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Background <p>Although the TNM staging system plays a critical role in guiding adjuvant chemotherapy for colorectal cancer (CRC), its precision for risk stratification in stage II and III CRC patients with proficient DNA mismatch repair (pMMR) remains limited. Therefore, precise predictive models and research on postoperative treatments are crucial for enhancing patient survival and improving quality of life.</p> Methods <p>This retrospective study analyzed 1051 pMMR CRC patients who underwent radical resection and were randomly assigned to training (n = 736) and validation (n = 315) groups. Immunohistochemistry and hematoxylin and eosin staining were utilized to evaluate regulatory-Immunoscore (RIS), tertiary lymphoid structures (TLS), and tumor budding (TB). The Tumor Aggression-Defense Index (TADI) was derived through a multi-factor COX regression model. Subgroup analysis demonstrated potential of TADI in guiding personalized adjuvant therapy for stage II and III CRC.</p> Results <p>Univariate and multivariate Cox analysis indicated that TADI was an independent prognostic indicator. Among stage II CRC, chemotherapy was significantly correlated with improved recurrence times in individuals with intermediate (95% CI 0.19–0.59, P &lt; 0.001) and high (95% CI 0.36–0.95, P = 0.031) TADI. In stage III CRC receiving adjuvant chemotherapy, a duration of 3&#xa0;months or longer was notably associated with a prolonged time to recurrence in those with high TADI (95% CI 0.40–0.98, P = 0.041) compared to durations of less than 3&#xa0;months.</p> Conclusion <p>The TADI serves as an effective parameter for predicting the survival outcomes of stage I-III pMMR CRC patients and guiding precision treatment strategies.</p>

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Tumor aggression-defense index–a novel indicator to predicts recurrence and survival in stage II-III colorectal cancer

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年1月22日

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  • Tong Wu,
  • Lin Fang,
  • Yuli Ruan,
  • Mengde Shi,
  • Dan Su,
  • Yue Ma,
  • Ming Ma,
  • Bojun Wang,
  • Yuanyu Liao,
  • Shuling Han,
  • Xiaolin Lu,
  • Chunhui Zhang,
  • Chao Liu,
  • Yanqiao Zhang

摘要

Background

Although the TNM staging system plays a critical role in guiding adjuvant chemotherapy for colorectal cancer (CRC), its precision for risk stratification in stage II and III CRC patients with proficient DNA mismatch repair (pMMR) remains limited. Therefore, precise predictive models and research on postoperative treatments are crucial for enhancing patient survival and improving quality of life.

Methods

This retrospective study analyzed 1051 pMMR CRC patients who underwent radical resection and were randomly assigned to training (n = 736) and validation (n = 315) groups. Immunohistochemistry and hematoxylin and eosin staining were utilized to evaluate regulatory-Immunoscore (RIS), tertiary lymphoid structures (TLS), and tumor budding (TB). The Tumor Aggression-Defense Index (TADI) was derived through a multi-factor COX regression model. Subgroup analysis demonstrated potential of TADI in guiding personalized adjuvant therapy for stage II and III CRC.

Results

Univariate and multivariate Cox analysis indicated that TADI was an independent prognostic indicator. Among stage II CRC, chemotherapy was significantly correlated with improved recurrence times in individuals with intermediate (95% CI 0.19–0.59, P < 0.001) and high (95% CI 0.36–0.95, P = 0.031) TADI. In stage III CRC receiving adjuvant chemotherapy, a duration of 3 months or longer was notably associated with a prolonged time to recurrence in those with high TADI (95% CI 0.40–0.98, P = 0.041) compared to durations of less than 3 months.

Conclusion

The TADI serves as an effective parameter for predicting the survival outcomes of stage I-III pMMR CRC patients and guiding precision treatment strategies.