IB Disease Research Articles

Expanding the Indications for Radical Trachelectomy

Radical trachelectomy has enabled select women with stage I cervical cancer to maintain fertility after treatment. Tumor size greater than 2 cm has been considered a contraindication, and those patients denied trachelectomy. We report our trachelectomy experience with tumors measuring 2 to 4 cm. We retrospectively reviewed the medical records of all patients planned for fertility-sparing radical trachelectomy. Largest tumor dimension was determined by physical examination, preoperative magnetic resonance imaging, or pathologic evaluation. No patient received neoadjuvant chemotherapy. Twenty-nine (26%) of 110 patients had stage IB1 disease with tumors 2 to 4 cm. Median age was 31 years (range, 22-40 years), and 83% were nulliparous. Thirteen patients (45%) had squamous cell carcinoma, 12 patients (41%) had adenocarcinoma, and 4 patients (14%) had adenosquamous carcinoma. Thirteen (45%) of 29 patients had positive pelvic nodes. All para-aortic nodes were negative. Owing to intraoperative frozen section, 13 patients (45%) underwent immediate hysterectomy and 1 patient (3%) definitive chemoradiation. Owing to high-risk features on final pathology, 6 patients (21%) who had retained their uterus received chemoradiation. Nine patients (31%) underwent a fertility-sparing procedure. At a median follow-up of 44 months (range, 1-90 months), there was one recurrence. Expanding radical trachelectomy inclusion criteria to women with 2- to 4-cm tumors allows for a fertility-sparing procedure in 30% of patients who would otherwise have been denied the option, with no compromise in oncologic outcome.

Distance Traveled for Treatment of Cervical Cancer

To evaluate the impact of distance from residence to treatment center on disease characteristics and recurrence of cervical cancer. A single-institution retrospective chart review of patients treated for cervical cancer during 2006-2011 was performed. Demographic, socioeconomic, and clinicopathologic characteristics were recorded. Distance traveled from home to treatment facility was calculated and categorized. Recurrence and follow-up data were extracted; progression-free survival and overall survival were calculated. SAS version 9.2 was used for statistical analysis. Two hundred nineteen patients met the study criteria; 75% were Caucasian. Forty-nine percent used tobacco. Twenty-five percent had stage III/IV disease. Insurance type was 46% private, 25% Medicaid, 20% Medicare, and 9% uninsured. Distance between residence and hospital was less than 15 miles (29%), 15 to 30 miles (21%), 30 to 50 miles (17%), and more than 50 miles (33%). Median follow-up period was 23 months (range, 1-65). Caucasians were more likely to travel more than 30 miles to a treatment center (P = 0.018) Non-Caucasians were less likely to have private insurance (P = 0.0005) and more likely to recur (P = 0.0045). Recurrence was highest (50%) in African Americans. Travel of more than 30 miles was not associated with age, stage, histology, tobacco abuse, employment, clinical trial enrollment, primary chemoradiation for stage IB disease, or delayed radiation. Travel of more than 30 miles was associated with government insurance (P = 0.029) and a trend toward unemployment (P = 0.059). Four-year progression-free survival (53% vs 52%; P = 0.992) and overall survival (57% vs 62%; P = 0.73) were similar between less than or more than 30-mile travel. Fifty percent of the patients reside more than 30 miles from treating hospital. Despite farther travel, stage of disease, clinical trial enrollment, treatment type, radiation completion, and recurrence rates were similar among patients with cervical cancer. Non-Caucasians are less likely to travel more than 30 miles.

Villoglandular Papillary Adenocarcinoma of the Cervix: A Series of 28 Cases Including Two With Lymph Node Metastasis

