Volumetric staging in radiotherapy for oropharyngeal cancers

2021 ◽  
pp. 030089162110509
Author(s):  
Marcin Miszczyk ◽  
Emilia Staniewska ◽  
Iwona Jabłońska ◽  
Aleksandra Lipka-Rajwa ◽  
Konrad Stawiski ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Oropharyngeal Cancer ◽  
Gross Tumor Volume ◽  
Tumor Volume ◽  
Stage Iv ◽  
Staging System ◽  
Tnm Staging ◽  
Independent Prognostic Factor ◽  
Tnm Staging System ◽  
Volumetric Staging

Introduction: Despite routine use of 3D radiotherapy planning in radical radio(chemo)therapy for oropharyngeal cancers, volumetric data have not been implemented in initial staging. We analyzed 228 oropharyngeal cancer cases treated at one institution between 2004 and 2014 to compare the predictive value of volumetric staging and tumor nodal metastasis staging system (TNM) and determine whether they could be complementary for the estimation of survival. Methods: This retrospective study analyzed 228 consecutive oropharyngeal cancer cases treated with radiotherapy (76.9%) or concurrent radiochemotherapy (23.1%) between 2004 and 2014. The volumetric parameters included primary gross tumor volume (pGTV), metastatic lymph nodes gross tumor volume (nGTV), and total gross tumor volume (tGTV), and were compared with the 7th edition of the TNM staging system. Results: Median overall survival (OS) was 30.3 months. In the receiver operating characteristic analysis, tGTV had the highest area under the curve (AUC) of 0.66, followed by pGTV (AUC,0.64), nGTV (AUC 0.62), and TNM (AUC 0.6). The median OS for patients with tGTV ⩽32.2 mL was 40.5 months, compared to 15.4 months for >32.2 mL ( p < 0.001). This threshold allowed for a statistically significant difference in survival between TNM stage IV cases with low and high tumor volume ( p < 0.001). Despite both TNM and tGTV reaching statistical significance in univariate analysis, only the tGTV remained an independent prognostic factor in the multivariate analysis (hazard ratio 1.07, confidence interval 1.02–1.12, p = 0.008). Conclusions: tGTV is an independent prognostic factor, characterized by a higher discriminatory value than the TNM staging system, and can be used to further divide stage IV cases into subgroups with significantly different prognosis.

scholarly journals Stromal Neutrophil Extracellular Trap Density Is an Independent Prognostic Factor for Cervical Cancer Recurrence

2021 ◽  
Vol 11 ◽  
Author(s):  
Bin Yan ◽  
Xuan Dai ◽  
Quanfu Ma ◽  
Xufeng Wu
Keyword(s):  
Cervical Cancer ◽  
Prognostic Factor ◽  
Tumor Microenvironment ◽  
Staging System ◽  
Tnm Staging ◽  
High Density ◽  
Independent Prognostic Factor ◽  
Neutrophil Extracellular Trap ◽  
Stromal Compartment ◽  
Tnm Staging System

BackgroundEmerging evidence indicates that the tumor microenvironment influences tumor progression and patient prognosis through various inflammatory cells. Polymorphonuclear neutrophils (PMNs) and their functional structures termed neutrophil extracellular traps (NETs) are prominent constituents of several malignant tumors and affect the tumor microenvironment and cancer evolution. Here, we investigate the prognostic value of PMNs and NETs for recurrence in patients with cervical cancer.MethodsThe study comprised 126 cervical cancer patients who were retrospectively enrolled. CD66b+ neutrophils and myeloperoxidase/citrullinated histone H3 (MPO/H3Cit)-labeled NETs were assessed by immunofluorescence, and the relationships with clinical and histopathologic features and patient outcome were evaluated.ResultsThe highest density of CD66b+ neutrophils were observed in the stromal compartment (median 55 cells/mm2). Above median densities of stromal CD66b+ neutrophils and NETs were significantly associated with short recurrence-free survival (RFS) (P = 0.041 and P = 0.006, respectively). Multivariate analysis identified high clinical stage (hazard ratio [HR] 6.40; 95% confidence interval [CI] 3.51-11.64; P &lt; 0.001), lymph node metastases (HR 4.69; 95% CI 3.09-9.66; P = 0.006) and high density of NETs (HR 2.66; 95% CI 1.21-5.82; P = 0.015) as independent prognostic factors for short RFS, whereas a high density of CD66b+ neutrophils was not significant. Patients with a high NET density showed worse recurrence status in every stage, but the difference was only significant for stage I (P = 0.042), not stages II, III, or IV (all P &gt; 0.05). Combining stromal NET density and the tumor, nodes, metastasis (TNM) staging system had better prognostic accuracy for cervical cancer than the TNM staging system alone at five and six years respectively (P = 0.010 and P = 0.023).ConclusionStromal NET density is an independent prognostic factor for RFS in cervical cancer. Combining NETs with the TNM staging system may further improve prognostic stratification.

