Longest Tumor Diameter Research Articles

Longitudinal registration of T1-weighted breast MRI: A registration algorithm (FLIRE) and clinical application

PurposeMRI is commonly used to aid breast cancer diagnosis and treatment evaluation. For patients with breast cancer, neoadjuvant chemotherapy aims to reduce the tumor size and extent of surgery necessary. The current clinical standard to measure breast tumor response on MRI uses the longest tumor diameter. Radiologists also account for other tissue properties including tumor contrast or pharmacokinetics in their assessment. Accurate longitudinal image registration of breast tissue is critical to properly compare response to treatment at different timepoints. MethodsIn this study, a deformable Fast Longitudinal Image Registration (FLIRE) algorithm was optimized for breast tissue. FLIRE was then compared to the publicly available software packages with high accuracy (DRAMMS) and fast runtime (Elastix). Patients included in the study received longitudinal T1-weighted MRI without fat saturation at two to six timepoints as part of asymptomatic screening (n = 27) or throughout neoadjuvant chemotherapy treatment (n = 32). T1-weighted images were registered to the first timepoint with each algorithm. ResultsAlignment and runtime performance were compared using two-way repeated measure ANOVAs (P < 0.05). Across all patients, Pearson's correlation coefficient across the entire image volume was slightly higher with statistical significance and had less variance for FLIRE (0.98 ± 0.01 stdev) compared to DRAMMS (0.97 ± 0.03 stdev) and Elastix (0.95 ± 0.03 stdev). Additionally, FLIRE runtime (10.0 mins) was 9.0 times faster than DRAMMS (89.6 mins) and 1.5 times faster than Elastix (14.5 mins) on a Linux workstation. ConclusionFLIRE demonstrates promise for time-sensitive clinical applications due to its accuracy, robustness across patients and timepoints, and speed.

Efficacy of radioactive 125I seed implantation in treating inoperable or refused operation head and neck cancers.

This study aims to observe the curative effect of radioactive 125I seed implantation in treating inoperable or refused operation head and neck cancer. Data from 132 patients with head and neck malignant tumors underwent computed tomography-guided radioactive 125I seed implantation from April 2004 to August 2020 were analyzed retrospectively. The Kaplan-Meier method was used to calculate the local control and survival rates. The logarithmic rank test and the Cox proportional risk model were used for univariate and multivariate analysis, respectively. A total of 132 patients were enrolled. All tumors were confirmed to be malignant through pathological analysis. Herein, we revealed that the seeds were implanted at the primary tumor site (23 cases, representing 17.4%), recurrent (9 cases, representing 6.8%), or metastatic lymph nodes (100 cases, representing 75.8%). Three months after the operation, 96 patients were evaluated as effective, whereas 36 patients were considered ineffective. The median local control time was 16 months; the local rates at 6, 12, 18, and 24 months were observed to be 75%, 47%, 35%, and 22%, respectively. The study reports a median survival period (OS) of 15 months. Additionally, the survival rates at 6, 12, 18, and 24 months were 61%, 42%, 31%, and 27%, respectively. Regarding side effects, skin or mucosal toxicity occurred in 14 patients. Grade I skin toxicity occurred in seven cases (5.3%), grade IV skin toxicity in one case (0.8%), grade I mucosal ulcer in four cases (3.0%), and grade I dry mouth in four cases (3.0%). The multivariate analysis showed that short-term efficacy and tumor site were independent prognostic factors (P < 0.001, 0.006, respectively). Additionally, the multivariate analysis showed that the independent OS influencing factors included D90, the longest tumor diameter, and short-term efficacy (P = 0.017, 0.001, <0.001). Radioactive 125I seed implantation is a safe and effective salvage therapy for patients with inoperable or refused operation head and neck cancer.

Clinical Outcomes in Adenoid Cystic Carcinoma of the Nasal Cavity and Paranasal Sinus: A Comparative Analysis of Treatment Modalities.

This study aimed to present the treatment patterns and outcomes for adenoid cystic carcinoma (ACC) arising in the nasal cavity and paranasal sinus. Sixty-one sinonasal ACC patients were retrospectively reviewed: 31 (50.8%) underwent surgery followed by postoperative radiation therapy (S+PORT), and 30 (49.2%) received definitive radiation therapy (D(C)RT). T4 disease was significantly more frequent in the D(C)RT group (25.8% vs. 80.0%, p < 0.001), where all T4b disease patients underwent D(C)RT. The 5-year local failure-free survival (LFFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival were 61.8% versus 37.8% (p = 0.003), 64.8% versus 38.1% (p = 0.036), 52.6% versus 19.3% (p = 0.010), and 93.2% versus 73.4% (p = 0.001) in the S+PORT and D(C)RT groups, respectively. The absolute differences in 5-year rates of LFFS, DMFS, and PFS between the two groups were smaller in the T3-4 subgroup. The univariate analysis showed that T4b disease, neurologic symptoms, longest diameter of tumor, radiological evidence of nerve involvement, and undergoing D(C)RT were associated with worse clinical outcomes, but the significance disappeared in the multivariate analysis, except for in the case of radiological evidence of nerve involvement. In conclusion, most patients with extensive disease underwent upfront D(C)RT and generally exhibited inferior clinical outcomes when compared to those with less extensive disease and who underwent S+PORT.

