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Zhang XQ, Miao CW, Liu LP, Wang CL, Chen JZ, Li WH, Hu XD. The prognostic value of 11 th Japanese classification and 8 th AJCC staging systems in Chinese patients with esophageal squamous cell carcinoma. J Cardiothorac Surg 2023; 18:251. [PMID: 37612706 PMCID: PMC10463410 DOI: 10.1186/s13019-023-02350-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/09/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Two staging systems, the 8th staging system by the American Joint Committee on Cancer (AJCC) and the 11th Japanese classification by Japan Esophageal Society (JES), are currently applied in the clinic for predicting the prognosis of patients with esophageal squamous cell carcinoma (ESCC). The differences between the two staging systems have been widely researched. However, little studies focus on the differences in specific staging between the two systems. Therefore, we aimed to compare the performance of different staging in predicting overall survival (OS) of Chinese patients with ESCC. METHODS This retrospective study included 268 patients who underwent radical esophagectomy and mediastinal lymph node dissection for ESCC between January 2008 and December 2013. Patients were staged by the 8th AJCC and 11th JES staging systems. OS was estimated using the Kaplan-Meier method and compared between N stages and between stage groupings using the log-rank test. Cox proportional hazards regression analysis was performed to identify factors independently related to outcome. Further, we compared the concordance indexes (C-indexes) of the two staging systems. RESULTS The mean age was 61.25 ± 7.056 years, median follow-up was 44.82 months, and 5-year OS rate was 47%. The OS was well predicted by the 8th AJCC N staging (P < 0.001) and the 11th JES N staging (P < 0.001), with a c-index of 0.638 (95% CI: 0.592-0.683) for AJCC N staging and 0.627 (95% CI: 0.583-0.670) for JES N staging (P = 0.13). In addition, the OS was also well predicted by stage groupings of the 8th AJCC (P < 0.001) and the 11th JES systems (P < 0.001), with a c-index of 0.658 (95% CI: 0.616-0.699) for 8th AJCC stage grouping and 0.629 (95% CI: 0.589-0.668) for the11th JES stage grouping (P = 0.211). CONCLUSIONS The prognostic effect of 11th JES staging system is comparable with that of AJCC 8th staging system for patients with ESCC. Therefore, both systems are applicable to clinical practice.
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Affiliation(s)
- Xi-Qin Zhang
- Shandong First Medical University, Jinan, 250000, Shandong, China
- Department of Radiotherapy, Xingning People's Hospital, Xingning, 514599, Guangdong, China
| | - Chuan-Wang Miao
- Shandong First Medical University, Jinan, 250000, Shandong, China
- Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China
| | - Lan-Pin Liu
- Shandong First Medical University, Jinan, 250000, Shandong, China
- Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China
| | - Cun-Liang Wang
- Shandong First Medical University, Jinan, 250000, Shandong, China
- Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China
| | - Jia-Zhen Chen
- Shandong First Medical University, Jinan, 250000, Shandong, China
- Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China
| | - Wan-Hu Li
- Shandong First Medical University, Jinan, 250000, Shandong, China
- Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China
| | - Xu-Dong Hu
- Shandong First Medical University, Jinan, 250000, Shandong, China.
- Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China.
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Emile SH, Silva-Alvarenga E, Horesh N, Freund MR, Garoufalia Z, Wexner SD. Concordance between clinical and pathologic assessment of T and N stages of rectal adenocarcinoma patients who underwent surgery without neoadjuvant therapy: A National Cancer Database analysis. Eur J Surg Oncol 2023; 49:426-432. [PMID: 36257901 DOI: 10.1016/j.ejso.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/01/2022] [Accepted: 09/21/2022] [Indexed: 10/07/2022]
Abstract
BACKGROUND Clinical assessment of T and N stages in rectal cancer is important to guide decision-making. The present study aimed to assess the accuracy of the clinical T and N staging of rectal cancer compared to the pathological staging and their overall agreement in a large cohort of patients. METHODS This retrospective study used data from the National Cancer Database (NCDB) between 2004 and 2017. Patients with non-metastatic rectal adenocarcinoma who did not receive neoadjuvant therapy were reviewed and the clinical T and N stages were compared to their pathologic counterparts. The overall concordance between clinical and pathologic assessments was calculated using Kappa coefficient. RESULTS The study included 8929 patients (57.3% male) with a mean age of 64 years. Clinical T stage and N stage were identical to pathologic stages in 70.3% and 77.6% of patients, respectively. Sensitivity and specificity of the clinical assessment of N stage was 35.2% and 95.5%, respectively. Concordance between the clinical and pathologic stages was moderate for the T stage (kappa = 0.575) and fair for the N stage (kappa = 0.346). Pathologic T4 stage (OR: 2.12, p < 0.0001), poorly differentiated adenocarcinoma (OR: 1.45, p = 0.026), lymphovascular invasion (OR: 4.5, p < 0.001), and longer time from diagnosis to first treatment (OR = 0.996, p = 0.046) were the independent predictors of N stage discrepancy. CONCLUSIONS There was a moderate agreement between the clinical and pathologic T stages and a fair agreement between the clinical and pathologic N stages. The clinical assessment of the N stage was highly specific yet had low sensitivity.
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Affiliation(s)
- Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA; Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt
| | - Emanuela Silva-Alvarenga
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA
| | - Nir Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA; Department of Surgery and Transplantation, Sheba Medical Center, Ramat Gan, Tel Aviv University, Tel Aviv, Israel
| | - Michael R Freund
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA; Department of General Surgery, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA.
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Zhang J, Teng X, Lam S, Sun J, Cheung AL, Ng SC, Lee FK, Au KH, Yip CW, Lee VH, Lin Z, Liang Y, Yang R, Han Y, Zhang Y, Kong FS, Cai J. Quantitative Spatial Characterization of Lymph Node Tumor for N Stage Improvement of Nasopharyngeal Carcinoma Patients. Cancers (Basel) 2022; 15. [PMID: 36612236 DOI: 10.3390/cancers15010230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023] Open
Abstract
This study aims to investigate the feasibility of improving the prognosis stratification of the N staging system of Nasopharyngeal Carcinoma (NPC) from quantitative spatial characterizations of metastatic lymph node (LN) for NPC in a multi-institutional setting. A total of 194 and 284 NPC patients were included from two local hospitals as the discovery and validation cohort. Spatial relationships between LN and the surrounding organs were quantified by both distance and angle histograms, followed by principal component analysis. Independent prognostic factors were identified and combined with the N stage into a new prognostic index by univariate and multivariate Cox regressions on disease-free survival (DFS). The new three-class risk stratification based on the constructed prognostic index demonstrated superior cross-institutional performance in DFS. The hazard ratios of the high-risk to low-risk group were 9.07 (p < 0.001) and 4.02 (p < 0.001) on training and validation, respectively, compared with 5.19 (p < 0.001) and 1.82 (p = 0.171) of N3 to N1. Our spatial characterizations of lymph node tumor anatomy improved the existing N-stage in NPC prognosis. Our quantitative approach may facilitate the discovery of new anatomical characteristics to improve patient staging in other diseases.
