Abdominal Lymph Node Metastasis Research Articles

Long-term Survival of Metastatic Melanoma to the Ileum with Evidence of Primary Cutaneous Disease after 15 years of follow-up: A Case Report

The small bowel is the most common site of gastrointestinal metastasis from cutaneous melanoma. Malignant melanoma has a poor prognosis, especially if distant metastases appear. Although rare primary melanoma of the small bowel has been described, more frequently these lesions originate from unknown cutaneous melanoma. Here we report the case of a 58-year-old man with a diagnosis of melanoma of the ileum without evidence of primary cutaneous disease. After 15 years, during the clinical and radiological follow-up, a cutaneous melanoma in the left parietal side of the scalp, probably corresponding to the primary lesion with abdominal node metastasis, was diagnosed. After 6 months of chemotherapy with fotemustine, the patient showed a complete response. At present, he is still alive 18 years after the diagnosis of intestinal metastasis.

Treatments of malignant peritoneal mesothelioma: A retrospective study on 47 cases.

e14611 Background: Malignant peritoneal mesothelioma (MPM) is a rare disease and prognosis is poor. The optimal treatment is still uncertain. Methods: A retrospective study on 47 patients with MPM treated by cytoreduction surgery (CRS), systemic chemotherapy and intraperitoneal (IP) in our institution from 1985 to 2006 was established. The primary end point was overall survival. The secondary end point was evaluation of prognostic variables for overall survival. Results: Follow-up was complete in all patients. The mean age was 51 years (standard deviation [SD], 12 years). Sixteen patients (34%) had diffused disease without organ involvement. Eleven patients (23%) had organ involvement. Eleven patients (23%) had diaphragm or abdominal wall involvement. Nine patients (19%) had positive lymph nodes. Twenty-one patients (44.7%) received CRS, platinum-based chemotherapy (GC: gemcitabine plus cisplatin; MIC mitomycine, isofomine plus cisplatin; PC: paclitaxel with cisplatin) and IP sequentially. Twenty-six patients(55.3%) treated by chemotherapy and IP sequentially. Nontreatment-related death and toxicity was well telorated. Twenty-six patients received second-line chemotherapy. The average time of overall survival was 18.1 months (95%CI,11.9-24.2) in CRS group and 10.0 months (95%CI, 7.7-12.3) in non CRS group, p = 0.011. Four prognostic factors which related to advance of disease were independently associated with poor survival in the multivariate analysis: organ involvement (p < 0.001), diaphragm or abdominal wall involvement (p < 0 .01), lymph node metastasis (p < 0 .01). Conclusions: The data suggest that CRS combined with systemic chemotherapy and IP which used sequentially achieved prolonged survival in selected patients. Organ involvement, diaphragm or abdominal wall involvement and lymph node metastasis independently correlated with decreased survival following comprehensive treatment. No significant financial relationships to disclose.

Impact of the pattern of lymph node metastasis on the clinical target volume in radiotherapy for thoracic esophageal squamous cell carcinoma

To study the pattern of lymph node metastasis of thoracic esophageal squamous cell carcinoma (ESCC) after esophagectomy and its impact on the clinical target volume (CTV) delineation in radiotherapy fpr thoracic ESCC. The pattern of lymph node metastasis was retrospectively analyzed in 1077 patients with primary thoracic ESCC. All patients received esophagectomy with two- or three-field lymphadenectomy. The clinicopathologic factors related to lymph node metastasis were then analyzed using logistic regression analysis. The rates of cervical, upper mediastinal, middle mediastinal, lower mediastinal and abdominal cavity lymph node metastasis were 16.7%, 33.3%, 11.1%, 5.6% and 5.6%, respectively. The rates of those node metastasis in the middle thoracic ESCC were 4.0%, 3.8%, 28.5%, 7.1% and 17.1%, respectively, and the rates of those node metastasis in the lower thoracic ESCC were 1.5%, 3.0%, 22.7%, 37.0% and 33.2%, respectively. The depth of tumor invasion, histologic differentiation and the length of tumor were showed to be statistically most significant risk factors of lymph node metastasis of ESCC (P < 0.001). The depth of tumor invasion, histologic differentiation, and length of tumor were closely correlated with lymph node metastasis of ESCC. All these factors and tumor location should be considered comprehensively when designing the target volume for radiotherapy.

