scholarly journals Clinicopathological factors associated with recurrence in patients undergoing resection of pancreatic solid pseudopapillary neoplasm

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Oscar Paredes ◽  
Kori Paredes ◽  
Yoshikuni Kawaguchi ◽  
Carlos Luque-Vasquez ◽  
Iván Chavez ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Pancreatic Resection ◽  
Stage Iii ◽  
Tumor Diameter ◽  
Clinicopathological Factors ◽  
Solid Pseudopapillary Neoplasm ◽  
Factors Associated ◽  
Node Metastasis ◽  
Ajcc Stage

Abstract Purpose Solid pseudopapillary neoplasm (SPN) is an uncommon pathology with a low-grade malignancy. Surgery is the milestone treatment. Nevertheless, despite appropriate management, some patients present recurrence. Risk factors associated with recurrence are unclear. The objective was to identify the clinicopathological factors associated with recurrence in patients with SPN treated with pancreatic resection. Methods Medical records of patients treated with pancreatic resection during 2006–2020 were evaluated. Patients with histological diagnosis of SPN were included. Survival analysis was performed to identify the clinicopathological factors related to recurrence. Results Seventy-four patients were diagnosed with SPN; 70 (94.6%) patients were female, and the median age was 20 years old. The median tumor diameter was 7.9 cm. Multivisceral resection was performed in 9 (12.2%) patients. Four (5.4%) patients presented lymph node metastasis.R0 resection was achieved in all cases. Six (8%) patients presented recurrence and the liver was the most frequent recurrence site (n = 5).After a median follow-up of 40.2 months, 9 (12%) patients died. Five (6.8%) patients died of disease progression. The 1–3- and 5-year overall survival (OS) was 97.1%, 90.2% and 79.9%, respectively. The 1–3-and-5-year recurrence-free survival (RFS) was 98.4%, 89.9% and 87%, respectively. In the univariate Cox-regression analysis, age ≥ 28 years(HR = 8.61, 95% CI 1.1–73.8),tumor diameter ≥ 10 cm(HR = 9.3, 95% CI 1.12–79.6),invasion of adjacent organs (HR = 7.45, 95% CI 1.5–36.9), lymph node metastasis (pN +) (HR = 16.8, 95% CI 2.96–94.9) and, AJCC Stage III (HR = 10.1, 95% CI 1.2–90.9) were identified as predictors for recurrence. Conclusions SPN is more frequently diagnosed in young women with a good overall prognosis after an R0 surgical resection even with disease recurrence. Age ≥ 28 years, larger tumors ≥ 10 cm, invasion of adjacent organs, lymph node metastasis(pN +) and, AJCC Stage III were predictors factors of recurrence in resected SPN.

scholarly journals Clinicopathological Factors Associated with Recurrence in Patients Undergoing Resection of Pancreatic Solid Pseudopapillary Neoplasm

2021 ◽  
Author(s):  
Oscar Paredes ◽  
Yoshikuni Kawaguchi ◽  
Carlos Luque-Vasquez ◽  
Ivan Chavez ◽  
Eduardo Payet ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Pancreatic Resection ◽  
Stage Iii ◽  
Low Grade ◽  
Tumor Diameter ◽  
Clinicopathological Factors ◽  
Solid Pseudopapillary Neoplasm ◽  
Factors Associated ◽  
Node Metastasis

