Carcinoma Registry Research Articles

Nab-paclitaxel as alternative treatment regimen in advanced cholangiocellular carcinoma.

Advanced cholangiocellular carcinoma has a poor prognosis with limited therapeutic options. Nab-paclitaxel has recently been described to be beneficial in metastatic pancreatic cancer improving overall and progression free survival (PFS). The potential antitumor activity of nab-paclitaxel in cholangiocellular carcinoma is hitherto unknown. We retrospectively analyzed an institutional cholangiocellular carcinoma registry to determine the potential biological activity of nab-paclitaxel in advanced intrahepatic cholangiocellular carcinoma. Disease control rate (DCR), PFS and overall survival (OS) upon nab-paclitaxel based treatment, after failure of platinum-containing first-line combination chemotherapy, was assessed. Twelve patients were identified. Five of 12 patients (42%) received nab-paclitaxel as second line, and 7 patients (56%) as third-line treatment. The objective DCR with nab-paclitaxel was 83% (10/12 patients). One patient had a complete remission (CR), two patients had a partial remission (PR) and 7 patients had stable disease (SD). Disease was rated progressive in two patients. In all 12 patients receiving nab-paclitaxel the median time to progression was 6 months (range, 2.1-19.5 months). Median OS after initiation of nab-paclitaxel treatment was 9 months (2.1-28.4 months). The median time of survival after diagnosis of advanced disease was 21.5 months, whereby 3 patients were alive at the date of censoring (04/01/2015). This is the first report suggesting substantial antitumor activity of nab-paclitaxel in advanced cholangiocellular carcinoma. In this small series, nab-paclitaxel based salvage chemotherapy appears to have a biological activity by controlling the disease and positively affecting survival. Randomized trials in this disease entity and subgroup of patients are urged.

Small carcinomas involving less than one-quarter of the rectal circumference: local excision is still associated with a high risk of nodal positivity.

A study was carried out to determine the relationship between mesorectal lymph nodal involvement and T stage in a group of patients with a rectal cancer involving less than one-quarter of the rectal circumference, such as might be selected for local excision. The data of patients having rectal resection between 2010 and 2014 were prospectively entered in a rectal carcinoma registry. A model for describing tumours involving less than one quadrant of the rectal circumference was created to facilitate the evaluation process. In all, 304 patients were included in the study. In 68 (22.4%) a small tumour (< 1 quadrant involved) was found. Of these, 26.5% had positive mesorectal lymph nodes (N+). In lesions of Stage ypT0 cancer 12.5% patients were node positive, in Stage Tis and T1 tumours there was no case of node positivity, but in Stage T2 and Stage T3 cancers the incidence of node positivity was 27.5% and 64%. The study demonstrated that, even for small tumours involving only one rectal quadrant, the risk of lymph nodal involvement was about 25%. Had the patients undergone local excision the treatment would have been incomplete.

Clinicopathological characteristics and oncological outcomes in patients with renal cell carcinoma registered in 2007: The first large-scale multicenter study from the Cancer Registration Committee of the Japanese Urological Association.

To describe the clinicopathological features and oncological outcomes of renal cell carcinoma diagnosed in Japan in 2007, the results of the large-scale renal cell carcinoma registration study carried out by the Japanese Urological Association are reported. The renal cell carcinoma survey was carried out by the Japanese Urological Association in 2012 to register newly diagnosed renal cell carcinoma cases in 2007 from 340 institutions nationwide. The survey included clinicopathological details, such as sex, age, family history, past history, smoking history, body mass index, reason for diagnosis, TNM classification, stage, histopathology, treatment and clinical outcomes. A total of 3663 cases diagnosed in 2007 were registered in this renal cell carcinoma registry program from 340 institutions. A total of 15 patients with a final diagnosis of oncocytoma were excluded, and 3648 cases of renal cell carcinoma were analyzed to evaluate oncological outcomes. The patients' median age was 63.9 years (range 5.9-95.1 years). Clear cell renal cell carcinoma was the most common histological subtype (77.2%), followed by papillary (5.0%) and chromophobe (3.2%) renal cell carcinoma. The most common initial treatment was radical nephrectomy (72.6%), and the most common secondary treatment was cytokine therapy (13.1%). Five-year overall survival rates in stages I, II, III, and IV were 94.8%, 90.2%, 78.8% and 39.6%, respectively. The 5-year overall survival rates for clear cell, papillary and chromophobe renal cell carcinomas, and carcinoma of the collecting ducts of Bellini were 88.6%, 79.8%, 93.0% and 40.0%, respectively. The present report is the first nationwide large-scale study to describe the clinicopathological characteristics and oncological outcomes of patients with renal cell carcinoma in Japan. Oncological outcomes depend on the clinical stage and histological subtype. Further investigations will be required to show improved oncological outcomes in the molecular targeted therapy era using the results of the present study as a baseline.

