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Xiao SM, Li J. Tumor budding in gastric cancer. World J Gastrointest Surg 2023; 15:578-591. [PMID: 37206064 PMCID: PMC10190737 DOI: 10.4240/wjgs.v15.i4.578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/04/2023] [Accepted: 03/21/2023] [Indexed: 04/22/2023] Open
Abstract
The tumor, nodes, metastasis (TNM) staging system has long been the gold standard for the classification and prognosis of solid tumors. However, the TNM staging system is not without limitations. Prognostic heterogeneity exists within patients at the same stage. Therefore, the pursuit of other biomarkers with the potential to classify patients with cancer has never stopped. One of them, tumor budding (TB), has gained much success in colorectal cancer. In recent years, TB in gastric cancer has attracted much attention from researchers, beginning to reveal the molecular and biological aspects of this phenomenon in gastric cancer, and has emerged as a promising prognostic biomarker in gastric cancer, predicting disease progression and unfavorable survival. Therefore, it is time and essential to provide a holistic overview of TB in gastric cancer, which has not been achieved and is the aim of this review.
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Affiliation(s)
- Shuo-Meng Xiao
- Department of Gastric Surgery, Sichuan Cancer Hospital, Chengdu 610041, Sichuan Province, China
| | - Jian Li
- Department of General Surgery, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang 621000, Sichuan Province, China
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Szalai L, Jakab Á, Kocsmár I, Szirtes I, Kenessey I, Szijártó A, Schaff Z, Kiss A, Lotz G, Kocsmár É. Prognostic Ability of Tumor Budding Outperforms Poorly Differentiated Clusters in Gastric Cancer. Cancers (Basel) 2022; 14:4731. [PMID: 36230653 PMCID: PMC9563769 DOI: 10.3390/cancers14194731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Small clusters of tumor cells at the invasion front of the tumor, known as “tumor budding” and larger clusters of cells, known as “poorly differentiated clusters”, are well known histological parameters to assess the outcome of colorectal cancer. However, their prognostic value for gastric cancer is less well investigated and controversial based on the studies conducted so far. In our retrospective study, we investigated the prognostic power of these two entities in a large cohort of gastric cancer patients. Our results demonstrate that tumor budding is an independent prognostic factor determining overall survival in gastric cancer, especially in intestinal type adenocarcinomas. In addition, budding can also predict the risk of lymph node metastases. However, although the trend is similar for poorly differentiated clusters, their predictive value is lower and they have not been shown to be an independent prognostic factor of survival in gastric cancer. Abstract The prognostic value of histological phenomena tumor budding (TB) and poorly differentiated clusters (PDCs) have been less studied in gastric cancer (GAC) and the data provided so far are controversial. In our study, 290 surgically resected GAC cases were evaluated for TB according to the criteria of International Tumor Budding Consensus Conference (ITBCC) and PDC, and both parameters were scored on a three-grade scale as described for colorectal cancer previously (0: Grade0, 1–4: Grade1, 5–9: Grade2 and ≥10: Grade3) and classified as low (Grade0–2) and high (Grade3) TB/PDC. High TB/PDC was associated with diffuse-type morphology, higher pT status, incomplete surgical resection, poor tumor differentiation and perineural and lymphovascular invasion. Multivariable survival analyses have shown an independent prognostic role of high TB with poorer overall survival in the total cohort (p = 0.014) and in intestinal-type adenocarcinomas (p = 0.005). Multivariable model revealed high TB as an independent predictor for lymph node metastasis in both the total cohort (p = 0.019) and in the intestinal type adenocarcinomas (p = 0.038). In contrast to tumor budding, no significant association was found between PDC and the occurrence of lymph node metastasis and tumor stage and even survival. In conclusion, tumor budding is an independent prognostic factor of survival in gastric cancer, especially in intestinal-type adenocarcinomas.
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Barresi V. Colorectal Cancer: From Pathophysiology to Novel Therapeutic Approaches. Biomedicines 2021; 9:biomedicines9121858. [PMID: 34944674 PMCID: PMC8698346 DOI: 10.3390/biomedicines9121858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Valeria Barresi
- Dipartimento di Diagnostica e Sanità Pubblica, Sezione di Anatomia Patologica, Università di Verona, 37134 Verona, Italy
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Caramaschi S, Mangogna A, Salviato T, Ammendola S, Barresi V, Manco G, Canu PG, Zanelli G, Bonetti LR. Cytoproliferative activity in colorectal poorly differentiated clusters: Biological significance in tumor setting. Ann Diagn Pathol 2021; 53:151772. [PMID: 34153686 DOI: 10.1016/j.anndiagpath.2021.151772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 06/04/2021] [Accepted: 06/10/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Poorly differentiated clusters (PDCs) have gained a significant prognostic role in colorectal carcinomas (CRCs) being associated to high risk of lymph node metastasis, shorter survival time and poor prognosis. The knowledge in PDC biology is not completely clear. MATERIALS AND METHODS We assessed Ki-67 LI in 45 CRCs showing ≥10 PDCs. We distinguished PDCs at the periphery of the tumor masses (pPDCs) from those within the tumor masses (cPDCs). We chose 3 cut-offs of Ki-67 labeling index (Ki-67 LI): <10%, 10-50%, and >50% of the labeled cells. RESULTS Ki-67 LI in pPDCs was<10% in 37 cases (82%), 10-50% in 6 cases (13%) and >50%in 2 cases (5%); Ki-67 LI in cPDCs was<10% in 4 cases (23.5%), 10-50% in 4 (23.5%) and >50% in 9 (54%). Ki-67 LI in tumor budding foci (TBs) was <10% in 8 cases (32%), 10-50% in 8 (32%) and >50% in 9 (36%). The difference of Ki-67 LI reaches the statistical significance (p < 0.005). Ki-67 LI <10% in the pPDCs was associated with nodal metastases (pN+) (p < 0.0001), pTNM stage III and IV(p < 0.0001) and TB (p < 0.001). Ki-67 LI > 50% in cPDC was significantly associated withpT3-pT4 and advanced pTNM stages (p < 0.0001), N+ (p = 0.0001) and LVI (p < 0.05). CONCLUSION Different Ki-67 LI detected between cPDCs and pPDCs suggesting a biological difference in PDCs. An actively proliferating central tumor areas can be distinguished from the peripheral portion of the tumors in which the cells interact with the stroma acquiring invasive and metastatic potential.
