Prognostic Staging System Research Articles

The prognostic and predictive value of the 8th American Joint Committee on Cancer (AJCC) staging system among early breast cancer patients aged

This study respectively analyzed the prognostic value and the role in treatment decision-making [breast-conserving surgery (BCS) + radiotherapy (RT) or mastectomy (MAST)] of the 8th American Joint Committee on Cancer (AJCC) pathological prognostic staging system compared with the 7th AJCC anatomical staging system among early breast cancer patients aged <50 years. Patients with T1-2N0M0 breast cancer aged <50 years were extracted from the Surveillance, Epidemiology, and End Results database between 2010 and 2014. Breast cancer-specific survival (BCSS) was used as the primary endpoint. Chi-squared test, receiver operating characteristics analysis, Kaplan-Meier method, and multivariate Cox proportional models were used to conduct statistical analysis. A total of 22,640 female patients were identified, and 24.4% of them reallocated to new stage groups from the 7th to the 8th AJCC staging. Among them, 46.2% (n=10,450) and 53.8% (n=12,190) of patients received BCS + RT and MAST, respectively. The 8th AJCC staging system was an independent prognostic factor for BCSS. Patients treated with BCS + RT had better BCSS compared to those treated with MAST (P<0.001). According to the 8th AJCC staging, BCS + RT could improve 5-year BCSS compared with MAST in patients with stage IA (P=0.006) and stage IB (P=0.001) diseases, while comparable BCSS was found between the two treatment arms in patients' stage IIA disease (P=0.366). Multivariate analyses replicated similar findings after stratification by the 8th AJCC stages. In patients with T1-2N0 breast cancer and aged <50 years, the 8th AJCC pathological staging system provides accurate prognostic information than the 7th anatomical staging. BCS + RT is the optimal local management for stage IA and IB diseases, while it is the optional management in stage IIA disease according to the 8th AJCC staging.

Prognostic and Predictive Value of the American Joint Committee on Cancer Pathological Prognostic Staging System in Nodal Micrometastatic Breast Cancer.

IntroductionTo investigate the prognostic and predictive effect of the American Joint Committee on Cancer (AJCC) 8th edition pathological prognostic staging system in patients with T1-2N1micM0 breast cancer who underwent mastectomy.MethodsData from T1-2N1micM0 breast cancer patients who underwent mastectomy from 2010–2014 were obtained from the Surveillance, Epidemiology, and End Results program. The chi-square test, binomial logistics regression, receiver-operating characteristics curve, competing-risk regression model, Cox proportional hazards regression model, and proportional hazard assumption were used for statistical analyses.ResultsWe identified 4,729 patients, including 1,062 patients were received postmastectomy radiotherapy (PMRT). Stage change occurred in 88.2% of the patients, of which 84.4% were downstaged and 3.7% were upstaged. Patients with higher pathological prognostic stages were independently predicted to receive PMRT. The 5-year breast cancer-specific survival (BCSS) was 97.5, 93.7, 90.1, 86.0, and 73.5% in disease stages IA, IB, IIA, IIB, and IIIA, respectively, according to the 8th edition criteria (P < 0.001). The AJCC 8th edition demonstrated moderate discriminative ability, and it had a significantly better ability to predict the BCSS than the AJCC 7th edition criteria (P < 0.001). The multivariate prognostic analysis showed that the new pathological prognostic staging was an independent prognostic factor affecting the BCSS. The BCSS worsened with an increase in the stage. The PMRT did not affect the BCSS regardless of the pathological prognostic stage. Similar trends were found using the competing-risks regression model.ConclusionsThe 8th AJCC breast cancer pathological prognostic staging system downstaged 84.4% of patients with T1-2N1micM0 disease and the survival outcome prediction with this staging system was more accurate than the AJCC 7th edition system. Our study does not support using the prognostic stage as a guideline to escalate of PMRT.

Molecular profile of pancreatic neuroendocrine neoplasms (PanNENs): Opportunities for personalized therapies.

Pancreatic neuroendocrine neoplasms (panNENs) are the second most common epithelial tumors of the pancreas. Despite improvements in prognostic grading and staging systems, it remains a challenge to predict the clinical behavior of panNENs and the response to specific therapies given the high degree of heterogeneity of these tumors. Most panNENs are nonfunctional and present as advanced disease. However, systemic therapies provide modest benefits. Therefore, there is a need for predictive biomarkers to develop personalized treatment and to advance new drug development. The somatostatin receptors remain the only clinically established prognostic and predictive biomarkers in panNENs. Oncogenic drivers are at a very low frequency. Commonly mutated genes in panNENs include MEN1, chromatin remodeling genes (DAXX and ATRX), and mammalian target of rapamycin pathway genes. In contrast, poorly differentiated neuroendocrine carcinomas (panNECs), which carry a very poor prognosis, have distinctive mutations in certain genes (eg, RB1 and p53). Ongoing research to integrate epigenomics will provide tremendous opportunities to improve current understanding of the clinical heterogeneity of pancreatic neuroendocrine tumors and provide invaluable insight into the biology of these tumors, new drug development, and establishing personalized therapies.

