scholarly journals A hypothesized TNM staging system based on the number and location of positive lymph nodes may better reflect the prognosis for patients with NSCLC

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Xiaoling Shang ◽  
Jia Liu ◽  
Zhenxiang Li ◽  
Jiamao Lin ◽  
Haiyong Wang
Keyword(s):  
Lymph Nodes ◽  
Staging System ◽  
Tnm Staging ◽  
Tnm Staging System ◽  
Positive Lymph Nodes

scholarly journals A Nomogram Based on the Log Odds of Positive Lymph Nodes Predicts the Prognosis of Patients With Distal Cholangiocarcinoma After Surgery

2021 ◽  
Vol 8 ◽  
Author(s):  
Rui Li ◽  
Zhenhua Lu ◽  
Zhen Sun ◽  
Xiaolei Shi ◽  
Zhe Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Staging System ◽  
Tnm Staging ◽  
Distal Cholangiocarcinoma ◽  
Tnm Staging System ◽  
Log Odds ◽  
Independent Risk Factors ◽  
Positive Lymph Nodes

Background: Lymph node (LN) metastasis is considered one of the most important risk factors affecting the prognosis of distal cholangiocarcinoma (DCC). This study aimed to demonstrate the superiority of log odds of positive lymph nodes (LODDS) compared with other LN stages, and to establish a novel prognostic nomogram to predict the cancer-specific survival (CSS) of DCC.Methods: From the Surveillance, Epidemiology and End Results (SEER) database, the data of 676 patients after DCC radical operation were screened, and patients were randomly divided into training (n = 474) and validation sets (n = 474). The prognostic evaluation performance of the LODDS and American Joint Commission on Cancer (AJCC) N stage and lymph node ratio (LNR) were compared using the Akaike information criteria, receiver operating characteristic area under the curve (AUC), and C-index. Multivariate Cox analysis was used to screen independent risk factors, and a LODDS-based nomogram prognostic staging model was established. The nomogram's precision was verified by C-index, calibration curves, and AUC, and the results were compared with those of the AJCC TNM staging system.Results:Compared with the other two stages of LN metastasis, LODDS was most effective in predicting CSS in patients with DCC. Multivariate analysis proved that LODDS, histologic grade, SEER historic stage, and tumor size were independent risk factors for DCC. The C-index of the nomogram, based on the above factors, in the validation set was 0.663. The 1-, 3-, and 5-y AUCs were 0.735, 0.679, and 0.745, respectively. Its good performance was also verified by calibration curves. In addition, the C-index and Kaplan-Meier analysis showed that the nomogram performed better than the AJCC TNM staging system.Conclusion:For postoperative patients with DCC, the LODDS stage yielded better prognostic efficiency than the AJCC N and LNR stages. Compared with the AJCC TNM staging system, the nomogram, based on the LODDS, demonstrated superior performance.

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.

scholarly journals A novel pN3 gastric cancer staging system with superior prognostic utility based upon the examination of over 31 lymph nodes: a propensity score-matching analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Qiantao Hu ◽  
Siwei Pan ◽  
Zijun Guo
Keyword(s):  
Gastric Cancer ◽  
Propensity Score ◽  
Lymph Nodes ◽  
Propensity Score Matching ◽  
Staging System ◽  
Tnm Staging ◽  
Survival Outcomes ◽  
The Novel ◽  
Risk Of Death ◽  
Tnm Staging System

Abstract Background Individuals with pN3 gastric cancer (GC) account for a large proportion of pN + GC, and exhibit poor survival outcomes. The pN3 stage is defined based upon the number of metastatic lymph nodes (mLNs), but the subclassification of pN3 patients based upon the number of examined LNs (eLNs) is rarely performed. Methods In total, 2894 pTxN3M0 GC patients in the Surveillance, Epidemiology, and End Results database that had undergone surgery from 2000 to 2016 were selected for analysis. The X-tile software was used to select the optimal cutoff values. Cox proportional regression analyses were used to evaluated hazard ratios corresponding to the risk of death. Selection bias was minimized via propensity score matching (PSM). Results As the number of eLNs rose, the risk of death for patients trended downwards. Survival analyses indicated that patients with ≤ 31 eLNs exhibited significantly poorer survival outcomes as compared to patients with > 31 eLNs (5-year OS: 18.4% vs. 24.7%), and this result remained significant when analyzing 857 pairs of patients following PSM analysis. Significant differences in prognosis were additionally observed when comparing pN3a and pN3b patients with ≤ 31 or > 31 eLNs under pT3/4a stage. For pT4b stage, pN3a patients with > 31 eLNs also exhibited a better prognosis than other patients. The novel TNM staging system designed exhibited excellent utility as a tool for the prognostic evaluation of this GC patient population. Conclusions These results suggest that in pN3 GC, a minimum of 32 LNs should be examined. The novel TNM staging system for pN3 patients described herein, which was developed based upon the number of eLNs, may thus be of value in clinical settings.

scholarly journals Prognostic Value of Lymphovascular Invasion in Stage Ⅱ Colorectal Cancer Patients with an Inadequate Examination of Lymph Nodes.

