OLGA staging for gastritis: A tutorial

Atrophic gastritis (resulting mainly from long-standing Helicobacter pylori infection) is a major risk factor for (intestinal-type) gastric cancer development and the extent/topography of the atrophic changes significantly correlates with the degree of cancer risk. The current format for histology reporting in cases of gastritis fails to establish an immediate link between gastritis phenotype and risk of malignancy. The histology report consequently does not give clinical practitioners and gastroenterologists an explicit message of use in orienting an individual patient's clinical management. Building on current knowledge of the biology of gastritis and incorporating experience gained worldwide by applying the Sydney System for more than 15 years, an international group of pathologists (Operative Link for Gastritis Assessment) has proposed a system for reporting gastritis in terms of stage (the OLGA staging system). Gastritis staging arranges the histological phenotypes of gastritis along a scale of progressively increasing gastric cancer risk, from the lowest (stage 0) to the highest (stage IV). This tutorial aims to provide unequivocal information on how to consistently apply the OLGA staging system in routine diagnostic histology practice.     

An evaluation of the American Joint Committee (pTNM) staging method for cancer of the colon and rectum

This study, using prospective data, compares the survival of 1011 patients who had a colorectal cancer resected at Concord Hospital between 1971 and 1983. The results are expressed both in terms of Australian clinicopathologic (CP) staging and the modified pTNM method proposed by the American Joint Committee for Cancer Staging and End Results reporting. The aim of the study was to determine which of the two staging methods gave the better guide to prognosis. The results indicate that pTNM does not add to information beyond that given by CP staging. We conclude that the pTNM classification is only partially able to separate patients into different survival groups; it is complicated and difficult to memorize, and does not give useful prognostic information beyond that provided by the simpler CP system.     

Comparison of three current staging systems for hepatocellular carcinoma: Japan integrated staging score, new Barcelona Clinic Liver Cancer staging classification, and Tokyo score

Background and Aim: Although various staging systems for hepatocellular carcinoma (HCC) have been developed in recent years, there is no worldwide consensus which staging system is best. The aim of the present study was to compare the performance of the currently developed three staging systems: the Japan integrated staging (JIS) score, new Barcelona Clinic Liver Cancer (BCLC) staging classification, and the Tokyo score. Methods: A total of 290 consecutive patients with HCC before initial treatment at Kinki University between January 1999 and December 2001 were included. The patients were stratified according to the three staging systems, and the performance of the staging systems was compared using survival time as the only outcome measure. Results: There were significant differences between all stages in the JIS score, while no significant difference was found between stages C and D in the BCLC staging classification and between all the scores, except between scores 0 and 1 and 2 and 3 in the Tokyo score. For all patients (n = 290), the radical treatment group (n = 208) and the non‐radical treatment group (n = 82), the likelihood ratio χ²‐test showed the highest value, and the Akaike information criterion value was lowest in the JIS score. Conclusion: The JIS score provided the best prognostic stratification in a Japanese cohort of HCC patients who were mainly diagnosed at early stages and treated with radical therapies.     

The science behind the 7th edition Tumour, Node, Metastasis staging system for lung cancer

The Tumour, Node, Metastasis (TNM) system for classifying lung cancer is the cornerstone of modern lung cancer treatment and underpins comparative research; yet is continuously evolving through updated revisions. The recently published Union for International Cancer Control 7th Edition TNM Classification for lung cancer addresses many of its predecessor's shortcomings and has been subject to rigorous evidence-based methodology. It is based on a retrospective analysis of over 80 000 lung cancer patients treated between 1990 and 2000 carried out by the International Association for the Study of Lung Cancer. The dataset was truly international and included patients treated by all modalities. Extensive internal and external validation of the findings has ensured that the recommendations are robust and generalizable. For the first time, a single classification system has been shown to be applicable not only to non-small cell lung cancer, but also to be of prognostic significance in small cell lung cancer and bronchopulmonary carcinoid tumours. We review the history of the Union for International Cancer Control TNM staging system, the changes in the most recent 7th edition and the strength of the scientific basis motivating these changes. Limitations of the current staging edition are explored, post-publication independent validation studies are reviewed, and the future of TNM staging for lung cancer is discussed.     

Staging accuracy of esophageal cancer by endoscopic ultrasound：A meta-analysis and systematic review

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.     

Criteria of unresectability and the decision-making process

Determination of the exact criteria for resectability in patients with cholangiocarcinoma and how they are most efficiently evaluated has many limitations. Among many factors taken into account in this decision-making process are: the condition of the patient, the biology of the disease, and the technical expertise of the surgeon and hospital. An attempt is made here to organize recommendations for the work-up of patients and the main criteria for resectability as best possible, keeping in mind that there will always be some limited room for exceptions, especially if the biology is favorable. Work-up and determination of resectability for patients with distal cholangiocarcinoma are more straightforward than at the other two sites of the disease (perihilar and peripheral). In general, these follow the same principles as those for other periampullary carcinomas (pancreas, ampullary, and duodenal). The work-up and determination of resectability for patients with peripheral cholangiocarcinoma can be relatively straightforward if the lesion is away from the hilus of the liver and does not involve a significant proportion of parenchyma, but can be problematic if it is more central or very large. Patients with perihilar cholangiocarcinomas are perhaps the most challenging, as factors such as patient condition, biology of the disease, local involvement of the major vessels and bile ducts at the hilum, and the future liver remnant all have a bearing in the decision-making process.     

