Lymph Node Involvement In Women Research Articles

The Prognostic Impact of Substantial Lymphovascular Space Invasion in Women with FIGO Stage I Uterine Endometrioid Carcinoma with Pathologically Negative Nodal Evaluation

Substantiallymphovascular space invasion (LVSI) is an important predictor of lymph node involvement in women with endometrial carcinoma. However, its prognostic significance in women with stage I who had pathologic negative nodal evaluation (PNNE) was not fully evaluated. We aimed to evaluate the prognostic significance of substantial LVSI on recurrence-free (RFS), disease-specific (DSS) and overall survival (OS) in women with FIGO stage I uterine endometrioid adenocarcinoma (EC). Our uterine cancer database was queried for women with stage I EC who had a hysterectomy and PNNE at our institution between 1/1990 and 11/2022. Postoperatively, patients were managed with observation or adjuvant radiation therapy (RT) with pelvic external beam RT or vaginal cuff brachytherapy (VB). Women with synchronous malignancies and those who received adjuvant chemotherapy were excluded. Pathologic specimens were retrieved and LVSI was quantified by Gynecology pathologists (none, focal or substantial). Patients' demographics, surgical and pathologic variables were analyzed. Predictors of RFS, DSS and OS using univariate (UVA) and multivariate analysis (MVA) were studied. One thousand fifty-two patients were identified with a median age of 63 years and median follow-up of 9.7 years. Median number of examined lymph node (LN) were 9 (range 4-18). 907 patients (86.2%) had no LVSI, 87 (8.3%) had focal and 58 (5.5%) had substantial LVSI. In patients with focal LVSI, 32.2% received pelvic RT and 39.1% received VB. In patients with substantial LVSI, 20.7% received pelvic RT and 58.6% received VB.Recurrence was diagnosed in 86 patients (8.2%). While any LVSI was associated with tumor recurrence, there was no significant difference for the site of initial recurrence between patients with focal vs. substantial LVSI. 5-year RFS was 93.3% (95% CI 91.5-95.1), 76.8% (67.2-87.7) and 79.1% (67.6-95.3) for no, focal and substantial LVSI. The 5-year DSS was 97.6% (96.5-98.7), 83.5% (75-93.1), and 90% (81.8-99.9); and 5-year OS was 90.7% (88.7-92.8), 72.8% (62.9-84.2) and 86% (76.2-97.2), respectively. Independent predictors of worse 5-year RFS and DSS include any LVSI, age > 60 years, higher tumor grade. Independent predictors of worse 5- year OS include any LVSI, age > 60, high comorbidity burden, and higher tumor grade. Our large data suggest similar recurrence-free, disease specific and OS for women with stage I uterine endometrioid carcinoma who had pathologically negative nodal evaluation and substantial or focal LVSI. There was no significant difference for the site of initial recurrence between patients with focal or substantial LVSI. Multi-institutional pooled analyses may be needed to validate our results.

Survival outcomes and patterns of failure in women with stage IIIC2 endometrial carcinoma

ObjectivesPara-aortic lymph node involvement in women with endometrial carcinoma (EC) is a poor prognostic factor. Many studies have included women with stage IIIC2 in cohorts of patients with advanced stage disease. The aim of this study was to analyze survival outcomes and patterns of failure in women with solely stage IIIC2 EC. MethodsWe identified women with FIGO stage IIIC2 EC who underwent surgical staging at our institution. In addition to descriptive analyses of patient demographics, tumor characteristics, and adjuvant treatment received, univariate log-rank analyses and Cox regression multivariate analyses (MVA) were performed to identify predictors of recurrence-free (RFS), disease-specific (DSS) and overall survival (OS). ResultsA total of 72 women were included in this study cohort. The median follow-up time was 43 months. The median number of positive para-aortic lymph nodes was one. Of the 61 women (84.7%) who received adjuvant therapy, 40 women (65.6%) received chemotherapy and radiation therapy (CRT), 17 women (27.9%) received chemotherapy alone (CT), and only 4 women (6.6%) received radiation therapy alone. Thirty-seven women (51.4%) experienced disease recurrence. Distant metastasis was the most common pattern of failure (73%). Five-year RFS, DSS, and OS were 48%, 51%, and 48%, respectively. Due to small study size, our exploratory multivariate analysis demonstrated that histologic grade was the only significant prognostic factor for DSS (p=0.03) and OS (p=0.02). The type of adjuvant therapy did not sustain its independent predictive significance for RFS, DSS and OS. ConclusionsOur findings suggest that almost half of women with stage IIIC2 can be cured with surgical staging and adjuvant therapies. The most common pattern of failure was distant metastasis calling for further optimization of systemic therapy.

