scholarly journals Prognostic Evaluation for Patients over 45 Years Old with Gallbladder Adenocarcinoma Resection: A SEER-Based Nomogram Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-11 ◽  
Author(s):  
Pengfei Li ◽  
Lujun Song
Keyword(s):  
Prognostic Factors ◽  
Lymph Node ◽  
Staging System ◽  
Lymph Node Staging ◽  
Internal Validation ◽  
Gallbladder Adenocarcinoma ◽  
Low Incidence ◽  
Using Data ◽  
Patient Prognosis ◽  
Lymph Node Stage

Gallbladder adenocarcinoma is the main histopathological type of gallbladder cancer (GBC), so it is particularly important to understand its biological characteristics. Due to the low incidence of this type of cancer, there are few studies with large sample sizes. The log of positive lymph nodes (LODDS) has been evaluated by many scholars as a lymph node stage that may play a better role than the 8th edition of the American Joint Committee on Cancer (AJCC) lymph node staging system in many cancers. However, the effect of LODDS has not been proven in gallbladder adenocarcinoma. Our research aimed to identify independent prognostic factors that are closely related to overall survival (OS) in patients with gallbladder adenocarcinoma over 45 years of age using data from the Surveillance, Epidemiology and, End Results (SEER) database. All patients were randomly divided into a modeling cohort and an internal validation cohort. Seven independent prognostic factors associated with OS—age, marital status, grade, tumor size, AJCC 8th edition T stage and M stage, and LODDS—were used to build a nomogram to predict 1-, 3-, and 5-year survival. The C-index of our nomogram was 0.735 (95% CI, 0.716 to 0.754), and together with the calibration curve and ROC curve validation, the results confirmed the prediction effect of our nomogram. We believe that our nomogram will be an accurate and convenient method for patient prognosis assessment in the future.

Optimal prognostic lymph node staging system for gallbladder adenocarcinoma: A multi-institutional study.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 364-364
Author(s):  
Neda Amini ◽  
Yuhree Kim ◽  
Ana Wilson ◽  
Cecilia Grace Ethun ◽  
Shishir Kumar Maithel ◽  
...  
Keyword(s):  
Lymph Node ◽  
Staging System ◽  
Lymph Node Staging ◽  
Study Cohort ◽  
Curative Intent ◽  
Risk Of Death ◽  
Increased Risk ◽  
Staging Systems ◽  
Gallbladder Adenocarcinoma ◽  
Better Than

364 Background: The American Joint Committee on Cancer (AJCC) classification is the most universally accepted lymph node (LN) staging system for gallbladder adenocarcinoma (GBA); however, it focuses more on location of LN metastasis than number of LN metastasis. Other lymph node staging systems have been proposed for GBA. We therefore sought to examine the performance of different staging systems including AJCC LN staging system, number of metastatic LN (NMLN), log odds of metastatic LN (LODDS), and LN ratio (LNR). Methods: Patients who underwent curative-intent resection for GBA between 2000 and 2015 and who had lymphadenectomy were identified from a multi-institutional database. The prognostic performance of four staging systems was compared by Harrell’s C and Akaike information criterion (AIC). Results: Overall 214 patients with a median age of 66.7 years (IQR 56.5, 73.1) were identified. A total 1,334 LNs were retrieved from 214 patients, with a median of 4 (IQR 2-8) LNs per patient. In the study cohort, 98 (45.5%) patients had LN metastasis with total of 271 positive LNs [median of 1 (IQR 1-3)]. Patients with LN metastasis had an increased risk of death (HR 1.87, 95%CI 1.24-2.82; P = 0.003). In addition, risk of death increased by each additional LN metastasis (HR 1.20, 95%CI 1.06-1.37; P = 0.005). In the entire cohort, LNR, in either a continuous (C-index: 0.603, AIC: 808.4) or a discrete scale (C-index 0.609, AIC 802.2), provided better discrimination versus LODDS, AJCC LN staging system, and NMLN. The relative performance of all scoring systems was better among patients who had ≥ 4 LN examined. In the cohort of patients with ≥ 4 LN examined, LODDS (C-index 0.621, AIC 363.8) had the best performance compared with LNR (C-index 0.615, AIC 368.7), AJCC LN staging system (C-index 0.601, AIC 373.4), and NMLN (C-index 0.613, AIC 369.5). Conclusions: LODDS and LNR performed better than the AJCC LN staging system. Among those who had more LN examined, LODDS performed better than LNR. LODDS and LNR should be incorporated into the AJCC LN staging system of GBA.

