Esophageal Cancer: The Mode of Lymphatic Tumor Cell Spread and Its Prognostic Significance

2001 ◽  
Vol 19 (7) ◽  
pp. 1970-1975 ◽  
Author(s):  
Stefan B. Hosch ◽  
Nikolas H. Stoecklein ◽  
U. Pichlmeier ◽  
Alexander Rehders ◽  
Peter Scheunemann ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cox Regression ◽  
Prognostic Significance ◽  
Staging System ◽  
Esophageal Resection ◽  
Cox Regression Analysis ◽  
Frequent Event ◽  
Skip Metastases

PURPOSE: Data on skip metastases and their significance are lacking for esophageal cancer. This issue is important to determine the extent of lymphadenectomy for esophageal resection. In this study we examined the lymphatic spread in esophageal cancer by routine histopathology and by immunohistochemistry.PATIENTS AND METHODS: A total of 1,584 resected lymph nodes were obtained from 86 patients with resected esophageal carcinoma and evaluated by routine histopathology. Additionally, frozen tissue sections of 540 lymph nodes classified as tumor-free by routine histopathology were screened for micrometastases by immunohistochemistry with the monoclonal antibody Ber-EP4. The lymph nodes were mapped according to the mapping scheme of the American Thoracic Society modified by Casson et al.RESULTS: Forty-four patients (51%) had pN1 disease, and 61 patients (71%) harbored lymphatic micrometastases detected by immunohistochemistry. Skip metastases detected by routine histopathology were present in 34% of pN1 patients. Skipping of micrometastases detected by immunohistochemistry was found in 66%. The presence of micrometastases was associated with a significantly decreased relapse-free and overall survival (56.0 v 10.0 months and > 64 v 15 months, P < .0001 and P = .004, respectively). Cox regression analysis revealed the independent prognostic influence of micrometastases in lymph nodes. Lymph node skipping had no significant independent prognostic influence on survival.CONCLUSION: Histopathologically and immunohistochemically detectable skip metastases are a frequent event in esophageal cancer. Only extensive lymph node sampling, in conjunction with immunohistochemical evaluation, will lead to accurate staging. An improved staging system is essential for more individualized adjuvant therapy.

scholarly journals Prognostic Significance of Sarcopenia in Patients with Unresectable Advanced Esophageal Cancer

2019 ◽  
Vol 8 (10) ◽  
pp. 1647 ◽  
Author(s):  
Sachiyo Onishi ◽  
Masahiro Tajika ◽  
Tsutomu Tanaka ◽  
Yutaka Hirayama ◽  
Kazuo Hara ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Prognostic Factor ◽  
Cox Regression ◽  
Prognostic Significance ◽  
Japanese Patients ◽  
Independent Prognostic Factor ◽  
Cancer Center ◽  
Advanced Esophageal Cancer ◽  
Cox Regression Analysis ◽  
Group 2

The prognostic significance of sarcopenia in unresectable advanced esophageal cancer remains unclear. Our study retrospectively evaluated 176 consecutive Japanese patients with esophageal squamous cell carcinoma who had been diagnosed with unresectable advanced cancer in Aichi Cancer Center Hospital between January 2007 and December 2014. Skeletal muscle mass was calculated from abdominal computed tomography (CT) scans before treatment, and patients were divided into sarcopenic and non-sarcopenic groups. Sarcopenia was present in 101 patients (57.4%). Eighty-two patients in the sarcopenic group and 63 patients in the non-sarcopenic group died during follow-up (mean: 20.3 months). The overall survival (OS) rate was significantly lower in the sarcopenic group compared to the non-sarcopenic group (2-year OS: 9.8% vs. 23.7%, p < 0.01). Cox regression analysis revealed only pretreatment sarcopenia as an independent prognostic factor (hazard ratio (HR): 1.48, 95% confidence interval (CI): 1.04–2.10, p = 0.03). In the sarcopenic group, withdrawn cases, for whom the planned treatment was discontinued for some reason, showed a significantly lower OS rate compared to complete cases (1-year OS: 11.0% vs. 59.9%, p < 0.01). The most common reason for discontinuation was aspiration pneumonia (64.5%). Presence of sarcopenia was an independent prognostic factor for unresectable advanced esophageal cancer. Identifying the presence of sarcopenia prior to treatment may improve the prognosis.