To investigate the clinicopathologic features, the management, and the outcome of villoglandular papillary adenocarcinoma (VGPA) of the uterine cervix. A retrospective review of patients' clinical characteristics, pathology, and the disease management, together with outcome information. A total of 28 patients with VGPA were treated. The median age of the patients was 38 years with a range of 26 to 65 years. Sixteen of the 21 patients presented with abnormal bleeding, and 5 patients had an abnormal Papanicolaou (Pap) test result. Nineteen patients had International Federation of Gynecology and Obstetrics stage IB disease, and 5 patients had stage IIB disease. Two of 24 patients, where the lymph node status was known, had positive nodes. Twenty patients underwent different types of radical surgery with or without pelvic radiotherapy, and 8 patients received platinum-based chemotherapy and pelvic radiotherapy with no surgery. The follow-up ranged from 5 to 168 months with a median of 35 months. Twenty-one patients are alive with no evidence of recurrent disease, 5 patients have died because of the disease recurrence, and 2 patients were lost to follow-up. The overall and disease-free 5-year survival for these patients was 82% and 75%, respectively. This study confirms the excellent prognosis of VGPA overall compared to the common forms of cervical cancer, but the prognosis is related to stage and pathology. A large multicenter prospective study is warranted to determine the most appropriate treatment for the disease. Until then, a meta-analysis on the subject would be of benefit.

New dilemmas in small-cell lung cancer TNM clinical staging

BackgroundMany patients with limited disease (LD) behave similarly to those with extensive disease (ED) from a prognostic point of view. On the other hand, a proportion of patients with ED small-cell lung cancer (SCLC) behave similarly to those with LD.Patients and methodsIn this retrospective study analysis, 764 patients with proven SCLC were included and managed with the same therapeutic protocols. Of these patients, 278 (36.4%) had LD, while 486 (63.6%) had ED.ResultsNo statistically significant difference was observed for survival for IA and IB disease stages (P = 0.254) and between IIA and IIB stages (P = 0.256) according to the new tumor, node, metastasis (TNM) staging classification classification. In addition, no statistical significant difference was observed for survival between patients with (IIA + IIB) and IIIA (P = 0.951), (IIA + IIIA, P = 0.658), and (IIB + IIIA, P = 0.573) stages. Statistical significant difference was observed for survival among the LD SCLC patients with (IA + IB), (IIA + IIB + IIIA), and IIIB stages (P < 0.001). Similarly, statistical significance was observed for ED SCLC patients with (IIA + IIB + IIIA), IIIB, and IV stages (P < 0.001).ConclusionsAlthough stratification of SCLC patients in LD and ED is generally satisfactory, the TNM staging system is recommended for more detailed prognostic information and treatment evaluation in these patients.

Galectin-7 levels predict radiation response in squamous cell carcinoma of the cervix

ObjectiveWe previously found that galectin-7 was upregulated in patients with cervical cancer who remained recurrence-free after chemoradiation. We hypothesized that pretreatment levels of galectin-7 predict radiation response in patients with squamous cell carcinoma (SCC) of the cervix. MethodsGalectin-7 expression was assessed by immunohistochemical staining of a tissue microarray of paraffin-embedded specimens from 161 patients with cervical SCC treated with definitive radiation therapy in 1980–1999. Galectin-7 expression was scored as absent or present. Distant metastasis-free survival (DMFS), disease-specific survival (DSS), and overall survival (OS) were computed using the Kaplan–Meier method and log-rank tests. ResultsThe median age at diagnosis was 45years (range 21–85) and median follow-up interval was 71months (range 0–285). Of the 161 patients, 105 (65%) had FIGO stage IB disease, 18 (11%) stage IIA, and 38 (24%) stage IIB. Median tumor diameter was 5.5cm (range 3.5–8). Seven patients (4%) received concurrent chemotherapy; 139 patients (86%) had galectin-7-positive tumors and 22 (14%) galectin-7-negative tumors. Five-year DMFS rates for patients with galectin-7-positive versus -negative tumors were 73% and 55% (p=0.05); DSS, 65% and 36% (p=0.004); and OS, 64% and 36% (p=0.005). In multivariate analysis adjusting for age, stage, and tumor diameter, galectin-7 expression remained a significant predictor of DMFS (hazard ratio [HR]=0.43, p=0.03), DSS (HR=0.34, p=0.001), and OS (HR=0.34, p=0.001). ConclusionsElevated galectin-7 expression is associated with improved outcomes after radiation therapy for cervical cancer. Further studies are required to validate these findings and clarify the role of galectin-7 in disease progression and radiation response.

