scholarly journals A novel staging system and clinical predictive nomogram for more accurate staging and prognosis of malignant pancreatic intraductal papillary mucinous neoplasms: a population-based study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Haoxiang Zhang ◽  
Chenggang Gao ◽  
Jiaoshun Chen ◽  
Shihong Wu ◽  
Jianwei Bai ◽  
...  
Keyword(s):  
Overall Survival ◽  
Locally Advanced ◽  
Staging System ◽  
The Body ◽  
Clinical Staging ◽  
Treatment Modalities ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Mucinous Neoplasms ◽  
Tumor Stages ◽  
Malignant Ipmn

Abstract Background The current guidelines of the American Joint Committee on Cancer (AJCC) for the staging of exocrine pancreatic tumors seem inapplicable to malignant pancreatic intraductal papillary mucinous neoplasms (IPMN). Therefore, we aimed to improve the accuracy of clinical staging and prognosis for malignant IPMN by modifiing current AJCC system. Methods We extracted data of 2001 patients with malignant IPMN from the Surveillance, Epidemiology, and End Results database between 2000 and 2016. Of these, 1401 patients were assigned to the primary cohort and 600 patients to the validation cohort. Results In Kaplan–Meier analysis of the primary cohort, the current AJCC guidelines were unable to distinguish between certain tumor substages (IA and IB in the 7th, IB and IIA in the 8th). The modified system that we regrouped based on the median overall survival and hazard ratios, was superior in tumor stage classifications. Age > 70 years, tumors located in the body or tail, high-grade differentiated tumors, surgery, chemotherapy, and tumor, lymph node, and metastasis (TNM) stage were identified as independent predictive factors for overall survival. Compared to that of TNM-based systems, the concordance index of the clinical predictive nomogram significantly improved (0.819; 95% confidence interval, 0.805–0.833), with excellent area under the receiver operating characteristic curves (1-, 3-, and 5-year: 0.881, 0.889, and 0.879, respectively). The calibration curves also showed good agreement between prediction and actual observation. The analysis of treatment modalities revealed that surgery resulted in better survival for all resectable malignant IPMN. The analysis of chemotherapy data reveals its potential in improving the prognosis of treatment for patients with locally advanced or distant metastases. Conclusions Our modified staging system improves the distinction of tumor stages. The nomogram was a more accurate and clinically reliable tool for prognosis prediction of patients with malignant IPMN.

scholarly journals A Novel Staging System and Clinical Predictive Nomogram for More Accurate Staging and Prognosis of Malignant Pancreatic Intraductal Papillary Mucinous Neoplasms: A Population-Based Study

2020 ◽  
Author(s):  
Haoxiang Zhang ◽  
Chenggang Gao ◽  
Jiaoshun Chen ◽  
Shihong Wu ◽  
Jianwei Bai ◽  
...  
Keyword(s):  
Overall Survival ◽  
Locally Advanced ◽  
Staging System ◽  
The Body ◽  
Clinical Staging ◽  
Treatment Modalities ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Mucinous Neoplasms ◽  
Tumor Stages ◽  
Malignant Ipmn

Abstract Background: The current guidelines of the American Joint Committee on Cancer (AJCC) for the staging of exocrine pancreatic tumors seem inapplicable to malignant pancreatic intraductal papillary mucinous neoplasms (IPMN). Therefore, we aimed to improve the accuracy of clinical staging and prognosis for malignant IPMN.Methods: We extracted data of 2001 patients with malignant IPMN from the Surveillance, Epidemiology, and End Results database between 2000 and 2016. Of these, 1401 patients were assigned to the primary cohort and 600 patients to the validation cohort.Results: In Kaplan-Meier analysis of the primary cohort, the current AJCC guidelines were unable to distinguish between certain tumor substages (IA and IB in the 7th, IB and IIA in the 8th). The modified system we regrouped based on the median overall survival and hazard ratios was superior in tumor stage classifications. Age > 70 years, tumors located in the body or tail, high-grade differentiated tumors, surgery, chemotherapy, and TNM stage were identified as independent predictive factors of overall survival. Compared to that of TNM-based systems, the concordance index of the clinical predictive nomogram significantly improved (0.819; 95% confidence interval, 0.805–0.833), with excellent area under the receiver operating characteristic curves (1-, 3-, and 5-year: 0.881, 0.889, and 0.879, respectively). The calibration curves also showed good agreement between prediction and actual observation. In the analysis of treatment modalities, surgery resulted in better survival for all resectable IPMN. Chemotherapy is the treatment of choice for locally advanced or distant metastases patients.Conclusion: Our modified staging system improves the distinction of tumor stages. The nomogram was a more accurate and clinically reliable tool in prognosis prediction of patients with IPMN.

