Invasion Node Research Articles

Effects of Microsatellite Instability on the Clinical and Pathological Characteristics of Colon Cancer and the Diagnostic Accuracy of Preoperative Abdominal CT Scans

Background: Microsatellite-stable (MSS) and microsatellite-instable (MSI) colon cancer (CC) cases have different characteristics. These characteristics may impact the accuracy of abdominal computed tomography (CT) scan examinations in MSI CC. Methods: A retrospective analysis was conducted to examine the effects of MSI CC on patients’ clinical and tumor characteristics. We determined the accuracy of radiological T and N staging compared to pathological T and N staging in CC patients and evaluated the influence of tumor- and patient-related factors on this accuracy. Results: A total of 131 CC patients who had undergone surgical resection were analyzed. Mismatch repair-deficient (dMMR) CC was predominantly found in the right hemicolon (p = 0.023); it was more likely to exhibit moderate (80.8%) or low-grade differentiation (p = 0.01) and had higher rates of mucinous differentiation (p = 0.001). The median neutrophil and platelet counts and C-reactive protein (CRP) levels at diagnosis were significantly higher in patients with dMMR CC (p = 0.022, p = 0.022, and p = 0.018). The depth of invasion influenced the CRP levels in dMMR CC cases (p = 0.015). The abdominal CT exam was accurate regarding the depth of colonic wall invasion in 58.1% and 38.5% of patients with mismatch repair-proficient (pMMR) and dMMR CC, respectively. The assessment of lymph node invasion was accurate in 44.8% of those with pMMR and 50.0% of those with dMMR CC. There was no significant difference in the accuracy in predicting the T and N statuses between the two groups. The accuracy in the determination of the T and N statuses was not affected by the parameters examined. Conclusions: dMMR CC has specific characteristic features. MSI does not affect the accuracy of preoperative abdominal CT.

Risk factors for lymph node metastasis and invasion depth in early gastric cancer: Analysis of 210 cases.

Gastric cancer is the leading cause of cancer-related deaths worldwide. Early gastric cancer (EGC) is often associated with the risk of lymph node metastasis, which influences treatment decisions. Despite the use of enhanced computed tomography, the prediction of lymph node involvement remains challenging. To investigate the risk factors for lymph node metastasis and invasion depth in patients with EGC. In total, 210 patients with pathologically diagnosed EGC were included in this study. Univariate and multivariate statistical analyses were used to predict risk factors for lymph node metastasis and invasion depth in patients with EGC. Among the 210 patients, 27 (12.9%) had lymph node metastases. Of the 117 patients with submucosal gastric cancer, 24 (20.5%) had lymph node metastases. Both univariate and multivariate analyses indicated that the depth of invasion in EGC was a risk factor for lymph node metastasis in these patients. Additionally, pathological type was identified as a risk factor for cancer cell invasion in patients with EGC. EGC invasion depth, not tumor type, size, age, sex, or location, predicts lymph node spread. Tumor type, not size, age, sex, or location, predicts cancer cell invasion.

Ganglioside GD2 Contributes to a Stem-Like Phenotype in Intrahepatic Cholangiocarcinoma.

GD2, a member of the ganglioside (GS) family (sialic acid-containing glycosphingolipids), is a potential biomarker of cancer stem cells (CSC) in several tumours. However, the possible role of GD2 and its biosynthetic enzyme, GD3 synthase (GD3S), in intrahepatic cholangiocarcinoma (iCCA) has not been explored. The stem-like subset of two iCCA cell lines was enriched by sphere culture (SPH) and compared to monolayer parental cells (MON). GS profiles were evaluated by chromatography, after feeding with radioactive sphingosine. Membrane GD2 expression was evaluated by FACS, and the expression of enzymes of GS biosynthesis was analysed by RT-qPCR. The modulation of stem features by GS was investigated invitro and invivo using GD3S-overexpressing cells and corroborated by global transcriptomic analysis. GS composition was markedly different comparing SPH and MON. Among complex GS, iCCA-SPH showed increased GD2 levels, in agreement with the high expression levels of GD3 and GM2/GD2 synthases. iCCA cells overexpressing GD3S had higher sphere-forming ability, invasive properties and drug resistance than parental cells. NOD/SCID mice implanted with CCLP1 cells overexpressing GD3S developed larger tumours than control cells. By global transcriptomic analysis, ontology investigation identified 74 processes shared by the iCCA-SPH and GD3S-transfected cells, with enrichment for development and morphogenesis processes, MAPK signalling and locomotion. In a cohort of patients with iCCA, GD3S expression was correlated with lymph node invasion, indicating a possible relevance of GD3S in the clinical setting. The profile of GS derivatives regulates the stem-like properties of iCCA cells.

