Prognostic Validity of a Novel American Joint Committee on Cancer Staging Classification for Pancreatic Neuroendocrine Tumors

2011 ◽  
Vol 29 (22) ◽  
pp. 3044-3049 ◽  
Author(s):  
Jonathan R. Strosberg ◽  
Asima Cheema ◽  
Jill Weber ◽  
Gang Han ◽  
Domenico Coppola ◽  
...  
Keyword(s):  
Neuroendocrine Tumors ◽  
Proportional Hazards ◽  
Tnm Classification ◽  
Survival Rates ◽  
Tnm Staging ◽  
Cox Proportional Hazards ◽  
Cancer Center ◽  
Pancreatic Neuroendocrine Tumors ◽  
American Joint Committee ◽  
Staging Classification

Purpose The American Joint Committee on Cancer (AJCC) staging manual (seventh edition) has introduced its first TNM staging classification for pancreatic neuroendocrine tumors (NETs) derived from the staging algorithm for exocrine pancreatic adenocarcinomas. This classification has not yet been validated. Methods Patients with pancreatic NETs treated at the H. Lee Moffitt Cancer Center between 1999 and 2010 were assigned a stage (I to IV) based on the new AJCC classification. Kaplan-Meier analyses for overall survival (OS) were performed based on age, race, histologic grade, incidental diagnosis, and TNM staging (European Neuroendocrine Tumors Society [ENETS] v AJCC) using log-rank tests. Survival time was measured from time of initial diagnosis to date of last contact or date of death. Multivariate modeling was performed using Cox proportional hazards regression. Weighted Cohen's κ coefficient was computed to evaluate the agreement of ENETS and AJCC classifications. Results We identified 425 patients with pancreatic NETs. On the basis of histopathologic grade, 5-year survival rates for low-, intermediate-, and high-grade tumors were 75%, 62%, and 7%, respectively (P < .001). When using the ENETS classification, 5-year OS rates for stages I, II, III, and IV were 100%, 88%, 85%, and 57%, respectively (P < .001). Subsequently, using the AJCC classification, 5-year OS rates for stages I, II, III, and IV were 92%, 84%, 81%, and 57%, respectively (P < .001). Both the novel AJCC classification and the ENETS classification were highly prognostic for survival. Conclusion The AJCC TNM classification for pancreatic NETs is prognostic for OS and can be adopted in clinical practice.

Prognostic Validity of the American Joint Committee on Cancer Staging Classification for Midgut Neuroendocrine Tumors

2013 ◽  
Vol 31 (4) ◽  
pp. 420-425 ◽  
Author(s):  
Jonathan R. Strosberg ◽  
Jill M. Weber ◽  
Max Feldman ◽  
Domenico Coppola ◽  
Kenneth Meredith ◽  
...  
Keyword(s):  
Neuroendocrine Tumors ◽  
Survival Rates ◽  
Cox Proportional Hazards ◽  
Stage Iiib ◽  
Cancer Center ◽  
Intermediate Grade ◽  
American Joint Committee ◽  
Survival Difference ◽  
Ajcc Staging ◽  
Staging Classification