P213 PROGNOSTIC SIGNIFICANCE OF CHANGES IN LYMPH NODE MORPHOLOGY ON SURVIVAL IN ESOPHAGEAL CANCER AFTER NEOADJUVANT THERAPY: A SYSTEMATIC REVIEW AND META-ANALYSES

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Hagens Eliza ◽  
Tukanova Karina ◽  
Jamel Sara ◽  
van Berge Henegouwen Mark ◽  
B Hanna George ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Neoadjuvant Therapy ◽  
Tumor Regression ◽  
Average Rate ◽  
Prognostic Significance ◽  
Number Of Patients ◽  
Meta Analyses ◽  
The Impact

Abstract Aim To assess the prognostic significance of lymph node regression or downstaging following neoadjuvant therapy for esophageal cancer. Background and methods The prognostic value of histomorphologic regression in the primary esophageal cancer has been established, whilst the impact of lymph node response on survival still remains unclear. An electronic search was performed to identify articles evaluating lymph node regression or downstaging after neoadjuvant chemo- or chemoradiotherapy. Random effects meta-analyses were performed for regression and downstaging and primary outcome was the hazard ratio (HR) for overall mortality. Survival data were compared between patients with complete regression and those with partial or no response. Histopathological tumor regression in lymph nodes was defined by the absence of viable cells or degree of fibrosis. Furthermore, survival of patients with downstaged lymph nodes to N0 were compared to those with positive nodes following treatment. Results Eight articles were included, 4 of which assessed tumor regression (number of patients=789) and 4 assessing downstaging (number of patients=1937). Complete tumor regression (average rate of 30.0%) in the lymph nodes was associated with higher survival [HR= 0.63, 95% CI (confidence interval) = 0.43 – 0.92; p=0.017] (figure 1). Lymph nodes downstaging (average rate of 47.6%) had improved survival compared to node positivity (HR = 0.38, 95% CI = 0.29 – 0.50; p<0.0001) (figure 2). Conclusion A prognostic benefit was seen in patients with good lymph node response to neoadjuvant therapy, suggesting this should be used as an important additional prognostic marker in staging and in comparative evaluation of different neoadjuvant regimes.

scholarly journals Residual Volume of Lymph Nodes During Chemoradiotherapy Based Nomogram to Predict Survival of Nasopharyngeal Carcinoma Patient Receiving Induction Chemotherapy

2021 ◽  
Vol 11 ◽  
Author(s):  
Yan Li ◽  
Jian Zang ◽  
Jingyi Liu ◽  
Shanquan Luo ◽  
Jianhua Wang ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Nasopharyngeal Carcinoma ◽  
Lymph Nodes ◽  
Induction Chemotherapy ◽  
Cox Regression ◽  
Staging System ◽  
Tnm Staging ◽  
Residual Volume ◽  
Discriminative Ability ◽  
Cox Regression Analysis

PurposeTo accurately stratify nasopharyngeal carcinoma (NPC) patients who were benefit from induction chemotherapy (IC) followed by chemoradiotherapy (CCRT), we established residual volume of lymph nodes during chemoradiotherapy based nomogram to predict survival for NPC patients.MethodsCox regression analysis were used to evaluate predictive effects of tumor volume parameters. Multivariate Cox regression analysis was used to identify the prognostic factors, and nomogram models were developed to predict survival of NPC patients receiving IC followed by CCRT.ResultsCompared with other tumor volumetric parameters, midRT GTVnd was the best predictive factor for OS (HR: 1.043, 95%CI: 1.031-1.055), PFS (HR: 1.040, 95%CI: 1.030- 1.051), and DMFS (HR: 1.046, 95%CI: 1.034 – 1.059) according to the HR of Cox regression analysis. Based on multivariate analysis, three nomograms included midRT GTVnd were constructed to predict 4-year survival. The C-index of nomograms for each survival endpoints were as follow (training cohort vs. validation cohort): 0.746 vs. 0.731 for OS; 0.747 vs. 0.735 for PFS; 0.768 vs. 0.729 for DMFS, respectively. AUC showed a good discriminative ability. Calibration curves demonstrated a consistence between actual results and predictions. Decision curve analysis (DCA) showed that the nomograms had better clinical predictive effects than current TNM staging system.ConclusionWe identified the best volumetric indicator associated with prognosis was the residual volume of lymph nodes at the fourth week of chemoradiotherapy for patients receiving IC followed by CCRT. We developed and validated three nomograms to predict specific probability of 4-year OS, PFS and DMFS for NPC patient receiving IC followed by CCRT.

scholarly journals Lymphadenectomy after neoadjuvant chemoradiation for esophageal adenocarcinoma: what is the optimal lymph nodes dissection?

