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Ono Y, Yilmaz O. Emerging and under-recognised patterns of colorectal carcinoma morphologies: a comprehensive review. J Clin Pathol 2024; 77:439-451. [PMID: 38448211 DOI: 10.1136/jcp-2023-208816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/22/2024] [Indexed: 03/08/2024]
Abstract
While the overwhelming majority of colorectal carcinomas (CRC) are diagnosed as adenocarcinoma not otherwise specified, there are numerous under-recognised morphologic patterns of CRC. These patterns are recognised by the WHO, appear in reporting manuals for the American Joint Committee of Cancer, and/or are listed on synoptic reports, while many other variants have either fallen out of favour or are emerging as future bona fide patterns. Herein, we discuss 13 variants: serrated adenocarcinoma, micropapillary adenocarcinoma, medullary carcinoma, neuroendocrine carcinoma, mucinous adenocarcinoma, signet-ring cell carcinoma, adenosquamous carcinoma, adenoma-like adenocarcinoma, lymphoglandular complex-like CRC, carcinoma with sarcomatoid components, cribriform-comedo-type adenocarcinoma, undifferentiated carcinoma and low-grade tubuloglandular adenocarcinoma. The purpose of this review is to scrutinise these variants by assessing their clinical characteristics, morphologic cues, as well as pitfalls, and address their prognostic significance. Our analysis aims to bring clarity and updated understanding to these variants, offering valuable insights for pathologists. This contributes to more nuanced CRC diagnosis and treatment strategies, highlighting the importance of recognising a broad spectrum of morphologic patterns in CRC.
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Affiliation(s)
- Yuho Ono
- Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Osman Yilmaz
- Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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2
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Deshpande V, Lee SH, Crabbe A, Pankaj A, Neyaz A, Ono Y, Rickelt S, Sonal S, Ferrone CR, Ting DT, Patil D, Yilmaz O, Berger D, Yilmaz O. Clinical, pathological, genetics and intratumoural immune milieu of micropapillary carcinoma of the colon. J Clin Pathol 2024; 77:387-393. [PMID: 37258254 DOI: 10.1136/jcp-2023-208895] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/14/2023] [Indexed: 06/02/2023]
Abstract
AIM Micropapillary carcinoma (MPC) is a recognised WHO variant of colonic carcinoma (CC), although little is known about its prognosis, immune microenvironment and molecular alterations. We investigated its clinical, pathological and immunological characteristics. METHODS We assessed 903 consecutive CCs and used the WHO definition to identify MPC. We recorded serrated and mucinous differentiation and mismatch repair (MMR) status. We performed immunohistochemistry and quantification on tissue microarrays for HLA class I/II proteins, beta-2-microglobulin (B2MG), CD8, CD163, LAG3, PD-L1, FoxP3, PD-L1and BRAF V600E. RESULTS We classified 8.6% (N=78) of CC as MPC. Relative to non-MPC, MPC was more often high grade (p=0.03) and showed serrated morphology (p<0.01); however, we found no association with extramural venous invasion (p=0.41) and American Joint Committee on Cancer stage (p=0.95). MPCs showed lower numbers of CD8 positive lymphocytes (p<0.01), lower tumour cell B2MG expression (p=0.04) and lower tumour cell PD-L1 expression (p<0.01). There was no difference in HLA class I/II, LAG3, FOXP3, CD163 and PD-L1 positive histiocytes. There was no association with MMR status or BRAF V600E relative to non-MPC. MPC was not associated with decreased disease-specific survival (p=0.36). CONCLUSION MPCs are associated with high-grade differentiation and a less active immune microenvironment than non-MPC. MPC is not associated with inferior disease-specific survival.
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Affiliation(s)
- Vikram Deshpande
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Soo Hyun Lee
- Department of Pathology, Boston Medical Center, Boston, Massachusetts, USA
| | - Andrew Crabbe
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amaya Pankaj
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Azfar Neyaz
- Department of Pathology, UPMC, Pittsburgh, Pennsylvania, USA
| | - Yuho Ono
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Steffen Rickelt
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Swati Sonal
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Cristina R Ferrone
- Depatment of General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David T Ting
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Deepa Patil
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Omer Yilmaz
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - David Berger
- Depatment of General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Massachusetts Gen Hosp, Boston, Massachusetts, USA
| | - Osman Yilmaz
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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3
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Pontarollo G, Bonjour M, Walter T, Pioche M, Lavrut PM, Rabeyrin M, Hervieu V, Fenouil T. Histopronostic factors in superficial colorectal adenocarcinomas treated by endoscopy: reproducibility and impact of immunohistochemistry and digital pathology. Virchows Arch 2024:10.1007/s00428-023-03722-3. [PMID: 38273213 DOI: 10.1007/s00428-023-03722-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/27/2023] [Accepted: 12/05/2023] [Indexed: 01/27/2024]
Abstract
Endoscopic dissection is the first-choice treatment for superficial pT1 colorectal adenocarcinoma (sCRC). Complementary surgery decision is influenced by histopronostic factors. Prognostic significance and reproducibility of each factor are not well established. The role of immunohistochemistry (IHC) and digital pathology in this context is unknown. Our aims were (1) to evaluate each histopronostic factor reproducibility comparing HES and IHC ± digital pathology and (2) to evaluate how the different techniques would affect indications for additional surgery. We performed a single-centre retrospective study of 98 patients treated between 2010 and 2019 in Hospices Civils de Lyon, France. We analyzed physical or digital slides of HES and keratin/desmin immunostaining of 98 sCRC dissection specimens. Three pathologists evaluate the histopronostic factors including submucosal invasion depth (SMI) measured using different recommended methods. Assessment of SMI with Ueno or JSCCR methods showed good to excellent interobserver reproducibility (IOR) (ICCs of 0.858 to 0.925) using HES staining and IHC. Assessment of budding on HES sections was poorly reproducible compared to IHC which exhibit moderate IOR (κ = 0.714). IHC increased high-grade budding detection. For lymphovascular invasion and poor differentiation, the IOR was poor (κ = 0.141, 0.196 and 0.313 respectively). IHC gave a better reproducibility for further treatment indication according to JSCCR criteria (κ = 0.763) or forthcoming European guidelines (κ = 0.659). Digital pathology was equivalent to the microscope for all analyses. Histopronostic factor reproducibility in sCRC is moderate. Immunohistochemistry may facilitate the evaluation of certain criteria and improve the reproducibility of treatment decisions.
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Affiliation(s)
- Guillaume Pontarollo
- Hospices Civils de Lyon, Institut de Pathologie Multi-sites, site EST, Groupement Hospitalier Est, 59 boulevard Pinel, 69677, Bron, France
| | - Maxime Bonjour
- Université de Lyon, Université Lyon 1, Lyon, France
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Thomas Walter
- Université de Lyon, Université Lyon 1, Lyon, France
- Hospices Civils de Lyon, service d'oncologie médicale, Hôpital Édouard Herriot, Lyon, France
| | - Mathieu Pioche
- Université de Lyon, Université Lyon 1, Lyon, France
- Hospices Civils de Lyon, service d'oncologie médicale, Hôpital Édouard Herriot, Lyon, France
| | - Pierre-Marie Lavrut
- Hospices Civils de Lyon, Institut de Pathologie Multi-sites, site EST, Groupement Hospitalier Est, 59 boulevard Pinel, 69677, Bron, France
| | - Maud Rabeyrin
- Hospices Civils de Lyon, Institut de Pathologie Multi-sites, site EST, Groupement Hospitalier Est, 59 boulevard Pinel, 69677, Bron, France
| | - Valérie Hervieu
- Hospices Civils de Lyon, Institut de Pathologie Multi-sites, site EST, Groupement Hospitalier Est, 59 boulevard Pinel, 69677, Bron, France
- Université de Lyon, Université Lyon 1, Lyon, France
| | - Tanguy Fenouil
- Hospices Civils de Lyon, Institut de Pathologie Multi-sites, site EST, Groupement Hospitalier Est, 59 boulevard Pinel, 69677, Bron, France.
- Université de Lyon, Université Lyon 1, Lyon, France.
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4
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Kerisnon@Krishnan T, Mohtarrudin N, Wan Yaacob WA, Hussin H. Grades of Poorly Differentiated Clusters are Associated with Lymph Node and the Tumour, Node and Metastasis Stages in Colorectal Carcinoma. Malays J Med Sci 2023; 30:70-78. [PMID: 38239248 PMCID: PMC10793141 DOI: 10.21315/mjms2023.30.6.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/10/2023] [Indexed: 01/22/2024] Open
Abstract
Background Colorectal carcinoma (CRC) is the third most common cancer globally. In Malaysia, CRC is most prevalent among males and the second most common cancer among females. The CRC arises mainly from the adenocarcinoma sequence. Poorly differentiated clusters (PDCs) and tumour budding (TB) are believed to represent sequential steps in tumour growth. Therefore, this study analysed the association between PDC grades with clinicopathological and demographic characteristics of CRC. Methods A total of 47 CRC cases previously diagnosed by histopathological examination were reviewed for the presence of PDCs and graded accordingly. The association between PDC grades with clinicopathological and demographic characteristics was statistically analysed. Results Out of the 47 cases with PDCs, most of them were of grade 3 (G3) (n = 27, 57.4%), followed by grade 2 (G2) (n = 13, 27.7%) and grade 1 (G1) (n = 7, 14.9%). Higher PDC grades (G2 and G3) were mainly observed in higher tumour stage (T); T3 (n = 26, 83.9%), T4 (n = 12, 92.3%), N1 (n = 20, 86.9%), N2 (n = 15, 100%). In addition, there was a significant association between PDC grades with the nodal stage (N) (P = 0.013) and the tumour, node and metastasis (TNM) stages (P = 0.012). Conclusion The PDC grades are useful for assessing the disease prognosis in CRC. A statistically significant association between PDC grades with N and TNM stages suggested that PDC grades are potential predictive parameters for invasive and metastatic risks in CRC.
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Affiliation(s)
- Thanamogan Kerisnon@Krishnan
- Department of Pathology, Hospital Raja Permaisuri Bainun, Perak,
Malaysia
- Department of Pathology, Faculty of Medicine and Health Sciences,
Universiti Putra Malaysia, Selangor, Malaysia
| | - Norhafizah Mohtarrudin
- Department of Pathology, Faculty of Medicine and Health Sciences,
Universiti Putra Malaysia, Selangor, Malaysia
| | | | - Huzlinda Hussin
- Department of Pathology, Faculty of Medicine and Health Sciences,
Universiti Putra Malaysia, Selangor, Malaysia
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5
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Jurescu A, Văduva A, Vița O, Gheju A, Cornea R, Lăzureanu C, Mureșan A, Cornianu M, Tăban S, Dema A. Colorectal Carcinomas: Searching for New Histological Parameters Associated with Lymph Node Metastases. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1761. [PMID: 37893479 PMCID: PMC10608479 DOI: 10.3390/medicina59101761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/21/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Colorectal cancer (CRC) continues to be an essential public health problem. Our study aimed to evaluate the prognostic significance of classic prognostic factors and some less-studied histopathological parameters in CRC. Materials and Methods: We performed a retrospective study on 71 colorectal carcinoma patients who underwent surgery at the "Pius Brînzeu" County Clinical Emergency Hospital in Timișoara, Romania. We analyzed the classic parameters but also tumor budding (TB), poorly differentiated clusters (PDCs) of cells, tumor-infiltrating lymphocytes (TILs), and the configuration of the tumor border on hematoxylin-eosin slides. Results: A high degree of malignancy (p = 0.006), deep invasion of the intestinal wall (p = 0.003), an advanced stage of the disease (p < 0.0001), lymphovascular invasion (p < 0.0001), perineural invasion (p < 0.0001), high-grade TB (p < 0.0001), high-grade PDCs (p < 0.0001), infiltrative tumor border configuration (p < 0.0001) showed a positive correlation with lymph node metastases. Conclusions: The analyzed parameters positively correlate with unfavorable prognostic factors in CRC. We highlight the value of classic prognostic factors along with a series of less-known parameters that are more accessible and easier to evaluate using standard staining techniques and that could predict the risk of relapse or aggressive evolution in patients with CRC.
