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Oral Oncology Aug 2020Oral squamous cell carcinoma (OSCC) is a common malignancy of the head and neck region. OSCC has a relatively low survival rate and the incidence of the disease is... (Review)
Review
Oral squamous cell carcinoma (OSCC) is a common malignancy of the head and neck region. OSCC has a relatively low survival rate and the incidence of the disease is increasing in some geographic areas. Staging and grading of OSCC are established prerequisites for management, as they influence risk stratification and are the first step toward personalized treatment. The current AJCC/UICC TNM staging (8th edition, 2017) of OSCC has included significant modifications through the incorporation of depth of invasion in the T stage and extracapsular spread/extranodal extension in the N stage. Further modifications for AJCC 8 have been suggested. On the other hand, the World Health Organization (WHO) classification (4th edition, 2017) still endorses a simple, differentiation-based histopathologic grading system of OSCC (despite its low prognostic value) and ignores factors such as tumor growth pattern and dissociation, stromal reactions (desmoplasia, local immune response), and tumor-stroma ratio. The various controversies and possible developments of the current staging and grading criteria of OSCC are briefly discussed in this update together with possible applications of artificial intelligence in the context of screening and risk stratification.
Topics: Carcinoma, Squamous Cell; Female; Humans; Male; Mouth Neoplasms; Neoplasm Grading; Neoplasm Staging; Prognosis
PubMed: 32446214
DOI: 10.1016/j.oraloncology.2020.104799 -
Pathologica Mar 2020The World Health Organization's new classification of breast tumors has just been published. This review aims to examine the morphological categorization of breast... (Review)
Review
The World Health Organization's new classification of breast tumors has just been published. This review aims to examine the morphological categorization of breast carcinomas which is still principally based on histological features and follows the traditions of histological typing. It gives a subjective and critical view on the WHO classifications and their changes over time, and describes the changes related to some of the most common or challenging breast carcinomas: in situ carcinomas, invasive breast carcinomas of no special type, lobular, cribriform, tubular, mucinous, papillary, metaplastic carcinomas and carcinomas with medullary pattern and those with apocrine differentiation are discussed in more details. Although the 5 edition of the classification is not perfect, it has advantages which are mentioned along with problematic issues of classifications.
Topics: Breast Neoplasms; Humans; Neoplasm Grading; Time Factors; World Health Organization
PubMed: 32202537
DOI: 10.32074/1591-951X-1-20 -
Missouri Medicine 2018Prostate cancer is common, and recent efforts in clinical management have focused on identifying patients who could be candidates from less aggressive management or who... (Review)
Review
Prostate cancer is common, and recent efforts in clinical management have focused on identifying patients who could be candidates from less aggressive management or who could benefit from more aggressive therapy. As prostate cancer histology, especially Gleason score, plays a critical role in predicting patient outcomes, attempts have been made to refine histologic classification and reporting in prostate cancer to facilitate patient risk stratification. This review discusses recent updates in prostate cancer grading and reporting.
Topics: Biopsy; Humans; Male; Neoplasm Grading; Prognosis; Prostate; Prostatic Neoplasms
PubMed: 30228708
DOI: No ID Found -
European Urology Jul 2016It has been 12 yr since the publication of the last World Health Organization (WHO) classification of tumours of the prostate and bladder. During this time, significant... (Review)
Review
UNLABELLED
It has been 12 yr since the publication of the last World Health Organization (WHO) classification of tumours of the prostate and bladder. During this time, significant new knowledge has been generated about the pathology and genetics of these tumours. Intraductal carcinoma of the prostate is a newly recognized entity in the 2016 WHO classification. In most cases, it represents intraductal spread of aggressive prostatic carcinoma and should be separated from high-grade prostatic intraepithelial neoplasia. New acinar adenocarcinoma variants are microcystic adenocarcinoma and pleomorphic giant cell adenocarcinoma. Modifications to the Gleason grading system are incorporated into the 2016 WHO section on grading of prostate cancer, and it is recommended that the percentage of pattern 4 should be reported for Gleason score 7. The new WHO classification further recommends the recently developed prostate cancer grade grouping with five grade groups. For bladder cancer, the 2016 WHO classification continues to recommend the 1997 International Society of Urological Pathology grading classification. Newly described or better defined noninvasive urothelial lesions include urothelial dysplasia and urothelial proliferation of uncertain malignant potential, which is frequently identified in patients with a prior history of urothelial carcinoma. Invasive urothelial carcinoma with divergent differentiation refers to tumours with some percentage of "usual type" urothelial carcinoma combined with other morphologies. Pathologists should mention the percentage of divergent histologies in the pathology report.
PATIENT SUMMARY
Intraductal carcinoma of the prostate is a newly recognized entity in the 2016 World Health Organization classification. Better defined noninvasive urothelial lesions include urothelial dysplasia and urothelial proliferation of uncertain malignant potential.
