scholarly journals The Multidisciplinary Treatment of Advanced Gallbladder Cancer to Disease-Free Survival: A Case Report

2021 ◽  
Author(s):  
Biao Zhang ◽  
Shuang Li ◽  
Zhaoyi Liu ◽  
Karieshinie Ghandalie Kalandika Peiris ◽  
Lifu Song ◽  
...  
Keyword(s):  
Lymph Node ◽  
Gallbladder Cancer ◽  
Lymph Node Metastases ◽  
Radical Surgery ◽  
Multidisciplinary Treatment ◽  
Disease Free Survival ◽  
Free Survival ◽  
Node Metastases ◽  
Advanced Gallbladder Cancer ◽  
Disease Free

Abstract Background: Gallbladder cancer is the most common malignant tumor in the biliary system and is characterized by strong aggressiveness and an extremely poor prognosis. Current treatment for advanced gallbladder cancer remains unsatisfactory. Here we reported a patient with stage IV gallbladder cancer who achieved disease-free survival by multidisciplinary treatment.Case presentation: A 73-year-old man presented to our hospital with right abdominal pain for 3 days and was diagnosed with advanced gallbladder cancer with multiple intrahepatic metastases and distant lymph node metastases. The patient initially received chemotherapy, targeted therapy, radioactive seed implantation, and immunotherapy as there was no specific indications for radical surgery. With the progression of these adjuvant therapies, the patient’s tumor makers gradually decreased but remained higher than normal, lymph node metastases gradually disappeared, and intrahepatic metastases were gradually limited to the left liver. Finally, the patient received a radical surgery of left hepatectomy with partial diaphragmatic resection and radical lymphadenectomy. To date, the patient has survived for more than six years post-treatment, and the level of tumor markers is normal and the imaging examination shows no signs of disease recurrence.Conclusion: The treatment of advanced gallbladder cancer remains pessimistic in the current medical arena. This successful case is an inspiration and we believe that multidisciplinary treatment can benefit patients with advanced gallbladder cancer and help them achieve long-term survival or even disease-free survival.

Prognostic Role of Lymph Node Metastases in Vulvar Cancer and Implications for Adjuvant Treatment

2012 ◽  
Vol 22 (3) ◽  
pp. 503-508 ◽  
Author(s):  
Linn Woelber ◽  
Christine Eulenburg ◽  
Matthias Choschzick ◽  
Andreas Kruell ◽  
Cordula Petersen ◽  
...  
Keyword(s):  
Lymph Node ◽  
Adjuvant Treatment ◽  
Lymph Node Metastases ◽  
Adjuvant Radiotherapy ◽  
Vulvar Cancer ◽  
Disease Free Survival ◽  
Free Survival ◽  
Node Negative ◽  
Node Metastases ◽  
Disease Free

ObjectiveLymph node metastases are the most important prognostic factor for recurrence and survival in vulvar cancer. However, information regarding the impact of the number of positive nodes in vulvar cancer is inconsistent, and so are recommendations when to apply adjuvant radiotherapy.MethodsOne hundred fifty-seven consecutive patients with primary squamous cell cancer of the vulva treated at our center were analyzed. All patients underwent primary surgery by triple incision resulting in complete tumor resection.ResultsMedian age was 61 years; 49 patients (31%) had lymph node metastases; 21 patients had 1, 13 had 2, and 15 had more than 2 positive lymph nodes. Thirty-two percent of the patients received adjuvant radiotherapy. The risk of lymph node metastases increased with age, greater tumor size, deeper invasion, and higher tumor grade. Median follow-up was 36 months; 23 patients (14.6%) developed disease recurrence (61% vulva, 35% groins, and 4% both). Compared with node-negative patients, survival in all node-positive patients was significantly impaired (P < 0.001; disease-free patients after 2 years: 88% in node-negative patients; 60%, 43%, and 29% in patients with 1, 2, and >2 affected nodes, respectively), whereas no significant difference between the node-positive subgroups could be demonstrated regarding disease-free survival. In multivariate analysis, lymph node status remained the most important prognostic factor regarding disease-free survival, but the effect of positive nodes differed significantly dependent on adjuvant treatment (P = 0.001). In patients without adjuvant radiotherapy to the groins/pelvis, the number of metastatic nodes was highly relevant for prognosis (hazard ratio, 1.752; P < 0.001), whereas this effect disappeared in patients who were treated with adjuvant radiotherapy (hazard ratio, 0.972; P = 0.828).ConclusionsThe negative impact of lymph node metastases is already evident in patients with only 1 affected lymph node. In patients receiving adjuvant radiotherapy, the negative effect of additional lymph node metastases is reduced; adjuvant treatment might therefore be beneficial in patients with only 1 positive node.

