Primary Tumor Size Research Articles

LBODP092 Proposal Of Indication For Completion Thyroidectomy In Follicular Thyroid Carcinoma Using TERT Promoter Mutational Status

Abstract Background Stepwise surgical approach with hemithyroidectomy and completion thyroidectomy was used to solve the dilemma of definite characterization of follicular thyroid carcinoma (FTC). However, which patients will be candidates for completion thyroidectomy has been controversial. The aim of this study is to clarify the selection criteria for completion thyroidectomy using TERT promoter mutation. Methods A total of 87 FTC patients who had information about TERT promoter mutation from August 1995 to November 2020 were investigated. The cumulative risk of initial distant metastasis, disease recurrence, and cancer-specific death according to primary tumor size in each of the WHO 2017 classifications were calculated. Results Of the 87 patients, 8 patients (9.2%) had initial distant metastasis, and 15 patients (17.2%) had persistent disease or developed structural recurrence. Threshold diameter for initial distant metastasis, disease recurrence, and cancer-specific death was 2cm in minimally invasive FTC (MI-FTC) with mutant TERT (M-TERT) and in encapsulated angioinvasive FTC (EA-FTC) with M-TERT, while in MI-FTC with wild-type TERT (WT-TERT) and EA-FTC with WT-TERT it was 4cm. Cumulative risk of initial distant metastasis, disease recurrence, and cancer-specific death according to primary tumor size in each WHO 2017 classification were significantly different only in patients with WT-TERT (P = 0. 001, P = 0. 019, and P = 0. 005, respectively). Conclusions The data suggested that 2 cm may be a critical threshold diameter for deciding completion thyroidectomy in MI-FTC with M-TERT and EA-FTC with M-TERT. TERT promoter mutational status can be a game changer for selecting candidates for completion thyroidectomy. Presentation: No date and time listed

Prognostic impact of extranodal extension (ENE) in surgically managed treatment-naive HPV-positive oropharyngeal squamous cell carcinoma with nodal metastasis

AbstractExtranodal extension (ENE) is a significant prognostic factor for human papilloma virus (HPV)-negative head and neck squamous cell carcinoma and is incorporated into AJCC 8th edition pN stage. It remains controversial whether ENE or the degree of ENE is prognostically relevant in HPV-positive oropharyngeal squamous cell carcinoma (OPSCC). A detailed clinicopathologic review was conducted in a large retrospective cohort of 232 surgically treated patients with HPV-positive OPSCC and nodal metastasis. Fifty-six patients (24%) had nodal metastasis with ENE. The median vertical extent of ENE was 2.9 mm (range 0.2–20.3 mm), and the median horizontal span of ENE was 2.5 mm (range: 0.3–14.0 mm). Comparing with patients without ENE, those with ENE were associated with a higher number of positive lymph nodes, lymphovascular invasion, perineural invasion, adjuvant chemotherapy, larger primary tumor size, and shorter follow up period. Patients with ENE had shortened overall survival (OS), disease specific survival (DSS), disease free survival (DFS), distant metastasis free survival (DMFS), and regional recurrence free survival (RRFS) on univariate survival analysis. The 5-year OS, DSS, and DFS were 95%, 97%, and 90% respectively for the group without ENE, and 64%, 71%, and 65% respectively for the group with ENE. On Multivariate survival analysis, the presence of ENE was an independent adverse prognostic factor for OS, DSS, and DFS. Additionally, major ENE defined as a vertical extent of ≥4 mm or irregular soft tissue deposit independently predicted shortened OS, DSS, and RFS. In conclusion, the presence of ENE, in particular major ENE, is an independent prognostic factor in HPV-positive OPSCC. Therefore, we propose to document the presence and extent of ENE for these tumors. Consideration may be given for AJCC 9th edition to include ENE into pN stage of HPV-positive OPSCC.

MRI- and PET-Based Assessment of Radiological and Clinical Factors Associated With Cervical Cancer Response to External Beam Radiation Therapy.

