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Zhu Z, Mao M, Song A, Gong H, Gu J, Dai Y, Feng F. Study on the diagnostic value of MDCT extramural vascular invasion in preoperative N staging of gastric cancer patients. BMC Med Imaging 2024; 24:20. [PMID: 38243288 PMCID: PMC10799446 DOI: 10.1186/s12880-024-01200-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/12/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND To explore the diagnostic value of multidetector computed tomography (MDCT) extramural vascular invasion (EMVI) in preoperative N Staging of gastric cancer patients. METHODS According to the MR-defined EMVI scoring standard of rectal cancer, we developed a 5-point scale scoring system to evaluate the status of CT-detected extramural vascular invasion(ctEMVI), 0-2 points were ctEMVI-negative status, and 3-4 points were positive status for ctEMVI. Patients were divided into ctEMVI positive group and ctEMVI negative group. The correlation between ctEMVI and clinical features was analyzed. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of ctEMVI for pathological metastatic lymph nodes and N staging, The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of pathological N staging using ctEMVI and short-axis diameter were generated and compared. RESULTS The occurrence rate of lymphovascular invasion (LVI) and proportion of tumors with a greatest diameter > 6 cm in the ctEMVI positive group was higher than that in the ctEMVI negative group (P < 0.05). Spearman correlation analysis showed a positive correlation between ctEMVI and LVI, N stage, and tumor size (P < 0.05). For ctEMVI scores ≥ 3,The AUC of ctEMVI for diagnosing lymph node metastasis, N stage ≥ N2, and N3 stage were 0.857, 0.802, and 0.758, respectively. The sensitivity, NPV and accuracy of ctEMVI for diagnosing N stage ≥ N2 were superior to those of short-axis diameter (P < 0.05), while sensitivity, specificity, PPV, NPV, and accuracy of ctEMVI for diagnosing N3 stage were superior to those of short-axis diameter (P < 0.05). CONCLUSION ctEMVI has important value in diagnosing metastatic lymph nodes and advanced N staging. As an important imaging marker, ctEMVI can be included in the preoperative imaging evaluation of patients, providing important assistance for clinical guidance and treatment.
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Affiliation(s)
- Zhengqi Zhu
- Department of Radiology, Nantong Tumor Hospital, No. 30, Tongyang North Road, Nantong, Jiangsu Province, 226006, China
| | - Mimi Mao
- Department of Radiology, Nantong Tumor Hospital, No. 30, Tongyang North Road, Nantong, Jiangsu Province, 226006, China
| | - Anyi Song
- Department of Radiology, Nantong Tumor Hospital, No. 30, Tongyang North Road, Nantong, Jiangsu Province, 226006, China
| | - Haipeng Gong
- Department of Radiology, Nantong Tumor Hospital, No. 30, Tongyang North Road, Nantong, Jiangsu Province, 226006, China
| | - Jianan Gu
- Department of Radiology, Nantong Tumor Hospital, No. 30, Tongyang North Road, Nantong, Jiangsu Province, 226006, China
| | - Yongfeng Dai
- Department of Radiology, Nantong Tumor Hospital, No. 30, Tongyang North Road, Nantong, Jiangsu Province, 226006, China
| | - Feng Feng
- Department of Radiology, Nantong Tumor Hospital, No. 30, Tongyang North Road, Nantong, Jiangsu Province, 226006, China.
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Li C, Liu D, Yao K, Liu J, Wang J, Zhang Y, Cui L, Wang L. Could the New p N Staging Classification Better Predict the Prognosis of Penile Cancer? A Population-Based Analysis. ARCH ESP UROL 2023; 76:481-486. [PMID: 37867332 DOI: 10.56434/j.arch.esp.urol.20237607.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND The 8th edition of the American Joint Committee on Cancer (AJCC) has made new revisions to the N staging of penile cancer (PeCa). This study aimed to evaluate the prognostic value of the new N staging classification. METHODS This cohort was included from the Surveillance, Epidemiology, and End Results (SEER) database (1988-2016). Overall survival (OS) and cancer-specific survival (CSS) were evaluated using Kaplan-Meier survival curve. The Cox proportional hazards model was employed to calculate hazard ratio (HR) and 95% confidence intervals (CI). RESULTS Among the included 583 patients, 270 patients had only one positive inguinal lymph node (ILNP), 115 had two ILNPs, and 198 had 3 or more ILNPs. Kaplan-Meier analysis indicated that The OS and CSS of patients with ILNP = 2 were not statistically different from those with ILNP = 1 (p = 0.394; p = 0.760), but had OS and CSS benefit over those with ILNP ≥3 (p = 0.017; p = 0.020). Cox proportional hazards regression analysis indicated that patients with ILNP = 2 and ILNP = 1 have similar OS and CSS (HR = 0.80, p = 0.153; HR = 0.74, p = 0.148), but patients with ILNP ≥3 had worse OS and CSS than patients with ILNP = 2 (HR = 1.56, p = 0.007; HR = 1.86, p = 0.003). CONCLUSIONS PeCa patients with only one or two lymph node metastases had similar survival outcomes. AJCC 8th edition pN staging has a better discriminative ability to predict the prognosis and can accurately stratify mortality risk in PeCa.
