Prognostic Factors In Carcinoma Research Articles

Tumor budding activity is an independent prognostic factor in squamous cell carcinoma of the vulva

Tumor budding activity (TBA) is recognized as a potential prognostic factor in carcinomas from several anatomic sites. This study evaluates the prognostic value of TBA in a cohort of squamous cell carcinoma of the vulva (VSCC). TBA, defined as clusters of <5 tumor cells that are detached from the main tumor and that infiltrate into surrounding stroma, was assessed in 82 cases of surgically excised VSCC and correlated with patient outcomes. All cases were classified into one of 3 groups: no TBA, low TBA (1-14 foci), and high TBA (≥15 foci). Twenty-three (29.1%), 37 (45.1%), and 22 (26.8%) cases showed no, low, and high TBA, respectively. High TBA was associated with reduced overall survival (OS) on multivariate analysis independent of FIGO stage, human papillomavirus (HPV) status, and p53 status. The majority of tumors with high TBA displayed a p53 mutant staining pattern (77.3%, 17 of 22). The 17 patients whose tumors displayed a p53 mutant/high TBA profile had worse outcomes when compared with 15 patients whose tumors showed a p53 mutant/no TBA or p53 mutant/low TBA profile (mean OS 37.5 versus 63.3 months, respectively, P=.002). High TBA was observed in only 5 of 47 HPV-associated cases, and this subsetalso seemed to display a worse patient outcome as compared with the rest of the HPV-associated cohort (OS 16.8 versus 142.8 months, P<.0001). In summary, these findings indicate that TBA is an independent prognostic indicator in VSCC patients, and that high TBA is associated with worse clinical outcomes.

Clinicopathological characteristics and prognosis analysis of 217 patients with carcinoma in the remnant stomach

To evaluate the clinicopathological features and prognostic factors of carcinoma in the remnant stomach (CRS). Clinicopathological data of 217 consecutive CRS patients from January 2000 to March 2017 at Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University were retrospectively analyzed. CRS was defined as the primary cancer arising from the remnant stomach following gastrectomy, regardless of the initial disease or operation, and at no special time interval. The clinicopathological features and treatment were compared between CRS after benign disease operation (CRS-B) group and CRS after gastric cancer operation (CRS-C) group, and factors influencing prognosis were analyzed using Cox regression model analysis. Of 217 patients, 189 were male and 28 were female with mean age of (60.9±11.2) years. The interval between the first and the second operations was (18.3±15.1) years. The CRS-B group comprised 108 patients and the CRS-C group comprised 109 patients. Compared to CRS-C group, CRS=B group had higher ratio of male [92.6% (100/108) vs. 81.7% (89/109), χ2=5.779, P=0.016], longer interval [30(25-40) years vs. 4(1.5-8.0) years, Z=-1.685, P=0.000], longer tumor diameter [(5.9±3.2) cm vs. (3.9±2.4) cm, t=3.390, P=0.000] and later tumor stage [patients in stage I(, II(, III(, and IIII(: 6 (8.0%), 14 (18.7%), 41 (54.7%), and 14 (18.7%) vs. 16 (25.4%), 14 (22.2%), 21(33.3%), and 12(19.0%), respectively, Z=-2.018, P=0.044]. A total of 138 patients underwent surgery, including 118(85.5%) patients of curative resection and 20(14.5%) patients of palliative resection. The other 79 patients did not receive surgery due to extensive metastasis or miscellaneous reasons. Among 138 patients receiving surgery, 3 patients underwent endoscopic resection, 6 patients underwent minimally invasive surgery (laparoscopy or robot), and 129 patients underwent laparotomy. Forty-eight patients underwent surgery involving combined resection. The median postoperative hospital stay was 10(8-14) days. The incidence of postoperative complication was 23.2%(32/138). A total of 91 patients were followed up for 7-120 months, including 51 patients in CRS-B group and 40 in CRS-C group. The overall 1-, 3-, and 5-year survival rates of the 75 patients receiving curative resection were 80.7%, 55.1%, and 41.6%, respectively. The overall 1-, 3-, and 5-year survival rates were 73.5%, 48.3%, and 29.0% respectively in CRS-B group and 83.1%, 51.2%, and 32.5% respectively in CRS-C group. There was no significant difference between two groups (P=0.527). Multivariate analysis showed that age (RR=1.879, 95%CI: 1.015-3.479, P=0.045), radical procedure (RR=2.956, 95%CI: 1.421-6.150, P=0.004) and TNM stage (RR=1.570, 95%CI: 1.047-2.354, P=0.029) were independent prognostic factors for CRS. As compared to the CRS-C group, the CRS-B group has higher percentage of male, longer interval, larger tumor diameter and later TNM stage. Radical resection indicates better prognosis.

