Clinical Tumor Node Metastasis Stage Research Articles

Development and validation of a machine learning-based 18F-fluorodeoxyglucose PET/CT radiomics signature for predicting gastric cancer survival

BackgroundSurvival prognosis of patients with gastric cancer (GC) often influences physicians’ choice of their follow-up treatment. This study aimed to develop a positron emission tomography (PET)-based radiomics model combined with clinical tumor-node-metastasis (TNM) staging to predict overall survival (OS) in patients with GC.MethodsWe reviewed the clinical information of a total of 327 patients with pathological confirmation of GC undergoing 18 F-fluorodeoxyglucose (18 F-FDG) PET scans. The patients were randomly classified into training (n = 229) and validation (n = 98) cohorts. We extracted 171 PET radiomics features from the PET images and determined the PET radiomics scores (RS) using the least absolute shrinkage and selection operator (LASSO) and random survival forest (RSF). A radiomics model, including PET RS and clinical TNM staging, was constructed to predict the OS of patients with GC. This model was evaluated for discrimination, calibration, and clinical usefulness.ResultsOn multivariate COX regression analysis, the difference between age, carcinoembryonic antigen (CEA), clinical TNM, and PET RS in GC patients was statistically significant (p < 0.05). A radiomics model was developed based on the results of COX regression. The model had the Harrell’s concordance index (C-index) of 0.817 in the training cohort and 0.707 in the validation cohort and performed better than a single clinical model and a model with clinical features combined with clinical TNM staging. Further analyses showed higher PET RS in patients who were older (p < 0.001) and those who had elevated CEA (p < 0.001) and higher clinical TNM (p < 0.001). At different clinical TNM stages, a higher PET RS was associated with a worse survival prognosis.ConclusionsRadiomics models based on PET RS, clinical TNM, and clinical features may provide new tools for predicting OS in patients with GC.

Comparison of Measurement and Prognostic Power of SUV Between High-Definition and Standard PET Imaging in Non-Small Cell Lung Cancer Patients.

This study aimed to evaluate the measurement and prognostic ability of the SUVmax of whole-body tumors (SUVmaxwb) in non-small cell lung cancer (NSCLC) patients, comparing high-definition (HD) PET imaging with standard-definition (SD) PET imaging. Methods: The study included 242 consecutive NSCLC patients who underwent baseline 18F-FDG PET/CT from April 2018 to January 2021. Two imaging techniques were used: HD PET (using ordered-subsets expectation maximization with point-spread function modeling and time-of-flight techniques and smaller voxels) and SD PET (with ordered-subsets expectation maximization and time-of-flight techniques). SUVmaxwb was determined by measuring all the tumor lesions in the whole body, and tumor-to-background ratio (TBR) was calculated using the background SUVmean of various body parts. Results: The patient cohort had an average age of 68.3 y, with 59.1% being female. During a median follow-up of 29.6 mo, 83 deaths occurred. SUVmaxwb was significantly higher in HD PET than SD PET, with respective medians of 17.4 and 11.8. The TBR of 1,125 tumoral lesions was also higher in HD PET. Univariate Cox regression analysis showed that SUVmaxwb from both HD and SD PET were significantly associated with overall survival. However, after adjusting for TNM (tumor, node, metastasis) stage, only SUVmaxwb from SD PET remained significantly associated with survival. Conclusion: HD PET imaging in NSCLC patients yields higher SUVmaxwb and TBR, enhancing tumor visibility. Despite this, its prognostic value is less significant than SD PET after adjusting clinical TNM stage. Thus, consideration should be given to using HD PET reconstruction to increase tumor visibility, and SD PET is recommended for NSCLC patient prognostication and therapeutic evaluation, as well as for the classification of lung nodules.

Correlation of Clinical and Pathological TNM Staging With Histopathological Grading in Oral Squamous Cell Carcinoma.

Background Oral squamous cell carcinoma (OSCC) is the most common type of head-neck cancer. The staging and grading of OSCC play an important role in disease management. Accurate staging helps in patient counseling, treatment planning, and prognostication in head-neck SCC. However, discrepancies between pathological and clinical staging have been stated, which affect disease prognosis. Method A retrospective review of 60 surgically treated patients with OSCC was done. Tumor-nodal-metastasis staging, both clinically and pathologically, was equated and tabulated to determine upstaging,downstaging, and cases where no stage change occurred. Additionally, the clinical and pathological TNM (tumor, node, metastasis) staging were correlated with the evaluation of histopathological grading. Results This study comprised 60 surgically operated OSCC patients. The T and N stages showed significant differences when compared clinically and pathologically. There was no significant correlation between histopathological grading and the disparities in TNM staging. Conclusion Some discrepancies exist between TNM staging evaluated clinically and pathologically for OSCC, which may show its effect on treatment planning and the prognosis of affected individuals. The histopathological analysis is the gold standard for the categorization of staging and grading in OSCC for proper treatment planning.

