Reappraisal of the prognostic significance of mitotic rate supports its reincorporation into the melanoma staging system

Cancer ◽  
2020 ◽  
Vol 126 (21) ◽  
pp. 4717-4725
Author(s):  
Mohammed Kashani‐Sabet ◽  
James R. Miller ◽  
Serigne Lo ◽  
Mehdi Nosrati ◽  
Jonathan R. Stretch ◽  
...  
Keyword(s):  
Prognostic Significance ◽  
Staging System ◽  
Mitotic Rate

scholarly journals Novel Insight into Multi-Hit Multiple Myeloma Based on "Two-Hit" Theory of Cancer Causation

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 47-48
Author(s):  
Chenxing Du ◽  
Xue-Han Mao ◽  
Jiahui Liu ◽  
Huishou Fan ◽  
Weiwei Sui ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Induction Therapy ◽  
Conflicts Of Interest ◽  
Prognostic Significance ◽  
Staging System ◽  
Hazard Ratio ◽  
Drug Induction ◽  
Double Hit ◽  
Definition Of ◽  
Standard Risk

Background: Current definition of multi-hit multiple myeloma (MM) is based upon the number of high-risk cytogenetic abnormalities (CA). But we may overlook the influence of standard-risk CA and different concurrent patterns. In fact, standard-risk t(11;14) and del(13q) may bring extra danger when concurrent with other CA. And the concurrency of two secondary CA may do more harm to patients than that of one secondary CA with one primary CA. This study is to answer whether CA number or pattern exert an impact on outcomes of MM patients. Methods: This study was carried out based on the prospective, non-randomized clinical trial BDH 2008/02. 537 MM patients with complete cytogenetic data were enrolled, of whom 64% (341/537) patients were treated with bortezomib-based three-drug induction therapy, and the remaining patients with thalidomide-based therapy. Autologous stem cell transplantation (ASCT) was recommended post induction therapy in transplant-eligible patients, and all patients received maintenance therapy for two years. CA were divided into primary CA [pCA: any type of IgH breakage], and secondary CA [sCA: del(17p), del(13q), gain(1q) (≥3 copies)] Results: In the era of novel agents, patients with pCA only did not have outcomes different from those patients without any FISH abnormality. Patients with s1 CA or s1+p CA had hazard ratio for PFS or OS of 1.5-2.0. Patients with s2 CA or s2+p CA had hazard ratio for PFS or OS of 2.0-3.0. Patients with concurrent del(13q), del(17p) and gain(1q) (s3 CA) had hazard ratio for PFS of 3.11 and for OS of 3.00. Patients with s3+p CA had hazard ratio for PFS of 4.65 and for OS of 6.16. Based on these results, we divided patients into four subgroups: no CA or only pCA, s1 CA in the presence or absence of pCA, s2 CA in the presence or absence of pCA, and s3 CA in the presence or absence of pCA. Both the PFS and OS decreased in a stepwise fashion with the accumulation of CA (Figure 1). Therefore, we defined double-hit MM as any one sCA in the presence or absence of pCA. Triple-hit MM referred to two sCA plus pCA or not, and quadra-hit MM referred to three sCA plus pCA or not. Furthermore, we confirmed the prognostic independence of CA pattern in the multivariant analysis with International Staging System (ISS) and LDH (Table 1). Conclusion: In this study, we found that the primary CA as a whole lost its adverse effect when treated by bortezomib-based regimens. CA subtype conferred a prognostic value. In details, secondary CA imposed an accumulative risk to patients. For the first time, we indicated that double-hit or triple-hit MM should be defined upon the number of secondary CA. This definition coincides with the "Two-Hit" theory of cancer causation and fits well with MM evolution model. The prognostic significance of CA pattern needs validation in further prospective trials. Disclosures No relevant conflicts of interest to declare.

scholarly journals Dermoscopic characteristics of melanoma according to the criteria „ulceration“ and „mitotic rate“ of the AJCC 2009 staging system for melanoma

