Postoperative chemoradiotherapy in patients with rectal cancer, prognostic factors for disease control and survival

13575 Background: The aim of this paper is an assessment of results of adjuvant chemoradiotherapy in patients with rectal cancer with respect to prognostic factors, causes of treatment failures and treatment tolerance. Methods: 178 pts with Dukes’ stage B or C rectal cancer received postoperative chemoradiotherapy between 1993 and 2002. Median age was 62; 110 patients were males, 68 were females. Median follow-up time was 45 months. Main endpoints of the analysis were locoregional recurrence-free survival (LRRFS), distant relapse free survival (DRFS), disease free survival (DFS) and overall survival (OS). Kaplan-Meier method was used to calculate survival rates. Univariate and multivariate analyses of prognostic factors were performed using log rank and Cox’s proportional hazard method. Results: The 5-year LRRFS was 73%, DRFS was 80%, DFS was 61% and OS was 65%. Lymph node involvement and method of resection (AR favoured) were the only independent prognostic factors for LRRFS. Lymph node involvement, in particular when four or more are involved, was independent prognostic factors for DFS. For DRFS are histological grade, lymph node involvement and extracapsular extension of the lymph node metastases. For OS, the independent prognostic factors were infiltration of the pararectal fatty tissue, lymph node involvement in particular when four or more are involved, total number of chemotherapy cycles (at least six favoured). The 5-year LRRFS was 73%, DRFS was 80%, DFS was 61% and OS was 65%. Radiation therapy was well tolerated in 45% of patients. Most common early reactions were diarrhoea, nausea/vomiting and leucopoenia. Conclusions: Involvement of lymph nodes and method of resection were the only independent prognostic factors for LRRFS. Prognostic factors for OS were infiltration of the pararectal fatty tissue, lymph node metastases, four or more involved lymph nodes, total number of chemotherapy cycles. No significant financial relationships to disclose.

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Prognostic Implications of the Distribution of Lymph Node Metastases in Rectal Cancer After Neoadjuvant Chemoradiotherapy

Journal of Clinical Oncology ◽

10.1200/jco.2007.12.7704 ◽

2008 ◽

Vol 26 (13) ◽

pp. 2106-2111 ◽

Cited By ~ 65

Author(s):

Tobias Leibold ◽

Jinru Shia ◽

Leyo Ruo ◽

Bruce D. Minsky ◽

Timothy Akhurst ◽

...

Keyword(s):

Rectal Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Metastatic Disease ◽

Lymph Node Metastases ◽

Median Number ◽

Preoperative Chemoradiotherapy ◽

Lymph Node Involvement ◽

Node Involvement ◽

Node Metastases

Purpose After preoperative chemoradiotherapy of rectal cancer, the number of retrievable and metastatic lymph nodes is decreased. The current TNM classification is based on number and not location of lymph node metastases and may understage disease after chemoradiotherapy. The aim of this study was to examine the prognostic significance of location of involved lymph nodes in rectal cancer patients after preoperative chemoradiotherapy. Patients and Methods We prospectively examined whole-mount specimens from 121 patients with uT3-4 and/or N+ rectal cancer who received preoperative chemoradiotherapy followed by resection. Location of involved lymph nodes was compared with median number of lymph nodes involved as well as presence of distant metastasis at presentation. Results Lymph node metastases were detected in 37 patients (31%). Thirteen patients with lymph node involvement along major supplying vessels (proximal lymph node metastases) had a significantly higher rate of distant metastatic disease at time of surgery than patients without proximal lymph node involvement (P < .001); median number of lymph nodes involved was two for patients with proximal lymph node metastases and 1.5 for patients with mesorectal lymph node involvement alone. Conclusion Our data suggest that, after preoperative chemoradiotherapy, proximal lymph node involvement is associated with a high incidence of metastatic disease at time of surgery. Because the median number of involved lymph nodes is low after preoperative chemoradiotherapy, the TNM staging system may not provide an accurate assessment of metastatic disease. Therefore, the ypTNM staging system should incorporate distribution as well as number of lymph node metastases after preoperative chemoradiotherapy for rectal cancer.

