Prognostic score for survival with pulmonary carcinoids: the importance of associating clinical with pathological characteristics

2020 ◽  
Vol 31 (3) ◽  
pp. 315-323
Author(s):  
Marco Chiappetta ◽  
Isabella Sperduti ◽  
Leonardo Petracca Ciavarella ◽  
Giovanni Leuzzi ◽  
Emilio Bria ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Cox Model ◽  
Prognostic Score ◽  
Multivariable Analysis ◽  
Prognostic Index ◽  
Staging System ◽  
Node Metastasis ◽  
T Stage ◽  
Node Ratio ◽  
Tumour Node

Abstract OBJECTIVES Lung carcinoids (LCs) are staged using the non-small-cell lung cancer tumour/node/metastasis staging system; the possibility of an LC-specific staging system is still being debated. The goal of our study was to construct a composite prognostic score for LC. METHODS From January 2002 to December 2014, data from 293 patients who underwent surgical treatment for LC in 7 research institutes were retrospectively analysed. A panel of established prognostic factors in addition to lymph node metastasis patterns (single/multiple N1–N2 station, skip metastasis, lobe specific), numbers of lymph nodes resected and the ratio between the numbers of metastatic lymph nodes and the numbers of lymph nodes resected (node ratio) were correlated to overall survival (OS) and disease-free survival (DFS). The log-hazard ratio (HR), obtained from the Cox model, was used to derive weighting factors for a continuous prognostic index, designed to identify differential outcome risks. The score was dichotomized according to maximally selected log-rank statistics. RESULTS Pathological analysis showed typical carcinoids in 223 (76.1%) and atypical carcinoids in 70 (23.9%) patients; the tumour/node/metastasis pattern was stage I in 72.4%, stage II in 18.1%, stage III in 9.5% and stage IV in 0.03% cases. The median numbers of lymph nodes resected was 12 (range 0–53); hilar and mediastinal node metastases were identified in 14% and 6.8% of cases, respectively. Overall, the 5-year OS and 5-year DFS rates were 90.6% and 76.7%, respectively. At multivariable analysis, sex, age, pathological T stage and node ratio were significantly related to a better OS; age, histological type, pathological T stage and node ratio were related to DFS. These factors were used to generate the prognostic score, which showed statistically significant differences between the high-risk and low-risk groups: 5-year OS = 96.6% if score <3.1 vs 63.5% if score ≥3.1 [P < 0.0001; HR 17.56, 95% confidence interval (CI) 5.45–56.53]; 5-year DFS 92.3% if score <1.5 vs 52.5% if score ≥ 1.5 (P < 0.0001; HR 7.95, 95% CI 3.48–18.16). CONCLUSIONS The proposed prognostic scores seem to be effective in predicting outcomes for patients with LCs.

scholarly journals Positive lymph node ratio is an index in predicting prognosis for remnant gastric cancer with insufficient retrieved lymph node in R0 resection

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Honghu Wang ◽  
Hao Qi ◽  
Xiaofang Liu ◽  
Ziming Gao ◽  
Iko Hidasa ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Ratio ◽  
Prognostic Index ◽  
Staging System ◽  
R0 Resection ◽  
Remnant Gastric Cancer ◽  
Curative Intent ◽  
Node Ratio

AbstractThe staging system of remnant gastric cancer (RGC) has not yet been established, with the current staging being based on the guidelines for primary gastric cancer. Often, surgeries for RGC fail to achieve the > 15 lymph nodes needed for TNM staging. Compared with the pN staging system, lymph node ratio (NR) may be more accurate for RGC staging and prognosis prediction. We retrospectively analyzed the data of 208 patients who underwent R0 gastrectomy with curative intent and who have ≤ 15 retrieved lymph nodes (RLNs) for RGC between 2000 and 2014. The patients were divided into four groups on the basis of the NR cutoffs: rN0: 0; rN1: > 0 and ≤ 1/6; rN2: > 1/6 and ≤ 1/2; and rN3: > 1/2. The 5-year overall survival (OS) rates for rN0, rN1, rN2, and rN3 were 84.3%, 64.7%, 31.5%, and 12.7%, respectively. Multivariable analyses revealed that tumor size (p = 0.005), lymphovascular invasion (p = 0.023), and NR (p < 0.001), but not pN stage (p = 0.682), were independent factors for OS. When the RLN count is ≤ 15, the NR is superior to pN as an important and independent prognostic index of RGC, thus predicting the prognosis of RGC patients more accurately.

scholarly journals The science behind the 7th edition Tumour, Node, Metastasis staging system for lung cancer

Respirology ◽  
2012 ◽  
Vol 17 (2) ◽  
pp. 247-260 ◽  
Author(s):  
HENRY M. MARSHALL ◽  
STEVEN C. LEONG ◽  
RAYLEEN V. BOWMAN ◽  
IAN A. YANG ◽  
KWUN M. FONG
Keyword(s):  
Lung Cancer ◽  
Staging System ◽  
Node Metastasis ◽  
7Th Edition ◽  
Tumour Node

Rhabdomyosarcoma: the Stanford experience using a TNM staging system.

