Risk factors of lymph node metastasis in undifferentiated early gastric cancers.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 171-171
Author(s):  
Il Kim ◽  
DaeYoung Cheung ◽  
Jin Il Kim ◽  
Jae J. Kim

171 Background: The aims of this retrospective study were to analyze risk factors of lymph node metastasis undifferentiated-type early gastric cancer (UD-type EGC) and to select the suitable patient for endoscopic resection. Methods: We analyzed 368 patients who had undergone gastrectomy with lymphadenectomy for UD-type EGC between November 2001 and July 2016 at the Yeouido St. Mary’s Hospital. Using clinicopathological factors of patient age, size, an endoscopic macroscopic tumor form, ulceration, depth, histology, lymphatic involvement (LI) and venous involvement (VI), LNM risk was examined and stratified by univariate analysis and multivariate analysis. Results: Of the 368 patients, the lymph node metastases rate in patients with EGC was 48 patients (13%). 204 (55 %) had mucosal cancers and 164 (45 %) had submucosal cancers. Univariate analysis revealed > 60 age, > 2 cm, submucosal(sm), poorly cohesive carcinoma as significant prognostic factors. On multivariate analysis, > 60 age (odd ratio , 2.20; 95% confidence interval, 1.19~4.06), submucosal(odd ratio , 9.38; 95% confidence interval, 4.08~21.56), poorly cohesive carcinoma (odd ratio, 0.33; 95% confidence interval, 0.12~0.86) were independent risk factors for lymph node involvement. Conclusions: LNM-related factors in undiff-EGC were age, depth and pathology. We proposed that risk factors for metastases should be considered when choosing surgery for EGC.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 19-19 ◽  
Author(s):  
Hayato Omori ◽  
Yuichiro Miki ◽  
Wataru Takagi ◽  
Fumiko Hirata ◽  
Taichi Tatsubayashi ◽  
...  

19 Background: Peritoneal recurrence is often observed in gastric cancer patients without serosal invasion. It is difficult for pathologists to evaluate whether tumor cells penetrate serosa or not, because the subserosa layer is very thin. We evaluated the incidence and risk factors of peritoneal recurrence in serosa -negative gastric cancer patients to clarify the mechanism of peritoneal recurrence in these patients. Methods: A total of 1,745 gastric cancer patients underwent R0 resection from 2002 to 2009 were enrolled. The incidence of peritoneal recurrence according to tumor depth was analyzed. In serosa-nagative patients, the univariate and multivariate analysis were performed to identify the risk factors for peritoneal recurrence. Results: Peritoneal recurrence was observed in 64 (3.7 %) out of 1,745 patients. The incidence of peritoneal recurrence according to depth of tumor invasion was in 0 / 466 in T1a, 5 / 567 (0.88 %) in T1b, 4 / 187 (2.1 %) in T2, 31 / 360 (7.9 %) in T3, 20 / 108 (15.9 %) in T4a, and 4 / 12 (25 %) in T4b, respectively (p<0.001). As for the risk factor for peritoneal recurrence in T3 patients, histologically undifferentiated type, negative lymphatic invasion, scirrhous type, invasive infiltrating growth pattern were the significant factors identified by univariate analysis. Only the invasive infiltrating growth pattern (OR3.44 p0.038) was selected as significant independent risk factor for peritoneal recurrence by multivariate analysis. In T1b / T2 patients, massive lymph node metastasis (N3a, 3b), scirrhous type were the significant factor for peritoneal recurrence by univariate analysis. Only massive lymph node metastasis (OR25.1 p<0.001) was selected as the significant independent risk factor by multivariate analysis. Conclusions: The incidence of peritoneal recurrence increases in proportion to the tumor depth. Invasive infiltrating growth pattern was selected as an independent risk factor for peritoneal recurrence in T3 patients, while it was massive lymph node metastasis in T1b / T2 patients. The results suggest the possibility that microscopic serosal invasion in T3 tumor and lymphatic progression in T1b / T2 tumor may contribute to peritoneal recurrence in gastric cancer.


