Stratification System Research Articles

MP58-02 EVALUATION OF AMERICAN UROLOGICAL ASSOCIATION RENAL CELL CARCINOMA RISK GROUPS FOR CHROMOPHOBE RENAL CELL CARCINOMA

You have accessJournal of UrologyCME1 Apr 2023MP58-02 EVALUATION OF AMERICAN UROLOGICAL ASSOCIATION RENAL CELL CARCINOMA RISK GROUPS FOR CHROMOPHOBE RENAL CELL CARCINOMA Cameron J. Britton, Christine M. Lohse, Andrew Zganjar, John C. Cheville, R. Houston Thompson, Bradley C. Leibovich, Stephen A. Boorjian, Vidit Sharma, and Aaron M. Potretzke Cameron J. BrittonCameron J. Britton More articles by this author , Christine M. LohseChristine M. Lohse More articles by this author , Andrew ZganjarAndrew Zganjar More articles by this author , John C. ChevilleJohn C. Cheville More articles by this author , R. Houston ThompsonR. Houston Thompson More articles by this author , Bradley C. LeibovichBradley C. Leibovich More articles by this author , Stephen A. BoorjianStephen A. Boorjian More articles by this author , Vidit SharmaVidit Sharma More articles by this author , and Aaron M. PotretzkeAaron M. Potretzke More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003311.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In patients after surgery for localized renal cell carcinoma, prognostic models have been developed for progression-free (PFS) and cancer-specific survival (CSS). Notably, chromophobe RCC (chRCC) is unable to be classified by the American Urological Association (AUA) risk stratification system, as histologic grading of chRCC is not currently recommended. We sought to compare the Mayo risk stratification system (Leibovich 2018, Eur Urol) with three modified versions of the AUA RCC risk stratification system for chRCC. METHODS: We queried the Mayo Clinic Nephrectomy Registry to identify patients treated with radical or partial nephrectomy for unilateral, sporadic, M0, chRCC from 1970 to 2012. AUA risk groups were defined using reported criteria excluding grade. Modified AUA risk groups included two proposed chRCC grading systems, including the Paner grading system and the Mayo extension of the Paner grade (Avulova 2021, Eur Urol). PFS and CSS were estimated using the Kaplan-Meier method. Predictive ability was summarized using c-indexes from Cox proportional hazard regression models. RESULTS: A total of 257 patients with chRCC were identified. PFS and CSS rates at 120 months after surgery were 84% and 90%, respectively. PFS rates using AUA risk groups, ignoring grade, are summarized in Figure 1a, while PFS rates using the Mayo risk groups are presented in Figure 1b. C-indexes for AUA and Mayo risk groups were similar at 0.76 and 0.75, respectively, for PFS, and 0.77 and 0.76, respectively for CSS. Comparisons of the three modified AUA risk stratification systems with and without grading systems are presented in Table 1. CONCLUSIONS: The modified AUA and Mayo risk stratification systems have robust c-indexes for PFS and CSS in patients with chRCC. These models can be used to counsel patients based on the final pathologic analysis. Incorporation of proposed chRCC grading systems rarely results in re-stratification. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e794 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cameron J. Britton More articles by this author Christine M. Lohse More articles by this author Andrew Zganjar More articles by this author John C. Cheville More articles by this author R. Houston Thompson More articles by this author Bradley C. Leibovich More articles by this author Stephen A. Boorjian More articles by this author Vidit Sharma More articles by this author Aaron M. Potretzke More articles by this author Expand All Advertisement PDF downloadLoading ...

MP63-15 T1 SUB-STAGING IS ASSOCIATED WITH WORSE ONCOLOGICAL OUTCOMES FOR PATIENTS TREATED WITH BACILLUS CALMETTE-GUERIN OR IMMEDIATE RADICAL CYSTECTOMY.

