Pathological Tumor Volume Research Articles

Pathological tumor volume as a simple quantitative predictive factor of survival in oral squamous cell carcinoma.

Oral squamous cell carcinoma (OSCC) is the eighth most common type of cancer in the world. Knowledge of prognostic factors of survival in OSCC is key. Several clinical and pathological prognostic factors have been investigated to develop a prognostic model of survival for patients with oral cancer. The present study focused on the association between pathological tumor volume (PTV) and overall survival time in patients with OSCC, regardless of cervical nodal status. The present study was a prospective study and covered 65 consecutive patients who received surgical treatment for oral cancer. The PTV was calculated according to dimensions of the postoperative specimen. Other pathological parameters as perineural and perivascular tumor spreading and extra-nodular propagation were also determined. The data were analyzed using the IBM SPSS 25.0 software. Cox PH regression model was built to analyze association between the PTV and survival time. Survival time was defined as the period from surgery to a target event or last contact. The results of the present study showed that PTV >4.24 cm3 was significantly associated with shorter overall survival time in patients with OSCC. The PTV value was higher in patients with metastasis and in patients with higher pathological tumor and node stage. In conclusion, PTV was an important pathological prognostic factor for survival in patients with OSCC.

Tumor volume definitions in head and neck squamous cell carcinoma – Comparing PET/MRI and histopathology

Background and purposeIn cancer treatment precise definition of the tumor volume is essential, but despite development in imaging modalities, this remains a challenge. Here, pathological tumor volumes from the surgical specimens were obtained and compared to tumor volumes defined from modern PET/MRI hybrid imaging. The purpose is to evaluate mismatch between the volumes defined from imaging and pathology was estimated and potential clinical impact. Methods and MaterialsTwenty-five patients with head and neck squamous cell carcinoma were scanned on an integrated PET/MRI system prior to surgery. Three gross tumor volumes (GTVs) from the primary tumor site were delineated defined from MRI (GTVMRI), PET (GTVPET) and one by utilizing both anatomical images and clinical information (GTVONCO). Twenty-five primary tumor specimens were extracted en bloc, scanned with PET/MRI and co-registered to the patient images. Each specimen was sectioned in blocks, sliced and stained with haematoxylin and eosin. All slices were digitalized and tumor delineated by a head and neck pathologist. The pathological tumor areas in all slices were interpolated yielding a pathological 3D tumor volume (GTVPATO). GTVPATOwas compared with the imaging GTV’s and potential mismatch was estimated. ResultsThirteen patients were included. The mean volume of GTVONCOwas larger than the GTV’s defined from PET or MRI. The mean mismatch of the GTVPATOcompared to the GTVPET, GTVMRIand GTVONCOwas 31.9 %, 54.5 % and 27.9 % respectively, and the entire GTVPATO was only fully encompassed in GTVONCO in 1 of 13 patients. However, after the addition of a clinical 5 mm margin the GTVPATO was fully encompassed in GTVONCO in 11 out of 13 patients. ConclusionsDespite modern hybrid imaging modalities, a mismatch between imaging and pathological defined tumor volumes was observed in all patients.A 5 mm clinical margin was sufficient to ensure inclusion of the entire pathological volume in 11 out of 13 patients.

Prediction of surgical margin status and location after radical prostatectomy using positive biopsy sites on 12-core standard prostate biopsy

We evaluated the surgical margin status after radical prostatectomy according to sites positive for prostate cancer on standard 12-core transrectal ultrasound-guided prostate biopsy. Among patients who underwent radical prostatectomy at Boramae Medical Center, 520 patients with preoperative prostate-specific antigen (PSA) level < 20 ng/mL and locally confined prostate cancer on preoperative magnetic resonance imaging, treated with nerve-sparing radical prostatectomy, were included in the analysis. The surgical margin was positive for cancer in 166 (31.9% of the total) patients. The preoperative PSA level (9.3 vs. 8.0, ng/mL p = 0.001) and number of positive cores on 12-core prostate biopsy (4.1 vs. 3.4, p = 0.003) were significantly higher in patients with positive surgical margins. Moreover, the biopsy Gleason grade was higher in patients with positive surgical margins (p = 0.001). However, the pathologic Gleason grade and tumor volume were equivalent between the 2 groups. On multivariate analysis, the detection of prostate cancer on anterior lateral biopsy was associated with an increased rate of positive surgical margins (hazard ratio [HR]: 1.781, p = 0.008) after adjusting for other variables. Anterior lateral (HR: 1.919, p = 0.020), basal lateral (HR: 9.176, p < 0.001), basal medial (HR: 3.302, p = 0.031), and mid lateral (HR: 2.501, p = 0.044) biopsies were associated with positive apical, posterior, basal, and lateral surgical margins, respectively, after adjusting for other variables. The sites of prostate cancer on standard 12-core prostate biopsy could be useful for predicting surgical margin positivity after radical prostatectomy. In other words, clinicians should consider the sites of prostate cancer on prostate biopsy to reduce margin positivity after radical prostatectomy.