Belzutifan for treatment of giant retinal hemangioblastoma with extrascleral extension associated with von Hippel-Lindau syndrome

Abstract Purpose: To describe the clinical response and safety profile of the novel HIF-2ɑ inhibitor belzutifan in treating a giant retinal hemangioblastoma (RHB) with extrascleral extension associated with von Hippel-Lindau syndrome (VHL). Methods: A 71-year-old woman with VHL presented with a giant RHB with extrascleral extension in her only remaining eye. She had no light perception OD and intraocular pressure (IOP) was 48. She requested enucleation due to chronic pain, but, due to concern for significant bleeding given the size of the neoplasm, a trial of belzutifan was initiated. Results: Within three months of treatment initiation, the patient reported an 80% reduction in pain. MRI showed 30% reduction in longest tumor diameter. Dose adjustments were guided by serum hemoglobin levels, allowing the patient to remain on the medication for over a year with continued tumor regression on MRI and avoid enucleation. Conclusion: RHB with extrascleral extension is exceedingly rare and its treatment is complex, often requiring enucleation or external beam radiotherapy. This report demonstrates the use of belzutifan to safely and successfully reduce ocular tumor burden of complicated RHB with extrascleral extension, ultimately decreasing the need for enucleation.

Involvement of NY-ESO-1 and MAGE-A4 in the pathogenesis of desmoid tumors.

The involvement of New York esophageal squamous cell carcinoma-1 (NY-ESO-1) and melanoma-associated antigen A4 (MAGE-A4) in soft-tissue sarcoma pathogenesis has recently been reported; however, their involvement in desmoid tumors (DTs) remains unknown. This study aimed to determine the involvement of NY-ESO-1 and MAGE-A4 in DTs. Immunostaining for β-catenin, NY-ESO-1, and MAGE-A4 was performed on DT biopsy specimens harvested at our institution. The positivity rate for each immune component was calculated. In addition, the correlations between the positivity rates for the immune molecules were investigated. The correlation between the positivity rate and age or longest diameter of each immune molecule was also investigated. β-catenin showed staining mainly in the tumor cell nuclei of DTs. Both NY-ESO-1 and MAGE-A4 showed staining in the nucleus, cytoplasm, and infiltrating lymphocytes of DT cells. The mean positive cell rates for β-catenin, NY-ESO-1, and MAGE-A4 were 43.9 ± 21.7, 30 ± 21.6, and 68.9 ± 20.8, respectively. A strong negative correlation was observed between β-catenin and MAGE-A4 positivity rates (r = -0.64). The positivity rates for NY-ESO-1 and MAGE-A4 showed a moderate positive correlation (r = -0.42). A very strong negative correlation was observed between age and the NY-ESO-1 positivity rate (r = -0.72). A weak negative correlation was observed between age and the MAGE-A4 positivity rate (r = -0.28). A medium negative correlation was observed between the longest tumor diameter and NY-ESO-1 positivity (r = -0.37). NY-ESO-1 and MAGE-A4 may be involved in the DT microenvironment. Thus, NY-ESO-1 and MAGE-A4 may be useful in the diagnosis of DT.

68Ga-FAPI-46 PET for cancer imaging: A prospective single-arm clinical trial.

3064 Background: Fibroblast activation protein (FAP) is expressed at high levels on tumor associated fibroblasts. FAP-directed radioligand positron-emission-tomography (FAP-PET) is a novel diagnostic tool for cancer. However, we currently do not understand the diagnostic performance of FAP-PET as compared to standard FDG-PET. Here we aim to compare tumor detection by FDG- vs. FAP-PET with independent validation of discrepant findings. Methods: Patients with (a) proven or suspected malignancy, (b) longest tumor diameter &gt;1 cm, (c) intended surgery or biopsy, and (d) no prior external beam radiation or systemic tumor therapy within 3 months underwent FDG- and FAP-PET for tumor localization on subsequent days. Clinical reads were analyzed prospectively on a per-patient and per-region basis (local, locoregional nodal, distant organ or soft tissue, bone). Discrepant findings were validated as true vs. false positive by histopathology or image follow-up. Tracer uptake in tumor tissue was assessed by SUVmax. Results: In total n=100 patients (median 62 years, male/female n=68/32) underwent FDG- and FAP-PET. Five most frequent tumor entities and respective median FDG vs FAP uptake were RCC (n=19; SUVmax 8.4 vs. 7.1), sarcoma (n=18; 10.3 vs. 10.9), NSCLC (n=10; 12.4 vs. 13.7), lymphoma (n=9; 18.3 vs. 10.9), and PDAC (n=8; 4.1 vs. 7.3). On a per-patient basis, FDG- vs FAP-PET localized malignancy in n=93/94 patients. FDG- vs FAP-PET was concordant for the assessment of 362/400 (91%) regions. n=16/400 (4%) regions were negative on FDG- and positive on FAP-PET (88% true, 12% false positive). n=22/400 (6%) regions were negative on FAP- and positive on FDG-PET (57% true, 43% false positive). Two false positive FDG-PET findings were due to tracer uptake in reactive lymph nodes. There were no PET-related adverse events. Conclusions: In patients with various tumor entities, standard FDG- and novel FAP-PET localized tumor equally well. Additionally, FAP-PET was associated with a lower rate of false positive findings, especially in lymph node assessments. Clinical trial information: NCT05160051 . [Table: see text]

PD08-12 PREDICTORS OF PROGRESSION AND DELAYED INTERVENTION IN SMALL RENAL MASS PATIENTS UNDERGOING ACTIVE SURVEILLANCE WITHOUT HEALTH-RELATED SELECTION BIAS

