cN0 Patients Research Articles

Intraparotid node metastasis affects the long-term survival of patients with resectable recurrent parotid gland carcinoma.

The recurrence rate of parotid gland cancer is high, but research on the prognosis of recurrent parotid gland cancer (RPC) is relatively limited. We aim to determine the potential prognosis factors of RPC. Retrospective cohort analysis. Tertiary cancer center. We conducted a retrospective review from 2012 to 2021 on RPC patients treated at the China National Cancer Center (CNCC). To analyze the impact of various variables on overall survival (OS) after recurrence, a univariate and multivariate Cox proportional hazard model was employed. A total of 50/218 (23.0%) patients diagnosed with RPC and underwent surgery. The 5-year OS of all RPC patients in this cohort was 61.9%. 5 of 50 patients (10%) exhibited intraparotid node (IPN) metastasis. By univariate and multivariate analyses, we found that IPN metastasis was one of the prognostic factors of OS (p = 0.039) in RPC patients. The presence of IPN metastasis was also related to poor survival in individuals with negative cervical lymph nodes (CN0) (p = 0.011). In terms of the influence of surgical margins on prognosis, our findings revealed that RPC patients with negative margins exhibited a higher survival result than those with positive margins (p = 0.002). According to this study, IPN metastasis indicate a high incidence of mortality inrecurrent parotid cancer patients. Particularly, in CN0 patients, the presence of IPN metastasis was associated with poor survival in CN0 patients.

Role of prophylactic central neck lymph node dissection for papillary thyroid carcinoma in the era of de-escalation.

Thyroid cancer is the most common endocrine malignancy. While there has been no appreciable increase in the observed mortality of well-differentiated thyroid cancer, there has been an overall rise in its incidence worldwide over the last few decades. Patients with papillary thyroid carcinoma (PTC) and clinical evidence of central (cN1) and/or lateral lymph node metastases require total thyroidectomy plus central and/or lateral neck dissection as the initial surgical treatment. Nodal status in PTC patients plays a crucial role in the prognostic evaluation of the recurrence risk. The 2015 guidelines of the American Thyroid Association (ATA) have more accurately determined the indications for therapeutic central and lateral lymph node dissection. However, prophylactic central neck lymph node dissection (pCND) in negative lymph node (cN0) PTC patients is controversial, as the 2009 ATA guidelines recommended that CND "should be considered" routinely in patients who underwent total thyroidectomy for PTC. Although the current guidelines show clear indications for therapeutic CND, the role of pCND in cN0 patients with PTC is still debated. In small solitary papillary carcinoma (T1, T2), pCND is not recommended unless there are high-risk prediction factors for recurrence and diffuse nodal spread (extrathyroid extension, mutation in the BRAF gene). pCND can be considered in cN0 disease with advanced primary tumors (T3 or T4) or clinical lateral neck disease (cN1b) or for staging and treatment planning purposes. The role of the preoperative evaluation is fund-amental to minimizing the possible detrimental effect of overtreatment of the types of patients who are associated with low disease-related morbidity and mortality. On the other hand, it determines the choice of appropriate treatment and determines if close monitoring of patients at a higher risk is needed. Thus, pCND is currently recommended for T3 and T4 tumors but not for T1 and T2 tumors without high-risk prediction factors of recurrence.

Temporal Trends and Factors Associated with Receipt of Post-mastectomy Radiation After Neoadjuvant Chemotherapy in Women with cT3 Breast Cancer.

Given the potential impact of increasingly effective neoadjuvant chemotherapy (NACT) on post-mastectomy radiotherapy (PMRT) recommendations, we examined temporal trends in post-NACT PMRT for cT3 breast cancer. We identified women ≥ 18 years in the National Cancer Database (NCDB) diagnosed 2004-2019 with cT3N0-1M0 breast cancer treated with chemotherapy and mastectomy. Multivariable logistic regression and Cox proportional hazards models were used to estimate associations between pathologic NACT response [complete response (CR), partial response (PR), or no response (NR); or disease progression (DP)] and PMRT and between PMRT and overall survival (OS), respectively. We identified 39,901 women (Asian/Pacific Islander 1731, Black 5875, Hispanic 3265, White 27,303). Among cN0 patients with CR, PMRT rates declined from 67% in 2004 to 35% in 2019 but remained unchanged for patients with DP. Relative to NR, CR [odds ratio (OR) 0.36, 95% confidence interval (CI) 0.29-0.46] and PR (OR 0.44, 95% CI 0.36-0.55) in cN0 patients were associated with lower odds of PMRT while DP (OR 1.33, 95% CI 1.05-1.69) was associated with higher odds. Among cN1 patients, PMRT rates decreased from 90% to 73% for CR between 2005 and 2019 and increased from 76% to 82% for DP between 2004 and 2019. Relative to NR, CR (OR 0.78, 95% CI 0.63-0.95) was associated with lower odds of PMRT while DP (OR 1.93, 95% CI 1.58-2.37) was associated with higher odds. PMRT was associated with improved OS among cN1 patients (hazard ratio (HR) 0.77, 95% CI 0.67-0.88). CR was associated with decreased PMRT receipt over time, while temporal trends following PR and DP differed by cN status, suggesting that nodal involvement guided PMRT receipt more than in-breast disease.