Superficial esophageal basaloid squamous cell carcinoma with rare form

We report here a case of superficial esophageal basaloid squamous cell carcinoma (BSC) that presented with a rare form. The patient was a 64-year-old man with a two-month history of dysphagia. Barium esophagography showed a polypoid tumor in the middle esophagus, measuring 2.5 cm in diameter and esophagoscopy demonstrated the lesion as protruding tumor with peduncle. The case was diagnosed as poorly differentiated squamous cell carcinoma by analyzing the biopsy specimen and computed tomogram demonstrated one abdominal lymph node metastasis. The patient underwent thoracic esophagectomy with three-field lymph node dissection. In the respected specimen, the tumor shape was similar to a mushroom, and the histological diagnosis was BSC invading the submucosal layer.

Performance of Integrated FDG-PET/Contrast-enhanced CT in the Diagnosis of Recurrent Pancreatic Cancer: Comparison with Integrated FDG-PET/Non-contrast-enhanced CT and Enhanced CT

The purpose of this study is to evaluate the accuracy of 2-deoxy-2-[F-18]fluoro-D: -glucose-positron emission tomography (FDG-PET)/computed tomography (CT) with intravenous contrast for depiction of recurrent pancreatic cancer, compared with PET/non-enhanced CT and CT. Forty-five patients previously treated for pancreatic cancer underwent PET/CT for suspected recurrence. Lesion status was determined on the basis of histopathology and radiological imaging follow-up. Patient-based analysis showed that sensitivity, specificity, and accuracy of PET/contrast-enhanced CT were 91.7%, 95.2%, and 93.3%, respectively, whereas those of PET/non-enhanced CT were 83.3%, 90.5%, and 86.7%, respectively, and those of enhanced CT were 66.7%, 85.7%, and 75.6%, respectively. In 21 patients whom the final diagnosis was obtained from the histopathologic examination, those figures of PET/contrast-enhanced CT were 94.7%, 50.0%, and 90.4%, respectively. The sensitivity of PET/contrast-enhanced CT in detecting local recurrence, abdominal lymph node metastasis, and peritoneal dissemination were 83.3%, 87.5%, and 83.3%, respectively. PET/contrast-enhanced CT is an accurate modality for assessing recurrence of pancreatic cancer.

Complete regression of advanced esophageal cancer with abdominal bulky lymph node metastasis treated by concurrent chemoradiotherapy using docetaxel, cisplatin, and 5-fluorouracil

In an attempt to improve survival of patients with locally advanced esophageal cancer, chemoradiotherapy consisting of cisplatin, 5-fluorouracil (5-FU), and irradiation has recently been used. For such patients, concurrent chemoradiotherapy using docetaxel in combination with cisplatin and 5-FU has been introduced and is under evaluation. We herein report an esophageal cancer patient with concomitant distant lymph node metastasis in whom a complete response was achieved by chemoradiation therapy. A 46-year-old man was diagnosed as having stage IV A esophageal cancer with synchronous bulky metastasis in the celiac lymph node, and concurrent chemoradiotherapy was started. Chemotherapy consisting of docetaxel (30 mg/m2 on days 1, 8), cisplatin (60 mg/m2 on day 1), and 5-FU (200 mg/m2/day, continuous infusion on days 1–14) was performed for 2 cycles. At the same time, irradiation therapy (1.8 Gy/day on 1–5 days every week for 6 weeks) was employed for both local and metastatic lesions. Although the patient experienced severe hematological toxicity throughout the course, chemoradiotherapy resulted in complete regression of both local and metastatic disease. Subsequently, he was followed as an outpatient without any maintenance therapy, and he has been free of disease for 38 months after completion of the combination therapy. Thus, concurrent chemoradiotherapy may be effective for esophageal cancer, even with visceral metastasis.