MicroRNA-200c-3p suppresses proliferation and invasion of nephroblastoma cells by targeting EP300 and inactivating the AKT/FOXO1/p27 pathway.

miR-200c-3p is aberrantly expressed in numerous cancers, but its underlying mechanisms in nephroblastoma are unknown. In our study, the differentially regulated miRNAs between the nephroblastoma tissues and adjacent non-neoplastic renal tissues were screened based on microarray analysis. The miR-200c-3p expression in nephroblastoma tissues and cells was detected by qRT-PCR. Then, the effects of miR-200c-3p mimic or inhibitor on cell proliferation, invasion, and migration were evaluated by CCK-8 assay, plate colony formation assay, soft agar assay, Transwell, and wound-healing assay in SK-NEP-1 and G401 cells. Afterward, the target gene of miR-200c-3p was predicted by TarBase, miRTarBase, miRDB softwares, and then verified by dual-luciferase reporter gene assay. The in vivo effects of miR-200c-3p on pathological changes and tumor volume were investigated in tumor xenograft mice by H&E staining and in vivo fluorescence imaging. ChIP assay was used to evaluate the relationship between histone acetyltransferase E1A-binding protein p300 (EP300) and P27, and the relationship of the role of miR-200c-3p in nephroblastoma and the AKT/FOXO1/p27 signaling pathways was evaluated by western blotting. Our study shows that miR-200c-3p was downregulated in nephroblastoma tissues and cells, and EP300 was a target gene of miR-200c-3p. Furthermore, miR-200c-3p mimic decreased cell proliferation and inhibited cell migration and invasion in nephroblastoma. Mechanistically, miR-200c-3p could inhibit p-AKT activity and enhance p-FOXO1 and p27 expression. Notably, the transcription factor P27 could bind to the EP300 promoter. This study demonstrates a new approach to treat nephroblastoma.

Implementing CT tumor volume and CT pleural thickness into future staging systems for malignant pleural mesothelioma

ObjectivesTumor thickness and tumor volume measured by computed tomography (CT) were suggested as valuable prognosticator for patients’ survival diagnosed with malignant pleural mesothelioma (MPM). The purpose was to assess the accuracy of CT scan based preoperatively measured tumor volume and thickness compared to actual tumor weight of resected MPM specimen and pathologically assessed tumor thickness, as well as an analysis of their impact on overall survival (OS).MethodsBetween 09/2013–08/2018, 74 patients were treated with induction chemotherapy followed by (extended) pleurectomy/decortication ((E)PD). In 53 patients, correlations were made between CT-measured volume and -tumor thickness (cTV and cTT) and actual tumor weight (pTW) based on the available values. Further cTV and pT/IMIG stage were correlated using Pearson correlation. Overall survival (OS) was calculated with Kaplan Meier analysis and tested with log rank test. For correlation with OS Kaplan-Meier curves were made and log rank test was performed for all measurements dichotomized at the median.ResultsMedian pathological tumor volume (pTV) and pTW were 530 ml [130 ml – 1000 ml] and 485 mg [95 g – 982 g] respectively. Median (IQR) cTV was 77.2 ml (35.0–238.0), median cTT was 9.0 mm (6.2–13.7). Significant association was found between cTV and pTV (R = 0.47, p < 0.001) and between cTT and IMIG stage (p = 0,001) at univariate analysis. Multivariate regression analysis revealed, that only cTV correlates with pTV. Median follow-up time was 36.3 months with 30 patients dead at the time of the analysis. Median OS was 23.7 months. 1-year and 3-year survival were 90 and 26% respectively and only the cTV remained statistically associated with OS.ConclusionPreoperatively assessed CT tumor volume and actual tumor volume showed a significant correlation. CT tumor volume may predict pathological tumor volume as a reflection of tumor burden, which supports the integration of CT tumor volume into future staging systems.

