Objective To investigate the accuracy of preoperative high-resolution magnetic resonance imaging (MRI) scans to predict tumor stage, lymph node stage, and circumferential resection margin (CRM) involvement. Methods Between September 2006 and May 2009, 42 patients with histologically proven rectal cancer by the colonoscopic biopsy in Peking Union Medical College Hospital were staged preoperatively using MRI. All of the patients underwent total mesorectum excision (TME) operation within 1 week after MRI examination. The specimens were reported according to the 2002 TNM staging system for primary colorectal cancer of the American Joint Committee on Cancer (AJCC). Concordance between radiologic staging of tumor, local lymph node, and CRM involvement and pathologic reporting was assessed by means of the Kappa statistic.Results For all of 42 patients, MRI correctly staged the tumor in 36 patients, understaged in 3 patients and overstaged in 3 patients. Statistically, there was a better correlation between pathologic and radiologic tumor staging (Kappa=0.731, P=0.000). MRI correctly staged lymph node status in 31 patients, understaged in 5 patients and overstaged in 6 patients. Statistically, there was a common correlation between pathologic and radiologic lymph node staging (Kappa=0.410, P=0.009). MRI correctly reported the status of the CRM in 40 patients. Statistically, there was the best correlation between pathologic and radiologic reporting of CRM involvement (Kappa=0.829, P=0.000). Conclusion Preoperative highresolution MRI scans has a good concordance with pathologic tumor stage but common with pathologic lymph node stage. Preoperative highresolution MRI can provide reliable information about CRM and thus help to choose which patient could benefit from the preoperative neoadjuvant therapy.
In this report, 1175 cases of resected gastric cancer were staged, followed up and statistincally calculated by using the international unifying new TNM staging system for gastric cancer. The prognostic value of the TNM staging system was also tested with relevant statistics. The results showed that:(1)the 5-year survival rates of Ⅰa、Ⅰb、Ⅱ、Ⅲa、Ⅲb and Ⅳ were 100%,84%,65%,43%,25% and 13% respectively; (2)The 5-year survival rates of the subgroups withing same stage were quite; (3)the analysys of correlation and regression between the new staging and the prognosis provided that correlation coefficient r equals to -0.990(Ｐ＜0.005), and regression coefficient b equals to -0.1345(Ｐ＜0.005). These results indicate that there is statistical identity beween the new TNM staging for gastric cancer and the prognosis, and certify the rationality for the new staging in application and its accuracy to reflect the prognosis.
ObjectiveTo explore the evaluation value of preoperative multislice spiral computed tomography angiography (MSCTA) for normative radical gastrectomy. MethodsThe anatomic distributions of celiac trunk and its three branches and their tributaries (common hepatic artery, right hepatic artery, left hepatic artery, splenic artery, and left gastric artery) of 86 patients with gastric cancer were comprehended by preoperative MSCTA, which were verified during the surgery. Simultaneously preoperative TNM staging was evaluated by MSCTA, which compared with postoperative pathological results. ResultsThe accuracy rate of preoperative MSCTA evaluating the distribution of celiac trunk and its three branches and their tributaries was 100%. Abnormal hepatic arteries were found in 22 cases by MSCTA, the mutation rate was 25.58%. Abnormal right hepatic arteries were found in 11 cases (12.79%), abnormal left hepatic arteries in 7 cases (8.14%), both abnormal right and left hepatic arteries in 1 case (1.16%), and abnormal common hepatic arteries in 3 cases (3.49%). Straight splenic arteries were found in 24 cases (27.91%), slightly curved splenic arteries in 44 cases (51.16%), and significantly curved splenic arteries in 18 cases (20.93%). Compared with postoperative pathological results, the accuracy rates of preoperative MSCTA evaluating gastric cancer T, N, and M staging were 75.58%（65/86）, 74.42%(64/86), and 91.86%(79/86), respectively. ConclusionsPreoperative MSCTA is an objective way to assess the distributions of celiac artery trunk and related tributaries of patients with gastric cancer. Also, it is an accurate method to evaluate the preoperative TNM stage of gastric cancer, which can help to make an individual operative plan and avoid the intraoperative injury of the artery.
【Abstract】Objective To evaluate the value of pTNM classification in predicting the prognosis of hepatic cell carcinoma after liver transplantation. Methods Fifty-nine HCC cases undergoing liver transplantation between April 1993 and January 2003 were retrospectively reviewed. Fiftynine cases were staged by using the pTNM classification. Results The 1-year survival rates were 66.67%, 66.67%, 40.91% and 31.75% for Ⅰ，Ⅱ，Ⅲa and Ⅳa stages，2-year survival rates were 66.67%, 66.67%, 21.29% and 31.75%, the difference was not statistically significant. Conclusion The pTNM classification is not good enough to predict the prognosis of hepatic cell carcinoma after liver transplantation.
