Clinical Stage Group Research Articles

Cancer of the Esophagus and Esophagogastric Junction: An Eighth Edition Staging Primer.

This primer for eighth edition staging of esophageal and esophagogastric epithelial cancers presents separate classifications for the clinical (cTNM), pathologic (pTNM), and postneoadjuvant pathologic (ypTNM) stage groups, which are no longer shared. For pTNM, pT1 has been subcategorized as pT1a and pT1b for the subgrouping pStage I adenocarcinoma and squamous cell carcinoma. A new, simplified esophagus-specific regional lymph node map has been introduced. Undifferentiated histologic grade (G4) has been eliminated; additional analysis is required to expose histopathologic cell type. Location has been removed as a category for pT2N0M0 squamous cell cancer. The definition of the esophagogastric junction has been revised. ypTNM stage groups are identical for both histopathologic cell types, unlike those for cTNM and pTNM.

Analysis of Prognostic Factors from 9387 Merkel Cell Carcinoma Cases Forms the Basis for the New 8th Edition AJCC Staging System.

The first consensus Merkel cell carcinoma (MCC) staging system was published in 2010. New information on the clinical course prompts review of MCC staging. A total of 9387 MCC cases from the National Cancer Data Base Participant User File with follow-up and staging data (1998-2012) were analyzed. Prognostic differences based on clinical and pathological staging were evaluated. Survival estimates were compared by disease extent. Sixty-five percent of cases presented with local disease, whereas 26 and 8% presented with nodal and distant disease. Disease extent at presentation was predictive of 5-year overall survival (OS) with estimates of 51, 35, and 14% for local, nodal, and distant disease. Tumor burden at the regional nodal basin was predictive of 5-year OS with estimates of 40 and 27% for clinically occult and clinically detected nodal disease. For local disease, we confirm improved prognosis when the regional nodal basin was negative by pathological compared with clinical staging. We identified 336 cases with clinically detected nodal disease and unknown primary tumor and showed improved prognosis over cases presenting with concurrent primary tumor (OS estimates of 42 vs. 27%). Analysis of a national dataset of MCC cases validates the predictive value of disease extent at presentation. Separation of clinical and pathological stage groups and regrouping of unknown primary tumors are supported by the analysis. The revised staging system provides more accurate prognostication and has been formally accepted by the AJCC staging committee for inclusion in the 8th edition.

Expression of hypoxia-inducible factor 1α in gastric cancer and its clinical signficance

To explore the expression level and location of hypoxia-inducible factor 1α (HIF-1α) in gastric cancer (GC) tissues and their relationship with clinicopathological features and clinical outcomes. From July to September 2015, 27 pairs of fresh paired GC tissues and adjacent normal tissues were gathered from the Eighth Department of General Surgery of the First Affiliated Hospital of Anhui Medical University. Quantitative real-time PCR (qRT-PCR) and Western blot were performed to detect the expression of HIF-1α mRNA and protein in these tissues. A total of 191 GC tissues and 46 randomly selected adjacent normal gastric tissues were consecutively collected between December 2006 and September 2008 from Department of General Surgery of the same hospital. Immunohistochemistry were performed on them to detect the expression of HIF-1α and CD34[described in terms of microvessel density (MVD)], and correlation of different locations of HIF-1α (in cytoplasm or nucleus) with MVD, clinicopathological features, and clinical prognosis was analyzed. The average relative expression level of HIF-1α mRNA in GC tissues (0.625±0.170) was significantly higher than in normal adjacent tissues (0.218±0.036, t=2.336, P=0.023) by qRT-PCR. From the results of Western blot, the expression level of HIF-1α protein increased in GC tissues compared with its corresponding normal tissues. Immunohistochemistry results revealed that positive HIF-1α staining was observed in 67.54% GC tissues and 45.65% normal tissues, with significant difference (P=0.006). And 35.08% in GC and 45.65% in normal tissues were cytoplasmic positive (P=0.138); while 37.17% in GC and only 2.17% in normal tissues were nuclear positive, with significant difference (P<0.001). High differentiation group and TNM clinical early stage (Ⅰ+ Ⅱ) group had significantly higher cytoplasmic HIF-1α expression positive rate compared with low differentiation group (P=0.008) and TNM clinical intermediate-advanced stage (Ⅲ+ Ⅳ) group (P=0.019); whereas low differentiation group had significantly higher nuclear HIF-1α expression positive rate compared with high differentiation group (P=0.043). The mean MVD in the nuclear HIF-1α positive GC group (115.6 ± 7.8) was higher than that in the cytoplasmic HIF-1α positive GC group (93.1±7.5, t=2.077, P=0.040). The median follow-up time was 56(3-81)months. Kaplan-Meier survival analysis and Log-Rank test results showed that nuclear HIF-1α positive patients had a shorter survival time (median 45 months) than cytoplasmic HIF-1α positive patients (median 64 months, P<0.001). Multivariate Cox regression analysis revealed that differentiation (HR=1.713; 95% CI: 1.019-2.882), depth of invasion (tumor stage, HR=6.137; 95% CI: 1.832-20.556) and lymph node metastasis (HR=2.788; 95% CI: 1.313-5.920) were independent prognostic factors for GC (all P<0.05). Different location of HIF-1α protein may be realted to the tumorigenesis and progression of GC, and may become a potential prognostic indicator of GC.

