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

The authors report the results of the retrospective analysis of 306 patients with nasopharyngeal carcinoma. All patients had received high-dose radiation therapy. First, overall results were analyzed, and then the prognostic value of the patients' data (age and sex) and of tumor features (histology, local spread, lymph node involvement). Crude actuarial survival rate is 42.9% (+/- 2.9) at 5 years; loco-regional control at the end of treatment was obtained in 16.8% of cases; 53.6% of them (126 patients) had relapses, especially on T and M. Cumulative relapse rate was 51.1% (+/- 3.3) at 5 years. Mean relapse-free interval was 10 months. All the clinical factors we examined had prognostic value; especially local tumor spread, with a worse prognosis for tumors with extra-nasopharyngeal spread (5-year survival: 38.3% +/- 6.9 for T3 and 33.9% +/- 4.8 for T4), and especially for tumors with neurological deficits (5-year survival: 19.9% +/- 6.3). Regional lymph node metastases were an important factor too, with a special emphasis on size (5-year survival: 26.4% +/- 6.5 in the cases with adenopathies with phi greater than 6 cm), and fixed adenopathies (5-year survival: 23.9% +/- 4.6). These prognostic factors are considered only in part in the current TNM 1987 staging system, which calls for its partial revision.
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PMID:[Rhinopharyngeal carcinoma. Clinical prognostic factors]. 200 23

Endosonography was performed preoperatively in 33 patients with common bile duct carcinoma and in 43 patients with carcinoma of the common hepatic duct and its bifurcation. The results were correlated with the histology of resected specimens according to the new (1987) TNM (tumor, node, metastasis) classification. Endosonography was accurate in the evaluation of the depth of tumor infiltration. Overall accuracy for common bile duct carcinoma and common hepatic duct carcinoma was 82.8% and 85%, respectively. Endosonography was helpful in diagnosing regional lymph node metastases but not accurate in diagnosing nonmetastatic lymph nodes. With common bile duct carcinoma, the incidence of lymph node metastasis increased with progressive depth of tumor infiltration. No such correlation was found in common hepatic duct carcinomas. In the staging of distant metastasis, this technique was limited by the low-penetration depth of ultrasonography. Thus, additional transcutaneous ultrasonography or computed tomography was necessary for complete staging. The routine use of the biopsy channel for endosonographically guided aspiration puncture will further enhance the diagnostic value of endosonography in the future.
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PMID:Endosonographic TNM staging of extrahepatic bile duct cancer: comparison with pathological staging. 201 80

We present the results of 186 breast cancer patients treated initially for locoregional disease by radiotherapy alone, combining cobalt therapy with external electron beam or interstitial iridium implants. According to the TNM classification, the patients were distributed as follows: 3 T1N0, 2 T1N1, 33 T2N0, 36 T2N1, 16 T3N0, 26 T3N1, 6 T3N2, 14 T4N0, 29 T4N1, 9 T4N2 and 12 T4N3. The 5- and 10-year survival rates (52.7% and 36.5%, respectively, for all patients) were directly correlated with the size and location of the breast tumor, and the extent of lymph node involvement. Locoregional recurrence was observed in 39.8% of the cases, metastasis alone in 26.8% of the cases, and a combination of local recurrence and distant metastasis in 14.5% of the cases. The local recurrences and metastases were directly correlated with the extent of locoregional involvement. Late complications and sequelae were mostly minor and occurred in less than 25% of the cases; severe sequelae occurred in no more than 2% of the cases. They depended on the initial tumor volume and the tumor dose. Our results, along with those in the literature, indicate that radiotherapy administered alone is a valid therapeutic option in breast cancer.
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PMID:Exclusive radical radiation therapy in breast carcinoma. 202 Jul 52

A twelve year series of 375 patients with gastric carcinoma has been studied. Patients were divided into TNM Groups. Tumours were classified as intestinal-type and diffuse. The patients with T1-3NOMO diffuse tumour were ten years younger than the patients with T1-3NOMO intestinal-type tumour. The mean age increased from T1 through T2 to those with T3 tumour. The age differences between the T-stages were the same in both groups, which indicate that once started, the diffuse and the intestinal-type tumours infiltrate the gastric wall at about the same rate. Among the patients with intestinal-type tumour, those with lymph node or distant metastases were three to seven years younger than the patients without metastases. On the other hand, the patients with diffuse tumour and metastases were as many years older than the patients without metastases. Apparently, tumour spread is age dependent and different between the two types of gastric carcinoma. The ill repute of the diffuse gastric carcinoma may therefore be explained by the advanced stage of that tumour at the time of treatment as compared to the intestinal-type tumour. The diffuse tumour seems to be clinically more silent and to give symptoms at a later stage than the intestinal-type tumour.
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PMID:The influence of age on the growth and spread of gastric carcinoma. 202 48

