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Chambers M, Andre AT, Wright JL, Vakar-Lopez F, Tretiakova M, Reder NP, Haffner MC, True LD. Outcome Analysis of a Series of Mixed-Grade, Non-muscle Invasive, Papillary Carcinomas of the Bladder. Int J Surg Pathol 2024:10668969241246492. [PMID: 38689480 DOI: 10.1177/10668969241246492] [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] [Indexed: 05/02/2024]
Abstract
Introduction. Papillary urothelial carcinomas are currently graded as either low- or high-grade tumors based on World Health Organization (WHO) 2022 guidelines for genitourinary tumors. However, a minority of tumors are mixed-grade tumors, composed predominantly of low-grade cancer with a minor high-grade component. In the 2022 WHO these cancers are recognized as having outcomes comparable to low-grade cancers, although data to date has been limited. Methods. The pathology records of a large academic institution were searched for mixed-grade, non-muscle invasive papillary carcinomas of the bladder and ureter in order to characterize prognosis of these cancers. Results. Of 136 cancers, the majority (n = 104, 76.5%) were solitary, mixed-grade tumors, while 21 (15.4%) had a concurrent low-grade cancer and 11 (8.1%) had multiple mixed-grade tumors at the time of diagnosis. At follow-up (median 48.3 months, range = 1.3 months-18.1 years), 71 cancers recurred (52.2%): 52 (38.2%) as low- or mixed-grade cancers and 18 (13.2%) as high-grade cancers. There were no instances of stage-progression to >pT2. Conclusions. The clinical outcome of mixed-grade carcinomas was similar to what has been reported for low-grade carcinomas. Based on our results, and prior congruent studies of mixed-grade lesions, these lesions may be regarded as a distinct sub-category with a better prognosis than high-grade tumors.
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Affiliation(s)
- Meagan Chambers
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Alexa T Andre
- University of Washington Medical School, Seattle, WA, USA
| | - Jonathan L Wright
- Department of Urology, University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Funda Vakar-Lopez
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Maria Tretiakova
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Nicholas P Reder
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Michael C Haffner
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lawrence D True
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
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2
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Marques TMDDM, Cerqueira WS, Neto JLDF, Kupper BEC, Takahashi RM, Bezerra TS, Stevanato Filho PR, Nakagawa WT, Lopes A, Aguiar S. Role of magnetic resonance imaging in the prediction of histological grade in soft tissue sarcomas. J Surg Oncol 2024. [PMID: 38685686 DOI: 10.1002/jso.27663] [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: 03/18/2024] [Revised: 04/22/2024] [Accepted: 04/22/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Soft tissue sarcomas are rare malignant tumors with significant heterogeneity. The importance of classifying histological grades is fundamental to defining the treatment approach. OBJECTIVE To evaluate magnetic resonance imaging (MRI) in predicting the histological grade of soft tissue sarcomas. METHODS A retrospective observational study included patients over 18 years undergoing MRI and primary tumor surgery at AC Camargo Cancer Center from January 2015 to June 2022. Two radiologists evaluated MRI criteria (size, margin definition, heterogeneity of the T2 signal, high-intensity peritumoral signal on T2, and postperitumoral contrast), and a grading prediction score was calculated. χ2 and logistic regression analyses were conducted. RESULTS Sixty-eight patients were included (38 men; median: 48 years). Moreover, 52 high-grade and 16 low-grade tumors were observed. The MRI criteria associated with histological grade were peritumoral high-intensity T2-weighted signals (p < 0.001) and peritumoral postcontrast enhancement (p = 0.006). Logistic regression confirmed their significance (odds ratio [OR]: 11.8 and 8.8, respectively). Each score point increment doubled the chance of high-grade tumors (OR: 2.0; p = 0.014). CONCLUSION MRI effectively predicts histological grades of soft tissue sarcomas. Peritumoral high-intensity T2-weighted signals and peritumoral postcontrast enhancement are valuable indicators of high-grade tumors. This highlights MRI's importance in treatment decision-making for sarcoma patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ademar Lopes
- Sarcoma Reference Center, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - Samuel Aguiar
- Sarcoma Reference Center, AC Camargo Cancer Center, Sao Paulo, Brazil
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3
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Shiina O, Kudo S, Ichimasa K, Takashina Y, Kouyama Y, Mochizuki K, Morita Y, Kuroki T, Kato S, Nakamura H, Matsudaira S, Misawa M, Ogata N, Hayashi T, Wakamura K, Sawada N, Baba T, Nemoto T, Ishida F, Miyachi H. Differentiation grade as a risk factor for lymph node metastasis in T1 colorectal cancer. DEN Open 2024; 4:e324. [PMID: 38155928 PMCID: PMC10753631 DOI: 10.1002/deo2.324] [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] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/26/2023] [Accepted: 12/06/2023] [Indexed: 12/30/2023]
Abstract
Objectives Japanese guidelines include high-grade (poorly differentiated) tumors as a risk factor for lymph node metastasis (LNM) in T1 colorectal cancer (CRC). However, whether the grading is based on the least or most predominant component when the lesion consists of two or more levels of differentiation varies among institutions. This study aimed to investigate which method is optimal for assessing the risk of LNM in T1 CRC. Methods We retrospectively evaluated 971 consecutive patients with T1 CRC who underwent initial or additional surgical resection from 2001 to 2021 at our institution. Tumor grading was divided into low-grade (well- to moderately differentiated) and high-grade based on the least or predominant differentiation analyses. We investigated the correlations between LNM and these two grading analyses. Results LNM was present in 9.8% of patients. High-grade tumors, as determined by least differentiation analysis, accounted for 17.0%, compared to 0.8% identified by predominant differentiation analysis. A significant association with LNM was noted for the least differentiation method (p < 0.05), while no such association was found for predominant differentiation (p = 0.18). In multivariate logistic regression, grading based on least differentiation was an independent predictor of LNM (p = 0.04, odds ratio 1.68, 95% confidence interval 1.00-2.83). Sensitivity and specificity for detecting LNM were 27.4% and 84.1% for least differentiation, and 2.1% and 99.3% for predominant differentiation, respectively. Conclusions Tumor grading via least differentiation analysis proved to be a more reliable measure for assessing LNM risk in T1 CRC compared to grading by predominant differentiation.
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Affiliation(s)
- Osamu Shiina
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Shin‐ei Kudo
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Katsuro Ichimasa
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
- Department of MedicineNational University of SingaporeSingaporeSingapore
| | - Yuki Takashina
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Yuta Kouyama
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Kenichi Mochizuki
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Yuriko Morita
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Takanori Kuroki
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Shun Kato
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Hiroki Nakamura
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Shingo Matsudaira
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Masashi Misawa
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Noriyuki Ogata
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Takemasa Hayashi
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Kunihiko Wakamura
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Naruhiko Sawada
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Toshiyuki Baba
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Tetsuo Nemoto
- Department of Diagnostic PathologyShowa University Northern Yokohama HospitalKanagawaJapan
| | - Fumio Ishida
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Hideyuki Miyachi
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
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Gallagher BDT, Chiam K, Bang A, Patel MI, Kench JG, Edwards S, Nair-Shalliker V, Smith DP. Descriptive analysis of prostate cancer pathology data from diagnosis and surgery in men from the 45 and Up Study. Pathology 2024; 56:39-46. [PMID: 38104002 DOI: 10.1016/j.pathol.2023.09.011] [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] [Received: 03/19/2023] [Revised: 08/12/2023] [Accepted: 09/19/2023] [Indexed: 12/19/2023]
Abstract
Information available from the New South Wales Cancer Registry (NSWCR) about the aggressiveness of prostate cancer is limited to the summary stage variable 'degree of spread', which contains a high proportion of cases defined as 'unknown'. In this study we demonstrate the feasibility of obtaining and analysing prostate cancer pathology data from stored pathology records. Pathology data were extracted from stored pathology records of incident prostate cancer cases in men participating in the 45 and Up Study, a large Australian prospective cohort study, who were diagnosed between January 2006 and December 2013. Baseline questionnaires from the 45 and Up Study were linked to the NSWCR. Demographic and pathology items were tabulated and associations described. We evaluated the completeness of pathological characteristics by degree of spread of cancer at diagnosis. Among the 123,921 men enrolled in the 45 and Up Study, 5,091 had incident prostate cancer and 5,085 were linked to a pathology record. The most complete variables included grade group of diagnostic (85.8%) and surgical (99.8%) specimens, margin status (98.1%), extraprostatic extension (95.1%) and seminal vesicle invasion (96.8%). Most diagnostic specimens were grade group 1 (26.6%) or 2 (23.5%). Of the 5,085 cases, 30.8% were classified by the NSWCR with unknown degree of spread; a pathology record could be extracted for 99.4% of these. The unknown degree of spread cases had similar levels of completeness and distribution of diagnostic and surgical pathology features to those with a localised degree of spread. This study demonstrated the feasibility of obtaining and analysing data derived from pathology reports from centralised state-based cancer registry notifications. Supplementing degree of spread information with pathology data from diagnosis and surgery will improve both the quality of research and policy aimed at improving the lives of men with prostate cancer.
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Affiliation(s)
- Benjamin D T Gallagher
- Faculty of Medicine and Health, Sydney School of Public Health, Camperdown, NSW, Australia; The Daffodil Centre, University of Sydney, Sydney, NSW, Australia.
| | - Karen Chiam
- Faculty of Medicine and Health, Sydney School of Public Health, Camperdown, NSW, Australia; The Daffodil Centre, University of Sydney, Sydney, NSW, Australia
| | - Albert Bang
- The Daffodil Centre, University of Sydney, Sydney, NSW, Australia
| | - Manish I Patel
- Department of Urology, Westmead Hospital, Specialty of Surgery, University of Sydney, Sydney, NSW, Australia
| | - James G Kench
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Sue Edwards
- Cancer Services and Information, Cancer Institute NSW, Sydney, NSW, Australia
| | - Visalini Nair-Shalliker
- The Daffodil Centre, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health Science, Macquarie University, Sydney, NSW, Australia
| | - David P Smith
- The Daffodil Centre, University of Sydney, Sydney, NSW, Australia; Menzies Health Institute Queensland, Griffith University, Southport, Qld, Australia; School of Public Health and Preventative Medicine, Monash University, Melbourne, Vic, Australia
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Moodi F, Khodadadi Shoushtari F, Ghadimi DJ, Valizadeh G, Khormali E, Salari HM, Ohadi MAD, Nilipour Y, Jahanbakhshi A, Rad HS. Glioma Tumor Grading Using Radiomics on Conventional MRI: A Comparative Study of WHO 2021 and WHO 2016 Classification of Central Nervous Tumors. J Magn Reson Imaging 2023. [PMID: 38031466 DOI: 10.1002/jmri.29146] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/07/2023] [Accepted: 11/11/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Glioma grading transformed in World Health Organization (WHO) 2021 CNS tumor classification, integrating molecular markers. However, the impact of this change on radiomics-based machine learning (ML) classifiers remains unexplored. PURPOSE To assess the performance of ML in classifying glioma tumor grades based on various WHO criteria. STUDY TYPE Retrospective. SUBJECTS A neuropathologist regraded gliomas of 237 patients into WHO 2016 and 2021 from 2007 criteria. FIELD STRENGTH/SEQUENCE Multicentric 0.5 to 3 Tesla; pre- and post-contrast T1-weighted, T2-weighted, and fluid-attenuated inversion recovery. ASSESSMENT Radiomic features were selected using random forest-recursive feature elimination. The synthetic minority over-sampling technique (SMOTE) was implemented for data augmentation. Stratified 10-fold cross-validation with and without SMOTE was used to evaluate 11 classifiers for 3-grade (2, 3, and 4; WHO 2016 and 2021) and 2-grade (low and high grade; WHO 2007 and 2021) classification. Additionally, we developed the models on data randomly divided into training and test sets (mixed-data analysis), or data divided based on the centers (independent-data analysis). STATISTICAL TESTS We assessed ML classifiers using sensitivity, specificity, accuracy, and the area under the receiver operating characteristic curve (AUC). Top performances were compared with a t-test and categorical data with the chi-square test using a significance level of P < 0.05. RESULTS In the mixed-data analysis, Stacking Classifier without SMOTE achieved the highest accuracy (0.86) and AUC (0.92) in 3-grade WHO 2021 grouping. The results of WHO 2021 were significantly better than WHO 2016 (P-value<0.0001). In the 2-grade analysis, ML achieved 1.00 in all metrics. In the independent-data analysis, ML classifiers showed strong discrimination between grade 2 and 4, despite lower performance metrics than the mixed analysis. DATA CONCLUSION ML algorithms performed better in glioma tumor grading based on WHO 2021 criteria. Nonetheless, the clinical use of ML classifiers needs further investigation. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Farzan Moodi
- Quantitative MR Imaging and Spectroscopy Group (QMISG), Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Delaram J Ghadimi
- Quantitative MR Imaging and Spectroscopy Group (QMISG), Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gelareh Valizadeh
- Quantitative MR Imaging and Spectroscopy Group (QMISG), Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Khormali
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hanieh Mobarak Salari
- Quantitative MR Imaging and Spectroscopy Group (QMISG), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Amin Dabbagh Ohadi
- Interdisciplinary Neuroscience Research Program, Tehran University of Medical Sciences, Tehran, Iran
- Departments of Pediatric Neurosurgery Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Yalda Nilipour
- Pediatric Pathology Research Center, Research Institute of Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amin Jahanbakhshi
- Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Saligheh Rad
- Quantitative MR Imaging and Spectroscopy Group (QMISG), Tehran University of Medical Sciences, Tehran, Iran
- Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran
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Taghipour Zahir S, Razavi SH, SafiDahaj F, Rahmani K, Sadeghinejad‐Alamabadi S. Prognosis and survival study in patients with gastric adenocarcinoma and its relationship with pRb expression alteration: A retrospective IHC-based study. Health Sci Rep 2023; 6:e1445. [PMID: 37519424 PMCID: PMC10372302 DOI: 10.1002/hsr2.1445] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/25/2023] [Accepted: 07/14/2023] [Indexed: 08/01/2023] Open
Abstract
Background and Objective Among cancers, gastric cancer has the fifth highest incidence worldwide and is the third most common mortality factor, which may have been due to inadequate knowledge of its molecular pathogenesis. The retinoblastoma gene (RB1), a tumor suppressor gene, may have a role in gastric cancer. This research aims to assess Rb expression as a prognostic marker to obtain more insight regarding gastric cancer. Methods This retrospective analytical study was done on 61 patients (45 males and 16 females) with gastric adenocarcinoma admitted from 2010 to 2012 in Shahid Sadoughi and Mortaz hospitals, Yazd, Iran. Demographic data, including age, gender, clinical signs and symptoms, and pathology reports, were retrieved from patients' hospital folders. Then, the altered Retinoblastoma gene expression was evaluated by immunohistochemistry studies. Acquired data were analyzed by SPSS software v.16. p < 0.05 was statistically considered meaningful. Results In this study, the ratio of men to women was higher (2.81:1), and the mean age of patients was 62.44 years. About 90.2% of patients died during the study. There was no meaningful relationship between the presence of pRb, the intensity of staining, the percentage of staining with patients' age, gender, tumor grading, and survival rate (p > 0.05). There was only a meaningful relationship between the grade of tumors and survival rate (p = 0.039). Conclusion Altered pRB expression is not common in gastric cancer and does not impact the survival and grading of tumors. Poorly differentiated tumors had an ominous outcome with the lowest survival time.
