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
AIM: To evaluate whether antiplatelet medication leads to an earlier stage colorectal cancer (CRC) diagnosis. METHODS: From January 2002 until March 2010, patients that presented to our institution with the initial di...AIM: To evaluate whether antiplatelet medication leads to an earlier stage colorectal cancer (CRC) diagnosis. METHODS: From January 2002 until March 2010, patients that presented to our institution with the initial diagnosis of CRC and were submitted to an open curative CRC resection or a palliative procedure were retrospectively reviewed. Exclusion criteria were the use of antithrombotic medication, i.e., coumarins, and appendiceal malignancies. Data acquired from medical files included age, gender, past medical history, antithrombotic treatment received prior to endoscopic diagnosis, preoperative imaging staging, location of the tumor, surgical and final histopathological report. Patients that did not receive any antithrombotic medication prior to the endoscopic diagnosis comprised the control group of the study, while patients that were on antiplatelet medication comprised the antiplatelet group. Primary end point was a comparison of CRC stage in the two groups of the study. CRC presenting symptoms and the incidence of each cancer stage in the two groups were also evaluated. RESULTS: A total of 387 patients with the diagnosis of CRC were submitted to our department for further surgical treatment. Ninety-eight patients (25.32%), with a median age of 71 years (range 52-91 years), were included in the antiplatelet group, while 289 (74.67%) patients, with a median age of 67 years (range 41-90 years), were not in any thrombosis prophylaxis medication (control group). Thirty-one patients were treated with some kind of palliative procedure, either endoscopic, such as endoscopic stent placement, or surgical, such as de-compressive colostomy or deviation. Coronary disease (77.55% - 76 patients), stroke recurrence prevention (14.28% - 14 patients) and peripheral arterial disease (8.16% - 8 patients) were the indications for the administration of antiplatelet treatment (aspirin, clopidogrel, ticlopidine or dipyridamole) in the antiplatelet group. All patients on aspirin treatment received a dosage of 100 mg/d, while the minimum prophylactic dosages were also used for the rest of the antiplatelet drugs. Investigation of an iron deficiency anemia (147 patients), per rectum blood loss (84 patients), bowel obstruction and/or perforation (81 patients), bowel habits alterations (32 patients), non-specific symptoms, such as weight loss, intermittent abdominal pain and fatigue, (22 patients) or population screening (21 patients) were the indications for the endoscopic investigation in both groups. Bleeding, either chronic presenting as anemia or acute was significantly higher (P = 0.002) for the antiplatelet arm of the study (71 patients - 72.4% of the antiplatelet group vs 160 patients - 55.3% of the control group). The mean tumor, node and metastasis stage was 2.57 ± 0.96 for the control group, 2.27 ± 0.93 for the antiplatelet group (P = 0.007) and 2.19 ± 0.92 for the subgroup of patients taking aspirin (P = 0.003). The incidence of advanced disease (stage IV) was lower for the antiplatelet group of the study (P = 0.033). CONCLUSION: The adverse effect of bleeding that is justifiably attached to this drug category seems to have a favorable impact on the staging characteristics of CRC.展开更多
Accurate cancer staging is the foundation of precision oncology and guides prognosis prediction and therapeutic decision-making. The conjoint TNM System by the American Joint Committee on Cancer (AJCC) and the Interna...Accurate cancer staging is the foundation of precision oncology and guides prognosis prediction and therapeutic decision-making. The conjoint TNM System by the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (UICC) has served as the global standard for tumor classification since inception.展开更多
This letter comments on Wei et al's study applying the Wave-Vision Transformer for oesophageal cancer classification.Highlighting its superior accuracy and efficiency,we discuss its potential clinical impact,limit...This letter comments on Wei et al's study applying the Wave-Vision Transformer for oesophageal cancer classification.Highlighting its superior accuracy and efficiency,we discuss its potential clinical impact,limitations in dataset diversity,and the need for explainable artificial intelligence to enhance adoption in pathology and personalized treatment.展开更多
Gallbladder cancer is an aggressive malignancy notorious for its poor prognosis and treatment challenges,even at early stages.In their recent work,Kim et al utilized data from the National Cancer Database to explore w...Gallbladder cancer is an aggressive malignancy notorious for its poor prognosis and treatment challenges,even at early stages.In their recent work,Kim et al utilized data from the National Cancer Database to explore whether adding chemotherapy to surgical intervention could improve survival outcomes for patients diagnosed with stage II gallbladder cancer.The use of adjuvant chemotherapy following curative surgery in this patient population has been a longstanding source of debate.Historically,the lack of clear guidelines for managing stage II gallbladder cancer has resulted in inconsistent,sometimes contradictory findings from various studies regarding the effectiveness of postoperative chemotherapy.Consequently,many clinicians have relied on studies involving other biliary tract cancers to justify the routine use of prophylactic chemotherapy after surgery,aiming to minimize recurrence risk.Given the rarity,high mortality rate,and the small sample sizes typical in gallbladder cancer studies,Kim et al’s contribution represents a significant and commendable effort to address these challenges.Kim et al designed a retrospective cohort study with well-defined inclusion criteria and clear treatment classifications.Notably,their findings suggested that in stage II gallbladder cancer,adjuvant chemotherapy did not yield a meaningful survival benefit over surgery alone.These results therefore casted doubt on the routine practice of administering chemotherapy to all patients postoperatively,prompted clinicians to reconsider their approach.Furthermore,this controversy directly influences clinical decisionmaking and guideline recommendations,as uncertainty regarding the benefit of adjuvant chemotherapy may lead to heterogeneous practices across different institutions and regions.This article critically assessed the research design,methodology,and clinical implications of the study by Kim et al.It also provided an in-depth exploration of the broader question regarding the appropriateness of adjuvant chemotherapy following surgery for stage II gallbladder cancer,highlighting the necessity of rigorous study designs to produce reliable evidence.展开更多
BACKGROUND Despite being the world’s most widely used system for staging and therapeutic guidance in hepatocellular carcinoma(HCC)treatment,the Barcelona clinic liver cancer(BCLC)system has limitations,especially reg...BACKGROUND Despite being the world’s most widely used system for staging and therapeutic guidance in hepatocellular carcinoma(HCC)treatment,the Barcelona clinic liver cancer(BCLC)system has limitations,especially regarding intermediate-grade(BCLC-B)tumors.The recently proposed Hong Kong liver cancer(HKLC)staging system appears useful but requires validation in Western populations.AIM To evaluate the agreement between BCLC and HKLC staging on the management of HCC in a Western population,estimating the overall patient survival.METHODS This was a retrospective study of HCC patients treated at a university hospital in southern Brazil between 2011 and 2016.Demographic,clinical,and laboratory data were collected.HCC staging was carried out according to the HKLC and BCLC systems to assess treatment agreement.Overall survival was estimated based on the treatment proposed in each system.RESULTS A total of 519 HCC patients were assessed.Of these,178(34.3%)were HKLC-I;95(18.3%)HKLC-IIA;47(9.1%)HKLC-IIB;29(5.6%)HKLC-IIIA;30(5.8%)HKLCIIIB;75(14.4%)HKLC-IV;and 65(12.5%)HKLC-V.According to the BCLC,25(4.9%)were BCLC-0;246(47.4%)BCLC-A;107(20.6%)BCLC-B;76(14.6%)BCLCC;and 65(12.5%)BCLC-D.The general agreement between the two systems was 80.0%-BCLC-0 and HKLC-I(100%);BCLC-A and HKLC-I/HKLC-II(96.7%);BCLC-B and HKLC-III(46.7%);BCLC-C and HKLC-IV(98.7%);BCLC-D and HKLC-V(41.5%).When sub-classifying BCLC-A,HKLC-IIB,HKLC-IIIA and HKLC-IIIB stages according to the up-to-7 in/out criterion,13.4,66.0,100 and 36.7%,respectively,of the cases were classified as up-to-7 out.CONCLUSION In a Western population,the general agreement between the two systems was 80.0%,although in BCLC-B cases the agreement was low,suggesting that some individuals could be candidates for the curative treatment recommended by the HKLC.The authors suggest that the BCLC system should be routinely employed,although for BCLC-B cases it should be associated with the HKLC system.展开更多