You have accessJournal of UrologyCME1 Apr 2023PD08-12 PREDICTORS OF PROGRESSION AND DELAYED INTERVENTION IN SMALL RENAL MASS PATIENTS UNDERGOING ACTIVE SURVEILLANCE WITHOUT HEALTH-RELATED SELECTION BIAS Muammer Altok, Arun Menon, Ahmed Aly, Kristopher Attwood, Tashionna White, Gaybrielle James, Bo Xu, Michael Petroziello, Charles Roche, and Eric Kauffman Muammer AltokMuammer Altok More articles by this author , Arun MenonArun Menon More articles by this author , Ahmed AlyAhmed Aly More articles by this author , Kristopher AttwoodKristopher Attwood More articles by this author , Tashionna WhiteTashionna White More articles by this author , Gaybrielle JamesGaybrielle James More articles by this author , Bo XuBo Xu More articles by this author , Michael PetrozielloMichael Petroziello More articles by this author , Charles RocheCharles Roche More articles by this author , and Eric KauffmanEric Kauffman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003239.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Active surveillance (AS) allows many patients with small renal masses (SRM) to avoid treatment, however study of progression and delayed intervention (DI) outcomes has been limited by high proportions of observation patients who are unfit for treatment. We recently described our initial clinical experience prospectively using pre-defined progression criteria for intervention (PCI) in a unique AS cohort of SRM patients lacking health-related selection. Our current objective was to identify predictors of PCI development and DI in this cohort. METHODS: From January 2013-March 2019, all patients with non-hereditary SRM seen by a single urologic oncologist at a National Comprehensive Cancer Network institute were recommended AS if predefined PCI were absent. PCI were defined prospectively as any SRM-related symptoms, unfavorable biopsy histology, cT3a stage, or any of the following without benign neoplastic biopsy histology: longest tumor diameter (LTD) >4 cm; growth rate >5 mm/year for LTD ≤3 cm or >3 mm/year for LTD >3 cm. DI was recommended during AS upon new PCI development. 5-year PCI-free and DI-free survival were assessed using Kaplan-Meier methods. Clinical variables at presentation or during AS (sex, age, race, body mass index, comorbidities, initial tumor number/size, biopsy histology) were tested for association with time to PCI development or DI. RESULTS: Of 208 consecutive SRM patients, 201 were PCI-free at presentation and underwent AS. With median follow up of 46 months, there were no metastases, and new PCI was diagnosed in 30% of AS patients, of which 69% underwent DI. Only 1 (1%) patient crossed over to DI without tumor PCI. 5-year PCI- and DI-free rates were 60% and 71%, respectively. On univariable analyses, shorter time to PCI was significantly associated with non-Caucasian race, lower Charlson score, initial LTD, and clear cell biopsy histology, while the latter 3 variables also significantly predicted shorter time to DI. On multivariable analyses including all variables, only clear cell biopsy histology independently predicted PCI and DI. On multivariable analyses excluding biopsy histology, only initial LTD independently predicted PCI and DI. CONCLUSIONS: Among SRM patients undergoing AS without health-related selection, LTD and clear cell biopsy histology are primary drivers of PCI development and DI. Non-Caucasian race and fewer comorbidities increase progression risk but not independently of LTD and histology. These findings may be useful for counseling AS patient candidates. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e237 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Muammer Altok More articles by this author Arun Menon More articles by this author Ahmed Aly More articles by this author Kristopher Attwood More articles by this author Tashionna White More articles by this author Gaybrielle James More articles by this author Bo Xu More articles by this author Michael Petroziello More articles by this author Charles Roche More articles by this author Eric Kauffman More articles by this author Expand All Advertisement PDF downloadLoading ...

MP64-12 ENRICHMENT FOR ADVERSE PATHOLOGY IN RESECTED SMALL RENAL MASSES THAT MEET OBJECTIVE PROGRESSION CRITERIA DURING ACTIVE SURVEILLANCE

You have accessJournal of UrologyCME1 Apr 2023MP64-12 ENRICHMENT FOR ADVERSE PATHOLOGY IN RESECTED SMALL RENAL MASSES THAT MEET OBJECTIVE PROGRESSION CRITERIA DURING ACTIVE SURVEILLANCE Muammer Altok, Arun Menon, Ahmed Aly, Tashionna White, Gaybrielle James, Bo Xu, Michael Petroziello, Charles Roche, and Eric Kauffman Muammer AltokMuammer Altok More articles by this author , Arun MenonArun Menon More articles by this author , Ahmed AlyAhmed Aly More articles by this author , Tashionna WhiteTashionna White More articles by this author , Gaybrielle JamesGaybrielle James More articles by this author , Bo XuBo Xu More articles by this author , Michael PetrozielloMichael Petroziello More articles by this author , Charles RocheCharles Roche More articles by this author , and Eric KauffmanEric Kauffman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003322.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Active surveillance (AS) is increasingly used in small renal mass (SRM) patients, however there is no uniform agreement on specific tumor progression criteria to trigger delayed intervention (DI). Ideal progression criteria for intervention (PCI) would selectively treat SRM with adverse pathology (15-25% of all SRM). However, patient factors (e.g., anxiety) have been the most common trigger for DI to date, which has challenged studying the efficacy of specific PCI thresholds. Recently, we described our AS experience prospectively using pre-defined PCI to almost exclusively trigger DI. The current study aimed to characterize pathologic outcomes of DI resection cases to assess the efficacy of these PCI thresholds for selecting SRM with adverse pathology. METHODS: From January 2013-April 2021, all patients with SRM seen at a cancer center were recommended AS if predefined PCI were absent, and DI was recommended only upon new PCI development. PCI were defined prospectively as any SRM-related symptoms, unfavorable biopsy histology, cT3a stage, or any of the following without benign neoplastic biopsy histology: longest tumor diameter (LTD) >4 cm; growth rate (GR) >5 mm/year for LTD ≤3cm or >3 mm/year for LTD >3 cm. Rates of adverse pathology were retrospectively assessed in DI resections and stratified by specific PCI thresholds met. RESULTS: Of 255 SRM patients with 31 months median follow up on AS, there were no metastases and new PCI was diagnosed in 67 (26%), of which 46 (69%) underwent DI, including 41 resections (39 partial, 2 radical). Only 1 DI resection was due to patient factors alone. All 41 DI resections were malignant and most (59%) had adverse pathology, including 51% high grade and 20% pT3a. Rapid GR was the most common trigger of DI (alone= 71% of DI cases; concomitant with LTD >4 cm=22% of DI cases), while LTD >4 cm alone was responsible for only 7% of DI cases. Biopsy histology, cT3a upstaging and symptoms were uncommonly met PCI thresholds (n=3) that were always accompanied by rapid growth and had adverse pathology in most (n=2) cases. CONCLUSIONS: Prospectively applied PCI thresholds defined herein effectively identified aggressive SRM cases for DI conversion, given notably higher rates of adverse pathology at DI compared to those historically reported for SRM resections. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e885 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Muammer Altok More articles by this author Arun Menon More articles by this author Ahmed Aly More articles by this author Tashionna White More articles by this author Gaybrielle James More articles by this author Bo Xu More articles by this author Michael Petroziello More articles by this author Charles Roche More articles by this author Eric Kauffman More articles by this author Expand All Advertisement PDF downloadLoading ...

