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Kobayashi M, Matsuoka Y, Uehara S, Tanaka H, Fujiwara M, Nakamura Y, Ishikawa Y, Fukuda S, Waseda Y, Tanaka H, Yoshida S, Fujii Y. Utility of positive core number on MRI-ultrasound fusion targeted biopsy in combination with PI-RADS scores for predicting unexpected extracapsular extension of clinically localized prostate cancer. Int J Urol 2024. [PMID: 38468553 DOI: 10.1111/iju.15451] [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: 10/20/2023] [Accepted: 02/20/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVES To evaluate the utility of magnetic resonance imaging (MRI) and MRI-ultrasound fusion targeted biopsy (TB) for predicting unexpected extracapsular extension (ECE) in clinically localized prostate cancer (CLPC). METHODS This study enrolled 89 prostate cancer patients with one or more lesions showing a Prostate Imaging-Reporting and Data System (PI-RADS) score ≥3 but without morphological abnormality in the prostatic capsule on pre-biopsy MRI. All patients underwent TB and systematic biopsy followed by radical prostatectomy (RP). Each lesion was examined by 3-core TB, taking cores from each third of the lesion. The preoperative variables predictive of ECE were explored by referring to RP specimens in the lesion-based analysis. RESULTS Overall, 186 lesions, including 81 (43.5%), 73 (39.2%), and 32 (17.2%) with PI-RADS 3, 4, and 5, respectively, were analyzed. One hundred and twenty-two lesions (65.6%) were diagnosed as cancer on TB, and ECE was identified in 33 (17.7%) on the RP specimens. The positive TB core number was ≤2 in 129 lesions (69.4%) and three in 57 lesions (30.6%). On the multivariate analysis, PI-RADS ≥4 (p = 0.049, odds ratio [OR] = 2.39) and three positive cores on TB (p = 0.005, OR = 3.07) were independent predictors of ECE. Lesions with PI-RADS ≥4 and a positive TB core number of 3 had a significantly higher rate of ECE than those with PI-RADS 3 and a positive TB core number ≤2 (37.5% vs. 7.8%, p < 0.001). CONCLUSIONS Positive TB core number in combination with PI-RADS scores is helpful to predict unexpected ECE in CLPC.
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Affiliation(s)
- Masaki Kobayashi
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Urology, Saitama Cancer Center, Ina, Japan
| | - Sho Uehara
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Tanaka
- Department of Radiology, Ochanomizu Surugadai Clinic, Tokyo, Japan
| | - Motohiro Fujiwara
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuki Nakamura
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yudai Ishikawa
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shohei Fukuda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuma Waseda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
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Wang JG, Zhong C, Zhang KC, Chen JB. Imaging classification of prostate cancer with extracapsular extension and its impact on positive surgical margins after laparoscopic radical prostatectomy. Front Oncol 2024; 14:1344050. [PMID: 38511144 PMCID: PMC10951392 DOI: 10.3389/fonc.2024.1344050] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/20/2024] [Indexed: 03/22/2024] Open
Abstract
Abstract To explore the impact of different imaging classifications of prostate cancer (PCa) with extracapsular extension (EPE) on positive surgical margins (PSM) after laparoscopic radical prostatectomy. Methods Clinical data were collected for 114 patients with stage PT3a PCa admitted to Ningbo Yinzhou No. 2 Hospital from September 2019 to August 2023. Radiologists classified the EPE imaging of PCa into Type I, Type II, and Type III. A chi-square test or t-test was employed to analyze the factors related to PSM. Multivariate regression analysis was conducted to determine the factors associated with PSM. Receiver operating characteristic curve analysis was used to calculate the area under the curve and evaluate the diagnostic performance of our model. Clinical decision curve analysis was performed to assess the clinical net benefit of EPE imaging classification, biopsy grade group (GG), and combined model. Results Among the 114 patients, 58 had PSM, and 56 had negative surgical margins. Multivariate analysis showed that EPE imaging classification and biopsy GG were risk factors for PSM after laparoscopic radical prostatectomy. The areas under the curve for EPE imaging classification and biopsy GG were 0.677 and 0.712, respectively. The difference in predicting PSM between EPE imaging classification and biopsy GG was not statistically significant (P>0.05). However, when used in combination, the diagnostic efficiency significantly improved, with an increase in the area under the curve to 0.795 (P<0.05). The clinical decision curve analysis revealed that the clinical net benefit of the combined model was significantly higher than that of EPE imaging classification and biopsy GG. Conclusions EPE imaging classification and biopsy GG were associated with PSM after laparoscopic radical prostatectomy, and their combination can significantly improve the accuracy of predicting PSM.
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Affiliation(s)
| | | | | | - Jun-Bo Chen
- Department of Radiology, Ningbo Yinzhou No. 2 Hospital, Ningbo, Zhejiang, China
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Wang Y, Rahman A, Duggar WN, Thomas TV, Roberts PR, Vijayakumar S, Jiao Z, Bian L, Wang H. A gradient mapping guided explainable deep neural network for extracapsular extension identification in 3D head and neck cancer computed tomography images. Med Phys 2024; 51:2007-2019. [PMID: 37643447 DOI: 10.1002/mp.16680] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 07/13/2023] [Accepted: 08/03/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Diagnosis and treatment management for head and neck squamous cell carcinoma (HNSCC) is guided by routine diagnostic head and neck computed tomography (CT) scans to identify tumor and lymph node features. The extracapsular extension (ECE) is a strong predictor of patients' survival outcomes with HNSCC. It is essential to detect the occurrence of ECE as it changes staging and treatment planning for patients. Current clinical ECE detection relies on visual identification and pathologic confirmation conducted by clinicians. However, manual annotation of the lymph node region is a required data preprocessing step in most of the current machine learning-based ECE diagnosis studies. PURPOSE In this paper, we propose a Gradient Mapping Guided Explainable Network (GMGENet) framework to perform ECE identification automatically without requiring annotated lymph node region information. METHODS The gradient-weighted class activation mapping (Grad-CAM) technique is applied to guide the deep learning algorithm to focus on the regions that are highly related to ECE. The proposed framework includes an extractor and a classifier. In a joint training process, informative volumes of interest (VOIs) are extracted by the extractor without labeled lymph node region information, and the classifier learns the pattern to classify the extracted VOIs into ECE positive and negative. RESULTS In evaluation, the proposed methods are well-trained and tested using cross-validation. GMGENet achieved test accuracy and area under the curve (AUC) of 92.2% and 89.3%, respectively. GMGENetV2 achieved 90.3% accuracy and 91.7% AUC in the test. The results were compared with different existing models and further confirmed and explained by generating ECE probability heatmaps via a Grad-CAM technique. The presence or absence of ECE has been analyzed and correlated with ground truth histopathological findings. CONCLUSIONS The proposed deep network can learn meaningful patterns to identify ECE without providing lymph node contours. The introduced ECE heatmaps will contribute to the clinical implementations of the proposed model and reveal unknown features to radiologists. The outcome of this study is expected to promote the implementation of explainable artificial intelligence-assiste ECE detection.
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Affiliation(s)
- Yibin Wang
- Department of Industrial and Systems Engineering, Mississippi State University, Mississippi State, Mississippi, USA
| | - Abdur Rahman
- Department of Industrial and Systems Engineering, Mississippi State University, Mississippi State, Mississippi, USA
| | - William Neil Duggar
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Toms V Thomas
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Paul Russell Roberts
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Srinivasan Vijayakumar
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Zhicheng Jiao
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Linkan Bian
- Department of Industrial and Systems Engineering, Mississippi State University, Mississippi State, Mississippi, USA
| | - Haifeng Wang
- Department of Industrial and Systems Engineering, Mississippi State University, Mississippi State, Mississippi, USA
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Pan K, Yao F, Hong W, Xiao J, Bian S, Zhu D, Yuan Y, Zhang Y, Zhuang Y, Yang Y. Multimodal radiomics based on 18F-Prostate-specific membrane antigen-1007 PET/CT and multiparametric MRI for prostate cancer extracapsular extension prediction. Br J Radiol 2024; 97:408-414. [PMID: 38308032 DOI: 10.1093/bjr/tqad038] [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: 08/12/2023] [Revised: 11/08/2023] [Accepted: 11/20/2023] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVES To compare the performance of the multiparametric magnetic resonance imaging (mpMRI) radiomics and 18F-Prostate-specific membrane antigen (PSMA)-1007 PET/CT radiomics model in diagnosing extracapsular extension (EPE) in prostate cancer (PCa), and to evaluate the performance of a multimodal radiomics model combining mpMRI and PET/CT in predicting EPE. METHODS We included 197 patients with PCa who underwent preoperative mpMRI and PET/CT before surgery. mpMRI and PET/CT images were segmented to delineate the regions of interest and extract radiomics features. PET/CT, mpMRI, and multimodal radiomics models were constructed based on maximum correlation, minimum redundancy, and logistic regression analyses. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) and indices derived from the confusion matrix. RESULTS AUC values for the mpMRI, PET/CT, and multimodal radiomics models were 0.85 (95% CI, 0.78-0.90), 0.73 (0.64-0.80), and 0.83 (0.75-0.89), respectively, in the training cohort and 0.74 (0.61-0.85), 0.62 (0.48-0.74), and 0.77 (0.64-0.87), respectively, in the testing cohort. The net reclassification improvement demonstrated that the mpMRI radiomics model outperformed the PET/CT one in predicting EPE, with better clinical benefits. The multimodal radiomics model performed better than the single PET/CT radiomics model (P < .05). CONCLUSION The mpMRI and 18F-PSMA-PET/CT combination enhanced the predictive power of EPE in patients with PCa. The multimodal radiomics model will become a reliable and robust tool to assist urologists and radiologists in making preoperative decisions. ADVANCES IN KNOWLEDGE This study presents the first application of multimodal radiomics based on PET/CT and MRI for predicting EPE.
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Affiliation(s)
- Kehua Pan
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Fei Yao
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Weifeng Hong
- Department of Radiology, The People's Hospital of Yuhuan, Taizhou 318000, China
| | - Juan Xiao
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Shuying Bian
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Dongqin Zhu
- Department of Nuclear Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Yaping Yuan
- The First Clinical Medical College, Wenzhou Medical University, Wenzhou 325000, China
| | - Yayun Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Yuandi Zhuang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Yunjun Yang
- Department of Nuclear Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
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Xiao VG, Kresnanto J, Moses DA, Pather N. Quantitative MRI in the Local Staging of Prostate Cancer: A Systematic Review and Meta-Analysis. J Magn Reson Imaging 2024; 59:255-296. [PMID: 37165923 DOI: 10.1002/jmri.28742] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Local staging of prostate cancer (PCa) is important for treatment planning. Radiologist interpretation using qualitative criteria is variable with high specificity but low sensitivity. Quantitative methods may be useful in the diagnosis of extracapsular extension (ECE). PURPOSE To assess the performance of quantitative MRI markers for detecting ECE. STUDY TYPE Systematic review and meta-analysis. SUBJECTS 4800 patients from 28 studies with histopathologically confirmed PCa on radical prostatectomy were pooled for meta-analysis. Patients from 46 studies were included for systematic review. FIELD STRENGTH/SEQUENCE Diffusion-weighted, T2-weighted, and dynamic contrast-enhanced MRI at 1.5 T or 3 T. ASSESSMENT PubMed, Embase, Web of Science, Scopus, and Cochrane databases were searched to identify studies on diagnostic test accuracy or association of any quantitative MRI markers with ECE. Results extracted by two independent reviewers for tumor contact length (TCL) and mean apparent diffusion coefficient (ADC-mean) were pooled for meta-analysis, but not for other quantitative markers including radiomics due to low number of studies available. STATISTICAL TESTS Hierarchical summary receiver operating characteristic (HSROC) curves were computed for both TCL and ADC-mean, but summary operating points were computed for TCL only. Heterogeneity was investigated by meta-regression. Results were significant if P ≤ 0.05. RESULTS At the 10 mm threshold for TCL, summary sensitivity and specificity were 0.76 [95% confidence interval (CI) 0.71-0.81] and 0.68 [95% CI 0.63-0.73], respectively. At the 15 mm threshold, summary sensitivity and specificity were 0.70 [95% CI 0.53-0.83] and 0.74 [95% CI 0.60-0.84] respectively. The area under the HSROC curves for TCL and ADC-mean were 0.79 and 0.78, respectively. Significant sources of heterogeneity for TCL included timing of MRI relative to biopsy. DATA CONCLUSION Both 10 mm and 15 mm thresholds for TCL may be reasonable for clinical use. From comparison of the HSROC curves, ADC-mean may be superior to TCL at higher sensitivities. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Vieley G Xiao
- Medical Education, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, 2052, Australia
- School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, 2052, Australia
| | - Jordan Kresnanto
- School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, 2052, Australia
| | - Daniel A Moses
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Kensington, New South Wales, 2052, Australia
- Prince of Wales Hospital, Sydney, New South Wales, 2031, Australia
| | - Nalini Pather
- Medical Education, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, 2052, Australia
- School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, 2052, Australia
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Lehner F, Crippa A, Sigg S, Eberli D, Mortezavi A. Transperineal template saturation and conventional biopsy for stage prediction in prostate cancer. BJU Int 2023; 132:696-704. [PMID: 37704215 DOI: 10.1111/bju.16181] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To evaluate the performance of risk calculators (RCs) predicting lymph node invasion (LNI) and extraprostatic extension (EPE) in men undergoing transperineal magnetic resonance imaging/transrectal ultrasound (TRUS)-fusion template saturation biopsy (TTSB) and conventional systematic TRUS-guided biopsy (SB). PATIENTS AND METHODS The RCs were tested in a consecutive cohort of 645 men undergoing radical prostatectomy with extended pelvic LN dissection between 2005 and 2019. TTSB was performed in 230 (35.7%) and SB in 415 (64.3%) men. Risk of LNI and EPE was calculated using the available RCs. Discrimination, calibration, and clinical usefulness stratified by different biopsy techniques were assessed. RESULTS Lymph node invasion was observed in 23 (10%) and EPE in 73 (31.8%) of cases with TTSB and 53 (12.8%) and 158 (38%) with SB, respectively. RCs showed an excellent discrimination and acceptable calibration for prediction of LNI based on TTSB (area under the curve [AUC]/risk estimation: Memorial Sloan Kettering Cancer Center [MSKCC]-RC 0.79/-4%, Briganti (2012)-RC 0.82/-4%, Gandaglia-RC 0.81/+6%). These were comparable in SB (MSKCC-RC 0.78/+2%; Briganti (2012)-RC 0.77/-3%). Decision curve analysis (DCA) revealed a net benefit at threshold probabilities between 3% and 6% when TTSB was used. For prediction of EPE based on TTSB an inferior discrimination and variable calibration were observed (AUC/risk estimation: MSKCC-RC 0.71/+8% and Martini (2018)-RC 0.69/+2%) achieving a net benefit on DCA only at risk thresholds of >17%. Performance of RCs for prediction of LNI and EPE based on SB showed comparable results with a better performance in the DCA for LNI (risk thresholds 1-2%) and poorer performance for EPE (risk threshold >20%). This study is limited by its retrospective single-institution design. CONCLUSIONS The potentially more accurate grading ability of TTSB did not result in improved performance of preoperative RCs. Prediction tools for LNI proved clinical usefulness while RCs for EPE did not.