BACKGROUNDColorectal cancer(CRC)typically progresses from benign colorectal polyps,whichrepresent a precursor to malignancy.Identifying the factors influencing thisprogression is crucial for early intervention and pre...BACKGROUNDColorectal cancer(CRC)typically progresses from benign colorectal polyps,whichrepresent a precursor to malignancy.Identifying the factors influencing thisprogression is crucial for early intervention and prevention.Although genetic andenvironmental factors have been widely studied,the role of lifestyle factors suchas physical activity,diet,smoking,sleep,and stress remains underexplored,especially in patients with early stage CRC or polyps.Recent evidence suggeststhat lifestyle behaviors may influence cancer progression by modulating inflammatorypathways,metabolic health,and immune function.For instance,highlevels of physical activity are linked to a reduced risk of CRC development,whereas poor dietary habits,smoking,and inadequate sleep have all beenimplicated in increased cancer risk and progression.Moreover,early-stage CRCpatients,who are often asymptomatic or have minimal symptoms,may particularlybenefit from lifestyle modifications to slow disease progression andimprove overall prognosis.The gap in understanding the specific influence ofthese lifestyle factors on colorectal polyps and early stage cancer progressionunderscores the need for comprehensive studies.By assessing several modifiablelifestyle factors and their association with disease progression,clinicians canidentify practical intervention points.These interventions could ultimately reducethe need for more aggressive treatments and improve the long-term outcomes inaffected patients.AIMTo investigate the association between lifestyle factors and disease progression inpatients with colorectal polyps and early stage cancer.METHODSIn this observational study conducted from January 2022 to December 2023,werecruited 120 patients with colorectal polyps or early stage cancer from Jiangshan People's Hospital.Lifestyle factors,including physical activity,dietary patterns,smoking status,sleep quality,andstress levels,were assessed using validated questionnaires.Disease progression was evaluated using standardizedfollow-up colonoscopies and pathological examinations.Cox proportional hazards models were used to analyzethe association between lifestyle factors and disease progression after adjusting for potential confounders.RESULTSDuring the median follow-up of 18.4 months,42(35.0%)patients experienced disease progression.High levels ofphysical activity were associated with reduced progression risk[adjusted hazard ratio(HR)0.55,95%confidenceinterval(CI):0.38-0.80,P=0.002]compared to low activity levels.High adherence to a healthy dietary patternshowed similar protective effects(adjusted HR 0.62,95%CI:0.43-0.89,P=0.009).Current smoking(adjusted HR1.92,95%CI:1.35-2.73,P<0.001)and poor sleep quality(adjusted HR 1.38,95%CI:1.05-1.82,P=0.021)wereassociated with increased progression risk.The impact of lifestyle factors was particularly pronounced in patientsyounger than 60 years and those with multiple polyps at baseline.CONCLUSIONThis study demonstrated significant associations between lifestyle factors and disease progression in colorectalpolyps and early stage cancer.Physical activity,dietary patterns,smoking status,and sleep quality have emergedas key modifiable factors influencing disease progression.These findings support the integration of lifestyleassessments and modifications in the clinical management of patients with colorectal neoplasia.展开更多
BACKGROUND Implementing nursing interventions in patients undergoing endoscopic treatment for intestinal polyps and early stage cancer can serve as a reference for reducing the incidence of complications,accelerating ...BACKGROUND Implementing nursing interventions in patients undergoing endoscopic treatment for intestinal polyps and early stage cancer can serve as a reference for reducing the incidence of complications,accelerating the recovery process,and improving the quality of life.AIM To impact of systematic nursing intervention on recovery,complications prevention,and quality of life after endoscopic surgery for intestinal polyps.METHODS This retrospective study included 157 patients who underwent endoscopic mucosal resection or endoscopic submucosal dissection at our hospital.The patients were divided into intervention and conventional groups,with no significant differences in age,sex,or surgical methods.The intervention group received multidimensional nursing interventions,including preoperative evaluation,intraoperative cooperation,postoperative rehabilitation,psychological support and nutritional management.The conventional group received standardized care.Clinical efficacy,inflammation and infection indicators,complication rates,rehabilitation indicators,and visual analog scale(VAS)scores were compared.RESULTS On the 7th day after surgery,C-reactive protein(CRP)and white blood cell levels were lower in the intervention group than in the conventional group.Complications occurred in 9.33%of the patients in the intervention group and 23.17%in the conventional group,with significant differences in fever and abdominal distension.The intervention group had shorter first exhaust and hospitalization durations than the control group.By day 3 post-surgery,the intervention group showed lower VAS scores and reduced anxiety and depression.High-risk factors included diabetes[relative risk(RR)=2.43,95%CI:1.21-4.86],laparotomy(RR=2.86,95%CI:1.22-6.71),CRP>15 mg/L(RR=3.12,95%CI:1.54-6.33),and procalcitonin>0.5 ng/mL 1 day after surgery(RR=2.91.95%CI:1.31-6.44),while systematic nursing interventions(OR=0.40,95%CI:0.18-0.89)reduced the complication risk by 60%.CONCLUSION Multidimensional nursing interventions have clinical value in endoscopic treatment of intestinal polyps and early stage cancer,reducing complications and hospital stay.This study provides a basis for establishing patientcentered guidelines.展开更多
BACKGROUND Non-small cell lung cancer(NSCLC)is the most prevalent subtype of lung cancer,accounting for approximately 85%of all lung cancer cases and remaining a major cause of cancer-related mortality worldwide.Despi...BACKGROUND Non-small cell lung cancer(NSCLC)is the most prevalent subtype of lung cancer,accounting for approximately 85%of all lung cancer cases and remaining a major cause of cancer-related mortality worldwide.Despite advances in diagnostic and therapeutic approaches,the incidence and mortality rates of NSCLC continue to rise,especially in low-income and middle-income countries.AIM To investigate the expression of cancer stem cell(CSC)markers and their relationship with the prognosis and survival of patients with stage IIIA NSCLC.METHODS A retrospective analysis was conducted on the clinical data and survival followup information of 61 patients with stage IIIA NSCLC treated at our hospital from February 2020 to June 2022,and all cases were confirmed as primary(nonrecurrent)diagnoses based on clinical and pathological records.All patients were followed up through outpatient visits or telephone interviews.The follow-up duration ranged from 6 to 51 months with a median follow-up time of 36 months.Overall survival(OS)was defined as the time from the date of pathological diagnosis to death or the last follow-up.Univariate and multivariate Cox regression analyses were performed to examine the relationship between clinical characteristics and OS.Immunohistochemistry was used to detect the expression of CSC markers[octamer-binding transcription factor 4(OCT4),trophoblast cell surface antigen-2(TROP-2),ATP-binding cassette subfamily G member 2(ABCG2),p75 neurotrophin receptor(p75NTR)]in NSCLC,followed by immunohistochemical scoring.The high H-scores of CSC markers,age,and micropapillary components were combined to generate a tumor stemness index(TSI).The Kaplan-Meier method was used to analyze the relationship between CSC markers,TSI,and OS in patients with NSCLC.RESULTS Multivariate Cox regression analysis showed that age[hazard ratio(HR)=1.952,95%confidence interval(CI):1.087-2.481,P=0.029]and micropapillary components(HR=2.716,95%CI:1.259-5.837,P=0.013)were significantly associated with OS.In NSCLC there were 21 cases with high OCT4 H-scores,27 cases with high TROP-2 H-scores,44 cases with high ABCG2 H-scores,and 44 cases with high p75NTR H-scores.In the survival analysis the high OCT4 expression group had a poorer prognosis(P=0.006).Further subtype analysis revealed no statistically significant difference in OS between high and low OCT4 H-score groups in patients with lung squamous cell carcinoma(P=0.457).However,in patients with lung adenocarcinoma high OCT4 expression had significantly poorer OS compared with those with low OCT4 expression(P=0.005).TROP-2,ABCG2,and p75NTR did not significantly affect the prognosis.TSI was significantly associated with OS in patients with NSCLC(HR=2.209,95%CI:1.238-3.681,P=0.027).CONCLUSION Age and micropapillary components were related to OS in patients with stage IIIA NSCLC.High expression of OCT4 and high TSI were associated with poor prognosis.展开更多