2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e17012-e17012
Author(s):  
Yifan Li ◽  
Ning Li ◽  
Lingying Wu

e17012 Background: To explore whether pathologically verified uterine corpus invasion (UCI) is a risk factor for patients with early-stage (IB1-IIA2) cervical carcinoma receiving radical surgery. Methods: A mathed-case comparison of early-stage cervical carcinoma patients with pathologically verified UCI to patients without UCI on a 1:1 ratio was conducted. High risk factors (lymph node metastasis, paremetrial invasion, vaginal margin invasion) and intermediate risk factors (lymphovascular space invasion (LVSI) and deep stromal invasion) were completely matched between UCI and non-UCI groups. Kaplan-Meier and Log-rank test were applied for univariate analysis, and COX proportional hazard regression models were used for multivariate analysis. Results: 1320 consecutive patients with cervical carcinoma received surgery in our centerfrom Jan. 1st2009 to Dec 31st2014. 79 (5.98%) cases with UCI were identified. Median follow-up time was 43 months. There were 22 cases with recurrence. In UCI group, the recurrence rate was 20.3% (16/79), and in non-UCI group the recurrence rate was 7.6% (6/79). On univariate analysis, SCC, neoadjuvant chemotherapy (NACT), lymph node metastasis, parametrial invasion, LVSI, deep stromal invasion, vaginal invasion and UCI were significantly associated with disease free survival (DFS). After multivariate analysis, UCI ( p= 0.02, RR3.832, 95% CI1.235-11.893)and lymph node metastasis ( p= 0.042, RR 2.890, 95% CI1.038-8.045) were still independent risk factors for deceased DFS. Conclusions: Pathologically verified uterine corpus invasion might be an independent risk factor for decreased DFS in patients with early-stage cervical carcinoma receiving radical surgery.


2019 ◽  
Author(s):  
Wei Hu ◽  
Jiao Zhou ◽  
Wenbo Zhou ◽  
Lun Wu ◽  
Shaohua Sun ◽  
...  

Abstract Background Patients with Pancreatic cancer (PC) have worse survival than patients with any other gastrointestinal malignancy. In present study, it is aim to investigate the prognostic factors of pancreatic carcinoma after curative resection . Methods 72 cases suffered from pancreatic carcinoma or periampullary carcinoma received curative, nine clinicopathologic factors that could possibly influence survival for postoperative mortality and overall survival were selected for univariate analysis and multivariate analysis using Cox proportional hazard mode. Results Univariate analysis showed that major factors of influence survival were size of the tumor, lymph node metastasis, and grade of differentiation (P<0.05). Multivariate analysis showed that lymph node metastasis and size of the tumor were the most important prognostic factors by multivariate analysis using the Cox proportional hazard model (P<0.01). Conclusions Prognostic factors of pancreatic carcinoma after resection are closed related to lymph node metastasis and the size of the tumor.


2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 35s-35s
Author(s):  
A. Choraria ◽  
S. Agrawal ◽  
I. Arun ◽  
S. Chatterjee ◽  
R. Ahmed