Purpose The American Joint Committee on Cancer (AJCC) staging manual has introduced a TNM staging classification for jejunal-ileal (midgut) neuroendocrine tumors (NETs). This classification has not been validated in a population consisting solely of midgut NETs. The purpose of this study was to test the prognostic validity of the classification in such a population. Methods Patients with jejunal and ileocecal NETs who were treated at the Moffitt Cancer Center between 2000 and 2010 were assigned stages (I through IV). Kaplan-Meier analyses for overall survival (OS) were performed on the basis of TNM stage and pathologic grade. Multivariate modeling was performed using Cox proportional hazards regression. Results We identified 691 patients with jejunal-ileocecal NETs. The AJCC classification in aggregate was highly prognostic for OS (P < .001). Five-year OS rates for stages I through IV were 100%, 100%, 91%, and 72%, respectively. The survival difference between stages III and IV was significant (P < .001); the difference between stages I/II versus III was not statistically significant (P = .1). Among patients with stage IIIB tumors, 5-year survival rates were 95% for resectable tumors versus 78% for unresectable mesenteric tumors (P = .02). A proliferative threshold of five mitoses per 10 high-power fields (HPF) was of greater prognostic value than a threshold of two mitoses per 10 HPF for discriminating between low- and intermediate-grade tumors. Conclusion Stage I and II midgut NETs are associated with identical survival rates. Stage IIIB tumors are heterogeneous, with significant differences in survival observed between resectable mesenteric lymph nodes versus unresectable masses in the root of the mesentery. A higher mitotic cutoff of five per 10 HPF may lead to improved prognostic differentiation between low- and intermediate-grade tumors. Revisions to the current AJCC staging and grading classification may be warranted.

scholarly journals Nomogram for individually predicting overall survival in rectal neuroendocrine tumors

2020 ◽  
Author(s):  
Xingyu Feng ◽  
Gengzhou Wei ◽  
Wei Wang ◽  
Yu Zhang ◽  
Yujie Zeng ◽  
...  
Keyword(s):  
Overall Survival ◽  
Neuroendocrine Tumors ◽  
Proportional Hazards ◽  
Southern China ◽  
Tnm Classification ◽  
Multivariable Analysis ◽  
Cox Proportional Hazards ◽  
Training Set ◽  
Discrimination Power ◽  
Who Grade

Abstract Background This study was designed to develop a nomogram that predicts the overall survival (OS) of rectal neuroendocrine tumors (NETs).Methods 310 patients with rectal neuroendocrine tumors in 5 hospitals in southern China were retrospectively analyzed. All the patients were assigned to the training set. A multivariable analysis using Cox proportional hazards regression was performed using the training set. And a nomogram was constructed. The validation set was performed using the data from Surveillance, Epidemiology, and End Result (SEER) databases of America (n=547).Results In the training set, the nomogram exhibited improved discrimination power compared with the WHO grade guidelines (Herrell’s C-index, 0.907 vs 0.809; p<0.001 ), and also improved compared with the seventh AJCC TNM classification (Herrell’s C-index, 0.907 vs 0.829; p<0.001 ). In the SEER validation sets, discrimination was also excellent (C-index, 0.824 vs 0.734 and 0.824 vs 0.766 respectively compared with G grade and TNM classification; both p <0.001). Calibration of the nomogram predicted survival corresponding closely with the actual survival. Conclusions We developed a nomogram predicting 1-, 3-year OS for rectal neuroendocrine tumors. Validation revealed excellent discrimination and calibration, suggested good clinical utility.

scholarly journals Prognostic Validity of the American Joint Committee on Cancer Eighth Edition Staging System for Well-Differentiated Pancreatic Neuroendocrine Tumors: A Retrospective Multinational Multicenter Study

2020 ◽  
Author(s):  
Hebin Wang ◽  
Ding Ding ◽  
Tingting Qin ◽  
Jun Liu ◽  
Hang Zhang ◽  
...  
Keyword(s):  
Neuroendocrine Tumors ◽  
Staging System ◽  
Tnm Staging ◽  
Stage I ◽  
Pancreatic Neuroendocrine Tumors ◽  
American Joint Committee ◽  
Staging Systems ◽  
Significant Difference ◽  
Well Differentiated ◽  
Eighth Edition

