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Li Destri G, Rinzivillo C, Vasquez E, Di Cataldo A, Puleo S, Licata A. Evaluation of the Prognostic Accuracy of Astler-coller's and Jass’ Classifications of Colorectal Cancer. TUMORI JOURNAL 2018; 87:127-9. [PMID: 11504364 DOI: 10.1177/030089160108700303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim The study aim was to determine whether the Jass classification is superior to that of Astler-Coller (modification of Dukes’ stage) in determining prognosis of patients treated for colorectal carcinoma. Study Design The authors used Jass’ classification to restage 263 patients who had undergone radical colorectal surgery and classified according to Astler-Coller. Results The results revealed that: 1) Astler-Coller's classification enables more accurate selection of patient groups where life expectancy can be predicted; 2) Jass’ classification enables statistically significant (P <0.05) improved prognostic discrimination of Astler-Coller's B2 patients, for which the probability of nonrecurrence of the disease is around 60%. Conclusions Although Astler-Coller's classification is still valid, Jass’ classification is useful for the prognostic discrimination of Astler-Coller's B2 patients.
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Affiliation(s)
- G Li Destri
- University of Catania, First Surgical Clinic, Policlinico, Italy.
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Secco GB, Campora E, Fardelli R, Lapertosa G, De Lucchi F, Gianquinto D, Bonfante P. Chromogranin-A Expression in Neoplastic Neuroendocrine Cells and Prognosis in Colorectal Cancer. TUMORI JOURNAL 2018; 82:390-3. [PMID: 8890977 DOI: 10.1177/030089169608200419] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims Chromogranin-A (CG), a cytoplasmic glycoprotein, is one of the markers most frequently used to identify the presence of neuroendocrine cells in the human gastrointestinal tract. Several authors have identified a subgroup of colorectal cancer patients with a severe prognosis whose tumors contained neuroendocrine CG-positive cells. In the present study, CG expression in 100 patients with colorectal adenocarcinoma treated from January 1983 to December 1988 with potentially curative surgery was analyzed and correlated with other prognostic factors and 5-year survival rate. Methods Samples tested immunohistochemically for CG were divided into three groups: I) negative; II) less than 1 CG-positive cell/mm2; III) more than 1 CG-positive cell/mm2. Results Of 100 patients with primary colorectal adenocarcinoma, 79% had tumors comprised of CG-negative cells, 17% had rare CG-positive cells, and 4% of cases could be classified in group III. No significant relation between CG expression and location of primary tumor, bowel wall infiltration, stage of disease or tumor grade according to Broders and Jass was observed. The 5-year survival was 53% and 52% for CG-positive and CG-negative lesions, respectively. Survival of patients with Dukes-Kirklin stage C and D was comparable in patients with CG-positive (33.3%) and CG-negative (30%) tumors. Conclusions CG expression cannot, at present, be recommended as a marker to identify prognostic subgroups in colorectal cancer patients.
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Affiliation(s)
- G B Secco
- Instituto di Patologia Chirurgica, Università di Genova, Italy
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Association between histological type of tumour growth and patient survival in t2-t3 lymph node-negative rectal cancer treated with sphincter-preserving total mesorectal excision. Pathol Oncol Res 2009; 16:201-6. [PMID: 19757194 DOI: 10.1007/s12253-009-9207-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Accepted: 09/01/2009] [Indexed: 01/30/2023]
Abstract
For rectal cancer patients without nodal metastases the identification of unfavourable factors can be helpful for the better selection for adjuvant therapy and multimodality treatment. The aim of this study was to evaluate the impact of clinico-histological parameters on prognosis in node-negative rectal cancer patients. One hundred and thirty-nine consecutive node negative rectal cancer patients with complete five-year follow-up were studied prospectively. All of them underwent curative anterior resection with total mesorectal excision technique. Seventy-eight patients with tumour penetration beyond the bowel wall received neo-adjuvant short-course radiation (25 Gy) followed by surgery within 1 week and postoperative chemotherapy with 5-fluorouracil and folinic acid in six cycles or adjuvant radiochemotherapy: irradiation (50.4 Gy) combined with chemotherapy (as above). Cancer-specific survival was calculated according to the Kaplan-Meier method. Variables significant in univariate analysis by log-rank test (P < 0.05) entered the Cox proportional hazard model. Survival was decreased for males, older patients (>60 years) with extraperitoneal, poorly differentiated cancers, tumours with mucinous histology and with the absence of lymphocytic infiltration but with the lack of statistical importance. Prognosis was significantly improved for patients with T2 tumours versus T3 (P < 0.01) and with cancers with expanding growth comparing to diffusely infiltrating ones (P < 0.01). In multivariate analysis these parameters significantly and independently influenced survival (P < 0.01 and P < 0.05, respectively). Diffusely infiltrating growth of tumour can reflect the more aggressive cancer behaviour and unfavourable course of disease despite the optimised local control. Apart from the extent of tumour penetration the type of invasive margin can be an additional parameter helpful for the optimal treatment planning and better patient selection for postoperative chemotherapy.
