Does the use of the 2009 FIGO classification of endometrial cancer impact on indications of the sentinel node biopsy?

Background  

Lymphadenectomy is debated in early stages endometrial cancer. Moreover, a new FIGO classification of endometrial cancer, merging stages IA and IB has been recently published. Therefore, the aims of the present study was to evaluate the relevance of the sentinel node (SN) procedure in women with endometrial cancer and to discuss whether the use of the 2009 FIGO classification could modify the indications for SN procedure.     

Clinical implications of metastatic lymph node ratio in gastric cancer

Background  

The 5-year survival rate in patients with gastric cancer is still poor, and lymph node metastasis is considered one of the most important prognostic factors. However, there are controversies in the classification of lymph node metastasis in gastric cancer. This study was carried out to investigate whether the metastatic lymph node ratio is a reliable classification of lymph node metastasis in gastric cancer in Chinese.     

Phenotypic characterization and risk factors for interval breast cancers in a population-based breast cancer screening program in Barcelona,Spain

Objective  

To analyze phenotypic classification and other risk factors for interval breast cancer, focusing on true interval and false negative cancers.     

Classifying breast cancer surgery: a novel, complexity-based system for oncological, oncoplastic and reconstructive procedures, and proof of principle by analysis of 1225 operations in 1166 patients

Background  

One of the basic prerequisites for generating evidence-based data is the availability of classification systems. Attempts to date to classify breast cancer operations have focussed on specific problems, e.g. the avoidance of secondary corrective surgery for surgical defects, rather than taking a generic approach.     

The relevance of intrinsic subtype to clinicopathological features and prognosis in 4,266 Japanese women with breast cancer

Background  

Estrogen receptor (ER), progesterone receptor (PgR), and HER2 expression status in breast cancer function as prognostic and predictive factors that enable individualized treatment. Intrinsic subtype classification has also been performed based on these and other biological and prognostic characteristics. However, clinical analysis of such subtypes in a large number of Japanese breast cancer patients has not yet been reported.     

Protein expression profile and prevalence pattern of the molecular classes of breast cancer - a Saudi population based study

Background  

Breast cancer is not a single entity but a diverse group of entities. Advances in gene expression profiling and immunohistochemistry as its surrogate marker have led to the unmasking of new breast cancer molecular subtypes, resulting in the emergence of more elaborate classification systems that are therapeutically and prognostically more predictive. Molecular class distribution across various ethnic groups may also reveal variations that can lead to different clinical outcomes in different populations.     

Time trends in pharyngeal cancer incidence in Norway 1981–2005: a subsite analysis based on a reabstraction and recoding of registered cases

Objective  

Incidence rates of oropharyngeal squamous cell carcinoma (SCC) have been reported to be increasing in several countries in recent decades, contrasting with trends of SCCs diagnosed in neighboring anatomical sites. We investigated whether changes in classification systems and/or coding/registration practices might explain the trends in Norway, focusing on changes in oropharyngeal cancer.     

Breast cancer screening in women at increased risk according to different family histories: an update of the Modena Study Group experience

Background  

Breast cancer (BC) detection in women with a genetic susceptibility or strong family history is considered mandatory compared with BC screening in the general population. However, screening modalities depend on the level of risk. Here we present an update of our screening programs based on risk classification.     

Clinicopathological analysis for recurrence of stage Ib gastric cancer (according to the second English edition of the Japanese classification of gastric carcinoma)

Background  

The prognosis for patients with stage Ib (second English edition of the Japanese classification of gastric carcinoma) gastric cancer is promising, with an expected 5-year survival of 90%. Despite this relatively high survival rate, the outcome for patients who experience recurrence is poor. To date, however, prognostic and recurrence factors for stage Ib gastric cancer are poorly understood, and appropriate adjuvant chemotherapy protocols have not been developed.     

