Extent Of Lymph Node Metastasis Research Articles

口腔癌の浸潤・転移における分子メカニズム

Cancer is now the leading cause of death in Japan. A rapid increase in cancer mortality is expected as Japan is facing as uper-aged society. Oral cancers rank sixth among the common malignancies globally, with a rising titer of around 40% in developing countries such as Southeast Asia. More than 90% of malignant neoplasms of the oral cavity and oropharynx are squamous cell carcinomas of the lining mucosa. Review of the literature indicates that the most important factor for the high mortality rate is the advanced stage of the disease at the time of diagnosis and treatment. In the prognosis of oral cancer, the extent of lymph node metastasis is a major determinant. Like most epithelial cancers, oral cancer develops through the accumulation of multiple genetic and epigenetic alterations in a multistep process. Recent molecular studies have advanced our understanding of the disease and provided a rationale to develop novel strategies for early detection, classification, prevention, and treatment. Attempts to identify the genes involved in the metastasis are pivotal for the early prediction of oral cancer behavior. However, the identity and time of onset of the alterations that endow cancer cells with these metastatic functions are largely unknown. The process of metastasis consists of sequential and selective steps including proliferation, induction of angiogenesis, detachment, motility, invasion into circulation, aggregation and survival in the circulation, cell arrest in distant capillary beds, and extravasation into organ parenchyma. In this review, we introduce recent findings of the molecular mechanism of oral cancer invasion and metastasis.

Prognostic analysis of different treatments for synchronous colorectal liver metastasis

To evaluate the effects of different treatments on the prognosis of patients with synchronous colorectal liver metastasis(CLM). Clinicopathological data of 121 patients with synchronous CLM in The First Affiliated Hospital of Xinjiang Medical University between January 2010 and December 2014 were retrospectively analyzed. According to the metastatic lesions, patients were divided into simple operation group(22 patients, receiving operation only), simple chemotherapy group(43 patients, receiving chemotherapy only), and combination group(56 patients, receiving chemotherapy based on operation). The prognosis of patients in three groups was investigated. Univariate and multivariate analyses were performed through the long-rank test and Cox model to evaluate the related factors affecting prognosis. The median survival time was 10(3-39) months in simple operation group, 7(3-36) months in simple chemotherapy group, and 18 (4-66) months in combination group. The differences among groups were all statistically significant (all P<0.05). Extent of lymph node metastasis, number of liver metastatic lesion, size of liver metastatic lesion, resection edge extent of liver metastatic lesion, and treatment method were independent factors of synchronous CLM(all P<0.05). Combination therapy of a variety of treatment can prolong the survival of patients with synchronous CLM.

Clinic, pathologicand biologic prognostic factors in endometrial cancer. A literature review.

Endometrial cancer (EC) is the most common gynecological malignancy in western countries which primarily affects postmenopausal women. The aim of this review is to outline the most important clinic, pathologic and biologic prognostic parameters in order to obtain the treatment outcomes in EC. Medline and Pubmed were searched for English language articles using keywords (i.e. “endometrial cancer”, “prognostic factors”). systematic reviews, retro-prospective studies, controlled and randomized clinical trials focused on prognostic information were selected. Bibliographies of articles found were searched for further relevant titles. The most significant reported prognostic factors are age, International Federation of Obstetrics and Gynecology stage, the histological subtype and grade of the tumor, peritoneal cytology, lymphovascular space involvement, invasion of the myometrum, tumors that extend to the cervical stroma,extra-uterine disease,tumor size,as well as the presence and extent of lymph node metastasis. Molecular biomarkers such as mutations in tumor suppressor genes, deoxyribonucleic acid mismatch repair, and the presence of a triple negative phenotype are considered worse prognostic factors, and may lead to a poor survival.

High microRNA-23a expression in laryngeal squamous cell carcinoma is associated with poor patient prognosis.