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Affiliation(s)
- Stefania Caramaschi
- Department of Medical and Surgical Sciences for Children & Adults, Division of Pathology, University-Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro Mangogna
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Tiziana Salviato
- Department of Medical and Surgical Sciences for Children & Adults, Division of Pathology, University-Hospital of Modena and Reggio Emilia, Modena, Italy.
| | - Serena Ammendola
- Department of Diagnostic and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Valeria Barresi
- Department of Diagnostic and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Gianrocco Manco
- Department of Surgery, University-Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Pina G Canu
- Department of Medical and Surgical Sciences for Children & Adults, Division of Pathology, University-Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Giuliana Zanelli
- Department of Medical and Surgical Sciences for Children & Adults, Division of Pathology, University-Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Luca Reggiani Bonetti
- Department of Medical and Surgical Sciences for Children & Adults, Division of Pathology, University-Hospital of Modena and Reggio Emilia, Modena, Italy
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Mitrovic B, Handley K, Assarzadegan N, Chang HL, Dawson HAE, Grin A, Hutchins GGA, Magill L, Quirke P, Riddell RH, Gray RG, Kirsch R. Prognostic and Predictive Value of Tumor Budding in Colorectal Cancer. Clin Colorectal Cancer 2021; 20:256-264. [PMID: 34099382 DOI: 10.1016/j.clcc.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Tumor budding (TB) is an adverse prognostic factor in colorectal cancer (CRC). International consensus on a standardized assessment method has led to its wider reporting. However, uncertainty regarding its clinical value persists. This study aimed to (1) confirm the prognostic significance of TB, particularly in stage II CRC; (2) to determine optimum thresholds for TB risk grouping; and (3) to determine whether TB influences responsiveness to chemotherapy. METHODS TB was assessed in CRC sections from 1575 QUASAR trial patients randomized between adjuvant chemotherapy and observation. Optimal risk group cutoffs were determined by maximum likelihood methods, with their influence on recurrence and mortality investigated in stratified log-rank analyses on exploratory (n = 504), hypothesis-testing (n = 478), and final (n = 593) data sets. RESULTS The optimal threshold for high-grade TB (HGTB) was ≥ 10 buds per 1.23 mm2. High-grade TB tumors had significantly worse outcomes than those with lower TB: 10-year recurrence 36% versus 22% (risk ratio, 2.00 [95% CI, 1.62-2.45]; 2P < .0001) and 10-year mortality 50% vs. 37% (risk ratio, 1.53 [95% CI, 1.34-1.76]; 2P < .0001). The prognostic significance remained equally strong after allowance for other pathological risk factors, including stage, grade, lymphovascular invasion, and mismatch repair status. There was a nonsignificant trend toward increasing chemotherapy efficacy with increasing bud counts. CONCLUSIONS TB is a strong independent predictor of recurrence. Chemotherapy efficacy is comparable in patients with higher and lower TB; hence, absolute reductions in recurrence and death with chemotherapy should be about twice as large in patients with ≥ 10 than < 10 TB counts.
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Affiliation(s)
- Bojana Mitrovic
- Department of Pathology and Laboratory Medicine, Health Sciences North, Sudbury, ON, Canada; University of Toronto, Toronto, Canada.
