Edition TNM Staging System Research Articles

Tumor-Infiltrating NETs Predict Postsurgical Survival in Patients with Pancreatic Ductal Adenocarcinoma.

Tumor-infiltrating neutrophils (TINs) indicate poor prognosis for patients with pancreatic ductal adenocarcinoma (PDAC). Activated neutrophils can generate neutrophil extracellular traps (NETs). Little is known about the presence and prognostic significance of tumor-infiltrating NETs in PDAC. This study enrolled 317 patients, in two independent sets (training and validation), who underwent curative pancreatectomy for PDAC in Shanghai Cancer Center. TINs and NETs were identified by immunohistochemical staining for CD15 and citrullinated histone H3, respectively. The relationship between clinicopathological features and outcomes was analyzed. Accuracy of prognostic prediction models was evaluated using concordance index (C-index) and Akaike information criterion (AIC). NETs were associated with OS (both, P < 0.001) and RFS (both, P < 0.001) in the training and validation sets. Tumor-infiltrating NETs predicted poor postsurgical survival of patients with PDAC. Moreover, multivariate analysis identified NETs and AJCC TNM stage as two independent prognostic factors for OS and RFS. Combination of NETs with the 8th edition TNM staging system (C-index, 0.6994 and 0.6669, respectively; AIC, 1067 and 1126, respectively) generated a novel model that improved the predictive accuracy for survival in both sets (C-index, 0.7254 and 0.7117, respectively; AIC, 1047 and 1102, respectively). The model combining presence of NETs with the 7th edition AJCC TNM staging system also had improved predictive accuracy. NETs were an independent prognostic factor in PDAC and incorporation of NETs along with the standard TNM stating system refined risk-stratification and predicted survival in PDAC with improved accuracy.

Quantifying Upstage Rate as a Function of Delay from Diagnostic Imaging for Locally-Advanced Lung Cancer Patients

Diagnosis and characterization of non-small cell lung cancer is done with diagnostic F18-FDG PET imaging as it is superior in sensitivity and specificity compared to conventional helical CT scans. Due to the aggressive nature of NSCLC, upstaging of disease is a concern for patients scheduled to undergo radical radiotherapy. We have reviewed our institution’s experience with treatment planning PET-CT scans and quantified the upstage rates. As part of a REB-approved study, PET-CT images acquired for treatment planning purposes. They were compared with PET-CT scans used for initial staging by two independent assessors. Patients’ age at diagnosis, sex, tumor histology, stage & date at diagnostic PET-CT, stage & date at treatment PET-CT and survival/follow-up were collected prospectively. AJCC 7th edition TNM Staging System was applied. Reported stages were compared and differences were reconciled by a third independent party. Descriptive statistics were calculated and the estimates of the upstage rates were obtained using the Kaplan-Meier product-limit method. Between October 2009 and February 2012, 28 patients were accrued to the study. The mean age was 64 years (range: 41-81). Eight were female and 19 were male. The majority of patients had Stage IIIA disease (15), with others having Stage IIIB (11), Stage IIA (1) and Stage IIB (1) disease. Predominant tumor histology was adenocarcinoma (71%). Median time between diagnostic and planning PET-CT scans was 21 days (range: 2-73). Overall upstaging occurred in 25% of patients. The TNM upstage breakdown was as follows: T-stage 7%, N-stage 14% and M-stage 11%. The 3 patients were found to have metastatic disease were switched to treatment with palliative intent. New nodal stations were found in 32% of patients, thereby necessitating a change in the treatment volumes. With the Kaplan-Meier product limit method the rate of overall upstaging increased with delay between staging and treatment planning PET-CT scans: 13% at 20 days (95% CI: 4%-95%), 33% at 40 days (95% CI: 14%-86%), and 56% at 60 days (95% CI: 29%-71%). The use of a treatment planning PET-CT demonstrated upstaging which altered patients’ treatment plans. Lengthened interval period between diagnostic PET and planning PET scans showed an increase in upstaging. Our data is consistent with two published studies which showed similar upstaging rates.

