RA09.07: SURGICAL MANAGEMENT OF EARLY ESOPHAGEAL CANCER BASED ON LYMPH NODE METASTASIS RISK.

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 41-41
Author(s):  
Xiaofeng Duan ◽  
Zhentao Yu
Keyword(s):  
Risk Factors ◽  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Node Dissection ◽  
Tumor Location ◽  
Individual Risk ◽  
Node Dissection ◽  
Early Esophageal Cancer ◽  
Node Metastasis ◽  
The Individual

Abstract Background Esophagectomy and lymph node dissection is still the main treatment for esophageal cancer. Endoscopic mucosal resection and submucosal dissection are increasingly becoming a treatment of choice to preserve the integrity of the esophagus and decrease the surgical trauma in early esophageal cancer. However, lymph node metastasos (LNM) risk is still a debate focus for the decision of treatment selection. Our objective was to evaluate the prevalence, pattern and risk factors of LNM in early stage esophageal cancer to improve surgical treatment allocation. Methods We identified patients with pathological T1 stage esophageal cancer who underwent esophagectomy and lymph node dissection. The pattern of LNM was analyzed and the risk factors related to LNM were assessed by univariate and multivariable logistic regression analysis.The nomogram model was used to estimate the individual risk of lymph node metastasis. Results In 143 patients, LNM rates were: all patients 17.5%, T1a 8.0%, and T1b 22.5% for T1b. Depth of tumor infiltration (P < 0.05), tumor size (P < 0.01), tumor location (P < 0.05), and tumor differentiation (P < 0.01) were independent risk factors related to LNM. These four parameters allowed the compilation of a nomogram to estimate the individual risk of LNM. Fig. Nomogram to estimate the individual risk of LNM. Each characteristic of the included parameters scores a specific number of points (points per parameter). The summarized total points score indicates the probability of LNM. For a middle esophageal cancer with middle differentiated (G2), 3 cm tumor (> 2.5cm) that invades the submucosa (pT1b), the calculated total scores is 129.5 = 87.5 + 21 + 0 + 21, hence the corresponding LNM risk is 20%. Conclusion T1 esophageal cancer has a relatively high LNM rate, and the depth of tumor infiltration, tumor size, tumor location and tumor differentiation are correlated with LNM. Nomograms that include factors can be used to predict individual LNM risk. The LNM risk and extent must be considered comprehensively in decision-making of a better surgical treatment and lymph node dissection strategy. Disclosure All authors have declared no conflicts of interest.

scholarly journals Clinical Analysis of Cervical Lymph Node Metastasis Risk Factors and the Feasibility of Prophylactic Central Lymph Node Dissection in Papillary Thyroid Carcinoma

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Yifan Chen ◽  
Shuo Chen ◽  
Xiaoying Lin ◽  
Xiangqing Huang ◽  
Xiaofang Yu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Node Dissection ◽  
Cervical Lymph Node Metastasis ◽  
Node Dissection ◽  
Central Lymph Node ◽  
Central Lymph Node Dissection ◽  
Node Metastasis ◽  
Central Lymph

Objective. To identify the risk factors for cervical lymph node metastasis (CLNM) and the feasibility of prophylactic central lymph node dissection. Methods. The characteristics of 1107 patients were extracted and analyzed. Univariate and multivariate analyses were used to identify risk factors associated with lymph node metastasis. The relationship between the central lymph node dissection (CLND) and lateral lymph node metastasis (LLNM) was analyzed using the correlation analysis. Results. The probability of CLNM was closely related to the male gender, age <55, and the increase of tumor size. Those patients with an increase in tumor size and CLNM were extremely prone to LLNM. Also, LLNM was more likely to happen in those with the more positive central lymph nodes. Routine prophylactic central lymph node dissection (P-CLND) did not increase the risk of complications. Conclusion. P-CLND should be considered as a reasonable surgical treatment for PTC.

scholarly journals Evaluation of subcarinal lymph node dissection and metastasis in transmediastinal radical esophagectomy

Esophagus ◽  
2021 ◽  
Author(s):  
Jun Shibamoto ◽  
Hitoshi Fujiwara ◽  
Hirotaka Konishi ◽  
Atsushi Shiozaki ◽  
Takuma Ohashi ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Transthoracic Esophagectomy ◽  
Node Dissection ◽  
Radical Esophagectomy ◽  
Node Metastasis ◽  
Subcarinal Lymph Node

