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Li Z, Li X, Guan S, Zhu G, Lin H, Wu H, Jia J, Guo Z, Cai Z, Zheng Q, Zhang H, Ruan F, Zheng X, Yang C, Xu Y, Ye J. Correlation Analysis Between Tumor Deposit and Clinicopathologic Characteristics and Prognosis of Gastric Cancer: A Multicenter Retrospective Study. Ann Surg Oncol 2024; 31:5984-5996. [PMID: 38814549 DOI: 10.1245/s10434-024-15508-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 05/09/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND The mechanism underlying the formation of gastric tumor deposits (TDs) is unclear. We aimed to explore the risk factors for the formation and prognostic value of TDs. METHODS This retrospective analysis included 781 locally advanced gastric cancer (LAGC) patients from four medical institutions in China, from June 2014 to June 2018. The risk factors for TD formation and prognostic value were determined through univariate and multivariate analyses. RESULTS Univariate analysis revealed that TD positivity was closely related to tumor diameter, Borrmann classification, differentiation degree, pT stage, pN stage, pTNM stage, and nerve and vascular invasion (p < 0.05). Multivariate logistic regression revealed that tumor diameter ≥ 5 cm (odds ratio [OR] 1.836, 95% confidence interval [CI] 1.165-2.894, p = 0.009) and vascular invasion (OR 2.152, 95% CI 1.349-3.433, p = 0.001) were independent risk factors for TD positivity. Multivariate Cox analysis revealed that TD positivity (OR 1.533, 95% CI 1.101-2.134, p = 0.011), tumor diameter ≥ 5 cm (OR 1.831, 95% CI 1.319-2.541, p < 0.001), pT4a stage (OR 1.652, 95% CI 1.144-2.386, p = 0.007), and vascular invasion (OR 1.458, 95% CI 1.059-2.008, p = 0.021) were independent risk factors for GC prognosis. The 5-year overall and disease-free survival of the TD-positive group showed significant effects among patients in the pT4a and pN3b stages (p < 0.05). CONCLUSIONS TDs are closely related to tumor diameter and vascular invasion in LAGC patients, and TD positivity is an independent prognostic factor for LAGC patients, especially those at pT4a and pN3b stages.
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Affiliation(s)
- Zhixiong Li
- Gastrointestinal Surgery Unit 1, The First Hospital of Putian City, Putian, 351100, Fujian, China
- Gastrointestinal Surgery Unit 2, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China
| | - Xinyu Li
- Department of Gastrointestinal Surgery, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, 362002, Fujian, China
| | - Shen Guan
- Department of Gastrointestinal Surgery, Clinical Oncology School of Fujian Medical University Fujian Cancer Hospital, Fuzhou, 350004, Fujian, China
| | - Guangwei Zhu
- Gastrointestinal Surgery Unit 2, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China
| | - Huimei Lin
- Department of Anorectal Surgery, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, 361021, Fujian, China
| | - Haiyan Wu
- Department of Pathology, The First Hospital of Putian City, Putian, 351100, Fujian, China
| | - Jing Jia
- Department of Gastrointestinal Surgery, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, 362002, Fujian, China
| | - Zipei Guo
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Zhiming Cai
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Qiajun Zheng
- Gastrointestinal Surgery Unit 2, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China
| | - Haoxiang Zhang
- Gastrointestinal Surgery Unit 2, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China
| | - Fangqiu Ruan
- Gastrointestinal Surgery Unit 2, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China
| | - Xu Zheng
- Gastrointestinal Surgery Unit 2, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China
| | - Chunkang Yang
- Department of Gastrointestinal Surgery, Clinical Oncology School of Fujian Medical University Fujian Cancer Hospital, Fuzhou, 350004, Fujian, China
| | - Yanchang Xu
- Gastrointestinal Surgery Unit 1, The First Hospital of Putian City, Putian, 351100, Fujian, China.
| | - Jianxin Ye
- Gastrointestinal Surgery Unit 2, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China.
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Guray Durak M, Gokcay D, Emecen SB, Ozdogan O, Sevinc AI, Ikiz AO, Dogan E, Karabay N, Ellidokuz H, Sarioglu S. Tumor deposits in thyroid carcinomas. Medicine (Baltimore) 2024; 103:e38952. [PMID: 39029040 PMCID: PMC11398754 DOI: 10.1097/md.0000000000038952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2024] Open
Abstract
Tumor deposits (TDs) are defined as discontinuous neoplastic masses within the lymphatic drainage pathway of the primary tumor. The poor prognostic implication of these masses have been demonstrated in various cancers. The aim of this study is to investigate the incidence of TDs in our thyroid carcinoma cases, which has not been studied so far to the best of our knowledge, and to determine the prognostic value of their existence. In this retrospective cohort study, 194 thyroid carcinoma cases with cervical lymph node sampling and/or dissection were reevaluated for TDs. The case series consisted of 176 thyroid papillary carcinoma (TPC) and 18 thyroid medullary carcinoma (TMC) patients. TDs were detected in 54 (27.8%) patients. TMC cases (55.6%) had significantly more TDs compared to TPCs (25.0%; P = .006). TDs were more common in women (P = .045), and in multifocal tumors (P = .017). In addition, cases with TDs had larger tumor size (P = .002), more lymphatic invasion (P = .009), extrathyroidal extension (P < .001), and distant metastasis (P < .001). The mean follow-up period of the patients was 120.1 months (range, 4-341 months). Locoregional recurrence detected in 17 patients (8.8%) was more common in TMC (33.3%) than TPC cases (6.3%; P = .002). Distant metastasis was identified in 27 patients (13.9%). Ten-year recurrence free survival (RFS) and overall survival (OS) for all patients were 89.0% and 92.4%, respectively. Mean estimated OS time for TD negative and TD positive cases were: 281.9 (±17.2), 325.6 (±6.2) and 217.6 (±27.4) months, respectively (P = .002). Sex (P = .001), tumor type (P = .002), pT classification of the tumor (P < .001), perineural invasion (P = .002) and TDs (P = .002) were significantly associated with OS. In TPC cases individually, extrathyroidal extension (P = .001) and TDs (P = .002) were significantly correlated with distant metastasis. In multivariate analysis, only tumor size was detected as an independent prognostic marker in TPC cases (P = .005). Our results demonstrate the existence of TDs in thyroid carcinoma cases, and indicate a more aggressive behavior pattern of TDs in these tumors.
