scholarly journals An evaluation of the role of tumor load in cytoreductive nephrectomy

2020 ◽  
Vol 14 (12) ◽  
Author(s):  
Andrew W. Silagy ◽  
Cihan Duzgol ◽  
Julian Marcon ◽  
Renzo G. DiNatale ◽  
Roy Mano ◽  
...  
Keyword(s):  
Primary Tumor ◽  
Tumor Volume ◽  
Cox Regression ◽  
Three Dimensional ◽  
Volumetric Analysis ◽  
Cytoreductive Nephrectomy ◽  
Primary Tumors ◽  
Cox Regression Analysis ◽  
Entire Cohort ◽  
Primary Tumor Volume

Introduction: New radiological tools can accurately provide preoperative three-dimensional spatial assessment of metastatic renal cell carcinoma (RCC) We aimed to determine whether the distribution, volume, shape, and fraction of RCC resected in a cytoreductive nephrectomy associates with survival. Methods: We retrospectively reviewed 560 patients undergoing cytoreductive nephrectomy performing a comprehensive volumetric analysis in eligible patients of all detectable primary and metastatic RCC prior to surgery. We used Cox regression analysis to determine the association between the volume, shape, fraction resected, and distribution of RCC and overall survival (OS). Results: There were 62 patients eligible for volumetric analysis, with similar baseline characteristics to the entire cohort, and median survivor followup was 34 months. Larger primary tumors were less spherical, but not associated with different metastatic patterns. Increased primary tumor volume and tumor size, but not the fraction of tumor resected, were associated with inferior survival. The rank of tumors based on unidimensional size did not completely correspond to the rank by primary tumor volume, however, both measurements yielded similar concordance for predicted OS. Larger tumor volume was not associated with a longer postoperative time off treatment. Conclusions: Primary tumor volume was significant for predicting OS, while the fraction of disease resected did not appear to impact upon patient outcomes. Although rich in detail, our study is potentially limited by selection bias. Future temporal studies may help elucidate whether the primary tumor shape is associated with tumor growth kinetics.

scholarly journals Automatic segmentation of head and neck primary tumors on MRI using a multi-view CNN

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Jens P.E. Schouten ◽  
Samantha Noteboom ◽  
Roland M. Martens ◽  
Steven W. Mes ◽  
C. René Leemans ◽  
...  
Keyword(s):  
Head And Neck ◽  
Treatment Planning ◽  
Primary Tumor ◽  
Tumor Volume ◽  
Automatic Segmentation ◽  
Neck Region ◽  
Primary Tumors ◽  
Head And Neck Region ◽  
Primary Tumor Volume ◽  
Mri Sequences

Abstract Background  Accurate segmentation of head and neck squamous cell cancer (HNSCC) is important for radiotherapy treatment planning. Manual segmentation of these tumors is time-consuming and vulnerable to inconsistencies between experts, especially in the complex head and neck region. The aim of this study is to introduce and evaluate an automatic segmentation pipeline for HNSCC using a multi-view CNN (MV-CNN). Methods The dataset included 220 patients with primary HNSCC and availability of T1-weighted, STIR and optionally contrast-enhanced T1-weighted MR images together with a manual reference segmentation of the primary tumor by an expert. A T1-weighted standard space of the head and neck region was created to register all MRI sequences to. An MV-CNN was trained with these three MRI sequences and evaluated in terms of volumetric and spatial performance in a cross-validation by measuring intra-class correlation (ICC) and dice similarity score (DSC), respectively. Results The average manual segmented primary tumor volume was 11.8±6.70 cm3 with a median [IQR] of 13.9 [3.22-15.9] cm3. The tumor volume measured by MV-CNN was 22.8±21.1 cm3 with a median [IQR] of 16.0 [8.24-31.1] cm3. Compared to the manual segmentations, the MV-CNN scored an average ICC of 0.64±0.06 and a DSC of 0.49±0.19. Improved segmentation performance was observed with increasing primary tumor volume: the smallest tumor volume group (<3 cm3) scored a DSC of 0.26±0.16 and the largest group (>15 cm3) a DSC of 0.63±0.11 (p<0.001). The automated segmentation tended to overestimate compared to the manual reference, both around the actual primary tumor and in false positively classified healthy structures and pathologically enlarged lymph nodes. Conclusion An automatic segmentation pipeline was evaluated for primary HNSCC on MRI. The MV-CNN produced reasonable segmentation results, especially on large tumors, but overestimation decreased overall performance. In further research, the focus should be on decreasing false positives and make it valuable in treatment planning.

