Outcomes and prognostic factors of patients with stage? ⅠB and? ⅡA pancreatic cancer according to the 8^(th) edition American Joint Committee on Cancer criteria

AIM To evaluate the changes in the 8^(th) edition American Joint Committee on Cancer(AJCC) for defining stage?ⅠB and?ⅡA pancreatic cancer and identify their prognostic factors.METHODS Pancreatic cancer patients were selected from the Surveillance Epidemiology and End Results database(1973-2013). The enrolled patients were divided into?ⅠB and?ⅡA groups based on tumor size according to the 8^(th) edition AJCC criteria. Clinical characteristics, including age, gender, race, tumor size, primary site, and grade were summarized. Univariate and multivariate analyses were performed to explore the prognostic factors of the?ⅠB and?ⅡA stages of pancreatic cancer under new criteria.RESULTS A total of 1349 pancreatic cancer patients were included. More patients had stage?ⅠB rather than stage?ⅡA. Stage?ⅠB tumors(54.85%) were mainly located in the head of the pancreas, while stage?ⅡA tumors were more often located in the tail and head of the pancreas(35.21% and 31.75%, respectively). The survival time of stage?ⅠB and?ⅡA patients had no significant difference. Univariate and multivariate analyses indicated that the prognostic factors of survival for stage?ⅠB and?ⅡA patients were different. for stage?ⅠB patients, age and primary site were the independent prognostic factors; for stage?ⅡA patients, age and grade were the independent prognostic factors. The risk of death was lower among patients aged ≤ 65 years than those aged > 65 years.CONCLUSION The prognostic factors for stage?ⅠB and?ⅡA patients are different, but age is the independent prognostic factor for all patients. The survival time of stage?ⅠB and?ⅡA patients has no significant difference.

Validation of American Joint Committee on Cancer 8th edition of TNM staging in resected distal pancreatic cancer

BACKGROUND In order to improve risk stratification and clinical management of the pancreatic ductal adenocarcinoma(PDAC),the American Joint Committee on Cancer(AJCC)has published its eighth edition staging manual.Some major changes have been introduced in the new staging system for both T and N categories.Given the rarity of resectable disease,distal pancreatic cancer is likely underrepresented in the published clinical studies,and how the impact of the staging system actually reflects on to clinical outcomes remain unclear.AIM To validate the AJCC 8th edition of TNM staging in distal PDAC.METHODS A retrospective cohort study was performed in seven academic medical centers in the United States.Clinicopathological prognostic factors associated with progression-free survival(PFS)and overall survival(OS)were evaluated through univariate and multivariate analyses.RESULTS Overall,454 patients were enrolled in the study,and were divided into 2 subgroups:Invasive intraductal papillary mucinous neoplasms(IPMN)(115 cases)and non-IPMN associated adenocarcinoma(339 cases).Compared to invasive IPMN,non-IPMN associated adenocarcinomas are more common in relatively younger patients,have larger tumor size,are more likely to have positive lymph nodes,and are associated with a higher tumor(T)stage and nodal(N)stage,lymphovascular invasion,perineural invasion,tumor recurrence,and a worse PFS and OS.The cohort was predominantly categorized as stage 3 per AJCC 7th edition staging manual,and it’s more evenly distributed based on 8th edition staging manual.T and N staging of both 7th and 8th edition sufficiently stratify PFS and OS in the entire cohort,although dividing into N1 and N2 according to the 8th edition does not show additional stratification.For PDAC arising in IPMN,T staging of the 7th edition and N1/N2 staging of the 8th edition appear to further stratify PFS and OS.For PDAC without an IPMN component,T staging from both versions fails to stratify PFS and OS.CONCLUSION The AJCC 8th edition TNM staging system provides even distribution for the T staging,however,it does not provide better risk stratification than previous staging system for distal pancreatic cancer.

Sino-US Joint Committee on High Energy Physics convenes in Beijing

The 27th Meeting of the Sino-U.S. Joint Committee on High Energy Physics took place on 17 and 18 November at the CAS Institute of High Energy Physics

A Retrospective Survival Analysis of Anatomic and Prognostic Stage Group Based on the American Joint Committee on Cancer 8th Edition Cancer Staging Manual in Luminal B Human Epidermal Growth Factor Receptor 2-negative Breast Cancer

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.

