125 research outputs found
Tumor budding outperforms ypT and ypN classification in predicting outcome of rectal cancer after neoadjuvant chemoradiotherapy
BACKGROUND:
Budding is a complementary prognostic factor for colorectal cancer. In this study, we aimed to clarify the role of tumor budding in rectal cancer patients after preoperative chemoradiotherapy.
METHODS:
A total of 124 patients with rectal cancer treated with neoadjuvant chemoradiotherapy and consecutive surgery were included. Surgical specimens were evaluated for budding and routine clinicopathological features. Budding was evaluated on hematoxylin and eosin (H&E)-stained slides and by cytokeratin immunohistochemical (IHC) staining.
RESULTS:
A budding rate of 36.9% (n =â38) by H&E and 55.6% (n =â55) by IHC was observed. Budding was significantly associated with a high ypT and ypN status, poor differentiation, and low degrees of tumor regression. Moreover, budding was strongly predictive of a worse patient outcome, as measured by tumor recurrence or death. In multivariate analyses, budding remained the only significant parameter for overall survival and was even superior to the ypT and ypN status (budding in H&E: hazard ratio (HR) 2.72, 95% confidence interval (95% CI) 1.15-6.44, p =â0.023; budding in IHC: HR 5.19, 95% CI 1.62-16.61, p =â0.006).
CONCLUSION:
Budding is a strong prognostic predictor of survival in rectal cancer patients after neoadjuvant therapy. A standardized evaluation of tumor budding after neoadjuvant therapy may thus aid in risk stratification and guide the clinical management of patients with rectal cancer. Immunostaining can help to enhance the diagnostic accuracy and prognostic significance
Diagnostic Confidence of Run-Off CT-Angiography as the Primary Diagnostic Imaging Modality in Patients Presenting with Acute or Chronic Peripheral Arterial Disease
Objectives To investigate the reliability of CT-angiography of the lower
extremities (run-off CTA) to derive a treatment decision in patients with
acute and chronic peripheral artery disease (PAD). Materials and Methods 314
patients referred for run-off CTA were includ-ed in this retrospective study.
First, diagnostic confidence of run-off CTA to derive a treat-ment decision
was assessed in an interdisciplinary vascular conference using a 2 point scale
(sufficient or not sufficient diagnostic confidence) and compared with the
image quality eval-uated by two readers in consensus in four different levels
(abdominopelvic, thigh, calf, foot arteries). Second, reliability of treatment
decision was verified in all patients undergoing re-vascularization therapy.
Results Diagnostic confidence of run-off CTA to derive a treatment deci-sion
was sufficient in all patients with acute and in 97% of patients (215/221)
with chronic PAD, whereas the rate of run-off CTA with non-diagnostic image
quality was considerably higher in the calf and foot level (acute vs. chronic;
calf: 28% vs.17%; foot: 52% vs. 20%). Reliability of treatment decision was
superior for patients with chronic (123/133 = 92%) than for patients with
acute PAD (64/78 = 82%, P = 0.02). Conclusion Run-off CTA is a reliable
imaging modality for primary diag-nostic work-up of patients with acute and
chronic PAD
Analysis of the Prognostic Effectiveness of a Multivisceral Resection for Locally Advanced Colorectal Cancer
Predictive Factors for Anastomotic Leakage after Simultaneous Resection of Synchronous Colorectal Liver Metastasis
Evidence for PTGER4, PSCA, and MBOAT7 as risk genes for gastric cancer on the genome and transcriptome level