BackgroundMicroRNA-23a (miR-23a) has been demonstrated to play an important role in the development of several types of cancer, but its role in tumorigenesis of laryngeal carcinoma is still unclear. The aim of this study was to investigate the expression patterns and clinical implications of miR-23a in laryngeal cancer.MethodsQuantitative RT-PCR was performed to evaluate the expression level of miR-23a in 52 pairs of laryngeal cancer. Analysis between miR-23a expression and clinical features of laryngeal carcinomas was performed by appropriate statistical methods. Role of miR-23a in laryngeal cancer cell migration and invasion was detected via transwell and matrigel assays, respectively.ResultsmiR-23a was significantly up-regulated in laryngeal cancer tissues compared to normal adjacent laryngeal tissues (P < 0.01). Tumors with high miR-23a expression had significantly greater extent of lymph node metastasis (P < 0.01), worse clinical stage (P < 0.05) and shorter overall five-year survival (P < 0.01) than those with low miR-23a expression. Both univariate and multivariate Cox hazard regression analysis results showed that clinical stage and miR-23a expression were significantly correlated with patient five-year survival (P < 0.01). miR-23a overexpression also significantly promoted laryngeal cancer cell migration and invasion in vitro.ConclusionsmiR-23a, an independent prognostic factor for laryngeal cancer, participates in the onset and progression of laryngeal cancer.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2021488014982305

Up-Regulation of MiR-452 Inhibits Metastasis of Non-Small Cell Lung Cancer by Regulating BMI1

Background/Aims: MicroRNAs (miRNAs) have been regarded as a new class of regulators in cellular processes in non-small cell lung cancer (NSCLC). However, the relationship between miR-452 and the development of NSCLC remains unclear. Methods: qRT-PCR was used to detect the expression of miR-452 and its target gene in NSCLC samples (n=60). The transwell assay was used to test the cell invasion capability. The regulation mechanism was confirmed by luciferase reporter assay and western blot assay. Results: In the current study, a relatively lower miR-452 and higher BMI1 expression levels were confirmed to be associated with advanced tumor stage and more extent of lymph nodes metastasis. In vitro, down-regulated miR-452 could enhance cell invasion capability. Furthermore, miR-452 modulated BMI1 expression by binding to its 3ʹ-UTR. The enhancement of cell invasion capability induced by down-regulated miR-452 was eliminated by repression of BMI1. Conclusions: Our results suggest that miR-452 plays a vital role in development of NSCLC, and this miR-452-BMI1 pathway might generate a novel insight into the treatment of NSCLC.

Lymph node metastasis: A bearing on prognosis in squamous cell carcinoma.

Nodal status is a significant predictor for survival of patients with oral squamous cell carcinoma (SCC), sentinel lymph node (SLN) biopsy, step sectioning of SLNs, and immunohistochemistry have changed the detection of tumor deposits in lymph nodes (LNs). The extent of LN metastasis is a major determinant for the staging and the prognosis of most human malignancies and often guides therapeutic decisions. Metastasis to regional lymph node (RLN) is a complex process. It is often associated with several clinical and pathological characteristics. The involvement of RLN is often, a harbinger for increased risk of metastasis. New knowledge in this area can enable the clinicians and pathologists to study and treat tumors in a more directed fashion. A molecular approach to factors that predicts the likelihood of RLN metastasis could eliminate the reoccurrence of the tumor in the form of "micrometastasis" and "skip" metastasis. The aim of this review is to discuss different modes of spread of metastasis in SCC.

Enhanced expression of long non-coding RNA ZXF1 promoted the invasion and metastasis in lung adenocarcinoma

