856 NODAL METASTASES AFTER NEOADJUVANT CHEMORADIATION AND R0 RESECTION IN ESOPHAGEAL ADENOCARCINOMA: PATTERNS AND PROGNOSIS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Caitlin Harrington ◽  
Rebecca Carr ◽  
Smita Sihag ◽  
Prasad Adusumilli ◽  
Manjit Bains ◽  
...  
Keyword(s):  
Lymph Node ◽  
Esophageal Adenocarcinoma ◽  
Lymph Node Metastases ◽  
Cox Regression ◽  
Neoadjuvant Chemoradiation ◽  
Nodal Metastasis ◽  
Nodal Metastases ◽  
Risk Of Recurrence ◽  
Increased Risk ◽  
Node Metastases

Abstract   Although the pattern of nodal metastasis and the prognosis of number and location of positive nodes have been well described with esophageal cancer undergoing upfront surgery, little is known about nodal metastasis after neoadjuvant treatment. The aim of this study is to assess the pattern of nodal metastases in esophageal adenocarcinoma treated with neoadjuvant chemoradiation and surgery and evaluate its effect on prognosis. Methods All patients with esophageal adenocarcinoma who had undergone neoadjuvant chemoradiation and an R0 esophagectomy between 2010 and 2018 at our institution were included (n = 577). Pathology reports were reviewed for sites of lymph node metastases. Patients were excluded if nodal stations were not listed separately (n = 40). Age, sex, race, tumor location, TRG, pT stage, number of positive lymph nodes, number of positive nodal stations, and specific nodal stations were analyzed for risk of recurrence using univariable Cox regression, and significant covariates were included in multivariable Cox regression model. Results Of 537 patients, 193(36%) had pathologic nodal metastases. 153 patients(28%) had single-station disease: 135(88%) at the paraesophageal station, 16(10%) at the left gastric, 1 at the subcarinal and 1 at the paratracheal station(0.65% each). 32 patients(6.0%) had two-station and 8(1.5%) had three-station disease. The majority of patients with multiple positive nodal stations had positive nodes in the paraesophageal(90%) and/or left gastric artery stations(60%). On multivariable analysis, the number of positive nodal stations (HR 1.59, CI 1.35–1.84, p < 0.001), subcarinal (HR 2.78, CI 1.54–5.03, p < 0.001), and paraesophageal stations (HR 2.0, CI 1.58–2.54, p < 0.001) were associated with increased risk of recurrence. Conclusion Patients who have undergone neoadjuvant and R0 esophagectomy for adenocarcinoma often have lymph node metastases at time of surgery, most commonly at the paraesophageal station. The number of nodal stations, along with subcarinal and paraesophageal metastases, were associated with increased risk of recurrence.

The risk of nodal metastasis in early adenocarcinoma of the uterine cervix*

2004 ◽  
Vol 14 (1) ◽  
pp. 104-109 ◽  
Author(s):  
J. Balega ◽  
H. Michael ◽  
J. Hurteau ◽  
D. H. Moore ◽  
J. Santiesteban ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastases ◽  
Medical Center ◽  
Conservative Surgery ◽  
Disease Recurrence ◽  
Nodal Metastasis ◽  
Pelvic Lymphadenectomy ◽  
Depth Of Invasion ◽  
Nodal Metastases ◽  
Node Metastases

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.

Distribution of lymph node metastases in esophageal adenocarcinoma after neoadjuvant chemoradiation therapy: a prospective study

2019 ◽  
Vol 34 (10) ◽  
pp. 4347-4357 ◽  
Author(s):  
Eliza R. C. Hagens ◽  
Hannah T. Künzli ◽  
Anne-Sophie van Rijswijk ◽  
Sybren L. Meijer ◽  
R. Clinton D. Mijnals ◽  
...  
Keyword(s):  
Lymph Node ◽  
Prospective Study ◽  
Esophageal Adenocarcinoma ◽  
Lymph Node Metastases ◽  
Neoadjuvant Chemoradiation ◽  
Chemoradiation Therapy ◽  
Neoadjuvant Chemoradiation Therapy ◽  
Node Metastases ◽  
A Prospective Study