Concordance between Clinical and Pathological T and N Stages in Polish Patients with Head and Neck Cancers

Background: The TNM (tumor, node, metastasis) staging system is important for the successful treatment of head and neck cancers (HNCs). This study aimed to evaluate the concordance between clinical and pathological T and N stages in patients with HNCs in Poland. Methods: In this single-center retrospective study, clinical and pathological TNM staging data on 203 patients undergoing surgical treatment for HNC between 2011 and 2018 were collected and compared. The study group was classified as underdiagnosed, overdiagnosed, or correctly diagnosed with HNC based on pathological TNM staging. The concordance between clinical and pathological staging was evaluated using the kappa coefficient. Results: Clinical and pathological TNM staging showed concordance in 59.9% of patients for primary tumor (T) and in 79.3% of patients for lymph node (N) classifications. Moderate agreement between the clinical and pathological stages was shown for stage T, while substantial agreement was revealed for stage N. The size and extent of the tumor were underestimated or overestimated in 73 of the 182 patients (40.1%), while lymph node involvement was downstaged in 11 of the 53 patients (20.7%). Conclusions: The disparities between clinical and pathological staging of HNC demonstrate the need for standardization in physical and pathological examinations, as well as radiographic imaging.

Clinicopathological and prognostic role of ROC1 in neoplasms: A PRISMA-compliant systematic review and meta-analysis.

Background:Regulator of cullins 1 (ROC1) is frequently overexpressed in multiple tumors, and many pieces of research demonstrate that ROC1 is associated with the prognosis and development of a diversity of neoplasms and it is able to serve as a promising prognostic biomarker. Here we performed this meta-analysis to evaluate the prognostic and clinicopathological significance of ROC1 in patients suffering from cancer.Methods:We searched Pubmed, Embase, Web of Science, Chinese National Knowledge Infrastructure (CNKI), and WanFang database. The role of ROC1 in cancers was evaluated by pooled hazard ratios (HRs), odd ratios (ORs) and 95% confidence intervals (CIs).Results:In total, 9 studies including 1002 patients were enrolled in this analysis. The pooled results showed that patients with high expression of ROC1 had poor overall survival (OS) (HR: 2.04, 95% CI: 1.48–2.60, P < 0.001) and recurrence-free survival (RFS) (HR: 1.727, 95% CI: 0.965–2.488, P < 0.001). Additionally, elevated expression of ROC1 was significantly correlated with advanced clinical Tumor Node Metastasis stage (OR: 2.708, 95% CI: 1.856–3.951, P < 0.001), positive lymph node metastasis (OR: 1.968; 95% CI: 1.294–2.993, P = .002), large tumor size (OR: 1.522, 95% CI: 1.079–2.149, P = .017) and poor tumor differentiation (OR: 2.448, 95% CI: 1.793–3.344, P < 0.001).Conclusions:Elevated ROC1 expression predicted worse prognosis and advanced pathological parameters in various cancers. ROC1 was a significant prognostic biomarker for poor survival in human cancers.

Increased prognostic value of clinical-reproductive model in Chinese female patients with esophageal squamous cell carcinoma.

