Changes In Clinicopathological Features Research Articles

Changing trends in gastric and colorectal cancer among surgical patients over 85 years old: A multicenter retrospective study, 2001-2021.

Whether patients over 85 years old with gastrointestinal cancer should undergo surgery remains controversial. We aimed to describe the changing trends of characteristics to provide more information to decision makers, and strive to find appropriate surgical plan. To describe the changing trends of characteristics to provide more information to decision makers, and strive to find appropriate surgical plan. A total of 218 gastric cancer (GC) patients and 563 colorectal cancer (CRC) patients who underwent surgery between 2001 and 2021 were enrolled in this retrospective analysis. Changes in clinicopathological features, surgical treatments, and survival status were analyzed longitudinally at 5-year intervals. Only 14 GC patients underwent laparoscopic surgery where 219 CRC patients had this procedure. Cardia and esophagogastric junction cancer increased in GC patients, and the proportion of sigmoid colon cancer decreased in CRC patients. Pulmonary infection gradually became the most common postoperative complication, its incidence in period 4 reached 48.79%. However, the incidence of anastomotic leakage decreased from 26.79% to 9.38% (P < 0.01). Additionally, 30-d mortality significantly decreased from 32.14% to 9.01%. Increases were observed in 5-year overall survival (OS) in GC patients from period 1 to period 4 (18.18% vs 33.32%, respectively) and CRC patients (0 vs 36.32%, respectively). Disease-free survival (DFS) also increased in GC and CRC patients (7.14% vs 27.74% and 0 to 36.03%, respectively). The average survival time of GC patients following radial lymphadenectomy was higher than in patients that underwent limited lymphadenectomy (26 vs 22 mo, respectively), the same was seen in CRC patients (44 vs 33 mo, respectively). This advantage was particularly evident in patients with TNM I, but not in patients with TNM II/III period cancer. The safety as well as effectiveness of surgery in ultra-elderly patients is increasing. Radical lymphadenectomy has advantages in patients with TNM I gastrointestinal cancer, but not TNM II/III.

Sporadic non-ampullary duodenal adenoma with low-grade dysplasia: Natural history and clinical management.

Background and study aims Management strategies for sporadic non-ampullary duodenal adenoma with low-grade dysplasia (LGD) are not well established. This study aimed to analyze progression factors and determine suitable treatment strategies for LGD lesions. Patients and methods We retrospectively analyzed consecutive LGD lesions (n = 125) in patients followed up for ≥ 6 months (median, 45 months) and evaluated the changes in clinicopathological features during follow-up. All LGD lesions were classified into two groups: stable LGD (no increase or < 5 mm increase in tumor size, with unchanged histological dysplasia grade) and progressive LGD (≥ 5 mm increase in tumor size and/or progression to high-grade dysplasia or adenocarcinoma). Results Eighty-six LGD were classified as stable and 39 as progressive. Location on the oral side of the papilla of Vater, large initial tumor size ( ≥ 10 mm), macroscopically complex type, red color, and nodularity were significantly frequent in progressive LGD than in stable LGD. In multivariate analysis, large initial tumor size (odds ratio [OR], 10.2; 95 % confidence interval [CI], 3.3–32.1; P < 0.001) and location on the oral side of the papilla of Vater (OR: 1.8, 95 % CI: 1.4–12.5; P = 0.012) were significant factors for progression. Moreover, initial tumor size < 5 mm rarely progressed (0%–3.9 %); however, initial tumor size ≥ 20 mm and 10–19 mm located on the oral side of the papilla of Vater had a high-risk progression rate (75.0–85.7 %). Conclusions According to the risk stratification of progression factors by initial tumor size and location, we can determine suitable treatment indications for LGD lesions.

How has the COVID-19 pandemic affected gastrointestinal surgery for malignancies and surgical infections?

ABSTRACTThe coronavirus disease 2019 (COVID-19) pandemic has affected infection control and prevention measures. We investigated the impact of the COVID-19 pandemic on postoperative infections and infection control measures in patients underwent gastrointestinal surgery for malignancies. We retrospectively evaluated changes in clinicopathological features, frequency of alcohol-based hand sanitizer use, frequency of postoperative complications, and microbial findings among our patients in February–May in 2019 (Control group) and 2020 (Pandemic group), respectively. Surgical resection in pathological stage III or IV patients was more frequently performed in the Pandemic group than in the Control group (P = 0.02). The total length of hospitalization and preoperative hospitalization was significantly shorter in the Pandemic group (P = 0.01 and P = 0.008, respectively). During the pandemic, hand sanitizer was used by a patients for an average of 14.9±3.0 times/day during the pandemic as opposed to 9.6±3.0 times/day in 2019 (p<0.0001). Superficial surgical site infection and infectious colitis occurred less frequently during the pandemic (P = 0.04 and P = 0.0002, respectively). In Pandemic group, Enterobacter, Haemophilus, and Candida were significantly decreased in microbiological cultures (P < 0.05, P < 0.05, P = 0.02, respectively) compared with Control group. Furthermore, a significant decrease in Streptococcus from drainage cultures was observed in the Pandemic group (P < 0.05). During the COVID-19 pandemic, a decrease in nosocomial infections was observed in the presence of an increase in alcohol-based hand sanitizer use.

