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Kurahashi Y, Tomita T, Nakamura T, Nakao E, Hojo Y, Kohno S, Ishida Y, Shinohara H. Proposal for T3 classification of esophagogastric junction carcinoma based on the interconnection of extramural anatomical structures. Esophagus 2023; 20:587-594. [PMID: 37470882 DOI: 10.1007/s10388-023-01023-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023]
Abstract
Classification of extramural invasion of esophagogastric junction carcinoma (EGJC) is not yet established. The anatomy surrounding the EGJ alters between the mediastinum and the abdominal cavity. This review proposed a T3 classification of EGJC based on anatomical continuity. Analysis of endoscopic ultrasound images, review of intraoperative images, and detailed observation of surgical specimens were followed by a review of the literature. In the EGJ, the muscularis propria of the esophagus is enclosed in mediastinal adipose tissue called the adventitia, which is surrounded by the diaphragmatic crus and contains the paraesophageal lymph nodes (LNs). After passing through the esophageal hiatus along with the vagus nerves and blood vessels, the adventitia joins the adipose tissue containing the paracardial LNs, which is covered by the peritoneum, and then further divides into the lesser and greater omentum. The connective tissue outside the muscularis propria of the stomach, including the adipose tissue of the omentum, is called the subserosa. According to the TNM classification, T3 esophageal and gastric cancer is defined as invasion of the adventitia and subserosa, respectively. Given that the adventitia is anatomically continuous with the subserosa, T3 tumors of the EGJ can be described as those that extend through the muscularis propria but do not invade the peritoneum or diaphragmatic crus. We propose classifying T3 EGJC as "tumor extends through muscularis propria" rather than using the separate terms "adventitia" and "submucosa". T4 could be "tumor perforates serosa or invades adjacent structures", as per the current gastric cancer classification.
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Affiliation(s)
- Yasunori Kurahashi
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Toshihiko Tomita
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Tatsuro Nakamura
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Eiichiro Nakao
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yudai Hojo
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Shugo Kohno
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yoshinori Ishida
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Hisashi Shinohara
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
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Wu LL, Li CW, Li K, Qiu LH, Xu SQ, Lin WK, Ma GW, Li ZX, Xie D. The Difference and Significance of Parietal Pleura Invasion and Rib Invasion in Pathological T Classification With Non-Small Cell Lung Cancer. Front Oncol 2022; 12:878482. [PMID: 35574398 PMCID: PMC9096107 DOI: 10.3389/fonc.2022.878482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/18/2022] [Accepted: 04/01/2022] [Indexed: 01/15/2023] Open
Abstract
Objective This study was to explore the difference and significance of parietal pleura invasion and rib invasion in pathological T classification with non-small cell lung cancer. Methods A total of 8681 patients after lung resection were selected to perform analyses. Multivariable Cox analysis was used to identify the mortality differences in patients between parietal pleura invasion and rib invasion. Eligible patients with chest wall invasion were re-categorized according to the prognosis. Cancer-specific survival curves for different pathological T (pT) classifications were presented. Results There were 466 patients considered parietal pleura invasion, and 237 patients served as rib invasion. Cases with rib invasion had poorer survival than those with the invasion of parietal pleura (adjusted hazard ratio [HR]= 1.627, P =0.004). In the cohort for parietal pleura invasion, patients with tumor size ≤5cm reached more satisfactory survival outcomes than patients with tumor size >5cm (unadjusted HR =1.598, P =0.006). However, there was no predictive difference in the cohort of rib invasion. The results of the multivariable analysis revealed that the mortality with parietal pleura invasion plus tumor size ≤5cm were similar to patients with classification pT3 (P =0.761), and patients for parietal pleura invasion plus tumor size >5cm and pT4 had no stratified survival outcome (P =0.809). Patients identified as rib invasion had a poorer prognosis than patients for pT4 (P =0.037). Conclusions Rib invasion has a poorer prognosis than pT4. Patients with parietal pleura invasion and tumor size with 5.1-7.0cm could be appropriately up-classified from pT3 to pT4.
