scholarly journals Radiological Correlates of pT3a Kidney Cancer: Importance of Irregular Tumor Sinus Border

2021 ◽  
Vol 19 (4) ◽  
Author(s):  
Yunlin Ye ◽  
Diego Aguilar Palacios ◽  
Rebecca Campbell ◽  
Alain Rizk ◽  
Hajime Tanaka ◽  
...  
Keyword(s):  
Tumor Size ◽  
Renal Vein ◽  
Imaging Finding ◽  
Tumor Biology ◽  
Preoperative Assessment ◽  
Continuous Variable ◽  
Strongly Correlated ◽  
Patient Counseling ◽  
Collateral Vessels ◽  
Sensitivity Specificity

Purpose: Preoperative assessment of T3a renal-cell-carcinoma (RCC) in absence of main renal vein involvement or lymph node enlargement is challenging but has potential implications for counseling and prognosis. Materials and Methods: A retrospective review of 1129 cT1-T3aN0M0 RCC patients managed with partial/radical nephrectomy (PN/RN) in our institution (2012-2014) was performed. Exclusion criteria included radiological evidence of main renal vein involvement or substantial lymphadenopathy. Eleven radiological findings suggestive of aggressive tumor biology or invasive phenotype based on prior literature were assessed for correlation with pT3a status. These included perinephric-findings (stranding, enhancing-nodule, collateral-vessels, or irregular-perinephric-tumor-contour), findings within the sinus (stranding, collecting-system invasion, branch-vein enlargement, or irregular-tumor-sinus-border [ITSB]), and tumor-necrosis, infiltrative-features, and tumor-size. Radiological assessment was blinded to final pathology. Sensitivity/specificity and logistic-regression analyses assessed the performance of each imaging-finding for detecting pT3a tumors. Results: Median tumor-size was 4.0cm and R.E.N.A.L. was 8. Median follow-up was 53 months (IQR:28-64). pT3a tumors were found in 281 patients (25%) and strongly correlated with local and systemic recurrence (p<0.02). ITSB was found in 350 patients (31%) and was the strongest predictor of pT3a status. Sensitivity/specificity/PPV/NPV/OR/C-Index for ITSB were 75%/84%/61%/91%/15.8(11.4-21.9)/0.80, for correlation with pT3a, respectively. The best predictive model included ITSB(yes/no) and tumor-size as a continuous variable (C-index=0.84). Addition of other imaging-findings did not improve the model (C-index=0.84). ITSB was the strongest contributor in all multivariable-models and also strongly correlated with recurrence-free-survival. Inter/intra-observer correlations for assessment of ITSB were 0.89/0.98, respectively. Conclusions: Our data suggest that ITSB and tumor-size associate with pT3a RCC, which could impact patient counseling.

scholarly journals Clinical Significance of Tumor Size, Pathological Invasion Sites Including Urinary Collecting System and Clinically Detected Renal Vein Thrombus as Predictors for Recurrence in pT3a Localized Renal Cell Carcinoma

Diagnostics ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. 154 ◽  
Author(s):  
Takuto Shimizu ◽  
Makito Miyake ◽  
Shunta Hori ◽  
Kota Iida ◽  
Kazuki Ichikawa ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Recurrence Rate ◽  
Tumor Size ◽  
Renal Cell ◽  
Renal Vein ◽  
Recurrence Rates ◽  
Renal Sinus ◽  
Collecting System ◽  
Urinary Collecting System

