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Ronfaut A, Attencourt C, Tesson JR, Sabbagh C, Regimbeau JM, Chatelain D. [Prognostic factors: Degree of subserosal invasion, tumor-serosal distance and subserosal elastic boundary invasion in colonic adenocarcinoma]. Ann Pathol 2024:S0242-6498(24)00159-7. [PMID: 39271441 DOI: 10.1016/j.annpat.2024.08.001] [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: 08/30/2023] [Revised: 07/28/2024] [Accepted: 08/10/2024] [Indexed: 09/15/2024]
Abstract
The aim was to study the prognostic impact of tumor infiltration of the subserosa in colonic adenocarcinoma, by evaluating the degree of tumor infiltration in the subserosa (DISS), tumor-serosa distance (DTS), and invasion of the elastic boundary of the subserosa (ILE) after elastic fiber staining. MATERIAL AND METHODS All patients operated on for colonic adenocarcinoma classified as pT3 without lymph node or visceral metastasis operated on at the CHU d'Amiens between 2004 and 2017 were included. All slides were reviewed by 2 pathologists. Bivariate and subgroup analyses were performed according to the presence of a DISS≤5mm or>5mm, a DTS≤1mm or>1mm and the presence or absence of an ILE. These statistical analyses were then correlated with the 5-year survival. RESULTS One hundred and one patients were included in the study. We performed elastic fiber staining on an average of 2 tumor blocks per case and 39.6% of patients had invasion of the elastic boundary. However, bivariate and subgroup analyses showed no statistically significant association between DISS, DTS or ILE and 5-year survival. CONCLUSION None of these three histopathological criteria proved to have prognostic value in our series, contrary to some results in the literature. However, as these data are subject to a number of confounding factors, we do not recommend that pathologists specify these different criteria in their reports.
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Affiliation(s)
- Arnaud Ronfaut
- Service d'anatomie pathologique du CHU d'Amiens, CHU Nord, centre hospitalier universitaire Amiens-Picardie site Nord, place Victor-Pauchet, 80000 Amiens, France.
| | - Christophe Attencourt
- Service d'anatomie pathologique du CHU d'Amiens, CHU Nord, centre hospitalier universitaire Amiens-Picardie site Nord, place Victor-Pauchet, 80000 Amiens, France.
| | - Jean-Rene Tesson
- Service d'anatomie pathologique du CHU d'Amiens, CHU Nord, centre hospitalier universitaire Amiens-Picardie site Nord, place Victor-Pauchet, 80000 Amiens, France.
| | - Charles Sabbagh
- Service de chirurgie digestive du CHU d'Amiens, CHU Sud, centre hospitalier universitaire Amiens-Picardie site Sud, 80054 Amiens, France.
| | - Jean-Marc Regimbeau
- Service de chirurgie digestive du CHU d'Amiens, CHU Sud, centre hospitalier universitaire Amiens-Picardie site Sud, 80054 Amiens, France.
| | - Denis Chatelain
- Service d'anatomie pathologique du CHU d'Amiens, CHU Nord, centre hospitalier universitaire Amiens-Picardie site Nord, place Victor-Pauchet, 80000 Amiens, France.
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2
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Bi F, Li X, Zhang Y, Wang Z, Dong Q, Zhang J, Sun D. Prognostic value of elastic lamina staining in patients with stage III colon cancer. World J Surg Oncol 2022; 20:391. [PMID: 36503509 PMCID: PMC9743714 DOI: 10.1186/s12957-022-02865-y] [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: 07/08/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The objectives of this study were to analyze the difference between the preoperative radiological and postoperative pathological stages of colorectal cancer (CRC) and explore the feasibility of elastic lamina invasion (ELI) as a prognostic marker for patients with stage III colon cancer. METHODS A total of 105 consecutive patients underwent radical surgery (R0 resection) for stage III colon cancer at the Cancer Hospital of China Medical University between January 2015 and December 2017. Clinicopathological features, including radiological stage and elastic lamina staining, were analyzed for prognostic significance in stage III colon cancer. RESULTS A total of 105 patients with stage III colon cancer who met the criteria and had complete data available were included. The median follow-up period of survivors was 41 months. During the follow-up period, 33 (31.4%) patients experienced recurrence after radical resection, and the 3-year disease-free survival (DFS) rate was 64.8%. The consistency between preoperative radiological and postoperative pathological staging was poor (κ = 0.232, P < 0.001). The accuracy of ≤ T2 stage diagnoses was 97.1% (102/105), that of T3 stage was 60.9% (64/105), that of T4a stage was 68.6% (72/105) and that of T4b stage was 91.4% (96/105). The DFS rate of T3 ELI (+) patients was significantly lower than that of both T3 ELI (-) patients (P = 0.000) and pT4a patients (P = 0.013). The DFS rate of T3 ELI (-) patients was significantly higher than that of pT4b patients (P=0.018). T3 ELI (+) (HR (Hazard ratio), 8.444 [95% CI, 1.736-41.067]; P = 0.008), T4b (HR, 57.727[95% CI, 5.547-600.754]; P = 0.001), N2 stage (HR, 10.629 [95% CI, 3.858-29.286]; P < 0.001), stage III (HR, 0.136 [95% CI, 0.31-0.589]; P = 0.008) and perineural invasion (PNI) (HR, 8.393 [95% CI, 2.094-33.637]; P = 0.003) were independent risk factors for postoperative recurrence of stage III colon cancer. CONCLUSIONS The consistency between preoperative radiological and postoperative pathological staging was poor, especially for tumors located in the ascending colon and descending colon. Elastic lamina staining is expected to become a stratified indicator of recurrence risk for patients with stage III colon cancer and a guide for individualized adjuvant chemotherapy, thus improving patient prognosis.