The identification of cancer-associated long non-coding RNAs (LncRNA) and the investigation of their molecular and biological functions are important for understanding the molecular biology and progression of cancer. This study aims to find the key LncRNA associated with lung adenocarcinoma and to evaluate its biological role and clinical significance in tumor progression. Microarray analysis of 32,756 LncRNA was performed to screen the significantly different LncRNA between human lung adenocarcinoma tissues and adjacent non-cancerous lung tissues, which was named as LncRNA ZXF1. Expression of LncRNA ZXF1 was analyzed in 62 lung adenocarcinoma tissues and adjacent non-cancerous lung tissues by quantitative reverse-transcription PCR (qRT-PCR). Correlations between LncRNA ZXF1 expression and the clinicopathological features and prognosis of patients were also analyzed. The inhibition of LncRNA ZXF1 using siRNA treatment was performed in order to explore its role in tumor progression. The effect of LncRNA ZXF1 on proliferation was evaluated by CCK-8 assay using A549 cell lines, and cell migration and invasion were detected by transwell assays. Here we found that LncRNA ZXF1 levels were remarkably increased in lung adenocarcinoma tissues compared with adjacent non-cancerous lung tissues (P<0.05), and up-regulated LncRNA ZXF1 was correlated with lymph node metastasis (P<0.05), tumor pathological stage (P<0.05) and the extent of lymph node metastasis (correlation coefficient=0.366). The 3-year overall survival rate of patients with higher LncRNA ZXF1 levels was remarkably reduced compared with patients with lower LncRNA ZXF1 levels, implying that patients with high levels of LncRNA ZXF1expression had a relatively poor prognosis. Inhibition of LncRNA ZXF1 by siRNA decreased the migration and invasion of A549 cells in vitro, while there was no significant effect in cell proliferation.

Activation of P21-activated protein kinase 2 is an independent prognostic predictor for patients with gastric cancer

Objectivep21-activated kinase (PAK) 2, as a member of the PAK family kinases, is involved in a number of hallmark processes including cell proliferation, survival, mitosis, apoptosis, motility and angiogenesis. However, the clinical significance of the activation of PAK2 in human gastric cancer has not been fully elucidated. The aim of this study was to investigate whether PAK2 expression and its phosphorylation status are correlated with tumor progression and prognosis in gastric cancer.MethodsExpression patterns and subcellular localizations of PAK2 and Ser20-phosphorylated PAK2 (pSer20PAK2) in 82 gastric cancer patients were detected by immunohistochemistry.ResultsBoth PAK2 and pSer20PAK2 immunostainings were localized in the cytoplasm of tumor cells of gastric cancer tissues. Compared with the normal gastric mucosa, the expression levels of PAK2 and pSer20PAK2 proteins were both significantly increased (both P < 0.001). Additionally, the patients displaying the over-expression of PAK2 and pSer20PAK2 proteins were dramatically associated with unfavorable clinicopathologic variables including higher tumor depth (P = 0.022 and 0.036, respectively), greater extent of lymph node metastasis ((P = 0.022 and 0.036, respectively), positive distant metastasis (P = 0.025 and 0.038, respectively) and advanced tumor stage (P = 0.018 and 0.031, respectively). Moreover, the patients overexpressing PAK2 and pSer20PAK2 proteins have poor overall survival rates relative to those without overexpression of these proteins. Furthermore, cox multi-factor analysis showed that PAK2 (p = 0.012) and pSer20PAK2 (p = 0.010) were independent prognosis factors for human gastric cancer.ConclusionOur data suggest for the first time that PAK2 activation may be associated with advanced tumor progression and poor prognosis of gastric cancer.Virtual slidesThe virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1236344107120406.

Clinical significance of lymph node metastasis in gastric cancer.

Gastric cancer, one of the most common malignancies in the world, frequently reveals lymph node, peritoneum, and liver metastases. Most of gastric cancer patients present with lymph node metastasis when they were initially diagnosed or underwent surgical resection, which results in poor prognosis. Both the depth of tumor invasion and lymph node involvement are considered as the most important prognostic predictors of gastric cancer. Although extended lymphadenectomy was not considered a survival benefit procedure and was reported to be associated with high mortality and morbidity in two randomized controlled European trials, it showed significant superiority in terms of lower locoregional recurrence and disease related deaths compared to limited lymphadenectomy in a 15-year follow-up study. Almost all clinical investigators have reached a consensus that the predictive efficiency of the number of metastatic lymph nodes is far better than the extent of lymph node metastasis for the prognosis of gastric cancer worldwide, but other nodal metastatic classifications of gastric cancer have been proposed as alternatives to the number of metastatic lymph nodes for improving the predictive efficiency for patient prognosis. It is still controversial over whether the ratio between metastatic and examined lymph nodes is superior to the number of metastatic lymph nodes in prognostic evaluation of gastric cancer. Besides, the negative lymph node count has been increasingly recognized to be an important factor significantly associated with prognosis of gastric cancer.

