Because of its value as a prognostic indicator and its reproducibility, tumour 'budding' would be a good index to estimate the aggressiveness of rectal cancer.
Positive lateral lymph node was the strongest predictor in both survival and local recurrence. Pelvic sidewall dissection may be indicated for patients with T3-T4 lower rectal cancers because of the greater probability of positive lateral lymph nodes.
Conventional tumor grading systems based on the degree of tumor differentiation may not always be optimal because of difficulty in objective assessment and insufficient prognostic value for decision making in colorectal cancer (CRC) treatment. This study aimed to determine the importance of assessing the number of poorly differentiated clusters as the primary criterion for histologic grading of CRC. Five hundred consecutive patients with curatively resected stage II and III CRCs (2000 to 2005) were pathologically reviewed. Cancer clusters of ≥5 cancer cells and lacking a gland-like structure were counted under a ×20 objective lens in a field containing the highest number of clusters. Tumors with <5, 5 to 9, and ≥10 clusters were classified as grade (G)1, G2, and G3, respectively (n=156, 198, and 146 tumors, respectively). Five-year disease-free survival rates were 96%, 85%, and 59% for G1, G2, and G3, respectively (P<0.0001). Poorly differentiated clusters affected survival outcome independent of T and N stages and could help in more effective stratification of patients by survival outcome compared with tumor staging (Akaike information criterion, 1086.7 vs. 1117.0; Harrell concordance index, 0.73 vs. 0.67). The poorly differentiated cluster-based grading system showed a higher weighted κ coefficient for interobserver variability (5 observers) compared with conventional grading systems (mean, 0.66 vs. 0.52; range, 0.55 to 0.73 vs. 0.39 to 0.68). Our novel histologic grading system is expected to be less subjective and more informative for prognostic prediction compared with conventional tumor grading systems and TNM staging. It could be valuable in determining individualized postoperative CRC treatment.
13The effects of the organic structure-directing agents (OSDAs) and Na cations for the synthesis of 14 ZSM-5 on the location of Al atom in the framework as well as the acidic and catalytic properties were 15 investigated. To achieve these purposes, ZSM-5 zeolites were synthesized by using four kinds of 16 organic structure-directing agents (OSDAs) including tetrapropylammonium hydroxide cations, 17 dipropylamine, cyclohexylamine and hexamethyleneimine with or without Na cations. In-situ FT-IR 18 spectroscopy using CO as probe molecule was applied to the evaluation of the acid property of the 19 ZSM-5 zeolites. The location of Al atoms was examined by high resolution 27 Al MAS and MQMAS 20 NMR techniques. The constraint index (CI) has been also used to estimate the distribution of acid 21 sites in the micropores. The location of acid sites was investigated based on the difference in the 22 transition-state shape-selectivity through the cracking of n-hexane and 3-methylpentane. Furthermore, 23 the cracking of various types of paraffins and the conversion of aromatic compounds were conducted to 24 clarify the acid site distributions. 25 26 KEYWORDS: MFI-type zeolite, organic structure-directing agents, Al distribution in the framework, 27 constraint index, 27 Al MAS and MQMAS NMR 28 29 30
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