Abstract Background: Solid pseudopapillary neoplasm (SPN) is an uncommon pathology with a low-grade malignancy. Surgery is the milestone treatment. Nevertheless, despite appropriate management, some patients present recurrence. Risk factors associated with recurrence are unclear. The objective of this study was to identify the clinicopathological factors associated with recurrence in patients with the diagnosis of SPN treated with pancreatic resection.Methods: In this retrospective single-center study, medical records of patients treated with pancreatic resection from January 2006 to January 2020 were evaluated. Patients with histological diagnosis of SPN were included. Survival analysis was performed to identify the clinicopathological factors related to recurrence.Results: A total of 589 patients underwent pancreatectomy and, 74(12.6%) were diagnosed with SPN. Seventy patients (94.6%) were female and 4 were male. The median age was 20 years old and, 49(67%) patients were <28 years. The principal symptom was abdominal pain (n=62)(83.8%). The pancreatic head was the most frequent tumor localization (n=32)(43.2%). Distal pancreatectomy was performed in 33(44.6%) patients, followed by pancreaticoduodenectomy (n=32)(43.2%). The median tumor diameter was 7.9cm and, 24(32%) patients presented tumors ≥ 10 cm. Multivisceral resection was performed in 9(12.2%) patients. Four(5.4%) patients presented lymph node metastasis. R0 resection was achieved in all cases. The overall 90-days postoperative morbidity and mortality were 54% and 1.4%, respectively. The pancreatic fistula was the principal postoperative complication(n=27;36.5%). Six(8%) patients presented recurrence after pancreas resection. Liver metastasis was the most frequent recurrence site(n=5). After a median follow-up of 40.2 months, 9(12%) patients died. Five(6.8%) patients died of disease progression. The 1-3-and-5-year OS was 97.1%,90.2% and 79.9%, respectively. The 1-3-and-5-year RFS was 98.4%,89.9% and 87%, respectively. In the univariate Cox regression analysis, age ≥28 years (HR=8.61,95%CI:1.1–73.8), tumor diameter ≥10cm (HR=9.3,95%CI:1.12-79.6), invasion of adjacent organs (HR=7.45,95%CI:1.5–36.9), lymph node metastasis (pN+) (HR=16.8,95%CI:2.96–94.9) and, AJCC(TNM) Stage III (HR=10.1,95%CI:1.2–90.9) were identified as predictors for recurrence. Conclusions: SPN is more frequently diagnosed in young women with a good overall prognosis after an R0 surgical resection even with disease recurrence. Age ≥28 years, larger tumors ≥10cm, invasion of adjacent organs, lymph node metastasis(N+) and, AJCC Stage III were predictors factors of recurrence in resected SPN.

scholarly journals Pure Well-Differentiated Adenocarcinoma Is a Safe Factor for Lymph Node Metastasis in T1 and T2 Colorectal Cancer: A Pilot Study

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Naohisa Yoshida ◽  
Masayoshi Nakanishi ◽  
Ken Inoue ◽  
Ritsu Yasuda ◽  
Ryohei Hirose ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Venous Invasion ◽  
Lymphatic Invasion ◽  
Clinicopathological Factors ◽  
Node Metastasis ◽  
Kappa Value ◽  
T1 And T2 ◽  
Well Differentiated

Background and Aims. Various risk factors for lymph node metastasis (LNM) have been reported in colorectal T1 cancers. However, the factors available are insufficient for predicting LNM. We therefore investigated the utility of the new histological factor “pure well-differentiated adenocarcinoma” (PWDA) as a safe factor for predicting LNM in T1 and T2 cancers. Materials and Methods. We reviewed 115 T2 cancers and 202 T1 cancers in patients who underwent surgical resection in our center. We investigated the rates of LNM among various clinicopathological factors, including PWDA. PWDA was defined as a lesion comprising only well-differentiated adenocarcinoma. The consistency of the diagnosis of PWDA was evaluated among two pathologists. In addition, 72 T1 cancers with LNM from 8 related hospitals over 10 years (2008–2017) were also analyzed. Results. The rates of LNM and PWDA were 23.5% and 20.0%, respectively, in T2 cancers. Significant differences were noted between patients with and without LNM regarding lymphatic invasion (81.5% vs. 36.4%, p<0.001), poor histology (51.9% vs. 19.3%, p=0.008), and PWDA (3.7% vs. 25.0%, p=0.015). The rates of LNM and PWDA were 8.4% and 36.1%, respectively, in T1 cancers. Regarding the 73 PWDA cases and 129 non-PWDA cases, the rates of LNM were 0.0% and 13.2%, respectively (p<0.001). Among the 97 cases with lymphatic or venous invasion, the rates of LNM in 29 PWDA cases and 68 non-PWDA were 0% and 14.7%, respectively (p=0.029). The agreement of the two pathologists for the diagnosis of PWDA was acceptable (kappa value > 0.5). A multicenter review showed no cases of PWDA among 72 T1 cancers with LNM. Conclusions. PWDA is considered to be a safe factor for LNM in T1 cancer.

