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Santoro A, Inzani F, Angelico G, Arciuolo D, Bragantini E, Travaglino A, Valente M, D’Alessandris N, Scaglione G, Sfregola S, Piermattei A, Cianfrini F, Roberti P, Zannoni GF. Recent Advances in Cervical Cancer Management: A Review on Novel Prognostic Factors in Primary and Recurrent Tumors. Cancers (Basel) 2023; 15:cancers15041137. [PMID: 36831480 PMCID: PMC9954634 DOI: 10.3390/cancers15041137] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Several pathological parameters, including tumor size, depth of stromal invasion, lympho-vascular space invasion and lymph node status, have been proposed as prognostic predictors in cervical cancer. However, given the high mortality and recurrence rate of cervical cancer, novel parameters that are able to provide additional prognostic information are needed in order to allow a better prognostic stratification of cervical cancer patients. METHODS A search was conducted on PubMed to identify relevant literature data regarding prognostic factors in cervical cancer. The key words "cervical cancer", "prognostic factors", "pathology", and "outcome" were used. RESULTS The novel pathological grading system based on tumor budding and cell nest size appeared the most relevant prognostic factor in primary neoplasms. Moreover, other potentially useful prognostic factors were tumor size, depth of stromal invasion, lympho-vascular space invasion, perineural invasion, tumor-free distance and tumor-infiltrating lymphocytes. Prognostic factors related to advanced-stage cervical cancer, including lymph-nodes status, endometrial and cervical involvement as well as distant metastases, were also taken into consideration. CONCLUSIONS According to our findings, tumor budding and cell nest size grading system, depth of stromal invasion, lympho-vascular space invasion, perineural invasion, tumor-free distance and tumor-infiltrating lymphocytes appeared the most relevant factors included in the pathology report.
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Affiliation(s)
- Angela Santoro
- Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Frediano Inzani
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS San Matteo Hospital, 27100 Pavia, Italy
| | - Giuseppe Angelico
- Pathology Unit, Cannizzaro Hospital, 95126 Catania, Italy
- Correspondence: (G.A.); (G.F.Z.)
| | - Damiano Arciuolo
- Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Emma Bragantini
- Department of Surgical Pathology, Ospedale S. Chiara, 38122 Trento, Italy
| | - Antonio Travaglino
- Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Michele Valente
- Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Nicoletta D’Alessandris
- Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giulia Scaglione
- Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Stefania Sfregola
- Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Alessia Piermattei
- Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Federica Cianfrini
- Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Paola Roberti
- Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Gian Franco Zannoni
- Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Pathology Institute, Catholic University of Sacred Heart, 00168 Rome, Italy
- Correspondence: (G.A.); (G.F.Z.)
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Li Y, Jia M, Cao L, Yu J, Gao H, Sun PL. Silva cumulative score and its relationship with prognosis in Endocervical adenocarcinoma. BMC Cancer 2022; 22:1172. [PMID: 36376880 PMCID: PMC9661810 DOI: 10.1186/s12885-022-10270-7] [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: 06/28/2022] [Accepted: 11/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background The Silva system has been demonstrated to have a good predictive value of lymph node metastasis (LNM) in endocervical adenocarcinoma (EAC). Tumours were classified based on the highest identified pattern of invasion in this system, this may not exactly reflect the true situation when it presents with a “mixed pattern” in some cases. Recent study has shown that patients with lymphovascular invasion (LVI) have worse prognosis in EAC. Here we design a Silva cumulative score (SCS) system which also combined the LVI status to explore its prognostic role in EAC patients. Methods A total of 120 patients with EAC were included in this study. Clinicopathological characteristics were retrospectively retrieved from the medical records and follow-up data were obtained. The clinicopathological information included age at diagnosis, depth of invasion (DOI), LNM, LVI, Silva classification, and SCS. SCS is a classification system based on the sum score of different Silva pattern which is founded on morphological phenomena. The relationships between the pathological characteristics and prognoses were analyzed. Results According to the Silva system, 11 (9.2%), 22 (18.3%) and 87 (72.5%) patients had patterns A, B, and C, respectively. Patients with pattern C had the highest incidence of LVI and LNM (p < 0.05). Although the Kaplan-Meier curves demonstrated that survival decreased with increasing Silva classification for A-C cancers, there was no statistically significant difference [disease-free survival (DFS): p = 0.181; overall survival (OS): p = 0.205]. There were 45 cases presented as mixed-type of Silva patterns. According to the SCS, 23 cases (19.2%) were rated as grade I, 31 cases (25.8%) as grade II and 66 (55.0%) cases as grade III. Patients with SCS grade III had the highest incidence of LVI and LNM (p < 0.05). Kaplan–Meier analysis revealed that patients with higher SCS had significantly shorter DFS and OS than those with lower SCS (p < 0.05). High SCS was an independent predictor of poorer OS and DFS (p < 0.05) in patients with EAC. Conclusions The application of the Silva system could effectively predict the LNM of patients and may be helpful in selecting an appropriate surgical procedure. The SCS system we designed showed a good predictive value for DFS and OS in EAC.