Cribriform Subtype is an Independent Predictor of Recurrence and Survival After Adjustment for the Eighth Edition of TNM Staging System in Patients With Resected Lung Adenocarcinoma

IntroductionAt present, cribriform arrangements are regarded as a pattern of acinar adenocarcinoma. However, recent studies have indicated that clinical outcomes for lung adenocarcinoma patients with cribriform subtype are unfavorable. To validate the prognostic significance of the cribriform pattern, we analyzed a series of 735 Japanese patients with resected lung adenocarcinoma, which was restaged according to the eighth edition of the TNM staging system. MethodsTumors were classified in accordance with the 2015 WHO classification of lung carcinomas. The cribriform pattern was defined by invasive back-to-back fused tumor glands with poorly formed glandular spaces or invasive tumor nests of tumors cells that produce glandular lumina. Recurrence-free probability (RFP) and overall survival (OS) was analyzed using the log-rank test and the Cox proportional hazards model. ResultsAfter the addition of the cribriform pattern, 54 of 90 acinar-predominant tumors were reclassified as cribriform subtype. Five-year RFP for patients with the cribriform subtype (51%) was lower than it was for patients with acinar and papillary subtype (81% and 80%, respectively) but was comparable to that for patients with solid subtype (48%). Five-year OS for patients with the cribriform subtype (49%) was lower than it was for patients with acinar and papillary subtype (90% and 81%, respectively). On multivariate analysis adjusted for the eighth edition of the TNM staging system, the cribriform subtype was an independent prognostic factor of a worse RFP and OS. ConclusionsWe have validated that the cribriform subtype is an independent factor of poor prognosis in patients with resected lung adenocarcinoma.

Staging and Treatment Implications of the 7th Vs. 8th AJCC Staging System for Oral Cancer

The eighth edition of the American Joint Committee on Cancer TNM staging has integrated depth of infiltration (DOI) into the T staging and extra-nodal extension (ENE) or Extracapsular spread (ECS) into the N staging as prognostic factors. Multiple studies have shown that ENE or ECS have been associated with worse survival outcomes and recurrence rates (1). DOI is indirectly correlated to poorer survival outcomes and recurrence rates by predicting nodal metastasis (2). This study intends to look at the potential change of management caused by the new staging system. An IRB approval by North Memorial Medical Center was granted for a retrospective chart review from 2014-2017 looking at 100 patients that were managed for oral squamous cell carcinoma using the seventh edition TNM staging system in the hospital. The same cohort of patients were then restaged using the eighth edition and comparison of management strategies based on the National Comprehensive Cancer Network guidelines was performed to evaluate if any staging discrepancies also translated to a difference in management. The individual components of the new staging system were also analyzed to see which impacted staging and management more frequently. Results showed a 14.3% overall rate of upstaging and an 8.6% overall rate in change of management leading to additional adjunctive treatment, DOI was involved in 40% of upstaging and no change in management, ENE/ECS positivity was involved in 60% of upstaging and 100% in change of management. No patients were downstaged using the eighth edition. We concluded that while DOI was involved in upstaging it has a less of an impact on management as compared to upstaging caused by ENE/ECS.

PS02.050: TUMOR LOCATION IS AN INDEPENDENT PROGNOSTIC FACTOR OF ESOPHAGEAL ADENOCARCINOMA BASED ON THE EIGHTH EDITION OF TNM STAGING SYSTEM IN CHINESE PATIENTS

Abstract Background Whether tumor location has any impact on the survival of esophageal adenocarcinoma patients remains controversial. In this study, we tried to investigate the prognostic value of tumor location for esophageal adenocarcinoma based on the eight edition of TNM staging system, which modified the description for positioning the esophagogastric junction (EGJ)tumor, in Chinese patients for the first time. Methods A retrospective analysis of patients who underwent esophagectomy for esophageal adenocarcinoma was conducted. Data for analysis included demographic data, comorbidity, pathologic findings, surgical approach, adjuvant therapy, and survival time. Tumor location was simply categorized into two groups (adenocarcinomas at EGJ and adenocarcinomas at other sites of esophagus). Both univariate and multivariate analyses were applied. Propensity-score matched (PSM) analysis was also conducted to eliminate the bias effects of confounding factors during comparison. Results A total of 107 patients from January 2009 to December 2015 was included for analysis. After a median follow-up time of 60.0 months, the median survival time of those patients was 41.0 months. In the univariate analysis, adenocarcinomas in the EGJ (P = 0.047), early pT stages (P = 0.030), and moderate/well differentiation (P = 0.022) were significantly correlated with better survival. In the multivariate analysis, tumor site [hazard ratio (HR) = 0.545; 95% confidence interval (CI) = 0.302–0.985], pT stage (HR = 0.295; 95% CI = 0.123–0.708), and tumor differentiation (HR = 0.458; 95% CI = 0.244–0.861) were significant independent prognostic factors for overall survival of those esophageal adenocarcinoma patients. After adjusted by PSM, adenocarcinoma at the EGJ still yielded significantly longer survival than those at other sites of esophagus (P = 0.026). Conclusion Tumor location was an independent prognostic factor for esophageal adenocarcinoma based on the eighth edition of TNM staging system in Chinese patients, which indicates that different surgical therapeutic modalities should be applied for esophageal adenocarcinoma with different tumor locations. Disclosure All authors have declared no conflicts of interest.