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Affiliation(s)
| | - Seyyed Hossein Razavi
- Clinical and Surgical PathologyShahid Sadoughi University of Medical SciencesYazdIran
| | - Farzan SafiDahaj
- Clinical and Surgical PathologyShahid Sadoughi University of Medical SciencesYazdIran
| | - Koorosh Rahmani
- Clinical and Surgical PathologyShahid Sadoughi University of Medical SciencesYazdIran
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7
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Zhou M, Paner GP. Point-Counterpoint: Grade Group 1 (Gleason Score 6) Prostate Cancer Should Be Renamed to Improve Public Health: Pathologists' Perspective. J Urol 2023; 210:23-25. [PMID: 37126310 DOI: 10.1097/ju.0000000000003511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/18/2023] [Indexed: 05/02/2023]
Affiliation(s)
- Ming Zhou
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Gladell P Paner
- Departments of Pathology and Surgery (Urology), University of Chicago Medical Center, Chicago, Illinois
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8
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Rafiee A, Mohammadizadeh F. Association of Lymphovascular Space Invasion (LVSI) with Histological Tumor Grade and Myometrial Invasion in Endometrial Carcinoma: A Review Study. Adv Biomed Res 2023; 12:159. [PMID: 37564444 PMCID: PMC10410422 DOI: 10.4103/abr.abr_52_23] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/15/2023] [Accepted: 03/18/2023] [Indexed: 08/12/2023] Open
Abstract
Endometrial carcinoma is one of the most frequent gynecological cancers in developed countries. Lymphovascular space invasion (LVSI), histological grade, and myometrial invasion (MMI) are important prognostic factors of endometrial carcinoma. LVSI is considered an independent poor prognostic factor in endometrial carcinoma. Based on the importance of LVSI, this study aimed to discuss the association of LVSI with tumor grade and MMI. A search of PubMed, EMBASE, Web of Science, Scopus, Google Scholar, and Cochrane Library was carried out to collect related studies. Consequently, most studies showed that LVSI is significantly associated with higher histologic grade and deep MMI.
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Affiliation(s)
- Azita Rafiee
- Pathologist, Iranian Medical and Pathology Laboratory, Zahedan, Iran
| | - Fereshteh Mohammadizadeh
- Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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9
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Guo Z, Tian Z, Shi F, Xu P, Zhang J, Ling C, Zeng Q. Radiomic Features of the Edema Region May Contribute to Grading Meningiomas With Peritumoral Edema. J Magn Reson Imaging 2022. [PMID: 36259547 DOI: 10.1002/jmri.28494] [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: 05/21/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Meningiomas are frequently accompanied by peritumoral edema (PTE). The potential value of radiomic features of edema region in meningioma grading has not been investigated. PURPOSE To investigate whether radiomic features of edema region contribute to grading meningiomas with PTE. STUDY TYPE Retrospective. POPULATION A total of 444 patients including 196 grade II and 248 WHO grade I meningiomas: 356 patients for training, 88 for validation. FIELD STRENGTH/SEQUENCE A 1.5-T/3.0-T, noncontrast T1-weighted (T1WI), T2-weighted (T2WI), contrast-enhanced T1-weighted (T1CE) spin echo sequences. ASSESSMENT A total of 851 radiomic features were extracted from each sequence on each region (tumor and edema region). These features were integrated by region respectively. Three subsets of clinical-radiomic features were constructed by joining clinical information (sex, age, tumor volume, and edema volume) and radiomic features of three regions: tumor, edema, and combined subsets. For each subset, features were filtered by the least absolute shrinkage and selection operator (LASSO) and Random Forest algorithm. Top 20 features of each subset were finally selected. STATISTICAL TESTS Stochastic Gradient Boosting, Random Forest, and Bagged AdaBoost predictive models were built based on each subset. Discriminative abilities of models were quantified using receiver operating characteristics (ROC) and the area under the curve (AUC). A P value < 0.05 was considered statistically significant. RESULTS Random Forest model based on combined subset (AUC [95% CI] = 0.880 [0.807-0.953]) had the best discriminative ability in grading meningiomas among the final models. The best model of edema subset and tumor subset were Random Forest model (AUC [95% CI] = 0.864 [0.791-0.938]) and Stochastic Gradient Boosting model (AUC [95% CI] = 0.844 [0.760-0.928]), respectively. DATA CONCLUSION Radiomic features of edema region may contribute to grading meningiomas with PTE. The Random Forest model based on combined subset surpasses the best model based on tumor or edema subset regarding grading meningiomas with PTE. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Zhige Guo
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University school of Medicine, Hangzhou, Zhejiang, China.,Department of Neurosurgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Zhongyu Tian
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University school of Medicine, Hangzhou, Zhejiang, China
| | - Feina Shi
- Department of Neurology, Sir Runrun Shaw Hospital of Zhejiang University school of Medicine, Hangzhou, Zhejiang, China
| | - Penglei Xu
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University school of Medicine, Hangzhou, Zhejiang, China.,Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Jianmin Zhang
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University school of Medicine, Hangzhou, Zhejiang, China.,Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Chenhan Ling
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University school of Medicine, Hangzhou, Zhejiang, China.,Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Qiang Zeng
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University school of Medicine, Hangzhou, Zhejiang, China.,Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, Zhejiang, China
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10
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Ameli S, Venkatesh BA, Shaghaghi M, Ghadimi M, Hazhirkarzar B, Rezvani Habibabadi R, Aliyari Ghasabeh M, Khoshpouri P, Pandey A, Pandey P, Pan L, Grimm R, Kamel IR. Role of MRI-Derived Radiomics Features in Determining Degree of Tumor Differentiation of Hepatocellular Carcinoma. Diagnostics (Basel) 2022; 12:diagnostics12102386. [PMID: 36292074 PMCID: PMC9600274 DOI: 10.3390/diagnostics12102386] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 08/22/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background: To investigate radiomics ability in predicting hepatocellular carcinoma histological degree of differentiation by using volumetric MR imaging parameters. Methods: Volumetric venous enhancement and apparent diffusion coefficient were calculated on baseline MRI of 171 lesions. Ninety-five radiomics features were extracted, then random forest classification identified the performance of the texture features in classifying tumor degree of differentiation based on their histopathological features. The Gini index was used for split criterion, and the random forest was optimized to have a minimum of nine participants per leaf node. Predictor importance was estimated based on the minimal depth of the maximal subtree. Results: Out of 95 radiomics features, four top performers were apparent diffusion coefficient (ADC) features. The mean ADC and venous enhancement map alone had an overall error rate of 39.8%. The error decreased to 32.8% with the addition of the radiomics features in the multi-class model. The area under the receiver-operator curve (AUC) improved from 75.2% to 83.2% with the addition of the radiomics features for distinguishing well- from moderately/poorly differentiated HCCs in the multi-class model. Conclusions: The addition of radiomics-based texture analysis improved classification over that of ADC or venous enhancement values alone. Radiomics help us move closer to non-invasive histologic tumor grading of HCC.
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Affiliation(s)
- Sanaz Ameli
- Department of Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | | | - Mohammadreza Shaghaghi
- Department of Radiology, Johns Hopkins Hospital, 600 N Wolfe St., Baltimore, MD 21287, USA
| | - Maryam Ghadimi
- Department of Radiology, Johns Hopkins Hospital, 600 N Wolfe St., Baltimore, MD 21287, USA
| | - Bita Hazhirkarzar
- Department of Radiology, Johns Hopkins Hospital, 600 N Wolfe St., Baltimore, MD 21287, USA
| | - Roya Rezvani Habibabadi
- Department of Radiology, University of Florida College of Medicine, 1600 SW Archer Rd., Gainesville, FL 32610, USA
| | - Mounes Aliyari Ghasabeh
- Department of Radiology, Saint Louis University, 1201 S Grand Blvd, St. Louis, MO 63104, USA
| | - Pegah Khoshpouri
- Department of Radiology, University of Washington Main Hospital, 1959 NE Pacific St., 2nd Floor, Seattle, WA 98195, USA
| | - Ankur Pandey
- Department of Radiology, University of Maryland Medical Center, 22 S Greene St., Baltimore, MD 21201, USA
| | - Pallavi Pandey
- Department of Radiology, Johns Hopkins Hospital, 600 N Wolfe St., Baltimore, MD 21287, USA
| | - Li Pan
- Department of Radiology, Johns Hopkins Hospital, 600 N Wolfe St., Baltimore, MD 21287, USA
| | - Robert Grimm
- Department of Radiology, Johns Hopkins Hospital, 600 N Wolfe St., Baltimore, MD 21287, USA
| | - Ihab R. Kamel
- Department of Radiology, Johns Hopkins Hospital, 600 N Wolfe St., Baltimore, MD 21287, USA
- Correspondence:
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11
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He Y, Gao W, Ying W, Feng N, Wang Y, Jiang P, Gong Y, Li X. A Novel Preoperative Prediction Model Based on Deep Learning to Predict Neoplasm T Staging and Grading in Patients with Upper Tract Urothelial Carcinoma. J Clin Med 2022; 11:jcm11195815. [PMID: 36233682 PMCID: PMC9571440 DOI: 10.3390/jcm11195815] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/01/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022] Open
Abstract
Objectives: To create a novel preoperative prediction model based on a deep learning algorithm to predict neoplasm T staging and grading in patients with upper tract urothelial carcinoma (UTUC). Methods: We performed a retrospective cohort study of patients diagnosed with UTUC between 2001 and 2012 at our institution. Five deep learning algorithms (CGRU, BiGRU, CNN-BiGRU, CBiLSTM, and CNN-BiLSTM) were used to develop a preoperative prediction model for neoplasm T staging and grading. The Matthews correlation coefficient (MMC) and the receiver-operating characteristic curve with the area under the curve (AUC) were used to evaluate the performance of each prediction model. Results: The clinical data of a total of 884 patients with pathologically confirmed UTUC were collected. The T-staging prediction model based on CNN-BiGRU achieved the best performance, and the MMC and AUC were 0.598 (0.592–0.604) and 0.760 (0.755–0.765), respectively. The grading prediction model [1973 World Health Organization (WHO) grading system] based on CNN-BiGRU achieved the best performance, and the MMC and AUC were 0.612 (0.609–0.615) and 0.804 (0.801–0.807), respectively. The grading prediction model [2004 WHO grading system] based on BiGRU achieved the best performance, and the MMC and AUC were 0.621 (0.616–0.626) and 0.824 (0.819–0.829), respectively. Conclusions: We developed an accurate UTUC preoperative prediction model to predict neoplasm T staging and grading based on deep learning algorithms, which will help urologists to make appropriate treatment decisions in the early stage.
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Affiliation(s)
- Yuhui He
- Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - Wenzhi Gao
- Department of Urology, Peking University First Hospital, Beijing 100034, China
- Department of Urology, The Third Hospital of Hebei Medical University, Shijiazhuang 050052, China
| | - Wenwei Ying
- Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - Ninghan Feng
- Department of Urology, The Second People’s Hospital of Wuxi, Wuxi 214002, China
| | - Yang Wang
- Department of Urology, The Second People’s Hospital of Wuxi, Wuxi 214002, China
| | - Peng Jiang
- Department of Urology, The Second People’s Hospital of Wuxi, Wuxi 214002, China
| | - Yanqing Gong
- Department of Urology, Peking University First Hospital, Beijing 100034, China
- Correspondence: (Y.G.); (X.L.)
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Beijing 100034, China
- Correspondence: (Y.G.); (X.L.)
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12
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Voicu IP, Napolitano A, Caulo M, Dotta F, Piccirilli E, Vinci M, Diomedi-Camassei F, Lattavo L, Carboni A, Miele E, Cacchione A, Carai A, Tomà P, Mastronuzzi A, Colafati GS. Developing a Predictive Grading Model for Children with Gliomas Based on Diffusion Kurtosis Imaging Metrics: Accuracy and Clinical Correlations with Patient Survival. Cancers (Basel) 2022; 14. [PMID: 36230701 DOI: 10.3390/cancers14194778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/25/2022] [Revised: 09/19/2022] [Accepted: 09/24/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose: To develop a predictive grading model based on diffusion kurtosis imaging (DKI) metrics in children affected by gliomas, and to investigate the clinical impact of the predictive model by correlating with overall survival and progression-free survival. Materials and methods: 59 patients with a histological diagnosis of glioma were retrospectively studied (33 M, 26 F, median age 7.2 years). Patients were studied on a 3T scanner with a standardized MR protocol, including conventional and DKI sequences. Mean kurtosis (MK), axial kurtosis (AK), radial kurtosis (RK), fractional anisotropy (FA), and apparent diffusion coefficient (ADC) maps were obtained. Whole tumour volumes (VOIs) were segmented semi-automatically. Mean DKI values were calculated for each metric. The quantitative values from DKI-derived metrics were used to develop a predictive grading model to develop a probability prediction of a high-grade glioma (pHGG). Three models were tested: DTI-based, DKI-based, and combined (DTI and DKI). The grading accuracy of the resulting probabilities was tested with a receiver operating characteristics (ROC) analysis for each model. In order to account for dataset imbalances between pLGG and pHGG, we applied a random synthetic minority oversampling technique (SMOTE) analysis. Lastly, the most accurate model predictions were correlated with progression-free survival (PFS) and overall survival (OS) using the Kaplan−Meier method. Results: The cohort included 46 patients with pLGG and 13 patients with pHGG. The developed model predictions yielded an AUC of 0.859 (95%CI: 0.752−0.966) for the DTI model, of 0.939 (95%CI: 0.879−1) for the DKI model, and of 0.946 (95%CI: 0.890−1) for the combined model, including input from both DTI and DKI metrics, which resulted in the most accurate model. Sample estimation with the random SMOTE analysis yielded an AUC of 0.98 on the testing set. Model predictions from the combined model were significantly correlated with PFS (25.2 months for pHGG vs. 40.0 months for pLGG, p < 0.001) and OS (28.9 months for pHGG vs. 44.9 months for pLGG, p < 0.001). Conclusions: a DKI-based predictive model was highly accurate for pediatric glioma grading. The combined model, derived from both DTI and DKI metrics, proved that DKI-based model predictions of tumour grade were significantly correlated with progression-free survival and overall survival.
