Prognostic significance of tumour budding, tumour–stroma ratio and desmoplastic stromal reaction in gall bladder carcinoma

2021 ◽  
pp. jclinpath-2021-207957
Author(s):  
Surbhi Goyal ◽  
Priyanka Banga ◽  
Nisha Meena ◽  
Geeta Chauhan ◽  
Puja Sakhuja ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
High Risk ◽  
Gall Bladder ◽  
Clinicopathological Parameters ◽  
Resection Margins ◽  
Tumour Stroma ◽  
Stromal Reaction ◽  
Positive Resection Margins ◽  
Desmoplastic Stromal Reaction ◽  
Tumour Budding

Aims and methodsThe prognostic role of tumour budding (TBd) and its interaction with the stromal microenvironment has gained a lot of attention recently, but remains unexplored in gall bladder cancer (GBC). We aimed to study the interrelationship of TBd by International Tumour Budding Consensus Conference scoring system, tumour–stroma ratio (TSR) and desmoplastic stromal reaction (DSR) with the conventional clinicopathological prognostic factors, mortality and overall survival (OS) in 96 patients of operated GBC.ResultsHigher age, high TNM stage, lymphovascular and perineural invasion, positive resection margins, higher TBd score, low TSR and immature DSR were significantly associated with worse OS. However, on multivariate analysis, only metastases, positive resection margins and TSR <50% proved to be independent prognostic factors. The TBd score of stroma-rich tumour group (6.40±4.69) was significantly higher than that of stroma-poor group (2.77±3.79, p≤0.001). The TBd score of immature and intermediate DSR groups was significantly higher than that of mature group (p≤0.001 and p=0.002, respectively). There was a strong interobserver agreement for TBd score, TSR and type of DSR (Cohen’s Kappa=0.726 to 0.864, p≤0.001). Stroma-rich tumours were significantly associated with immature DSR and fibrotic DSR with high TSR (p≤0.001).ConclusionA high TBd, low TSR and immature DSR were significantly associated with several high-risk clinicopathological parameters and poor OS in GBC. These novel, simple, reproducible and cost-effective parameters may be included in the routine reporting checklist for GBC as additional prognostic parameters that can substratify the high-risk patients.

scholarly journals Parotid mucoepidermoid carcinoma with extensive intravenous metastasis: a case report

2021 ◽  
Vol 4 (1) ◽  
pp. 71-74
Author(s):  
Alice Flavell-Birch ◽  
Helen D Brasch ◽  
Swee T Tan
Keyword(s):  
Case Report ◽  
High Risk ◽  
Head And Neck ◽  
Adjuvant Radiotherapy ◽  
Mucoepidermoid Carcinoma ◽  
Resection Margins ◽  
Tumour Stage ◽  
Histological Grading ◽  
Adults And Children ◽  
Positive Resection Margins

Salivary tumours are uncommon, comprising only 2–5 per cent of head and neck neoplasms,1 with mucoepidermoid carcinoma (MEC) being the most common salivary cancer in both adults and children.1–4 Clinically, head and neck MEC can present variably from being asymptomatic to locally or metastatically aggressive.5,6 Treatment is primary surgical resection with neck dissection. The use of adjuvant radiotherapy is indicated for patients at high risk of recurrence, such as those with a high tumour stage, positive resection margins and high histological grading.6–8 

Outcomes and prognostic factors of localized, resected malignant salivary gland tumors: Examining a single institution’s 12-year experience to discover indications for adjuvant chemotherapy.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17587-e17587
Author(s):  
Tyler Gutschenritter ◽  
Michael Machiorlatti ◽  
Sara Vesely ◽  
Bilal Ahmad ◽  
Wajeeha Razaq ◽  
...  
Keyword(s):  
Salivary Gland ◽  
Prognostic Factors ◽  
Perineural Invasion ◽  
Smoking History ◽  
Adjuvant Chemoradiotherapy ◽  
Resection Margins ◽  
Survival Outcomes ◽  
Positive Resection Margins ◽  
Male Sex