Age related changes in clinicopathologic features of oral squamous cell carcinoma (OSCC) in Iranian patients: An epidemiologic study

Introduction: Clinicopathologic characteristics of oral Squamous cell carcinoma (OSCC) affected by age, although it is controversial. In this study the differences in clinicopathological features of OSCC were compared between patients younger and older than 40 years' old. Materials and methods: In this retrospective study the histopathologic records of OSCC patients who underwent surgery in Cancer Institute of Iran during 2005-2015 were retrieved. The demographic and histopathologic features of patients in two groups of younger than 40 and older than 40 years old were recorded and descriptive analysis was used for statistical interpretation between groups. Results: The most cases of OSCC in both groups was registered in males with 14.3% and 85.7% of cases in younger and older than 40, retrospectively. Tongue was the most prevalent anatomic location of OSCC in both groups (39%). Based on clinicopathologic features, most prevalent pathologic degree of OSCC in younger aged patients was moderately differentiated OSCC (14.5%). In patients older than 40, well differentiated OSCC (87.7%) was more prevalent. Conclusion: Based on histopathologic features, the moderately differentiated and well differentiated OSCC were more in younger and older patients than 40, respectively. The finding suggests that OSCC has more malignant feature in young patients.

Clinicopathological Features and Type of Surgery for Lynch Syndrome: Changes during the Past Two Decades.

PurposeThe Korean Hereditary Tumor Registry, the first and one of the largest registries of hereditary tumors in Korea, has registered about 500 families with hereditary cancer syndromes. This study evaluates the temporal changes in clinicopathologic features and surgical patterns of Lynch syndrome (LS) patients.Materials and MethodsData on 182 unrelated LS patients were collected retrospectively. The patients were divided into the period 1 group (registered in 1990-2004) and 2 (registered in 2005-2014). The clinical characteristics of the two groups were compared to identify changes over time.ResultsThe period 1 group included 76 patients; the period 2 group, 106 patients. The mean ages at diagnosis were 45.1 years (range, 13 to 85 years) for group 1 and 49.7 years (range, 20 to 84 years) for group 2 (p=0.015). The TNM stage at diagnosis did not differ significantly—period 1 group: stage 0-I (n=18, 23.7%), II (n=37, 48.7%), III (n=19, 25.0%), and IV (n=2, 2.6%); period 2 group: stage 0-I (n=30, 28.3%), II (n=35, 33.0%), III (n=37, 34.9%), and IV (n=4, 3.8%). Extended resection was more frequently performed (55/76, 72.4%) in the period 1 group than period 2 (49/106, 46.2%) (p=0.001).ConclusionColorectal cancer in patients with LS registered at the Korean Hereditary Tumor Registry is still diagnosed at an advanced stage, more than two decades after registry’s establishment. Segmental resection was more frequently performed in the past decade. A prompt nationwide effort to raise public awareness of hereditary colorectal cancer and to support hereditary cancer registries is required in Korea.

Abstract P3-07-11: Trends in clinicopathologic features and systemic therapy use in breast cancer patients: Findings from the National Cancer Database

