Impact of the T and N stage in the American Joint Committee on Cancer (AJCC) 8th edition staging system for pancreatic cancer with curative resection.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 261-261
Author(s):  
Akiko Todaka ◽  
Akira Fukutomi ◽  
Mitsuhiro Furuta ◽  
Hiromichi Shirasu ◽  
Masahiro Kawahira ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Adjuvant Treatment ◽  
Tumor Size ◽  
Curative Resection ◽  
Staging System ◽  
Median Number ◽  
New Classification ◽  
N Classification ◽  
N Stage ◽  
The Impact

261 Background: The 8th edition of the AJCC staging system for pancreatic cancer contains several changes. T and N classification incorporate tumor size and number of positive lymph node (LN). The aim of this study was to evaluate the impact on the outcomes of the new classification for the patients who underwent curative resection and received adjuvant treatment with S-1. Methods: We retrospectively reviewed 96 patients who underwent curative resection for pancreatic ductal adenocarcinoma and received adjuvant treatment with S-1 (40, 50, or 60 mg according to body-surface area, orally administered twice a day for 28 days followed by a 14-day rest, every 6 weeks [one cycle], for up to four cycles) at our institution between January 2007 and December 2015. Inclusion criteria were as follows: PS0/1, adequate-organ functions, no critical complication, start of adjuvant therapy within 10 weeks after resection, and no active concomitant malignancy. Results: 66 patients were satisfied with these criteria. Patients characteristics were as follows: median age 67 years (range, 43-83), male 40 (61%), Pancreatoduodenectomy / Distal / Total pancreatectomy 50/14/2, combined portal vein or superior mesenteric vein resection 25 (38%), no postoperative complication 25 (38%), Well/Moderately/Poorly differentiated type 23/41/2, the median tumor size 30mm (range, 13-130), the median number of dissected LN 25 (range, 10-60), the median number of positive LN 2 (range, 0-8), and the resection margin status (R0/1) 62/4. The distribution in the 8th edition (1A/1B/2A/2B/3) was 6(9%) / 10(15%) / 5(8%) / 36(54%) / 9(14%), respectively. 2-year overall survival (OS) and relapse-free survival (RFS) were 70% and 52%. In the 8th edition staging system (1A/1B/2A/2B/3), 2-year OS and RFS were 100/90/80/66/40% and 83/70/53/49/22%, respectively. 2-year OS and RFS by T classification according to AJCC 8th edition were 100/68/56% and 90/39/56% (T1/2/3), while those by N classification were 90/66/40% and 70/49/22% (N0/1/2), respectively. Conclusions: The survival was poor with progress of the stage in the new classification. Especially at N stage, it might be suggested an association with prognosis.

scholarly journals Prognostic Discrepancy of the 6th and 7th UICC N Classification for Lymph Node Staging in Gastric Cancer Patients after Curative Resection

2017 ◽  
Vol 10 (1) ◽  
pp. 57-65 ◽  
Author(s):  
Sung Jin Oh ◽  
Byoung Jo Suh ◽  
Jong Kwon Park ◽  
Sung Don Oh ◽  
Hang Jong Yu
Keyword(s):  
Gastric Cancer ◽  
Curative Resection ◽  
Staging System ◽  
Tnm Staging ◽  
7Th Edition ◽  
Kaplan Meier ◽  
Tnm Staging System ◽  
N Classification ◽  
N Stage ◽  
Uicc Staging System