Prognostic value of the standardized uptake value maximum change calculated by dual-time-point (18)F-fluorodeoxyglucose positron emission tomography imaging in patients with advanced non-small-cell lung cancer.

PurposeThe purpose of this study was to investigate the prognostic value of the standardized uptake value maximum (SUVmax) change calculated by dual-time-point 18F-fluorodeoxyglucose positron emission tomography (PET) imaging in patients with advanced non-small-cell lung cancer (NSCLC).Patients and methodsWe conducted a retrospective review of 115 patients with advanced NSCLC who underwent pretreatment dual-time-point 18F-fluorodeoxyglucose PET acquired at 1 and 2 hours after injection. The SUVmax from early images (SUVmax1) and SUVmax from delayed images (SUVmax2) were recorded and used to calculate the SUVmax changes, including the SUVmax increment (ΔSUVmax) and percent change of the SUVmax (%ΔSUVmax). Progression-free survival (PFS) and overall survival (OS) were determined by the Kaplan–Meier method and were compared with the studied PET parameters, and the clinicopathological prognostic factors in univariate analyses and multivariate analyses were constructed using Cox proportional hazards regression.ResultsOne hundred and fifteen consecutive patients were reviewed, and the median follow-up time was 12.5 months. The estimated median PFS and OS were 3.8 and 9.6 months, respectively. In univariate analysis, SUVmax1, SUVmax2, ΔSUVmax, %ΔSUVmax, clinical stage, and Eastern Cooperative Oncology Group (ECOG) scores were significant prognostic factors for PFS. Similar results were significantly correlated with OS, except %ΔSUVmax. In multivariate analysis, ΔSUVmax and %ΔSUVmax were significant factors for PFS. On the other hand, ECOG scores were only identified as independent predictors of OS.ConclusionOur results demonstrated the prognostic value of the SUVmax change in predicting the PFS of patients with advanced NSCLC. However, SUVmax change could not predict OS.

Correlation between cognitive impairment and diabetic nephropathy in patients with Type 2 diabetes mellitus

To explore the correlation between diabetic nephropathy (DN) and cognitive impairment through examining the cognitive function and the metabolism of the cerebrum in Type 2 diabetes mellitus patients at different stages of renal function. Eighty six patients with Type 2 diabetes mellitus (T2DM) were enrolled for this study. According to the urinary albumin excretion rate (UAER), the patients were divided into a T2DM without DN group (DM group, n=33), an early DN group (DN-III group, n=26) and a clinical stage group (DN-IV group, n=27). Thirty healthy adults were selected as a control group (NC group). Biochemical indexes and UAER were measured, and glomerular filtration rate (GFR) was detected by single-photon emission computed tomography (SPECT). The cognitive function was measured by Montreal Cognitive Assessment (MoCA, Beijing version) and mini-mental state examination (MMSE). The peak areas of N-acetylasparte (NAA), creatine (Cr), choline-containing compounds (Cho) were detected by proton magnetic resonance spectroscopy (1H-MRS). 1) There was no statistical difference in MMSE scores between the DM group and the control group. The scores of MoCA in the DN-III group or in the DN-IV group were significant less than that in the NC group (F=3.66, P<0.05); 2) There was significant difference in left N-acetylaspartate (LNAA), left choline (LCho) among the diabetes groups. Compared with the DM group, the level of LNAA was decreased significantly (t=3.826, P<0.05) while the LCho was increased significantly (t=4.373, P<0.05) in the DN groups, with statistic difference between the 2 groups (t=3.693, P<0.05); 3) The MoCA scores of T2DM patients were negatively correlated with UAER (r=-0.285, P<0.05), while positively correlated with GFR (r=0.379, P<0.05); 4) Logistic regression analysis indicated that UAER and GFR were the major risky factors for diabetic cognitive impairment. Diabetic cognitive impairment is closely correlated with the nephropathy in patients with Type 2 diabetes. With the decline in glomerular filtration function, the cognitive disorder tends to be aggravated. The hippocampal brain metabolism may have some changes in left side of Cho/Cr in patients with diabetic nephropathy.

