Limited Lymph Node Metastases Research Articles

Identifying clinicopathological risk factors for regional lymph node metastasis in Chinese patients with T1 breast cancer: a population-based study.

To analyze clinicopathological risk factors and regular pattern of regional lymph node metastasis (LNM) in Chinese patients with T1 breast cancer and the effect on overall survival (OS) and disease-free survival (DFS). Between 1999 and 2020, breast cancer patients meeting inclusion criteria of unilateral, no distant metastatic site, and T1 invasive ductal carcinoma were reviewed. Clinical pathology characteristics were retrieved from medical records. Survival analysis was performed using Kaplan-Meier methods and an adjusted Cox proportional hazards model. We enrolled 11,407 eligible patients as a discovery cohort to explore risk factors for LNM and 3484 patients with stage T1N0 as a survival analysis cohort to identify the effect of those risk factors on OS and DFS. Compared with patients with N- status, patients with N+ status had a younger age, larger tumor size, higher Ki67 level, higher grade, higher HR+ and HER2+ percentages, and higher luminal B and HER2-positive subtype percentages. Logistic regression indicated that age was a protective factor and tumor size/higher grade/HR+ and HER2+ risk factors for LNM. Compared with limited LNM (N1) patients, extensive LNM (N2/3) patients had larger tumor sizes, higher Ki67 levels, higher grades, higher HR- and HER2+ percentages, and lower luminal A subtype percentages. Logistic regression indicated that HR+ was a protective factor and tumor size/higher grade/HER2+ risk factors for extensive LNM. Kaplan-Meier analysis indicated that grade was a predictor of both OS and DFS; HR was a predictor of OS but not DFS. Multivariate survival analysis using the Cox regression model demonstrated age and Ki67 level to be predictors of OS and grade and HER2 status of DFS in stage T1N0 patients. In T1 breast cancer patients, there were several differences between N- and N+ patients, limited LNM and extensive LNM patients. Besides, HR+ plays a dual role in regional LNM. In patients without LNM, age and Ki67 level are predictors of OS, and grade and HER2 are predictors of DFS.

Long-term Outcomes of Six-Fraction Stereotactic Ablative Radiotherapy to Limited Lymph Node Metastases: An Institutional Case Series

Lymph node (LN) metastasis is one of the most common sites to develop disease recurrence or progression after initial cancer treatment. Aggressive local treatment such as surgery or radiotherapy might benefit selected patients with limited metastatic LN(s). Stereotactic ablative radiotherapy (SABR) has been shown to achieve high local control rates with limited toxicities, yet the efficacy and patterns of failure have not been well studied with long-term follow-up. Herein, we report institutional outcomes of patients receiving six-fraction-SABR to involved metastatic LN(s). Since 2012, patients with oligo-metastatic or oligo-progressive LN(s) referred for radical radiotherapy and underwent six-fraction SABR were enrolled for retrospective chart and image review. Response was assessed by RECIST 1.1. Failure patterns and toxicities were recorded. Progression-free survival and overall survival (OS) were estimated by Kaplan-Meier method and log-rank test was used for analysis of prognostic factors. Forty-two patients with forty-six irradiation nodal sites were treated with SABR in this retrospective study. The majority (23/42) were lung cancer patients and the most frequent treatment sites were mediastinum and hilum (26/46). The median SABR dose was 45 Gy (range 30-45 Gy). Only one patient experienced grade 3 gastrointestinal toxicity. With the median follow-up of 52.8 months, median OS is 26.7 months (range 3.3–73.9 months). In-field failure rate is less than 5% (n = 2), and five patients (10.9%) developed isolated recurrences at elective regional lymphatics. The One-year and two-year cumulative isolated regional failure rates are 8.7% and 10.9%, respectively. Patients received >40 Gy (BED10 66.6 Gy) had a significant superior OS compared to those treated with <40 Gy (median OS: 33.6 months versus 10.0 months, log-rank test p = 0.01). Radical treatment of oligo-metastatic or oligo-progressive involved LN(s) with SABR in six fractions seems to provide high local control rate with low-risk of treatment-related toxicities and is not associated with excessive recurrence rates at elective nodal regions after long-term follow-up. A prospective phase II trial to further evaluate the efficacy, safety and patterns of failure for SABR in limited LN metastases was ongoing. Table Failure Sites after LN(s) SABR (N = 46)Abstract 2418; TableVariableNumberWithin RT field2 (4.3%)Isolated elective field5 (10.9%)Distant field35 (76.1%) Open table in a new tab

Can a Durable Disease-Free Survival be Achieved With Surgical Resection in Patients With Pathological Node Positive Renal Cell Carcinoma?

Patients with isolated regional nodal metastases from renal cell carcinoma are a distinct cohort for which resection of involved lymph nodes may be therapeutic. We assessed the outcomes of patients treated at our institution with pathological node positive renal cell carcinoma without concomitant metastatic disease (T(any)N+M0). A total of 2,521 patients with nonmetastatic renal cell carcinoma (T(any)N(any)M0) of any histological subtype treated with nephrectomy were identified between 1995 and 2009. Pathological regional node positive disease in the absence of clinically detectable metastases (T(any)N(1-2)M0) was present in 68 patients (2.7%) and these patients formed our study cohort. Patients were assessed for timing and location of recurrence, disease specific survival and overall survival. Multivariate Cox regression analysis was performed to define factors predictive of recurrence and overall survival. Of the 68 patients with T(any)N(1-2)M0 renal cell carcinoma 22.1% were free of disease at a median followup of 43.5 months. In those patients experiencing recurrence, disease was detected within the first 4 months after surgery in 51% and was most commonly detected at multiple organ sites. The Kaplan-Meier estimated 5-year overall survival and disease specific survival was 37% and 39%, respectively. Predictors of a favorable outcome included an Eastern Cooperative Oncology Group performance status of 0, single node involvement, absence of sarcomatoid features and papillary histology. Nephrectomy with lymph node dissection can provide a durable disease-free survival in a proportion of patients with regionally advanced renal cell carcinoma and limited lymph node metastases.

Long-Term Survival After Resection for Advanced Gastric Carcinoma

Although several prognostic indicators for gastric carcinoma have been reported, characteristics of long-term survivors with advanced gastric carcinoma have not yet been clarified. We compared clinicopathologic features of 54 patients who survived for >10 years after resection for advanced gastric carcinoma with those of 72 patients who died of recurrence. Long-term survivors were characterized by small tumor size (6.2 cm vs. 8.1 cm, p < 0.01), negative serosal invasion (50% vs. 32%, p < 0.05), few lymph node metastases (fewer than seven) (89% vs. 56%, p < 0.01), limited lymph node metastases (nO, nl) (89% vs. 40%, p < 0.01), and earlier stage (I or II) (50% vs. 16%, p < 0.01). These results indicate that small tumor size, negative serosal invasion, and fewer than seven positive nodes were the predictors of long-term survival after resection for advanced gastric carcinoma.

Result of treatment of patients with stage D 1 prostatic carcinoma

Between 1972 and 1982, 59 patients who had documented pelvic lymph node metastases, proved by pelvic lymphadenectomy, were available for analysis. Radical retropubic prostatectomy was the primary treatment in 33 patients with or without other therapies, while 23 patients received external beam radiation therapy as their primary treatment. Three patients received hormonal therapy alone. Forty-two of 59 patients are alive for a crude survival of 71 per cent. Sixteen patients have died of metastases. Patients with low-grade tumors, small tumor burden, and limited lymph node metastases had excellent short-term survival after radical prostatectomy.