基于组织病理学肿瘤微环境构建风险评分及其在原发性可手术结直肠癌中的预后价值

AIMS: The incidence and mortality rates of colorectal cancer (CRC) are increasing worldwide. We aimed to construct a novel classification system, Risk Score, based on the histopathological tumour microenvironment and assess its prognostic value in primary operable CRC. METHODS AND RESULTS: Patients with stage I-III CRC who underwent radical resection between January 2020 and September 2021 were recruited. Eligible patients were randomized in a 1:1 ratio into a training cohort and a validation cohort. Tumour budding, tumour-stromal type, tumour-infiltrating lymphocytes, and tumour-stroma ratio were evaluated using the H&E sections of all excised specimens. The Risk Score was then developed on the basis of these four histopathological features, and its prognostic value was analysed. In the training cohort, patients with a high-Risk Score had shorter disease-free survival (DFS; HR 2.58, 95% CI: 1.78-3.72, P < 0.001) and overall survival (OS; HR 2.85, 95% CI: 1.74-4.67, P < 0.001) compared with those with a low Risk Score. Multivariate analysis revealed that the Risk Score remained an independent prognostic indicator of DFS and OS. These findings were confirmed in the validation cohort. A nomogram integrating all independent variables was also established to predict the individual risk of recurrence. CONCLUSION: In this study, we developed a prognostic model to accurately predict disease progression and mortality in operable CRC and to guide adjuvant chemotherapy.