BACKGROUNDIn China, it has been well recognized that some female patients with esophageal squamous cell carcinoma (ESCC) have different overall survival (OS) time, even with the same tumor-node-metastasis (TNM) stage, challenging the prognostic value of the TNM system alone. An effective predictive model is needed to accurately evaluate the prognosis of female ESCC patients.AIMTo construct a novel prognostic model with clinical and reproductive data for Chinese female patients with ESCC, and to assess the incremental prognostic value of the full model compared with the clinical model and TNM stage.METHODSA new prognostic nomogram incorporating clinical and reproductive features was constructed based on univariatie and Cox proportional hazards survival analysis from a training cohort (n = 175). The results were recognized using the internal (n = 111) and independent external (n = 85) validation cohorts. The capability of the clinical–reproductive model was evaluated by Harrell’s concordance index (C-index), Kaplan–Meier curve, time-dependent receiver operating characteristic (ROC), calibration curve and decision curve analysis. The correlations between estrogen response and immune-related pathways and some gene markers of immune cells were analyzed using the TIMER 2.0 database. RESULTSA clinical–reproductive model including incidence area, age, tumor differentiation, lymph node metastasis (N) stage, estrogen receptor alpha (ESR1) and beta (ESR2) expression, menopausal age, and pregnancy number was constructed to predict OS in female ESCC patients. Compared to the clinical model and TNM stage, the time-dependent ROC and C-index of the clinical–reproductive model showed a good discriminative ability for predicting 1-, 3-, and 5-years OS in the primary training, internal and external validation sets. Based on the optimal cut-off value of total prognostic scores, patients were classified into high- and low-risk groups with significantly different OS. The estrogen response was significantly associated with p53 and apoptosis pathways in esophageal cancer.CONCLUSIONThe clinical–reproductive prognostic nomogram has an incremental prognostic value compared with the clinical model and TNM stage in predicting OS in Chinese female ESCC patients.

Prediction of Microvascular Invasion and Its M2 Classification in Hepatocellular Carcinoma Based on Nomogram Analyses.

Background and AimsAs a key pathological factor, microvascular invasion (MVI), especially its M2 grade, greatly affects the prognosis of liver cancer patients. Accurate preoperative prediction of MVI and its M2 classification can help clinicians to make the best treatment decision. Therefore, we aimed to establish effective nomograms to predict MVI and its M2 grade.MethodsA total of 111 patients who underwent radical resection of hepatocellular carcinoma (HCC) from January 2017 to December 2019 were retrospectively collected. We utilized logistic regression and least absolute shrinkage and selection operator (LASSO) regression to identify the independent predictive factors of MVI and its M2 classification. Integrated discrimination improvement (IDI) and net reclassification improvement (NRI) were calculated to select the potential predictive factors from the results of LASSO and logistic regression. Nomograms for predicting MVI and its M2 grade were then developed by incorporating these factors. Area under the curve (AUC), calibration curve, and decision curve analysis (DCA) were respectively used to evaluate the efficacy, accuracy, and clinical utility of the nomograms.ResultsCombined with the results of LASSO regression, logistic regression, and IDI and NRI analyses, we founded that clinical tumor-node-metastasis (TNM) stage, tumor size, Edmondson–Steiner classification, α-fetoprotein (AFP), tumor capsule, tumor margin, and tumor number were independent risk factors for MVI. Among the MVI-positive patients, only clinical TNM stage, tumor capsule, tumor margin, and tumor number were highly correlated with M2 grade. The nomograms established by incorporating the above variables had a good performance in predicting MVI (AUCMVI = 0.926) and its M2 classification (AUCM2 = 0.803). The calibration curve confirmed that predictions and actual observations were in good agreement. Significant clinical utility of our nomograms was demonstrated by DCA.ConclusionsThe nomograms of this study make it possible to do individualized predictions of MVI and its M2 classification, which may help us select an appropriate treatment plan.

MR evaluation of tongue carcinoma in the assessment of depth of invasion with histopathological correlation: A single center experience.

