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Results for “prognostic stratification”

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PubMed2006

Immunohistochemical profiling based on Bcl-2, CD10 and MUM1 expression improves risk stratification in patients with primary nodal diffuse large B cell lymphoma.

Clinical outcome in patients with diffuse large B cell lymphomas (DLBCL) is poorly predictable. Expression of proteins related to germinal centre B (GCB) cell or activated B cells (ABC) and expression of apoptosis-regulating proteins Bcl-2 and XIAP have been found previously to be strongly associated with clinical outcome. In this study we aimed to develop an algorithm based on expression of GCB/ABC-related proteins CD10, Bcl-6 and MUM1 and apoptosis-inhibiting proteins Bcl-2, XIAP and cFLIP for optimal stratification of DLBCL patients into prognostically favourable and unfavourable groups. Expression of CD10 and cFLIP was associated with better overall survival (both p = 0.03), whereas expression of MUM1, Bcl-2 and XIAP was associated with poor clinical outcome (p = 0.01, p = 0.0007 and p = 0.03, respectively). Multivariate analysis revealed that Bcl-2 was the strongest prognostic marker followed by CD10 and MUM1. Stratification of patients according to a new algorithm based on expression of these three markers improved patient risk stratification into low and particularly high clinical risk groups (p = 0.04 and p < 0.0001, respectively). We conclude that, in our group of primary nodal DLBCLs, a new algorithm, based on expression of the apoptosis-inhibiting protein Bcl-2 and the GCB/ABC-related proteins CD10 and MUM1, strongly predicts outcome in International Prognostic Index (IPI)-low and -high patients. Its predictive power is stronger than previously published algorithms based on only GCB/ABC- or apoptosis-regulating proteins.

Adult↗

PubMed1985

Adaptive allocation in randomized controlled trials.

Adaptive allocation has been proposed as a procedure to reduce the risk of chance imbalance of important prognostic factors in randomized controlled trials when the number of prognostic factors is large. In this article, minimization, a type of adaptive allocation, is compared to simple randomization and stratified allocation in a series of Monte Carlo simulations. Three outcomes are studied: estimated treatment effect, size of the rejection region, and power. Minimization produced an unbiased estimate of treatment effect and increased power when compared to simple randomization. Student's t test was conservative for both minimization and stratified allocation. Minimization and stratification produced similar improvements in power but there was some evidence that minimization might produce higher power than stratification when some prognostic variables cannot be included in the stratified allocation scheme.

Analysis of Variance↗

PubMed1993

Short and long term outcome in a consecutive series of 419 patients with acute dialysis-requiring renal failure.

UNLABELLED: This analysis was done in a consecutive series of 419 patients with potentially reversible acute renal failure (ARF) requiring dialysis treated during the 12 year period January 1977 to December 1988. The aims were to describe the relationship between morbidity, mortality, and the year of admission, to evaluate the effects of various follow-up periods and stratification on main prognostic factors, and to report long term survival. RESULTS: 1) There was a significantly higher (p < 0.001) number of organ failures/patient in the last 6 year period compared with the first 6 year period. 2) Early (day 90) mortality was 46% and did not change significantly during the 12 year period. 3) Etiology, age of the patient, and the severity and the progression of the underlying disease were the most important factors determining outcome. 4) Time of censorship and stratification of the patients influenced prediction models. 5) Estimated 5 year survival rate was 52% (95% confidence limits 44-60%) in patients with a medical etiology, and 28% (95% confidence limits 20-36%) in patients with a surgical etiology. CONCLUSIONS: 1) Prognosis did not change significantly during the 12 year study period, and was almost solely dependent on the severity and progression of the underlying disease process. 2) Changed censoring time and stratification were important tools for enhancing the yield of information from the study. 3) The time(s) and method(s) of risk scoring, stratification(s) of patients, the time(s) of censorship on vital status, and the method for statistical analysis have to be identical if results of treatment for ARF from different centers should be compared.

Acute Kidney Injury↗

PubMed1995

[Short and long term prognosis of acute renal failure requiring dialysis. An analysis of 419 consecutive patients].

