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Strous MTA, Faes TKE, Gubbels ALHM, van der Linden RLA, Mesker WE, Bosscha K, Bronkhorst CM, Janssen-Heijnen MLG, Vogelaar FJ, de Bruïne AP. A high tumour-stroma ratio (TSR) in colon tumours and its metastatic lymph nodes predicts poor cancer-free survival and chemo resistance. Clin Transl Oncol 2022; 24:1047-1058. [PMID: 35064453 DOI: 10.1007/s12094-021-02746-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/22/2021] [Accepted: 12/01/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Despite known high-risk features, accurate identification of patients at high risk of cancer recurrence in colon cancer remains a challenge. As tumour stroma plays an important role in tumour invasion and metastasis, the easy, low-cost and highly reproducible tumour-stroma ratio (TSR) could be a valuable prognostic marker, which is also believed to predict chemo resistance. METHODS Two independent series of patients with colon cancer were selected. TSR was estimated by microscopic analysis of 4 µm haematoxylin and eosin (H&E) stained tissue sections of the primary tumour and the corresponding metastatic lymph nodes. Patients were categorized as TSR-low (≤ 50%) or TSR-high (> 50%). Differences in overall survival and cancer-free survival were analysed by Kaplan-Meier curves and cox-regression analyses. Analyses were conducted for TNM-stage I-II, TNM-stage III and patients with an indication for chemotherapy separately. RESULTS We found that high TSR was associated with poor cancer-free survival in TNM-stage I-II colon cancer in two independent series, independent of other known high-risk features. This association was also found in TNM-stage III tumours, with an additional prognostic value of TSR in lymph node metastasis to TSR in the primary tumour alone. In addition, high TSR was found to predict chemo resistance in patients receiving adjuvant chemotherapy after surgical resection of a TNM-stage II-III colon tumour. CONCLUSION In colon cancer, the TSR of both primary tumour and lymph node metastasis adds significant prognostic value to current pathologic and clinical features used for the identification of patients at high risk of cancer recurrence, and also predicts chemo resistance.
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Affiliation(s)
- M T A Strous
- Department of Surgery, VieCuri Medical Centre, Tegelseweg 210, 5912 BL, Venlo, The Netherlands. .,Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - T K E Faes
- Department of Pathology, VieCuri Medical Centre, Venlo, The Netherlands
| | - A L H M Gubbels
- Department of Pathology, VieCuri Medical Centre, Venlo, The Netherlands
| | | | - W E Mesker
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | - K Bosscha
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - C M Bronkhorst
- Department of Pathology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - M L G Janssen-Heijnen
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Epidemiology, VieCuri Medical Center, Venlo, The Netherlands
| | - F J Vogelaar
- Department of Surgery, VieCuri Medical Centre, Tegelseweg 210, 5912 BL, Venlo, The Netherlands
| | - A P de Bruïne
- Department of Pathology, VieCuri Medical Centre, Venlo, The Netherlands
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Gerets JCWL, Kool M, Simons PCG, Aarts F, Vogelaar FJ. Prevalence of underlying malignancies in complex cysts of the breast. Breast Dis 2022; 41:89-95. [PMID: 34542054 DOI: 10.3233/bd-201057] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The management of complex cysts of the breast is an ongoing topic of discussion. The aim of this study was to determine the prevalence of underlying malignancy in radiologically diagnosed complex cysts, and to assess whether watchful waiting could be the preferred method to safely manage complex cysts of the breast. SUBJECTS AND METHODS A single-center retrospective study was performed between May 2003 and November 2019 in the VieCuri Medical Centre. Women with a radiologically diagnosed complex cyst of the breast were included. Prevalence of underlying malignancy was calculated, as were absolute risk reduction and number needed to treat in order to diagnose malignancy. In addition, patient characteristics were compared to determine characteristics associated with malignancy. RESULTS Of 78 radiologically diagnosed complex cysts of the breast, five (6,4%) were found to be malignant. The number needed to treat was calculated at 12,8 (absolute riks reduction 0,078). Age (P = 0,003) was associated with malignancy. CONCLUSION Complex cysts of the breast could be managed more conservatively. Patient characteristics can be used to assess the eligibility for radiological follow-up. This, in turn, would lead to a lower NNT and possibly a decrease in disease burden and healthcare costs.
