scholarly journals Intrahepatic Cholangiocarcinoma: An International Multi-Institutional Analysis of Prognostic Factors and Lymph Node Assessment

2011 ◽  
Vol 29 (23) ◽  
pp. 3140-3145 ◽  
Author(s):  
Mechteld C. de Jong ◽  
Hari Nathan ◽  
Georgios C. Sotiropoulos ◽  
Andreas Paul ◽  
Sorin Alexandrescu ◽  
...  
Keyword(s):  
Lymph Node ◽  
Median Survival ◽  
Intrahepatic Cholangiocarcinoma ◽  
Tumor Size ◽  
Vascular Invasion ◽  
Relative Effect ◽  
Prognostic Information ◽  
Factors Associated ◽  
Tumor Number ◽  
The Impact

Purpose To identify factors associated with outcome after surgical management of intrahepatic cholangiocarcinoma (ICC) and examine the impact of lymph node (LN) assessment on survival. Patients and Methods From an international multi-institutional database, 449 patients who underwent surgery for ICC between 1973 and 2010 were identified. Clinical and pathologic data were evaluated using uni- and multivariate analyses. Results Median tumor size was 6.5 cm. Most patients had a solitary tumor (73%) and no vascular invasion (69%). Median survival was 27 months, and 5-year survival was 31%. Factors associated with adverse prognosis included positive margin status (hazard ratio [HR], 2.20; P < .001), multiple lesions (HR, 1.80; P = .001), and vascular invasion (HR, 1.59; P = .015). Tumor size was not a prognostic factor (HR, 1.03; P = .23). Patients were stratified using the American Joint Committee on Cancer/International Union Against Cancer T1, T2a, and T2b categories (seventh edition) in a discrete step-wise fashion (P < .001). Lymphadenectomy was performed in 248 patients (55%); 74 of these (30%) had LN metastasis. LN metastasis was associated with worse outcome (median survival: N0, 30 months v N1, 24 months; P = .03). Although patients with no LN metastasis were able to be stratified by tumor number and vascular invasion (N0; P < .001), among patients with N1 disease, multiple tumors and vascular invasion, either alone or together, failed to discriminate patients into discrete prognostic groups (P = .34). Conclusion Although tumor size provides no prognostic information, tumor number, vascular invasion, and LN metastasis were associated with survival. N1 status adversely affected overall survival and also influenced the relative effect of tumor number and vascular invasion on prognosis. Lymphadenectomy should be strongly considered for ICC, because up to 30% of patients will have LN metastasis.

scholarly journals Intrahepatic cholangiocarcinoma: An international, multi-institutional analysis of prognostic factors and lymph node assessment.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 162-162 ◽  
Author(s):  
T. M. Pawlik ◽  
C. Pulitano ◽  
S. Alexandrescu ◽  
T. C. Gamblin ◽  
C. Ferrone ◽  
...  
Keyword(s):  
Lymph Node ◽  
Median Survival ◽  
Intrahepatic Cholangiocarcinoma ◽  
Tumor Size ◽  
Vascular Invasion ◽  
Primary Liver Cancer ◽  
Margin Status ◽  
Prognostic Information ◽  
Factors Associated ◽  
The Impact

162 Background: Intrahepatic cholangiocarcinoma (ICC) is a rare and poorly understood primary liver cancer. The role of routine lymphadenectomy at the time of surgical resection remains poorly defined. We sought to identify factors associated with outcome following surgical management of ICC and examine the impact of lymph node (LN) assessment on survival. Methods: 411 patients who underwent curative intent surgery for ICC between 1973-2010 were identified from an international multi-institutional database. Clinical and pathologic data were evaluated using uni- and multivariate analyses. Results: Median tumor size was 6.5 cm. Most patients had a solitary tumor (55%) and no evidence of vascular invasion (64%). Resection involved ≥hemi-hepatectomy (74%) and margin status was R0 (82%). Overall median survival was 28 months and 5-year survival was 32%. Factors associated with adverse prognosis included positive margin status (HR=3.11; p<0.001), multiple lesions (HR=2.16; p=0.007) and vascular invasion (HR=2.13; p=0.01). Tumor size was not a prognostic factor (HR=1.05; p=0.08). Lymphadenectomy was performed in 233 (57%) patients; 87 (37%) had LN metastasis. LN metastasis was associated with worse outcome (median survival: N0 39 months vs. N1 21 months; p=0.02). Preoperative factors such as tumor size, number, and morphologic subtype did not predict presence of LN metastasis (all p>0.05); however, vascular invasion did (OR=2.24; p=0.003). Conclusions: While tumor size provides no prognostic information, tumor number, vascular invasion, and LN metastasis were associated with survival. Presence of LN metastasis cannot be predicted using preoperative tumor features. Lymphadenectomy should be routinely performed for ICC as up to one-quarter of patients will have LN metastasis. No significant financial relationships to disclose.