Derivation and Validation of a Novel Lipid Metabolism Level-Based Prognostic Scoring System, Enbc Score, for Newly Diagnosed Mature T and NK Cell Lymphoma

Introduction:The current prognostic scoring systems for mature T and NK cell lymphomas are still insufficient in predicting the outcomes of patients. It is urgently needed to identify novel predictors and develop a more accurate risk stratification system. Lipid metabolism accounts for a significant proportion in the tumor energy metabolism and even occupies a dominant position in non-glycolysis-dependent tumors. Dyslipidemia has been confirmed to be related to inferior outcomes of patients with solid tumors and several hematological malignancies. Nevertheless, there has been none prognostic scoring system containing lipid metabolism-related indicator reported at present. Thus, we aimed to investigate the association between lipid metabolism level and clinical outcomes, and further develop a novel lipid-based prognostic model in patients with newly-diagnosed mature T and NK cell lymphomas. Methods:The study was performed retrospectively in Shandong Provincial Hospital. The patients were divided to the training cohort (from January 2006 to December 2016) and the prospective validation cohort (from January 2017 to June 2020). The inclusion criteria contain: (1) pathologically confirmed; (2) newly diagnosed; (3) with complete clinical and follow-up data; (4) without previous malignancies. The basic data comparison of the two cohorts was performed by Studentttest or Mann-Whitney U test for continuous variables and the chi-square test or Fisher's exact test for categorical data. Univariate analysis and multivariate Cox regression analysis were performed to detect independent predictors and generate a novel prognostic staging system. The efficiency and accuracy of the new scoring system were assessed in two cohorts from different aspects, including time-dependent receiver operating characteristic curves, Brier score and decision curve analysis. Results:We developed EnBC score from a retrospective 115-patient training cohort using a multivariate Cox regression model and tested it in a prospective 58-patient validation cohort. The score was calculated by the extranodal involved sites, β2-microglobulin and serum total cholesterol (Table 1). EnBC score divided patients into four risk grades, low risk (0 point), low-intermediate risk (1 point), intermediate-high risk (2 points), high risk (3 points) (Table 2). Kaplan-Meier curves proved that patients in four risk grades presented significantly distinct long-term prognoses (median OS, NA vs. NA vs. 14.0 vs. 4.0 months, P&amp;lt;0.0001; median PFS, 84.0 vs. 19.0 vs. 8.0 vs. 1.5 months, P&amp;lt;0.0001) (Figure 1). Therewith, we examined the efficiency and accuracy of EnBC score in the training and validation cohort, respectively. Its predictive discrimination capacity, as determined by the area under the time-dependent receiver operating characteristic curves, was greater than that of the present commonly used scoring systems (AUCs of OS, EnBC 0.885-0.963 vs. IPI 0.785-0.873 vs. PIT 0.781-0.845; AUCs of PFS, EnBC 0.832-0.922 vs. IPI 0.781-0.842 vs. PIT 0.761-0.799). The Brier score, as an indicator of predictive calibrating performance, was also better or similar to the other models (OS, EnBC 0.146-0.181 vs. IPI 0.155-0.203 vs. PIT 0.167-0.209; PFS, EnBC 0.164-0.189 vs. IPI 0.159-0.183 vs. PIT 0.168-0.190). In addition, the decision curve analysis also proved that EnBC score possessed larger net benefits than IPI and PIT in the entire patient population (Figure 2). Conclusion:We verified for the first time that abnormal serum lipid metabolism level was significantly associated with the prognosis of patients with mature T and NK cell lymphoma. Furthermore, we developed a novel lipid-based EnBC score and proved that this score was more accurate and effective in predicting the prognoses of treat-naïve de novo mature T and NK cell lymphoma patients than other staging systems. This study provided novel evidences for precise prognostic stratification and individualized therapy of mature T and NK cell lymphoma patients. Disclosures No relevant conflicts of interest to declare.

Survival Analysis and Prognostic Factors in Prostate Cancer Patients: A Single Center Experience in Eastern Anatolia