Prognostic factors of carcinoma ex pleomorphic adenoma of the salivary glands, with emphasis on the widely invasive carcinoma: a clinicopathologic analysis of 361 cases in a Chinese population

To analyze the clinicopathologic characteristics and prognostic factors of salivary carcinoma ex pleomorphic adenoma (Ca-ex-PA) and widely invasive Ca-ex-PA in a Chinese population. The clinicopathologic parameters of 361 patients with primary Ca-ex-PA from our 2001-2012 cohort were retrospectively reviewed, and the correlation between the parameters and disease-specific survival was statistically analyzed. Of 361 patients with Ca-ex-PA, 229 were male, 132 were female. 191 tumors were invasive carcinoma, 77 minimally invasive, and 93 noninvasive. For 334 (93%) patients, follow-up information was available, and only one of 160 patients with noninvasive or minimally invasive Ca-ex-PA died as a result of the tumor. Of 174 patients with widely invasive Ca-ex-PA, 54 (31%) died as a result of the tumor. Using the Kaplan-Meier method, age, T stage, N stage, histologic grade, and proportion of carcinoma were found to be significantly associated with disease-specific survival of widely invasive Ca-ex-PA. Cox regression analysis indicated that T stage and N stage were independent prognostic factors of disease-specific survival of widely invasive Ca-ex-PA. Widely invasive Ca-ex-PA had a much worse clinical outcome compared with noninvasive or minimally invasive Ca-ex-PA. T stage and N stage are the most important independent factors for predicting prognosis in Chinese patients with widely invasive Ca-ex-PA.

Pathology of the Adrenal Cortex: a Reappraisal of the Past 25 Years Focusing on Adrenal Cortical Tumors

A reappraisal of the major advances in the diagnostic pathology of adrenal cortical lesions and tumors in the last 25 years is presented, with special reference to the definition of malignancy in primary adrenal cancer and its variants. Slightly more than 25 years ago, Weiss proposed his diagnostic scoring system for adrenal cortical carcinoma. This represented a milestone for adrenal pathologists and the starting point for further modifications of the system, either through minor changes in the scoring procedure itself or concentrating on some particular Weiss criterion such as mitotic index, integrated into alternative scoring schemes or algorithms that are currently under validation. Improvements in diagnostic immunohistochemistry have led to the identification of markers of cortical origin, such as Melan-A, alpha-inhibin, and SF-1 and of prognostic factors in carcinoma, such as the Ki-67 proliferation index and SF-1 itself. With regard to hyperplastic conditions, genetic investigations have allowed the association of the majority of cases of primary pigmented nodular adrenocortical disease (PPNAD) in Carney complex to mutations in the gene encoding the regulatory subunit 1A of protein kinase A (PRKAR1A). Other hereditary conditions are also associated with adrenal cortical tumors, including the Li-Fraumeni, Beckwith-Wiedemann, Gardner, multiple endocrine neoplasia type 1, and neurofibromatosis type 1 syndromes. Moreover, several advances have been made in the knowledge of the molecular background of sporadic tumors, and a number of molecules/genes are of particular interest as potential diagnostic and prognostic biomarkers.

