Survival outcomes of poorly differentiated colorectal carcinoma variants: Insights from a single teaching institute

IF 2.7 2区 医学 Q2 PATHOLOGY
Zhengfan Xu , Brian K. Theisen , Qing Chang , Daniel Schultz , Beena U. Ahsan
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引用次数: 0

Abstract

The morphologic diagnosis of colorectal carcinoma (CRC) is typically straight forward. However, there are certain subtypes of CRC that pose diagnostic challenges for daily practice due to sometimes overlapping morphologic and immunohistochemical features. These subtypes include poorly differentiated adenocarcinoma NOS, in the absence of conventional morphology (PDA-NOS), large cell neuroendocrine carcinoma (LCNEC), medullary carcinoma (MC), undifferentiated carcinoma (UC) and lymphoepithelioma-like carcinoma (LELC). This study aims to see if there is a survival difference between poorly differentiated variants of CRC, as well as other clinicopathological features that may affect prognosis. Additionally, we analyzed interobserver agreement among gastrointestinal pathologists (GP) at our institution in subclassifying poorly differentiated CRC. All consecutive patients with the diagnoses of PDA-NOS, MC, LCNEC, UC and LELC between July 2018 and July 2023 were included. Cox proportional regression test was used for multivariate analysis, while log-rank and Kaplan-Meier tests were used for univariate and survival analyses. Out of the same cohort of patients, 58 samples identified and reviewed by 3 GI-subspecialty-trained pathologists who were asked to assign the cases as PDA-NOS, LCNEC, MC, UC and LELC. Interobserver agreement was analyzed using Fleiss Kappa. Of the total 77 patients, 63 were PDA-NOS, 3 were LCNEC, 6 were MC, 4 were UC and 1 was LELC patients. Multivariate analysis using Cox proportional regression showed that tumor size (p = 0.001, HR = 1.22, 95% CI 1.08–1.38), patient age (p = 0.001, HR 1.73, 95% CI 1.24–2.40), and M stage (p = 0.02, HR 2.22, 95% CI 1.14–4.32) were significantly associated with worse OS. For the 58 cases analyzed, 3 GP agreed on 42 (72%) cases. The most common diagnosis was PDA-NOS and for 33 (57%) agreement was unanimous. There was moderate agreement (k 0.41–0.60) between all 3 GP. Our study evaluated the challenges associated with histological evaluation of colon cancers with poorly differentiated morphologies. Among the diagnoses considered in the study, MC and LCNEC had different prognostic implications compared to PDA-NOS and UC. Additionally, our GP showed moderate interobserver agreement, indicating that some level of variability in diagnosing poorly differentiated CRC subtypes may be inevitable.
低分化结直肠癌变体的生存结果:来自单一教学机构的见解。
结直肠癌(CRC)的形态学诊断通常是直截了当的。然而,由于有时形态和免疫组织化学特征重叠,某些CRC亚型对日常实践构成诊断挑战。这些亚型包括无常规形态的低分化腺癌NOS (PDA-NOS)、大细胞神经内分泌癌(LCNEC)、髓样癌(MC)、未分化癌(UC)和淋巴上皮瘤样癌(LELC)。本研究旨在了解CRC低分化变体之间是否存在生存差异,以及其他可能影响预后的临床病理特征。此外,我们分析了本机构胃肠病理学家(GP)对低分化结直肠癌的亚分类的观察者间一致性。纳入2018年7月至2023年7月期间所有连续诊断为PDA-NOS、MC、LCNEC、UC和LELC的患者。多因素分析采用Cox比例回归检验,单因素和生存分析采用log-rank和Kaplan-Meier检验。在同一队列患者中,58个样本由3名gi亚专科培训的病理学家鉴定和审查,他们被要求将病例分配为PDA-NOS, LCNEC, MC, UC和LELC。使用Fleiss Kappa分析观察者间的一致性。77例患者中,PDA-NOS 63例,LCNEC 3例,MC 6例,UC 4例,LELC 1例。Cox比例回归多因素分析显示,肿瘤大小(p=0.001, HR = 1.22, 95% CI 1.08 - 1.38)、患者年龄(p=0.001, HR 1.73, 95% CI 1.24 - 2.40)和M分期(p=0.02, HR 2.22, 95% CI 1.14 - 4.32)与较差的OS显著相关。在分析的58例病例中,3名GP同意42例(72%)。最常见的诊断是PDA-NOS,其中33例(57%)一致同意。所有3个GP之间有中等一致性(k值为0.41 - 0.60)。我们的研究评估了与形态学低分化结肠癌的组织学评估相关的挑战。在本研究考虑的诊断中,MC和LCNEC与PDA-NOS和UC相比具有不同的预后意义。此外,我们的GP显示了适度的观察者间一致性,这表明诊断低分化CRC亚型的某种程度的变异性可能是不可避免的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Human pathology
Human pathology 医学-病理学
CiteScore
5.30
自引率
6.10%
发文量
206
审稿时长
21 days
期刊介绍: Human Pathology is designed to bring information of clinicopathologic significance to human disease to the laboratory and clinical physician. It presents information drawn from morphologic and clinical laboratory studies with direct relevance to the understanding of human diseases. Papers published concern morphologic and clinicopathologic observations, reviews of diseases, analyses of problems in pathology, significant collections of case material and advances in concepts or techniques of value in the analysis and diagnosis of disease. Theoretical and experimental pathology and molecular biology pertinent to human disease are included. This critical journal is well illustrated with exceptional reproductions of photomicrographs and microscopic anatomy.
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