Intraoperative Pathology Assessment May Lead to Overtreatment of the Axilla in Clinically Node-Negative Breast Cancer Patients Undergoing Upfront Mastectomy.

Randomized trials have established the safety of observation or axillary radiation (AxRT) as an alternative to axillary lymph node dissection (ALND) in patients with limited nodal disease who undergo upfront surgery. Variability remains in axillary management strategies in cN0 patients undergoing mastectomy found to have one to two positive sentinel lymph nodes (SLNs). We examined the impact of intraoperative pathology assessment in axillary management in a national cohort of AMAROS-eligible mastectomy patients. The National Cancer Database was used to identify AMAROS-eligible cT1-2N0 breast cancer patients undergoing upfront mastectomy and SLN biopsy (SLNB) and found to have one to two positive SLNs, from 2018 to 2019. We constructed a variable defining intraoperative pathology as 'not performed/not acted on' if ALND was either not performed or performed at a later date than SLNB, or 'performed/acted on' if SLNB and ALND were completed on the same day. Adjusted multivariable analysis examined predictors of treatment with both ALND and AxRT. Overall, 8222 patients with cT1-2N0 disease underwent upfront mastectomy and had one to two positive SLNs. Intraoperative pathology was performed/acted on in 3057 (37.2%) patients. These patients were significantly more likely to have both ALND and AxRT than those without intraoperative pathology (41.0% vs. 4.9%; p<0.001). On multivariate analysis, the strongest predictor of receiving both ALND and AxRT was use of intraoperative pathology (odds ratio 8.99, 95% confidence interval 7.70-10.5; p<0.001). We advocate that consideration should be made for omission of routine intraoperative pathology in mastectomy patients likely to be recommended postmastectomy radiation to minimize axillary overtreatment with both ALND and AxRT in appropriate patients.

Nodal metastasis in surgically treated laryngeal squamous cell carcinoma.

Management of the neck in laryngeal squamous cell carcinoma (LSCC) is essential to oncologic control and survival. We aim to describe patterns and rates of clinical/pathologic lymph node disease, elective neck dissection (END), and occult lymph node metastasis (LNM) in patients with surgically-managed LSCC. Retrospective cohort study of patients in the National Cancer Database (NCDB) diagnosed with LSCC between January 2004 and December 2016 who underwent primary surgery. Seven thousand eight hundred and seventy-six patients met inclusion criteria. For cN0 patients, the rates of END and occult LNM both increased with tumor stage and were highest for supraglottic tumors. Predictors of occult LNM included supraglottic site, pathologic T3 and T4 stage, positive margins, and presence of lymphovascular invasion (p < 0.05). The propensity for cervical LNM in surgically-managed LSCC varies based on primary tumor site and stage, and a variety of disease factors increase risk of occult LNM.

Breast-Conserving Therapy is Associated with Improved Survival Without an Increased Risk of Locoregional Recurrence Compared with Mastectomy in Both Clinically Node-Positive and Node-Negative Breast Cancer Patients.

Randomized trials demonstrated equivalent survival between breast-conserving surgery combined with radiotherapy (BCT) and mastectomy alone. Contemporary retrospective studies using pathological stage have reported improved survival with BCT. However, pathological information is unknown before surgery. To mimic real-world surgical decision-making, this study assesses oncological outcomes by using clinical nodal status. Female patients aged 18-69 years who were treated with upfront BCT or mastectomy between 2006 and 2016 for T1-3N0-3 breast cancer were identified by using prospective, provincial database. The patients were divided into clinically node-positive (cN+) and node-negative (cN0) strata. Multivariable logistic regression was used to assess the effect of local treatment type on overall survival (OS), breast cancer-specific survival (BCSS), and locoregional recurrence (LRR). Of 13,914 patients, 8228 had BCT and 5686 had mastectomy. Mastectomy patients had higher-risk clinicopathological factors: pathologically positive axillary staging was 21% in BCT and 38% in mastectomy groups. Most patients received adjuvant systemic therapy. For cN0 patients, 7743 had BCT and 4794 had mastectomy. On multivariable analysis, BCT was associated with improved OS (hazard ratio [HR] 1.37, p<0.001) and BCSS (HR 1.32, p<0.001), whereas LRR was not different between the groups (HR 0.84, p=0.1). For cN+ patients, 485 had BCT and 892 had mastectomy. On multivariable analysis, BCT was associated with improved OS (HR 1.46, p=0.002) and BCSS (HR 1.44, p=0.008), whereas LRR was not different between the groups (HR 0.89, p=0.7). In the era of contemporary systemic therapy, BCT was associated with better survival than mastectomy, without an increased risk of locoregional recurrence for both cN0 and cN+ presentations.