Proposal of a new lymph node staging system for gastric cancer: study from two institutions in China

2014 ◽  
Vol 31 (10) ◽  
Author(s):  
Jizhun Zhang ◽  
Kewei Jiang ◽  
Yong Liu ◽  
Yingjiang Ye ◽  
Liang Lv ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Staging System ◽  
Lymph Node Staging ◽  
Cancer Study ◽  
Gastric Cancer Study

Comparison of lymph node staging system in gastric cancer using time-dependent ROC analysis with Harrell’s concordance index.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 12-12
Author(s):  
Etsuro Bando ◽  
Norihiko Sugisawa ◽  
Masanori Tokunaga ◽  
Yutaka Tanizawa ◽  
Taiichi Kawamura ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Survival Rate ◽  
Roc Analysis ◽  
Staging System ◽  
Time Dependent ◽  
Lymph Node Staging ◽  
Anatomical Location ◽  
Node Negative ◽  
Staging Systems

12 Background: The aim this study was to clarify what the most informative pathologic lymph node staging system in gastric cancer is, by using time-dependent receiver operating characteristic (ROC) analysis with Harrell’s concordance (c) index. Methods: This study enrolled 2747 primary gastric cancer patients, without prior chemotherapy, who underwent R0 or R1 macroscopically curative resection. We calculated concordance indices of different 3 nodal staging systems (anatomical level based on JPN 13th edition vs. numbers of metastatic nodes based upon TNM 7th edition vs. ratio of metastatic nodes; derived from Yu’s definition {Yu et al. Br J Surg;1997,N0:0, N1;0-0.1, N2;0.1-0.25, N3;0.25-}) for survival. Results: (Anatomical level) Harrell’s c-index was 0.754 with 5-year survival rate of N0; 93%, N1; 73%, N2; 51%, N3; 19%. C-index without node-negative patients was 0.628. (Numbers of positive nodes) C-index was 0.767 with 5-year survival rate of N0; 93%, N1; 81%, N2; 68%, N3; 37%. C-index without node-negative patients was 0.669. (Ratio of nodal involvement) C-index was 0.770 with 5-year survival rate of N0; 93%, N1; 80%, N2; 63%, N3; 29%. C-index without node-negative patients was 0.691, which is significantly larger than those in anatomical level or numbers of positive nodes (p<0.001, p=0.014, respectively). (Comparison of Staging System) If combined pT category with ratio grading system without pStage IA, new staging system is the significantly most informative (c-index; 0.760) than JPN 13th (c-index; 0.735) or TNM 7th (c-index; 0.742) (p=0.009, p=0.023, respectively). Conclusions: Lymph node staging system based on the conception of ratio of metastatic nodes is the most informative staging system than those with anatomical location or numbers of metastatic nodes. These results suggested that in gastric cancer pathologic staging system in next TNM classification should include the ratio of metastatic nodes.

A novel simplified approach to incorporating lymph node ratio into gastric cancer staging.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 24-24
Author(s):  
Sarah B. Fisher ◽  
Malcolm Hart Squires ◽  
Sameer H. Patel ◽  
David A. Kooby ◽  
Kenneth Cardona ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Node Ratio ◽  
Staging System ◽  
Cancer Staging ◽  
Lymph Node Staging ◽  
Cox Regression Analysis ◽  
Simplified Approach ◽  
Staging Systems ◽  
Node Ratio

24 Background: Previous investigators have reported on the value of lymph node ratio (LNR, defined as the number of positive nodes divided by the total number of nodes assessed) in gastric adenocarcinoma (GAC) staging. Given the complexity of previously proposed staging systems, it has not gained widespread acceptance. The aim of our study was to offer a novel simplified approach to incorporating LNR into gastric cancer staging. Methods: 131 patients who underwent curative intent resection with lymphadenectomy for GAC between 1/00-6/11 were identified. Clinicopathologic factors were assessed. Primary outcome was overall survival (OS). Results: Median age was 64 yrs, 51% were male. Median tumor size was 3.5 cm, 67% were poorly differentiated, 20% had perineural invasion, 31% had lymphovascular invasion, and 6% had a positive margin. Locoregional nodal metastases were present in 59% (n=77, N0: 41%, N1: 18%, N2: 22%, N3a: 14%, N3b: 5%). Median number of lymph nodes (LN) assessed was 15.5. Mean FU was 27.3 mos, median OS was 29.3 mos. Median LNR was 0.4 (.04-1). Patients with LNR ≥0.4 had decreased OS as compared to patients with LNR <0.4 (15.1 vs 41.5 mos, p<0.0001); the survival of patients with LNR <0.4 was similar to that of node negative pts (48 mos, p=0.882). On Cox regression analysis, LNR ≥0.4 was more strongly associated with decreased OS (HR 3.09, 95%CI: 1.81-5.26; p<0.0001) compared to the AJCC 7th edition N stage (HR 1.36, 95%CI: 1.11-1.68; p=0.004). In the subset of patients who were inadequately staged and had <16 nodes examined, a LNR ≥0.4 was associated with reduced survival compared to a LNR <0.4 (17.3 vs 41.5 mos, p=.04). Conclusions: Compared to the current lymph node staging system, a lymph node ratio using 0.4 as the cutoff may more accurately predict survival outcomes. It seems to be particularly useful in patients who have inadequate nodal assessment. This simplified approach to lymph node ratio may be a more valuable staging tool than the current AJCC nodal staging system for gastric cancer and needs to be validated.