To describe the relationship between morbidity, mortality, and year of admission we studied 419 patients with acute dialysis-requiring renal failure. Effects of various follow-up periods and stratification on main prognostic factors were evaluated. There was a significantly higher (p < 0.001) number of organ failures/patient during the second six-year period compared with the first six-year period. Early (day 90) mortality was 46% and unchanged during the period. Estimated five year survival rate (95% confidence limits) was 52% (44-60) in patients with a medical etiology, and 28% (20-36) in patients with a surgical etiology. Prognosis was dependent on the severity and progression of the underlying disease process. Changed censoring time and stratification were important tools for enhancing the yield of information from the study. Time(s) and method(s) of risk scoring, stratification(s) of patients, time(s) of censorship, and method of statistical analysis should be identical when comparing results of treatment for acute renal failure from different centres.

Acute Kidney Injury↗

PubMed1995

Prognostic factors and risk group analysis in follicular carcinoma of the thyroid.

BACKGROUND: The understanding of prognostic factors has facilitated stratification of risk groups in differentiated carcinoma of the thyroid. The prognostic factors have clearly identified the risk groups as low, intermediate, and high risk. Risk group categorization has facilitated a selective surgical approach for thyroid carcinoma. METHODS: A retrospective review of 228 patients with follicular carcinoma of the thyroid was undertaken. Various prognostic factors and risk groups were analyzed. Univariate and multivariate analyses were performed, and the survival curves were plotted by the Kaplan-Meier method. Fifty-nine (26%) patients presented with Hürthle cell histology. The risk groups revealed 62 patients in the low, 84 in the intermediate, and 82 in the high risk groups. RESULTS: The 10-year survival for low, intermediate, and high risk groups was 98%, 88%, and 56%, respectively, and the 20-year survival for the same groups was 97%, 87%, and 49%, respectively. Adverse prognostic factors included age older than 45 years (p < 0.001), Hürthle cell variety (p = 0.05), extrathyroidal extension, tumor size exceeding 4 cm, and the presence or absence of distant metastasis (p < 0.001). Gender, focality, and presence of lymph node metastasis had no significant impact on prognosis. CONCLUSIONS: Patients in the low risk group have excellent survival, whereas the high risk group behaves poorly. Appropriate selection of treatment for the primary disease and adjuvant therapy should be considered on the basis of the prognostic factors and risk group analysis.

Adenocarcinoma, Follicular↗

PubMed1989

Ewing's sarcoma. A retrospective study of histological and immunohistochemical factors and their relation to prognosis.

Histological and immunohistochemical features of 87 patients with conventionally diagnosed Ewing's sarcoma were studied retrospectively on routinely processed material and evaluated with regard to prognostic significance. 74% were convincingly positive when stained for vimentin, 13% were doubtful, and 13% were negative. A varying degree of positivity for neuron-specific enolase (NSE) was found in 15%; these cases all co-expressed vimentin. A single tumour contained scattered cytokeratin-positive cells. Positivity for the leukocyte common antigen (LCA) could be demonstrated in three cases; these were excluded from the statistical analysis of prognostic factors. Growth pattern, soft tissue invasion, monomorphic or dimorphic cell population, and PAS-, NSE- or vimentin-positivity did not influence survival significantly. However, prognosis was increasingly poor with increasing degree of necrosis: median survival was 28 months for grade I necrosis (less than 10%), 16 months for grade II (10-50%), and 11 months for grade III (greater than 50%), p less than 0.0005. A mitosis count of less than 1 per high-powerfield (HPF) was correlated to a median survival of 26 months, greater than or equal to 1 per HPF to 12 months, p less than 0.05. The findings indicate some degree of heterogeneity in Ewing's sarcoma which may be related to primitive peripheral neuroectodermal tumours (PNETs), or be a true blastoma. In future trials, diagnostic criteria (including immunohistochemistry) should be clearly defined and materials should be large enough to allow for stratification according to prognostic factors.

Adolescent↗

PubMed2002

Acute lymphoblastic leukemia.

