Tumor aggression-defense index–a novel indicator to predicts recurrence and survival in stage II-III colorectal cancer
Abstract 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 mod...
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BMC
2025-01-01
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| Series: | Journal of Translational Medicine |
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| Online Access: | https://doi.org/10.1186/s12967-025-06141-x |
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| author | 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 |
| author_facet | 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 |
| author_sort | Tong Wu |
| collection | DOAJ |
| description | Abstract 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. |
| format | Article |
| id | doaj-art-ca4f535ac5bf46c0b92c949a9ae51d0a |
| institution | Kabale University |
| issn | 1479-5876 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Translational Medicine |
| spelling | doaj-art-ca4f535ac5bf46c0b92c949a9ae51d0a2025-01-26T12:50:10ZengBMCJournal of Translational Medicine1479-58762025-01-0123111510.1186/s12967-025-06141-xTumor aggression-defense index–a novel indicator to predicts recurrence and survival in stage II-III colorectal cancerTong Wu0Lin Fang1Yuli Ruan2Mengde Shi3Dan Su4Yue Ma5Ming Ma6Bojun Wang7Yuanyu Liao8Shuling Han9Xiaolin Lu10Chunhui Zhang11Chao Liu12Yanqiao Zhang13Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer HospitalPhase I Clinical Research Center, The Affiliated Hospital of Qingdao University in ShandongDepartment of Gastrointestinal Medical Oncology, Harbin Medical University Cancer HospitalDepartment of Gastrointestinal Medical Oncology, Harbin Medical University Cancer HospitalDepartment of Gastrointestinal Medical Oncology, Harbin Medical University Cancer HospitalDepartment of Gastrointestinal Medical Oncology, Harbin Medical University Cancer HospitalDepartment of Gastrointestinal Medical Oncology, Harbin Medical University Cancer HospitalDepartment of Gastrointestinal Medical Oncology, Harbin Medical University Cancer HospitalDepartment of Gastrointestinal Medical Oncology, Harbin Medical University Cancer HospitalDepartment of Gastrointestinal Medical Oncology, Harbin Medical University Cancer HospitalDepartment of Orthopedic Surgery, Harbin Medical University Cancer HospitalDepartment of Gastrointestinal Medical Oncology, Harbin Medical University Cancer HospitalDepartment of Gastrointestinal Medical Oncology, Harbin Medical University Cancer HospitalDepartment of Gastrointestinal Medical Oncology, Harbin Medical University Cancer HospitalAbstract 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.https://doi.org/10.1186/s12967-025-06141-xColorectal cancerRegulatory-immunoscoreTertiary lymphoid structuresTumor buddingTumor aggression-defense index |
| spellingShingle | 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 Tumor aggression-defense index–a novel indicator to predicts recurrence and survival in stage II-III colorectal cancer Journal of Translational Medicine Colorectal cancer Regulatory-immunoscore Tertiary lymphoid structures Tumor budding Tumor aggression-defense index |
| title | Tumor aggression-defense index–a novel indicator to predicts recurrence and survival in stage II-III colorectal cancer |
| title_full | Tumor aggression-defense index–a novel indicator to predicts recurrence and survival in stage II-III colorectal cancer |
| title_fullStr | Tumor aggression-defense index–a novel indicator to predicts recurrence and survival in stage II-III colorectal cancer |
| title_full_unstemmed | Tumor aggression-defense index–a novel indicator to predicts recurrence and survival in stage II-III colorectal cancer |
| title_short | Tumor aggression-defense index–a novel indicator to predicts recurrence and survival in stage II-III colorectal cancer |
| title_sort | tumor aggression defense index a novel indicator to predicts recurrence and survival in stage ii iii colorectal cancer |
| topic | Colorectal cancer Regulatory-immunoscore Tertiary lymphoid structures Tumor budding Tumor aggression-defense index |
| url | https://doi.org/10.1186/s12967-025-06141-x |
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