Analysis of lymphangiogenetic factors in invasive bladder cancer—A tissue microarray analysis

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15530-15530
Author(s):  
C. Wulfing ◽  
E. Herrmann ◽  
T. Kopke ◽  
E. Eltze ◽  
J. Neumann ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Lymph Node ◽  
Tissue Microarray ◽  
Lymph Node Metastases ◽  
Regional Lymph Node ◽  
Disease Free Survival ◽  
Free Survival ◽  
Tumor Stages ◽  
Node Metastases ◽  
Disease Free

15530 Introduction: Vascular endothelial growth factors (VEGF) -C, -D and their receptor Flt-4 play an emerging role in lymphangiogenesis of different tumor types. Our aim was to determine the role of VEGF-C, VEGF-D and Flt-4 in invasive transitional cell carcinoma of the bladder. Material and Methods: Archival tumor tissue of 286 patients, who had previously undergone radical cystectomy at our institution, was reviewed and representative tumor blocks were selected for constructing a tissue microarray (TMA). Paraffin sections were assessed immunohistochemically using mono- and polyclonal antibodies against VEGF-C, VEGF-D and Flt-4. Staining results were analysed semiquantitatively and correlated with various clinicopathological factors. Results: Overexpression of VEGF-C, VEGF-D and Flt-4 was found in 24.1%, 37.4% and 46.3% of cases, respectively. While there was no association of VEGF-C to histopathological parameters and clinical outcome, patients with VEGF-D overexpression had higher pathological tumor stages (p=0.021) and regional lymph node metastases (p=0.016). Furthermore, they had significantly worse disease-free survival (p=0.042). Overexpression of Flt-4 was found in the subgroup of G3- and G4-tumors (p=0.001) and correlated with a shorter period of disease- free survival (p=0.033). Conclusion: VEGF-C, VEGF-D and Flt-4 are overexpressed in bladder cancer. VEGF-D predicts higher tumor stages and regional lymph node metastases. It is associated with a worse disease-free survival as well as Flt-4 in the subgroup of high-grade tumors. Further studies should be initiated to evaluate VEGF-D and Flt-4 as potential targets in bladder cancer. No significant financial relationships to disclose.

The prognostic value of histopathologic grading parameters and microvessel density in patients with early squamous cell carcinoma of the uterine cervix.

2002 ◽  
Vol 12 (1) ◽  
pp. 32-41 ◽  
Author(s):  
M Graflund ◽  
B Sorbe ◽  
A Hussein ◽  
M Bryne ◽  
M Karlsson
Keyword(s):  
Lymph Node ◽  
Prognostic Factor ◽  
Squamous Cell ◽  
Microvessel Density ◽  
Lymph Node Metastases ◽  
Disease Free Survival ◽  
Lymph Node Status ◽  
Free Survival ◽  
Node Metastases ◽  
Disease Free

