Computed Tomography-Based Radiomics in Predicting T Stage and Length of Esophageal Squamous Cell Carcinoma

BackgroundBecause of the superficial and infiltrative spreading patterns of esophageal squamous cell carcinoma (ESCC), an accurate assessment of tumor extent is challenging using imaging-based clinical staging. Radiomics features extracted from pretreatment computed tomography (CT) or magnetic resonance imaging have shown promise in identifying tumor characteristics. Accurate staging is essential for planning cancer treatment, especially for deciding whether to offer surgery or radiotherapy (chemotherapy) in patients with locally advanced ESCC. Thus, this study aimed to evaluate the predictive potential of contrast-enhanced CT-based radiomics as a non-invasive approach for estimating pathological tumor extent in ESCC patients.MethodsPatients who underwent esophagectomy between October 2011 and September 2017 were retrospectively studied and included 116 patients with pathologically confirmed ESCC. Contrast-enhanced CT from the neck to the abdomen was performed in all patients during the 2 weeks before the operation. Radiomics features were extracted from segmentations, which were contoured by radiologists. Cluster analysis was performed to obtain clusters with similar radiomics characteristics, and chi-squared tests were used to assess differences in clinicopathological features and survival among clusters. Furthermore, a least absolute shrinkage and selection operator was performed to select radiomics features and construct a radiomics model. Receiver operating characteristic analysis was used to evaluate the predictive ability of the radiomics signatures.ResultsAll 116 ESCC patients were divided into two groups according to the cluster analysis. The chi-squared test showed that cluster-based radiomics features were significantly correlated with T stage (p = 0.0254) and tumor length (p = 0.0002). Furthermore, CT radiomics signatures exhibited favorable predictive performance for T stage (area under the curve [AUC] = 0.86, sensitivity = 0.77, and specificity = 0.87) and tumor length (AUC = 0.95, sensitivity = 0.92, and specificity = 0.91).ConclusionsCT contrast radiomics is a simple and non-invasive method that shows promise for predicting pathological T stage and tumor length preoperatively in ESCC patients and may aid in the accurate assessments of patients in combination with the existing examinations.

Intratumoral Injection of H101 in Combination With Concurrent Chemoradiotherapy for Locally Advanced Cervical Cancer

BackgroundTo evaluate the clinical benefit of concurrent chemoradiotherapy in combination with H101 injection for the treatment of locally advanced cervical cancer (LACC) patients.MethodsThe patients, all diagnosed with stage IIB or III cervical cancer according to The International Federation of Gynecology and Obstetrics (FIGO) stage (2009) with tumor length ≥6cm were enrolled at Zhejiang Cancer Hospital from July 2015 to April 2017. All patients received concurrent chemoradiotherapy (CCRT) in combination with intratumoral H101 injection before and during external beam radiotherapy (EBRT). The parameters recorded and analyzed included progression-free survival (PFS), overall survival (OS), tumor regression after EBRT and side effects, which were compared to another group of patients with similar characteristics treated with CCRT alone.ResultsTwenty patients were treated with CCRT in combination with intratumoral H101 injection and another group of 20 patients treated with CCRT alone was selected as control. The median follow-up time was 38 months (range 10-58 months). The 3-year local, regional, and overall PFS rates were 95% vs 66.6%(p = 0.02), 95% vs 62.5%(p = 0.029), and 65% vs 43.8%(p = 0.19), for H101 group and control group respectively. The 3-year (OS) was 74.3% vs 54.5%(p = 0.098), respectively. The median reduction of tumor length and volume for H101 group and control group were 37.7% vs 28.7%(p = 0.016) and 75.1% vs 62.4%(p = 0.001), respectively. The major adverse event related to H101 was fever.ConclusionCCRT in combination with intratumoral H101 injection is effective in treating LACC, and has an acceptable safety profile.Trial registrationThe study was registered at Chinese Clinical Trail Registry (ChiCTR-OPC-15006142).