Nuclear localization of NF-kappaB p65 in primary prostate tumors is predictive of pelvic lymph node metastases

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10077-10077
Author(s):  
L. Lessard ◽  
P. Bellon-Gagnon ◽  
M. Alam-Fahmy ◽  
P. Karakiewicz ◽  
A. Mes-Masson ◽  
...  
Keyword(s):  
Lymph Node ◽  
Radical Prostatectomy ◽  
Lymph Node Metastasis ◽  
Lymph Node Metastases ◽  
Cox Regression ◽  
Control Group ◽  
Primary Tumors ◽  
Node Metastasis ◽  
Increased Risk ◽  
Node Metastases

10077 Background: Pelvic lymph node metastases are associated with a greater risk of prostate cancer recurrence and peripheral metastasis. Unfortunately, markers predictive of lymph node metastasis and/or recurrence after radical prostatectomy are limited and new molecular markers are needed to identify patients at higher risk of progression. NF-kB (p65) is a candidate molecular marker already associated with poor clinical outcomes such as biochemical recurrence and bone metastasis. We have also reported elevated nuclear p65 expression in prostate cancer lymph node metastasis. Pertinent to this issue, we tested whether the nuclear localization of p65 in radical prostatectomy specimens could predict the presence of lymph node metastases. Methods: Following informed consent, 51 patients who underwent radical prostatectomy were included in the study: 20 patients had lymph node metastasis at surgery and 31 patients had no evidence of lymph node metastasis and were used as the control group. All cases in the control group had no biochemical relapse 5 years following radical prostatectomy. NF-kB expression in prostate tumor sections was assessed by immunohistochemistry using a monoclonal NF-kB p65 antibody. The relation between nuclear p65 expression in primary tumors and lymph node metastasis was tested in univariate and multivariate Cox regression models. Results: Primary tumors of metastatic patients had an average of 21.25% of tumor cells with nuclear p65 expression as opposed to 9.42% of tumor cells of control patients (p=0.001). Univariate Cox regression demonstrated a 7.5% increased risk of having lymph node metastases for each percent increase in p65 nuclear staining (p=0.003). In the multivariate model, after controlling for pre-operative PSA (p=0.175), Gleason patterns (p=0.382), pathological stage (p=0.436), extracapsular extension (p=0.243) and seminal vesicle invasion (p=0.016), nuclear p65 was associated with an 8.8% increased risk for lymph node metastases (p=0.024). Conclusion: In univariate and multivariate analyses, p65 nuclear expression was strongly predictive of lymph node invasion. We propose that nuclear NF-kB (p65) may serve as a useful independent molecular marker for stratifying patients at risk for lymph node metastases. No significant financial relationships to disclose.

scholarly journals Identifying Biomarkers in Lymph Node Metastases of Esophageal Adenocarcinoma for Tumor-Targeted Imaging

2020 ◽  
Vol 24 (2) ◽  
pp. 191-200 ◽  
Author(s):  
D. J. J. M. de Gouw ◽  
M. Rijpkema ◽  
T. J. J. de Bitter ◽  
V. M. Baart ◽  
C. F. M. Sier ◽  
...  
Keyword(s):  
Lymph Node ◽  
Esophageal Adenocarcinoma ◽  
Lymph Node Metastases ◽  
Targeted Imaging ◽  
Node Metastases

Outcomes of patients with clinical lymphadenopathy treated with radical prostatectomy.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 106-106
Author(s):  
T. T. Higuchi ◽  
R. H. Breau ◽  
E. C. Umbreit ◽  
E. J. Bergstralh ◽  
L. J. Rangel ◽  
...  
Keyword(s):  
Lymph Node ◽  
Radical Prostatectomy ◽  
Lymph Nodes ◽  
Surgical Therapy ◽  
Lymph Node Metastases ◽  
Preoperative Imaging ◽  
Risk Of Death ◽  
Radiology Reports ◽  
Increased Risk ◽  
Node Metastases

