Pathological Stage In Patients Research Articles

Role of primary cilium in pancreatic ductal adenocarcinoma (Review).

The primary cilium is a non‑motile cellular structure extending from the apical membrane of epithelial cells that is involved in several processes due to its ability to receive and elaborate different signals. Ciliogenesis and its obliteration are essential for proliferating cells, and several signalling pathways are responsible for their regulation. In fact, the primary cilium is a central hub for numerous signalling pathways implicated in a variety of biological processes, such as the Hedgehog, mammalian target of rapamycin and Wnt pathways. Loss of primary cilia has been recently correlated with different types of tumours, including pancreatic ductal adenocarcinoma (PDAC). K‑Ras and HDAC2 were recently identified as possible ciliogenesis regulators in PDAC, likely acting through Aurora A kinase (AURKA) which, in turn, controls inositol polyphosphate‑5‑phosphatase E. However, the exact molecular mechanisms underlying this regulatory effect remain to be fully elucidated. In the present study, the regulation of the main genes involved in primary cilia assembly/resorption was reconstructed showing the links with the Hedgehog and phosphoinositide 3‑kinase/AKT pathways. Finally, by analysing gene expression databases, the regulatory genes that have high probability to be associated with prognosis, histological grade and pathological stage in patients with PDAC have been highlighted. However, further experimental studies are required to reach definitive conclusions on the roles of these genes. Improving our understating of ciliogenesis and its regulators may help develop ciliotherapies using histone deacetylase and AURKA inhibitors, which may induce re‑differentiation of tumour cells into normal cells by reducing tumour growth or inducing apoptosis of cancer cells.

Impact of Preoperative Imaging on Identifying Rapid Recurrence in Head and Neck Cancer

Rapid recurrence, defined as detectable tumor recrudescence after an oncologically sound primary operation but prior to initiating postoperative radiation therapy (PORT), is now recognized to be an underreported poor prognostic factor in head and neck cancer (HNC), occurring at a rate of 15-30% across different series. We sought to determine and analyze the impact of preoperative imaging on detection of rapid recurrence at the time of Computer Tomography (CT) simulation. CT simulation images of HNC patients treated with primary surgery and PORT between 2009 and 2017 were retrospectively reviewed by a neuroradiologist blinded to patient outcome but provided with pre-operative imaging and the surgical pathology report. Findings in the operative bed, ipsilateral neck and/or contralateral neck considered either suspected or definite recurrence were categorized as rapid recurrence. Multivariable analysis (MVA) was conducted to ascertain risk factors for rapid recurrence. Variables included were: days between imaging and surgery, number of imaging modalities, extranodal extension (ENE), lymphovascular invasion (LVI), perineural invasion (PNI), and pathologic stage. A total of 188 HNC patients were included with oral cavity and squamous cell carcinoma being the most common subsite (58%) and histology (84%). Overall, 22% had ENE, 24% had LVI, 45% had PNI, and 77% were AJCC 7th edition pathologic stage III/IV. Thirty-eight patients (20%) were identified to have rapid recurrence, of which 21 were at the operative bed, 17 were at the ipsilateral neck and 13 were at the contralateral neck. 13 patients (34%) had rapid recurrence at multiple sites. The median time between initial imaging and day of surgery for patients with and without rapid recurrence was 24.5 and 27 days, respectively (p= 0.28). Pre-operative imaging modality included CT, Magnetic Resonance Imaging (MRI) and Positron Emission Tomography fused to CT dataset (PET/CT). 107 patients (57%) had a single imaging modality and among them 86 had CT, 13 had MRI, and 8 had PET/CT. 81 patients (43%) had > 1 imaging modality; most frequently anatomic imaging (CT and/or MRI) and PET/CT (81%). The median time from initial imaging and day of surgery in patients with 1 and > 1 imaging modality were 24 and 31 days, respectively (p= 0.02). On MVA, patients with pre-operative PET/CT were less likely to have local or regional rapid recurrence (OR=0.30, 95% CI 0.13-0.73, p< 0.01). ENE was a predictor of rapid recurrence (OR 2.7, 95% CI 1.01-7.4, p= 0.05). There were no difference in ENE, LVI, PNI or pathologic stage in patients with and without PET/CT. The time between the initial imaging and the date of operation was not associated with rapid recurrence. Patients evaluated with functional preoperative imaging modalities were less likely to have rapid recurrence at the primary site and/or neck(s) at the time of CT simulation.