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Affiliation(s)
- Feifei Bi
- grid.459742.90000 0004 1798 5889Medical Oncology Department of Gastrointestinal Cancer, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Xiaoyan Li
- grid.459742.90000 0004 1798 5889Department of Pathology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Yong Zhang
- grid.459742.90000 0004 1798 5889Department of Pathology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Zekun Wang
- grid.459742.90000 0004 1798 5889Department of Medical Imaging, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Qian Dong
- grid.459742.90000 0004 1798 5889Medical Oncology Department of Gastrointestinal Cancer, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Jingdong Zhang
- grid.459742.90000 0004 1798 5889Medical Oncology Department of Gastrointestinal Cancer, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Deyu Sun
- grid.459742.90000 0004 1798 5889Department of Radiation Oncology Gastrointestinal and Urinary and Musculoskeletal Cancer, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
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3
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Zwanenburg ES, Wisselink DD, Klaver CEL, van der Bilt JDW, Tanis PJ, Snaebjornsson P. The measured distance between tumor cells and the peritoneal surface predicts the risk of peritoneal metastases and offers an objective means to differentiate between pT3 and pT4a colon cancer. Mod Pathol 2022; 35:1991-2001. [PMID: 36123540 DOI: 10.1038/s41379-022-01154-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 12/24/2022]
Abstract
Substantial variability exists in what pathologists consider as pT4a in colorectal cancer when tumor cells are within 1 mm of the free peritoneal surface. This study aimed to determine if the measured sub-millimeter distance between tumor cells and the free peritoneal surface would offer an objective means of stratifying patients according to the risk of developing peritoneal metastases. Histological slides of patients included in the COLOPEC trial, with resectable primary c/pT4N0-2M0 colon cancer, were centrally reassessed. Specific tumor morphological variables were collected, including distance from tumor to free peritoneal surface, measured in micrometers (µm). The primary outcome, 3-year peritoneal metastasis rate, was compared between four groups of patients stratified for relation of tumor cells to the peritoneum: 1) Full peritoneal penetration with tumor cells on the peritoneal surface, 2) 0-99 µm distance to the peritoneum, 3) 100-999 µm to the peritoneum, and 4) ≥1000 µm to the peritoneum, by using Kaplan-Meier analysis. In total, 189 cases were included in the present analysis. Cases with full peritoneal penetration (n = 89), 0-99 µm distance to the peritoneal surface (n = 34), 100-999 µm distance (n = 33), and ≥1000 µm distance (n = 33), showed significantly different 3-year peritoneal metastases rates of 25% vs 29% vs 6% vs 12%, respectively (Log Rank, p = 0.044). N-category did not influence the risk of peritoneal metastases in patients with a tumor distance beyond 100 µm, while only the N2 category seemed to result in an additive risk in patients with a distance of 0-99 µm. The findings of this study suggest that the measured shortest distance between tumor cells and the free peritoneal surface is useful as an objective means of stratifying patients according to the risk of developing peritoneal metastases. This simple measurement is practical and may help in providing a precise definition of pT4a. Trial registration: NCT02231086 (Clinicaltrials.gov).
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Affiliation(s)
- Emma S Zwanenburg
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Daniel D Wisselink
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Charlotte E L Klaver
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Jarmila D W van der Bilt
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands.,Department of Surgery, Flevoziekenhuis University of Amsterdam, Hospitaalweg 1, Almere, the Netherlands
| | - Pieter J Tanis
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus Medical Center, Doctor Molewaterplein 40, Rotterdam, the Netherlands
| | - Petur Snaebjornsson
- Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, the Netherlands.
