Aim: The aim of this study was to evaluate survival rates and treatment response in stage I–IV gastric cancer in relation to tumor stage (TNM), histology, Lauren’s classification and tumor localization. Patients and Methods: Clinical and histopathological data of 160 patients with stage I–IV gastric cancer were analyzed in this retrospective, single-center study. Results: Most patients (73.1%) showed an advanced or metastatic tumor stage (III/IV). The median 3-year overall survival (OS) was 20 ± 16.8 months and correlated significantly with tumor stage (I: OS 30.6 ± 15 months vs. IV: 10.4 ± 9.3 months; p < 0.0001). Stage III/IV tumors were significantly more often poorly differentiated (G3; p = 0.011) and located in the corpus region. Signet ring cell (SRC) cancers were found in a larger proportion of these tumors when compared with locally limited gastric cancers (43.1% vs. 16.3%; p = 0.002). SRC tumors occurred predominantly in women and younger patients and histology was significantly more often of the diffuse subtype according to Lauren (7.5% vs. 63.2%; p < 0.0001) and poorly differentiated (G3 in 95% vs. 73%; p = 0.001). Conclusions: SRC gastric cancer correlates with poor histopathological criteria and poor prognosis when compared with other histological subtypes. These observations underline the need for more effective treatment in addition to standard approaches.
Purpose: Cholangiocarcinoma (CC) is characterized by a still unfavorable prognosis due to a late diagnosis and high recurrence rate. In this retrospective study prognostic factors for long-term survival and an immunohistochemical panel of markers (IHC) for distinction of CC and other primary liver malignancies were analyzed. Materials and Methods: In 208 patients with CC clinical data, tumor characteristics and the primary mode of treatment were analyzed using univariate and multivariate statistics. In 145 cases the immunohistochemical profile of the tumors was established using markers such as CK7, CK20, CA19-9, HepPar-1, AFP, CD34 and CDX2 routinely in comparison to 60 cases of HCC (control group). Significance of marker expression in relation to histological subtype were estimated using SPSS 10.0. Results: Median overall survival (OS) was 18.8±22.5 months. Multivariate analysis identifies subtype of CC / tumor localisation (dCC vs. iCC or pCC), tumor size (P=0.001), grading (P=0.002) and tumor resection (P<0.0001) as independent prognostic factors for survival. CK7, CK20 and CA19-9 were the most commonly overexpressed markers in CC (86.2%, 55.2% and 50%), whereas expression of these markers in HCC was significantly less frequent (24.3%, 0% and 8.3%, respectively; P<0.001 and P<0.0001). Conclusions: Tumor localization and stage, surgical resection and tumor biology as expressed by tumor cell differentiation are the most important factors for OS in CC. Best predictive markers for differentiation between CC and HCC were CK7, CK20 and HepPar-1. Using this panel a fast and accurate differentiation was possible in more than 95% of all analyzed liver tumors.
BACKGROUND: Prognosis of advanced hepatocellular carcinoma (HCC) is still poor. In this retrospective study prognostic factors for long-term survival and an immunohistochemical panel for discrimination of HCC from other liver malignancies were analyzed. MATERIALS AND METHODS: In 181 primary liver tumors clinical data, tumor characteristics and the primary mode of treatment were analyzed using univariate and multivariate statistics. In 156 cases (145 HCC, 36 intrahepatic CCC) the immunohistochemical profile of the tumor tissue using molecular markers as HepPar-1, AFP, CD34, CK7, CK20, CA19-9 and CDX2 was established routinely. Significance of marker expression, sensitivity, specify and positive predictive value of the analyzed markers in relation to histological subtype were estimated using SPSS 10.0. RESULTS: Median overall survival (OS) was 15 ± 19.2 months. Multivariate analysis identified tumour size (p = 0.001), grading (p = 0.002), proliferative activity (Ki67 level; p = 0.032), multifocal tumour (p = 0.045), liver function (Child-Pugh score, p = 0.045) and performed tumour resection (p < 0.0001) as independent prognostic factors for survival. HepPar-1 was the most frequently expressed marker in HCC (positive in 71.8%; p < 0.0001) whereas positive AFP staining was less common (positive in 48.7%; p < 0.0001). The CD34 protein as a marker for vascular-associated tissue showed a positive reaction in 54.1% of tissues from HCC patients in comparison to 2 patients (6%) with cholangiocarcinoma (p < 0.0001). CONCLUSIONS: Our data identified tumor stage, tumor biology and performed surgical therapy as independent prognostic factors for OS in HCC. Best predictive markers for differentiation between HCC and CCC were HepPar-1, CK7 and CA19-9. Using this panel fast and accurate differentiation by IHC was possible in more than 95% of the patients.
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