T1b Group Research Articles

Radiofrequency ablation for solitary T1N0M0 papillary thyroid carcinoma in the danger triangle area: a preliminary analysis

Objectives To evaluate the feasibility, efficacy, and safety of radiofrequency ablation (RFA) for solitary T1N0M0 papillary thyroid carcinoma (PTC) in the danger triangle area. Methods 94 participants (mean age 44.45 ± 13.08; 73 females) with solitary T1N0M0 PTC in the danger triangle area who underwent percutaneous RFA at the hospital from January 2018 to April 2020 were retrospectively analyzed. Key ablation procedures included sufficient paratracheal fluid isolation, low-power, and short active tip (5 mm working electrode). Tumor size changes at different time points after RFA, technical success rates, tumor disappearance, disease progression, and complications were recorded and compared. Results Contrast-enhanced ultrasonography revealed that complete tumor ablation was performed with a 100% success rate in these patients. Post-ablation, the maximum diameter and volume of the ablation zone increased at the first and third month (p < 0.001), followed by a gradual decrease in size, without significant difference by the 6th month. The tumor disappearance rate was 76.59% (72/94), with higher rates in the T1a group compared to the T1b group (80% [64/80] VS57.1% [8/14], p < 0.001). There were no local recurrences. The incidence of new lesions and LNM was 3.2% (3/94), limited to the T1a subgroup. Further ablation was successfully applied to all new lesions and LMN. Mild voice changes were the only complication, with a rate of 3.2% (3/94), resolved within 4 months after RFA. Conclusions Sufficient paratracheal fluid isolation combined with a low-power, short active tip radiofrequency ablation strategy is a safe and effective method for treating solitary T1N0M0 PTC in the danger triangle area.

444. SHOULD T2 ESOPHAGEAL SQUAMOUS CELL CARCINOMA BE SUBCLASSIFIED WITH RESPECT TO LYMPH NODE INVOLVEMENT AND SURVIVAL?

Abstract Background Whether T2 esophageal squamous cell carcinoma should be subclassified into circular muscle (T2a) and longitudinal muscle (T2b) remains controversial. We aimed to investigate the effect of the depth of muscularis propria invasion on the incidence of lymph node involvement and patient survival outcomes in T2 esophageal squamous cell carcinoma. Methods We identified patients with pT2 esophageal squamous cell carcinoma who underwent primary surgery from January 2009 to June 2017. The pathological information of the depth of muscularis propria invasion was reassessed, and patients were grouped into the T2a group and T2b group. Binary logistic regression was used to determine risk factors for lymph node metastases. The impact of the depth of muscularis propria invasion on survival was investigated using Kaplan–Meier analysis and a Cox proportional hazard regression model. Results This study included a total of 750 patients from three institutes. The depth of muscularis propria invasion (OR: 3.95, 95% CI: 2.46–6.35; P &amp;lt; 0.001) was correlated with lymph node metastases using logistic regression. T substage (OR: 1.37, 95% CI: 1.05–1.79; P &amp;lt; 0.001) and N status (OR: 1.51, 95% CI: 1.05–2.17; P &amp;lt; 0.001) were independent risk factors in multivariate Cox regression analysis. The T2a group had better overall survival (OR: 1.52, 95% CI: 1.19–1.94; P = 0.001) than the T2b group, specifically in T2N0 patients (OR: 1.38, 95% CI: 1.08–1.94; P = 0.035). Conclusions The depth of muscularis propria invasion should be subclassified to T2a and T2b with respect to lymph node involvement and survival outcomes in T2 esophageal squamous cell carcinoma.

Treatment of FIGO 2018 stage IIIC cervical cancer with different local tumor factors