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Affiliation(s)
- Fabienne Lehner
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Alessio Crippa
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Silvan Sigg
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Ashkan Mortezavi
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, University Hospital Basel, Basel, Switzerland
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Guerra A, Alves FC, Maes K, Maio R, Villeirs G, Mouriño H. Risk Biomarkers for Biochemical Recurrence after Radical Prostatectomy for Prostate Cancer Using Clinical and MRI-Derived Semantic Features. Cancers (Basel) 2023; 15:5296. [PMID: 37958468 PMCID: PMC10650512 DOI: 10.3390/cancers15215296] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
OBJECTIVES This study aimed to assess the impact of the covariates derived from a predictive model for detecting extracapsular extension on pathology (pECE+) on biochemical recurrence-free survival (BCRFS) within 4 years after robotic-assisted radical prostatectomy (RARP). METHODS Retrospective data analysis was conducted from a single center between 2015 and 2022. Variables under consideration included prostate-specific antigen (PSA) levels, patient age, prostate volume, MRI semantic features, and Grade Group (GG). We also assessed the influence of pECE+ and positive surgical margins on BCRFS. To attain these goals, we used the Kaplan-Meier survival function and the multivariable Cox regression model. Additionally, we analyzed the MRI features on BCR (biochemical recurrence) in low/intermediate risk patients. RESULTS A total of 177 participants with a follow-up exceeding 6 months post-RARP were included. The 1-year, 2-year, and 4-year risks of BCR after radical prostatectomy were 5%, 13%, and 21%, respectively. The non-parametric approach for the survival analysis showed that adverse MRI features such as macroscopic ECE on MRI (mECE+), capsular disruption, high tumor capsular contact length (TCCL), GG ≥ 4, positive surgical margins (PSM), and pECE+ on pathology were risk factors for BCR. In low/intermediate-risk patients (pECE- and GG < 4), the presence of adverse MRI features has been shown to increase the risk of BCR. CONCLUSIONS The study highlights the importance of incorporating predictive MRI features for detecting extracapsular extension pre-surgery in influencing early outcomes and clinical decision making; mECE+, TCCL, capsular disruption, and GG ≥ 4 based on pre-surgical biopsy were independent prognostic factors for early BCR. The presence of adverse features on MRI can assist in identifying low/intermediate-risk patients who will benefit from closer monitoring.
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Affiliation(s)
- Adalgisa Guerra
- Department of Radiology, Hospital da Luz Lisbon, 1500-650 Lisboa, Portugal;
| | - Filipe Caseiro Alves
- Faculty of Medicine, Clinical Research CIBIT/ICNAS, University of Coimbra, 3004-504 Coimbra, Portugal;
| | - Kris Maes
- Department of Urology, Hospital da Luz Lisbon, 1500-650 Lisboa, Portugal;
| | - Rui Maio
- Department of Radiology, Hospital da Luz Lisbon, 1500-650 Lisboa, Portugal;
- Nova Medical School, Nova University of Lisbon, 1169-056 Lisbon, Portugal
| | - Geert Villeirs
- Department of Medical Imaging, Ghent University Hospital, 9000 Ghent, Belgium;
| | - Helena Mouriño
- CEAUL, Centro de Estatística e Aplicações, Faculdade de Ciências, Universidade de Lisboa, 1749-016 Lisboa, Portugal;
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Tao H, Wei Y, Shen Z, Liu Z. Matched-pair analysis of the impact of low-dose postoperative radiotherapy on prognosis in patients with advanced hypopharyngeal squamous cell carcinoma without positive surgical margins and extracapsular extension. Front Oncol 2023; 13:1089275. [PMID: 37746267 PMCID: PMC10513504 DOI: 10.3389/fonc.2023.1089275] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 08/15/2023] [Indexed: 09/26/2023] Open
Abstract
Background We conducted a comparative analysis between low and high-dose postoperative radiotherapy in patients with hypopharyngeal squamous cell carcinoma (HPSCC) in stage III or IV without positive surgical margins and extracapsular extension (ECE). Propensity score matching (PSM) was used to eliminate confounding factors and reduce bias. Methods The matched-pair analysis included 156 patients divided into two groups: the low-dose radiotherapy group (LD-RT 50 Gy, 78 cases) and the high-dose radiotherapy group (HD-RT 60 Gy, 78 cases). Both cohorts were statistically comparable in terms of age, gender, subsite, and TNM classification. Results The median follow-up time was 49 months (ranging from 5 to 100 months). The overall survival (OS) rate, progression-free survival (PFS) rate, locoregional control rate (87% vs. 85.7%; p = 0.754), distant metastases-free survival (79.2% vs. 76.6%; p = 0.506), and the occurrence of second primary tumors (96.1% vs. 93.5%; p = 0.347) showed no significant differences between the LD-RT group and the HD-RT group. The 3-year OS was 64.9% and 61% in the low-dose and high-dose group, respectively, and 63% in the entire group (p = 0.547). The 3-year PFS was 63.6% and 54.5% (p = 0.250), respectively, and the 3-year PFS of the entire group was 59.1%. Multivariate analyses revealed that pathological T and N classification, and pathological differentiation were associated with 3-year OS, PFS, and LRFS and were independent prognostic factors (p < 0.05). LD-RT was not associated with an increased risk of death and disease progression compared to HD-RT. Conclusion The results of postoperative low-dose radiotherapy did not show inferiority to those of high-dose radiation for patients with advanced hypopharyngeal cancer without positive surgical margins and ECE in terms of OS, PFS, locoregional control, and metastases-free survival.
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Affiliation(s)
| | - Yumei Wei
- Department of Head and Neck Radiotherapy, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
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Wang JG, Huang BT, Huang L, Zhang X, He PP, Chen JB. Prediction of extracapsular extension in prostate cancer using the Likert scale combined with clinical and pathological parameters. Front Oncol 2023; 13:1229552. [PMID: 37614509 PMCID: PMC10442837 DOI: 10.3389/fonc.2023.1229552] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/20/2023] [Indexed: 08/25/2023] Open
Abstract
Abstract This study aimed to investigate the independent clinical, pathological, and radiological factors associated with extracapsular extension in radical prostatectomy specimens and to improve the accuracy of predicting extracapsular extension of prostate cancer before surgery. Methods From August 2018 to June 2023, the clinical and pathological data of 229 patients with confirmed prostate cancer underwent radical prostatectomy from The Second Hospital of Yinzhou. The patients' multiparametric magnetic resonance imaging data were graded using the Likert scale. The chi-square or independent-sample T-test was used to analyze the related factors for an extracapsular extension. Multivariate analysis was used to identify independent factors associated with extracapsular extension in prostate cancer. Additionally, receiver operating characteristic curve analysis was used to calculate the area under the curve and assess the diagnostic performance of our model. The clinical decision curve was used to analyze the clinical net income of Likert scale, biopsy positive rate, biopsy GG, and combined mode. Results Of the 229 patients, 52 had an extracapsular extension, and 177 did not. Multivariate analysis showed that the Likert scale score, biopsy grade group and biopsy positive rate were independent risk factors for extracapsular extension in prostate cancer. The area under the curves for the Likert scale score, biopsy grade group, and biopsy positive rate were 0.802, 0.762, and 0.796, respectively. Furthermore, there was no significant difference in the diagnostic efficiency for extracapsular extension (P>0.05). However, when these three factors were combined, the diagnostic efficiency was significantly improved, and the area under the curve increased to 0.905 (P<0.05). In the analysis of the decision curve, The clinical net income of the combined model is obviously higher than that of Likert scale, biopsy positive rate, and biopsy GG. Conclusion The Likert scale, biopsy grade group and biopsy positive rate are independent risk factors for extracapsular extension in prostate cancer, and their combination can significantly improve the diagnostic efficiency for an extracapsular extension.
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Affiliation(s)
- Jun-guang Wang
- Department of Radiology, Ningbo Yinzhou No. 2 Hospital, Ningbo, Zhejiang, China
| | | | | | | | | | - Jun-bo Chen
- Department of Radiology, Ningbo Yinzhou No. 2 Hospital, Ningbo, Zhejiang, China
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Sun YK, Yu Y, Xu G, Wu J, Liu YY, Wang S, Dong L, Xiang LH, Xu HX. Added value of shear-wave elastography in the prediction of extracapsular extension and seminal vesicle invasion before radical prostatectomy. Asian J Androl 2023; 25:259-264. [PMID: 36153925 PMCID: PMC10069689 DOI: 10.4103/aja202256] [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] [Indexed: 11/04/2022] Open
Abstract
The purpose of this study was to analyze the value of transrectal shear-wave elastography (SWE) in combination with multivariable tools for predicting adverse pathological features before radical prostatectomy (RP). Preoperative clinicopathological variables, multiparametric magnetic resonance imaging (mp-MRI) manifestations, and the maximum elastic value of the prostate (Emax) on SWE were retrospectively collected. The accuracy of SWE for predicting adverse pathological features was evaluated based on postoperative pathology, and parameters with statistical significance were selected. The diagnostic performance of various models, including preoperative clinicopathological variables (model 1), preoperative clinicopathological variables + mp-MRI (model 2), and preoperative clinicopathological variables + mp-MRI + SWE (model 3), was evaluated with area under the receiver operator characteristic curve (AUC) analysis. Emax was significantly higher in prostate cancer with extracapsular extension (ECE) or seminal vesicle invasion (SVI) with both P < 0.001. The optimal cutoff Emax values for ECE and SVI were 60.45 kPa and 81.55 kPa, respectively. Inclusion of mp-MRI and SWE improved discrimination by clinical models for ECE (model 2 vs model 1, P = 0.031; model 3 vs model 1, P = 0.002; model 3 vs model 2, P = 0.018) and SVI (model 2 vs model 1, P = 0.147; model 3 vs model 1, P = 0.037; model 3 vs model 2, P = 0.134). SWE is valuable for identifying patients at high risk of adverse pathology.
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Affiliation(s)
- Yi-Kang Sun
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai 200072, China.,Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai 200032, China
| | - Yang Yu
- Department of Urology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200072, China
| | - Guang Xu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai 200072, China
| | - Jian Wu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai 200072, China
| | - Yun-Yun Liu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai 200072, China
| | - Shuai Wang
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai 200072, China
| | - Lin Dong
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai 200072, China
| | - Li-Hua Xiang
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai 200072, China
| | - Hui-Xiong Xu
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai 200032, China
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Duggar WN, Vengaloor Thomas T, Wang Y, Rahman A, Wang H, Roberts PR, Bian L, Gatewood RT, Vijayakumar S. Preoperative Prediction and Identification of Extracapsular Extension in Head and Neck Cancer Patients: Progress and Potential. Cureus 2023; 15:e34769. [PMID: 36909098 PMCID: PMC10001423 DOI: 10.7759/cureus.34769] [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] [Accepted: 02/08/2023] [Indexed: 02/11/2023] Open
Abstract
Background This study aimed to demonstrate both the potential and development progress in the identification of extracapsular nodal extension in head and neck cancer patients prior to surgery. Methodology A deep learning model has been developed utilizing multilayer gradient mapping-guided explainable network architecture involving a volume extractor. In addition, the gradient-weighted class activation mapping approach has been appropriated to generate a heatmap of anatomic regions indicating why the algorithm predicted extension or not. Results The prediction model shows excellent performance on the testing dataset with high values of accuracy, the area under the curve, sensitivity, and specificity of 0.926, 0.945, 0.924, and 0.930, respectively. The heatmap results show potential usefulness for some select patients but indicate the need for further training as the results may be misleading for other patients. Conclusions This work demonstrates continued progress in the identification of extracapsular nodal extension in diagnostic computed tomography prior to surgery. Continued progress stands to see the obvious potential realized where not only can unnecessary multimodality therapy be avoided but necessary therapy can be guided on a patient-specific level with information that currently is not available until postoperative pathology is complete.
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Affiliation(s)
- William N Duggar
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | | | - Yibin Wang
- Industrial Systems and Engineering, Mississippi State University, Starkville, USA
| | - Abdur Rahman
- Industrial Systems and Engineering, Mississippi State University, Starkville, USA
| | - Haifeng Wang
- Industrial Systems and Engineering, Mississippi State University, Starkville, USA
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Paul R Roberts
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Linkan Bian
- Industrial Systems and Engineering, Mississippi State University, Starkville, USA
| | - Ronald T Gatewood
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
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12
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Washino S, Ito K, Miyagawa T. Prostate-specific antigen level, biopsy grade group, and tumor-capsular contact length on magnetic resonance imaging are independently associated with an extraprostatic extension. Int J Urol 2022; 29:1455-1461. [PMID: 36001632 DOI: 10.1111/iju.15012] [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: 11/28/2021] [Accepted: 07/21/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To define the clinicopathological and radiological factors independently associated with the existence of an extraprostatic extension in radical prostatectomy specimens. METHODS A total of 202 patients who underwent robotic prostatectomy following biparametric magnetic resonance imaging were assessed. We evaluated the clinicopathological and magnetic resonance imaging variables. We performed receiver-operating characteristic curve analyses to identify factors associated with extraprostatic extension. We engaged in multivariate analysis to identify factors independently associated with such extension. RESULTS Extraprostatic extensions were apparent in the final prostatectomy specimens of 62 patients (31%). The areas under the curves of the prostate-specific antigen level, the biopsy grade group, and the tumor-capsular contact length on magnetic resonance imaging were 0.76, 0.71, and 0.70, respectively, in receiver-operating characteristic analysis when used to predict extraprostatic extension; thus, higher than the areas under the curves of the other variables (0.61-0.68). The prostate-specific antigen level (odds ratio 1.090, p = 0.004), the biopsy grade group (odds ratios 2.678 and 6.358, p = 0.017 and p < 0.001 for grade group 3-4 and 5), and the tumor-capsular contact length (odds ratio 1.079, p = 0.001) were independently associated with extraprostatic extension. When the three factors were combined, the area under the receiver-operator characteristic curve increased to 0.79. CONCLUSIONS The prostate-specific antigen level, the biopsy grade group, and the tumor-capsular contact length on magnetic resonance imaging were independently associated with extracapsular extension.
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Affiliation(s)
- Satoshi Washino
- Department of Urology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Koichi Ito
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Tomoaki Miyagawa
- Department of Urology, Jichi Medical University Saitama Medical Center, Saitama, Japan
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Sun SW, Xu X, Liu QP, Chen JN, Zhu FP, Liu XS, Zhang YD, Wang J. LiSNet: An artificial intelligence -based tool for liver imaging staging of hepatocellular carcinoma aggressiveness. Med Phys 2022; 49:6903-6913. [PMID: 36134900 DOI: 10.1002/mp.15972] [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: 02/26/2022] [Revised: 08/01/2022] [Accepted: 08/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Presurgical assessment of hepatocellular carcinoma (HCC) aggressiveness can benefit patients' treatment options and prognosis. PURPOSE To develop an artificial intelligence (AI) tool, namely, LiSNet, in the task of scoring and interpreting HCC aggressiveness with computed tomography (CT) imaging. METHODS A total of 358 patients with HCC undergoing curative liver resection were retrospectively included. Three subspecialists were recruited to pixel-wise annotate and grade tumor aggressiveness based on CT imaging. LiSNet was trained and validated in 193 and 61 patients with a deep neural network to emulate the diagnostic acumen of subspecialists for staging HCC. The test set comprised 104 independent patients. We subsequently compared LiSNet with an experience-based binary diagnosis scheme and human-AI partnership that combined binary diagnosis and LiSNet for assessing tumor aggressiveness. We also assessed the efficiency of LiSNet for predicting survival outcomes. RESULTS At the pixel-wise level, the agreement rate of LiSNet with subspecialists was 0.658 (95% confidence interval [CI]: 0.490-0.779), 0.595 (95% CI: 0.406-0.734), and 0.369 (95% CI: 0.134-0.566), for scoring HCC aggressiveness grades I, II, and III, respectively. Additionally, LiSNet was comparable to subspecialists for predicting histopathological microvascular invasion (area under the curve: LiSNet: 0.668 [95% CI: 0.559-0.776] versus subspecialists: 0.699 [95% CI: 0.591-0.806], p > 0.05). In a human-AI partnered diagnosis, combining LiSNet and experience-based binary diagnosis can achieve the best predictive ability for microvascular invasion (area under the curve: 0.705 [95% CI: 0.589-0.820]). Furthermore, LiSNet was able to indicate overall survival after surgery. CONCLUSION The designed LiSNet tool warrants evaluation as an alternative tool for radiologists to conduct automatic staging of HCC aggressiveness at the pixel-wise level with CT imaging. Its prognostic value might benefit patients' treatment options and survival prediction.