MicroRNA-548c-5p inhibits the proliferation of breast cancer cells through regulating Wnt/β-catenin signaling pathway.

The aim of this study was to explore the function of microRNA-548c-5p in breast cancer (BCa) and the underlying mechanism. Our findings might help to provide a theoretical basis for the diagnosis and treatment of BCa. Quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) was used to detect the expression level of microRNA-548c-5p in BCa tumor tissues and para-cancerous tissues. The relationship between microRNA-548c-5p expression and clinical indicators of BCa was analyzed. Meanwhile, the expression of microRNA-548c-5p in the BCa cells was detected by qRT-PCR as well. MicroRNA-548c-5p overexpression and the knockdown models were constructed in BCa cell lines MCF-7 and MDA-MB-231. Subsequently, Cell Counting Kit-8 (CCK-8), colony formation and 5-ethynyl-2'-deoxyuridine (EdU) assays were performed to analyze the influence of microRNA-548c-5p on biological functions of BCa cells. Finally, the interaction between microRNA-548c-5p and Wnt/b-catenin signaling pathway was investigated. QRT-PCR results showed that the expression level of microRNA-548c-5p in BCa tumor tissues was remarkably lower than that of adjacent tissues, and the difference was statistically significant (p<0.05). Compared with patients with high expression of microRNA-548c-5p, the pathological stage of patients with low microRNA-548c-5p expression was significantly higher (p<0.05). Similarly, microRNA-548c-5p overexpression remarkably decreased the proliferation ability of BCa cells in vitro. However, microRNA-548c-5p knockdown showed an opposite trend. In addition, Wnt1, a key factor in the Wnt/b-catenin signaling pathway, was found remarkably up-regulated in BCa cell lines and tissues. Wnt1 expression was negatively correlated with microRNA-548c-5p expression. Western Blotting results demonstrated that microRNA-548c-5p mimics remarkably down-regulated the levels of the proteins in the Wnt/b-catenin signaling pathway. Conversely, opposite results were observed in microRNA-548c-5p inhibitor group. The rescue experiments in the cells revealed that there might be a mutual regulation between microRNA-548c-5p and Wnt1, thereby together regulating the malignant growth of BCa. MicroRNA-548c-5p was lowly expressed in BCa tissues and cells, which was closely related to the pathological stage of BCa. In addition, microRNA-548c-5p significantly inhibited the proliferation of BCa cells via modulating Wnt/b-catenin signaling pathway.

Assessment of Lymph Node Evaluation in Patients with Clinically Node Negative Merkel Cell Carcinoma of the Head and Neck

Lymph node evaluation with sentinel lymph node biopsy is indicated by the NCCN for Merkel cell carcinoma (MCC) of the head and neck. The aim of the study is to evaluate the effect of receipt of lymph node evaluation (LNE) on potential survival impact and pathologic staging of patients with clinically node negative, non-metastatic disease of the head and neck. We hypothesized there to be a mortality benefit with LNE.

P82 A PROPENSITY SCORE MATCHED COHORT STUDY TO EVALUATE THE ASSOCIATION OF LYMPH NODE RETRIEVAL WITH LONG-TERM OVERALL SURVIVAL IN PATIENTS WITH ESOPHAGEAL CANCER

Abstract Introduction Previous studies evaluating the association of LN yield and survival presented conflicting results and many may be influenced by confounding and stage migration. This study aimed to evaluate whether the quality indicator ‘retrieval of at least 15 lymph nodes (LNs)’ is associated with better long-term survival and more accurate pathological staging in patients with esophageal cancer treated with neoadjuvant chemoradiotherapy and resection. Methods Data of esophageal cancer patients who underwent neoadjuvant chemoradiotherapy and surgery between 2011-2016 was retrieved from the Dutch Upper Gastrointestinal Cancer Audit. Patients with &lt;15 LNs and ≥15 LNs were compared after propensity score matching based on patient and tumor characteristics. The primary endpoint was 3-year survival. To evaluate the effect of LN yield on the accuracy of pathological staging, pathological N-stage was evaluated and 3-year survival was analyzed in a subgroup of patients node-negative disease. Results In 2260 of 3281 patients (67%) ≥15 LNs were retrieved. In total, 992 patients with ≥15 LNs were matched to 992 patients with &lt;15 LNs. The 3-year survival did not differ between the two groups (57% versus 54%, p=0.28). pN+ was scored in 41% of patients with ≥15 LNs versus 35% of patients with &lt;15 LNs. For node-negative patients, the 3-year survival was significantly better for patients with ≥15 LNs (69% versus 61%, p=0.01). Conclusions In this propensity score matched cohort, 3-year survival was comparable for patients with ≥15 LNs, although increasing nodal yield was associated with more accurate staging. In node-negative patients, 3-year survival was higher for patients with ≥15 LNs.