The recent eighth tumor-node-metastasis (TMN) staging system classifies renal cell carcinoma (RCC) with perirenal fat invasion (PFI), renal sinus fat invasion (SFI), or renal vein invasion (RVI) as stage pT3a. However, limited data are available on whether these sites have similar prognostic value or recurrence rate. We investigated the recurrence rate based on tumor size, pathological invasion sites including urinary collecting system invasion (UCSI), and clinically detected renal vein thrombus (cd-RVT) with pT3aN0M0 RCC. We retrospectively reviewed 91 patients with pT3aN0M0 RCC who underwent surgical treatment. Patients with tumor size > 7 cm, UCSI, three invasive sites (PFI + SFI + RVI), and cd-RVT showed a significant correlation with high recurrence rates (hazard ration (HR) 2.98, p = 0.013; HR 8.86, p < 0.0001; HR 14.28, p = 0.0008; and HR 4.08, p = 0.0074, respectively). In the multivariate analysis, tumor size of >7 cm, the presence of UCSI, and cd-RVT were the independent predictors of recurrence (HR 3.39, p = 0.043, HR 7.31, p = 0.01, HR 5.06, p = 0.018, respectively). In pT3a RCC, tumor size (7 cm cut-off), UCSI, and cd-RVT may help to provide an early diagnosis of recurrence.

scholarly journals Change in Tumor Size by RECIST Correlates Linearly With Overall Survival in Phase I Oncology Studies

2012 ◽  
Vol 30 (21) ◽  
pp. 2684-2690 ◽  
Author(s):  
Rajul K. Jain ◽  
J. Jack Lee ◽  
Chaan Ng ◽  
David Hong ◽  
Jing Gong ◽  
...  
Keyword(s):  
Overall Survival ◽  
Phase I ◽  
Anticancer Agents ◽  
Tumor Size ◽  
Continuous Variable ◽  
Phase I Trials ◽  
Management Options ◽  
Cox Models ◽  
Kaplan Meier ◽  
The Relationship

Purpose RECIST is used to quantify tumor changes during exposure to anticancer agents. Responses are categorized as complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD). Clinical trials dictate a patient's management options based on the category into which his or her response falls. However, the association between response and survival is not well studied in the early trial setting. Patients and Methods To study the correlation between response as quantified by RECIST and overall survival (OS, the gold-standard survival outcome), we analyzed 570 participants of 24 phase I trials conducted between October 2004 and May 2009, of whom 468 had quantifiable changes in tumor size. Analyses of Kaplan-Meier estimates of OS by response and null Martingale residuals of Cox models were the primary outcome measures. All analyses are landmark analyses. Results Kaplan-Meier analyses revealed strong associations between change in tumor size by RECIST and survival (P = 4.5 × 10−6 to < 1 × 10−8). The relationship was found to be near-linear (R2 = 0.75 to 0.92) and confirmed by the residual analyses. No clear inflection points were found to exist in the relationship between tumor size changes and survival. Conclusion RECIST quantification of response correlates with survival, validating RECIST's use in phase I trials. However, the lack of apparent boundary values in the relationship between change in tumor size and OS demonstrates the arbitrary nature of the CR/PR/SD/PD categories and questions emphasis placed on this categorization scheme. Describing tumor responses as a continuous variable may be more informative than reporting categoric responses when evaluating novel anticancer therapies.

Discovery and validation of a quantitative, stromal-associated imaging biomarker of pancreatic ductal adenocarcinoma (PDAC).

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 228-228 ◽  
Author(s):  
Mohamed Zaid ◽  
Baishali Chaudhury ◽  
Gauri R. Varadhachary ◽  
Matthew H. G. Katz ◽  
Joseph M. Herman ◽  
...  
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Proportional Hazards ◽  
Quantitative Imaging ◽  
Tumor Biology ◽  
Continuous Variable ◽  
Cox Proportional Hazards ◽  
Imaging Biomarker ◽  
Ductal Adenocarcinoma ◽  
Arterial Phase ◽  
Treatment Naïve