You have accessJournal of UrologyCME1 Apr 2023MP63-15 T1 SUB-STAGING IS ASSOCIATED WITH WORSE ONCOLOGICAL OUTCOMES FOR PATIENTS TREATED WITH BACILLUS CALMETTE-GUERIN OR IMMEDIATE RADICAL CYSTECTOMY. Roberto Contieri, Wei Shen Tan, Valentina Grajales, Kelly Bree, Patrick Hensley, Charles C. Guo, Neema Navai, Colin P. Dinney, and Ashish M. Kamat Roberto ContieriRoberto Contieri More articles by this author , Wei Shen TanWei Shen Tan More articles by this author , Valentina GrajalesValentina Grajales More articles by this author , Kelly BreeKelly Bree More articles by this author , Patrick HensleyPatrick Hensley More articles by this author , Charles C. GuoCharles C. Guo More articles by this author , Neema NavaiNeema Navai More articles by this author , Colin P. DinneyColin P. Dinney More articles by this author , and Ashish M. KamatAshish M. Kamat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003321.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: T1 sub-staging has been demonstrated to be of prognostic value in patients with NMIBC treated with intravesical therapy. However, it remains underutilized and has not been included in risk group stratification systems. Herein, we sought to evaluate the prognostic value of T1 substaging in patients treated with Bacillus Calmette-Guerin (BCG) or immediate radical cystectomy (iRC). METHODS: We performed an IRB approved retrospective study analyzing NMIBC patients with pT1 disease treated with either BCG or iRC between 2000 and 2020. Lamina propria (LP) invasion characteristics were classified to either: 1) focal and/or superficial (FS), 2) extensive and/or multifocal (EM), or 3) not specified. Cox regression models, adjusted for tumor and patient characteristics, were used to predict CSS, MFS and PFS. Logistic regression model was used to predict stage >T2 at iRC. RESULTS: A total of 411 T1 HG patients were identified; focal/superficial and extensive/multifocal LP invasion was found in 147 (35.8%) and 149 (36.2%) patients, respectively. Characteristics of LP invasion were not specified in 115 (28%) cases. EM LP invasion was a predictor of both CSS (Hazard ratio (HR): 5.38, 95% CI: 1.8-16.1, p=0.003) and MFS (HR:3.60, 95% CI: 1.51-8.53, p=0.004). Overall, 303 received BCG and 108 underwent iRC. Median follow-up was 49.4 months. Patients with EM LP invasion were significantly more likely to receive iRC (34% vs. 19% p=0.003). Among patients treated with iRC, stage ≥T2 was identified in 21 (19%). T1 substaging was independently associated with upstage at RC (OR: 4.71, 95% CI: 1.06-20.8, p=0.04). Among BCG-treated patients, progression occurred in 41 (13.5%) individuals. EM LP invasion again emerged as an independent predictor of progression after BCG at MV analysis (HR: 5.07, 95% CI: 2-12.55, p<0.001). CONCLUSIONS: Patients with extensive/multifocal LP invasion have poorer CSS and MFS whether treated with BCG or iRC. T1 substaging provides valuable prognostic information and should be reported in pathology reports. Source of Funding: This research was supported by the Wayne B. Duddlesten Professorship in Cancer Research, the Raymond and Maria Floyd Bladder Cancer Research Foundation Grant, NIH/NCI UTMD Anderson SPORE in Genitourinary Cancer (p50CA091846), the Cancer Center Support Grant (NCI Grant P30 CA016672) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e877 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roberto Contieri More articles by this author Wei Shen Tan More articles by this author Valentina Grajales More articles by this author Kelly Bree More articles by this author Patrick Hensley More articles by this author Charles C. Guo More articles by this author Neema Navai More articles by this author Colin P. Dinney More articles by this author Ashish M. Kamat More articles by this author Expand All Advertisement PDF downloadLoading ...

Ultrasound-Based Risk Stratification System for the Assessment of Partially Cystic Thyroid Nodules

ObjectiveTo develop and validate a risk stratification system for the prediction of malignancy in partially cystic thyroid nodules (PCTNs). MethodsWe retrospectively reviewed the sonography data of patients with PCTNs from 2 medical centers—Hangzhou Traditional Chinese Medicine Hospital and Hangzhou First People’s Hospital—from January 2020 to December 2021. The independent risk factors for malignant PCTNs were evaluated using the univariate and multivariate logistic regression analyses. The nomogram prediction efficiency was assessed using the area under the curve and calibration curves. The decision curve analysis was used to determine the clinical value of the predictive model. ResultsA total of 285 patients were enrolled in this retrospective study, and of 301 PCTNs, 242 were benign and 59 were malignant. Younger age, hypoechoic, irregular margin, and microcalcifications were found to be the independent risk factors for malignant PCTNs. The area under the curve, sensitivity, and specificity were 0.860, 77.1%, and 84.7% in the training data set and 0.897, 91.7%, and 87.0% in the external validation data set, respectively. The total point of nomogram was >161, which showed the best to predict malignancy in PCTNs. ConclusionOur findings demonstrated that the risk stratification system for the assessment of PCTNs showed good prediction capacities.

Integrated clinicopathologic and molecular analysis of endometrial carcinoma: Prognostic impact of the new ESGO-ESTRO-ESP endometrial cancer risk classification and proposal of histopathologic algorithm for its implementation in clinical practice.

The European Society of Gynecologic Oncology/European Society of Radiation Therapy and Oncology/European Society of Pathology (ESGO/ESTRO/ESP) committee recently proposed a new risk stratification system for endometrial carcinoma (EC) patients that incorporates clinicopathologic and molecular features. The aim of the study is to compare the new ESGO/ESTRO/ESP risk classification system with the previous 2016 recommendations, evaluating the impact of molecular classification and defining a new algorithm for selecting cases for molecular analysis to assign the appropriate risk class. The cohort included 211 consecutive EC patients. Immunohistochemistry and next-generation sequencing were used to assign molecular subgroups of EC: POLE mutant (POLE), mismatch repair deficient (MMRd), p53 mutant (p53abn), and no specific molecular profile (NSMP). Immuno-molecular analysis was successful in all cases, identifying the four molecular subgroups: 7.6% POLE, 32.2% MMRd, 20.9% p53abn, and 39.3% NSMP. The recent 2020 guidelines showed a 32.7% risk group change compared with the previous 2016 classification system: the reassignment is due to POLE mutations, abnormal p53 expression, and a better definition of lymphovascular space invasion. The 2020 system assigns more patients to lower-risk groups (42.2%) than the 2016 recommendation (25.6%). Considering the 2020 risk classification system that includes the difference between "unknown molecular classification" and "known," the integration of molecular subgroups allowed 6.6% of patients to be recategorized into a different risk class. In addition, the use of the proposed algorithm based on histopathologic parameters would have resulted in a 62.6% reduction in molecular analysis, compared to applying molecular classification to all patients. Application of the new 2020 risk classification integrating clinicopathologic and molecular parameters provided more accurate identification of low-and high-risk patients, potentially allowing a more specific selection of patients for post-operative adjuvant therapy. The proposed histopathologic algorithm significantly decreases the number of tests needed and could be a promising tool for cost reduction without compromising prognostic stratification.

The sensitivity of TIRADS scoring on ultrasonography in the management of thyroid nodules.

