Cancer TNM Staging Research Articles

Malignant Cutaneous Tumors

This chapter reviews the most common malignant cutaneous tumors. The section on malignant tumors of the epidermis discusses nonmelanoma skin cancer (i.e., basal cell carcinoma and squamous cell carcinoma) and malignant melanoma. The section on malignant tumors of the dermis covers metastatic tumors, primary tumors (Merkel cell carcinoma, Paget disease, extramammary Paget disease, angiosarcoma, and dermatofibrosarcoma protuberans), and Kaposi sarcoma (i.e., classic Kaposi sarcoma, African Kaposi sarcoma, organ-transplant Kaposi sarcoma, and HIV-associated Kaposi sarcoma). The final section covers cutaneous lymphomas. The coverage of each disease includes a discussion of epidemiology, etiology, diagnosis, differential diagnosis, treatment, and prognosis. Tables provide the adjusted estimated relative risks of melanoma by nevus type and number, the American Joint Committee on Cancer (AJCC) TNM classification and staging system, the estimated probability of 10-year survival in patients with primary cutaneous melanoma, and an overview of overview of therapy for cutaneous T cell lymphoma. Figures illustrate the presentation of many malignant cutaneous tumors. This review contains 10 highly rendered figures, 5 tables, and 105 references.

Malignant Cutaneous Tumors

This chapter reviews the most common malignant cutaneous tumors. The section on malignant tumors of the epidermis discusses nonmelanoma skin cancer (i.e., basal cell carcinoma and squamous cell carcinoma) and malignant melanoma. The section on malignant tumors of the dermis covers metastatic tumors, primary tumors (Merkel cell carcinoma, Paget disease, extramammary Paget disease, angiosarcoma, and dermatofibrosarcoma protuberans), and Kaposi sarcoma (i.e., classic Kaposi sarcoma, African Kaposi sarcoma, organ-transplant Kaposi sarcoma, and HIV-associated Kaposi sarcoma). The final section covers cutaneous lymphomas. The coverage of each disease includes a discussion of epidemiology, etiology, diagnosis, differential diagnosis, treatment, and prognosis. Tables provide the adjusted estimated relative risks of melanoma by nevus type and number, the American Joint Committee on Cancer (AJCC) TNM classification and staging system, the estimated probability of 10-year survival in patients with primary cutaneous melanoma, and an overview of overview of therapy for cutaneous T cell lymphoma. Figures illustrate the presentation of many malignant cutaneous tumors. This review contains 10 highly rendered figures, 5 tables, and 105 references.

Malignant Cutaneous Tumors

This chapter reviews the most common malignant cutaneous tumors. The section on malignant tumors of the epidermis discusses nonmelanoma skin cancer (i.e., basal cell carcinoma and squamous cell carcinoma) and malignant melanoma. The section on malignant tumors of the dermis covers metastatic tumors, primary tumors (Merkel cell carcinoma, Paget disease, extramammary Paget disease, angiosarcoma, and dermatofibrosarcoma protuberans), and Kaposi sarcoma (i.e., classic Kaposi sarcoma, African Kaposi sarcoma, organ-transplant Kaposi sarcoma, and HIV-associated Kaposi sarcoma). The final section covers cutaneous lymphomas. The coverage of each disease includes a discussion of epidemiology, etiology, diagnosis, differential diagnosis, treatment, and prognosis. Tables provide the adjusted estimated relative risks of melanoma by nevus type and number, the American Joint Committee on Cancer (AJCC) TNM classification and staging system, the estimated probability of 10-year survival in patients with primary cutaneous melanoma, and an overview of overview of therapy for cutaneous T cell lymphoma. Figures illustrate the presentation of many malignant cutaneous tumors. This review contains 10 highly rendered figures, 5 tables, and 105 references.