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4
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Macchi L, Bao QR, Albertoni L, Fassan M, Chiminazzo V, Scarpa M, Spolverato G, Pucciarelli S. Prognostic significance of additional histologic features for subclassification of pathological T3 colon cancer. Int J Clin Oncol 2022; 27:1428-1438. [PMID: 35716324 PMCID: PMC9393148 DOI: 10.1007/s10147-022-02192-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/18/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Additional histologic features of T3 colon cancer, such as tumour depth invasion beyond muscularis propria and elastic lamina invasion (ELI), have taken interest for a more accurate staging. METHODS Patients with pT3 and pT4a (control group) colon adenocarcinoma were retrospectively collected from our institutional database. The study group was divided according to depth of tumour invasion < 5 mm and ≥ 5 mm, and into ELI - and ELI + . Chi-square test was used to compare the clinicopathological characteristics. OS and DFS were estimated using Kaplan-Meier method and compared with the log-rank test. Univariable and multivariable Cox proportional hazard models were employed to assess the effect on OS and DFS. RESULTS Out of 290 pT3 tumours, 168 (58%) had a depth of tumour invasion < 5 mm and 122 (42%) ≥ 5 mm. The 5-year OS and DFS were 85.2, 68.7 and 60.9%, and 81.4, 73.9 and 60.1% in pT3 < 5 mm, pT3 ≥ 5 mm, and pT4a respectively (p = 0.001, p = 0.072). Considering ELI - (n = 157, 54%) and ELI + (n = 133, 46%), the 5-year OS and DFS were 78.9, 76.7, and 60.9%, and 75.5, 81.5, and 60.1% in ELI - , ELI + and pT4a respectively (p = 0.955, p = 0.462). At multivariable analysis, the depth of invasion was found to be an independent predictive factor for OS (HR 2.04, 95%CI 1.28-3.24, p = 0.003) and DFS (HR 1.98, 95%CI 1.24-3.18, p = 0.004), while ELI did not result a prognostic factor for OS nor DFS. CONCLUSION In pT3 colon cancer, depth of tumour invasion ≥ 5 mm is an independent risk factor for OS and DFS, whereas ELI did not result a prognostic factor affecting OS nor DFS.
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Affiliation(s)
- Lorenzo Macchi
- General Surgery 3, Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Quoc Riccardo Bao
- General Surgery 3, Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Laura Albertoni
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padua, Italy
| | - Matteo Fassan
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padua, Italy
- Veneto Institute of Oncology (I.O.V. IRCSS), Padua, Italy
| | - Valentina Chiminazzo
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Marco Scarpa
- General Surgery 3, Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Gaya Spolverato
- General Surgery 3, Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.
| | - Salvatore Pucciarelli
- General Surgery 3, Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
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5
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Reproducibility of AJCC Criteria for Classifying Deeply Invasive Colon Cancers Is Suboptimal for Consistent Cancer Staging. Am J Surg Pathol 2020; 44:1381-1388. [PMID: 32931163 DOI: 10.1097/pas.0000000000001510] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The eighth edition of the American Joint Committee on Cancer (AJCC) Staging Manual attempts to address ambiguity in the pT category assignment for colon cancer from prior editions. Despite modifications, the distinction between the pT3 and pT4a categories continues to be a source of diagnostic confusion. In this study, we assessed interobserver agreement among pathologists from different institutions in the application of AJCC eighth edition criteria for categorizing deeply invasive colonic adenocarcinomas. We identified morphologic patterns that produce diagnostic confusion. We assessed 47 colon cancers that closely approached the serosal surface. Six pathologists with interest in gastrointestinal pathology and 4 focused in other subspecialties classified each case as pT3 or pT4a, based on examination of low-magnification and high-magnification images of the most deeply invasive area. Interobserver agreement was assessed using Fleiss' κ. Cases displayed 3 morphologic patterns at the advancing tumor edge, namely, (1) continuous invasion through an inflammatory focus, (2) pushing border, and (3) infiltrative glands and cell clusters with serosal reaction. Gastrointestinal pathologists achieved slight (κ=0.21) or moderate (κ=0.46) and (κ=0.51) agreement in each category, whereas agreement among nongastrointestinal pathologist was fair (0.31) and (0.39), or moderate (0.57) for each category, respectively. In 10 (21%) cases, the distinction between pT3 and pT4a would have changed the overall clinical stage. We conclude that histologic criteria for serosal penetration is a persistent source of diagnostic ambiguity for gastrointestinal and general pathologists in the pT categorization of colon cancers. Clarification of these criteria will help ensure uniform reporting of pathologic and clinical stage.