To determine the sensitivity of ACR-TIRADS scoring by comparing its results with those obtained on biopsy of respective specimens. This prospective study including N=205 patients with thyroid nodules was conducted in ENT Department of MTI Hayatabad Medical complex, Peshawar during the period from May 1, 2019 to April 30, 2022. Preoperative ultrasonography with assigning of TIRADS scores was performed in all patients. Appropriate thyroidectomies were performed in these patients and specimen biopsied. Pre-op TIRADS scores were compared with biopsy results. To determine the sensitivity of TIRADS, TR1 and TR2 were considered 'benign' and TR3, TR4, TR5 were considered 'malignant' for comparison with biopsy results. The mean age of patients was 37.68 years with standard deviation of ±11.52. The M: F ratio was 1:3.5. Nineteen patients (9.27%) had solitary thyroid nodules & 186 (90.73%) had multinodular goiters. TIRADS scoring was benign for 171 (83.41%) and malignant for 34 (16.58%) nodules. The biopsy results revealed 180 (87.80%) nodules to benign and the rest as malignant. The sensitivity, specificity and diagnostic accuracy were calculated at 80%, 92.77% and 91.21% respectively. Chi square test and p-value determination showed that there was a strong positive concordance between TIRADS scores & biopsy results which is highly significant (p=.001). The Ultrasonographic ACR-TIRADS scoring and risk stratification system is highly sensitive for detecting malignancy in thyroid nodules. It is, therefore, a reliable technique in the initial assessment of thyroid nodules and decisions can safely be based on its results. In cases of doubt, clinical judgment should be exercised before making final decision.

The diagnostic efficacy and inappropriate biopsy rate of ACR TI-RADS and ATA guidelines for thyroid nodules in children and adolescents.

This study is aimed at evaluating the diagnostic efficacy and unnecessary fine-needle aspiration (FNA) rate of ultrasound-based risk stratification for thyroid nodules in the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) and the American Thyroid Association (ATA) risk stratification systems. Children and adolescents with pathology confirmed thyroid nodules were retrospectively included in this study. A total of 217 thyroid nodules from multicenter of Union Medical College Hospital, China Japan Friendship Hospital and Civil Aviation Hospital were included, the diagnostic efficiency and unnecessary FNA rate were calculated according to ACR and ATA guidelines. Among all thyroid nodules, 139 nodules were malignant, and 78 nodules were benign. Choosing ATA high suspicion and ACR TI-RADS TR5 as benign and malignant cut-off points, the area under the curve and sensitivity of ATA were higher than ACR (AUC: 0.887 vs 0.840, p=0.0037; sensitivity 81.3% vs 71.0%, P <0.049;specificity 96.2% vs 97.4%, p=1.000;specificity both 85.9%); choosing high/intermediate suspicion in ATA and ACR TR4/5 as benign and malignant cut-off points, the two guidelines demonstrated similar diagnostic efficacy (AUC:0.890 vs 0.897, p=0.6038, sensitivity 92.1% vs 93.5%, P =0.817;specificity both 85.9%, p=1.000). The inappropriate FNA rate of ACR guideline was relatively lower (ATA 42.9% vs ACR 27.2%, P <0.001). If ACR TI-RADS TR5 nodules less than 1.0cm were included in the FNA indication, the unnecessary biopsy rate would be further reduced to 17.9%. This study indicated that both ATA and ACR TI-RADS risk stratification systems could provide a feasible differential diagnosis of benign and malignant thyroid nodules, while the ACR risk stratification system demonstrates a lower rate of inappropriate FNA rate. In addition, it was necessary to further study the minimum FNA threshold of thyroid nodules in Children and adolescents in order to reduce the missed biopsy rate of malignant nodules.

Diagnostic Performance of Six Ultrasound Risk Stratification Systems for Thyroid Nodules: A Systematic Review and Network Meta-Analysis.

BACKGROUND. Risk stratification systems for evaluating thyroid nodules on ultrasound use varying approaches to classify levels of suspicion for malignancy, leading to variable performance. OBJECTIVE. The purpose of this study was to perform a network meta-analysis comparing six risk stratification systems used to evaluate thyroid nodules on ultrasound in terms of their diagnostic performance for the detection of thyroid cancer. EVIDENCE ACQUISITION. Five bibliometric databases were searched for studies published through August 31, 2022, that compared at least two of six ultrasound risk stratification systems (the American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi [AACE/ACE/AME] system; American College of Radiology Thyroid Imaging Reporting and Data System [ACR TI-RADS]; the American Thyroid Association [ATA] risk stratification system; European Thyroid Association Thyroid Imaging Reporting and Data System [EU-TIRADS]; the Korean Thyroid Imaging Reporting and Data System [K-TIRADS] endorsed by the Korean Thyroid Association and the Korean Society of Thyroid Radiology; and the Thyroid Imaging Reporting and Data System developed by Kwak et al. [Kwak TIRADS]) in terms of their diagnostic performance for the detection of thyroid cancer, with cytologic or histologic evaluation used as a reference standard. The studies' risk of bias was evaluated using the Newcastle-Ottawa Scale. A meta-analysis of each system was performed to identify the risk category threshold that had the highest accuracy as well as the highest sensitivity and specificity at this threshold. Network meta-analysis was used to perform hierarchic ranking and identify the systems having the highest sensitivities and specificities at each system's most accurate threshold. EVIDENCE SYNTHESIS. The analysis included 39 studies with 49,661 patients. All studies were of fair (n = 17) or good (n = 22) quality. The most accurate risk category thresholds were class 3 (high risk) for the AACE/ACE/AME system, TR5 (highly suspicious) for ACR TI-RADS, EU-TIRADS 5 (high risk) for EU-TIRADS, 4c (moderate concern but not classic for malignancy) for Kwak TIRADS, K-TIRADS 5 (high suspicion) for K-TIRADS, and high suspicion for the ATA system. At these thresholds, the systems had sensitivity of 64-77% and specificity of 82-90%. Network meta-analysis identified the highest sensitivity and highest specificity for ACR TI-RADS, followed by K-TIRADS. CONCLUSION. Of six risk stratification systems, ACR TI-RADS had the highest diagnostic performance for the detection of thyroid nodules on ultrasound. CLINICAL IMPACT. This network meta-analysis can inform decisions regarding implementation of the risk stratification systems and can aid future system updates.