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13
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Flores AR, Rêma A, Mesquita JR, Taulescu M, Seixas F, Gärtner F, Amorim I. Vimentin and Ki-67 immunolabeling in canine gastric carcinomas and their prognostic value. Vet Pathol 2022; 59:903-914. [PMID: 35972070 DOI: 10.1177/03009858221117858] [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] [Indexed: 11/17/2022]
Abstract
This study evaluated the expression of vimentin and Ki-67 proliferative index (PI) by immunohistochemistry in 30 canine gastric carcinomas (GCs) and a possible association with clinical and pathological features and patient's survival time. Vimentin immunoreactivity was assessed in neoplastic cells (in primary lesions, emboli, and metastases) and tumor-associated stroma (TAS) of canine GCs. Ki-67 PI was quantified in the neoplastic epithelial component. Vimentin immunolabeling in neoplastic cells was found in 30% of the primary lesions, in 82% of the neoplastic emboli, and in 50% of the metastases; in TAS, it was observed in all cases. A mean of 16% of the TAS was immunolabeled for vimentin. High vimentin immunolabeling in the TAS (>16%) was detected in 40% of cases. The average value of Ki-67 PI was 50%, and 80% of the lesions had Ki-67 PI above 20%. Vimentin immunolabeling in neoplastic cells was more frequent in less-differentiated carcinomas (diffuse [29%] and indeterminate types [75%]) than well-differentiated carcinomas (intestinal type [0%], P = .049). No significant differences were observed in vimentin immunolabeling in the TAS or Ki-67 PI according to histological diagnosis, depth of invasion, presence of neoplastic emboli or metastases. However, vimentin immunolabeling in the TAS was positively correlated with Ki-67 PI (r = .394, P = .031). Furthermore, a moderate negative correlation was observed between Ki-67 PI and survival time (r = -0.540). Our results suggest that vimentin and Ki-67 PI have potential for providing prognostic information in cases of canine GCs.
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Affiliation(s)
- Ana R Flores
- Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal.,Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal.,University of Trás-os-Montes and Alto Douro, Vila Real, Portugal.,Associate Laboratory for Animal and Veterinary Sciences, Vila Real, Portugal
| | - Alexandra Rêma
- Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - João R Mesquita
- Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Marian Taulescu
- University of Agricultural Sciences and Veterinary Medicine of Cluj-Napoca, Cluj-Napoca, Romania.,Synevovet Laboratory, Chiajna, Romania
| | - Fernanda Seixas
- University of Trás-os-Montes and Alto Douro, Vila Real, Portugal.,Associate Laboratory for Animal and Veterinary Sciences, Vila Real, Portugal
| | - Fátima Gärtner
- Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal.,Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal.,i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Irina Amorim
- Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal.,Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal.,i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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14
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Matsuoka M, Onodera T, Yokota I, Iwasaki K, Hishimura R, Suzuki Y, Kondo E, Iwasaki N. Comparison of clinical features between patients with bone and soft tissue fibrosarcomas. J Surg Oncol 2022; 126:1299-1305. [PMID: 35938632 DOI: 10.1002/jso.27049] [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: 04/04/2022] [Revised: 07/15/2022] [Accepted: 07/26/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVES Fibrosarcomas predominantly arise in soft tissues, but can also develop in bone. Because of their rarity, whether bone development has an impact on clinical features has not been addressed. METHODS We included fibrosarcoma patients diagnosed between 1983 and 2016 in the Surveillance, Epidemiology, and End Results database. Differences in clinical features between fibrosarcoma of bone (FS-B) and fibrosarcoma of soft tissue (FS-ST) were investigated. RESULTS After excluding patients without information regarding cause of death, site of origin, distant tumor or survival, 1443 patients were included. Of those, 98 patients had FS-B. Patients with FS-B were younger, more frequently male, with fibrosarcomas that more often developed in an extremity and were histologically high-grade. In contrast, no difference in potential to metastasize was observed. Survival was almost equal between FS-B and FS-ST (FS-B/FS-ST: cancer-specific survival, hazard ratio [HR]: 1.2, 95% confidence interval [CI]: 0.8-1.7; overall survival, HR: 1.3, 95% CI: 0.9-1.7). CONCLUSIONS Our results clearly indicated that patient backgrounds differed, such as younger age and greater tendencies to affect males, develop in an extremity and show high-grade tumor in patients with FS-B. In contrast, no differences were observed in distant metastatic potential or survival.
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Affiliation(s)
- Masatake Matsuoka
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Koji Iwasaki
- Department of Functional Reconstruction for the Knee Joint, Hokkaido University, Hokkaido, Japan
| | - Ryosuke Hishimura
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Yuki Suzuki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Hokkaido, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
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15
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Perera M, Assel MJ, Benfante NE, Vickers AJ, Reuter VE, Carlsson S, Laudone V, Touijer KA, Eastham JA, Scardino PT, Fine SW, Ehdaie B. Oncologic Outcomes of Total Length Gleason Pattern 4 on Biopsy in Men with Grade Group 2 Prostate Cancer. J Urol 2022; 208:309-16. [PMID: 35363038 DOI: 10.1097/JU.0000000000002685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Gleason Score 7 prostate cancer comprises a wide spectrum of disease risk, and precise substratification is paramount. Our group previously demonstrated that the total length of Gleason pattern (GP) 4 is a better predictor than %GP4 for adverse pathological outcomes at radical prostatectomy. We aimed to determine the association of GP4 length on prostate biopsy with post-prostatectomy oncologic outcomes. MATERIALS AND METHODS We compared 4 GP4 quantification methods-including maximum %GP4 in any single core, overall %GP4, total length GP4 (mm) across all cores and length GP4 (mm) in the highest volume core-for prediction of biochemical recurrence-free survival after radical prostatectomy using multivariable Cox proportional hazards regression. RESULTS A total of 457 men with grade group 2 prostate cancer on biopsy subsequently underwent radical prostatectomy. The 3-year biochemical recurrence-free survival probability was 85% (95% CI 81-88). On multivariable analysis, all 4 GP4 quantification methods were associated with biochemical recurrence-maximum %GP4 (HR=1.30; 95% CI 1.07-1.59; p=0.009), overall %GP4 (HR=1.61; 95% CI 1.21-2.15; p=0.001), total length GP4 (HR=2.48; 95% CI 1.36-4.52; p=0.003) and length GP4 in highest core (HR=1.32; 95% CI 1.11-1.57; p=0.001). However, we were unable to identify differences between methods of quantification with a relatively low event rate. CONCLUSIONS These findings support further studies on GP4 quantification in addition to the ratio of GP3 and GP4 to classify prostate cancer risk. Research should also be conducted on whether GP4 quantification could provide a surrogate endpoint for disease progression for trials in active surveillance.
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16
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Widodo I, Ghozali A, Purwanto I, Ferronika P. Stromal Tumor Infiltrating Lymphocytes (sTILs) Were Associated with a Higher Grade and a Lower Stage of Indonesian Triple Negative Breast Cancers. Asian Pac J Cancer Prev 2022; 23:2749-2754. [PMID: 36037130 DOI: 10.31557/apjcp.2022.23.8.2749] [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] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to investigate the association of sTILs with clinicopathological parameters and overall survival (OS) in patients with triple negative breast cancer (TNBC). METHODS One hundred and twenty-five paraffin embedded tissue of patients with TNBC, collected from Dr. Sardjito General Hospital Yogyakarta, Indonesia, between 2008-2017, were used in this study. Stromal TILs were examined from hematoxylin and eosin (H&E)-stained samples, and classified as either low or high score using 20% cut-off. Analysis of the association of sTILs with clinicopathological parameters, relative risk (RR) and OS used 95% confidence interval (CI) with significance set as p<0.05. RESULTS The higher proportion of TNBC patients in this study were ≥40 years old (83.3%), high tumor grade (68%), tumor stage >IIIa (56%), alive (50.4%), and with low sTILs (54.4%). The results showed significant association between sTILs and a higher grade or a lower stage of tumor (B = 0.259, 95%CI = 0.090-0.468, p = 0.004 and B = -0.255, 95%CI = -0.433 - -0.080, p = 0.005, respectively ). Meanwhile sTILs were not associated with age at diagnosis (B = 0.027, 95%CI = -0.193 - 0.264 p = 0.758 nor 3-year OS of patients (HR = 0.342, 95%CI = 0.41 - 1.43 p = 0.402). CONCLUSION The results indicate that sTILs may serve as an additional pathological parameter for TNBC.
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Affiliation(s)
- Irianiwati Widodo
- Department of Anatomic Pathology, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Indonesia
| | - Ahmad Ghozali
- Department of Anatomic Pathology, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Indonesia
| | - Ibnu Purwanto
- Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Indonesia
| | - Paranita Ferronika
- Department of Anatomic Pathology, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Indonesia
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17
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Galtung KF, Lauritzen PM, Baco E, Berg RE, Naas AM, Rud E. Predictive Performance of Prospectively Applied ISUP and Fuhrman Grade in Nonmetastatic Renal Cell Carcinoma. Anticancer Res 2022; 42:2967-2975. [PMID: 35641263 DOI: 10.21873/anticanres.15780] [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: 04/07/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM In 2012, the International Society of Urological Pathology (ISUP) recommended replacing Fuhrman with ISUP for grading renal cell carcinoma (RCC). Our aim was to report recurrence-free survival (RFS) and assess prognostic value of ISUP and Fuhrman for predicting recurrence using original pathology assessment and routine follow-up data. PATIENTS AND METHODS In this single-institution retrospective cohort study, 686 patients underwent a single session total or partial nephrectomy due to nonmetastatic RCC (nmRCC). Of those, 564 had tumors prospectively graded according to either ISUP or Fuhrman, which defined the cohorts. RFS was defined as the interval from surgery to local recurrence and/or metastasis. Differences in RFS were calculated with log rank test. Cox models adjusted for risk factors were used for predicting recurrence. RESULTS During a median follow-up of 36 months in the ISUP group (n=152), 11% developed recurrent disease. RFS was significantly lower for grade 4 compared to 1-3 (p<0.001), but non-significant between 1-3. Grade was the only significant predictor in multivariate analyses. During a median follow-up time of 50 months in the Fuhrman group (n=412), 16% developed recurrent disease. There was a significant difference in RFS between grades 2 and 3 (p=0.003) and between 3 and 4 (p<0.001), but non-significant between 1 and 2 (p=0.063). Grade, positive surgical margin, tumor size ≥4 cm, and pT were significant predictors of recurrence in multivariate analyses. CONCLUSION ISUP grading alone is an accurate tool for predicting recurrence in patients with nmRCC.
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Affiliation(s)
| | | | - Eduard Baco
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - Rolf Eigil Berg
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | | | - Erik Rud
- Department of Radiology, Oslo University Hospital, Oslo, Norway
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18
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Bonde TM, Westerberg M, Aly M, Eklund M, Adolfsson J, Bill-Axelson A, Garmo H, Stattin P, Robinson D. Time to castration-resistant prostate cancer and prostate cancer death according to PSA response in men with non-metastatic prostate cancer treated with gonadotropin releasing hormone agonists. Scand J Urol 2022; 56:169-175. [PMID: 35548951 DOI: 10.1080/21681805.2022.2070275] [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] [Indexed: 10/18/2022]
Abstract
Objectives: To predict castration-resistant prostate cancer (CRPC) and prostate cancer (Pca) death by use of clinical variables at Pca diagnosis and PSA levels after start of gonadotropin-releasing hormone agonists (GnRH) in men with non-metastatic castration sensitive prostate cancer (nmCSPC).Materials and Methods: PSA values for 1603 men with nmCSPC in the National Prostate Cancer Register of Sweden who received GnRH as primary treatment were retrieved from Uppsala-Örebro PSA Cohort and Stockholm PSA and Biopsy Register. All men had measured PSA before (pre-GnRH PSA) and 3-6 months after (post-GnRH PSA) date of start of GnRH. Unadjusted and adjusted Cox models were used to predict CRPC by PSA levels. PSA levels and ISUP grade were used to construct a risk score to stratify men by tertiles according to risk of CRPC and Pca death.Results: 788 (49%) men reached CRPC and 456 (28%) died of Pca during follow-up. Post-GnRH PSA predicted CRPC regardless of pre-GnRH PSA. CRPC risk increased with higher post-GnRH PSA, HR 4.7 (95% CI: 3.4-6.7) for PSA > 16 ng/mL vs 0-0.25 ng/mL and with ISUP grade, HR 3.7 (95%: 2.5-5.4) for ISUP 5 vs ISUP 1. Risk of Pca death in men above top vs bellow bottom tertile of post-GnRH PSA and ISUP grade was HR 4.1 (95% CI: 3.0-5.5).Conclusion: A risk score based on post-GnRH PSA and ISUP grade could be used for early identification of a target group for future clinical trials on additional therapy to GnRH.
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Affiliation(s)
- Tiago M Bonde
- Department of Urology, Ryhov Hospital, Jönköping, Sweden
| | | | - Markus Aly
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.,Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Jan Adolfsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Anna Bill-Axelson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Hans Garmo
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - David Robinson
- Department of Urology, Ryhov Hospital, Jönköping, Sweden
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19
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Waisman Malaret AJ, Chang P, Zhu K, Zheng Y, Newcomb LF, Liu M, McKenney JK, Brooks JD, Carroll P, Dash A, Filson CP, Gleave ME, Liss M, Martin FM, Morgan TM, Nelson PS, Lin DW, Wagner AA. Evaluating the Outcomes of Active Surveillance in Grade Group 2 Prostate Cancer: Prospective Results from the Canary PASS Cohort. J Urol 2021;:101097JU0000000000002354. [PMID: 34854745 DOI: 10.1097/JU.0000000000002354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Active surveillance (AS) for grade group (GG) 2 patients is not yet well defined. We sought to compare clinical outcomes of men with GG1 and GG2 prostate cancer undergoing AS in a large prospective North American cohort. MATERIALS AND METHODS Participants were prospectively enrolled in an AS study with protocol-directed followup at 10 centers in the U.S. and Canada. We evaluated time from diagnosis to biopsy grade reclassification and time to treatment. In men treated after initial surveillance, adverse pathology and recurrence were also analyzed. RESULTS At diagnosis, 154 (9%) had GG2 and 1,574 (91%) had GG1. Five-year reclassification rates were similar between GG2 and GG1 (30% vs 37%, p=0.11). However, more patients with GG2 were treated at 5 years (58% vs 34%, p <0.001) and GG at diagnosis was associated with time to treatment (HR=1.41; p=0.01). Treatment rates were similar in patients who reclassified during AS, but in patients who did not reclassify, those diagnosed with GG2 underwent definitive treatment more often than GG1 (5-year treatment rates 52% and 12%, p <0.0001). In participants who underwent radical prostatectomy after initial surveillance, the adjusted risk of adverse pathology was similar (HR=1.26; p=0.4). Biochemical recurrence within 3 years of treatment for GG2 and GG1 patients was 6% for both groups. CONCLUSIONS In patients on AS, the rate of definitive treatment is higher after an initial diagnosis of GG2 than GG1. Adverse pathology after radical prostatectomy and short-term biochemical recurrence after definitive treatment were similar between GG2 and GG1.