PS02.050: TUMOR LOCATION IS AN INDEPENDENT PROGNOSTIC FACTOR OF ESOPHAGEAL ADENOCARCINOMA BASED ON THE EIGHTH EDITION OF TNM STAGING SYSTEM IN CHINESE PATIENTS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 134-134
Author(s):  
Yidan Lin ◽  
Hanyu Deng
Keyword(s):  
Prognostic Factor ◽  
Survival Time ◽  
Esophageal Adenocarcinoma ◽  
Staging System ◽  
Tumor Location ◽  
Tnm Staging ◽  
Independent Prognostic Factor ◽  
Chinese Patients ◽  
Tnm Staging System ◽  
Eighth Edition

Abstract Background Whether tumor location has any impact on the survival of esophageal adenocarcinoma patients remains controversial. In this study, we tried to investigate the prognostic value of tumor location for esophageal adenocarcinoma based on the eight edition of TNM staging system, which modified the description for positioning the esophagogastric junction (EGJ)tumor, in Chinese patients for the first time. Methods A retrospective analysis of patients who underwent esophagectomy for esophageal adenocarcinoma was conducted. Data for analysis included demographic data, comorbidity, pathologic findings, surgical approach, adjuvant therapy, and survival time. Tumor location was simply categorized into two groups (adenocarcinomas at EGJ and adenocarcinomas at other sites of esophagus). Both univariate and multivariate analyses were applied. Propensity-score matched (PSM) analysis was also conducted to eliminate the bias effects of confounding factors during comparison. Results A total of 107 patients from January 2009 to December 2015 was included for analysis. After a median follow-up time of 60.0 months, the median survival time of those patients was 41.0 months. In the univariate analysis, adenocarcinomas in the EGJ (P = 0.047), early pT stages (P = 0.030), and moderate/well differentiation (P = 0.022) were significantly correlated with better survival. In the multivariate analysis, tumor site [hazard ratio (HR) = 0.545; 95% confidence interval (CI) = 0.302–0.985], pT stage (HR = 0.295; 95% CI = 0.123–0.708), and tumor differentiation (HR = 0.458; 95% CI = 0.244–0.861) were significant independent prognostic factors for overall survival of those esophageal adenocarcinoma patients. After adjusted by PSM, adenocarcinoma at the EGJ still yielded significantly longer survival than those at other sites of esophagus (P = 0.026). Conclusion Tumor location was an independent prognostic factor for esophageal adenocarcinoma based on the eighth edition of TNM staging system in Chinese patients, which indicates that different surgical therapeutic modalities should be applied for esophageal adenocarcinoma with different tumor locations. Disclosure All authors have declared no conflicts of interest.

