Search PubMed⌕ Search

Biomedical subjects

P Hermanek

Publications and source records attributed to P Hermanek.

317 records · Page 18Linked to original sources
PubMedDate not supplied

Residual tumor (R) classification and prognosis.

The tumor status following treatment is described by the residual tumor (R) classification: R0, no residual tumor; R1, microscopic residual tumor; R2, macroscopic residual tumor. Residual tumor may be found in the area of primary tumor and its regional lymph nodes and/or at distant sites. The R classification reflects the effects of treatment and influences further treatment planning. Furthermore, the R classification is a strong predictor of prognosis. An acceptable long-term prognosis can be expected only in R0 patients. Although there exist clear correlations between stage and R classification the differences in prognosis of R0 versus R1,2 cannot be explained by differences in stage alone. The prognostic significance of R classification is demonstrated by respective data for non-small cell lung carcinoma, squamous cell carcinoma of oesophagus, gastric carcinoma, ductal adenocarcinoma of the pancreas, colorectal carcinoma, lung and liver metastases.

Carcinoma, Ductal, Breast↗
PubMedDate not supplied

News of TNM and its use for classification of gastric cancer.

Tumor classification is associated with two inherent problems: (1) to find a compromise between the simplicity needed for a wide application by the medical community and sufficient differentiation and specification required for the presently high differentiation in treatment options and for detailed analysis of treatment results; and (2) to achieve an agreement between the stability necessary for data collection over long periods and the needed continuous inclusion of new proposals that arise by advances in diagnostic and therapeutic methods and the increasing knowledge of prognostic factors. The aim of this report is to inform on the changes and expansions of the international classification of gastric carcinoma during the last few years, to refer to new developments, to point out the relations between established classifications and molecular biology, and to show the future trend in tumor classification.

Carcinoma↗
PubMedDate not supplied

pTNM and residual tumor classifications: problems of assessment and prognostic significance.

The anatomic extent of tumor (TNM, pTNM) and, in case of treatment, the residual tumor status following treatment (residual tumor, or R classification) are the strongest predictors for outcome of patients with gastrointestinal cancer. The results of the pTNM and the R classifications depend on the methods used. In particular, the pN classification correlates with the number of nodes examined. The findings of micrometastases or isolated tumor cells in bone marrow should be indicated, and such cases must be analyzed separately from other metastatic cases. The same applies to patients with positive cytology in ascites fluid or peritoneal washings without gross involvement of the peritoneum. For the R classification the additional descriptors (conv), for conventional methods used, and (soph), for sophisticated, are recommended to indicate the methods used for classification. In general, long-term survival can be expected only after R0 resection (resection without residual tumor). The observed 5-year survival after R0 resection is 15% to 40% for esophageal carcinoma, 40% to 75% for gastric carcinoma, and 55% to 60% for colorectal carcinoma; the respective figures for R1 and R2 resections are only about 5% each. In R1 and R2 cases prognosis is determined primarily by the absence or presence of distant metastases, and pT and pN are of minor significance. After R0 resection there is a wide spectrum of prognoses. Careful pTNM classification allows a good estimation of the prognosis and can be considered the gold standard for any analysis of treatment results.

Gastrointestinal Neoplasms↗
PubMedDate not supplied

Comparison of factors influencing the prognosis of Japanese, German, and Dutch gastric cancer patients.

As a result of Japanese reports of improved survival of gastric cancer patients after extended lymph node dissection, a study was undertaken to evaluate factors that might influence these results. The influence of staging was evaluated by stratifying 1085 patients of the National Cancer Center of Japan and grouping them according to the three commonly used systems; UICC's old and new TNM systems (fourth edition) and the system of the Japanese Research Society for the study of Gastric Cancer (JRSGC). No survival difference was found between the stages of the three systems, except for stage II, where the new TNM and the JRSGC differed (p < 0.05). In a second analysis, the incidence of the most important prognostic factors for advanced gastric cancer was compared among three institutions: the National Cancer Center Tokyo, Japan (NCC), the University Hospital Erlangen, Germany (UHE) and the University Hospital Maastricht in The Netherlands (UHM). Japanese patients were on average 3 years younger than the German patients and 8 years younger than the Dutch patients, and had a higher proportion of advanced (T4) carcinomas. Male-female distribution, histology, and lymph node invasion were comparable in the three groups. From these data a rather worse prognosis for Japanese advanced gastric cancer patients could be expected. However, the observed 5-year survival rates show a marked advantage for the Japanese patients: 57% (NCC) versus 34% (UHE) and 31% (UHM). The survival difference for stage II patients between the new TNM and the JRSGC staging systems is not sufficient to explain this advantage. This result underlines the importance of the Japanese therapeutic approach.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMedDate not supplied

Clinicopathological staging for colorectal cancer: an International Documentation System (IDS) and an International Comprehensive Anatomical Terminology (ICAT).

