TNM staging of testis cancer

Of one-thousand patients with testicular cancer treated mainly at the Memorial Sloan-Kettering Cancer Center from 1949 to 1974, 304 patients with pure seminoma and 659 patients with either embryonal carcinoma (329), teratocarcinoma (310) or pure choriocarcinoma (20), were staged clinicopathologically according to the TNM Classification. Paratesticular structures were involved (T_2–4) in 7% of all germinomas; para-aortic lymph nodes (N_1–3) in 15% of seminomas and 31 % of carcinomas; juxtaregional lymph nodes (N₄) in 6% of seminomas and 8% of carcinomas; and distant organs (M₁) in 4% of seminomas and 23% of carcinomas. Five year survivals were 80% in T₁ and 77% in t_2–4 pure seminomas, and 46% in T₁ and 34% in T_2–4 germinal carcinomas. The 5-year survival rates in pure seminoma versus germinal carcinomas, were 88% versus 76% in N₀M₀ 64% versus 36% in N_1–3, 53% versus 30% in N₄, and 27% versus 11% in M₁ tumors. Cancer recurrence in 5 or more years was 28% in T₁ and 18% in T_2–4 pure semnomas, and 58% in T₁ and 70% in T_2–4 germinal carcinomas. The recurrence rates in pure seminoma versus germinal carcinomas, were 17% versus 29% in N₀M₀ 55% versus 67% in N_1–3, 53% versus 74% in N₄, and identically 91% in M₁ tumors.     

Relative prognostic value of TNM7 vs TNM6 in staging oesophageal cancer

Background:

Stage migration consequent upon new cancer staging definitions may result in artifactual alterations in stage-specific survival and prognosis. The aim of this study was to determine the influence of the new TNM7 oesophageal cancer (OC) system on stage categorisation and survival when compared with historical controls.

Methods:

A total of 202 patients diagnosed with operable OC and undergoing oesophagectomy (118 neoadjuvant chemotherapy) were studied. Patients originally classified and staged using TNM6 were retrospectively re-staged using TNM7.

Results:

Re-classification of TNM7 resulted in stage migration in 11.9% of patients (9.9% downstaged, 2.0% upstaged) when compared with TNM6. Five-year survival for stages I, II and III was 78%, 46% and 18% using TNM6, compared with 62%, 51% and 18%, respectively, using TNM7. Univariable analysis revealed that histological grade (P=0.006), pT (P<0.0001), TNM6 pN (P<0.0001), TNM7 pN (P<0.0001), number of lymph node metastases (P<0.0001), TNM6 stage group (P<0.0001), TNM7 stage group (P<0.0001) and TNM7 prognostic group (P<0.0001) were all associated with survival. Multivariable analysis revealed that only the TNM7 prognostic group was independently and significantly associated with survival.

Conclusion:

TNM7 is a better prognostic tool than TNM6 and represents an important advance in staging OC.     

Imaging diagnosis in preoperative TNM staging of lung cancer

Conventional chest radiography (CR), computed tomography (CT) and magnetic resonance imaging (MRI) as staging modalities were compared in assessing the tumor extension and node status before operation in 57 patients with non-small cell bronchogenic carcinoma. The results showed that accuracy of 47 T1 and T2 lesions was 94%, 73% and 77% for CR, CT and MRI, respectively. CR and CT correctly evaluated 1 of the 2 T3 lesions and MRI was correct in both. CT and MRI correctly evaluated 4 of the 7 T4 lesions. MRI was superior to CT for left pulmonary artery invasion, but inferior to CT for pleural metastases. CR underestimated all of the 7 T4 lesions. The mediastinal lymph node metastases were evaluated preoperatively, giving sensitivities in CR, CT and MRI of 17%, 71% and 67%, respectively. The sensitivity of CT and MRI was higher than CR (P less than 0.01). The short axis of nodes greater than or equal to 10 mm was recommended for metastasis on the right side of mediastinum and the long axis greater than or equal to 10 mm for that in the other areas of mediastinum.     

CT在肺癌临床分期中的应用和评价

为使肺癌得到正确的诊断和治疗，应用新的肺癌国际TNM分期标准是十分重要的。由于CT有助于在肺癌诊断和分期过程中对于原发肿瘤和纵隔淋巴结的评估，同时也有助于搜寻远处转移灶。因此，CT是肺癌最重要的辅助影像检查，而且也可进一步明确观察大气管、大血管、淋巴结及胸膜受侵犯的情况，从而为肺癌的TNM分期提供更有价值的信息和资料。PET-CT的图像融合可使肺癌的定位更加准确，使解剖位置和病灶代谢两者关系更为完善。PET／CT的联合检查和图像融合可改进肺癌的术前TNM分期，可能成为肺癌无创性分期中最为优良的方法。     

Perspectives on current tumor-node-metastasis (TNM) staging of cancers of the colon and rectum

Improvements in classifications of cancers based on discovery and validation of important histopathological parameters and new molecular markers continue unabated. Though still not perfect, recent updates of classification schemes in gastrointestinal oncology by the American Joint Commission on Cancer (tumor-node-metastasis [TNM] staging) and the World Health Organization further stratify patients and guide optimization of treatment strategies and better predict patient outcomes. These updates recognize the heterogeneity of patient populations with significant subgrouping of each tumor stage and use of tumor deposits to significantly "up-stage" some cancers; change staging parameters for subsets of IIIB and IIIC cancers; and introduce of several new subtypes of colon carcinomas. By the nature of the process, recent discoveries that are important to improving even routine standards of patient care, especially new advances in molecular medicine, are not incorporated into these systems. Nonetheless, these classifications significantly advance clinical standards and are welcome enhancements to our current methods of cancer reporting.     