2021 ◽  
Author(s):  
Zhenyan Gao ◽  
Huihua Cao ◽  
Xiang Xu ◽  
Qing Wang ◽  
Yugang Wu ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Nodes ◽  
Prognostic Value ◽  
Multivariate Analyses ◽  
Disease Free Survival ◽  
Staging System ◽  
Tnm Staging ◽  
Tnm Staging System ◽  
Kras Status ◽  
Serum Cea

Abstract BackgroundLymphovascular invasion (LVI) is defined as the existence of cancer cells in lymphatics or blood vessels. This study aimed to evaluate the prognostic value of LVI in stage Ⅱ colorectal cancer (CRC) patients with inadequate examination of lymph nodes (ELNs) and further combined LVI with the TNM staging system to determine the predictive efficacy for CRC prognosis. Adjuvant chemotherapy (ACT) was then evaluated for stage Ⅱ CRC patients with LVI positivity (LVI +).MethodsThe clinicopathologic records of 1420 CRC patients treated at the Third Affiliated Hospital of Soochow University between February 2007 and February 2013 were retrospectively reviewed. LVI was examined by hematoxylin-eosin (HE) staining. Kaplan-Meier analysis followed by a log-rank test was used to analyze survival rates. Univariate and multivariate analyses were performed using a Cox proportional hazards model. The Harrell’s concordance index (C-index) was used to evaluate the accuracy of different systems in predicting prognosis.ResultsThe LVI status was significantly associated with pT stage, degree of differentiation, tumor stage, serum CEA and CA19-9 levels, perineural invasion (PNI) and KRAS status. The 5-year overall survival (OS) rate of stage Ⅱ patients with < 12 ELNs and LVI + was less than stage ⅢA. Multivariate analyses showed that LVI, pT-stage, serum CEA and CA19-9 levels, PNI and KRAS status were significant prognostic factors for stage Ⅱ patients with < 12 ELNs. The 8th TNM staging system combined with LVI showed a higher C-index than the 8th TNM staging system alone (C-index, 0.895 vs. 0.833). Among patients with LVI + the ACT group had a significantly higher 5-year OS and 5-year disease-free survival (DFS) than the surgery alone (SA) group (5-year OS, 66.7% vs. 40.9%, P = 0.004; 5-year DFS, 64.1% vs. 36.3%, P = 0.002).ConclusionsLVI is an independent prognostic risk factor for stage Ⅱ CRC patients. Combining LVI with the 8th TNM staging system improved the predictive accuracy for CRC prognosis. ACT in stage Ⅱ CRC patients with LVI + is beneficial for survival.

A western validation of a novel gastric cancer prognostic model using American data.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 2-2
Author(s):  
Bryan S. Goldner ◽  
Ki Jun Song ◽  
Taeil Son ◽  
Hyoung-Il Kim ◽  
Laleh Melstrom ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Nodes ◽  
Prediction Model ◽  
Cancer Patients ◽  
Staging System ◽  
Tnm Staging ◽  
Prediction Tool ◽  
C Statistic ◽  
Tnm Staging System ◽  
Gastric Cancer Patients

2 Background: A novel prediction model, the Yonsei University Gastric Cancer Prediction Tool was developed by an international collaborative group (G6+) for accurate determination of 5-year overall survival of gastric cancer patients. This prediction model was created using a prospectively maintained single institution database of 12,399 patients and included clinically relevant factors not accounted for in the TNM staging system. This prediction model was validated using external data sets from Asia; its’ applicability in the American population has yet to be determined through a validated data set. Methods: Using the SEER dataset, 2014 release, all patients with gastric adenocarcinoma diagnosed between the years 2002 –2012 who underwent resection were selected. The following characteristics were selected for analysis: age, sex, gender, depth of tumor invasion, number of positive lymph nodes, total lymph nodes retrieved, presence of distant metastasis, extent of resection, and histology. These data were processed through a recently published prognostic nomogram to obtain concordance index (C-statistic) using the bootstrap method and calibration was assessed. This was compared to the current prognostic index, the TNM staging system. Results: A total of 26,019 possible patients were identified from the SEER database, years 2002-2012. Of these, 11,765 had complete datasets. Validation of the prognostication model revealed a C-statistic of 0.762 (95% CI 0.754-0.769). This is compared to the 7thTNM staging model, C-statistic 0.683 (95% CI 0.677-0.689). The new nomogram was found to be significantly more accurate with a p-value of < 0.001. Conclusions: Our study validates a novel prediction model for gastric cancer in the American patient population. Using this model, superior accuracy in prognosticating the 5-year survival of gastric cancer patients was confirmed in the western cohort strongly supporting its global applicability. This model also allows for inclusion of those who did not undergo adequate lymphadenectomy or who underwent a non-curative resection and can be a useful prediction tool for an increasing number of gastric cancer patients world-wide.

scholarly journals Can the Tumor Deposits Be Counted as Metastatic Lymph Nodes in the UICC TNM Staging System for Colorectal Cancer?