LncRNA CASC11 promotes the development of esophageal carcinoma by regulating KLF6.

The aim of this study was to investigate the expression level of long non-coding RNA (lncRNA) CASC11 in esophageal carcinoma (ECa), and to further explore its relationship with clinical progression, pathological parameters, and prognosis of ECa patients. Quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) was used to examine the level of lncRNA CASC11 in 45 pairs of ECa tissues and adjacent normal tissues. The relationship between the lncRNA CASC11 level and clinical progression, pathological parameters, and prognosis of ECa patients was analyzed. Meanwhile, the level of lncRNA CASC11 in the ECa cell lines was verified by qPCR as well. In addition, lncRNA CASC11 knockdown model was constructed using lentiviral transfection in ECa cell lines. Subsequently, the cell counting kit-8 (CCK8), colony formation assay, and flow cytometry were used to explore the effect of lncRNA CASC11 on the biological functions of the ECa cells. Finally, the Western Blot and the recovery experiments were used to explore the potential mechanism. In this work, the qPCR results showed that the expression level of lncRNA CASC11 in the ECa tissues was remarkably higher than that of the adjacent normal tissues, and the difference was statistically significant (p<0.05). Compared with patients with a low level of lncRNA CASC11, the pathological stage of patients with high expression was significantly higher, while the overall survival rate was lower (p<0.05). Compared with negative control (NC) group, the proliferation ability of the cells in the lncRNA CASC11 knockdown group CASC11 significantly decreased, whereas cell apoptosis remarkably increased (p<0.05). The Western Blot results revealed that protein expression of KLF6 was remarkably up-regulated after lncRNA CASC11 knockdown. In addition, the recovery experiments found that lncRNA CASC11 and KLF6 had mutual regulation, thereby promoting the malignant progression of ECa. LncRNA CASC11 expression was remarkably up-regulated in ECa, which was associated with the pathological stage and poor prognosis of ECa. In addition, lncRNA CASC11 could promote the malignant progression of ECa by mutual regulation of KLF6.

MiRNA-206 inhibits proliferation of renal clear cell carcinoma by targeting ZEB2.

The purpose of this study was to investigate the effect of microRNA-206 on the malignant progression of renal clear cell carcinoma (RCC). In addition, whether microRNA-206 could regulate ZEB2 expression and the underlying mechanisms was also explored. Quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) was performed to examine microRNA-206 level in 46 tumor tissue specimens and adjacent ones of RCC patients. Also, the relationship between microRNA-206 expression and clinical indicators of RCC was analyzed. The negative control (NC) and microRNA-206 mimics were transfected into RCC cell lines, and the transfection efficiency was verified by qRT-PCR. The effects of microRNA-206 on the proliferation and apoptosis of RCC cells were analyzed by cell counting kit-8 (CCK-8), clone formation, and flow cytometry assays. Finally, the regulation of microRNA-206 on the downstream gene ZEB2 was indicated by Western Blot and cell recovery experiments. qRT-PCR results showed that the expression level of microRNA-206 in tumor tissue samples of RCC patients was remarkably lower than that in adjacent normal tissues, and the difference was statistically significant. Meanwhile, compared with patients with high expression of microRNA-206, the pathological stage of patients with low expression of microRNA-206 was higher, and the overall survival rate was lower. In the RCC cell lines (Caki-1 and Caki-2), the cell proliferation ability of the microRNA-206 overexpression group was remarkably weakened, while the cell apoptosis rate was oppositely enhanced when compared with the NC group. In addition, this study demonstrated that ZEB2 expression was remarkably increased in RCC cells as well as tissues and was negatively correlated with microRNA-206 expression. At the same time, microRNA-206 mimics was found remarkably reduced in the expression of proteins in ZEB2-related signaling pathway, including ZEB2, β-catenin, cyclinD1, c-Myc, MMP-2, and MMP-9. In the cell reverse experiment, the overexpression of ZEB2 was found to be able to counteract the impact of microRNA-206 mimics on RCC cell proliferation and apoptosis and thus, participated in the malignant progression of RCC. This study revealed that microRNA-206 was remarkably associated with the pathological stage and poor prognosis of RCC patients. In addition, microRNA-206 might inhibit the malignant progression of RCC by regulating the targeted ZEB2.

