Subphrenic Lymph Node Metastasis Predicts Poorer Prognosis for Nasopharyngeal Carcinoma Patients With Metachronous Metastasis

AimWe retrospectively analyzed the distribution of distant lymph node metastasis and its impact on prognosis in patients with metastatic NPC after treatment.MethodsFrom 2010 to 2016, 219 NPC patients out of 1,601 (182 from the Affiliated Cancer Hospital and Institute of Guangzhou Medical University, and 37 from the Affiliated Dongguan Hospital, Southern Medical University) developed distant metastasis after primary radiation therapy. Metastatic lesions were divided into groups according to location: bones above the diaphragm (supraphrenic bone, SUP-B); bones below the diaphragm (subphrenic bone, SUB-B); distant lymph nodes above the diaphragm (supraphrenic distant lymph nodes, SUP-DLN); distant lymph nodes below the diaphragm (subphrenic distant lymph nodes, SUB-DLN), liver, lung, and other lesions beyond bone/lung/distant lymph node above the diaphragm (supraphrenic other lesions, SUP-OL); other lesions beyond bone/liver/distant lymph node below the diaphragm (subphrenic other lesions, SUB-OL); the subtotal above the diaphragm (supraphrenic total lesions, SUP-TL); and the subtotal below the diaphragm (subphrenic total lesions, SUB-TL). Kaplan–Meier methods were used to estimate the probability of patients’ overall survival (OS). Univariate and multivariate analyses were applied using the Cox proportional hazard model to explore prediction factors of OS.ResultsThe most frequent metastatic locations were bone (45.2%), lung (40.6%), liver (32.0%), and distant lymph nodes (20.1%). The total number of distant lymph node metastasis was 44, of which 22 (10.0%) were above the diaphragm, 18 (8.2%) were below the diaphragm, and 4 (1.8%) were both above and below the diaphragm. Age (HR: 1.02, 95% CI: 1.00, 1.03, p = 0.012), N stage (HR: 1.26, 95% CI: 1.04, 1.54, p = 0.019), number of metastatic locations (HR: 1.39, 95% CI: 1.12, 1.73, p = 0.003), bone (HR: 1.65, 95% CI: 1.20, 2.25, p = 0.002), SUB-B (HR: 1.51, 95% CI: 1.07, 2.12, p = 0.019), SUB-DLN (HR: 1.72, 95% CI: 1.03, 2.86, p = 0.038), and SUB-O L(HR: 4.46, 95% CI: 1.39, 14.3, p = 0.012) were associated with OS. Multivariate analyses revealed that a higher N stage (HR: 1.23, 95% CI: 1.00, 1.50, p = 0.048), SUB-DLN (HR: 1.72, 95% CI: 1.02, 2.90, p = 0.043), and SUB-OL (HR: 3.72, 95% CI: 1.14, 12.16, p = 0.029) were associated with worse OS.ConclusionSubphrenic lymph node metastasis predicts poorer prognosis for NPC patients with metachronous metastasis; however, this needs validation by large prospective studies.

Tocilizumab Controls Paraneoplastic Inflammatory Syndrome but Does Not Suppress Tumor Growth of Angiomatoid Fibrous Histiocytoma

Angiomatoid fibrous histiocytoma (AFH) is a rare soft tissue tumor that rarely metastasizes but lacks effective systemic therapy once it propagates. In some reports, high interleukin-6 (IL-6) production promotes tumor growth by autocrine stimulation and tocilizumab, an IL-6 receptor antagonist, can control AFH growth. Here, we present a case report on a patient with local recurrence and distant lymph node metastasis of AFH treated with tocilizumab. As a result, the inhibition of the IL-6 signaling pathway controlled paraneoplastic inflammatory syndrome (PIS); however, the local recurrent tumor progressed. This case implied that IL-6 is not necessarily the cause of tumor growth in AFH. Therefore, physicians should bear in mind that watchful observation is needed whether tocilizumab can control tumor progression despite the amelioration of PIS associated with the attenuated effect of IL-6 on AFH.

Disease-specific Factors Influenced Lymph Node Metastasis of Diagnostic Accuracy of 18F Fluorodeoxyglucose Positron Emission Tomography/computed Tomography in Colorectal Cancer : a Single-center Study

Background: The usefulness of preoperative lymph node metastasis diagnosis by 18F fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in colorectal cancer management has been reported, but inadequate diagnostic accuracy precludes routine preoperative application. Therefore, the purpose of this study was to examine the factors influencing the diagnostic accuracy of lymph node metastasis by PET/CT in patients with colorectal cancer.Methods: We retrospectively identified 864 patients who underwent preoperative PET/CT and colorectal cancer resection at Shizuoka General hospital from January 2017 to December 2019. We examined factors influencing the diagnostic accuracy of PET/CT to detect lymph node metastasis generally and lymph node metastasis for each TNM stage according to the UICC-TNM 8th edition.Results: The overall sensitivity and specificity of PET/CT to detect lymph node metastasis in patients with colorectal cancer were 61.2% and 75.9%, respectively. Distant lymph node metastasis was diagnosed more accurately than regional lymph node metastasis. “T category” (T1/T2 vs. T3/T4) was an independent factor affecting the lymph node metastasis diagnostic capability among patients negative for lymph node metastasis [p<0.01; odds ratio 2.20; 95% CI 1.28-3.84], while among patients positive for lymph node metastasis, “Tumor diameter” was significantly associated with the lymph node metastasis diagnostic capability on univariate analysis [p=0.02]. The sensitivity and specificity of PET/CT for Stage I (T1/T2, N0) were 82.5% and 84.6%, respectively. For more advanced tumors, the diagnostic ability to detect lymph node metastasis decreased. Conclusions: Disease-specific factors such as T category and tumor diameter significantly impacted on LN metastasis diagnosis by PET/CT in patients with colorectal cancer. We recommended the preoperative application of PET/CT only for the diagnosis of distant lymph node metastasis.

