scholarly journals RA09.02: LYMPH NODE RESPONSE AFTER NEOADJUVANT CHEMORADIATION THERAPY FOR ESOPHAGEAL ADENOCARCINOMA: TIME FOR AN APPROPRIATE YPN CLASSIFICATION

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 40-40
Author(s):  
Lieven Depypere ◽  
Gert De Hertogh ◽  
Johnny Moons ◽  
An-Lies Provoost ◽  
Toni Lerut ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Esophageal Adenocarcinoma ◽  
Primary Tumor ◽  
Median Overall Survival ◽  
Lymph Node Involvement ◽  
Neoadjuvant Chemoradiation ◽  
Chemoradiation Therapy ◽  
Node Involvement

Abstract Background Response of the primary tumor and lymph node involvement are the most important prognosticators in resected patients with esophageal adenocarcinoma after neoadjuvant chemoradiation. Response on the primary tumor is well established using T(umor) R(egression) G(rading). However, little is known about the prognostic value of lymph node response in these patients. Methods Hematoxylin-eosin slides of 193 adenocarcinoma patients with clinical suspicion of lymph node involvement (cN+) and treated with neoadjuvant chemoradiation therapy between 2008 and 2015 were all reassessed by a senior pathologist. Lymph node response (LNR) was defined as a combination of central fibrosis and at least one other characteristic such as hemosiderin pigment, acellular mucin pools, foam cells, giant cells or calcifications. Lymph nodes were categorized in four categories: 1° as positive (ypN+) when viable tumor was found according to TNM 8th edition. 2° as negative (ypN0) in absence of any viable tumor. 3° as lymph nodes with signs of LNR (LNR+). 4° as lymph nodes without signs of LNR (LNR-). All patients were grouped according to lymph node positivity and lymph node regression. Multivariate and survival analysis were performed by Cox proportional hazard regression analysis. Results Thirty-four patients were ypN + /LNR + , 60 were ypN + /LNR-, 41 were ypN0/LNR + and 58 were ypN0/LNR-. Median overall survival was respectively 41.0 months, 18.5 months, 31.2 months and 62.9 months. Survival was significantly different between ypN0 groups (P = 0.045) but not between ypN + groups (P = 0.299). Multivariate analysis showed that LNR was an independent prognosticator (P = 0.011). Conclusion In cN + esophageal adenocarcinoma patients treated with neoadjuvant chemoradiation with final pathology being ypN0 after esophagectomy, median overall survival is doubled when no signs of LNR were found suggesting these patients were in fact true N0 and that ypN0/LNR + have a similar prognosis as ypN + /LNR + . Using these four categories of ypN allows for more precise evaluation of the impact of induction therapy. Disclosure All authors have declared no conflicts of interest.

scholarly journals Extracapsular Lymph Node Involvement in Ovarian Carcinoma

Cancers ◽  
2019 ◽  
Vol 11 (7) ◽  
pp. 924 ◽  
Author(s):  
Sabine Heublein ◽  
Heiko Schulz ◽  
Frederik Marmé ◽  
Martin Angele ◽  
Bastian Czogalla ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Primary Tumor ◽  
Tumor Tissue ◽  
Lymph Node Involvement ◽  
Node Positive ◽  
Node Involvement ◽  
Lymph Node Positive

Ovarian cancer (OC) spread to retro-peritoneal lymph nodes is detected in about one out of two patients at primary diagnosis. Whether the histologic pattern of lymph node involvement i.e., intra-(ICG) or extracapsular (ECG) cancer growth may affect patients’ prognosis remains unknown. The aim of the current study was to analyze the prevalence of ECG and ICG in lymph node positive ovarian cancer. We further investigated whether ECG may be related to patients’ prognosis and whether biomarkers expressed in the primary tumor may predict the pattern of lymph node involvement. Lymph node samples stemming from 143 OC patients were examined for presence of ECG. Capsular extravasation was tested for statistical association with clinico-pathological variables. We further tested 27 biomarkers that had been determined in primary tumor tissue for their potential to predict ECG in metastatic lymph nodes. ECG was detected in 35 (24.5%) of 143 lymph node positive patients. High grade (p = 0.043), histologic subtype (p = 0.006) and high lymph node ratio (LNR) (p < 0.001) were positively correlated with presence of ECG. Both ECG (p = 0.024) and high LNR (p = 0.008) were predictive for shortened overall survival. A four-protein signature determined from the primary tumor tissue was associated with presence of concomitant extracapsular spread in lymph nodes of the respective patient. This work found extracapsular spread of lymph node metastasis to be a common feature of lymph node positive ovarian cancer. Since ECG was positively associated with grade, LNR and shortened overall survival, we hypothesize that the presence of ECG may be interpreted as an indicator of tumor aggressiveness.

