scholarly journals Effect of Pathologic Tumor Response and Nodal Status on Survival in the Medical Research Council Adjuvant Gastric Infusional Chemotherapy Trial

2016 ◽  
Vol 34 (23) ◽  
pp. 2721-2727 ◽  
Author(s):  
Elizabeth C. Smyth ◽  
Matteo Fassan ◽  
David Cunningham ◽  
William H. Allum ◽  
Alicia F.C. Okines ◽  
...  
Keyword(s):  
Lymph Node ◽  
Medical Research ◽  
Lymph Node Metastases ◽  
Research Council ◽  
Medical Research Council ◽  
Pathologic Response ◽  
Lymph Node Status ◽  
Node Status ◽  
Esophagogastric Cancer ◽  
Node Metastases

Purpose The Medical Research Council Adjuvant Gastric Infusional Chemotherapy (MAGIC) trial established perioperative epirubicin, cisplatin, and fluorouracil chemotherapy as a standard of care for patients with resectable esophagogastric cancer. However, identification of patients at risk for relapse remains challenging. We evaluated whether pathologic response and lymph node status after neoadjuvant chemotherapy are prognostic in patients treated in the MAGIC trial. Materials and Methods Pathologic regression was assessed in resection specimens by two independent pathologists using the Mandard tumor regression grading system (TRG). Differences in overall survival (OS) according to TRG were assessed using the Kaplan-Meier method and compared using the log-rank test. Univariate and multivariate analyses using the Cox proportional hazards method established the relationships among TRG, clinical-pathologic variables, and OS. Results Three hundred thirty resection specimens were analyzed. In chemotherapy-treated patients with a TRG of 1 or 2, median OS was not reached, whereas for patients with a TRG of 3, 4, or 5, median OS was 20.47 months. On univariate analysis, high TRG and lymph node metastases were negatively related to survival (Mandard TRG 3, 4, or 5: hazard ratio [HR], 1.94; 95% CI, 1.11 to 3.39; P = .0209; lymph node metastases: HR, 3.63; 95% CI, 1.88 to 7.0; P < .001). On multivariate analysis, only lymph node status was independently predictive of OS (HR, 3.36; 95% CI, 1.70 to 6.63; P < .001). Conclusion Lymph node metastases and not pathologic response to chemotherapy was the only independent predictor of survival after chemotherapy plus resection in the MAGIC trial. Prospective evaluation of whether omitting postoperative chemotherapy and/or switching to a noncross-resistant regimen in patients with lymph node-positive disease whose tumor did not respond to preoperative epirubicin, cisplatin, and fluorouracil may be appropriate.

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

2008 ◽  
Vol 18 (6) ◽  
pp. 1279-1284 ◽  
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.

Does mammography affect the nodal status at presentation in 40- to 49-year-old breast cancer patients?

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 55-55
Author(s):  
L. Hopkins ◽  
S. H. Chang ◽  
L. J. Kirstein ◽  
T. Fulop ◽  
S. C. Malamud ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Invasive Breast Cancer ◽  
Lymph Node Metastases ◽  
Screening Mammography ◽  
Nodal Status ◽  
Lymph Node Status ◽  
Average Risk ◽  
Node Status ◽  
Node Metastases

55 Background: It has previously been demonstrated that mammographically-detected breast cancers present as earlier stage disease than those detected as a palpable finding. In addition, it is well known that the single most important prognostic indicator in breast cancer is lymph node status. The benefit of screening mammography in women age 40-49 has been questioned recently, and has led to a change in the recommendations by the United States Preventative Services Task Force (USPSTF) to begin screening mammography in the average risk woman at age 50, rather than 40. In this study, we sought to determine whether detection of breast cancer in 40-49 year old women by screening mammography is associated with negative nodal status at presentation. Methods: A prospectively collected database was reviewed to identify 460 women ages 40-49 diagnosed with invasive breast cancer from 2003-2008. The method of detection of the breast cancer was noted, and the lymph node status at presentation was identified. Results: There were 460 eligible patients with invasive breast cancer for whom information regarding nodal status was available. Of these, 205 patients were diagnosed with a mammographic finding, and 255 patients presented with a palpable abnormality. In the group whose cancers were detected on mammography, 18% presented with lymph node metastases. This is significantly lower than the 41% who presented with a palpable finding (p<0.0001). For 40-49 year old women with invasive breast cancer, the likelihood of having a positive lymph node at presentation is 3.2 times higher if her cancer is detected as a palpable abnormality rather than on mammography (odds ratio) (CI: 2.1-5.0) (Table). Conclusions: Our analysis demonstrates that a patient diagnosed with invasive breast cancer in her 40s is more likely to present with lymph node metastases if her cancer is detected as a palpable mass, compared to those detected on mammography. This has certain prognostic importance, and provides an additional rationale for performing screening mammography in women of this age group. [Table: see text]