MP64-11 OUTCOMES OF ACTIVE SURVEILLANCE FOR YOUNG AND HEALTHY PATIENTS WITH SMALL RENAL MASSES

You have accessJournal of UrologyCME1 Apr 2023MP64-11 OUTCOMES OF ACTIVE SURVEILLANCE FOR YOUNG AND HEALTHY PATIENTS WITH SMALL RENAL MASSES Muammer Altok, Arun Menon, Ahmed Aly, Tashionna White, Gaybrielle James, Bo Xu, Michael Petroziello, Charles Roche, and Eric Kauffman Muammer AltokMuammer Altok More articles by this author , Arun MenonArun Menon More articles by this author , Ahmed AlyAhmed Aly More articles by this author , Tashionna WhiteTashionna White More articles by this author , Gaybrielle JamesGaybrielle James More articles by this author , Bo XuBo Xu More articles by this author , Michael PetrozielloMichael Petroziello More articles by this author , Charles RocheCharles Roche More articles by this author , and Eric KauffmanEric Kauffman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003322.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Reported outcomes for active surveillance (AS) in patients with small renal masses (SRM) are heavily biased towards older and unhealthier patients. The safety, tolerability and rates of delayed intervention (DI) for AS in younger and healthier SRM patients remains largely unexplored. Here we report outcomes at a single center for SRM patients with estimated life expectancy (LE) >20 years who were managed with AS±DI. METHODS: From January 2013-March 2019, all patients with non-hereditary SRM presenting to a single urologic oncologist at a National Comprehensive Cancer Network institute were recommended AS if predefined progression criteria for intervention (PCI) were absent. PCI was defined prospectively as any SRM-related symptoms, unfavorable biopsy histology, cT3a stage, or either of the following without benign neoplastic biopsy histology: longest tumor diameter (LTD) >4 cm; growth rate >5 mm/year for LTD ≤3 cm or >3 mm/year for LTD >3 cm. DI was considered during AS only upon PCI development. Patients with LE >20 years were retrospectively identified. LE was estimated using social security LE estimations adjusted by age, gender, and Charlson Comorbidity Index. The 3- and 5-year rates of PCI-freedom and DI-freedom were determined. RESULTS: Among 90 consecutive SRM patients with LE >20 years (median age 57, IQR 47-61), 89 (99%) patients (101 SRMs) did not meet PCI at presentation and underwent AS. With median follow-up of 44 months, 31/89 (35%) AS patients developed PCI, of whom 21/31 (68%) underwent DI (all surgery). One (1%) AS patient crossed over to DI without PCI development. 3- and 5-year PCI-free rates were 68% and 56%, respectively, and 3- and 5-year DI-free rates were 75% and 67%, respectively. No patient developed metastasis. CONCLUSIONS: AS using predefined PCI in otherwise unselected SRM patients is well tolerated and allows most SRM patients with >20 years LE to avoid treatment over 5 years. Long-term DI rates and oncologic safety in younger/healthier patients require further study. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e885 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Muammer Altok More articles by this author Arun Menon More articles by this author Ahmed Aly More articles by this author Tashionna White More articles by this author Gaybrielle James More articles by this author Bo Xu More articles by this author Michael Petroziello More articles by this author Charles Roche More articles by this author Eric Kauffman More articles by this author Expand All Advertisement PDF downloadLoading ...

Phase II study of axitinib prior to partial nephrectomy to preserve renal function: An interim analysis of the PADRES clinical trial.

683 Background: In renal cell carcinoma (RCC), partial nephrectomy (PN) is indicated for patients with solitary kidney, chronic kidney disease, or bilateral tumors. A subset of these patients, however, may have large and complex renal masses not initially suitable for PN. Neoadjuvant Tyrosine Kinase Inhibitor therapy has shown promising results in cytoreducing renal tumors and may permit PN in circumstances not otherwise feasible. Methods: This was a single arm phase II clinical trial of neoadjuvant axitinib in patients with complex (RENAL nephrometry score 10-12 and cT1b-cT3M0) biopsy-proven clear cell RCC with strong indications for partial nephrectomy (PN), and in whom radical nephrectomy may result in dialysis dependence. Axitinib 5 mg was administered orally twice daily for 8 weeks prior to surgery. Primary outcome was reduction in longest tumor diameter; secondary outcomes included tumor response (RECIST), change in RENAL score, feasibility of PN, change in estimated glomerular filtration rate (DeGFR), and post-surgical complications. Results: 26 patients were enrolled. 19 (73.1%) patients had ≥ clinical T3a staged tumors. Post therapy, 17 (65.4%) patients had ≥T3a staged tumors. Axitinib resulted in reductions in tumor size (7.7 vs. 6.3 cm, p&lt;0.001) and RENAL score (11 vs. 10, p &lt;0.001); 9 (34.6%) had partial response, and 17 (65.4%) stable disease by RECIST criteria. PN was successfully performed in 19 (73.1%); 24 (96.8%) achieved negative margins. Six (23.1%) had Clavien III-IV post-surgical complications. Median percentage DeGFR was 14.7%; one (3.8%) patient who had a radical nephrectomy had long-term dialysis dependence. Conclusions: Neoadjuvant axitnib resulted in significant reductions in tumor size and complexity, enabling PN in a cohort of complex renal masses, and with acceptable safety and functional preservation. Clinical trial information: NCT03438708 . [Table: see text]

PNI-Based Nomograms to Predict Tumor Progression and Survival for Patients with Unresectable Hepatocellular Carcinoma Undergoing Transcatheter Arterial Chemoembolization.

