Incidence Of Node Involvement Research Articles

Micropapillary breast carcinoma in comparison with invasive duct carcinoma. Does it have an aggressive clinical presentation and an unfavorable prognosis?

BackgroundInvasive micropapillary carcinoma (IMPC) was first proposed as an entity by Fisher et al. In the 2003 World Health Organization (WHO) guidelines for histologic classification of the breast tumors. IMPC was recognized as a distinct, rare histological subtype of breast cancer.IMPC is emerging as a surgical and oncological challenge due to its tendency to manifest as a palpable mass, larger in size and higher in grade than IDC with more rate of lymphovascular invasion (LVI) and lymph node (LN) involvement, which changes the surgical and adjuvant management plans to more aggressive, with comparative prognosis still being a point of ongoing debate.Aim of the studyIn this study, we compared the clinicopathological characteristics, survival and surgical management of breast cancer patients having invasive micropapillary carcinoma pathological subtype in comparison to those having invasive duct carcinoma.MethodThis is a comparative study on female patients presented to Baheya center for early detection and treatment of breast cancer, in the period from 2015 to 2022 diagnosed with breast cancer of IMPC subtype in one group compared with another group of invasive duct carcinoma. we analyzed 138 cases of IMPC and 500 cases of IDC.ResultsThe incidence of LVI in the IMPC group was 88.3% in comparison to 47.0% in the IDC group (p < 0.001). IMPC had a higher incidence of lymph node involvement than the IDC group (68.8% and 56% respectively). IMPC had a lower rate of breast conserving surgery (26% vs.37.8%) compared with IDC.The survival analysis indicated that IMPC patients had no significant difference in overall survival compared with IDC patients and no differences were noted in locoregional recurrence rate and distant metastasis rate comparing IMPCs with IDCs.ConclusionThe results from our PSM analysis suggested that there was no statistically significant difference in prognosis between IMPC and IDC patients after matching them with similar clinical characteristics. However, IMPC was found to be more aggressive, had larger tumor size, greater lymph node metastasis rate and an advanced tumor stage.

444. SHOULD T2 ESOPHAGEAL SQUAMOUS CELL CARCINOMA BE SUBCLASSIFIED WITH RESPECT TO LYMPH NODE INVOLVEMENT AND SURVIVAL?

Abstract Background Whether T2 esophageal squamous cell carcinoma should be subclassified into circular muscle (T2a) and longitudinal muscle (T2b) remains controversial. We aimed to investigate the effect of the depth of muscularis propria invasion on the incidence of lymph node involvement and patient survival outcomes in T2 esophageal squamous cell carcinoma. Methods We identified patients with pT2 esophageal squamous cell carcinoma who underwent primary surgery from January 2009 to June 2017. The pathological information of the depth of muscularis propria invasion was reassessed, and patients were grouped into the T2a group and T2b group. Binary logistic regression was used to determine risk factors for lymph node metastases. The impact of the depth of muscularis propria invasion on survival was investigated using Kaplan–Meier analysis and a Cox proportional hazard regression model. Results This study included a total of 750 patients from three institutes. The depth of muscularis propria invasion (OR: 3.95, 95% CI: 2.46–6.35; P &amp;lt; 0.001) was correlated with lymph node metastases using logistic regression. T substage (OR: 1.37, 95% CI: 1.05–1.79; P &amp;lt; 0.001) and N status (OR: 1.51, 95% CI: 1.05–2.17; P &amp;lt; 0.001) were independent risk factors in multivariate Cox regression analysis. The T2a group had better overall survival (OR: 1.52, 95% CI: 1.19–1.94; P = 0.001) than the T2b group, specifically in T2N0 patients (OR: 1.38, 95% CI: 1.08–1.94; P = 0.035). Conclusions The depth of muscularis propria invasion should be subclassified to T2a and T2b with respect to lymph node involvement and survival outcomes in T2 esophageal squamous cell carcinoma.

Is lobectomy sufficient for multifocal papillary thyroid microcarcinoma?

