T1 Carcinoma Research Articles

Depth of Invasion Threshold for Recommending Elective Neck Dissection in T1 or T2 Oral Squamous Cell Carcinoma

BackgroundThere is variability in the literature on the role of the depth of invasion (DOI) for recommending an elective neck dissection (END). PurposeThe purpose of the study is to estimate the DOI threshold for recommending an END. Study Design/Setting/SampleA retrospective cohort study was performed at McGill University Health Centre from 2008-2018 with 5 years of follow-up. The sample was subjects with clinical T1/T2 oral squamous cell carcinoma (OSCC) and clinically negative neck. Subjects with previous head and neck cancer were excluded. Predictor VariableThe primary predictor variable was DOI measured from the basement membrane of the adjacent normal mucosa on final pathology, coded as <4mm or ≥4mm. DOI is a continuous variable converted to a binary variable. Main Outcome VariableThe main outcome variable was time to development of neck disease (RD+) defined as the time from surgery to development of pathologic nodes. Time to RD+ for pathologic nodes discovered from the END was considered 0 months. The secondary outcome variable was overall survival. CovariatesDemographics (age, sex, smoking/alcohol history) and tumor characteristics (tumor location, clinical T, tumor differentiation, perineural invasion, lymphovascular invasion) were analyzed. AnalysesTime to RD+ and survival were analyzed using Cox hazard ratio, Kaplan-Meier curves, and log-rank test. Student T-test and Chi-square test were used for bivariate analyses; p≤0.05 was statistically significant. ResultsThe final sample were 64 subjects (average age 65.25 (SD 13.06) years and 36 (56.2%) males). Twenty-nine subjects had DOI<4mm, and the 5-year RD+ was 3.4% (the 1 occurrence of RD+ was at 5.3 months). Thirty-five subjects had DOI≥4mm, and the 5-year RD+ was 45.7% (15 subjects had RD+ discovered from the END, and 1 subject had RD+ at 7.6 months). DOI≥4mm had significantly higher risk of RD+ than DOI<4mm (HR 17.91; 95% CI 2.37-135.3; p=0.01), which remained significant after adjusting for clinical T, tumor differentiation, perineural invasion, and lymphovascular invasion (HR 9.53; 95% CI 1.12-81.44; p<0.05). The shallowest DOI with >20% risk of RD+ was in the DOI 4-4.9mm group. Conclusions/Relevance: Among patients with OSCC of T1 or T2 and clinically negative necks, END should be considered with DOI≥4mm.

850MO Phase II randomized trial of chemotherapy followed by surgery and PORT versus surgery and PORT for organ preservation of T3 and T4a (selected T4b) sinonasal squamous cell carcinoma (SNC): A trial of the ECOG-ACRIN cancer research group (EA3163)

850MO Phase II randomized trial of chemotherapy followed by surgery and PORT versus surgery and PORT for organ preservation of T3 and T4a (selected T4b) sinonasal squamous cell carcinoma (SNC): A trial of the ECOG-ACRIN cancer research group (EA3163)

Letter to the Editor: Early Sonographic Detection of Gallbladder Carcinoma Can Improve Patient Outcomes: A Case Report—by Kimbrow. How is T1 or Shallow T2 Gallbladder Carcinoma Depicted With Sonography?

Letter to the Editor: Early Sonographic Detection of Gallbladder Carcinoma Can Improve Patient Outcomes: A Case Report—by Kimbrow. How is T1 or Shallow T2 Gallbladder Carcinoma Depicted With Sonography?

Comparison of clinical characteristics between ACOSOG Z0011-eligible cohort and sentinel lymph node-positive breast cancer patients in Hong Kong.

