Objective:To validate the eighth edition of the AJCC staging system in patients with pancreatic adenocarcinoma receiving only stereotactic body radiation therapy and chemotherapy,and to propose modifications to improv...Objective:To validate the eighth edition of the AJCC staging system in patients with pancreatic adenocarcinoma receiving only stereotactic body radiation therapy and chemotherapy,and to propose modifications to improve prognostic accuracy.Methods:Patients with pathologically confirmed pancreatic adenocarcinoma without metastasis who were undergoing only chemoradiotherapy were included and staged according to the seventh and eighth editions of the AJCC staging system.Meanwhile,another group of stage T4 patients from the above enrollment with only portal vein involvement with or without tumor thrombi(PV±PVTT)were retrieved for survival comparisons.Modifications were proposed according to the survival comparisons.A cohort from the SEER database was used for external validation of the modified staging system.Results:A total of 683 patients were included.Patients with N2 or N1 but different T stages had significantly different survival outcomes according to the eighth edition.The survival of patients with(PV±PVTT)was comparable to that of patients with T4 tumors.The concordance index of the seventh and eighth editions,and the modified staging system was 0.744(95%CI:0.718—0.769),0.750(95%CI:0.725—0.775),and 0.788(95%CI:0.762-0.813),respectively.For external validation,the concordance index was 0.744(95%CI:0.718-0.770),0.750(95%CI:0.724-0.776),and 0.788(95%CI:0.762-0.814),respectively.Conclusions:The modified staging system is suggested to have the m ost accurate prognostic value.Hence,PV土PVTT should be added to the definition of T4 tumors regardless of tumor size.Patients with N2 or N1 in different T stages could be regrouped into different substages.Additionally,stage III should be subclassified into IIIA(T3N 2 and T4N 0)and IIIB(T4N 1-2).展开更多
Objective： We retrospectively analyzed the clinical prognostic value of the 8th edition of the American Joint Committee on Cancer （AJCC） staging system for luminal A breast cancer. Methods： Using both the anatomic...Objective： We retrospectively analyzed the clinical prognostic value of the 8th edition of the American Joint Committee on Cancer （AJCC） staging system for luminal A breast cancer. Methods： Using both the anatomic and prognostic staging in the 8th edition of AJCC cancer staging system, we restaged patients with luminal A breast cancer treated at the Breast Disease Center, Peking University First Hospital from 2008 to 2014. Follow-up data including 5-year disease free survival （DFS）, overall survival （OS） and other clinic-pathological data were collected to analyze the differences between the two staging subgroups. Results： This study included 421 patients with luminal A breast cancer （median follow-up, 61 months）. The 5- year DFS and OS rates were 98.3% and 99.3%, respectively. Significant differences in 5-year DFS but not OS were observed between different anatomic disease stages. Significant differences were observed in both 5-year DFS and O S between different prognostic stages. Application of the prognostic staging system resulted in assignment of 175 of 421 patients （41.6%） to a different group compared to their original anatomic stages. In total, 102 of 103 patients with anatomic stage IlA changed to prognostic stage IB, and 24 of 52 patients with anatomic stage lib changed to prognostic stage IB, while 1 changed to prognostic stage liIB. Twenty-two of 33 patients with anatomic stage IliA were down-staged to IlA when staged by prognostic staging system, and the other 11 patients were down-staged to liB. Two patients with anatomic stage IIIB were down-staged to IliA. Among seven padents with anatomic stage IIIC cancer, two were down-staged to IliA and four were down-staged to stage I]IB. Conclusions： The 8th edition of AJCC prognostic staging system is an important supplement to the breast cancer staging system. More clinical trials are needed to prove its ability to guide selection of proper systemic therapy and predict prognosis of breast cancer.展开更多