Abstract Background The aim of the present study was to evaluate subcarinal lymph node dissection in transmediastinal radical esophagectomy and subcarinal lymph node metastasis in patients with esophageal cancer. Methods Three hundred and twenty-three patients with primary esophageal cancer who underwent transmediastinal or transthoracic esophagectomy with radical two- or three-field lymph node dissection were retrospectively investigated. The clinicopathological characteristics of patients with subcarinal lymph node metastasis were analyzed in detail. Results The median of dissected subcarinal lymph nodes in transmediastinal and transthoracic esophagectomy groups was 6 and 7, respectively, and there was no significant difference between the two groups (p = 0.12). Of all patients, 26 (8.0%) were pathologically diagnosed as positive for subcarinal lymph node metastasis, whereas only 7 (26.9%) of those with metastasis were preoperatively diagnosed as positive. In addition, all patients with subcarinal lymph node metastasis had other non-subcarinal lymph node metastasis. By univariate analysis, subcarinal lymph node metastasis was found in larger (≥ 30 mm) and deeper (T3/T4a) primary lesions (p = 0.02 and 0.02, respectively), but it was not found in 49 patients with the primary lesion located in the upper thoracic esophagus. Conclusions Subcarinal lymph nodes can be dissected in transmediastinal esophagectomy, almost equivalent to transthoracic esophagectomy. The tumor size, depth, and location may be predictive factors for subcarinal lymph node metastasis.

scholarly journals Risk Factors for Lymph Node Metastasis in Clinical Stage IA3 Lung Adenocarcinoma Patients

2021 ◽  
Author(s):  
Yuan-Liang Zheng ◽  
Ju Sheng ◽  
Ri-Sheng Huang ◽  
Jun Zhao
Keyword(s):  
Risk Factors ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lung Adenocarcinoma ◽  
Lymph Node Dissection ◽  
Mediastinal Lymph Node ◽  
Clinical Stage ◽  
Node Dissection ◽  
Node Metastasis ◽  
Systematic Lymph Node Dissection

Abstract Background: lymph node metastasis is a poor prognostic factor for lung cancer; however, the risk of lymph node metastasis has not been clarified yet, so it is controversial to conduct systematic lymph node dissection for early lung cancer. Therefore, this study aimed to focus on analyzing the predictive factors for lymph node metastasis in patients with clinical stage IA3 lung adenocarcinoma.Methods: Our study group retrospectively analyzed all surgical patients admitted to our hospital from January 1, 2017 to June 2021, and these patients were considered having stage IA3 lung adenocarcinoma. A total of 334 patients underwent lobectomy combined with systematic lymph node dissection. Univariate and multivariate logistic regression analysis were adopted to predict the risk factors of lymph node metastasis.Results: Among the 334 patients eligible for this study, the overall mediastinal lymph node metastasis rate was 15.27%. There were 45 cases of N1 metastasis and 11 cases of N2 metastasis, 5 cases had both N1 and N2 metastasis at the same time. The patients were divided into three groups according to consolidation tumor ratio (CTR) values (<0.25, 0.25-0.5, >0.5). The lymph node metastasis rates in each CTR group were 1.8% (2/112), 11.7% (17/145) and 41.6% (32/77), respectively. The mediastinal lymph node metastasis rate in patients with carcinoembryonic antigen (CEA>5ng/ml) was 57.89% (22/38). The receiver operating characteristic curve (ROC) showed that the area under the curve (AUC) of CTR, pathological type and CEA were 0.790 [95% confidence interval (CI): 0.727 – 0.853，P<0.001]; 0.800（95% CI:0.735–0.865，P<0.001）;0.682（95% CI: 0.591–0.773, P<0.001）;respectively. Multivariate regression analysis showed that these listed factors were significantly correlated with lymph node metastasis of clinical stage IA3 lung adenocarcinoma: CEA [Odds Ratio (OR)=3.05, P=0.016], CTR 0.25 to 0.5 (OR=14.12, P<0.017), CTR>0.5 (OR=7.75, P=0.015), micropapillary adenocarcinoma (OR=15.704, P<0.001), and solid adenocarcinoma (OR=8.971, P=0.001).Conclusions: CEA (>5ng/ml), histologic subtype and CTR (>0.25) are important predictors of lymph node metastasis in clinical stage IA3 lung adenocarcinoma, systematic lymph node dissection should be the prior choice for patients with clinical stage IA3 incorporated with risk factors. The lymph node dissection method in stage IA3 should be alternative from those in stage IA1 and IA2.