Impact of surgery and chemotherapy on survival in patients with advanced cholangiocarcinoma: A multivariate analysis in a cohort of 242 consecutive patients

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4133-4133
Author(s):  
C. Dreyer ◽  
C. Le Tourneau ◽  
S. Faivre ◽  
V. Paradis ◽  
Q. Zhan ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Lymph Node ◽  
Median Survival ◽  
Tumor Size ◽  
Positive Impact ◽  
Univariate Analysis ◽  
Lymph Node Involvement ◽  
Node Involvement ◽  
The Impact

4133 Background: Cholangiocarcinoma remains an orphan disease for which prospective studies are missing to evaluate the impact of systemic chemotherapy on survival. Methods: Univariate and multivariate analysis of parameters that might impact survival were analyzed in a cohort of 242 consecutive patients with cholangiocarcinoma treated in a single institution between 2000 and 2004. Variables were WHO performance status (PS), age, symptoms, tumor size, extent of the disease, lymph node involvement, site of metastasis, tumor markers, pathology, and type of treatment including surgery, chemotherapy and radiotherapy. Results: Statistically significant prognostic factors of survival in univariate analysis are displayed in the table : In multivariate analysis, PS, tumor size and surgery were independent prognostic factors. Subgroup analysis demonstrated that in patients with advanced diseases (lymph node involvement, peritoneal carcinomatosis and/or distant metastasis), patients who had no surgery benefited of chemotherapy (median survival 13.1 versus 7.4 months in patients with/without chemotherapy, p = 0.006). Moreover, survival was further improved when patients could benefit of chemotherapy following total and/or partial resection (median survival 22.9 versus 13.0 months in patients with/without chemotherapy, p = 0.03). Conclusions: This study strongly suggests the positive impact on survival of multimodality approaches including surgery and chemotherapy in patients with advanced cholangiocarcinoma. [Table: see text] No significant financial relationships to disclose.

scholarly journals Determinants of Individual Support for Independence: Evidence from Montenegro

2021 ◽  
pp. 1-20
Author(s):  
Pëllumb Kelmendi ◽  
Christian Pedraza
Keyword(s):  
Individual Preference ◽  
Minority Rights ◽  
Relative Effect ◽  
Factors Associated ◽  
Eu Integration ◽  
Eu Membership ◽  
Individual Support ◽  
Nationally Representative ◽  
Democratic Principles ◽  
The Impact

Abstract This article investigates the determinants of individual support for independence in Montenegro. We outline five theoretically distinct groups of factors covered by the literature and evaluate their impact on individual preference for independence. Using observational data obtained from a nationally representative survey conducted in Montenegro in 2003–2004, we find support for several hypotheses, showing that identity, income, and partisanship significantly impact individual opinion about independence. We also investigate and discuss the relative effect size of different factors associated with preference for independence. Additionally, we test variables with hitherto unexplored implications for opinions on independence, including the impact of support for EU membership, as well as support for democratic principles. Our logistic regression analyses reveal that attitudes towards EU integration and minority rights are strongly associated with support for independence. By systematically analyzing existing and new hypotheses with data from an understudied case, our findings contribute to the nascent literature on individual preferences for independence.

Risk of nodal disease in patients with MRI-detected extramural vascular invasion in rectal cancer: a systematic review and meta-analysis

2020 ◽  
pp. 030089162097586
Author(s):  
Pratik Tripathi ◽  
Zhen Li ◽  
Yaqi Shen ◽  
Xuemei Hu ◽  
Daoyu Hu
Keyword(s):  
Systematic Review ◽  
Rectal Cancer ◽  
Lymph Node ◽  
Vascular Invasion ◽  
Literature Search ◽  
Meta Analysis ◽  
Adjuvant Chemoradiotherapy ◽  
Cochrane Library ◽  
Nodal Disease ◽  
The Impact