Small cell lung cancer(SCLC)constitutes approximately 15%of all lung cancer cases,characterized by rapid tumor growth,a high pro-liferation rate,and a propensity for early metastasis.1 Approximately one-third of SCLC ...Small cell lung cancer(SCLC)constitutes approximately 15%of all lung cancer cases,characterized by rapid tumor growth,a high pro-liferation rate,and a propensity for early metastasis.1 Approximately one-third of SCLC patients are diagnosed at the limited-stage.Histor-ically,the standard of care for these patients has been 4-6 cycles of concurrent chemoradiotherapy(cCRT),with the exception of a minor-ity of early-stage T1-2N0 patients who may undergo radical surgery.2 Despite an initial high sensitivity to treatment,over 50%of patients experience disease recurrence within two years,with a median overall survival(OS)ranging from 16 to 24 months.For the past three decades,while there have been novel explorations in radiotherapy dosing and fractionation,the treatment paradigm for limited-stage SCLC(LS-SCLC)has remained largely unchanged,with no significant improvement in patient survival outcomes.展开更多
Esophageal cancer is a serious malignancy with regards to mortality and prognosis. It is a growing health concern that is expected to increase in incidence over the next 10 years. Squamous cell carcinoma is the most c...Esophageal cancer is a serious malignancy with regards to mortality and prognosis. It is a growing health concern that is expected to increase in incidence over the next 10 years. Squamous cell carcinoma is the most common histological type of esophageal cancer worldwide, with a higher incidence in developing nations. With the increased prevalence of gastroesophageal reflux disease and obesity in developed nations, the incidence of esophageal adenocarcinoma has dramatically increased in the past 40 years. Esophageal cancer is staged according to the widely accepted TNM system. Staging plays an integral part in guiding stage specific treatment protocols and has a great impact on overall survival. Common imaging modalities used in staging include computed tomography, endoscopic ultrasound and positron emission tomography scans. Current treatment options include multimodality therapy mainstaysof current treatment include surgery, radiation and chemotherapy. Tumor markers of esophageal cancer are an advancing area of research that could potentially lead to earlier diagnosis as well as playing a part in assessing tumor response to therapy.展开更多
AIM: To evaluate the accuracy of endoscopic ultrasound (EUS) in the staging of esophageal cancer. METHODS: Only EUS studies confirmed by surgery were selected. Articles were searched in Medline and Pubmed. Two reviewe...AIM: To evaluate the accuracy of endoscopic ultrasound (EUS) in the staging of esophageal cancer. METHODS: Only EUS studies confirmed by surgery were selected. Articles were searched in Medline and Pubmed. Two reviewers independently searched and extracted data. Meta-analysis of the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratio. Pooling was conducted by both the Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran’s Q test based upon inverse variance weights. RESULTS: Forty-nine studies (n = 2558) which met the inclusion criteria were included in this analysis. Pooled sensitivity and specificity of EUS to diagnose T1 was 81.6% (95% CI: 77.8-84.9) and 99.4% (95% CI: 99.0-99.7), respectively. To diagnose T4, EUS had a pooled sensitivity of 92.4% (95% CI: 89.2-95.0) and specificity of 97.4% (95% CI: 96.6-98.0). With Fine Needle Aspiration (FNA), sensitivity of EUS to diagnose N stage improved from 84.7% (95% CI: 82.9-86.4) to 96.7% (95% CI: 92.4-98.9). The P value for the χ2 test of heterogeneity for all pooled estimates was > 0.10. CONCLUSION: EUS has excellent sensitivity and specificity in accurately diagnosing the TN stage of esophageal cancer. EUS performs better with advanced (T4) than early (T1) disease. FNA substantially improves the sensitivity and specificity of EUS in evaluating N stage disease. EUS should be strongly considered for staging esophageal cancer.展开更多
Squamous cell carcinoma of the oral cavity and oropharynx have been used synonymously and interchangeably in the world literature in the context of head and neck cancers.As the 21st century progresses,divergence betwe...Squamous cell carcinoma of the oral cavity and oropharynx have been used synonymously and interchangeably in the world literature in the context of head and neck cancers.As the 21st century progresses,divergence between the two have become more evident,particularly due to evidence related to human papillomavirus-associated oropharyngeal squamous cell carcinoma.As such,the American Joint Committee on Cancer recently published the 8th edition Cancer Staging Manual,serving as a continued global resource to clinicians and researchers.Through changes in staging related to T and N clinical and pathologic classifications,the new system is expected to influence current management guidelines of these cancers that have distinct anatomic and etiopathogenic characteristics.This article aims to review such impactful changes in a time of critical transition of the staging of head and neck cancer and how these changes may affect clinicians and researchers worldwide.展开更多
BACKGROUND Carcinomas of the anal canal are staged according to the size and extent of the disease;however,we propose including a novel ultrasound(US)staging system,based on depth of tumor invasion.In this study the c...BACKGROUND Carcinomas of the anal canal are staged according to the size and extent of the disease;however,we propose including a novel ultrasound(US)staging system,based on depth of tumor invasion.In this study the clinical American Joint Committee on Cancer(AJCC)staging guidelines and the US classificationss in patients with anal cancer were compared.AIM To evaluate the prognostic role of the US staging system in patients with anal cancer.METHODS The data of 48 patients with anal canal squamous cells carcinoma,observed at our University Hospital between 2007 and 2017,who underwent pre-treatment assessment with pelvic magnetic resonance imaging(MRI),total body computed tomography(CT)scan and endoanal US were retrospectively reviewed.Anal canal tumors were clinically staged according to AJCC,determined by MRI by measurement of the longest tumor diameter,and CT scan.Endoanal US was performed with a high multi-frequency(9-16 MHz),360°rotational mechanical probe;US classification was based on depth of tumor penetration through the anal wall,according to Giovannini’s study.All patients were treated with definitive radiation combined with 5-fluorouracile and Mitomycin-C.After treatment patients were followed-up regularly.RESULTS At baseline there were 30 and 32 T1-2,18 and 16 T3-4,31 and 19 N+patients classified according to the clinical AJCC and US staging system respectively.After a mean follow-up of 98 months,38 patients(79.1%)are alive and 28(58.3%)are disease free.During follow up 20 patients(41.6%)experienced recurrences.After univariate analysis,American Society of Anesthesiologists(ASA)score(P=0.00000001)and US staging(P=0.009)were significantly related to disease-free survival(DFS).When overall survival and DFS functions were compared,a statistically significant difference was observed for DFS survival when the US staging was applied with respect to the clinical AJCC staging.By combining the 2 significant prognostic variables,namely the US staging with the ASA score,four risks groups with different prognoses were identified.CONCLUSION Our findings suggest that US staging may be superior to traditional clinical staging,since it is significantly associated with DFS in anal cancer patients.展开更多
A series of 225 consecutive lung cancer patients were prospectively randomized into a study group (75 patients) and a control group (150 Palients), and the agreement between CTNM (clinical staging) and PTNM (pathologi...A series of 225 consecutive lung cancer patients were prospectively randomized into a study group (75 patients) and a control group (150 Palients), and the agreement between CTNM (clinical staging) and PTNM (pathological staging) was evaluated. Radical mediastinal lymph node dissection was performed and on an average 11.5 nodes were dissected each case in the study group.Only suspected metastatic lymph nodes, 3.4 on an average,were dissected each cast in the coutrol group. CTNM classification was made according to clinical examination,chest image exainination and bronchoscopy in every patient and PTNM staging was made after thoracotomy.Then the agreement of CTNM and PTNM staging was judged by Kappa value. The results showed that the Kappa value in the two groups was lower than the effective standard value of 0.4, which was poorer in the study groul, (KaPPa=4).097) than that in thecontrol group tKappaed.371). The Principal influencing cause was that N was not well evaluated by CTNM. The priucipal manifestation of the staging iuconsistency was that the stage of PTNM was advanced than that of CTNM. In the study group 43% of patients showeil an increased stage and this occurred in 33% of the control group (P< 0.05).The results of the study show that at present the CTNM staging has not fully satisfied the necds of practice and requires to be further improved. The operative procedure that only suspected involved mediastinal lymph nodes are dissected can not meet the needs of PTNM staging. In order to make PTNM staging accurately and evaluate the results of treatment for lung caucer, radical mediastinal lymph node dissection should be performed in every operable Patient.展开更多