N stages of the seventh edition of TNM Classification are the most intensive variables for predictions of the overall survival of gastric cancer patients who underwent limited lymphadenectomy

The objective of this study was to explore the prognostic prediction rationality of the seventh edition N stage for gastric cancer (GC) patients who underwent the limited lymphadenectomy. Clinicopathological data of 769 GC patients who underwent the curative resection between 1997 and 2006 were analyzed for demonstration that the seventh edition N stage had the significant superiorities of prognostic prediction to the patients who underwent the limited lymphadenectomy. Although the extent of lymphadenectomy was associated with the overall survival (OS) of gastric cancer (GC) patients, the N stages of the seventh edition of the TNM Classification were identified as the most intensively independent predictors of GC prognosis. Using stratum analysis, the 5-year survival rate of patients who underwent limited lymphadenectomy was observed to be significantly different from that of patients who underwent extended lymphadenectomy, regardless of the extent of lymph node metastasis. Multinomial logistic regression analysis revealed that combining the extents of lymph node metastasis and lymphadenectomy could improve the prediction accuracy of patient survival status. Case control analysis showed that regardless of the extent of lymphadenectomy, the seventh edition N stages featured significant superiority for OS evaluation of GC patients. The seventh edition N stage had the prediction rationality for the OS of GC patients who underwent the limited lymphadenectomy.

Increased number of metastatic lymph nodes in adenocarcinoma of the ampulla of Vater as a prognostic factor: A proposal of new nodal classification

Although the number of metastatic lymph nodes in most gastrointestinal carcinomas is correlated inversely with prognosis, the prognostic value of the number of metastatic lymph nodes in ampullary adenocarcinoma has not been well characterized. Lymph node metastasis was assessed in the Surveillance, Epidemiology and End Results database in 1,057 ampullary adenocarcinomas that were operatively resected and for which at least 12 lymph nodes were examined. A complex pattern of survival versus extent of lymph node metastasis was captured by censored local regression. The impact of the extent of lymph nodes metastasis on survival was investigated by use of the K-adaptive partitioning algorithm to identify the most significant cut-off points of metastatic lymph nodes affecting survival. Two significant cut-off points (0 and 2) for the metastatic lymph node segregated patients into 3 groups with clinically important differences in median survival: patients with no metastatic lymph node (477 cases) had a median survival of 91 months, patients with 1-2 metastatic lymph nodes (279 cases) had a median survival of 29 months, whereas patients with ≥3 metastatic Lymph nodes (301 cases) had a median survival of 19 months (P < .0001). These results were validated with additional single institution dataset (318 cases, P < .0001). The present results suggest that the nodal classification of ampullary adenocarcinoma should be categorized N0 (no metastatic lymph node), N1 (1-2 metastatic lymph nodes), and N2 (≥3 metastatic lymph nodes).

Expression of APC, β-catenin and E-cadherin in Tunisian patients with gastric adenocarcinoma: clinical significance