| | - Kelly Handley
- Birmingham Clinical Trials Unit, Birmingham, United Kingdom
| | | | | | | | | | - Gordon G A Hutchins
- Section of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom
| | - Laura Magill
- Birmingham Clinical Trials Unit, Birmingham, United Kingdom
| | - Philip Quirke
- Section of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom
| | - Robert H Riddell
- University of Toronto, Toronto, Canada; Mount Sinai Hospital, Toronto, ON, Canada
| | - Richard G Gray
- Clinical Trial Service Unit & Epidemiological Studies, University of Oxford, United Kingdom
| | - Richard Kirsch
- University of Toronto, Toronto, Canada; Mount Sinai Hospital, Toronto, ON, Canada
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Smit MA, van Pelt GW, Dequeker EM, Al Dieri R, Tollenaar RA, van Krieken JHJ, Mesker WE. e-Learning for Instruction and to Improve Reproducibility of Scoring Tumor-Stroma Ratio in Colon Carcinoma: Performance and Reproducibility Assessment in the UNITED Study. JMIR Form Res 2021; 5:e19408. [PMID: 33739293 PMCID: PMC8122297 DOI: 10.2196/19408] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 12/14/2020] [Accepted: 03/03/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The amount of stroma in the primary tumor is an important prognostic parameter. The tumor-stroma ratio (TSR) was previously validated by international research groups as a robust parameter with good interobserver agreement. OBJECTIVE The Uniform Noting for International Application of the Tumor-Stroma Ratio as an Easy Diagnostic Tool (UNITED) study was developed to bring the TSR to clinical implementation. As part of the study, an e-Learning module was constructed to confirm the reproducibility of scoring the TSR after proper instruction. METHODS The e-Learning module consists of an autoinstruction for TSR determination (instruction video or written protocol) and three sets of 40 cases (training, test, and repetition sets). Scoring the TSR is performed on hematoxylin and eosin-stained sections and takes only 1-2 minutes. Cases are considered stroma-low if the amount of stroma is ≤50%, whereas a stroma-high case is defined as >50% stroma. Inter- and intraobserver agreements were determined based on the Cohen κ score after each set to evaluate the reproducibility. RESULTS Pathologists and pathology residents (N=63) with special interest in colorectal cancer participated in the e-Learning. Forty-nine participants started the e-Learning and 31 (63%) finished the whole cycle (3 sets). A significant improvement was observed from the training set to the test set; the median κ score improved from 0.72 to 0.77 (P=.002). CONCLUSIONS e-Learning is an effective method to instruct pathologists and pathology residents for scoring the TSR. The reliability of scoring improved from the training to the test set and did not fall back with the repetition set, confirming the reproducibility of the TSR scoring method. TRIAL REGISTRATION The Netherlands Trial Registry NTR7270; https://www.trialregister.nl/trial/7072. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/13464.
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Affiliation(s)
- Marloes A Smit
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Elisabeth Mc Dequeker
- Department of Public Health and Primary Care, Biomedical Quality Assurance Research Unit, University of Leuven, Leuven, Belgium
| | | | - Rob Aem Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - J Han Jm van Krieken
- Department of Pathology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
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- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
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Archilla I, Díaz-Mercedes S, Aguirre JJ, Tarragona J, Machado I, Rodrigo MT, Lopez-Prades S, Gorostiaga I, Landolfi S, Alén BO, Balaguer F, Castells A, Camps J, Cuatrecasas M. Lymph Node Tumor Burden Correlates With Tumor Budding and Poorly Differentiated Clusters: A New Prognostic Factor in Colorectal Carcinoma? Clin Transl Gastroenterol 2021; 12:e00303. [PMID: 33939382 PMCID: PMC7909319 DOI: 10.14309/ctg.0000000000000303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 12/18/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Molecular lymph node (LN) staging in early colorectal cancer (CRC) has demonstrated to be more precise than conventional histopathology pN staging. Tumor budding (TB) and poorly differentiated clusters (PDCs) are associated with LN metastases, recurrences, and lower survival in CRC. We evaluated the correlation between the total tumor load (TTL) in LNs from CRC surgical specimens with patient outcome, TB, and PDC. METHODS In this retrospective multicentre study, 5,931 LNs from 342 stage I-III CRC were analyzed by both hematoxylin and eosin and molecular detection of tumor cytokeratin 19 mRNA by one-step nucleic acid amplification. TB and PDC were evaluated by hematoxylin and eosin and cytokeratin 19 immunohistochemistry. RESULTS One-step nucleic acid was positive in 38.3% patients (n = 131). Tumor Budding was low in 45% cases, intermediate in 25%, and high in 30%. Poorly Differentiated Clusters were low-grade G1 in 53%, G2 in 32%, and G3 in 15%. TB and PDC correlated with TTL, high-grade, lymphovascular and perineural invasion, pT, pN and stage (P < 0.001). TB, PDC, and TTL ≥ 6,000 copies/µL were associated with worse overall survival (P = 0.002, P = 0.013, and P = 0.046) and disease-free survival (P < 0.001). DISCUSSION The implementation of more sensitive molecular methods to assess LN status is a promising alternative approach to pN staging, which could be integrated to other factors to help risk stratification and management of patients with early-stage CRC. This study demonstrates the correlation of the amount of LN tumor burden with TB and PDCs. TTL is related to the outcome and could be used as a new prognostic factor in CRC (see Visual Abstract, Supplementary Digital Content 2, http://links.lww.com/CTG/A512).