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Affiliation(s)
- Cheng Li
- Department of Urology, The Third Xiangya Hospital, Central South University, 410013 Changsha, Hunan, China
| | - Dingwen Liu
- Department of Urology, The Third Xiangya Hospital, Central South University, 410013 Changsha, Hunan, China
| | - Kun Yao
- Department of Urology, The Third Xiangya Hospital, Central South University, 410013 Changsha, Hunan, China
| | - Jianye Liu
- Department of Urology, The Third Xiangya Hospital, Central South University, 410013 Changsha, Hunan, China
| | - Jinrong Wang
- Department of Urology, The Third Xiangya Hospital, Central South University, 410013 Changsha, Hunan, China
| | - Yichuan Zhang
- Department of Urology, The Third Xiangya Hospital, Central South University, 410013 Changsha, Hunan, China
| | - Lina Cui
- Department of Urology, The Third Xiangya Hospital, Central South University, 410013 Changsha, Hunan, China
| | - Long Wang
- Department of Urology, The Third Xiangya Hospital, Central South University, 410013 Changsha, Hunan, China
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Chloupek A, Kania J, Jurkiewicz D. Concordance between Clinical and Pathological T and N Stages in Polish Patients with Head and Neck Cancers. Diagnostics (Basel) 2023; 13:2202. [PMID: 37443596 DOI: 10.3390/diagnostics13132202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/06/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The TNM (tumor, node, metastasis) staging system is important for the successful treatment of head and neck cancers (HNCs). This study aimed to evaluate the concordance between clinical and pathological T and N stages in patients with HNCs in Poland. METHODS In this single-center retrospective study, clinical and pathological TNM staging data on 203 patients undergoing surgical treatment for HNC between 2011 and 2018 were collected and compared. The study group was classified as underdiagnosed, overdiagnosed, or correctly diagnosed with HNC based on pathological TNM staging. The concordance between clinical and pathological staging was evaluated using the kappa coefficient. RESULTS Clinical and pathological TNM staging showed concordance in 59.9% of patients for primary tumor (T) and in 79.3% of patients for lymph node (N) classifications. Moderate agreement between the clinical and pathological stages was shown for stage T, while substantial agreement was revealed for stage N. The size and extent of the tumor were underestimated or overestimated in 73 of the 182 patients (40.1%), while lymph node involvement was downstaged in 11 of the 53 patients (20.7%). CONCLUSIONS The disparities between clinical and pathological staging of HNC demonstrate the need for standardization in physical and pathological examinations, as well as radiographic imaging.
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Affiliation(s)
- Aldona Chloupek
- Department of Cranio-Maxillofacial Surgery, Military Institute of Medicine-National Research Institute, 04-142 Warsaw, Poland
| | - Joanna Kania
- Department of Pathology, Military Institute of Medicine-National Research Institute, 04-142 Warsaw, Poland
| | - Dariusz Jurkiewicz
- Department of Otolaryngology and Oncology, Military Institute of Medicine-National Research Institute, 04-142 Warsaw, Poland
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Wu J, Wang H, Yin X, Wang X, Wang Y, Lu Z, Zhang J, Zhang Y, Xue Y. Efficacy of Lymph Node Location-Number Hybrid Staging System on the Prognosis of Gastric Cancer Patients. Cancers (Basel) 2023; 15:cancers15092659. [PMID: 37174124 PMCID: PMC10177424 DOI: 10.3390/cancers15092659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/18/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Lymph node metastasis location and number significantly affects the prognosis of patients with gastric cancer (GC). This study was designed to examine a new lymph node hybrid staging (hN) system to increase the predictive ability for patients with GC. METHODS This study analyzed the gastrointestinal treatment of GC at the Harbin Medical University Cancer Hospital from January 2011 to December 2016, and selected 2598 patients from 2011 to 2015 as the training cohort (hN) and 756 patients from 2016 as the validation cohort (2016-hN). The study utilized the receiver operating characteristic curve (ROC), c-index, and decision curve analysis (DCA) to compare the prognostic performance of the hN with the 8th edition of AJCC pathological lymph node (pN) staging for GC patients. RESULTS The ROC verification of the training cohort and validation cohort based on each hN staging and pN staging showed that for each N staging, the hN staging had a training cohort with an AUC of 0.752 (0.733, 0.772) and a validation cohort with an AUC of 0.812 (0.780, 0.845). In the pN staging, the training cohort had an AUC of 0.728 (0.708, 0.749), and the validation cohort had an AUC of 0.784 (0.754, 0.824). c-Index and DCA also showed that hN staging had a higher prognostic ability than pN staging, which was confirmed in the training cohort and the verification cohort, respectively. CONCLUSION Lymph node location-number hybrid staging can significantly improve the prognosis of patients with GC.
