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Qiu Y, Chen Y, Shen H, Yan S, Li J, Wu W. Naples Prognostic Score: A Novel Predictor of Survival in Patients with Triple-Negative Breast Cancer. J Inflamm Res 2024; 17:5253-5269. [PMID: 39135978 PMCID: PMC11318610 DOI: 10.2147/jir.s472917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 08/02/2024] [Indexed: 08/15/2024] Open
Abstract
Purpose This study investigated the correlation between the Naples prognostic score (NPS), clinicopathological traits, and the postoperative prognoses of patients with triple-negative breast cancer (TNBC). Based on NPS, a predictive nomogram was developed to estimate the long-term survival probabilities of patients with TNBC post-surgery. Patients and Methods We retrospectively examined the clinical records of 223 women with TNBC treated at Ningbo Medical Center, Lihuili Hospital between January 1, 2016 and December 31, 2020. Blood tests and biochemical analyses were conducted before surgery. The prognostic nutritional index (PNI), controlling nutritional status (CONUT), neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and NPS were determined based on blood-related markers. A Kaplan-Meier survival analysis assessed the association between NPS, PNI, CONUT score, overall survival (OS), and breast cancer-specific survival (BCSS). Predictive accuracy was evaluated using the area under the receiver operating characteristic curve (AUC) and C index. The patients were randomly divided into the training and the validation group (6:4 ratio). A nomogram prediction model was developed and evaluated using the R Software for Statistical Computing (RMS) package. Results NPS outperformed other scores in predicting inflammation outcomes. Patients with an elevated NPS had a poorer prognosis (P<0.001). Lymph node ratio (LNR), surgical method, postoperative chemotherapy, and NPS independently predicted OS, whereas M stage, LNR, and NPS independently predicted BCSS outcome. The OS and BCSS predicted by the nomogram model aligned well with the actual OS and BCSS. The decision curve analysis showed significant clinical utility for the nomogram model. Conclusion In this study, NPS was an important prognostic indicator for patients with TNBC. The nomogram prognostic model based on NPS outperformed other prognostic scores for predicting patient prognosis. The model demonstrated a clear stratification ability for patient prognosis, which emphasized the potential benefits of early intervention for high-risk patients.
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Affiliation(s)
- Yu Qiu
- The Affiliated Lihuili Hospital, Ningbo University, Ningbo, 315000, People’s Republic of China
- Health Science Center, Ningbo University, Ningbo, Zhejiang, 315000, People’s Republic of China
| | - Yan Chen
- The Affiliated Lihuili Hospital, Ningbo University, Ningbo, 315000, People’s Republic of China
- Health Science Center, Ningbo University, Ningbo, Zhejiang, 315000, People’s Republic of China
| | - Haoyang Shen
- The Affiliated Lihuili Hospital, Ningbo University, Ningbo, 315000, People’s Republic of China
- Health Science Center, Ningbo University, Ningbo, Zhejiang, 315000, People’s Republic of China
| | - Shuixin Yan
- The Affiliated Lihuili Hospital, Ningbo University, Ningbo, 315000, People’s Republic of China
- Health Science Center, Ningbo University, Ningbo, Zhejiang, 315000, People’s Republic of China
| | - Jiadi Li
- The Affiliated Lihuili Hospital, Ningbo University, Ningbo, 315000, People’s Republic of China
- Health Science Center, Ningbo University, Ningbo, Zhejiang, 315000, People’s Republic of China
| | - Weizhu Wu
- The Affiliated Lihuili Hospital, Ningbo University, Ningbo, 315000, People’s Republic of China
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Bartlett JM, Xu K, Wong J, Pond G, Zhang Y, Spears M, Salunga R, Mallon E, Taylor KJ, Hasenburg A, Markopoulos C, Dirix L, van de Velde CJ, Rea D, Schnabel CA, Treuner K, Bayani J. Validation of the Prognostic Performance of Breast Cancer Index in Hormone Receptor-Positive Postmenopausal Breast Cancer Patients in the TEAM Trial. Clin Cancer Res 2024; 30:1509-1517. [PMID: 38345755 PMCID: PMC11016895 DOI: 10.1158/1078-0432.ccr-23-2436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/01/2023] [Accepted: 02/08/2024] [Indexed: 04/16/2024]
Abstract