The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial resulted in de-escalation of axillary surgery among early-stage breast cancer patients with low-volume sentinel lymph node (SLN) disease undergoing breast-conserving surgery and radiation therapy. Nevertheless, the mastectomy rate in the Chinese population remains high. This study compared the clinical characteristics of the ACOSOG Z0011-eligible cohort with SLN-positive breast cancer patients in Hong Kong. This retrospective analysis of a prospectively maintained database at a university-affiliated breast cancer centre in Hong Kong was performed from June 2014 to May 2019. The database included all patients with clinical tumour (T) stage T1 or T2 invasive breast carcinoma, no palpable adenopathy, one or two positive SLNs on histological examination, and no prior neoadjuvant systemic treatment. Comparisons were made between the mastectomy and breast-conserving treatment groups in our cohort, along with the sentinel-alone arm in the ACOSOG Z0011 trial. One hundred and seventy-one patients met the inclusion criteria: 112 underwent mastectomy and 59 underwent breast-conserving treatment. Our mastectomy group had higher prevalences of T2 tumours (P<0.001), lymphovascular invasion (P<0.001), and SLN macrometastases (P=0.004) compared with the ACOSOG Z0011 cohort. However, in our patient population, mean pathological size slightly differed between the mastectomy and breast-conserving treatment groups (2.2 cm vs 1.8 cm; P=0.005). Other histopathological features were similar. This study demonstrated that clinicopathological features were comparable between SLN-positive breast cancer patients undergoing mastectomy and those undergoing breast-conserving treatment. Low-risk SLN-positive mastectomy patients may safely avoid completion axillary lymph node dissection.

Characteristics and Prognosis of Sporadic Neoplasias Detected in Patients with Ulcerative Colitis

Introduction: Patients with ulcerative colitis (UC) develop not only UC-associated neoplasias but also sporadic neoplasias (SNs). However, few studies have described the characteristics of SNs in patients with UC. Therefore, this study aimed to evaluate the clinical features and prognosis of SNs in patients with UC. Methods: A total of 141 SNs in 59 patients with UC, detected by surveillance colonoscopy at Hiroshima University Hospital between January 1999 and December 2021, were included. SNs were diagnosed based on their location, endoscopic features, and histopathologic findings along with immunohistochemical staining for Ki67 and p53. Results: Of the SNs, 91.5% were diagnosed as adenoma and 8.5% were diagnosed as carcinoma (Tis carcinoma, 3.5%; T1 carcinoma, 5.0%). 61.0% of the SNs were located in the right colon, 31.2% were located in the left colon, and 7.8% were located in the rectum. When classified based on the site of the lesion, 70.9% of SNs occurred outside and 29.1% within the affected area. Of all SNs included, 95.7% were endoscopically resected and 4.3% were surgically resected. Among the 59 patients included, synchronous SNs occurred in 23.7% and metachronous multiple SNs occurred in 40.7% during surveillance. The 5-year cumulative incidence of metachronous multiple SNs was higher in patients with synchronous multiple SNs (54.2%) than in those without synchronous multiple SNs (46.4%). Conclusion: Patients with UC with synchronous multiple SNs are at a higher risk of developing metachronous multiple SNs and may require a closer follow-up by total colonoscopy than patients without synchronous SNs.

Hybrid endoscopic approaches for complex colorectal polyps with a non-lifting sign: the Greek experience.

Hybrid approaches combining endoscopic full-thickness resection (EFTR) with conventional techniques (endoscopic mucosal resection [EMR], endoscopic submucosal dissection [ESD]) have enabled the resection of difficult fibrotic colorectal adenomas exhibiting a "non-lifting" sign, and polyps in difficult positions. We present our cohort treated with either EMR+EFTR or ESD+EFTR as salvage hybrid endoscopic approaches for complex colorectal polyps not amenable to conventional techniques. Retrospective analysis included technical success, histological confirmation of margin-free resection, assessment of adverse events and follow up with histological assessment. All patients underwent follow-up endoscopy at least 6 and 12 months post-resection. Fourteen patients underwent hybrid EFTR procedures (11 EMR+EFTR and 3 ESD+EFTR). Technical success was achieved in all cases where the full-thickness resection device (FTRD) was advanced to the site of the resection (100%). In 2 cases, the FTRD system could not be passed through the sigmoid colon because of severe chronic diverticulitis, subsequent fibrosis and stiffness. The mean lesion size in the EMR+EFTR group (41.7 mm; range 20-50 mm) was larger than the ESD+EFTR group (31.7 mm; range 30-35 mm). Six patients (42.9%) were histologically diagnosed with T1 carcinoma. The mean duration of hospitalization was 1.4 days. Follow-up endoscopy was available in all patients and no recurrence was observed with histological confirmation during a mean follow-up period of 15.4 months. Hybrid procedures appear to be safe and effective treatments for complex colorectal lesions not amenable to EMR, ESD or EFTR alone, because of the lesion size, positive non-lifting sign, and difficult positions.