Prostate brachytherapy in Ghana: our initial experience.

PurposeThis study presents the experience of a brachytherapy team in Ghana with a focus on technology transfer and outcome. The team was initially proctored by experienced physicians from Europe and South Africa.Material and methodsA total of 90 consecutive patients underwent either brachytherapy alone or brachytherapy in combination with external beam radiotherapy for prostate carcinoma between July 2008 and February 2014 at Korle Bu Teaching Hospital, Accra, Ghana. Patients were classified as low-risk, intermediate, and high-risk according to the National Comprehensive Cancer Network (NCCN) criteria. All low-risk and some intermediate risk group patients were treated with seed implantation alone. Some intermediate and all high-risk group patients received brachytherapy combined with external beam radiotherapy.ResultsThe median patient age was 64.0 years (range 46-78 years). The median follow-up was 58 months (range 18-74 months). Twelve patients experienced biochemical failure including one patient who had evidence of metastatic disease and died of prostate cancer. Freedom from biochemical failure rates for low, intermediate, and high-risk cases were 95.4%, 90.9%, and 70.8%, respectively. Clinical parameters predictive of biochemical outcome included: clinical stage, Gleason score, and risk group. Pre-treatment prostate specific antigen (PSA) was not a statistically significant predictor of biochemical failure. Sixty-nine patients (76.6%) experienced grade 1 urinary symptoms in the form of frequency, urgency, and poor stream. These symptoms were mostly self-limiting. Four patients needed catheterization for urinary retention (grade 2). One patient developed a recto urethral fistula (grade 3) following banding for hemorrhoids.ConclusionsOur results compare favorably with those reported by other institutions with more extensive experience. We believe therefore that, interstitial permanent brachytherapy can be safely and effectively performed in a resource challenged environment if adequate training and proctoring is provided.

The relationship between cognitive reserve and the clinical stage of HIV infection

ABSTRACTThe objective of this study was to determine whether the effect of cognitive reserve (CR) on neuropsychological functioning differs according to the clinical stage of HIV infection. A sample of 34 HIV-positive individuals aged 23–49, with a minimum of 9 years of formal education, was assessed. Participants were grouped according to the Centers for Disease Control and Prevention's (CDC) clinical stages (A = 10, B = 16, C = 8). CR was calculated for each clinical stage group in accordance with estimates of premorbid IQ, years of education, and occupational attainment. The sum of these three variables was then transformed into z-scores. Individuals above the median were classified as having “High” CR (HCR), those below the median were classified as “Low” CR (LCR). Participants completed an evaluation of cognitive and executive functions based on selected, modified tasks from the HIV University of Miami Annotated Neuropsychological test in Spanish (HUMANS). Assessment included the following domains: attention, memory (visual, verbal, and working memory), executive functions (cognitive flexibility, switching), language (naming), and visual constructive skills (block design). HCR outperformed LCR in all cognitive domains. Comparison of HCR and LCR in each clinical stage revealed that the effect of CR was stronger in stage B than in stages A and C, suggesting that this effect does indeed vary among stages.

Inflammatory and cardiac biomarkers are differentially expressed in clinical stages of Chagas disease