BackgroundTo compare the oncological outcomes of patients with FIGO 2018 stage IIIC cervical cancer (CC) involving different local tumor factors who underwent abdominal radical hysterectomy (ARH), neoadjuvant chemotherapy and radical surgery (NACT), or radical chemoradiotherapy (R-CT).MethodsBased on tumor staging, patients with stage IIIC were divided into T1, T2a, T2b, and T3 groups. Kaplan–Meier and Cox proportional hazards regression analysis were used to compare their overall survival (OS) and disease-free survival (DFS) of 5 years.ResultsWe included 4,086 patients (1,117, 1,019, 869, and 1,081 in the T1, T2a, T2b, and T3 groups, respectively). In the T1 group, NACT was correlated with a decrease in OS (hazard ratio [HR] = 1.631, 95% confidence interval [CI]: 1.150–2.315, P = 0.006) and DFS (HR = 1.665, 95% CI: 1.255–2.182, P < 0.001) than ARH. ARH and NACT were not correlated with OS (P = 0.226 and P = 0.921) or DFS (P = 0.343 and P = 0.535) than R-CT. In the T2a group, NACT was correlated with a decrease in OS (HR = 1.454, 95% CI: 1.057–2.000, P = 0.021) and DFS (HR = 1.529, 95% CI: 1.185–1.974, P = 0.001) than ARH. ARH and NACT were not correlated with OS (P = 0.736 and P = 0.267) or DFS (P = 0.714 and P = 0.087) than R-CT. In the T2b group, NACT was correlated with a decrease in DFS (HR = 1.847, 95% CI: 1.347–2.532, P < 0.001) than R-CT nevertheless was not correlated with OS (P = 0.146); ARH was not correlated with OS (P = 0.056) and DFS (P = 0.676). In the T3 group, the OS rates of ARH (n = 10), NACT (n = 18), and R-CT (n = 1053) were 67.5%, 53.1%, and 64.7% (P = 0.941), and the DFS rates were 68.6%, 45.5%, and 61.1%, respectively (P = 0.761).ConclusionR-CT oncological outcomes were not entirely superior to those of NACT or ARH under different local tumor factors with stage IIIC. NACT is not suitable for stage T1, T2a, and T2b. Nevertheless ARH is potentially applicable to stage T1, T2a, T2b and T3. The results of stage T3 require confirmation through further research due to disparity in case numbers in each subgroup.

The Mitochondrial Origins of the Hellenistic Individuals of Ayasuluk Hill

Objective: The present study aimed to extract ancient DNA from the remains of three individuals from the 4th century BC in order to determine the haplogroups through a mitochondrial DNA study, thus providing information about Anatolian migrations in ancient times. Materials and Methods: For this purpose, the study examined the remains of three bodies found at the bottom of the city walls from the archeological excavations between 2007-2008 and dated to the 4th century BC. After taking anthropometric measurements, the study examined the mitochondrial HVR1 and HVR2 regions by using Sanger sequencing and then used online programs to evaluate the data from the sequencing. Results: As a result of the study, death due to a possible injury from a sharp object was observed on the right femur of one of the three individuals. The maternal haplogroups of the individuals were determined to belong to the T2b group of European origin. Conclusion: The present study obtained genetic information regarding three individuals found at the bottom of the ancient city walls on Ayasuluk Hill. These results will provide important information about the commander of the ruins found on the walls of the Ayasuluk Hill of the ancient city of Ephesus, which constantly changed hands during the Wars of the Diadochi.

Lymph node metastasis in T1 colorectal cancer with the only high-risk histology of submucosal invasion depth ≥ 1000μm.

The number of patients undergoing additional surgery after endoscopic resection (ER) for T1 colorectal cancer (CRC) is increasing. Regarding high-risk histology of lymph node metastasis (LNM) in T1 CRC, a submucosal invasion depth ≥ 1000μm (T1b) alone may be related to a low incidence of LNM. This study was conducted to clarify the incidence of LNM and to identify factors associated with LNM in T1 CRC with high-risk histology characterized only by T1b. We retrospectively investigated patients with pathological T1b CRC who underwent colorectal resection between 2010 and 2020. Patients were divided into two groups with high-risk histology: those in whom the only high-risk feature was T1b (low-risk T1b group, n = 263), and those with T1b as well as lymphovascular invasion, tumor budding, or poorly differentiated or mucinous adenocarcinoma (high-risk T1b group, n = 289). The incidences of LNM and recurrence were compared. Multivariate analysis was performed to identify factors associated with LNM in the low-risk T1b group. The incidences of LNM were 3.8% and 21.6% in the Low- and High-risk T1b groups, respectively (p < 0.01), while the 5-year recurrence rates in the two groups were 0.6% and 3.4%, respectively (p = 0.10). Multivariate analysis revealed that only a predominant histological type of moderately differentiated adenocarcinoma (p = 0.04) was independently associated with LNM in the low-risk T1b group. When considering the omission of additional surgery after ER in cases of T1 CRC whose only high-risk histological feature is T1b, attention should be paid to the predominant histological type.

Discussion on the rationality of FIGO 2018 stage IIIC for cervical cancer with oncological outcomes: a cohort study.