Background: The validity of N classification of the 7th edition of the American Joint Committee on Cancer/Union Internationale contre le Cancer (AJCC/UICC) tumor-node-metastasis (TNM) staging system is still under debate. The purpose of this study was to evaluate the prognostic efficacy of the 7th edition of the AJCC/UICC TNM staging system (focusing on N stage), in comparison with the 6th edition, at a single Eastern institution. Methods: We analyzed 1,435 patients with gastric cancer who underwent curative resection performed from September 1998 to August 2003 at the Memorial Jin-Pok Kim Korea Gastric Cancer Center. We analyzed the survival rate of the patients according to the AJCC/UICC 6th and 7th editions, and compared each stage, focusing on N stage. Results: Significant differences in the 5-year survival rates were observed between the 6th and the 7th AJCC/UICC staging system. In the 6th edition staging system, the Kaplan-Meier curves discriminated each N stage significantly. In contrast, there was no difference in terms of survival curves for N stage according to the 7th edition, especially between N1 and N2: the Kaplan-Meier plots of survival curves between N1 (77.0%) and N2 (78.1%) stages overlapped significantly (p < 0.05). Conclusion: Although the 7th UICC staging system is a more detailed and sophisticated system in the T category, there was no prognostic significance between the pN1 and pN2 stages according to our data. Therefore, we suggest establishing a new UICC staging system taking into consideration the application of the N stage.

Retrospective analysis of adjuvant treatment for localized, operable uterine leiomyosarcoma.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11072-11072
Author(s):  
Jomjit Chantharasamee ◽  
Karlton Wong ◽  
Pasathorn Potivongsajarn ◽  
Amir Aqorbani ◽  
Bartosz Chmielowski ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Treatment ◽  
Tumor Size ◽  
Disease Free Survival ◽  
Mitotic Rate ◽  
Stage I ◽  
Uterine Leiomyosarcoma ◽  
Recurrence Rates ◽  
The Impact

11072 Background: Surgery is the standard of care for uterine leiomyosarcoma, but recurrence rates are high and outcomes are poor. Standard adjuvant treatment of localized uterine leiomyosarcoma(uLMS) has not yet been established as clinical trials to address this question have been small or hindered by slow accrual. Methods: We reviewed the medical records of patients with uLMS who underwent upfront surgery between 2000-2018. We evaluated the clinical characteristics and adjuvant therapy on outcomes. Patient characteristics and treatment outcomes were described using descriptive statistics. Kaplan-Meier survival analysis was used for DFS. Cox proportional hazard regression was used to compare difference between groups. Results: 59 patients with a median age of 52 years were analyzed and the median time from surgery to adjuvant treatment was 47 days. 48/59 (81.4%) underwent TAH-BSO. 64.4% were FIGO stage I, 16.9% were stage II and 6.7% were stage III. The median tumor size was 11 cm (range: 3-21cm) and the median mitotic rate was 13 mitoses/ 10 high-power fields (HPF), (range: 1-63). 34/59 (57.6%) of patients received adjuvant chemotherapy +/- radiation therapy and 25 patients (42.3%) did not receive adjuvant treatment. With a median follow-up time of 42.8 months, 42 patients (71.2%) had disease relapse and 15 (35.7%) had pulmonary metastases. The median disease-free survival (mDFS) for all patients was 23.1 months. Any adjuvant treatment (chemotherapy or radiation) had a trend toward longer mDFS than no adjuvant treatment (36.6 vs 13.6 months, p = 0.14). Patients who had adjuvant chemotherapy had a non-significant longer mDFS compared to who did not receive any adjuvant treatment (33.8 vs 13.6 months, p = 0.18). Patients with stage I disease had trend towards higher mDFS in the chemotherapy group, it was not statistically significant (29.7 vs 16.6 months, p = 0.59). Multivariate analysis found that the independent prognostic factors for worse DFS included tumor size larger than 10 cm, and mitotic rate over 10/ 10HPF. More morcellated specimens were found in non-adjuvant treatment arm (36%) compare to 8% in adjuvant arm. In the non-treatment arm, 14 patients had recurrences within 6 months. Conclusions: In a retrospective uLMS population, the mDFS was 23.1 months. Tumor size > 10cm and mitotic rate > 10/10 HPF were independent prognostic factors for lower DFS. The non-treatment group had a significantly higher number of patient with morcellization and relapsed within 6 months, confounding analyses of the impact of adjuvant chemotherapy.