1986 ◽  
Vol 4 (3) ◽  
pp. 370-378 ◽  
Author(s):  
T J Pedrick ◽  
S S Donaldson ◽  
R S Cox
Keyword(s):  
Lymph Nodes ◽  
Staging System ◽  
Tnm Staging ◽  
Actuarial Survival ◽  
Entire Study ◽  
Histologic Subtype ◽  
Tnm System ◽  
T Stage ◽  
Tnm Staging System ◽  
Extent Of Disease

Seventy-four patients with rhabdomyosarcoma were initially staged according to the Intergroup Rhabdomyosarcoma Study (IRS) grouping classification and then retrospectively using a TNM staging system based on the initial clinical extent of disease. The TNM system includes T1, tumor confined to site or organ of origin; T2, regional extension beyond the site of origin; N0, normal lymph nodes; N1, lymph nodes containing tumor; M0, no evidence of metastases; and M1, distant metastases. All patients received combination chemotherapy, and more than 90% received radiation therapy as part of their initial treatment program with curative intent. Fifty-three of 74 patients (72%) were group III according to the IRS system, indicating unresectable or gross residual tumor. A more uniform distribution was achieved using the TNM system. Freedom from relapse (FFR) was 43% and the actuarial survival rate was 47% for the entire study group at 10 years. All but one relapse occurred within 3 years of initial diagnosis, and only three of 38 relapsed patients were salvaged. All TNM stage I patients are surviving disease free. Among patients having stages II, III, and IV disease by the TNM system, FFR was 53%, 26%, and 11%, and the survival rates were 47%, 36%, and 33%, respectively. Thirty-two of 74 patients (43%) had evidence of lymph node involvement at presentation, and 28 (88%) of these had primary lesions that extended beyond the site of origin (T2 primary). Histologic subtype and primary site had little impact on outcome in a multivariate analysis, and T stage was identified as the single most significant covariate correlated with survival; a model composed of both T stage and M stage was the best one for predicting relapse. The presented data support a study using a prospectively assigned TNM staging system based on the initial clinical extent of disease for use in future therapeutic trials.

Validation of the Princess Margaret immune oncology prognostic index (PM-IPI) for patients (pts) treated in immune oncology (IO) early phase trials.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 3070-3070
Author(s):  
Daphne Day ◽  
Anna Spreafico ◽  
Stephanie Lheureux ◽  
Albiruni Ryan Abdul Razak ◽  
Aaron Richard Hansen ◽  
...  
Keyword(s):  
Early Phase ◽  
Prognostic Score ◽  
Performance Status ◽  
Multivariable Analysis ◽  
Prognostic Index ◽  
Immune Checkpoints ◽  
Early Phase Trials ◽  
Metastatic Sites ◽  
Ecog Ps ◽  
Immune Oncology