e17587 Background: Survival outcomes remain poor in salivary gland malignancies (SGMs) with multiple poor prognostic factors despite adjuvant radiotherapy. We examined prognostic factors that portended poor survival in resected SGMs to determine possible indications for adjuvant chemoradiotherapy. Methods:Patients who underwent curative resection with or without adjuvant radiotherapy between 2002 and 2014 were identified and retrospective chart review was performed. Bivariate analysis was performed on continuous variables using Analysis of Variance. Chi-Square analysis and Fishers Exact Tests were performed on categorical variables. To evaluate the overall survival (OS) and disease-free survival (DFS), Kaplan-Meier curves and log-rank tests of homogeneity were used. Results: Overall, 99 patients met inclusion criteria. Median follow-up time was 46.8 months. Univariate analysis revealed male sex, smoking history ≥ 10 pack-years, high grade, stage III-IVB, squamous cell histology, and perineural invasion significantly impacted OS and DFS. High-risk histopathology significantly impacted DFS and trended towards poor OS. Positive resection margins trended towards significantly impacting DFS. Multivariate analysis revealed only male sex and perineural invasion significantly impacted OS and DFS. Conclusions: Survival outcomes remain poor for patients with high-grade, late-stage tumors with perineural invasion. Specifically, perineural invasion is a poor prognostic factor regardless of age, histology, stage, and grade. Males and patients with a smoking history ≥ 10 pack-years have worse survival outcomes with male sex being a more influential prognostic factor. Notably, this is the first study to quantify patient’s smoking history in malignant salivary gland tumors and assess the impact of pack-year smoking history on survival outcomes. Given our observed trend, positive resection margins would likely become significant influencer of DFS with larger sample size and longer follow up. Adjuvant chemoradiotherapy should be evaluated in patients with the above-mentioned characteristics.

Prognostic factors in patients with nonmetastatic gastric cancer treated with contemporary multimodality strategies.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 451-451
Author(s):  
Ariceli Alfaro ◽  
Tuyen Hoang ◽  
Jasmine Huynh ◽  
Jingran Ji ◽  
Andrew H. Ko ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Cox Regression ◽  
Cancer Recurrence ◽  
High Volume ◽  
Multimodality Therapy ◽  
Resection Margins ◽  
Study Cohort ◽  
Curative Intent ◽  
California Cancer Registry ◽  
Positive Resection Margins

451 Background: We conducted a retrospective study to evaluate clinical outcomes in patients with non-metastatic gastric adenocarcinoma (nmGA) treated at two high-volume academic institutions within the University of California (UC) system. Methods: Electronic Health Records and California Cancer Registry of demographic and clinical data were collected for pts with nmGA who underwent surgery with curative intent from 2010-2017. Medical chart reviews were conducted to validate outcomes. We used multivariate Cox regression to determine prognostic factors for cancer recurrence and overall survival. Results: Demographics of study cohort (n = 406): mean age 65 years; 71% male; 58% Caucasian, 26% Asian, 13% Latino. There was an even distribution between pts with locoregionally advanced (defined as pT4 or pN1+) vs. localized (pT1-3, pN0) disease. Tumor histology: 49% intestinal, 19% diffuse, 13% mixed, 19% unknown. Type of surgery: 27% open gastrectomy, 59% laparoscopic, 14% unknown. Multimodality therapy: 29% received perioperative systemic rx alone (48% adjuvant only, 52% neoadjuvant +/- adjuvant), 35% received perioperative systemic rx plus radiation (40% adjuvant only, 60% neoadjuvant +/- adjuvant), 36% underwent surgery only. With median f/u time after surgery of 5 years, 21% of pts developed cancer recurrence and 43% had died. Weight loss prior to diagnosis, locoregional stage, and positive resection margins were a/w recurrence (HR = 1.6-2.5, p < .05). Only locoregional stage was prognostic for worse survival (HR = 2.7, p < .0001). Positive resection margins were seen in 6% of pts and were a/w diffuse histology and tumor size > 4cm (odds ratio = 2.9-8.8, p < .02). Multimodality therapy was not a/w recurrence but was a/w longer survival after adjusting for stage (HR = 0.3, p < .0001). Addition of radiation to systemic rx did not confer further improvements in either recurrence or survival. Conclusions: This study highlights contemporary practice patterns for pts with nmGA and demonstrates a survival benefit with multimodality rx. Additional data are being gathered from other UC medical centers to confirm these findings and explore differences across institutions and ethnicities.