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Wang W, Ding Y, Jiang W, Li X. Can Cervical Lymph Node Metastasis Increase the Risk of Distant Metastasis in Papillary Thyroid Carcinoma? Front Endocrinol (Lausanne) 2022; 13:917794. [PMID: 35813656 PMCID: PMC9263207 DOI: 10.3389/fendo.2022.917794] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/20/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Distant metastasis (DM) is a rare event and has a negative effect on the prognosis for papillary thyroid carcinoma (PTC). The relationship between cervical lymph node metastasis and DM is complicated and unclear. This study aimed to evaluate the impact of N stage subclassification on different distant metastasis sites based on age stratification, especially for patients with papillary thyroid microcarcinoma. METHODS A total of 28,712 patient with PTC cases between 2010 and 2018 were extracted from the Surveillance, Epidemiology, and End Results database. Multivariable logistic regression analysis was utilized to adjust for confounding variables. Risk stratification, including positive lymph node number and lymph node ratio, was established by receiver operating characteristic curves to help predict DM. RESULTS Lung was the most common metastatic site regardless of N0, N1a disease, or N1b disease. As the N stage increased, the higher the rate of DM identified. After age stratification, only N1b disease significantly increased the risk of lung metastasis (LM; odds ratio, OR = 20.45, P < 0.001) rather than bone metastasis (BM; OR = 3.46, P > 0.05) in younger patients. However, in older patients, N1b disease significantly increased the risk of both LM (OR = 4.10, P < 0.001) and BM (OR = 2.65, P = 0.007). In patients with papillary thyroid microcarcinoma (PTMC), N1a disease did not increase the risk of DM, LM, and BM compared with N0 disease (P > 0.05). Furthermore, combined N stage with risk stratification has well performance in predicting DM (area under the curve, AUC = 0.761). Similar results were shown in PTC patients with LM (AUC = 0.770) and BM (AUC = 0.729). CONCLUSION Overall, the incidence of DM significantly increased with the progress of N disease after age stratification. N1a disease did not increase the risk of DM in PTMC patients, regardless of LM or BM. Combined N stage with risk stratification may be beneficial for DM prediction.
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Affiliation(s)
- Wenlong Wang
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Ying Ding
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Wei Jiang
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Wei Jiang, ; Xinying Li,
| | - Xinying Li
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Wei Jiang, ; Xinying Li,
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Zhou W, Yue Y. Developing and Validating Novel Nomograms for Predicting the Overall Survival and Cancer-Specific Survival of Patients With Primary Vulvar Squamous Cell Cancer. Front Med (Lausanne) 2021; 8:777605. [PMID: 34926520 PMCID: PMC8678051 DOI: 10.3389/fmed.2021.777605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/01/2021] [Indexed: 11/18/2022] Open
Abstract
Background: To develop and validate novel nomograms for better predicting the overall survival (OS) and cancer-specific survival (CSS) of patients with vulvar squamous cell cancer (VSCC). Methods: A retrospective analysis using a population-based database between 2004 and 2016 was carried. A 10-fold cross-validation with 200 repetitions was used to choose the best fit multivariate Cox model based on the net-benefit of decision curve analysis. Net-benefit, Harrell's C concordance statistic (C-statistic) of calibration plot, and area under the receiver operating characteristic curve (AUC) were used to evaluate the model prediction accuracy. Nomograms of the OS and CSS were generated based on the best fit model. Results: Of the 6,792 patients with VSCC, 5,094 (75%) and 1,698 (25%) were allocated to the training and validation cohort, respectively. All the variables were balanced between the training and validation cohorts. Age, insurance, tumor size, pathological grade, radiotherapy, chemotherapy, invasion depth, lymphadenectomy, sentinel lymph nodes biopsy, surgery, N stage, and M stage were in the best fit model for generating nomograms. The decision curve analysis, calibration plot, and receiver operating characteristic (ROC) curve show the better prediction performance of the model compared to previous studies. The C-statistics of our model for OS prediction are 0.80, 0.83, and 0.81 in the training, validation, and overall cohorts, respectively, while for CSS prediction are 0.83, 0.85, and 0.84. The AUCs for 3- and 5-year OS are the same and are 0.81, 0.83, and 0.81 in the training, validation, and overall cohorts, respectively. The AUCs for 3- and 5-year CSS are 0.78 and 0.80, 0.79 and 0.80, and 0.79 and 0.80 in those three cohorts. Conclusions: Our model shows the best prediction accuracy of the OS and CSS for patients with vulvar cancer (VC), which is of significant clinical practice value.
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Affiliation(s)
- Weili Zhou
- Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang, China
| | - Yangyang Yue
- Department of Health Management, Shengjing Hospital, China Medical University, Shenyang, China
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Desiderio J, Sagnotta A, Terrenato I, Garofoli E, Mosillo C, Trastulli S, Arteritano F, Tozzi F, D'Andrea V, Fong Y, Woo Y, Bracarda S, Parisi A. Long-term survival of patients with stage II and III gastric cancer who underwent gastrectomy with inadequate nodal assessment. World J Gastrointest Surg 2021; 13:1463-1483. [PMID: 34950434 PMCID: PMC8649557 DOI: 10.4240/wjgs.v13.i11.1463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/30/2021] [Accepted: 10/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastric cancer is an aggressive disease with frequent lymph node (LN) involvement. The NCCN recommends a D2 lymphadenectomy and the harvesting of at least 16 LNs. This threshold has been the subject of great debate, not only for the extent of surgery but also for more appropriate staging. The reclassification of stage IIB through IIIC based on N3b nodal staging in the eighth edition of the American Joint Committee on Cancer (AJCC) staging system highlights the efforts to more accurately discriminate survival expectancy based on nodal number. Furthermore, studies have suggested that pathologic assessment of 30 or more LNs improve prognostic accuracy and is required for proper staging of gastric cancer.
AIM To evaluate the long-term survival of advanced gastric cancer patients who deviated from expected survival curves because of inadequate nodal evaluation.
METHODS Eligible patients were identified from the Surveillance, Epidemiology, and End Results database. Those with stage II–III gastric cancer were considered for inclusion. Three groups were compared based on the number of analyzed LNs. They were inadequate LN assessment (ILA, < 16 LNs), adequate LN assessment (ALA, 16-29 LNs), and optimal LN assessment (OLA, ≥ 30 LNs). The main outcomes were overall survival (OS) and cancer-specific survival. Data were analyzed by the Kaplan-Meier product-limit method, log-rank test, hazard risk, and Cox proportional univariate and multivariate models. Propensity score matching (PSM) was used to compare the ALA and OLA groups.
RESULTS The analysis included 11607 patients. Most had advanced T stages (T3 = 48%; T4 = 42%). The pathological AJCC stage distribution was IIA = 22%, IIB = 18%, IIIA = 26%, IIIB = 22%, and IIIC = 12%. The overall sample divided by the study objective included ILA (50%), ALA (35%), and OLA (15%). Median OS was 24 mo for the ILA group, 29 mo for the ALA group, and 34 mo for the OLA group (P < 0.001). Univariate analysis showed that the ALA and OLA groups had better OS than the ILA group [ALA hazard ratio (HR) = 0.84, 95% confidence interval (CI): 0.79–0.88, P < 0.001 and OLA HR = 0.73, 95%CI: 0.68–0.79, P < 0.001]. The OS outcome was confirmed by multivariate analysis (ALA HR = 0.68, 95%CI: 0.64–0.71, P < 0.001 and OLA: HR = 0.48, 95%CI: 0.44–0.52, P < 0.001). A 1:1 PSM analysis in 3428 patients found that the OLA group had better survival than the ALA group (OS: OLA median = 34 mo vs ALA median = 26 mo, P < 0.001, which was confirmed by univariate analysis (HR = 0.81, 95%CI: 0.75–0.89, P < 0.001) and multivariate analysis: (HR = 0.71, 95%CI: 0.65–0.78, P < 0.001).
