Sa1650 Incidence and Predictors of Lymph Node Involvement in Early Stage Gastric Adenocarcinoma in the United States

e15068 Background: Despite radical oncologic resection with extended lymph node removal, patients with adenocarcinoma of the gastro-esophageal junction or stomach in UICC stage I show only a 5-year survival of 60-80% (Hölscher et al, 2009; Siewert et al. 1998). The aim of this retrospective study was to analyze the long-term survival of caucasian patients with early stage gastric cancer as for this population exist only sparse data. Patients with lymph-node involvement were not included as this parameter is a well-known negative prognostic marker. Methods: Tissue specimens and clinical data from patients with gastric cancer treated in the years 1993 to 2010 at the Charité, Berlin were collected retrospectively. Patients with stage T1 and T2 pN0M0 gastric cancer treated only by surgery including D1- and D2-lymphnode dissection were included in this study. Patients without relapse were followed-up for a minimum period of 24 months. Results: 97 patients (w = 36, m = 61, age 29-90 years) with a follow-up time from 6 to 208 months were identified. The 5-year survival was 94.85% (for details, see Table). Conclusions: The present data indicate a much better prognosis (5-year survival of 95%) of UICC I patients than previously described (60-80%). In harmony with other studies, our data demonstrate that R1, L1 or V1 resection seem to be a risk factor for recurrence whereas signet-ring differentiation was not found as a risk factor in our patient cohort. Ongoing work involves a broad panel of immunohistochemical markers to select prognostic expression profiles which help to identify patients with early gastric cancer at higher risk. This study was supported by the Berliner Krebsgesellschaft, grant DAFF201101. [Table: see text]

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Survival improvement and prognosis for hepatocellular carcinoma: analysis of the SEER database

BMC Cancer ◽

10.1186/s12885-021-08904-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jingli Ding ◽

Zhili Wen

Keyword(s):

Hepatocellular Carcinoma ◽

Prognostic Factors ◽

Lymph Node ◽

The United States ◽

Lymph Node Involvement ◽

Seer Database ◽

Old Patients ◽

Female Ratio ◽

Node Involvement ◽

Over Time

Abstract Background Hepatocellular carcinoma (HCC) incidences have been increasing in the United States. This study aimed to examine temporal trend of HCC survival and determine prognostic factors influencing HCC survival within the U.S. population. Methods The Surveillance Epidemiology, and End Results (SEER) database was used to identify patients diagnosed with primary HCC from 1988 to 2015. Overall survival (OS) and disease-specific survival (DSS) were calculated by the Kaplan-Meier method. Univariate and multivariate Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for prognostic factors and comparing survival between patients diagnosed at different periods (per 5-year interval). Results A total of 80,347 patients were included. The proportions of both young patients (< 45 years) and old patients (≥75 years) decreased over time (P < 0.001) and the male-to-female ratio increased over time (P < 0.001). Significant decreasing temporal trends were observed for HCC severity at diagnosis, including SEER stage, tumor size, tumor extent, and lymph node involvement (P < 0.001 for all). OS and DSS of patients with HCC improved over time (P < 0.001). After adjusting for patient and tumor characteristics and treatment difference, period of diagnosis retained an independent factor for improved DSS and its prognostic significance was evident for localized and regional HCC (P < 0.001), but not for distant HCC. On multivariate analyses, young age, female gender, Hispanic ethnicity, and married status were predictors favoring DSS, whereas a worse DSS was observed for patients with tumor > 5 cm, with vascular invasion, and with lymph node involvement. Patients treated with liver-directed therapy (HR = 0.54, 95% CI: 0.35–0.56), hepatic resection (HR = 0.35, 95% CI: 0.33–0.37), and transplantation (HR = 0.14, 95% CI: 0.13–0.15) had significantly longer DSS compared with those who received no surgery. In stratified analyses, the beneficial effects of surgical approach, regardless therapy type, were significant across all stages. Conclusions Our results indicate a significant improvement in survival for HCC patients from 1988 to 2015, which may be attributable to advances in early diagnosis and therapeutic approaches.

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Low Frequency of Lymph Node Metastases in Patients in the United States With Early-stage Gastric Cancers That Fulfill Japanese Endoscopic Resection Criteria

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2018.11.031 ◽

2019 ◽

Vol 17 (9) ◽

pp. 1763-1769 ◽

Cited By ~ 11

Author(s):

Yuri Hanada ◽

Alyssa Y. Choi ◽

Joo Ha Hwang ◽

Peter V. Draganov ◽

Lauren Khanna ◽

...

Keyword(s):

United States ◽

Lymph Node ◽

Endoscopic Resection ◽

Lymph Node Metastases ◽

Early Stage ◽

Low Frequency ◽

The United States ◽

Gastric Cancers ◽

Node Metastases

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Frozen section examination of sentinel lymph nodes can be used as a decisional tool in the surgical management of early cervical cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-000904 ◽

2020 ◽

Vol 30 (3) ◽

pp. 358-363 ◽

Cited By ~ 5

Author(s):

Agnieszka Rychlik ◽

Martina Aida Angeles ◽

Federico Migliorelli ◽

Sabrina Croce ◽

Eliane Mery ◽

...