2021 ◽  
Author(s):  
Yahua Wu ◽  
Mingqiang Lin ◽  
Mengyan Zhang ◽  
Tianxiu Liu ◽  
Zhiping Wang ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Esophageal Adenocarcinoma ◽  
Cox Regression ◽  
Neoadjuvant Chemoradiotherapy ◽  
Cox Regression Analysis ◽  
Risk Of Death ◽  
Group 3 ◽  
Lymph Nodes Dissection ◽  
Group 1

Abstract Background The optimal lymph nodes dissection (LND) for esophageal adenocarcinoma (EAC) patients who underwent neoadjuvant chemoradiotherapy (NCRT) is controversial. Methods Patients were selected from Surveillance Epidemiology and End Results database. Multivariable Cox analysis was used to identify predictors of overall survival (OS). Restricted Cubic Splines (RCS) was used to examine the relationship between the number of LND and OS. Result 2,019 patients with non-metastatic EAC underwent NCRT were stratified into three groups according to LND using X-tile software: group 1: 1–8, group 2: 9–14, group 3: ≥15. In Multivariable Cox Regression analysis, the death risk was reduced by 22% (P = 0.001), 43% (P < 0.001) respectively, for patients in groups 2, 3 compared with those in group 1. The results were similar for patients with pathological lymph node-negative (ypN0) EAC patients. But for pathological lymph node-positive (ypN+) patients, a significantly reduced hazard was present only in group 3 (P < 0.001). RCS exhibited a nonlinear relationship between the number of lymph nodes removed and OS for ypN0 EAC (P = 0.002). The risk of death sharply dropped until around 24 nodes removed and then started to steadily increase afterward. However, for ypN + EAC, it showed a linear relationship between LND and OS (P = 0.205), with a better OS when an increase in the number of lymph nodes removed. Conclusions For ypN0 patients, the optimal LND was approximately 24 lymph nodes, with the number of lymph nodes removed beyond 24 nodes did not provide additional benefit. However, for ypN + patients, a more extensive lymphadenectomy could favor survival.

scholarly journals Clinical impact of abdominal versus mediastinal metastases as a prognostic factor for poor outcomes following esophageal cancer surgery: a retrospective study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yutaka Miyawaki ◽  
Hiroshi Sato ◽  
Shuichiro Oya ◽  
Hirofumi Sugita ◽  
Yasumitsu Hirano ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Regression Analysis ◽  
Lymph Node ◽  
Prognostic Factor ◽  
Cox Regression ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Systemic Recurrence ◽  
Significant Difference

Abstract Background Surgery is still the mainstay of radical treatment for resectable esophageal cancer (EC). It is apparent that the presence or spread of lymph node metastasis (LNM) is a powerful prognostic factor in patients with EC who are eligible for curative treatment. Although the importance and efficacy of lymph node dissection in radical esophagectomy have been reported, the clinical or prognostic relevance of specific metastatic patterns within the mediastinal cavity and abdomen remains unclear. Methods We retrospectively analyzed the association of postoperative survival with clinical mediastinal LNM (cMLNM) and abdominal LNM (cALNM) in 157 patients who underwent radical EC surgery at our hospital between May 2012 and March 2018. Results A significant difference in cause-specific survival (CSS) was observed between patients with and without cALNM (log-rank p = 0.000). A multivariate Cox regression analysis revealed that cALNM and thoracic surgery (mediastinal lymphadenectomy via conventional open right thoracotomy or video-assisted thoracoscopic surgery) independently predicted CSS (p = 0.0007 and 0.021, respectively). Moreover, a significant difference in systemic recurrence-free survival was observed between those with and without cALNM (log-rank p = 0.000). Multivariate Cox regression analysis revealed that cALNM and sex independently predicted systemic recurrence-free survival (p = 0.000 and 0.015, respectively). Conclusion cALNM was an independent poor prognostic factor for CSS after EC surgery. It may also be an independent prognostic factor for postoperative systemic recurrence, which can shorten the CSS. For patients with cALNM-positive EC who have a high potential risk of systemic metastases, more extensive treatment besides the conventional perioperative systemic chemotherapy may be necessary.