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Lymph Nodes Involvement and Lymphadenectomy in Thymic Tumors: Tentative Answers for Unsolved Questions

Cancers ◽

10.3390/cancers13205085 ◽

2021 ◽

Vol 13 (20) ◽

pp. 5085

Author(s):

Debora Brascia ◽

Angela De De Palma ◽

Marcella Schiavone ◽

Giulia De De Iaco ◽

Francesca Signore ◽

...

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Lymph Node Dissection ◽

Lymph Node Metastases ◽

Lymph Node Involvement ◽

Postoperative Management ◽

Anterior Mediastinum ◽

Node Dissection ◽

Node Metastases ◽

Thymic Tumors

Thymic tumors are the most common primary neoplasms of the anterior mediastinum, although, when compared with the entire thoracic malignancies, they are still rare. Few studies addressed the questions about lymph node involvement pattern in thymic neoplasms, about which subgroup of patients would be appropriate candidates for lymph node dissection or about the extent of lymphadenectomy or which lymph nodes should be harvested. The aim of this review is to collect evidence from the literature to help physicians in designing the best surgical procedure when dealing with thymic malignancies. A literature review was performed through PubMed and Scopus in May 2021 to identify any study published in the last 20 years evaluating the frequency and the extent of lymph node dissection for thymic tumors, its impact on prognosis and on postoperative management. Fifteen studies met the inclusion criteria and were included in this review, with a total of 9452 patients with thymic cancers; lymph node metastases were found in 976 (10.3%) patients in total. The current literature is heterogeneous in the classification and reporting of lymph node metastases in thymic carcinoma, and data are hardly comparable. Surgical treatment should be guided by the few literature-based pieces of evidence and by the experience of the physicians.

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Pattern and clinical predictors of lymph node metastases in epithelial ovarian cancer

International Journal of Gynecological Cancer ◽

10.1111/j.1525-1438.2007.00931.x ◽

2007 ◽

Vol 17 (6) ◽

pp. 1238-1244 ◽

Cited By ~ 76

Author(s):

P. Harter ◽

K. Gnauert ◽

R. Hils ◽

T. G. Lehmann ◽

A. Fisseler-Eckhoff ◽

...

Keyword(s):

Ovarian Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Epithelial Ovarian Cancer ◽

Lymph Node Metastases ◽

Frozen Section ◽

Vena Cava ◽

Lymph Node Involvement ◽

Clinical Predictors ◽

Node Metastases

Para-aortic lymphadenectomy is part of staging in early epithelial ovarian cancer (EOC) and could be part of therapy in advanced EOC. However, only a minority of patients receive therapy according to guidelines or have attendance to a specialized unit. We analyzed pattern of lymphatic spread of EOC and evaluated if clinical factors and intraoperative findings reliably could predict lymph node involvement, in order to evaluate if patients could be identified in whom lymphadenectomy could be omitted and who should not be referred to a center with capacity of performing extensive gynecological operations. Retrospective analysis was carried out of all patients with EOC who had systematic pelvic and para-aortic lymphadenectomy during primary cytoreductive surgery. One hundred ninety-five patients underwent systematic pelvic and para-aortic lymphadenectomy. Histologic lymph node metastases were found in 53%. The highest frequency was found in the upper left para-aortic region (32% of all patients) and between vena cava inferior and abdominal aorta (36%). Neither intraoperative clinical diagnosis nor frozen section of pelvic nodes could reliably predict para-aortic lymph node metastasis. The pathologic diagnosis of the pelvic nodes, if used as diagnostic tool for para-aortic lymph nodes, showed a sensitivity of only 50% in ovarian cancer confined to the pelvis and 73% in more advanced disease. We could not detect any intraoperative tool that could reliably predict pathologic status of para-aortic lymph nodes. Systematic pelvic and para-aortic lymphadenectomy remains part of staging in EOC. Patients with EOC should be offered the opportunity to receive state-of-the-art treatment including surgery

