Lymphovascular and perineural invasion as selection criteria for adjuvant therapy in intrahepatic cholangiocarcinoma: a multi-institution analysis

AbstractObjectivesCriteria for the selection of patients for adjuvant chemotherapy in intrahepatic cholangiocarcinoma (IHCC) are lacking. Some authors advocate treating patients with lymph node (LN) involvement; however, nodal assessment is often inadequate or not performed. This study aimed to identify surrogate criteria based on characteristics of the primary tumour.MethodsA total of 58 patients who underwent resection for IHCC between January 2000 and January 2010 at any of three institutions were identified. Primary outcome was overall survival (OS).ResultsMedian OS was 23.0months. Median tumour size was 6.5cm and the median number of lesions was one. Overall, 16% of patients had positive margins, 38% had perineural invasion (PNI), 40% had lymphovascular invasion (LVI) and 22% had LN involvement. A median of two LNs were removed and a median of zero were positive. Lymph nodes were not sampled in 34% of patients. Lymphovascular and perineural invasion were associated with reduced OS [9.6months vs. 32.7months (P= 0.020) and 10.7months vs. 32.7months (P= 0.008), respectively]. Lymph node involvement indicated a trend towards reduced OS (10.7months vs. 30.0months; P= 0.063). The presence of either LVI or PNI in node-negative patients was associated with a reduction in OS similar to that in node-positive patients (12.1months vs. 10.7months; P= 0.541). After accounting for adverse tumour factors, only LVI and PNI remained associated with decreased OS on multivariate analysis (hazard ratio4.07, 95% confidence interval 1.60–10.40; P= 0.003).ConclusionsLymphovascular and perineural invasion are separately associated with a reduction in OS similar to that in patients with LN-positive disease. As nodal dissection is often not performed and the number of nodes retrieved is frequently inadequate, these tumour-specific factors should be considered as criteria for selection for adjuvant chemotherapy

Remote sensing in landscape ecology: experiences and perspectives in a European context

That the relationship between remote sensing and landscape ecology is significant is due in large part to the strong spatial component within landscape ecology. However it is nevertheless necessary to have frequent overview of the interface between remote sensing and landscape ecology, particularly in the light of developments in the types of image data and techniques. The use of remote sensing within European landscape ecology provides a rich range of examples of the interface, including application of some of the latest types of image data. This paper is an overview of the interface that remote sensing has with European landscape ecology, with seven examples of the application of image data in European landscape ecology and examination of associated landscape classification issues. These examples are discussed in terms of the trends and the different roles for image data in landscape ecology that they illustrate, and in particular their classificatory and informational implications. It is suggested that with regard to classification there is a need for re-examination of the roles of image dat

Impact of the Austrian Agri-environmental scheme on diversity of landscapes, plants and birds

Agricultural management is a major driver of changes in floral and faunal species richness of anthropogenic landscapes. Counteracting the negative impact of industrialized agriculture by providing subsidies to farmers for environmentally friendly agricultural practices, agri-environmental schemes (AES) are the most important policy instruments to protect European biodiversity in agricultural landscapes. However, as they are rarely cost-effective, there is an urgent need for evaluation and improvement. To assess the environmental effects of the Austrian AES, we mapped landscapes and vascular plants in 1998 and 2003 and birds in 2003. The sampling areas were located in the three most important types of Austrian agricultural landscape, i.e., grassland in alpine valleys and basins, mixed agriculture in mountain areas, and eastern arable land. We investigated the agri-environmental measures (AEMs) in a parcel-wise manner and analyzed their effects on landscape values and biodiversity. Reduction of agrochemicals showed positive effects on biodiversity of vascular plants in grassland and birds in arable land. Targeted measures that directly address threatened species were most effective, but had much less coverage. Contradicting developments became apparent for landscape structure and ecological infrastructures, but effects of the AES were generally larger in simple than in complex landscapes. We conclude that AEMs are currently not targeted enough to effectively halt biodiversity losses, and recommend better regionalization by offering landscape-context specific measures, stronger focus on maintenance and improvement of landscape diversity, avoidance of counterproductive development, and improvement of the coverage of specific conservation measures

Can we measure ecological sustainability? Landscape pattern as an indicator for naturalness and land use intensity at regional, national and European level

European landscapes have been shaped over the centuries by processes related to human land use, which are reflected in regionally distinct landscape patterns. Since landscape pattern has been linked to biodiversity and other ecological values of the landscapes, this paper explores landscape pattern as a tool for ecological sustainability assessments at the regional (Austrian Cultural Landscapes), national (Austria) and European (European Union + Norway, Switzerland) level with focus on agricultural landscapes. A set of landscape metrics served as a basis to assess naturalness and geometrisation of Austrian and European landscapes as a proxy for their sustainability. To achieve an accurate spatially explicit assessment, we applied a spatial reference framework consisting in units that are homogeneous in biophysical and socio-economic contexts, adapted the regional approach for its application at European level, and developed relative sustainability thresholds for the landscape metrics. The analyses revealed that several landscape metrics, particularly the “Number of Shape Characterising Points” showed a high correlation with the degree of naturalness. The sustainability map of Austria based on an ordinal regression model revealed well-known problem regions of ecological sustainability. At the European level, the relative deviation from the average pattern showed clearly the simplification processes in the landscapes. However, a better spatial resolution of land cover data would add to the refinement of pattern analysis in regions and therefore the assessment of sustainability. We recommend the combination of information of different scales for the formulation and implementation of sustainability policie