Background: Sentinel lymph node (SLN) biopsy accurately stages the axilla, but is time consuming and resource intensive. Nomograms and scoring systems have been developed, based on clinical and pathologic data available before surgery, to attempt to predict the likelihood of lymph node metastasis before surgery. As the management of the axilla in patients with low nodal burden changes, it is also important to predict whether there will be further axillary disease in patients with a positive SLN. Aim: To explore the risk factors for SLN and non-SLN metastasis in Indian women with breast cancer, by analysis of clinical and pathologic data. To assess the validity and clinical utility of two MSKCC nomograms that predicts axillary lymph node status for Western patients. Methods: Clinical data, and pathologic data available from core biopsy, for a consecutive series of women having SLNB was analyzed, and was plotted on two MSKCC nomograms. Univariate analysis was done by χ2 and Fischer exact tests and multivariate analysis was done by logistic regression method. A receiver-operating characteristic (ROC) curve was drawn and predictive accuracy was assessed by calculating the area under the ROC curve (AUC). Results: 34% (89 out of 256) of our patients had SLN positivity. When correlated with SLN metastasis by univariate analysis, LVI (χ2 = 80, P ≤ 0.001), PNI (χ2 = 13.36, P ≤ 0.001), ER+ (χ2 = 6.85, P = 0.009), PR+ (χ2 = 7.1, P = 0.008) and age ( P = 0.03) were significant. However, multivariate analysis showed that age (OR=1.04, P = 0.007) and LVI (OR=0.07, P ≤ 0.001) were identified as independent predictors for SLN metastasis. The area under the ROC curve was 0.772 and it fairly correlated with MSKCC nomogram. Patients with MSKCC scores lower than 38% had a frequency of SLN metastasis of 7.7% (5/65) and this cut-off could be used as a guide for not doing frozen section analysis in this subgroup. Further axillary dissection showed 41% (38 out of 92) had non-sentinel nodes positive. When correlated with non-SLN metastasis by univariate analysis, LVI (χ2 = 8.8, P = 0.003), PNI (χ2 = 6.85, P = 0.009), and extracapsular extension (χ2 = 4.18, P = 0.04) were significant. Number of SLN negative ( P = 0.01), SLN ratio (number of SLN positive/total number of SLN removed) ( P = 0.01) and size of SLN metastasis ( P = 0.002) were significant. However, multivariate analysis showed that only size of SLN metastasis (OR=0.845, P = 0.02) was identified as independent predictor for non-SLN metastasis. The area under the ROC curve was 0.66 and it poorly correlated with MSKCC nomogram. Conclusion: The MSKCC nomogram can provide a fairly accurate prediction of the probability of SLN metastasis, but is not for non-SLN metastasis. An institutional nomogram for non-SLN metastasis, including additional factors such as size of SLN metastasis, may improve prediction.


2016 ◽  
Vol 26 (6) ◽  
pp. 1169-1175 ◽  
Author(s):  
Cem Onal ◽  
Ozan C. Guler ◽  
Berna A. Yildirim

ObjectivesThe aim of this work was to evaluate the prognostic role of pretreatment neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in recipients of definitive chemoradiotherapy (ChRT) for cervical cancer.MethodsIn 235 patients given definitive ChRT for histologically confirmed cervical cancer, clinical data and pretreatment complete blood cell counts were analyzed. Prognostic and therapeutic ramifications of NLR and PLR were assessed.ResultsMedian pretreatment NLR and PLR were 3.03 (range, 1.04–13.03) and 133.02 (range, 36.3–518.16), respectively. Both NLR and PLR correlated significantly with tumor size, lymph node metastasis, and treatment response. In addition to NLR and PLR, tumor stage, size, and nodal metastasis were identified by univariate analysis as significant predictors of overall survival (OS) and progression-free survival (PFS). By multivariate analysis, independent predictors of OS and PFS were NLR (OS: hazard ratio [HR], 3.322; 95% confidence interval [CI], 1.905–5.790; PFS: HR, 3.579; 95% CI, 2.106–6.082; both P < 0.001) and lymph node metastasis (OS: HR, 2.620; 95% CI, 1.706–4.023; PFS: HR, 2.989; 95% CI, 1.918–4.378; both P < 0.001), although patients’ age (HR, 1.019; 95% CI, 1.003–1.035; P = 0.02) was also significantly predictive of OS.ConclusionsPretreatment NLR and PLR were associated with larger tumors, lymph node metastasis, and poorer therapeutic responses to definitive ChRT. By multivariate analysis, pretreatment NLR and lymph node metastasis were found independently predictive of OS and PFS, whereas patients’ age was significantly predictive of OS only. In patients with advanced cervical cancer, NLR is a potential biomarker, serving to guide systemic therapy and predict treatment outcomes.


2020 ◽  
Author(s):  
Jingjing Wang ◽  
Jingjing Wang ◽  
Tao Meng ◽  
Tao Meng ◽  
Ke Chen ◽  
...  