Tumor immune contexture predicts recurrence after prostatectomy and efficacy of androgen deprivation and immunotherapy in prostate cancer

BackgroundProstate cancer is one of the most common cancers in men with notable interpatient heterogeneity. Implications of the immune microenvironment in predicting the biochemical recurrence-free survival (BCRFS) after radical prostatectomy and the efficacy of systemic therapies in prostate cancer remain ambiguous.MethodsThe tumor immune contexture score (TICS) involving eight immune contexture-related signatures was developed using seven cohorts of 1120 patients treated with radical prostatectomy (training: GSE46602, GSE54460, GSE70769, and GSE94767; validation: GSE70768, DKFZ2018, and TCGA). The association between the TICS and treatment efficacy was investigated in GSE111177 (androgen deprivation therapy [ADT]) and EGAS00001004050 (ipilimumab).ResultsA high TICS was associated with prolonged BCRFS after radical prostatectomy in the training (HR = 0.32, 95% CI 0.24–0.45, P < 0.001) and the validation cohorts (HR = 0.45, 95% CI 0.32–0.62, P < 0.001). The TICS showed stable prognostic power independent of tumor stage, surgical margin, pre-treatment prostatic specific antigen (PSA), and Gleason score (multivariable HR = 0.50, 95% CI 0.39–0.63, P < 0.001). Adding the TICS into the prognostic model constructed using clinicopathological features significantly improved its 1/2/3/4/5-year area under curve (P < 0.05). A low TICS was associated with high homologous recombination deficiency scores, abnormally activated pathways concerning DNA replication, cell cycle, steroid hormone biosynthesis, and drug metabolism, and fewer tumor-infiltrating immune cells (P < 0.05). The patients with a high TICS had favorable BCRFS with ADT (HR = 0.25, 95% CI 0.06–0.99, P = 0.034) or ipilimumab monotherapy (HR = 0.23, 95% CI 0.06–0.81, P = 0.012).ConclusionsOur study delineates the associations of tumor immune contexture with molecular features, recurrence after radical prostatectomy, and the efficacy of ADT and immunotherapy. The TICS may improve the existing risk stratification systems and serve as a patient-selection tool for ADT and immunotherapy in prostate cancer.

Validation of the prognostic significance of the 2022 European LeukemiaNet risk stratification system in intensive chemotherapy treated aged 18 to 65 years patients with de novo acute myeloid leukemia.

The European LeukemiaNet (ELN) recently proposed a revised recommendation for the diagnosis and management of acute myeloid leukemia (AML) in adults, recognized as ELN-2022. However, validation in a large real-world cohort remains lacking. In this study, we aimed to validate the prognostic relevance of the ELN-2022 in a cohort of 809 de novo, non-M3, younger (ages 18-65 years) AML patients receiving standard chemotherapy. The risk categories of 106 (13.1%) patients were reclassified from that determined using ELN-2017 to that determined using ELN-2022. The ELN-2022 effectively helped distinguish patients as favorable, intermediate, and adverse risk groups in terms of remission rates and survival. Among patients who achieved first complete remission (CR1), allogeneic transplantation was beneficial for those in the intermediate risk group, but not for those in the favorable or adverse risk groups. We further refined the ELN-2022 system by re-categorizing AML patients with t(8;21)(q22;q22.1)/RUNX1::RUNX1T1 with KIThigh , JAK2 or FLT3-ITDhigh mutations into the intermediate risk subset, AML patients with t(7;11)(p15;p15)/NUP98::HOXA9 and AML patients with co-mutated DNMT3A and FLT3-ITD into the adverse risk subsets, and AML patients with complex or monosomal karyotypes, inv (3)(q21.3q26.2) or t(3;3)(q21.3;q26.2)/GATA2,MECOM(EVI1) or TP53 mutation into the very adverse risk subset. The refined ELN-2022 system performed effectively to distinguish patients as favorable, intermediate, adverse, and very adverse risk groups. In conclusion, the ELN-2022 helped distinguish younger, intensively treated patients into three groups with distinct outcomes; the proposed refinement of ELN-2022 may further improve risk stratification among AML patients. Prospective validation of the new predictive model is necessary.

Prospective study and proposal of an outcome predictive nomogram in a consecutive prospective series of differentiated thyroid cancer based on the new ATA risk categories and TNM.

The personalized management of differentiated thyroid cancer (DTC) is currently based on the postoperative TNM staging system and the ATA risk stratification system (RSS), both updated in 2018 and 2015, respectively. We aimed to evaluate the impact of the last two editions of TNM and ATA RSS in the prediction of persistent/recurrent disease in a large series of DTC patients. Our prospective study included 451 patients undergone thyroidectomy for DTC. We classified the patients according to TNM (both VIII and VII ed.) and stratified them according to the ATA RSS (both 2015 and 2009). We then evaluated the response to the initial therapy after 12-18 months according to the ATA "ongoing" risk stratification, and analyzed the variables associated with persistent/recurrent disease by multivariate analysis. The performance of the last two ATA RSSs was not significantly different. By staging patients according to the VIII or VII TNM editions, we found significant differences only in the distribution of patients with structural disease classified in stages III and IV. At multivariate analysis, only T-status and N-status were independently associated with persistent/recurrent disease. Overall, ATA RSSs and TNMs showed low predictive power in terms of persistent/recurrent disease (by Harrell's test). In our series of DTC patients, the new ATA RSS as well as the VIII TNM staging provided no additional benefit compared to the previous editions. Moreover, the VIII TNM staging system may underestimate disease severity in patients with large and numerous lymph node metastases at diagnosis.

