Quantitative Evaluation of Lymphoid Reaction And Cd8 + T-Lymphocytes and It’s Association With Grading and Staging Of Colorectal Carcinoma - 5 Years Study (3 Years Retrospective and 2 Years Prospective Study.

Abstract

Introduction: Staging of colorectal carcinoma (CRC) is done on histopathological criteria such as depth of tumor invasion, presence or absence of regional lymph node involvement, distant metastases and on tumor cell differentiation as defined by World Health Organization (WHO). Accurate classification of tumor is necessary for the assessment of prognosis and proper treatment of the patient. In various studies it was noted that increase in inflammatory cell infiltrate is linked with better survival of the patient and gives prognostic value which is independent of the stage of disease. Quantification of T lymphocytes and inflammatory reaction grading are regarded as important prognostic factors. Hence the present study was undertaken to assess role of quantitative estimation of lymphoid reaction and CD8+T lymphocyte count and its association with grading and staging in colorectal cancer. Objectives: 1) Quantitative evaluation of peritumoral lymphoid reaction and CD8+ T lymphocytic infiltration by CD8 IHC marker in colorectal carcinoma. 2) To evaluate the association between lymphoid reaction and CD8+T lymphocytic infiltration with grading and staging of colorectal carcinoma. Materials and Methods: H & E stained sections of colorectal carcinoma of resection specimens which were diagnosed as carcinoma in Department of Pathology from May 2015 to May 2020 were evaluated for grading and staging. All cases were evaluated for age, sex, Tumor location, Histological Grade, pT stage, pN stage, and peritumoral LR. Tumour tissue blocks on which quantitative evaluation of peritumoral LR was done, same blocks DocuSign Envelope ID: 7E9CAFEF171B08F3--D09598C5--44EE0653--A8EF775-D515E0B229E764F9B6399F1 IX were further processed for IHC CD8+ T lymphocytic marker and scores were evaluated. Scores of lymphoid reaction and CD 8+ T lymphocytic infiltration were correlated with grading and staging of colorectal carcinoma. Results: Mean age of CRC patient in the present study was 52.8 years with male to female ratio 1:1 and commonest site was proximal colon. Majority of the cases were moderately differentiated adenocarcinoma amounting to 89% and were of stage pT3 amounting to 42.1% followed by stage pT2 and stage pN0 followed by pN1 stage. Peritumoral LR and CD8+ Lymphocytic count was highest in well differentiated adenocarcinoma and pT1 and pT2 stage and in stage pN0 Conclusion: Peritumoral LR and CD8+T lymphocyte count were high in moderately differentiated adenocarcinoma and in Stage 1 to stage 3 as compared to stage 4b. These findings suggest that there is association of peritumoral LR and grading and staging of CRC and can be considered as prognostic markers for CRC. Hence further extensive evaluation with good number of cases is needed to conclude Peritumoral LR and CD8+T lymphocyte count as prognostic marker of CRC.