nodal disease
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2021 ◽  
Vol 11 (12) ◽  
pp. 1379
Author(s):  
Roxana Pintican ◽  
Magdalena Maria Duma ◽  
Madalina Szep ◽  
Diana Feier ◽  
Dan Eniu ◽  
...  

Purpose: The aim of this study is to evaluate the role of US in depicting axillary nodal disease in high-risk patients with and without pathogenic mutations. Methods: The retrospective study included consecutive high-risk breast cancer (BC) patients who underwent a multigene testing panel for hereditary cancers, pre-operative axillary US and breast/axillary surgery. The group was divided into patients with pathogenic mutations (PM group) and patients without PM. Statistical analyses were performed using GraphPad Prism by applying Chi-square and Fisher exact tests, with a reference p-value < 0.05 and a CI of 95%. Results: Out of 190 patients with BC, 96 (51%) were negative and 94 (49%) were positive for PM as follows: 28 (25.5%) BRCA1, 16 (17%) BRCA2, 15 (16%) CHECK2, 14 (14%) RAD Group, 7 (7%) PALB, 6 (6%) NBN, 3 (3%) TP53 and ATM and 2 (2%) BARD1. US was positive in 88 of the patients, 36 with PM and 52 without PM. US and surgery (>= N1 stage) were both positive in 31 (62%) of PM patients and 44 (88%) of patients without genetic changes. There were 19 (61%) false negative US examinations in the PM group and 6 (13%) in the group without genetic changes, respectively. If the US is positive, there is a 2.6 times greater risk of positive nodes in PM patients (p-value < 0.000, 95% CI = 4.2–37.9), and a 6.2 times greater risk of positive nodes in patients without genetic changes (p-value < 0.000, 95%CI = 8.4–37.4). In the PM group, US compared to surgery reached a sensitivity = 62, with PPV = 86 and NPV = 67. In the BRCA1/2 subgroup, there is 2.5 greater times risk of nodal disease if the US is positive (p-value = 0.001, 95%CI = 2.6–76). In patients without PM, US compared to surgery reached a sensitivity = 88, PPV = 84 and NPV = 86. Conclusion: US is more sensitive in depicting axillary nodal disease in high-risk patients without PM compared to PM patients. Furthermore, there are more false negative US examinations in PM patients, compared to surgery patients.


2021 ◽  
pp. 31-32
Author(s):  
Gridhati Srinivas ◽  
Tarun Kumar Dutta

Rosai-Dorfman disease (RDD) is a rare, benign, and predominantly nodal disease that most commonly presents as bilateral, painless cervical lymphadenopathy; although inguinal, axillary, mediastinal, and hilar lymphadenopathy has also been reported. Apart from nodal involvement, RDD has extra nodal manifestations involving bone, soft tissue, and liver as well as constitutional symptoms of fever, night sweats, and weight loss, which make it reasonable to rule out the infectious, autoimmune, and malignant conditions as the differential diagnosis.


Author(s):  
Axel Sahovaler ◽  
John J. W. Lee ◽  
Wei Xu ◽  
Susie Su ◽  
Ali Hosni ◽  
...  

Abstract Background Report the incidence of contralateral nodal failure rates in well-lateralized oropharyngeal carcinoma treated with upfront surgery and unilateral neck management. Methods Lateralized oropharyngeal carcinomas treated with upfront surgery using transoral robotic surgery (TORS) and unilateral neck management (unilateral neck dissection ± unilateral radiation treatment) were identified. Primary endpoint was contralateral regional control (CRC). Secondary endpoints were local control (LC), and overall survival (OS). Results Thirty-two patients were included. Pathologic T categories included 66% pT1, 31% pT2 and 3% pT3. Nodal diseases comprised 41% N0 and 47% N1 (AJCC 8th). Twenty-three (72%) patients had HPV related tumors. 3-years CRC, LC and OS were 100%, 96% (89–100) and 96% (CI 89–100). One patient developed a second primary with contralateral nodal disease. Only one patient died from another primary cancer. Conclusion In selected patients with lateralized oropharyngeal cancer, treatment with TORS and ipsilateral management of the neck may be oncologically safe without significant risk of contralateral failure. Level of evidence: Level 2. Graphical abstract


Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 49-49
Author(s):  
Daniel A. Ermann ◽  
Victoria A. Vardell ◽  
Harsh Shah ◽  
Randa Tao ◽  
David K. Gaffney ◽  
...  