Exchange of International Staging System for Durie&Salmon Staging System in Therapeutic Strategy for Multiple Myeloma.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5167-5167
Author(s):  
Shingo Kurahashi ◽  
Hiroto Narimatsu ◽  
Takumi Sugimoto ◽  
Isamu Sugiura
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Clinical Outcome ◽  
Therapeutic Strategy ◽  
Staging System ◽  
Stage I ◽  
Stage Ii ◽  
Clinical Staging ◽  
Secondary Malignancy ◽  
International Staging System

Abstract Introduction: Since multiple myeloma (MM) is not a curative disease and clinical outcome is variable, chemotherapy is started only when patients developed organ impairment or progression of disease. As for clinical staging, Durie&Salmon (DS) system is in use. The International Staging System (ISS) for MM has been recently reported to provide simple and useful prognostic grouping (Greipp et al. 2005). However, its usefulness in therapeutic strategy has not been clearly demonstrated. Patients and methods: We reviewed medical records of patients with MM, newly diagnosed in Toyohashi Municipal Hospital between May 1997 and April 2004. They were all stratified based on both ISS and DS system. Results: The median age of 55 patients was 67 years (range; 46–86). M protein isotypes included IgG (n=33), IgA (n=13), BJP (n=6) and IgD (n=1). Fifty-two patients were treated with chemotherapy and 12 of those patients underwent autologous peripheral blood stem cell transplantation. The median follow-up of the patients was 26.8 months (range; 1.4–77.5). Their staging and overall survival (OS) are summarized on the following table. ISS predicted OS more clearly than DS system in our study. Overall survival based on ISS and DS system ISS DS stage no. of patients OS at 3 yrs no. of patients OS at 3 yrs I 14 1.00 3 0.67 II 22 0.55 20 0.79 III 19 0.25 32 0.40 p-value 0.0102 0.3287 Thirteen of the 14 patients with ISS stage I are alive at median months of 31.5 (10.4–73.8), and only one patient died of secondary malignancy at 44.9 months from diagnosis. The patients with ISS stage I included 86% of DS stage II and III patients, who are usually required treatment. Conclusions and discussions: ISS could predict clinical outcome more clearly than DS system. The patients’ prognosis was good in ISS stage I although many patients with DS stage II and III was included in this group. We suggests that early treatment to the patients with ISS stage I might not be necessarily required. Further studies are needed to adopt ISS instead of DS system in therapeutic strategy. Figure Figure

Circulating tumor cells in locally advanced pancreatic adenocarcinoma: The ancillary study Circe 07 of the LAP 07 trial.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 188-188
Author(s):  
Florence Huguet ◽  
François-Clément Bidard ◽  
Christophe Louvet ◽  
Laurent Mineur ◽  
Olivier Bouche ◽  
...  
Keyword(s):  
Overall Survival ◽  
Tumor Cells ◽  
Circulating Tumor Cells ◽  
Randomized Study ◽  
Locally Advanced ◽  
Multivariable Analysis ◽  
Treatment Modalities ◽  
Detection Rates ◽  
Ancillary Study ◽  
Systemic Treatments