BackgroundThis study explored the rationality of the 2018 International Federation of Gynecology and Obstetrics (FIGO) stage IIIC for cervical cancer to determine outcomes.MethodsWe conducted a retrospective study of cervical cancer patients who had received radical surgery or Radiotherapy. Multivariate analysis was used to compare 5-year overall survival (OS) and disease-free survival (DFS) for FIGO 2018 stages IIIA, IIIB, and IIIC cervical cancer patients. Based on tumor-node-metastasis (TNM) staging, IIIC cases were divided into 5 subgroups: T1a, T1b, T2a, T2b, and T3. The 5-year OS and DFS of the different IIIC subgroups were further compared using multivariate analysis.Results(I) The 5-year OS for FIGO 2018 IIIA (n=251), IIIB (n=1,824), and IIIC (n=3,137) were 73.7%, 69.0%, and 74.3%, respectively (P<0.001), and DFS rates were 64.3%, 60.6%, and 68.0%, respectively (P<0.001). Multivariate analysis indicated that IIIA was associated with 5-year OS [hazard ratio (HR) =0.998, 95% confidence interval (CI): 0.739–1.349, P=0.990], but there was no significant correlation with DFS (HR =1.081, 95% CI: 0.843–1.387, P=0.539). Compared with IIIC, IIIB had a lower 5-year OS (HR =1.291, 95% CI: 1.135–1.468, P<0.001) and DFS (HR =1.354, 95% CI: 1.215–1.508, P<0.001). (II) The 5-year OS of the T1a group (n=4), T1b group (n=861), T2a group (n=587), T2b (n=641) group, and T3 group (n=1,044) were 100.0%, 81.9%, 76.1%, 74.0%, and 65.0%, respectively (P<0.001), and the 5-year DFS were 100.0%, 74.5%, 65.9%, 72.6%, and 61.3%, respectively (P<0.001). Multivariate analysis indicated that compared with the T1b group, T2a (HR =1.405, 95% CI: 1.076–1.834, P=0.012), T2b (HR =1.592, 95% CI: 1.203–2.108, P=0.001), and T3 (HR =2.495, 95% CI: 1.971–3.157, P<0.001) were associated with a lower 5-year OS. T2a (HR =1.372, 95% CI: 1.108–1.699, P=0.004), T2b (HR =1.337, 95% CI: 1.061–1.684, P=0.014), and T3 (HR =2.015, 95% CI: 1.659–2.446, P<0.001) were associated with lower 5-year DFS.ConclusionsThe outcome for FIGO 2018 stage IIIC cervical cancer is not worse than that for stage IIIB or IIIA. The outcome for stage IIIC is related to local tumor factors. As the local tumor progresses, the oncological outcome worsens.

1532 Strict Trifecta Outcomes of Robotic-Assisted Partial Nephrectomy inT1a and T1b Renal Tumours

Abstract Aim To evaluate and compare strict Trifecta outcomes of robotic assisted partial nephrectomy (RAPN) in patients with T1a and T1b renal tumours. Method A retrospective analysis of 146 consecutive patients undergoing a robotic assisted partial nephrectomy for T1a and T1b renal tumours from 2014-2019. Patient demographics, tumour characteristics, strict trifecta measures including warm ischaemia time, minimal renal function change (≤15% postoperative eGFR decrease), complications, and surgical margin positivity were collected, as well as intra-operative and oncological outcomes. Results In total 146 patients underwent RAPN. 113 patients had T1a tumours, 30 had T1b with a mean tumour size of 2.5cm (0.8-3.9cm) and 4.5cm (4.1-7cm) respectively, and 3 patients had T2a tumours. The nephrometry score was higher in stage T1b patients, however all other variables were similar between the two stage groups. Overall strict Trifecta was 75.5% with 77.9% in T1a group compared to 66.7% in T1b group (p = 0.21). Postoperative renal function was preserved in 102 patients in T1a vs 26 patients in T1b. Approximately 9 patients with T1a had positive surgical margin compared to 3 patients in T1b cohort. Post-operatively 3 patients in T1b (10%) group developed a Clavien Dindo score of 3 complications, compared to none in the T1a group (p 0.009). These were due to pseudoaneurysm and bleeding. No statistical difference in Fuhrman score and tumour types in the two groups. No cancer recurrences were observed during the 30 months follow up period in both T1a and T1b groups. Conclusions RAPN is a feasible treatment choice in selected T1b renal tumours.

Effect of CT image acquisition parameters on diagnostic performance of radiomics in predicting malignancy of pulmonary nodules of different sizes.