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6
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Klaver CEL, Bulkmans N, Drillenburg P, Grabsch HI, van Grieken NCT, Karrenbeld A, Koens L, van Lijnschoten I, Meijer J, Nagtegaal ID, Sagaert X, Seldenrijk K, van Velthuysen MF, Bruggink AH, Tanis PJ, Snaebjornsson P. Interobserver, intraobserver, and interlaboratory variability in reporting pT4a colon cancer. Virchows Arch 2020; 476:219-230. [PMID: 31616981 PMCID: PMC7028812 DOI: 10.1007/s00428-019-02663-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 08/02/2019] [Accepted: 09/02/2019] [Indexed: 12/23/2022]
Abstract
Clinical significance of the pT4 category in colon cancer is increasing with several therapeutic implications. The aim of this study was to evaluate variability in diagnosing pT4a colon cancer. Twelve pathologists classified 66 preselected scanned Hematoxylin/Eosin-stained slides with tumor cells at a distance of 25-1500 μm (n = 22), 0-25 μm (n = 22), or on (n = 22) the peritoneal surface. Inter- and intraobserver variability were calculated using Kappa statistics. For interlaboratory variability, pathology reports of pT3 and pT4a colon cancer were extracted from the Dutch Pathology Registry between 2012 and 2015. The proportion of pT4a (pT4a/(pT3+pT4a)) was compared between 33 laboratories. Potential risk of understaging was assessed by determining the average number of blocks taken from pT3 and pT4a N0-2M0 tumors with metachronous peritoneal metastasis. Interobserver variability among 12 pathologists was 0.50 (95%CI 0.41-0.60; moderate agreement). Intraobserver variability (8 pathologists) was 0.71 (substantial agreement). A total of 7745 reports with pT3 or pT4aN0-2M0 colon cancer from 33 laboratories were included for interlaboratory analysis. Median percentage of pT4a was 15.5% (range 3.2-24.6%). After adjustment for case mix, 8 labs diagnosed pT4a significantly less or more frequently than the median lab. Metachronous peritoneal metastases were histologically verified in 170 of 6629 pT3 and in 129 of 1116 pT4a tumors, with a mean number of blocks of 4.03(SD 1.51) and 4.78 (SD 1.76) taken from the primary tumors, respectively (p < 0.001). A substantial variability in diagnosing pT4a colon cancer exists, both at pathologist and laboratory level. Diagnosis of pT4a stage appears to be challenging and there is a need for standardizing assessment of this pathological entity.
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Affiliation(s)
- Charlotte E. L. Klaver
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Nicole Bulkmans
- Department of Pathology, Spaarne Gasthuis, Hoofddorp, Netherlands
| | | | - Heike I. Grabsch
- Department of Pathology, GROW School for Oncology and Developmental Pathology, Maastricht UMC+, and Pathology & Tumor Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | | | | | - Lianne Koens
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Jos Meijer
- Pathology DNA location Rijnstate, Arnhem, Netherlands
| | | | | | - Kees Seldenrijk
- Pathology DNA, Location St. Antonius Hospital, Nieuwegein, Netherlands
| | | | - Annette H. Bruggink
- PALGA, the nationwide network and registry of histo- and cytopathology in the Netherlands, Utrecht, Netherlands
| | - Pieter J. Tanis
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Petur Snaebjornsson
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, Netherlands
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7
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Odate T, Vuong HG, Mochizuki K, Oishi N, Kondo T. Assessment of peritoneal elastic laminal invasion improves survival stratification of pT3 and pT4a colorectal cancer: a meta-analysis. J Clin Pathol 2019; 72:736-740. [DOI: 10.1136/jclinpath-2019-206056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/05/2019] [Accepted: 08/19/2019] [Indexed: 12/24/2022]
Abstract
Evaluating peritoneal elastic laminal invasion (ELI) has been proposed as an additional assessment for pT3 colorectal cancers (CRC). Its clinical significance has not yet been established. We performed a meta-analysis to investigate the prognostic impact of ELI assessment for subcategorisation of pT3 CRC. We performed a search in three electronic databases. HR and its 95% CI for overall survival (OS) and disease-free survival (DFS) were calculated using the random effects model weighted by the inverse variance method. We identified six studies that met inclusion criteria out of an original 703 studies found with our database search terms. Our meta-analysis included 1925 patients with pT3 and pT4a CRCs. The presence of ELI in pT3 CRC was associated with shortened OS compared with ELI negative pT3 CRC (HR=1.76; 95% CI 1.21 to 2.55); whereas the DFS was not statistically significant (HR=1.79; 95% CI 0.91 to 3.52). Furthermore, pT4a patients’ OS (HR=1.84; 95% CI 1.41 to 2.40) and DFS (HR=1.88; 95% CI 1.17 to 3.04) were even worse than the OS and DFS of pT3 ELI (+) patients. ELI is a useful marker for stratifying patients with pT3 or pT4a CRCs into three prognostically distinct groups. We recommend the subcategorisation of pT3 CRC by ELI for better prognostic assessment and treatment strategy of patients with CRC.
