Stage Discrepancy Research Articles

The Influence of Clinical and Pathological Stage Discrepancy on Cancer Specific Survival in Patients Treated for Renal Cell Carcinoma

We compared clinical and pathological staging in a contemporary, consecutive series of patients treated with partial or radical nephrectomy for renal cell carcinoma and we determined the effect of clinical and pathological stage discrepancy on outcomes. We collected retrospective clinical, pathological and survival data on 264 consecutive patients with clinical T1-3 renal cell carcinoma who were treated with laparoscopic or open partial or radical nephrectomy at a single institution from 1994 to 2003. Pathological up staging occurred in 44 of 264 patients (17%) patients. Of 135 clinical T1 tumors 25 (18.5%) and 18 of 85 (21.2%) clinical T2 tumors were pathologically up staged. Patients with clinical T1 and T2 tumors were stratified into 2 groups, including those with the same clinical and pathological stage, and those with pathological up staging. Mean 5-year recurrence-free survival +/- SD for same stage vs pathologically up staged clinical T1 (84.3% +/- 4.4% vs 47.4% +/- 11.5%) and clinical T2 (80.0% +/- 6.8% vs 40.7% +/- 13.4%) tumors was significantly different (p < 0.0002). Five-year cancer specific survival for same stage vs pathologically up staged clinical T1 tumors was significantly different (98.5% +/- 1.5% vs 69.7% +/- 11.3%, p = 0.0005), while that for clinical T2 tumors approached clinical significance (90.9% +/- 5.0% vs 72.7% +/- 13.4%, p = 0.0501). Stage discrepancy is common in surgically treated patients diagnosed with renal masses and it has a significant impact on clinical outcome. Implications of such clinical and pathological stage discrepancy should be considered when counseling patients and determining therapeutic approaches.

Discrepancy between Clinical and Pathologic Stage: Impact on Prognosis after Radical Cystectomy

ObjectivesWe compared clinical and pathologic staging in a large, contemporary, consecutive series of patients who were treated with radical cystectomy and pelvic lymphadenectomy, and determined the effect of stage discrepancy on outcomes. MethodsWe collected retrospective data from 778 consecutive patients with bladder transitional cell carcinoma who were treated with radical cystectomy and pelvic lymphadenectomy, and for whom the clinical and pathologic stage were available. ResultsPathologic upstaging occurred in 42% of patients, and pathologic downstaging occurred in 22%. Forty percent of patients with non-muscle-invasive clinical stage had muscle-invasive pathologic stage. Thirty-six percent of patients with organ-confined clinical stage had non-organ-confined pathologic stage (≥pT3N0 or pTanyN-positive). Patients with higher clinical stage were more likely to be upstaged to non-organ-confined disease (p<0.001). Patients were stratified into three groups: pathologically upstaged, same clinical and pathologic stage, and pathologically downstaged. When adjusted for the effects of standard postoperative features, upstaged patients were at a significantly higher risk of disease recurrence and bladder cancer-specific death than patients who had the same pathologic and clinical stage, who in turn were at significantly higher risk than downstaged patients. This observation remained true within each clinical stage strata. Within each pathologic stage strata, clinical stage did not substratify into different risk groups. ConclusionsClinical to pathologic stage discrepancy is a relatively common finding after extirpative surgery for bladder cancer. Clinical outcomes after radical cystectomy are largely driven by pathologic stage. Better clinical staging is necessary to improve patient evaluation and management.

Two-Phase Transport Model for the Pyrolysis Process of a Vertical Wood Cylinder, Including the Surrounding Flow Field

This paper describes a mathematical model for the pyrolysis of a small dry pine wood cylinder. The computational domain is axisymmetric and involves the heating chamber, with the wood cylinder vertically situated in the centre of the chamber. The model simulates the laminar flow around the particle and the laminar flow inside the wood/char matrix by applying a two-phase transport model where the solid wood/char matrix acts as one phase and the various gases produced from the pyrolysis process is assembled in the other phase. Convective, conductive and thermal radiation transfer modes are included in the model. A two-step pyrolysis reaction scheme is used for the modelling of the conversion from wood to tar and gas. Both the thermal conductivity and the permeability of the wood/char matrix are modelled anisotropically in order to capture the directional differences in heat and mass transport, existing in real wood. Results from simulations are compared with measurements from literature for the centre core solid temperature and the conversion from wood to char, tar and pyrolysis gas in the particle during heating. The results show very good agreement with the measured temperature profile. The simulated conversion profile shows an overall good agreement with the measurements, however with discrepancies in the early stage of the process. Besides the successful validation with the experimental data, it provides us with all the details of the distribution of the migrating pyrolysis gas and tar, the temperature, the velocity flow field and pressure in the wood/char cylinder.