A New Prognostic Model for Radiation-Based Hepatocellular Carcinoma Treatment

Background: There are no clinical staging models based on radiotherapy for HCC. Existing models of hepatocellular carcinoma (HCC) staging may not predict the prognosis of radiotherapy perfectly. Therefore, in this study, we created a new staging model for radiotherapy-based treatment for the prognostic classification of HCC. Methods: This multicenter cohort study included 1191 patients with HCC. The training cohort included 658 patients, who underwent stereotactic body radiotherapy, and the external validation cohort included 533 patients, who underwent intensity-modulated radiotherapy. The new staging model, and existing Barcelona Clinic Liver Cancer (BCLC), TNM, and China Liver Cancer (CNLC) staging systems, were used for prognostic analyses. Patients with HCC treated with radiotherapy were separated into different stages and substages. Long-term overall survival outcomes and time-dependent receiver operating characteristic (ROC) curves were analyzed. Findings: In the training cohort, the median follow-up time was 60·0 months (range, 6–100 months). The new staging model could separate patients into different stages with four notably different curves, and substage s with seven notably different curves. The BCLC, TNM, and CNLC staging systems could not differentiate among all the stages. In the external validation cohort, the median follow-up time was 58·0 months (range, 6–120 months). The new staging system showed discriminatory ability similar to the training cohort and a better area under the curve of time-dependent ROC compared to BCLC, TNM, and CNLC staging in the entire cohort. Interpretation: The modified staging model showed good discriminatory ability to separate patients into different stages and substages after radiotherapy and may supplement other HCC staging systems. Funding Information: National Natural Science Foundation of China (81903257); China International Medical Foundation-Tumor Precise Radiotherapy Spark Program (2019-N-11-01); Guangxi Natural Science Foundation (2020GXNSFAA297171); Guangxi BaGui Scholars’ Special Fund; Guangxi Medical University Training Program for Distinguished Young Scholars; High-level innovation team and outstanding scholar program in Guangxi Colleges and Universities. Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki as reflected in a priori approval by the Ethics Committees of Guangxi Medical University Cancer Hospital and the respective institutions (LW2021008). Written informed consent was obtained from each patient included in the study.

The clinicopathological and survival analysis of urological mucosal melanoma: A single-center retrospective observational study.

e21588 Background: Primary mucosal melanoma arising in the urinary tract is rare and poorly characterized. Methods: The records of patients with urological mucosal melanoma who presented to the department of Renal Cancer and Melanoma of Peking University Cancer Hospital between September, 2004 and April, 2019 were reviewed. Available clinicopathological and molecular characteristics were summarized, including pathological parameters, gene mutation, primary surgical intervention, systemic treatment and clinical course. The rates of local recurrence rate, loco-regional lymph node metastasis and distant metastasis were assessed. American Joint Committee on Cancer (AJCC) TNM Staging System for bladder cancer/renal pelvis and ureter cancer/urethral carcinoma (8th ed., 2017) were adopted for staging. Results: Fifty-eight patients were involved in the study with a median age of 62.5 years (range: 32-82). The anatomic sites of the primary urological mucosal melanomas were from the urethra (89.7%), bladder (6.9%), ureter (0%) and kidney (0%), and the left (4.4%) were from multiple loci. At initial diagnosis, 75.9% (n=44) were stage I/II disease, 1.7% (n=1) stage III, and 22.4% (n=13) stage IV. There was 3.4% incidence of CKIT mutation and 1.7% of BRAF mutation. After median follow-up of 22.6 mo, 31.4% (16/51) relapsed locally after organ-preserved surgery. 21.6% (11/51) and 39.2% (20/51) developed metastases to reginal lymph nodes and distance, respectively. The median relapse free survival and median overall survival were 12.2 (95%CI: 7.9-16.4) mo and 33.9 (95%CI: 19.2-48.6) mo, respectively. Univariate Cox analysis showed that TNM stage and systemic adjuvant therapy were the prognostic factors of OS, while no association was found with Breslow thickness, miotic rate, ulceration and gender. Conclusions: Urological mucosal melanoma predominantly arises from lower urinary tract with rare BRAF and CKIT mutation. AJCC TNM Staging System for urothelial carcinoma is proved practical for urothelial melanoma, which should be validated in larger population. Future research is required to identify adjuvant treatment approaches to improve disease outcomes.

Comparative assessment of the eighth and seventh AJCC staging edition prognostic performance of patients with p16 positive oropharynx cancer.

