Current concepts of colorectal cancer resection pathology

Nagtegaal, Irıs D.

doi:10.1111/his.12563

Cited by 7 publications

(7 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The LNC is one of the most controversial among these tumor-related factors. It has been proposed as a quality indicator [6, 35] and is augmented in extended lymphadenectomy, the relevant long-term benefit of which has not been effectively demonstrated because of the absence of prospective clinical trials of extended colonic surgeries [35, 36]. Inadequate LNC assessment is involved in interpretation of stage migration, which is considered a source of survival heterogeneity in patients with CRC, but its influences are limited [14, 35, 36].…”

Section: Discussionmentioning

confidence: 99%

“…However, patients with a high risk of postoperative progression of CRC require additional interventions and informed decision-making with the help of physicians [3–5]. Among the vast spectrum of clinicopathological information [3, 6], the American Joint Committee on Cancer (AJCC) stages of CRC are fundamental for choosing optimal clinical interventions, and their use remains at the forefront of predicting and treating CRC [7]. Unfortunately, many observations are not consistent with the assumed relationship between advanced anatomical stages and reduced survival probabilities.…”

Section: Introductionmentioning

confidence: 99%

“…Patient-specific factors such as sex, ethnicity, and marital status are also associated with survival [1, 2, 20, 21], representing untapped information that may be useful for individualized therapies and outcomes. Many other parameters included in routine pathologic reports are also apparent survival determinants, including tumor location, size, histology, grade, differentiation, lymph node count (LNC), lymph node ratio (LNR), and surgical extent [6]. All of these elements are inseparable qualities of a “successful cancer career,” of which more detailed evaluations are still required, however.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Nomograms to predict survival after colorectal cancer resection without preoperative therapy

et al. 2016

View full text Add to dashboard Cite

BackgroundThe predictive accuracy of the American Joint Committee on Cancer (AJCC) stages of colorectal cancer (CRC) is mediocre. This study aimed to develop postoperative nomograms to predict cancer-specific survival (CSS) and overall survival (OS) after CRC resection without preoperative therapy.MethodsEligible patients with stage I to IV CRC (n = 56072) diagnosed from 2004 to 2010 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. The patients were allocated into training (n = 27,700), contemporary (n = 3158), and prospective (n = 25,214) validation cohorts. Clinically important variables were incorporated and selected using the Akaike information criterion in multivariate Cox regressions to derive nomograms with the training cohort. The performance of the nomograms was assessed and externally testified using the concordance index (c-index), bootstrap validation, calibration, time-dependent receiver-operating characteristic curves, Kaplan–Meier curves, mosaic plots, and decision curve analysis (DCA). Performance of the conventional AJCC stages was also compared with the nomograms using similar statistics.ResultsThe nomograms for CSS and OS shared common predictors: sex, age, race, marital status, preoperative carcinoembryonic antigen status, surgical extent, tumor size, location, histology, differentiation, infiltration depth, lymph node count, lymph node ratio, and metastasis. The c-indexes of the nomograms for CSS and OS were 0.816 (95 % CI 0.810–0.822) and 0.777 (95 % CI 0.772–0.782), respectively. Performance evaluations showed that the nomograms achieved considerable predictive accuracy, appreciable reliability, and significant clinical validity with wide practical threshold probabilities, while the results remained reproducible when applied to the validation cohorts. Additionally, model comparisons and DCA proved that the nomograms excelled in stratifying each AJCC stage into three significant prognostic subgroups, allowing for more robust risk classification with an improved net benefit.ConclusionsWe propose two prognostic nomograms that exhibit improved predictive accuracy and net benefit for patients who have undergone CRC resection. The established nomograms are intended for risk assessment and selection of suitable patients who may benefit from adjuvant therapy and intensified follow-up after surgery. Independent external validations may still be required.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Nomograms to predict survival after colorectal cancer resection without preoperative therapy

et al. 2016

View full text Add to dashboard Cite

show abstract

“…There is well documented variation between centres in the demonstration of EMVI [ 1 , 5 , 7 , 12 , 16 , 19 – 27 ]. Despite which, EMVI is recognised as an important prognostic feature [ 12 , 16 , 22 , 28 – 30 ]. As such, reporting of the presence or absence of EMVI in colorectal cancer excision specimens is recommended by professional organisations including the Royal College of Pathologists (UK) and the College of American Pathologists [ 3 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

