Estimating survival probability in stage III melanoma: A multivariable individualized patient risk assessment nomogram

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8020-8020
Author(s):  
D. G. Coit ◽  
C. Qin Zhou ◽  
A. Patel ◽  
K. Panageas
Keyword(s):  
Risk Assessment ◽  
Overall Survival ◽  
Patient Care ◽  
Staging System ◽  
Stage Iii ◽  
Patient Risk ◽  
Ajcc Staging System ◽  
Predicting Outcome ◽  
Stage Iii Melanoma ◽  
Ajcc Staging

8020 Background: Recent revisions in the AJCC staging system have increased its complexity without comparable improvement in prognostic accuracy for patients with Stage III melanoma. Furthermore, there remains significant prognostic heterogeneity, even within Stages IIIA, IIIB, and IIIC. The current study was undertaken to develop a model for individual patient risk assessment, both to facilitate patient care, and to help define prognostically homogeneous patient populations for entry into clinical trials. Methods: Patients with AJCC Stage III melanoma were identified from a prospective single institution database. Overall survival was calculated from the date of Stage III to last followup. A multivariate Cox model of independent prognostic factors was developed, and a multivariable individualized patient risk assessment nomogram was built from that model. Results: Among 1,064 patients with Stage III melanoma, 535 have died, at a median followup of 44 months. Independent predictors of overall survival are shown in the table. Individual patient three and five year survival was predicted by incorporating all eight variables into a prognostic nomogram. The nomogram was superior to the AJCC Staging system in predicting outcome in Stage III melanoma patients. Conclusions: Individual patient risk assessment is more accurate than traditional AJCC staging in predicting outcome in Stage III melanoma. This approach, which can be easily incorporated into a handheld computing environment, offers potential advantages for both patient care and clinical research, and should be explored in the next iteration of the AJCC staging system. [Table: see text] No significant financial relationships to disclose.

Stage III melanoma incidence and impact of transitioning to the 8th AJCC staging system: a US population-based study

2019 ◽  
Vol 15 (4) ◽  
pp. 359-370 ◽  
Author(s):  
Ahmad Tarhini ◽  
Sameer Ghate ◽  
Raluca Ionescu-Ittu ◽  
Sherry Shi ◽  
Antonio Nakasato ◽  
...  
Keyword(s):  
Staging System ◽  
Population Based ◽  
Stage Iii ◽  
Population Based Study ◽  
System A ◽  
Melanoma Incidence ◽  
Ajcc Staging System ◽  
Stage Iii Melanoma ◽  
Ajcc Staging

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.

Lack of apparent difference in outcome between clinically staged IIIA and IIIB non-small-cell lung cancer treated with radiation therapy.

1990 ◽  
Vol 8 (3) ◽  
pp. 409-415 ◽  
Author(s):  
W J Curran ◽  
P M Stafford
Keyword(s):  
Lung Cancer ◽  
Radiation Therapy ◽  
Performance Status ◽  
Staging System ◽  
Large Cell ◽  
Stage Iii ◽  
Cancer Center ◽  
Apparent Difference ◽  
Ajcc Staging System ◽  
Ajcc Staging

The current American Joint Committee on Cancer (AJCC) staging system for bronchogenic carcinoma, which divides stage III M0 cases into stages IIIA and IIIB, is based on the observation that selected patients with IIIA disease (T3 or N2) can undergo complete surgical resection, in distinction to IIIB patients (T4 or N3). To understand the value of this system when applied to clinically staged (CS) patients treated with a standard nonoperative approach, the records of patients with squamous cell, large-cell, and adenocarcinoma of the lung treated with radiation therapy (RT) at the Fox Chase Cancer Center from 1978 to 1987 were reviewed. Three hundred sixteen patients were identified as having CS III M0 disease treated with single daily fraction RT without chemotherapy or sensitizers. Of these, the distinction between IIIA (166) and IIIB (140) could be made for 306 patients. The median survival time (MST) for all CS III patients was 9.6 months, and the 2-year survival was 17%. No difference was observed in MST between CS IIIA and IIIB patients (9.4 v 9.8 months, P = .78), in 2-year survival (17% v 18%), or in rate of first failure within the RT field (43% v 44%). MSTs for the 157 CS IIIA and IIIB patients with less than 5% weight loss and Zubrod performance status (PS) 0 to 1 were 13.0 and 15.8 months (P = .29), respectively. This lack of difference in outcome for CS IIIA and IIIB patients receiving RT has important implications in the design and stratification of future nonoperative trials for stage III lung cancer.