PLoS ONE ◽  
2017 ◽  
Vol 12 (4) ◽  
pp. e0174871 ◽  
Author(s):  
Teresa Deinlein ◽  
Edith Arzberger ◽  
Iris Zalaudek ◽  
Cesare Massone ◽  
Juan Garcias-Ladaria ◽  
...  
Keyword(s):  
Staging System ◽  
Mitotic Rate

A TNM-Based Clinical Staging System of Ocular Adnexal Lymphomas

2009 ◽  
Vol 133 (8) ◽  
pp. 1262-1267 ◽  
Author(s):  
Sarah E. Coupland ◽  
Valerie A. White ◽  
Jack Rootman ◽  
Bertil Damato ◽  
Paul T. Finger
Keyword(s):  
Prognostic Significance ◽  
Staging System ◽  
Clinical Staging ◽  
Disease Extent ◽  
Non Hodgkin Lymphoma ◽  
Ann Arbor ◽  
Data Points ◽  
Specific Factors ◽  
Clinical Staging System ◽  
User Friendly

Abstract Context.—The ocular adnexal lymphomas (OAL) arise in the conjunctiva, orbit, lacrimal gland, and eyelids. To date, they have been clinically staged using the Ann Arbor staging system, first designed for Hodgkin and later for nodal, non–Hodgkin lymphoma. The Ann Arbor system has several shortcomings, particularly when staging extranodal non– Hodgkin lymphomas, such as OAL, which show different dissemination patterns from nodal lymphomas. Objective.—To describe the first TNM-based clinical staging system for OAL. Design.—Retrospective literature review. Results.—We have developed, to our knowledge, the first American Joint Committee on Cancer–International Union Against Cancer TNM-based staging system for OAL to overcome the limitations of the Ann Arbor system. Our staging system defines disease extent more precisely within the various anatomic compartments of the ocular adnexa and allows for analysis of site-specific factors not addressed previously. It aims to facilitate future studies by identifying clinical and histomorphologic features of prognostic significance. This system is for primary OAL only and is not intended for intraocular lymphomas. Conclusions.—Our TNM-based staging system for OAL is a user-friendly, anatomic documentation of disease extent, which creates a common language for multicenter and international collaboration. Data points will be collected with the aim of identifying biomarkers to be incorporated into the staging system.

Sub-staging specific differences in recurrence-free, progression-free and cancer-specific survival for patients with T1 bladder cancer: a systematic review and meta-analysis

2020 ◽  
Author(s):  
GuanQiu Chen ◽  
Tao Yang ◽  
Pu Zhang ◽  
Meng-Zhao Zhang ◽  
Bo Yang ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Prognostic Significance ◽  
Treatment Strategies ◽  
Progression Free Survival ◽  
Staging System ◽  
Cochrane Library ◽  
Significant Prognostic Factor ◽  
Cancer Specific Survival ◽  
Free Survival ◽  
Significant Difference

Abstract Background: The efficiency of the T1 sub-staging system on categorizing bladder cancer (BC) patients into subgroups with different clinical outcomes was unclear. We summarized relevant evidences, including recurrence-free survival (RFS), progression-free survival (PFS) and cancer-specific survival (CSS), to analyze the prognostic significance of T1 sub-stage.Methods: Systematic literature searches of MEDLINE, EMBASE and the Cochrane Library were performed. We pooled data on recurrence, progression, and CSS from 35 studies.Results: The pooled hazard ratios (HRs) and 95% confidence intervals (CIs) indicated the difference in RFS between T1a sub-stage and T1b sub-stage (HR1.28, 95%CI 1.14-1.43). The significant difference was observed in PFS between the two arms (HR 2.18, 95%CI 1.95-2.44). Worse CSS was found in T1b patients than T1a patients (HR 1.45, 95%CI 1.28-1.64).Conclusions: T1 sub-staging system based on the invasion depth into muscularis mucosae (MM) can be a significant prognostic factor for RFS, PFS, and CSS of patients with T1-BC. Urologists and pathologists are encouraged to work together to give a precise sub-stage classification of T1-BC, and T1 sub-staging system should be a routine part of any histopathological report when possible. Different treatment strategies need to be developed for both T1a-BC and T1b-BC.

scholarly journals Is Preoperative Fibrinogen Associated with the Survival Prognosis of Gastric Cancer Patients? A Multi-centered, Propensity Score-Matched Retrospective Study

