TNM Staging and Grading

BACKGROUND Perihilar cholangiocarcinoma (pCCA) is a highly aggressive malignancy with poor prognosis. Accurate prediction is of great significance for patients’ survival outcome. OBJECTIVE The present study aimed to propose a prognostic nomogram for predicting the overall survival (OS) for patients with pCCA. METHODS We conducted a retrospective analysis in a total of 940 patients enrolled from the Surveillance, Epidemiology, and End Results (SEER) program and developed a nomogram based on the prognostic factors identified from the cox regression analysis. Concordance index (C-index), risk group stratification and calibration curves were adopted to test the discrimination and calibration ability of the nomogram with bootstrap method. Decision curves were also plotted to evaluate net benefits in clinical use against TNM staging system. RESULTS On the basis of multivariate analysis, five independent prognostic factors including age, summary stage, surgery, chemotherapy, together with radiation were selected and entered into the nomogram model. The C-index of the model was significantly higher than TNM system in the training set (0.703 vs 0.572, P<0.001), which was also proved in the validation set (0.718 vs 0.588, P<0.001). The calibration curves for 1-, 2-, and 3-year OS probabilities exhibited good agreements between the nomogram-predicted and the actual observation. Decision curves displayed that the nomogram obtained more net benefits than TNM staging system in clinical context. The OS curves of two distinct risk groups stratified by nomogram-predicted survival outcome illustrated statistical difference. CONCLUSIONS We established and validated an easy-to-use prognostic nomogram, which can provide more accurate individualized prediction and assistance in decision making for pCCA patients.

Download Full-text

P52.09 Proposals for Revision of N Descriptors in the Forthcoming Edition of TNM Staging for NSCLC

Journal of Thoracic Oncology ◽

10.1016/j.jtho.2021.01.922 ◽

2021 ◽

Vol 16 (3) ◽

pp. S523

Author(s):

X. Shang ◽

H. Wang ◽

H. Wang

Keyword(s):

Tnm Staging

Download Full-text

Comparison between silicon photomultiplier-based and conventional PET/CT in patients with suspected lung cancer—a pilot study

EJNMMI Research ◽

10.1186/s13550-019-0504-y ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Johan Economou Lundeberg ◽

Jenny Oddstig ◽

Ulrika Bitzén ◽

Elin Trägårdh

Keyword(s):

Lung Cancer ◽

Expectation Maximization ◽

Image Interpretation ◽

Imaging Study ◽

Reconstruction Algorithm ◽

Tnm Staging ◽

Reconstruction Algorithms ◽

Silicon Photomultiplier ◽

Standardized Uptake Values ◽

Pet Ct

Abstract Background Lung cancer is one of the most common cancers in the world. Early detection and correct staging are fundamental for treatment and prognosis. Positron emission tomography with computed tomography (PET/CT) is recommended clinically. Silicon (Si) photomultiplier (PM)-based PET technology and new reconstruction algorithms are hoped to increase the detection of small lesions and enable earlier detection of pathologies including metastatic spread. The aim of this study was to compare the diagnostic performance of a SiPM-based PET/CT (including a new block-sequential regularization expectation maximization (BSREM) reconstruction algorithm) with a conventional PM-based PET/CT including a conventional ordered subset expectation maximization (OSEM) reconstruction algorithm. The focus was patients admitted for 18F-fluorodeoxyglucose (FDG) PET/CT for initial diagnosis and staging of suspected lung cancer. Patients were scanned on both a SiPM-based PET/CT (Discovery MI; GE Healthcare, Milwaukee, MI, USA) and a PM-based PET/CT (Discovery 690; GE Healthcare, Milwaukee, MI, USA). Standardized uptake values (SUV) and image interpretation were compared between the two systems. Image interpretations were further compared with histopathology when available. Results Seventeen patients referred for suspected lung cancer were included in our single injection, dual imaging study. No statically significant differences in SUVmax of suspected malignant primary tumours were found between the two PET/CT systems. SUVmax in suspected malignant intrathoracic lymph nodes was 10% higher on the SiPM-based system (p = 0.026). Good consistency (14/17 cases) between the PET/CT systems were found when comparing simplified TNM staging. The available histology results did not find any obvious differences between the systems. Conclusion In a clinical setting, the new SiPM-based PET/CT system with a new BSREM reconstruction algorithm provided a higher SUVmax for suspected lymph node metastases compared to the PM-based system. However, no improvement in lung cancer detection was seen.