Prognostic factors of carcinoma of the body and tail of the pancreas

Objective To investigate the clinical and pathological prognostic factors of the carcinoma of the body and tail of the pancreas.Methods The clinical data of 64 patients with the carcinoma of the body and tail of the pancreas who received radical resection at the Cancer Hospital of Tianjin Medical University from January 1998 to December 2008 were retrospectively analyzed.Abdominal ultrasound,computed tomography and tumor markers detection were carried out preoperatively to learn the condition of the patients.No patient received neoadjuvant therapy before operation,and chemotherapy,biotherapy and radiotherapy were applied to all the patients after radical resection.Indicators including the gender,age,onset of back pain,site,diameter and differentiation of tumors,operative procedure,lymph node metastasis,metastatic rate of lymph nodes,extra-and intra-pancreatic neural invasion,splenic artery invasion,splenic vein invasion,retroperitoneal soft tissue infiltration,venulae infiltration and TNM staging were collected.The survival curve was drawn by Kaplan-Meier method,and the survival was analyzed by Log-rank test.Univariate and multivariate analysis were carried out by chi-square test and COX proportional hazards model,respectively.Results All patients received R0 resection,and the mean number of lymph node resected was 15 (range,12-22).There were 5 patients with pancreatic leakage,3 with delayed gastric emptying,1 with peritoneal infection,and 1 with deep venous thrombosis,no perioperative mortality was detected.All the 64 patients were with ductal adenocarcinoma and cystadenocarcinoma,and 9 patients were with high differentiated tumor,35 with moderate differentiated tumor and 20 with low differentiated tumor.There were 4 patients with tumor in the TNM IA stage,9 in the TNM IB stage,17 in the TNM Ⅱ A stage and 34 in the TNM Ⅱ B stage.Twenty-six patients died of tumor local recurrence and 18 died of tumor distal metastasis.The 1-,3-,5-year survival rates were 42.2％,17.2％ and 15.6％,respectively,and the median survival time was 19.0 months.The result of univariate analysis showed that back pain,maximum tumor diameter,differentiation,lymph node metastasis,metastatic rate of lymph nodes,extra-pancreatic neural invasion,splenic artery invasion and TNM staging were factors affecting prognosis (x2=10.658,8.371,18.910,6.605,28.382,14.571,19.476,32.155,P ＜0.05).The result of multivariate analysis showed that tumor differentiation,metastatic rate of lymph nodes,extra-pancreatic neural invasion,splenic artery invasion,TNM staging were the independent factors affecting prognosis (RR =2.509,2.107,6.692,5.109,4.784,P ＜ 0.05).Conclusion Tumor differentiation,metastatic rate of lymph nodes,extra-pancreatic neural invasion,splenic artery invasion and TNM staging are the risk factors affecting the prognosis of carcinoma of the body and tail of the pancreas. Key words: Pancreatic neoplasms ; Surgical procedure, operative ; Prognosis

Tumor Grade Improves the Prognostic Ability of American Joint Committee on Cancer Stage in Patients With Penile Carcinoma

Penile cancer is rare. Thus, predicting cancer specific mortality may be difficult. We devised an accurate and yet easily applicable predictive rule that compares favorably with 2 previous models (73.8% and 74.7% accuracy, respectively). We identified patients treated with primary tumor excision for all stages of penile squamous cell carcinoma between 1998 and 2006. Disease stage definitions using Surveillance, Epidemiology and End Results stage, American Joint Committee on Cancer stage and TNM classification, and tumor grade were used to predict cancer specific mortality. Predictive accuracy estimates were compared using the DeLong method for related AUCs. Surveillance, Epidemiology and End Results stage alone (1 predictor variable) was least accurate (74.5%). American Joint Committee on Cancer stage with tumor grade (2 predictor variables) was the most simple and most accurate (80.9%, p <0.001). A benefit similar to that of American Joint Committee on Cancer stage with tumor grade was seen for TNM classification and TG (80.7%, p = 0.8). However, this rule (4 predictor variables) was more complex than American Joint Committee on Cancer stage and tumor grade. American Joint Committee on Cancer stage combined with tumor grade is the simplest, most accurate cancer specific mortality prediction rule after primary tumor excision for penile squamous cell carcinoma. This method is also more accurate than 2 previous cancer specific mortality prediction rules.

Invasion of the Splenic Artery Is a Crucial Prognostic Factor in Carcinoma of the Body and Tail of the Pancreas

A retrospective study was performed to determine the prognostic implications of invasion to the splenic vessels in pancreatic body and tail cancer. Involvement of the splenic artery (SA) and vein (SV) is frequently observed in carcinoma of the body and tail of the pancreas, but its correlation with various other clinicopathologic factors and prognosis has not been explored in detail. Fifty-one patients who had undergone distal pancreatectomy for invasive adenocarcinoma of the body and tail of the pancreas were discreetly selected from the prospective data base for analyses. Cases that required extended surgery due to invasion of the major vessels such as the portal vein, common hepatic artery, celiac artery, and superior mesenteric artery were excluded. Correlation between invasion of the splenic vessels and prognosis and other clinicopathologic factors were analyzed. Seventeen patients with invasion of the SA had a significantly inferior prognosis compared with those without the invasion (P = 0.0067), whereas invasion of the SV, observed in 24 patients, did not affect prognosis. Additionally, invasion of the SA significantly correlated with tumor size > or = 2 cm, anterior serosal infiltration, perineural invasion and SV invasion (P = 0.0440, P = 0.0406, P = 0.0460, and P = 0.0173, respectively). In univariate analysis, SA invasion, lymph node metastasis, and anterior serosal infiltration were identified as significant poor prognostic factors. In multivariable analysis, only SA invasion was an independent prognostic factor (odds ratio, 2.611, P = 0.0196). Our results indicated that the invasion of the SA, but not that of the SV, is a crucial prognostic factor in pancreatic body and tail cancer.