Integrated analysis from multicentre studies identities m7G-related lncRNA-derived molecular subtypes and risk stratification systems for gastric cancer.

Gastric cancer (GC) is the fourth leading cause of cancer death worldwide. Due to the lack of effective chemotherapy methods for advanced gastric cancer and poor prognosis, the emergence of immunotherapy has brought new hope to gastric cancer. Further research is needed to improve the response rate to immunotherapy and identify the populations with potential benefits of immunotherapy. It is unclear whether m7G-related lncRNAs influence tumour immunity and the prognosis of immunotherapy. This study evaluated 29 types of immune cells and immune functions in gastric cancer patients, and m7G-related lncRNAs and their molecular subtypes were identified. In addition, we also studied the biological function characteristics of m7G-related lncRNA molecular subtypes. Finally, the patient's risk score was calculated based on m7G-related lncRNAs, and a nomogram of staging and risk groups was established to predict the prognosis. For experimental verification, RT-qPCR were preformed from the native cohort. After identifying m7G-related lncRNAs and their molecular subtypes, we found three molecular subtypes, the B subtype had the highest level of infiltration, and the B subtype may benefit more from immunotherapy. We divided GC patients into two regulator subtypes based on biological function. The two subtypes have significant immunological differences and can be used to judge ICI treatment. We established a risk score formula based on five lncRNAs, including LINC00924, LINC00944, LINC00865, LINC00702, and ZFAS1. Patients with poor prognoses were closely related to patients in the high-risk group. After comprehensive analysis of different risk groups, the efficacy of the high-risk group on bleomycin, cisplatin, docetaxel, doxorubicin and etoposide was better than that of the low-risk group, suggesting that risk subgroups based on risk scores play a guiding role in chemotherapy and that the high-risk group may benefit more from immunotherapy. RT-qPCR results showed that LINC00924, LINC00944, and LINC00865 were highly expressed in tumour tissues, while LINC00702 and ZFAS1 were expressed at low levels in tumour tissues. In conclusion, we were the first to discover that m7G-related lncRNAs play a vital role in the tumour immune microenvironment of gastric cancer, and a risk prediction model was established to identify patients with potential benefits from immunotherapy and predict the prognosis of GC patients.

O-RADS US Risk Stratification and Management System: Case-based Learning Approach for Daily Practice

HomeRadioGraphicsVol. 43, No. 3 PreviousNext UltrasoundRadioGraphics FundamentalsO-RADS US Risk Stratification and Management System: Case-based Learning Approach for Daily PracticeKalesha Hack, Lori Strachowski, Rochelle F. Andreotti, Hournaz Ghandehari, Priyanka Jha, Christopher Lim, Chirag Patel, Phyllis Glanc Kalesha Hack, Lori Strachowski, Rochelle F. Andreotti, Hournaz Ghandehari, Priyanka Jha, Christopher Lim, Chirag Patel, Phyllis Glanc Author AffiliationsFrom the Department of Medical Imaging, University of Toronto, Sunnybrook Health Sciences Centre, MG160, 2075 Bayview Ave, Toronto, ON, Canada M4N 3M5 (K.H., H.G., C.L., C.P., P.G.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (L.S., P.J.); and Department of Radiology, Vanderbilt University, Nashville, Tenn (R.F.A.).Address correspondence to P.G. (email: [email protected]).Kalesha HackLori StrachowskiRochelle F. AndreottiHournaz GhandehariPriyanka JhaChristopher LimChirag PatelPhyllis Glanc Published Online:Feb 23 2023https://doi.org/10.1148/rg.220079MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractUnderstanding the O-RADS US lexicon and how to apply it accurately can improve care in daily practice by decreasing unnecessary follow-up and surgery and promoting rapid referral to a gynecologic oncologist.Suggested ReadingsAndreotti RF, Timmerman D, Benacerraf BR, et al. Ovarian-Adnexal Reporting Lexicon for Ultrasound: A White Paper of the ACR Ovarian-Adnexal Reporting and Data System Committee. J Am Coll Radiol 2018;15(10):1415–1429 [Published correction appears in J Am Coll Radiol 2019;16(3):403–406.]. Crossref, Medline, Google ScholarAndreotti RF, Timmerman D, Strachowski LM, et al. O-RADS US risk stratification and management system: a consensus guideline from the ACR Ovarian-Adnexal Reporting and Data System Committee. Radiology 2020;294(1):168–185. Link, Google ScholarBasha MAA, Metwally MI, Gamil SA, et al. Comparison of O-RADS, GI-RADS, and IOTA simple rules regarding malignancy rate, validity, and reliability for diagnosis of adnexal masses. Eur Radiol 2021;31(2):674–684. Crossref, Medline, Google ScholarCao L, Wei M, Liu Y, et al. Validation of American College of Radiology Ovarian-Adnexal Reporting and Data System Ultrasound (O-RADS US): Analysis on 1054 adnexal masses. Gynecol Oncol 2021;162(1):107–112. Crossref, Medline, Google ScholarGiede KC, Kieser K, Dodge J, Rosen B. Who should operate on patients with ovarian cancer? An evidence-based review. Gynecol Oncol 2005;99(2):447–461. Crossref, Medline, Google ScholarGlanc P, Benacerraf B, Bourne T, et al. First international consensus report on adnexal masses: management recommendations. J Ultrasound Med 2017;36(5):849–863. Crossref, Medline, Google ScholarHack K, Gandhi N, Kahn D, Glanc P. OC03.05: External validation O-RADS ultrasound risk stratification and management system. Ultrasound Obstet Gynecol 2021;58(S1):8–9. Crossref, Google ScholarHack K, Glanc P. The Abnormal Ovary: Evolving Concepts in Diagnosis and Management. Obstet Gynecol Clin North Am 2019;46(4):607–624. Crossref, Medline, Google ScholarLevine D, Patel MD, Suh-Burgmann EJ, et al. Simple adnexal cysts: SRU consensus conference update on follow-up and reporting. Radiology 2019;293(2):359–371. Link, Google ScholarPi Y, Wilson MP, Katlariwala P, et al. Diagnostic accuracy and inter-observer reliability of the O-RADS scoring system among staff radiologists in a North American academic clinical setting. Abdom Radiol (NY) 2021;46(10):4967–4973. Crossref, Medline, Google ScholarSadowski, EA, et al. O-RADS MRI Risk Stratification System: Guide for Assessing Adnexal Lesions from the ACR O-RADS Committee. Radiology 2022;303:35–47. Link, Google ScholarStrachowski LM, Jha P, Chawla TP, et al. O-RADS for Ultrasound: A User's Guide, From the AJR Special Series on Radiology Reporting and Data Systems. AJR Am J Roentgenol 2021;216(5):1150–1165. Crossref, Medline, Google ScholarTimmerman D. Lack of standardization in gynecological ultrasonography. Ultrasound Obstet Gynecol 2000;16(5):395–398. Crossref, Medline, Google ScholarArticle HistoryReceived: Apr 8 2022Revision requested: May 16 2022Revision received: June 3 2022Accepted: June 8 2022Published online: Feb 23 2023 FiguresReferencesRelatedDetailsAccompanying This ArticleO-RADS US Risk Stratification and Management System: Case-based Learning Approach for Daily PracticeFeb 23 2023Default Digital Object SeriesRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 43, No. 3 Slide PresentationAbbreviations Abbreviations: O-RADS Ovarian-Adnexal Reporting and Data System Metrics Altmetric Score PDF download

