Absence Of Positive Lymph Nodes Research Articles

Management of high-risk endometrial cancer: are we there yet?

Management of high-risk endometrial cancer: are we there yet?

Factors associated with better survival in patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma

Introduction: The prognosis of pancreatic adenocarcinoma (PAC) remains poor even after better surgical and perioperative care. Objective: To identify factors associated with better survival in patients with PAC treated with pancreaticoduodenectomy (PDD) at our institution. Methods: Case-control study of PAC patients treated with PDD at our Hospital between January 2002 and December 2015. For statistical analysis, we compared the patients surviving more than 36 months after the operation, to the ones who did not reach this period. Biodemographic, clinical, histopathological and morbimortality data were compared between cases and controls using logistic regression. Results: Seventy patients were analyzed; mean age of 62, ± 11 years; 40 (57%) women. Mean and overall survival was 34 months and 22% at five years for the entire series. Mean resected lymph nodes was 18 ± 9. Twenty-one cases (30%) reached a survival greater than 36 months. At univariate analysis, R0 resection, the absence of positive lymph nodes, the absence of perineural infiltration and early stages (IA, IB and IIA) were associated with survival greater than 36 months (p < 0,05). After multivariable analysis, the absence of diabetes mellitus at the time of diagnosis (OR:12, 95% CI 1.7–84.3); the absence of perineural infiltration (OR: 7, 95% CI 1.3–36.3) and early stages (OR: 10, 05% CI 2.1–49.1) were demonstrated to be independent factors associated with survival greater than three years. Conclusion: Early stages of the disease, the absence of diabetes mellitus and no perineural infiltration at specimen were associated with survival greater than three years.

(P24) Patterns of Care and Outcomes in Early Stage Neuroendocrine Carcinoma of the Cervix

Neuroendocrine small cell carcinoma (NESCC) is a rare form of cervical cancer associated with poor outcomes. When compared to other histotypes of invasive carcinoma arising in the uterine cervix, NESCC tend to present at more advanced stages, demonstrate greater frequency of regional lymph node involvement, and, stage by stage, have a worse 5-year prognosis than invasive squamous carcinomas. However, due to their rarity, consensus regarding the optimal therapeutic strategy for early stage disease is lacking. After obtaining IRB approval, all women in the National Cancer Database diagnosed with early stage (FIGO1-IIA) NESCC were identified. Coded patient demographics, tumor characteristics, and data regarding treatment were abstracted. Univariate and multivariate analyses, including Cox survival regression analyses, were performed using SPSS Version 24.0 (SPSS Inc., Chicago, IL). A total of 104 subjects with stage I-IIA NESCC whose treatment included hysterectomy were identified. Mean age at diagnosis for these women was 41 +/- 14.1 years. Stage at diagnosis for these subjects was IA (n=12), IB1 (n=46), 1B2 (n=33) and IIA (n=5). Eight subjects were reported to have IB disease not otherwise specified. Nearly half (n=50, 48.1%) were treated with a combination of hysterectomy, radiation and chemotherapy, while smaller proportions of women were treated a combination of hysterectomy and chemotherapy (n=33, 31.7%), hysterectomy alone (n=20, 19.2%) or hysterectomy with adjuvant radiotherapy (n=1, 1.0%, p<0.0001). A total of 18 patients who received radiotherapy also received brachytherapy. Of these, 8 received neoadjuvant brachytherapy while the remainder received adjuvant brachytherapy. In univariate analysis, lower stage, Caucasian or Hispanic race/ethnicity, the absence of positive lymph nodes, and negative surgical margins were each significantly associated with improved survival (all p<0.05). However, the addition of radiotherapy to treatment plans did not significantly improve outcomes (p>0.05). Furthermore, neither the timing of chemotherapy (neoadjuvant vs. adjuvant) nor type of chemotherapy used (multi-agent vs. single-agent) were associated with improved OS (p>0.05), either in unstratified univariate analyses or when subjects were stratified by treatment regimen or tumor size (>4cm vs <4 cm; p>0.05). Lastly, we found that neoadjuvant chemotherapy failed to increase the likelihood of negative surgical margins for stage IB2 tumors (p >0.05). In multivariate analyses, tumor stage and patient race were the only variables that remained significantly associated with OS (p<0.05) . Use of chemotherapy and/or radiotherapy had no influence on survival after controlling for other variables. Analysis of U.S. hospital-based data indicates that neither chemotherapy nor radiation improves outcomes of surgically resectable early stage (FIGO IA-IIA) neuroendocrine carcinomas of the uterine cervix. This finding suggests that a prospective analysis of new treatment options is warranted with the goal of optimizing outcomes and quality of life for women impacted by NESCC.