Morphologic Spectrum of Estrogen Receptor–Negative Breast Carcinoma

2002 ◽  
Vol 126 (3) ◽  
pp. 325-330
Author(s):  
Richard Scawn ◽  
Sami Shousha
Keyword(s):  
Estrogen Receptor ◽  
Lymph Node ◽  
Lymph Node Metastases ◽  
Lymph Node Status ◽  
Tumor Diameter ◽  
Axillary Lymph ◽  
Prolactin Receptors ◽  
Breast Carcinomas ◽  
Node Status ◽  
Node Metastases

Abstract Context.—Estrogen receptor (ER)-negative breast carcinomas are a heterogeneous group of breast cancers that are generally thought to be aggressive. Objective.—To determine the morphologic and immunohistochemical spectrum of a consecutive series of ER-negative breast carcinomas, in an attempt to understand the pathogenesis and behavior of these lesions. Design.—Seventy-four consecutive cases of ER-negative invasive carcinomas were studied. Hematoxylin-eosin–stained sections were reviewed, and new sections were stained for c-erbB-2, p53, vimentin, and androgen and prolactin receptors. The findings were correlated with the axillary lymph node status as a measure of tumor aggressiveness. Setting.—The histopathology department of a tertiary referral teaching hospital. Results.—The tumors included 50 (68%) invasive ductal carcinomas, 21 (28%) medullary/atypical medullary carcinomas, and 1 each of invasive lobular, apocrine, and papillary carcinoma. Some of the invasive ductal cases had distinctive features that are described in this report. Maximum tumor diameter varied between 5 and 100 mm. Sixty tumors (81%) were grade 3, 13 (18%) were grade 2, and 1 (1%) was grade 1. Of the 60 cases in which the axillary node status was known, 34 (57%) had metastases, and 26 did not. Tumors associated with positive nodes were significantly larger than those associated with negative nodes (37.2 vs 17.8 mm, P &lt; .001). A higher percentage of node-negative tumors were c-erbB-2 positive (42% vs 21%, P &lt; .05). There were no differences between the 2 groups with regard to histologic type, tumor grade, or the expression of p53, vimentin, or androgen or prolactin receptors Conclusions.—Many ER-negative breast carcinomas have distinctive microscopic features. Not all ER-negative tumors are aggressive, as judged by the absence of lymph node metastases in 43% of cases in this series. Tumor size is the most important indicator for the likelihood of the presence of lymph node metastases. The wide range of tumor sizes encountered in this series suggests that the ER status of a tumor is determined early in its natural history and supports the existence of 2 separate pathways for the development of ER-negative and ER-positive breast carcinomas.

RA09.04: THE LYMPH NODE STATUS OF PT1 ESOPHAGOGASTRIC JUNCTIONAL ADENOCARCINOMA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 40-40
Author(s):  
Shuhei Mayanagi ◽  
Hirofumi Kawakubo ◽  
Koichi Suda ◽  
Yuko Kitagawa
Keyword(s):  
Lymph Node ◽  
Conflicts Of Interest ◽  
Proximal Gastrectomy ◽  
Treatment Guideline ◽  
Positive Node ◽  
University Hospital ◽  
Lymph Node Status ◽  
Metastatic Lymph ◽  
Node Status ◽  
Esophagogastric Cancer

Abstract Background There is no consensus regarding the optimal extent of lymphadenectomy for the esophagogastric junctional (EGJ) cancer. The Japanese esophagogastric cancer treatment guideline showed the tentative standard in the extent of lymphadenectomy based on the location, histology and T-categories. The purpose of this study is to identify the lymph node status in patients with pT1 EGJ adenocarcinoma. Methods From January 2000 to November 2016, we underwent radical resection with or without sentinel lymph node (SN) mapping for esophagogastric cancer at Keio University Hospital. We identified 38 patients with pT1 adenocarcinoma with its center located within 2cm of the junction. We then analyzed the lymph node status and SN distribution. Results The primary tumor that had their epicenter within the proximal of the cardia in 37%, that had their epicenter within the distal of the cardia in 63% of all patients (n = 12, 26). The surgical procedures were proximal gastrectomy (n = 30); subtotal esophagectomy (n = 4); and total gastrectomy(n = 4). Two patients (5%) had positive lymph node metastasis. Of the 2 patients with positive node, one patient had the metastatic lymph node along the short gastric vessels and the other patient had the metastatic lymph nodes along both the left gastric artery and the celiac artery. Those 2 patients with positive node had no recurrence. However, liver or local (anastomotic) recurrence occurred in 1 patients, respectively. SN was accomplished in all patients who underwent SN mapping and diagnostic accuracy based on the SN status was 100% (17/17). Conclusion Our results suggested that lower mediastinal lymphadenectomy was of limited significance in patients with pT1 EGJ adenocarcinoma. SN mapping may be contributory to the optimal extent of lymphadenectomy. Disclosure All authors have declared no conflicts of interest.