Pathologic tumor volume predicting survival outcomes of patients with local advanced glottic carcinoma

Objective:The aim of this study was to evaluate the predicting role of tumor volume as evaluated by postoperative pathologic examination on overall survival（OS） and disease free survival（DFS） in patients with local advanced glottic carcinoma. Methods:In this study, the records of 406 consecutive patients with local advanced glottic carcinoma（T3-T4 stages） who underwent surgery ± chemoradiotherapy from January 2005 to December 2010 were retrospectively reviewed and followed up. The demographic characteristics, disease staging, and pathologic tumor volume were analyzed. The optimal cutoff values of tumor volume for OS and DFS were obtained by using receiver operating characteristic（ROC） curves. The association of tumor volume with T stages were assessed by using Logistic regression model, and the relationship between tumor volume and OS and DFS rates were evaluated by using Cox regression models. Results:The 5-and 10-year OS rates were 62.9% and 55.4%, respectively. The 5-and 10-year DFS rates were 55.5% and 50.8%, respectively. The mean tumor volume was（5.1±6.7） cm³, T4 stage patients had higher tumor volume than those of patients with T3 stage（P<0.001）. The factor of tumor volume was correlated with T stages by using Logistic regression analyses（OR=13.81, 95%CI: 6.03-31.59, P<0.001）. The optimal cutoff values of tumor volume that were both at 3 cm³ for OS and DFS rates were obtained by using ROC curve plots. The OS and DFS rates of glottic carcinoma patients with tumor volume ≤ 3 cm³ were better when compared with those of patients with tumor volume>3 cm³（P<0.001）. Upon multivariate analyses, tumor volume was strongly correlated with poorer OS and DFS rates and remained independent prognostic factors for both the OS and DFS of patients with glottic carcinoma（OS: HR=1.59, 95%CI: 1.09-2.32, P＝0.017; DFS: HR=1.54, 95%CI: 1.08-2.20, P=0.016）. Conclusion:This study demonstrates that tumor volume is correlated with T stages, and this factor is an independent predictive factor of survival outcomes in patients with local advanced glottic carcinoma.

Testicular ultrasound underestimates the size of small testicular masses: a radiologic-pathologic correlation study.

Increasing use and resolution of testicular ultrasound imaging has resulted in a greater diagnosis of non-palpable small testicular masses and subsequent over-treatment with orchiectomy. Our aim was to determine the diagnostic accuracy of testicular ultrasound to accurately determine the pathologic size of small testicular masses (SMTMs) and to evaluate the association of various measurements with benign pathology. Retrospectively, an institutional testicular cancer database was reviewed to evaluate the patients who underwent an orchiectomy for a testicular mass seen on ultrasound from 2003 to 2017. Three-dimensional measurements were compared from the ultrasound and pathology specimens, including other measures such as tumor volume and percentage of testicular volume. Finally, the predictive accuracy of maximum diameter and tumor volume to predict benign pathology was evaluated using receiver-operating curve analysis. We identified 208 patients and showed that ultrasound significantly underestimated sub-centimeter testicular masses (mean difference 0.56cm, 95%CI 0.89-0.14, p = 0.004) and testicular masses between 1 and < 2cm (mean difference 0.50cm, 95%CI 0.97-0.15, p = 0.009). Tumor volume measured on ultrasound was consistently similar to pathologic tumor volume across all sizes and was significantly correlated (Spearman's Rho = 0.81). Mass volume had a greater predictive accuracy for benign pathology than maximum diameter using a 1cm cut-off (AUC 0.65 vs 0.60). Using the maximal diameter, testicular ultrasound significantly miscalculated the pathologic dimensions of masses less than 2cm compared to orchiectomy specimens. Volumetric measurements may better represent actual tumor sizes for SMTMs and may be a more useful measure for identifying those a higher risk for benign pathology, however, further studies are required.

Tumor Volume Can Be Used as a Parameter Indicating the Severity of Disease in Parathyroid Cancer

ObjectiveTo determine whether tumor volume and tumor size are related to disease severity in parathyroid cancer (PC). MethodsPatients treated for PC at our institution were retrospectively identified. Data were collected about clinical and pathologic characteristics, laboratory parameters, tumor volume, recurrence, metastasis, and mortality. Correlation analysis was applied to laboratory parameters, tumor volume, and tumor size in PC patients. ResultsThe study included 20 patients diagnosed with PC at our center. The median follow-up was 33 months. Serum calcium (median, 12.5 mg/dL), serum parathormone (PTH) (median, 743 pg/mL), and serum alkaline phosphatase (ALP) (median, 298 U/L) levels were found to be increased, and 25-hydroxyvitamin D (25[0H)D) (median, 12.3 ng/mL) and serum phosphorus (median, 2.1 mg/dL) levels were decreased. Magnesium level was within normal limits (median, 1.9 mg/dL). The median tumor volume was 5.7 mL and median tumor size was 2.5 cm. Significant positive correlations were found between tumor volume and calcium, ALP, and PTH levels. A significant negative correlation was found between tumor volume and 25(OH)D level. There were no significant correlations between tumor size and calcium, ALP, PTH, and 25(OH)D. ConclusionThese results found that the tumor volume affected PTH, calcium, ALP, and 25(OH)D levels. The morbidity and mortality associated with PC were usually associated with PTH secretion and hypercalcemia. Therefore, tumor volume may be a more effective parameter than tumor size when evaluating the severity of disease.

