The clinicopathological and survival analysis of urological mucosal melanoma: A single-center retrospective observational study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21588-e21588
Author(s):  
Bixia Tang ◽  
Xieqiao Yan ◽  
Zhihong Chi ◽  
Siming Li ◽  
Chuanliang Cui ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Regional Lymph Node ◽  
Stage Iv ◽  
Staging System ◽  
Tnm Staging ◽  
Mucosal Melanoma ◽  
Future Research ◽  
Molecular Characteristics ◽  
Urethral Carcinoma ◽  
Tnm Staging System

e21588 Background: Primary mucosal melanoma arising in the urinary tract is rare and poorly characterized. Methods: The records of patients with urological mucosal melanoma who presented to the department of Renal Cancer and Melanoma of Peking University Cancer Hospital between September, 2004 and April, 2019 were reviewed. Available clinicopathological and molecular characteristics were summarized, including pathological parameters, gene mutation, primary surgical intervention, systemic treatment and clinical course. The rates of local recurrence rate, loco-regional lymph node metastasis and distant metastasis were assessed. American Joint Committee on Cancer (AJCC) TNM Staging System for bladder cancer/renal pelvis and ureter cancer/urethral carcinoma (8th ed., 2017) were adopted for staging. Results: Fifty-eight patients were involved in the study with a median age of 62.5 years (range: 32-82). The anatomic sites of the primary urological mucosal melanomas were from the urethra (89.7%), bladder (6.9%), ureter (0%) and kidney (0%), and the left (4.4%) were from multiple loci. At initial diagnosis, 75.9% (n=44) were stage I/II disease, 1.7% (n=1) stage III, and 22.4% (n=13) stage IV. There was 3.4% incidence of CKIT mutation and 1.7% of BRAF mutation. After median follow-up of 22.6 mo, 31.4% (16/51) relapsed locally after organ-preserved surgery. 21.6% (11/51) and 39.2% (20/51) developed metastases to reginal lymph nodes and distance, respectively. The median relapse free survival and median overall survival were 12.2 (95%CI: 7.9-16.4) mo and 33.9 (95%CI: 19.2-48.6) mo, respectively. Univariate Cox analysis showed that TNM stage and systemic adjuvant therapy were the prognostic factors of OS, while no association was found with Breslow thickness, miotic rate, ulceration and gender. Conclusions: Urological mucosal melanoma predominantly arises from lower urinary tract with rare BRAF and CKIT mutation. AJCC TNM Staging System for urothelial carcinoma is proved practical for urothelial melanoma, which should be validated in larger population. Future research is required to identify adjuvant treatment approaches to improve disease outcomes.

New and Important Changes in the TNM Staging System for Breast Cancer

2018 ◽  
pp. 457-467 ◽  
Author(s):  
Gabriel N. Hortobagyi ◽  
Stephen B. Edge ◽  
Armando Giuliano
Keyword(s):  
Breast Cancer ◽  
Regional Lymph Node ◽  
Staging System ◽  
Distant Metastases ◽  
Tnm Staging ◽  
Pathology Report ◽  
Imaging Evaluation ◽  
Complete Surgical Excision ◽  
Tnm Staging System ◽  
Eighth Edition

Expanded understanding of biologic factors that modulate the clinical course of malignant disease have led to the gradual integration of biomarkers into staging classifications. The American Joint Committee on Cancer (AJCC) TNM staging system is universally used and has largely displaced other staging classifications for most, although not all, cancers. Many of the chapters of the eighth edition of the AJCC TNM staging system integrated biomarkers with anatomic definitions. The Breast Chapter added estrogen receptor (ER) and progesterone receptor (PR) expression, HER2 expression, and/or amplification and histologic grade to the anatomic assessment of tumor size, regional lymph node involvement, and distant metastases (known as TNM). While preserving an anatomic staging system for continuity and for regions where modern biomarkers are not always available, the eighth edition emphasizes the increased prognostic precision of the clinical prognostic stage groups and the pathologic prognostic stage groups. The clinical prognostic stage groups are applicable to all patients with primary breast cancer before any treatment has been implemented, but require a clinical and imaging evaluation as well as a biopsy with grade and available ER, PR, and HER2 results; the pathologic prognostic stage groups are applicable to all patients treated with complete surgical excision as first treatment and also require a complete pathology report, grade, and ER, PR, and HER2. Applying the pathologic prognostic stage groups to a large database of patients staged by basic TNM groupings changed the stage grouping of almost 40% of patients. Grouping by pathologic prognostic stage groups led to a better prognostic distribution of the group and more precise individual prognostication.