Association Between Lymph Node Density and Disease Specific Survival in Patients With Penile Cancer

We assessed the value of lymph node density for predicting disease specific survival after lymphadenectomy for penile cancer. Data were collected retrospectively in 75 and prospectively in 88 consecutive patients with squamous cell carcinoma of the penis treated at M. D. Anderson Cancer Center between 1979 and 2007. We identified 45 patients with penile cancer and nodal metastasis who underwent lymphadenectomy with curative intent. Lymph node density was analyzed as a categorical variable by grouping patients into 2 or 3 categories based on equal percents. We explored the prognostic value of lymph node density for predicting disease specific survival in this cohort. Median followup was 23.7 months in all patients. By the time of analysis 22 patients had died, including 18 (82%) of penile cancer and 4 (18%) of other causes. Median lymph node density in patients alive or dead of other causes was 3.4% (IQR 2.9-5.9) compared to 43.3% (IQR 15.6-80) in those dead of disease (p <0.001). Median lymph node density in all patients was 6.7%. Estimated 5-year disease specific survival in patients with lymph node density 6.7% or less was significantly better than that in patients with lymph node density greater than 6.7% (91.2%, 95% CI 53.9-98.8 vs 23.3%, 95% CI 7.0-45.1, p <0.001). In models comparing lymph node density to known prognostic features lymph node density remained statistically significant, while the other factors were no longer statistically associated with disease specific survival. Lymph node density proved to be a significantly better prognosticator of disease specific survival than the current TNM nodal staging system in patients with penile cancer and nodal involvement. Further independent validation is required to determine the clinical usefulness of lymph node density in this patient population.

Prise en charge des curages ganglionnaires cervicaux en pathologie tumorale ORL

The presence of metastases in cervical lymph nodes (except distant metastasis) is the most significant independent prognostic factor in carcinoma of the head and neck. The purpose of this article is firstly to review the anatomy of the neck compartments, the types of neck dissection and secondly to describe recommendations for the technical procedures required and thus to provide a full informative report to optimise management by the clinician.

Comparison of Contrast Enhanced Color Doppler Targeted Biopsy to Conventional Systematic Biopsy: Impact on Gleason Score

Prostate cancer grading with Gleason score is an important prognostic factor. This prospective randomized study compares ultrasound systematic biopsy vs contrast enhanced color Doppler targeted biopsy for the impact on Gleason score findings. We examined 690 men (mean age 56 years, range 41 to 77) with a serum total prostate specific antigen of 1.25 ng/ml or greater, a free-to-total prostate specific antigen ratio less than 18% and/or a suspicious digital rectal examination. Contrast enhanced color Doppler targeted biopsies with a limited number of cores (5 or less) were performed in hypervascular areas of the peripheral zone during administration of the ultrasound contrast agent Sonovuetrade mark (Bracco, Milano, Italy). Ten systematic biopsies were obtained in a standard spatial distribution. Cancer detection rates and Gleason score were compared. Prostate cancer was identified in 221 of 690 subjects (32%) with a mean prostate specific antigen of 4.6 ng/ml (range 1.4 to 35.0). Prostate cancer was detected in 180 of 690 subjects (26%) with contrast enhanced color Doppler targeted biopsy and in 166 of 690 patients (24%) with systematic ultrasound biopsy. The Gleason score of all 180 cancers detected on contrast enhanced color Doppler targeted biopsy was 6 or higher (mean 6.8). The Gleason score of all 166 cancers detected on systematic biopsy ranged from 4 to 6 and mean Gleason score was 5.4. Contrast enhanced color Doppler targeted biopsy detected significantly higher Gleason scores compared to systematic biopsy (Wilcoxon rank sum test p <0.003). Contrast enhanced color Doppler targeted biopsy detected cancers with higher Gleason scores and more cancer than systematic biopsy. Therefore, contrast enhanced color Doppler seems to be helpful in the grading of prostate cancer, which is important for defining prognosis and deciding treatment.