RA10.06: THE ROLE AND PROGNOSTIC SIGNIFICANCE OF AORTOPULMONARY, ANTERIOR MEDIASTINAL, AND TRACHEOBRONCHIAL LYMPH NODES IN ESOPHAGEAL CANCER: UPDATE OF THE 2018 TNM STAGING SYSTEM

Abstract Background The eighth edition of the American Joint Committee on Cancer TNM staging for esophageal cancer will be implemented at the beginning of 2018. The nodal staging process in the eighth edition remains unchanged from that in the seventh edition in that it was based on the number of lymph nodes (LNs) involved, but the regional lymph node map has been revised. The aortopulmonary (station 5), anterior mediastinal (station 6), and tracheobronchial (station 10) nodes have been omitted from the regional lymph node map for the new TNM staging. However, the role and prognostic significance of these LN stations are not clear. The purpose of this study was to investigate whether the revised nodal staging used in the eighth edition staging system is appropriate, and to verify the role, prognostic significance, and therapeutic value of these LNs in esophageal cancer. Methods The records of patients who underwent esophagectomy for cancer in our department between January 2007 and January 2013 were retrospectively analyzed. The rate of metastases and the index of estimated benefit from lymph node dissection (IEBLD) were calculated for stations 5, 6, and 10 LNs. LN metastasis and patient survival were analyzed and the efficacy of the eighth edition TNM staging system was verified. Results A total of 1637 patients (1350 men, 287 women) were included. The frequencies of dissection of stations 5, 6, and 10 LNs were 34.3% (562/1637), 15.9% (260/1637), and 50.9% (833/1637), respectively. The calculated rate of metastasis to these stations was 3.2% (18/562), 2.3% (6/260), and 4.9% (41/833), respectively. No difference was found in the N stage determined by the seventh and eighth edition N staging systems. The survival curves differed significantly between N stages calculated using the eighth edition TNM system (P &lt; 0.001). The IEBLD values of stations 5, 6, and 10 LNs were 0.57, 0, and 0.97, respectively. Station 5 or 10 LN(+ ) patients had worse median survival time and 5-year overall survival rate compared with LN(–) patients (P &lt; 0.01). Univariate analysis showed that differentiation, T stage, N stage (both seventh and eighth edition calculations), and metastasis to stations 5 and 10 LNs were associated with long-term survival. Conclusion Metastasis to stations 5, 6, or 10 LNs was infrequent. If stations 5, 6, and 10 LNs were omitted in the eighth edition calculation to determine the N stage based on the number of metastatic LNs, this did not influence the accuracy and survival-predicting efficacy of the eighth edition TNM staging. The therapeutic value of lymphadenectomy of stations 5, 6, and 10 was limited. Metastasis to stations 5, 6, and 10 LNs indicated more advanced N stage, which was associated with poor survival. However, no survival difference was found between station 6 LN(+ ) and LN(–) subgroups, possibly because of the limited numbers of cases. Disclosure All authors have declared no conflicts of interest.

