Adjuvant chemotherapy in nonmetastatic goblet cell carcinomas: A population-based analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16203-e16203
Author(s):  
Valentina Tateo ◽  
Elisa Andrini ◽  
Davide Campana ◽  
Giuseppe Lamberti
Keyword(s):  
Multivariate Analysis ◽  
Adjuvant Chemotherapy ◽  
Lymph Nodes ◽  
Univariate Analysis ◽  
Population Based ◽  
Tumor Diameter ◽  
Nodal Involvement ◽  
Metastatic Lymph Nodes ◽  
Risk Of Death ◽  
Metastatic Lymph

e16203 Background: Goblet cell carcinoma (GCC) is a rare mixed endocrine-neuroendocrine tumor arising almost exclusively in the appendix. The optimal management of these patients is still unclear, given GCC rarity and the difficulty in proper pathology diagnosis. We sought to explore the efficacy of adjuvant chemotherapy (ACT) in GCC extracted from the Surveillance, Epidemiology and End Result (SEER) US registry. Methods: Patients with pathology diagnosis of GCC were identified in the SEER registry by the 8243 ICD-09 code. Data about sex, age, tumor stage at diagnosis, number of analyzed and positive lymph-nodes, chemotherapy and survival were collected. Lymph node ratio (LNR) was calculated as the ratio between the number of metastatic lymph-nodes and removed lymph nodes. The best cutoff to predict survival state at 5-year from diagnosis was calculated. The primary endpoint was overall survival (OS). Results: Overall, 1055 GCC patients (51.7% male, median age 57 years) were identified. The median tumor diameter was 20 mm. According to the American Joint Committee on Cancer staging manual 7th edition, 128 patients (12.1%) had nodal involvement (N+): 95 were N1 and 33 were N2, while 66 (6.3%) had distant metastasis (M+). Prognostic LNR cutoff was 0.16. Using this cutoff, LNR was ≤0.16 in 674 patients (63.9%), and > 0.16 in 125 patients (11.8%). The median OS was 232 months (95% confidence interval [95%CI]: 153.4-310.5). Overall, 5-year survival rate (OS-5) was 73.4% (N = 453). At univariate analysis age, tumor diameter, M+, N+, number of lymph nodes removed, number of metastatic lymph nodes and LNR were significantly associated with the risk of death. At multivariate analysis, age, M+, N+, number of removed lymph nodes, and number of metastatic lymph nodes retained their association. After excluding M+ and N+ patients, 897 localized GCC patients (52.8% male) were analyzed. Fifty-five patients (6.1%) received ACT and OS-5 was 83.8% (N = 425). CT was administered more often in tumors with higher histological grade, higher T stage and greater tumor diameter. At the multivariate analysis, only age and number of removed lymph nodes were independently associated with the risk of death. Notably, ACT was not associated with increased survival. Ninety-two patients (57.6% male) had nodal involvement without distant metastases: 73 were N1 and 19 were N2. In 56 patients (60.9%) LNR was ≤0.16, while it was > 0.16 in 35 (38.0%). Thirty-five patients (38%) received ACT, without significant imbalances. OS-5 was 45.2% (N = 28). At univariate analysis, age, N2, number of metastatic lymph nodes and LNR were significantly associated with the risk of death. At multivariate analysis, only the number of metastatic lymph nodes retained its association. Of note, ACT was not associated with increased survival. Conclusions: In GCC, ACT was not associated with increased survival in our population-based analysis, irrespective of nodal involvement.

Comparison of the prognostic significance between the number of metastatic lymph nodes and nodal stage based on their location in patients with gastric cancer.

