EP.TH.63Predictive significance of tumour size in patients undergoing curative surgery for colorectal cancers: Retrospective cohort study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shahab Hajibande ◽  
Mohammed Barghash ◽  
Asaf Khan ◽  
Baqar Ali
Keyword(s):  
Overall Survival ◽  
Lymph Nodes ◽  
Tumour Size ◽  
Venous Invasion ◽  
Lymphocytic Infiltration ◽  
R0 Resection ◽  
Curative Surgery ◽  
Specimen Length ◽  
Rectal Cancers ◽  
Positive Lymph Nodes

Abstract Aims Evaluating predictive significance of tumour size in patients undergoing curative colorectal cancer surgery. Methods Patients undergoing curative surgery (77.6% Laparoscopic) for colorectal cancer by a single surgeon between January 2013 and January 2020 inclusive. Linear/binary logistic regression analyses were modelled to assess whether colonic or rectal tumour size could predict R0 resection, specimen length, length >120mm, number of harvested lymph nodes, >12 harvested lymph nodes, number of positive lymph nodes, lymphocytic infiltration, venous invasion, and overall survival. Results Total of 192 patients (124 colon and 68 rectal cancers) were eligible. In colon cancer patients, tumour size was independent predictor of the number of harvested lymph nodes (P < 0.001), the number of positive lymph nodes (P = 0.001), and lymphocytic infiltration (P = 0.009). It did not predict R0 resection (P = 0.563), specimen length (P = 0.111), specimen length >120mm (P = 0.186), >12 harvested lymph nodes (P = 0.145), venous invasion (P = 0.103), 5-year overall survival (P = 0.543). Independent predictor in rectal cancers was the number of harvested lymph nodes (P < 0.001), and the number of positive lymph nodes (P < 0.001). It did not predict R0 resection (P = 0.108), specimen length (P = 0.774), specimen length >120mm (P = 0.405), >12 harvested lymph nodes (P = 0.069), lymphocytic infiltration (P = 0.912), venous invasion (P = 0.105), and 5-year overall survival (P = 0.413). Conclusions Current study results suggest tumour size alone may not have a significant predictive value in terms of oncological or survival outcomes in patients undergoing curative surgery for cancer of colon or rectum.

scholarly journals Rare lung cancers—Primary pulmonary leiomyosarcoma: A case report

2021 ◽  
Author(s):  
Laurenz Nagl ◽  
Andreas Seeber ◽  
Gerlig Widmann ◽  
Katja Schmitz ◽  
Herbert Maier ◽  
...  
Keyword(s):  
Case Report ◽  
Lymph Node ◽  
Tumour Size ◽  
Lymph Node Status ◽  
R0 Resection ◽  
Interdisciplinary Management ◽  
Curative Surgery ◽  
Lung Cancers ◽  
Tumour Control ◽  
Complete Tumour

SummaryPrimary pulmonary sarcomas (PPS) are rare mesenchymal lung cancers, which do not present clinically or radiological different to lung carcinomas. Definite PPS diagnosis can only be made by histological analysis and detailed staging examinations in order to exclude a secondary pulmonary malignancy such as metastatic soft tissue sarcoma or another solid tumour. Here we present the case of a 66-year-old woman with a pulmonary mass infiltrating the diaphragm and the mediastinal adipose tissue, which was identified as leiomyosarcoma. The patient received curative surgery with complete tumour R0 resection. The prognosis of PPS is defined by tumour size, lymph node status and histological grading. Surgery is the mainstay of therapy and there is no definitive indication for adjuvant therapy for R0-resected and lymph-node-negative patients like in our case. However, multimodal therapy approaches such as (neo)adjuvant chemo- and radiotherapy can contribute to improving locoregional tumour control, which is the most important prognostic factor. With our case report we want to raise awareness for pulmonary sarcomas as a relevant proportion of rare lung cancers which have to be kept in mind during the differential diagnosis. Moreover, we aim to discuss the complex and individual interdisciplinary management.