An updated and validated PET/CT volumetric prognostic index for non-small cell lung cancer

ObjectivesWhole-body metabolic tumor volume (MTVWB) and TNM staging are independent prognostic factors for overall survival (OS) in non-small cell lung cancer (NSCLC). We aimed to update and validate the PET/CT volumetric prognostic index (PVP index) using the new 8th edition TNM staging system to evaluate its prognostic power versus TNM staging and MTVWB alone. Materials and MethodsThis study was a retrospective analysis of 949 non-small cell lung cancer (NSCLC) patients diagnosed between 2004 and 2014. Clinical TNM stage, MTVWB, age and gender, tumor histology type at the initial staging PET/CT exam, as well as treatment history and long-term survival data were obtained. Patients were randomly assigned to modeling or validation group. Univariate and multivariate Cox regression analyses were performed to compare PVP index, TNM stage, and MTVWB in the validation group. ResultsThe updated PVP index included the 3 variables TNM stage, and MTVWB and age. Univariate Cox models showed significant association of PVP index with overall survival (OS) in patients with NSCLC (with Hazard ratio HR = 2.88 in the validation group, p < 0.001). The C-statistic of the PVP index (C-statistic = 0.71 in the validation group) was significantly greater than that of 8th edition TNM staging (C-statistic = 0.68, p = 0.029), MTVWB (C-statistic = 0.68, p = 0.001), and patient age (C-statistic = 0.53, p < 0.001). Multivariate Cox regression analyses demonstrated significant association of PVP index with OS (with HR = 2.80, p < 0.001) after adjusting patient’s gender and tumor histology. ConclusionsThe updated PVP index provides a quantitative risk assessment for NSCLC patients using 8th edition TNM staging, MTVWB, and age. The index provides a simple and practical way for the care team to incorporate the independent prognostic value of both the TNM stage and MTVWB. This approach can further improve the accuracy of overall survival prognosis.

Tumor size classification of the 8th edition of TNM staging system is superior to that of the 7th edition in predicting the survival outcome of pancreatic cancer patients after radical resection and adjuvant chemotherapy

The 8th edition of TNM staging system has been released and it incorporates many changes to the T and N classifications for pancreatic cancer. Comparative study between the 7th and 8th edition of TNM staging system from Asian population has not been reported yet. This study aimed to compare the 7th and 8th edition of staging system for pancreatic cancer by using a cohort of pancreatic cancer patients from China after R0 pancreaticoduodenectomy and adjuvant chemotherapy. The results showed according to the pT classification of 7th edition, pT3 was predominant (87.25%), however, the new edition led to a more equal distribution of pT classification. pT1, pT2 and pT3 was 27.45%, 56.86% and 15.69%, respectively. According to the new pN classification, 18.63% of the patients were pN2. The pT classification in the 8th edition was significantly superior to that in the 7th edition at stratifying patients by overall survival. The pN classification in the 8th edition failed to show an advantage over the 7th edition in stratifying patients by overall survival. Therefore, the new pT classification, but not the new pN classification, showed a significant advantage over the previous edition at predicting the overall survival of pancreatic cancer patients.

Development and Validation of a Nomogram Prognostic Model for SCLC Patients.

SCLC accounts for almost 15% of lung cancer cases in the United States. Nomogram prognostic models could greatly facilitate risk stratification and treatment planning, as well as more refined enrollment criteria for clinical trials. We developed and validated a new nomogram prognostic model for SCLC patients using a large SCLC patient cohort from the National Cancer Database (NCDB). Clinical data for 24,680 SCLC patients diagnosed from 2004 to 2011 were used to develop the nomogram prognostic model. The model was then validated using an independent cohort of 9700 SCLC patients diagnosed from 2012 to2013. The prognostic performance was evaluated using pvalue,concordance index and integrated area under the (time-dependent receiver operating characteristic) curve (AUC). The following variables were contained in the final prognostic model: age, sex, race, ethnicity, Charlson/Deyo score, TNM stage (assigned according to the American Joint Committee on Cancer [AJCC] eighth edition), treatment type (combination of surgery, radiation therapy, and chemotherapy), and laterality. The model was validated in an independent testing group with a concordance index of 0.722 ± 0.004 and an integrated area under the curve of 0.79. The nomogram model has a significantly higher prognostic accuracy than previously developed models, including the AJCC eighth edition TNM-staging system. We implemented the proposed nomogram and four previously published nomograms in an online webserver. We developed a nomogram prognostic model for SCLC patients, and validated the model using an independent patient cohort. The nomogram performs better than earlier models, including models using AJCC staging.