Molecular Detection of Lymph Node Metastases with One-Step Nucleic Acid Amplification (OSNA) Pooling in Prostate Cancer: The POPCORN Study.

Pelvic lymph node dissection (PLND) is the most accurate procedure for lymph node (LN) staging in prostate cancer (PCa) patients. LN sectioning and hematoxylin and eosin (H&E) staining of at least one slice remains the gold standard for LN evaluation, potentially leading to misdetection of small metastatic focus. Entire LN analysis is possible with One-Step Nucleic Acid Amplification (OSNA) by detecting cytokeratin 19 (CK19) mRNA as a surrogate for LN invasion. This study aimed to compare postoperative performance of OSNA pooling with conventional H&E staining for pathological LN detection in PCa patients. POPCORN was an observational, prospective, and multicenter study of patients with PCa who underwent PLND. Dissected LNs were analyzed by both methods. This study included 2503 LNs from 131 patients, showing no statistically significant differences in pathological LN detection. Concordance between methods was high (93.9%), as were specificity (96.6%) and negative predictive value (96.6%) of OSNA pooling. The measure of agreement (Cohen's Kappa [κ]) was 0.70. Only eight (6.1%) discordances were observed, including four misdetections from each method. Results showed a high concordance between OSNA pooling and H&E staining, suggesting that OSNA pooling may be a good alternative to H&E staining to detect LN metastases in PCa patients.

The effect of PSMA PET/CT on clinical decision-making of radical prostatectomy and pelvic lymph node dissection.

To evaluate the effect of prostate-specific membrane antigen (PSMA) PET/computed tomography (CT) on clinical decision-making of radical prostatectomy (RP) and pelvic lymph node dissection (PLND) after its utilization in daily clinical practice at an European high-volume cancer center. Patients who had unfavorable intermediate- and high-risk prostate cancer between 2017 and 2021 were included retrospectively and divided into two groups; those who staged using PSMA PET/CT (group 1) and those who staged using conventional modalities (group 2). Clinical decision-making of RP over nonsurgical treatments and f PLND were primary endpoints and evaluated using regression models. PSMA PET/CT claimed significantly more N1 (24.2% vs. 11.3%; P = 0.01; OR, 1.97; 95% CI, 1.18-3.28) but insignificantly more M1 disease (9.9% vs. 5.7%; P = 0.42; OR, 1.91; 95% CI, 0.39-9.23), compared with the conventional imaging modalities. miN0 stage was related to more RP decisions compared with cN0 stage ( P < 0.001; OR, 1.91; 95% CI, 1.48-2.46). PLND decision-making was significantly driven by positive c\miN stage findings, which were more reliable when it was reported after a PSMA PET/CT examination ( P < 0.001; OR, 35.55; 95% CI, 6.74-187.45 for conventional imaging modalities vs. P < 0.001; OR, 91.72; 95% CI, 11.25-747.56 for PSMA PET/CT). Patients with no suspicion of lymph node invasion on molecular imaging (PSMA PET/CT) tended to be referred to RP more compared to radiological imaging. Also, the PLND decision was strongly driven by staging findings. Compared with conventional imaging, PSMA PET/CT findings were more reliable during PLND decision-making.

A novel tool to predict lymph node metastasis in patients with prostate cancer based on clinical and 68Ga-PSMA PET/CT parameters.