This is a comprehensive overview on the most recent developments in diagnosis and treatment of acute lymphoblastic leukemia (ALL). Dr. Dieter Hoelzer and colleagues give an overview of current chemotherapy approaches, prognostic factors, risk stratification, and new treatment options such as tyrosine kinase inhibitors and monoclonal antibodies. Furthermore the role of minimal residual disease (MRD) for individual treatment decisions in prospective clinical studies in adult ALL is reviewed. Drs. Ching-Hon Pui and Mary Relling discuss late treatment sequelae in childhood ALL. The relation between the risk of second cancer and treatment schedule, pharmacogenetics, and gene expression profile studies is described. Also pathogenesis, risk factors, and management of other complications such as endocrinopathy, bone demineralization, obesity, and avascular necrosis of bone is reviewed. Dr. Fred Appelbaum addresses long-term results, late sequelae and quality of life in ALL patients after stem cell transplantation. New options for reduction of relapse risk, e.g., by intensified conditioning regimens or donor lymphocyte infusions, for reduction of mortality and new approaches such as nonmyeloablative transplantation in ALL are discussed. Drs. Jacques van Dongen and Tomasz Szczepanski demonstrate the prognostic value of MRD detection via flow cytometry or PCR analysis in childhood ALL. They discuss the relation between MRD results and type of treatment protocol, timing of the follow-up samples, and the applied technique and underline the importance of standardization and quality control. They also review MRD-based risk group definition and clinical consequences.

Adult↗

PubMed2005

[News in therapeutic management of chronic lymphoid leukemia].

Chronic lymphocytic leukemia follows an extremely variable clinical course with survival range from months to decades. Some patients present minimal symptoms and others organomegaly requiring rapidly therapy. Therapeutic options take into account efficacy, toxicity and prognostic factors. One of the well known prognosis factor is the clinical staging developed either by Rai et al. or by Binet et al. However, there is an important heterogeneity concerning the course of the disease among patients within a single stage group. Recently, several important observations related to the biologic significance of VH gene mutational status, expression of CD38, over-expression of ZAP-70 and chromosomal aberrations have led to the ability to identify high risk patients with rapid disease progression and lower survival. It has been demonstrated that the VH mutation status is clinically highly relevant. CLL patients with unmutated VH gene show an unfavourable course with a very rapid progression. Specific genomic aberrations have been associated with disease characteristics such as lymphadenopathy related to 11q deletion and resistance to treatment related to 17p deletion. VH gene mutation status and genomic aberrations appear separate parameters when considering their prognostic relevance but nevertheless they are correlated: unfavourable aberrations (11q- and 17p-) occur more frequently in VH unmutated CLL patients. According to these prognostic factors, several treatments including purine analogues and/or monoclonal antibodies have been tested with different schedules and doses of monoclonal antibodies (rituximab and alemtuzumab) considering safety to determine the better efficacy. Infections and haemolytic anemia remain the most frequent complications during conventional chemotherapy. In autologous transplant setting, the transplant related mortality is less than 10%, but survival curve do not show a plateau with about 50% of patients relapsing at 4 years. Conventional allogeneic transplantation could achieve durable remission and probably cure the disease but at the price of a too high transplant related mortality related to depressive immune status and old age of CLL population. In order to minimize the toxicity and to improve graft-versus-leukemia effect, development of reduced intensity conditioning (RIC) regimens appear particularly important for CLL patients. Recent studies, although a still short follow-up show very promising results and use of monoclonal antibodies in the conditioning or just after transplant could improve the results of allogeneic stem cell transplantation and cure a larger number of CLL patients. Recent advances to categorize CLL patients according to risk stratification regarding new prognostic factors (FISH, CD38, ZAP70, Ig mutational status) should allow to define better the best therapeutic strategy. In parallel, age, co morbidities and the notion of the risk-adapted strategy have also an important impact adding.

Age Factors↗

PubMed2007

Therapy-related myelodysplastic syndrome: morphologic subclassification may not be clinically relevant.