A resampling-based meta-analysis for detection of differential gene expression in breast cancer

Background  

Accuracy in the diagnosis of breast cancer and classification of cancer subtypes has improved over the years with the development of well-established immunohistopathological criteria. More recently, diagnostic gene-sets at the mRNA expression level have been tested as better predictors of disease state. However, breast cancer is heterogeneous in nature; thus extraction of differentially expressed gene-sets that stably distinguish normal tissue from various pathologies poses challenges. Meta-analysis of high-throughput expression data using a collection of statistical methodologies leads to the identification of robust tumor gene expression signatures.     

Pathologie als Gatekeeper

Background

Lung cancer is the cancer type with the highest number of cancer deaths and non-small cell lung cancer (NSCLC) is the most frequent subtype. In the last years the knowledge on this tumor type has developed rapidly and fortunately this has led to an improvement in diagnostic stratification and new therapeutic opportunities.

Objectives

This review represents a selective overview on recent results of the tumor pathology of NSCLC and highlights the importance of the interaction between pathology and clinical disciplines. The main focus is laid on novel aspects of morphological and molecular tumor classification.

Material and methods

This overview is based on recent publications and the involvement of the authors in committees and panels that are related to the classification and therapy of lung cancer patients.

Results and conclusion

The report provides on the one hand a short outlook on the new WHO classification of lung tumors that is currently in preparation. On the other hand it reviews molecular changes of lung cancer with a special emphasis on those alterations that may have potential therapeutic relevance.     

A new gene expression signature,the ClinicoMolecular Triad Classification,may improve prediction and prognostication of breast cancer at the time of diagnosis

Introduction  

When making treatment decisions, oncologists often stratify breast cancer (BC) into a low-risk group (low-grade estrogen receptor-positive (ER+)), an intermediate-risk group (high-grade ER+) and a high-risk group that includes Her2+ and triple-negative (TN) tumors (ER-/PR-/Her2-). None of the currently available gene signatures correlates to this clinical classification. In this study, we aimed to develop a test that is practical for oncologists and offers both molecular characterization of BC and improved prediction of prognosis and treatment response.     

Tumour response interpretation with new tumour response criteria vs the World Health Organisation criteria in patients with bone-only metastatic breast cancer

Background:

We compared the utility of a new response classification (MDA; based on computed tomography (CT), magnetic resonance imaging (MRI), plain radiography (XR), and skeletal scintigraphy (SS)) and the World Health Organisation response classification (WHO; based on XR and SS) in stratifying breast cancer patients with bone-only metastases with respect to progression-free survival (PFS), overall survival (OS), and clinical response.

Methods:

We retrospectively reviewed 41 patients with bone-only metastatic breast cancer and assigned responses according to the MDA and WHO criteria. We analysed whether the MDA or WHO response classifications correlated with PFS and OS.

Results:

With the MDA criteria, there were significant differences in PFS between patients classified as responders and those classified as nonresponders (P=0.025), but with the WHO criteria, there were not. Neither criteria distinguished responders from nonresponders in terms of OS. MDA response criteria correlated better than WHO response criteria with clinical response assessment.

Conclusions:

The MDA classification is superior to the WHO classification in differentiating between responders and nonresponders among breast cancer patients with bone-only metastases. Application of the MDA classification may allow bone lesions to be considered measurable disease. Prospective study is needed to test the MDA classification among patients with bone metastasis.     

Validation of the seventh edition of the American Joint Committee on Cancer TNM staging system for gastric cancer

BACKGROUND:

The seventh edition of the American Joint Committee on Cancer (AJCC) TNM classification for gastric cancer was published in 2010 and included major revisions. The aim of the current study was to evaluate the validity of the seventh edition TNM classification for gastric cancer based on an Asian population.

METHODS:

A total of 2916 gastric cancer patients who underwent R0 surgical resection from 1989 through 2008 in a single institute were included, and were analyzed according to the seventh edition of the TNM classification for validation.