188 Background: Pancreatic carcinoma is one of the leading causes of cancer-related mortality. At time of diagnosis, 30% of patients present with a locally advanced unresectable but non metastatic carcinoma (LAPC). Theoretically, patients with micrometastatic dissemination at diagnosis should benefit from systemic treatments, whereas radiation therapy should be favored in the others. Based on the hypothesis that circulating tumor cells (CTC) count is a surrogate of the cancer metastatic abilities, CTC detection rates and prognostic value were studied in a prospective cohort of LAPC patients. Methods: LAP07 international multicenter randomized study assesses in patients whose LAPC is controlled after 4 months of gemcitabine-based chemotherapy whether to administrate a chemoradiotherapy could increase overall survival versus continuation of chemotherapy alone. A subgroup of patients included in LAP 07 trial were prospectively screened for CTC before the start of the chemotherapy and after two months of treatment, using the CellSearch technique. Clinico-pathological characteristics and survival of patients were obtained prospectively and were correlated with CTC detection. Results: Seventy-nine patients were included in this ancillary study. One or more CTC/7.5ml were detected in 5% of patients before treatment and in 9% of patients after two months of chemotherapy (overall detection rate: 11% of patients). CTC positivity was associated with poor tumor differentiation (p=0.04), and with shorter overall survival in multivariable analysis (RR=2.5, p=0.01), together with anemia (p=0.005). Conclusions: The evaluation of micrometastatic disease using CTC detection appears as a promising tool which could help to personalize treatment modalities in LAPC patients. Clinical trial information: CDR0000589283.

scholarly journals A mixed-type intraductal papillary mucinous neoplasm of the pancreas with a histologic combination of gastric and pancreatobiliary subtypes in a 70-year-old woman: a case report

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Sawsan Ismail ◽  
Rama Darwisho ◽  
Mohammed Ali ◽  
Maen Haidar ◽  
Mohammad Adib Houreih ◽  
...  
Keyword(s):  
Histological Examination ◽  
Intraductal Papillary Mucinous Neoplasm ◽  
Mixed Type ◽  
Epigastric Pain ◽  
The Body ◽  
Diagnostic Methods ◽  
Pancreatic Ducts ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Mucinous Neoplasm ◽  
Mucinous Neoplasms

Abstract Background Intraductal papillary mucinous neoplasms are rare papillary pancreatic neoplasms arising from major pancreatic ducts, characterized by duct dilation and mucin secretion. They comprise approximately 1% of all exocrine neoplasms and are classified according to their anatomical sites into main duct-type, branch duct-type, and mixed-type intraductal papillary mucinous neoplasms. Histological examination plays a crucial role in distinguishing and classifying intraductal papillary mucinous neoplasms into gastric, intestinal, pancreatobiliary, and oncocytic subtypes. Case presentation We present the case of a 70-year-old Syrian woman who was admitted to our hospital due to an intermittent epigastric pain accompanied by diarrhea and weight loss with a recent diagnosis of diabetes mellitus. Following clinical, laboratory, and radiological examination, distal pancreatectomy involving the body and the tail of the pancreas was performed. Interestingly, histological examination of the resected specimens revealed the diagnosis of a mixed-type intraductal papillary mucinous neoplasm with a unique combination of gastric and pancreatobiliary subtypes. Conclusion To the best of our knowledge, the combination of multiple histological subtypes of intraductal papillary mucinous neoplasms has been recorded in a few studies with reference to the challenging histological detection. Herein, we report a rare case with a significant histological combination, highlighting the difficulties in differential diagnosis due to the absence of ancillary techniques, with a brief review on diagnostic methods, histological characteristics and surgical recommendations.

scholarly journals Sinonasal Melanoma: A Single Institutional Analysis and Future Directions

2018 ◽  
Vol 80 (05) ◽  
pp. 484-492 ◽  
Author(s):  
Taylor Manton ◽  
Brittny Tillman ◽  
Jonathan McHugh ◽  
Emily Bellile ◽  
Scott McLean ◽  
...  
Keyword(s):  
Overall Survival ◽  
Advanced Disease ◽  
Locally Advanced ◽  
Staging System ◽  
Mitotic Rate ◽  
Stage Iii ◽  
The Past ◽  
7Th Edition ◽  
Kaplan Meier ◽  
Ajcc Staging

