A novel tumor-node-metastasis (TNM) staging system of diffuse malignant peritoneal mesothelioma using outcome analysis of a multi-institutional database*

Background. Previous studies have demonstrated that the tumor-stromal ratio (TSR) was an independent prognostic factor in several types of carcinomas. This study aimed at exploring the prognostic significance of the TSR in invasive breast cancer using immunohistochemistry (IHC)-stained tissue microarrays (TMAs) and integrating the TSR into the traditional tumor-node-metastasis (TNM) staging system. Methods. The prepared 7 TMAs containing 240 patients with 480 invasive BC specimens were stained with cytokeratin (CK) by the IHC staining method. The ratio of tumor cells and stromal cells was visually assessed. TSR > 1 and TSR ≤ 1 were categorized as the high TSR (low stroma) and low TSR (high stroma) groups, respectively, and the prognostic value of the TSR at 5-year disease-free survival (5-DFS) was analyzed. A new Ts-TNM (tumor stroma-tumor-node-metastasis) staging system was established and assessed. Results. IHC staining of CK could specifically label tumor cells with clear contrast, making it easy to manually assess TSR. High TSR (low stroma) and low TSR (high stroma) were observed in 52.5% (n = 126) and 47.5 (n = 114) of the cases, according to the division of value 1. A Kaplan–Meier analysis showed that patients in the low TSR group had a worse 5-DFS compared with patients in the high TSR group (P=0.022). Multivariable analysis indicated that the T stage (P=0.014), N status (P<0.001), histological grade (P<0.001), estrogen receptor status (P=0.015), and TSR (P=0.011) were independent prognostic factors of invasive BC patients. The new Ts-TNM staging system combining TSR, tumor staging, lymph node status, and metastasis staging was established. The receiver operating characteristic (ROC) curve analysis demonstrated that the ability of the Ts-TNM staging system to predict recurrence was not lower than that of the TNM staging system. Conclusions. This study confirms that the TSR is a prognostic indicator for invasive breast cancer. The Ts-TNM staging system containing stromal and tumor information may optimize risk stratification for invasive breast cancer.

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Impacts of the American Joint Committee on Cancer (AJCC) 8th edition tumor, node, metastasis (TNM) staging system on outcomes of differentiated thyroid cancer in Thai patients

Heliyon ◽

10.1016/j.heliyon.2021.e06624 ◽

2021 ◽

Vol 7 (3) ◽

pp. e06624

Author(s):

Yotsapon Thewjitcharoen ◽

Waralee Chatchomchuan ◽

Krittadhee Karndumri ◽

Sriurai Porramatikul ◽

Sirinate Krittiyawong ◽

...

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Staging System ◽

Tnm Staging ◽

Tumor Node Metastasis ◽

Node Metastasis ◽

American Joint Committee ◽

Tnm Staging System ◽

8Th Edition

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Reconsideration of the lymph node metastasis pattern (N factor) from intrahepatic cholangiocarcinoma using the International Union Against Cancer TNM staging system for primary liver carcinoma

Cancer ◽

10.1002/(sici)1097-0142(19981101)83:9<1923::aid-cncr7>3.0.co;2-# ◽

1998 ◽

Vol 83 (9) ◽

pp. 1923-1929 ◽

Cited By ~ 51

Author(s):

Yoshihiro Nozaki ◽

Masayuki Yamamoto ◽

Iwao Ikai ◽

Yuzo Yamamoto ◽

Nobuhiro Ozaki ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Metastasis ◽

Intrahepatic Cholangiocarcinoma ◽

Staging System ◽

Tnm Staging ◽

Liver Carcinoma ◽

International Union ◽

Primary Liver Carcinoma ◽

Node Metastasis ◽

Tnm Staging System

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Different View on Tumor Size Dilemma in Tumor-Node-Metastasis Staging System for Thymoma

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0040-1715490 ◽

2020 ◽

Author(s):

Ayten Kayı Cangir ◽

Bülent Mustafa Yenigün ◽

Tamer Direk ◽

Gokhan Kocaman ◽

Ugurum Yücemen ◽

...