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Affiliation(s)
- Merih Guray Durak
- Department of Pathology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Deniz Gokcay
- Department of Pathology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Serra Begum Emecen
- Department of Pathology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ozhan Ozdogan
- Department of Nuclear Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ali Ibrahim Sevinc
- Department of General Surgery, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ahmet Omer Ikiz
- Department of Ear, Nose, Throat and Head & Neck Surgery, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ersoy Dogan
- Department of Ear, Nose, Throat and Head & Neck Surgery, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Nuri Karabay
- Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Hulya Ellidokuz
- Department of Preventive Oncology, Dokuz Eylul University Institute of Oncology, Izmir, Turkey
| | - Sulen Sarioglu
- Department of Pathology, Dokuz Eylul University School of Medicine, Izmir, Turkey
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Hayashi M, Abe M, Fujita T, Matsushita H. Prognostic effect of categorized tumor deposits in gastric cancer: A single-center retrospective study. Surgery 2024; 175:373-379. [PMID: 37940432 DOI: 10.1016/j.surg.2023.09.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/02/2023] [Accepted: 09/26/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Tumor deposits are defined as all types of isolated cancer lesions without lymphocyte aggregates considered part of the lymph node. Tumor deposits have been reported as a negative prognostic factor. However, the survival significance of categorized tumor deposits is uncertain, particularly in gastric cancer. This study aimed to investigate the prognostic difference among categorized tumor deposits. METHODS Patients who underwent gastrectomy for gastric cancer were enrolled. All tumor deposits were categorized into irregular nodule, irregular nodule star, smooth nodule, and vascular/neural invasion. There are some cases with more than 2 categorized tumor deposits. These cases were categorized as tumor deposit complex in the following analysis. We performed survival analysis between the patients with and without tumor deposits, and compared the survival among each categorized tumor deposit. RESULTS Of 868 patients, there were 96 (11.1%) and 772 (88.9%) patients with and without tumor deposits. Vascular/neural invasion, smooth nodule, irregular nodule, irregular nodule star, and the tumor deposits complex was observed in 6 (6.3%), 15 (15.6%), 43 (44.8%), 1 (1.0%), and 31 (32.3%) patients. Patients with tumor deposits displayed poorer survival than those without; the 3-year overall survival: tumor deposits negative = 87.0%, tumor deposits positive = 53.2% (P < .001). Survival analysis revealed tumor deposits can be a prognostic risk factor (hazard ratio: 1.9854, 95% confidence interval: 1.393-2.830, P < .01). Irregular nodule and the tumor deposits complex demonstrated the worst prognosis (irregular nodule 3-year overall survival: 51.2%, tumor deposits complex 3-year overall survival: 41.9%, P = .001), whereas smooth nodule demonstrated better prognosis (smooth nodule 3-year overall survival: 80%). CONCLUSION Tumor deposits exerted a negative survival effect in gastric cancer. Irregular nodule and the tumor deposits complex displayed a strong prognostic effect.
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Affiliation(s)
- Masato Hayashi
- Department of Surgery, Tochigi Cancer Center Hospital, Utsunomiya, Japan.
| | - Makoto Abe
- Department of Pathology, Tochigi Cancer Center Hospital, Utsunomiya, Japan
| | - Takeshi Fujita
- Department of Surgery, Tochigi Cancer Center Hospital, Utsunomiya, Japan
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Song X, Liu K, Liao X, Zhu Y, Peng B, Zhang W, Zhao L, Chen X, Yang K, Hu J. Clinical significance of tumor deposits in gastric cancer after radical gastrectomy: a propensity score matching study. World J Surg Oncol 2023; 21:325. [PMID: 37833750 PMCID: PMC10571457 DOI: 10.1186/s12957-023-03208-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVE The value of tumor deposits (TDs) in the prognosis and staging of gastric cancer (GC) is still under debate. This study aims to evaluate the prognostic value of TDs and the best ways to incorporate TDs in the TNM classification of GC. METHODS Patients (n = 3460) undergoing curative gastrectomy for GC in the West China Hospital from 2005 to 2017 were retrospectively reviewed and divided into two groups according to the TD status (positive vs. negative). Later, clinicopathological features and overall survival (OS) between the two groups were compared. Thereafter, the associations between the presence of TD and other clinicopathological factors were evaluated through logistic regression. In addition, univariate and multivariate Cox regression were conducted for determining prognostic factors. The possibility of selection bias was reduced through conducting the 1:1 propensity score matching (PSM) analysis. The modified classification systems proposed previously that incorporated TDs into the TNM staging system were assessed. RESULTS There were 10.5% of patients (362/3460) diagnosed with TDs. TDs were significantly related to unfavorable factors such as advanced T stage and N stage and independently associated with poor prognosis. The 5-year OS of patients with TDs was significantly lower than that of patients without TDs (31.0% vs. 60.9%, P < 0.001), whereas higher than that of patients with peritoneal metastasis (31.0% vs. 5.0%, P < 0.001). In patients receiving chemotherapy, the 5-year OS of patients with TDs was also significantly lower than that of patients without TDs (42.0% vs. 50.9%, P = 0.026). Moreover, the system incorporating TDs in the TNM classification as metastatic lymph nodes outperformed others. CONCLUSIONS TDs are related to the aggressive characteristics and are an independent prognostic factor for GC. Incorporating TDs in the TNM classification as the metastatic lymph nodes increases the accuracy in predicting prognosis.
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Affiliation(s)
- Xiaohai Song
- Department of General Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
- Gastric Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Kai Liu
- Department of General Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
- Gastric Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Xuliang Liao
- Department of General Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
- Gastric Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Yunfeng Zhu
- Department of General Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
- Gastric Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - BoQiang Peng
- Department of General Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
- Gastric Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Weihan Zhang
- Department of General Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
- Gastric Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Linyong Zhao
- Department of General Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
- Gastric Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Xiaolong Chen
- Department of General Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
- Gastric Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Kun Yang
- Department of General Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
- Gastric Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
| | - Jiankun Hu
- Department of General Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China.
- Gastric Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China.