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Affiliation(s)
- Ivan Archilla
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clínic, University of Barcelona, IDIBAPS, Spain
| | - Sherley Díaz-Mercedes
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clínic, University of Barcelona, IDIBAPS, Spain
| | | | - Jordi Tarragona
- Pathology Department, Hospital Arnau de Vilanova, Lleida, Spain
| | - Isidro Machado
- Pathology Department, Instituto Valenciano de Oncologia and Hospital QuironSalud, Valencia, Spain
| | - Maria Teresa Rodrigo
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clínic, University of Barcelona, IDIBAPS, Spain
| | - Sandra Lopez-Prades
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clínic, University of Barcelona, IDIBAPS, Spain
| | - Iñigo Gorostiaga
- Pathology Department, Arava University Hospital, Vitoria-Gasteiz, Spain
| | - Stefania Landolfi
- Pathology Department, Vall Hebron University Hospital, Barcelona, Spain
| | - Begoña Otero Alén
- Molecular Pathology Division, Pathology Department, CHUAC/INIBIC, A Coruña, Spain
| | - Francesc Balaguer
- Gastroenterology Department, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
- Centro de Investigación Biomédica en Red. Enfermedades Hepáticas y Digestivas (CIBERehd). ISCiii. Spain
| | - Antoni Castells
- Gastroenterology Department, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
- Centro de Investigación Biomédica en Red. Enfermedades Hepáticas y Digestivas (CIBERehd). ISCiii. Spain
| | - Jordi Camps
- Gastroenterology Department, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
- Centro de Investigación Biomédica en Red. Enfermedades Hepáticas y Digestivas (CIBERehd). ISCiii. Spain
| | - Miriam Cuatrecasas
- Pathology Department, Center of Biomedical Diagnosis (CDB), Hospital Clínic, University of Barcelona, IDIBAPS, Spain
- Centro de Investigación Biomédica en Red. Enfermedades Hepáticas y Digestivas (CIBERehd). ISCiii. Spain
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Shivji S, Conner JR, Barresi V, Kirsch R. Poorly differentiated clusters in colorectal cancer: a current review and implications for future practice. Histopathology 2020; 77:351-368. [PMID: 32358792 DOI: 10.1111/his.14128] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/16/2020] [Accepted: 04/26/2020] [Indexed: 12/13/2022]
Abstract
Poorly differentiated clusters (PDC), defined as small groups of ≥5 tumour cells without glandular differentiation, have gained recent attention as a promising prognostic factor in colorectal cancer (CRC). Numerous studies have shown PDC to be significantly associated with other adverse histopathological features and worse clinical outcomes. PDC may hold particular promise in stage II colon cancer, where risk stratification plays a critical role in patient selection for adjuvant chemotherapy. In addition, emerging evidence suggests that PDC can predict lymph node metastasis in endoscopically resected pT1 CRC, potentially helping the selection of patients for oncological resection. In 'head-to-head' comparisons, PDC grade has consistently outperformed conventional histological grading systems both in terms of risk stratification and reproducibility. With a number of large-scale studies now available, this review evaluates the evidence regarding the prognostic significance of PDC, considers its relationship with other emerging invasive front prognostic markers (such as tumour budding and stroma type), assesses its 'practice readiness', addressing issues such as interobserver reproducibility, scoring methodologies and special histological subtypes (e.g. micropapillary and mucinous carcinoma), and draws attention to ongoing challenges and areas in need of further study. Finally, emerging data on the role of PDC in non-colorectal cancers are briefly considered.
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Affiliation(s)
- Sameer Shivji
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - James R Conner
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Valeria Barresi
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Richard Kirsch
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
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Aralica G, Šarec Ivelj M, Pačić A, Baković J, Milković Periša M, Krištić A, Konjevoda P. Prognostic Significance of Lacunarity in Preoperative Biopsy of Colorectal Cancer. Pathol Oncol Res 2020; 26:2567-76. [PMID: 32617959 DOI: 10.1007/s12253-020-00851-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 10/23/2022]
Abstract
The quantity and quality of preoperative material in colorectal cancer is often limiting factor in determination of risk factors and therapy planning. The most important negative prognostic factors are intravascular and perineural invasion, as well as tumor budding. Usually, the only parameter available in preoperative biopsy is tumor budding. However, the growing body of evidence suggests that cancer differentiation based on the poorly differentiated clusters has better prognostic value. The limiting factor in applying of these new parameters is reproducible, simple, cheap and fast method of their determination. In this paper we investigated the prognostic value of lacunarity, determined in preoperative biopsy. Lacunarity is a measure of spatial heterogeneity (inhomogeneity) in an image. It quantifies how objects fill the space, and enables analysis of gaps distribution, homogeneity of gaps, and presence of structures. It was shown that lacunarity and the total number of buds could be combined in a model which clearly divides colorectal cancer patients in low, medium and high risk subgroups. The paper also points out that the quantitative numerical methods are superior to semiquantitative methods, and that individual methods should be combined using algorithms to obtain a more accurate prediction. Because the study described is designed as a pilot study, verification is needed on a larger sample of patients from independent researchers.
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Ammendola S, Turri G, Marconi I, Burato G, Pecori S, Tomezzoli A, Conti C, Pedrazzani C, Barresi V. The presence of poorly differentiated clusters predicts survival in stage II colorectal cancer. Virchows Arch 2021; 478:241-8. [PMID: 32577812 DOI: 10.1007/s00428-020-02880-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/12/2020] [Accepted: 06/19/2020] [Indexed: 12/24/2022]
Abstract
In stage II colorectal carcinoma (CRC), adjuvant chemotherapy is reserved to cases at high risk of adverse outcome. This study aims to investigate the prognostic value of tumor budding (TB) and poorly differentiated clusters (PDC) in this setting. In a cohort of 149 patients with surgically resected stage II CRC not undergoing neoadjuvant or adjuvant treatments, we assessed the prognostic value of several clinical-pathological variables, including PDC and TB, on cancer-specific survival (CSS). Rectal location, lymphovascular invasion, and a number of lymph nodes < 12 confirmed to be significant and independent predictors of shorter CSS. A total of 117 CRCs were graded as PDC-G1 (0-4 PDCs), 19 as PDC-G2 (5-9 PDCs), and 13 as PDC-G3 (> 9 PDCs). Ninety-eight cases had PDC absent. TB foci were found in 91 CRCs; 121 were classified Bd1, 16 were Bd2, and 12 were Bd3. PDC-G2/G3 was significantly prognostic of shorter CSS (P < 0.0001). Among PDC-G1 cases, the presence of PDC was significantly associated with reduced CSS (P < 0.0001). Moreover, in the whole 149 CRCs, it had higher sensitivity and specificity to identify high-risk patients, compared to PDC grade, and it was independently associated with shorter CSS at multivariate analysis. High TB grade (Bd3) was significantly associated with shorter CSS (P = 0.0001), but it lost prognostic value at multivariate analysis. These findings suggest that the presence of PDC in stage II CRCs might be added to the pool of high-risk factors, warranting the use of adjuvant chemotherapy.
