The 8th edition of AJCC cancer staging system will be launched all over the world in January 1, 2018. The major advances in the 8th edition are the introduction of non-anatomic prognostic and predictive factors supported by I(-II( grade evidence based on histopathology and molecular biology, and the improvement of prognostic assessment system based on these factors, including CEA level, cancer retraction score, circumference margin, lymphatic invasion, peripheral nerve invasion, microsatellite instability, KRAS/NRAS gene mutation and BRAF gene mutation. In the background of evidence-based medicine and precise medicine, combination of anatomic staging and non-anatomic classification system is very important for establishing and improving the prognostic and predictive assessment system of colorectal cancer. This will help to assess colorectal cancer staging and grouping much better, evaluate the prognosis, predict individualized efficacy, and promote clinical practice of colorectal cancer from traditional population-based diagnosis and treatment to the precise individualized care.
Carcinoembryonic Antigen ; blood ; Colorectal Neoplasms ; classification ; diagnosis ; Female ; Humans ; Male ; Microsatellite Instability ; Mutation ; Neoplasm Invasiveness ; Neoplasm Staging ; standards ; Precision Medicine ; methods ; trends ; Prognosis ; Proto-Oncogene Proteins B-raf ; genetics ; Proto-Oncogene Proteins p21(ras) ; genetics

OBJECTIVE: Since European Society for Medical Oncology (ESMO) recommendations and French guidelines, pelvic lymphadenectomy should not be systematically performed for women with early-stage endometrioid endometrial cancer (EEC) preoperatively assessed at presumed low- or intermediate-risk. The aim of our study was to evaluate the change of our surgical practices after ESMO recommendations, and to evaluate the rate and morbidity of second surgical procedure in case of understaging after the first surgery. METHODS: This retrospective single-center study included women with EEC preoperatively assessed at presumed low- or intermediate-risk who had surgery between 2006 and 2013. Two periods were defined the times before and after ESMO recommendations. Demographics characteristics, surgical management, operative morbidity, and rate of understaging were compared. The rate of second surgical procedure required for lymph node resection during the second period and its morbidity were also studied. RESULTS: Sixty-one and sixty-two patients were operated for EEC preoperatively assessed at presumed low-or intermediate-risk before and after ESMO recommendations, respectively. Although immediate pelvic lymphadenectomy was performed more frequently during the first period than the second period (88.5% vs. 19.4%; p<0.001), the rate of postoperative risk-elevating or upstaging were comparable between the two periods (31.1% vs. 27.4%; p=0.71). Among the patients requiring second surgical procedure during the second period (21.0%), 30.8% did not undergo the second surgery due to their comorbidity or old age. For the patients who underwent second surgical procedure, mean operative time of the second procedure was 246.1+/-117.8 minutes. Third operation was required in 33.3% of them because of postoperative complications. CONCLUSION: Since ESMO recommendations, second surgical procedure for lymph node resection is often required for women with EEC presumed at low- or intermediate-risk. This reoperation is not always performed due to age/comorbidity of the patients, and presents a significant morbidity.
Aged ; Carcinoma, Endometrioid/epidemiology/pathology/*surgery ; Endometrial Neoplasms/epidemiology/pathology/*surgery ; Female ; Humans ; *Hysterectomy/methods/statistics & numerical data ; Lymph Node Excision/*methods/standards/statistics & numerical data ; Middle Aged ; Morbidity ; Neoplasm Staging/standards ; Pelvis ; Postoperative Complications/epidemiology ; Prognosis ; Reoperation/statistics & numerical data ; Retrospective Studies ; *Salpingectomy/methods/statistics & numerical data

No abstract available.
Fallopian Tube Neoplasms/classification/*pathology ; Female ; Gynecology/organization & administration/standards ; Humans ; International Agencies ; Neoplasm Staging/methods/*standards ; Obstetrics/organization & administration/standards ; Ovarian Neoplasms/classification/*pathology ; Peritoneal Neoplasms/classification/*pathology ; *Practice Guidelines as Topic