Analysis of the therapeutic effect of esophagectomy with extended 2-field lymph node dissection for esophageal carcinoma

To summarize the surgical effect and clinical application value of esophagectomy with extended 2-field lymph node dissection for patients with esophageal carcinoma. From June 1987 to December 2008, 1690 patients with esophageal cancer underwent esophagectomy with extended 2-field (thoracic and abdominal) dissection of lymph nodes. Patients with the middle and lower thoracic esophageal cancer underwent Ivor-Lewis esophagectomy, and patients with upper thoracic esophageal cancer underwent Akiyama esophagectomy. 2-field (thoracic and abdominal) lymph node metastases information and the 1, 3, 5, 10-year survival rates were analyzed retrospectively. Lymph node metastases were found in 713 patients. The lymph node metastases rate was 42.2% (713/1690).Thoracic lymph node metastasis rate was 39.3% (665/1690), among which in the right pleural apical para-tracheal triangle was 20.7% (349/1690), in the posterior upper mediastinum was 26.3% (444/1690), in the lower mediastinum was 18.2% (307/1690). Abdominal lymph node metastasis rate was 20.1% (339/1690). THE Postoperative complication rate was 16.4% (278/1690), among which the pulmonary complication rate ranking the first, was 43.6% (136/312). The operative mortality rate was 0.2%. The 1-year, 3-year, 5-year and 10-year survival rates were 88.2% (1388/1574), 63.5% (868/1367), 54.8% (705/1287) and 30.8% (232/754), respectively. The 5-year survival rate in patients without lymph node metastasis was 76.2% (448/588), but that in patients with lymph node metastases was 36.8% (257/669). The results of this study demonstrated that Ivor-Lewis and Akiyama esophagectomy with two-field lymph node dissection exposes the operation fields clearly and make radical lymphadenectomy thoroughly, especially the lymph nodes in the posterior upper mediastinum around the recurrent laryngeal nerve and in the right pleural apical para-tracheal triangle. It is essential that patients with esophageal carcinoma with lymph node metastases should undergo esophagectomy with extended 2-field dissection of lymph nodes. This can elevate the postoperative 5-year survival rate remarkably.

The pattern and prevalence of lymphatic spread in thoracic oesophageal squamous cell carcinoma

Oesophageal squamous cell carcinoma (SCC) is a common type of cancer in China. The knowledge of its pattern of lymphatic metastasis would be of clinical value for surgical and radiation oncologists to treat this disease. A large series of 1850 thoracic oesophageal SCC was retrospectively analysed after extended oesophagectomy with three-field lymphadenectomy (3FL). Specimens were assessed for pattern of lymphatic spread. Of the 1850 patients, 1081 (58.4%) developed mediastinal, cervical and/or abdominal node metastases. The lymphatic metastasis rates were 35.6%, 22.2%, 26.5%, 6.1% and 26.5%, respectively, for the cervical, upper, middle, lower mediastinal nodes and abdominal nodes. The adjacent mediastinal node metastasis alone occurred in 5.5% of patients, and the multiple level or skip node spread accounted for 20.9% and 73.6% of patients with node metastases. Upward lymphatic spread developed in 46.4% of patients, both up- and downward in 33.2%, and the downward, 20.5%. For the upper oesophageal SCC, the most common node metastasis was in the cervical (49.5%) and followed by the upper mediastinal (28.7%), middle mediastinal (11.4%), abdominal (8.0%) and lower mediastinal (1.4%) nodes. For the middle oesophageal SCC, the highest incidence of node spread was also in the cervical (35.0%) and similar rates in the middle mediastinal (29.8%), abdominal (27.2%) and upper mediastinal (22.4%) nodes, but the least in the lower mediastinal (6.0%) node. For the lower oesophageal SCC, more node metastasis occurred in the abdominal (51.7%), and followed by the middle mediastinal (25.6%), cervical (17.2%), lower mediastinal (13.9%) and upper mediastinal (10.0%). However, the lymphatic metastasis rates of the upper, middle and lower thoracic oesophageal SCC were similar. The unfavourable factors for lymphatic metastasis were long oesophageal lesion (p<0.000), late T stage (p<0.000) and poor differentiation of tumour cells (p<0.000). The prevalence was: (1) lymphatic spread prone to the upward in the upper oesophageal SCC, downward in the lower one and both up- and downward in the middle one with in favour of the upward and (2) multiple level and skip node metastases were very often seen. The unfavourable factors for node spread were long oesophageal lesion, late T stage and poor differentiation of tumour cells.