The relationship between the prognostic nutritional index (PNI) and the prognosis of malignancy has been increasingly mentioned in recent research. This study aimed to construct nomograms based on the PNI to predict tumor progression and survival in patients with unresectable hepatocellular carcinoma (HCC) undergoing transcatheter arterial chemoembolization (TACE). The development set included 785 patients who underwent their first TACE between 2012 and 2016, and the validation set included 336 patients who underwent their first TACE between 2017 and 2018. The clinical outcomes included the time to progression (TTP) and overall survival (OS). Cox regression was applied to screen for independent risk factors of TTP and OS in the development set, and PNI-based nomograms were constructed for TTP and OS. The predictive performance of nomograms was conducted through the C-index, calibration curves, and decision analysis curves in the development set and validation set. After multivariate analysis, the prognostic predictors of both TTP and OS included portal vessel invasion, extrahepatic metastasis, tumor number, alpha-fetoprotein (AFP) level, longest tumor diameter, and PNI. Furthermore, the Child-Pugh classification and platelets (PLTs) were independent risk factors for OS only. Nomograms for predicting TTP and OS were constructed using TTP and OS prognostic factors. In the development set and the validation set, the C-index of the TTP nomograms was 0.699 (95% confidence interval (CI): 0.680-0.718) and 0.670 (95%CI: 0.638-0.702), and the C-index of the OS nomograms was 0.730 (95%CI: 0.712-0.748) and 0.700 (95%CI: 0.665-0.723), respectively. Nomograms based on the PNI can effectively predict tumor progression and survival in patients with unresectable HCC undergoing TACE.

Obesity and narrow pelvis prolong the operative time in conventional laparoscopic rectal cancer surgery, but not in a two-team transanal total mesorectal excision approach.

Narrow pelvis, tumor diameter, and obesity have been reported as clinical variables correlated with the difficulty of conventional laparoscopic low anterior resection (Lap-LAR). A two-team transanal total mesorectal excision (TaTME) approach where the transabdominal and TaTME are performed simultaneously might reduce the difficulty associated with these factors. This study aimed to clarify the factors associated with the longer time required for TME (TME time) in conventional Lap-LAR and a two-team approach for TaTME. We analyzed 52 patients with rectal carcinoma treated with Lap-LAR and 35 patients treated with TaTME. We performed simple linear regression analysis to assess the association between TME time and bony pelvic size using 3D pelvimetry, longest tumor diameter, and body mass index (BMI). Linear regression analysis demonstrated a highly significant association between TME time and obstetric conjugate (R2 =0.098, P=.024) and BMI (R2 =0.307, P < .001) in the Lap-LAR group, while no significant association was observed in the TaTME group. Male patients, who had a narrower bony pelvis and higher BMI than female patients, had longer TME time than female patients in the Lap-LAR group (213 minutes vs 172 minutes, P=.021), while the TME time of male and female patients did not differ in the TaTME group (122 minutes vs 108 minutes, P=.451). The TME time in the TaTME group was significantly shorter than that in the Lap-LAR group (121 minutes vs 197 minutes, P < .001). A two-team TaTME approach provided a shorter TME time compared to conventional Lap-LAR, regardless of pelvic size and BMI.

The feasibility analysis of multi-slice spiral CT features of gastric stromal tumors in predicting pathological National Institutes of Health risk classification

Objective: To investigate the feasibility of multi-slice spiral CT(MSCT) imaging features of gastric stromal tumor (GST) in predicting pathological NIH risk classification, providing imaging basis for patients with GST before treatment. Methods: The clinical and CT imaging data of 504 patients(506 GST lesions), 259males and 245 females, aged from 13 to 85(60±11) years, with GST confirmed by surgery and pathology collected in the Zhongshan Hospital Affiliated to Fudan University and the Affiliated TCM Hospital of Southwest Medical University. According to pathological NIH risk classification, 506 lesions were divided into low risk group (very low and low risk degree, 277 lesions) and high risk group (medium and high risk degree, 229 lesions).Clinical data and imaging characteristics were compared between two groups. Multivariate logistic regression analysis was performed to screen out independent risk factors for statistically significant imaging indicators. Receiver operating curve (ROC) was used to evaluate the predictive value of tumor length for risk classification. Resulst: Between low risk group and high risk group,there were significant differences in gender(male/female:131/146 vs 129/100), gastrointestinal bleeding(present/absent:39/238 vs 59/170), morphology(regular/Irregular:218/59 vs 95/134), calcification(present/absent:36/241 vs 53/176), degree of necrosis(0°/Ⅰ°/Ⅱ°/Ⅲ°:197/61/16/3 vs 58/98/32/41), ulceration(present/absent:32/245 vs 94/135), growth pattern(endophytic/exophytic/mixed:102/105/70 vs 44/98/87), tumor location(fundus/cardia/body/angle/antrum:98/7/135/12/25 vs 98/6/114/5/6), feeding artery(present/absent:32/245 vs 104/125), vascular enhancement(present/absent:19/258 vs 88/141), effusion of around the disease(present/absent:0/277 vs 13/216), positive sign of fat around the disease(present/absent:0/277 vs 30/199),maximum long diameter[2.82(2.04,3.80) cm vs 5.93(4.06,8.29) cm] and short diameter [2.31(1.60,2.88) cm vs 4.40(3.21,6.37) cm]of tumor(all P<0.05).The maximum long diameter of tumor (OR=2.08,95%CI:1.35-3.20) and ulceration positive(OR=2.01,95%CI:1.03-3.92) were independent risk factors of risk classification(all P<0.05).Gastric antrum was used as the reference for tumor location, gastric fundus(OR=7.77,95%CI:2.00-30.24) and gastric body(OR=3.93,95%CI:1.03-15.01) were independent risk factors of risk classification(all P<0.05).The area under curve(AUC) of the maximum long diameter of tumor for predicting risk classification was 0.87, and the optimal critical value, sensitivity and specificity were 4.98cm, 62.9% and 95.3% respectively. Conclusions: MSCT image features of GST had certain characteristics. MSCT has certain predictive value for pathological NIH risk classification of GST, which can provide certain imaging basis for patients before treatment.