CONCLUSION Proper nodal staging is a critical issue in gastric cancer. Assessment of an inadequate number of LNs places patients at high risk of adverse long-term survival outcomes.
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Affiliation(s)
- Jacopo Desiderio
- Department of Digestive Surgery, St. Mary’s Hospital, Terni 05100, Italy
- Department of Surgical Sciences, Sapienza University of Rome, Rome 00161, Italy
| | - Andrea Sagnotta
- Department of General Surgery and Surgical Oncology, San Filippo Neri Hospital, Rome 00135, Italy
| | - Irene Terrenato
- Biostatistics and Bioinformatic Unit, Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Eleonora Garofoli
- Department of Medical Oncology, St. Mary’s Hospital, Terni 05100, Italy
| | - Claudia Mosillo
- Department of Medical Oncology, St. Mary’s Hospital, Terni 05100, Italy
| | - Stefano Trastulli
- Department of Digestive Surgery, St. Mary’s Hospital, Terni 05100, Italy
| | | | - Federico Tozzi
- Division of Surgical Oncology and Endocrine Surgery, Mays Cancer Center, University of Texas Health Science Center San Antonio, San Antonio, TX 78229, United States
| | - Vito D'Andrea
- Department of Surgical Sciences, Sapienza University of Rome, Rome 00161, Italy
| | - Yuman Fong
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, LA, 91010, United States
| | - Yanghee Woo
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, LA, 91010, United States
| | - Sergio Bracarda
- Department of Medical Oncology, St. Mary’s Hospital, Terni 05100, Italy
| | - Amilcare Parisi
- Department of Digestive Surgery, St. Mary’s Hospital, Terni 05100, Italy
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Bai Y, Rong L, Hu B, Ma X, Wang J, Chen H. The Combination of T Stage and the Number of Pathologic Lymph Nodes Provides Better Prognostic Discrimination in Early-Stage Cervical Cancer With Lymph Node Involvement. Front Oncol 2021; 11:764065. [PMID: 34804967 PMCID: PMC8602848 DOI: 10.3389/fonc.2021.764065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Stage I and II cervical cancer with pelvic and/or para-aortic lymph node (LN) metastases are upstaged to stage IIIC under the new FIGO 2018 staging system, and radical chemoradiotherapy was recommended. But heterogeneity in outcome existed in this group of patients. We conducted this retrospective analysis to evaluate the heterogeneity of these patients and tried to provide a more detailed classification to reflect the prognosis and guide the treatment. We also evaluated the efficacy and toxicity of surgery followed by sequential chemoradiotherapy in this cohort. Methods Early-stage cervical cancer with LN involvement that had radical hysterectomy followed by sequential chemoradiotherapy were retrospectively analyzed. Survival analyses were conducted to identify the prognostic factors. Results A total of 242 patients were included in the study; 64 (26.4%) patients had treatment failure, and 51 (21.1%) died. Pathology, T stage, the number of pathologic LN (pLN), and neoadjuvant chemotherapy or not were independent prognostic factors for disease-free survival and overall survival (OS). Patients with T1N < 3 pLN had significantly better survival than T2N < 3 pLN/T1-2 N≥ 3 pLN, with failure rates of 11.6% and 35.8% in each group; and 5 year OS was 92% and 62%, respectively (P = 0.000). About 1.5% of the patients discontinued radiotherapy, and 14.1% had G3-4 hematological toxic effects during radiotherapy; 1.7% developed G2-3 lower limb edema, and 2.9% developed severe urinary toxicity. Conclusion Nodal involvement alone is inadequate as the sole pathologic factor to predict survival in early-stage cervical cancer. The combination of tumor and node subcategory provides better prognostic discrimination.
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Affiliation(s)
- Yongrui Bai
- Department of Radiation Oncology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Ling Rong
- Department of Radiation Oncology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Bin Hu
- Department of Radiation Oncology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xiumei Ma
- Department of Radiation Oncology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Jiahui Wang
- Department of Radiation Oncology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Haiyan Chen
- Department of Radiation Oncology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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Yang YH, Kim HE, Park BJ, Lee S, Park SY, Lee CY, Kim DJ, Paik HC, Lee JG. Positive nodal status is still a risk factor for long-term survivors of non-small cell lung cancer 5 years after complete resection. J Thorac Dis 2021; 13:5826-5834. [PMID: 34795931 PMCID: PMC8575849 DOI: 10.21037/jtd-21-854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/13/2021] [Indexed: 12/25/2022]
Abstract
Background Lung cancer has a poor prognosis; the number of long-term survivors (LTSs) is small compared with that of other cancers. Few studies have focused on late recurrence in LTSs with lung cancer. The purpose of this study was to analyze the risk factors for survival and late recurrence in LTSs after disease-free period of 5 years. Methods A retrospective analysis of patients with a disease-free survival of at least 5 years after surgical resection for non-small cell lung cancer (NSCLC) between January 1998 and December 2012 was conducted. Patients who underwent neo-adjuvant therapy, had an incomplete resection, or had advanced stage (stages IIIb and IV) cancer were excluded. Results A total of 1,254 (53.2%) of 2,357 patients were enrolled. Of these, 759 (60.5%) were men, and the mean patient age was 61.9±10.1 (range, 10-87 years) years. Pathologic N0 (997 patients, 79.5%) and stage I (860 patients, 68.6%) were the dominant stages. Late recurrence occurred in 22 patients (1.8%) 5 years postoperatively. On multivariate analysis, male sex, older age, node-positive status, and late recurrence were found to be independent risk factors for overall survival (OS), while a node-positive status was the only independent risk factor for disease-free survival [hazard ratio (HR) =3.824; P=0.002; 95% confidence interval (CI): 1.658-8.821]. Conclusions The nodal stage at the time of surgical resection was found to be an independent risk factor for both OS and disease-free survival 5 years after initial treatment in patients with completely resected NSCLC.
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Affiliation(s)
- Young Ho Yang
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ha Eun Kim
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung Jo Park
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seokkee Lee
- Department of Cardiovascular and Thoracic Surgery, Cheongju St. Mary's Hospital, Catholic University of Korea, Cheongju, Republic of Korea
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chang Young Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dae Joon Kim
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyo Chae Paik
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Gu Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Kim HK. What Should Thoracic Surgeons Consider during Surgery for Ground-Glass Nodules?: Lymph Node Dissection. J Chest Surg 2021; 54:342-347. [PMID: 34611082 PMCID: PMC8548189 DOI: 10.5090/jcs.21.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/11/2021] [Accepted: 09/02/2021] [Indexed: 11/16/2022] Open
Abstract
Thoracic surgeons need to be aware of several important points regarding intraoperative lymph node dissection during surgery for non-small cell lung cancer with ground-glass opacities. The first point relates to the need for lymph node dissection during sublobar resection. Since even patients undergoing sublobar resection may benefit from lymph node dissection, it should be selectively performed according to adequate indications, which require further study. Second, there seems to be no difference in postoperative morbidity between systematic sampling and systematic dissection, but the survival benefit from systematic dissection remains unclear. The results of randomized controlled trials on this topic are conflicting, and their evidence is jeopardized by a high risk of bias in terms of the study design. Therefore, further randomized controlled trials with a sound design should investigate this issue. Third, more favorable survival outcomes tend to be positively associated with the number of examined lymph nodes. Minimum requirements for the number of examined lymph nodes in non-small cell lung cancer should be defined in the future. Finally, lobe-specific lymph node dissection does not have a negative prognostic impact. It should not be routinely performed, but it can be recommended in selected patients with smaller, less invasive tumors. Results from an ongoing randomized controlled trial on this topic should be awaited.