228 Background: As pancreatic ductal adenocarcinoma (PDAC) remains highly lethal, biomarkers are needed to identify patients who may benefit from specific therapeutic strategies. We previously described a qualitative computed tomography (CT) based biomarker - delta classification, whereby high delta tumors showed lower stromal content, more aggressive biology and poorer outcomes, than their counterparts. Here, we describe a quantitative method to differentiate these patients and predict outcomes. Methods: We retrospectively identified 101 treatment naïve patients who underwent pancreatectomy as a discovery cohort and 90 patients who underwent preoperative gemcitabine-based chemoradiation for validation. All patients underwent a pre-therapy pancreatic protocol CT and were classified as high or low delta, as described before. We semi-automatically segmented the tumors, chose normal pancreatic (NP) tissue and abdominal fat as references, then measured relative enhancement values using Philips IntelliSpace8 multimodality tumor tracking. We then analyzed the arterial and portal-venous phases separately using ROC and cox proportional hazards. Results: Delta class significantly associated with normalized enhancement values (NEV) in the arterial phase referenced to NP (P<0.0001, AUC =90%). A cutoff of 0.72 was identified that also distinguished high and low delta groups in the validation cohort (P<0.0001). As a continuous variable, the NEV was associated with distant metastasis free survival (DMFS) and overall survival (OS) on uni and multivariate analyses, accounting for traditional survival covariates. Using cutoff of 0.72, patients with high NEV had longer median OS (39 and 35.9 months) compared to those with low NEV (17.5 and 17.6 months, P=<0.0001) in discovery and validation cohorts, respectively. Similarly, patients with high NEV had longer median DMFS (46.6 and 62.2 months) compared to those with low NEV (15.6 and 13.1 months, P=0.005) in discovery and validation cohorts, respectively. Conclusions: The NEV measurement on baseline CT scans may serve as a quantitative imaging biomarker that can objectively reflect tumor biology and provide prognostic insight.

The spinal distribution of metastatic renal cell carcinoma: Support for locoregional rather than arterial hematogenous mode of early bony dissemination.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 742-742
Author(s):  
Kyrollis Attalla ◽  
Cihan Duzgol ◽  
Lily McLaughlin ◽  
Jessica Flynn ◽  
Irina Ostrovnaya ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Tumor Size ◽  
Renal Cell ◽  
Spinal Metastasis ◽  
Tumor Biology ◽  
Molecular Features ◽  
Metastatic Involvement ◽  
Distant Spread

742 Background: To investigate the distribution of spinal metastasis in metastatic renal cell carcinoma (mRCC) and to explore relationships between biological and clinical factors and patterns of spinal spread. Methods: An institutional database was queried to identify patients with mRCC and spinal metastatic involvement from June 2005 – November 2018. A blinded radiologist examined all cross-sectional imaging involving the spine and scored each level for absence or presence of disease. Clinical and biologic features including primary tumor size and degree of spinal and non-bony metastatic involvement (including regional lymph node and distant deposits) were collected. Spinal distributions were evaluated by the Kolmogorov Smirnov test and compared across radiographic and clinical parameters. Results: One-hundred patients with 685 spinal levels involved by mRCC were evaluated. A nonuniform spatial distribution was observed across the cohort; a preponderance of thoracolumbar involvement was noted with the mode at L3 (p<0.001). No difference in metastatic distribution was observed in right versus left-sided tumors. Tumors <4cm compared to >7cm, patients who had distant spread versus bone-only disease, and patients with increasing number of spine levels involved (1 versus >5 levels) had a significantly different distribution (p<0.001 for all comparisons). Smaller tumor size, distant spread, and greater number of involved levels appeared to have a more uniform distribution of spinal metastasis. Conclusions: These data support a dominant locoregional as opposed to arterial hematogenous mechanism for the early dissemination of mRCC to the spine. This is concordant with the theory of the valveless Batson plexus acting as a conduit for such spread, as the kidneys are compartmentally distinct from, but reside just anterior to the spine at L1-L3. Characterizations of the biologic molecular features contributing to osseous tropism and aggressive tumor biology (as seen in the subset of patients with uniform spread, such as outlier patients with small tumors), have implications for surveillance and are an area of active investigation.

scholarly journals Proposal of a New Definition of “Very Early” Intrahepatic Cholangiocarcinoma—A Retrospective Single-Center Analysis

