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 Integrated analysis of serum lipid profile for predicting clinical outcomes of patients with malignant biliary tumor

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Lejia Sun ◽  
Xin Ji ◽  
Dongyue Wang ◽  
Ai Guan ◽  
Yao Xiao ◽  
...  
Keyword(s):  
Serum Lipids ◽  
Predictive Ability ◽  
Staging System ◽  
Tnm Staging ◽  
Integrated Analysis ◽  
Survival Prediction ◽  
Related Factors ◽  
Tnm System ◽  
Tnm Staging System ◽  
Lipid Parameters

Abstract Background Serum lipids were reported to be the prognostic factors of various cancers, but their prognostic value in malignant biliary tumor (MBT) patients remains unclear. Thus we aim to assess and compare prognosis values of different serum lipids, and construct a novel prognostic nomogram based on serum lipids. Methods Patients with a confirmed diagnosis of MBT at our institute from 2003 to 2017 were retrospectively reviewed. Prognosis-related factors were identified via univariate and multivariate Cox regression analyses. Then the novel prognostic nomogram and a 3-tier staging system were constructed based on these factors and further compared to the TNM staging system. Results A total of 368 patients were included in this study. Seven optimal survival-related factors—TC/HDL >  10.08, apolipoprotein B >  0.9 g/L, lipoprotein> 72 mg/L, lymph node metastasis, radical cure, CA199 > 37 U/mL, and tumor differentiation —were included to construct the prognostic nomogram. The C-indexes in training and validation sets were 0.738 and 0.721, respectively. Besides, ROC curves, calibration plots, and decision curve analysis all suggested favorable discrimination and predictive ability. The nomogram also performed better predictive ability than the TNM system and nomogram without lipid parameters. And the staging system based on nomogram also presented better discriminative ability than TNM system (P < 0.001). Conclusions The promising prognostic nomogram based on lipid parameters provided an intuitive method for performing survival prediction and facilitating individualized treatment and was a great complement to the TNM staging system in predicting overall survival.

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.

scholarly journals Immunoscore As A Predictor Of Disease Recurrences And Patients’ Survival in Colon Cancer : A Clinicopathologic Study.

2020 ◽  
Vol 8 (E) ◽  
pp. 143-149
Author(s):  
Reham Shehab El Nemr Esmail ◽  
Amr Kamal ◽  
Marwa Shabana
Keyword(s):  
Colon Cancer ◽  
Sensitivity And Specificity ◽  
Staging System ◽  
Good Prognosis ◽  
Tnm Staging ◽  
Image Analysis System ◽  
Predictive Values ◽  
Tnm System ◽  
Clinicopathologic Study ◽  
Tnm Staging System

BACKGROUND: For years, the American Joint Committee of Cancer/International Union against Cancer TNM staging system was the only accepted staging system for colorectal cancer. Different studies highlighted limitations in this staging system with the need to another staging approach that takes into consideration the individual patient immune response. Recently, the immunoscore was introduced; however, no accurate data regarding its sensitivity and specificity over the routinely used TNM staging system. AIM: We aimed to provide definite sensitivity, septicity, and predictive values for both IS and TNM staging system in prognosis prediction, as evidence-based statistical documentation of its validity to clinical use. METHODS: Fifty-three slides of colon cancer cases were stained for CD3 and CD8 immunohistochemical stains. The density of the stained cells was measured used an image analysis system in the core of the tumor and invasive margin. Immunoscore was calculated and results were compared with TNM in the recurrence-free survival of the patients. The sensitivity and specificity for each test were calculated. RESULTS: High IS was correlated with a good prognosis in the studied cases. IS sensitivity reached 85.7% compared to 28.6% in TNM staging system and the specificity was 78.1% compared to 37.5% in TNM system. CONCLUSION: IS is a promising prognostic estimation tool in colon cancer with better sensitivity and specificity than TNM staging system. The routine use of IS is now becoming a mandatory step.

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 Evaluation of the Eighth Edition of the American Joint Committee on Cancer TNM Staging System for Gastric Cancer: An Analysis of 7371 Patients in the SEER Database

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Long-Long Cao ◽  
Jun Lu ◽  
Ping Li ◽  
Jian-Wei Xie ◽  
Jia-Bin Wang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Survival Rates ◽  
Stage Iv ◽  
Staging System ◽  
Tnm Staging ◽  
Stage Migration ◽  
Seer Database ◽  
Tnm System ◽  
American Joint Committee ◽  
Tnm Staging System

Objective. To investigate the validity of the 8thedition of the American Joint Committee on Cancer (AJCC) TNM staging system for gastric cancer.Methods. The clinicopathologic data of 7371 patients who were diagnosed with gastric cancer and had 16 or more involved lymph nodes (LNs) were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database and retrospectively reviewed.Results. Stage migration occurred primarily during stage III between the 7thand 8thedition TNM staging systems. Stages IIIB and IIIC in the 7thedition staging system were divided in the 8thedition and had obvious differences in survival rates (bothP<0.001). The 8thedition TNM stages IIIC and IV showed similar survival rates (P=0.101). The prognosis of patients with T4aN3bM0 was not different from that of patients with TxNxM1 (P=0.433), while the prognosis of patients with T4bN3bM0 was significantly poorer than that of patients with TxNxM1 (P=0.008). A revised TNM system with both T4aN3bM0 and T4bN3bM0 incorporated into stage IV was proposed. Multivariable regression analysis showed that the revised TNM system, but not the 7thand 8theditions, was an independent factor for disease-specific survival (DSS) in the third step of the analysis. Further analyses revealed that the revised TNM system had superior discriminatory ability to the 8thedition staging system, which was also an improvement over the 7thedition staging system.Conclusion. The 8thedition of the AJCC TNM staging system is superior to the 7thedition for predicting the DSS rates of gastric cancer patients. However, for better prognostic stratification, it might be more suitable for T4aN3bM0/T4bN3bM0 to be incorporated into stage IV in the 8thedition TNM staging system.

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.

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