The Prognostic Significance of Cytopenia in Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 746-746
Author(s):  
Clive S. Zent ◽  
Wei Ding ◽  
Karin F. Giordano ◽  
Susan M. Schwager ◽  
Tait D. Shanafelt ◽  
...  
Keyword(s):  
Poor Prognosis ◽  
Accurate Determination ◽  
Prognostic Significance ◽  
Lymphocytic Leukemia ◽  
Clinical Staging ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Staging Systems ◽  
Prognostic Importance ◽  
Worse Prognosis

Abstract Background: Historically, CLL patients with cytopenia were thought to have a poor prognosis and cytopenia is a key feature of CLL clinical staging systems. The implications of cytopenia in CLL could have changed because of improved diagnostic accuracy, increased recognition of early stage disease, and better treatments. Newer data suggest that the etiology of cytopenia determines its prognostic importance in CLL. Patients with cytopenia caused by autoimmune disease (AID) are less likely to have the poor prognosis associated with patients with bone marrow (BM) failure. To determine the prognostic significance of cytopenia in patients with CLL, we performed an observational study at Mayo Clinic Rochester (MCR). Methods: We studied all patients with CLL seen in the Division of Hematology at MCR from 1 January 1995 to 31 December 2004 (n = 1,750). Cytopenia (hemoglobin < 10 g/dL or platelet count < 100 × 09/L) was considered due to BM failure in patients with extensive BM involvement by CLL (< 20% residual myeloid tissue on BM biopsy) or reticulocytopenia without other causes persisting > 3 months after CLL therapy. Cytopenia was attributed to AID in patients with autoimmune hemolytic anemia (AIHA), immune thrombocytopenia (ITP), pure red blood cell aplasia (PRCA), or autoimmune granulocytopenia (AIG). Results: Median age at diagnosis of CLL was 63.7 years (69% male). Cytopenia occured in 423 (24.2%) patients. In 303 patients, cytopenia was due to CLL (228 BM failure and 75 AID). In 120 patients cytopenia was due to CLL related factors (splenomegaly, n = 11; possible AID, n = 18; treatment of CLL, n = 16) or non CLL causes (other malignancy, n = 12; iron deficiency, n = 11; anemia of chronic disease, n = 10; renal failure, n = 6; drugs effect, n = 4; surgical blood loss n = 4). In 28 (6.6%) patients the cause of cytopenia was not definitively determined. Of the patients with BM failure, 97 (43%) had cytopenia at CLL diagnosis (70% male, median age 63.3 years [range 32–95]), The AID patients the median age of CLL diagnosis was 66.7 years (range 30–85) with 79% male. AID diagnoses were AIHA (n = 41), ITP (n= 35), PRCA (n=8), and AIG (n=3); 9 patients had > 1 AID. Survival from diagnosis of cytopenia was significantly better for patients with AID (median 9.1 years) than BM failure (median 4.4 years, p < 0.001). AID patients had a longer survival from diagnosis of CLL (median 12.4 years) versus the rest of the CLL population (median 9.5 years, p = 0.020) but patients with BM failure at diagnosis had a worse prognosis (median 6.2 years, p < 0.001). Conclusion: We show that the etiology of cytopenia in CLL patients determines its prognostic importance. Anemia and thrombocytopenia caused by BM failure, but not AID, are associated with a significantly worse prognosis. These data show the importance of accurate determination of the etiology of cytopenia in all patients with CLL. Cytopenia in patients with AID is not a marker of advanced stage disease; these patients often need different management compared to those with BM failure. Cytopenia due to AID versus BM failure can be difficult to distinguish and a BM study should be done in all patients considered for treatment. Patients with cytopenia due to AID cannot be meaningfully classified by current clinical staging systems. We believe that efforts to review the NCI-WG 96 criteria are timely and should consider the etiology of cytopenia in CLL patients.

Vaginal sarcoma: the Royal Marsden experience

1994 ◽  
Vol 4 (5) ◽  
pp. 337-341 ◽  
Author(s):  
H. Y.S. Ngan ◽  
J. H. Shepherd ◽  
C. Fisher ◽  
P. Blake
Keyword(s):  
Late Stage ◽  
Poor Prognosis ◽  
Recurrent Disease ◽  
Early Stage ◽  
Tumor Grade ◽  
Intermediate Grade ◽  
Early Stage Disease ◽  
The Poor ◽  
Stage Disease ◽  
Prognostic Importance

Six patients with vaginal sarcoma are reported here. This clinicopathologic review confirms the poor prognosis of this disease. However, there were three 5-year survivors, all of whom had early stage disease and low to intermediate grade tumors. Apart from tumor grade, stage was of prognostic importance. Late recurrences at 5 and 21 years were noted in two of the three 5-year survivors. Neither chemotherapy nor radiotherapy were of use in the treatment of late stage or recurrent disease.

