Extended lymphadenectomy and adjuvant chemotherapy in muscle-invasive bladder cancer treated by radical cystectomy.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 287-287
Author(s):  
Peter J. Bostrom ◽  
Tuomas Mirtti ◽  
Martti Nurmi ◽  
Matti Laato ◽  
Bas W.G. Van Rhijn ◽  
...  
Keyword(s):  
Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Lymph Node Dissection ◽  
Cox Regression ◽  
Interaction Model ◽  
Node Dissection ◽  
Cox Regression Analysis ◽  
Survival Difference ◽  
Significant Difference ◽  
The University

287 Background: Level 1 evidence is weak for adjuvant chemotherapy (AC) after cystectomy, but surveys indicate physicians refer patients for AC more frequently than for neoadjuvant chemotherapy (NC). The exact benefit of an extended pelvic lymph node dissection (ePLND) remains debated. We addressed the issue of AC and ePLND analyzing two academic centers RC databases with opposite approaches, one using ePLND and AC, the other performing a limited lymph node dissection and no AC. Methods: Two ethics approved RC databases including consecutive BC patients undergoing RC at the University Health Network, Canada and the University of Turku, Finland were studied. Excluding non-urothelial cases and patients receiving NC, 563 patients were available for analysis. Clinicopathological variables, rate and extent of PLND and rate of adjuvant cisplatin-based chemotherapy were analyzed using the χ2-test. Kaplan-Meier method and multivariate Cox regression analysis were used to analyze survival. Results: In Toronto, patients had more extensive PLNDs (>10 nodes removed, 58% vs. 8%, p<0.001), higher rate of nodal metastases (26% vs. 7%, p<0.001), and received more often AC (21% vs. 1%, p<0.001). Positive margin rates were similar (4% in both centers). No BC specific survival difference was demonstrated in ≤ pT2a or in pT4a tumors. There was a trend for improved survival in pT2b tumors (10y BC specific survival 65% vs. 42%, p=0.23) and a significant difference favouring the Toronto cohort in pT3a and pT3b tumors (55% vs. 31%, p=0.025; 43% vs. 28% p=0.06, respectively). In multivariate analysis, N-stage (HR 2.5, 95% CI 1.5-4.1; p<0001) and ePLND (HR 0.53, 95% CI 0.31-0.93, p=0.026) significantly affected disease specific survival. The benefit of AC did not reach significance (HR 0.61, 95% CI 0.36-1.05, p=0.072). An interaction model combining ePLND and AC was significantly related to improved outcome (HR 0.49, 95% CI 0.26-0.92, p=0.026). Conclusions: Despite not being randomized, using 2 study cohorts that received completely opposite managements in terms of ePLND and AC, our results support that ePLND and AC may offer a survival advantage in T2b and especially in T3 BC treated with RC.

scholarly journals Survival Outcomes of Radical Prostatectomy + Extended Pelvic Lymph Node Dissection and Radiotherapy in Prostate Cancer Patients With a Risk of Lymph Node Invasion Over 5%: A Population-Based Analysis

2020 ◽  
Vol 10 ◽  
Author(s):  
Junru Chen ◽  
Yuchao Ni ◽  
Guangxi Sun ◽  
Sha Zhu ◽  
Jinge Zhao ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
Radical Prostatectomy ◽  
Lymph Node Dissection ◽  
Cox Regression ◽  
Pelvic Lymph Node Dissection ◽  
Pelvic Lymph Node ◽  
Survival Outcomes ◽  
Node Dissection ◽  
Survival Difference

PurposeWe aimed to compare the efficacy of radical prostatectomy (RP) + extended pelvic lymph node dissection (ePLND) and radiotherapy (RT) in localized prostate cancer (PCa) patients with a risk of lymph node invasion (LNI) over 5%.MethodsThe Surveillance, Epidemiology, and End Results (SEER) databases were used to identify patients with PCa from 2010 to 2014. Propensity score matching (PSM) was performed to balance baseline characteristics between patients in different treatment groups. Kaplan-Meier curves and Cox regression were used to assess the effects of treatments on cancer-specific survival (CSS) and overall survival (OS).ResultsOverall 20584 patients were included in this study, with 4,057 and 16,527 patients receiving RP + ePLND and RT, respectively. After PSM, patients with RP + ePLND had similar CSS (5-year CSS rate: 97.8% vs. 97.2%, P=0.310) but longer OS (5-year OS rate: 96.0% vs. 90.8%, P&lt;0.001) compared to those receiving RT. When separating RT cohort into external beam radiotherapy (EBRT) group and EBRT+ brachytherapy (BT) group, treatments with RP + ePLND and EBRT+ BT achieved equivalent OS and were both superior to EBRT alone (5-year OS rate: 96.0% vs. 94.4% vs. 90.0%, P&lt;0.001). Subgroup analyses and multivariate analyses further confirmed the superiority of RP + ePLND and EBRT+ BT.ConclusionRP + ePLND and EBRT + BT were associated with better survival outcomes compared to EBRT alone in PCa patients with a probability of LNI over 5%. However, no survival difference was observed between RP + ePLND and EBRT + BT.