EDITORIAL COMMENT

Despite improvements in cross-sectional imaging and endoscopy, survival rates for patients with high-grade upper tract urothelial carcinoma (UTUC) have not improved in 2 decades. Nearly half of all patients with high-risk features die within 5 years, and patients with locally-advanced disease have less than a 2-year median survival. 1 Lehmann J Suttmann H Kovac I et al. Transitional cell carcinoma of the ureter: prognostic factors influencing progression and survival. Eur Urol. 2007; 51: 1281-1288 Google Scholar , 2 Brown GA Busby JE Wood CG et al. Nephroureterectomy for treating upper urinary tract transitional cell carcinoma: time to change the treatment paradigm?. BJU Int. 2006; 98: 1176-1180 Google Scholar Given the persistently poor prognosis for patients with high-risk UTUC, a shift in treatment paradigm is needed. 3 Liao RS Gupta M Schwen ZR et al. Comparison of pathological stage in patients treated with and without neoadjuvant chemotherapy for high risk upper tract urothelial carcinoma. J Urol. 2018; 200: 68-73 Google Scholar

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios inversely correlate to clinical and pathologic stage in patients with resectable pancreatic ductal adenocarcinoma.

Post-surgical pathology (SP) staging correlates with long-term survival. Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) have been shown to predict prognosis and extent of tumor in patients with metastatic pancreatic ductal adenocarcinoma (PDAC). This study aimed to correlate NLR and PLR to radiological clinical staging (CS), carbohydrate antigen (CA) 19-9 tumor marker and SP staging in patients with resectable-PDAC (R-PDAC); and to investigate NLR and PLR as potential markers to guide neoadjuvant therapy. Data were collected retrospectively from R-PDAC patients who received upfront surgery from November 2011 to December 2016. NLR and PLR values on the day of diagnosis and surgery were collected. SP, tumor size, location, resected margins (RM), lymphovascular/perineural invasion (LVI/PNI), lymph node involvement, and AJCC/TNM 8th Edition staging were obtained. Associations were assessed using linear, ordinal logistic, and poison regressions or Kruskal Willis Rank Sum Test per the nature of outcome variables, with statistical significance at p-value <0.05. Fifty-five patients were identified with resectable stage I (61%) and II (38%). They had a mean age of 66 years (48-87 years) and were 47.2% male, 83.6% white, 90.9% non-Hispanic and 89% with ECOG 0-1. NLR/PLR at diagnosis for R0, R1 and R2 were 6.7/241, 4.8/224, and 2.9/147 (P=0.01/0.002), respectively. NLR/PLR for N0 and N1 were 5.1/212 and 2.7/138.3 (P=0.03/0.009) at diagnosis. No other significant association was detected. These findings suggest that NLR/PLR inversely correlates with RM and lymph node status in patients with R-PDAC, but require prospective evaluation in clinically defined scenarios.

Prediction of pathologic stage in non-small cell lung cancer using machine learning algorithm based on CT image feature analysis