Accuracy of TNM staging system in prognostic stratification of stage IV digestive endocrine tumors.

2010 ◽  
Vol 28 (15_suppl) ◽  
pp. e14588-e14588
Author(s):  
E. Merola ◽  
F. Panzuto ◽  
M. Rinzivillo ◽  
R. Valente ◽  
C. Bestani ◽  
...  
Keyword(s):  
Stage Iv ◽  
Staging System ◽  
Tnm Staging ◽  
Endocrine Tumors ◽  
Tnm Staging System ◽  
Prognostic Stratification

W1131 Accuracy of the Novel TNM Staging System in the Prognostic Stratification of Patients With Advanced, Stage IV Digestive Endocrine Tumors

2010 ◽  
Vol 138 (5) ◽  
pp. S-658
Author(s):  
Elettra Merola ◽  
Francesco Panzuto ◽  
Maria Rinzivillo ◽  
Stefano Festa ◽  
Claudia Bestani ◽  
...  
Keyword(s):  
Stage Iv ◽  
Staging System ◽  
Tnm Staging ◽  
Endocrine Tumors ◽  
Advanced Stage ◽  
The Novel ◽  
Tnm Staging System ◽  
Prognostic Stratification

Volumetric staging in radiotherapy for oropharyngeal cancers

2021 ◽  
pp. 030089162110509
Author(s):  
Marcin Miszczyk ◽  
Emilia Staniewska ◽  
Iwona Jabłońska ◽  
Aleksandra Lipka-Rajwa ◽  
Konrad Stawiski ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Oropharyngeal Cancer ◽  
Gross Tumor Volume ◽  
Tumor Volume ◽  
Stage Iv ◽  
Staging System ◽  
Tnm Staging ◽  
Independent Prognostic Factor ◽  
Tnm Staging System ◽  
Volumetric Staging

Introduction: Despite routine use of 3D radiotherapy planning in radical radio(chemo)therapy for oropharyngeal cancers, volumetric data have not been implemented in initial staging. We analyzed 228 oropharyngeal cancer cases treated at one institution between 2004 and 2014 to compare the predictive value of volumetric staging and tumor nodal metastasis staging system (TNM) and determine whether they could be complementary for the estimation of survival. Methods: This retrospective study analyzed 228 consecutive oropharyngeal cancer cases treated with radiotherapy (76.9%) or concurrent radiochemotherapy (23.1%) between 2004 and 2014. The volumetric parameters included primary gross tumor volume (pGTV), metastatic lymph nodes gross tumor volume (nGTV), and total gross tumor volume (tGTV), and were compared with the 7th edition of the TNM staging system. Results: Median overall survival (OS) was 30.3 months. In the receiver operating characteristic analysis, tGTV had the highest area under the curve (AUC) of 0.66, followed by pGTV (AUC,0.64), nGTV (AUC 0.62), and TNM (AUC 0.6). The median OS for patients with tGTV ⩽32.2 mL was 40.5 months, compared to 15.4 months for >32.2 mL ( p < 0.001). This threshold allowed for a statistically significant difference in survival between TNM stage IV cases with low and high tumor volume ( p < 0.001). Despite both TNM and tGTV reaching statistical significance in univariate analysis, only the tGTV remained an independent prognostic factor in the multivariate analysis (hazard ratio 1.07, confidence interval 1.02–1.12, p = 0.008). Conclusions: tGTV is an independent prognostic factor, characterized by a higher discriminatory value than the TNM staging system, and can be used to further divide stage IV cases into subgroups with significantly different prognosis.