Performance of a novel TNM staging system for pancreatic neuroendocrine tumors versus the current AJCC staging system.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 156-156
Author(s):  
Motaz Qadan ◽  
Yifei Ma ◽  
Brendan C. Visser ◽  
Jeffrey A. Norton ◽  
George A. Poultsides
Keyword(s):  
Overall Survival ◽  
Neuroendocrine Tumors ◽  
Staging System ◽  
Pancreatic Neuroendocrine Tumors ◽  
Population Database ◽  
Curative Intent ◽  
Discriminatory Ability ◽  
Tnm System ◽  
Ajcc Staging System ◽  
Ajcc Staging

156 Background: Adopting a unified staging system for pancreatic neuroendocrine tumors (PNET) has been challenging. Currently, the American Joint Committee on Cancer (AJCC) recommends the use of the pancreatic adenocarcinoma staging system for PNET. We sought to validate this recommendation on a large administrative population database. Methods: Surveillance, Epidemiology, and End Results (SEER) data were used to identify patients with PNET (excluding patients with large cell, small cell, or mixed endocrine-exocrine carcinoma) who underwent curative-intent surgical resection from 1983 to 2008. The discriminatory ability of the AJCC system (recorded by SEER since 2004) was examined and a new TNM system was devised utilizing extent of disease variables. Results: Of 1,202 patients identified, 51% were female. Median age was 55 years (range, 9-93). Lymph node metastasis (present in 43% of patients) was associated with worse overall survival (OS) after resection (10-year OS, 50% vs 63%, p<.0001), as was the presence of distant metastasis (present in 24% of patients, 10-year OS, 35% vs 63%, p<.0001).The current AJCC system (available in 412 patients) distinguished overall survival adequately only between stages I and II, but not between II and III, or III and IV (Table). By modifying the T stage to be based only on size (0-1 cm, 1-2 cm, 2-4 cm, and > 4 cm) and by revising the grouping allocation, we propose a novel TNM system with improved discriminatory ability (Table). Conclusions: In this study validating the current AJCC staging system for PNET, we found stages II, III, and IV to perform similarly. We propose a simplified TNM system that better discriminates between outcomes. [Table: see text]

scholarly journals Stage II Differentiated Thyroid Cancer Is a High-Risk Disease in Patients <45/55 Years Old

2019 ◽  
Vol 104 (11) ◽  
pp. 4941-4948 ◽  
Author(s):  
Zeming Liu ◽  
Xiaopei Shen ◽  
Rengyun Liu ◽  
Guangwu Zhu ◽  
Tao Huang ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Mortality Risk ◽  
Older Patients ◽  
Differentiated Thyroid Cancer ◽  
Staging System ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Ajcc Staging System ◽  
Ajcc Staging