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8
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Lei G, Yang H, Hong T, Zhou C, Li J, Liu W, Hu J, Zeng L, Chen G, Chen Q, Zhang Y, Yang N. Elastic staining-a rejuvenated method to reassess prognosis and serosal invasion in patients with pT3N0M0 gastric cancer. Hum Pathol 2017; 65:79-84. [PMID: 28504204 DOI: 10.1016/j.humpath.2017.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/12/2017] [Accepted: 04/29/2017] [Indexed: 10/19/2022]
Abstract
Prognosis of pT3N0M0 gastric cancer (GC) varies greatly, though the major factor conferring poor prognosis is unclear. Subserosal elastic lamina invasion (ELI+) is closely associated with poor outcomes in pT3 colorectal cancer, but related research on GC is unavailable. This study aimed to identify the influence of ELI+ on the prognosis of patients with pT3N0M0 GC and its relationship with serosal invasion using elastic staining. We retrospectively reviewed 94 and 28 patients with pT3N0M0 and pT4aN0M0 GC who underwent gastrectomy between 1994 and 2005. For the former, one section with invasion depth closest to the peritoneal surface and one corresponding paraffin block for each specimen were selected for conventional elastic staining to assess the relationship between ELI+ and patients' clinical characteristics and survival. pT3N0M0 GC specimens were divided into 3 groups based on staining results: ELI+ (N=51), non-invasion (N=31), and unidentified (N=12). ELI+ was closely related to recurrence and lymphovascular invasion. Five-year disease-free (DFS) (46%) and overall (OS) (36%) survival rates were significantly lower in the ELI+ than in the non-invasion or unidentified groups (P<.0001); no obvious difference was found between the ELI+ and pT4aN0M0 groups (P=.25). Multivariate analysis showed ELI+ and recurrence as independent prognostic factors for DFS in pT3 GC patients. In conclusion, elastic staining is an effective and highly feasible method for predicting prognosis and evaluating the serosal invasion depth of pT3 GC. pT3 GC accompanied with ELI+ is an obvious adverse prognostic factor and could be considered a treatment for pT4a GC.
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Affiliation(s)
- Guang Lei
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital, Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, China, 410013; Graduate School, University of South China, Hunan Hengyang, China, 421001
| | - Haiyan Yang
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital, Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, China, 410013
| | - Ting Hong
- Graduate School, University of South China, Hunan Hengyang, China, 421001
| | - Chunhua Zhou
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital, Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, China, 410013
| | - Jigang Li
- Department of Pathology, Hunan Cancer Hospital, Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, China, 410013
| | - Wenbin Liu
- Department of Pathology, Hunan Cancer Hospital, Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, China, 410013
| | - Jun Hu
- Department of Pathology, Hunan Cancer Hospital, Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, China, 410013
| | - Liang Zeng
- Department of Pathology, Hunan Cancer Hospital, Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, China, 410013
| | - Gong Chen
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital, Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, China, 410013; Graduate School, University of South China, Hunan Hengyang, China, 421001
| | - Qiong Chen
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital, Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, China, 410013; Graduate School, University of South China, Hunan Hengyang, China, 421001
| | - Yongchang Zhang
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital, Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, China, 410013.
| | - Nong Yang
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital, Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, China, 410013.
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9
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Chen JH, Borges M. Histopathology and enhanced detection of tumor invasion of peritoneal membranes. PLoS One 2017; 12:e0173833. [PMID: 28282462 PMCID: PMC5345882 DOI: 10.1371/journal.pone.0173833] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 02/27/2017] [Indexed: 01/19/2023] Open
Abstract
Tumor invasion of the peritoneal membrane may have an adverse prognostic significance, but its histopathologic features can be diagnostically difficult to recognize. We observed that local peritoneal injury associated with tumor invasion is characterized by activation and proliferation of serosal stromal cells that express cytokeratin, a characteristic property of injured serosal membranes that may have diagnostic utility. To explore this, we examined 120 primary tumors of the gastrointestinal tract and pancreaticobiliary system using cytokeratin and elastic stains to assess for tumor invasion of peritoneal membranes. Peritoneal invasion by tumor was associated with retraction, splaying, and destruction of the elastic lamina and proliferation of keratin-expressing stromal cells of serosal membranes. All 82 peritoneal invasive tumors were characterized by neoplastic cells that invaded the elastic lamina and the serosal connective tissue with neoplastic cells that abutted or were surrounded by keratin-positive stromal cells, whereas all 38 tumors limited to the subserosa showed none of these features. The diagnosis of tumor invasion of peritoneal membranes is enhanced by the combined use of cytokeratin and elastic stains, which in turn would enable better histopathologic correlation with patient treatment and outcome.