Risk factors for paraaortic lymph node metastasis in endometrial cancer.

The purpose of this study was to determine the risk factors for paraaortic lymph node (LN) metastasis in endometrial cancer (EC) patients who underwent comprehensive surgical staging. A total of 641 women with EC (endometrioid, non-endometrioid, or mixed histology) who underwent comprehensive surgical staging including pelvic and paraaortic LN dissection between 2008 and 2016 were included in this retrospective study. Patient data were analyzed with respect to paraaortic LN involvement, and predictive factors for paraaortic LN metastasis were investigated. Lymph node metastasis was detected in 90 (14%) patients, isolated pelvic LN metastasis in 28 (4.3%), isolated paraaortic LN metastasis in 15 (2.3%), and both pelvic and paraaortic LN metastasis in 47 (7.3%) women, respectively. Univariate analysis showed that the risk of paraaortic LN metastasis significantly increased in patients with non-endometrioid histology, age greater than 60years, grade 3 tumor, deep myometrial invasion, lymphovascular space invasion (LVSI), primary tumor diameter (≥2cm), cervical stromal invasion, adnexal involvement, serosal invasion, pelvic LN involvement, two or more positive pelvic LNs, and positive peritoneal cytology (p<0.05). At the end of multivariate analysis, the presence of LVSI [odds ratio (OR), 4.8; 95% confidence interval (CI), 1.25-18.2; p=0.022] and pelvic LN metastasis (OR, 18.8; 95% CI, 5.7-61.6; p<0.001) remained as independent risk factors for paraaortic LN involvement in women with EC. The presence of LVSI and pelvic LN involvement appear to be independent risk factors for paraaortic LN metastasis in patients with EC. LVSI may be considered as a routine pathological parameter during frozen section analysis in women with EC undergoing surgery.

Tumor Size, an Additional Prognostic Factor to Include in Low-Risk Endometrial Cancer: Results of a French Multicenter Study.

Additional tools are needed to improve the selection of women with early-stage endometrial cancer (EC) at increased risk of nodal metastases and/or recurrence to adapt surgical staging and adjuvant therapies. The aim of this study was to assess the impact of EC tumor size on nodal status and recurrence-free survival (RFS) according to European risk groups for recurrence. Data of 633 women with early-stage EC who received primary surgical treatment between 2001 and 2012 were abstracted from a multicenter database. Optimal tumor size cut-offs were determined by a minimal p value approach according to final nodal status. Logistic regression was used to determine the impact of defined tumor size on nodal involvement, and the Kaplan-Meier method was used to estimate the survival distribution. The number of women with final low-, intermediate-, and high-risk EC was 302, 204, and 127, respectively. Tumor size was correlated with nodal status and RFS in women with low-risk EC, while no correlation was found for women with intermediate/high-risk EC. Tumor size ≥35 mm emerged as the optimal threshold for a higher rate of nodal involvement (odds ratio 4.318, 95 % CI 1.13-16.51, p = 0.03) and a lower RFS (p = 0.005) in women with low-risk EC. Tumor size is an independent prognostic factor of lymph node involvement in women with low-risk EC and could be a valuable additional histological criterion for selecting women at increased risk of lymph node metastases to better adapt surgical staging.

