Apoptosis as a Prognostic Factor in Colorectal Carcinoma Comparison of TUNEL Method and Immunohistochemical Expression of Caspase-3Kunac, Nenad, MD*; Šundov, Željko, MD, PhD†; Vilović, Katarina, MD, PhD*Applied Immunohistochemistry & Molecular Morphology: March 2019 - Volume 27 - Issue 3 - p e22–e27 doi: 10.1097/PAI.0000000000000623 Online Articles: Research Article Buy Abstract Author InformationAuthors Article MetricsMetrics The development of colorectal cancer is known to be characterized by a sequence of events during which normal colonic epithelium gradually transforms to carcinoma, the adenoma-carcinoma sequence. Apoptosis plays an important role in the development and maintenance of tissue homeostasis. Currently, there is no agreement in the literature about the prognosis of apoptosis in colorectal cancer. The number of studies examining the expression of caspases in colorectal cancer is very limited, and they have not examined any correlation between expression and patient survival. This study included histologic samples from 179 patients diagnosed with colon cancer. We used the TdT-mediated X-dUTP nick end labeling method and caspase-3 labeling to identify the degree of apoptosis. Our results show that lower apoptotic index measured by TdT-mediated X-dUTP nick end labeling method and lower immnuhistochemical expression of caspase-3 is associated with shorter disease-free survival and overall survival. However, only apoptotic index is proven to be an independent survival indicator. The results of our study are consistent with the proposed models of carcinogenesis of colorectal cancer that emphasize resistance to apoptosis as a decisive factor in the progression of the disease and resistance to treatment. Departments of *Pathology, Forensic Medicine and Cytology †Gastroenterology, Clinical Hospital Center Split, Split, Croatia The authors declare no conflict of interest. Reprints: Nenad Kunac, MD, Department of Pathology, Forensic Medicine and Cytology, Clinical Hospital Center Split, Spinčićeva 1, 21000 Split, Croatia (e-mail: firstname.lastname@example.org). Received April 8, 2014 Accepted October 18, 2017 Copyright 2019 Wolters Kluwer Health, Inc. All rights reserved.