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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In January 1987, the 4th edition of the TNM classification for malignant lung tumours by the International Union Cancer (UICC) came into effect. Thus, for the first time, a uniform worldwide staging system for lung cancer became available. In order to validate the new TNM definitions for lung cancer the data of 3,000 patients were analysed prospectively. Several items were examined: 1) the agreement between clinically (TNM) and pathologically (pTNM) confirmed classification; 2) the value of the various diagnostic techniques estimating the pathologically confirmed classification; 3) the influence of the TNM definitions on separating distinct prognostic groups. With regard to the primary tumour (T), clinical and pathological classifications were identical in 64%; for lymph node involvement (N) the agreement was 48%; for distant metastases it was 90% and for the stages it was 55%. As for the primary tumour (T) the accuracy of radiography (59%) was nearly identical to computed tomography (58%). Both techniques were less precise in determining the extent of lymph node involvement (computed tomography 50%, radiography 43%, correct assessments). The statistically significant differences in prognosis for the various T-, N- and M-categories as well as for the stages could be confirmed. By the new 1987 TNM definitions (4th edition) for lung cancer international conformity became feasible as well as practical, and the improvement in its prognostic relevance provided, therefore, a more reliable basis for establishing guidelines for individual oncological concepts of therapy.
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PMID:Classification of lung cancer: first experiences with the new TNM classification (4th edition). 180 67

The present study compares clinical and pathological findings and survival data from 410 patients who have undergone extended radical mastectomies in our hospital during the 20 years from 1967 with those derived from 261 who underwent mastectomies without dissections of the internal mammary nodes, in order to determine the value of additional internal mammary node dissection following standard radical mastectomy. Extended radical mastectomy was used in 289 of 361 (80.1%) patients with medial tumors, and in 121 of 310 (39.0%) with lateral tumors. Metastases to the internal mammary nodes were found in 18.5% (76) of all patients, in 20.4% (59) of the patients with medial tumors and in 14.0% (17) of those with lateral tumors. Of the patients with medial tumors, internal mammary node metastases were found in seven of 44 (15.9%) at TNM Stage I, and the rate of metastases rose with advances in stage. Internal mammary node metastases alone, without those to the axillary nodes, were found in 14 patients (4.8%) with medial tumors and in two with lateral tumors. The 10-year survival rate in patients with medial tumors and metastases to the internal mammary nodes only was 67.0%, which was as good as that in patients with metastases to the axillary nodes only. In conclusion, extended radical mastectomy was valuable in the treatment of relatively early medial breast cancer at TNM Stages I and II.
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PMID:Efficacy of internal mammary node dissection in the treatment of breast cancer. 180 47

Extrarenal Wilms' tumors are rare and have mainly been the subject of isolated case reports. This retrospective evaluation of 34 patients suggests a clinical course very similar to that of renal Wilms' tumor. While clinical presentation varies according to the extrarenal localization, investigations to determine the size of the primary tumor (T), regional lymph node involvement (N), and the occurrence of distant metastasis (M) are very similar, ie, chest x-ray, abdominal ultrasound (US), and computed axial tomographic (CAT) scan of the abdomen and chest. Stage grouping according to the pathologic TNM classification showed stage I in 30%, stage II in 10%, stage IIIa in 34%, stage IIIb in 23%, and stage IVa in 3%; four patients could not be staged. Evaluation of therapy and survival indicate the need for postoperative chemotherapy (CT) to all patients, while the same data suggest that the drugs used for renal Wilms' tumor are equally effective for extrarenal Wilms' tumor. Radiotherapy (RT) probably should be reserved for those patients with unresectable gross residual disease and for metastatic disease. The radiation dose used in the reviewed cases varied from 2,000 to 5,000 cGy. However, recent experience suggests that high doses are not justified in renal Wilms' tumor. The estimated overall 2-year survival of the 34 patients is 82% (95% confidence interval, 63% to 92%).
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PMID:Extrarenal Wilms' tumor: staging, treatment, and prognosis. 184 74

We have reviewed retrospectively the records of 157 patients, less than or equal to 30 years of age with nasopharyngeal carcinoma (NPC) from 218 such cases identified in the tumor registry files of three major teaching hospitals in Taipei, Taiwan. These cases were diagnosed between 1 January 1982 and 31 December 1985, with a minimum follow-up of 2 years. The average age was 25, with a male/female ratio of 1.67. The TNM (tumor size, nodes, metastases) classification of 127 patients showed T1, 22%; T2, 33.1%; T3, 23.6%; T4, 21.3%; N0, 26%; N1, 16.5%; N2, 27.6%; N3, 30%; and M1, 13.4%. Antibody titer to Epstein-Barr virus capsular antigen (EBVCA) were elevated in 45 of 48 patients tested. Of the 29 patients who had hepatitis B (HB) viral survey done 34.5% were positive for HB surface antigen (HBsAg). Of 13 patients with elevated EBVCA antibody who were also tested for HB, six were HBsAg carrier. Actuarial survival rates of 2 and 3 years are 70 and 62%, respectively, among the 90 patients who were followed regularly or to death. HBsAg carriers and patients with M1 disease had a shorter survival time. We concluded that patients less than 30 years of age seemed to have an increased incidence of NPC, compared to that in an earlier report. Our patients frequently presented with advanced stage and poor prognosis. The high rate of HB carrier raises the possibility that HBV may play a role in the carcinogenesis and tumor growth in some NPC patients. Future prospective studies are needed.
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PMID:Nasopharyngeal carcinoma in young patients. 184 56