Endoscopic Resection Techniques for Precancerous and Early Cancerous Lesions in the Rectum

Today, endoscopy plays a decisive role not only in the detection of colorectal adenomas and carcinomas, but also in the treatment of precancerous lesions, in particular flat adenomas and early carcinomas. In recent years, endoscopic submucosal dissection (ESD) has become increasingly important alongside classic polypectomy and mucosal resection after saline injection using a snare (EMR). Using ESD the lesion is marked, injected submucosally using viscous substances and the mucosa incised and tunneled with a transparent cap and a fine diathermy knife. Particularly in the case of widespread and high-risk lesions ESD enables a quasi-surgical "en bloc" resection almost regardless of size, with a histological R0 resection rate of far over 90% in specialized centers. ESD enables an excellent histopathological evaluation and has a low recurrence risk of 1-3%. Endoscopic full-thickness resection using a dedicated device (FTRD system) represents another addition to the armamentarium. It can be used for circumscribed submucosal, suspicious or scarred changes up to 2cm in the middle and upper rectum. Endoscopic intermuscular dissection (EID) enables histopathological analysis of the complete submucosa beyond the mucosa and upper submucosal layer by including the circular inner muscle layer within the resection specimen. It reduces basal R1 situations and offers a new perspective for T1 carcinomas through curative, organ-preserving endoscopic therapy, especially in the case of deep submucosal infiltration alone, without other risk factors for metastases. Indications, the procedure itself and significance of the various techniques for premalignant and early malignant lesions in the rectum are presented.

How Can We Identify T1 or Shallow T2 Gallbladder Carcinoma Using Ultrasound? Comment on Okaniwa, S. How Can We Manage Gallbladder Lesions by Transabdominal Ultrasound? Diagnostics 2021, 11, 784.

I am keenly interested in ultrasound diagnosis of the invasion depth of gallbladder carcinoma (GBC) [...].

Do patients with cN0 oral squamous cell carcinoma benefit from elective neck dissection? A large-scale population-based study

BackgroundThe neck management of clinical-nodal negative (cN0) oral squamous cell carcinoma (OSCC) remains controversial. Elective neck dissection (END) and observation are the main strategies, but it is still not clear who could benefit the most from END. The purpose of this study was to clarify the potential clinical factors that affect the therapeutic value of END and to explore the actual characteristics associated with benefit from END.MethodsPatients with cN0 OSCC were identified in the SEER database from 2000 to 2019. 5-year Overall survival (OS) and disease-specific survival (DSS) were analyzed using the Kaplan‒Meier method, and the hazard ratios (HRs) for survival were estimated using the Cox regression model. Multiple subgroup analyses of DSS and OS among different factors, comparing END and No END, were performed.ResultsA total of 17,019 patients with cN0 OSCC were included. The basic survival analysis and Cox regression model showed that END increased the probability of 5-year DSS and OS and was an independent prognostic factor. However, among patients who underwent only primary tumor surgery, no significant differences were found between the END and No END groups in 5-year DSS (P = 0. 585) and OS (P = 0.465). Further subgroup analysis showed that primary sites and T stage, but not other factors, might influence the benefit of END. Significant differences were found for T1 (P < 0.001 for OS) and T2 (P = 0.001 for DSS and < 0.001 for OS) tongue squamous cell carcinoma (TSCC) but not for other primary tumor sites.ConclusionThis large-scale retrospective population-based cohort study suggests that not all patients with cN0 OSCC could benefit from END. Patients with cN0 TSCC are recommended to undergo END, especially with early-stage tumors.

Lokalno radikalno lečenje patoloških lezija rektuma minimalno invazivnim hirurškim pristupima