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Mander BJ, Carney LJ, Scott HJ, Donaldson DR. Jass staging is a predictor of outcome following “curative” resection of Dukes' B colorectal carcinoma. Surgeon 2006; 4:227-30. [PMID: 16892840 DOI: 10.1016/s1479-666x(06)80064-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIMS We have sought to determine if the addition of the Jass pathological classification to Dukes' staging would provide improved prognostic information for patients undergoing curative surgery for Dukes' B colorectal carcinoma. PATIENTS AND METHODS One hundred and eighty three patients who underwent curative surgery for Dukes' B colorectal cancers between December 1988 and January 1998 were identified. An assessment of Jass scoring was made at the time of initial histological staging. All patients entered a comprehensive follow-up system. RESULTS Jass grouping was found to correlate significantly with cancer specific mortality rates; group III having a worse prognosis than groups I and II (p<0.005). There was no significant difference between either local recurrence or systemic recurrence and the Jass group. CONCLUSION The Jass classification provides additional prognostic information in patients following curative resection of Dukes' B colorectal carcinoma and may therefore facilitate the selection of patients who will benefit most from adjuvant treatment
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Affiliation(s)
- B J Mander
- Department of Surgery, St Peter's Hospital, Surrey, UK
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Abstract
BACKGROUND In 1987 Jass described a modified staging system for colorectal cancer using two anatomical criteria in common with the Dukes system; extent of spread through the bowel wall and the presence or absence of lymph node involvement. Additionally it used two 'biological' criteria; the nature of the expanding margin of the tumour (pushing or infiltrating), and the presence or absence of lymphocytic infiltration within the tumour. This study aims to determine whether a combination of the Dukes and Jass staging systems provides a better predictor of five year survival in patients with colorectal cancer than Dukes stage alone. METHOD The Dukes and Jass stages along with vital status at five years were recorded for all 612 patients undergoing resection for colorectal cancer at the Royal Bolton Hospital and the Beaumont (BMI) Hospital, Bolton between 1991 and 1998. Kaplan-Meier survival curves with log rank test were used to show how survival correlated with Jass group stratified by Dukes stage. RESULTS Both the Dukes B and the Dukes C tumours could be divided into groups with significantly different five year survival rates when stratified by Jass group. Five year survival for Dukes stage B, Jass group II tumours was 73.74% compared to Dukes B Jass III tumours whose survival was 51.38% (P = 0.0018). Five year survival for Dukes C Jass III tumours was 43.18% and for Dukes C Jass IV survival was 24.39% (P = 0.0029). CONCLUSION By combining the biological criteria of the Jass staging system with the anatomically based Dukes system, both Dukes B and C tumours can be divided into groups with significantly different five year survival figures.
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Affiliation(s)
- A C Haslam
- Department of Surgery, Royal Bolton Hospital, Bolton, UK.