Clinical significance of ZAP-70 protein expression in B-cell chronic lymphocytic leukemia

Blood ◽  
2006 ◽  
Vol 108 (3) ◽  
pp. 853-861 ◽  
Author(s):  
Maria Ilaria Del Principe ◽  
Giovanni Del Poeta ◽  
Francesco Buccisano ◽  
Luca Maurillo ◽  
Adriano Venditti ◽  
...  
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
B Cell ◽  
Prognostic Significance ◽  
Normal Karyotype ◽  
Progression Free Survival ◽  
Lymphocytic Leukemia ◽  
Clinical Staging ◽  
Mutational Status ◽  
Staging Systems ◽  
Cell Chronic Lymphocytic Leukemia

Abstract The clinical course of B-cell chronic lymphocytic leukemia (B-CLL) is variable, and novel biologic parameters need to be added to the clinical staging systems to predict an indolent or aggressive outcome. We investigated the 70-kDa zeta-associated protein (ZAP-70), CD38, soluble CD23 (sCD23), and cytogenetics in 289 patients with B-CLL. Both a shorter progression-free survival (PFS) and overall survival (OS) were observed in ZAP-70+ (P < .001), in CD38+ (P < .001) and in sCD23+ patients (P < .001 and P = .013, respectively). ZAP-70+CD38+ or ZAP-70+ patients with an unmutated IgVH status showed both a shorter PFS (P < .001) and OS (P < .001 and P < .001, respectively) as compared with ZAP-70–/CD38– or ZAP-70– patients with mutated IgVH genes. Discordant patients showed an intermediate outcome. Note, ZAP-70+ patients even if CD38– or mutated showed a shorter PFS, whereas ZAP-70– patients even if CD38+ or unmutated had a longer PFS. Furthermore, ZAP-70 positivity was associated with a shorter PFS both within normal karyotype (P < .001) and within the poor-risk cytogenetic subset (P = .02). The predictive value of ZAP-70 expression was confirmed in multivariate analysis. Thus, ZAP-70 protein determined by flow cytometry improves the prognostic significance of cytogenetics and appears to be a better predictor of outcomes than IgVH gene mutational status. On this line, we recommend and are also interested in conducting a prospective randomized trial of early intervention versus observation for ZAP-70+ patients.

scholarly journals How to Improve the Definition of Chronic Lymphocytic Leukemia Outcome Using a Simple Flow Cytometric Score Based on CD49d and Homing Marker Expression

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5567-5567
Author(s):  
Valentina Giudice ◽  
Monia Rocco ◽  
Luca Pezzullo ◽  
Giancarlo Villani ◽  
Rosa Rosamilio ◽  
...  
Keyword(s):  
Early Stage ◽  
Lymphocytic Leukemia ◽  
Early Stage Disease ◽  
Cd38 Expression ◽  
Flow Cytometric ◽  
Stage Disease ◽  
Genetic Abnormalities ◽  
Staging Systems ◽  
Definition Of