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Affiliation(s)
- Aura Jurescu
- Department of Microscopic Morphology-Morphopathology, ANAPATMOL Research Center, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Adrian Văduva
- Department of Microscopic Morphology-Morphopathology, ANAPATMOL Research Center, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Department of Pathology, “Pius Brînzeu” County Clinical Emergency Hospital, 300723 Timişoara, Romania
| | - Octavia Vița
- Department of Microscopic Morphology-Morphopathology, ANAPATMOL Research Center, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Adelina Gheju
- Emergency County Hospital Deva, 330032 Deva, Romania
| | - Remus Cornea
- Department of Microscopic Morphology-Morphopathology, ANAPATMOL Research Center, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Department of Pathology, “Pius Brînzeu” County Clinical Emergency Hospital, 300723 Timişoara, Romania
| | - Codruța Lăzureanu
- Department of Microscopic Morphology-Morphopathology, ANAPATMOL Research Center, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Department of Pathology, “Pius Brînzeu” County Clinical Emergency Hospital, 300723 Timişoara, Romania
| | - Anca Mureșan
- Department of Microscopic Morphology-Morphopathology, ANAPATMOL Research Center, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Department of Pathology, “Pius Brînzeu” County Clinical Emergency Hospital, 300723 Timişoara, Romania
| | - Marioara Cornianu
- Department of Microscopic Morphology-Morphopathology, ANAPATMOL Research Center, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Department of Pathology, “Pius Brînzeu” County Clinical Emergency Hospital, 300723 Timişoara, Romania
| | - Sorina Tăban
- Department of Microscopic Morphology-Morphopathology, ANAPATMOL Research Center, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Department of Pathology, “Pius Brînzeu” County Clinical Emergency Hospital, 300723 Timişoara, Romania
| | - Alis Dema
- Department of Microscopic Morphology-Morphopathology, ANAPATMOL Research Center, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Department of Pathology, “Pius Brînzeu” County Clinical Emergency Hospital, 300723 Timişoara, Romania
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6
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Xiao SM, Li J. Tumor budding in gastric cancer. World J Gastrointest Surg 2023; 15:578-591. [PMID: 37206064 PMCID: PMC10190737 DOI: 10.4240/wjgs.v15.i4.578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/04/2023] [Accepted: 03/21/2023] [Indexed: 04/22/2023] Open
Abstract
The tumor, nodes, metastasis (TNM) staging system has long been the gold standard for the classification and prognosis of solid tumors. However, the TNM staging system is not without limitations. Prognostic heterogeneity exists within patients at the same stage. Therefore, the pursuit of other biomarkers with the potential to classify patients with cancer has never stopped. One of them, tumor budding (TB), has gained much success in colorectal cancer. In recent years, TB in gastric cancer has attracted much attention from researchers, beginning to reveal the molecular and biological aspects of this phenomenon in gastric cancer, and has emerged as a promising prognostic biomarker in gastric cancer, predicting disease progression and unfavorable survival. Therefore, it is time and essential to provide a holistic overview of TB in gastric cancer, which has not been achieved and is the aim of this review.
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Affiliation(s)
- Shuo-Meng Xiao
- Department of Gastric Surgery, Sichuan Cancer Hospital, Chengdu 610041, Sichuan Province, China
| | - Jian Li
- Department of General Surgery, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang 621000, Sichuan Province, China
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7
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Zhou B, Zhou Y, Tang Y, Bao Y, Zou L, Yao Z, Feng X. Intravoxel incoherent motion MRI for rectal cancer: correlation of diffusion and perfusion characteristics with clinical-pathologic factors. Acta Radiol 2023; 64:898-906. [PMID: 35619546 DOI: 10.1177/02841851221100081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Colorectal cancer is the most common cause of cancer-related death worldwide. Magnetic resonance imaging (MRI) has become a promising alternative method for staging the cancer. PURPOSE To evaluate parameters of intravoxel incoherent motion (IVIM) and their relationships with clinical-pathologic factors in rectal cancers. MATERIAL AND METHODS A total of 51 patients with histopathologically proven rectal cancer who underwent preoperative pelvic MRI were prospectively enrolled. Parameters (ADC, D, D*, and f) derived from IVIM-diffusion-weighted imaging (DWI) were independently measured by two radiologists. Student's t-test, receiver operating characteristic curves, and Spearman correlation were used for statistical analysis. RESULTS ADC, D, and D* were significantly higher in pT1-2 tumors than in pT3-4 tumors (1.108 ± 0.233 vs. 0.950 ± 0.176, 0.796 ± 0.199 vs. 0.684 ± 0.114, 0.013 ± 0.005 vs. 0.008 ± 0.003, respectively; P < 0.05). D* exhibited a strong correlation with the tumor stage (r = -0.675, P < 0.001). In poorly differentiated cluster (PDC) grading, ADC, D*, and f were significantly lower in high-grade tumors than in low-grade tumors (0.905 ± 0.148 vs. 1.064 ± 0.200, 0.008 ± 0.002 vs. 0.011 ± 0.005, and 0.252 ± 0.032 vs. 0.348 ± 0.058, respectively; P < 0.05). The f value exhibited a significantly strong correlation with the PDC grades (r = -0.842, P < 0.001), and higher sensitivity and specificity (95.2% and 75.9%) than those shown by the ADC, D, and D* values. CONCLUSION IVIM parameters, especially f, demonstrated a strong correlation with histologic grades and showed a better performance in differentiating between high- and low-grade rectal cancers. These parameters would be helpful in predicting tumor aggressiveness and prognosis.
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Affiliation(s)
- Bijing Zhou
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Yiming Zhou
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Yibo Tang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Yun Bao
- Department of Pathology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Liping Zou
- Department of Pathology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Zhenwei Yao
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Xiaoyuan Feng
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
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Prognostic Ability of Tumor Budding Outperforms Poorly Differentiated Clusters in Gastric Cancer. Cancers (Basel) 2022; 14:cancers14194731. [PMID: 36230653 PMCID: PMC9563769 DOI: 10.3390/cancers14194731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Small clusters of tumor cells at the invasion front of the tumor, known as “tumor budding” and larger clusters of cells, known as “poorly differentiated clusters”, are well known histological parameters to assess the outcome of colorectal cancer. However, their prognostic value for gastric cancer is less well investigated and controversial based on the studies conducted so far. In our retrospective study, we investigated the prognostic power of these two entities in a large cohort of gastric cancer patients. Our results demonstrate that tumor budding is an independent prognostic factor determining overall survival in gastric cancer, especially in intestinal type adenocarcinomas. In addition, budding can also predict the risk of lymph node metastases. However, although the trend is similar for poorly differentiated clusters, their predictive value is lower and they have not been shown to be an independent prognostic factor of survival in gastric cancer. Abstract The prognostic value of histological phenomena tumor budding (TB) and poorly differentiated clusters (PDCs) have been less studied in gastric cancer (GAC) and the data provided so far are controversial. In our study, 290 surgically resected GAC cases were evaluated for TB according to the criteria of International Tumor Budding Consensus Conference (ITBCC) and PDC, and both parameters were scored on a three-grade scale as described for colorectal cancer previously (0: Grade0, 1–4: Grade1, 5–9: Grade2 and ≥10: Grade3) and classified as low (Grade0–2) and high (Grade3) TB/PDC. High TB/PDC was associated with diffuse-type morphology, higher pT status, incomplete surgical resection, poor tumor differentiation and perineural and lymphovascular invasion. Multivariable survival analyses have shown an independent prognostic role of high TB with poorer overall survival in the total cohort (p = 0.014) and in intestinal-type adenocarcinomas (p = 0.005). Multivariable model revealed high TB as an independent predictor for lymph node metastasis in both the total cohort (p = 0.019) and in the intestinal type adenocarcinomas (p = 0.038). In contrast to tumor budding, no significant association was found between PDC and the occurrence of lymph node metastasis and tumor stage and even survival. In conclusion, tumor budding is an independent prognostic factor of survival in gastric cancer, especially in intestinal-type adenocarcinomas.
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Ji X, Kang M, Zhao X, Li X, Guo Y, Xie P, Yu Y, Tian Z. Poorly differentiated cluster grade-a vital predictor for lymph node metastasis and oncological outcomes in patients with T1 colorectal cancer: a retrospective study. BMC Gastroenterol 2022; 22:409. [PMID: 36064316 PMCID: PMC9442993 DOI: 10.1186/s12876-022-02492-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/31/2022] [Indexed: 12/24/2022] Open
Abstract
Background T1 colorectal cancers have a low lymph node metastasis rate and good prognosis. Thus, endoscopic resection is an attractive choice. This study aimed to describe the value of poorly differentiated cluster grade in identifying endoscopically curable T1 colorectal cancers. Methods We included 183 T1 colorectal cancer patients who underwent curative resection. Univariate and multivariate logistic regressions were used to identify lymph node metastasis predictors. The Akaike information criterion was used to determine whether poorly differentiated cluster grade was the best predictor. Backward regression was used to screen the variables. Survival analyses were conducted to determine the prognostic predictive power of poorly differentiated cluster grade. Correlations among predictors and concordance between our pathologists were also investigated. Results Poorly differentiated cluster grade was an independent predictor for lymph node metastasis (adjusted odds ratio [OR]G 3 = 0.001; 95% confidence interval [95% CI]G 3 = < 0.001, 0.139) in T1 colorectal cancer patients; moreover, it had the best predictive value (AIC = 61.626) among all indicators. It was also screened for inclusion in the predictive model. Accordingly, a high poorly differentiated cluster grade independently indicated shorter overall survival (hazard ratio [HR]G 2 = 4.315; 95% CIG 2 = 1.506, 12.568; HRG 3 = 5.049; 95% CIG 3 = 1.326, 19.222) and disease-free survival (HRG 3 = 6.621; 95% CIG 3 = 1.472, 29.786). Conclusions Poorly differentiated cluster grade is a vital reference to manage T1 colorectal cancer. It could serve as an indicator to screen endoscopically curable T1 colorectal cancers.
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Affiliation(s)
- Xiaolin Ji
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, 266003, Shandong, China
| | - Mei Kang
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, 266003, Shandong, China
| | - Xianzhi Zhao
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, 266003, Shandong, China
| | - Xiaoyu Li
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, 266003, Shandong, China
| | - Yingjie Guo
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, 266003, Shandong, China
| | - Ping Xie
- Department of Internal Medicine, Weicheng District Weifang City Peoples Hospital, Weifang, Shandong, China
| | - Yanan Yu
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, 266003, Shandong, China
| | - Zibin Tian
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, 266003, Shandong, China.
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10
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Crafa F, Vanella S, Catalano OA, Pomykala KL, Baiamonte M. Role of one-step nucleic acid amplification in colorectal cancer lymph node metastases detection. World J Gastroenterol 2022; 28:4019-4043. [PMID: 36157105 PMCID: PMC9403438 DOI: 10.3748/wjg.v28.i30.4019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 06/03/2022] [Accepted: 07/22/2022] [Indexed: 02/06/2023] Open
Abstract
Current histopathological staging procedures in colorectal cancer (CRC) depend on midline division of the lymph nodes (LNs) with one section of hematoxylin and eosin staining. Cancer cells outside this transection line may be missed, which could lead to understaging of Union for International Cancer Control Stage II high-risk patients. The one-step nucleic acid amplification (OSNA) assay has emerged as a rapid molecular diagnostic tool for LN metastases detection. It is a molecular technique that can analyze the entire LN tissue using a reverse-transcriptase loop-mediated isothermal amplification reaction to detect tumor-specific cytokeratin 19 mRNA. Our findings suggest that the OSNA assay has a high diagnostic accuracy in detecting metastatic LNs in CRC and a high negative predictive value. OSNA is a standardized, observer-independent technique, which may lead to more accurate staging. It has been suggested that in stage II CRC, the upstaging can reach 25% and these patients can access postoperative adjuvant chemotherapy. Moreover, intraoperative OSNA sentinel node evaluation may allow early CRC to be treated with organ-preserving surgery, while in more advanced-stage disease, a tailored lymphadenectomy can be performed considering the presence of aberrant lymphatic drainage and skip metastases.
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Affiliation(s)
- Francesco Crafa
- Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
| | - Serafino Vanella
- Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
| | - Onofrio A Catalano
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
| | - Kelsey L Pomykala
- Department of Nuclear Medicine, Department of Radiological Sciences, David Geffen School of Medicine at University of California, Los Angeles, University Hospital Essen, University of Duisburg-Essen, Essen 45141, Germany
| | - Mario Baiamonte
- Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
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11
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Shi H, Ye L, Lu W, Lu B. Grading of endocervical adenocarcinoma: a novel prognostic system based on tumor budding and cell cluster size. Mod Pathol 2022; 35:524-532. [PMID: 34593968 DOI: 10.1038/s41379-021-00936-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 11/09/2022]
Abstract
A novel 3-tiered grading system based on tumor budding activity and cell nest size has been validated to be highly prognostic in organ-wide squamous cell carcinomas. In this study, we applied a similar grading system with slight modification to assess the prognostic value in an institutional cohort of well annotated endocervical adenocarcinomas (EAC) consisting of 398 consecutive cases with surgical resection, no neoadjuvant chemotherapy, and higher than stage pT1a. Each case was reviewed by the International Endocervical Adenocarcinoma Criteria and Classification (IECC) and Silva pattern classification, and scored on tumor budding activity and cell cluster size to form the basis of a novel grading system. High budding activity, small tumor cell cluster size, and novel grade 3 were more frequently associated with a decreased overall survival time and tumor recurrence time (p < 0.001), and several other clinicopathologic factors including HPV-independent adenocarcinoma, lymphovascular invasion, lymph node metastasis, advanced FIGO stage, and Silva pattern C (p < 0.05). Moreover, the novel grading system was helpful in stratifying overall survival in HPV-associated adenocarcinoma (p = 0.036) and gastric-type adenocarcinoma (p = 0.033). On multivariate analysis, novel grade 3 was an adverse indicator for overall survival and tumor recurrence independently of age and FIGO stage (p < 0.05). By comparison, Silva pattern C was only associated with tumor relapse (p = 0.020) in HPV-associated adenocarcinomas whereas the conventional FIGO system was not associated with overall survival and tumor recurrence in EAC (p > 0.05). In conclusion, our study demonstrates that the grading system based on tumor budding activity and cell cluster size is robust in prognostic assessment that outperforms the conventional FIGO grading and Silva pattern classification in EAC. The novel grading system, if further validated, could be applicable in routine pathologic descriptions of EAC by providing useful information in clinical decision-making.
