scholarly journals Prognostic Significance of Number of Lymph Nodes Harvested in Patients with Node Negative Antral Gastric Adenocarcinoma Undergoing Laparoscopic Curative Resection

2020 ◽  
Author(s):  
Ümit Mercan ◽  
Ogün Eren ◽  
Cemil Yüksel ◽  
Salim Demirci
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Gastric Adenocarcinoma ◽  
Disease Free Survival ◽  
Free Survival ◽  
Node Negative ◽  
T Stage ◽  
Patient Prognosis ◽  
Clinicopathological Variables ◽  
Disease Free

Introduction: The most important parameters affecting patient prognosis in gastric cancer are the T stage and regional lymph node invasion. Although it is known that lymph node positive patients have poor long-term survival and recurrence and metastasis rates are higher than patients with lymph node negative, recurrence and metastasis may also develop in lymph node negative patients. Studies have found that the most likely causes of this situation are mictometastases which cannot be detected in routine pathological examination and the inability to remove a sufficient number of lymph nodes. There is no clear consensus regarding the number of lymph nodes to be removed and there are very few studies in the literature on this subject. Aim: To determine the effect of the number of lymph nodes harvested in laparoscopically resected, lymph node negative, early stage antral gastric adenocarcinoma on patient prognosis. Materials and Methods: A retrospective study was conducted from January 2015 to January 2020 in which 62 patients with pT1N0, pT2N0 and pT3N0 tumour located in gastric antrum were included. Distal gastrectomy, partial omentectomy and lymph node dissection were performed to all patients. The number of lymph nodes harvested were determined from pathology reports. The patients were divided into two groups according to the number of lymph nodes as below 15 or above 15 and clinicopathological variables and overall and disease-free survival rates were compared between these two groups. X2 or Fisher-Exact test and Student-T or Mann-Whitney U test were used for comparing clinicopathological variables and Kaplan-Meier survival curves and Cox regression model for survival analysis. All p-values less than 0.05 were considered statistically significant. Results: It has been found that the mean overall survival in groups with lymph node removal ≥ and <15 was 55.07±2.28 (95% CI: 50.60 ~ 59.55) months and 34.80±4.26 (95% CI: 26.43 ~ 43.17) months and mean disease-free survival was 59.43±1.10 (95% CI: 57.26 ~ 61.59) months and 27.85±4.19 (95% CI: 19.63 ~ 36.07) months, respectively. The difference was statistically significant (p=0.001, p=0.002). Conclusion: Present study concludes that removal of a minimum of 15 lymph nodes in radical gastrectomy and lymphadenectomy is effective on overall and disease-free survival, regardless of the T stage. In addition, removal of 15 or more lymph nodes can provide more accurate and appropriate staging and affect patients’ decision to be directed towards adjuvant therapy.

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.

Prognostic impact of lymph node retrieval and ratio in gastric cancer: A single-center U.S. experience.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 17-17
Author(s):  
Joyce Wong ◽  
Shams Rahman ◽  
Nadia Saeed ◽  
Hui-Yi Lin ◽  
Khaldoun Almhanna ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Ratio ◽  
Disease Free Survival ◽  
Prognostic Impact ◽  
Free Survival ◽  
Lymph Node Retrieval ◽  
Node Ratio ◽  
Disease Free

