COMPARISON OF CLASSIC AND QUANTITATIVE PROGNOSTIC FACTORS IN COLORECTAL-CANCER

Despite the many pathologic and clinical variables shown to influence survival rates in patients with colorectal cancer, the prediction of o utcome after curative resection is still not completely reliable. Duke s-classification has been historically the strongest prognostic indica tor and the most frequently employed method. In this study our aim was to search for significant independent histological and morphometric f actors that could possibly be used in predicting the outcome of differ ent stages of color-ectal cancer: We analysed the clinical follow-lip data of 308 patients with colorectal adenocarcinoma (followed-up for a mean of 14.4 years). The clinical findings were correlated to histolo gical and morphometric factors to establish their value as predictors of colorectal adenocarcinoma. Clinical, histological and morphometric factors were significantly interrelated. The large invasive tumours ha d larger nuclei, a larger variation in nuclear size, and they wave als o rapidly proliferating. In univariate survival analysis Dukes, the me an nuclear area (NA), standard deviation of nuclear area (SDNA), nucle ar perimetry (PE) and the mean of the longest nuclear axis (Dmax) were the most important predictors of recurrence-free survival (RFS). TNM- categories, Dukes, histological grade and all the quantitative variabl es were significant predictors of cancer related survival. In a multiv ariate analysis of T1 -4N0-3M0 tumours (n = 164) N-category, nuclear a rea and the year of operation and in local tumours (T1 -2N0M0) (n = 70 ) Dmax and Dukes predicted RFS. Important determinants of survival in all 269 cases were M-category, Dukes and Dmax and in local tumours (T1 -2N0M0) (n = 67) Dmax. These results indicate that although an accurat e prognostic evaluation of colorectal carcinomas can be based on TNM- and Dukes-classification, nuclear morphometry can give additional prog nostic information.