The TNM classification of cancers arising in the upper aerodigestive tract is a generally useful and widely applied method for estimating prognosis and planning therapy. In two retrospective reviews of patients with oral cavity cancers, we identified additional histopathological characteristics that were significantly related to treatment outcome. A study of 136 patients with squamous cell carcinoma of the anterior tongue (without clinical metastases) demonstrated, in a multifactorial analysis, three factors associated with a high risk of occult metastases: Clinical size of the primary tumor, presence of perineural invasion, and male gender. In a second analysis, of 89 patients with squamous cell carcinoma of the buccal mucosa, many pathologic and clinical parameters were related to prognosis using single-factor analysis. However, in multifactorial analysis only tumor thickness and vascular invasion were predictive of outcome.
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PMID:Histopathological prognostic factors of certain primary oral cavity cancers. 214 38

The prognostic significance of conventional TNM staging remains the standard for determining prognosis in breast carcinoma. The presence (or absence) of axillary lymph node metastases remains the single most important parameter for predicting patient outcome. The presence of regional lymph node metastases implies that the primary tumor has the capacity for successfully completing the steps of the metastatic cascade. However, the absence of regional lymph node metastases does not ensure that distant or systemic seeding of tumor cells has not occurred, only that it is less likely. Staging data appear to be refined by addition of several standard morphological parameters. Although there is considerable overlap and interaction between these factors, as well as with staging data, there is strong evidence that grade, necrosis, inflammatory cell "immune response," and possibly pattern of invasion and intravascular tumor each independently supplement staging information. Some data appear to have independent significance only when applied to specific patient subsets, raising serious question as to their biologic importance. Nevertheless, morphological data are subjective and susceptible to observer variation and have less statistical power in predicting patient outcome than staging data. It was initially thought that DNA analysis of breast cancer by flow cytometry might supplant morphological data in assessing tumor behavior. The following conclusions can now be drawn: (1) there is no clear association between aneuploidy and SPF and stage; (2) aneuploid tumors are associated with higher SPF and shorter disease-free survival while diploid-range tumors generally have lower SPF and longer disease-free survival; (3) aneuploid DNA content is significantly associated with markers of decreased morphological (grade) and biochemical (ER status) differentiation. Determination of S-phase fraction by FCM appears to be a rapid and potentially easy method for obtaining kinetic information on individual breast tumors, although the technology for improving the accuracy of SPF measurements is still under development (e.g., tumor cell gating, debris subtraction). SPF appears to be comparable to other kinetic measurements, such as TLI, and shows many of the same associations with morphological and clinical data as ploidy. This is due to the close association of ploidy and SPF. Which of these parameters is more important for predicting patient outcome has not been clearly defined. Additional technological refinements for determining SPF may result in a more prominent prognostic role for this measurement. Three problems have limited our ability to draw specific conclusions about the biologic significance of tumor ploidy and SPF.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Prognostic significance of morphological parameters and flow cytometric DNA analysis in carcinoma of the breast. 215 77

Two anatomic subsets of patients with stage IIIa non-small cell cancer of the lung are candidates for definitive surgical treatment. The first group includes patients with T1, T2, or T3 primary tumors and regional lymph node metastases confined to the ipsilateral mediastinal and subcarinal lymph nodes (N2 disease). There is controversy over the selection of this group of patients for surgery; some physicians do not believe that resection is an option if there is any evidence of mediastinal lymph node involvement. The second group is composed of patients with limited, circumscribed extrapulmonary extension of the primary tumor and lymph node metastasis, if present, limited to the hilar and peribronchial nodes (T3 N0-1 M0 disease). Peripheral tumors invading the chest wall, tumors originating in the superior sulcus of the lung, and those with limited involvement of the pericardium or the main bronchus are included. A five-year cumulative survival rate of 28 percent was documented for 198 consecutive patients undergoing complete resection for stage IIIa non-small cell lung cancer, 21 percent for the T1-3 N2 group, and 39 percent for the T3 N0-N1 patients. Cell type was not a statistically significant variable for survival; however, a superior outcome was observed for patients with squamous cell carcinoma in every TNM category. The results support surgical treatment as a valid option for selected patients with extrapulmonary extension of the disease.
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PMID:Expanded possibilities for surgical treatment of lung cancer. Survival in stage IIIa disease. 215 77

