Analysis of a diagnostic strategy for patients with suspected tumors of unknown origin.

1995 ◽  
Vol 13 (8) ◽  
pp. 2094-2103 ◽  
Author(s):  
J L Abbruzzese ◽  
M C Abbruzzese ◽  
R Lenzi ◽  
K R Hess ◽  
M N Raber
Keyword(s):  
Computed Tomography ◽  
Ovarian Cancer ◽  
Primary Tumor ◽  
Radiographic Finding ◽  
Diagnostic Evaluation ◽  
Survival Duration ◽  
Rank Test ◽  
Diagnostic Strategy ◽  
Primary Tumors ◽  
Specific Patient

PURPOSE Diagnostic strategies designed to identify the underlying primary malignancies in patients with unknown primary tumors (UPTs) have relied on retrospective analyses. We analyzed 879 consecutive patients referred with suspected UPTs to determine the yield and cost of a limited diagnostic evaluation, assess the contribution of specific studies to diagnosis, and analyze the survival patterns of patients in whom the primary tumor was diagnosed. PATIENTS AND METHODS Data from patients with a suspected UPT were entered into a computerized data base, and the patients underwent a predefined limited diagnostic evaluation. Primary malignancies were diagnosed by pathologic review alone or by pathologic criteria plus a physical or radiographic finding. Survival was measured from diagnosis, estimated using the Kaplan-Meier method, and compared using the Cox-Mantel log-rank test. RESULTS A primary tumor was found in 179 of 879 patients (20%). The survival duration of patients in whom the primary tumor was diagnosed was superior to that of patients in whom the primary tumor remained unknown. Specific patient subsets contributed most to the improved survival duration of the group in which the primary tumor was found, including lymphoma patients diagnosed solely by pathologic criteria and female patients with primary breast or ovarian cancer. The cost of diagnosis was mostly due to the extensive use of computed tomography. Except for ovarian cancer, computed tomography rarely identified treatable primary tumors. CONCLUSION The limited diagnostic evaluation used in this study identified patients with treatable malignancies and increased the survival duration of a population of suspected UPT patients. Primary malignancies with the best survival can be diagnosed through careful pathologic review and focused evaluations for breast and ovarian cancer in women.

Contrast enhanced CT (CE-CT) changes and nephrometry down-scoring of unresectable primary renal cell carcinoma (RCC) tumors in patients (Pts) treated with neoadjuvant sunitinib.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 299-299 ◽  
Author(s):  
M. Salem ◽  
S. N. Shah ◽  
L. S. Wood ◽  
P. Elson ◽  
A. Medsinge ◽  
...  
Keyword(s):  
Primary Tumor ◽  
Objective Response ◽  
Sign Test ◽  
Rank Test ◽  
Primary Tumors ◽  
Venous Thrombus ◽  
Nephrometry Score ◽  
Primary Renal Cell Carcinoma ◽  
Contrast Enhanced Ct ◽  
The Impact