The impact of tumor size on survival in T3 non-small cell lung-cancer with direct extension.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e20033-e20033
Author(s):  
Clara H. Kim ◽  
Michelle C. Salazar ◽  
Jessica R. Hoag ◽  
Joshua E. Rosen ◽  
Brian N. Arnold ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Tumor Size ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Adjuvant Chemoradiation ◽  
Direct Extension ◽  
Cox Proportional Hazard Models ◽  
N Stage ◽  
The Impact

e20033 Background: Tumor size is an important prognostic variable that affects clinical decision-making in NSCLC including the use of adjuvant therapy. However, the association between tumor size and survival in a subset of patients who have T3 NSCLC with direct extension into nearby structures (T3dx) has not been explicitly characterized. We hypothesize that tumor size impacts survival and prognosis within this cohort. Methods: Patients with T3dxin 2006-2013 who underwent lobectomy or pneumonectomy were identified in the National Cancer Database. Patients who received neoadjuvant therapy or had positive margins were excluded. Tumor size was categorized based on cutoffs used by current staging guidelines and patients were stratified by pathologic N stage (see table). Cox proportional hazard models were used to measure the independent impact of tumor size on survival. Results: Overall, 0.1-3cm tumors exhibit superior 5-year survival compared to 3.1-5cm and >5cm tumors. Tumor size is significantly associated with survival in N0 patients but not in N1 and N2 patients. Use of adjuvant chemotherapy is associated with improved survival in the overall cohort and all subgroups; however, use of adjuvant chemoradiation may be associated with inferior survival in the overall cohort. Conclusions: Larger tumor size is associated with inferior survival in T3dx in the absence of nodal disease. T3dx requires a more tailored approach to adjuvant therapy than other T3 subgroups. Adjuvant chemotherapy appears to benefit all patients with T3dx; however, the role of adjuvant chemoradiation is less clear. [Table: see text]

Adjuvant therapy for margin positive pancreatic cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 390-390 ◽  
Author(s):  
Caitlin Takahashi ◽  
Ravi Shridhar ◽  
Cynthia L. Harris ◽  
Justin Lee ◽  
Anjan Jayantilal Patel ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Adjuvant Therapy ◽  
Tumor Size ◽  
Statistical Tests ◽  
Surgical Care ◽  
Tumor Grade ◽  
Node Positive ◽  
R1 Resection ◽  
Dismal Prognosis ◽  
The Impact

390 Background: Pancreatic cancer continues to have a dismal prognosis despite improvements in surgical care. Approximately 26% of patients are deemed resectable, and at the time of operation, 28% will have R1 resections. Adjuvant chemotherapy (AC) or chemoradiation (CRT) is recommended, however the magnitude of benefit is unclear. We sought to examine the impact these therapies on R1 resected pancreatic cancer. Methods: Utilizing the National Cancer Database we identified patients who underwent pancreatic resection for adenocarcinoma. Patients were stratified by resection status and adjuvant therapy. Baseline comparisons of patient characteristics were made using Mann-Whitney U, Kruskal Wallis and Pearson’s Chi-square test as appropriate. Survival analyses were performed using the Kaplan-Meier method. Multivariable cox proportional models(MVA) were developed to identify predictors of survival. All statistical tests were two-sided and α <0.05 was considered significant. Results: We identified 28,440 patients: 22,005 (77.4%) underwent R0 resections and 6,435 (22.4%) underwent R1 resections with a median age of 67.5 years (18-90) and median tumor size of 3.1 cm (2.4-4.2). Patients with tumor size >2cm were more likely to undergo R1 resections, p<0.001. Within the R1 resection group, AC was administered in 1,802 (19.4%), CRT 2,153 (28.5%), and no adjuvant therapy (NA) 2,480 (21.4%). Adjuvant therapy improved survival in all patients with median and 5-year survival of: AC (21.7 months, 17.45%), CRT (23.3 months, 20.9%) vs NA (19.5 months, 19.1%), p<0.001. In the R1 resection cohort survival was also improved with adjuvant therapy with CRT demonstrating the most significant improvement: AC (15.9 months, 6.5%), CRT (18.7 months. 11.2%) vs NA (12.5 months, 8.7%), p<0.001. Additionally CRT but not AC improved survival in the R1 node negative, p<0.004, and node positive, p<0.001. AC benefited survival in R1 node positive patients, p<0.001. MVA revealed age, tumor grade, tumor size >2cm, T-stage, N-stage, AC, and CRT were predictive of survival. Conclusions: Patients with pancreatic cancer who undergo R1 resection have significant improvement in survival when treated with adjuvant CRT and AC. However, benefits were greater in those receiving adjuvant CRT.