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Affiliation(s)
- Shu Wen Sun
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Xun Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Qiu Ping Liu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Jie Neng Chen
- The College of Electronics and Information Engineering, Tongji University, Shanghai, China
| | - Fei Peng Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Xi Sheng Liu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Yu Dong Zhang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Jie Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
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14
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Chen L, Chen L, Liang Z, Shao Y, Sun X, Liu J. Value of Contrast-Enhanced Ultrasound in the Preoperative Evaluation of Papillary Thyroid Carcinoma Invasiveness. Front Oncol 2022; 11:795302. [PMID: 35096595 PMCID: PMC8795613 DOI: 10.3389/fonc.2021.795302] [Citation(s) in RCA: 2] [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: 10/14/2021] [Accepted: 12/17/2021] [Indexed: 01/20/2023] Open
Abstract
Objective To evaluate the diagnostic performance of preoperative contrast-enhanced ultrasound (CEUS) in the detection of extracapsular extension (ECE) and cervical lymph node metastasis (LNM) of papillary thyroid carcinoma (PTC) and the added value of CEUS in the evaluation of PTC invasiveness to conventional ultrasound (US). Materials and Methods A total of 62 patients were enrolled retrospectively, including 30 patients with invasive PTCs (Group A, ECE or LNM present) and 32 patients with non-invasive PTCs (Group B). All patients underwent US and CEUS examinations before surgery. US and CEUS features of PTCs and lymph nodes were compared between groups. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of US, CEUS, and the combination of the two in the detection of ECE and LNM of PTCs were calculated. Logistic regression was used to analyze relationships between variables. Results The PTC size was larger in group A on both US and CEUS (P = 0.001, P = 0.003). More PTCs showed hyper-enhancement in group A (P = 0.013) than in group B. More PTCs had >25% contact between PTC and the thyroid capsule and discontinued capsule on US and CEUS (all P < 0.05) in group A than in group B. More absent hilum and calcification of lymph nodes were observed in group A (both P < 0.05) than in group B on US. More centripetal perfusion and enlarged lymph nodes were observed in group A (both P < 0.05) than in group B on CEUS. CEUS alone and US combined with CEUS manifested higher diagnostic accuracy (79.0%) than US alone (72.6%) in the detection of ECE. The combination of US and CEUS manifested the highest diagnostic accuracy (95.2%) than CEUS alone (90.3%) and US alone (82.2%) in the detection of LNM. Diagnoses of ECE and LNM by the combination of US and CEUS were independent risk factors for PTC invasiveness [odds ratio (OR) = 29.49 and 97.20, respectively; both P = 0.001]. Conclusion CEUS or US combined with CEUS is recommended for the detection of PTC ECE, while the combination of US and CEUS is most recommended for LNM detection. CEUS plays an essential role in the preoperative evaluation of PTC invasiveness.
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Affiliation(s)
- Lei Chen
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Luzeng Chen
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Zhenwei Liang
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Yuhong Shao
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Xiuming Sun
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Jinghua Liu
- Department of Ultrasound, Peking University First Hospital, Beijing, China
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15
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Vengaloor Thomas T, Kanakamedala MR, Bhanat E, Abraham A, Mundra E, Albert AA, Giri S, Bhandari R, Vijayakumar S. Predictors of Extracapsular Extension in Patients With Squamous Cell Carcinoma of the Head and Neck and Outcome Analysis. Cureus 2021; 13:e16680. [PMID: 34466317 PMCID: PMC8392822 DOI: 10.7759/cureus.16680] [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] [Accepted: 07/27/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Extracapsular extension (ECE) in the lymph nodes for patients with head and neck cancer has been found to be a poor prognostic factor in multiple studies. The purpose of the study is to evaluate the predictive factors for ECE on computer tomography (CT) imaging for patients undergoing surgery and to analyze outcomes. Methods We conducted an Institutional Review Board-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective review of 82 patients with biopsy-proven squamous cell carcinomas of the head and neck who underwent definitive surgery without neoadjuvant chemotherapy or radiation therapy. CT scans were evaluated for the level of involvement, size, and presence or absence of central necrosis. Extracapsular extension in lymph nodes on the postoperative pathology was correlated with the central necrosis in the lymph nodes appreciated on the CT neck with contrast. Survival estimates were evaluated using the Kaplan-Meier test. Results ECE on postoperative pathology was seen in 74.07% of patients who had evidence of central necrosis in lymph nodes on preoperative CT neck compared to 46.43% without CT necrosis (p=0.013). The incidence of ECE is higher in poorly differentiated tumors and also nodal stages >N2c at presentation. Patents with ECE had inferior disease-free and overall survival (OS). Conclusions Our results reveal that patients with necrosis on CT and with moderately to poorly differentiated tumors have a high incidence of extracapsular extension. There was no difference in local control (LC) between the groups of patients, but the OS was inferior in patients with ECE. Predicting extracapsular extension upfront helps to formulate the appropriate treatment. We propose to study additional chemotherapy to improve outcomes in patients with positive extracapsular extension.
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Affiliation(s)
| | | | - Eldrin Bhanat
- Orthopaedic Surgery, University of Mississippi Medical Center, Jackson, USA
| | - Anu Abraham
- Pathology, Universtiy of Mississippi Medical Center, Jackson, USA
| | - Eswar Mundra
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Ashley A Albert
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Shankar Giri
- Radiation Oncology, G.V. (Sonny) Montgomery VA Medical Center, Jackson, USA
| | - Rahul Bhandari
- Radiation Oncology, G.V. (Sonny) Montgomery VA Medical Center, Jackson, USA
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Day AT, Yang AM, Tanamal P, Blackwell JM, Wang E, Sumer BD, Bishop JA, Hughes RS, Khan SA, Sher DJ. Extracapsular extension, pathologic node status, and adjuvant treatment in primary surgery patients with human papillomavirus-mediated oropharyngeal cancer: A national hospital-based retrospective cohort analysis. Head Neck 2021; 43:3345-3363. [PMID: 34331477 DOI: 10.1002/hed.26825] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 07/02/2021] [Accepted: 07/19/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The significance of extracapsular extension (ECE) and adjuvant treatment paradigm in patients with surgically managed human papillomavirus-positive (HPV+) oropharyngeal cancer (OPC) is debated. METHODS National, hospital-based, retrospective cohort study of 2663 patients pN+ HPV+ OPC who underwent primary surgery. RESULTS Patients with ECE had a 1.74-times risk of death (95% confidence interval [CI]: 1.26-2.40, p = 0.001) compared to patients without ECE. Among patients with pN1, ECE-positive disease, risk of overall mortality was similar across treatment paradigms (surgery alone: ref; adjuvant radiation therapy [RT]: aHR: 0.81; 95% CI: 0.36-1.85; p = 0.62; adjuvant CRT: aHR: 0.66; 95% CI: 0.34-1.32; p = 0.24). Patients with pN2 ECE-positive disease treated with adjuvant RT alone exhibited similar risk of all-cause mortality (hazard ratio: 1.04, 95% CI: 0.24-4.47, p = 0.96) compared to adjuvant chemoradiation (CRT). In patients with advanced, ECE-positive disease (e.g., pT3-T4pN2), adjuvant CRT did not reduce the risk of overall mortality relative to adjuvant RT. CONCLUSION Although pathologic ECE negatively predicts for survival in patients with HPV+ OPC, our analyses support expansion of postoperative de-intensification clinical trial eligibility criteria in patients with ECE-positive disease.
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Affiliation(s)
- Andrew T Day
- Department of Otolaryngology - Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Alex M Yang
- Department of Otolaryngology - Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Priscilla Tanamal
- Department of Otolaryngology - Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - James-Michael Blackwell
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ellen Wang
- Department of Otolaryngology - Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Baran D Sumer
- Department of Otolaryngology - Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Justin A Bishop
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Randall S Hughes
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Saad A Khan
- Department of Internal Medicine, Stanford Health Care, Palo Alto, California, USA
| | - David J Sher
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas, USA
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Bai H, Xia W, Ji X, He D, Zhao X, Bao J, Zhou J, Wei X, Huang Y, Li Q, Gao X. Multiparametric Magnetic Resonance Imaging-Based Peritumoral Radiomics for Preoperative Prediction of the Presence of Extracapsular Extension With Prostate Cancer. J Magn Reson Imaging 2021; 54:1222-1230. [PMID: 33970517 DOI: 10.1002/jmri.27678] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Preoperative prediction of extracapsular extension (ECE) of prostate cancer (PCa) is important to guide clinical decision-making and improve patient prognosis. PURPOSE To investigate the value of multiparametric magnetic resonance imaging (mpMRI)-based peritumoral radiomics for preoperative prediction of the presence of ECE. STUDY TYPE Retrospective. POPULATION Two hundred eighty-four patients with PCa from two centers (center 1: 226 patients; center 2: 58 patients). Cases from center 1 were randomly divided into training (158 patients) and internal validation (68 patients) sets. Cases from center 2 were assigned to the external validation set. FIELD STRENGTH/SEQUENCE A 3.0 T MRI scanners (three vendors). Sequence: Pelvic T2-weighted turbo/fast spin echo sequence and diffusion weighted echo planar imaging sequence. ASSESSMENT The peritumoral region (PTR) was obtained by 3-12 mm (half of the tumor length) 3D dilatation of the intratumoral region (ITR). Single-MRI radiomics signatures, mpMRI radiomics signatures, and integrated models, which combined clinical characteristics with the radiomics signatures were built. The discrimination ability was assessed by area under the receiver operating characteristic curve (AUC) in the internal and external validation sets. STATISTICAL TESTS Fisher's exact test, Mann-Whitney U-test, DeLong test. RESULTS The PTR radiomics signatures demonstrated significantly better performance than the corresponding ITR radiomics signatures (AUC: 0.674 vs. 0.554, P < 0.05 on T2-weighted, 0.652 vs. 0.546, P < 0.05 on apparent diffusion coefficient, 0.682 vs. 0.556 on mpMRI in the external validation set). The integrated models combining the PTR radiomics signature with clinical characteristics performed better than corresponding radiomics signatures in the internal validation set (eg. AUC: 0.718 vs. 0.671, P < 0.05 on mpMRI) but performed similar in the external validation set (eg. AUC: 0.684, vs. 0.682, P = 0.45 on mpMRI). DATA CONCLUSION The peritumoral radiomics can better predict the presence of ECE preoperatively compared with the intratumoral radiomics and may have better generalization than clinical characteristics. EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: 2.
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Affiliation(s)
- Honglin Bai
- School of Biomedical Engineering (Suzhou), Division of Life Science and Medicine, University of Science and Technology of China, Hefei, 230026, China.,Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163, China
| | - Wei Xia
- Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163, China
| | - Xuefu Ji
- The School of Electro-Optical Engineering, Changchun University of Science and Technology, Changchun, 130013, China
| | - Dong He
- Department of Urology, The First Affiliated Hospital of SooChow University, Suzhou, 215006, China
| | - Xingyu Zhao
- School of Biomedical Engineering (Suzhou), Division of Life Science and Medicine, University of Science and Technology of China, Hefei, 230026, China.,Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163, China
| | - Jie Bao
- Department of Radiology, The First Affiliated Hospital of SooChow University, Suzhou, 215006, China
| | - Jian Zhou
- Department of Radiology, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Xuedong Wei
- Department of Urology, The First Affiliated Hospital of SooChow University, Suzhou, 215006, China
| | - Yuhua Huang
- Department of Urology, The First Affiliated Hospital of SooChow University, Suzhou, 215006, China
| | - Qiong Li
- Department of Radiology, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Xin Gao
- Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163, China.,Department of Radiology, Shanxi Province Cancer Hospital, Shanxi Medical University, Taiyuan, 030013, China
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Merder E, Arıman A, Dinçer S, Altunrende F. Can we use neutrophil to lymphocyte ratio in the diagnosis and prediction of extracapsular extension in localized prostate cancer? Urologia 2021; 89:203-209. [PMID: 33960239 DOI: 10.1177/03915603211014864] [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] [Indexed: 11/16/2022]
Abstract
PURPOSE We investigated role of neutrophil-to-lymphocyte ratio (NLR) in the diagnosis and prediction of extracapsular extension (ECE) in clinically localized prostate cancer (PCa). MATERIALS AND METHODS A total of 396 patients with clinically localized PCa who underwent open radical retropubic prostatectomy (RRP), and 260 patients with benign prostatic hyperplasia (BPH) who underwent suprapubic prostatectomy were included in the study. Preoperative NLR, prostate specific antigen (PSA), prostate specific antigen density (PSAD), free PSA, prostate volume (PV), free/total PSA (f/t PSA) in both groups, and relation of NLR with PSA, Gleason Score (GS), and pathologic stage in PCa group were investigated. Records of patients were analyzed retrospectively. RESULTS NLR, free PSA, f/t PSA, and PV were statistically higher in BHP, and PSAD was higher in PCa group. In PCa group, NLR was found to be higher in patients with PSA >10 ng/ml compared to those with less than ⩽10 ng/ml. NLR increases as the preoperative GS increases, and it was higher in pT3 patients than pT2 patients. NLR was statistically higher in those patients with positive lymph nodes than those without after RRP (p = 0.029). CONCLUSION NLR is not a sufficient biomarker in differentiating clinically localized PCa from BPH. NLR increases as preoperative GS and pathologic stage increases. Lymph node involved patients after RRP have statistically higher NLR. NLR can be an indicator of ECE and lymph-node involvement in clinically localized PCa.
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Affiliation(s)
- Erkan Merder
- Urology, Prof.Dr.Cemil Taşçıoğlu City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ahmet Arıman
- Urology, Prof.Dr.Cemil Taşçıoğlu City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Selvi Dinçer
- Prof.Dr.Cemil Taşçıoğlu City Hospital Radiation Oncology, University of Health Sciences, Istanbul
| | - Fatih Altunrende
- Urology, Prof.Dr.Cemil Taşçıoğlu City Hospital, University of Health Sciences, Istanbul, Turkey
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Tirelli G, de Groodt J, Sia E, Belgrano MG, Degrassi F, Boscolo-Rizzo P, Cova MA, Marcuzzo AV. Accuracy of the Anatomage Table in detecting extranodal extension in head and neck cancer: a pilot study. J Med Imaging (Bellingham) 2021; 8:014502. [PMID: 33542944 DOI: 10.1117/1.jmi.8.1.014502] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 01/05/2021] [Indexed: 01/02/2023] Open
Abstract
Purpose: To assess whether the three-dimensional reconstructions of preoperative computed tomography (CT) scans are helpful for establishing extranodal extension (ENE) in head and neck carcinoma. Approach: Patients with a histological diagnosis of ENE ( pENE + ) were considered "cases" and patients with negative histological examination for ENE ( pENE - ) were considered "controls." Cases and controls were divided into two groups: a major nodes (MaN) group (lymph nodes on CT > 15 mm ) and a minor nodes (MiN) group (lymph nodes on CT ≤ 15 mm ). The preoperative CT scans were uploaded to the Anatomage Table and were randomly and blindly provided to the radiologist for assessment. The findings at the Anatomage Table were compared with those of CT and magnetic resonance imaging (MRI) scans. Results: Analysis of data from the MaN group showed that the Anatomage Table had a higher percentage of concordance with histopathological examination (90%) than the CT and MRI scans. The Anatomage Table had 100% sensitivity in identifying all pENE + patients, associated with a lower specificity. The negative predictive value of 100% allowed identification of pENE - patients. In the MiN group, on the other hand, sensitivity was lower, related to a high number of false-negative results. Conclusions: The Anatomage Table could represent a useful tool for preoperatively establishing the extranodal extension of cervical lymph node metastasis.
