ABSTRACT
Differentiation-based histologic grading of colorectal carcinoma (CRC) is widely used, but its clinical impact is limited by insufficient prognostic value, interobserver disagreement, and the difficulty of its application to CRC with specific histologic types such as mucinous and medullary carcinoma. A recently proposed novel grading system based on quantifying poorly differentiated clusters (PDCs) claims to have the advantages of reproducibility and improved prognostic value, and might apply to heterogeneous CRC. We aimed to validate the clinicopathologic significance of the PDCs-based grading system and to determine the relationship between this grading system and microsatellite instability (MSI). Two hundred and one patients who had undergone radical surgery were reviewed. Based on the number of PDCs, 85, 58, and 58 tumors were classified as grade (G) 1 (42.3%), G2 (28.9%), and G3 (28.9%), respectively. PDCs-based grade was significantly associated with T, N, and M stages; lymphovascular invasion; conventional histologic grade; and frequent tumor budding (all P <0.001). In multivariate analysis, PDCs-based grade was found to be an independent prognostic factor for disease-free survival (P = 0.022; hazard ratio, 3.709 [G2], 7.461 [G3]). G3 CRC significantly correlated with high MSI (MSI-H) compared to G1 and G2 (P = 0.002; odds ratio, 5.750). In conclusion, this novel grading would provide valuable prognostic information to a greater number of patients and would require continued verification. PDCs-based grading is feasible for CRCs with heterogeneous morphology, and we propose that the association between G3 and MSI-H be further evaluated in different histological subtypes of CRC.
Subject(s)
Female , Humans , Male , Middle Aged , Colorectal Neoplasms/genetics , Disease-Free Survival , Lymphatic Metastasis/pathology , Microsatellite Instability , Neoplasm Grading/methods , Tumor Burden/physiologyABSTRACT
O adenocarcinoma da próstata é a terceira causa mais freqüente de óbito por câncer em pacientes acima de 55 anos de idade e a principal em homens acima de 75 anos. Os fatores considerados prognósticos deste carcinoma são nível de PSA, grau histológico (Gleason), estadiamento, margens cirúrgicas e tamanho do tumor. Contudo, o tamanho do tumor como fator prognóstico de recorrência é controverso na literatura. No presente trabalho estudaram-se as relações entre o PSA pré-operatório, comprometimento de vesículas seminais (pT3b ou superior), o grau histológico, a extensão extra prostática, as margens cirúrgicas com a extensão do tumor, o Gleason 7 (3+4) versus 7 (4+3) e a proliferação celular em 48 espécimes de prostatectomia radical devido a adenocarcinoma da próstata nos serviços de anatomia patológica do Hospital Professor Edgard Santos (Hospital das Clínicas de Salvador - BA), CLlNNAZA@ - Clinica Nazaré e Serviço de Oncologia da Bahia (CICAN), no período entre 2000 e 2003. No nosso estudo houve uma relação estatisticamente significante quando correlacionamos o percentual de comprometimento da glândula por tumor com o nível de PSA pré-operatório, parâmetros histopatológicos e índice de proliferação celular...