Histopathological basis of prostate cancer conspicuity on multiparametric magnetic resonance imaging: A systematic review and meta-analysis

Background / Introduction: Prostate cancer detection by multiparametric magnetic resonance imaging (mpMRI) is associated with high pathological grade and tumour volume, however, it is likely that other features influence conspicuity. The objective of this review was to synthesise literature describing the histopathological basis of cancer conspicuity on mpMRI.

Correlation of Pathological Complete Response With Tumor Volume Reduction During Neoadjuvant Chemoradiotherapy in Lung Cancer.

We retrospectively investigated the relationship between pathological complete response (pCR) and tumor volume (TV) reduction during neoadjuvant chemoradiation therapy (NACRT) in non-small cell lung cancer (NSCLC). We evaluated patients who received NACRT (50 Gy/25 fractions with platinum-doublet) plus surgery for NSCLC. TVs before and during NACRT (TVbefore and TVduring, respectively) were measured based on the sums of the volumes of primary tumors and clinically positive lymph nodes. Relative change in TV was computed as % (TVduring - TVbefore)/TVbefore Results: In total, 31 patients were analyzed. The median of the relative change in TV was - 49% and ranged from -83 to -10%. Postoperatively, pCR was achieved in 11 patients (35%). In multivariate analysis, the relative change in TV was found to be an independent predictor of pCR (p=0.003). TV reduction during NACRT appears to be associated with pCR in NSCLC.

Postoperative Biochemical Failure in Patients With PI-RADS Category 4 or 5 Prostate Cancers: Risk Stratification According to Zonal Location of an Index Lesion

OBJECTIVE. The objective of our study was to assess postoperative biochemical failure in patients with prostate cancer according to zonal location of an index lesion classified as Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) category 4 or 5. MATERIALS AND METHODS. Consecutive patients (n = 232) with prostate cancer who had PI-RADSv2 category 4 or 5 lesions on MRI and who underwent radical prostatectomy were retrospectively evaluated. We investigated clinical (prostate-specific antigen density), MRI (PI-RADSv2 category of index lesion and zonal location, assessed as peripheral zone [PZ] or transition zone [TZ], of index lesion), and pathologic (tumor volume, tumor grade, and presence of extraprostatic extension) parameters. We analyzed Kaplan-Meier survival curves and the Cox proportional hazards model to assess 2-year biochemical failure-free survival and identify significant parameters associated with postoperative biochemical failure RESULTS. Biochemical failure occurred in 14.2% of patients (33/232). Two-year biochemical failure-free survival of patients with a PI-RADSv2 category 4 or 5 index lesion was 81.3%. For all patients, 2-year biochemical failure-free survival was different according to PI-RADSv2 category (category 4, 86.4%; category 5, 74.5%; p = 0.021) or zonal location (PZ, 75.3%; TZ, 96.8%; p = 0.003). Two-year biochemical failure-free survival in patients with category 4 lesions was similar in patients with PZ lesions (83.1%) and those with TZ lesions (100.0%) (p = 0.072), whereas it was different in patients with category 5 lesions (PZ, 62.0%; TZ, 95.0%; p = 0.002). In multivariate analysis, only zonal location of an index lesion on MRI was associated with biochemical failure (hazard ratio = 0.155; p = 0.012). CONCLUSION. Zonal location of an index lesion on MRI may be a useful imaging bio-marker to predict postoperative biochemical failure.

Molecular subtypes of invasive breast cancer: correlation between PET/computed tomography and MRI findings