ImportanceMultifocal papillary thyroid microcarcinoma (PTMC) has been associated with a higher incidence of lymph node involvement, bilateral involvement, and extrathyroidal extension compared to unifocal papillary thyroid cancer (PTC). ObjectiveTo describe the incidence and determinants of survival for patients with multifocal PTMC using the Surveillance, Epidemiology, and End Result (SEER) database. Design, setting, participantsThe SEER registry was utilized to calculate survival trends for patients with PTMC between 2010 and 2015. Patient data was then analyzed with respect to age, sex, race, multifocality, and types of surgery rendered. Main outcomes and measuresOverall Survival (OS) and Disease Specific Survival (DSS). Results22,283 cases of papillary thyroid microcarcinoma (T1a N0 M0) were identified. The cohort was composed of 82.6 % females, and about 82 % of patients were of white race. The mean age at diagnosis was 51.9 years. Multifocal PTMC was present in 32.2 % of the tumors (n = 7186). 73.9 % of patients underwent total thyroidectomy and 23.0 % received lobectomy. OS at 2 and 5 years was 98 % and 95 %, respectively. Multivariate analysis revealed that age, sex, and multifocality were determinants of OS. Only age was a determinant of DSS. Kaplan-Meier survival analysis revealed that multifocal PTMC had similar mean OS between lobectomy and total thyroidectomy patients (69.59 months versus 69.82 months). Conclusions and relevancePTMC has a good prognosis. Our analysis revealed that age was a determinant of OS and DSS; sex and multifocality were also prognosticators for OS. The type of surgery, whether lobectomy or total thyroidectomy, was not a determinant of survival in multifocal PTMC.

Predictors of nodal metastases in early stage HER2+ breast cancer: Deciding on treatment approach with neoadjuvant chemotherapy vs. upfront surgery

BackgroundThe purpose of this study is to evaluate preoperative predictors of nodal metastases in patients with early-stage, HER2-positive (HER2+) breast cancer. MethodsThe SEER Database was queried to identify women with a first diagnosis of stage I-II (T1-T2) HER2-positive breast cancer treated with upfront surgery in 2018. Multivariable logistic regression was used to identify clinical characteristics independently associated with nodal involvement. ResultsOverall, 3333 women with stage I-II HER2+ breast cancer met inclusion criteria and were included in the study. The median age at diagnosis was 59 years (IQR, 51–69 years). Most patients underwent breast-conserving surgery (60.9%), with a median of 3 (IQR 2–4) axillary lymph nodes removed. On final pathology, 762 (22.9%) of T1-T2 HER2+ patients were node positive; 2.7% pN0[i+], 3.7% pN1mi, 15.1% pN1, and 1.4% pN2. Women less than 40 years and those between 40 and 49 years showed the highest proportion of axillary lymph node metastasis, in 33.7% and 30.7% respectively, and declining with age (p < 0.001). Patients with triple-positive breast cancer had the highest rates of nodal involvement (24.8%), compared to 20.7% ER+/PR-/HER2+ and 19.6% of HER2-enriched patients (p = 0.006). On adjusted analysis, age, biologic subtype, tumour size, and type of surgery remained independent predictors of nodal involvement. On subgroup analysis, women under age 50 with T1c HER2-enriched or triple-positive breast cancer had a 33% and 35% incidence of nodal involvement, which declined with age. ConclusionsThe likelihood of pathologic nodal involvement in early-stage HER2+ breast cancer is contingent on age, ER/PR status, and tumour size.