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Affiliation(s)
- Haiyan Shi
- Department of Surgical Pathology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Lei Ye
- Department of Surgical Pathology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Weiguo Lu
- Center for Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province and Department of Gynecological Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Bingjian Lu
- Department of Surgical Pathology and Center for Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
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12
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Sorrentino L, De Ruvo N, Serra F, Salati M, Ricciardolo AA, Bonetti LR, Gelmini R. Role of poorly differentiated cluster in gastric cancer: is it a new prognosis factor? Scand J Gastroenterol 2022; 57:44-49. [PMID: 34524049 DOI: 10.1080/00365521.2021.1974932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Poorly differentiated Clusters (PDCs) of tumor cells composed of more than five elements have been recently described in gastrointestinal cancers and correlate with a worse prognosis. Our study aims to investigate PDC occurrence in a series of patients with gastric cancer and correlate it with lymph node status and clinical outcome. MATERIAL AND METHODS 50 patients were included in the study; PDCs count was graduated as G1, G2, and G3 according to Ueno classification (PDCs count at 20× <5, 5-9 and ≥10 respectively). We collected several clinicopathologic variables such as tumor location, pTNM stage, vascular or perineural invasion, and lymph-node ratio for each case. RESULTS The presence of PDCs was related to vascular invasion (p < .013) and recurrence event (p < .027). When the population was categorized according to the number of PDCs, a significant correlation was found with the presence of lymph node metastasis (p < .000), the Lymph Node Ratio (p < .002), WHO stage at the diagnosis (p < .000) and vascular invasion (p < .001). At the univariate and multivariate analysis, PDCs were found as an independent risk factor for recurrence (HR 1.94; CI 95% 1.209-3.121; p < .006 and HR 0.401; CI 95% 0.187-0.862; p < .017 respectively). The Kaplan-Meier curves for OS and DFS showed a significant association between PDCs and shorter time to recurrence or survival. CONCLUSION PDC is a strong prognostic factor in gastric cancer, easily detectable, and feasible. As far as we know, this is the first report in Literature of a strong correlation between PDC and survival in patients with operated gastric cancer.
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Affiliation(s)
- L Sorrentino
- Department of General Surgery - Unit of General, Emergency and Oncological Surgery, AOU of Modena University of Modena and Reggio Emilia, Modena, Italy
| | - N De Ruvo
- Department of General Surgery - Unit of General, Emergency and Oncological Surgery, AOU of Modena University of Modena and Reggio Emilia, Modena, Italy
| | - F Serra
- Department of General Surgery - Unit of General, Emergency and Oncological Surgery, AOU of Modena University of Modena and Reggio Emilia, Modena, Italy
| | - M Salati
- Department of Oncology and Hematology - Oncological Unit, AOU of Modena University of Modena and Reggio Emilia, Modena, Italy
| | - A A Ricciardolo
- Department of General Surgery - Unit of General, Emergency and Oncological Surgery, AOU of Modena University of Modena and Reggio Emilia, Modena, Italy
| | - L R Bonetti
- Department of Laboratory Medicine and Pathological Anatomy - Unit of Pathological Anatomy, AOU of Modena University of Modena and Reggio Emilia, Modena, Italy
| | - R Gelmini
- Department of General Surgery - Unit of General, Emergency and Oncological Surgery, AOU of Modena University of Modena and Reggio Emilia, Modena, Italy
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13
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Caramaschi S, Mangogna A, Salviato T, Ammendola S, Barresi V, Manco G, Canu PG, Zanelli G, Bonetti LR. Cytoproliferative activity in colorectal poorly differentiated clusters: Biological significance in tumor setting. Ann Diagn Pathol 2021; 53:151772. [PMID: 34153686 DOI: 10.1016/j.anndiagpath.2021.151772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 06/04/2021] [Accepted: 06/10/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Poorly differentiated clusters (PDCs) have gained a significant prognostic role in colorectal carcinomas (CRCs) being associated to high risk of lymph node metastasis, shorter survival time and poor prognosis. The knowledge in PDC biology is not completely clear. MATERIALS AND METHODS We assessed Ki-67 LI in 45 CRCs showing ≥10 PDCs. We distinguished PDCs at the periphery of the tumor masses (pPDCs) from those within the tumor masses (cPDCs). We chose 3 cut-offs of Ki-67 labeling index (Ki-67 LI): <10%, 10-50%, and >50% of the labeled cells. RESULTS Ki-67 LI in pPDCs was<10% in 37 cases (82%), 10-50% in 6 cases (13%) and >50%in 2 cases (5%); Ki-67 LI in cPDCs was<10% in 4 cases (23.5%), 10-50% in 4 (23.5%) and >50% in 9 (54%). Ki-67 LI in tumor budding foci (TBs) was <10% in 8 cases (32%), 10-50% in 8 (32%) and >50% in 9 (36%). The difference of Ki-67 LI reaches the statistical significance (p < 0.005). Ki-67 LI <10% in the pPDCs was associated with nodal metastases (pN+) (p < 0.0001), pTNM stage III and IV(p < 0.0001) and TB (p < 0.001). Ki-67 LI > 50% in cPDC was significantly associated withpT3-pT4 and advanced pTNM stages (p < 0.0001), N+ (p = 0.0001) and LVI (p < 0.05). CONCLUSION Different Ki-67 LI detected between cPDCs and pPDCs suggesting a biological difference in PDCs. An actively proliferating central tumor areas can be distinguished from the peripheral portion of the tumors in which the cells interact with the stroma acquiring invasive and metastatic potential.
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Affiliation(s)
- Stefania Caramaschi
- Department of Medical and Surgical Sciences for Children & Adults, Division of Pathology, University-Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro Mangogna
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Tiziana Salviato
- Department of Medical and Surgical Sciences for Children & Adults, Division of Pathology, University-Hospital of Modena and Reggio Emilia, Modena, Italy.
| | - Serena Ammendola
- Department of Diagnostic and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Valeria Barresi
- Department of Diagnostic and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Gianrocco Manco
- Department of Surgery, University-Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Pina G Canu
- Department of Medical and Surgical Sciences for Children & Adults, Division of Pathology, University-Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Giuliana Zanelli
- Department of Medical and Surgical Sciences for Children & Adults, Division of Pathology, University-Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Luca Reggiani Bonetti
- Department of Medical and Surgical Sciences for Children & Adults, Division of Pathology, University-Hospital of Modena and Reggio Emilia, Modena, Italy
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14
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Archilla I, Díaz-Mercedes S, Aguirre JJ, Tarragona J, Machado I, Rodrigo MT, Lopez-Prades S, Gorostiaga I, Landolfi S, Alén BO, Balaguer F, Castells A, Camps J, Cuatrecasas M. Lymph Node Tumor Burden Correlates With Tumor Budding and Poorly Differentiated Clusters: A New Prognostic Factor in Colorectal Carcinoma? Clin Transl Gastroenterol 2021; 12:e00303. [PMID: 33939382 PMCID: PMC7909319 DOI: 10.14309/ctg.0000000000000303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 12/18/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Molecular lymph node (LN) staging in early colorectal cancer (CRC) has demonstrated to be more precise than conventional histopathology pN staging. Tumor budding (TB) and poorly differentiated clusters (PDCs) are associated with LN metastases, recurrences, and lower survival in CRC. We evaluated the correlation between the total tumor load (TTL) in LNs from CRC surgical specimens with patient outcome, TB, and PDC. METHODS In this retrospective multicentre study, 5,931 LNs from 342 stage I-III CRC were analyzed by both hematoxylin and eosin and molecular detection of tumor cytokeratin 19 mRNA by one-step nucleic acid amplification. TB and PDC were evaluated by hematoxylin and eosin and cytokeratin 19 immunohistochemistry. RESULTS One-step nucleic acid was positive in 38.3% patients (n = 131). Tumor Budding was low in 45% cases, intermediate in 25%, and high in 30%. Poorly Differentiated Clusters were low-grade G1 in 53%, G2 in 32%, and G3 in 15%. TB and PDC correlated with TTL, high-grade, lymphovascular and perineural invasion, pT, pN and stage (P < 0.001). TB, PDC, and TTL ≥ 6,000 copies/µL were associated with worse overall survival (P = 0.002, P = 0.013, and P = 0.046) and disease-free survival (P < 0.001). DISCUSSION The implementation of more sensitive molecular methods to assess LN status is a promising alternative approach to pN staging, which could be integrated to other factors to help risk stratification and management of patients with early-stage CRC. This study demonstrates the correlation of the amount of LN tumor burden with TB and PDCs. TTL is related to the outcome and could be used as a new prognostic factor in CRC (see Visual Abstract, Supplementary Digital Content 2, http://links.lww.com/CTG/A512).
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Affiliation(s)
- Ivan Archilla
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clínic, University of Barcelona, IDIBAPS, Spain
| | - Sherley Díaz-Mercedes
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clínic, University of Barcelona, IDIBAPS, Spain
| | | | - Jordi Tarragona
- Pathology Department, Hospital Arnau de Vilanova, Lleida, Spain
| | - Isidro Machado
- Pathology Department, Instituto Valenciano de Oncologia and Hospital QuironSalud, Valencia, Spain
| | - Maria Teresa Rodrigo
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clínic, University of Barcelona, IDIBAPS, Spain
| | - Sandra Lopez-Prades
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clínic, University of Barcelona, IDIBAPS, Spain
| | - Iñigo Gorostiaga
- Pathology Department, Arava University Hospital, Vitoria-Gasteiz, Spain
| | - Stefania Landolfi
- Pathology Department, Vall Hebron University Hospital, Barcelona, Spain
| | - Begoña Otero Alén
- Molecular Pathology Division, Pathology Department, CHUAC/INIBIC, A Coruña, Spain
| | - Francesc Balaguer
- Gastroenterology Department, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
- Centro de Investigación Biomédica en Red. Enfermedades Hepáticas y Digestivas (CIBERehd). ISCiii. Spain
| | - Antoni Castells
- Gastroenterology Department, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
- Centro de Investigación Biomédica en Red. Enfermedades Hepáticas y Digestivas (CIBERehd). ISCiii. Spain
| | - Jordi Camps
- Gastroenterology Department, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
- Centro de Investigación Biomédica en Red. Enfermedades Hepáticas y Digestivas (CIBERehd). ISCiii. Spain
| | - Miriam Cuatrecasas
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clínic, University of Barcelona, IDIBAPS, Spain
- Centro de Investigación Biomédica en Red. Enfermedades Hepáticas y Digestivas (CIBERehd). ISCiii. Spain
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15
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Turri G, Barresi V, Valdegamberi A, Gecchele G, Conti C, Ammendola S, Guglielmi A, Scarpa A, Pedrazzani C. Clinical Significance of Preoperative Inflammatory Markers in Prediction of Prognosis in Node-Negative Colon Cancer: Correlation between Neutrophil-to-Lymphocyte Ratio and Poorly Differentiated Clusters. Biomedicines 2021; 9:biomedicines9010094. [PMID: 33478082 PMCID: PMC7835814 DOI: 10.3390/biomedicines9010094] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/14/2021] [Accepted: 01/16/2021] [Indexed: 02/06/2023] Open
Abstract
Although stage I and II colon cancers (CC) generally show a very good prognosis, a small proportion of these patients dies from recurrent disease. The identification of high-risk patients, who may benefit from adjuvant chemotherapy, becomes therefore essential. We retrospectively evaluated 107 cases of stage I (n = 28, 26.2%) and II (n = 79, 73.8%) CC for correlations among preoperative inflammatory markers, histopathological factors and long-term prognosis. A neutrophil-to-lymphocyte ratio greater than 3 (H-NLR) and a platelet-to-lymphocyte ratio greater than 150 (H-PLR) were significantly associated with the presence of poorly differentiated clusters (PDC) (p = 0.007 and p = 0.039, respectively). In addition, H-NLR and PDC proved to be significant and independent survival prognosticators for overall survival (OS; p = 0.007 and p < 0.001, respectively), while PDC was the only significant prognostic factor for cancer-specific survival (CSS; p < 0.001,). Finally, the combination of H-NLR and PDC allowed an optimal stratification of OS and CSS in our cohort, suggesting a potential role in clinical practice for the identification of high-risk patients with stage I and II CC.