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Early Stage ◽

Frozen Section ◽

Lymph Node Involvement ◽

Stage Iiic ◽

Frozen Section Examination ◽

Early Stage Cervical Cancer ◽

Node Involvement ◽

The Impact

IntroductionSentinel lymph node (SLN) detection has been shown to be accurate in detecting lymph node involvement in early-stage cervical cancer. The objective of this study was to evaluate the accuracy of frozen section examination in the assessment of SLN status, with the aim of adequately driving the intra-operative decision.MethodsWe designed a retrospective study including patients from two comprehensive cancer centers between January 2001 and December 2018 with early-stage cervical cancer (IA1-IB2 according to International Federation of Gynecology and Obstetrics (FIGO) 2018) undergoing SLN dissection. The SLN procedure was performed using a cervical injection with technetium-99m combined with blue dye or indocyanine green in most cases.ResultsA total of 176 patients fulfilled inclusion criteria. Bilateral mapping was detected in 153 (86.7%) of them. Nineteen of these patients (12.4%) had SLN involvement: 13 with macrometastases, three with micrometastases and three with isolated tumor cells (ITC). Macrometastatic disease was missed on frozen section in 3/13 FIGO 2018 stage IIIC patients. The three patients with ITC were also missed by frozen section examination.Considering only macrometastases as lymph node involvement, frozen section sensitivity was 76.9% (95% CI 49.7 to 91.8) and negative predictive value (NPV) was 97.9% (95% CI 94.0 to 99.3) in patients with bilateral detection. Including micrometastases, sensitivity was 81.2% (95% CI 57.0 to 93.4) and NPV remained at 97.9% (95% CI 93.9 to 99.3).ConclusionsWith a prevalence of final-stage IIIC in patients with pre-operative early-stage cervical cancer of the order of 10% in this series, the NPV of frozen section examination of SLN is very high, with an inferior limit of the CI superior to 94%. Diagnostic accuracy remains acceptable even if micrometastases are considered. The impact of missed ITC has not been established. Frozen section examination can be incorporated in the intra-operative decision algorithm.

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Mo1081 LYMPH NODE INVOLVEMENT IN GASTRIC ADENOCARCINOMA USING A LARGE U.S. NATIONAL COHORT

Gastroenterology ◽

10.1016/s0016-5085(20)32625-1 ◽

2020 ◽

Vol 158 (6) ◽

pp. S-781-S-782

Author(s):

Rosemary Nustas ◽

Ahmed A. Messallam ◽

Theresa W. Gillespie ◽

Leslie Blackshear ◽

Steven Keilin ◽

...

Keyword(s):

Lymph Node ◽

Gastric Adenocarcinoma ◽

Lymph Node Involvement ◽

National Cohort ◽

Node Involvement

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Lymph node metastases in the prognosis of gastroenteropancreatic neuroendocrine tumors.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.224 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 224-224

Author(s):

Jacob Andrew Martin ◽

Juan P. Wisnivesky ◽

Michelle Kang Kim

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Neuroendocrine Tumors ◽

The United States ◽

Lymph Node Involvement ◽

Gastroenteropancreatic Neuroendocrine Tumors ◽

Cancer Specific Survival ◽

Cox Models ◽

Node Involvement ◽

Negative Controls

224 Background: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are a diverse group of malignancies affecting over 65,000 patients in the United States. GEP-NETs are currently classified as lymph node positive (N1) or negative (N0). The prognostic utility of the extent of lymph node involvement remains unknown. In this study, we used a population-based registry to investigate the relationship between lymph node ratio (LNR) and survival in patients with GEP-NETs. Methods: We used the Surveillance, Epidemiology, and End Results (SEER) data registry to identify patients with histologically confirmed, surgically resected NETs with lymph node involvement diagnosed between 1988 and 2011. Patients were divided into three groups based on the ratio of positive lymph nodes to total lymph nodes examined (LNR): ²0.20, >0.2-0.5, and >0.5. Kaplan-Meier, log-rank analysis, and Cox models were used to compare NET cancer-specific survival according to LNR category. Results: We identified 8,113 patients with GEP-NETs. Primary sites included small intestine (N=3,651), colon (N= 2,042), pancreas (N=1,070), appendix (N= 683), stomach (N=389), and rectum (N=278). Patients were 49% female, 76% white, and 12% black. Ten-year NET-specific survival rates were significantly different among patients in the three LNR groups and LN negative controls (p<.0001). Survival was worse in patients with LNRs of >0.2-0.5 (Hazard Ratio (HR) 1.338, p=.0002), and >0.5 (HR 1.692, p<.0001) compared to LN-negative controls. Higher LNR was correlated with worse survival. Conclusions: The degree of lymph node involvement is a prognostic factor across the most common primary sites of GEP-NETs. This information may be used clinically and in stratifying patients for clinical trials. Results across multiple sites may also be generalizable to GEP-NETs from rare primary locations that are difficult to study. [Table: see text]

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