To investigate the effect of CT image acquisition parameters on the performance of radiomics in classifying benign and malignant pulmonary nodules (PNs) with respect to nodule size. We retrospectively collected CT images of 696 patients with PNs from March 2015 to March 2018. PNs were grouped by nodule diameter: T1a (diameter ≤ 1.0cm), T1b (1.0cm < diameter ≤ 2.0cm), and T1c (2.0cm < diameter ≤ 3.0cm). CT images were divided into four settings according to slice-thickness-convolution-kernels: setting 1 (slice thickness/reconstruction type: 1.25mm sharp), setting 2 (5mm sharp), setting 3 (5mm smooth), and random setting. We created twelve groups from two interacting conditions. Each PN was segmented and had 1160 radiomics features extracted. Non-redundant features with high predictive ability in training were selected to build a distinct model under each of the twelve subsets. The performance (AUCs) on predicting PN malignancy were as follows: T1a group: 0.84, 0.64, 0.68, and 0.68; T1b group: 0.68, 0.74, 0.76, and 0.70; T1c group: 0.66, 0.64, 0.63, and 0.70, for the setting 1, setting 2, setting 3, and random setting, respectively. In the T1a group, the AUC of radiomics model in setting 1 was statistically significantly higher than all others; In the T1b group, AUCs of radiomics models in setting 3 were statistically significantly higher than some; and in the T1c group, there were no statistically significant differences among models. For PNs less than 1cm, CT image acquisition parameters have a significant influence on diagnostic performance of radiomics in predicting malignancy, and a model created using images reconstructed with thin section and a sharp kernel algorithm achieved the best performance. For PNs larger than 1cm, CT reconstruction parameters did not affect diagnostic performance substantially. • CT image acquisition parameters have a significant influence on the diagnostic performance of radiomics in pulmonary nodules less than 1cm. • In pulmonary nodules less than 1cm, a radiomics model created by using images reconstructed with thin section and a sharp kernel algorithm achieved the best diagnostic performance. • For PNs larger than 1cm, CT image acquisition parameters do not affect diagnostic performance substantially.

Comparative analysis of the gut microbiota in bighead carp under different culture patterns.

To investigate the phylogenetic composition and functional potential of bighead carp (Hypophthalmichthys nobilis) gut microbiome in two rearing patterns (bighead carp polycultured with Oreochromis niloticus in pond A and bighead carp polycultured with Cyprinus carpio in pond B, respectively), as well as the changes of plankton in the cultured water at four different time points. The intestinal contents were sequenced using Illumina HiSeq of bacterial 16S rRNA. Cyanophyta and Chlorophyta were the prevalent phytoplankton in the water, whereas Rotifers and Protozoa were the predominant zooplankton. In all, 779,563 quality-filtered sequences and 8870 amplicon sequence variants were obtained from 24 samples that numbered T1A1 to T4A3 and T1B1 to T4B3, resulting in 35 phyla, with Proteobacteria, Firmicutes, Fusobacteria and Cyanobacteria dominating. According to alpha diversity and beta diversity measurements, the bacterial communities were diverse, Chao1 richness and Pielou's evenness were significantly lower in the T2B and T4B groups. The gut bacterial communities of T1A, T1B, T2A and T2B groups differed from those of other samples, which formed distinctly clusters with principal coordinate analysis and non-metric multidimensional scaling analysis. PICRUSt2 predictive function analysis revealed that different culture patterns influenced the gut microbiota metabolic capacity. Intestinal bacteria belonging to the phyla Proteobacteria, Firmicutes, Cyanobacteria and Fusobacteria are better suited to inhabit in various environments and perform specific functions. Furthermore, contact with the external environment and nutrient intake also stimulate the variety of intestinal microbiotas in polycultured bighead carp. This is the first comprehensive, high-throughput investigation of gut microbiota diversity in bighead carp during various seasons in two polycultured patterns and provide preliminary information on gut microbiome composition and changes, laying a crucial foundation for future research on fish culture patterns in various environments.

Prognostic Significance of Tumor Location in T2 Gallbladder Cancer: A Systematic Review and Meta-Analysis.