Pelvic Lymph Node Dissection for Penile Carcinoma: Extent of Inguinal Lymph Node Involvement as an Indicator for Pelvic Lymph Node Involvement and Survival

We identified pathological parameters of inguinal lymph node involvement with the aim of predicting pelvic lymph node involvement and survival. A total of 308 patients with penile carcinoma and adequate followup were included in this study. The outcome of 102 patients who underwent lymphadenectomy for lymph node metastases was analyzed further. Histopathological characteristics of the regional lymph nodes were reviewed including unilateral or bilateral involvement, the number of involved nodes, pathological tumor grade of the involved nodes, and the presence of extracapsular growth. Tumor grade of the involved inguinal lymph nodes (OR 6.0, 95% CI 1.2-30.3) and the number of involved nodes (2 or less vs more than 2) (OR 12.1, 95% CI 3.0-48.1) were independent prognostic factors for pelvic lymph node involvement. Extracapsular growth (OR 2.3, 95% CI 1.1-4.8), bilateral inguinal involvement OR 3.4, 95% CI 1.2-9.4) and pelvic lymph node involvement (OR 3.1, 95% CI 1.4-6.6) were independent prognostic factors for disease specific survival. Patients with only 1 or 2 inguinal lymph nodes involved without extracapsular growth and no poorly differentiated tumor within these nodes are at low risk of pelvic lymph node involvement and have a good prognosis with a 5-year survival rate of approximately 90%. Pelvic lymph node dissection seems to be unnecessary in these cases.

Human papillomavirus genotype as a prognostic factor in carcinoma of the uterine cervix

The clinical implications of specific human papillomavirus (HPV) types in invasive cervical carcinomas are only now beginning to be appreciated. The objective of this study was to determine the clinical implications and prognostic value of the HPV genotype in cervical carcinomas. In this study, we employed an HPV DNA chip to detect the type-specific sequence of HPV from cervical swabs taken from women with biopsy-proven neoplastic lesions of the cervix. We divided the patients into four groups: HPV-negative, HPV-16-related, HPV-18-related, and intermediate risk type-related. Associations with clinicopathologic data (stage, histologic type, lymph node status, parametrial invasion, lymphvascular space invasion, tumor size, vaginal involvement) and overall survival were assessed. HPV DNA was detected in 81.4% of the patients, and 19.0% harbored multiple HPV variants. HPV-16-related was the predominant type and was detected in 47.4% (46/97) of the patients. The HPV-16-related types were detected more frequently in patients with squamous cell carcinomas, whereas the HPV-18-related types were more prevalent in cases of adenocarcinomas and adenosquamous carcinomas (P < 0.05). Otherwise, no significant correlations were detected between the HPV genotype and any other clinicopathologic parameters. After a median follow-up of 30 months, the 5-year survival rate was lower in the HPV-18-related patients, but this difference was not found to be statistically significant, according to the results of the log-rank test. We conclude that neither the presence nor type of HPV DNA bears any prognostic significance in cases of cervical carcinoma.

Nodal involvement as an indicator of postoperative liver metastasis in carcinoma of the papilla of Vater

Although lymph node metastatic involvement is one of the most important prognostic factors for carcinoma of the papilla of Vater, a detailed analysis of this factor in relation to prognosis has not been conducted. From 1985 to 2003, 29 patients with carcinoma of the papilla of Vater underwent pancreaticoduodenectomy and dissection of regional lymph nodes at Yamagata University Hospital. We analyzed clinicopathologic variables in relation to prognosis and precisely evaluated nodal involvement in each patient to determine lymphatic flow. Furthermore, the relationship between recurrent site and nodal involvement was investigated. The overall survival rate was 55% at 5 years. The significant prognostic factors were morphological ulcer formation (P = 0.04), histological type (P = 0.03), nodal involvement (P = 0.002), and lymphatic invasion (P = 0.03). Multivariate analysis indicated no independent factor, but nodal involvement may be the strongest prognostic factor. The overall rate of nodal involvement was 41.4% (12 of 29 patients). The metastatic rates in the superior posterior pancreaticoduodenal lymph nodes, the inferior posterior pancreaticoduodenal lymph nodes, the superior mesenteric lymph nodes, and paraaortic lymph nodes were high (31.0%, 20.7%, 17.2%, and 13.8%, respectively). Patients with nodal involvement had a significantly higher rate of liver metastasis after surgery than those without it (P = 0.02). Ulcer formation and histological type were significantly correlated with nodal involvement (P = 0.05 and P = 0.002, respectively). Nodal involvement is the most important prognostic factor in patients with carcinoma of the papilla of Vater. Patients with nodal involvement are at high risk of liver metastasis; therefore, adjuvant therapy may be necessary for the control of liver metastasis. Preoperative ulcer formation and histological type in the biopsy specimen are good indicators for extended lymph node dissection and adjuvant therapy, because these variables are correlated with nodal involvement. However, our data revealed only the sites of the positive nodes, without addressing the effect of extended lymph node dissection and adjuvant chemotherapy. To date, there has been reporting of extended lymph node dissection and adjuvant chemotherapy in patients with carcinoma of the papilla of Vater. Further studies will be necessary to resolve these problems.