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Affiliation(s)
- Lei-Lei Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chong-Wu Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Kun Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Li-Hong Qiu
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Shu-Quan Xu
- School of Medicine, Tongji University, Shanghai, China
| | - Wei-Kang Lin
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Guo-Wei Ma
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhi-Xin Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
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Mikoshiba T, Ozawa H, Watanabe Y, Kawaida M, Sekimizu M, Saito S, Yoshihama K, Nakamura S, Nagai R, Imanishi Y, Kameyama K, Ogawa K. Pretherapeutic Predictive Factors for Histological High-Grade Parotid Gland Carcinoma. Laryngoscope 2021; 132:96-102. [PMID: 34245171 DOI: 10.1002/lary.29728] [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: 04/02/2021] [Revised: 06/04/2021] [Accepted: 06/23/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The histological grade of parotid gland carcinoma (PGC) is an important prognostic factor; however, the diagnosis prior to treatment has been challenging to make. This study aimed to investigate whether the pretreatment clinical findings, including hematological inflammatory, nutritional, and immune markers, could predict the histological grade of PGC. STUDY DESIGN Retrospective study. METHODS We retrospectively enrolled 111 patients with PGC and evaluated the correlation between histological grade and pretreatment clinical findings such as age, sex, tumor staging, facial nerve paralysis, pain or tenderness, adhesion to the surrounding tissues or tumor immobility, and hematological markers. RESULTS Sixty patients (54%) were diagnosed with histological high-grade PGC. Univariate analysis revealed that age, T classification, N classification, TNM stage, facial nerve paralysis, adhesion/immobility, C-reactive protein (CRP), and CRP-to-albumin ratio (CAR) were significant predictors of PGC histological grade. On multivariate analysis, high T classification (T3, 4), high N classification (≥1), and elevated CRP (≥0.22 mg/dL) were independent predictors of high-grade PGC. CONCLUSIONS Pretreatment T classification, N classification, and CRP are significant predictors of the histological grading of PGC. Our results are useful for treatment planning and obtaining appropriate informed consent from the patients before treatment. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Takuya Mikoshiba
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Ozawa
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yoshihiro Watanabe
- Department of Otorhinolaryngology, Head and Neck Surgery, International University of Health and Welfare School of Medicine, Narita, Chiba, Japan
| | - Miho Kawaida
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Mariko Sekimizu
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shin Saito
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Keisuke Yoshihama
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shintaro Nakamura
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Ryoto Nagai
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yorihisa Imanishi
- Department of Otorhinolaryngology, Head and Neck Surgery, International University of Health and Welfare School of Medicine, Narita, Chiba, Japan
| | - Kaori Kameyama
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Kaoru Ogawa
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
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Ren X, Liang S, Li Y, Ji Y, Li L, Qin C, Fang K. ENAM gene associated with T classification and inhibits proliferation in renal clear cell carcinoma. Aging (Albany NY) 2021; 13:7035-7051. [PMID: 33539322 PMCID: PMC7993715 DOI: 10.18632/aging.202558] [Citation(s) in RCA: 2] [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: 11/04/2020] [Accepted: 12/23/2020] [Indexed: 01/18/2023]
Abstract
The potential involvement of T classification-related genes in renal clear cell carcinoma (ccRCC) must be further explored. Public data were obtained from The Cancer Genome Atlas (TCGA) database. An overall survival (OS) predictive model was developed and validated (TCGA train, 5 years, AUC = 0.73, 3 years, AUC = 0.73, 1 year, AUC = 0.76; TCGA test, 5 years, AUC = 0.74, 3 years, AUC = 0.65, 1 year, AUC = 0.73; TCGA all, 5 years, AUC = 0.72, 3 years, AUC = 0.71, 1 year, AUC = 0.75). Finally, ENAM was selected for further analysis. In vitro experiment indicated that ENMA is downregulated in ccRCC, and its knockdown could promote proliferation in two cancer cell lines (OSRC-2 and SW839). Immune infiltration analysis revealed that ENAM could remarkably increase the content of cytotoxic cells, NK CD56 cells, NK cells and CD8+ T cells in the tumor immune microenvironment, which may be one reason for its tumor-inhibiting effect. In summary, ENAM may suppress cell proliferation in ccRCC and can be used as a potential reference value for the relief and immunotherapy of ccRCC.