BackgroundChagas disease has a long clinically silent period following Trypanosoma cruzi infection and before development of overt clinical pathology; detectable biomarkers of infection and pathogenesis are urgently needed. We tested 22 biomarkers known to be associated with cardiomyopathy to evaluate if a biomarker signature could successfully classify T. cruzi seropositive subjects into clinical Chagas disease stage groups. MethodsThis cross-sectional retrospective case–control study enrolled T. cruzi seropositive blood donors (BD) who were further characterized as having chronic Chagas cardiomyopathy (CC-BD) or not (nonCC-BD) and seronegative (SN) control donors; we also included clinically diagnosed Chagas cardiomyopathy patients (CC-P). All subjects underwent a health history questionnaire, medical examination, electro- and echocardiograms (ECG and Echo) and phlebotomy. Biomarkers were measured on blinded samples by luminex bead array and Ortho VITROS. ResultsA clear biomarker pattern was observed only in more severe cardiac disease; this pattern included significantly elevated levels of inflammatory cytokines IFN-γ, IL-6, IL-10 and TNF-α and soluble cardiovascular disease biomarkers CK-MB, troponin, myoglobin, VCAM and NTproBNP while there were lower levels of MPO, PAI-1, and MCP-1. The markers determined to be the most predictive of disease by ROC curve analysis were NTproBNP and T. cruzi PCR status. ConclusionsAlthough many biomarkers demonstrated increased or decreased concentrations among the clinical forms of Chagas disease, NTproBNP and T. cruzi PCR were the only tests that would independently be of clinical value for disease staging, in concert with ECG, Echo and clinical assessments.

Definitive chemoradiation for non-small-cell lung cancer: could a consensus be reached?

There is currently no consensus as to which chemotherapy to combine with thoracic radiotherapy (TRT) in the setting of definitive chemoradiation for non-small-cell lung cancer (NSCLC). We aimed to retrospectively evaluate the efficacy and report outcome measures of cisplatin/etoposide with conventionally fractionated TRT over a 9-year period. Cisplatin 50 mg/m² on days 1, 8, 29, and 36 and etoposide 50 mg/m² on days 1-5 and 29-33 with conventionally fractionated conformal radiation therapy starting on day 1 was given to 201 eligible patients. Patient records were reviewed for overall survival (OS) and progression-free survival (PFS). The 2-year OS and PFS were 53% and 47%, respectively, while the 3-year OS and PFS were 18% and 17%, respectively. No grade 4 or treatment-related deaths were recorded, and grade 3 hematologic toxicity occurred in only 22 patients (11%) in the form of granulocytopenia and thrombocytopenia. Multivariable analysis showed clinical stage and Eastern Cooperative Oncology Group performance status to statistically significantly affect PFS and OS. Cisplatin and etoposide in these doses with conventionally fractionated TRT is a well-tolerated, effective treatment schedule in the definitive treatment of unresectable or inoperable NSCLC.

Comparison of anal cancer outcomes in public and private hospital patients treated at a single radiation oncology center.

To compare clinical and treatment characteristics and outcomes in locally advanced anal cancer, a potentially curable disease, in patients referred from a public or private hospital. We retrospectively reviewed 112 anal cancer patients from a public and a private hospital who received definitive chemoradiotherapy at the same cancer center between 2004 and 2013. Tumor stage, radiotherapy delay, radiotherapy duration, and unplanned treatment breaks ≥10 days were compared using t-test and χ(2) test. Overall survival (OS), disease free survival (DFS), and colostomy free survival (CFS) were examined using the Kaplan-Meier method and compared with the log-rank test. Cox proportional hazard models for OS and DFS were developed. The follow-up was 14.9 months (range, 0.7-94.8 months). Public hospital patients presented with significantly higher clinical T stage (P<0.05) and clinical stage group (P<0.05), had significantly longer radiotherapy delays (P<0.05) and radiotherapy duration (P<0.05), and had more frequent radiation therapy (RT) breaks ≥10 days (P<0.05). Three-year OS showed a marked trend in favor of private hospital patients for 3-year OS (72.8% vs. 48.9%; P=0.171), 3-year DFS (66.3% vs. 42.7%, P=0.352), and 3-year CFS (86.4% vs. 68.9%, P=0.299). Referral hospital was not predictive of OS or DFS on multivariate analysis. Public hospital patients presented at later stage and experienced more delays in initiating and completing radiotherapy, which may contribute to the trend in poorer DFS and OS. These findings emphasize the need for identifying clinical and treatment factors that contribute to decreased survival in low socioeconomic status (SES) populations.

