RESULTS OF THE ANALYSIS OF CLINICAL, MORPHOLOGICAL FACTORS FOR THE PROGNOSIS OF RENAL CELL CARCINOMA

This article analyzes the main clinical, morphological factors affecting the outcome of the disease, and determines their proportion. Favorable clinical and morphological signs were: absence of lymphovascular invasion, lymphocytic infiltration of the tumor, small tumor size, absence of concomitant pathology. Adverse prognosis factors include: lymphovascular invasion, absence of tumor infiltration by lymphocytes, large tumor size and severe concomitant pathologies.

SOLID PSEUDOPAPILLARY NEOPLASM OF THE PANCREAS: PRESENTATION OF A CASE AND REVIEW OF THE LITERATURE

Solid pseudopapillary neoplasms (SPN) of the pancreas are rare tumors, occurring in 1-2% of all pancreatic neoplasms; of these 10 to 15% have an aggressive presentation. Most of the patients present disease localized to the pancreas, however, between 9-15% may present local invasion and metastasis. The clinical presentation in the vast majority of SPN is asymptomatic, even despite a large tumor size. We present a case of a 16-year-old female patient with a psedupapillary tumor of the pancreas (Frantz tumor) who was admitted due to abdominal pain and weight loss lasting 3 months.

Comparison of Lobectomy and Sublobar Resection for Stage IA Elderly NSCLC Patients (≥70 Years): A Population-Based Propensity Score Matching’s Study

BackgroundTo investigate the differences in survival between lobectomy and sub-lobar resection for elderly stage I non-small-cell lung cancer (NSCLC) patients using the Surveillance, Epidemiology, and End Results (SEER) registry.MethodThe data of stage IA elderly NSCLC patients (≥ 70 years) with tumors less than or equal to 3 cm in diameter were extracted. Propensity-matched analysis was used. Lung cancer-specific survival (LCSS) was compared among the patients after lobectomy and sub-lobar resection. The proportional hazards model was applied to identify multiple prognostic factors.ResultsA total of 3,504 patients met criteria after propensity score matching (PSM). Although the LCSS was better for lobectomy than for sub-lobar resection in patients with tumors ≤ 3 cm before PSM (p < 0.001), no significant difference in the LCSS was identified between the two treatment groups after PSM (p = 0.191). Multivariate Cox regression showed the elder age, male gender, squamous cell carcinoma (SQC) histology type, poor/undifferentiated grade and a large tumor size were associated with poor LCSS. The subgroup analysis of tumor sizes, histologic types and lymph nodes (LNs) dissection, there were also no significant difference for LCSS between lobectomy and sub-lobar resection. The sub-lobar resection was further divided into segmentectomy or wedge resection, and it demonstrated that no significant differences in LCSS were identified among the treatment subgroups either. Multivariate Cox regression analysis showed that the elder age, poor/undifferentiated grade and a large tumor size were a statistically significant independent factor associated with survival.ConclusionIn terms of LCSS, lobectomy has no significant advantage over sub-lobar resection in elderly patients with stage IA NSCLC if lymph node assessment is performed adequately. The present data may contribute to develop a more suitable surgical treatment strategy for the stage IA elderly NSCLC patients.

Distinguishing Choroidal Nevi from Melanomas Using the MOLES Algorithm: Evaluation in an Ocular Nevus Clinic

Objective: The aim of this study was to determine the sensitivity and specificity of the MOLES scoring system in differentiating choroidal melanomas from nevi according to Mushroom shape, Orange pigment, Large tumor size, Enlarging tumor, and Subretinal fluid (SRF). Methods: Color photographs, fundus-autofluorescence images, and optical coherence tomography of 222 melanocytic choroidal tumors were reviewed. Each MOLES feature was retrospectively scored between 0 and 2 and tumors categorized as “common nevus,” “low-risk nevus,” “high-risk nevus,” and “probable melanoma” according to the total score. MOLES scores were compared with the experts’ diagnosis of melanoma. Results: The MOLES scoring system indicated melanoma in all 81 tumors diagnosed as such by ocular oncologists (100% sensitivity) and nevus in 135 of 141 tumors given this diagnosis by these experts (95.7% specificity). Of the 6 tumors with discordant diagnoses, 4 had basal diameters exceeding 6 mm, all with SRF and/or orange pigment, and 2 small tumors showed either significant SRF with traces of orange pigment, or vice versa. Conclusions: The MOLES system for diagnosing melanocytic choroidal tumors compares well with expert diagnosis but needs to be evaluated when deployed by ophthalmologists and community optometrists in a wide variety of working environments.