DEFINITION criteria for left main bifurcation stenting &amp;minus; from clinical need to a formula

Percutaneous coronary intervention using drug-eluting stents for coronary bifurcation lesions is associated with higher rates of in-stent restenosis, myocardial infarction, and revascularisation as compared with non-coronary bifurcation lesions. The increased percentage of suboptimal results after stenting bifurcation lesions is largely, if not always, due to the extreme complexity of the anatomy. Obviously, one weapon (stenting technique) does not suit all enemies (bifurcation lesions with different anatomies), and it underscores the importance of establishing a stratification system.

Abstract P3-03-25: An Automated Risk Stratification System for Breast Cancer Screening using Thermalytix

Abstract Background: As opposed to conventional age-based population-level breast screening strategies, risk-stratified breast screening programs are emerging as a new approach to balanced population screening methodology where the screening frequency and choice of modality (mammography/tomosynthesis or magnetic resonance imaging) is determined based on accurate personalized estimation of an individual’s risk score. A woman identified with low risk can now be screened less frequently, avoiding repeated mammography screening where radiation risk outweighs the benefits in that particular individual. The standard questionnaire based risk stratification is found to be less reliable and imaging based risk stratification mechanisms are being explored in recent years. In this study, we evaluate the performance of a new computer-aided image analysis technique called Thermalytix that automatically generates a personalized risk score using a combination of imaging and questionnaire information for risk stratification of women. Methodology: Thermalytix is an artificial intelligence system that uses thermal imaging and questionnaire data for predicting the risk of breast cancer. Thermalytix analyzes spatio-thermal signatures and vascular patterns in the breast region along with patients’ complaints and age to generate a score called B-Score (or BHARATI Score) which ranges from 1 to 5. B-Score of 1 indicates low risk of malignancy and a B-Score of 5 indicates the highest risk of malignancy. To evaluate the effectiveness of risk stratification using B-Scores, we performed retrospective analysis of thermal and participants’ data acquired from two registered clinical studies. One study (CTRI/2017/10/0 10 115) is a multi-site study conducted in Bangalore, India, and the other study (NCT04688086) is a single site study conducted in Delhi, India. Both these study sites are geographically distant with 2000 KM apart from each other and comprise a diversified population from India. Results: In total, 717 eligible women were considered in this study with age varying from 18 years to 80 years. Reports from standard of care procedures involving mammography, ultrasound and biopsy (as needed), were collectively considered by a radiologist to determine the ground truth for malignancy. Out of 717 women, 85 women were thus concluded as malignant. When used in a blinded fashion, Thermalytix graded 275 women as B-Score 1 (lowest risk), 225 women as B-Score 2, 44 women as B-Score 3, 137 women as B-Score 4 and 36 women as B-Score 5 (highest risk). The fraction of malignancies in the cohorts corresponding to B-Score categories from 1 to 5 were found to be progressively higher (0.36%, 1.33%, 29.55%, 33.58% and 61.11%, respectively) - showing the correctness of the proposed personalized risk scoring methodology. Conclusion: Thermalytix test, a low-cost, radiation-free, contactless and privacy aware test was used as a technique to determine the breast cancer risk of a woman.. The results obtained in the study show that a high B-score of 5 indicates a high risk for malignancy with 61.11% chance of breast cancer. Likewise the lowest B-Score of 1 indicates low risk for malignancy with just 0.36% percentage of women in the cohort found with malignancy. These results combined with other experiential benefits of Thermalytix test makes it a promising risk stratification mechanism enabling differential frequency of screening while balancing the cost and risk versus benefit. Large scale studies, however, need to be conducted to see the ground benefits of the proposed approach in a screening program implementation. Distribution of study population in different risk cohorts Higher risk correlates with higher malignancy rate Citation Format: Siva Teja Kakileti, Himanshu Madhu, Richa Bansal, Akshita Singh, Sudhakar Sampangi, Bharat Aggarwal, Geetha Manjunath. An Automated Risk Stratification System for Breast Cancer Screening using Thermalytix [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-03-25.

