scholarly journals Proposal of "Perihilar surrounding area" in relation to regional lymphadenectomy in selected patients with intrahepatic cholangiocarcinoma

2016 ◽  
Author(s):  
Naoto Gotohda ◽  
Yuichiro Kato ◽  
Shinichiro Takahashi ◽  
Masaru Konishi
Keyword(s):  
Lymph Node ◽  
Retrospective Study ◽  
Liver Resection ◽  
Intrahepatic Cholangiocarcinoma ◽  
Primary Tumor ◽  
Extrahepatic Bile Duct ◽  
Surrounding Area ◽  
Primary Tumors ◽  
Poor Prognostic Factor ◽  
Regional Lymphadenectomy

Abstract Objectives and Background　Lymph node (LN) metastasis is well recognized as a poor prognostic factor in intrahepatic cholangiocarcinoma (ICC), however, the efficacy of LN dissection for ICC remains unclear. We clarify a targeted papulation of ICC to evaluate it in this study. Methods　A retrospective study of patients who underwent liver resection without the extrahepatic bile duct for ICC was conducted. The pattern of LN recurrence and the location of the primary tumor were evaluated. Results　Between January 2003 and July 2014, 52 patients with ICC underwent surgery. Fourteen patients had LN recurrence, of whom 6 patients had LN recurrence only. Excluding patients with LN dissection at surgery, the primary tumor was limited to the perihilar surrounding area in patients with LN recurrence only. Recurrence rate in LNs was 50% in patients with primary tumors originating in the perihilar surrounding area, which was significantly higher than the rate of 13% in patients with primary tumors originating in other areas. Conclusions　Primary tumors in the perihilar surrounding area have a high risk of LN recurrence. Regional lymphadenectomy combined with hepatectomy should be carried out in patients with ICC located in this area. The incidence of LN metastasis and the possibility of preventing LN recurrence could be effectively revealed by regional lymphadenectomy in selected patients.

Primary Tumor Site, Size, Patients Age and Axillary Lymph Nodes in Breast Cancers

1986 ◽  
Vol 72 (3) ◽  
pp. 259-265 ◽  
Author(s):  
Salvatore Toma ◽  
Stefano Bonassi ◽  
Riccardo Puntoni ◽  
Guido Nicolò
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Primary Tumor ◽  
Lymph Node Involvement ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Breast Cancers ◽  
Primary Tumor Site ◽  
Primary Tumors ◽  
Node Involvement

This study considers the correlations between some characteristics of the primary tumor and level of lymph node involvement in 185 primary breast cancers. The average number of lymph nodes was higher in N + women than in N— women. Primary tumors with a diameter of more than 4 cm yielded the highest mean number of lymph nodes (17.5). The risk of developing lymph node metastases was fourfold in tumors with a diameter greater than 2 cm when compared to those with a diameter less than or equal to 2 cm. The most commonly metastasized lymph node level, in both large and small tumors, was the first; however, one-fifth of the patients had simultaneous lymph node metastasis in all three axillary levels. Although the left breast was the most affected (58.9 %), there was no evidence of a different risk of metastasis between the two breasts; 34.1 % of the tumors were multifocal. Lymph node involvement was higher in women under 50 years of age with a primary tumor larger than 2 cm.

scholarly journals Mitochondrial DNA alteration in primary and metastatic colorectal cancer: Different frequency and association with selected clinicopathological and molecular markers

Tumor Biology ◽  
2017 ◽  
Vol 39 (3) ◽  
pp. 101042831769224 ◽  
Author(s):  
Britta Kleist ◽  
Thuja Meurer ◽  
Micaela Poetsch
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Microsatellite Instability ◽  
Metastatic Colorectal Cancer ◽  
Lymph Node Metastases ◽  
Primary Tumor ◽  
Distant Metastases ◽  
Primary Tumors ◽  
Node Metastases ◽  
Mitochondrial Microsatellite Instability

