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Objective @#To explore the prognostic value of chemoradiotherapy based on the depth of invasion (DOI) in patients with oral squamous cell carcinoma.@* Methods @#Patients with oral squamous cell carcinoma who received surgical treatment in a hospital from 2008 to 2016 were enrolled. The chi-square test was used to compare the effects of DOI on postoperative cervical lymph node metastasis and local recurrence. The effects of chemoradiotherapy on postoperative cervical lymph node metastasis, local recurrence, and survival were analyzed based on the DOI.@*Results@# A total of 111 patients with oral squamous cell carcinoma were included in this study. The postoperative local recurrence rate (P<0.05) and cervical lymph node metastasis rate (P<0.05) of patients with 5 mm < DOI ≤ 10 mm and DOI > 10 mm were significantly higher than those with DOI ≤ 5 mm. The time of postoperative recurrence was concentrated within two years after the operation. The greater the DOI was, the shorter the time to postoperative recurrence (P<0.05). The addition of postoperative chemoradiotherapy did not significantly improve the postoperative local recurrence rate, cervical lymph node metastasis or survival rate of patients with different DOIs (P > 0.05). @*Conclusion@#DOI has important predictive value for postoperative recurrence, cervical lymph node metastasis and survival rate. However, DOI cannot be used as an independent index to guide whether chemoradiotherapy is needed after oral cancer surgery.
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Background: The eighth edition of the American Joint Committee on Cancer (AJCC) for oral cancer has incorporated additional pathological features like depth of invasion (DOI) and extranodal extension (ENE) into T and N staging. The incorporation of these two factors will impact the staging and, hence, the treatment decisions. The aim of the study was to clinically validate the new staging system in predicting the outcome in patients treated for carcinoma oral tongue. The study also examined the correlation of pathological risk factors with survival. Methods: We studied 70 patients with squamous cell carcinoma of the oral tongue who underwent primary surgical treatment at a tertiary care center in the year 2012. All these patients were restaged pathologically according to the new AJCC eighth staging system. The 5-year overall survival (OS) and disease-free survival (DFS) were calculated using the Kaplan–Meier method. Akaike information criterion and concordance index were calculated between both staging systems to identify a better predictive model. Log-rank test and univariate Cox regression analysis were conducted to find out the significance of different pathological factors on outcome. Results: Incorporation of DOI and ENE resulted in 47.2% and 12.8% stage migration, respectively. DOI less than 5 mm was associated with a 5-year OS and DFS of 100% and 92.9%, respectively, compared to 88.7% and 85.1%, respectively, when the DOI was more than 5 mm. Presence of lymph node involvement, ENE, and perineural invasion (PNI) were associated with inferior survival. The eighth edition had lower Akaike information criterion and improved concordance index values compared with the seventh edition. Conclusion: The eighth edition of AJCC allows better risk stratification. Restaging of cases based on the eighth edition AJCC staging manual resulted in significant upstaging with difference in survival.
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Objective:To evaluate type B2 vessels for predicting the invasion depth of superficial esophageal squamous cell carcinoma (SESCC) under narrow band imaging-magnifying endoscopy (NBI-ME), and to analyse the influencing factors of over-prediction and under-prediction.Methods:A total of 86 SESCC patients with 86 lesions confirmed by postoperative pathology, who underwent NBI-ME to evaluate the invasion depth of esophageal tumor and were observed for type B2 vessels in Department of Digestive Endoscopy of Fujian Provincial Hospital from January 2015 to April 2020, were included in the case-control study. According to the postoperative pathological results, the patients were divided into the correct prediction group ( n=25) and the wrong prediction group ( n=61), and the accuracy of prediction was calculated. The wrong prediction group was further divided into the over-prediction group ( n=49) and the under-prediction group ( n=12) to find the influencing factors of over-prediction and under-prediction, respectively. Further, multivariate Logistic analysis was performed to explore the independent influential factors for the prediction. Results:The accuracy of type B2 vessels under NBI-ME for predicting the invasion depth of SESCC was only 29.07% (25/86), and the over-prediction rate and