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Affiliation(s)
- Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Liu Q, Li J, Xin B, Sun Y, Feng D, Fulham MJ, Wang X, Song S. 18F-FDG PET/CT Radiomics for Preoperative Prediction of Lymph Node Metastases and Nodal Staging in Gastric Cancer. Front Oncol 2021; 11:723345. [PMID: 34589429 PMCID: PMC8474469 DOI: 10.3389/fonc.2021.723345] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/19/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The accurate assessment of lymph node metastases (LNMs) and the preoperative nodal (N) stage are critical for the precise treatment of patients with gastric cancer (GC). The diagnostic performance, however, of current imaging procedures used for this assessment is sub-optimal. Our aim was to investigate the value of preoperative 18F-FDG PET/CT radiomic features to predict LNMs and the N stage. METHODS We retrospectively collected clinical and 18F-FDG PET/CT imaging data of 185 patients with GC who underwent total or partial radical gastrectomy. Patients were allocated to training and validation sets using the stratified method at a fixed ratio (8:2). There were 2,100 radiomic features extracted from the 18F-FDG PET/CT scans. After selecting radiomic features by the random forest, relevancy-based, and sequential forward selection methods, the BalancedBagging ensemble classifier was established for the preoperative prediction of LNMs, and the OneVsRest classifier for the N stage. The performance of the models was primarily evaluated by the AUC and accuracy, and validated by the independent validation methods. Analysis of the feature importance and the correlation were also conducted. We also compared the predictive performance of our radiomic models to that with the contrast-enhanced CT (CECT) and 18F-FDG PET/CT. RESULTS There were 185 patients-127 men, 58 women, with the median age of 62, and an age range of 22-86 years. One CT feature and one PET feature were selected to predict LNMs and achieved the best performance (AUC: 82.2%, accuracy: 85.2%). This radiomic model also detected some LNMs that were missed in CECT (19.6%) and 18F-FDG PET/CT (35.7%). For predicting the N stage, four CT features and one PET feature were selected (AUC: 73.7%, accuracy: 62.3%). Of note, a proportion of patients in the validation set whose LNMs were incorrectly staged by CECT (57.4%) and 18F-FDG PET/CT (55%) were diagnosed correctly by our radiomic model. CONCLUSION We developed and validated two machine learning models based on the preoperative 18F-FDG PET/CT images that have a predictive value for LNMs and the N stage in GC. These predictive models show a promise to offer a potentially useful adjunct to current staging approaches for patients with GC.
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Affiliation(s)
- Qiufang Liu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiaru Li
- School of Computer Science, The University of Sydney, Sydney, NSW, Australia
| | - Bowen Xin
- School of Computer Science, The University of Sydney, Sydney, NSW, Australia
| | - Yuyun Sun
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Dagan Feng
- School of Computer Science, The University of Sydney, Sydney, NSW, Australia
| | - Michael J. Fulham
- School of Computer Science, The University of Sydney, Sydney, NSW, Australia
- Department of Molecular Imaging, Royal Prince Alfred Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Xiuying Wang
- School of Computer Science, The University of Sydney, Sydney, NSW, Australia
| | - Shaoli Song
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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11
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Mou A, Li H, Chen XL, Fan YH, Pu H. Tumor size measured by multidetector CT in resectable colon cancer: correlation with regional lymph node metastasis and N stage. World J Surg Oncol 2021; 19:179. [PMID: 34134714 PMCID: PMC8210336 DOI: 10.1186/s12957-021-02292-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/04/2021] [Indexed: 01/22/2023] Open
Abstract
Background Lymph node metastasis (LNM) is a risk factor for poor long-term outcomes and a prognostic factor for disease-free survival in colon cancer. Preoperative lymph node status evaluation remains a challenge. The purpose of this study is to determine whether tumor size measured by multidetector computed tomography (MDCT) could be used to predict LNM and N stage in colon cancer. Material and methods One hundred six patients with colon cancer who underwent radical surgery within 1 week of MDCT scan were enrolled. Tumor size including tumor length (Tlen), tumor maximum diameter (Tdia), tumor maximum cross-sectional area (Tare), and tumor volume (Tvol) were measured to be correlated with pathologic LNM and N stage using univariate logistic regression analysis, multivariate logistic analysis, and receiver operating characteristic (ROC) curve analysis. Results The inter- and intraobserver reproducibility of Tlen (intraclass correlation coefficient [ICC] = 0.94, 0.95, respectively), Tdia (ICC = 0.81, 0.93, respectively), Tare (ICC = 0.97, 0.91, respectively), and Tvol (ICC = 0.99, 0.99, respectively) parameters measurement are excellent. Univariate logistic regression analysis showed that there were significant differences in Tlen, Tdia, Tare, and Tvol between positive and negative LNM (p < 0.001, 0.001, < 0.001, < 0.001, respectively). Multivariate logistic regression analysis revealed that Tvol was independent risk factor for predicting LNM (odds ratio, 1.082; 95% confidence interval for odds ratio, 1.039, 1.127, p<0.001). Tlen, Tdia, Tare, and Tvol could distinguish N0 from N1 stage (p < 0.001, 0.041, < 0.001, < 0.001, respectively), N0 from N2 (all p < 0.001), N0 from N1-2 (p < 0.001, 0.001, < 0.001, < 0.001, respectively), and N0-1 from N2 (p < 0.001, 0.001, < 0.001, < 0.001, respectively). The area under the ROC curve (AUC) was higher for Tvol than that of Tlen, Tdia, and Tare in identifying LNM (AUC = 0.83, 0.82, 0.69, 0.79), and distinguishing N0 from N1 stage (AUC = 0.79, 0.78, 0.63, 0.74), N0 from N2 stage (AUC = 0.92, 0.89, 0.80, 0.89, respectively), and N0-1 from N2 stage (AUC = 0.84, 0.79, 0.76, 0.83, respectively). Conclusion Tumor size was correlated with regional LNM in resectable colon cancer. In particularly, Tvol showed the most potential for noninvasive preoperative prediction of regional LNM and N stage.
