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Wu J, Shou JZ, Wang YC. Survival Analysis of Lymphoepithelioma-Like Carcinoma of the Urinary Bladder and the Effect of Surgical Treatment Modalities on Prognosis. Front Surg 2021; 8:706537. [PMID: 34692761 PMCID: PMC8529967 DOI: 10.3389/fsurg.2021.706537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/02/2021] [Accepted: 09/03/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: This study aimed to investigate the prognostic factors of patients with lymphoepithelioma-like carcinoma of the urinary bladder (LELCB) and explore the value of surgical treatment. Methods: Data of patients with LELCB were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The multivariate analysis was performed using the stepwise Cox proportional hazards regression model and conditional inference tree method to identify significant prognosticators of overall survival (OS) from the parameters such as age, gender, lymph node involvement, tumor extent, radiation, chemotherapy, and surgery type. Literature review (LR) was performed, and eligible cases were used to validate prognostic classification using the Kaplan-Meier method with log-rank tests. Results: Sixty patients with a median age of 69.5 years were identified from the SEER database and 91 patients through LR. The Cox analysis identified age, gender, lymph node involvement, and surgical approach as independent prognosticators of OS. Based on the nomogram scores, patients were stratified into three prognostic groups: (I) patients younger than 70 years; (II) patients older than 70 years, who received bladder-sparing therapy (BST); and (III) patients older than 70 years undergoing radical cystectomy (RC). Patients in group II had the worst outcomes in terms of OS compared with patients in groups I and III (p < 0.001 and p = 0.03, respectively). A similar survival pattern was found in the LR cohort. Conclusion: The nomogram provided individualized prognostic quantification of OS in patients with LELCB. BST could yield favorable outcomes when treating LELCB, especially for younger patients, whereas older patients might derive more survival benefit from RC.
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Affiliation(s)
- Jie Wu
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian-Zhong Shou
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu-Chen Wang
- Chinese Academy of Sciences (CAS) Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Beijing, China
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Fang WL, Chen MH, Huang KH, Lin CH, Chao Y, Lo SS, Li AFY, Wu CW, Shyr YM. The Clinicopathological Features and Genetic Alterations in Epstein-Barr Virus-Associated Gastric Cancer Patients after Curative Surgery. Cancers (Basel) 2020; 12:cancers12061517. [PMID: 32531970 PMCID: PMC7352714 DOI: 10.3390/cancers12061517] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 05/17/2020] [Revised: 06/06/2020] [Accepted: 06/07/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Epstein–Barr virus (EBV)-associated gastric cancer (GC) is one of four major gastric cancer types and is traditionally considered to be related to lymphoepithelioma-like GC. Few studies have investigated the clinical significance of EBV infection in intestinal/solid type, diffuse (poorly cohesive) type, and lymphoepithelioma-like GC. Methods: A total of 460 GC patients receiving curative surgery were enrolled. The clinicopathological features, genetic alterations and prognoses were compared between patients with and without EBV infection. Results: EBV-positive GC patients (n = 43) had more tumors located in the upper and middle stomach, more common in lymphoepithelioma-like carcinoma, more lymphoid stroma, fewer Helicobacter pylori infections, and higher programmed death-ligand 1 (PD-L1) expression than EBV-negative GC patients. For intestinal/solid type GC, EBV-positive tumors were more likely to be located in the upper and middle stomach, have more lymphoid stroma, fewer Helicobacter pylori infections, higher PD-L1 expression, and more liver metastases than EBV-negative tumors. For diffuse (poorly cohesive) type GC, EBV-positive tumors were more likely to be located in the upper stomach, and have more lymphoid stroma than EBV-negative tumors. For lymphoepithelioma-like GC, EBV-positive tumors had more PI3K/AKT pathway mutations than EBV-negative tumors. Conclusions: Intestinal/solid type GC patients with EBV-positive tumors were associated with higher PD-L1 expression and more liver metastases, while lymphoepithelioma-like GC patients with EBV-positive tumors had more PI3K/AKT pathway mutations. Immunotherapy and targeted therapy may be beneficial for these groups of patients. Routine EBV survey is recommended in GC.
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Affiliation(s)
- Wen-Liang Fang
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (K.-H.H.); (C.-W.W.); (Y.-M.S.)
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan; (M.-H.C.); (Y.C.); (S.-S.L.); (A.F.-Y.L.)
- Correspondence:
| | - Ming-Huang Chen
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan; (M.-H.C.); (Y.C.); (S.-S.L.); (A.F.-Y.L.)
- Center of Immuno-Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Kuo-Hung Huang
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (K.-H.H.); (C.-W.W.); (Y.-M.S.)
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan; (M.-H.C.); (Y.C.); (S.-S.L.); (A.F.-Y.L.)
| | - Chien-Hsing Lin
- Genome Research Center, National Yang-Ming University, Taipei 11221, Taiwan;
| | - Yee Chao
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan; (M.-H.C.); (Y.C.); (S.-S.L.); (A.F.-Y.L.)
