The Tumor Burden Score

Sasaki, Kazunari; Morioka, Daisuke; Conci, Simone; Margonis, Georgios Antonios; Sawada, Yu; Ruzzenente, Andrea; Kumamoto, Takafumi; Iacono, Calogero; Andreatos, Nikolaos; Guglielmi, Alfredo; Endo, Itaru; Pawlik, Timothy M.

doi:10.1097/sla.0000000000002064

Cited by 322 publications

(141 citation statements)

References 49 publications

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“…Tumor burden is thought to be an important risk factor in multiple malignancies, usually reflecting the degree of tumor damage to the body [17, 18]. In solid tumors, such as melanoma, breast cancer, and lung cancer, tumor burden is always represented as the tumor size assessed using a CT scan [17].…”

Section: Introductionmentioning

confidence: 99%

Ratio of Immune Response to Tumor Burden Predicts Survival Via Regulating Functions of Lymphocytes and Monocytes in Diffuse Large B-Cell Lymphoma

Niu

Yin

et al. 2018

Cell Physiol Biochem

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Background/Aims: Diffuse large B-cell lymphoma (DLBCL) is an aggressive disease, and is the most common type of lymphoma in adults. Although significant progress in treatment has been made using chemotherapy combinations, there exist a large amount of relapse or refractory cases. Thus, effective clinical biomarkers for DLBCL are urgently needed. Our study aims to explore the predictive significance of using the immune response to tumor burden ratio [defined as the lymphocyte to monocyte ratio (LMR)/lactate dehydrogenase (LDH) levels] in 184 DLBCL patients and the potential mechanism underlying the use of the LMR to tumor burden ratio in predicting patient survival. Methods: The correlation between serum LDH levels and tumor levels assessed by PET-CT was determined using Spearman’s correlation analysis. Clinical data from 184 DLBCL patients was assessed using receiver operating characteristic curve analysis and survival analysis. The potential correlation between tumor burden and lymphocytes or monocytes was analyzed by immunohistochemical staining, flow cytometry, and ELISA analysis of patient samples. In addition, we performed in vitro studies to further determine the effects of tumor burden on the anti-tumor activity of T lymphocytes. Results: We observed that serum LDH was an excellent surrogate marker of tumor burden in DLBCL patients, and that the ratio of LMR to LDH was an independent prognostic biomarker capable of predicting survival in DLBCL patients. Further analysis showed that a high tumor burden was correlated with decreased Ki67 expression in T cells, either in the solid tumor tissue or in the circulating blood. In addition, based on an in vitro co-culture study, a higher tumor burden led to the suppression of the anti-tumor response of T cells. Furthermore, we found that a higher tumor burden was correlated with the differentiation of monocytes to tumor associated macrophages in the tumor micro-environment. Both results demonstrate the importance of considering both the immune system and tumor burden for prognostic analysis. Conclusion: Our study has identified a novel clinical biomarker, namely, the immune response to tumor burden ratio, that can be used to distinguish survival outcomes in DLBCL patients, and demonstrated the potential mechanism underlying the use of this biomarker, that incorporates both the immune system and tumor burden, for use in future clinical applications.

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Section: Introductionmentioning

confidence: 99%

Ratio of Immune Response to Tumor Burden Predicts Survival Via Regulating Functions of Lymphocytes and Monocytes in Diffuse Large B-Cell Lymphoma

Niu

Yin

et al. 2018

Cell Physiol Biochem

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“…The recent inventions of useful devices and computer-aided diagnosis are being utilized in gastric cancer surgery [12,13]. More recently, some novel and unique methodological approaches have been widely used in various medical fields [14,15]. Solitary lymph node metastasis analysis and our present study might be included among these innovative research advances [2].…”

Section: Discussionmentioning

confidence: 94%

Lymphatic Routes of Gastric Cancer Metastasis Elucidated by Triple Lymph Node Analysis