Introduction In the era of MRI-guided external beam radiation therapy (EBRT), complete radiological response (CR) is often seen in cervical cancer (CC) with 4-6 weeks of chemotherapy and EBRT. The clinical and radiological factors associated with this observation were investigated in this study. Materials and methods One hundred and twenty-four CC patients treated with concurrent chemotherapy, EBRT, and brachytherapy (BT) from January 2008 to July 2015 were retrospectively screened. Initial primary gross tumor volume (GTVINITIAL) was estimated after contouring on a planning CT scan registered with pre-EBRT PET and MRI. The maximum standardized uptake value (SUV) of GTVINITIAL from each PET scan report was collected. Spearman's rank correlation coefficient (rho) values were calculated to assess the relationships among age, tumor size, and SUV. Tumor radiological response during EBRT prior to BT was calculated by contouring the final primary gross tumor volume (GTVFINAL) using MRI obtained prior to BT. CRrates during EBRT were estimated from GTVINITIAL and GTVFINAL and compared by the level of various factors using Fisher's exact test (two-sided). Results Forty-eight patients met the inclusion criteria of the study with a median age of 50 years. The median GTVINITIAL was 82 cc. The median SUV was 14.9. A significant correlation was seen between SUV and GTVINITIAL with a larger tumor size associated with a higher SUV. CR rates were numerically higher for patients who were aged <50 years, or with >37.5 Gy radiation dose at or before the second MRI, or with GTVINITIAL <100 cc, or with no nodes involved or with stages IB or IIA. Conclusions Our study identified higher CC primary tumor CR rates during EBRT in younger patients (<50) with smaller tumors (100 cc) without nodal involvements as well as a positive correlation between PET FDG (18F-fluorodeoxyglucose)-SUV and CC primary tumor size.

Surgical efficacy and survival prediction of patients with unspecified malignant bone tumors

BackgroundThe surgical efficacy and prognostic outcomes of patients with unspecific malignant bone tumors (UMBTs) remain unclear. The study is to address: 1) What are the clinicopathological features and prognostic determinants for patients with UMBTs? 2) Can a nomogram be developed for clinicians to predict the short and long-term outcomes for individuals with UMBTs? 3) Does surgery improve outcomes for UMBT patients who received radiotherapy or chemotherapy after balancing the confounding bias?Methods400 UMBT patients were filtrated from the Surveillance, Epidemiology, and End Results database to assess the clinicopathological features, treatments, and factors affecting prognosis. The optimal cutoff values of continuous variables were identified by the x-tile software. Kaplan-Meier method and multivariate Cox proportional hazard modeling were performed to evaluate the independent prognostic factors. Nomogram was further developed by using R software with rms package. The surgical efficacy was further assessed for patients receiving radiotherapy or chemotherapy after performing propensity score matching.ResultsThe enrolled cohort included 195 (48.8%) female and 205 (51.2%) male patients. The 2- and 5-year cancer-specific survival (CSS) and overall survival (OS) rate were 58.2 ± 3.0%, 46.8 ± 3.2%, and 46.5 ± 2.6%, 34.4 ± 2.5%, respectively. Nomogram was finally developed for CSS and OS according to the identified independent factors: age, tumor extent, primary tumor surgery, tumor size, and pathology grade. For UMBT patients who received radiotherapy or chemotherapy, surgical intervention was associated with better CSS (pr = 0.003, pc = 0.002) and OS (pr = 0.035, pc = 0.002), respectively.ConclusionsNomogram was developed for individual UMBT patient to predict short and long-term CSS and OS rate, and more external patient cohorts are warranted for validation. Surgery improves outcomes for UMBT patients who received either radiotherapy or chemotherapy.

The Value of Fine Needle Aspiration Biopsy in the Pre-Operative Assessment of the Axilla in Breast Cancer Patients

This paper reviews the role of fine needle aspiration biopsy (FNAB) in assessing the axilla prior to definitive surgery or neoadjuvant therapy in breast cancer patients. The radiological criteria for biopsy are discussed and pathological techniques and pitfalls illustrated. The sensitivity and specificity of the technique and the clinical utility are addressed, with particular reference to the current controversies in the management of the axilla in the light of the American College of Surgeons Oncology Group Z0011 trial results. The low morbidity procedure of FNAB is recommended when the radiological and clinical features suggest a high yield from the abnormal axillary nodes, with consideration of core biopsy if an expected positive result is not obtained or the circumstances require tissue for ancillary studies. In conclusion, FNAB of the axilla is a highly sensitive procedure which can offer further valuable information to assist in clinical decision making. The technique is of particular value in the setting of a large primary tumour size and multiple enlarged nodes. A summary flow chart is provided to facilitate pre-operative management of the axilla and to encourage a universal approach.

Location matters: LAG3 levels are lower in renal cell carcinoma metastatic sites compared to primary tumors, and expression at metastatic sites only may have prognostic importance.