The aim of the study was to investigate the diagnostic value of fluorodeoxyglucose-18 (FDG)-PET/computed tomography (CT) and MRI parameters in determining the molecular subtypes of invasive breast cancer. Data from 55 primary invasive breast cancer masses in 51 female patients who underwent pre-treatment PET/CT and MRI scans, and histopathological diagnosis at the authors' center were retrospectively reviewed. The relationship between FDG-PET/CT and MRI parameters, including maximum and mean standard uptake values (SUVmax and SUVmean, respectively), mean metabolic index (MImean) and metabolic tumor volume (MTV) values obtained from FDG-PET, and shape, margin, internal contrast-enhancement characteristics, kinetic curve types, functional tumor volume (FTV), apparent diffusion coefficient (ADC) values obtained from MRI was evaluated. Subsequently, differences among molecular subtypes (i.e. luminal A, luminal B, c-erbB-2 positive, and triple-negative) in terms of PET/CT and MRI parameters were evaluated. The luminal B subtype of invasive breast cancer had higher SUVmax and SUVmean (P = 0.002 and P = 0.017, respectively) values than the luminal A subtype. In addition, the triple-negative subtype had a higher SUVmax (P = 0.028) than the luminal A subtype. There was a statistically significant positive correlation between pathological tumor volume (PTV) and SUVmean (P = 0.019, r = 0.720). SUVmax and ADC were negatively correlated (P = 0.001; r = -0.384). A very strong positive correlation was detected between MTV and FTV (P = 0.000; r = 0.857), and between MTV and PTV (P = 0.006, r = 0.796), and between FTV and PTV (P = 0.006, r = 0.921). Results of the present study suggest that SUVmax was superior to MRI findings in predicting molecular subtypes and that MRI was superior to PET/CT in predicting PTV.

MP62-05 IMPACT OF INTRA-DUCTAL CARCINOMA ON CLINICAL OUTCOMES IN MEN WITH PROSTATE CANCER: SYSTEMATIC REVIEW AND META-ANALYSIS

You have accessJournal of UrologyProstate Cancer: Staging I (MP62)1 Apr 2020MP62-05 IMPACT OF INTRA-DUCTAL CARCINOMA ON CLINICAL OUTCOMES IN MEN WITH PROSTATE CANCER: SYSTEMATIC REVIEW AND META-ANALYSIS Jatinder Kumar*, Shiva Gautam, Daniel Norez, Muhhamad Alam, Karthik Tanneru, Soroush Bazargani, Syed Behzaad Jazayeri, Hariharan Palayapalayam Ganapathi, Mark Bandyk, Joseph Costa, Shahriar Koochekpour, and KC Balaji Jatinder Kumar*Jatinder Kumar* More articles by this author , Shiva GautamShiva Gautam More articles by this author , Daniel NorezDaniel Norez More articles by this author , Muhhamad AlamMuhhamad Alam More articles by this author , Karthik TanneruKarthik Tanneru More articles by this author , Soroush BazarganiSoroush Bazargani More articles by this author , Syed Behzaad JazayeriSyed Behzaad Jazayeri More articles by this author , Hariharan Palayapalayam GanapathiHariharan Palayapalayam Ganapathi More articles by this author , Mark BandykMark Bandyk More articles by this author , Joseph CostaJoseph Costa More articles by this author , Shahriar KoochekpourShahriar Koochekpour More articles by this author , and KC BalajiKC Balaji More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000937.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intra-ductal carcinoma of the prostate (IDC-P) is an aggressive variant of prostate cancer (PC) that is associated with characteristic molecular and genetic features with the incidence of approximately 20%. The available studies have shown that identification of IDC-P in PC tissue to be an independent variable in the prediction of pathological stage, tumor volume, Gleason score, and treatment failure. The effect of IDC-P on clinical outcomes is yet to be clarified. We carried out a systematic review and meta-analysis of clinical outcomes in patients with IDC-P. METHODS: A meta-analysis by fixed-effect model was conducted using 12 studies reporting hazard ratio (HR) and meeting our selection criteria, which included the patient population, intervention, outcome, study design approach, and selected endpoints. In men with PC with or without IDC-P; we compared castration-resistant free survival (CFS) and overall survival (OS) for metastatic-PC with IDC-P (Group 1), biochemical recurrence free (BRF) and/or cancer-specific survival (CSS). Patients were analyzed in two groups; with localized-PC and IDC-P undergoing radical prostatectomy (Group 2a) or radiotherapy (Group 2b). RESULTS: Patients with metastatic-PC and IDC-P (Group 1), the pooled HR for CFS and OS were 1.69 (95% Confidence Interval (CI): 1.30-2.21) and 2.00 (95% CI: 1.38-2.91), respectively. In group 2a, BRF and CSS, patients with IDC-P had high HR 2.63 (95% CI: 1.99-3.49) and 2.87 (95% CI: 1.65-5.01), respectively. Likewise, IDC-P in group 2b patients demonstrated a HR of 2.04 (95% CI: 1.10-3.78) for BRFS. CONCLUSIONS: Patients with IDC-P demonstrated poorer outcomes including lower BRF following radical prostatectomy, radiation therapy either in primary and salvage settings than in the patients without IDC-P. In addition, metastatic-PC patients with IDC-P had shorter time to progression to castration-resistance and poor OS as compared with localized PC. Our analysis and review of the literature suggest that IDC-P may be used as prognostic and predictive morphological evidence to influence clinical management in men with PC including pelvic lymph node dissection and pelvic radiotherapy. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e947-e947 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jatinder Kumar* More articles by this author Shiva Gautam More articles by this author Daniel Norez More articles by this author Muhhamad Alam More articles by this author Karthik Tanneru More articles by this author Soroush Bazargani More articles by this author Syed Behzaad Jazayeri More articles by this author Hariharan Palayapalayam Ganapathi More articles by this author Mark Bandyk More articles by this author Joseph Costa More articles by this author Shahriar Koochekpour More articles by this author KC Balaji More articles by this author Expand All Advertisement PDF downloadLoading ...