under-prediction rates were 56.98% (49/86) and 13.95% (12/86), respectively. Univariate analysis showed that the classification of type B2 area ( χ2=36.25, P<0.001), the distinct endoscopic features (nodules, thickening and obvious depression, χ2=22.90, P<0.001), and inflammation around type B2 vessels ( χ2=9.54, P=0.004) were related to the over-prediction of the invasion depth of SESCC, and the distinct endoscopic features were related to the under-prediction of the invasion depth ( P=0.016). Multivariate Logistic regression analysis showed that B2-narrow (type B2 area ≤5 mm) ( P<0.001, OR=241.988,95% CI:15.229-3 845.252) and inflammation around type B2 vessels ( P=0.033, OR=12.801, 95% CI: 1.226-133.713) were independent risk factors for over-predicting the invasion depth of SESCC, while the distinct endoscopic features were independent protective factors for over-prediction ( P<0.001, OR=0.012, 95% CI: 0.001-0.150). The distinct endoscopic feature was an independent risk factor for under-predicting invasion depth of SESCC with type B2 vessels ( P=0.027, OR=7.899, 95% CI: 1.259-49.565). Conclusion:The accuracy of predicting the invasion depth of SESCC is low only based on type B2 vessels in NBI-ME, and over-prediction is prone to occur. B2-narrow, inflammation around type B2 vessels and without nodules, thickening and obvious depression are closely related to the over-prediction of invasion depth of SESCC by type B2 in NBI-ME, and nodules, thickening and obvious depression are closely associated with the under-prediction. However, whether the combined assessment of type B2 vessels under NBI-ME and endoscopic manifestation can improve the accuracy of prediction needs to be confirmed by further studies.
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Objective@#To investigate the effect of elective neck dissection on the 5-year survival rate of patients with early oral squamous cell carcinoma.@*Methods@#The data of 100 patients with early oral squamous cell carcinoma (cT1-2N0M0) were retrospectively analyzed. In 61 cases, the primary tumor was subjected to elective neck dissection (END). Neck observation and follow-up (NOF) were performed in 39 cases with enlarged resection of primary lesions. Clinicopathological data such as pT staging, pathology classification,the rate of cervical lymph node metastasis and the 5-year survival rate of the patients were statistically analyzed.@*Results@#The 5-year survival rates of the END and NOF groups were 86.9% and 69.2%, respectively, and the difference was statistically significant (P=0.028). END treatment was significantly better than NOF in controlling cervical lymph node metastasis in early oral squamous cell carcinoma (P=0.009). After stratified analysis of histopathological features, the 5-year survival rate of patients with pathological T2 (pT2) stage OSCC in the END group was significantly higher than that in the NOF group (P=0.020). The 5-year survival rate of patients with moderate and poorly differentiated pathological grade OSCC in the END group was significantly higher than that in the NOF group (P=0.013). @*Conclusion @# END is effective for the management of the cervical lymph node metastasis rate in early OSCC patients. For patients with pT2 stage or low differentiation pathological grade, active END can significantly improve the 5-year survival rate.
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Objective To investigate the predictive value of depth of invasion (DOI) of tongue squamous cell carcinoma (TSCC) for cervical lymph node metastasis and prognosis. Methods We retrospectively analyzed the clinical and pathological data of 73 patients with T1/2 TSCC. ROC curve was used to determine the optimal cut-off value of DOI for predicting cervical lymph node metastasis, and logistic regression analysis was performed to analyze the related factors affecting cervical lymph node metastasis of TSCC. Kaplan-Meier method and Cox regression analysis were used for survival analysis. Results Among 73 patients, 18 patients were with lymph node metastasis and 55 patients were without lymph node metastasis. The median DOI with and without lymph node metastasis were 8.00 and 5.00 mm, respectively (P=0.003). The optimal cut-off value for DOI was 6.15 mm, with AUC 0.75 (95%CI: 64.1%~87.1%, P=0.001), sensitivity 77.8% and specificity 63.6%. DOI and pathological differentiation were independent prognostic factors for cervical lymph node metastasis in multivariate analysis. DOI, nerve invasion and pathological differentiation were independent prognostic factors of survival in Cox regression analysis. Conclusion DOI of TSCC patients has important predictive value for both cervical lymph node metastasis and prognosis. Neck lymph node dissection is recommended for patients with DOI > 6.15 mm to improve survival rate and reduce recurrence rate.