Abstract P3-03-03: Quantitative multiparametric MRI predicts response to neoadjuvant therapy in the community setting

Abstract Background: Early and accurate prediction of response to neoadjuvant therapy (NAT) would empower personalization of breast cancer treatment regimens based on expected response. Noninvasive, quantitative dynamic contrast-enhanced (DCE-MRI) and diffusion-weighted magnetic resonance imaging (DW-MRI), when performed during the course of NAT, can accurately predict the ultimate pathological response. While these techniques have been incorporated into clinical trials in the academic setting, they have not yet been translated to the community setting, where most cancer patients receive their care. Implementation of quantitative MRI in the community setting widely expands the potential impact it can provide by 1) allowing community settings to participate in clinical trials that require quantitative MRI, and 2) advancing quantitative MRI towards standard-of-care for prediction of response in breast cancer. Methods: Women with locally advanced breast cancer (N = 28) were imaged four times during the course of NAT: 1) prior to the start of NAT, 2) after 1 cycle of NAT, 3) after 2-4 cycles of NAT, and 4) 1 cycle after MRI #3. Imaging data was acquired on 3T Siemens Skyra scanners equipped with breast coils and sited in a community hospital and radiology clinic, respectively. DW-MRI and DCE-MRI were acquired over 10 slices of 5 mm thickness. DW-MRI was acquired with diagonal monopolar diffusion-encoding gradients with b-values of 0, 200, and 800 s/mm2 in a total scan time of 1 minute 39 seconds. Voxel wise tumor cellularity was quantified using the apparent diffusion coefficient (ADC). For DCE-MRI, a gadolinium-based contrast agent was administered intravenously at 2 mL/sec after the acquisition of baseline scans. DCE-MRI data was acquired dynamically with a temporal resolution of 7.27 seconds for a total acquisition time of 8 minutes. The volume transfer constant Ktrans was calculated using Patlak analysis of DCE-MRI data to characterize the tumor vasculature. The tumor was semi-automatically segmented using a manually drawn region of interest followed by fuzzy c-means clustering of DCE-MRI data to identify a functional tumor volume. Measurements of tumor volume were combined with both ADC and Ktrans to yield metrics of tumor cellularity and bulk tumor flow, respectively. Results: Women who achieved pathological complete response at the time of surgery (pCR; n=8) displayed significantly different treatment-induced changes in MRI-derived tumor parameters versus women who did not achieve pCR (non-pCR, n=20). After 1 cycle of NAT, women who achieved pCR had smaller functional tumor volume and lower cellularity (p &amp;lt; 0.05) than non-pCR study participants. At the third and fourth MRI, tumor volume, ADC, Ktrans, cellularity, and bulk tumor flow were all significantly different between the pCR and non-pCR cohorts (p &amp;lt; 0.05). Of note, longest tumor diameter was not predictive of pCR at any time point in this study. Conclusions: This study demonstrates that quantitative DCE- and DW-MRI can be implemented successfully in community care facilities within standard-of-care settings for imaging locally advanced breast cancer. Metrics extracted from the change in DW-MRI (ADC) and DCE-MRI (Ktrans) can accurately predict pathological complete response to neoadjuvant therapy and may be more sensitive to tumor response than the RECIST criteria. Furthermore, incorporating quantitative metrics with tumor volume further increases the ability to predict pathological response to NAT in locally advanced breast cancer. While there are still challenges to address to effectively implement these quantitative metrics into the clinical workflow, this study is first in its kind to transition a decade’s worth of quantitative MRI advancements from academic settings into standard-of-care. Citation Format: John Virostko, Anna G Sorace, Kalina P Slavkova, Anum S Kazerouni, Angela M Jarrett, Julie C DiCarlo, Stefanie Woodard, Sarah Avery, Boone W Goodgame, Debra Patt, Thomas E Yankeelov. Quantitative multiparametric MRI predicts response to neoadjuvant therapy in the community setting [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-03-03.

Trends, Symptoms, and Outcomes of Resectable Giant Mediastinal Tumors.

Describing the changes in surgical procedures and factors affecting the surgical outcome of patients who have undergone complete resection of giant mediastinal tumors (GMTs, diameter ≥ 10 centimeters) could improve preoperative decision-making and prognostic evaluations. We accessed data from three sources, which are case reports on surgical treatment of GMTs from PubMed, Web of Science, and EMBASE until June 1, 2019; patients with resected GMT from the Surveillance, Epidemiology, and End Results (SEER) database; and retrospective review of medical records in our institution from 2000 to 2019. The worldwide distribution, clinicopathological characteristics, symptom profile, prognosis of patients with GMT resection, and nomogram for surgical outcome prediction are reported. A total of 242 rare GMT cases from four continents (Asia, North America, South America, and Europe) were included. The median age of the patients was 40 (IQR: 27, range: 13–83) years, and the male-to-female ratio was 1.57:1. Dyspnea, shortness of breath, cough, and chest pain or discomfort were the major symptoms at presentation. The prognosis of benign and low-grade malignant GMTs was superior to that of high-grade malignant GMTs. Tumor malignancy played the most critical role in predicting postoperative survival, followed by longest tumor diameter and a posterior mediastinum location. The findings of this study suggest that the number of successful GMT surgeries has increased over the last decade and describe clinical features of GMTs. Physicians should prioritize tumor malignancy as a leading factor in predicting outcome rather than tumor size.

