Prognosis of Mesorectal Tumor Deposits in Patients with Rectal Cancer Treated with Neoadjuvant Chemoradiotherapy and Total Mesorectal Excision

BACKGROUND

Tumor deposits (TDs) are associated with adverse prognostic factors and decreased survival in colon cancer. However, there is no information of their survival impact in rectal cancer with neoadjuvant chemoradiotherapy (n-CRT).

METHODS

Retrospective study in 223 patients with rectal cancer with n-CRT. A survival analysis of factors associated with decreased overall survival (OS) including TDs was performed.

RESULTS

From 223 patients, 131 (58.7%) were men, mean age 59.8 (± 13.06) years, and 42 (18.8%) of them revealed TDs. Survival analysis of TDs showed no association with mortality. Factors associated with decreased 5-year OS were the histologic grade (p = 0.42), perineural invasion (p = 0.001), and mesorectal quality (p = 0.067). Perineural invasion (HR = 2.335, 95% CI = 1.198-4.552) remained as independent factor in the multivariate analysis.

CONCLUSIONS

TDs were not associated with mortality in rectal cancer patients treated with n-CRT. Factors associated with decreased survival were inadequate mesorectal quality and perineural invasion.

Prognosis of polypoid melanoma: a comparative study with non-polypoid melanomas

Polypoid melanoma is considered an exophytic and frequently non-pigmented variant of nodular melanoma with an adverse prognosis; however, very few studies have been published about it with contradictory results. Therefore, our objective was to determine the prognostic value of this configuration in melanomas. A transversal retrospective study of 724 cases was analyzed according to the main configuration (polypoid vs. non-polypoid) regarding their clinicopathologic characteristics and survival analysis. Of the 724 cases, 35 (4.8%) met the definition of polypoid melanoma; such cases, compared with non-polypoid melanomas, were associated with a high Breslow thickness (7 mm vs. 3 mm), 68.6% had a Breslow >4 mm; showed different clinical stages of presentation, and presented more ulceration (77.1 vs. 51.4%). In the 5-year overall survival (OS) analysis, polypoid melanoma is associated with a lower 5-year OS, together with lymph node metastasis, Breslow thickness, clinical stage, mitoses per mm2, vertical growth phase, ulceration, and state of the surgical margins; however, in the multivariate analysis, the factors that remained independent predictors of death were the Breslow thickness groups, the clinical stage, the presence of ulceration, and the state of the surgical margins. Polypoid melanoma was not an independent predictor of OS. We found a prevalence of 4.8% of polypoid melanomas, which showed a worse prognosis than non-polypoid melanomas, explained by a higher proportion of ulcerated cases, greater Breslow thickness, and ulceration. However, polypoid melanoma was not an independent predictor of death.

Recurrence rate and survival implications of surgical margins in patients with acral melanoma. Is a wide margin necessary?

INTRODUCTION

Appropriate size of resection margins in acral melanoma is not clearly established.

OBJECTIVE

To investigate whether narrow-margin excision is appropriate for thick acral melanoma.

METHODS

Three-hundred and six patients with acral melanoma were examined. Factors associated with recurrence and survival were analyzed according to surgical margin size (1 to 2 cm and > 2 cm).

RESULTS

Out of 306 patients, 183 were women (59.8%). Median Breslow thickness was 6 mm; 224 cases (73.2%) were ulcerated, 154 patients (50.3%) had clinical stage III disease, while 137 were at stage II (44.8%) and 15 at stage IV (4.9%). All cases had negative margins, with a median of 31.5 mm. A Breslow thickness of 7 mm (p = 0.001) and clinical stage III (p = 0.031) were associated with recurrence; the factors associated with survival were Breslow index (p = 0.047), ulceration (p = 0.003), advanced clinical stage (p < 0.001), and use of adjuvant therapy (p = 0.003).

CONCLUSION

A resection margin of 1 to 2 cm did not affect tumor recurrence or survival in patients with acral melanoma.

The usefulness of intraoperative consultation for the diagnosis of borderline ovarian tumors

Background

Borderline ovarian tumors (BTs) must be recognized during the surgery by intraoperative consultation (IOC) to guide surgical treatment; however, this diagnosis can be imprecise. Therefore, this study aimed to evaluate the diagnostic accuracy of IOC for the diagnosis of BT.

Methods

A retrospective cohort study was carried out including all women diagnosed with a pelvic tumor consecutively surgically treated from 2005 to 2015 with IOC. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LR) for the IOC and BTs.