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Affiliation(s)
- Junpeng Wu
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150081, China
| | - Hao Wang
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150081, China
| | - Xin Yin
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150081, China
| | - Xibo Wang
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150081, China
| | - Yufei Wang
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150081, China
| | - Zhanfei Lu
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150081, China
| | - Jiaqi Zhang
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150081, China
| | - Yao Zhang
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150081, China
| | - Yingwei Xue
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150081, China
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Yang F, Wu C, Bo Z, Xu J, Yi B, Li J, Qiu Y. The clinical value of regional lymphadenectomy for intrahepatic cholangiocarcinoma. Asian J Surg 2021; 45:376-380. [PMID: 34340896 DOI: 10.1016/j.asjsur.2021.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVE The aim of this study was to explore the clinical value of lymph node dissection (LND) for intrahepatic cholangiocarcinoma (ICC). METHODS Clinical and pathological data were collected from 147 ICC patients who attended two tertiary centers over the past 5 years. The patients were classified into two groups: the LND group (group A) and the no-performance LND (NLND) group (group B). Clinical and pathological parameters were compared between the two groups to analyze the impact of LND on the long-term survival time of ICC patients. RESULTS Of the 147 patients, 54.4% (80) received LND and 42.5% (34/80) of these were found to have lymph node metastasis (LNM). LND did not increase postoperative complications (27.5%, P = 0.354), but postoperative hospital stays were longer (12.2 ± 6.3 d, P = 0.005) in group A compared with group B (20.9%, 9.5 ± 3.5 d). The 5-year survival rates of groups A and B are almost similar (21% vs 29%, P = 0.905). The overall survival rate of cN0 (diagnosis obtained by imaging) is better than pN1 (diagnosis obtained by histopathology), but lower than pN0 (all P < 0.05). Compared with NLND, the median survival time of LND patients with T1 has not significantly improved (29.3 vs 35.1 months, P = 0.762), but the patients with T2-4 has been significantly increased (29.0 vs 17.1 months, P = 0.040). Elevated CA19-9 level (HR = 1.764, 95% CI: 1.113-2.795, P = 0.016), vascular invasion (HR = 2.697, 95% CI: 1.103-6.599, P = 0.030), and T category (HR = 1.848, 95% CI: 1.059-3.224, P = 0.031) were independent risk factors for poor long-term survival time of the ICC patients (all P values < 0.05). CONCLUSION ICC patients with cN0 may have LNM, and the long-term survival time of LNM patients is usually poor. We suggest that patients with ICC may require routine LND, especially those with T2-4 category.
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Affiliation(s)
- Facai Yang
- Hepato-pancreato-biliary Center, Zhongda Hospital, School of Medicine, Southeast University Nanjing, 210009, China; Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China.
| | - Changkang Wu
- Department of Hepatobiliary Surgery, Hepatobiliary and Pancreatic Minimally Invasive Technology Laboratory, Affiliated Hospital of North Sichuan Medical College, Hepatobiliary and Intestine Research Institute, North Sichuan Medical College, Nanchong, 637000, China
| | - Zhiyuan Bo
- Department of Biliary Surgery, Third Affiliated Hospital of Naval Military Medical University, Shanghai, 200438, China
| | - Jian Xu
- Department of Hepatobiliary Surgery, Hepatobiliary and Pancreatic Minimally Invasive Technology Laboratory, Affiliated Hospital of North Sichuan Medical College, Hepatobiliary and Intestine Research Institute, North Sichuan Medical College, Nanchong, 637000, China
| | - Bin Yi
- Department of Hepatobiliary Surgery, Hepatobiliary and Pancreatic Minimally Invasive Technology Laboratory, Affiliated Hospital of North Sichuan Medical College, Hepatobiliary and Intestine Research Institute, North Sichuan Medical College, Nanchong, 637000, China
| | - Jingdong Li
- Department of Hepatobiliary Surgery, Hepatobiliary and Pancreatic Minimally Invasive Technology Laboratory, Affiliated Hospital of North Sichuan Medical College, Hepatobiliary and Intestine Research Institute, North Sichuan Medical College, Nanchong, 637000, China.
| | - Yinghe Qiu
- Department of Biliary Surgery, Third Affiliated Hospital of Naval Military Medical University, Shanghai, 200438, China.
