HIPEC scoring system: A preoperative model including clinical and radiographic parameters to improve patient selection.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 695-695
Author(s):  
Gabrielle Gauvin ◽  
Maxwell Kilcoyne ◽  
Kwan-Keat Ang ◽  
Leigh T Selesner ◽  
Brian L. Egleston ◽  
...  
Keyword(s):  
Lymph Node ◽  
Predictive Model ◽  
Multivariable Analysis ◽  
Scoring Systems ◽  
Lymph Node Involvement ◽  
Primary Diagnosis ◽  
Cancer Center ◽  
Improve Patient Selection ◽  
Omental Caking ◽  
Node Involvement

695 Background: Most studies looking at long-term outcomes in patients undergoing cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (CS/HIPEC) are based on scoring systems performed at the time of the operation. With a morbidity as high as 67%, it is crucial to carefully choose the patients who will benefit from this procedure. In this study, we evaluated preoperative factors that could impact patient outcomes. Results were used to create a predictive model for patients considered for CS/HIPEC. Methods: Patients assessed for CS/HIPEC at our tertiary cancer center between 2012 and 2017 were considered for this study. Postoperative complications, recurrence free survival (RFS) and overall survival (OS) were used as endpoints, and multivariable analysis accounting for demographics, clinical, bloodwork, radiologic and pathologic findings was performed. Results: Sixty-eight patients were considered for CS/HIPEC. Preoperative elements found to have an impact on OS were lymph node involvement (p = 0.001) and high extent of carcinomatosis (p < 0.001) on computed tomography (CT) scan. Findings that impacted RFS were lymphovascular invasion (p = 0.042), lymph node involvement (p = 0.061) and omental caking (p = 0.010) on CT. Our preoperative predictive model is presented in table. An increased rate of complications was seen in smokers (p = 0.031), obese patients (p = 0.005) and carcinomatosis diagnosed ≤ 12 months from the primary diagnosis (p = 0.069). In our experience, performing CS/HIPEC did improve OS (p = 0.036) after adjustment for age, race, smoking, and BMI. Conclusions: Preoperative findings could help physicians in their discussions with patients prior to pursue CS/HIPEC. These interesting findings will be used to inform the next step of our study: a prospective clinical trial. [Table: see text]

scholarly journals Stereotactic Body Radiotherapy for Lymph Node Oligometastases: Real-World Evidence From 90 Consecutive Patients

2021 ◽  
Vol 10 ◽  
Author(s):  
Petr Burkon ◽  
Iveta Selingerova ◽  
Marek Slavik ◽  
Petr Pospisil ◽  
Lukas Bobek ◽  
...  
Keyword(s):  
Lymph Node ◽  
Stereotactic Body Radiotherapy ◽  
Systemic Treatment ◽  
Multivariable Analysis ◽  
Progression Free Survival ◽  
Lymph Node Involvement ◽  
Primary Tumors ◽  
Real World Evidence ◽  
Node Involvement ◽  
Time To Relapse

AimsTo evaluate the efficacy and toxicity of extracranial stereotactic body radiotherapy (SBRT) in the treatment of oligometastatic lymph node involvement in the mediastinum, retroperitoneum, or pelvis, in a consecutive group of patients from real clinical practice outside clinical trials.MethodsA retrospective analysis of 90 patients with a maximum of four oligometastases and various primary tumors (the most common being colorectal cancers). The endpoints were local control of treated metastases (LC), freedom from widespread dissemination (FFWD), progression-free survival (PFS), overall survival (OS), and freedom from systemic treatment (FFST). Acute and delayed toxicities were also evaluated.ResultsThe median follow-up after SBRT was 34.9 months. The LC rate at three and five years was 68.4 and 56.3%, respectively. The observed median FFWD was 14.6 months, with a five-year FFWD rate of 33.7%. The median PFS was 9.4 months; the three-year PFS rate was 19.8%. The median FFST was 14.0 months; the five-year FFST rate was 23.5%. The OS rate at three and five years was 61.8 and 39.3%, respectively. Median OS was 53.1 months. The initial dissemination significantly shortened the time to relapse, death, or activation of systemic treatment—LC (HR 4.8, p &lt; 0.001), FFWD (HR 2.8, p = 0.001), PFS (HR 2.1, p = 0.011), FFST (HR 2.4, p = 0.005), OS (HR 2.2, p = 0.034). Patients classified as having radioresistant tumors noticed significantly higher risk in terms of LC (HR 13.8, p = 0.010), FFWD (HR 3.1, p = 0.006), PFS (HR 3.5, p &lt; 0.001), FFST (HR 3.2, p = 0.003). The multivariable analysis detected statistically significantly worse survival outcomes for initially disseminated patients as well as separately in groups divided according to radiosensitivity. No grade III or IV toxicity was reported.ConclusionOur study shows that targeted SBRT is a very effective and low toxic treatment for oligometastatic lymph node involvement. It can delay the indication of cytotoxic chemotherapy and thus improve and maintain patient quality of life. The aim of further studies should focus on identifying patients who benefit most from SBRT, as well as the correct timing and dosage of SBRT in treatment strategy.