A new prognostic staging system for pulmonary metastases from colorectal cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 454-454
Author(s):  
Tomoichiro Hirosawa ◽  
Michio Itabashi ◽  
Yoshiko Bamba ◽  
Shimpei Ogawa ◽  
Kenichi Sugihara ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Lymph Node ◽  
Pulmonary Resection ◽  
Pulmonary Metastases ◽  
Hepatic Metastases ◽  
Staging System ◽  
Related Factors ◽  
Group A ◽  
Node Metastases ◽  
Prognostic Staging System

454 Background: A number of studies have examined the prognostic factors associated with pulmonary metastases of colorectal carcinoma (CRC). However, it has not yet been clarified which factor to emphasize taking the treatment strategy into consideration. Methods: The baseline characteristics and outcomes on 352 CRC patients undergoing complete pulmonary resection were collected from 19 institutions by the Japanese Society for Cancer of the Colon and Rectum (JSCCR) Study Group (Group A). The clinical and pathological factors were entered into a multivariate analysis to identify independent variables that were helpful for accurately predicting the long-term prognoses after pulmonary resection. Using the prognostic factors of Group A and the following processes (1) to (3), we developed and examined a new prognostic staging system (PSS): (1) Pulmonary (PUL) staging was performed using only pulmonary metastases-related factors in order to further clarify the prognosis. (2) The PSS was created using the PUL staging, primary cancer-related factors and hepatic metastases-related factors. (3) The new PSS was examined in a validation study in a series of 944 patients from 110 institutions of the JSCCR by the 78th society of the JSCCR (Group B). Results: (1) PUL1a: No. of metastases (No.) = 1 and DFI > 2 years;(The 5-year OS: 66.7%, RFS rates: 52.8%). PUL1b: No. = 1 and DFI ≤ 2 years or No. = 2 or No. ≥ 3 and a unilateral distribution; (47.4%, 30.7%). PUL2:No. ≥ 3 and a bilateral distribution or the presence of lymph node metastases or pleural dissemination; (17.4%, 11.1%), (p<0.01). (2) Grade A: PUL1a and lymph node metastases of N0, N1 or N2, or PUL1b and N0; (75.4%, 55.1%). Grade B: PUL1a and N3 or hepatic metastases cases or PUL1b and N1 or N2; (52.0%, 30.8%). Grade C: PUL1b and N3 or hepatic metastases cases or PUL2; (18.2%, 9.0%), (p<0.01). (3) Grade A (n=324): 75.3%, 53.7%; Grade B (n=359): 60.8%, 41.5% and Grade C (n=261): 48.2%, 21.9%. (p<0.01). Conclusions: Our new PSS was useful for the selection of patients suitable for pulmonary resection.

scholarly journals Development of a novel salivary gland cancer lymph node staging system

Cancer ◽  
2018 ◽  
Vol 124 (15) ◽  
pp. 3171-3180 ◽  
Author(s):  
Katri Aro ◽  
Allen S. Ho ◽  
Michael Luu ◽  
Sungjin Kim ◽  
Mourad Tighiouart ◽  
...  
Keyword(s):  
Salivary Gland ◽  
Lymph Node ◽  
Staging System ◽  
Salivary Gland Cancer ◽  
Lymph Node Staging

scholarly journals A “perfect” lymph node staging system requires a “perfect” surgery

2016 ◽  
Vol 1 ◽  
pp. 10-10 ◽  
Author(s):  
Laura Ruspi ◽  
Federica Galli ◽  
Francesco Frattini ◽  
Chiara Peverelli ◽  
Giuseppe Di Rocco ◽  
...  
Keyword(s):  
Lymph Node ◽  
Staging System ◽  
Lymph Node Staging