Factors associated with better survival in patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma

Background: The prognosis of pancreatic adenocarcinoma (PAC) remains poor even after better surgical and perioperative care. The objective is to identify factors associated with better survival in patients with PAC treated with pancreaticoduodenectomy (PDD) at our institution. Methods: Non-concurrent cohort study of patients with LLR at the Hospital Clinico of Universidad Catolica from August 2004 to May 2017. The data were obtained from a database specially designed for hepatobiliary surgery. Major hepatectomies were defined as those with resection of 3 or more segments. Biodemographic, clinical and morbimortality data were analyzed. Results: Seventy patients were analyzed; mean age of 62 ± 11 years; 40 (57%) women. Mean and overall survival was 34 months and 22% at five years for the entire series. Mean resected lymph nodes was 18 ± 9. Twenty-one cases (30%) reached a survival greater than 36 months. At univariate analysis, R0 resection, the absence of positive lymph nodes, the absence of perineural infiltration and early stages (IA, IB and IIA) were associated with survival greater than 36 months (p < 0,05). After multivariable analysis, the absence of diabetes mellitus at the time of diagnosis (OR: 12, 95% CI 1.7–84.3), the absence of perineural infiltration (OR: 7, 95% CI 1.3–36.3) and early stages (OR: 10, 05% CI 2.1–49.1) were demonstrated to be independent factors associated with survival greater than three years. Conclusion: Early stages of the disease, the absence of diabetes mellitus and no perineural infiltration at specimen were associated with survival greater than three years.

Abstract 4786: Cellular localization of PRMT5 correlates with poor recurrent free survival in triple-negative breast cancer (TNBC)

Abstract PURPOSE: TNBC is an aggressive disease with limited effective targeted therapies. Protein arginine methyltransferase 5 (PRMT5) is an enzyme that symmetrically methylates arginine residues of both histone and non-histone proteins that regulate cellular growth and drive malignant transformation. PRMT5 is an oncogenic marker for aggressive cancers with limited treatment options like glioblastoma multiforme (GBM) and mantle cell lymphoma (MCL) and PRMT5 knockdown has been shown to improve survival in a preclinical model of GBM. The expression profile of PRMT5 in TNBC has not been previously evaluated. METHODS: We obtained a clinical database of TNBC patients that correlates to tissue samples collected after resection of the original breast tumor (n = 106). Tissue microarrays (TMA) were stained for PRMT5 and graded based on level of cytoplasmic and nuclear staining. The association of PRMT5 expression with patient overall survival (OS) and recurrent free survival (RFS) was analyzed using a log-rank test. Multivariate COX regression model was used to evaluate PRMT expression level as independent predictor of OS and RFS with histopathologic factors such as lymph node involvement and tumor size. RESULTS: High cytoplasmic levels of PRMT5 in TNBC correlated with improvement in RFS (p = 0.043, CI 0.218-0.976), while showing no correlation with OS. High levels of nuclear PRTM5 did not show a significant correlation with OS or RFS. Patients with tumors showing high nuclear and low cytoplasmic levels of PRMT5 had the worst OS and RFS (p&amp;lt;0.05). When accounting for stage, lymph node status, and nuclear or cytoplasmic PRMT5 levels, higher stages predicted worse RFS with stage 3 being the worst (p&amp;lt;0.01). Having high PRMT5 in the cytoplasm alone was associated with an improved RFS trend (p = 0.08), but TNBC with low cytoplasmic PRMT5 and high nuclear PRMT5 levels was significant for predicting worse RFS (p = 0.005). Most TNBC with high cytoplasmic levels of PRMT5 were Stage 2 (65%) and most TNBC with low nuclear levels of PRMT5 were also Stage 2 (64%). In stage 3 cancers, 55% had low cytoplasmic levels of PRMT5 while 44% had high nuclear levels of PRMT5. The levels of PRMT5 in the cytoplasm or nucleus were no different depending on the presence or absence of positive lymph nodes at the time of diagnosis. CONCLUSIONS: PRMT5 is variably expressed in TNBC and the cellular location of PRMT5 correlates with RFS and OS. Having association between tumors with low cytoplasmic and high nuclear levels with significantly worse RFS implies that high cytoplasmic PRMT5 may have a protective effect. These results prompt further investigation into the biologic role of PRMT5 in TNBC and whether it can serve as a potential therapeutic target. Citation Format: Elaine P. Alexander, Christian T. Earl, Xiaokui Mo, Konstantin Shilo, Robert A. Baiocchi, Maryam B. Lustberg. Cellular localization of PRMT5 correlates with poor recurrent free survival in triple-negative breast cancer (TNBC). [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4786. doi:10.1158/1538-7445.AM2015-4786

690 Can immediate adjuvant therapy be avoided in patients with prostate specimen Gleason ≥ 8, organ confined disease, absence of positive lymph nodes and surgical margins, who undergo robot-assisted laparoscopic radical prostatectomy?