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Affiliation(s)
- Jey-Hsin Chen
- CellNetix Pathology and Laboratories, Seattle, Washington, United States of America
- Swedish Medical Center, Seattle, Washington, United States of America
| | - Melissa Borges
- CellNetix Pathology and Laboratories, Seattle, Washington, United States of America
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10
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Kojima M, Ochiai A. Special cancer microenvironment in human colonic cancer: Concept of cancer microenvironment formed by peritoneal invasion (CMPI) and implication of subperitoneal fibroblast in cancer progression. Pathol Int 2016; 66:123-131. [PMID: 26816328 PMCID: PMC4832348 DOI: 10.1111/pin.12389] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/06/2016] [Indexed: 12/31/2022]
Abstract
Clinical outcomes of colorectal cancer are influenced not by tumor size, but by spread into the bowel wall. Although assessment of serosal involvement is an important pathological feature for classification of colon cancer, its diagnostic consistency has been questioned. Using elastic staining, we assessed elastic laminal invasion (ELI) for more objective stratification of deep tumor invasion around the peritoneal surface. In addition, pathological characteristic features of marked tumor budding, fibrosis, and macrophage infiltration in the tumor area with ELI was elucidated. This characteristic tumor area was termed cancer microenvironment formed by peritoneal elastic laminal invasion (CMPI). We elucidated histoanatomical layer-dependent heterogeneity of fibroblast in colonic tissue. Furthermore, subperitoneal fibroblasts (SPFs) play a crucial role in tumor progression and metastasis in CMPI. Our ELI and CMPI concept contributes not only to objective pathological diagnosis, but also sheds light on biological research of special cancer microenvironments detectable in human colorectal cancers. Herein, we describe the diagnostic utility of ELI and morphological alteration in advanced colorectal cancers to determine the phenomenon that occurs when tumors invade around the peritoneal surface. Next, biological research of CMPI is reviewed to stress the importance of pathological research to establish new biological concepts.
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Affiliation(s)
- Motohiro Kojima
- Pathology DivisionExploratory Oncology Research & Clinical Trial CenterNational Cancer CenterChibaJapan
| | - Atsushi Ochiai
- Pathology DivisionExploratory Oncology Research & Clinical Trial CenterNational Cancer CenterChibaJapan
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Yokota M, Kojima M, Higuchi Y, Nishizawa Y, Kobayashi A, Ito M, Saito N, Ochiai A. Gene expression profile in the activation of subperitoneal fibroblasts reflects prognosis of patients with colon cancer. Int J Cancer 2015; 138:1422-31. [PMID: 26370611 DOI: 10.1002/ijc.29851] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 07/28/2015] [Accepted: 08/28/2015] [Indexed: 12/25/2022]
Abstract
Tumors can create a heterogenetic tumor microenvironment. We recently identified the pathologically unique cancer microenvironment formed by peritoneal invasion (CMPI), and revealed that subperitoneal fibroblasts (SPFs) within peritoneal tissue play a crucial role in tumor progression through their interaction with cancer cells. Therefore, the genes in SPFs altered by cancer stimulation may include some biologically important factors associated with patient prognosis. In this study, we aimed to identify new biomarkers using genes specifically upregulated in SPFs by cancer-cell-conditioned medium (CCCM) stimulation (SPFs CCCM response genes; SCR genes) in colon cancer (CC). We constructed two frameworks using SCR gene data: a publicly released microarray dataset, and validation cases with freshly frozen CC samples to identify genes related to short recurrence-free survival (RFS). In the first framework, we selected differentially expressed genes between the high and low SCR gene expression groups. In the second framework, genes significantly related to short RFS were selected by univariate analysis using all SCR genes, and multivariate analysis was performed to select robust genes associated with short RFS. We identified CTGF, CALD1, INHBA and TAGLN in the first framework, and PDLIM5, MAGI1, SPTBN1 and TAGLN in the second framework. Among these seven genes, high expression of three genes (CALD1, TAGLN and SPTBN1) showed a poor prognosis in our validation cases. In a public microarray dataset, SCR gene expression was associated with the expression of ECM component, EMT, and M2-macrophage associated genes, which was concordant with the pathological features of CMPI. Thus, we successfully identified new prognostic factors.