Objective: Prostate cancer (PC), one of the most common malignancies of the urogenital tract, is more common in older men and shows significant prognostic differences among individuals. In recent years, new grade groups and American Joint Committee on Cancer (AJCC) stage groups have been used to predict prognosis. However, there is limited information on the prognostic significance of this new system in PC patients in Turkey. In this study, we aimed to evaluate the follow-up results of patients with diagnosis of PC, and the clinical significance of the new prognostic staging system in this patient population in Eastern Anatolia Region.&#x0D; Methods: Retrospectively, 141 PC patients being followed up in Erzurum Ataturk University of Medical Oncology Department were included in this study. The relationships between overall survival (OS) and progression free survival (PFS) and clinical-pathological parameters were analysed using Kaplan-Meier curves and compared with the log-rank test. Univariate and multivariate analysis were used to determine the prognostic significance of clinical and pathologic variables for PFS and OS.&#x0D; Results: The median age of patients was 69 and the majority of them were stage IV patients (79.4%). The median value of prostate specific antigen (PSA) was 39 ng/mL and the median Gleason score was 8. The majority of the patients had PSA value of ≥ 20 ng / ml (61.7%) and Gleason grade group 5 (35.5%). The median PFS and OS values were 29 and 33 months, respectively. The 5-year survival rates were 50% for local-locoregional disease and 20% for metastatic disease. PFS and OS were longer in patients with good Eastern Cooperative Oncology Group (ECOG) performance status (0-1), early stage (I-II), undergone to surgery, having low PSA (&lt; 10 ng / ml) and low Gleason group (1-2). According to the multivariate analysis; stage, PSA and Gleason grade group were independent prognostic factors for both PFS and OS.&#x0D; Conclusion: The new grading system, PSA and AJCC staging system are independent prognostic factors in patients with PC. Considering that patients in our region have shorter life spans compared to the world, these prognostic factors should be used more effectively in daily practice in determination of treatment strategy.

A Mathematical Model to Predict Diagnostic Periods for Secondary Distant Metastases in Patients with ER/PR/HER2/Ki-67 Subtypes of Breast Cancer

Previously, a consolidated mathematical model of primary tumor (PT) growth and secondary distant metastasis (sdMTS) growth in breast cancer (BC) (CoMPaS) was presented. The aim was to detect the diagnostic periods for visible sdMTS via CoMPaS in patients with different subtypes ER/PR/HER2/Ki-67 (Estrogen Receptor/Progesterone Receptor/Human Epidermal growth factor Receptor 2/Ki-67 marker) of breast cancer. CoMPaS is based on an exponential growth model and complementing formulas, and the model corresponds to the tumor-node-metastasis (TNM) staging system and BC subtypes (ER/PR/HER2/Ki-67). The CoMPaS model reflects (1) the subtypes of BC, such as ER/PR/HER2/Ki-67, and (2) the growth processes of the PT and sdMTSs in BC patients without or with lymph node metastases (MTSs) in accordance with the eighth edition American Joint Committee on Cancer prognostic staging system for breast cancer. CoMPaS correctly describes the growth of the PT in the ER/PR/HER2/Ki-67 subtypes of BC patients and helps to calculate the different diagnostic periods, depending on the tumor volume doubling time of sdMTS, when sdMTSs might appear. CoMPaS and the corresponding software tool can help (1) to start the early treatment of small sdMTSs in BC patients with different tumor subtypes (ER/PR/HER2/Ki-67), and (2) to consider the patient almost healthy if sdMTSs do not appear during the different diagnostic periods.

Real-world data on the survival outcome of patients with newly diagnosed Waldenström macroglobulinemia.

Background/AimsWaldenström macroglobulinemia (WM) is a rare lymphoproliferative disorder that usually follows an indolent clinical course. However, some patients show an aggressive clinical course leading to death. We explored the risk factors predicting poor prognosis in WM patients.MethodsWe retrospectively analyzed 47 patients diagnosed with WM between 2000 and 2018 to explore risk factors predicting poor prognosis using various clinical and laboratory parameters and risk models including the International Prognostic Staging System for WM (IPSS-WM).ResultsOver a median follow-up duration of 80.4 months, 29 patients died. The main causes of death were disease progression, organ failure related to amyloidosis, and infection. The median overall survival (OS) was 55.1 months, and 14 patients, including three with amyloidosis, died within 2 years. Serum β2-microglobulin level higher than 4 mg/dL was significantly associated with poor OS. Accordingly, the IPSS-WM showed a significant association with poor prognosis compared with other risk models, and the low-risk group had better OS than intermediate- and high-risk groups. In the retrospective analysis using the results of targeted sequencing in two cases representing good and bad prognosis, different patterns of mutation profiles were observed, including mutations of MYD88, TP53, ARID1A, and JAK2 in a refractory case.ConclusionsSerum β2-microglobulin could be a single biomarker strongly predictive of poor survival of WM patients, and the low-risk group of the IPSS-WM risk model including serum β2-microglobulin has better prognostic value than other risk models. Mutation analysis also might provide additional information to predict high-risk patients.

Abstract 2346: Clinical manifestation, staging and prognosis of hepatocellular carcinoma in Gambian patients

