Prognostic implications of the seventh edition of the international union against cancer classification for patients with gastric cancer: the Western experience of patients treated in a single-center European institution

PURPOSE Validity of the seventh edition of the American Joint Committee on Cancer/International Union Against Cancer (AJCC/UICC) staging systems for gastric cancer has been evaluated in several studies, mostly in Asian patient populations. Only few data are available on the prognostic implications of the new classification system on a Western population. Therefore, we investigated its prognostic ability based on a German patient cohort. PATIENTS AND METHODS Data from a single-center cohort of 1,767 consecutive patients surgically treated for gastric cancer were classified according to the seventh edition and were compared using the previous TNM/UICC classification. Kaplan-Meier analyses were performed for all TNM stages and UICC stages in a comparative manner. Additional survival receiver operating characteristic analyses and bootstrap-based goodness-of-fit comparisons via Bayesian information criterion (BIC) were performed to assess and compare prognostic performance of the competing classification systems. RESULTS We identified the UICC pT/pN stages according to the seventh edition of the AJCC/UICC guidelines as well as resection status, age, Lauren histotype, lymph-node ratio, and tumor grade as independent prognostic factors in gastric cancer, which is consistent with data from previous Asian studies. Overall survival rates according to the new edition were significantly different for each individual's pT, pN, and UICC stage. However, BIC analysis revealed that, owing to higher complexity, the new staging system might not significantly alter predictability for overall survival compared with the old system within the analyzed cohort from a statistical point of view. CONCLUSION The seventh edition of the AJCC/UICC classification was found to be valid with distinctive prognosis for each stage. However, the AJCC/UICC classification has become more complex without improving predictability for overall survival in a Western population. Therefore, simplification with better predictability of overall survival of patients with gastric cancer should be considered when revising the seventh edition.

Pelvic lymph node dissection in the context of radical cystectomy: a thorough insight into the connection between patient, surgeon, pathologist and treating institution

Pelvic lymph node dissection (PLND) in patients with bladder cancer varies widely in extent, technique employed, and pathological workup of specimens. The present paper provides an overview of the existing evidence regarding the effectiveness of PLND and elucidates the interactions between patient, surgeon, pathologist, and treating institution as well as their cumulative impact on the final postoperative lymph node (LN) staging. Bladder cancer patients undergoing radical cystectomy with extended PLND appear to have better oncologic outcomes compared to patients undergoing radical cystectomy and limited PLND. Attempts have been made to define and assess the quality of PLND according to the number of lymph nodes identified. However, lymph node counts depend on multiple factors such as patient characteristics, surgical template, pathological workup, and institutional policies; hence, meticulous PLND within a defined and uniformly applied extended template appears to be a better assurance of quality than absolute lymph node counts. Nevertheless, the prognosis of the patients can be partially predicted with findings from the histopathological evaluation of the PLND specimen, such as the number of positive lymph nodes, extracapsular extension, and size of the largest LN metastases. Therefore, particular prognostic parameters should be addressed within the pathological report to guide the urologist in terms of patient counseling.

Gender in Theology and Religion: a Success Story?! Report from a Conference

In January 2011 some fifty scholars from different parts of Europe met in Groningen, the Netherlands for an expert meeting entitled Gender in theology and religion: a success story?! to analyze the factors that contribute to the successful mainstreaming of gender in a theological discipline and to reflect on the future of gender studies in theology and religious studies. Different speakers highlighted the many successes of gender studies in theology and religious studies: its power to 'trouble' the disciplines and their heuristic categories; its contribution to the development of other disciplines such as queer studies and postcolonial studies; the many PhD studies produced; the number of significant publications that had appeared over the last years. All indicate that gender studies in theology and religious studies have matured. But the participants also pointed towards the ambiguity of the success of gender studies in the academy: the indeterminacy of the institutional position and positions of gender studies in the theological disciplines in seminaries, departments faculties and universities; the lack of male scholars’ engagement in gender studies, which is expressed by their absence in these studies and/or the low reception of gender studies publications in their disciplines. Both ambiguities represent a danger for the future of gender studies, according to the participants in the meeting. In order to further the success of gender in theology and religion they formulated the following recommendations: to analyze the position of these studies in their institutions from the perspective of the implied audience (church, academy, ordinary theologians); engage men in gender studies; embrace the cultural turn in religious studies; develop interdisciplinary cooperations with gender studies in the humanities; engage creatively with the changing role of religion in contemporary society; analyze whose perspective one follows and authorizes in the perception of theology, religious studies and gender studies themselves; record the history of women’s and gender studies in theology and religion, and honor and celebrate the successes.

An adaptive Newton-method based on a dynamical systems approach

The traditional Newton method for solving nonlinear operator equations in Banach spaces is discussed within the context of the continuous Newton method. This setting makes it possible to interpret the Newton method as a discrete dynamical system and thereby to cast it in the framework of an adaptive step size control procedure. In so doing, our goal is to reduce the chaotic behavior of the original method without losing its quadratic convergence property close to the roots. The performance of the modified scheme is illustrated with various examples from algebraic and differential equations.

Implications for the Discovery of Extraterrestrial Life: A Theological Approach

Recent remarks of Pope Francis spark anew an important discussion: are we alone in the Universe? The article follows traces of the idea of extraterrestrial life throughout philosophy, evaluates the current considerations about the probability of extraterrestrial life and discusses the potential implications for the discovery of such life from a theological point of view. This “thought experiment” covers basic insights on creation, revelation and redemption.