Impact of Chemotherapy and Radiotherapy on the Survival of Elderly Esophagus Cancer Patients after Surgery: A SEER Database Analysis

BackgroundEsophagus cancer (EC) is a common and lethal carcinoma, however, the effectiveness and feasibility of the conventional treatments for the elderly patients with surgery have not been discussed fully. The purpose of the current study is to discuss the potential effect of chemotherapy and radiotherapy on the prognosis.ResultsBy PSM, chemotherapy (sHR: 0.588, 95%CI: 0.453-0.763, P<0.001) and radiotherapy (sHR: 0.652, 95%CI: 0.513-0.83, P<0.001) were showed a negative correlation to the probability of cancer specific death (CSD). Based on the nomogram, patients with poor differentiation, large tumor size, advanced T-staging, lymphatic metastasis and distant metastasis tended to benefit from chemotherapy (HR: 0.441, 95%CI: 0.364-0.533, P < 0.001) or radiotherapy (HR: 0.539, 95%CI: 0.448-0.649, P < 0.001) to decrease the probabilities of CSD, while no benefit or even harm was showed among the low-risk ones. ConclusionAggressive treatment such as chemotherapy or radiotherapy was considered effective for the selective elder patients with EC.

The association between hyperfibrinogenemia and clinicopathological factors, and the survival analysis of gastric cancer.

e16547 Background: It is reported that hyperfibrinogenemia is commonly seen in gastric cancer. This study aim to discuss the association between fibrinogen level and preoperative clinicopathological factors and to evaluate the value as a predictor of prognosis. Methods: Retrospectively reviewed the medical records and follow-up data of patients with gastric cancer who underwent curative resection from January 2011 to December 2014 at Surgery Department of the Fourth Hospital of Hebei Medical University. Fibrinogen was measured a week before the surgery. Results: A total of 248 cases were enrolled. The means±SD of fibrinogen was 3.28±1.06g/L. Fibrinogen level was higher in older adults(≥60y), advanced tumor, poorly differentiated, deep invasion, lymph node metastasis, large tumor size and in those with high CEA, platelet count, albumin, NLR and PLR,( P< 0.05). All the people were divided by the TNM staging system and found that the plasma fibrinogen was higher in stageⅡand Ⅲ (stageⅠvs. stageⅡ: 2.84±0.72g/L vs. 3.36±1.18g/L, P= 0.009;stageⅠvs. stage Ⅲ: 2.84±0.72g/L vs. 3.43±1.07g/L, P< 0.001), however, there was no difference between stageⅡand Ⅲ( P= 0.662)(our study did not enrolled stage IV patients).When patients were classified into 4 groups according to the T classification, the plasma fibrinogen level gradually increased with increasing depth of cancer invasion (one way ANOVA; P= 0.002). Yet, when the patients who have lymph nodes metastasis classified according to the N classification, the differences among them did not have statistically significance ( P= 0.333). Multivariate analysis revealed that hyperfibrinogenemia had an independent association with advanced cancer (odds ratio,2.686(1.012-7.125); P= 0.047), lymph node metastasis (odds ratio,2.012 (1.012-3.125); P= 0.035) and tumor size(odds ratio,1.949 (1.099-3.454); P= 0.022). Our study aslo suggested that the patients with hyperfibrinogenemia before surgery showed a significantly lower survival rate (Log-Rank test; P< 0.001), hyperfibrinogenemia was a independent predictor on the overall survival, which could predict worse clinical outcome. Conclusions: Hyperfibrinogenemia may be considered a useful biomarker to predict advanced tumor, lymph node metastasis and large tumor size and can be a good predictor of worse clinical outcome.