Aberrant activation of the Wnt signalling pathway is a key feature of many cancers. β-Catenin, adenomatous polyposis coli (APC) and E-cadherin are major players in this pathway. The aim of this study is to examine the expression of β-catenin, APC and E-cadherin in tumour tissues of 80 Tunisian patients with gastric carcinoma and to determine the methylation status of the APC promoter in tumour tissues. Associations between protein expression and clinico-pathological parameters, including prognosis, were performed. Positive expression of β-catenin, APC and E-cadherin was observed in 77.5, 68.7 and 60% of cases, respectively. Tumours lacking membranous expression of β-catenin had greater extent of lymph node metastasis, poor differentiation and advanced T-stage. The expression of E-cadherin correlated with poor differentiation (P = 0.05) and β-catenin expression (P = 0.004). With regards to prognosis, the overall survival time was significantly prolonged for patients showing normal β-catenin expression (exclusively or predominantly membranous staining) alone or combined with positive APC expression (P log rank = 0.008 and 0.003, respectively). The methylated pattern of APC promoter 1A was detected in 43.8% of cases and correlated with T-stage (P = 0.046) and distant metastasis (P = 0.037). No correlation was found between the methylated profile of APC promoter 1A and the expression of APC protein in tumour tissues. Our findings suggest that deregulation of the Wnt pathway via abnormal expression of β-catenin and E-cadherin occurred frequently in gastric carcinoma and correlated with worse clinical behaviour.

Is early surveillance with CT scan necessary in patients with stage II/III colorectal cancer: A retrospective study

This analysis aims to evaluate the value of early surveillance within 6 months after resection for stage II/III colorectal cancer (CRC). Patients with stage II/III CRC who received surgery with curative intent for CRC were included. CT scans of the chest, abdomen, and pelvis performed within 6 months after surgery were evaluated. Among 150 patients included in the study, 10 patients (1 occurred in stage II disease and 9 occurred in stage III) were diagnosed as recurrence within 6 months after surgery. The proportion of patients diagnosed as recurrence was significantly higher in stage III disease than in stage II disease (P = 0.01). The likelihood of recurrence within 6 months was associated with the extent of lymph node metastases (r = 0.205, P = 0.012). Three patients with recurrent disease underwent salvage resection with curative intent. Early surveillance with CT scan within 6 months after curative resection may not be necessary for stage II disease. Although, the strategy may be helpful for stage III disease considering the high incidence of salvage surgery for recurrence disease, the early detection of recurrence could not be translated into survival benefit.

Downregulation of microRNA-206 is a potent prognostic marker for patients with gastric cancer

MicroRNA-206 (miR-206), as a homolog of miR-1, plays important roles in tumorigenesis and tumor progression of various human malignancies, including breast cancer, endometrial endometrioid carcinoma, rhabdomyosarcoma, glioma, lung cancer, and laryngeal cancer. However, its involvement in gastric cancer has remained unclear. To examine the expression patterns and clinical implications of miR-206 in gastric cancer. Quantitative RT-PCR was performed to evaluate the expression levels of miR-206 in 98 pairs of gastric cancer and normal adjacent mucosa. In addition, the clinicopathologic significance and the prognostic value of miR-206 expression were further determined. At first, miR-206 expression was significantly downregulated in gastric cancer tissues when compared with normal adjacent mucosa (P<0.001). Next, tumors with low miR-206 expression had a greater extent of lymph node metastasis (P=0.01), presence of venous invasion (P=0.008), and hematogenous recurrence (P=0.01), and were at a worse stage (P=0.03) than the tumors with a high miR-206 expression. Then, the gastric cancer patients with a low miR-206 expression had shorter overall survival than those with a high miR-206 expression (P=0.02). Furthermore, multivariate analysis showed that miR-206 expression was an independent prognostic factor for patients with gastric cancer. Our results strongly suggest that the downregulation of miR-206 was significantly correlated with tumor progression and may be a potent prognostic marker of gastric cancer. miR-206 might serve as a promising therapeutic target for the treatment of this cancer.

Molecular and Functional Imaging for Detection of Lymph Node Metastases in Prostate Cancer

Knowledge on lymph node metastases is crucial for the prognosis and treatment of prostate cancer patients. Conventional anatomic imaging often fails to differentiate benign from metastatic lymph nodes. Pelvic lymph node dissection is an invasive technique and underestimates the extent of lymph node metastases. Therefore, there is a need for more accurate non-invasive diagnostic techniques. Molecular and functional imaging has been subject of research for the last decades, in this respect. Therefore, in this article the value of imaging techniques to detect lymph node metastases is reviewed. These techniques include scintigraphy, sentinel node imaging, positron emission tomography/computed tomography (PET/CT), diffusion weighted magnetic resonance imaging (DWI MRI) and magnetic resonance lymphography (MRL). Knowledge on pathway and size of lymph node metastases has increased with molecular and functional imaging. Furthermore, improved detection and localization of lymph node metastases will enable (focal) treatment of the positive nodes only.