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Affiliation(s)
- Giancarlo Tirelli
- Azienda Sanitaria Universitaria Giuliano Isontina-ENT Clinic, Trieste, Italy
| | - Jasmina de Groodt
- Unit of Diagnostic and Interventional Radiology, Cattinara Hospital, ASUGI, Trieste, Italy
| | - Egidio Sia
- Azienda Sanitaria Universitaria Giuliano Isontina-ENT Clinic, Trieste, Italy
| | | | - Ferruccio Degrassi
- Unit of Diagnostic and Interventional Radiology, Cattinara Hospital, ASUGI, Trieste, Italy
| | - Paolo Boscolo-Rizzo
- University of Padua, Treviso Regional Hospital, Otolaryngology, Treviso, Italy
| | - Maria Assunta Cova
- Unit of Diagnostic and Interventional Radiology, Cattinara Hospital, ASUGI, Trieste, Italy
| | - Alberto Vito Marcuzzo
- Azienda Sanitaria Universitaria Giuliano Isontina-ENT Clinic, Trieste, Italy.,ENT and Head and Neck Surgery Clinic, Department of Medical, Surgical and Health Sciences, ASUGI, Trieste, Italy
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Bhalli H, Chen S, Day A, Tillman B, Gordin E, Truelson J, Sher D, Myers L, Gao J, Sumer BD. Factors Associated with Lymph Node Count in Mucosal Squamous Cell Carcinoma Neck Dissection. Laryngoscope 2021; 131:1516-1521. [PMID: 33393667 DOI: 10.1002/lary.29353] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/02/2020] [Accepted: 12/11/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE/HYPOTHESIS Decreased lymph node count (LNC) from neck dissection (ND) for mucosal head and neck squamous cell carcinoma (HNSCC) patients is correlated with decreased survival. Advanced age and low BMI due to undernutrition from dysphagia from advanced T-stage tumors are common in patients with HNSCC. We studied the relationship between these two well-described causes for immune dysfunction and LNC in patients undergoing neck dissection. STUDY DESIGN We conducted a retrospective review at a single tertiary care institution of patients with HNSCC that underwent neck dissection from 2006 to 2017. METHODS Stepwise linear and logistic regression analyses were performed on 247 subjects to identify independent significant factors associated with 1) the LNC per neck level dissected; 2) advanced T-stage. One-way ANOVA was utilized to demonstrate differences between the p16 positive and negative subgroups. RESULTS Low BMI (<23 vs. ≥23) (P = .03), extra nodal extension (ENE) (P = .0178), and advanced age (P = .005) were associated with decreased LNC per neck level dissected on multivariable analysis. Higher T-stage (P = .0005) was correlated with low BMI (<23) after controlling for the effects of tobacco, smoking, sex, ECE, and p16 status. p16+ patients, on average had higher BMI, were younger and produced a higher nodal yield (P < .0001, .007, and .035). CONCLUSIONS Patient intrinsic factors known to correlate with decreased immune function and worse outcomes, including p16 negative status, advanced age, and low BMI from undernutrition and ENE are associated with low nodal yield in neck dissections. LNC may be a metric for anti-tumor immune function that correlates with prognosis and T-stage. LEVEL OF EVIDENCE 3 Laryngoscope, 131:1516-1521, 2021.
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Affiliation(s)
- Hamza Bhalli
- University of Texas Southwestern Medical School, Dallas, Texas, U.S.A
| | - Shuqing Chen
- Department of Otolaryngology Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Andrew Day
- Department of Otolaryngology Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Brittny Tillman
- Department of Otolaryngology Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Eli Gordin
- Department of Otolaryngology Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - John Truelson
- Department of Otolaryngology Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - David Sher
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Larry Myers
- Department of Otolaryngology Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Jinming Gao
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Baran D Sumer
- Department of Otolaryngology Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
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21
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Liu H, Tang K, Xia D, Wang X, Zhu W, Wang L, Yang W, Peng E, Chen Z. Added Value of Biparametric MRI and TRUS-Guided Systematic Biopsies to Clinical Parameters in Predicting Adverse Pathology in Prostate Cancer. Cancer Manag Res 2020; 12:7761-7770. [PMID: 32922077 PMCID: PMC7457849 DOI: 10.2147/cmar.s260986] [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: 05/07/2020] [Accepted: 08/06/2020] [Indexed: 01/22/2023] Open
Abstract
Objective To develop novel models for predicting extracapsular extension (EPE), seminal vesicle invasion (SVI), or upgrading in prostate cancer (PCa) patients using clinical parameters, biparametric magnetic resonance imaging (bp-MRI), and transrectal ultrasonography (TRUS)-guided systematic biopsies. Patients and Methods We retrospectively collected data from PCa patients who underwent standard (12-core) systematic biopsy and radical prostatectomy. To develop predictive models, the following variables were included in multivariable logistic regression analyses: total prostate-specific antigen (TPSA), central transition zone volume (CTZV), prostate-specific antigen (PSAD), maximum diameter of the index lesion at bp-MRI, EPE at bp-MRI, SVI at bp-MRI, biopsy Gleason grade group, and number of positive biopsy cores. Three risk calculators were built based on the coefficients of the logit function. The area under the curve (AUC) was applied to determine the models with the highest discrimination. Decision curve analyses (DCAs) were performed to evaluate the net benefit of each risk calculator. Results A total of 222 patients were included in this study. Overall, 83 (37.4%), 75 (33.8%), and 107 (48.2%) patients had EPE, SVI, and upgrading at final pathology, respectively. The addition of bp-MRI data improved the discrimination of models for predicting SVI (0.807 vs 0.816) and upgrading (0.548 vs 0.625) but not EPE (0.766 vs 0.763). Similarly, models including clinical parameters, bp-MRI data, and information on systematic biopsies achieved the highest AUC in the prediction of EPE (0.842), SVI (0.913), and upgrading (0.794), and the three corresponding risk calculators yielded the highest net benefit. Conclusion We developed three easy-to-use risk calculators for the prediction of adverse pathological features based on patient clinical parameters, bp-MRI data, and information on systematic biopsies. This may be greatly beneficial to urologists in the decision-making process for PCa patients.
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Affiliation(s)
- Hailang Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, People's Republic of China
| | - Kun Tang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, People's Republic of China
| | - Ding Xia
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, People's Republic of China
| | - Xinguang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, People's Republic of China
| | - Wei Zhu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, People's Republic of China
| | - Liang Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, People's Republic of China
| | - Weimin Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, People's Republic of China
| | - Ejun Peng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, People's Republic of China
| | - Zhiqiang Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, People's Republic of China
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Hatten KM, Amin J, Isaiah A. Machine Learning Prediction of Extracapsular Extension in Human Papillomavirus-Associated Oropharyngeal Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2020; 163:992-999. [PMID: 32600154 DOI: 10.1177/0194599820935446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/25/2022]
Abstract
OBJECTIVE To determine whether machine learning (ML) can predict the presence of extracapsular extension (ECE) prior to treatment, using common oncologic variables, in patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC). STUDY DESIGN Retrospective database review. SETTING National Cancer Database study. METHODS All patients with HPV-associated OPSCC treated surgically between January 1, 2010, and December 31, 2015, were selected from the National Cancer Database. Patients were excluded if surgical pathology reports did not include information regarding primary tumor stage, number of metastatic regional lymph nodes, size of largest metastatic regional lymph node, and tumor grade. The data were split into a random distribution of 80% for training and 20% for testing with ML methods. RESULTS A total of 3753 adults with surgically treated HPV-associated OPSCC met criteria for inclusion in the study. Approximately 38% of these patients treated with surgical management demonstrated ECE. ML models demonstrated modest accuracy in predicting ECE, with the areas under the receiver operating characteristic curves ranging from 0.58 to 0.68. The conditional inference tree model (0.66) predicted the metastatic lymph node number to be the most important predictor of ECE. CONCLUSION Despite a large cohort and the use of ML algorithms, the power of clinical and oncologic variables to predict ECE in HPV-associated OPSCC remains limited.
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Affiliation(s)
- Kyle M Hatten
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Julian Amin
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Amal Isaiah
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Maryland, Baltimore, Maryland, USA
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Maráz R, Venczel L, Sikorszki L, Ambrózay É, Serfőző O, Rajtár M, Cserni G. [The importance of the extracapsular extension of the sentinel node metastasis in the surgical treatment of breast cancer]. Magy Seb 2020; 73:16-22. [PMID: 32172574 DOI: 10.1556/1046.73.2020.1.2] [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] [Indexed: 11/19/2022]
Abstract
Introduction: The introduction of sentinel node biopsy (SNB) has led to a significant decrease of axillary lymph node dissections (ALND). The importance of the extracapsular extension (ECE) in the sentinel lymph node (SN) remains unclear. Method: The data of 635 patients with T1-T2N0M0 invasive breast cancer who underwent SNB between 2014 and 2018 were retrospectively analysed. 25% of the SNB patients (158) had metastasis in the SNs. These patients were grouped based on the presence or absence of ECE. The main objective of our study was to analyse the occurrence of massive (>3) node metastasis in the case of ECE negative and ECE positive patients, where ALND was performed. Results: There were 91/158 patients (58%) in the ECE negative group and 67/158 patients (42%) in the ECE positive group. ALND was performed in 42% of the ECE negative and in 69% of the ECE positive patients. There were no significant differences in the mean age of the patients; size, histological type and grade of the tumours, presence of lymphovascular invasion and proportion of hormone and HER2 receptor positivities. In the ECE negative ALND group, pN1 involvement was 82%, pN2+pN3 involvement represented 18% of cases. In the ECE positive ALND group, pN1 involvement was 60%, pN2+pN3 involvement was found in 40% of cases. The presence of ECE was associated with greater axillary disease burden. These results show a significant difference (p = 0.038). Conclusions: ECE of the SN is an important predictor for non-sentinel lymph node involvement. These data suggest, when ECE is confirmed, it is a further factor to be considered in deciding about ALND.
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Affiliation(s)
- Róbert Maráz
- Általános Sebészeti Osztály, Bács-Kiskun Megyei Kórház, a Szegedi Tudományegyetem Általános Orvostudományi Kar Oktatókórháza 6000 Kecskemét, Nyíri út 38.,Onkoradiológiai Központ, Bács-Kiskun Megyei Kórház, a Szegedi Tudományegyetem Általános Orvostudományi Kar Oktatókórháza Kecskemét
| | - László Venczel
- Általános Sebészeti Osztály, Bács-Kiskun Megyei Kórház, a Szegedi Tudományegyetem Általános Orvostudományi Kar Oktatókórháza 6000 Kecskemét, Nyíri út 38
| | - László Sikorszki
- Általános Sebészeti Osztály, Bács-Kiskun Megyei Kórház, a Szegedi Tudományegyetem Általános Orvostudományi Kar Oktatókórháza 6000 Kecskemét, Nyíri út 38
| | - Éva Ambrózay
- Kecskeméti Centrum, MaMMa Egészségügyi Zrt. Kecskemét
| | | | - Mária Rajtár
- Nukleáris Medicina Osztály, Bács-Kiskun Megyei Kórház, a Szegedi Tudományegyetem Általános Orvostudományi Kar Oktatókórháza Kecskemét
| | - Gábor Cserni
- Általános Patológiai Osztály, Bács-Kiskun Megyei Kórház, a Szegedi Tudományegyetem Általános Orvostudományi Kar Oktatókórháza Kecskemét.,Általános Orvostudományi Kar, Patológiai Intézet, Szegedi Tudományegyetem Szeged
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24
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Sheppard SC, Giger R, Bojaxhiu B, Sachpekidis C, Dammann F, Dettmer MS, Arnold A, Wartenberg J, Nisa L. Multimodal Imaging With Positron Emission Tomography/Computed Tomography and Magnetic Resonance Imaging to Detect Extracapsular Extension in Head and Neck Cancer. Laryngoscope 2020; 131:E163-E169. [PMID: 32142169 DOI: 10.1002/lary.28602] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/22/2020] [Accepted: 02/10/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess the ability of specific positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI) features to detect extracapsular extension (ECE) in head and neck squamous cell carcinoma (HNSCC) patients. STUDY DESIGN Retrospective study in a tertiary certified university cancer institute. METHODS We performed a review of patients with advanced HNSCC at Bern University Hospital between 2014 and 2018. Patients with pretherapeutic PET/CT and/or MRI who underwent neck dissection were included, with 212 patients fulfilling inclusion criteria. Blinded evaluation of specific PET/CT and MRI features with respect to presence of ECE was performed. Histopathological examination of neck dissection specimens was used as the gold standard to determine ECE status. RESULTS Out of the 212 included patients, 184 had PET/CT, 186 MRI, and 158 both modalities. Overall clinical stage IV (odds ratio [OR]: 2.26, 95% confidence interval [CI]: 2.25-11.74), ill-defined margins in both PET/CT and MRI (OR: 3.48, 95% CI: 1.21-9.98 and OR: 2.14, 95% CI: 0.94-4.89, respectively), and a maximum standardized uptake value ≥ 10 (OR: 5.44, 95% CI: 1.21-9.98) were all significant independent predictors of ECE. When combined, these four features led to a cumulative score able to predict ECE status with an accuracy of 91.43%. CONCLUSIONS The current findings indicate specific features in PET/CT and MRI are potential predictors of ECE status and may help in pretherapeutic stratification in HNSCC. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E163-E169, 2021.
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Affiliation(s)
- Sean C Sheppard
- Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Beat Bojaxhiu
- Institute of Nuclear Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Christos Sachpekidis
- Institute of Nuclear Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Florian Dammann
- Department of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | | | - Andreas Arnold
- Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Jan Wartenberg
- Institute of Nuclear Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Lluís Nisa
- Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.,Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.,Department of Biomedical Research, University of Bern, Bern, Switzerland
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25
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Ma S, Xie H, Wang H, Han C, Yang J, Lin Z, Li Y, He Q, Wang R, Cui Y, Zhang X, Wang X. MRI-Based Radiomics Signature for the Preoperative Prediction of Extracapsular Extension of Prostate Cancer. J Magn Reson Imaging 2019; 50:1914-1925. [PMID: 31062459 DOI: 10.1002/jmri.26777] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [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: 03/20/2019] [Revised: 04/19/2019] [Accepted: 04/22/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Radiomics approaches based on multiparametric MRI (mp-MRI) have shown high accuracy in prostate cancer (PCa) management. However, there is a need to apply radiomics to the preoperative prediction of extracapsular extension (ECE). PURPOSE To develop and validate a radiomics signature to preoperatively predict the probability of ECE for patients with PCa, compared with the radiologists' interpretations. STUDY TYPE Retrospective. POPULATION In total, 210 patients with pathology-confirmed ECE status (101 positive, 109 negative) were enrolled. FIELD STRENGTH/SEQUENCE T2 -weighted imaging (T2 WI), diffusion-weighted imaging, and dynamic contrast-enhanced imaging were performed on two 3.0T MR scanners. ASSESSMENT A radiomics signature was constructed to predict the probability of ECE prior to radical prostatectomy (RP). In all, 17 stable radiomics features of 1619 extracted features based on T2 WI were selected. The same images were also evaluated by three radiologists. The predictive performance of the radiomics signature was validated and compared with radiologists' interpretations. STATISTICAL TESTS A radiomics signature was developed by a least absolute shrinkage and selection operator (LASSO) regression algorithm. Samples enrolled were randomly divided into two groups (143 for training and 67 for validation). Discrimination, calibration, and clinical usefulness were validated by analysis of the receiver operating characteristic (ROC) curve, calibration curve, and the decision curve, respectively. The predictive performance was then compared with visual assessments of three radiologists. RESULTS The radiomics signature yielded an AUC of 0.902 and 0.883 in the training and validation cohort, respectively, and outperformed the visual assessment (AUC: 0.600-0.697) in the validation cohort. Pairwise comparisons demonstrated that the radiomics signature was more sensitive than the radiologists (75.00% vs. 46.88%-50.00%, all P < 0.05), but obtained comparable specificities (91.43% vs. (88.57%-94.29%); P ranged from 0.64-1.00). DATA CONCLUSION A radiomics signature was developed and validated that outperformed the radiologists' visual assessments in predicting ECE status. LEVEL OF EVIDENCE 4 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;50:1914-1925.