Surgical Management and Prognostic Factors Based on 50 Tectal Plate Gliomas

BackgroundThe management and prognostic factors of tectal glioma (TG) remain ambiguous, because it is an extremely rare neoplasm that occurs predominantly in the pediatric population. The objective of this study was to evaluate the risk factors for progression-free survival (PFS) in TG patients after ETV operation, elucidate the radiological features of TG, and propose a treatment protocol.MethodsFrom 2002 to 2018, 50 patients that preoperative imaging manifestations were low-grade TGs were treated at our institute. Clinical features, treatments, radiologic findings, biopsies, and pertinent risk factors were evaluated.ResultsA total of 50 patients with a diagnosis of TG were identified. Twenty-six (52%) patients were males. The median age at diagnosis was 11.5 years (range 0.5–19 years). All patients had symptoms related to obstructive hydrocephalus and were treated with endoscopic third ventriculostomy (ETV). After a median follow-up duration of 59 months (range 11.0–208.0 months), progression occurred in six patients (12%), with a median PFS time of 18.0 months (range 4.0–56.0 months). Twelve patients (24%) underwent a biopsy, one patient (8.3%) was diagnosed with anaplastic oligodendroglioma, one patient (8.3%) was diagnosed with astrocytoma (WHO grade II-III), five patients (41.7%) were diagnosed with pilocytic astrocytoma, and the type of tumor could not be confirmed in five patients (41.7%) due to the small amount of tumor sample, thus, these patients were diagnosed with gliosis. PFS rates at 1 and 5 years were 91.2% ± 4.2% and 84.9% ± 5.9%, respectively. A multivariate model demonstrated that a large tumor size and cystic changes are risk factors for progression.ConclusionETV has been uniformly successful in the management of hydrocephalus caused by TG. A large tumor size and cystic changes are risk factors for progression. Under the condition of safety, a biopsy should be performed. For patients with low-grade TG, ETV is often the only surgical procedure that most patients require.HighlightsTectal gliomas are generally low-grade gliomas with a favorable prognosis.The only surgical procedure that most patients with tectal glioma require is ETV.Under the condition of safety, neuroendoscopy for a pathological diagnosis should be performed.A large tumor size and cystic changes are risk factors for progression.

Proportion of vulvar premalignant and malignant lesions in overall vulvar specimens in Thailand

BackgroundVulvar lesion is one of the common gynecologic problems.ObjectiveTo assess the proportion of vulvar premalignant and malignant lesions in overall vulvar specimens and to evaluate the clinicopathologic features of each vulvar lesion in King Chulalongkorn Memorial Hospital (KCMH).MethodsPathological microscopic slides and medical records of the patients who underwent vulvar-related operations between January 1, 2002 and December 31, 2015 were reviewed. Patients’ clinical characteristics and pathologic features were evaluated and analyzed.ResultsA total number of 700 patients were included. The proportion of malignant and premalignant lesions in overall vulvar specimens were 16.3% and 8.4%, respectively. Squamous cell carcinoma was the most common malignant vulvar lesion (48.2%), whereas vulvar intraepithelial neoplasia 1 (VIN1) (33.9%) was the most common lesion in the premalignant group. On multivariate analysis, four clinical factors were significantly associated with malignancy risk: increased parity (odds ratio [OR] 1.19, P = 0.010), large tumor size (OR 2.00, P < 0.001), lesion at clitoris (OR 16.67, P = 0.002), and erythematous lesion (OR 2.41, P = 0.026).ConclusionsThe proportion of malignant and premalignant lesions in overall vulvar specimens was 24.7% in KCMH. Increased parity, large tumor size, clitoris-located lesion, and erythematous lesion were associated with increasing malignancy risk.