RA02.08: SALVAGE LYMPHADENECTOMY FOR 14 PATIENTS OF ESOPHAGEAL CANCER AFTER DEFINITIVE CHEMORADIOTHRAPY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 22-22
Author(s):  
Kazuki Odagiri ◽  
Makoto Yamasaki ◽  
Koji Tanaka ◽  
Yasuhiro Miyazaki ◽  
Tomoki Makino ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Lymph Nodes ◽  
Conflicts Of Interest ◽  
Treatment Guideline ◽  
Hospital Death ◽  
Curative Surgery ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Salvage Lymphadenectomy

Abstract Background Salvage Lymphadenectomy is regarded as the only curative surgery to residual or recurrence lymph nodes of esophageal cancer after definitive chemoradiotherapy (dCRT). However, salvage lymphadenectomy is not described in the Japanese esophageal cancer treatment guideline because of little evidences for the safety and efficacy. Methods From January 2011 to December 2015, we performed 14 salvage lymphadenectomies to residual or recurrence LN of esophageal squamous cell carcinoma(ESCC) in Osaka University. We assessed postoperative complications and long-term outcome. Results Average age was 64 year-olds (SD: 5.2). Male: Female = 11: 3. cStage I: II-IV = 7: 7. Surgery to cervical LN were 11 patients and abdominal LN were 3 patients. Surgery to residual LN (res-LN) were 9 patients and recurrence LN (rec-LN) were 5 patients. rec-LN patient's median time to recurrence after dCRT was 14.3 months (10.2–29.3). 4 patients were performed lymphadenectomy resecting with adjacent organs, 3 patients were bronchus (trachea? ) and 1 patient was right subclavian artery. 4 patients had postoperative complication, two were pneumonia, one was pulmonary thrombosis and one was lymphorrhea, but there was no serious case (Clavien-Dindo Grade II or less). We didn’t have hospital death. Six of 14 patients had recurrence and died after salvage lymphadenectomy. Recurrence sites were 2 mediastinal lymph nodes and liver, lung, loco-regional and peritoneal. But no patients had recurrence of main tumor. 5-year overall survival rate was 51.1%. Median survival time in 9 patients, surgery to res-LN, was 18.9 months (10.4–132 months) and 5 patients, surgery to rec-LN, was 4.9 months (1.4–26.6 months). Surgery to res-LN patients were longer than rec-LN patients in overall survival after salvage lymphadenectomy (P = 0.395). There was no difference due to the difference in recurrence site of the cancer in overall survival after salvage lymphadenectomy. Conclusion Our data show salvage lymphadenectomy safety and effectiveness after dCRT. Salvage lymphadenectomy may extend the prognosis of patients with esophageal cancer after dCRT. Thus, salvage lymphadenectomy may be one of the treatment options for the patients with residual or recurrent, especially the former, lymph node after definitive CRT, although it is necessary to evaluate in many cases. Disclosure All authors have declared no conflicts of interest.

Comparative analysis of resected duodenal and ampullary adenocarcinoma.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 362-362
Author(s):  
Angelena Crown ◽  
Alicia M Edwards ◽  
Flavio G. Rocha ◽  
Vincent J. Picozzi ◽  
Scott Helton ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lymph Nodes ◽  
Surgical Complications ◽  
Cox Regression ◽  
Ampullary Adenocarcinoma ◽  
Curative Intent ◽  
T Stage ◽  
Survival Difference ◽  
Pathologic Features ◽  
Positive Lymph Nodes