While great strides have been made in the treatment of advanced renal cell carcinoma (RCC) with the emergence of immune checkpoint inhibitors (ICIs) and VEGFR-targeting drugs, sizable proportions of patients still do not respond to upfront therapy and long-term responses only occur in a minority of patients. There is therefore a great need for the development of better predictors of response and an increased understanding of mechanisms of resistance to these therapies. Alternative immune checkpoints outside the PD-1/PD-L1 axis, such as LAG3, have been implicated as one mechanism of resistance to ICIs. These checkpoints thus represent attractive therapeutic targets, and indeed the LAG3 inhibitor relatlimab was recently approved for the treatment of metastatic melanoma in combination with anti-PD-1 therapy. LAG3 inhibitors are being evaluated for RCC as well. In this context, a better understanding of LAG3 expression patterns in RCC and how they relate to clinicopathologic features of disease and response to immunotherapy may give insight into mechanisms of resistance to PD-1 inhibitors and aid in the identification of subgroups of patients more likely to benefit from certain drug regimens. In this study, we assessed LAG3 protein levels in leukocytes in normal kidney adjacent to RCC, primary RCC tumors, and matched metastatic tumors, including large numbers of brain metastases. We found that LAG3 protein levels are on average lower at metastatic sites compared to matched primary tumors, and that the difference was more pronounced in patients with high-risk clinical characteristics, including those with larger primary tumor size, grade 4 tumors, IMDC poor-risk disease, and initial presentation with brain metastases. We further saw that the prognostic value of LAG3 levels varies depending on the tissue site queried (i.e., primary tumor versus metastases), and that relatively higher LAG3 levels at metastatic sites may predict a better response to immunotherapy and longer overall survival after the development of metastatic disease. These findings may have important implications for the design of future studies involving LAG3 or other immunotherapies in RCC.

Evaluation of relationship between maximum SUV measured on 18F-FDG PET/CT with tumor pathological types, size, lymph node metastasis and distant metastasis in non-small cell lung cancer

BackgroundLung cancer is the most commonly diagnosed cancer, of which the non-small cell lung cancer (NSCLC) accounts for approximately 80% of the newly diagnosed lung cancer. The prognosis of lung tumors depends on early and accurate staging as well as the histopathological type of the tumor. It is suggested that NSCLC with different histopathological types and primary tumor sizes can elicit variable max.SUV values on 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG) PET/CT with different lymph nodes and distant metastatic potential. In this study, we aim to evaluate the relationship between the maximum SUV measured on (18F-FDG) PET/CT with tumor pathological type, primary tumor size, lymph node metastasis, and distant metastasis in NSCLC.ResultsThis is a cross-sectional analysis of the (FDG-PET/CT) findings of 40 patients with NSCLC. Statistical analysis is used to determine correlation between max.SUV and tumor size, with each pathological type, nodal (N) staging and distant metastasis (M) staging. The primary lung tumors histopathological types were 25 (62.5%) adenocarcinomas, 12 (30%) squamous cell carcinomas and 3 (7.5%) large cell carcinomas. The max.SUV and tumor size of the squamous cell carcinoma group were significantly higher than max.SUV of adenocarcinoma and large cell cancer groups (P = 0.000009). A significant positive correlation was found between the primary tumor max.SUV and tumoral size. Neither lymph node nor distant metastases involvement was correlated with tumor max.SUV.ConclusionsThe tumor size and histologic subtype both strongly influence FDG uptake in lung cancer. Nonetheless, max.SUV cannot be regarded as a predictive of metastases or lymph node involvement.

S1066 High 1-Year Survival Rate of UnresecTable Pancreatic Cancer Size Smaller Than 4 cm in Diameter Treated With Concurrent EUS-RFA: An Average Treatment Effect on the Treated Weighted Survival Analysis