Diagnostic Performance of Ultrasound-Based Risk Stratification Systems for Thyroid Nodules: A Systematic Review and Meta-Analysis.

This study investigated the diagnostic performance of biopsy criteria in four society ultrasonography risk stratification systems (RSSs) for thyroid nodules, including the 2021 Korean (K)-Thyroid Imaging Reporting and Data System (TIRADS). The Ovid-MEDLINE, Embase, Cochrane, and KoreaMed databases were searched and a manual search was conducted to identify original articles investigating the diagnostic performance of biopsy criteria for thyroid nodules (≥1 cm) in four widely used society RSSs. Eleven articles were included. The pooled sensitivity and specificity were 82% (95% confidence interval [CI], 74% to 87%) and 60% (95% CI, 52% to 67%) for the American College of Radiology (ACR)-TIRADS, 89% (95% CI, 85% to 93%) and 34% (95% CI, 26% to 42%) for the American Thyroid Association (ATA) system, 88% (95% CI, 81% to 92%) and 42% (95% CI, 22% to 67%) for the European (EU)-TIRADS, and 96% (95% CI, 94% to 97%) and 21% (95% CI, 17% to 25%) for the 2016 K-TIRADS. The sensitivity and specificity were 76% (95% CI, 74% to 79%) and 50% (95% CI, 49% to 52%) for the 2021 K-TIRADS1.5 (1.5-cm size cut-off for intermediate-suspicion nodules). The pooled unnecessary biopsy rates of the ACR-TIRADS, ATA system, EU-TIRADS, and 2016 K-TIRADS were 41% (95% CI, 32% to 49%), 65% (95% CI, 56% to 74%), 68% (95% CI, 60% to 75%), and 79% (95% CI, 74% to 83%), respectively. The unnecessary biopsy rate was 50% (95% CI, 47% to 53%) for the 2021 K-TIRADS1.5. The unnecessary biopsy rate of the 2021 K-TIRADS1.5 was substantially lower than that of the 2016 K-TIRADS and comparable to that of the ACR-TIRADS. The 2021 K-TIRADS may help reduce potential harm due to unnecessary biopsies.

Prognostic nomogram for estimating survival in patients with resected muscle-invasive bladder cancer receiving chemotherapy.

Chemotherapy has been proven to bring survival benefit in patients with resected muscle-invasive bladder cancer (MIBC), which is increasingly recommended. Our objective was to establish an effective model for estimating the overall survival (OS) and cancer-specific survival (CSS) in these patients. 2,030 patients diagnosed with resected MIBC receiving chemotherapy were acquired from the Surveillance, Epidemiology, and End Result (SEER) database, which were randomized 7:3 into a primary set (1,421 patients) and an internal validation set (609 patients). Significant predictors for OS and CSS were identified by Cox regression models, which were then utilized to develop prognostic nomogram. The performance of the model was assessed by utilizing calibration, area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA). Six independent prognostic factors, including age, race, histology, T stage, N stage and regional nodes examined, made up the nomogram. The AUCs of the primary cohort was 0.751 and 0.753 for 3- and 5- year OS and 0.751 and 0.754 for 3-and 5- year CSS, respectively. The calibration plots proved the nomograms' satisfactory discrimination. The results of DCA manifested that our models had an excellent clinical applicability. In addition, a risk stratification system was established according to the nomogram' risk score. Obvious difference was found in different groups (P < 0.001). The established prediction nomogram provides a simple-to-use tool for estimating the survival probability of resected MIBC patients treated with chemotherapy, which can assist clinicians make individualized treatment plans.

A Novel Prognostic Score Based on Multiple Quantitative Parameters of Chest CT for Patients with Synchronous Multiple Primary Lung Cancer: Is Solid Component Size a Better Prognostic Indicator?

There is no simple and definitive way to predict the prognosis of synchronous multiple primary lung cancer (SMPLC). In this study, we developed a clinical prognostic score for predicting the survival of patients with SMPLC. This study included 206 patients with SMPLC between 2011 and 2020 at three hospitals. Kaplan-Meier analysis was used to determine the optimal cutoff values for the quantitative chest computed tomography (CT) parameters. Multivariable Cox proportional hazards regression was carried out to identify independent prognostic factors for predicting overall survival (OS) and disease-free survival (DFS). The time-dependent receiver operating characteristic curve was analyzed to evaluate the prognostic performance. A CT-based prognostic score (CTPS) comprising six chest CT parameters was developed. Compared with T stage, CTPS had a higher prediction accuracy for OS and DFS. All C-indices of the model reached a satisfactory level in both the development and validation cohorts. Significant differences in the OS and DFS curves were observed when the patients were stratified into different risk groups. The high-risk group (CTPS of 5-6) had poorer survival than the low-risk group (CTPS of 0-4). The developed CTPS and the corresponding risk stratification system are valid for predicting the survival of patients with SMPLC.

Combined analysis of PHOX2B at two time points and its value for further risk stratification in high-risk neuroblastoma.