PS01.185: STATUS OF SUBCARINAL LYMPH NODE METASTASIS AND DISSECTION STRATEGY FOR THORACIC ESOPHAGEAL CARCINOMA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 102-102
Author(s):  
Long-Qi Chen ◽  
Yun-Cang Wang ◽  
Han-Yu Deng
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Esophageal Carcinoma ◽  
Lymph Node Dissection ◽  
Node Dissection ◽  
Node Metastasis ◽  
Esophageal Tumors ◽  
Metastasis Rate ◽  
Subcarinal Lymph Node

Abstract Background The subcarinal lymph node metastasis, although with the debate whether it is a characteristic of lung cancer or esophageal cancer, is prevalent in esophageal carcinoma, and with the incidence of 4.1%-17.5% according to some estimates. The aim of this study is to assess the pattern of subcarinal lymph node metastasis and the dissection strategy for thoracic esophageal carcinoma. Methods A large cohort, retrospective study was conducted on 596 patients with thoracic esophageal carcinoma treated from July 2008 to December 2010. The metastasis rate of subcarinal lymph node was investigated. Survival of patients treated by different dissection strategies was compared. The effectiveness index was used to assess the outcome of subcarinal lymph node dissection. Results Of 596 patients, 447 had documented subcarinal lymph node dissection (75.0%). According to whether the subcarinal lymph node was harvested or not, they were divided into two groups: dissection group (n = 447) and non-dissection group (n = 149). Their 5-year survival rates were 48.3 ± 1.7 months for dissection group vs. 38.1 ± 2.8 months for non-dissection group (P < 0.001). The overall subcarinal node metastasis rate in the dissection group was 12.5% (56/447). Based on the status of subcarinal nodes, there was a significant difference in survival, 52.3 ± 1.8 months with negative nodes (n = 391) compared to 19.9 ± 2.2 months for those with positive nodes (n = 56) (P < 0.001). Subgroup analysis was further conducted for the positive subcarinal nodes patients. The metastasis rates in patients with upper, middle and lower esophageal cancer were 5.4%, 15.1% and 10.1%, respectively (P < 0.05 for comparison between patients with upper and other segments). The effectiveness indices for these three groups of patients were as 0%, 4.8% and 27.2%, respectively. The metastasis rates for T0, T1, T2, T3 and T4 esophageal carcinoma were 0%, 0%, 3.5%, 10.7% and 19.0%, respectively (P < 0.05 for comparison between T0/T1/T2 and T3/T4 tumors. Conclusion Thoracic esophageal carcinoma has a high incidence of subcarinal lymph node metastasis, especially among those with middle and lower esophageal cancer, and for deeper invaded tumors. Therefore, for middle and lower esophageal tumors, subcarinal lymph node dissection is necessary, whereas for T1/2 upper esophageal tumors, subcarinal lymph node dissection can be spared from subcarinal lymph node dissection. Disclosure All authors have declared no conflicts of interest.

scholarly journals Long non-coding RNA SPRY4-IT1 as a promising indicator for three field lymph-node dissection of thoracic esophageal carcinoma

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Peng Qie ◽  
Qifan Yin ◽  
Xuejiao Xun ◽  
Yongbin Song ◽  
Shaohui Zhou ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Node Dissection ◽  
Mediastinal Lymph Node ◽  
High Expression ◽  
Expression Level ◽  
Node Dissection ◽  
Node Metastasis ◽  
T Classification

Abstract Background Esophageal squamous cell carcinoma(ESCC) is one of the most common tumors worldwide. Esophagectomy with three-field lymph node dissection(3FLND) is the radical surgical procedure for esophageal cancer. However, 3FLND is not widely used due to it’s higher mortality rate and higher incidence of postoperative complications. There is an urgent need to identify novel biomarkers that can guide the most proper lymph-node dissection in esophageal cancer patients. Method Ninety-two patients with thoracic ESCC undergoing 3FLND were enrolled into our study from the Department of Thoracic Surgery of the Fourth Hospital affiliated to the Hebei Medical University and Hebei General Hospital between Jun 2011 and Dec 2015. Retrospectively collected data from these 92 patients was used to explore the relationship between the lymph-node metastasis、recurrence and the SPRY4-IT1 expression level and to determine whether 3FLND should be performed in patients with thoracic ESCC. Results The findings revealed that the SPRY4-IT1 expression was significantly higher in esophageal cancer tissues than in adjacent noncancerous tissues. (P < 0.01). Furthermore, the high expression of SPRY4-IT1 was significantly correlated with tumor differentiation (P = 0.029), T classification (P = 0.013), lymph node metastasis(P = 0.022) and pathological stage (P = 0.001). The increased expression of SPRY4-IT1 was associated with a higher risk of cervical and superior mediastinal lymph-node metastasis(P = 0.039).However, no significant association was observed between the risk of cervical and superior mediastinal lymph-node recurrence and the SPRY4-IT1 expression level in the thoracic ESCC patients performed 3FLND(P = 0.509). Conclusions Our data support the assumption that the high expression of SPRY4-IT1 is associated with a high risk of lymph node metastasis and it has potential application as a indicator for guiding on three-field lymph node dissection in patients with thoracic ESCC. Randomized controlled trials with a large cohort of patients will be needed to confirm this conclusion in the future.

