Evaluation of Depth of Invasion and Tumor Thickness as a Prognostic Factor for Early-Stage Oral Squamous Cell Carcinoma: A Retrospective Study

The aim of this study was to compare the effect of using depth of invasion (DOI) versus tumor thickness (TT) as a prognostic factor for early-stage oral squamous cell carcinoma (OSCC). A total of 57 patients with early-stage OSCC treated surgically from 2009 to 2014 at our institution were reviewed retrospectively. Histopathological measurement of DOI and TT was performed. The validation of DOI and TT as prognostic factors was conducted using a Kaplan–Meier survival analysis. TT had no association with disease-specific survival (DSS) or progression-free survival (PFS) in this cohort; however, increased DOI was significantly associated with decreased DSS but not correlated to decreased PFS. The T category of the 7th edition of AJCC was statistically associated with both DSS and PFS; however, the T category of the 8th edition of the AJCC was only associated with DSS. In this study group, TT could not be used as a prognostic factor, and DOI was not by itself sufficient to predict prognosis for early-stage OSCC. The T category in AJCC 8th Edition cannot be considered the sole prognostic factor for early OSCC, so additional prognostic factors may need to be considered.

Elective neck dissection versus watchful waiting in the management of early tongue cancers with node negative neck: our experience of 68 cases

<p><strong>Background: </strong>Prognosis for tongue squamous cell carcinoma depends upon lymph node metastasis and the treatment plan depends upon the management of cervical lymph node metastasis.<strong></strong></p><p><strong>Methods: </strong>A prospective analysis of early squamous cell carcinoma oral tongue was done February 2017 to February 2020 in previously untreated and biopsy proven patients with T1-2N0 cancer of tongue and patients with clinically negative nodes on the basis of palpation, ultrasound and computerized tomography (CT) and previously untreated and biopsy proven patients with T1-2N0 cancer of oral cavity. After proper work up, patients were divided into two groups. Group 1 (n=35) patients that underwent a surgical excision of primary tumor with 15mm safe margin and selective neck dissection (level I, II, III), group 2 (n=33) patients that underwent surgical excision of primary tumor with 15 mm safe margin and neck observation. All patients with tumor thickness ≥4 mm were included in this group. </p><p><strong>Results: </strong>The study included 51 (75%) males and 17(25%) female patients. In this study, recurrence was significantly related to tumor thickness (p&lt;0.05) i.e., &gt;4 mm tumor thickness showed significantly higher local recurrence and nodal recurrences. Also, a significantly higher relationship was seen between nodal recurrence and postoperative close surgical margins (p&lt;0.05).</p><p><strong>Conclusions: </strong>Elective neck dissection becomes necessary in patients with T2N0 tumors and tumor thickness of &gt;4 mm as frequency of occult metastasis and recurrence is more in these patients.</p>

Correlations Between Visual Acuity, Presenting Symptoms and Histopathological Findings in Enucleated Eyes with Uveal Melanoma

Visual outcomes after treatment of uveal melanoma have been investigated repeatedly. In this paper, we evaluate the correlation between visual acuity (VA) prior to enucleation, presenting symptoms and findings upon histopathological examination of eyes and tumors. Sixty nine patients were included. Their mean best corrected visual acuity (BCVA) prior to enucleation was LogMAR 0.80 (SD 0.70). Patients that reported low VA or blurry vision did not have lower BCVA upon refraction (p=0.34). Patients with low BCVA had tumors with greater apical tumor thickness (p=0.027), basal diameter (p=0.012) and stage (p=0.014). The experience of a shadow in the visual field correlated with presence of vasculogenic mimicry in the tumor (p<0.001). In multivariate Cox regressions with tumor thickness and diameter as covariates, tumor cell type and infiltration of the optic nerve head were associated with increased hazard for melanoma-related mortality (3.2 and 3.6, respectively). We conclude that patients that report low VA do not necessarily have worse BCVA. The latter do however have tumors with larger dimensions, at more advanced stage. A shadow in the VF correlates with presence of vasculogenic mimicry, which is an independent predictor for poor prognosis along with tumor infiltration of the optic disc and tumor cell type.

Predictive Factors for Metastasis of Skin Melanoma of Varying Thickness According to Breslow to Sentinel Lymph Nodes