Abstract.Graflund M, Sorbe B, Hussein A, Bryne M, Karlsson M.The purpose of this study was to investigate the prognostic importance of clinical and histopathologic factors, including malignancy grading systems (MGS), partial index (PI), invasive front grading (IFG), and microvessel density. A complete geographic series of 172 early stage (FIGO I–II) cervical carcinomas treated by Wertheim-Meigs surgery during the period 1965–1990 was studied. The patients were followed up for at least 10 years. Significant prognostic factors for disease-free survival were lymph node status (P < 0.0000001), radical surgical margins (P = 0.00003), and tumor size (P = 0.008). In a multivariate Cox analysis it was shown that lymph node status was the single most important prognostic factor with regard to disease-free survival. The total MGS and the PI scores were highly significantly (P = 0.0001) associated with pelvic lymph node metastases and disease-free survival rate in squamous cell carcinomas. The MGS and the PI systems were superior to the IFG system in predicting lymph node metastases. The total IFG score was also a statistically highly significant (P = 0.003) prognostic factor with regard to disease-free survival in both univariate and multivariate analyses. Microvessel density was a nonsignificant prognostic factor. There was a highly significant (P = 0.002) association between vascular space invasion of tumor cells and the presence of lymph node metastases. In conclusion, histopathologic malignancy grading systems provide valuable prognostic information in patients with early stage squamous cell carcinomas of the uterine cervix.

The prognostic value of FDG-PET measured by standardized uptake value in patients with melanoma stage III evaluated in a prospective study

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20000-e20000
Author(s):  
E. Bastiaannet ◽  
J. R. De Jong ◽  
A. H. Brouwers ◽  
A. J. Suurmeijer ◽  
H. J. Hoekstra
Keyword(s):  
Lymph Node ◽  
Fdg Pet ◽  
Prognostic Value ◽  
Standardized Uptake Value ◽  
Disease Free Survival ◽  
Free Survival ◽  
Node Metastasis ◽  
Node Metastases ◽  
Melanoma Patients ◽  
Disease Free

e20000 Background: FDG-PET is a sensitive modality to detect melanoma metastases; melanomas are typically FDG-avid and melanoma shows an unpredictable pattern of spread. Furthermore, FDG-PET is able to quantify FDG uptake and the amount of FDG uptake, measured by the standardized uptake value (SUV), might be important for the prediction of disease specific survival (DSS) or disease free survival (DFS). Therefore, aim of this study was to perform a prospective analysis to determine whether SUV is of prognostic value in the DFS and DSS of melanoma patients with palpable lymph node metastases. Methods: From July 2002 until December 2007, all consecutive patients with palpable, histology or cytology proven lymph node metastases of melanoma referred to the University Medical Centre Groningen for examination with FDG-PET were prospectively included. The SUVmean (70% isocontour) and SUVmax in the lymph node metastasis were calculated for patients who showed no distant metastases on chest X-Ray, FDG-PET and CT. Univariate and multivariate survival analysis was performed to determine whether SUV was associated with DFS and DSS (Cox Proportional Hazard analysis). Results: Overall, 70 patients were eligible. High SUV values were present in axillary metastases (p=0.118), in patients who had more than 15 nodes removed (p=0.061) and in patients with a large tumor size in the lymph node (p=0.0001). Patients with a low SUVmean had a 3-years DFS of 54.3% as compared to 28.1% for patients with a high SUVmean (HR 2.02;p=0.051). In multivariate analysis SUVmean seems to be associated with DFS (p=0.063). DSS for patients with a high SUV was decreased, however not statistically significant (HR 1.71; p=0.182). Conclusions: The SUV in the lymph node metastasis seems to be associated with disease-free survival for melanoma patients clinically stage III. No significant financial relationships to disclose.

scholarly journals Applicability of sentinel lymph node oriented treatment strategy for gallbladder cancer

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0247079
Author(s):  
Koya Yasukawa ◽  
Akira Shimizu ◽  
Hiroaki Motoyama ◽  
Koji Kubota ◽  
Tsuyoshi Notake ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Gallbladder Cancer ◽  
Disease Free Survival ◽  
Free Survival ◽  
Node Disease ◽  
Local Lymph Node ◽  
The Relationship ◽  
Disease Free ◽  
Better Than