Refining the eighth edition AJCC TNM classification and prognostic groups for papillary thyroid cancer with lateral nodal metastasis

BackgroundIn the eighth edition, TNM staging system omits location of nodal metastasis as a criterion for staging patients with papillary thyroid cancer (PTC). Accordingly, all of non-metastatic N1b PTC patients are classified as stage I or II solely according to an age-cutoff of 55 years. We hypothesized that incorporating other lymph node (LN) factors into TNM staging system would better predict cancer-specific mortality (CSM) in N1b patients. MethodsWe enrolled 745 N1b PTC patients without distant metastasis. Alternative prognostic LN factors and cut-off points were assessed using Cox regression and time-dependent ROC analysis. Alternative prognostic groupings were derived based on minimal hazard differences for CSM among groups stratified by LN risk and age. We assessed accuracy of CSM prediction. ResultsLateral LN ratio (LNR) >0.3 and largest LN size >3 cm were prognostic factors for CSM. Stage II patients (eighth edition) with LN risk (lateral LNR >0.3 or largest LN size >3 cm) had a much higher CSM rate (20.9%) than those in the same stage without LN risk (3.2%). Alternative prognostic grouping (Group 1, <55 years without LN risk; Group 2, <55 years with LN risk or ≥55 years without LN risk; and Group 3, ≥55 with LN risk) achieved higher proportions of variance explained (PVEs) for predicting CSM (10.7%) than those of the eighth edition TNM staging system (4.8%). ConclusionsThe proposed grouping for N1b patients using LN risk can distinguish patients with poor prognosis from those with good prognosis better than the eighth edition TNM staging system.

Stage I synchronous multiple primary non-small cell lung cancer: CT findings and the effect of TNM staging with the 7th and 8th editions on prognosis.

Studies have reported that up to 8% of non-small cell lung cancers (NSCLC) involve multiple lesions; no detailed study has assessed the prognosis of early synchronous multiple primary non-small cell lung cancer (SMPNSCLC) (T1N0M0, T2aN0M0). We aimed to assess the spiral CT manifestations of SMPNSCLC during stage I and evaluate the effect of TNM staging with the 7th and 8th editions on the prognosis. We retrospectively analyzed the data of patients who were examined, operated, and pathologically confirmed as having NSCLC from January 1, 2009, to December 31, 2010, and were followed-up for 5 years. The number of cases with stage I SMPNSCLC and solitary primary NSCLC (SPNSCLC) was 36 and 133 as per the 7th edition TNM staging system and 34 and 111 as per the 8th edition TNM staging system, respectively. The relationship between sex, age, smoking history, emphysema, surgical procedure, pathological type, tumor location, and tumor size was evaluated between the two groups, along with the correlation between prognosis and TNM staging with the 7th and 8th editions. A total of 1,948 cases of NSCLC underwent surgery, including 36 cases of stage I SMPNSCLC (77 lesions; 1.85%) with an age of onset of 44-86 years (median age, 60 years). The tumors primarily included adenocarcinoma (93.5%), with a diameter of 0.4-4.5 cm (median, 2.3 cm). CT indicated round/oval tumors in 81.8% cases, lobulation in 79.2% cases, spiculation sign in 70.1% cases, bronchial truncation sign in 31.2% cases, and pleural indentation in 75.3% cases. Moreover, CT indicated the presence of 36 (46.8%) solid nodules and 41 (53.2%) sub-solid nodules. With the 7th edition TNM staging system, the 5-year overall survival (OS) and disease-free survival (DFS) rates for stage ISMPNSCLC were 86.1% and 72.2%, respectively, which did not significantly differ from the prognosis of 133 cases of stage I SPNSCLC (P=0.587, P=0.273). With the 8th edition TNM staging system, the 5-year OS and DFS rates for stage I SMPNSCLC were 88.2% and 73.5%, respectively, which also did not significantly differ with the prognosis of 111 cases of stage I SPNSCLC (P=0.413, P=0.235). Adenocarcinoma was the main pathological type among the cases with stage I SMPNSCLC. Multiple synchronous lesions almost had the malignant characteristics of primary lung cancer, particularly the presence of single or multiple sub-solid nodules. Moreover, stage I SMPNSCLC has a similar prognosis as stage I SPNSCLC. The postoperative outcomes of stage I SMPNSCLC patients remained consistent regardless of whether the 7th or 8th edition TNM staging system was used for staging.