scholarly journals Predictive Value of Tumor Load in Breast Cancer Sentinel Lymph Nodes for Second Echelon Lymph Node Metastases

2007 ◽  
Vol 29 (6) ◽  
pp. 497-505
Author(s):  
C. H. M. van Deurzen ◽  
R. van Hillegersberg ◽  
M. G. G. Hobbelink ◽  
C. A. Seldenrijk ◽  
R. Koelemij ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Invasive Breast Cancer ◽  
Primary Tumor ◽  
Lymph Node Involvement ◽  
Consecutive Series ◽  
Axillary Lymph ◽  
Tumor Load ◽  
Node Involvement

Background: The need for routine axillary lymph node dissection (ALND) in patients with invasive breast cancer and low-volume sentinel node (SN) involvement is questionable. Accurate prediction of second echelon lymph node involvement could identify those patients most likely to benefit from ALND.Methods: A consecutive series of 317 patients with invasive breast cancer and a tumor positive axillary SN followed by ALND was reviewed. Clinicopathologic features of the primary tumor and the SN were assessed as possible predictors of second echelon lymph node involvement.Results: Second echelon metastases were found in 116/317 cases (36.6%). Frequency of second echelon lymph node involvement in patients with isolated tumor cells (ITC, N = 23), micro- (N = 101) and macrometastases (N = 193) was 13%, 20% and 48%, respectively (p < 0.001). Based on the area % of SN occupied by tumor no subgroup of patients could be selected with less than 20% second echelon lymph node involvement. However, none of the patients with SN ITC or micrometastases and a primary tumor size ≤1 cm (N = 12, 3.8%) had second echelon lymph node involvement.Conclusions: Accurately measured SN tumor load predicts second echelon lymph node involvement. However, even in patients with ITC, the second echelon lymph nodes are involved in 13% justifying ALND.

Primary Tumor Site, Size, Patients Age and Axillary Lymph Nodes in Breast Cancers

1986 ◽  
Vol 72 (3) ◽  
pp. 259-265 ◽  
Author(s):  
Salvatore Toma ◽  
Stefano Bonassi ◽  
Riccardo Puntoni ◽  
Guido Nicolò
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Primary Tumor ◽  
Lymph Node Involvement ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Breast Cancers ◽  
Primary Tumor Site ◽  
Primary Tumors ◽  
Node Involvement

This study considers the correlations between some characteristics of the primary tumor and level of lymph node involvement in 185 primary breast cancers. The average number of lymph nodes was higher in N + women than in N— women. Primary tumors with a diameter of more than 4 cm yielded the highest mean number of lymph nodes (17.5). The risk of developing lymph node metastases was fourfold in tumors with a diameter greater than 2 cm when compared to those with a diameter less than or equal to 2 cm. The most commonly metastasized lymph node level, in both large and small tumors, was the first; however, one-fifth of the patients had simultaneous lymph node metastasis in all three axillary levels. Although the left breast was the most affected (58.9 %), there was no evidence of a different risk of metastasis between the two breasts; 34.1 % of the tumors were multifocal. Lymph node involvement was higher in women under 50 years of age with a primary tumor larger than 2 cm.

scholarly journals Prognostic Factors of Lymph Nodes in Colorectal Carcinoma

2020 ◽  
Vol 17 (5) ◽  
pp. 7-14
Author(s):  
Marilena Stoian ◽  
Lucia Indrei ◽  
Victor Stoica
Keyword(s):  
Lymph Node ◽  
Colorectal Carcinoma ◽  
Lymph Nodes ◽  
Primary Tumor ◽  
Regional Lymph Node ◽  
Laboratory Data ◽  
Lymph Node Involvement ◽  
Acceptable Error ◽  
Regional Lymph Node Involvement ◽  
Node Involvement