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Affiliation(s)
- Giulia Turri
- Unit of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134 Verona, Italy; (G.T.); (A.V.); (G.G.); (C.C.); (A.G.)
| | - Valeria Barresi
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, 37134 Verona, Italy; (V.B.); (S.A.); (A.S.)
| | - Alessandro Valdegamberi
- Unit of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134 Verona, Italy; (G.T.); (A.V.); (G.G.); (C.C.); (A.G.)
| | - Gabriele Gecchele
- Unit of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134 Verona, Italy; (G.T.); (A.V.); (G.G.); (C.C.); (A.G.)
| | - Cristian Conti
- Unit of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134 Verona, Italy; (G.T.); (A.V.); (G.G.); (C.C.); (A.G.)
| | - Serena Ammendola
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, 37134 Verona, Italy; (V.B.); (S.A.); (A.S.)
| | - Alfredo Guglielmi
- Unit of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134 Verona, Italy; (G.T.); (A.V.); (G.G.); (C.C.); (A.G.)
| | - Aldo Scarpa
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, 37134 Verona, Italy; (V.B.); (S.A.); (A.S.)
| | - Corrado Pedrazzani
- Unit of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134 Verona, Italy; (G.T.); (A.V.); (G.G.); (C.C.); (A.G.)
- Correspondence: ; Tel.: +39-(0)45-8124464-6719; Fax: +39-(0)45-8027426
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16
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Ueno H, Ishiguro M, Nakatani E, Ishikawa T, Uetake H, Matsui S, Teramukai S, Murotani K, Ajioka Y, Shimazaki H, Maeda A, Takuma K, Yoshida T, Kambara T, Matsuda K, Takagane A, Tomita N, Sugihara K. Optimal Criteria for G3 (Poorly Differentiated) Stage II Colon Cancer: Prospective Validation in a Randomized Controlled Study (SACURA Trial). Am J Surg Pathol 2020; 44:1685-1698. [PMID: 32868525 PMCID: PMC7690643 DOI: 10.1097/pas.0000000000001570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Grade 3 (G3, poorly differentiated) is an important treatment-decision factor in stage II colon cancer, but no unified diagnostic criteria are established. According to previous studies, an intratumoural poorly differentiated area with no glandular formation (POR) that fills the microscopic field of a ×40 objective lens was an essential factor that defined G3. We aimed to prospectively validate this in a randomized controlled study of adjuvant chemotherapy (SACURA trial). We enrolled 991 patients with stage II colon cancer. POR was graded according to the ×40 objective lens rule and the intensity of poorly differentiated clusters (Grade), and its prognostic power was compared with that of the conventional tumor grade on the basis of predominant histology rule (Grade). According to Grade, 313, 526, and 152 tumors were classified as G1, G2, and G3, respectively, and the 5-year relapse-free survival (RFS) rates were 91.1%, 82.9%, and 74.7%, respectively (P<0.0001). When G3 and G3 were alternatively added to the prognostic model consisting of 8 conventional factors, only G3 was a significant factor for RFS (P=0.040, Wald test). The adverse impact of G3 on RFS was greater in the microsatellite stable/microsatellite instability-low subset than that in the full analysis set. In the microsatellite stable/microsatellite instability-low subset, the 5-year RFS rate of patients with G3 tumors in the chemotherapy group achieved greater improvement (9.1%) than the surgery-alone group. The least differentiation policy with the ×40 objective lens rule may be highlighted as the diagnostic criterion for G3 because of its validated prognostic value.
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Affiliation(s)
| | | | - Eiji Nakatani
- Division of Statistical Analysis of Research Support Center, Shizuoka General Hospital, Shizuoka
- Division of Medical Statistics, Translational Research Center for Medical Innovation, Foundation for Biomedical Research and Innovation at Kobe
| | | | | | - Shigeyuki Matsui
- Department of Biostatistics, Graduate School of Medicine, Nagoya University, Aichi
| | - Satoshi Teramukai
- Department of Biostatistics, Kyoto Prefectural University of Medicine, Kyoto
| | - Kenta Murotani
- Biostatistics Center, Kurume University, Graduate School of Medicine
| | - Yoichi Ajioka
- Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata
| | | | | | - Kunio Takuma
- Department of Surgery, Tokyo Metropolitan Tama Medical Center
| | - Takefumi Yoshida
- Department of Surgery, Social Insurance Tagawa Hospital, Fukuoka
| | | | - Keiji Matsuda
- Department of Surgery, Teikyo University School of Medicine, Tokyo
| | - Akinori Takagane
- Department of Surgery, Hakodate Goryokaku Hospital, Hokkaido, Japan
| | - Naohiro Tomita
- Department of Surgery, Division of Lower GI Surgery, Hyogo College of Medicine, Hyogo
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17
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Tumor Budding and Poorly Differentiated Clusters in Small Intestinal Adenocarcinoma. Cancers (Basel) 2020; 12:cancers12082199. [PMID: 32781596 PMCID: PMC7465895 DOI: 10.3390/cancers12082199] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 12/12/2022] Open
Abstract
The clinicopathologic and prognostic significances of tumor budding (TB) and poorly-differentiated clusters (PDC) have not been investigated in small intestinal adenocarcinomas (SIACs). In 236 surgically-resected SIACs, we counted TB (single cells or clusters ≤4 tumor cells) and PDC (clusters ≥5 tumor cells) at the peritumoral-invasive front (p) and in the intratumoral area (i) independently to classify as grade-1 (≤4), grade-2 (5–9), or grade-3 (≥10). Consequently, grades-2 and -3 were considered high-grade. High-pTB, -iTB, -pPDC, and -iPDC were observed in 174 (73.7%), 129 (54.7%), 118 (50.0%), and 85 (36.0%) cases, respectively. High-TB/PDCs were more frequently observed in tumors with high-grade, higher T- and N-categories and stage grouping, and perineural or lymphovascular invasion. Patients with high-TB/PDC had a shorter survival than those with low-TB/PDC. In a multivariate analysis, high-pTB, nonintestinal type, high N-category, retroperitoneal seeding, and microsatellite-stable were worse independent-prognostic predictors. Subgroup analysis demonstrated that patients with high-pTB showed worse survival (median: 42.5 months) than those with low-pTB (133.7 months; p = 0.007) in the lower stage (stages I–II) group. High-TB/PDC, both in peritumoral and intratumoral localizations, were associated with aggressive behaviors in SIACs. High-pTB can be used as an adverse prognostic indicator in SIAC patients, especially when patients are in early disease stages.
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18
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Shivji S, Conner JR, Barresi V, Kirsch R. Poorly differentiated clusters in colorectal cancer: a current review and implications for future practice. Histopathology 2020; 77:351-368. [PMID: 32358792 DOI: 10.1111/his.14128] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/16/2020] [Accepted: 04/26/2020] [Indexed: 12/13/2022]
Abstract
Poorly differentiated clusters (PDC), defined as small groups of ≥5 tumour cells without glandular differentiation, have gained recent attention as a promising prognostic factor in colorectal cancer (CRC). Numerous studies have shown PDC to be significantly associated with other adverse histopathological features and worse clinical outcomes. PDC may hold particular promise in stage II colon cancer, where risk stratification plays a critical role in patient selection for adjuvant chemotherapy. In addition, emerging evidence suggests that PDC can predict lymph node metastasis in endoscopically resected pT1 CRC, potentially helping the selection of patients for oncological resection. In 'head-to-head' comparisons, PDC grade has consistently outperformed conventional histological grading systems both in terms of risk stratification and reproducibility. With a number of large-scale studies now available, this review evaluates the evidence regarding the prognostic significance of PDC, considers its relationship with other emerging invasive front prognostic markers (such as tumour budding and stroma type), assesses its 'practice readiness', addressing issues such as interobserver reproducibility, scoring methodologies and special histological subtypes (e.g. micropapillary and mucinous carcinoma), and draws attention to ongoing challenges and areas in need of further study. Finally, emerging data on the role of PDC in non-colorectal cancers are briefly considered.
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Affiliation(s)
- Sameer Shivji
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - James R Conner
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Valeria Barresi
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Richard Kirsch
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
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19
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Ueno H, Konishi T, Ishikawa Y, Shimazaki H, Ueno M, Aosasa S, Saiura A, Shinto E, Kajiwara Y, Mochizuki S, Nakamura T, Yamamoto J. Primary Tumor Histology Affects Oncological Outcomes Independently of the Anatomical Extent of Disease in Colorectal Liver Metastasis. JMA J 2020; 3:240-250. [PMID: 33150258 PMCID: PMC7590386 DOI: 10.31662/jmaj.2018-0004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 05/08/2020] [Indexed: 12/30/2022] Open
Abstract
Introduction Growing evidence indicates the prognostic importance of the crosstalk between cancer cells and stroma through the induction of epithelial-mesenchymal transition (EMT). This study aimed to clarify the prognostic value of evaluating primary tumor histology with the anatomical extent of disease in patients with colorectal liver metastasis (CRLM). Methods Prognostic analyses were performed in 411 CRLM patients who underwent hepatectomy at two institutions. Tumors were graded into one of three histological categories based on integrated assessment of EMT-associated histology (HistologyEMT) in primary tumors, i.e., poorly differentiated clusters (PDCs) and desmoplastic reaction (DR). Results A prognostic grouping system for the anatomical extent of disease (N stage, liver metastasis number and size, and extrahepatic disease; Gradeanatomical) stratified patients into three groups with different five-year relapse-free survival (RFS) rates after hepatectomy: A, 31% (191 patients); B, 15% (124 patients); and C, 6% (96 patients; P < 0.0001). HistologyEMT (A, G1 PDC and mature-type DR; C, G3 PDC and immature-type DR; and B, others) identified 49, 120, and 242 patients with 46%, 5%, and 22% five-year RFS, respectively (P < 0.0001). Among prognostic factors, the Akaike information criterion was most favorable in Gradeanatomical, followed by HistologyEMT. Multivariate analysis demonstrated that these two factors independently impacted RFS; two-year RFS after hepatectomy in different patient groups had a wide range (10%-76%). Conclusions Histological assessment of dedifferentiation and the stromal environment of primary tumors contributed to effective risk stratification of early relapse after hepatectomy, which could be useful to determine clinical management for CRLM patients.
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Affiliation(s)
- Hideki Ueno
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Tsuyoshi Konishi
- Gastroenterology Center, Cancer Institute Hospital, Tokyo, Japan
| | - Yuichi Ishikawa
- Division of Pathology, Cancer Institute Hospital, Tokyo, Japan
| | - Hideyuki Shimazaki
- Department of Laboratory Medicine, National Defense Medical College, Saitama, Japan
| | - Masashi Ueno
- Gastroenterology Center, Cancer Institute Hospital, Tokyo, Japan
| | - Suefumi Aosasa
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Akio Saiura
- Gastroenterology Center, Cancer Institute Hospital, Tokyo, Japan
| | - Eiji Shinto
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Yoshiki Kajiwara
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Satsuki Mochizuki
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Takahiro Nakamura
- Laboratory for Mathematics, National Defense Medical College, Tokorozawa, Japan.,Laboratory for Statistical Analysis, Center for Genomic Medicine, RIKEN, Tokyo, Japan
| | - Junji Yamamoto
- Department of Surgery, National Defense Medical College, Saitama, Japan
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20
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Prognostic Value of Poorly Differentiated Clusters in Liver Metastatic Lesions of Colorectal Carcinoma. Am J Surg Pathol 2020; 43:1341-1348. [PMID: 31318710 DOI: 10.1097/pas.0000000000001329] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Colorectal liver metastasis (CRLM) is the most common pattern of metastases or recurrence in colorectal carcinoma; however, no robust pathologic prognostic factors have been identified. This study aimed to verify the prognostic value of poorly differentiated clusters (PDC) in liver metastatic lesions and to clarify the correlation between PDC in liver metastatic lesions (PDC) and the primary tumor histology. Consecutive patients who underwent resection for CRLM were pathologically reviewed. PDC was defined as cancer clusters comprising ≥5 cancer cells and lacking glandular formation and was quantifiably graded as G1 (<5 clusters), G2 (5 to 9 clusters), and G3 (≥10 clusters) based on the highest number of clusters observed under ×20 magnification. The cohort comprised 204 patients. PDC was classified as G1, G2, and G3 for 68, 69, and 67 patients, respectively, and it was significantly associated with PDC grade in the primary tumor (P<0.001). Among the potential prognostic factors, tumor budding in the primary tumor, PDC in the primary tumor, the number of liver metastases, extrahepatic metastasis, and PDC significantly influenced overall survival (OS) after CRLM resection. According to the PDC grade, the 5-year OS rates were 68.9%, 48.3%, and 39.5% for G1, G2, and G3 (P<0.001), respectively. Multivariate analysis for OS showed that PDC grade, tumor budding in the primary tumor, the number of liver metastasis and extrahepatic metastasis were independent prognostic factors. In conclusion, there is a correlation in the PDC grade between the primary tumor and liver metastatic lesion, and PDC grade could be a promising new prognostic factor after CRLM resection.
