Department of Pathology, Koc University School of Medicine and Koc University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey.
Department of Pathology, Emory University, Atlanta, GA, USA.
Mod Pathol. 2022 Jun;35(6):777-785. doi: 10.1038/s41379-021-00995-4. Epub 2021 Dec 30.
The advancing edge profile is a powerful determinant of tumor behavior in many organs. In this study, a grading system assessing the tumor-host interface was developed and tested in 181 pancreatic neuroendocrine tumors (PanNETs), 63 of which were <=2 cm. Three tumor slides representative of the spectrum (least, medium, and most) of invasiveness at the advancing edge of the tumor were selected, and then each slide was scored as follows. Well-demarcated/encapsulated, 1 point; Mildly irregular borders and/or minimal infiltration into adjacent tissue, 2 points; Infiltrative edges with several clusters beyond the main tumor but still relatively close, and/or satellite demarcated nodules, 3 points; No demarcation, several cellular clusters away from the tumor, 4 points; Exuberantly infiltrative pattern, scirrhous growth, dissecting the normal parenchymal elements, 5 points. The sum of the rankings on the three slides was obtained. Cases with scores of 3-6 were defined as "non/minimally infiltrative" (NI; n = 77), 7-9 as "moderately infiltrative" (MI; n = 68), and 10-15 as "highly infiltrative" (HI; n = 36). In addition to showing a statistically significant correlation with all the established signs of aggressiveness (grade, size, T-stage), this grading system was found to be the most significant predictor of adverse outcomes (metastasis, progression, and death) on multivariate analysis, more strongly than T-stage, while Ki-67 index did not stand the multivariate test. As importantly, cases <=2 cm were also stratified by this grading system rendering it applicable also to this group that is currently placed in "watchful waiting" protocols. In conclusion, the proposed grading system has a strong, independent prognostic value and therefore should be considered for integration into routine pathology practice after being evaluated in validation studies with larger series.
前沿边缘形态是许多器官中肿瘤行为的一个强有力的决定因素。在这项研究中，开发并测试了一种评估肿瘤-宿主界面的分级系统，该系统应用于 181 例胰腺神经内分泌肿瘤（PanNETs），其中 63 例肿瘤直径<=2cm。选择了代表肿瘤前沿侵袭性的一系列（最不、中等和最）三个肿瘤切片，然后对每个切片进行如下评分。边界清楚/包膜完整，1 分；边界轻度不规则和/或仅轻度浸润邻近组织，2 分；边缘浸润，肿瘤内有几个簇状结构，但仍相对接近，和/或卫星包膜结节，3 分；无包膜，远离肿瘤的几个细胞簇，4 分；明显浸润模式，硬癌样生长，解剖正常实质成分，5 分。三个切片的评分总和。得分 3-6 分的病例定义为“非/最小浸润性”（NI；n=77），7-9 分为“中度浸润性”（MI；n=68），10-15 分为“高度浸润性”（HI；n=36）。除了与所有已确立的侵袭性标志物（分级、大小、T 分期）呈统计学显著相关性外，该分级系统在多变量分析中也是不良预后（转移、进展和死亡）的最显著预测因子，比 T 分期更为显著，而 Ki-67 指数在多变量检验中不成立。同样重要的是，该分级系统也适用于直径<=2cm 的病例，这使得该系统也适用于目前处于“观察等待”方案的这一组病例。总之，该分级系统具有较强的独立预后价值，因此在经过更大系列验证研究评估后，应考虑将其纳入常规病理实践。
