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Background: Two staging systems, the 8th staging system by the American Joint Committee on Cancer (AJCC) and the 11th Japanese classification by Japan Esophageal Society (JES), are currently applied in the clinic for predicting the prognosis of patients with esophageal squamous cell carcinoma (ESCC). The differences between the two staging systems have been widely researched. However, little studies focus on the differences in specific staging between the two systems. Therefore, we aimed to compare the performance of different staging in predicting overall survival (OS) of Chinese patients with ESCC. Methods: This retrospective study included 268 patients who underwent radical esophagectomy and mediastinal lymph node dissection for ESCC between January 2008 and December 2013. Patients were staged by the 8th AJCC and 11th JES staging systems. OS was estimated using the Kaplan–Meier method and compared between N stages and between stage groupings using the log-rank test. Cox proportional hazards regression analysis was performed to identify factors independently related to outcome. Further, we compared the concordance indexes (C-indexes) of the two staging systems. Results: The mean age was 61.25 ± 7.056 years, median follow-up was 44.82 months, and 5-year OS rate was 47%. The OS was well predicted by the 8th AJCC N staging (P < 0.001) and the 11th JES N staging (P < 0.001), with a c-index of 0.638 (95% CI: 0.592–0.683) for AJCC N staging and 0.627 (95% CI: 0.583–0.670) for JES N staging (P = 0.13). In addition, the OS was also well predicted by stage groupings of the 8th AJCC (P < 0.001) and the 11th JES systems (P < 0.001), with a c-index of 0.658 (95% CI: 0.616–0.699) for 8th AJCC stage grouping and 0.629 (95% CI: 0.589–0.668) for the11th JES stage grouping (P = 0.211). Conclusions: The prognostic effect of 11th JES staging system is comparable with that of AJCC 8th staging system for patients with ESCC. Therefore, both systems are applicable to clinical practice. [ABSTRACT FROM AUTHOR]

Simple Summary: The N staging system for Nasopharyngeal Carcinoma (NPC) is constantly improving for better survival risk stratification with accumulating clinical evidence. Discovering new prognostic factors often depends on clinical observations, which often lack comprehensiveness and precision. This study aimed to propose new quantitative spatial characterizations of LN tumor and demonstrate their feasibility of improving N stage. Independent anatomical prognostic factors were discovered and achieved superior risk stratification performance when combined with N stage. This quantitative approach could be applied to other cancer sites to discover new prognostic or predictive factors and ultimately benefit precision medicine. This study aims to investigate the feasibility of improving the prognosis stratification of the N staging system of Nasopharyngeal Carcinoma (NPC) from quantitative spatial characterizations of metastatic lymph node (LN) for NPC in a multi-institutional setting. A total of 194 and 284 NPC patients were included from two local hospitals as the discovery and validation cohort. Spatial relationships between LN and the surrounding organs were quantified by both distance and angle histograms, followed by principal component analysis. Independent prognostic factors were identified and combined with the N stage into a new prognostic index by univariate and multivariate Cox regressions on disease-free survival (DFS). The new three-class risk stratification based on the constructed prognostic index demonstrated superior cross-institutional performance in DFS. The hazard ratios of the high-risk to low-risk group were 9.07 (p < 0.001) and 4.02 (p < 0.001) on training and validation, respectively, compared with 5.19 (p < 0.001) and 1.82 (p = 0.171) of N3 to N1. Our spatial characterizations of lymph node tumor anatomy improved the existing N-stage in NPC prognosis. Our quantitative approach may facilitate the discovery of new anatomical characteristics to improve patient staging in other diseases. [ABSTRACT FROM AUTHOR]