scholarly journals A population-based analysis of clinical features and lymph node dissection in head and neck malignant neurogenic tumors

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaolian Fang ◽  
Shengcai Wang ◽  
Junyang Zhao ◽  
Yamei Zhang ◽  
Jie Zhang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lymph Node ◽  
Head And Neck ◽  
Lymph Node Dissection ◽  
Cox Regression ◽  
Population Based ◽  
Node Dissection ◽  
Cox Regression Analysis ◽  
Neurogenic Tumors ◽  
Chemotherapy Administration

Abstract Background The influence of lymph node dissection (LND) on survival in patients with head and neck neurogenic tumors remains unclear. We aimed to determine the effect of LND on the outcomes of patients with head and neck neurogenic tumors. Methods Data of patients with surgically treated head and neck neurogenic tumors were identified from the Surveillance, Epidemiology, and End Results (SEER) database (1975–2016) to investigate the relationship between LND and clinical outcomes by survival analysis. Subgroup analysis was performed in IVa and IVb group. Results In total, 662 head and neck neurogenic tumor patients (median age: 49.0 [0–91.0] years) met the inclusion criteria, of whom 13.1% were in the IVa group and 86.9% were in the IVb group. The median follow-up time was 76.0 months (range: 6.0–336.0 months), and the 5-year and 10-year overall survival was 82.4% (95% CI, 0.79–0.85) and 69.0% (95% CI, 0.64–0.73). Cox regression analysis revealed older age (P < .001), advanced stage (P = .037), African American race (P = .002), diagnosis before 2004 (P < .001), and chemotherapy administration (P < .001) to be independent negative predictors of overall survival. Kaplan-Meier analysis demonstrated that LND was not a predictor of clinical nodal negativity (cN0) in either IVa or IVb patients. Conclusions In head and neck neurogenic patients, LND may not impact the outcome of cN0 in either IVa or IVb group. These data can be recommended in guiding surgical plan and future studies.

Urachal versus nonurachal adenocarcinomas of the bladder: A population-based report.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 450-450
Author(s):  
Maxine Sun ◽  
Guillermo de Velasco ◽  
Christian P Meyer ◽  
Joaquim Bellmunt ◽  
Paul L. Nguyen ◽  
...  
Keyword(s):  
Lymph Node ◽  
Urinary Bladder ◽  
Lymph Node Dissection ◽  
Cox Regression ◽  
Survival Rates ◽  
Disease Stage ◽  
Regression Analyses ◽  
Node Dissection ◽  
Survival Difference ◽  
Urachal Adenocarcinoma

450 Background: Previous studies are inconclusive on whether urachal vs. non-urachal adenocarcinomas of the urinary bladder have different prognoses. Our objective was to assess survival differences between urachal vs. non-urachal adenocarcinomas in light of evolving treatment strategies over the past years. Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients with a diagnosis of adenocarcinoma of the urinary bladder between years 1988 and 2012. The variable of interest was urachal vs. non-urachal adenocarcinomas. Kaplan-Meier curves and log-rank tests were performed to assess the univariable effect of urachal vs. non-urachal adenocarcinomas on survival. Multivariable Cox regression analyses were performed for prediction of cancer-specific mortality (CSM) and overall mortality. Sub-analyses comprised of competing-risks regression models. Results: Overall, 2345 (89%) and 301 (11%) non-urachal and urachal adenocarcinoma patients were identified, respectively. The 5-year CSM-free survival rates for urachal vs. non-urachal adenocarcinomas were 63% vs. 50% (P< 0.001). For the same groups, the 5-year overall survival rates were 50% vs. 32%, respectively (P< 0.001). In multivariable Cox regression analyses, no difference was recorded between urachal vs. non-urachal adenocarcinomas for CSM (hazard ratio [HR]: 0.86, P= 0.2) or any mortality (HR: 0.84, P= 0.07). Important prognosticators of CSM and survival were surgery, lymph node dissection, disease stage and grade. Conclusions: No survival difference was recorded in the current study between urachal vs. non-urachal adenocarcinoma of the bladder. However, surgery and lymph node dissection constitute important factors for both tumor types.