6067 Background: The American Joint Committee on Cancer (AJCC) TNM staging system defines the anatomical extent of disease and serves as a guide for treatment and prognosis. The favorable prognosis of p16+ oropharyngeal squamous cell carcinoma (OPSCC) compared to p16 negative counterpart led to major updates in the AJCC 8th edition. Its prognostic performance, however, warrants further validation. Methods: We included patients diagnosed with p16+ OPSCC enrolled in a prospective registry ( Stiefel) at The University of Texas MD Anderson Cancer Center between March 2015 and December 2018. Patients’ stage at diagnosis was classified according to the AJCC 7th (AJCC-7) and 8th (AJCC-8) editions. Overall survival (OS) and progression-free survival (PFS) was defined as time from diagnosis to death or to progression or death, respectively. The Kaplan-Meier method was used to calculate 1- and 3-year survival probabilities. Differences between groups were compared using the log-rank test. Prognostic discriminative performance of each staging system was evaluated using Harrel’s C-statistic. Survival differences between heavy (> 10 pack-years [PY]) vs. light/never smokers (≤ 10 PY) by AJCC-8 staging groups was assessed with the log-rank test. Results: Of 463 patients, the median follow-up was 34.7 months (2.3-169.74). Nearly 90% (N=413) of patients were down-staged from AJCC-7 to AJCC-8 with 69% of patients with IVA disease based on AJCC-7 (N=319) re-staged as stage I (N=196 [42%]), II (N=79 [17%]) or III (44 [10%]) according to AJCC-8. Over 60% (N=279) of patients were staged as I with AJCC-8. Compared to AJCC-7, AJCC-8 had improved prognostic ability (C-statistic, 0.58 for AJCC-7 vs. 0.63 for AJCC-8) and provided better discriminative survival probabilities at 1 and 3-year follow-up (Table). Similar results were observed for PFS. Smoking status did not impact OS when stratified by AJCC-8 staging groups: I, p=0.347; II, p=0.310; and III, p=0.532 for > 10 vs. ≤ 10 PY. Conclusions: Our cohort validates that the AJCC-8 provides better prognostic discriminative performance when compared to AJCC-7, however, a disproportionate number of patients were classified as stage I. Smoking was not associated with survival within each staging group.[Table: see text]

MiR-205 suppressed the malignant behaviors of breast cancer cells by targeting CLDN11 via modulation of the epithelial-to-mesenchymal transition.

Some Aberrant expression of miRNAs plays an important role in the occurrence and distant metastasis of breast cancer. This study aimed to identify crucial miRNA signatures for breast cancer using microarray data from the Gene Expression Omnibus database, including ductal carcinoma in situ and invasive duct carcinoma. In this study, we founded that miR-205 was significantly down-regulated in breast cancer, and the low expression of miR-205 was significantly associated with the TNM stage of breast cancer. In vitro, functional studies revealed that over-expression of miR-205 inhibited the proliferation and promoted apoptosis of breast cancer cells MDA-MB-231. Mechanistically, claudin 11 (CLDN11) was found to be the direct target of miR-205; the function of miR-205 could be exerted via downregulation of the target gene CLDN11 in breast cancer cells. Furthermore, the over-expression of miR-205 promoted the expression of the epithelial marker E-cadherin but reduced the mesenchymal markers in breast cancer cells. These results collectively indicated the tumor-suppressive role of miR-205 in breast cancer by targeting CLDN11; implying miR-205 may serve as a novel therapeutic target for breast cancer.

Aggressive Thyroid Cancer is Associated With Suppressor Circulating Immunophenotype

Abstract Introduction: The influence of the immune system on follicular cell-derived thyroid cancer behavior has been suggested by various studies but this information has not been comprehensively translated into a prediction for thyroid cancer prognosis. We aimed to identify circulating immune cell profiles associated with thyroid cancer prognosis. This information would be a significant advance in the field of thyroid cancer management. Methods: We performed a single-center prospective cohort study of 32 follicular-cell derived thyroid cancer patients enrolled at the time of initial or subsequent surgery. We performed peripheral blood multi-parameter flow cytometry and collected relevant clinicopathologic, biochemical and radiologic data. We classified patients based on the AJCC TNM cancer stage, American Thyroid Association (ATA) initial risk of recurrence, and status of disease during follow-up. Results: On initial immunophenotyping, patients with aggressive/advanced thyroid cancer (ATA high risk vs. intermediate/low risk; AJCC stage 3/4 vs. 1/2; recurrence or distant metastases vs. no evidence of disease during follow-up) demonstrated increased circulating monocytes and granulocytes but decreased all lymphocytes, T cells (specifically CD4+ and gamma delta) and natural killer (NK) T-like cells. Further immunophenotyping revealed that aggressive/advanced thyroid cancer had increased circulating CD4+CD45+RO effector memory but decreased CD4+CD45+RA central memory T cells and increased regulatory T cells. Stage 3/4 thyroid cancer patients additionally had increased circulating CD33+HLADR- myeloid-derived suppressor cells (MDSCs) as compared to stage1/2. Conclusions: Aggressive thyroid cancer at presentation (AJCC stage, ATA risk category) or during follow-up (distant metastases) is characterized by a circulating immunophenotype comprising of increased immune suppressor cells (regulatory T cells, MDSCs, effector memory T cells) but decreased immune activator cells (CD4+ T cells, gamma delta T cells, NK T-like cells, central memory T cells) as compared to less aggressive thyroid cancer. This circulating immunophenotype may serve as a biomarker for cancer prognosis and guide the selection and development of novel immunotherapies for advanced thyroid cancer.