scholarly journals Predictors of Spontaneous Rupture of Hepatocellular Carcinoma and Clinical Outcomes Following Hepatectomy

2021 ◽  
Author(s):  
Yiran Chen ◽  
Jing Zhao ◽  
Deliang Guo ◽  
Chang Xu ◽  
Qian Zhu
Keyword(s):  
Hepatocellular Carcinoma ◽  
Tumor Size ◽  
Curative Resection ◽  
Postoperative Morbidity ◽  
Clinicopathological Parameters ◽  
Hospital Death ◽  
Term Survival ◽  
Increased Risk ◽  
Significant Difference ◽  
The Impact

Abstract Objective: To explore the independent predictive factors of spontaneous tumor rupture (STR) in patients undergoing curative resection of hepatocellular carcinoma (HCC), and to evaluate the impact of STRHCC on long-term survival after hepatectomy. Methods: The clinicopathological parameters of 106 patients with STRHCC and 201 patients with nonruptured HCC who underwent hepatectomy from January 2007 to November 2011 at the Eastern Hepatobiliary Surgery Hospital and Zhongnan Hospital of Wuhan University were analyzed using propensity score matching (PSM) and logistic regression model. Results: Factors including complicated hypertension, cirrhosis, total bilirubin (TB), tumor size, and seroperitoneum were independent predictors of STR. For all 307 HCC patients, the 1-, 3- and 5-year overall survival (OS) rates were 54.0%, 37.3% and 33.8% respectively. After propensity matching scores, the 1-, 3-, and 5-year OS rates in the ruptured group remained significantly lower at 41.5%, 23.5%, and 17.5% when compared with the nonruptured group at 70.8%, 47.1%, and 37.6% respectively, while the 1-, 3-, and 5-year Disease-free survival (DFS) rates between the groups did not differ significantly (50.4%, 35.1%, 27.1% vs 55.4%, 38.2%, 27.4%). STRHCC was significant associated with increased risk of OS, but not of shorter DFS. No significant difference in postoperative morbidity or hospital death was observed between the groups. Conclusion: Factors including complicated hypertension, liver cirrhosis, higher TB levels, tumor size > 5cm, and seroperitoneum are significant predictors of STR. STR results in poorer OS but not DFS in patients undergoing curative resection for HCC. STRHCC has no impact on postoperative morbidity and mortality after hepatectomy.

Toward an Optimized Staging System for Pancreatic Ductal Adenocarcinoma: A Clinically Interpretable, Artificial Intelligence–Based Model

2021 ◽  
pp. 1220-1231
Author(s):  
Dimitris Bertsimas ◽  
Georgios Antonios Margonis ◽  
Yifei Huang ◽  
Nikolaos Andreatos ◽  
Holly Wiberg ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Tumor Size ◽  
Area Under The Curve ◽  
Staging System ◽  
Nodal Status ◽  
Ductal Adenocarcinoma ◽  
Risk Of Death ◽  
Staging Systems ◽  
N Stage