Background Utility of the sentinel lymph node (SLN) biopsy in some malignancies has been reported, however, research on that of gallbladder cancer (GBC) is rare. The aim of this study is to investigate whether the concept of SLN is applicable to T2/3 GBC. Methods A total of 80 patients who underwent resection for gallbladder cancer were enrolled in this study. Patients with GBC were stratified into two groups based on the location of tumor, peritoneal-side (T2p or 3p) and hepatic-side (T2h or 3h) groups. We evaluated the relationship between cystic duct node (CDN) and downstream lymph node (LN) status. CDN was defined as a SLN in this study. Results Thirty-eight patients were classified into T2, including T2p (n = 18) and T2h (n = 20), and 42 patients into T3, including T3p (n = 22) andT3h (n = 20). The incidence of LN metastasis was significantly higher in hepatic-side than peritoneal-side in both T2 and T3 (P = 0.036 and 0.009, respectively). In T2, 14 T2p had negative CDN and downstream LN, however, three T2h had negative CDN and positive downstream LNs (defined as a skipped LN metastasis) (P = 0.043). In T3, patients with skipped LN metastasis were significantly higher in T3h (n = 11) than those in T3p (n = 2) (P<0.001). There was no recurrence of the local lymph node. Disease-free survival in the T2p and T3p were significantly better than those in the T2h and T3h (P = 0.005 and 0.025, respectively). Conclusion The concept of SLN can be applicable to T2p GBC, where the downstream LNs dissection can be omitted.

Present Status of Treatment for Invasive Cervical Carcinoma

1979 ◽  
Vol 65 (5) ◽  
pp. 611-624 ◽  
Author(s):  
Fabio Volterrani ◽  
Giampiero Prosperini ◽  
Davide Sigurtà ◽  
Stefania Vona ◽  
Renato Musumeci ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastases ◽  
Postoperative Radiotherapy ◽  
Disease Free Survival ◽  
Stage Ii ◽  
Term Survival ◽  
Stage Ib ◽  
Retrospective Clinical Study ◽  
Node Metastases ◽  
Disease Free

The results are presented of a retrospective clinical study carried out on 341 patients affected with cancer of the uterine cervix, with lymphography in the pretreatment diagnostic work-up, treated in our Institute from January 1961 to December 1976. The clinical classification of the patients studied was: 157 cases in Stage I (46.0%), 95 cases in Stage II (27.9%), and 89 cases in Stages III and IV (26.1%). During the period considered, the therapeutic approach for carcinoma of the cervix was practically constant and in line with the therapeutic policy most frequently followed for these neoplasms. For the early stages (9/341 patients or 27.6%) preference was given to a radical surgery and postoperative radiotherapy combination; for borderline cases and « bulky » and « barrel-shaped » lesions, radiotherapy usually preceded surgical treatment to enlarge its indications and improve its results (36/341 patients or 10.5%). The cases that were more developed locally or that presented contraindications to surgery received radiological treatment alone (211/341 patients or 61.9%). Radiotherapy treatment consisted of radium therapy performed with a single application of 226Ra conventional sources, followed by percutaneous irradiation with 60Co-teletherapy in the more developed cases and/or in the presence of lymph node metastases. All the patients were submitted to diagnostic lymphography at the onset of the treatment and 92 (26.9%) had lymph node metastases. In the framework of this clinical review, the 5-year disease-free survival from onset of the treatment varied from 88.2% for the cases at Stage Ib occult, 72.5% for the cases at Stage Ib, 63.8% for the Stage II cases, to 40.5% for the cases at Stages III and IV. The presence of a pathologic report at lymphography makes a considerable difference in terms of disease-free, long-term survival after treatment.

scholarly journals Prognostic Value of Histological Grading in Noninflammatory Canine Mammary Carcinomas in a Prospective Study With Two-Year Follow-Up