Objective To improve esophageal lymph node staging and investgate an ideal esophageal lymph node metastasis staging method. Methods The clinical pathological data and followup data of the 236patients who had undergone thoracic esophagectomy with at least 6 lymph nodes (LN) removed from January 1985 to December 1989 were analyzed retrospectively. Cox proportional hazard model was used to screen risk factors, and Logrank test was applied to perform survival analysis according to lymph node metastasis staging (number, distance and extent). Results The 10-year follow-up rate was 92.3%（218/236）. The overall 1-year, 5-year and 10-year survival rates were 80.2%, 43.1% and 34.2% respectively. One hundred and twelve (47.4%) patients had LN metastasis, and their 5-year survival rates were lower than that of patients without LN metastasis (14.8% vs. 66.6%; χ2=77.18, P=0.000). Cox regression analysis showed that besides depth of invasion, differentiation grade and LN metastasis, the number, distance and extent of LN metastasis were the independent risk factors which could influence prognosis. A further analysis was given via univariate Logrank test. When grouped according to the number of LN metastasis, there were significant differences in overall survival rates (χ2=96.00,P=0.000), but no significant difference was found in survival rates between N2 and N3 group(Pgt;0.05). When grouped according to the distance of LN metastasis, there were significant differences in overall survival rates (χ2=79.29, P=0.000), but no significant difference was found in survival rates among S1, S2 and S3 group(Pgt;0.05). When grouped according to the extent of LN metastasis (0, 1, and ≥2 fields), there were significant differences in overall survival rates (χ2=87.47, P=0.000), and so were the survival rates among groups (χ2=5.14, P=0.023). Conclusion Revising the current Nclassification of TNM staging of esophageal cancer according to the extent of LN metastasis(0, 1, and ≥2 fields) is more reasonable, and can reflect the prognosis of patients with esophageal cancer after esophagectomy better.
Lung cancer management is complex and requires a multi-disciplinary approach to provide comprehensive care. Interventional pulmonology (IP) is an evolving field that utilizes minimally invasive modalities for the initial diagnosis and staging of suspected lung cancers. Endobronchial ultrasound guided sampling of mediastinal lymph nodes for staging and detection of driver mutations is instrumental for prognosis and treatment of early and later stage lung cancers. Advances in navigational bronchoscopy allow for histological sampling of suspicious peripheral lesions with minimal complication rates, as well as assisting with fiducial marker placements for stereotactic radiation therapy. Furthermore, IP can also offer palliation for inoperable cancers and those with late stage diseases. As the trend towards early lung cancer detection with low dose computed tomography is developing, it is paramount for the pulmonary physician with expertise in lung nodule management, minimally invasive sampling and staging to integrate into the paradigm of multi-specialty care.
The TNM staging of lung cancer which is now widely used in clinic was formally proposed in 1997. It has played quite an important role in directing the diagnosis and treatment of lung cancer as well as the clinical research in the past decade. However, at the same time, there are some insufficiencies which are emerging gradually. By collecting the clinical information from 100 869 patients, in 2007, International Association for the Study of Lung Cancer(IASLC) made a deep analysis on the relativity between TNM staging and prognosis, and put forward the suggestions to revise the Seventh Edition of the TNM staging of lung cancer: (1) According to the size of tumor, the primary T staging is divide into T1a (the maximum tumor diameter≤2 cm), T1b (3 cm≥the maximum tumor diameter＞2 cm), T2a (5 cm≥the maximum tumor diameter＞3 cm) and T2b (7 cm≥the maximum tumor diameter＞5 cm); (2) T 2c (the maximum tumor diameter gt;7 cm) and additional nodules in the same lobe are classified as T3, while nodules in the ipsilateral nonprimary lobe are classified as T4;(3) Cancerous hydrothorax, pericardial effusion and the additional nodules in the contralateral lung are classified as M1a, while the extrapulmonary metastases are classified as M1b. It is believed that the new revised edition will has higher international authority and identification degree, and it will play a more meticulous and accurate guiding role in the treatment of lung cancer and its predicting prognosis in the future. At the same time, it will provide a new starting point to the research of lung cancer.
Objective To establish a predictive model for long-term tumor-specific survival after surgery for patients with intermediate to advanced medullary thyroid cancer (MTC) based on American Joint Committee on Cancer (AJCC) TNM staging, by using the Surveillance, Epidemiology, and End Results (SEER) Database. Methods The data of 692 patients with intermediate to advanced MTC who underwent total thyroidectomy and cervical lymph node dissection registered in the SEER database during 2004–2017 were extracted and screened, and were randomly divided into 484 cases in the modeling group and 208 cases in the validation group according to 7∶3. Cox proportional hazard regression was used to screen predictors of tumor-specific survival after surgery for intermediate to advanced stage MTC and to develop a Nomogram model. The accuracy and usefulness of the model were tested by using the consistency index (C-index), calibration curve, time-dependent ROC curve and decision curve analysis (DSA). Results In the modeling group, the multivariate Cox proportional hazard regression model indicated that the factors affecting tumor-specific survival after surgery in patients with intermediate to advanced MTC were AJCC TNM staging, age, lymph node ratio (LNR), and tumor diameter, and the Nomogram model was developed based on these results. The modeling group had a C-index of 0.827 and its area under the 5-year and 10-year time-dependent ROC curves were 0.865 [95%CI (0.817, 0.913)], 0.845 [95%CI (0.787, 0.904)], respectively, and the validation group had a C-index of 0.866 and its area under the 5-year and 10-year time-dependent ROC curves were 0.866 [95%CI (0.798, 0.935)] and 0.923 [95%CI (0.863, 0.983)], respectively. Good agreement between the model-predicted 5- and 10-year tumor-specific survival rates and the actual 5- and 10-year tumor-specific survival rates were showed in both the modeling and validation groups. Based on the DCA curve, the new model based on AJCC TNM staging was developed with a significant advantage over the former model containing only AJCC TNM staging in terms of net benefits obtained by patients at 5 years and 10 years after surgery. Conclusion The prognostic model based on AJCC TNM staging for predicting tumor-specific survival after surgery for intermediate to advanced MTC established in this study has good predictive effect and practicality, which can help guide personalized, precise and comprehensive treatment decisions and can be used in clinical practice.