Objective: to analyze and evaluate the application value of magnetic resonance in the staging diagnosis of cervical cancer. Methods: thirty-five patients who underwent pelvic magnetic resonance examination in our hosp...Objective: to analyze and evaluate the application value of magnetic resonance in the staging diagnosis of cervical cancer. Methods: thirty-five patients who underwent pelvic magnetic resonance examination in our hospital were randomly selected as the research object. Before the pathological examination, all patients used magnetic resonance to carry out staging diagnosis of cervical cancer, and the corresponding diagnosis results were obtained. Results: through the analysis of the results of magnetic resonance diagnosis, the accuracy, sensitivity and specificity of magnetic resonance diagnosis of cervical cancer reached 92.86%, 94.83% and 83.33% respectively. For the patients diagnosed as true positive by MRI, the stages of cervical cancer were ⅠB1, ⅠB2, ⅡA1 and ⅡA2, respectively, and the difference was statistically significant (p < 0.05). Conclusion: magnetic resonance imaging is a very sensitive and accurate diagnostic method in the process of cervical cancer staging diagnosis. Through the use of this diagnostic method, doctors and patients can understand the patient's condition development more clearly, and can provide certain reference for clinical treatment. Therefore, magnetic resonance imaging has great application and promotion value in cervical cancer staging diagnosis.展开更多
Background： Current understanding of tumor biology suggests that breast cancer is a group of diseases with different intrinsic molecular subtypes. Anatomic staging system alone is insufficient to provide future outco...Background： Current understanding of tumor biology suggests that breast cancer is a group of diseases with different intrinsic molecular subtypes. Anatomic staging system alone is insufficient to provide future outcome information. The American Joint Committee on Cancer （AJCC） expert panel updated the 8th edition of the staging manual with prognostic stage groups by incorporating biomarkers into the anatomic stage groups. In this study, we retrospectively analyzed the data from our center in China using the anatomic and prognostic staging system based on the AJCC 8th edition staging manual. Methods： We reviewed the data from January 2008 to December 2014 for cases with Luminal B Human Epidermal Growth Factor Receptor 2 （HER2）-negative breast cancer in our center. All cases were restaged using the AJCC 8th edition anatomic and prognostic staging system. The Kaplan-Meier method and log-rank test were used to compare the survival differences between different subgroups. SPSS software version 19.0 （IBM Corp., Armonk, NY, USA） was used for the statistical analyses. Results： This study consisted of 796 patients with Luminal B HER-negative breast cancer. The 5-year disease-free survival （DFS） of 769 Stage I-III patients was 89.7%, and the 5-year overall survival （OS） of all 796 patients was 91.7%. Both 5-year DFS and 5-year OS were significantly different in the different anatomic and prognostic stage groups, There were 372 cases （46.7%） assigned to a different group. The prognostic Stage II and III patients restaged from anatomic Stage III had significant differences in 5-year DFS （v2 = 11.319; P = 0.001） and 5-year OS （χ2 = 5.225, P = 0.022）. In addition, cases restaged as prognostic Stage I, II, or III from the anatomic Stage II group had statistically significant differences in 5-year DFS （χ2 = 6.510, P = 0.039） but no significant differences in 5-year OS （χ2 = 5.087, P = 0.079）. However, the restaged prognostic Stage I and II cases from anatomic Stage I had no statistically significant differences in either 5-year DFS （χ2 = 0.440, P = 0.507） or 5-year OS （χ2= 1.530, P = 0.216）. Conclusions： The prognostic staging system proposed in the AJCC 8th edition refines the anatomic stage group in Luminal B HER2-negative breast cancer and will lead to a more personalized approach to breast cancer treatment.展开更多
Preoperative staging of the axilla in women with invasive breast cancer using ultrasound-guided needle biopsy(UNB) identifies approximately 50% of patients with axillary nodal metastases prior to surgical intervention...Preoperative staging of the axilla in women with invasive breast cancer using ultrasound-guided needle biopsy(UNB) identifies approximately 50% of patients with axillary nodal metastases prior to surgical intervention. Although moderately sensitive, it is a highly specific staging strategy that is rarely falsely-positive, hence a positive UNB allows patients to be triaged to axillary lymph-node dissection(ALND) avoiding potentially unnecessary sentinel node biopsy(SNB). In this review, we extend our previous work through an updated literature search, focusing on studies that report data on UNB utility. Based on data for 10,934 breast cancer patients, sourced from 35 studies, a positive UNB allowed triage of 1,745 cases(simple proportion 16%) to axillary surgical treatment: the utility of UNB was a median 19.8% [interquartile range(IQR) 11.6%-26.7%] across these studies. We also modelled data from a subgroup of studies, and estimated that amongst patients with metastases to axillary nodes, the odds ratio(OR) for high nodal disease burden for a positive UNB versus a negative UNB was 4.38 [95% confidence interval(95% CI): 3.13, 6.13], P<0.001. From this model, the estimated proportion with high nodal disease burden was 58.9%(95% CI: 50.2%, 67.0%) for a positive UNB, whereas the estimated proportion with high nodal disease burden was 24.6%(95% CI: 17.7%, 33.2%) if UNB was negative. Overall, axillary UNB has good clinical utility and a positive UNB can effectively triage to ALND. However, the evolving landscape of axillary surgical treatment means that UNB will have relatively less utility where surgeons have modified their practice to omission of ALND for minimal nodal metastatic disease.展开更多
Objective To determine the value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for staging of lung cancer. Methods The study was retrospective,a total of 52 patients underwent EBUSTBN...Objective To determine the value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for staging of lung cancer. Methods The study was retrospective,a total of 52 patients underwent EBUSTBNA for known or suspected lung cancer. All patients were detected enlarged mediastinal lymph nodes on CT scan (≥ 1. 0 cm) . Results Of the 52 patients,41 patients were found with N2 or N3 disease展开更多
In the present review we discuss the recent developments and future directions in the multimodal treatment of locally advanced rectal cancer, with respect to staging and re-staging modalities, to the current role of n...In the present review we discuss the recent developments and future directions in the multimodal treatment of locally advanced rectal cancer, with respect to staging and re-staging modalities, to the current role of neoadjuvant chemo-radiation and to the conservative and more limited surgical approaches based on tumour response after neoadjuvant combined therapy. When initial tumor staging is considered a high accuracy has been reported for T pre-treatment staging, while preoperative lymph node mapping is still suboptimal. With respect to tumour re-staging, all the current available modalities still present a limited accuracy, in particular in defining a complete response. The role of short vs long-course radiotherapy regimens as well as the optimal time of surgery are still unclear and under investigation by means of ongoing randomized trials. Observational management or local excision following tumour complete response are promising alternatives to total mesorectal excision, but need further evaluation, and their use outside of a clinical trial is not recommended.The preoperative selection of patients who will benefit from neoadjuvant radiotherapy or not, as well as the proper identification of a clinical complete tumour response after combined treatment modalities,will influence the future directions in the treatment of locally advanced rectal cancer.展开更多
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.