scholarly journals The Role of Lymphadenectomy in Surgical Staging of Endometrial Cancer

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Nikki L. Neubauer ◽  
John R. Lurain
Keyword(s):  
Risk Factors ◽  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Node Dissection ◽  
Myometrial Invasion ◽  
Surgical Staging ◽  
Node Dissection ◽  
Node Metastasis ◽  
Gynecology And Obstetrics

Surgical staging, including lymph node sampling, for endometrial cancer was adopted by the International Federation of Gynecology and Obstetrics (FIGO) in 1988 based on reports demonstrating diagnostic and therapeutic advantages. This review focuses on the incidence of lymph node metastasis, risk factors for lymph node involvement, the effect of lymph node metastasis on prognosis, the therapeutic effect and diagnostic usefulness of lymphadenectomy, risks of lymph node dissection, and future directions in surgical staging of endometrial cancer. Surgical staging identifies most patients with extrauterine disease as well as uterine risk factors for recurrence, thereby allowing for a more informed approach to postoperative adjuvant therapy. Lymphadenectomy as a part of surgical staging is not required in patients assessed intraoperatively to be at low risk for lymph node metastasis (<2 cm grade 1 tumors with superficial myometrial invasion), however, a systematic lymph node dissection should be performed in most other patients with endometrial cancer. In the future, molecular markers may be useful to predict preoperatively tumor aggressiveness and lymph node metastasis. It is hoped that an approach of surgical staging with selective lymph node dissection will improve survival and spare patients additional surgical complications or unnecessary postoperative exposure to radiation and/or chemotherapy.

scholarly journals Long Non-coding RNA SPRY4-IT1 as a Promising Indicator for Three Field Lymph-node Dissection of Thoracic Esophageal Carcinoma

2020 ◽  
Author(s):  
Peng Qie ◽  
Qifan Yin ◽  
Xuejiao Xun ◽  
Yongbin Song ◽  
Shaohui Zhou ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Node Dissection ◽  
Mediastinal Lymph Node ◽  
High Expression ◽  
Expression Level ◽  
Node Dissection ◽  
Node Metastasis ◽  
T Classification

Abstract Backgroup：Esophageal squamous cell carcinoma(ESCC) is one of the most common tumors worldwide. Esophagectomy with three-field lymph node dissection(3FLND) is the radical surgical procedure for esophageal cancer. However, 3FLND is not widely used due to it’s higher mortality rate and higher incidence of postoperative complications. There is an urgent need to identify novel biomarkers that can guide the most proper lymph-node dissection in esophageal cancer patients.Method：Ninety-two patients with thoracic ESCC undergoing 3FLND were enrolled into our study from the Department of Thoracic Surgery of the Fourth Hospital affiliated to the Hebei Medical University and Hebei General Hospital between Jun 2011 and Dec 2015. Retrospectively collected data from these 92 patients was used to explore the relationship between the lymph-node metastasis、recurrence and the SPRY4-IT1 expression level and to determine whether 3FLND should be performed in patients with thoracic ESCC. Results: The findings revealed that the SPRY4-IT1 expression was significantly higher in esophageal cancer tissues than in adjacent noncancerous tissues. (P<0.01). Furthermore, the high expression of SPRY4-IT1 was significantly correlated with tumor differentiation (P=0.029), T classification (P=0.013), lymph node metastasis(P=0.022) and pathological stage (P=0.001). The increased expression of SPRY4-IT1 was associated with a higher risk of cervical and superior mediastinal lymph-node metastasis(P = 0.039).However, no significant association was observed between the risk of cervical and superior mediastinal lymph-node recurrence and the SPRY4-IT1 expression level in the thoracic ESCC patients performed 3FLND(P=0.509). Conclusions: Our data support the assumption that the high expression of SPRY4-IT1 is associated with a high risk of lymph node metastasis and it has potential application as a indicator for guiding on three-field lymph node dissection in patients with thoracic ESCC. Randomized controlled trials with a large cohort of patients will be needed to confirm this conclusion in the future.

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