Abstract Purpose The mortality risk of stage II differentiated thyroid cancer (DTC) based on the American Joint Committee on Cancer (AJCC) staging system requires further investigation. Methods Retrospective study of DTC in the US Surveillance, Epidemiology, and End Results program for disease-specific mortality risk in various AJCC stages, with patient age stratification of stage II disease. Results Using AJCC staging system 6.0, hazard ratios (HRs) of mortality for stage II DTC in patients &lt;45 yo and patients ≥45 yo and stages III, IVA, IVB, and IVC compared with stage I were 46.95, 4.95, 9.82, 57.37, 222.10, and 468.68, respectively, showing a robustly higher mortality risk in stage II disease in patients &lt;45 yo than in older patients (P &lt; 0.001), comparable with stage IVA (P = 0.482). Similar results were obtained with AJCC 7.0. With AJCC 8.0, HRs of mortality for stage II in patients &lt;55 yo and patients ≥55 yo and stages III, IVA, and IVB compared with stage I were 75.16, 11.23, 69.45, 134.94, and 235.70, respectively, showing a robustly higher risk in stage II disease in patients &lt;55 yo than in older patients (P &lt; 0.001), comparable with stage III (P = 0.57). Kaplan-Meier survival curves displayed a sharp decline with stage II disease in patients &lt;45/55 yo compared with older patients. Conclusions The mortality risk of stage II DTC was sharply differentiated at patient age 45/55 years, being robustly high in younger patients and comparable with stage III/IVA. This emphasizes the importance of considering age when managing stage II DTC and not treating it as a uniformly low-risk disease.

scholarly journals The prognostic significance of different proportion of signet-ring cells of colorectal carcinoma

2021 ◽  
Author(s):  
Wei Chen ◽  
Huajun Cai ◽  
Kui Chen ◽  
Xing Liu ◽  
Weizhong Jiang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Cox Regression ◽  
Prognostic Significance ◽  
Staging System ◽  
Signet Ring Cell ◽  
Significant Difference ◽  
Signet Ring ◽  
Ajcc Staging System ◽  
Ajcc Staging

While the prognosis of patients with partial SRCC (PSRCC) has been rarely reported, colorectal signet-ring cell carcinoma (SRCC) has been associated with poor prognosis. The aim of this study was to analyze the prognosis of patients with different SRC composition and establish a prediction model. A total of 91 patients with SRC component were included in the study. These patients were divided into two groups: SRCC group (SRC composition > 50%; n=41) and partial SRCC (PSRCC) group (SRC composition ≤ 50%; n=50). COX regression model was used to identify independent prognostic factors for overall survival (OS). A predictive nomogram was established and compared with the 7th AJCC staging system. After a median follow-up of 16 months, no significant difference in OS was observed in either group. Preoperative carcinoembryonic antigen (CEA) level, pN stage, M stage, preoperative ileus, and adjuvant chemotherapy were independent prognostic risk factors for OS (p<0.05). A nomogram for predicting the overall survival of colorectal SRCC was established with a C-index of 0.800, and it showed better performance than that of the 7th AJCC staging system (p<0.001). In summary, the ratio of SRC component was not an independent prognostic factor of the OS. Those patients with less than 50% of SRC component should be given the same clinical attention. A predictive nomogram for survival based on five independent prognostic factors was developed and showed better performance than the 7th AJCC staging system. This resulted to be helpful for individualized prognosis prediction and risk assessment.

scholarly journals Development and validation of a nomogram to predict overall survival for patients with metastatic renal cell carcinoma

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Wenwen Zheng ◽  
Weiwei Zhu ◽  
Shengqiang Yu ◽  
Kangqi Li ◽  
Yuexia Ding ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Staging System ◽  
Seer Database ◽  
Ajcc Staging System ◽  
Ajcc Staging ◽  
Metastatic Rcc