Introduction:Magnetic resonance imaging (MRI) has become the cornerstone for pretreatment evaluation of carcinoma tongue and provides accurate information regarding the extent of the lesion and depth of invasion that helps the clinician to optimize treatment strategy. Aim of the study is to correlate MRI and histopathological findings, to evaluate the role of MRI in loco-regional tumor node metastasis (TNM) staging, and to assess the depth of invasion of tongue carcinoma. Materials and Methods:This study was undertaken on 30 patients with clinical diagnosis of tongue carcinoma referred for MR imaging at a tertiary care hospital over the 2-year period between July 2017 and June 2019. MRI was performed with GE 1.5 Tesla scanner, neurovascular (NV) array coil. Clinical and MRI staging of tongue carcinoma was done preoperatively and correlated. Post-surgery, histopathological TNM staging was done and correlated with clinical and MRI TNM staging. The cutoff value of histopathological (HP) depth that could determine the existence of nodal metastasis was 5 mm. Results:In 30 patients diagnosed with tongue carcinoma, the incidence was higher in males (92%). Moderate agreement (k = 0.512) was noted for T staging between clinical and MRI staging assessments. Fair agreement (k = 0.218) was noted for N stage between clinical and MRI staging assessments. There was good agreement (k = 0.871) for M stage between the clinical and MRI staging assessments. Good agreement (k = 0.822 and k = 0.767, respectively) was noted for both T staging and Nstaging between MRI and histopathology staging assessments. The agreement for the T stage was poor (k = 0.012) between the clinical and histopathology staging assessments. Agreement for the N stage was also poor (k = 0.091) between the clinical and histopathology staging assessments. Mean depth of invasion by histology and MRI was 14.22 mm and 16.12 mm, respectively. Moderate agreement (k = 0.541) was noted between clinical and pathological tumor depth and good agreement (k = 0.844) was noted between radiological and pathological tumor depth. As for the T1WGd MRI depth with a cutoff value of 5 mm, the nodal metastasis rate in the group with values >5 mm was 52%, and for those <5 mm was 24%, both of which were significantly different (P = 0.040). Pearson's correlation coefficient of HP depth and T1WGd MRI depth was 0.851 (P < 0.001) suggesting that HP depth shows a strong correlation with T1WGd MRI depth. Conclusion:MRI is the imaging modality of choice for evaluation of tongue carcinoma as MRI helps in accurate staging of the tumor using TNM classification which is crucial for optimizing treatment options. The current study shows a high correlation between MRI and histopathological findings regarding thickness of tumor and depth of invasion. MRI and histopathology assessments of tumor spread were equivalent to within 0.5 mm DOI. Estimation of invasion depth using MRI as a preoperative study in oral tongue carcinoma is essential in planning surgical treatment strategies such as the extent of elective neck dissection. Invasion depth, which greatly affects occult node metastases, must be included in the TNM staging of oral tongue carcinoma.

Application of the proposed eighth edition of the American Joint Committee on Cancer/Union of International Cancer Control esophageal cancer staging system in esophageal cancer patients

AbstractObjectiveThe eighth edition of the American Joint Committee on Cancer/Union of International Cancer Control esophageal cancer staging system was proposed in early 2018. The eighth edition staging system includes clinical staging, pathological staging, and neoadjuvant pathological staging, which fills in the blank of non‐operative staging of esophageal cancer. However, there are few reports on the eighth edition of clinical staging, and the purpose of the present study was to verify the prognostic value of the new American Joint Committee on Cancer clinical staging system for esophageal cancer patients who undergo radical radiation therapy.MethodsA total of 544 patients with esophageal cancer from Tianjin Medical University Cancer Institute and Hospital between March 2010 and September 2016 were staged according to the eighth American Joint Committee on Cancer clinical staging system. The Kaplan–Meier method was used to calculate the survival rate of the patients. The Cox regression model was used for multivariate prognostic analysis.ResultsAll the patients were divided into different groups by the eighth American Joint Committee on Cancer clinical tumor–node–metastasis staging system: 40 patients with T2; 157 patients with T3; 347 patients with T4; 132 patients with N0; 193 patients with N1; 172 patients with N2; 47 patients with N3; 81 patients with stage II; 102 patients with state III; and 361 patients with stage IVA. The 3‐year survival rates of stage T2, stage T3, and stage T4 were 60.1%, 45.6%, and 30.8%, respectively (P &lt; 0.001). The 3‐year survival rates of stage N0, stage N1, stage N2, and stage N3 were 48.2%, 40.7%, 29.4%, and 17.3%, respectively (P &lt; 0.001). The 3‐year survival rates of stage II, stage III, and stage IVA were 59.3%, 40.1%, and 31.2%, respectively (P &lt; 0.001). In univariate analysis, age, concurrent chemoradiotherapy, T stage, N stage, Karnofsky marking system, the sixth edition staging system and the eighth edition staging system were important prognostic factors in univariate analyses. In multivariate analysis, concurrent chemotherapy and N stage were important prognostic factors.ConclusionsBased on the data from Tianjin Medical University Cancer Institute and Hospital, the eighth edition clinical staging system had a better predictive ability for esophageal cancer patients who underwent radical radiation therapy.

Large-scale Circulating microRNA Profiling for the Liquid Biopsy of Prostate Cancer.