Keyword(s):

Tumor Size ◽

Tnm Classification ◽

Staging System ◽

Tnm Staging ◽

R0 Resection ◽

Tumor Diameter ◽

Tumor Node Metastasis ◽

Node Metastasis ◽

The Mean ◽

Definition Of

Abstract Background Although tumor size is included in the definition of T descriptor in the tumor-node-metastasis (TNM) classification of many solid tumors, it is not considered for thymomas. This study aimed to assess the relationship of tumor diameters (the largest tumor diameter [LTD] and the mean tumor diameter [MTD]) with survival in thymoma patients undergoing surgical resection in a single center. Methods The study included 127 thymoma patients (age, 49.2 ± 15.2 years; 65 males), who were evaluated based on pathological tumor sizes according to the LTD and MTD ([largest diameter + shortest diameter] / 2) and divided into three subgroups for each parameter as: patients with an LTD of ≤5 cm, 5.1 to 10 cm, and >10 cm and patients with an MTD of ≤5, 5.1 to 10, and >10 cm. Results In thymoma patients, survival significantly differed according to the presence of myasthenia gravis (p = 0.018), resection status (R0 or R1; p = 0.001), T status (p = 0.015), and the Masaoka–Koga stage (p = 0.003). In the LTD subgroups, the overall survival of those with R0 resection was lower in those with an LTD of 5.1 to 10 cm than in those with an LTD of ≤5 cm (p = 0.051) and significantly lower in those with an MTD of 5.1 to 10 cm than in those with an MTD of ≤5 cm (p = 0.027). In the MTD subgroups, survival decreased as the tumor size increased. Conclusion Both smaller tumor size and complete resection are associated with better survival in thymoma patients. Therefore, the largest or the mean tumor size might be considered as a criterion in the TNM staging for thymoma.

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A proposed staging system for diffuse malignant peritoneal mesothelioma patients undergoing cytoreductive surgery and perioperative intraperitoneal chemotherapy

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.4150 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 4150-4150

Author(s):

P. H. Sugarbaker ◽

T. Yan ◽

D. Yoo ◽

E. Brun ◽

C. Cerruto ◽

...

Keyword(s):

Overall Survival ◽

Intraperitoneal Chemotherapy ◽

Cytoreductive Surgery ◽

Staging System ◽

Peritoneal Mesothelioma ◽

Nuclear Size ◽

Prognostic Parameters ◽

Malignant Peritoneal Mesothelioma ◽

Diffuse Malignant Peritoneal Mesothelioma ◽

The Mean

4150 Background: There is no staging system available for diffuse malignant peritoneal mesothelioma (DMPM). This study evaluated seven clinical, seven radiological and twelve histopathologic prognostic parameters for survival of patients with DMPM. Methods: Between September 1989 and September 2005, sixty-two DMPM patients who were treated in a uniform fashion utilizing cytoreductive surgery combined with heated intraoperative intraperitoneal chemotherapy, with cisplatin and doxorubicin, followed by early postoperative intraperitoneal paclitaxel from postoperative day 1 to day 5 were included in this study. All prognostic parameters were analyzed in univariate and multivariate analyses using overall survival as the endpoint. The clinical and radiological data were obtained prospectively. A review of the histopathological features of DMPM was performed by two experienced pathologists, who individually evaluated each case. The mean number of specimens taken from separate anatomic sites was 11 ± 4 per patient. The mean number of slides studied was 20 ± 8 per patient. Results: The median follow-up was 37 months (range 8 to 143 months). The overall survival was 79 months (range 1 to 143 months) and 5-year survival was 50%. The following 14 prognostic variables were significant for survival in the univariate analysis: gender (p = 0.045), peritoneal cancer index (p = 0.038), completeness of cytoreduction score (p = 0.010), interpretive CT findings of the small bowel (p = 0.001), histologic type (p < 0.001), nuclear size (p < 0.001), nuclear/cytoplasmic ratio (p < 0.001), mitotic count (p < 0.001), atypical mitosis (p < 0.001), chromatin pattern (p < 0.001), cellular necrosis (p < 0.001), perineural invasion (p = 0.037), stroma pattern (p < 0.001) and depth of invasion (p = 0.014). In the multivariate analysis, the only factor that was independently associated with an improved survival was nuclear size. The 3-year survival rates with nuclear size of 10–20 μm, 21–30 μm, 31–40 μm and > 40 μm were 100%, 87%, 27% and 0%, respectively. Conclusions: Nuclear size was the dominant factor determining overall survival in patients with DMPM. A histopathological staging system based on measurement of the nuclear size was proposed. No significant financial relationships to disclose.