1993 ◽  
Vol 11 (10) ◽  
pp. 1894-1900 ◽  
Author(s):  
T Ichikura ◽  
S Tomimatsu ◽  
Y Okusa ◽  
K Uefuji ◽  
S Tamakuma
Keyword(s):  
Gastric Cancer ◽  
Multivariate Analysis ◽  
Survival Rate ◽  
Lymph Nodes ◽  
Prognostic Significance ◽  
Cox Proportional Hazards Model ◽  
Depth Of Invasion ◽  
Metastatic Lymph Nodes ◽  
Nodal Stage ◽  
Metastatic Lymph

PURPOSE To determine which is the better prognostic determinant in gastric cancer: number of positive metastatic lymph nodes or current nodal stage. PATIENTS AND METHODS Seven hundred seventy-seven patients who underwent potentially curative resections for gastric cancer were divided into three groups according to the depth of invasion. The influence of the number of positive nodes on their survival rate was analyzed. A multivariate analysis by the Cox proportional hazards model was used to determine independent prognostic factors. RESULTS A decreased survival rate was associated with an increased number of positive nodes in all of the subjects and in each of the three groups. Patients with one to three positive nodes had as good a prognosis as those without nodal involvement when each of the three groups was analyzed separately. Using a multivariate analysis in the patients with four or more positive nodes, we found that the number of positive nodes was the most important prognostic determinant (P < .0001), followed by the depth of invasion (P < .02), and that the nodal stage was not significantly prognostic. Further multivariate analysis in the patients with one to three positive nodes showed that nodal stage and number of positive nodes were not significantly prognostic. CONCLUSION The number of metastatic nodes should be adopted for classification of nodal stage in gastric cancer.

Validation study of sentinel lymph node mapping using radio- and dye-guided methods in gastric cancer: 431 cases at a single institution.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 76-76
Author(s):  
M. Niihara ◽  
H. Takeuchi ◽  
S. Kamiya ◽  
T. Kaburagi ◽  
T. Oyama ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Early Gastric Cancer ◽  
Lymph Nodes ◽  
False Negative ◽  
Tumor Diameter ◽  
Remnant Gastric Cancer ◽  
Metastatic Lymph Nodes ◽  
Metastatic Lymph

76 Background: Some papers have reported that sentinel lymph node (SLN) concept can be applied in patients with early gastric cancer, in particular clinically T1N0M0 or T2N0M0 with a tumor diameter of 4cm or less. Little is, however, available on the SLN study with the other criteria than listed above. The aim of the present work was to investigate the accuracy of the SLN biopsy of gastric cancer with various stages and evaluate the indication for SLN navigated gastrectomy. Methods: A total of 431 consecutive patients were diagnosed with operable gastric cancer during the period April 1999 through December 2007. Reasons for inclusion were, in principle, T1N0M0 or T2N0M0 gastric cancer. However, several patients diagnosed preoperatively with T3N0M0, T2N1M0, remnant gastric cancer, multiple gastric cancers and additional treatment after endoscopic therapy were also enrolled in this study according to their request. All patients underwent a radical gastrectomy with SLN mapping with an informed consent. The SLNs were identified using both radio-guided and dye-guided method. Results: Detection rate of hot and/or blue node was 95.8% (413/431). The accuracy of metastatic status based on SLN was 97.6% (403/413). In six of 10 false-negative cases, some clinical backgrounds and problems were present; scirrhous gastric cancer, the tumor penetration of serosa, multiple lesions, remnant gastric cancer after partial resection and the technical issue of tracer injection. Nine of these 10 false-negative cases had the metastatic lymph nodes within only the sentinel basins. Specifically, in the group of clinically T1N0M0 untreated gastric cancer with a tumor diameter of 4 cm or less, there were only 3 false- negative cases. In addition, all the metastatic lymph nodes of the 3 cases located within the sentinel basins. Conclusions: Our study suggested that SLN concept for untreated early gastric cancer could be validated. The sentinel basin dissection might be used to advantage to improve curativity for gastric cancer. No significant financial relationships to disclose.

