Significance of the Absolute Number and Ratio of Metastatic Lymph Nodes in Predicting Postoperative Survival for the International Federation of Gynecology and Obstetrics Stage IA2 to IIA Cervical Cancer

2013 ◽  
Vol 23 (1) ◽  
pp. 157-163 ◽  
Author(s):  
Ying Chen ◽  
Lei Zhang ◽  
Jing Tian ◽  
Xin Fu ◽  
Xiubao Ren ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
International Federation ◽  
Proportional Hazard ◽  
Metastatic Lymph Nodes ◽  
Node Metastasis ◽  
Cox Proportional Hazard ◽  
Gynecology And Obstetrics

PurposeThis study aimed to evaluate the ratio of metastatic and removed lymph nodes (RPL) and the number of metastatic lymph nodes (MLNs) in predicting postoperative survival for International Federation of Gynecology and Obstetrics stage IA2 to IIA cervical cancer after radical hysterectomy and pelvic lymphadenectomy (RHPL).MethodsA retrospective study was conducted in which 120 patients with lymph node metastasis who underwent RHPL for cervical cancer from 2000 to 2006 was analyzed to identify the prognostic indicators by using Kaplan-Meier and Cox proportional hazard methods.ResultsOf 588 patients with cervical cancer who underwent RHPL, the 5-year survival rate (YSR) of 120 with lymph node metastasis was much lower than that of 468 without lymph node metastasis (22.4% vs 84.4%, P < 0.001). By cut-point survival analysis, RPL cutoff was designed as 10%, with the 5-YSR of 42.9% and 11.8%, and MLN count cutoffs were designed as 1 and 5, with the 5-YSR of 62.5%, 20.8%, and 7.8%, respectively. With univariate analysis, increasing RPL and MLN counts were associated with a poorer survival in women with node metastasis cervical cancers. Stage, histologic grade, RPL, and MLN count were significant independent prognostic factors for survival in a multivariate Cox proportional hazard model. In addition, RPL was verified superior to MLN count in prognostic evaluation for patients with IA2 to IIA cervical cancer after RHPL because the hazard ratio of RPL (3.195) was higher than that of MLN count (1.578).ConclusionsThe RPL and MLN count may be used as the independent prognostic parameters in patients with cervical cancer with lymph node metastasis after RHPL. Comparison of the superiority of RPL and MLN count for better predicting the survival of patients with cervical cancer deserves to be investigated further.

Identification of risk factors associated with pelvic lymph node metastasis in patients with stage IB1 cervical cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e18005-e18005
Author(s):  
Ping Jiang ◽  
Jing Cai ◽  
Xiaoqi He ◽  
Hongbo Wang ◽  
Weihong Dong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Tumor Size ◽  
Node Metastasis ◽  
Parametrial Invasion ◽  
Pelvic Lymph Node Metastasis ◽  
Internal Iliac

e18005 Background: Evaluation the distribution of nodal metastases in the stage IB1 cervical cancer and the risk factors associated with pelvic lymph node metastasis (LNM) at each anatomic location. Methods: 728 patients with stage IB1 cervical cancer who underwent radical hysterectomies and systemic pelvic lymphadenectomies from January 2008 to December 2017 were retrospectively studied. All removed pelvic lymph nodes were pathologically examined, and the risk factors for LNM at the obturator, internal iliac, external iliac, and common iliac regions were evaluated by univariate and multivariate logistic regression analyses. Results: 20,134 lymph nodes were analysed with the average number of 27.80 (± SD 9.43) lymph nodes per patient. Nodal metastases were present in 266 (14.6%) patients. The obturator was the most common site for nodal metastasis (42.5%) followed by the internal iliac nodes (20.3%) and the external iliac nodes (19.9%), while the common iliac (9.8%) and parametrial (7.5%) nodes were the least likely to be involved. Tumor size more than 2 cm, histologically proven lymphovascular space involvement (LVSI) and parametrial invasion correlated independently significantly with the higher risk of the lymphatic metastasis. Obesity (BMI≥25) was independently significantly negatively correlated with the risk of lymphatic metastases. All the positive common iliac nodes were found in patients with tumors greater than 2 cm. The multivariate analysis showed that tumor size greater than 3 cm was associated with a 16.6-fold increase in the risk for common iliac LNM. Interestingly, tumor size was not an independent risk factor for pelvic LNM in the lower regions, i.e., the obturator, internal iliac and external iliac areas, where LVSI was the most significant predictor for LNM. In addition, parametrial invasion was related to external and internal iliac LNM; deep stromal invasion and age less than 50 years were associated with obturator LNM. Conclusions: The incidence of lymph node metastasis in patients with stage IB1 cervical cancer is low but prognostically relevant. The data offer the opportunity for tailored individual treatment in selected patients with small tumors and obesity.