299 Background: The impact of neoadjuvant sunitinib on CE-CT parameters and nephrometry score of primary RCC tumors remains unknown. Methods: Retrospective review of baseline and prenephrectomy CE-CT from a prospective phase II trial of neoadjuvant sunitinib (50 mg sunitinib continuous dosing) in unresectable primary RCC tumors with or without metastatic disease. CE-CT parameters and R.E.N.A.L. nephrometry score for each lesion were determined in pts who underwent subsequent surgery. RECIST and MASS criteria were used to assess primary tumor radiographic response. CT changes were analyzed using the sign test and Wilcoxon signed rank test. Results: Twenty nine pts were enrolled, of which 13 pts (85%M; median age 63y) underwent post-sunitinib resection of 16 primary tumors (3 pts had multifocal RCC). Post-therapy, 88% of tumors had decreased long diameter (median 32% decrease, p<0.001 vs. baseline), 88% decreased attenuation (median 30 HU reduction, p=0.006) and 69% increased necrosis (p=0.001). 56% of tumors had a decrease in nephrometry score (median 1 point decrease; 10 to 9, p=004). At baseline, 81% of tumors were highly complex by nephrometry score; following therapy 46% of the highly complex tumors became moderately complex. At baseline 13 tumors abutted renal hilar vital structures, whereas following treatment 4 tumors demonstrated abutment. Adenopathy decreased (range, 23%-83%) in 4/4 patients with enlarged baseline lymph nodes, with complete resolution in 1 patient. RECIST objective response was seen in 38% and SD in 56% of primary tumors; 1 tumor had PD based on size despite > 95% necrosis. MASS criteria response was favorable 38%, intermediate 62%. Two of four pts had reduction in extent of venous thrombus (1 pt from level 0 to resolved and 1 pt from level IV to II). Conclusions: Neoadjuvant sunitinib resulted in decreased size/attenuation, increased necrosis of the primary tumor and reduction in lymphadenopathy and venous thrombus in pts who underwent subsequent surgery. Sunitinib reduced the RENAL nephrometry score and facilitated nephrectomy, notably due to impact on tumor proximity to vital structures in the renal hilum. [Table: see text]

CD73 expression in primary and metastatic renal cell carcinoma (RCC).

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 643-643 ◽  
Author(s):  
Abhishek Tripathi ◽  
Sarah E Johnston ◽  
Yan D Zhao ◽  
Oudai Hassan ◽  
Linda F Thompson ◽  
...  
Keyword(s):  
Primary Tumor ◽  
Checkpoint Inhibitors ◽  
Statistical Significance ◽  
Method Comparison ◽  
Rank Test ◽  
Primary Tumors ◽  
Metastatic Tissue ◽  
Pathologic Features ◽  
Cd73 Expression ◽  
The Impact

643 Background: Agents targeting the PD-1 pathway have improved outcomes in RCC. CD73 may be an additional mechanism which tumors can exploit for immune evasion. It is regulated by hypoxia inducible factor (HIF) and converts AMP to adenosine. The resulting increase in extracellular adenosine can inhibit T-cell effector function. We evaluated CD73 expression in primary and metastatic tumor samples in patients with RCC. Methods: A commercial TMA (US Biomax) consisting of 31 primary clear cell RCC samples (2 with sarcomatoid features) with 8 matched and 1 unmatched metastases was used to assess CD73 expression. A genitourinary pathologist (OH) confirmed pathology and grade. Immunohistochemistry (IHC) was performed using a monoclonal anti-CD73 antibody (Cell Signaling; D7F9A). A combined score (CS: % of cells positive x intensity) was employed to quantify CD73 expression. Expression levels between matched primary and metastatic tissue was compared using Wilcoxon signed-rank test. Correlation of CD73 expression (CS > 0) in primary tumor with baseline clinical and pathologic characteristics was assessed using Kruskal-Wallis and Fisher's exact tests. Overall survival (OS) was estimated using the Kaplan-Meier method. Comparison between CD73 expression groups used log rank test. Results: CD73 expression was seen in 19% (n = 6) of primary and 66.7% (n = 6) of metastatic samples. Among matched primary and metastatic samples (n = 8 each), median CS was 25 (Q1-Q3:0-105) in metastatic samples while none of the corresponding primary samples demonstrated CD73 expression (median CS = 0, p = 0.062). CD73 expression in primary tumor samples did not correlate with baseline clinical or pathologic features. Five-year OS was 50% in patients who expressed CD73 in primary tumors compared to 84% in those who did not (p = 0.26). Conclusions: We observed a numerical increase in CD73 expression in metastatic tissue compared to primary RCC samples and worse 5 year OS. The small number of samples has limited statistical significance. Further studies are needed to examine the impact of CD73 expression on outcomes in RCC patients treated with currently approved checkpoint inhibitors and the investigational CD73 antagonists that are in early phases of development.