Results

A total of 758 patients were enrolled, the median age was 44 years, the median tumor size was 11.8 cm, and the median CA-125 levels were 45.65 U/µL. After IOC, 458 (64.1%) cases were diagnosed as benign, 111 (14.7%) as BT, and 161 (21.2%) as malignant. The definitive diagnosis was a benign tumor in 448 (59.1%) cases, BT in 110 (14.5%), and 200 (26.4%) cases were malignant. The diagnostic accuracy of the IOC for BT diagnosis was 89.8% (sensitivity =65.5%, specificity =93.9%). The diagnosis performance of IOC for the diagnosis between BT and benign tumors (n=546) had a sensitivity of 69.9%, a specificity of 98.4%, and a diagnostic accuracy of 84%; meanwhile for the diagnosis between BT and malignant tumors (n=242) IOC had a sensitivity of 92.3%, a specificity of 81.7%, and a diagnostic accuracy of 87%.

Conclusions

For practitioners, knowing the accuracy and limitations of the IOC for BT enables the better selection of cases to perform a complete staging surgery.

Prognostic variables in patients with thick melanomas. Analysis of 362 cases

BACKGROUND

Melanoma epidemiological and prognostic studies are based on Caucasian populations, in whom the predominant subtype is superficially-spreading melanoma and in whom thin melanomas (Breslow < 3 mm) predominate. Mexican patients show a predominance of thick melanomas (Breslow ≥ 3 mm), and the acral subtype is the most common. There are no publications on prognostic factors in thick melanomas. We hypothesize that we will identify factors that determine the prognosis in this group of patients.

OBJECTIVE

To identify clinical-pathological factors associated with the prognosis of patients with thick melanomas in the Mexican population.

MATERIAL AND METHODS

Data on melanomas with Breslow > 3 mm were collected from 2010 to 2015. The prognostic influence of various clinical-pathological factors was analyzed.

RESULTS

The most common subtypes were acral melanoma in 271 patients (74.9 %) and nodular melanoma in 49 (13.5 %). Median Breslow thickness was 7 mm. 56.6 % of the patients had lymph node metastases (clinical stage [CS] III), 269 (74.3 %) had ulceration, and surgical margins were positive in 15 (4.1 %). Elevated neutrophil: lymphocyte ratio (≥ 2) was found in 188 (51.9 %). The variables associated with lower overall survival were CS (p < 0.001), Breslow thickness (p = 0.044), ulceration (p = 0.004), mitotic activity (p < 0.001), < 2-cm margin (p < 0.001) and an increased neutrophil: lymphocyte ratio (p = 0.037). In the multivariate analysis, the factors associated with overall survival were CS, mitotic activity, and surgical margin.

CONCLUSIONS

In patients with thick melanomas, overall survival is influenced by mitotic activity, a positive margin, and clinical stage.

Gastrointestinal Stromal Tumors Risk of Recurrence Stratification by Tumor Volume is a Best Predictor Compared with Risk Based on Mitosis and Tumor Size

PURPOSE

Gastrointestinal stromal tumors (GIST) have the potential to recur and metastasize. Several prognostic schemes have been developed, mostly based on the mitotic count, diameter, and tumor site. However, these systems are not precise enough. The research question was whether the tumor size determined by volumetry allows a better risk stratification than the traditional system, and our aim was to determine the value of tumor volumetry, a feasible and simple parameter, in the recurrence of GIST.

METHODS

Seventy-four cases of GIST were studied. The cases presented with non-metastatic disease, which were resected and did not receive imatinib. We compared the clinico-pathologic features of the cases with recurrence against those with non-recurrence and compared the tumor volumetry against the classification system based on tumor size and mitosis.

RESULTS

The median age was 58 years (range: 25 to 91 years). Half of the cases were presented in the stomach. The tumor size had a median of 8 cm (range of 1-30 cm). The median mitosis count for 50 HPF was 4 (range 0-92). During the period of study, 16 (21.6%) patients suffered recurrence. The significant differences were that patients with recurrence accounted for more deaths and the follow-up period was larger. The area under the curve (AUC) of the volumetry classification was superior to the AUC of the classification system based on tumor size and mitosis (NIH-criteria) (p = .05).

CONCLUSION

Tumor volumetry calculated in the surgical specimen and/or pre-operative tomography was superior to the NIH consensus in stratifying the risk of recurrence in GIST.

Report of three cases of gastric choriocarcinomas-an emphasis on morphologic changes in the non-affected gastric mucosa

Primary gastric choriocarcinomas (PGC) are very rare and aggressive neoplasms with a worrisome prognosis. Most cases are reported in Asia and presented in middle-aged adults with male predominance. Most cases are associated with an intestinal adenocarcinoma; however, the pathogenesis of this tumor is uncertain. No previous reports exist of the characteristics of the non-tumoral stomach in these patients, and this data that could help to clarify their pathogenesis. We presented a series of three cases of PGC in Latin American patients, emphasizing the characteristics of non-neoplastic mucosa.