Predictive Value of Kanagawa Cancer Center Scoring System for Lymph Node Metastasis and Need for Lymphadenectomy in Patients With Endometrial Cancer: A Validation Study

2018 ◽  
Vol 28 (7) ◽  
pp. 1290-1296 ◽  
Author(s):  
Mozhdeh Momtahan ◽  
Marjan Hosseini ◽  
Minoo Robati ◽  
Fatemesadat Najib
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Predictive Value ◽  
Scoring System ◽  
Tumor Volume ◽  
Lymph Node Involvement ◽  
Cancer Center ◽  
Node Metastasis ◽  
Node Involvement

ObjectivesThe objective of this study was to determine the predictive value of Kanagawa Cancer Center (KCC) scoring system for lymph node metastasis and need for lymphadenectomy in patients with endometrial cancer.MethodsThis cross-sectional study was conducted during a 2-year period in a gynecologic oncology referral center in Southern Iran. We included a total number of 94 patients with endometrial cancer. Preoperative assessment included tumor volume, myometrium invasion, histology, and CA125. The KCC was calculated for all the patients. All the patients underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy along with dissection of pelvic and para-aortic lymph nodes. The histopathology of the dissected lymph nodes was considered as criterion standard, and the predictive value of KCC was evaluated accordingly.ResultsThe mean ± SD age of the patients was 56.8 ± 10.2 years. Overall, 26 patients (27.7%) tested positive for lymph node involvement. The sensitivity, specificity, positive predictive value, and negative predictive value of KCC for lymph node involvement was found to be 35.3%, 100%, 100%, and 64.7%, respectively. Overall, the predictive value according to the area under the curve measured by receiver operating characteristic curve was found to be 0.890 (0.823–0.956) indicative of moderate accuracy. Lymph node involvement was associated with higher Federation of Gynecology and Obstetrics stage (P< 0.001), higher tumor volume (P= 0.003), higher histological subtype (P< 0.001), positive CA125 (P< 0.001), and higher KCC score (P< 0.001).ConclusionsThe KCC scoring system has a moderate accuracy for predicting the lymph node involvement in patients with endometrial cancer.

Impact of extra-nodal metastasis on survival in gastric cancer patients with lymph node involvement.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 57-57
Author(s):  
Noriyuki Nishiwaki ◽  
Masanori Tokunaga ◽  
Kenichiro Furukawa ◽  
Keiichi Fujiya ◽  
Hayato Omori ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Prognostic Factor ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Multivariable Analysis ◽  
Lymph Node Involvement ◽  
Nodal Metastasis ◽  
Node Involvement ◽  
Gastric Cancer Patients

57 Background: Extra-nodal metastasis (ENM) is defined as a tumor nodule without lymph node structure, and distinguished from lymph node metastasis by histological findings. Despite the possible difference in metastatic mechanism, both are counted as metastasized lymph nodes according to the 3rd English edition of Japanese Classification of Gastric Carcinoma, and thus the prognostic value of ENM remains unclear. The aim of this study was to clarify the clinicopathogical characteristics and prognostic impact of ENM in gastric cancer patients with lymph node involvement. Methods: This study included 388 patients who underwent curative gastrectomy for primary gastric cancer between January 2009 and August 2013. A total of 2093 pathologically positive tumor nodules, including both metastatic lymph nodes and ENM, were examined. Clinicopathological characteristics and survival outcomes were compared between an ENM positive (ENMP) group (95 patients) and an ENM negative (ENMN) group (293 patients). In addition, multivariable analysis was performed to clarify the independent prognostic factors. Results: ENM was found in 269 of 2093 tumor nodules (12.9 percent). The incidence of ENM was significantly higher in patients with large tumor size, high pathological T stage (pT), high pathological N stage (pN) and in those with macroscopic infiltrative tumors, vascular and lymphatic invasion. Three-year relapse free survival was significantly worse in the ENMP group (56.5%) than in the ENMN group (82.4%, p < 0.001). Multivariable analysis revealed that ENM as well as age, pT and histological type was an independent prognostic factor. Conclusions: ENM is an independent prognostic factor in gastric cancer patients with lymph node involvement. A new N classification stratified by the presence of ENM might be considered.