Abstract Background Heterogeneity of metastatic renal cell carcinoma (RCC) constraints accurate prognosis prediction of the tumor. We therefore aimed at developing a novel nomogram for accurate prediction of overall survival (OS) of patients with metastatic RCC. Methods We extracted 2010 to 2016 data for metastatic RCC patients in the Surveillance, Epidemiology, and End Results (SEER) database, and randomly stratified them equally into training and validation sets. Prognostic factors for OS were analyzed using Cox regression models, and thereafter integrated into a 1, 3 and 5-year OS predictive nomogram. The nomogram was validated using the training and validation sets. The performance of this model was evaluated by the Harrell’s concordance index (C-index), calibration curve, integrated discrimination improvement (IDI), category-free net reclassification improvement (NRI), index of prediction accuracy (IPA), and decision curve analysis (DCA). Results Overall, 2315 metastatic RCC patients in the SEER database who fulfilled our inclusion criteria were utilized in constructing a nomogram for predicting OS of newly diagnosed metastatic RCC patients. The nomogram incorporated eight clinical factors: Fuhrman grade, lymph node status, sarcomatoid feature, cancer-directed surgery and bone, brain, liver, and lung metastases, all significantly associated with OS. The model was superior to the American Joint Committee on Cancer (AJCC) staging system (7th edition) both in training (C-indices, 0.701 vs. 0.612, P < 0.001) and validation sets (C-indices, 0.676 vs. 0.600, P < 0.001). The calibration plots of the nomogram corresponded well between predicted and observed values. NRI, IDI, and IPA further validated the superior predictive capability of the nomogram relative to the AJCC staging system. The DCA plots revealed reliable clinical application of our model in prognosis prediction of metastatic RCC patients. Conclusions We developed and validated an accurate nomogram for individual OS prediction of metastatic RCC patients. This nomogram can be applied in design of clinical trials, patient counseling, and rationalizing therapeutic modalities.

scholarly journals Diagnostic and prognostic values of upregulated SPC25 in patients with hepatocellular carcinoma

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e9535
Author(s):  
Xiaolin Yang ◽  
Hongzhi Sun ◽  
Ying Song ◽  
Li Yang ◽  
Haibo Liu
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Roc Curve ◽  
Cox Regression ◽  
Expression Patterns ◽  
Staging System ◽  
Cancer Genome ◽  
Ajcc Staging System ◽  
Ajcc Staging ◽  
Neoplastic Tissues

Background Spindle pole body component 25 (SPC25) plays a vital role in many cellular processes, such as tumorigenesis. However, the clinical significance of SPC25 in hepatocellular carcinoma (HCC) has not been investigated. This study aimed to explore the expression patterns of SPC25 in HCC and non-neoplastic tissues and to investigate the diagnostic and prognostic values of SPC25. Method The expression of SPC25 was examined in 374 HCC issues and 50 non-neoplastic tissues from The Cancer Genome Atlas (TCGA) cohort. The diagnostic and prognostic values of SPC25 were analyzed via receiver operating characteristic (ROC) curve and survival analyses, respectively. Univariate and multivariate Cox regression analyses were used to identify the prognostic factors and to establish a nomogram. The diagnostic and prognostic values were further validated in an external cohort from the International Cancer Genome Consortium (ICGC) database. Results The expression of SPC25 in HCC tissues was significantly higher than that in normal tissues in both cohorts (all P < 0.001). The ROC curve analysis indicated that SPC25 expression has high diagnostic value in HCC with area under the curve (AUC) value of 0.969 (95% confidence interval [CI] [0.948–0.984]) and 0.945 (95% CI [0.920–0.965]) for TCGA and ICGC cohorts, respectively. Patients with HCC exhibiting high SPC25 expression were associated with worse prognosis than those exhibiting low SPC25 expression in both cohorts (all P < 0.001). SPC25 was independently associated with overall survival in both cohorts (all P < 0.001). The concordance indices of the nomogram for predicting overall survival in TCGA and ICGC cohorts were 0.647 and 0.805, respectively, which were higher than those of the American Joint Committee on Cancer (AJCC) staging system. Conclusion SPC25 was upregulated in HCC and independently predicted poor overall survival of patients with HCC. Therefore, SPC25 is an effective diagnostic and prognostic biomarker for HCC. An SPC25-based nomogram was more accurate and useful than the AJCC staging system to predict prognosis of HCC.

scholarly journals Development and validation of a nomogram to predict overall survival for patients with metastatic renal cell carcinoma

2020 ◽  
Author(s):  
Wenwen Zheng ◽  
Weiwei Zhu ◽  
Shengqiang Yu ◽  
Kangqi Li ◽  
Yuexia Ding ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Staging System ◽  
Survival Prediction ◽  
Seer Database ◽  
Training Set ◽  
Ajcc Staging System ◽  
Validation Set ◽  
Ajcc Staging ◽  
Metastatic Rcc

