Impact of Microscopic Extranodal Tumor Deposits on the Outcome of Patients With Rectal Cancer

Prabhudesai, Ashish; Arif, Syeda Faiza; Finlayson, Caroline; Kumar, Devinder

doi:10.1007/s10350-004-6809-5

Cited by 62 publications

(52 citation statements)

References 16 publications

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“…The CRM status, i.e., positive or negative, has repeatedly been demonstrated to be the best predictor for local recurrence and disease-free survival (DFS) after preoperative RCT and surgery, and one would expect that a considerable decrease in tumor burden would be associated with a larger CRM [16][17][18]. Although the association of TD with unfavorable prognosis has been confirmed in many colorectal cancer studies, none of them looked at the prognostic value of TD after preoperative RCT [19][20][21][22][23]. Nagtegaal and Quirke [24] and Quirke et al [25] regarded the presence of residual "microfoci" or tumor deposits as a good response to preoperative RCT; they speculated that the presence of TDs in this setting might have resulted from fragmentation of the advanced primary tumor (cT≥3), creating separate tumor nodules of various sizes and shapes in the mesorectum.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of tumor shrinkage versus fragmentation following radiochemotherapy and surgery for rectal cancer

et al. 2015

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Most patients with rectal cancer receive neoadjuvant radiochemotherapy (RCT), causing a variable decrease in tumor mass. We evaluated the prognostic impact of pathologic parameters reflecting tumor response to RCT, either directly or indirectly. Seventy-six rectal cancer patients receiving neoadjuvant RCT between 2006 and 2009 were included. We studied the association between disease-free survival (DFS) and the "classical" clinicopathologic features as well as tumor deposits, circumferential resection margin (CRM), Dworak regression grade, and tumor and nodal downstaging. Patients with tumor downstaging had a longer DFS (p = 0.05), indicating a more favorable prognosis when regression was accompanied by a decrease in tumor infiltrative depth, referred to as tumor shrinkage. Moreover, tumor downstaging was significantly associated with larger CRM and nodal downstaging (p = 0.02), suggesting that shrinkage of the primary tumor was associated with a decreased nodal tumor load. Higher Dworak grade did not correlate with tumor downstaging, nor with higher CRM or prolonged DFS. This implies that tumor mass decrease was sometimes due to fragmentation rather than shrinkage of the primary tumor. Lastly, the presence of tumor deposits was clearly associated with reduced DFS (p = 0.01). Assessment of tumor shrinkage after RCT via tumor downstaging and CRM is a good way of predicting DFS in rectal cancer, and shrinkage of the primary tumor is associated with a decreased nodal tumor load. Assessing regression based on the amount of tumor in relation to stromal fibrosis does not accurately discern tumor fragmentation from tumor shrinkage, which is most likely the reason why Dworak grade had less prognostic relevance.

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Section: Introductionmentioning

confidence: 99%

Prognostic value of tumor shrinkage versus fragmentation following radiochemotherapy and surgery for rectal cancer

et al. 2015

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“…11 However, it has been suggested that those nodules often are not derived from destroyed metastatic nodes but are intravascular, perivascular, or perineural extensions of the primary tumor, and represent a feature of poor prognosis, independently of their number and size. 25,50,51 Thus, the sixth edition of the UICC/AJCC staging guidelines classified those nodules into two entities: a nodule with a smooth contour is classified in the pN category as a regional lymph node metastasis, whereas a nodule with an irregular contour is classified in the T category coded as V1 or V2 for venous invasion. 5,6 In the present study, the authors identified tumor nodules without histologic evidence of residual node in 17 cases (11 percent) from Stage III patients.…”

Section: Discussionmentioning

confidence: 99%

Tumor Invasion of Lymph Node Capsules in Patients with Dukes C Colorectal Adenocarcinoma

Yano¹,

Saitō²,

Kirihara³

et al. 2006

Diseases of the Colon &Amp; Rectum

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“…Some TDs may be lymph node metastases, in which the pre-existing node is no longer recognizable. Strong correlations have been demonstrated between the presence or number of TDs and intramural vascular invasion, extramural vascular invasion, perineural invasion, lymphatic invasion and lymph node metastases (11). Ueno et al demonstrated that the incidence of TDs is higher in cases with extracapsular growth of lymph node metastases, compared with cases with lymph node metastases with an intact capsule (12).…”

Section: Discussionmentioning

confidence: 99%

Kolorektal Kanserlerde Perikolonik Tümör Depozitlerinin Sıklığı

Ali̇moğlu¹,

Eren²,

Tolan³

et al. 2016

Anadolu Kliniği Tıp Bilimleri Dergisi

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Güncel olarak, hastalar arasında prognostik farklılıkları değerlendirmek için Amerikan Kanser Ortak Komitesi (American Joint Committee on Cancer-AJCC) tarafından geliştirilen Tümör-Nodül-Metastaz (TNM) Evreleme Sistemi kullanılmaktadır. Amacımız kolorektal kanser nedeniyle ameliyat olan hastalarda perikolonik tümör depozitlerinin görülme sıklığını değerlendirmek ve tümör evreleri ile ilişkisini göstermektir. Gereç ve Yöntemler: Kolorektal kanser için cerrahi rezeksiyon yapılan toplam 190 hastanın patolojik bulguları retrospektif olarak değerlendirildi. Evreleme, Amerikan Kanser Ortak Komitesi kanser evreleme kılavuzunun yedinci edisyonuna uygun olarak gerçekleştirildi. Bulgular: 190 kolorektal kanserli hastanın 30'unda (%15,8) perikolonik tümör depoziti saptandı. Patoloji sonuçlarına göre hastaların %66,6'sı T3, %46,6'sı ise N1c evresinde idi. Ayrıca %56,6 olgu Evre IIIB olarak rapor edildi. Tartışma ve Sonuç: Lenf nodu tutulumunun diğer kanıtları yok ise perikolonik tümör depozitlerinin varlığı hastalığın Evre II'den Evre III'e yeniden sınıflandırılmasını sağlar. Evre III'teki hastalarda adjuvan tedavi gerekmesi nedeniyle tümör depozitlerinin varlığından dolayı ortaya çıkan üst evreye kayma önemlidir.

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Impact of Microscopic Extranodal Tumor Deposits on the Outcome of Patients With Rectal Cancer

Cited by 62 publications

References 16 publications

Prognostic value of tumor shrinkage versus fragmentation following radiochemotherapy and surgery for rectal cancer

Prognostic value of tumor shrinkage versus fragmentation following radiochemotherapy and surgery for rectal cancer

Tumor Invasion of Lymph Node Capsules in Patients with Dukes C Colorectal Adenocarcinoma

Kolorektal Kanserlerde Perikolonik Tümör Depozitlerinin Sıklığı

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