This study attempts to determine whether primary tumor tissue could reliably represent metastatic colorectal cancer in therapy-guiding analysis of mitochondrial microsatellite instability. Therefore, we investigated the concordance of microsatellite instability in D310, D514, and D16184 (mitochondrial DNA displacement loop), and its association with selected clinical categories and KRAS/NRAS/BRAF/PIK3CA/TP53 mutation status between primary and metastatic colorectal cancer tissue from 119 patients. Displacement loop microsatellite instability was significantly more frequently seen in lymph node metastases (53.1%) compared to primary tumors (37.5%) and distant metastases (21.4%) ( p = 0.0183 and p = 0.0005). The discordant rate was significantly higher in lymph node metastases/primary tumor pairs (74.6%) than in distant metastases/primary tumor pairs (52.4%) or lymph node metastases/distant metastases pairs (51.6%) ( p = 0.0113 and p = 0.0261) with more gain (86.7%) than loss (61.1%) of microsatellite instability in the discordant lymph node metastases ( p = 0.0024). Displacement loop instability occurred significantly more frequently in lymph node metastases and distant metastases of patients with early colorectal cancer onset age <60 years ( p = 0.0122 and p = 0.0129), was found with a significant high rate in a small cohort of TP53-mutated distant metastases ( p = 0.0418), and was associated with TP53 wild-type status of primary tumors ( p = 0.0009), but did not correlate with KRAS, NRAS, BRAF, or PIK3CA mutations. In conclusion, mitochondrial microsatellite instability and its association with selected clinical and molecular markers are discordant in primary and metastatic colorectal cancer, which could have importance for surveillance and therapeutic strategies.

scholarly journals The Clinical Value of Regional Lymphadenectomy for Intrahepatic Cholangiocarcinoma: Results of A Retrospective Cohort Study

2020 ◽  
Author(s):  
Facai YANG ◽  
Changkang WU ◽  
Taian CHEN ◽  
Anqi DUAN ◽  
Jian XU ◽  
...  
Keyword(s):  
Lymph Node ◽  
Intrahepatic Cholangiocarcinoma ◽  
Survival Rates ◽  
Clinical Value ◽  
Regional Lymphadenectomy ◽  
Group A ◽  
Hospital Stays ◽  
Independent Risk Factors ◽  
Group B ◽  
The Impact

Abstract Objective: The aim of this study was to explore the clinical value of lymph node dissection (LND) for intrahepatic cholangiocarcinoma (ICC). Methods: Clinical and pathological data were collected from 147 ICC patients who attended two tertiary centers over the past 5 years. The patients were classified into two groups: the LND group (group A) and the no-performance LND (NLND) group (group B). Clinical and pathological parameters were compared between the two groups to analyze the impact of LND on the prognosis of ICC patients. Results: Of the 147 patients, 54.4% (80) received LND and 42.5% (34/80) of these were found to have lymph node metastasis (LNM) in postoperative pathological diagnosis. Patients undergoing LND usually have a larger surgical range, including hemihepatectomy and enlarged hemihepatectomy (P = 0.001). LND did not increase postoperative complications (27.5%, P = 0.354), but postoperative hospital stays were longer (12.2 ± 6.3 d, P = 0.005) in group A compared with group B (20.9%, 9.5 ± 3.5 d). The 5-year survival rates of groups A and B are almost similar (21% vs 29%, P=0.905). The overall survival rate of cN0 (diagnosis obtained by imaging) is better than pN1 (diagnosis obtained by histopathology), but lower than pN0. (all P < 0.05). Elevated CA19-9 level (HR = 1.764, 95% CI: 1.113 ~ 2.795 , P = 0.016), vascular invasion (HR = 2.697, 95% CI: 1.103 ~ 6.599, P = 0.030), and T staging (HR = 1.848, 95% CI: 1.059 ~ 3.224, P = 0.031) were independent risk factors for poor ICC prognosis (all P values > 0.05).Conclusion: ICC patients with cN0 may have LNM, and the prognosis of LNM patients is usually poor. Our data may support routine lymphadenectomy for ICC.

scholarly journals A Head-to-Head Comparison of 68Ga-DOTA-FAPI-04 and 18F-FDG PET/MR in Patients with Nasopharyngeal Carcinoma: A Prospective Study

2021 ◽  
Author(s):  
Chunxia Qin ◽  
Fang Liu ◽  
Jing Huang ◽  
Weiwei Ruan ◽  
Qingyao Liu ◽  
...  
Keyword(s):  
Lymph Node ◽  
Nasopharyngeal Carcinoma ◽  
Lymph Nodes ◽  
Skull Base ◽  
Primary Tumor ◽  
Fdg Pet ◽  
Distant Metastases ◽  
Tracer Uptake ◽  
Visual Evaluation ◽  
Primary Tumors