PURPOSE Patients with early-stage hormone receptor-positive (HR+) breast cancer face a prolonged risk of recurrence even after adjuvant endocrine therapy. The Breast Cancer Index (BCI) is significantly prognostic for overall (0-10 years) and late (5-10 years) distant recurrence (DR) risk in N0 and N1 patients. Here, BCI prognostic performance was evaluated in HR+ postmenopausal women from the Tamoxifen and Exemestane Adjuvant Multinational (TEAM) trial. EXPERIMENTAL DESIGN 3,544 patients were included in the analysis (N = 1,519 N0, N = 2,025 N+). BCI risk groups were calculated using pre-specified cutoff points. Kaplan-Meier analyses and log-rank tests were used to assess the prognostic significance of BCI risk groups based on DR. Hazard ratios (HR) and confidence intervals (CI) were calculated using Cox models with and without clinical covariates. RESULTS For overall 10-year DR, BCI was significantly prognostic in Ni0 (N = 1,196) and N1 (N = 1,234) patients who did not receive prior chemotherapy (P < 0.001). In patients who were DR-free for 5 years, 10-year late DR rates for low- and high-risk groups were 5.4% and 9.3% (N0 cohort, N = 1,285) and 4.8% and 12.2% (N1 cohort, N = 1,625) with multivariate HRs of 2.25 (95% CI, 1.30-3.88; P = 0.004) and 2.67 (95% CI, 1.53-4.63; P < 0.001), respectively. Late DR performance was substantially improved using previously optimized cutoff points, identifying BCI low-risk groups with even lower 10-year late DR rates of 3.8% and 2.7% in N0 and N1 patients, respectively. CONCLUSIONS The TEAM trial represents the largest prognostic validation study for BCI to date and provides a more representative assessment of late DR risk to guide individualized treatment decision-making for HR+ patients with early-stage breast cancer.
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Affiliation(s)
- John M.S. Bartlett
- Cancer Research UK Scotland Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Keying Xu
- Diagnostic Development, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Jenna Wong
- Biotheranostics, A Hologic Company, San Diego, California
| | - Gregory Pond
- Department of Biostatistics, McMaster University, Hamilton, Ontario
| | - Yi Zhang
- Biotheranostics, A Hologic Company, San Diego, California
| | - Melanie Spears
- Diagnostic Development, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario
| | | | | | - Karen J. Taylor
- Cancer Research UK Scotland Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Annette Hasenburg
- Department of Gynecology and Obstetrics, University Center Mainz, Mainz, Germany
| | | | - Luc Dirix
- St. Augustinus Hospital, Antwerp, Belgium
| | | | - Daniel Rea
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | | | - Kai Treuner
- Biotheranostics, A Hologic Company, San Diego, California
| | - Jane Bayani
- Diagnostic Development, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario
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Huang X, Xu X, Xu A, Luo Z, Li C, Wang X, Fu D. Exploring the most appropriate lymph node staging system for node-positive breast cancer patients and constructing corresponding survival nomograms. J Cancer Res Clin Oncol 2023; 149:14721-14730. [PMID: 37584708 DOI: 10.1007/s00432-023-05283-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/11/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND The lymph node (LN) status is a crucial prognostic factor for breast cancer (BC) patients. Our study aimed to compare the predictive capabilities of three different LN staging systems in node-positive BC patients and develop nomograms to predict overall survival (OS). METHODS We enrolled 71,213 eligible patients from the SEER database, and 667 cases from our hospital were used for external validation. All patients were divided into two groups based on the number of removed lymph nodes (RLNs). The prognostic abilities of pN stage, positive LN ratio (LNR), and log odds of positive LN (LODDS) were compared using the C-indexes and AUC values. LASSO regression was performed to identify significant factors associated with prognosis and develop corresponding nomogram models. RESULTS Our study found that LNR had superior predictive performance compared to pN and LODDS among patients with RLNs < 10, while pN performed better in patients with RLNs ≥ 10. In the training set, the nomogram models exhibited excellent clinical applicability, as evidenced by the C-indexes, ROC curves, calibration plots, and decision curve analysis curves. Moreover, the nomogram classification accurately differentiated risk subgroups and improved discrimination. These results were externally validated in the validation cohort. CONCLUSION Physicians should select different LN staging systems based on the number of RLNs. Our novel nomograms demonstrated excellent performance in both internal and external validations, which may assist in patient counseling and guide treatment decision-making.