(1) Background: The AJCC Cancer Staging Manual, Eighth Edition, subdivided T2 GBC into T2a and T2b. However, there still exist a lack of evidence on the prognostic significance of tumor location. The aim of the present study was to examine the existing evidence to determine the prognostic significance of tumor location of T2 gallbladder cancer (GBC) and to evaluate the optimal surgical extent according to tumor location. (2) Methods: We searched for relevant literature published in the electronic databases PubMed, MEDLINE, Web of Science, Cochrane Library, and Embase before September 2020 using search terms related to gallbladder, cancer, and stage. Data were weighted and pooled using random-effects modeling. (3) Results: Seven studies were deemed eligible for inclusion, representing a cohort of 1789 cases of resected T2 GBC. The overall survival for T2b tumor was significantly worse than that for T2a tumor (HR, 2.141; 95% confidence interval (CI), 1.140 to 4.023; I2 = 71.4%; Pchi2 = 0.007). The rate of lymph node metastasis was lower in the T2a group (26.6%) than in the T2b group (36.6%) (OR, 2.164; 95% CI, 1.309 to 3.575). There was no evidence of a survival difference between the patients who underwent extended cholecystectomy and simple cholecystectomy in T2a GBC (OR, 0.802; 95% CI, 0.618 to 1.042) and T2b GBC (OR, 0.820; 95% CI, 0.620 to 1.083). (4) Conclusions: Hepatic side tumor was a significant poor prognostic factor in T2 GBC. Extended cholecystectomy and simple cholecystectomy showed comparable survival outcomes in T2 GBC, and additional large-scale prospective studies are warranted to establish evidence-based treatment guidelines for T2 GBC.

Prognostic significance of tumor location in T2 gallbladder: A systematic review and meta-analysis

The purpose of this study is to examine the existing evidence to determine the prognostic significance of tumor location of T2 gallbladder cancer (GBC) and to evaluate the optimal surgical extent according to tumor location. Eligible studies examining the association between tumor location of T2 GBC and survival were sought using the Medline, Cochrane, and EMBASE databases to September 2020. The primary endpoint was overall survival according to tumor location. All statistical analyses were performed using Comprehensive Meta-Analysis version 2.0. Seven studies were deemed eligible for inclusion representing a cohort of 1,789 case of resected T2 GBC. The overall survival for T2a tumor was significantly better than that for T2b tumor (hazard ratio [HR], 2.141; 95% confidence interval [CI], 1.140 to 4.023; I2 = 71.4%; Pchi2 = 0.007). The rate of lymph node metastasis was lower in T2a group compared with that in T2b group (odd ratio [OR], 2.164; 95% CI, 1.309 to 3.575; number needed to benefit [NNTB], 3.6; 95% CI, NNTB 3.1 to NNTB 4.3). There was no evidence of a survival difference between extended cholecystectomy and simple cholecystectomy in T2a GBC (OR, 0.802; 95% CI, 0.618 to 1.042; I2 = 0.0%; Pchi2 = 0.928) and T2b GBC (OR, 0.816; 95% CI, 0.622 to 1.070; I2 = 0.0%; Pchi2 = 0.512). Tumor location was significantly associated with the prognosis of T2 GBC patients. Extended cholecystectomy and simple cholecystectomy showed comparable survival outcomes in T2 GBC.

Short-term clinical outcomes of non-curative endoscopic submucosal dissection for early esophageal adenocarcinoma.

Few Western studies highlighted the outcomes of endoscopic submucosal dissection (ESD) for early esophageal adenocarcinoma (EAC). Data regarding the outcomes of noncurative ESDs remains scarce. In this study, we share our experience with ESD for early EAC with a focus on noncurative ESDs. A retrospective single-center analysis of consecutive patients who underwent ESD for early EAC from August 2015 through February 2020. Primary outcomes included the clinical outcomes of noncurative ESDs along with overall en bloc, R0 and curative resection rates. Secondary outcomes included comparing results between T1a and T1b tumors. Final group included 23 T1a and 17 T1b EAC patients. Patients' median Charlson comorbidity index was five. En bloc resection rate was (97.5%). Compared to the T1b group, the T1a group had a statistically significantly higher R0 (78.3 vs. 41.2%; P = 0.0235), curative (73.9 vs. 11.8%; P = 0.0001) and accumulative endoscopic curative resection rates (82.6 vs. 23.5%; P = 0.0003). A study flowchart is presented in (Fig. 1). Out of the 21 noncurative ESDs, 10 patients (47.6%) underwent R0 esophagectomy, 6 patients (28.6%) are undergoing surveillance endoscopies without additional therapy, 3 patients (14.3%) underwent repeat curative ESD and 1 patient (4.76%) is receiving chemotherapy with surveillance endoscopy. Over median endoscopic follow-up of 22.5 months (IQR, 14.25-30.75), 2 out of 10 patients with noncurative ESDs had recurrent disease. ESD achieved a higher curative resection rate in T1a EAC when compared to T1b. Despite a lower curative resection rate in T1b EAC, certain patients might benefit from a conservative multimodal therapy.

