Histological assessment of stromal maturity as a prognostic factor in surgically treated gastric adenocarcinoma

Kemi, Niko; Eskuri, Maarit; Pohjanen, Vesa-Matti; Karttunen, Tuomo J.; Kauppila, Joonas H.

doi:10.1111/his.13934

Cited by 19 publications

(23 citation statements)

References 22 publications

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“…This study comprised data from 60 patients with colorectal adenocarcinoma who underwent surgical resection at our health system. Surgeries including block resection (1), right hemicolectomy (20), left hemicolectomy (27), transverse colectomy (5), rectosigmoidectomy (7). The mean age for our patient cohort was 67.4.…”

Section: Clinicopathologic and Patient Characteristicsmentioning

confidence: 99%

“…Previous work has been undertaken to discover the essence of tumor budding (TB) [4] and stromal differentiation (SD) [2] in the CRC tumoral microenvironment. Histologically, SD has been demonstrated to be clinically signi cant in cancers of the breast [5], cervix [6] and stomach [7]; however, TB and SD has been most intensively study in colorectal cancer. Overall, immature SD and high TB are seen as bad players, being associated with reduced survival and higher pathologic stage [8].…”

Section: Introductionmentioning

confidence: 99%

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Superpixel Image Segmentation of the Tumoral Microenvironment in Colorectal Cancer: Frontiers Beyond the Microscope

Hacking

Alexis

et al. 2021

Preprint

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Colorectal cancer (CRC) is the most common malignancy of the gastrointestinal (GI) tract and accounts for 9% of all cancers. The stroma and the tumoral microenvironment represent brave new frontiers for patients with colorectal cancer. Here we demonstrate novel superpixel image segmentation (SIS) techniques for whole slide images (WSI) to unravel this biology. Findings of significance include the association of low proportionated stromal area (PSA), high immature stromal percentage (ISP) and high myxoid stroma ratio (MSR) with worse prognostic outcomes in our CRC patients. Overall, stromal markers outperformed all others at predicting clinical outcomes. In particular, MSR may be able to prognosticate patients independent of tumor stage and may be the most optimal way to effectively prognosticate CRC patients which circumvents the need for more extensive deep learning (DL) based computational profiling. Approaches demonstrated here can be performed by a trained pathologist and very easily recorded during synoptic cancer reporting with appropriate quality assurance. Future well-designed, robust clinical trials will have the ultimate say in determining whether digital image analysis and superpixel image segmentation can better tailor the need for adjuvant therapy in patients with colorectal cancer.

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Section: Clinicopathologic and Patient Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Superpixel Image Segmentation of the Tumoral Microenvironment in Colorectal Cancer: Frontiers Beyond the Microscope

Hacking

Alexis

et al. 2021

Preprint

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“…After completion of clinical data retrieval from the patient records and pathology, we are planning a number of studies to assess postoperative complications and surgical factors such as anastomotic technique in relation to complications, as well as validation of previously identified histological risk factors of long-term gastric cancer mortality. 19–21 The collection and evaluation of biobank samples for histological diagnoses is also gaining speed. The first update and extension of the cohort with 5 more years of registry data and consequent patient records and samples is planned for year 2022.…”

Section: Findings To Datementioning

confidence: 99%

Cohort profile: gastric cancer in the population-based, Finnish National Esophago-Gastric Cancer Cohort (FINEGO) Study

