Lymph node metastases in resected pancreatic ductal adenocarcinoma: predictors of disease recurrence and survival

A functional and widely accepted definition of microinvasive cervical adenocarcinoma remains elusive. The purpose of this study was to determine at which depth of invasion the likelihood of lymph node metastasis or disease recurrence was so small that conservative surgery could be considered appropriate. Charts of patients with adenocarcinoma of the cervix (ACC) who underwent radical hysterectomy and pelvic lymphadenectomy (n = 98) at Indiana University Medical Center from 1987 to 1998 were retrospectively reviewed. Patients with stage IA1–IB1 lesions were included in the study. Patients treated with preoperative radiotherapy were excluded. Pathologic parameters evaluated included histologic type, depth of stromal invasion (DOI), and the presence of lymphatic vascular space invasion, or lymph node metastases. The patient median age was 39 years (20–65). The median time of follow-up was 30 months (4–124). Lymph node metastases were found in ten patients and 11 developed recurrences. The precise DOI could be measured in 84 patients. Of the 48 patients with cancers with a DOI ≤ 5 mm, none had involved parametria or nodes; whereas eight of the 36 with a DOI > 5 mm had nodal metastases (P = 0.00069). None of these 48 patients with a tumor DOI ≤ 5 mm developed a recurrence whereas six of the 36 patients with a tumor DOI > 5 mm developed recurrent disease (P = 0.0048). The risk of nodal metastases and recurrence is so low in patients with ACC and DOI ≤ 5 mm that for patients with such depth documented on conization with negative margins pelvic lymphadenectomy may be omitted.

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Influence of preoperatively detected circulating tumor cells on the outcome of patients with urothelial carcinoma of the bladder treated with radical cystectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.5_suppl.268 ◽

2012 ◽

Vol 30 (5_suppl) ◽

pp. 268-268

Author(s):

Michael Rink ◽

Armin Soave ◽

Felix K. Chun ◽

Roland Dahlem ◽

Sarah Minner ◽

...

Keyword(s):

Lymph Node ◽

Radical Cystectomy ◽

Lymph Node Metastases ◽

Disease Recurrence ◽

Disease Outcome ◽

Patient Counseling ◽

Blood Samples ◽

Nodal Stage ◽

Cancer Of The Bladder ◽

Node Metastases

268 Background: Circulating tumour cells (CTC) are frequently detectable in the peripheral blood of patients with urothelial cancer of the bladder (UCB) prior to radical cystectomy (RC). We hypothesize that CTC can predict advanced stages, nodal status and disease outcome after radical cystectomy and therefore represent an optimal biomarker for treatment decision making and patient counseling. Methods: Blood samples of 120 consecutive, clinically non-metastatic UCB patients scheduled for RC were prospectively investigated for CTC. Preoperatively collected blood samples (7.5 ml) were analysed for CTC using the CellSearch system (Veridex, USA). Uni- and multivariable models evaluated the association of CTC status and number of CTC with clinical and nodal stage and disease outcome. Results: CTC were detectable in 30/120 patients (25%) with an average number of 5.7±18.3 CTC (range:1-100; median:1). Eighteen patients (60.0%) had 1 CTC/7.5mL, 8 patients (26.7%) had 2-5 CTC and 4 patients (13.3%) had >5 CTC, respectively. CTC status was not associated with tumour stage, grade, lymph node metastases or lymphovascular invasion. Moreover, increasing numbers of CTC were not associated with higher stages or increasing numbers of lymph node metastases. However, at a median follow-up of 18 months (range:1-48 months) CTC detection prior to RC was an independent risk factor for disease recurrence (p<0.001, HR=4.9, 95%CI 2.1–11.7) and cancer-related death (p=0.002, HR=4.9, 95%CI 1.7-13.6). Disease recurrence and cancer-related death were not associated with the number of detected CTC. Conclusions: Although CTC can not predict pathological or nodal stage, they are associated with inferior disease outcome. Detection of even 1 CTC/7.5 mL blood in UCB patients prior to RC is an independent predictor for disease recurrence and cancer-related death. These findings are very important for future investigations, as they are in contradiction to theories supporting a cut-off value of 5 or more CTC needed for accurate outcome prediction. Therefore, CTC may represent a feasible biomarker for monitoring response to neoadjuvant and adjuvant chemotherapy.

