Association between lymph node examination and nodal staging for pancreatic adenocarcinoma: A population-based analysis.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15772-e15772
Author(s):  
Rui-hua Xu ◽  
Zi-Xian Wang ◽  
Miaozhen Qiu ◽  
Ying Jin ◽  
Ming-ming He ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lymph Node ◽  
Pancreatic Adenocarcinoma ◽  
Nodal Staging ◽  
Cox Models ◽  
T Stage ◽  
Chow Test ◽  
Lymph Node Examination ◽  
Over Time ◽  
Nonlinear Increase

e15772 Background: The minimum number of examined lymph nodes (ELNs) for accurate nodal staging remains controversial and has not been recommended by the NCCN guidelines for pancreatic adenocarcinoma (PADC). We aimed to evaluate the time trends in the ELN count and the proportion of node-positive PADC (N+%), as well as determine the minimal threshold for the ELN count. Methods: We analyzed 9258 patients with resectable PADC between 2000 and 2012 in the SEER database (18 registries). Changes in the ELN count and N+% over time were evaluated using the Spearman correlation analysis and the Cochran-Armitage test, respectively. Multivariable logistic and Cox models were used to evaluate the association between the ELN count and N+% and overall survival after adjusted for clinicopathologic features (i.e., race/ethnicity, sex, age, marital status, SEER region, year of diagnosis, tumor grade, tumor site, 8th AJCC T stage, and surgical type). Restricted cubic spline modeling was used to handle possible nonlinear effects of the ELN count as a continuous covariate in the multivariable models. Structural breakpoints, which were considered the threshold of clinical impact, were determined by the Chow test. Results: The median ELN count increased from 9 (interquartile range: 5−15) in 2000 to 16 (11−23) in 2012 ( Ptrend < 0.001), and the N+% increased from 61.1% to 67.2% ( Ptrend < 0.001). An increased ELN count was associated with a nonlinear increase in N+% ( P < 0.001), and the Chow test revealed a threshold ELN count of 8 (ORadjusted for ≥ 8 vs. < 8 ELNs, 2.42 [95% CI, 2.19−2.68]). The 8-ELN threshold was confirmed in patients with declared N0 disease: A larger number of ELNs was correlated with a nonlinear increase in overall survival among these patients ( P < 0.001), with the threshold ELN count also being 8 (HRadjustedfor ≥ 8 vs. < 8 ELNs, 0.79 [95% CI, 0.75−0.87]). Moreover, the 8-ELN threshold remained valid regardless of T stage and year of diagnosis. Conclusions: Lymph node examination has increased markedly over time and was associated with an overall shift toward higher-staged PADC. We recommend 8 ELNs as the cut point for improvement of prognostic accuracy and quality measurement of lymph node examination.

Predicting overall survival for patients with periampullary carcinoma.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 376-376
Author(s):  
Vincent Yeung ◽  
Yutao Gong ◽  
Jialu Yu ◽  
Yan Yu ◽  
Bo Lu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lymph Node ◽  
Cox Regression ◽  
Model Performance ◽  
Positive Lymph Node ◽  
Tubular Adenocarcinoma ◽  
Tumor Differentiation ◽  
Tumor Histology ◽  
T Stage ◽  
Operative Care

376 Background: The purpose of this study was to develop a model predicting the overall survival of patients with peri-ampullary cancer (PAC) following resection, with or without adjuvant therapy. This will help guide physicians in providing optimal post-operative care. Methods: Patients treated between 2006-2012 in our institutional pancreatic tumor registry were analyzed. All patients underwent pancreaticoduodenectomy for PAC. 334 patients had adequate records for analysis and were used to develop a multivariate model based on Cox regression. The variables used in our analysis were age, gender, T-stage, tumor differentiation, positive lymph node ratio (# positive/total), positive resection margins, chemotherapy, radiation therapy (RT), and tumor histology. Multivariate Cox hazards regression tested significance. Model performance was evaluated by the concordance index (c-index). Results: Median age of the cohort was 65 years. 54% of the patients were male. Median follow-up time was 16 months. Median overall survival was 19 months. T-stages were as follows: 7% T1, 9% T2, 77% T3, and 8% T4. 27% of the patients had a positive tumor margin, 68% of patients had positive lymph node spread. 81% of the patients had tubular adenocarcinoma, 9% ampullary adenocarcinoma, 5% cholangiocarcinoma, and 4% duodenal carcinoma. T-stage, tumor differentiation, tumor histology, positive lymph node (PLN) ratio, and adjuvant chemotherapy had a statistically significant association with overall survival (Table 1). The model performance c-index was evaluated as 0.630 with 95% CI as [0.571, 0.690], from a bootstrapping internal validation test on 3-year-survival. Conclusions: This model shows promise in predicting survival following resection for patients with PAC. More patient cases and further analysis of additional factors including specific RT related parameters and specific chemotherapy regimen are needed for development of a more robust model. [Table: see text]

