Clinical versus pathologic staging for prostate adenocarcinoma: how do they correlate?

OBJECTIVES: We assessed the ability of 3 clinical factors-stage, D'Amico risk stratification, and Roach formula-estimated nodal risk-to predict the pathologic outcomes in a modern cohort of prostate cancer patients. METHODS: Data were obtained from the Surveillance, Epidemiology, and End Results Program for 2004 and 2005. Men with adenocarcinoma of the prostate who had complete staging information were included. Patients were stratified according to the D'Amico criteria into low, intermediate, or high-risk groups using clinical T-stage, Gleason sum, and prostate specific antigen. Comparison was made with risk groups obtained after replacing clinical with pathologic T-stage. In addition, the Roach formula-predicted risk of positive lymph nodes was calculated and compared with the pathologic incidence of positive nodes. RESULTS: A total of 56,446 patients were included, of whom 13,135 had a prostatectomy with complete pathologic staging. Of 3476 patients with clinically palpable disease, who underwent prostatectomy, 2.5% were down-T-staged pathologically, whereas 34.7% were up-T-staged. Replacing clinical T-stage with pathologic T-stage in the D'Amico risk stratification resulted in the majority of men being up-risk-stratified to a higher risk group. Three hundred and forty-three patients had positive nodes. The patients with a Roach formula-predicted likelihood of positive nodes of 0% to 5%, 5.1% to 10%, 10.1% to 15%, and greater than 15% were found to have 0.2%, 0.5%, 1.2%, and 6.6% pathologic incidence of positive nodes, respectively. CONCLUSIONS: Pathologic staging results in higher risk stratification than that predicted by clinical criteria in the majority of patients. Nodal positivity at diagnosis is uncommon in the current era, and the Roach formula overestimates the actual risk of node-positive disease.

Does the revised International Federation of Gynecology and Obstetrics staging system for endometrial cancer lead to increased discrimination in patient outcomes?

BACKGROUND: Recent changes were made to the International Federation of Gynecology and Obstetrics (FIGO) staging system for endometrial cancer. The objective of this study was to compare survival outcomes for patients who were staged according to the 1988 FIGO staging system versus the 2009 FIGO staging system. METHODS: Data were obtained from the Surveillance, Epidemiology, and End Results Program for the years 1998 to 2006. Patients who had a diagnosis of adenocarcinoma of the uterus with complete staging information were included. Patients were staged according to the 1988 and 2009 FIGO staging systems, and Kaplan-Meier estimates were derived for cause-specific survival (CSS). Univariate and multivariate analyses using Cox proportional hazards models were used to identify the factors associated with survival. RESULTS: In total, 47,284 patients were included. The median follow-up was 37 months. The 5-year CSS rates for patients who had 2009 FIGO stage IA and IB disease were 96.6% and 89.9%, respectively (P < .0001). After accounting for age, grade, and race, this survival difference remained significant (hazard ratio [HR], 1.97; 95% confidence interval [CI], 1.74-2.24; P < .0001). Patients who had 1988 FIGO stage IIA disease had a 5-year CSS rate similar to that of patients who had 1988 FIGO stage IC disease (88.6% vs 89.9%, respectively; P = .09). Patients who had positive pelvic washings had a 5-year CSS rate similar to that of patients who had stage IIIA disease according to the 2009 FIGO system (74.2% vs 72.1%, respectively; P = .37). The 5-year CSS rate for patients who had stage IIIC1 disease was significantly improved compared with that for patients who had stage IIIC2 disease (68.2% vs 57.3%, respectively; P < .0001). In the multivariate model, the survival difference remained (HR, 1.49; 95% CI, 1.26-1.76; P < .0001). CONCLUSIONS: The 2009 staging system for endometrial cancer produced better discrimination in CSS outcomes compared with the 1988 system.

Curative radiation therapy for pancreatic malignancies.

Surgery is generally considered as the only curative therapy for pancreatic cancer; however, even with optimal surgery, long-term cure is achieved in very few patients, thus highlighting the need for adjuvant therapies. Radiation therapy, usually in combination with chemotherapy, plays a role in the setting of unresectable, nonmetastatic pancreatic cancer. Its role in the adjuvant setting remains controversial and as yet undefined. This article reviews the role of radiation therapy in the adjuvant and definitive settings, and describes recent improvements in the delivery of radiotherapy that allow for improved dose delivery with decreased toxicity.