We sought to develop a model that predicts lymph node invasion (LNI) in patients with intermediate- and high-risk prostate cancer incorporating preoperative clinical and 68Ga-prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) parameters. A cohort of 413 consecutive patients diagnosed with prostate cancer who underwent 68Ga- PSMA PET/CT prior to radical prostatectomy from 2015-2020 was used to develop and validate the model. The cohort was split into a learning (70%) and a validation group (30%). The former was used to identify clinical and 68Ga-PSMA PET/CT parameters (number and diameter of PET-positive lymph nodes) for prediction of pathologic LNI by applying multivariable logistic regression analyses. The discrimination ability of the model was evaluated using the area under the receiver operating characteristic (ROC) curve and internal validation was performed using the validation cohort. One-hundred sixty-three men (39%) were categorized as high-risk, 168 (41%) as unfavorable-intermediate-risk, and 82 (20%) as favorable-intermediate-risk. Thirty-one patients (7.5%) had LNI on final pathology. All underwent extended lymph node dissection. Clinical stage, the presence of PET-positive lymph nodes, and diameter of the largest PET-positive node were included in the final predictive model. Four different categories were defined for estimating the risk for LNI. Internal validation was completed after applying the four-tire classification on both the learning and validation groups and achieving similar results. The sensitivity, specificity, positive predictive value, and negative predictive value of the model were 97%, 54%, 15%, and 99%, respectively, and area under the ROC curve was 0.906 (95% confidence interval 0.83-0.95, p<0.001). Using a 5% cutoff as a threshold for performing lymph node dissection, only one patient with LNI on final pathology would have been classified erroneously as node negative, while 206 (50%) men would have been spared an unwarranted lymph node dissection. We present a novel prediction model for LNI that incorporates clinical staging and molecular imaging data. Pending further validation, this model may improve the risk stratification and patient selection for lymph node dissection at time of radical prostatectomy.

Influence of Tumor Laterality and Focality on Clinical Implications and Tumor Advancement in Well-Differentiated Thyroid Cancer.

The accurate preoperative diagnosis of TC plays a very important role in the selection of an appropriate treatment strategy. In addition to the hypoechogenicity of thyroid lesions on ultrasound and the presence of microcalcifications or high cell atypia on FNAB, highlighting the features of laterality and focality and ascertaining their influence (alone or combined) on TC staging and appropriate treatment are crucial. A retrospective analysis of the clinical data of 697 patients admitted to the study center between 2008 and 2023 was conducted. Preoperative data (age, sex, type of surgery, ultrasound, and FNAB data) and postoperative histopathological data indicating TC advancement (pTNM, extrathyroidal extension, vascular invasion) were collected and analyzed. Patients presenting well-differentiated TCs (papillary TC and follicular TC) were isolated for better clinical evaluation. Finally, patients were divided into four groups according to their laterality and focality features, and the influences of combinations of these features on TC advancement were analyzed. The largest group included patients with unilateral and solitary TC (n = 461). This group had the lowest rate of negative prognostic features: extrathyroidal extension, lymph node invasion, distant metastases, and vascular invasion (25.81%, 19.96%, 3.69%, and 26.46%, respectively). In contrast, the group with bilateral and multifocal TC (n = 40) presented the highest percentages of the mentioned features (82.50%, 82.50%, 7.50%, and 77.50%, respectively). All the results were statistically significant (p < 0.0001). Laterality and focality features may be important parameters in the management of TC and should be accurately determined. These features should be combined and a more aggressive treatment method should be selected to reduce the reoperation rate.

BPDCN: state of the art.

The emergence of blastic plasmacytoid dendritic cell neoplasm (BPDCN) as its own distinct entity within the pantheon of hematologic malignancies is due to the growing understanding of its unique multiorgan clinical presentation and characteristic skin lesions. The occurrence of BPDCN is generally heralded by a multicompartmental presentation of violaceous cutaneous lesions, involvement by bone marrow and/or blood, lymph node invasion, and an inclination toward extramedullary organ involvement, including, most remarkably, central nervous system (CNS)/cerebrospinal fluid positivity. With a median age historically of ≥ 70 years and up to 5:1 male predominance in most of the field's earlier studies, the most notable development in the modern era is the recognition of emerging important groups with BPDCN, such as female, pediatric, and adolescent/young adult patients; CNS + BPDCN patients; and an increasing number of cases being diagnosed worldwide. These trends are in line with the increased educational and research efforts, greater international collaboration, and markedly improved diagnostic tools and clinical approaches among hematology/oncology, hematopathology, dermatology, and dermatopathology teams around the world. Now, with over 5 years since the first commercially approved targeted agent specifically dedicated for BPDCN, the CD123-targeted agent tagraxofusp, improvements have been demonstrated particularly in the frontline setting for patients with BPDCN. The field is abundant with hope, as it has experienced advancements including greater molecular characterization, expanded identification of potential targets for therapy beyond CD123, advent of combination therapies, improving parameters for stem cell transplantation, and novel clinical trials specifically available for patients with BPDCN.

