Risk factors and prognostic significance of lateral pelvic lymph node dissection after neoadjuvant chemoradiotherapy for rectal patients with clinically suspected lateral lymph node metastasis

Aim It is still controversial whether the addition of lateral pelvic lymph node (LPN) dissection (LPND) to total mesorectal excision (TME) can provide a survival benefit after neoadjuvant chemoradiotherapy (nCRT) in rectal cancer patients with pathological lateral lymph node metastasis (LPNM). Methods Patients with clinically suspected LPNM who underwent nCRT followed by TME + LPND were systematically reviewed and divided into the positive LPN group (n = 15) and the negative LPN group (n = 58). Baseline characteristics, clinicopathological data and survival outcomes were collected and analysed. Results Of the 73 patients undergoing TME + LPND after nCRT, the pathological LPNM rate was 20.5% (15/73). Multivariate analysis showed that a post-nCRT LPN short diameter ≥ 7 mm (OR 49.65; 95% CI 3.98–619.1; P = 0.002) and lymphatic invasion (OR 9.23; 95% CI 1.28–66.35; P = 0.027) were independent risk factors for pathological LPNM. The overall recurrence rate of patients with LPNM was significantly higher than that of patients without LPNM (60.0% vs 27.6%, P = 0.018). Multivariate regression analysis identified that LPNM was an independent risk factor not only for overall survival (OS) (HR 3.82; 95% CI 1.19–12.25; P = 0.024) but also for disease-free survival (DFS) (HR 2.33; 95% CI 1.02–5.14; P = 0.044). Moreover, N1-N2 stage was another independent risk factor for OS (HR 7.41; 95% CI 1.63–33.75; P = 0.010). Conclusions Post-nCRT LPN short diameter ≥ 7 mm and lymphatic invasion were risk factors for pathological LPNM after nCRT. Furthermore, patients with pathological LPNM still show an elevated overall recurrence rate and poor prognosis after TME + LPND. Strict patient selection and intensive perioperative chemotherapy are crucial factors to ensure the efficacy of LPND.

Risk Factors and a Prediction Model of Lateral Lymph Node Metastasis in CN0 Papillary Thyroid Carcinoma Patients With 1–2 Central Lymph Node Metastases

BackgroundPapillary thyroid cancer (PTC) in clinically lymph node-negative (cN0) patients is prone toward lymph node metastasis. As a risk factor for tumor persistence and local recurrence, lateral lymph node metastasis (LLNM) is related to the number of central lymph node metastases (CLNMs).MethodsWe performed LLNM risk stratification based on the number of CLNMs for cN0 PTC patients who underwent thyroidectomy and lymph node dissection between January 2013 and December 2018. A retrospective analysis was applied to the 274 collected patients with 1-2 CLNMs. We examined the clinicopathological characteristics of the patients and constructed a LASSO model.ResultsIn the 1–2 CLNM group, tumors >10 mm located in the upper region and nodular goiters were independent risk factors for LLNM. Specifically, tumors >20 mm and located in the upper region contributed to metastasis risk at level II. Hashimoto’s thyroiditis reduced this risk (p = 0.045, OR = 0.280). Age ≤ 30 years and calcification (microcalcification within thyroid nodules) correlated with LLNM. The LASSO model divided the population into low- (25.74%) and high-risk (57.25%) groups for LLNM, with an AUC of 0.715.ConclusionsFor patients with 1–2 CLNMs, young age, calcification, nodular goiter, tumor >10 mm, and tumor in the upper region should alert clinicians to considering a higher occult LLNM burden. Close follow-up and therapy adjustment may be warranted for high-risk patients.

Risk Factors and Prognostic Significance of Lateral Pelvic Lymph Node Dissection After Neoadjuvant Chemoradiotherapy for Rectal Patients with Clinically Suspected Lateral Lymph Node Metastasis

Aim It is still controversial whether the addition of lateral pelvic lymph node (LPN) dissection (LPND) to total mesorectal excision (TME) can provide a survival benefit after neoadjuvant chemoradiotherapy (nCRT) in rectal cancer patients with pathological lateral lymph node metastasis (LPNM).Methods Patients with clinically suspected LPNM who underwent nCRT followed by TME+LPND were systematically reviewed and divided into the positive LPN group (n=15) and the negative LPN group (n=58). Baseline characteristics, clinicopathological data and survival outcomes were collected and analysed.Results Of the 73 patients undergoing TME+LPND after nCRT, the pathological LPNM rate was 20.5% (15/73). Multivariate analysis showed that a post-nCRT LPN size ≥7 mm (OR: 55.43; 95% CI, 4.24-724.42; P=0.002) and lymphatic invasion (OR: 11.81; 95% CI, 1.75-79.59; P=0.011) were independent risk factors for pathological LPNM. The overall recurrence rate of patients with LPNM was significantly higher than that of patients without LPNM (60.0% vs 27.6%, P=0.018). Multivariate regression analysis identified that LPNM was an independent risk factor not only for overall survival (OS) (HR: 3.82; 95% CI, 1.19-12.25; P=0.024) but also for disease-free survival (DFS) (HR: 2.50; 95% CI, 1.05-5.92; P=0.038). Moreover, N1-N2 stage was another independent risk factor for OS (HR: 7.41; 95% CI, 1.63-33.75; P=0.010).Conclusions Post-nCRT LPN size ≥7 mm and lymphatic invasion were risk factors for pathological LPNM after nCRT. Furthermore, even if TME+LPND is performed after nCRT, patients with pathological LPNM still show an elevated overall recurrence rate and poor prognosis.Statement：For patients with pathological LPNM, whether the employment of nCRT can reduce the local recurrence rate and improve survival is still not clear. The aim of this study was to identify risk factors for LPNM and investigate the oncological outcomes and prognostic values.