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Objective @#To analyze the accuracy of the infiltrating depth of tongue squamous cell carcinoma measured by magnetic resonance imaging (MRI) using pathological sections under a light microscope to provide a clinical reference.@*Methods @#Seventy-three patients with tongue squamous cell carcinoma who visited the Department of Stomatology of the First Hospital of Shanxi Medical University and Xiangya Stomatological Hospital from January 2018 to September 2020 were selected. Preoperative MRI was performed to evaluate the infiltration depth of tongue squamous cell carcinoma, and intraoperative frozen pathological sections were used to confirm the infiltration depth of tongue squamous cell carcinoma measurement. @*Results @#The infiltration depth of tongue squamous cell carcinoma measured by T1-weighted imaging was 1.11 mm (95% CI=0.51-1.70; t=3.72; P < 0.001), and the correlation coefficient r was 0.95. The T2-weighted average overestimation was 2.17 mm (95% CI=1.32-3.02; t=5.10; P < 0.001), and the correlation coefficient was 0.92. The Bland-Altman plot showed good consistency between T1- and T2-weighted images and pathologic measurements.@*Conclusion @#The infiltration depth of tongue squamous cell carcinoma measured by MRI is more accurate, with an average overestimation of 1-2 mm compared with pathological measurements, and T1-weighted images are better than T2-weighted images.
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Background: The grading of oral squamous cell carcinoma can be useful along with TNM staging in determining treatment plan. The aim is to evaluate the prognostic value of histopathological grading of oral squamous cell carcinoma and to find its importance in setting appropriate treatment plan.Methods: The study includes 60 oral squamous cell carcinoma cases surgically operated during January 2012 to December 2018. From the archival paraffin blocks and available resected specimens of each case, the histological parameters used in Bryne’s invasive grading system and Almangush BD model were evaluated and compared to their prognosis.Results: The parameters used in BD model-tumor budding and depth of invasion were found to be statistically significant with prognosis of the disease. Except for nuclear polymorphism, the parameters used in Bryne’s invasive front grading system do not correlate with prognosis.Conclusion: Based on the prognostic significance, tumor budding ≥5 buds in the invasive front area and depth of invasion ≥4mm can be used as risk factors in prospective clinical trials by considering them in early stage disparity cases for multimodality treatment approach and elective neck dissection.
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Depth of invasion is a newly added index for TNM staging of oral cancer in the eighth edition. Preoperative evaluation of depth of invasion not only provides a reference for surgical margin, but also serves as an independent prognostic factor for predicting lymph node metastases. At present, the main methods for assessing the depth of invasion of tongue squamous cell carcinoma include ultrasound examination, MRI, CT, positron emission tomography (PET) and histopathological examination. This paper summarizes the evaluation method and clinical effect of depth of invasion of tongue cancer, and analyzes its advantages and boundedness. In addition, this study is expected to provide a reference for the surgical treatment of tongue squamous cell carcinoma.
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BACKGROUND/AIMS: Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) has been used as a treatment for early gastric cancer (EGC). This study was performed to evaluate the usefulness of the endoscopic findings for diagnosing the depth of invasion in EGC patients. METHODS: We retrospectively analyzed the endoscopic findings of 558 EGC patients who were diagnosed after gastrectomy, EMR or ESD at Dong-A University Hospital between 2000 and 2006, and we divided them into two groups (the mucosa group versus the submucosa group). Nine factors were assessed (Type I or IIa: surface color, surface irregularity, the Yamada type and pitting on the apex; Type IIb: surface color, surface irregularity and marginal definiteness: Type IIc or III: ulcer base irregularity, shape of the converging folds, center of the converging folds and marginal elevation). The tumor size and histologic type were assessed for all the EGCs. RESULTS: Ulcer base irregularity (p=0.005), marginal elevation (p=0.001), and the shape of the converging folds (p=0.018) showed significant correlation with the depth of invasion in type IIc or III EGCs. Tumor size ( <2 cm) showed a significant correlation with mucosal invasion for all the EGCs. CONCLUSIONS: These results support the usefulness of the endoscopic findings for making the therapeutic decision for performing EMR or ESD through predicting the depth of invasion of EGCs.