T1572 Clinicopathological Significance of Abdominal Paraaortic Lymph Node Metastasis in Patients with Lower Thoracic Esophageal Cancer

T1572 Clinicopathological Significance of Abdominal Paraaortic Lymph Node Metastasis in Patients with Lower Thoracic Esophageal Cancer

Analysis of lymph node metastases in early esophageal carcinoma and treatment regimens

To investigate the incidence of lymph node metastasis (LNM) in early esophageal carcinoma and the techniques of dissection. Standard three-field dissection was performed in patients with small superficial esophageal carcinoma detected by endoscopy from 1993 - 2007. The lymph node metastases in different regions were identified by histopathology. The survival rate of the cases was analyzed. A total of 149 patients with early esophageal carcinoma were identified by postoperative pathological examination. The overall lymph node metastasis (LNM) rate was 22.8%, and the degree of LNM was 2.4% in all fields. Most lymph node metastases from upper thoracic esophageal carcinoma were found in cervical and the right upper mediastinal nodes. The LNM from middle thoracic esophageal carcinoma were approximately equal in the cervical, mediastinal, and abdominal lymph nodes, and abdominal lymph node metastasis predominated in lower thoracic esophageal carcinoma. The metastatic rate of LNM adjacent to the right recurrent laryngeaal nerve was the highest (44.1%). Significant differences were shown among the rates of LNM in relation to different macroscopic pattern, depth of invasion and differentiation of tumor (P < 0.01), but not to the longitudinal length of tumor (P > 0.05). The overall 5-year survival rate was 77.9%. It was 87.0% in patients without LNM, and 47.1% in those with LNM. Lymph node metastasis in early esophageal carcinoma is in a high frequency. Patients with tumor invasion into the mucosa or lamina propria but without lymph node metastasis may undergo a local operation such as endoscopic mucosectomy and have a good prognosis. Patients with tumor invasion into the muscularis mucosae or submucosa should be treated with radical surgery with three-field lymphadenectomy, especially, to dissect the lymph nodes adjacent to the recurrent laryngeal nerve.

Mode of Lymphadenectomy and Surgical Outcome of Upper Thoracic Esophageal Squamous Cell Carcinoma

IntroductionOnly a few studies have evaluated the impact of clinicopathological variables and cervical lymphadenectomy on survival in patients with upper thoracic esophageal squamous cell carcinoma (SCC). Material and MethodsFrom 1960 to 2005, a total of 167 consecutive patients with upper thoracic esophageal SCC underwent esophagectomy. Of these patients, 108 underwent surgery between 1960 and 1989 and 59 between 1990 and 2005. A total of 65 patients were treated with cervical lymphadenectomy. Univariate and multivariate analyses were performed to evaluate the impact of clinicopathological variables on surgical outcome and possible predictors for cervical lymph node metastasis. Results and DiscussionThe overall 5-year survival of the later period was significantly better than the former period (43% vs 13%, p < 0.01). Based on Cox’s proportional hazards model, T3/T4 tumors, thoracic or abdominal node metastasis, venous invasion, residual cancer, absence of cervical lymphadenectomy, and hospital morbidity were independent risk factors for reduced survival in patients with upper thoracic esophageal SCC. A total of 31 (48%) of 65 patients who underwent cervical lymphadenectomy showed positive nodes in cervical field. ConclusionBased on logistic regression analysis, T3/T4 tumors and recurrent nerve node metastasis were possible risk factors for cervical node metastasis.