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20
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Raffone A, Travaglino A, Raimondo D, Maletta M, De Vivo V, Visiello U, Casadio P, Seracchioli R, Zullo F, Insabato L, Mollo A. Uterine carcinosarcoma vs endometrial serous and clear cell carcinoma: A systematic review and meta-analysis of survival. Int J Gynaecol Obstet 2021; 158:520-527. [PMID: 34797919 PMCID: PMC9543416 DOI: 10.1002/ijgo.14033] [Citation(s) in RCA: 6] [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: 07/27/2021] [Revised: 11/06/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022]
Abstract
Background It is unclear whether uterine carcinosarcoma (UCS) is more aggressive than endometrial serous carcinoma (SC) and clear cell carcinoma (CCC). Objectives To compare the prognosis of UCS to that of endometrial SC and CCC, through a systematic review and meta‐analysis. Methods Four electronic databases were searched from January 2000 to October 2020. All studies assessing hazard ratio (HR) for death in UCS vs SC and/or CCC. HRs for death with 95% confidence interval were extracted and pooled by using a random‐effect model. A significant P‐value <0.05 was adopted. Results Six studies with 11 029 patients (4995 with UCS, 4634 with SC, 1346 with CCC and 54 with either SC or CCC) were included. UCS showed a significantly worse prognosis than SC/CCC both overall (HR = 1.51; P = 0.008) and at early stage (HR = 1.58; P < 0.001). Similar results were found for UCS vs SC (HR = 1.53; P < 0.001) and UCS vs CCC (HR = 1.60; P < 0.001). Conclusions Compared to SC and CCC, UCS has a significantly worse prognosis, with a 1.5–1.6‐fold increased risk of death. This might justify a more aggressive treatment for UCS compared to SC and CCC. Further studies are necessary to define the prognostic impact of different molecular subgroups. Uterine carcinosarcoma shows worse prognosis than serous and clear cell carcinoma; this could impact patient management.
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Affiliation(s)
- Antonio Raffone
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy.,Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Antonio Travaglino
- Pathology Unit, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Diego Raimondo
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Manuela Maletta
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Valentino De Vivo
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | | | - Paolo Casadio
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Renato Seracchioli
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Fulvio Zullo
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Luigi Insabato
- Pathology Unit, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Antonio Mollo
- Gynecology and Obstetrics Unit, Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana", University of Salerno, Baronissi, Italy
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Itoga R, Matsuoka M, Onodera T, Yokota I, Iwasaki K, Matsubara S, Hishimura R, Suzuki Y, Iwata A, Kondo E, Iwasaki N. Brain Metastasis in Soft Tissue Sarcoma at Initial Presentation. Anticancer Res 2021; 41:5611-5616. [PMID: 34732433 DOI: 10.21873/anticanres.15376] [Citation(s) in RCA: 4] [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: 08/14/2021] [Revised: 09/10/2021] [Accepted: 09/29/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Brain metastasis is a rare condition among patients with soft tissue sarcoma (STS), and its precise incidence remains unclear. The aim of this study was to investigate which patients should be screened for brain metastasis. PATIENTS AND METHODS We identified all patients with STS diagnosed between 2010 and 2015 in the SEER database. Incidence of brain metastasis at initial presentation and higher incidence of brain metastasis by histological subtype were investigated. In addition, risk factors for brain metastasis were examined. RESULTS A total of 26,676 patients were included for analysis, of whom 162 patients (0.6%) had brain metastasis. Alveolar soft part sarcoma (6.3%), malignant hemangioendothelioma (3.1%) and malignant schwannoma (2.6%) showed higher incidence of brain metastasis. Deep-rooted tumor, trunk tumor, and histological high-grade tumor tended to show higher incidence of brain metastasis. CONCLUSION Risk factors for brain metastasis were deep location, trunk development and histologically high-grade tumor, or specific histological subtypes.
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Affiliation(s)
- Ryo Itoga
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masatake Matsuoka
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan;
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Koji Iwasaki
- Department of Functional Reconstruction for the Knee Joint, Hokkaido University, Sapporo, Japan
| | - Shinji Matsubara
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ryosuke Hishimura
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuki Suzuki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Akira Iwata
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Chung MS, Choi YJ, Lee YS, Yoon BI, Ha US. How Much Reliable Is the Current Belief on Grade Group 1 Prostate Cancer? Pathol Oncol Res 2021; 27:629489. [PMID: 34257593 PMCID: PMC8262215 DOI: 10.3389/pore.2021.629489] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 03/15/2021] [Indexed: 11/25/2022]
Abstract
Objective: To evaluate the clinicopathological characteristics of grade group 1 (GG1) prostate cancer in Korean populations. Methods: We retrospectively analyzed 492 consecutive radical prostatectomy specimens from our institution, which included those from 322 men with clinical GG1 and 170 with clinical GG2 tumors between years 2009 and 2018. The incidence of Gleason score (GS) upgrading, extraprostatic extension (EPE), and seminal vesicle invasion (SVI) were evaluated in patients with clinical GG1. In pathological GG1 cases, the distribution of adverse pathological features including EPE, lymphovascular invasion (LVI), perineural invasion (PNI), and biochemical recurrence (BCR) was analyzed. Results: Altogether, 78 (24.2%) out of 322 men in the clinical GG1 group demonstrated upgrading of GS, including 19 men with pathological Gleason score 4 + 3 = 7 and 6 with ≥ pathological Gleason score 4 + 4 = 8 cases. EPE was found in 37 (11.5%) and 22 (8.9%) men in clinical GG1 and pathological GG1 group, respectively. The incidence of LVI and PNI in the pathological GG1 cases was 2.8% (n = 7) and 28.6% (n = 71), respectively. BCR was observed in 4 men in pathological GG1 T2 (n = 226) and 2 men in GG1 T3 (n = 22) group. When we compared the pathological features between pathological GG1 T3 vs. GG2 T2, there was no statistical differences in the incidence of LVI and PNI between the two groups. Conclusions: Contrary to the current concept that GG1 is almost always clinically insignificant, it seems that GG1 still possess its respectable position as a group of cancer with aggressiveness. These findings should be kept in mind when deciding on treatment options for prostate cancer patients in the Asian populations.
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Affiliation(s)
- Mun Su Chung
- Department of Urology, International St. Mary's Hospital, Catholic Kwandong University, Incheon, South Korea
| | - Yeong Jin Choi
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Young Sub Lee
- Department of Hospital Pathology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Byung Il Yoon
- Department of Urology, International St. Mary's Hospital, Catholic Kwandong University, Incheon, South Korea
| | - U-Syn Ha
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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23
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Matsumoto K, Omura M, Takeda T, Kosaka T, Hashiguchi A, Takamatsu K, Yasumizu Y, Tanaka N, Morita S, Mizuno R, Asanuma H, Oya M. Grading of Multifocal Prostate Cancer Cases in which the Largest Volume and the Highest Grade Do Not Coincide within One Lesion. J Urol 2021; 206:338-45. [PMID: 33818138 DOI: 10.1097/JU.0000000000001765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE In general, the index lesion of prostate cancer has the largest tumor volume, the highest Grade Group (GG), and the highest stage (concordant cases). However, these factors sometimes do not coincide within one lesion (discordant cases). In such discordant cases, the largest tumor may not be of biological significance and the secondary tumor may more greatly impact the prognosis. MATERIALS AND METHODS We retrospectively reviewed the medical records of patients who underwent radical prostatectomy, and we identified 580 (85.3%) concordant cases and 100 (14.7%) discordant cases. The end point of this study was biochemical recurrence, and median followup was 4.2 years. RESULTS Among discordant cases in which GGs of the largest tumor and the highest GG tumor differed, the majority (67 patients) had the largest tumor of GG 2, and we set them as the study cohort. On the other hand, we regarded 212 concordant cases with an index tumor of GG 2 as the control cohort. The study cohort comprised 48 (71.6%) patients with a secondary tumor of GG 3 and 19 (28.4%) with a secondary tumor of GG 4/5. Kaplan-Meier curves revealed that the 5-year biochemical recurrence-free survival rates were 76%, and 67%, respectively. The 5-year biochemical recurrence-free survival rate of the control cohort was 91%, which was significantly better than that of the study cohort (p=0.013 and p=0.014, respectively). CONCLUSIONS Our study suggests that the prognosis of discordant cases is better determined by the secondary cancer lesion with the highest GG instead of the largest lesion.
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Sathianathen NJ, Oestreich MC, Brown SJ, Gupta S, Konety BR, Dahm P, Kunath F. Abiraterone acetate in combination with androgen deprivation therapy compared to androgen deprivation therapy only for metastatic hormone-sensitive prostate cancer. Cochrane Database Syst Rev 2020; 12:CD013245. [PMID: 33314020 PMCID: PMC8092456 DOI: 10.1002/14651858.cd013245.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Indexed: 12/11/2022]
Abstract
BACKGROUND Systemic androgen deprivation therapy (ADT), also referred to as hormone therapy,ÃÂ has long been the primary treatment for metastatic prostate cancer. Additional agents have been reserved for the castrate-resistant disease stage when ADT start becoming less effective. Abiraterone is an agent with an established role in that disease stage, which has only recently been evaluated in the hormone-sensitive setting. OBJECTIVES To assess the effects of early abiraterone acetate, in combination with systemic ADT, for newly diagnosed metastatic hormone-sensitive prostate cancer. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, six other databases, two trials registries, grey literature, and conference proceedings, up to 15 May 2020. We applied no restrictions on publication language or status. SELECTION CRITERIA We included randomized trials, in which men diagnosed with hormone-sensitive prostate cancer were administered abiraterone acetate and prednisolone with ADT or ADTÃÂ alone. DATA COLLECTION AND ANALYSIS Two review authors independently classified studies and abstracted data from the included studies. We performed statistical analyses using a random-effects model. We rated the quality of evidence according to the GRADE approach. MAIN RESULTS The search identified two randomized controlled trials (RCT), with 2201 men, who were assigned to receive either abiraterone acetate 1000 mg once daily and low dose prednisone (5mg) in addition to ADT, or ADT alone. In the LATITUDE trial, the median age and range of men in the intervention group was 68 (38 to 89) years, and 67 (33 to 92) years in the control group. Nearly all of the men in thisÃÂ study (97.6%) had prostate cancer with a Gleason score of at least 8 (ISUP grade group 4). Primary outcomes The addition of abiraterone acetate to ADT reduces the probability of death from any cause compared to ADT alone (hazard ratio [HR] 0.64, 95% confidence interval [CI] 0.56 to 0.73; 2 RCTs, 2201 men; high certainty of evidence); this corresponds to 163 fewer deaths per 1000 men with hormone-sensitive metastaticÃÂ prostate cancerÃÂ (210 fewer to 115 fewer) at five years. Abiraterone acetate in addition to ADT probably results in little to no differenceÃÂ in quality of life compared to ADT alone, measured with the Functional Assessment of Cancer Therapy-prostate total score (FACT-P; range 0 to 156; higher values indicates better quality of life),ÃÂ at 12 months (mean difference [MD] 2.90 points, 95% CI 0.11 to 5.60; 1 RCT, 838 men; moderate certainty of evidence). Secondary outcomes Abiraterone plus ADT increases the risk of grades III to V adverse events compared to ADT alone (risk ratio [RR] 1.34, 95% CI 1.22 to 1.47; 1 RCT, 1199 men; high certainty of evidence); this corresponds to 162 more grade III to VÃÂ events per 1000 men with hormone-sensitive metastaticÃÂ prostate cancerÃÂ (105 more to 224 more) at a median follow-up of 30ÃÂ months. Abiraterone acetate in addition to ADT probably reduces the probability of death due to prostate cancer compared to ADT alone (HR 0.58, 95% CI 0.50 to 0.68; 2 RCTs, 2201 men; moderate certainty of evidence). This corresponds to 120 fewer death from prostate cancer per 1000 men with hormone-sensitive metastaticÃÂ prostate cancerÃÂ (95% CI 145 fewer to 90 fewer) afterÃÂ a median follow-up of 30 months. The addition of abiraterone acetate to ADT probably decreases the probability of disease progression compared to ADT alone (HR 0.35, 95%CI 0.26 to 0.49; 2 RCTs, 2097 men; moderate certainty of evidence). This corresponds to 369 fewer incidences of disease progression per 1000 men with hormone-sensitive metastaticÃÂ prostate cancerÃÂ (456 fewer to 256 fewer)ÃÂ after a median follow-up of 30 months. The addition of abiraterone acetate to ADT probably increases the risk of discontinuing treatment due to adverse events compared to ADT alone (RR 1.50, 95% CI 1.17 to 1.92; 1 RCT, 1199 men; moderate certainty of evidence). This corresponds to 51 more men (95% CI 17 more to 93 more) discontinuing treatment because of adverse events per 1000 men treated with abiraterone acetate and ADT compared to ADT alone afterÃÂ a median follow-up of 30 months. AUTHORS' CONCLUSIONS The addition of abiraterone acetate to androgen deprivation therapy improves overall survival but probably not quality of life. ItÃÂ probably also extends disease-specific survival, and delays disease progression compared to androgen deprivation therapy alone. However, the risk of grades III to V adverse events is increased, and probably, so is the risk of discontinuing treatment due to adverse events.
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Affiliation(s)
| | - Makinna C Oestreich
- University of Minnesota Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sarah Jane Brown
- Health Sciences Libraries, University of Minnesota, Minneapolis, Minnesota, USA
| | - Shilpa Gupta
- Department of Medicine, Division of Hematology, Oncology and Transplatation, University of Minnesota, Minneapolis, Minnesota, USA
| | - Badrinath R Konety
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Philipp Dahm
- Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | - Frank Kunath
- Department of Urology, University Hospital Erlangen, Erlangen, Germany
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Ranasinghe W, Reichard CA, Nyame YA, Sundi D, Tosoian JJ, Wilkins L, Alam R, Achim MF, Wang X, Stephenson AJ, Klein EA, Ross AE, Allaf ME, Davis JW, Chapin BF. Downgrading from Biopsy Grade Group 4 Prostate Cancer in Patients Undergoing Radical Prostatectomy for High or Very High Risk Prostate Cancer. J Urol 2020; 204:748-53. [PMID: 32259468 DOI: 10.1097/JU.0000000000001074] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE We examined rates of Grade Group 4 downgrading at radical prostatectomy among men diagnosed with high and very high risk prostate cancer at biopsy. MATERIALS AND METHODS A pooled cohort of 1,776 patients from 3 tertiary referral centers who underwent radical prostatectomy for National Comprehensive Cancer Network® high risk (prostate specific antigen greater than 20 ng/ml, or Grade Group 4-5, or clinical stage T3 or greater) or very high risk (primary Gleason pattern 5, or more than 4 biopsy cores with Grade Group 4-5, or 2 or more high risk features) disease from 2005 to 2015 were reviewed. Overall 893 patients with Grade Group 4 disease at biopsy were identified and 726 patients were available for analysis. Multivariable logistic regression models were fit to determine factors associated with downgrading to Grade Group 3 or less at radical prostatectomy. RESULTS Overall 333 (45%) cases were downgraded to Grade Group 3 or less at radical prostatectomy. Of these cases 198 (27%) had concordant Grade Group 4 biopsy and radical prostatectomy pathology and 195 (27%) were upgraded at radical prostatectomy to Grade Group 5. Of high risk cases with biopsy Grade Group 4 disease 49% had any downgrading vs 29% of very high risk cases (p <0.0001). Downgrading to Grade Group 2 or less occurred in 16% (98 of 604) of high risk and 7% (8 of 122) of very high risk cases (p <0.01). Downgraded cases had a lower prostate specific antigen, fewer positive biopsy cores and lower clinical stage (p <0.01). On multivariable analysis fewer positive biopsy cores were significantly associated with downgrading at radical prostatectomy (p <0.01). CONCLUSIONS In this cohort of patients with high risk/very high risk prostate cancer, downgrading from biopsy Grade Group 4 at radical prostatectomy occurred less frequently than in other published reports. Any downgrading was significantly less common in very high risk compared to high risk patients, and downgrading to Grade Group 2 or less occurred in a minority of cases in high risk and very high risk patients.
