Nuclear Size as Prognostic Determinant in Stage II and Stage III Colorectal Adenocarcinoma

Abstract

Background: The prognostic value of morphometric nuclear features was assessed in stage II and stage III colorectal cancer (CRC). Materials and Methods: Primary tumors from 123 CRC patients were analyzed using an image overlay drawing system for the following nuclear size features: area, perimeter, diameter and form features. Results: The nuclear area (NA) was significantly different in tumors at different localizations (p=0.029). A large NA was a significant predictor of recurrent disease, with overall response (OR) 3.09 (1.37-6.95) (p=0.006). The NA was significantly larger in recurrent cases (106.3 μm²) than in non-recurrent ones (96.6 μm²) (p=0.007) and was a significant predictor of disease-free survival (DFS) in univariate (Kaplan-Meier) analysis (log-rank p=0.0239). However, lymph node involvement was the most powerful predictor of DFS in multivariate analysis, with OR 3.371 (95%CI 1.17-9.65) (p=0.024) and disease recurrence the only independent predictor of disease-specific survival (DSS), with OR 48.4 (95%CI 6.30-371.73). Conclusion: Quantitative measurement of the NA seems to accurately discriminate the patients, among stage II and III colorectal cancer, who are likely to develop disease recurrence. Image morphometry seems to be a useful adjunct tool in examining the subgroup of lymph node-negative patients to predict the risk of disease recurrence and indications for adjuvant therapy.