Tumor size and prognosis in aggressively treated osteosarcoma.

1996 ◽  
Vol 14 (3) ◽  
pp. 848-858 ◽  
Author(s):  
P Bieling ◽  
N Rehan ◽  
P Winkler ◽  
K Helmke ◽  
R Maas ◽  
...  
Keyword(s):  
Tumor Size ◽  
Tumor Volume ◽  
Cox Regression ◽  
Prognostic Significance ◽  
Three Dimensional ◽  
Three Dimensions ◽  
Cox Regression Analysis ◽  
X Ray ◽  
Dimensional Measure ◽  
Length Width

PURPOSE The aim of this retrospective analysis was to investigate the prognostic significance and optimal measures of tumor size in osteosarcoma treated with intensive neoadjuvant chemotherapy. PATIENTS AND METHODS Initial anterior-posterior (AP) and lateral x-ray films of 128 patients treated within the trials Cooperative Osteosarcoma Study (COSS)-80, -82, and -86, were evaluated for the following three tumor diameters: length, width, and depth. Metastasis-free survival (MFS) analyses were performed in univariate and multivariate models with one, two, and three dimensions of the tumor as absolute or relative measures (tumor length, referred to bone length, plane and volume to body-surface area). RESULTS Univariate analyses of MFS showed a high prognostic significance of all absolute measures. Relative measures, at best, showed a comparable predictive value. Cox regression analysis indicated the high prognostic significance of absolute tumor volume (ATV; P < .0001) and histologic response (P < .0001). None of 19 patients with an ATV < or = 70 cm3 and only four of 53 with an ATV < or = 150 cm3 relapsed, while in patients with an ATV more than 150 cm3, the relapse rate remained 40% to 60%, irrespective of further increase in volume. CONCLUSION Initial tumor size is an important and easily obtainable prognostic factor in osteosarcoma and may serve as a basis for risk-adapted therapy. It is best represented by the absolute three-dimensional measure ATV. There is a cut-off point regarding the incidence of metastases at a tumor volume of approximately 150 cm3 as calculated from two-plane x-ray films.

scholarly journals Bone-Specific Metastasis Pattern of Advanced-Stage Lung Adenocarcinoma According to the Localization of the Primary Tumor

2021 ◽  
Vol 27 ◽  
Author(s):  
Peter Radeczky ◽  
Judit Moldvay ◽  
Janos Fillinger ◽  
Beata Szeitz ◽  
Bence Ferencz ◽  
...  
Keyword(s):  
Lung Adenocarcinoma ◽  
Primary Tumor ◽  
Cox Regression ◽  
Distant Metastases ◽  
Tumor Location ◽  
Skeletal Metastases ◽  
Advanced Stage ◽  
Primary Tumors ◽  
Cox Regression Analysis ◽  
Primary Tumor Location

Background: Patients with advanced-stage lung adenocarcinoma (LADC) often develop distant metastases in the skeletal system. Yet, the bone-specific metastasis pattern is still controversial. We, therefore, aimed to examine how the primary tumor location affects bone specificity and survival in LADC patients diagnosed with skeletal metastases.Methods: In total, 209 bone-metastatic Caucasian LADC patients from two thoracic centers were included in this study. Focusing on the specific location of primary tumors and bone metastatic sites, clinicopathological variables were included in a common database and analyzed retrospectively. Skeletal metastases were diagnosed according to the contemporary diagnostic guidelines and confirmed by bone scintigraphy. Besides region- and side-specific localization, primary tumors were also classified as central or peripheral tumors based on their bronchoscopic visibility.Results: The most common sites for metastasis were the spine (n = 103) and the ribs (n = 60), followed by the pelvis (n = 36) and the femur (n = 22). Importantly, femoral (p = 0.022) and rib (p = 0.012) metastases were more frequently associated with peripheral tumors, whereas centrally located LADCs were associated with humeral metastases (p = 0.018). Moreover, we deduced that left-sided tumors give rise to skull metastases more often than right-sided primary tumors (p = 0.018). Of note, however, the localization of the primary tumor did not significantly influence the type of affected bones. Multivariate Cox regression analysis adjusted for clinical parameters demonstrated that central localization of the primary tumor was an independent negative prognostic factor for overall survival (OS). Additionally, as expected, both chemotherapy and bisphosphonate therapy conferred a significant benefit for OS.Conclusion: The present study demonstrates unique bone-specific metastasis patterns concerning primary tumor location. Peripherally located LADCs are associated with rib and femoral metastases and improved survival outcomes. Our findings might contribute to the development of individualized follow‐up strategies in bone-metastatic LADC patients and warrant further clinical investigations on a larger sample size.