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Li Y, Li S, Liu L, Zhang LY, Wu D, Xie TY, Wang XX. Incorporation of perigastric tumor deposits into the TNM staging system for primary gastric cancer. World J Gastrointest Oncol 2023; 15:1605-1615. [PMID: 37746641 PMCID: PMC10514718 DOI: 10.4251/wjgo.v15.i9.1605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/15/2023] [Accepted: 08/02/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND The current prognostic significance of perigastric tumor deposits (TDs) in gastric cancer (GC) remains unclear. AIM To assess the prognostic value of perigastric TDs and put forward a new TNM staging framework involving TDs for primary GC. METHODS This study retrospectively analyzed the pathological data of 6672 patients with GC who underwent gastrectomy or surgery for GC with other diseases from January 1, 2012 to December 31, 2017 at the Chinese PLA General Hospital. According to the presence of perigastric TDs or not, the patients were divided into TD-positive and TD-negative groups by using the method of propensity score matching. The differences between TD-positive and TD-negative patients were analyzed using binary logistic regression modeling. The Kaplan-Meier method was used to plot survival curves. Multivariate Cox regression modeling and the log-rank test were used to analyze the data. RESULTS Perigastric TDs were found to be positive in 339 (5.09%) of the 6672 patients with GC, among whom 237 were men (69.91%) and 102 were women (30.09%) (2.32:1). The median age was 59 years (range, 27 to 78 years). Univariate and multivariate survival analyses indicated that TD-positive GC patients had a poorer prognosis than TD-negative patients (P < 0.05). The 1-, 3-, and 5-year overall survival rates of GC patients with TDs were 68.3%, 19.6%, and 11.2%, respectively, and these were significantly poorer than those without TDs of the same stages. There was significant variation in survival according to TD locations among the GC patients (P < 0.05). A new TNM staging framework for GC was formulated according to TD location. When TDs appear in the gastric body, the original stages T1, T2, and T3 are classified as T4a with the new framework, and the original stages T4a and T4b both are classified as T4b. When TDs appear in the lesser curvature, the previous stages N0, N1, N2, and N3 now both are classified as N3. When TDs appear in the greater curvature or the distant tissue, the patient should be categorized as having M1. With the new GC staging scheme including TDs, the survival curves of patients in the lower grade TNM stage with TDs were closer to those of patients in the higher grade TNM stage without TDs. CONCLUSION TDs are a poor prognostic factor for patients with primary GC. The location of TDs is associated with the prognosis of patients with primary GC. Accordingly, we developed a new TNM staging framework involving TDs that is more appropriate for patients with primary GC.
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Affiliation(s)
- Yang Li
- Medical School of Chinese People's Liberation Army, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Shuo Li
- Medical School of Chinese People's Liberation Army, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Lu Liu
- Medical School of Chinese People's Liberation Army, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Li-Yu Zhang
- Medical School of Chinese People's Liberation Army, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Di Wu
- Medical School of Chinese People's Liberation Army, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Tian-Yu Xie
- Department of General Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Xin-Xin Wang
- Department of General Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
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Ahn H, Song GJ, Jang SH, Son MW, Lee HJ, Lee MS, Lee JH, Oh MH, Jeong GC, Yun JH, Lee SM, Lee JW. Predicting the Recurrence of Gastric Cancer Using the Textural Features of Perigastric Adipose Tissue on [ 18F]FDG PET/CT. Int J Mol Sci 2022; 23:ijms231911985. [PMID: 36233285 PMCID: PMC9569486 DOI: 10.3390/ijms231911985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/01/2022] [Accepted: 10/08/2022] [Indexed: 12/05/2022] Open
Abstract
This study aimed to assess the relationship between the histopathological and textural features of perigastric adipose tissue (AT) on 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) and to evaluate the prognostic significance of perigastric AT textural features in predicting recurrence-free survival (RFS) in patients with gastric cancer. Sixty-nine patients with gastric cancer who underwent staging [18F]FDG PET/CT and subsequent curative surgery were retrospectively reviewed. Textural features of perigastric AT were extracted from PET images. On histopathological analysis, CD4, CD8, and CD163 cell infiltration and matrix metalloproteinase-11 and interleukin-6 (IL-6) expression in perigastric AT were graded. The degree of CD163 cell infiltration in perigastric AT was significantly correlated with the mean standardized uptake value (SUV), SUV histogram entropy, grey-level co-occurrence matrix (GLCM) energy, and GLCM entropy of perigastric AT. The degree of IL-6 expression in the perigastric AT was significantly correlated with the mean and median SUVs of perigastric AT. In multivariate survival analysis, GLCM entropy, GLCM dissimilarity, and GLCM homogeneity of perigastric AT were significant predictors of RFS. The textural features of perigastric AT on [18F]FDG PET/CT significantly correlated with inflammatory response in perigastric AT and were significant prognostic factors for predicting RFS in patients with gastric cancer.
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Affiliation(s)
- Hyein Ahn
- Department of Pathology, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea
| | - Geum Jong Song
- Department of Surgery, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea
| | - Si-Hyong Jang
- Department of Pathology, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea
| | - Myoung Won Son
- Department of Surgery, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea
| | - Hyun Ju Lee
- Department of Pathology, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea
| | - Moon-Soo Lee
- Department of Surgery, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea
| | - Ji-Hye Lee
- Department of Pathology, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea
| | - Mee-Hye Oh
- Department of Pathology, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea
| | - Geum Cheol Jeong
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea
| | - Jong Hyuk Yun
- Department of Surgery, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea
| | - Sang Mi Lee
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea
- Correspondence: (S.M.L.); (J.W.L.); Tel.: +82-41-570-3540 (S.M.L.); +82-32-290-2975 (J.W.L.)
| | - Jeong Won Lee
- Department of Nuclear Medicine, College of Medicine, Catholic Kwandong University, International St. Mary’s Hospital, 25 Simgok-ro 100-gil, Seo-gu, Incheon 22711, Korea
- Correspondence: (S.M.L.); (J.W.L.); Tel.: +82-41-570-3540 (S.M.L.); +82-32-290-2975 (J.W.L.)