Efficacy and Safety of Thermal Ablation for Treatment of Solitary T1N0M0 Papillary Thyroid Carcinoma: A Multicenter Retrospective Study.

Background Microwave ablation (MWA) and radiofrequency ablation (RFA) have recently attracted interest as minimally invasive treatment modalities for papillary thyroid carcinoma (PTC). However, the ablation outcomes of T1N0M0 PTC are not well characterized. Purpose To evaluate the efficacy and safety of thermal ablation (MWA or RFA) of solitary T1N0M0 PTC in patients who were ineligible for (due to presence of comorbid cardiovascular disease, renal failure, other malignancy, etc) or who refused surgery. Materials and Methods This was a retrospective multicenter study of 847 patients (660 women) who underwent thermal ablation for PTC (673 T1a, 174 T1b) between March 2015 and March 2020; of these patients, 645 underwent MWA and 202 underwent RFA. The mean age of patients was 46 years ± 11 (standard deviation) (age range, 18-81 years); the mean follow-up time was 22 months ± 13 (range, 6-60 months). Changes in tumor size and volume and the rates of technical success, tumor disappearance, disease progression, and complications were assessed. Results The technical success rate was 100%. Relative to preablation measurements, the maximum diameter and volume of the ablation zone increased during the 1st month after ablation (P < .001), whereas there was no difference by the 3rd month; subsequently, the tumors showed reduction in size at 6, 9, and 12 months (all P < .001). Complete disappearance of tumors occurred in 68% of patients (577 of 847; 69% [466 of 673] in the T1a group vs 64% [111 of 174] in the T1b group; P < .001). The postablation disease progression rate was 1.1% (nine of 847 patients; 0.9% [six of 673 patients] in the T1a group vs 1.7% [three of 174 patients] in the T1b group; P = .54). The overall complication rate was 3.4% (29 of 847 patients; 2.7% [18 of 673 patients] in the T1a group vs 6.3% [11 of 174 patients] in the T1b group; P = .02). Conclusion This multicenter study provided evidence that thermal ablation is an effective and safe treatment option in selected -patients with solitary T1N0M0 papillary thyroid carcinoma. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Baek and Cho in this issue.

Comparison of the T descriptor of the 7th and 8th editions of the TNM staging system for non-small cell lung cancer after radiotherapy: An analysis from the TCP modelling perspective

The tumour, node, metastasis (TNM) staging system employs a configuration that depicts the anatomic extent of cancer, thereby enhancing the exchange of information between oncologists. This study aims to incorporate the T descriptor of the TNM classification system into a tumour control probability (TCP) model. A mechanistic TCP model based on the linear-quadratic concept combined with the Poisson statistic was developed to assess variations in local tumour control according to the 7th and 8th editions of the TNM classification system. The simulation involved a single cohort of 354 patients with non-small cell lung cancer (NSCLC). The estimated mean gross tumour volumes (GTV) were 2.3–500 cm3 and 0.4–350 cm3 in accordance with the recommendations of the 7th and 8th editions, respectively. The predicted TCP for the T1a vs. T1b group after applying 2 Gy in 30 fractions was 48% ± 1.09% vs. 43% ± 1.05% according to the 7th edition and 51.5% ± 0.80% vs. 47.8% ± 0.85% according to the 8th edition. The differences in the predicted TCP between the adjacent T category groups in the 8th edition were all significant. Similar findings were observed in the 7th edition, except for the T3 vs. T4 stage. The TCP model outcomes based on the T descriptors of the 8th TNM revealed an enhanced model fit, a higher R2 and a lower RMSE compared with those of the 7th TNM, implying the superior discriminatory ability of the later edition.

Prognostic Significance of Tumor Location in T2 Gallbladder Cancer: A Korea Tumor Registry System-BiliaryPancreas (KOTUS-BP) Database Analysis

