{
  "abstract": "Introduction The desmoplastic reaction (DR), a fibrotic stromal response surrounding the tumor, reflects the tissue response to tumor invasion and is associated with tumor aggressiveness. Combining DR with established pathological and clinical features such as tumor differentiation, tumor budding, lymph node status, and carcinoembryonic antigen levels may improve prognostic stratification in colorectal cancer. The aim of this study was to assess the prognostic significance of a novel tumor differentiation and microenvironment scoring system in colorectal cancer.Methods A retrospective study including patients diagnosed with primary colon or rectal cancer, from 2014 to 2022, was conducted. The D&M (Disease and Microenvironment) scoring system was applied. According to this score, glandular differentiation was scored as well (0 point), moderate (1 point), or poor (2 points). Tumor buddings were classified as low (0 point), moderate (1 point), or high (2 points). Tumor depth and desmoplastic reaction were scored as follows: pT1 or 2 (0 point), pT3 or 4+DR immature (1 point) and pT3 or 4+DR immature (2 points). Lymph node metastasis was classified as pN0 (0 point), pN1 (1 point), or pN2 (2 points). Preoperative carcinoembryonic antigen levels were categorized as <5 ng/mL (0 points) or ≥5 ng/mL (1 point). Based on the total score, patients were stratified into three risk groups: score I (0–2 points), score II (3–4 points), and score III (5–6 points).Results Eighty-four patients were included, with a mean age at disease diagnosis of 60 ± 12 years and a sex ratio M/F=1.89. The distribution of the D&M scoring system was as follows: low risk (score I): 42 patients (50%); intermediate risk (score II): 23 patients (28%); high risk (score III): 17 patients (20%); and very high risk (score IV): 2 patients (2%). The D&M scoring system was significantly associated with cancer-related mortality (p<0.001), with a mortality risk-ratio of 3.04 for patients with a D&M score high or very high. Comparing the Kaplan Meier survival Curves, overall survival was significantly reduced in patients with a DM score of III or VI, with a median survival of 20.8 months compared to 81.6 months (Log Rank = 0.001). When considering only the intermediate risk group, we observed a higher mortality rate in the group with a score of 4 compared to a score of 3 (64% vs. 42%). Thus, the mortality risk arises to 3.6 when considering all patients with a DM score ≥ 4 (p<0.001). Overall survival was significantly reduced in patients with a DM score ≥ 4, with 1-, 3-, and 5-year survival rates of 27%, 4%, and 0% versus 89%, 78%, and 62% (Log Rank = 0.001). The survival study showed that a DM score ≥ 4 was an independent factor of mortality (OR=8.31; 95%CI [1.38-49.91]; p=0.02).Conclusion Our study showed that the novel differentiation and microenvironment (D&M) scoring system is a strong, independent predictor of mortality in colorectal cancer, with scores ≥ 4 identifying patients at significantly higher risk. These findings highlight the potential clinical utility of this score in stratifying patient prognosis and guiding personalized treatment strategies.",
  "authors": [
    {
      "affiliations": [
        "Internal Security Forces Hospital La Marsa, Tunis, Tunisia"
      ],
      "name": "Myriam Ayari"
    },
    {
      "affiliations": [
        "Internal Security Forces Hospital La Marsa, Tunis, Tunisia"
      ],
      "name": "Wafa Khemiri"
    },
    {
      "affiliations": [
        "Internal Security Forces Hospital La Marsa, Tunis, Tunisia"
      ],
      "name": "Sarra Ben Azouz"
    },
    {
      "affiliations": [
        "Internal Security Forces Hospital La Marsa, Tunis, Tunisia"
      ],
      "name": "Taieb Jomni"
    }
  ],
  "title": "P326 Mapping the tumor microenvironment: a histopathology-based prognostic score of colorectal cancer",
  "uid": "578ca6ba-a4d8-5ca1-9f52-6ae5e920ad6e"
}