scholarly journals Optimal examined lymph node count in node-negative colon cancer should be determined

2021 ◽  
Author(s):  
Huolun Feng ◽  
Zejian Lyu ◽  
Weijun Liang ◽  
Guanfu Cai ◽  
Zhenru Deng ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
Optimal Number ◽  
Cutoff Point ◽  
Optimal Cutoff ◽  
Cox Models ◽  
Node Negative ◽  
Lymph Node Count ◽  
Optimal Cutoff Point

Background: We aimed to investigate the association between optimal examined lymph node (ELNs) and overall survival to determine the optimal cutoff point. Methods: Cox models and locally weighted scatterplot smoothing were used to fit hazard ratios and explore an optimal cutoff point based on the Chow test. Results: Overall survival increased significantly with the corresponding increase in the number of ELNs after adjusting for covariates. In Chow's test, the optimal cutoff point for node-negative colon cancer was 15, which was validated in both cohorts after controlling for confounders (Surveillance, Epidemiology, and End Results database: hazard ratio: 0.701, p < 0.001; single-center: HR: 0.563, p = 0.031). Conclusions: We conservatively suggest that the optimal number of ELNs for prognostic stratification is 15 in node-negative colon cancer.

A 21-year analysis of lymph node trends in colon cancer: Do quality measures really matter?

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 539-539
Author(s):  
Danielle M. Hari ◽  
Alexander Stojadinovic ◽  
Connie G. Chiu ◽  
Anna M. Leung ◽  
Myung-Shin Sim ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
Quality Measures ◽  
Quality Measure ◽  
Stage I ◽  
Stage Ii ◽  
Lymph Node Yield ◽  
The Impact ◽  
Over Time

539 Background: Lymph node (LN) number has been endorsed as a quality measure (QM) in colon cancer (CC) because of the impact on survival. However, the current mandate requiring > 12 LNs has been questioned. We evaluated whether compliance of this QM has improved and whether this has impacted overall survival (OS). Methods: The Surveillance, Epidemiology, and End Results (SEER) Database was queried to identify patients (pts) with pathologically confirmed, localized and regional CC (Stage I-III) diagnosed between 1988 and 2008. Interval trends in lymph node (LN) harvest and OS were evaluated over time (Year Strata (YS): 1988-1993, 1994-1998, 1999-2003 and 2004-2008). Results: For pts with local and regional CC, 181,035 had confirmed LN examinations. For Stages I-III, there has been a dramatic improvement in compliance for pts with > 12 LNs harvested over the recent two 5-yr periods (19, 21, 18% respectively, p<0.0001) whereas previously only a 5-7% increase occurred over time (see Table ). This rise in compliance had the greatest effect on the increased survival trend for stage II CC with minimal change for those with Stage I and Stage III CC. Irrespective of LN examined there has been a significant increase in OS for all stages over time (p<.0001). Conclusions: In the largest time-dependent assessment of lymph node examination in colon cancer, significant improvements in surgical quality measures have occurred over the past decade for Stage I, II and III. These measures have translated into improvements in overall survival particularly for Stage II disease. Lymph node yield alone is not an adequate quality measure for patients with stage I and III colon cancer. [Table: see text]

Does lymphadenectomy improve survival in patients with intermediate risk endometrial cancer? A multicentric study from the FRANCOGYN Research Group