HLA-monomorphic determinants of the primary tumor in breast cancer patients

Background. Molecules of the major histocompatibility complex in cancer are currently being widely studied, and their clinical significance is still the subject of controversy. It is reported that they might have an important predictive value in the effectiveness of immunotherapy. The study of the expression HLA molecules status in breast cancer provides a deeper understanding of the biological properties of the tumor, in particular to identify the features of its immunological phenotype, which may further influence on breast cancer therapy.Aim. To evaluate the frequency of HLA-immunophenotypes in breast cancer and their relationship with the clinical and morphological features of the primary tumor.Materials and methods. This study included 82 patients with breast cancer who received treatment at the N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia. Immunophenotyping of the primary tumor was performed by immunofluorescence on cryostat sections. The reaction was evaluated using a ZEISS Axioscope 5 luminescent microscope (Zeiss AG, Germany). The study was dominated by patients with stage IIB 54 %, stage IIA was detected in 5 % of cases, IIIA – in 12 % of cases, IIIB – in 21 % of cases, IIIC – 8 %. Infiltrative ductal breast cancer was diagnosed in 67 % of patients (n = 55), infiltrative-lobular – in 22 % of cases (n = 18), other types – in 11 % (n = 9). The frequency of immunophenotypes was studied depending on the clinical and morphological characteristics of breast cancer.Results. It was found that in the group as a whole, the HLA-binegative immunophenotype of breast cancer was predominant. It dominated at stage T4 compared to the HLA-I+/HLA-DR+ phenotype (100 and 0 %), p = 0.042. At the same time, it should be noted that in T4 primary tumor the HLA-I+/HLA-DR– immunophenotype was also observed. The relationship this immunophenotype was noted with the stage: frequency at stage IIIA was higher than the HLA-I+/HLA-DR+ phenotype, 60 and 40 %, p = 0.01. Both HLA-DR-negative immunophenotypes were characterized by a high incidence of lymph node involvement and the absence of estrogen receptor expression. 80 % of receptor-negative tumors were noted in HLA-binegative immunophenotype compared to phenotype HLA-I+/HLA-DR+, p = 0.022; the similar data were obtained for the HLA-I+/HLA-DR– immunophenotype (p = 0.037).Conclusion. HLA immunophenotypes analysis of breast cancer revealed the HLA-binegative immunophenotype of breast cancer was predominant. The second most common immunophenotype was the absence of expression of HLA-DR molecules. The association of HLA-immunophenotypes with the stage of the tumor process, the size of the primary tumor, and the expression status of estrogen receptors was revealed.

Clinicopathological features of Epstein-Barr virus-associated superficial early stage gastric cancer treated with endoscopic submucosal dissection.

Epstein-Barr virus (EBV) is known to be involved in gastric carcinogenesis. EBV-associated early gastric carcinoma (EBVEGC) has a lower incidence of lymph node involvement and could be an expanded indication for endoscopic submucosal dissection (ESD) treatment. To clarify the prevalence and clinicopathological features of EBVEGC. This study reviewed 618 lesions in 519 patients treated with ESD between 2014 and 2016. Tissue microarray sections were subjected to in situ hybridization staining for EBV-encoded small RNA transcripts (EBER). Lesions positive for EBER were compared with control lesions and were retrospectively analyzed. 12 (1.9%) of the 618 lesions were EBVEGC. EBVEGCs were more frequently located near the atrophic border than control lesions in the middle or upper stomach and were reddish. EBVEGC invasion was deeper and more often histologically undifferentiated. On narrow-band imaging magnifying endoscopy, the EBVEGC group significantly more often showed an endoscopic lace pattern, defined as an absent or obscure microsurface pattern and a microvascular pattern of a tiny, dense, and irregular subepithelial capillary network. The rate of curative resection was significantly lower in the EBVEGC group. Only 1.9% of the ESD specimens were EBV-positive. Endoscopic features could raise clinical suspicion of EBV infection.

Retrospective Review on Role of Neck Dissection in Laryngectomy of Patients With N0 Laryngeal Carcinoma.

ObjectivesThe primary objective is to evaluate the incidence of occult nodal metastasis in patients undergoing total laryngectomy with cN0 disease. Other objectives are to compare the survival between different treatments of the neck, identify possible associated risk factors, and evaluate the effectiveness of elective neck dissection in this population with regards to oncological outcomes.Study DesignRetrospective review.SettingTertiary hospitals in Hong Kong.MethodsRetrospective study was performed on patients who underwent total laryngectomy from 2008 to 2017 in New Territories West and Hong Kong West Clusters of the Hospital Authority of Hong Kong as primary or salvage treatment for cN0 squamous cell carcinoma (SCC) of the larynx. Incidence of neck dissection, incidence of nodal involvement, possible predictors, and oncological outcomes were analyzed.ResultsSeventy-seven patients were included, of whom 61 underwent either ipsilateral or bilateral neck dissection. Most (90.1%) of the patients with total laryngectomy done had locally advanced disease. Overall occult nodal metastasis rate was 20.6%, and only 3.8% of them had contralateral nodal metastasis. Occult nodal metastasis was significantly less in salvage laryngectomy (P = .045), while midline involvement and pT3/4 disease seem to be predictors for contralateral nodal metastasis.ConclusionThere is significantly lower incidence of occult nodal metastasis in cN0 laryngeal SCC in the salvage setting, and occult contralateral nodal metastasis is not common in the cohort. Neck dissection during a salvage laryngectomy for cN0 disease could be avoided while contralateral neck dissection might be considered in cases of locally advanced disease with midline involvement.