Risk stratification of high-risk neuroblastoma (NB) is crucial for exploring treatments. This study aimed to explore the value of minimal residual disease (MRD) based on PHOX2B levels for further risk stratification in high-risk NB. The expression of PHOX2B was monitored at two time points (after two and six cycles of induction chemotherapy, TP1 and TP2, respectively) by real-time polymerase chain reaction (RT-PCR). The clinical characteristics between groups and survival rates were analyzed. The study included 151 high-risk patients. Positive expression of PHOX2B at diagnosis was seen in 129 cases. PHOX2B was mainly expressed in patients with high lactate dehydrogenase (LDH) and neuron-specific enolase (NSE) levels (p<.001), bone marrow metastasis (p<.001), more than three metastatic organs (p<.001), 11q23 loss of heterozygosity (LOH) (p=.007), and when more events occurred (p=.012). The 4-year EFS rate was significantly lower in patients with positive PHOX2B expression compared to thenegative group at diagnosis (32.9%±6.2% vs. 74.5%±10.1%, p=.005). We stratified the 151 patients into three MRD risk groups: low high-risk (low-HR), with TP1 less than 10-4 and TP2 less than 10-4 ; ultra-HR, with TP1 greater than or equal to 10-2 or TP2 greater than or equal to 10-4 , and others classified as intermediate-HR. Patients in ultra-HR had the worst survival rate compared with other two groups (p=.02). In a multivariate model, MRD risk stratification based on PHOX2B levels at TP1 and TP2 was an independent prognostic factor for high-risk patients (p=.001). Patients in ultra-HR were associated with 11q23 LOH (p<.001), more than three organs of metastasis (p=.005), bone marrow metastasis (p<.001), and occurrenceofmore events (p=.009). MRD risk stratification based on PHOX2B levels at two time points (after two and six cycles of induction chemotherapy) provideda stratification system for high-risk NB, which successfully predicted treatment outcomes. Our results present an effective method for further stratification of high-risk NB.

Geotraverse «Granite—Odesa—Kryvyi Rih—Pereschepine

The article examines the results of research carried out by the methods of reflected waves and common depth point (MRW-CDP) on the «Granit» geotraverse, which crosses the whole of Ukraine from the southwest to the northeast and passes through the territories of Odesa, Mykolaiv, Dnipropetrovsk, and Kharkiv regions, west of Belgorod region of Russia. In structural and tectonic terms, the geotraverse crosses large geological structures: the marginal part of the Scythian Plate (SP), the Ukrainian Shield (USH), the Dnieper-Donetsk Basin (DDB) and the southern slope of the Voronezh Crystalline Massif (VCM). The analysis of the features of the registered wave field and the completed structural constructions of the consolidated crust and upper mantle in the section of the «Granite» geotraverse shows a complex heterogeneous structure with certain spatially correlated regularities, against the background of which there are numerous inhomogeneities characteristic of both individual blocks and their individual intervals. The cross-sections of all the studied geostructures are characterized by a high level of saturation with non-extended, unevenly distributed reflective elements, which occupy positions from subhorizontal to steeply sloping in space. With all the diversity of the mutual location of both individual boundaries and their groups, a fairly strict correlation is established, which primarily provides information about the nature of stratification, deformations, and the stress state of the structures of the consolidated crust and upper mantle. In the modern structure of the crust, a significant role belongs to faults and tectonic plates, the vast majority of which are manifested as inclined zonal bodies with different orientations. Systems of faults and plates form a complex hierarchical interdependence. The «crust-mantle» transition zone is a complex, laterally variable area, with a thickness of 3 to 7 km, caused by systems of subhorizontal stratification, expressed by the concentration of reflective elements. The largest homogeneous and contrasting region of the transition is manifested in the structures of ancient consolidation, with a thickness of the crust of about 40 km. As a result of the research, more detailed information on the structure of individual tectonic elements was obtained, and some general principles of the structure of the transition zone from the ancient continental platform to the active folded belt were clarified.

Adjuvant immunotherapy in renal cell carcinoma: A living systematic review and network meta-analysis (NMA).

694 Background: The treatment landscape of localized renal cell carcinoma (RCC) is rapidly evolving. Recent trials have demonstrated contrasting efficacy with adjuvant immunotherapy. Therefore, we sought to assess the mixed treatment comparisons among different adjuvant treatment options using updated data from trials and quantified the absolute effect with these treatments stratified by risk categories. Methods: This living network meta-analysis was conducted using the living interactive evidence (LIvE) synthesis framework. We used stratified baseline risks of disease progression from observational data and at 5, 10, 15 years from the Leibovich risk stratification system (based on risk scores ranging from 0 to ≥15). Corresponding intervention risks were then approximated using relative effect estimates (from NMA) and baseline risks. The difference between CIRs and baseline risks were calculated to present absolute risk differences in each risk category. Results: This NMA included eight RCTs with 8480 participants and seven unique treatment options. Pembrolizumab (pembro; rank 1) was associated with improved disease-free survival (DFS) when compared to atezolizumab (atezo; rank 6; hazard ratio: 0.68; 0.49;0.93), and nivolumab-ipilimumab (nivoipi; rank 5; 0.68; 0.48-0.97). However, no statistically significant difference was observed between pembro and atezo for overall survival (0.53; 0.28-1.01). Survival data for nivoIpi was not reported. No new statistically significant differences were observed since last update. The absolute benefit of atezo and nivoipi was minimal with higher T and N patients (Table). The results were similar with increasing Leibovich risk scores. Conclusions: Current evidence favors the use of a risk adapted approach when offering adjuvant immunotherapy. Adjuvant pembrolizumab remains a preferred treatment in patients with RCC who underwent nephrectomy. [Table: see text]