Pathological stage after neoadjuvant chemoradiation and esophagectomy superiorly predicts survival in patients with esophageal squamous cell carcinoma

Background and purposeTo assess the usefulness of pathological stage according to the 7th edition of the Union for International Cancer Control–American Joint Committee on Cancer (UICC–AJCC) as a prognostic tool in patients undergoing neoadjuvant chemoradiation followed by esophagectomy (trimodality therapy, TMT) for locally advanced esophageal squamous cell carcinoma. Material and methodsOne hundred twenty-five eligible patients completing TMT were enrolled for analysis. The clinical (cTNM7) and pathological (ypTNM7) stage groups of their tumors were prospectively classified, and re-grouped by the 6th edition (ypTNM6). Survival was analyzed using the Kaplan–Meier method. The Cox proportional hazard model and the Akaike information criterion (AIC) were used to compare the performance of staging systems. ResultsWith a median follow-up of 24.6months, 54 patients (43.2%) died. Forty patients (32%) achieved pathological complete remission (pCR). The median survival was 31.8months. On multivariate analysis, ypTNM7 (but not pCR or pN) was the only independent factor affecting overall survival (p<0.001). The ypTNM7 was superior to cTNM7 or ypTNM6 in predicting both overall and recurrence-free survival after TMT based on AIC values and Cox proportional hazard model analysis. ConclusionsIn patients with locally advanced esophageal squamous cell carcinoma undergoing TMT, ypTNM7 is the best predictor of survival.

Prognostic value of 18F-fluorodeoxyglucose uptake before treatment for pharyngeal cancer

The purpose of this study was to evaluate an association found between overall survival of patients with pharyngeal squamous cell carcinoma (SCC) and pretreatment [(18)F]-2-fluorodeoxyglucose ((18)F-FDG) uptake, which are assessed by positron emission tomography combined with computed tomography (PET/CT). Next, we asked whether (18)F-FDG uptake is correlated with overall survival in patients with pharyngeal SCC who underwent radical treatments such as surgery and radiotherapy in the multivariate analysis with adjustments for the clinical stage, primary site and treatment group. Forty-nine patients who were newly diagnosed as resectable pharyngeal SCC underwent pretreatment (18)F-FDG-PET/CT. We used the maximum standardized uptake value (SUVmax) as (18)F-FDG uptake. Overall survival rate was calculated by the Kaplan-Meier method. Univariate survival analysis was analyzed by log-rank test, and multivariate survival analysis was performed by a Cox proportional hazards model. Patients with SUVmax of the primary site ≥8 significantly exhibited shorter overall survival in univariate analysis (p < 0.04). Moreover, SUVmax of the primary site ≥8 was a significant prognostic factor in the multivariate analysis (p < 0.03). These results suggested that SUVmax of the primary site obtained by pretreatment (18)F-FDG-PET/CT assessment is an important prognostic factor in patients with pharyngeal SCC.

Physical Status of Human Papillomavirus Integration in Cervical Cancer Is Associated with Treatment Outcome of the Patients Treated with Radiotherapy

Integration of human papillomavirus (HPV) DNA into the host genome is a critical aetiological event in the progression from normal cervix to intraepithelial neoplasm, and finally to invasive cervical cancer. However, there has been little work on how HPV integration status relates to treatment outcome for cervical carcinomas. In the current study, HPV E2 and E6 gene copy numbers were measured in 111 cervical cancer tissues using real-time QPCR. Integration patterns were divided into four groups: single copy-integrated with episomal components (group 1), single copy-integrated without episomal components (group 2), multicopy tandem repetition-integrated (group 3), and low HPV (group 4) groups. A relapse-predicting model was constructed using multivariable Cox proportional hazards model to classify patients into different risk groups for disease-free survival (DFS). The model was internally validated using bootstrap resampling. Oligonucleotide microarray analysis was performed to evaluate gene expression patterns in relation to the different integration groups. DFS rate was inferior in the order of the patients in group 4, group 2/3, and group 1. Multivariate analysis showed that histologic grade, clinical stage group, and integration pattern were significant prognostic factors for poor DFS. The current prognostic model accurately predicted the risk of relapse, with an area under the receiver operating characteristic curve (AUC) of 0.74 (bootstrap corrected, 0.71). In conclusion, these data suggest that HPV integration pattern is a potent prognostic factor for tailored treatment of cervical cancer.