Identification of intraoperative hypoxemia and hypoproteinemia as prognostic indicators in anastomotic leakage post-radical gastrectomy: an 8-year multicenter study utilizing machine learning techniques.

Complications and mortality rates following gastrectomy for gastric cancer have improved over recent years; however, complications such as anastomotic leakage (AL) continue to significantly impact both immediate and long-term prognoses. This study aimed to develop a machine learning model to identify preoperative and intraoperative high-risk factors and predict mortality in patients with AL after radical gastrectomy. For this investigation, 906 patients diagnosed with gastric cancer were enrolled and evaluated, with a comprehensive set of 36 feature variables collected. We employed three distinct machine learning algorithms-extreme gradient boosting (XGBoost), random forest (RF), and k-nearest neighbor (KNN)-to develop our models. To ensure model robustness, we applied k-fold cross-validation for internal validation of the four models and subsequently validated them using independent datasets. In contrast to the other machine learning models employed in this study, the XGBoost algorithm exhibited superior predictive performance in identifying mortality risk factors for patients with AL across one, three, and five-year intervals. The analysis identified several common risk factors affecting mortality rates at these intervals, including advanced age, hypoproteinemia, a history of anemia and hypertension, prolonged operative time, increased intraoperative bleeding, low intraoperative percutaneous arterial oxygen saturation (SPO2) levels, T3 and T4 tumors, tumor lymph node invasion, and tumor peripheral nerve invasion (PNI). Among the three machine learning models examined in this study, the XGBoost algorithm exhibited superior predictive capabilities concerning the prognosis of patients with AL following gastrectomy. Additionally, the use of machine learning models offers valuable assistance to clinicians in identifying crucial prognostic factors, thereby enhancing personalized patient monitoring and management.

Comprehensing the role of serum GGT in colorectal carcinoma: cancer risk, prognostic and diagnostic significance.

Effective biomarkers are necessary for early diagnosis, prognosis, and therapy monitoring of colorectal cancer (CRC), a disease that continues to be a major worldwide health problem. Due to a potential connection to colorectal cancer, serum gamma-glutamyl transferase (GGT), an important enzyme in metabolism of glutathioneand cellular stress response, has drawn attention. GGT is an essential component of the antioxidant system that protects against oxidative stress. It is mostly found in organs such as the liver, kidneys, and biliary tract. Numerous health problems, such as metabolic disorders, liver illnesses, and several types of cancer, are linked to elevated blood GGT levels. This review aims to clarify the function of serum GGT in colorectal cancer by examining clinical research conducted over the past 20years. A comprehensive analysis of pertinent literature identifies associations between high blood GGT levels and carcinoma of the colon risk, prognosis, and diagnostic potential. Increased GGT and a higher risk of colorectal cancer are positively correlated, according to epidemiological data consistently. The predictive capacity of GGT for colorectal adenomas underscores its use in early identification and preventive approaches. Additional clinical evidence indicates that higher GGT levels in CRC patients are associated with poorer outcomes, such as invasion of lymph nodes, advanced tumour stages, and decreased overall survival. Furthermore, changes in GGT levels after therapy offer information about patient survival and treatment effectiveness, highlighting its importance in therapy monitoring. In summary, this review underscores the multifaceted role of serum GGT in CRC, offering insights into its value as a biomarker for risk assessment, prognosis, and therapeutic monitoring, while emphasizing the need for further research to validate its clinical utility.