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Jesinghaus M, Boxberg M, Schmitt M, Kriegsmann M, Harms A, Lang C, Muley T, Winter H, Kriegsmann K, Warth A, Stenzinger A, Denkert C, Hoffmann H, Safi S, Weichert W. Cellular dissociation grading on biopsies of pulmonary squamous cell carcinoma provides prognostic information across all stages and is congruent with resection specimen grading. J Pathol Clin Res 2022; 8:567-578. [PMID: 36111649 PMCID: PMC9535098 DOI: 10.1002/cjp2.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/08/2022] [Accepted: 08/31/2022] [Indexed: 12/29/2022]
Abstract
Grading of squamous cell carcinomas (SCCs) based on tumour budding and cell nest size has been termed cellular dissociation grading (CDG) and was suggested as a robust outcome predictor when assessed in biopsies and resections of various extrapulmonary SCCs. In pulmonary SCC (pSCC), this has so far been shown only for resected cancers. As most lung cancers are inoperable, it is of utmost importance to clarify whether the prognostic impact of CDG is retained in the biopsy setting. Two independent pSCC biopsy cohorts from Munich (n = 134, non-resected) and Heidelberg (n = 135, resected) were assessed. Tumour budding and cell nest size measures were assembled into the three-tiered CDG system (G1-G3). Data were correlated with clinicopathological parameters and overall- (OS), disease-specific- (DSS), and disease-free survival (DFS). Interobserver variability and concordance between biopsy and resection specimen were also investigated. CDG was highly congruent between biopsy and resection specimens (κ = 0.77, p < 0.001). In both pSCC cohorts, biopsy-derived CDG strongly impacted on OS, DSS, and DFS (e.g. DFS: p < 0.001). In multivariate survival analyses, CDG remained a stage independent predictor of survival in both cohorts (DFS: p < 0.001 respectively; hazard ratio Munich cohort: CDG-G2: 4.31, CDG-G3; 5.14; Heidelberg cohort: CDG-G2: 5.87, CDG-G3: 9.07). Interobserver agreement for CDG was almost perfect (κ = 0.84, p < 0.001). We conclude that assessment of CDG based on tumour budding and cell nest size is feasible on pSCC biopsies and harbours stage independent prognostic information in resectable as well as non-resectable pSCC. Integration of this grading approach into clinicopathological routine should be considered.
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Affiliation(s)
- Moritz Jesinghaus
- Institute of Pathology, University Hospital MarburgMarburgGermany,Institute of Pathology, Technical University MunichMunichGermany
| | - Melanie Boxberg
- Institute of Pathology, Technical University MunichMunichGermany,Institute of Pathology Munich NorthMunichGermany
| | - Maxime Schmitt
- Institute of Pathology, University Hospital MarburgMarburgGermany,Institute of Pathology, Technical University MunichMunichGermany
| | - Mark Kriegsmann
- Institute of Pathology, University Hospital HeidelbergHeidelbergGermany,Member of the German Center for Lung Research (DZL)HeidelbergGermany
| | - Alexander Harms
- Institute of Pathology, University Hospital HeidelbergHeidelbergGermany
| | - Corinna Lang
- Institute of Pathology, Technical University MunichMunichGermany
| | - Thomas Muley
- Member of the German Center for Lung Research (DZL)HeidelbergGermany,Translational Lung Research Center Heidelberg (TLRC‐H)HeidelbergGermany,Translational Research UnitThoraxklinik at Heidelberg University HospitalHeidelbergGermany
| | - Hauke Winter
- Member of the German Center for Lung Research (DZL)HeidelbergGermany,Translational Lung Research Center Heidelberg (TLRC‐H)HeidelbergGermany,Department of Thoracic SurgeryThoraxklinik at Heidelberg University HospitalHeidelbergGermany
| | - Katharina Kriegsmann
- Department of Hematology, Oncology and RheumatologyUniversity Hospital HeidelbergHeidelbergGermany
| | | | - Albrecht Stenzinger
- Institute of Pathology, University Hospital HeidelbergHeidelbergGermany,Member of the German Center for Lung Research (DZL)HeidelbergGermany
| | - Carsten Denkert
- Institute of Pathology, University Hospital MarburgMarburgGermany
| | - Hans Hoffmann
- Department of Thoracic SurgeryKlinikum Rechts der Isar (MRI)MunichGermany
| | - Seyer Safi
- Department of Thoracic SurgeryKlinikum Rechts der Isar (MRI)MunichGermany
| | - Wilko Weichert
- Institute of Pathology, Technical University MunichMunichGermany,German Cancer Consortium (DKTK), Partner Site MunichHeidelbergGermany,Comprehensive Cancer Center Munich (CCCM)MunichGermany
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Jesinghaus M, Herz AL, Kohlruss M, Silva M, Grass A, Lange S, Novotny A, Ott K, Schmidt T, Gaida M, Hapfelmeier A, Denkert C, Weichert W, Keller G. Post-neoadjuvant assessment of tumour budding according to ITBCC subgroups delivers stage- and regression-grade independent prognostic information in intestinal-type gastric adenocarcinoma. JOURNAL OF PATHOLOGY CLINICAL RESEARCH 2022; 8:448-457. [PMID: 35715937 PMCID: PMC9353660 DOI: 10.1002/cjp2.284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/20/2022] [Accepted: 06/02/2022] [Indexed: 11/09/2022]