In practice, cases of therapy-related myelodysplastic syndrome (t-MDS) are often classified according to morphologic schemes used for de novo MDS. However, there are few data addressing the appropriateness of such classification. We studied 155 patients with therapy-related acute myeloid leukemia (t-AML)/t-MDS to determine whether subclassification by the World Health Organization (WHO) criteria for de novo MDS provides prognostic information in t-MDS. In addition, we assessed whether cytogenetic stratification by the International Prognostic Scoring System (IPSS) guidelines or karyotypic complexity was prognostically important. We found no differences in median survival times among patients classified into the different WHO subgroup of MDS or according to their bone marrow blast percentage; our results indicate a uniformly poor outcome in t-MDS regardless of morphologic classification. However, significant survival differences correlated with cytogenetic stratification according to IPSS guidelines and/or karyotypic complexity. We found only a borderline difference in median survival of patients with an initial t-MDS diagnosis compared with patients with an initial t-AML diagnosis.

Acute Disease↗

PubMed1999

Valve orifice area alone is an insufficient index of aortic stenosis severity: effects of the proximal and distal geometry on transaortic energy loss.

BACKGROUND AND AIMS OF THE STUDY: Standard measures of hemodynamic severity of aortic valve stenosis vary widely among patients with and without clinical symptoms. Our hypothesis is that valve orifice area alone is not the sole determinant of adverse clinical outcome. Stenotic orifice area ratio is ratio of the cross-sectional stenotic orifice area to the down-stream, ascending aorta cross-sectional area. Determination of workload together with aortic valve orifice area ratio might improve risk stratification among asymptomatic patients with critical aortic stenosis. Accordingly, application of both parameters together might be useful in guiding management decisions in this condition. METHODS: In this study the dependency of transaortic fluid mechanical energy transfer (one component of left ventricular workload) on aortic valve orifice area is shown using modeling and experimental techniques. RESULTS: For a stroke volume of 62 ml at a heart rate of 60 beats/min, the piston work (analogous to left ventricular work) increased by 17% as the stenotic orifice area ratio decreased from 0.60 to 0.25, by 35% as the ratio fell from 0.25 to 0.20, and by 73% as the ratio fell from 0.20 to 0.10. CONCLUSIONS: As predicted by the fundamental fluid mechanical theory, simulated left ventricular work and energy loss in aortic stenosis are influenced not only by the effective stenotic valve orifice area, but also by the geometry of the inflow and outflow conduits, proximal and distal to the valve. These findings might explain clinically observed discrepancies between valve orifice area and the onset of the classical symptoms of severe aortic stenosis that reflect the left ventricular workload. Consideration of the left ventricular work in addition to the effective valve orifice area should enhance clinical evaluation, prognostication and risk stratification among patients with severe aortic stenosis.

Aorta↗

PubMed2006

Corrected QT variability in serial electrocardiograms in long QT syndrome: the importance of the maximum corrected QT for risk stratification.

OBJECTIVES: We evaluated the incremental prognostic information provided by multiple corrected QT (QTc) measurements on serial electrocardiograms (ECGs) in patients with the inherited long QT syndrome (LQTS). BACKGROUND: A baseline QTc of > or =500 ms has been shown to be associated with increased risk of cardiac events among LQTS patients. However, the value of QTc measurements on follow-up ECGs in risk assessment has not been determined. METHODS: The risk of a first LQTS-related cardiac event during adolescence was assessed in 375 patients enrolled in the International LQTS Registry for whom serial follow-up ECGs were recorded before age 10. RESULTS: The mean +/- SD difference between the minimum and maximum QTc values on serial ECGs recorded in study patients was 47 +/- 40 ms. The maximum QTc interval recorded before age 10 was the strongest predictor of cardiac events during adolescence (adjusted hazard ratio [HR] = 2.74; p < 0.001). Other follow-up QTc measures, including the baseline, the mean, and the most recent QTc interval recorded before age 10, were less significant risk factors. After adjusting for the maximum QTc value during follow-up, no significant association remained between the baseline QTc value and the risk of subsequent cardiac events (HR = 1.04; p = 0.91). CONCLUSIONS: In LQTS patients, there is a considerable variability in QTc measures in serial follow-up ECGs. The maximum QTc interval provides incremental prognostic information beyond the baseline measurement. We suggest that risk stratification in LQTS patients should include follow-up ECG data.