OBJECTIVE: To evaluate the accuracy of magnetic resonance imaging (MRI) with lumen distention for rectal cancer staging and circumferential resection margin (CRM) involvement prediction. MATERIALS AND METHODS: Seventy-three patients with primary rectal cancer underwent high-resolution MRI with a phased-array coil performed using 60-80 mL room air rectal distention, 1-3 weeks before surgery. MRI results were compared to postoperative histopathological findings. The overall MRI T staging accuracy was calculated. CRM involvement prediction and the N staging, the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were assessed for each T stage. The agreement between MRI and histological results was assessed using weighted-kappa statistics. RESULTS: The overall MRI accuracy for T staging was 93.6% (k = 0.85). The accuracy, sensitivity, specificity, PPV and NPV for each T stage were as follows: 91.8%, 86.2%, 95.5%, 92.6% and 91.3% for the group < or = T2; 90.4%, 94.6%, 86.1%, 87.5% and 94% for T3; 98,6%, 85.7%, 100%, 100% and 98.5% for T4, respectively. The predictive CRM accuracy was 94.5% (k = 0.86); the sensitivity, specificity, PPV and NPV were 89.5%, 96.3%, 89.5%, and 96.3% respectively. The N staging accuracy was 68.49% (k = 0.4). CONCLUSION: MRI performed with rectal lumen distention has proved to be an effective technique both for rectal cancer staging and involved CRM predicting.
Adult ; Aged ; *Air ; Dilatation/methods ; Female ; Humans ; Magnetic Resonance Imaging/*methods/standards ; Male ; Middle Aged ; Neoplasm Staging/*methods ; Prospective Studies ; Rectal Neoplasms/*pathology/surgery ; Rectum/*pathology ; Sensitivity and Specificity

INTRODUCTIONPreoperative staging is essential for the optimal treatment and surgical planning of colorectal cancers. This study was aimed to evaluate the accuracy of colorectal cancer staging done using contrast-enhanced multidetector computed tomographic colonography (CEMDCTC).

METHODSWe recruited 25 patients with 28 proven colorectal cancers. A 16-slice multidetector computed tomography scanner was used to generate two-dimensional multiplanar reformatted sagittal, coronal and oblique coronal images, and three-dimensional virtual colonography (endoluminal) images. Axial and reformatted views were analysed, and TNM staging was done. Patients underwent surgery and conventional colonoscopy, and surgical histopathological correlation was obtained.

RESULTSThe diagnostic accuracies for TNM colorectal cancer staging were 92.3% for T staging, 42.3% for N staging and 96.1% for M staging using CEMDCTC. There was excellent positive correlation for T staging between CEMDCTC and both surgery (κ-value = 0.686) and histopathology (κ-value = 0.838) (p < 0.0001), and moderate positive correlation for N staging between CEMDCTC and surgery (κ-value = 0.424; p < 0.0001). The correlation between CEMDCTC and histopathology for N staging was poor (κ-value = 0.186; p < 0.05); the negative predictive value was 100% for lymph node detection. Moderate positive correlation was seen for M staging between CEMDCTC and both surgery (κ-value = 0.462) and histopathology (κ-value = 0.649). No false negatives were identified in any of the M0 cases.

CONCLUSIONCEMDCTC correlated well with pathologic T and M stages, but poorly with pathologic N stage. It is an extremely accurate tool for T staging, but cannot reliably distinguish between malignant lymph nodes and enlarged reactive lymph nodes.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Colonography, Computed Tomographic ; methods ; standards ; Colorectal Neoplasms ; diagnosis ; pathology ; surgery ; Contrast Media ; Female ; Humans ; Lymph Nodes ; pathology ; Male ; Middle Aged ; Multidetector Computed Tomography ; standards ; Neoplasm Staging ; methods ; Prospective Studies ; Reproducibility of Results ; Young Adult

Rectal cancer is one of the most common malignancies in human. Because rectal cancer locates in the narrow pelvis and is close to many complicated anatomic structures, seeking R0 resection and decreasing the positive rate of circumferential resection margin become the focus of concern for surgeons. The authors review the diagnosis standard of rectal cancer in AJCC TNM cancer staging (seventh edition) and guideline of College of American Pathologists, and propose the concept of "diagnosis priority using the standardized methods". Selecting the correct medical imaging and pathology diagnosis methods is the key to improve the standardized and individualized comprehensive therapy.
Diagnostic Imaging ; methods ; standards ; Humans ; Neoplasm Staging ; Prognosis ; Rectal Neoplasms ; diagnosis ; pathology