Abdominal lymph node metastasis from prostatic adenocarcinoma in a patient with esophageal squamous cell carcinoma

We report a case of prostate cancer that was discovered by lymph node metastasis to along the common hepatic arterial nodes. The patient was a 72-year-old man who had undergone esophagectomy as surgical treatment of esophageal cancer. The obtained specimen of along the common hepatic arterial lymph node showed adenocarcinoma, which was positive for prostate-specific antigen (PSA). The histological findings of the esophageal lesion demonstrated squamous cell carcinoma. Serum PSA was 350 ng/ml and prostate needle biopsy revealed adenocarcinoma. The patient commenced on total androgen blockade consisting of LH-RH analogue and bicalutamide (anti-androgen). However, the patient died due to recurrence of esophageal carcinoma.

Abdominal Lymph Node Metastasis in Patients with Mid Thoracic Esophageal Squamous Cell Carcinoma

There are few reports about abdominal lymph node metastasis of mid thoracic esophageal carcinoma. This study was designed to explore the pattern of abdominal lymph node metastasis in patients with mid thoracic esophageal squamous cell carcinoma and to evaluate the prognostic factors. The complete data of 368 patients with mid thoracic esophageal squamous cell carcinoma, who underwent modified Ivor-Lewis esophagectomy with two-field lymphadenectomy from January 1998 to January 2003, were reviewed. Survival rate was calculated by Kaplan-Meier method. Cox regression analysis was performed to identify risk prognostic factors. Abdominal lymph node metastasis occurred in 58 (15.8%) patients: 34.5% (20/58) of them were stage T1 and T2. Skipping abdominal node metastasis was recognized in 13.8% (8/58) patients: all were stage T1 and T2. The overall 5-year survival rate of patients with abdominal lymph node metastasis (10.3%) was lower than that of those with thoracic node metastasis (18.3%). The prognosis of patients with distant abdominal lymph node metastasis was poor, and no one could survive more than 5 years. Cox regression analysis showed that five or more positive nodes and distant abdominal node metastasis were independent risk factors of patients with abdominal lymph node metastasis. Abdominal lymph node metastasis in patients with mid thoracic esophageal squamous cell carcinoma occurred frequently, and the surgery favorable for extensive abdominal lymph node dissection should be selected. The prognosis of patients with abdominal lymph node metastasis was poor, especially those with more positive nodes and distant abdominal node metastasis.

The patterns and prognostic factors of abdominal lymph node metastasis in patients with the middle thoracic esophageal squamous cell carcinoma

To investigate the patterns of abdominal lymph node metastasis in patients with the middle thoracic esophageal squamous cell carcinoma and to evaluate the prognostic factors. Three hundred and sixty-eight patients with the middle thoracic esophageal squamous cell carcinoma from January 1998 to January 2003 were reviewed. There were 289 male and 79 female patients. The age ranged from 38 to 79 years, with a mean of 56 years. Preoperative clinical stage was stage I to III, and all patients underwent Ivor-Lewis esophagectomy with two-field lymphadenectomy. Follow-up was completed for all patients with a mean time of 68 months. Survival rate was calculated by Kaplan-Meier method. COX regression analysis was performed to identify risk prognostic factors. Abdominal lymph node metastasis occurred in 58 (15.8%) patients, with 36.2% (21/58) of them being in stage T1 or T2. Skipping abdominal lymph node metastasis was recognized in 13.8% (8/58) patients, with all of them being in stage T1 or T2. The overall 5-year survival rate of patients with abdominal lymph node metastasis (10.3%) was lower than that of those with thoracic lymph node metastasis (18.3%). The prognosis of patients with distant abdominal lymph node metastasis was bad, and nobody could survive over 5 years.COX analysis showed that 5 or more positive nodes and distant abdominal node metastasis were independent risk factors of patients with abdominal lymph node metastasis. Abdominal lymph node metastasis in patients with the middle thoracic esophageal squamous cell carcinoma occurs frequently, and the surgery favorable for extensive abdominal lymph node dissection should be selected. The prognosis of patients with abdominal lymph node metastasis is poor, especially those with more positive nodes and distant abdominal node metastasis.