Lymph node distribution in patients with remnant gastric cancer.

Remnant gastric cancer (RGC) is defined as a carcinoma that develops in the gastric remnant from 5years after gastrectomy, regardless of the primary gastric disease. The pattern of lymph node dissemination in these patients is not well understood. The present study aims to understand the lymph node distribution of patients with RGC in a single center. In a total of 1380 patients with gastric cancer, between 1998 and 2020, 43 patients operated on for RGC were analyzed. The pattern of lymph node dissemination was evaluated based on the number of dissected lymph node stations, the number of positive lymph node stations, the positivity index at each analyzed station, the number of dissected lymph nodes per patient, and the positivity index per lymph node station. A mean of 13.0 ± 8.1 lymph nodes were dissected. The incidence of lymph node involvement by dissected station was higher at Stations 19, 11p, 3, 4sb and 7 (50, 40, 37.5, 36 and 31.7%, respectively). Among the positive dissected stations, Station 3 with 52.2%, 4sb with 39.1% and 4sa with 34.8% were the most affected. There was no predilection for lymph node involvement when comparing the lesser and greater gastric curvature. The dissection of Stations 3, 4sb and 4sa is fundamental in surgical treatment with curative purposes. The totalization of gastrectomy with lymphadenectomy of the perigastric and supra-pancreatic stations should be the surgery of choice.

The impact of obesity on triple negative breast cancer (TNBC) outcomes at a diverse academic cancer center.

e12529 Background: Multiple studies have linked obesity (BMI ≥30 kg/m2) to poor outcomes from triple negative breast cancer (TNBC). To further explore the association between obesity and TNBC, we conducted a retrospective chart review at our institution to examine the association of race and obesity with disease free survival (DFS) and pathologic complete response (pCR) rates. Our institution is a unique setting in which to study this because of its large African-American (AA) pt population relative to other academic medical centers in the United States. Methods: A chart review of 247 early-stage TNBC pts treated from 2004- 2017 was conducted. All cases were retrieved from pathology archival reports. Of these 247 pts, 116 were treated with adjuvant chemotherapy and 131 were treated with neoadjuvant chemotherapy (NAT). Pts were categorized as obese (BMI = / &gt; 30) and non-obese (BMI &lt; 30), AA [n = 151], Caucasian [n = 84], other [n = 11], and missing [n = 1]. The association of race and BMI with pCR following NAT (for the NAT group), and the association of race and BMI with DFS (for all pts) was evaluated. Results: 50.3% of AA pts and 32% of Caucasians were obese. 43% of obese pts had node-positive disease at diagnosis, compared with 31% of non-obese pts. Among the node-positive TNBC pts, non-obese pts had a trend towards a longer DFS than obese pts with a HR 0.80 (95% CI 0.37 – 1.71) and a non-statistically significant p-value of 0.562. We evaluated pCR rates based on race and BMI. Among AA pts, 56.9% did not achieve pCR after NAT, and of these pts 44.4% were obese; 43.1% achieved pCR and of these 58.8% were obese (p = 0.206). Among Caucasian pts, 65% did not achieve pCR, and of these 43.3% were obese; of the 35% of Caucasian pts who achieved pCR, 31.25% were obese (p = 0.424). Among pts who eventually developed distant metastases, there was a strong trend towards shorter DFS in the obese group, with a HR 1.92 (95% CI 0.94-3.95) and a non-statistically significant p-value of 0.075. Conclusions: In this sizable population of TNBC pts at a racially diverse academic medical center, obesity was associated with a higher incidence of nodal involvement at diagnosis, and shorter interval of time to development of distant metastatic disease. Race was not found to impact pCR or DFS in a statistically significant way. This could have been related to small sample size (particularly in the NAT group), or because some socioeconomic variables often tied to poor outcomes among minority pts may have been minimized in this study. The association of obesity with node positivity at diagnosis and with shorter interval times for development of metastases highlights the importance of adopting initiatives to minimize obesity in oncology practices and in the primary care setting. Improving access to healthy food and to safe spaces for exercise will help to prevent obesity, and thus may reduce the risk of developing TNBC and improve breast cancer outcomes among all pts, regardless of race.