Abstract INTRODUCTION: The clinical manifestations of patients with Hepatocellular carcinoma (HCC) have changed significantly in the last decades in countries that have adopted screening tests. In developing countries due to the rarity of surveillance/screening programs coupled with diagnostic challenges of HCC, most patients present late. OBJECTIVE: To evaluate the clinical manifestations, staging and prognostic factors of HCC in Gambian patients. METHODS: Patients with suspected HCC referred to the main liver clinic at the Medical Research Council were recruited from June 2011 to September 2019. The diagnostic criteria for HCC comprised of ultrasound demonstration of liver mass greater than or equal to 2 cm combined with alpha-fetoprotein (AFP) level of greater than or equal to 200 ng/ml and/or histopathological confirmation. Clinical, radiological, fibroelastrography and laboratory data were collected in all patients. Kaplan -Meier, univariate and multivariate cox regression analyses were used to assess factors related to survival in these patients. RESULTS: Five hundred and seventy three patients were recruited into the study. The mean age of HCC patient was 40 years and mostly males (81%). The most common constitutional symptoms were weight loss (84.1%), easy fatiguability (86.3%) while the most common gastrointestinal symptoms were early satiety (79.9%) and abdominal pain (81.8%). The most common signs were hepatomegaly (76.6%) and abdominal tenderness (48.1%). Multi-focal lesions were more common on ultrasound scan (63.4%) compared to single lesions, and the median fibroelastography score was 74 kpa in these patients. Hepatitis B surface Antigen (HBsAg) carriage was present in 69.6% of HCC patients with a median AFP of 4044 ng/ml. WHO performance status 1, BCLC stage C and Child-Pugh stage A were most common among this patient group. HBsAg-positive patients with HCC were mostly males, much younger, most likely to have jaundice, dark urine, abdominal tenderness, raised transaminases, haemoglobin and international normalised ratio (INR) levels and decreased platelet counts. HCC patients who were HBsAg-negative tended to be older, more likely to have weight loss, easy fatiguability, hypertension and had a much better median survival (42.5 days vs 35 days). Both prognostic staging systems had good stratification of survival. Independent factors that affect survival were abdominal pain, jaundice at the time of presentation, hyponatremia and hypoglycaemia. CONCLUSIONS: HBV is a significant factor in HCC in The Gambia. Young males who are the main work-force are disproportionately affected, are more likely to be symptomatic and have much shorter survival. In resource limited countries like The Gambia where screening programmes and therapeutic interventions are limited, the prognosis and survival of patients with HCC patients is poor, emphasizing the need for early preventative strategies. Citation Format: Sheikh Omar Bittaye, Ramou Njie, Muhammed Tekanyi, Abubacarr Kambi, Saydiba Tamba, Gibril Fatty, Yusupha Bah, Abdoulie Jatta, Lamin Sanneh, Momodou Musa Sisawo. Clinical manifestation, staging and prognosis of hepatocellular carcinoma in Gambian patients [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2346.

Validation of the revised 8th AJCC breast cancer clinical prognostic staging system: analysis of 5321 cases from a single institution.

The anatomic stage groups (ASG) have been arguably the most powerful in predicting breast cancer (BC) outcomes. Recognizing the prognostic influence of histologic grade and receptor status, the 8th AJCC mandates their incorporation into the newly established prognostic stage groups (PSG). This staging scheme was subsequently revised to provide pathological and clinical prognostic stage tables (PPSG/CPSG) due to its incapability to categorize a significant subset of BCs, with the former only used for patients having surgical resection as the initial treatment, and the latter for all patients. Given the increasingly used neoadjuvant therapy, PPSG cannot be assigned in a significant proportion of higher staged BCs. In this study, we validated the CPSG in a cohort of 5321 BCs. Compared to ASG, the application of CPSG resulted in assigning 16.1% and 27.2% of cases to a higher or a lower stage group in non-stage IV BCs, respectively. The changes were seen mostly frequently in ASG IB, followed by IIIC, IIB, IIA, IIIA, IIIB, and IA. In 7.9% of cases, the assigned CPSG changed more than one stage group from the ASG. CPSG provided an improved overall discriminating power in predicting BC-specific survival when compared to ASG. Pairwise comparison using the Cox proportional hazard model demonstrated further advantages for CPSG as the latter showed a significant difference in all categories when compared to their proximate groups, except IIA vs. IB and IIIA vs. IIIB. In contrast, a significantly different hazard was only seen when comparing IIB vs. IIA, IIIA vs. IIB, and IV vs. IIIC for ASG. Thus, the revised 8th AJCC CPSG provided a superior overall staging scheme for predicting prognostic outcomes in BC patients receiving standard of care treatment. Further validation using the available data with larger populations and longer follow-up may be needed to refine and improve this table.

A Novel Staging System to Forecast the Cancer-Specific Survival of Patients With Resected Gallbladder Cancer.

Objective: Gallbladder cancer (GBC) is one of the most aggressive malignant tumors, and there is no effective and convenient method for predicting cancer-specific survival (CSS). We aim to develop a novel nomogram staging system based on the positive lymph node ratio (pLNR) for GBC patients.Methods:A total of 1,356 patients enrolled in the study. We evaluated the prognostic value of the pLNR and built a prognostic nomogram staging system based on the pLNR in the training cohort. The concordance index and calibration plots were used to evaluate model discrimination. The predictive accuracy and clinical value of the nomograms were measured by decision curve analysis (DCA). The CSS nomogram was further validated in an internal validation cohort.Results:The pLNR was an independent prognostic factor for CSS based on Cox regression analyses. A prognostic nomogram that combined T classification, pLNR, M classification, histologic grade, live metastasis, and tumor size was formulated with a c-index of 0.763 (95% CI, 0.728–0.798), while the c-indexes for the staging system of AJCC 8th, 7th, and 6th for CSS prediction were 0.718, 0.718, and 0.717, respectively. The calibration curves showed perfect agreement. The DCA showed that the nomogram provided substantial clinical value. The nomogram (the AUCs for 1, 3, and 5 years were 0.693, 0.716, and 0.726, respectively,) showed high prognostic accuracy.Conclusion:We have developed a formulated nomogram staging system based on the pLNR that allows more accurate individualized predictions of CSS for resected GBC patients than the AJCC staging systems.