362 Background: Duodenal and ampullary adenocarcinomas are rare gastrointestinal cancers that share similar anatomic location and treatment strategy. We report a single-institution experience regarding the association between clinicopathologic features, treatment, and survival outcomes. Methods: A retrospective review of all patients resected with curative intent for duodenal adenocarcinoma (DUO) between 2005-2015 and ampullary adenocarcinoma (AMP) between 2011-2015 at VMMC was performed. For AMP, histologic subtyping into intestinal (IT) and pancreatobiliary (PB) phenotypes was determined. Demographic and clinicopathologic parameters were compared between DUO and AMP patients using Chi-square test. Overall survival was calculated using Kaplan-Meier analysis and prognostic factors were identified by univariate Cox regression. Results: Patients with DUO (n = 44) presented at higher T-stage (p = 0.002) and with larger tumors (4.35cm vs 2.33cm, p < 0.001) than AMP patients (n = 46). DUO patients had a higher rate of surgical complications (68% vs 41%, p = 0.01) with a trend for more pancreatic fistulas (36% vs 20%, p = 0.08). There was no difference in median overall survival between groups. Factors positively influencing survival included Caucasian race (p = 0.02) and normal CA19-9 level at diagnosis (p = 0.01). Tumor factors negatively influencing survival included positive lymph nodes (p = 0.04), lymphovascular invasion (p = 0.001), and perineural invasion (p = 0.02). Within AMP, the PB subtype presented at higher T-stage (p = 0.01) and with more positive lymph nodes (p = 0.03) than IT. There was no difference in survival between subtypes. Majority received adjuvant chemotherapy (88.8% in AMP, 76.3% in DUO), fewer received adjuvant radiotherapy (23.3% in AMP, 30% in DUO), but no survival difference was seen. Conclusions: DUO presents with larger tumors and higher T-stage than AMP and is associated with more surgical complications. The PB phenotype has more advanced pathologic features than IT. No survival difference was seen between anatomic locations or subtypes. Better surgical and chemotherapeutic strategies may be needed to overcome high risk features. Longer follow-up with more patients is needed to confirm these findings.

Role of adjuvant therapy after R0 resection for patients with distal cholangiocarcinoma.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 355-355
Author(s):  
Young Saing Kim ◽  
In Gyu Hwang ◽  
Song-ee Park ◽  
Eun Young Kim ◽  
Jung Hun Kang ◽  
...  
Keyword(s):  
Lymph Node ◽  
Adjuvant Therapy ◽  
Lymph Nodes ◽  
Multivariable Analysis ◽  
Cox Proportional Hazards Model ◽  
Lymph Node Status ◽  
R0 Resection ◽  
Distal Cholangiocarcinoma ◽  
Positive Lymph Nodes

355 Background: There is still debated regarding the optimal treatment strategy in cholangiocarcinoma after curative resection. The aim of this study was to analyze the role of adjuvant therapy in R0-resected distal cholangiocarcinoma. Methods: We retrospectively reviewed the medical records of patients who underwent R0 resection for distal cholangiocarcinoma between January 2001 and December 2013 at six cancer centers in Korea. Adjuvant therapy consisted of chemotherapy (CT), chemoradiotherapy (CRT), or radiotherapy (RT). Multivariable Cox proportional hazards model was used to identify prognostic factors for overall survival (OS). Results: A total of 158 patients were included in the analysis; 47 patients (29.7%) had lymph node involvement. Fifty-six patients (35.4%) received adjuvant therapy (CT/CRT/RT: 27/20/9, respectively). Patients with advanced TNM stage (p = 0.001), T3/T4 disease (p = 0.009), positive lymph nodes (p = 0.052) and elevated CA 19-9 (p = 0.071) were more likely to receive adjuvant therapy. The effect of adjuvant therapy varied according to the treatment modality. Multivariable analysis showed a significant improvement in OS with CRT (Hazard ratio (HR) 0.25, 95% CI 0.08-0.83, p = 0.024) and CT (HR 0.21, 95% CI 0.08-0.53, p = 0.001). However, RT alone was associated with shorter OS (HR 2.38, p = 0.040), along with T3/T4 disease (HR 2.12, p = 0.012) and positive lymph nodes (HR 2.30, p = 0.008). In the subset analysis according to lymph node status, adjuvant therapy not including RT alone was associated with a significant OS advantage both in node-negative patients (median, 103.3 vs. 54.9 months, p = 0.037) and node-positive patients (not reached vs. 22.6 months, p = 0.013). Conclusions: Our results showed that patients receiving adjuvant CT or CRT had significant improvement in OS. In addition, the benefit of adjuvant therapy (except RT alone) was observed even in patients with negative lymph nodes.

Are axillary recurrence and overall survival affected by axillary extranodal tumor extension in breast cancer? Implications for radiation therapy.