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Affiliation(s)
- Shuai Ma
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Huihui Xie
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Huihui Wang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Chao Han
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Jiejin Yang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Zhiyong Lin
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Yifan Li
- Department of Urology, Peking University First Hospital and Institute of Urology, Peking University, Beijing, China
| | - Qun He
- Department of Urology, Peking University First Hospital and Institute of Urology, Peking University, Beijing, China
| | - Rui Wang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Yingpu Cui
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Xiaodong Zhang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Xiaoying Wang
- Department of Radiology, Peking University First Hospital, Beijing, China
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Abstract
OBJECTIVES To update the algorithm for performing incremental nerve sparing (NS) using our multiparametric magnetic resonance imaging (mpMRI)-based nomogram. PATIENTS AND METHODS We applied the coefficients of the nomogram to the observations extracted from our population of patients who underwent robot-assisted radical prostatectomy between February 2014 and October 2015 and who received preoperative mpMRI. The information considered were PSA level, highest side-specific biopsy Gleason grade group, highest ipsilateral percentage core involvement with the highest Gleason grade group, and extracapsular extension (ECE) on mpMRI. The nomogram-derived probability [P (%)], after internal validation, was used as the independent variable on a classification tree to identify the most significant thresholds for ECE prediction. Incremental NS was performed as follows: Grade 1 NS: intrafascial dissection between the peri-prostatic veins and the pseudocapsule of the prostate; Grade 2 NS: inter-fascial dissection along the peri-venous plane; Grade 3 NS: inter-fascial dissection through the outer compartment of the lateral prostatic fascia; Grade 4 NS: extrafascial dissection. RESULTS Data from 561 patients were considered, and 829 prostatic lobes with biopsy-documented tumour were analysed. Overall, 142 lobes presented ECE that was focal in 27 (19%) cases. The classification tree identified four risk categories. In the low- [P (%) ≤10], intermediate- [P (%) 10-21], high [P (%) 21-73] and very-high-risk [P(%) >73] groups, the ECE rates were 3.3%, 16%, 61.6% and 90%, respectively. Amongst those, ECE was focal in 41.7%, 31.7%, 7.9% and 0%, respectively. CONCLUSION We suggest that Grade 1 NS (intrafascial) should be performed in the low-risk group. The inter-fascial approach, namely grades 2 and 3 NS, should be performed in the intermediate- and high-risk categories, respectively. Grade 4 NS (extrafascial) should be performed in the very-high-risk group. The current algorithm yields a better accuracy than the previous one; however, prospective validation is warranted.
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Affiliation(s)
- Alberto Martini
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shivaram Cumarasamy
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenneth G Haines
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashutosh K Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Martini A, Gupta A, Lewis SC, Cumarasamy S, Haines KG, Briganti A, Montorsi F, Tewari AK. Development and internal validation of a side-specific, multiparametric magnetic resonance imaging-based nomogram for the prediction of extracapsular extension of prostate cancer. BJU Int 2018. [PMID: 29676063 DOI: 10.1111/bju.14353)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To develop a nomogram for predicting side-specific extracapsular extension (ECE) for planning nerve-sparing radical prostatectomy. MATERIALS AND METHODS We retrospectively analysed data from 561 patients who underwent robot-assisted radical prostatectomy between February 2014 and October 2015. To develop a side-specific predictive model, we considered the prostatic lobes separately. Four variables were included: prostate-specific antigen; highest ipsilateral biopsy Gleason grade; highest ipsilateral percentage core involvement; and ECE on multiparametric magnetic resonance imaging (mpMRI). A multivariable logistic regression analysis was fitted to predict side-specific ECE. A nomogram was built based on the coefficients of the logit function. Internal validation was performed using 'leave-one-out' cross-validation. Calibration was graphically investigated. The decision curve analysis was used to evaluate the net clinical benefit. RESULTS The study population consisted of 829 side-specific cases, after excluding negative biopsy observations (n = 293). ECE was reported on mpMRI and final pathology in 115 (14%) and 142 (17.1%) cases, respectively. Among these, mpMRI was able to predict ECE correctly in 57 (40.1%) cases. All variables in the model except highest percentage core involvement were predictors of ECE (all P ≤ 0.006). All variables were considered for inclusion in the nomogram. After internal validation, the area under the curve was 82.11%. The model demonstrated excellent calibration and improved clinical risk prediction, especially when compared with relying on mpMRI prediction of ECE alone. When retrospectively applying the nomogram-derived probability, using a 20% threshold for performing nerve-sparing, nine out of 14 positive surgical margins (PSMs) at the site of ECE resulted above the threshold. CONCLUSION We developed an easy-to-use model for the prediction of side-specific ECE, and hope it serves as a tool for planning nerve-sparing radical prostatectomy and in the reduction of PSM in future series.
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Affiliation(s)
- Alberto Martini
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Akriti Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sara C Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shivaram Cumarasamy
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenneth G Haines
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alberto Briganti
- Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Ashutosh K Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Delouya G, Tiberi D, Bhatnagar SR, Campeau S, Saad F, Taussky D. Impact of adipose tissue on prostate cancer aggressiveness - analysis of a high-risk population. Horm Mol Biol Clin Investig 2018; 36:hmbci-2018-0049. [PMID: 30471220 DOI: 10.1515/hmbci-2018-0049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 07/06/2018] [Accepted: 09/11/2018] [Indexed: 12/15/2022]
Abstract
Background We investigated whether visceral adiposity is associated with more aggressive disease at prostatectomy. Materials and methods Four hundred and seventy-four patients referred for postoperative adjuvant or salvage radiotherapy were included in this study. Primary endpoints were positive surgical margins (pSM) or extracapsular extension (ECE). Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were manually contoured. Univariate and multivariate logistic regression was performed. Results In univariate analysis, VAT volume (p = 0.006), adipose tissue ratio (VAT/SAT, p = 0.003), density of the SAT (p = 0.04), as well as age (p < 0.001) were associated with pSM. In the univariate analysis, SAT density was associated with a trend towards a higher rate of ECE (p = 0.051) but visceral fat volume (p = 0.01), as well as the adipose tissue ratio (p = 0.03) were both protective factors. None of the adipose tissue measurements or BMI had an influence on biochemical recurrence or overall survival (all p ≥ 0.5). Conclusions SAT-volume and increased SAT-density were generally associated with more aggressive prostate cancers whereas VAT as a protective factor. These findings emphasize a possible mechanism for the association between obesity and prostate cancer aggressiveness.
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Affiliation(s)
- Guila Delouya
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada.,CRCHUM-Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - David Tiberi
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Sahir R Bhatnagar
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC H3A 1A2, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Côte Ste. Catherine, Montreal, QC H3T 1E2, Canada
| | - Shanie Campeau
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Fred Saad
- Department of Urology, University of Montreal Health Center, Montreal, Canada
| | - Daniel Taussky
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada.,CRCHUM-Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
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Varra V, Woody NM, Reddy C, Joshi NP, Geiger J, Adelstein DJ, Burkey BB, Scharpf J, Prendes B, Lamarre ED, Lorenz R, Gastman B, Manyam BV, Koyfman SA. Suboptimal Outcomes in Cutaneous Squamous Cell Cancer of the Head and Neck with Nodal Metastases. Anticancer Res 2018; 38:5825-5830. [PMID: 30275206 DOI: 10.21873/anticanres.12923] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 08/06/2018] [Revised: 08/23/2018] [Accepted: 08/24/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND/AIM There are limited data regarding survival, failure patterns, and factors associated with disease recurrence in patients with cutaneous squamous cell cancer of the head and neck (cSCC-HN) with nodal metastases. PATIENTS AND METHODS A retrospective analysis of patients with cSCC-HN metastatic to cervical and/or parotid lymph nodes treated with surgery and post-operative radiation therapy was performed. RESULTS This study included 76 patients (57 immunocompetent and 18 immunosuppressed) with a median follow-up of 18 months. Overall survival, disease-free survival (DFS), and disease recurrence (DR) at 2 years was 60%, 49%, and 40%, respectively. Immunosuppressed patients had significantly lower 2-year DFS (28% vs. 55%; p=0.003) and higher DR (61% vs. 34%; p=0.04) compared to immunocompetent patients. Analysis of immunocompetent patients demonstrated extracapsular extension (ECE) as the only factor associated with DR (p<0.0001). CONCLUSION Patients with nodal metastases from cSCC-HN have suboptimal outcomes. ECE and immunosuppression were significantly associated with DR.
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Affiliation(s)
- Vamsi Varra
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Neil M Woody
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Chandana Reddy
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Nikhil P Joshi
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Jessica Geiger
- Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, OH, U.S.A
| | - David J Adelstein
- Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Brian B Burkey
- Department of Otolaryngology, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Joseph Scharpf
- Department of Otolaryngology, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Brandon Prendes
- Department of Otolaryngology, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Eric D Lamarre
- Department of Otolaryngology, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Robert Lorenz
- Department of Otolaryngology, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Brian Gastman
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Bindu V Manyam
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, U.S.A.
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Kanyılmaz G, Fındık S, Yavuz BB, Aktan M. The Significance of Extent of Extracapsular Extension in Patients with T1-2 and N1 Breast Cancer. Eur J Breast Health 2018; 14:218-224. [PMID: 30288496 DOI: 10.5152/ejbh.2018.4038] [Citation(s) in RCA: 6] [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] [Received: 03/02/2018] [Accepted: 06/20/2018] [Indexed: 11/22/2022]
Abstract
Objective The prognostic importance of extracapsular extension (ECE) in breast cancer is not yet clear, especially in patients with pathological T1-2 and N1 (pT1-2N1) disease. We aimed to investigate whether the extent of ECE was an independent prognostic factor for survival outcomes in patients with pT1-2N1 breast cancer. Materials and Methods A total number of 131 patients with pT1-2N1 breast cancer treated between 2009 and 2015 were retrospectively evaluated. A single pathologist re-analyzed the histologic examples of all cases. The extent of ECE was graded from 0 to 4. Results There was a significant correlation between the number of lymph nodes involved and ECE grade (p=0.004). According to the univariate analysis, lymphovascular invasion (LVI) and ECE grade were the significant prognostic factors for overall survival (OS); age, number of metastatic lymph nodes, menopausal status, and ECE grade were the prognostic factors for disease-free survival (DFS). With a median follow-up of 46 months, grade 3-4 ECE seems to be notably associated with a shorter OS and DFS in multivariate analysis. The mean OS was 85 months for the patients with grade 0-2 ECE vs 75 months for the patients with grade 3-4 ECE (p=0.003). The mean DFS was 83 months for the patients with grade 0-3 ECE vs 68 months for the patients with grade 4 ECE (p=<0.0001). Conclusion This research has shown that the extent of ECE is an important prognostic factor for survival in pT1-2N1 breast cancer patients and grade 3-4 ECE seems to be notably associated with a shorter OS and DFS.
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Affiliation(s)
- Gül Kanyılmaz
- Department of Radiation Oncology, Necmettin Erbakan University Meram Medicine School, Konya, Turkey
| | - Sıddıka Fındık
- Department of Pathology, Necmettin Erbakan University Meram Medicine School, Konya, Turkey
| | - Berrin Benli Yavuz
- Department of Radiation Oncology, Necmettin Erbakan University Meram Medicine School, Konya, Turkey
| | - Meryem Aktan
- Department of Radiation Oncology, Necmettin Erbakan University Meram Medicine School, Konya, Turkey
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Wang HM, Liao CT, Yen TC, Chen SJ, Lee LY, Hsieh CH, Lin CY, Ng SH. Clues toward precision medicine in oral squamous cell carcinoma: utility of next-generation sequencing for the prognostic stratification of high-risk patients harboring neck lymph node extracapsular extension. Oncotarget 2016; 7:63082-92. [PMID: 27590518 DOI: 10.18632/oncotarget.11762] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 08/26/2016] [Indexed: 02/03/2023] Open
Abstract
Patients with resected oral squamous cell carcinoma (OSCC) harboring extracapsular extension (ECE) of the involved lymph node, show poor and heterogeneous outcomes. We aim to improve their prognostic stratification by combining genetic information from next-generation sequencing (NGS) using traditional clinicopathological prognosticators. The hotspot mutation regions of 45 cancer-related genes were investigated using NGS with an ultra-deep (>1000×) sequencing approach in formalin-fixed paraffin-embedded samples obtained from 201 patients with resected OSCC harboring ECE. Adjuvant chemoradiotherapy (CRT) and the number of nodes with ECE were the most important traditional prognosticators for disease-specific survival (DSS). The 5-year DSS for patients with CRT versus without, was 55% versus 21% (P < 0.001), and that for 1-3 versus ≥ 4 ECEs was 60% versus 25% (P = 0.001), respectively. Multivariate analysis in patients who received adjuvant CRT for 1-3 ECEs (i.e., those with a favorable expected prognosis) identified the following adverse prognostic factors: 1) margin of < 5 mm for locoregional failure (66% versus 30%, P = 0.007) and DSS (42% versus 63%, P = 0.039); 2) HRAS mutation for distant failure (55% versus 25%, P = 0.007) and DSS (36% versus 63%, P = 0.024); and 3) TP53 DNA-binding domain missense mutations for DSS (52% versus 71%, P = 0.025) and overall survival (39% versus 61%, P = 0.007).We conclude that genetic information from NGS may improve the prognostic stratification offered by traditional prognosticators in resected OSCC patients with ECE. Our findings will contribute to implementation of precision medicine in OSCC patients.
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Sertdemir M, Weidner AM, Schoenberg SO, Morelli JN, Haecker A, Kirchner M, Weiss C, Hausmann D, Dinter DJ, Attenberger UI. Is There a Role for Functional MRI for the Assessment of Extracapsular Extension in Prostate Cancer? Anticancer Res 2018; 38:427-432. [PMID: 29277805 DOI: 10.21873/anticanres.12240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 10/16/2017] [Revised: 11/06/2017] [Accepted: 11/08/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Exctracapsular extension (ECE) in prostate cancer has a high impact on treatment decision. MRI might predict presence of ECE non-invasively. PATIENTS AND METHODS Triplanar T2w-sequences, DWI (diffusion weighted imaging) and DCE (dynamic contrast-enhanced imaging) of 34 patients with PCa were analyzed to prior prostatectomy. Sensitivity (SS) and specificity (SP) of T2w, apparent diffusion coefficient (ADC), plasma flow (PF) and mean transit time (MTT) normalized by PCa/normal tissue ratio for prediction of CI (capsular infiltration)/ECE were determined by area-under-the-receiver-operating-characteristics analysis. RESULTS SS/SP for detecting ECE was 29/85. AUC (area under the curve) of ECE cases was 0.98/0.92/0.69 (cut-off-ratios 3.2/0.51/0.46), SS 93/100/86% and SP 95/80/50% for PF-/MTT-/ADC-ratios, respectively. PF- and MTT-ratios between CI and without CI/ECE differed significantly (PF, p<0.0001; MTT, p=0.0134) with SS/SP 84/89% for PF and SS/SP 52/100% for MTT-ratios. No significant differences regarding ADC-ratios were identified. CONCLUSION ECE/CI can be assessed by quantitative DCE analysis with great diagnostic confidence and higher specificity than ADC.
