New Approach to the Substaging of Node-Positive Colorectal Adenocarcinoma

Sternberg, A; Sibirsky, Ohn; Cohen, David S.; Blumenson, Leslie E.; Rodrı́guez-Bigas, Miguel A.; Petrelli, Nicholas J.

doi:10.1007/s10434-999-0161-x

Cited by 14 publications

(9 citation statements)

References 34 publications

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“…On the other hand, the current TNM N1/N2 categorization failed to separate a 171 node-positive cohort into subsets with respect to cancer recurrence or cancer-related death. 19 This unexpected finding questions the adequacy of subcategorization.…”

Section: Discussionmentioning

confidence: 86%

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Colorectal Cancer Staging: Reappraisal of N/PN Classification

Vaccaro¹,

Bonadeo²,

Benati³

et al. 2004

Diseases of the Colon &Amp; Rectum

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Section: Discussionmentioning

confidence: 86%

“…[14][15][16][17][18] Moreover, the only series reporting survival according to this current version failed to show any difference between N1 and N2 subcategories. 19 These findings question whether the current categorization of Stage III is appropriate.…”

mentioning

confidence: 90%

Colorectal Cancer Staging: Reappraisal of N/PN Classification

Vaccaro¹,

Bonadeo²,

Benati³

et al. 2004

Diseases of the Colon &Amp; Rectum

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“…Venous invasion may be used to enhance the power of existing staging systems as predictors of individual prognosis by subdividing stages according to the presence or absence of venous invasion, 21 or it may be combined with other variables to form a completely new classification of CRC. 22 According to the National Institutes of Health consensus statement on adjuvant treatment of CRC, regional lymph node status is currently the main indicator for the administration of systemic adjuvant treatment.…”

Section: Discussionmentioning

confidence: 99%

Conclusions from a study of venous invasion in stage IV colorectal adenocarcinoma

Sternberg¹,

Amar²,

Alfici³

et al. 2002

Journal of Clinical Pathology

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Aims: Venous invasion is an established predictor of prognosis in colorectal cancer (CRC). The reported incidence of venous invasion in CRC specimens varies between 10% and 89.5%, mainly as a result of interobserver variability and differences in specimen processing (for example, staining with haematoxylin and eosin (H+E) alone versus the addition of an elastic fibre stain). This study was performed with three purposes in mind, namely: (1) To assess and compare the incidence of venous invasion diagnosed on H+E stained tissue versus tissue stained with both H+E and an elastic fibre stain. (2) To estimate the inherent false negative rate associated with the diagnosis of venous invasion by histopathological evaluation of resected CRC specimens. (3) To compare the resulting data regarding incidence, quantity, site, and type of venous invasion to the pertinent literature. Methods: Venous invasion was assessed on sections from 81 CRCs resected from patients with synchronous distant metastases (hepatic and non-hepatic). Only stage IV tumours were studied for the following reasons: (1) it can be assumed that in all patients with distant haematogenous metastases venous invasion had occurred, thus enabling the false negative rate to be calculated; (2) there can be no dispute about the clinical relevance of the various characteristics of venous invasion identified in the tumours of patients with synchronous distant haematogenous metastases; and (3) to eliminate the effect of variance in tumour stage on the incidence of venous invasion. Initially, H+E stained sections were studied for venous invasion. Sections that were negative or questionable with regard to venous invasion were then stained with an elastic fibre stain, and a second search for venous invasion was carried out. Venous invasion was characterised by incidence, quantity, type, and site. The χ 2 test for independence was used to compare the incidence of venous invasion in colonic versus rectal and rectosigmoid primary tumours, and in patients with hepatic versus non-hepatic metastases. Results: Venous invasion was identified in 42 (51.9%) (of the 81 specimens on H+E stained sections. The addition of the elastic fibre stain enabled the diagnosis of venous invasion in 15 (38.5%) of the remaining 39 specimens, increasing the overall incidence to 57 of 81 cases (70.4%). Of the 57 positive specimens, venous invasion was minimal in 27 (47.4%), intermediate in five, (8.8%) and massive in 25 (43.9%). Only intramural veins were involved in 18 (31.6%), only extramural veins in 26 (45.6%), and both intramural and extramural veins in 13 (22.8%) of the 57 positive specimens. The filling type of venous invasion was found in 41 (71.9%), the floating type in 28 (49.1%), and the infiltrating type in six (10.5%) of the 57 positive specimens. There was no significant difference between the incidence of venous invasion in the colon (42 of 60; 70%) versus rectal and rectosigmoid tumours (15 of 21; 71.4%; p = 0.8539), nor in the incidence of venous invasion in patients with hepatic (...

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“…8 As far as vascular invasion is concerned, it is still unclear whether different types of vascular invasion (lymphatic or venous) are prognostically relevant as independent factors. 9 A proposal to include venous invasion among stage influencing factors in colorectal cancer has already been made [10][11][12] and it is still being debated as to whether this finding per se may have clinical implications on tumor staging. 13 In this regard, we believe that grouping tumor deposits with other types of vascular invasion will account for the prognostic heterogeneity of these particular lesions.…”

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confidence: 99%

Tumor deposits are encountered in advanced colorectal cancer and other adenocarcinomas: an expanded classification with implications for colorectal cancer staging system including a unifying concept of in-transit metastases

et al. 2009

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The seventh edition of the TNM Classification of Malignant Tumors is due to be published soon. In the current version dating back to 2002, tumor deposits, which are metastatic lesions commonly encountered in the routine histopathological examination of advanced colorectal cancer specimens, are classified according to their shape with different implications for staging. So distinguished, these lesions are considered either as metastatic lymph nodes (N category) or as vascular invasions (T category). We recently proposed a more comprehensive classification approach that also includes the M category. Relying on two of our independent recent studies, we aim here to provide suggestions for a novel classification of tumor deposits with diverse implications for TNM staging system of colorectal cancer. Furthermore, we show that tumor deposits are not limited to colorectal cancer, but they are common to different adenocarcinoma types.

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New Approach to the Substaging of Node-Positive Colorectal Adenocarcinoma

Cited by 14 publications

References 34 publications

Colorectal Cancer Staging: Reappraisal of N/PN Classification

Colorectal Cancer Staging: Reappraisal of N/PN Classification

Conclusions from a study of venous invasion in stage IV colorectal adenocarcinoma

Tumor deposits are encountered in advanced colorectal cancer and other adenocarcinomas: an expanded classification with implications for colorectal cancer staging system including a unifying concept of in-transit metastases

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