106 Background: Some patients with lymph node metastases experience prolonged survival following radical prostatectomy. The purpose of this study was to determine the outcome of patients with clinically suspicious lymph nodes on preoperative imaging who underwent radical prostatectomy and lymphadenectomy. Methods: Patients with lymph node metastases diagnosed during radical prostatectomy from 1988-2003 were reviewed. Patients with preoperative CT or MRI images were included in the study. Radiology reports were reviewed to determine if patients had clinically suspicious lymphadenopathy (cN+). For all analyses, patients with cN+ were compared to those with clinically negative nodes (cN−). Results: Preoperative imaging was available in 202 men with lymph node metastasis at the time of prostatectomy. Of these 17% (34/202) were cN+. None had pre-operative lymph node biopsy and none had abandoned prostatectomy. At a median follow-up of 11.1 years, PSA recurrence occurred in 50% (17/34) and 49% (82/186), local recurrence in 18% (6/34) and 13% (22/186) and systemic progression in 32% (11/34) and 24% (40/186) of patients with cN+ and cN-, respectively. On multivariate analysis, cN+ was not associated with increased risk of death (HR 1.66, p=0.1). Conclusions: cN+ patients undergoing surgical therapy for prostate cancer may experience similar outcomes to cN− patients. The presence of clinically suspicious lymph nodes on preoperative imaging should not be an absolute contraindication for surgical therapy. No significant financial relationships to disclose.

scholarly journals ¿Qué podemos esperar de las guías ATA 2014 en el manejo de cáncer temprano de tiroides?

2017 ◽  
Vol 2 (4) ◽  
pp. 5-10
Author(s):  
Alvaro Sanabria ◽  
Alejandro Román González
Keyword(s):  
Lymph Node ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Lymph Node Metastases ◽  
Radioactive Iodine ◽  
Papillary Thyroid ◽  
Tsh Suppression ◽  
Asymptomatic Patients ◽  
Increased Risk ◽  
Node Metastases

El carcinoma papilar de tiroides es un tumor frecuente en mujeres y el número de casos nuevos viene en crecimiento. La mayoría de estos casos de novo son tumores menores de 2 centímetros. Parte de la responsabilidad de este aumento es explicable por un uso mayor de ayudas diagnósticas. Esto ha permitido detectar el cáncer de tiroides temprano o clínicamente silente. En esta población, el manejo ha sido típicamente agresivo, incluyendo cirugías extensas (tiroidectomía total) seguidas por terapia con yodo radiactivo y supresión de TSH. Las próximas guías plantearán cuatro grandes modificaciones: 1. Estadificación dinámica del riesgo (respuesta completa, respuesta bioquímica incompleta, respuesta estructural incompleta e indeterminada) 2. Disminución de las indicaciones y de la dosis de ablación con yodo radiactivo, específicamente el uso de esta terapia debe estar ajustado al riesgo basal de recurrencia (bajo, intermedio, alto) del paciente y debe tenerse en cuenta el número de ganglios linfáticos afectados, el tamaño de las metástasis ganglionares, la histología y el tamaño del tumor. Una dosis de 30 mCi de 131yodo es igual de eficaz para negativizar la tiroglobulina que una dosis de 100 mCi. 3. Extensión de la cirugía (cirugía parcial en tumores menores de 4 cm con histología favorable) y 4. Terapia de supresión con levotiroxina con metas más laxas de TSH, dado el riesgo de osteoporosis y arritmias con una supresión exagerada de TSH, especialmente en la población de edad avanzada.Abstract Papillary thyroid carcinoma is a frequent cancer in women. An increase in the number of new cases has been detected in the last years. However, tumors smaller than 2 cms represent the largest sample in those new detected cancers. The cause of this increment is partially responsibility of an increased use of diagnostic aids such as ultrasound, even in asymptomatic patients. The management of these clinically silent tumors has been quite aggressive with extensive surgery (total thyroidectomy) followed by radioactive iodine therapy and TSH suppression. The next papillary thyroid carcinoma guidelines will address 4 important modifications: 1. Dynamic approach to risk stratification (Complete response, incomplete biochemical response, incomplete structural response and indeterminate response) 2. Decrease in the indication and dose of radioactive iodine. The use of this therapy must be adjusted to the basal risk of recurrence with consideration of the number of lymph node metastases, the size of the lymph node metastases, the histopathologic variant and the size of the primary tumor. A dose of 30mCi of 131I is as effective as a dose of 100 mCi for thyroid ablation. 3. Extension of the thyroidectomy (partial surgery in tumors smaller than 4 cms without unfavorable histopathology and 4. Higher TSH goal with levothyroxine suppression therapy. A strict TSH suppression has been associated with increased risk of osteoporosis and cardiac arrhythmias, especially in older population.