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Affiliation(s)
| | - Anja M Weidner
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany
| | - John N Morelli
- Department of Radiology, St. John's Medical Center, Tulsa, OK, U.S.A
| | - Axel Haecker
- Department of Urology, University Medical Center Mannheim, Mannheim, Germany
| | - Matthias Kirchner
- Institute of Pathology, University Medical Center Mannheim, Mannheim, Germany
| | - Christel Weiss
- Department of Biostatistics, University Medical Center Mannheim, Mannheim, Germany
| | - Daniel Hausmann
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany
| | | | - Ulrike I Attenberger
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany
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Patel VR, Sandri M, Grasso AAC, De Lorenzis E, Palmisano F, Albo G, Coelho RF, Mottrie A, Harvey T, Kameh D, Palayapalayam H, Wiklund P, Bosari S, Puliatti S, Zuccolotto P, Bianchi G, Rocco B. A novel tool for predicting extracapsular extension during graded partial nerve sparing in radical prostatectomy. BJU Int 2017; 121:373-382. [PMID: 28941058 DOI: 10.1111/bju.14026] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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: 11/29/2022]
Abstract
OBJECTIVES To create a statistical tool for the estimation of extracapsular extension (ECE) level of prostate cancer and determine the nerve-sparing (NS) approach that can be safely performed during radical prostatectomy (RP). PATIENTS AND METHODS A total of 11 794 lobes, from 6 360 patients who underwent robot-assisted RP between 2008 and 2016 were evaluated. Clinicopathological features were included in a statistical algorithm for the prediction of the maximum ECE width. Five multivariable logistic models were estimated for: presence of ECE and ECE width of >1, >2, >3, and >4 mm. A five-zone decision rule based on a lower and upper threshold is proposed. Using a graphical interface, surgeons can view patient's pre-treatment characteristics and a curve showing the estimated probabilities for ECE amount together with the areas identified by the decision rule. RESULTS Of the 6 360 patients, 1 803 (28.4%) were affected by non-organ-confined disease. ECE was present in 1 351 lobes (11.4%) and extended beyond the capsule for >1, >2, >3, and >4 mm in 498 (4.2%), 261 (2.2%), 148 (1.3%), 99 (0.8%) cases, respectively. ECE width was up to 15 mm (interquartile range 1.00-2.00). The five logistic models showed good predictive performance, the area under the receiver operating characteristic curve was: 0.81 for ECE, and 0.84, 0.85, 0.88, and 0.90 for ECE width of >1, >2, >3, and >4 mm, respectively. CONCLUSION This novel tool predicts with good accuracy the presence and amount of ECE. Furthermore, the graphical interface available at www.prece.it can support surgeons in patient counselling and preoperative planning.
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Affiliation(s)
- Vipul R Patel
- Global Robotics Institute, Florida Hospital-Celebration Health Celebration, University of Central Florida School of Medicine, Orlando, FL, USA
| | - Marco Sandri
- Data Methods and Systems Statistical Laboratory, University of Brescia, Brescia, Italy
| | - Angelica A C Grasso
- Department of Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Policlinico, University of Milan, Milan, Italy
| | - Elisa De Lorenzis
- Department of Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Policlinico, University of Milan, Milan, Italy
| | - Franco Palmisano
- Department of Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Policlinico, University of Milan, Milan, Italy
| | - Giancarlo Albo
- Department of Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Policlinico, University of Milan, Milan, Italy
| | - Rafael F Coelho
- Department of Urology, Instituto do Cancer, Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas, Sao Paulo, SP, Brazil
| | - Alexander Mottrie
- Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.,OLV Vattikuti Robotic Surgery Institute, Melle, Belgium
| | - Tadzia Harvey
- Global Robotics Institute, Florida Hospital-Celebration Health Celebration, University of Central Florida School of Medicine, Orlando, FL, USA
| | - Darian Kameh
- Global Robotics Institute, Florida Hospital-Celebration Health Celebration, University of Central Florida School of Medicine, Orlando, FL, USA
| | - Hariharan Palayapalayam
- Global Robotics Institute, Florida Hospital-Celebration Health Celebration, University of Central Florida School of Medicine, Orlando, FL, USA
| | - Peter Wiklund
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Silvano Bosari
- Division of Pathology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Policlinico, University of Milan, Milan, Italy
| | - Stefano Puliatti
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Zuccolotto
- Big & Open Data Innovation Laboratory, University of Brescia, Brescia, Italy
| | - Giampaolo Bianchi
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
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Chen Y, Yu W, Fan Y, Zhou L, Yang Y, Wang H, Jiang Y, Wang X, Wu S, Jin J. Development and comparison of a Chinese nomogram adding multi-parametric MRI information for predicting extracapsular extension of prostate cancer. Oncotarget 2017; 8:22095-103. [PMID: 27564265 DOI: 10.18632/oncotarget.11559] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 07/10/2016] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To improve the performation of a nomogram for predicting side-specific extracapsular extension (SS-ECE). RESULTS One hundred and ninety-six patients (55.5%) had ECE on final pathology. Bilateral and unilateral ECE rate was 13.9% (49/353) and 41.6% (147/353), respectively. The mean age was 65.9 years and the mean serum prostate specific antigen (PSA) was 15.0 ng/ml. Based on multivariate logistic regression analysis, clinical stage (cStage), PSA, Gleason sum, percentage of positive cores, and ECE risk score were significant predictors of ECE. The current nomogram had higher predictive accuracy (0.851) and superior calibration. According to the decision curve analysis (DCA) results, the updated nomogram demonstrated a high net benefit across a wide range of threshold probabilities. MATERIALS AND METHODS We studied 353 patients with cStage T1c-T3 prostate cancer underwent radical prostatectomy. The candidate predictors associated with ECE were cStage, PSA, Gleason sum, percentage of positive cores, maximum cancer percentage and ECE risk score from multi-parametric magnetic resonance imaging (MP-MRI). The receiver operating characteristic (ROC) analysis was performed and an updated nomogram was constructed. The DCA was performed to test the predictive ability of the nomogram. In addition, the validation and calibration of the Memorial Sloan-Kettering cancer center (MSKCC) nomograms were performed in the current subjects. CONCLUSIONS Predictors, including cStage, PSA, Gleason sum, percentage of positive cores, maximum cancer percentage, and ECE risk score, were combined to construct a SS-ECE prediction nomogram. And the current nomogram might help urologists in decision-making process of preserving or resecting neurovascular bundles preoperatively.
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Giacalone NJ, Qureshi MM, Mak KS, Kirke D, Patel SA, Shah BA, Salama AR, Jalisi S, Truong MT. Adjuvant chemoradiation does not improve survival in elderly patients with high-risk resected head and neck cancer. Laryngoscope 2017; 128:831-840. [PMID: 28833217 DOI: 10.1002/lary.26798] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 03/28/2017] [Revised: 06/06/2017] [Accepted: 06/21/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Randomized trials have demonstrated that adjuvant chemoradiotherapy (CRT) confers an overall survival (OS) benefit over adjuvant radiation therapy (RT) alone in patients with resected head and neck squamous cell carcinoma (HNSCC) with adverse pathologic features (positive surgical margins [SM+] and/or extracapsular extension [ECE]). Whether this OS benefit exists in an elderly population remains unknown. STUDY DESIGN Retrospective database study. METHODS Using the National Cancer Database, we identified 1,686 elderly patients (age ≥70 years) with resected HNSCC with SM+ and/or ECE, who received adjuvant CRT (491 patients, 29%) or adjuvant RT alone (1,195 patients, 71%) between 1998 and 2011. Three-year survival rates were estimated using the Kaplan-Meier method both before and after propensity score matching (PSM). Crude and adjusted hazard ratios (HR) with 95% confidence intervals (CI) were computed using Cox regression modeling. RESULTS Median follow-up was 23.5 and 42.8 months for all and surviving patients, respectively. Three-year OS was 50.7% and 44.4% among patients receiving adjuvant CRT and RT alone, respectively (P = .002). On multivariate analysis, there was no significant improvement in OS with adjuvant CRT relative to adjuvant RT alone (HR: 0.88, 95% CI: 0.73-1.06). Similarly, a PSM cohort showed no significant difference in the 3-year OS for patients receiving adjuvant CRT versus adjuvant RT alone (48.8% and 50.9%, respectively; P = .839). CONCLUSIONS Although the addition of chemotherapy to adjuvant RT has been proven effective in randomized trials of patients with resected HNSCC with SM+ or ECE, it may be less efficacious in an elderly patient population treated outside of a controlled trial setting. LEVEL OF EVIDENCE 2c. Laryngoscope, 128:831-840, 2018.
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Affiliation(s)
- Nicholas J Giacalone
- Harvard Radiation Oncology Program, Boston, Massachusetts, U.S.A.,Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Muhammad M Qureshi
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Kimberley S Mak
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Diana Kirke
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Sagar A Patel
- Harvard Radiation Oncology Program, Boston, Massachusetts, U.S.A.,Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Bhartesh A Shah
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Andrew R Salama
- Department of Oral and Maxillofacial Surgery, Boston Medical Center, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, U.S.A
| | - Scharukh Jalisi
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Minh Tam Truong
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
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Curry J, Tassone P, Gill K, Tuluc M, BarAd V, Mollaee M, Whitaker-Menezes D, Rodeck U, Luginbuhl A, Cognetti D, Keane W, Martinez-Outschoorn U. Tumor Metabolism in the Microenvironment of Nodal Metastasis in Oral Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2017; 157:798-807. [PMID: 28608777 DOI: 10.1177/0194599817709224] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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] [Indexed: 12/15/2022]
Abstract
Objective In many cancers, including head and neck squamous cell carcinoma (HNSCC), different regions within a tumor have different metabolic phenotypes. Transfer of metabolites between compartments promotes tumor growth and aggressive behavior. Metabolic compartmentalization in HNSCC nodal metastases has not been studied, nor has its impact on extracapsular extension or clinical outcomes been determined. Study Design Retrospective analysis based on immunohistochemistry staining. Setting Tertiary care center. Subjects and Methods Primary tumors and nodal metastases from 34 surgically treated oral cavity HNSCC patients with extracapsular extension (ECE) were stained for monocarboyxlate transporter (MCT) 4, MCT1, translocase of outer mitochondrial membrane 20, and Ki-67. Strength of staining was assessed using a computer-assisted pathology algorithm. Immunohistochemistry (IHC) scores along with clinical factors were used to predict disease-free survival (DFS). Results Patterns of IHC staining showed metabolic compartmentalization both at the primary tumor sites and in nodal metastases. MCT4 staining in the perinodal stroma was significantly higher in specimens with ECE greater than 1 mm (macro-ECE, P = .01). Patients with high perinodal MCT4 staining were compared with those with low perinodal MCT4 staining. On multivariate analysis, only high perinodal MCT4 staining had a significant impact on DFS ( P = .02); patients with high perinodal MCT4 had worse survival. DFS was not significantly worsened by advancing T stage, N stage, ECE extent, or perineural invasion. Conclusion Oral HNSCC displays compartmentalized tumor metabolism at both primary and metastases. Greater cancer-associated stromal conversion around ECE, denoted by high stromal MCT4, may be a biomarker for aggressive disease and worsened DFS.
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Affiliation(s)
- Joseph Curry
- 1 Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Patrick Tassone
- 1 Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kurren Gill
- 1 Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Madalina Tuluc
- 2 Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Voichita BarAd
- 3 Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mehri Mollaee
- 2 Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Diana Whitaker-Menezes
- 4 Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ulrich Rodeck
- 5 Department of Dermatology & Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Adam Luginbuhl
- 1 Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David Cognetti
- 1 Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - William Keane
- 1 Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Matsuoka Y, Ishioka J, Tanaka H, Kimura T, Yoshida S, Saito K, Fujii Y, Kihara K. Impact of the Prostate Imaging Reporting and Data System, Version 2, on MRI Diagnosis for Extracapsular Extension of Prostate Cancer. AJR Am J Roentgenol 2017; 209:W76-84. [PMID: 28570124 DOI: 10.2214/AJR.16.17163] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The purpose of this study is to validate the Prostate Imaging Reporting and Data System, version 2 (PI-RADSv2), in assessing extracapsular extension (ECE), compared with PI-RADS, version 1 (PI-RADSv1). MATERIALS AND METHODS A total of 210 patients with clinically localized prostate cancer underwent MRI and radical prostatectomy. Two readers independently interpreted the MR images. In PI-RADSv1, 5-point ECE risk scoring was used. In PI-RADSv2, ECE criteria included morphologic features and a tumor-capsule contact length (CL) greater than 10 mm. The diagnostic performance of each PI-RADS version and the cutoff CL were evaluated. RESULTS ECE was found in 56 patients (26.7%). In PI-RADSv1, maximal accuracy was achieved with a risk score of 3 or greater. At this threshold, positive findings on PI-RADSv1 and PI-RADSv2 were identified in 21.0-34.3% and 49.0-51.4% of patients, respectively. Compared with PI-RADSv1, PI-RADSv2 had higher negative predictive values (84.9-89.1% vs 96.3-97.1%, respectively; p = 0.003 and 0.021, for each reader). PI-RADSv1 and PI-RADSv2 had positive predictive values of 56.9-70.5% and 49.1-50.5%, respectively (p = 0.025 and 0.300, respectively). Interobserver kappa values for PI-RADSv1 and PI-RADSv2 were 0.511 and 0.781, respectively. The best cutoff CL was greater than 10 mm among patients without morphologic features of ECE. For patients positive for ECE on the basis of PI-RADSv2 but not PI-RADSv1, 73.3-74.1% of prostate cancer cases with a biopsy Gleason score of 7 or less and 35.7-44.4% of cases with a biopsy Gleason score of 8 or higher were overstaged. CONCLUSION PI-RADSv2 reduces understaging and improves interobserver agreement in ECE assessment. However, overstaging is a concern, and the biopsy Gleason score may have a complementary role in reducing overstaging.
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Druskin SC, Liu JJ, Young A, Feng Z, Dianat SS, Ludwig WW, Trock BJ, Macura KJ, Pavlovich CP. Prostate MRI prior to radical prostatectomy: effects on nerve sparing and pathological margin status. Res Rep Urol 2017; 9:55-63. [PMID: 28459044 PMCID: PMC5403124 DOI: 10.2147/rru.s128499] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 11/23/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess the positive surgical margin (PSM) and nerve sparing (NS) rates in patients who underwent prostate MRI (pMRI) prior to radical prostatectomy (RP) and compare them with matched, nonimaged control RP patients. METHODS We identified 204 men who underwent preoperative pelvic MRI (pelMRI), of whom 176 (86.3%) underwent pMRIs, within 60 days of RP, and compared them (1:1) with a nonim-aged control group matched by surgeon, age, race, body mass index (BMI), prostate-specific antigen (PSA), pathological Gleason score, prostate specimen weight, and RP year. RESULTS The rates of nonfocal extracapsular extension (nfECE) on RP pathology in the MRI and control groups were similar. PSM rates were lower in the MRI group (13.7% vs 19.3%; P=0.14), but the difference did not meet statistical significance; this was also the case in patients with nfECE on RP pathology (27.7% vs 39.5%; P=0.3). NS rates were similar between groups. In the MRI group, 54 (26.5%) patients had an MRI suspicious for nfECE; their PSM rate (20.4%) was higher than that of patients with an MRI not suspicious for nfECE (11.3%; P=0.11), but the difference lacked statistical significance; the former group had significantly lower rates of NS. Limitations of the study include sample power and nonuniform heeding of MRI results by each surgeon. CONCLUSION MRI did not significantly decrease the rates of PSM, including in the subset of patients with nfECE on final pathology. Even wider resection may be necessary in patients with MRIs suggesting locally-advanced disease. Studies with greater power are needed.