Pre-metastatic niche in oral squamous cell carcinoma: Insights from a transcriptomic meta-analysis

Primary tumors can precondition a pre-metastatic niche, promoting the colonization of circulating neoplastic cells and influencing the secondary tumor microenvironment. Nevertheless, the mechanisms underlying the formation of this niche, as well as perineural invasion in oral squamous cell carcinoma (OSCC), are not well-elucidated. The study aims to identify differentially expressed genes (DEGs) and related pathways associated with pre-metastatic niche and perineural invasion in OSCC. We evaluated metastatic and non-metastatic primary tumor samples, healthy oral tissues, OSCC samples, metastatic lymph nodes from patients with OSCC, and normal lymph node samples. The GEO2R tool was applied to identify mRNAs differentially expressed between tissues exhibiting features of a pre-metastatic niche and normal tissue samples, including selected non-metastatic and metastatic OSCC samples. We also performed an analysis of perineural invasion-negative and perineural invasion-positive tumor samples. Our data revealed that SERPINE1, SPP1, CALCA, and MMP13 genes were upregulated. These upregulated genes are associated with several cancer-related pathways, while downregulated genes are mainly associated with immune responses, axon guidance, and the neurotrophin signaling pathway. Given the upregulation of the circadian rhythm pathway in metastatic lymph nodes, we also performed a correlation analysis that allows users to compute function-specific parameters, with resulting figures dynamically displayed to conveniently access the tumor&amp;rsquo;s immunological, clinical, and genomic features. Downregulation of the circadian rhythm gene PER3 and upregulation of Bhlhe40 were associated with poor survival outcomes. In conclusion, we postulate that during lymph node invasion, OSCCs activate axonal guidance genes, such as SERPENE1, L1AM, CXCR4, and SPP1. As neoplastic cells establish themselves, circadian rhythm genes are upregulated, contributing to immune evasion and promoting tumor growth.

Clinicopathological Significance of Extranodal Adipose Tissue Invasion in Metastatic Lymph Nodes in Patients With Prostate Cancer.

Lymph node (LN) metastasis is a poor prognostic factor in patients with prostate cancer. Elucidating the mechanisms underlying cancer progression in the metastatic microenvironment of LNs is crucial to establishing novel therapies. Adipocytes interact with cancer cells and regulate cancer progression. In this study, we aimed to clarify the clinicopathological significance of extranodal adipose tissue invasion in metastatic LNs and preoperative adipokine concentration in patients with prostate cancer exhibiting metastatic LNs. We examined the pathological findings of primary and metastatic nodes and clinical information of 66 specimens from 46 patients with prostate cancer. A sub-analysis was performed to assess the relationship between preoperative adiponectin/leptin concentrations and clinical/pathological findings in the blood samples of 56 patients with prostate cancer who either did or did not show LN metastasis. The number of metastatic LNs in patients correlated with the involvement of adipose tissue and lymphovascular invasion (p = 0.039 and < 0.001, respectively). Preoperative adiponectin concentration was lower in patients with resected margin-positive and extraprostatic extension-positive primary cancers (p = 0.0071 and 0.02, respectively). Preoperative adiponectin concentrations were significantly lower in patients with metastatic LNs than in patients without LN metastasis (p < 0.001). Moreover, leptin concentrations were significantly higher in patients with metastatic LNs than in patients without LN metastasis (p < 0.001). In patients with metastatic LNs, preoperative adiponectin concentrations were significantly lower in patients with biochemical recurrence than in patients without biochemical recurrence (p = 0.031). There was no correlation between biochemical recurrence and pathological findings. This is the first report on the detailed histopathological characteristics of prostate cancer with LN metastases and the significance of preoperative adiponectin concentration in predicting the pathological features of primary cancers. Also, adipokines are a significant prediction factor of LN metastases for prostate cancer patients. Adipose tissue and adipose-secreting factors may be involved in the progression of metastatic and primary prostate cancer.

Multi-task Bayesian model combining FDG-PET/CT imaging and clinical data for interpretable high-grade prostate cancer prognosis.