Breast cancer stem cells mutations: A new understanding of intratumoral heterogeneity.

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 25-25
Author(s):  
Cory Donovan ◽  
Amy Skinner ◽  
Rodney F. Pommier ◽  
Jennifer L. Alabran ◽  
Patrick Muller ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Node Metastases ◽  
Lymph Node Status ◽  
Significant Heterogeneity ◽  
Axillary Lymph ◽  
Fresh Tissue ◽  
Axillary Lymph Node Metastases ◽  
Mutation Status ◽  
Node Metastases

25 Background: Breast cancer has long been recognized as a heterogeneous disease. This has profound implications for diagnosis, treatment and disease recurrence. Oncogenic mutations have been identified in breast cancer cells with stem-like and progenitor properties (BCSC). We have previously reported that BCSC mutations correlated with axillary lymph node metastases. This was even more significant when micrometastatic disease was included. Our hypothesis is that tumor heterogeneity extends to the genetics of BCSC, and that BCSC mutations are better predictors of lymph node status than whole tumor genetics. Methods: BCSC from fresh tissue specimens were matched to their whole tumor specimens. BCSC and whole tumor DNA were sent for PCR-based mutation analysis. Patient data was collected by chart review. Results: Twenty-eight matched BCSC and whole tumor samples were analyzed. PI3K/Akt signaling mutations in PIK3CA, AKT1, HRAS, and MET were identified in BCSC from 10 tumors. In 4 of these, mutations were also identified in the corresponding whole tumor specimens. In 4 patients, mutations were identified in whole tumor samples only. Fourteen tumors had no mutations. Tumor stage, grade, receptor status, and age did not correlate with tumor or BCSC mutation status. In contrast to BCSC mutations, mutation status of the whole tumor did not correlate with micro or macro metastatic disease in the lymph node (p = 0.92). Conclusions: Mutations in BCSC are more predictive of lymph node metastases than mutations identified in the tumors. Thus, PI3K/Akt pathway mutations in tumor precursor cells may have a stronger influence on tumor metastatic potential than mutations identified in whole tumor samples. Whole tumors and BCSC populations demonstrate significant heterogeneity, as mutations identified in BCSC and tumors were not always concordant. Rare BCSC populations must be tested separately as they provide crucial prognostic and treatment information in conjunction with whole tumor genetic analyses.

p53, p21, pRB, and p16 Expression Predict Clinical Outcome in Cystectomy With Bladder Cancer

2004 ◽  
Vol 22 (6) ◽  
pp. 1014-1024 ◽  
Author(s):  
Shahrokh F. Shariat ◽  
Hideo Tokunaga ◽  
JainHua Zhou ◽  
JaHong Kim ◽  
Gustavo E. Ayala ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Lymph Node ◽  
Radical Cystectomy ◽  
Cancer Progression ◽  
Lymph Node Metastases ◽  
Lymph Node Status ◽  
Altered Expression ◽  
Pathologic Features ◽  
Node Metastases ◽  
P16 Expression

Purpose To determine whether p53, p21, pRB, and/or p16 expression is associated with bladder cancer stage, progression, and prognosis. Patients and Methods Immunohistochemical staining for p53, p21, pRB, and p16 was carried out on serial sections from archival specimens of 80 patients who underwent bilateral pelvic lymphadenectomy and radical cystectomy for bladder cancer (median follow-up, 101 months). Results p53, p21, and pRB or p16 expression was altered in 45 (56%), 39 (49%), and 43 (54%) tumors, respectively. Sixty-six patients (83%) had at least one marker altered, and 21 patients (26%) had all three altered. Abnormal expressions of p53, p21, and pRB/p16 expression were associated with muscle-invasive disease (P = .007, P = .003, and P = .003, respectively). The alteration of each marker was independently associated with disease progression (P ≤ .038) and disease-specific survival (P ≤ .039). In multivariable models that included standard pathologic features and p53 with p21 or p53 with pRB/p16, only p53 and lymph node metastases were associated with bladder cancer progression (P ≤ .026) and death (P ≤ .028). In models that included p21 and pRB/p16, only p21 and lymph node metastases were associated with bladder cancer progression (P ≤ .022) and death (P ≤ .028). In a model that included the combined variables p53/p21 and pRB/p16, only p53/p21 and lymph node status were associated with bladder cancer progression (P ≤ .047) and death (P ≤ .036). The incremental number of altered markers was independently associated with an increased risk of bladder cancer progression (P = .005) and mortality (P = .007). Conclusion Although altered expression of each of the four cell cycle regulators is associated with bladder cancer outcome in patients undergoing radical cystectomy, p53 is the strongest predictor, followed by p21, suggesting a more pivotal role of the p53/p21 pathway in bladder cancer progression.