Abstract Background Sinonasal melanoma is a rare disease with a high mortality rate. The surgical management paradigm has significantly changed over the past decade with the introduction of expanded endonasal techniques. There have also been advances in management of metastatic and locally advanced disease with the advent of immunotherapy. Methods Single-institution retrospective review of adult patients with sinonasal melanoma, surgically managed at the University of Michigan over a 9-year period. Thirty-one patients met inclusion criteria. All patients were retrospectively staged according to the 7th Edition AJCC staging system for mucosal melanoma. Parameters that may affect survival were analyzed using Cox's proportional hazard models and survival outcomes were analyzed with the Kaplan–Meier method. Additionally, a review of three patients with distant metastatic disease receiving immunotherapy is presented. Results Most patients were managed endoscopically (67%), and had stage III disease (71%). However, 57% of stage IVB tumors were successfully managed endoscopically. Stage statistically impacted overall survival whereas distant control was impacted by stage, site of origin, mitotic rate, and necrosis. The 2-year overall survival for all stages was 77% which declined with advanced disease. Two-year locoregional control and distant control showed similar trends. Conclusion Treatment of sinonasal melanoma has drastically changed over the past decade with increased use of expanded endonasal techniques. Our review revealed excellent 2-year overall survival in stage III disease with an appreciable decline in survival in more advanced disease. Immunotherapy may play a large role is future management given the high-risk of distant metastasis.

Analyzing Intraductal Papillary Mucinous Neoplasms Using Artificial Neural Network Methodologic Triangulation

2019 ◽  
Vol 14 (4) ◽  
pp. 21-32 ◽  
Author(s):  
Steven Walczak ◽  
Jennifer B. Permuth ◽  
Vic Velanovich
Keyword(s):  
Neural Network ◽  
Pancreatic Cancer ◽  
Pancreatic Cyst ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Methodological Triangulation ◽  
Average Survival ◽  
Mucinous Neoplasms ◽  
Artificial Neural ◽  
The Impact ◽  
Malignant Ipmn

Intraductal papillary mucinous neoplasms (IPMN) are a type of mucinous pancreatic cyst. IPMN have been shown to be pre-malignant precursors to pancreatic cancer, which has an extremely high mortality rate with average survival less than 1 year. The purpose of this analysis is to utilize methodological triangulation using artificial neural networks and regression to examine the impact and effectiveness of a collection of variables believed to be predictive of malignant IPMN pathology. Results indicate that the triangulation is effective in both finding a new predictive variable and possibly reducing the number of variables needed for predicting if an IPMN is malignant or benign.

Treatment patterns and outcomes of locally advanced gall bladder cancer: A National Cancer Database (NCDB) analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16147-e16147
Author(s):  
Pragnan Kancharla ◽  
Lynna Alnimer ◽  
Yazan Samhouri ◽  
Karthik Shankar ◽  
Veli Bakalov ◽  
...  
Keyword(s):  
Overall Survival ◽  
Gall Bladder ◽  
Survival Data ◽  
Treatment Modality ◽  
Locally Advanced ◽  
Treatment Patterns ◽  
Treatment Selection ◽  
Treatment Modalities ◽  
Median Income ◽  
Radiation Use

e16147 Background: Gall bladder (GB) cancer is rare but an aggressive disease especially when presenting at an advanced stage. There is controversy regarding the best treatment approach for locally advanced disease. In this NCDB analysis, we aim to study treatment patterns for T3, T4, and/or N1 GB cancer and estimate survival for each treatment modality. We also sought to investigate clinical and socioeconomic predictors of treatment selection. Methods: We conducted a retrospective cohort analysis using de-identified data accessed from the NCDB. The NCDB provided records of 39,229 patients diagnosed with GB cancer between 2004-2017. We excluded patients who were not treated at the reporting facility, those with no histologic confirmation of the diagnosis, those with no survival data available and those with T1, T2 and metastatic disease. We did exploratory analysis and divided patients into six arms based on treatment modality (Table). Stepwise multivariable regression models were used to analyze predictors of treatment selection. Survival estimates were calculated using the Kaplan Meier and proportional Cox hazard regression methods. Results: We identified 7,004 patients with GB cancer who fulfilled the inclusion and exclusion criteria. Median age was 68 years. There were 69.5% females, and the majority of patients were white (66.1%). Receiving treatment at an academic/research center (OR 0.37, 95% CI 0.19-0.73, p <0.01), black patients (OR 0.55 95% CI 0.36-0.85, p <0.01) and higher education (OR 0.58, 95% CI 0.37-0.91, p 0.02) decreased the odds of receiving surgery. Meanwhile, the presence of lymphovascular invasion was seen more amongst patients with receipt of surgery. For patients who underwent radiation, increasing age (OR 0.97, 95% CI 0.97-0.98, p <0.01) and higher histologic grade (OR 0.65, CI 0.46-0.92, p .02) were associated with less radiation use. Median income between $50,354-$63,332 (OR 1.28, 95% CI 1.02-1.60, p 0.04) was associated with more radiation use. Patient who received triple therapy had improved survival compared with other modalities (HR 0.51, CI 0.46-0.57, p <0.01). Median overall survival (OS) for the whole population was 13.0 months (CI 12.6-13.5) (Table) Conclusions: American patients with T3, T4, and/or N1 GB cancer received variable treatment modalities. Patients who underwent triple-modality therapy in our analysis had improved adjusted-overall survival compared with other modalities. Limitations include unmeasured confounding factors, selection bias and the retrospective design. We also identified clinical and socioeconomic factors that affect treatment selection.[Table: see text]