scholarly journals A Predictive Model for Lymph Node Involvement with Malignancy on PET/CT in Non–Small-Cell Lung Cancer

2015 ◽  
Vol 10 (8) ◽  
pp. 1207-1212 ◽  
Author(s):  
Malcolm D. Mattes ◽  
Wolfgang A. Weber ◽  
Amanda Foster ◽  
Ariella B. Moshchinsky ◽  
Salma Ahsanuddin ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Lymph Node ◽  
Small Cell Lung Cancer ◽  
Predictive Model ◽  
Cell Lung Cancer ◽  
Lymph Node Involvement ◽  
Small Cell ◽  
Small Cell Lung ◽  
Pet Ct ◽  
Node Involvement

Mucus Gland Tumors of the Larynx and Laryngopharynx

1976 ◽  
Vol 85 (4) ◽  
pp. 498-503 ◽  
Author(s):  
Ronald H. Spiro ◽  
John S. Lewis ◽  
Steven I. Hajdu ◽  
Elliot W. Strong
Keyword(s):  
Lymph Node ◽  
Local Recurrence ◽  
Treatment Failure ◽  
Cervical Lymph Node ◽  
Lymph Node Involvement ◽  
Primary Site ◽  
Cancer Center ◽  
Upper Aerodigestive Tract ◽  
Node Involvement ◽  
Mucus Gland

During the 30–year period from 1939 through 1968, 20 patients were seen who had “minor salivary” tumors arising in the mucus glands of the larynx or laryngopharynx. This group comprised about 3% of more than 600 patients with mucus gland tumors of the upper aerodigestive tract treated at Memorial Sloan-Kettering Cancer Center during the same interval. In each instance the tumor was malignant, and all but three of these patients were men. Location and histology of these uncommon tumors is described. Only 2 of 18 treated cases were “cured.” Uncontrolled cervical lymph node involvement or distant metastasis was more often the reason for treatment failure, rather than local recurrence at the primary site.

Evaluation of pre-operative clinical finding and per-operative assessment of carcinoma stomach in tertiary settings of Bangladesh

2020 ◽  
Vol 22 (1) ◽  
pp. 43-46
Author(s):  
Mst Jesmen Nahar ◽  
Md Mahiuddin Matubber ◽  
Md Mahbubur Rahman ◽  
Md Mahbubur Rahman ◽  
Syed Muhammad Baqul Billah ◽  
...  
Keyword(s):  
Lymph Node ◽  
Clinical Picture ◽  
Preoperative Evaluation ◽  
Lymph Node Involvement ◽  
Lesion Detection ◽  
Clinical Feature ◽  
P Value ◽  
Operative Finding ◽  
Node Involvement ◽  
Carcinoma Stomach

Background: Carcinoma stomach, a major killer cancer all over the world, is still presenting late in developing countries due to delay in early diagnosis, lack of awareness, infrastructure etc. Objectives: To establish the importance of preoperative evaluation on operability of carcinoma stomach. Methods: Sixty clinically and histopathologically diagnosed ca stomach cases who underwent surgery in department of Bangabandhu Sheikh Mujib Medical University, Dhaka, and Dhaka Medical College Hospital, Dhaka in 2011 were assessed with clinical picture, investigations, preoperative evaluation and peroperative findings were recorded. Z test for proportion was used to assess clinical decision predictability with a p value of :s;0.05 as significant. Results: Male (73.33%) predominant with 2.75:1 male:female ratio was observed. Mobility, fixity and abdominal lymphadenopathy were not well detected through clinical assessment (p=0.001) while ascites, metastasis and Shelf of Slummer were similar in both clinical and operative finding. The endoscopy of upper GIT finding gave a unique picture as the findings were almost same as were found during operation. USG detected a lesser proportion of the clinical condition compared to peroperative condition whereas CT performed better than the USG except for the lesion detection. Though Computed Tomography (CT) detected higher percentage of lesion, metastasis, ascites and lymph node involvement compared to ultrasonogram (USG), it was significantly higher only for lesion detection (p=0.002) and lymph node involvement (p=<0.001). In the similar manner USG assessment of lesion detection (p=<0.001) and lymph node involvement (p=0.003) was significantly low compared to operative finding. When we looked between CT and operative finding only lesion detection was significantly low (p=0.01) indicating CT to be most effective predictor of clinical picture for operative decision. Preoperative plan were mostly not in accordance with peroperative decision except for total gastrectomy. Conclusion: The study indicates weakness in clinical detection and pre-operative plan compared to per-operative finding. Hence combination of clinical feature and investigation tools especially endoscopy of upper GIT combined with CT is recommended to predict a better operative decision. Journal of Surgical Sciences (2018) Vol. 22 (1): 43-46

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