Prognostic impact of tumor length in esophageal Cancer: a systematic review and Meta-analysis

Background In clinical studies, it has been observed that esophageal cancer (EC) patient prognosis can be very different even for those patients with tumors of the same TNM stage. Tumor length has been analysed as a possible independent prognostic factor in many studies, but no unanimous conclusion has been reached. Therefore, this review used a meta-analysis to evaluate the association between tumor length and prognosis in EC patients. Methods A systematic search for relevant articles was performed in PubMed, Web of Science, and Embase. Hazard ratios (HRs) and 95% confidence intervals (CIs) were used as effective measures to estimate the correlation between tumor length and prognosis, including overall survival, disease-free survival, progression-free survival, disease-specific survival, and cancer-specific survival. STATA 15.0 software was used to perform the meta-analysis and the data synthesis. Results Finally, 41 articles with 28,973 patients were included in our study. The comprehensive statistical results showed that long tumors are an independent prognostic parameter associated with poor overall survival (OS) (HR = 1.30; 95% CI: 1.21–1.40, p < .001) and disease-free survival (DFS) (HR = 1.38; 95% CI: 1.18–1.61, p < .001) in EC patients. Subgroup analyses also suggested a significant correlation between long tumors and poor OS. Sensitivity analysis and publication bias evaluation confirmed the reliability and stability of the results. Similar results were obtained in the analyses of progression-free survival (PFS), disease-specific survival (DSS), and cancer-specific survival (CSS). Conclusion The results of this meta-analysis showed that long tumors were related to poor OS, DFS, PFS, DSS and CSS in EC patients. Tumor length might be an important predictor of prognosis in EC patients, and it can be used as an independent staging index. Further well-designed and large-scale prospective clinical studies are needed to confirm these findings.

DIAGNOSTIC ACCURACY IN RESECABLE ESOPHAGEAL CANCER

INTRODUCTION In localized oesophageal cancer (EC), a correct clinical tumor staging is essential in order to offer an optimal treatment, although often challenging. The aim of this work is to assess the accuracy of the diagnostic tests by comparing them with the pathological staging. MATERIAL AND METHODS Retrospective observational study of patients who underwent oesophagectomy for cancer in a referral hospital between January 2003 and September 2019. Those patients who received neoadjuvant treatment were excluded in order to avoid bias from dowstaging effects. The preoperative stage cT and cN as well as the combination of both (cTNM) were compared with the pathological stage of the surgical specimen (pT, pN, pTNM), considered the gold standard. Computed tomography (CT) and endoscopic ultrasound (EUS) were evaluated for cT and cN, while Positron emission tomography (PET/CT) only for cN. Furthermore, the pT stage was correlated with the tumor length described in the oesophagogram (EG). RESULTS Among the 63 patients included, the clinical staging was correct in 16 cases (global accuracy 25.4%), it was overstaged in 21 (33.2%) and understaged in 26 (41.3%). For cT staging, the accuracy of EUS was higher than that of CT (46.6% and 34.9% respectively), specially for early stages. EG tumor length correlated with pT stage (p &lt; 0.05). For cN staging, PET/CT had the highest sensitivity (50.0%) and NPV (75.0%). CONCLUSIONS Despite the multiple diagnostic tools used, the global accuracy of clinical staging in localized EC is still a challenge, with the therapeutic and prognostic implications that this entails.

