Mufaddal Kazi

Stromal Tumor infiltrating lymphocytes (sTILs) as a prognostic biomarker in Ovarian Cancer After Neoadjuvant chemotherapy

The aim of the study was to evaluate the prognostic impact of sTILs on survival in a specific cohort of patients of high grade serous epithelial ovarian cancer following interval cytoreductive surgery ± HIPEC. Formalin fixed, paraffin embedded (FFPE) tumor tissue of high grade serous ovarian cancer of 168 patients, undergoing interval cytoreductive surgery were evaluated by dedicated oncopathologists. The average stromal TIL percentage was calculated for each patient, for ovary and omentum. To determine a threshold for TILS in Ovarian cancer which can serve as a reference value for validation as a prognostic biomarker, we applied maximally distributed rank statistics using the 'maxstat' package from 'R-stats'. Overall survival was the endpoint for measuring prognosis. The prognostic significant of TILs on survival was determined using univariable log rank test and multivariable cox-regression analysis. The Intraclass coefficient for sTILS in the ovary was 0.882 [95 %CI 0.85-0.90] and 0.93 for sTILs in the omentum was 0.93 [95 %CI 0.91-0.95] showing that there was good interobserver agreement between the pathologist. Threshold for sTILS was 20 % for the ovary and 26 % for the omentum. sTILS in the ovary separated by the cut-off 20 %, showed an improvement in overall survival (OS) in both univariate as well as multivariate analysis. (Log rank 0.97 (0.94-0.99, p = 0.007), cox regression analysis, [HR 0.96 (95 %CI 0.93-0.99, p = 0.003) ] respectively. While our study provides some evidence for the prognostic role of sTILs in advanced high-grade serous epithelial ovarian cancer, the determined cut-off threshold warrants additional validation in future studies.

The Significance of the Morphological Appearance of Peritoneal Lesions on Imaging in Patients With Peritoneal Malignancies—A Report From Phase 1 of the PRECINCT Study

ABSTRACTBackground and AimThis is a report from Phase 1 of the prospective, observational, PRECINCT (Pattern of peritoneal dissemination and REsponse to systemic Chemotherapy IN Common and uncommon peritoneal Tumours) study, in which we studied the incidence of disease at pathological evaluation in different morphological appearances of peritoneal malignancies (PM) on imaging.MethodsRadiological findings were captured in a specific format that included a description of the morphological appearance of PM and a correlation performed with pathological findings.ResultsIn 630 patients enroled at seven centres (September 2022–December 2023), 24 morphological terms were used. Among prespecified terms (N = 8 used in 6350 [92.2%] regions), scalloping was pathologically positive in 93.5%, confluent disease in 78.8%, tumour nodules in 69.6%, thickening in 66.1%, infiltration in 56.3%. Among unspecified appearances (N = 16) for 540 (7.8%) regions, ‘enhancement’ was positive in 41.5%, micronodules in 65.3% and nodularity in 60.2%. Hierarchal clustering placed gastric cancer and rare tumours together and colorectal cancer, ovarian cancer and peritoneal mesothelioma in one cluster.ConclusionsThe incidence of disease at pathological evaluation for most morphological appearances was high (> 50%). Morphological description should be provided in routine radiology reports. A set of standardized terms with their description should be developed by a consensus among experienced radiologists.