Identifying the Association Rules between Clinicopathologic Factors and Higher Survival Performance in Operation-Centric Oral Cancer Patients Using the Apriori Algorithm

This study computationally determines the contribution of clinicopathologic factors correlated with 5-year survival in oral squamous cell carcinoma (OSCC) patients primarily treated by surgical operation (OP) followed by other treatments. From 2004 to 2010, the program enrolled 493 OSCC patients at the Kaohsiung Medical Hospital University. The clinicopathologic records were retrospectively reviewed and compared for survival analysis. The Apriori algorithm was applied to mine the association rules between these factors and improved survival. Univariate analysis of demographic data showed that grade/differentiation, clinical tumor size, pathology tumor size, and OP grouping were associated with survival longer than 36 months. Using the Apriori algorithm, multivariate correlation analysis identified the factors that coexistently provide good survival rates with higher lift values, such as grade/differentiation = 2, clinical stage group = early, primary site = tongue, and group = OP. Without the OP, the lift values are lower. In conclusion, this hospital-based analysis suggests that early OP and other treatments starting from OP are the key to improving the survival of OSCC patients, especially for early stage tongue cancer with moderate differentiation, having a better survival (>36 months) with varied OP approaches.

Trends in the survival of patients with nasopharyngeal carcinoma between 1976 and 2005 in Sihui, China: a population-based study

Both the incidence and mortality of nasopharyngeal carcinoma (NPC) have decreased in Hong Kong and Taiwan but not in mainland China. The goal of this study was to analyze trends in NPC patient survival between 1976 and 2005 in Sihui, an area of mainland China with a population at high risk for NPC. A total of 1,761 patients diagnosed with NPC between 1976 and 2005 according to the records of Sihui Cancer Registry were followed to the end of 2006. We determined their observed and relative survival rates and used Cox proportional hazards regression analysis to predict prognosis. Our results showed that the 5-year and 10-year observed survival rates of NPC patients in Sihui were 50.5% and 36.9%, respectively, and the median survival time was 5.1 years. The 5-year observed survival rate of NPC patients diagnosed after 2000 was 69.8%, significantly higher than that of patients diagnosed between 1976 and 1985 (42.5%; P < 0.001, relative risk = 0.28). Similarly, the 5-year relative survival rate was 84.8% between 2000 and 2005 but 51.8% between 1976 and 1985. Besides date of diagnosis, other prognostic factors included patient sex and age and NPC clinical stage and histologic type. The relative risks of death from NPC were 0.76 [95% confidence interval (CI): 0.65–0.90] for female comparing to male and 1.28 (95% CI: 1.00–1.64) for WHO type I comparing to WHO types II and III. For the eldest age group and the latest clinical stage group, the relative risks were 2.22 (95% CI: 1.73–2.84) and 3.41 (95% CI: 2.34–4.49), respectively. Our results indicate that the survival of NPC patients in Sihui has significantly increased in recent years and this increase is not influenced by patient's sex, age, histologic type, and clinical stage. A reduction in mortality rate is expected in coming years.

Endoscopic Ultrasound for Early Stage Esophageal Adenocarcinoma: Implications for Staging and Survival

Patients often receive induction therapy based on endoscopic ultrasound (EUS)-identified nodal spread (N1) or deep tumor invasion (T3), although controversy exists regarding the role of induction therapy for early stage disease. We aim to evaluate the reliability of EUS in identifying early stage disease and the subsequent impact on treatment and outcomes. We retrospectively studied 149 patients who underwent EUS and esophagectomy for adenocarcinoma between January 2000 and December 2008. Computed tomography (CT) was performed in all patients, whereas positron emission tomography (PET) was performed in 91%. Clinical stage (c), pathologic stage (p), operative mortality, and survival were recorded. Unanticipated pathologic nodal disease was similar in patients with cT1N0 and cT2N0 tumors (6/25 [24%] versus 7/18 [38.8%]; p=0.6). Among the 18 cases of cT2N0 disease, 9 (50%) were pathologically staged as T1N0, 8 (44%) were upstaged to pT3N0-1, and 1 (6%) was pT2N0. One case of cT1N0 tumor (4%) was upstaged to pT3N0. Among patients with cT1-2N0 tumors, 5-year disease-free survival for the group that was appropriately staged was 89.8% versus 39.9% for the group that had a higher pathologic stage than their clinical stage (ie, >T2N0) (p<0.001). Operative mortality for patients with cT1-2N0 tumors was 0/43 (0%), which was no different from that in the higher clinical stage groups with (1/37, 2.7%) or without (2/68, 2.9%) induction therapy (p=0.5). Multivariate analysis identified marked/intense uptake on staging PET (odds ratio, 5.76, 95%; confidence interval, 1.25 to 26.52; p=0.021) to be a factor predictive of upstaging of cT1-2N0 tumors. Current staging techniques are inadequate for predicting T1-2N0 disease in esophageal adenocarcinoma. Survival is excellent with operation alone in patients with tumors appropriately staged as T1-2N0, although patients with tumors upstaged to greater than T2N0 have significantly worse survival. Other preoperative factors such as PET uptake may help select patients with cT1-2N0 tumors that will be upstaged at resection.