Abstract ObjectiveTo explore the effects of gender and age differences in the risk factors for lymph node metastasis in patients and analysis prognosis of patients of early gastric cancer (EGC). MethodsA total of 411 patients with EGC who underwent surgical treatment at the First Affiliated Hospital of Anhui Medical University from 2011 to 2017 were included in this study and grouped according to gender and age. Retrospective analysis of the effects of gender and age on tumor size, histological type, depth of invasion, and ulcer type was performed, and differences in the clinicopathological characteristics of lymphovascular invasion were noted. Follow-up of the postoperative recurrence and metastasis of the patients and analysis of their prognosis were finally conducted. All follow-ups ended in August 2020. ResultThe participants in this study ranged in age from 25 years to 85 years (average, 60.27 ± 10.77 years). A total of 57 (13.9%) of the patients showed lymph node metastasis. Females accounted for 25.5% (105/411) while males accounted for 74.5% (306/411) of the study population. Patients aged ≤60 years accounted for 55.5% (228/411) while patients aged >60 years accounted for 44.5% (183/411) of the study population. Univariate analysis of male patients showed that tumor size, depth of tumor invasion, ulcerative tumors, and lymphovascular invasion are related to lymph node metastasis (P < 0.05). Univariate analysis of female patients showed that tumor size, depth of tumor invasion, tumor histology, and lymphovascular invasion are related to lymph node metastasis (P < 0.05). Univariate analysis of patients aged ≤60 years showed that depth of tumor invasion, ulcerative tumors, and lymphovascular invasion are related to lymph node metastasis (P < 0.05). Univariate analysis of patients aged >60 years showed that depth of tumor invasion, ulcerative tumors, and lymphovascular invasion are related to lymph node metastasis (P < 0.05). Multivariate analysis of male patients, female patients, and patients aged ≤60 years showed that depth of tumor invasion is an independent risk factor for lymph node metastasis. Multivariate analysis of patients aged >60 years showed that depth of tumor invasion, ulcerative tumors, and lymphovascular invasion are independent risk factors for lymph node metastasis. ConclusionThe risk factors for lymph node metastasis in patients with EGC differed according to gender and age. The results provide a reference for choosing suitable treatment options for these patients.


2015 ◽  
Vol 25 (9) ◽  
pp. 1677-1682 ◽  
Author(s):  
Yasushi Mabuchi ◽  
Tamaki Yahata ◽  
Aya Kobayashi ◽  
Yuko Tanizaki ◽  
Michihisa Shiro ◽  
...  

ObjectiveThe aim of this study was to clarify the clinicopathologic factors of stages IB to IIB cervical adenocarcinoma.MethodsSeveral clinicopathologic factors were compared between 35 patients who underwent radical hysterectomy and pelvic lymphadenectomy due to cervical adenocarcinoma stages IB to IIB and 77 patients with squamous cell carcinoma (SCC).ResultsIn patients with adenocarcinoma, univariate analysis demonstrated that International Federation of Gynecology and Obstetrics stage, tumor size, and lymphovascular space invasion were significantly associated with progression-free survival (PFS), whereas FIGO stage, lymphovascular space invasion, and lymph node metastasis were significantly associated with overall survival (OS). However, multivariate analysis revealed that FIGO stage was the only significant factor for PFS in patients with adenocarcinoma. In patients with SCC, univariate analysis demonstrated that FIGO stage and lymph node metastasis were significantly associated with PFS, whereas FIGO stage, lymphovascular space invasion, and lymph node metastasis were significantly associated with OS. Multivariate analysis revealed that lymph node metastasis was the only significant factor for PFS and OS in patients with SCC. In 26 patients who were positive for high-risk human papillomavirus (HPV), including both adenocarcinoma and SCC patients, univariate and multivariate analyses revealed that HPV18 was significantly associated with poorer PFS compared with non-HPV18. There was a significant difference in distribution of HPV genotype between adenocarcinoma and SCC.ConclusionsCareful treatment may be necessary for the patients with lymphovascular space invasion in early-stage cervical adenocarcinoma. The presence of HPV18 may have an influence on the prognosis of early-stage cervical carcinoma.


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