An exploratory subgroup analysis of race and gender in squamous cancer of the head and neck: Inferior outcomes for African American males in the LORHAN database

Previous retrospective analyses show poor outcomes for African American (AA) patients with head and neck carcinoma (HNC). Such racial disparities are not well understood, and generally studies have been too small to investigate subgroups and interactions related to race. The longitudinal oncology registry of head and neck carcinoma registry was used to identify patients ⩾18 years of age with squamous cell carcinoma of the head and neck, with no baseline metastases, and with an adequate record of survival time. Patient demographic and treatment characteristics were evaluated as a function of race and other known potential confounders of outcome. Associations between patient characteristics, including smoking, stage, performance status, and overall survival (OS) and progression-free survival (PFS) outcomes were also examined. Analysis of OS and PFS confirmed prior reports of inferior outcomes in AA patients vs. Whites with median OS/3-yr rate 41.7 mo/52% in AAs vs. 56.6 mo/70% in Whites (hazard ratio: 1.69 [95% confidence interval: 1.42, 2.01]). The elevated risk for worse OS and PFS in AAs remained, after multivariate adjustment. African American males incurred most of the excess risk compared to AA females. This exploratory study confirmed a worse OS and PFS prognosis for AA patients, and it documents that most of the excess risk occurs in AA males. Future studies should confirm these findings and should investigate biological and other factors that account for such profound differences in outcomes.

The German Adrenocortical Carcinoma (ACC) Registry – Establishment and First Results

ACC is a rare tumor with poor prognosis. Its low incidence hinders the development of a reliable database on clinical manifestations, prognosis, and the impact of different treatment options. The purpose of the German ACC Registry is to evaluate these aspects in a large retrospective series and to establish a prospective database to improve patient care and recruitment for future clinical trials.

The German Adrenocortical Carcinoma (ACC) Registry – establishment and first results

ACC is a rare tumor with a poor prognosis. Its low incidence hinders the development of a reliable database on clinical manifestations, prognosis, and the impact of different treatment options. The purpose of the German ACC Registry is to evaluate these aspects in a large retrospective series, and to establish also a prospective database to improve patient care and recruitment for future clinical trials.

Squamous cell carcinoma of the skin - histopathological features and their significance for the clinical outcome

Owing to the rising incidence of tumours, the question of reliable risk classification is becoming increasingly significant. Participation in the multicentre carcinoma registry maintained by the Association of Operative and Oncological Dermatology of the German Dermatological Society requires, in addition to the parameters of clinical staging and grading already established by the International Union against Cancer, description of other histopathological criteria related to prognosis, with special attention to microstaging. One hundred and eighty-four patients with squamous cell carcinoma of the skin were examined. The histological parameters, carcinoma type, Breslow index, invasion level, growth form, grading and mitotic index were recorded and classified, and clinical staging was performed. It was found that the clinical criterion of tumour diameter (T-category) determines the further course of the disease. The other parameters taken into account, namely pathohistological microstaging and grading, can increase the accuracy of prognosis evaluation, and in particular enable carcinomas of the T1-category to be classified as either high malignant or low malignant tumours. The desmoplastic squamous cell carcinoma subtype is a potential risk tumour. Endophytic tumours are more malignant in their development than exophytically-growing carcinomas, and the probability of recurrence and metastatic tumour spread further increases when ulceration can be detected by microscope. In order to distinguish metastatic and recurring carcinomas, in addition to determining the invasion levels after Clark, measuring the Breslow index proved to be an important criterion. Quoting the mitotic index augmented the grading system, which further improved the reliability of malignancy assessment. The TNM categories currently applied to squamous cell carcinomas of the skin must be supplemented by additional histological parameters which, according to our findings, permit more accurate classification of high and low malignant tumours.

Squamous cell carcinoma of the skin – histopathological features and their significance for the clinical outcome

Background Owing to the rising incidence of tumours, the question of reliable risk classification is becoming increasingly significant.Objective Participation in the multicentre carcinoma registry maintained by the Association of Operative and Oncological Dermatology of the German Dermatological Society requires, in addition to the parameters of clinical staging and grading already established by the International Union against Cancer, description of other histopathological criteria related to prognosis, with special attention to microstaging.Methods One hundred and eighty-four patients with squamous cell carcinoma of the skin were examined. The histological parameters, carcinoma type, Breslow index, invasion level, growth form, grading and mitotic index were recorded and classified, and clinical staging was performed.Results It was found that the clinical criterion of tumour diameter (T-category) determines the further course of the disease. The other parameters taken into account, namely pathohistological microstaging and grading, can increase the accuracy of prognosis evaluation, and in particular enable carcinomas of the T1-category to be classified as either high malignant or low malignant tumours. The desmoplastic squamous cell carcinoma subtype is a potential risk tumour. Endophytic tumours are more malignant in their development than exophytically-growing carcinomas, and the probability of recurrence and metastatic tumour spread further increases when ulceration can be detected by microscope. In order to distinguish metastatic and recurring carcinomas, in addition to determining the invasion levels after Clark, measuring the Breslow index proved to be an important criterion. Quoting the mitotic index augmented the grading system, which further improved the reliability of malignancy assessment. Conclusions The TNM categories currently applied to squamous cell carcinomas of the skin must be supplemented by additional histological parameters which, according to our findings, permit more accurate classification of high and low malignant tumours.

