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Ophthalmology Jul 2022To assess the predictive value of the tumor staging system in the AJCC Cancer Staging Manual, Eighth Edition, and histologic features for outcomes and metastasis...
PURPOSE
To assess the predictive value of the tumor staging system in the AJCC Cancer Staging Manual, Eighth Edition, and histologic features for outcomes and metastasis patterns in conjunctival melanoma (CM).
DESIGN
Retrospective, single-center cohort study.
PARTICIPANTS
Eighty-three patients with CM were treated at Shanghai Ninth People's Hospital between 2000 and 2021.
METHODS
We reviewed the clinical and histologic parameters and used Kaplan-Meier survival curves and Cox proportional hazards regression models for risk factor analyses.
MAIN OUTCOME MEASURES
Time to nodal/distant metastasis, disease-specific survival, metastatic pattern, and metastatic site.
RESULTS
At presentation, 5 patients (6%) had clinical tumor (cT)1 disease, 34 patients (41%) had cT2 disease, and 44 patients (53%) had cT3 disease. Four patients (5%) had nodal metastasis (N1), and none had distant metastasis (M1). During follow-up, 12 patients (14%) developed nodal metastasis, 29 patients (35%) developed distant metastasis, and 26 patients (31%) died of disease. The brain, liver, and lung were common distant metastasis sites. Higher cT category was associated with increased risks of distant metastasis (P < 0.001) and disease-specific death (P = 0.002). The separate analysis of primary and recurrent tumors at presentation showed that the patients with cT3 tumors had a higher risk of distant metastasis than those with cT2 tumors. Greater tumor thickness, ulceration, and the presence of regression were correlated with distant metastasis. Previously unreported mutations were detected in the tumor suppressor genes FAT atypical cadherin 4 (FAT4) and spleen associated tyrosine kinase (SYK). Among the 29 patients who developed distant metastasis, we analyzed 2 patterns of metastasis: Eleven patients (38%) developed nodal metastasis before distant metastasis, and 18 patients (62%) developed distant metastasis without previously known nodal metastasis. The patients with cT3 tumors were more likely to follow the latter metastasis pattern (P = 0.02).
CONCLUSIONS
Conjunctival melanoma presented with mostly advanced stages and high rates of distant metastasis in the current Chinese cohort. This study confirmed the prognostic value of the tumor staging system in the AJCC Cancer Staging Manual, Eighth Edition, for Chinese patients. Histologic features, such as tumor thickness and ulceration, should be emphasized when assessing prognosis and guiding the treatment of CM.
Topics: Bone Neoplasms; Breast Neoplasms; China; Cohort Studies; Conjunctival Neoplasms; Female; Humans; Lymphatic Metastasis; Melanoma; Neoplasm Recurrence, Local; Neoplasm Staging; Prognosis; Retrospective Studies; Ulcer; United States
PubMed: 35245602
DOI: 10.1016/j.ophtha.2022.02.029 -
Frontiers in Endocrinology 2023Medullary thyroid carcinoma (MTC) patients with distant metastases frequently present a relatively poor survival prognosis. Our main purpose was developing a nomogram...
Establishment and validation of a nomogram model for predicting distant metastasis in medullary thyroid carcinoma: An analysis of the SEER database based on the AJCC 8th TNM staging system.
OBJECTIVE
Medullary thyroid carcinoma (MTC) patients with distant metastases frequently present a relatively poor survival prognosis. Our main purpose was developing a nomogram model to predict distant metastases in MTC patients.
METHODS
This was a retrospective study based on the Surveillance, Epidemiology, and End Results (SEER) database. Data of 807 MTC patients diagnosed from 2004 to 2015 who undergone total thyroidectomy and neck lymph nodes dissection was included in our study. Independent risk factors were screened by univariate and multivariate logistic regression analysis successively, which were used to develop a nomogram model predicting for distant metastasis risk. Further, the log-rank test was used to compare the differences of Kaplan-Meier curves of cancer-specific survival (CSS) in different M stage and each independent risk factor groups.
RESULTS
Four clinical parameters including age > 55 years, higher T stage (T3/T4), higher N stage (N1b) and lymph node ratio (LNR) > 0.4 were significant for distant metastases at the time of diagnosis in MTC patients, and were selected to develop a nomogram model. This model had satisfied discrimination with the AUC and C-index of 0.894, and C-index was confirmed to be 0.878 through bootstrapping validation. A decision curve analysis (DCA) was subsequently made to evaluate the feasibility of this nomogram for predicting distant metastasis. In addition, CSS differed by different M stage, T stage, N stage, age and LNR groups.
CONCLUSIONS
Age, T stage, N stage and LNR were extracted to develop a nomogram model for predicting the risk of distant metastases in MTC patients. The model is of great significance for clinicians to timely identify patients with high risk of distant metastases and make further clinical decisions.