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Kotova ES, Savochkina YA, Doludin YV, Vasilyev AO, Prilepskay EA, Potoldykova NV, Babalyan KA, Kanygina AV, Morozov AO, Govorov AV, Enikeev DV, Kostryukova ES, Ilina EN, Govorun VM, Pushkar DY, Sharova EI. Identification of Clinically Significant Prostate Cancer by Combined PCA3 and AMACR mRNA Detection in Urine Samples. Res Rep Urol 2020; 12:403-413. [PMID: 32984088 PMCID: PMC7505712 DOI: 10.2147/rru.s262310] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 05/15/2020] [Accepted: 08/19/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose Preclinical evaluation of PCA3 and AMACR transcript simultaneous detection in urine to diagnose clinical significant prostate cancer (prostate cancer with Gleason score ≥7) in a Russian cohort. Patients and Methods We analyzed urine samples of patients with a total serum PSA ≥2 ng/mL: 31 men with prostate cancer scheduled for radical prostatectomy, 128 men scheduled for first diagnostic biopsy (prebiopsy cohort). PCA3, AMACR, PSA and GPI transcripts were detected by multiplex reverse transcription quantitative polymerase chain reaction, and the results were used for scores for calculation and statistical analysis. Results There was no significant difference between clinically significant and nonsignificant prostate cancer PCA3 scores. However, there was a significant difference in the AMACR score (patients scheduled for radical prostatectomy p=0.0088, prebiopsy cohort p=0.029). We estimated AUCs, optimal cutoffs, sensitivities and specificities for PCa and csPCa detection in the prebiopsy cohort by tPSA, PCA3 score, PCPT Risk Calculator and classification models based on tPSA, PCA3 score and AMACR score. In the clinically significant prostate cancer ROC analysis, the PCA3 score AUC was 0.632 (95%CI: 0.511–0.752), the AMACR score AUC was 0.711 (95%CI: 0.617–0.806) and AUC of classification model based on the PCA3 score, the AMACR score and total PSA was 0.72 (95%CI: 0.58–0.83). In addition, the correlation of the AMACR score with the ratio of total RNA and RNA of prostate cells in urine was shown (tau=0.347, p=6.542e–09). Significant amounts of nonprostate RNA in urine may be a limitation for the AMACR score use. Conclusion The AMACR score is a good predictor of clinically significant prostate cancer. Significant amounts of nonprostate RNA in urine may be a limitation for the AMACR score use. Evaluation of the AMACR score and classification models based on it for clinically significant prostate cancer detection with larger samples and a follow-up analysis is promising.
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Affiliation(s)
- Elena S Kotova
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | | | - Yuriy V Doludin
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - Alexander O Vasilyev
- Department of Urology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Elena A Prilepskay
- Department of Urology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | | | - Konstantin A Babalyan
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | - Alexandra V Kanygina
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | | | - Alexander V Govorov
- Department of Urology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | | | - Elena S Kostryukova
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | - Elena N Ilina
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | - Vadim M Govorun
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | - Dmitry Y Pushkar
- Department of Urology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Elena I Sharova
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
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Okoń K, Dyduch G, Białas MB, Milian-Ciesielska K, Szpor J, Leszczyńska I, Tyrak K, Szopiński T, Chłosta P. Image analysis discloses differences in nuclear parameters between ERG+ and ERG- prostatic carcinomas. POL J PATHOL 2020; 71:20-9. [PMID: 32429651 DOI: 10.5114/pjp.2020.95412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Prostatic carcinoma (PC) is the most frequent urologic cancer and one of the most frequent cancers in males; it is a heterogeneous disease, in terms of molecular features, morphology and prognosis. About half of cases depends on TMPRSS2-ETS translocation which leads to a production of ERG transcription factor. ERG+ and ERG- cancers seem to differ in a number of features, which could lead to an altered nuclear structure; the aim of the study was to test this hypothesis. The material consisted of total 39 PC cases, representing ERG+ and ERG-, as well as Gleason pattern 3 and 4. Filtering by color deconvolution and automatic segmentation were used, and the properly detected nuclei were manually selected. From each case fifty nuclei were obtained; then geometric features and texture parameters were assessed. The analysis of the collected data showed differences both between ERG+/ERG- and Gleason pattern 3 and 4 cases in most of the features analyzed. Our results suggest that indeed the ERG status, thus likely TMPRSS2-ETS translocation, has an impact on morphology of nuclei in PC, and their differences are evident enough to be detectable by image analysis.
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Iczkowski KA, van Leenders GJLH. Eight Endorsements of the International Society of Urological Pathology from the 2019 Consensus Conference on Grading of Prostatic Carcinoma. J Urol 2021; 205:8-10. [PMID: 32897768 DOI: 10.1097/JU.0000000000001356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
INTRODUCTION The literature contains few studies that focus on the relationship between International Society of Urological Pathology (ISUP) score upgrade and complete blood count (CBC) parameters for patients with low-risk prostate cancer and studies achieved inconclusive results. METHODS We retrospectively analyzed our institutional database for patients with prostate cancer who underwent radical prostatectomy (RP) between 1994 and 2017. In total, we included 633 patients with low-risk prostate cancer in the study. We investigated the effects of clinicopathologic factors on ISUP score upgrade. Moreover, we compared RP pathologic outcomes between the patients with and without ISUP score upgrade. RESULTS The mean age and follow-up periods were 61.09±6.61 years and 41.9±1.8 months, respectively. ISUP score upgrade was observed in 207 patients (32.7%). In multivariate analysis, high prostate-specific antigen (PSA) density and percentage of positive cores were found to be significantly associated with ISUP score upgrade (p = 0.003 and p = 0.003, respectively). The neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, monocyte-lymphocyte ratio, and eosinophil-lymphocyte ratio were found to have no effect on ISUP score upgrade (p = 0.856, p = 0.353, p = 0.128, and p = 0.074, respectively). The percentage of tumors, surgical margin positivity, seminal vesicle invasion rate, and extraprostatic extension rate in RP pathology were higher in patients with ISUP score upgrade (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively). CONCLUSIONS Approximately one-third of the patients in our series had ISUP score upgrade in RP pathology. PSA density and the percentage of positive cores were found to be the factors significantly associated with ISUP score upgrade. CBC-related factors had no effect on ISUP score upgrade.
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Affiliation(s)
| | - Meylis Artykov
- Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Berk Hazir
- Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Burak Citamak
- Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Mesut Altan
- Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Sertac Yazici
- Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Bulent Akdogan
- Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Haluk Ozen
- Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey
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Bian Y, Jiang H, Ma C, Wang L, Zheng J, Jin G, Lu J. CT-Based Radiomics Score for Distinguishing Between Grade 1 and Grade 2 Nonfunctioning Pancreatic Neuroendocrine Tumors. AJR Am J Roentgenol 2020; 215:852-63. [PMID: 32755201 DOI: 10.2214/AJR.19.22123] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE. The objective of our study was to explore the relationship between a CT-based radiomics score and grade of nonfunctioning pancreatic neuroendocrine tumors (PNETs) and to evaluate the ability of a calculated CT radiomics score to distinguish between grade 1 and grade 2 nonfunctioning PNETs. MATERIALS AND METHODS. This retrospective study assessed 102 patients with surgically resected, pathologically confirmed nonfunctioning PNETs who underwent MDCT from January 2014 to December 2017. Radiomic methods were used to extract features from portal venous phase CT scans, and the least absolute shrinkage and selection operator (LASSO) method was used to select the features. Multivariate logistic regression models were used to analyze the association between the CT radiomics score and nonfunctioning PNET grades. The performance of the CT radiomics score was assessed on the basis of its discriminative ability and clinical usefulness. RESULTS. The CT radiomics score, which consisted of four selected features, was significantly associated with nonfunctioning PNET grades. Every 1-point increase in radiomics score was associated with a 57% increased risk of grade 2 disease. The score also showed high accuracy (AUC = 0.86 for all PNETs; AUC = 0.81 for PNETs ≤ 2 cm). The best cutoff point for maximal sensitivity and specificity was a CT radiomics score of -0.134. Decision curve analysis showed that the CT radiomics score is clinically useful. CONCLUSION. The CT radiomics score shows a significant association with the grade of nonfunctioning PNETs and provides a potentially valuable noninvasive tool for distinguishing between different grades of nonfunctioning PNET, especially among patients with tumors 2 cm or smaller.
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Abstract
To determine the value of 3T magnetic resonance imaging (MRI) texture analysis in differentiating high- from low-grade soft-tissue sarcoma.Forty-two patients with soft-tissue sarcomas who underwent 3T MRI were analyzed. Qualitative and texture analysis were performed on T1-, T2- and fat-suppressed contrast-enhanced (CE) T1-weighted images. Various features of qualitative and texture analysis were compared between high- and low-grade sarcoma. Areas under the receiver operating characteristic curves (AUC) were calculated for texture features. Multivariate logistic regression analysis was used to analyze the value of qualitative and texture analysis.There were 11 low- and 31 high-grade sarcomas. Among qualitative features, signal intensity on T1-weighted images, tumor margin on T2-weighted images, tumor margin on fat-suppressed CE T1-weighted images and peritumoral enhancement were significantly different between high- and low-grade sarcomas. Among texture features, T2 mean, T1 SD, CE T1 skewness, CE T1 mean, CE T1 difference variance and CE T1 contrast were significantly different between high- and low-grade sarcomas. The AUCs of the above texture features were > 0.7: T2 mean, .710 (95% confidence interval [CI] .543-.876); CE T1 mean, .768 (.590-.947); T1 SD, .730 (.554-.906); CE T1 skewness, .751 (.586-.916); CE T1 difference variance, .721 (.536-.907); and CE T1 contrast, .727 (.530-.924). The multivariate logistic regression model of both qualitative and texture features had numerically higher AUC than those of only qualitative or texture features.Texture analysis at 3T MRI may provide additional diagnostic value to the qualitative MRI imaging features for the differentiation of high- and low-grade sarcomas.
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Affiliation(s)
- Ji Hyun Hong
- Department of Radiology, Seoul St. Mary's Hospital, the Catholic University of Korea, Seocho-gu
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Gangdong-gu
| | - Won-Hee Jee
- Department of Radiology, Seoul St. Mary's Hospital, the Catholic University of Korea, Seocho-gu
| | | | - Yang-Guk Chung
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, the Catholic University of Korea, Seocho-gu, Seoul, Korea
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Abstract
PURPOSE 5α-Reductase inhibitors reduced the risk of prostate cancer in 25% in 2 randomized trials but increased the risk of Gleason 8-10 at biopsy. One explanation is that 5α-reductase inhibitors induce morphological changes in prostate cancer cells similar to higher Gleason grades but without its adverse biology. We compared risk of prostate cancer death between men on 5α-reductase inhibitors and men not on 5α-reductase inhibitors before prostate cancer diagnosis in each Gleason Grade Group. MATERIALS AND METHODS Prostate Cancer data Base Sweden consists of linkages between the National Prostate Cancer Register, the Prescribed Drug Registry and the Cause of Death Registry. Of 89,227 men diagnosed with prostate cancer between July 2007 and December 2016, 5,816 had been on 5α-reductase inhibitors for more than 180 days before the date of diagnosis. Followup ended in December 2018. A Cox proportional hazard model was used to assess hazard ratio for prostate cancer death. Adjustments for age, comorbidity, education and curative treatment were made. Men with high risk cancer were stratified according to Gleason Grade Group. RESULTS In men with high risk cancer the risk of prostate cancer death was similar among 5α-reductase inhibitor users and nonusers, with Gleason Grade Group 1 HR 1.02 (95% CI 0.53-1.95), Gleason Grade Group 2 HR 1.04 (95% CI 0.65-1.69), Gleason Grade Group 3 HR 1.27 (95% CI 0.89-1.80), Gleason Grade Group 4 HR 0.95 (95% CI 0.76-1.18) and Gleason Grade Group 5 HR 0.99 (95% CI 0.83-1.19), for 5α-reductase inhibitor users vs nonusers. CONCLUSIONS We found no evidence that 5α-reductase inhibitors affect Gleason grading as no difference in mortality was observed among 5α-reductase inhibitor users and nonusers in each Gleason group.
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Su ZT, Patel HD, Epstein JI, Pavlovich CP, Allaf ME. Downgrading of grade group 2 intermediate-risk prostate cancer from biopsy to radical prostatectomy: Comparison of outcomes and predictors to identify potential candidates for active surveillance. Cancer 2020; 126:1632-1639. [PMID: 32031685 DOI: 10.1002/cncr.32709] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 08/30/2019] [Revised: 11/27/2019] [Accepted: 12/19/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND A proportion of men with grade group (GG) 2 intermediate risk (IR) prostate cancer are downgraded to GG1 or harbor favorable pathology (FP, defined as GG1 or GG2 with <5% Gleason pattern 4) at radical prostatectomy (RP). Prediction of downgrading or FP may help identify potential active surveillance candidates within this group that have outcomes similar to biopsy low-risk (LR) disease. METHODS We performed a comparative cohort study of biopsy LR and IR men who underwent RP at The Johns Hopkins Hospital and Bayview Medical Center between 2005 and 2018. We evaluated pathological outcomes at RP and recurrence-free survival (RFS). Multivariable logistic regression and Cox proportional hazards regression were applied and individual predicted probabilities were calculated. RESULTS Among 2943 biopsy GG2 IR patients, 223 (7.6%) were downgraded to GG1, while 525 (17.8%) had FP; 730 of 1325 biopsy LR patients (55.1%) were upgraded (GG >1). Concordance statistics for final predictive regression models were 0.76 for downgrading and 0.70 for upgrading. Biopsy GG2 IR patients downgrading to GG1 or harboring FP had similar RFS to biopsy LR patients. A cutoff of >10% predicted probability of downgrading (24.7% of patients; hazard ratio [HR], 1.55; 95% CI, 0.89-2.68) or >20% predicted probability of FP (37.0% of patients; HR, 1.35; 95% CI, 0.81-2.24) led to similar RFS to biopsy LR patients. CONCLUSION GG2 IR patients who experience downgrading or harbor FP had similar oncologic outcomes as LR patients. The developed models may serve as tools to inform patients about the risks of pathological downgrading/upgrading and help identify a segment of GG2 IR patients who would consider pursuing active surveillance based on predicted probability cutoffs.