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Affiliation(s)
- Sasha C Druskin
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jen-Jane Liu
- Department of Urology, Oregon Health and Science University, Portland, OR
| | - Allen Young
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Zhaoyong Feng
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Seyed S Dianat
- Department of Radiology, University of Minnesota Twin Cities, Minneapolis, MN
| | - Wesley W Ludwig
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bruce J Trock
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Katarzyna J Macura
- Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christian P Pavlovich
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD
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Woo S, Kim SY, Cho JY, Kim SH. Length of capsular contact on prostate MRI as a predictor of extracapsular extension: which is the most optimal sequence? Acta Radiol 2017; 58:489-497. [PMID: 27439401 DOI: 10.1177/0284185116658684] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 01/02/2023]
Abstract
Background Length of capsular contact (LCC) is a promising biomarker for predicting extracapsular extension (ECE), but the most optimal magnetic resonance imaging (MRI) sequence for measuring LCC is yet to be determined. Purpose To evaluate LCC using different MRI sequences for determining ECE in prostate cancer. Material and Methods A total of 185 patients underwent prostate MRI followed by radical prostatectomy. LCC was measured separately on T2-weighted (T2W) images, apparent diffusion coefficient (ADC) maps, and dynamic contrast-enhanced (DCE) MRI. LCCs (LCCT2, LCCADC, LCCDCE, and LCCmax [greatest value of 3 LCCs]) were compared between sequences using Wilcoxon signed rank test and was tested for determining ECE using the Mann-Whitney U test, ROC curve analysis, and logistic regression analysis. Results There were no significant differences among LCCs ( P = 0.333-0.837). All LCCs were significantly greater in patients with ECE ( P < 0.001). The optimal threshold value for predicting ECE was >14, >13, >12, and >14 mm for LCCT2, LCCADC, LCCDCE, and LCCmax, respectively. LCCmax yielded the highest area under the curve (0.895) which was significantly greater than that by LCCADC (0.858, P = 0.030). Otherwise, there were no significant difference between LCCs ( P = 0.052-0.985). At univariate analysis, age, clinical stage, PSA, Gleason score, and all LCCs were significantly associated with ECE ( P < 0.001-0.040). At multivariate analysis, GS ( P ≤ 0.008) and all LCCs ( P < 0.001) were independently predictive factors. Conclusion LCC measured on any sequence was significantly different in patients with and without ECE and was independently associated with the presence of ECE. Although LCCmax showed the greatest ability to predict ECE, there was relatively equivalent performance among different MRI sequences.
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Affiliation(s)
- Sungmin Woo
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang Youn Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong Yeon Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Seung Hyup Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
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Kim W, Kim CK, Park JJ, Kim M, Kim JH. Evaluation of extracapsular extension in prostate cancer using qualitative and quantitative multiparametric MRI. J Magn Reson Imaging 2016; 45:1760-1770. [PMID: 27749009 DOI: 10.1002/jmri.25515] [Citation(s) in RCA: 16] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/05/2016] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To investigate the value of multiparametric magnetic resonance imaging (mpMRI) for extracapsular extension (ECE) in prostate cancer (PCa). MATERIALS AND METHODS In all, 292 patients who received radical prostatectomy and underwent preoperative mpMRI at 3T were enrolled retrospectively. For determining the associations with ECE, the likelihood of ECE was assessed qualitatively on T2 -weighted imaging (T2 WI) and combined T2 WI and diffusion-weighted imaging (DWI) or dynamic contrast-enhanced imaging (DCEI). Quantitative MRI parameters were measured in PCa based on histopathological findings. Two models for detecting ECE including imaging and clinical parameters were developed using multivariate analysis: Model 1 excluding combined T2 WI and DWI and DCEI and Model 2 excluding combined T2 WI and DWI, and combined T2 WI and DCEI. Diagnostic performance of imaging parameters and models was evaluated using the area under the receiver operating characteristics curve (Az). RESULTS For detecting ECE, the specificity, accuracy, and Az of combined T2 WI and DWI or DCEI were statistically better than those of T2 WI (P < 0.05), and all quantitative MRI parameters showed a statistical difference between the patients with and without ECE (P < 0.05). On multivariate analysis, significant independent markers in Model 1 were combined T2 WI and DWI, combined T2 WI and DCEI, and Ktrans (P < 0.05). In Model 2, significant markers were combined T2 WI and DWI and DCEI, Ktrans , Kep , and Ve (P < 0.05). The Az values of models 1 and 2 were 0.944 and 0.957, respectively. CONCLUSION mpMRI may be useful to improve diagnostic accuracy of the models for determining the associations with ECE in PCa. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;45:1760-1770.
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Affiliation(s)
- Wooil Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chan Kyo Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jung Jae Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Minji Kim
- Biostatistics and Clinical Epidemiology Center, Samsung Hospital, Seoul, Korea
| | - Jae-Hun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Tamada T, Sone T, Kanomata N, Miyaji Y, Kido A, Jo Y, Yamamoto A, Ito K. Value of preoperative 3T multiparametric MRI for surgical margin status in patients with prostate cancer. J Magn Reson Imaging 2016; 44:584-93. [PMID: 26872679 DOI: 10.1002/jmri.25185] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 11/25/2015] [Accepted: 01/25/2016] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To examine the value of preoperative multiparametric magnetic resonance imaging (MRI) as a predictor of surgical margin (SM) status in patients with prostate cancer (PC). MATERIALS AND METHODS The Institutional Review Board approved this retrospective study; the requirement for informed consent was waived. Fifty-six male patients with histologically proven PC underwent preoperative 3T multiparametric MRI including high b value (0, 2000 s/mm(2) ) diffusion-weighted imaging. In each patient, clinical data, such as biopsy Gleason score and D'Amico clinical risk score, and multiparametric MRI findings, such as tumor location, tumor size, tumor extension in the apical or proximal region, tumor apparent diffusion coefficient (ADC), and the presence or absence of MRI findings of extracapsular extension (ECE) were evaluated. Statistical evaluations included the Fisher's exact test, χ(2) test, Mann-Whitney U-test, and logistic regression analysis. RESULTS On histopathological evaluation, 15 patients (27%) were SM-positive (SMP group), and 41 (73%) were SM-negative (SMN group). The tumor ADC was significantly lower in the SMP group than in the SMN group (P = 0.001). The frequency of tumor extension in the apex or base and suspected ECE on MRI were significantly higher in the SMP group than in the SMN group (P = 0.037 and 0.011, respectively). On multivariate analysis, tumor ADC was the only predictor of SM status in PC (P = 0.003). CONCLUSION PC with positive SM was characterized by tumor extension in the apical and proximal regions, lower tumor ADC, and tumors with positive MRI findings of ECE, compared to tumors with negative SM. J. Magn. Reson. Imaging 2016;44:584-593.
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Affiliation(s)
- Tsutomu Tamada
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Teruki Sone
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Naoki Kanomata
- Department of Pathology, Kawasaki Medical School, Kurashiki, Japan
| | - Yoshiyuki Miyaji
- Department of Urology, Kawasaki Medical School, Kurashiki, Japan
| | - Ayumu Kido
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Yoshimasa Jo
- Department of Urology, Kawasaki Medical School, Kurashiki, Japan
| | - Akira Yamamoto
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Katsuyoshi Ito
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
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Kamaya A, Tahvildari AM, Patel BN, Willmann JK, Jeffrey RB, Desser TS. Sonographic Detection of Extracapsular Extension in Papillary Thyroid Cancer. J Ultrasound Med 2015; 34:2225-2230. [PMID: 26518279 DOI: 10.7863/ultra.15.02006] [Citation(s) in RCA: 38] [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] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/17/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To identify and evaluate sonographic features suggestive of extracapsular extension in papillary thyroid cancer. METHODS Three board-certified radiologists blinded to the final pathologic tumor stage reviewed sonograms of pathologically proven cases of papillary thyroid cancer for the presence of extracapsular extension. The radiologists evaluated the following features: capsular abutment, bulging of the normal thyroid contour, loss of the echogenic capsule, and vascularity extending beyond the capsule. RESULTS A total of 129 cases of pathologically proven thyroid cancer were identified. Of these, 51 were excluded because of lack of preoperative sonography, and 16 were excluded because of pathologic findings showing anaplastic carcinoma, follicular carcinoma, or microcarcinoma (<10 mm). The final analysis group consisted of 62 patients with papillary thyroid carcinoma, 16 of whom had pathologically proven extracapsular extension. The presence of capsular abutment had 100% sensitivity for detection of extracapsular extension. Conversely, lack of capsular abutment had a 100% negative predictive value (NPV) for excluding extracapsular extension. Contour bulging had 88% sensitivity for detection of extracapsular extension and when absent had an 87% NPV. Loss of the echogenic capsule was the best predictor of the presence of extracapsular extension, with an odds ratio of 10.23 (P = .034). This sonographic finding had 75% sensitivity, 65% specificity, and an 88% NPV. Vascularity beyond the capsule had 89% specificity but sensitivity of only 25%. CONCLUSIONS Sonographic features of capsular abutment, contour bulging, and loss of the echogenic thyroid capsule have excellent predictive value for excluding or detecting extracapsular extension and may help in biopsy selection, surgical planning, and treatment of patients with papillary thyroid cancer.
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Affiliation(s)
- Aya Kamaya
- Department of Radiology, Stanford University Medical Center, Stanford, California USA (A.K., J.K.W., R.B.J., T.S.D.); VA Palo Alto Health Care System, Palo Alto, California USA (A.M.T.); and Department of Radiology, Duke University, Durham, North Carolina USA (B.N.P.).
| | - Ali M Tahvildari
- Department of Radiology, Stanford University Medical Center, Stanford, California USA (A.K., J.K.W., R.B.J., T.S.D.); VA Palo Alto Health Care System, Palo Alto, California USA (A.M.T.); and Department of Radiology, Duke University, Durham, North Carolina USA (B.N.P.)
| | - Bhavik N Patel
- Department of Radiology, Stanford University Medical Center, Stanford, California USA (A.K., J.K.W., R.B.J., T.S.D.); VA Palo Alto Health Care System, Palo Alto, California USA (A.M.T.); and Department of Radiology, Duke University, Durham, North Carolina USA (B.N.P.)
| | - Juergen K Willmann
- Department of Radiology, Stanford University Medical Center, Stanford, California USA (A.K., J.K.W., R.B.J., T.S.D.); VA Palo Alto Health Care System, Palo Alto, California USA (A.M.T.); and Department of Radiology, Duke University, Durham, North Carolina USA (B.N.P.)
| | - R Brooke Jeffrey
- Department of Radiology, Stanford University Medical Center, Stanford, California USA (A.K., J.K.W., R.B.J., T.S.D.); VA Palo Alto Health Care System, Palo Alto, California USA (A.M.T.); and Department of Radiology, Duke University, Durham, North Carolina USA (B.N.P.)
| | - Terry S Desser
- Department of Radiology, Stanford University Medical Center, Stanford, California USA (A.K., J.K.W., R.B.J., T.S.D.); VA Palo Alto Health Care System, Palo Alto, California USA (A.M.T.); and Department of Radiology, Duke University, Durham, North Carolina USA (B.N.P.)
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Veronese N, Nottegar A, Pea A, Solmi M, Stubbs B, Capelli P, Sergi G, Manzato E, Fassan M, Wood LD, Scarpa A, Luchini C. Prognostic impact and implications of extracapsular lymph node involvement in colorectal cancer: a systematic review with meta-analysis. Ann Oncol 2015; 27:42-8. [PMID: 26483050 DOI: 10.1093/annonc/mdv494] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [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: 09/01/2015] [Accepted: 10/05/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The extranodal extension (ENE) of nodal metastasis (i.e. the extension of tumor cells through the nodal capsule into the perinodal adipose tissue) has recently emerged as an important prognostic factor in different types of malignancies. However, the tumor-node-metastasis (TNM) staging system for colorectal cancer does not consider it as a prognostic parameter. Therefore, we conducted a systematic review and meta-analysis to determine the prognostic role of ENE in patients with lymph node-positive colorectal cancer. MATERIALS AND METHODS Two independent authors searched PubMed and SCOPUS until 7 January 2015 without language restrictions. Prospective studies reporting data on prognostic parameters in subjects with colorectal cancer, comparing participants with the presence of ENE (ENE+) versus only intranodal extension (ENE-) were eligible. Data were summarized using risk ratios (RRs) for the number of deaths/recurrences and hazard ratios (HRs) together with 95% confidence intervals (CIs) for time-dependent risk related to ENE+, adjusted for potential confounders. RESULTS Thirteen studies including 1336 patients were identified with a median follow-up of 4.7 years. ENE was associated with a higher T stage and tumor grading. In addition, ENE was associated with a significantly increased risk of all-cause mortality (RR = 1.75; 95% CI 1.42-2.16, P < 0.0001, I(2) = 60%; HR = 1.69, 95% CI 1.32-2.17, P < 0.0001, I(2) = 46%) and of recurrence of disease (RR = 2.07, 95% CI 1.65-2.61, P < 0.0001, I(2) = 47%; HR = 2.31, 95% CI 1.54-3.44, P < 0.0001, I(2) = 48%). CONCLUSIONS Based of these results, in colorectal cancer, ENE should be considered from the gross sampling to the pathology report, as well as in future oncologic staging systems.
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Affiliation(s)
- N Veronese
- Department of Medicine, DIMED, University of Padua, Padua
| | - A Nottegar
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - A Pea
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - M Solmi
- Department of Neuroscience, University of Padua, Padua, Italy
| | - B Stubbs
- Health Service and Population Research Department, King's College London, London, UK
| | - P Capelli
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - G Sergi
- Department of Medicine, DIMED, University of Padua, Padua
| | - E Manzato
- Department of Medicine, DIMED, University of Padua, Padua
| | - M Fassan
- Department of Medicine, DIMED, University of Padua, Padua
| | - L D Wood
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - A Scarpa
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy ARC-NET Research Center, Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - C Luchini
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy ARC-NET Research Center, Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
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Fischer S, Lin D, Simon RM, Howard LE, Aronson WJ, Terris MK, Kane CJ, Amling CL, Cooperberg MR, Freedland SJ, Vidal AC. Do all men with pathological Gleason score 8-10 prostate cancer have poor outcomes? Results from the SEARCH database. BJU Int 2015; 118:250-7. [PMID: 26351095 DOI: 10.1111/bju.13319] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 02/06/2023]
Abstract
OBJECTIVE To determine whether there are subsets of men with pathological high grade prostate cancer (Gleason score 8-10) with particularly high or low 2-year biochemical recurrence (BCR) risk after radical prostatectomy (RP) when stratified into groups based on combinations of pathological features, such as surgical margin status, extracapsular extension (ECE) and seminal vesicle invasion (SVI). MATERIALS AND METHODS We identified 459 men treated with RP with pathological Gleason score 8-10 prostate cancer in the SEARCH database. The men were stratified into five groups based on pathological characteristics: group 1, men with negative surgical margins (NSMs) and no ECE; group 2, men with positive surgical margin (PSMs) and no ECE; group 3, men with NSMs and ECE; group 4, men with PSMs and ECE; and group 5, men with SVI. Cox proportional hazards models and the log-rank test were used to compare BCR among the groups. RESULTS At 2 years after RP, pathological group was significantly correlated with BCR (log-rank, P < 0.001) with patients in group 5 (+SVI) having the highest BCR risk (66%) and those in group 1 (NSMs and no ECE) having the lowest risk (14%). When we compared groups 2, 3, and 4, with each other, there was no significant difference in BCR among the groups (~50% 2-year BCR risk; log-rank P = 0.28). Results were similar when adjusting for prostate-specific antigen, age, pathological Gleason sum and clinical stage, or after excluding men who received adjuvant therapy. CONCLUSIONS In patients with high grade (Gleason score 8-10) prostate cancer after RP, the presence of either PSMs, ECE or SVI was associated with an increased risk of early BCR, with a 2-year BCR risk of ≥50%. Conversely, men with organ-confined margin-negative disease had a very low risk of early BCR despite Gleason score 8-10 disease.