RESULTS:

When adjusted using the seventh edition of the TNM classification, upstaging was observed in 771 patients (26.4%) and downstaging was observed in 178 patients (6.1%) compared with the sixth edition of the TNM classification. The relative risk (RR) of seventh edition pT classification was found to be increased with regular intensity compared with the sixth edition pT classification. The RR of seventh edition pN classification was found to be increased with irregular intensity compared with the sixth edition pN classification. In survival analysis, there were significant differences noted for each stage of disease, but only a marginal difference was demonstrated between stage IA and stage IB (P = .049). In the hybrid TNM classification, which combines the seventh edition pT classification and the sixth edition pN classification, both pT and pN classifications demonstrated a more ideal distribution of the RR, and 5‐year survival rates also showed a significant difference for each stage (P <.01).

CONCLUSIONS:

The seventh edition of the TNM classification was considered valid based on the results of the current study. However, the hybrid TNM classification, comprised of a combination of the seventh edition pT classification and sixth edition pN classification, should be considered for the next edition. Cancer 2011. © 2011 American Cancer Society.     

Health care costs of depression in patients diagnosed with cancer

Objective

Depression is common among patients diagnosed with cancer. Patients with cancer and depression use more health care services compared with nondepressed cancer patients. The current study seeks to estimate the added cost of depression in cancer patients in the first year after cancer diagnosis.

Methods

Health care charges were obtained for 2051 depressed and 11 182 nondepressed patients with an International Classification of Diseases, Ninth Revision, diagnosis of cancer in the 2014 calendar year from the University of California San Diego Healthcare System. The annual health care charges for cancer patients with and without depression were analyzed using generalized linear models with a log‐link function and gamma distribution, covarying for age, sex, race/ethnicity, comorbid diseases, and presence of metastatic disease. Total cost data were broken down into several categories including ambulatory care, emergency department visits, and hospital visits.

Results

Depressed cancer patients had total annual health care charges that were 113% higher than nondepressed cancer patients (B = 0.76; P < .001). The estimated mean charges for depressed patients were $235 337 compared with $110 650 for nondepressed patients. Depressed cancer patients incurred greater charges than nondepressed patients in ambulatory care (B = 0.70; P < .001), emergency department charges (B = 0.31; P < .001), and hospital charges (B = 0.39; P < .001).

Conclusions

Depressed cancer patients incur significantly higher health care charges across multiple cost categories including ambulatory care, emergency department visits, and hospital visits. Future research should investigate if interventions for detecting and treating depression are effective for reducing health care use and costs in cancer patients.

     

Impact of pretreatment thrombocytosis on blood-borne metastasis and prognosis of gastric cancer

Background

Thrombocytosis has been associated with malignancies and poor prognostic implications in cancer patients. In the present study the prognostic significance of pretreatment platelet (PLT) level was assessed with regard to recurrence and survival in patients with primary gastric adenocarcinoma.

Methods

The authors reviewed the prospective data of 1593 gastric cancer patients who received curative gastrectomy with extended lymphadenectomy. The correlations of PLT level with recurrence and overall survival were evaluated by both univariate and multivariate analyses.

Results

Thrombocytosis (≥40 × 10⁴/μL), present in 6.4% of the patients prior to curative surgery, was more frequently associated with advanced T and N classification, larger tumor size, anemia, and leukocytosis (p < 0.05). In patients with pretreatment thrombocytosis compared to those without it, five-year survival rate was worse (56.9% vs. 65.5%; p = 0.043), and recurrence rate was higher mainly due to the frequent hematogenous spread (51.0% vs. 34.5%; p < 0.001). Furthermore, risk of blood-borne metastasis was almost three-fold higher in patients with pretreatment thrombocytosis (Odds ratio 2.83 [95% CI 1.67–4.77], p < 0.001).

Conclusions

Pretreatment thrombocytosis correlated significantly with poor prognosis and can be used as an independent predictor of recurrence by blood-borne metastasis in gastric cancer.     

How many names for a rose: Inconsistent classification of multiple foci of lung cancer due to ambiguous rules

Objectives

Stage classification is important because it allows consistent definition of patient groups, and thus provides a foundation for comparison of outcomes. For patients with multiple pulmonary foci of lung cancer, however, the classification rules are ambiguous and confusing.