2021 ◽  
Vol 10 (18) ◽  
pp. 4073
Author(s):  
Oliver Beetz ◽  
Angelica Timrott ◽  
Clara A. Weigle ◽  
Andreas Schroeter ◽  
Sebastian Cammann ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Intrahepatic Cholangiocarcinoma ◽  
Tumor Size ◽  
Tumor Biology ◽  
Extrahepatic Disease ◽  
Term Outcome ◽  
Term Survival ◽  
Long Term Outcome ◽  
Definition Of

Intrahepatic cholangiocarcinoma (ICC) is a rare disease with poor outcome, despite advances in surgical and non-surgical treatment. Recently, studies have reported a favorable long-term outcome of “very early” ICC (based on tumor size and absence of extrahepatic disease) after hepatic resection and liver transplantation, respectively. However, the prognostic value of tumor size and a reliable definition of early disease remain a matter of debate. Patients undergoing resection of histologically confirmed ICC between February 1996 and January 2021 at our institution were reviewed for postoperative morbidity, mortality, and long-term outcome after being retrospectively assigned to two groups: “very early” (single tumor ≤ 3 cm) and “advanced” ICC (size > 3 cm, multifocality or extrahepatic disease). A total of 297 patients were included, with a median follow-up of 22.8 (0.1–301.7) months. Twenty-one (7.1%) patients underwent resection of “very early” ICC. Despite the small tumor size, major hepatectomies (defined as resection of ≥3 segments) were performed in 14 (66.7%) cases. Histopathological analyses revealed lymph node metastases in 5 (23.8%) patients. Patients displayed excellent postoperative outcome compared to patients with “advanced” disease: intrahospital mortality was not observed, and patients displayed superior long-term survival, with a 5-year survival rate of 58.2% (versus 24.3%) and a median postoperative survival of 62.1 months (versus 25.3 months; p = 0.013). In conclusion, although the concept of a “very early” ICC based solely on tumor size is vague as it does not necessarily reflect an aggressive tumor biology, our proposed definition could serve as a basis for further studies evaluating the efficiency of either surgical resection or liver transplantation for this malignant disease.

scholarly journals Encoding strongly-correlated many-boson wavefunctions on a photonic quantum computer: application to the attractive Bose-Hubbard model

Quantum ◽  
2021 ◽  
Vol 5 ◽  
pp. 572
Author(s):  
Saad Yalouz ◽  
Bruno Senjean ◽  
Filippo Miatto ◽  
Vedran Dunjko
Keyword(s):  
Hubbard Model ◽  
Quantum Computer ◽  
Quantum Algorithms ◽  
Experimental System ◽  
Quantum Circuit ◽  
Continuous Variable ◽  
Computer Application ◽  
Strongly Correlated ◽  
Many Body ◽  
Boson Systems

Variational quantum algorithms (VQA) are considered as some of the most promising methods to determine the properties of complex strongly correlated quantum many-body systems, especially from the perspective of devices available in the near term. In this context, the development of efficient quantum circuit ansatze to encode a many-body wavefunction is one of the keys for the success of a VQA. Great efforts have been invested to study the potential of current quantum devices to encode the eigenstates of fermionic systems, but little is known about the encoding of bosonic systems. In this work, we investigate the encoding of the ground state of the (simple but rich) attractive Bose-Hubbard model using a Continuous-Variable (CV) photonic-based quantum circuit. We introduce two different ansatz architectures and demonstrate that the proposed continuous variable quantum circuits can efficiently encode (with a fidelity higher than 99%) the strongly correlated many-boson wavefunction with just a few layers, in all many-body regimes and for different number of bosons and initial states. Beyond the study of the suitability of the ansatz to approximate the ground states of many-boson systems, we also perform initial evaluations of the use of the ansatz in a variational quantum eigensolver algorithm to find it through energy minimization. To this end we also introduce a scheme to measure the Hamiltonian energy in an experimental system, and study the effect of sampling noise.