Clinicopathological Study of Supraglottic Carcinoma of Larynx

Introduction: Incidence of supraglottic carcinoma is more common which may be related to poor nutrition with personal habit like smoking and chewing habit of betel leaves with various ingredient.&#x0D; Objectives: To find out the incidence, age and sex distribution, occupation and clinical presentation of supraglottic carcinoma of larynx.&#x0D; Materials and Methods: In this prospective study, 30 patients of supraglottic carcinoma are collected from department of ENT and Head-Neck surgery, Combined Military Hospital, Dhaka from July 2012 to July 2013.&#x0D; Results: Patients belongs to different age groups, ranging from 40 to 80 years and maximum patients are in 50 to 60 years of age. The male to female ratio is 5:1. In this series, majority of patients are smoker (66.66%). Most of them are from low socio-economic group. The incidence of lymph node involvement is 40% (12 cases). Maximum number of patients presents with exophytic lesion (60%). Ulcerative lesions are 26.66% and infiltrative lesions are 13.33%. Maximum numbers of patients have T2 lesions (80%). T1 lesions are 20%. In this study all cases are histopathologically confirmed to be squamous cell carcinoma (100%). In this study, all cases are M0 state.&#x0D; Conclusion: Supraglottic carcinoma occurs between 40-80 years of age, more common in 5th and 6th decades. Chewing betel nut and tobacco should be avoided to reduce the risk of supraglottic carcinoma and early presentation &amp; diagnosis will improve the prognosis of patients.&#x0D; JAFMC Bangladesh. Vol 15, No 2 (December) 2019: 224-226

Variations in clinical features and oncologic behaviors of T1 colorectal cancer according to tumor location.

Different genetic characteristics according to tumor location result in variations in survival rates and treatment responses in advanced colorectal cancer (CRC). However, the effects of tumor location during early CRC are still unclear. Patients with T1 CRC treated between 2003 and 2019 were enrolled from a prospectively collected database. Patients were once divided into four groups, then combined into two groups (right- and left-sided CRC) according to the tumor location, and clinical features and oncologic behaviors were compared. In total, 458 patients were analyzed. Right-sided CRC had a lower incidence of polypoid type tumor than left-sided CRC (36/126 (28.6%) vs 186/332 (56.0%), p < 0.001). There were no differences in tumor size, pathological grade, pT1 substage and lymphovascular invasion between right- and left-sided CRC. Overall, lymph nodal involvement was observed in 42/458 (9.1%) patients. Right-sided CRC had a lower rate of patients with lymph nodal involvement than left-sided CRC (6/126 (4.8%) vs 36/332 (10.8%), p = 0.04). The present study revealed that there were significant differences in the macroscopic type and the incidence of lymph node involvement between right- and left-sided CRC. The clinical features and oncologic behaviors of T1 CRC are possible to vary according to tumor location.

A prospective study to evaluate the impact and independency of depth of invasion in comparison with other clinicopathologic prognostic variables in oral cavity malignancy

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Depth of invasion is included in the staging of oral cavity malignancies in the recent 8&lt;sup&gt;th&lt;/sup&gt; edition of American Joint Committee on Cancer or tumour, node and metastasis staging system. This study analyses the impact of diffuse optical imaging (DOI) on incidence of lymph node involvement, stage migration, postoperative margin and independency.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Postoperative HPE of fifty patients with oral cavity malignancy operated in our institute from January 2018 were collected. Depth of invasion and other pathological parameters were documented. DOI divided into three groups and statistical analysis done. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; No lymph node metastasis is found in superficial tumours, 43% of intermediate thickness and 76% of deep tumours had lymph node involvement. Positive margin is seen only in patients with tumour DOI more than 0.5 cm, more than 50% of deep tumours had close margins while 75% of superficial tumours had adequate margin. Out of the 24 T3 tumours in this study 13 were upstaged due to inclusion of DOI, which would have been T2 according to the previous staging system. There is 54.1% (13 out of 24) upstaging in T3 tumours (T2 to T3), 23% (3 out of 13) in T2 (T1 to T2). There is no significant correlation between DOI and anatomical site, tumour size, tumour thickness, lymphovascular invasion and grade.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Depth of invasion in oral cavity malignancies impacts adversely lymph node metastasis and margin status. It is an independent prognostic factor in oral cavity malignancy.&lt;/p&gt;

Surgical treatment of lung cancer with adjacent lobe invasion in relation to fissure integrity.