1995 ◽  
Vol 13 (1) ◽  
pp. 47-53 ◽  
Author(s):  
C Leonard ◽  
M Corkill ◽  
J Tompkin ◽  
B Zhen ◽  
D Waitz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Radiation Therapy ◽  
Lymph Nodes ◽  
High Power ◽  
Axillary Recurrence ◽  
Axillary Lymph ◽  
High Power Field ◽  
Tumor Extension ◽  
Positive Lymph Nodes

PURPOSE To determine the overall survival and local recurrence significance of axillary lymph node extranodal tumor extension (ETE) and whether axillary/chest-wall irradiation influenced any of these outcomes. MATERIALS AND METHODS The records of 81 breast cancer patients treated with radical or modified radical mastectomy at a single surgical practice were eligible for study. Thirty-four patients had ETE: 17 with focal ETE (< 10 x high-power field) and 17 with extensive ETE (> 10 x high-power field). RESULTS With a median follow-up duration of 92 months, only two patients had an axillary recurrence (2%): one had focal ETE and one had no ETE. Neither of these patients received axillary radiation therapy. Overall survival and recurrence-free survival were significantly decreased with ETE in patients whether axillary radiation therapy had been administered or not. Analysis showed that the age of the patient correlated significantly with extensive ETE (P = .04) and that the number of positive lymph nodes (< or = three v > three) correlated significantly with ETE (whether focal or extensive) (P = .0001). A multivariate analysis of extranodal tumor extension and number of positive lymph nodes showed that ETE was associated with decreased survival (P = .05), although to a lesser degree than number of positive lymph nodes (P = .003). CONCLUSION These results show that ETE is associated with decreased survival and increased recurrence rates regardless of the extent of the radiation therapy field. Also, ETE does not necessarily indicate a significantly increased incidence of axillary recurrence. Therefore, axillary irradiation based on this pathologic finding may not be indicated.

The effect of total lymph nodes removed and the lymph node ratio on overall survival in resected pancreatic cancer.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 371-371
Author(s):  
Christina Wai ◽  
Karthik Devarajan ◽  
John Parker Hoffman
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Lymph Node Ratio ◽  
Median Number ◽  
Surgical Margins ◽  
Node Ratio ◽  
Positive Lymph Nodes

371 Background: Previous studies evaluating lymph node status in pancreatic cancer have demonstrated that the ratio of positive nodes to total numbers resected is an important prognostic factor for survival. In our study we sought to see if the total number of nodes removed and lymph node ratio (LNR) would influence overall survival. Methods: A retrospective chart review of 210 patients from July 1998 to July 2011 who underwent resection of pancreatic adenocarcinoma was done. Patients were evaluated for demographic information, neoadjuvant therapy status, surgical margins, pathological stage, total number of lymph nodes retrieved and the number of positive lymph nodes. The LNR was calculated by taking the number of positive lymph nodes to the total number of lymph nodes retrieved. The endpoint evaluated was overall survival (OS). Results: Of the 210 patients, 107 (51%) were male and 103 (49%) were female. The median age was 68. A total of 110 patients had 1 or more positive nodes. The median number of nodes evaluated for all patients was 15 (range 2-51) and the median number of positive lymph nodes was 1. In patients with positive lymph nodes, the median LNR was 0.15 or 15%. For the 210 patients, in univariate analysis, there was a statistically significant association between LNR and overall survival. When the LNR reached >11.2%, patient survival was worse (p=0.018). The total number of nodes removed was not significantly associated with OS for those with positive or negative nodes. However, with multivariable CART analysis, taking into account T stage and surgical margins, LNR had a significant impact on overall survival only for patients who had a R0 resection and T0-T2 disease. If there LNR was > 0, survival was better (p=0.043). Conclusions: In certain GI malignancies, complete evaluation of local lymph nodes is important and changes the survival of patients. In T0-T2 stage pancreatic cancer patients resected with negative margins, outcome is worse if there are positive nodes in these patients. Therefore based on our data, the LNR may be useful for determining the prognosis of early T stage cancer patients.