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Affiliation(s)
- Xiao Huang
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Xiangnan Xu
- Department of Breast Surgery, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu Province, China
| | - An Xu
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Zhou Luo
- Department of Breast Surgery, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Chunlian Li
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China
- Department of Breast Surgery, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Xueying Wang
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China
- Department of Breast Surgery, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Deyuan Fu
- Department of Breast Surgery, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu Province, China.
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Ergun Y, Dogan M, Ucar G, Karacin P, Karacin C. Efficacy of adjuvant CDK4/6 inhibitors in hormone receptor-positive breast cancer: a systematic review and meta-analysis. Expert Opin Pharmacother 2023; 24:1901-1909. [PMID: 37701962 DOI: 10.1080/14656566.2023.2258791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/11/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND The combination of cyclin-dependent kinase 4/6 (CDK4/6) inhibitors and standard endocrine therapy (ET) in the adjuvant treatment of hormone receptor (HR)-positive/HER2-negative breast cancer (BC) has yielded conflicting results. We performed a pooled analysis of the adjuvant efficacy of CDK4/6 inhibitors by including data from the NATALEE trial, the most recent trial on this topic. METHODS We searched major databases and congress proceedings until 7 June 2023 to identify randomized controlled trials (RCT) comparing adjuvant CDK4/6 inhibitor plus ET combination versus ET in HR-positive/HER2-negative early-stage BC. RESULTS Four RCTs involving a total of 17,749 patients were included. According to the pooled analysis of these four studies, significant improvement in invasive disease-free survival (iDFS) was observed with the addition of CDK4/6 inhibitors to standard ET (HzR: 0.81, 95% CI 0.67-0.97). IDFS benefit was irrespective from menopausal status, Ki-67 index, tumor grade, and previous chemotherapy. CDK4/6 inhibitors plus ET had a significant improvement in iDFS in stage 3 whereas there was a trend toward better iDFS in stage 2 (HzR for stage 3: 0.67, 95% CI 0.58-0.78; HzR for stage 2: 0.74, 95% CI 0.55-1.01). CONCLUSIONS Addition of CDK4/6 inhibitors to standard ET in the adjuvant treatment of HR-positive/HER2-negative early-stage BC improves iDFS.
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Affiliation(s)
- Yakup Ergun
- Department of Medical Oncology, Batman World Hospital, Batman, Turkey
| | - Mutlu Dogan
- Department of Medical Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Gokhan Ucar
- Department of Medical Oncology, Ankara City Hospital, Ankara, Turkey
| | - Pınar Karacin
- Department of Gynecology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Cengiz Karacin
- Department of Medical Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
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Danzinger S, Pöckl K, Kronawetter G, Pfeifer C, Behrendt S, Gscheidlinger P, Harrasser L, Mühlböck H, Dirschlmayer W, Schauer C, Reitsamer R, Uher H, Schönau K, Delmarko I, Singer CF. Axillary lymph node status and invasive lobular breast cancer : Analysis of the Clinical Tumor Register of the AGO Austria. Wien Klin Wochenschr 2023; 135:463-471. [PMID: 37010596 PMCID: PMC10497662 DOI: 10.1007/s00508-023-02162-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/10/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Invasive lobular carcinoma (ILC) represents the second most common type of invasive breast cancer (BC). Although ILC generally have good prognostic properties (positive estrogen receptor, ER, low tumor grade), they are generally diagnosed at a more advanced stage. The data on the axillary lymph node status in ILC compared to invasive ductal carcinoma (IDC) are considered controversial. Therefore, the aim of this study was to compare the pathological node stage (pN) between ILC and IDC in an Austria-wide register. METHODS Data of the Clinical Tumor Register (Klinisches TumorRegister, KTR) of the Austrian Association for Gynecological Oncology (AGO) were retrospectively analyzed. Patients with primary early BC, invasive lobular or ductal, diagnosed between January 2014 and December 2018, and primary surgery were included. A total of 2127 tumors were evaluated and compared in 2 groups, ILC n = 303, IDC n = 1824. RESULTS A total of 2095 patients were analyzed in the study. In the multivariate analysis, pN2 and pN3 were observed significantly more frequently in ILC compared with IDC (odds ratio, OR 1.93; 95% confidence interval, CI 1.19-3.14; p = 0.008 and OR 3.22; 95% CI: 1.47-7.03; p = 0.003; respectively). Other factors associated with ILC were tumor grades 2 and 3, positive ER, and pathological tumor stage (pT) 2 and pT3. In contrast, concomitant ductal carcinoma in situ, overexpression of the human epidermal growth factor receptor 2 (HER2), and a moderate and high proliferation rate (Ki67) were found less frequently in ILC. CONCLUSION The data show an increased risk of extensive axillary lymph node metastasis (pN2/3) in ILC.