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Dziedzic DA, Cackowski MM, Zbytniewski M, Gryszko GM, Woźnica K, Orłowski TM. The influence of the number of lymph nodes removed on the accuracy of a newly proposed N descriptor classification in patients with surgically-treated lung cancer. Surg Oncol 2021; 37:101514. [PMID: 33429325 DOI: 10.1016/j.suronc.2020.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The International Association for the Study of Lung Cancer has proposed a new classification of N descriptor based on the number of metastatic lymph nodes (LNs) stations, including skip metastasis. The aim of the study was to determine the effect of removed LNs on the adequacy of this new classification. MATERIALS AND METHODS The material was collected retrospectively based on the database of the Polish Lung Cancer Group, including information on 8016 patients with non-small cell lung cancer operated in 23 thoracic surgery centers in Poland. The material covered the period from January 2005 to September 2015. We divided patients into two groups: ≤6LNs and >6LNs removed. RESULTS In the whole group, an average of 13.4 nodes and 4.54 nodal stations were removed. 5-year survivals in the >6LNs group vs ≤ 6LNs group were: 62.3% and 55.1% (N0), 44.5% and 35.9% (N1a), 34.1% and 31,7% (N1b), 37.3% and 26.3% (N2a1), 32.4% and 26.7% (N2a2), 29.4% and 29.2% (N2b1), and 22.0% and 23.0% (N2b2), respectively. Comparing these groups, we detected significant differences at N0 (p < 0.001) and N2a1 (p = 0.022). In the ≤6LNs group, the survival curves for N2a1, N2a2, N2b1, and N2b2 overlapped (p > 0.05). In the >6LNs group, the survival curves were significantly different between grades, with survival for N2a1 better than N1b (p = 0.232). CONCLUSION The proposed classification N descriptor is potentially better at differentiating patients into different stages. The accuracy of the classification depends on the number of lymph nodes removed. Therefore, the extent of lymphadenectomy has a significant impact on the staging of surgically-treated lung cancer.
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Affiliation(s)
- Dariusz A Dziedzic
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Plocka Street 26, 01-138, Warsaw, Poland.
| | - Marcin M Cackowski
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Plocka Street 26, 01-138, Warsaw, Poland
| | - Marcin Zbytniewski
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Plocka Street 26, 01-138, Warsaw, Poland
| | - Grzegorz M Gryszko
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Plocka Street 26, 01-138, Warsaw, Poland
| | - Katarzyna Woźnica
- Faculty of Mathematics and Information Science, Warsaw University of Technology, Koszykowa Street 75, 00-662, Warsaw, Poland
| | - Tadeusz M Orłowski
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Plocka Street 26, 01-138, Warsaw, Poland
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Sang NV, Duc NM, Duc PH, Tuan PA. The value of multidetector-row computed tomography in lymph node staging of gastric cancer: a preliminary Vietnamese study. Contemp Oncol (Pozn) 2020; 24:125-31. [PMID: 32774138 DOI: 10.5114/wo.2020.97484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/07/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction Gastric cancer (GC) is the fourth most common malignant disease in the world, following breast cancer, colorectal cancer, and lung cancer. This study aimed to evaluate the usefulness of multidetector-row computed tomography (MDCT) in identifying the metastatic lymph node of GC. Material and methods A cross-sectional study was performed after receiving approval by the institutional review board. A total of 88 patients with GC, who underwent radical gastrectomy, were examined by MDCT. Categorical variables were compared using Fisher’s exact test. The discriminating ability of lymph node size was determined according to an area under the receiver operating curve(AUROC) analysis, and the optimal cut-off point was determined. Results The proportion of metastatic lymph node patients in the proximal group (32.3%) was significantly higher than that in the distal group (18.4%). T categorisation and lymph node sizes were significantly different between the non-metastatic lymph node and metastatic lymph node groups. The AUROC for lymph node size was 0.738, with an optimal cut-off point of 7.5 mm,producing a sensitivity of 71.5% and a specificity of 70.5%. Conclusions MDCT displayed medium accuracy for the determination of metastatic lymph nodes and N categorisation. Based on our findings, although MDCT is generally the first choice for preoperative assessments in GC patients, other diagnostic modalities should supplement MDCT in order to achieve more precise N staging.