Diagnosing metastatic disease in inguinal nodes in penile cancer: Do we have a test and the evidence?

Nodal metastasis is the most important prognostic factor in carcinoma of the penis. Clinical examination is inaccurate for diagnosing nodal involvement. Routine prophylactic block dissection carries a high risk of morbidity and a small but definite incidence of mortality. Procedures such as fine needle aspiration cytology with or without imaging guidance, anatomic sentinel node sampling, medial inguinal lymph node biopsy and dynamic sentinel node mapping, have all been tried, of which the last has proved most useful. Newer investigations like lymphotropic nano-particle enhanced MRI, squamous cell carcinoma antigen estimation and DNA flow cytometry are still experimental. It appears that in spite of numerous tests available for diagnosing metastatic disease in nodes before it becomes clinically apparent, the only test which currently holds promise is dynamic sentinel node mapping using radio isotopes with or without intraoperative colored dye, to identify the draining nodes for sampling. The only other alternative may be to recommend prophylactic node dissection in all T2, T3 or T4 patients or in all patients with Grade 2 or 3 T1 tumors, in whom the risk of nodal metastases is very high.

RE: HOW TO AVOID FALSE-NEGATIVE DYNAMIC SENTINEL NODE PROCEDURES IN PENILE CARCINOMA

No AccessJournal of UrologyLetters to the Editor/Errata1 Feb 2005RE: HOW TO AVOID FALSE-NEGATIVE DYNAMIC SENTINEL NODE PROCEDURES IN PENILE CARCINOMAis correction ofHOW TO AVOID FALSE-NEGATIVE DYNAMIC SENTINEL NODE PROCEDURES IN PENILE CARCINOMA B.K. Kroon, S. Horenblas, S.H. Estourgie, A.P. Lont, R.A. Valdés Olmos, and O.E. Nieweg B.K. KroonB.K. Kroon More articles by this author , S. HorenblasS. Horenblas More articles by this author , S.H. EstourgieS.H. Estourgie More articles by this author , A.P. LontA.P. Lont More articles by this author , R.A. Valdés OlmosR.A. Valdés Olmos More articles by this author , and O.E. NiewegO.E. Nieweg More articles by this author View All Author Informationhttps://doi.org/10.1097/01.ju.0000151250.12738.3eAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "RE: HOW TO AVOID FALSE-NEGATIVE DYNAMIC SENTINEL NODE PROCEDURES IN PENILE CARCINOMA." The Journal of Urology, 173(2), p. 663 References 1 : Prospective validation of the association of local tumor stage and grade as a predictive factor for occult lymph node micrometastasis in patients with penile carcinoma and clinically negative inguinal lymph nodes. J Urol2001; 165: 1506. Link, Google Scholar 2 : Tumor stage, vascular invasion and the percentage of poorly differentiated cancer: independent prognosticators for inguinal lymph node metastasis in penile squamous cancer. J Urol2001; 165: 1138. Link, Google Scholar 3 : Grade, local stage and growth pattern as prognostic factors in carcinoma of the penis. Eur Urol1997; 32: 442. Google Scholar 4 : Up-to-date management of carcinoma of the penis. Eur Urol1997; 32: 5. Google Scholar 5 : Prognostic factors in carcinoma of the penis: multivariate analysis of 145 patients treated with amputation and lymphadenectomy. J Urol1996; 156: 1506. Google Scholar Department of Urology; St. George’s Hospital; London, United Kingdom© 2005 by American Urological Association, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology9 Nov 2018HOW TO AVOID FALSE-NEGATIVE DYNAMIC SENTINEL NODE PROCEDURES IN PENILE CARCINOMA Volume 173Issue 2February 2005Page: 663 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.MetricsAuthor Information B.K. Kroon More articles by this author S. Horenblas More articles by this author S.H. Estourgie More articles by this author A.P. Lont More articles by this author R.A. Valdés Olmos More articles by this author O.E. Nieweg More articles by this author Expand All Advertisement PDF downloadLoading ...