Introduction: Treatment of small primary pancreatic ductal adenocarcinoma (PDAC), unresecTable due to of blood vessel involvement or distant metastasis, relies on systemic therapy only. We hypothesized that concurrent EUS-guided radiofrequency ablation (EUS-RFA) might control the primary tumor and improve patients’ outcomes. Methods: A prospective series of unresecTable PDAC patients with primary tumor size ≤4 cm who underwent EUS-RFA using a 19-gauge RFA needle (STARmed Koyang, Korea) from Jan 2017 – Jan 2022 were compared with matched historical controls. A propensity score was calculated using tumor size, staging, age adjusted Charleston Comorbidity Index (CCI), Chemotherapy regimen received, and interactions between CCI regimen and staging. This was used to reweight observations so covariate distribution in the chemotherapy only group equalled that of the RFA group (Average Treatment effect on the Treated weights). We used the VIVA combo RF system with an energy of 50 Watts and impedance of 100 Ohms. Chemotherapy was given if the patients were deemed tolerable by oncologists. The patients were followed for at least 12 months to see the survival rates. Results: 46 patients comprised of 11 patients in EUS-RFA group and 35 patients in control group were included in the analysis. The mean (SD) age was 63 (13.5) years in the RFA group and 68 (8.1) years in control group. Characteristics of patients, along with the standard mean differences before and after weighting are show in in Table. Median weighted survival was 14 months in the RFA group versus 6.1 months in the controls. The adjusted survival probability at 6 and 12 months was 73% and 64% in the EUS-RFA group, versus 69% and 17% in the controls. The hazard ratio (HR) for death was 0.38 (95%CI 0.17 to 0.84); p=0.016 in the RFA group versus the controls. Median weighted time to progression was 6.1 in the RFA group versus 3.9 months in the controls. The adjusted progression-free survival at 6 and 12 months in the EUS-RFA group were 55% and 36%, versus 28% and 4% in the controls; the HR for progression was 0.57 (95%CI 0.36 – 1.26); p = 0.16 in the RFA group versus controls. The adverse events were only mild abdominal pain which were observed in 8.3% of total RFA operations. Conclusion: In patients PDAC with primary lesions ≤4 cm that cannot be cured by surgery, EUS-RFA combined with chemotherapy resulted in improved survival and progression free survival with minimal adverse events.Figure 1.: Treatment outcomes compared RFA group with control group Table 1. - Baseline characteristics of the enrolled patients *Data are mean (SD) or n(%) as appropriate. Percentages are rounded to 1 decimal place and may not equal 100% Characteristic Raw (unweighted) After weighting Prospective cases (n=11) Historical controls (n=35) Prospective cases (n=11) Historical controls (n=35) Standardized mean difference p-value Mean age (years) 63 (13.5) 68 (8.1) Female sex, n(%) 9 (81.8) 22 (62.9) Mean CCI score 2.91 (2.4) 2.89 (1.3) 2.91 2.94 -0.055 0.98 Tumor diameter (cm) 3.25 (0.51) 3.10 (0.58) 3.25 3.25 0.008 0.90 Regimen, n(%) None 3 (27.3) 6 (17.1) 27.3 26.3 0.022 0.96 First-line 3 (27.3) 16 (45.7) 27.3 27.0 0.005 0.99 Second-line 5 (45.5) 13 (37.1) 45.5 46.7 -0.025 0.96 Staging Stage III 6 (54.6) 24 (68.6) 54.5 56.6 0.021 0.97 Stage IV 5 (45.5) 11 (31.4) 45.5 43.4 -0.021 0.97

Role of intraoperative frozen section evaluation of sentinel lymph node in breast carcinoma

Background Breast carcinoma is the most common malignancy in women worldwide. Intraoperative frozen section of SLNs can detect metastatic disease, allowing immediate axillary dissection and avoiding the need for reoperation, at the same time it avoids unnecessary dissection of uninvolved LNs.Aim of the study 1. To evaluate the current role of frozen section in identifying patients who could benefit from it. 2. To verify the accuracy of intraoperative frozen section examination for SLNs. Materials and methods In this combined retrospective and prospective study, we reviewed the outcome for 33 female patients with breast cancer who underwent intraoperative SLN biopsy, at (Al-Shariqa laboratory) and (Ghazi Al-Hariri Hospital, Medical City) Baghdad, Iraq. and compared it with the permanent H&E sections, covering the period between Jan.2019 and Jan.2021Results: The patients age was ranging from 32 to 79 years with a mean of 50.7 years and the highest proportion was ≥ 40 years (90%). Only 10 patients (30.3%) of the total cases were diagnosed as having POSITIVE SLNs by intraoperative frozen section examination, while 23 patients (69.7%) had NEGATIVE SLNs. Nine of them (90%) were of ductal type, while only 1 case (10%) was of lobular type. all 10 cases (100%), the primary tumor size measured >2cm, (i.e: pT2). Validity of frozen section examination in comparison with permanent sections showed a sensitivity and specificity of 100%. Conclusions: Intraoperative frozen section evaluation of SLN biopsy is a reliable method, it offers a high sensitivity, specificity and diagnostic accuracy when compared with permanent section

Clinical prediction model based on 18F-FDG PET/CT plus contrast-enhanced MRI for axillary lymph node macrometastasis.