Comparison of health-related quality of life and cosmetic outcome between traditional gasless trans-axillary endoscopic thyroidectomy and modified gasless trans-axillary endoscopic thyroidectomy for patients with papillary thyroid microcarcinoma.

Gasless trans-axillary endoscopic thyroidectomy (GTET) has been proved to provide better cosmetic results; however, it has limitations as dissection of central neck lymph nodes is difficult. We developed a modified approach (MGTET-modified GTET) and compared it with the traditional one in terms of patients' health-related quality of life (HRQoL) and cosmetic results in order to provide more convincing therapeutic results. Between January 2021 and June 2021, 100 cN0 patients who had a confirmed diagnosis of papillary thyroid microcarcinoma were randomized to undergo either MGTET (n = 50) or GTET (n = 50). These two groups' baseline characteristics, intraoperative and postoperative findings, were compared. The Patient and Observer Scar Assessment Scale (POSAS) was determined 6 months after surgery. Thyroid Cancer-Specific Quality of Life Questionnaire was used to assess HRQoL at 1, 3, 6, and 12 months after surgery. M-GTET was associated with a larger number of lymph nodes dissected (p < 0.001), lower drainage volume (p < 0.001), shorter hospital stay (p < 0.001), and shorter axillary incision (p < 0.001). POSAS was more favorable in M-GTET. HRQoL was significantly better for MGTET in terms of less problems with scar (p < 0.001). Our study suggests that MGTET provides better therapeutic, cosmetic, and HRQoL outcomes.

Omission of breast surgery for predicted pCR patients with MRI and vacuum-assisted biopsy in breast cancer after neoadjuvant chemotherapy: A multicenter, single-arm, non-inferiority trial (OPTIMIST trial).

TPS627 Background: Advances in chemotherapeutic and targeted agents have increased pathologic complete response (pCR) rates after neoadjuvant systemic therapy (NST). The role of surgery is essential to remove cancer when residual tumor is present, but it may be limited to pathologic confirmation in those with a pCR. As an alternative, pCR can be accurately evaluated with vacuum-assisted biopsy (VAB) in patients suggested to have a pCR on imaging. We aim to show a non-inferiority of omitting breast surgery in patients evaluated to have a pCR on image-guided VAB. Methods: The OPTIMIST trial is a prospective, multicenter, single-arm, non-inferiority clinical study. Sixteen tertiary care hospitals in South Korea are participating. Women diagnosed with invasive ductal carcinoma, a clip marker placed in the tumor, and who had completed NST with exceptional response are screened for eligibility. Inclusion criteria: women aged 19-75; cT1-2N0-2M0; triple-negative, HER2+, or low estrogen receptor (&lt;10%); post-NST MRI size ≤1cm and lesion-to-background signal enhancement ratio ≤1.6. Exclusion criteria: malignant calcification &gt;2cm; multifocal, bilateral, or inflammatory breast cancer; other malignancy within five years; BRCA1/2 mutation carrier. Under ultrasound or stereotactic guidance, VAB is performed targeting the clip marker to obtain a minimum of 6 cores using 7-10 G needles. When pCR is confirmed, breast surgery is omitted. cN0 patients with post-NST MRI tumor size ≤0.5cm and no suspicious lymph nodes, axillary lymph node surgery could also be omitted. Patients with residual tumor or atypical cells proceed with routine surgery. All patients are required to receive whole breast irradiation with tumor bed boost. According to previous studies, the 5-year disease-free survival (DFS) for patients with a pCR after NST was assumed to be 88%. The one-sided test with a non-inferiority margin of 4% and statistical power of 80% at a significance level of 0.05 resulted in a sample size of 384 patients to forego breast surgery. An expected 20% residual tumor on VAB and a 10% dropout resulted in a total of 533 subjects. Primary endpoint: 5-year DFS. Secondary endpoint: 5-year ipsilateral breast tumor recurrence-free survival, 5-year overall survival, 5-year invasive DFS, residual axillary lymph node rate, quality of life scores, symptoms (VAS), and medical cost. An interim analysis is planned at 50% enrollment with a median follow-up period of 1 year. The data safety monitoring board will determine the continuation of the study considering the 1-year DFS. The first patient was enrolled on September 22, 2022, and 12 patients have been enrolled as of February 14, 2023. We plan to complete the target accrual by December 2025. Clinical trial information: NCT05505357 .