Background:The tumor-node-metastasis(TNM)staging system does not perform well for guiding individualized induc-tion or adjuvant chemotherapy for patients with locoregionally advanced nasopharyngeal carcinoma(NPC).We a...Background:The tumor-node-metastasis(TNM)staging system does not perform well for guiding individualized induc-tion or adjuvant chemotherapy for patients with locoregionally advanced nasopharyngeal carcinoma(NPC).We attempted to externally validate the Pan’s nomogram,developed based on the 8th edition of the American Joint Committee on Cancer(AJCC)/Union for International Cancer Control(UICC)staging system,for patients with locoregionally advanced disease.In addition,we investigated the reliability of Pan’s nomogram for selection of participants in future clinical trials.Methods:This study included 535 patients with locoregionally advanced NPC who were treated between March 2007 and January 2012.The 5-year overall survival(OS)rates were calculated using the Kaplan-Meier method and compared with predicted outcomes.The calibration was tested using calibration plots and the Hosmer-Lemeshow test.Discrimination ability,which was assessed using the concordance index,as compared with other predictors.Results:Pan’s nomogram was observed to underestimate the 5-year OS of the entire cohort by 8.65%[95%confi-dence interval(CI)−9.70 to−7.60%,P<0.001]and underestimated the 5-year OS of each risk group.The differences between the predicted and observed 5-year OS rates were smallest among low-risk patients(<135 points calculated using Pan’s nomogram;which predicted minus observed OS,−6.41%,95%CI−6.75 to−6.07%,P<0.001)and were largest among high-risk patients(≥160 points)(−13.56%,95%CI−15.48 to−11.63%,P<0.001).The Hosmer-Lemeshow test suggested that the predicted and observed 5-year OS rates had no ideal relationship(P<0.001).Pan’s nomogram had better discriminatory ability compared with the levels of Epstein-Barr virus DNA acid(EBV DNA)and the 7th or 8th AJCC/UICC staging system,although not better compared with the combination of EBV DNA and the 8th staging system.Additionally,Pan’s nomogram was marginally inferior to our predictive model,which included the 8th AJCC/UICC N-classification,age,gross primary tumor volume,lactate dehydrogenase,and body mass index.Conclusions:Pan’s nomogram underestimated the 5-year OS of patients with locoregionally advanced NPC at our cancer center,and may not be a precise tool for selecting participants for clinical trials.展开更多
基金grants from the Special Project of Ministry of Science and Technology(Grant No.2017 YFC0113104)We thank Dr.Jiuhong Chen for helpful comments,Dr.Fabienne Hirigoyenberry and Dr.Huijun Chen,for language editing and LinkDoc for their constructive advice in patient follow-up.
文摘Objective:To validate the eighth edition of the AJCC staging system in patients with pancreatic adenocarcinoma receiving only stereotactic body radiation therapy and chemotherapy,and to propose modifications to improve prognostic accuracy.Methods:Patients with pathologically confirmed pancreatic adenocarcinoma without metastasis who were undergoing only chemoradiotherapy were included and staged according to the seventh and eighth editions of the AJCC staging system.Meanwhile,another group of stage T4 patients from the above enrollment with only portal vein involvement with or without tumor thrombi(PV±PVTT)were retrieved for survival comparisons.Modifications were proposed according to the survival comparisons.A cohort from the SEER database was used for external validation of the modified staging system.Results:A total of 683 patients were included.Patients with N2 or N1 but different T stages had significantly different survival outcomes according to the eighth edition.The survival of patients with(PV±PVTT)was comparable to that of patients with T4 tumors.The concordance index of the seventh and eighth editions,and the modified staging system was 0.744(95%CI:0.718—0.769),0.750(95%CI:0.725—0.775),and 0.788(95%CI:0.762-0.813),respectively.For external validation,the concordance index was 0.744(95%CI:0.718-0.770),0.750(95%CI:0.724-0.776),and 0.788(95%CI:0.762-0.814),respectively.Conclusions:The modified staging system is suggested to have the m ost accurate prognostic value.Hence,PV土PVTT should be added to the definition of T4 tumors regardless of tumor size.Patients with N2 or N1 in different T stages could be regrouped into different substages.Additionally,stage III should be subclassified into IIIA(T3N 2 and T4N 0)and IIIB(T4N 1-2).