PurposeTo explore imaging biomarkers that can be used for diagnosis and prediction of pathologic stage in non-small cell lung cancer (NSCLC) using multiple machine learning algorithms based on CT image feature analysis.MethodsPatients with stage IA to IV NSCLC were included, and the whole dataset was divided into training and testing sets and an external validation set. To tackle imbalanced datasets in NSCLC, we generated a new dataset and achieved equilibrium of class distribution by using SMOTE algorithm. The datasets were randomly split up into a training/testing set. We calculated the importance value of CT image features by means of mean decrease gini impurity generated by random forest algorithm and selected optimal features according to feature importance (mean decrease gini impurity > 0.005). The performance of prediction model in training and testing sets were evaluated from the perspectives of classification accuracy, average precision (AP) score and precision-recall curve. The predictive accuracy of the model was externally validated using lung adenocarcinoma (LUAD) and lung squamous cell carcinoma (LUSC) samples from TCGA database.ResultsThe prediction model that incorporated nine image features exhibited a high classification accuracy, precision and recall scores in the training and testing sets. In the external validation, the predictive accuracy of the model in LUAD outperformed that in LUSC.ConclusionsThe pathologic stage of patients with NSCLC can be accurately predicted based on CT image features, especially for LUAD. Our findings extend the application of machine learning algorithms in CT image feature prediction for pathologic staging and identify potential imaging biomarkers that can be used for diagnosis of pathologic stage in NSCLC patients.

Expression of miR-26b in ovarian carcinoma tissues and its correlation with clinicopathology.

The expression of microRNA (miR)-26b in ovarian carcinoma tissues, its correlation with clinicopathology, and its effect on diagnostic value and prognosis of ovarian cancer was investigated. A total of 74 patients with ovarian cancer (the study group) and 30 patients with benign ovarian tumors (the control group) in the Affiliated Hospital of Inner Mongolia Medical University from July 2011 to June 2013 were retrospectively analyzed. The expression of miR-26b in ovarian carcinoma tissues was detected by fluorescence reverse transcription-quantitative polymerase chain reaction (RT-qPCR), and the correlation between the expression of miR-26b and the pathological features of ovarian carcinoma tissues and prognosis of patients was analyzed. The expression level of miR-26b in the study group (0.28±0.07) was significantly lower than that in the control group (0.54±0.11; P<0.050). There was no significant correlation between miR-26b expression and age, tumor type, exercise habit, smoking habit of patients with ovarian cancer (P>0.050), but there was close correlation between the miR-26b expression and lymph node metastasis, differentiation degree and pathological stage of patients with ovarian cancer (P<0.001). ROC curve showed that the area under curve (AUC) was 0.839, and when the maximum cut-off value was 0.815, the sensitivity and specificity of miR-26b in diagnosing the ovary was 84.932% and 77.936%, respectively. The 5-year overall survival rate in the low-expression group (61.54%) was significantly lower than that in the high-expression group (84.85; P=0.028). miR-26b is under-expressed in the ovary and has a close relationship with pathological stage, differentiation degree, and lymph node metastasis of ovarian cancer, which indicates that miR-26b is involved in the occurrence and development of ovarian cancer and is expected to be an effective indicator for treatment and diagnosis of ovarian cancer and the prognosis of patients.

Comparison of clinical and pathologic staging in esophageal cancer.

31 Background: Randomized trials have demonstrated improved disease-free survival for more advanced esophageal cancer treated with neoadjuvant chemo radiation (NCXRT). However, accurately treating a patient relies on the accuracy of pre-treatment T and N staging with endoscopy ultrasound and cross-sectional imaging, which is unknown, and can lead to over or under-treatment. Therefore, the objective of this study is to compare the clinical and pathologic staging in patients with early esophageal cancer that would be impacted by inaccurate clinical staging. Methods: Primary, non-metastatic esophageal cancer patients who had upfront esophagectomy without neoadjuvant CXRT between 2004 and 2013 were identified in the National Cancer database. The Kappa index was used to determine patient and tumor characteristics that effected concordance between clinical and pathologic T and N staging (p &gt; 0.05 shows discordance). Results: Of 1810, 43 % of clinical T2 tumors were upstaged compared to 38% of T1 and 13% of clinical T2 were downstaged. Clinically positive N1 disease had the greatest concordance (91%) between clinical and pathologically staging, compared to clinical N0, where 57% were upstaged. Some patient groups significantly impacted the concordance rates of staging. T-Stage was less accurate (more discordant) in females (68%, kappa 0.41, p = 0.057) and Blacks (59%, kappa 0.023, p = 0.069) whereas overall N-stage was more discordant in Hispanics (83%, kappa, 0.67, p = 0.165). Conclusions: Accurate staging for esophageal adenocarcinoma can significantly impact the course of treatment. Upfront surgical resection of clinical T1 lesions and node negative tumors are at risk for under-treatment due to poor concordance with pathological stage, which may lead to decreased survival compared to a regimen of NCXRT. Clinicians should be aware of patient and tumor characteristics that increase the likelihood of discordance between clinical and pathologic staging when discussing treatment options for patients with esophageal cancer.