Incidental Detection of Ovarian Cancer as a Solitary Peridiaphragmatic Distant Lymph Node Metastasis without Pelvic Lesions on 18F-FDG PET/CT

The spreading pattern of ovarian carcinoma is unique and unlike most other cancers, because exfoliated ovarian cancer cells primarily disseminate within the abdominal cavity, which are then transported throughout the peritoneum by physiological peritoneal fluid. An initial manifestation of a solitary peridiaphragmatic distant metastatic lymph node without peritoneal involvement is very rare. This study reports a case with an incidentally found single hypermetabolic mass in the peridiaphragmatic space without a pelvic lesion in the baseline staging 18 F-FDG PET/CT that histologically turned out to be metastatic serous papillary carcinoma due to ovarian cancer. 18F-FDG PET/CT may allow the identification of the initial manifestation of unexpected distant oligometastatic statuses of an unknown primary ovarian cancer.

Rare aggressive solid pseudopapillary neoplasm of the ovary with metastatic disease following surgical resection

Extra-pancreatic solid pseudopapillary neoplasms (SPNs) are rare tumours with an overall favourable prognosis and low malignant potential. SPNs with metastatic spread, distant lymph node metastasis and extrapancreatic origin are exceedingly rare. Significant controversy regarding the treatment and the management of metastatic disease exists and, currently, there are no standardised guidelines or treatment recommendations for the use of adjuvant therapy. In this case report, the authors present a patient with widely metastatic SPN of likely ovarian origin with the invasion of the inguinal lymph nodes and multiple abdominal metastatic deposits. Using the currently available literature, the authors discuss treatment options for metastatic SPN of the ovary and highlight the need for continued research in this important field.

circCOL6A3_030 is involved in the metastasis of gastric cancer by encoding polypeptide

Background Gastric cancer (GC) is a serious digestive tract disease that threatens human life worldwide, and the prognosis of gastric cancer accompanied by distant lymph node or the distant metastasis organs is worse. The purpose of this study was to investigate the role of circular RNA COL6A3_030 (circBase ID: hsa_circ_0006401; circRNADb ID: hsa_circ_28198; circBank ID: hsa_circCOL6A3_030) in GC metastasis. Methods qRT-PCR analysis using back-splicing primers and Sanger sequencing of PCR products were performed to identify circCOL6A3_030 in GC tissues and cell lines; RNA-FISH assay was performed to validate the subcellular localization of circCOL6A3_030. Transwell and wound-healing assays were carried out to evaluate the migration ability of GC cells. Western blot was conducted to detect the polypeptide encoded by circCOL6A3_030 in cells. Results circCOL6A3_030 was down-regulated in GC tissues and cell lines, while circCOL6A3_030 was up-regulated in GC with distant lymph node metastasis. The migration of circCOL6A3_030 silenced GC cells was significantly inhibited in both SGC-7901 and BGC-823 cell lines. Importantly, in vivo assay, silencing circCOL6A3_030 could reduce liver metastases from gastric cancer cells. Meanwhile, further studies suggested that circCOL6A3_030 encoded a small peptide that had a function as a tumor-promoting metastasis factor and immunohistochemistry confirmed the presence of this polypeptide. Conclusions To sum up, our study showed that circCOL6A3_030 promoted GC cell migration by encoding a small peptide called circCOL6A3_030_198aa. Therefore, our results highlight the potential role of circCOL6A3_030 for clinical diagnosis and treatment of GC with distant lymph node metastasis.

Smoking duration and intensity associated with tumour aggressiveness in patients with urothelial carcinoma of the bladder: A correlation study