Abstract Background/Aims. The aim of this study was to establish whether, and to what extent, preand intraoperatively detected characteristics (demographic, anamnestic and laboratory data) and tumor characteristics can be used in the assessment of regional lymph node involvement in patients with colorectal carcinoma. The assessment also included the number of lymph nodes involved in patients with positive lymph nodes. Considering that the number of obtained lymph nodes is resected specimens, assessment parameters also included the percentage of the involved lymph nodes within the total population of lymph nodes. Methodology. From 2010-2019, 46 patients with carcinoma of the rectum and sigmoid colon were studied, with a total number of 736 lymph nodes evaluated. Out of the total number of lymph nodes, 577 (78.4%) were benign and 159 (21.6%), malignant. Data were analyzed by multi-variant statistical methods: discriminant analysis and multiple regression. Results. For this patient group, we evaluated the following potentially predictive factors for lymph node involvement: age; serum hemoglobin, albumin and alkaline phosphatase levels; weight loss; and the primary tumor localization characteristics: histological type, macroscopic growth pattern and depth of tumor invasion of the bowel wall. We found that there was no difference in the prediction of regional lymph node involvement between analysis of the aforementioned parameters and analysis of the isolated discriminators only. Conclusion. A predictability likelihood of 83.78% greatly surpasses the acceptable error tolerance level of 5%. Correlation of demographic, anamnestic and laboratory data about the patient and the characteristics of the primary tumor cannot be used in distinguishing malignant lymph nodes from benign ones. These data cannot be the basis for exact intraoperative staging and thus cannot be significant criteria foe decision-making about operative treatment modalities.

scholarly journals Clinical Features and Outcomes of 24 Cases of Blastic Plasmacytoid Dendritic Cell Neoplasm-Single Institutional Experience

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3755-3755
Author(s):  
Afshan Idrees ◽  
Xiaohui Zhang ◽  
Reza Setoodeh ◽  
Samir Dalia ◽  
Ling Zhang ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Overall Survival ◽  
Lymph Node ◽  
Peripheral Blood ◽  
Median Overall Survival ◽  
Plasmacytoid Dendritic Cell ◽  
Skin Lesions ◽  
Lymph Node Involvement ◽  
Hematopoietic Stem ◽  
Node Involvement

Abstract Background: Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, aggressive hematopoietic malignancy originating from precursor plasmacytoid dendritic cells. Clinically, patients usually present with skin lesions and simultaneous involvement of peripheral blood, bone marrow, lymph node, spleen and central nervous system. Median survival from diagnosis has been reported to range from 9 to 12 months (Julia F et al. Br J Dermatol. 2013;579-86). The optimal treatment for BPDCN has not been established yet. Majority of patients demonstrate response to lymphoma or acute lymphoblastic leukemia-like chemotherapy induction regimens. A consolidation with autologous or allogeneic hematopoietic stem cell transplantation may improve outcome of selected patients. Limited data are available regarding prognostic and predictive factors. In this study we analyzed clinical and laboratory characteristics and assessed their impact on clinical outcome. Methods and Materials: Patients with diagnosis of BPDCN at Moffitt Cancer Center between 2000 and 2015 were retrieved from a clinical database. The diagnosis was confirmed by morphology, laboratory data, and immunopehnotying, according to 2008 WHO Classification of Hematopoietic Neoplasms. The relevant clinicopathologic features extracted from electronic medical records were recorded. Treatment modalities and responses to therapy were correlated with clinical outcomes. A univariate linear discriminant analysis was used for risk stratification. Overall survival was analyzed by Kaplan-Meier method. Results: We identified 24 patients with a median age of 74 years (range: 36-94 years) and a male:female ratio of 23:1. Mean hemoglobin was 11.83 2.48 g/dL; mean platelet count was 134 ± 84 k/µL; and mean white blood count was 6.34 ± 7.25 k/µL. Only one patient had an Eastern Cooperative Oncology Group (ECOG) performance status greater than 2. Four patients demonstrated skin lesions only. Twenty patients (83.3%) demonstrated extracutaneous or systemic involvements. Peripheral blood, bone marrow, lymph node, spleen and cerebrospinal fluid (CSF) involvements were found in 11 (45.8%), 16 (66.7%), 8(33.3%), and 4(17%) patients, respectively. Six of 20 (30%) patients with systemic involvement were treated with CHOP. Two of 6 patients were treated with hyper-CVAD followed by an allogeneic hematopoietic stem cell transplant. Autologous transplant was administered to one patient who was treated with both CHOP and ICE induction regimens. Median overall survival (OS) of the cohort was 49.9 months (95% CI, 19.9 - 81 months) and median follow up duration was 33.5 months (95% CI, 3-147 months). Statistical analysis showed the following parameters were not prognostic predictors of OS at diagnosis: hemoglobin level (<10 g/dL), leukocytosis (>11,000/ul), thrombocytopenia (<100,000/ul), age >60, peripheral blood and bone marrow involvement (p=0.51, p=0.278, p=0.684, p=0.9288, p=0.2074, and p=0.8633, respectively). Lymph node involvement at diagnosis was associated with a shorter OS compared to those without lymph node involvement (p=0.0305). CHOP versus more aggressive chemotherapies did not show difference in OS (p=0.8939). Bone marrow transplant (1 autologous and 2 allogeneic) showed a trend to have longer OS (86 versus 64 months; p=0.12). Conclusion: BPDCN has an aggressive biological behavior. Median overall survival of 49.9 months observed in our study compares favorably with OS of 12 months in previous reports. Lymph node involvement at diagnosis may have adverse impact on clinical outcomes. Larger scale studies are needed to identify risk factors that may have impact on outcomes and to establish standardized therapy in patients with BPDCN. Disclosures Sokol: Seatle Genetics: Research Funding; Spectrum: Consultancy; Celgene: Consultancy.