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Affiliation(s)
- Mitsuru Yokota
- Division of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, 277-8577, Japan.,Department of Surgery, Keio University School of Medicine, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Motohiro Kojima
- Division of Pathology, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, 277-8577, Japan
| | - Youichi Higuchi
- Laboratory of Cancer Biology, Department of Integrated Biosciences, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Chiba, 277-8561, Japan
| | - Yuji Nishizawa
- Division of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, 277-8577, Japan
| | - Akihiro Kobayashi
- Division of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, 277-8577, Japan
| | - Masaaki Ito
- Division of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, 277-8577, Japan
| | - Norio Saito
- Division of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, 277-8577, Japan
| | - Atsushi Ochiai
- Division of Pathology, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, 277-8577, Japan
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Frankel WL, Jin M. Serosal surfaces, mucin pools, and deposits, oh my: challenges in staging colorectal carcinoma. Mod Pathol 2015; 28 Suppl 1:S95-108. [PMID: 25560604 DOI: 10.1038/modpathol.2014.128] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 07/11/2014] [Accepted: 07/12/2014] [Indexed: 02/06/2023]
Abstract
Colorectal carcinoma is the third most common cancer in the United States. Proper and standardized pathologic staging is vital for prognostic assessment and impacts therapeutic decisions. The Tumor Node Metastasis (TNM) staging system was developed by the American Joint Committee on Cancer (AJCC) to be a data-driven, evidence-based staging system providing an accurate prediction of outcome. The AJCC 7th edition (2010) included several changes clarifying some issues and leading to new controversies. We aim to address selected challenging issues in tumor T staging, neoadjuvant treatment effects in rectal cancer, and definition of lymph node vs tumor deposit. Serosal involvement in colorectal cancer is staged as T4, which is associated with decreased survival and may impact additional therapy decisions. Although careful sampling and sectioning are helpful, challenges remain in interpretation of tumor within 1 mm of serosal surface with a reaction. Elastic stain as a surrogate marker for serosal invasion has been studied, but its usefulness remains unclear. Some unique issues in rectal cancer include the presence of serosa in proximal but not in distal tumors and post-neoadjuvant effects. Tumor should be staged based on tumor cells rather than acellular mucin pools. Additionally, tumor response should be graded only in primary tumor but not in lymph nodes or metastatic sites. The distinction between tumor deposits and lymph nodes has been modified in AJCC TNM from using size in the 5th edition, to the round contour in the 6th edition, to only features of residual lymph node architecture in the 7th edition. Interobserver variability remains but tumor deposits should be documented when present. The number of deposits should not be added to the total number of positive lymph nodes, and the N1c designation should only be used in cases without any positive lymph nodes. Future clarification will likely evolve as more data become available.
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Affiliation(s)
- Wendy L Frankel
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ming Jin
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Clinical impact of elastic laminal invasion in colon cancer: elastic laminal invasion-positive stage II colon cancer is a high-risk equivalent to stage III. Dis Colon Rectum 2014; 57:830-8. [PMID: 24901683 DOI: 10.1097/dcr.0000000000000124] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Elastic laminal invasion is defined as tumor invasion beyond the peritoneal elastic lamina. It is one of the factors affecting the prognosis of patients with colon cancer. OBJECTIVE This study aimed to investigate the clinical impact of elastic laminal invasion in colon cancer and the magnitude of the worse prognosis of elastic laminal invasion-positive, node-negative patients. DESIGN This was a retrospective cohort study. SETTINGS This study reviewed data from a tertiary care cancer center in Japan. PATIENTS The records of 436 patients with pT3 or pT4a colon cancer who underwent curative resection between January 1996 and December 2006 were reviewed. MAIN OUTCOME MEASURES The primary outcome measure was recurrence-free survival. Cox regression analyses established the factors associated with recurrence-free survival. Six groups formed by combining the factors were compared. RESULTS Of the patients with pT3 disease, those who were positive for elastic laminal invasion had a 5-year recurrence-free survival rate of 73.8% compared with a rate of 85.0% in those who were negative for elastic laminal invasion and 53.5% in patients with pT4 disease. Three unfavorable prognostic factors were identified, including lymph node metastasis, positive elastic laminal invasion, and a lack of adjuvant chemotherapy. Log-rank analysis revealed statistically significant differences in recurrence-free survival between group 1 (node negative, elastic laminal invasion negative, and no adjuvant chemotherapy) and group 3 (node negative, elastic laminal invasion positive, and no adjuvant chemotherapy). The HR for group 1 compared with group 3 was 0.49 (95% CI, 0.27-0.90). Furthermore, the HRs for group 2 (node positive, elastic laminal invasion negative, and received adjuvant chemotherapy) and group 4 (node positive, elastic laminal invasion positive, and received adjuvant chemotherapy) vs group 3 were 0.77 (95% CI, 0.35-1.69) and 1.36 (95% CI, 0.62-2.98). LIMITATIONS Our study has limited prediction accuracy of our prognostic stratification, and an analysis of small subgroups may not have been capable of detecting significant differences. In addition, a wide range of hematoxylin and eosin- and elastica-stained slides were examined per case. CONCLUSIONS Elastic laminal invasion adversely influences prognosis in pT3 and pT4a colon cancer. Although elastic laminal invasion positivity does not affect prognosis in node-positive patients receiving adjuvant chemotherapy, node-negative patients with elastic laminal invasion have a similar risk of recurrence as node-positive patients.