Topics: Carcinoma; Humans; Immunophenotyping; Male; Neoplasm Grading; Neoplasm Invasiveness; Prostatic Neoplasms; Urinary Bladder Neoplasms; World Health Organization
PubMed: 26996659
DOI: 10.1016/j.eururo.2016.02.028 -
JAMA Surgery Aug 2022Focal therapy of prostate cancer must balance the oncologic outcome and functional outcome. High-frequency irreversible electroporation (H-FIRE) can destroy cancer...
IMPORTANCE
Focal therapy of prostate cancer must balance the oncologic outcome and functional outcome. High-frequency irreversible electroporation (H-FIRE) can destroy cancer cells while selectively preserving surrounding nerves and blood vessels, but no clinical trials have been conducted, to our knowledge.
OBJECTIVE
To evaluate the efficacy and safety of H-FIRE in the treatment of localized prostate cancer (PCa).
DESIGN, SETTING, AND PARTICIPANTS
This was a single-group, objective performance criteria, nonrandomized controlled trial. Recruitment began on May 2, 2018, and ended March 27, 2019. The follow-up duration was 6 months. This was a multicenter trial conducted at 4 tertiary teaching hospitals in China. Patients with low or intermediate risk of biochemical recurrence of localized and locally advanced PCa were eligible. Key inclusion criteria were serum prostate-specific antigen (PSA) level less than 20 ng/mL, clinical stage of T2c or less, and Gleason score of 7 or less. Data were analyzed from January 20 to February 20, 2021.
INTERVENTION
H-FIRE ablation of all lesions identified with biopsy.
MAIN OUTCOMES AND MEASURES
The primary end point was 6-month clinically significant PCa (csPCa), which was defined as any biopsy core with Gleason score of greater than or equal to 7, or Gleason score of 6 plus maximum cancer core length of greater than 3 mm or an increase from the original cancer burden. Secondary outcomes were calculated in patients who actually received H-FIRE treatment.
RESULTS
A total of 117 patients (median [IQR] age, 67 [62-73] years) were recruited from 4 centers, and 109 patients (27 [24.8%] low risk and 82 [75.2%] intermediate risk) actually received H-FIRE. Median (IQR) PSA level was 9.0 (6.0-12.7) ng/mL. Among the 100 patients who underwent biopsy at 6 months, the 6-month csPCa rate was 6.0% (95% CI, 2.2%-12.6%; P < .001; 1 in the treatment zone and 5 outside the treatment zone). Superiority criteria vs the historical control of 20% was achieved. PCa was detected in 14 patients, with a Gleason score of 7 in 2 patients and 6 in the remaining 12 patients. At 6 months, median (IQR) PSA level was 1.08 (0.4-3.2) ng/mL, median (IQR) International Prostate Symptom Score was 4.5 (2.0-9.5), and median (IQR) International Index of Erectile Function 5 score was 2.0 (0.5-12.5). Superiority vs the 20% historical control was also met in the subgroup analysis that only included the 57 patients with Gleason score of 7 at baseline (3.5% 6-month csPCa; 95% CI, 0.4%-12.1%).
CONCLUSIONS AND RELEVANCE
The rate of 6-month csPCa with H-FIRE ablation was lower than the historical control using other energy platforms.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT03838432.
Topics: Aged; Electroporation; Humans; Male; Neoplasm Grading; Prostate-Specific Antigen; Prostatic Neoplasms; Treatment Outcome
PubMed: 35793110
DOI: 10.1001/jamasurg.2022.2230 -
CNS Neuroscience & Therapeutics Feb 2021We aimed to create a tumor recurrent-based prediction model to predict recurrence and survival in patients with low-grade glioma.
AIMS
We aimed to create a tumor recurrent-based prediction model to predict recurrence and survival in patients with low-grade glioma.
METHODS
This study enrolled 291 patients (188 in the training group and 103 in the validation group) with clinicopathological information and transcriptome sequencing data. LASSO-COX algorithm was applied to shrink predictive factor size and build a predictive recurrent signature. GO, KEGG, and GSVA analyses were performed for function annotations of the recurrent signature. The calibration curves and C-Index were assessed to evaluate the nomogram's performance.
RESULTS
This study found that DNA repair functions of tumor cells were significantly enriched in recurrent low-grade gliomas. A predictive recurrent signature, built by the LASSO-COX algorithm, was significantly associated with overall survival and progression-free survival in low-grade gliomas. Moreover, function annotations analysis of the predictive recurrent signature exhibited that the signature was associated with DNA repair functions. The nomogram, combining the predictive recurrent signature and clinical prognostic predictors, showed powerful prognostic ability in the training and validation groups.
CONCLUSION
An individualized prediction model was created to predict 1-, 2-, 3-, 5-, and 10-year survival and recurrent rate of patients with low-grade glioma, which may serve as a potential tool to guide postoperative individualized care.