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Wu G, Li J, Qin C. Reduced RANBP9 expression is associated with poor prognosis in colorectal cancer patients. Transl Cancer Res 2019; 8:2704-2712. [PMID: 35117028 PMCID: PMC8797687 DOI: 10.21037/tcr.2019.10.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/10/2019] [Indexed: 11/09/2022]
Abstract
Background Colorectal cancer (CRC) is the third most common malignancy worldwide. RANBP9 is a RAN-binding protein that has been reported to be a reliable predictor for prognosis in some human cancers. The mechanism of RANBP9 involvement in CRC carcinogenesis is unknown. This study measured RANBP9 expression levels in CRC to determine its association with clinicopathological parameters. Methods This study included 228 CRC patients who underwent radical resection. RANBP9 expression was determined using immunohistochemistry. Based on follow-up data, the correlation of RANBP9 expression levels with clinicopathological parameters, including disease free survival (DFS) and overall survival (OS) was evaluated. Results Reduced RANBP9 expression was correlated with tumor location (P=0.014), vascular invasion (P=0.057) and normal serum carcinoembryonic antigen levels (P=0.001). Patients with reduced RANBP9 expression had a 5-year DFS rate of 63.0% compared to 78.9% for patients with high expression levels of RANBP9 (P=0.015). Subgroup analysis demonstrated that reduced RANBP9 expression was significantly correlated with a worse DFS rate (P=0.037) for patients with left-sided colon cancer. RANBP9 was found to be an independent predictive factor for estimating DFS rate (P=0.029, hazard ratio: 0.580, 95% confidence interval: 0.356–0.946) and OS. Conclusions RANBP9 expression levels is a potential prognostic factor for estimating CRC survival rates in patients after surgery.
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Affiliation(s)
- Guangbin Wu
- Department of General surgery, Jinshan Hospital, Fudan University, Shanghai 201508, China
| | - Ji Li
- Department of General surgery, Jinshan Hospital, Fudan University, Shanghai 201508, China
| | - Chunzhi Qin
- Department of General surgery, Jinshan Hospital, Fudan University, Shanghai 201508, China
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Aikawa A, Fujita H, Kosaka T, Minato H, Kiyokawa E. Clinicopathological significance of heterogeneic ezrin expression in poorly differentiated clusters of colorectal cancers. Cancer Sci 2019; 110:2667-2675. [PMID: 31175699 PMCID: PMC6676292 DOI: 10.1111/cas.14093] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/31/2019] [Accepted: 06/06/2019] [Indexed: 12/28/2022] Open
Abstract
Multicellular structures, such as tumor buddings and poorly differentiated clusters (PDC), exist at the invasive front of colorectal cancers (CRC). Although it has been reported that CRC with PDC showed frequent lymph node metastases with a worse prognosis, the molecular markers of PDC that are responsible for prognosis have not been identified. We here noticed for the first time that Ezrin, a regulator of the actin cytoskeleton, is expressed in the corner cells of PDC. We then aimed to verify whether heterogeneous Ezrin expression in PDC predicts the prognosis of CRC patients. We immunohistochemically analyzed Ezrin expression in PDC of 184 patients with completely resected stages I‐III CRC. We established the Ezrin corner score (ECS), which quantifies the tendency of Ezrin‐positive cells to accumulate at the corners of PDC. On the basis of ECS values, 2 indices, the mean ECS and the number of PDC with high ECS, were obtained. Both indices were significantly higher in CRC with lymphatic invasion, higher PDC grade, and presence of micropapillary (MP) PDC. The mean ECS‐high group showed shorter recurrence‐free survival than the mean ECS‐low group but without significance. The other index, the number of ECS‐high PDC, was significantly associated with recurrence‐free survival. These results suggest that Ezrin is involved in PDC progression and lymphatic invasion, and that ECS may be a marker for aggressive PDC.
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Affiliation(s)
- Akane Aikawa
- Department of Oncologic Pathology, Kanazawa Medical University, Kahoku-gun, Japan.,Department of Diagnostic Pathology, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Hideto Fujita
- Department of Surgery, Kanazawa Medical University, Kahoku-gun, Japan
| | - Takeo Kosaka
- Department of Surgery, Kanazawa Medical University, Kahoku-gun, Japan
| | - Hiroshi Minato
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Etsuko Kiyokawa
- Department of Oncologic Pathology, Kanazawa Medical University, Kahoku-gun, Japan
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Abstract
Context.—
Pathologic assessment of colorectal cancer resection specimens plays an important role in postsurgical management and prognostication in patients with colorectal cancer. Challenges exist in the evaluation and reporting of these specimens, either because of difficulties in applying existing guidelines or related to newer concepts.
Objective.—
To address challenging areas in colorectal cancer pathology and to provide an overview of the literature, current guidelines, and expert recommendations for the handling of colorectal cancer resection specimens in everyday practice.
Data Sources.—
PubMed (US National Library of Medicine, Bethesda, Maryland) literature review; reporting protocols of the College of American Pathologists, the Royal College of Pathologists of the United Kingdom, and the Japanese Society for Cancer of the Colon and Rectum; and classification manuals of the American Joint Committee on Cancer and the Union for International Cancer Control.