Computed Tomography Features and Clinical Prognostic Characteristics of Hepatoid Adenocarcinoma of the Stomach.

PurposeHepatoid adenocarcinoma of the stomach (HAS) is a highly malignant and aggressive tumor. The purpose of this study was to describe the clinical, computed tomography (CT), and prognostic features of HAS to increase the awareness of this entity and determine its distinguishing features from non-HAS tumors.MethodsThe CT features and clinical data of 47 patients in our hospital with pathologically documented HAS were retrospectively analyzed, and the relevant differences between pure HAS (pHAS) and mixed HAS (mHAS) were determined. In addition, 141 patients with non-HAS tumors in the same T stage in the same period were selected as the control group. The data were compared between the two groups, and factors affecting the prognosis of HAS were analyzed. In addition, we included 9 patients with HAS and 27 patients with non-HAS tumors from another center for external validation.ResultsThe patients in the HAS group were predominantly men (n = 33), and the tumor location was mostly the cardia or fundus (n = 27). Between the HAS and non-HAS groups, there were observed differences in terms of: sex, serum alpha-fetoprotein (AFP), carbohydrate antigen (CA)-125, and CA-724 levels; longest tumor diameter; degree of differentiation; vascular invasion; N stage, M stage, and tumor-node-metastasis (TNM) stage; thickest tumor diameter; plain CT attenuation; arterial-phase CT attenuation; CT attenuation between the venous and arterial phases; enhancement modes; and degrees of enhancement (all P < 0.05). In the data from another center for external validation, there were observed differences in terms of: age, degree of differentiation, vascular invasion, thickest tumor diameter, the ratio of arterial CT attenuation to CT attenuation of the abdominal aorta at the same level (RA), CT attenuation difference between the venous phase and arterial phase (HUv-a) (all P < 0.05). The results of the multivariate analysis revealed that the independent factors for differentiation were serum AFP level (P = 0.001), M stage (P = 0.038), and tumor enhancement on CT (P = 0.014). Among patients in the HAS group, 72.34% had pHAS and 27.66% had mHAS. The thickest tumor diameter and the longest short diameter of the metastatic lymph nodes of the mHAS group were on average 6.39 cm and 1.45 cm, respectively, which were larger than those in the pHAS group. The median progression-free survival time was 18.25 months in the HAS group, which was shorter than that in the non-HAS group (72.96 months; P = 0.001). The median overall survival time in the HAS group was 24.80 months, which was shorter than that in the non-HAS group (67.96 months; P = 0.001). The factors affecting the prognosis of HAS were M stage (P = 0.001), overall TNM stage (P = 0.048), presence of vascular cancer emboli (P = 0.040), and pHAS type (P = 0.046). Multifactorial analysis revealed that M stage (P = 0.027) and pHAS type (P = 0.009) were independent risk factors affecting the prognosis of HAS.ConclusionAlthough HAS is a rare clinical entity, it should be considered in the differential diagnosis of gastric tumors. Patients with HAS often have advanced-stage disease at presentation and a worse prognosis than patients with non-HAS tumors. CT findings, combined with laboratory results, can support the diagnosis of HAS. However, the final diagnosis needs to be confirmed with a histopathologic examination. If the postoperative pathologic findings reveal the mHAS type, a rapid clinical intervention and a detailed follow-up with CT are essential.

Multimodal functional imaging for early response assessment in patients with gastrointestinal stromal tumor treated with tyrosine kinase inhibitors.

Several imaging modalities are used in the early work-up of patients with gastrointestinal stromal tumor (GIST) receiving tyrosine kinase inhibitor (TKI) treatment and there is a need to establish whether they provide similar or complimentary information. To compare 18F-fluorodeoxyglucose positron emission tomography (FDG PET), computed tomography (CT) and magnetic resonance imaging (MRI) as early predictors of three-month outcomes for patients with GIST receiving TKI treatment. Thirty-five patients with advanced GIST were prospectively included between February 2011 and June 2017. FDG PET, contrast-enhanced CT (CECT), and MRI were performed before and early after onset of TKI treatment (range 8-18 days). Early response was categorized according to mRECIST (CT), the Choi criteria (CECT), and PERCIST (FDG PET/CT). For MRI, volumetry from T2-weighted images and change in apparent diffusion coefficient (ADC) from diffusion-weighted imaging was used. The reference standard for early assessment was the three-month mRECIST evaluation based on CT. At three months, both stable disease (SD) and partial response (PR) were categorized as response. Clinical usefulness was defined as agreement between early and three-month assessment. At the three-month assessment, 91% (32/35) were responders, 37% (13/35) PR, 54% (19/35) SD, and 9% (3/35) had progressive disease (PD). Early assessment correctly predicted three-month response in 93% (27/29) for MRI, 80% (28/35) for PERCIST, 74% (26/35) for Choi, and 23% (8/35) for mRECIST. Six patients had non-FDG-avid tumors. For the FDG-avid tumors, PET/CT correctly predicted three-month response in 97% (28/29). MRI was superior to CECT for early assessment of TKI-treatment response in GIST. If the tumor was FDG-avid, PET and MRI were equally good. Changes in functional parameters were superior to changes in longest tumor diameter (mRECIST).

The Ependymal Region Prevents Glioblastoma From Penetrating Into the Ventricle via a Nonmechanical Force.

