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Pohle M, Magheli A, Diederichs W, Ecke T, Fischer T, Kempkensteffen C, Knispel H, Lehsnau M, Miller K, Pretzer J, Schostak M, Winter A, Zacharias M, Hinz S. [The Onkonet database: taking stock of an Internet-based, multi-centre database on surgical prostate cancer treatment]. Aktuelle Urol 2022; 53:75-81. [PMID: 31195415 DOI: 10.1055/a-0919-3993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The Onkonet database has been developed and coordinated by the Berliner Tumorzentrum e. V. (http://www.prostata-ca.net) and contains data on pre-, peri- and postoperative parameters of radical prostatectomy documented since January 2005. With its user-friendly interface and its integrated benchmarking tool, the main goal of Onkonet was to outline and improve the surgical care of prostate cancer patients in Germany. This study aimed to analyse all Onkonet data documented from the beginning of the project until June 2018. We focused on the completeness and plausibility of data to investigate and define the possibilities and limits of further analyses. PATIENTS AND METHODS All patients who underwent radical prostatectomy in one of the urological clinics participating in this project until June 2018 were included in this retrospective study. The completeness of all documented patient data was analysed using Excel 2013. The statistical analysis was descriptive. RESULTS A total of 21 474 patients were documented in Onkonet. 58,6 % (12 591) of them had a complete dataset including date of birth, date of surgery, dates of hospitalisation and discharge, initial PSA value, Gleason score of the biopsy, clinical T stage, pathological T stage, pathological Gleason score, as well as information on the surgical technique. Mean completeness of pre-operative parameters was 26,8 %, of hospitalisation parameters 64,5 %, and of pathological parameters 58,1 %. Amongst these, the documentation of the pathological T stage was complete in 80,1 %, documentation of N stage in 78,8 %, of M stage in 74,8 %, of pathological Gleason Score in 78,7 %, and of R1 status in 78,7 %. Completeness of follow-up data was 8,1 %, with PSA data being available in 27,2 %, continence data in 23,0 %, and potency data in 13,9 %. CONCLUSIONS Comprising 21 474 documented patients and over 200 parameters, Onkonet is one of the most comprehensive clinical registers for the documentation of prostate cancer patients in Germany. The data analysis showed that the limitations of such a database are mainly due to the high number of parameters and the high susceptibility to errors due to manual data submission.
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Affiliation(s)
- Margit Pohle
- Charité Universitätsmedizin Berlin, Klinik für Urologie, Berlin
| | - Ahmed Magheli
- Vivantes Klinikum Am Urban, Klinik für Urologie, Berlin
| | | | - Thorsten Ecke
- HELIOS-Klinikum Bad Saarow, Urologische Klinik, Bad Saarow
| | - Tom Fischer
- Vivantes Klinikum im Friedrichshain, Klinik für Urologie und Kinderurologie, Berlin
| | | | - Helmut Knispel
- Alexianer St. Hedwig Krankenhaus, Klinik für Urologie, Berlin
| | - Mike Lehsnau
- Havelland Kliniken GmbH, Klinik für Urologie, Nauen
| | - Kurt Miller
- Charité Universitätsmedizin Berlin, Klinik für Urologie, Berlin
| | - Jana Pretzer
- Unfallkrankenhaus Berlin, Klinik für Urologie und Neuro-Urologie, Berlin
| | - Martin Schostak
- Otto-von-Guericke-Universität Magdeburg, Klinik für Urologie und Kinderurologie, Magdeburg
| | - Alexander Winter
- Carl von Ossietzky Universität Oldenburg, Fakultät für Medizin und Gesundheitswissenschaften, Klinikum Oldenburg, Universitätsklinik für Urologie, Oldenburg
| | - Mario Zacharias
- Vivantes Auguste-Viktoria-Klinikum Berlin, Klinik für Urologie, Berlin
| | - Stefan Hinz
- Vivantes Klinikum Am Urban, Klinik für Urologie, Berlin
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Abdel-Rahman O. Revisiting the AJCC staging system of adrenocortical carcinoma. J Endocrinol Invest 2022; 45:89-94. [PMID: 34170487 DOI: 10.1007/s40618-021-01618-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/16/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the performance characteristics of AJCC 7th and 8th staging systems among patients with adrenal cortical carcinoma. METHODS Surveillance, Epidemiology, and End Results (SEER) 18-registry was accessed and patients with adrenocortical carcinoma who were diagnosed 2010-2015 with complete information about AJCC 7th staging system were included. AJCC 8th staging system information was then reconstructed for each patient using available TNM staging variables. Kaplan-Meier overall survival estimates, multivariable Cox regression analysis, and concordance index (C-statistic) were used to examine the performance characteristics of both staging systems. RESULTS A total of 574 patients with a diagnosis of adrenocortical carcinoma were included in the current analysis. Using Kaplan-Meier survival estimates, overall survival was