Adolescent↗

PubMed1997

Comparison of patient characteristics and outcome between a single-institution phase II trial and a cooperative-group phase II trial with identical eligibility in metastatic melanoma.

Differences in overall survival and response rates are often noted when promising single-institution phase II treatment regimens are evaluated in a cooperative group setting. One reason for this discrepancy may be the differences in patient characteristics at the time of registration. In the metastatic melanoma literature, the prognostic factors for survival that are most frequently identified are the number of metastatic sites, visceral involvement, performance status, liver involvement, and possibly the disease-free interval and gender. A prognostic factor for response appears to be sites of involvement. A comparison of patient characteristics and outcome was conducted for patients entered in similar phase II melanoma trials at a single institution versus those in a cooperative group. Sixty-four patients at Wayne State University (WSU) were compared with 96 patients who had nearly identical eligibility criteria and were registered in the Southwest Oncology Group (SWOG). All patients were receiving comparable phase II treatments for metastatic melanoma. Southwest Oncology Group patients were significantly older (p < 0.001), had worse performance status (p = 0.03), had more visceral involvement (p = 0.001), and were more likely to have two or more metastatic sites (p = 0.02). No significant differences in gender (p = 0.55), absence or presence of liver involvement (p = 0.12), or disease-free interval were noted. These disparities, despite similar eligibility, may partly explain the observed differences in survival (WSU median = 10 months, SWOG median = 7 months; p = 0.13) and response rates (WSU = 31%, SWOG = 15%; p = 0.02) between the two groups of patients. Investigators should report these important patient characteristics in treatment reports. These differences highlight the difficulty in comparing single-institution and cooperative-group phase II trials, even with comparable patient eligibility. This serves to emphasize the need for well-designed phase III trials when comparing treatment approaches and stratification for the prognostic factors identified.

Adult↗

PubMed1998

Philadelphia chromosome-positive (Ph+) childhood acute lymphoblastic leukemia: good initial steroid response allows early prediction of a favorable treatment outcome.

Among 4,760 acute lymphoblastic leukemia (ALL) patients enrolled from 1986 to 1995 in two subsequent trials of the BFM and AIEOP study group, 61 patients were found to have Philadelphia chromosome-positive (Ph+) ALL. These patients were analyzed for presenting features and treatment outcome to identify specific prognostic factors. Treatment stratification was based on initial cell mass and early response as determined by blast count in peripheral blood after a 7-day induction prephase with prednisone and one dose of intrathecal methotrexate on day 1. All patients were treated by similar intensive Berlin-Frankfurt-Münster (BFM) protocols. The median age of Ph+ patients was 7.5 years, the median white blood cell count (WBC) was 75 x 10(9)/L, 77% of patients had common ALL, and 29% coexpressed myeloid markers. After a median observation time of 4.2 years, 29 of 61 patients are alive (survival probability [pSUR] at 4 years, 0.49; standard error [SE], 0.06), and 24 of 61 are in first complete remission (CR1; probability of event-free survival [pEFS] at 4 years, 0.38; SE, 0.06). Twenty (35%) of 57 evaluable patients had >/=1,000 leukemic blasts per microliter of blood on day 8 of induction (defined as prednisone-poor-response [PPR]). These patients were older (10.0 v 6.88 years; P = .02) and had a higher WBC (144 v 29 x 10(9)/L; P = .0016) as compared with patients with prednisone good response (PGR; <1,000 blasts/microL at day 8). Only 2 of 20 patients (10%) with PPR remained in CR1 and alive: 6 patients with PPR did not survive after allogeneic bone marrow transplantation (BMT) due to recurring disease (n = 3) and toxicity (n = 3), and 12 nontransplanted patients died due to progression (n = 5) or relapse (n = 7). In contrast, 26 (70%) of the 37 patients with PGR are alive. Of 18 patients transplanted by allo-BMT, 1 relapsed (now in CR2) and 4 died after BMT. Among the 19 patients with PGR treated by chemotherapy alone, 8 remained in CR1 and 11 relapsed, of which 4 are in CR2 or CR3. The prednisone response emerged as the only independent prognostic factor for survival in Cox regression analysis. Thus, two thirds of Ph+ childhood ALL cases can be identified early by PGR, which, when treated with intensive BFM chemotherapy, with or without BMT, have a significantly lower risk of treatment failure. With a median continuous complete remission (CCR) time of 4.1 years, pEFS for PGR is 0.55 (SE, 0.08) compared with 0.10 (SE, 0.07) in patients with PPR (P = .0001). PGR is also an indicator for treatment responsiveness and durable second remission after relapse, which in turn may provide a second chance for BMT.