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Xiao S, Guo J, Zhang W, Hu X, Wang R, Chen Z, Lai C. A Six-microRNA Signature Nomogram for Preoperative Prediction of Tumor Deposits in Colorectal Cancer. Int J Gen Med 2022; 15:675-687. [PMID: 35082517 PMCID: PMC8785134 DOI: 10.2147/ijgm.s346790] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/29/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Tumor deposits (TDs) are acknowledged negative prognostic factors in colorectal cancer (CRC), and their pathogenesis remains a puzzle. This study aimed to construct and validate a nomogram available for preoperative TDs prediction in CRC patients. Patients and Methods Patients from the Surveillance, Epidemiology, and End Results (SEER) and the cancer genome atlas (TCGA) databases were randomly divided into training and validation sets according to the sample size ratio of 7:3. Univariate logistic regression was performed for identifying differentially expressed microRNAs between TDs and non-TDs. Nomograms for TDs prediction were developed from the multivariate logistic regression model with least absolute shrinkage and selection operator and were validated internally in terms of accuracy, calibration, and clinical utility. Based on the target genes, pathways tightly associated with TDs were selected using enrichment analysis. Results Six clinicopathologic factors and expressions of six microRNAs (miR-614, miR-1197, miR-4770, miR-3136, miR-3173, and miR-4636) differed significantly between TDs and non-TDs CRC patients from the SEER and TCGA training sets. We compared potential prediction discrimination between two nomograms: a clinicopathologic nomogram and a six-microRNA signature nomogram. The six-microRNA signature nomogram revealed better accuracy than the clinicopathologic one for TDs prediction (AUC values of 0.96 and 0.93 in the validation cohort). The calibration plots and decision curve analysis demonstrated that the six-microRNA signature nomogram had better validity and a greater prognostic benefit versus the clinicopathologic one for TDs prediction. Calcium signaling pathways were closely associated with roles of the six microRNAs in TDs of CRC patients. Conclusion The six-microRNA signature nomogram can be used as an efficient tool for preoperative TDs prediction in CRC patients.
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Affiliation(s)
- Shihan Xiao
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
- International Joint Research Center of Minimally Invasive Endoscopic Technology Equipment & Standardization, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Jianping Guo
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Wuming Zhang
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
- International Joint Research Center of Minimally Invasive Endoscopic Technology Equipment & Standardization, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Xianqin Hu
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
- International Joint Research Center of Minimally Invasive Endoscopic Technology Equipment & Standardization, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Ran Wang
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
- International Joint Research Center of Minimally Invasive Endoscopic Technology Equipment & Standardization, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Zhikang Chen
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
- International Joint Research Center of Minimally Invasive Endoscopic Technology Equipment & Standardization, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
- Hunan Key Laboratory of Precise Diagnosis and Treatment of Gastrointestinal Tumor, Xiangya Hospital Central South University, Changsha, Hunan Province, People’s Republic of China
- Correspondence: Zhikang Chen; Chen Lai Department of General Surgery, Xiangya Hospital, Central South University, 87th Xiangya Road, Kaifu District, Changsha, Hunan, People’s Republic of ChinaTel +86-13875982443Tel +86-13875982443 Email ;
| | - Chen Lai
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
- International Joint Research Center of Minimally Invasive Endoscopic Technology Equipment & Standardization, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
- Hunan Key Laboratory of Precise Diagnosis and Treatment of Gastrointestinal Tumor, Xiangya Hospital Central South University, Changsha, Hunan Province, People’s Republic of China
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8
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Díaz del Arco C, Ortega Medina L, Estrada Muñoz L, García Gómez de las Heras S, Fernández Aceñero MJ. Pathologic Lymph Node Staging of Gastric Cancer. Am J Clin Pathol 2021; 156:749-765. [PMID: 34273159 DOI: 10.1093/ajcp/aqab031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/13/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The TNM classification is the main tool for lymph node (LN) staging in gastric cancer (GC). However, alternative LN staging systems have been proposed, and the role of features other than the number of metastatic LNs is being investigated. Our aim is to discuss the main challenges of LN assessment in GC. METHODS Comprehensive review of the literature on alternative LN staging systems, examined LNs, sentinel LN (SLN) biopsy, LN micrometastases (LNMIs), extracapsular extension (ECE), and tumor deposits (TDs) in GC. RESULTS Many controversies exist regarding LN assessment in GC. The TNM classification shows excellent prognostic performance, but alternative prognostic methods such as the LN ratio or log odds of positive LNs have demonstrated to be better than the TNM system in terms of prognostic accuracy. The value of SLN biopsy and LNMIs in GC is still unclear, and several challenges concerning their clinical impact and pathologic analysis must be overcome before their introduction in clinical practice. Most authors have identified ECE and TDs as independent prognostic factors for survival in GC. CONCLUSIONS Further studies should be performed to evaluate the impact of these features on the TNM classification and patient outcomes, as well as to standardize alternative LN staging systems.
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Affiliation(s)
- Cristina Díaz del Arco
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain
- Complutense University of Madrid, Madrid, Spain
| | - Luis Ortega Medina
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain
- Complutense University of Madrid, Madrid, Spain
| | | | | | - M Jesús Fernández Aceñero
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain
- Complutense University of Madrid, Madrid, Spain
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9
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Clinicopathological factors associated with the presence of tumor deposits in resected gastric cancer patients. Heliyon 2021; 7:e07185. [PMID: 34141939 PMCID: PMC8188374 DOI: 10.1016/j.heliyon.2021.e07185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/29/2021] [Accepted: 05/27/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose The role of tumor deposits (TDs) in the staging of gastric cancer is currently debatable. TDs are defined as tumoral nodules in perigastric adipose tissue with no evidence of lymphatic, vascular, or neural structures. Clinicopathological factors related to the presence of TDs are not well defined. This study aimed to identify the clinicopathological factors associated with the presence of TDs in resected gastric cancer patients. Materials and methods This prospective study included patients diagnosed with gastric cancer and treated with D2 radical gastrectomy from January 2019 to January 2020. Univariate and multivariate analyses were performed to determine the factors related to the presence of TDs. Results A total of 111 patients were eligible and TDs were present in 31 of them (28%). In the univariate analysis, male gender (p = 0.027), tumor size ≥ 5cm (p = ≤0.001), serosa and adjacent organs invasion (pT4a and pT4b) (p = ≤0.001), ≥16 metastatic lymph nodes (pN3b) (p = ≤0.001), and TNM stage III tumors (p = ≤0.001) were significantly associated with the presence of TDs. The multivariate analysis showed that a tumors size ≥5 cm (OR = 3.69, 95% CI: 1.17-11.6), serosa and adjacent organs invasion (pT4a and pT4b) (OR = 3.78, 95% CI: 1.31-10.86) and ≥16 metastatic lymph nodes (pN3b) (OR = 3.21, 95%CI:1.06-9.7) were independent risk factors for the presence of TDs. Conclusions Larger tumors (tumor size ≥ 5cm), serosa and adjacent organs invasion (pT4 and pT4b), and ≥16 metastatic lymph nodes (pN3b) were independent risk factors for the presence of TDs.