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Humans , Gastrectomy , Mucous Membrane , Retrospective Studies , Stomach Neoplasms , UlcerABSTRACT
BACKGROUND/AIMS: We investigated the clinical significance of the criteria of the absolute and relative depth of invasion for submucosal invasive colorectal carcinomas. METHODS: We analyzed retrospectively the clinicopathological features of 29 submucosal invasive colorectal cancers. The relative depth of submucosal invasion was evaluated by a relative (sm1, 2, 3) classification and the absolute depth of submucosal invasion was measured in micrometers from the lower border of the muscularis mucosa to the deepest cancer gland. RESULTS: All sm1 cancers showed a submucosal layer invasion of less than 1,000micronm; invasion was seen between 500micronm and 1,000micronm. The rate of lymphovascular invasion was higher for sm1c, sm2 and sm3 than for sm1a and sm1b, and the rate of invasion was higher for a level of 500micronm or more than for a level of 500micronm or less for the depth of submucosal invasion. One of sixteen patients that underwent surgery showed lymph node involvement. For this patient, the relative depth of invasion was sm1c and the absolute depth was 900micronm. CONCLUSIONS: Endoscopically treated submucosal colorectal cancer needs to be evaluated by the absolute depth in addition to the relative depth. It seems that a submucosal invasive cancer less than 500micronm in submucosal depth probably can be treated by endoscopic resection.
Subject(s)
Humans , Classification , Colon , Colonic Neoplasms , Colorectal Neoplasms , Lymph Nodes , Mucous Membrane , Retrospective StudiesABSTRACT
BACKGROUND/AIMS: We investigated the clinical significance of the criteria of the absolute and relative depth of invasion for submucosal invasive colorectal carcinomas. METHODS: We analyzed retrospectively the clinicopathological features of 29 submucosal invasive colorectal cancers. The relative depth of submucosal invasion was evaluated by a relative (sm1, 2, 3) classification and the absolute depth of submucosal invasion was measured in micrometers from the lower border of the muscularis mucosa to the deepest cancer gland. RESULTS: All sm1 cancers showed a submucosal layer invasion of less than 1,000micronm; invasion was seen between 500micronm and 1,000micronm. The rate of lymphovascular invasion was higher for sm1c, sm2 and sm3 than for sm1a and sm1b, and the rate of invasion was higher for a level of 500micronm or more than for a level of 500micronm or less for the depth of submucosal invasion. One of sixteen patients that underwent surgery showed lymph node involvement. For this patient, the relative depth of invasion was sm1c and the absolute depth was 900micronm. CONCLUSIONS: Endoscopically treated submucosal colorectal cancer needs to be evaluated by the absolute depth in addition to the relative depth. It seems that a submucosal invasive cancer less than 500micronm in submucosal depth probably can be treated by endoscopic resection.
Subject(s)
Humans , Classification , Colon , Colonic Neoplasms , Colorectal Neoplasms , Lymph Nodes , Mucous Membrane , Retrospective StudiesABSTRACT
PURPOSE: Some gastric cancer patients in whom the cancer has infiltrated up to the muscularis propria (mp) have a good postoperative course similar to that of early gastric cancer (EGC) patients (this does not match the general classification of gastric cancer). Therefore, we performed a retrospective analysis of 125 patients with mp gastric cancer based on the degree of mp invasion. MATERIALS AND METHODS: The clinicopathologic features of 125 cases of mp gastric cancer were subdivided according to depth of invasion, and were retrospectively reviewed and compared with the surgical features of 222 patients with gastric cancer invading the submucosa (sm). For each tumor, using the section that showed the greatest extent of invasion, we evaluated the degree of tumor invasion into the mp layer at a magnification of x100. The patients were classified into 2 groups: mp1, the tumor was limited to the first of the 3 mp layers, and mp2, the tumor had expanded beyond the first layer. RESULTS: Patients with mp1 (n=50) had a significantly lower incidence of lymph node metastasis, and a smaller tumor size than patients with mp2 (n=75)(P=0.01 and P=0.029, respectively). The 5-year survival rate of mp1 patients was significantly better than that of mp2 patients (95.3% vs. 77.6%, P=0.0282), but was similar to that (91.2%) of the 222 sm patients. The 5-year survival rate of mp patients without lymph node metastasis (n=55) was significantly better than that of those with lymph node metastasis (n=70)(93.3% vs. 78.2%, P=0.0192). Patients with mp1 had a significantly higher incidence of lymph node metastasis (42.5% vs 23%, P=0.006) than patients with sm. CONCLUSION: There were clear differences in clinical features between the mp1 and the mp2 patients. Subdivision of mp gastric cancer according to the depth of invasion may enable a more precise prognosis and a more pertinent treatment plan for mp patients. In particular, as the clinicopathological findings and surgical outcomes for mp1 patients were akin to those of the sm patients, mp1 patients may require treatment analogous to that administered to patients with sm gastric cancer.
