Survival Impact of Primary Tumor Lymph Node Status and Circulating Tumor Cells in Patients with Colorectal Liver Metastases

575 Background: Response to neoadjuvant therapy in the primary tumor and nodal metastasis predicts benefit to patients as shown in several large clinical trials. We have previously shown that changes in tumor blood flow (BF) measured by [15O]-water PET predict pathologic primary tumor response. We now test whether primary tumor blood flow changes also predict axillary nodal metastases response and post-therapy lymph node status among women with locally advanced breast cancer (LABC) receiving neoadjuvant chemotherapy. Methds: Fifty-five women with a primary diagnosis of LABC underwent dynamic [15O]-water PET scans prior to and at midpoint of neoadjuvant chemotherapy. We evaluated associations between tumor BF changes and pathologic primary tumor response: categorized as complete (CR), partial (PR) or no response (NR). We also assessed the relationship between primary tumor BF changes and post-therapy axillary lymph node status, categorizing the high risk (HR) group as 4+ nodes with extracapsular extension (ECE, n=12) versus the lower risk (LR) group with either fewer than 4+ nodes or without ECE (n=43). Results: The median changes in BF versus tumor response were: CR = -77%, PR = -40%, and, NR = +20% (P = <0.001). For axillary node response, the median BF change among HR patients was +20% versus - 49% among LR patients (P = 0.004). Eight of 17 patients with an increase in tumor blood flow were HR whereas 4/38 patients with decreased tumor blood flow were HR (P = 0.002). Conclusions: Change in primary tumor blood flow over the course of neoadjuvant chemotherapy predicts pathologic response to treatment with a substantial decrease observed among CRs. An increase in primary tumor BF with treatment portends significant residual primary tumor and a nearly 50% chance of very high-risk nodal disease post-therapy. No significant financial relationships to disclose.

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Prediction of Axillary Lymph Node Status of Breast Cancer Patients by Tumorbiological Factors of the Primary Tumor

Strahlentherapie und Onkologie ◽

10.1007/s00066-005-1374-y ◽

2005 ◽

Vol 181 (9) ◽

pp. 580-586 ◽

Cited By ~ 11

Author(s):

Tanja Fehm ◽

Holger Maul ◽

Sigrun Gebauer ◽

Alexander Scharf ◽

Peter Baier ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Cancer Patients ◽

Primary Tumor ◽

Axillary Lymph Node ◽

Lymph Node Status ◽

Axillary Lymph ◽

Axillary Lymph Node Status ◽

Breast Cancer Patients ◽

Node Status

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Assessment of role of eosinophils in the progression of tongue carcinoma

Asian Journal of Medical Sciences ◽

10.3126/ajms.v7i5.15037 ◽

2016 ◽

Vol 7 (5) ◽

pp. 17-21 ◽

Cited By ~ 1

Author(s):

Kaveri Hallikeri ◽

Swetha Acharya ◽

Shilpa Chatni ◽

Darshika Gandhi ◽

BR Patil

Keyword(s):

Lymph Node ◽

Tumor Cells ◽

Squamous Cell ◽

Radical Neck Dissection ◽

Tumor Thickness ◽

Lymph Node Status ◽

Invasive Front ◽

Chi Square ◽

Node Status ◽

Group I

Background: Tumor associated tissue eosinophilia (TATE) is known as stromal infiltration of eosinophils in the stroma of tumor not associated with tumor necrosis or ulceration. It has been described in a variety of neoplasms, but the role in oral squamous cell carcinoma (OSCC) of tongue has not yet been clearly defined. Association of TATE with OSCC has shown variable results ranging from favorable to unfavorable or even no influence on prognosis.Aims and Objectives: The aim of the present study was to correlate TATE with histopathological grades, lymph node status, tumor thickness and nature of tumor cells at the invasive front in OSCC of tongue.Material and Methods: Retrospectively fifty six cases of OSCC of tongue treated with radical neck dissection were included, which were divided into Group I consists 22 cases (lymph node with metastasis) & Group II consists 34 cases (lymph node without metastasis). H & E stained sections were used to analyze TATE and compared with histopathological grades, lymph node status, tumor thickness and nature of invasive front. Statistical analysis was done using Chi-square test.Results: TATE did not have any significant association with histopathological grades, lymph node status and nature of tumor cells at invasive front. But, tumor thickness and presence of eosinophils showed significant association. Also as the tumor thickness increased, the cells were more discohesive at the invasive front region.Conclusion: Microenvironment of tumor significantly contributes in the tumor progression. Tumor thickness, nature of tumor cells at the invasive front and TATE together can help in assessing the behavior of tongue squamous cell carcinoma.Asian Journal of Medical Sciences Vol.7(5) 2016 17-21