CNPC-Amoco Joint Technical Cooperation Committee Set UP

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Computed tomography-based radiomics diagnostic approach for differential diagnosis between early-and late-stage pancreatic ductal adenocarcinoma

BACKGROUND One of the primary reasons for the dismal survival rates in pancreatic ductal adenocarcinoma(PDAC)is that most patients are usually diagnosed at late stages.There is an urgent unmet clinical need to identify and develop diagnostic methods that could precisely detect PDAC at its earliest stages.METHODS A total of 71 patients with pathologically proved PDAC based on surgical resection who underwent contrast-enhanced computed tomography(CT)within 30 d prior to surgery were included in the study.Tumor staging was performed in accordance with the 8th edition of the American Joint Committee on Cancer staging system.Radiomics features were extracted from the region of interest(ROI)for each patient using Analysis Kit software.The most important and predictive radiomics features were selected using Mann-Whitney U test,univar-iate logistic regression analysis,and minimum redundancy maximum relevance(MRMR)method.Random forest(RF)method was used to construct the radiomics model,and 10-times leave group out cross-validation(LGOCV)method was used to validate the robustness and reproducibility of the model.RESULTS A total of 792 radiomics features(396 from late arterial phase and 396 from portal venous phase)were extracted from the ROI for each patient using Analysis Kit software.Nine most important and predictive features were selected using Mann-Whitney U test,univariate logistic regression analysis,and MRMR method.RF method was used to construct the radiomics model with the nine most predictive radiomics features,which showed a high discriminative ability with 97.7%accuracy,97.6%sensitivity,97.8%specificity,98.4%positive predictive value,and 96.8%negative predictive value.The radiomics model was proved to be robust and reproducible using 10-times LGOCV method with an average area under the curve of 0.75 by the average performance of the 10 newly built models.CONCLUSION The radiomics model based on CT could serve as a promising non-invasive method in differential diagnosis between early and late stage PDAC.

Standardizing the classification of gastric cancer patients with limited and adequate number of retrieved lymph nodes:an externally validated approach using real-world data

Background:Currently,there is no formal consensus regarding a standard classification for gastric cancer(GC)patients with<16 retrieved lymph nodes(rLNs).Here,this study aimed to validate a practical lymph node(LN)staging strategy to homogenize the nodal classification of GC cohorts comprising of both<16(Limited set)and≥16(Adequate set)rLNs.Methods:All patients in this study underwent R0 gastrectomy.The overall survival(OS)difference between the Limited and Adequate set from a large Chinese multicenter dataset was analyzed.Using the 8th American Joint Committee on Cancer(AJCC)pathological nodal classification(pN)for GC as base,a modified nodal classification(N’)resembling similar analogy as the 8th AJCC pN classification was developed.The performance of the proposed and 8th AJCC GC subgroups was compared and validated using the Surveillance,Epidemiology,and End Results(SEER)dataset comprising of 10,208 multi-ethnic GC cases.Results:Significant difference in OS between the Limited and Adequate set(corresponding N0–N3a)using the 8th AJCC system was observed but the OS of N0_(limited)vs.N1_(adequate),N1_(limited)vs.N2_(adequate),N2_(limited)vs.N3_(aadequate),and N3_(alimited)vs.N3_(badequate)subgroups was almost similar in the Chinese dataset.Therefore,we formulated an N’classification whereby only the nodal subgroups of the Limited set,except for pT1N0M0 cases as they underwent less extensive surgeries(D1 or D1+gastrectomy),were re-classified to one higher nodal subgroup,while those of the Adequate set remained unchanged(N’0=N0_(adequate)+pT1N0M0_(limited),N’1=N1_(adequate)+N0_(limited)(excluding pT1N0M0_(limited)),N’2=N2_(adequate)+N1_(limited),N’3a=N3_(aadequate)+N2_(limited),and N’3b=N3_(badequate)+N3_(alimited)).This N’classification demonstrated less heterogeneity in OS between the Limited and Adequate subgroups.Further analyses demonstrated superior statistical performance of the pTN’M system over the 8th AJCC edition and was successfully validated using the SEER dataset.Conclusion:The proposed nodal staging strategy was successfully validated in large multi-ethnic GC datasets and represents a practical approach for homogenizing the classification of GC cohorts comprising of patients with<16 and≥16 rLNs.

Prognostic role of ultrasonography staging in patients with anal cancer

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.

A nomogram predicting the recurrence of hepatocellular carcinoma in patients after laparoscopic hepatectomy

Background:Patients with hepatocellular carcinoma(HCC)undergoing surgical resection still have a high 5-year recurrence rate(~60%).With the development of laparoscopic hepatectomy(LH),few studies have compared the efficacy between LH and traditional surgical approach on HCC.The objective of this study was to establish a nomo-gram to evaluate the risk of recurrence in HCC patients who underwent LH.Methods:The clinical data of 432 patients,pathologically diagnosed with HCC,underwent LH as initial treatment and had surgical margin>1 cm were collected.The significance of their clinicopathological features to recurrence-free survival(RFS)was assessed,based on which a nomogram was constructed using a training cohort(n=324)and was internally validated using a temporal validation cohort(n=108).Results:Hepatitis B surface antigen(hazard ratio[HR],1.838;P=0.044),tumor number(HR,1.774;P=0.003),tumor thrombus(HR,2.356;P=0.003),cancer cell differentiation(HR,0.745;P=0.080),and microvascular tumor invasion(HR,1.673;P=0.007)were found to be independent risk factors for RFS in the training cohort,and were used for con-structing the nomogram.The C-index for RFS prediction in the training cohort using the nomogram was 0.786,which was higher than that of the 8th edition of the American Joint Committee on Cancer TNM classification(C-index,0.698)and the Barcelona Clinic Liver Cancer staging system(C-index,0.632).A high consistency between the nomogram prediction and actual observation was also demonstrated by a calibration curve.An improved predictive benefit in RFS and higher threshold probability of the nomogram were determined by receiver operating characteristic curve analysis,which was also confirmed in the validation cohort compared to other systems.Conclusions:We constructed and validated a nomogram able to quantify the risk of recurrence after initial LH for HCC patients,which can be clinically implemented in assisting the planification of individual postoperative surveil-lance protocols.