BackgroundIntraventricular penetration is rare in glioblastoma (GBM). Whether the ependymal region including the ependyma and subventricular zone (SVZ) can prevent GBM invasion remains unclear.MethodsMagnetic resonance imaging (MRI) and haematoxylin–eosin (HE) staining were performed to evaluate the size and anatomical locations of GBM. Binary logistic regression analysis was used to assess the correlation between tumor-ependyma contact, ventricle penetration and clinical characteristics. Cell migration and invasion were assessed via Transwell assays and an orthotopic transplantation model.ResultsAmong 357 patients with GBM, the majority (66%) showed ependymal region contact, and 34 patients (10%) showed ventricle penetration of GBM. GBM cells were spread along the ependyma in the orthotopic transplantation model. The longest tumor diameter was an independent risk factor for GBM-ependymal region contact, as demonstrated by univariate (OR = 1.706, p < 0.0001) and multivariate logistic regression analyses (OR = 1.767, p < 0.0001), but was not associated with ventricle penetration. Cerebrospinal fluid (CSF) could significantly induce tumor cell migration (p < 0.0001), and GBM could grow in CSF. Compared with those from the cortex, cells from the ependymal region attenuated the invasion of C6 whether cocultured with C6 or mixed with Matrigel (p = 0.0054 and p = 0.0488). Immunofluorescence analysis shows a thin gap with GFAP expression delimiting the tumor and ependymal region.ConclusionThe ependymal region might restrict GBM cells from entering the ventricle via a non-mechanical force. Further studies in this area may reveal mechanisms that occur in GBM patients and may enable the design of new therapeutic strategies.

Abstract PD6-08: DCE-MRI derived imaging features for characterizing invasive lobular breast cancer and predicting recurrence-free survival after neoadjuvant therapy

Abstract Background With current imaging technologies, assessing response to neoadjuvant chemotherapy (NAC) or neoadjuvant endocrine therapy (NET) remains a challenge for patients with invasive lobular carcinoma (ILC). Therefore, we evaluated imaging features from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) before and after neoadjuvant therapy in a cohort of patients with ILC, including the longest tumor diameter (LD), functional tumor volume (FTV), and peak signal enhancement ratio (SER). FTV is the sum of all image voxels enhancing above a set threshold within a defined region, and has been validated as a predictor of recurrence-free survival (RFS) for breast cancer. SER is a measure of contrast wash-in and wash-out and reflects neovascularity of tumors. We determined whether baseline and post-treatment imaging features differed by type of neoadjuvant therapy and if they were associated with RFS in neoadjuvantly treated ILC regardless of treatment type. Methods With institutional review board approval, a retrospective analysis of pre- and post-treatment breast DCE-MRI was performed on a cohort of ILC patients receiving neoadjuvant therapy between 1998 and 2017. We compared pre-treatment, post-treatment, and percent reduction (α) in LD, FTV, and peak SER by neoadjuvant treatment type (i.e. NAC or NET) using the Wilcoxon rank-sum test. Univariate t-tests, Chi-squared tests, analysis of variance, and Spearmen’s correlation were used to evaluate associations of clinicopathologic features and treatment type. Univariate and multivariate associations with RFS in the entire neoadjuvantly treated cohort adjusting for treatment type were evaluated using the log-rank test and Cox proportional hazards models. Results A cohort of 76 patients with pre- and post-treatment MRI were included in this study, of whom 42 (55.3%) received NAC and 34 (44.7%) received NET. The NAC group was significantly younger (55 vs. 60 years, p=0.013), less likely to have stage 1 disease (26.2% vs. 73.5%, p&amp;lt;0.001), and showed a trend of having more human epidermal growth factor 2 receptor-positive (HER2) tumors. The mean follow up time was 4.9 years with no difference between treatment groups. Patients in the NAC group had significantly larger pre-treatment LD and FTV but no difference was found in pre-treatment peak SER between groups. Post-treatment LD, FTV, and peak SER did not differ between treatment groups (Table 1). Those receiving NAC had significantly greater reduction in FTV compared to those receiving NET; αLD and α peak SER did not differ. In a multivariate Cox proportional hazards model including all patients in the cohort, higher pre-treatment peak SER was significantly associated with worse RFS regardless of neoadjuvant treatment type when adjusting for age, stage, receptor subtype, and tumor grade (hazard ratio 1.3, p=0.005, 95% CI 1.1-1.6). Neither LD nor FTV were associated with RFS on multivariate analysis. ConclusionPre-treatment peak SER measured by MRI may provide prognostic information beyond standard clinicopathologic variables in patients with ILC receiving either neoadjuvant chemotherapy or endocrine therapy. Further evaluation in a larger ILC cohort is needed to validate our initial findings. Table 1. Comparison of MR imaging features of ILC patients receiving neoadjuvant chemotherapy and neoadjuvant endocrine therapy.Overall(n=76)NAC(n=42)NET(n=34)P-valuePre-treatment (median, IQR)LD (cm)2.7, 1.6-5.44.6, 2.5-71.8, 1.4-3.20.0006FTV (cc)5.8, 2.2-16.48.7, 4.1-24.23.0, 0.9-80.0004SER0.9, 0.8-1.00.9, 0.9-1.00.9, 0.8-1.10.8335Post-treatment (median, IQR)LD (cm)1.1, 0-1.91.0, 0-1.81.3, 0-1.90.6071FTV (cc)0.5, 0.1-1.80.3, 0.1-1.80.7, 0.3-1.80.2196SER0.9, 0.8-1.00.8, 0.8-1.00.9, 0.8-1.10.2321Percent reduction (%)LD44.6, 15.1-10079.6, 33.8-10033.8, 10.1-1000.0958FTV93, 72.5-97.495.8, 90.7-99.172.6, 43.1-94.5&amp;lt;0.0001SER8.5, -11.1-19.710.7, -6.0-21.81.9, -15.1-17.90.3041 Citation Format: Geraldine Tran, Ella Jones, Wen Li, Kelly Fahrner-Scott, David Newitt, Bonnie Joe, Laura Esserman, Nola Hylton, Rita Mukhtar. DCE-MRI derived imaging features for characterizing invasive lobular breast cancer and predicting recurrence-free survival after neoadjuvant therapy [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD6-08.

Bayesian Network Modelling As a New Tool in Predicting of the Early Progression of Disease in Follicular Lymphoma Patients

Bayesian Network Modelling As a New Tool in Predicting of the Early Progression of Disease in Follicular Lymphoma Patients