The high false-positive rate of prostate-specific antigen (PSA) may lead to unnecessary prostate biopsies. Therefore, the United States Preventive Services Task Force recommends that decisions regarding PSA-based screening of prostate cancer should be made with caution in men ages 55-69 years, and that men ≥70 years should not undergo PSA screening. Here, we investigated the potential of serum miRNAs as an accurate diagnostic method in patients with suspected prostate cancer. Serum samples of 809 patients with prostate cancer, 241 negative prostate biopsies, and 500 patients with other cancer types were obtained from the National Cancer Center, Japan. Forty-one healthy control samples were obtained from two other hospitals in Japan. Comprehensive microarray analysis was performed for all samples. Samples were divided into three sets. Candidate miRNAs for prostate cancer detection were identified in the discovery set (n = 123). A diagnostic model was constructed using combinations of candidate miRNAs in the training set (n = 484). The performance of the diagnostic model was evaluated in the validation set (n = 484). In the discovery set, 18 candidate miRNAs were identified. A robust diagnostic model was constructed using the combination of two miRNAs (miR-17-3p and miR-1185-2-3p) in the training set. High diagnostic performance with a sensitivity of 90% and a specificity of 90% was achieved in the validation set regardless of the Gleason score and clinical tumor-node-metastasis stage. The model developed in this study may help improve the diagnosis of prostate cancer and reduce the number of unnecessary prostate biopsies.

Development trend of assessment system in gastric cancer based on evolution of staging criteria

There are two major stage classification systems for gastric cancer: the tumor-node-metastasis (TNM) staging by the International Union against Cancer (UICC)/the American Joint Committee on Cancer(AJCC) and the Japanese Classification of Gastric Carcinoma by the Japanese Gastric Cancer Association(JGCA). The evolution of these two systems showed the advancement of gastric cancer treatment. The independence of TNM and JGCA staging system is not conducive to global communication and cooperation. The integration of 2010 Japan's 14th edition of the General Rules for Gastric Cancer Study and the 7th edition of UICC/AJCC TNM staging formed an internationally unified clinical staging system. TNM staging determined by the N factor according to the number of lymph node metastasis more accurately stratified the survival curves of different stages. On January 1, 2018, the 8th edition of the TNM staging system for gastric cancer was officially implemented. The 8th edition of TNM staging provided a new definition of the staging criteria for esophagogastric junction cancer. On the basis of a single staging system, clinical TNM staging(cTNM) and neoadjuvant treatment staging (ypTNM) were added. N3a and N3b were seperately staged, and adjustments were made to the histological grading. A comprehensive treatment plan was determined by accurate clinical staging in the model of multidisciplinary diagnosis and treatment for gastric cancer. Comprehensive application of endoscopic ultrasonography (EUS), multi-slice spiral CT(MDCT), positron computed tomography combined with CT(PET-CT), and staging laparoscopy can improve the accuracy of preoperative staging of gastric cancer. The emergence of ypTNM staging is a highlight of the 8th edition of the staging, but due to insufficient case data for cTNM and ypTNM staging, the staging criteria are relatively broad, and more data validation, refinement and revision are required in the future. The 8th edition system is superior to the 7th edition system in terms of homogeneity, discriminatory ability, and monotonicity of gradients for Chinese patients with gastric cancer. The new version of the staging can guide clinicians to develop treatment plans more rationally, evaluate the treatment more scientifically, and assess the prognosis more accurately. New lymph node staging methods such as metastatic rate(rN), log odds of positive lymph nodes (LODDS), and a new staging system based on the anatomical range of lymph node metastasis can also better predict the prognosis of patients. At present, molecular type of gastric cancer has little significance for prognosis guidance, and may be rewritten or supplemented with TNM staging of gastric cancer in the future. This article discusses the history, current status and research progress of gastric cancer staging.

A 13-year experience with gastric neuroendocrine tumors: A single institute study

Purpose Gastric neuroendocrine tumors (GNETs) are relatively uncommon. Although they frequently follow indolent clinical courses, GNETs have the potential for metastasis. The aim of this study was to analyze the clinicopathological characteristics of GNETs and explore the prognostic factors associated with overall survival of patients with GNETs. Methods All patients who underwent resection of GNETs from 2003 to 2016 at St. Vincent’s Hospital were identified retrospectively. Demographic data, tumor characteristics, and survival results were evaluated. Results Of the 32 patients with GNETs, 10 patients (31.3%) had an endoscopic resection and 22 (68.7%) had a surgical resection. In terms of the European Neuroendocrine Tumor Society (ENETS) tumor-node-metastasis (TNM) staging systems, three (9.4%), seven (21.9%), five (15.6%), 13 (40.6%), and four patients (12.5%) were classified as stages 0, I, II, III, and IV, respectively. Overall survival differed significantly according to disease stage. Patients with positive symptoms, larger tumor size, and advanced stage had lower survival rates than those with other types. Conclusion ENETS TNM stage is a reliable parameter for assessment of the prognosis of patients with GNETs. Clinical symptoms, tumor size, and TNM stage are associated with survival of patients with GNETs. Keywords: Neuroendocrine tumors, Stomach, Stage, Survival

High expression of special AT-rich sequence binding protein-1 predicts esophageal squamous cell carcinoma relapse and poor prognosis.