Abstract Background: The prognosis of metastatic renal cell carcinoma (RCC) patients vary widely because of clinical and pathological heterogeneity. We aimed to develop a novel nomogram to predict overall survival (OS) for this population. Methods: Metastatic RCC patients were selected from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2016. These patients were randomly assigned to a training set and a validation set at a ratio of 1:1. Significant prognostic factors of survival were identified through Cox regression models and then integrated to form a nomogram to predict 1-, 3- and 5-year OS. The nomogram was subsequently subjected to validations via the training and the validation sets. The performance of this model was evaluated by using Harrell’s concordance index (C-index), calibration curve, integrated discrimination improvement (IDI), net reclassification improvement (NRI), and decision curve analysis (DCA). Results: Overall, 2315 eligible metastatic RCC patients were enrolled from the SEER database. A nomogram of survival prediction for patients of newly diagnosed with metastatic RCC was established, in which eight clinical factors significantly associated with OS were involved, including Fuhrman grade, lymph node status, sarcomatoid feature, cancer-directed surgery, bone metastasis, brain metastasis, liver metastasis, and lung metastasis. The new model presented better discrimination power than the American Joint Committee on Cancer (AJCC) staging system (7th edition) in the training set (C-indexes, 0.701 vs. 0.612, P <0.001) and the validation set (C-indexes, 0.676 vs. 0.600, P <0.001). The calibration plots of the nomogram exhibited optimal agreement between the predicted values and the observed values. The results of NRI and IDI also indicated the superior predictive capability of the nomogram relative to the AJCC staging system. The DCA plots revealed higher clinical use of our model in survival prediction. Conclusions: We developed and validated an effective nomogram to provide individual OS prediction for metastatic RCC patients, which would be beneficial to clinical trial design, patient counseling, and therapeutic modality selection.

scholarly journals Development and validation of a Nomogram for predicting the Overall Survival of Patients With Pancreatic Ductal Adenocarcinoma of the Head of the Pancreas

2021 ◽  
Author(s):  
Zhilong Liu ◽  
Haohui Yu ◽  
Mingrong Cao ◽  
Jiexing Li ◽  
Yulin Huang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Staging System ◽  
The United States ◽  
Ductal Adenocarcinoma ◽  
Seer Database ◽  
Training Set ◽  
Head Of The Pancreas ◽  
Ajcc Staging System ◽  
Ajcc Staging

Abstract Background: The purpose of this study is to develop and validate a nomogram to predict the overall survival (OS) of patients with Pancreatic Ductal Adenocarcinoma of the Head of the Pancreas (PDAC-HP).Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database, we collected patients with PDAC-HP in the United States between 2004 and 2015. Patients were randomly divided into training set and validating set at a ratio of 7:3. The training set is used to develop a nomogram for predicting OS. These indicators such as the C index, the area under curve (AUC) of the receiver operating characteristic (ROC), calibration plots and the net reclassification improvement (NRI) and the integrated discrimination improvement (IDI) were used to evaluate the prediction accuracy of the nomogram.Results: A total of 33,893 patients with PDAC-HP over 20 years old were diagnosed between 2004 and 2015 were collected from the SEER database. Using multivariable Cox regression analysis, we identified eight risk factors that were associated with OS, such as age at diagnosis, sex, marital status at diagnosis, race, AJCC staging, surgery, radiotherapy and chemotherapy. A nomogram was constructed based on these variables. Compared with the AJCC staging system, the nomogram has a better C index and AUC in the training set and validatiing set. The calibration plots indicated that the nomogram was able to accurately predict the OS of patients with PDAC-HP at 1, 3, and 5 years.Conclusions: We developed and validated a nomogram, and predicted the OS of patients with PDAC-HP at 1, 3, and 5 years. Compared with the AJCC staging system, the nomogram we constructed has better performance. It shows that our nomogram could be served as an effective tool for prognostic evaluation of patients with PDAC-HP.

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