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Affiliation(s)
- Sabine Danzinger
- Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Karin Pöckl
- Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Gerit Kronawetter
- Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Christian Pfeifer
- Department of Statistics, University of Innsbruck, Innsbruck, Austria
| | - Sandra Behrendt
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Patricia Gscheidlinger
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Lois Harrasser
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Helmut Mühlböck
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Walter Dirschlmayer
- Department of Obstetrics and Gynecology, Hospital Barmherzige Schwestern Ried, Ried im Innkreis, Austria
| | - Christian Schauer
- Department of Gynecology, Hospital Barmherzige Brüder Graz, Graz, Austria
| | - Roland Reitsamer
- Department of Gynecology, Paracelsus Medical University, University Hospital Salzburg, Landeskrankenhaus Salzburg, Salzburg, Austria
| | - Heidemarie Uher
- Department of Surgery, Breast Health Center, Hospital Landstraße, Vienna, Austria
| | - Kristina Schönau
- Department of General, Visceral and Tumor Surgery, Breast Health Center, Hospital Ottakring, Vienna, Austria
| | - Irmgard Delmarko
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Christian F. Singer
- Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
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6
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Xu P, Wu D, Liu X. A proposed grading scheme for predicting recurrence in medullary thyroid cancer based on the Ki67 index and metastatic lymph node ratio. Endocrine 2023:10.1007/s12020-023-03328-4. [PMID: 36823341 DOI: 10.1007/s12020-023-03328-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 02/10/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE The Ki67 index and lymph node ratio (LNR) have been proposed as components of alternative pathological classification schemes, but the most appropriate classification for patients with medullary thyroid cancer (MTC) remains unknown. The aim of the present study was to examine the usefulness of a new grading system combining the Ki67 index and LNR as a predictor of prognostic and disease-free survival (DFS) in MTC. METHODS We conducted a retrospective study of patients with MTC who were registered at Sun Yat-sen University Cancer Center, Guangzhou, P. R. China from June 2003 to October 2021. The DFS rates were assessed using risk-adjusted Cox proportional hazard regression modeling to explore the relationship among pathological features, nutritional status and DFS. The Ki67 index (cutoff value: 5% and 10%) and LNR (cutoff value: 0.2 and 0.3) were combined to create a new grading system. RESULTS In total, 101 matched patients were assessed. The integrated grading system showed better separation of Kaplan Meier (KM) curves for DFS. As the grading stage progressed, there was a significant stepwise decrease in DFS, which was better than Ki67, LNR and N staging alone. According to the grading system, the high-risk group had a worse prognosis. CONCLUSION The proposed grading scheme demonstrated a better prognostic performance in MTC patients than the Ki67, LNR and N staging alone. However, larger scale studies are needed to further verify our findings.
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Affiliation(s)
- Pengfei Xu
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, PR China
- State Key Laboratory of Oncology in South China, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, PR China
- Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, PR China
| | - Di Wu
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, PR China
- State Key Laboratory of Oncology in South China, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, PR China
- Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, PR China
| | - Xuekui Liu
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, PR China.
- State Key Laboratory of Oncology in South China, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, PR China.
- Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, PR China.