PurposePositron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI) are useful for detecting axillary lymph node (ALN) metastasis in invasive ductal breast cancer (IDC); however, there is limited clinical evidence to demonstrate the effectiveness of the combination of PET/CT plus MRI. Further axillary surgery is not recommended against ALN micrometastasis (lesion ≤2 mm) seen in sentinel lymph nodes, especially for patients who received proper adjuvant therapy. We aimed to evaluate the efficacy of a prediction model based on PET/CT plus MRI for ALN macrometastasis (lesion >2 mm) and explore the possibility of risk stratification of patients using the preoperative PET/CT plus MRI and biopsy findings.Materials and methodsWe retrospectively investigated 361 female patients (370 axillae; mean age, 56 years ± 12 [standard deviation]) who underwent surgery for primary IDC at a single center between April 2017 and March 2020. We constructed a prediction model with logistic regression. Patients were divided into low-risk and high-risk groups using a simple integer risk score, and the false negative rate for ALN macrometastasis was calculated to assess the validity. Internal validation was also achieved using a 5-fold cross-validation.ResultsThe PET/CT plus MRI model included five predictor variables: maximum standardized uptake value of primary tumor and ALN, primary tumor size, ALN cortical thickness, and histological grade. In the derivation (296 axillae) and validation (74 axillae) cohorts, 54% and 61% of patients, respectively, were classified as low-risk, with a false-negative rate of 11%. Five-fold cross-validation yielded an accuracy of 0.875.ConclusionsOur findings demonstrate the validity of the PET/CT plus MRI prediction model for ALN macrometastases. This model may aid the preoperative identification of low-risk patients for ALN macrometastasis and provide helpful information for PET/MRI interpretation.

Feline pulmonary carcinoma: Gross, histological, metastatic, and immunohistochemical aspects.

Feline pulmonary carcinoma (FPC) is an uncommon neoplasm with unique morphological features. We describe the gross, histological, metastatic, and immunohistochemical aspects of FPC, based on postmortem examinations from an 11-year retrospective study. Thirty-nine cases were selected. Predispositions were observed in senior (P < .001) and Persian (P = .039) cats. There were three gross patterns of the pulmonary tumors: (a) a large nodule and additional smaller nodules, (b) a solitary nodule, and (c) small, multifocal to coalescent nodules. Extrapulmonary metastases were present in 22/39 cases (56.4%), mainly in the regional lymph nodes (17/39, 43.5%), skeletal muscles (9/39, 23%), kidneys (6/39, 15.3%), and parietal pleura (4/39, 10.2%). The primary tumor size was correlated with the occurrence of extrapulmonary metastases (P = .002). Histologically, the tumors were classified as papillary adenocarcinoma (19/39, 48.7%), adenosquamous carcinoma (ADS) (8/39, 20.5%), acinar adenocarcinoma (6/39, 15.3%), solid adenocarcinoma (3/39, 7.6%), lepidic adenocarcinoma (2/39, 5.1%), and micropapillary adenocarcinoma (1/39, 2.5%). By immunohistochemistry, 39/39 cases (100%) were positive for pancytokeratin, 34/39 (87.1%) for thyroid transcription factor-1, and 8/39 (20.5%) for vimentin. Immunoreactivity for p40 was detected in the squamous component of all ADSs (8/8, 100%) and occasionally in the glandular component of adenocarcinomas (10/31, 32.2%). Napsin A expression was absent in all feline tissue tested. The results indicate that a modified and simplified histological classification based on current human and domestic animal systems is appropriate for cats. Additionally, this study highlights the utility of p40 as an immunohistochemical marker for the diagnosis of FPC with squamous differentiation.

A novel nomogram for decision-making assistance on exemption of axillary lymph node dissection in T1-2 breast cancer with only one sentinel lymph node metastasis.

BackgroundT1–2 breast cancer patients with only one sentinel lymph node (SLN) metastasis have an extremely low non-SLN (NSLN) metastatic rate and are favorable for axillary lymph node dissection (ALND) exemption. This study aimed to construct a nomogram-based preoperative prediction model of NSLN metastasis for such patients, thereby assisting in preoperatively selecting proper surgical procedures.MethodsA total of 729 T1–2 breast cancer patients with only one SLN metastasis undergoing sentinel lymph node biopsy and ALND were retrospectively selected from Harbin Medical University Cancer Hospital between January 2013 and December 2020, followed by random assignment into training (n=467) and validation cohorts (n=262). A nomogram-based prediction model for NSLN metastasis risk was constructed by incorporating the independent predictors of NSLN metastasis identified from multivariate logistic regression analysis in the training cohort. The performance of the nomogram was evaluated by the calibration curve and the receiver operating characteristic (ROC) curve. Finally, decision curve analysis (DCA) was used to determine the clinical utility of the nomogram.ResultsOverall, 160 (21.9%) patients had NSLN metastases. Multivariate analysis in the training cohort revealed that the number of negative SLNs (OR: 0.98), location of primary tumor (OR: 2.34), tumor size (OR: 3.15), and lymph-vascular invasion (OR: 1.61) were independent predictors of NSLN metastasis. The incorporation of four independent predictors into a nomogram-based preoperative estimation of NSLN metastasis demonstrated a satisfactory discriminative capacity, with a C-index and area under the ROC curve of 0.740 and 0.689 in the training and validation cohorts, respectively. The calibration curve showed good agreement between actual and predicted NSLN metastasis risks. Finally, DCA revealed the clinical utility of the nomogram.ConclusionThe nomogram showed a satisfactory discriminative capacity of NSLN metastasis risk in T1–2 breast cancer patients with only one SLN metastasis, and it could be used to preoperatively estimate NSLN metastasis risk, thereby facilitating in precise clinical decision-making on the selective exemption of ALND in such patients.