Download Full-text

Distinctive Prognostic Value and Cellular Functions of Osteopontin Splice Variants in Human Gastric Cancer

Cells ◽

10.3390/cells10071820 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1820

Author(s):

Chengcheng Hao ◽

Yuxin Cui ◽

Jane Lane ◽

Shuqin Jia ◽

Jiafu Ji ◽

...

Keyword(s):

Gastric Cancer ◽

Cancer Cells ◽

Cell Lines ◽

Prognostic Value ◽

Splice Variants ◽

Tnm Staging ◽

Migration And Invasion ◽

Ros Production ◽

Gastric Cancer Cells ◽

Normal Tissues

Background: Osteopontin (OPN) splice variants are identified as predictors of tumour progression and therapeutic resistance in certain types of solid tumours. However, their roles in gastric cancer (GC) remain poorly characterized. The current study sought to assess the prognostic value of the three OPN splice variants (namely OPN-a, OPN-b, and OPN-c) in gastric cancer and their potential functions within gastric cancer cells. Methods: RNA extraction and reverse transcription were performed using our clinical cohort of gastric carcinomas and matched normal tissues (n = 324 matched pairs). Transcript levels were determined using real-time quantitative PCR. Three OPN splice variants overexpressed cell lines were created from the gastric cancer cell line HGC-27. Subsequently, biological functions, including cell growth, adhesion, migration, and invasion, were studied. The potential effects of OPN isoforms on cisplatin and 5-Fu were evaluated by detecting cellular reactive oxygen species (ROS) levels in the HGC-27-derived cell lines. Results: Compared with normal tissues, the expression levels of three splice variants were all elevated in gastric cancer tissues in an order of OPN-a > OPN-b > OPN-c. The OPN-a level significantly increased with increasing TNM staging and worse clinical outcome. There appeared to be a downregulation for OPN-c in increasing lymph node status (p < 0.05), increasing TNM staging, and poor differentiation. High levels of OPN-a and OPN-b were correlated with short overall survival and disease-free survival of gastric cancer patients. However, the low expression of OPN-c was significantly associated with a poor prognosis. Functional analyses further showed that ectopic expression of OPN-c suppressed in vitro proliferation, adhesiveness, migration, and invasion properties of HGC-27 cells, while the opposite role was seen for OPN-a. Cellular ROS detection indicated that OPN-a and OPN-c significantly promoted ROS production after treatment with 5-Fu comparing to OPN-vector, while only OPN-a markedly induced ROS production after treatment with cisplatin. Conclusion: Our results suggest that OPN splice variants have distinguished potential to predict the prognosis of gastric cancer. Three OPN variants exert distinctive functions in gastric cancer cells. Focusing on specific OPN isoforms could be a novel direction for developing diagnostic and therapeutic approaches in gastric cancer.

Download Full-text

Validation of the T Descriptor (TNM-8) in T3N0 Non-Small-Cell Lung Cancer Patients; a Bicentric Cohort Analysis with Arguments for Redefinition

Cancers ◽

10.3390/cancers13081812 ◽

2021 ◽

Vol 13 (8) ◽

pp. 1812

Author(s):

Philip Baum ◽

Samantha Taber ◽

Stella Erdmann ◽

Thomas Muley ◽

Mark Kriegsmann ◽

...