2019 ◽  
Vol 44 (1) ◽  
pp. 213-222
Author(s):  
Lin-Yong Zhao ◽  
Yong-Liang Zhao ◽  
Jun-Jiang Wang ◽  
Qi-Di Zhao ◽  
Wen-Qi Yi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Propensity Score ◽  
Cancer Patients ◽  
Prognostic Significance ◽  
Staging System ◽  
Tnm Staging ◽  
Plasma Fibrinogen ◽  
Tnm Staging System ◽  
N Stage ◽  
Gastric Cancer Patients

Abstract Background The prognostic significance of preoperative plasma fibrinogen in patients with operable gastric cancer remains under debate. This study aimed to elucidate the prognostic value of fibrinogen in gastric cancer patients underwent gastrectomy. Methods A total of 4351 patients with gastric cancer collected from three comprehensive medical centers were retrospectively evaluated. Patients were categorized by minimum P value using X-tile, while the baseline confounders for fibrinogen was balanced through propensity score matching (PSM). The relationships between fibrinogen and other clinicopathologic features were evaluated, and nomogram was constructed to assess its prognostic improvement compared with TNM staging system. Results Fibrinogen was significantly correlated with macroscopic type, tumor differentiation, tumor size, and T and N stage. The factors, fibrinogen and T stage as well as N stage, were identified to be independent prognostic factors after PSM. Nomogram based on fibrinogen demonstrated a smaller Akaike information criterion (AIC) and a larger concordance index (C-index) than TNM staging system, illustrating that fibrinogen might be able to improve the prognostic accuracy. Conclusions Preoperative plasma fibrinogen levels in gastric cancer patients were significantly correlated with tumor progression, which could be regarded as a reliable marker for survival prognostic prediction.

scholarly journals Prognosis of aggressive lymphomas: a study of five prognostic models with patients included in the LNH-84 regimen

Blood ◽  
1989 ◽  
Vol 74 (2) ◽  
pp. 558-564 ◽  
Author(s):  
B Coiffier ◽  
E Lepage
Keyword(s):  
Performance Status ◽  
Prognostic Significance ◽  
Staging System ◽  
Prognostic Models ◽  
Cancer Center ◽  
Malignant Lymphomas ◽  
Prognostic System ◽  
Ann Arbor ◽  
Md Anderson ◽  
Better Than

Abstract Four prognostic models described for aggressive malignant lymphomas and the classical Ann Arbor staging system were used to compare the survival of 737 patients treated with the LNH-84 regimen. The aim of the study was to determine the optimal prognostic system at the time of diagnosis. Three institutions have described these models after multivariate analyses: the Dana Farber Cancer Institute (DFCI1 and DFCI2), the MD Anderson Hospital (MDAH), and the Memorial Sloan- Kettering Cancer Center (MSKCC). The models were constructed with the following variables: performance status, LDH level, and tumor extension. The latter is the most difficult to assess: it was considered as the number of extranodal sites and the diameter of the largest mass in DFCI1, stage and the diameter of the largest mass in DFCI2, the number of extranodal and extensive nodal sites in MDAH, and the number of nodal sites and their localization in MSKCC. Univariate studies with LNH-84 regimen patients showed all these variables to have major prognostic significance (logrank tests: P less than 10(-4)). All five prognostic systems divided patients into three subgroups: good, intermediate, and poor prognosis. Logrank analyses of survival showed highly significant differences (X2 greater than 90 and P less than 10(- 6)) between the subgroups. No gross difference was found between the models, and none was better than the others. A new, internationally accepted prognostic system for the expression and comparison of treatment results in aggressive malignant lymphomas should include major univariate prognostic parameters and must be reliable and easy to use in clinical practice. Until such time, stage or LDH level are the best alternatives.