scholarly journals Pelvic lymph node dissection and its extent on survival benefit in prostate cancer patients with a risk of lymph node invasion >5%: a propensity score matching analysis from SEER database

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Junru Chen ◽  
Zhipeng Wang ◽  
Jinge Zhao ◽  
Sha Zhu ◽  
Guangxi Sun ◽  
...  
Keyword(s):  
Lymph Node ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Lymph Node Dissection ◽  
Cox Regression ◽  
Pelvic Lymph Node Dissection ◽  
Pelvic Lymph Node ◽  
Seer Database ◽  
Node Dissection ◽  
Significant Difference

AbstractPelvic lymph node dissection (PLND) represents the gold standard for nodal staging in PCa and is recommended for patients with a probability of lymph node invasion (LNI) >5%. However, the therapeutic role of PLND and its extent remains a debate. In this study, data of 20,668 patients treated with radical prostatectomy (RP) with and without PLND from SEER database between 2010 and 2015 were retrospectively analyzed. All patients had a risk of LNI >5% according to 2012-Briganti nomogram. Propensity score matching (PSM) was performed to balance baseline characteristics between patients with and without PLND. Kaplan-Meier curves and Cox regression were used to evaluate the impacts of the PLND and its extent on cancer-specific survival (CSS) and overall survival (OS). In overall cohort, patients with PLND were associated with more aggressive clinicopathologic characteristics and had poorer survival compared to those without PLND (5-year CSS rate: 98.4% vs. 99.7%, p < 0.001; 5-year OS rate: 96.3% vs. 97.8%, p < 0.001). In the post-PSM cohort, no significant difference in survival was found between patients with and without PLND (5-year CSS rate: 99.4% vs. 99.7%, p = 0.479; 5-year OS rate: 97.3% vs. 97.8%, p = 0.204). In addition, the extent of PLND had no impact on prognosis (all p > 0.05). Subgroup analyses reported similar negative findings. In conclusion, neither PLND nor its extent was associated with survival in North American patients with a risk of LNI >5%. The cut-off point of 5% probability of LNI might be too low to show benefits in survival in patients underwent PLND.

scholarly journals Docetaxel, cisplatin and 5-fluorouracil adjuvant chemotherapy following three-field lymph node dissection for stage II/III N1, 2 esophageal cancer

2014 ◽  
Vol 2 (5) ◽  
pp. 719-724 ◽  
Author(s):  
TADASUKE HASHIGUCHI ◽  
MOTOMI NASU ◽  
TAKASHI HASHIMOTO ◽  
TETSUJI KUNIYASU ◽  
HIROHUMI INOUE ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Lymph Node Dissection ◽  
Stage Ii ◽  
Node Dissection

scholarly journals Prognostic Factors and Clinical Characteristics of Patients with Primary Duodenal Adenocarcinoma: A Single-Center Experience from China

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Qing-Long Jiang ◽  
Xiang-Hui Huang ◽  
Ying-Tai Chen ◽  
Jian-Wei Zhang ◽  
Cheng-Feng Wang
Keyword(s):  
Prognostic Factors ◽  
Lymph Node ◽  
Vascular Invasion ◽  
Curative Resection ◽  
Cox Regression ◽  
Early Stage ◽  
Palliative Surgery ◽  
Duodenal Adenocarcinoma ◽  
Cox Regression Analysis ◽  
Survival Difference