Oncological outcomes following radical cystectomy for urothelial carcinoma of the bladder with positive lymph nodes.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 584-584
Author(s):  
Seyedeh Sanam Ladi Seyedian ◽  
Zhoobin Bateni ◽  
Shane Pearce ◽  
Saum Ghodoussipour ◽  
Azadeh Nazami ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lymph Nodes ◽  
Urothelial Carcinoma ◽  
Radical Cystectomy ◽  
Subgroup Analysis ◽  
Clinical Evidence ◽  
Multivariable Analysis ◽  
Risk Of Recurrence ◽  
Oncological Outcomes ◽  
Positive Lymph Nodes

584 Background: To determine oncological outcomes among patients who underwent radical cystectomy (RC) for urothelial carcinoma (UC) of the bladder with positive lymph nodes (LN). Methods: On a retrospective review of 4093 patients from our institutional IRB approved cystectomy database from Jan 1971 to Dec 2017, we identified 3284 patients who underwent RC for UC of the bladder. We included patients with positive LNs at the final pathology. The data was stratified into three groups based on number of positive LNs: 1, 2-9, and more than 10 positive LNs. Multivariable analysis was performed to identify prognostic factors for overall survival (OS) and recurrence-free survival (RFS). A subgroup analysis was performed to assess the oncological outcomes in cases that did not receive any chemotherapy (adjuvant or neoadjuvant). Results: 712 patients (22%) had positive LN after RC. Median age was 68 years and 76% of patients were male. 105 (15%) patients had clinical evidence of LN involvement on pre-operative imaging. Patient characteristics are provided in Table. Five-year (5-y) RFS for 1, 2-9 and 10+ positive LNs was 39%, 36% and 16%, respectively (p<0.001). 5-y OS were 45%, 33% and 14%, respectively (p<0.001). On multivariable analysis, more than 10 positive LNs pathologic tumor stage >pT2, and neoadjuvant chemotherapy were associated with increased risk of recurrence and worse overall survival after radical cystectomy. Adjuvant chemotherapy was associated with decreased risk of recurrence and better overall survival after radical cystectomy. On subgroup analysis of patients with positive LNs without peri-operative chemotherapy, 5-y RFS for 1, 2-9 and 10+ positive LNs was 25%, 32% and 5%, respectively (p<0.001). 5-y OS was 31%, 20% and 4%, respectively (p<0.001). Conclusions: Only 15% of patients with positive LNs have clinical evidence of LN involvement prior to cystectomy. Oncological outcomes after radical cystectomy are associated with the number of involved LNs. Surgery alone can be curative in 20-30% of patients with less than 10+ LN.

scholarly journals THE ROLE OF SERUM CK-18, MMP-9 AND TIPM-1 LEVELS IN PREDICTING R0 RESECTION IN PATIENTS WITH GASTRIC CANCER

2018 ◽  
Vol 31 (4) ◽  
Author(s):  
Sevki PEDUK ◽  
Mursit DINCER ◽  
Cihad TATAR ◽  
Bahri OZER ◽  
Ahmet KOCAKUSAK ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Nodes ◽  
Clinical Stage ◽  
Perioperative Period ◽  
R0 Resection ◽  
Advanced Imaging ◽  
Curative Surgery ◽  
Common Cause ◽  
Curative Therapy

ABSTRACT Background: Gastric cancer is the 3rd most common cause of death in men and the 5th common in women worldwide. Today, surgery is the only curative therapy. Currently available advanced imaging modalities can predict R0 resection in most patients, but it can only be detected with certainty in the perioperative period. Aim: To determine the role of serum CK18, MMP9, TIMP1 levels in predicting R0 resection in patients with gastric cancer. Methods: Fifty consecutive patients scheduled for curative surgery with gastric adenocarcinoma diagnosed between 2013-2015 were included. One ml of blood was taken from the patients to analyze CK18, MMP9 and TIMP1. Results: CK18, MMP9 and TIMP1 levels were positively correlated with pathological N and the stage (p<0,05). CK-18, MMP-9 and TIMP-1 averages in positive clinical lymph nodes and in clinical stage 3, were found to be higher than the averages of those with negative clinical lymph nodes and in clinical stage 2 (p<0,05). Conclusion: Although serum CK-18, MMP-9 and TIMP-1 preoperatively measured in patients scheduled for curative surgery did not help to evaluate gastric tumor resectability, they were usefull in predicting N3-stage.

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