Topics: Brain Neoplasms; DNA Repair; Female; Follow-Up Studies; Glioma; Humans; Male; Neoplasm Grading; Nomograms; Predictive Value of Tests
PubMed: 33063446
DOI: 10.1111/cns.13464 -
European Urology Mar 2016Despite revisions in 2005 and 2014, the Gleason prostate cancer (PCa) grading system still has major deficiencies. Combining of Gleason scores into a three-tiered...
BACKGROUND
Despite revisions in 2005 and 2014, the Gleason prostate cancer (PCa) grading system still has major deficiencies. Combining of Gleason scores into a three-tiered grouping (6, 7, 8-10) is used most frequently for prognostic and therapeutic purposes. The lowest score, assigned 6, may be misunderstood as a cancer in the middle of the grading scale, and 3+4=7 and 4+3=7 are often considered the same prognostic group.
OBJECTIVE
To verify that a new grading system accurately produces a smaller number of grades with the most significant prognostic differences, using multi-institutional and multimodal therapy data.
DESIGN, SETTING, AND PARTICIPANTS
Between 2005 and 2014, 20,845 consecutive men were treated by radical prostatectomy at five academic institutions; 5501 men were treated with radiotherapy at two academic institutions.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Outcome was based on biochemical recurrence (BCR). The log-rank test assessed univariable differences in BCR by Gleason score. Separate univariable and multivariable Cox proportional hazards used four possible categorizations of Gleason scores.
RESULTS AND LIMITATIONS
In the surgery cohort, we found large differences in recurrence rates between both Gleason 3+4 versus 4+3 and Gleason 8 versus 9. The hazard ratios relative to Gleason score 6 were 1.9, 5.1, 8.0, and 11.7 for Gleason scores 3+4, 4+3, 8, and 9-10, respectively. These differences were attenuated in the radiotherapy cohort as a whole due to increased adjuvant or neoadjuvant hormones for patients with high-grade disease but were clearly seen in patients undergoing radiotherapy only. A five-grade group system had the highest prognostic discrimination for all cohorts on both univariable and multivariable analysis. The major limitation was the unavoidable use of prostate-specific antigen BCR as an end point as opposed to cancer-related death.
CONCLUSIONS
The new PCa grading system has these benefits: more accurate grade stratification than current systems, simplified grading system of five grades, and lowest grade is 1, as opposed to 6, with the potential to reduce overtreatment of PCa.
PATIENT SUMMARY
We looked at outcomes for prostate cancer (PCa) treated with radical prostatectomy or radiation therapy and validated a new grading system with more accurate grade stratification than current systems, including a simplified grading system of five grades and a lowest grade is 1, as opposed to 6, with the potential to reduce overtreatment of PCa.
Topics: Aged; Decision Support Techniques; Humans; Kallikreins; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Neoplasm Grading; Predictive Value of Tests; Proportional Hazards Models; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Radiotherapy; Reproducibility of Results; Sweden; Time Factors; Treatment Outcome; United States
PubMed: 26166626
DOI: 10.1016/j.eururo.2015.06.046 -
Annals of Oncology : Official Journal... Jun 2016
Topics: Humans; Male; Neoplasm Grading; Prostate-Specific Antigen; Prostatic Neoplasms; Prostatic Neoplasms, Castration-Resistant
PubMed: 27091809
DOI: 10.1093/annonc/mdw179 -
Asian Journal of Surgery Jun 2023
Topics: Humans; Male; Neoplasm Grading; Overdiagnosis; Prostate-Specific Antigen; Overtreatment
PubMed: 36624005
DOI: 10.1016/j.asjsur.2022.12.147 -
Archives of Pathology & Laboratory... May 2019The combination of grading and staging is the basis of current standard of care for prediction for most cancers. D. F. Gleason created the current prostate cancer (PCa)... (Review)
Review
CONTEXT.—
The combination of grading and staging is the basis of current standard of care for prediction for most cancers. D. F. Gleason created the current prostate cancer (PCa) grading system. This system has been modified several times. Molecular data have been added. Currently, all grading systems are cancer-cell based.
OBJECTIVE.—
To review the literature available on host response measures as reactive stroma grading and stromogenic carcinoma, and their predictive ability for PCa biochemical recurrence and PCa-specific death.
DATA SOURCES.—
Our own experience has shown that reactive stroma grading and the subsequently binarized system (stromogenic carcinoma) can independently predict biochemical recurrence and/or PCa-specific death, particularly in patients with a Gleason score of 6 or 7. Stromogenic carcinoma has been validated by 4 other independent groups in at least 3 continents.
CONCLUSIONS.—
Broders grading and Dukes staging have been combined to form the most powerful prognostic tools in standard of care. The time has come for us to incorporate measures of host response (stromogenic carcinoma) into the arsenal of elements we use to predict cancer survival, without abandoning what we know works. These data also suggest that our current definition of PCa might need some revision.
Topics: Humans; Male; Neoplasm Grading; Prostatic Neoplasms; Tumor Microenvironment
PubMed: 30865488
DOI: 10.5858/arpa.2018-0242-RA