Fractional percentage of tumor volume removed is a predictor of outcome following cytoreductive nephrectomy for metastatic renal cell carcinoma

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4599-4599 ◽  
Author(s):  
S. Collins ◽  
P. M. Pierorazio ◽  
J. M. McKiernan ◽  
M. C. Benson
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Primary Tumor ◽  
Renal Cell ◽  
Tumor Volume ◽  
Rank Test ◽  
Cytoreductive Nephrectomy ◽  
Primary Tumors

4599 Background: Metastatic renal cell carcinoma, (M+)RCC, is associated with poor overall survival with only 10–20% of patients alive at 2-years. The objective of this study is to determine if the fractional percentage of tumor volume (FPTV) removed at cytoreductive nephrectomy predicts disease specific survival (DSS). Methods: The Columbia Urologic Oncology Database was reviewed and 1,016 patients were identified that underwent renal surgery from 1988 to the present. A retrospective cohort of 93 patients were identified with (M+)RCC at the time of nephrectomy. The prospective database was reviewed to determine the FPTV removed and remaining following surgery. Patients were stratified to having greater or less than 90% of their cancer burden removed. Primary outcome was defined as DSS. Kaplan-Meier analysis with log-rank test was performed to determine survival advantage between groups. A Cox proportional hazard model was fit for PTR in both univariate and multivariate models. Secondary analyses were conducted to determine if the size of primary tumor affected outcome and if FPTV affected hospitalization time. Results: 63 of 77 patients had >90% of their tumor burden removed. Median follow-up time was 8.6 months. Median DSS times were calculated to be 18.8 and 3.6 months for patients with >90% and <90% PTR respectively (p < 0.001). The hazard ratio for death was 5.73 for patients with <90% of tumor removed (p < 0.001). Those with >90% removed had larger primary tumors, 10.6cm vs. 7.2cm in the <90% removed group (p = 0.01). Outcome analysis by size of primary tumor demonstrated no difference in survival. Patients with <90% removed spent 13.6% of DSS time hospitalized compared to 6.3% for those with >90% removed (p = 0.89). Conclusions: For patients with (M+)RCC, overall survival is limited but can be extended by cytoreductive nephrectomy. FPTV expected to be removed is a simple and available method to counsel patients regarding the benefits of surgical intervention. No significant financial relationships to disclose.

scholarly journals Metastases to the Kidney: An Analysis of 35 Cases and a Review of Literature

2021 ◽  
Vol 10 ◽  
Author(s):  
Jinchao Chen ◽  
Nienie Qi ◽  
Shaoxing Zhu
Keyword(s):  
Primary Tumor ◽  
Cox Regression ◽  
Renal Tumors ◽  
Imaging Features ◽  
Renal Surgery ◽  
Primary Tumors ◽  
Renal Metastasis ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Renal Metastases

IntroductionIn addition to being rare, metastases to the kidney present clinicians with issues regarding their treatment.Materials and MethodsWe retrospectively analyzed 35 cases of diagnosed renal metastases. The clinical characteristics, imaging features, pathological features, diagnosis, and treatment were analyzed, and Kaplan-Meier methods and Cox regression analysis were used to calculate overall survival (OS) and influencing factors.ResultsThe average age of the patients was 62 years, and 40% presented with symptoms. The most common primary tumor was lung cancer (60%), and two patients had renal metastases coexisting with renal cell carcinoma. The average interval from primary tumor to renal metastasis was 29.4 months. Only 45.5% of the patients who underwent enhanced computerized tomography were diagnosed with renal metastases. Renal biopsy was performed in 16 patients (45.7%), leading to a diagnosis in 15 (93.8%). Twenty-one patients (60%) received surgical treatment, and median recurrence free survival of these patients was 7 months (95% CI, 5 to 12). Overall, the median OS was 44 months for patients who underwent renal surgery, and 52 months for patients who did not (P = 0.672). However, for patients without metastases at other sites, surgery could significantly prolong OS (P = 0.001).ConclusionAlthough rare, the possibility of renal metastasis should be considered after finding renal tumors in patients with primary tumors in other organs, and can be diagnosed by imaging examination and puncture biopsy. For patients without other metastases, surgical intervention can be considered for the renal lesions.

