Heather Dawson1, Alexander Novotny2, Karen Becker3, Daniel Reim2, Rupert Langer4, Irene Gullo5, Magali Svrcek6, Jan H Niess7, Radu Tutuian7, Kaspar Truninger8, Ioannis Diamantis9, Annika Blank4, Inti Zlobec10, Robert H Riddell11, Fatima Carneiro5, Jean-François Fléjou6, Robert M Genta12, Alessandro Lugli4. 1. Clinical Pathology Division, Institute of Pathology, University of Bern, Bern, Switzerland; Translational Research Unit, Institute of Pathology, University of Bern, Bern, Switzerland. Electronic address: heather.dawson@pathology.unibe.ch. 2. Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Germany. 3. Institute of Pathology, Klinikum Rechts der Isar, Technische Universität München, Germany. 4. Clinical Pathology Division, Institute of Pathology, University of Bern, Bern, Switzerland; Translational Research Unit, Institute of Pathology, University of Bern, Bern, Switzerland. 5. Centro Hospitalar de São João/Medical Faculty of Porto, Porto, Portugal; Institute of Molecular Pathology and Immunology of the University of Porto/i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal. 6. Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Service d'Anatomie Pathologique, Paris, France. 7. University Clinic of Visceral Surgery and Medicine, Inselspital Bern, Switzerland. 8. Gastroenterologie Oberaargau, Langenthal, Switzerland. 9. Privatklinik Linde, Biel, Switzerland. 10. Translational Research Unit, Institute of Pathology, University of Bern, Bern, Switzerland. 11. Department of Pathology and Laboratory Medicine, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada. 12. Miraca Life Sciences, Research Institute, Irving, TX, United States; University of Texas Southwestern Medical Center, Dallas, TX, United States.
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 6.5cm (AUC 0.8; OR 1.397, 95% CI 1.35-1.446), and 6cm for lymph node metastases (AUC 0.775; OR 1.389, 95% CI 1.338-1.442). The 6cm 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.
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 6.5cm (AUC 0.8; OR 1.397, 95% CI 1.35-1.446), and 6cm for lymph node metastases (AUC 0.775; OR 1.389, 95% CI 1.338-1.442). The 6cm 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.