Conclusions.—
This review has addressed issues and challenges affecting quality of colorectal cancer pathology reporting. High-quality pathology reporting is essential for prognostication and management of patients with colorectal cancer.
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Affiliation(s)
- Heather Dawson
- From the Institute of Pathology, University of Bern, Bern, Switzerland (Dr Dawson); Pathology and Laboratory Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada (Drs Dawson and Kirsch); the Department of Colorectal Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom (Dr Messenger); and Pathology and Laboratory Medicine, Western Univer
| | - Richard Kirsch
- From the Institute of Pathology, University of Bern, Bern, Switzerland (Dr Dawson); Pathology and Laboratory Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada (Drs Dawson and Kirsch); the Department of Colorectal Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom (Dr Messenger); and Pathology and Laboratory Medicine, Western Univer
| | - David Messenger
- From the Institute of Pathology, University of Bern, Bern, Switzerland (Dr Dawson); Pathology and Laboratory Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada (Drs Dawson and Kirsch); the Department of Colorectal Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom (Dr Messenger); and Pathology and Laboratory Medicine, Western Univer
| | - David Driman
- From the Institute of Pathology, University of Bern, Bern, Switzerland (Dr Dawson); Pathology and Laboratory Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada (Drs Dawson and Kirsch); the Department of Colorectal Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom (Dr Messenger); and Pathology and Laboratory Medicine, Western Univer
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Barresi V, Lionti S, Bonetti LR. Poorly differentiated clusters in colorectal liver metastases: Prognostic significance in synchronous and metachronous metastases. J Surg Oncol 2018; 117:1856-1857. [DOI: 10.1002/jso.25077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 03/13/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Valeria Barresi
- Department of Pathology in Evolutive Age and Adulthood “Gaetano Barresi”; University of Messina; Messina Italy
| | - Simona Lionti
- Department of Pathology in Evolutive Age and Adulthood “Gaetano Barresi”; University of Messina; Messina Italy
| | - Luca Reggiani Bonetti
- Department of Laboratory Integrated Activities; Anatomic Pathology and Legal Medicine; University of Modena and Reggio Emilia; Modena Italy
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Lee VWK, Chan KF. Tumor budding and poorly-differentiated cluster in prognostication in Stage II colon cancer. Pathol Res Pract 2018; 214:402-407. [DOI: 10.1016/j.prp.2017.12.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/15/2017] [Accepted: 12/31/2017] [Indexed: 12/21/2022]
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Abstract
AIM This study is aimed to determine whether trimethylamine-N-oxide (TMAO) is a predictor of prognosis of patients with colorectal cancer. METHODS Pretreatment TMAO serum levels were determined in 108 patients with colorectal cancer and 30 healthy controls. RESULTS Median serum TMAO level was significantly higher in colorectal cancer patients than in healthy controls (p < 0.01). No correlation was observed between the disease-free survival and the type of chemotherapy regimen used, tumor location or lymphovascular invasion. Patients with high serum TMAO level had significantly shorter disease-free survival than patients with low serum TMAO level. Multivariate analysis showed that serum TMAO level and distant metastases were independent prognostic factors. CONCLUSION Pretreatment serum TMAO level is identified as a new independent prognostic biomarker in patients with colorectal cancer.
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Affiliation(s)
- Xiaomei Liu
- Department of Oncology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou 121001, P.R. China
| | - Heng Liu
- Department of Oncology, Liaohe Oil Field General Hospital, Panjin 124000, P.R. China
| | - Caijun Yuan
- Department of Oncology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou 121001, P.R. China
| | - Yinxu Zhang
- Department of Surgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou 121001, P.R. China
| | - Wei Wang
- Department of Oncology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou 121001, P.R. China
| | - Shuding Hu
- Department of Surgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou 121001, P.R. China
| | - Lei Liu
- Department of Surgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou 121001, P.R. China
| | - Ying Wang
- Department of Oncology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou 121001, P.R. China
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Abdalmassih M, Sivananthan G, Raizman Z, Lambert P, Wirtzfeld D, Bashir B, Wightman R, Daniel K, Nashed M. Prognostic markers of recurrence and survival in rectal cancer treated with neoadjuvant chemoradiotherapy and surgery. Colorectal Cancer 2018. [DOI: 10.2217/crc-2017-0015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: To identify markers of recurrence and survival in patients with locally advanced rectal cancer who received neoadjuvant chemoradiotherapy and surgery. Materials & methods: A total of 280 patients were identified in Manitoba between 2007 and 2012. Demographics and clinical data were collected. Cox regression models were used to identify outcome predictors. Results: A total of 53 patients achieved pathological complete response (pCR) and 160 patients received adjuvant chemotherapy (ACT). The median follow-up duration was 2.06 years. Recurrence and survival rates at 5 years were 33.2 and 77.0%, respectively. pCR and lymphovascular invasion predicted recurrence. pCR and ACT predicted better survival. Conclusion: pCR is a significant predictor of recurrence and survival and may be considered as an oncological end point. The patients who achieve pCR may not derive additional survival benefit from ACT.
