A Modified T-stage Classification for Gastric Neuroendocrine Tumors

Colon and rectal neuroendocrine tumors (NETs) are often studied as one entity. Recent evidence suggests that worse outcomes are associated with colon compared with rectal NETs; direct comparisons are lacking. Our aim was to assess clinicopathologic, treatment, and survival differences between these diseases. All patients who underwent resection of colorectal NETs at one institution from 2000 to 2014 were included and analyzed. Of 29 patients, 12(41%) had colon and 17 (59%) had rectal NETs. Baseline demographics were similar between groups, although colon patients tended to be symptomatic at presentation (67% vs 44%, P = 0.41). Eighty-three per cent of colon patients underwent surgical resection, whereas 77 per cent of rectal patients underwent endoscopic or transanal resection ( P = 0.003). Colon patients had larger (3.4 cm vs 0.7 cm, P = 0.03), higher T-stage (T3/T4: 91% vs 14%, P = 0.003), higher grade tumors (42% vs 12%, P = 0.09) with more lymph nodes (58% vs 24%, P = 0.12) and lymphovascular invasion positivity (58% vs 24%, P = 0.32). Five-year disease-specific survival was 53% versus 80 per cent for colon and rectal patients, respectively ( P = 0.22). After excluding high-grade tumors, colon NETs were associated with lymphovascular invasion positivity (100% vs 17%, P = 0.05) and advanced T-stage (80% vs 8%, P = 0.01). Colon and rectal 5-year disease-specific survival was 67 versus 80 per cent ( P = 0.86). Colon and rectal NETs clinically seem to be distinct entities. Colon tumors have more aggressive clinicopathologic features, which may translate to worse outcomes. These differences in tumor biology may demand distinct management and should be further studied in a multi-institutional setting.

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A Novel T-Stage Classification System for Adrenocortical Carcinoma: Proposal from the U.S. Adrenocortical Carcinoma Study Group

VideoEndocrinology ◽

10.1089/ve.2017.0115 ◽

2018 ◽

Vol 5 (3) ◽

Author(s):

Cecilia G. Ethun ◽

Caroline E. Poorman ◽

Lauren M. Postlewait ◽

Thuy B. Tran ◽

Jason D. Prescott ◽

...

Keyword(s):

Adrenocortical Carcinoma ◽

Classification System ◽

Study Group ◽

T Stage ◽

Stage Classification ◽

The U.S

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Can we improve our ability to assess primary tumor stage of prostate cancer in patients with MRI-visible lesions? Development and external validation of a novel T-stage classification based on clinical and MRI findings

European Urology Open Science ◽

10.1016/s2666-1683(20)33753-8 ◽

2020 ◽

Vol 19 ◽

pp. e1722-e1723

Author(s):

G. Gandaglia ◽

G. Ploussard ◽

M. Valerio ◽

A. Mattei ◽

G. Marra ◽

...

Keyword(s):

Prostate Cancer ◽

Primary Tumor ◽

External Validation ◽

Tumor Stage ◽

Mri Findings ◽

T Stage ◽

Stage Classification

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Effect of computed tomography window settings and reconstruction plane on 8th edition T-stage classification in patients with lung adenocarcinoma manifesting as a subsolid nodule

European Journal of Radiology ◽

10.1016/j.ejrad.2017.11.015 ◽

2018 ◽

Vol 98 ◽

pp. 130-135 ◽

Cited By ~ 8

Author(s):

Hyungwoo Ahn ◽

Kyung Won Lee ◽

Kyung Hee Lee ◽

Jihang Kim ◽

Kwhanmien Kim ◽

...

Keyword(s):

Computed Tomography ◽

Lung Adenocarcinoma ◽

T Stage ◽

Stage Classification ◽

8Th Edition ◽

Reconstruction Plane ◽

Subsolid Nodule

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A novel t-stage classification system for adrenocortical carcinoma: Proposal from the U.S. Adrenocortical Carcinoma Study Group.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.266 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 266-266

Author(s):

Caroline Elizabeth Poorman ◽

Cecilia Grace Ethun ◽

Lauren McLendon Postlewait ◽

Thuy Tran ◽

Timothy M. Pawlik ◽

...