Subject(s)
Humans , Classification , Incidence , Lymph Nodes , Neoplasm Metastasis , Prognosis , Retrospective Studies , Stomach Neoplasms , Survival RateABSTRACT
PURPOSE: Some gastric cancer patients in whom the cancer has infiltrated up to the muscularis propria (mp) have a good postoperative course similar to that of early gastric cancer (EGC) patients (this does not match the general classification of gastric cancer). Therefore, we performed a retrospective analysis of 125 patients with mp gastric cancer based on the degree of mp invasion. MATERIALS AND METHODS: The clinicopathologic features of 125 cases of mp gastric cancer were subdivided according to depth of invasion, and were retrospectively reviewed and compared with the surgical features of 222 patients with gastric cancer invading the submucosa (sm). For each tumor, using the section that showed the greatest extent of invasion, we evaluated the degree of tumor invasion into the mp layer at a magnification of x100. The patients were classified into 2 groups: mp1, the tumor was limited to the first of the 3 mp layers, and mp2, the tumor had expanded beyond the first layer. RESULTS: Patients with mp1 (n=50) had a significantly lower incidence of lymph node metastasis, and a smaller tumor size than patients with mp2 (n=75)(P=0.01 and P=0.029, respectively). The 5-year survival rate of mp1 patients was significantly better than that of mp2 patients (95.3% vs. 77.6%, P=0.0282), but was similar to that (91.2%) of the 222 sm patients. The 5-year survival rate of mp patients without lymph node metastasis (n=55) was significantly better than that of those with lymph node metastasis (n=70)(93.3% vs. 78.2%, P=0.0192). Patients with mp1 had a significantly higher incidence of lymph node metastasis (42.5% vs 23%, P=0.006) than patients with sm. CONCLUSION: There were clear differences in clinical features between the mp1 and the mp2 patients. Subdivision of mp gastric cancer according to the depth of invasion may enable a more precise prognosis and a more pertinent treatment plan for mp patients. In particular, as the clinicopathological findings and surgical outcomes for mp1 patients were akin to those of the sm patients, mp1 patients may require treatment analogous to that administered to patients with sm gastric cancer.
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Humans , Classification , Incidence , Lymph Nodes , Neoplasm Metastasis , Prognosis , Retrospective Studies , Stomach Neoplasms , Survival RateABSTRACT
Colorectal cancer is the most common cancer of the digestive tract in western countries. In Korea, its mortality rate has markedly increased in recent 15 years. The mortality of colon cancer can be decreased by proper screening and subsequent polypectomy. Early colon cancer is defined as colon cancer that infiltrates within mucosa and submucosa regardless of lymph nodes invasion and has favorable outcomes. It can be easily removed by endoscopic procedures. The depth of submucosal invasion should be determined before endoscopic removal by various parameters, such as shape, pit patterns by magnifying endoscopy, and endoscopic ultrasonography. After endoscopic removal, the tissue specimen should be carefully examined for the completeness of the removal.
