A novel t-stage classification system for adrenocortical carcinoma: Proposal from the U.S. Adrenocortical Carcinoma Study Group.

266 Background: The 7th AJCC T-stage classification system for adrenocortical carcinoma (ACC), based on size and extra-adrenal invasion, does not adequately stratify patients by survival. Lymphovascular invasion (LVI) is a known poor prognostic factor. We propose a novel T-stage system that incorporates LVI to better risk-stratify patients undergoing resection for ACC. Methods: Patients undergoing curative-intent resections for ACC from 1993-2014 at 13 institutions comprising the US ACC Study Group were included. Primary outcome was disease-specific survival (DSS). Results: Of 265 patients with ACC, 149 had complete data for analysis. The current T-stage system failed to differentiate patients with T2 vs T3 disease ( p= 0.10). Presence of LVI was associated with worse DSS compared to no LVI (36 vs. 168mos; p= 0.001). After accounting for the individual components of the current T-stage system (size and extra-adrenal invasion), LVI persisted as a poor prognostic factor on multivariable analysis (HR 2.14, 95% CI 1.05-4.38, p= 0.04). LVI positivity further stratified patients with T2 and T3 disease, (T2: 37mos vs median not reached; T3: 36 vs 96mos; p =0.03), but did not influence survival in patients with T1 or T4 disease. By incorporating LVI, a new T-stage classification system was created: [T1: < 5cm, (-)local invasion, (+/-)LVI; T2: > 5cm, (-)local invasion, (-)LVI OR any size, (+)local invasion, (-)LVI; T3: > 5cm, (-)local invasion, (+)LVI OR any size, (+)local invasion, (+)LVI; T4: any size, (+)adjacent organ invasion, (+/-)LVI]. Each progressive new T-stage group was associated with worse median DSS (T1: 167mos; T2: 96mos; T3: 37mos; T4: 15mos; p< 0.001). Conclusions: The current AJCC T-stage system for ACC does not adequately stratify patients by survival, particularly for T2 and T3 disease. The proposed T-stage classification system, which incorporates lymphovascular invasion, better differentiates T2 and T3 disease and accurately stratifies patients by disease-specific survival. If externally validated, this novel T-stage classification should be considered for future AJCC staging systems.

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A Novel T-Stage Classification System for Adrenocortical Carcinoma: Proposal from the U.S. Adrenocortical Carcinoma Study Group

VideoEndocrinology ◽

10.1089/ve.2017.0115 ◽

2018 ◽

Vol 5 (3) ◽

Author(s):

Cecilia G. Ethun ◽

Caroline E. Poorman ◽

Lauren M. Postlewait ◽

Thuy B. Tran ◽

Jason D. Prescott ◽

...

Keyword(s):

Adrenocortical Carcinoma ◽

Classification System ◽

Study Group ◽

T Stage ◽

Stage Classification ◽

The U.S

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A Novel T-Stage Classification System for Adrenocortical Carcinoma: Proposal from the US Adrenocortical Carcinoma Study Group

Annals of Surgical Oncology ◽

10.1245/s10434-017-6236-1 ◽

2017 ◽

Vol 25 (2) ◽

pp. 520-527 ◽

Cited By ~ 10

Author(s):

Caroline E. Poorman ◽

Cecilia G. Ethun ◽

Lauren M. Postlewait ◽

Thuy B. Tran ◽

Jason D. Prescott ◽

...

Keyword(s):

Adrenocortical Carcinoma ◽

Classification System ◽

Study Group ◽

T Stage ◽

The Us ◽

Stage Classification

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Proposal of a new T-stage classification system for ampullary carcinoma based on Surveillance, Epidemiology and End Result (SEER) database

Hepatobiliary & Pancreatic Diseases International ◽

10.1016/j.hbpd.2021.07.009 ◽

2021 ◽

Author(s):

Shi-Jie Wang ◽

Yi-Fei Li ◽

Shan Liao ◽

You-Zhu Wei ◽

Yan-Ming Zhou

Keyword(s):

Classification System ◽

Ampullary Carcinoma ◽

Seer Database ◽

T Stage ◽

Stage Classification

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Colon and Rectal Neuroendocrine Tumors: Are They Really One Disease? A Single-Institution Experience over 15 Years

The American Surgeon ◽

10.1177/000313481808400525 ◽

2018 ◽

Vol 84 (5) ◽

pp. 717-726 ◽

Cited By ~ 2

Author(s):

Justine S. Broecker ◽

Cecilia G. Ethun ◽

Lauren M. Postlewait ◽

Nina Le ◽

Mia Mcinnis ◽

...

Keyword(s):

