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MeSH Terms
Aged, 80 and over
Colorectal Neoplasms / pathology*
Middle Aged
Neoplasm Grading / standards,  statistics & numerical data
Observer Variation
Young Adult
Comment In:
Am J Surg Pathol. 2013 Jun;37(6):943-5   [PMID:  23629448 ]
Am J Surg Pathol. 2014 Jan;38(1):143-4   [PMID:  24335644 ]

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