Clinicopathological features and impact of adjuvant chemotherapy on the long-term survival of patients with multiple gastric cancers:a propensity score matching analysis

Background:Little is known about the correlation between the clinicopathological features,postoperative treatment,and prognosis of multiple gastric cancers(MGCs).In this study,we aimed to investigate the correlation between these features and the impact of postoperative adjuvant chemotherapy on the long-term survival of patients with MGC.Methods:The clinical and pathological data of patients diagnosed with gastric adenocarcinoma who had radical gastrectomy from January 2007 to December 2016 were analyzed.Using propensity score matching,the prognostic differences,and the impact of postoperative adjuvant chemotherapy between those with MGC and solitary gastric cancers(SGC)were compared.Results:Among the 4107 patients investigated,the incidence of MGC was 3.2%(133/4107).Before matching,patients with MGC and SGC had disparities in the type of gastrectomy,pathological tumor stage(pT),pathological node stage(pN),and pathological tumor-node-metastasis stage(pTNM).After a 1:4 ratio matching,the clinical data of 133 cases of MGC and 532 cases of SGC were found to be comparable.The 5-year overall survival(OS)rate was 56.6%in the entire matched cohort,48.1%in the MGC group,and 58.7%in the SGC group(P=0.013).Multivariate analysis revealed that MGC,age,pT stage,pN stage,and adjuvant chemotherapy were independent predictors of OS(all P<0.05).Stratified analyses demonstrated that for the cohort of advanced gastric cancer(AGC)patients who did not had adjuvant chemotherapy,the 5-year OS rate of advanced cases of MGC was inferior than that of SGC patients(34.0%vs.46.1%,respectively;P=0.025)but there were no significant difference in the 5-year OS rate between advanced MGC and SGC patients who had adjuvant chemotherapy(48.0%vs.53.3%,respectively;P=0.292).Further,we found that the 5-year OS rate of advanced MGC who had adjuvant chemotherapy was significantly higher than those who did not had adjuvant chemotherapy(48.0%vs.34.0%,P=0.026).Conclusions:Patients with advanced MGC was identified as having a poorer survival as to SGC patients,but the implementation of postoperative adjuvant chemotherapy showed that it had the potential to significantly improve the long-term prognoses of MGC patients.

Retrieved lymph nodes from different anatomic groups in gastric cancer:a proposed optimal number,comparison with other nodal classification strategies and its impact on prognosis

Background:The optimal number of retrieved lymph nodes(LNs)in gastric cancer(GC)is still debatable and previ-ous studies proposing new classification alternatives mostly focused on the number of retrieved LNs without proper consideration on the anatomic nodal groups’location.Here,we assessed the impact of retrieved LNs from different nodal location groups on the survival of GC patients.Methods:Stage I-III gastric cancer patients who had radical gastrectomy were investigated.LN grouping was deter-mined according to the 13th edition of the JCGC.The optimal cut-off values of retrieved LNs in different LN groups(Group 1 and 2)were calculated,based on which a proposed nodal classification(rN)simultaneously accounting the optimal number and location of retrieved LNs was proposed.The performance of rN was then compared to that of LN ratio,log-odds of metastatic LNs(LODDs)and the 8th edition of the Union for International Cancer Control/American Joint Committee on Cancer(UICC/AJCC)N classification.Results:The optimal cut-off values for Group 1 and 2 were 13 and 9,respectively.The 5-year overall survival(OS)was higher for patients in retrieved Group 1 LNs>13(vs.Group 1 LNs≤13,63.2%vs.57.9%,P=0.005)and retrieved Group 2 LNs>9(vs.Group 2 LNs≤9,72.5%vs.60.7%,P=0.009).Patients staged as pN0-3b were sub classified using this Group 1 and 2 nodal analogy.The OS of pN0-N2 patients in retrieved Group 1 LNs>13 or Group 2 LNs>9 were superior to those in retrieved Group 1 LNs≤13 and Group 2 LNs≤9(All P<0.05);except for pN3 patients.The rN clas-sification was formulated and demonstrated better 5-year OS prognostication performance as compared to the LNR,LODDs,and the 8th UICC/AJCC N staging system.Conclusions:The retrieval of>13 and>9 LNs for Group 1 and Group 2,respectively,could represent an alternative lymph node retrieval approach in radical gastrectomy for more precise survival prognostication and minimizing staging migration,especially if>16 LNs is found to be difficult.