Topics: Humans; Middle Aged; Neoplasm Staging; Nomograms; Retrospective Studies; Thyroid Neoplasms
PubMed: 36875492
DOI: 10.3389/fendo.2023.1119656 -
AJR. American Journal of Roentgenology Aug 2017The objective of this study is to evaluate patterns of distant metastasis and identified factors that may increase the risk of distant metastasis in pediatric patients...
OBJECTIVE
The objective of this study is to evaluate patterns of distant metastasis and identified factors that may increase the risk of distant metastasis in pediatric patients with rhabdomyosarcoma.
MATERIALS AND METHODS
This retrospective study included 69 patients (age, ≤ 20 years) who had rhabdomyosarcoma diagnosed between January 2000 and February 2016. Various imaging features, including distant metastasis, were evaluated on initial and follow-up imaging studies. Differences in the distribution of distant metastasis on the basis of the primary location were analyzed. Logistic regression analysis was performed to identify factors associated with distant metastasis.
RESULTS
Twenty-six of the 69 patients (37.7%) had distant metastasis. Nineteen of the 26 patients had distant metastasis noted at initial presentation, and 15 of the 26 patients had new metastasis noted during follow-up. The most common site of metastasis was bone (n = 14), followed by lung (n = 12) and distant lymph nodes (n = 9). Lymph node metastasis more frequently developed in patients with primary rhabdomyosarcoma in an extremity than in patients with primary rhabdomyosarcoma that developed at other sites (p = 0.003). Of 15 patients who had metastasis during follow-up, nine (60%) did not appear to have simultaneous locoregional recurrence at the time of the discovery of distant metastasis. Older age at presentation and unfavorable sites of the primary tumor were significantly associated with distant metastasis in multivariate analysis.
CONCLUSION
Distant metastasis of rhabdomyosarcomas in pediatric patients showed different patterns according to the location of the primary tumor and even occurred without local recurrence.
Topics: Adolescent; Child; Diagnostic Imaging; Female; Humans; Male; Neoplasm Metastasis; Neoplasm Staging; Prognosis; Retrospective Studies; Rhabdomyosarcoma; Risk Factors; Soft Tissue Neoplasms; Survival Rate
PubMed: 28590782
DOI: 10.2214/AJR.16.17466 -
Cancer Diagnosis & Prognosis 2022Chondrosarcoma (CS) is a rare primary malignant bone tumor, which is the second most common tumor after osteosarcoma. Since chemotherapy and radiotherapy have poor...
BACKGROUND/AIM
Chondrosarcoma (CS) is a rare primary malignant bone tumor, which is the second most common tumor after osteosarcoma. Since chemotherapy and radiotherapy have poor efficacy for CS, amputation or surgical wide resection is the main strategy for localized high-grade CS, making CS therapy difficult. As studies on high-grade CS are limited owing to its rare nature, there are many unknown prognostic factors for survival.
PATIENTS AND METHODS
This retrospective cohort study included 44 patients with high-grade CS who underwent surgery at a single institution. Overall survival (OS), distant failure-free survival (DFFS), and local failure-free survival (LFFS) were evaluated using the Kaplan-Meier method. Furthermore, we evaluated prognostic factors for survival in patients with high-grade CS using univariate and multivariate analyses.
RESULTS
The 5-year OS, LFFS, and DFFS rates of high-grade CS were 75.9%, 90.8%, and 66.5%, respectively. Univariate analysis revealed that tumor size, tumor grade, and surgical margin were significant prognostic factors for OS and DFFS, and distant metastasis was significantly associated with OS. Furthermore, the multivariate analysis indicated that the presence of local recurrence and distant metastasis was significantly associated with OS.
CONCLUSION
Local recurrence and distant metastasis were significant prognostic factors for high-grade CS.
PubMed: 36340450
DOI: 10.21873/cdp.10159 -
Head & Neck Sep 2017Most trials in head and neck cancer emphasize locoregional control, as this is the main pattern of therapy failure. However, up to 15% of patients develop distant...
BACKGROUND
Most trials in head and neck cancer emphasize locoregional control, as this is the main pattern of therapy failure. However, up to 15% of patients develop distant metastases. The purpose of this study was to present the investigated factors associated with distant metastasis in a single-center patient cohort.
METHODS
A retrospective analysis of a single-center patient cohort over an 18-year period has been performed. We report on prevalence and incidence of distant metastasis, timing in relation to locoregional failure, Kaplan-Meier analysis for actuarial distant control rates, and univariate analysis taking into account histological, etiologic, surgical, site-dependent, stage-dependent characteristics, modality of primary therapy, and locoregional control.