scholarly journals The many faces of pseudomyxoma peritonei: a radiological review based on 30 cases

2019 ◽  
Vol 52 (6) ◽  
pp. 372-377
Author(s):  
Cássia Fonseca ◽  
Saulo Carvalho ◽  
Teresa Margarida Cunha ◽  
Rui Tiago Gil ◽  
Nuno Abecasis
Keyword(s):  
Computed Tomography ◽  
Pseudomyxoma Peritonei ◽  
Primary Tumor ◽  
Ovarian Tumors ◽  
Preoperative Imaging ◽  
Low Grade ◽  
Imaging Features ◽  
Imaging Findings ◽  
Primary Tumors ◽  
Histologic Subtype

Abstract Objective: To determine the most common imaging features of pseudomyxoma peritonei (PMP), as well as the histologic subtypes of the primary tumors. Materials and Methods: We reviewed 30 cases of women with pathologically confirmed PMP. Only computed tomography scans were available. All cases were retrospectively studied by four radiologists, working independently. We identified the most common imaging findings, the predominant primary site of the disease, and the growth pattern. The most common sites of recurrence were also analyzed. Results: The most common computed tomography finding was peritoneal/omental nodules (including “omental caking”), followed by visceral scalloping and non-mucinous ascites. The most common site of the primary tumor was the appendix (in 63.3%), followed by the ovaries (in 16.6%), and 16.6% of the tumors were of undetermined origin. There was one case of synchronous appendiceal and ovarian tumors. Low-grade mucinous neoplasm was the most common histologic subtype, accounting for 84.2% of the appendiceal tumors and 40% of the ovarian tumors. Conclusion: Although PMP is a relatively rare entity, radiologists must be aware of its possible imaging findings, common locations, and possible patterns of recurrence. The origin of the primary tumor should also be investigated. Future studies are needed in order to determine which preoperative imaging findings predict surgical outcomes and to characterize the main findings of radiological recurrence.

Discordant treatment response in primary tumors and lymph node metastases after four weeks of preoperative PD-1 blockade in head and neck squamous cell carcinoma (HNSCC).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6016-6016 ◽  
Author(s):  
Adam Luginbuhl ◽  
Jennifer Maria Johnson ◽  
Madalina Tuluc ◽  
Stacey Mardekian ◽  
Larry Harshyne ◽  
...  
Keyword(s):  
Primary Tumor ◽  
Ordinal Data ◽  
Complete Response ◽  
Giant Cells ◽  
Primary Lesion ◽  
Rank Test ◽  
Data Set ◽  
Primary Tumors ◽  
Immune Parameters ◽  
Signed Rank Test

6016 Background: Discordant radiographic responses are described in other tumor types in response to immunotherapy with response at some anatomic sites and progression in others. Here we determined the frequency of discordant treatment effects (TE) in HNSCC patients treated with immunotherapy in the context of a neoadjuvant trial. Methods: 23 Patients with resectable primary HNSCC were 1:1 randomized to receive nivolumab (240 mg IV Q 2 weeks x 2) or nivolumab and tadalafil 10 mg daily. Surgery was performed 4 weeks after the first nivolumab infusion. Resection specimens were graded histopathologically by two pathologists. Areas exhibiting TE (defined by fibrosis with chronic inflammation, foamy macrophage reaction and multinucleated giant cells) were expressed relative to the total tumor area. This was assessed in the primary tumor and all lymph nodes (LN). Each primary lesion and individual LN was defined as a) no response 0%TE, b) minimal response 1-19%TE, c) response 20-99% or d) complete response 100%. Concordance was defined if primary lesion and LNs were in the same ordinal data set. Results: 11/23 (48%) of subjects experienced concordant ΤΕ in the primary tumor and LNs. Within this cohort, 3 patients had a complete pathologic response both at the primary site and LNs. In contrast, 12/23 patients (52%) revealed discordant ΤΕ between the primary tumor sites (average of 17% TE) and involved LNs (average of 62% TE), (p= 0.018; signed rank test). Interestingly, in the discordant group, TE effects in LNs were invariably greater than in primary lesions. In 5 of 11 patients with multiple involved LN, the TE varied between nodes. This included patients with adjacent LNs demonstrating 0% and 100% TE in the same level. Systemic and local immune parameters as they relate to concordant and discordant TEs in individual patients will be presented including a type 1 immune bias. Conclusions: Early histologic evaluation of TE in patients with HNSCC receiving immunotherapy demonstrate a wide variety of response between the primary tumor and LNs. Further investigations will lend insight into complex interactions of cancer cells with the microenvironment. Clinical trial information: NCT03238365.