Arteriovenous neoadjuvant FLEOX chemotherapy with nutritional support improves the resectable rate for advanced gastric cancer

To summarize the resectable rate of advanced gastric cancer characterized by abdominal lymph node metastases with the arteriovenous neoadjuvant FLEOX chemotherapy plus appropriate nutritional support. Arteriovenous neoadjuvant FLEOX chemotherapy was administered to 50 patients of gastric cancer with advanced abdominal lymph node metastases. Of the 50 patients, 42 had never received any previous therapy and preoperative CT scanning revealed unresectable tumors because of advanced lymph node (station No.3, 7, 9, 12) or distant lymph node (No.14,16) metastases. The other 8 were characterized with relapse of severe lymph node metastases or with unresectable lymph node metastases demonstrated by exploratory laparotomy. Arteriovenous neoadjuvant FLEOX chemotherapy was conducted as follows: from day 1 to day 5, 5-FU 370 mg/m(2) and leukovorin 30 mg/kg intravenously, at day 6 and day 20, CDDP 70 mg/m(2) and epotoside 70 mg/m(2) intraarterially. This FLEOX regimen was repeated every five weeks for two or three courses. Out of the 50 patients,12 malnutritional cases received parenteral and/or enteral nutritional support according to the nutritional condition. Arteriovenous neoadjuvant FLEOX chemotherapy was then administered after the improvement of nutritional state. Their nutritional support methods were adapted to their chemotherapy as well. All the patients' general conditions and symptoms were improved significantly. For the 50 cases, the imageological and histological response rate (CR+PR) was 84.0%, and curative resection rate was 78.0%. Thus, 39 patients underwent subtotal or total gastrectomy, even combined organ resection, with D(2)+alpha or D(3) lymphadenectomy. Despite neoadjuvant chemotherapy, all malnutritional cases had significant weight gain after nutritional support, and other nutritional indexes,such as serum albumin, also resumed to normal. Arteriovenous neoadjuvant FLEOX chemotherapy proves favorable therapeutic effect for gastric cancer with advanced abdominal lymph node metastases, and downstages inoperable metastatic lymph nodes for radical operation. This combined modality regimen and nutritional support may play an important role in the treatment of advanced gastric cancer.

Evaluation of combined docetaxel and nedaplatin chemotherapy for recurrent esophageal cancer compared with conventional chemotherapy using cisplatin and 5-fluorouracil: a retrospective study

This retrospective study evaluated the safety and efficacy of combination chemotherapy using docetaxel and nedaplatin in an outpatient setting compared with those of chemotherapy using cisplatin (CDDP) and 5-Fu under hospitalization. Subjects comprised 21 patients who had been diagnosed with recurrent esophageal squamous cell carcinoma (ESCC), with 10 patients receiving combination chemotherapy comprising CDDP and 5-fluorouracil (5-Fu) under hospitalization (FP group; n = 10), and 11 patients receiving combination chemotherapy comprising docetaxel and nedaplatin in an outpatient setting (Doc/Ned group; n = 11). In the Doc/Ned group, patients received 30 mg/m(2) of docetaxel over a 1-h infusion on day 1, followed by 40 mg/m(2) of nedaplatin over a 2-h infusion on day 1 in an outpatient setting. In the Doc/Ned group, complete response was observed in two patients (18.1%), one with liver metastasis and one with abdominal lymph node metastasis, and two (18.1%) achieved partial response. In contrast, no complete responses were obtained in the FP group, and partial response was observed in only one patient (10.0%) with local recurrence. Response rates were thus 36.3% for the Doc/Ned group and 10.0% for the FP group. With a median follow-up of 234 days in the Doc/Ned group and 279 days in the FP group, median survival time (MST) was 234 days in the Doc/Ned group and 378 days in the FP group. No significant differences in MST were identified between groups. Thus regimen based on docetaxel and nedaplatin allows administration on an outpatient basis and appears feasible for recurrent ESCC as a second-line chemotherapy.