The purpose of tumour staging for colorectal cancer (CRC) is to help define clinical management, facilitate communication between physicians, provide a basis for stratification and analysis of treatment results in prospective studies, and provide some prognostic information for patients and their families. The World Congresses of Gastroenterology, Digestive Endoscopy, and Coloproctology, Working Party on staging for CRC studied six commonly used systems to review their strengths and weaknesses. Although it was concluded that defining a new staging system was unnecessary, it was recognized that there is a need to define a terminology to describe the full anatomic extent of spread of CRC. Furthermore, we note that there are several additional features, derived from both clinical and pathology information, which have had prognostic significance shown by appropriately constructed multivariate analyses and which can be used to formulate a more accurate prognostic index than that provided by a description of anatomical tumour spread. Thus the Working Party came to two principal conclusions. First, a standard format should be adopted for the collection of the essential data required for prospective studies, and we recommend the 'International Documentation System (IDS) for CRC' for this purpose. Second, a nomenclature which describes the full anatomical extent of tumour spread and residual tumour status in CRC has been defined and should be adopted, from which all currently used staging systems can be derived. We have called this nomenclature the 'International Comprehensive Anatomical Terminology (ICAT) for CRC'. In the event that these recommendations are adopted, we envision that there will be improved clarity in the documentation of treatment outcome for patients with CRC and improved communication of results derived from prospective studies. Furthermore, an acceptance of IDS and ICAT would set the scene to develop a prognostic index for individual patients with CRC by the expansion of anatomical clinicopathology staging information to include additional factors which have independent prognostic significance.

Colorectal Neoplasms↗
PubMedDate not supplied

Tumors of the gastrointestinal tract and the pancreas: histopathology, staging and prognosis.

At present, the pathologist is an important member of the treatment team who provides information and consultation for selecting treatment, estimating prognosis and evaluating outcome. The pathologist's functions include pretreatment microscopic diagnosis, intraoperative consultation and histopathologic examination of tumor resection specimens. Tumor classification follows international rules published by the UICC and the WHO. The strongest predictors of outcome are the residual tumor (R) classification and the TNM/pTNM classification of anatomic extent before treatment. The new 5th edition of TNM (1997) contains some changes in the classification of gastric, colorectal and exocrine pancreatic carcinoma. There are some pathological features which independently influence prognosis in addition to R and TNM. For the most biological and molecular markers the prognostic significance remains to be proven. In future, the main objective of prognostic factor research will be the development of prognostic systems.

Colorectal Neoplasms↗
PubMedDate not supplied

Disseminated tumor cells versus micrometastasis: definitions and problems.

The finding of single tumor cells or small tumor cell groups in the lymph and blood (including bone marrow aspirations) should be designated as isolated or disseminated tumor cells. The UICC (1992) recommended to identify such findings by the addition of "(i)" (for isolated tumor cells). In contrast, micrometastasis (2 mm or less) should be indicated by the addition of "(mi)". Before introduction of the examination of lymph nodes or bone marrow aspirations regarding isolated (disseminated) tumor cells the methods have to be standardized and the clinical relevance (independent prognostic significance, assistance in selection of patients for adjuvant treatment) has to be evaluated in prospective large scale studies.

Biopsy, Needle↗
PubMedDate not supplied

Prognostic factors of rectum carcinoma--experience of the German Multicentre Study SGCRC. German Study Group Colo-Rectal Carcinoma.

A reliable evaluation of results of multimodal treatment requires the knowledge of the course of disease in patients treated by surgery alone and of the relevant prognostic factors. The data of a prospective multicentre observation study (Study Group Colo-Rectal Carcinoma, SGCRC) were analyzed by uni- and multivariate methods for the endpoints locoregional recurrence and observed overall survival. 1121 patients with invasive rectum carcinomas are included. In 1056 (94.2%) patients the tumor was resected, 34 patients (3.0%) received postoperative adjuvant therapy, 61 patients (5.4%) preoperative and 25 (2.2%) pre- and postoperative radiation. The observed 5-year survival rate for R0 (no residual tumor) was 55% (95% confidence interval 52-58%), for R1 and R2 only 7% (3-11%). Following R0 resection the 5-year survival rates varied according to pT (74-24%) and pN (68-33%). The 5-year survival was 74% (68-80%) for stage I, 62% (56-68%) for stage II, 40% (35-45%) for stage III and 9% (0-21%) for stage IV. Stage III is prognostically inhomogeneous: pN1: 5-year survival 47% (39-55%), pN2, 3: 34% (27-41%) (p < 0.01). The rate of locoregional recurrence is influenced by tumor related factors (stage and tumor site) and treatment related factors. Local spillage of tumor cells, the treating institution and the individual surgeon are independent factors influencing locoregional recurrence. Between locoregional recurrence and observed 5-year survival exists a highly significant correlation. The most important tumor related prognostic factors following surgical treatment are residual tumor status (R classification) and anatomic extent as described by pTNM and stage grouping UICC). The treating institution as well as the individual surgeon are further independent "prognostic factors" which determine the frequency of locoregional recurrence and thus survival. In analysis of treatment results the institution and the surgeon should be considered, in studies on adjuvant treatment a stratification according to department and surgeon is needed.

Analysis of Variance↗