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The value of tumor marker and cytokine analysis for the assessment of regional lymph node status in cervical cancer patients

International Journal of Gynecological Cancer ◽

10.1111/j.1525-1438.2007.01176.x ◽

2008 ◽

Vol 18 (6) ◽

pp. 1279-1284 ◽

Cited By ~ 11

Author(s):

B. Kotowicz ◽

M. Fuksiewicz ◽

M. Kowalska ◽

J. Jonska-Gmyrek ◽

M. Bidzinski ◽

...

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Lymph Node Metastases ◽

Regional Lymph Node ◽

Serum Levels ◽

Lymph Node Involvement ◽

Lymph Node Status ◽

Node Status ◽

Node Involvement ◽

Node Metastases

The aim of the study was to evaluate the utility of the measurements of the circulating tumor markers, squamous cell carcinoma antigen (SCCA), CA125, carcinoembryonic antigen (CEA), cytokeratin fragment 19 (CYFRA 21.1), and the cytokines, interleukin-6 and vascular endothelial growth factor (VEGF), to estimate regional lymph node involvement in patients with cervical cancer. The study comprised 182 untreated patients with cervical cancer. The regional lymph node status was assessed either by the postsurgical histopathologic examination or by the computed tomography (CT). Concentrations of SCCA, CEA, and CA125 were determined using the Abbott Instruments system, of CYFRA 21.1 by the Roche kits, and of IL-6 and VEGF by the ELISA of R&D Systems (Minneapolis, MN). For the statistical analyses, Mann–Whitney U test and χ2 test were applied. Serum levels of SCCA, CEA, CA125, CYFRA 21.1, IL-6, and VEGF were measured in patients with specified pelvic and para-aortic lymph node status. SCCA, CA125, and IL-6 levels were found to be significantly higher in patients with lymph node metastases than in those with no lymph node involvement. Also, the percentage of patients with simultaneously elevated concentrations of SCCA and CA125 or SCCA and IL-6 differed depending on the lymph node status and was significantly higher in the series of patients with lymph node metastases. Simultaneous assessment of serum levels of SCCA and CA125 or SCCA and IL-6 in patients with cervical cancer may be useful for the regional lymph node evaluation, especially in patients with advanced stages, when the lymph nodes are examined only by CT, with no histologic confirmation.

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Retroperitoneal Lymph Nodes in Transitional Cell Carcinoma of the Kidney and Ureter

Advances in Urology ◽

10.1155/2009/181927 ◽

2009 ◽

Vol 2009 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Shilajit D. Kundu ◽

Scott E. Eggener

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Transitional Cell Carcinoma ◽

Cell Carcinoma ◽

Transitional Cell ◽

Lymph Node Involvement ◽

Therapeutic Benefit ◽

Cancer Specific Survival ◽

Node Involvement ◽

Node Metastases

The incidence of transitional cell carcinoma of the kidney and ureter is low and for that reason limited data exists regarding the appropriate management of regional retroperitoneal lymph nodes. Lymph node metastases have consistently been associated with an adverse prognosis. However, five-year cancer-specific survival following nephroureterectomy and lymphadenectomy for patients with lymph node involvement ranges from 0–39%, suggesting a therapeutic benefit. This review covers the primary tumor characteristics associated with lymph node involvement, imaging of the lymph nodes, as well as the rationale, role, patient selection, suggested anatomic templates, and technical considerations for lymphadenectomy.

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Macroscopic lymph-node involvement and neck dissection predict lymph-node recurrence in papillary thyroid carcinoma.

