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International consensus guidelines for scoring the histopathological growth patterns of liver metastasis

Research output: Contribution to journalJournal articleResearchpeer-review


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  • Pieter-Jan van Dam
  • Eric P van der Stok
  • Laure-Anne Teuwen
  • Gert G Van den Eynden
  • Martin Illemann
  • Sophia Frentzas
  • Ali W Majeed
  • Rikke L Eefsen
  • Robert R J Coebergh van den Braak
  • Anthoula Lazaris
  • Maria Celia Fernandez
  • Boris Galjart
  • Ole Didrik Laerum
  • Roni Rayes
  • Dirk J Grünhagen
  • Michelle Van de Paer
  • Yves Sucaet
  • Hardeep Singh Mudhar
  • Michael Schvimer
  • Hanna Nyström
  • Mark Kockx
  • Nigel C Bird
  • Fernando Vidal-Vanaclocha
  • Peter Metrakos
  • Eve Simoneau
  • Cornelis Verhoef
  • Luc Y Dirix
  • Steven Van Laere
  • Zu-Hua Gao
  • Pnina Brodt
  • Andrew R Reynolds
  • Peter B Vermeulen
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BACKGROUND: Liver metastases present with distinct histopathological growth patterns (HGPs), including the desmoplastic, pushing and replacement HGPs and two rarer HGPs. The HGPs are defined owing to the distinct interface between the cancer cells and the adjacent normal liver parenchyma that is present in each pattern and can be scored from standard haematoxylin-and-eosin-stained (H&E) tissue sections. The current study provides consensus guidelines for scoring these HGPs.

METHODS: Guidelines for defining the HGPs were established by a large international team. To assess the validity of these guidelines, 12 independent observers scored a set of 159 liver metastases and interobserver variability was measured. In an independent cohort of 374 patients with colorectal liver metastases (CRCLM), the impact of HGPs on overall survival after hepatectomy was determined.

RESULTS: Good-to-excellent correlations (intraclass correlation coefficient >0.5) with the gold standard were obtained for the assessment of the replacement HGP and desmoplastic HGP. Overall survival was significantly superior in the desmoplastic HGP subgroup compared with the replacement or pushing HGP subgroup (P=0.006).

CONCLUSIONS: The current guidelines allow for reproducible determination of liver metastasis HGPs. As HGPs impact overall survival after surgery for CRCLM, they may serve as a novel biomarker for individualised therapies.

Original languageEnglish
JournalB J C
Issue number10
Pages (from-to)1427-1441
Number of pages15
Publication statusPublished - 7 Nov 2017

    Research areas

  • Humans, Liver Neoplasms, Neoplasm Metastasis, Journal Article, Practice Guideline

ID: 52667780