Analysis of Patients With Stage IIIC Endometrial Cancer

2014 ◽  
Vol 24 (6) ◽  
pp. 1033-1041 ◽  
Author(s):  
Taner Turan ◽  
Isin Ureyen ◽  
Ipek Duzguner ◽  
Enis Ozkaya ◽  
Tolga Tasci ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Prognostic Factor ◽  
Lymph Nodes ◽  
Univariate Analysis ◽  
Independent Prognostic Factor ◽  
Stage Iiic ◽  
Metastatic Lymph Nodes ◽  
Systematic Lymphadenectomy ◽  
Metastatic Lymph ◽  
Gynecology And Obstetrics

ObjectiveWe aimed to define the factors that are related to recurrence and survival in patients with stage IIIC endometrial carcinoma in this study.Materials and MethodsA total of 147 patients who underwent staging surgery and had a diagnosis of stage IIIC1 to IIIC2 endometrial cancer according to the International Federation of Gynecology and Obstetrics 2009 were included. Patients whose data could not be obtained and patients with a diagnosis of uterine sarcoma and with synchronous tumors were excluded.ResultsMean age of the patients was 58.6 years. Among these patients, 63 had stage IIIC1 and 84 had stage IIIC2 disease. Extrauterine spread was detected in 22% of the patients. Median number of paraaortic (PA) and pelvic lymph nodes removed were 16.5 and 38, respectively. Paraaortic and pelvic nodal involvements were detected in 84 patients and 125 patients, respectively. Radiotherapy was applied more commonly as an adjuvant therapy. Three-year progression-free survival (PFS) and 3-year disease-specific survival (DSS) were 65% and 84%, respectively. Seventy percent of the recurrences were outside the pelvis. Site of metastatic lymph nodes and the number of metastatic PA lymph nodes were associated with 3-year PFS and lymphovascular space invasion; site of metastatic lymph nodes and the presence of recurrence were associated with 3-year DSS in the univariate analysis. Although any surgicopathological factor was not related to 3-year PFS, only the presence of recurrence was an independent prognostic factor for a 3-year DSS in the multivariate analysis (hazard ratio, 0.017; 95% confidence interval, 0.002–0.183).ConclusionsThe number of debulked metastatic lymph nodes and PA involvement were associated with recurrence in the univariate analysis. The presence of recurrence was the only independent prognostic factor detecting survival. Therefore, systematic lymphadenectomy involving PA lymph nodes instead of sampling should be performed in patients with high risk for nodal involvement in endometrial cancer.

scholarly journals The Clinical and Prognosis Value of the Number of Metastatic Lymph Nodes in Papillary Thyroid Carcinoma Patients

2020 ◽  
Author(s):  
Ling Zhan ◽  
Hong-fang Feng ◽  
Xi-zi Yu ◽  
Ling-rui Li ◽  
Jun-long Song ◽  
...  
Keyword(s):  
Lymph Node ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Lymph Nodes ◽  
Tumor Size ◽  
Tumor Diameter ◽  
Papillary Thyroid ◽  
Metastatic Lymph Nodes ◽  
Metastatic Lymph ◽  
High Prevalence

Abstract Objective: It has been reported that papillary thyroid carcinoma (PTC) patients with lymph node metastasis (LNM) are more associated with adverse outcomes. This study aimed to assess the correlation between the lymph node (LN) status and clinical prognosis in PTC patients. Methods: We retrospectively reviewed the medical records of PTC patients who underwent initial thyroid cancer surgery in Renmin Hospital of Wuhan University between 2017 and 2019. 1021 PTC patients with total checked number of lymph nodes ≥5 were involved in this study. The clinicopathological characteristics of patients were compared according to the LN status and the number of metastatic lymph nodes (NMLNs). Results: The LNM and NMLNs>5 were seen in 694 (68.0%) and 222 (21.7%) cases, respectively. Young patients, patients with larger tumor diameter, bilaterality, multifocality and gross extrathyroidal extension (ETE) were more inclined to LNM and NMLNs >5 (P<0.001). The patients with LNM (pN1) were mainly among males and were exhibited multifocality and advanced tumor stage (P<0.001), while pN1 patients with NMLNs >5 were negatively associated with advanced tumour stage (P<0.05). Recurrence-free survival among pN1 patients was significantly different between 2 groups (NMLNs ≤5: 0/472, 100.0%; NMLNs >5: 5/222, 97.7%; P=0.002). In multivariate logistic regression analysis, the male (OR=2.580, P<0.001), 10-mm tumor size (OR=1.770, P<0.001), tumor gross ETE (OR=2.004, P<0.001) were independent predictors for the high prevalence of LNM. Similarly, 10-mm tumor size (OR=1.399, P<0.05), bilaterality (OR=2.350, P<0.001) and tumor gross ETE (OR=2.660, P<0.05) were also independent predictors for the high prevalence of NMLNs >5; 10-year age was an independent predictor for the low prevalence of the LNM (OR=0.658, P<0.001) and NMLNs >5 (OR=0.678, P<0.001). Conclusions: The status of the cervical LNs and the NMLNs should be correctly evaluated to guide reasonable treatment and careful follow-up.