scholarly journals Prognostic Factors of the Postoperative Pancreatic Carcinoma and Implications for Identification of Potential Long-term Survivors

2019 ◽  
Author(s):  
Wei Hu ◽  
Jiao Zhou ◽  
Wenbo Zhou ◽  
Lun Wu ◽  
Shaohua Sun ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Pancreatic Carcinoma ◽  
Univariate Analysis ◽  
Postoperative Mortality ◽  
Proportional Hazard ◽  
Node Metastasis ◽  
Cox Proportional Hazard

Abstract Background Patients with Pancreatic cancer (PC) have worse survival than patients with any other gastrointestinal malignancy. In present study, it is aim to investigate the prognostic factors of pancreatic carcinoma after curative resection . Methods 72 cases suffered from pancreatic carcinoma or periampullary carcinoma received curative, nine clinicopathologic factors that could possibly influence survival for postoperative mortality and overall survival were selected for univariate analysis and multivariate analysis using Cox proportional hazard mode. Results Univariate analysis showed that major factors of influence survival were size of the tumor, lymph node metastasis, and grade of differentiation (P<0.05). Multivariate analysis showed that lymph node metastasis and size of the tumor were the most important prognostic factors by multivariate analysis using the Cox proportional hazard model (P<0.01). Conclusions Prognostic factors of pancreatic carcinoma after resection are closed related to lymph node metastasis and the size of the tumor.

scholarly journals Comparison of non-schistosomal colorectal cancer and schistosomal colorectal cancer

2020 ◽  
Author(s):  
Weixia Wang ◽  
Kui Lu ◽  
Limei Wang ◽  
Hongyan Jing ◽  
Weiyu Pan ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Clinical Stage ◽  
Clinicopathological Features ◽  
Proportional Hazard ◽  
Node Metastasis ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Cox Proportional Hazard Regression

Abstract Aim: The purpose of this study was to compare clinicopathological features of patients with non-schistosomal and schistosomal colorectal cancer to explore the effect of schistosomasis on CRC patients` clinical outcomes. Methods: 351 cases of CRC were retrospectively analyzed in this study. Survival curves were constructed by using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazard regression models were performed to identify associations with outcome variables.Results: Patients with schistosomiasis (CRC-S) were significantly older (Table 3, P＜0.001) than patients without schistosomiasis (CRC-NS). However, there were no significant differences between CRC-S and CRC-NS patients in other clinicopathological features. Schistosomiasis were associated with adverse overall survival upon K-M analysis (P=0.0277). By univariate and multivariate analysis, as shown in Table 2, gender (P=0.003), TNM stage (P＜0.001), schistosomiasis (P=0.025), lymphovascular invasion (P=0.030) and cancer node (P＜0.001) were all independent predictors in the whole cohort. When patients were stratified according to clinical stage and lymph node metastasis state. Schistosomiasis was also an independent predictors in patients with stage Ⅲ-Ⅳ tumors and in patients with lymph node metastasis, but not in patients with stage Ⅰ-Ⅱ tumors and in patients without lymph node metastasis.Conclusion: Schistosomiasis was significantly correlated with OS and it was an independent prognostic factor for OS in the whole cohort. When patients were stratified according to clinical stage and lymph node metastasis state, schistosomiasis was still an independent unfavorably prognosis factor for OS in patients with stage Ⅲ-Ⅳ tumors or patients with lymph node metastasis.

scholarly journals A Study of the Correlation Between M2 Macrophages and Lymph Node Metastasis of Colorectal Cancer

2020 ◽  
Author(s):  
Yanping Wang ◽  
Jikun Wang ◽  
Jinhao Liu ◽  
Zuoxiu Shi ◽  
Yanlei Chen ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Comprehensive Treatment ◽  
M2 Macrophage ◽  
M2 Macrophages ◽  
Metastatic Lymph Nodes ◽  
Node Metastasis ◽  
Metastatic Lymph