Abstract Introduction: Breast cancer remains the most common malignancy affecting women in the United States. We sought to identify temporal trends in the clinicopathologic features of breast cancer over the last 13 years, along with changes in systemic therapy usage to treat this disease. Methods: The National Cancer Database is a national resource maintained by the CoC and the American Cancer Society that captures 70% of the newly diagnosed breast cancers in the US. We utilized the beta-PUF file of the NCDB, which included 1,669,679 patients with invasive breast cancer patients from 1998 to 2010, and analyzed trends in clinicopathologic features as well as use of systemic chemo- and hormonal therapy. Results: Over the 13 years of the study, a significant trend was noted to older age, lower grade and fewer positive lymph nodes (all p&amp;lt;0.001). Yet, the proportion of patients receiving systemic chemotherapy and hormonal therapy also increased over this time period (p&amp;lt;0.001). These trends remained when the time period was bisected into an early (prior to 2004) and later (after 2004) time period (shown in the table below). Receipt of systemic therapy was positively correlated with younger age, larger tumor size, higher grade and more positive lymph nodes over this time period (all p&amp;lt;0.001). There was a small increase in tumor size (&amp;lt;0.1 mm) in the latter period, but other factors were more favorable. Nonetheless, there has been a significantly higher utilization of systemic chemotherapy (OR: 1.107; 95% CI: 1.017-1.098, p&amp;lt;0.001) and hormonal therapy (OR: 1.588; 95% CI: 1.578-1.598, p&amp;lt;0.001) in more recent years, even when controlling for changes in clinicopathologic features on multivariate analysis. Prior to 2004After 2004p-valueMean age at diagnosis (years)60.160.3&amp;lt;0.001Mean tumor size (mm)20.120.2&amp;lt;0.001Mean number of positive nodes1.31.2&amp;lt;0.001Proportion grade 3 (%)36.834.6&amp;lt;0.001Proportion receiving chemotherapy (%)41.142.2&amp;lt;0.001Proportion receiving hormonal therapy (%)41.753.5&amp;lt;0.001 Conclusions: These data demonstrate that while early detection may be increasing the number of low grade node-negative tumors in older patients, our use of systemic therapy has become more liberal. Increasing use of hormonal therapy may be due to more aggressive guidelines and a lower threshold for ER-positivity; increasing use of chemotherapy may be the result of more efficacious drugs with lower toxicity being available to treat limited disease. Nonetheless, implications in terms of cost vs. benefit of our more aggressive approach may warrant further evaluation. Citation Format: Anees B Chagpar, Sarah Mougalian, Donald Lannin, Maysa Abu-Khalaf, Brigid Killelea, Tara Sanft, Lajos Pusztai. Trends in clinicopathologic features and systemic therapy use in breast cancer patients: Findings from the National Cancer Database [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-07-11.

Hepatolithiasis: analysis of Japanese nationwide surveys over a period of 40 years.

The aims of the present study are to clarify the changes in clinicopathologic features, diagnosis and treatment for hepatolithiasis, and propose an appropriate management strategy in Japan. The research group conducted nationwide surveys seven times in the past over a period of 40 years. Furthermore, a cohort was followed up in 2010. We analyzed the clinical features, diagnosis tools, treatment procedures, outcomes, and predictive factors for cholangiocarcinoma. Surgery was the primary method for hepatolithiasis up to 1998, and the frequency of its use has decreased since then. In 2011, 66.7% of hepatolithiasis patients were treated using nonsurgical approaches. In addition, endoscopic retrograde cholangiography (ERC) with stone extraction was the most frequently performed procedure (22.7%). However, the incidences of residual stone and recurrent stone after ERC with stone extraction were higher than those after percutaneous transhepatic cholangioscopic lithotomy and surgery. Bile duct stricture and dilatation during follow up were significant risk factors for stone recurrences. In the cohort study, stone removal only and age >65 years were significant factors for the development of cholangiocarcinoma. In patients without a history of cholangioenterostomy, left-lobe-type stones were a risk factor, and hepatectomy reduced the risk of the development of cholangiocarcinoma significantly. Nonsurgical treatment may be performed as the first-line treatment for hepatolithiasis. Surgery should be performed on patients who were treated incompletely after nonsurgical treatment. However, hepatectomy may be recommended for patients with left-lobe-type stones and without a history of cholangioenterostomy.

Glomerular Density-Associated Changes in Clinicopathological Features of Minimal Change Nephrotic Syndrome in Adults

Background: Differences in nephron number and/or glomerular size between individuals, in relation to intrauterine growth retardation or low birth weight, have been suggested to affect the clinical course of minimal change nephrotic syndrome (MCNS) in children. However, no previous study has investigated the potential influences of these histological variables on the clinical course of adult patients with MCNS. Methods: The glomerular density (GD; the number of non-sclerotic glomeruli per renal cortical area) and the glomerular volume (GV) were evaluated using renal biopsy specimens from adult patients with a histological diagnosis of MCNS (n = 50). Relationships between these variables and clinicopathological features, including the initial response to corticosteroid therapy, were analyzed. Results: Both the GD (1.5–6.5/mm²) and the GV (1.2–4.4 × 10⁶ µm³) showed about 4-fold variations, and a close inverse correlation was observed between these two variables. Notably, the MCNS patients with a low GD showed a trend towards having similar clinicopathological characteristics as patients with a histological diagnosis of focal segmental glomerular sclerosis, as compared to the MCNS patients with a high GD. In addition, during the initial treatment with corticosteroids, the number of patients achieving complete remission was significantly lower in the MCNS patients with a low GD than that in the MCNS patients with a high GD. Conclusion: These results suggest that the GD in renal biopsies may be an important determinant of the glomerular size variability, and can therefore influence the clinical phenotype, such as the response to corticosteroid therapy, in adult patients with MCNS.