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21
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Arpa G, Grillo F, Giuffrida P, Nesi G, Klersy C, Mescoli C, Lenti MV, Lobascio G, Martino M, Latella G, Malvi D, Macciomei MC, Fociani P, Villanacci V, Rizzo A, Ferrero S, Sessa F, Orlandi A, Monteleone G, Biancone L, Cantoro L, Tonelli F, Ciardi A, Poggioli G, Rizzello F, Ardizzone S, Sampietro G, Solina G, Oreggia B, Papi C, D'Incà R, Vecchi M, Caprioli F, Caronna R, D'Errico A, Fiocca R, Rugge M, Corazza GR, Luinetti O, Paulli M, Solcia E, Di Sabatino A, Vanoli A. Separation of Low- Versus High-grade Crohn's Disease-associated Small Bowel Carcinomas is Improved by Invasive Front Prognostic Marker Analysis. J Crohns Colitis 2020; 14:295-302. [PMID: 31418007 DOI: 10.1093/ecco-jcc/jjz140] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Crohn's disease-associated small bowel carcinoma is a rare event, usually reported to have a severe prognosis. However, in previous investigations we have found a minority of cases displaying a relatively favourable behaviour, thus outlining the need to improve the histopathological prediction of Crohn's disease-associated small bowel carcinoma prognosis. METHODS As in recent studies on colorectal cancer, a substantial improvement in prognostic evaluations has been provided by the histological analysis of the tumour invasive front; we therefore systematically analysed the tumour budding and poorly differentiated clusters in the invasive front of 47 Crohn's disease-associated small bowel carcinomas collected through the Small Bowel Cancer Italian Consortium. RESULTS Both tumour budding and poorly differentiated cluster analyses proved highly effective in prognostic evaluation of Crohn's disease-associated small bowel carcinomas. In addition, they retained prognostic value when combined with two other parameters, i.e. glandular histology and stage I/II, both known to predict a relatively favourable small bowel carcinoma behaviour. In particular, association of tumour budding and poorly differentiated clusters in a combined invasive front score allowed identification of a minor subset of cancers [12/47, 25%] characterised by combined invasive front low grade coupled with a glandular histology and a low stage [I or II] and showing no cancer-related death during a median follow-up of 73.5 months. CONCLUSIONS The improved distinction of lower- from higher-grade Crohn's disease-associated small bowel carcinomas provided by invasive front analysis should be of potential help in choosing appropriate therapy for these rare and frequently ominous neoplasms.
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Affiliation(s)
- Giovanni Arpa
- Unit of Anatomic Pathology, Department of Molecular Medicine, University of Pavia, and Fondazione IRCCS San Matteo Hospital, Pavia, Italy
| | - Federica Grillo
- Pathology Unit, Department of Surgical and Diagnostic Sciences, University Hospital and Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Paolo Giuffrida
- Department of Internal Medicine, Fondazione IRCCS San Matteo Hospital, University of Pavia, Pavia, Italy
| | - Gabriella Nesi
- Division of Pathological Anatomy, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Catherine Klersy
- Service of Clinical Epidemiology & Biometry, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
| | - Claudia Mescoli
- Pathology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine, Fondazione IRCCS San Matteo Hospital, University of Pavia, Pavia, Italy
| | - Gessica Lobascio
- Unit of Anatomic Pathology, Department of Molecular Medicine, University of Pavia, and Fondazione IRCCS San Matteo Hospital, Pavia, Italy
| | - Michele Martino
- Department of Internal Medicine, Fondazione IRCCS San Matteo Hospital, University of Pavia, Pavia, Italy
| | - Giovanni Latella
- Gastroenterology Unit, Department of Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Deborah Malvi
- Department of Experimental, Diagnostic and Specialty Medicine [DIMES], Institute of Oncology and Transplant Pathology, University of Bologna, Policlinico St Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Paolo Fociani
- Unit of Pathology, Luigi Sacco University Hospital, Milan, Italy
| | | | - Aroldo Rizzo
- Pathology Unit, Cervello Hospital, Palermo, Italy
| | - Stefano Ferrero
- Division of Pathology, Department of Biomedical, Surgical and Dental Sciences, University of Milan, and Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fausto Sessa
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Augusto Orlandi
- Department of Biopathology and Image Diagnostics, University of Tor Vergata, Rome, Italy
| | | | - Livia Biancone
- Department of Systems Medicine, University of Tor Vergata, Rome, Italy
| | - Laura Cantoro
- Gastroenterologia Aziendale USL Umbria, Perugia, Italy
| | - Francesco Tonelli
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Antonio Ciardi
- Department of Radiological, Oncological, Pathological Sciences, Umberto I Hospital, La Sapienza University, Rome, Italy
| | - Gilberto Poggioli
- Surgery of the Alimentary Tract, Department of Medical and Surgical Sciences, Sant'Orsola - Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Fernando Rizzello
- Intestinal Chronic Bowel Disease Unit, Department of Medical and Surgical Sciences, Sant'Orsola Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | | | | | - Barbara Oreggia
- General Surgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Policlinico, Milan, Italy
| | | | - Renata D'Incà
- Gastroenterology Section, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, and Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Flavio Caprioli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, and Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Roberto Caronna
- Surgical Sciences, Umberto I Hospital, La Sapienza University, Rome, Italy
| | - Antonietta D'Errico
- Department of Experimental, Diagnostic and Specialty Medicine [DIMES], Institute of Oncology and Transplant Pathology, University of Bologna, Policlinico St Orsola-Malpighi Hospital, Bologna, Italy
| | - Roberto Fiocca
- Pathology Unit, Department of Surgical and Diagnostic Sciences, University Hospital and Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Massimo Rugge
- Pathology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Gino Roberto Corazza
- Department of Internal Medicine, Fondazione IRCCS San Matteo Hospital, University of Pavia, Pavia, Italy
| | - Ombretta Luinetti
- Unit of Anatomic Pathology, Department of Molecular Medicine, University of Pavia, and Fondazione IRCCS San Matteo Hospital, Pavia, Italy
| | - Marco Paulli
- Unit of Anatomic Pathology, Department of Molecular Medicine, University of Pavia, and Fondazione IRCCS San Matteo Hospital, Pavia, Italy
| | - Enrico Solcia
- Unit of Anatomic Pathology, Department of Molecular Medicine, University of Pavia, and Fondazione IRCCS San Matteo Hospital, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, Fondazione IRCCS San Matteo Hospital, University of Pavia, Pavia, Italy
| | - Alessandro Vanoli
- Unit of Anatomic Pathology, Department of Molecular Medicine, University of Pavia, and Fondazione IRCCS San Matteo Hospital, Pavia, Italy
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22
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Bertoni L, Barresi V, Bonetti LR, Caramaschi S, Mangogna A, Lionti S, Azzoni P, Carnevale G, Pisciotta A, Salviato T. Poorly differentiated clusters (PDC) in colorectal cancer: Does their localization in tumor matter? Ann Diagn Pathol 2019; 41:106-111. [DOI: 10.1016/j.anndiagpath.2019.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/07/2019] [Accepted: 06/15/2019] [Indexed: 02/07/2023]
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23
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Cho SJ, Kakar S. Tumor Budding in Colorectal Carcinoma: Translating a Morphologic Score Into Clinically Meaningful Results. Arch Pathol Lab Med 2019; 142:952-957. [PMID: 30040461 DOI: 10.5858/arpa.2018-0082-ra] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - Tumor budding has received increasing recognition as an important independent prognostic factor in colorectal carcinoma. Prominent tumor budding in adenocarcinoma arising in a polyp has been shown to be a risk factor for lymph node involvement. The variability in methods used for evaluating tumor budding in different studies and lack of standardized guidelines have impeded routine inclusion of tumor budding in pathology reports. This changed last year with consensus guidelines based on the International Tumor Budding Consensus Conference (ITBCC). These guidelines have been included in the recent College of American Pathologists (CAPs) Colorectal Cancer Protocol. The consensus methodology will allow uniform reporting of this finding, but challenges in interpretation in the setting of intense inflammation, fibrosis, or gland fragmentation need to be addressed in future guidelines. OBJECTIVE - To provide a brief overview of the known clinical significance of tumor budding in colorectal carcinoma and discuss the practical aspects of its implementation on a routine basis. DATA SOURCES - English-language pathology literature. CONCLUSIONS - Tumor budding has been shown to be an independent prognostic marker in colorectal carcinomas and the routine reporting of tumor buds is now advocated by using the approach outlined by the ITBCC guidelines. Tumor budding is included in the CAP protocol as a recommended element. Presence of prominent tumor budding in an adenocarcinoma in a polyp may have implications for management, such as additional resection, while it serves as a prognostic factor in other settings.
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Affiliation(s)
| | - Sanjay Kakar
- From the Department of Pathology, University of California, San Francisco
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24
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Fadaka AO, Pretorius A, Klein A. Biomarkers for Stratification in Colorectal Cancer: MicroRNAs. Cancer Control 2019; 26:1073274819862784. [PMID: 31431043 PMCID: PMC6704426 DOI: 10.1177/1073274819862784] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 06/08/2019] [Accepted: 06/13/2019] [Indexed: 12/18/2022] Open
Abstract
Colorectal cancer (CRC) is one of the most widely recognized and deadly malignancies worldwide. In spite of the fact that the death rates have declined over the previous decade, particularly because of enhanced screening or potential treatment alternatives, CRC still remains the third leading cause of cancer-related mortality in the world, with an estimated incidence of over 1 million new cases and approximately 600 000 deaths estimated yearly. Unlike prostate and lung cancer, CRC is not easily detectable in its early stage, which may also account for its high mortality rate. MicroRNAs (miRNAs) are a class of noncoding RNAs. The roles of these noncoding RNAs have been implicated in cancer pathogenesis, most especially CRC, due to their ability to posttranscriptionally regulate the expression of oncogenes and tumor suppressor genes. Dysregulated expression of many miRNAs regulates the expression of hundreds of growth regulatory genes and pathways that are important in the multistep model of colorectal carcinogenesis. If CRC is detected early, it is a largely treatable disease. Early diagnosis, including the identification of premalignant adenomas, is regarded a major concept for improving patient survival in CRC treatment. Several lines of research suggest that miRNAs are closely implicated in the metastatic process in CRC and some of these miRNAs could be useful as promising clinical tools for identifying specific stages of CRC due to their differential expression. This review discusses the correlation between CRC staging relative to the specific expression of miRNA for early detection, treatment, and disease management.
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Affiliation(s)
- Adewale Oluwaseun Fadaka
- Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Cape Town, South Africa
| | - Ashley Pretorius
- Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Cape Town, South Africa
| | - Ashwil Klein
- Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Cape Town, South Africa
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25
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Barel F, Auffret A, Cariou M, Kermarrec T, Samaison L, Bourhis A, Badic B, Jézéquel J, Cholet F, Bail JP, Marcorelles P, Nousbaum JB, Robaszkiewicz M, Doucet L, Uguen A. High reproducibility is attainable in assessing histoprognostic parameters of pT1 colorectal cancer using routine histopathology slides and immunohistochemistry analyses. Pathology 2019; 51:46-54. [DOI: 10.1016/j.pathol.2018.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/08/2018] [Accepted: 10/15/2018] [Indexed: 12/11/2022]
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26
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Pure Well-Differentiated Adenocarcinoma Is a Safe Factor for Lymph Node Metastasis in T1 and T2 Colorectal Cancer: A Pilot Study. Gastroenterol Res Pract 2018; 2018:8798405. [PMID: 30581465 PMCID: PMC6276412 DOI: 10.1155/2018/8798405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/07/2018] [Accepted: 09/25/2018] [Indexed: 12/18/2022] Open
Abstract
Background and Aims Various risk factors for lymph node metastasis (LNM) have been reported in colorectal T1 cancers. However, the factors available are insufficient for predicting LNM. We therefore investigated the utility of the new histological factor "pure well-differentiated adenocarcinoma" (PWDA) as a safe factor for predicting LNM in T1 and T2 cancers. Materials and Methods We reviewed 115 T2 cancers and 202 T1 cancers in patients who underwent surgical resection in our center. We investigated the rates of LNM among various clinicopathological factors, including PWDA. PWDA was defined as a lesion comprising only well-differentiated adenocarcinoma. The consistency of the diagnosis of PWDA was evaluated among two pathologists. In addition, 72 T1 cancers with LNM from 8 related hospitals over 10 years (2008-2017) were also analyzed. Results The rates of LNM and PWDA were 23.5% and 20.0%, respectively, in T2 cancers. Significant differences were noted between patients with and without LNM regarding lymphatic invasion (81.5% vs. 36.4%, p < 0.001), poor histology (51.9% vs. 19.3%, p = 0.008), and PWDA (3.7% vs. 25.0%, p = 0.015). The rates of LNM and PWDA were 8.4% and 36.1%, respectively, in T1 cancers. Regarding the 73 PWDA cases and 129 non-PWDA cases, the rates of LNM were 0.0% and 13.2%, respectively (p < 0.001). Among the 97 cases with lymphatic or venous invasion, the rates of LNM in 29 PWDA cases and 68 non-PWDA were 0% and 14.7%, respectively (p = 0.029). The agreement of the two pathologists for the diagnosis of PWDA was acceptable (kappa value > 0.5). A multicenter review showed no cases of PWDA among 72 T1 cancers with LNM. Conclusions PWDA is considered to be a safe factor for LNM in T1 cancer.