Abstract Background: Lymph node metastasis is a major prognostic factor of colorectal cancer and an important indicator for individualized treatment. M2 macrophages play a key role in carcinogenesis and tumor development, not only enhancing invasiveness, but also promoting lymph node metastasis. The purpose of this study was to investigate the effect of CD163-positive M2 macrophages on lymph node metastasis in colorectal cancer.Methods: Postoperative lymph node tissues were obtained from 120 patients with colorectal cancer who underwent radical surgery in the First Affiliated Hospital of Jinzhou Medical University between December 2019 and May 2020. We detected the expression of the CD163 protein in lymph nodes by immunohistochemistry. Furthermore, the relationship between M2 macrophages identified by this marker and lymph node metastasis were analyzed using the independent sample T-test and Chi-square test.Results: M2 macrophages were increased not only in metastatic lymph nodes, but also in non-metastatic lymph nodes adjacent to the cancer. The M2 macrophage count was higher in patients with macro-metastases than in those with micro-metastases.Conclusions: M2 macrophages represent an important factor for the promotion of lymph node metastasis in colorectal cancer, and may be a potential marker for its prediction. This may offer a new target for the comprehensive treatment of colorectal cancer.

scholarly journals Distribution pattern and prognosis of metastatic lymph nodes in cervical posterior to level V in nasopharyngeal carcinoma patients

2020 ◽  
Author(s):  
Chaoyang Jiang ◽  
Ji Ma ◽  
Hui Gao ◽  
Ling Zhang ◽  
Hua Li ◽  
...  
Keyword(s):  
Lymph Node ◽  
Nasopharyngeal Carcinoma ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Distribution Pattern ◽  
Cervical Region ◽  
Target Area ◽  
Metastatic Lymph Nodes ◽  
Node Metastasis ◽  
Metastatic Lymph

Abstract Background:Lymph node metastasis in the cervical region posterior to level V (PLV) often occurs in patients with nasopharyngeal carcinoma (NPC), but the significance of lymph node metastasis in this region and the delineation of the radiotherapy target area have not been reported. We aimed to explore the distribution pattern and prognosis of metastatic lymph nodes in the PLV region in patients with NPC.Methods:We retrospectively studied 605 cases of NPC diagnosed by pathology from December 2011 to November 2017. All patients were subjected to an enhanced CT scan from the cranial apex to 2 cm below the sternoclavicular joints. The nodal distribution at each level was assessed in accordance with the Radiation Therapy Oncology Group (RTOG) guidelines proposed in 2013. The central points of the metastatic lymph nodes of the PLV region in the patients were recreated proportionally on the CT images of a standard patient with N0 NPC in reference to the normal anatomy of the PLV area. The correlation between the PLV region and the other levels, the nodal location, and the characteristics and prognosis of the PLV region were analyzed.Results:Lymph node metastasis occurred in 557 (92.06%) of 605 patients, and the top four areas with the highest probability of metastasis were level IIb (77.85%), level VIIa (73.05%), level IIa (60.0%), and level III (41.48%). There were 30 patients (4.95%) with lymph node metastasis in the PLV region. A total of 49 metastatic lymph nodes from the PLV region were counted, and the mean distance of the central point of each lymph node from the leading edge of the trapezius muscle was 14 mm. Linear regression correlation analysis suggested that lymph node metastasis in the PLV region was associated with ipsilateral level IVa (P=0.018), level Va, level Vb, and level Vc lymph node metastasis (all P<0.001). The 5-year OS, PFS, LRFS, and DMFS of 29 patients with lymph node metastasis in the PLV region were 41.6%, 27.7%, 89.1%, and 47.3%, respectively. The 5-year OS, PFS, LRFS, and DMFS of patients with N3 NPC with or without lymph node metastasis in the PLV region were 41.8% vs 67.3% (P=0.007), 27.8% vs 48.5% (P=0.005), 92.3% vs 80.5% (P=0.521), 40.6% vs 78.4% (P<0.001), respectively. Multivariate analysis showed that lymph node metastasis in the PLV region was an independent prognostic factor for DMFS (P<0.05).Conclusion:NPC patients with lymph node metastasis in the PLV region had a poor prognosis and a high risk of distant metastasis. When patients have lymph node metastasis in levels IVa and V, the posterior boundary of the radiotherapy target in ipsilateral level V should be appropriately moved backward. We recommend that the margin of the PLV region may be a new cervical lymph node segment for head and neck tumors.