Aortic dissection at the University hospital of the West Indies: A 20-year clinicopathological study of autopsy cases.

BackgroundAn autopsy study of aortic dissection (AD) at our institution was previously reported. In the approximately 20 years since then, however, many aspects of diagnosis and treatment of this disease have changed, with a fall in mortality reported in many centers around the world. An impression amongst our pathologists that, there might be an increase in the prevalence of AD in the autopsy service at our hospital, since that earlier report, led to this repeated study, in an attempt to validate that notion. We also sought to identify any changes in clinicopathological features between the two series or any occurring during this study period itself.FindingsAll cases of AD identified at autopsy, during the 20-year period since the conclusion of the last study, were collected and pertinent clinical and pathological data were analyzed and compared, both within the two decades of this study period and against the results of the last study.Fifty-six cases comprised this study group including 36 males and 20 females, with a mean age of 63.9 years. There were, more patients in the second decade (n = 33; 59%) compared with the first decade (n = 23; 41%). Hypertension as a risk factor was identified in 52 (93%) cases and rupture occurred in 49 (88%) cases. A clinical diagnosis of AD was considered prior to surgery or autopsy in 25 (45%) cases overall, more during the second decade. Surgery was attempted in 25% of all cases with an increase in the second decade compared with the first.ConclusionsCompared with the earlier review, a variety of changes in the profile of patients with AD in the autopsy service has been noted, including a reversal in the female predominance seen previously. Other observations include an increase in cases where the correct clinical diagnosis was considered and in which surgical treatment was attempted, changes also evident when the second decade of the present study was compared with the earlier decade. Overall, there were many positive trends. However, areas that could still be improved include an increased index of suspicion for the diagnosis of AD and perhaps in the initiation of treatment, earlier, in those cases where the correct diagnosis was considered.

Changes in clinicopathological features and survival after gastrectomy for gastric cancer over a 20-year period

The pattern of gastric cancer in the Western world is changing, with an increased proportion of tumours in the upper stomach. The aim of this study was to investigate changes in clinicopathological features and survival of patients with resected gastric cancer at a single institution, in an area of high incidence in the Far East. Clinical features and pathological findings were compared in patients with gastric cancer who underwent gastrectomy at Seoul National University Hospital during four consecutive periods (1986-1990, 1991-1995, 1996-2000 and 2001-2006). There were 12 026 patients. The mean age increased from 53·4 years in the first period to 57·4 years in the last (P < 0·001). The proportion of patients aged 70 years or older also increased, reaching 16·1 per cent in the final period. Upper-third cancer increased from 5·3 per cent in the first period to 14·0 per cent in the fourth (P < 0·001). Early gastric cancer (pathological T1) increased continuously over the four time intervals, from 24·8 to 48·9 per cent (P < 0·001). The overall 5-year survival rate increased from 64·0 per cent in the first period to 73·2 per cent at the end (P < 0·001), and this survival improvement was apparent in patients aged 40 years or more. The mean age of patients with gastric cancer has increased during the past 20 years. The proportion of early gastric cancer and overall survival have gradually increased, especially in patients aged over 40 years.

The Feasibility of Expectant Management with Inner-city Men with Newly Diagnosed Localized Prostate Cancer

To determine the compliance rate for treatment recommendations consistent with expectant management of inner-city men with prostate cancer. Twenty-seven out of 560 men who underwent biopsy of the prostate were found to harbor cancer and opted for expectant management. Clinic and hospital records were reviewed for adherence to follow-up schema. Of the 27 men on expectant management, 22 men (82%) adhered to strict follow-up schema. At 6-month follow-up, there were no significant changes in clinicopathologic features (e.g., prostate specific antigen (PSA), Gleason score, and stage). With a median follow-up of 12 months, only 2 men demonstrated a rise of more than 30% from baseline PSA (repeat biopsy demonstrated persistent low grade, low stage disease). Our findings imply that expectant management may be feasible in inner-city settings. Thus, in subsequent expectant management trials, inner-city men should be actively recruited.