PURPOSE The American Joint Committee on Cancer (AJCC) eighth edition schema for pancreatic ductal adenocarcinoma treats T and N stage as independent factors and uses positive lymph nodes (PLNs) to define N stage, despite data favoring lymph node ratio (LNR). We used artificial intelligence–based techniques to compare PLN with LNR and investigate interactions between tumor size and nodal status. METHODS Patients who underwent pancreatic ductal adenocarcinoma resection between 2000 and 2017 at six institutions were identified. LNR and PLN were compared through shapley additive explanations (SHAP) analysis, with the best predictor used to define nodal status. We trained optimal classification trees (OCTs) to predict 1-year and 3-year risk of death, incorporating only tumor size and nodal status as variables. The OCTs were compared with the AJCC schema and similarly trained XGBoost models. Variable interactions were explored via SHAP. RESULTS Two thousand eight hundred seventy-four patients comprised the derivation and 1,231 the validation cohort. SHAP identified LNR as a superior predictor. The OCTs outperformed the AJCC schema in the derivation and validation cohorts (1-year area under the curve: 0.681 v 0.603; 0.638 v 0.586, 3-year area under the curve: 0.682 v 0.639; 0.675 v 0.647, respectively) and performed comparably with the XGBoost models. We identified interactions between LNR and tumor size, suggesting that a negative prognostic factor partially overrides the effect of a concurrent favorable factor. CONCLUSION Our findings highlight the superiority of LNR and the importance of interactions between tumor size and nodal status. These results and the potential of the OCT methodology to combine them into a powerful, visually interpretable model can help inform future staging systems.

The impact of dihydropyrimidine dehydrogenase expression in pancreatic cancer patients who undergo curative resection with S-1 adjuvant chemotherapy

Pancreatology ◽  
2016 ◽  
Vol 16 (4) ◽  
pp. S142
Author(s):  
Masaaki Murakawa ◽  
Toru Aoyama ◽  
Yohei Miyagi ◽  
Yosuke Atsumi ◽  
Keisuke Kazama ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Curative Resection ◽  
Dihydropyrimidine Dehydrogenase ◽  
The Impact

scholarly journals Longitudinal quality of life data can provide insights on the impact of adjuvant treatment for pancreatic cancer-Subset analysis of the ESPAC-1 data

2009 ◽  
Vol 124 (12) ◽  
pp. 2960-2965 ◽  
Author(s):  
Ross Carter ◽  
Deborah D. Stocken ◽  
Payla Ghaneh ◽  
Simon R. Bramhall ◽  
Attila Olah ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pancreatic Cancer ◽  
Adjuvant Treatment ◽  
Life Data ◽  
Subset Analysis ◽  
The Impact

Feasibility and impact on resectability of FOLFIRINOX in locally-advanced and borderline pancreatic cancer.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 318-318 ◽  
Author(s):  
Fabienne Portales ◽  
Benedicte Gagniard ◽  
Simon Thezenas ◽  
Emmanuelle Samalin ◽  
Eric Assenat ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Locally Advanced ◽  
Survival Rates ◽  
Pancreatic Head ◽  
Progression Free Survival ◽  
Median Number ◽  
Morbidity Rate ◽  
R0 Resection ◽  
First Line ◽  
The Impact

318 Background: Pancreatic cancer (PC) has a poor prognostic. Only patients who undergo a complete R0 surgery have longer survival rates. Treatment of locally-advanced (LA) and borderline (BL) PC is controversial. Folfirinox is considered as a standard first-line treatment in metastatic patients. The aim of our study was to evaluate the impact of Folfirinox in LA and BL PC. Methods: We performed a retrospective analysis of prospectively-collected data from LA and BL PC patients treated with original Folfirinox in our institution between January 2010 and February 2015. Results: 35 patients were enrolled, 20(57.1%) pancreatic head adenocarcinoma, 19(54.3%) LA and 16(45.7%) BL PC, 54.3% male, median age 60 years old [44-74]. OMS was 0, 1, 2 for 21(61.8%), 11(32.4%), 2(5.9%) patients. Median CA19.9 level was 5N [1-33]. All patients had Folfirinox in first-line followed by radiochemotherapy (RTCT) in 23(65.7%) patients, with Gemzar and Xeloda in 21 and 2 patients. Median number of chemotherapy cycles was 4 [1-13]. The grade 3-4 toxicity rate was 17.1% (n = 6), mainly digestive (67%), hematologic (16.7%), none neurologic. There was no toxic death. 17(46%) patients underwent surgery, 7 LA and 10 BL, with a R0 resection in 13 patients, mainly 8 PT3 (57.1%), no PT0, and 14N+. The morbidity rate was 40%, including 3 fistulae and 2 hemorrhages. Median overall survival was 24 months (95%CI:14-44), 53 (95%CI:26-.) and 12 months (95%CI: 9-19) in surgery versus no-surgery patients (p< 0.001). Progression-free survival was 13.9 months (95%CI:11.2-17.1), 16.2 (95%CI:13.7-25.3) and 9.5 (95%CI:7.4-15.9) months in surgery versus no-surgery patients. 13 patients were still alive at the time of analysis, with a median follow-up of 44 months (95%CI:7-53). 30 patients had disease progression, locally, distant or both in 7(24.1%), 20(69.0%) and 3(13.1%) patients. Weight loss, OMS status, abdominal pain and CA199 level at diagnosis were not correlated with better survival. Conclusions: Folfirinox, followed or not by RTCT, as inductive treatment for LA and BL PC is feasible with acceptable toxicity, and allowed resectability in 37.1% patients, and thus a longer survival. Further studies are needed to confirm these encouraging results.