Extent of prophylactic postoperative radiotherapy after radical surgery of thoracic esophageal squamous cell carcinoma

The aim of this study was to assess if the entire mediastinum (M), the bilateral supraclavicular area (S), and the left gastric area (L) should be all included in the irradiation volume. The clinical data of 204 patients with thoracic esophageal squamous cell carcinoma who had undergone prophylactic postoperative radiotherapy after radical surgery were retrospectively reviewed. They were classified into four groups: group A, 26 patients with irradiated M alone; group B, 139 patients with irradiated M + S; group C, 10 patients with irradiated M + L; and group D, 29 patients with irradiated M + S + L. The 5-year disease-free survival rates were 36% in group A, 31% in group B, 40% in group C and 44% in group D (chi2=3.05, P =0.39), respectively. Multivariate analysis revealed that the irradiated extent was not a significant influential factor (hazard ratio=0.84, 95% confidence interval, 0.69-1.03, P =0.10). None of 43 patients without the L irradiated and with disease in the upper and middle upper thirds (defined in middle third but with upper third invaded), and one of 83 patients without the L irradiated and with disease in the middle third only thoracic esophagus were shown to have abdominal lymph node metastasis. Supraclavicular lymph node metastasis in patients in the lower and middle lower thirds (defined in middle third but with lower third invaded) were, respectively, 1/43 and 1/18 whether the S was irradiated or not. It seems unnecessary that the L be irradiated when the primary site is in the upper, middle, and middle upper thirds of the thoracic esophagus after radical surgery. Similarly, S may be unnecessarily irradiated in the lower and middle lower thirds.

MRI and hybrid PET/CT for monitoring tumour metastasis in a metastatic breast cancer model in rabbit

To study tumour growth and metastasis in a rabbit metastatic breast cancer (MBC) model and find the most sensitive screening modality in monitoring tumour metastasis. The MBC model was established by injecting a VX2 tumour mass suspension into the mammary glands of 23 rabbits and was monitored by using physical examination, X-ray, MRI and hybrid PET/CT. Of all 23 rabbits, axillary lymph node metastasis was detected in 21 (91%) at day 33 after tumour inoculation, mediastinal node metastasis in five (22%) at day 42, abdominal node metastasis in two (9%) at day 48, lung metastasis in six (26%) at day 39, liver metastasis in three (13%) at day 48, and lumbar spine metastasis in one (4%) at day 51. Tumour invasion of pleura was found in one, stomach wall in one, and pleura and stomach concurrently in one rabbit. Sensitivity for detection of lymph node metastases was 78.6% (22/28) and 67.9% (19/28) with MRI and PET/CT, respectively; and sensitivity for detection of metastases in distant organs was 85.7% (12/14) and 71.4% (10/14), respectively. The MBC model used here exhibits fast tumour growth and extensive metastasis in a relatively short period. Its metastatic pattern is quite similar to that of human MBC and hence could be potentially used as a model for testing imaging modalities and translational research, e.g., MBC management. MRI is superior to PET/CT in monitoring tumour metastasis.