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Cho WK, Park W, Jeong Y, Kim H, Kim N. Patterns of regional recurrence according to molecular subtype in patients with pN2 breast cancer treated with limited field regional irradiation. Jpn J Clin Oncol 2023; 53:57-62. [PMID: 36305299 DOI: 10.1093/jjco/hyac161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/28/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE There is little evidence regarding the radiotherapy modification based on molecular subtypes in breast cancer. This study aimed to identify the risk and patterns of regional recurrence according to molecular subtype in patients with pN2 breast cancer. METHODS We identified 454 patients who underwent radical surgery for breast cancer with 4-9 axillary lymph node metastases. All patients underwent axillary lymph node dissection, adjuvant chemotherapy and limited-field regional nodal irradiation. The rates and patterns of regional recurrence were compared between the following three subgroups: luminal type (estrogen receptor- and/or progesterone receptor-positive), HER2-type (estrogen receptor- and progesterone receptor-negative and HER2-positive) and triple-negative type (estrogen receptor-, progesterone receptor- and HER2-negative). RESULTS Regional recurrence occurred in 18/454 patients (4%). The risk of regional recurrence was higher in the triple-negative (hazard ratio 7.641) and HER2-type (hazard ratio 4.032) subtypes than in the luminal subtype. The predominant pattern of regional recurrence was inside the radiotherapy field in triple-negative breast cancer and outside the radiotherapy field in HER2-type and luminal-type cancers. CONCLUSIONS In patients with pN2 breast cancer, the risk of regional recurrence was higher in the triple-negative and HER2-type than in the luminal type. In-field recurrence was predominant in triple-negative cancer, while out-field recurrence was frequent in luminal and HER2-type breast cancers.
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Affiliation(s)
- Won Kyung Cho
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yuri Jeong
- Department of Radiation Oncology, Wonkwang University Hospital, Iksan, Republic of Korea
| | - Haeyoung Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Nalee Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Wang X, Wu Y, Li X, Hong J, Zhang M. Log odds of negative lymph nodes/T stage ratio (LONT): A new prognostic tool for differentiated thyroid cancer without metastases in patients aged 55 and older. Front Endocrinol (Lausanne) 2023; 14:1132687. [PMID: 37033269 PMCID: PMC10073738 DOI: 10.3389/fendo.2023.1132687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/01/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND The optimal approach to assess the postoperative status of lymph nodes in differentiated thyroid cancer (DTC) remains controversial. Our aim was to determine if the log odds of negative lymph nodes/T stage ratio (LONT) could serve as a new prognostic and predictive tool for DTC without metastases in patients aged ≥ 55 years. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was used to study the role of LONT in patients aged ≥55 years diagnosed with DTC without metastases. The primary outcome was overall survival (OS). The Kaplan-Meier method and the Cox proportional hazard regression model were used to calculate the outcome. Moreover, the robustness of research findings was evaluated using sensitivity analyses. RESULTS A total of 21,172 DTC patients aged ≥55 years without distant metastasis were enrolled. Multivariate Cox regression analyses and a "floating absolute risk" analysis showed that a LONT ≥0.920 (vs. -0.56 to 0.92) was a protective factor for OS in DTC patients. Sensitivity analyses revealed an E-value of 1.98 for the obtained LONT value. In subgroup analyses, LONT was correlated significantly with OS in different subgroups of negative lymph nodes, stage-I-II subgroups and the N0 subgroup. The conditional probability of survival of DTC improved with prolonged survival time in the LONT ≥0.920 group. CONCLUSION A high LONT was associated with longer OS compared with low LONT in patients aged ≥55 years with non-metastatic DTC. LONT could provide valuable information for undertaking postoperative evaluations.