RESULTS
Of 1022 patients, 141 (13.8%) were diagnosed with distant metastases involving 283 sites. Actuarial rates of distant control were 88%, 84%, 80%, and 79% at 1, 2, 5, and 10 years, respectively. Factors associated with distant metastasis are stage grouping and regional node positivity, extranodal extension, locoregional residual disease, and human papillomavirus (HPV) negative status in oropharyngeal squamous cell carcinoma.
CONCLUSION
Distant metastases in head and neck cancer led to dismal prognosis. Factors associated with distant metastasis are related to characteristics of the primary tumor. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1733-1743, 2017.
Topics: Adult; Aged; Aged, 80 and over; Belgium; Carcinoma, Squamous Cell; Cause of Death; Cohort Studies; Databases, Factual; Disease-Free Survival; Female; Head and Neck Neoplasms; Humans; Kaplan-Meier Estimate; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Metastasis; Neoplasm Staging; Prognosis; Retrospective Studies; Risk Assessment; Squamous Cell Carcinoma of Head and Neck; Survival Analysis
PubMed: 28650113
DOI: 10.1002/hed.24687 -
Cancers Jul 2019Although metastases of ovarian and peritoneal carcinomatosis are most commonly found within the peritoneal cavity, there is a number of other rare distant sites that... (Review)
Review
Although metastases of ovarian and peritoneal carcinomatosis are most commonly found within the peritoneal cavity, there is a number of other rare distant sites that have been reported. Our goal is to provide an evidence-based summary of the available literature considering the rare distant metastatic sites of ovarian and peritoneal carcinomatosis. A comprehensive search of the literature was conducted, with Medline/PubMed being searched for cases of rare metastatic disease originated from primary ovarian and peritoneal cancer with related articles up to 2019 including terms such as "ovarian cancer", "metastases", "peritoneal" and others. The most common mechanism of ovarian cancer metastases consists of primarily dissemination within the peritoneal cavity, while, rare and distant sites can either occur at the beginning or during the course of the disease and they are usually associated with hematogenous route and lymphatic invasion, having poor prognosis, with the least common sites being skin, bone, CNS, eye, placenta, central airways, rare lymph nodes, intra-abdominal organs, heart and breast. The occurrence of metastatic sites described in this review represents the most common rare distant metastatic sites, and even though their patterns of metastases are still not fully clarified due to the rarity of the reports, they offer valuable information considering the pathophysiology of the disease.
PubMed: 31344859
DOI: 10.3390/cancers11081044 -
IEEE Transactions on Bio-medical... Oct 2020The ability to measure event-related potentials (ERPs) as practical, portable brain vital signs is limited by the physical locations of electrodes. Standard electrode...
OBJECTIVE
The ability to measure event-related potentials (ERPs) as practical, portable brain vital signs is limited by the physical locations of electrodes. Standard electrode locations embedded within the hair result in challenges to obtaining quality signals in a rapid manner. Moreover, these sites require electrode gel, which can be inconvenient. As electrical activity in the brain is spatially volume distributed, it should be possible to predict ERPs from distant sensor locations at easily accessible mastoid and forehead scalp regions.
METHODS
An artificial neural network was trained on ERP signals recorded from below hairline electrode locations (Tp9, Tp10, Af7, Af8 referenced to Fp1, Fp2) to predict signals recorded at the ideal Cz location.
RESULTS
The model resulted in mean improvements in intraclass correlation coefficient relative to control for all stimulus types (Standard Tones: +9.74%, Deviant Tones: +3.23%, Congruent Words: +15.25%, Incongruent Words: +25.43%) and decreases in RMS Error (Standard Tones: -26.72%, Deviant Tones: -17.80%, Congruent Words: -28.78%, Incongruent Words: -29.61%) compared to the individual distant channels. Measured vs predicted ERP amplitudes were highly and significantly correlated with control for the N100 (R = 0.5, p < 0.05), P300 (R = 0.75, p < 0.01), and N400 (R = 0.75, p < 0.01) ERPs.
CONCLUSION
ERP waveforms at distant channels can be combined using a neural network autoencoder to model the control channel features with better precision than those at individual distant channels. This is the first demonstration of feasibility of predicting evoked potentials and brain vital signs using signals recorded from more distant, practical locations.
SIGNIFICANCE
This solves a key engineering challenge for applications that require portability, comfort, and speed of measurement as design priorities for measurement of event-related potentials across a range of individuals, settings, and circumstances.
Topics: Brain; Electrodes; Electroencephalography; Evoked Potentials; Female; Humans; Male; Scalp
PubMed: 32070941
DOI: 10.1109/TBME.2020.2973617 -
Acta Medica Okayama Apr 2022Cases of breast cancer metastasis after achieving a pathological complete response (pCR) with neoadjuvant chemotherapy (NAC) are sometimes encountered in clinical...