Development and external validation of a nomogram predicting overall survival after curative resection of colon cancer.

ObjectiveTo develop and externally validate a prognostic nomogram to predict overall survival (OS) in patients with resectable colon cancer.MethodsData for 50,996 patients diagnosed with non-metastatic colon cancer were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were assigned randomly to the training set (n = 34,168) or validation set (n = 16,828). Independent prognostic factors were identified by multivariate Cox proportional hazards regression analysis and used to construct the nomogram. Harrell’s C-index and calibration plots were calculated using the SEER validation set. Additional external validation was performed using a Chinese dataset (n = 342).ResultsHarrell’s C-index of the nomogram for OS in the SEER validation set was 0.71, which was superior to that using the 7th edition of the American Joint Committee on Cancer TNM staging (0.59). Calibration plots showed consistency between actual observations and predicted 1-, 3-, and 5-year survival. Harrell’s C-index (0.72) and calibration plot showed excellent predictive accuracy in the external validation set.ConclusionsWe developed a nomogram to predict OS after curative resection for colon cancer. Validation using the SEER and external datasets revealed good discrimination and calibration. This nomogram may help predict individual survival in patients with colon cancer.

Clinical study of CT enhanced scan in preoperative TNM staging of advanced gastric cancer and the effect of misdiagnosis rate.

Clinical study of CT enhanced scan in preoperative TNM staging of advanced gastric cancer and the effect of misdiagnosis rate.

Pre-colectomy location and TNM staging of colon cancer by the computed tomography colonography: a diagnostic performance study

BackgroundThe Chinese Society of Clinical Oncology guidelines 2018 and the recent update of that (version 2020) recommends accurate examination before major treatment for decision(s) in cases of colon cancer. Also, the difficulty in the identification of the lesion during colectomy may lead to resection of a wrong segment of the colon or a more extensive resection than planned. Accurate pre-colectomy local staging of colon cancer is required to make decisions for treatment of colon cancer. The objective of the study was to evaluate the diagnostic performance of the computed tomography colonography (CTC) for pre-colectomy tumor location and tumor, node, and metastasis (TNM) staging of colon cancer.MethodsData of preoperative colonoscopies, CTC, surgeries, and surgical pathology of a total of 269 patients diagnosed with colon cancer by colonoscopy and biopsy and underwent pre-colectomy location and TNM staging by CTC were collected and analyzed. The consistency between the radiological and the surgery/surgical-pathological for location and TN stages of colon tumor were estimated with the weighted kappa or kappa coefficient (κ) at 95% confidence interval (CI).ResultsCTC detected 261 (93%) and colonoscopy detected 201 (72%) correct locations of tumors. Sensitivity and accuracy of CTC for detection of location of colon tumors were 100% and 92.58% (κ = 0.89; 95% Cl: 0.83–0.95). 72.48% sensitivity, 90.64% specificity, and 83.57% accuracy were reported for CTC in differentiation of tumors confined to the colon wall (T1/T2) from advanced tumors (T3/T4) (κ = 0.69, 95% Cl: 0.51–0.75). 81.01% sensitivity, 89.11% specificity, and 83.93% accuracy of CTC was reported for differentiation of tumors between low–intermediate risk and high risk (κ = 0.68, 95% Cl: 0.53–0.75). 69.31% sensitivity, 66.15% specificity, and 67.14% accuracy of CTC were reported for N staging of tumors (κ = 0.41, 95% Cl: 0.59–0.69).ConclusionsCTC has high diagnostic parameters for pre-colectomy location and T staging of colon tumors except patients of colon cancer who received neoadjuvant chemotherapy.Level of EvidenceIII.Technical Efficacy Stage2.