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Affiliation(s)
- Xiaohan Ren
- The State Key Laboratory of Reproductive Medicine, Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Shengjie Liang
- Department of Urology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Huinan, Pudong, Shanghai 201399, China
| | - Yang Li
- Department of Urology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Huinan, Pudong, Shanghai 201399, China
| | - Yisheng Ji
- The First Clinical Medical College, Nanjing Medical University, Nanjing 211166, China
| | - Lin Li
- The First Clinical Medical College, Nanjing Medical University, Nanjing 211166, China
| | - Chao Qin
- The State Key Laboratory of Reproductive Medicine, Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Kai Fang
- Department of Urology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Huinan, Pudong, Shanghai 201399, China
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Zhu E, Dai C, Xie H, Su H, Hu X, Li M, Fan J, Liu J, Zhu Q, Zhang L, Ke H, Chen C. Lepidic component identifies a subgroup of lung adenocarcinoma with a distinctive prognosis: a multicenter propensity-matched analysis. Ther Adv Med Oncol 2020; 12:1758835920982845. [PMID: 33488781 PMCID: PMC7768877 DOI: 10.1177/1758835920982845] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 07/14/2020] [Accepted: 12/01/2020] [Indexed: 01/15/2023] Open
Abstract
Background: Our aim was to investigate the prognostic impact of the lepidic component on T stage in patients with lung adenocarcinoma (LUAD). Methods: A retrospective data set including 863 cases of LUAD with lepidic component and 856 cases without lepidic component was used to identify matched lepidic-positive and lepidic-negative cohorts (n = 376 patients per group) using a propensity-score matching. Primary outcome variables included recurrence-free survival (RFS) and overall survival (OS). Prognostic factors were assessed by Cox regression analysis and Kaplan–Meier estimates. Results: Multivariate analysis revealed that lepidic component presence was an independent prognostic factor for prolonged RFS (p < 0.001) and OS (p < 0.001). Furthermore, lepidic ratio (LR) >25% or ⩽25% were confirmed to be independent prolonged survival predictors. No survival differences were observed between patients with LUAD with LR >25% or ⩽25% (RFS p = 0.333; OS p = 0.078). The 5-year OS rates of patients with LUAD with a lepidic component were 90% regardless of the T stage, and these survival rates were significantly better than those of patients with LUAD without a lepidic component in the corresponding T stage. Multivariate analysis confirmed that T stage was associated with survival only in patients with LUAD without a lepidic component. Conclusions: Lepidic component presence identifies a LUAD subgroup with an excellent prognosis independent of the LR, pathological T classification. Considering the lepidic component presence may improve prognostic predictions for patients with LUAD.
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Affiliation(s)
- Erjia Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Chenyang Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Huikang Xie
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Hang Su
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Xuefei Hu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Ming Li
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Nanjing, People's Republic of China
| | - Junqiang Fan
- Department of Thoracic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Jinshi Liu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
| | - Quan Zhu
- Department of Thoracic Surgery, Jiangsu Province Hospital, Nanjing, People's Republic of China
| | - Lei Zhang
- Department of Thoracic Surgery, The First People's Hospital of Changzhou, Changzhou, People's Republic of China
| | - Honggang Ke
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Nantong University, Nantong, People's Republic of China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Zhengmin Road 507, Shanghai 200443, China
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Almangush A, Pirinen M, Youssef O, Mäkitie AA, Leivo I. Risk stratification in oral squamous cell carcinoma using staging of the eighth American Joint Committee on Cancer: Systematic review and meta-analysis. Head Neck 2020; 42:3002-3017. [PMID: 32548858 DOI: 10.1002/hed.26344] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/27/2019] [Revised: 04/23/2020] [Accepted: 05/30/2020] [Indexed: 12/24/2022] Open
Abstract
The eighth edition of the American Joint Committee on Cancer (AJCC8) staging manual has major changes in oral squamous cell carcinoma (OSCC). We searched PubMed, OvidMedline, Scopus, and Web of Science for studies that examined the performance of AJCC8 in OSCC. A total of 40 808 patients were included in the studies of our meta-analysis. A hazard ratio (HR) of 1.87 (95%CI 1.78-1.96) was seen for stage II, 2.65 (95%CI 2.51-2.80) for stage III, 3.46 (95%CI 3.31-3.61) for stage IVa, and 7.09 (95%CI 4.85-10.36) for stage IVb. A similar gradual increase in risk was noted for the N classification. For the T classification, however, there was a less clear variation in risk between T3 and T4. AJCC8 provides a good risk stratification for OSCC. Future research should examine the proposals introduced in the published studies to further improve the performance of AJCC8.