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Affiliation(s)
- Michael Abdalmassih
- Cancer Care Manitoba, Radiation Oncology, 675 McDermot Ave, Winnipeg, MB, R3E 0V9, Canada
| | - Gokulan Sivananthan
- Cancer Care Manitoba, Radiation Oncology, 675 McDermot Ave, Winnipeg, MB, R3E 0V9, Canada
| | - Zachary Raizman
- Cancer Care Manitoba, Radiation Oncology, 675 McDermot Ave, Winnipeg, MB, R3E 0V9, Canada
| | - Pascal Lambert
- Cancer Care Manitoba, Epidemiology & Cancer Registry, Winnipeg, MB, Canada
| | - Debrah Wirtzfeld
- Department of Family Medicine, University of Manitoba, Winnipeg, MB, R3T 2N2, Canada
| | - Bashir Bashir
- Cancer Care Manitoba, Radiation Oncology, 675 McDermot Ave, Winnipeg, MB, R3E 0V9, Canada
- Department of Radiology, University of Manitoba, Radiology, Winnipeg, MB, Canada
| | - Robert Wightman
- Department of Pathology, University of Manitoba, Pathology, Winnipeg, MB, Canada
| | - Kroeker Daniel
- Department of Family Medicine, University of Manitoba, Winnipeg, MB, R3T 2N2, Canada
| | - Maged Nashed
- Cancer Care Manitoba, Radiation Oncology, 675 McDermot Ave, Winnipeg, MB, R3E 0V9, Canada
- Department of Radiology, University of Manitoba, Radiology, Winnipeg, MB, Canada
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Eriksen AC, Sørensen FB, Lindebjerg J, Hager H, dePont Christensen R, Kjær-Frifeldt S, Hansen TF. The prognostic value of tumour stroma ratio and tumour budding in stage II colon cancer. A nationwide population-based study. Int J Colorectal Dis 2018; 33:1115-1124. [PMID: 29785462 PMCID: PMC6060800 DOI: 10.1007/s00384-018-3076-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE High-risk patients with stage II colon cancer (CC) may benefit from adjuvant chemotherapy, but additional prognostic markers are needed for better stratification. We investigated the prognostic value of tumour stroma ratio (TSR) and tumour budding (TB). METHODS A nationwide population-based cohort of 573 patients with stage II CC was included. TSR was scored on hematoxylin and eosin sections as low TSR (> 50% stroma) and high TSR (≤ 50% stroma). TB was evaluated in hotspots on pan-cytokeratin stained sections in 10 high power fields (HPF) at the invasive front and classified by the mean number of buds per HPF as high grade budding (≥ 10 buds) or low-grade budding (< 10 buds). The prognostic value was investigated in Cox proportional hazard models for recurrence-free survival (RFS) and overall survival (OS). RESULTS Low TSR was associated with worse RFS (HR = 1.342 (95% CI 1.006-1.791), p = 0.045) and OS (HR = 1.376 (95% CI 1.016-1.862), p = 0.039). Furthermore, an association was found between low TSR and microsatellite stabile tumours (p < 0.001). The mean number of buds per HPF was associated to TSR with increasing number of buds related to a lower TSR (p = 0.026). No statistically significant prognostic impact of TB regarding OS or RFS was detected. CONCLUSIONS TSR provided valuable prognostic information, and adding TSR to the current risk stratification may contribute to better patient selection. The estimates of TSR and TB were found to be associated, but no prognostic value of TB was documented.
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Affiliation(s)
- Ann Christina Eriksen
- Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark ,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark ,Department of Pathology, Lillebaelt Hospital, Beriderbakken 4, DK-7100 Vejle, Denmark
| | - Flemming B. Sørensen
- Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark ,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark ,Department of Clinical Medicine, University Institute of Pathology, Aarhus University Hospital, University of Aarhus, Aarhus, Denmark
| | - Jan Lindebjerg
- Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark ,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark ,Danish Colorectal Cancer Group (DCCG), Hvidovre, Denmark
| | - Henrik Hager
- Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark ,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | | | - Torben F. Hansen
- Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark ,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark ,Danish Colorectal Cancer Group (DCCG), Hvidovre, Denmark
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Reggiani Bonetti L, Lionti S, Domati F, Pagliani G, Mattioli E, Barresi V. Histological grading based on poorly differentiated clusters is predictive of tumour response and clinical outcome in rectal carcinoma treated with neoadjuvant chemoradiotherapy. Histopathology 2017; 71:393-405. [DOI: 10.1111/his.13242] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 04/11/2017] [Accepted: 04/16/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Luca Reggiani Bonetti
- Department of Laboratory Integrated Activities, Anatomical Pathology and Legal Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - Simona Lionti
- Department of Pathology in Evolutive Age and Adulthood ‘Gaetano Barresi’; University of Messina; Messina Italy
| | - Federica Domati
- Department of Laboratory Integrated Activities, Anatomical Pathology and Legal Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - Giuliana Pagliani
- Department of Laboratory Integrated Activities, Anatomical Pathology and Legal Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - Elisabetta Mattioli
- Department of Laboratory Integrated Activities, Anatomical Pathology and Legal Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - Valeria Barresi
- Department of Pathology in Evolutive Age and Adulthood ‘Gaetano Barresi’; University of Messina; Messina Italy
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Barresi V, Reggiani Bonetti L, Ieni A, Caruso RA, Tuccari G. Poorly Differentiated Clusters: Clinical Impact in Colorectal Cancer. Clin Colorectal Cancer 2017; 16:9-15. [DOI: 10.1016/j.clcc.2016.06.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/06/2016] [Accepted: 06/10/2016] [Indexed: 12/15/2022]