scholarly journals CD169 Expression on Lymph Node Macrophages Predicts in Patients With Gastric Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Keiichiro Kumamoto ◽  
Takashi Tasaki ◽  
Koji Ohnishi ◽  
Michihiko Shibata ◽  
Shohei Shimajiri ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Immune Responses ◽  
Lymph Nodes ◽  
Advanced Gastric Cancer ◽  
Cox Regression ◽  
Regional Lymph Nodes ◽  
Cox Regression Analysis ◽  
Anti Cancer ◽  
Cancer Tissues

The induction of an anti-cancer immune responses is potentially associated with the efficacy of anti-cancer therapy. Recent studies have indicated that sinus macrophages in regional lymph nodes are involved in anti-cancer immune responses in the cancer microenvironment. In the present study, we investigated the correlation between lymphocyte infiltration in cancer tissues and macrophage activation in regional lymph nodes. We retrospectively identified 294 patients with gastric cancer who underwent surgery from 2008 to 2012. Using immunohistochemistry, we evaluated CD169-expression on CD68-positive macrophages, and the density of CD8-postive lymphocytes in tumor microenvironment. We statistically examined the correlation between CD169 and CD8 expression, and performed Cox regression analysis of potential prognostic factors, including CD169 and CD8 expression, for cancer-specific survival (CSS) in patients with total and advanced gastric cancer. CD169 overexpression in lymph node sinus macrophages (LySMs) was positively correlated to the density of CD8-positive lymphocytes in primary cancer tissues (R = 0.367, p &lt; 0.001). A high density of CD8-positive T lymphocytes in the primary site and a high level of CD169 expression in LySMs were independently associated with greater CSS in patients with total and advanced gastric cancer (p &lt; 0.05 for all). The expression on CD169 in LySMs is a predictor of a favorable clinical course in patients with gastric cancer, and might be useful for evaluating anti-cancer immune responses.

scholarly journals P-OGC25 Prognostic significance of extracapsular lymph node involvement after gastrectomy for gastric adenocarcinoma

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Pooja Prasad ◽  
Jakub Chmelo ◽  
Shajahan Wahed ◽  
Maziar Navidi ◽  
Alexander Phillips
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Gastric Adenocarcinoma ◽  
Independent Predictor ◽  
Prognostic Significance ◽  
Lymph Node Involvement ◽  
Cox Regression Analysis ◽  
Factors Associated ◽  
Node Involvement ◽  
The Impact

Abstract Background Lymph node involvement is a key prognostic indicator in gastric adenocarcinoma. Little is known of the impact of extracapsular lymph node involvement (LNI) upon the prognosis of patients undergoing curative resection of gastric cancer. The aim of this study was to assess the incidence and prognostic significance of extracapsular LNI in patients undergoing a gastrectomy for gastric adenocarcinoma.  Methods Consecutive patients who underwent a subtotal or total gastrectomy with curative intent for adenocarcinoma of the stomach or gastro-oesophageal junction in a single, high-volume U.K. centre between 2010 and 2018 were identified from contemporaneously maintained database. Patients with a pN0 status on final histology and those who died in-hospital were excluded from analysis. Factors associated with survival were studied with univariable and multivariable cox regression analysis. A p value of &lt; 0.05 was deemed significant.  Results The study included 235 patients. A median (IQR) of 32 (24-43) lymph nodes were resected and median (IQR) 4 (1-9) lymph nodes were positive. Of them, extracapsular LNI was identified in 123 (52%) of patients. Factors associated with survival on univariable analysis were R1 resection (p = 0.001), p/ypT stage (p &lt; 0.001), p/ypN stage (p &lt; 0.001) and extracapsular LNI (p = 0.001). Median survival among patients who had extracapsular LNI was 19 months versus 49 months among patients who did not (p &lt; 0.001).  Extracapsular LNI was not an independent predictor of survival on multivariable analysis (p = 0.535).  Conclusions Extracapsular LNI is associated with poor prognosis among patients undergoing a curative gastrectomy. However, it is not an independent predictor of survival among this patient population. 

