Kategorie: Onkologická diagnostika
Téma: The role of the pathologist in the indication of the cancer treatment
Číslo abstraktu: 006
Autoři: prof. MUDr. Jan Žaloudík, CSc.
A) Negative lymph node (No) status varied widely in 14 regionsranging from 12-33% in the case of colon carcinoma and 3-13% in the case of malignant melanoma. It is unlikely that the proportions of stages l-ll and III are so different between regions with comparable numbers of cases and without any organized selection. In both diagnoses the shift from stage II (with NO) to stage III (with N+) indicates adjuvant therapy.
B) Completeness of resection (Re), as classified by parameters RO, R1 or R2, was not reported for instance in 6% of breast, 12% of rectal, 18% of bronchogenic, 38% of pancreatic and 50% of hepatocellular carcinomas. Microscopic (R1) or macroscopic (R2) residual tumor will certainly dictate a postoperative therapeutic strategy different from RO.
C) Clinical stage (St) of malignant disease was not reported in 7% of malignant melanomas, 10% of breast, 15% of colorectal, 16% of uterine cervix, 18% of prostate, 18% of renal, 30% of bronchogenic and 48 % of pancreatic carcinomas, and 39% of soft tissue sarcomas. In this array of cancer diagnoses the unknown stages reflect both difficult and defective diagnostic efforts. However, an appropriate therapeutic strategy cannot be determined without knowing the stage of disease or estimate of treatment efficacy.
D) Investigation of tumor grade (InG) in terms of degree of malignancy or aggressiveness in each individual case involves several aspects from standard histological grading criteria in various tumor types to new panels for gene expression grading indices. The approach and results in each treatment center/hospital have become more dependent on pathological expertise and the use of newer molecular methods. For instance, it has been suggested according to gene expression arrays that breast cancers are classified as basal cell-like, HER2-like, luminal A and luminal B. However, these subtypes also correspond to different phenotypes as detected by ER, HER2 and p53 immu-nohistochemistry. On the other hand standard histological grading, despite its impact on prognosis and indication for adjuvant therapy, was missing for 23% of breast, 18% of colorectal, 24% of uterine cervix and 16% of bladder early stage carcinomas. In soft tissue sarcomas, where the clinical stage is determined by grading, the histological grade was not reported in 42% cases.
In conclusion, it needs to be stressed that new molecular markers and predictors can be effectively utilized only if the standard classification criteria of malignant tumors are not missing or ignored.
Datum přednesení příspěvku: 24. 4. 2009