Multiport staging laparoscopy in esophageal and cardiac carcinoma

Between February 1993 and September 2000, 320 patients with esophageal cancer were referred to our oesophagogastric unit. One hundred and thirty-three consecutive patients with histologically proven carcinoma of the esophagus were assessed with a view to resection using multiport staging laparoscopy. Multiport staging laparoscopy was performed as a short stay/day case procedure in 133 patients with esophageal and oesophagogastric junctional carcinoma. Multiple ports were used to inspect the liver, omentum, peritoneal surfaces, coeliac/left gastric lymph nodes and obtain biopsies and cytology. Satisfactory assessment was possible in 127 cases (95%). Laparoscopy detected incurable disease in 31 patients (24%), some of whom had more than one contraindication to surgery, including hepatic metastases (n = 10), peritoneal metastases (n = 12) and malignant small volume ascites (n = 5). Lymph node metastases were confirmed histologically by biopsy at laparoscopy in 26 patients (fixed nodes, n = 14; mobile nodes, n = 12). Sensitivity for the detection of liver and peritoneal metastases was 100%, and lymph node metastases were 83%. Specificity for detection of hepatic metastases was 99%, 100% for peritoneal metastases and 82% for lymph node metastases. Ninety-nine patients proceeded to definitive surgery and only two were unresectable. Multiport laparoscopic assessment of metastases in patients with esophageal carcinoma avoids unnecessary surgery and allows for more efficient use of theatre and intensive care time.     

超声内镜在直肠癌新辅助治疗后再分期的应用价值研究

目的 探讨超声内镜在直肠癌新辅助放化疗后再分期的准确性.方法 61例初诊直肠癌患者纳入研究,新辅助治疗后行超声内镜分期,并与手术后病理分期进行比较.结果放化疗后EUS对直肠癌T分期的总准确率为59.0%(36/61),36.1%(22/61)的病例分期过高,4.9%(3/61)的病例分期过低.EUS对直肠癌N分期准确率为68.9%(42/61),14.7%(9/61)的病例分期过高,16.4%(10/61)的病例分期过低.结论 EUS对新辅助治疗后的直肠癌进行再分期的准确率降低.     

超声内镜在直肠癌新辅助治疗后再分期的应用价值研究

目的 探讨超声内镜在直肠癌新辅助放化疗后再分期的准确性.方法 61例初诊直肠癌患者纳入研究,新辅助治疗后行超声内镜分期,并与手术后病理分期进行比较.结果放化疗后EUS对直肠癌T分期的总准确率为59.0%(36/61),36.1%(22/61)的病例分期过高,4.9%(3/61)的病例分期过低.EUS对直肠癌N分期准确率为68.9%(42/61),14.7%(9/61)的病例分期过高,16.4%(10/61)的病例分期过低.结论 EUS对新辅助治疗后的直肠癌进行再分期的准确率降低.     

Staging systems: is there a surgical staging and a medical one?

Clinical staging systems for cancer provide guidelines for patient assessments and therapeutic decisions. Furthermore, appropriate staging is essential for objective comparison between the outcomes of different treatments, including clinical trials. While the prognosis of most solid tumors is generally dependent on tumor stage at presentation, prediction of prognosis in hepatocellular carcinoma (HCC) patients is more complicated because underlying liver function also affects patient survival. The Okuda classification and the pathologic tumor–node–metastasis classification are most commonly used internationally, but each has its own limitation. Several new staging systems for HCC have recently been reported from Italy, Japan, and Spain. Most prognostic models consist of parameters reflecting tumor stage and liver function reservoir, which were selected based on analyses of large series of HCC patients. Ideally, staging systems should be applicable to any HCC patient. However, each existing staging system may have been characterized by the patient population based on which it was constructed. For practical purposes, staging systems should be simple and based on data that are easily obtainable. Consensus is yet to be achieved on the optimal staging system for HCC that assures progress in the development of novel therapies.     

超声内镜在直肠癌新辅助治疗后再分期的应用价值研究

目的 探讨超声内镜在直肠癌新辅助放化疗后再分期的准确性.方法 61例初诊直肠癌患者纳入研究,新辅助治疗后行超声内镜分期,并与手术后病理分期进行比较.结果放化疗后EUS对直肠癌T分期的总准确率为59.0%(36/61),36.1%(22/61)的病例分期过高,4.9%(3/61)的病例分期过低.EUS对直肠癌N分期准确率为68.9%(42/61),14.7%(9/61)的病例分期过高,16.4%(10/61)的病例分期过低.结论 EUS对新辅助治疗后的直肠癌进行再分期的准确率降低.     