Abstract Background:There is no widely-accepted staging system for pancreatic neuroendocrine tumors (pNETs). The aim of this study was to validate the American Joint Committee on Cancer (AJCC) 8th edition staging system for well-differentiated (G1/G2) pNETs.Methods:A multicenter dataset (n=1086) was used to evaluate the application of the AJCC 7th and 8th, the European Neuroendocrine Tumor Society (ENETS), and the modified ENETS (mENETS) staging systems for well-differentiated pNETs.Results:The proportion of patients with stage III tumors was extremely low (1.1%) according to the AJCC 7th staging system. For the ENETS staging system, patients with stage IIIA disease had worse estimated mean survival than patients with stage IIIB disease (78.9 vs. 107.3 months). When comparing with patients in stage I, the AJCC 7th, ENETS, and mENETS staging systems showed good performance in discriminating between stages; however, there was no significant difference in some stages when the reference was defined as the earlier stage. When the reference was defined as stage I or the earlier stage, there was a significant inter-stage difference in the AJCC 8th staging system.Conclusions:The AJCC 8th staging system is more suitable for pNETs than other TNM staging systems and may be adopted in clinical practice.

Pretreatment hemoglobin level influences local control and survival of T1-T2 squamous cell carcinomas of the glottic larynx.

1995 ◽  
Vol 13 (8) ◽  
pp. 2077-2083 ◽  
Author(s):  
D A Fein ◽  
W R Lee ◽  
A L Hanlon ◽  
J A Ridge ◽  
C J Langer ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Head And Neck ◽  
Local Control ◽  
Squamous Cell ◽  
Proportional Hazards ◽  
Survival Rates ◽  
Local Control Rate ◽  
Cox Proportional Hazards ◽  
Hemoglobin Level ◽  
Cancer Center

PURPOSE A number of reports have documented the relationship between pretreatment hemoglobin level and local control and/or survival in the treatment of cervix, bladder, and advanced head and neck tumors. Consideration of correcting anemia before initiation of radiation therapy may prove increasingly important as clinical trials use intensive induction chemotherapy in the treatment of head and neck carcinomas. Neoadjuvant chemotherapy may produce anemia, which in turn may reduce the effectiveness of subsequent irradiation. MATERIALS AND METHODS One hundred nine patients with T1-2N0 squamous cell carcinoma of the glottic larynx were treated with definitive radiotherapy at the Fox Chase Cancer Center between June 1980 and November 1990. Follow-up times ranged from 26 to 165 months (median, 82). RESULTS The 2-year local control rate for patients who presented with a hemoglobin level < or = 13 g/dL was 66%, compared with 95% for patients with a hemoglobin level more than 13 g/dL (P = .0018). The 2-year survival rate for patients with a hemoglobin level < or = 13 g/dL was 46%, compared with 88% for patients with a hemoglobin level more than 13 g/dL (P < .001). Cox proportional hazards regression analysis showed that hemoglobin level (P = .0016) was the only variable that significantly influenced local control (P = .0016) and survival (P < .0001). CONCLUSION Patients who presented with hemoglobin levels more than 13 g/dL had significantly higher local control and survival rates. The strong apparent correlation between hemoglobin level, local control, and survival supports consideration of correcting anemia before initiation of radiation therapy.

Incidental diagnosis of pancreatic neuroendocrine tumors.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 190-190
Author(s):  
A. Cheema ◽  
L. K. Kvols ◽  
J. R. Strosberg
Keyword(s):  
Neuroendocrine Tumors ◽  
Early Stage ◽  
Hormone Secretion ◽  
Survival Rates ◽  
Stage Iv ◽  
Stage I ◽  
Cancer Center ◽  
Pancreatic Neuroendocrine Tumors ◽  
7Th Edition ◽  
Symptomatic Diagnosis