Breast Cancer: Primary Tumor Characteristics Related to Lymph Node Involvement

1981 ◽  
Vol 67 (1) ◽  
pp. 19-26 ◽  
Author(s):  
Alessandro Rasponi ◽  
Alberto Costa ◽  
Rosaria Bufalino ◽  
Alberto Morabito ◽  
Maurizio Nava ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Primary Tumor ◽  
Lymph Node Involvement ◽  
Maximum Diameter ◽  
Histologic Type ◽  
Regional Lymph Nodes ◽  
The Status ◽  
Node Involvement ◽  
Node Metastases

From November 1st 1977 to August 31st 1978, 842 consecutive patients with operable breast cancer were observed at the National Cancer Institute of Milan. Characteristics of the primary tumor and the status of regional lymph nodes were evaluated at clinical and postsurgical examination: it was found that qualitative characteristics of the primary were properly defined by clinicians, who usually overestimated maximum diameter of the primary. The status of regional lymph nodes is not reliable at clinical examination: 34.5 % of clinically uninvolved nodes were found to contain metastatic growth at histologic examination. Age of patients, maximum diameter of the primary, histologic type and quadrant of origin of the primary tumor were significantly related to the frequency of regional node metastases. Multifactorial analysis showed that the last three factors were independent variables, while age, which is significant by itself, loses importance when adjusted by at least one of the other three factors. Frequency of extension of node metastases beyond the lymph node capsule was found to be related to the number of involved nodes: maximum diameter, histologic type and site of origin are significantly related to the frequency of extracapsular invasion. This study confirms that the evaluation of the status of regional lymph nodes is not reliable at clinical examination and indicates that characteristics of the primary may be useful in predicting regional lymph node involvement. The direct correlation between the number of involved nodes and the frequency of infiltration beyond the capsule suggests that prognosis of patients with positive nodes depends more on this factor than on the number of involved nodes.

Impact of Extracapsular Lymph Node Involvement After Neoadjuvant Chemoradiation Therapy Followed by Surgery in Carcinoma of the Esophagus

2018 ◽  
Vol 268 (6) ◽  
pp. 1000-1007 ◽  
Author(s):  
Lieven P. Depypere ◽  
Johnny Moons ◽  
Christophe Mariette ◽  
Xavier B. D’Journo ◽  
Pascal A. Thomas ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Involvement ◽  
Neoadjuvant Chemoradiation ◽  
Chemoradiation Therapy ◽  
Carcinoma Of The Esophagus ◽  
Neoadjuvant Chemoradiation Therapy ◽  
Node Involvement
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