文摘AIM: To evaluate whether antiplatelet medication leads to an earlier stage colorectal cancer (CRC) diagnosis. METHODS: From January 2002 until March 2010, patients that presented to our institution with the initial diagnosis of CRC and were submitted to an open curative CRC resection or a palliative procedure were retrospectively reviewed. Exclusion criteria were the use of antithrombotic medication, i.e., coumarins, and appendiceal malignancies. Data acquired from medical files included age, gender, past medical history, antithrombotic treatment received prior to endoscopic diagnosis, preoperative imaging staging, location of the tumor, surgical and final histopathological report. Patients that did not receive any antithrombotic medication prior to the endoscopic diagnosis comprised the control group of the study, while patients that were on antiplatelet medication comprised the antiplatelet group. Primary end point was a comparison of CRC stage in the two groups of the study. CRC presenting symptoms and the incidence of each cancer stage in the two groups were also evaluated. RESULTS: A total of 387 patients with the diagnosis of CRC were submitted to our department for further surgical treatment. Ninety-eight patients (25.32%), with a median age of 71 years (range 52-91 years), were included in the antiplatelet group, while 289 (74.67%) patients, with a median age of 67 years (range 41-90 years), were not in any thrombosis prophylaxis medication (control group). Thirty-one patients were treated with some kind of palliative procedure, either endoscopic, such as endoscopic stent placement, or surgical, such as de-compressive colostomy or deviation. Coronary disease (77.55% - 76 patients), stroke recurrence prevention (14.28% - 14 patients) and peripheral arterial disease (8.16% - 8 patients) were the indications for the administration of antiplatelet treatment (aspirin, clopidogrel, ticlopidine or dipyridamole) in the antiplatelet group. All patients on aspirin treatment received a dosage of 100 mg/d, while the minimum prophylactic dosages were also used for the rest of the antiplatelet drugs. Investigation of an iron deficiency anemia (147 patients), per rectum blood loss (84 patients), bowel obstruction and/or perforation (81 patients), bowel habits alterations (32 patients), non-specific symptoms, such as weight loss, intermittent abdominal pain and fatigue, (22 patients) or population screening (21 patients) were the indications for the endoscopic investigation in both groups. Bleeding, either chronic presenting as anemia or acute was significantly higher (P = 0.002) for the antiplatelet arm of the study (71 patients - 72.4% of the antiplatelet group vs 160 patients - 55.3% of the control group). The mean tumor, node and metastasis stage was 2.57 ± 0.96 for the control group, 2.27 ± 0.93 for the antiplatelet group (P = 0.007) and 2.19 ± 0.92 for the subgroup of patients taking aspirin (P = 0.003). The incidence of advanced disease (stage IV) was lower for the antiplatelet group of the study (P = 0.033). CONCLUSION: The adverse effect of bleeding that is justifiably attached to this drug category seems to have a favorable impact on the staging characteristics of CRC.
基金supported by the Sanming Project of Medicine in Shenzhen (SZSM202211017)。
文摘Accurate cancer staging is the foundation of precision oncology and guides prognosis prediction and therapeutic decision-making. The conjoint TNM System by the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (UICC) has served as the global standard for tumor classification since inception.
文摘This letter comments on Wei et al's study applying the Wave-Vision Transformer for oesophageal cancer classification.Highlighting its superior accuracy and efficiency,we discuss its potential clinical impact,limitations in dataset diversity,and the need for explainable artificial intelligence to enhance adoption in pathology and personalized treatment.
文摘Gallbladder cancer is an aggressive malignancy notorious for its poor prognosis and treatment challenges,even at early stages.In their recent work,Kim et al utilized data from the National Cancer Database to explore whether adding chemotherapy to surgical intervention could improve survival outcomes for patients diagnosed with stage II gallbladder cancer.The use of adjuvant chemotherapy following curative surgery in this patient population has been a longstanding source of debate.Historically,the lack of clear guidelines for managing stage II gallbladder cancer has resulted in inconsistent,sometimes contradictory findings from various studies regarding the effectiveness of postoperative chemotherapy.Consequently,many clinicians have relied on studies involving other biliary tract cancers to justify the routine use of prophylactic chemotherapy after surgery,aiming to minimize recurrence risk.Given the rarity,high mortality rate,and the small sample sizes typical in gallbladder cancer studies,Kim et al’s contribution represents a significant and commendable effort to address these challenges.Kim et al designed a retrospective cohort study with well-defined inclusion criteria and clear treatment classifications.Notably,their findings suggested that in stage II gallbladder cancer,adjuvant chemotherapy did not yield a meaningful survival benefit over surgery alone.These results therefore casted doubt on the routine practice of administering chemotherapy to all patients postoperatively,prompted clinicians to reconsider their approach.Furthermore,this controversy directly influences clinical decisionmaking and guideline recommendations,as uncertainty regarding the benefit of adjuvant chemotherapy may lead to heterogeneous practices across different institutions and regions.This article critically assessed the research design,methodology,and clinical implications of the study by Kim et al.It also provided an in-depth exploration of the broader question regarding the appropriateness of adjuvant chemotherapy following surgery for stage II gallbladder cancer,highlighting the necessity of rigorous study designs to produce reliable evidence.