Osteosarcoma prognostic nomograms for predicting the 10-year probability of mortality and recurrence.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 11020-11020
Author(s):  
Haotong Wang ◽  
Ruoyu Miao ◽  
Alex Jacobson ◽  
Saveli Goldberg ◽  
David C. Harmon ◽  
...  
Keyword(s):  
Local Control ◽  
Tumor Size ◽  
Cox Regression ◽  
Predictive Accuracy ◽  
Cox Model ◽  
Cox Proportional Hazards ◽  
Histologic Grade ◽  
Patient Counseling ◽  
Histologic Subtype ◽  
Radiation History

11020 Background: The multidisciplinary approach in treatment of osteosarcoma has been well established and well adopted nationwide. This study combined the clinical prognostic factors at initial presentation into a nomogram to predict local control (LC), metastasis free survival (MFS), and overall survival (OS) for patients with non-metastatic bone osteosarcoma. Methods: We reviewed 397 osteosarcoma patients treated from 1995 to 2014. Patients with metastatic disease at diagnosis or limited follow up were excluded, resulting in 283 cases for analysis. Clinical and pathologic variables were recorded. Predictive variables included age at diagnosis, gender, previous radiation history, site, tumor size, histologic subtype, histologic grade, extra-osseous extension (EOE), lymphovascular invasion (LVI), necrosis rate and margin. The multivariate Cox proportional hazards regression was used to analyze survival outcomes and risk variables. Results: At 10 years, LC was 70.4% (95% confidence interval, CI: 64.0%-76.7%), MFS was 64.7% (95% CI: 58.1%-71.3%), and OS was 61.5% (95% CI: 54.9%-68.1%). Multivariate Cox model identified age (p = 0.033), site (p = 0.020), EOE (p = 0.017), LVI (p = 0.011), and margin (p = 0.039) were correlated with LC; age (p = 0.028), tumor size (p < 0.001), histologic grade (p = 0.039), and LVI (p = 0.014) were correlated with MFS; whereas age (p < 0.001), prior radiation history (p = 0.010), tumor size (p = 0.002), histologic subtype (p = 0.012), EOE (p = 0.002), and LVI (p = 0.001) were associated with OS. The nomograms were drawn on the basis of the Cox regression model and were internally validated using bootstrapping, with predictive accuracy of ±7.2% for 10-year LC, ±7.4% for 10-year MFS, and ±7.5% for 10-year OS. Conclusions: Nomograms have been developed to predict the 10-year local-control failure, recurrence and death. We suggest that this tool at presentation may be useful for individualized risk evaluation, patient counseling, and making clinical decisions.

Systematic analysis of parameters predicting pathological axillary status (ypN0 vs. ypN+) in patients converting from cN+ to ycN0 through primary systemic therapy (PST).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 560-560
Author(s):  
Cornelia Liedtke ◽  
Hans-Christian Kolberg ◽  
Laura Kerschke ◽  
Dennis Goerlich ◽  
Ingo Bauerfeind ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Tumor Biology ◽  
Model Performance ◽  
Area Under The Curve ◽  
Axillary Staging ◽  
Patient Counseling ◽  
Primary Systemic Therapy ◽  
Systematic Analysis ◽  
Logistic Regression Models ◽  
Leave One Out