Cervical Cancer

These NCCN Clinical Practice Guidelines in Oncology for Cervical Cancer focus on early-stage disease, because it occurs more frequently in the United States. After careful clinical evaluation and staging, the primary treatment of early-stage cervical cancer is either surgery or radiotherapy. These guidelines include fertility-sparing and non-fertility-sparing treatment for those with early-stage disease, which is disease confined to the uterus. A new fertility-sparing algorithm was added for select patients with stage IA and IB1 disease..

Influence of patient characteristics on survival following treatment with helical stereotactic body radiotherapy (SBRT) in stage I non-small-cell lung cancer.

To determine the influence of patient and tumor characteristics on clinical outcomes in patients with early-stage non-small cell lung cancer (NSCLC) treated with helical intensity modulated stereotactic body radiotherapy (SBRT). From March 2005 to August 2010 a total of 62 patients with biopsy proven Stage I NSCLC underwent helical SBRT with 48 Gy in 4 fractions or 60 Gy in 5 fractions. Patient and tumor characteristics including tumor stage, age, sex, tumor histology, maximal tumor diameter, and smoking history, were evaluated in regard to local control and overall survival using Kaplan-Meier survival curves and the Cox proportional hazard method. Treatment related toxicity in the patient subgroups was evaluated. The median follow-up was 28 months. Total cohort local control was 93.55% and 3-year overall survival (OS) was 53.4%. Those patients with Stage IA disease had a 3-year OS of 64.4% versus 32.1% for Stage IB disease (P = 0.042). Tumors classified as T1a (≤20 mm) and T1b (20-30 mm) had significantly increased overall survival compared to T2 (>30 mm) tumors (P = 0.046). There was a slight survival advantage in those patients with adenocarcinoma. No correlation between age, gender or smoking history, and overall survival was found. Nine patients had radiation related toxicity, which was increasingly more common with advancing age. Helical SBRT is an effective method to treat NSCLC and the most significant prognostic factors were tumor stage and size. There was no correlation between age, gender, and smoking history.

Management of cervical cancer patients with isolated para-aortic lymph node metastases

To the editor: For patients with locally advanced cervical cancer, the current guidelines recommend primary chemoradiation [1]. Therefore, pretherapeutic staging has an important role in the management of female patients with locally advanced cervical cancer. Assessment of the nodal involvement of the para-aortic lymph node (PALN) is critical for determining the field of radiation therapy (RT). Extended-field RT, concurrent cisplatin-containing chemotherapy, and brachytherapy should be considered in the case of PALN metastasis. Jang et al. [2] report the outcomes of 40 cervical cancer patients with isolated PALN metastases at initial diagnosis. This interesting and valuable article demonstrates the association between treatment outcomes and the features of PALN metastasessuch as size, site, and number. The number and size of PALNs were shown to correlate with progression-free survival. The authors suggest that the radiologic features of PALN can be used to determine the prognosis of patients with isolated PALN metastases. As the authors define PALN involvement based on imaging, the criteria for lymph node involvement should be clarified. In addition, it should also be noted that there are limitations including the false-positive and false-negative results of conventional imaging studies (magnetic resonance imaging or computed tomography) in detecting PALN metastases. It makes hard for clinicians to determine whether to perform extended-field RT based solely on imaging studies. It would be even more interesting if the authors were to show the correlation between the radiologic and pathologic findings in seven patients who underwent radical hysterectomy. In recent years, positron emission tomography/computed tomography (PET/CT) has been recommended for stage IB2 or advanced disease as it is considered to be more sensitive than conventional imaging studies in detecting node or distant metastases [3]. Future studies based on PET/CT are required in order to identify prognostic factors and treatment outcomes for locally advanced cervical cancer. Furthermore, survival data for patients with PALN metastases detected surgically and treated by extended-field RT in a randomized trial setting is rare [4]. Therefore, the impact of surgical staging in women with locally advanced cervical cancer should be evaluated in future trials, considering the high rate of false-negative PALN involvement from imaging studies. Bearing in mind that postoperative complications and the delay of definite chemoradiation can occur from nodal staging surgery, a comprehensive cost-effective analysis is required to clarify the best treatment strategy for locally advanced stage cervical cancer.