基金supported by research grants from the Beijing Municipal Commission of Health and Family Planning(No.2009-1011)the Beijing Municipal Science and Technology Commission(No.D090507043409010 and Z131107002213007)the Precision Medicine Special Project of National Key Research and Development Program(No.2016YFC0901302)
文摘Objective： We retrospectively analyzed the clinical prognostic value of the 8th edition of the American Joint Committee on Cancer （AJCC） staging system for luminal A breast cancer. Methods： Using both the anatomic and prognostic staging in the 8th edition of AJCC cancer staging system, we restaged patients with luminal A breast cancer treated at the Breast Disease Center, Peking University First Hospital from 2008 to 2014. Follow-up data including 5-year disease free survival （DFS）, overall survival （OS） and other clinic-pathological data were collected to analyze the differences between the two staging subgroups. Results： This study included 421 patients with luminal A breast cancer （median follow-up, 61 months）. The 5- year DFS and OS rates were 98.3% and 99.3%, respectively. Significant differences in 5-year DFS but not OS were observed between different anatomic disease stages. Significant differences were observed in both 5-year DFS and O S between different prognostic stages. Application of the prognostic staging system resulted in assignment of 175 of 421 patients （41.6%） to a different group compared to their original anatomic stages. In total, 102 of 103 patients with anatomic stage IlA changed to prognostic stage IB, and 24 of 52 patients with anatomic stage lib changed to prognostic stage IB, while 1 changed to prognostic stage liIB. Twenty-two of 33 patients with anatomic stage IliA were down-staged to IlA when staged by prognostic staging system, and the other 11 patients were down-staged to liB. Two patients with anatomic stage IIIB were down-staged to IliA. Among seven padents with anatomic stage IIIC cancer, two were down-staged to IliA and four were down-staged to stage I]IB. Conclusions： The 8th edition of AJCC prognostic staging system is an important supplement to the breast cancer staging system. More clinical trials are needed to prove its ability to guide selection of proper systemic therapy and predict prognosis of breast cancer.
基金supported by the Sun Yat-sen University Clinical Research 5010 Program(2015020)the National Natural Science Foundation of China(No.81672665)+1 种基金the Sci-Tech Project Foundation of Guangdong Province(No.2016A020215087)the Natural Science Foundation of Guangdong Province(No.2015A030313024).
文摘Background:The tumor-node-metastasis(TNM)staging system does not perform well for guiding individualized induc-tion or adjuvant chemotherapy for patients with locoregionally advanced nasopharyngeal carcinoma(NPC).We attempted to externally validate the Pan’s nomogram,developed based on the 8th edition of the American Joint Committee on Cancer(AJCC)/Union for International Cancer Control(UICC)staging system,for patients with locoregionally advanced disease.In addition,we investigated the reliability of Pan’s nomogram for selection of participants in future clinical trials.Methods:This study included 535 patients with locoregionally advanced NPC who were treated between March 2007 and January 2012.The 5-year overall survival(OS)rates were calculated using the Kaplan-Meier method and compared with predicted outcomes.The calibration was tested using calibration plots and the Hosmer-Lemeshow test.Discrimination ability,which was assessed using the concordance index,as compared with other predictors.Results:Pan’s nomogram was observed to underestimate the 5-year OS of the entire cohort by 8.65%[95%confi-dence interval(CI)−9.70 to−7.60%,P<0.001]and underestimated the 5-year OS of each risk group.The differences between the predicted and observed 5-year OS rates were smallest among low-risk patients(<135 points calculated using Pan’s nomogram;which predicted minus observed OS,−6.41%,95%CI−6.75 to−6.07%,P<0.001)and were largest among high-risk patients(≥160 points)(−13.56%,95%CI−15.48 to−11.63%,P<0.001).The Hosmer-Lemeshow test suggested that the predicted and observed 5-year OS rates had no ideal relationship(P<0.001).Pan’s nomogram had better discriminatory ability compared with the levels of Epstein-Barr virus DNA acid(EBV DNA)and the 7th or 8th AJCC/UICC staging system,although not better compared with the combination of EBV DNA and the 8th staging system.Additionally,Pan’s nomogram was marginally inferior to our predictive model,which included the 8th AJCC/UICC N-classification,age,gross primary tumor volume,lactate dehydrogenase,and body mass index.Conclusions:Pan’s nomogram underestimated the 5-year OS of patients with locoregionally advanced NPC at our cancer center,and may not be a precise tool for selecting participants for clinical trials.