3070 Background: We previously developed the PM-IPI (ECOG performance status [PS] > / = 1, albumin < lower limit of normal [LLN] and > 2 metastatic sites) from a retrospective cohort of 192 pts treated in phase I IO trials (development cohort). The PM-IPI prognosticated for overall survival (OS), 90-day mortality (90DM) and was associated with improved overall response rate (ORR) and progression free survival (PFS). Our aim was to prospectively validate the PM-IPI in an independent cohort of pts treated on IO trials. Methods: We included 152 consecutively treated advanced solid tumor pts at PM from Aug 2015 to Aug 2016 in 24 IO early phase trials, targeting immune checkpoints and/or co-stimulatory molecules. Pts from the development cohort were excluded. The ability of the PM-IPI to prognosticate OS and 90DM, and predict PFS and ORR was compared with the previously published Royal Marsden Hospital prognostic score (RMI: albumin < 35g/L, LDH > upper limit of normal and > 2 metastatic sites) using the C-index (0.5 = no discrimination, 1 = perfect discrimination) and Area Under the Curve (AUC). Results: Median age was 59y (range 20-86), 28%/72% of pts were ECOG PS 0/1, and 88% had at least 1 prior systemic therapy (range 0-7). The most common tumor sites were gastrointestinal (23%), gynecological (16%), head and neck (15%) and urological (10%). Median PFS and OS were 9.0 and 39.7 wk respectively and 90DM was 14%. ORR was 7% by RECIST 1.1, immune related RECIST or immune related response criteria. In multivariable analysis, ECOG PS > / = 1 (HR 2.7, p = 0.01), albumin < LLN (HR 2.1, p = 0.01) and > 2 metastatic sites (HR 1.8, p = 0.04) were independently prognostic for OS. Pts with a PM-IPI score of 2-3 compared to 0-1 had significantly shorter OS (HR 3.3, p < 0.0001), PFS (HR 1.7, p = 0.005) and higher 90DM (OR 12.2, p = 0.019), and a trend towards lower ORR (OR 0.4, p = 0.15). The prognostic performance of PM-IPI was superior to the RMI for OS and 90DM, but not PFS and ORR (Table). Conclusions: In this independent validation cohort, the PM-IPI prognosticated for OS and 90DM and was associated with PFS. Validation in a large external cohort is ongoing. [Table: see text]

scholarly journals Validation of The 2018 FIGO Staging System for Predicting The Prognosis of Patients With Stage IIIC Cervical Cancer

2021 ◽  
Author(s):  
Xingtao Long ◽  
Qi Zhou ◽  
Dongling Zou ◽  
Dong Wang ◽  
Jingshu Liu ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Multivariable Analysis ◽  
Staging System ◽  
Risk Of Death ◽  
T Stage ◽  
Figo Staging ◽  
Gynecology And Obstetrics ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Standardized Treatment

Abstract Purpose We aimed to validate the prognostic performance of the 2018 International Federation of Gynecology and Obstetrics(FIGO) IIIC staging system for patients with cervical cancer. Methods We conducted a retrospective analysis of patients with stage III cervical cancer according to the 2018 FIGO staging system who received standardized treatment from January 2011 to December 2014. Results Multivariable analysis revealed that stage IIIC1 was not significantly associated with increased risk of death compared with stages IIIA (hazard ratio [HR] = 1.432; 95% confidence interval [CI]: 0.867 to 2.366; P = 0.161) and IIIB (HR = 1.261; 95% CI: 0.871 to 1.827; P = 0.219). Stage IIIC2 was an independent indicator of increased risk of mortality compared with stages IIIA (HR = 2.958; 95% CI :1.757 to 4.983; P < 0.001) and IIIB (HR = 2.606; 95% CI: 1.752 to 3.877; P < 0.001). We stratified patients with stage IIIC1 according to T stage and compared survival outcomes. Stage IIIC1 (T1) was associated with longer 5-year overall survival (OS) compared with stages IIIA (P = 0.004) or IIIB (P < 0.001). An optimal cut-off value (= 2) was established for predicting the prognosis of stage IIIC1p(T1/T2a), which was associated with the number of pelvic lymph nodes metastases (PLNMs). Patients with stage IIIC1pN1-2 experienced longer 5-year OS compared those with stages IIIA (P = 0.01) or IIIB (P < 0.001). Conclusion Patients with stage IIIC1 cervical cancer exhibited heterogeneous clinical characteristics reflecting their variable prognoses, depending on T-stage and the extent of PLNMs

Evaluating the role of immune-checkpoint inhibitor (ICI) combinations in patients (pts) with unselected “cold” tumors enrolled in early clinical trials (CT).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 2597-2597
Author(s):  
Omar Saavedra Santa Gadea ◽  
Alberto Hernando-Calvo ◽  
Roger Berche ◽  
Maria Vieito ◽  
Irene Brana ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Ovarian Cancer ◽  
Clinical Trials ◽  
Cox Model ◽  
Prognostic Score ◽  
Prognostic Index ◽  
Progression Free Survival ◽  
Olfactory Neuroblastoma ◽  
Kaplan Meier ◽  
Best Response