Small Cell Carcinoma of the Uterine Cervix: Clinical Outcome of Concurrent Chemoradiotherapy with a Multidrug Regimen

Small cell carcinoma of the uterine cervix (SCCC) is a rare subtype of cervical cancer with an aggressive behavior. Although SCCC has a worse prognosis than other histological types of uterine cervical cancer such as squamous cell carcinoma or adenocarcinoma, standard therapy for SCCC remains to be established due to its rarity. The purpose of this study was to evaluate the efficacy and toxicity of concurrent chemoradiotherapy (CCRT) using a regimen consisting of vincristine, adriamycin, and cyclophosphamide alternating with cisplatin and etoposide (VAC/PE). We analyzed a series of 9 patients with SCCC. Five patients with stage IB disease underwent radical hysterectomy followed by CCRT. Four patients with advanced stage disease received CCRT primarily. With a median follow-up duration of 47.4 months (range, 10.5 to 86.4 months), 4 out of 5 patients with stage IB disease were alive without recurrence. In 4 patients with advanced stage disease, the response rate was 75% (complete response, 1; partial response, 2; progressive disease, 1). One patient with stage IVB disease remained without recurrence for 89.5 months. At 5 years, overall survival (OS) and progression-free survival for all patients was 52% and 56%, respectively. Patients with early-stage disease had an 80% 5-year OS rate compared to 25% for patients with advanced stage disease. Although all patients developed grade 3-4 neutropenia, CCRT using VAC/PE is feasible in both the primary and adjuvant settings for SCCC. In particular, this combined modality therapy may improve both local control and survival as postoperative treatment in patients with early-stage disease.

Clinical Impact of Immune Microenvironment in Stage I Lung Adenocarcinoma: Tumor Interleukin-12 Receptor β2 (IL-12Rβ2), IL-7R, and Stromal FoxP3/CD3 Ratio Are Independent Predictors of Recurrence

Mounting evidence suggests that tumor-infiltrating immune cells have prognostic value for patients with solid organ malignancies. Our aim was to investigate the prognostic significance of the immune microenvironment in patients with stage I lung adenocarcinoma (ADC). Using tissue microarray and immunohistochemistry, we investigated eight types of tumor-infiltrating immune cells in the tumor nest and tumor-associated stroma as well as tumor expression of five cytokines in a uniform cohort of 956 patients with stage I lung ADC (478 each in training and validation cohorts). Although a high density of stromal forkhead box P3 (FoxP3) -positive cells was associated with shorter recurrence-free probability (RFP; P = .043), the relative proportion of stromal FoxP3 to CD3 was a stronger predictor of recurrence (5-year RFP, 85% for high v 77% for low ratio; P = .004). High expression of tumor interleukin-12 receptor β2 (IL-12Rβ2) was associated with better outcome (5-year RFP, 90% for high v 80% for low expression; P = .026), whereas high expression of tumor IL-7R was associated with worse outcome (5-year RFP, 76% for high v 86% for low expression; P = .001). In multivariate analysis, these immune markers were independently associated with recurrence. Although IL-7R remained significant for poor overall survival, all the markers remained prognostic for recurrence in patients with stages IA and IB disease as well as for patients with tumors ≤ 2 cm. Our investigation confirms the biologic and prognostic significance of the tumor immune microenvironment for patients with stage I lung ADC and provides support for its use to stratify clinical outcome and immunotherapeutic interventions.

Abstract P1-01-06: Evaluation of the stage IB designation of the 7th edition of the AJCC staging system: Biologic factors are more important