Abstract PurposeTo conduct a head-to-head comparison of the diagnostic ability of 68Ga-DOTA-FAPI-04 (68Ga-FAPI) and 18F-FDG PET/MR in nasopharyngeal carcinoma (NPC) patients.MethodsPatients diagnosed with NPC were prospectively enrolled. All patients underwent head-and-neck 68Ga-FAPI PET/MR and 18F-FDG PET/MR within one week. Primary tumor, lymph node numbers, and tracer uptake were compared by SUVmax and visual evaluation. The primary tumor volumes derived from 68Ga-FAPI, 18F-FDG PET, and MRI were also compared.ResultsFifteen patients were enrolled from June to August 2020. Both 68Ga-FAPI and 18F-FDG PET had 100% detection rate of the primary tumor. The 68Ga-FAPI SUVmax of primary tumors (13.87±5.13) was lower than that of 18F-FDG (17.73±6.84), but the difference was not significant (p=0.078). Compared with 18F-FDG, 68Ga-FAPI PET improved the delineation of skull-base invasion in eight out of eight patients and intracranial invasion in four out of four patients. When 25%SUVmax of 68Ga-FAPI or 20%SUVmax of 18F-FDG was utilized as a threshold for determining tumor volume, it was highly consistent with MRI. 18F-FDG PET detected much more positive lymph nodes than 68Ga-FAPI (100 vs 48). The SUVmax of 48 paired lymph nodes was significantly lower on 68Ga-FAPI than 18F-FDG (8.67±3.88 vs 11.79±6.17, p<0.001). Additionally, 68Ga-FAPI further detected four highly suspected small, distant metastases in three patients. Compared with 18F-FDG, 68Ga-FAPI changed overall staging in six of fifteen patients, with three patients being up-staged, and three down-staged.Conclusion68Ga-FAPI outperforms 18F-FDG in delineating the primary tumor and detecting suspected distant metastases, particularly in the evaluation of skull-base and intracranial invasion, suggesting 68Ga-FAPI hybrid PET/MR has the potential to serve as a single-step staging modality for patients with NPC. However, its value regarding lymph node and distant metastases evaluation needs further study.Trial registration: NCT04554719. Registered September 8, 2020 - retrospectively registered, http://clinicaltrails.gov/show/ NCT04554719

The Added Value of [68Ga]Ga-DOTA-FAPI-04 PET/CT in Patients with Head and Neck Cancer of Unknown Primary with [18F]FDG Negative Findings

2021 ◽  
Author(s):  
Bingxin Gu ◽  
Xiaoping Xu ◽  
Ji Zhang ◽  
Xiaomin Ou ◽  
Zuguang Xia ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Lymph Node ◽  
Bone Metastases ◽  
Head And Neck ◽  
Primary Tumor ◽  
Cancer Of Unknown Primary ◽  
Unknown Primary ◽  
Primary Tumors ◽  
Pet Ct ◽  
The Mean

Abstract Purpose [18F]fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) plays an important role in location of primary tumor for patients with head and neck cancer of unknown primary (HNCUP). But sometimes, [18F]FDG PET/CT still cannot find the primary malignancy. As 68Ga-radiolabeled fibroblast activation protein inhibitor (FAPI) PET/CT has promising results in detecting different tumor entities, our study aimed to evaluate the performance of [68Ga]Ga-DOTA-FAPI-04 PET/CT for detecting the primary tumor in HNCUP patients with negative [18F]FDG findings.Methods A total of eighteen patients (16 males and 2 females; median age, 55 years; range, 24-72 years) with negative [18F]FDG findings were eligible in this study. All patients underwent [18F]FDG and [68Ga]Ga-DOTA-FAPI-04 PET/CT within one week. Biopsy and histopathological examinations were done in the sites with positive [68Ga]Ga-DOTA-FAPI-04 PET/CT findings. Results [68Ga]Ga-DOTA-FAPI-04 PET/CT detected the primary tumor in 7 of 18 patients (38.89%). The primary tumors sites were in nasopharynx (1/7), palatine tonsil (2/7), submandibular gland (2/7), and hypopharynx (2/7). The primary tumors showed mild to intensive uptake of FAPI (mean SUVmax, 8.79; range, 2.60-16.50) and excellent tumor-to-contralateral normal tissue ratio (mean SUVmax ratio, 4.50; range, 2.17-8.21). In lesion-based analysis, a total of 65 lymph nodes and 17 bone metastatic lesions were identified. The mean SUVmax of lymph node metastases were 9.05 ± 5.29 for FDG and 9.08 ± 4.69 for FAPI (p = 0.975); as for bone metastases, the mean SUVmax were 8.11 ± 3.00 for FDG and 6.96 ± 5.87 for FAPI, respectively (p = 0.478). The mean tumor-to-background ratio (TBR) values of lymph node and bone metastases were 10.65 ± 6.59 vs. 12.80 ± 8.11 (p = 0.100) and 9.08 ± 3.35 vs. 9.14 ± 8.40 (p = 0.976), respectively.Conclusion We present first evidence of diagnostic role of [68Ga]Ga-DOTA-FAPI-04 PET/CT in HNCUP, and our study demonstrated that [68Ga]Ga-DOTA-FAPI-04 PET/CT had the potential to improve the detection rate of primary tumor in HNCUP patients with negative FDG findings. Moreover, [68Ga]Ga-DOTA-FAPI-04 had similar performance in assessing metastases with [18F]FDG.