Horse-Shoe Flap Reconstruction Technique in Breast Surgery: From The Smallest Defect to The Biggest—A Case Series

Chest wall resections and reconstructions are routinely performed to close defects after primary breast tumor resections. Depending on the size of primary breast tumors, the reconstructive technique requires more challenging approaches. In this study, we would like to introduce a novel technique which can be applied as a method in covering various sizes of skin defects after mastectomy termed as “horse-shoe flap technique.” We conducted a series of case reports of patients who underwent chest wall coverage after primary breast tumor resections between October 2018 and November 2019 and selected five cases of breast cancer patients. These patients were treated with the horse-shoe flap technique which relies on shape as its main concept. All chest defects must form a circular shape, based on the principle that adequate safe tumor margins are best achieved with a circular incision. The donor flap was drawn and taken from the outer circle area with a larger arc, depending on the defect's diameter size. Five post-mastectomy chest wall defect cases had been successfully closed with this technique. Patients were all female, ranging from 36 to 55 years of age. The smallest chest defect was 4 cm in diameter, and the largest was 26 cm. All the defects were closed using a 120-degree horse-shoe flap design. One patient experienced marginal necrotic skin, and one case had formed postoperative seroma. The horse-shoe flap technique proves to be an excellent option for closing chest skin defects which can be applied for various sizes of skin defects with minor complications.

Characteristics and Prognostic Nomogram for Primary Lung Lepidic Adenocarcinoma.

Background Lepidic adenocarcinoma (LPA) is an infrequent subtype of invasive pulmonary adenocarcinoma (ADC). However, the clinicopathological features and prognostic factors of LPA have not been elucidated. Methods Data from the Surveillance, Epidemiology, and End Results (SEER) database of 4191 LPA patients were retrospectively analyzed and compared with non-LPA pulmonary ADC to explore the clinicopathological and prognosis features of LPA. Univariate and multivariate Cox proportional hazard models were performed to identify independent survival predictors for further nomogram development. The nomograms were validated using the concordance index, receiver operating characteristic curves, and calibration plots, as well as decision curve analysis, in both the training and validation cohorts. Results Compared with non-LPA pulmonary ADC patients, those with LPA exhibited unique clinicopathological features, including more elderly and female patients, smaller tumor size, less pleural invasion, and lower histological grade and stage. Multivariate analyses showed that age, sex, race, tumor location, primary tumor size, pleural invasion, histological grade, stage, primary tumor surgery, and chemotherapy were independently associated with overall survival (OS) and cancer-specific survival (CSS) in patients with LPA. The nomograms showed good accuracy compared with the actual observed results and demonstrated improved prognostic capacity compared with the TNM stage. Conclusions LPA is more frequently diagnosed in older people and women. LPA was inclined to be smaller in tumor size and lower in tumor grade and staging, which may indicate a favorable prognosis. The constructed nomograms accurately predict the long-term survival of LPA patients.

Lymph node ratio in lateral neck is an independent risk factor for recurrence-free survival in papillary thyroid cancer patients with positive lymph nodes.

The purpose of this study was to explore the impact of the lymph node ratio on prognosis in papillary thyroid cancer patients with lymph node metastasis. Data from papillary thyroid cancer patients with positive nodes who were initially treated at our institution during 2015-2016 were analysed. Univariate and multivariate Cox proportional hazard models were adopted to predict prognostic factors. A receiver operating characteristic (ROC) curve was used to find the best cut-off value of the lymph node ratio (LNR). Kaplan-Meier curves were used to show the relationship between the LNR in the lateral neck and recurrence-free survival. The median follow-up time was 64.6 months, and recurrence occurred in 16 of 662 patients (2.27%). Univariate analysis showed that male sex, primary tumour size (&gt;17 mm), visible extrathyroidal extension, LNR in the central neck (&gt;0.5), LNR in the lateral neck (&gt;0.10), and visible extranodal extension were significantly correlated with recurrence-free survival (RFS) (p &lt; 0.05). Multivariate analysis using the Cox proportional hazards model showed that the LNR in the lateral neck was an independent risk factor for RFS (p = 0.039; HR 14.76). The LNR in the lateral neck was an independent risk factor for recurrence-free survival. For patients with a high lymph node ratio in the lateral neck, more frequent follow-up might be needed.