基金the Research Incentive Fund of the Hospital de Clínicas de Porto Alegre,CNPq(National Counsel of Technological and Scientific Development)CAPES(Coordination for the Improvement of Higher Education Personnel)for financial support
文摘BACKGROUND Despite being the world’s most widely used system for staging and therapeutic guidance in hepatocellular carcinoma(HCC)treatment,the Barcelona clinic liver cancer(BCLC)system has limitations,especially regarding intermediate-grade(BCLC-B)tumors.The recently proposed Hong Kong liver cancer(HKLC)staging system appears useful but requires validation in Western populations.AIM To evaluate the agreement between BCLC and HKLC staging on the management of HCC in a Western population,estimating the overall patient survival.METHODS This was a retrospective study of HCC patients treated at a university hospital in southern Brazil between 2011 and 2016.Demographic,clinical,and laboratory data were collected.HCC staging was carried out according to the HKLC and BCLC systems to assess treatment agreement.Overall survival was estimated based on the treatment proposed in each system.RESULTS A total of 519 HCC patients were assessed.Of these,178(34.3%)were HKLC-I;95(18.3%)HKLC-IIA;47(9.1%)HKLC-IIB;29(5.6%)HKLC-IIIA;30(5.8%)HKLCIIIB;75(14.4%)HKLC-IV;and 65(12.5%)HKLC-V.According to the BCLC,25(4.9%)were BCLC-0;246(47.4%)BCLC-A;107(20.6%)BCLC-B;76(14.6%)BCLCC;and 65(12.5%)BCLC-D.The general agreement between the two systems was 80.0%-BCLC-0 and HKLC-I(100%);BCLC-A and HKLC-I/HKLC-II(96.7%);BCLC-B and HKLC-III(46.7%);BCLC-C and HKLC-IV(98.7%);BCLC-D and HKLC-V(41.5%).When sub-classifying BCLC-A,HKLC-IIB,HKLC-IIIA and HKLC-IIIB stages according to the up-to-7 in/out criterion,13.4,66.0,100 and 36.7%,respectively,of the cases were classified as up-to-7 out.CONCLUSION In a Western population,the general agreement between the two systems was 80.0%,although in BCLC-B cases the agreement was low,suggesting that some individuals could be candidates for the curative treatment recommended by the HKLC.The authors suggest that the BCLC system should be routinely employed,although for BCLC-B cases it should be associated with the HKLC system.
文摘BACKGROUNDColorectal cancer(CRC)typically progresses from benign colorectal polyps,whichrepresent a precursor to malignancy.Identifying the factors influencing thisprogression is crucial for early intervention and prevention.Although genetic andenvironmental factors have been widely studied,the role of lifestyle factors suchas physical activity,diet,smoking,sleep,and stress remains underexplored,especially in patients with early stage CRC or polyps.Recent evidence suggeststhat lifestyle behaviors may influence cancer progression by modulating inflammatorypathways,metabolic health,and immune function.For instance,highlevels of physical activity are linked to a reduced risk of CRC development,whereas poor dietary habits,smoking,and inadequate sleep have all beenimplicated in increased cancer risk and progression.Moreover,early-stage CRCpatients,who are often asymptomatic or have minimal symptoms,may particularlybenefit from lifestyle modifications to slow disease progression andimprove overall prognosis.The gap in understanding the specific influence ofthese lifestyle factors on colorectal polyps and early stage cancer progressionunderscores the need for comprehensive studies.By assessing several modifiablelifestyle factors and their association with disease progression,clinicians canidentify practical intervention points.These interventions could ultimately reducethe need for more aggressive treatments and improve the long-term outcomes inaffected patients.AIMTo investigate the association between lifestyle factors and disease progression inpatients with colorectal polyps and early stage cancer.METHODSIn this observational study conducted from January 2022 to December 2023,werecruited 120 patients with colorectal polyps or early stage cancer from Jiangshan People's Hospital.Lifestyle factors,including physical activity,dietary patterns,smoking status,sleep quality,andstress levels,were assessed using validated questionnaires.Disease progression was evaluated using standardizedfollow-up colonoscopies and pathological examinations.Cox proportional hazards models were used to analyzethe association between lifestyle factors and disease progression after adjusting for potential confounders.RESULTSDuring the median follow-up of 18.4 months,42(35.0%)patients experienced disease progression.High levels ofphysical activity were associated with reduced progression risk[adjusted hazard ratio(HR)0.55,95%confidenceinterval(CI):0.38-0.80,P=0.002]compared to low activity levels.High adherence to a healthy dietary patternshowed similar protective effects(adjusted HR 0.62,95%CI:0.43-0.89,P=0.009).Current smoking(adjusted HR1.92,95%CI:1.35-2.73,P<0.001)and poor sleep quality(adjusted HR 1.38,95%CI:1.05-1.82,P=0.021)wereassociated with increased progression risk.The impact of lifestyle factors was particularly pronounced in patientsyounger than 60 years and those with multiple polyps at baseline.CONCLUSIONThis study demonstrated significant associations between lifestyle factors and disease progression in colorectalpolyps and early stage cancer.Physical activity,dietary patterns,smoking status,and sleep quality have emergedas key modifiable factors influencing disease progression.These findings support the integration of lifestyleassessments and modifications in the clinical management of patients with colorectal neoplasia.
文摘BACKGROUND Implementing nursing interventions in patients undergoing endoscopic treatment for intestinal polyps and early stage cancer can serve as a reference for reducing the incidence of complications,accelerating the recovery process,and improving the quality of life.AIM To impact of systematic nursing intervention on recovery,complications prevention,and quality of life after endoscopic surgery for intestinal polyps.METHODS This retrospective study included 157 patients who underwent endoscopic mucosal resection or endoscopic submucosal dissection at our hospital.The patients were divided into intervention and conventional groups,with no significant differences in age,sex,or surgical methods.The intervention group received multidimensional nursing interventions,including preoperative evaluation,intraoperative cooperation,postoperative rehabilitation,psychological support and nutritional management.The conventional group received standardized care.Clinical efficacy,inflammation and infection indicators,complication rates,rehabilitation indicators,and visual analog scale(VAS)scores were compared.RESULTS On the 7th day after surgery,C-reactive protein(CRP)and white blood cell levels were lower in the intervention group than in the conventional group.Complications occurred in 9.33%of the patients in the intervention group and 23.17%in the conventional group,with significant differences in fever and abdominal distension.The intervention group had shorter first exhaust and hospitalization durations than the control group.By day 3 post-surgery,the intervention group showed lower VAS scores and reduced anxiety and depression.High-risk factors included diabetes[relative risk(RR)=2.43,95%CI:1.21-4.86],laparotomy(RR=2.86,95%CI:1.22-6.71),CRP>15 mg/L(RR=3.12,95%CI:1.54-6.33),and procalcitonin>0.5 ng/mL 1 day after surgery(RR=2.91.95%CI:1.31-6.44),while systematic nursing interventions(OR=0.40,95%CI:0.18-0.89)reduced the complication risk by 60%.CONCLUSION Multidimensional nursing interventions have clinical value in endoscopic treatment of intestinal polyps and early stage cancer,reducing complications and hospital stay.This study provides a basis for establishing patientcentered guidelines.