Diagnostic rather than prognostic markers-relationship between EpCAM overexpression and lung cancer: a meta-analysis.

Epithelial cell adhesion molecule (EpCAM) is one of the most commonly used markers of cancer stem cells (CSCs). However, the diagnostic and prognostic significance of EpCAM in lung cancer remains largely undetermined. In the present study, we systematically summarized and elucidated the correlation between EpCAM overexpression and lung cancer through a meta-analysis. Six databases (PubMed, Web of Science, Cochrane Library, and Embase, CnKI and Wanfang Database) were systematically searched. Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) criteria were adopted to assess the qualities of the included studies. Relevant data were extracted for meta-analysis using the Stata12.0 software. Unadjusted mixed odds ratios (ORs) or hazard ratios (HRs) with 95% confidence interval (95% CI) were estimated to evaluate the correlation between EpCAM overexpression and lung cancer. The sensitivity and specificity of the included studies were used to construct the summary receiver operator characteristic (SROC) curve and calculate the area under the SROC curve (AUC). A total of 14 studies consisting of 2,658 lung cancer patients were included following the PICOS principle. We found that the EpCAM expression was significantly higher in lung cancer patients compared with normal controls, including patients with benign pulmonary diseases (OR =63.71, 95% CI, 14.59-278.21, P=0.003) and healthy individuals (OR =520.08, 95% CI, 16.38-16,510.80, P=0.002), and its overexpression was negatively associated with the TNM stage (III + IV) (OR =0.41, 95% CI, 0.21-0.82, P=0.073. The combined sensitivity and specificity of EpCAM overexpression in the diagnosis of lung cancer were 0.79 (95% CI, 0.59-0.90) and 0.98 (95% CI, 0.95-0.99), respectively, and the SROC-AUC was 0.98 (95% CI, 0.97-0.99). Multivariate analysis of 322 lung cancer patients showed that there was no significant correlation between the EpCAM overexpression and prognosis of lung cancer (HR =2.28, 95% CI, 0.80-6.51, P=0.002). Deeks' funnel plot analysis showed the existence of publication bias (P=0.000). Our present findings suggested that EpCAM overexpression was not sensitive enough to predict the prognosis of lung cancer. Moreover, it was also a potential diagnostic indicator for lung cancer and correlated with TNM staging of lung cancer.

Controlling nutritional status score as a prognostic marker to predict overall survival in resected biliary tract cancers.

BackgroundThe aim of our study was to explore the prognostic significance of the preoperative controlling nutritional status (CONUT) score and establish a nomogram to predict overall survival (OS) and to achieve a more accurate prognostic risk stratification.MethodsClinicopathological records of 371 patients who underwent surgical resection for biliary tract cancers (BTC) from December 2002 to December 2017 were reviewed retrospectively. The associations of the CONUT score with clinicopathological factors and OS were evaluated. Univariate and multivariable Cox regression analysis were used to screen out independent predictors. A nomogram was developed and validated to estimate OS.ResultsThe CONUT score was an independent predictor of OS [hazard ratio 1.478, 95% confidence interval (CI), 1.078–2.025, P=0.015]. And patients with a high CONUT score tended to have a poor prognosis with poor differentiation (P=0.011) of tumor cells and longer hospital stays (P=0.046). Besides the CONUT score, carbohydrate antigen 19-9, surgical method, and the American Joint Committee on Cancer (AJCC; 7th edition) TNM stage were contained in the final prognostic model. An OS nomogram was generated to visually predict 1-, 3-, and 5-year OS. The C-index was 0.714 (95% CI, 0.673–0.755) and 0.679 (95% CI, 0.616–0.742) in the development and validation cohort respectively. The nomogram provided superior discriminative power than the AJCC TNM staging system. The nomogram also demonstrated good risk stratification power in the entire cohort of BTC patients as well as for both BTC and surgical method subgroups.ConclusionsThe nomogram based on the CONUT score can predict OS in patients with BTCs, and it performed better than the AJCC TNM staging system.

Factors leading to the risk of stroke mortality: a cross-sectional study with lung cancer patient-based large sample.