Cases of breast cancer metastasis after achieving a pathological complete response (pCR) with neoadjuvant chemotherapy (NAC) are sometimes encountered in clinical practice. We investigated the prognostic factors for pCR in patients with breast cancer after NAC. This retrospective cohort study included patients with localized breast cancer who underwent NAC followed by surgery between 2004 and 2020 and achieved a pCR. The associations between clinical factors and distant metastasis-free survival rate were statistically analyzed. We analyzed data for 127 patients. Twelve patients (9.4%) had distant metastases, and seven (5.5%) died. For estrogen receptor (ER)-positive patients, the distant metastasis-free survival rate was 94.6% for both 5 and 8 years. In contrast, ER-negative patients had a distant metastasis-free survival rate of 87.6% and 85.4% for 5 and 8 years (p=0.094), respectively. In cT0-2 patients, the distant metastasis-free survival rate was 92.4% for 5 years and 90.5% for 8 years, whereas in cT3-4 patients, the distant metastasis-free survival rate was 83.5% for 5 years and 83.5% for 8 years (p=0.301). This study suggested that patients with ER-negative, pre-NAC cT3 or T4 breast cancer who had achieved a pCR after NAC tended to have a worse prognosis.
Topics: Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Chemotherapy, Adjuvant; Female; Humans; Neoadjuvant Therapy; Prognosis; Retrospective Studies
PubMed: 35503437
DOI: 10.18926/AMO/63403 -
Frontiers in Oncology 2024Extraocular sebaceous carcinoma (SC), particularly those outside the head and neck region, is rare and not well-described.
INTRODUCTION
Extraocular sebaceous carcinoma (SC), particularly those outside the head and neck region, is rare and not well-described.
PURPOSE
This study aimed to explore the epidemiology and identify the prognostic factors of non-head and neck SC, describe the possible relevant factors of distant metastasis, and provide implications for distant metastasis screening.
METHODS
Data from the 17 registries in the Surveillance, Epidemiology, and End Results database were retrospectively collected for patients with SC outside the head and neck from 2000 through 2020. Overall survival (OS) and disease-specific survival (DSS) were the primary endpoints. Survival analysis was conducted through Kaplan-Meier curves, and multivariate analysis was carried out using Cox proportional hazard models.
RESULTS
A total of 1,237 patients with SC outside the head and neck were identified. The mean age at diagnosis of the entire patient cohort was 67.7 years (30 to 90+ years), and the mean tumor size was 2.2 cm (0.1-16 cm). Patients with distant disease experienced the lowest OS (mean, 29.5 months) than those with localized disease and regional disease ( < 0.0001). Multivariate analysis revealed that age, tumor size, and stage were independent determinants of OS; age, stage, and primary site were independent determinants of DSS. Tumor grade and lymph node status had less prognostic value for survival. Undifferentiated tumors have a trend toward distant metastasis, especially those at the primary site of the trunk.
CONCLUSION
The prognosis of the non-head and neck SC is excellent, while the survival of distant disease is very poor. Distant metastasis screening can be considered for undifferentiated tumors, especially those located in the trunk region with large tumor sizes.
PubMed: 38800410
DOI: 10.3389/fonc.2024.1395273 -
BMC Cancer Mar 2023Breast cancer has become the most common malignant tumour worldwide. Distant metastasis is one of the leading causes of breast cancer-related death. To verify the...
BACKGROUND
Breast cancer has become the most common malignant tumour worldwide. Distant metastasis is one of the leading causes of breast cancer-related death. To verify the performance of clinicomics-guided distant metastasis risk prediction for breast cancer via artificial intelligence and to investigate the accuracy of the created prediction models for metachronous distant metastasis, bone metastasis and visceral metastasis.
METHODS
We retrospectively enrolled 6703 breast cancer patients from 2011 to 2016 in our hospital. The figures of magnetic resonance imaging scanning and ultrasound were collected, and the figures features of distant metastasis in breast cancer were detected. Clinicomics-guided nomogram was proven to be with significant better ability on distant metastasis prediction than the nomogram constructed by only clinical or radiographic data.
RESULTS
Three clinicomics-guided prediction nomograms on distant metastasis, bone metastasis and visceral metastasis were created and validated. These models can potentially guide metachronous distant metastasis screening and lead to the implementation of individualized prophylactic therapy for breast cancer patients.
CONCLUSION
Our study is the first study to make cliniomics a reality. Such cliniomics strategy possesses the development potential in artificial intelligence medicine.
Topics: Humans; Female; Breast Neoplasms; Retrospective Studies; Artificial Intelligence; Nomograms; Bone Neoplasms
PubMed: 36918809
DOI: 10.1186/s12885-023-10704-w