A proposal for a novel and simple TNM staging for gastric cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 21-21 ◽  
Author(s):  
Taeil Son ◽  
Jiyu Sun ◽  
Hyoung-Il Kim ◽  
Jong Won Kim ◽  
Jae-Ho Cheong ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Metastatic Lymph Node ◽  
Stage Iv ◽  
Staging System ◽  
Tnm Staging ◽  
Rank Test ◽  
Discrimination Power ◽  
Tnm Staging System ◽  
N Classification ◽  
T Classification

21 Background: Current TNM staging system for gastric cancer has controversies regarding N classification. We aimed to develop a simple and novel TNM staging system for gastric cancer by re-grouping N classification. Methods: We retrospectively reviewed 14260 patients treated for gastric cancer. To develop simple combinations of TNM staging with similar weighted value between T and N classification, N classification was restructured with different cutoffs. The optimal cutoffs for the number of metastatic lymph node which maximize the x2 statistic of log-rank test for survival differences among patients were selected. C-statistic was used to compare the discriminating performance of the proposed N classification with the current N classification in the TNM staging system. We performed validation with 2 external datasets from a hospital in Korea (n = 1500) and SEER (n = 11324). Results: We identified the new cutoffs of N classification as 1~4, 5~10, 11~24, and 25 or more for N1, N2, N3a, and N3b, respectively. We found survival of the new N3b classification was similar to M1, regardless of T classification. Thus, we stratified these groups of N3b and M1 disease as stage IV, simultaneously. Our new TNM staging had similar weighted value between T and N classification resulting in simple combinations. (Table) Survival curves of subgroups in the new TNM staging had higher x2 value than current staging system (x2: 8239 vs. 7023, respectively) and homogeneity among subgroups in the same stage increased. However, C-statistics (0.801, 95%CI: 0.795, 0.807) of new model showed similar discrimination power than that (0.797, 95%CI: 0.791, 0.803) in 7th TNM staging system. C-statistics were also similar in other hospital in Korea (0.805 vs. 0.802, respectively) and SEER database (0.709 vs. 0.706, respectively). Conclusions: This novel staging system by recalculating cut-offs of N classification provides exceptionally simple and practical way to stratify substages in TNM staging for gastric cancer. [Table: see text]

scholarly journals Evaluation of the Eighth Edition of the American Joint Committee on Cancer TNM Staging System for Gastric Cancer: An Analysis of 7371 Patients in the SEER Database

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Long-Long Cao ◽  
Jun Lu ◽  
Ping Li ◽  
Jian-Wei Xie ◽  
Jia-Bin Wang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Survival Rates ◽  
Stage Iv ◽  
Staging System ◽  
Tnm Staging ◽  
Stage Migration ◽  
Seer Database ◽  
Tnm System ◽  
American Joint Committee ◽  
Tnm Staging System

Objective. To investigate the validity of the 8thedition of the American Joint Committee on Cancer (AJCC) TNM staging system for gastric cancer.Methods. The clinicopathologic data of 7371 patients who were diagnosed with gastric cancer and had 16 or more involved lymph nodes (LNs) were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database and retrospectively reviewed.Results. Stage migration occurred primarily during stage III between the 7thand 8thedition TNM staging systems. Stages IIIB and IIIC in the 7thedition staging system were divided in the 8thedition and had obvious differences in survival rates (bothP<0.001). The 8thedition TNM stages IIIC and IV showed similar survival rates (P=0.101). The prognosis of patients with T4aN3bM0 was not different from that of patients with TxNxM1 (P=0.433), while the prognosis of patients with T4bN3bM0 was significantly poorer than that of patients with TxNxM1 (P=0.008). A revised TNM system with both T4aN3bM0 and T4bN3bM0 incorporated into stage IV was proposed. Multivariable regression analysis showed that the revised TNM system, but not the 7thand 8theditions, was an independent factor for disease-specific survival (DSS) in the third step of the analysis. Further analyses revealed that the revised TNM system had superior discriminatory ability to the 8thedition staging system, which was also an improvement over the 7thedition staging system.Conclusion. The 8thedition of the AJCC TNM staging system is superior to the 7thedition for predicting the DSS rates of gastric cancer patients. However, for better prognostic stratification, it might be more suitable for T4aN3bM0/T4bN3bM0 to be incorporated into stage IV in the 8thedition TNM staging system.