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27
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Athanasakis E, Xenaki S, Venianaki M, Chalkiadakis G, Chrysos E. Newly recognized extratumoral features of colorectal cancer challenge the current tumor-node-metastasis staging system. Ann Gastroenterol 2018; 31:525-534. [PMID: 30174388 PMCID: PMC6102465 DOI: 10.20524/aog.2018.0284] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 03/13/2018] [Indexed: 12/12/2022] Open
Abstract
One of the most common malignant tumors in humans, colorectal cancer has been extensively studied during the past few decades. Staging colorectal cancer allows clinicians to obtain precise prognostic information and apply specific treatment procedures. Apart from remote metastases, the depth of tumor infiltration and lymph node involvement have traditionally been recognized as the most important factors predicting outcome. Variations in the molecular signature of colorectal cancer have also revealed differences in phenotypic aggressiveness and therapeutic response rates. This article presents a review of the extratumoral environment in colorectal surgery.
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Affiliation(s)
- Elias Athanasakis
- Department of General Surgery, University Hospital of Heraklion Crete, Greece
| | - Sofia Xenaki
- Department of General Surgery, University Hospital of Heraklion Crete, Greece
| | - Maria Venianaki
- Department of General Surgery, University Hospital of Heraklion Crete, Greece
| | - George Chalkiadakis
- Department of General Surgery, University Hospital of Heraklion Crete, Greece
| | - Emmanuel Chrysos
- Department of General Surgery, University Hospital of Heraklion Crete, Greece
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28
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Clinical Impact and Prognostic Role of KRAS/BRAF/PIK3CA Mutations in Stage I Colorectal Cancer. DISEASE MARKERS 2018; 2018:2959801. [PMID: 30018674 PMCID: PMC6029483 DOI: 10.1155/2018/2959801] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/04/2018] [Accepted: 05/20/2018] [Indexed: 02/07/2023]
Abstract
Stage I colorectal carcinoma has excellent prognosis, with 5-year survival rate up to 95%. The occurrence of lymphovascular invasion, tumor budding, high number of PDC, or lymph node micrometastases is associated with tumor progression. The aim of this study was to evaluate the mutational status of 62 stage I colorectal carcinomas (CRC) (taken from 37 patients surviving more than five years since the initial diagnosis and from 25 patients who died of disease) and to correlate it with histopathological features and the clinical outcome. Mutations of KRAS, NRAS, BRAF, and PIK3CA genes were analyzed through Myriapod Colon Status Kit, using the high-throughput genotyping platform Sequenom MassARRAY System. Mutations in those genes were found in 31 cases (50%) and mainly in those with poor prognosis. The most frequent mutations occurred at codons 12 and 13 of the KRAS gene (40% of cases). We found concomitant PIK3CA mutations in 5 cases (8%). The presence of PIK3CA mutations was mainly observed in tumors with poor prognosis and with unfavorable histopathological prognostic features. High PDC grade (P = 0.0112), the presence of tumor budding (P = 0.0334), LVI (P < 0.0001), KRAS mutations (P = 0.0228), PIK3CA mutations (P = 0.0214), multiple genetic mutations in KRAS and PIK3CA genes (P = 0.039), and nodal micrometastases (P < 0.0001) were significant prognostic variables for CSS. The presence of LVI was the only independent and statistically significant prognostic variable for CSS in our cohort of pTNM stage I CRCs. The analysis of KRAS/PIK3CA mutational status may be used to identify patients with stage I CRC at high risk of bad outcome and who may need additional treatments, including biological therapies.
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29
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Fonseca GM, de Mello ES, Coelho FF, Kruger JAP, Faraj SF, Jeismann VB, Pawlik TM, Herman P. Reply to "Poorly differentiated clusters in colorectal liver metastases: Prognostic significance in synchronous and metachronous metastases". J Surg Oncol 2018; 117:1858-1859. [PMID: 29723413 DOI: 10.1002/jso.25079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Gilton M Fonseca
- Digestive Surgery Division, Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Evandro S de Mello
- Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Fabricio F Coelho
- Digestive Surgery Division, Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Jaime A P Kruger
- Digestive Surgery Division, Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Sheila F Faraj
- Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Vagner B Jeismann
- Digestive Surgery Division, Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Timothy M Pawlik
- The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Paulo Herman
- Digestive Surgery Division, Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
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30
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Barresi V, Lionti S, Bonetti LR. Poorly differentiated clusters in colorectal liver metastases: Prognostic significance in synchronous and metachronous metastases. J Surg Oncol 2018; 117:1856-1857. [DOI: 10.1002/jso.25077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 03/13/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Valeria Barresi
- Department of Pathology in Evolutive Age and Adulthood “Gaetano Barresi”; University of Messina; Messina Italy
| | - Simona Lionti
- Department of Pathology in Evolutive Age and Adulthood “Gaetano Barresi”; University of Messina; Messina Italy
| | - Luca Reggiani Bonetti
- Department of Laboratory Integrated Activities; Anatomic Pathology and Legal Medicine; University of Modena and Reggio Emilia; Modena Italy
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31
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Lionti S, Reggiani Bonetti L, Bettelli S, Spallanzani A, Gelsomino F, Barresi V. Histopathological variables in liver metastases of patients with stage IV colorectal cancer: potential prognostic relevance of poorly differentiated clusters. Hum Pathol 2018; 78:115-124. [PMID: 29715463 DOI: 10.1016/j.humpath.2018.04.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/08/2018] [Accepted: 04/12/2018] [Indexed: 02/07/2023]
Abstract
The prognosis of patients with colorectal liver metastases (LMs) is mostly established on clinical variables or on the anatomic extent of colorectal cancer (CRC). Histopathological factors of LMs which may actually reflect the biological aggressiveness of the tumor are not routinely considered to define the risk of worse clinical outcome in those patients. The number of poorly differentiated clusters (PDCs) of neoplastic cells in primary CRC is associated with metastatic risk and bad prognosis, but PDC presence in LMs has been barely analyzed thus far. We assessed PDC presence in the histological slides of surgically resected and synchronous LMs in 63 patients with CRC who had been not submitted to any neoadjuvant treatments. Then, we analyzed its association with patients' cancer-specific survival (CSS) or progression-free survival. The presence of PDCs (P = .016) and PDC localization at tumor edge of LMs (P = .0004) were significantly associated with shorter CSS. PDC presence at the periphery of LMs and positive resection margin were independent prognostic variables for CSS. PDC localization at the tumor edge of LMs was a significant (P = .0079) and independent prognosticator of shorter progression-free survival. Our data suggest that PDC presence and peripheral localization in LMs may be relevant to predict outcome and useful for clinical decision making in patients with colorectal synchronous LMs.
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Affiliation(s)
- Simona Lionti
- Department of Pathology in Evolutive Age and Adulthood "Gaetano Barresi," University of Messina, 98125, Messina, Italy
| | - Luca Reggiani Bonetti
- Department of Laboratory Integrated Activities, Anatomic Pathology and Legal Medicine, University of Modena and Reggio Emilia, 41125, Modena, Italy
| | - Stefania Bettelli
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, 41124, Modena, Italy
| | - Andrea Spallanzani
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, 41124, Modena, Italy
| | - Fabio Gelsomino
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, 41124, Modena, Italy
| | - Valeria Barresi
- Department of Pathology in Evolutive Age and Adulthood "Gaetano Barresi," University of Messina, 98125, Messina, Italy.
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32
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Lee VWK, Chan KF. Tumor budding and poorly-differentiated cluster in prognostication in Stage II colon cancer. Pathol Res Pract 2018; 214:402-407. [DOI: 10.1016/j.prp.2017.12.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/15/2017] [Accepted: 12/31/2017] [Indexed: 12/21/2022]
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33
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Fonseca GM, de Mello ES, Faraj SF, Kruger JAP, Coelho FF, Jeismann VB, Lupinacci RM, Cecconello I, Alves VAF, Pawlik TM, Herman P. Prognostic significance of poorly differentiated clusters and tumor budding in colorectal liver metastases. J Surg Oncol 2018; 117:1364-1375. [DOI: 10.1002/jso.25017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 01/15/2018] [Indexed: 01/07/2023]
Affiliation(s)
- Gilton M. Fonseca
- Digestive Surgery Division, Liver Surgery Unit; Department of Gastroenterology; University of Sao Paulo Medical School; São Paulo Brazil
| | - Evandro S. de Mello
- Department of Pathology; University of Sao Paulo Medical School; São Paulo Brazil
| | - Sheila F. Faraj
- Department of Pathology; University of Sao Paulo Medical School; São Paulo Brazil
| | - Jaime A. P. Kruger
- Digestive Surgery Division, Liver Surgery Unit; Department of Gastroenterology; University of Sao Paulo Medical School; São Paulo Brazil
| | - Fabricio F. Coelho
- Digestive Surgery Division, Liver Surgery Unit; Department of Gastroenterology; University of Sao Paulo Medical School; São Paulo Brazil
| | - Vagner B. Jeismann
- Digestive Surgery Division, Liver Surgery Unit; Department of Gastroenterology; University of Sao Paulo Medical School; São Paulo Brazil
| | - Renato M. Lupinacci
- Service de Chirurgie Digestive; Viscérale et Endocrinienne, Groupe Hospitalier Diaconesses; Croix Saint Simon; São Paulo Brazil
| | - Ivan Cecconello
- Digestive Surgery Division, Liver Surgery Unit; Department of Gastroenterology; University of Sao Paulo Medical School; São Paulo Brazil
| | - Venancio A. F. Alves
- Department of Pathology; University of Sao Paulo Medical School; São Paulo Brazil
| | | | - Paulo Herman
- Digestive Surgery Division, Liver Surgery Unit; Department of Gastroenterology; University of Sao Paulo Medical School; São Paulo Brazil
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Hong M, Kim JW, Shin MK, Kim BC. Poorly Differentiated Clusters in Colorectal Adenocarcinomas Share Biological Similarities with Micropapillary Patterns as well as Tumor Buds. J Korean Med Sci 2017; 32:1595-1602. [PMID: 28875602 PMCID: PMC5592172 DOI: 10.3346/jkms.2017.32.10.1595] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 06/24/2017] [Indexed: 01/06/2023] Open
Abstract
In colorectal carcinoma, poorly differentiated clusters (PDCs) are a poor prognostic indicator and show morphological continuity and behavioral similarities to micropapillary patterns (MPPs) as well as tumor buds (TBs). Epithelial-mesenchymal transition (EMT) and inhibition of cancer-stromal interactions may contribute to the development of PDCs. To clarify the biological nature of PDCs, we examined immunohistochemical stainings for β-catenin, Ki-67, E-cadherin, epithelial cell adhesion molecule (EpCAM), MUC1, and epithelial membrane antigen (EMA), which are associated with EMT and cancer-stromal interactions. The expression frequencies and patterns of PDCs, TBs, and differentiated neoplastic glands from the tumor center (TC) were compared. In the study group (117 cases), the nuclear β-catenin staining index was higher in PDCs (37.3%) and TBs (43.3%) than in neoplastic glands from TC (8.9%, P < 0.001). The mean Ki-67 labeling index in TC was 71.5%, whereas it was decreased in PDCs (31.2%) and TBs (10.2%, P < 0.001). E-cadherin and EpCAM displayed a tendency to be found along the cell membrane in TC samples (91.5% and 92.3%, respectively), whereas they showed loss of membranous staining in PDC (44.4% and 36.8%, respectively) and TB samples (60.7% and 68.4%, respectively). An inside-out pattern for MUC1 and EMA was frequently observed in PDC (48.7% and 45.3%, respectively) and TB samples (46.2% and 45.3%, respectively), but not in TC samples. Our data demonstrate that there is a pathogenetic overlap among PDCs, TBs, and MPPs and suggest that they might represent sequential growth patterns that branch from common biological processes such as dedifferentiation and alteration in cancer-stromal interactions.