Neuroendocrine Tumors ◽

Lymphovascular Invasion ◽

Tumor Biology ◽

Institutional Setting ◽

Disease Specific Survival ◽

Single Institution ◽

Transanal Resection ◽

T Stage ◽

Survival Differences ◽

Disease Specific

Colon and rectal neuroendocrine tumors (NETs) are often studied as one entity. Recent evidence suggests that worse outcomes are associated with colon compared with rectal NETs; direct comparisons are lacking. Our aim was to assess clinicopathologic, treatment, and survival differences between these diseases. All patients who underwent resection of colorectal NETs at one institution from 2000 to 2014 were included and analyzed. Of 29 patients, 12(41%) had colon and 17 (59%) had rectal NETs. Baseline demographics were similar between groups, although colon patients tended to be symptomatic at presentation (67% vs 44%, P = 0.41). Eighty-three per cent of colon patients underwent surgical resection, whereas 77 per cent of rectal patients underwent endoscopic or transanal resection ( P = 0.003). Colon patients had larger (3.4 cm vs 0.7 cm, P = 0.03), higher T-stage (T3/T4: 91% vs 14%, P = 0.003), higher grade tumors (42% vs 12%, P = 0.09) with more lymph nodes (58% vs 24%, P = 0.12) and lymphovascular invasion positivity (58% vs 24%, P = 0.32). Five-year disease-specific survival was 53% versus 80 per cent for colon and rectal patients, respectively ( P = 0.22). After excluding high-grade tumors, colon NETs were associated with lymphovascular invasion positivity (100% vs 17%, P = 0.05) and advanced T-stage (80% vs 8%, P = 0.01). Colon and rectal 5-year disease-specific survival was 67 versus 80 per cent ( P = 0.86). Colon and rectal NETs clinically seem to be distinct entities. Colon tumors have more aggressive clinicopathologic features, which may translate to worse outcomes. These differences in tumor biology may demand distinct management and should be further studied in a multi-institutional setting.

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Proposal for a new T-stage classification system for distal cholangiocarcinoma: a 10-institution study from the U.S. Extrahepatic Biliary Malignancy Consortium

HPB ◽

10.1016/j.hpb.2016.07.009 ◽

2016 ◽

Vol 18 (10) ◽

pp. 793-799 ◽

Cited By ~ 9

Author(s):

Lauren M. Postlewait ◽

Cecilia G. Ethun ◽

Nina Le ◽

Timothy M. Pawlik ◽

Stefan Buettner ◽

...

Keyword(s):

Classification System ◽

Distal Cholangiocarcinoma ◽

Biliary Malignancy ◽

T Stage ◽

Stage Classification ◽

The U.S

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Proposal for a new t-stage classification system for distal cholangiocarcinoma: A 10-institution study from the U.S. extrahepatic biliary malignancy consortium

HPB ◽

10.1016/j.hpb.2016.02.018 ◽

2016 ◽

Vol 18 ◽

pp. e4-e5

Author(s):

L. Postlewait ◽

T. Pawlik ◽

G. Poultsides ◽

K. Idrees ◽

R. Fields ◽

...

Keyword(s):

Classification System ◽

Distal Cholangiocarcinoma ◽

Biliary Malignancy ◽

T Stage ◽

Stage Classification ◽

The U.S

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A Novel Classification System for Spinal Instability in Neoplastic Disease: An Evidence-Based Approach and Expert Consensus From the Spine Oncology Study Group

Yearbook of Neurology and Neurosurgery ◽

10.1016/j.yneu.2011.05.003 ◽

2011 ◽

Vol 2011 ◽

pp. 284-286

Author(s):

R. Riesenburger

Keyword(s):

Classification System ◽

Expert Consensus ◽

Spinal Instability ◽

Neoplastic Disease ◽

Study Group ◽

Evidence Based

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Combination of GP88 Expression in Tumor Cells and Tumor-Infiltrating Immune Cells Is an Independent Prognostic Factor for Bladder Cancer Patients

Cells ◽

10.3390/cells10071796 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1796

Author(s):

Markus Eckstein ◽

Verena Lieb ◽

Rudolf Jung ◽

Danijel Sikic ◽

Katrin Weigelt ◽

...

Keyword(s):

Bladder Cancer ◽

Prognostic Factor ◽

Tumor Cells ◽

Immune Cells ◽

Potential Candidate ◽

Poor Prognostic Factor ◽

Risk Of Death ◽

Increased Risk ◽

Muscle Invasive ◽

Disease Specific

Urothelial bladder cancer (BCa) is the ninth most commonly diagnosed cancer worldwide and accounts for approximately 3% of global cancer diagnoses. We are interested in prognostic markers that may characterize tumor cells (TCs) and immune cells (ICs) and their relationship in BCa. A potential candidate marker that meets these criteria is progranulin (GP88), which is expressed separately in TCs and ICs. We analyzed GP88 expression by immunohistochemistry (IHC) in 196 muscle-invasive BCa samples using a tissue microarray. The immunoreactive score for GP88 staining in TCs and the percentage of GP88-positive ICs was determined. An easy cutoff for the staining status of TCs (positive vs. negative) and ICs (0% vs. >0%) and, more generally, negative vs. positive GP88 staining could be applied. We detected 93 patients (47.4%) and 92 patients (46.9%) with GP88-positive TCs or ICs, respectively. The IHC results were correlated with clinicopathological and survival data. Positive GP88 staining in TCs appeared to be an independent poor prognostic factor for disease-specific survival (DSS) (RR (relative risk) = 1.74; p = 0.009) and recurrence-free survival (RFS) (RR = 1.92; p = 0.002). In contrast, negative GP88 staining in ICs was an independent negative predictor for overall survival (OS) (RR = 2.18; p < 0.001), DSS (RR = 2.84; p < 0.001) and RFS (RR = 2.91; p < 0.001) in multivariate Cox’s regression analysis. When combining GP88 staining in TCs and ICs, a specific combination of GP88-positive TCs and GP88-negative ICs was associated with a 2.54-fold increased risk of death, a 4.21-fold increased risk of disease-specific death and a 4.81-fold increased risk of recurrence compared to GP88-negative TCs and GP88-positive ICs. In summary, GP88 positivity in TCs is a negative prognostic factor for DSS and RFS. In addition, GP88 positivity can mark ICs that are associated with a good prognosis (OS, DSS and RFS). The combination of GP88 staining in TCs and ICs appears to be a significant independent prognostic biomarker in muscle-invasive BCa.

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