Prognostic validation and treatment decision making of the 8th edition of the American Joint Committee on Cancer pathological staging system for elderly women with early-stage breast cancer.

Purpose: To determine the prognostication and treatment decision making of the American Joint Committee on Cancer (AJCC) 8th pathological staging system in elderly women (aged ≥65 years) with T1-2N0M0 breast cancer (BC).Results: We included 67699 patients, and patients were restaged into stage IA (84.9%), IB (8.9%), and IIA (6.2%) using the 8th AJCC edition criteria. Overall, 69.4% and 30.6% of them underwent breast-conservation surgery (BCS) and mastectomy (MAST), respectively. In patients who received BCS, 30.3% of them underwent postoperative radiotherapy (RT). Patients with a higher pathological stage were more likely to receive MAST. The 5-year breast cancer-specific mortality rate was 2.2%, 6.5% and 13.7% in stage IA, IB, and IIA, respectively. Patients treated with BCS and RT had significantly lower risk of breast cancer-specific mortality compared to those treated with MAST or with BCS alone regardless of the pathological prognostic stages (P<0.001).Conclusions: The 8th AJCC pathological prognostic staging system provides accurate risk stratification and impacts the treatment decision making for elderly women with early-stage BC.Methods: We identified stage T1-2N0M0 BC patients using the Surveillance, Epidemiology, and End Results database. Statistical analyses were used binomial logistic regression, and multivariable competing risk models in the Cox model framework.

A comparative study of conventional anatomic staging with new prognostic staging of the American joint committee on cancer (AJCC) 8th edition on breast carcinoma in a tertiary Heath care centre of Puducherry

The American joint committee on cancer (AJCC) eighth edition staging system integrates clinical laboratory testing for a more comprehensive and personalized prognostic staging criteria. This study aims to revaluate the clinic pathological character of tumour and prognostic staging system. Retrospective analysis was conducted on patients with invasive breast carcinoma for the period of four years from August 2016 – July 2020, conventional anatomic staging were restaged to prognostic staging. total 77 cases 23 (29.9%) cases stage unchanged, 18 (23.4%) cases Down staged and 36 (46.7%) cases upstaged. 36.5% cases of grade II were down staged, as it is ER, PR positive and Her 2 Neu negative, 90.5% of grade III were upstaged all cases were triple negative. More sample size and survival rate estimation along with present study will provide more insight toward the changes and impact on tumour biology and predictive value of prognostic staging of 8th edition AJCC.

Prognostic value of the AJCC 8th edition staging system for Japanese patients treated with surgery followed by radiotherapy for breast cancer.

American Joint Committee on Cancer (AJCC) 8th Edition Breast Cancer Staging System, biological information in addition to anatomical information was added as a basis for prognosis evaluation, but its prognostic impact in Japanese patients treated with postoperative radiotherapy has not been discussed. To determine the applicability of the updated prognostic staging system, we evaluated the prognostic value and confirmed the effectiveness of this system in patients in whom postoperative radiotherapy was performed. Patients who were treated with postoperative radiotherapy for breast cancer in our institution between January 2011 and December 2015 were restaged by the AJCC 8th pathological prognosis staging system, and then overall survival (OS), disease-free survival (DFS) rates and hazard ratios (HR) were analyzed to compare the predictive fit of the two staging systems. Five hundred and seven patients who in whom postoperative radiotherapy was performed for breast cancer were enrolled in this study. 36.1% patients were downstaged and 5.3% patients were upstaged from the 7th to 8th editions staging system classification. Kaplan-Meier curves and HRs showed differences in OS and DFS rates between the 7th edition and 8th edition staging systems. The AJCC 8th edition prognostic stage system has a better prognostic prediction of OS and DFS than does the 7th edition anatomic stage system. Compared with the 7th edition in breast cancer, AJCC 8th edition prognostic stage system has more precise stratification and superior prognostic value, providing a more accurate reference for the choice of radiotherapy for patients with breast cancer.