Abstract Purpose: The stage IB designation was added to the AJCC 7th edition staging system to denote micrometastasis in patients with T1 tumors. We have previously examined this group and found that receptor status and nuclear grade were better survival discriminates than the presence of micrometastases. The current study was undertaken to validate this finding in a larger cohort from the American College of Surgeons Oncology Group (ACOSOG) Z0010 study. Methods: Clinicopathologic and outcomes data from patients enrolled on ACOSOG Z0010 were recorded. All patients underwent breast conserving surgery, sentinel lymph node biopsy and whole breast radiation for clinical T1-2, N0 breast cancer. Sentinel lymph nodes were evaluated by H&amp;E locally and if negative, by immunohistochemistry (IHC) at a central laboratory. Patients were staged according to the 7th edition AJCC system and recurrence-free (RFS), disease-specific (DSS) and overall survival (OS) were determined using the Kaplan-Meier method and compared using the log-rank test. Results: There were 5210 eligible and evaluable patients enrolled on ACOSOG Z0010. AJCC stage distribution was known in 4590 and included: 2849 (62.0%) stage IA, 376 (8.2%) stage IB, 878 (19.1%) stage IIA, 322 (7.0%) stage IIB, and 170 (3.7%) stage III. Median follow-up for the cohort was 9.0 years (range 0–12.6). Five and 10-year RFS, DSS and OS rates for patients with stage IA versus IB disease are shown in table 1. There were no significant differences between groups. When all stage I patients (stage IA and IB) were evaluated by ER status (positive vs negative) or grade (grade 1 vs 2 vs 3), these biologic factors were able to significantly discriminate patients with respect to RFS, DSS and OS (table 2). Conclusion: Differentiating patients with micrometastases (stage IB) from node negative patients (stage IA) does not stratify patients well with respect to survival. Biologic factors including ER status and grade are better discriminants of survival than the presence of small volume nodal metastases in patients with early stage breast cancer. Breast cancer staging should include biologic factors from the primary tumor. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-01-06.

Adjuvant Chemotherapy and Age-Related Biases in Non–Small Cell Lung Cancer

Five-year survival for early-stage lung cancer despite complete surgical resection is approximately 50%. Adjuvant chemotherapy has been shown to improve survival in some patients. Older cancer patients do not always receive standard therapy. The purpose of this study was to determine if there were age-related biases concerning the use of adjuvant chemotherapy after lobectomy for elderly patients with non-small cell lung cancer (NSCLC). A prospective lung cancer outcomes database was queried for all patients undergoing lobectomy for NSCLC pathologic stage IB and higher between April 2006 and October 2010. Patients who received neoadjuvant treatment or who died within 30 days of operation were excluded. Ninety-nine patients met the inclusion criteria. Patients were divided into 2 groups based on age (<70 or ≥70 years). The use of adjuvant chemotherapy was compared between groups. Sixty-nine patients (70%) were younger than 70 years and 30 (30%) were 70 years or older. There was a significant difference in the use of adjuvant chemotherapy between the 2 groups, with 46 (66.7%) of the younger patients and 7 (25%) of the elderly patients receiving adjuvant treatment (p<0.01). The difference persisted when analyzed by stage, with older patients less likely to receive chemotherapy among all patients with stage IB disease, stage II or more advanced disease, and stage IB lesions greater than or equal to 4 cm plus stage II or more advanced disease. In multivariate analysis of preoperative and postoperative factors, age remained the only independent predictor of chemotherapy use. Patients undergoing lobectomy who were 70 years of age or older received adjuvant chemotherapy less often than did younger patients.

Risk assessment model for overall survival in patients with locally advanced cervical cancer treated with definitive concurrent chemoradiotherapy

ObjectiveTo develop a nomogram for predicting the probability of 5year survival after definitive concurrent chemoradiotherapy (CCRT) in locally advanced cervical cancer (LACC). MethodsBetween 1998 and 2008, 209 patients with LACC were treated with definitive CCRT. Multivariate analysis using Cox proportional hazards regression model was performed. A nomogram based on this Cox model was developed and internally validated by bootstrapping. Its performance was assessed by using the concordance index and a calibration curve. ResultsThe median age was 55years (range, 26–78). Of the patients, 9, 16, 129, 3, 42 and 10 had FIGO stage IB2, IIA, IIB, IIIA, IIIB, and IVA disease, respectively. Histology revealed that 190, 13, 4, and 2 patients had squamous, adenocarcinoma, adenosquamous, and small cell cervical cancer, respectively. In 91 patients, PET/CT was performed before CCRT. The median follow-up period was 51months (range, 6–151) and there were 50 (23.9%) disease-related deaths. Multivariate regression analysis revealed that histology, tumor size, and paraaortic lymph node metastasis (defined by MRI), but not PET/CT before CCRT, were independent predictors of overall survival. A nomogram for predicting the 5year survival incorporating these three significant variables was constructed. The concordance index was 0.69. The predictive ability of the nomogram proved to be superior to that of the FIGO staging system (p<0.05). ConclusionsThe nomogram was a better predictive model for overall survival than the FIGO staging system. If externally validated, it could be used to counsel patients with LACC who must choose additional treatment modalities after definitive CCRT.