Survival benefit of thermal ablation therapy for patients with stage II-III non-small cell lung cancer: A propensity-matched analysis

BackgroundThermal ablation (TA) is considered a safe alternative to surgical resection for the treatment of non-small cell lung cancer (NSCLC). While previous studies have shown that TA is beneficial for stage I NSCLC patients, however, few have reported on TA efficacy in patients with stage II-III NSCLC. The current study investigated the impact of TA on the overall survival (OS) and cancer-specific survival (CSS) of patients with stage II-III NSCLC.MethodsData on patients with stage II-III NSCLC who did not undergo surgical resection between 2004 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM), Kaplan-Meier survival curves, and Cox regression were used for statistical analyses.ResultsA total of 57,959 stage II-III NSCLC patients who did not undergo surgical resection were included in this study, 261 of whom received TA. Overall, TA was associated with a longer OS (p = 0.035) and CSS (p = 0.005) than non-ablation. After 1:3 PSM, 252 patients receiving TA and 732 patients not receiving ablation were enrolled in the matched cohort. The OS (p = 0.047) and CSS (p = 0.029) remained higher in the TA group than in the non-ablation group after PSM. Cox regression analysis showed that age, sex, primary tumor site, pathological type, tumor size, radiotherapy, chemotherapy, and thermal ablation were independently associated with OS and CSS (p <0.05). Subgroup analysis found that the advantages of TA were more pronounced among individuals ≥70 years of age, with tumor size ≤3.0 cm, or who did not receive radiotherapy.ConclusionTA could be an effective alternative treatment for stage II-III NSCLC patients unsuitable for surgical resection, particularly those ≥70 years of age, with tumor size ≤3.0 cm, or who have not received radiotherapy.

Influence of Site, Size, Depth of Invasion and Histologic Grading on the Occurrence of Cervical Level IIb Metastasis and Extranodal Extension in Clinically N0 Neck of Patients with OSCC: A Single Center Retrospective Analysis.

Depth of Invasion ≥ 4mm, T stage and primary site with more than 20% chances for occult metastasis are currently the accepted indications for elective neck dissection. Nodal metastasis decreases survival by 50%. ENE further reduces the prognosis. Dissection of level IIb lymph nodes in clinically N0 neck does not improve survival. A total of 320 patients were evaluated. Binary and multiple logistic regression and chi-square test were used for data analysis. ROC curve with Youden's J index was used to set up a cutoff value for DOI. The predictor variables were site, size, grading and depth of invasion of primary tumor. Incidence of level IIb metastasis and ENE were the outcomes. The study revealed a significant association and risk stratification between primary tumor characteristics with the occurrence of ENE. The cutoff value for DOI predicting ENE was 12.5mm. Tumors of the oral tongue were an independent risk factor for level IIb metastasis. Size of primary tumor, DOI, tumors of the mandibular alveolus and poor grading are independent risk factors for ENE. Isolated metastasis to level IIb rarely occurs in the absence of concomitant level IIa metastasis. Size, DOI and grading were significantly associated with level IIb metastasis. However, only tumors of the oral tongue were independent risk factor.

Intraoperative Radiofrequency Ablation for Contralateral Benign Nodules in Unilateral Thyroid Cancer Patients to Relieve Anxiety.