Correlation Between mpMRI Staging and Final Surgical Pathology in Prostate Cancer

Purpose: We evaluated the role of multiparametric magnetic resonance imaging (mpMRI) in the diagnosis of prostate cancer and predicting of surgical staging of prostate cancer.&#x0D; &#x0D; Materials and Methods: The study was done in 110 subjects who got mpMRI before radical prostatectomy in our hospital from 2016 to 2019. Preoperative mpMRI findings of 110 were compared to surgical pathology results following radical Prostatectomy. A comparison was made between pathologic staging of prostate cancer and the mpMRI findings.&#x0D; &#x0D; Results: pathologic evaluation confirmed prostate cancer foci (237) were recognized in 110 subjects. Generally, mpMRI sensitivity of 46.4% was found for prostate cancer detection (110/237). Pathological tumor volume was a significant predictor of prostate cancer detection using mpMRI. In 33% of the cases, the pathologic staging is precisely similar to mpMRI and in 43%of the cases, there was a slight difference between the pathologic staging and staging by mpMRI but the cancer was confined to the prostate.in 24% of the cases, there was a significant difference between the pathologic staging and staging by mpMRI. The mpMRI was not able to identify the significant cancer in 24% of the cases.&#x0D; &#x0D; Conclusion: The preoperative mpMRI was useful in detecting prostate cancer and in predicting surgical staging. However, the detection of 24% of clinically significant cancer was missed using mpMRI. As we move toward personalized medicine, use of MRI to biopsy each man&amp;#39;s prostate differently rather than based on a pre-defined 12 core seems to be supported in the recent literature.

Abstract P2-16-26: Mixed invasive ductal and lobular carcinoma (IDC/L) behaves similarly to invasive lobular carcinoma (ILC) with regard to neoadjuvant chemotherapy response and metastatic dissemination

Abstract Mixed invasive ductal and lobular carcinoma (Mixed IDC/L) is a rare subtype (3-5%) of invasive breast cancer with elusive pathophysiology. This entity is characterized by a mixed population of both ductal and lobular components within an individual tumor. Few studies have been published to date which compare Mixed IDC/L to invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) from a histopathologic perspective. Available literature on this topic is sparse and has been conflicting with regards to outcomes, and no studies to date describe the response of Mixed IDC/L to neoadjuvant chemotherapy. Patients with ILC have been shown to have lower response rates to neoadjuvant chemotherapy as compared to patients with IDC, which in turn leads to lower rates of successful breast conserving surgery and higher rates of re-excision due to positive margins. We aimed to compare Mixed IDC/L to pure ILC with regards to response to neoadjuvant chemotherapy and the need for repeat surgical intervention. We identified 26 patients with Mixed IDC/L and 113 patients with ILC who received neoadjuvant chemotherapy at our institution between 1990 – 2017. At baseline, the groups had a similar median age, as well as ER H-score, PR H-score, and Ki-67 index. There was no statistical difference in rates of pathologic complete response (pCR) or percent tumor volume reduction post therapy between the two groups. Similarly, the percent of patients that required re-excision was not statistically different. Interestingly, the metastatic pattern was similar between the groups and included sites of dissemination such as the peritoneal cavity and omentum, which are not common sites of metastasis for IDC. These findings suggest that Mixed IDC/L tumors behave similarly to ILC with regard to their response to neoadjuvant chemotherapy and patterns of metastatic spread. These findings support a prominent role for the lobular component in this mixed subtype in driving biology, including response to neoadjuvant therapy and metastatic dissemination. Ongoing efforts are directed towards incorporating data from the IDC cohort, as well as evaluation of changes in histology, ER/PR H-scores, and Ki-67 levels as a result of therapy. These data may imply that Mixed IDC/L tumors may behave clinically more like ILC than IDC, but larger studies are needed to study this rare breast cancer subtype. Citation Format: Azadeh Nasrazadani, Jennifer M Atkinson, Yujia Li, Priscilla F McAuliffe, Rachel C Jankowitz, Leisha A Emens, George C Tseng, Adrian V Lee, Norman Wolmark, Steffi Oesterreich, Peter C Lucas. Mixed invasive ductal and lobular carcinoma (IDC/L) behaves similarly to invasive lobular carcinoma (ILC) with regard to neoadjuvant chemotherapy response and metastatic dissemination [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-16-26.