Significantly Decreased Methylthioadenosine Phosphorylase Expression in Malignant Melanoma

Significantly Decreased Methylthioadenosine Phosphorylase Expression in Malignant Melanoma

Prognostic impact of cell type under the seventh TNM staging system in resected non-small cell lung cancer.

We retrospectively investigated whether histological cell type could affect patient prognosis for each stage according to the seventh edition of the TNM classification. Clinical records of 1623 consecutive non-small cell lung cancer patients who underwent surgery between 1990 and 2007 were retrospectively reviewed. Over 92% of these patients had either adenocarcinoma (Ad; n = 1043, 64.3%) or squamous cell carcinoma (Sq; n = 452, 27.9%). The overall 5-year survival rates for patients of all stages with Ad, Sq, large cell carcinoma (La), and adenosquamous cell carcinoma (As) were 67%, 56%, 58%, and 41%, respectively. Ad patients experienced better survival than Sq, As, or La patients (HR: 0.66, P < 0.0001; HR: 0.38, P = 0.011; HR: 0.69, P = 0.057, respectively). Stage IA Ad patients experienced better survival than stage IA Sq patients (5-year survival; Ad/Sq = 91%/78%, log-rank test, P = 0.001). Such a difference was also observed among seventh-edition TNM stage IB patients (5-year survival; Ad/Sq = 78%/64%, log-rank test, P = 0.048), but not for sixth-edition stage IB patients. Multivariate analysis demonstrated that histological cell type is a significant prognostic factor among stage I ≥ T1b Ad and Sq patients. Survival after complete resection of new stage I ≥ T1b Sq patients is significantly worse than that of Ad patients, which could be partially attributed to stage migration effect in stage IB disease between the sixth and seventh editions of the TNM staging system.

Outcomes of High-Dose-Rate Interstitial Brachytherapy in the Treatment of Locally Advanced Cervical Cancer: Long-term Results

The purpose of this study was to determine locoregional control (LRC), disease-free survival (DFS), and toxicity of high-dose-rate interstitial brachytherapy (HDR-ISBT) in the treatment of locally advanced cervical cancer. Between March 1996 and May 2009, 116 patients with cervical cancer were treated. Of these, 106 (91%) patients had advanced disease (International Federation of Gynecology and Obstetrics stage IIB-IVA). Ten patients had stage IB, 48 had stage II, 51 had stage III, and 7 had stage IVA disease. All patients were treated with a combination of external beam radiation therapy (EBRT) to the pelvis (5040 cGy) and 2 applications of HDR-ISBT to a dose of 3600 cGy to the implanted volume. Sixty-one percent of patients also received interstitial hyperthermia, and 94 (81%) patients received chemotherapy. Clinical LRC was achieved in 99 (85.3%) patients. Three-year DFS rates were 59%, 67%, 71%, and 57% for patients with stage IB, II, III, and IVA disease, respectively. The 5-year DFS and overall survival rates for the entire group were 60% and 44%, respectively. Acute and late toxicities were within acceptable limits. Locally advanced cervical cancer patients for whom intracavitary BT is unsuitable can achieve excellent LRC and OS with a combination of EBRT and HDR-ISBT.

Expression and association of HER2 with prognosis in early-stage (T1–T2N0M0) non-small cell lung cancer