Abstract Introduction Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of Non-Hodgkin Lymphoma, with approximately 25-30% of patients presenting as early or limited-stage (stage I and II). Though treatment with chemoimmunotherapy is standard of care, the role of consolidative radiotherapy (RT) in limited-stage (LS) patients is not well defined. Recent studies have attempted to shorten chemotherapy courses and eliminate RT for LS patients. Additionally, recent single institutional data has suggested LS patients with extranodal (EN) disease may have better outcomes if treated with RT. We aimed to investigate whether the addition of RT provided a survival benefit in early-stage DLBCL patients based on primary site at presentation comparing nodal to EN disease. Methods The National Cancer Database was utilized to identify patients diagnosed with LS-DLBCL from 2004 to 2015. Only patients treated with multiagent chemotherapy were included. Patients with international prognostic index (IPI) score available were separated into low (0-1 factors) or high-risk (2-4) groups. Landmark analysis was performed to exclude patients with last contact, including death, within 12 months of diagnosis. Kaplan-Meier survival analysis was used to compare overall survival (OS). Cox regression analysis was used to identify hazard ratios for survival using RT between subgroups. Results Of the 39,745 LS patients identified, 62.9% had nodal disease and 37.1% had EN disease with stage I disease accounting for 51.5% of patients. Only 6,628 patients had reported IPI scores with the majority having low-risk IPI (69.2%). Compared to patients with only nodal disease, patients with EN involvement were more likely to receive consolidative RT (42.9% vs 37.2%; p&lt;0.05). EN patients were most likely to receive RT with primary bone (67.7% of 1526 patients), skin/soft tissue (60.3% of 1353), breast (58.6% of 652), testes (58.4% of 950) and thyroid (56.6% of 1059) involvement (all p&lt;0.05). GI (18.1% of 4652) and lung (23.3% of 614) primaries were least likely to receive RT (p&lt;0.05). With a median follow up of 58.8 months, the addition of RT was associated with improved 5-year OS for all LS patients as compared to those treated with chemotherapy alone (68 vs. 62%, p&lt;0.001). While RT was associated with improved 5-year OS in both the nodal and EN disease patients, nodal patients had a greater benefit of receiving RT as compared to EN patients (nodal: 71% vs. 63%, p&lt;0.001; EN: 64% vs. 62%; p&lt;0.001). Specifically, in EN patients, the addition of RT significantly increased 5-year OS for skin/soft tissue (60% vs. 57%, p&lt;.001), head and neck (63% vs. 60%, p&lt;0.02), testicular (63% vs. 45%, p&lt;.001), and thyroid sites (73% vs. 67%, p &lt;0.02). Furthermore, RT slightly improved 5-year OS outcomes for patients with both low-risk (75% vs. 73%; p&lt;0.01) and high-risk IPI (52% vs. 50%; p&lt;0.04). On multivariate analysis, adjusting for age, stage, and Charlson-Deyo comorbidity score, the addition of RT was an independent factor for improved survival for all LS patients (Hazard Ratio [HR] 0.84, 95% Confidence Interval [CI] 0.81-0.88; p&lt;0.001) along with EN sites of skin/soft tissue (HR 0.72, 95% CI 0.58-0.88; p&lt;0.01), testicle (HR 0.70, 95% CI 0.54-0.90, p&lt;0.01) and thyroid (HR 0.68, 95% CI 0.51-0.90; p&lt;0.01). No significant survival differences were observed in patients with EN involvement of the lung, bone, breast, or GI tract when RT was added to their treatment. Conclusions We report the largest retrospective study on EN outcomes utilizing consolidative RT in early-stage DLBCL. Though there is no consensus on optimal treatment indications for RT in LS-DLBCL, this data shows improved OS in both nodal only disease and within specific EN disease subgroups when RT is added to front-line chemotherapy. As recent studies have attempted to shorten chemotherapy cycles and limit the use of RT, these results suggest caution against omission of RT in select patients. Figure 1 Figure 1. Disclosures Shah: AstraZeneca: Research Funding; Seattle Genetics: Research Funding; Epizyme: Research Funding. Stephens: TG Therapeutics: Membership on an entity's Board of Directors or advisory committees; Novartis: Research Funding; Abbvie: Consultancy; JUNO: Research Funding; Innate Pharma: Membership on an entity's Board of Directors or advisory committees; Adaptive: Membership on an entity's Board of Directors or advisory committees; Arqule: Research Funding; Mingsight: Research Funding; Beigene: Membership on an entity's Board of Directors or advisory committees; Epizyme: Membership on an entity's Board of Directors or advisory committees; AstraZeneca: Consultancy; CSL Behring: Consultancy; Celgene: Consultancy; Karyopharm: Membership on an entity's Board of Directors or advisory committees, Research Funding.


Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1423-1423
Author(s):  
Deborah M. Stephens ◽  
Hongli Li ◽  
Louis S. Constine ◽  
John P. Leonard ◽  
Brad S. Kahl ◽  
...  