Perioperative Activation of Disseminated Tumor Cells in Bone Marrow of Patients With Prostate Cancer

2009 ◽  
Vol 27 (10) ◽  
pp. 1549-1556 ◽  
Author(s):  
Dorothea Weckermann ◽  
Bernhard Polzer ◽  
Thomas Ragg ◽  
Andreas Blana ◽  
Günter Schlimok ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Bone Marrow ◽  
Tumor Cells ◽  
Cox Regression ◽  
Systemic Disease ◽  
Disseminated Tumor Cells ◽  
Comparative Genomic ◽  
Prognostic Impact ◽  
Primary Tumors ◽  
Cox Regression Analysis

Purpose The outcome of prostate cancer is highly unpredictable. To assess the dynamics of systemic disease and to identify patients at high risk for early relapse we followed the fate of disseminated tumor cells in bone marrow for up to 10 years and genetically analyzed such cells isolated at various stages of disease. Patients and Methods Nine hundred bone marrow aspirates from 384 patients were stained using the monoclonal antibody A45-B/B3 directed against cytokeratins 8, 18, and 19. Log-rank statistics and Cox regression analysis were applied to determine the prognostic impact of positive cells detected before surgery (244 patients) and postoperatively (214 patients). Samples from primary tumors (n = 55) and single disseminated tumor cells (n = 100) were analyzed by comparative genomic hybridization. Results Detection of cytokeratin-positive cells before surgery was the strongest independent risk factor for metastasis within 48 months (P < .001; relative risk [RR], 5.5; 95% CI, 2.4 to 12.9). In contrast, cytokeratin-positive cells detected 6 months to 10 years after radical prostatectomy were consistently present in bone marrow with a prevalence of approximately 20% but had no influence on disease outcome. Characteristic genotypes of cytokeratin-positive cells were selected at manifestation of metastasis. Conclusion Cytokeratin-positive cells in the bone marrow of prostate cancer patients are only prognostically relevant when detected before surgery. Because we could not identify significant genetic differences between pre- and postoperatively isolated tumor cells before manifestation of metastasis, we postulate the existence of perioperative stimuli that activate disseminated tumor cells. Patients with cytokeratin-positive cells in bone marrow before surgery may therefore benefit from adjuvant therapies.

scholarly journals Tumor Volume Reduction Rate to Induction Chemotherapy Is a Prognostic Factor for Locally Advanced Head and Neck Squamous Cell Carcinoma: a Retrospective Cohort Study

2021 ◽  
Author(s):  
Chi-hsien Huang ◽  
Ting-Chun Lin ◽  
Ming-Yu Lien ◽  
Fu-Ming Cheng ◽  
Kai-Chiun Li ◽  
...  
Keyword(s):  
Tumor Volume ◽  
Cox Regression ◽  
Reduction Rate ◽  
Volume Reduction ◽  
Cancer Site ◽  
Rank Test ◽  
Primary Cancer ◽  
Cox Regression Analysis ◽  
Log Rank Test ◽  
Tumor Volume Reduction

Abstract BackgroundAim of this study was to evaluate the prognostic of tumor volume reduction rate (TVRR) status post induction chemotherapy (IC) in LA-HNSCC.MethodsPatients with newly diagnosed LA-HNSCC from year 2007 to 2016 at a single center were included in this retrospective study. All patients had received IC as TPF (taxotere, platinum, fluorouracil) followed by daily definitive intensity-modulated radiotherapy (IMRT) for 70 Gy in 35 fractions concurrent with or without cisplatin-based chemotherapy. Tumor volume reduction rate of the primary tumor (TVRR-T) and lymph node (TVRR-N) was measured and calculated by contrast-enhanced CT images at diagnosis, and one month after final IC cycle, and analyzed though a univariate and multivariate Cox regression model.ResultsNinety patients of the primary cancer sites at hypopharynx (31/90, 34.4%), oropharynx (29/90, 32.2%), oral cavity (19/90, 21.1%) and larynx (11/90, 12.2%) were included in this study, with a median follow-up time interval of 3.9 years. In univariate Cox regression analysis, the TVRR-T as the only variable showed a significant difference for disease-free survival (DFS) (hazard ratio [HR] 0.77, 95% confidence interval (CI) 0.63 to 0.96; P = 0.02), aside from cancer site, RECIST, age and IC dose. In multivariate Cox regression analysis, The TVRR-T was also an independently significant prognostic factor for DFS (HR 0.77, 95% CI 0.62 to 0.97; P = 0.02). At a cutoff value using TVRR-T of 50% in Kaplan-Meier survival analysis, the DFS was significant higher with TVRR-T ≥ 50% group (log-rank test, p = 0.024), and also a trend of improved OS. (log-rank test, p = 0.069).ConclusionsTVRR-T was related to improved DFS and trend of improved OS. Other factors including patient’s age at diagnosis, the primary cancer site, and RECIST, were not significantly related to DFS.