Keyword(s):

Lung Cancer ◽

Adjuvant Chemotherapy ◽

Tumor Size ◽

Cohort Analysis ◽

Lung Cancer Surgery ◽

Tnm Staging ◽

Parietal Pleura ◽

Tumor Diameter ◽

Lung Cancer Patients ◽

Multiple Nodules

The current pT3N0 category represents a heterogeneous subgroup involving tumor size, separate tumor nodes in one lobe, and locoregional growth pattern. We aim to validate outcomes according to the eighth edition of the TNM staging classification. A total of 281 patients who had undergone curative lung cancer surgery staged with TNM-7 in two German centers were retrospectively analyzed. The subtypes tumor size >7 cm and multiple nodules were grouped as T3a, and the subtypes parietal pleura invasion and mixed were grouped as T3b. We stratified survival by subtype and investigated the relative benefit of adjuvant chemotherapy according to subtype. The 5-year overall survival (OS) rates differed between the different subtypes tumor diameter >7 cm (71.5%), multiple nodules in one lobe (71.0%) (grouped as T3a), parietal pleura invasion (59.%), and mixed subtype (5-year OS 50.3%) (grouped as T3b), respectively. The cohort as a whole did not gain significant OS benefit from adjuvant chemotherapy. In contrast, adjuvant chemotherapy significantly improved OS in the T3b subgroup (logrank p = 0.03). This multicenter cohort analysis of pT3N0 patients identifies a new prognostic mixed subtype. Tumors >7 cm should not be moved to pT4. Patients with T3b tumors have significantly worse survival than patients with T3a tumors.

Download Full-text

Assessment of Immunological Features in Muscle-Invasive Bladder Cancer Prognosis Using Ensemble Learning

Cancers ◽

10.3390/cancers13071624 ◽

2021 ◽

Vol 13 (7) ◽

pp. 1624

Author(s):

Christos G. Gavriel ◽

Neofytos Dimitriou ◽

Nicolas Brieu ◽

Ines P. Nearchou ◽

Ognjen Arandjelović ◽

...

Keyword(s):

Bladder Cancer ◽

Statistical Significance ◽

Tnm Staging ◽

Cancer Prognosis ◽

Clinical Staging ◽

Invasive Bladder Cancer ◽

P Value ◽

Muscle Invasive Bladder Cancer ◽

Tissue Samples ◽

Muscle Invasive

The clinical staging and prognosis of muscle-invasive bladder cancer (MIBC) routinely includes the assessment of patient tissue samples by a pathologist. Recent studies corroborate the importance of image analysis in identifying and quantifying immunological markers from tissue samples that can provide further insight into patient prognosis. In this paper, we apply multiplex immunofluorescence to MIBC tissue sections to capture whole-slide images and quantify potential prognostic markers related to lymphocytes, macrophages, tumour buds, and PD-L1. We propose a machine-learning-based approach for the prediction of 5 year prognosis with different combinations of image, clinical, and spatial features. An ensemble model comprising several functionally different models successfully stratifies MIBC patients into two risk groups with high statistical significance (p value < 1×10−5). Critical to improving MIBC survival rates, our method correctly classifies 71.4% of the patients who succumb to MIBC, which is significantly more than the 28.6% of the current clinical gold standard, the TNM staging system.

Download Full-text

Pathologic Determination of Multifocality in pT1a1 Squamous Cell Carcinoma of the Cervix: A Retrospective Analysis

International Journal of Surgical Pathology ◽

10.1177/1066896921990726 ◽

2021 ◽

pp. 106689692199072

Author(s):

Jingjing Hu ◽

Kojo R. Rawish ◽

Mariah Leivo ◽

Dennis Adams ◽

Somaye Y. Zare ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Residual Disease ◽