Introduction: The most common pathological changes treated in the rectum are neoplastic polyps (villous, tubular, and tubulovillous adenomas) and rectal adenocarcinomas. Until now, precancerous lesions of the type of neoplastic polyps have been treated with a local approach, and patients with advanced cancers have been operated on with a radical surgical intervention, either classically or laparoscopically. Aim: In this paper, we will show the advantages and disadvantages of certain local surgical approaches to pathological changes in the rectum. Material and methods: Our research analyzed two groups of patients. In the first group, patients with pathological lesions of the rectum were treated with local transanal excision (TAE), and the second group of patients were treated with the newly introduced technique of transanal minimally invasive surgery (TAMIS). In the period from September 2021 to March 2023. at the CHC Zemun in Surgery Clinic, a total of 12 patients were operated on with the TAMIS procedure and 15 patients with the TAE technique for various pathological changes in the rectum. In all patients, the changes were localized in the rectum from 5 to 15 cm from the anocutaneous line in the TAMIS group and from 0 to 6 cm in the TAE group. Pathological changes could not be resected by endoscopic polypectomy. Results: The average duration of the operations was longer in the TAMIS group and amounted to 45 minutes, while the operations lasted an average of 20 minutes in the TAE group. During the surgical procedure, mucosectomy is most often performed, followed by resection of the full thickness of the rectal wall, and resection of the rectal wall with part of the mesorectal tissue was performed the least frequently in both analyzed groups. In 3 patients we had preparation fragmentation, and in 1 case we had positive margins by histopathological postoperative analysis in the TAMIS group. In the TAE group, we had one patient with preparation fragmentation and a positive margin. Patients with a positive margin in both the TAE and TAMIS groups belonged to villous adenomas with a high degree of dysplasia. The final HP finding in both groups most often spoke in favor of tubulovillous adenoma with a low to medium degree of dysplasia. In both groups, we had 2 cases of early intramucosal carcinoma T1 stage. Discussion: The postoperative period of hospitalization is shorter in TAE compared to TAMIS (1.3 days compared to 1.8 days). We had no serious postoperative complications in any of the observed groups. In one case, we had postoperative bleeding, which was treated with endoscopic hemostasis. Such low percentages of postoperative complications, even in our small series of patients, justify the introduction of the TAMIS procedure into daily practice for the surgical treatment of large endoscopically unresectable rectal polyps of high rectal localization. Conclusion: Based on our work and the available literature, we can conclude that radical local resections of TAE and TAMIS are a viable alternative to surgical radical rectal resection in polypoid changes and early T1 rectal cancers with less morbidity, faster recovery, and lower treatment costs. These techniques are safe, effective, and reproducible.

The Relationship between Body Mass Index (BMI) and Clinical Pathological Profile of Invasive Breast Carcinoma Patients in the Department of Anatomic Pathology FKUI/RSCM from 2019 to 2022

Background&#x0D; Breast cancer is the most prevalent malignancy among women and is the second largest contributor to cancer-related deaths globally. Women with a high body mass index (BMI) are at a greater risk of developing breast cancer and an increased risk of lymph node metastasis. This retrospective study aimed to determine the relationship between BMI and the clinical pathological profile of invasive breast carcinoma (IBC) patients.&#x0D; Method&#x0D; This study was conducted from 2019 to 2022. Data were collected through the archives of the Department of Anatomic Pathology FKUI/RSCM (Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital). Clinical pathological data were collected. The histological type, grade, lymphovascular invasion, and lymph node metastasis of the tumors were re-evaluated. The chi-square hypothesis test was used to determine the relationship between BMI and clinical pathological profile. The results were considered statistically significant with a p &lt;0.05.&#x0D; Result&#x0D; A total of 151 cases of IBC with lymph node dissection from 2019 to 2022 were included in this study, all of which were female, with the majority being &gt;50 years old (55%). The most common tumor size and histological type were T2 (39,7%) and invasive ductal carcinoma NST (74,8%), 49% of cases were grade 3 tumors. Most IBC cases had an obese BMI (49%), 63.1% with lymph node metastasis had an overweight-obese BMI. Statistical analysis was performed between BMI and lymph node metastasis status, and p-value=0.025 was obtained. The relationship between tumor size and lymphovascular invasion with lymph node metastasis was also found to be statistically significant, as indicated by a p-value of 0.000.&#x0D; Conclusion&#x0D; Cases with lymph node metastasis had the highest rate of overweight-obesity, and a significant relationship was found between BMI and lymph node metastasis status. A significant relationship was also found between tumor size and lymphovascular invasion with lymph node metastasis.

Excision of malignant and pre-malignant rectal lesions by transanal endoscopic microsurgery in patients under 50 years of age.