2018 ◽  
Vol 29 (2) ◽  
pp. 282-289
Author(s):  
Lilia Bougherara ◽  
Henri Azaïs ◽  
Hélène Béhal ◽  
Geoffroy Canlorbe ◽  
Marcos Ballester ◽  
...  
Keyword(s):  
Overall Survival ◽  
Endometrial Cancer ◽  
Lymph Node ◽  
Survival Rates ◽  
Intermediate Risk ◽  
Nodal Staging ◽  
Relapse Free Survival ◽  
Multicentric Study ◽  
Free Survival ◽  
The Impact

ObjectiveThe role of lymphadenectomy in intermediate risk endometrial cancer remains uncertain. We evaluated the impact of lymphadenectomy on overall survival and relapse-free survival for patients with intermediate risk endometrial cancer.MethodsWe retrospectively reviewed patients from the FRANCOGYN database with intermediate risk endometrial cancer, based on pre-operative and post-operative criteria (type 1, grade 1–2 tumors with deep (> 50%) myometrial invasion and no lymphovascular space invasion), who received primary surgical treatment between November 2002 and August 2013. We compared overall survival and relapse-free survival between staged and unstaged patients.ResultsFrom 1235 screened patients, we selected 108 patients with intermediate risk endometrial cancer. Eighty-two (75.9%) patients underwent nodal staging (consisting of pelvic +/- para-aortic lymphadenectomy). Among them, 35 (32.4%) had lymph node disease. The median follow-up was 25 months (range 0.4 to 155.0). The overall survival rates were 82.5% for patients staged (CI 64.2 to 91.9) vs 77.9 % for unstaged patients (CI 35.4 to 94.2) (P = 0.73). The relapse-free survival rates were 68.9% for staged patients (CI 51.2 to 81.3) vs 68.8% for unstaged patients (CI 29.1 to 89.3) (P=0.67).ConclusionSystematic nodal staging does not appear to improve overall survival and relapse-free survival for patients with IR EC but could provide information to tailor adjuvant therapy. Sentinel lymph node dissection may be an effective and less invasive alternative staging technique and should provide a future alternative for this population.

Salvage Endoscopic Nasopharyngectomy in Recurrent Nasopharyngeal Carcinoma: Prognostic Factors and Treatment Outcomes

2020 ◽  
pp. 194589242096405
Author(s):  
Wanpeng Li ◽  
Hanyu Lu ◽  
Huan Wang ◽  
Huankang Zhang ◽  
Xicai Sun ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Lymph Node ◽  
Nasopharyngeal Carcinoma ◽  
Lymph Node Metastasis ◽  
Tumor Necrosis ◽  
Survival Rates ◽  
Node Metastasis ◽  
T Stage ◽  
Recurrent Nasopharyngeal Carcinoma

Background This study aimed to investigate the demographics, treatment outcomes, and prognostic factors of salvage endoscopic nasopharyngectomy in recurrent nasopharyngeal carcinoma (NPC). Methods We conducted a retrospective analysis of 189 patients who underwent treatment for recurrent NPC from January 2006 to June 2018. The Kaplan–Meier method and log-rank test were used to assess survival rates. A Cox regression model was used for multivariate survival analyses. Results We included 132 men and 57 women in the study, with a median age of 51 (range, 25–85) years. The overall 1-, 3-, and 5-year survival rates were 82.2%, 59.5%, and 43.6%, respectively, during a median follow-up of 24 (range, 2–111) months. In subjects over 50 years of age, diabetes, low body mass index (BMI < 20 kg/m2), low hemoglobin (<120 g/l) levels, increased neutrophil to lymphocyte ratio (NLR; ≥ 6), advanced T stage (rT3 and rT4), lymph node metastasis, and positive surgical margins were associated with a poor prognosis in terms of overall survival. Cox multivariate regression analyses showed significant differences in age, BMI, NLR, diabetes, T stage, N stage, and tumor necrosis. Conclusions In subjects over 50 years of age, diabetes, low BMI, increased NLR, advanced T stage, lymph node metastasis, and tumor necrosis were independent prognostic factors for overall survival.

scholarly journals Prognostic factors of surgically-treated patients with cancer of the right colon: a ten years' experience of a single universitary institution