文摘BACKGROUND Non-small cell lung cancer(NSCLC)is the most prevalent subtype of lung cancer,accounting for approximately 85%of all lung cancer cases and remaining a major cause of cancer-related mortality worldwide.Despite advances in diagnostic and therapeutic approaches,the incidence and mortality rates of NSCLC continue to rise,especially in low-income and middle-income countries.AIM To investigate the expression of cancer stem cell(CSC)markers and their relationship with the prognosis and survival of patients with stage IIIA NSCLC.METHODS A retrospective analysis was conducted on the clinical data and survival followup information of 61 patients with stage IIIA NSCLC treated at our hospital from February 2020 to June 2022,and all cases were confirmed as primary(nonrecurrent)diagnoses based on clinical and pathological records.All patients were followed up through outpatient visits or telephone interviews.The follow-up duration ranged from 6 to 51 months with a median follow-up time of 36 months.Overall survival(OS)was defined as the time from the date of pathological diagnosis to death or the last follow-up.Univariate and multivariate Cox regression analyses were performed to examine the relationship between clinical characteristics and OS.Immunohistochemistry was used to detect the expression of CSC markers[octamer-binding transcription factor 4(OCT4),trophoblast cell surface antigen-2(TROP-2),ATP-binding cassette subfamily G member 2(ABCG2),p75 neurotrophin receptor(p75NTR)]in NSCLC,followed by immunohistochemical scoring.The high H-scores of CSC markers,age,and micropapillary components were combined to generate a tumor stemness index(TSI).The Kaplan-Meier method was used to analyze the relationship between CSC markers,TSI,and OS in patients with NSCLC.RESULTS Multivariate Cox regression analysis showed that age[hazard ratio(HR)=1.952,95%confidence interval(CI):1.087-2.481,P=0.029]and micropapillary components(HR=2.716,95%CI:1.259-5.837,P=0.013)were significantly associated with OS.In NSCLC there were 21 cases with high OCT4 H-scores,27 cases with high TROP-2 H-scores,44 cases with high ABCG2 H-scores,and 44 cases with high p75NTR H-scores.In the survival analysis the high OCT4 expression group had a poorer prognosis(P=0.006).Further subtype analysis revealed no statistically significant difference in OS between high and low OCT4 H-score groups in patients with lung squamous cell carcinoma(P=0.457).However,in patients with lung adenocarcinoma high OCT4 expression had significantly poorer OS compared with those with low OCT4 expression(P=0.005).TROP-2,ABCG2,and p75NTR did not significantly affect the prognosis.TSI was significantly associated with OS in patients with NSCLC(HR=2.209,95%CI:1.238-3.681,P=0.027).CONCLUSION Age and micropapillary components were related to OS in patients with stage IIIA NSCLC.High expression of OCT4 and high TSI were associated with poor prognosis.
基金supported by the Young Talents Program of Jiangsu Cancer Hospital(grant number:QL201813).
文摘Small cell lung cancer(SCLC)constitutes approximately 15%of all lung cancer cases,characterized by rapid tumor growth,a high pro-liferation rate,and a propensity for early metastasis.1 Approximately one-third of SCLC patients are diagnosed at the limited-stage.Histor-ically,the standard of care for these patients has been 4-6 cycles of concurrent chemoradiotherapy(cCRT),with the exception of a minor-ity of early-stage T1-2N0 patients who may undergo radical surgery.2 Despite an initial high sensitivity to treatment,over 50%of patients experience disease recurrence within two years,with a median overall survival(OS)ranging from 16 to 24 months.For the past three decades,while there have been novel explorations in radiotherapy dosing and fractionation,the treatment paradigm for limited-stage SCLC(LS-SCLC)has remained largely unchanged,with no significant improvement in patient survival outcomes.
文摘Esophageal cancer is a serious malignancy with regards to mortality and prognosis. It is a growing health concern that is expected to increase in incidence over the next 10 years. Squamous cell carcinoma is the most common histological type of esophageal cancer worldwide, with a higher incidence in developing nations. With the increased prevalence of gastroesophageal reflux disease and obesity in developed nations, the incidence of esophageal adenocarcinoma has dramatically increased in the past 40 years. Esophageal cancer is staged according to the widely accepted TNM system. Staging plays an integral part in guiding stage specific treatment protocols and has a great impact on overall survival. Common imaging modalities used in staging include computed tomography, endoscopic ultrasound and positron emission tomography scans. Current treatment options include multimodality therapy mainstaysof current treatment include surgery, radiation and chemotherapy. Tumor markers of esophageal cancer are an advancing area of research that could potentially lead to earlier diagnosis as well as playing a part in assessing tumor response to therapy.
文摘AIM: To evaluate the accuracy of endoscopic ultrasound (EUS) in the staging of esophageal cancer. METHODS: Only EUS studies confirmed by surgery were selected. Articles were searched in Medline and Pubmed. Two reviewers independently searched and extracted data. Meta-analysis of the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratio. Pooling was conducted by both the Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran’s Q test based upon inverse variance weights. RESULTS: Forty-nine studies (n = 2558) which met the inclusion criteria were included in this analysis. Pooled sensitivity and specificity of EUS to diagnose T1 was 81.6% (95% CI: 77.8-84.9) and 99.4% (95% CI: 99.0-99.7), respectively. To diagnose T4, EUS had a pooled sensitivity of 92.4% (95% CI: 89.2-95.0) and specificity of 97.4% (95% CI: 96.6-98.0). With Fine Needle Aspiration (FNA), sensitivity of EUS to diagnose N stage improved from 84.7% (95% CI: 82.9-86.4) to 96.7% (95% CI: 92.4-98.9). The P value for the χ2 test of heterogeneity for all pooled estimates was > 0.10. CONCLUSION: EUS has excellent sensitivity and specificity in accurately diagnosing the TN stage of esophageal cancer. EUS performs better with advanced (T4) than early (T1) disease. FNA substantially improves the sensitivity and specificity of EUS in evaluating N stage disease. EUS should be strongly considered for staging esophageal cancer.
文摘Squamous cell carcinoma of the oral cavity and oropharynx have been used synonymously and interchangeably in the world literature in the context of head and neck cancers.As the 21st century progresses,divergence between the two have become more evident,particularly due to evidence related to human papillomavirus-associated oropharyngeal squamous cell carcinoma.As such,the American Joint Committee on Cancer recently published the 8th edition Cancer Staging Manual,serving as a continued global resource to clinicians and researchers.Through changes in staging related to T and N clinical and pathologic classifications,the new system is expected to influence current management guidelines of these cancers that have distinct anatomic and etiopathogenic characteristics.This article aims to review such impactful changes in a time of critical transition of the staging of head and neck cancer and how these changes may affect clinicians and researchers worldwide.
文摘BACKGROUND Carcinomas of the anal canal are staged according to the size and extent of the disease;however,we propose including a novel ultrasound(US)staging system,based on depth of tumor invasion.In this study the clinical American Joint Committee on Cancer(AJCC)staging guidelines and the US classificationss in patients with anal cancer were compared.AIM To evaluate the prognostic role of the US staging system in patients with anal cancer.METHODS The data of 48 patients with anal canal squamous cells carcinoma,observed at our University Hospital between 2007 and 2017,who underwent pre-treatment assessment with pelvic magnetic resonance imaging(MRI),total body computed tomography(CT)scan and endoanal US were retrospectively reviewed.Anal canal tumors were clinically staged according to AJCC,determined by MRI by measurement of the longest tumor diameter,and CT scan.Endoanal US was performed with a high multi-frequency(9-16 MHz),360°rotational mechanical probe;US classification was based on depth of tumor penetration through the anal wall,according to Giovannini’s study.All patients were treated with definitive radiation combined with 5-fluorouracile and Mitomycin-C.After treatment patients were followed-up regularly.RESULTS At baseline there were 30 and 32 T1-2,18 and 16 T3-4,31 and 19 N+patients classified according to the clinical AJCC and US staging system respectively.After a mean follow-up of 98 months,38 patients(79.1%)are alive and 28(58.3%)are disease free.During follow up 20 patients(41.6%)experienced recurrences.After univariate analysis,American Society of Anesthesiologists(ASA)score(P=0.00000001)and US staging(P=0.009)were significantly related to disease-free survival(DFS).When overall survival and DFS functions were compared,a statistically significant difference was observed for DFS survival when the US staging was applied with respect to the clinical AJCC staging.By combining the 2 significant prognostic variables,namely the US staging with the ASA score,four risks groups with different prognoses were identified.CONCLUSION Our findings suggest that US staging may be superior to traditional clinical staging,since it is significantly associated with DFS in anal cancer patients.