Post-therapy pathologic tumor volume predicts survival in gastric cancer patients who underwent neoadjuvant chemotherapy and gastrectomy

BackgroundTo demonstrate that post-therapy pathological tumor volume (ypTV) should be considered as an independent prognostic factor in advanced gastric cancer (GC) patients who underwent neoadjuvant chemotherapy (NAC) and gastrectomy.MethodsA total of 253 GC patients who received gastrectomy between January 2010 and December 2016 in our hospital were enrolled in this study. Clinicopathologic factors were evaluated using univariable and multivariable analysis. ypTV was calculated using π* (tumor diameter/2)2 *tumor invasion depth (cm3).ResultsCut-point survival analysis demonstrated that the appropriate cut-offs for ypTV were 3, 6, 10, and 19 (cm3). Patients with tumor volumes of 0–3.0, 3.1–6.0, 6.1–10.0, 10.1–19.0, ≥19.1 cm3 were defined as ypTV1, 2, 3, 4a and 4b. Using multivariable analysis, the tumor volume (ypTV stage, P < 0.05), ypN stage (P < 0.05), response to NAC (P < 0.05), vascular invasion (P < 0.05) and ypTvNM staging (P < 0.05) were independent prognostic factors. Kaplan-Meier analysis demonstrated that the 8th AJCC/UICC ypTNM staging was not a significant predictor for survival (P > 0.05); however, our newly defined ypTvNM staging was a significant predictor for survival (P < 0.05).ConclusionsypTV should be considered as an independent prognostic factor for GC patients after NAC. ypTvNM staging should be recommended to improve the accuracy of prognostic prediction for GC patients who received NAC plus gastrectomy.

Tumor Volume Index as a Prognostic Factor in Patients after Curative Esophageal Cancer Resection

The tumor, node, metastasis classification system for staging esophageal cancer does not include tumor volume although it may be an important prognostic factor. We evaluated the prognostic value of tumor volume in esophageal cancer. We performed a retrospective study in patients with histologically confirmed primary esophageal cancer who underwent curative esophagectomy at our facility between April 1992 and December 2013. The Tumor Depth Parameter (TDP) was defined as mucosa = 1, submucosa = 2, muscularis propria = 3, adventitia = 4, and invasion into adjacent organs = 5. The pathological Tumor Volume Index (TVI) was defined as the major axis × the minor axis × TDP. The appropriate tumor diameter and TVI cutoff values were determined by the Youden index obtained from the receiver operating characteristic curve. Prognostic factors for overall survival were evaluated by univariate analysis and Cox proportional hazards regression models. We enrolled 302 patients. In the univariate analysis, patient age and sex, thoracoscopic surgery, tumor depth of invasion and diameter, lymph node metastasis, and the TVI were significantly associated with overall survival. In our multivariate analysis, patient age and sex, thoracoscopic surgery, lymph node metastasis, and the TVI were independently associated with overall survival. The pathological TVI was an independent prognostic factor in patients with esophageal carcinoma and could be included in the staging system of esophageal cancer.

Smaller Prostate Volume is Associated with Adverse Pathological Features and Biochemical Recurrence after Radical Prostatectomy

Introduction: The relationship between prostate cancer (PCa) and benign prostatic hyperplasia is unclear. Reduction in androgenicity and lower intraprostatic growth factor concentrations in smaller prostates may serve a more ideal environment for the development of aggressive tumors. We determined if prostate volume was associated with adverse pathological features, tumor volume, and biochemical recurrence (BCR) in men undergoing radical prostatectomy (RP) for PCa. Materials and Methods: We retrospectively identified 192 men who underwent RP at our institution for PCa from 2010 to 2016 years. Prostate volume was based on RP specimen weight, and cumulative tumor volume was calculated. Means were compared with one-way ANOVA test and proportions with Chi-square analysis. Multivariate logistic regression was performed to determine independent predictors of BCR after RP. Results: Patients with prostate volume &gt;60 g were less likely to have high-risk PCa (Gleason grade group &gt;4) (7.1% vs. 13.4%; P = 0.042), node-positive disease (7.1% vs. 13.4%, P = 0.042), and BCR (10.7% vs. 25.0%, P = 0.002) after surgery. Linear regression showed an inverse relationship between prostate and tumor volume (R = 0.267; P &lt; 0.05). On multivariate logistic regression, prostate volume &gt;30 g (odds ratio [OR]: 0.21, 95% confidence interval [CI]: 0.09–0.88; P = 0.015) and &gt;60 g (OR: 0.14, 95% CI: 0.03–0.74; P = 0.002) were independent predictors of reduced BCR at mean follow-up of 24 months.Conclusions: Smaller prostate volume was associated with adverse pathological features, increased tumor volume, higher incidence of pathological node-positive disease, and increased rates of BCR. Prostate volume should be considered as a prognostic feature when counseling patients with both elevated prostate-specific antigen and newly diagnosed PCa.