Abstract
Tumour budding (TB) has been associated with adverse clinicopathological factors and poor survival in a plethora of therapy‐naïve carcinoma entities including gastric adenocarcinoma (GC). As conventional histopathological grading is usually omitted in the post‐neoadjuvant setting of GC, our study aimed to investigate the prognostic impact of TB in GCs resected after neoadjuvant therapy. We evaluated TB according to the criteria from the International Tumour Budding Consensus Conference (ITBCC) in 167 post‐neoadjuvant resections of intestinal‐type GC and correlated the results with overall survival (OS) and clinicopathological parameters. GCs were categorised into Bd1 (0–4 buds, low TB), Bd2 (5–9 buds, intermediate TB), and Bd3 (≥10 buds, high TB). Carcinomas with intermediate and high TB were significantly enriched in higher ypTNM stages and strongly associated with reduced 5‐year OS in univariable analyses (p < 0.001). In multivariable analyses including sex, age, resection status, UICC stage, and tumour regression grading, TB remained a stage‐independent predictor of survival (p < 0.001, hazard ratio Bd2: 2.60, Bd3: 4.74). The assessment of TB according to the ITBCC criteria provides valuable prognostic information in the post‐neoadjuvant setting of intestinal‐type GC and may be a considerable substitute for the conventional grading system in GCs after neoadjuvant therapy.
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Affiliation(s)
- Moritz Jesinghaus
- Institute of Pathology, University Hospital Marburg, Marburg, Germany.,Institute of Pathology, Technical University Munich, Munich, Germany
| | - Anna-Lina Herz
- Institute of Pathology, Technical University Munich, Munich, Germany
| | - Meike Kohlruss
- Institute of Pathology, Technical University Munich, Munich, Germany
| | - Miguel Silva
- Institute of Pathology, Technical University Munich, Munich, Germany
| | - Albert Grass
- Institute of Pathology, University Hospital Marburg, Marburg, Germany
| | - Sebastian Lange
- II Medizinische Klinik, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Alexander Novotny
- Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Katja Ott
- Department of Surgery, Klinikum Rosenheim, Rosenheim, Germany
| | - Thomas Schmidt
- Department of Surgery, University of Heidelberg, Heidelberg, Germany.,Department of Surgery, University Hospital Köln, Köln, Germany
| | - Matthias Gaida
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexander Hapfelmeier
- Institute of General Practice and Health Services Research, Technical University Munich, Munich, Germany.,Institute for AI and Informatics in Medicine, School of Medicine, Technical University Munich, Munich, Germany
| | - Carsten Denkert
- Institute of Pathology, University Hospital Marburg, Marburg, Germany
| | - Wilko Weichert
- Institute of Pathology, Technical University Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.,Comprehensive Cancer Center Munich (CCCM), Munich, Germany
| | - Gisela Keller
- Institute of Pathology, Technical University Munich, Munich, Germany
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Li J, Li X, Yang J. A Novel Prognostic Stratified System Based on Tumor Budding and the Cell Nest Size in Ureter Urothelial Carcinoma. Appl Bionics Biomech 2022; 2022:6988237. [PMID: 35572056 PMCID: PMC9106466 DOI: 10.1155/2022/6988237] [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: 02/21/2022] [Revised: 04/07/2022] [Accepted: 04/12/2022] [Indexed: 11/18/2022] Open
Abstract
At present, malignant tumor stratification based on the TNM stage is very important for predicting patient prognosis and selecting appropriate treatment. The prognostic factor of ureter urothelial carcinoma is mainly based on the stage according to AJCC (8th) TNM classification. None of the histomorphologic features is recommended to assess patient's prognosis. Recently, a novel three-tiered grading system based on tumor budding and the cell nest size (referred as TBNS system) has been applied to be highly prognostic for some squamous cell carcinomas, including esophageal, pulmonary, uterine cervix cancer, and endocervical endocarcinoma. In this study, we explored the application of this TBNS grading system in ureter urothelial carcinoma consisting 87 surgically resected cases and no neoadjuvant therapy. Tumor budding and the cell nest size were assessed and correlated with clinicopathological data and survival. The results showed that higher tumor budding, cell nest size, and TBNS grading system were strongly related to shorter overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS). Multivariate survival analysis showed the TBNS grading system to be closely related to the independent prognosis of DFS and DSS. In conclusion, the TBNS grading system based on tumor budding and cell nest size, if further validated, could satisfactorily predict the prognosis of uterine urothelial carcinoma and be applicable in routine pathologic description of this cancer type.