To identify the risk factors for stroke mortality among lung cancer patients on the basis of the Surveillance, Epidemiology, and End Results (SEER) database. The clinical data of lung cancer patients diagnosed between 2004 and 2016 were collected in the SEER database. The stroke mortality of lung cancer patients was compared with the general population using standardized mortality ratios (SMRs). COX proportional hazard model was applied to analyze the risk factors for stroke mortality among lung cancer patients. Among 82 454 patients, 4821 (5.85%) died of stroke. The stroke mortality rate in lung cancer patients significantly increased compared with the general population [SMR: 1.73, 95% confidential interval (95% CI), 1.69–1.78]. Differences were pronounced between the patients with stroke death and those without regarding all the basic characteristics (P < 0.001). Multivariate COX analysis showed that the risk factors for stroke mortality among lung cancer patients included increasing age, males, the black, grade II–III, distant metastasis and higher American Joint Committee on Cancer (AJCC) TNM stage, whereas adenocarcinoma was found to be a protective factor compared with squamous cell carcinoma. Increasing age, males, the black, grade II–III, distant metastasis and higher TNM stage are associated with an increased risk of stroke mortality among lung cancer patients, but adenocarcinoma with a lowered risk.

What are survivorship care plans failing to tell men after prostate cancer treatment?

Survivorship care plans contain important information for patients and primary care physicians regarding appropriate care for cancer survivors after treatment. We describe the completeness of prostate cancer survivorship care plans and evaluate the concordance of follow-up recommendations with guidelines. We analyzed 119 prostate cancer survivorship care plans from one academic and one community cancer center, abstracting demographics, cancer/treatment details, and follow-up recommendations. Follow-up recommendations were compared with the American Cancer Society (ACS), American Society of Clinical Oncology (ASCO), and National Comprehensive Cancer Network (NCCN) guidelines. Content in >90% of plans included cancer TNM stage; prostate-specific antigen (PSA) at diagnosis; radiation treatment details (98% of men received radiation); and PSA monitoring recommendations. Potential treatment-specific side effects were listed for 82% of men who had surgery, 86% who received androgen deprivation therapy (ADT), and 97% who underwent radiation. The presence of posttreatment symptoms was noted in 71% of plans. Regarding surveillance follow-up, all guidelines recommend an annual digital rectal exam (DRE). No plans specified DRE. However, all 71 plans at the community site recommended at least annual follow-up visits with urology, radiation oncology, and primary care. Only 2/48 plans at the academic site specified follow-up visits. All guidelines recommend PSA testing every 6-12 months for 5 years, then annually. For the first 5 years, 90% of plans were guideline-concordant, 8% suggested oversurveillance, and 2% were incomplete. In men receiving ADT, ACS and ASCO recommend bone density imaging and NCCN recommends testosterone levels. Of 77 men on ADT, 1% were recommended bone density imaging and 16% testosterone level testing. While care plan content is more complete for demographic and treatment summary information, both sites had gaps in reporting posttreatment symptoms and ADT-related testing recommendations. These findings highlight the need to improve the quality of information in care plans, which are important in communicating appropriate follow-up recommendations to patients and primary care physicians.

Distant Lymph Node Metastases From Breast Cancer—Is it Time to Review TNM Cancer Staging?

Distant Lymph Node Metastases From Breast Cancer—Is it Time to Review TNM Cancer Staging?

Pegylated liposomal doxorubicin-induced hand-foot syndrome predicted by serum metabolomic profiling and prevented by calcium dobesilate

Pegylated liposomal doxorubicin-induced hand-foot syndrome predicted by serum metabolomic profiling and prevented by calcium dobesilate

Survival prediction after upfront surgery in patients with pancreatic ductal adenocarcinoma: Radiomic, clinic-pathologic and body composition analysis