Abstract The identification of new molecular markers in Chronic Lymphocytic Leukemia (CLL) allowed to better define prognosis and clinical outcome. The actual staging systems could estimate the prognosis, but not the rapidity of disease evolution. Neither the identification of new molecular markers did allow to foresee the evolution and clinical response, because discordant findings were mostly reported. The aim of the present study was (1) to confirm the independent prognostic role of CD49d as a single marker in CLL patients, (2) to investigate the relationship between CD49d and other well-established CLL-membrane predictor markers (CD5, CD11c, CD20 and CD38) or clinical staging systems and (3) to evaluate the role of an immunophenotypic score based on the flow-cytometric detection of CD5, CD11c, CD20, CD38 and CD49d in the work up of CLL staging. Heparinized whole blood was collected from 68 CLL patients for immunophenotyping using the following antibodies: anti kappa, anti-lambda, CD5, CD11c, CD19, CD20, CD23, CD38, CD45, CD49d. A scoring system was elaborated combining 5 membrane markers: CD5, CD11c, CD20, CD38 and CD49d. Antigens were divided in two groups, favorable (CD5 and CD20) and unfavorable (CD11c, CD38 and CD49d) prognostic markers, and the cut-off of positivity was chosen according to the literature (30% for CD5, CD11c, CD20 and CD38, and 45% for CD49d). A value of "0" or "1" ("2" only for CD49d positivity) was assigned according to antigen expression. Finally, we defined a favorable phenotype when the sum of all the cytometric features was equal or less than 2, conversely the unfavorable phenotype was defined for a sum equal or greater than 3 (between 3 and 6). Flow cytometric analysis showed high CD49d expression in CD19+ cells in 47% of patients (n=32), and high CD38 expression in 44% of subjects (n=30), simultaneously expressed in 28% of patients (n=19). The 19% (n=13) of all CLL patients were CD5-, and interestingly the 85% of them showed higher expression of CD49d. Linear correlation was found between CD49d and CD38 (r2=0.08772, p=0.0142), and between CD49d and CD20 expression (r2=0.2490, p<0.0001). For CD5, the opposite tendency was registered (r2=0.1944, p=0.0002). Strong negative correlation between higher CD49d expression and total lymphocyte count was found (Pearson r = -0.3577, r2=0.1279, p=0.0068), but not for hemoglobin level and platelet count. The statistical power of each parameter of the score was also calculated by Chi-square test and all markers displayed a statistically significant weight (p<0.0001). After assessed the prognostic power of each marker, we applied the score to staged patients. Forty patients (59%) had a Favorable Phenotype and 28 of them (70%) an early stage disease; in this group of patients, only 7.5% (n=3) showed CD49d high expression. The overall response rate (ORR) was of 58%. The other 28 patients (41%) showed an Unfavorable Phenotype and 21 of them (75%) had an early stage disease. In this arm, all subjects carried>45% of CD49d positive cells. Four patients with Unfavorable Phenotype received chemotherapy with an ORR of 25%. Furthermore, a small population (n=16) of our CLL cohort was also studied for genetic abnormalities using FISH technique. According to FISH analysis, 25% of studied patients were classifies as very low-risk and, interestingly, no one of them showed an Unfavorable Phenotype (only one patient carried CD49d as unique negative marker). In our cohort, 50% of patients were low-risk with no genetic abnormalities or +12, but 63% of them showed an Unfavorable Phenotype with high CD49d and CD38 expression in 100% and 60% of cases, respectively. Our data confirm the independent negative prognostic role of CD49d and suggest a stronger prognostic power compared to CD38 in the definition of CLL outcome, because of its complex activity as homing marker, signaling receptor and anti-apoptotic molecule. Thus, the prognostic significance of CD49d may be enhanced when considered in comparison with other established markers, as CD11c and CD38. In conclusion, our results propose the use of the CD49d marker in combination with other B-cell membrane antigens as an additional tool for routine diagnosis and risk-stratification of CLL patients. Identification of high-risk phenotype with a simple scoring method could improve the treatment of these patients, who could take advantage of the most recent molecular targeting therapies. Disclosures No relevant conflicts of interest to declare.

scholarly journals Hypercalcemia Remains an Adverse Prognostic Factor for Newly Diagnosed Patients with Symptomatic Multiple Myeloma in the Era of Novel Anti-Myeloma Therapies, Independently of Age, ISS Stage and Treatment Type: An Analysis of 2129 Patients

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2113-2113 ◽  
Author(s):  
Athanasios Zomas ◽  
Evangelos Terpos ◽  
Eirini Katodritou ◽  
Argiris Symeonidis ◽  
Sosana Delimpasi ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Prognostic Factor ◽  
Serum Calcium ◽  
Bone Disease ◽  
Poor Prognosis ◽  
Prognostic Significance ◽  
Newly Diagnosed ◽  
Treatment Type ◽  
Prognostic Importance ◽  
Definition Of