- Center of Immuno-Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Su-Shun Lo
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan; (M.-H.C.); (Y.C.); (S.-S.L.); (A.F.-Y.L.)
- Department of Surgery, National Yang-Ming University Hospital, Yilan 26058, Taiwan
| | - Anna Fen-Yau Li
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan; (M.-H.C.); (Y.C.); (S.-S.L.); (A.F.-Y.L.)
- Department of Pathology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Chew-Wun Wu
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (K.-H.H.); (C.-W.W.); (Y.-M.S.)
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan; (M.-H.C.); (Y.C.); (S.-S.L.); (A.F.-Y.L.)
| | - Yi-Ming Shyr
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (K.-H.H.); (C.-W.W.); (Y.-M.S.)
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan; (M.-H.C.); (Y.C.); (S.-S.L.); (A.F.-Y.L.)
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Abstract
The diagnosis of lung cancer in pregnancy is rare. Most cases are quite advanced and have dismal outcomes despite treatment. We present the case of a 26-year-old woman who was diagnosed with Stage IIIA (T3N2M0) squamous-cell carcinoma of the lung with lymphoepithelioma-like features at the 18(th) week of pregnancy. A chest CT revealed a large right hilar mass with obliteration of the right main bronchus and resulting collapse of the right lung with mediastinal shift to the right. A transbronchial biopsy of the mass and a subcarinal lymph node confirmed poorly differentiated squamous cell carcinoma with lymphoepithelioma-like features. Brain MRI, PET, and CT scans were negative for distant metastasis. The patient received four cycles of neoadjuvant cisplatin and docetaxel with a complete radiographic response. She delivered a healthy baby girl at 35 weeks gestation. Post-partum, she received radiation to the right hilum and mediastinum as consolidation. The patient continues to remain free of disease more than 16 months after initial diagnosis. To our knowledge, this is the only reported case of lung cancer in pregnancy where there is a complete response to chemotherapy. The histology is also distinct from other reported cases. In addition, this case exemplifies the relative safety and efficacy of chemotherapy during the later stages of pregnancy. As long as a patient is beyond the first trimester of pregnancy, platinum-based doublet chemotherapy may be considered as a feasible treatment option.
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Affiliation(s)
| | - Jun Zhang
- Medicine, Baylor College of Medicine
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Fadare O, Renshaw IL, Rubin C. Pleomorphic lymphoepithelioma-like carcinoma of the urinary bladder. Int J Clin Exp Pathol 2008; 2:194-199. [PMID: 19079656 PMCID: PMC2583638] [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] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Accepted: 06/15/2008] [Indexed: 05/27/2023]
Abstract
Lymphoepithelioma-like carcinoma (LELC) of the urinary bladder is often mixed with conventional transitional cell carcinoma and/or other histotypes. The pathologist's determination of the morphologic purity of a given LELC at the biopsy stage is a clinically relevant endeavour, because there is some anecdotal evidence suggesting that pure or predominant LELC may be comparatively chemosensitive and have a favorable prognostic profile, which may potentially offer the possibility of effective therapy without bladder resection. The precise degree of cellular pleomorphism that is allowed in a pure LELC is unclear. We describe herein an otherwise conventional and pure LELC that showed, in a localized area that constituted approximately 25% of the overall tumor volume, a two to six fold variation in nuclear size, including multinucleated tumor cells. These pleomorphic areas were set in the same lymphoplasmacytic infiltrate as their conventional counterparts, and similarly displayed cellular syncytia. We performed a detailed immunophenotypic comparison between the conventional areas and the pleomorphic areas. No significant differences were found between the 2 areas in overall lymphoplasmacytic or histiocytic density, lymphocytic CD4/CD8 ratio, and lymphoplasmacytic kappa/lambda ratio. Similarly, both displayed similar qualitative and quantitative staining indices for p53, Ki67, cytokeratin AE1/AE3 and p16(INKa). Scattered cells were cytoplasmically beta-catenin positive exclusively in the pleomorphic areas; however these cells were not notably larger than the cells in the conventional areas. Both components were immunohistochemically negative for HMB-45, CD1a, the estrogen receptor, Epstein-Barr virus, CD117, D2-40, CD56, cytokeratin 20 and chromogranin. Clinicopathologic analysis of a series of cases is required to establish if there is any significance to nuclear pleomorphism in LELC. However, the phenotypic similarity between the 2 areas in this case, the intimate admixture of the pleomorphic cells with the lymphoplasmacytic infiltrate, and their syncytial pattern of growth, all suggest that pure LELC may display marked nuclear pleomorphism, and that this finding may not, in of itself, be a valid basis for removing a case from the "pure" group.
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Affiliation(s)
- Oluwole Fadare
- Department of Pathology, Wilford Hall Medical Center, Lackland AFB, TX, USA
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