Comparison of 3 Ways of Dissecting the Pancreatoduodenectomy Specimen and Their Impact in the Lymph Node Count and the Lymph Node Metastatic Ratio

Background. Lymph node metastasis (LNM) is a strong prognostic factor in the cancer of the pancreatobiliary tree, but it is influenced by the number of lymph nodes (LNs). The lymph node ratio (LNR) is considered a more reliable factor than the number of LNM. The aim was to examine the LN retrieval and the LNR of 3 pathologic work-up strategies. Methods. Pancreaticoduodenectomies (n = 165) were analyzed comparing 3 pathological dissection techniques, classified as “control,” “Verbeke method,” and “Adsay method” groups. Results. The mean of the dissected LNs and the number of cases with >20 LNs were superior in the Adsay method group, compared with the other groups ( P < .001). The LNR was different between the Adsay and Verbeke groups (0.144 vs 0.069, P = .032). The median of the 3 positive LNs was associated with decreased survival compared with an absence of LNM (3-year specific survival of 48% vs 22%, P = .011). In the multivariate analysis, LNM (hazard ratio = 6.148, 95% confidence interval = 2.02-8.1, P = .042) and the evaluation of >15 LNs (hazard ratio = 12.52, 95% confidence interval = 5.51-21.01, P = .001) were independent predictors of survival. Conclusion. The Adsay technique for LN retrieval was associated with a better LN count, more cases with LNM, and an LNR >0.1.

Acral Lentiginous Melanoma: Survival Analysis of 715 Cases

Introduction:

Acral lentiginous melanoma (ALM) is an aggressive variant of melanoma; the incidence, prevalence, and prognosis differ among populations. We analyzed clinicopathological features and survival in Hispanics, a population with high ALM prevalence.

Material and Methods:

From 1144 patients with melanoma, we analyzed 715 ALMs and 429 non-ALMs from the National Referral Cancer Centre and compared survival.

Results:

Of the ALM group, 62.8% were female; the median age was 58 years. The mean Breslow thickness was 3.56 ± 7.16 mm. ALM patients showed an estimated 5-year disease-specific survival (DSS) of 53.3%, 52.7%, and 40.8% for stage I, II, and III, respectively. For non-ALM patients, the DSS rates were 66%, 60.8%, and 48.4% for stage I, II, and III disease, respectively. Overall, the 1-, 3-, and 5-year DSS rates for patients with ALM were 85.1%, 59.4%, and 46.3%, respectively; for non-ALM patients, they were 81.3%, 64.8%, and 55.7%, respectively ( P = .168). In the multivariate analysis, factors associated with decreased DSS were high Breslow thickness, recurrence, ulceration, male sex, and advanced stage.

Conclusions:

The 1-, 3-, and 5-year DSS rates of patients with ALM were not statistically different from those of non-ALM patients. In addition to known adverse prognostic factors, male sex was also associated with worse survival.

Frequency of Defective Mismatch Repair System in a Series of Consecutive Cases of Colorectal Cancer in a National Cancer Center

BACKGROUND

The frequency of colorectal cancer (CRC) with defective mismatch repair (dMMR) is estimated between 5 and 15%. In our population, the frequency of dMMR is unknown. Our objective was to show the frequency of dMMR.

METHODS

Determination of dMMR with immunohistochemistry was performed prospectively for 202 patients who presented consecutively with CRC for the first time at our institution.

RESULTS

The median age was 59 years (IQR 47 to 68), 119 (58.9%) were women, and 43 (21.3%) cases showed dMMR. The only clinicopathological characteristics associated with dMMR were the location in the right colon and the presence of a family history of cancer. In the multivariate analysis, only the presence of the tumor in the right colon was associated with dMMR (OR = 5.823, 95%-C.I. = 2.653-12.784, p < .001).

CONCLUSION

The 21.3% of the cases demonstrated a dMMR and the only clinical-pathological characteristic associated with dMMR was location in the right colon.

Colorectal lymphoma in Mexico: clinico-pathological and survival analysis

Background

Primary colorectal lymphomas (PCLs) are very rare. We analyze a series of PCL to establish an approximate frequency of the disease and their clinico-pathological characteristics.

Methods

A retrospective cross-sectional study in a third-level hospital from 2006-2016. Clinico-pathologic features of 18 cases are presented.

Results

PCL corresponded to 1.5% of malignant colorectal neoplasms. Ten cases presented in men, the median age was 57 years, diffuse large B-cell lymphoma (DLBCL) was the most common subtype (55.6%), 55.6% presented in cecum, 83.4% as unique polypoid tumor and the median size was 52.5 mm. The most prevalent presentation symptom was abdominal pain (61.1%). Six cases (33%) received initial surgery followed by chemotherapy, 7 cases (39%) received only chemotherapy, 2 cases received only surgery and 3 cases no-treatment. The 2-year disease specific survival was 62.7%. The only factors associated with improved survival in univariate analysis were use of surgery followed by chemotherapy (P=0.043) and HIV (P=0.043). On multivariate analysis none factor was an independent risk factor for decreased survival.

Conclusions

The improved overall survival rates in our series emphasize the importance of surgery followed systemic therapy in the treatment of this disease.