Genetic associations between variants on chromosome 5p13 and 8q24 and gastric cancer (GC) have been previously reported in the Asian population. We aimed to replicate these findings and to characterize the associations at the genome and transcriptome level. We performed a fine-mapping association study in 1926 GC patients and 2012 controls of European descent using high dense SNP marker sets on both chromosomal regions. Next, we performed expression quantitative trait locus (eQTL) analyses using gastric transcriptome data from 143 individuals focusing on the GC associated variants. On chromosome 5p13 the strongest association was observed at rs6872282 (PÂ =Â 2.53Â ĂÂ 10-04) and on chromosome 8q24 at rs2585176 (PÂ =Â 1.09Â ĂÂ 10-09). On chromosome 5p13 we found cis-eQTL effects with an upregulation of PTGER4 expression in GC risk allele carrier (PÂ =Â 9.27Â ĂÂ 10-11). On chromosome 8q24 we observed cis-eQTL effects with an upregulation of PSCA expression in GC risk allele carrier (PÂ =Â 2.17Â ĂÂ 10-47). In addition, we found trans-eQTL effects for the same variants on 8q24 with a downregulation of MBOAT7 expression in GC risk allele carrier (PÂ =Â 3.11Â ĂÂ 10-09). In summary, we confirmed and refined the previously reported GC associations at both chromosomal regions. Our data point to shared etiological factors between Asians and Europeans. Furthermore, our data imply an upregulated expression of PTGER4 and PSCA as well as a downregulated expression of MBOAT7 in gastric tissue as risk-conferring GC pathomechanisms
Animal experimental trials using rat colitis models
Ătiologie und Pathogenese der chronisch entzĂŒndlichen Darmerkrankungen, Morbus
Crohn und Colitis ulcerosa, sind trotz zahlreicher neuer wissenschaftlicher
Erkenntnisse ungeklÀrt. Das Ziel dieser Arbeit war es, den Stellenwert der
Mikrozirkulation in diesem Zusammenhang zu evaluieren. Dazu erfolgten
intravitalmikroskopische Untersuchungen am gesunden Darm sowie bei zwei
verschiedenen Colitis-Modellen der Ratte. Bei der TNBS-Colitis kommt es im
akuten, bei der Mitomycin C-Colitis im chronischen Stadium der EntzĂŒndung zu
signifikanten Störungen der mukosalen Mikrozirkulation. SchlieĂlich wurden im
Rahmen einer Interventionsstudie verschiedene Substanzen appliziert. Es zeigt
sich, dass die Gabe des selektiven Endothelin-A-Rezeptor-Antagonisten
LU-135252 zu einer signifikanten Besserung sÀmtlicher
Mirkozirkulationsparameter sowie auch der klinischen Befunde gegenĂŒber der
Kontroll-TNBS-Colitisgruppe fĂŒhrt. Die Zufuhr des selektiven COX-2-Inhibitors
NS-398 hat denselben Effekt, wenn auch nicht so ausgeprÀgt. Der hemmende
Einfluss beider Substanzen auf die LeukozytenâEndothelâInteraktion scheint
hierbei eine Rolle zu spielen. Da die Endothelin-A-Rezeptor-Blockade
allerdings hinsichtlich der Colitis-AktivtÀt signifikant effektiver ist, muss
ein weiterer Mechanismus im Sinne einer direkten Wirkung auf den kapillÀren
Blutfluss vorliegen, was die pathogenetische Bedeutung der Mikrozirkulation
fĂŒr die Progression der Colitis unterstreicht.The etiology and pathogenesis of chronic inflammatory bowel disease, Crohnâs
disease and ulcerative colitis, remains unclear despite numerous new
scientific findings. The aim of this study was to evaluate the role of the
microcirculation in this context. For this purpose, intravital microscopic
examination of the healthy bowel and in two different rat colitis models was
performed. Significant disturbances of the mucosal microcirculation were
observed at the acute inflammatory stage of TNBS colitis and at the chronic
stage of mitomycin C colitis. Finally, different substances were applied in an
intervention study. Application of the selective endothelin-A receptor
antagonist LU-135252 resulted in a significant improvement of all
microcirculatory parameters and clinical findings compared to the control TNBS
colitis group. The same effect, though not as pronounced, was seen with the
selective COX-2 inhibitor NS-398. The inhibitory influence of the two
substances on leukocyte-endothelium interaction seems to play a role. However,
there may be another mechanism like a direct effect on capillary blood flow,
since endothelin A receptor blockade is significantly more effective with
regard to colitis activity, underscoring the pathogenetic role of the
microcirculation on the progression of colitis
Chirurgie des primÀren kolorektalen Karzinoms - warum gelingt die lokale R0-Resektion nicht in jedem Fall?
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