Clinical significance of carcinoembryonic antigen in peritoneal lavage from patients with gastric cancer

Peritoneal carcinomatosis is the most common pattern of recurrence of gastric cancer, and it is important to identify patients at high risk for recurrence. Although the carcinoembryonic antigen level in peritoneal lavage (pCEA) was reported to be a useful biomarker to predict peritoneal recurrence in a small series, its clinical significance has not been fully validated. We evaluated the clinical significance of pCEA in a large cohort of patients with gastric cancer. We prospectively analyzed the pCEA level in 597 patients with histologically proven gastric cancer who underwent laparotomy. A significant relationship was demonstrated between the value of pCEA and clinicopathologic features, such as the peritoneal lavage cytology, peritoneal metastasis, the depth of tumor invasion, and the lymph node metastasis. The cutoff value was set at 100 ng/g of protein, and 134 of the 462 patients who underwent curative surgery had positive pCEA findings. The overall and the intraperitoneal-recurrence-related survival of patients positive for pCEA were significantly poorer than those of pCEA-negative patients. When we analyzed the patients with pathologic stage I through III gastric cancers separately, the pCEA-positive patients had poorer prognoses than the pCEA-negative patients who had stage III gastric cancer. In a univariate analysis, the tumor size, depth of tumor invasion, lymph node metastasis, histologic type, serum CEA (sCEA), and pCEA were found to affect the patients' outcomes, although a multivariate analysis found only the extent of lymph node metastasis to be an independent prognostic factor. The pCEA level is a useful biomarker to predict gastric cancer-related death. Moreover, the pCEA level may be useful to identify a cohort of patients with gastric cancer who need more intensive adjuvant chemotherapy to improve their prognoses.

Reduced expression of miR-22 in gastric cancer is related to clinicopathologic characteristics or patient prognosis

ObjectiveInvolvements of microRNA-22 (miR-22) in cancer development have attracted much attention, but its role in tumorigenesis of gastric cancer is still largely unknown. Therefore, the aim of this study was to investigate the expression patterns and clinical implications of miR-22 in gastric cancer.MethodsQuantitative RT-PCR was performed to evaluate the expression levels of miR-22 in 98 pairs of gastric cancer and normal adjacent mucosa.ResultsCompared with normal adjacent mucosa, miR-22 expression was significantly downregulated in gastric cancer tissues (P < 0.001). Of 98 patients with gastric cancer, 58 (59.2%) were placed in the low miR-22 expression group and 40 (40.8%) were placed in the high miR-22 expression group. In addition, tumors with low miR-22 expression had greater extent of lymph node metastasis (P = 0.02) and distant metastasis (P = 0.01), and were at a worse stage (P = 0.01) than the tumors with high miR-22 expression. Moreover, the gastric cancer patients with low miR-22 expression had shorter overall survival than those with high miR-22 expression (P = 0.03). MiR-22, determined by multivariate analysis, was an independent prognostic factor for patients with gastric cancer.ConclusionOur data offer the convincing evidence that the reduced expression of miR-22 was significantly associated with malignant development of gastric cancer and may be a novel prognostic marker of this disease. miR-22 might have potentials in the application of cancer therapy for patients with gastric cancer.