compared among different AJCC stages for both versions; and the P value was significant (< 0.001) for both comparisons. C-statistic was then calculated for both staging systems and the results were as follows: for AJCC 7th version: 0.726 (95% CI 0.683-0.769); and for AJCC 8th version: 0.745 (95% CI 0.704-0.786). Patients with M1 disease (stage IV according to AJCC 8th edition) were then divided according to the extent of distant metastases into single versus multiple sites of metastases. Using Kaplan-Meier survival estimates, patients with a single site of metastases have better overall survival (P = 0.006). A C-statistic for a hypothetical modification of AJCC 8th staging system subdividing stage IV patients into IVA and IVB based on the number of metastatic sites was: 0.753 (95% CI 0.713-0.794). CONCLUSIONS There is a minimal difference in the prognostic performance between both versions of the AJCC staging system. Subdivision of stage IV cancer into stage IVA and IVB (according to the number of organs with metastatic deposits) should be considered in subsequent versions of adrenocortical carcinoma staging.
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Affiliation(s)
- O Abdel-Rahman
- Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, T6G 1Z2, Canada.
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Li Q, Xu K, Tian J, Lu Z, Pu J. Metformin mitigates PLCε gene expression and modulates the Notch1/Hes and androgen receptor signaling pathways in castration-resistant prostate cancer xenograft models. Oncol Lett 2021; 22:715. [PMID: 34429755 PMCID: PMC8371978 DOI: 10.3892/ol.2021.12976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/13/2021] [Indexed: 12/28/2022] Open
Abstract
The present study aimed to establish a mouse model of patient-derived castration-resistant prostate cancer (CRPC) xenograft tumors, and to evaluate the effects of various doses of metformin on phospholipase Cε (PLCε) expression and the neurogenic locus notch homolog protein 1 (Notch1)/hairy and enhancer of split 1 and androgen receptor (AR) signaling pathways via western blotting and reverse transcription-quantitative PCR. Additionally, phorbol 12-myristate 13-acetate was used to activate PLC, and Jagged1 was used as a Notch activator to verify whether metformin could suppress CRPC development via the PLCε/Notch1/AR pathways. The results confirmed that metformin may serve critical roles in CRPC by significantly inhibiting the occurrence, growth and proliferation of CRPC tumors by decreasing PLCε/Notch1 expression and AR nucleation.
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Affiliation(s)
- Qi Li
- Department of Urology, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, Jiangsu 215500, P.R. China
| | - Ke Xu
- Department of Urology, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, Jiangsu 215500, P.R. China
| | - Jianguo Tian
- Department of Urology, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, Jiangsu 215500, P.R. China
| | - Zhicheng Lu
- Department of Urology, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, Jiangsu 215500, P.R. China
| | - Jianming Pu
- Department of Urology, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, Jiangsu 215500, P.R. China
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Tang X, Guo C, Liu S, Guo J, Hua K, Qiu J. A novel prognostic nomogram utilizing the 2018 FIGO staging system for cervical cancer: A large multicenter study. Int J Gynaecol Obstet 2021; 155:86-94. [PMID: 33587753 DOI: 10.1002/ijgo.13644] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/20/2021] [Accepted: 02/12/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the prognostic performance of the revised 2018 FIGO staging system for cervical cancer. METHODS This retrospective multicenter study enrolled cervical cancer patients with 2009 FIGO Stage IA1-IIA2 who underwent surgeries between January 2006 and December 2017 in four tertiary hospitals. Patients were restaged according to the 2018 FIGO staging system by reviewing their medical data. RESULTS Of 3238 cervical cancer patients included, 1841 (56.9%) patients were restaged: 641 (34.9%) due to tumor size, 544 (29.5%) due to lymph node metastasis, 614 (33.4%) due to the inconsistency between pre- and postoperative assessments, and 42 due to the cancellation of invasion width in Stage IA. After restaging, a clear tendency of decreased recurrence-free survival (RFS) and overall survival (OS) with increasing stage was observed. Multivariate Cox analysis showed that 2018 FIGO stage, parametrial involvement, and histology were independent prognostic factors for both OS and RFS (P < 0.05). Based on these factors, we established predictive nomograms with c-indexes of 0.735 and 0.721, showing good predictive ability for cervical cancer. CONCLUSION The revised 2018 FIGO staging system can better reflect the survival of cervical cancer patients. Based on it, we established a nomogram that can predict the prognosis of cervical cancer patients more precisely.