scholarly journals Replication of newly proposed TNM staging system for medullary thyroid carcinoma: a nationwide study

2019 ◽  
Vol 8 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Jes Sloth Mathiesen ◽  
Jens Peter Kroustrup ◽  
Peter Vestergaard ◽  
Per Løgstrup Poulsen ◽  
Åse Krogh Rasmussen ◽  
...  
Keyword(s):  
United States ◽  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Stage Iv ◽  
Staging System ◽  
The United States ◽  
Population Based ◽  
Tnm Staging ◽  
Medullary Thyroid ◽  
Tnm Staging System

A recent study proposed new TNM groupings for better survival discrimination among stage groups for medullary thyroid carcinoma (MTC) and validated these groupings in a population-based cohort in the United States. However, it is unknown how well the groupings perform in populations outside the United States. Consequently, we conducted the first population-based study aiming to evaluate if the recently proposed TNM groupings provide better survival discrimination than the current American Joint Committee on Cancer (AJCC) TNM staging system (seventh and eighth edition) in a nationwide MTC cohort outside the United States. This retrospective cohort study included 191 patients identified from the nationwide Danish MTC cohort between 1997 and 2014. In multivariate analysis, hazard ratios for overall survival under the current AJCC TNM staging system vs the proposed TNM groupings with stage I as reference were 1.32 (95% CI: 0.38–4.57) vs 3.04 (95% CI: 1.38–6.67) for stage II, 2.06 (95% CI: 0.45–9.39) vs 3.59 (95% CI: 1.61–8.03) for stage III and 5.87 (95% CI: 2.02–17.01) vs 59.26 (20.53–171.02) for stage IV. The newly proposed TNM groupings appear to provide better survival discrimination in the nationwide Danish MTC cohort than the current AJCC TNM staging. Adaption of the proposed TNM groupings by the current AJCC TNM staging system may potentially improve accurateness in survival discrimination. However, before such an adaption further population-based studies securing external validity are needed.

scholarly journals Proposed Staging System for Patients With HPV-Related Oropharyngeal Cancer Based on Nasopharyngeal Cancer N Categories

2016 ◽  
Vol 34 (16) ◽  
pp. 1848-1854 ◽  
Author(s):  
Kristina R. Dahlstrom ◽  
Adam S. Garden ◽  
William N. William ◽  
Ming Yann Lim ◽  
Erich M. Sturgis
Keyword(s):  
Oropharyngeal Cancer ◽  
Proportional Hazards ◽  
Regional Lymph Node ◽  
Nasopharyngeal Cancer ◽  
Cancer Control ◽  
Staging System ◽  
Tnm Staging ◽  
Cox Proportional Hazards ◽  
Risk Of Death ◽  
Tnm Staging System

Purpose Patients with human papillomavirus (HPV)–related oropharyngeal cancer (OPC) generally present with more advanced disease but have better survival than patients with HPV-unrelated OPC. The current American Joint Commission on Cancer (AJCC)/Union for International Cancer Control (UICC) TNM staging system for OPC was developed for HPV-unrelated OPC. A new staging system is needed to adequately predict outcomes of patients with HPV-related OPC. Patients and Methods Patients with newly diagnosed HPV-positive OPC (by p16 immunohistochemistry or in situ hybridization) treated at our institution from January 2003 through December 2012 were included. By using recursive partitioning analysis (RPA), we developed new stage groupings with both traditional OPC regional lymph node (N) categories and nasopharyngeal carcinoma (NPC) N categories. Survival was estimated by the Kaplan-Meier method, and the relationship between stage and survival was examined by using Cox proportional hazards regression analysis. Results A total of 661 patients with HPV-positive OPC met the inclusion criteria. With the traditional TNM staging system, there was no difference in survival between stages (P = .141). RPA with NPC N categories resulted in more balanced stage groups and better separation between groups for 5-year survival than RPA with traditional OPC N categories. With the stage groupings that were based in part on NPC N categories, the risk of death increased with increasing stage (P for trend < .001), and patients with stage III disease had five times the risk of death versus patients with stage IA disease. Conclusion New stage groupings that are based on primary tumor (T) categories and NPC N categories better separate patients with HPV-positive OPC with respect to survival than does the current AJCC/UICC TNM staging system. Although confirmation of our findings in other patient populations is needed, we propose consideration of NPC N categories as an alternative to the traditional OPC N categories in the new AJCC/UICC TNM staging system that is currently being developed.