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Affiliation(s)
- Sean Fischer
- Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, NC, USA.,Urology Section, Veterans Affairs Medical Center, Durham, NC, USA
| | - Daniel Lin
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Ross M Simon
- Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, NC, USA.,Urology Section, Veterans Affairs Medical Center, Durham, NC, USA
| | - Lauren E Howard
- Urology Section, Veterans Affairs Medical Center, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - William J Aronson
- Urology Section, Department of Surgery, Veterans Affairs Medical Center of Greater Los Angeles, Los Angeles, CA, USA.,Department of Urology, University of California at Los Angeles Medical Center, Los Angeles, CA, USA
| | - Martha K Terris
- Urology Section, Division of Surgery, Veterans Affairs Medical Center, Augusta, GA, USA.,Division of Urologic Surgery, Department of Surgery, Medical College of Georgia, Augusta, GA, USA
| | - Christopher J Kane
- Division of Urology, Department of Surgery, University of California at San Diego Medical Center, San Diego, CA, USA
| | | | - Matt R Cooperberg
- Department of Urology, University of California at San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA.,Urology Section, Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Stephen J Freedland
- Urology Section, Veterans Affairs Medical Center, Durham, NC, USA.,Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Adriana C Vidal
- Urology Section, Veterans Affairs Medical Center, Durham, NC, USA.,Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Liu W, Shao Y, Guan B, Hao J, Cheng X, Ji K, Wang K. Extracapsular extension is a powerful prognostic factor in stage IIA-IIIA non-small cell lung cancer patients with completely resection. Int J Clin Exp Pathol 2015; 8:11268-11277. [PMID: 26617851 PMCID: PMC4637666] [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: 06/26/2015] [Accepted: 07/29/2015] [Indexed: 06/05/2023]
Abstract
The purpose of this study is to evaluate the relationship between extracapsular extension (ECE) and clinicopathology, and its influence on the prognosis in non-small cell lung cancer (NSCLC) patients. Clinical data from 388 stage IIA-IIIA NSCLC patients who underwent curative resection and confirmed ECE positive were reviewed. The Fisher's exact or Chi-square test was used to analyze the associations between ECE and the clinical pathology. The log-rank test and Cox regression model were used to evaluate the factors influencing disease-free survival (DFS) and overall survival (OS). ECE was detected in 85 (21.9%) patients, and it had a significant correlation with advanced T stage, pathological stage and histologic type of adenocarcinoma. For the whole population, the median OS was 39.0 months, and the 5-year OS rate was 33.9%. In multivariate analysis, both ECE status and postoperative chemotherapy were significant factors for OS. The median DFS for all patients was 26.0 months, and the 5-year DFS rate was 21.7%. In multivariate analysis, pathologic stage, ECE, and postoperative chemotherapy were the independent predictor factors for DFS. Further analysis found that the locoregional recurrence-free survival and the distant recurrence-free survival rates in ECE negative group were also significantly higher than in the ECE positive group. For NSCLC patients with lymph node metastasis, the presence of ECE occurs more frequently in advanced stage and histologic type of adenocarcinoma and it may be a powerful prognostic factor which reflects the aggressive biological behavior.
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MESH Headings
- Adenocarcinoma/mortality
- Adenocarcinoma/pathology
- Adenocarcinoma/surgery
- Adenocarcinoma of Lung
- Adult
- Aged
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Non-Small-Cell Lung/secondary
- Carcinoma, Non-Small-Cell Lung/surgery
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Chemotherapy, Adjuvant
- Chi-Square Distribution
- Disease Progression
- Disease-Free Survival
- Female
- Humans
- Kaplan-Meier Estimate
- Lung Neoplasms/mortality
- Lung Neoplasms/pathology
- Lung Neoplasms/surgery
- Male
- Middle Aged
- Multivariate Analysis
- Neoplasm Invasiveness
- Neoplasm Recurrence, Local
- Neoplasm Staging
- Pneumonectomy/adverse effects
- Pneumonectomy/mortality
- Proportional Hazards Models
- Radiotherapy, Adjuvant
- Retrospective Studies
- Risk Factors
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Weishuai Liu
- Department of Pain Management and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer Tianjin 300060, P. R. China
| | - Yuejuan Shao
- Department of Pain Management and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer Tianjin 300060, P. R. China
| | - Bingqing Guan
- Department of Pain Management and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer Tianjin 300060, P. R. China
| | - Jianlei Hao
- Department of Pain Management and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer Tianjin 300060, P. R. China
| | - Xianjiang Cheng
- Department of Pain Management and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer Tianjin 300060, P. R. China
| | - Kai Ji
- Department of Pain Management and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer Tianjin 300060, P. R. China
| | - Kun Wang
- Department of Pain Management and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer Tianjin 300060, P. R. China
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Gomez-Iturriaga A, Crook J, Casquero F, Carvajal C, Urresola A, Canteli B, Ezquerro A, Hortelano E, Cacicedo J, Espinosa JM, Perez F, Minguez P, Bilbao P. Impact of intraoperative MRI/TRUS fusion on dosimetric parameters in cT3a prostate cancer patients treated with high-dose-rate real-time brachytherapy. J Contemp Brachytherapy 2014; 6:154-60. [PMID: 25097555 DOI: 10.5114/jcb.2014.43299] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 05/06/2014] [Accepted: 06/26/2014] [Indexed: 12/19/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the impact of intraoperative MRI/TRUS fusion procedure in cT3a prostate cancer patients treated with high-dose-rate (HDR) real-time brachytherapy. Material and methods Prostate gland, dominant intraprostatic lesions (DILs), and extracapsular extension (ECE) were delineated in the pre-brachytherapy magnetic resonance images (MRI) of 9 consecutive patients. The pre-implant P-CTVUS (prostate clinical target volume) was defined as the prostate seen in the transrectal ultrasound (TRUS) images. The CTVMR includedthe prostate with the ECE image (ECE-CTV) as defined on the MRI. Two virtual treatment plans were performed based on the MRI/TRUS fusion images, the first one prescribing 100% of the dose to the P-PTVUS, and the second prescribing to the PTVMR. The implant parameters and dose-volume histogram (DVH) related parameters of the prostate, OARs, and ECE were compared between both plans. Results Mean radial distance of ECE was 3.6 mm (SD: 1.1). No significant differences were found between prostate V100, V150, V200, and OARs DVH-related parameters between the plans. Mean values of ECE V100, V150, and V200 were 85.9% (SD: 15.1), 18.2% (SD: 17.3), and 5.85% (SD: 7) when the doses were prescribed to the PTVUS, whereas ECE V100, V150, and V200 were 99.3% (SD: 1.2), 45.8% (SD: 22.4), and 19.6% (SD: 12.6) when doses were prescribed to PTVMR (p = 0.028, p = 0.002 and p = 0.004, respectively). Conclusions TRUS/MRI fusion provides important information for prostate brachytherapy, allowing for better coverage and higher doses to extracapsular disease in patients with clinical stage T3a.
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47
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Furukawa M, Dillon JK, Futran ND, Anzai Y. The prevalence of lymph node metastases in clinically N0 necks with oral cavity squamous cell carcinoma: is CT good enough for nodal staging? Acta Radiol 2014; 55:570-8. [PMID: 23963150 DOI: 10.1177/0284185113499326] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Nodal metastases and extracapsular extension (ECE) are important prognostic indicators. However, the diagnostic accuracy of CT is still limited for patients with clinically N0 neck. PURPOSE To determine the prevalence of lymph node (LN) metastases and ECE for oral cavity squamous cell carcinoma (SCC) patients with clinical and CT negative preoperative neck. MATERIAL AND METHODS Thirty-two patients with N0 oral cavity SCC who underwent neck dissection were included in this retrospective analysis. The size of LN was measured on transverse CT images, and radiological size criterion was based upon a minimal axial diameter of 10 mm. Pathology was used as the standard reference. Imaging and histopathological correlation was done for 132 LN levels in the 32 patients. RESULTS Fourteen of 32 patients (44%) had metastatic nodes and six patients had ECE. Among 132 LN levels, 22 levels (17%) had metastatic LNs (level I 5/37, level II 8/39, level III 7/35, level IV 2/18), and eight of 22 levels with metastases had ECE. Poorly differentiated histology was a predictive factor for LN metastases or ECE (poorly versus well and moderately differentiated SCC: P=0.07 for LN metastases and P=0.08 for ECE, respectively). T-classification was also an important predictor for occult nodal metastases (2 of 10 patients in T1, 12 of 22 patients in T2-4), although it did not reach statistical significance (P=0.11). CONCLUSION Diagnostic accuracy of CT is limited among N0 oral cavity SCC patients. Neck dissection should be performed, particularly for patients with poorly differentiated SCC or higher T-classification.
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Affiliation(s)
- Matakazu Furukawa
- Department of Radiology, University of Washington, Seattle, WA, USA
- Department of Radiology, Yamaguchi University Graduate School of Medicine, Japan
| | - Jasjit K Dillon
- Department of Otolaryngology, Head and Neck Surgery, University of Washington, Seattle, WA, USA
| | - Neal D Futran
- Department of Otolaryngology, Head and Neck Surgery, University of Washington, Seattle, WA, USA
| | - Yoshimi Anzai
- Department of Radiology, University of Washington, Seattle, WA, USA
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48
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Karnes RJ, Bergstralh EJ, Davicioni E, Ghadessi M, Buerki C, Mitra AP, Crisan A, Erho N, Vergara IA, Lam LL, Carlson R, Thompson DJS, Haddad Z, Zimmermann B, Sierocinski T, Triche TJ, Kollmeyer T, Ballman KV, Black PC, Klee GG, Jenkins RB. Validation of a genomic classifier that predicts metastasis following radical prostatectomy in an at risk patient population. J Urol 2013; 190:2047-53. [PMID: 23770138 PMCID: PMC4097302 DOI: 10.1016/j.juro.2013.06.017] [Citation(s) in RCA: 240] [Impact Index Per Article: 21.8] [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] [Accepted: 06/05/2013] [Indexed: 01/17/2023]
Abstract
PURPOSE Patients with locally advanced prostate cancer after radical prostatectomy are candidates for secondary therapy. However, this higher risk population is heterogeneous. Many cases do not metastasize even when conservatively managed. Given the limited specificity of pathological features to predict metastasis, newer risk prediction models are needed. We report a validation study of a genomic classifier that predicts metastasis after radical prostatectomy in a high risk population. MATERIALS AND METHODS A case-cohort design was used to sample 1,010 patients after radical prostatectomy at high risk for recurrence who were treated from 2000 to 2006. Patients had preoperative prostate specific antigen greater than 20 ng/ml, Gleason 8 or greater, pT3b or a Mayo Clinic nomogram score of 10 or greater. Patients with metastasis at diagnosis or any prior treatment for prostate cancer were excluded from analysis. A 20% random sampling created a subcohort that included all patients with metastasis. We generated 22-marker genomic classifier scores for 219 patients with available genomic data. ROC and decision curves, competing risk and weighted regression models were used to assess genomic classifier performance. RESULTS The genomic classifier AUC was 0.79 for predicting 5-year metastasis after radical prostatectomy. Decision curves showed that the genomic classifier net benefit exceeded that of clinical only models. The genomic classifier was the predominant predictor of metastasis on multivariable analysis. The cumulative incidence of metastasis 5 years after radical prostatectomy was 2.4%, 6.0% and 22.5% in patients with low (60%), intermediate (21%) and high (19%) genomic classifier scores, respectively (p<0.001). CONCLUSIONS Results indicate that genomic information from the primary tumor can identify patients with adverse pathological features who are most at risk for metastasis and potentially lethal prostate cancer.
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49
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Jeong IG, Lim JH, You D, Kim MH, Choi HJ, Kim JK, Cho KS, Hong JH, Ahn H, Kim CS. Incremental value of magnetic resonance imaging for clinically high risk prostate cancer in 922 radical prostatectomies. J Urol 2013; 190:2054-60. [PMID: 23791890 DOI: 10.1016/j.juro.2013.06.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2013] [Indexed: 01/19/2023]
Abstract
PURPOSE We investigated the incremental value of magnetic resonance imaging in addition to clinical variables for predicting pathological outcomes and disease recurrence in patients with clinically high risk prostate cancer. MATERIALS AND METHODS A total of 922 consecutive patients with clinically high risk prostate cancer underwent magnetic resonance imaging before radical prostatectomy. We created multivariate logistic regression and Cox proportional hazards models with clinical variables only or combined with magnetic resonance imaging data to predict pathological outcomes and biochemical recurrence. The models were compared using ROC curves and the Harrell concordance index. RESULTS The proportion of patients with pathological extracapsular extension, seminal vesicle invasion and lymph node metastasis was 57.5%, 12.7% and 6.3%, respectively. The sensitivity and specificity of extracapsular extension, seminal vesicle invasion and lymph node metastasis detection were 43% and 84.2%, 34.9% and 93.8%, and 14.0% and 96.9%, respectively. The area under the ROC curve of the model with clinical variable and magnetic resonance imaging data was greater than that of the model with clinical variables alone to predict extracapsular extension and seminal vesicle invasion (0.734 vs 0.697, p=0.001 and 0.750 vs 0.698, p<0.001, respectively). The 5-year biochemical recurrence-free survival rate was 56.1%. To predict biochemical recurrence the concordance index of the multivariate model with clinical variables only and with clinical variables plus magnetic resonance imaging data was 0.563 and 0.599, respectively (p=0.003). CONCLUSIONS Magnetic resonance imaging findings have incremental value in addition to clinical variables for predicting pathological outcomes and disease recurrence.
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50
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Whelan C, Kawachi M, Smith DD, Linehan J, Babilonia G, Mejia R, Wilson T, Smith SS. Expressed prostatic secretion biomarkers improve stratification of NCCN active surveillance candidates: performance of secretion capacity and TMPRSS2:ERG models. J Urol 2013; 191:220-6. [PMID: 23669563 DOI: 10.1016/j.juro.2013.05.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Active surveillance is a viable patient option for prostate cancer provided that a clinical determination of low risk and presumably organ confined disease can be made. To standardize risk stratification schemes the NCCN (National Comprehensive Cancer Network®) provides guidelines for the active surveillance option. We determined the effectiveness of expressed prostatic secretion biomarkers for detecting occult risk factors in NCCN active surveillance candidates. MATERIALS AND METHODS Expressed prostatic secretion specimens were obtained before robot-assisted radical prostatectomy. Secretion capacity biomarkers, including total RNA and expressed prostatic secretion specimen volume, were measured by standard techniques. RNA expression biomarkers, including TXNRD1 mRNA, prostate specific antigen mRNA, TMPRSS2:ERG fusion mRNA and PCA3 mRNA, were measured by quantitative reverse-transcription polymerase chain reaction. RESULTS Of the 528 patients from whom expressed prostatic secretions were collected 216 were eligible for active surveillance under NCCN guidelines. Variable selection on logistic regression identified 2 models, including one featuring types III and VI TMPRSS2:ERG variants, and one featuring 2 secretion capacity biomarkers. Of the 2 high performing models the secretion capacity model was most effective for detecting cases in this group that were up-staged or up-staged plus upgraded. It decreased the risk of up-staging in patients with a negative test almost eightfold and decreased the risk of up-staging plus upgrading about fivefold while doubling the prevalence of up-staging in the positive test group. CONCLUSIONS Noninvasive expressed prostatic secretion testing may improve patient acceptance of active surveillance by dramatically reducing the presence of occult risk factors among those eligible for active surveillance under NCCN guidelines.
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Affiliation(s)
| | - Mark Kawachi
- Division of Urology, City of Hope, Duarte, California
| | - David D Smith
- Division of Biostatistics, City of Hope, Duarte, California
| | | | | | - Rosa Mejia
- Clinical Research Information Support, City of Hope, Duarte, California
| | | | - Steven S Smith
- Division of Urology, City of Hope, Duarte, California; Beckman Research Institute, City of Hope, Duarte, California.
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