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Open Access Research article

The role and prognostic value of apoptosis in colorectal carcinoma

Julia Alcaide1, Rafael Funez2, Antonio Rueda13, Elisabeth Perez-Ruiz13, Teresa Pereda2, Isabel Rodrigo2, Rafael Coveñas4, Miguel Muñoz4 and Maximino Redondo35*

Author affiliations

1 Division of Medical Oncology, Onco-Hematology Department, A.S. Costa del Sol, Autovia A-7, Km 187, Marbella, Malaga, CP 29603, Spain

2 Department of Pathology, A.S. Costa del Sol, Autovia A-7, Km 187, Marbella, Malaga, CP 29603, Spain

3 Red de Investigacion en Servicios de Salud (REDISSEC), Spain

4 Research Laboratory, Hospital Infantil Universitario Virgen del Rocio, Sevilla, CP 41013, Spain

5 Research Unit, A.S. Costa del Sol, University of Malaga, Marbella, Malaga, CP 29603, Spain

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Citation and License

BMC Clinical Pathology 2013, 13:24  doi:10.1186/1472-6890-13-24

Published: 10 October 2013



Alterations to apoptosis are a common occurrence in human tumours. The aim of our study was to determine the influence of apoptotic variations on the carcinogenesis and prognosis of colorectal carcinomas (CRCs).


A TUNEL assay was performed on archival material from 103 colorectal carcinomas, 26 adenomas and 20 samples of normal epithelia.


The number of apoptotic cells was higher in CRCs (1.09 ± 0.13) than in adenomas (0.38 ± 0.23, p = 0.059) and normal epithelium (0.06 ± 0.04, p = 0.001). In addition, the apoptotic index (AI) was greater in metastatic disease (stage IV) than in other stages (p = 0.017). No relationship was found between apoptotic rates and age, gender or tumour grade. However, patients with tumours that showed higher AI values had a significantly lower disease-free survival (DFS) and overall survival (OS) than those with tumours that had lower AIs (p = 0.020 and p = 0.027). In a multivariate Cox proportional hazards model, AI remained a significant independent predictor of survival.


We conclude that disregulated apoptosis is an important event during CRC development and progression. Higher AIs are associated with more aggressive tumours and a poorer prognosis for patients with CRC.

Apoptosis; Colorectal carcinoma; Prognosis