Acta Endocrinologica ◽

10.1530/eje-07-0603 ◽

2008 ◽

Vol 158 (4) ◽

pp. 551-560 ◽

Cited By ~ 128

Author(s):

Stéphane Bardet ◽

Elodie Malville ◽

Jean-Pierre Rame ◽

Emmanuel Babin ◽

Guy Samama ◽

...

Keyword(s):

Risk Factors ◽

Lymph Node ◽

Lymph Node Metastases ◽

Lymph Node Involvement ◽

Cumulative Probability ◽

Papillary Thyroid ◽

Node Involvement ◽

Node Metastases ◽

Group 3 ◽

Group 2

ObjectiveWhether lymph-node dissection (LND) influences the lymph-node recurrence (LNR) risk in patients with papillary thyroid cancer remains controversial. The prognostic impact of macroscopic and microscopic lymph-node involvement at diagnosis is also an unresolved issue. A retrospective study was conducted to assess the influence of various LND procedures and to search for LNR risk factors.MethodsOverall 545 patients without distant metastases prior to surgery and main tumour ≥10 mm were included. A total thyroidectomy was performed in all patients with either no LND (Group 1,n=161), bilateral LND of the central and lateral compartments (Group 2,n=181) or all other dissection modalities (Group 3,n=203). Post-operative radioiodine was given to 496 (91%) patients. The 10-year cumulative probability of LNR was assessed and a prognostic study using multivariate analysis was performed.ResultsMacroscopic lymph-node metastases were present in 118 patients, 57 diagnosed before surgery and 61 only at surgery (including 81% in the central compartment). Overall, the 10-year cumulative probability of LNR was 7%. Macroscopic lymph-node metastases (P=0.001), extra-thyroidal invasion (P=0.017) and male gender (P=0.05) were independent risk factors, while bilateral LND of the central and lateral compartments was protective (P=0.028). In patients with macroscopic lymph-node metastases, the 10-year probability was lower in Group 2 than in Group 3 (10% vs 30%,P<0.01). In patients without macroscopic lymph-node metastases (n=427), no significant differences were observed between the three LND groups.ConclusionsPatients with macroscopic, but not microscopic, lymph-node involvement have a major LNR risk and need an optimal LND at primary surgery.

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Specificity of radiographic lymphadenopathy for lymph node metastasis in renal cell carcnioma.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.7_suppl.442 ◽

2015 ◽

Vol 33 (7_suppl) ◽

pp. 442-442

Author(s):

Matthew Mossanen ◽

Manjiri Dighe ◽

Bryan Wilson ◽

Daniel W. Lin ◽

Jonathan L. Wright ◽

...

Keyword(s):

Lymph Node ◽

Metastatic Disease ◽

Lymph Node Metastases ◽

Predictive Value ◽

Renal Cell ◽

Multivariate Logistic Regression Analysis ◽

Lymph Node Involvement ◽

Preoperative Imaging ◽

Node Involvement ◽

Node Metastases

442 Background: Approximately 30% of patients with renal cell carcinoma (RCC) will have metastatic disease at the time of diagnosis. Patients without preoperative lymphadenopathy (LAD) radiographically rarely have positive nodes at the time of nephrectomy. We sought to evaluate the specificity of radiographic LAD for lymph node metastases in patients with and without clinical metastatic RCC. Methods: We retrospectively reviewed all nephrectomies performed at our institution from 2003-2013. We identified patients with clinical stage classification T2-T3 (cT2-T3) RCC and stratified patients by clinical N and M classification. Lymphadenectomy was performed at surgeon discretion. Performance statistics for preoperative imaging for pathologic lymph node metastases and multivariable logistic regressions models to identify patient characteristics associated with lymph node metastases were generated. Results: A total of 223 patients were identified. Of these, 85 (38%) had clinical evidence of metastatic disease while 138 (62%) did not. In patients with clinical metastatic disease, LND was performed in 68%; of those without clinical metastatic disease, LND was performed in 48%. Radiographic LAD for those with clinical metastatic disease (26/85 patients, 31%) had sensitivity of 94%, specificity of 49%, positive predictive value (PPV) of 43%, and negative predictive value (NPV) of 95% for pathologically confirmed lymph node involvement. Radiographic LAD for patients without clinical metastatic disease (37/138 patients, 27%) had sensitivity of 90%, specificity of 52%, PPV of 25%, and NPV of 96% for pathologically confirmed lymph node involvement. On multivariate logistic regression analysis (adjusted for age, gender, smoking status, obesity, non-clear cell histology, and grade) having clinical metastatic disease was significantly associated with pathologic node positivity (RR = 3.37, 95% CI 1.19 – 20.6). Conclusions: Radiographic lymphadenopathy is a nonspecific finding in patients with RCC and LND is not routinely performed at our institution. However, in the setting of clinical metastatic disease, radiographic LAD is more likely to represent pathological lymph node metastases.