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Affiliation(s)
- Anna Mou
- Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, 32# Second Section of First Ring Rd, Qingyang District, Chengdu, 610072, China.,Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China
| | - Hang Li
- Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, 32# Second Section of First Ring Rd, Qingyang District, Chengdu, 610072, China. .,Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China.
| | - Xiao-Li Chen
- Department of Radiology, Sichuan Cancer Hospital, Chengdu, 610072, China
| | - Yang-Hua Fan
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100032, China
| | - Hong Pu
- Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, 32# Second Section of First Ring Rd, Qingyang District, Chengdu, 610072, China.,Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China
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12
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Wu J, Li L, Chen J, Liu Y, Xu J, Peng Z. Clinical value of CTLA4 combined with clinicopathological factors in evaluating the prognosis of breast cancer. Gland Surg 2020; 9:1328-1337. [PMID: 33224807 DOI: 10.21037/gs-20-359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Clinical prediction of breast cancer prognosis relies on both clinical-pathological features and biological markers. Many studies have revealed that tumor cytotoxic T lymphocyte antigen 4 (CTLA4) expression may present prognostic predicting value in cancers. We intended to explore the prognostic value of significant clinicopathological parameters and CTLA4 for predicting survival of patients with breast cancer. Methods A total of 229 breast cancer patients who had radical surgery treatment between Sep 2009 and April 2011 were enrolled in this study. Immunohistochemical staining was performed to evaluate CTLA4 grade and Ki-67 index in breast cancer tissue. Univariate and multivariate logistic analysis, Kaplan-Meier survival analysis and ROC curve were used to explore the association between CTLA4 or clinicopathological parameters and disease-free survival (DFS). A nomogram was constructed based on the regression model to predict DFS of patients with breast cancer. Results CTLA4 grade (OR 1.730, 95% CI: 1.213-2.468, P=0.002), Ki-67 (OR 1.449, 95% CI: 1.069-1.964, P=0.017) and N stage (lymph node metastasis) (OR 2.268, 95% CI: 1.588-3.303, P=0.000) showed significantly association with DFS of breast cancer patients. All these factors were independent predictors for poor survival, as patients with stage N2-3 tumors, high CTLA4 grade and Ki-67 index showed low survival probability (P<0.01). The conjunction of these factors exhibited good discrimination value (AUC 0.815, 95% CI: 0.749-0.882, P=0.000). Nomogram performed based on CTLA4 grade, Ki-67 index and N stage provided an efficient method to predict DFS of patients with breast cancer. Conclusions The high expression of CTLA4 and Ki-67 together with lymph node metastasis in breast cancer are independent risk factors that affect the prognosis of breast cancer patients. They have the potentiality to be utilized conjunctively as predictor in clinical practice.
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Affiliation(s)
- Junyi Wu
- Department of General Surgery, Shanghai General Hospital of Nanjing Medical University, Shanghai, China
| | - Lei Li
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayi Chen
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Liu
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junming Xu
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhihai Peng
- Department of General Surgery, Shanghai General Hospital of Nanjing Medical University, Shanghai, China
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13
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Zhu J, Wang W, Xu S, Jia C, Zhang Q, Xia Y, Wang W, Wen M, Wang X, Wang H, Zhang Z, Cai L, Zhang L, Jiang T. Evaluation of the Effect of Lymph Node Status on the Survival of Non-Small Cell Lung Cancer Patients With Brain Metastases: Applications of a Novel Grade Prognostic Assessment Score Model Involving N Stage. Front Oncol 2020; 10:563700. [PMID: 33194635 PMCID: PMC7604417 DOI: 10.3389/fonc.2020.563700] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/25/2020] [Indexed: 12/25/2022] Open
Abstract
Background Grade prognostic assessment (GPA) is widely used to evaluate the prognosis of non-small cell lung cancer (NSCLC) patients with brain metastases (BMs). This study aimed to investigate whether lymph node status (LNS) could be included as one of the GPA variables for NSCLC with BMs. Methods Overall, 586 patients with NSCLC and BMs were retrospectively analyzed. Overall survival stratified by LNS was analyzed using the Kaplan-Meier method. Multivariate analysis was also performed to identify independent prognostic factors using the Cox proportional hazards progression model. In the updated GPA index, prognostic factors and criteria of GPA score were weighted by effect magnitude relative risk (RR) and statistical significance. Results In NSCLC patients with BMs, those with lymph node involvement had worse overall survival (mOS, 13.4 months vs. 25.9 months, P <0.001) than those without lymph node involvement. Multivariate analysis showed that LNS might be an independent prognostic factor (RR: 1.702, CI: 1.340–2.162, P <0.001). Finally, five prognostic factors including LNS, the age of the patient, Karnofsky performance status (KPS), the number of BMs, and extracranial metastases were enrolled in our novel GPA index. With the updated GPA index involving the N stage, survival analysis was also performed. Prognostic results were significantly different among these four subgroups (Class A vs. Class B, P=0.047; Class B vs. Class C, P<0.001; Class C vs. Class D, P=0.007). Conclusions These results indicate that LNS might be an indispensable prognostic factor in NSCLC with BM. The novel GPA model involving the N stage could provide more reliable evidence to estimate the survival of NSCLC patients with BMs.
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Affiliation(s)
- Jianfei Zhu
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, China.,Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Thoracic Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Wuping Wang
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Shuonan Xu
- Department of Thoracic Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Chenghui Jia
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Qingqing Zhang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Yanmin Xia
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Wenchen Wang
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Miaomiao Wen
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Xuejiao Wang
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Hongtao Wang
- Department of Thoracic Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Zhipei Zhang
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Ling Cai
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Lanjun Zhang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Tao Jiang
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, China
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Ishihara S, Horiguchi A, Endo I, Wakaki T, Hirano S, Yamaue H, Yamamoto M. Prognostic impact of the number of metastatic lymph nodes in distal bile duct cancer: An analysis of Japanese registration cases by the study group for biliary surgery of the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci 2020; 27:396-401. [PMID: 32128955 DOI: 10.1002/jhbp.730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 02/12/2020] [Accepted: 02/25/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Lymph node metastasis is an important prognostic factor for distal bile duct cancer. The number of lymph node metastases was adopted for nodal classification. However, different cutoff values have been proposed, ranging from two to five. METHODS A total of 1748 cases who underwent curative surgery with pancreatoduodenectomy for distal bile duct cancer registered in the nationwide biliary tract cancer registry in Japan from 2008 to 2013 were included. Univariate Cox regression was performed to assess the effect of prognostic lymph node metastasis counts on mortality and to determine cutoff values. RESULTS The overall survival rate after resection was 47.4% at 5 years. Univariate and multivariate analysis found prognostic factors to include lymph node metastasis. The cutoff point was set to two lymph node metastases using the Cox model. There were significant differences in pairwise comparisons between three groups by the number of metastatic lymph node (P < .001 for 0 vs 1-2 and P = .003 for 1-2 vs ≥3). CONCLUSION Our data suggest lymph node classification as N0 (patients without lymph node metastases), N1 (metastasis in 1-2 regional lymph nodes), and N2 (metastases in ≥3 regional lymph nodes).