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Chen J, Zhou C, He M, Zhen Z, Wang J, Hu X. A Meta-Analysis And Systematic Review Of Accuracy Of Endoscopic Ultrasound For N Staging Of Gastric Cancers. Cancer Manag Res 2019; 11:8755-8764. [PMID: 31632135 PMCID: PMC6774993 DOI: 10.2147/cmar.s200318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 09/12/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Endoscopic ultrasonography (EUS) is widely used as a staging modality for gastric cancer. However, the results of studies on the use of EUS for N staging in gastric cancer vary. This study aimed at studying the overall diagnostic accuracy of EUS for N staging of gastric cancer. METHODS Published studies were identified through searching the MEDLINE, Web of Science, EMBASE, SpringerLink and ScienceDirect databases. A bivariate random effect model was used to estimate the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). A hierarchical summary receiver operating characteristic curves (HSROC) based on the pooled data was also computed. RESULTS Fifty studies (5223 patients) were included in this analysis. The pooled sensitivity, specificity, PLR, NLR and DOR of EUS for N staging were 0.82 (95% CI 0.78 to 0.85), 0.68 (0.63 to 0.73), 2.6 (2.2 to 3.0), 0.27 (0.22 to 0.32), and 10 (8 to 12), respectively. The area under the HSROC was 0.83. CONCLUSION The EUS may provide a clinically useful tool to guide physicians in the N staging of gastric cancer. However, physicians must note that the EUS has a relatively low specificity.
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Affiliation(s)
- Jiafei Chen
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Chaoyang Zhou
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Min He
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Zhiming Zhen
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Jie Wang
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Xiaofei Hu
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
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Xu JY, Li Z, Cui HY, Du J, Chen J, Qiao JC, He XW, Song JH, Wei JM, Yang YM. [The effect of standardized lymphectomy and sampling of resected lymph nodes on TNM staging of resectable pancreatic head cancer]. Zhonghua Wai Ke Za Zhi 2019; 57:572-577. [PMID: 31422625 DOI: 10.3760/cma.j.issn.0529-5815.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To examine the effect of standardized lymphectomy and sampling of resected lymph nodes (LN) on TNM staging of resectable pancreatic head cancer. Methods: Consecutive patients with resectable pancreatic head cancer who received standard pancreatoduodenctomy at Department of General Surgery in Beijing Hospital from December 2017 to November 2018 were recruited as study group. After operation, the surgeon sampled lymph nodes from the fresh specimen following the Japanese Gastric Cancer Guidelines.Thirty-three cases were recruited in the study group and the mean age was (59.8±15.2) years.Pathologic reports from December 2015 to November 2016 were taken as control group, containing 29 cases with age of (57.0±13.0) years. Number of lymph nodes, standard-reaching ratio and positive nodes ratio were compared between two groups. According to the seventh edition and eighth edition of TNM staging, the changes of N staging and TNM staging were analysed. The quantitative data conforming to normal distribution were tested by independent sample t test, the quantitative data not conforming to normal distribution were tested by rank sum test, and the enumeration data were analysed by χ(2) test. Results: The basal data of the two groups were comparable (all P>0.05) . The number of lymph nodes sampled in the study group was 23.27±8.87, significantly more than in control group (12.86±5.90, t=0.653, P=0.000) .Ratio of cases with more than 15 nodes was 81.8% (27/33) in the study group and 34.5% (10/29) in the control group with statistical significance (χ(2)=14.373, P=0.000) . In the study group, the positive lymph node ratios of No. 17a+17b, 14a+14b, 8a+8p LN were 36.4% (12/33) , 30.3% (10/33) and 9.1% (3/33) respectively. The positive lymph node ratio in No.14a+14b LN was higher than in No.8 LN (χ(2)=4.694, P=0.030) . According to the change in N staging system in the AJCC eighth edition, 2 cases (6.1%, 2/33) changed from ⅠB to ⅡA, 7 cases (21.2%, 7/33) from ⅡA to ⅠB and 5 cases (15.2%, 5/33) changed from ⅡB to Ⅲ (25.0%, 5/20) . Conclusions: No.14 LN should be treated as the first station rather than second station because of the anatomic character and higher metastatic ratio. Standardised lymphectomy and sampling may increase the number of LN resected and improve the TNM staging of resectable pancreatic head cancer.