Fractional percentage of tumor volume removed is a predictor of outcome following cytoreductive nephrectomy for metastatic renal cell carcinoma

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4599-4599 ◽  
Author(s):  
S. Collins ◽  
P. M. Pierorazio ◽  
J. M. McKiernan ◽  
M. C. Benson
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Primary Tumor ◽  
Renal Cell ◽  
Tumor Volume ◽  
Rank Test ◽  
Cytoreductive Nephrectomy ◽  
Primary Tumors

4599 Background: Metastatic renal cell carcinoma, (M+)RCC, is associated with poor overall survival with only 10–20% of patients alive at 2-years. The objective of this study is to determine if the fractional percentage of tumor volume (FPTV) removed at cytoreductive nephrectomy predicts disease specific survival (DSS). Methods: The Columbia Urologic Oncology Database was reviewed and 1,016 patients were identified that underwent renal surgery from 1988 to the present. A retrospective cohort of 93 patients were identified with (M+)RCC at the time of nephrectomy. The prospective database was reviewed to determine the FPTV removed and remaining following surgery. Patients were stratified to having greater or less than 90% of their cancer burden removed. Primary outcome was defined as DSS. Kaplan-Meier analysis with log-rank test was performed to determine survival advantage between groups. A Cox proportional hazard model was fit for PTR in both univariate and multivariate models. Secondary analyses were conducted to determine if the size of primary tumor affected outcome and if FPTV affected hospitalization time. Results: 63 of 77 patients had >90% of their tumor burden removed. Median follow-up time was 8.6 months. Median DSS times were calculated to be 18.8 and 3.6 months for patients with >90% and <90% PTR respectively (p < 0.001). The hazard ratio for death was 5.73 for patients with <90% of tumor removed (p < 0.001). Those with >90% removed had larger primary tumors, 10.6cm vs. 7.2cm in the <90% removed group (p = 0.01). Outcome analysis by size of primary tumor demonstrated no difference in survival. Patients with <90% removed spent 13.6% of DSS time hospitalized compared to 6.3% for those with >90% removed (p = 0.89). Conclusions: For patients with (M+)RCC, overall survival is limited but can be extended by cytoreductive nephrectomy. FPTV expected to be removed is a simple and available method to counsel patients regarding the benefits of surgical intervention. No significant financial relationships to disclose.

scholarly journals Targeting progesterone signaling prevents metastatic ovarian cancer

2020 ◽  
Vol 117 (50) ◽  
pp. 31993-32004
Author(s):  
Olga Kim ◽  
Eun Young Park ◽  
Sun Young Kwon ◽  
Sojin Shin ◽  
Robert E. Emerson ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Deleterious Mutation ◽  
Peritoneal Metastases ◽  
Cancer Development ◽  
Serous Carcinoma ◽  
Cancer Type ◽  
High Grade ◽  
Primary Tumors ◽  
High Risk Populations ◽  
Genetic Deletion