Surgical therapy offers the only chance for long-term cure of patients with hepatocellular carcinoma. The role of partial and total hepatectomy with subsequent liver replacement was analyzed in a consecutive series of 198 patients. It was the aim of this study to compare both treatment modalities on the basis of various clinicopathological prognostic factors including the TNM system of pathological classification. One hundred thirty-one resections and 61 transplantations were performed for the following histological diagnoses: hepatocellular carcinoma without coexisting liver disease (86) or associated with various hepatic abnormalities (79), fibrolamellar carcinoma (19), and mixed hepatocholangiocellular carcinoma (8). Overall actuarial survival rates at 5 years were 35.8% following resection and 15.2% after transplantation, respectively. For partial hepatectomy, factors significantly associated with improved long-term outcome were: age 30-50 years, hepatocellular carcinoma without coexisting liver disease, fibrolamellar carcinoma, solitary tumor, unilobar location, absence of vascular invasion, portal vein thrombosis or extrahepatic spread, primary tumor categories pT 2/3, stage groups II/III, and curative operation (R0). Regarding total hepatectomy, the corresponding figures were: pT2, absence of portal vein thrombosis or extrahepatic spread (negative regional lymph nodes, no distant metastases), stage group II, and curative surgery. It could be clearly shown by uni- and multivariate analyses that the pTNM classification is of clinical value regarding the assessment of prognostic significance after resection and transplantation. A group of 13 patients had secondary resection (8) or transplantation (6) for intrahepatic tumor recurrence. Whereas in all resected patients cancer recurred again, 5 of 6 transplant recipients are alive and disease-free at 12-40 months. The results of this study demonstrate that liver resection is the treatment of choice for primary liver cancer while transplantation may be indicated, especially in cases of nonresectable or recurrent lesions. Thus, the therapeutic spectrum for hepatocellular carcinoma should include both partial and total hepatectomy, being integrated into one common concept.
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PMID:Surgical treatment of hepatocellular carcinoma: experience with liver resection and transplantation in 198 patients. 185 88

Fifty consecutive patients with gastric adenocarcinoma proved by means of biopsy underwent preoperative staging with endoscopic ultrasonography (US). Dynamic computed tomography (CT) of the chest and abdomen was performed before surgery in 33 of the patients. In all 50 patients, the TNM classification of the American Joint Committee on Cancer was used to compare the imaging findings with pathologic findings in specimens resected at surgery. When the depth of tumor penetration was evaluated, the findings at endoscopic US and those at pathologic examination were concordant in 46 of 50 patients (92%), and the findings at dynamic CT and those at pathologic examination, in 14 of 33 patients (42%) (P less than .00042). Evaluation of regional lymph node metastases showed a concordance of 78% with endoscopic US and 48% with dynamic CT (P less than .038). Overall determination of stage with both dynamic CT and endoscopic US showed a concordance of 73%, compared with a concordance of 45% for dynamic CT alone (P less than .028).
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PMID:Preoperative staging of gastric cancer: comparison of endoscopic US and dynamic CT. 192 68

During an 11-year period a total of 314 patients underwent surgery for renal carcinoma; 70 had venous extension of the tumour, 31 had extension to the main renal vein and were staged V1 and 39 had involvement of the inferior vena cava and were staged V2. Special attention was paid to the latter group, which was divided into 2 subgroups: V2a for caval extension without ingrowth and V2b for caval extension with infiltration of the caval wall. Thirty-eight patients with caval involvement underwent surgery, with a 13% post-operative mortality rate. Most of the patients with malignant caval ingrowth (V2b) had concomitant lymph node and distant metastases. However, some had negative lymph nodes and no metastases at the time of operation. Perifascial nephrectomy associated with caval tumour removal or lateral subhepatic caval resection for patients staged V2aNOMO significantly increased the survival rate when compared with that of patients with no surgery on the obstructed vena cava. Total resection of the completely obstructed subhepatic vena cava for patients staged V2bNOMO has limited indications but, in selected cases, may prolong survival. This retrospective study supports the reintroduction of indicator V in the TNM staging of renal carcinoma and suggests the splitting of stage V2 into V2a for patients with free-floating caval extension and V2b for caval thrombus with ingrowth and caval wall infiltration.
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PMID:Renal carcinoma with inferior vena cava malignant thrombosis. 193 52