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Affiliation(s)
- Shin Ishihara
- Department of Community Medicine, Fujita Health University, Toyoake, Japan
| | - Akihiko Horiguchi
- Department of Gastroenterological Surgery, Fujita Health University, Nagoya, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of medicine, Yokohama, Japan
| | - Toshifumi Wakaki
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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15
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Shin K, Park SJ, Lee J, Park CH, Song KY, Lee HH, Seo HS, Jung YJ, Park JM, Lee SH, Roh SY, Kim IH. Efficacy of capecitabine and oxaliplatin versus S-1 as adjuvant chemotherapy in gastric cancer after D2 lymph node dissection according to lymph node ratio and N stage. BMC Cancer 2019; 19:1232. [PMID: 31852475 PMCID: PMC6921502 DOI: 10.1186/s12885-019-6433-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/04/2019] [Indexed: 12/24/2022] Open
Abstract
Background We sought to assess the prognostic significance of lymph node ratio (LNR) and N stage in patients undergoing D2 gastrectomy and adjuvant chemotherapy, S-1, and XELOX and to compare the efficacy of them according to LNRs and N stages to evaluate the clinical impact of using LNRs compared with using N staging. Methods Patients undergoing D2 gastrectomy with adequate lymph node dissection and adjuvant chemotherapy for stage II/III gastric cancer between Mar 2011 and Dec 2016 were analysed. Of the 477 patients enrolled, 331 received S-1 and 146 received XELOX. LNR groups were segregated as 0, 0–0.1, 0.1–0.25, and > 0.25 (LNR0, 1, 2, and 3, respectively). Propensity score matching (PSM) was used to minimise potential selection bias and compare DFS and OS stratified by LNRs and N stages in the two treatment groups. Results After PSM, the sample size of each group was 110 patients, and variables were well balanced. All patients had more than 15 examined lymph nodes (median 51, range 16~124). In multivariate analysis, LNR (> 0.25) and N stage (N3) showed independent prognostic value in OS and DFS, but LNR (> 0.25) showed better prognostic value. In subgroup analysis, the LNR3 group showed better 5-year DFS (20% vs 54%; HR 0.29; p = 0.004) and 5-year OS (26% vs 67%; HR 0.28; p = 0.020) in the XELOX group. The N3 group showed better 5-year DFS (38% vs 66%; HR 0.40; p = 0.004) and 5-year OS (47% vs 71%; HR 0.45; p = 0.019) in the XELOX group. Stage IIIC showed better 5-year DFS (22% vs 57%; HR 0.32; p = 0.004) and 5-year OS (27% vs 68%; HR 0.32; p = 0.009) in the XELOX group. The LNR3 group within N3 patients showed better 5-year DFS (21% vs 55%; HR 0.31; p = 0.004) and 5-year OS (27% vs 68%; HR 0.34; p = 0.018) in the XELOX group. Conclusions LNR showed better prognostic value than N staging. LNR3, N3 and stage IIIC groups showed the superior efficacy of XELOX to that of S-1. And the LNR3 group within N3 patients showed more survival benefit from XELOX. LNR > 0.25, N3 stage and stage IIIC were the discriminant factors for selecting XELOX over S-1. Trial registration Not applicable (retrospective study).
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Affiliation(s)
- Kabsoo Shin
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea
| | - Se Jun Park
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea
| | - Jinsoo Lee
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea
| | - Cho Hyun Park
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Department of Gastric Cancer Centre, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kyo Young Song
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Department of Gastric Cancer Centre, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Han Hong Lee
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Department of Gastric Cancer Centre, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ho Seok Seo
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Department of Gastric Cancer Centre, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yoon Ju Jung
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Department of Gastric Cancer Centre, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jae Myung Park
- Department of Gastric Cancer Centre, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung Hak Lee
- Department of Gastric Cancer Centre, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Department of Clinical Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sang Young Roh
- Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - In-Ho Kim
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea. .,Department of Gastric Cancer Centre, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea. .,Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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16
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Ma X, Shen F, Jia Y, Xia Y, Li Q, Lu J. MRI-based radiomics of rectal cancer: preoperative assessment of the pathological features. BMC Med Imaging 2019; 19:86. [PMID: 31747902 PMCID: PMC6864926 DOI: 10.1186/s12880-019-0392-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/29/2019] [Indexed: 02/06/2023] Open
Abstract
Background This study aimed to evaluate the significance of MRI-based radiomics model derived from high-resolution T2-weighted images (T2WIs) in predicting tumor pathological features of rectal cancer. Methods A total of 152 patients with rectal cancer who underwent surgery without any neoadjuvant therapy between March 2017 and September 2018 were included retrospectively. The patients were scanned using a 3-T magnetic resonance imaging, and high-resolution T2WIs were obtained. Lesions were delineated, and 1029 radiomics features were extracted. Least absolute shrinkage and selection operator was used to select features, and multilayer perceptron (MLP), logistic regression (LR), support vector machine (SVM), decision tree (DT), random forest (RF), and K-nearest neighbor (KNN) were trained using fivefold cross-validation to build a prediction model. The diagnostic performance of the prediction models was assessed using the receiver operating characteristic curves. Results A total of 1029 features were extracted, and 15, 11, and 11 features were selected to predict the degree of differentiation, T stage, and N stage, respectively. The best performance of the radiomics model for the degree of differentiation, T stage, and N stage was obtained by SVM [area under the curve (AUC), 0.862; 95% confidence interval (CI), 0.750–0.967; sensitivity, 83.3%; specificity, 85.0%], MLP (AUC, 0.809; 95% CI, 0.690–0.905; sensitivity, 76.2%; specificity, 74.1%), and RF (AUC, 0.746; 95% CI, 0.622-0.872; sensitivity, 79.3%; specificity, 72.2%). Conclusion This study demonstrated that the high-resolution T2WI–based radiomics model could serve as pretreatment biomarkers in predicting pathological features of rectal cancer.
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Affiliation(s)
- Xiaolu Ma
- Department of Radiology, Changhai Hospital of Shanghai, Shanghai, China
| | - Fu Shen
- Department of Radiology, Changhai Hospital of Shanghai, Shanghai, China.
| | - Yan Jia
- Huiying Medical Technology Co., Ltd, Beijing, China
| | - Yuwei Xia
- Huiying Medical Technology Co., Ltd, Beijing, China
| | - Qihua Li
- Huiying Medical Technology Co., Ltd, Beijing, China
| | - Jianping Lu
- Department of Radiology, Changhai Hospital of Shanghai, Shanghai, China
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17
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Zhang J, Liu L, Wang G, Huang C, Chen Y, Zhang Y, Guo C, Li S. New perspective to evaluate N1 staging: The peripheral lymph node metastasis status of non-small cell lung cancer. Thorac Cancer 2019; 10:2253-2258. [PMID: 31617316 PMCID: PMC6885437 DOI: 10.1111/1759-7714.13213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/09/2019] [Accepted: 09/18/2019] [Indexed: 12/11/2022] Open
Abstract
Background Lymph node (LN) metastasis status is the decision‐making basis for the surgical procedure and adjuvant therapy modalities. Fewer studies have previously focused on LN metastasis in N1 station, especially on peripheral lymph node (PLN) metastasis in N1 station. This study aimed to reveal the metastasis status of PLN of non‐small cell lung cancer (NSCLC), and investigate its effects on N staging. Methods We retrospectively evaluated a consecutive series of patients who underwent curative resection for histologically confirmed N1 NSCLC. Propensity score matching (PSM) was used to analyze the effects of PLN on N staging. Results A total of 105 patients with confirmed pathological N1 (pN1) stage NSCLC with solitary nodule and without neoadjuvant therapy were enrolled into the study: 55 patients had intraperipheral LN metastasis (IPLNM), and 50 patients had extra‐peripheral LN metastasis (EPLNM). Before PSM analysis, type of location (P = 0.002), surgical procedure (P = 0.008), number of positive LNs (P = 0.029), number of LNs removed (P = 0.010), lobe of lung cancer (P = 0.031), and vascular invasion (P = 0.049) showed significant differences between the two groups. After PSM analysis, statistically there were differences in type of location (P = 0.034), number of positive LNs (P = 0.008) and vascular invasion (P = 0.049) between them. Conclusion PLN metastasis was a quite common pattern of LN metastasis in N1 station of NSCLC. IPLNM occurred more frequently in central NSCLC and NSCLC with vascular invasion, and thoracotomy was likely to secure more accurate PLN staging. Clinicians should pay great attention to PLN dissection. Follow‐up data will be needed in order to detect the prognosis of IPLNM patients.