Integrative analysis of cancer driver genes in prostate adenocarcinoma.

Large-scale genomics studies have identified recurrently mutated genes in the ETS gene family, including fusions and copy number variations (CNVs), which are involved in the development of prostate adenocarcinoma (PRAD). However, the aetiology of PRAD remains to be fully elucidated. In the present study, 333 driver genes were identified using four computational tools: OncodriveFM, OncodriveCLUST, iCAGES and DrGaP. In addition, 32 driver pathways were identified using DrGaP. SPOP, TP53, SPTA1, AHNAK, HMCN1, ATM, FOXA1, CSMD3, LRP1B and FREM2 were the 10 most recurrently mutated genes in PRAD. ITGAL, TAGAP, SIGLEC10, RAC2 and ITGA4 were the five hub genes in the yellow module that were associated with the number of positive lymph nodes. Hierarchical clustering analysis of the 20 driver genes with the most frequent CNVs revealed three clusters of patients with PRAD. Cluster 3 tumours exhibited significantly higher numbers of positive lymph nodes, higher Gleason scores, more advanced cancer stages and poorer prognosis than cluster 1 and 2 tumours. A total of 48 genes were significantly associated with the number of positive lymph nodes, Gleason scores and pathologic stage in patients with PRAD. The identified set of cancer genes and pathways sheds light on the tumorigenesis of PRAD and creates avenues for the development of prognostic biomarkers and driver gene-targeted therapies in PRAD.

Microscopic hematuria predicts lower stage in patients with upper tract urothelial carcinoma.

BackgroundThe aim of this study was to assess the association between the severity of hema-turia (microscopic or gross) and the tumor stage and grade in a population of histopathologically confirmed upper tract urothelial carcinoma (UTUC) patients.Patients and methodsWe conducted a multicenter, observational study of patients who were newly diagnosed with UTUC between January 2011 and December 2016. Demographic information, pathology, and the status of hematuria were retrospectively reviewed. The association between the severity of hematuria and the tumor stage and grade was evaluated using logistic regression.ResultsThe UTUC patients presented with gross hematuria (GH, 76.7%), microscopic hematuria (MH, 11.1%), and no hematuria (12.2%) at the time of diagnosis. The pathological stages at diagnosis for those with MH were Ta in 5.1%, T1 in 47.5%, and ≥T2 in 47.5%. The stages at diagnosis for those with GH were Ta in 1.7%, T1 in 35.5%, and ≥T2 in 62.7%. On univariate and multivariate logistic regression analyses, after adjusting for clinical factors such as age, gender, and smoking history, GH was an independent risk factor for muscle-invasive UTUC (≥T2 disease) at diagnosis (OR 1.89, 95% CI 1.073–3.329; P=0.027). High-grade tumor was found in 47.8% of patients with GH and 39.0% of those with MH. The severity of hematuria was not associated with tumor grade.ConclusionWe are the first to report evidence that microscopic hematuria at presentation accurately predicts lower pathological stage in patients with newly diagnosed UTUC. Earlier detection of disease, before the development of GH, may influence the treatment decision and survival. The type of hematuria at the time of diagnosis does not impact the tumor grade.

Nodal involvement adversely affects prognosis in pulmonary carcinoid tumors

This study aims to analyze the prognostic factors affecting survival in pulmonary carcinoid tumors. Gender, age, smoking habit, comorbidity, localization of the tumor, T status, N status, histological type, and pathological stage of patients who had undergone resection of pulmonary carcinoid tumor between January 1, 2005 and December 31, 2016 were retrospectively reviewed. A total of 47 patients (18 male, 29 female; mean age 50.5 years; range, 23 to 74 years) consisting of 40 typical and 7 atypical carcinoid tumor cases were included in our study. Anatomical resection and systematic mediastinal lymph node dissection was performed on all patients. Pathological studies revealed lymphatic involvement in six patients (12.8%; 4 pN1 and 2 pN2). In the typical group (n=40), three patients were classified N1 (7.5%) and one patient N2 (2.5%). In the atypical group (n=7), one patient were classified N1 (14.3%) and one patient N2 (14.3%). Throughout the study, four patients with typical histology (10%) and two patients with atypical histology (28.6%) had nodal involvement. All six patients with nodal involvement underwent adjuvant radiotherapy. Atypical histology (p=0.005) and nodal involvement (p=0.008) were determined as negative prognostic factors in statistical analysis. Systematic hilar and mediastinal nodal dissection play a crucial role in the surgical treatment of pulmonary carcinoid tumors.