OBJECTIVE: To compare the accuracy of computed tomography (CT) with that of gastroscopy for the extent of evaluation of longitudinal tumor and type-specific diagnosis of Borrmann type IV gastric cancer. MATERIALS AND METHODS: Fifty-nine patients (35 men with mean age of 60 years and 24 women with mean age of 55 years) who underwent surgical resection of Borrmann type IV gastric cancer were included in this study. Histopathological analysis data was used as a reference standard to confirm the clinical interpretations of gastroscopy and CT for the diagnosis of Borrmann type IV and evaluation of longitudinal tumor extent. For the evaluation of longitudinal extent, gastroscopic and CT results were classified as underestimated, accurate, or overestimated. The McNemar test was used to identify statistically significant differences in the accuracy between gastroscopy and CT. RESULTS: For the diagnosis of Borrmann type IV gastric cancer, the accuracy of CT was significantly higher than that of gastroscopy (74.6% [44/59] vs. 44.1% [26/59], p < 0.001). CT was significantly more accurate in assessing the overall tumor extent than gastroscopy (61.4% [35/57] vs. 28.1% [16/57], p < 0.001). The proximal (75.4% [43/57] vs. 50.9% [29/57], p = 0.003) and distal tumor extent (71.9% [41/57] vs. 43.9% [25/57], p < 0.05) were more accurately predicted by CT compared with gastroscopy. The underestimation of tumor extent was a major source of error in both examinations. CONCLUSION: CT was found to be more predictive than gastroscopy in type-specific diagnosis and the evaluation of longitudinal tumor extent in patients with Borrmann type IV gastric cancer.
Adult ; Aged ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Gastrectomy ; Gastroscopy/*methods ; Humans ; Male ; Middle Aged ; Neoplasm Staging/*methods/standards ; Reproducibility of Results ; Retrospective Studies ; Stomach Neoplasms/*diagnosis/surgery ; Tomography, X-Ray Computed/*methods

Carcinoma, Squamous Cell ; diagnosis ; therapy ; China ; Combined Modality Therapy ; Esophageal Neoplasms ; diagnosis ; therapy ; Esophagectomy ; methods ; Esophagoscopy ; Humans ; Neoplasm Staging ; Practice Guidelines as Topic ; standards ; Research

BACKGROUND AND OBJECTIVEAlthough surgery is the only possible means to cure gastric cancer, the prognosis is often discrepant. The American Joint Committee on Cancer / International Union against Cancer (AJCC/UICC) published the TNM classification of Malignant Tumors (seventh edition) for gastric cancer recently. This study aimed to use this new edition staging system to investigate the prognostic factors for gastric cancer.

METHODSThe clinicopathologic data of 980 patients with gastric cancer treated by surgical resection in our hospital between January 2000 and December 2006 were analyzed retrospectively. The overall survival rate was determined by using Kaplan-Meier method and log-rank test was used to determine significance. The prognosis was analyzed using univariate analysis and multivariate analysis with the Cox proportional hazards model. The 6th and 7th edition AJCC/UICC TNM staging systems were used to compare the survival outcomes for the cohort of patients.

RESULTSThe overall 1-, 3-, 5-year survival rates for the whole group were 82.5%, 58.7%, and 52.6%. The 5-year survival rates for patients with pTNM stage I, II, III, and IV disease classified by the 7th edition staging system were 93.2%, 72.4%, 39.1%, and 5.2%, respectively. In both univariate analysis and Cox multivariate analysis, age, tumor site, tumor size, histological type, resection type, radical resection, lymphatic/venous invasion, depth of invasion, nodal status, metastasis, retrieved lymph nodes, metastatic lymph node ratio, and adjuvant chemotherapy were prognostic factors with these patients.

CONCLUSIONCompared with the 6th edition system, the new edition of TNM staging system for gastric cancer can accurately predict the survival after operation.

Adenocarcinoma ; classification ; pathology ; surgery ; Adenocarcinoma, Mucinous ; classification ; pathology ; surgery ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Signet Ring Cell ; classification ; pathology ; surgery ; Cohort Studies ; Female ; Follow-Up Studies ; Gastrectomy ; methods ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; methods ; standards ; Proportional Hazards Models ; Retrospective Studies ; Stomach Neoplasms ; classification ; pathology ; surgery ; Survival Rate ; Young Adult

Adenocarcinoma ; classification ; pathology ; Carcinoma, Squamous Cell ; classification ; pathology ; Esophageal Neoplasms ; classification ; pathology ; Humans ; International Cooperation ; Lymphatic Metastasis ; pathology ; Neoplasm Invasiveness ; Neoplasm Staging ; methods ; standards ; Societies, Medical ; United States