scholarly journals Subdivision of metastatic colorectal cancer for identifying patients who benefit more from primary tumor resection

2021 ◽  
Author(s):  
Dakui Luo ◽  
Zezhi Shan ◽  
Zhiqiang Li ◽  
Simin Chen ◽  
Sanjun Cai ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Prognostic Factors ◽  
Primary Tumor ◽  
Cox Regression ◽  
Tumor Resection ◽  
Signet Ring Cell ◽  
Normal Serum ◽  
Primary Tumor Resection ◽  
Cox Regression Analysis ◽  
Serum Cea

Abstract Background Stage IV colorectal cancer (CRC) patients are heterogeneous with distinctive clinicopathologic features and prognosis. Radical resection of primary tumor and distant metastases is associated with improved survival outcomes in metastatic CRC. The value of palliative primary tumor resection is controversial. The present study explored which subgroups benefited more from primary tumor resection in metastatic CRC. Methods Between 2004 and 2015, patients with metastatic CRC were identified using the surveillance, epidemiology, and end results (SEER) database. Uni- and multivariable Cox regression analysis were performed to identify factors associated with decreased cancer-specific mortality. The subgroups were divided based on the independent prognostic factors. Results Age, marital status, race, serum CEA, histologic type, differentiation, tumor location, surgery of primary or metastatic lesion, site of metastases, number of metastatic sites, chemotherapy and radiotherapy were identified as independent prognostic factors. Patients with non-white race, normal serum CEA, non-signet ring cell carcinoma, well or moderate differentiation, surgery of metastases, isolated liver metastasis, single metastasis, receiving chemotherapy or radiotherapy presented more survival benefit from primary tumor resection. Conclusion Subgroup of metastatic CRC optimizes decision-making and selected patients will benefit more from primary tumor resection.

Clinical Characteristics, Pathology and Outcome of 237 Patients With Synovial Sarcoma: Single Center Experience

2021 ◽  
pp. 106689692110560
Author(s):  
Hao Cheng ◽  
Chi Yihebali ◽  
Hongtu Zhang ◽  
Lei Guo ◽  
Susheng Shi
Keyword(s):  
Overall Survival ◽  
Synovial Sarcoma ◽  
Tumor Size ◽  
Clinical Characteristics ◽  
Cox Regression ◽  
Survival Outcomes ◽  
Tumor Diameter ◽  
Single Center ◽  
Primary Tumors ◽  
Cox Regression Analysis

Background Synovial sarcoma (SS) is a rare soft tissue sarcoma. Available data regarding survival outcomes of patients with SS still remains limited. In this study, a single center retrospective analysis was performed to investigate the clinical characteristics, pathology and survival outcomes in patients with SS in China. Methods Patient data were systematically reviewed at the National Cancer Center from January 2015 to December 2020. The general information and treatment condition of patients were collected. Overall survival (OS) was evaluated using the Kaplan-Meier and Cox regression method. Results A total of 237 consecutive patients were included in this study (follow-up cut-off date: December, 2020). The median age of patients involved was 35 years (ranging from 5 to 83 years) and the mean tumor diameter was 5.3 cm (ranging from .2 to 26.0 cm). The main findings of the immunohistochemical staining analyses were EMA (111/156) (71%), keratin (32/64) (50.0%), keratin (12/20) (60%), keratin (42/70) (60%), S-100 (18/160) (11%), BCL-2 (128/134) (96%), CD99 (137/148) (93%) and TLE1 (23/26) (88%). It was found that 109 patients (66%) were presented with monophasic subtype and 55 (34%) with biphasic subtype. A total of 137 patients were tested by FISH method and 119 patients (87%) demonstrated SS18 rearrangement, whereas 18 patients (13%) did not show SS18 rearrangement. Generally, it was found that the 3-year OS rate was 86% and the 3-year DFS was 55%. Results of univariate analysis revealed that age, tumor size, tumor site, radiotherapy and targeted therapy were significantly correlated with the overall survival ( P < .05). Further, multivariate Cox regression analysis revealed that age, tumor size and radiotherapy were significantly associated with OS ( P < .05). Conclusions In conclusion, this study shows that the outcomes of patients with SS significantly decrease with age and tumor size. It was evident that radiotherapy is an independent and positive prognostic factor for patients with SS. In addition, it was shown that the prognosis of SS varies with tumor location. For instance, primary tumors in lower extremities have a higher prognosis, whereas tumors located in thorax have a lower prognosis.

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