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Kojima M, Higuchi Y, Yokota M, Ishii G, Saito N, Aoyagi K, Sasaki H, Ochiai A. Human subperitoneal fibroblast and cancer cell interaction creates microenvironment that enhances tumor progression and metastasis. PLoS One 2014; 9:e88018. [PMID: 24505356 PMCID: PMC3913740 DOI: 10.1371/journal.pone.0088018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 01/02/2014] [Indexed: 01/29/2023] Open
Abstract
Backgrounds Peritoneal invasion in colon cancer is an important prognostic factor. Peritoneal invasion can be objectively identified as periotoneal elastic laminal invasion (ELI) by using elastica stain, and the cancer microenvironment formed by the peritoneal invasion (CMPI) can also be observed. Cases with ELI more frequently show distant metastasis and recurrence. Therefore, CMPI may represent a particular milieu that facilitates tumor progression. Pathological and biological investigations into CMPI may shed light on this possibly distinctive cancer microenvironment. Methods We analyzed area-specific tissue microarrays to determine the pathological features of CMPI, and propagated subperitoneal fibroblasts (SPFs) and submucosal fibroblasts (SMFs) from human colonic tissue. Biological characteristics and results of gene expression profile analyses were compared to better understand the peritoneal invasion of colon cancer and how this may form a special microenvironment through the interaction with SPFs. Mouse xenograft tumors, derived by co-injection of cancer cells with either SPFs or SMFs, were established to evaluate their active role on tumor progression and metastasis. Results We found that fibrosis with alpha smooth muscle actin (α-SMA) expression was a significant pathological feature of CMPI. The differences in proliferation and gene expression profile analyses suggested SPFs and SMFs were distinct populations, and that SPFs were characterized by a higher expressions of extracellular matrix (ECM)-associated genes. Furthermore, compared with SMFs, SPFs showed more variable alteration in gene expressions after cancer-cell-conditioned medium stimulation. Gene ontology analysis revealed that SPFs-specific upregulated genes were enriched by actin-binding or contractile-associated genes including α-SMA encoding ACTA2. Mouse xenograft tumors derived by co-injection of cancer cells with SPFs showed enhancement of tumor growth, metastasis, and capacity for tumor formation compared to those derived from co-injection with cancer cells and SMFs. Conclusions CMPI is a special microenvironment, and interaction of SPFs and cancer cells within CMPI promote tumor growth and metastasis.
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Affiliation(s)
- Motohiro Kojima
- Pathology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Youichi Higuchi
- Pathology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Mitsuru Yokota
- Colorectal and Pelvic Surgery Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Genichiro Ishii
- Pathology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Norio Saito
- Colorectal and Pelvic Surgery Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Kazuhiko Aoyagi
- Genetic Division, National Cancer Center Research Institute, Chuo-ku, Tokyo, Japan
| | - Hiroki Sasaki
- Genetic Division, National Cancer Center Research Institute, Chuo-ku, Tokyo, Japan
| | - Atsushi Ochiai
- Pathology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
- * E-mail:
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Grin A, Messenger DE, Cook M, O'Connor BI, Hafezi S, El-Zimaity H, Kirsch R. Peritoneal elastic lamina invasion: limitations in its use as a prognostic marker in stage II colorectal cancer. Hum Pathol 2013; 44:2696-705. [PMID: 24074534 DOI: 10.1016/j.humpath.2013.07.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 07/10/2013] [Accepted: 07/12/2013] [Indexed: 02/08/2023]
Abstract
Peritoneal involvement in colorectal cancer (CRC) is an adverse prognostic feature, which may prompt consideration of adjuvant chemotherapy in stage II disease. Controversies and challenges surrounding its assessment have led to consideration of peritoneal elastic lamina invasion (ELI) as an alternative marker of advanced local spread. The objectives of this study were (1) to evaluate the prognostic significance of peritoneal ELI in stage II CRC and (2) to determine the feasibility of ELI assessment in routine practice with the use of an elastic stain. Two hundred seventeen patients with stage II CRC (186, pT3; 31, pT4) were assessed for ELI and other established adverse histologic features. Of the pT3 tumors, 31 (16.7%) were ELI positive, 121 (65%) were ELI negative, and 34 (18.3%) lacked an identifiable elastic lamina. There were no significant differences in disease-free survival between pT3 ELI-negative and ELI-positive tumors (P = .517). The disease-free survival of pT4 tumors was significantly lower than that of pT3 ELI-negative tumors (P = .024) and pT3 ELI-positive tumors (P = .026), respectively. The elastic lamina was detected less frequently in right-sided pT3 tumors compared with left-sided tumors (65/91 [71.4%] versus 87/95 [91.6%], P < .001). Right-sided tumors were also associated with a reduction in the staining intensity of the elastic lamina (P < .001). In conclusion, peritoneal ELI was not an adverse prognostic factor in this study. The frequent absence of an identifiable elastic lamina, particularly in right-sided tumors, may limit the use of ELI as a prognostic marker in CRC.
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Affiliation(s)
- Andrea Grin
- Department of Laboratory Medicine, St Michael's Hospital, Toronto, Canada M5B 1W8; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada M5S 1A5
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