Predictors of biochemical recurrence after Retzius-sparing robot-assisted radical prostatectomy: Analysis of 359 cases with a median follow-up period of 26months.

Our aim was to evaluate the predictors of biochemical recurrence after Retzius-sparing robot-assisted radical prostatectomy. The study cohort consisted of 359 consecutive non-metastatic prostate cancer patients who underwent Retzius-sparing robot-assisted radical prostatectomy between November 2012 and January 2016. According to the National Comprehensive Cancer Network prostate cancer risk classification, 164 patients (45.7%) had high- or very high-risk prostate cancer. No patient received adjuvant therapy until documented biochemical recurrence. Biochemical recurrence-free survival was estimated using the Kaplan-Meier method. Univariable and multivariable Cox proportional hazards regression models were used to determine variables predictive of biochemical recurrence. The median follow-up period was 26months (interquartile range 19-38months). The overall biochemical recurrence rate was 14.8%, and the median time to biochemical recurrence was 11months (interquartile range 6-22months). The 3-year biochemical recurrence-free survival probability was 71.2%, 72.1%, 88.7%, 82.3% and 95.7% in very high-, high-, intermediate-, low- and very low-risk prostate cancer, respectively (log-rank, P<0.001). On multivariable analysis, preoperative prostate-specific antigen (hazard ratio 1.03, 95% confidence interval 1.02-1.04; P<0.0001), percentage of maximum core involvement on biopsy (hazard ratio 1.02, 95% confidence interval 1.01-1.03; P=0.029) and clinical stage ≥T3a (hazard ratio 2.12, 95% confidence interval 1.02-4.39; P=0.043) were predictors of biochemical recurrence, whereas pathological Gleason score ≥8 (hazard ratio 5.63, 95% confidence interval 1.62-19.61; P=0.007) and pathological tumor volume (hazard ratio 1.08, 95% confidence interval 1.04-1.20; P<0.001) were the main pathological predictors of biochemical recurrence. Retzius-sparing robot-assisted radical prostatectomy confers effective biochemical recurrence control at the mid-term follow-up period. Preoperative prostate-specific antigen, advanced clinical stage and higher Gleason score were important predictors of biochemical recurrence after Retzius-sparing robot-assisted radical prostatectomy. Long-term oncological safety still needs to be established.

Diagnostic performance of diffusion-weighted imaging for prostate cancer: Peripheral zone versus transition zone.

ObjectivesDiffusion-weighted imaging (DWI) has been shown to be an important component of multiparametric magnetic resonance imaging (mpMRI). We compared performance of DWI for detection of prostate cancer (PCa) in peripheral zone (PZ) and transition zone (TZ) of prostate.Materials and methodsWe reviewed data of 460 subjects who underwent preoperative 3.0-Tesla mpMRI and subsequently radical prostatectomy. Level of suspicion for PCa was graded using 5-grade Likert-scale from DWI. Topographic analyses were performed for location of tumor foci at each surgical specimen. Among those with DWI grade ≥ III, we analyzed concordance rate on the location of radiologic and pathologic index lesions between DWI and surgical specimens.ResultsAmong 460 patients, 351 (76.3%) patients showed suspicious DWI lesions (57.5% in PZ, 42.5% in TZ). Multivariates regression analyses revealed significant associations between high DWI grade and adverse pathologic outcomes including pathologic stage, Gleason score, tumor volume and extracapsular extension (all p < 0.05). Overall concordance rates between DWI and surgical specimen were 75.8%, significantly higher in PZ than TZ (82.2% vs. 67.1% p = 0.002). Such concordance rate showed a positive linear association with increase in DWI grading (p < 0.001). Among 109 patients with DWI grade I-II, 28 (25.7%) harbored high grade disease (pathologic Gleason score ≥ 4 + 3).ConclusionsDWI detects tumors in PZ of prostate more accurately than those in TZ. Such accuracy of DWI was shown to be more evident with higher DWI grade. Meanwhile, a negative DWI did not guarantee absence of high grade PCa.