Objective: The aims of this study were to investigate the clinical features and clinical outcomes of T2 gallbladder cancer (GBC) according to tumor location and determine the prognostic significance of tumor location and an appropriate surgical strategy for T2 GBC. Methods: Using Korea tumor registry system- biliarypancreas (KOTUS-BP) database, between 2000 and 2014, a total 707 patients with T2 GBC who underwent curative resection were enrolled. Results: 309 patients were T2a, and 398 patients were T2b. The incidence of lymph node metastasis in T2b tumor group was 37.5% and significantly higher than that of T2a tumor group (29.5%). After a median follow-up period of 43 (range 3-189) months, the 5-year disease-specific survival (76% vs. 69%, p=0.019) and disease-free survival of the T2a group were better than those of the T2b group (69% vs. 57%, p=0.002). However, there was no significant difference in survival between Stage IIa (T2aN0) and Stage IIb (T2bN0) (83% vs.74%, p=0.149). There were no significant survival differences between T2a and T2b groups according to whether hepatic resection was performed or not. Multivariate analysis revealed that lymph node metastasis was the only significant poor prognostic factor (hazard ratio 2.966, 95% confidence interval 1.960-4.489, p < 0.001). Conclusion: In T2 GBC, simple cholecystectomy and lymph node dissection for staging work-up could be recommended irrespective of tumor location. Postoperative adjuvant therapy should be considered, because lymph node metastasis was a significant poor prognostic factor, systemic recurrence was more common, and recurrence occurred more frequently among patients with lymph node metastasis.

Survival analysis of patients with stage T2a and T2b perihilar cholangiocarcinoma treated with radical resection

BackgroundBoth the 7th and 8th editions of the American Joint Committee on Cancer (AJCC) staging system for perihilar cholangiocarcinoma (pCCA) had the same definition for T2a and T2b. But the value of this classification as prognostic factor remains unclear.Methods178 patients with stage T2a or T2b who underwent curative intent resection for pCCA between Jan 2010 and Dec 2018 were enrolled. Relationships between survival and clinicopathological factors including patient demographics and tumor characteristics were evaluated using univariate and multivariate Cox regression analysis. The overall survival (OS) were calculated by Kaplan-Meier method.ResultsThere was no significant difference in OS between T2a and T2b groups, and the median OS duration were 37 and 31 months (P = 0.354). Both the 7th and 8th edition of the AJCC TNM staging demonstrated a poor prognostic predictive performance. High level of preoperative AST (≥85.0 IU/L) and CA19–9 (≥1000 U/mL), vascular resection and lower pathological differentiation of the tumor were the independent predictors for poor survival after resection.ConclusionThe newly released 8th edition of AJCC staging system demonstrated a poor ability to discriminate the prognosis of patients with stage T2a and T2b pCCA after resection.

The Relationship between Post-colonoscopy Colorectal Cancer and Quality Indicators of Colonoscopy: The Latest Single-center Cohort Study with a Review of the Literature.

Objective This study aims to elucidate the association between the clinical characteristics of post-colonoscopy colorectal cancer (PCCRC) and quality indicators (QIs) of colonoscopy. Methods Patients with PCCRC who underwent total colonoscopy (TCS) and were histologically diagnosed with adenocarcinoma within six months to five years of the last examination were included in this study. PCCRC and normally detected cancer (NDC) identified within the same period were compared in terms of their clinicopathological characteristics. Furthermore, the QIs at PCCRC detection were compared to those at the last examination. Results Patients with PCCRC had a significantly higher rate of colon surgery history than those with NDC (PCCRC: 25/76, 32.9%; NDC: 31/1,437, 2.2%; p<0.001), but the invasion depth in these patients was significantly shallower (PCCRC: ≤Tis/≥T1, 37/39; NDC: ≤Tis/≥T1, 416/1,021; p<0.001). Among patients with PCCRC, the T1b group had significantly more non-polypoid growth (NPG)-type cases than PG-type CRC cases (p=0.018). The adenoma detection rate (ADR) of colonoscopists performing TCS was 30.2-52.8%. Furthermore, the ADR of colonoscopists at the time of PCCRC detection (36.7%±5.9%) was significantly higher than that of colonoscopists who performed the last examination (34.9%±4.4%; p=0.034). The withdrawal time for negative colonoscopy (WT-NC) at detection was significantly longer than that at the last examination (at detection: 494.3±253.8 s; at last examination: 579.5±243.6 s; p=0.010). Conclusion Given that these PCCRC cases were post-colon surgery cases, had a long WT-NC, and were detected by colonoscopists with a high ADR, most cases showed lesions that were missed during the previous colonoscopy. Caution should be practiced in order to avoid missing flat, NPG-type tumors.

The Effect of Adjuvant Treatment in Small Node-negative HER2-positive Breast Cancer: Which Subgroup Will Benefit?