scholarly journals Increased Risk of Brain Metastases Among Patients with Melanoma and PROM2 Expression in Metastatic Lymph Nodes

2020 ◽  
Author(s):  
Thuy Thi Nguyen ◽  
Guillaume Gapihan ◽  
Pauline Tetu ◽  
Frédéric Pamoukdjian ◽  
Morad El Bouchtaoui ◽  
...  
Keyword(s):  
Lymph Node ◽  
Brain Metastases ◽  
Lymph Nodes ◽  
Metastatic Melanoma ◽  
Metastatic Lymph Nodes ◽  
Transcriptomic Data ◽  
Risk Of Death ◽  
Metastatic Lymph ◽  
Increased Risk ◽  
Melanoma Brain Metastases

Abstract Background: Melanoma brain metastases are the main cause of specific death among patients with metastatic melanoma. The biology of melanoma brain metastases remains largely to be deciphered, as there have been only a few genomic studies on brain metastatic samples. In this study, melanoma metastatic lymph nodes were used with the aim to identify biomarkers associated with the occurrence of brain metastases. Methods: Fifty-one patients with melanoma lymph node metastasis and a median follow-up of 48 months were included in the development cohort. Transcriptomic data were obtained from these metastatic lymph nodes and patients who developed brain metastases and those who did not were compared. Recommendations for tumour marker prognostic studies (REMARK recommendations) were followed.Results: From transcriptomic data, we identified PROM2 which was significantly overexpressed in metastatic lymph nodes of patients who developed brain metastases compared to those who did not. Using immunohistochemistry with two different anti-PROM2 antibodies, a PROM2 score was developed for metastatic lymph nodes. Using a cut-off of 5, a PROM2 mean score ≥5 was significantly associated with an increased risk of brain metastases and an increased hazard risk of death by 4.These results were confirmed in an internal validation cohort of 50 additional patients with melanoma lymph node metastases.Conclusions: In this study, we identified PROM2 expression as a biomarker predictive of the occurrence of distant metastases, particularly brain metastases, among patients with stage III melanoma. Our findings open new perspectives to validate PROM2 as a useful biomarker for clinical trials in the adjuvant setting, and as a potential biotarget for the treatment of metastatic melanoma.

scholarly journals The Number of Metastatic Lymph Nodes is a Useful Predictive Factor for Recurrence after Surgery for Nonmetastatic Nonfunctional Neuroendocrine Neoplasm of the Pancreas

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
G. Capretti ◽  
G. Nappo ◽  
V. Smiroldo ◽  
M. Cereda ◽  
B. Branciforte ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Predictive Factors ◽  
Pancreatic Surgery ◽  
Univariate Analysis ◽  
Mitotic Count ◽  
Neuroendocrine Neoplasm ◽  
Nodal Metastases ◽  
Regional Lymph Nodes ◽  
Metastatic Lymph Nodes ◽  
Metastatic Lymph