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Affiliation(s)
- Alhadi Almangush
- Department of Pathology, University of Helsinki, Helsinki, Finland.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Institute of Biomedicine, Pathology, University of Turku, Turku, Finland.,Faculty of Dentistry, University of Misurata, Libya
| | - Matti Pirinen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland.,Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland
| | - Omar Youssef
- Department of Pathology, University of Helsinki, Helsinki, Finland.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Antti A Mäkitie
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ilmo Leivo
- Institute of Biomedicine, Pathology, University of Turku, Turku, Finland
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Goto M, Kawaguchi K, Fukui T, Nakamura S, Hakiri S, Ozeki N, Mori S, Hashimoto K, Ito T, Yokoi K. Verification of T descriptor with consolidation size for sub-centimeter non-small cell lung cancer. Surg Today 2019; 49:907-912. [PMID: 31115697 DOI: 10.1007/s00595-019-01821-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Received: 01/23/2019] [Accepted: 04/21/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE In the most recent (eighth) edition of the TNM classification, the clinical T descriptor has been adapted to measure the consolidation size of sub-solid lung cancer. Sub-centimeter non-small cell lung cancer (NSCLC) has thereby been subclassified into three groups: Tis, T1mi, and T1a; however, the revision has not been validated well. Thus, we investigated the clinicopathological characteristics and long-term oncological outcomes of sub-centimeter NSCLCs based on the solid size. METHODS The subjects of this retrospective review were 99 patients who underwent complete resection for NSCLC with ≤ 1 cm in consolidation size on computed tomography (CT). Survival was reanalyzed after reclassification according to the new TNM classification. RESULTS This cohort consisted of 14 patients with cTis tumors, 18 with cT1mi tumors, and 67 with cT1a tumors. Among the patients with tumors classified as cT1a, two had lymph node metastasis and two had vascular invasion. The cumulative incidences of recurrence at 5 and 10 years were 0% for cTis/cT1mi tumors, and 4.5% and 6.1% for cT1a tumors, respectively. CONCLUSIONS There may be pathological and survival differences between cTis/cT1mi tumors and cT1a tumors, but not between cTis tumors and cT1mi tumors.
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Affiliation(s)
- Masaki Goto
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Koji Kawaguchi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takayuki Fukui
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shota Nakamura
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shuhei Hakiri
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Naoki Ozeki
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shunsuke Mori
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kumiko Hashimoto
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Toshinari Ito
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kohei Yokoi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Pan XX, Tong LH, Chen YF, Li FL, Tang WB, Liu YJ, Yang W. A simplified T classification based on the 8th edition of the UICC/AJCC staging system for nasopharyngeal carcinoma. Cancer Manag Res 2019; 11:3163-3169. [PMID: 31114358 PMCID: PMC6489657 DOI: 10.2147/cmar.s185860] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 03/07/2019] [Indexed: 01/31/2023] Open
Abstract
Objective: This study aimed to establish a simplified T classification based on the 8th edition of the Union for International Cancer Control/American Joint Committee on Cancer (UICC/AJCC) staging system for nasopharyngeal carcinoma (NPC). Methods: In total, 325 patients with NPC were included in this study. All patients underwent magnetic resonance imaging, and the staging criteria were recorded. These patients were subjected to staging with the 8th edition of the UICC/AJCC staging system for NPC. Results: Involvement of the oropharynx, nasal cavity, adjacent soft tissue (medial pterygoid, lateral pterygoid, and prevertebral muscles), cervical vertebra, orbit, and hypopharynx were always accompanied by other equivalently or more advanced T-stage classifications. All cases with involvement of the paranasal sinuses showed skull base erosion. The majority of cases with involvement of the pterygoid structure showed skull base erosion. Conclusion: According to the simplification principle, the following new T classification based on the 8th edition of the UICC/AJCC staging system was established: T1, tumor confined to nasopharynx, or beyond the nasopharynx without parapharyngeal involvement; T2, tumor with extension to the parapharyngeal space; T3, tumor with infiltration to bony structures at the skull base; T4, tumor with intracranial extension, involvement of the cranial nerves or parotid gland, and/or extensive soft tissue infiltration beyond the lateral surface of the lateral pterygoid muscle. Validation with a large series of patients is needed.