Clinical Misstagings and Risk Factors of Occult Nodal Disease in Non-Small Cell Lung Cancer

Our objective was to compare the clinical to the pathologic stage in patients with non-small cell lung cancer (NSCLC). A prospective database from 1 surgeon was reviewed. Patients had NSCLC, chest tomography (CT), and most had positron emission tomography (PET). Those with suggested N1, N2, central tumors, or tumors larger than 5 cm underwent mediastinoscopy or endobronchial ultrasound, or both, and if N2 negative, underwent resection with complete thoracic lymphadenectomy. Between January 2006 and December 2016, there were 1,444 consecutive patients. The sensitivity and specificity for CT was 76% and 79% for pathologic stage I, 48% and 89% for stage II, and 58% and 88% for stage III. The sensitivity and specificity for PET was 77% and 70% for pathologic stage I, 43% and 88% for stage II, and 46% and 93% for stage III. Pathologic N1 disease was proven in 7% of patients and missed in 4% by CT, 5% by PET, and 3% by both. Pathologic N2 disease was proven in 20% of patients and missed in 9% by CT, 10% by PET, and 8% by both. Occult N2 disease was present in 10% of clinically stage Ipatients and in 21% of clinically stage II patients. Independentpredictors of occult N1 disease included highmaximum standardized uptake value (p= 0.034) and predictors of N2 disease included African American race (p= 0.020) and large tumor size (p= 0.047). Despite advancements in CT, PET, and minimally invasive nodal biopsy, there remains significant NSCLC misstaging, especially for N2 disease. Improved, targeted N2 lymph node biopsy may improve preresection staging.

Correlation Between Clinical and Pathologic Staging in Colon Cancer: Implications for Neoadjuvant Treatment

BackgroundRecent randomized trials suggest improved outcomes in patients with locally advanced colon cancer (LACC) treated with neoadjuvant chemotherapy (NAC). Optimal selection of patients for NAC depends on accurate clinical staging. The purpose of this study was to examine the degree of correlation between clinical and pathologic staging in patients with colon cancer (CC). MethodsAdult patients with non-metastatic CC who underwent surgery were identified from the National Cancer Data Base between 2006 and 2014. Data on clinical and pathologic staging was obtained. Kappa index was used to determine the correlation between clinical and pathologic staging. ResultsOne hundred five thousand five hundred sixty-nine patients were identified. The overall correlation rate between clinical and pathologic staging for T stage was 80% (kappa 0.7) and 83% for N stage (kappa 0.6). The correlation rate was 54% for T1, 76% for T2, 95% for T3, and 94% for T4 (P<0.001). This compared with 81% for N0, 82% for N1, and 97% for N2 (P<0.001). The sensitivity and specificity of clinical staging for identifying T3/T4 vs T1/T2 were 80 and 98%, respectively, compared to 60 and 98% for N1/N2 vs N0 (P<0.001). ConclusionsOur findings suggest that current modalities used for clinical staging are accurate in predicting pathologic stage for advanced but not early T and N disease. Further optimization of clinical staging is essential for the accurate selection of patients who may benefit from neoadjuvant therapy and to avoid overtreatment of low-risk patients.