Socioeconomic factors and survival in patients with non-metastatic head and neck squamous cell carcinoma.

The effect of socioeconomic factors on receipt of definitive treatment and survival outcomes in non‐metastatic head and neck squamous cell carcinoma (HNSCC) remains unclear. Eligible patients (n = 37 995) were identified from the United States Surveillance, Epidemiology and End Results (SEER) database between 2007 and 2012. Socioeconomic factors (i.e., median household income, education level, unemployment rate, insurance status, marital status and residence) were included in univariate/multivariate Cox regression analysis; validated factors were used to generate nomograms for cause‐specific survival (CSS) and overall survival (OS), and a prognostic score model for risk stratification. Low‐ and high‐risk groups were compared for all cancer subsites. Impact of race/ethnicity on survival was investigated in each risk group. Marital status, median household income and insurance status were included in the nomograms for CSS and OS, which had higher c‐indexes than the 6th edition TNM staging system (all P < 0.001). Based on three disadvantageous socioeconomic factors (i.e., unmarried status, uninsured status, median household income <US $65 394), the prognostic score model generated four risk subgroups with scores of 0, 1, 2 or 3, which had significantly separated CSS/OS curves (all P < 0.001). Low‐risk patients (score 0–1) were more likely to receive definitive treatment and obtain better CSS/OS than high‐risk patients (score 2–3). Chinese and non‐Hispanic black patients with high‐risk socioeconomic status had best and poorest CSS/OS, respectively. Therefore, marital status, median household income and insurance status have significance for predicting survival outcomes. Low‐risk socioeconomic status and Chinese race/ethnicity confer protective effects in HNSCC.

P1.03-069 EGFR Mutations Have Greater Influence on Survival Than Proposed M Descriptors of New TNM Classification for Lung Cancer

The forthcoming 8th edition of TNM staging system for lung cancer proposes revision of M descriptor. No changes of M1a category is suggested, while further sub-classification of M1b category into M1b (single distant metastatic lesion in single organ) and M1c (multiple distant metastatic lesions) is proposed. The limitations of new classification due to lack of information on EGFR and ALK status that significantly impact treatment response and outcome have been pointed out, however no further analysis addressing this issue has been published. Here we report the impact of EGFR mutation status on survival in view of new TNM classification system. Database of 479 metastatic non-small cell lung cancer (NSCLC) patients, treated between 2009 and 2011, all tested for EGFR mutations, was retrospectively reviewed to categorize them into one of the new sub-groups according to new M descriptors. Medical records of 355 patients, among them 89 with EGFR mutations (EGFR-m), had sufficient information that allowed appropriate new categorization. After a median follow up of 53.9 months, median overall survival (mOS) of EGFR-m patients (20.6 months) was significantly longer than mOS of patients without EGFR mutations (8.3 months, p<0.001). Patients with the smallest disease burden (M1b sub-group) had the longest mOS among EGFR wild type patients (EGFR-wt) and EGFR-m patients, 14.4 months and 41.1 month, respectively. However, due to small number of patients in M1b subgroup, the difference was not statistically significant (p=0.08). In spite of widespread metastatic disease in M1c EGFR-m patients, they had longer mOS than M1b EGFR-wt patients with the lowest disease burden, 18.8 vs 14.4 months, respectively. EGFR mutational status has probably more important impact on mOS than the number of metastasis or number of metastatic sites in NSCLC. Our results indicate that further analysis is warranted to address this issue.Tabled 1M descriptorEGFR-mEGFR-wtnmOS (months)nmOS (months)pM1a1722.36110.70.022M1b541.13214.40.080M1c6718.81736.6<0.001all8920.62668.3<0.001 Open table in a new tab

A Nomogram based on Inflammatory Factors C-Reactive Protein and Fibrinogen to Predict the Prognostic Value in Patients with Resected Non-Small Cell Lung Cancer.