From January 1980 to December 1987, 100 patients with carcinoma of the hypopharynx, staged according to TNM (UICC-1978) criteria, received exclusive radiation therapy at the Radiotherapy Department of the General Hospital of Varese. The median follow-up is 9 months (range: 1-97). Irradiation was delivered with 60Co or with 10 MV photons and tissue-equivalent bolus. Two opposed parallel lateral fields or rotational technique were used, with progressive shrinking of treated volume in order to spare the spinal cord after 45 Gy. Direct fields of electron beams (6-15 MeV) were employed as boosts on the residual nodes. Median total doses: 64.5 Gy to T and N1-3, 45 Gy to N0. A conventional fractionation (2 Gy once a day, 5 times a week) was used in 37 outpatients, while an accelerated hyperfractionated regimen (1.5 Gy twice a day, 5 times a week, with a six hours' interval between each fraction) was employed in 63 inpatients, in order to shorten hospitalization. The five-year overall survival (Kaplan-Meier) of the 100 treated patients is 10%, while the five-year disease-free survival of the 40 patients in complete clinical remission at the end of radiation therapy is 19.8%. The five-year loco-regional control rate after exclusive radiotherapy is 19.1%. Complete remission at the end of treatment seems to represent the only significant prognostic variable affecting survival: five-year overall survival is 32% for the 40 patients achieving complete remission and only 4.4% for the others (p less than 0.05). On the contrary, tumor extension (T class) seems to affect only the two-year local control rate: 35.2% and 10.9% for T1 + T2 and T3 + T4 respectively (p less than 0.1). The main cause of failure after radiation therapy is represented by the lack of control at the primary site (T) alone or associated with regional adenopathies (N). The analysis of isoeffect parameters, according to CRE model, has not shown any evident dose-response relationship for local control. Late effects were observed in 7% of the patients and were similar to those reported in the literature. The occurrence of both distant metastases, 3% in our experience, and secondary tumors (9%) is lower than those previously reported. The present retrospective study strongly reconfirms the inadequacy of exclusive radiation therapy as the sole treatment modality for carcinoma of the hypopharynx and suggests the need of combination therapy (surgery and radiation) as primary treatment.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Exclusive radiotherapy of carcinoma of the hypopharynx. Retrospective study of a series of 100 patients]. 194 70

The use of ultrasound combined with ultrasound-guided fine-needle aspiration biopsy (UGFAB) of supraclavicular lymph nodes in the pretreatment staging of 37 patients with squamous cell carcinoma of the esophagus is described. All patients underwent computed tomography (CT) scans of the chest and the abdomen and ultrasound of the abdomen and supraclavicular regions. Supraclavicular lymph node metastases (Stage IV disease according to the tumor nodes metastasis [TNM] classification) were cytologically diagnosed in seven (18.9%) of the 37 patients. In two of these patients, no other metastases were found. In the other five patients, UGFAB replaced more invasive diagnostic procedures. Due to their superficial location, ultrasound and UGFAB of the supraclavicular lymph nodes was relatively simple to perform, and contributed to an improved staging of squamous cell carcinoma of the esophagus.
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PMID:Ultrasound and ultrasound-guided fine needle aspiration biopsy of supraclavicular lymph nodes in patients with esophageal carcinoma. 198 52

Transcolorectal endosonography (TES) with use of both a nonoptic instrument and an echocolonoscope was performed in 91 patients with colorectal carcinomas (61 rectal and 30 colonic). Correlation of results at TES with results of histologic analysis of resected specimens according to the 1987 TNM classification demonstrated that TES allowed accurate staging of all tumors except T2 carcinomas, which were often accompanied by peritumoral inflammation or abscesses. Overall, the accuracy of staging rectal and colonic carcinomas with TES was 81% and 93%, respectively; overstaging occurred in 13% and understaging in 2%. For regional lymph nodes, the accuracy of staging with TES was 70%, the sensitivity was 94%, and the specificity was 55%. Correlations between findings at TES and the Dukes classification were as follows: for rectal carcinoma, 48% for class A, 50% for class B, and 96% for class C; for colonic carcinoma, 67% for class A, 46% for class B, and 91% for class C. Overall accuracy was 67%. With the addition of abdominal computed tomographic or ultrasonographic examinations to evaluate distant metastases, TES should become an important imaging technique for clinical TNM staging of colorectal carcinomas.
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PMID:Colorectal carcinoma: preoperative TNM classification with endosonography. 200 70


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