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Cianchi F, Palomba A, Messerini L, Boddi V, Asirelli G, Perigli G, Bechi P, Taddei A, Pucciani F, Cortesini C. Tumor angiogenesis in lymph node-negative rectal cancer: correlation with clinicopathological parameters and prognosis. Ann Surg Oncol 2002; 9:20-6. [PMID: 11829426 DOI: 10.1245/aso.2002.9.1.20] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Intratumoral microvessel density (MVD) could be used as a prognostic factor in colorectal cancer. We retrospectively analyzed the value of microvessel count in predicting the clinical outcome of stage I and II (Dukes A and B) rectal cancer patients. METHODS Eighty-four patients who had undergone curative resection of lymph node-negative rectal cancer were included. Tumor type and differentiation, the depth of local invasion, venous invasion, the character of the invasive margin, and the degree of lymphocytic infiltration were evaluated for each tumor specimen. Immunohistochemical staining for the CD31 endothelial antigen was performed to highlight the microvessels. RESULTS The median value of MVD was 45 microvessels. Low MVD (microvessels < or = 45) was observed in 41 patients (48.8%), and high MVD (>45) was found in 43 (51.2%). The presence of conspicuous lymphocytic infiltration was significantly associated with increased vessel density. With uni- and multivariate survival analysis MVD did not show any prognostic significance. The character of the invasive margin was the only parameter with independent prognostic value. CONCLUSIONS MVD does not seem to provide any additional prognostic information when compared with standard histopathological parameters in lymph node-negative rectal cancer. It is likely that the strong association between MVD and the presence of conspicuous lymphocytic infiltration may interfere with its predictive value.
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Affiliation(s)
- Fabio Cianchi
- Department of General Surgery, University of Florence, Italy.
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Ropponen KM, Eskelinen MJ, Lipponen PK, Alhava E, Kosma VM. Prognostic value of tumour-infiltrating lymphocytes (TILs) in colorectal cancer. J Pathol 1997. [PMID: 9349235 DOI: 10.1002/(sici)1096-9896(199707)182:3%3c318::aid-path862%3e3.0.co;2-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Clinical follow-up data of 276 colorectal adenocarcinoma patients treated in Kuopio University Hospital between 1976 and 1986 and followed up for a mean of 14 years were analysed. The clinical findings were correlated with tumour-infiltrating lymphocytes (TILs) and with histological and quantitative factors including nuclear parameters and volume-corrected mitotic index. In univariate survival analysis, TNM classification, Dukes' stage, histological grade, and TILs were significant predictors of survival. TNM classification, Dukes' stage, and TILs also predicted recurrence-free survival. In multivariate analysis, TILs were an independent prognostic factor of survival in all cases, as well as in patients with T1-4N0-3M0 and T1-4N1-3M1. TILs also independently predicted recurrence-free survival. TILs can provide important prognostic information in colorectal cancer to be used in evaluating for adjuvant therapy in different tumour stages.
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Affiliation(s)
- K M Ropponen
- Department of Pathology and Forensic Medicine, University of Kuopio, Finland
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Cianchi F, Messerini L, Palomba A, Boddi V, Perigli G, Pucciani F, Bechi P, Cortesini C. Character of the invasive margin in colorectal cancer: does it improve prognostic information of Dukes staging? Dis Colon Rectum 1997; 40:1170-5; discussion 1175-6. [PMID: 9336111 DOI: 10.1007/bf02055162] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE The clinical significance and prognostic value of the histopathologic parameters used in both the Dukes and Jass classifications were evaluated to select those with an independent effect on survival after radical surgery for colorectal cancer. METHODS The depth of local spread (limited to the bowel wall or extended beyond it), the number of metastatic lymph nodes (none, 1-4, more than 4), the character of the invasive margin (pushing or infiltrating), and the presence or absence of conspicuous peritumoral lymphocytic infiltration were assessed in 235 patients who had undergone radical resection for colorectal cancer. The influence of these variables on survival was studied by univariate and multivariate analysis. RESULTS No significant difference in survival was found between patients with conspicuous peritumoral infiltrate and those without it; moreover, multivariate analysis failed to show any independent prognostic value for either lymphocytic infiltration or depth of local invasion. However, the character of the invasive margin and the number of metastatic lymph nodes were identified as the only variables with any independent importance on survival. Based on these data, a new prognostic model may be proposed; it uses the character of the infiltrative margin as a discriminating factor among patients within the lymph node-negative (Dukes A and B stages) and lymph node-positive (Dukes C1 and C2 subsets) groups. A good prognosis for Dukes A, B, and C1 patients was associated with pushing tumors; C1 and C2 patients with infiltrating tumors had a poor prognosis. On the whole, the new prognostic model has allowed for the placement of 59.6 percent of our patients into groups that provide a confident prognosis. The clinical outcome of Dukes A and B patients with infiltrating tumors is still uncertain. CONCLUSIONS The character of the invasive margin is an important prognostic factor in colorectal cancer. The association of this parameter with the traditional Dukes classification may provide additional useful prognostic information and aid in the selection of those patients who could most benefit from adjuvant therapy.