Purpose: This study aimed to develop an effective nomogram for predicting survival in surgically treated non-small cell lung cancer patients.Methods: We retrospectively evaluated 856 NSCLC in this study. Cox regression analyses were performed to identify significant prognostic factors for developing a nomogram to predict overall survival (OS). The discriminative ability was assessed with the concordance index (C-index).Results: On multivariate analysis of the 856 cohort, independent factors for survival were CRP, fibrinogen, tumor status, nodal status, distant metastasis and clinical stage, which were entered into the nomogram. The C-index of the established nomogram 0.720 (95% CI: 0.671-0.769) was higher than that of the seventh edition TNM staging system 0.689 (95% CI: 0.668-0.709) for predicting OS (P < 0.05). Compared with patients with low CRP levels (< 8.6 g/L) and low fibrinogen levels (< 3.7 g/L), patients with high CRP and fibrinogen levels had shorter OS. Subgroup analyses revealed that the nomogram was a favorable prognostic parameter in stage I-IV NSCLC (P < 0.05).Conclusion: A nomogram integrating CRP and fibrinogen, which could be convenient and feasible to obtain from the serum preoperatively, may assist in risk stratification for individual patient with resected NSCLC.

Development and validation of a nomogram for predicting the survival of patients with non-metastatic nasopharyngeal carcinoma after curative treatment.

BackgroundThe TNM staging system is far from perfect in predicting the survival of individual cancer patients because only the gross anatomy is considered. The survival rates of the patients who have the same TNM stage disease vary across a wide spectrum. This study aimed to develop a nomogram that incorporates other clinicopathologic factors for predicting the overall survival (OS) of non-metastatic nasopharyngeal carcinoma (NPC) patients after curative treatments.MethodsWe retrospectively collected the clinical data of 1520 NPC patients who were diagnosed histologically between November 2000 and September 2003. The clinical data of a separate cohort of 464 patients who received intensity-modulated radiation therapy (IMRT) between 2001 and 2010 were also retrieved to examine the extensibility of the model. Cox regression analysis was used to identify the prognostic factors for building the nomogram. The predictive accuracy and discriminative ability were measured using the concordance index (c-index).ResultsWe identified and incorporated 12 independent clinical factors into the nomogram. The calibration curves showed that the prediction of OS was in good agreement with the actual observation in the internal validation set and IMRT cohort. The c-index of the nomogram was statistically higher than that of the 7th edition TNM staging system for predicting the survival in both the primary cohort (0.69 vs. 0.62) and the IMRT cohort (0.67 vs. 0.63).ConclusionWe developed and validated a novel nomogram that outperformed the TNM staging system in predicting the OS of non-metastatic NPC patients who underwent curative therapy.

Development and validation of a prognostic nomogram based on the log odds of positive lymph nodes (LODDS) for breast cancer.

BackgroundTo evaluate the prognostic effect of log odds of positive lymph nodes (LODDS) and develop a nomogram for survival prediction in breast cancer patients at the time of surgery.ResultsLODDS was an independent risk factor for cancer-related death in breast cancer (hazard ratio: 1.582, 95%CI: 1.190-2.104). Menopausal status, tumor size, pathological lymph node staging, estrogen receptor status and human epidermal growth factor receptor-2 status were also included in the nomogram. The calibration plots indicated optimal agreement between the nomogram prediction and actual observation. Discrimination of nomogram was superior to the seventh edition TNM staging system [C-index: 0.745 vs. 0.721 (p = 0.03) in training cohort; 0.796 vs. 0.726 (p < 0.01) in validation cohort].MethodsWe retrospectively evaluated 2023 breast cancer patients from Jan 2002 to Dec 2008 at our center. The cohort was randomly divided into training cohort and validation cohort. Univariate and multivariate analyses were performed to identify prognostic factors, and nomogram was established using Cox regression model in training cohort. External validation of the nomogram was performed in the validation cohort.ConclusionsThe LODDS is an independent prognostic indicator in breast cancer and the novel nomogram can provide individual prediction of cancer-specific survival and help prognostic assessment for breast cancer patients.

Verification of T-plus staging system for colorectal cancer based on nomogram analysis of single center’s 25-year follow-up.