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Affiliation(s)
- Jiaqi Zhang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guige Wang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Cheng Huang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yeye Chen
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye Zhang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chao Guo
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Park BJ, Kim TH, Shin S, Kim HK, Choi YS, Kim J, Zo JI, Shim YM, Cho JH. Recommended Change in the N Descriptor Proposed by the International Association for the Study of Lung Cancer: A Validation Study. J Thorac Oncol 2019; 14:1962-1969. [PMID: 31442497 DOI: 10.1016/j.jtho.2019.07.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/15/2019] [Accepted: 07/26/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The International Association for the Study of Lung Cancer recently proposed a new N descriptor by combining the location of metastatic lymph nodes (LNs), nN (single-station versus multiple-station), and absence versus presence of skip metastasis as pN1a, pN1b, pN2a1, pN2a2 and pN2b. This study aimed to evaluate the discriminatory ability and prognostic performance of the proposed N descriptor in a large independent NSCLC cohort. METHODS We analyzed 1228 patients who underwent major pulmonary resection for pathological N1 or N2 NSCLC between 2004 and 2014. Survival analysis using the Cox proportional hazard model was performed to assess the prognostic significance of the N descriptor. RESULTS From 2004 to 2014, a total of 7437 patients were operated on for NSCLC. Patients pathologically confirmed as having N1 (n = 732) or N2 (n = 496) disease after surgery were included. The median total number of dissected LNs was 24 (range 10-83), and the median number of involved LNs was 2 (range 1-40). The 5-year overall survival rates were 62.6%, 57.0%, 64.7%, 48.4%, and 42.8% for stages N1a, N1b, N2a1, N2a2, and N2b, respectively. Analysis of overall and recurrence-free survival revealed that N2a1 is not sufficiently distinguished from N1a and N1b. In terms of overall survival, N1b is not sufficiently distinguished from N2a2. CONCLUSION On the basis of the N descriptor proposed by the International Association for the Study of Lung Cancer, some of the prognostic implications of the five groups overlapped. It would be better to classify similar prognostic groups into three or four groups to divide the group. A large-scale prospective study is needed to validate these N descriptors.
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Affiliation(s)
- Byung Jo Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Ho Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sumin Shin
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Ill Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Deng Y, Peng J, Zhao Y, Sui Q, Zhao R, Lu Z, Qiu M, Lin J, Pan Z. Lymph node ratio as a valuable prognostic factor for patients with colorectal liver-only metastasis undergoing curative resection. Cancer Manag Res 2018; 10:2083-2094. [PMID: 30140159 PMCID: PMC6054757 DOI: 10.2147/cmar.s169029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Recent studies have suggested that the lymph node ratio (LNR) is a prognostic indicator for various malignancies. However, LNR has not been evaluated in colorectal liver-only metastasis (CRLM). This study aimed to investigate the prognostic value of LNR in patients with CRLM after curative resection. Patients and methods We retrospectively investigated the clinicopathologic features of 154 CRLM patients who underwent curative resection between 2005 and 2015. We classified patients into low and high groups based on their LNR by using the X-tile software. Survival curves were plotted through Kaplan–Meier method and compared by log-rank test. Cox proportional hazards analysis was performed to identify the factors associated with recurrence-free survival (RFS) and overall survival (OS). Results The patients were divided into two groups in which 124 patients were identified as LNR ≤0.33 and 30 patients as LNR >0.33. Compared to low LNR, high LNR was significantly associated with poor 3-year RFS (47.2% vs 16.7%, P=0.001) and OS (72.8% vs 45.3%, P=0.003) rates. Multivariate analysis indicated that the LNR was an independent predictor for 3-year RFS (hazard ratio, 2.124; 95% CI, 1.339–3.368; P=0.001) and OS (HR, 2.287; 95% CI, 1.282–4.079; P=0.005). However, the node (N) stage and lymph node distribution were not significantly associated with the 3-year RFS (P=0.071, P=0.226) or OS (P=0.452, P=0.791) in patients with CRLM. Conclusion This study demonstrated that LNR was an independent predictor for 3-year RFS and OS in patients with CRLM who underwent curative resection and that its prognostic value was superior to that of N stage and lymph node distribution.
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Affiliation(s)
- Yuxiang Deng
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China, ;
| | - Jianhong Peng
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China, ;
| | - Yujie Zhao
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China, ;
| | - Qiaoqi Sui
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China, ;
| | - Ruixia Zhao
- Department of Public Health, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zhenhai Lu
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China, ;
| | - Miaozhen Qiu
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Junzhong Lin
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China, ;
| | - Zhizhong Pan
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China, ;
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Abstract
Imaging determines the optimal treatment for rectal cancer patients. High-resolution magnetic resonance imaging (MRI) overcomes many of the known limitations of previous methods. When performed in accordance with the recommended standards, MRI enables accurate staging of both early and advanced rectal cancer, accurate response assessment, the delineation of recurrent disease and planning surgical treatment in a safe and effective manner. Tumour-related high-risk features with known adverse outcomes can be preoperatively identified and treated with neoadjuvant chemoradiotherapy. Further, MRI post-treatment tumour response assessment using TRG grading system also predicts the likely survival outcomes and in the future will be used to modify treatment further by stratification into good and poor responders. There is a paucity of literature with validated outcome data concerning use of diffusion-weighted imaging and positron emission tomography (PET)/computed tomography (CT), and in the absence of any validated methods and outcome data, their use in the initial assessment and restaging after treatment is limited to research protocols. Combination MRI and CT is essential for distant spread assessment and recurrent disease, and currently PET-CT is sometimes used in the workup of patients with recurrent and metastatic disease.
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Xue F, Hu C, He X. Long-term Patterns of Regional Failure for Nasopharyngeal Carcinoma following Intensity-Modulated Radiation Therapy. J Cancer 2017; 8:993-999. [PMID: 28529611 PMCID: PMC5436251 DOI: 10.7150/jca.17858] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 12/23/2016] [Indexed: 11/23/2022] Open
Abstract
Purpose: To analyze the long-term patterns of regional failure following intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC). Methods: From January 2005 to December 2010, 275 non-metastatic NPC patients treated with IMRT were retrospectively enrolled. Patients staged as II (lymph nodes measuring 4 or more cm in diameter), III or IV also received chemotherapy. Failures were assessed as in-field or out-field relative to the pretreatment planning computed tomography data sets. Univariate and multivariate analyses were performed with Cox proportional hazards model to analyze the effect of various prognostic factors on regional failure-free survival (RFFS) and overall survival (OS). Results: During a median follow-up of 71 months, the RFFS and OS rates were 94.3% and 83.9%, respectively. Seventeen patients developed regional failures, of which 16 were in-field; one patient showed an out-field failure in the parotid gland, and no recurrences were seen for level Ib. Failures in level II and in the retropharyngeal area accounted for 70.6% (12/17) and 52.9% (9/17) of all failures, respectively. The 5-year RFFS rates for patients with classifications of N0-1 and N2-3 were 98.5% and 90.2%, respectively (p = 0.001). Multivariate analysis showed that N stage was the only independent prognostic predictor of RFFS (HR 7.363, 95% CI 1.516-35.756, p = 0.013). Conclusions: The regional failure of NPC after treatment with IMRT is uncommon but is significantly higher in N2-3 patients than in N0-1 patients. In-field failures represent the main pattern of regional recurrence and are most often detected in level II and in the retropharyngeal area, while out-field failure is rare. Close attention should be directed to NPC patients with advanced N stages.