Gleason grading and prognostic factors in carcinoma of the prostate

Gleason grade of adenocarcinoma of the prostate is an established prognostic indicator that has stood the test of time. The Gleason grading method was devised in the 1960s and 1970s by Dr Donald F Gleason and members of the Veterans Administration Cooperative Urological Research Group. This grading system is based entirely on the histologic pattern of arrangement of carcinoma cells in H&E-stained sections. Five basic grade patterns are used to generate a histologic score, which can range from 2 to 10. These patterns are illustrated in a standard drawing that can be employed as a guide for recognition of the specific Gleason grades. Increasing Gleason grade is directly related to a number of histopathologic end points, including tumor size, margin status, and pathologic stage. Indeed, models have been developed that allow for pretreatment prediction of pathologic stage based upon needle biopsy Gleason grade, total serum prostate-specific antigen level, and clinical stage. Gleason grade has been linked to a number of clinical end points, including clinical stage, progression to metastatic disease, and survival. Gleason grade is often incorporated into nomograms used to predict response to a specific therapy, such as radiotherapy or surgery. Needle biopsy Gleason grade is routinely used to plan patient management and is also often one of the criteria for eligibility for clinical trials testing new therapies. Gleason grade should be routinely reported for adenocarcinoma of the prostate in all types of tissue samples. Experimental approaches that could be of importance in the future include determination of percentage of high-grade Gleason pattern 4 or 5, and utilization of markers discovered by gene expression profiling or by genetic testing for DNA abnormalities. Such markers would be of prognostic usefulness if they provided added value beyond the established indicators of Gleason grade, serum prostate-specific antigen, and stage. Currently, established prognostic factors for prostatic carcinoma recommended for routine reporting are TNM stage, surgical margin status, serum prostate-specific antigen, and Gleason grade.

Analysis of Clinicopathological Prognostic Parameters in Adenocarcinoma of the Gastric Cardia

Background: The optimal extent of resection for carcinoma of gastric cardia remains a subject of controversy. Although both total gastrectomy (TG) and proximal gastrectomy (PG) have their own advantages, similar survival rates were given for both. The main aim of this study is to investigate whether the extent of resection is an important prognostic factor in carcinoma of the gastric cardia.Method: Records of 60 patients with carcinoma of gastric cardia, operated on between the January 1989-January 1993 at Istanbul University, Cerrahpasa Medical Faculty Department of General Surgery, were reviewed retrospectively. The relationship between clinico-histopathological variables and 5-year survival was retrospectively analysed. Results: Of the 14 clinico-histopathological variables, eight (age, local invasion, grade, lymphatic micro-invasion, depth of penetration, lymph node involvement, type of operation and stage of disease) were found to have a significant influence on survival. Among those clinico-histopathological variables that influenced 5-year survival on univariate analysis, only age (p = 0.0029) and depth of tumour penetration (p = 0.008) independently affected survival. Conclusion: According to our results, depth of tumour penetration and age are the only variables which were found to independently affect 5-year survival. Depth of tumour penetration may serve as a potential marker for a biologically more aggressive tumour. The extent of resection (TG vs. PG) does not affect the long-term survival of the adeno-carcinoma of the cardia.

Contemporary Morbidity From Lymphadenectomy For Penile Squamous Cell Carcinoma: The M.D. Anderson Cancer Center Experience