Previous studies of the roles of special AT-rich sequence binding protein-1 (SATB1) in the development and progression of cancer have suggested that SATB1 promotes cancer cell metastasis. The aim of the present study is to evaluate the role of SATB1 in the progression and prognosis of esophageal squamous cell carcinoma (ESCC). ESCC tissues were collected from 102 patients and SATB1 mRNA expression was measured by reverse transcription-quantitative polymerase chain reaction. The association between expression of SATB1 mRNA with clinicopathological features and prognosis was assessed, and the prognosis of ESCC was evaluated using Kaplan-Meier survival curves. In the 102 ESCC tissues, SATB1 mRNA expression correlated with the clinical tumor node metastasis stage (P<0.05), but not with any other clinicopathological features (including age, gender, tumor differentiation grade, adjuvant radio/chemotherapy, or the consumption of alcohol and use of cigarettes) (P>0.05). The disease-free survival (DFS) and overall survival (OS) of patients with high SATB1 expression was decreased compared with those with low SATB1 expression. The present study indicated that SATB1 mRNA expression was associated with the postoperative recurrent and poor prognosis in ESCC. SATB1 may be a novel marker for predicting the recurrent and worse prognosis of ESCC.

Correlation between microRNA expression, clinicopathological characteristics, and prognosis in patients with Non-small cell Lung Cancer: A retrospective study.

BackgroundLung cancer prognosis is related to various factors; however, the comprehensive relationship between these factors, including microRNAs (miRNAs), and lung cancer prognosis has not been determined. Thus, the aim of this study was to identify the key factors associated with lung cancer prognosis.MethodsWe retrospectively analyzed prognosis and relevant factors in 216 non‐small cell lung cancer (NSCLC) patients diagnosed from January 2008 to December 2014. Paraffin‐embedded lung tissue samples were used to detect miRNA‐21 and miRNA‐155. Clinical information was collected, including tumor malignancy, tumor node metastasis (TNM) classification, pathological type, site of the original tumor, and lung involvement. The association between factors and overall survival was analyzed. A Cox proportional hazard model was used to perform univariate and multivariate analyses.ResultsAge at surgery (hazard ratio [HR] 1.021, 95% confidence interval [CI] 1.003–1.040), TNM stages II (HR 3.858, 95% CI 2.449–6.078) and III (HR 3.099, 95% CI 1.911–5.023), and miRNA‐21 (HR 1.002, 95% CI 1.001–1.003) and miRNA‐155 expression (HR 1.131, 95% CI 1.064–1.202) were independent prognostic factors in NSCLC patients. MiRNA‐21 expression with TNM stages II (HR 1.282, 95% CI 1.197–1.372) and III (HR 1.247, 95% CI 1.149–1.354) interacted to affect prognosis in NSCLC patients.ConclusionsOlder age, higher clinical TNM stage, and increased miRNA‐21 and miRNA‐155 expression in NSCLC tissue were independently associated with poor survival in NSCLC patients. MiRNA‐21 expression and clinical TNM stage interacted to affect prognosis.

Systematic review of CYFRA 21-1 as a prognostic indicator and its predictive correlation with clinicopathological features in Non-small Cell Lung Cancer: A meta-analysis.

AIMTo evaluate the value of Cytokeratin 19 fragment for its survival prognostic indicator and predictive correlation with clinicopathological features in Non-small Cell Lung Cancer.METHODSEligible studies or databases for articles were retrieved via search systematically. Pooled effect was calculated to evaluate the association between Cytokeratin 19 fragment level and long-term overall survival, as well as the tumor clinicopathological features in Non-small Cell Lung Cancer patients. A fixed-effects or random-effects model was used to calculate the Pooled risk ratios (RRs) and corresponding 95 % confidence intervals (CIs).RESULTSSix studies were up to the selection criteria. This meta-analysis indicated that Cytokeratin 19 fragment high level expression correlated with lower 2-year overall survival (RR =0.47; 95%CI: 0.28-0.79), higher Tumor Node Metastasis stage (II+III+IV) (RR =1.43; 95%CI: 1.15-1.76) in Non-small Cell Lung Cancer. The pooled RR estimates indicated that there is no statistical significance of Cytokeratin 19 fragment level expression in the advanced Non-small Cell Lung Cancer (IIIB+IV) (RR =1.43, 95% CI: 0.85-2.43).CONCLUSIONCytokeratin 19 fragment is a negative prognosis indicator and its high level expression indicates higher Tumor Node Metastasis pathological stage (II+III+IV) in Non-small Cell Lung Cancer. In advanced Non-small Cell Lung Cancer, the level of serum Cytokeratin 19 fragment appears to provide more prognostic information than it does for clinical Tumor Node Metastasis stage information. Further studies are required to confirm our results.

