Heterogeneity of Colorectal Dysplastic Polyps and Adenocarcinomas: The Relationship Between Tumor-Infiltrating Lymphocytes and Tumor Buds, Features of Progression and Prognosis
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Colorectal cancer remains one of the most common and clinically significant malignancies worldwide, characterized by complex molecular, histopathological, and immunological mechanisms underlying tumor initiation and progression. The adenoma-carcinoma sequence, accompanied by progressive genetic and epigenetic alterations, represents the principal pathway of colorectal carcinogenesis. Increasing evidence highlights the substantial heterogeneity of colorectal dysplastic polyps and adenocarcinomas, which significantly influences tumor behavior, metastatic potential, therapeutic response, and patient prognosis.
This critical literature review summarizes contemporary data regarding the pathogenesis, classification, molecular characteristics, and prognostic biomarkers of colorectal dysplastic polyps and adenocarcinomas. Particular emphasis is placed on the interaction between tumor-infiltrating lymphocytes (TILs) and tumor buds, which are increasingly recognized as key indicators of epithelial-mesenchymal transition, immune evasion, invasive potential, and tumor aggressiveness. The review discusses major molecular pathways and biomarkers involved in colorectal tumorigenesis, including APC, KRAS, TP53, BRAF, microsatellite instability (MSI), CpG island methylator phenotype (CIMP), E-cadherin, β-catenin, Ki-67, Bcl-2, VEGF, and CD163.
Furthermore, the manuscript evaluates the clinical significance of integrating TNM staging, Consensus Molecular Subtypes (CMS), and immunoscore systems into modern personalized oncology approaches. Current evidence suggests that assessment of TILs and tumor budding may serve as valuable prognostic and predictive biomarkers, contributing to improved risk stratification and individualized therapeutic decision-making in colorectal cancer patients.
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