690 Can immediate adjuvant therapy be avoided in patients with prostate specimen Gleason ≥ 8, organ confined disease, absence of positive lymph nodes and surgical margins, who undergo robot-assisted laparoscopic radical prostatectomy?

Age of Diagnosis Throughout the Years at Núcleo de Oncologia da Bahia

INTRODUCTION: It has been suggested that there has been an increase in breast cancer incidence in young women in the last decade. The aim of this study is to verify if there was any change, in the past few decades, referring to the age of diagnosis of breast cancer patients at Nucleo de Oncologia da Bahia, located in Salvador, Bahia, Brazil. MATERIALS AND METHODS: This is a descriptive study that included 2612 patients diagnosed with breast cancer between the years 1974 and 2010 in a single private institution, specialized in the diagnosis and treatment of breast cancer. Data was collected retrospectively from medical records. The variables of interest were: a) socio-demographics: year of diagnosis, age at diagnosis and ethnicity; b) clinical: body mass index (BMI) (continuous variable), family history of breast cancer; c) tumor histology (ductal or others), size of the tumor (> or < 2 cm), presence or absence of positive lymph nodes at the time of diagnosis and presence or absence of metastasis at the time of diagnosis. All tests were two-tailed and results with p values 0. 05 were considered statistically significant. Data was analyzed using Statistical Package for Social Sciences software (version 17. 0, SPSS, Chicago IL, USA). Data was analyzed by an independent professional and a confidentiality agreement was established before access to the data. RESULTS: Regarding age at diagnosis, over the years, the average age was gradually increased. Each year, age increased 0. 279 (coefficient not standardized). This data was also positive for BMI at diagnosis and there was a negative relation regarding other variables: younger patients presented greater tumor size (standard error de 0. 605 with p < 0. 001), more positive lymph nodes (standard error 0.59 with p < 0. 001) and more often non-white ethnicity (standard error 0.55 with p < 0. 001). CONCLUSION: in spite of a tendency to believe in a recent increase of breast cancer incidence in younger women, this hypothesis was not confirmed in our population. Unlike, present belief there was an increase in median age of diagnosis. However, a relation can be established between younger patients and more aggressive tumors confirmed in literature data.

Superficial Soft Tissue Sarcomas of the Extremities and Trunk

Superficial soft tissue sarcomas (sSTS) are an important and frequent subtype of soft tissue sarcoma (STS). A wider knowledge of this tumor type may lead to better strategies in tumor therapy. An institutional review was performed on all patients with primary sSTS of the extremities and trunk operated on between 1990 and 2003. The medical records of 108 patients with sSTS were analyzed. The local recurrence rate was 11% after a median of 25 (mean 42) months. Metastases occurred in 21 patients (19%), and 79 patients lived without evidence of disease after a mean follow-up of 112 +/- 42 months. Mean survival time was 89 months at a cumulative 5-year survival rate of 85%. R0 resection significantly enhanced cumulative survival (p = .001), as did patient age < 60 years (p = .002), tumor grading G1 and G2 compared to G3 (p = .004), absence of positive lymph nodes (p = .018), and no occurrence of metastases (p = .001). Tumor size < or = 5 cm reduced the local recurrence rate significantly (p = .044). Significant multivariate risk factors for metastases were age > or = 60 years (p = .016) and tumor grade G3 (p = .021). Patients with sSTS who are > or = 60 years of age or who have G3 tumors have a high risk of distant metastases. Patients with T2 tumors have an elevated risk for local recurrence. Certainly all patients with sSTS should be in a tight after-care program to allow early diagnosis of local recurrence or distant metastases. Age < 60 years, tumor grade G1/2, no positive regional lymph nodes (N0), and a R0 resection are significant prognostic factors for survival.

Prospectively Packaged Ilioinguinal Lymphadenectomy for Penile Cancer: The Disseminative Pattern of Lymph Node Metastasis

We prospectively evaluated the disseminative pattern of lymph node metastasis in penile cancer cases using packaged lymphadenectomy. In addition, we analyzed prognostic factors of the extent of lymph node metastasis. Packaged inguinal lymphadenectomy was performed in 46 patients. A total of 24 patients with 1 or more positive inguinal lymph nodes underwent packaged iliac lymphadenectomy. Inguinal lymphadenectomy was divided into 3 packages, including medial inguinal, lateral inguinal and Cloquet's node packages. Medial and lateral inguinal packages were separated by the lateral surface of the femoral artery and the saphenous vein. Iliac lymphadenectomy was divided into 3 packages, including external iliac, obturator and common iliac packages. Clinicopathological features of the primary tumor and lymph nodes were correlated with the extent of lymph node metastasis. Of 92 groin basins 27 cases of inguinal lymphadenectomy and 7 of iliac lymphadenectomy had lymph node metastasis. Medial inguinal and external iliac packages were the most common involved regions in inguinal and iliac lymphadenectomy cases, respectively. No extended lymph node metastasis was observed in the absence of positive lymph nodes in the medial inguinal package. In groin basins with lymph node metastasis in the medial inguinal package extranodal extension was a significant predictor of extended lymph node metastasis. Cloquet's node was associated with iliac lymph node metastasis on univariate analysis. However, it was of limited predictive value in patients with 1 or 2 positive inguinal lymph nodes. The medial inguinal package defined in our study was the first involved lymph node region in penile cancer cases. Extranodal extension was an important predictor of extended lymph node metastasis beyond the medial inguinal package.