BackgroundTumor with adjacent lobe invasion (T‐ALI) is an uncommon condition. Controversy still exists regarding the optimal resection of adjacent lobe invasion, and the prognostic value in relation to fissure integrity at the tumor invasion point. The aims of this paper were to evaluate the prognosis of T‐ALI with regard to fissure integrity, and type of resection.MethodsThis was a retrospective multicenter study which included all consecutive patients with T‐ALI undergoing surgical treatment. Based on radiological, intraoperative and histological findings, T‐ALI patients were differentiated into two groups based on whether the fissure was complete (T‐ALI‐A group) or incomplete (T‐ALI‐D Group) at the level of tumor invasion point. Clinico‐pathological features and survival of two study groups were analyzed and compared.ResultsStudy population included 135 patients, of these 98 (72%) were included into T‐ALI‐A group, and 37 (38%) into T‐ALI‐D Group. T‐ALI‐D patients had better overall survival than T‐ALI‐A patients (63.9 ± 7.0 vs. 48.9 ± 3.9; respectively, P = 0.01) who presented with a higher incidence of lymph node involvement (35% vs. 4%; P = 0.004), and recurrence rate (43% vs. 16%; P = 0.01). At multivariable analysis, T‐ALI‐D (P = 0.01), pN0 stage (P = 0.0002), and pT≤5 cm (P = 0.0001) were favorable survival prognostic factors.ConclusionsT‐ALI‐D presented a better prognosis than T‐ALI‐A while extent of resection had no effect on survival. Thus, in patients with small T‐ALI‐D and without lymph node involvement, sublobar resection of adjacent lobe rather than lobectomy could be indicated.Key points The extent of resection of adjacent lobe had no effect on survival while T‐ALI‐D, pN0 stage, and pT≤5 cm were significant prognostic factors.In patients with small T‐ALI‐D and without lymph node involvement, sublobar resection of adjacent lobe could be indicated as an alternative to lobectomy.

Changing trends in HER-2 neu positive breast cancers in women: A study by a medical student and his preceptor.

e12509 Background: Breast cancer affects 3.5 million women in the United States with 155, 000 women living with metastatic breast cancer in the US with 40,290 deaths every year. In particular, HER-2 NEU positive lesions are aggressively malignant, with increased recurrence and decreased survival but good response to Herceptin. This study reviews trends of breast cancers and looks in depth into prognostic indicators, in HER-2 NEU positive breast cancers. Methods: Anonymized medical data including demographics and tumor characteristics from San Antonio Regional Hospital’s (SARH) tumor registry database were collected from 2015-2017. Inclusion criteria included female patients with a diagnosis of invasive breast cancers. Data was stratified according to age at diagnosis, race of the patient, histologic grade, size of the tumor, lymph node status, HER-2 NEU status and stage (pathologic and clinical). Results: From 2015 to 2017 we identified 371 patients with invasive breast cancers. The percentages of HER-2 NEU positive patients in these years was 15.7%, 16.0%, and 9.4% in 2015, 2016 and 2017 respectively. This represented a 6.6% drop in HER-2 NEU positive patients from 2016 to 2017. We then looked at all HER-2 NEU positive breast cancers. In 2017, 71% of patients with HER-2 NEU positive tumors presented with a low pathologic size compared to 36% in 2016 and 44% in 2015, and 29% presented with low histologic grade compared to 14% in 2016 and 12% in 2015, and 0% of patients presented with lymph node metastases compared to 18% in 2016 and 20% in 2015. Overall 100% of patients with HER-2 NEU positive tumors presented at a low stage compared to 73% in 2016 and 52% in 2015. Conclusions: Our data shows a decrease in HER-2 NEU positive cancers from 2015 to 2017. It is important to note that these HER-2 NEU lesions were associated with, smaller pathologic size, lower histologic grade, lower incidence of lymph node involvement and lower clinical stage. The identification of this subset of low grade, low stage HER-2 NEU positive tumors may be attributed to newer imaging modalities such as digital tomosynthesis and more aggressive preventive screening measures. These sensitive screening techniques may ensure a good clinical outcome.