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Affiliation(s)
- Fen Xue
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Shanghai, China
| | - Chaosu Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Shanghai, China
| | - Xiayun He
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Shanghai, China
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Fairweather M, Jajoo K, Sainani N, Bertagnolli MM, Wang J. Accuracy of EUS and CT imaging in preoperative gastric cancer staging. J Surg Oncol 2015; 111:1016-20. [PMID: 25872753 DOI: 10.1002/jso.23919] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/19/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Neoadjuvant therapy is recommended for locally advanced gastric cancer patients (stage IB-IIIC). The objective of this study is to evaluate the accuracy of endoscopic ultrasound (EUS) and computed tomography (CT) in identifying patients with locally advanced gastric cancer. METHODS Patients with gastric adenocarcinoma who underwent gastrectomy at our institution were reviewed. Preoperative EUS and CT staging were compared with pathologic staging to determine accuracy. RESULTS Between 2001 and 2013, 280 patients were identified. Forty-nine patients (18%) who underwent preoperative staging by EUS were analyzed. The accuracy of EUS in identifying individual T stage and N stage was 41.0% and 42.9%, respectively. EUS had moderate accuracy in differentiating locally advanced from early (stage 0-IA) disease (75.5%, area under curve (AUC) 0.772). For individual T stage and N stage, the accuracy of CT was 4.0% and 56%, respectively. CT had relatively poor accuracy in differentiating locally advanced from early disease (60.0%, AUC 0.649). CONCLUSIONS EUS and CT had poor performance in identifying individual T and N stage although EUS demonstrated moderate accuracy in identifying patients with locally advanced disease. A combined staging approach, in addition to further optimization of staging modalities, is required for accurate staging for patients with gastric cancer.
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Affiliation(s)
- Mark Fairweather
- Department of Surgery, Division of Surgical Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kunal Jajoo
- Department of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nisha Sainani
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Monica M Bertagnolli
- Department of Surgery, Division of Surgical Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jiping Wang
- Department of Surgery, Division of Surgical Oncology, Brigham and Women's Hospital, Boston, Massachusetts
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Wang Z, Zhou Q, Liu J, Tang S, Liang X, Zhou Z, He Y, Peng H, Xiao Y. Tumor size of breast invasive ductal cancer measured with contrast-enhanced ultrasound predicts regional lymph node metastasis and N stage. Int J Clin Exp Pathol 2014; 7:6985-6991. [PMID: 25400785 PMCID: PMC4230066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 09/15/2014] [Indexed: 06/04/2023]
Abstract
PURPOSE This study aimed to determine the role of breast invasive ductal cancer (BIDC) size measured with Contrast-enhanced Ultrasound (CEUS) in the prediction of regional lymph node metastasis (LNM) and N stage. METHODS One hundred and six consecutive patients with breast lesions underwent ultrasound imaging within 2 weeks before mastectomy and axillary lymph node dissection. The largest transverse (width) and anteroposterior (depth) diameter were measured under CEUS by using calipers. The correlation between tumor size and regional LNM metastasis and N stage was evaluated. RESULTS Univariate analysis showed the diameters measured with CEUS were associated with lymph node metastasis (P < 0.05). The tumor size could distinguish grouped N stage (all P < 0.05). Tumor area (TA) might be an indicator that can differentiate No BIDC from N1-3 BIDC (cutoff = 5.37 cm(2)), N0-1 BIDC from N2-3 BIDC (cutoff = 6.48 cm(2)), and N0-2 BIDC from N3 BIDC (cutoff = 8.23 cm(2)) with the sensitivity of 71%, 72% and 83%, respectively, and the specificity of 79%, 68% and 84%, respectively. CONCLUSIONS The TA of BIDC measured with CEUS may be a predictor of regional LNM and N stage.
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Affiliation(s)
- Zhiyuan Wang
- Department of Ultrasound, The Second Xiangya Hospital of Central South UniversityChangsha 410011, China
- Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South UniversityChangsha 410013, China
| | - Qichang Zhou
- Department of Ultrasound, The Second Xiangya Hospital of Central South UniversityChangsha 410011, China
| | - Jun Liu
- Department of Radiology, The Second Xiangya Hospital of Central South University, The School of Public Administration of Central South UniversityChangsha 410011, China
| | - Shichu Tang
- Department of Ultrasound, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South UniversityChangsha 410013, China
| | - Xia Liang
- Department of Ultrasound, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South UniversityChangsha 410013, China
| | - Zhengyu Zhou
- Department of Ultrasound, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South UniversityChangsha 410013, China
| | - Ying He
- Department of Breast Surgery, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South UniversityChangsha 410013, China
| | - Hui Peng
- Department of Ultrasound, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South UniversityChangsha 410013, China
| | - Yuanming Xiao
- Health Management Center, The Third Xiangya Hospital of Central South UniversityChangsha 410013, China
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Yang Y, Tang T, Peng W, Xia L, Wang X, Duan B, Shu Y. The comparison of miR-155 with computed tomography and computed tomography plus serum amyloid A protein in staging rectal cancer. J Surg Res 2014; 193:764-71. [PMID: 25261908 DOI: 10.1016/j.jss.2014.08.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 08/17/2014] [Accepted: 08/22/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Recently identified class of microRNAs (miRNAs) provided a new insight in cancer research. As a member of miRNAs family, miR-155 expression demonstrated the correlation with tumor stage. Thus, its expression level can be potentially used for staging rectal tumors. The aim of this study was to systematically evaluate the potential abilities of miR-155 in preoperatively N staging. MATERIALS AND METHODS Expression of miR-155 was detected and quantitated in rectal cancer tissues and in adjacent nonmalignant tissues from 40 patients by TaqMan MicroRNA assays. Preoperative enhanced computed tomography (CT) scan, serum amyloid A protein (SAA), carcinoembryonic antigen (CEA), and postoperative pathologic biopsy were performed. RESULTS A significant overexpression of miR-155 was observed in rectal carcinoma tissues (0.137 ± 0.095 versus 0.093 ± 0.091, P = 0.043). High expression of miR-155 in N1-2 (0.09 ± 0.038 versus 0.183 ± 0.111, P = 0.001) and III and IV stages (0.091 ± 0.039 versus 0.178 ± 0.111, P = 0.002) presented its potential correlation with N and tumor-node-metastasis combined stages. Receiver operating characteristics curve analysis showed that miR-155 could discriminate N0 from N1-2 with 85.0% sensitivity and 85.0% specificity at the cutoff value of 0.125. miR-155 and CT had nearly equal performances in sensitivity (0.850 versus 0.700, P = 0.450) and specificity (0.850 versus 0.550, P = 0.077) in predicting N1-2 stage. Compared with CT + SAA, miR-155 had similar sensitivity (0.850 versus 0.950, P = 0.617) but higher specificity (0.750 versus 0.200, P = 0.015) for lymph node assessment. CONCLUSIONS Increase in the expression of miR-155 might represent a potential valuable marker for rectal carcinoma N and combined tumor-node-metastasis staging.
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Affiliation(s)
- Yun Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Tian Tang
- Department of Hepatic Surgery and Hepatic Transplantation Center, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China
| | - Wei Peng
- Department of Gynecology and Obstetrics, West China Women's and Children's Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China
| | - Lin Xia
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xiaodong Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Baofeng Duan
- Department of Oncology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Ye Shu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
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