RA07.02: IDENTIFYING TUMOR MARKERS IN ESOPHAGEAL ADENOCARCINOMA AND LYMPH NODE METASTASES FOR TARGETED FLUORESCENCE IMAGING

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 34-34
Author(s):  
Didi De Gouw ◽  
Bastiaan Klarenbeek ◽  
Mark Rijpkema ◽  
Kiek Verrijp ◽  
Maroeska Rovers ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Fluorescence Imaging ◽  
Tumor Markers ◽  
Esophageal Adenocarcinoma ◽  
Lymph Node Metastases ◽  
Detection Rate ◽  
Metastatic Lymph Nodes ◽  
Metastatic Lymph ◽  
Node Metastases

Abstract Background Neoadjuvant chemoradiotherapy (nCRT) followed by resection of the tumor with two field lymphadenectomy is a standard treatment for esophageal cancer. After nCRT, however, in more than 70% of patients no lymph node metastases are found, suggesting extensive overtreatment. Tumor-targeted fluorescence imaging is a promising technique to detect lymph node metastases intra-operatively and guide personalized resection. The aim of this study is to identify potential viable tumor markers for fluorescence imaging of lymph node metastases in patients with esophageal adenocarcinoma (EAC). Methods Immunohistochemistry (IHC) was performed on tissue microarrays from EAC’s patients that underwent surgical resection between 2007 and 2016. Patients were subdivided in five groups, non-pretreated patients with and without metastatic lymph nodes, complete responders, partial responders and non-responders after nCRT. Five membranous markers, c-MET, CAIX, EGFR, EpCAM, HER2, and two cytoplasmic markers, VEGF-A and VEGF-A receptor were included. Tumor marker expression was scored on intensity (none (0), slight (1), moderate (2), strong (3)) and the percentage of positive cells (estimation). Threshold for positive detection rate was defined as an intensity of ≥ 2 in more than 10% the cells. Results EpCAM showed the highest expression in metastastic lymph nodes, with a median intensity of 3 (range 2–3) in > 70% of the tumor cells. Expression was found in 37 out of 39 EAC’s (95%). VEGF-A and CAIX expression was observed in 28 of 33 (85%) and 10 of 33 (30%) of metastatic lymph nodes and 34 of 39 (87%) and 17 of 39 (44%) in the primary EAC’s, respectively. For the other tumor biomarkers the detection rate ranged between 0 and 11% for metastatic lymph nodes and primary EAC’s. Only EpCAM and VEGF-A showed weak, non-specific staining in the fibrotic tissue. Conclusion High expression rates in primary EAC and metastatic lymph nodes were observed using immunohistochemical antibodies for EpCAM, VEGF-A and CA-IX, making these clinically relevant viable EAC tumor markers. A phase 1 dose finding study targeting VEGF-A by Bevacizumab-800-CW in patient with EAC is in preparation. Disclosure All authors have declared no conflicts of interest.

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