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Affiliation(s)
- Mineui Hong
- Department of Pathology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jeong Won Kim
- Department of Pathology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
| | - Mi Kyung Shin
- Department of Pathology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Byung Chun Kim
- Department of Surgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Reggiani Bonetti L, Lionti S, Domati F, Pagliani G, Mattioli E, Barresi V. Histological grading based on poorly differentiated clusters is predictive of tumour response and clinical outcome in rectal carcinoma treated with neoadjuvant chemoradiotherapy. Histopathology 2017; 71:393-405. [DOI: 10.1111/his.13242] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 04/11/2017] [Accepted: 04/16/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Luca Reggiani Bonetti
- Department of Laboratory Integrated Activities, Anatomical Pathology and Legal Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - Simona Lionti
- Department of Pathology in Evolutive Age and Adulthood ‘Gaetano Barresi’; University of Messina; Messina Italy
| | - Federica Domati
- Department of Laboratory Integrated Activities, Anatomical Pathology and Legal Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - Giuliana Pagliani
- Department of Laboratory Integrated Activities, Anatomical Pathology and Legal Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - Elisabetta Mattioli
- Department of Laboratory Integrated Activities, Anatomical Pathology and Legal Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - Valeria Barresi
- Department of Pathology in Evolutive Age and Adulthood ‘Gaetano Barresi’; University of Messina; Messina Italy
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Analysis of KRAS , NRAS , PIK3CA , and BRAF mutational profile in poorly differentiated clusters of KRAS-mutated colon cancer. Hum Pathol 2017; 62:91-98. [DOI: 10.1016/j.humpath.2016.12.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 11/27/2016] [Accepted: 12/04/2016] [Indexed: 02/06/2023]
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Barresi V, Reggiani Bonetti L, Ieni A, Caruso RA, Tuccari G. Poorly Differentiated Clusters: Clinical Impact in Colorectal Cancer. Clin Colorectal Cancer 2017; 16:9-15. [DOI: 10.1016/j.clcc.2016.06.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/06/2016] [Accepted: 06/10/2016] [Indexed: 12/15/2022]
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Zhu L, Pan Z, Ma Q, Yang W, Shi H, Fu C, Yan X, Du L, Yan F, Zhang H. Diffusion Kurtosis Imaging Study of Rectal Adenocarcinoma Associated with Histopathologic Prognostic Factors: Preliminary Findings. Radiology 2016; 284:66-76. [PMID: 27929929 DOI: 10.1148/radiol.2016160094] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose To determine the correlation between diffusion kurtosis imaging (DKI)-derived parameters and prognostic factors for rectal adenocarcinoma. Materials and Methods This study was approved by the local institute review board, and written informed consent was obtained from each patient. Data from 56 patients (median age, 59.5 years; age range, 31-86 years) with rectal adenocarcinoma between April 2014 and September 2015 were involved in this prospective study. DKI (b = 0, 700, 1400, and 2100 sec/mm2) and conventional diffusion-weighted imaging (b = 0, 1000 sec/mm2) were performed. Kurtosis and diffusivity from DKI and apparent diffusion coefficients (ADCs) from diffusion-weighted imaging were measured by two radiologists. Student t test, receiver operating characteristic curves, and Spearman correlation were used for statistical analysis. Results Kurtosis was significantly higher in high-grade than in low-grade rectal adenocarcinomas on the basis of both the number of poorly differentiated clusters (PDCs) (1.136 ± 0.086 vs 0.988 ± 0.060, P < .05) and World Health Organization (WHO) grades (1.103 ± 0.086 [standard deviation] vs 1.034 ± 0.103, P < .05). In PDC grading, the diffusivity and ADC were significantly lower in high-grade tumors than in low-grade tumors (1.187 ± 0.150 vs 1.306 ± 0.129 and 1.020 ± 0.113 vs 1.108 ± 0.097, respectively; P < .05) and showed similar correlations with histologic grades (r = -0.486 and r = -0.406, respectively; P > .05). Compared with both diffusivity and ADC, kurtosis showed significantly higher sensitivity (83.3% [20 of 24] vs 70.8% [17 of 24] and 70.8% [17 of 24], respectively) and specificity (96.8% [31 of 32] vs 84.4% [24 of 32] and 81.3% [26 of 32], respectively). Kurtosis showed a better correlation with PDC grades than with WHO grades (r = 0.797 vs r = 0.293, P < .05). Kurtosis was significantly higher in pN1-2 than in pN0 tumors (1.086 ± 0.103 vs 1.009 ± 0.086, P < .05). Conclusion Kurtosis derived from DKI demonstrated a higher correlation with histologic grades compared with diffusivity and ADC. It also showed better performance in differentiating between high- and low-grade rectal adenocarcinomas and between pN1-2 and pN0 tumors. © RSNA, 2016.
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Affiliation(s)
- Lan Zhu
- From the Departments of Radiology (L.Z., Z.P., W.Y., H.S., L.D., F.Y., H.Z.) and Pathology (Q.M.), Ruijin Hospital affiliated to Shanghai Jiao Tong University of Medicine, No. 197 Ruijin Er Road, Shanghai, China 200025; Siemens Shenzhen Magnetic Resonance, Shenzhen, China (C.F.); and MR Collaboration NE Asia, Siemens Healthcare, Shanghai, China (X.Y.)
| | - Zilai Pan
- From the Departments of Radiology (L.Z., Z.P., W.Y., H.S., L.D., F.Y., H.Z.) and Pathology (Q.M.), Ruijin Hospital affiliated to Shanghai Jiao Tong University of Medicine, No. 197 Ruijin Er Road, Shanghai, China 200025; Siemens Shenzhen Magnetic Resonance, Shenzhen, China (C.F.); and MR Collaboration NE Asia, Siemens Healthcare, Shanghai, China (X.Y.)
| | - Qian Ma
- From the Departments of Radiology (L.Z., Z.P., W.Y., H.S., L.D., F.Y., H.Z.) and Pathology (Q.M.), Ruijin Hospital affiliated to Shanghai Jiao Tong University of Medicine, No. 197 Ruijin Er Road, Shanghai, China 200025; Siemens Shenzhen Magnetic Resonance, Shenzhen, China (C.F.); and MR Collaboration NE Asia, Siemens Healthcare, Shanghai, China (X.Y.)
| | - Wenjie Yang
- From the Departments of Radiology (L.Z., Z.P., W.Y., H.S., L.D., F.Y., H.Z.) and Pathology (Q.M.), Ruijin Hospital affiliated to Shanghai Jiao Tong University of Medicine, No. 197 Ruijin Er Road, Shanghai, China 200025; Siemens Shenzhen Magnetic Resonance, Shenzhen, China (C.F.); and MR Collaboration NE Asia, Siemens Healthcare, Shanghai, China (X.Y.)
| | - Hongyuan Shi
- From the Departments of Radiology (L.Z., Z.P., W.Y., H.S., L.D., F.Y., H.Z.) and Pathology (Q.M.), Ruijin Hospital affiliated to Shanghai Jiao Tong University of Medicine, No. 197 Ruijin Er Road, Shanghai, China 200025; Siemens Shenzhen Magnetic Resonance, Shenzhen, China (C.F.); and MR Collaboration NE Asia, Siemens Healthcare, Shanghai, China (X.Y.)
| | - Caixia Fu
- From the Departments of Radiology (L.Z., Z.P., W.Y., H.S., L.D., F.Y., H.Z.) and Pathology (Q.M.), Ruijin Hospital affiliated to Shanghai Jiao Tong University of Medicine, No. 197 Ruijin Er Road, Shanghai, China 200025; Siemens Shenzhen Magnetic Resonance, Shenzhen, China (C.F.); and MR Collaboration NE Asia, Siemens Healthcare, Shanghai, China (X.Y.)
| | - Xu Yan
- From the Departments of Radiology (L.Z., Z.P., W.Y., H.S., L.D., F.Y., H.Z.) and Pathology (Q.M.), Ruijin Hospital affiliated to Shanghai Jiao Tong University of Medicine, No. 197 Ruijin Er Road, Shanghai, China 200025; Siemens Shenzhen Magnetic Resonance, Shenzhen, China (C.F.); and MR Collaboration NE Asia, Siemens Healthcare, Shanghai, China (X.Y.)
| | - Lianjun Du
- From the Departments of Radiology (L.Z., Z.P., W.Y., H.S., L.D., F.Y., H.Z.) and Pathology (Q.M.), Ruijin Hospital affiliated to Shanghai Jiao Tong University of Medicine, No. 197 Ruijin Er Road, Shanghai, China 200025; Siemens Shenzhen Magnetic Resonance, Shenzhen, China (C.F.); and MR Collaboration NE Asia, Siemens Healthcare, Shanghai, China (X.Y.)
| | - Fuhua Yan
- From the Departments of Radiology (L.Z., Z.P., W.Y., H.S., L.D., F.Y., H.Z.) and Pathology (Q.M.), Ruijin Hospital affiliated to Shanghai Jiao Tong University of Medicine, No. 197 Ruijin Er Road, Shanghai, China 200025; Siemens Shenzhen Magnetic Resonance, Shenzhen, China (C.F.); and MR Collaboration NE Asia, Siemens Healthcare, Shanghai, China (X.Y.)
| | - Huan Zhang
- From the Departments of Radiology (L.Z., Z.P., W.Y., H.S., L.D., F.Y., H.Z.) and Pathology (Q.M.), Ruijin Hospital affiliated to Shanghai Jiao Tong University of Medicine, No. 197 Ruijin Er Road, Shanghai, China 200025; Siemens Shenzhen Magnetic Resonance, Shenzhen, China (C.F.); and MR Collaboration NE Asia, Siemens Healthcare, Shanghai, China (X.Y.)
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Interlaboratory Variability in the Histologic Grading of Colorectal Adenocarcinomas in a Nationwide Cohort. Am J Surg Pathol 2016; 40:1100-8. [DOI: 10.1097/pas.0000000000000636] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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40
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KRAS, NRAS, BRAF mutations and high counts of poorly differentiated clusters of neoplastic cells in colorectal cancer: observational analysis of 175 cases. Pathology 2016; 47:551-6. [PMID: 26352110 DOI: 10.1097/pat.0000000000000300] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A novel grading system based on the counting of poorly differentiated clusters (PDC) of neoplastic cells at the invasive margin and in the tumour stroma was recently introduced among the histological parameters predictive of adverse clinical outcome in colorectal cancer (CRC). The aim of this study was to correlate the histological grade based on PDC and the mutational status of KRAS, NRAS and BRAF genes in 175 consecutive CRCs. The highest PDC count under the objective lens of a ×20 microscopic field in each tumour was considered for grading assessment, so that PDC counts <5, 5-9 and ≥10 PDCs were defined grade 1, grade 2 and grade 3, respectively. Hotspots mutations were identified using the MassArray platform. Overall, there were 42 (24%) mutated tumours. Mutational status was significantly associated with high pT stage (p = 0.0021), advanced pTNM stage (p = 0.0018), nodal metastases (p = 0.006), tumour budding (p = 0.022) and high PDC grade (p = 0.0022). KRAS mutations were significantly associated with PDC grade (p = 0.0379), while BRAF mutations were associated with PDC-G3 although statistical significance was not reached. No significant associations were found between NRAS and PDC. The significant association between mutated KRAS and PDC grade suggests that KRAS mutations may be involved in the formation of PDC.
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Prognostic relevance of histopathological features in signet ring cell carcinoma of the colorectum. Virchows Arch 2016; 469:267-75. [DOI: 10.1007/s00428-016-1983-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 05/24/2016] [Accepted: 06/29/2016] [Indexed: 01/05/2023]
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Yang M, Rehman AU, Zuo C, Sheehan CE, Lee EC, Lin J, Zhao Z, Choi E, Lee H. A novel histologic grading scheme based on poorly differentiated clusters is applicable to treated rectal cancer and is associated with established histopathological prognosticators. Cancer Med 2016; 5:1510-8. [PMID: 27165693 PMCID: PMC4867664 DOI: 10.1002/cam4.740] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/20/2016] [Accepted: 03/29/2016] [Indexed: 12/14/2022] Open
Abstract
The conventional histologic grading of colorectal cancer (CRC) is less suited for resected rectal cancer following neoadjuvant chemoradiation. Enumeration of poorly differentiated clusters (PDC) is a recently proposed histologic grading scheme. We aimed to apply PDC grading to treated rectal cancer and to test the prognostic significance of this novel approach. Archived hematoxylin and eosin slides of 72 rectal adenocarcinomas resected following neoadjuvant treatment were retrieved. PDC, tumor budding, and tumor regression were assessed. The parameters were correlated with clinicopathological features and survival. PDC was strongly associated with tumor budding, perineural invasion (PNI), metastasis, and low degree of tumor regression. Tumor budding was significantly associated with lymphovascular invasion and PNI, and metastasis. Tumors with a lower degree of regression were more likely to show high pathologic T stage and advanced clinical stage. Local recurrence was associated with poor survival. PDC did not correlate with overall survival. PDC grading is applicable to resected rectal cancer status post neoadjuvant treatment and correlates with established histopathological prognosticators. PDC and tumor budding may represent a histologic spectrum reflective of the same biological significance. Validation and incorporation of these simple histologic grading schemes may strengthen the prognostic power of the histologic parameters that influence the oncologic outcome in treated rectal cancer. Further study to evaluate the significance of PDC as an oncologic prognosticator is warranted.