Propensity score matched analysis of neoadjuvant therapy for resectable pancreatic cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 381-381
Author(s):  
Kenneth L Meredith ◽  
Jamie Huston ◽  
Anjan Jayantilal Patel ◽  
Richard H. Brown ◽  
Fadi Kayali ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Propensity Score ◽  
Adjuvant Therapy ◽  
Neoadjuvant Therapy ◽  
Cancer Patients ◽  
Tumor Size ◽  
Survival Benefit ◽  
Categorical Variables ◽  
Resectable Pancreatic Cancer ◽  
The Impact

381 Background: Neoadjuvant therapy (NT) for resectable pancreatic cancer continues to be debated. There is little data to demonstrate survival benefit over patients who were treated with up front surgery (UFS) vs NT. We sought to examine the impact of neoadjuvant chemotherapy (NCT), neoadjuvant chemoradiation (NCRT), and UFS on survival in pancreatic cancer patients. Methods: The NCDB was accessed to identify patients with pancreatic adenocarcinoma. Propensity score matching (PSM) was performed against age, tumor size, margin status, and institutional surgery volume. Patient characteristics (continuous and categorical variables) were compared using Mann-Whitney U, Kruskal Wallis and Pearson’s Chi-square test as appropriate. Survival analyses were performed using the Kaplan-Meier method. Multivariable cox proportional hazard models (MVA) were developed to identify predictors of survival. All statistical tests were two-sided and α < 0.05 was considered significant. Results: After PSM, 5,034 patients (UFS 2,517; NT 2,517: 1,143 NCT and 1,374 NCRT) were included in the analysis. There was no difference in age, tumor size, or grade among cohorts. The mean nodes positive were 1.6 ± 2.6 in NT and 2 ± 3.3 in UFS, p = 0.02. In the pre-matched cohort R0 resections were performed in 75.9% UFS, 82.9% NCRT, and 79.6% NCT, p < 0.001. The median and 5 year survival for NCT, NCRT and UFS was 28.6 months and 25.2%, 25.7 months and 22.2%, and 21.3 months and 21.7%, p < 0.001. Adjuvant therapy (chemotherapy (CT) or CRT) in the UFS did demonstrate a survival benefit 22.5 months vs 18.6 months, p < 0.001, however this did not benefit NCT or NCRT, p = 0.8 and p = 0.8 respectively. Additionally survival in the UFS with adjuvant therapy either CT or CRT was still decreased compared to either NCT or NCRT, p < 0.001 and p = 0.001 respectively. MVA demonstrated that age, T-stage, lymph nodes positive, R0 resection, grade, NCT and NCRT were predictors of survival. Conclusions: Neoadjuvant therapy improves survival in resectable pancreatic cancer patients. NCT and NCRT demonstrated survival benefit compared to UFS even with adjuvant therapy. Patients with resectable pancreatic cancer should be considered for neoadjuvant therapy.

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