Abstract Hypercalcemia is a defining feature of symptomatic multiple myeloma (MM). Its presence has been associated with lytic bone disease and complications such as renal impairment. The definition of hypercalcemia for symptomatic myeloma requires a corrected serum calcium >11 mg/dl or 1 mg/dl above the upper limit of normal. However, the prognostic significance of hypercalcemia has not been studied extensively, especially in the era of novel anti-myeloma therapies. To address this issue, we analyzed 2129 patients with symptomatic MM who were treated within the centers of the Greek Myeloma Study Group. Using the definition of IMWG, 19.5% of the patients with symptomatic MM had hypercalcemia (i.e. corrected serum calcium ≥ 11 mg/dl). The incidence of hypercalcemia decreased over time (23% before 2000, 18.7% during period 2000-2006 and 16.3% after 2007; p=0.004). The presence of hypercalcemia was strongly associated with severe anemia (Hb <10 g/dl), low platelet counts < 130x109/l, advanced ISS stage, moderate or severe renal dysfunction, elevated LDH, poor performance status (PS) and extensive bone disease (p<0.001 for all comparisons). Regarding bone disease, only 4 patients had hypercalcemia without lytic bone lesions in plain X-rays. In the subgroup of patients, treated in a single center (Alexandra Hospital), with available cytogenetics (N=418), hypercalcemia was associated with the presence of del13q (by FISH) (p=0.003) and of amp1q21 (p=0.022), marginally with the presence of del17p (p=0.081), but not with t(4;14) (p=0.392) or t(11;14) (p=0.66). In multivariate analysis hypercalcemia (>11 mg/dl) was independently associated with poor prognosis (HR: 1.248, 95% CI 1.082-1.439, p=0.002), along with ISS stage, age, poor PS, elevated LDH, Hb <10 g/dl, platelet counts <130x109/L. The prognostic importance of hypercalcemia was independent of the presence of osteolytic bone disease and identified groups with poor prognosis within each ISS-stage (Figure). This effect was more pronounced in patients with ISS-1 (median OS 73 vs 41 months in the presence of hypercalcemia, p<0.001) or ISS-2 (median overall survival (OS) 43 vs 22 months in the presence of hypercalcemia, p=0.001), while in patients with ISS-3, hypercalcemia was associated with very poor outcome (11 vs 27 months of patients without hypercalcemia, p<0.018). Hypercalcemia was also associated with a two-fold increase in the risk of early death (within <2 months): 9.4% vs 4.6% (p<0.001). The presence of hypercalcemia remains a significant prognostic factor even after the introduction of novel therapies, after 2000. We compared the OS of patients with hypercalcemia before and after 2000: the median OS of patients who presented with hypercalcemia improved from 17 months before 2000 to 36 months after 2000 (p<0.001). When the effect of different treatments (conventional chemotherapy, thalidomide, lenalidomide, bortezomib) was evaluated then the use of novel agents was associated with a major improvement in survival of patients with hypercalcemia (median OS: 44, 45 and 46.5 months for those treated with thalidomide, lenalidomide or bortezomib, respectively vs 19 months for those treated with conventional regimens in the absence of novel agents, p<0.001). However, the prognostic importance of hypercalcemia was independent of the type of primary therapy. A prognostic score which includes ISS stage (1, 2 and 3 points for ISS-1, -2 and -3, respectively), presence of hypercalcemia (1 point, 0 for no hypercalcemia) and age (1, 2, 3 and 4 points for ages <55, 55-65, 65-75 and >75 years, respectively), could identify 7 groups of patients with very distinct outcomes and median OS of >10 years (score 2), 84 months (score 3), 55 months (score 4), 42 months (score 5), 31 months (score 6), 19 months (score 7) and 14 months (score 8; p<0.001). In conclusion, hypercalcemia is present in about 19.5% of patients with newly diagnosed symptomatic MM and is associated with poor outcome and specific cytogenetic abnormalities (del 13q by FISH, amp1q21). Its prognostic significance is independent of age, ISS stage and treatment type. The use of new drugs has improved the survival of patients with hypercalcemia, however, the prognostic implications of the presence of hypercalcemia indicates that this factor should be taken into account for the prognostic assessment of patients with MM together with other established factors such as ISS and age. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals Clinical staging of chronic lymphocytic leukemia

Blood ◽  
1975 ◽  
Vol 46 (2) ◽  
pp. 219-234 ◽  
Author(s):  
KR Rai ◽  
A Sawitsky ◽  
EP Cronkite ◽  
AD Chanana ◽  
RN Levy ◽  
...  
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Median Survival ◽  
Prognostic Significance ◽  
Stage Iv ◽  
Staging System ◽  
Lymphocytic Leukemia ◽  
Stage Ii ◽  
Stage Iii ◽  
Clinical Staging ◽  
Survival Times

