Risk for Pelvic Metastasis and Role of Pelvic Lymphadenectomy in Node-Positive Vulvar Cancer-Results from the AGO-VOP.2 QS Vulva Study

The need for pelvic treatment in patients with node-positive vulvar cancer (VSCC) and the value of pelvic lymphadenectomy (LAE) as a staging procedure to plan adjuvant radiotherapy (RT) is controversial. In this retrospective, multicenter analysis, 306 patients with primary node-positive VSCC treated at 33 gynecologic oncology centers in Germany between 2017 and 2019 were analyzed. All patients received surgical staging of the groins; nodal status was as follows: 23.9% (73/306) pN1a, 23.5% (72/306) pN1b, 20.4% (62/306) pN2a/b, and 31.9% (97/306) pN2c/pN3. A total of 35.6% (109/306) received pelvic LAE; pelvic nodal involvement was observed in 18.5%. None of the patients with nodal status pN1a or pN1b and pelvic LAE showed pelvic nodal involvement. Taking only patients with nodal status ≥pN2a into account, the rate of pelvic involvement was 25%. In total, adjuvant RT was applied in 64.4% (197/306). Only half of the pelvic node-positive (N+) patients received adjuvant RT to the pelvis (50%, 10/20 patients); 41.9% (122/291 patients) experienced recurrent disease or died. In patients with histologically-confirmed pelvic metastases after LAE, distant recurrences were most frequently observed (7/20 recurrences). Conclusions: A relevant risk regarding pelvic nodal involvement was observed from nodal status pN2a and higher. Our data support the omission of pelvic treatment in patients with nodal status pN1a and pN1b.

Pattern of breast cancer presentation during the coronavirus disease pandemic: results from a cohort study in the UK

Background: This study aimed to explore the hypothesis that the stage of breast cancer at initial diagnosis in 2020 is more advanced compared with 2019. Methods: Tumor, node, metastasis and Union for International Cancer Control (UICC) stages of new breast cancer diagnoses at the Bucks Breast Unit from May to October 2019 and 2020 were reviewed. A p < 0.05 was considered significant. Results: Average UICC stage increased from 1a in 2019 to 2a in 2020 (p < 0.01). Excluding cancers detected through screening, UICC stage still increased from 1b in 2019 to 2a in 2020 (p = 0.0184). There was a significant increase in the percentage of node-positive patients (p = 0.0063) and patients with metastatic disease (p = 0.0295) on initial presentation. Conclusion: Overall, patients presented with higher UICC stages and more node-positive and metastatic disease on initial diagnosis in 2020 compared with 2019.

Pattern of Nutritional status in Node Negative versus Node Positive Head and Neck Cancer patients undergoing treatment - a prospective cohort study

Purpose The aim of this study was to study the nutritional profile of node negative and node positive patients undergoing treatment for head and neck squamous cell cancer (HNSCC). Methods This prospective cohort study was conducted between 2018 and 2020. Patients diagnosed with HNSCC, planned for treatment were enrolled after written informed consent. In Node negative(N0) and Node positive(N+) cohorts of patients, nutritional status was determined using- anthropometric measures and Subjective Global Assessment (SGA) scale pre-treatment, during and after treatment. Statistical analysis was performed using SPSS version 22. Data was analyzed using parametric and non-parametric tests, p value of 0.05 was considered significant. Results 161 patients were analyses, 73 N0 and 88 N+ cohorts. Pre-treatment, 9.6 to 20.4% patients in N0 and 23.9 to 32.8% patients in N+ cohorts were malnourished. Incidence of malnutrition at completion of treatment was 40.8–52.5% overall, 20.5–41.1% N0, 39.5–62.8% N+. Mean reduction in weight (11.1% ±7.82 v/s 6.26% ±8.3, p=0.000), mean reduction in BMI (2.57 ±1.87 v/s 1.29 ±1.62, p=0.000), median reduction in MUAC (2cm v/s 1cm, p=0.000) and median increase in SGA score were higher (13 v/s 6, p=0.000) in multi-modality as compared to single modality treatment. Similar findings were noted in N0 and N+ cohorts. Conclusion As compared to N0, N+ patients had higher burden of malnutrition at diagnosis, more worsening of nutritional parameters during treatment. More decline in Nutritional status was seen in patients receiving multi-modality as compared to single modality treatment.

Lymphatic invasion is a prognostic factor of pathological N0 esophageal squamous cell carcinoma

Summary Adjuvant treatment after upfront esophagectomy for esophageal squamous cell carcinoma (ESCC) is indicated only for patients with lymph node metastasis in Japan. However, the recurrence rate after curative resection is high even for node-negative patients; thus, understanding the prognostic factors for patients with node-negative ESCC, which still remains unidentified, is important. Here, we aimed to reveal the prognostic factors for the long-term outcomes of patients with node-negative ESCC. Moreover, we compared the long-term outcomes among high-risk node-negative and node-positive patients. This single-institution retrospective study included 103 patients with pT1b-3N0 ESCC who underwent upfront surgery to identify the population at a high risk of recurrence. To compare overall survival (OS) and recurrence-free survival (RFS) between high-risk node-negative and node-positive patients, 51 node-positive ESCC patients with pStage IIIA or less who had undergone upfront surgery were also included. Univariable and multivariable analyses were performed using the Cox proportional hazard regression model. OS and RFS were compared using the log-rank test. Only lymphatic invasion (Ly+) was associated with worse 3-year OS (hazard ratio, 8.63; 95% confidence interval, 2.09–35.69; P = 0.0029) and RFS (hazard ratio, 4.87; 95% confidence interval, 1.69–14.02; P = 0.0034). The node-negative and Ly+ patients showed significantly worse OS (P = 0.0242) and RFS (P = 0.0114) than the node-positive patients who underwent chemotherapy. Ly+ is the only independent prognostic factor in patients with node-negative ESCC. Patients with node-negative and Ly+ ESCC may benefit from adjuvant treatment.