Multifocal extramural venous invasion detected with an elastin stain as a predictor of cancer-specific outcomes in stage I-III resected colorectal cancer (CRC).
Notice bibliographique
Résumé
114 Background: ExtraMural Venous Invasion (EMVI) is considered an indicator of poor prognosis in patients who have undergone resection of primary CRC, but its use has not been widely adopted in staging systems or nomograms. Staining for elastin may facilitate the accurate detection of EMVI and minimize interobserver variability, as well as enable the assessment of specific features of EMVI including focality and size. We examined the prognostic potential of EMVI detected by elastin staining at a tertiary center that performs a high volume of CRC resections. Methods: This is a single-institution, observational study of consecutive patients who underwent resection of primary CRC between 01/2011 and 12/2016 (n=556). All pathology specimens were re-assessed by expert reviewers who were blinded to patient outcomes. Venous invasion was detected using an elastin trichrome stain and classified as IntraMural or ExtraMural. The number of VI foci, as well as the maximum foci width and length, were also determined. Disease-specific and recurrence-free survival (DSS, RFS) were estimated using the Kaplan-Meier method and group differences were assessed using the log-rank test. Cox proportional-hazard models were used to calculate hazard ratios (HR) and 95% CI. For the present analysis, patients with stage IV (n=86) CRC were excluded. Results: The cohort for analysis included 470 patients (264M, 206F; TNM 8th edition Stage I/II n=291; Stage III n=179) with a median follow-up time of 63 months (0.1-114). EMVI was detected in 33% of all cases (20% in Stage I/II vs. 55% in Stage III; p<0.0001). For the entire cohort, DSS and RFS at 5 years were 86% and 76%, respectively. The presence of EMVI was associated with significantly worse DSS and RFS at 5-years (73% and 54%) compared to patients with no VI (92% and 85%) or IMVI alone (93% and 89%; p<0.0001). The majority of EMVI was multifocal (69%) vs. unifocal (31%). Interestingly, multifocal EMVI was prognostic for worse 5-year DSS (65%), whereas unifocal EMVI was similar to the absence of EMVI (91% and 92%, respectively; p<0.0001). A Cox-proportional hazards model showed worsening DSS with increasing number of detected EMVI foci (1 focus: HR 1.1, 2-4 foci: HR 3.3, >4 foci: HR 7.9; p<0.0001). A similar trend was observed for RFS. Neither the maximum width or length of EMVI foci were prognostic of DSS or RFS. Conclusions: To our knowledge, the prognostic role of EMVI focality in CRC has not been previously explored. In this cohort of Stage I - III CRC patients, multifocal EMVI as assessed by elastin staining was a powerful predictor of cancer-specific death and recurrence-free survival. Elastin staining, which improves the accuracy and objectivity of EMVI detection, may allow validation of EMVI as an independent prognostic variable that should be incorporated into staging systems and nomograms.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».