title: Macroscopy predicts tumor progression in gastric cancer: A retrospective patho-historical analysis based on Napoleon Bonaparte's autopsy report.
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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors: 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.
authors: Heather
authors: H
authors: Dawson
authors: Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Germany.
authors: Alexander
authors: A
authors: Novotny
authors: Institute of Pathology, Klinikum Rechts der Isar, Technische Universität München, Germany.
authors: Karen
authors: K
authors: Becker
authors: Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Germany.
authors: Daniel
authors: D
authors: Reim
authors: Clinical Pathology Division, Institute of Pathology, University of Bern, Bern, Switzerland; Translational Research Unit, Institute of Pathology, University of Bern, Bern, Switzerland.
authors: Rupert
authors: R
authors: Langer
authors: 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.
authors: Irene
authors: I
authors: Gullo
authors: Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Service d'Anatomie Pathologique, Paris, France.
authors: Magali
authors: M
authors: Svrcek
authors: University Clinic of Visceral Surgery and Medicine, Inselspital Bern, Switzerland.
authors: Jan H
authors: JH
authors: Niess
authors: University Clinic of Visceral Surgery and Medicine, Inselspital Bern, Switzerland.
authors: Radu
authors: R
authors: Tutuian
authors: Gastroenterologie Oberaargau, Langenthal, Switzerland.
authors: Kaspar
authors: K
authors: Truninger
authors: Privatklinik Linde, Biel, Switzerland.
authors: Ioannis
authors: I
authors: Diamantis
authors: Clinical Pathology Division, Institute of Pathology, University of Bern, Bern, Switzerland; Translational Research Unit, Institute of Pathology, University of Bern, Bern, Switzerland.
authors: Annika
authors: A
authors: Blank
authors: Translational Research Unit, Institute of Pathology, University of Bern, Bern, Switzerland.
authors: Inti
authors: I
authors: Zlobec
authors: Department of Pathology and Laboratory Medicine, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada.
authors: Robert H
authors: RH
authors: Riddell
authors: 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.
authors: Fatima
authors: F
authors: Carneiro
authors: Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Service d'Anatomie Pathologique, Paris, France.
authors: Jean-François
authors: JF
authors: Fléjou
authors: Miraca Life Sciences, Research Institute, Irving, TX, United States; University of Texas Southwestern Medical Center, Dallas, TX, United States.
authors: Robert M
authors: RM
authors: Genta
authors: Clinical Pathology Division, Institute of Pathology, University of Bern, Bern, Switzerland; Translational Research Unit, Institute of Pathology, University of Bern, Bern, Switzerland.
authors: Alessandro
authors: A
authors: Lugli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D005197:Famous Persons; D005260:Female; D049671:History, 18th Century; D049672:History, 19th Century; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013270:Stomach / Q000473:pathology*; D013274:Stomach Neoplasms / Q000266:history / Q000473:pathology*; D055815:Young Adult
keywords: Autopsy; Gastric cancer; Napoleon Bonaparte; Tumor size