A method of clinical staging of chronic lymphocytic leukemia (CLL) has been proposed which is based on the concept that CLL is a disease of progressive accumulation of nonfunctioning lymphocytes: stage O, bone marrow and blood lymphocytosis only; stage 1, lymphocytosis with enlarged nodes; stage II, lymphocytosis with enlarged spleen or liver or both; stage III, lymphocytosis with anemia; and stage IV:lymphocytosis with thrombocytopenia. Analysis of 125 patients. in the present series showed the following median survival times (in months) from diagnosis: stage 0, is greater than 150; stage I 101; stage II, 71; stage III, 19; stage IV, 19, The median survival for the entire series was 71 mo. The prognostic significance of the stage remained even after adjustment was made for age and sex. However, both sex and age were shown to be poor predictors of survival after adjustment for stage. The method of staging proved to be a reliable predictor of survival whether used at diagnosis or during the course of the disease. The proposed staging system was an equally accurate indicator for survival when applied to two other previously published studies of large series of patients.

scholarly journals Clinical Staging and Flowcytomteric CD38 and Zap 70 Prognostic Indicators in Sudanese Patients with Chronic Lymphocytic Leukemia

2020 ◽  
Author(s):  
Enaam Abdelrhman Abdelgader ◽  
Nada Hassan Eltayeb ◽  
Tasniem Ahmed Eltahir ◽  
Osama Ali Altayeb ◽  
Eman Abbass Fadul ◽  
...  
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Stage Iv ◽  
Cross Sectional Study ◽  
Lymphocytic Leukemia ◽  
Clinical Staging ◽  
Prognostic Indicators ◽  
P Value ◽  
Cross Sectional ◽  
Cd38 Expression ◽  
Staging Systems

Background: The clinical course of chronic lymphocytic leukemia is highly variable. The determination of ZAP70 and CD38 is increasingly utilized as prognostic factor for chronic lymphocytic leukemia. The aim of conducting this study was to investigate the frequency of CD38 and ZAP70 expression among Sudanese Chronic lymphocytic leukemia (CLL) patients and to relate them to the Binet and Rai clinical staging systems. Method: A total of 93 patients (mean age; 62.29 ± 11.68, sd) were enrolled in this cross-sectional study. CD38 and ZAP70 expression levels were measured with four color flowcytometry using the cut-off values of 20% for ZAP70 and 30% for CD38 expression. Staging was assessed by using clinical examination and CBC for all patients. Data were analyzed using the Statistical Package for Social science for Windows (SPSS), version 22. Results: There were 93 CLL patients and the median age of the group was 63 years (36–95 years). About 71% of the patients presented with lymphadenopathy, 53.8% with splenomegaly, 73.1% with anemia, and 45.2% with thrombocytopenia. There was higher frequency of Binet stage C and Rai stage IV (62 [66.6%] patients and 34 [36.5%] patients, respectively). In addition, CD38 and ZAP70 showed higher frequency among Binet and Rai advance stages. ZAP70 and CD38 positivity were detected in 21 patients (22.6%) and 31 patients (33.3%), respectively. There was no statistically significant association between ZAP70 and CD38 and clinical staging systems (P-value > 0.05). Conclusion: No significant association was observed between Flowcytometric (CD38 and Zap70) Prognostic Indicators and clinical staging systems. Keywords: chronic lymphocytic Leukemia, Flowcytometry, ZAP70, CD38, clinical staging systems

Prognostic nomogram and index for overall survival in previously untreated patients with chronic lymphocytic leukemia

Blood ◽  
2007 ◽  
Vol 109 (11) ◽  
pp. 4679-4685 ◽  
Author(s):  
William G. Wierda ◽  
Susan O'Brien ◽  
Xuemei Wang ◽  
Stefan Faderl ◽  
Alessandra Ferrajoli ◽  
...  
Keyword(s):  
Overall Survival ◽  
Chronic Lymphocytic Leukemia ◽  
Prognostic Model ◽  
Clinical Decision Making ◽  
Early Stage ◽  
Lymphocytic Leukemia ◽  
Cox Proportional Hazards Model ◽  
Cancer Center ◽  
Early Stage Disease ◽  
Staging Systems

Abstract The clinical course for patients with chronic lymphocytic leukemia is extremely heterogeneous. The Rai and Binet staging systems have been used to risk-stratify patients; most patients present with early-stage disease. We evaluated a group of previously untreated patients with chronic lymphocytic leukemia (CLL) at initial presentation to University of Texas M. D. Anderson Cancer Center to identify independent characteristics that predict for overall survival. Clinical and routine laboratory characteristics for 1674 previously untreated patients who presented for evaluation of CLL from 1981 to 2004 were included. Univariate and multivariate analyses identified several patient characteristics at presentation that predicted for overall survival in previously untreated patients with CLL. A multivariate Cox proportional hazards model was developed, including the following independent characteristics: age, β-2 microglobulin, absolute lymphocyte count, sex, Rai stage, and number of involved lymph node groups. Inclusion of patients from a single institution and the proportion of patients younger than 65 years may limit this model. A weighted prognostic model, or nomogram, predictive for overall survival was constructed using these 6 characteristics for 5- and 10-year survival probability and estimated median survival time. This prognostic model may help patients and clinicians in clinical decision making as well as in clinical research and clinical trial design.