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Affiliation(s)
- Xiaoyan Tang
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics and Gynecology of Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Chenyan Guo
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics and Gynecology of Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Songping Liu
- Department of Obstetrics and Gynecology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Jingjing Guo
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics and Gynecology of Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Keqin Hua
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics and Gynecology of Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Junjun Qiu
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics and Gynecology of Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
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Oweira H, Abdel-Rahman O, Mehrabi A, Reissfelder C. Assessment of the external validity of the AJCC 8 th staging system for small intestinal adenocarcinoma: a time to reconsider the role of tumor location? J Gastrointest Oncol 2019; 10:421-428. [PMID: 31183191 DOI: 10.21037/jgo.2019.01.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background The current study evaluates the validity and performance of the 8th edition of the American Joint Committee on Cancer (AJCC) staging system for small intestinal adenocarcinoma patients. Methods Surveillance, Epidemiology and End Results (SEER) database [2004-2015] was explored and AJCC 6th, 7th, and 8th versions were assigned for each patient. Through Kaplan-Meier estimates, overall survival analyses were conducted. Cox regression analysis (adjusted for age, race, gender, sub-site, grade and surgical treatment) was conducted for cancer-specific survival and additionally, pairwise hazard ratio comparisons were performed. Results A total of 2,997 small intestinal adenocarcinoma patients were eligible and included in the analysis. Overall survival was compared according to the three AJCC staging systems. For the three versions, the P value for the trend in overall survival was significant (P<0.0001). Cancer-specific Cox regression hazard was calculated for the three staging systems. Pairwise hazard ratio comparisons between different AJCC 6th stages were conducted and all P values for comparisons were significant (P<0.0001). Pairwise hazard ratio comparisons between different AJCC 7th and 8th stages were also performed, and all comparisons were significant (P<0.05) except for stage IIB vs. IIIA. C-statistic (using death from small intestinal adenocarcinoma as the dependent variable) for AJCC 6th staging system was: 0.645 [standard error (SE): 0.011; 95% CI: 0.623-0.668]; for c-statistic for AJCC 7th staging system was 0.658 (SE: 0.011; 95% CI: 0.637-0.680); while c-statistic for AJCC 8th staging system was 0.660 (SE: 0.011; 95% CI: 0.638-0.682). Multivariate analysis of factors affecting cancer-specific survival suggested that older age (P=0.005), higher lymph node ratio (P<0.0001) and duodenal localization of the primary are associated with worse outcomes (P=0.008). Conclusions There is no evidence that AJCC 8th system provided better prognostic characterization compared to previous AJCC staging systems for small intestinal adenocarcinoma. Subsite-specific staging paradigms should be explored in future editions of the staging system.