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Significance of lymph node metastasis in patients with diffuse malignant peritoneal mesothelioma

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2006.05.009 ◽

2006 ◽

Vol 32 (9) ◽

pp. 948-953 ◽

Cited By ~ 44

Author(s):

T.D. Yan ◽

D. Yoo ◽

P.H. Sugarbaker

Keyword(s):

Lymph Node ◽

Lymph Node Metastasis ◽

Peritoneal Mesothelioma ◽

Malignant Peritoneal Mesothelioma ◽

Node Metastasis ◽

Diffuse Malignant Peritoneal Mesothelioma

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Establishment of a Nomogram by Integrating Molecular Markers and Tumor-Node-Metastasis Staging System for Predicting the Prognosis of Hepatocellular Carcinoma

Digestive Surgery ◽

10.1159/000494219 ◽

2018 ◽

Vol 36 (5) ◽

pp. 426-432 ◽

Cited By ~ 4

Author(s):

Xi-Tai Huang ◽

Liu-Hua Chen ◽

Chen-Song Huang ◽

Jian-Hui Li ◽

Jian-Peng Cai ◽

...

Keyword(s):

Molecular Markers ◽

Validation Cohort ◽

External Validation ◽

Staging System ◽

Tnm Staging ◽

Hazard Ratio ◽

Tumor Node Metastasis ◽

Training Cohort ◽

Tnm Staging System

Aims: This study aimed to develop a valuable nomogram by integrating molecular markers and tumor-node-metastasis (TNM) staging system for predicting the long-term outcome of patients with hepatocellular carcinoma (HCC). Methods: The gene expression profiles of HCC patients undergoing liver resection were obtained from the Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) database. One hundred and ninety-nine patients from TCGA and 94 patients from GEO were selected to be part of the training cohort and validation cohort respectively. Univariate and multivariate cox analyses were performed to identify genes with independent prognostic values for overall survival (OS) of HCC patients in training cohort. Risk score was calculated based on the coefficients and Z-score of 3 genes for each patient. The nomogram was developed based on the risk score and TNM staging system. Discrimination and predictive accuracy of the nomogram were measured by using the concordance index (C-index) and calibration curve. The efficacy of the nomogram was tested in the external validation cohort. Results: Univariate and multivariate cox analyses revealed that EXT2 (p = 0.035, hazard ratio 13.412), ETV5 (p = 0.010, hazard ratio 4.325), and CHODL (p < 0.001, hazard ratio 6.286) were independent prognostic factors and chosen for further nomogram establishment. The C-index of the nomogram for predicting the OS in the training cohort was superior to that of the TNM staging system (0.77 vs. 0.64, p < 0.01). The calibration curve of predicted 1-, 3-, and 5-year OS showed satisfactory accuracy. The external validation cohort showed good performance of comprehensive nomogram as well. Conclusion: The novel nomogram by integrating the molecular markers and TNM staging system has better performance in predicting long-term prognosis in HCC patients than the TNM staging system alone.

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