scholarly journals Noninvasive CT radiomic model for preoperative prediction of lymph node metastasis in early cervical carcinoma

2020 ◽  
Vol 93 (1108) ◽  
pp. 20190558
Author(s):  
Jiaming Chen ◽  
Bingxi He ◽  
Di Dong ◽  
Ping Liu ◽  
Hui Duan ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Cervical Carcinoma ◽  
Ct Images ◽  
International Federation ◽  
Clinical Feature ◽  
Data Set ◽  
Node Metastasis ◽  
Gynecology And Obstetrics ◽  
Model Combining

Objective: To build and validate a CT radiomic model for pre-operatively predicting lymph node metastasis in early cervical carcinoma. Methods and materials: A data set of 150 patients with Stage IB1 to IIA2 cervical carcinoma was retrospectively collected from the Nanfang hospital and separated into a training cohort (n = 104) and test cohort (n = 46). A total of 348 radiomic features were extracted from the delay phase of CT images. Mann–Whitney U test, recursive feature elimination, and backward elimination were used to select key radiomic features. Ridge logistics regression was used to build a radiomic model for prediction of lymph node metastasis (LNM) status by combining radiomic and clinical features. The area under the receiver operating characteristic curve (AUC) and κ test were applied to verify the model. Results: Two radiomic features from delay phase CT images and one clinical feature were associated with LNM status: log-sigma-2–0 mm-3D_glcm_Idn (p = 0.01937), wavelet-HL_firstorder_Median (p = 0.03592), and Stage IB (p = 0.03608). Radiomic model was built consisting of the three features, and the AUCs were 0.80 (95% confidence interval: 0.70 ~ 0.90) and 0.75 (95% confidence intervalI: 0.53 ~ 0.93) in training and test cohorts, respectively. The κ coefficient was 0.84, showing excellent consistency. Conclusion: A non-invasive radiomic model, combining two radiomic features and a International Federation of Gynecology and Obstetrics stage, was built for prediction of LNM status in early cervical carcinoma. This model could serve as a pre-operative tool. Advances in knowledge: A noninvasive CT radiomic model, combining two radiomic features and the International Federation of Gynecology and Obstetrics stage, was built for prediction of LNM status in early cervical carcinoma.

How should we stage and tailor treatment strategy in locally advanced cervical cancer? Imaging versus para-aortic surgical staging

2020 ◽  
Vol 30 (9) ◽  
pp. 1434-1443
Author(s):  
Alejandra Martinez ◽  
Martina Aida Angeles ◽  
Denis Querleu ◽  
Gwenael Ferron ◽  
Christophe Pomel
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Locally Advanced ◽  
Surgical Staging ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer ◽  
Node Metastasis ◽  
Pet Ct

Para-aortic lymph node status at initial assessment is the most important prognostic factor and a key point for the therapeutic strategy in patients with locally advanced cervical cancer. Undiagnosed lymph node metastasis is a major clinical problem as the finding of positive para-aortic lymph nodes leads to treatment modification, with a possible impact on disease free survival. When aortic lymph node disease is discovered, radiotherapy is extended to the para-aortic area, and other treatment modalities may be considered. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) is the most accurate imaging examination to assess para-aortic extension in patients with locally advanced cervical cancer. The gold standard to identify para-aortic extension remains histologic evaluation of the lymph nodes. Indeed, PET/CT fails to detect approximately 10–15% of patients with negative PET/CT aortic nodes who have lymph node metastasis on pathologic staging. Patients with positive pelvic lymph nodes have para-aortic extension in 25–30% of cases, and surgical staging will lead to treatment modification and probably to improved para-aortic and distant control. Surgical staging also avoids unnecessary toxicity associated with extended field radiation in approximately 75% of patients with pelvic lymph node metastasis. The best modality to identify para-aortic extension is histological evaluation of the lymph nodes, but the survival benefit of surgical staging remains controversial. On the other hand, current studies include a majority of patients without pelvic lymph node spread, who are likely to be those who will benefit the least from surgical staging.

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