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10
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Yu S, Zhu Y, Shi X, Diao W, Zhu X, Gao Z, Chen X. The prognostic significance of tumor deposits in patients with head and neck squamous cell carcinomas. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:377. [PMID: 33842598 PMCID: PMC8033359 DOI: 10.21037/atm-20-4369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Background A tumor deposit (TD) is a phenomenon that has not been well studied in head and neck squamous cell carcinoma (HNSCC) but might have prognostic significance. The present study was conducted to explore the presence and the prognostic significance of TDs in patients with HNSCCs. Methods Six hundred forty-two pathologically confirmed HNSCC patients with neck dissection samples were enrolled in this retrospective study. Patients were followed up and evaluated every 3 months in the first 3 years after surgery, and every 6 months thereafter by physical examination and computed tomography (CT)/magnetic resonance imaging (MRI) scans. The five-year overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were compared in the TD and non-TD groups using multivariable analyses and propensity score matching (PSM) methodology (1:1). Results The 5-year OS, DSS, and RFS rate of all patients was 77.3%, 80.6%, and 71.9%, respectively. In the multivariable analyses, poorer rates of OS (HR =2.345, P<0.001), DSS (HR =2.818, P<0.001), and RFS (HR =2.536, P<0.001) were observed in the TD versus the non-TD group. In the PSM cohort, eighty-one patients who had TDs were paired with 70 patients without TDs. Significantly diminished rates of DSS (P=0.040) and RFS (P=0.004) were found in the TD versus the non-TD group. Conclusions In response to sparse reports regarding TDs in HNSCCs, the present study proposes the TD as an independent poor prognostic factor meriting further research because of its association with diminished OS, DSS, and RFS rates.
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Affiliation(s)
- Shuting Yu
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yingying Zhu
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaohua Shi
- Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wenwen Diao
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoli Zhu
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zhiqiang Gao
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xingming Chen
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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11
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Tan J, Yang B, Xu Z, Zhou S, Chen Z, Huang J, Gao H, Zheng S, Wen L, Han F. Tumor deposit indicates worse prognosis than metastatic lymph node in gastric cancer: a propensity score matching study. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:671. [PMID: 31930072 DOI: 10.21037/atm.2019.10.33] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background The prognostic value of tumor deposit (TD) in gastric cancer is controversial. This study aims to investigate the prognostic value of TD. Methods The consecutive patients diagnosed with gastric cancer from October 2007 to October 2012 were selected. The patients were divided by whether they suffered TD into two groups. The basic data were comparable between the two groups after propensity score matching (PSM), then survival analysis [overall survival (OS) and cancer-specific survival (CSS)] was applied in two groups. After that, all the patients were divided by pN staging and survival analysis were applied in each subgroup. At last, all patients were divided into TD group, pN1 stage group, pN2 stage group, pN3a, and pN3b stage group, OS and CSS were compared between them. Multivariable competing risk analyses tested association of TD with OS and CSS, before and after PSM. Results Eight hundred and three patients were concluded. After PSM, 137 patients with TD and 274 patients without TD were selected, the 5-year OS and CSS rates of patients with TD were significantly worse than patients without TD (OS: 19.7% vs. 42.0%, P<0.001; CSS: 22.6% vs. 45.6%, P<0.001). In all patients' survival analysis, the 5-year OS and CSS rates of TD group were comparable with pN3a group (OS: 19.7% vs. 25.3%, P=0.221, CSS: 22.6% vs. 30.1%, P=0.092) and pN3b group (OS: 19.7% vs. 19.6% P=0.349, CSS: 22.6% vs. 23.5%, P=0.452). Meanwhile, on multivariable cox regression analyses, the presence of TD significantly reduces the OS and CSS of patients in gastric cancer. Conclusions TD has a marked impact on the prognosis of gastric cancer. Even patients with TD had the same prognosis with pN3 stage.
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Affiliation(s)
- Jianan Tan
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Bin Yang
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Zhimeng Xu
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510000, China
| | - Shengning Zhou
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Zhitao Chen
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Jing Huang
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Han Gao
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Senyou Zheng
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Liqiang Wen
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Fanghai Han
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
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12
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Tonouchi A, Sugano M, Tokunaga M, Sugita S, Watanabe M, Sato R, Kaito A, Akimoto T, Ochiai A, Kinoshita T, Kuwata T. Extra-perigastric Extranodal Metastasis is a Significant Prognostic Factor in Node-Positive Gastric Cancer. World J Surg 2019; 43:2499-2505. [PMID: 31312947 DOI: 10.1007/s00268-019-05076-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Extranodal metastasis is an isolated tumor nodule without a residual lymph node structure and has been reported as a poor prognostic factor in gastric cancer. The aim of this study is to assess the prognostic value of extranodal metastasis, especially from the viewpoint of its anatomical distribution. METHODS A total of 139 consecutive gastric cancer patients who underwent curative surgery with lymph node metastasis between 2008 and 2009 were included. Clinicopathological features and patient survival outcomes were retrospectively assessed. Patients with extranodal metastasis were subdivided into two groups: perigastric extranodal metastasis, located near the perigastric area (#1-#7 according to the Japanese classification of gastric carcinoma 15th edition), and extra-perigastric extranodal metastasis, located alongside the major vessels (#8-#12). RESULTS Extranodal metastasis was found in 51 patients (37%), and it was more frequent in those with bulky, ≥pT3, and pStage III tumors. All patients with extra-perigastric extranodal metastasis had recurrence, resulting in a 0% 5-year overall survival rate, which was significantly worse than that of patients with perigastric extranodal metastasis (59%), or those without extranodal metastasis (84%; P < 0.001). Multivariable analysis identified the presence of extra-perigastric extranodal metastasis as an independent poor prognostic factor. CONCLUSIONS Extranodal metastasis, especially extra-perigastric extranodal metastasis, was a pivotal poor prognostic factor in node-positive gastric cancer. Recognizing extra-perigastric extranodal metastasis would help provide optimal therapeutic options to these high-risk patients.