scholarly journals Prognostic Significance of Estrogen Receptor Alpha in Oral Squamous Cell Carcinoma

Cancers ◽  
2021 ◽  
Vol 13 (22) ◽  
pp. 5763
Author(s):  
Christian Doll ◽  
Carolin Bestendonk ◽  
Kilian Kreutzer ◽  
Konrad Neumann ◽  
Anne Pohrt ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Estrogen Receptor ◽  
Lymph Node ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Lymph Node Metastases ◽  
Primary Tumor ◽  
Primary Tumors ◽  
Node Metastases ◽  
Primary Lymph Node

Introduction: Several studies suggest an estrogen receptor alpha (ERα)-mediated influence on the pathogenesis of oral squamous cell carcinoma (OSCC), as described for other malignancies that are not considered to be primarily hormone-dependent. Recently, an association between ERα expression and improved survival in oropharyngeal squamous cell carcinoma (OPSCC) has been found. However, the prognostic relevance of ERα in OSCC has not been proven to date. Therefore, the aim of this study was to evaluate ERα expression in OSCC in a large patient cohort and analyze its influence on survival and recurrence. Material and Methods: A total of 316 patients with primary OSCC who received initial surgical therapy were included in this analysis. The expression of ERα was evaluated on tissue microarrays by immunohistochemistry in the primary tumor and/or primary lymph node metastases. The expression level was quantified by light microscopy using the immunoreactive score (IRS) for estrogen receptor detection. An IRS equal to or greater than 2 was considered positive. The 5-year overall survival (OS) and relapse-free survival (RFS) were examined by the Kaplan–Meier method and log-rank test. Results: A total of 316 patients (111 females; 205 males) with a mean age of 61.3 years (range 27–96 years) were included in this study. In 16 patients (5.1%; 6 females and 10 males), positive ERα expression was found in the primary tumor (n = 11; 11/302) or lymph node metastases (n = 5; 5/52). Patients with positive ERα expression in primary tumors/primary lymph node metastases had a significantly lower OS and RFS (p = 0.012; p = 0.0053) compared to ERα-negative patients. Sub-group analysis in relation to gender revealed a highly significant influence of ERα expression on OS and RFS in males but not in females, both for the ERα-positive primary tumor cohort (males: p = 0.0013; p < 0.0001; females: p = 0.56; p = 0.89) and the ERα-positive primary tumor/primary lymph node metastasis cohort (males: p < 0.0001; p < 0.0001; females: p = 0.95; p = 0.96). In multivariate cox regression analysis, the ERα IRS of primary tumors (dichotomized; ERα+ vs. ERα−) was an independent risk factor for OS (HR = 4.230; 95%CI 1.616–11.076; p = 0.003) and RFS (HR = 12.390; 95%CI 4.073–37.693; p < 0.001) in the male cohort. There was a significant difference (p = 0.006) of ERα positivity with regard to the localization of the primary tumor. ERα positivity in the primary tumor was significantly associated (p = 0.026) with UICC stage, with most of the cases being diagnosed in stage IV. Furthermore, there was a significantly (p = 0.049) higher rate of bone infiltration in ERα-positive patients. Conclusion: Expression of ERα is rare in OSCC; however, it is associated with a dramatic decrease in OS in male patients. Further studies are necessary to confirm our results and to evaluate the exact mechanism underlying this observation. Hence, ERα-positive OSCC patients might benefit from an ER-based therapeutic (adjuvant) approach in the future.

scholarly journals Origins of lymphatic and distant metastases in human colorectal cancer

Science ◽  
2017 ◽  
Vol 357 (6346) ◽  
pp. 55-60 ◽  
Author(s):  
Kamila Naxerova ◽  
Johannes G. Reiter ◽  
Elena Brachtel ◽  
Jochen K. Lennerz ◽  
Marc van de Wetering ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Primary Tumor ◽  
Phylogenetic Trees ◽  
Evolutionary Relationship ◽  
Distant Metastases ◽  
Human Colorectal Cancer ◽  
Regional Lymph Nodes ◽  
Primary Tumors

The spread of cancer cells from primary tumors to regional lymph nodes is often associated with reduced survival. One prevailing model to explain this association posits that fatal, distant metastases are seeded by lymph node metastases. This view provides a mechanistic basis for the TNM staging system and is the rationale for surgical resection of tumor-draining lymph nodes. Here we examine the evolutionary relationship between primary tumor, lymph node, and distant metastases in human colorectal cancer. Studying 213 archival biopsy samples from 17 patients, we used somatic variants in hypermutable DNA regions to reconstruct high-confidence phylogenetic trees. We found that in 65% of cases, lymphatic and distant metastases arose from independent subclones in the primary tumor, whereas in 35% of cases they shared common subclonal origin. Therefore, two different lineage relationships between lymphatic and distant metastases exist in colorectal cancer.