Postoperative nomogram for predicting survival after resection for intrahepatic cholangiocarcinoma.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 4129-4129
Author(s):  
Dario Ribero ◽  
Stefano Rosso ◽  
Antonio Daniele Pinna ◽  
Gennaro Nuzzo ◽  
Alfredo Guglielmi ◽  
...  
Keyword(s):  
Intrahepatic Cholangiocarcinoma ◽  
Missing Values ◽  
Cox Regression ◽  
Predictive Accuracy ◽  
Tumour Size ◽  
Staging System ◽  
Internal Validation ◽  
Staging Systems ◽  
Patient Prognosis ◽  
Uicc Staging System

4129 Background: Conventional staging systems have limited value for survival estimation in individual patients because of the multiple predictors of outcome. Nomograms may overcome these limitations. Thus we developed and internally validated a postoperative nomogram to predict survival after resection of intrahepatic cholangiocarcinoma (IHC) and compared its predictions to those obtained using the 7th Ed. AJCC/UICC stage groupings. Methods: Prospective clinicopathologic data from 574 patients who underwent hepatic resection at 12 tertiary hepatobiliary centres (1995-2011) were used. After inputting missing values with regression imputation, the nomogram was developed from a Cox regression model with overall survival (OS) as the primary end-point. Calibration and internal validation were performed calculating the agreement between observed and predicted outcomes in terms of percentage of predicted errors (PE). Discrimination was quantified with the concordance index (CI). Both CI and PE were then corrected for over-optimism using bootstrapping with 100-fold cross-validation sampling. Credibility intervals around 3- and 5-year predicted survival were estimated from an empirical Bayesian model. Results: At last follow-up (median duration 27.6 months) 243 patients had died. Three and five-years OS were 52% and 39%. The predictive accuracy of the nomogram (CI: 66.5), which includes 7 variables (tumour size and number, lymph-node metastases, vascular invasion, perineural invasion, CA19.9 level, and radicality of resection), was good and superior to that of the current AJCC/UICC staging system (CI: 58.4). Percentage of PE for the AJCC/UICC staging system were 24%, while the studied model offered a PE slightly under 20%. Heterogeneity was observed in the distribution of nomogram-predicted survival probabilities within stage groups. Conclusions: The nomogram developed in this study overcomes some of the prognostic limitations associated with simple models by including all prognostic variables excluded from the AJCC/UICC staging system and may serve as an instrument for future refinements in determining individual patient prognosis necessary for accurate patients stratification.

scholarly journals Construction and External Validation of a Nomogram for Predicting Survival of Intrahepatic Cholangiocarcinoma Patients Without Lymph Node and Distant Metastasis

2021 ◽  
Author(s):  
Chuang Jiang ◽  
Fei Teng ◽  
Yunyou Tang ◽  
Ziqi Zhang ◽  
Yimin Chen ◽  
...  
Keyword(s):  
Lymph Node ◽  
Intrahepatic Cholangiocarcinoma ◽  
Validation Cohort ◽  
External Validation ◽  
Staging System ◽  
Tnm Staging ◽  
Internal Validation ◽  
West China Hospital ◽  
Training Cohort ◽  
West China

Abstract BackgroundThe purpose of this study was to construct and external validate a nomogram for predicting overall survival(OS) in intrahepatic cholangiocarcinoma (ICC) patients classified as N0M0 according to the 7th edition of American Joint Committee on Cancer (AJCC) TNM staging system.Methods:812 ICC patients without distant and lymph node metastasis between 2011 to 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database, then randomly assigned to the training cohort(n=648) or internal validation cohort(n=164), external validation cohort consisted of 136 ICC patients with N0M0 stage treated in West China Hospital of Sichuan University from 2013 to 2015. The precision of the nomogram was validated internally using SEER validation cohort and externally using the patients’ data of West China Hospital. Results :The nomogram was established to predict 1-year, 3-year and 5-year OS and the calibration curve showed nomogram prediction performance was in good agreement with the actual results. The C‑index of the nomogram was 0.750(95% CI:0.731-0.769) in the training cohort, and the internal and external validated C-indexes were 0.803(95% CI:0.783-0.823) and 0.681(95% CI:0.524-0.838), respectively. In the training, internal and external validation cohort, the 1-year, 3‑year and 5‑year AUCs were (0.772,0.809,0.798),(0.896,0.868,0.896) and (0.673,0.786,0.886), respectively.Conclusions This nomogram has an excellent predictive effect on the 1- ,3-, 5-year OS of ICC patients with stage N0M0 and guide the optimal treatment for these type of patients.

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