Apatinib for epithelioid sarcoma: analysis on eight advanced stage cases in a single institute.

e22551 Background: Epithelioid sarcoma (ES) is a rare high grade soft tissue sarcoma with high incidence of lymph node involvement and distant metastasis. It is widely recognized that ES is not sensitive to chemotherapy and radiation, surgical treatment is the only curative option for localized diseases. Tyrosine kinase inhibitors (TKIs) has been proven to be effective in sarcomas, here we report the experience of Apatinib in 8 advanced ES cases. Methods: ES patients treated in Fudan University Shanghai Cancer Center from Dec, 2016 to Aug, 2018 were accrued retrospectively. Those with locally advanced diseases or distant metastasis were treated with orally Apatinib 500mg, daily use for at least 2 months. Assessment of efficacy and side effects were recorded every 2 months and patients were then treated according to reponses to Apatinib. Results: There were 8 patients with locally advanced or late stage ES in a total 20 ES patients during the study period. There were 6 males and 2 females with median age of 55 years (20-73). 3 of the 8 were classical type and 5 were proximal type. 7 of the 8 patients were locally advanced and 1 was with lung metastasis at diagnosis. 4 of the 8 had a partial response to Apatinib and one patient has a downstaged ES which was surgically removed. The other 4 had a stable disease to Apatinib but 2 were not able to tolerate side effects and stopped at first evaluation, the other 2 remains progression free. Main side effects included skin rash, hypertension and diarrhea. Hypertension was the only Grade 3-4 side effect. With median follow-up of 12 months, 6 remains progression free, the 2 patients who didn’t tolerate side effects and stopped Apatinib developed lung metastasis. Conclusions: Apatinib has unproven but promising effect in ES, TKI is an option especially for those not sensitive to cytotoxic agents and radiation.

Management of fibrolamellar hepatocellular carcinoma.

Fibrolamellar hepatocellular carcinoma (FLHCC) is a primary liver tumor. It is a pathologically distinct variety of hepatocellular carcinoma (HCC). The term 'fibrolamellar' is derived from the presence of thick fibrous collagen bands surrounding the tumor cells. It is a relatively rare tumor of unknown biology. It has a distinctive predilection for adolescents and young adults with no underlying liver disease or cirrhosis. FLHCC patients have higher incidence of lymph node involvement than conventional HCC patients probably owing to larger median tumor size at presentation. Most cases present at an advanced stage at the time of initial diagnosis, however, curative intent treatment options can still be offered to up to 70% of patients. Surgery (resection/liver transplantation) is the current mainstay of treatment and remains the only potentially curative option. As recurrences are common, alternative therapies are under investigation. FLHCCs have traditionally been considered less chemo-responsive than their conventional HCC counterparts, but in advanced cases multimodality treatments can be effective. Compared to stage-matched non-cirrhotic patients with HCC, patients with FLHCC do not have a favourable prognosis and do not respond differently to treatment. The survival advantage observed in FLHCC over conventional HCC is most likely due to younger age at presentation and absence of cirrhosis.

Incidence of Lymph Node Metastases in Women With Low-Risk Early Cervical Cancer (

To determine the incidence of lymph node metastasis in women with low-risk cervical cancer stage IA2 or IB1 (<2 cm) without lymph-vascular space invasion. A multicenter retrospective study was performed in patients who underwent radical or simple hysterectomy, conization, or trachelectomy plus pelvic lymphadenectomy for cervical cancer between January 2000 and June 2016. A total of 271 patients were included in the study. Median age and body mass index were 46 years (range, 23-77 years) and 24 kg/m (range, 18-48 kg/m), respectively. Twenty-two patients had stage IA2 (8.1%), and 249 (91.9%) had stage IB1. The median tumor size was 14 mm (range, 5-20 mm). Tumor grades were 1 (n = 63 [23.2%]), 2 (n = 120 [44.3%]), 3 (n = 63 [23.2%]), and unknown (25 [9.2%]). Median depth stromal invasion was 6 mm (range, 3-20 mm). Histologic subtypes included squamous (n = 171 [63.1%]), adenocarcinoma (n = 92 [33.9%]), and adenosquamous (n = 8 [3.0%]). Overall incidence of lymph node metastasis was 2.9% (n = 8). The incidence of lymph node involvement in G1, G2, and G3 was 0% (0/63), 5% (6/120), and 3.1% (2/63), respectively. No patient with stage IA2 (regardless of grade or histology) or G1 cervical cancer less than 2 cm (stage IB1) had lymph node metastasis. Patients with stage IA2 or IB1 (G1) with tumor size of less than 2 cm and no lymph-vascular space invasion may not need lymph node evaluation. On the other hand, 95% and 98% of patients with grade 2 or 3 tumors, respectively, could potentially undergo an unnecessary lymphadenectomy. Further studies with bigger sample size are required to confirm these results.