Background: Lymph node metastasis (LNM) is a risk factor for poor long-term outcomes and a prognostic factor for disease-free survival in colon cancer. Preoperative lymph node status evaluation remains a challenge. The purpose of this study is to determine whether tumor size measured by multidetector computed tomography (MDCT) could be used to predict LNM and N stage in colon cancer. Material and methods: One hundred six patients with colon cancer who underwent radical surgery within 1 week of MDCT scan were enrolled. Tumor size including tumor length (Tlen), tumor maximum diameter (Tdia), tumor maximum cross-sectional area (Tare), and tumor volume (Tvol) were measured to be correlated with pathologic LNM and N stage using univariate logistic regression analysis, multivariate logistic analysis, and receiver operating characteristic (ROC) curve analysis. Results: The inter- and intraobserver reproducibility of Tlen (intraclass correlation coefficient [ICC] = 0.94, 0.95, respectively), Tdia (ICC = 0.81, 0.93, respectively), Tare (ICC = 0.97, 0.91, respectively), and Tvol (ICC = 0.99, 0.99, respectively) parameters measurement are excellent. Univariate logistic regression analysis showed that there were significant differences in Tlen, Tdia, Tare, and Tvol between positive and negative LNM (p < 0.001, 0.001, < 0.001, < 0.001, respectively). Multivariate logistic regression analysis revealed that Tvol was independent risk factor for predicting LNM (odds ratio, 1.082; 95% confidence interval for odds ratio, 1.039, 1.127, p<0.001). Tlen, Tdia, Tare, and Tvol could distinguish N0 from N1 stage (p < 0.001, 0.041, < 0.001, < 0.001, respectively), N0 from N2 (all p < 0.001), N0 from N1-2 (p < 0.001, 0.001, < 0.001, < 0.001, respectively), and N0-1 from N2 (p < 0.001, 0.001, < 0.001, < 0.001, respectively). The area under the ROC curve (AUC) was higher for Tvol than that of Tlen, Tdia, and Tare in identifying LNM (AUC = 0.83, 0.82, 0.69, 0.79), and distinguishing N0 from N1 stage (AUC = 0.79, 0.78, 0.63, 0.74), N0 from N2 stage (AUC = 0.92, 0.89, 0.80, 0.89, respectively), and N0-1 from N2 stage (AUC = 0.84, 0.79, 0.76, 0.83, respectively). Conclusion: Tumor size was correlated with regional LNM in resectable colon cancer. In particularly, Tvol showed the most potential for noninvasive preoperative prediction of regional LNM and N stage. [ABSTRACT FROM AUTHOR]

Objective: To investigate the value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) combined with diffusion-weighted imaging (DWI) in the diagnosis of preoperative TN stage and benign and malignant mesenteric lymph nodes. Methods: 80 patients with rectal cancer who were received by Benxi Central Hospital Affiliated to China Medical University and Shengjing Hospital Affiliated to China Medical University from February 2017 to October 2019 were selected, they were scanned with conventional Magnetic resonance imaging (MRI), DCE-MRI and DWI to obtain the quantitative parameters of DCE-MRI and DWI [transfer constant (Ktrans), extravascular extracellular volume fraction(Ve), rate constant of backflux (Kep) and apparent diffusion coefficient (ADC)]. DCE-MRI and DWI parameters of different T, N stages and different properties of mesenteric lymph nodes were compared, and its diagnostic efficacy in T, N stages and properties of mesenteric lymph nodes. Results: The levels of Ktrans, Kep and Ve in rectal cancer were higher than that in normal intestinal wall, and ADC was lower than that in normal intestinal wall (P<0.05). The levels of Ktrans, Kep and Ve in T Ⅲ - Ⅳ, N1 and mesangial malignant lymph nodes were higher than that in TⅠ～Ⅱ group, N0 group and mesangial benign lymph node group (P<0.05), the levels of Ktrans, Kep, Ve in patients with TNM stage N1 were higher than that in patients with N0, and ADC was lower than that in patients with N0 (P<0.05). The sensitivity, specificity, positive predictive value and negative predictive value of combined diagnosis were higher. Conclusion: DCE-MRI combined with DWI is of high value in the preoperative diagnosis of T, N stage and mesenteric lymph nodes of rectal cancer. [ABSTRACT FROM AUTHOR]

Background: We sought to assess the prognostic significance of lymph node ratio (LNR) and N stage in patients undergoing D2 gastrectomy and adjuvant chemotherapy, S-1, and XELOX and to compare the efficacy of them according to LNRs and N stages to evaluate the clinical impact of using LNRs compared with using N staging.Methods: Patients undergoing D2 gastrectomy with adequate lymph node dissection and adjuvant chemotherapy for stage II/III gastric cancer between Mar 2011 and Dec 2016 were analysed. Of the 477 patients enrolled, 331 received S-1 and 146 received XELOX. LNR groups were segregated as 0, 0-0.1, 0.1-0.25, and > 0.25 (LNR0, 1, 2, and 3, respectively). Propensity score matching (PSM) was used to minimise potential selection bias and compare DFS and OS stratified by LNRs and N stages in the two treatment groups.Results: After PSM, the sample size of each group was 110 patients, and variables were well balanced. All patients had more than 15 examined lymph nodes (median 51, range 16~124). In multivariate analysis, LNR (> 0.25) and N stage (N3) showed independent prognostic value in OS and DFS, but LNR (> 0.25) showed better prognostic value. In subgroup analysis, the LNR3 group showed better 5-year DFS (20% vs 54%; HR 0.29; p = 0.004) and 5-year OS (26% vs 67%; HR 0.28; p = 0.020) in the XELOX group. The N3 group showed better 5-year DFS (38% vs 66%; HR 0.40; p = 0.004) and 5-year OS (47% vs 71%; HR 0.45; p = 0.019) in the XELOX group. Stage IIIC showed better 5-year DFS (22% vs 57%; HR 0.32; p = 0.004) and 5-year OS (27% vs 68%; HR 0.32; p = 0.009) in the XELOX group. The LNR3 group within N3 patients showed better 5-year DFS (21% vs 55%; HR 0.31; p = 0.004) and 5-year OS (27% vs 68%; HR 0.34; p = 0.018) in the XELOX group.Conclusions: LNR showed better prognostic value than N staging. LNR3, N3 and stage IIIC groups showed the superior efficacy of XELOX to that of S-1. And the LNR3 group within N3 patients showed more survival benefit from XELOX. LNR > 0.25, N3 stage and stage IIIC were the discriminant factors for selecting XELOX over S-1.Trial Registration: Not applicable (retrospective study). [ABSTRACT FROM AUTHOR]