文摘A series of 225 consecutive lung cancer patients were prospectively randomized into a study group (75 patients) and a control group (150 Palients), and the agreement between CTNM (clinical staging) and PTNM (pathological staging) was evaluated. Radical mediastinal lymph node dissection was performed and on an average 11.5 nodes were dissected each case in the study group.Only suspected metastatic lymph nodes, 3.4 on an average,were dissected each cast in the coutrol group. CTNM classification was made according to clinical examination,chest image exainination and bronchoscopy in every patient and PTNM staging was made after thoracotomy.Then the agreement of CTNM and PTNM staging was judged by Kappa value. The results showed that the Kappa value in the two groups was lower than the effective standard value of 0.4, which was poorer in the study groul, (KaPPa=4).097) than that in thecontrol group tKappaed.371). The Principal influencing cause was that N was not well evaluated by CTNM. The priucipal manifestation of the staging iuconsistency was that the stage of PTNM was advanced than that of CTNM. In the study group 43% of patients showeil an increased stage and this occurred in 33% of the control group (P< 0.05).The results of the study show that at present the CTNM staging has not fully satisfied the necds of practice and requires to be further improved. The operative procedure that only suspected involved mediastinal lymph nodes are dissected can not meet the needs of PTNM staging. In order to make PTNM staging accurately and evaluate the results of treatment for lung caucer, radical mediastinal lymph node dissection should be performed in every operable Patient.
文摘Objective: to analyze and evaluate the application value of magnetic resonance in the staging diagnosis of cervical cancer. Methods: thirty-five patients who underwent pelvic magnetic resonance examination in our hospital were randomly selected as the research object. Before the pathological examination, all patients used magnetic resonance to carry out staging diagnosis of cervical cancer, and the corresponding diagnosis results were obtained. Results: through the analysis of the results of magnetic resonance diagnosis, the accuracy, sensitivity and specificity of magnetic resonance diagnosis of cervical cancer reached 92.86%, 94.83% and 83.33% respectively. For the patients diagnosed as true positive by MRI, the stages of cervical cancer were ⅠB1, ⅠB2, ⅡA1 and ⅡA2, respectively, and the difference was statistically significant (p < 0.05). Conclusion: magnetic resonance imaging is a very sensitive and accurate diagnostic method in the process of cervical cancer staging diagnosis. Through the use of this diagnostic method, doctors and patients can understand the patient's condition development more clearly, and can provide certain reference for clinical treatment. Therefore, magnetic resonance imaging has great application and promotion value in cervical cancer staging diagnosis.
文摘Background： Current understanding of tumor biology suggests that breast cancer is a group of diseases with different intrinsic molecular subtypes. Anatomic staging system alone is insufficient to provide future outcome information. The American Joint Committee on Cancer （AJCC） expert panel updated the 8th edition of the staging manual with prognostic stage groups by incorporating biomarkers into the anatomic stage groups. In this study, we retrospectively analyzed the data from our center in China using the anatomic and prognostic staging system based on the AJCC 8th edition staging manual. Methods： We reviewed the data from January 2008 to December 2014 for cases with Luminal B Human Epidermal Growth Factor Receptor 2 （HER2）-negative breast cancer in our center. All cases were restaged using the AJCC 8th edition anatomic and prognostic staging system. The Kaplan-Meier method and log-rank test were used to compare the survival differences between different subgroups. SPSS software version 19.0 （IBM Corp., Armonk, NY, USA） was used for the statistical analyses. Results： This study consisted of 796 patients with Luminal B HER-negative breast cancer. The 5-year disease-free survival （DFS） of 769 Stage I-III patients was 89.7%, and the 5-year overall survival （OS） of all 796 patients was 91.7%. Both 5-year DFS and 5-year OS were significantly different in the different anatomic and prognostic stage groups, There were 372 cases （46.7%） assigned to a different group. The prognostic Stage II and III patients restaged from anatomic Stage III had significant differences in 5-year DFS （v2 = 11.319; P = 0.001） and 5-year OS （χ2 = 5.225, P = 0.022）. In addition, cases restaged as prognostic Stage I, II, or III from the anatomic Stage II group had statistically significant differences in 5-year DFS （χ2 = 6.510, P = 0.039） but no significant differences in 5-year OS （χ2 = 5.087, P = 0.079）. However, the restaged prognostic Stage I and II cases from anatomic Stage I had no statistically significant differences in either 5-year DFS （χ2 = 0.440, P = 0.507） or 5-year OS （χ2= 1.530, P = 0.216）. Conclusions： The prognostic staging system proposed in the AJCC 8th edition refines the anatomic stage group in Luminal B HER2-negative breast cancer and will lead to a more personalized approach to breast cancer treatment.
基金partly funded by National Health and Medical Research Council (NHMRC) program (Grant No. 633003) to the Screening & Test Evaluation Program, Australia
文摘Preoperative staging of the axilla in women with invasive breast cancer using ultrasound-guided needle biopsy(UNB) identifies approximately 50% of patients with axillary nodal metastases prior to surgical intervention. Although moderately sensitive, it is a highly specific staging strategy that is rarely falsely-positive, hence a positive UNB allows patients to be triaged to axillary lymph-node dissection(ALND) avoiding potentially unnecessary sentinel node biopsy(SNB). In this review, we extend our previous work through an updated literature search, focusing on studies that report data on UNB utility. Based on data for 10,934 breast cancer patients, sourced from 35 studies, a positive UNB allowed triage of 1,745 cases(simple proportion 16%) to axillary surgical treatment: the utility of UNB was a median 19.8% [interquartile range(IQR) 11.6%-26.7%] across these studies. We also modelled data from a subgroup of studies, and estimated that amongst patients with metastases to axillary nodes, the odds ratio(OR) for high nodal disease burden for a positive UNB versus a negative UNB was 4.38 [95% confidence interval(95% CI): 3.13, 6.13], P<0.001. From this model, the estimated proportion with high nodal disease burden was 58.9%(95% CI: 50.2%, 67.0%) for a positive UNB, whereas the estimated proportion with high nodal disease burden was 24.6%(95% CI: 17.7%, 33.2%) if UNB was negative. Overall, axillary UNB has good clinical utility and a positive UNB can effectively triage to ALND. However, the evolving landscape of axillary surgical treatment means that UNB will have relatively less utility where surgeons have modified their practice to omission of ALND for minimal nodal metastatic disease.
文摘Objective To determine the value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for staging of lung cancer. Methods The study was retrospective,a total of 52 patients underwent EBUSTBNA for known or suspected lung cancer. All patients were detected enlarged mediastinal lymph nodes on CT scan (≥ 1. 0 cm) . Results Of the 52 patients,41 patients were found with N2 or N3 disease
文摘In the present review we discuss the recent developments and future directions in the multimodal treatment of locally advanced rectal cancer, with respect to staging and re-staging modalities, to the current role of neoadjuvant chemo-radiation and to the conservative and more limited surgical approaches based on tumour response after neoadjuvant combined therapy. When initial tumor staging is considered a high accuracy has been reported for T pre-treatment staging, while preoperative lymph node mapping is still suboptimal. With respect to tumour re-staging, all the current available modalities still present a limited accuracy, in particular in defining a complete response. The role of short vs long-course radiotherapy regimens as well as the optimal time of surgery are still unclear and under investigation by means of ongoing randomized trials. Observational management or local excision following tumour complete response are promising alternatives to total mesorectal excision, but need further evaluation, and their use outside of a clinical trial is not recommended.The preoperative selection of patients who will benefit from neoadjuvant radiotherapy or not, as well as the proper identification of a clinical complete tumour response after combined treatment modalities,will influence the future directions in the treatment of locally advanced rectal cancer.