2012 ◽  
Vol 50 (1) ◽  
pp. 94-105 ◽  
Author(s):  
L. Peña ◽  
P. J. De Andrés ◽  
M. Clemente ◽  
P. Cuesta ◽  
M. D. Pérez-Alenza
Keyword(s):  
Overall Survival ◽  
Lymph Node ◽  
Histological Grade ◽  
Clinical Stage ◽  
Disease Free Survival ◽  
Histological Grading ◽  
Free Survival ◽  
Node Metastases ◽  
Disease Free

In this prospective study, a canine-adapted histological grading method was compared with histopathological and clinical characteristics and was evaluated as a prognostic indicator in canine mammary carcinomas (CMCs). Recruited dogs with at least 1 malignant mammary tumor ( n = 65) were clinically evaluated, surgically treated, and followed up (minimum follow-up 28 months, maximum 38 months). Histopathological diagnoses were performed according to Goldschmidt et al (2011). Tumors were graded as grade I (29/65), grade II (19/65), and grade III (17/65). The tumor size, clinical stage, histological diagnosis, presence/absence of myoepithelial proliferation, and regional lymph node metastases at diagnosis were significantly associated with histological grade. The histological grade, age, clinical stage, tumor subtype group, and lymph node metastases at time of diagnosis were significantly associated with the development of recurrences and/or metastases, cancer-associated death, and survival times (disease-free survival and overall survival) in univariate analyses. A subdivision of clinical stage I (T1N0M0) into stages IA and IB was proposed in terms of prognosis. The clinical stage, histological grade, and spay status were selected as independent prognostic variables (multivariate analyses) with disease-free survival as the dependent variable. When overall survival was evaluated as a dependent variable, clinical stage and histological grade were selected as the independent covariates. This grading system is a useful prognostic tool, facilitates histological interpretation, and offers uniform criteria for veterinary pathologists. Comparative studies on CMCs performed in different countries should take into account possible changes in the prognoses due to different proportions of spayed females among the selected dog population.

Gender-Specific Prognostic Markers of Patients with Gallbladder Cancer after Surgical Resection

2010 ◽  
Vol 76 (11) ◽  
pp. 1269-1274 ◽  
Author(s):  
Xiao-Dong He ◽  
Wei Liu ◽  
Lian-Yuan Tao ◽  
Lei Cai ◽  
Li Zhou ◽  
...  
Keyword(s):  
Lymph Node ◽  
Gallbladder Cancer ◽  
Surgical Resection ◽  
Curative Resection ◽  
Disease Free Survival ◽  
Term Survival ◽  
Free Survival ◽  
Female Patients ◽  
Gender Specific ◽  
Disease Free

The aim of this study was to elucidate gender-specific markers for postresectional long-term survival of gallbladder cancer (GBC) based on a cohort of Chinese patients. Clinicopathological records of 81 patients (27 males and 54 females) after surgical resection for GBC were reviewed retrospectively. The influence of each variable on survival was determined using the Kaplan-Meier method and log-rank test. For females, Cox regression analysis was also adopted. Univariate analysis showed that the absence of lymph node and distant metastases, differentiation grade, and curative resection were associated with prolonged survival for all males, whereas tumor size, differentiation grade, and the presence of lymph node metastases influenced the overall or disease-free survival of patients after curative resection (all P < 0.05). On the other hand, Nevin stage was an independent marker for both overall survival for all females and overall and disease-free survival for female patients who underwent curative resection. Additionally, resection type and differentiation grade were of independent prognostic significance for different subgroups of females (all P < 0.05). Our data suggested that tumor-related factors affect prognosis of both male and female patients with GBC after resection. Of these factors, tumor differentiation status might be more significant for males, but Nevin stage had a stronger predictive potential for females.

scholarly journals Prophylactic Central Lymph Node Dissection Improves Disease-Free Survival in Patients with Intermediate and High Risk Differentiated Thyroid Carcinoma: A Retrospective Analysis on 399 Patients

Cancers ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1658
Author(s):  
Fabio Medas ◽  
Gian Canu ◽  
Federico Cappellacci ◽  
Giacomo Anedda ◽  
Giovanni Conzo ◽  
...  
Keyword(s):  
Lymph Node ◽  
High Risk ◽  
Disease Free Survival ◽  
Node Dissection ◽  
Central Lymph Node ◽  
Free Survival ◽  
Central Lymph Node Dissection ◽  
Node Metastases ◽  
Central Lymph ◽  
Disease Free