Nonsentinel Lymph Node Status in Patients With Cutaneous Melanoma: Results From a Multi-Institution Prognostic Study

2014 ◽  
Vol 32 (9) ◽  
pp. 935-941 ◽  
Author(s):  
Sandro Pasquali ◽  
Simone Mocellin ◽  
Nicola Mozzillo ◽  
Andrea Maurichi ◽  
Pietro Quaglino ◽  
...  
Keyword(s):  
Lymph Node ◽  
Prognostic Factor ◽  
Lymph Nodes ◽  
Prognostic Value ◽  
Cox Regression ◽  
Staging System ◽  
Lymph Node Status ◽  
Significant Prognostic Factor ◽  
Nonsentinel Lymph Node ◽  
Positive Lymph Nodes

Purpose We investigated whether the nonsentinel lymph node (NSLN) status in patients with melanoma improves the prognostic accuracy of common staging features; then we formulated a proposal for including the NSLN status in the current melanoma staging system. Patients and Methods We retrospectively collected the clinicopathologic data of 1,538 patients with positive SLN status who underwent completion lymph node dissection (CLND) at nine Italian centers. Multivariable Cox regression survival analysis was used to identify independent prognostic factors. Literature meta-analysis was used to summarize the available evidence on the prognostic value of the NSLN status in patients with positive SLN. Results NSLN metastasis was observed in 353 patients (23%). After a median follow-up of 45 months, NSLN status was an independent prognostic factor for melanoma-specific survival (hazard ratio [HR] = 1.34; 95% CI, 1.18 to 1.52; P < .001). NSLN status efficiently stratified the prognosis of patients with two to three positive lymph nodes (n = 387; HR = 1.39; 95% CI, 1.07 to 1.81; P = .013), independently of other staging features. Searching the literature, this patient subgroup was investigated in other two studies. Pooling the results (n = 620 patients; 284 NSLN negative and 336 NSLN positive), we found that NSLN status is a highly significant prognostic factor (summary HR = 1.59; 95% CI, 1.27 to 1.98; P < .001) in patients with two to three positive lymph nodes. Conclusion These findings support the independent prognostic value of the NSLN status in patients with two to three positive lymph nodes, suggesting that this information should be considered for the routine staging in patients with melanoma.

Prognostic significance of lymph node dissection on stage-specific survival for patients with primary small intestine tumor treated with enterectomy: A population-based study, 2004-2015

2020 ◽  
Author(s):  
Yifei Chen ◽  
Fei He ◽  
Dan Guo ◽  
Yarui Li ◽  
Ruhua Wang ◽  
...  
Keyword(s):  
Small Intestine ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cox Regression ◽  
Cox Model ◽  
Prognostic Significance ◽  
Survival Curves ◽  
Small Bowel Tumors ◽  
Kaplan Meier ◽  
Better Than

Abstract Background: The positive rate of lymph node detection(LND) can be used as a predictor of prognosis for patients undergoing radical resection of small bowel tumors; thorough local LND may be crucial for the accurate staging and management of the disease.The purpose of our study was to determine the effect of the LND in specific stages. Methods: This study included 5413 patients with primary small intestine tumors after enterectomy within SEER database from 2004-2015. A multivariable COX model and Kaplan-Meier plots survival curves were used to analyze survival.Results: Of the 5413 patients, 4675(86.4%) underwent lymphadenectomy, and 3896(72.0%) were moved 4 or more than 4 lymph nodes. LND was performed in 67.8%, 83.3%, 87.9%, 89.3% in pT1/2/3/4 disease. In multivariable Cox regression analyses, LND was associated with OS and CSS, and the extended LND are better than limited LND (all P<0.05 except pT2). Kaplan-Meier plots survival curves showed that LND can benefit patients.Conclusions: The removal of LND with 4 or more lymph nodes in pT1/3/4 patients has relatively obvious benefits for survival. The effect of LND with more lymph nodes is significantly better than limited LND. For pT1, pT3 and pT4, LND can be considered.

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