The most common technique for treating benign and early malignant rectal lesions is transanal endoscopic microsurgery (TEM). Local excision is an acceptable technique for high-risk and elderly patients, but there are hardly any data regarding young patients. To describe TEM outcomes in patients under 50 years of age. We collected demographic, clinical, and pathological data from all patients under the age of 50 years who underwent the TEM procedure at Hasharon Rabin Medical Center from January 2005 to December 2018. During the study period, a total of 26 patients under the age of 50 years underwent TEM procedures. Their mean age was 43.3 years. Eleven (42.0%) were male. The mean operative time was 67 min, and the mean tumor size was 2.39 cm, with a mean anal verge distance of 8.50 cm. No major intraoperative or postoperative complications were recorded. The median length of stay was 2 d. Seven (26.9%) lesions were adenomas with low-grade dysplasia, four (15.4%) were high-grade dysplasia adenomas, two were T1 carcinomas (7.8%), and three were T2 carcinomas (11.5%). No residual disease was found following endoscopic polypectomy in two patients (7.8%), but four (15.4%) had other pathologies. Surgical margins were negative in all cases. Local recurrence was detected in one patient 33 mo following surgery. Among young adult patients, TEM for benign rectal lesions has excellent outcomes. It may also offer a balance between the efficacy of complete oncologic resection and postoperative quality of life in the treatment of rectal cancer. In some cases, it may be considered an alternative to radical surgery.

Prevalence of Recurrence in Early Tongue Cancer T1 or T2 with or Without Neck Dissection

Background: Patients with T1 T2 N0 mouth or tongue cancer that has been confirmed by a doctor may choose to have a neck dissection. Some say that nodal return of a T1 original tumor is well controlled, while others say that salvage is more often the exception than the rule. Objective: To determine the likelihood of recurrence in T1 or T2 early tongue carcinoma with or without neck dissection. Methods: The prospective cross-sectional clinical study was conducted from March 2021 to March 2023 at the Department of ENT and Head Neck Surgery, Combined Military Hospital, Dhaka. All 100 patients who presented with clinically determined T1 and T2 disease, as defined by the American Joint Committee on Cancer (AJCC), were treated at the Department of Otolaryngology of the Combined Military Hospital in Dhaka and underwent primary surgical resection of the tumor with or without neck dissection. The study eliminated cases of cancer involving the base of the tongue or recurring oral tongue cancer. Results: In the neck dissection group, 3(6%) experienced local recurrence, 2(4%) experienced regional recurrence, and 1 (2%) experienced both (local and regional recurrence). There will be no dissection. 10(20%) Local recurrence, 3 (6%), Regional recurrence, and 1 (2% combined local and regional recurrence). Recurrence was 4(8%) in the neck dissection group and 14(28%) in the no dissection group. Conclusion: In this study, the overall recurrence rate was 8% in neck dissection and 28% in no neck dissection. The overall recurrence rate in the no neck dissection group was significantly greater than in the neck dissection group. Bangladesh J Otorhinolaryngol 2023; 29(1): 5-10

Efficacy and safety of combined EMR and endoscopic full-thickness resection (hybrid EFTR) for large nonlifting colorectal adenomas.

Endoscopic full-thickness resection (EFTR) with a full-thickness resection device (FTRD) has become the standard technique for selected nonlifting colorectal adenomas, but tumor size is the major limitation. However, large lesions might be approached in combination with EMR. Herein, we report the largest single-center experience to date of combined EMR and EFTR (hybrid EFTR) in patients with large (≥25mm) nonlifting colorectal adenomas not amenable to EMR or EFTR alone. This is a single-center retrospective analysis of consecutive patients who underwent hybrid EFTR of large (≥25mm) nonlifting colorectal adenomas. Outcomes of technical success (successful advancement of the FTRD with consecutive successful clip deployment and snare resection), macroscopic complete resection, adverse events, and endoscopic follow-up were evaluated. Seventy-five patients with nonlifting colorectal adenomas were included. Mean lesion size was 36.5mm (range, 25-60mm), and 66.6% were located in the right side of the colon. Technical success was 100% with macroscopic complete resection in 97.3%. Mean procedure time was 83.6 minutes. Adverse events occurred in 6.7%, leading to surgical therapy in 1.3%. Histology revealed T1 carcinoma in 16%. Endoscopic follow-up was available in 93.3% (mean follow-up time, 8.1 months; range, 3-36) and showed no signs of residual or recurrent adenoma in 88.6%. Recurrence (11.4%) was treated endoscopically. Hybrid EFTR is safe and effective for advanced colorectal adenoma that cannot be approached by EMR or EFTR alone. Hybrid EFTR expands the indication of EFTR substantially in selected patients.

