Premium
Immunohistochemical alterations in invasive adenocarcinoma in endoscopically resected adenoma and factors associated with risk of residual or recurrent disease
Author(s) -
Cubiella J.,
Arias M. D.,
Penin M. C.,
Quintas P.,
Couto I.,
Cobian C.,
Bujanda L.,
FernándezSeara J.
Publication year - 2012
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2012.03051.x
Subject(s) - medicine , immunohistochemistry , adenocarcinoma , gastroenterology , pathology , resection margin , univariate analysis , cancer , surgery , multivariate analysis , resection
Aim We determined the pattern of immunohistochemical expression in invasive adenocarcinoma in endoscopically resected adenoma, its relationship with the risk of residual or recurrent disease and the related factors. Method We included individuals with malignant polyps resected endoscopically in the period 1999–2009. Clinical and endoscopic data were collected. All histological specimens were re‐analysed. CD44, matrix metalloproteinase 9 (MMP‐9), vascular endothelial growth factor‐β (VEGF‐β), β‐catenin, laminin and cyclooxygenase 2 (COX‐2) expression were determined by immunohistochemistry. A multivariate logistic regression was performed to determine variables independently associated with the risk of residual or recurrent disease. Results One‐hundred and fifty‐one malignant polyps (114 pedunculated; mean size ± SD = 22.61 ± 10.86 mm) were resected endoscopically. Resection was fragmented and incomplete in 26.5% and 8.6% of patients, respectively. Surgical resection was performed on 71 (47%) patients. After a median follow‐up of 44 months, residual ( n = 12) or recurrent ( n = 6) disease was detected in 17 patients. Conventional histology showed that 32.1% met high‐risk histological criteria. Immunohistochemical expression was positive for CD44, MMP‐9, VEGF‐β, β‐catenin, laminin and COX‐2 in 63.3%, 25.3%, 45%, 38.8%, 79% and 34.5% of specimens, respectively, with no differences between both groups. Variables associated with residual or recurrent disease in the univariate analysis were: nonpedunculated morphology ( P = 0.07); fragmented ( P < 0.001) or incomplete resection ( P < 0.001); margin infiltration ( P = 0.04); and histological high‐risk lesion ( P = 0.003). Finally, incomplete resection (OR = 12.16, 95% CI = 3.15–46.98; P < 0.001) and histological high risk (OR = 4.73, 95% CI = 1.33–16.74; P = 0.002) were independently associated with the risk of residual or recurrent disease. Conclusion Immunohistochemistry could not predict residual or recurrent disease. Only incomplete excision and histological high risk did so. The factors independently associated were histological high‐risk lesion and incomplete resection.