Association between very small tumour size and increased cancer‐specific mortality after radical prostatectomy in lymph node‐positive prostate cancer

Muralidhar, Vinayak; Mahal, Brandon A.; Nezolosky, Michelle D.; Beard, Clair J.; Feng, Felix Y.; Martin, Neil E.; Efstathiou, Jason A.; Choueiri, Toni K.; Pomerantz, Mark; Sweeney, Christopher J.; Trinh, Quoc‐Dien; Heiden, Matthew G. Vander; Nguyen, Paul L.

doi:10.1111/bju.13248

Cited by 11 publications

(5 citation statements)

References 34 publications

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“…As vinayak et al. ( 27 ) had same view, they found patients who had LNM in very small prostate cancers presented a particularly aggressive disease variant compared with larger tumors. These small tumors may represent higher mutation rates and thus evade the body’s immune surveillance and anti-tumor immune response.…”

Section: Discussionmentioning

confidence: 72%

“…These studies may support our hypothesis that smaller tumors in EC patients with LNM may represent greater biological aggressiveness and earlier acquisition of genetic changes that promote tumor cell spread to regional or distant sites. As vinayak et al (27) had same view, they found patients who had LNM in very small prostate cancers presented a particularly aggressive disease variant compared with larger tumors. These small tumors may represent higher mutation rates and thus evade the body's immune surveillance and antitumor immune response.…”

Section: Discussionmentioning

confidence: 74%

“…However, some evidence could be found for other cancers. Muralidhar et al ( 27 ). observed that patients with small Ts (< 0.1 cm) in prostate cancer suffered from a poorer long-term prognosis than did patients with larger Ts, and small Ts might be associated with LN involvement.…”

Section: Discussionmentioning

confidence: 99%

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Association of Tumor Size With Prognosis in Patients With Resectable Endometrial Cancer: A SEER Database Analysis

et al. 2022

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This study aimed to explore the relationship between tumor size (Ts) and prognosis in endometrial cancer (EC). A total of 52,208 patients with EC who underwent total hysterectomy were selected from the Surveillance, Epidemiology, and End Results Program database. Overall survival (OS) and endometrial cancer-specific survival (ESS) were chosen as survival outcomes. The Cox proportional hazards model was used to explore the effect of Ts on prognosis. The restricted cubic splines based on the Cox regression model were used to determine the nonlinear relationship between Ts and survival. When Ts was analyzed as a categorical variable, the risk of death increased with Ts, with the highest risk in patients with Ts > 9 cm with regard to all-cause death (ACD) (hazard ratio [HR] 1.317; 95% confidence interval [CI], 1.196-1.450; P < 0.001) and endometrial cancer-specific death (ESD) (HR, 1.378; 95% CI, 1.226-1.549; P < 0.001). As a continuous variable, Ts showed a nonlinear relationship with ACD (HR, 1.061; 95% CI, 1.053-1.069; P < 0.001) and ESD (HR, 1.062; 95% CI, 1.052-1.073; P < 0.001). The risk of mortality increased quickly with Ts when Ts was less than 7.5 cm and then leveled off when Ts was larger than 7.5 cm in all patients. Among patients with lymph node metastasis, the risk of poor prognosis decreased rapidly with Ts when Ts was less than 3.5 cm, and subsequently increased sharply with Ts when Ts ranged from 3.5 cm to 7.5 cm, and then increased slowly when Ts was larger than 7.5 cm (P < 0.001 for nonlinearity). There was a nonlinear relationship between Ts and prognosis in patients with EC. Clinicians should not ignore the impact of small tumors on prognosis in EC patients with lymph node metastasis.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 74%

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Association of Tumor Size With Prognosis in Patients With Resectable Endometrial Cancer: A SEER Database Analysis

et al. 2022

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“…In 2011, an impressive research found that very small tumors would present aggressive biology when involved in node-positive breast cancer (16). Then, similar findings were demonstrated in colon and prostate cancer (17,18). These findings challenged the traditional view that cancer gains the ability to metastasize as it grows to a larger size (9).…”

Section: Discussionmentioning

confidence: 98%

Increased cancer-specific mortality of very small size in carcinoembryonic antigen-elevated rectal cancer

Pan¹,

Cui²,

Cai³

et al. 2019

Ann. Transl. Med.