For unilateral papillary thyroid carcinoma (PTC) with contralateral benign nodules, optimal extent of surgery remains controversial. This retrospective cohort study was performed to evaluate the life quality of patients who underwent lobectomy alone and lobectomy with radiofrequency ablation (RFA). From October 2014 to October 2018, unilateral PTC patients with contralateral benign nodules reported by fine-needle aspiration cytology who encountered anxiety about contralateral nodule progression underwent lobectomy for PTC and intraoperative RFA for contralateral nodules. The patients who underwent thyroid lobectomy were matched for sex, age at time of surgery, number, size, and location of primary tumors and contralateral nodules to the patients who underwent lobectomy with intraoperative RFA. Three questionnaires were used to evaluate life quality in the two groups. The complications and rate of patients who were not required to receive thyroid-stimulating hormone suppression therapy were recorded. One hundred forty-eight patients with 194 contralateral nodules underwent RFA in the lobectomy plus RFA group, and age- and sex-matched patients underwent thyroid lobectomy alone. The mean volume reduction ratio was 67.7% at 12mo and 95.2% at 24mo. After a median follow-up of 4.2y, nine patients (6.1%) in the lobectomy plus RFA group and 17 (11.5%) in the thyroid lobectomy-alone group underwent completion thyroidectomy (P=0.100). Patients who underwent lobectomy plus RFA had a better quality of life in terms of anxiety, physiological health, social and family aspects, and psychological and sensory features that were measured cross-sectionally at 6mo using three instruments. Intraoperative RFA is effective in terms of volume reduction of contralateral nodules and improved quality of life for unilateral PTC patients with anxiety about disease progression.

Associations of CD34, Ki67, layer of invasion and clinical pathological characteristics, prognosis outcomes in gastrointestinal stromal tumors-a retrospective cohort study.

BackgroundGastrointestinal stromal tumors (GIST) is the most common interstitial tumor of the digestive tract. GIST, like other malignancies, can recur, metastasize, and even metastasize to the brain, leading to death. Therefore, the prevention and treatment of GIST is very important. The clinical features of GIST are uniquely different to those of other common malignancies. Therefore, it is of great significance to explore the relationship between the pathological features and prognosis of GIST to strengthen the prevention and treatment of GIST. The objectives of this study were to study the clinical features of Ki67, Cluster Differentiation 34 (CD34), and their correlations in the Jianghuai region of China in recent years, and to analyze their relationship with prognosis.MethodsA total of 423 cases of GIST in Northern Jiangsu People’s Hospital in Yangzhou from 2013 to 2020 were retrospectively analyzed. The data of CD34, Ki67 and layer of invasion was collected, and their associations with the clinical pathological characteristics, prognosis outcomes of GIST were studied. CD34 and Ki67 were tested by immunohistochemistry (IHC) And data was analyzed by chi-square test, t-test, Kaplan-Meier (KM) method survival curve, Log-rank test, and Cox regression.ResultsThe results showed that CD34 was associated with the clinical features of primary site, tumor size, risk, recurrence, and progression-free survival (PFS) (P<0.001, =0.01, <0.001, =0.039 and =0.018), but not with nuclear division or overall survival (OS) (P>0.05). Further, Ki67 was associated with nuclear division, tumor size, risk, recurrence, and PFS (P<0.001, <0.001, <0.001, <0.001 and <0.001), but there was no significant correlation with the primary site and CD34 (P>0.05), and Ki67 was associated with OS, but there was no statistical significance (P=0.0507). The layer of invasion was associated with the primary site, nuclear division, tumor size, risk, CD34, smooth muscle actin (SMA), recurrence, Ki67, and PFS (P<0.001, <0.001, <0.001, <0.001, <0.001, <0.001, <0.001, <0.001 and =0.0025), but not with OS (P=0.6680).ConclusionsCD34, Ki67, and layer of invasion may play important roles in the occurrence and development of GIST, affecting the prognosis of GIST.

Utilizing Computed Tomography to Analyze the Morphomic Change between Patients with Localized and Metastatic Renal Cell Carcinoma: Body Composition Varies According to Cancer Stage.

Background: This study aimed to elucidate the change of body composition in different clinical stages of renal cell carcinoma (RCC) by analyzing computed tomography (CT) images. Methods: We enrolled patients diagnosed with RCC in a tertiary medical center who did not mention body weight loss or symptoms of cachexia. We grouped patients into those with localized RCC and those with metastatic RCC. Analyses of the volume of skeletal muscles tissue (SMT), subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT) calculated based on CT images were performed and included subgroup analyses by sex and age. The correlation between tumor size and body composition in localized RCC was also examined. Results: A total of 188 patients were enrolled in this study. There was significantly lower VAT (p = 0.015) in the metastatic group than in the localized group. SAT, body weight, and body mass index (BMI) were not significantly different between these two groups. In the subgroup analysis, a significant difference in SMT and VAT was noted in the male and younger subgroups but not in the female and older subgroups. Regarding primary tumor size in localized RCC, VAT was significantly higher in patients with larger tumors (p = 0.003). Conclusions: In localized RCC, VAT volume was significantly larger in those with large primary tumor size. However, the VAT was significantly lower in those with metastatic status comparing to those with localized disease. The clinical course of cancers closely correlates with body composition.