Practice patterns in ongoing neoadjuvant ATNEC trial for patients with cT1-3N1M0 breast cancer: Response to neoadjuvant chemotherapy (NACT), targeted axillary dissection and breast conservation rates.

e12609 Background: Patients presenting with cT1-3N1M0 breast cancer often receive NACT to enable breast and/or axillary conservation. Targeted axillary dissection (TAD) (sentinel node biopsy (SNB) + removal of marked involved node) has been proposed to reduce the false negative rate of SNB after NACT in cN1 patients. In ATNEC, cT1-3N1M0 patients receive NACT followed by SNB/TAD. If the sentinel nodes (SN) have converted to benign (ypN0), patients are randomly assigned to Axillary Treatment vs no Axillary Treatment. Node marking is recommended in the study and sites are offered training to help them adopt node marking in a standardized way. Objectives: To prospectively evaluate the practice patterns and response to NACT, uptake of node marking, marked node identification rates and breast conservation rates in the ongoing UK ATNEC trial. The trial aims to recruit 1900 patients. Methods: Data for all patients who were randomized until 01-Feb-23 across 78 UK centers were included in these analyses. Patients were cT1-3N1M0 at presentation, received NACT and were found to have no residual nodal disease (ypN0) on SNB/TAD. Results: Among the 120 randomized patients (median age 54 [range 28-77] years) (median BMI 26.4 [range 17.6-51.1]), 53% (64) were post-menopausal, 78% (94) had breast conserving surgery (BCS) and 22% (26) mastectomy. At presentation, 14% (17) were T3, 64% (77) T2 and 20% (24) T1. 70% (84) had grade 3 tumors. 62% (74) were HER2 positive, 31% (37) triple negative (TNBC) and 9% (7) HER2 negative (ER or PgR positive). 54% (65) had an anthracycline and taxane based NACT and 36%(43) had platinum containing NACT. Median of 4 nodes [interquartile range 3-5] were removed during SNB/TAD. Of 109 patients with node marking data, the involved node was marked in 73% (80). The marked node was identified and removed in 95% (76/80), marked node was the SN in 88% (67/76). Of the 109 patients with data for breast tumor post NACT, 69% (75) had pathological complete response (pCR), 7% (8) DCIS only, 24% (26) invasive cancer. Of the 63 patients with complete breast tumor response on imaging, 17% (11) had residual DCIS/invasive cancer. 50% (21/42) of patients with partial response or stable breast tumor on imaging had no residual tumor on histology (ypT0). Of the 107 patients with data on post NACT axillary imaging, 14% (15) had partial or stable disease but pCR on histology. Conclusions: Majority of UK patients having NACT have HER2 positive or TNBC. Although 69% patients had a pCR (ypT0) in the breast, BCS rates remain low. Imaging has limited accuracy in predicting pCR after NACT. 3 in 4 patients randomized had their node marked, with a 95% intra-operative identification rate; demonstrating ATNEC has successfully rolled out node marking in the UK. Clinical trial information: NCT04109079 .

Tailored axillary surgery (TAS) in patients with clinically node-positive breast cancer in the upfront surgery setting: A prospective, single-arm, multicenter trial.

TPS628 Background: Axillary lymph node dissection (ALND), which can induce lymphedema, has been omitted in clinically node-negative(cN0) patients with positive sentinel lymph nodes (SLNs) if they meet the eligibility criteria of ACOSOG Z0011. Furthermore, the omission of ALND has been attempted through targeted axillary dissection (TAD) in patients whose cN+ status converts to ycN0 after neoadjuvant chemotherapy. However, ALND remains the standard of care in patients with cN+ who undergo upfront surgery. The aims of this trial are to establish a surgical method of tailored axillary surgery (TAS), which combines TAD and SLN biopsy among patients with cN+ who undergo upfront surgery, and to determine the appropriate criteria for a Phase III TAS trial. Methods: We have planned a single-arm Phase II trial to confirm the feasibility and assess patient eligibility for TAS. A total of 300 patients will be enrolled from 33 study sites in Japan. The eligibility criteria are as follows: 1) histologically-proven invasive breast cancer, 2) upfront surgery is planned, 3) pathologically-diagnosed metastatic lymph node (cytology or core needle biopsy), 4) 1-3 LN metastases in level I by imaging, 5) cT1-3, and 6) females aged ≥18 and ≤74 years on the enrollment date. TAS involves removing marking lymph nodes by TAD (clip, wire, or tattoo) and SLNB, and ALND up to Level II are performed after TAS. These LNs are defined as non-TAS LNs. The primary endpoint is the non-TAS LNs positive rate. Clinicopathological factors (the number of suspected metastases by imaging, the number of metastases in LNs resected by TAS, tumor size, and invasive ductal/lobular carcinoma) are analyzed to predict the non-TAS LN metastasis rate (e.g., &lt; 10%). By using these clinicopathological factors, we determine the eligibility of TAS to omit ALND safely. The secondary endpoints are TAS LNs identification rate, labeled LNs identification rate, marked lymph node resection rate, arm edema incidence rate, and QOL (FACT-B, QuickDASH). After this feasibility study, we will conduct a phase III trial that omits ALND using TAS to investigate the regional recurrence rate.

Variations in Penile Cancer Management: Results From the Global Society of Rare Genitourinary Tumors Survey.