The Relationship of Age and Clinicopathologic Pattern to the Aggressiveness of Thyroid Cancer

Objective: To study the relation of age and clinicopathologic pattern to the aggressiveness of thyroid cancer cases and the treatment results of patients from western region of Saudi Arabia with differentiated thyroid carcinoma referred for treatment in King Abdulaziz Hospital and Oncology Center, Jeddah, Saudi Arabia. Methods: Retrospective review of 174 patients with differentiated thyroid carcinoma and analysis of the clinicopathologic characteristics, age correlation to different risk factors, treatment protocol and results were performed. Results: Analysis of the clinicopathologic pattern showed no statistically significant difference between patients in the different age groups except for extrathyroid extension and lymph node involvement. Patients older than 45 years had a statistically significant lower incidence of nodal involvement and a higher rate of extrathyroid extension (-131 dose of 200 mCi was used in 8 patients with distant metastases. In 24 patients with radioiodine-avid cervical lymph nodes and six patients with a gross residual tumor, an Iodine-131 dose of 150 mCi was used. For the whole study group, the 5-year overall survival and disease-free survival were 96% and 88%. Conclusion: Despite the fact that differentiated thyroid carcinoma is among the most curable cancer some patients are still at high risk for recurrent and increased mortality.

Clinical Characteristics and Patterns of Care in Locally Advanced Paranasal Sinus Cancer: A National Cancer Database Study

Paranasal sinus cancer (PSC) is a rare malignancy occurring in approximately 3% of all head and neck cancers. Surgical resection of the primary site followed by adjuvant external beam radiation therapy (RT) is considered the standard of care. However, the incidence of lymph node involvement and the utilization of chemotherapy has not been clearly defined in locally advanced PSC. Using the NCDB, we identified all patients with locally advanced Stage III, IVA and IVB PSC diagnosed between 2004 and 2014. We extracted data regarding various patient and tumor characteristics as well as treatments received, whether surgery, radiation and/or chemotherapy. The incidence of clinical lymph node involvement was identified and the utilization of chemotherapy in node-negative patients was investigated. There were a total of 6,682 patients identified as clinical Stage III, IVA and IVB. The incidence of clinical lymph node involvement in this group was 22% (1,378 patients). 5,087 patients were clinical node-negative and were further analyzed in this study regarding the utilization of chemotherapy. 3,435 (68%) of node-negative patients underwent surgical resection of the primary site. EBRT (median dose of 60 Gy and range of 50-70 Gy) was administered in 3,676 patients, with a majority (65%) of the patients receiving adjuvant therapy. Chemotherapy was administered in 2,156 (42%) of patients, 183 with neoadjuvant intent. The incidence of clinically positive lymph nodes in locally advanced PSC is 22% per NCDB. In patients who were clinically node-negative, surgical resection followed by adjuvant external beam radiation therapy is performed in the majority. While systemic chemotherapy is not considered as standard of care, almost half of these patients received systemic chemotherapy. To investigate further, analysis on the impact of chemotherapy and overall survival will be presented.

Regional Metastatic Behavior of Nonfunctional Pancreatic Neuroendocrine Tumors: Impact of Lymph Node Positivity on Survival.

Literature addressing the significance of lymph node positivity in the management of nonfunctional pancreatic neuroendocrine tumors (PNETs) is conflicting. The National Cancer Data Base was queried for patients who underwent surgical resection of nonfunctional PNETs between 1998 and 2011. Clinical data and overall survival were analyzed using χ and Cox proportional hazards regression. Multiple imputation was used as a comparative analysis because of the high number of patients missing data on tumor grade. Two thousand seven hundred thirty-five patients were identified. The overall incidence of lymph node metastasis was 51%. In the subset of patients with grade 1 tumors less than 1 cm, 24% had positive lymph nodes. Overall median survival for patients with negative lymph nodes was 11 years compared with 8 years for lymph node-positive patients (P < 0.001). On multivariate survival analysis, tumor grade, distant metastases, regional lymph node involvement, positive surgical margins, male sex, and older age were predictive of decreased overall survival. Lymph node positivity was associated with decreased overall survival. The incidence of lymph node involvement in resected low-grade tumors less than 1 cm is higher than previously reported. Patients selected for resection of PNETs should be offered lymphadenectomy for staging.