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Affiliation(s)
- J C W L Gerets
- Department of Surgery, VieCuri Medical Centre, Venlo, The Netherlands
| | - M Kool
- Department of Surgery, VieCuri Medical Centre, Venlo, The Netherlands
| | - P C G Simons
- Department of Radiology, VieCuri Medical Centre, Venlo, The Netherlands
| | - F Aarts
- Department of Surgery, VieCuri Medical Centre, Venlo, The Netherlands
| | - F J Vogelaar
- Department of Surgery, VieCuri Medical Centre, Venlo, The Netherlands
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van der Linden RLA, Rijstenberg LL, van der Linden JC, Vogelaar FJ, Nagtegaal ID, Pruijt JFM, van de Velde CJH, van den Brule A, Bosscha K. Node negative colorectal cancer patients: assesment of high-risk features on recurrence. Pathol Res Pract 2020; 216:153034. [PMID: 32825973 DOI: 10.1016/j.prp.2020.153034] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The introduction of population-based screening programs for colorectal cancer (CRC) results in less patients with advanced disease. There is an increase in the amount of node negative CRC, which makes adequate risk stratification for this particular group of patients necessary. The addition of more risk factors to the conventional histological high-risk factors is investigated in this retrospective study. PATIENTS AND METHODS A cohort of 227 node negative (stage I and II) CRC patients who were not treated with adjuvant chemotherapy were selected from two previously conducted cohort studies. Detailed histopathological examination was performed by two independent observers and molecular background (BRAF/RAS mutations, microsatellite status (MSI)) was studied. Univariate analyses were used to analyse differences in histological and mutational characteristics between patients with and without recurrence. P-values below 0.05 were considered statistically significant. RESULTS Poorly differentiated histology (p:0.002), BRAF mutation (p:0.002) and MSI status (p:0.006) were found significant relevant risk factors that were related to recurrent disease. Poorly differentiated histology was associated with intermediate/high tumor budding (TB) (p:0.001), a BRAF mutation (p:0.001) and MSI status (p:0.001). A combination of all three features (poorly differentiated histology, BRAF and MSI) was more often present in the recurrence group. CONCLUSIONS Recurrence in node negative CRC patients could be better predicted when molecular features such as, BRAF mutation and MSI status are incorporated into a model with poorly differentiated CRC. Therefore, these features might help in the selection of patients who possibly will benefit from adjuvant treatment.
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Affiliation(s)
- R L A van der Linden
- Department of Surgery, Jeroen Bosch Hospital,' s-Hertogenbosch, The Netherlands; Department of Pathology, Radboudumc, Nijmegen, The Netherlands.
| | - L L Rijstenberg
- Department of Pathology, Radboudumc, Nijmegen, The Netherlands
| | - J C van der Linden
- Department of Pathology, Jeroen Bosch Hospital,' s-Hertogenbosch, The Netherlands
| | - F J Vogelaar
- Department of Surgery, VieCuri Medical Center, Venlo, The Netherlands
| | - I D Nagtegaal
- Department of Pathology, Radboudumc, Nijmegen, The Netherlands
| | - J F M Pruijt
- Department of Oncology, Jeroen Bosch Hospital,' s-Hertogenbosch, The Netherlands
| | - C J H van de Velde
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - A van den Brule
- Department of Pathology, Lab for Molecular Diagnostics, Jeroen Bosch Hospital,' s-Hertogenbosch, The Netherlands
| | - K Bosscha
- Department of Surgery, Jeroen Bosch Hospital,' s-Hertogenbosch, The Netherlands
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Vogelaar FJ, Reimers MS, van der Linden RLA, van der Linden JC, Smit VTHBM, Lips DJ, van de Velde CJH, Bosscha K. The diagnostic value of one-step nucleic acid amplification (OSNA) for sentinel lymph nodes in colon cancer patients. Ann Surg Oncol 2014; 21:3924-30. [PMID: 24912612 DOI: 10.1245/s10434-014-3820-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Lymph node status in colon cancer is critical for prognosis estimation and treatment allocation. The purpose of this study was to compare the performance of one-step nucleic acid amplification (OSNA) through detection of cytokeratin 19 mRNA levels with routine pathological examination (RP) and multilevel fine pathological examination (FP) in sentinel lymph nodes (SLN), detected using the ex vivo SLN mapping (SLNM) procedure, in presurgically defined nonmetastatic colon cancer patients. METHODS In this prospective study, 325 SLNs of 128 patients from the Jeroen Bosch Hospital in 's-Hertogenbosch and the Leiden University Medical Center were investigated by RP (H&E), FP (H&E and Keratin Pan immunohistochemical staining), and OSNA. The SLNs were harvested by the SLNM procedure, using Patent blue or Indocyanine green. SLNs were divided and separate parts were used for RP, FP, and the OSNA assay. RESULTS The diagnostic value of OSNA was 82.1 and 100 % for both FP and combined method (OSNA and FP) compared with RP. An upstaging rate of 20.2 % was obtained with the use of OSNA only and 36.4 % with the use of FP only. An upstaging rate of 46.5 % was obtained by combining the two methods together. CONCLUSIONS OSNA and FP appeared to be promising tools for the detection of lymph node micro- and macrometastases in SLNs after SLNM. The performances of OSNA and FP in this study were superior to RP. Because OSNA allows analysis of the whole lymph node, sampling bias can be avoided. OSNA therefore may improve tumor staging.