ObjectiveTo investigate the value of radiomic features at contrast-enhanced CT integrated with clinic-pathologic features and body composition measures for predicting survival after upfront surgery in patients with pancreatic ductal adenocarcinoma (PDAC). MethodsTwo hundred and ninety-nine patients with PDAC who underwent surgical resection were included and allocated to training set (210 patients) and validation set (89 patients). The radiomics signature for predicting survival was constructed by using the least absolute shrinkage and selection operator Cox regression. Multivariable Cox regression analysis was used to construct a radiomics model based on radiomics signature, clinic-pathologic features and body composition measures. A clinical model without radiomics signature was also developed. Model performance was analyzed by Harrell’s concordance index (C-index) and time-independent receiver operating characteristic (ROC) analysis. The Kaplan-Meier (KM) method was used for survival analysis. ResultsFive independent variables were selected for the radiomics model: radiomics signature, carbohydrate antigen 19–9, skeletal muscle index, histologic grade and postoperative chemotherapy. The radiomics-based model provided better predictive performance (C-index = 0.73; all p < 0.05) than the clinical model without radiomics signature and American Joint Committee on Cancer (AJCC) TNM staging system. Patients were stratified as high-risk and low-risk group by the radiomics model. The KM analysis showed a significant difference between two groups (p < 0.05). ConclusionThe radiovdmics-based model integrating with clinic-pathologic features and body composition measures could predict survival after surgical resection in PDAC patients.

Relationship of depth of invasion to survival outcomes and patterns of recurrence for T3 oral tongue squamous cell carcinoma

IntroductionCurrent research is elucidating how the addition of depth of invasion (DOI) to the 8th edition of the American Joint Committee on Cancer (AJCC) TNM staging for oral cavity squamous cell carcinoma influences its prognostic accuracy. However, there is limited research on survival in pT3N0M0 oral tongue SCC (OTSCC) patients when stratifying by DOI. ObjectivesDetermine 5-year overall survival (OS), and cancer-specific survival (CSS) for patients with pT3N0M0 oral OTSCC based on shallow DOI (<10 mm) and deep DOI (10–20 mm). MethodsRetrospective review involving three tertiary care cancer centers in North America. cT3N0M0 OTSCC patients receiving primary surgical treatment from 2004 to 2018 were identified. Inclusion: age > 18 years old and confirmation of pT3N0M0 OTSCC on surgical pathology. Exclusion: patients undergoing palliative treatment or previous head and neck surgery/radiotherapy. Analysis comprised two groups: shallow pT3 (tumor diameter > 4 cm, DOI < 10 mm) and deep pT3 (DOI 10 mm-20 mm). ResultsOne hundred and four patients with pT3N0M0 OTSCC were included. Mean age was 59.1 years (range: 18–80.74). Age, gender, and Charlson Comorbidity Index were similar between the two groups (p > 0.05). Recurrence, LVI, PNI, and positive margins were more common in deep T3 tumors (P < 0.05). 5-year OS (50% vs 26%, p = 0.006) and CSS (72% vs 24%, p = 0.005) were worse in deep pT3 tumors. Deep pT3 disease was an independent predictor of OS (p = 0.004) and CSS (p = 0.01) on Cox-Regression analysis. ConclusionDOI is an independent predictor of poor survival in pT3N0M0 OTSCC patients. Consideration should be given to escalating adjuvant therapy for deep pT3N0M0 OTSCC patients.

Influence of body mass index at diagnosis on outcome of thyroid cancer in children and adolescents

PurposeTo systemically examine the relationship between body mass index, the extent of thyroid cancer and metastatic burden at diagnosis, and overall outcomes in children and adolescents with thyroid cancer. MethodsA retrospective series of children and adolescents with differentiated thyroid cancer who underwent total thyroidectomy and 131I therapy was analyzed. Body mass index (BMI) at the time of surgery was assessed. The Chinese age- and sex-specific BMI percentile criteria for screening overweight and obesity in children and adolescents were used to define the overweight and obesity among patients. The relationship between BMI and clinicopathological features and clinical outcomes of the disease was evaluated by logistic regression modeling, incorporating the eighth edition of the American Joint Committee on Cancer TNM staging system and the 2015 American Thyroid Association guidelines. ResultsThis study included 181 children and adolescents with differentiated thyroid cancer (82.9% females, median age 17 years). The mean BMI was 21.0 ± 3.9 kg/m2; 77.9% of the patients (N = 141) were normal weight, 13.2% (N = 24) were overweight, and 8.8% (N = 16) were obese. No positive associations were noted between BMI and T, N, or M stage on logistic regression analyses. The absence of an association was also demonstrated on analysis by BMI categories. After a median follow-up of 51 months, 114 children and adolescents (63.0%) had achieved excellent response to therapy. No associations were noted for persistent/recurrent disease among BMI groups. ConclusionOur study highlights the absence of increased disease burden at the time of thyroid cancer diagnosis in pediatric patients with high BMI along with the same prognosis compared with normal-weight pediatric patients.