PLoS ONE ◽  
2012 ◽  
Vol 7 (3) ◽  
pp. e34087 ◽  
Author(s):  
Yong-Xi Song ◽  
Peng Gao ◽  
Zhen-Ning Wang ◽  
Ji-Wang Liang ◽  
Zhe Sun ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Nodes ◽  
Staging System ◽  
Tnm Staging ◽  
Metastatic Lymph Nodes ◽  
Metastatic Lymph ◽  
Tnm Staging System

The tumor-log odds of positive lymph nodes-metastasis staging system, a new staging system for gastric cancer after D2 resection in China.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14655-e14655
Author(s):  
Rui-hua Xu ◽  
Miao-zhen Qiu
Keyword(s):  
Gastric Cancer ◽  
Lymph Nodes ◽  
Cox Regression ◽  
Staging System ◽  
Tnm Staging ◽  
Cut Points ◽  
Tnm System ◽  
Prognostic Assessment ◽  
Log Odds ◽  
Positive Lymph Nodes

e14655 Background: In this study, we established a hypothetical tumor-lodds-metastasis (TLM) and tumor-ratio-metastasis (TRM) staging system. Moreover we compared them with the 7th edition of American Joint Committee on Cancer tumor-nodes-metastasis (AJCC TNM) staging system in gastric cancer patients after D2 resection. Methods: A total of 1000 gastric carcinoma patients receiving treatment in our center were selected for the analysis. Finally, 730 patients who received D2 resection were retrospectively studied. Patients were staged using the TLM, TRM and the 7th edition AJCC TNM system. Survival analysis was performed with a Cox regression model. We used two parameters to compare the TNM, TRM and TLM staging system, the -2log likelihood and the hazard ratio. Results: The cut points of lymph node ratio (LNR) were set as 0, 0-0.3, 0.3-0.6, 0.6-1.0. And for the log odds of positive lymph nodes (LODDS), the cut points were established as≤-0.5, -0.5-0, 0-0.5, >0.5. There were significant differences in survival among patients in different LODDS classifications for each pN or LNR groups. When stratified by the LODDS classifications, the prognosis was highly homologous between those in the according pN or LNR classifications. Multivariate analysis shown that TLM staging system was better than the TRM or TNM system for the prognostic evaluation. Conclusions: The TLM systems was superior to the TRM or TNM system for prognostic assessment of gastric adenocarcinoma patients after D2 resection.

Prognostic nomogram to predict overall survival for patients with perihilar cholangiocarcinoma: A population-based study of SEER database (Preprint)

2020 ◽  
Author(s):  
Chendong Wang
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Staging System ◽  
Tnm Staging ◽  
Survival Outcome ◽  
Perihilar Cholangiocarcinoma ◽  
Cox Regression Analysis ◽  
Calibration Curves ◽  
Tnm Staging System ◽  
Net Benefits

BACKGROUND Perihilar cholangiocarcinoma (pCCA) is a highly aggressive malignancy with poor prognosis. Accurate prediction is of great significance for patients’ survival outcome. OBJECTIVE The present study aimed to propose a prognostic nomogram for predicting the overall survival (OS) for patients with pCCA. METHODS We conducted a retrospective analysis in a total of 940 patients enrolled from the Surveillance, Epidemiology, and End Results (SEER) program and developed a nomogram based on the prognostic factors identified from the cox regression analysis. Concordance index (C-index), risk group stratification and calibration curves were adopted to test the discrimination and calibration ability of the nomogram with bootstrap method. Decision curves were also plotted to evaluate net benefits in clinical use against TNM staging system. RESULTS On the basis of multivariate analysis, five independent prognostic factors including age, summary stage, surgery, chemotherapy, together with radiation were selected and entered into the nomogram model. The C-index of the model was significantly higher than TNM system in the training set (0.703 vs 0.572, P<0.001), which was also proved in the validation set (0.718 vs 0.588, P<0.001). The calibration curves for 1-, 2-, and 3-year OS probabilities exhibited good agreements between the nomogram-predicted and the actual observation. Decision curves displayed that the nomogram obtained more net benefits than TNM staging system in clinical context. The OS curves of two distinct risk groups stratified by nomogram-predicted survival outcome illustrated statistical difference. CONCLUSIONS We established and validated an easy-to-use prognostic nomogram, which can provide more accurate individualized prediction and assistance in decision making for pCCA patients.

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