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Tumour necrosis is a postoperative prognostic marker for pancreatic cancer patients with a high interobserver reproducibility in histological evaluation.

Hiraoka N, Ino Y, Sekine S, Tsuda H, Shimada K, Kosuge T, Zavada J, Yoshida M, Yamada K, Koyama T, Kanai Y - Br. J. Cancer (2010)

Bottom Line: Tumour necrosis reflects the presence of hypoxia, which can be indicative of an aggressive tumour phenotype.The reproducibility of identifying histological parameters was tested by asking five independent observers to blindly review 51 examples of PDC.In addition, metastatic status, and lymphatic, venous, and intrapancreatic neural invasion were independent prognostic factors for shorter DFS and metastatic status, margin status, lymphatic invasion, and intrapancreatic neural invasion were independent prognostic factors for DSS.

View Article: PubMed Central - PubMed

Affiliation: Pathology Division, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. nhiraoka@ncc.go.jp

ABSTRACT

Background: Tumour necrosis reflects the presence of hypoxia, which can be indicative of an aggressive tumour phenotype. The aim of this study was to investigate whether histological necrosis is a useful predictor of outcome in patients with pancreatic ductal carcinoma (PDC).

Methods: We reviewed histopathological findings in 348 cases of PDC in comparison with clinicopathological information. We counted small necrotic foci (micronecrosis) as necrosis, in addition to massive necrosis that had been only defined as necrosis in previous studies. The reproducibility of identifying histological parameters was tested by asking five independent observers to blindly review 51 examples of PDC.

Results: Both micronecrosis and massive necrosis corresponded to hypoxic foci expressing carbonic anhydrase IX detected by immunohistochemistry. Multivariate survival analysis showed that histological necrosis was an independent predictor of poor outcome in terms of both disease-free survival (DFS) and disease-specific survival (DSS) of PDC patients. In addition, metastatic status, and lymphatic, venous, and intrapancreatic neural invasion were independent prognostic factors for shorter DFS and metastatic status, margin status, lymphatic invasion, and intrapancreatic neural invasion were independent prognostic factors for DSS. The interobserver reproducibility of necrosis identification among the five independent observers was 'almost perfect' (κ-value of 0.87).

Conclusion: Histological necrosis is a simple, accurate, and reproducible predictor of postoperative outcome in PDC patients.

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Related in: MedlinePlus

Kaplan–Meier survival curves showing a comparison of disease-free survival between cases in which histological necrosis was present and absent (P-values obtained by log-rank test) (left columns). Kaplan–Meier survival curves showing a comparison of disease-specific survival between cases, in which histological necrosis was present and absent (P-values obtained by log-rank test) (right columns).
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fig4: Kaplan–Meier survival curves showing a comparison of disease-free survival between cases in which histological necrosis was present and absent (P-values obtained by log-rank test) (left columns). Kaplan–Meier survival curves showing a comparison of disease-specific survival between cases, in which histological necrosis was present and absent (P-values obtained by log-rank test) (right columns).

Mentions: Survival analysis demonstrated an association between the presence of necrosis and shorter DFS (P<0.0001; HR=2.007; 95% CI: 1.531–2.630) and DSS (P<0.0001; HR=2.196; 95% CI: 1.659–2.905) (Figure 4). A similar association was found in patients with PDC at each TNM stages (Figure 4).


Tumour necrosis is a postoperative prognostic marker for pancreatic cancer patients with a high interobserver reproducibility in histological evaluation.

Hiraoka N, Ino Y, Sekine S, Tsuda H, Shimada K, Kosuge T, Zavada J, Yoshida M, Yamada K, Koyama T, Kanai Y - Br. J. Cancer (2010)

Kaplan–Meier survival curves showing a comparison of disease-free survival between cases in which histological necrosis was present and absent (P-values obtained by log-rank test) (left columns). Kaplan–Meier survival curves showing a comparison of disease-specific survival between cases, in which histological necrosis was present and absent (P-values obtained by log-rank test) (right columns).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2965866&req=5

fig4: Kaplan–Meier survival curves showing a comparison of disease-free survival between cases in which histological necrosis was present and absent (P-values obtained by log-rank test) (left columns). Kaplan–Meier survival curves showing a comparison of disease-specific survival between cases, in which histological necrosis was present and absent (P-values obtained by log-rank test) (right columns).
Mentions: Survival analysis demonstrated an association between the presence of necrosis and shorter DFS (P<0.0001; HR=2.007; 95% CI: 1.531–2.630) and DSS (P<0.0001; HR=2.196; 95% CI: 1.659–2.905) (Figure 4). A similar association was found in patients with PDC at each TNM stages (Figure 4).

Bottom Line: Tumour necrosis reflects the presence of hypoxia, which can be indicative of an aggressive tumour phenotype.The reproducibility of identifying histological parameters was tested by asking five independent observers to blindly review 51 examples of PDC.In addition, metastatic status, and lymphatic, venous, and intrapancreatic neural invasion were independent prognostic factors for shorter DFS and metastatic status, margin status, lymphatic invasion, and intrapancreatic neural invasion were independent prognostic factors for DSS.

View Article: PubMed Central - PubMed

Affiliation: Pathology Division, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. nhiraoka@ncc.go.jp

ABSTRACT

Background: Tumour necrosis reflects the presence of hypoxia, which can be indicative of an aggressive tumour phenotype. The aim of this study was to investigate whether histological necrosis is a useful predictor of outcome in patients with pancreatic ductal carcinoma (PDC).

Methods: We reviewed histopathological findings in 348 cases of PDC in comparison with clinicopathological information. We counted small necrotic foci (micronecrosis) as necrosis, in addition to massive necrosis that had been only defined as necrosis in previous studies. The reproducibility of identifying histological parameters was tested by asking five independent observers to blindly review 51 examples of PDC.

Results: Both micronecrosis and massive necrosis corresponded to hypoxic foci expressing carbonic anhydrase IX detected by immunohistochemistry. Multivariate survival analysis showed that histological necrosis was an independent predictor of poor outcome in terms of both disease-free survival (DFS) and disease-specific survival (DSS) of PDC patients. In addition, metastatic status, and lymphatic, venous, and intrapancreatic neural invasion were independent prognostic factors for shorter DFS and metastatic status, margin status, lymphatic invasion, and intrapancreatic neural invasion were independent prognostic factors for DSS. The interobserver reproducibility of necrosis identification among the five independent observers was 'almost perfect' (κ-value of 0.87).

Conclusion: Histological necrosis is a simple, accurate, and reproducible predictor of postoperative outcome in PDC patients.

Show MeSH
Related in: MedlinePlus