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Colonic Neoplasms , Colorectal Neoplasms , Diagnosis , Endoscopy , Endosonography , Gastrointestinal Tract , Korea , Lymph Nodes , Mass Screening , Mortality , Mucous MembraneABSTRACT
BACKGROUND/AIMS: Endoscopic ultrasonography (EUS) has been used in assessing the depth of cancer invasion of the stomach. The aim of this study was to compare the factors which were likely to affect the diagnostic accuracy of EUS for the depth of invasion in early gastric cancer (EGC). METHODS: Seventy eight EGC patients were pre-operatively examined by EUS. The depth of invasion by EUS was compared with the histopathologic finding of the resected specimen. The diagnostic accuracy of EUS was analyzed according to the factors which were likely to affect the accuracy. RESULTS: The diagnostic accuracy of EUS for the depth of invasion was 78% (46/49) in mucosal cancer, 68.4% (13/19) in submucosal cancer (p<0.05). Overall diagnostic accuracy of EUS in EGC was 75.6%. The diagnostic accuracy of the flat submucosal cancer was 55.6% and was significantly lower than other types of mucosal or submucosal cancers in endoscopic morphology (p<0.05). CONCLUSIONS: The depth of invasion per se with respective endoscopic findings affected the diagnostic accuracy of EUS for the depth of invasion in EGC. Other factors did not affect the diagnostic accuracy of EUS for the depth of invasion in EGC.
Subject(s)
Humans , Endosonography , Stomach , Stomach NeoplasmsABSTRACT
BACKGROUND/AIMS: If a cancer lesion without ulcer can be correctly staged as mucosal, it can be a candidate for curative endoscopic treatment such as endoscopic mucosal resection. The aim of this study was to evaluate the usefulness of EUS and endoscopy in diagnosing mucosal cancer of stomach. METHODS: Findings of endoscopy and EUS were independently reviewed by the conventional criteria for diagnosing depth of invasion and compared with histologic findings in 65 patients having EGC without ulcers. RESULTS: Overall accuracy of diagnosing depth of invasion were 69% by endoscopy and 78% by EUS. The accuracy rates according to the macroscopic type by endoscopy were 86% (12/14) for type I, 75% (3/4) for type IIa, 75% (9/12) for type IIa+IIc, 50% (2/4) for type IIc+IIa, 66% (19/29) for type IIc and 0% (0/2) for type IIc+IIb. The accuracy rates according to the macroscopic type by EUS were 93% (13/ 14) for type I, 50% (2/4) for type IIa, 75% (9/12) for type IIa+IIc, 50% (2/4) for type IIc+IIa, 83% (24/29) for type IIc and 50% (1/2) for type IIc+IIb. All lesions that were classified as limited to the mucosa on both conventional endoscopy and EUS in type I (n=9), IIa (n=2), IIa+IIc (n=2) and IIc (n=11) were limited to the mucosa by histologic findings. CONCLUSIONS: This study suggests that if both modalities show the findings of mucosal lesion in type I and IIc of EGC, endoscopic mucosal resection may be considered as a curative treatment.
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Humans , Endoscopy , Endosonography , Mucous Membrane , Stomach Neoplasms , UlcerABSTRACT
PURPOSE: This study was designed to evaluate the clinical charateristics, surgical treatment and outcome of carcinoid tumors of the rectum. METHODS: A retrospective review of the charts of all patients treated for rectal carcinoid tumors at Kangbuk Samsung Medical Center between Jan 1989 and April 1998. Thirteen patients with rectal carcinoids tumors were treated. Follow-up data, histopathological information and surgical procedures were obtained from case notes. RESULTS: There were 10 men and 3 women. The ages ranged from 28 to 60 years (mean 41.1 years for all, 43.8 years for men and 32 years for women). Eight patients (61.5%) had no symptoms. Of the five patients, four complained of rectal bleeding (30.8%), and one complained of defecational difficulty (7.7%). Size of rectal carcinoid tumor was less than 1 cm in 7 patients (53.8%), between 1 cm and 2 cm in 2 patients (15.4%), in four patients (30.8%) larger than 2 cm. Three patients were treated in Abdominoperineal resection. Two patients underwent stapled low anterior resection. The remaining 8 patients underwent conservative resection (3 colonoscopic polypectomy and electrocauterization, 2 colonoscopic snaring biopsy, 2 transanal resection and one Mason's operation). The depth of invasion was contained within sutmucosa in 3 patients. Liver metastasis was found in 2 patients. Average follow-up time was 35.6 months. Two patients died of mutiple mestastasis (liver, bone, peritoneum) 9 and 30months later. CONCLUSION: We concluded that tumors smaller than 1 cm could be managed by local treatment whereas larger than 2 cm should be managed by radical treatment.