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Clinicopathological significance of neutrophil-rich colorectal carcinoma
  1. Bruce G Rottmann1,
  2. Natalie Patel1,
  3. Muhammad Ahmed1,
  4. Yanhong Deng2,
  5. Maria Ciarleglio2,
  6. Monika Vyas3,
  7. Dhanpat Jain1,
  8. Xuchen Zhang1
  1. 1Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
  2. 2Yale Center for Analytical Sciences, Yale University School of Medicine, New Haven, Connecticut, USA
  3. 3Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Xuchen Zhang, Department of Pathology, Yale School of Medicine, New Haven, Connecticut CT 06510, USA; xuchen.zhang{at}


Aims The importance of the interaction between tumour cells and neutrophils has recently begun to emerge. However, the significance of tumour-infiltrating neutrophil (TIN) in colorectal carcinomas (CRCs) remains unclear. The aim of this study was to investigate the prognostic significance of TIN in CRCs.

Methods CRCs were evaluated for TIN and were classified as neutrophil-rich (NR), neutrophil-intermediate (NI) and neutrophil-poor (NP) based on the presence of >15, 5–15 and <5 TIN per 100 tumour cells, respectively. Various clinicopathological parameters were recorded in each case including age, gender, histological grade, tumour, node, metastasis (TNM) stage, tumour location and DNA mismatch repair (MMR) status.

Results Among the 348 CRC cases reviewed, 38 cases were NR, 43 cases were NI and 267 cases were NP. High TIN was associated with higher histological grade (p=0.0222), right-sided tumour location (p=0.0025), advanced TNM stage (p=0.0346) and higher rate of MMR-deficient CRCs (p=0.0027). Patients with NR CRCs had significantly poorer 5-year recurrence-free survival comparing to patients with NI or NP CRCs on Kaplan-Meier analysis (p=0.0001) and high TIN remained an independent risk factor with multivariate analysis (p=0.0137; HR: 1.930, 95% CI: 1.144 to 3.255). NR CRCs are more commonly seen in MMR-deficient than in MMR-proficient CRCs (p=0.0006). Patients with MMR-deficient NR CRCs showed similar 5-year recurrence-free survival compared with MMR-proficient NR CRCs.

Conclusions Our findings reveal that high TIN confers poorer patient prognosis in both MMR-proficient and MMR-deficient CRCs.

  • colorectal neoplasms
  • pathology
  • surgical
  • rectal neoplasms
  • gastrointestinal neoplasms

Data availability statement

All data relevant to the study are included in the article.

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Data availability statement

All data relevant to the study are included in the article.

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  • BGR and NP are joint first authors.

  • Handling editor Runjan Chetty.

  • Contributors XZ and DJ conceived and designed the initial study. NP and XZ reviewed the slides. BGR, NP, MA, MV and XZ collected the clinicopathological data. YD and MC analysed the data. BGR, NP and XZ drafted and revised the manuscript. All authors edited the manuscript and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.