Low local recurrence rate without postmastectomy radiation in node-negative breast cancer patients with tumors 5 cm and larger

To assess the need for adjuvant radiotherapy following mastectomy for patients with node-negative breast tumors 5 cm or larger. Between 1981 and 2002, a total of 70 patients with node-negative breast cancer and tumors 5 cm or larger were treated with mastectomy and adjuvant systemic therapies but without radiotherapy at three institutions. We retrospectively assessed rates and risk factors for locoregional failure (LRF), overall survival (OS), and disease-free survival (DFS) in these patients. With a median follow-up of 85 months, the 5-year actuarial LRF rate was 7.6% (95% confidence interval, 3%-16%). LRF was primarily in the chest wall (4/5 local failures), and lymphatic-vascular invasion (LVI) was statistically significantly associated with LRF risk by the log-rank test (p=0.017) and in Cox proportional hazards analysis (p=0.038). The 5-year OS and DFS rates were 83% and 86% respectively. LVI was also significantly associated with OS and DFS in both univariate and multivariate analysis. This series demonstrates a low LRF rate of 7.6% among breast cancer patients with node-negative tumors 5 cm and larger after mastectomy and adjuvant systemic therapy. Our data indicate that further adjuvant radiation therapy to increase local control may not be indicated by tumor size alone in the absence of positive lymph nodes. LVI was significantly associated with LRF in our series, indicating that patients with this risk factor require careful consideration with regard to further local therapy.

Prediction of appropriateness of local endoscopic treatment for high-grade dysplasia and early adenocarcinoma by EUS and histopathologic features

Endoscopic techniques are being developed for the local treatment of early stage esophageal cancer. However, such therapy is not appropriate for patients with lymph node metastasis. The aim of this study was to analyze the histopathologic features of high-grade dysplasia and early stage adenocarcinoma and to relate these to lymph node involvement. Pathology reports were reviewed for all 367 patients who underwent subtotal esophagectomy for high-grade dysplasia or adenocarcinoma of the esophagus or the gastroesophageal junction between January 1993 and December 2001. Patients with histopathologically confirmed high-grade dysplasia or T1 carcinoma were included (n = 77). Pre-operative EUS results were assessed. All lesions were histopathologically subdivided in 6 different stages (mucosal 1-3 and submucosal 1-3). EUS staged 61 patients as N0. EUS correctly predicted the absence of positive lymph nodes in 57 (93%) of these patients. Histopathologically, m1, m2, m3, and sm1 cancers never had lymph node metastases, whereas 3 of 13 sm2 tumors (23%) and 9 of 13 sm3 tumors (69%) had lymph node involvement. Lymphangio invasion was present exclusively in sm2 and sm3 cancers. Factors that predicted the presence of lymph node metastasis were the following: tumor diameter greater than 3 cm, infiltration of malignancy beyond sm1, poor differentiation grade, and lymphangio invasion, although only infiltration beyond sm1 remained significant in the definitive multivariate analysis. EUS and the histopathologic features of high-grade dysplasia and early stage adenocarcinoma of the esophagus or the gastroesophageal junction can predict the presence of lymph node involvement. These data can be used to identify patients for whom local endoscopic treatment may be appropriate.

The treatment of premalignant and malignant lesions of the vulva

We have reviewed our treatment of premalignant and malignant disease of the vulva in 78 patients seen at Colorado General Hospital since 1955. Premalignant lesions can be managed conservatively. Wide local excision or local 5-FU cream usually arrests premalignant disease without further surgery. Patients with premalignant disease treated by one of these methods need to be followed closely in order to detect recurrence. Microinvasive lesions can be treated by wide local excision in selected cases; in others simple vulvectomy is the treatment of choice. Forty-three patients with invasive vulval carcinoma were treated by radical vulvectomy and removal of lymph nodes. Extension at the operation to include the deep retroperitoneal nodes aided in the cure of but one of the 43 patients. Thirty-four patients (79 per cent) are alive and free of disease three to 18 years after radical vulvectomy. Patients with metastasis to regional lymph nodes had a 40 per cent survival rate. If the patients had Stage I, II, or III disease, the presence or absence of positive lymph nodes did not affect the prognosis in our series. All patients with Stage IV disease had positive nodes and eight of nine died.