This Month in Adult Urology

No AccessJournal of UrologyThis Month in Adult Urology1 Jul 2018This Month in Adult Urology Joseph A. Smith Joseph A. SmithJoseph A. Smith More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.03.119AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "This Month in Adult Urology." The Journal of Urology, 200(1), pp. 1–2 References 1 : The relationship between sleep disorders and lower urinary tract symptoms: results from the NHANES. J Urol2018; 200: 161. Link, Google Scholar 2 : Long-term outcome of a single intervention population based prostate cancer screening study. J Urol2018; 200: 82. Link, Google Scholar 3 : Comparison of pathological stage in patients treated with and without neoadjuvant chemotherapy for high risk upper tract urothelial carcinoma. J Urol2018; 200: 68. Link, Google Scholar 4 : Volitional voiding of the bladder after spinal cord injury: validation of bilateral lower extremity motor function as a key predictor. J Urol2018; 200: 154. Link, Google Scholar 5 : National imaging trends after percutaneous nephrolithotomy. J Urol2018; 200: 147. Link, Google Scholar 6 : Role of magnetic resonance imaging targeted biopsy in detection of prostate cancer harboring adverse pathological features of intraductal carcinoma and invasive cribriform carcinoma. J Urol2018; 200: 104. Link, Google Scholar 7 : The impact of immediate salvage surgery on corporeal length preservation in patients presenting with penile implant infections. J Urol2018; 200: 171. Link, Google Scholar 8 : Evolving use of prebiopsy prostate magnetic resonance imaging in the Medicare population. J Urol2018; 200: 89. Link, Google Scholar © 2018 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 200Issue 1July 2018Page: 1-2 Advertisement Copyright & Permissions© 2018 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph A. Smith More articles by this author Expand All Advertisement PDF downloadLoading ...

Correlation of clinical and pathological staging and response to neoadjuvant therapy in resected pancreatic cancer

BackgroundNeoadjuvant therapy (NAT) has been increasingly employed to optimize outcomes in pancreatic cancer; however, little is known about its pathologic impact. MethodsThe National Cancer Data Base (2003–2011) was retrospectively reviewed for patients with pancreatic carcinoma who underwent initial surgery or NAT followed by resection. Response to NAT, determined by comparing clinical and pathologic stage, and survival were evaluated. Results16,087 patients underwent initial pancreatectomy and 2307 patients received NAT. Clinical stage correlated poorly with pathological stage in patients who received initial surgery (κ = 0.2865, p < 0.001). With NAT, 21.9% were downstaged, 47.9% had no stage change, and 30.3% progressed. In clinical stage II disease, patients downstaged with neoadjuvant chemotherapy or multimodality therapy demonstrated improved survival over patients who did not respond or who progressed (P = 0.0022, P = 0.0012, respectively). This benefit was not preserved in stage III disease (P = 0.7380, P = 0.0726, respectively). In multivariable analysis, downstage in disease was associated with a 19% lower hazard of mortality (HR 0.81, 95% CI: 0.7–0.92, P = 0.002). ConclusionsClinical stage correlates poorly with pathological stage in resectable pancreatic cancer. The majority of patients do not experience a change in stage with NAT. Those with early stage disease, responsive to NAT, experience a survival benefit.

Comparison of Pathological Stage in Patients Treated with and without Neoadjuvant Chemotherapy for High Risk Upper Tract Urothelial Carcinoma

High risk upper tract urothelial carcinoma has been associated with poor survival outcomes. Limited retrospective data support neoadjuvant chemotherapy prior to radical nephroureterectomy. To validate prior findings we evaluated differences in the pathological stage distribution in patients with high risk upper tract urothelial carcinoma based on the administration of neoadjuvant chemotherapy before radical nephroureterectomy. We retrospectively analyzed the records of 240 patients with upper tract urothelial carcinoma at The Johns Hopkins Hospital from 2003 to 2017. Patients with biopsy proven high grade disease and a visible lesion on cross-sectional imaging were offered neoadjuvant chemotherapy prior to radical nephroureterectomy. A control group of a time matched cohort of patients with biopsy proven high grade disease underwent extirpative surgery alone. The chi-square and Fisher exact tests were used to evaluate clinical and pathological variables between the cohorts. There were 32 patients in the study group and 208 in the control group. Significantly lower pathological stage was noted in the study group than in the control group (p <0.001). Significantly fewer patients with pT2 disease or higher were treated with neoadjuvant chemotherapy (37.5% vs 59.6%, p = 0.02). There was a 46.5% reduction in the prevalence of pT3 disease or higher in study group patients without clinically node positive or low volume metastatic disease (25.9% vs 48.4%, p = 0.04). A 9.4% complete remission rate was observed in patients who underwent neoadjuvant chemotherapy. Patients with high risk upper tract urothelial carcinoma treated with neoadjuvant chemotherapy were noted to have a lower pathological stage distribution than patients treated with radical nephroureterectomy alone.