Prognostic Significance of Tumor Deposits in Combination with Lymph Node Metastasis in Stage III Colon Cancer: A Propensity Score Matching Study

2020 ◽  
Vol 86 (2) ◽  
pp. 164-170
Author(s):  
Peilin Zheng ◽  
Chen Lai ◽  
Weimin Yang ◽  
Zhikang Chen
Keyword(s):  
Colon Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Propensity Score ◽  
Confidence Interval ◽  
Propensity Score Matching ◽  
Stage Iii ◽  
Stage Iii Colon Cancer ◽  
Node Metastasis

Tumor deposits in colon cancer are related to poor prognosis, whereas the prognostic power of tumor deposits in combination with lymph node metastasis (LNM) is controversial. This study aimed to compare the overall survival between LNM alone and LNM in combination with tumor deposits, and to verify whether the number of tumor deposits can be considered LNM in patients with both LNM and tumor deposits in stage III colon cancer by propensity score matching (PSM). Patients carrying resected stage III adenocarcinoma of colon cancer were identified from the Surveillance, Epidemiology, and End Results database (2010–2015). The Kaplan-Meier method, Cox proportional hazard models and PSM were used. On the whole, 23,168 patients (20,451 (88.3%) with only LNM and 2,717 (11.7%) with both LNM and tumor deposits) were selected. After undergoing PSM, patients with both LNM and tumor deposits showed worse overall survival (hazard ratio = 1.33, 95% confidence interval: 1.20–1.47, P < 0.001). After the number of tumor deposits was added with that of positive regional lymph nodes, patients with both LNM and tumor deposits seemed to have prognostic implications similar to those with LNM alone (hazard ratio = 1.02, 95% confidence interval: 0.93–1.12, P = 0.66). The simultaneous presence of LNM and tumor deposits, as compared with the presence of only LNM, had an association with a worse outcome. Tumor deposits should be considered as LNM in patients with both tumor deposits and LNM in stage III colon cancer.

scholarly journals Cervical invasion, lymphovascular space invasion, and ovarian metastasis as predictors of lymph node metastasis and poor outcome on stages I to III endometrial cancers: a single-center retrospective study

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Min Li ◽  
Shuwei Wu ◽  
Yangqin Xie ◽  
Xiaohui Zhang ◽  
Zhanyu Wang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Regression Models ◽  
Cox Regression ◽  
Myometrial Invasion ◽  
Ovarian Metastasis ◽  
Surgical Staging ◽  
Tumor Diameter ◽  
Node Metastasis

Abstract Background The aim of this study is to determine pathological factors that increase the risk of LNM and indicate poor survival of patients diagnosed with endometrial cancer and treated with surgical staging. Method Between January 2010 and November 2018, we enrolled 874 eligible patients who received staging surgery in the First Affiliated Hospital of Anhui Medical University. The roles of prognostic risk factors, such as age, histological subtype, tumor grade, myometrial infiltration, tumor diameter, cervical infiltration, lymphopoiesis space invasion (LVSI), CA125, and ascites, were evaluated. Multivariable logistic regression models were used to identify the predictors of LNM. Kaplan–Meier and COX regression models were utilized to study the overall survival. Results Multivariable regression analysis confirmed cervical stromal invasion (OR 3.412, 95% CI 1.631–7.141; P < 0.01), LVSI (OR 2.542, 95% CI 1.061–6.004; P = 0.04) and ovarian metastasis (OR 6.236, 95% CI 1.561–24.904; P = 0.01) as significant predictors of nodal dissemination. Furthermore, pathological pattern (P = 0.03), myometrial invasion (OR 2.70, 95% CI 1.139–6.40; P = 0.01), and lymph node metastasis (OR 9.675, 95% CI 3.708–25.245; P < 0.01) were independent predictors of decreased overall survival. Conclusions Cervical invasion, lymphopoiesis space invasion, and ovarian metastasis significantly convey the risk of LNM. Pathological type, myometrial invasion, and lymph node metastasis are all important predictors of survival and should be scheduled for completion when possible in the surgical staging procedure.