超声内镜在直肠癌新辅助治疗后再分期的应用价值研究

目的 探讨超声内镜在直肠癌新辅助放化疗后再分期的准确性.方法 61例初诊直肠癌患者纳入研究,新辅助治疗后行超声内镜分期,并与手术后病理分期进行比较.结果放化疗后EUS对直肠癌T分期的总准确率为59.0%(36/61),36.1%(22/61)的病例分期过高,4.9%(3/61)的病例分期过低.EUS对直肠癌N分期准确率为68.9%(42/61),14.7%(9/61)的病例分期过高,16.4%(10/61)的病例分期过低.结论 EUS对新辅助治疗后的直肠癌进行再分期的准确率降低.     

超声内镜在直肠癌新辅助治疗后再分期的应用价值研究

目的 探讨超声内镜在直肠癌新辅助放化疗后再分期的准确性.方法 61例初诊直肠癌患者纳入研究,新辅助治疗后行超声内镜分期,并与手术后病理分期进行比较.结果放化疗后EUS对直肠癌T分期的总准确率为59.0%(36/61),36.1%(22/61)的病例分期过高,4.9%(3/61)的病例分期过低.EUS对直肠癌N分期准确率为68.9%(42/61),14.7%(9/61)的病例分期过高,16.4%(10/61)的病例分期过低.结论 EUS对新辅助治疗后的直肠癌进行再分期的准确率降低.     

超声内镜在直肠癌新辅助治疗后再分期的应用价值研究

目的 探讨超声内镜在直肠癌新辅助放化疗后再分期的准确性.方法 61例初诊直肠癌患者纳入研究,新辅助治疗后行超声内镜分期,并与手术后病理分期进行比较.结果放化疗后EUS对直肠癌T分期的总准确率为59.0%(36/61),36.1%(22/61)的病例分期过高,4.9%(3/61)的病例分期过低.EUS对直肠癌N分期准确率为68.9%(42/61),14.7%(9/61)的病例分期过高,16.4%(10/61)的病例分期过低.结论 EUS对新辅助治疗后的直肠癌进行再分期的准确率降低.     

超声内镜在直肠癌新辅助治疗后再分期的应用价值研究

目的 探讨超声内镜在直肠癌新辅助放化疗后再分期的准确性.方法 61例初诊直肠癌患者纳入研究,新辅助治疗后行超声内镜分期,并与手术后病理分期进行比较.结果放化疗后EUS对直肠癌T分期的总准确率为59.0%(36/61),36.1%(22/61)的病例分期过高,4.9%(3/61)的病例分期过低.EUS对直肠癌N分期准确率为68.9%(42/61),14.7%(9/61)的病例分期过高,16.4%(10/61)的病例分期过低.结论 EUS对新辅助治疗后的直肠癌进行再分期的准确率降低.     

超声内镜在直肠癌新辅助治疗后再分期的应用价值研究

目的 探讨超声内镜在直肠癌新辅助放化疗后再分期的准确性.方法 61例初诊直肠癌患者纳入研究,新辅助治疗后行超声内镜分期,并与手术后病理分期进行比较.结果放化疗后EUS对直肠癌T分期的总准确率为59.0%(36/61),36.1%(22/61)的病例分期过高,4.9%(3/61)的病例分期过低.EUS对直肠癌N分期准确率为68.9%(42/61),14.7%(9/61)的病例分期过高,16.4%(10/61)的病例分期过低.结论 EUS对新辅助治疗后的直肠癌进行再分期的准确率降低.     

超声内镜在直肠癌新辅助治疗后再分期的应用价值研究

目的 探讨超声内镜在直肠癌新辅助放化疗后再分期的准确性.方法 61例初诊直肠癌患者纳入研究,新辅助治疗后行超声内镜分期,并与手术后病理分期进行比较.结果放化疗后EUS对直肠癌T分期的总准确率为59.0%(36/61),36.1%(22/61)的病例分期过高,4.9%(3/61)的病例分期过低.EUS对直肠癌N分期准确率为68.9%(42/61),14.7%(9/61)的病例分期过高,16.4%(10/61)的病例分期过低.结论 EUS对新辅助治疗后的直肠癌进行再分期的准确率降低.     

超声内镜在直肠癌新辅助治疗后再分期的应用价值研究

目的 探讨超声内镜在直肠癌新辅助放化疗后再分期的准确性.方法 61例初诊直肠癌患者纳入研究,新辅助治疗后行超声内镜分期,并与手术后病理分期进行比较.结果放化疗后EUS对直肠癌T分期的总准确率为59.0%(36/61),36.1%(22/61)的病例分期过高,4.9%(3/61)的病例分期过低.EUS对直肠癌N分期准确率为68.9%(42/61),14.7%(9/61)的病例分期过高,16.4%(10/61)的病例分期过低.结论 EUS对新辅助治疗后的直肠癌进行再分期的准确率降低.     

Hepatocellular carcinoma staging systems: Hong Kong liver cancer vs Barcelona clinic liver cancer in a Western population

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 was80.0%-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 and36.7%, respectively, of the cases were classified as up-to-7 out.CONCLUSION In a Western population, the general agreement between the two systems was80.0%, 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.