Impact of clinical tumor–node–metastasis staging on survival in gastric carcinoma patients receiving surgery

Preoperative clinical staging of gastric cancer is used to determine therapeutic strategies. However, the impact of the clinical stage on survival has not been completely investigated, although the relationship between pathologic staging and survival outcome has been reported. The aim of the present study was to clarify the predictability of patient survival based on clinical staging and to evaluate the usefulness of staging as an indicator for selecting the treatment modality. A total of 3033 patients who underwent surgery for gastric cancer were included. A survival analysis was conducted based on the seventh edition of the tumor-node-metastasis (TNM) clinical staging system of the American Joint Committee on Cancer. The predictive ability of the TNM clinical stage for survival was evaluated by Harrell's C-index, a measure of the separation of survival distributions. The cumulative 5-year survival rates according to the clinical stage were 94.3% (IA), 84.7% (IB), 71.7% (IIA), 56.1% (IIB), 55.7% (IIIA), 42.3% (IIIB), 22.8% (IIIC), and 9.1% (IV). Although no significant difference was observed between clinical stages IIB and IIIA (p=0.865), significant differences existed between all other clinical stages (p<0.001). Harrell's C-index applied to these results was 0.825 (95% confidence interval 0.819-0.831). The seventh edition of the TNM clinical staging system has a strong prognostic ability with a satisfactory C-index and should be considered valuable for selecting therapeutic strategies for the treatment of gastric cancer.

Lower expressed miR-198 and its potential targets in hepatocellular carcinoma: a clinicopathological and in silico study.

PurposeTo investigate the clinicopathological value and potential roles of microRNA-198 (miR-198) in hepatocellular carcinoma (HCC).MethodsNinety-five formalin-fixed paraffin-embedded HCC and the para-cancerous liver tissues were gathered. Real-time reverse transcription quantitative polymerase chain reaction was applied to determine the miR-198 expression. The association between the miR-198 expression and clinicopathological features was examined. Meanwhile, potential target messenger RNAs of miR-198 in HCC were obtained from 14 miRNA prediction databases and natural language processing method, in which we pooled the genes related to the tumorigenesis and progression of HCC and classified them by their frequency. The selected target genes were finally analyzed in the Gene Ontology analysis and Kyoto Encyclopedia of Genes and Genomes pathway.ResultsmiR-198 expression was significantly lower in HCC than that in adjacent noncancerous liver tissues (1.30±0.72 vs 2.01±0.58, P<0.001). Low miR-198 expression was also correlated to hepatitis C virus infection (r=−0.48, P<0.001), tumor capsular infiltration (r=−0.43, P<0.001), metastasis (r=−0.26, P<0.010), number of tumor nodes (r=−0.25, P=0.013), vaso-invasion (r=−0.24, P=0.017), and clinical tumor node metastasis stage (r=−0.23, P=0.024). Altogether, 1,048 genes were achieved by the concurrent prediction from at least four databases and natural language processing indicated 1,800 genes for HCC. Further, 127 overlapping targets were further proceeded with for pathway analysis. The most enriched Gene Ontology terms in the potential target messenger RNAs of miR-198 were cell motion, cell migration, cell motility, and regulation of cell proliferation in biological process; organelle lumen, membrane-enclosed lumen, and nuclear lumen in cellular component; and enzyme binding, protein domain-specific binding, and protein kinase activity in molecular function. Kyoto Encyclopedia of Genes and Genomes analysis showed that these target genes were obviously involved in focal adhesion and pathways in cancer.ConclusionLower expression of miR-198 was related to several clinicopathological parameters in HCC patients. miR-198 might play a regulatory role through its target genes in the development of HCC.

To evaluate disparity between clinical and pathological tumor-node-metastasis staging in oral cavity squamous cell carcinoma patients and its impact on overall survival: An institutional study.