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Affiliation(s)
- Jialin Li
- Department of Pathology, Jinzhou Medical University, Jinzhou, Liaoning, 40 Songpo Road, Linghe District, Jinzhou, Liaoning, China
| | - Xinyue Li
- Department of Pathology, Jinzhou Medical University, Jinzhou, Liaoning, 40 Songpo Road, Linghe District, Jinzhou, Liaoning, China
| | - Jing Yang
- Department of Pathology, Jinzhou Medical University, Jinzhou, Liaoning, 40 Songpo Road, Linghe District, Jinzhou, Liaoning, China
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Beer A, Reber A, Paireder M, Schoppmann SF, Heber S, Schiefer AI. Tumor cell budding in preoperative biopsies of esophageal and gastroesophageal junction carcinoma independently predicts survival in a grade-dependent manner. Surgery 2022; 172:567-574. [DOI: 10.1016/j.surg.2022.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/01/2022] [Accepted: 02/28/2022] [Indexed: 11/16/2022]
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Independent validation of distinct clinicopathological features and prognosis among usual-type, mucinous-type and gastric-type endocervical adenocarcinoma categorised by new WHO classification (2020). Pathology 2022; 54:555-562. [PMID: 35346505 DOI: 10.1016/j.pathol.2021.12.301] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/20/2021] [Accepted: 12/31/2021] [Indexed: 11/22/2022]
Abstract
The new World Health Organization (WHO) classification of tumours of the female genital tract (2020) divides endocervical adenocarcinoma (EAC) into human papilloma virus (HPV)-related adenocarcinoma (HPVA) and HPV-independent adenocarcinoma (HPVI) to underscore the morphological and pathogenetic correlation. It may be potentially prognostic. In this study, we appraised the new WHO classification in an independent, single institution-based EAC cohort from China to assess the clinicopathological features and prognostic value among tumour types. Our study cohort contained 402 consecutive, surgically excised EACs consisting of 298 (74.1%) HPVA, 88 (21.9%) HPVI and 16 (4%) adenocarcinomas not otherwise specified (NOS). Usual-type (55.7%) and gastric-type adenocarcinoma (GAC) (18.2%) was the most common type in HPVA and HPVI, respectively. Block p16 staining (94.7% vs 24.4%) and HPV mRNA signal (89.4% vs 0) were more common in HPVA than in HPVI (p<0.001). HPVI or GAC were more frequently associated with prognostically adverse variables including old age, large tumour size, deep invasion of the cervical wall, high tumour stage, spread of the upper genital tract, lymphovascular invasion, and mutant-type p53 expression, compared to HPVA or mucinous/usual-type HPVA, respectively (all p<0.001). In univariate survival analysis, HPVI had a worse overall survival and higher tumour recurrence compared to HPVA (p<0.05). Mucinous-type HPVA showed a worse prognosis than usual-type HPVA, but better than GAC (p<0.001). Multivariate survival analysis demonstrated that HPVI was independently associated with a worse overall survival and tumour recurrence (p<0.05) while GAC was an adverse prognostic factor independently of FIGO stage (p<0.05). Our findings validate the value of the new WHO classification in prognostic stratification and pathogenetic correlation in EAC and its subtypes.
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