Adolescent↗

PubMed1998

Patterns of failure in differentiated carcinoma of the thyroid based on risk groups.

BACKGROUND: Risk-group stratification based on prognostic factors is well established in differentiated carcinoma of the thyroid gland. Patients in the low-risk group have an excellent prognosis, whereas there is significant mortality associated with the high-risk group. The purpose of this paper is to analyze the patterns of treatment failure in the various (local, regional, distant, and associated mortality) risk groups. METHODS: In a retrospective review of a consecutive series of 1038 previously untreated patients with differentiated carcinoma of the thyroid during a period of 55 years, various prognostic factors and risk groups were analyzed. Significant prognostic factors were patient's age, presence of distant metastasis, extrathyroid extension, size, and grade of the tumor. Based on these factors, patients were divided into low- (39%), intermediate- (39%), and high- (22%) risk groups. RESULTS: The overall treatment-failure rates in the low-, intermediate-, and high-risk groups were 13%, 26%, and 50%, respectively, whereas the mortality rates in the same groups were 1%, 10%, and 33%, respectively. CONCLUSIONS: The overall incidence of recurrence rate in the low-risk group is only 13%, compared with 50% in the high-risk group. The incidence of distant metastasis in the low-risk group is only 2%, compared with 34% in the high-risk group. The understanding of the patterns of treatment failure in different risk groups reaffirms the need to direct treatment strategies based on individual risk groups and intraoperative findings.

Adult↗

PubMed2004

Salvage surgical resection after high-dose ifosfamide (HDIF) based regimens in advanced soft tissue sarcoma (ASTS): a potential positive selection bias--a study of the Spanish group for research on sarcomas (GEIS).

PURPOSE: To assess the impact of different factors on response rate (RR), time to tumor progression (TTP), and overall survival time (OS) in patients with locally advanced or metastatic soft tissue sarcoma (ASTS), included in three protocols with high-dose ifosfamide (HDIF). PATIENTS AND METHODS: One hundred fifty six ASTS patients included in three consecutive phase II trials with HDIF (>10 g/m(2)), alone or in combination with doxorubicin (DX), were analyzed. Cofactors were institution, trial, gender, age, performance status, histologic type, grade of malignancy, prior radiotherapy, presence of locoregional disease, metastatic site, salvage surgery, number of organs involved, and disease-free interval. RESULTS: By multivariate analysis performance status >0 and lack of salvage surgery correlated with a poorer survival. A good-risk and a poor-risk group were identified, with median survival time (OS) of 29, 5, and 10 months, respectively (P = 0.00001). The 1-, 2-, and 3-year OS for 83 good-risk patients (either with PS = 0 or receiving salvage surgery) was 83, 44, and 29%, respectively, those figures being 37, 7, and 3% for 73 poor-risk patients. CONCLUSION: The design of randomized trials in ASTS including HDIF should consider those prognostic factors as stratification variables.

Adult↗

PubMed2004

[Diagnostic imaging of pulmonary lymphangiosis carcinomatosis].