Management of the neck in T1 and T2 buccal squamous cell carcinoma

Buccal squamous cell carcinoma (SCC) appears to behave more aggressively than other oral subsites, in particular with regards to regional disease at presentation and regional recurrence. Adequate management of the neck is of the utmost importance but is still the subject of debate. An international multicentre retrospective review of 101 patients treated for T1–T2 buccal SCC was performed. Twenty-four were staged clinical node positive (cN+) and underwent therapeutic neck dissection, while 77 were node negative (cN0), with 32 undergoing elective neck dissection (END), with an occult nodal metastasis rate of 28.1%. Depth of invasion (DOI) < 4 mm was associated with a significantly lower rate of cervical nodal metastasis (87.5% versus 12.5%; P = 0.033). END demonstrated a non-significantly lower regional recurrence rate compared to observation (6.3% versus 8.9%, P = 0.670). Regional recurrence was more common in pN+ (24%) and undissected cases (8.9%) than in pN0 patients (0%) (P = 0.011) and was associated with DOI > 5 mm (P = 0.002). Regional recurrence resulted in a reduction in survival (24 versus 93 months, P < 0.001). In the pT2cN0 group, END improved survival (123 versus 26 months, P = 0.009). It is suggested that END be performed in cT2N0 buccal SCC, particularly for tumours with DOI > 4 mm.

Diagnostic and therapeutic strategies for colorectal tumor with positive muscle-retracting sign.

Endoscopic submucosal dissection (ESD) for colorectal tumors with positive muscle-retracting (MR) sign often results in incomplete resection or discontinuation owing to the difficulty of submucosal dissection. The present study aimed to evaluate the usefulness of endoscopic ultrasonography (EUS) in diagnosing the MR sign and performing ESD using the pocket-creation method (PCM). Thirty-six cases of colorectal tumors with positive MR sign during ESD between January 2015 and December 2021 were retrospectively reviewed. Cases were divided into two groups: 1) the conventional method (CM) group, comprising 29 cases, and 2) the PCM group with seven cases, in which preoperative EUS and ESD using PCM were performed. Treatment outcomes were compared between the groups. The diagnostic yield of EUS for the MR sign was evaluated among large sessile tumors >20 mm in which preoperative EUS was performed. Histologic diagnosis was adenoma or Tis carcinoma in 12 cases (33%), T1 carcinoma in 18 cases (50%), T2 carcinoma in four cases (11%), and unevaluable in two cases (6%). The sensitivity and specificity of the EUS-MR sign for large sessile tumors were 87.5% and 83.3%, respectively. ESD was achieved in all cases in the PCM group, although it was discontinued in eight cases (28%) in the CM group. There were significant differences between the PCM and CM groups in en bloc resection (100% vs. 48%, p = 0.013) and R0 resection rates (71% vs. 31%, p = 0.049). The MR sign can be predicted by preoperative EUS, and ESD using PCM allows en bloc resection.

Programmed death-ligand 1 and p53 as a biomarker in predicting oropharyngeal squamous cell carcinoma

Introduction. Currently, the pathogenetic role of the human papillomavirus (HPV) in carcinogenesis is well studied, that most cases of oropharyngeal squamous cell carcinoma are associated with the persistence of this infection. In addition to HPV infection, the involvement of programmed death-ligand 1 (PD-L1) and p53 proteins in the initiation and progression of oropharyngeal squamous cell carcinoma provides their formation as additional biomarkers in predicting the disease.Aim. To study the prognostic role of PD-L1 and p53 expression in oropharyngeal squamous cell carcinoma depending on HPV status.Materials and methods. The study included 62 patients with oropharyngeal squamous cell carcinoma T1–4N0–3M0 (Tumor, Nodus and Metastasis, (TNM), 7th edition) treated in 2015–2020 at the Republican Specialized Scientific and Practical Medical Center of Oncology and Radiology and in the Tashkent and Samarkand city branches. All patients underwent immunohistochemical analysis for the presence of p16INK4a, PD-L1 and p53 protein expression in formalin-fixed and paraffin-embedded tumor tissue samples.Results. Based on the results of the assessment, it was found that positive HPV status, low and medium levels of PD-L1 expression and positive regulation of wild-type p53 are associated with favorable outcomes in patients with oropharyngeal squamous cell carcinoma. Negative HPV status, high and very high levels of PD-L1 expression, loss of wild type p53 function with upregulation of p53 mutant type leads to worse disease outcomes.Conclusion. Thus, the assessment of the expression of the onco-suppressor protein p53 helps to determine the biology of cancer cells in patients with oropharyngeal squamous cell carcinoma and suggest sensitivity to ongoing therapy, and by studying the regulation of the PD-L1 protein, antitumor immune regulation can be suggested in these patients.

