Tumor necrosis has been reported to represent an independent prognostic factor in colorectal cancer, but its evaluation methods have not been described in sufficient detail to introduce tumor necrosis evaluation into clinical use. To study the potential of tumor necrosis as a prognostic indicator in colorectal cancer, criteria for 3 methods for its evaluation were defined: the average percentage method (tumor necrosis percentage of the whole tumor), the hotspot method (tumor necrosis percentage in a single hotspot), and the linear method (the diameter of the single largest necrotic focus). Cox regression models were used to calculate cancer-specific mortality hazard ratios (HRs) for tumor necrosis categories in 2 colorectal cancer cohorts with more than 1800 cases. For reproducibility assessment, 30 cases were evaluated by 9 investigators, and Spearman's rank correlation coefficients and Cohen's kappa coefficients were calculated. We found that all 3 methods predicted colorectal cancer-specific survival independent of other prognostic parameters, including disease stage, lymphovascular invasion, and tumor budding. The greatest multivariable HRs were observed for the average percentage method (cohort 1: HR for ≥ 40% vs. <3% 3.03, 95% CI, 1.93-4.78; cohort 2: HR for ≥ 40% vs. < 3% 2.97; 95% CI, 1.63-5.40). All 3 methods had high reproducibility, with the linear method showing the highest mean Spearman's correlation coefficient (0.91) and Cohen's kappa (0.70). In conclusion, detailed criteria for tumor necrosis evaluation were established. All 3 methods showed good reproducibility and predictive ability. The findings pave the way for the use of tumor necrosis as a prognostic factor in colorectal cancer.

中文翻译：

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建立肿瘤坏死标准作为结直肠癌的预后指标。


据报道，肿瘤坏死是结直肠癌的独立预后因素，但其评估方法尚未得到足够详细的描述，无法将肿瘤坏死评估引入临床。为了研究肿瘤坏死作为结直肠癌预后指标的潜力，定义了3种评估方法的标准：平均百分比法（整个肿瘤的肿瘤坏死百分比）、热点法（单个热点的肿瘤坏死百分比） ）和线性法（单个最大坏死灶的直径）。 Cox 回归模型用于计算 2 个超过 1800 例结直肠癌队列中肿瘤坏死类别的癌症特异性死亡率风险比 (HR)。为了进行再现性评估，9名研究者对30个病例进行了评估，并计算了Spearman等级相关系数和Cohen卡帕系数。我们发现，所有 3 种方法均可预测结直肠癌特异性生存，独立于其他预后参数，包括疾病分期、淋巴血管侵袭和肿瘤出芽。采用平均百分比法观察到最大的多变量 HR（队列 1：HR ≥ 40% 对比 <3% 3.03，95% CI，1.93-4.78；队列 2：HR ≥ 40% 对比 < 3% 2.97 ；95% CI，1.63-5.40）。所有 3 种方法均具有较高的重现性，其中线性方法显示出最高的平均 Spearman 相关系数 (0.91) 和 Cohen 的 kappa (0.70)。总之，建立了肿瘤坏死评估的详细标准。所有 3 种方法均表现出良好的重现性和预测能力。这些发现为使用肿瘤坏死作为结直肠癌的预后因素铺平了道路。