Macroscopy predicts tumor progression in gastric cancer: A retrospective patho-historical analysis based on Napoleon Bonaparte's autopsy report

Heather Dawson, Alexander Novotny, Karen Becker, Daniel Reim, Rupert Langer, Irene Gullo, Magali Svrcek, Jan H. Niess, Radu Tutuian, Kaspar Truninger, Ioannis Diamantis, Annika Blank, Inti Zlobec, Robert H. Riddell, Fatima Carneiro, Jean François Fléjou, Robert M. Genta, Alessandro Lugli

Research output: Contribution to journalArticle

Abstract

Background The cause of Napoleon Bonaparte's death remains controversial. Originally suggested to be gastric cancer, whether this was truly neoplastic or a benign lesion has been recently debated. Aims To interpret findings of original autopsy reports in light of the current knowledge of gastric cancer and to highlight the significance of accurate macroscopy in modern-day medicine. Methods Using original autopsy documents, endoscopic images and data from current literature, Napoleon's gastric situation was reconstructed. In a multicenter collection of 2071 gastric cancer specimens, the relationship between tumor size and features of tumor progression was assessed. Results Greater tumor size was associated with advanced pT, nodal metastases and Borrmann types 3–4 (p < 0.001). The best cut-off for predicting pT3-4 tumors was 6.5 cm (AUC 0.8; OR 1.397, 95% CI 1.35–1.446), and 6 cm for lymph node metastases (AUC 0.775; OR 1.389, 95% CI 1.338–1.442). The 6 cm cut-off of had a positive predictive value of 0.820 for nodal metastases and a negative predictive value of 0.880 for distant metastases. Conclusion This analysis combines Napoleon's autopsy with present-day knowledge to support gastric cancer as his terminal illness and emphasizes the role of macroscopy, which may provide valuable information on gastric cancer progression and aid patient management.

Original languageEnglish (US)
Pages (from-to)1378-1385
Number of pages8
JournalDigestive and Liver Disease
Volume48
Issue number11
DOIs
StatePublished - Nov 1 2016

Keywords

  • Autopsy
  • Gastric cancer
  • Napoleon Bonaparte
  • Tumor size

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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    Dawson, H., Novotny, A., Becker, K., Reim, D., Langer, R., Gullo, I., Svrcek, M., Niess, J. H., Tutuian, R., Truninger, K., Diamantis, I., Blank, A., Zlobec, I., Riddell, R. H., Carneiro, F., Fléjou, J. F., Genta, R. M., & Lugli, A. (2016). Macroscopy predicts tumor progression in gastric cancer: A retrospective patho-historical analysis based on Napoleon Bonaparte's autopsy report. Digestive and Liver Disease, 48(11), 1378-1385. https://doi.org/10.1016/j.dld.2016.07.013