Prognostic Factors and Outcome for Patients with Esophageal Squamous Cell Carcinoma Underwent Surgical Resection Alone: Evaluation of the Seventh Edition of the American Joint Committee on Cancer Staging System for Esophageal Squamous Cell Carcinoma

More data are essential to test the efficacy of the seventh edition of the American Joint Committee on Cancer (AJCC) staging system for esophageal squamous cell carcinoma (ESCC). This retrospective study was designed to identify the prognostic factors for survival of patients with ESCC who underwent surgical resection alone and to evaluate the new AJCC staging system for ESCC. Data of a single-center cohort of 2011 patients with ESCC who underwent surgical resection alone according to the new staging system were reviewed. Univariate and multivariate analyses were performed to identify prognostic factors. The 1-, 3-, and 5-year overall survival rates were 83.5, 57.4, and 47.4%, respectively, with a median survival time of 51.0 months. Age, histologic grade, R-category, pT category, pN category, pM category, pTNM stage, and the extent of lymph node metastasis were independent prognostic factors (p < 0.05). In separate subgroup analyses, the survival differences were not significant for pN2 versus pN3 category (p = 0.159) and stages IA versus IB (p = 0.922). Subdivisions by depth of infiltration rather than tumor grade for pT1N0M0 cancers and modified nodal categories (0, 1, 2-3, and ≥4 positive lymph nodes) better represented a survival advantage. The seventh edition of the AJCC staging system for ESCC is acceptable in predicting survival. However, tumor location does not influence survival in our study. Subdivisions of pT1N0M0 cancers and the N-classification may need to be modified.

What is the Burden of Axillary Disease after Neoadjuvant Therapy in Women with Locally Advanced Breast Cancer?

The burden of axillary disease in patients with locally advanced breast cancer (labc) after neoadjuvant therapy (nat) has not been extensively described in a large modern cohort. Here, we describe the extent of nodal metastases after nat in patients with labc. All patients with labc treated at a single institution during 2002-2007 were identified. Demographic, radiologic, and pathologic variables were extracted. To assess the extent of lymph node metastases after nat, patients were separated into two groups: those with and without clinical or radiologic evidence of lymph node metastases before nat. Axillary lymph nodes retrieved at surgery that had no evidence of metastases after hematoxylin and eosin (h&e) staining underwent further pathology evaluation. Of the 116 patients identified, 115 were female (median age: 48.5). Before nat, 26 patients were clinically and radiologically node-negative; of those 26, 14 were histologically negative on final pathology. After serial sectioning and immunohistochemistry, 9 of 26 (35%) were node-negative. Of the 90 patients who had clinical or radiologic evidence of lymph node metastases before nat, 23 (26%) had no evidence of lymph node metastases on h&e staining. After serial sectioning and immunohistochemistry, 19 (21%) had no further axillary lymph node metastases. Overall, 76% of patients had pathology evidence of lymph node metastases after nat. Most patients with labc have axillary metastases after nat. Our findings support axillary lymph node dissection and locoregional radiation in most patients with labc after nat.

Lymph node dissection for esophageal cancer

The prevalence of lymph node (LN) metastasis in esophageal cancer (EC) is widely spread to all three fields, namely, to the neck region, the mediastinal region and the abdominal region. Furthermore, the status of LN metastasis has been recognized as a key factor that influences the outcome after EC surgery. Therefore, the latest version of the UICC/AJCC TNM classification (7th edition) applied the number of metastatic LNs as an N factor. However, the precise clinical diagnosis of metastatic LNs is still difficult. This is mainly because there are many micrometastases in EC. Therefore, the Japanese Classification of Esophageal Cancer (10th edition) has not incorporated the number of LN metastases into the N factor for its staging system and the accurate preoperative diagnosis of LN status is currently one of the most important issues to be resolved for EC. Given the frequency and extent of LN metastasis and its significance for the survival, controlling LN metastasis is a rational therapeutic strategy, and an extended LN dissection, such as three-field lymph node dissection may be logical, although appropriate patient selection is necessary. On the other hand, recent arguments have supported a reduction of unnecessary LN dissection in esophagectomy. To curtail unnecessary LN dissection, one of the current topics is sentinel lymph node-guided surgery and is being investigated as part of the next generation surgeries for EC. In this article, recent literatures were reviewed and we discuss the current status of lymph node dissection in EC.