We propose a fully automatic multi-task Bayesian model, named Bayesian Sequential Network(BSN), for predicting high-grade(Gleason 8) prostate cancer(PCa) prognosis using pre-prostatectomy FDG-PET/CT images and clinical data. BSN performs one classification task and five survival tasks: predicting lymph node invasion (LNI), biochemical recurrence-free survival (BCR-FS), metastasis-free survival, definitive androgen deprivation therapy-free survival, castration-resistant PCa-free survival, and PCa-specific survival(PCSS). Experiments are conducted using a dataset of 295patients. BSN outperforms widely used nomograms on all tasks except PCSS, leveraging multi-task learning and imaging data. BSN also provides automated prostate segmentation, uncertainty quantification, personalized feature-based explanations, and introduces dynamic predictions, a novel approach that relies on short-term outcomes to refine long-term prognosis. Overall, BSN shows great promise in its ability to exploit imaging and clinicopathological data to predict poor outcome patients that need treatment intensification with loco-regional or systemic adjuvant therapy for high-risk PCa.

Validation of lymphovascular invasion as a predictor of lymph-node invasion in squamous cell carcinoma of the penis.

The aim of this study was to validate lymphovascular invasion (LVI) as a predictor of lymph-node invasion (LNI) in squamous cell carcinoma of the penis (SCCP). Within the Surveillance, Epidemiology, and End Results database (2010-2020), we identified SCCP patients who underwent lymphadenectomy with known LVI status. Univariable logistic regression models (LRMs) addressed LNI. Harrell's concordance index (c-index) quantified accuracy after 2000 bootstrap resamples for internal validation. Multivariable LRMs included the most informative, statistically significant predictors. Subgroup analyses were repeated in organ-confined (T1b-T2) and non-organ confined (T3-T4) stages. Of 586 SCCP patients, 219 (37%) had LVI. LVI was associated with higher rate of LNI (66 vs. 43%; P<0.001). Positive predictive value of LVI was 66 vs. 57% for negative predictive value. In multivariable LRMs, LVI independently predicted LNI (Odds ratio [OR]: 2.41; P<0.001). Bootstrap-adjusted c-index of multivariable model was 0.570 without LVI vs. 0.639 with LVI. In subgroup analyses, LVI independently predicted LNI in organ-confined (OR: 2.23; P<0.001) and in non-organ confined stages (OR: 3.10; P<0.001). In subgroup analyses, addition of LVI increased c-index from 0.530 to 0.595 in organ-confined and from 0.599 to 0.682 in non-organ confined. The current study validates LVI as an independent predictor of LNI in SCCP. LVI increases the accuracy of LNI predictions in the overall cohort as well as in organ-confined and non-organ confined stages. However, stage and grade even with the added consideration of LVI are not accurate enough to provide LNI prediction in individual patients.

The Prognostic Values of Serum Liver Enzymes in Intrahepatic Cholangiocarcinoma Patients After Liver Resection: A Multi-Institutional Analysis of 605 Patients.

The value of liver enzymes, such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT), in predicting the prognosis of intrahepatic cholangiocarcinoma (ICC) patients who underwent curative resection has not been elucidated. Therefore, we aimed to construct prognostic nomograms for surgically treated ICC patients. The impact of liver enzymes on overall survival (OS) and recurrence-free survival (RFS) was analysed using Kaplan-Meier analysis and evaluated by univariate and multivariate analyses. Nomograms were constructed for predicting the probability of 1-, 3-, and 5-year OS and RFS and evaluated by receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA). High ALT, AST, ALP and GGT levels were associated with worse prognoses in surgically treated ICC patients. Nomograms for OS and RFS were constructed based on five prognostic factors: number of high liver enzyme (No. HLE), CA19-9 ≥ 37 U/mL, multiple tumours, lymph node invasion and microvascular invasion (MVI). Compared with 8th edition TNM stage, these nomograms showed better predictive value. The C-index and 1-, 3- and 5-year areas under the curve (AUCs) of the nomograms for OS and RFS in the discovery and validation cohorts were higher than those of the 8th TNM stage. The calibration plots indicated that there was good agreement between the actual observations and predictions. Preoperative ALT, AST, ALP and GGT levels could predict prognosis in surgically treated ICC patients. The nomograms showed good predictive ability for predicting the survival of ICC patients.