The clinicopathological and survival analysis of urological mucosal melanoma: A single-center retrospective observational study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21588-e21588
Author(s):  
Bixia Tang ◽  
Xieqiao Yan ◽  
Zhihong Chi ◽  
Siming Li ◽  
Chuanliang Cui ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Regional Lymph Node ◽  
Stage Iv ◽  
Staging System ◽  
Tnm Staging ◽  
Mucosal Melanoma ◽  
Future Research ◽  
Molecular Characteristics ◽  
Urethral Carcinoma ◽  
Tnm Staging System

e21588 Background: Primary mucosal melanoma arising in the urinary tract is rare and poorly characterized. Methods: The records of patients with urological mucosal melanoma who presented to the department of Renal Cancer and Melanoma of Peking University Cancer Hospital between September, 2004 and April, 2019 were reviewed. Available clinicopathological and molecular characteristics were summarized, including pathological parameters, gene mutation, primary surgical intervention, systemic treatment and clinical course. The rates of local recurrence rate, loco-regional lymph node metastasis and distant metastasis were assessed. American Joint Committee on Cancer (AJCC) TNM Staging System for bladder cancer/renal pelvis and ureter cancer/urethral carcinoma (8th ed., 2017) were adopted for staging. Results: Fifty-eight patients were involved in the study with a median age of 62.5 years (range: 32-82). The anatomic sites of the primary urological mucosal melanomas were from the urethra (89.7%), bladder (6.9%), ureter (0%) and kidney (0%), and the left (4.4%) were from multiple loci. At initial diagnosis, 75.9% (n=44) were stage I/II disease, 1.7% (n=1) stage III, and 22.4% (n=13) stage IV. There was 3.4% incidence of CKIT mutation and 1.7% of BRAF mutation. After median follow-up of 22.6 mo, 31.4% (16/51) relapsed locally after organ-preserved surgery. 21.6% (11/51) and 39.2% (20/51) developed metastases to reginal lymph nodes and distance, respectively. The median relapse free survival and median overall survival were 12.2 (95%CI: 7.9-16.4) mo and 33.9 (95%CI: 19.2-48.6) mo, respectively. Univariate Cox analysis showed that TNM stage and systemic adjuvant therapy were the prognostic factors of OS, while no association was found with Breslow thickness, miotic rate, ulceration and gender. Conclusions: Urological mucosal melanoma predominantly arises from lower urinary tract with rare BRAF and CKIT mutation. AJCC TNM Staging System for urothelial carcinoma is proved practical for urothelial melanoma, which should be validated in larger population. Future research is required to identify adjuvant treatment approaches to improve disease outcomes.

scholarly journals Validation of the 8th edition UICC/AJCC TNM staging system for HPV associated oropharyngeal cancer patients managed with contemporary chemo-radiotherapy

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Kirsten van Gysen ◽  
Mark Stevens ◽  
Linxin Guo ◽  
Dasantha Jayamanne ◽  
David Veivers ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Oropharyngeal Cancer ◽  
Staging System ◽  
Tnm Staging ◽  
Tnm Staging System ◽  
8Th Edition

Accuracy of TNM staging system in prognostic stratification of stage IV digestive endocrine tumors.

2010 ◽  
Vol 28 (15_suppl) ◽  
pp. e14588-e14588
Author(s):  
E. Merola ◽  
F. Panzuto ◽  
M. Rinzivillo ◽  
R. Valente ◽  
C. Bestani ◽  
...  
Keyword(s):  
Stage Iv ◽  
Staging System ◽  
Tnm Staging ◽  
Endocrine Tumors ◽  
Tnm Staging System ◽  
Prognostic Stratification

W1131 Accuracy of the Novel TNM Staging System in the Prognostic Stratification of Patients With Advanced, Stage IV Digestive Endocrine Tumors

2010 ◽  
Vol 138 (5) ◽  
pp. S-658
Author(s):  
Elettra Merola ◽  
Francesco Panzuto ◽  
Maria Rinzivillo ◽  
Stefano Festa ◽  
Claudia Bestani ◽  
...  
Keyword(s):  
Stage Iv ◽  
Staging System ◽  
Tnm Staging ◽  
Endocrine Tumors ◽  
Advanced Stage ◽  
The Novel ◽  
Tnm Staging System ◽  
Prognostic Stratification