scholarly journals Ten-Year Survival after Liver Resection for Colorectal Metastases: Systematic Review and Meta-Analysis

ISRN Oncology ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-11 ◽  
Author(s):  
Saleh Abbas ◽  
Vincent Lam ◽  
Michael Hollands
Keyword(s):  
Prognostic Factors ◽  
Liver Resection ◽  
Resection Margin ◽  
Meta Analysis ◽  
Colorectal Metastases ◽  
Resection Margins ◽  
Primary Disease ◽  
Clear Resection Margin ◽  
Node Involvement ◽  
Positive Resection Margins

Background. Liver resection in metastatic colorectal cancer is proved to result in five-year survival of 25–40%. Several factors have been investigated to look for prognostic factors stratifications such as resection margins, node involvement in the primary disease, and interval between the primary disease and liver metastases. Methods. We searched MEDLINE and EMBASE for studies that reported ten-year survival. Metaanalysis was performed to analyse the effect of recognised prognostic factors on cure rate for colorectal metastases. The meta-analysis was performed according to Ottawa-Newcastle method of analysis for nonrandomised trials and according to the guidelines of the PRISMA. Results. Eleven studies were included in the analysis, which showed a ten-year survival rate of 12–36%. Factors that have favourable impact are clear resection margin, low level of CEA, single metastatic deposit, and node negative disease. The only factor that excluded patients from cure is the positive status of the resection margin. Conclusion. Predicted ten-year survival after liver resection for colorectal metastases varies from 12 to 36%. Only positive resection margins resulted in no 10-year survivors. No patient can be excluded from consideration for liver resection so long the result is negative margins.

scholarly journals High-risk morphological features are less prevalent among small (<5mm) papillary thyroid microcarcinomas compared to larger (≥5mm) tumors: a study of 206 cases

2021 ◽  
Vol 67 (2) ◽  
pp. 108-114
Author(s):  
Emőke-Andrea Szász ◽  
Adela Nechifor-Boilă ◽  
Ancuța Zahan ◽  
Angela Borda
Keyword(s):  
High Risk ◽  
Giant Cells ◽  
Lymph Node Involvement ◽  
Morphological Features ◽  
Resection Margins ◽  
Multinucleated Giant Cells ◽  
Papillary Thyroid ◽  
Tumor Aggressiveness ◽  
Stromal Reaction ◽  
Nuclear Features

Abstract Introduction: Papillary thyroid microcarcinoma (PTMC) is defined as a PTC measuring 1 cm or less, incidentally discovered. The aim of this study was to determine whether small (<5mm) tumors by contrast with large (≥5mm) ones are less frequently associated with high-risk morphological features, predictive of tumor aggressiveness. Materials and methods: All consecutive PTMC cases registered at the Department of Pathology, Târgu-Mureş Emergency County Hospital between 2003-2014 were reviewed. The following have been assessed: tumor size, subcapsular versus nonsubcapsular location, extrathyroidal extension/invasion into the perithyroidal adipose tissue, multifocality, resection margins, lymph node involvement, histological variant, tumor border, stromal reaction (fibrosis/desmoplasia/sclerosis), presence of plump pink cells, nuclear features of the tumor cells, intratumoral lymphocytic infiltrate, multinucleated giant cells, psammoma bodies and stromal calcification. The cases were split in two categories: small (< 5mm) and large (≥ 5mm) PTMCs and the pathological features were evaluated in comparison. Results: Our study included 206 cases, 91 large and 115 small PTMCs, respectively. Large PTMCs were significantly associated with the presence of plump pink cells (p=0.002), well developed PTC nuclear features (p=0.003), stromal reaction (fibrosis/desmoplasia/sclerosis) (p<0.001), infiltrative tumor border (p=0.011), subcapsular location (p<0.001), positive resection margins (p=0.022), stromal calcifications (p<0.001) and intratumoral multinucleated giant cells (p<0.001). Small PTMCs were generally well circumscribed and nonsubcapsular. Conclusions: Our results have shown that small (<5mm) PTMCs are less frequently associated with high-risk morphological features, predictive of tumor aggressiveness compared with large (≥5mm) tumors and could thus be considered as low-risk cancers.