560 Background: Optimization of axillary staging in patients converting from cN+ to ycN0 through PST is needed. The aim of this analysis was to develop a nomogram predicting the probability of ypN+ after PST based on clinical/pathological parameters. Methods: Patients converting from cN+ to ycN0 through PST from a prospective study (SENTINA arm C) were included. Univariate/multivariate analyses were carried out for 14 clinical/pathological parameters to predict ypN+ using logistic regression models. Odds ratios and 95% confidence intervals were reported. Model performance was assessed by leave-one-out cross-validation (LOOCV at .5 cut-offs) and ROC analyses. Calculations were performed using the SAS Software (Version 9.4). Results: 553 patients were assessed. Stepwise backward variable selection based on a multivariate analysis of all significant parameters resulted in a model (5M, Table, N = 369 evaluable) including ER (3.81; 2.25-6.44), multifocality (2.22; 1.26-3.92), LVI (9.16; 4.68-17.90), detection of SLN after PST (.50; .26-.95) and ycT (1.03; 1.01-1.06). In LOOCV, this model had an area under the curve of .81. Multivariate analysis of parameters available preoperatively showed an association between ypN0/ypN+, ER and ycT. Full subset selection resulted in a model (2M, N = 414) containing only ER (4.36; 2.80, 6.81) and ycT (1.04; 1.02, 1.07). Conclusions: A prediction model including parameters evaluable before/after definitive surgery resulted in a nomogram with acceptable accuracy. Limitation to parameters evaluable before surgery (i.e. ER, ycT) showed reduced accuracy that was comparable/superior to accuracy of using individual parameters. Since tumor biology was the strongest parameter in our models, we hypothesize that modern tumor biologic parameters such as gene expression profiling might optimize prediction of axillary status after PST improving patient counseling. [Table: see text]

Gastrointestinal stromal tumors: Immune protein expression and clinical outcomes.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 124-124
Author(s):  
Andrew M. Blakely ◽  
Andres Matoso ◽  
Thomas J. Miner
Keyword(s):  
Clinical Outcomes ◽  
Tumor Size ◽  
Gastrointestinal Stromal Tumors ◽  
Care Center ◽  
Treatment Options ◽  
Tertiary Care ◽  
Tumor Biology ◽  
Benign Tumors ◽  
Stromal Tumors ◽  
Significant Difference

124 Background: The immune microenvironment is emerging as an important prognostic factor with potential therapeutic targets for various malignancies. Although programmed death-ligand 1 (PD-L1) and indoleamine 2,3-dioxygenase (IDO) have been studied in some tumor types, significance of their expression in gastrointestinal stromal tumors (GISTs) is largely unknown. Methods: Tissue microarrays at an academic tertiary care center were constructed from pathology files from 1996 to 2016. Immunohistochemistry for PD-L1 and IDO was performed and correlated with tumor size, mitoses, and clinical outcomes. Tumor infiltrating lymphocytes (TILs) were counted using image analysis software. Results: 131 GISTs were analyzed. Median patient age was 64 years (range 30-89); 51.1% were male. Tumor location included 89 stomach (67.9%), 34 small bowel (26.0%), 4 colorectal (3.1%), and 4 other (3.1%). Median follow-up was 58 months. Mean tumor size was 5.6±4.5cm, range 0.5 to 24; mean mitoses were 7.2/50HPF. 19 (14.5%) metastasized to mesentery (n = 8), liver (n = 6), and elsewhere (n = 5). Mean survival was 61 months (range 7-127); 5 patients died of disease (3.8%). PD-L1 immunostain was positive in 89 (67.9%), including 11 of 19 (57.9%) malignant and 78 of 112 (69.6%) benign tumors (p = 0.4). PD-L1 positive tumors were larger (6.3±4.4 vs. 4.4±3.4 cm; p = 0.02) and had more mitoses/50HPF (8.9±5.4 vs. 3.9±3.5; p = 0.006) than PD-L1 negative tumors. IDO immunostain was positive in 116 (88.5%), including 14 of 19 (73.7%) malignant and 102 of 112 (91.1%) benign tumors (p = 0.07). There was no significant difference in size or mitotic count between IDO positive and negative tumors. Mean number of CD8-positive TILs was 168±35/mm2 and mean number of PD-L1 positive TILs was 147±28/mm2 in PD-L1 positive tumors. PD-L1 positive tumors had significantly more TILs than PD-L1 negative tumors (113±21 vs. 104±18; p < 0.001). Conclusions: The majority of GISTs express PD-L1 and IDO. Expression of PD-L1 was associated with increased tumor size and higher mitotic activity. PD-L1 and IDO could play a significant role in the tumor biology of GISTs; immunotherapy targeting one or both may provide novel treatment options.

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