Background: Lymph node (LN) metastasis status is the decision‐making basis for the surgical procedure and adjuvant therapy modalities. Fewer studies have previously focused on LN metastasis in N1 station, especially on peripheral lymph node (PLN) metastasis in N1 station. This study aimed to reveal the metastasis status of PLN of non‐small cell lung cancer (NSCLC), and investigate its effects on N staging. Methods: We retrospectively evaluated a consecutive series of patients who underwent curative resection for histologically confirmed N1 NSCLC. Propensity score matching (PSM) was used to analyze the effects of PLN on N staging. Results: A total of 105 patients with confirmed pathological N1 (pN1) stage NSCLC with solitary nodule and without neoadjuvant therapy were enrolled into the study: 55 patients had intraperipheral LN metastasis (IPLNM), and 50 patients had extra‐peripheral LN metastasis (EPLNM). Before PSM analysis, type of location (P = 0.002), surgical procedure (P = 0.008), number of positive LNs (P = 0.029), number of LNs removed (P = 0.010), lobe of lung cancer (P = 0.031), and vascular invasion (P = 0.049) showed significant differences between the two groups. After PSM analysis, statistically there were differences in type of location (P = 0.034), number of positive LNs (P = 0.008) and vascular invasion (P = 0.049) between them. Conclusion: PLN metastasis was a quite common pattern of LN metastasis in N1 station of NSCLC. IPLNM occurred more frequently in central NSCLC and NSCLC with vascular invasion, and thoracotomy was likely to secure more accurate PLN staging. Clinicians should pay great attention to PLN dissection. Follow‐up data will be needed in order to detect the prognosis of IPLNM patients. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether gross tumour volume (GTV) of adenocarcinoma of oesophagogastric junction (AOG) measured on fat-suppression T2-weighted imaging (FS-T2WI) and diffusion-weighted imaging (DWI) correlates with regional lymph node metastasis and N stage.Materials and Methods: The study was approved by the institutional ethics committee, and written informed consent was obtained. Forty-six patients with AOG underwent preoperative magnetic resonance scans including FS-T2WI and DWI with b-values of 500 and 800 s/mm2. GTV was measured on FS-T2WI and DWI. Statistical analyses were performed to determine association of GTV with N stage.Results: Univariate analysis showed GTV measured on FS-T2WI and DWI with b-values of 500 and 800 s/mm2 were correlated with lymph node metastasis (all Ps < 0.05). Spearman rank correlation tests demonstrated a trend toward an increase in GTV obtained on previous sequences with increasing N stage (r = 0.578 to 0.591, all Ps < 0.001). Mann-Whitney U tests showed GTV obtained on previous sequences could distinguish grouped N stages (all Ps < 0.05). Receiver operating curve analyses demonstrated that GTV obtained on FS-T2WI and DWI with b-value of 500 s/mm2 and DWI with b-value of 800 s/mm2 might differentiate stage N0 from stages N1-3 (cutoff, 19.70 cm3, 16.70 cm3 and 12.24 cm3, respectively), stages N0-1 from N2-3 (cutoff: 22.16 cm3, 17.54 cm3 and 14.17 cm3, respectively), stages N0-2 from N3 (cutoff: 25.57 cm3, 29.27 cm3 and 22.73 cm3, respectively).Conclusion: There is a trend toward an increase in GTV obtained on FS-T2WI and DWI sequences with increasing N stage. [ABSTRACT FROM AUTHOR]

