The Current Staging Systems of Tumor and Their Pitfalls

A special issue of Cancers (ISSN 2072-6694).

Deadline for manuscript submissions: closed (31 January 2022) | Viewed by 12973

Special Issue Editors


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Guest Editor
Polistudium SRL, Milan, Italy
Interests: palliative care; research methodology; consensus approaches; cancer; pediatrics
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Guest Editor
1. Gastroenterology Unit, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy
2. Gastroenterology and Digestive Endoscopy Unit, Foggia University Hospital, 71122 Foggia, Italy
Interests: hepatocellular carcinoma; liver Diseases; liver cirrhosis; liver transplantation; hepatobiliary surgery; liver surgery; cholangiocarcinoma; gastroenterology; liver failure
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Department of Liver Cancer Biology, Liver Transplant Institute, Inonu University, Malatya 44280, Turkey
Interests: HCC therapies

Special Issue Information

Dear colleagues,

We are honored to introduce you a new Special Issue entitled “The Current Staging Systems of Tumor and Their Pitfalls” which is open for submissions now in Cancers.

Accurate staging of tumors is crucial to estimate prognosis and identify appropriate management options. The staging protocols, however, continue to evolve and are under constant revision and change, also due to advances in molecular oncology approaches. Moreover, current staging systems often present a number of pitfalls and controversial issues. We feel that it is time to discuss the current staging systems of several neoplasms and their pitfalls in a single, dedicated editorial initiative.

Both original research articles and reviews are welcome for consideration. Contributors are invited to express their own views and hypotheses, provided that they are supported by evidence or experimental data.

Dr. Luca Giacomelli
Dr. Rodolfo Sacco
Prof. Brian Carr
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • staging systems
  • classification
  • treatment

Published Papers (6 papers)

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Editorial

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4 pages, 200 KiB  
Editorial
Understanding the Drawbacks of the Current Tumor Staging Systems: How to Improve?
by Luca Giacomelli, Rodolfo Sacco, Simonetta Papa and Brian I. Carr
Cancers 2023, 15(4), 1242; https://doi.org/10.3390/cancers15041242 - 15 Feb 2023
Cited by 1 | Viewed by 940
Abstract
Tumor stage definition is required for the description of the diagnosis and the development and use of treatment guidelines, as well as to enable clinical research (including clinical trials) and cancer surveillance [...] Full article
(This article belongs to the Special Issue The Current Staging Systems of Tumor and Their Pitfalls)

Research

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15 pages, 2563 KiB  
Article
Do We Need TNM for Tracheal Cancers? Analysis of a Large Retrospective Series of Tracheal Tumors
by Aleksandra Piórek, Adam Płużański, Paweł Teterycz, Dariusz Mirosław Kowalski and Maciej Krzakowski
Cancers 2022, 14(7), 1665; https://doi.org/10.3390/cancers14071665 - 25 Mar 2022
Cited by 6 | Viewed by 2064
Abstract
Due to the low incidence of primary tracheal neoplasms, there is no uniform system for staging of this disease. Our retrospective analysis based on registry data included 89 patients diagnosed with primary tracheal cancer at the National Research Institute of Oncology in Warsaw, [...] Read more.
Due to the low incidence of primary tracheal neoplasms, there is no uniform system for staging of this disease. Our retrospective analysis based on registry data included 89 patients diagnosed with primary tracheal cancer at the National Research Institute of Oncology in Warsaw, Poland, between January 2000 and December 2016. We analyzed demographic, clinical, pathological, therapeutic, and survival data. The staging—for the purpose of our analysis—was performed retrospectively on the basis of imaging results. Tumor (T) category was defined as a disease confined to the trachea or lesion derived from the trachea and spreading to adjacent structures and organs. Node (N) and metastases (M) categories were divided into absence/presence of metastasis in regional lymph nodes and the absence/presence of distant metastasis. Survival analysis was performed depending on the clinical presentation of these features. There was a significant difference in overall survival depending on the T, N, M categories in the entire group. In the group of patients undergoing radical treatment, the T and N categories had a statistically significant impact on overall survival. In the group of patients treated with palliative aim, only the T category had an impact on overall survival. Multivariate analysis showed statistical significance for the T category in patients undergoing radical and those receiving palliative treatment. The assessment of the anatomical extent of lesions may help decide about treatment options and prognosis. Full article
(This article belongs to the Special Issue The Current Staging Systems of Tumor and Their Pitfalls)
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12 pages, 1699 KiB  
Article
Looking for a Simplified Diagnostic Model to Identify Potentially Lethal Cases of Prostate Cancer at Initial Diagnosis: An ImGO Pilot Study
by Serena Macrini, Simona Francesconi, Cecilia Caprera, Daniela Lancia, Matteo Corsi, Marco Gunnellini, Andrea Rocchi, Anjuta Pireddu, Fiovo Marziani, Claudia Mosillo, Maria Letizia Calandrella, Claudia Caserta, Diana Giannarelli, Annalisa Guida, Stefano Ascani and Sergio Bracarda
Cancers 2022, 14(6), 1542; https://doi.org/10.3390/cancers14061542 - 17 Mar 2022
Cited by 4 | Viewed by 1658
Abstract
The recurrent genetic anomalies used to classify prostate cancer (PC) into distinct molecular subtypes have limited relevance for clinical practice. In consideration of WHO 2016 histological classification, which includes the introduction of Gleason Score 4 for patients with cribriform component and the definition [...] Read more.
The recurrent genetic anomalies used to classify prostate cancer (PC) into distinct molecular subtypes have limited relevance for clinical practice. In consideration of WHO 2016 histological classification, which includes the introduction of Gleason Score 4 for patients with cribriform component and the definition of intraductal carcinoma as a new entity, a retrospective pilot study was conducted to investigate, by histological review, if there were any variations of Gleason Score and the incidence of intraductal carcinoma and cribriform pattern, intended as “phenotypic” markers of potentially lethal PC, among metastatic castration-sensitive PC (mCSPC) and metastatic castration-resistant PC (mCRPC) samples. Potentially predictive factors were also assessed. Among 125 cases, a variation in the Gleason Score was reported in 26% of cases. A cribriform (36%) or intraductal (2%) pattern was reported in a higher percentage. Of them, a primary Gleason pattern 4 was reported in 80% of cases. All patients with intraductal carcinoma present a BRCA2 mutation, also found in 80% of cases with a cribriform pattern. This pilot study documented some hypothesis-generating data, as the evaluation of de novo mCSPC and mCRPC as phenotypic/biologic model to be translated in clinical practice. A cribriform pattern/intraductal carcinoma might be a marker of potentially lethal PC. The high incidence of TP53 and BRCA2 mutations in de novo mCSPC may also have a therapeutic implication. Full article
(This article belongs to the Special Issue The Current Staging Systems of Tumor and Their Pitfalls)
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17 pages, 1955 KiB  
Article
Metabolomic Analysis of Actinic Keratosis and SCC Suggests a Grade-Independent Model of Squamous Cancerization
by Valeria Righi, Camilla Reggiani, Elisabetta Tarentini, Adele Mucci, Alessia Paganelli, Anna Maria Cesinaro, Ema Mataca, Shaniko Kaleci, Barbara Ferrari, Marco Meleti and Cristina Magnoni
Cancers 2021, 13(21), 5560; https://doi.org/10.3390/cancers13215560 - 5 Nov 2021
Cited by 7 | Viewed by 2148
Abstract
Background—Actinic keratoses (AKs) are the most common sun-induced precancerous lesions that can progress to squamocellular carcinoma (SCC). Recently, the grade-independent association between AKs and SCC has been suggested; however, the molecular bases of this potential association have not been investigated. This study has [...] Read more.
Background—Actinic keratoses (AKs) are the most common sun-induced precancerous lesions that can progress to squamocellular carcinoma (SCC). Recently, the grade-independent association between AKs and SCC has been suggested; however, the molecular bases of this potential association have not been investigated. This study has assessed the metabolomic fingerprint of AK I, AK II, AK III and SCC using high resolution magic angle spinning (HR-MAS) nuclear magnetic resonance (NMR) spectroscopy in order to evaluate the hypothesis of grade-independent association between AK and SCC. Association between AKs and SCCs has also been evaluated by histopathology. Methods—Metabolomic data were obtained through HR-MAS NMR spectroscopy. The whole spectral profiles were analyzed through multivariate statistical analysis using MetaboAnalyst 5.0. Histologic examination was performed on sections stained with hematoxylin and eosin; statistical analysis was performed using STATA software version 14. Results—A group of 35 patients affected by AKs and/or SCCs and 10 healthy controls were enrolled for metabolomics analysis. Histopathological analysis was conducted on 170 specimens of SCCs and AKs (including the ones that underwent metabolomic analysis). SCCs and AK I were found to be significantly associated in terms of the content of some metabolites. Moreover, in the logistic regression model, the presence of parakeratosis in AKs appeared to be less frequently associated with SCCs, while AKs with hypertrophy had a two-fold higher risk of being associated with SCC. Conclusions—Our findings, derived from metabolomics and histopathological data, support the notion that AK I are different from healthy skin and share some different features with SCCs. This may further support the expanding notion that all AKs should be treated independently from their clinical appearance or histological grade because they may be associated with SCC. Full article
(This article belongs to the Special Issue The Current Staging Systems of Tumor and Their Pitfalls)
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11 pages, 981 KiB  
Article
Identification of Clinical Phenotypes and Related Survival in Patients with Large HCCs
by Brian I. Carr, Vito Guerra, Rossella Donghia, Fabio Farinati, Edoardo G. Giannini, Luca Muratori, Gian Ludovico Rapaccini, Maria Di Marco, Eugenio Caturelli, Marco Zoli, Rodolfo Sacco, Ciro Celsa, Claudia Campani, Andrea Mega, Maria Guarino, Antonio Gasbarrini, Gianluca Svegliati-Baroni, Francesco Giuseppe Foschi, Elisabetta Biasini, Alberto Masotto, Gerardo Nardone, Giovanni Raimondo, Francesco Azzaroli, Gianpaolo Vidili, Maurizia Rossana Brunetto and Franco Trevisaniadd Show full author list remove Hide full author list
Cancers 2021, 13(4), 592; https://doi.org/10.3390/cancers13040592 - 3 Feb 2021
Cited by 5 | Viewed by 1937
Abstract
Background. Hepatocellular carcinoma (HCC) factors, especially maximum tumor diameter (MTD), tumor multifocality, portal vein thrombosis (PVT), and serum alpha-fetoprotein (AFP), influence survival. Aim. To examine patterns of tumor factors in large HCC patients. Methods. A database of large HCC patients was examined. Results. [...] Read more.
Background. Hepatocellular carcinoma (HCC) factors, especially maximum tumor diameter (MTD), tumor multifocality, portal vein thrombosis (PVT), and serum alpha-fetoprotein (AFP), influence survival. Aim. To examine patterns of tumor factors in large HCC patients. Methods. A database of large HCC patients was examined. Results. A multiple Cox proportional hazard model on death identified low serum albumin levels and the presence of PVT and multifocality, with each having a hazard ratio ≥2.0. All combinations of these three parameters were examined in relation to survival. Using univariate Cox analysis, the combination of albumin >3.5 g/dL and the absence of both PVT and multifocality had the best survival rate, while all combinations that included the presence of PVT had poor survival and hazard ratios. We identified four clinical phenotypes, each with a distinct median survival: patients with or without PVT or multifocality plus serum albumin ≥3.5 (g/dL), with each subgroup displaying high (≥100 IU/mL) or low (<100 IU/mL) blood AFP levels. Across a range of MTDs, we identified only two significant trends, blood AFP and platelets. Conclusions. Patients with large HCCs have distinct phenotypes and survival, as identified by the combination of PVT, multifocality, and blood albumin levels. Full article
(This article belongs to the Special Issue The Current Staging Systems of Tumor and Their Pitfalls)
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Review

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11 pages, 757 KiB  
Review
Microwave Ablation Versus Radiofrequency Ablation for Treatment of Hepatocellular Carcinoma: A Meta-Analysis of Randomized Controlled Trials
by Antonio Facciorusso, Mohamed A. Abd El Aziz, Nicola Tartaglia, Daryl Ramai, Babu P. Mohan, Christian Cotsoglou, Sara Pusceddu, Luca Giacomelli, Antonio Ambrosi and Rodolfo Sacco
Cancers 2020, 12(12), 3796; https://doi.org/10.3390/cancers12123796 - 16 Dec 2020
Cited by 67 | Viewed by 3141
Abstract
There are limited and discordant results on the comparison between microwave ablation (MWA) and radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC). This meta-analysis aims to compare the two treatments in terms of efficacy and safety, based on a meta-analysis of [...] Read more.
There are limited and discordant results on the comparison between microwave ablation (MWA) and radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC). This meta-analysis aims to compare the two treatments in terms of efficacy and safety, based on a meta-analysis of randomized-controlled trials (RCTs). A computerized bibliographic search was performed on the main databases throughout August 2020. The primary outcome was the complete response rate, while survival rate (at 1-, 2-, 3-, and 5-year), disease-free survival rate (at 1-, 2-, 3-, and 5-year), local and distant recurrence rate, adverse event rate, and number of treatment sessions were the secondary outcomes. Seven RCTs enrolling 921 patients were included. No difference in terms of complete response between the two treatments was observed (risk ratio (RR) 1.01, 95% CI 0.99–1.02). Survival rates were constantly similar, with RRs ranging from 1.05 (0.96–1.15) at 1 year to 0.91 (0.81–1.03) at 5 years. While local recurrence rate was similar between MWA and RFA (RR 0.70, 0.43–1.14), distant recurrence rate was significantly lower with MWA (RR 0.60, 0.39–0.92). Disease-free survival at 1, 2, and 3 years was similar between the two groups with RR 1.00 (0.96–1.04), 0.94 (0.84–1.06), and 1.06 (0.93–1.21), respectively. On the other hand, RR for disease-free survival at 5 years was significantly in favor of MWA (3.66, 1.32–42.27). Adverse event rate was similar between the two treatments (RR 1.06, 0.48–2.34), with bleeding and hematoma representing the most frequent complications. Our results indicate a similar efficacy and safety profile between the two techniques. MWA seems to decrease the rate of long-term recurrences, but this finding needs to be confirmed in further trials. Full article
(This article belongs to the Special Issue The Current Staging Systems of Tumor and Their Pitfalls)
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