Significant upstaging of patients with stage I pancreatic cancer from clinical to pathologic staging.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 349-349
Author(s):  
Heather Stuart ◽  
Caroline Ripat ◽  
Basem Azab ◽  
Danny Yakoub ◽  
Dido Franceschi ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Early Stage ◽  
Clinical Stage ◽  
Stage I ◽  
Clinical Staging ◽  
Early Stage Disease ◽  
Risk Of Mortality ◽  
Stage Disease ◽  
Pathologic Staging ◽  
Group 2

349 Background: Clinical staging of patients with pancreatic cancer is essential to determine if neo-adjuvant treatment, surgery or palliative treatment is required. Patients with early stage disease often receive upfront surgery, where as patients with more advanced disease often receive neo-adjuvant therapy. Therefore the accuracy of clinical staging significantly influences management decisions. This study investigates the correlation between clinical and pathologic staging for patients with stage I pancreatic cancer. Methods: A retrospective review of patients with pancreatic cancer in National Cancer Data Base from 1998-2006 was preformed. The clinical stage of patients with presumed stage I disease was compared to the postoperative pathologic stage. Cox proportional hazard ratio model and regression analysis were used to determine factors associated with mortality and upstaging, respectively. Results: 1697 patients with clinical stage I pancreatic cancer were divided into two groups. Group 1 was comprised of patients who were stage I postoperatively and Group 2 was comprised of patients that were upstaged to either stage II, III or IV postoperatively. There were 704 (41%) in group 1 and 993 (59%) in group 2. Within group 2, 595 (60%) were stage II, 321 (32%) were stage III and 77 (8%) were stage IV. Patients that were upstaged after surgery had an increased risk of mortality (HR 1.414, p < 0.001), whereas patients that received adjuvant chemotherapy had a decreased risk of mortality (HR 0.799, p < 0.001). Compared to Grade 1 tumors, Grade 2 and 3 tumors on biopsy were most likely to be upstaged on final pathology (p < 0.001). Conclusions: Patients with stage I pancreatic cancer are often candidates for upfront surgery, however this study demonstrates that a large number are upstaged on postoperative staging. Recognizing this may lead clinicians to administer neo-adjuvant treatment in a greater number of patients with early stage disease in order to optimize survival.

Neuroendocrine Differentiation in Colorectal Carcinomas Assessing its Prognostic Significance

2003 ◽  
Vol 89 (1) ◽  
pp. 49-53 ◽  
Author(s):  
Pinar Atasoy ◽  
Arzu Ensari ◽  
Salim Demirci ◽  
Nazmiye Kurşun
Keyword(s):  
Chromogranin A ◽  
Poor Prognosis ◽  
Prognostic Significance ◽  
Neuron Specific Enolase ◽  
Neuroendocrine Differentiation ◽  
Colorectal Cancers ◽  
Histologic Type ◽  
Colorectal Carcinomas ◽  
Neuroendocrine Marker ◽  
Worse Prognosis

Aims and Background There is evidence that colorectal carcinomas with extensive neuroendocrine features have a substantially worse prognosis than those without, but the frequency and clinical significance of neuroendocrine features in conventional carcinomas has not been settled since few studies have been performed, with conflicting results. The aim of the study was to investigate neuroendocrine differentiation in colorectal carcinomas in relation to its prognostic significance. Methods In 50 patients with colorectal carcinoma, the extent and intensity of staining with each of the three antibodies (chromogranin A, neuron-specific enolase and synaptophysin) were determined and correlated with the histologic type, grade, stage of the tumor and survival time of the patients. Results We observed chromogranin A expression in 38%, neuron-specific enolase expression in 26%, and synaptophysin expression in 6% of the tumors. Chromogranin A was the most frequently and strongly expressed marker in our study. Of the three antibodies studied, only chromogranin A positivity was correlated with grade and stage of the tumors and was associated with a decreased effect on survival. Conclusions Our results show that chromogranin A is the most sensitive and specific neuroendocrine marker. Chromogranin A positivity appears to bear a poor prognosis in patients with colorectal cancers.

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