The diagnosis of pulmonary lymphangiosis carcinomatosa (PLC) is of great importance for the prognostically-oriented therapy stratification of tumor patients. In this field, high-resolution computed tomography (HRCT) is the state of the art in imaging. Using HRCT, it is possible to identify pulmonary parenchymal structures in a detailed fashion to evaluate interstitial patterns. This step is preceded by an x-ray of the thorax that detects pathological findings and rules out other diseases. The typical characteristics of PLC are described with particular attention to HR-phenomenology, and discussed in comparison with the literature regarding anatomy and pathogenesis. Finally, conclusions are drawn for differential diagnosis and supported by characteristic cases.

Carcinoma↗

PubMed2026

Gastric carcinoma classification in the WHO 6th edition (2026): Updated framework and emerging entities.

The sixth edition of the WHO Classification of Digestive System Tumours (2026) represents an important step in the continuing evolution of gastric carcinoma classification. While preserving morphology as the foundation of diagnosis, it incorporates advances in molecular pathology, genotype-phenotype correlations, tumour evolution, and predictive biomarker assessment. This review summarizes the development of the WHO classification from the third edition (2000) to the sixth edition (2026) and highlights its relationship with other major classification systems, including those of Laurén, Nakamura, and the Japanese Gastric Carcinoma Association (JGCA). Major histological categories remain largely unchanged; however, several important conceptual and diagnostic refinements have been introduced. These include recognition of crawling-type adenocarcinoma as a distinctive variant of tubular adenocarcinoma, subclassification of poorly cohesive carcinoma into signet-ring cell and non-signet-ring cell subtypes, introduction of the concept of pure signet-ring cell carcinoma, and increased emphasis on tumour evolution. The sixth edition also expands and refines the spectrum of uncommon gastric carcinoma subtypes, including gastric carcinoma with lymphoid stroma, AFP-producing carcinoma, micropapillary adenocarcinoma, gastric adenocarcinoma of fundic-gland type, and gastric sarcomatoid carcinoma. Crucially, molecular subgroups originally proposed by The Cancer Genome Atlas (TCGA) and actionable biomarkers-including HER2 (ERBB2), Claudin 18.2, mismatch repair deficiency/microsatellite instability (dMMR/MSI), and programmed death-ligand 1 (PD-L1)-have transitioned from research-based categories into essential tools for precision oncology. Rather than providing exhaustive diagnostic criteria, this review offers a conceptual framework and encourages consultation of the original WHO text for full details. These advances illustrate the transition of gastric carcinoma classification from a predominantly morphology-based system toward an integrated histomolecular framework that more closely links pathological diagnosis with tumour biology, prognostication, and therapeutic stratification.

Crawling-type adenocarcinoma↗

PubMed2006

Significance of histologic type of primary lesion and metastatic lymph nodes as a prognostic factor in stage III colon cancer.

PURPOSE: This study was designed to investigate whether the histologic types of the primary lesion and of metastatic lymph nodes in Stage III colon cancer are useful as prognostic factors. The usefulness of adjuvant chemotherapy in a randomized, controlled trial by using these prognostic factors as stratification criteria was also investigated. METHODS: Stage III colon cancer patients were enrolled and were divided into two groups: Group W, in which the histologic type of both primary tumors and metastatic lymph nodes was well-differentiated adenocarcinoma; and Group U, in which the primary tumors and the metastatic lymph nodes were of any type other than well-differentiated. Group W patients were assigned to Treatment Arm A (surgery alone) or Arm B (surgery, then 1-hexylcarbamoyl-5-fluorouracil); and Group U patients, to Treatment Arm C (same as B), and Arm D (surgery + 1-hexylcarbamoyl-5-fluorouracil + mitomycin C). RESULTS: The Group W five-year survival rate was significantly superior to that in Group U (P = 0.0035). There was a better survival rate in Treatment Arm A than Arm B (P = 0.0321), but no difference between Treatment Arms C and D. CONCLUSIONS: In Stage III colon cancer, the prognosis of cases whose primary lesion and lymph node tissues are both well differentiated is extremely good. In such cases, it is possible for adjuvant chemotherapy to have a deleterious effect, and therefore, it is not recommended.

Adenocarcinoma↗