Lymphography and Computed Tomography in Lymph Node Metastases from Malignant Melanoma

1988 ◽  
Vol 29 (4) ◽  
pp. 391-394 ◽  
Author(s):  
E. A. Abdi ◽  
T. Terry
Keyword(s):  
Computed Tomography ◽  
Lymph Node ◽  
Malignant Melanoma ◽  
Lymph Node Metastases ◽  
False Positive ◽  
False Negative ◽  
Lymph Node Involvement ◽  
Lymph Node Status ◽  
Specificity And Sensitivity ◽  
Node Metastases

Contrast lymphography and regional computed tomography (CT) were performed prior to lymph node dissection in 49 patients with clinical suggestion of lymph node metastases from malignant melanoma. The overall specificity and sensitivity for lymphography was 62% and 70%, respectively, and for CT 83 % and 70%, repectively. There was 67% concordance of the radiologic reports. The combined modality sensitivity and specificity were 79% and 84%, respectively. Clinical lymph node examination was poor in accurately diagnosing lymph node involvement with melanoma (42% true positive, 58% false positive). Lymphography produced too many false negative and false positive reports to be of value in detecting lymph node metastases on its own. CT was slightly superior to lymphography in correctly predicting the lymph node status of the upper extremity. The present clinical and radiologic techniques would seem to be inadequate for detecting lymph node metastases in malignant melanoma.

scholarly journals Circulating microRNAs in Early Breast Cancer Patients and Its Association With Lymph Node Metastases

2020 ◽  
Author(s):  
Daniel Escuin ◽  
Laura López-Vilaró ◽  
Olga Bell ◽  
Josefina Mora ◽  
Antonio Moral ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Cancer Patients ◽  
Early Breast Cancer ◽  
Lymph Node Status ◽  
Breast Cancer Patients ◽  
Circulating Mirnas ◽  
Node Status ◽  
Differentially Expressed Mirnas ◽  
Node Metastases

Abstract Background: In recent years, miRNAs have emerged as important regulators of many cellular processes, including the various steps of the metastatic process. In addition, circulating miRNAs appear to be surprisingly stable in peripheral blood making them ideal noninvasive biomarkers for disease diagnosis. Here, we investigated the expression profile of circulating miRNAs and their association with the metastatic lymph node status in early breast cancer patients. Methods: We designed a proof-of-principle study using 16 plasma samples from patients with known sentinel lymph node status (n=12 positive and n=4 negative). We performed RNA-sequencing and validated the results by qPCR. Gene Ontology term enrichment and KEGG pathway analyses were carried out using DAVID tools.Results: We found16 differentially expressed miRNAs after adjusting for false discovery correction (q < 0.01) in patients with positive samples. Thirteen miRNAs were down-regulated (miR-339-5p, miR-133a-3p, miR-326, miR-331-3p, miR-369-3p, miR-328-3p, miR-26a-3p, miR-139-3p, miR-493-3p, miR-664a-5p, miR-323b-3pmiR-1307-3p and miR-423-3p) and 3 were up-regulated (miR-101-3p, miR-146a-5p and miR-144-3p). Hierarchical clustering using differentially expressed miRNAs clearly distinguished patients according to their lymph node status. We did not find any difference in the miRNA expression profile between plasma samples associated with macrometastasis or micrometastasis. The expression of 9 miRNAs was validated by qPCR. Moreover, gene ontology analysis showed a significant enrichment of biological processes associated with the regulation of the epithelial mesenchymal transition, cell proliferation and transcriptional regulation. Conclusions: Our results indicated the potential role of several circulating miRNAs as surrogate markers of lymph node metastases in early breast cancer patients. Further validation in a larger cohort of patients will be necessary to confirm our results.

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