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Affiliation(s)
- Michelle Yang
- Department of Pathology, University of Vermont, Burlington, Vermont
| | - Aseeb Ur Rehman
- Anatomic Pathology, Albany Medical College, Albany, New York
| | - Chunlai Zuo
- Anatomic Pathology, Albany Medical College, Albany, New York
| | | | - Edward C Lee
- Department of Surgery, Albany Medical Center, Albany, New York
| | - Jingmei Lin
- Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana
| | - Zijin Zhao
- Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana
| | - Euna Choi
- Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana
| | - Hwajeong Lee
- Anatomic Pathology, Albany Medical College, Albany, New York
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Reggiani Bonetti L, Barresi V, Bettelli S, Domati F, Palmiere C. Poorly differentiated clusters (PDC) in colorectal cancer: what is and ought to be known. Diagn Pathol 2016; 11:31. [PMID: 27004798 PMCID: PMC4802878 DOI: 10.1186/s13000-016-0481-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 03/10/2016] [Indexed: 01/22/2023] Open
Abstract
Background The counting of poorly differentiated clusters of 5 or more cancer cells lacking a gland-like structure in a tumor mass has recently been identified among the histological features predictive of poor prognosis in colorectal cancer. Main body Poorly differentiated clusters can easily be recognized in the histological sections of colorectal cancer routinely stained with haematoxylin and eosin. Despite some limitations related to specimen fragmentation, counting can also be assessed in endoscopic biopsies. Based on the number of poorly differentiated clusters that appear under a microscopic field of a ×20 objective lens (i.e., a microscopic field with a major axis of 1 mm), colorectal cancer can be graded into malignancies as follows: tumors with <5 clusters as grade 1, tumors with 5 to 9 clusters as grade 2, and tumors with ≥10 clusters as grade 3. High poorly differentiated cluster counts are significantly associated with peri-neural and lympho-vascular invasion, the presence of nodal metastases or micrometastases, as well as shorter overall and progression free survival to colorectal cancer. Conclusion The morphological aspects and clinical relevance of poorly differentiated clusters counting in colorectal cancer are discussed in this review.
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Affiliation(s)
- Luca Reggiani Bonetti
- Department of Diagnostic Medicine and Public Health, University of Modena and Reggio Emilia - Section of Pathology, Via del Pozzo, 41124, Modena, Italy
| | - Valeria Barresi
- Department of Pathology, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Stefania Bettelli
- Department of Diagnostic Medicine and Public Health, University of Modena and Reggio Emilia - Section of Pathology, Via del Pozzo, 41124, Modena, Italy
| | - Federica Domati
- Department of Diagnostic Medicine and Public Health, University of Modena and Reggio Emilia - Section of Internal Medicine, Via del Pozzo, 41124, Modena, Italy
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Barresi V, Reggiani Bonetti L, Ieni A, Branca G, Tuccari G. Histologic prognostic markers in stage IIA colorectal cancer: a comparative study. Scand J Gastroenterol 2016; 51:314-20. [PMID: 26554618 DOI: 10.3109/00365521.2015.1084646] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE pTNM stage IIA colorectal cancer (CRC) is not currently submitted to any adjuvant treatment due to its good prognosis. Nevertheless, a percentage of cases unexpectedly recur. The aim of this study was to assess and compare the prognostic value and inter-observer agreement of a novel histological grading system based on the counting of poorly differentiated clusters (PDC) of cancer cells and that of conventional histological grade, lymphatic, venous and perineural invasion (LVI, VI, PNI), tumour budding (TB) and tumor border configuration in stage IIA CRC. MATERIALS AND METHODS the afore mentioned histological parameters were assessed in 82 stage IIA CRCs. Inter-observer agreement and correlation with tumour relapse were analyzed by using Fleiss-Cohen's weighted K statistics, Fisher exact test and Chi-squared test. The Mantel-Cox log-rank test was applied to assess the strength of association with disease-free interval (DFI). RESULTS inter-observer agreement was very good/good in the assessment of PDC presence and grade, while it was moderate at best in the evaluation of the other parameters. The presence of PDC, high PDC grade, LVI and TB were significantly associated with disease progression (p < 0.0001; p = 0.0012; p = 0.0308; p = 0.0002) and shorter DFI (p = 0.0001; p < 0.0001; p = 0.0129; p = 0.0008). PDC presence (p < 0.0001) and TB (p = 0.012) were independent prognostic factors in multivariate analysis. CONCLUSIONS our findings suggest that the assessment of PDC may be useful to stratify patients with stage IIA CRC for recurrence risk, and to identify high risk patients who could benefit from adjuvant chemotherapy.
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Affiliation(s)
- Valeria Barresi
- a Department of Human Pathology "G. Barresi" , Unit of Anatomic Pathology, University of Messina , Italy and
| | - Luca Reggiani Bonetti
- b Department of Laboratory Integrated Activities , Anatomic Pathology and Legal Medicine, University of Modena and Reggio Emilia , Modena , Italy
| | - Antonio Ieni
- a Department of Human Pathology "G. Barresi" , Unit of Anatomic Pathology, University of Messina , Italy and
| | - Giovanni Branca
- a Department of Human Pathology "G. Barresi" , Unit of Anatomic Pathology, University of Messina , Italy and
| | - Giovanni Tuccari
- a Department of Human Pathology "G. Barresi" , Unit of Anatomic Pathology, University of Messina , Italy and
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Estudio de factores histológicos predictivos de metástasis ganglionar locorregional en adenocarcinoma colorrectal mínimamente invasivo pT1. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 39:1-8. [DOI: 10.1016/j.gastrohep.2015.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/02/2015] [Accepted: 04/08/2015] [Indexed: 01/31/2023]
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Kleist B, Poetsch M. Neuroendocrine differentiation: The mysterious fellow of colorectal cancer. World J Gastroenterol 2015; 21:11740-11747. [PMID: 26556999 PMCID: PMC4631973 DOI: 10.3748/wjg.v21.i41.11740] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/07/2015] [Accepted: 09/15/2015] [Indexed: 02/06/2023] Open
Abstract
Neuroendocrine differentiation in sporadic colorectal cancer has been recognized since decades, but its clinical impact is still controversially discussed. Detailed parameter analyses hint at the possibility that probably not neuroendocrine differentiation itself, but its association with poor grade of tumor differentiation, lymph node metastases, distant metastases and other unfavorable features contribute to worse clinical outcome. However, other studies deny a relationship between neuroendocrine differentiation and prognosis of colorectal cancer. This review elucidates, whether new insights into the origin of neuroendocrine differentiation in the intestinal epithelium, its regulation by mTOR pathway components and its possible link to the intestinal stem cell compartment could determine a role of neuroendocrine cells as prognostic marker and putative therapeutic target in sporadic colorectal cancer.
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Barresi V, Reggiani Bonetti L, Ieni A, Domati F, Tuccari G. Prognostic significance of grading based on the counting of poorly differentiated clusters in colorectal mucinous adenocarcinoma. Hum Pathol 2015; 46:1722-9. [PMID: 26344416 DOI: 10.1016/j.humpath.2015.07.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 06/26/2015] [Accepted: 07/06/2015] [Indexed: 01/11/2023]
Abstract
Mucinous adenocarcinoma (MAC) of the colon and rectum is a histological entity with still indefinite prognostic significance. Although it was previously designated as poorly differentiated by convention, the most recent World Health Organization guidelines indicate that the level of maturation of the epithelium determines differentiation in MAC and that microsatellite instability status should be taken into account for its histological grading. Nonetheless, precise criteria for grading are not provided, and the prognostic value of histological grading in MAC still remains unclear. In the present study we aimed to investigate the prognostic value of a grading system based on the counting of poorly differentiated clusters (PDC) of neoplastic cells in 108 colorectal MACs and to compare its reproducibility and significance with those of a grading system based on glandular differentiation. We found that PDC grade was more reproducible and significantly associated with disease progression (P = .0089) as well as with death from colorectal cancer (P = .0035) in our MACs, as compared to the grade based on glandular differentiation, which was not associated with any of the clinicopathologic variables. Moreover, PDC grade emerged as a significant, independent prognostic factor of recurrence-free survival (P = .0198) and cancer-specific survival (P = .0293) in MAC. Interestingly, the prognostic value of PDC grade was unaltered following incorporation of mismatch repair system status in grading. In conclusion, we demonstrated for the first time that PDC grading is feasible, reproducible, and prognostically relevant in MAC, which may support its use in routine practice.
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Affiliation(s)
- Valeria Barresi
- Department of Human Pathology, University of Messina, Messina 98125, Italy.
| | - Luca Reggiani Bonetti
- Department of Laboratory Integrated Activities, Anatomic Pathology and Legal Medicine, University of Modena and Reggio Emilia, Modena 41124, Italy
| | - Antonio Ieni
- Department of Human Pathology, University of Messina, Messina 98125, Italy
| | - Federica Domati
- Department of Internal Medicine, University of Modena and Reggio Emilia, Modena 41124, Italy
| | - Giovanni Tuccari
- Department of Human Pathology, University of Messina, Messina 98125, Italy
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Barresi V, Bonetti LR. Correlation between microsatellite instability status and grading assessed by the counting of poorly differentiated clusters in colorectal cancer. Hum Pathol 2015; 46:1063. [DOI: 10.1016/j.humpath.2015.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/05/2015] [Indexed: 11/17/2022]
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Ueno H, Konishi T, Ishikawa Y, Shimazaki H, Ueno M, Aosasa S, Saiura A, Hase K, Yamamoto J. Prognostic value of poorly differentiated clusters in the primary tumor in patients undergoing hepatectomy for colorectal liver metastasis. Surgery 2015; 157:899-908. [PMID: 25731780 DOI: 10.1016/j.surg.2014.12.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 08/07/2014] [Accepted: 12/09/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND This study aimed to determine the prognostic value of a novel grading system based on the histologic assessment of poorly differentiated clusters (PDCs) in the primary lesions in patients with hepatectomy for colorectal liver metastasis (CRLM). Preoperative survival predictors for CRLM are required to determine candidates for perioperative chemotherapy who would otherwise have a poor prognosis. METHODS In total, 411 consecutive patients undergoing curative resection of primary colorectal cancers and metastatic liver lesions at 2 institutions were enrolled. Cancer clusters comprising ≥ 5 cancer cells, lacking a gland-like structure, were defined as PDCs and quantifiably graded. RESULTS According to PDCs, 65, 127, and 219 patients were classified as being grades (G)1, G2, and G3, respectively. PDCs were associated with T and N stages and tumor budding in primary tumor, extrahepatic disease, and serum CEA levels (P ≤ .0001-.045), but not with the number and size of liver metastasis. PDC grade significantly influenced recurrence rate in extrahepatic sites, including the lung and peritoneum (P < .0001). The 2-year disease-free survival after hepatectomy was 64.6%, 38.8%, and 22.4% in G1, G2, and G3, respectively. Based on multivariate analysis, PDC grade was selected as an independent prognostic factor together with other conventional factors such as extrahepatic disease and the number of liver metastasis. CONCLUSION PDC grade in primary lesions is a novel potent prognostic indicator in CRLM independent of the anatomic extent of disease. Notably, PDC grade can bias survival rates in clinical studies targeting perioperative chemotherapy in CRLM.
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Affiliation(s)
- Hideki Ueno
- Department of Surgery, National Defense Medical College, Saitama, Japan.
| | - Tsuyoshi Konishi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - Yuichi Ishikawa
- Division of Pathology, Cancer Institute Hospital, Tokyo, Japan
| | - Hideyuki Shimazaki
- Department of Laboratory Medicine, National Defense Medical College, Saitama, Japan
| | - Masashi Ueno
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - Suefumi Aosasa
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Akio Saiura
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - Kazuo Hase
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Junji Yamamoto
- Department of Surgery, National Defense Medical College, Saitama, Japan
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Kim JW, Shin MK, Kim BC. Clinicopathologic impacts of poorly differentiated cluster-based grading system in colorectal carcinoma. J Korean Med Sci 2015; 30:16-23. [PMID: 25552879 PMCID: PMC4278023 DOI: 10.3346/jkms.2015.30.1.16] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 10/20/2014] [Indexed: 12/16/2022] Open
Abstract
Differentiation-based histologic grading of colorectal carcinoma (CRC) is widely used, but its clinical impact is limited by insufficient prognostic value, interobserver disagreement, and the difficulty of its application to CRC with specific histologic types such as mucinous and medullary carcinoma. A recently proposed novel grading system based on quantifying poorly differentiated clusters (PDCs) claims to have the advantages of reproducibility and improved prognostic value, and might apply to heterogeneous CRC. We aimed to validate the clinicopathologic significance of the PDCs-based grading system and to determine the relationship between this grading system and microsatellite instability (MSI). Two hundred and one patients who had undergone radical surgery were reviewed. Based on the number of PDCs, 85, 58, and 58 tumors were classified as grade (G) 1 (42.3%), G2 (28.9%), and G3 (28.9%), respectively. PDCs-based grade was significantly associated with T, N, and M stages; lymphovascular invasion; conventional histologic grade; and frequent tumor budding (all P <0.001). In multivariate analysis, PDCs-based grade was found to be an independent prognostic factor for disease-free survival (P = 0.022; hazard ratio, 3.709 [G2], 7.461 [G3]). G3 CRC significantly correlated with high MSI (MSI-H) compared to G1 and G2 (P = 0.002; odds ratio, 5.750). In conclusion, this novel grading would provide valuable prognostic information to a greater number of patients and would require continued verification. PDCs-based grading is feasible for CRCs with heterogeneous morphology, and we propose that the association between G3 and MSI-H be further evaluated in different histological subtypes of CRC.
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Affiliation(s)
- Jeong Won Kim
- Department of Pathology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Mi Kyung Shin
- Department of Pathology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Byung Chun Kim
- Department of Surgery, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul, Korea
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