Effective cancer prevention requires the discovery and intervention of a factor critical to cancer development. Here we show that ovarian progesterone is a crucial endogenous factor inducing the development of primary tumors progressing to metastatic ovarian cancer in a mouse model of high-grade serous carcinoma (HGSC), the most common and deadliest ovarian cancer type. Blocking progesterone signaling by the pharmacologic inhibitor mifepristone or by genetic deletion of the progesterone receptor (PR) effectively suppressed HGSC development and its peritoneal metastases. Strikingly, mifepristone treatment profoundly improved mouse survival (∼18 human years). Hence, targeting progesterone/PR signaling could offer an effective chemopreventive strategy, particularly in high-risk populations of women carrying a deleterious mutation in the BRCA gene.

scholarly journals Non-Coding RNAs as Biomarkers of Tumor Progression and Metastatic Spread in Epithelial Ovarian Cancer

Cancers ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1839
Author(s):  
Karolina Seborova ◽  
Radka Vaclavikova ◽  
Lukas Rob ◽  
Pavel Soucek ◽  
Pavel Vodicka
Keyword(s):  
Ovarian Cancer ◽  
Tumor Progression ◽  
Expression Profiles ◽  
Gene Expression Profiles ◽  
Distant Metastases ◽  
Regulatory Elements ◽  
Metastatic Spread ◽  
Response To Treatment ◽  
Primary Tumors ◽  
Non Coding Rnas

Ovarian cancer is one of the most common causes of death among gynecological malignancies. Molecular changes occurring in the primary tumor lead to metastatic spread into the peritoneum and the formation of distant metastases. Identification of these changes helps to reveal the nature of metastases development and decipher early biomarkers of prognosis and disease progression. Comparing differences in gene expression profiles between primary tumors and metastases, together with disclosing their epigenetic regulation, provides interesting associations with progression and metastasizing. Regulatory elements from the non-coding RNA families such as microRNAs and long non-coding RNAs seem to participate in these processes and represent potential molecular biomarkers of patient prognosis. Progress in therapy individualization and its proper targeting also rely upon a better understanding of interactions among the above-listed factors. This review aims to summarize currently available findings of microRNAs and long non-coding RNAs linked with tumor progression and metastatic process in ovarian cancer. These biomolecules provide promising tools for monitoring the patient’s response to treatment, and further they serve as potential therapeutic targets of this deadly disease.

scholarly journals Alveolar bone heights of maxillary central incisors in unilateral cleft lip and palate patients using cone-beam computed tomography evaluation

2021 ◽  
Author(s):  
Marcin Stasiak ◽  
Anna Wojtaszek-Słomińska ◽  
Bogna Racka-Pilszak
Keyword(s):  
Computed Tomography ◽  
Cone Beam Computed Tomography ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Contralateral Side ◽  
Cone Beam ◽  
Rank Test ◽  
Cross Sectional ◽  
Alveolar Bone Grafting

Abstract Purpose The aims of this retrospective cross-sectional study were to measure and compare labial and palatal alveolar bone heights of maxillary central incisors in unilateral cleft lip and palate patients, following STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. Patients and methods The study group consisted of 21 patients with a mean age of 16 years. High-resolution cone-beam computed tomography was performed at least one year after secondary alveolar bone grafting. The experimental side was the cleft side and the contralateral side without congenital cleft was the control. Measurements were performed on incisors’ midsagittal cross-sections. The Wilcoxon signed-rank test was used for intergroup comparisons. Results The labial and palatal distances between alveolar bone crests and cementoenamel junctions were significantly greater on the cleft side than on the noncleft side. Mean differences were 0.75 and 1.41 mm, respectively. The prevalence of dehiscences at the cleft side maxillary central incisors was 52% on the labial surface and 43% on the palatal surface. In the controls, it was 19% and 14%, respectively. Conclusion The cleft-adjacent maxillary central incisors had more apically displaced alveolar bone crests on the labial and palatal sides of the roots than the controls. Higher prevalence of dehiscences was found on the cleft side. Bone margin differences predispose to gingival height differences of the central incisors. These differences could increase the demands of patients to obtain more esthetic treatment results with orthodontic extrusion and periodontal intervention on the cleft side.

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