190 Background: Pancreatic neuroendocrine tumors are often discovered incidentally during radiologic or endoscopic examinations. The incidence of incidental detection is unknown. It is also unclear whether patients with incidentally discovered, asymptomatic tumors should be treated similarly to patients who present with tumor-related symptoms. Methods: A database of 425 patients with pancreatic neuroendocrine tumors treated at the H. Lee Moffitt Cancer Center was developed. Patient charts were reviewed to assess whether their diagnosis was incidental or prompted by tumor-related symptoms such as pain, jaundice, or neuroendocrine hormone secretion. The frequency of “incidentalomas” was categorized by TNM stage (AJCC, 7th edition). Overall survival was stratified by “incidental” versus “symptomatic” diagnosis. Results: Among 425 patients with histologically proven pancreatic neuroendocrine tumors, 112 patients (26%) had tumors that were discovered incidentally. The majority of stage I tumors (55%) were incidentally discovered. Among patients with stage IV tumors, 20% were detected incidentally (Table). Median survival of patients with incidentally discovered tumors was 103 months versus 84 months in patients who were symptomatic at diagnosis. Conclusions: A sizeable fraction of patients with pancreatic neuroendocrine tumors are diagnosed incidentally during evaluations for other conditions or unrelated symptoms. The majority of patients with stage I tumors are incidentally diagnosed. The increased incidence of pancreatic neuroendocrine “incidentaloms” may be contributing to improving survival rates in this disease. This study highlights the necessity of developing guidelines for management of patients with incidentally discovered, early-stage tumors. [Table: see text] No significant financial relationships to disclose.

Risk of metastatic spread in patients with early-stage, surgically resected pancreatic neuroendocrine tumors.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 338-338
Author(s):  
J. R. Strosberg ◽  
A. Cheema ◽  
J. Weber ◽  
L. K. Kvols
Keyword(s):  
Neuroendocrine Tumors ◽  
Early Stage ◽  
Tnm Classification ◽  
Locally Advanced ◽  
Metastatic Spread ◽  
Cancer Center ◽  
Separate Analysis ◽  
Recurrence Free Survival ◽  
Pancreatic Neuroendocrine Tumors ◽  
Free Survival

338 Background: The risk of metastatic spread among patients with early-stage surgically resected pancreatic neuroendocrine tumors has not been well established. Methods: Patients with surgically resected localized or locally advanced pancreatic neuroendocrine tumors treated at the H. Lee Moffitt Cancer Center between 1999 and 2010 were assigned a stage (I-III) based on the new AJCC classification. Recurrence-free survival was measured for each stage. A separate analysis was performed excluding patients who had been referred to Moffitt Cancer Center after metastatic recurrence. Results: 123 patients with nonmetastatic, surgically resected pancreatic neuroendocrine tumors were identified. 5-year recurrence-free survival correlated with AJCC stage (p=0.01; Table). Conclusions: The novel AJCC 7th edition TNM classification for pancreatic neuroendocrine tumors is highly prognostic for recurrence in patients with surgically resected nonmetastatic tumors. [Table: see text] No significant financial relationships to disclose.

Complete clinical (CC) responders to definite chemoradiation or radiation therapy (CRT/RT) for esophageal cancer (EC): A survival analysis.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14560-e14560
Author(s):  
Xavier Mirabel ◽  
Emmanuelle Tresch ◽  
Olivier Romano ◽  
Sylvain Dewas ◽  
Eric Amela ◽  
...  
Keyword(s):  
Weight Loss ◽  
Proportional Hazards ◽  
Tnm Classification ◽  
Survival Rates ◽  
Cox Proportional Hazards ◽  
Stage I ◽  
Stage Iii ◽  
Predictors Of Outcome ◽  
Morphological Examination ◽  
Stage Grouping