RA10.06: THE ROLE AND PROGNOSTIC SIGNIFICANCE OF AORTOPULMONARY, ANTERIOR MEDIASTINAL, AND TRACHEOBRONCHIAL LYMPH NODES IN ESOPHAGEAL CANCER: UPDATE OF THE 2018 TNM STAGING SYSTEM

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 43-44
Author(s):  
Wen-Ping Wang ◽  
Yu-Shang Yang ◽  
Song-Lin He ◽  
Wei-Peng Hu ◽  
Long-Qi Chen
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Regional Lymph Node ◽  
Prognostic Significance ◽  
Staging System ◽  
Tnm Staging ◽  
Therapeutic Value ◽  
Tnm Staging System ◽  
N Stage ◽  
Eighth Edition

Abstract Background The eighth edition of the American Joint Committee on Cancer TNM staging for esophageal cancer will be implemented at the beginning of 2018. The nodal staging process in the eighth edition remains unchanged from that in the seventh edition in that it was based on the number of lymph nodes (LNs) involved, but the regional lymph node map has been revised. The aortopulmonary (station 5), anterior mediastinal (station 6), and tracheobronchial (station 10) nodes have been omitted from the regional lymph node map for the new TNM staging. However, the role and prognostic significance of these LN stations are not clear. The purpose of this study was to investigate whether the revised nodal staging used in the eighth edition staging system is appropriate, and to verify the role, prognostic significance, and therapeutic value of these LNs in esophageal cancer. Methods The records of patients who underwent esophagectomy for cancer in our department between January 2007 and January 2013 were retrospectively analyzed. The rate of metastases and the index of estimated benefit from lymph node dissection (IEBLD) were calculated for stations 5, 6, and 10 LNs. LN metastasis and patient survival were analyzed and the efficacy of the eighth edition TNM staging system was verified. Results A total of 1637 patients (1350 men, 287 women) were included. The frequencies of dissection of stations 5, 6, and 10 LNs were 34.3% (562/1637), 15.9% (260/1637), and 50.9% (833/1637), respectively. The calculated rate of metastasis to these stations was 3.2% (18/562), 2.3% (6/260), and 4.9% (41/833), respectively. No difference was found in the N stage determined by the seventh and eighth edition N staging systems. The survival curves differed significantly between N stages calculated using the eighth edition TNM system (P < 0.001). The IEBLD values of stations 5, 6, and 10 LNs were 0.57, 0, and 0.97, respectively. Station 5 or 10 LN(+ ) patients had worse median survival time and 5-year overall survival rate compared with LN(–) patients (P < 0.01). Univariate analysis showed that differentiation, T stage, N stage (both seventh and eighth edition calculations), and metastasis to stations 5 and 10 LNs were associated with long-term survival. Conclusion Metastasis to stations 5, 6, or 10 LNs was infrequent. If stations 5, 6, and 10 LNs were omitted in the eighth edition calculation to determine the N stage based on the number of metastatic LNs, this did not influence the accuracy and survival-predicting efficacy of the eighth edition TNM staging. The therapeutic value of lymphadenectomy of stations 5, 6, and 10 was limited. Metastasis to stations 5, 6, and 10 LNs indicated more advanced N stage, which was associated with poor survival. However, no survival difference was found between station 6 LN(+ ) and LN(–) subgroups, possibly because of the limited numbers of cases. Disclosure All authors have declared no conflicts of interest.

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