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Background: The present study aimed to investigate the cause-specific survival (CSS) of very small rectal cancer in the context of preoperative serum carcinoembryonic antigen (CEA) elevation.Methods: Patients diagnosed with node-negative rectal cancer from the Surveillance, Epidemiology, and End Results (SEER) database from January 2004 to December 2010 meeting the inclusion criteria were identified for this study. The Cox proportional hazards regression analyses were conducted to identify independent factors associated with CSS. Pearson's chi-squared tests and Kaplan-Meier methods were performed.Results: A total of 8,413 patients were included into our study. Kaplan-Meier analyses showed lower 7-year CSS rate of very small tumors (≤5 mm) compared to those larger than 40 mm (70.4% vs. 76.0%, logrank P=0.469). Multivariate Cox analyses showed that patients with very small tumor size (≤5 mm) was also associated with a significantly increased risk of cancer-specific mortality compared with those with large tumor size (HR =2.567, 95% CI: 1.285 to 5.130, P=0.008, using ≥41 mm, C+ as a reference).Conclusions: Very small tumor size in the context of preoperative serum CEA elevation could be a surrogate for biological aggressiveness. Our finding would provide a better understanding of tumor biology for us and elicit more future biological researches.

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“…Although the traditional view of malignant progression is that cancer gains metastatic ability through an accumulation of mutations as they grow to a large size, recent studies have suggested that for some tumors, the acquisition of metastatic potential may occur early in cancer development, even in the absence of detectable primary tumors. It was previously reported that very small tumor size with intensive lymph node involvement was related to worse survival in breast cancer [ 8 ], colon cancer [ 9 ] and prostate cancer [ 10 ]. In melanoma, Sanjay et al [ 5 ] discovered that in LN positive melanomas, patients with tumor thickness ≤0.50 mm had higher mortality than those with tumor thickness 0.51–1.00 mm or 1.01–2.00 mm.…”

Section: Discussionmentioning

confidence: 99%

Discordance of pathological thin melanoma thickness and T stage in SEER registry: impacts on clinical management and research directions

Wang

Liu

et al. 2017

Oncotarget

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BackgroundUltrathin melanoma was previously demonstrated to have higher risk for melanoma-specific mortality using SEER database. However, these guideline-changing conclusions has been recently challenged by miscoding of thickness. This present study was performed to assess the prognosis of thin and ultrathin melanoma using only surgically-treated, pathologically confirmed and after removal of discordant cases.MethodsMelanoma patients from SEER database who were initially diagnosed with histologically confirmed and surgically treated melanoma from 1998 to 2012 were included. Subjects with discordance between T stage and tumor thickness were excluded. Kaplan-Meier curves, log-rank test and multivariate Cox proportional hazards regression models were used.Results55,754 patients met the strict inclusion criteria, but 16 (0.02%) and 803 (1.4%) patients were removed due to T0 stage and discordance between T stage and thickness, respectively. Therefore, 54,935 patients entered the analyses, among which 52,751 were LN negative and 2,184 were LN positive. In either overall or LN-negative patients, a straightforward dose-effect relationship of larger thickness with increasing mortality was observed. In contrast, in LN positive patients, the T1 subgroup demonstrated a similar survival with tumors in T2 mm subgroup. Multivariable analysis revealed same pattern, and significant interaction between T stage and LN involvement was found. Further categorizing T1 melanoma into 10 equal 0.10 mm increments demonstrated an unexpected “N”-shaped pattern of mortality in overall and LN negative ultrathin melanoma but not in LN positive melanoma.ConclusionsNo difference in mortality was observed in T1-3 tumors with LN involvement. External and independent validation studies are warranted.

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Association between very small tumour size and increased cancer‐specific mortality after radical prostatectomy in lymph node‐positive prostate cancer

Cited by 11 publications

References 34 publications

Association of Tumor Size With Prognosis in Patients With Resectable Endometrial Cancer: A SEER Database Analysis

Association of Tumor Size With Prognosis in Patients With Resectable Endometrial Cancer: A SEER Database Analysis

Increased cancer-specific mortality of very small size in carcinoembryonic antigen-elevated rectal cancer

Discordance of pathological thin melanoma thickness and T stage in SEER registry: impacts on clinical management and research directions

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