There is paucity of evidence and consensus on various aspects of management of penile cancer (PeCa), which is intuitive considering the rarity of this disease. We present here the details of an online survey conducted by the Global Society of Rare Genito-urinary Tumors (GSRGT) with the aim of capturing the variations in PeCa care across different regions of the world. An online questionnaire was developed by experts within the GSRGT and then circulated via email in English and Spanish versions to clinicians dealing with PeCa. Respondents were allowed 8 weeks to reply. We received 102 responses; the majority of them were from South America (37.2%) followed by North America and Asia (17.6% each). Only 11.7% of the respondents treated more than 25 patients with PeCa annually. Total penectomy is performed by 21.5% of the respondents in >50% of their patients. Less than a fifth of the experts (19.6%) responded that >50% of their patients are clinically node-negative (cN0) at presentation. For intermediate-risk cN0 patients (T1 G2 cancer), about a third of the experts chose surveillance. For invasive inguinal staging, the options of Dynamic Sentinel Lymph Node Biopsy (DSNB), Modified Inguinal Lymph Node Dissection (MILD), Superficial Inguinal Lymph Node Dissection (SILD), and Video-Endoscopic Inguinal Lymphadenectomy (VEIL) were chosen by 28.4%, 26.4%, 31.3%, and 13.7% of the respondents respectively. Considerable variation was seen in the worldwide use of these techniques. For clinically node-positive patients, respondents were in favor of giving adjuvant chemotherapy instead of neoadjuvant chemotherapy, except for cN3 patients. The results of this questionnaire objectified the variations in global practices in the management of PeCa. This serves as the baseline information which can help prioritize research areas for multinational collaborative efforts, a key mission of the GSRGT.

Reflex MammaPrint testing on breast core biopsies: A single center experience.

e12581 Background: Breast cancer genomic assays are well established in the adjuvant setting, but still evolving in the neoadjuvant setting. Recent data shows that MammaPrint (MP)/BluePrint (BP) genomic assays in the neoadjuvant setting can reclassify hormone receptor positive (HR+), HER2 negative (HER2-) tumors into intrinsic phenotypes with corresponding responses to neoadjuvant therapy (NAC). We performed reflex MP/BP assays on invasive breast cancer core biopsies and evaluated the relationships between clinical risk, molecular risk and intrinsic phenotype. Methods: 150 consecutive HR+, HER2- invasive breast cancers were identified by core biopsy in a tertiary care cancer center and underwent reflex MP/BP testing by an external central laboratory between July 2021 and Jan 2022. Retrospective review was completed on patient demographics and tumor characteristics; descriptive statistics were performed. Results: Of 150 newly diagnosed HR+ HER2- breast cancers, 141 successfully had a reflex MP/BP test performed; 9 were not performed due to technical feasibility or clerical error. Of the 141 patients with a completed MP/BP assay, 7 had recurrent disease, and 8 had metastatic disease, these were excluded. Patients were categorized as clinically high (cHR) or low risk (cLR) using the criteria from the MINDACT trial and as molecularly high risk (MP HR) or low risk (MP LR) per their MP results. We then grouped patients with discordant clinical and molecular risk. We then examined clinical features and NAC receipt amongst these clinical and molecular risk groups. Conclusions: There was discordance between clinical and molecular risk in 38% of our cohort, 20% were cLR/MP and 18% were cHR/MP LR. The decision to give NAC was primarily driven by clinical risk as only 1 patient with cLR/MP HR received NAC. Amongst cHR/MP LR 87% did not get NAC, but this appears to have been a clinical decision as only 7 of these patients had a pre-operative oncology visit at which MP/BP was mentioned. Most (72%) of &gt; cN1 patients received NAC, of the 5 who didn’t, 4 were in the MP LR group and had a pre-operative oncology visit where MP was mentioned. In this select group the genomic assay may have influenced the decision to withhold NAC. Reflex genomic assays for HR+ HER2- breast cancer may not be useful; the decision to integrate molecular risk into the decision for NAC is multifactorial and stage of disease may be most impactful. Further work is needed in this area. [Table: see text] [Table: see text]

Neglected lymph nodal metastases in patients with renal cancer: when to extend the anatomical template of lymph node dissection during nephrectomy.

