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Comparative validation of assessment criteria for Crohn-like lymphoid reaction in colorectal carcinoma
  1. Jung Ho Kim1,
  2. Kyung-Ju Kim2,
  3. Jeong Mo Bae2,
  4. Ye-Young Rhee2,
  5. Nam-Yun Cho3,
  6. Hye Seung Lee4,
  7. Gyeong Hoon Kang2,3
  1. 1Department of Pathology, SMG-SNU Boramae Medical Centre, Seoul, Korea
  2. 2Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
  3. 3Laboratory of Epigenetics, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
  4. 4Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
  1. Correspondence to Professor Gyeong Hoon Kang, Department of Pathology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Korea; ghkang{at}snu.ac.kr

Abstract

Aims Crohn-like lymphoid reaction (CLR) in colorectal carcinoma (CRC) is associated with a favourable prognosis and microsatellite instability-high (MSI-H) status. However, there is a lack of consensus on optimal criteria for CLR assessment. The aim of this study was to comparatively validate traditional and novel assessment criteria for CLR.

Methods CLR status in 212 MSI-H CRCs was assessed independently by two pathologists using three different criteria: (1) traditional semiquantitative criteria (Graham–Appelman criteria), (2) the largest lymphoid aggregate (LA) size-based criteria (Ueno criteria) and (3) LA density-based criteria (Väyrynen–Mäkinen criteria).

Results Among the three criteria, the Väyrynen–Mäkinen criteria-based CLR assessment showed the best interobserver agreement (κ value, 0.71; intraclass correlation coefficient, 0.76). Pathologically, intense CLR (grade 2) by Graham–Appelman criteria, active CLR (largest LA size ≥1 mm) by Ueno criteria and high-density CLR (≥0.38 LAs/mm) by Väyrynen–Mäkinen criteria significantly correlated with an early cancer stage (stage I/II). In Kaplan–Meier analysis, both CLR statuses determined by Ueno criteria and Väyrynen–Mäkinen criteria were associated with significant differences in disease-free survival in MSI-H CRC patients (p=0.005 and p=0.001, respectively). In multivariable analysis, both active CLR and high-density CLR proved to be independent favourable prognostic factors in MSI-H CRC (HR, 0.47; 95% CI 0.24 to 0.9 for active CLR and HR, 0.5; 95% CI 0.28 to 0.89 for high-density CLR).

Conclusions Our study confirms that the two recently suggested criteria (Ueno criteria and Väyrynen–Mäkinen criteria) for CLR assessment are fairly reproducible methods and can serve as superior prognosticators in CRC.

  • GUT PATHOLOGY
  • HISTOPATHOLOGY
  • COLORECTAL CANCER
  • TUMOUR IMMUNITY

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