17 Background: Recommendations for extended lymphadenectomy in gastric cancer is thought to be associated with improved overall survival (OS), although defining adequate lymphadenectomy remains controversial. Methods: A single-institution, prospectively-maintained database of patients referred for surgical care of gastric cancer was reviewed. Patients were stratified by number of examined lymph nodes (eLN): <5, 6-10, 11-15, and >15 and positive LNs (LN+) stratified by 0, 1-2, 3-6, 7-15, and >15. Lymph node ratio (LN+:eLN) was evaluated, stratified by 0, 0.01-0.2, 0.21-0.5, and >0.5. Disease-free-survival (DFS) and OS were the primary endpoints, determined by Kaplan-Meier analyses. Results: From 1997-2012, 222 patients were included; most were male (N=122, 55%) with median age 67 (range 17-92) years. Of 220 (99%) patients surgically explored, 164 (74%) ultimately underwent resection. Median OS of the entire cohort was 22 months. Gender, ethnicity, and smoking status did not impact OS. Pathologic factors such as perineural invasion, lymphovascular invasion, and poor differentiation adversely affected OS, P<0.05. A median 14 lymph nodes (LN) were retrieved (range 0-45), with a median of one positive LN (range 0-31). No OS or disease-free survival (DFS) difference was observed when comparing <5, 6-10, 11-15, and >15 eLN, P=0.30. LN+ affected both OS and DFS: median OS was 52 months for 0 LN+ and decreased to 21 months with 1-2 LN+, 34 months 3-6 LN+, 25 months 7-15 LN+, and 11.5 months with >15 LN+. Similarly, median DFS decreased from 35 months with 0 LN+ to 19 months with 1-2 LN+, 9 months with 3-6 LN+, 13.5 months with 7-15 LN+, and 7.5 months with >15 LN+. Lymph node ratio demonstrated worse median OS with increasing ratio: 49 months for ratio of 0, 37 months for 0.01-0.2, 27 months for 0.21-0.5, and 12 months for >0.5, P<0.0001. DFS was similar: 35months for ratio of 0, 22 months for 0.01-0.2, 13 months for 0.21-0.5, and 7 months for >0.5, P<0.0001. Conclusions: Extent of lymphadenectomy does not impact OS or DFS. Presence of LN+ adversely impacts OS and DFS. Lymph node ratio may be a better prognostic indicator than number of eLN or LN+ in gastric cancer.

Neck Dissections Based on Sentinel Lymph Node Navigation Versus Elective Neck Dissections in Early Oral Cancers: A Randomized, Multicenter, and Noninferiority Trial

2021 ◽  
pp. JCO.20.03637
Author(s):  
Yasuhisa Hasegawa ◽  
Kiyoaki Tsukahara ◽  
Seiichi Yoshimoto ◽  
Kouki Miura ◽  
Junkichi Yokoyama ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lymph Node ◽  
Survival Rate ◽  
Sentinel Lymph Node ◽  
Lower Limit ◽  
Disease Free Survival ◽  
Sentinel Lymph Nodes ◽  
Free Survival ◽  
Node Negative ◽  
Disease Free

PURPOSE This study aimed to compare patients with early oral cavity squamous cell carcinoma (OCSCC) (tumor category [T] 1-2, node-negative, and no distant metastasis) treated with traditional elective neck dissection (ND) with those managed by sentinel lymph node biopsy (SLNB) using survival and neck function and complications as end points. METHODS Sixteen institutions in Japan participated in the study (trial registration number: UMIN000006510). Patients of age ≥ 18 years with histologically confirmed, previously untreated OCSCC (Union for International Cancer Control TNM Classification of Malignant Tumors 7th edition T1-2, node-negative no distant metastasis), with ≥ 4 mm (T1) depth of invasion, were randomly assigned to undergo standard selective ND (ND group; n = 137) or SLNB-navigated ND (SLNB group; n = 134). The primary end point was the 3-year overall survival rate, with a 12% noninferiority margin; secondary end points included postoperative neck functionality and complications and 3-year disease-free survival. Sentinel lymph nodes underwent intraoperative multislice frozen section analyses for the diagnosis. Patients with positive sentinel lymph nodes underwent either one-stage or second-look ND. RESULTS Pathologic metastasis-positive nodes were observed in 24.8% (34 of 137) and 33.6% (46 of 134) of patients in the ND and SLNB groups, respectively ( P = .190). The 3-year overall survival in the SLNB group (87.9%; lower limit of one-sided 95% CI, 82.4) was noninferior to that in the ND group (86.6%; lower limit 95% CI, 80.9; P for noninferiority < .001). The 3-year disease-free survival rate was 78.7% (lower limit 95% CI, 72.1) and 81.3% (75.0) in the SLNB and ND groups, respectively ( P for noninferiority < .001). The scores of neck functionality in the SLNB group were significantly better than those in the ND group. CONCLUSION SLNB-navigated ND may replace elective ND without a survival disadvantage and reduce postoperative neck disability in patients with early-stage OCSCC.