A Comprehensive Study of Extramural Venous Invasion in Colorectal Cancer

McClelland

Murray

2015

PLoS ONE

View full text Add to dashboard Cite

Colorectal cancer is a common malignancy and a leading cause of cancer related death. Cancer staging following resection is key to determining any adjuvant therapy in those patients with high risk disease. In colorectal cancer, tumour stage and lymph node stage are the main pathological factors which have been considered to influence outcome. Increasing emphasis is now being placed on other factors, especially the presence of extramural venous invasion (EMVI). It is important to understand the relationship of EMVI with other pathological factors and to confirm that in an individual centre that EMVI is being detected at an appropriate rate and is of prognostic significance. This comprehensive study assesses the reporting and prognostic significance of EMVI in a single centre, using prospectively collected data from histopathology reports of a cohort of 2405 patients who underwent surgery for colorectal cancer over a nine year period. Overall, EMVI was reported in 27.9% of colorectal cancer excision specimens. In tumours (n = 1928) that had not received neoadjuvant therapy, the presence of EMVI varied significantly depending on tumour site (χ2 = 12.03, p<0.005), tumour stage (χ2 = 268.188, p<0.001), lymph node stage (χ2 = 294.368, p<0.001) and Dukes’ stage (χ2 = 253.753, p<0.001). Multivariate analysis confirmed EMVI as a significant independent prognostic indicator (p<0.001). In conclusion, the presence of EMVI as an independent prognostic indicator is shown and is related to other pathological and prognostic factors. This study emphasises the requirement for the accurate identification of EMVI in colorectal cancer excision specimens and also understanding the relationship of EMVI with other prognostic factors.

show abstract

“…Lymph node count (LNC) is an important parameter of routine pathological report after resection of colorectal cancer (CRC) [1, 2]. Adequacy of lymph node assessment is usually required for accurate staging of patients with CRC [3, 4].…”

Section: Introductionmentioning

confidence: 99%

A Nomogram to Predict Adequate Lymph Node Recovery before Resection of Colorectal Cancer

et al. 2016

View full text Add to dashboard Cite

Increased lymph node count (LNC) has been associated with prolonged survival in colorectal cancer (CRC), but the underlying mechanisms are still poorly understood. The study aims to identify new predictors and develop a preoperative nomogram for predicting the probability of adequate LNC (≥ 12). 501 eligible patients were retrospectively selected to identify clinical-pathological factors associated with LNC ≥ 12 through univariate and multivariate logistic regression analyses. The nomogram was built according to multivariate analyses of preoperative factors. Model performance was assessed with concordance index (c-index) and area under the receiver operating characteristic curve (AUC), followed by internal validation and calibration using 1000-resample bootstrapping. Clinical validity of the nomogram and LNC impact on stage migration were also evaluated. Multivariate analyses showed patient age, CA19-9, circulating lymphocytes, neutrophils, platelets, tumor diameter, histology and deposit significantly correlated with LNC (P < 0.05). The effects were marginal for CEA, anemia and CRC location (0.05 < P < 0.1). The multivariate analyses of preoperative factors suggested decreased age, CEA, CA19-9, neutrophils, proximal location, and increased platelets and diameter were significantly associated with increased probability of LNC ≥ 12 (P < 0.05). The nomogram achieved c-indexes of 0.75 and 0.73 before and after correction for overfitting. The AUC was 0.75 (95% CI, 0.70–0.79) and the clinically valid threshold probabilities were between 10% and 60% for the nomogram to predict LNC < 12. Additionally, increased probability of adequate LNC before surgery was associated with increased LNC and negative lymph nodes rather than increased positive lymph nodes, lymph node ratio, pN stages or AJCC stages. Collectively, the results indicate the LNC is multifactorial and irrelevant to stage migration. The significant correlations with preoperative circulating markers may provide new explanations for LNC-related survival advantage which is reflected by the implication of regional and systemic antitumor immune responses.

show abstract

Current concepts of colorectal cancer resection pathology

Cited by 7 publications

References 57 publications

Nomograms to predict survival after colorectal cancer resection without preoperative therapy

Nomograms to predict survival after colorectal cancer resection without preoperative therapy

A Comprehensive Study of Extramural Venous Invasion in Colorectal Cancer

A Nomogram to Predict Adequate Lymph Node Recovery before Resection of Colorectal Cancer

Contact Info

Product

Resources

About