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Affiliation(s)
- Xuezhen Wang
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yufan Wu
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xiaoxia Li
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jinsheng Hong
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- *Correspondence: Jinsheng Hong, ; Mingwei Zhang,
| | - Mingwei Zhang
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- *Correspondence: Jinsheng Hong, ; Mingwei Zhang,
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Guo P, Wang X, Xia L, Shawureding N, Hu Z. Analysis of factors associated with the prognosis of papillary thyroid cancer and the construction of a survival model. Cancer Med 2022; 12:7868-7876. [PMID: 36560883 PMCID: PMC10134317 DOI: 10.1002/cam4.5555] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 12/05/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To study the survival prediction value of lymph node ratio (LNR) and preoperative thyroglobulin (Tg) in the prognosis of thyroid papillary carcinoma (PTC). METHODS A total of 495 patients with PTC and lymph node metastasis treated at the Cancer Hospital of Xinjiang Medical University were selected for a retrospective study. The disease-free survival (DFS) of patients was the follow-up endpoint. DFS was calculated for all patients. The Cox proportional risk regression model and nomogram were used to predict the survival prognosis of PTC with lymph node metastasis by index. LNR and preoperative Tg level cutoff values were obtained using ROC curves. To express DFS, Kaplan-Meier survival curves were created. Using 3- and 5-year calibration curves and AUC values, the prognostic models' precision and discrimination were assessed. Clinical decision curve analysis was used to forecast clinical benefitability. Finally, the results were validated using internal cross-validation. RESULTS The cutoff values of LNR and preoperative Tg level were 0.295 and 50.24, respectively, and they were divided into two groups according to the cutoff values. Multifactorial Cox regression models showed that NLNM, LNR, and preoperative Tg level (all p < 0.05) were independent risk factors affecting the prognosis of PTC with lymph node metastasis. Kaplan-Meier curves showed higher DFS rates in the group with low NLNM (<10), LNR (<0.295), and preoperative Tg level (<50.24) groups. The 3-year and 5-year calibration curves showed good agreement. A ROC curve analysis was performed on the nomogram model, and its AUC values at 3 and 5 years were, respectively, 0.805 and 0.793. Clinical decision curves indicate good clinical benefit. Finally, internal cross-validation demonstrated the legitimacy of the prognostic model. CONCLUSION The LNR and preoperative Tg levels, in combination with other independent factors, were effective in predicting the survival prognosis for patients with PTC.
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Affiliation(s)
- Peng Guo
- Department of Nuclear Medicine, The Affiliated Cancer Hospital of Xinjiang Medical University, People's Republic of China
| | - Xinhua Wang
- Department of Nuclear Medicine, The Affiliated Cancer Hospital of Xinjiang Medical University, People's Republic of China
| | - Luhua Xia
- Department of Nuclear Medicine, The Affiliated Cancer Hospital of Xinjiang Medical University, People's Republic of China
| | - Nadiremu Shawureding
- Department of Nuclear Medicine, The Affiliated Cancer Hospital of Xinjiang Medical University, People's Republic of China
| | - Zhiheng Hu
- Department of Nuclear Medicine, The Affiliated Cancer Hospital of Xinjiang Medical University, People's Republic of China
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First Comprehensive Report of Clinicopathological Profile of Breast Cancer from Bihar, India. Indian J Surg Oncol 2021; 12:598-602. [PMID: 34658590 DOI: 10.1007/s13193-021-01404-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 07/27/2021] [Indexed: 12/24/2022] Open
Abstract
Only a few countries of the world have a population more than Bihar, but due to the lack of a cancer registry, authentic research, and publications, data regarding the clinicopathological characteristics of breast cancer patients from this state are scarce. The present study was aimed to report the clinicopathological characteristics of breast cancer patients at a tertiary care center in Bihar, India. This is a retrospective review of a prospectively maintained database of patients of breast cancer treated between January-2018 and March-2020. One hundred fifteen patients with breast carcinoma were included of which 112 (97.4%) were women. The mean age was 47.28 ± 11.62 years and 54.5% of women were postmenopausal. Most patients had a clinical stage of II or III (44.5% each) while 8.7% of patients had stage IV disease. Invasive ductal carcinoma no special type (IDC-NST) was the most common histology (85.2%). The majority of tumors were grade II (55.6%), lymphovascular invasion was seen in 45.6%, and perineural invasion in 18.4%. Estrogen receptor was found in 41.8%, progesterone receptor was positive in 47.3%, and human epidermal growth factor receptor-2 (HER-2/Neu) overexpression was observed in 39.8%. Triple-negative breast cancer was found in 26.2% of patients. The majority underwent mastectomy (71.3%) while breast conservation was done in 26%. All except one patient underwent axillary lymph node dissection for axillary staging. 43.5% patients received neoadjuvant chemotherapy, 52.9% received adjuvant chemotherapy, while 3.5% patients received palliative chemotherapy. The clinicopathological profile of breast cancer patients from Bihar is similar to that reported from other parts of India except for a lower rate of distant metastasis.
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