516 Background: We proposed T-plus staging system which abandon the criterion to discriminate stage II/III by lymph node status and strengthens weighting of the T stage according to cluster analysis of the summary survival data of SEER. In this study, this principle of the T-plus staging system was verified with single center data by nomogram analysis. Methods: The 1,099 patients with colorectal cancer diagnosed before 2005 were analyzed to build a novel staging system based on nomogram (nomo-staging system). The remaining 981 patients diagnosed after 2005 were used to test the performance of nomo-staging system, T-plus staging system and the 7th edition TNM staging system by Akaike information criteria (AIC), Harrell’s c-index and the area under the curve (AUC) of Receiver Operating Characteristic to predict 5-year overall survival. A smaller AIC, higher c-index and higher AUC indicated a better staging system. Results: The nomo-staging system and T-plus staging system were listed in Table 1. The validation found that the 7th edition TNM staging system showed the weakest performance. For AIC, both nomo-staging system and T-plus staging system showed smaller value than the 7th edition TNM staging system (3214.912 vs. 3224.643 vs. 3229.810). For Harrell’s c-index, both the T-plus staging system and nomo-staging system showed higher value than the 7th edition TNM staging system (0.6814 vs. 0.6787 vs. 0.6778). For AUC to predict 5-year OS, the T-plus staging system and nomo-staging system showed slightly higher value than the 7th edition TNM staging system (0.6944 vs. 0.6924 vs. 0.6913). Conclusions: We propose replacement of lymph node status as the criterion to discriminate colorectal cancer stage II/III with greater weighting of the T stage. [Table: see text]

Predictors of Recurrence after Curative Resection in Patients with Early-Stage Non-Small Cell Lung Cancer.

BackgroundThere have been various results from studies concerning the predictors of recurrence in early-stage nonsmall cell lung cancer (NSCLC). Therefore, an accurate assessment is needed to guide effective adjuvant therapy. We investigated the predictors of a recurrence in patients with resected, early-stage NSCLC and the risk factors associated with locoregional or distant recurrence.MethodsThis retrospective study was conducted on patients at the Pusan National University Hospital from January 2006 to December 2011. Patients with pathological stages I or II were included in this study, as based on the seventh edition TNM staging system. Multivariate Cox proportional hazard models were used to identify factors associated with recurrence.ResultsTwo hundred and forty-nine patients were included. Among them, 180 patients were stage I, and 69 were stage II. Overall, by multivariate analysis, the independent factors associated with a 5-year total recurrence were the presence of visceral pleural invasion (VPI) (p=0.018) and maximal standardized uptake values (SUVs) of tumors on positron emission tomography (PET) >4.5 (p=0.037). The VPI was the only independent risk factor associated with both locoregional and distant recurrence, in the analysis of the patterns of tumor recurrence and their risk factors. In the subgroup analysis of stage I patients, three variables (male, VPI and resection margin positive) were significantly associated with a 5-year recurrence.ConclusionThe independent factors associated with postoperative recurrence in early-stage NSCLC were as follows: PET SUV >4.5 and the presence of VPI. For patients with those factors adjuvant therapy should be recommended as a more efficacious treatment.

Evaluation of the seventh AJCC TNM staging system for gastric cancer: a meta-analysis of cohort studies

The AJCC seventh edition TNM classification for gastric cancer was released in 2010 and included major revision. Large-volume gastric cancer centers have evaluated the prognostic significance of the new system and obtained paradoxical results. The authors performed a meta-analysis of these studies to evaluate the new classification. Fifteen eligible studies with 38,972 patients were included in the analysis. Hazard ratios (HRs) and associated 95 % confidence intervals were extracted from identified studies. The primary outcome was overall survival. The HRs for the seventh edition T classification and N classification were found to increase steadily and reasonably. The cumulative survival rates of the seventh edition subgroups of T classifications demonstrated obvious differences; meanwhile, the differences between subgroups of N classifications including N3a and N3b categories were also significant. The 5-year survival rates according to the seventh edition TNM staging system were 94.71 % (stage IA), 88.72 % (stage IB), 80.45 % (stage IIA), 67.24 % (stage IIB), 53.68 % (stage IIIA), 37.56 % (stage IIIB), and 21.26 % (stage IIIC), respectively. The results of this study indicate that the seventh edition of the TNM classification was considered valid, although further evaluation was needed for N3a and N3b categories.

The 6&lt;SUP&gt;th&lt;/SUP&gt; and 7&lt;SUP&gt;th&lt;/SUP&gt; edition TNM staging system in predicting prognosis of gastric cancer patients after operation: a comparative study

The 6&lt;SUP&gt;th&lt;/SUP&gt; and 7&lt;SUP&gt;th&lt;/SUP&gt; edition TNM staging system in predicting prognosis of gastric cancer patients after operation: a comparative study