Sentinel Lymph Node Biopsy With Metastasis: Can Axillary Dissection Be Avoided in Some Patients With Breast Cancer?

1999 ◽  
Vol 17 (6) ◽  
pp. 1720-1720 ◽  
Author(s):  
Carol Reynolds ◽  
Rosemarie Mick ◽  
John H. Donohue ◽  
Clive S. Grant ◽  
David R. Farley ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Tumor Size ◽  
Primary Tumor ◽  
Axillary Dissection ◽  
Metastatic Breast ◽  
Axillary Lymph ◽  
Primary Tumors ◽  
Primary Tumor Size

PURPOSE: Recent studies have suggested that the sentinel lymph node (SLN) biopsy is an accurate alternative staging procedure for women with breast cancer. The goal of this study was to identify a subset of breast cancer patients in whom metastatic disease was confined only to the SLN. MATERIALS AND METHODS: From two institutions, we recruited 222 women with breast cancer for SLN biopsy. A SLN biopsy was performed in each patient, followed by an axillary dissection in 182 patients. Histologic and immunohistochemical cytokeratin stains were used on all SLNs. RESULTS: The SLN was identified in 220 (97.8%) of the 225 biopsies. Evidence of metastatic breast cancer in the SLN was found in 60 (27.0%) of the 222 patients. Of these patients, 32 (53.3%) had evidence of tumor in the SLN only. By multivariate analysis, two factors were found to be significantly associated with a higher likelihood of tumor involvement in the non-SLNs: primary tumor size larger than 2.0 cm (P = .0004) and macrometastasis (> 2.0 mm) in the SLN (P = .002). Additional analysis revealed that none (0%; 95% confidence interval, 0% to 18.5%) of the 18 patients with primary tumors ≤ 2.0 cm and micrometastasis to the SLN had remaining axillary lymph node involvement. CONCLUSION: The primary tumor size and metastasis size in the SLN are independent factors in predicting the incidence of tumor in the non-SLNs. Therefore, the SLN biopsy alone may be adequate for staging and/or therapy decision making in patients with primary breast tumors ≤ 2.0 cm and micrometastasis in the SLN.

scholarly journals Mutational Landscape of Paired Primary and Synchronous Metastatic Lymph Node in Chemotherapy Naive Gallbladder Cancer

2021 ◽  
Author(s):  
Boqiang Fan ◽  
Xianfeng Xu ◽  
Xuehao Wang
Keyword(s):  
Phylogenetic Analysis ◽  
Lymph Node ◽  
Gallbladder Cancer ◽  
Primary Tumor ◽  
Copy Number ◽  
Metastatic Lymph Node ◽  
Copy Number Variations ◽  
Driver Mutations ◽  
Primary Tumors ◽  
Metastatic Lymph

Abstract Background: Comprehensive genomic analysis of paired primary tumors and their metastatic lesions may provide new insights into the biology of metastatic processes and therefore guide the development of novel strategies for intervention. To date, our knowledge of the genetic divergence and phylogenetic relationships in gallbladder cancer (GBC) is limited.Methods:We performed whole exome sequencing (WES) for 5 patients with primary tumor, metastatic lymph node (LNM) and corresponding normal tissue. Mutations, mutation signatures and copy number variations were analyzed with state-of-art bioinformatics methods. Phylogenetic tree was also generated to infer metastatic pattern. Results:Five driver mutations were detected in these patients. Among which, TP53 was the only shared mutation between primary tumor and LNM. Although tumor mutational burden was comparable between primary tumor and LNM, higher mutation burden was observed in LNM of one patient. Copy number variations (CNVs) burden was higher in LNM than their primary tumor. Phylogenetic analysis indicated both linear and parallel progression of metastasis exist in these patients. TP53 mutation and CNVs were homogenously between primary tumor and LNM.Conclusions:High consistence of genetic landscape were shown between primary tumor and LNM in GBC. However, heterogenicity still exist between primary tumor and LNM in particular patients in term of driver mutation, TMB and CNV burden. Phylogenetic analysis indicated both Linear and parallel progression of metastasis were exist among these patients.

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