Number of lymph nodes recovered as an independent prognostic factor in predicting outcome in patients with pathologically node-negative rectal cancer following preoperative chemo/radiotherapy.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 606-606 ◽  
Author(s):  
Sree Lakshmi Rodda ◽  
Amandeep Singh Dhadda ◽  
Peter D. Dickinson ◽  
Abed M Zaitoun ◽  
Eric M Bessell
Keyword(s):  
Rectal Cancer ◽  
Multivariate Analysis ◽  
Lymph Nodes ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Free Survival ◽  
Node Negative ◽  
Disease Free

606 Background: To determine the importance of number of lymph nodes recovered on outcome in pathological node negative rectal cancer patients who had received chemo/radiotherapy prior to surgery. Methods: We retrospectively analysed data from 262 patients with locally advanced rectal cancer who received pre-operative chemo/radiotherapy at Castle Hill Hospital, Cottingham and Nottingham University Hospital between 2001 and 2008. Patients were treated with CT planned radiotherapy to a dose of 45-50 Gy in 25 fractions with concurrent fluoropyrimidine chemotherapy. Surgery was normally performed at an interval of 6-8 weeks. There were 152 patients who were found to be pathologically node negative for further analysis. Median follow-up was 51.5 months Patients were grouped into < 10 nodes recovered or > 10 nodes recovered. Disease free survival (DFS) and overall survival (OS) was assessed using Log rank test. Multivariate analysis was performed using Cox-regression analysis. Results: Of the 152 patients analysed, 67.1 % (n=102 ) had fewer than 10 nodes recovered and 32.8% (n=50) had greater than 10 nodes recovered. The median number of nodes recovered was 7 (range 0-39). There was a improvement in 5 year DFS and OS in group who had more than 10 nodes recovered compared to group with less than 10 nodes recovered ( DFS at 5yrs :86.5% vs. 61.5%, p=0.01, OS at 5 yrs : 77.8% vs. 67.4% , P =0.059). On multivariate analysis pathological T-stage , circumferential resection margin (CRM) status and number of lymph nodes recovered were found to be independent predictors of disease free survival (p=0.002). Conclusions: The number of lymph nodes retrieved following surgery for locally advanced rectal cancer patients following chemo/radiotherapy is an independent prognostic factor in pathologically node negative patients. This may need to be considered when making subsequent adjuvant chemotherapy decisions.

scholarly journals Sentinel Node Biopsy after Neoadjuvant Chemotherapy for Breast Cancer: Preliminary Experience with Clinically Node Negative Patients after Systemic Treatment

2021 ◽  
Vol 11 (3) ◽  
pp. 172
Author(s):  
Alejandro Martin Sanchez ◽  
Daniela Terribile ◽  
Antonio Franco ◽  
Annamaria Martullo ◽  
Armando Orlandi ◽  
...  
Keyword(s):  
Lymph Node ◽  
False Negative ◽  
Neoadjuvant Treatment ◽  
Disease Free Survival ◽  
Lymph Node Biopsy ◽  
Axillary Lymph ◽  
Free Survival ◽  
Oncological Outcomes ◽  
Node Biopsy ◽  
Disease Free

Sentinel lymph node biopsy (SLNB) following neoadjuvant treatment (NACT) has been questioned by many studies that reported heterogeneous identification (IR) and false negative rates (FNR). As a result, some patients receive axillary lymph node dissection (ALND) regardless of response to NACT, leading to a potential overtreatment. To better assess reliability and clinical significance of SLNB status on ycN0 patients, we retrospectively analyzed oncological outcomes of 399 patients treated between January 2016 and December 2019 that were either cN0-ycN0 (219 patients) or cN1/2-ycN0 (180 patients). The Endpoints of our study were to assess, furthermore than IR: oncological outcomes as Overall Survival (OS); Distant Disease Free Survival (DDFS); and Regional Disease Free Survival (RDFS) according to SLNB status. SLN identification rate was 96.8% (98.2% in patients cN0-ycN0 and 95.2% in patients cN+-ycN0). A median number of three lymph nodes were identified and removed. Among cN0-ycN0 patients, 149 (68%) were confirmed ypN0(sn), whereas regarding cN1/2-ycN0 cases 86 (47.8%) confirmed an effective downstaging to ypN0. Three year OS, DDFS and RDFS were significantly related to SLNB positivity. Our data seemed to confirm SLNB feasibility following NACT in ycN0 patients, furthermore reinforcing its predictive role in a short observation timing.

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