2597 Background: In order to improve the expected response rate (ORR) of less than 10% in cold tumors, several ICI combinations are being evaluated in clinical trials. However, most of these trials don’t require any biomarker and pts are included based solely in histology. We aimed to assess the benefit of ICI combinations in pts with unselected cold tumors included in early CT. Methods: ICI naïve pts with cold tumors treated from 2015 to 2021 with ICI combinations in early CT at VHIO were reviewed. Clinico-pathological data and anti-tumor activity were extracted from a prospective database. ORR was defined as per RECIST v1.1 and clinical benefit rate (CBR) as complete/partial response (CR/PR) + stable disease (SD) for ≥ 4 months (m). Kaplan Meier estimates of progression-free survival (PFS) and overall survival (OS) were calculated and a Cox model according to LIPI (Lung Immune Prognostic Index = baseline LDH and derived neutrophil to lymphocyte ratio) was constructed. Immune-related adverse events (irAE) were classified as per CTCAE v.4.03. Hyperprogressive disease (HPD) was evaluated using RECIST v1.1 (Matos et al, 2020). Results: Out of 97 pts, median age was 62y, 61% had ECOG 0 and 29.8% had LIPI 0 (good prognostic score). Most pts had microsatellite stable (MSS) colorectal cancer (60.8%) or ovarian cancer (14.4%). Regimens included anti-PD1/L1 + another ICI in 69% (most commonly anti-LAG3 [26,8%] and CD40 agonist [20.9%]), anti-PD1/L1 + other molecule in 21.7% (most commonly SHP2 inhibitor [33.3%] and anti p53-HDM2 [28.5%]) and bispecific antibodies in 9.3% (anti-PD1/L1 + anti-LAG3 or CD137 agonist). No patient achieved a response. CBR was 15.3% (11 pts with MSS colorectal cancer, 2 ovarian cancer, 1 olfactory neuroblastoma, 1 paraganglioma). 33 pts (34%) presented irAE, 15 pts (15.5%) had irAE ≥ G2, 4 pts (4.1%) had G3 irAE (dry mouth, hypertransaminasemia, myocarditis and neutrophils count decreased) and 1 patient (1%) had G4 hyperglicemia. 58 pts (59.7%) had progressive disease (PD) as best response, 19 of these pts (32.7%) presented irAE. Overall, 20 pts (20.6%) met definition of HPD, representing 34.4% of pts with PD as best response. Median PFS for overall and CBR population were 1.9 m (CI95% 1.7-2.0) and 5.9 m (5.4-NR), respectively. Median OS for overall population was 7.6 m (5.9-9.5), with a trend for improved OS if LIPI good score vs. others (12.6 m vs. 6.2 m, hazard ratio 1.9, (CI 95% 1.1-3.3), p = 0.02). Among hyperprogressors, median OS was 5.33 m (3.39 - NR) and significantly worse LIPI scores (intermediate [1] or poor [2]) were observed as compared to pts with CBR (75% vs 53.3% p = 0.001). Conclusions: ICI combinations demonstrated very limited activity in pts with unselected cold tumors. However, the risk for irAE and HPD remain substantial. Further drug-biomarker co-development strategies are urgently needed to increase the risk benefit ratio for these pts.

scholarly journals Clinical and Biologic Features Predictive of Survival After Relapse of Neuroblastoma: A Report From the International Neuroblastoma Risk Group Project

2011 ◽  
Vol 29 (24) ◽  
pp. 3286-3292 ◽  
Author(s):  
Wendy B. London ◽  
Victoria Castel ◽  
Tom Monclair ◽  
Peter F. Ambros ◽  
Andrew D.J. Pearson ◽  
...  
Keyword(s):  
Cox Regression ◽  
Risk Group ◽  
Cox Model ◽  
Multivariable Analysis ◽  
Staging System ◽  
Group Project ◽  
Risk Of Death ◽  
Survival After Relapse ◽  
First Relapse ◽  
Time To Relapse

Purpose Survival after neuroblastoma relapse is poor. Understanding the relationship between clinical and biologic features and outcome after relapse may help in selection of optimal therapy. Our aim was to determine which factors were significantly predictive of postrelapse overall survival (OS) in patients with recurrent neuroblastoma—particularly whether time from diagnosis to first relapse (TTFR) was a significant predictor of OS. Patients and Methods Patients with first relapse/progression were identified in the International Neuroblastoma Risk Group (INRG) database. Time from study enrollment until first event and OS time starting from first event were calculated. Cox regression models were used to calculate the hazard ratio of increased death risk and perform survival tree regression. TTFR was tested in a multivariable Cox model with other factors. Results In the INRG database (N = 8,800), 2,266 patients experienced first progression/relapse. Median time to relapse was 13.2 months (range, 1 day to 11.4 years). Five-year OS from time of first event was 20% (SE, ± 1%). TTFR was statistically significantly associated with OS time in a nonlinear relationship; patients with TTFR of 36 months or longer had the lowest risk of death, followed by patients who relapsed in the period of 0 to less than 6 months or 18 to 36 months. Patients who relapsed between 6 and 18 months after diagnosis had the highest risk of death. TTFR, age, International Neuroblastoma Staging System stage, and MYCN copy number status were independently predictive of postrelapse OS in multivariable analysis. Conclusion Age, stage, MYCN status, and TTFR are significant prognostic factors for postrelapse survival and may help in the design of clinical trials evaluating novel agents.