Metaphase Cytogenetics Adds to Gene Expression Profiling in the Identification of High Risk Multiple Myeloma.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 114-114
Author(s):  
Guido Tricot ◽  
Fenghuang Zhan ◽  
Bart Barlogie ◽  
Yongsheng Huang ◽  
Jeffrey Sawyer ◽  
...  
Keyword(s):  
Gene Expression ◽  
Multiple Myeloma ◽  
Gene Expression Profiling ◽  
Expression Profiling ◽  
Prognostic Significance ◽  
Staging System ◽  
Treatment Modalities ◽  
Prognostic Impact ◽  
Newly Diagnosed ◽  
Prognostic Information

Abstract The International Staging System (ISS), based on B2-microglobulin and albumin levels at the time of diagnosis, has now generally been adopted as a new prognostic classification system for multiple myeloma (MM). While readily and widely applicable, ISS does not account for genetic disease features, such as metaphase (CA) and interphase fluorescence in situ hybridization (FISH) cytogenetic abnormalities, which when examined in the context of standard prognostic variables, confer higher hazards of relapse and disease-related death. Recently, gene expression profiling (GEP) uncovered the major prognostic significance for outcome of high expression of CKS1B, a gene mapping to an amplicon at chromosome 1q21. We have performed a comprehensive study of CA, FISH, GEP and ISS staging in 351 newly diagnosed MM patients, treated uniformly on Total Therapy 2. We have analyzed outcome based on a combination of high CKS1B by GEP and CA. GEP-based t(11;14) was prognostically favorable, irrespective of expression of CKS1B and, therefore, was removed from the group of patients with high CKS1B expression. After this adjustment, with the combination of both CA and high CKS1B (approximately 10% of all patients) conferred a very poor outcome with only 24% and 40% of such patients being event-free and/surviving at 3 years, compared with 72% and 84% for the others (p values : <.0001). Such patients fared poorly, irrespective of their ISS stage. Similar prognostic information could be gained by combining CA with FISH-defined amplification of 1q21 and t(11;14). Because of their major prognostic impact, all newly diagnosed patients should be tested for these genetic markers. Novel treatment modalities are justified in the small subgroup of such poor prognosis patients, since they derive only a minor benefit from advances in MM therapy. CKS1B Q4 + CA (with no CCND1) vs. Others CKS1B Q4 + CA (with no CCND1) vs. Others

Molecular Staging of Intracranial Ependymoma in Children and Adults

2010 ◽  
Vol 28 (19) ◽  
pp. 3182-3190 ◽  
Author(s):  
Andrey Korshunov ◽  
Hendrik Witt ◽  
Thomas Hielscher ◽  
Axel Benner ◽  
Marc Remke ◽  
...  
Keyword(s):  
Genetic Markers ◽  
Survival Data ◽  
Copy Number ◽  
Cox Regression ◽  
Prognostic Significance ◽  
Staging System ◽  
Comparative Genomic ◽  
Molecular Staging ◽  
Copy Number Aberrations ◽  
Intracranial Ependymoma

Purpose The biologic behavior of intracranial ependymoma is unpredictable on the basis of current staging approaches. We aimed at the identification of recurrent genetic aberrations in ependymoma and evaluated their prognostic significance to develop a molecular staging system that could complement current classification criteria. Patients and Methods As a screening cohort, we studied a cohort of 122 patients with ependymoma before standardized therapy by using array-based comparative genomic hybridization. DNA copy-number aberrations identified as possible prognostic markers were validated in an independent cohort of 170 patients with ependymoma by fluorescence in situ hybridization analysis. Copy-number aberrations were correlated with clinical, histopathologic, and survival data. Results In the screening cohort, age at diagnosis, gain of 1q, and homozygous deletion of CDKN2A comprised the most powerful independent indicators of unfavorable prognosis. In contrast, gains of chromosomes 9, 15q, and 18 and loss of chromosome 6 were associated with excellent survival. On the basis of these findings, we developed a molecular staging system comprised of three genetic risk groups, which was then confirmed in the validation cohort. Likelihood ratio tests and multivariate Cox regression also demonstrated the clear improvement in predictive accuracy after the addition of these novel genetic markers. Conclusion Genomic aberrations in ependymomas are powerful independent markers of disease progression and survival. By adding genetic markers to established clinical and histopathologic variables, outcome prediction can potentially be improved. Because the analyses can be conducted on routine paraffin-embedded material, it will now be possible to prospectively validate these markers in multicenter clinical trials on population-based cohorts.

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