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Affiliation(s)
- J Y Xu
- Department of General Surgery, Beijing Hospital, National Centre of Gerontology, Beijing 100730, China
| | - Z Li
- Department of General Surgery, Beijing Hospital, National Centre of Gerontology, Beijing 100730, China
| | - H Y Cui
- Department of General Surgery, Beijing Hospital, National Centre of Gerontology, Beijing 100730, China
| | - J Du
- Department of Pathology, Beijing Hospital, National Centre of Gerontology, Beijing 100730, China
| | - J Chen
- Department of General Surgery, Beijing Hospital, National Centre of Gerontology, Beijing 100730, China
| | - J C Qiao
- Department of General Surgery, Beijing Hospital, National Centre of Gerontology, Beijing 100730, China
| | - X W He
- Department of General Surgery, Beijing Hospital, National Centre of Gerontology, Beijing 100730, China
| | - J H Song
- Department of General Surgery, Beijing Hospital, National Centre of Gerontology, Beijing 100730, China
| | - J M Wei
- Department of General Surgery, Beijing Hospital, National Centre of Gerontology, Beijing 100730, China
| | - Y M Yang
- Department of General Surgery, Peking University First Hospital, Beijing 100034, China
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Pei JP, Zhang CD, Fan YC, Dai DQ. Comparison of Different Lymph Node Staging Systems in Patients With Resectable Colorectal Cancer. Front Oncol 2019; 8:671. [PMID: 30697530 PMCID: PMC6340930 DOI: 10.3389/fonc.2018.00671] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/20/2018] [Indexed: 12/14/2022] Open
Abstract
Background and Objectives: Currently, the United States Joint Commission on Cancer (AJCC) N staging, lymph node positive rate (LNR), and log odds of positive lymph nodes (LODDS) are the main lymph node (LN) staging systems. However, the type of LN staging system that is more accurate in terms of prognostic performance remains controversial. We compared the prognostic accuracy of the three staging systems in patients with CRC and determine the best choice for clinical applications. Methods: From the Surveillance, Epidemiology, and End Results (SEER) database, 56,747 patients were identified who were diagnosed with CRC between 2004 and 2013. Akaike's Information Criterion (AIC) and Harrell's Consistency Index (c-index) were used to assess the relative discriminative abilities of different LN staging systems. Results: In 56,747 patients, when using classification cut-off values for evaluation, the LNR of Rosenberg et al. showed significantly better predictive power, especially when the number of dissected lymph nodes (NDLN) were insufficient. When analyzed as a continuous variable, the LODDS staging system performed the best and was not affected by the NDLN. Conclusions: We suggest that the LNR of Rosenberg et al. should be introduced into the AJCC system as a supplement when the NDLN is insufficient until the optimal LODDS cut-off values are calculated.
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Affiliation(s)
- Jun-Peng Pei
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Chun-Dong Zhang
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China.,Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yu-Chen Fan
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Dong-Qiu Dai
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China.,Cancer Center, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
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Kang M, Zhou P, Wei T, Zhao T, Long J, Li G, Yan H, Feng G, Liu M, Zhu J, Wang R. A novel N staging system for NPC based on IMRT and RTOG guidelines for lymph node levels: Results of a prospective multicentric clinical study. Oncol Lett 2018; 16:308-316. [PMID: 29928416 PMCID: PMC6006447 DOI: 10.3892/ol.2018.8676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 02/27/2018] [Indexed: 11/05/2022] Open
Abstract
The present study aimed to investigate the cervical lymph node metastasis of nasopharyngeal carcinoma (NPC) and to establish a novel N staging standard for NPC, based on intensity modulated radiation therapy (IMRT) via a prospective multicenter clinical trial. Between January 2006 and December 2009, a total of 492 patients with NPC without distant metastasis were included in the present study. All patients were treated with IMRT. According to Radiation Therapy Oncology Group division standards, the present study proposed a novel N staging system following the review of magnetic resonance images in comparison with the 7th edition of Union for International Cancer Control/American Joint Committee on Cancer (UICC/AJCC) staging system. Retropharyngeal lymph nodes, cervical lymph node level and cervical lymph node laterality were independent prognostic factors used in multivariate analyses. According to the results of the risk variety, the present study suggested that the novel N staging system included: N0 (no lymph node metastasis), N1 [retropharyngeal or/and unilateral upper cervical (I, II, III, Va, VIIb, VIII, IX and X regions) lymph node metastasis], N2 [bilateral upper cervical (I, II, III, Va, VIIb, VIII, IX and X regions) lymph node metastasis] and N3 (lymph node metastasis in IVa and Vb regions and their lower regions). The novel N staging system proposed in the present study performs better in risk difference and distribution balance. Furthermore, the differences of 5-year curves of distant metastasis-free survival and overall survival had greater statistically significant differences compared with the 7th edition of the UICC/AJCC staging system. The present study suggested a novel N staging system for cervical lymph node metastasis of NPC, which may predict the prognosis of patients with NPC in a more objective and accurate way.