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Affiliation(s)
- Akiko Tonouchi
- Department of Gastric Surgery, National Cancer Center Hospital East, Kashiwa, Japan
- Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masato Sugano
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Japan
- Exploratory Oncology Research & Clinical Trial Center (EPOC), National Cancer Center, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Masanori Tokunaga
- Department of Gastric Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Shizuki Sugita
- Department of Gastric Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Masahiro Watanabe
- Department of Gastric Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Reo Sato
- Department of Gastric Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Akio Kaito
- Department of Gastric Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Tetsuo Akimoto
- Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Atsushi Ochiai
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Japan
- Exploratory Oncology Research & Clinical Trial Center (EPOC), National Cancer Center, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Takahiro Kinoshita
- Department of Gastric Surgery, National Cancer Center Hospital East, Kashiwa, Japan
- Exploratory Oncology Research & Clinical Trial Center (EPOC), National Cancer Center, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Takeshi Kuwata
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Japan.
- Exploratory Oncology Research & Clinical Trial Center (EPOC), National Cancer Center, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
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Hu K, Wang S, Wang Z, Li L, Huang Z, Yu W, Chen Z, Wu QF. Clinicopathological risk factors for gastric cancer: a retrospective cohort study in China. BMJ Open 2019; 9:e030639. [PMID: 31542754 PMCID: PMC6756371 DOI: 10.1136/bmjopen-2019-030639] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/28/2019] [Accepted: 09/02/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To examine the potential clinicopathological factors affecting the prognosis of patients with gastric cancer after surgical treatment in China. METHODS Between 1 January 2001 and 31 December 2012, a total of 716 patients aged 22-84 years with gastric cancer were enrolled in the study. Survival analysis techniques including log rank test and Cox proportional hazard regression model were applied to evaluate the prognostic significance of clinicopathological characteristics in terms of survival time. RESULTS Of the 24 demographic and pathological variables collected in the data, 16 prognostic factors of gastric cancer were found to have statistically significant influences on survival time from the unadjusted analyses. The adjusted analysis furtherly revealed that age, age square, lymph node metastasis rate group, tumour size group, surgical type II, number of cancer nodules, invasion depth group and the interaction between surgical type II and tumour size group were important prognosis and clinicopathological factors for gastric cancer in Chinese. CONCLUSION Our study with relatively large sample size and many potential risk factors enable us to identify independent risk factors associated with the prognosis of gastric cancer. Findings from the current study can be used to assist clinical decision-making, and serve as a benchmark for the planning of future prognosis and therapy for patients with gastric carcinoma.
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Affiliation(s)
- Kongwang Hu
- Department of General Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Shuaili Wang
- School of Life Sciences, University of Science and Technology of China, Hefei, China
| | - Zikun Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Longlong Li
- Department of General Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhiguo Huang
- Department of General Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Weiqiang Yu
- School of Life Sciences, University of Science and Technology of China, Hefei, China
| | - Zhongxue Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Qing-Fa Wu
- School of Life Sciences, University of Science and Technology of China, Hefei, China
- School of Data Science, University of Science and Technology of China, Hefei, Anhui, China
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14
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Graham Martínez C, Knijn N, Verheij M, Nagtegaal ID, van der Post RS. Tumour deposits are a significant prognostic factor in gastric cancer - a systematic review and meta-analysis. Histopathology 2019; 74:809-816. [PMID: 30376189 PMCID: PMC6850601 DOI: 10.1111/his.13781] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 10/29/2018] [Indexed: 12/11/2022]
Abstract
AIMS Tumour deposits (TDs) are clusters of cancer cells in the soft tissue that are discontinuous from the primary tumour. In this review we are exploring their relevance for prognosis in patients with gastric cancer. METHODS AND RESULTS A literature search was performed to identify studies providing data on TDs and prognosis in gastric cancer patients. Eight papers were included in the meta-analysis, which was carried out in terms of risk ratios (RR) and hazard ratios (HR) with 95% confidence interval (95% CI). Of 7445 patients, 1551 had TDs (20.9%). TDs were associated with a decreased overall survival (OS) in univariate (HR = 2.82, 95% CI = 1.9-4.3) and multivariate analyses (HR = 1.65, 95% CI = 1.3-2.1). TDs were also associated with known prognostic factors such as synchronous metastatic disease (RR = 9.5), invasion depth (RR = 1.8), lymph node metastasis (RR = 1.7), lymphatic invasion (RR = 1.7), vascular invasion (RR = 2.6) and poor differentiation (RR = 1.2). CONCLUSIONS We found a strong indication that TDs are independent predictors of prognosis in patients with gastric cancer; hence, TDs should be included in the staging of gastric cancers.
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Affiliation(s)
| | - Nikki Knijn
- Department of PathologyRadboud university medical centreNijmegenthe Netherlands
| | - Marcel Verheij
- Department of RadiotherapyRadboud University Medical CentreNijmegenthe Netherlands
| | - Iris D Nagtegaal
- Department of PathologyRadboud university medical centreNijmegenthe Netherlands
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15
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Durak MG, Canda T, Yilmaz B, Seker NS, Kokkoz SE, Alicikus ZA, Akturk N, Gorken IB, Ellidokuz H, Sevinc AI, Saydam S, Sarioglu S. Prognostic Importance of Tumor Deposits in the Ipsilateral Axillary Region of Breast Cancer Patients. Pathol Oncol Res 2019; 25:577-583. [PMID: 30368727 DOI: 10.1007/s12253-018-0515-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 10/21/2018] [Indexed: 10/28/2022]
Abstract
Tumor deposits (TD) are irregular discrete tumor masses in adipose tissue, discontinuous from the primary tumor, that are described in various cancers. The incidence and/or prognostic value of TD in breast carcinomas have not been studied so far. We reevaluated 145 breast cancer patients, diagnosed and treated between 2001 and 2006 at our institution for the presence and incidence of TD. Histologic type, grade, size of the primary tumor, estrogen receptor, progesterone receptor, human epidermal growth factor receptor-2 status of the tumor, and presence of peritumoral lymphovascular invasion were included in the data. TD were detected in 42 cases (29.0%). The mean age of the patients was 52.2 years (27-82). Most patients (79.3%) had either invasive carcinoma of no special type (NST) or invasive lobular carcinoma, and most tumors (86.9%) were either grade 2 or 3. After excluding TD from the number of metastatic lymph nodes, the pN status of 9 patients changed. Univariate analysis of 110 patients with follow-up information revealed that the new pN status (p = 0.036), presence of local recurrence (p = 0.016) and TD (p = 0.003) were significantly correlated with distant metastases. The median follow-up of the patients was 84 months (5-161), 10-year disease-free survival and overall survival were 67.2% and 73.7%, respectively. In multivariate analysis, presence of TD remained independently associated with distant metastasis (p = 0.002). The probability of distant metastasis was 3.3 times higher in patients with TD. These results emphasize that TD are present in breast cancer patients, and that their presence should warn the clinician in terms of possible distant metastasis. Therefore, presence of TD, the evaluation of which is neither time consuming nor require sophisticated methods, should be included in pathology reports.