The role of lymph node dissection (LND) in patients with renal cell carcinoma (RCC) is still controversial. However, detecting lymph node invasion (LNI) is key due to prognostic implications and to identify patients who might benefit from adjuvant therapies such as adjuvant pembrolizumab. Out of 796 patients, 261 (33%) received eLND, of whom 62 (8%) for suspicious lymph node (LN) metastases at preoperative staging (cN1). eLND was divided in 3 anatomical areas: (1) hilar, (2) side-specific (pre-/para-aortic or pre-/para-caval) and (3) inter-aorto-caval nodes. Overall maximum LN diameter was measured by a dedicated radiologist for each patient. Multivariable logistic regression models (MVA) were tested for the effect of maximum LN diameter in predicting the presence of nodal metastases outside the anatomical area of cN1. LNI was confirmed in 50% of cN1, whilst only 13 out of 199 cN0 patients were pN1 at final histology (6.5%; p < 0.001). In a per-patient analysis, of 62 cN1 patients, 24% vs. 18% vs. 8% harboured pN1 disease only inside vs. in-outside vs. only outside the suspicious anatomical field of cN1 at preoperative CT/MRI scan. At MVA, increasing diameter of suspicious LNs was independently associated with risk of finding positive LNs outside the suspicious anatomical field (OR 1.05, 95%CI 1.02-1.11; p = 0.02). Roughly 50% of cN1 patients undergoing eLND will harbour LN metastases, also outside the suspicious radiological area, and maximum LNs diameter at preoperative imaging correlates with such risk. Thus, an eLND might be justified in patients with large suspicious LN metastases, to better stage this patient population and to improve postoperative treatment management.

Clinical feasibility and oncological safety of non-radioactive targeted axillary dissection after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: a prospective diagnostic and prognostic study.

Targeted axillary dissection (TAD) includes biopsy of clipped lymph node and sentinel lymph nodes. However, clinical evidence regarding clinical feasibility and oncological safety of non-radioactive TAD in a real-world cohort remains limited. In this prospective registry study, patients routinely underwent clip insertion into biopsy-confirmed lymph node. Eligible patients received neoadjuvant chemotherapy followed by axillary surgery. Main endpoints included the false-negative rate (FNR) of TAD and nodal recurrence rate. Data from 353 eligible patients were analyzed. After completion of neoadjuvant chemotherapy, 85 patients directly proceeded to axillary lymph node dissection (ALND), furthermore, TAD with or without ALND was performed in 152 and 85 patients, respectively. Overall detection rate of clipped node was 94.9% (95% CI, 91.3-97.4%) and FNR of TAD was 12.2% (95% CI, 6.0-21.3%) in our study, with FNR decreasing to 6.0% (95% CI, 1.7-14.6%) in initially cN1 patients. During a median follow-up of 36.6 months, 3 nodal recurrences occurred (3/237 with ALND; 0/85 with TAD alone), with a 3-year freedom-from-nodal-recurrence rate of 100.0% among the TAD-only patients and 98.7% among the ALND patients with axillary pathologic complete response ( P =0.29). TAD is feasible in initially cN1 breast cancer patients with biopsy-confirmed nodal metastases. ALND can safely be foregone in patients with negativity or a low volume of nodal positivity on TAD, with a low nodal failure rate and no compromise of 3-year recurrence-free survival.

Diagnostic performance of FDG PET/MRI for cervical lymph node metastasis in patients with clinically N0 head and neck cancer.

Treatment management in cases of head and neck squamous cell cancer (HNSCC) that are clinically negative for lymph node metastases (cN0) is still an important topic of discussion. There is increasing interest in sensitive imaging modalities that can detect the risk of occult metastases at levels below 20%. This study aimed to examine the efficacy of integrated positron emission tomography (PET)/magnetic resonance imaging (MRI) in determining neck nodal metastasis status in cN0 patients with HNSCC. In this retrospective study, 44 patients who underwent neck dissection with the diagnosis of HNSCC between January 2018 and August 2020 were analyzed. Clinical examinations, including ultrasonography, were performed to identify cervical metastases in HNSCC patients with preoperative cN0. A nuclear medicine specialist visually evaluated the MRI, PET, and PET/MRI results. Histopathologically, 86.4% of patients were classified as N0. According to the histopathological results, MRI showed 50% sensitivity, 89.5% specificity, 91.8% negative predictive value (NPV), 42.8% positive predictive value (PPV) and 84% accuracy, while PET showed 83.3% sensitivity, 68.4% specificity, 96.2% NPV, 29.4% PPV and 70.4% accuracy. PET/MRI was more successful in distinguishing pathological N0 and N+ patients (83.3% sensitivity, 92.1% specificity, 97.2% NPV, 62.5% PPV and 90.9% accuracy). PET/MRI is more sensitive and has a higher NPV compared to MRI alone, while its sensitivity was found to be comparable to that of PET. In addition, with its ability to detect pathological N0 patients, PET/MRI may significantly decrease the number of unnecessary neck dissections.