Relevance of Positive Resection Margins in Ductal Pancreatic Adenocarcinoma and Prognostic Factors

2020 ◽  
Vol 98 (2) ◽  
pp. 85-91
Author(s):  
Juan Ocaña ◽  
Alfonso Sanjuanbenito ◽  
Alba García ◽  
José Manuel Molina ◽  
Eduardo Lisa ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Pancreatic Adenocarcinoma ◽  
Resection Margins ◽  
Ductal Pancreatic Adenocarcinoma ◽  
Positive Resection Margins

scholarly journals PROGNOSTIC FACTORS OF RELAPSE IN THE SURGICAL TREATMENT OF DESMOID FIBROIDS OF THE TRUNK AND EXTREMITIES

2019 ◽  
Vol 6 (1) ◽  
pp. 21-32
Author(s):  
A. V. Yadrina ◽  
V. Yu. Karpenko ◽  
O. V. Novikova ◽  
N. M. Bychkova ◽  
V. A. Derzhavin ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Surgical Treatment ◽  
Upper Limb ◽  
Soft Tissues ◽  
Histological Study ◽  
Shoulder Girdle ◽  
Resection Margins ◽  
Positive Resection Margins ◽  
Reconstructive Plastic Surgery

Purpose of the study. Evaluation of the results of surgical treatment of desmoid fibroids (DF) using reconstructive plastic surgery and determination of possible prognostic factors of relapses.Patients and methods. The results of surgical treatment of 40 patients with desmoid fibroids of extra abdominal local­ization were analyzed. In 45% of patients, the tumor was located in soft tissues of the shoulder girdle and upper limb, in 35% — on the trunk, in 20% — in soft tissues of the lower limb and in 7% of patients on the neck. The tumor size varied from 2 to 20 cm, the median was 8 ± 4.38 cm. Surgical treatment for newly diagnosed DF was performed in 22 (55%) patients, and for recurrent tumors — in 18 (45%) patients.Results. According to the planned histological study, negative resection boundaries were established in 24/40 patients (63%). In the remaining 16 cases (37%) positive resection margins were obtained: R1 in 14 patients and R2 in 2 patients. Adjuvant treatment is recommended for 14 patients with resection R1/R2. The duration of follow — up after treatment ranged from 6 to 107 months, median‑16.5 months. During follow-up, relapses were diagnosed in 14 patients (35%). No deaths have been reported.Conclusion. Surgical treatment of DF of extraabdominal localization is accompanied by a sufficiently high frequency of relapses. According to the results of the study, an unfavorable factor in the development of relapses is the location of the tumor in soft tissues of the shoulder girdle and upper limb.

Inverted Papilloma: Prognostic Factors with Implications for Resection Margins

2013 ◽  
Vol 74 (S 01) ◽  
Author(s):  
Giant Lin ◽  
Mark Zacharek ◽  
Sarah Akkina ◽  
Steven Chinn ◽  
Jonathan McHugh ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Inverted Papilloma ◽  
Resection Margins

scholarly journals Radiation-Associated Angiosarcoma of the Breast and Chest Wall Treated with Thermography-Controlled, Contactless wIRA-Hyperthermia and Hypofractionated Re-Irradiation

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3911
Author(s):  
Markus Notter ◽  
Emanuel Stutz ◽  
Andreas R. Thomsen ◽  
Peter Vaupel
Keyword(s):  
Local Recurrence ◽  
Background Radiation ◽  
Definitive Treatment ◽  
Resection Margins ◽  
Recurrence Rates ◽  
Rate Dependent ◽  
Angiosarcoma Of The Breast ◽  
Positive Resection Margins ◽  
Locally Recurrent ◽  
Tumor Extent