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Affiliation(s)
- F J Vogelaar
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
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Vogelaar FJ, Schuttevaer HM, Willems JM. A patient with an inguinal mass: a groin hernia? Neth J Med 2009; 67:399-400. [PMID: 20009118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- F J Vogelaar
- Department of Surgery, Rijnland Hospital, Leiderdorp, the Netherlands.
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Vogelaar FJ, Bronkhorst MWGA. [Diagnostic image (240). A neonate with a swollen, red and painful mamma]. Ned Tijdschr Geneeskd 2005; 149:1456. [PMID: 16010958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
In a 5-week-old girl suppurative mastitis was observed caused by Staphylococcus aureus.
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Affiliation(s)
- F J Vogelaar
- Leids Universitair Medisch Centrum, afd. Heelkunde, Postbus 9600, 2300 RC Leiden.
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Steenvoorde P, Vogelaar FJ, Oskam J, Tollenaar RA. [Giant diverticulum of the sigmoid]. Ned Tijdschr Geneeskd 2004; 148:855; author reply 855. [PMID: 15141655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Vogelaar FJ, Molenaar IQ, Adhin S, Steenvoorde P. Invagination of the appendix: diagnostic laparoscopy? Dig Dis Sci 2004; 49:351-2. [PMID: 15104383 DOI: 10.1023/b:ddas.0000017464.50532.d5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Abstract
BACKGROUND A rare complication of diverticulosis of the colon is giant colonic diverticula (GCD). The condition was first described in English literature in 1953. METHODS A Medline search was undertaken for English, French and German language articles on 'giant colonic diverticula'. RESULTS A total of 135 patients were identified, presenting with a total of 155 GCD. With a complication rate of 28% and an operative mortality of 5%, GCD seems to have a high clinical significance. Radiological examination of choice seems to be plain abdominal X-ray and CT examination, barium enema carries the risk of perforation of the diverticulum, and should not be performed. CONCLUSIONS There are different therapeutic options, in our opinion diverticulectomy alone is not the treatment of choice. Because of the possibility of recurrence and oncological reasons, colectomy seems to be the best treatment. The creation of a protecting colostomy depends on other operative findings.
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Affiliation(s)
- P Steenvoorde
- Department of Surgery, Rijnland Hospital, Leiderdorp, The Netherlands.
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van Dam MS, Kok GJ, Munneke M, Vogelaar FJ, Vliet Vlieland TP, Taminiau AH. Measuring physical activity in patients after surgery for a malignant tumour in the leg. The reliability and validity of a continuous ambulatory activity monitor. J Bone Joint Surg Br 2001; 83:1015-9. [PMID: 11603514 DOI: 10.1302/0301-620x.83b7.12195] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Abstract
A continuous ambulatory activity monitor allows objective measurement of the amount and intensity of physical activity. We examined the reliability and validity of this device in the assessment of seven aspects of function over a period of 24 hours in 20 patients who had undergone limb salvage or amputation for a tumour in the leg. The test-retest reliability was determined by undertaking identical assessments on two separate days. The measurements were compared with other indicators of functional status and quality of life in order to determine the validity of the monitor. Its reliability was satisfactory, with intraclass correlation coefficients ranging from 0.65 to 0.91. Significant correlations were seen between the 'time spent walking' and the Musculoskeletal Tumor Society rating scales and the Rand-36 physical functioning score. There was also a significant association between the 'movement intensity during walking' and the Musculoskeletal Tumor Society score. The satisfactory reliability and validity of the monitor shows considerable promise for its use as a device for measuring physical activity objectively in patients after surgery for limb-salvage or an amputation.
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Affiliation(s)
- M S van Dam
- Leiden University Medical Centre, The Netherlands
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van Dam MS, Kok GJ, Munneke M, Vogelaar FJ, Vlieland TPMV, Taminiau AHM. Measuring physical activity in patients after surgery for a malignant tumour in the leg. ACTA ACUST UNITED AC 2001. [DOI: 10.1302/0301-620x.83b7.0831015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A continuous ambulatory activity monitor allows objective measurement of the amount and intensity of physical activity. We examined the reliability and validity of this device in the assessment of seven aspects of function over a period of 24 hours in 20 patients who had undergone limb salvage or amputation for a tumour in the leg. The test-retest reliability was determined by undertaking identical assessments on two separate days. The measurements were compared with other indicators of functional status and quality of life in order to determine the validity of the monitor. Its reliability was satisfactory, with intraclass correlation coefficients ranging from 0.65 to 0.91. Significant correlations were seen between the ‘time spent walking’ and the Musculoskeletal Tumor Society rating scales and the Rand-36 physical functioning score. There was also a significant association between the ‘movement intensity during walking’ and the Musculoskeletal Tumor Society score. The satisfactory reliability and validity of the monitor shows considerable promise for its use as a device for measuring physical activity objectively in patients after surgery for limb-salvage or an amputation.
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Affiliation(s)
| | | | | | | | | | - A. H. M. Taminiau
- Department of Orthopaedics, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands
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