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Breast Cancer: Primary Tumor Characteristics Related to Lymph Node Involvement

Tumori Journal ◽

10.1177/030089168106700104 ◽

1981 ◽

Vol 67 (1) ◽

pp. 19-26 ◽

Cited By ~ 4

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.

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Clinicostatistical Analysis of Rhinopharyngeal Neoplasms Treated by Radiotherapy from 1928 to 1963 (314 Cases)

Tumori Journal ◽

10.1177/030089166605200506 ◽

1966 ◽

Vol 52 (5) ◽

pp. 375-391 ◽

Cited By ~ 1

Author(s):

Alberto Banfi ◽

Giuseppe Carnevali ◽

Gianfranco Coopmans De Yoldi ◽

Ugo Felci ◽

Adalgiso Guzzon

Keyword(s):

Lymph Node ◽

Survival Rate ◽

Lymph Node Metastases ◽

Regional Lymph Node ◽

Lymph Node Involvement ◽

Favourable Outcome ◽

Node Involvement ◽

Node Metastases ◽

Epithelial Neoplasms ◽

Base Of The Skull

Results obtained by radiotherapy in 314 cases of rhinopharyngeal neoplasms treated from 1928 to 1963 at the Institute of Radiology of the Medical School and at the National Cancer Institute are presented. The series of cases includes 61 epithelial neoplasms, 117 rhinopharyngiomas, 112 connective neoplasms and 24 cases non histologically proved. In 41.7 % of the cases regional lymph node invasion was the first sign of the disease. Regional lymph node involvement was present at the beginning of radiotherapy in 72.5 % of the cases. Sixty-eight cases, hospitalized from 1928 to 1945, were prevailingly treated with endocavitary radiumtherapy and by roentgentherapy. One hundred and sixty cases, hospitalized from 1946 to 1958, were treated by various procedures and, in the last years, almost exclusively by multiple small fields roentgentherapy and by convergent roentgentherapy. Most of the 80 cases treated from 1959 to 1963 were submitted to telecobalt therapy. In the connective neoplasms (lympho- and reticulosarcomas) the overall 3-year and 5-year survival rate has been 34.2 % and 28.5 % respectively. In particular, cases without regional lymph node invasion at the beginning of the treatment had a 5-year survival rate of 61.5 %, opposite to 15.4 % in patients with lymph node metastases. In the other histological forms (rhinopharyngiomas, epitheliomas and non ascertained cases) the overall 3-year survival was 28 %, and the 5-year survival 19.6 %. In patients showing no lymph node involvement at the beginning of the treatment the 5-year survival rate was 37.8 %, in those with unilateral invasion 15.8 %, and in those with bilateral lymph node metastases 5.8 %. In epithelial neoplasms, the 5-year survival was 12.5 % in patients who had, at the beginning of the treatment, neurological or radiological signs of metastases to the base of the skull, and 21.9 % in patients, without involvement of the base of the skull. A statistical analysis of the results obtained in the various periods showed a more favourable outcome in patients treated by telecobalt therapy, as demonstrated both by average life and 3-year and 5-year survival rates.

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