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Affiliation(s)
- Min Kang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Pingting Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Tingting Wei
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Tingting Zhao
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Jianxiong Long
- School of Public Health, Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Guisheng Li
- Department of Radiation Oncology, Liuzhou Worker Hospital, Liuzhou, Guangxi 545000, P.R. China
| | - Haolin Yan
- Department of Radiation Oncology, First People's Hospital of Yulin City, Yulin, Guangxi 537000, P.R. China
| | - Guosheng Feng
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, P.R. China
| | - Meilian Liu
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi 541000, P.R. China
| | - Jinxian Zhu
- Department of Radiation Oncology, Wuzhou Red Cross Hospital, Wuzhou, Guangxi 543000, P.R. China
| | - Rensheng Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
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Abstract
The 8th edition of UICC/AJCC TNM staging for esophageal cancer will start in use since 2018. The nodal staging in this version of TNM system remains unchanged from the 7th edition that based on the number of lymph nodes (LN) involved, except the limited revision of the regional LN map. In this review, N staging revision was evaluated from its initially simple definition of negative (N0) and positive (N1) LN(s) to the current positive node number based proposal. Meanwhile the disadvantages of current N staging were discussed. The refined nodal staging system in view of the number of metastatic node stations was introduced; as well as the extent and station of metastatic node could better reflect the disease progression and prognosis. The controversy on N staging of esophagogastric junction cancer was also discussed. Other reported N staging associated elements including LN ratio and lymphatic vessel invasion were reviewed and evaluated.
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Affiliation(s)
- Wen-Ping Wang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Song-Lin He
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yu-Shang Yang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Long-Qi Chen
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
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13
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Stabile Ianora AA, Telegrafo M, Lucarelli NM, Lorusso V, Scardapane A, Niccoli Asabella A, Moschetta M. Comparison between CT Net enhancement and PET/CT SUV for N staging of gastric cancer: A case series. Ann Med Surg (Lond) 2017; 21:1-6. [PMID: 28751975 PMCID: PMC5519227 DOI: 10.1016/j.amsu.2017.07.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 07/09/2017] [Accepted: 07/09/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The therapeutic approach of gastric cancer strictly depends on TNM staging mainly provided by CT and PET/CT. However, the lymph node size criterion as detected by MDCT causes a poor differential diagnosis between reactive and metastatic enlarged lymph nodes with low specificity values. Our study aims to compare 320-row CT Net enhancement and fluorine-18 fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (F-FDG PET/CT) SUV for N staging of gastric cancer. MATERIALS AND METHODS 45 patients with histologically proven gastric cancer underwent CT and F-FDG PET/CT. Two radiologists in consensus evaluated all images and calculated the CT Net enhancement and F-FDG PET/CT SUV for N staging, having the histological findings as the reference standard. CT and F-FDG PET/CT sensitivity, specificity, diagnostic accuracy, positive and negative predictive values (PPV and NPV) were evaluated and compared by using the Mc Nemar test. RESULTS The histological examination revealed nodal metastases in 29/45 cases (64%). CT Net enhancement obtained sensitivity, specificity, accuracy, PPV and NPV of 90%, 81%, 87%, 90% and 81%, respectively. F-FDG PET/CT SUV obtained sensitivity, specificity, accuracy, PPV and NPV of 66%, 88%, 73%, 90% and 58%, respectively. No statistically significant difference between the two imaging modalities was found (p = 0.1). CONCLUSION CT Net enhancement represents an accurate tool for N staging of gastric cancer and could be considered as the CT corresponding quantitative parameter of F-FDG PET/CT SUV. It could be applied in the clinical practice for differentiating reactive lymph nodes from metastatic ones improving accuracy and specificity of CT.
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Affiliation(s)
- Amato Antonio Stabile Ianora
- DIM – Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Michele Telegrafo
- DIM – Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Nicola Maria Lucarelli
- DIM – Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Valentina Lorusso
- DIM – Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Arnaldo Scardapane
- DIM – Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Artor Niccoli Asabella
- DIM – Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Marco Moschetta
- DETO – Department of Emergency and Organ Transplantations, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy
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Shen G, Hu S, Deng H, Kuang A. Performance of DWI in the Nodal Characterization and Assessment of Lung Cancer: A Meta-Analysis. AJR Am J Roentgenol 2016; 206:283-90. [PMID: 26587799 DOI: 10.2214/AJR.15.15032] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The purpose of this study is to assess the diagnostic performance of DWI in the N stage assessment of patients with lung cancer. MATERIALS AND METHODS The PubMed, EMBASE, Cochrane Library, Web of Science, and EBSCO English-language databases and two Chinese-language databases were searched for eligible studies. On the basis of the data extracted from included studies, we determined the pooled sensitivity and specificity, calculated the positive and negative likelihood ratios, and constructed summary ROC curves. In addition, we also performed threshold effect analysis, metaregression analysis, subgroup analysis, and publication bias analysis to explain the source of heterogeneity. RESULTS A total of 18 articles involving 1116 patients met the inclusion criteria. On a per-patient basis, the pooled sensitivity and specificity estimates of DWI were 0.68 (95% CI, 0.63-0.73) and 0.92 (95% CI, 0.90-0.94), respectively. On a per-lesion basis, the corresponding estimates were 0.72 (95% CI, 0.69-0.75) for sensitivity and 0.96 (95% CI, 0.95-0.96) for specificity. Only the analysis method (quantitative vs qualitative) affected the diagnostic accuracy on the basis of subgroup and metaregression analysis. CONCLUSION Current evidence suggests that DWI is beneficial in the nodal assessment of patients with lung cancer, and it is necessary to conduct high-quality prospective studies regarding the use of DWI in detecting metastatic lymph nodes of lung cancer to determine its true value.