Aim. To evaluate the clinical risk factors influencing overall survival of patients with duodenal adenocarcinoma after potentially curative resection. Methods. A series of 201 patients with primary duodenal adenocarcinoma who underwent surgery from 1999 to 2014 at Chinese Medical Academic Cancer Hospital were studied by retrospective chart review and subsequent telephone follow-up. Results. Resectional surgery was performed in 138 of the 201 patients to attempt curative treatment, while 63 patients were treated with palliative surgery. Median survival of patients who underwent resectional operation was 57 months, whereas that of patients who had palliative surgery was shorter, 7 months (p<0.001). For patients who underwent radical resection, the overall 1-, 3-, and 5-year survival rates were 87.3, 59.1, and 44.1%, respectively. Multivariate Cox regression analysis revealed that lymph node metastasis (HR 31.76, 2.14 to 470.8; p=0.012) and vascular invasion (HR 3.75, 1.24 to 11.38; p=0.020) were independent prognostic factors negatively associated with survival in patients undergoing curative resection. There was no survival difference between the groups treated by the pancreaticoduodenectomy (n=20) and limited resection (n=10) for early-stage duodenal adenocarcinoma (p=0.704). Conclusions. Duodenal adenocarcinoma is a rare disease. Curative resection is the best treatment for appropriate patients. Lymph node metastases and vascular invasion are negative prognostic factors.

scholarly journals Positive sentinel lymph nodes should be followed by axillary lymph node dissection

2007 ◽  
Vol 10 (5) ◽  
pp. 1-4
Author(s):  
F. Hoehne ◽  
H. Mabry ◽  
A. E. Giuliano
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Axillary Lymph Node Dissection ◽  
Lymph Node Dissection ◽  
Axillary Lymph Node ◽  
Survival Advantage ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Term Survival ◽  
Survival Difference

The use of sentinel lymph node biopsy (SLNB) has revolutionized breast surgery for early stage breast cancer. SLNB accurately stages the axilla without the morbidity of axillary lymph node dissection (ALND). While allowing those patients with No disease to avoid a potentially morbid dissection, SLNB is a diagnostic procedure which identifies nodal disease and is not designed to replace ALND in patients with metastatic disease in the axilla. ALND provides regional disease control, assists physicians in making decisions for patients regarding systemic therapy, and may or may not have a survival advantage. The American College of Surgeons Oncology Group Z0011 study was constructed to determine whether there was a survival difference between completion ALND vs. observation in patients with a positive sentinel lymph node (SLN). Without strong data from randomized, controlled trials regarding the locoregional and long-term survival of patients who undergo observation after a positive SLN, patients should be offered completion ALND for a positive SLNB although ALND may offer no survival advantage.

scholarly journals Prognostic Value of Lymph Node Dissection for Intrahepatic Cholangiocarcinoma Patients With Clinically Negative Lymph Node Metastasis: A Multi-Center Study From China

2021 ◽  
Vol 11 ◽  
Author(s):  
Qiao Ke ◽  
Lei Wang ◽  
Ziguo Lin ◽  
Jianying Lou ◽  
Shuguo Zheng ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Node Dissection ◽  
Subgroup Analysis ◽  
Node Dissection ◽  
Node Metastasis ◽  
Negative Lymph Node ◽  
Significant Difference ◽  
Multi Center Study ◽  
Center Study

BackgroundThe clinical value of lymph-node dissection (LND) for intrahepatic carcinoma (ICC) patients with clinically negative lymph node metastasis (LNM) remains unclear; hence we conducted a multi-center study to explore it.MethodsPatients who were diagnosed ICC with clinically negative LNM and underwent hepatectomy with or without LND from December 2012 to December 2015 were retrospectively collected from 12 hepatobiliary centers in China. Overall survival (OS) was analyzed using the Kaplan–Meier method, and then subgroup analysis was conducted stratified by variables related to the prognosis.ResultsA total of 380 patients were eligible including 106 (27.9%) in the LND group and 274 (72.1%) in the non-LND group. Median OS in the LND group was slightly longer than that in the non-LND group (24.0 vs. 18.0 months, P = 0.30), but a significant difference was observed between the two groups (24.0 vs. 14.0 months, P = 0.02) after a well-designed 1:1 propensity score matching without increased severe complications. And, LND was identified to be one of the independent risk factors of OS (HR = 0.66, 95%CI = 0.46–0.95, P = 0.025). Subgroup analysis in the matched cohort showed that patients could benefit more from LND if they were male, age &lt;60 years, had no HBV infection, with ECOG score &lt;2, CEA ≤5 ug/L, blood loss ≤400 ml, transfusion, major hepatectomy, resection margin ≥1 cm, tumor size &gt;5 cm, single tumor, mass-forming, no satellite, no MVI, and no perineural invasion (all P &lt; 0.05). Furthermore, only patients with pathologically confirmed positive LNM were found to benefit from postoperative adjuvant therapy (P &lt; 0.001).ConclusionWith the current data, we concluded that LND would benefit the selected ICC patients with clinically negative LNM and might guide the postoperative management.

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