Nodal involvement (actually categorized as positive or negative) is an important prognostic factor after surgery for pancreatic neuroendocrine neoplasms (pNENs). We aim to evaluate the predictive role of the number of nodal metastases after pancreatic resection for pNENs. We analyzed from a prospectively maintained database all pancreatic resections for nonmetastatic nonfunctioning pNENs performed in our institution from 2011 to 2016. According to the number of nodal metastases, enhancing the actual categorization, we distinguished the following: N0, no nodal metastases; N1, 1-3 metastatic lymph nodes; and N2, metastases in 4 or more regional lymph nodes. Recurrence and disease-free survival (DFS) were evaluated. The predictive value in terms of recurrence for each clinicopathological data, including the number of metastatic lymph nodes, was calculated. Univariate and multivariate analyses were conducted. 77 patients underwent pancreatic surgery for pNENs. N0, N1, and N2 resections were found in 52 (67.5%), 16 (20.8%), and 9 (11.7%) cases, respectively. Mean follow-up of the entire cohort was 48 (±25) months. The recurrence rate was 11.8%, and the mean time of recurrence was 12 (±14) months. DFS was 83.7 months (76.0 - 91.5). At a univariate analysis, factors associated with recurrence were mitotic count (OR 1.19, p=0.001), Ki67 value (OR 1.06, p=0.001), the presence of nodal metastases (OR 11.54, p=0.002), and metastases in 4 or more regional lymph nodes (N2) (OR 30.19, p=0.002). At a multivariate analysis, only mitotic count (OR 1.51, p=0.005) and N2 resection (OR 134.74, p=0.002) were found to be predictive factors of recurrence. The number of metastatic lymph nodes and mitotic count is the most significant predictive factors of recurrence after pancreatic surgery for nonmetastatic nonfunctioning pNENs.

scholarly journals Usefulness of Hybrid PET/MRI in Clinical Evaluation of Head and Neck Cancer Patients

Cancers ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 511 ◽  
Author(s):  
Natalia Samolyk-Kogaczewska ◽  
Ewa Sierko ◽  
Dorota Dziemianczyk-Pakiela ◽  
Klaudia Beata Nowaszewska ◽  
Malgorzata Lukasik ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Lymph Nodes ◽  
Head And Neck ◽  
Neck Cancer ◽  
Predictive Value ◽  
Tumor Volume ◽  
Preoperative Staging ◽  
Tumor Diameter ◽  
Metastatic Lymph Nodes ◽  
Metastatic Lymph

(1) Background: The novel hybrid of positron emission tomography/magnetic resonance (PET/MR) examination has been introduced to clinical practice. The aim of our study was to evaluate PET/MR usefulness in preoperative staging of head and neck cancer (HNC) patients (pts); (2) Methods: Thirty eight pts underwent both computed tomography (CT) and PET/MR examination, of whom 21 pts underwent surgical treatment as first-line therapy and were further included in the present study. Postsurgical tissue material was subjected to routine histopathological (HP) examination with additional evaluation of p16, human papillomavirus (HPV), Epstein-Barr virus (EBV) and Ki67 status. Agreement of clinical and pathological T staging, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of CT and PET/MR in metastatic lymph nodes detection were defined. The verification of dependences between standardized uptake value (SUV value), tumor geometrical parameters, number of metastatic lymph nodes in PET/MR and CT, biochemical parameters, Ki67 index, p16, HPV and EBV status was made with statistical analysis of obtained results; (3) Results: PET/MR is characterized by better agreement in T staging, higher specificity, sensitivity, PPV and NPV of lymph nodes evaluation than CT imaging. Significant correlations were observed between SUVmax and maximal tumor diameter from PET/MR, between SUVmean and CT tumor volume, PET/MR tumor volume, maximal tumor diameter assessed in PET/MR. Other correlations were weak and insignificant; (4) Conclusions: Hybrid PET/MR imaging is useful in preoperative staging of HNC. Further studies are needed.