Comparison of capability of dynamic O2-enhanced MRI and quantitative thin-section MDCT to assess COPD in smokers

The purpose of this study was to directly and prospectively compare the capability of dynamic O(2)-enhanced MRI and quantitatively assessed thin-section MDCT to assess smokers' COPD in a large prospective cohort. The GOLD criteria for smokers were used to classify 187 smokers into four clinical stage groups as follows: smokers without COPD (n=56) and with mild (n=54), moderate (n=52) and severe or very severe COPD (n=24). All smokers underwent dynamic O(2)-enhanced MRI, MDCT and pulmonary function tests. Mean relative enhancement ratio and mean wash-in time on MRI and CT-based functional lung volume (CT-based FLV) as well as the ratio of airway wall area to total airway area on MDCT were computationally calculated. Then, all indexes were significantly correlated with functional parameters. To determine the efficacy of all indexes for clinical stage classification, the indexes for the four clinical groups were statistically compared by using Tukey's honestly significant difference multiple comparison test. All indexes had significant correlations with functional parameters (p<0.0001). All indexes except CT-based FLV in all groups had significant differences each other (p<0.05). Dynamic O(2)-enhanced MRI for assessment of COPD in smokers is potentially as efficacious as quantitatively assessed thin-section MDCT.

Surgery in pancreatic cancer (PC): Identifying potential barriers.

290 Background: Due to lack of effective systemic therapy, surgical resection remains the mainstay of treatment of PC and the only potential for cure. Even though mortality of PC surgery has decreased in recent years, surgical rates remain lower than for other cancer types. We performed an analysis of early-stage PC to determine factors that may prevent patients from undergoing surgery. Methods: PC cases diagnosed between 1996 and 2008 were identified from the Veteran's Affairs Central Cancer Registry. Patients with early stage disease, defined as AJCC clinical stage group 1-3, were included. Data were analyzed using biostatistical software SPSS. Chi-square analysis was performed for categorical variables comparing those who underwent surgery (SUR) and those in which surgery was not performed (SNP). Kaplan-Meier analysis was used for estimates of overall survival. Results: Of 1,306 cases identified, 97.7% were male, 78% where white. Surgery was performed in 251 (19.2%) cases. Surgery was not recommended in 739 (56.6%) and contraindicated due to patient related factors in 198 (15.2%) cases. Surgery was recommended but not performed due to unknown reasons in 59 (4.5%); patient refusal in 43 (3.3%) and “other reasons” in 16 (1.2%) cases. Mean age in SUR vs. SNP was 64.1 vs. 67.5 years. Median survival was 11.1 months in SUR vs. 5.5 months SNP (p&lt;0.001). On univariate analysis, patients with diabetes had less surgery (10.5%) compared to other comorbidities (p&lt;0.001). Tumors in the body of the pancreas had less surgery (4.8%) compared to the head or tail (19.9%, 23.6%, p&lt;0.001). Sex, race, alcohol, and tobacco use did not significantly impact surgery rates (p&gt;0.05). On multivariable analysis including race, sex, primary site, comorbidity, chemotherapy, radiation, alcohol, and tobacco use, only comorbidity was independently associated with less surgery. Conclusions: In this registry-based, retrospective analysis of early stage PC, although SUR patients had better survival than SNP, surgery was not recommended as a treatment option for most patients by their providers. Whereas comorbid conditions do seem to influence this decision, race and patient refusal was not a major factor. No significant financial relationships to disclose.