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Circulating Tumor Cells and Prognosis of Patients with Resectable Colorectal Liver Metastases or Widespread Metastatic Colorectal Cancer: A Meta-Analysis

Annals of Surgical Oncology ◽

10.1245/s10434-013-2907-8 ◽

2013 ◽

Vol 20 (7) ◽

pp. 2156-2165 ◽

Cited By ~ 78

Author(s):

Bas Groot Koerkamp ◽

Nuh N. Rahbari ◽

Markus W. Büchler ◽

Moritz Koch ◽

Jürgen Weitz

Keyword(s):

Colorectal Cancer ◽

Liver Metastases ◽

Metastatic Colorectal Cancer ◽

Tumor Cells ◽

Circulating Tumor Cells ◽

Colorectal Liver Metastases ◽

Meta Analysis

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The Prognostic Value of the Primary Tumor's Nodal Status after Surgery for Colorectal Liver Metastases in the Era of Effective Systemic Therapy

Digestive Surgery ◽

10.1159/000381755 ◽

2015 ◽

Vol 32 (3) ◽

pp. 208-216 ◽

Cited By ~ 4

Author(s):

Eric P. van der Stok ◽

Dirk J. Grünhagen ◽

Wijnand J. Alberda ◽

Maxime Reitsma ◽

Joost Rothbarth ◽

...

Keyword(s):

Colon Cancer ◽

Lymph Node ◽

Adjuvant Chemotherapy ◽

Systemic Therapy ◽

Primary Tumor ◽

Prognostic Value ◽

Colorectal Liver Metastases ◽

Nodal Status ◽

Lymph Node Status ◽

Primary Colon

Background: The nodal status of primary colorectal cancer is of prognostic value for survival after the resection for colorectal liver metastases (CRLM). However, in the past decade, effective adjuvant chemotherapy for lymph node positive primary colon cancer was introduced. This study evaluated the prognostic value of primary lymph node status in patients with resectable metachronous CRLM in the era of effective systemic therapy. Methods: Between January 2000 and December 2011, all consecutive patients undergoing curative liver resection for CRLM were retrospectively analyzed. Overall survival (OS) was analyzed by the localization of the primary tumor (colon vs. rectum) and by lymph node status (positive vs. negative) of the primary tumor. Results: A total of 286 patients with metachronous CRLM's were selected. Five-year OS was similar for colon and rectal primaries (42 and 40%, p = 0.62). Lymph node positivity was only a prognostic factor in rectal primaries (N+ 32% vs. N0 49%, p = 0.04) and not in colon primaries (N+ 42% vs. N0 41%, p = 0.99). In multivariate analysis, these results were confirmed. Conclusion: The current study demonstrates that the nodal status of primary colon malignancies does not have prognostic value in patients undergoing resection for metachronous CRLM. A possible explanation might be the administration of effective adjuvant chemotherapy in node positive colon cancer.

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The anatomic localization of circulating tumor cells and the immediate impact of surgery and radiofrequency ablation

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e22004 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e22004-e22004

Author(s):

L. Jiao ◽

C. Apostolopoulos ◽

J. Jacob ◽

N. Johnson ◽

N. Tsim ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Liver Metastases ◽

Tumor Cells ◽

Circulating Tumor Cells ◽

Open Surgery ◽

Colorectal Liver Metastases ◽

Surgical Interventions ◽

Resection Of Metastases ◽

Few Data ◽

The Impact

e22004 Background: There are few data on the impact of immediate and differing surgical interventions on circulating tumor cells (CTCs), nor their compartmentalization or localization in different anatomic vascular sites. Methods: CTCs from consecutive patients with colorectal liver metastases were quantitated prior to and immediately after open surgery, laparoscopic resection, open radiofrequency ablation (RFA) or percutaneous RFA. For individuals undergoing open surgery, either hepatic resections or open RFA, CTCs were examined in both systemic and portal circulation by measuring CTCs in samples derived from the peripheral vein, an artery, the portal vein and hepatic vein. Results: A total of 29 consecutive patients with colorectal liver metastases were included with a median age of 55 (range 30 - 88 years). CTCs were localized to the hepatic portosystemic macrocirculation with significantly greater numbers than in the systemic vasculature. Surgical procedures led to a statistically significant fall in CTCs at all sites measured (p<0.05). Conversely, RFA, either open or percutaneous was associated with an increase in CTCs. Conclusions: Surgical resection of metastases but not RFA decreases CTC levels. In patients with colorectal liver metastases, CTCs are localized to the hepatic (and probably pulmonary) macrocirculations. This may explain why metastases in sites other than the liver and lungs, are infrequently observed in cancer. No significant financial relationships to disclose.