Purpose: To evaluate the prognostic factors in patients with Breslow skin melanoma of various thicknesses that affect the incidence of metastases in the signal lymph nodes (SLN).Material and methods: From November 2018 to November 2020, 324 patients with diagnosed melanoma of the skin of various localization and stages were examined and operated on. We used lymphotropic colloidal radiopharmaceutical (RPh) labeled with 99mTc. RPh with an activity of 150 MBq was administered one day before the operation intradermally around the scar of resected melanoma or peritumorally at 4 points in the case of a primary tumor. Lymphoscintigraphy was performed 1–3 hours after the RP injection on a Symbia E or Symbia E gamma camera (Siemens, Germany). Anteroposterior and lateral static polypositional scintigraphy was performed to determine the topography and mark the SLN. 324 planar studies were performed. In 259 cases, an additional study was performed SPECT (including SPECT / CT) on a Symbia T2 device (Siemens, Germany). Surgical intervention was performed the next day, taking into account the data of intraoperative radiometry using a domestic specialized hand-held gamma detector Radical (Amplituda, Russia).Results: The mean primary melanoma Breslow thickness was 2.77 ± 2.2 mm (range 0.2–13.0 mm). Localization of SLN: axillary (n = 161. 51 %), inguinal (n = 100. 31 %), cervical (n = 16. 5 %), submandibular (n = 9. 3 %), supraclavicular (n = 4. 1 %), more than one basin (n = 34. 9 %). In the group of melanomas <0.75 mm thick, no SLN metastases were found, among 0.75–1 mm melanomas, one positive lymph node with metastasis (SLN+) was found, in the largest group of melanomas of medium thickness (1–3.5 mm) — 25 (17 %). The largest percentage of metastases in SLN is determined in thick melanomas (>3.5 mm) — 17 (28 %), which is consistent with the data of foreign literature, while SLN is most often affected with a Breslow tumor thickness of more than 7 mm.In the group with negative sentinel lymph nodes (SLN–), the average tumor thickness according to Breslow was 2.6 ± 2.0 mm, in the SLN+ group — 4.0 ± 2.9 mm, the differences between the groups are statistically significant, which is confirmed by the result of one-way analysis of variance.The optimal threshold value of tumor thickness according to Breslow for the isolation of patients with a positive prognosis of metastasis in the SLN is 2.0 mm. It is characterized by the maximum levels of sensitivity (79 %) and specificity (59.1 %). An older age of patients (over 35 years old) is also associated with an increased incidence of metastases in the SLN, but this indicator is not statistically significant. Most often, SLN metastases were detected when the primary tumor was localized in the back (more often in men) and lower extremities (more often in women), while they are thicker (> 3.5 mm).Conclusion: 1. According to the ROC-analysis, the optimal threshold value of the tumor thickness according to Breslow for the isolation of patients with a positive prognosis of metastasis in the SLN is 2.0 mm. It is characterized by the maximum levels of sensitivity (79 %) and specificity (59.1 %). 2. Statistically significant prognostic factors of metastasis in SLN: localization of the primary tumor in the back (more often in men) and lower extremities (more often in women); Breslow thickness over 3.5 mm. 3. The absence of the influence of gender and age was noted, with a slight predominance of women in both groups.

Implementing CT tumor volume and CT pleural thickness into future staging systems for malignant pleural mesothelioma

Objectives Tumor thickness and tumor volume measured by computed tomography (CT) were suggested as valuable prognosticator for patients’ survival diagnosed with malignant pleural mesothelioma (MPM). The purpose was to assess the accuracy of CT scan based preoperatively measured tumor volume and thickness compared to actual tumor weight of resected MPM specimen and pathologically assessed tumor thickness, as well as an analysis of their impact on overall survival (OS). Methods Between 09/2013–08/2018, 74 patients were treated with induction chemotherapy followed by (extended) pleurectomy/decortication ((E)PD). In 53 patients, correlations were made between CT-measured volume and -tumor thickness (cTV and cTT) and actual tumor weight (pTW) based on the available values. Further cTV and pT/IMIG stage were correlated using Pearson correlation. Overall survival (OS) was calculated with Kaplan Meier analysis and tested with log rank test. For correlation with OS Kaplan-Meier curves were made and log rank test was performed for all measurements dichotomized at the median. Results Median pathological tumor volume (pTV) and pTW were 530 ml [130 ml – 1000 ml] and 485 mg [95 g – 982 g] respectively. Median (IQR) cTV was 77.2 ml (35.0–238.0), median cTT was 9.0 mm (6.2–13.7). Significant association was found between cTV and pTV (R = 0.47, p < 0.001) and between cTT and IMIG stage (p = 0,001) at univariate analysis. Multivariate regression analysis revealed, that only cTV correlates with pTV. Median follow-up time was 36.3 months with 30 patients dead at the time of the analysis. Median OS was 23.7 months. 1-year and 3-year survival were 90 and 26% respectively and only the cTV remained statistically associated with OS. Conclusion Preoperatively assessed CT tumor volume and actual tumor volume showed a significant correlation. CT tumor volume may predict pathological tumor volume as a reflection of tumor burden, which supports the integration of CT tumor volume into future staging systems.

Quantitative CT Analysis to Predict Esophageal Fistula in Patients With Advanced Esophageal Cancer Treated by Chemotherapy or Chemoradiotherapy

BackgroundEsophageal fistula is one of the most serious complications of chemotherapy or chemoradiotherapy (CRT) for advanced esophageal cancer. This study aimed to evaluate the performance of quantitative computed tomography (CT) analysis and to establish a practical imaging model for predicting esophageal fistula in esophageal cancer patients administered chemotherapy or chemoradiotherapy. MethodsThis study retrospectively enrolled 204 esophageal cancer patients (54 patients with fistula, 150 patients without fistula) and all patients were allocated to the test and validation cohorts according to the time of inclusion in a 1:1 ratio. Ulcer depth, tumor thickness and length, and minimum and maximum enhanced values for esophageal cancer were measured in pretreatment CT imaging. Logistic regression analysis was used to evaluate the associations of CT quantitative measurements with esophageal fistula. Receiver operating characteristic curve (ROC) analysis was also used. ResultsLogistic regression analysis showed that independent predictors of esophageal fistula included tumor thickness [odds ratio (OR)=1.167; p = 0.037], the ratio of ulcer depth to adjacent tumor thickness (OR=164.947; p < 0.001), and the ratio of minimum to maximum enhanced CT value (OR=0.006; p = 0.039) in the test cohort at baseline CT imaging. These predictors were used to establish a predictive model for predicting esophageal fistula, with areas under the receiver operating characteristic curves (AUCs) of 0.946 and 0.841 in the test and validation groups, respectively. ConclusionQuantitative pretreatment CT analysis has excellent performance for predicting fistula formation in esophageal cancer patients who treated by chemotherapy or chemoradiotherapy.