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Affiliation(s)
- Xing-Xi Pan
- Department of Oncology, Nanhai Hospital Affiliated to Southern Medical University, Foshan, Guangdong 528200, People's Republic of China
| | - Li-Hua Tong
- Department of Oncology, Nanhai Hospital Affiliated to Southern Medical University, Foshan, Guangdong 528200, People's Republic of China
| | - Yong-Fa Chen
- Department of Oncology, Nanhai Hospital Affiliated to Southern Medical University, Foshan, Guangdong 528200, People's Republic of China
| | - Fei-Long Li
- Department of Oncology, Nanhai Hospital Affiliated to Southern Medical University, Foshan, Guangdong 528200, People's Republic of China
| | - Wu-Bing Tang
- Department of Oncology, Nanhai Hospital Affiliated to Southern Medical University, Foshan, Guangdong 528200, People's Republic of China
| | - Ya-Jie Liu
- Department of Oncology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, People's Republic of China
| | - Wen Yang
- Department of Oncology, Nanhai Hospital Affiliated to Southern Medical University, Foshan, Guangdong 528200, People's Republic of China
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Mair M, Nair D, Nair S, Malik A, Mishra A, Kannan S, Bobdey S, Singhvi H, Chaturvedi P. Comparison of tumor volume, thickness, and T classification as predictors of outcomes in surgically treated squamous cell carcinoma of the oral tongue. Head Neck 2018; 40:1667-1675. [PMID: 29734474 DOI: 10.1002/hed.25161] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 12/19/2016] [Revised: 09/13/2017] [Accepted: 02/05/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND As per TNM classification, superficial tumors with a favorable prognosis are fallaciously clubbed together with unfavorable, deeply infiltrating lesions in the same classification. METHODS This is a retrospective study of 588 patients with treatment-naive oral tongue cancers. Binary logistic regression was used to identify predictors of nodal metastasis and extracapsular spread (ECS) using tumor volume and thickness as separate models. The C-index was generated to quantify predictive accuracy of T classification, thickness, and tumor volume for survival. RESULTS Compared to T classification, tumor volume and thickness were better predictors of nodal metastasis and ECS. Predictive accuracy for disease-free survival (DFS) and overall survival (OS) given by C-index was equal and better for thickness (0.60 and 0.69) and tumor volume (0.61 and 0.69) as compared to T classification (0.59 and 0.64, respectively). For early-stage T1 to T2 oral tongue cancer, thickness is a better predictor of nodal metastasis as compared to tumor volume and T classification. CONCLUSION Concordance between the tumor thickness and volume proves that tumor thickness can be taken as a surrogate and reliable predictor of outcomes instead of calculating the tumor volume.
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Affiliation(s)
- Manish Mair
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Deepa Nair
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Sudhir Nair
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Akshat Malik
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Aseem Mishra
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Sadhana Kannan
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Saurabh Bobdey
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, India
| | - Hitesh Singhvi
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
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Chen MB, Ji XZ, Liu YY, Zeng P, Xu XY, Ma R, Guo ZD, Lu JW, Feng JF. Ulk1 over-expression in human gastric cancer is correlated with patients' T classification and cancer relapse. Oncotarget 2018; 8:33704-33712. [PMID: 28410240 PMCID: PMC5464904 DOI: 10.18632/oncotarget.16734] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 02/12/2017] [Accepted: 03/04/2017] [Indexed: 12/26/2022] Open
Abstract
Ulk1 is a key autophagy protein. Here, we tested expression and potential function of Ulk1 in human gastric cancer. Ulk1 mRNA and protein were significantly elevated in multiple fresh human gastric cancer tissues. Its level was relatively low in surrounding normal epithelial tissues. Ulk1 over-expression was also observed in several gastric cancer cell lines (AGS, HGC-27, and SNU601). Remarkably, Ulk1 knockdown by targeted-shRNA inhibited AGS gastric cancer cell survival and proliferation. On the other hand, exogenous Ulk1 over-expression could further promote AGS cell survival and proliferation. Immunohistochemistry (IHC) staining assay of 145 paraffin-embedded gastric cancer tissues showed that Ulk1 was over-expressed in majority (114 out of 145) of gastric cancer tissues. Importantly, high Ulk1 expression in gastric cancer was correlated with patients' T classification and cancer relapse. Together, we demonstrate that Ulk1 over-expression in human gastric cancer is pro-survival. Its over-expression is associated with patients' T classification and cancer relapse.