Background: The impact of magnetic resonance imaging–detected extramural vascular invasion (mrEMVI) in distant metastasis is well known but its correlation with prevalence of lymph node metastasis is less studied. The aim of this systematic review and meta-analysis was to assess the prevalence of nodal disease in mrEMVI–positive and negative cases in rectal cancer. Methods: Following guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic literature search in PubMed, Web of Science, Cochrane Library, and EMBase was carried out to identify relevant studies published up to May 2019. Results: Our literature search generated 10 studies (863 and 1212 mrEMVI–positive and negative patients, respectively). The two groups (mrEMVI–positive and negative) were significantly different in terms of nodal disease status (odds ratio [OR] 3.15; 95% confidence interval [CI] 2.12–4.67; p < 0.001). The prevalence of nodal disease was 75.90% vs 52.56% in the positive mrEMVI vs negative mrEMVI group, respectively ( p < 0.001). The prevalence of positive lymph node in positive mrEMVI patients treated with neoadjuvant/adjuvant chemoradiotherapy (nCRT/CRT) (OR 2.47; 95% CI 1.65–3.69; p < 0.001) was less compared with the patients who underwent surgery alone (OR 6.25; 95% CI 3.74–10.44; p < 0.001). Conclusion: The probability of positive lymph nodes in cases of positive mrEMVI is distinctly greater compared with negative cases in rectal cancer. Positive mrEMVI indicates risk of nodal disease prevalence increased by threefold in rectal cancer.

Is Radiotherapy Warranted Following Intrahepatic Cholangiocarcinoma Resection? The Impact of Surgical Margins and Lymph Node Status on Survival

2016 ◽  
Vol 23 (S5) ◽  
pp. 912-920 ◽  
Author(s):  
Abdulrahman Y. Hammad ◽  
Nick G. Berger ◽  
Dan Eastwood ◽  
Susan Tsai ◽  
Kiran K. Turaga ◽  
...  
Keyword(s):  
Lymph Node ◽  
Intrahepatic Cholangiocarcinoma ◽  
Surgical Margins ◽  
Lymph Node Status ◽  
Node Status ◽  
The Impact

scholarly journals Risk factors of lymph node metastasis in the splenic hilum of gastric cancer patients: A meta-analysis

2020 ◽  
Author(s):  
Jun Du ◽  
Yangchao Shen ◽  
Wenwu Yan ◽  
Jinguo Wang
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Tumor Size ◽  
Vascular Invasion ◽  
Meta Analysis ◽  
Diffuse Type ◽  
Splenic Hilum ◽  
Borrmann Type

Abstract BackgroundThe issue of whether or not splenic hilum lymph nodes (SHLN) should be excised in radical gastrectomy with D2 lymph node dissection remains controversial. In this study, we identified the clinicopathological features in patients with gastric cancer that could serve as predictive risk factors of SHLN metastasis. MethodsWe searched Medline, Embase, PubMed and Web of Science databases from inception to May 2020 and consulted the related references. Overall, 15 articles evaluating a total of 4377 patients were included for study. The odds ratios (OR) of each risk factor and corresponding 95% confidence intervals (CI) were determined using Revman 5.3 software.ResultsOur meta-analysis revealed tumor size greater than 5 cm (p < 0.01), tumor localization in the greater curvature (p < 0.01), diffuse type (Lauren’s classification) (p < 0.01), Borrmann type 3–4 (p < 0.01), poor differentiation and undifferentiation (p < 0.01), depth of invasion T3–T4 (p < 0.01), number of lymph node metastases N2–N3 (p < 0.01), distant metastasis M1 (p < 0.01), TNM stage 3–4 (p < 0.01), vascular invasion (p = 0.01), and lymphatic invasion (p < 0.01) as potential risk factors of SHLN metastasis. Moreover, positivity of Nos. 1, 2, 3, 4sa, 4sb, 4d, 6, 7, 9, 11, and 16 lymph nodes for metastasis was strongly associated with SHLN metastasis.ConclusionsTumor size, tumor location, Lauren’s diffuse type, Borrmann type, degree of differentiation, T stage, N stage, M stage, TNM stage, vascular invasion, lymphatic infiltration, and other positive lymph nodes are risk factors for SHLN metastasis.

The role of lymphatic vascular invasion in the prognosis and determination of therapy in surgically resected non-small cell carcinoma of the lung.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 7554-7554
Author(s):  
Malcolm M. DeCamp ◽  
Adin-Cristian Andrei ◽  
Satvik Ramakrishna ◽  
Laura Nyshel Medford-Davis ◽  
Julia Shelkey ◽  
...  
Keyword(s):  
Vascular Invasion ◽  
Total Population ◽  
Distant Recurrence ◽  
Small Cell ◽  
Matched Pairs ◽  
Prognostic Information ◽  
Factors Affecting ◽  
Distant Failure ◽  
Resected Nsclc ◽  
The Impact