A New Scoring Method for Personalized Prognostic Prediction in Patients with Combined Hepatocellular and Cholangiocarcinoma After Surgery

Background and AimCombined hepatocellular and cholangiocarcinoma (cHCC-CCA) is a rare but aggressive primary liver cancer with dismal prognosis. We aim to develop a new scoring method for personalized prognostic prediction in patients with cHCC-CCA undergoing surgical resection. MethodsBetween January 1993 and December 2015, a total of 296 Allen type C cHCC-CCA patients who had received surgical resection in Liver Cancer Institute, Zhongshan Hospital were retrospectively enrolled. A novel prognostic scoring method for cHCC-CCA (PSM-CHCC model) was established and validated. The predictive value of the new model was compared with current prognostic staging systems. ResultsThe scoring model was developed based on the independent prognostic variables identified by Cox regression model. Based on the PSM-CHCC model, patients were stratified into three prognostic subgroups according to their individual score: A (scoring 0–2), B (scoring 3–5), and C (scoring > 5). The prediction performance of the PSM-CHCC model outperformed the widely accepted TNM staging system and other staging systems in both training and validation cohorts. Subgroup analysis also verified the discrimination efficacy of the PSM-CHCC model. ConclusionsThe newly established PSM-CHCC model may facilitate prognostic stratification and clinical decision-making in patients with cHCC-CCA.

Validation of the 8th edition of the American Joint Committee on Cancer Pathological Prognostic Staging for young breast cancer patients.

Purpose: This study aimed to validate the newly proposed American Joint Committee on Cancer (AJCC) pathological prognostic staging system for young breast cancer patients (aged ≤40 years).Results: We included 12811 women in this study. Overall, 52.8% of patients in the 7th AJCC stages were restaged to the 8th AJCC pathological staging system, including 10.7% upstaged and 42.1% downstaged. The receiver operating characteristics analysis showed that the new staging system had a better role in predicting breast cancer-specific survival (BCSS) compared with 7th edition staging (P<0.001). The results of the multivariate prognostic analysis showed that the hazard ratio of BCSS increased with the 8th AJCC stages, while the 7th anatomic stages had no significant difference in BCSS.Conclusions: The novel pathological staging system could provide more accurate prognostic stratification for young women with breast cancer because of the high proportion of stage migration.Patients and Methods: Data for young breast cancer patients diagnosed between 2010 and 2014 were included from the Surveillance, Epidemiology, and End Results program. Chi-squared test, Kaplan–Meier method, receiver operating characteristics curve, and Cox proportional hazard analysis were applied to statistical analysis.

Total tumor volume as a prognostic value for survival following liver resection in patients with hepatocellular carcinoma. Retrospective cohort study.

BackgroundTotal tumor volume (TTV) can provide a simplified parameter in describing the tumor burden by incorporating the size and number of tumor nodules into one continuous variable. The aim of the study was to evaluate the prognostic value of TTV in resection of hepatocellular carcinoma (HCC).MethodsPatients who underwent liver resection for HCC between 2012 and 2017 were retrospectively analyzed. Patients were divided into a group with TTV ≤65.5 cm³ (which nearly equal to a single tumor with a diameter of 5 cm), and another group with TTV > 65.5 cm³.ResultsTwo hundred and four patients were included in this study (108 patients had TTV ≤ 65.5cm3, and 96 patients had TTV > 65.5 cm³). Ninety patients (44.1%) were within Milan and 114 patients (55.9%) were beyond Milan criteria. Eighteen patients (15.8%) of beyond Milan criteria had TTV ≤ 65.5 cm³, with a median survival of 32 months which is comparable to a median survival of patients with TTV< 65.5 cm³ (38 months, P = 0.38). TTV-based Cancer of Liver Italian Program (CLIP) score gained the highest value of likelihood ratio 114.7 and the highest Concordance-index 0.73 among other prognostic scoring and staging systems. In multivariate analysis, independent risk factors for diminished survival were serum AFP level >400 ng/ml, TTV >65.5 cm³, microvascular invasion, postoperative decompensation (all P values < 0.05).ConclusionTTV is a feasible prognostic measure to describe the tumor burden in patients with HCC. TTV-CLIP score may provide good prognostic value for resection of HCC than other staging systems.

Clinical Staging and Flowcytomteric CD38 and Zap 70 Prognostic Indicators in Sudanese Patients with Chronic Lymphocytic Leukemia

Background: The clinical course of chronic lymphocytic leukemia is highly variable. The determination of ZAP70 and CD38 is increasingly utilized as prognostic factor for chronic lymphocytic leukemia. The aim of conducting this study was to investigate the frequency of CD38 and ZAP70 expression among Sudanese Chronic lymphocytic leukemia (CLL) patients and to relate them to the Binet and Rai clinical staging systems.&#x0D; Method: A total of 93 patients (mean age; 62.29 ± 11.68, sd) were enrolled in this cross-sectional study. CD38 and ZAP70 expression levels were measured with four color flowcytometry using the cut-off values of 20% for ZAP70 and 30% for CD38 expression. Staging was assessed by using clinical examination and CBC for all patients. Data were analyzed using the Statistical Package for Social science for Windows (SPSS), version 22.&#x0D; Results: There were 93 CLL patients and the median age of the group was 63 years (36–95 years). About 71% of the patients presented with lymphadenopathy, 53.8% with splenomegaly, 73.1% with anemia, and 45.2% with thrombocytopenia. There was higher frequency of Binet stage C and Rai stage IV (62 [66.6%] patients and 34 [36.5%] patients, respectively). In addition, CD38 and ZAP70 showed higher frequency among Binet and Rai advance stages. ZAP70 and CD38 positivity were detected in 21 patients (22.6%) and 31 patients (33.3%), respectively. There was no statistically significant association between ZAP70 and CD38 and clinical staging systems (P-value &gt; 0.05).&#x0D; Conclusion: No significant association was observed between Flowcytometric (CD38 and Zap70) Prognostic Indicators and clinical staging systems.&#x0D; Keywords: chronic lymphocytic Leukemia, Flowcytometry, ZAP70, CD38, clinical staging systems