Background:Accurate clinical staging is important for patient counseling, treatment planning, prognostication, and rational design of clinical trials. In head and neck squamous cell carcinoma, discrepancy between clinical and pathological staging has been reported.Objective:To evaluate any disparity between clinical and pathological tumor-node-metastasis (TNM) staging in oral cavity squamous cell carcinoma (OCSCC) patients and any impact of the same on survival.Materials and Methods:Retrospective chart review from year 2007 to 2013, at a tertiary care center.Statistical Analysis:All survival analyses were performed using SPSS for Windows version 15 (Chicago, IL, USA). Disease-free survival curves were generated using Kaplan–Meier algorithm.Results:One hundred and twenty-seven patients with OCSCC were analyzed. Seventy-nine (62.2%) were males and 48 (37.8%) females with a mean age at presentation 43.6 years (29–79 years). The highest congruence between clinical and pathological T-staging seen for clinical stage T1 and T4 at 76.9% and 73.4% with pathological T-stage. Similarly, the highest congruence between clinical and pathological N-stage seen for clinical N0 and N3 at 86.4% and 91.7% with pathological N-stage. Of clinically early stage patients, 67.5% remained early stage, and 32.5% were upstaged to advanced stage following pathological analysis. Of the clinically advanced stage patients, 75% remained advanced, and 25% were pathologically downstaged. This staging discrepancy did not significantly alter the survival.Conclusion:Some disparity exists in clinical and pathological TNM staging of OCSCC, which could affect treatment planning and survival of patients. Hence, more unified and even system of staging for the disease is required for proper decision-making.

Overexpression of C35 in breast carcinomas is associated with tumor progression and lymphnode metastasis.

To investigate C35 protein expression in breast carcinoma and to investigate its clinicopathological significance, a total of 68 cases of breast carcinoma and 20 cases of normal breast tissue samples were obtained from the clinic. Protein expression of C35, ER, PR and HER-2 were determined using immunohistochemistry. The correlations between C35 expression and clinicopathological parameters were analyzed on the basis of individual clinicopathologic records. Overexpression of C35 was detected in 56 of 68 (82.35%) breast carcinoma samples and only 3 of 20 (15%) normal breast tissue samples, and frequency of C35 expression was significantly associated with clinical Tumor Node Metastasis staging and Scarff-Bloom-Richardson grade (p < 0.05), but was not related to patients age, menstrual status and tumor diameter. C35 expression was positively related with the expression of HER-2 (r = 0.207), whereas negatively related with the expression of ER and PR. Further, C35 was prevalent in all four molecular subtypes of breast carcinoma with no significant difference of expression frequency. However, they have significant differences in lymphatic metastasis cases compared to the non-metastasis cases (p < 0.05). Since C35 protein was extensively expressed in all stages of breast carcinoma, and was closely associated with tumor progression and lymph node metastasis, it might be used as a reliable biomarker or therapeutic target for diagnosis and treatment.

Improvement in Clinical TNM Staging Documentation Within a Prostate Cancer Quality Improvement Collaborative

To assess the effectiveness of a feedback and educational intervention to increase documentation of clinical tumor-node-metastasis (TNM) stage among urologists in a statewide quality improvement collaborative. The Michigan Urological Surgery Improvement Collaborative (MUSIC) is a consortium of urology practices that aims to improve the quality and cost-efficiency of prostate cancer care. In pilot data collection activities, trained abstractors recorded medical record documentation of clinical TNM stage by participating urologists. We compared levels of TNM stage documentation in 12 MUSIC practices at baseline and after performance feedback and a collaborative-wide educational intervention. We examined patient and practice characteristics associated with documentation of TNM stage. We accrued 491 and 581 men with newly diagnosed prostate cancer during the baseline and postfeedback phases of data collection, respectively. At baseline, 58% of patients had clinical TNM staging in the medical record, ranging from 19% to 96% across 12 practices (P <.05). After the intervention, documentation improved to 79% of patients overall, with 7 individual practices achieving significant improvements (all P <.05). The greatest improvements in documentation occurred among patients treated in smaller practices (ie, 1-4 urologists). After collaborative review of staging criteria and feedback of baseline performance, urologists in MUSIC practices dramatically improved documentation of clinical TNM stage. This finding underscores the behavioral change possible with the collaborative quality improvement model and ensures the necessary risk stratification data for our ongoing efforts to improve care.