Materials and methods

We surveyed experts and clinicians who regularly evaluate patients with lung cancer to see how similar or different their interpretation of the official stage classification was for such patients.

Results

We found a great deal of inconsistency in how four clinical scenarios were classified. No method of classification was chosen by a majority when there were more than two choices allowed by the classification rules. In a scenario with pulmonary foci of cancer of different histologic types, 86% classified this as separate primary cancers and 14% as multifocal lung cancer.

Conclusion

The marked variability in classification must be taken into account when interpreting reported outcomes of patients with multiple pulmonary foci of lung cancer.     

Effect of including cancer‐specific variables on models examining short‐term outcomes

BACKGROUND:

The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) generally has not collected cancer‐specific variables. Because increasing numbers of studies are using ACS NSQIP data to study cancer surgery, the objectives of the current study were 1) to examine differences between existing ACS NSQIP variables and cancer registry variables, and 2) to determine whether the addition of cancer‐specific variables improves modeling of short‐term outcomes.

METHODS:

Data from patients in the ACS NSQIP and National Cancer Data Base (NCDB) who underwent colorectal resection for cancer were linked (2006‐2008). By using regression methods, the relative importance of cancer staging and neoadjuvant therapy variables were assessed along with their effects on morbidity, serious morbidity, and mortality.

RESULTS:

From 146 hospitals, 11,405 patients were identified who underwent surgery for colorectal cancer (colon, 85%; rectum, 15%). The NCDB metastatic cancer variable and the ACS NSQIP disseminated cancer variables agreed marginally (Cohen kappa coefficient, 0.454). For mortality, only the ACS NSQIP disseminated cancer variable and the NCDB stage IV variable were identified as important predictors; whereas the variables stage I through III, tumor (T)‐classification, and lymph node (N)‐classification were not selected. Cancer stage variables were inconsistently important for serious morbidity (stage IV, T‐classification), superficial surgical site infection (N‐classification), venous thromboembolism (metastatic cancer), and pneumonia (T‐classification). With respect to neoadjuvant therapy, ACS NSQIP and NCDB variables agreed moderately (kappa, 0.570) and predicted superficial surgical site infection, serious morbidity, and organ space surgical site infection. The model fit was similar regardless of the inclusion of stage and neoadjuvant therapy variables.

CONCLUSIONS:

Although advanced disease stage and neoadjuvant therapy variables were predictors of short‐term outcomes, their inclusion did not improve the models. Cancer 2013. © 2012 American Cancer Society.     

Anastomotic leakage and presacral abscess formation after locally advanced rectal cancer surgery: Incidence,risk factors and treatment

Purpose of the study

Anastomotic leakage (AL) and presacral abscess (PA) after rectal cancer surgery are a major concern for the colorectal surgeon. In this study, incidence, prognosis and treatment was assessed.

Methods

Patients operated on in our institute, between 1994 and 2011, for locally advanced rectal cancer (LARC, T3+/T4M0) were included. Morbidity was scored using the Clavien-Dindo classification. Prognostic factors were analysed using binary logistic regression.

Results

517 patients were included after a low anterior resection (n = 219) or abdominoperineal resection (n = 232). AL occurred in 25 patients (11.4%); 50 patients (9.7%) developed a PA. We identified intraoperative blood loss ≥4500 cc (p = 0.038) and the era of surgery; patients operated on before the year 2006 (p = 0.042); as risk factors for AL. The time between last day of neo-adjuvant treatment and surgery, <8 weeks is significantly associated with the development of PA (p = 0.010).

Conclusions

In our population of LARC patients we found an incidence of 9.7% PA and 11.4% AL, with a 12% mortality rate for AL, which is comparable to surgery in general colorectal cancer. Increased intraoperative blood loss and surgery prior to 2006 are associated with AL. Increased intraoperative blood loss and a timing interval <8 weeks increases the risk of PA formation.