The expression of human epidermal growth factor receptor 2 (HER2) is related to tumor progression in many human malignancies. This study evaluated the significance of HER2 in early-stage non-small cell lung cancer (NSCLC). Specimens were obtained from 172 patients with early-stage (T1-T2N0M0) NSCLC, which included T1N0M0 (n = 52) and T2N0M0 (n = 120). The expression of HER2 was determined by immunohistochemistry (IHC). HER2 expression and its relationship with clinicopathological parameters and survival were analyzed. The expression of HER2 was significantly higher in the non-squamous cell carcinoma than in the squamous cell carcinoma (74.3 % vs. 53.7 %, p = 0.008). HER2 expression and tumor size were independent prognostic indicators in the multivariate analysis (p = 0.007 and p = 0.015, respectively). Expression of HER2 indicated a worse 5-year overall survival (65 % vs. 86 %, p = 0.014), especially for stages IB and IIA diseases (p = 0.035 and p = 0.043, respectively) and adenocarcinoma (p = 0.047). Therefore, HER2 may be related with the pathogenesis of NSCLC and act as an unfavorable prognostic factor in T1N0M0 and T2N0M0 NSCLC, especially in stages IB and IIA diseases.

New revised FIGO 2008 staging system for endometrial cancer produces better discrimination in survival compared with the 1988 staging system

The aim of this study was to analyze the stage migration and survival of endometrial cancer by the revised FIGO 2008 staging system compared with the 1988 staging system. A total of 355 patients with endometrial cancer, who underwent complete surgical staging, were enrolled. We compared the surgical stages and survival by FIGO 1988 staging system with those by FIGO 2008 staging system. 2008 FIGO staging system resulted in an increase of stage I patients and decrease of stage II and IIIa patients. The 5-year overall survival (OS) rates for patients with 2008 FIGO stage IA and IB disease were 98.2% and 91.9%, respectively (P = 0.004). Five-year OS rate of new stage II (82.6%) was significantly worse than that of new stage IA (98.2%, P = 0.003). Patients with positive washing cytology alone revealed a 5-year OS rate similar to that of patients with new stage IIIA disease (96.2% vs. 90.9%, respectively; P = 0.53). The 5-year OS rate for patients with stage IIIC1 disease was improved compared with that for patients with stage IIIC2 disease (85.7% vs. 63.0%, respectively; P = 0.08). New revised FIGO 2008 staging system for endometrial cancer produced better discrimination in OS outcomes compared with the 1988 system.

Time course, clinical pathways, and long‐term hazards risk trends of disease progression in patients with classic mycosis fungoides

Mycosis fungoides (MF) is an indolent primary cutaneous T-cell lymphoma. To the authors' knowledge, no data currently are available regarding the evolution over time of the risk of developing specific pathways of disease progression. This retrospective study analyzed 1422 patients with MF who were diagnosed and followed from 1975 through 2010 in 27 Italian Study Group for Cutaneous Lymphoma centers. The primary objectives were to ascertain the time course, pathways, and hazards risk trends of cutaneous/extracutaneous disease progression; to evaluate whether different tumor-lymph node-metastasis-blood (TNMB) stages have different pathways of disease progression; and to analyze differences between tumor-stage and erythrodermic MF with regard to clinical onset, disease evolution, and prognosis. The secondary objective was to provide a further validation for the revised International Society for Cutaneous Lymphomas and the Cutaneous Lymphoma Task Force of the European Organization of Research and Treatment of Cancer (ISCL/EORTC) classification. The median follow-up was 14.5 years; stage progression occurred in 29.7% of patients and blood involvement was the most frequent extracutaneous site of disease progression. Patients with stage IA to stage IB disease demonstrated a steady low annual incidence of disease progression to tumor-stage (1%-2%); patients with stage IIA disease had a higher risk within the first years (up to 9.4%). Erythroderma evolved with a significantly higher frequency from patches/plaques (13.9%/28.2%) than tumors (P = .028 and P = .013, respectively). Hazards rates of extracutaneous involvement were low (< 1%). The T-score was found to be associated with extracutaneous involvement site, tumor-stage disease with lymph node/visceral lesions, and erythroderma with blood involvement. TNMB classification and stage progression resulted as independent prognostic variables being detected on multivariate analysis; the type of extracutaneous involvement was found to affect survival . The data from the current study support the need for a stage-tailored follow-up, suggest that the classification of tumor-stage disease at a stage below erythroderma could be modified, and offer a further validation for the revised TNMB classification.

PTU-125 Positive calprotectin but negative investigations-what next?

IntroductionFaecal markers are an increasingly established markers of gastrointestinal inflammation. Faecal calprotectin has an important role in differentiating functional from organic disease.1 2 However a small proportion of patients have...