e14560 Background: For pts with EC being treated with definite CRT/RT, predictors of outcome are baseline nutritional status and CC response to CRT. As data concerning predictors of outcome for CC responders are lacking, we tried to identify them. Methods: Among 402 consecutive pts with EC who underwent definite CRT/RT in our institution from 1/1998 to 12/2003, 110 were found CC responders, and were retrospectively reviewed. Baseline staging included endoscopy with biopsies, and CT-scan and/or EUS. CC responders were defined as pts without evidence of tumor on morphological examination with biopsies, 4 to 6 weeks after treatment. Univariate and multivariate analyses were performed using log-rank and Cox proportional hazards models, and survival curves were estimated using the Kaplan-Meier method. Results: Pts were staged according to EUS-AJCC staging (stage I-II=39, stage III-IVa=37, ukn=34) and/or CT staging (stage I-II=54, stage III-IVa=32, ukn=24). Baseline pt and tumor characteristics were as follows: M/F = 98/12, median age = 60, ADK/SCC = 7/103, tumor site (upper/middle/lower third) = 41/50/19, weight loss none/<10%/≥10% = 36/45/29, dysphagia gr.0/1/≥2 = 30/14/65. Pts received a median dose of RT of 50.4Gy (30-65), and concomitant chemotherapy in 95/110 cases. Post treatment nutritional characteristics were : weight loss during treatment none/<10%≥10% = 35/38/37, remaining dysphagia gr.0/1/≥2 = 54/24/32. During follow up (median: 6 [0.4-9.8] years), 16 pts got esophagectomy (recurrence: 3, some reasons: 13). Median survival was 2.5 years, and 3- and 5-year survival rates were 46.9%, and 33.5%, respectively. Neither TNM classification nor stage grouping, histological type, gender, or treatment types were found to have any influence on outcome. Predictors of improved OS were: absence of weight loss during treatment, and absence of dysphagia with normal oral intakes after treatment. Conclusions: One EC pt out of 3 with CC response after definite CRT/RT is still alive at 5 years. The absence of weight loss during treatment, and of remaining dysphagia after treatment are significant predictors of better survival in pts found CC responders to definite CRT/RT for EC.

Modified Staging Classification for Pancreatic Neuroendocrine Tumors on the Basis of the American Joint Committee on Cancer and European Neuroendocrine Tumor Society Systems

2017 ◽  
Vol 35 (3) ◽  
pp. 274-280 ◽  
Author(s):  
Guopei Luo ◽  
Ammar Javed ◽  
Jonathan R. Strosberg ◽  
Kaizhou Jin ◽  
Yu Zhang ◽  
...  
Keyword(s):  
Neuroendocrine Tumor ◽  
Neuroendocrine Tumors ◽  
Statistical Significance ◽  
Staging System ◽  
Hazard Ratio ◽  
Stage Iii ◽  
Pancreatic Neuroendocrine Tumors ◽  
American Joint Committee ◽  
Ajcc Staging ◽  
Staging Classification

Purpose The European Neuroendocrine Tumor Society (ENETS) and the American Joint Committee on Cancer (AJCC) staging classifications are two widely used systems in managing pancreatic neuroendocrine tumors. However, there is no universally accepted system. Methods An analysis was performed to evaluate the application of the ENETS and AJCC staging classifications using the SEER registry (N = 2,529 patients) and a multicentric series (N = 1,143 patients). A modified system was proposed based on analysis of the two existing classifications. The modified system was then validated. Results The proportion of patients with AJCC stage III disease was extremely low for both the SEER series (2.2%) and the multicentric series (2.1%). For the ENETS staging system, patients with stage I disease had a similar prognosis to patients with stage IIA disease, and patients with stage IIIB disease had a lower hazard ratio for death than did patients with stage IIIA disease. We modified the ENETS staging classification by maintaining the ENETS T, N, and M definitions and adopting the AJCC staging definitions. The proportion of patients with stage III disease using the modified ENETS (mENETS) system was higher than that of the AJCC system in both the SEER series (8.9% v 2.2%) and the multicentric series (11.6% v 2.1%). In addition, the hazard ratio of death for patients with stage III disease was higher than that for patients with stage IIB disease. Moreover, statistical significance and proportional distribution were observed in the mENETS staging classification. Conclusion An mENETS staging classification is more suitable for pancreatic neuroendocrine tumors than either the AJCC or ENETS systems and can be adopted in clinical practice.

Sign in / Sign up

Export Citation Format

Share Document