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Affiliation(s)
- Zhuo T Su
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hiten D Patel
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan I Epstein
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christian P Pavlovich
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mohamad E Allaf
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Jansson F, Folkvaljon F, Stattin P, Bratt O, Akre O. Risk of Postoperative Up Staging or Upgrading among Men with Low Risk Familial Prostate Cancer. J Urol 2020; 204:79-81. [PMID: 32003613 DOI: 10.1097/JU.0000000000000793] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE We investigated whether men with biopsy verified, low grade cancer and a family history of lethal or advanced prostate cancer are at particularly high risk for harboring undetected high grade disease. MATERIALS AND METHODS Upgrading and up staging of prostate cancer are common after prostatectomy. In a nationwide population based cohort we identified 6,854 men with low risk prostate cancer who underwent radical prostatectomy. Among these men 1,739 (25%) had a history of prostate cancer in a first-degree relative and 289 (4%) had a first-degree relative with lethal or advanced prostate cancer. RESULTS Compared to men with no familial occurrence of prostate cancer, the odds ratio for the risk of up staging among men with a familial occurrence of high risk or lethal prostate cancer was 1.06 (95% CI 0.76-1.47). The corresponding odds ratio for upgrading was 1.17 (0.91-1.50). CONCLUSIONS We found no association between family history of prostate cancer and up staging or upgrading after radical prostatectomy.
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Carlsson S, Benfante N, Alvim R, Sjoberg DD, Vickers A, Reuter VE, Fine SW, Vargas HA, Wiseman M, Mamoor M, Ehdaie B, Laudone V, Scardino P, Eastham J, Touijer K. Risk of Metastasis in Men with Grade Group 2 Prostate Cancer Managed with Active Surveillance at a Tertiary Cancer Center. J Urol 2020; 203:1117-1121. [PMID: 31909690 DOI: 10.1097/ju.0000000000000742] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE We studied the risk of metastatic prostate cancer development in men with Grade Group 2 disease managed with active surveillance at Memorial Sloan Kettering Cancer Center. MATERIALS AND METHODS A total of 219 men with Grade Group 2 prostate cancer had disease managed with active surveillance between 2000 and 2017. Biopsy was performed every 2 to 3 years, or upon changes in magnetic resonance imaging, prostate specific antigen level or digital rectal examination. The primary outcome was development of distant metastasis. The Kaplan-Meier method was used to estimate treatment-free survival. RESULTS Median age at diagnosis was 67 years (IQR 61-72), median prostate specific antigen was 5 ng/ml (IQR 4-7) and most patients (69%) had nonpalpable disease. During followup 64 men received treatment, including radical prostatectomy in 36 (56%), radiotherapy in 20 (31%), hormone therapy in 3 (5%) and focal therapy in 5 (8%). Of the 36 patients who underwent radical prostatectomy 32 (89%) had Grade Group 2 disease on pathology and 4 (11%) had Grade Group 3 disease. Treatment-free survival was 61% (95% CI 52-70) at 5 years and 49% (95% CI 37-60) at 10 years. Three men experienced biochemical recurrence, no men had distant metastasis and no men died of prostate cancer during the followup. Median followup was 3.1 years (IQR 1.9-4.9). CONCLUSIONS Active surveillance appears to be a safe initial management strategy in the short term for carefully selected and closely monitored men with Grade Group 2 prostate cancer treated at a tertiary cancer center. Definitive conclusions await further followup.
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Affiliation(s)
- Sigrid Carlsson
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.,Institute of Clinical Sciences, Department of Urology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Nicole Benfante
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ricardo Alvim
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Victor E Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Samson W Fine
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Michal Wiseman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Maha Mamoor
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Behfar Ehdaie
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vincent Laudone
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter Scardino
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James Eastham
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Karim Touijer
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Ling C, Shi F, Zhang J, Jiang B, Dong F, Zeng Q. In vivo measurement of cytoplasmic organelle water fraction using diffusion-weighted imaging: Application in the malignant grading and differential diagnosis of gliomas. Medicine (Baltimore) 2019; 98:e17949. [PMID: 31725652 PMCID: PMC6867796 DOI: 10.1097/md.0000000000017949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Recently, we have proposed a theoretical modified tri-exponential model for multi-b-value diffusion-weighted imaging (DWI) to measure the cytoplasmic organelle water fraction (COWF). This study aims to investigate whether COWF maps are effective in evaluating the malignant degree of gliomas and distinguishing primary central nervous system lymphomas (PCNSL) from gliomas.We performed this retrospective study based on our prospectively collected data. All patients underwent preoperative multi-b-value DWI. Parametric maps were derived from multi-b-value DWI maps using the modified tri-exponential model. Receiver operating characteristic analyses were used to assess the diagnostic accuracy of the parameter maps. Pearson correlation coefficients were calculated to investigate the correlations between the parameters and the Ki-67 proliferation index.A total of 66 patients were enrolled, including 16 low-grade gliomas (LGG), 45 high-grade gliomas (HGG), and 5 PCNSL. The mean COWF values were significantly different among LGG (3.1 ± 1.4%), HGG (6.9 ± 2.8%), and PCNSL (14.0 ± 2.2%) (P < .001). The areas under the curves of the mean COWF value in distinguishing HGG from LGG and distinguishing PCNSL from gliomas were 0.899 and 0.980, respectively. The mean COWF value had a moderate correlation with the Ki-67 proliferation index (r = 0.647).The COWF map is useful in malignant grading of gliomas, and may be helpful in distinguishing PCNSL from gliomas.
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Affiliation(s)
| | | | | | - Biao Jiang
- Department of Radiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Fei Dong
- Department of Radiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Stovsky M, Klein EA, Chait A, Manickam K, Stephenson AJ, Wagner M, Dineen M, Lotan Y, Partin A, Baniel J, Kestranek A, Gawande P, Boris Zaslavsky. Clinical Validation of IsoPSA™, a Single Parameter, Structure Based Assay for Improved Detection of High Grade Prostate Cancer. J Urol 2019; 201:1115-20. [PMID: 30810464 DOI: 10.1097/JU.0000000000000185] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Current prostate specific antigen markers to detect prostate cancer are limited by low specificity for high grade disease. IsoPSA™ is a blood based, structure focused assay which predicts risk by partitioning the isoforms of prostate specific antigen that are linked to cancer in an aqueous 2-phase reagent system. We validated the clinical performance of this assay for identifying high grade disease in a new contemporary biopsy cohort. MATERIALS AND METHODS We performed a multicenter prospective validation in 271 men scheduled for prostate biopsy at a total of 7 academic and community centers who were enrolled between May 2017 and March 2018. Blood samples were obtained for assay prior to biopsy. The discrimination power of the assay to detect high grade prostate cancer (Gleason 7 or greater) was evaluated by ROC analysis and compared to prior results. Clinical performance was further improved by comparison with multiparametric magnetic resonance imaging-ultrasound vs transrectal ultrasound guided biopsies. RESULTS The assay AUC was 0.784 for high grade vs low grade cancer/benign histology, which was superior to the AUCs of total prostate specific antigen and percent free prostate specific antigen. If 1,000 patients were biopsied, the assay would have reduced the number of unnecessary biopsies from 705 to 402 (43%) with only 22 missed high grade cancers, of which 7 would have been Gleason sum 4 + 3 or higher. Subset analysis of multiparametric magnetic resonance imaging guided biopsy produced a substantial improvement of the AUC to 0.831. CONCLUSIONS Validation of the structure based IsoPSA assay demonstrated statistical concordance with previously reported results and verified its superior performance vs concentration based prostate specific antigen and the free-to-total prostate specific antigen ratio. The assay improvement in detecting high grade prostate cancer using multiparametric magnetic resonance imaging-ultrasound guided biopsy may help define a new diagnostic paradigm.
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Stone NN, Crawford ED, Skouteris VM, Arangua P, Metsinis PM, Lucia MS, La Rosa FG, Werahera PN. The Ratio of the Number of Biopsy Specimens to Prostate Volume (Biopsy Density) Greater Than 1.5 Improves the Prostate Cancer Detection Rate in Men Undergoing Transperineal Biopsy of the Prostate. J Urol 2019; 202:264-271. [PMID: 30835628 DOI: 10.1097/ju.0000000000000204] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We sought to determine the minimum number of transperineal prostate mapping biopsies needed to optimize the prostate cancer detection rate. MATERIALS AND METHODS A total of 436 men underwent transperineal prostate mapping biopsy at 2 institutions. Biopsy density was calculated as the ratio of the total number of specimens retrieved (mean 59.4) to prostate volume (mean 44.9 cc). Associations of biopsy density with prostate specific antigen, prostate specific antigen density, cancer diagnosis and the Gleason score were tested by ANOVA and the chi-square test. Regression analysis was done to determine factors associated with a positive transperineal prostate mapping biopsy and Gleason score 7 or higher cancer. RESULTS Transperineal prostate mapping biopsy was positive in 299 of 436 men (68.6%). The mean number of positive cores was 7.1 (range 1 to 41) and mean biopsy density was 1.46 (range 0.39 to 3.67). The mean number of cores in positive vs negative transperineal prostate mapping biopsies was 1.61 vs 1.14 (p <0.001). Biopsy density cut points of 0.5 or less, greater than 0.5 to 1.0, greater than 1.0 to 1.5 and greater than 1.5 were associated with positive biopsy in 25%, 37.4%, 70.7% and 84.9% of patients (p <0.001). Dichotomizing biopsy density to 1.5 or less vs greater than 1.5 resulted in a positive biopsy rate of 56.4% vs 84.9% (OR 1.5, 95% CI 1.3-1.7, p <0.001). More Gleason score 6 cancers were diagnosed with higher biopsy density (94 of 158 or 59.5% vs 62 of 141 or 44.9%, p = 0.007). However, the number of positive cores with Gleason score 6 was greater in men with higher biopsy density at 4.9 vs 3.6 (p = 0.036). Prostate specific antigen (p = 0.053) and biopsy density (p = 0.012) were significant on regression analysis for positive transperineal prostate mapping biopsy and Gleason score 7+ disease. CONCLUSIONS Biopsy density greater than 1.5 increases the diagnosis of prostate cancer by 1.5 times, detects higher volume Gleason score 6 disease and should be considered the optimal sampling approach when performing transperineal prostate mapping biopsy.
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Affiliation(s)
- Nelson N Stone
- Department of Urology, Icahn School of Medicine at Mount Sinai , New York , New York
| | - E David Crawford
- Departments of Radiation Oncology and Pathology, University of Colorado Anschutz Medical Campus , Aurora , Colorado
| | | | - Paul Arangua
- Departments of Radiation Oncology and Pathology, University of Colorado Anschutz Medical Campus , Aurora , Colorado
| | | | - M Scott Lucia
- Departments of Radiation Oncology and Pathology, University of Colorado Anschutz Medical Campus , Aurora , Colorado
| | - Francisco G La Rosa
- Departments of Radiation Oncology and Pathology, University of Colorado Anschutz Medical Campus , Aurora , Colorado
| | - Priya N Werahera
- Departments of Radiation Oncology and Pathology, University of Colorado Anschutz Medical Campus , Aurora , Colorado
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Wu SG, Zhang WW, Wang J, Lian CL, Sun JY, Chen YX, He ZY. Progesterone receptor status and tumor grade predict the 21-gene recurrence score of invasive lobular breast cancer. Biomark Med 2019; 13:1005-1012. [PMID: 31234641 DOI: 10.2217/bmm-2019-0209] [Citation(s) in RCA: 6] [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] [Indexed: 12/16/2022] Open
Abstract
Aim: To assess the association between established clinicopathological variables and the 21-gene recurrence score (RS) stratification of invasive lobular carcinoma (ILC) of the breast. Materials & methods: We identified 9030 ILC patients from the Surveillance, Epidemiology and End Results database. Results: Older age, higher grade tumor and progesterone receptor (PR)-negative disease were independent predictors of high-risk RS stratification. Among patients with PR-positive tumors, 3, 6 and 15% with well-differentiated (G1), moderately-differentiated (G2) and poorly and/or undifferentiated (G3) disease were in the high-risk cohort, respectively. In patients with PR-negative tumors: 16, 24 and 41% of patients with G1, G2 and G3 disease were in the high-risk cohort, respectively. Conclusion: The 21-gene RS testing may not be necessary for patients with PR+/G1-2 ILC.
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Affiliation(s)
- San-Gang Wu
- Department of Radiation Oncology, Cancer Hospital, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Fujian, 361003, PR China
| | - Wen-Wen Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong, 510060, PR China
| | - Jun Wang
- Department of Radiation Oncology, Cancer Hospital, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Fujian, 361003, PR China
| | - Chen-Lu Lian
- Department of Radiation Oncology, Cancer Hospital, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Fujian, 361003, PR China
| | - Jia-Yuan Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong, 510060, PR China
| | - Yong-Xiong Chen
- Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology & Visual Science, Medical College, Xiamen University, Fujian, 361005, PR China
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong, 510060, PR China
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Morera DS, Hasanali SL, Belew D, Ghosh S, Klaassen Z, Jordan AR, Wang J, Terris MK, Bollag RJ, Merseburger AS, Stenzl A, Soloway MS, Lokeshwar VB. Clinical Parameters Outperform Molecular Subtypes for Predicting Outcome in Bladder Cancer: Results from Multiple Cohorts, Including TCGA. J Urol 2020; 203:62-72. [PMID: 31112107 DOI: 10.1097/JU.0000000000000351] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Studies indicate that molecular subtypes in muscle invasive bladder cancer predict the clinical outcome. We evaluated whether subtyping by a simplified method and established classifications could predict the clinical outcome. MATERIALS AND METHODS We subtyped institutional cohort 1 of 52 patients, including 39 with muscle invasive bladder cancer, an Oncomine™ data set of 151 with muscle invasive bladder cancer and TCGA (The Cancer Genome Atlas) data set of 402 with muscle invasive bladder cancer. Subtyping was done using simplified panels (MCG-1 and MCG-Ext) which included only transcripts common in published studies and were analyzed for predicting metastasis, and cancer specific, overall and recurrence-free survival. TCGA data set was further analyzed using the Lund taxonomy, the Bladder Cancer Molecular Taxonomy Group Consensus and TCGA 2017 mRNA subtype classifications. RESULTS Muscle invasive bladder cancer specimens from cohort 1 and the Oncomine data set showed intratumor heterogeneity for transcript and protein expression. MCG-1 subtypes did not predict the outcome on univariate or Kaplan-Meier analysis. On multivariate analysis N stage (p ≤0.007), T stage (p ≤0.04), M stage (p=0.007) and/or patient age (p=0.01) predicted metastasis, cancer specific and overall survival, and/or the cisplatin based adjuvant chemotherapy response. In TCGA data set publications showed that subtypes risk stratified patients for overall survival. Consistently the MCG-1 and MCG-Ext subtypes were associated with overall but not recurrence-free survival on univariate and Kaplan-Meier analyses. TCGA data set included 21 low grade specimens of the total of 402 and subtypes associated with tumor grade (p=0.005). However, less than 1% of muscle invasive bladder cancer cases are low grade. In only high grade specimens the MCG-1 and MCG-Ext subtypes could not predict overall survival. On univariate analysis subtypes according to the Bladder Cancer Molecular Taxonomy Group Consensus, TCGA 2017 and the Lund taxonomy were associated with tumor grade (p <0.0001) and overall survival (p=0.01 to <0.0001). Regardless of classification, subtypes had about 50% to 60% sensitivity and specificity to predict overall and recurrence-free survival. On multivariate analyses N stage and lymphovascular invasion consistently predicted recurrence-free and overall survival (p=0.039 and 0.003, respectively). CONCLUSIONS Molecular subtypes reflect bladder tumor heterogeneity and are associated with tumor grade. In multiple cohorts and subtyping classifications the clinical parameters outperformed subtypes for predicting the outcome.