Kubota¹,

Suzuki²,

Fujikawa³

et al. 2017

J Tumor Res

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Background: Although the development of lymphatic invasion by gastric cancer has been solved using 'solitary lymph node metastasis' research, few facts are known about the sequential flow following the sentinel station. Aim: In this study, we investigate the lymphatic spread of gastric cancers using 'triple lymph nodes metastases' analysis. Methods: During January 2001 and December 2015, 402 subsequent patients with gastric cancer underwent gastrectomy with standardized lymph node dissection at our institute. Among them, lymph node involvement was revealed in 234 patients by a histopathological study. The lymphatic spread of gastric cancer was analyzed theoretically based on the probability of additional lymph node metastases from each station. Results: The numbers of cases were 64, 41, 17, 23, 17, 13 and 59 according to the number of metastases of 1, 2, 3, 4, 5, 6 and 7 or more, respectively. The lesser curvature lymph node (#3) was the key station and skip metastasis was sometimes seen in lymph nodes of the intermediate region at the solitary lymph node metastasis stage. Some lymphatic flows were demonstrated by double and triple lymph node metastasis analysis, especially many flows from perigastric toward intermediate regions. Conclusion: This study demonstrated theoretically a lymphatic route for gastric cancer cells using a novel methodology. The results may be applicable to making preoperative diagnosis and for deciding on optimal lymph node dissection in gastric cancer surgery.

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“…The metro-ticket system was first used for HCC [7,8]. Later, the principle was applied to patients undergoing hepatic resection of colorectal liver metastasis (CRLM), thus establishing a new tumor burden score model that can accurately distinguish the prognosis of CRLM patients [15]. Similar to the models for HCC and CRLM, we modeled the pT stage and pN stage on a Cartesian plane and forecasted the OS of patients undergoing radical resection of GC based on this model (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Figuratively, each point on the chart may be said to represent a potential "destination", while the origin of the Cartesian plane (0, 0) is considered as a central "Metro" station. The longer the trip away from the origin (increased pT and pN stage), the higher the price of the "ticket" (reduced survival) [8,15].…”

Section: Discussionmentioning

confidence: 99%

A novel TNM staging system for gastric cancer based on the metro-ticket paradigm: a comparative study with the AJCC-TNM staging system

et al. 2019

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Background The metro-ticket prognostic tool for hepatocellular carcinoma has been proven to predict outcome, but a similar concept has not been investigated for GC. The objective of the current study was to apply the principles of the metro-ticket paradigm to develop a novel TNM staging system (nTNM) for gastric cancer (GC). Methods The nTNM considered the distance from the origin on a Cartesian plane incorporating the pN (x-axis) and pT (y-axis) stages. GC patients undergoing radical resection at Fujian Medical University Union Hospital (FMUUH) (n = 4267) were included. The nTNM was validated using 2 external cohorts from the Sun Yat-sen University Cancer Center (SYSUCC) (n = 1800) and Surveillance, Epidemiology, and End Results (SEER) (n = 3227) databases. Results nTNM classes with the same distance from the origin have same stage; the stage increases with this distance. Among all patients, 48.0% (n = 2049) were restaged in the nTNM compared with the 7th edition of the AJCC-TNM classification; 26.2% (n = 1116) were downstaged in the nTNM compared with the 8th edition. The nTNM provides significant survival differences between stages (all P < 0.001). The survival difference between stages IB and IIA was especially large for the nTNM (P < 0.001) compared to the 7th and 8th editions (P = 0.073). The concordance index and hazard ratio increased successively with the nTNM stage. Similar findings were observed in both external cohorts. Conclusion Compared with the AJCC-TNM classification, the nTNM for GC is easier to remember and provides some improvements; therefore, the nTNM may be considered for adoption in future editions of the AJCC-TNM classification.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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The Tumor Burden Score

Abstract: An externally validated "Metro-ticket" TBS model had excellent prognostic discriminatory power. TBS may be an accurate tool to account for the impact of tumor morphology on long-term survival among patients undergoing resection of CRLM.

Cited by 322 publications

References 49 publications

Ratio of Immune Response to Tumor Burden Predicts Survival Via Regulating Functions of Lymphocytes and Monocytes in Diffuse Large B-Cell Lymphoma

Ratio of Immune Response to Tumor Burden Predicts Survival Via Regulating Functions of Lymphocytes and Monocytes in Diffuse Large B-Cell Lymphoma

Lymphatic Routes of Gastric Cancer Metastasis Elucidated by Triple Lymph Node Analysis

A novel TNM staging system for gastric cancer based on the metro-ticket paradigm: a comparative study with the AJCC-TNM staging system

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