Prediction of skip mediastinal lymph node metastasis in surgical patients with clinical N0 non-small-cell lung cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e18554-e18554
Author(s):  
Rie Nakahara ◽  
Haruko Suzuki ◽  
Haruhisa Matsuguma ◽  
Seiji Igarashi
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Mediastinal Lymph Node ◽  
Mediastinal Lymph Node Dissection ◽  
Tumor Diameter ◽  
Node Dissection ◽  
Hilar Lymph Node ◽  
Node Metastasis ◽  
Serum Cea ◽  
Hilar Lymph Node Metastasis

e18554 Background: It has been reported that the prognosis of surgical non-small-cell lung cancer (NSCLC) patients with skip-N2 metastasis (without hilar lymph node metastasis) is generally more favorable than that of those with pathological N2 disease. Therefore, when a surgeon determines whether to perform mediastinal lymph node dissection, it is important to accurately predict skip-N2 metastasis in surgical patients without hilar lymph node metastasis. Methods: Of the patients who had undergone complete resection for NSCLC in our hospital between October 1986 and December 2010, 741 with cN0 NSCLC who had undergone mediastinal lymph node dissection were analyzed. The relationship between the lymph node metastasis status and clinicopathological parameters (age, gender, and serum CEA level, histological type, primary tumor location, tumor diameter, pleural invasion(pl), lymphatic invasion(ly), vascular invasion(v)) was analyzed, and factors that predict differences between pN0 and skip-N2 patients were identified. Results: Of the 741 patients, 609 had pN0 disease, 62 pN1 disease, and 70 pN2 disease. Of the pN2 patients, 23 had skip metastases to the mediastinal nodes alone. No significant difference was observed in the gender, age, or histological type between the N0 and skip N2 groups. However, the serum CEA level, tumor diameter, and pl(+) rate were significantly higher (p=0.0028), larger (mean, 3.7 cm, p=0.012), and higher (p=0.0064), respectively, in the skip-N2 group. Also, the ly(+) and v(+) rates were significantly higher in the skip-N2 group. Skip-N2 appeared more frequently with primary tumors in the lower lobes than with those in the upper lobes. Conclusions: Even if no hilar lymph node metastasis is found during surgery in patients with a high serum CEA level, large tumor diameter or lower lobe location, they may have skip-N2 lymph node metastasis. Although the p factor status becomes clear after surgery, patients with pleural indentation so marked as to raise the suspicion of pl(+) have a high probability of skip-N2 metastasis. Mediastinal lymph node dissection is preferable in these patients.

Clinicopathologic characteristics of patients who underwent additional gastrectomy after incomplete endoscopic resection for early gastric cancer.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 39-39 ◽  
Author(s):  
Jae Jin Hwang ◽  
Dong Ho Lee ◽  
Ae-Ra Lee ◽  
Hyuk Yoon ◽  
Cheol Min Shin ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Residual Tumor ◽  
Incomplete Resection ◽  
Histologic Diagnosis ◽  
Factors Associated ◽  
Node Metastasis ◽  
H Pylori ◽  
Additional Gastrectomy

39 Background: Endoscopic resection (ER) is widely accepted as standard treatment for early gastric cancer (EGC) without lymph node metastasis. However, surgery is sometimes needed after endoscopic mucosal resection (EMR)/endoscopic submucosal dissection (ESD) due to incomplete resection. We analyzed the clinicopathological characteristics of patients who underwent additional gastrectomy after incomplete EMR/ESD. Methods: From 2003 to 2013, 80 patients received additional gastrectomy after EMR/ESD due to incomplete resection. The patients were grouped according to the presence of histologic residual tumor in specimens obtained by gastrectomy as residual tumor (RT, n = 47) or non-residual tumor (NRT, n = 33). We analyzed reasons for gastrectomy, tumor characteristics of RT and NRT group, risk factors associated with residual tumor, retrospectively from medical records. Results: After the gastrectomy, the positive residual tumor rate and lymph node metastasis rate were 58.7% (47/80) and 7.5% (6/80). RT group showed significantly higher rate of lateral and vertical margin involvement compared to NRT group (59.5 vs. 15.1%).Multivariate analysis demonstrated that endoscopic piecemeal resection, H. pylori infection, depressed or mixed type, large tumor size (> 2cm), histologic diagnosis (signet ring cell carcinoma or mixed carcinoma) were significantly independent predictive factors associated with positive residual tumor of patients who underwent additional gastrectomy after incomplete EMR/ESD (p < 0.05). Conclusions: For complete and curative ER, endoscopists should try to determine the depth of invasion, histologic diagnosis accurately and to eradicate the H. pylori infection before ER. During ER, wide marking and En bloc resection could be considered to avoid the risk of incomplete resection.

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