Resectable gastric cancer: should we apply a tailored surgical strategy according to microsatellite status?

BackgroundMicrosatellite instability (MSI-H) represents a small subgroup of gastric cancer (GC) with a favorable prognostic and predictive significance. This study aimed to investigate locoregional nodes involvement, overall survival (OS) and disease-free survival (DFS), and the interplay between molecular subtypes and histological profiles in relation to survival outcomes in MSI versus MSS GC. MethodsThis study included 72 GC patients treated with surgery with or without chemotherapy from 2017 to 2023. Clinicopathological characteristics, OS and DFS were compared between LN-positive and negative patients, stratified by microsatellite status, treatments, molecular profiles, tumor cell types. ResultsMSI GC was more common in older patients (79.0 versus 70.2 years, p<0.001), predominantly females (73.68% vs. 43.32%, p=0.023), and associated with intestinaltype histology (94.5% vs. 49%, p=0.002). Positive LN and lymphovascular invasion were lower in the MSI group (2.73 vs. 4.15 p=0.366; 36.8% vs. 64.5% p=0.039). MSI showed slightly better OS and DFS (84.2% vs. 66% p=0.108; 84.62% vs. 63.89% p=0.120). MSI GC also had improved OS and DFS in both LNs positive (OS 72.7% vs. 61.3% p=0.255; DFS 75% vs. 50% p=0.148) and LNs negative groups (OS 100% vs. 85.7% p=0.149; DFS 100% vs. 85.7% p=0.376). In patients not receiving chemotherapy, MSI/intestinal-type had the highest OS and DFS (77% and 87.5%), whereas MSS/mixed-type group had the poorest (25% and 100%)(p=0.024 and p=0.290). With chemotherapy, MSI/intestinal-type had the highest OS and DFS (100% and 100%), whereas MSS/mixed-type group had the poorest (66.7% and 50%)(p=0.741 and p=0.397, respectively). ConclusionsMSI GCs have a significantly lower risk of locoregional lymph node involvement and better OS and DFS compared to MSS tumors. Secondly, treatment responses diverge based on MSI status: patients with MSI tumors benefit more from upfront surgical interventions, while those with MSS, particularly mixed histotypes, demonstrate improved outcomes with preoperative chemotherapy. These results advocate for a tailored therapeutic approach that considers microsatellite status, Lauren classification as well as clinical conditions of patients.

Assessing the influence of prostate tissue traits on Gallium-68 prostate-specific membrane-antigen positron-emission tomography/computed tomography: Predictive factors for image positivity and locoregional recurrence in prostate cancer patients treated with radical prostatectomy and without prior or salvage treatment.

BACKGROUNDGallium-68 prostate-specific membrane-antigen positron-emission tomography/computed tomography (68Ga-PSMA-11 PET/CT) has recently emerged as a novel imaging modality, potentially improving oncologic outcomes for prostate cancer patients. This study aimed to assess the potential predictive factors associated with 68Ga-PSMA-11 PET/CT positivity following persistent prostate-specific antigen (PSA) levels and primary biochemical recurrence post-radical prostatectomy (RP), focusing on prostate specimen characteristics. Furthermore, we aim to identify predictive factors for locoregional recurrence. METHODSWe conducted a retrospective analysis of 230 prostate cancer patients treated with RP and without prior salvage or adjuvant radiotherapy or systemic treatments. All patients underwent 68Ga-PSMA-11 PET/CT scans to detect prostate cancer recurrence detection. Pathological findings were carefully examined and correlated with 68Ga-PSMA-11 PET/CT positivity and locoregional recurrence. RESULTSOur analysis showed that 68Ga-PSMA-11 PET/CT positivity was associated with ISUP grade group ≥ 3, presence of positive lymph node invasion at the time of RP, positive extraprostatic extension, involvement of seminal vesicles and post-RP PSA levels ≥ 0.1 ng/ml. Additionally, we identified ISUP grade group 2 and ISUP grade group ≥ 3, whether with or without positive lymph node invasion, along with extraprostatic extension, involvement of seminal vesicles and post-RP PSA ≥ 0.1 ng/ml, were identified as factors associated with pelvic node recurrence. CONCLUSIONSPathological findings emerge as robust predictors of 68Ga-PSMA-11 PET/CT positivity and locoregional recurrences in cases of initial biochemical recurrence or persistence without prior adjuvant or salvage treatment. This diagnostic approach facilitates potential adjustments in management strategies, such as PSMA-guided radiotherapy or PSMA-guided lymphadenectomy.