Inguinal lymphadenectomy can be curative in patients with small volume inguinal metastases and those with more significant adenopathy responding to combination chemotherapy. However, several series collected for 15 to 40 years attest to the significant morbidity associated with lymphadenectomy. We reviewed our recent experience with lymphadenectomy in patients with invasive penile cancer who were judged to require inguinal staging and therapeutic procedures to assess the incidence and magnitude of complications caused by this procedure, especially in those with no palpable adenopathy (prophylactic group). A total of 106 lymphadenectomy procedures were performed in 53 patients. The indications for dissection were prophylactic in 66 (62%) patients in whom a superficial dissection alone was completed on the ipsilateral side, therapeutic in 28 (26%) in whom superficial, deep and ipsilateral pelvic dissections were performed, and palliative in 12 (11%) undergoing extensive resection of inguinal and abdominal wall tissue after chemotherapy. Minor postoperative complications included those requiring local wound débridement in the clinic, mild to moderate leg edema, seroma formation not requiring aspiration and minimal skin edge necrosis requiring no therapy. Major complications included severe leg edema interfering with ambulation, skin flap necrosis requiring a skin graft, rehospitalization, deep venous thrombosis, death, or reexploration or other invasive procedures performed in the operating room. The incidence and magnitude of complications were compared with prior reports from our center and other series. A total of 41 (68%) minor and 19 (32%) major complications occurred with the 106 dissections (31 of 53 patients, 58%). Prophylactic and therapeutic dissections were associated with a lower incidence of complications compared with palliative dissections (p = 0.017 to 0.049). The incidence of major complications also trended lower in the prophylactic group compared with other indications (p = 0.05). One patient in the palliative group died of sepsis on postoperative day 15. When compared with 3 prior series, the incidence of skin edge necrosis in our series was significantly lower (8% versus 45% to 62%, p <0.0001). Similarly, the incidence and severity of edema in our series were significantly lower than in a prior report from our institution (23% versus 50%, p <0.0001). For select patients undergoing prophylactic inguinal dissection to detect the presence of microscopic metastases, the incidence and magnitude of complications appeared acceptable in our contemporary experience. Similarly the morbidity of therapeutic lymphadenectomy appeared acceptable, considering the potential therapeutic benefit. However, significant complications, including death, can be associated with palliative groin dissection. Optimal candidates are those having a significant response to systemic chemotherapy whose groins are grossly uninfected.

Human papillomavirus as a prognostic factor in carcinoma of the penis

BACKGROUND Many studies have tried to identify prognostic factors to guide the selection of patients at high risk for metastases in penile carcinoma. The authors evaluated human papillomavirus (HPV) status with respect to clinical features, incidence of metastases, and prognosis of penile carcinoma. METHODS Human papillomavirus DNA was detected using the polymerase chain reaction on paraffin embedded material from 82 patients with penile carcinoma. The following variables were recorded: age, marital status, clinical staging, tumor surgery extension, histologic grade, tumor thickness, lymphatic and venous embolization, corpora cavernosa and corpus spongiosum infiltration, urethral infiltration, mononuclear and eosinophilic infiltrate, and lymph node spread. Follow-up ranged from 0.1 to 453 months. RESULTS Human papillomavirus DNA was detected in 30.5% (25 of 82) of samples. HPV-16 was the most frequent type detected (13 of 25, 52%). Human papillomavirus DNA positive tumors had less lymphatic embolization by neoplastic cells than HPV negative ones (P = 0.007). The logistic regression revealed that only lymphatic embolization was related to HPV status. There was no difference, however, between HPV DNA negative and HPV DNA positive patients according to presence of lymph node metastases (P = 0.386). No difference was found in the 10-year survival rate (68.4% vs. 69.1%; P = 0.830) between the two groups. CONCLUSIONS These data suggest that HPV status does not influence prognosis in invasive penile carcinoma. Cancer 2001;91:2315–21. © 2001 American Cancer Society.

Elevated cyclooxygenase-2 expression correlates with diminished survival in carcinoma of the cervix treated with radiotherapy

Purpose: The purpose of this study was to examine the relationship between overall survival and prognostic factors in carcinoma of the cervix treated with radiation therapy. A clinicopathologic study was performed on 24 patients. Methods and Materials: Formalin-fixed, paraffin-embedded tumor biopsies were stained for Cyclooxygenase-2 (COX-2), Topoisomerase I, Topoisomerase II, and p53. Clinical factors such as stage, grade, tumor size, pre- and post-treatment hemoglobin level, and radiotherapy dose were also evaluated. Results: Median follow-up was 75 months for living patients. The only immunohistochemical or clinical factor that was associated with improved survival was decreased COX-2 distribution staining. High COX-2 distribution staining was associated with decreased overall survival ( p = 0.021) and decreased disease-free survival ( p = 0.015) by log-rank comparison of Kaplan-Meier survival curves. The 5-year overall survival rates for tumors with low vs. high COX-2 distribution values were 75% and 35%, respectively. COX-2 staining intensity was found to correlate positively with tumor size ( p = 0.022). Conclusion: These findings indicate that increased expression of COX-2 portends a diminished survival in patients with invasive carcinoma of the cervix treated with radiotherapy. Because COX-2 is an early-response gene involved in angiogenesis and inducible by different stimuli, these data may indicate opportunity to intervene with specific inhibitors of COX-2 in carcinoma of the cervix.