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Affiliation(s)
- Merih Guray Durak
- Department of Pathology, Dokuz Eylul University Faculty of Medicine, Inciralti, 35340, Izmir, Turkey.
| | - Tulay Canda
- Department of Pathology, Dokuz Eylul University Faculty of Medicine, Inciralti, 35340, Izmir, Turkey
| | - Betul Yilmaz
- Department of Pathology, Dokuz Eylul University Faculty of Medicine, Inciralti, 35340, Izmir, Turkey
| | - Nazli Sena Seker
- Department of Pathology, Dokuz Eylul University Faculty of Medicine, Inciralti, 35340, Izmir, Turkey
| | - Seda Eryigit Kokkoz
- Department of Pathology, Dokuz Eylul University Faculty of Medicine, Inciralti, 35340, Izmir, Turkey
| | - Zumre Arican Alicikus
- Department of Radiation Oncology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Nesrin Akturk
- Department of Radiation Oncology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Ilknur Bilkay Gorken
- Department of Radiation Oncology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Hulya Ellidokuz
- Department of Preventive Oncology, Dokuz Eylul University Institute of Oncology, Izmir, Turkey
| | - Ali Ibrahim Sevinc
- Department of General Surgery, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Serdar Saydam
- Department of General Surgery, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Sulen Sarioglu
- Department of Pathology, Dokuz Eylul University Faculty of Medicine, Inciralti, 35340, Izmir, Turkey
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16
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Chen H, Tang Z, Chen L, Li H, Wang X, Liu F, Sun Y. Evaluation of the impact of tumor deposits on prognosis in gastric cancer and a proposal for their incorporation into the AJCC staging system. Eur J Surg Oncol 2018; 44:1990-1996. [DOI: 10.1016/j.ejso.2018.10.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 02/03/2023] Open
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17
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Chen XL, Zhao LY, Xue L, Xu YH, Zhang WH, Liu K, Chen XZ, Yang K, Zhang B, Chen ZX, Chen JP, Zhou ZG, Hu JK. Prognostic significance and the role in TNM stage of extranodal metastasis within regional lymph nodes station in gastric carcinoma. Oncotarget 2018; 7:67047-67060. [PMID: 27563811 PMCID: PMC5341856 DOI: 10.18632/oncotarget.11478] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 08/10/2016] [Indexed: 02/05/2023] Open
Abstract
The role of extranodal metastasis (ENM) in TNM stage in gastric carcinoma (GC) is controversial. This study was aimed to make a detailed investigation of the prognostic significance and the role in TNM stage of ENM in GC. The patients with primary GC, who underwent gastrectomy with curative intention in West China Hospital from January 2005 to December 2011, were retrospectively enrolled. The prognosis and clinicopathological traits were compared between ENM positive (ENMP) and negative (ENMN) groups in all patients, TNM I-II, III and IV stages, respectively. The significance of the number and the role in TNM stage of ENM were also assessed. In our study, 1457 patients were enrolled, with 1324 (90.9%) in ENMN group and 133 (9.1%) in ENMP group. ENMP group had significantly more advanced GC and worse prognosis (all p<0.05) than ENMN group in all patients, TNM I-II stages and TNM III stage. ENM>2 subgroup had remarkably larger tumor size (p=0.002) and more advanced N stage (p=0.016) than ENM=1-2 subgroup. The number of ENM was an independent prognostic factor in ENMP group (p=0.029). The prognosis of ENM>2 in TNM I-III stages was significantly worse than ENMN patients in TNM III stage. The C-index of TNM stage plus the number of ENM was significantly higher than that of current TNM stage alone (p=0.005). In conclusion, the patients in ENMP subgroup had more advanced GC and worse prognosis than those in ENMN subgroup. It might be more reasonable to categorize ENM>2 into TNM IV stage.
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Affiliation(s)
- Xiao-Long Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lin-Yong Zhao
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lian Xue
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yu-Hui Xu
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Wei-Han Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Kai Liu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xin-Zu Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Kun Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Bo Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zhi-Xin Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jia-Ping Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zong-Guang Zhou
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Institution of Digestive Surgery, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jian-Kun Hu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
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18
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Beyond T, N and M: The impact of tumor deposits on the staging and treatment of colorectal and gastric carcinoma. Surg Oncol 2018; 27:129-137. [PMID: 29937162 DOI: 10.1016/j.suronc.2018.02.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/28/2018] [Accepted: 02/17/2018] [Indexed: 12/12/2022]
Abstract
This review aims to describe the results of the most recent studies on the prognostic value of TDs and highlight the impact of TDs on the staging and treatment of colorectal and gastric carcinoma. For colorectal carcinoma TDs have an adverse prognostic effect that is at least similar to that of positive regional lymph nodes. However, support is growing in favor of including of TDs in the M category, rather than the N or T categories of the TNM classification. Moreover, TDs seem to have an adverse effect on outcomes not only in patients without lymph node involvement but also in patients with nodal involvement. Although the prognostic impact of TDs in gastric cancer appears to be undeniable, the actual prognostic determinants of TDs, particularly in relation to the number, size and histological types, remain to be established. Although the 7th and 8th Edition of the TNM classification of colorectal and gastric carcinoma includes TDs in the N category, no current procedures or methods to assess preoperative or intraoperative N-status allow TD detection. After neoadjuvant treatment for advanced rectal carcinoma, the presence of TDs may indicate incomplete eradication of the main tumor and not discontinuous tumor foci. TDs have an undeniable prognostic impact but no algorithm of staging and strategy of treatment has been conformed to this prognostic factor to overcome the classical T,N, and M prognostic categories. Staging and treatment of colorectal and gastric cancers should be reconsidered in light of the emerging prognostic value of TDs.