Tumor deposit serves as a prognostic marker in gastric cancer: A propensity score-matched analysis comparing survival outcomes.

BackgroundGastric cancer (GC) treatment is determined by accurate tumor staging. The value of tumor deposit (TD) in prognostic prediction staging system is not yet determined.MethodsWe retrospectively analyzed clinical information on GC patients who underwent gastrectomy at the Department of General Surgery of the Chinese PLA General Hospital from July 2014 to June 2016. Propensity score matching (PSM) was performed to reduce the possibility of selection bias according to the presence of TD.ResultsOf the 1034 GC patients, 240 (23.21%) presented with TD, which was associated with younger age and larger tumor size (all P < .05). TD‐positive patients had a worse survival than TD‐negative patients before (P < .001) and after (P = .017) matching. Multivariable analysis showed that mortality risk of patients with TD increased by 58%, 62%, 37%, and 40% in the crude (HR = 1.58, 95% CI 1.32‐1.89, P < .001), adjusted I (HR = 1.62, 95% CI 1.35‐1.94, P < .001), adjusted II (HR = 1.37, 95% CI 1.13‐1.66, P = .001), and adjusted III (HR = 1.40, 95% CI 1.16‐1.68, P < .001) models before matching. Similarly, in the PSM cohort patients with TD had worse prognosis in the crude (HR = 1.32, 95% CI 1.07‐1.63, P = .011), adjusted I (HR = 1.35, 95% CI 1.09‐1.67, P = .005), adjusted II (HR = 1.26, 95% CI 1.00‐1.58, P = .049), and adjusted III (HR = 1.33, 95% CI 1.07‐1.65, P = .010) models. TD had a similar value range between N1 and N2 stages among different models.ConclusionsAmong GC patients, TD is associated with survival and may have a role in the staging of patients.

Prognostic validation and therapeutic decision-making of the AJCC eighth pathological prognostic staging for T3N0 breast cancer after mastectomy.

BackgroundT3N0 breast cancer might be a distinct clinical and biological entity, with higher heterogeneity and presenting diverse responses to locoregional and systemic therapy. The aim of the current study was to validate the prognostic effect and assess the treatment decision‐making of the American Joint Committee on Cancer (AJCC) eighth pathological prognostic staging in T3N0 breast cancer after mastectomy.MethodsWe retrospectively included 2465 patients with stage T3N0 breast cancer who had undergone mastectomy between 2010 and 2014 using the data from Surveillance, Epidemiology, and End Results program. The primary endpoint of this study was breast cancer–specific survival (BCSS).ResultsOf the entire cohort, 76.0% of patients in the seventh AJCC staging system were restaged to the eighth AJCC pathological prognostic staging system. A total of 1431 (58.1%) and 1175 (47.7%) of them received chemotherapy and postmastectomy radiotherapy (PMRT), respectively. Pathological staging was an independent prognostic factor for BCSS. Using pathological prognostic stage IA as the reference, BCSS gradually became worse with increased hazard ratios. The 5‐years BCSS was 96.9%, 95.5%, 91.1%, 85.6%, and 75.5% in pathological prognostic stage IA, IB, IIA, IIB, and IIIA breast cancers, respectively (P < .001). In pathological prognostic stage IA, IB, and IIA breast cancers, the receipt of PMRT or chemotherapy was not correlated with better BCSS. However, PMRT was correlated with better BCSS in pathological prognostic stage IIB disease (P = .006), but not in pathological prognostic IIIA disease. Moreover, chemotherapy was correlated with better BCSS in pathological prognostic stage IIIA disease (P = .006), but not in pathological prognostic stage IIB disease.ConclusionsThe eighth AJCC pathological prognostic staging system provides more risk stratification of T3N0 breast cancers after mastectomy and might affect individualized decision‐making for chemotherapy and PMRT in this patient subset.