BackgroundWe conducted this study to evaluate whether patients with T1a/b, node-negative (N−), human epidermal growth factor receptor 2-positive (HER2+) breast cancers benefited from adjuvant therapy, and explored better treatment strategies for these patients. Patients and MethodsPatients with T1a/b, N−, HER2+ breast cancers during 2000 through 2004 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. The Gray test was used to evaluate breast cancer-specific death (BCSD) and non-BCSD. To identify patients more suitable for chemotherapy, subgroup analyses were conducted according to tumor size and estrogen receptor (ER) status, and plots of hazard rate of death (HRD) were drawn to present the changes of BCSD. ResultsA total of 2940 patients with T1a/b, N−, HER2+ breast cancers were included; more patients in the T1b group received chemotherapy compared with the T1a group (65.18% vs. 29.30%; P < .001). Patients receiving chemotherapy did not benefit from it (5-year incidences of BCSD: 1.00% in the non-chemotherapy group vs. 1.18% in the chemotherapy group; P = .853). Compared with those in the T1a group, patients in the T1b group had similar prognosis (P = .532), whereas ER status was significantly associated with survival (P = .048). HRD had a peak in years 2 to 5, which was more obvious in the ER− group. ConclusionChemotherapy, which is mainly decided by tumor size, fails to render survival benefits for patients with T1a/b, N−, HER2+ breast cancers. ER status, rather than tumor size, is important for clinicians to make adjuvant treatment decisions. The peak of BCSD occurs 2 to 5 years after diagnosis, and an at least 5-year follow-up is recommended for these patients.

Clinicopathological Differences in T2 Gallbladder Cancer According to Tumor Location.

We aimed to identify clinicopathological differences and factors affecting survival outcomes of stage T2a and T2b gallbladder cancer (GBC) and validate the oncological benefits of regional lymphadenectomy and hepatic resection in these patients. This single-center study enrolled patients who were diagnosed with pathologically confirmed T2 GBC and underwent curative resection between January 1995 and December 2017. Eighty-two patients with T2a and 50 with T2b GBCs were identified, and clinical information was retrospectively collected from medical records and analyzed. Five-year overall survival rates were 96.8% and 80.7% in T2a and T2b groups, respectively (P = .007). Three- and 5-year survival rates among all patients with T2 GBC without and with lymph node metastasis were 97.2% and 94.4% and 81.3% and 81.3%, respectively (P = .029). There was no difference in survival rates between the 2 groups according to whether hepatic resection was performed (P = .320). However, in the T2b group, those who underwent hepatic resection demonstrated a better survival rate than those who did not (P = .029). The T2b group had more multiple recurrence patterns than the T2a group, and the lymph nodes were the most common site in both groups. Multivariate analysis revealed that lymph node metastasis, vascular invasion, and tumor location were significant independent prognostic factors. Hepatic resection was not always necessary in patients with peritoneal-side GBC. Considering clinicopathological features and recurrence patterns, a systematic treatment plan, including radical resection and adjuvant treatment, should be established for hepatic-side GBC.

Retrospective study of efficacy of adjuvant chemotherapy using tegafur-uracil in patients with non-small cell lung cancer with primary tumor size of 4.1-5.0 cm.

The staging of patients with a tumor of diameter 4.1-5.0 cm and no lymphatic/distant metastases have been up-graded to stage IIA in the latest 8th edition of the TNM staging system. However, the efficacy of adjuvant tegafur-uracil (UFT) therapy in these patients, which has been recommended in the guideline issued by The Japan Lung Cancer Society, remains unclear. We evaluated the efficacy of adjuvant UFT therapy among a cohort by retrospective analyses of multicentric database. In 2005-2007, 130 patients with p-stage IB non-small cell lung cancer (NSCLC) (diagnosed according to the 7th edition of the TNM staging system) and tumor size of ≥3.1 cm underwent anatomic complete resection at nine of our affiliated hospitals. We retrospectively reviewed the clinicopathological characteristics and the outcomes among these patients. Ninety-eight patients had tumor size of 3.1-4.0 cm (T2a group), whereas 32 patients had tumor size >4.0 cm (T2b group). Overall, patients who received adjuvant UFT showed a tendency of better outcomes than patients who did not [hazard ratio (HR) 0.564; 95% confidence interval (CI), 0.257-1.238, P=0.147]. In subgroup analyses, patients who received adjuvant UFT also tended to show better outcomes than those who did not in both T2a group and T2b group (HR 0.504; 95% CI, 0.202-1.255, P=0.132 in T2a group and HR 0.855; 95% CI, 0.181-4.033, P=0.843 in T2b group, respectively). Our results suggest that adjuvant UFT therapy have the potential to improve postoperative outcomes even in patients with p-stage IIA disease, as classified according to the 8th edition of the TNM staging system.