Cervical Squamous Cell Carcinoma ◽

Tnm Staging ◽

Stromal Invasion ◽

Lateral Extent ◽

Clinicopathologic Parameters

When more than one focus of stromal invasion is present in a superficially invasive cervical squamous cell carcinoma (SCC), determination of the tumoral lateral extent/horizontal extension, and hence tumor-nodes-metastases (TNM) staging, can be problematic. In recent years, a diagnostic approach to distinguish multifocal pT1a1 from pT1b cases has gained increased attention. These criteria call for classifying SCC as multifocal when invasive foci are separated by blocks of uninvolved cervical tissues, and/or are located on separated cervical lips in a tumor that is discontinuous, and/or are situated far apart (≥2 mm) from each other. In this study, we assess our experience with multifocal stage pT1a1 cervical SCC that was retrospectively classified as such using these criteria. Slides from the loop electrosurgical excision or conization specimens, comprising 212 pT1a1, 173 pT1a2, and 206 pT1b cases, were reviewed. Twenty-four (11%) of the 212 pT1a1 cases were classified as multifocal after review. The 24 multifocal pT1a1 cases were compared with the 188 unifocal pT1a1 cases regarding a variety of clinicopathologic parameters. Notably, these 2 groups showed no significant differences regarding all parameters that were evaluated, including patient age, recurrence rate, primary tumoral features in the primary excision specimen (rate of positive margins, median depth of stromal invasion, frequency of lymphovascular invasion), and frequency of residual disease in additional excisions. In summary, we demonstrate comparably favorable patient outcomes in both unifocal and multifocal cases of pT1a1 SCC of the cervix, and, accordingly, we conclusively affirm the validity of the aforementioned criteria for establishing multifocality.

Download Full-text

Trends of incidence and prognosis of primary adenocarcinoma of the bladder

Therapeutic Advances in Urology ◽

10.1177/17562872211018006 ◽

2021 ◽

Vol 13 ◽

pp. 175628722110180

Author(s):

Haowen Lu ◽

Weidong Zhu ◽

Weipu Mao ◽

Feng Zu ◽

Yali Wang ◽

...

Keyword(s):

Prediction Model ◽

Marital Status ◽

Cox Regression ◽

Tnm Staging ◽

Primary Site ◽

Primary Adenocarcinoma ◽

Cancer Specific Survival ◽

Training Cohort ◽

Cox Regression Analysis ◽

Ajcc Stage

Background: Primary adenocarcinoma of the bladder (ACB) is a rare malignant tumor of the bladder with limited understanding of its incidence and prognosis. Methods: Patients diagnosed with ACB between 2004 and 2015 were obtained from the SEER database. The incidence changes of ACB patients between 1975 and 2016 were detected by Joinpoint software. Nomograms were constructed based on the results of multivariate Cox regression analysis to predict overall survival (OS) and cancer-specific survival (CSS) in patients with ACB, and the constructed nomograms were validated. Results: The incidence of ACB was trending down from 1991 to 2016. A total of 1039 patients were included in the study and randomly assigned to the training cohort (727) and validation cohort (312). In the training cohort, multivariate Cox regression showed that age, marital status, primary site, histology type, grade, AJCC stage, T stage, SEER stage, surgery, radiotherapy, and chemotherapy were independent prognostic factors for OS, whereas these were age, marital status, primary site, histology type, grade, AJCC stage, T/N stage, SEER stage, surgery, and radiotherapy for CSS. Based on the above Cox regression results, we constructed prognostic nomograms for OS and CSS in ACB patients. The C-index of the nomogram OS was 0.773 and the C-index of CSS was 0.785, which was significantly better than the C-index of the TNM staging prediction model. The area under the curve (AUC) and net benefit of the prediction model were higher than those of the TNM staging system. In addition, the calibration curves were very close to the ideal curve, suggesting appreciable reliability of the nomograms. Conclusion: The incidence of ACB patients showed a decreasing trend in the past 25 years. We constructed a clinically useful prognostic nomogram for calculating OS and CSS of ACB patients, which can provide a personalized risk assessment for ACB patient survival.

Download Full-text