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Mirak SA, Shakeri S, Bajgiran AM, Felker ER, Sung KH, Asvadi NH, Khoshnoodi P, Markovic D, Ponzini D, Ahuja P, Sisk A, Reiter RE, Lu D, Raman SS. Three Tesla Multiparametric Magnetic Resonance Imaging: Comparison of Performance with and without Endorectal Coil for Prostate Cancer Detection, PI-RADS™ version 2 Category and Staging with Whole Mount Histopathology Correlation. J Urol 2019; 201:496-502. [PMID: 30273608 DOI: 10.1016/j.juro.2018.09.054] [Citation(s) in RCA: 16] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE We investigated the performance of 3 Tesla multiparametric magnetic resonance imaging with and without an endorectal coil to detect prostate cancer with a whole mount histopathology reference. MATERIALS AND METHODS This retrospective HIPAA (Health Insurance Portability and Accountability Act) compliant, institutional review board approved, case-control study included patients who underwent 3 Tesla multiparametric magnetic resonance imaging with and without an endorectal coil from July 2009 to December 2016 prior to prostatectomy. The tumor detection rate was calculated for total and index lesions. Lesion magnetic resonance imaging and histopathology features were compared between the 2 groups. Using SPSS®, version 24 p <0.05 was considered significant. RESULTS A total of 871 whole mount histopathology lesions in 429 patients with a mean ± SD age of 61.8 ± 7 years were included in analysis. The subcohorts with and without an endorectal coil comprised 260 and 169 patients with a total of 529 and 342 lesions, respectively. The overall tumor detection rates in all patients, and in the endorectal coil and nonendorectal coil subcohorts were 49.6% (432 of 871 patients), 50.5% (267 of 529) and 48.2% (165 of 342), respectively. The index tumor detection rates overall, and in the endorectal coil and nonendorectal coil subcohorts were 77.6% (333 of 429 patients), 78.5% (204 of 260) and 76.3% (129 of 169), respectively. In the endorectal coil and nonendorectal coil subcohorts we detected 35.9% (66 of 184) and 48.4% (76 of 157) of anterior lesions (p = 0.019), 58% (200 of 345) and 48.1% (89 of 185) of posterior lesions (p = 0.025), 37.3% (41 of 110) and 54.4% (62 of 114) of transition zone lesions (p = 0.010), and 53.7% (225 of 419) and 45.2% (103 of 228) of peripheral lesions (p = 0.033), respectively. After adjusting for clinical and pathological factors the endorectal coil group only showed higher detection of peripheral and posterior prostate cancer. CONCLUSIONS We found that 3 Tesla multiparametric magnetic resonance imaging with and without an endorectal coil had similar detection of overall and index prostate cancer. However, the endorectal coil subcohort had significantly higher detection of posterior and peripheral prostate cancer, and lower detection of anterior and transition zone prostate cancer.
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Affiliation(s)
- Sohrab Afshari Mirak
- Departments of Radiological Sciences, David Geffen School of Medicine at UCLA , Los Angeles , California
| | - Sepideh Shakeri
- Departments of Radiological Sciences, David Geffen School of Medicine at UCLA , Los Angeles , California
| | | | - Ely R Felker
- Departments of Radiological Sciences, David Geffen School of Medicine at UCLA , Los Angeles , California
| | - Kyung Hyun Sung
- Departments of Radiological Sciences, David Geffen School of Medicine at UCLA , Los Angeles , California
| | - Nazanin Hajarol Asvadi
- Departments of Radiological Sciences, David Geffen School of Medicine at UCLA , Los Angeles , California
| | - Pooria Khoshnoodi
- Departments of Radiological Sciences, David Geffen School of Medicine at UCLA , Los Angeles , California
| | - Daniela Markovic
- Department of Medicine, University of California-Los Angeles , Los Angeles , California
| | - Danielle Ponzini
- Departments of Radiological Sciences, David Geffen School of Medicine at UCLA , Los Angeles , California
| | - Preeti Ahuja
- Departments of Radiological Sciences, David Geffen School of Medicine at UCLA , Los Angeles , California
| | - Anthony Sisk
- Pathology, David Geffen School of Medicine at UCLA , Los Angeles , California
| | - Robert E Reiter
- Urology, David Geffen School of Medicine at UCLA , Los Angeles , California
| | - David Lu
- Departments of Radiological Sciences, David Geffen School of Medicine at UCLA , Los Angeles , California
| | - Steven S Raman
- Departments of Radiological Sciences, David Geffen School of Medicine at UCLA , Los Angeles , California
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Faiena I, Salmasi A, Mendhiratta N, Markovic D, Ahuja P, Hsu W, Elashoff DA, Raman SS, Reiter RE. PI-RADS Version 2 Category on 3 Tesla Multiparametric Prostate Magnetic Resonance Imaging Predicts Oncologic Outcomes in Gleason 3 + 4 Prostate Cancer on Biopsy. J Urol 2019; 201:91-97. [PMID: 30142318 DOI: 10.1016/j.juro.2018.08.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE Three Tesla multiparametric magnetic resonance imaging with PI-RADS™ (Prostate Imaging Reporting and Data System) version 2 scoring is a common tool in prostate cancer diagnosis which informs the likelihood of a cancerous lesion. We investigated whether PI-RADS version 2 also predicts adverse pathology features mainly in patients with biopsy Gleason score 3 + 4 disease. MATERIALS AND METHODS We reviewed the records of 326 consecutive men with a preoperative template and/or magnetic resonance imaging-ultrasound fusion biopsy Gleason score of 6-7 from a prospectively maintained database of men who underwent robotic radical prostatectomy. The primary analysis was done in patients with biopsy Gleason score 3 + 4 to assess the primary outcome of adverse pathology features on univariate and multivariate logistic regression. The secondary outcome was biochemical recurrence-free survival using the Kaplan-Meier method. Similar analysis was done in patients with a biopsy Gleason score of 6-7. RESULTS Of men with Gleason score 3 + 4 findings 27%, 15%, 36% and 23% showed a PI-RADS version 2 score of 0-2, 3, 4 and 5, respectively. On univariate analysis PI-RADS version 2 category 5 predicted adverse pathology features vs categories 0-2 (OR 10.7, 95% CI 3.7-31, p ≤0.001). On multivariate analysis the PI-RADS version 2 category 5 was associated with adverse pathology when adjusting for preoperative magnetic resonance imaging targeted biopsy (OR 11.4, 95% CI 3.7-35, p ≤0.0001). In men with a targeted biopsy Gleason score of 3 + 4 prostate cancer PI-RADS version 2 category 5 was associated with adverse pathology (OR 14.7, 95% CI 1.5-146.9, p = 0.02). Of men with biopsy Gleason score 3 + 4 disease 92% and 58% with a PI-RADS version 2 score of 4 and 5, respectively, had 2-year biochemical recurrence-free survival. CONCLUSIONS A PI-RADS version 2 category 5 lesion in patients with a biopsy Gleason score 3 + 4 lesion predicted adverse pathology features and biochemical recurrence-free survival. These findings suggest that preoperative 3 Tesla multiparametric magnetic resonance imaging may serve as a prognostic marker of treatment outcomes independently of biopsy Gleason score or biopsy type.
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Affiliation(s)
- Izak Faiena
- Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine, University of California-Los Angeles , Los Angeles , California
| | - Amirali Salmasi
- Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine, University of California-Los Angeles , Los Angeles , California
| | - Neil Mendhiratta
- Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine, University of California-Los Angeles , Los Angeles , California
| | - Daniela Markovic
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California-Los Angeles , Los Angeles , California
| | - Preeti Ahuja
- Department of Radiology, David Geffen School of Medicine, University of California-Los Angeles , Los Angeles , California
| | - William Hsu
- Department of Radiology, David Geffen School of Medicine, University of California-Los Angeles , Los Angeles , California
| | - David A Elashoff
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California-Los Angeles , Los Angeles , California
| | - Steven S Raman
- Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine, University of California-Los Angeles , Los Angeles , California.,Department of Radiology, David Geffen School of Medicine, University of California-Los Angeles , Los Angeles , California
| | - Robert E Reiter
- Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine, University of California-Los Angeles , Los Angeles , California.,Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California-Los Angeles , Los Angeles , California
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Wissing M, Brimo F, Chevalier S, Scarlata E, McKercher G, O'Flaherty A, Aprikian S, Thibodeau V, Saad F, Carmel M, Lacombe L, Têtu B, Ekindi-Ndongo N, Latour M, Trudel D, Aprikian A. Optimization of the 2014 Gleason grade grouping in a Canadian cohort of patients with localized prostate cancer. BJU Int 2018; 123:624-631. [PMID: 30113732 DOI: 10.1111/bju.14512] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To evaluate the five-tier Gleason grade group (GG) scoring of prostate cancers adopted by the International Society of Urology Pathology (ISUP) in 2014, and to propose modifications to optimize its performance. PATIENTS AND METHODS Data were obtained from PROCURE, a prospective cohort of patients with localized prostate cancer undergoing radical prostatectomy in Québec, 2006-2013. Surgical specimens were evaluated by genitourinary pathologists using 2014 ISUP criteria. Treatment failure was defined as biochemical recurrence and/or initiation of secondary, non-adjuvant therapy. Analyses were conducted using Kaplan-Meier methods, log-rank tests, Cox proportional hazards models and Harrell's concordance indices. RESULTS A total of 1 917 patients were included, with a median follow-up of 69 months. The 5-year treatment failure rates were 9.6%, 23.5%, 43.1%, 52.6% and 84.3% in GG1-5, respectively (P < 0.001 when comparing GG2 with GG3). Treatment failure rates for patients in GG2 and GG3 with tertiary Gleason 5 pattern were higher than patients in the same group without a tertiary pattern (P < 0.001), but were similar to rates for patients in GGs 3 or 4 without a tertiary pattern (P > 0.3). Primary Gleason pattern (4/5) predicted treatment failure in GG5 (5-year failure rates 82.3% vs 97.1%, respectively; P = 0.001). The five-tier GG system had greater accuracy as a prognostic indicator compared with the four-tier system (Harrell's concordance index 0.716 vs 0.676). When upgrading patients in GG2/3 with tertiary Gleason 5 pattern to patients in GG3/4, and separating patients in GG5 by primary Gleason pattern, the Harrell's concordance index increased to 0.730. CONCLUSION The five-tier GG system increased accuracy for predicting treatment failure compared with the previous grading systems, but can be further improved.
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Affiliation(s)
- Michel Wissing
- Department of Urology, McGill University Health Centre, Montreal, QC, Canada.,Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, QC, Canada
| | - Fadi Brimo
- Department of Pathology, McGill University Health Centre, Montreal, QC, Canada
| | - Simone Chevalier
- Department of Urology, McGill University Health Centre, Montreal, QC, Canada
| | - Eleonora Scarlata
- Department of Urology, McGill University Health Centre, Montreal, QC, Canada
| | - Ginette McKercher
- Department of Urology, McGill University Health Centre, Montreal, QC, Canada.,PROCURE, Mount Royal, QC, Canada
| | - Ana O'Flaherty
- Department of Urology, McGill University Health Centre, Montreal, QC, Canada
| | | | | | - Fred Saad
- Department of Surgery, Université de Montréal, Montreal, QC, Canada
| | - Michel Carmel
- Department of Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Louis Lacombe
- Department of Surgery, Laval University, Quebec City, QC, Canada
| | - Bernard Têtu
- Department of Pathology, Laval University, Quebec City, QC, Canada
| | | | - Mathieu Latour
- Department of Pathology and Cell Biology, Université de Montreal, Montreal, QC, Canada
| | - Dominique Trudel
- Department of Pathology and Cell Biology, Université de Montreal, Montreal, QC, Canada
| | - Armen Aprikian
- Department of Urology, McGill University Health Centre, Montreal, QC, Canada
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Goldberg H, Klaassen Z, Chandrasekar T, Wallis CJD, Toi A, Sayyid R, Bhindi B, Nesbitt M, Evans A, van der Kwast T, Sweet J, Perlis N, Hamilton RJ, Kulkarni GS, Finelli A, Zlotta A, Fleshner N. Evaluation of an Aggressive Prostate Biopsy Strategy in Men Younger than 50 Years. J Urol 2018; 200:1056-1061. [PMID: 29758220 DOI: 10.1016/j.juro.2018.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE Longitudinal cohort studies and guidelines demonstrate that prostate specific antigen 1 ng/ml or greater in younger patients confers an increased risk of delayed prostate cancer death. At our institution we have used an aggressive biopsy strategy in younger patients with prostate specific antigen 1 ng/ml or greater. Our objective was to determine the proportion of detected cancer and specifically clinically significant cancer by this strategy. MATERIALS AND METHODS The prostate biopsy database at Princess Margaret Cancer Centre was queried for patients younger than 50 years who underwent a first prostate biopsy between 2000 and 2016. We included only patients who underwent prostate biopsy due to prostate specific antigen 1 ng/ml or greater and those with a suspicious digital rectal examination, a positive family history or a suspicious lesion on transrectal ultrasound. All clinical and pathological parameters were analyzed. Patients were stratified according to specific prostate specific antigen values. Multivariable logistic regression was performed to ascertain predictors of any prostate cancer diagnosis and of clinically significant prostate cancer. RESULTS Of the 199 patients who met study inclusion criteria 37 (19%) were diagnosed with prostate cancer and 8 (22%) had a Gleason score of 7 or greater. Of those diagnosed with prostate cancer 25 (68%) had prostate specific antigen 1.5 ng/ml or greater and all men with a Gleason score of 7 or greater had prostate specific antigen 1.5 ng/ml or greater. Notably 19 patients (51%) had prostate cancer exceeding the Epstein criteria for active surveillance. Factors predicting prostate cancer included a positive family history, rising prostate specific antigen and lower prostate volume. CONCLUSIONS Our results justify adopting an aggressive prostate biopsy strategy in men younger than 50 years with prostate specific antigen 1.5 ng/ml or greater while patients with prostate specific antigen less than 1.5 ng/ml are unlikely to have significant cancer. Special attention should be given to patients with a smaller prostate and a positive family history.