Keyword(s):

Adrenocortical Carcinoma ◽

Classification System ◽

Lymphovascular Invasion ◽

Study Group ◽

Poor Prognostic Factor ◽

Local Invasion ◽

T Stage ◽

Stage Classification ◽

Stage System ◽

Disease Specific

266 Background: The 7th AJCC T-stage classification system for adrenocortical carcinoma (ACC), based on size and extra-adrenal invasion, does not adequately stratify patients by survival. Lymphovascular invasion (LVI) is a known poor prognostic factor. We propose a novel T-stage system that incorporates LVI to better risk-stratify patients undergoing resection for ACC. Methods: Patients undergoing curative-intent resections for ACC from 1993-2014 at 13 institutions comprising the US ACC Study Group were included. Primary outcome was disease-specific survival (DSS). Results: Of 265 patients with ACC, 149 had complete data for analysis. The current T-stage system failed to differentiate patients with T2 vs T3 disease ( p= 0.10). Presence of LVI was associated with worse DSS compared to no LVI (36 vs. 168mos; p= 0.001). After accounting for the individual components of the current T-stage system (size and extra-adrenal invasion), LVI persisted as a poor prognostic factor on multivariable analysis (HR 2.14, 95% CI 1.05-4.38, p= 0.04). LVI positivity further stratified patients with T2 and T3 disease, (T2: 37mos vs median not reached; T3: 36 vs 96mos; p =0.03), but did not influence survival in patients with T1 or T4 disease. By incorporating LVI, a new T-stage classification system was created: [T1: < 5cm, (-)local invasion, (+/-)LVI; T2: > 5cm, (-)local invasion, (-)LVI OR any size, (+)local invasion, (-)LVI; T3: > 5cm, (-)local invasion, (+)LVI OR any size, (+)local invasion, (+)LVI; T4: any size, (+)adjacent organ invasion, (+/-)LVI]. Each progressive new T-stage group was associated with worse median DSS (T1: 167mos; T2: 96mos; T3: 37mos; T4: 15mos; p< 0.001). Conclusions: The current AJCC T-stage system for ACC does not adequately stratify patients by survival, particularly for T2 and T3 disease. The proposed T-stage classification system, which incorporates lymphovascular invasion, better differentiates T2 and T3 disease and accurately stratifies patients by disease-specific survival. If externally validated, this novel T-stage classification should be considered for future AJCC staging systems.

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The Eighth Edition of the American Joint Committee on Cancer Distant Metastases Stage Classification for Metastatic Pancreatic Neuroendocrine Tumors Might Be Feasible for Metastatic Pancreatic Ductal Adenocarcinomas

Neuroendocrinology ◽

10.1159/000502382 ◽

2019 ◽

Vol 110 (5) ◽

pp. 364-376 ◽

Cited By ~ 5

Author(s):

Junmiao Wen ◽

Jiayan Chen ◽

Di Liu ◽

Xinyan Xu ◽

Min Fan ◽

...

Keyword(s):

Prognostic Factors ◽

Neuroendocrine Tumors ◽

Metastatic Disease ◽

Stage Iv ◽

Distant Metastases ◽

World Health ◽

Neuroendocrine Neoplasm ◽

Pancreatic Neuroendocrine Tumors ◽

American Joint Committee ◽

Stage Classification

Background: Significant modifications have been made to the 8th edition of the American Joint Committee on Cancer (AJCC) distant metastases (M) stage classification for metastatic pancreatic neuroendocrine tumors (PanNETs). We aimed to validate this revised classification among metastatic PanNET patients using the Surveillance, Epidemiology, and End Results database. We further sought to evaluate the feasibility of applying this classification to metastatic pancreatic neuroendocrine carcinoma (PanNEC) and pancreatic ductal adenocarcinoma (PDAC) patients. Methods: Stage IV pancreatic neuroendocrine neoplasm (PanNEN, including G1/G2 PanNET and G3 PanNEC classified according to the World Health Organization [WHO] 2010 grading scheme) and PDAC patients with metastatic disease diagnosed between 2010 and 2015 were identified and restaged according to the revised M stage classification for PanNET. Overall survival (OS) was compared using Kaplan-Meier analysis and log-rank test. Uni- and multivariate Cox regression models were utilized to identify prognostic factors. Results: A total of 1,371 stage IV PanNEN and 634 PDAC patients were included. Among PanNEN patients, liver (75.0%) was the most common metastatic site, followed by distant lymph nodes (8.5%), lung (8.4%), bone (7.3%), and brain (1.0%). The 5-year OS for PanNET patients with M1a, M1b, and M1c stage was 44.15, 53.32, and 19.70%, respectively. However, survival comparison showed no significant difference between M1a and M1b stages among PanNET patients. Similar findings were noted after applying this classification to PanNEC patients. Multivariate analysis showed that the age at diagnosis and the number of distant metastatic sites were independent prognostic factors for metastatic PanNEN patients. Interestingly, excellent survival discrimination by M stage among stage IV PDAC patients was noted (M1a vs. M1b vs. M1c, 5-year OS: 5.42, 2.46, and 0%, respectively). Conclusion: Our study is the first large sample-based validation of the AJCC 8th M stage classification for PanNET. The revised classification did not effectively stratify metastatic PanNEN patients. However, further study is warranted to validate this classification for PanNET patients according to the WHO 2017 classification. Interestingly, the revised M stage classification might be feasible for PDAC patients with metastatic disease.

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