Clinicopathologic Features of Superficial Esophageal Cancer: Results of Consecutive 100 Patients

The depth of tumor penetration is a crucial factor in determining the prognosis of patients with esophageal carcinoma. Patients with superficial esophageal carcinoma (SEC) have a far more favorable clinical course compared with those with advanced cancers. The outcome for patients with mucosal cancer is excellent with a 5-year survival rate exceeding 80%. On the other hand, submucosal cancer often metastasizes to regional and/or distant lymph nodes or other organs, and the prognosis of these patients are far from satisfactory. Among 334 patients with esophageal cancer who underwent surgery between December 1980 and December 2006, 100 patients (30%) had SEC confined to the epithelium, lamina propria mucosa, or submucosa. Patient and tumor characteristics of those 100 patients were studied. The prevalence of SEC has increased from 13% (8 of 61) in the initial 5-year period (1985-1989) to 44% (41 of 93) in the recent 7-year period (2000-2006). Subjective symptoms were present in 7 (14%) of 51 mucosal cancers and in 13 (27%) of 49 submucosal cancers. The remaining 80 patients (80%) had no subjective symptoms. Ninety-one patients (91%) were diagnosed to have the lesions by endoscopy at the time of screening for gastric problems, and only nine were detected by gastrointestinal series. Four of 51 patients with mucosal cancer had venous or lymph vessel invasion, and among those, only one (2%) had a solitary perigastric lymph node metastasis. In 49 patients with submucosal cancer, 35 (71%) had lymph vessel invasion, 28 (57%) had venous invasion, and 16 (33%) had lymph node metastases. In particular, 15 of 35 patients with positive lymph vessel invasion had lymph node metastasis, whereas only 1 of 14 with negative lymph vessel invasion had lymph node metastasis (P < .05). Among 17 patients with nodal involvement, 4 patients with upper thoracic SEC had upper mediastinum and/or cervical nodal metastases, 11 patients with middle thoracic SEC had widespread upper and lower mediastinal and abdominal metastases, and 2 patients with lower thoracic SEC had lower and abdominal lymph node metastases. Seventy-nine patients were alive without recurrence at last follow-up. Five of 49 patients with submucosal cancer died of recurrent disease, and 4 of these developed regional nodal recurrence around the bilateral laryngeal recurrent nerves. Forty-two patients (42%) developed double cancers during the follow-up period, and 5 died of a second cancer. The 3- and 5-year survival rates of all 100 patients were 85% and 73%, and those disease-specific survival rates were 96% and 93%, respectively. The 3- and 5-year survival rates for patients with mucosal cancer were 89% and 83%, and those for submucosal cancer were 80%, and 64%, respectively. Esophagectomy with extensive lymphadenectomy should be carried out particularly for upper thoracic submucosal cancer, whereas esophagectomy with moderate lymphadenectomy may be preferred for mucosal cancer. Patients with SEC should be examined for another primary cancer preoperatively and periodically during follow-up.

Perigastric lymph node metastasis does not affect the survival of squamous cell carcinoma of the oesophagus treated with two‐field oesophagectomy

Aim: There are some discrepancies as to the prognostic value of perigastric lymph node (LN) metastasis in the survival of squamous oesophageal carcinoma. The present study aimed to compare survival following standard oesophagectomy in the treatment of squamous oesophageal carcinoma with or without perigastric abdominal LN metastasis.Methods: From 1998 to 2003, 17 patients with squamous cell carcinoma of the mid or lower oesophagus who had abdominal LN metastasis upon pathological examination underwent Ivor Lewis oesophagectomy. They did not receive further adjuvant therapy. The clinical outcomes of this cohort were compared to a control of 34 patients of similar age, gender and T staging who had no perigastric nodal diseases upon oesophagectomy.Results: There was no significant difference between the two groups in terms of the demographics, tumour size, differentiation of the tumour, duration of operation, volume of blood loss, and the type of oesophagectomy. The cumulative 3‐year survival rate was similar between those with abdominal LN metastasis or those without abdominal LN metastasis (52.9% vs 47.1%; log–rank test P = 0.61).There was also no significant difference in the rates of recurrence between the two groups (58.8% vs 58.8%; P = 0.1).Conclusions: Perigastric LN metastasis over the lesser curvature, left gastric artery and pericardial regions does not affect the survival of patients with squamous cell carcinoma of the oesophagus treated by two‐field oesophagectomy.