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Affiliation(s)
- Hanan Goldberg
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada.
| | - Zachary Klaassen
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Thenappan Chandrasekar
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Christopher J D Wallis
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Ants Toi
- Department of Medical Imaging, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Rashid Sayyid
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Bimal Bhindi
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Michael Nesbitt
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Andrew Evans
- Department of Pathology, Laboratory Medicine and Pathology, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Theo van der Kwast
- Department of Pathology, Laboratory Medicine and Pathology, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Joan Sweet
- Department of Pathology, Laboratory Medicine and Pathology, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Nathan Perlis
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Girish S Kulkarni
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Alexandre Zlotta
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Neil Fleshner
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Gill IS, Azzouzi AR, Emberton M, Coleman JA, Coeytaux E, Scherz A, Scardino PT. Randomized Trial of Partial Gland Ablation with Vascular Targeted Phototherapy versus Active Surveillance for Low Risk Prostate Cancer: Extended Followup and Analyses of Effectiveness. J Urol 2018; 200:786-793. [PMID: 29864437 DOI: 10.1016/j.juro.2018.05.121] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE The prospective PCM301 trial randomized 413 men with low risk prostate cancer to partial gland ablation with vascular targeted photodynamic therapy in 207 and active surveillance in 206. Two-year outcomes were reported previously. We report 4-year rates of intervention with radical therapy and further assess efficacy with biopsy results. MATERIALS AND METHODS Prostate biopsies were mandated at 12 and 24 months. Thereafter patients were monitored for radical therapy with periodic biopsies performed according to the standard of care at each institution. Ablation efficacy was assessed by biopsy results overall and in field in the treated lobe or the lobe with index cancer. RESULTS Conversion to radical therapy was less likely in the ablation cohort than in the surveillance cohort, including 7% vs 32% at 2 years, 15% vs 44% at 3 years and 24% vs 53% at 4 years (HR 0.31, 95% CI 0.21-0.46). Radical therapy triggers were similar in the 2 arms. Cancer progression rates overall and by grade were significantly lower in the ablation cohort (HR 0.42, 95% CI 0.29-0.59). End of study biopsy results were negative throughout the prostate in 50% of patients after ablation vs 14% after surveillance (risk difference 36%, 95% CI 28-44). Gleason 7 or higher cancer was less likely for ablation than for surveillance (16% vs 41%). Of the in field biopsies 10% contained Gleason 7 cancer after ablation vs 34% after surveillance. CONCLUSIONS In this randomized trial of partial ablation of low risk prostate cancer photodynamic therapy significantly reduced the subsequent finding of higher grade cancer on biopsy. Consequently fewer cases were converted to radical therapy, a clinically meaningful benefit that lowered treatment related morbidity.
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Affiliation(s)
- Inderbir S Gill
- Institute of Urology, University of Southern California, Los Angeles, California
| | - Abdel-Rahmene Azzouzi
- Department of Urology, Angers University Hospital, Angers, France; STEBA Biotech, Paris, France
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Jonathan A Coleman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Avigdor Scherz
- Department of Plants and Environmental Sciences, Weizmann Institute of Science, Rehovot, Israel
| | - Peter T Scardino
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
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Al Johi RS, Seifeldein GS, Moeen AM, Aboulhagag NA, Moussa EM, Hameed DA, Imam HM. Diffusion weighted magnetic resonance imaging in bladder cancer, is it time to replace biopsy? Cent European J Urol 2018; 71:31-37. [PMID: 29732204 PMCID: PMC5926631 DOI: 10.5173/ceju.2017.1427] [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: 05/11/2017] [Revised: 10/05/2017] [Accepted: 01/16/2018] [Indexed: 12/18/2022] Open
Abstract
Introduction To assess if the apparent diffusion coefficient (ADC) value of magnetic resonance imaging (MRI) can discriminate between the cell type, histological grade and improve staging of urinary bladder cancer (BC). Material and methods 102 patients with urinary bladder masses underwent MRI using a 1.5 T machine. T2 weighted and diffusion weighted imaging (DWI) using b values of 0, 150, 500 and 1000 s/mm2 were done. The ADC values of bladder masses were measured. These values were correlated with the histopathologic results. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of T2WI, DWI and T2WI plus DWI for detecting bladder lesions were evaluated. RESULTS The cut-off ADC value for diagnosing malignant bladder wall pathologies was ≤1 x 10-3 mm2/s with 94.5% sensitivity and 87.5% specificity. The mean ADC value of different malignant cell types was statistically insignificant. A significant difference in ADC values was found between G1 and G3 (P = 0.000), G2 and G3 (P = 0.045) but not between G1 and G2 (p = 0.066). Staging accuracy for differentiation between invasive and non-invasive lesions was nearly the same for all MRI data sets. For differentiation between organ confined (pT1–pT2) and non-organ confined lesions (pT3–pT4), staging accuracy was better in T2WI plus DWI (83%) as compared to DWI alone (77%) or T2WI alone (75%). Conclusions Adding DWI and the ADC value to T2WI improve the accuracy of MRI in BC detection and staging. However, at this time point, MRI cannot replace transurethral resection (TUR) biopsy or distinguish sharply between all different histologic grades and cell types.
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Affiliation(s)
- Rima S Al Johi
- Department of Radiology, Assiut University, Assiut, Egypt
| | | | - Ahmed M Moeen
- Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | - Noha A Aboulhagag
- Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ehab M Moussa
- Department of Radiology, Assiut University, Assiut, Egypt
| | - Diaa A Hameed
- Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | - Hisham M Imam
- Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
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Dimitroulis P, Rabenalt R, Nini A, Hiester A, Esposito I, Schimmöller L, Antoch G, Albers P, Arsov C. Multiparametric Magnetic Resonance Imaging/Ultrasound Fusion Prostate Biopsy-Are 2 Biopsy Cores per Magnetic Resonance Imaging Lesion Required? J Urol 2018; 200:1030-1034. [PMID: 29733837 DOI: 10.1016/j.juro.2018.05.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE For multiparametric magnetic resonance imaging/ultrasound fusion prostate biopsy the number of biopsy cores obtained is arbitrarily established by urologists. Moreover, a general consensus is lacking on the number of biopsy cores to be obtained from a single magnetic resonance imaging lesion. Therefore, we evaluated the feasibility of obtaining only 1 biopsy core per magnetic resonance imaging lesion. MATERIALS AND METHODS We retrospectively evaluated a total of 2,128 biopsy cores of 1,064 prostatic lesions (2 cores per lesion) in 418 patients in regard to prostate cancer detection (histology) and the Gleason score of the first biopsy core compared to the second biopsy core. Two analyses were performed, including patient level analysis based on prostate cancer detection per patient and lesion level analysis based exclusively on the histology of each lesion regardless of the overall histological outcome of the case. RESULTS The overall prostate cancer detection rate was 45.7% (191 of 418 patients). The first biopsy core detected 170 of all 191 prostate cancers (89%). In 17 of these 170 prostate cancers (10%) the second biopsy core revealed Gleason score upgrading. Nine of the 21 prostate cancers (43%) missed by the first biopsy core had a Gleason score of 6. Altogether 537 of the 2,128 biopsy cores were positive, including 283 first (26.6%) and 254 second (24%) biopsy cores (p ≤0.001). The concordance between the first and second biopsy cores was 89% (κ = 0.71). There was a discrepancy with Gleason score upgrading in 28 of 212 lesions (13.2%) with positive first and second biopsy cores. CONCLUSIONS Our study shows that obtaining more than 1 biopsy core per magnetic resonance imaging lesion only slightly improves the prostate cancer detection rate and Gleason grading.
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Affiliation(s)
- Pantelis Dimitroulis
- Department of Urology, University Hospital Düsseldorf, Heinrich-Heine University Medical Faculty, Düsseldorf, Germany
| | - Robert Rabenalt
- Department of Urology, University Hospital Düsseldorf, Heinrich-Heine University Medical Faculty, Düsseldorf, Germany.
| | - Alessandro Nini
- Department of Urology, University Hospital Düsseldorf, Heinrich-Heine University Medical Faculty, Düsseldorf, Germany; Unit of Urology, Division of Oncology, Department of Urology, Istituto di Ricerca Urologica, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
| | - Andreas Hiester
- Department of Urology, University Hospital Düsseldorf, Heinrich-Heine University Medical Faculty, Düsseldorf, Germany
| | - Irene Esposito
- Department of Pathology, University Hospital Düsseldorf, Heinrich-Heine University Medical Faculty, Düsseldorf, Germany
| | - Lars Schimmöller
- Department of Diagnostic and Interventional Radiology, University Hospital Düsseldorf, Heinrich-Heine University Medical Faculty, Düsseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, University Hospital Düsseldorf, Heinrich-Heine University Medical Faculty, Düsseldorf, Germany
| | - Peter Albers
- Department of Urology, University Hospital Düsseldorf, Heinrich-Heine University Medical Faculty, Düsseldorf, Germany
| | - Christian Arsov
- Department of Urology, University Hospital Düsseldorf, Heinrich-Heine University Medical Faculty, Düsseldorf, Germany
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Hofbauer SL, Maxeiner A, Kittner B, Heckmann R, Reimann M, Wiemer L, Asbach P, Haas M, Penzkofer T, Stephan C, Friedersdorff F, Fuller F, Miller K, Cash H. Validation of Prostate Imaging Reporting and Data System Version 2 for the Detection of Prostate Cancer. J Urol 2018; 200:767-773. [PMID: 29733838 DOI: 10.1016/j.juro.2018.05.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE The second version of the PI-RADS™ (Prostate Imaging Reporting and Data System) was introduced in 2015 to standardize the interpretation and reporting of prostate multiparametric magnetic resonance imaging. Recently low cancer detection rates were reported for PI-RADS version 2 category 4 lesions. Therefore the aim of the study was to evaluate the cancer detection rate of PI-RADS version 2 in a large prospective cohort. MATERIALS AND METHODS The study included 704 consecutive men with primary or prior negative biopsies who underwent magnetic resonance imaging/ultrasound fusion guided targeted biopsy and 10-core systematic prostate biopsy between September 2015 and May 2017. All lesions were rated according to PI-RADS version 2 and lesions with PI-RADS version 2 category 3 or greater were biopsied. An ISUP (International Society of Urological Pathology) score of 2 or greater (ie Gleason 3 + 4 or greater) was defined as clinically significant prostate cancer. RESULTS The overall cancer detection rate of PI-RADS version 2 categories 3, 4 and 5 was 39%, 72% and 91% for all prostate cancer, and 23%, 49% and 77% for all clinically significant prostate cancer, respectively. If only targeted biopsy had been performed, 59 clinically significant tumors (16%) would have been missed. The PI-RADS version 2 score was significantly associated with the presence of prostate cancer (p <0.001), the presence of clinically significant prostate cancer (p <0.001) and the ISUP grade (p <0.001). CONCLUSIONS PI-RADS version 2 is significantly associated with the presence of clinically significant prostate cancer. The cancer detection rate of PI-RADS version 2 category 4 lesions was considerably higher than previously reported. When performing targeted biopsy, the combination with systematic biopsy still provides the highest detection of clinically significant prostate cancer.
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Affiliation(s)
| | - Andreas Maxeiner
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Beatrice Kittner
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Robin Heckmann
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Laura Wiemer
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Patrick Asbach
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Haas
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Penzkofer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Carsten Stephan
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Florian Fuller
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kurt Miller
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hannes Cash
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Cui Y, Li X, Gao S, Li Z, Li Y, Lu M, Sun Y. Utility of CT in differentiating liver metastases of well-differentiated gastroenteropancreatic neuroendocrine neoplasms from poorly-differentiated neuroendocrine neoplasms. Chin J Cancer Res 2018; 30:31-39. [PMID: 29545717 DOI: 10.21147/j.issn.1000-9604.2018.01.04] [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] [Indexed: 11/18/2022] Open
Abstract
Objective To determine the capability of dynamic enhanced computed tomography (CT) to differentiate liver metastases (LMs) of well-differentiated from poorly-differentiated gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs). Methods Patients with LMs of GEP-NENs who underwent dynamic enhanced CT examination in Peking University Cancer Hospital from January 2009 to October 2015 were included and data were retrospectively analyzed. We assessed the qualitative and quantitative CT features to identify the significant differentiating CT features of LMs of poorly-differentiated GEP-NENs from those of well-differentiated GEP-NENs using univariate analysis and a multivariate logistic regression model. Results The study included 22 patients with LMs of well-differentiated GEP-NENs and 32 patients with LMs of poorly-differentiated GEP-NENs. Univariate analysis revealed statistically significant differences between the LMs of well- and poorly-differentiated GEP-NENs in terms of feeding arteries (36.4% vs. 75.0%, χ2=8.061, P=0.005), intratumoral neovascularity (18.2% vs. 59.4%, χ2=9.047, P=0.003), lymphadenopathy (27.3% vs. 81.2%, χ2=15.733, P<0.001), tumor-to-aortic ratio in the hepatic arterial and portal venous phase (T-A/AP: 0.297±0.080vs. 0.251±0.059, t=2.437, P=0.018; T-A/PVP: 0.639±0.138 vs. 0.529±0.117, t=3.163, P=0.003) and tumor-to-liver ratio in the hepatic arterial phase (T-L/AP: 1.108±0.267 vs. 0.907±0.240, t=2.882, P=0.006). The LMs of poorly-differentiated GEP-NENs showed more feeding arteries, more intratumoral neovascularity, more lymphadenopathy and a lower tumor-to-aortic ratio. Multivariate analysis suggested that intratumoral neovascularity [P=0.015, OR=0.108, 95% confidence interval (95% CI), 0.018-0.646], lymphadenopathy (P=0.001, OR=0.055, 95% CI, 0.009-0.323) and T-A/PVP (P=0.004, OR=5.3E-5, 95% CI, 0.000-0.044) were independent factors for differentiating LMs of poorly-differentiated from well-differentiated GEP-NENs. Conclusions Dynamic enhanced CT features (intratumoral neovascularity, lymphadenopathy and T-A/PVP) are useful in the pathological classification of LMs of GEP-NENs.
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Affiliation(s)
- Yong Cui
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1Department of Radiology
| | - Xiaoting Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1Department of Radiology
| | - Shunyu Gao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1Department of Radiology
| | - Zhongwu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1Department of Radiology
| | - Yanling Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1Department of Radiology
| | - Ming Lu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1Department of Radiology
| | - Yingshi Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1Department of Radiology
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Chen C, Chen Y, Hu LK, Jiang CC, Xu RF, He XZ. The performance of the new prognostic grade and stage groups in conservatively treated prostate cancer. Asian J Androl 2018; 20:366-371. [PMID: 29493549 PMCID: PMC6038159 DOI: 10.4103/aja.aja_5_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Indexed: 11/08/2022] Open
Abstract
We evaluated the prognosis of the new grade groups and American Joint Committee on Cancer (AJCC) stage groups in men with prostate cancer (PCa) who were treated conservatively. A total of 13 798 eligible men were chosen from the Surveillance Epidemiology and End Results database. The new grade and AJCC stage groups were investigated on prostate biopsy specimens. Kaplan–Meier survival analysis and multivariable hazards models were applied to estimate the association of new grade and stage groups with overall survival (OS) and PCa-specific survival (CSS). Mean follow-up was 42.65 months (95% confidence interval: 42.47–42.84) in the entire cohort. The 3-year OS and CSS rates stepped down for grade groups 1–5 and AJCC stage groups I–IVB, respectively. After adjusting for clinical and pathological characteristics, all grade groups and AJCC stage groups were associated with higher all-cause and PCa-specific mortality compared to the reference group (all P ≤ 0.003). In conclusion, we evaluated the oncological outcome of the new grade and AJCC stage groups on biopsy specimens of conservatively treated PCa. These two novel clinically relevant classifications can assist physicians to determine different therapeutic strategies for PCa patients.
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Affiliation(s)
- Cheng Chen
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Ye Chen
- Department of Urology, Nanyang Second General Hospital, Nanyang 473012, China
| | - Lin-Kun Hu
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Chang-Chuan Jiang
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10019, USA
| | - Ren-Fang Xu
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Xiao-Zhou He
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
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