PD10-02 USING THE NEGATIVE PREDICTIVE VALUE AND SUVMAX OF PSMA PET/CT FOR AVOIDING PELVIC LYMPH NODE DISSECTION WITH RADICAL PROSTATECTOMY

You have accessJournal of UrologyCME1 Apr 2023PD10-02 USING THE NEGATIVE PREDICTIVE VALUE AND SUVMAX OF PSMA PET/CT FOR AVOIDING PELVIC LYMPH NODE DISSECTION WITH RADICAL PROSTATECTOMY Amandeep Arora, Archi Agarwal, Mahendra Pal, Ganesh Bakshi, Santosh Menon, Gujela Ajit, and Gagan Prakash Amandeep AroraAmandeep Arora More articles by this author , Archi AgarwalArchi Agarwal More articles by this author , Mahendra PalMahendra Pal More articles by this author , Ganesh BakshiGanesh Bakshi More articles by this author , Santosh MenonSantosh Menon More articles by this author , Gujela AjitGujela Ajit More articles by this author , and Gagan PrakashGagan Prakash More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003250.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The prostate-specific membrane antigen positron-emission-tomography (PSMA-PET) scan is increasingly being utilized for staging prostate cancer (PCa). Here, we sought to evaluate the accuracy of the PSMA-PET scan with the aim of identifying patients who could be spared a pelvic lymph node dissection (PLND) at the time of radical prostatectomy (RP) based on the results of the PSMA-PET scan. METHODS: We retrospectively reviewed records of patients who underwent a PSMA-PET scan followed by an RP with extended PLND (external iliac, obturator and common iliac nodes) at our tertiary cancer care centre from Aug 2015 - September 2022. Patients were classified as clinically node negative or positive (cN0 or cN+) based on the PSMA PET scan. The nodal status in the PSMA-PET scan was compared with the final histopathology of the PLND (pN0 or pN+). RESULTS: A total of 205 patients were included and were stratified as follows based on MRI and PSMA-PET scans: 6 (2.9%) low-risk, 49 (23.9%) intermediate-risk, 46 (22.4%) high-risk localized, 89 (43.4%) locally-advanced node-negative and 15 (7.3%) node-positive patients. The sensitivity, specificity, positive predictive value, and negative predictive value of the PSMA PET scan for nodal status were 37.5%, 98.2%, 80% and 89.4% respectively. The NPV was 89.4%, 93.8%, 87% and 86.6% for overall, intermediate-risk, high-risk localized and locally-advanced node-negative patients respectively. The median SUVmax of the primary prostate lesion in patients who were true negatives for nodes, as identified by the PSMA-PET scan, was significantly lower (12.8 vs 26.4, p<0.001) than that in patients who were false negative (cN0 on PSMA but pN+ in final pathology). Of the 190 cN0 patients, 20 had a false negative PSMA PET scan. Three of the 49 intermediate-risk patients had a false negative PSMA PET scan for nodes; the SUVmax scores of their prostate lesions were 26.59, 40.06 and 54.55 which were much higher than the median SUVmax score (12.8) in patients with a true negative scan. For the 135 high-risk cN0 patients, the 17 false negative patients had a median SUVmax of 24.37 compared to those with a true negative scan (13.57), p<0.001. CONCLUSIONS: The high NPV of PSMA-PET scan coupled with the SUVmax of the primary prostatic lesion can help avoid a PLND in intermediate and high-risk patients with a ‘negative’ PSMA-PET scan. The results can be considered as hypothesis generating and indicate the use of PSMA as a biomarker for predicting nodal disease. Further larger studies can help determine the ideal cut-off values for the SUVmax of the primary lesion. Source of Funding: No © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e326 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amandeep Arora More articles by this author Archi Agarwal More articles by this author Mahendra Pal More articles by this author Ganesh Bakshi More articles by this author Santosh Menon More articles by this author Gujela Ajit More articles by this author Gagan Prakash More articles by this author Expand All Advertisement PDF downloadLoading ...