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Affiliation(s)
- Min-Bin Chen
- Department of Radiotherapy & Oncology, Kunshan First People's Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu Province, China
| | - Xiao-Zhi Ji
- Departments of Medical Oncology, Jiangsu Cancer Hospital Affiliated to Nanjing Medical University, Jiangsu Province Institute of Cancer, Nanjing, Jiangsu Province, China.,Xuzhou Medical University, Xuzhou, Jiangsu, P.R. China
| | - Yuan-Yuan Liu
- Department of Radiotherapy & Oncology, Kunshan First People's Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu Province, China
| | - Ping Zeng
- Department of Radiotherapy & Oncology, Kunshan First People's Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu Province, China
| | - Xin-Yu Xu
- Departments of Pathology, Jiangsu Cancer Hospital Affiliated to Nanjing Medical University, Jiangsu Province Institute of Cancer, Nanjing, Jiangsu Province, China
| | - Rong Ma
- Clinical Cancer Research Center, Jiangsu Cancer Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Zheng-Dong Guo
- Departments of Medical Oncology, Jiangsu Cancer Hospital Affiliated to Nanjing Medical University, Jiangsu Province Institute of Cancer, Nanjing, Jiangsu Province, China.,Xuzhou Medical University, Xuzhou, Jiangsu, P.R. China
| | - Jian-Wei Lu
- Departments of Medical Oncology, Jiangsu Cancer Hospital Affiliated to Nanjing Medical University, Jiangsu Province Institute of Cancer, Nanjing, Jiangsu Province, China.,Xuzhou Medical University, Xuzhou, Jiangsu, P.R. China
| | - Ji-Feng Feng
- Departments of Medical Oncology, Jiangsu Cancer Hospital Affiliated to Nanjing Medical University, Jiangsu Province Institute of Cancer, Nanjing, Jiangsu Province, China
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11
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Karakas Y, Dizdar O, Aksoy S, Hayran M, Altundag K. The Effect of Total Size of Lesions in Multifocal/Multicentric Breast Cancer on Survival. Clin Breast Cancer 2017; 18:320-327. [PMID: 29183716 DOI: 10.1016/j.clbc.2017.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 07/14/2017] [Revised: 09/28/2017] [Accepted: 11/02/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND In this study, we aimed to assess the prognostic performance of determining the T stage according to the total size of lesions compared with the size of the largest lesion in the breast in patients with multifocal/multicentric (MF/MC) breast cancer. PATIENTS AND METHODS The charts of the patients with MF/MC breast cancer who were diagnosed between 2003 and 2014 were reviewed. The T stage of MF/MC tumors was determined according to the largest lesion size (Tmax) as well as the sum of the longest diameters of the lesions (Tsum) in the breast. RESULTS Multifocal/multicentric tumors were identified in 323 of 3890 patients (8.3%) with breast cancer. Ten-year rates of overall survival (OS; 75% and 74%; P = .965) and disease-free survival (DFS; 66% and 61%; P = .817) were similar in patients with unifocal and MF/MC tumors, respectively. When the T stage was determined by summing the sizes of the lesions, the T stage of 67 (20.7%) and 63 (19.5%) patients advanced from T1 to T2 and from T2 to T3, respectively. Thus, the T stage increased in 130 patients (40.2%) according to American Joint Committee on Cancer. Discriminatory ability of Tsum was better than Tmax in terms of OS and DFS, as shown with higher Royston D and Harrel C statistics and Schemper V values. CONCLUSION The new T classification proposed in this report stands out as a better predictive classification particularly in patients with low disease burden.