Abstract P5-06-23: Comparison of the AJCC eighth edition prognostic stage and anatomic stage in different histological breast cancer types and proposal of a novel score system

Abstract Background: The objective of the current study was to validate the prognostic staging system (PS) proposed in AJCC 8th edition staging manual among patients with invasive ductal carcinoma (IDC) and patients with invasive lobular carcinoma (ILC) respectively, and to compare the predictive performances of PS in both cohorts. Method: Patients diagnosed with IDC and ILC from 2010 to 2015 in the Surveillance, Epidemiology and End Results (SEER) database were retrospectively identified. Patients were restaged according to anatomic staging system (AS) and PS. Disease-specific survival (DSS) and overall survival (OS) were estimated by Kaplan-Meier method. The predictive performances of different staging systems were quantified and compared based on Harrell’s concordance index (C-index) and Akaike information criterion (AIC) calculated from Cox models. New staging score systems were established by assigning points to DSS-associated prognostic factors to improve risk stratification. Results: A total of 184,541 female patients were included in the final analyses, with 166,084 (90%) cases in the IDC cohort while 18,475 (10%) cases in the ILC cohort. Stage distribution and survival outcomes of different stages were showed in Table1. In IDC cohort, the PS (C-index, 0.8281; AIC, 110274.5) showed superiority in risk stratification compared with the AS (C-index, 0.8125; AIC, 112537.0; P&amp;lt;0.001 for C-index) with respect to DSS. In ILC cohort, the PS (C-index, 0.8281; AIC, 7124.423) was not superior to the AS (C-index, 0.8324; AIC, 7144.818; P=0.748 for C-index) in prognosis prediction with respect to DSS. Similar results were observed with respect to OS. Among three score systems specially designed for ILC patients, the score system defined by AS plus grade plus estrogen receptor and progesterone receptor (AS+GEP) allowed for better staging (C-index, 0.8085; AIC 7178.448). Detailed point assignments were listed in Table2. Conclusion: Compared with AS, the PS provided more accurate stratification for patients with IDC, but not for patients with ILC. The AS+GEP score system may fit ILC tumors better. Further investigation was needed to refine tumor staging. Table1. Distribution and survival outcomes by anatomic stages and prognostic stages in IDC cohort(N=166,084) and ILC cohort(N=18,475).StageIDC cohortILC cohortN (%)4-year DSS4-year OSN (%)4-year DSS5-year OSASIA85807(51.7)98.7195.687779(42.1)99.2395.99IB4500(2.7)97.7495.63326(1.8)98.6394.57IIA38186(23.0)95.2591.314596(24.9)97.4392.75IIB19762(11.9)91.2387.282628(14.2)96.3492.13IIIA10879(6.6)84.5381.462010(10.9)92.0587.14IIIB2831(1.7)75.3368.83202(1.1)74.6568.15IIIC4119(2.5)71.8267.22916(5.0)77.5573.94PSIA102448(61.7)98.8695.7012156(65.9)98.8095.27IB25722(15.5)95.7292.203553(19.3)95.4991.22IIA17329(10.4)91.0087.13757(4.1)95.1189.06IIB6599(4.0)86.7183.40541(2.9)91.6886.15IIIA7092(4.3)82.3078.281049(5.7)83.0177.15IIIB3431(2.1)76.0071.12313(1.7)72.3369.12IIIC3463(2.1)57.4352.3887(0.5)52.5348.09 Table 2. Univariate and multivariate analyses for factors associated with DSS and point assignment in ILC cohort.FactorUnivariate analysisMultivariate analysisModel AS+GModel AS+GEPHRPHRPHRPPointStageIA1/11/0IB1.84&amp;lt;0.0011.750.3541.870.2690IIA3.34&amp;lt;0.0013.15&amp;lt;0.0013.15&amp;lt;0.0011IIB5.31&amp;lt;0.0014.91&amp;lt;0.0015.04&amp;lt;0.0012IIIA10.74&amp;lt;0.0019.76&amp;lt;0.0019.82&amp;lt;0.0013IIIB30.16&amp;lt;0.00126.49&amp;lt;0.00123.86&amp;lt;0.0014IIIC31.41&amp;lt;0.00127.90&amp;lt;0.00126.06&amp;lt;0.0014Grade11/11/021.75&amp;lt;0.0011.43&amp;lt;0.0012.380.014134.30&amp;lt;0.0012.47&amp;lt;0.0012.06&amp;lt;0.0011ER statusPositive1/1/0Negative6.85&amp;lt;0.0012.51&amp;lt;0.0011PR statusPositive1/1/0Negative2.47&amp;lt;0.0011.75&amp;lt;0.0011HER2 statusNegative1/Positive1.270.253Abbreviations for tables: AS, anatomic staging system; PS, prognostic staging system; IDC, invasive ductal carcinoma; ILC, invasive lobular carcinoma; DSS, disease -specific survival; OS, overall survival; HR, hazard ratio; ER, estrogen receptor; PR, progesterone receptor; HER2, human epidermal growth factor receptor 2; AS+G,anatomic stage plus grade; AS+GEP, anatomic stage plus grade plus estrogen receptor plus progesterone receptor. Citation Format: Shuning Ding, Jiayi Wu, Caijin Lin, Lisa Andriani, Weilin Chen, Deyue Liu, Li Zhu. Comparison of the AJCC eighth edition prognostic stage and anatomic stage in different histological breast cancer types and proposal of a novel score system [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 P5-06-23.