Management of clinical T1 bladder transitional cell carcinoma by radical cystectomy

High-grade bladder cancer involving the lamina propria is considered superficial disease. This spectrum is generally treated with TUR plus intravesical therapy. However, significant understaging jeopardizes long-term survival and improvements and radical surgery represents a provocative alternative. We evaluated disease-free and cancer-specific survival (CSS) in our cohort of patients with high-grade T1 tumors. A total of 318 patients with bladder cancer underwent radical cystectomy between 1990 and 2000 at our institution. Of these, 66 had cT1 tumors with or without Carcinoma in-situ (CIS). Our multidisciplinary bladder cancer database was queried to perform a multivariate analysis on clinical parameters such as: age, race, sex, cystectomy year, intravesical therapy, angiolymphatic-invasion and tumor upstage in relation to recurrence and survival. The clinical stage was accurate in 44 of the cases (66%). However, 27% were upstaged by cystectomy and 12% of the cT1 + CIS patients had nodal disease. Patients with cT1 tumors plus CIS had a significantly worse CSS. Those with persistent disease after an initial course of BCG therapy appeared to have worse CSS also. At a median follow up of 4 years, overall cancer-specific mortality was 22%, however, pathologic T1 ± CIS had 92% CSS at 10 years. Our data suggests that some cT1 bladder cancer tumors have assiduous clinical courses evidenced in staging discrepancies. For high-grade tumors, early cystectomy and orthotopic diversion increases life expectancy significantly and should be carry out early rather than late.

Treatment of Natural Geometry in Finite Volume River Flow Computations

A method is proposed for the treatment of irregular bathymetry in one-dimensional finite volume computations of open-channel flow. The strategy adopted is based on a reformulation of the Saint-Venant equations. In contrast with the usual treatment of topography effects as source terms, the method accounts for slope and nonprismaticity by modifying the momentum flux. This makes it possible to precisely balance the hydrostatic pressure contributions associated with variations in valley geometry. The characteristic method is applied to the revised equations, yielding topographic corrections to the numerical fluxes of an upwind scheme. Further adaptations endow the scheme with an ability to capture transcritical sections and wetting fronts in channels of abrupt topography. To test the approach, the scheme is first applied to idealized benchmark problems. The method is then used to route a severe flood through a complex river system: the Tanshui in Northern Taiwan. Computational results compare favorably with gauge records. Discrepancies in water stage represent no more than a fraction of the magnitude of typical bathymetry variations.

Xid mice reveal the interplay of homeostasis and Bruton's tyrosine kinase-mediated selection at multiple stages of B cell development

Human X-linked agammaglobulinemia (XLA) and murine X-linked immune defect (XID) are both immunodeficiencies mediated by mutations in Bruton's tyrosine kinase (Btk), yet the developmental stage(s) affected remain controversial. To further refine the placement of the XID defect(s), we used bromodeoxyuridine labeling to determine turnover, production and transition rates of developing B cell subsets in normal, xid and xid mice expressing a human Bcl-2 transgene (xid/bcl-2). We find the xid mutation manifest at two stages of B cell development. The first is early, reducing pre-B cell production by restricting pro-B to pre-B cell transit. Surprisingly, this impairment is offset by increased survival of cells progressing from the pre- to immature B cell pool, suggesting that Btk-independent homeostatic mechanisms act to maintain this compartment. The second point of action is late, substantially reducing mature B cell production. Together, these findings reconcile apparent discrepancies in the developmental stage affected by the murine versus human lesions and suggest previously unappreciated homeostatic processes that act at the pre-B to immature B cell transition. Finally, Btk likely functions differently at these two checkpoints, since ectopic Bcl-2 expression fails to directly complement the early xid lesion, yet reverses the defect impeding final B cell maturation.

Langenskiöld classification of tibia vara: an assessment of interobserver variability.

Six pediatric orthopaedic specialists and six senior orthopaedic residents independently classified 60 radiographs of infantile tibia vara according to the six-stage Langenskiöld classification. Correlation coefficients and percentage agreement were similar in both groups. Interobserver agreement was good for early and late stages, but was poor for intermediate stages. We caution clinicians that small but frequent discrepancies in radiographic staging impart a dubious prognostic value to the Langenskiöld classification.

Histologic grade and lymph node metastasis in squamous cell carcinoma of the cervix

One hundred fifty-nine patients with squamous cell carcinoma of the cervix who underwent laparotomy were evaluated with regard to histologic grade, clinical stage, and surgical stage. Pelvic and/or paraaortic node metastases were also studied. Patients with poorly differentiated tumors, regardless of clinical stage, demonstrated pelvic and/or paraaortic nodal metastases more frequently than patients with better differentiated tumors. In patients with poorly differentiated tumors, staging discrepancies were more common. These findings suggest that histologic grading should be taken into consideration in the treatment planning of patients with cervical carcinoma.