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Affiliation(s)
- Yusuf Karakas
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - Omer Dizdar
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - Sercan Aksoy
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - Mutlu Hayran
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - Kadri Altundag
- Mustafa Kadri Altundag (MKA) Breast Cancer Clinic, Ankara, Turkey.
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12
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Hattori A, Matsunaga T, Takamochi K, Oh S, Suzuki K. Prognostic impact of a ground glass opacity component in the clinical T classification of non-small cell lung cancer. J Thorac Cardiovasc Surg 2017; 154:2102-2110.e1. [PMID: 28947198 DOI: 10.1016/j.jtcvs.2017.08.037] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 07/25/2017] [Accepted: 08/10/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine whether solid component size and the presence of a ground glass opacity (GGO) component are independently associated with survival outcomes in patients with early-stage non-small cell lung cancer (NSCLC) using the eighth edition Lung Cancer Stage Classification. METHODS We retrospectively evaluated 1029 surgically resected early-stage NSCLCs. T categories were assigned based on solid component size using the eighth classification. All tumors were classified into 1 of 2 groups: the GGO group or the solid group. We evaluated the prognostic impact of several clinicopathological variables in clinical T classification using a Cox proportional hazard model. RESULTS On multivariable analysis, the presence of a GGO component (hazard ratio [HR], 0.314; 95% confidence interval [CI], 0.181-0.529: P < .001) and solid component size (HR, 1.021; 95% CI, 1.006-1.036; P = .006) were identified as independently significant prognostic factors of overall survival. However, after accounting for the presence of a GGO component, neither maximum tumor size nor solid component size added to the prediction of long-term survival. Moreover, tumor size significantly affected survival outcome only in the solid group (HR, 1.020; 95% CI, 1.006-1.034; P = .004). Survival was excellent at ≥90% despite the revised T categories, provided that the tumor had a ground glass appearance. Meanwhile, tumor size significantly affected survival only in the solid group (P < .001). CONCLUSIONS The presence of a GGO component is a significant prognostic factor in early-stage NSCLC. External validation is required to assess whether it should be adopted as a novel factor in clinical T staging.
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Affiliation(s)
- Aritoshi Hattori
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
| | - Takeshi Matsunaga
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Shiaki Oh
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
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13
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Miyabe J, Hanamoto A, Tatsumi M, Hamasaki T, Takenaka Y, Nakahara S, Kishikawa T, Suzuki M, Takemoto N, Michiba T, Yoshioka Y, Isohashi F, Konishi K, Ogawa K, Hatazawa J, Inohara H. Metabolic tumor volume of primary tumor predicts survival better than T classification in the larynx preservation approach. Cancer Sci 2017; 108:2030-2038. [PMID: 28787757 PMCID: PMC5623730 DOI: 10.1111/cas.13345] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 06/01/2017] [Revised: 07/13/2017] [Accepted: 07/14/2017] [Indexed: 01/06/2023] Open
Abstract
We aimed to determine whether pretreatment metabolic tumor volume of the primary tumor (T-MTV) or T classification would be a better predictor of laryngectomy-free survival (LFS) and overall survival (OS) after chemoradiotherapy in patients with locally advanced laryngeal or hypopharyngeal cancer requiring total laryngectomy. We analyzed 85 patients using a Cox proportional hazards model and evaluated its usefulness by Akaike's information criterion. A T-MTV cut-off value was determined by time-dependent receiver operating characteristic curve analysis. Interobserver reliability for measuring T-MTV was estimated by the intraclass correlation coefficient (ICC). After adjustment for covariables, T-MTV, irrespective of whether a continuous or dichotomized variable, and T classification remained independent predictors of LFS and OS. Large T-MTV (>28.7 mL) was associated with inferior LFS (hazard ratio [HR], 4.16; 95% confidence interval [CI], 1.97-8.70; P = 0.0003) and inferior OS (HR, 3.18; 95% CI, 1.47-6.69; P = 0.004) compared with small T-MTV (≤28.7 mL). The T-MTV model outperformed the T classification model in predicting LFS and OS (P = 0.007 and 0.01, respectively). Three-year LFS and OS rates for patients with small versus large T-MTV were 68% vs 9% (P < 0.0001) and 77% vs 25% (P < 0.0001), respectively, whereas those for patients with T2-T3 versus T4a were 61% vs 31% (P = 0.003) and 71% vs 48% (P = 0.10), respectively. ICC was 0.99 (95% CI, 0.99-1.00). Given the excellent interobserver reliability, T-MTV is better than T classification to identify patients who would benefit from the larynx preservation approach.
