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World J Gastroenterol. Jul 14, 2022; 28(26): 3101-3115
Published online Jul 14, 2022. doi: 10.3748/wjg.v28.i26.3101
Clinical implications and mechanism of histopathological growth pattern in colorectal cancer liver metastases
Bing-Tan Kong, Qing-Sheng Fan, Xiao-Min Wang, Qing Zhang, Gan-Lin Zhang
Bing-Tan Kong, Qing-Sheng Fan, Xiao-Min Wang, Qing Zhang, Gan-Lin Zhang, Department of Oncology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
Bing-Tan Kong, School of Graduates, Beijing University of Chinese Medicine, Beijing 100029, China
Author contributions: Kong BT performed the majority of the writing, and prepared the figures and tables; Fan QS, Wang XM and Zhang Q conceptualized the manuscript; Zhang GL revised the manuscript, provided guidance on the overall concept and execution of the manuscript; and All authors have read and approved the final manuscript.
Supported by National Nature Science Foundation, No. 81873111, No. 82174454, and No. 82074182; Natural Science Foundation of Beijing, No. 7202066.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gan-Lin Zhang, PhD, Associate Research Scientist, Department of Oncology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23 Back Road of Art Gallery, Dongcheng District, Beijing 100010, China. kalinezhang@163.com
Received: January 17, 2022
Peer-review started: January 17, 2022
First decision: April 11, 2022
Revised: April 21, 2022
Accepted: June 16, 2022
Article in press: June 16, 2022
Published online: July 14, 2022
Processing time: 176 Days and 17.9 Hours
Abstract

Liver is the most common site of metastases of colorectal cancer, and liver metastases present with distinct histopathological growth patterns (HGPs), including desmoplastic, pushing and replacement HGPs and two rare HGPs. HGP is a miniature of tumor-host reaction and reflects tumor biology and pathological features as well as host immune dynamics. Many studies have revealed the association of HGPs with carcinogenesis, angiogenesis, and clinical outcomes and indicates HGP functions as bond between microscopic characteristics and clinical implications. These findings make HGP a candidate marker in risk stratification and guiding treatment decision-making, and a target of imaging observation for patient screening. Of note, it is crucial to determine the underlying mechanism shaping HGP, for instance, immune infiltration and extracellular matrix remodeling in desmoplastic HGP, and aggressive characteristics and special vascularization in replacement HGP (rHGP). We highlight the importance of aggressive features, vascularization, host immune and organ structure in formation of HGP, hence propose a novel "advance under camouflage" hypothesis to explain the formation of rHGP.

Keywords: Colorectal cancer liver metastases; Histopathological growth pattern; Desmoplastic histopathological growth pattern; Replacement histopathological growth pattern; Prognostic value; Vessel co-option

Core Tip: Histopathological growth pattern (HGP) reflects tumor–host interaction, vascularization, aggressiveness and immune infiltration. Remarkable performance on predicting survival and recurrence and distinct response to therapies makes HGP a promising prognostic biomarker and stratification parameter in pretreatment decision-making. Exploiting on mechanism of HGP would provide potential therapeutic targets. In this context, we propose one novel “advance under camouflage” hypothesis to interpret formation of replacement HGP.