Abstract Introduction Several recent pivotal trials have changed the standard of care for patients with limited stage (LS) diffuse large B-cell lymphoma (DLBCL) to minimize the number of chemoimmunotherapy cycles and/or eliminate the need for radiotherapy (RT) without compromising excellent long-term outcomes (Poeschel 2019; Persky 2020; Bologna 2021). However, there may be subsets of patients where an abbreviated treatment approach is insufficient. With this in mind, Bobillo (2021), retrospectively reviewed pts with LS DLBCL treated with RCHOP (4-6 cycles) +/- RT and reported an extranodal (EN) presentation had shorter PFS and OS compared with nodal presentation. In these pts, consolidative RT prolonged survival in pts with EN disease, especially those with a positive PET scan at the end of chemotherapy. We sought to validate these findings by analyzing patients with LS DLBCL treated on 3 consecutive SWOG studies (S0014, S0313, S1001). Methods From 4/1/00 - 6/1/16, 234 eligible patients with non-bulky (exception of 2 patients on S0014) LS DLBCL were accrued to S0014 (n=60), S0313 (n=43), or S1001 (n=131), Enrolled pts received therapy with RCHOP x 3 + involved field radiotherapy (IFRT; 26%); RCHOP x 3 + IFRT + ibritumomab tiuxetan (24%); or RCHOP x 4 (51%). In S1001, an interim PET (iPET) scan was performed after RCHOP x 3 and considered negative if the Deauville Score was ≤3. Fisher's exact test compared the distribution of the characteristics and treatments received at 2-sided a of .05. PFS was calculated from date of randomization until progression/relapse/death. OS was calculated from date of randomization until death. PFS and OS estimates were calculated using the Kaplan-Meier method. Results Median follow-up is 7 years (range 1.1 - 15.8 years). Median age was 62 (range 18 - 85) and 68% had stage-modified international prognostic index (sm-IPI) of 0-1. Of the 234 pts, 104 (44%) had EN disease. Most common sites of EN disease were head & neck (n=55; nasopharynx=14; oral cavity=17; orbit=2; parotid=4; sinus=7; submandibular gland=1; thyroid=9; vocal cord=1), skin/soft tissue/muscle (n=12), gastrointestinal tract (n=11), bone (n=6), and breast (n=6). Clinical characteristics (age, stage, LDH, sm-IPI) and treatments received between EN and nodal disease groups were not statistically different. For the whole group, estimated 10-year PFS and OS were 71% (95% CI: 64% - 77%) and 77% (95% CI: 69% - 83%), respectively. For patients with extranodal versus nodal disease, there was no difference in the estimated 10-year PFS (74% vs 68%; 2-sided logrank p-value=.51, Figure 1A) or 10-year OS (77% vs 77%; 2-sided logrank p-value=.65; Figure 1B). For the 55 pts with EN disease of the head & neck, estimated 10-year PFS and OS were 61% (44% - 74%) and 77% (63% - 87%). Among the 104 pts with EN disease who received versus did not receive IFRT, there was no difference in the estimated 5-year PFS (83% vs 87%; 2-sided logrank p-value=.52) or 5-year OS (85% vs 92%; 2-sided logrank p-value=.28). Of 55 pts with EN disease treated on S1001, 5 (9%) pts had iPET+, 47 (85.5%) pts had iPET-, and 3 (5.5%) pts did not have iPET. In the 5 pts with EN disease and iPET+, all received IFRT and 1 progressed. There were 50 pt deaths. Of these, cause of death was lymphoma in 16 (32%), second cancer in 6 (12%), other in 15 (30%), and unknown in 13 (26%). Conclusions Patients with LS DLBCL treated on 3 SWOG studies had excellent and prolonged PFS and OS regardless of EN versus nodal presentation, or whether they received consolidative IFRT or not. Our dataset does not support EN disease as an adverse prognostic factor for pts with LS DLBCL. As such, we do not recommend consolidation with radiotherapy in pts with non-bulky LS DLBCL presenting with EN disease. There were too few patients with EN disease treated on S1001 that had iPET+ to make a recommendation for PET-adapted IFRT. The majority of pts in our dataset had EN disease of the head & neck, which appears to have similar survival as nodal presentation. As seen in previous studies, there was a continuous rate of relapse without plateau of the PFS curves. Most common known cause of death in was lymphoma, which supports the need for long term follow-up. Figure 1 Figure 1. Disclosures Stephens: Celgene: Consultancy; Mingsight: Research Funding; Arqule: Research Funding; Adaptive: Membership on an entity's Board of Directors or advisory committees; TG Therapeutics: Membership on an entity's Board of Directors or advisory committees; JUNO: Research Funding; Novartis: Research Funding; Abbvie: Consultancy; AstraZeneca: Consultancy; CSL Behring: Consultancy; Epizyme: Membership on an entity's Board of Directors or advisory committees; Beigene: Membership on an entity's Board of Directors or advisory committees; Innate Pharma: Membership on an entity's Board of Directors or advisory committees; Karyopharm: Membership on an entity's Board of Directors or advisory committees, Research Funding. Leonard: ADC Therapeutics, AstraZeneca, Bayer, BMS/Celgene, Epizyme, Inc., Genmab, Gilead/Kite, Karyopharm, BMS/Celgene, Regeneron, MEI Pharma, Miltenyi, Roche/Genentech, Sutro: Consultancy; Roche/Genentech: Consultancy. Kahl: Abbvie, ADCT, AstraZeneca, Beigene, Celgene, Teva, Janssen, MTEM, Bayer, InCyte, Adaptive, Genentech, Roche, MEI, KITE, TG Therapeutics, Epizyme, Takeda: Consultancy; Abbvie, BeiGene, AstraZeneca, Acerta: Research Funding; Research to Practice: Speakers Bureau. Smith: Celgene, Genetech, AbbVie: Consultancy; Alexion, AstraZeneca Rare Disease: Other: Study investigator. Friedberg: Bayer: Other: DSMC ; Novartis: Other: DSMC ; Acerta: Other: DSMC . OffLabel Disclosure: ibritumomab tiuxetan is not FDA approved for marketing in DLBCL


PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259529
Author(s):  
Kelly Yi Ping Liu ◽  
Sarah Yuqi Zhu ◽  
Alan Harrison ◽  
Zhao Yang Chen ◽  
Martial Guillaud ◽  
...  

Background Early-stage oral squamous cell carcinoma (OSCC) patients have a one-in-four risk of regional metastasis (LN+), which is also the most significant prognostic factor for survival. As there are no validated biomarkers for predicting LN+ in early-stage OSCC, elective neck dissection often leads to over-treatment and under-treatment. We present a machine-learning-based model using the quantitative nuclear phenotype of cancer cells from the primary tumor to predict the risk of nodal disease. Methods and findings Tumor specimens were obtained from 35 patients diagnosed with primary OSCC and received surgery with curative intent. Of the 35 patients, 29 had well (G1) or moderately (G2) differentiated tumors, and six had poorly differentiated tumors. From each, two consecutive sections were stained for hematoxylin & eosin and Feulgen-thionin staining. The slides were scanned, and images were processed to curate nuclear morphometric features for each nucleus, measuring nuclear morphology, DNA amount, and chromatin texture/organization. The nuclei (n = 384,041) from 15 G1 and 14 G2 tumors were randomly split into 80% training and 20% test set to build the predictive model by using Random Forest (RF) analysis which give each tumor cell a score, NRS. The area under ROC curve (AUC) was 99.6% and 90.7% for the training and test sets, respectively. At the cutoff score of 0.5 as the median NRS of each region of interest (n = 481), the AUC was 95.1%. We then developed a patient-level model based on the percentage of cells with an NRS ≥ 0.5. The prediction performance showed AUC of 97.7% among the 80% (n = 23 patient) training set and with the cutoff of 61% positive cells achieved 100% sensitivity and 91.7% specificity. When applying the 61% cutoff to the 20% test set patients, the model achieved 100% accuracy. Conclusions Our findings may have a clinical impact with an easy, accurate, and objective biomarker from routine pathology tissue, providing an unprecedented opportunity to improve neck management decisions in early-stage OSCC patients.


2021 ◽  
Vol 233 (5) ◽  
pp. e39-e40
Author(s):  
Erin Mackinney ◽  
Amna Khokar ◽  
Richard A. Prinz ◽  
David J. Winchester ◽  
Krista Kutcha ◽  
...  

Author(s):  
Sona Rafieyan ◽  
Yousef Kananizadeh ◽  
Elahe Reyhani

Oral cancer comprises a group of neoplasms affecting any fields of the oral cavity, pharyngeal regions and salivary glands. However, this term tends to be used interchangeably with oral squamous cell carcinoma (OSCC), which represents the most common of all oral neoplasms. It is estimated that more than 90% of all oral neoplasms are OSCC. Oral SCC prefers to spread through the lymphatic system than the bloodstream, and in this region tongue tumors have the greatest potential for neck metastases.Primary tumor’s histopathologic features like depth of invasion, thickness, growth pattern, differentiation, lymphovascular or vascular invasion have a limited prognostic value for nodal disease. cervical lymph node status accurate assessment in HNSCC patients is critical issue because of its influences on prognosis and treatment decisions, USgFNAC proved widely accepted not only because of safety and availability in diagnosis but also it is repeatable, minimally invasive and cost-effectiveness.


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