Background Recently identified class of microRNAs (miRNAs) provided a new insight in cancer research. As a member of miRNAs family, miR-155 expression demonstrated the correlation with tumor stage. Thus, its expression level can be potentially used for staging rectal tumors. The aim of this study was to systematically evaluate the potential abilities of miR-155 in preoperatively N staging. Materials and methods Expression of miR-155 was detected and quantitated in rectal cancer tissues and in adjacent nonmalignant tissues from 40 patients by TaqMan MicroRNA assays. Preoperative enhanced computed tomography (CT) scan, serum amyloid A protein (SAA), carcinoembryonic antigen (CEA), and postoperative pathologic biopsy were performed. Results A significant overexpression of miR-155 was observed in rectal carcinoma tissues (0.137 ± 0.095 versus 0.093 ± 0.091, P = 0.043). High expression of miR-155 in N1-2 (0.09 ± 0.038 versus 0.183 ± 0.111, P = 0.001) and III and IV stages (0.091 ± 0.039 versus 0.178 ± 0.111, P = 0.002) presented its potential correlation with N and tumor-node-metastasis combined stages. Receiver operating characteristics curve analysis showed that miR-155 could discriminate N0 from N1-2 with 85.0% sensitivity and 85.0% specificity at the cutoff value of 0.125. miR-155 and CT had nearly equal performances in sensitivity (0.850 versus 0.700, P = 0.450) and specificity (0.850 versus 0.550, P = 0.077) in predicting N1-2 stage. Compared with CT + SAA, miR-155 had similar sensitivity (0.850 versus 0.950, P = 0.617) but higher specificity (0.750 versus 0.200, P = 0.015) for lymph node assessment. Conclusions Increase in the expression of miR-155 might represent a potential valuable marker for rectal carcinoma N and combined tumor-node-metastasis staging. [ABSTRACT FROM AUTHOR]

Background: Invasive lobular cancer (L) differs clinically and morphologically from invasive ductal cancer (D); differences notwithstanding, Nottingham grades are provided in both. This study compared 22,719 lobular carcinomas with 201,517 ductal carcinomas, dividing them into the grades: well differentiated (W), moderately differentiated (M), poorly differentiated (P), and ungraded to see if differences between comparable grades of lobular and ductal cancer were uniform, consistent with the notion the grading system provides similar information for both cancer subtypes. Methods: The Surveillance, Epidemiology and End Results (SEER) database was used to limn relationships among grades, as respects proportions of patients with T3 tumors and nodal metastases, as well as cancer-specific survival. Taken into account were age, estrogen and progesterone receptor status, and the administration of radiotherapy. Results: More lobular than ductal carcinomas were T3; grades were not homogenous, with the incidence rate ratio (IRR) comparing lobular and ductal carcinomas being 8.2 for well differentiated, 4.1 for moderately differentiated, and 2.48 for poorly differentiated. With respect to nodal metastases, the 1.16 W L:W D IRR (P < 0.05) was not explicable by chance, but both the 0.97 M L:M D IRR (P > 0.05) and the 0.96 P L:P D IRR (P > 0.05) could have been due to chance. As respects survival, neither the 1.4 P L:P D time ratio (TR) (P < 0.05) nor the 1.23 M L:M D TR (P < 0.05) could have been explained by chance; the 1.05 W L: W D (P > 0.05) might have been due to chance. Conclusion: Grades of lobular carcinoma imply different meanings than do grades of ductal carcinoma. Studies of breast cancer should not assume commonality with respect to grade. [ABSTRACT FROM AUTHOR]

Objective The purpose of the present study was to investigate the impact of tumour regression and the post-treatment lymph node status on the prognosis of rectal cancer treated by preoperative neoadjuvant chemoradiotherapy. Method One hundred and thirty-five patients with locally advanced T3 and T4 rectal tumours received preoperative long-course chemoradiation, to a dose of 60 Gy external radiation and oral 5-fluorouracil 300 mg/m2 daily and Leukovorin 22.5 mg/day 5 days a week. Surgery was performed 8 weeks after the end of treatment. The tumour response was evaluated according to the tumour regression grade system and lymph node status in the surgical specimen was assessed. The prognostic value of clinico-pathological parameters was analysed using univariate analysis and Kaplan–Meier methods for comparison of groups. Results All patients responded to treatment and 47% had a major response, including 25 (19%) complete responders. The median follow-up was 26 months (range 12–94 months). The cancer specific survival was 82% and there was a significant lower survival rate in the group of patients with post-treatment lymph node metastases compared to lymph-node negative patients [63% and 87% respectively ( P = 0.007)]. Furthermore patients with a major tumour response and no lymph node metastases in the surgical specimen after treatment had a survival rate of 100% compared with 60% in the group of patients with major response but lymph node metastases after surgery ( P < 0.01). Conclusion The combined assessment of lymph-node status and tumour response has strong prognostic value in locally advanced rectal cancer patient treated with preoperative long-course chemoradiation. [ABSTRACT FROM AUTHOR]