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Affiliation(s)
- F Cianchi
- Clinica Chirurgica Generale, Universita' di Firenze, Florence, Italy
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Abstract
Clinical follow-up data of 276 colorectal adenocarcinoma patients treated in Kuopio University Hospital between 1976 and 1986 and followed up for a mean of 14 years were analysed. The clinical findings were correlated with tumour-infiltrating lymphocytes (TILs) and with histological and quantitative factors including nuclear parameters and volume-corrected mitotic index. In univariate survival analysis, TNM classification, Dukes' stage, histological grade, and TILs were significant predictors of survival. TNM classification, Dukes' stage, and TILs also predicted recurrence-free survival. In multivariate analysis, TILs were an independent prognostic factor of survival in all cases, as well as in patients with T1-4N0-3M0 and T1-4N1-3M1. TILs also independently predicted recurrence-free survival. TILs can provide important prognostic information in colorectal cancer to be used in evaluating for adjuvant therapy in different tumour stages.
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Affiliation(s)
- K M Ropponen
- Department of Pathology and Forensic Medicine, University of Kuopio, Finland
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Neoptolemos JP, Oates GD, Newbold KM, Robson AM, McConkey C, Powell J. Cyclin/proliferation cell nuclear antigen immunohistochemistry does not improve the prognostic power of Dukes' or Jass' classifications for colorectal cancer. Br J Surg 1995; 82:184-7. [PMID: 7749683 DOI: 10.1002/bjs.1800820214] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Immunohistochemistry of cyclin/proliferation cell nuclear antigen (PCNA) is an attractive alternative to tumour cell proliferation activity determined by flow cytometry which has been shown to be independently predictive of survival in patients with colorectal carcinoma and to enhance Dukes' classification. Dukes' and Jass' histopathological classifications were determined in 91 patients who had undergone curative resection for cancer of the colon (n = 51) or rectum (n = 40) and followed up for a minimum of 10 years. PCNA immunohistochemistry was possible in 79 tumours. Univariate analysis revealed that Jass' (P < 0.0001) and Dukes' classifications (P < 0.0002) were powerful predictors of survival but that the PCNA index had little prognostic power (P = 0.4). Multivariate analysis of both classifications showed similar predictive power and the PCNA index improved the prediction of survival when used with either classification for patients with colon cancer (chi 2 = 5.3, 1 d.f., P = 0.02 for each combination). The PCNA index, however, was not predictive for rectal cancer. Patients with the lowest PCNA index had the worst prognosis.
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Affiliation(s)
- J P Neoptolemos
- Academic Department of Surgery, City Hospital, Birmingham, UK
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Abstract
Staging of colorectal cancer has become increasingly important to select groups of patients for limited or more extensive surgery, and for adjuvant radiotherapy and chemotherapy. The main treatment is still surgery, but subgroups may benefit from adjuvant therapy, even accepting additional side effects. Accurate staging is necessary to define different treatment groups. A critical review is given of the present methods of clinicopathological staging.
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Affiliation(s)
- O Kronborg
- Department of Surgical Gastroenterology, Odense University Hospital, Denmark
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Abstract
The prognostic power of the extent of tumour invasion is indisputable; Dukes' classification has repeatedly been proven to be strongly correlated with patient survival. Modifications have led only to confusion, resulting in caution being required in the classification of patients with Dukes' A tumours. In the UK, the American tumour node metastasis and Australian clinicopathological systems are frequently considered too complex for routine clinical use. Meanwhile, Jass's classification may be complicated by observer variation between pathologists, and recent evidence suggests that it offers no advantage over that of Dukes. All the conventional staging systems also fail to take the skill of the surgeon into account when determining outcome. Attempts at quantifying tumour structure have not heralded the expected major advance. For instance, the expense and uncertain prognostic value of tumour DNA content assessed by flow cytometry are likely to restrict widespread use of this technique. It may soon be possible, however, to provide optimum treatment for patients based on individual tumour doubling times. Classification using knowledge of how a small number of cells in the tumour have the ability to invade locally, enter blood vessels and metastasize would also provide important prognostic information on which treatment could be based. Until then, the ease of use and high prognostic power of Dukes' classification ensure that, after 60 years, it is still the 'gold standard' against which all other prognostic classifications in colorectal cancer should be assessed.
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Affiliation(s)
- G T Deans
- Queen's University Department of Surgery, Belfast, UK
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