Immunohistochemical alterations in invasive adenocarcinoma in endoscopically resected adenoma and factors associated with risk of residual or recurrent disease

Abstract

Aim:  We determined the pattern of immunohistochemical expression in invasive adenocarcinoma in adenoma endoscopically resected, its relationship with risk of residual or recurrent disease, and the factors related.

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. CD-44, MMP-9, VEGF-β, β-catenin, laminin and COX-2 expression were determined by immunohistochemistry. A multivariate logistic regression was performed to determine variables independently associated to the risk of residual or recurrent disease.

Results:  151 malignant polyps (114 pedunculated, mean size 22.61±10.86mm) were resected endoscopically. Resection was fragmented and incomplete in 26.5% and 8.6% of cases respectively. Surgical resection was performed on 71 (47%) patients. After a median follow-up of 44 months, residual (12) or recurrent (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: non pedunculated 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 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.

© 2012 The Authors Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland