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The eighth edition of the American Joint Committee on Cancer melanoma staging system relies on assessments of the primary tumor (T), regional lymph nodes (N), and distant metastatic sites (M). Its notable updates include tumor thickness measurements to the nearest 0.1 mm, revision of T1a and T1b definitions, re-evaluation of N category descriptors, increased number of stage III subgroupings, and incorporation of a new M1d designation, among others. These changes were based on analyses of a large contemporary international melanoma database. Ultimately, these revisions were made to improve staging and prognostication, risk stratification, and selection of patients for clinical trials.

OBJECTIVE. The N category has been significantly updated in the 8th edition of the American Joint Committee on Cancer's TNM classification. To ensure correct tumor staging, prognosis, and management, it is critical to be aware of these changes. This article reviews the updated N category, organ-specific regional lymph nodes, and lymphatic drainage pathways for cancers of the digestive system from the esophagus to the anal canal. CONCLUSION. Detection of lymph node involvement may be challenging, and knowledge of nodal characteristics, lymphatic drainage pathways, and imaging modalities is essential to optimize detection rate to ensure accurate staging, prognosis estimation, and streamlined management.

In this extended note we give a precise definition of fully extended topological field theories \`a la Lurie. Using complete n-fold Segal spaces as a model, we construct an (∞,n)-category of n-dimensional cobordisms, possibly with tangential structure. We endow it with a symmetric monoidal structure and show that we can recover the usual category of cobordisms nCob and the cobordism bicategory nCobext from it.

Background/Aim. The outcome of rectal cancer is dependant on the stage of the tumour. There are several classification systems used to describe the extent of the disease. The aim of this study was to compare the efficacy of transrectal ultrasonography (TRUS) in preoperative local staging of rectal cancer using endosonographic probes with different views (180? vs 360?), as well as an influence of experience of an endoscopist on the TRUS performance. Methods. TRUS was performed in 127 patients with rectal carcinoma by two endoscopists. Seventy-one patients were examined with a 180? endosonographic probe (group A) and 56 patients with a 360? rotating probe (group B). All findings were compared with a histopathology report. Results. TRUS had a diagnostic overall accuracy of 91.3% for the tumor (T) category (k = 0.866, SE (k) = 0.038, p < 0.0001) and 71.7% for the node (N) category (? = 0.374, SE (k) = 0.082, p < 0.0001). In the group A, TRUS had a diagnostic overall accuracy of 88.7% for the T category (? = 0.805, SE (k) = 0.063, p < 0.0001), and 70.4% for the N category (? = 0.376, SE (k) = 0.101, P < 0.0001). In the group B, TRUS had a diagnostic overall accuracy of 94.6% for the T category (? = 0.920, SE (k) = 0.044, p < 0.0001), and 73.2% for the N category (? = 0.379, SE (k) = 0.131, p = 0.004). Experience of the endoscopist had no significant influence on results of preoperative staging of rectal cancer by using TRUS. Conclusion. The accuracy rate of TRUS in the preoperative local staging of rectal cancer is high. Our results imply no significant difference in the overall accuracy rates when using endosonographic probes with different views (180? vs 360?). Also, there was no significant influence of endoscopist experience on results obtained.

The 8th edition of the American Joint Committee on Cancer Tumor‐Node‐Metastasis (AJCC‐TNM) staging system for esophageal cancer (EC) retained the definition of N categories based on the number of metastatic lymph nodes (LN). However, it is difficult to accurately determine the number of metastatic LN without surgery. This study aimed to propose a revision to the N categories of the 8th edition AJCC‐TNM staging system that makes staging easier to perform and better represents the prognosis of non‐surgical esophageal squamous cell cancer (ESCC). We retrospectively reviewed the data of 336 patients with ESCC. The revised N categories were based on the anatomic regions of LN metastasis (cervix, thorax and abdomen). Survival was analyzed using the Kaplan‐Meier method and compared using the log‐rank test. Multivariate analyses were performed using the Cox proportional hazard model. Survival differences were adequately discriminated when the revised N categories were used. Subgroup analyses by T stage showed significant difference in overall survival between the revised N categories. Multivariate analyses demonstrated that T stage, revised N category, age, sex and treatment modality were independent risk factors, with the revised N category being the most significant variable. The revised N categories determined in this study can be used to fill gaps in the staging system for patients with non‐surgical ESCC, which can help clinicians to make better treatment decisions and more effectively predict patient prognoses. Future large‐scale studies are required to validate these results.

OBJECTIVE. Organ-specific nonregional and regional lymph nodes vary considerably among tumors. Nonregional lymph node involvement equals metastasis, which is critical to detect to ensure correct tumor staging, management, and prognosis. Knowledge of nodal nomenclature and anatomy is therefore essential in every cross-sectional imaging study. CONCLUSION. This article reviews the most important changes and highlights of the N category of the American Joint Committee on Cancer 8th edition of the TNM classification for urogenital cancers.

To explore the prognostic value of different radiologic extranodal extension (rENE) grades and their potential improvement for the 8th edition N category in nasopharyngeal carcinoma (NPC).From 2009 to 2013, a cohort of 1887 patients with NPC was retrospectively enrolled and randomized to the training (n = 955) and validation (n = 932) groups. rENE was categorized as follows: grade 0, nodes without rENE; grade 1, nodes with rENE infiltrating the surrounding fat only; grade 2, matted nodes; grade 3, nodes with rENE infiltrating adjacent structures.The percentage of patients with MRI-positive cervical nodes was 66.5% (1254/1887), of whom grade 0, 1, 2 and 3 rENE cases accounted for 33.2% (416/1254), 14.9% (187/1254), 36.5% (458/1254) and 15.4% (193/1254), respectively. The kappa coefficients for the inter-rater and intra-rater assessments were 0.63, 0.51, 0.65 and 0.93, and 0.76, 0.69, 0.72 and 1.0 in grade 0, 1, 2 and 3 rENE, respectively. Grade 3 rENE rather than grades 0-2 rENE was an independent unfavorable predictor of overall survival and disease-free survival (P 0.001). Recursive partitioning analysis was applied to refine the N category: eN0 (N0), eN1 (N1 without grade 3), eN2 (N2 without grade 3), and eN3 (N1/N2 with grade 3, N3). Compared to the current system, the proposed N category performed better in hazard consistency, hazard discrimination, sample size balance and outcome prediction.Grade 3 rENE was an independent unfavorable indicator of NPC. Upstaging patients in N1-2 with grade 3 rENE to N3 led to a superior prognostic performance.

This study is to investigate optimum apparent diffusion coefficient (ADC) parameter for predicting lymphovascular invasion (LVI), lymph node metastasis (LNM) and histology type in resectable rectal cancer. 58 consecutive patients with resectable rectal cancer were retrospectively identified. The minimum, maximum, average ADC and ADC difference value were obtained on ADC maps. Maximum ADC and ADC difference value increased with the appearance of LVI (r = 0.501 and 0.495, P r = 0.615 and 0.695, P r = − 0.269, P = 0.041). ADC difference value was an independent risk factor for predicting LVI (odds ratio = 1.323; P = 0.005) and LNM (odds ratio = 1.526; P = 0.005). Maximum ADC and ADC difference value could distinguish N0 from N1 category, N0 from N1–N2, N0–N1 from N2 (all P P = 0.041). ADC difference value had higher area under the receiver operating characteristic curve than maximum ADC in identifying LVI (0.828 vs 0.797), N0 from N1 category (0.947 vs 0.847), N0 from N1–N2 (0.935 vs 0.874), and N0–N1 from N2 (0.814 vs 0.770). ADC difference value may be superior to the other ADC value parameters to predict LVI, N category and histology type of resectable rectal cancer.

Initial staging is a key part of the initial evaluation of non-small cell lung cancer. It relies on the 7th edition of the TNM classification. Proposals have been recently developed for the 8th edition of the classification, which is due to be enacted in early 2017. Among these proposals, the weight of tumor size has been increased and new N descriptors have been introduced to further describe N category depending on the number station involved. Regarding M descriptors, oligometastatic disease is distinguished from multiple distant extrathoracic metastases.

To compare the prognostic value of 3 different lymph node scoring systems “ log odds of positive nodes (LODDS), lymph node ratio (rN), and lymph node yield “ in an effort to improve the staging of oral cancer. We identified 3958 oral cancer patients from Surveillance, Epidemiology, and End Results database from 2007 to 2013. In univariate analysis, LODDS, pN, rN, and lymph node yield were prognostic factors for 5-year disease-specific survival (DSS) and overall survival (OS). Multivariate analysis indicated that patients with LODDS 4 had worst 5-year DSS and OS. Stage migration occurred in pN1 and pN2 patients with LODDS 4. In pN1 patients, those with LODDS 4 had the worst 5-year DSS (41.2%) and OS (31.6%) than patients with pN1 and LODDS 2–3. In pN2 patients, those with LODDS4 had the worst 5-year DSS (34.5%) and OS (27.4%) than patients with pN2 and LODDS 2–3. The proposed staging system, which incorporates LODDS with AJCC pN, had better discriminability and prediction accuracy for predicting survival. We also noted that patients with LODDS 4 given adjuvant radiotherapy had better 5-year DSS and OS. The LODDS should be considered as a future candidate measurement for N category in oral cancer.

The purpose of this research is to analyze suitability salt pond in the Siduwonge Village, Randangan Distric, Pohuwato Regency. This research used spatial analysis and laboratory test to know salt qualities. Result of this research show that salt from Siduwonge Village is quite suitable for use as consumption salt and industrial salt. Spatial analysis of salt ponds found that salt fields area belong to S1 category was ±183 ha, salt fields area belong to S2 category was ±1,109 ha and area belong to N category was 6,652 ha.

Objective To evaluate whether mechanical bowel preparation before radical prostatectomy ameliorates damage from rectal injury in radical prostatectomy. Methods Among 35 099 radical prostatectomy cases in the Japanese Diagnosis Procedure Combination database 2007–2012, those where a rectal injury occurred were stratified into a preoperative mechanical bowel preparation group (polyethylene glycol electrolyte, magnesium citrate solution and sodium picosulfate) and a non-mechanical bowel preparation group. The associations between mechanical bowel preparation and rectal injury were evaluated by multivariate regression analysis for: (i) subsequent infectious complications; (ii) requirement of delayed colostomy formation after primary closure; (iii) postoperative length of stay; and (iv) total costs. Covariates were age, surgical approach, Charlson Comorbidity Index, T and N category, hospital volume, hospital academic status, and colostomy formation. Results Overall, 151 rectal injury cases (0.43%) were identified. Of those, 73 patients (48%) received mechanical bowel preparation. Multivariate analyses showed that all four outcomes were not statistically different between mechanical bowel preparation and non-mechanical bowel preparation groups (infectious complication rate: 12% vs 10%, P = 0.80; delayed colostomy rate: 21% vs 31%, P = 0.34; length of stay: 28 vs 30 days, P = 0.84; and total costs: $24 665 vs $23 837, P = 0.81). Conclusion Our analysis did not detect a beneficial impact of mechanical bowel preparation on perioperative morbidity associated with rectal injury during radical prostatectomy. This finding suggests that mechanical bowel preparation might be safely omitted before radical prostatectomy.

Background: We examined the possibility of predicting prognosis by the number of lymph node metastases. Methods: Two hundred and forty nine patients with lymph node metastases who underwent curative surgery for colon cancer were enrolled in this study. We calculated cancer-specific survival according to the number of lymph node metastases. Results: There was a tendency toward better rates of cancer-specific survivals among the patients with 1 LNM, compared with those with 2 LNM (p = 0.07). When comparing cancer-specific survival between the patients with 1, 2-3 and 4 or more lymph node metastases, cancer-specific survival was well stratified (p i.e., the patients with 1, 2 and 3 and 4 or more lymph node metastases. This study was in favor of the TNM classification in which N category is classified by the number of lymph node metastases.

The aim of this study was to determine whether rectal distention influences the accuracy of MRI for tumor staging and for measuring of maximal extramural depth of tumor spread and distance between tumor and mesorectal fascia (MRF).Fifty patients with rectal carcinoma underwent MRI before and after rectal distention. Both sets of MR images were reviewed by two radiologists. The scores for depiction of the mass (1-4 scale), T and N category, distance from normal rectal wall to MRF, maximal extramural depth of tumor spread, and distance between tumor and MRF were evaluated.The visualization scores on MR images obtained with the rectum distended were significantly higher than those on images obtained without distention (90% vs 58% for score 4, p0.001). The accuracy of T category assessed on distended images was slightly higher than the accuracy on nondistended images (88.6% vs 84.1% for observer 1, 84.1% vs 81.8% for observer 2), but the accuracy of N category was stable. The distance between normal rectal wall and MRF was significantly less on distended images than on nondistended images (p0.05). However, there was no significant difference between nondistended and distended images for maximal extramural depth and distance between tumor and MRF (p0.05).Rectal distention significantly improved visualization of tumors on MR images. It also improved T category assessment to some extent. Although the distance between normal rectal wall and MRF was significantly less with rectal distention than without rectal distention, maximal extramural depth and the distance between tumor and MRF did not vary significantly with or without rectal distention.

Background: Approximately 25% of patients with colorectal cancer present synchronous metastases, most frequently located in the liver. Aims: The assessment of optimal therapeutic strategies for the primary tumor in such patients. Methods: We analyzed the outcomes of 209 patients who underwent simultaneous or delayed resection of the primary tumor and liver metastases, the survival rates of patients with initially unresectable liver metastases that were rendered resectable, and the prognostic factors related to the primary tumor. Results: The outcomes of simultaneous resections were similar to those of delayed resection. In patients with initially unresectable liver metastases that were rendered resectable, the survival rates were similar to those of patients with initially resectable metastases. The survival rate of N2 patients was significantly lower than those of N1 and N0 patients. Conclusions: Simultaneous resection provides a safety profile and survival rate similar to that of delayed resection. The N category allows for prognostic estimation in metastatic colorectal patients.

We give a framework for comparing on the one hand theories of n-categories that are weakly enriched operadically, and on the other hand n-categories given as algebras for a contractible globular operad. Examples of the former are the definition by Trimble and variants (Cheng-Gurski) and examples of the latter are the definition by Batanin and variants (Leinster). We will show how to take a theory of n-categories of the former kind and produce a globular operad whose algebras are the n-categories we started with. We first provide a generalisation of Trimble's original theory that allows for the use of other parametrising operads in a very general way, via the notion of categories weakly enriched in V where the weakness is parametrised by an operad P in the category V. We define weak n-categories by iterating the weak enrichment construction using a series of parametrising operads P_i. We then show how to construct from such a theory an n-dimensional globular operad for each $n \geq 0$ whose algebras are precisely the n-categories we constructed by iterated weak enrichment, and we show that the resulting globular operad is contractible precisely when the operads P_i are contractible. We then show how the globular operad associated with Trimble's topological definition is related to the globular operad used by Batanin to define fundamental n-groupoids of spaces., Comment: 47 pages including extensive 11 page introduction. This version has shorter abstract and correction to description of Cisinski's work

To compare the local-regional staging accuracy of the conventional two-dimensional (2D) T2-weighted imaging protocol and of the three-dimensional (3D) T2-weighted imaging protocol for preoperative magnetic resonance (MR) imaging in rectal cancer patients.This retrospective study was approved by the institutional review board, and a waiver of informed consent was obtained. A review was conducted of 109 preoperative 3-T MR images obtained with 2D and 3D T2-weighted imaging protocols in rectal cancer patients. Two radiologists independently assessed the radiologic findings for T and N category lesions, conspicuity of tumor margin, and image quality of 2D and 3D data. Interactive multiplanar reconstruction was performed for 3D data analysis. The linear weighted kappa values for T2-weighted imaging staging results (2D and 3D data) and histopathologic staging results were calculated and compared. Wilcoxon signed rank test was performed to compare tumoral conspicuity and overall image quality.T category lesion staging accuracy values for 2D and 3D data, respectively, were 66.0% and 67.0% for reviewer 1 (P = .465) and 63.3% and 56.9% for reviewer 2 (P = .402). N category lesion staging accuracy values for 2D and 3D T2-weighted images, respectively, were 64.2% and 57.8% for reviewer 1 (P = .427) and 47.7% and 62.4% for reviewer 2 (P = .666). Tumor conspicuity was better for 2D T2-weighted imaging, but no significant difference in image quality was observed.Preoperative MR imaging in rectal cancer patients for staging with conventional 2D and multiplanar reconstruction 3D T2-weighted imaging protocols showed no significant differences in accuracy of T and N category staging and overall image quality, as determined by degree of artifact. However, the 3D T2-weighted imaging protocol had limitations in regard to lesion conspicuity.

There are 13 sites subjected to the World Heritage Convention in Poland. Polish properties placed on the World Heritage (WH) List, up till now, were classified as cultural sites (C category) except for the Bialowieza Forest (N category). In this paper, Polish properties of the WH are submitted to a comprehensive analysis in order to recognize their specific and significant geo(morpho)logical values. The Council of Europe and UNESCO recommend this procedure. Among Polish sites of WH, four have been favored as characterized by their special abiotic values: Cracow's Historic Centre, Wieliczka Salt Mine, Kalwaria Zebrzydowska, and Muskauer Park/Park Muzakowski. The abiotic features of these sites substantially contribute to the creation and development of their historical and cultural values and, in two cases (Wieliczka, Muskauer Park/Park Muzakowski), are important enough for reconsideration of the criteria of valorization for the WH List. The abiotic elements should be regarded as features developing their categorization towards natural criteria.

Background There remains controversy over what constitutes the optimal rational extent of lymphadenectomy, in other words, the concept of rational lymphadenectomy, for cancer of the cervical esophagus. The purpose of this study was to propose the concept of a rational N category for cancer of the cervical esophagus that indicates more clearly which cluster(s) of lymph nodes should be resected during resection of a cancer of the cervical esophagus.

Background There remains controversy as to which lymph nodes should be or need to be resected to cure patients with a cancer in the esophagogastric junction (EGJ).

Endosonography is currently the gold standard for the local staging of rectal carcinoma, but its accuracy varies from 62% to 91%. This study aimed to determine the accuracy of endosonography, to evaluate the interobserver variability, and to compare the performance of the 7.5-MHz and the 10-MHz ultrasound scanners. Between 1990 and 2000, 458 patients with rectal cancer were included in the study. All the patients had undergone rectal endosonography with a 7.5-MHz scan (period 1: 1990–1996) or a 10-MHz scan (period 2: 1997–2000). Endosonographic staging was compared with pathologic staging. The overall rate for correctly classified patients was 69% with respect to the T category and 68% with respect to the N category. There was no difference between the two scanners. In terms of accuracy, the T3 category tumors were the most (86%) and the T4 tumors the least (36%) accurately classified. Overstaging of tumors (19%) was much more frequent than understaging (12%). A high interobserver variability of 61% to 77% was noted. For pT1 tumors, the 10-MHz scan was almost two times more accurate than the 7.5-MHz scan (71% vs 36%). The accuracy of endosonographic staging of rectal carcinoma very much depends on the T category. A high-resolution scanner and an experienced examiner can help to ensure that endosonography remains an important tool in the staging process of patients with rectal carcinoma, especially early carcinoma.

This is an explanation of how cohomology is seen through the lens of n-category theory. Special topics include nonabelian cohomology, Postnikov towers, the theory of ‘n-stuff’, and n-categories for n = −1 and −2. A lengthy appendix clarifies certain puzzles and ventures into deeper waters such as higher topos theory. An annotated bibliography provides directions for further study.

version définitive, substantiellement remaniée de l'article "Cofibrant complexes are free" [hal-00148697] -accessible en ligne : http://intlpress.com/HHA/v10/n1/a7; International audience; We define a notion of cofibration among $\infty$-categories and show that the cofibrant objects are exactly the free ones, that is, those generated by polygraphs.

This note presents the first known class of termination orders for 3-polygraphs, together with an application., Comment: 4 pages, 12 figures

Background: To evaluate the diagnostic accuracy of endosonography (EUS) in preoperative staging of stomach cancer. Methods: Sixty-two patients with gastric carcinoma were investigated by endosonography. 49 underwent surgery. EUS reports were compared with operative and histology findings. Tumours were staged according to the 2000. TNM classification. Results: EUS had a diagnostic accuracy of 89,8% for the T category, 83,7% for the N category. Conclusion: EUS is an excellent clinical procedure for the staging of local-regional spread of gastric cancer and useful complement to the other gastrointestinal examinations for evaluation of these tumours.

– Tumour deposits: Tumour deposits have been mostly described in colorectal cancer where they have been classified at first according to their size and then according to their contour, while in the current tumour-node-metastasis (TNM) classification (TNM7), assignment of tumour deposits has been left to the discretion of the pathologists, and a new N category (N1c) in stage III has been defined for them. However, in the literature, there is not much evidence concerning the prognostic value of different types of tumour deposits and many things still remain unclear about their nature. In a recent work by Nagteggal et al. it has been demonstrated that the presence of tumour deposits may be used in the staging of colorectal cancer but currently, they are not incorporated in the TNM classification of other adenocarcinomas, including pancreatic cancer. Moreover, so far (PubMed search on 12th March 2013) there is no original publication investigating the prognostic role of

Children made a series of evaluative judgements of 20 nonsense words, which they were told to imagine were people's names. Each subject judged half the names in terms of two-category rating scales containing an affirmative (A) response category which was evaluatively positive (E +) and a negative (n) category which was evaluatively negative (E -), e.g. ‘happy-not happy’, the other half were judged in terms of scales where the A category was E -, and the N category E +, e.g. ‘rude - not rude’. The main finding was a highly significant tendency for subjects to give more A than N responses, irrespective of evaluative content: in addition, a tendency for subjects to give more E - than E + responses, irrespective of grammatical form, approached significance.

This paper studies 3-polygraphs as a framework for rewriting on two-dimensional words. A translation of term rewriting systems into 3-polygraphs with explicit resource management is given, and the respective computational properties of each system are studied. Finally, a convergent 3-polygraph for the (commutative) theory of Z/2Z-vector spaces is given. In order to prove these results, it is explained how to craft a class of termination orders for 3-polygraphs.