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The Carcinoma–Stromal Ratio of Colon Carcinoma Is an Independent Factor for Survival Compared to Lymph Node Status and Tumor Stage

Analytical Cellular Pathology ◽

10.1155/2007/175276 ◽

2007 ◽

Vol 29 (5) ◽

pp. 387-398 ◽

Cited By ~ 2

Author(s):

Wilma E. Mesker ◽

Jan M. C. Junggeburt ◽

Karoly Szuhai ◽

Pieter de Heer ◽

Hans Morreau ◽

...

Keyword(s):

Colon Cancer ◽

Lymph Node ◽

Primary Tumor ◽

Independent Study ◽

Stage I ◽

Individual Risk ◽

Lymph Node Status ◽

Cox Regression Analysis ◽

Candidate Marker ◽

Node Status

Background: Tumor staging insufficiently discriminates between colon cancer patients with poor and better prognosis. We have evaluated, for the primary tumor, if the carcinoma-percentage (CP), as a derivative from the carcinoma-stromal ratio, can be applied as a candidate marker to identify patients for adjuvant therapy. Methods: In a retrospective study of 63 patients with colon cancer (stage I–III, 1990–2001) the carcinoma-percentage of the primary tumor was estimated on routine H&E stained histological sections. Additionally these findings were validated in a second independent study of 59 patients (stage I–III, 1980–1992). (None of the patients had received preoperative chemo- or radiation therapy nor adjuvant chemotherapy.) Results: Of 122 analyzed patients 33 (27.0%) had a low CP and 89 (73.0%) a high CP. The analysis of mean survival revealed: overall-survival (OS) 2.13 years, disease-free- survival (DFS) 1.51 years for CP-low and OS 7.36 years, DFS 6.89 years for CP-high. Five-year survival rates for CP-low versus CP-high were respectively for OS: 15.2% and 73.0% and for DFS: 12.1% and 67.4%. High levels of significance were found (OS p < 0.0001, DFS p < 0.0001) with hazard ratio’s of 3.73 and 4.18. In a multivariate Cox regression analysis, CP remained an independent variable when adjusted for either stage or for tumor status and lymph-node status (OSp < 0.001, OSp < 0.001). Conclusions: The carcinoma-percentage in primary colon cancer is a factor to discriminate between patients with a poor and a better outcome of disease. This parameter is already available upon routine histological investigation and can, in addition to the TNM classification, be a candidate marker to further stratify into more individual risk groups.

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Unique Localization of Circulating Tumor Cells in Patients With Hepatic Metastases

Journal of Clinical Oncology ◽

10.1200/jco.2009.24.5837 ◽

2009 ◽

Vol 27 (36) ◽

pp. 6160-6165 ◽

Cited By ~ 61

Author(s):

Long R. Jiao ◽

Christos Apostolopoulos ◽

Jimmy Jacob ◽

Richard Szydlo ◽

Natalia Johnson ◽

...

Keyword(s):

Liver Metastases ◽

Tumor Cells ◽

Circulating Tumor Cells ◽

Open Surgery ◽

Colorectal Liver Metastases ◽

Hepatic Metastases ◽

Surgical Interventions ◽

Hepatic Portal ◽

Few Data ◽

The Impact

Purpose There are few data on the impact of immediate and differing surgical interventions on circulating tumor cells (CTCs), nor their compartmentalization or localization in different anatomic vascular sites. Patients and Methods CTCs from consecutive patients with colorectal liver metastases were quantified before and immediately after open surgery, laparoscopic resection, open radiofrequency ablation (RFA), or percutaneous RFA. For individuals undergoing open surgery, either hepatic resections or open RFA, CTCs were examined in both systemic and portal circulation by measuring CTCs in samples derived from the peripheral vein, an artery, the hepatic portal vein, and the hepatic vein. Results A total of 29 consecutive patients with colorectal liver metastases with a median age of 55 years (range, 30 to 88 years) were included. CTCs were localized to the hepatic portosystemic macrocirculation with significantly greater numbers than in the systemic vasculature. Surgical procedures led to a statistically significant fall in CTCs at multiple sites measured. Conversely, RFA, either open or percutaneous, was associated with a significant increase in CTCs. Conclusion Surgical resection of metastases, but not RFA, immediately decreases CTC levels. In patients with colorectal liver metastases, CTCs appear localized to the hepatic (and pulmonary) macrocirculations. This may explain why metastases in sites other than the liver and lungs are infrequently observed in cancer.

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