MP50-04 OVERALL SURVIVAL IN PENILE CANCER: ANALYSIS OF A LARGE CONTEMPORARY COHORT TREATED AT A TERTIARY REFERRAL CENTRE

You have accessJournal of UrologyCME1 Apr 2023MP50-04 OVERALL SURVIVAL IN PENILE CANCER: ANALYSIS OF A LARGE CONTEMPORARY COHORT TREATED AT A TERTIARY REFERRAL CENTRE James Churchill, Ashwin Sachdeva, Craig Jones, Allaudin Issa, Christian Fankhauser, Andrew Hudson, Anna Tran, Pedro Oliveira, Helen Johnson, Maurice Lau, Arie Parnham, and Vijay Sangar James ChurchillJames Churchill More articles by this author , Ashwin SachdevaAshwin Sachdeva More articles by this author , Craig JonesCraig Jones More articles by this author , Allaudin IssaAllaudin Issa More articles by this author , Christian FankhauserChristian Fankhauser More articles by this author , Andrew HudsonAndrew Hudson More articles by this author , Anna TranAnna Tran More articles by this author , Pedro OliveiraPedro Oliveira More articles by this author , Helen JohnsonHelen Johnson More articles by this author , Maurice LauMaurice Lau More articles by this author , Arie ParnhamArie Parnham More articles by this author , and Vijay SangarVijay Sangar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003298.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Penile squamous cell carcinoma (PSCC) is rare and overall survival (OS) in metastatic disease remains poor. This study examines the OS, classified by TNM stage, in a large contemporary cohort of PSCC patients managed at a tertiary referral centre. METHODS: We analysed retrospective data from a prospectively maintained database for patients with PSCC treated between 2003 and 2022. We excluded clinically node-negative (cN0) patients who did not undergo invasive nodal staging (pNX). TNM stage was defined by histopathology (AJCC version 8) except where clinical/radiological findings of fixed inguinal nodes (cN3), pelvic lymphadenopathy (cN3) or distant metastatic disease (M1) were present. All patients were treated according to local guidelines. The primary outcome of OS (time from definitive primary surgery to death, censored for last follow-up) was analysed using the Kaplan-Meier method and log rank test. Multivariate Cox regression analysis for age, p16 status, TNM-stage and grade was performed. Audit approval was obtained from the host clinical governance committee. RESULTS: We identified 634 eligible patients. Baseline characteristics were similar in each group, with median age 64 years (range 26-94) and median follow-up 55 months (range 0-187). We describe OS (Figure 1) and risk of death by N and M stage, after multivariate analysis (Table 1). CONCLUSIONS: We demonstrate the contemporary OS outcomes of a large cohort of penile cancer patients receiving standard of care treatment at a tertiary referral centre, with significant OS differences by N and M stage. Our data confirm the poor survival outcomes of patients with N3 and M1 disease and these groups should be the target for developing novel management strategies. Conversely, patients with N1 and N2 disease have significantly longer survival, reinforcing the need for predictive biomarkers to help refine patient selection for optimal management. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e686 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information James Churchill More articles by this author Ashwin Sachdeva More articles by this author Craig Jones More articles by this author Allaudin Issa More articles by this author Christian Fankhauser More articles by this author Andrew Hudson More articles by this author Anna Tran More articles by this author Pedro Oliveira More articles by this author Helen Johnson More articles by this author Maurice Lau More articles by this author Arie Parnham More articles by this author Vijay Sangar More articles by this author Expand All Advertisement PDF downloadLoading ...

MP80-18 SURVIVAL AFTER RADICAL PROSTATECTOMY VS RADIATION THERAPY IN CLINICAL NODE POSITIVE PROSTATE CANCER PATIENTS: A MULTICENTRIC STUDY

MP80-18 SURVIVAL AFTER RADICAL PROSTATECTOMY VS RADIATION THERAPY IN CLINICAL NODE POSITIVE PROSTATE CANCER PATIENTS: A MULTICENTRIC STUDY

Sinonasal mucosal melanoma: Is there a need for elective neck irradiation?

Background and purposeSinonasal mucosal melanoma (SNMM) is a rare malignant neoplasm. The regional failure pattern and effectiveness of elective neck irradiation (ENI) were not well defined. Here, we would assess the value of ENI for clinical node negative (cN0) SNMM patients. Materials and methodsA total of 107 SNMM patients treated at our institution over a period of 30 years was retrospectively analyzed. ResultsFive patients had lymph node metastases at diagnosis. Among the 102 cN0 patients analyzed, 37 patients had received ENI, and 65 patients had not. ENI significantly reduced the regional recurrence rate from 23.1% (15/65) to 2.7% (1/37). Ipsilateral levels Ib and II were the most common locations of regional relapse. Multivariate analysis also showed that ENI was the only independent favorable predictor for the achievement of regional control (HR: 9.120; 95% CI: 1.204–69.109; P = 0.032). ConclusionThis is the largest cohort of SNMM patients from a single institution analyzed for the assessment of the value of ENI on regional control and survival. ENI significantly reduced the regional relapse rate in our study. Ipsilateral levels Ib and II might be considerable when deliver elective neck irradiation, more evidence is needed in the future.

Sentinel Lymph Node Biopsy in Breast Cancer Patients Undergoing Neo-Adjuvant Chemotherapy: Clinical Experience with Node-Negative and Node-Positive Disease Prior to Systemic Therapy

Sentinel lymph node biopsy (SLNB) has emerged as the standard procedure to replace axillary lymph node dissection (ALND) in breast cancer (BC) patients undergoing neo-adjuvant chemotherapy (NAC). SLNB is accepted in clinically node-negative (cN0) patients; however, its role in clinically node-positive (cN+) patients is debatable. We performed a retrospective analysis of BC patients undergoing NAC and SLNB. Our aim was to evaluate the clinical significance of SLNB in the setting of NAC. This was accomplished by comparing the characteristics and oncological outcomes between cN0 and cN+ patients prior to NAC and type of axillary surgery. A total of 291 patients were included in the analysis: 131 were cN0 and 160 were cN+ who became ycN0 after NAC. At a median follow-up of 43 months, axillary recurrence occurred in three cN0 (2.3%) and two cN+ (1.3%) patients. However, there were no statistically significant differences in oncological outcomes (disease-free survival, distant disease-free survival, overall survival, and breast-cancer-specific survival) between cN0 and cN+ patients nor between patients treated with SLNB only or ALND. SLNB in the setting of NAC is an acceptable procedure with a general good prognosis and low axillary failure rates for both cN0 and cN+ patients.