scholarly journals The value of lymph node ratio and total number of lymph nodes examined for resected pancreatic signet ring cell carcinoma: a retrospective cohort study

2020 ◽  
Author(s):  
Chao Ren ◽  
Feng Xue ◽  
Yinying Wu ◽  
Zheng Wang
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Lymph Node Ratio ◽  
Signet Ring Cell Carcinoma ◽  
Signet Ring Cell ◽  
Node Metastasis ◽  
Signet Ring ◽  
Node Ratio ◽  
Ring Cell

Abstract Background—Pancreatic signet ring cell carcinoma (SRCC) was an exceedingly rare histological subtype of pancreatic cancer. Previous studies focused on the trends of incidence and independent predictors of pancreatic SRCC. Our objectives of the study was to analyze the prognostic value of lymph node ratio (LNR) and explore the minimal number of lymph nodes examined to accurately evaluate the N stage in resected pancreatic signet ring cell carcinoma.Method—The data diagnosed from January 1, 1990 to December 31, 2016 constituted the study cohort from the Surveillance, Epidemiology, and End Results(SEER) registry. We calculated overall survival (OS) of these patients using Kaplan–Meier analysis and Cox proportional hazards model and used receiver-operating characteristic curve (ROC) analysis to investigate the discriminatory ability of the total number of lymph nodes examined(TNLE) relative to whether lymph node metastasis.Results—The median number of lymph nodes examined among 120 patients of resected pancreatic SRCC was 14 (interquartile range, 6.25 to 20.0).According to the univariate analysis of overall survival(OS) result, age, grade, chemotherapy, LNR and TNLE were significantly different(P<0.05).Multivariate survival analysis showed that LNR and grade were the independent prognostic indicators after pancreatic SRCC resection for OS. TNLE ≥ 8 showed the highest discriminatory power to evaluate whether the lymph node metastasis (AUC 0.656, 95%CI 0.564-0.741, Youden index 0.2533, sensitivity 78.67%, specificity 46.67%, P= 0.003)Conclusion—Our study indicated that LNR was a valuable independent prognostic factor for resected pancreatic SRCC. Regional lymphadenectomy of at least 8 lymph nodes was necessary to stage patients accurately. Enough number lymph nodes examined was necessary for the clinicians to accurately predict the significance of LNR in resected pancreatic SRCC.

Tumour–node–metastasis staging of human papillomavirus negative upper aerodigestive tract cancers: a critical appraisal

2015 ◽  
Vol 129 (12) ◽  
pp. 1148-1155 ◽  
Author(s):  
U Aydil ◽  
U Duvvuri ◽  
Y Kizil ◽  
A Köybaşioğlu
Keyword(s):  
Human Papillomavirus ◽  
Current Knowledge ◽  
Anterior Commissure ◽  
Staging System ◽  
Scientific Data ◽  
Aerodigestive Tract ◽  
Upper Aerodigestive Tract ◽  
Node Metastasis ◽  
Upper Aerodigestive Tract Cancers ◽  
Tumour Node

AbstractObjective:The tumour–node–metastasis staging system has a dynamic structure that is continuously being updated as scientific data develops. This review discusses some suggested revisions on tumour–node–metastasis staging of human papillomavirus negative upper aerodigestive tract cancers.Methods:The seventh edition of The American Joint Committee on Cancer Staging Manual was reviewed and important issues that could be considered for revision were identified and discussed.Results:According to our assessment of the oncological outcomes of previous studies, the following factors should be considered for revision: anterior commissure involvement and subglottic extension in laryngeal cancers; underlying bone involvement in hard palate and upper alveolar ridge cancers; tumour thickness in oral cancers; and extracapsular spread and carotid artery involvement in neck metastases.Conclusion:Sufficient data on the prognostic importance of these issues have been reported. Suggested revisions in line with current knowledge on the clinical behaviour of upper aerodigestive tract cancers would improve the relevancy of staging.

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