ObjectiveTo understand the relation between the occupation and long-term prognosis of the patients with colorectal cancer (CRC) based on the Database from Colorectal Cancer (DACCA). MethodsThe selected updated DACCA database as of June 29, 2022 was used for this study. The included patients were assigned into intellectual occupations group (intellectual group) and manual occupations group (manual group) referring to relevant regulatory documents in China. The survival status of the intellectual group and the manual group was compared, and then were stratified by pTNM stage. ResultsA total of 1 974 patients were included from the DACCA database according to the selection criteria, 349 of whom in the intellectual group and 1 625 of whom in the manual group. The intellectual group had higher 5-year cumulative overall survival rate (92.1% vs. 84.5%, P<0.001) and disease-specific survival rate (92.1% vs. 85.8%, P=0.002), as well as higher 10-year cumulative overall survival rate (72.4% vs. 55.2%, P<0.001) and disease-specific survival rate (75.4% vs. 59.1%, P<0.001) compared to the manual group. The stratified analysis by pTNM stage found that, for the patients with pTNM Ⅲ stage, the 5- and 10-year cumulative overall survival rates of the intellectual group were higher than those of the manual group (94.0% vs. 82.3%, P<0.001; 67.1% vs. 43.7%, P=0.014), simultaneous the 5- and 10-year cumulative disease-specific survival rates were the same as the overall survival rate (94.0% vs. 83.5%, P=0.001; 69.5% vs. 47.9%, P=0.026). Furthermore for the the patients with pTNM Ⅱ stage , it was found that the the 10-year cumulative disease-specific survival rate of the intellectual group was higher than that of the manual group (93.5% vs. 78.7%, P=0.009).ConclusionsFrom the analysis results of this study, occupation might be related to long-term prognosis in CRC cancer patients. A general trend is that the long-term prognosis of patients with intellectual occupations might be better than that of patients with manual occupations, and this difference might be relatively marked in the patients with pTNM Ⅱ and Ⅲ stages, but it needs to be autious and objective.
ObjectiveTo analyze the relation between the literacy and prognosis in the patients with colorectal cancer (CRC) in the current version of the Database from Colorectal Cancer of West China (DACCA). MethodsThe version of DACCA selected for this data analysis was updated on September 12, 2022. The data items analyzed included age, gender, literacy, tumour site, nature of tumour, pathological TNM (pTNM) stage, survival status, and survival time. The overall survival and disease-specific survival of the CRC patients with different literacy (illiteracy, primary, secondary, and tertiary educations) after radical resection were compared, and then which were analyzed in the patients with different pTNM stages. ResultsA total of 3 692 data eligible for the study were screened, of which 202 were illiteracy, 1 054 were primary education, 1 809 were secondary education, and 627 were tertiary education; And there were 13 of stage 0, 406 of stage Ⅰ, 1 193 of stage Ⅱ, 1 139 of stage Ⅲ, and 941 of stage Ⅳ. The differences in the comparison of the pTNM stage and the nature of the tumour among the patients with the four levels of literacy were not statistically significant (P>0.05), while the differences in the comparison of the gender, age, and tumour site were statistically significant (P<0.001). The overall survival and disease-specific survival curves of the CRC patients with different literacy had no statistical differences (χ2=1.982, P=0.576; χ2=2.618, P=0.454), and the stratified overall survival curves had no statistical differences among the patients with pTNM stages Ⅰ to Ⅳ (stage Ⅰ: χ2=1.361, P=0.715; stage Ⅱ: χ2=3.507, P=0.320; stage Ⅲ: χ2=3.144, P=0.370; stage Ⅳ: χ2=4.993, P=0.172), and the stratified disease-specific survival curves had no statistical differences (stage Ⅰ: χ2=0.723, P=0.868; stage Ⅱ: χ2=3.295, P=0.348; stage Ⅲ: χ2=4.767, P=0.190; stage Ⅳ: χ2=6.177, P=0.103). ConclusionsThe results of this study based on real-world big data analysis suggests that the differences of overall survival and disease-specific survival of CRC patients with different literacy levels (illiterate, primary, secondary, and tertiary education) are not statistically significant, and the results of stratified analysis based on pTNM staging are consistent with this. In the future, limitations of this study can be excluded and further analysis can be conducted by combining treatment details or expanding sample data to seek more realistic results.