Clinical relevance of TNM staging system according to breast cancer subtypes

BackgroundThere has been reported that the association between nodal spread and tumor size was disrupted in triple-negative breast cancer (TNBC) and it showed characteristically early relapse. The TNM (tumor–node–metastasis) staging system might not be equally effective as a prognostic indicator for all subtypes. The aim of our study was to evaluate the usefulness of the staging according to subtypes.Patients and methodsWe conducted a retrospective analysis of invasive breast cancer patients who received curative surgery at Samsung Medical Center from 2000 to 2004. Relapse-free survivals (RFS) by stage were analyzed.ResultsThousand eight hundred and seventy-nine patients who were available clinicopathologic data were included. These patients were divided into three subtypes: hormone receptor (HR)+, human epidermal growth factor receptor 2+, and triple negative groups. As the stage became more advanced, the slope of each stage of the RFS curves of patients with HR+ and HER2+ steadily increased. In contrast, RFS curves intermingled and showed overlap from stage 1 to 3A in TNBC patients. There was only wide separation of RFS curves between stage 1-3A and 3B-3C in TNBC.ConclusionsThe current TNM staging system might not be enough for encompassing the tumor biology and for predicting outcomes to make therapeutic decisions for all BCs, especially for TNBC patients.     

Revision of breast cancer staging: the 6th edition of the TNM Classification

A Breast Task Force comprised of nationally known experts in the field of breast cancer treatment was charged with recommending additions and changes for the 6th edition of the TNM Classification that were based on published evidence and/or were consistent with widespread clinical consensus. Additions made to the staging system were designed to facilitate the uniform collection of clinically relevant information about new techniques for the detection of metastatic cells. These additions include quantitative criteria to distinguish micrometastases from isolated tumor cells, and specific identifiers to record the use of sentinel lymph node biopsy, immunohistochemical (IHC) staining, and molecular biology techniques. Revisions of the previous staging system are related to the number of affected axillary lymph nodes and to the classification of level III axillary lymph nodes and lymph nodes outside of the axilla.     

非小细胞肺癌分期技术的应用研究及第七版肺癌分期的解析

肺癌最常用的肿瘤分期系统是TNM分期,国际肺癌研究协会(IASLC)在第13界世界肺癌大会上公布了新修订的第七版肺癌TNM分期.准确的临床分期有赖于从病史、临床检查、影像学检查及侵入性检查等多方面分析,准确的临床分期对于指导治疗具有重要意义,第七版肺癌TNM分期分别从原发病灶、淋巴结转移及远隔脏器转移方面分别作了修订,使之更准确地对应患者预后.     

基于97分期的非小细胞肺癌术后分期和生存研究

目的 基于国际抗癌联盟的肺癌ＴＮＭ９７分期,探讨影响非小细胞肺癌分期和生存的因素。方法 采集１９６９年４月－１９９３年１２月的１７５７例连续手术病例（包括完全性切除病例,减量切除病例和单纯剖胸探查病例）随访至１９９８年１１月３０日,用ＳＰＳＳ统计软件包的Ｋａｐｌａｎ－Ｍｅｉｅｒ和ＣｏｘＩＢ期５３．９％,Ⅱ期３３．５％,ⅢＡ期１４．７％,ⅢＢ期５．５％,Ⅳ期７．０％,总５年生存率２８．２％,５,１０     

Modified staging system for pulmonary carcinoids on the basis of lung cancer TNM system

Background

Pulmonary carcinoids are being staged along the lines of lung cancer American Joint Committee on Cancer (AJCC) staging system. The current study evaluated the prognostic value of a modified staging system for patients with pulmonary carcinoid.

Patients and methods

Surveillance, Epidemiology and End Results (SEER) database (2004–2014) was searched through SEER*Stat program. Through recursive partitioning analysis and subsequent decision tree formation, suggested stages were constructed. Overall survival analyses were performed through Kaplan–Meier analysis. The cancer-specific Cox regression hazard (adjusted for age, gender, race, sub-site and surgery) was calculated and pairwise comparisons of hazard ratios were conducted.

Results

A total of 6395 pulmonary carcinoid patients were recruited in the period from 2004–2014. Pairwise hazard ratio comparisons among different AJCC 8th stages were conducted and all comparisons were non-significant except for stage IIB vs. stage IIIA and stage IIIA vs. stage IIIB. Pairwise hazard ratio comparisons among different modified staging system stages were conducted and all comparisons were significant except for stage III vs. stage IV. C-statistic (using death from pulmonary carcinoid as the dependent variable) for AJCC 8th staging system was: 0.794 (SE 0.013; 95% CI 0.769–0.818); for AJCC 7th staging system was: 0.789 (SE 0.013; 95% CI 0.764–0.815), while c-statistic for the modified staging system was: 0.802 (SE 0.012; 95% CI 0.778–0.827).

Conclusion

The proposed modified staging system provided a simpler yet prognostically more relevant classification of pulmonary carcinoids compared to AJCC staging systems (both 7th and 8th editions).