2015 ◽  
Vol 28 (1) ◽  
pp. 3-7 ◽  
Author(s):  
Sergio Carlos NAHAS ◽  
Caio Sergio Rizkallah NAHAS ◽  
Leonardo Alfonso BUSTAMANTE-LOPEZ ◽  
Rodrigo Ambar PINTO ◽  
Carlos Frederico Sparapan MARQUES ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Lymph Node ◽  
Lymph Node Involvement ◽  
Advanced Stage ◽  
Right Colon ◽  
T Stage ◽  
Node Involvement ◽  
N Stage ◽  
The Right

BACKGROUND: Colorectal cancer is one of the most common malignancies in the world. There are many controversies in the literature about the prognostic value of primary tumor location. Many studies have shown higher survival rates for tumors in the right colon, and worse prognosis for lesions located more distally in the colon. AIM: To analyze the results of surgical treatment of right-sided colon cancers patients operated in one decade period and identify the prognostic factors that were associated with lower overall survival in stages I-IV patients. METHODS: A retrospective review from the prospectively collected database identified 178 patients with right-sided colon cancer surgically treated with curative intent. Demographic factors (gender and age), tumor factors (site, T stage, N stage, M stage, histological type and tumor differentiation), and lymph node yield were extracted to identify those associated with lower overall survival. RESULTS: Mean age was 65 (±12) years old, and 105 (56.1%) patients were female. Most common affected site was ascending colon (48.1%), followed by cecum (41.7%) and hepatic flexure (10.2%). Mean length of hospital stay was 14 (±2.8) days. T stage distribution was T1 (4.8%), T2 (7.5%), T3 (74.9%), and T4 (12.8%). Nodal involvement was present in 46.0%, and metastatic disease in 3.7%. Twelve or more lymph nodes were obtained in 87.2% of surgical specimens and 84.5% were non-mucinous tumors. Mean survival time was 38.3 (±30.8) months. Overall survival was affected by T stage, N stage, M stage, and final stage. Lymph node involvement (OR=2.06) and stage III/IV (OR=2.81) were independent negative prognostic factors. CONCLUSION: Right-sided colon cancer presented commonly at advanced stage. Advanced stage and lymph node involvement were factors associated with poor long term survival.

Toxicities of axitinib, sunitinib and temsirolimus: implications for progression-free and overall survival in metastatic renal cell cancer

2020 ◽  
Author(s):  
Annemarie Uhlig ◽  
Johannes Uhlig ◽  
Lutz Trojan ◽  
Michael Woike ◽  
Marianne Leitsmann ◽  
...  
Keyword(s):  
Overall Survival ◽  
Cancer Patients ◽  
Skin Reaction ◽  
Renal Cell Cancer ◽  
Renal Cell ◽  
Cell Cancer ◽  
Progression Free Survival ◽  
Cox Models ◽  
Metastatic Renal Cell Cancer ◽  
Hand Foot Skin Reaction

The aim of this study was to evaluate the association between axitinib, sunitinib and temsirolimus toxicities and patient survival in metastatic renal cell cancer patients. Overall survival (OS) and progression-free survival (PFS) of metastatic renal cell cancer patients from the prospective multicenter STAR-TOR study were assessed using multivariable Cox models. A total of 1195 patients were included (n = 149 axitinib; n = 546 sunitinib; n = 500 temsirolimus). The following toxicities significantly predicted outcomes: hand–foot skin reaction (hazard ratio [HR] = 0.29) for PFS with axitinib; stomatitis (HR = 0.62) and pneumonitis (HR = 0.23) for PFS with temsirolimus; stomatitis (HR = 0.52) and thrombocytopenia (HR = 0.6) for OS with temsirolimus; fatigue (HR = 0.71) for PFS with sunitinib; hand–foot skin reaction (HR = 0.56) and fatigue (HR = 0.58) for OS with sunitinib. In conclusion, in metastatic renal cell cancer, axitinib, sunitinib and temsirolimus demonstrate specific toxicities that are protective OS/PFS predictors.

Breast cancer preoperative 18FDG-PET, overall survival prognostic separation compared with the lymph node ratio

Breast Cancer ◽  
2021 ◽  
Author(s):  
Vincent Vinh-Hung ◽  
Hendrik Everaert ◽  
Olena Gorobets ◽  
Hilde Van Parijs ◽  
Guy Verfaillie ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
Lymph Node Ratio ◽  
18Fdg Pet ◽  
Node Ratio
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