Favorable intermediate risk prostate cancer with biopsy Gleason score of 6

Background To identify potential prognostic factors among patients with favorable intermediate risk prostate cancer with a biopsy Gleason score 6. Methods From 2003 to 2019, favorable intermediate risk patients who underwent radical prostatectomy were included in this study. All patients were evaluated preoperatively with MRI. Using PI-RADS scores, patients were divided into two groups, and clinic-pathological outcomes were compared. The impact of preoperative factors on significant pathologic Gleason score upgrading (≥ 4 + 3) and biochemical recurrence were assessed via multivariate analysis. Subgroup analysis was performed in patients with PI-RADS ≤ 2. Results Among the 239 patients, 116 (48.5%) were MRI-negative (PI-RADS ≤ 3) and 123 (51.5%) were MRI-positive (PI-RADS > 3). Six patients in the MRI-negative group (5.2%) were characterized as requiring significant pathologic Gleason score upgrading compared with 34 patients (27.6%) in the MRI-positive group (p < 0.001). PI-RADS score was shown to be a significant predictor of significant pathologic Gleason score upgrading (OR = 6.246, p < 0.001) and biochemical recurrence (HR = 2.595, p = 0.043). 10-years biochemical recurrence-free survival was estimated to be 84.4% and 72.6% in the MRI-negative and MRI-positive groups (p = 0.035). In the 79 patients with PI-RADS ≤ 2, tumor length in biopsy cores was identified as a significant predictor of pathologic Gleason score (OR = 11.336, p = 0.014). Conclusions Among the patients with favorable intermediate risk prostate cancer with a biopsy Gleason score 6, preoperative MRI was capable of predicting significant pathologic Gleason score upgrading and biochemical recurrence. Especially, the patients with PI-RADS ≤ 2 and low biopsy tumor length could be a potential candidate to active surveillance.

A Retrospective Study of 52 Patients With Primary Small Cell Carcinoma of the Esophagus Treated With Radical Surgery

Background: Primary small cell carcinoma of the esophagus (SCCE) is a rare and extremely fatal disease. We aim to evaluate the efficacy of radical surgery for resectable SCCE and to explore potential prognostic factors. Methods: We retrospectively reviewed 52 consecutive SCCE patients who underwent radical surgery from February 1993 to November 2014 at a single institution. The Kaplan-Meier estimator with log-rank test was used to assess overall survival (OS), disease-free survival (DFS) and median survival time. Univariate and multivariable analyses were used to evaluate prognostic factors through Cox proportional hazard regression model. Results: Twenty-five (48.1%) patients were treated with surgery alone, whereas 27 (51.9%) patients underwent adjuvant therapy after surgery. The median OS time was 17.4 months (95% CI: 13.5-21.3). The median DFS time was 13.4 months (95% CI: 7.7-19.0). Patients whose tumors were located in the lower part of thoracic esophagus and the esophagogastric junction showed significantly better OS (27.0 vs. 13.2 months, P = 0.016) and DFS (27.0 vs. 11.3 months, P = 0.017) than those located in the upper and middle parts. Patients with N0 status experienced significantly better OS (21.4 vs. 11.6 months, P = 0.012) and DFS (21.4 vs. 8.6 months, P = 0.012) than those with N+ status. Patients whose tumor lengths were shorter than 5 cm had a better OS (17.4 vs. 5.7 months, P = 0.035) than those longer than 5 cm. Patients who underwent chemotherapy experienced a significantly improved OS (21.0 vs. 14.1 months, P = 0.032) compared to surgery alone. Multivariable analysis showed that lower tumor location, shorter tumor length, pN0 status and chemotherapy independently predicted better OS; lower tumor location and pN0 status independently predicted better DFS. Conclusions: Radical surgery in combination with chemotherapy has better outcomes than surgery alone for resectable SCCE. Higher tumor location, longer tumor length, lymph node metastasis and not undergoing chemotherapy independently predict worse prognoses.

Prognostic Impact of Tumor Length in Esophageal Cancer: A Systematic Review and Meta-analysis