Key Issues in Reporting Common Cancer Specimens: Problems in Pathologic Staging of Colon Cancer

2006 ◽  
Vol 130 (3) ◽  
pp. 318-324 ◽  
Author(s):  
Carolyn C. Compton
Keyword(s):  
Colorectal Cancer ◽  
Prognostic Factor ◽  
Staging System ◽  
Tnm Staging ◽  
International Union ◽  
Cancer Resection ◽  
American Joint Committee ◽  
Colorectal Cancer Resection ◽  
Tnm Staging System ◽  
Pathologic Staging

Abstract Context.—Standardized pathologic assessment is a quality measure for cancer care. Objective.—Pathologic staging parameters and the clinically important stage-independent pathologic factors that pathologists find most problematic to evaluate in colorectal cancer resection specimens are reviewed. The objective of this review is to provide practical guidance for the practicing surgical pathologist. Data Sources.—Published literature related to the TNM staging system for colorectal cancer of the American Joint Committee on Cancer and the International Union Against Cancer and to stage-independent tissue-based prognostic factor evaluation was included in the review. Study Selection, Data Extraction, and Synthesis.—Published guidelines from authoritative sources and published peer-reviewed data related to colorectal cancer staging and pathologic prognostic factor assessment were included for consideration. The general and site-specific rules of application of the American Joint Committee on Cancer and International Union Against Cancer TNM staging system for the colorectum and the protocol for evaluation of colorectal cancer resection specimens of the Cancer Committee of the College of American Pathologists served as the basis for discussion and amplified with practical advice on specific application. Conclusions.—Standardization of pathologic evaluation of colorectal cancer resection specimens is essential for optimal patient care and is aided by the use of data-driven guidelines that are easily understood and consistently applied.

A proposal for a novel and simple TNM staging for gastric cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 21-21 ◽  
Author(s):  
Taeil Son ◽  
Jiyu Sun ◽  
Hyoung-Il Kim ◽  
Jong Won Kim ◽  
Jae-Ho Cheong ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Metastatic Lymph Node ◽  
Stage Iv ◽  
Staging System ◽  
Tnm Staging ◽  
Rank Test ◽  
Discrimination Power ◽  
Tnm Staging System ◽  
N Classification ◽  
T Classification

21 Background: Current TNM staging system for gastric cancer has controversies regarding N classification. We aimed to develop a simple and novel TNM staging system for gastric cancer by re-grouping N classification. Methods: We retrospectively reviewed 14260 patients treated for gastric cancer. To develop simple combinations of TNM staging with similar weighted value between T and N classification, N classification was restructured with different cutoffs. The optimal cutoffs for the number of metastatic lymph node which maximize the x2 statistic of log-rank test for survival differences among patients were selected. C-statistic was used to compare the discriminating performance of the proposed N classification with the current N classification in the TNM staging system. We performed validation with 2 external datasets from a hospital in Korea (n = 1500) and SEER (n = 11324). Results: We identified the new cutoffs of N classification as 1~4, 5~10, 11~24, and 25 or more for N1, N2, N3a, and N3b, respectively. We found survival of the new N3b classification was similar to M1, regardless of T classification. Thus, we stratified these groups of N3b and M1 disease as stage IV, simultaneously. Our new TNM staging had similar weighted value between T and N classification resulting in simple combinations. (Table) Survival curves of subgroups in the new TNM staging had higher x2 value than current staging system (x2: 8239 vs. 7023, respectively) and homogeneity among subgroups in the same stage increased. However, C-statistics (0.801, 95%CI: 0.795, 0.807) of new model showed similar discrimination power than that (0.797, 95%CI: 0.791, 0.803) in 7th TNM staging system. C-statistics were also similar in other hospital in Korea (0.805 vs. 0.802, respectively) and SEER database (0.709 vs. 0.706, respectively). Conclusions: This novel staging system by recalculating cut-offs of N classification provides exceptionally simple and practical way to stratify substages in TNM staging for gastric cancer. [Table: see text]

Sign in / Sign up

Export Citation Format

Share Document