Introduction: Smoking is well recognized as the most important risk factor for the malignancy of bladder. Cigarette smoking is associated with a higher risk of bladder cancer. The influence of various parameters of smoking history was still unclear. The purpose of this study was to examine the relationship between smoking intensity and clinico-pathological features of bladder cancer. Methods: This was a retrospective study with non-probability consecutive sampling. All patients with urothelial cell carcinoma of the bladder in our hospital during 2009–2018 were included in the present study. The data were collected from medical records and then divided into three groups according to the intensity of smoking. The data were analysed, with statistical significance determined using Spearman’s rank correlation coefficient. Result: The data from a total of 260 urothelial bladder cancer patients were collected between 2009 and 2018. Based on statistical testing, it was found that there was a strong correlation between smoking intensity and local staging (T; rs=0.827), with a greater tendency to develop a larger tumour growth as the smoking intensity increased. There was also a weak correlation between smoke intensity and grading ( rs=0.139). Meanwhile, no correlation was found between smoking intensity and the incidence of regional (N; rs=0.119) and distant lymph node metastasis (M; rs=0.239). Smoke status and intensity had a weak correlation with lesion ( rs=0.163 and 0.206, respectively). The type of cigarette and local staging had a small correlation ( rs=0.166). Conclusion: This study demonstrated that smoking intensity was significantly correlated only with primary tumour progression and grading, but not with the progression of regional and distant metastasis. There was a weak correlation between smoking status and intensity with the type of lesion, whether a solitary nodule or multiple nodules. This study also demonstrated a small correlation between the type of cigarette and local staging. Level of evidence: 3

Impact of fiducial markers placements on the delineation of target volumes in radiation therapy for oesophageal cancer: final results of the FIDUCOR study

Purpose This prospective monocentric phase II study (FIDUCOR-study) aimed at the assessment of the impact of fiducial markers (FMs) implantation on conformal chemo-radiation therapy (CRT) planning in esophageal carcinoma (EC) patients. Methods/materials Fifteen EC patients were enrolled in the study. Each patient underwent two simulation CT-scans before (CT1) and after (CT2) FMs implantation, in the same position. FMs (3 mm length gold markers, preloaded in a 22G needle) were implanted after sedation, under EUS and X-Ray guidance, and were placed at the tumor’s extremities, and in the visible lymph nodes. Target delineation and treatment plan were both performed first on CT1 with the assistance of, diagnosis-CT, gastroscopy- and EUS-details, and second on CT2 using FMs and CT-data. The value of FMs implantation was assessed by the difference of growth-tumor-volume (GTV) and clinical-target-volume (CTV) between CT1-based and CT2-based delineation. A significant difference was defined as a ≥5 mm-difference on axial(x) or coronal(y) slices, a ≥10mm-difference on sagittal slices, or a ≥20%-difference in GTV. The impact on dose distribution in organs at risk (OAR) (lung, heart, liver) was also studied. Results Between 09/2014 and 12/2015, 15 patients could achieve fiducial procedures, without any complication. One FM migration occurred. We observed a significant modification of the GTV-dimension in 100% of the cases (15/15, 95%CI: [78.2;100.0]), mainly due to a difference in sagittal dimension with a mean variation of 11.2 mm and a difference> 10 mm for 8/15 patients (53.3%). One patient had a significant isocenter displacement as high as 20 mm. The esophagus tumor was not seen on the CT-scan in one patient due to its small size. One patient had a distant lymph node metastasis not visible on CT-scan. We observed no significant impact on OAR distribution. Conclusion In our study, FMs-implantation appeared to have positive impact on accurate volume definition in EC-patients. Registration trial number NCT02526134 since the 06-18-2013 ; URL https://clinicaltrials.gov/ct2/show/NCT02526134

Staging Laparoscopy in Patients with Intrahepatic Cholangiocarcinoma: Is It Still Useful?

<b><i>Background:</i></b> The role of staging laparoscopy in patients with intrahepatic cholangiocarcinoma remains unclear. Despite extensive preoperative imaging, approximately 25% of patients are deemed unresectable at laparotomy due to metastasized disease. The aim of this study was to evaluate the frequency of unresectable disease found at staging laparoscopy and to identify predictors for detecting metastasized intrahepatic cholangiocarcinoma. <b><i>Methods:</i></b> We retrospectively collected records of all patients with intrahepatic cholangiocarcinoma, presenting at our institution from 2008 to 2017. Staging laparoscopy was performed on the suspicion of distant metastases and on indication in larger tumors. The yield and sensitivity of staging laparoscopy was calculated. Reasons for unresectability at staging laparoscopy or laparotomy were recorded. <b><i>Results:</i></b> Among a total of 80 patients with potentially resectable intrahepatic cholangiocarcinoma, 35 patients underwent staging laparoscopy on the suspicion of distant metastases. Unresectable disease was found at staging laparoscopy in 15 patients. Reasons for unresectability were liver metastasis (<i>n</i> = 6), peritoneal metastasis (<i>n</i> = 4), severe cirrhosis (<i>n</i> = 2), locally advanced tumor with satellite lesions (<i>n</i> = 1), and distant lymph node metastasis (<i>n</i> = 2). Considering optimal preoperative imaging, the true yield of staging laparoscopy was 20% (7/35). Two patients did not undergo laparotomy due to progression after staging laparoscopy. Of the remaining 18 patients who underwent laparotomy, 6 patients (30%) had unresectable disease, mostly because of distant metastasis (<i>n</i> = 4). <b><i>Conclusions:</i></b> The role of staging laparoscopy to detect unresectable intrahepatic cholangiocarcinoma is highly dependent on the quality of preoperative imaging. Currently, no accurate selection criteria on imaging exist to select patients with intrahepatic cholangiocarcinoma who potentially benefit from staging laparoscopy.