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Liang J, Lv H, Liu Q, Li H, Wang J, Cui E. Role of diffusion-weighted magnetic resonance imaging and apparent diffusion coefficient values in the detection of gastric carcinoma. Int J Clin Exp Med 2015; 8:15639-15647. [PMID: 26629058 PMCID: PMC4658947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 07/22/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The study evaluated the applicability of diffusion-weighted magnetic resonance imaging (DW-MRI) and apparent diffusion coefficient (ADC) values in the diagnosis and staging of gastric carcinoma (GC). METHODS From December, 2013 to December, 2014, 35 GC patients were selected from the Department of Oncology. Carcinomatous gastric tissues were collected as the case group, and normal gastric tissues were collected as the control group. The DW-MRI examination was performed on a 3.0-T GE Signa Excite MRI scanner. The ADC values of carcinomatous and normal gastric tissues were measured. A statistical meta-analysis was further performed. RESULTS DW-MRI identified 75.0% (3/4) patients with T1, 75.0% (6/8) patients with T2, 86.4% (19/22) patients with T3, and 100.0% (1/1) patient with T4, showing an accuracy for T staging of 82.9% (29/35); identified 92.9% (13/14) patients of N0, 58.3% (7/12) patents of N1, 62.5% (5/8) patents of N2, and 100.0% (1/1) patients of N3, showing an accuracy for N staging of 74.3% (26/35). The average ADC value in the case group was apparently lower than the control group (P < 0.001); in the poorly differentiated group was lower than the moderately and well differentiated groups (F = 111.1, P < 0.001). Pairwise comparison of the average ADC value between the poorly, moderately and well differentiated groups showed statistical significance (all P < 0.05). Meta-analysis further confirmed a higher average ADC value in the case group than the control group (SMD = -4.136, 95% CI = -5.344~-2.928, P < 0.001). CONCLUSION DW-MRI is proved to be an attractive, noninvasive, quantitative and useful technique in the diagnosis and staging of GC.
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Affiliation(s)
- Jianxiao Liang
- Shandong UniversityJinan 250012, P. R. China
- Department of Radiology, Dongying People’s HospitalDongying 257091, P. R. China
| | - Hailian Lv
- Department of MRI Division, Shengli Oilfield Central HospitalDongying 257034, P. R. China
| | - Qingwei Liu
- Department of Radiology, Shandong Provincial HospitalJinan 250014, P. R. China
| | - Hongfu Li
- Department of Radiology, Dongying People’s HospitalDongying 257091, P. R. China
| | - Jiangquan Wang
- Department of Medical Services, Dongying People’s HospitalDongying 257091, P. R. China
| | - Engang Cui
- Department of Radiology, Dongying People’s HospitalDongying 257091, P. R. China
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Kijima S, Sasaki T, Nagata K, Utano K, Lefor AT, Sugimoto H. Preoperative evaluation of colorectal cancer using CT colonography, MRI, and PET/CT. World J Gastroenterol 2014; 20:16964-16975. [PMID: 25493009 PMCID: PMC4258565 DOI: 10.3748/wjg.v20.i45.16964] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 07/13/2014] [Accepted: 08/28/2014] [Indexed: 02/06/2023] Open
Abstract
Imaging studies are a major component in the evaluation of patients for the screening, staging and surveillance of colorectal cancer. This review presents commonly encountered findings in the diagnosis and staging of patients with colorectal cancer using computed tomography (CT) colonography, magnetic resonance imaging (MRI), and positron emission tomography (PET)/CT colonography. CT colonography provides important information for the preoperative assessment of T staging. Wall deformities are associated with muscular or subserosal invasion. Lymph node metastases from colorectal cancer often present with calcifications. CT is superior to detect calcified metastases. Three-dimensional CT to image the vascular anatomy facilitates laparoscopic surgery. T staging of rectal cancer by MRI is an established modality because MRI can diagnose rectal wall laminar structure. N staging in patients with colorectal cancer is still challenging using any imaging modality. MRI is more accurate than CT for the evaluation of liver metastases. PET/CT colonography is valuable in the evaluation of extra-colonic and hepatic disease. PET/CT colonography is useful for obstructing colorectal cancers that cannot be traversed colonoscopically. PET/CT colonography is able to localize synchronous colon cancers proximal to the obstruction precisely. However, there is no definite evidence to support the routine clinical use of PET/CT colonography.
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