et al. 2020

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PurposeThe Finnish National Esophago-Gastric Cancer Cohort (FINEGO) was established with the aim of identifying factors that could contribute to improved outcomes in oesophago-gastric cancer. The aim of this study is to describe the patients with gastric cancer included in FINEGO.ParticipantsA total of 10 457 patients with gastric cancer or tumour diagnosis in the Finnish Cancer Registry or the Finnish Patient Registry during 1987–2016 were included in the cohort, with follow-up from Causes of Death Registry until 31 December 2016. All of the participants were at least 18 years of age, and had undergone either resectional or endoscopic mucosal surgery with curative or palliative intent.Findings to dateOf the 10 457 patients, 90.1% were identified to have cancer in both cancer and patient registries. In all, the median age was 70 at the time of surgery, 54.5% of the patients were men and 64.4% had no comorbidities. Education data were available for 31.1% of the patients, of whom the majority had had <12 years of formal education. Of the 7798 with cancer staging data available, 41.1% had a local cancer. Adenocarcinoma was the most common (94.2%) histological type. Almost all patients underwent open gastrectomy and 214% in hospitals with annual volume of more than 30 gastrectomies per year. A total of 8561 deaths occurred during the study period, of which 6474 were due to oesophago-gastric cancers. The 5-year survival was 34.6% and 5-year cancer-specific survival was 39.7%.Future plansThe data in FINEGO can be currently used for registry-based research but is being expanded by data extraction from patient records and scanning of histological samples from the Finnish biobanks. Initially, we are planning on studies on the national trends in treatment and mortality, and studies on the demographic factors and their influence on survival.

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“…In the eld of histopathology, SD has been recently described in many notable cancer subtypes: colon, breast, cervix, esophagus and stomach [6][7][8][9][10] . In the breast, SD has been found to predict clinical outcomes, immune pro les and molecular phenotypes 9 .…”

Section: Introductionmentioning

confidence: 99%

Nature and Significance of Stromal Differentiation, PD-L1, and VISTA in GIST: Shifting Current Paradigms

Hacking

et al. 2021

Preprint

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The nature and significance of stromal differentiation (SD), program death-ligand 1 (PD-L1), and v-domain Ig suppressor of T cell activation (VISTA) in gastrointestinal stromal tumor (GIST) is largely unknown. Looking forward, the assessment of SD and immune check point inhibition will become more ubiquitous in surgical pathology. Immature, myxoid stroma has been found to be a poor prognostic signature in many cancer subtypes (colon, breast, cervix, esophagus, stomach); although little is known regarding its significance in GIST. For immune check-point inhibition, studies have demonstrated high PD-L1 and expression to be associated with patient outcomes in numerous cancer subtypes. The present body of work aims to discover the role of SD, PD-L1 and VISTA: both in terms of its nature, and its significance in a clinical setting. Here we found PD-L1 expression in immune cells (IC) and immature SD to be associated with worse cancer free survival, while positive VISTA expression was found to be associated with improved outcomes. High-grade immature SD had the highest propensity for death/recurrence and was the only variable found to have prognostic significance on multivariate analysis. Our findings support the evaluation of SD, PD-L1 and VISTA in GIST, with clinical practice implications for pathologists. Ultimately, we hope our findings lead to improved prognostication, further optimization of therapeutics, and improved outcomes in a true clinical environment. For GIST, tumoral differentiation (TD) may be performed in isolation by pathologists, but cautiously; PD-L1 and VISTA could be on the cutting edge of an immunotherapeutic revolution, and SD may be the answer to clinical heterogeneity in GIST. We hope that this work can serve as a lexicon and a guide for discovering the essence of stroma in GIST, while also being a catalyst for pathologists to shoulder the adoption of SD in cancer.

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Histological assessment of stromal maturity as a prognostic factor in surgically treated gastric adenocarcinoma

Cited by 19 publications

References 22 publications

Superpixel Image Segmentation of the Tumoral Microenvironment in Colorectal Cancer: Frontiers Beyond the Microscope

Superpixel Image Segmentation of the Tumoral Microenvironment in Colorectal Cancer: Frontiers Beyond the Microscope

Cohort profile: gastric cancer in the population-based, Finnish National Esophago-Gastric Cancer Cohort (FINEGO) Study

Nature and Significance of Stromal Differentiation, PD-L1, and VISTA in GIST: Shifting Current Paradigms

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