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Affiliation(s)
- Junji Miyabe
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University School of Medicine, Osaka, Japan
| | - Atsushi Hanamoto
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University School of Medicine, Osaka, Japan
| | - Mitsuaki Tatsumi
- Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Toshimitsu Hamasaki
- Research and Development Initiative Center, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yukinori Takenaka
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University School of Medicine, Osaka, Japan
| | - Susumu Nakahara
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University School of Medicine, Osaka, Japan
| | - Toshihiro Kishikawa
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University School of Medicine, Osaka, Japan
| | - Motoyuki Suzuki
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University School of Medicine, Osaka, Japan
| | - Norihiko Takemoto
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University School of Medicine, Osaka, Japan
| | - Takahiro Michiba
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University School of Medicine, Osaka, Japan
| | - Yasuo Yoshioka
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Fumiaki Isohashi
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koji Konishi
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuhiko Ogawa
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Jun Hatazawa
- Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University School of Medicine, Osaka, Japan
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14
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Park H, An S, Eo SH, Song KB, Park JH, Kim KP, Lee SS, Cho H, Seo DW, Kim SC, Yu E, Hong SM. Survival effect of tumor size and extrapancreatic extension in surgically resected pancreatic cancer: proposal for improved T classification. Hum Pathol 2014; 45:2341-6. [PMID: 25248573 DOI: 10.1016/j.humpath.2014.06.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 06/25/2014] [Accepted: 06/28/2014] [Indexed: 12/19/2022]
Abstract
The T classification for pancreatic cancer of the American Joint Committee on Cancer may be inaccurate owing to lack of consideration of tumor size in cases of extension beyond the pancreas. To examine the accuracy of American Joint Committee on Cancer staging and to determine the prognostic implication of combined tumor size and extrapancreatic extension, 6145 cases of pancreatic ductal adenocarcinomas from the Surveillance, Epidemiology, and End Results database were categorized according to tumor size and extension as follows: group 1 (G1, ≤2 cm and limited to the pancreas), G2 (>2 cm and limited to the pancreas), G3 (≤2 cm with extrapancreatic extension), and G4 (>2 cm with extrapancreatic extension). The median survival of G1, G2, G3, and G4 were 23, 15, 19, and 14 months, respectively (P < .001), and the survival time in G3 was closer to that of G2 than G4. To test the classification system for accuracy of prognosis, G3 was merged with G2. The survival discrimination of this new grouping was greater (overall comparison, P < .001; G1 versus G2 + G3, P < .001; G2 + G3 versus G4, P < .001; χ(2) = 92.043) than that of the current T-classification scheme (overall comparison, P < .001; G1 versus G2, P < .001; G2 versus G3 + G4, P = .048; χ(2) = 60.424). To better discriminate survival, patients with a tumor less than or equal to 2 cm extending beyond the pancreas should be downstaged from the current class T3 to class T2.
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Affiliation(s)
- Hosub Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Republic of Korea
| | - Soyeon An
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Republic of Korea
| | - Soo-Heang Eo
- Department of Statistics, Korea University, Seoul, 136-701, Republic of Korea
| | - Ki-Byung Song
- Department of Hepatobiliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Republic of Korea
| | - Jin-hong Park
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Republic of Korea
| | - Kyu-pyo Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Republic of Korea
| | - Sang Soo Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Republic of Korea
| | - HyungJun Cho
- Department of Statistics, Korea University, Seoul, 136-701, Republic of Korea
| | - Dong-Wan Seo
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Republic of Korea
| | - Song Cheol Kim
- Department of Hepatobiliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Republic of Korea
| | - Eunsil Yu
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Republic of Korea
| | - Seung-Mo Hong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Republic of Korea.
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15
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Abstract
TNM cancer staging, conceived 70 years ago, was first applied to the esophagus in 1977. Prior staging was neither data-driven nor harmonized with stomach cancer. Machine-learning analysis of worldwide data addressed these shortcomings in the 7th edition. The 8th edition considers 6 problems in attempting to advance esophageal cancer staging.
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