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Surgical Management of Patients with Neuroendocrine Neoplasms of the Appendix: Appendectomy or More

Neuroendocrinology ◽

10.1159/000478742 ◽

2017 ◽

Vol 106 (3) ◽

pp. 242-251 ◽

Cited By ~ 18

Author(s):

Nikhil Pawa ◽

Ashley K. Clift ◽

Helai Osmani ◽

Panagiotis Drymousis ◽

Andrzej Cichocki ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Metastases ◽

Residual Disease ◽

Disease Recurrence ◽

Right Hemicolectomy ◽

Neuroendocrine Neoplasms ◽

Number Of Patients ◽

Node Metastases ◽

Current Guidelines

Background: Appendiceal neuroendocrine neoplasms (ANEN) are mostly indolent tumours treated effectively with simple appendectomy. However, controversy exists regarding the necessity of oncologic right hemicolectomy (RH) in patients with histologic features suggestive of more aggressive disease. We assess the effects of current guidelines in selecting the surgical strategy (appendectomy or RH) for the management of ANEN. Methods/Aims: This is a retrospective review of all ANEN cases treated over a 14-year period at 3 referral centres and their management according to consensus guidelines of the European and the North American Neuroendocrine Tumor Societies (ENETS and NANETS, respectively). The operation performed, the tumour stage and grade, the extent of residual disease, and the follow-up outcomes were evaluated. Results: Of 14,850 patients who had appendectomies, 215 (1.45%) had histologically confirmed ANEN. Four patients had synchronous non-ANEN malignancies. One hundred and ninety-three patients had index appendectomy. Seventeen patients (7.9%) had lymph node metastases within the mesoappendix. Forty-nine patients underwent RH after appendectomy. The percentages of 30-day morbidity and mortality after RH were 2 and 0%, respectively. Twelve patients (24.5%) receiving completion RH were found to have lymph node metastases. Two patients had liver metastases, both of them synchronous. The median follow-up was 38.5 months (range 1-143). No patient developed disease recurrence. Five- and 10-year overall survival for all patients with ANEN as the only malignancy was both 99.05%. Conclusions: The current guidelines appear effective in identifying ANEN patients at risk of harbouring nodal disease, but they question the oncological relevance of ANEN lymph node metastases. RH might present an overtreatment for a number of patients with ANEN.

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Performance of Serum CA125 as a Prognostic Biomarker in Patients With Uterine Papillary Serous Carcinoma

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e31821091b5 ◽

2011 ◽

Vol 21 (3) ◽

pp. 529-534 ◽

Cited By ~ 15

Author(s):

Divya Gupta ◽

Marc J. Gunter ◽

Kathleen Yang ◽

Stephen Lee ◽

Lisa Zuckerwise ◽

...

Keyword(s):

Lymph Node ◽

Metastatic Disease ◽

Lymph Node Metastases ◽

Disease Recurrence ◽

Serous Carcinoma ◽

Ca 125 ◽

Uterine Papillary Serous Carcinoma ◽

Serum Ca125 ◽

Node Metastases ◽

Papillary Serous Carcinoma

HypothesisSerum CA125 is a potential biomarker for metastatic disease and recurrence in patients with uterine papillary serous carcinoma (UPSC).MethodsAll patients with UPSC who had preoperative CA125 measurement and surgical staging between 1998 and 2008 at the participating institutions were included in this analysis (N = 52). Data were extracted from patients' records. Fisher exact and χ2tests were used to assess the association of CA125 levels with clinical and pathological variables. The correlation between CA125 levels (high/low) and lymph node metastases (positive/negative) was evaluated using Spearman correlation coefficients. The association of CA125 elevation with recurrence-free survival was assessed using Cox proportional hazards regression modeling.ResultsPreoperative CA125 elevation (>30 U/mL) was observed in 9 (17%) patients and was associated with advanced International Federation of Gynecologists and Obstetricians (FIGO) stage III/IV disease (P= 0.002), lymph node involvement (P= 0.007), and presence of omental metastases (P= 0.001). Disease recurrence and survival data were available for 51 of the 52 patients. During a mean follow-up time of 36 months, 15 (29%) patients experienced disease recurrence and 10 (19%) patients died. There was a moderate positive correlation between CA125 levels and lymph node metastases (r2= 0.39). On multivariate survival analysis, an elevated CA125 level compared to nonelevated CA-125 was not associated with disease recurrence (hazard ratio, 1.61; 95% confidence interval, 0.55-4.77).ConclusionsPreoperative CA125 levels were significantly associated with metastatic disease in patients with UPSC. However, in this study of surgically staged UPSC patients, preoperative CA125 elevation was not an independent predictor of disease recurrence.

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