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Affiliation(s)
- Hani Oweira
- Center for Visceral and Specialized Tumor Surgery, Hirslanden Medical Center, Zurich, Switzerland.,Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Omar Abdel-Rahman
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.,Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Arianeb Mehrabi
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Christoph Reissfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Lee H, Lee M, Byun SS, Lee SE, Hong SK. Evaluation of Prostate Cancer Stage Groups Updated in the 8th Edition of the American Joint Committee on Cancer Tumor–Node–Metastasis Staging Manual. Clin Genitourin Cancer 2019; 17:e221-e226. [DOI: 10.1016/j.clgc.2018.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 11/27/2022]
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Abdel-Rahman O, Cheung WY. Impact of Prior Local Treatment on the Outcomes of Metastatic Hormone-Sensitive Prostate Cancer: Secondary Analysis of a Randomized Controlled Trial. Clin Genitourin Cancer 2018; 16:466-472. [PMID: 30098982 DOI: 10.1016/j.clgc.2018.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/14/2018] [Accepted: 07/14/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Local treatment of metastatic prostate cancer and its impact on future disease course requires further assessment. We sought to evaluate the impact of prior local treatment to the prostate on the outcomes of hormone-sensitive prostate cancer (HSPC) patients recruited in the CHAARTED study. PATIENTS AND METHODS We performed a retrospective analysis of the prospectively collected data among patients with metastatic HSPC in the CHAARTED study, a phase 3 multicenter study conducted between 2006 and 2014. The CHAARTED study compared androgen deprivation therapy plus docetaxel versus androgen deprivation therapy alone among patients with metastatic HSPC. The main outcomes of the current analysis are overall survival, progression-free survival, prostate cancer-specific survival, and time to castration-resistant disease as assessed by Kaplan-Meier analysis, log-rank testing, and Cox regression models. RESULTS Kaplan-Meier overall survival estimates were produced according to whether patients underwent prior local treatment and results were stratified by treatment arm. For both treatment arms, patients with prior local treatment had better overall survival (P < .01). Similarly, Kaplan-Meier progression-free survival estimates were produced according to whether patients underwent prior local treatment, and results were stratified by the treatment arm. For both treatment arms, patients with prior local treatment had better progression-free survival (P < .01). In an adjusted Cox multivariate model (adjusted for assigned study treatment arm, age, baseline prostate-specific antigen, and baseline Gleason score, volume of the disease (low risk or high risk) and baseline performance status), patients with prior local treatment had better overall survival (P = .045), progression-free survival (P = .035), and cancer-specific survival (P = .010) compared to those without prior local treatment. Moreover, they had a longer time to development of castration-resistant disease (P = .025). CONCLUSION Patients with metastatic HSPC and prior local treatment had better overall, progression-free, and cancer-specific survivals compared to those without prior local treatment. The impact of these findings on the treatment paradigms for metastatic HSPC should be thoroughly evaluated.
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Affiliation(s)
- Omar Abdel-Rahman
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt; Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Winson Y Cheung
- Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, Alberta, Canada.
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Abdel-Rahman O. Dissecting the heterogeneity of localized prostate cancer risk groups through integration of percent of positive cores. Future Oncol 2018; 14:1469-1476. [PMID: 29745768 DOI: 10.2217/fon-2017-0596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To develop a modified risk stratification scheme for localized prostate cancer incorporating percent of positive cores (PPC). METHODS SEER database was accessed for eligible patients. Assessment of the prognostic value of PPC was conducted in a multivariate Cox regression model. A modified risk stratification scheme was proposed. RESULTS In a multivariate model, higher PPC was associated with worse cancer-specific survival (p < 0.0001). A modified risk-stratification scheme was proposed incorporating PPC. Concordance index was evaluated and the results were: D'Amico model: 0.782 (SE: 0.014; 95% CI: 0.755-0.810); modified model: 0.809 (SE: <0.001; 95% CI: 0.781-0.837). CONCLUSION Integration of PPC into the risk stratification model for localized prostate cancer improves its performance.