ES was performed preoperatively in 39 patients with a proximal bile duct carcinoma. The results were correlated with the histologic findings of resected specimens or intraoperative excision according to the new (1987) TNM classification. ES was accurate in assessing the depth of tumor infiltration. The overall accuracy of ES was 83.8%. Overstaging of T2 carcinoma occurred in three of ten patients (30%) and understaging of T3 carcinoma occurred in 3 of 27 patients (11%). ES was helpful in diagnosing lymph node metastasis (accuracy, 92.9%) but not accurate in defining nonmetastatic lymph nodes (accuracy, 18.8%). Difficulties occurred in distinguishing inflammatory lymph nodes and micrometastatic lymph node involvement. ES was not accurate in diagnosing hepatic metastases and peritoneal dissemination because of the limited penetration depth of ultrasound. The incidence of lymph node metastasis of advanced stage carcinoma was approximately 40%. Technical improvements, such as reduction of the diameter of the echoprobe, easy handling of ES-guided cytologic puncture, and the routine use of a catheter echoprobe during ERCP will further enhance the accuracy of ES.
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PMID:Preoperative TNM classification of proximal extrahepatic bile duct carcinoma by endosonography. 216 63

To determine the accuracy of computed tomography (CT) of the chest in the staging of lung cancer, we studied 418 patients with primary pulmonary carcinoma between 1979 and 1986. Each had a preoperative scan performed before detailed operative staging. Each CT scan was analyzed for components of the current TNM staging system. Computed tomography sensitivity and specificity for mediastinal lymph node metastasis were 84.4% and 84.1%, with corresponding positive and negative predictive accuracies of 68.7% and 92.9%, respectively. When TNM stages were derived from CT scans, only 190 of 418 (45.4%) completely agreed with operative staging. An additional 53 of 418 (12.7%) predicted the correct stage, although components of the TNM system were incorrect. In 94 of 418 scans (22.5%) CT overestimated the stage, whereas in 81 (19.4%) CT downgraded the stage. Computed tomography suggested metastatic lesions in liver, lung, adrenal gland, bone, or abdominal lymph nodes in 40 of 373 scans (10.7%); only five of 40 (12.5%) had documented metastasis. In summary, CT of the chest cannot accurately stage primary lung carcinoma according to the TNM classification. Because the negative predictive accuracy for mediastinal lymph node metastasis remains high (92.9%), invasive staging can be deferred for definitive thoracotomy when no lymphadenopathy is evident on CT. The high negative predictive accuracy for scans of the chest and upper abdomen makes CT a useful tool for exclusion of metastatic disease.
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PMID:Can computed tomography of the chest stage lung cancer? Yes and no. 198 65

Endosonography (ES) was used for the preoperative TNM (1987) staging of tumors in 43 patients with pancreatic cancer and 24 patients with ampullary carcinomas. These results were correlated with the histologic findings of resected specimens. Early-stage tumors could be distinguished from advanced stages of cancer with ES. Detailed images of ductular and parenchymal abnormalities allowed distinction between pancreatic and ampullary carcinomas based on anatomic location. The overall accuracy of ES in the assessment of tumor classification in pancreatic and ampullary carcinoma was 92% and 88%, respectively. In diagnosing regional lymph nodes in pancreatic and ampullary tumors the accuracy of ES was 74% and 54%, respectively. For diagnosing metastatic lymph nodes in pancreatic and ampullary carcinoma the accuracy of ES was 91% and 80%, respectively. The prevalence of lymph node metastases in T1 pancreatic cancers and T1 ampullary carcinomas was 40% and 0%, respectively. Discrimination between inflammation and metastases was difficult with ES. ES was not accurate in assessing distant metastases because of the limited penetration depth of ultrasound.
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PMID:Ampullopancreatic carcinoma: preoperative TNM classification with endosonography. 218 84


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