A cost-effectiveness analysis of colorectal screening for hereditary nonpolyposis colorectal carcinoma gene carriers

It has been estimated that the prevalence of carriers of a mutated mismatch repair (MMR) gene among the general population in Western countries is between 5 and 50 per 10,000. These carriers have a risk of >85% of developing colorectal carcinoma (CRC) and therefore need careful follow-up. The objective of this study was to analyze the cost-effectiveness of CRC surveillance of carriers of a mutated MMR gene. The authors constructed a model to estimate the potential health effects (life expectancy) and healthcare costs of two strategies: 1) surveillance, with colonoscopy every 2-3 years, and 2) no CRC surveillance. Estimates of the lifetime risk of developing CRC and the stage distribution of CRC for symptomatic patients were derived from the Dutch hereditary nonpolyposis colorectal carcinoma (HNPCC) registry. The CRC stage specific relative survival rates and the effectiveness of surveillance in preventing or detecting cancer early were based on Finnish studies. The costs of surveillance and treatment were derived from recent American studies. The results showed that 1) surveillance of gene carriers led to an increase in life expectancy of 7 years, and 2) the costs of surveillance under a wide range of assumptions are less than the costs of no CRC surveillance. CRC surveillance of HNPCC gene carriers appears to be effective and considerably less costly than no CRC surveillance and therefore deserves to be supported by governmental agencies and health insurance organizations.

A New Approach to the Treatment of Certain Bladder Carcinomas

CARCINOMA of the bladder is a disease of relatively common occurrence, comprising about 0.4 per cent of all human tumors. The relative incidence is much higher in urologic practice, and in Young's Clinic 4 per cent of 12,500 cases were bladder tumors. They are nearly four times as common in men as in women, and, for practical purposes, occur between the ages of fifty and sixty-nine but from age sixty to sixty-four seems to be the period of most frequent occurrence. They may occur anywhere in the bladder but are slightly more common on the lateral walls than elsewhere. The trigone is the next most common region, the exact locations being as follows: As a general rule, the tumors occurring in the vault of the bladder are of the highest histologic grade of malignancy, namely, Grades 3 and 4, while in marked contrast, those involving the trigone, lateral wall, and neck of the bladder are commonly of histologic Grades 1 and 2. Based on the figures of the Carcinoma Registry of the American Urological Association, a tumor located on the lateral wall, the trigone, or the neck of the bladder has approximately an even chance to be either Grade 1 or 2, while 75 per cent of vault tumors will be Grades 3 or 4. From observations made upon dye workers, it seems likely that the malignant tumor originates in the basal layer of the epithelium about the terminal blood vessels and that it may reach considerable size before the superficial epithelium becomes involved. The tumor then usually follows the vascular supply into the deeper layers. If this concept is valid, it seems doubtful that we will ever be able to make an early diagnosis of bladder tumor, unless a cystoscopic examination becomes a routine procedure along with periodic health examination. Therefore, it is evident that hematuria, frequency, dysuria, pain, and retention are still our diagnostic signs; hematuria being the initial symptom in 75 per cent of all tumors. The hematuria of neoplasm begins without warning, is painless, begins and ceases without apparent cause or reason, and usually stops before the patient has had the courage to consult his physician. The following period is symptomless and the patient feels a sense of security. Knowing that his first attack ceased without treatment, the second attack of hematuria is regarded with less apprehension and this routine is repeated over and over until retention occurs, or until the hematuria is continuous. Only then does the physician see the patient, only to find a tumor so large that surgery is out of the question. The cystoscope reveals a picture varying with the numerous types of tumor which may be encountered. A simple papilloma presents itself as a pedicle from which delicate, translucent fronds wave to and fro in the cystoscopic fluid, while in a sessile papilloma, the fronds arise from a broad base and resemble a fragment of pink coral. These papillomas may be single or multiple.

Tenth Anniversary Report of the Carcinoma Registry Committee of the American Urological Association, 1927–1937

Tenth Anniversary Report of the Carcinoma Registry Committee of the American Urological Association, 1927–1937

Grading of Epithelial Tumors of the Urinary Bladder A Study of the Cell Types and the Methods of Grading of the Cases in the Carcinoma Registry of the American Urological Association

Grading of Epithelial Tumors of the Urinary Bladder A Study of the Cell Types and the Methods of Grading of the Cases in the Carcinoma Registry of the American Urological Association

Cancer of the Bladder: A Study of the Five-Year End Results in 658 Epithelial Tumors of the Bladder in the Carcinoma Registry of the American Urological Association: The Committee of Carcinoma Registry

Cancer of the Bladder: A Study of the Five-Year End Results in 658 Epithelial Tumors of the Bladder in the Carcinoma Registry of the American Urological Association: The Committee of Carcinoma Registry

Cancer of the Bladder. A Study Based on 902 Epithelial Tumors of the Bladder in the Carcinoma Registry of the American urological Association. The Committee on Carcinoma Registry

Cancer of the Bladder. A Study Based on 902 Epithelial Tumors of the Bladder in the Carcinoma Registry of the American urological Association. The Committee on Carcinoma Registry