A study of morphological prognostic factors in colorectal cancer and survival analysis

Context: Globally, colorectal cancer (CRC) is one of the leading causes of cancer death. Many Asian countries experience an increasing incidence of CRC due to changes in diet and lifestyle. Many pathological prognostic factors other than the tumor-node-metastasis (TNM) staging reflect the biological behavior of tumor tissue and influence the treatment and survival. Aims: The aim is to evaluate: (1) Various morphological prognostic factors of colorectal cancer, (2) the correlation of the prognostic factors with survival, and (3) the prognostic factors with independent prognostic significance. Settings and Design: Descriptive study conducted in a tertiary care center in Kerala. Materials and Methods: Five hundred and eighty-seven resected specimens of CRC received from January 1, 2007 to October 31, 2012 were studied for various morphological prognostic factors. Overall survival and disease-free survival were obtained by Kaplan Meier survival analysis. Cox regression analysis was performed to identify the predictors of survival. Results: CRC incidence was higher in the age group 40–60 years and males were dominant. Rectum was the common site with bleeding per rectum as a common symptom. Predominant tumors had ulcerative gross configuration, size ?5 cm and were free of transverse, radial margin involvement. Majority of tumors were well-differentiated adenocarcinoma with invasion beyond muscularis propria, without vascular, perineural invasion, and lymph node involvement and were in Stage II. The overall and disease-free 3-year survival rates were 89.1% and 88%, respectively. Among the eight significant factors in univariate analysis, tumor histology, depth of invasion, and perineural invasion were found to have independent prognostic significance in multivariate analysis. Conclusions: In addition to the TNM staging, other morphological prognostic factors should be given importance, while considering the patients for adjuvant therapy to improve the survival rates in CRC.

Magnetic resonance evaluation of intra dural spinal tumors with histopathology correlation.

Background: Tumors of the spinal cord or canal constitute approximately 15% to 20% of central nervous system tumors. The differential diagnosis of spinal neoplasms is primarily based on location of the lesion relative to the spinal cord and the age, sex and clinical presentation. The aim and objective of the study was to determine the sensitivity of magnetic resonance imaging (MRI) in diagnosing intra spinal tumors and to correlate findings on MRI with histopathological diagnosis. Methods: This is a retrospective study. The study group included all the patients who presented to our hospital with progressive sensory or motor deficits, para or quadriperesis with or without bladder/bowel Involvement. Only patients with Intra dural lesions such as intradural extra medullary and Intra medullary lesions were included in the study. All the extra dural lesion cases such as vertebral tumors, degenerative/osteoporotic compressions and Trauma related cord compressions were excluded from the study. Results: Of the forty intradural tumors, 28 were extramedullary and 12 were intramedullary. Most of the tumors were located in the cervical and the dorsolumbar spine accounting for more than 50%. The most common tumor encountered in our study was schwannoma (22/40), followed by ependymoma (7/40), meningioma (4/40), astrocytoma (4/40), one each of Hemangioblastoma, Neuroentericcyst and Dermoid cyst. Ependymomas, Astrocytomas and hemangioblastoma were intramedullary lesions and the remaining lesions constituted Intra Dural extra medullary lesions. Conclusions: MRI was found to be a highly sensitive imaging procedure and the method of choice for intradural tumor evaluation and to differentiate extra medullary from Intra medullary lesions. It is not sensitive enough to differentiate the Intra medullary tumors. Nevertheless, definite diagnosis could be made by histopathology only.

Prognosis of early mucinous gastric carcinoma

PURPOSE: Little is known about the clinicopathological features of early mucinous gastric carcinoma (MGC). The purpose of this study was to compare the clinicopathological features and prognosis between patients with early MGC and those with early nonmucinous gastric carcinoma (NMGC). METHODS: We reviewed the records of 2,732 patients diagnosed with gastric carcinoma who were treated surgically. There were 14 patients (0.5%) with early MGC and 958 with early NMGC. RESULTS: Early MGC patients had a higher prevalence of elevated type (71.4%) compared with early NMGC patients (29.5%). More early MGC patients had submucosal carcinoma, compared with early NMGC patients (78.6% vs. 64.1%). The overall 5-year survival of the patients with early MGC was 97.2% as compared with 92.7% for the patients with early NMGC (P < 0.01). The statistically significant prognostic parameters influencing the 5-year survival rate according to Cox's proportional hazard regression model were: age (risk ratio, 2.22; 95% confidence interval [CI], 1.62-3.04; P < 0.01); sex (risk ratio, 1.97; 95% CI, 1.42-2.73; P < 0.01); and lymph node metastases (risk ratio, 1.88; 95% CI, 1.28-2.77; P < 0.01). CONCLUSION: Patients with early MGC had a better prognosis than those with early NMGC. Mucinous histology itself appears not to be an independent prognostic factor. Therefore, early detection is important for improving the prognosis for patients with gastric carcinoma regardless of tumor histology.