Factors impacting use of adjuvant therapy in lip and oral cavity squamous cell carcinoma: A NCDB analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e18556-e18556
Author(s):  
Poornima Ramadas ◽  
Dongliang Wang ◽  
Danning Huang ◽  
Abirami Sivapiragasam
Keyword(s):  
Squamous Cell Carcinoma ◽  
Multivariate Analysis ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Oral Cavity ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Univariate Analysis ◽  
Positive Lymph Nodes

e18556 Background: Two trials followed by a combined analysis of the trials in head and neck squamous cell carcinoma (SCC) established that the benefit of adjuvant chemotherapy concurrent with radiation (CRT) was only noted in patients with extracapsular extension of nodal disease (ECE) and positive resection margins (PM). Despite this recommendation, other high-risk pathological features including pT3 or pT4 disease, positive lymph nodes, perineural involvement, vascular tumor embolism and level IV or V lymph node involvement have been noted to increase the risk of recurrence and adjuvant chemotherapy has been utilized for these patients. We report an observational study to evaluate the factors impacting use of CRT in patients with oral cavity and lip SCC. Methods: We conducted a retrospective study of patients with oral cavity and lip SCC who underwent resection of primary tumor with or without neck dissection in the reporting hospital in the NCDB database. We compared demographic, clinical and pathological characteristics of patients who received adjuvant CRT versus radiation alone. Multivariate analysis was performed using logistic regression model. Results: Out of the 58,481 patients reported to have surgery in NCDB from 2004 to 2016, 11,413 patients received adjuvant therapy. In univariate analysis, patients who received CRT were most likely less than 65 years of age, males, patients with no insurance or private insurance, lower Charlson Deyo score, Stage IVA, pT4, grade 2 or higher, tumor size > 4cm, positive lymph nodes, involvement of level IV and V nodes, lymphovascular invasion, ECE and PM. In multivariate analysis, factors which influenced receiving CRT were age between 40 and 65 years, males, Stage IVA (compared to Stage I to III), positive nodes, ECE and PM. A total of 984 patients received CRT without having ECE or PM. Conclusions: In addition to ECE and PM, positive lymph nodes was the major pathological factor in patients receiving CRT compared to RT alone.

Evaluating malignant intraductal papillary mucinous neoplasm: A population-based study.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 324-324
Author(s):  
Carrie Luu ◽  
Rebecca A. Nelson ◽  
Byrne Lee ◽  
Gagandeep Singh ◽  
Joseph Kim
Keyword(s):  
Multivariate Analysis ◽  
Lymph Nodes ◽  
Intraductal Papillary Mucinous Neoplasm ◽  
Univariate Analysis ◽  
Survival Rates ◽  
Tumor Grade ◽  
Population Based ◽  
Curative Surgery ◽  
Mucinous Neoplasm ◽  
Invasive Ipmn

324 Background: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas has been increasingly recognized. Due to a paucity of evidence, the management and treatment of IPMN is still under debate. We hypothesize that with increased awareness, the incidence and resection rates for IPMN would increase. Using a population-based cancer registry, we examined incidence, prognostic factors, and survival for IPMN. Methods: Patients diagnosed with invasive IPMN from 1988 to 2009 were identified by the Surveillance, Epidemiology, and End Results (SEER) database. Patient demographics, clinical and pathologic factors, and therapies received (surgery and/or radiation) were analyzed. Survival was assessed by Kaplan-Meier method; Cox proportional hazard modeling was used for multivariate analysis. Results: 2,987 patients were identified. Over the study period, there was a decrease in age-adjusted incidence. The overall resection rate was 20.6% with an increase in annual rates of resection. On univariate analysis, age greater than 65 years, tumor location, poorly differentiated tumor grade, higher T stage, and positive lymph nodes predicted worse survival; more recent diagnosis, higher number of lymph nodes examined, and surgery were indicators of improved survival. On multivariate analysis, curative surgery remained predictive of survival. Patients who underwent surgery had median survival rates of 87, 18, and 14 months compared to 6, 7, and 5 months in the no surgery group for stages I, II, and III, respectively. Conclusions: Although recent reports show increasing incidence of IPMN, our study involving a population-based cohort demonstrates decreasing incidence of malignant IPMN. This may be accounted for by increased detection of non-malignant disease. It is imperative that we identify patients with invasive IPMN early so that they may benefit from the survival advantage conferred by curative resection.

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