Background: In clinical work, it has been increasingly found that the prognosis is still very different even for esophageal cancer (EC) patients with the same TNM stage. Tumor length has been analysed as a possible independent prognostic factor in many studies, but no unanimous conclusion has been reached. Therefore, this review used a meta-analysis to evaluate the association between tumor length and prognosis in EC patients.Methods: A systematic search for relevant articles was performed in PubMed, Web of Science, and Embase. Hazard ratios (HRs) and 95% confidence intervals (CIs) were used as effective measures to estimate the correlation between tumor length and prognosis, including overall survival, disease-free survival, progression-free survival, disease-specific survival, and cancer-specific survival. STATA 15.0 software was used to perform the meta-analysis and the data synthesis.Results: Finally, 41 articles with 28,973 patients were included in our study. The comprehensive statistical results showed that long tumors are an independent prognostic parameter associated with poor overall survival (OS) (HR=1.30; 95% CI: 1.21-1.40, p<.001) and disease-free survival (DFS) (HR=1.38; 95% CI: 1.18-1.61, p<.001) in EC patients. Subgroup analyses also suggested a significant correlation between long tumors and poor OS. Sensitivity analysis and publication bias evaluation confirmed the reliability and stability of the results. Similar results were obtained in the analyses of progression-free survival (PFS), disease-specific survival (DSS), and cancer-specific survival (CSS).Conclusion: The results of this meta-analysis showed that long tumors were related to poor OS, DFS, PFS, DSS and CSS in EC patients. Tumor length might be an important predictor of prognosis in EC patients, and it can be used as an independent staging index. Further well-designed and large-scale prospective clinical studies are needed to confirm these findings.

A New Risk Score Model Based on Lactate Dehydrogenase Predicting Prognosis in Esophageal Squamous Cell Carcinoma Treated With Chemoradiotherapy

Purpose: The current study was to assess the prognostic value of the lactate dehydrogenase (LDH) in esophageal squamous cell cancer (ESCC) patients and to generate a risk score model to predict prognosis in patients who undergone chemoradiotherapy. Patients and Methods: 614 ESCC patients who received chemoradiotherapy were performed from 2012 to 2016.The optimal cutoff points for continuous variables were calculated by the X-tile program. We analyzed the association between LDH level and clinicopathological characteristics. And a 1:3 propensity score matching analysis was used to compensate for differences in baseline characteristics. The Kaplan-Meier methods and Cox regression models were used to explore the prognostic factors for overall survival (OS) and progression-free survival (PFS). Based on the results, we developed a corresponding risk score model and assessed its predictive capacity in the subgroups. Results: The optimal cutoff points of age, CEA, Cyfra21-1, tumor length, total dose and LDH were defined as follows:69 years, 2.4 ng/ml, 6.4 ng/ml, 6.5 cm, 58.8Gy and 134 U/L, respectively. A high level of LDH was associated with advanced M stage (p=0.005) and larger tumor length (p=0.026). Patients in the high-LDH group had shorter PFS and worse OS than those in the low-LDH group. Multivariate survival analysis indicated that pretreatment serum LDH level (p=0.039)，Cyfra21-1 level (p=0.003), tumor length (p=0.013), clinical N stage (p=0.047) and clinical M stage (p=0.011) were independent predictors for OS. Furthermore, a risk score model based on these five prognostic factors was established to divide patients into three groups with obvious prognosis (χ2 = 20.53, p< 0.0001). Conclusion: Pretreatment serum LDH levels may be a reliable factor in predicting the therapeutic effect of chemoradiotherapy in ESCC. A risk score model combined LDH, Cyfra21-1 and other prognostic factors could help to guide a personalized management. Further validation is needed before widely used in clinical practice.

Web-based Prostate Visualization Tool

Proper treatment of prostate cancer is essential to increase the survival chance. In this sense, numerous studies show how important the communication between all stakeholders in the clinic is. This communication is difficult because of the lack of conventions while referring to the location where a biopsy for diagnosis was taken. This becomes even more challenging taking into account that experts of different fields work on the data and have different requirements. In this paper a web-based communication tool is proposed that incorporates a visualization of the prostate divided into 27 segments according to the PI-RADS protocol. The tool provides 2 working modes that consider the requirements of radiologist and pathologist while keeping it consistent. The tool comprises all relevant information given by pathologists and radiologists, such as, severity grades of the disease or tumor length. Everything is visualized using a colour code for better undestanding.