scholarly journals Ablation in Pancreatic Cancer: Past, Present and Future

Cancers ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 2511
Author(s):  
Govindarajan Narayanan ◽  
Dania Daye ◽  
Nicole M. Wilson ◽  
Raihan Noman ◽  
Ashwin M. Mahendra ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Treatment Modalities ◽  
Locoregional Treatment ◽  
Insidious Onset ◽  
Poor Treatment ◽  
Poor Treatment Response

The insidious onset and aggressive nature of pancreatic cancer contributes to the poor treatment response and high mortality of this devastating disease. While surgery, chemotherapy and radiation have contributed to improvements in overall survival, roughly 90% of those afflicted by this disease will die within 5 years of diagnosis. The developed ablative locoregional treatment modalities have demonstrated promise in terms of overall survival and quality of life. In this review, we discuss some of the recent studies demonstrating the safety and efficacy of ablative treatments in patients with locally advanced pancreatic cancer.

scholarly journals The laparoscopic enucleation for branch duct type intraductal papillary mucinous neoplasms located at the body of pancreas: A case report

2015 ◽  
Vol 143 (5-6) ◽  
pp. 332-336 ◽  
Author(s):  
Dejan Stevanovic ◽  
Dragos Stojanovic ◽  
Nebojsa Mitrovic ◽  
Damir Jasarovic ◽  
Sanja Milenkovic ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
The Body ◽  
Pancreatic Tumors ◽  
Low Grade ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Branch Duct ◽  
Mucinous Neoplasms ◽  
Gastric Type ◽  
Branch Duct Type ◽  
Laparoscopic Enucleation

Introduction. Intraductal papillary mucinous neoplasms (IPMN) are among the most common cystic neoplasms of the pancreas, but they represent only 1-3% of all exocrine pancreas tumors. With the development of diagnostic possibilities the number of patients with IPMN is constantly increasing and represents approximately 20% of all surgically treated pancreatic tumors. The development of laparoscopic surgery has led to advances in the treatment of cystic tumors of the pancreas with the emergence of new surgical dilemma in the choice of surgical techniques in patients with IPMN. Case Outline. A 23-year-old patient was admitted to the hospital with non-specific symptoms of upper abdomen. Performed diagnostics indicated the existence of a tumor formation at the periphery of the pancreas, in the region of the proximal corpus, 8?5 cm in diameter. The cystic formation, wall thickness 3 mm, was filled with dense contents and injected into the tissue of the pancreas, but did not lead to an extension of the pancreatic duct. After adequate preoperative preparation the patient was operated on, when a laparoscopic enucleation of cystic tumor with coagulation and cutting off communication between the peripheral pancreatic duct and pancreatic tumors was performed by using ultrasound scissors. Histopathological analysis of the specimen indicated an IPMN of the branch duct type (BD-IPMN) with a low grade dysplasia. The line of resection was without cellular atypia. Immunohistochemical analysis showed positivity on tumor mucins (MUC-5 and MUC-2), which is typical for gastric type of BD-IPMN. Six months postoperatively the patient showed no signs of recurrence of the disease. Conclusion. Surgical treatment is the dominant choice for the treatment for IPMN. Although minimally invasive, laparoscopic enucleation of BD-IPMN is able to achieve an adequate level of radicality without the accompanying complications and with short postoperative recovery period.

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