P071 The first external validation of the briganti nomogram to predict lymph node invasion in prostate cancer in the UK — updating the nomogram for uk clinical practice

P071 The first external validation of the briganti nomogram to predict lymph node invasion in prostate cancer in the UK — updating the nomogram for uk clinical practice

The Association Between Lymphovascular or Perineural Invasion in Radical Prostatectomy Specimen and Biochemical Recurrence.

The aim of this study was to test for the association between lymphovascular invasion or perineural invasion in radical prostatectomy (RP) specimens and biochemical recurrence (BCR). Relying on a tertiary-care database, we identified prostate cancer patients treated with RP between January 2014 and June 2023. Of these, the majority underwent robotic-assisted RP (81%). Kaplan-Meier survival analyses and Cox regression models addressed BCR according to either lymphovascular invasion or perineural invasion in RP specimens. Additionally, the linear trend test assessed the association between the Gleason Grade Group or pathologic tumor stage and lymphovascular or perineural invasion. Of 822 patients, 78 (9%) exhibited lymphovascular invasion and 633 (77%) exhibited perineural invasion in RP specimens. In survival analyses, the five-year BCR-free survival rates were 62% in patients with lymphovascular invasion vs. 70% in patients without lymphovascular invasion (p = 0.04) and 64% in patients with perineural invasion vs. 82% in patients without perineural invasion (p = 0.01). In univariable Cox regression models, lymphovascular invasion (hazard ratio 1.58, 95% confidence interval 1.01-2.47; p = 0.045) and perineural invasion (hazard ratio 1.77, 95% confidence interval 1.13-2.77; p = 0.013) were both associated with a higher BCR rate. After accounting for age at surgery, PSA value, pathologic tumor stage, Gleason Grade Group, lymph node invasion, positive surgical margin, surgical approach, and adjuvant radiation therapy, lymphovascular (p = 0.740) or perineural invasion (p = 0.341) were not significantly associated with a higher BCR since the Gleason Grade Group and pathologic tumor stage highly correlated with lymphovascular as well as perineural invasion. In univariable models, lymphovascular or perineural invasion is associated with BCR. After adjustment for standard pathologic tumor characteristics, lymphovascular or perineural invasion is not an independent predictor for BCR.

Is There a Correlation Between Platelet Count, Mesenteric Lymph Node Involvement, and Hematogenous Metastases in Advanced Stage Ovarian Cancer?

Ovarian cancer remains a major cause of death in women worldwide, mainly due to late diagnosis and the lack of a reliable screening test for early detection of the disease. In this context, attention has been focused on the identification of other prognostic factors that might allow a better identification of cases with worse long-term outcome. Data of patients who underwent cytoreductive surgery between 2014-2019 were retrospectively reviewed and 57 patients were considered eligible for this study. These cases were further classified according to preoperative platelet count, with a cut-off value of 335,000/μl as a positive predictive value for long-term survival. According to this value, there were 27 cases with a preoperative platelet count lower than 335,000/μl and 30 cases with a preoperative platelet count higher than 335,000/μl. Cases in the second group had a significantly higher peritoneal carcinomatosis index (p=0.002), a higher proportion of digestive serosa involvement (p<0.001), and a higher proportion of mesenteric lymph node involvement and hematogenous metastases (p=0.005 and p=0.001, respectively). When analyzing long-term outcomes, all these factors had a significant impact on overall survival. Preoperative thrombocytosis appears to be positively associated with gastrointestinal serosa involvement, mesenteric lymph node invasion, and the presence of hematogenous metastases, thus significantly influencing the long-term outcome of patients with advanced ovarian cancer.