The role of prophylactic central lymph node dissection (pCLND) in the treatment of differentiated thyroid cancer (DTC) is controversial and still a matter of debate. The primary outcome of our study was to assess whether pCLND is effective in reducing the incidence of recurrent disease, and the secondary goal was to estimate the incidence of postoperative complications in patients who underwent pCLND and to evaluate the prognostic value of occult node metastases. In this retrospective study, we included patients with preoperative diagnosis of DTC and clinically uninvolved lymph nodes (cN0). The patients were divided into two groups, depending on the surgical approach: total thyroidectomy alone (TT group) or total thyroidectomy and pCLND (pCLND group). Three hundred and ninety-nine patients were included in this study, 320 (80.2%) in the TT group and 79 (19.8%) in the pCLND group. There were no significant differences in morbidity among the two groups. Histopathological evaluation demonstrated a similar distribution of aggressive features, especially regarding multicentricity, extrathyroidal extension, and angioinvasivity between the two groups. Occult lymph node metastases were found in 20 (25.3%) patients in the pCLND group. Prophylactic CLND was effective in improving disease-free survival in patients with intermediate and high risk of disease recurrence (p = 0.0392); occult lymph node metastases resulted as a significant negative prognostic factor (p < 0.001).

scholarly journals Tumour-Infiltrating Lymphocytes (TILs) and PD-L1 Expression Correlate with Lymph Node Metastasis, High-Grade Transformation and Shorter Metastasis-Free Survival in Patients with Acinic Cell Carcinoma (AciCC) of the Salivary Glands

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 965
Author(s):  
Selina Hiss ◽  
Markus Eckstein ◽  
Patricia Segschneider ◽  
Konstantinos Mantsopoulos ◽  
Heinrich Iro ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Node Metastases ◽  
Immune Cell ◽  
High Grade ◽  
Free Survival ◽  
Node Metastasis ◽  
Node Metastases ◽  
High Grade Transformation ◽  
Infiltrating Lymphocytes

Objectives: The aim of this study was to assess the number of tumour-infiltrating lymphocytes (TILs) and the expression of Programmed Cell Death 1 Ligand 1 (PD-L1) in Acinic Cell Carcinoma (AciCC) of the salivary glands, to enable a correlation with clinico-pathological features and to analyse their prognostic impact. Methods: This single centre retrospective study represents a cohort of 36 primary AciCCs with long-term clinical follow-up. Immunohistochemically defined immune cell subtypes, i.e., those expressing T-cell markers (CD3, CD4 and CD8) or a B-cell marker (CD20) were characterized on tumour tissue sections. The number of TILs was quantitatively evaluated using software for digital bioimage analysis (QuPath). PD-L1 expression on the tumour cells and on immune cells was assessed immunohistochemically employing established scoring criteria: tumour proportion score (TPS), Ventana immune cell score (IC-Score) and combined positive score (CPS). Results: Higher numbers of tumour-infiltrating T- and B- lymphocytes were significantly associated with high-grade transformation. Furthermore, higher counts of T-lymphocytes correlated with node-positive disease. There was a significant correlation between higher levels of PD-L1 expression and lymph node metastases as well as the occurrence of high-grade transformation. Moreover, PD-L1 CPS was associated with poor prognosis regarding metastasis-free survival (p = 0.049). Conclusions: The current study is the first to demonstrate an association between PD-L1 expression and lymph node metastases as well as grading in AciCCs. In conclusion, increased immune cell infiltration of T and B cells as well as higher levels of PD-L1 expression in AciCC in association with high-grade transformation, lymph node metastasis and unfavourable prognosis suggests a relevant interaction between tumour cells and immune cell infiltrates in a subset of AciCCs, and might represent a rationale for immune checkpoint inhibition.

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