Prostate Cancer-specific Survival and Time to Recurrence Outcomes for Men Treated with Radical Prostatectomy, Intensity Modulated Radiation Therapy, or Brachytherapy at MD Anderson Cancer Center

Clinical effectiveness (CE) research for the treatment of men presenting with clinically localized prostate cancer is evolving. Comparable outcomes following radical prostatectomy (RP), intensity modulated radiation therapy (IMRT), and brachytherapy (BT) are difficult to generalize without risk-stratification based on central pathologic review. The purpose of this study is to analyze outcomes of patients treated with radical prostatectomy (RP), intensity modulated radiation therapy (IMRT), and brachytherapy (BT) at a single tertiary cancer center. From January 2000 thru December 2001, an IRB-approved retrospective analysis was performed on 745 men at the M.D. Anderson Cancer Center (MDACC). Patients presenting with clinical T1-T3 disease and Gleason score (GS) 6-10 disease were treated with either RP (n = 388), IMRT (n = 254), or BT (n = 103). Kaplan-Meier estimates were used to determine the time to recurrence (TTR) and prostate cancer specific survival (PCSS). The Cox proportional hazards regression model was used to estimate the hazard ratios for predetermined potential prognostic factors for TTR and PCSS. These factors were modeled in a univariate and multivariate model to examine contribution to differences between the groups. The median follow-up was 7.2 years for RP, 7.2 years for IMRT, and 7.6 years for BT. The IMRT group had significantly higher mean PSA, biopsy Gleason score, clinical T stage, and risk grouping. On univariate analysis, factors associated with a shorter TTR include T2 or T3 clinical stage (p < 0.0001), high (p < 0.001), or intermediate (p < 0.01) risk group, PSA greater than 10 ng/mL (p < 0.001), Gleason 4+3 versus 3+4 (p < 0.001), and treatment with IMRT (p = 0.015). On multivariate analysis, significant factors for TTR were PSA greater than 10 ng/mL (HR = 4.29, p = 0.004) and T2 (HR = 3.26; p < 0.001) or T3 (HR = 2.84; p = 0.05) clinical stage. 5 year PCSS was 99.7% for RP, 100% for BT, and 98.3% for IMRT. For PCSS, the only statistically significant factor on univariate analysis was high risk group (p = 0.028). On multivariate analysis, no factors reached significance for PCSS. At MDACC, low and intermediate risk prostate cancer patients have similar PCSS and TTR when treated with RP, IMRT, or BT. Additional factors such as patient satisfaction, quality of life, and cost-benefit analyses will enhance clinical effectiveness research for prostate cancer treatment.

Expression of bone morphogenetic protein-7 in prostate cancer

Objective To investigate the expression of bone morphogenetic protein-7(BMP-7)in the tissue of prostate cancer(PCa). Methods The pathological samples of 87 cases of PCa were collected.The average age was 66(59-78)years,preoperative of t-PSA was 45.7(2.4-138.2)ng/ml.Gleason score:37 cases were≤6,18 cases were 7,32 cases were≥8.Stages:stage I(T1aN0M0)+stageⅡ(T1bN0M0,T1cN0M0,T2N0M0)20 cases;StageⅢ(T3N0M0)20;Stage Ⅳ(T4N0 M0,TxN1 M0,TxN0 M1)47 cases.According to bone scan or positron emission computed tomography-CT test results,patients were divided into PCa without bone metastasis,42 cases and PCa with bone metastasis,45 cases.Thirty cases of BPH were set as controls.BMP-7 in the PCa and BPH were detected by PV immunohistochemical study.Statistical analysis was done between two groups to compare the differential expression of BMP-7 and serum t-PSA in PCa, and BPH tissues.Results BMP-7 expression in the absorbance A value in benign prostatic hyperplasia was 70.55±5.41, in prostate cancer tissue 70.47± 6.18, no significant differences between the 2 groups(P>0.05).BMP-7 expression in the absorbance A value in prostate cancer without bone metastasis was 65.94 ± 1.76, but with bone metastasis 74.80±5.76.There was a significant difference (P<0.05).Gleason score≤6 absorbance A value was 65.96 ± 1.56, Gleason 7 absorbance A value 65.83 ± 2.75,≥8 absorbance A value 78.06±1.39.Compared with Gleason score≥8, BMP-7 expression in the absorbance A value were significantly lower than the latter (P<0.05).Clinical stage grouping of BMP-7 expression in the absorbance A value: Stage Ⅰ + Ⅱ 65.86±1.72, Stage Ⅲ 65.87±1.85, Stage 74.49±5.83.There was a significant difference (P<0.05).In PCa tissues, BMP-7 of the absorbance A value and the serum t-PSA values showed a positive correlation (r=0.77,P,<0.05). Conelusions The expression level of BMP-7 has occurred in the high pathological Gleason score, late clinical stage, particularly in bone metastasis cases.The expression level of BMP-7 and serum t-PSA have a positive correlation. Key words: Prostatic neoplasms; Carcinoma; Bone morphogenetic protein-7; Bone metastases