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Stammes MA, Prevoo HA, Ter Horst MC, Groot SA, Van de Velde CJ, Chan AB, de Geus-Oei LF, Kuppen PJ, Vahrmeijer AL, Pasquale EB, Sier CF. Evaluation of EphA2 and EphB4 as Targets for Image-Guided Colorectal Cancer Surgery. Int J Mol Sci 2017; 18:E307. [PMID: 28165374 DOI: 10.3390/ijms18020307] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 12/30/2016] [Accepted: 01/21/2017] [Indexed: 12/15/2022] Open
Abstract
Targeted image-guided oncologic surgery (IGOS) relies on the recognition of cell surface-associated proteins, which should be abundantly present on tumor cells but preferably absent on cells in surrounding healthy tissue. The transmembrane receptor tyrosine kinase EphA2, a member of the A class of the Eph receptor family, has been reported to be highly overexpressed in several tumor types including breast, lung, brain, prostate, and colon cancer and is considered amongst the most promising cell membrane-associated tumor antigens by the NIH. Another member of the Eph receptor family belonging to the B class, EphB4, has also been found to be upregulated in multiple cancer types. In this study, EphA2 and EphB4 are evaluated as targets for IGOS of colorectal cancer by immunohistochemistry (IHC) using a tissue microarray (TMA) consisting of 168 pairs of tumor and normal tissue. The IHC sections were scored for staining intensity and percentage of cells stained. The results show a significantly enhanced staining intensity and more widespread distribution in tumor tissue compared with adjacent normal tissue for EphA2 as well as EphB4. Based on its more consistently higher score in colorectal tumor tissue compared to normal tissue, EphB4 appears to be a promising candidate for IGOS of colorectal cancer. In vitro experiments using antibodies on human colon cancer cells confirmed the possibility of EphB4 as target for imaging.
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Rogers AC, Winter DC, Heeney A, Gibbons D, Lugli A, Puppa G, Sheahan K. Systematic review and meta-analysis of the impact of tumour budding in colorectal cancer. Br J Cancer 2016; 115:831-40. [PMID: 27599041 DOI: 10.1038/bjc.2016.274] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 07/20/2016] [Accepted: 08/01/2016] [Indexed: 12/27/2022] Open
Abstract
Background: Tumour budding is a histological finding in epithelial cancers indicating an unfavourable phenotype. Previous studies have demonstrated that it is a negative prognostic indicator in colorectal cancer (CRC), and has been proposed as an additional factor to incorporate into staging protocols. Methods: A systematic review of papers until March 2016 published on Embase, Medline, PubMed, PubMed Central and Cochrane databases pertaining to tumour budding in CRC was performed. Study end points were the presence of lymph node metastases, recurrence (local and distal) and 5-year cancer-related death. Results: A total of 7821 patients from 34 papers were included, with a mean rate of tumour budding of 36.8±16.5%. Pooled analysis suggested that specimens exhibiting tumour budding were significantly associated with lymph node positivity (OR 4.94, 95% CI 3.96–6.17, P<0.00001), more likely to develop disease recurrence over the time period (OR 5.50, 95% CI 3.64–8.29, P<0.00001) and more likely to lead to cancer-related death at 5 years (OR 4.51, 95% CI 2.55–7.99, P<0.00001). Conclusions: Tumour budding in CRC is strongly predictive of lymph node metastases, recurrence and cancer-related death at 5 years, and its incorporation into the CRC staging algorithm will contribute to more effective risk stratification.
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Reggiani Bonetti L, Barresi V, Bettelli S, Domati F, Palmiere C. Poorly differentiated clusters (PDC) in colorectal cancer: what is and ought to be known. Diagn Pathol 2016; 11:31. [PMID: 27004798 PMCID: PMC4802878 DOI: 10.1186/s13000-016-0481-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 03/10/2016] [Indexed: 01/22/2023] Open
Abstract
Background The counting of poorly differentiated clusters of 5 or more cancer cells lacking a gland-like structure in a tumor mass has recently been identified among the histological features predictive of poor prognosis in colorectal cancer. Main body Poorly differentiated clusters can easily be recognized in the histological sections of colorectal cancer routinely stained with haematoxylin and eosin. Despite some limitations related to specimen fragmentation, counting can also be assessed in endoscopic biopsies. Based on the number of poorly differentiated clusters that appear under a microscopic field of a ×20 objective lens (i.e., a microscopic field with a major axis of 1 mm), colorectal cancer can be graded into malignancies as follows: tumors with <5 clusters as grade 1, tumors with 5 to 9 clusters as grade 2, and tumors with ≥10 clusters as grade 3. High poorly differentiated cluster counts are significantly associated with peri-neural and lympho-vascular invasion, the presence of nodal metastases or micrometastases, as well as shorter overall and progression free survival to colorectal cancer. Conclusion The morphological aspects and clinical relevance of poorly differentiated clusters counting in colorectal cancer are discussed in this review.
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Affiliation(s)
- Luca Reggiani Bonetti
- Department of Diagnostic Medicine and Public Health, University of Modena and Reggio Emilia - Section of Pathology, Via del Pozzo, 41124, Modena, Italy
| | - Valeria Barresi
- Department of Pathology, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Stefania Bettelli
- Department of Diagnostic Medicine and Public Health, University of Modena and Reggio Emilia - Section of Pathology, Via del Pozzo, 41124, Modena, Italy
| | - Federica Domati
- Department of Diagnostic Medicine and Public Health, University of Modena and Reggio Emilia - Section of Internal Medicine, Via del Pozzo, 41124, Modena, Italy
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