Prediction of Cervical Lymph Node Metastasis in Clinically Node-Negative T1 and T2 Papillary Thyroid Carcinoma Using Supervised Machine Learning Approach.

Papillary thyroid carcinoma (PTC) is generally considered an indolent cancer. However, patients with cervical lymph node metastasis (LNM) have a higher risk of local recurrence. This study evaluated and compared four machine learning (ML)-based classifiers to predict the presence of cervical LNM in clinically node-negative (cN0) T1 and T2 PTC patients. The algorithm was developed using clinicopathological data from 288 patients who underwent total thyroidectomy and prophylactic central neck dissection, with sentinel lymph node biopsy performed to identify lateral LNM. The final ML classifier was selected based on the highest specificity and the lowest degree of overfitting while maintaining a sensitivity of 95%. Among the models evaluated, the k-Nearest Neighbor (k-NN) classifier was found to be the best fit, with an area under the receiver operating characteristic curve of 0.72, and sensitivity, specificity, positive and negative predictive values, F1 and F2 scores of 98%, 27%, 56%, 93%, 72%, and 85%, respectively. A web application based on a sensitivity-optimized kNN classifier was also created to predict the potential of cervical LNM, allowing users to explore and potentially build upon the model. These findings suggest that ML can improve the prediction of LNM in cN0 T1 and T2 PTC patients, thereby aiding in individual treatment planning.

Consideration for reclassification of pathologically upstaged T3a renal cell carcinomas.

644 Background: Pathological upstaging to pT3a disease can occur after the surgical treatment of clinical T1 and T2 Renal Cell Carcinomas (RCCs), and this upstaging has been previously shown to be associated with poorer outcomes. With an intent to delve deeper into the disparateness in outcomes of pT3a disease, we investigated the survival of patients with an initial clinical stage of cT1, cT2 and cT3a. Methods: Using the National Cancer Database (NCDB), patients with RCC were categorized by pathological and clinical staging of RCC according to the American Joint Committee on Cancer Guidelines (AJCC). The primary outcome was measured as overall survival (OS) at the end of follow up. Five-year survival rates and Kaplan-Meier Analysis assessed the differences between cT1 → pT3a, cT2 → pT2, cT2 → pT3a, and cT3a → pT3a. Multivariable cox regression (MVA) assessed predictors OS with age, sex, ethnicity, Charlson Score, socioeconomic status, geography, tumor size histology and grade, lymph node metastasis, surgical margins, and surgery type (partial versus radical nephrectomy) as covariates. Results: 53908 patients were analyzed (10789 cT1 → pT3a, 22183 cT2 → pT2, 9676 cT2 → pT3a, 11260 cT3a → pT3a, mean follow up 62.3 months). Of all pT3a patients, 64.5% were upstaged from cT1-2. MVA for OS demonstrated Hispanic ethnicity to be protective (hazard ratio [HR]=0.88, P&lt;0.001) and revealed different histologic risks. MVA for OS demonstrated that cT2 → pT3a (HR=1.33, P&lt;0.001, cT1 → pT3a [ref]) and cT3a → pT3a (HR=1.35, P&lt;0.001, cT1 → pT3a [ref]) were associated with worsened OS, and that cT1 → pT3a and cT2 → pT2 (HR=0.96, P&lt;0.052, cT1 → pT3a [ref]) were associated with improved OS. Kaplan-Meier analysis revealed a difference in 5 year overall survival as well (cT1→pT3a 72%, cT2→pT2 77%, cT2→pT3a 61%, and cT3a→pT3a 59%, p &lt; 0.001). Conclusions: Patients with cT1 upstaged to pT3a have similar outcomes to cT2 staged to pT2 and better outcomes than cT2 upstaged with the latter’s outcomes being more like cT3a staged to pT3a. The TNM staging system from AJCC for RCCs should consider these outcomes and adjust the grouping for RCCs accordingly.

Proposal for reclassification of T1 and T2A renal cell carcinoma: Analysis of the National Cancer Database

Proposal for reclassification of T1 and T2A renal cell carcinoma: Analysis of the National Cancer Database