Background: Radiation-associated angiosarcoma of the breast (RAASB) is a rare, challenging disease, with surgery being the accepted basic therapeutic approach. In contrast, the role of adjuvant and systemic therapies is a subject of some controversy. Local recurrence rates reported in the literature are mostly heterogeneous and are highly dependent on the extent of surgery. In cases of locally recurrent or unresectable RAASB, prognosis is very poor. Methods: We retrospectively report on 10 consecutive RAASB patients, most of them presenting with locally recurrent or unresectable RAASB, which were treated with thermography-controlled water-filtered infrared-A (wIRA) superficial hyperthermia (HT) immediately followed by re-irradiation (re-RT). Patients with RAASB were graded based on their tumor extent before onset of radiotherapy (RT). Results: We recorded a local control (LC) rate dependent on tumor extent ranging from a high LC rate of 100% (two of two patients) in the adjuvant setting with an R0 or R2 resection to a limited LC rate of 33% (one of three patients) in patients with inoperable, macroscopic tumor lesions. Conclusion: Combined HT and re-RT should be considered as an option (a) for adjuvant treatment of RAASB, especially in cases with positive resection margins and after surgery of local recurrence (LR), and (b) for definitive treatment of unresectable RAASB.

Predicting Surgical Margins in Patients With Borderline Resectable and Locally Advanced Pancreatic Cancer Undergoing Resection

2021 ◽  
pp. 000313482110111
Author(s):  
Weizheng Ren ◽  
Dimitrios Xourafas ◽  
Stanley W. Ashley ◽  
Thomas E. Clancy
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Ductal Adenocarcinoma ◽  
Resection Margins ◽  
Borderline Resectable ◽  
Stepwise Selection ◽  
R1 Resection ◽  
Positive Resection Margins

Background Many patients with borderline resectable/locally advanced pancreatic ductal adenocarcinoma (borderline resectable [BR]/locally advanced [LA] pancreatic ductal adenocarcinoma [PDAC]) undergoing resection will have positive resection margins (R1), which is associated with poor prognosis. It might be useful to preoperatively predict the margin (R) status. Methods Data from patients with BR/LA PDAC who underwent a pancreatectomy between 2008 and 2018 at Brigham and Women’s Hospital were retrospectively reviewed. Logistic regression analysis was used to evaluate the association between R status and relevant preoperative factors. Significant predictors of R1 resection on univariate analysis ( P < .1) were entered into a stepwise selection using the Akaike information criterion to define the final model. Results A total of 142 patients with BR/LA PDAC were included in the analysis, 60(42.3%) had R1 resections. In stepwise selection, the following factors were identified as positive predictors of an R1 resection: evidence of lymphadenopathy at diagnosis (OR = 2.06, 95% CI: 0.99-4.36, P = .056), the need for pancreaticoduodenectomy (OR = 3.81, 96% CI: 1.15-15.70, P = .040), extent of portal vein/superior mesenteric vein involvement at restaging (<180°, OR = 3.57, 95% CI: 1.00-17.00, P = .069, ≥180°, OR = 7,32, 95% CI: 1.75-39.87, P = .010), stable CA 19-9 serum levels (less than 50% decrease from diagnosis to restaging, OR = 2.27, 95% CI: 0.84-6.36 P = .107), and no preoperative FOLFIRINOX (OR = 2.17, 95% CI: 0.86-5.64, P = .103). The prognostic nomogram based on this model yielded a probability of achieving an R1 resection ranging from <5% (0 factors) to >70% (all 5 factors). Conclusions Relevant preoperative clinicopathological characteristics accurately predict positive resection margins in patients with BR/LA PDAC before resection. With further development, this model might be used to preoperatively guide surgical decision-making in patients with BR/LA PDAC.

Sign in / Sign up

Export Citation Format

Share Document