7554 Background: Lymphatic-vascular invasion (LVI) is not currently considered in staging of non-small cell lung cancer (NSCLC). We assessed the impact of LVI on overall survival (OS), local/distant recurrence (LR/DR) and patterns of recurrence. Methods: 869 consecutive patients who underwent a definitive surgical resection ± adjuvant chemotherapy for NSCLC from 2000–2008 were qualified for analysis if they did not receive any adjuvant/neo-adjuvant radiotherapy, had at least three months of follow-up, and did not have a history of other cancers within 5 years. Tumors with LVI (N = 160) were compared to tumors without LVI (N = 705). LR/DR rates at 2,3, and 5 years were calculated by the methods of Kaplan-Meier. Association between LVI and OS and LR/DR were compared in the total population and in a propensity matched population (PS) by factors affecting OS and LR/DR (n=160 matched pairs). Results: OS, LR, and DR were significantly worse in patients with LVI in the total population and in the subset of patients matched by propensity score (Table). In the PS-matched pairs, LVI was associated with a greater number of N1 nodes involved, a longer length of stay, higher histologic grade, and higher T-stage. Patterns of local failure (P<.001) but not distant failure (P=.11) differed between patients with and without LVI. Tumors with LVI were 3-fold more likely to recur in ipsilateral mediastinal nodes. In a subset analysis of tumors < 4cm (n=121 PS matched pairs), LVI was also associated with higher LR, DR, a lower OS and a 4-fold risk of mediastinal nodal recurrence. Conclusions: Detection of LVI in resected NSCLC predicts aggressive biologic behavior and provides important prognostic information. LVI may help identify high-risk cohorts within discreet TNM stages who could benefit from adjuvant therapies. [Table: see text]

Tumor Size Predicts Vascular Invasion and Histologic Grade Among Patients Undergoing Resection of Intrahepatic Cholangiocarcinoma

2014 ◽  
Vol 18 (7) ◽  
pp. 1284-1291 ◽  
Author(s):  
Gaya Spolverato ◽  
Aslam Ejaz ◽  
Yuhree Kim ◽  
Georgios C. Sotiropoulos ◽  
Andreas Pau ◽  
...  
Keyword(s):  
Intrahepatic Cholangiocarcinoma ◽  
Tumor Size ◽  
Vascular Invasion ◽  
Histologic Grade

The Impact of Tumor Size on Early Distal Gastric Cancer of the Lymph Node Metastasis

2012 ◽  
Author(s):  
Jun Lu ◽  
Chang-Ming Huang ◽  
Chao-Hui Zheng ◽  
Ping Li ◽  
Jian-Wei Xie ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Tumor Size ◽  
Node Metastasis ◽  
Distal Gastric Cancer ◽  
The Impact

scholarly journals Associated Lichen Sclerosis Increases the Risk of Lymph Node Metastases of Vulvar Cancer

2020 ◽  
Vol 9 (1) ◽  
pp. 250
Author(s):  
Yohann Dabi ◽  
Marie Gosset ◽  
Sylvie Bastuji-Garin ◽  
Rana Mitri-Frangieh ◽  
Sofiane Bendifallah ◽  
...  
Keyword(s):  
Lymph Node ◽  
Tumor Size ◽  
Vulvar Cancer ◽  
Univariate Analysis ◽  
Lymph Node Involvement ◽  
Lymph Node Status ◽  
Local Extension ◽  
Lichen Sclerosis ◽  
Node Involvement ◽  
The Impact

The most important prognostic factor in vulvar cancer is inguinal lymph node status at the time of diagnosis, even in locally advanced vulvar tumors. The aim of our study was to identify the risk factors of lymph node involvement in these women, especially the impact of lichen sclerosis (LS). We conducted a retrospective population-based cross-sectional study in two French referral gynecologic oncology institutions. We included all women diagnosed with a primary invasive vulvar cancer. Epithelial alteration adjacent to the invasive carcinoma was found in 96.8% (n = 395). The most frequently associated was LS in 27.7% (n = 113). In univariate analysis, LS (p = 0.009); usual type VIN (p = 0.04); tumor size >2 cm and/or local extension to vagina, urethra or anus (p < 0.01), positive margins (p < 0.01), thickness (p < 0.01) and lymphovascular space invasion (LVSI) (p < 0.01) were significantly associated with lymph node involvement. In multivariate analysis, only LS (OR 2.3, 95% CI [1.2–4.3]) and LVSI (OR 5.6, 95% CI [1.7–18.6]) remained significantly associated with positive lymph node. LS was significantly associated with older patients (p = 0.005), anterior localization (p = 0.017) and local extension (tumor size > 2 cm: p = 0.001). LS surrounding vulvar cancer is an independent factor of lymph node involvement, with local extension and LVSI.

Sign in / Sign up

Export Citation Format

Share Document