Application of the 8th edition of the AJCC yTNM staging system shows improved prognostication in a single center cohort of esophageal carcinomas

Kröll, Dino; Noser, Laura; Erdem, Suna; Storni, Federico; Arnold, Dominik; Dislich, Bastian; Zlobec, Inti; Candinas, Daniel; Seiler, Christian; Langer, Rupert

doi:10.1016/j.suronc.2017.12.005

Cited by 12 publications

(9 citation statements)

References 27 publications

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“…The introduction of the ypTNM was one of the major modifications in the 8th edition of the AJCC classification. 3 Although the ypStage showed a slightly better predictive accuracy than the pStage, 18 the prognostic value of the ypTNM system has often been challenged. 4 , 5 First of all, ypT status shares the same categories with pT status that were originally targeted for treatment‐naïve tumors.…”

Section: Discussionmentioning

confidence: 99%

Tumor regression grade combined with lymph node status in esophageal squamous cell carcinoma after neoadjuvant chemoradiotherapy

et al. 2022

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Section: Discussionmentioning

confidence: 99%

Tumor regression grade combined with lymph node status in esophageal squamous cell carcinoma after neoadjuvant chemoradiotherapy

et al. 2022

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“…The design of the study and reporting of results adhered to guidelines described by Iglesias et al 10 Ethics approval was not required. 14 Data were anonymized, and no financial incentive was provided for the experts. The full expert elicitation exercise, training material, and evidence dossier are found in the Appendix (see Appendix in Supplemental Materials found at https://doi.…”

Section: Methodsmentioning

confidence: 99%

Expert Elicitation to Inform a Cost-Effectiveness Analysis of Screening for Renal Cancer

et al. 2019

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Background: Population screening for renal cell carcinoma (RCC) using ultrasound has the potential to improve survival outcomes; however, a cost-effectiveness analysis (CEA) has yet to be performed. Owing to the lack of existing evidence, we performed structured expert elicitation to derive unknown quantities to inform the CEA.Objective: To elicit the cancer stage distribution (proportion of individuals with each stage of cancer) for different RCC screening scenarios and the annual transition probabilities for undiagnosed disease becoming diagnosed in the National Health Service. Methods:The study design and reporting adhered to the Reporting Guidelines for the Use of Expert Judgement in Model-Based Economic Evaluations. The elicitation was conducted face-to-face or via telephone between each individual expert and the facilitator, aided by online material. For multinomial data, Connor-Mosimann and modified Connor-Mosimann distributions were fitted for each expert and for all experts combined using mathematical linear pooling.Results: A total of 24 clinical experts were invited, and 71% participated (7 urologists, 6 oncologists, 4 radiologists). The modified Connor-Mosimann distribution provided the best fit for most elicited quantities. Greater uncertainty was noted for the elicited transition probabilities compared with the elicited stage distributions. Conclusion:We performed the first expert elicitation of RCC screening parameters, crucial information that will inform the CEA of screening. In addition, the elicited quantities may enable future health economic evaluations assessing the value of diagnostic tools and pathways in RCC.

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“…The study included a total of 239 patients with locally advanced adenocarcinoma of the esophagus (EAC) as defined by the WHO classification [40] who were treated with neoadjuvant chemotherapy or chemoradiotherapy. Both collectives have been described in detail before and differed in their therapeutic approach [41,42]: The first collective comprised 92 cases, treated between 1994 and 2002 in the department of surgery of the Technische Universität München, Munich [42]. Neoadjuvant treatment consisted of a cisplatin/5-fluorouracil/Leucovorine-based chemotherapy with or without additional paclitaxel.…”

Section: Patientsmentioning

confidence: 99%

“…The second collective comprised 147 patients, treated between 2001 and 2016 at the department of Surgery of the Inselspital University Hospital Bern [41]. Neoadjuvant treatment was predominantly composed of combined radiation with at least 40 gray and a 5-fluorouracil and Cisplatin/Carboplatin-based chemotherapy with or without additional Paclitaxel or Docetaxel.…”

Section: Patientsmentioning

confidence: 99%

“…Histopathological examination of the resection specimens and the assessment of TNM categories was performed as described before [41][42][43]. Data for histopathological tumor regression according to Becker (Tumor regression grade (TRG) 1a = complete regression; TRG1b = <10% residual tumor; TRG2 = 10-50% residual tumor; TRG3 = >50% residual tumor) and determined by experienced pathologists with a special focus on gastrointestinal tumors (KB, RL) were obtained from previous studies [41,42] or generated for the purpose of the present work.…”

Section: Post Neoadjuvant Tnm Staging and Tumor Regression Gradingmentioning

confidence: 99%

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Tumor Regression in Lymph Node Metastases of Esophageal Adenocarcinomas after Neoadjuvant Therapy

Osecky

Kröll

Feith

et al. 2020

Gastrointestinal Disorders

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Tumor regression following neoadjuvant treatment can be observed in lymph node (LN) metastases similar to the primary tumor in esophageal adenocarcinomas (EAC). We evaluated the prognostic significance of tumor regression in LN metastases of locally advanced EAC of 239 patients treated with neoadjuvant radiochemotherapy (RCTX) or chemotherapy (CTX) followed by esophagectomy. We examined retrospectively the LN for histopathologic signs of regression, i.e., nodular fibrosis and acellular mucin. LN classification was performed according to two parameters: presence (−) or absence (+) of residual tumor and regression characteristics in the LN, resulting in four categories: LN−/REG−, LN−/REG+, LN+/REG+, LN+/REG−. In total, LN metastases with residual tumor were detectable in 117/239 (49%) cases. Regression in LN were observed in 85/239 cases (35.5%). The distribution of the LN/REG categories were as follows: 97 patients (40.6%) were LN−/REG−. A total of 25 patients (10.5%) were LN−/REG+. A total of 60 (25.1%) were LN+/REG+ and 57 (23.8%) LN+/REG−. The LN/Reg categorization had a significant prognostic value in univariate analysis (p < 0.001) and multivariate analysis (HR = 1.326; p = 0.002) with similar results for the subgroups of patients treated with RCTX or CTX. The prognosis of LN−/REG+ was worse than LN−/REG− but better than both LN+ categories, which was demonstrated in the Kaplan–Meier curves but did not reach statistical significance (p = 0.104 and p = 0.090, respectively). In contrast, there was no difference between LN+/REG+ and LN+/REG− (p = 0.802). In summary, regression in LN metastases of EAC can be observed in a significant number of patients after neoadjuvant therapy. Complete regression of former LN metastases in comparison to “true” negative LN seems to be of prognostic relevance but additional studies are needed to confirm this trend seen in our study.

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Application of the 8th edition of the AJCC yTNM staging system shows improved prognostication in a single center cohort of esophageal carcinomas

Cited by 12 publications

References 27 publications

Tumor regression grade combined with lymph node status in esophageal squamous cell carcinoma after neoadjuvant chemoradiotherapy

Tumor regression grade combined with lymph node status in esophageal squamous cell carcinoma after neoadjuvant chemoradiotherapy

Expert Elicitation to Inform a Cost-Effectiveness Analysis of Screening for Renal Cancer

Tumor Regression in Lymph Node Metastases of Esophageal Adenocarcinomas after Neoadjuvant Therapy

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