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Sarioglu S, Kilicarslan E, Aydin B, Kozen MA, Akman F, Oztop I, Ada E, Ikiz AO. Tumor deposits in salivary gland tumors. Pathol Int 2018; 68:183-189. [DOI: 10.1111/pin.12637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 12/20/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Sulen Sarioglu
- Department of Pathology; Dokuz Eylul University School of Medicine; Izmir Turkey
| | - Emel Kilicarslan
- Department of Pathology; Bitlis Tatvan Public Hospital; Bitlis Turkey
| | - Barbaros Aydin
- Department of Radiation Oncology; Dokuz Eylul University School of Medicine; Izmir Turkey
| | - Melih Arif Kozen
- Department of Otorhinolaryngology; Dokuz Eylul University School of Medicine; Izmir Turkey
| | - Fadime Akman
- Department of Radiation Oncology; Dokuz Eylul University School of Medicine; Izmir Turkey
| | - Ilhan Oztop
- Department of Medical Oncology; Dokuz Eylul University School of Medicine; Izmir Turkey
| | - Emel Ada
- Department of Radiology; Dokuz Eylul University School of Medicine; Izmir Turkey
| | - Ahmet Omer Ikiz
- Department of Otorhinolaryngology; Dokuz Eylul University School of Medicine; Izmir Turkey
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20
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Anup S, Lu J, Zheng CH, Li P, Xie JW, Wang JB, Lin JX, Chen QY, Cao LL, Lin M, Yu Q, Yang YH, Huang CM. Prognostic significance of perigastric tumor deposits in patients with primary gastric cancer. BMC Surg 2017; 17:84. [PMID: 28724367 PMCID: PMC5518113 DOI: 10.1186/s12893-017-0280-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 07/07/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The presence and the prognostic significance of perigastric tumor deposits (TDs) in primary gastric cancer have not been extensively studied. The aim of this study was to evaluate the prognostic significance perigastric TDs in primary gastric cancer. METHODS From 2005 to 2010, 1250 patients underwent R0 gastrectomy at the Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China. Out of 1250 patients, 132 patients with perigastric TDs were identified. Additionally, 132 patients with staged matched gastric cancer without tumor deposits were selected as a control group. RESULTS Perigastric TDs were observed in 132 (10.5%) of the 1250 patients with gastric cancer who underwent R0 gastrectomy. There were 94 males (71.21%) and 38 females (28.79%) (2.47:1). The mean age was 57.21 years. Clinicopathologic characteristics between the two groups matched well. There was a significant difference in the overall survival of those with and without TDs by univariate (p<0.05) and multivariate (p < 0.05) survival analysis. The 1-, 3-and 5-year overall survival rates of patients with TDswere69.6%, 39.3%, and 24.2%, respectively, and were significantly poorer than those of the staged matched control group. There was no correlation between the number of TDs and patient survival in patients with gastric cancer (p>0.05); however, when comparing each pT tumor group with the perigastric TD group, the stage T4 survival rate was very similar to that observed in patients with TDs. CONCLUSIONS Perigastric TDs are an independent predictive prognostic factor for gastric cancer and may be appropriately considered a form of serosal invasion. We suggest that TDs should be included in TNM staging system for better outcomes.
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Affiliation(s)
- Shrestha Anup
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qian Yu
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ying-Hong Yang
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
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21
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Sarioglu S, Akbulut N, Iplikci S, Aydin B, Dogan E, Unlu M, Ellidokuz H, Ada E, Akman F, Ikiz AO. Tumor deposits in head and neck carcinomas. Head Neck 2015; 38 Suppl 1:E256-60. [PMID: 25546631 DOI: 10.1002/hed.23981] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/13/2014] [Accepted: 12/18/2014] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Tumor deposits, nodules in the peritumoral adipose tissue with no architectural residue of lymph node, have previously been described in colorectal adenocarcinomas. To date, however, there has been no examination of tumor deposits in head and neck squamous cell carcinoma (HNSCC). METHODS Neck dissection specimens of 140 patients with HNSCC were reevaluated for tumor deposits. RESULTS Tumor deposits were detected in 24 cases (17%). Cases with tumor deposits had more lymphatic invasion (p = .007), higher pathological N classification (p = .00), and more frequently showed distant metastasis (p = .003). Disease-free and overall survival were significantly shorter for tumor deposit positive cases (p = .016 and p = .005, respectively). Only tumor deposits were significant for overall survival. Tumor deposits increased the risk of recurrent disease 2294 times. Tumor deposits and pericapsular invasion were identified as independent prognostic markers; tumor deposits increased the risk of death from disease 3.4 times, whereas pericapsular invasion was associated with a 2.2-fold increase in the risk of death. CONCLUSION These results highlight the existence of tumor deposits in neck dissection specimens of HNSCC and their association with poor prognosis. © 2015 Wiley Periodicals, Inc. Head Neck 38: E256-E260, 2016.
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Affiliation(s)
- Sulen Sarioglu
- Department of Pathology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Nilhan Akbulut
- Department of Pathology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Selen Iplikci
- Department of Pathology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Barbaros Aydin
- Department of Radiation Oncology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Ersoy Dogan
- Department of Otorhinolaryngology - Head and Neck Surgery, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Mehtat Unlu
- Department of Pathology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Hulya Ellidokuz
- Department of Preventive Oncology, Dokuz Eylul University, Institute of Oncology, Izmir, Turkey
| | - Emel Ada
- Department of Radiodiagnostics, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Fadime Akman
- Department of Radiation Oncology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Ahmet Omer Ikiz
- Department of Otorhinolaryngology - Head and Neck Surgery, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
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