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Affiliation(s)
- Omar Abdel-Rahman
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Lotfy El Sayed Street, Cairo, 11566, Egypt.,Department of Oncology, University of Calgary and Tom Baker Cancer Center, Calgary, Alberta T2N4N2, Canada
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Oweira H, Giryes A, Mannhart M, Decker M, Schlumpf R, Abdel-Rahman O. Assessment of the external validity of the American Joint Committee on Cancer 8th staging system for anal carcinoma. Curr Med Res Opin 2018; 34:923-929. [PMID: 29448859 DOI: 10.1080/03007995.2018.1441817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The current study evaluates the prognostic value of the 8th edition of the American Joint Committee on Cancer (AJCC) staging system for patients with anal carcinoma. PATIENTS AND METHODS The Surveillance, Epidemiology and End Results (SEER) database (2004-2014) was explored and AJCC 6th and 8th stages were formulated. Through Kaplan-Meier analysis, overall survival analyses were performed. The Cox regression model (adjusted for age, gender, histology, ethnicity, subsite and grade) was calculated for cancer-specific survival and, subsequently, pairwise comparisons of hazard ratios were calculated. RESULTS A total of 11,934 anal carcinoma patients were included in the analysis. Overall survival was compared according to both AJCC 6th and 8th systems. For both staging systems, the p value for the trend in overall survival was significant (p < .0001). Nevertheless, for the AJCC 6th system, stage IIIA and IIIB curves were overlapping; while for the AJCC 8th system, the median survival for stage IIB was lower than the mean survival for stage IIIA (74 months vs. 96 months). Moreover, stage IIIB and stage IIIC curves were overlapping. The cause-specific (cancer-specific) Cox regression hazard was calculated for both staging systems. Pairwise hazard ratio comparisons between different AJCC 6th stages were performed and all p values for comparisons were significant (p < .05). Pairwise hazard ratio comparisons between different AJCC 8th stages were performed and only the following comparisons were significant (p < .0001) (I vs. IIA; IIA vs. IIB; IIIC vs. IV). The C-statistic (using death from anal carcinoma as the dependent variable) for the AJCC 6th staging system was: 0.681 (SE: 0.009; 95% CI: 0.664-0.698); while the C-statistic for the AJCC 8th staging system was 0.687 (SE: 0.008; 95% CI: 0.670-0.703). CONCLUSIONS There is no evidence of significant improvement in the AJCC 8th edition compared to AJCC 6th (or 7th) edition in terms of overall or cancer-specific survival prediction.
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Affiliation(s)
- Hani Oweira
- a Oncology Department , Swiss Cancer Institute , Cham , Switzerland
- b Department of General , Visceral and Transplant Surgery, University of Heidelberg , Heidelberg , Germany
- c Chirurgisches Zentrum Zürich , Zürich , Switzerland
| | - Anwar Giryes
- a Oncology Department , Swiss Cancer Institute , Cham , Switzerland
| | | | - Michael Decker
- e Oncology Department , Zentrum für Integrative Onkologie, Zurich , Switzerland
| | - Rolf Schlumpf
- c Chirurgisches Zentrum Zürich , Zürich , Switzerland
| | - Omar Abdel-Rahman
- f Clinical Oncology Department, Faculty of Medicine , Ain Shams University , Cairo , Egypt
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Assessment of the prognostic value of the 8th AJCC staging system for patients with clinically staged prostate cancer; A time to sub-classify stage IV? PLoS One 2017; 12:e0188450. [PMID: 29182656 PMCID: PMC5705121 DOI: 10.1371/journal.pone.0188450] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 11/07/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The American Joint Committee on Cancer (AJCC) staging system (8th edition) for prostate cancer has been published. The current study seeks to validate the prognostic performance of the changes in the new system among clinically staged prostate cancer patients registered within the surveillance, epidemiology and end results (SEER) database. METHODS SEER database (2004-2014) has been accessed through SEER*Stat program and AJCC 7th and 8th edition stages were calculated utilizing T, N and M stages as well as baseline prostatic specific antigen (PSA) and grade group. Cancer-specific and overall survival analyses according to 6th, 7th and 8th editions were conducted through Kaplan-Meier analysis. Moreover, multivariate analysis was conducted through a Cox proportional hazard model. RESULTS A total of 110499 patients with prostate cancer were identified in the period from 2004-2014.For cancer- specific survival according to 8th AJCC, all pair wise P values for comparison were significant (<0.01) except for stage IIA vs. IIB; while for overall survival according to 8th AJCC, all pair wise P values for comparison were significant (<0.02) except for stage IIIA vs. IIIB. Results of c-index assessment for cancer-specific survival for the three AJCC editions were as follows: c-index for AJCC 6th edition was 0.816; c-index for AJCC 7th edition was 0.897; c-index for AJCC 8th edition was 0.907. For stage IVB prostate cancer (i.e.M1 disease), further sub-staging was proposed according to M1 sub-stage (i.e. M1a, M1b and M1c). Pair wise comparison between these proposed sub-stages was conducted for both cancer-specific and overall survival. For both cancer-specific and overall survival, all pair wise P values for comparisons were <0.0001. CONCLUSION Compared to older staging systems (6th and 7th), the 8th system is more discriminatory. Further sub-classification of stage IV disease is suggested.
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