A Prediction Model for the Presence of Axillary Lymph Node Involvement in Women with Invasive Breast Cancer: A Focus on Older Women

Axillary lymph node (ALN) status at diagnosis is the most powerful prognostic indicator for patients with breast cancer. Our aim is to examine the contribution of variables that lead to ALN metastases in a large dataset with a high proportion of patients greater than 70 years old. Using the data from two multicenter prospective studies, a retrospective review was performed on 2,812 patients diagnosed with clinically node-negative invasive breast cancer from 1996 to 2005 and who underwent ALN sampling. Univariate and multivariate logistic regression were used to identify variables that were strongly associated with axillary metastases, and an equation was developed to estimate risk of ALN metastases. Of the 2,812 patients with invasive breast cancer, 18% had ALN metastases at diagnosis. Based on univariate analysis, tumor size, lymphovascular invasion (LVI), tumor grade, age at diagnosis, menopausal status, race, tumor location, tumor type, and estrogen and progesterone receptor status were statistically significant. The relationship between age and involvement of axillary metastases was nonlinear. In multivariate analysis, LVI, tumor size and menopausal status were the most significant factors associated with ALN metastases. Age, however, was not a significant contributing factor for axillary metastases. Tumor size, LVI, and menopausal status are strongly associated with ALN metastases. We believe that age may have been a strong factor in previous analyses because there was not an adequate representation of women in older age groups and because of the violation of the assumption of linearity in their multivariate analyses.

Contribution of pelvic and para-aortic lymphadenectomy with sentinel node biopsy in patients with IB2–IIB cervical cancer

Objective:Detection of lymph node involvement in women with IB2–IIB cervical cancer could have a positive effect on survival. We set out to evaluate the incidence of pelvic and/or para-aortic lymph node involvement using the sentinel node (SN) biopsy and its impact on survival.Methods:From 2002 to 2010, 66 women with IB2–IIB cervical cancer underwent a pelvic and paraaortic lymphadenectomy with SN biopsy. Survival between groups according to lymph node status was evaluated.Results:Mean tumour size was 43.5 mm. At least one SN was detected in 69% of the 45 SN procedures performed. Sixteen of these patients had metastatic SN and the false negative rate was 20%. Metastatic pelvic SNs or non-SNs were detected in 33 patients (50%), including pelvic-positive nodes in 26 (40%), pelvic- and paraaortic-positive lymph nodes in seven (11%), and paraaortic skip metastases in two (6%). Positive paraaortic node was the sole determinant for disease-free survival (DFS) and overall survival (OS; P<0.001). Differences in DFS and OS between groups according to the nodal status were observed (P<0.001).Conclusion:SN procedure gave a higher rate of metastasis detection. Further studies are required to evaluate whether pre-therapeutic node staging, including paraaortic and pelvic lymphanedectomy, should be performed.

Axillary Lymph Node Involvement in Women With Breast Cancer: Does It Depend on Age?

Introduction Despite the reduced aggressiveness of breast cancer with older age, elderly patients are diagnosed with larger and more advanced tumors compared with younger patients. We studied the specific relationship between lymph node (LN) involvement and age. Patients and Methods Data were analyzed on 12,152 consecutive breast cancer patients who were operated on between 1995 and 2006 in a single institution. Cubic spline logistic models were used. Results LN involvement was present in 5409 patients (44.5%). Median age was 52 years; median tumor diameter was 1.7 cm; 83.4% had positive estrogen receptors; and 15.3% had human epidermal growth factor receptor (HER)2/ neu overexpression. At the univariate analysis, the probability of LN involvement decreased with increasing age up to approximately 65 years, but it increased thereafter. However, when investigating the relationship in pT strata, after adjusting for other prognostic factors, we observed no increase of LN involvement probability in elderly patients. Conclusion Increasing risk of LN involvement in the elderly can be explained by delayed diagnosis in this age group. Lack of systematic screening programs for this subpopulation and tendency of the elderly to wait longer before consulting a physician might be blamed. Aging per se does not increase the risk of LN involvement.

Prevalence of Lymph Node Metastasis in Primary Mucinous Carcinoma of the Ovary

To estimate the prevalence of lymph node involvement in women with primary mucinous ovarian carcinomas. A retrospective study was performed of patients with primary mucinous ovarian carcinomas evaluated at a single institution between 1985 and 2007. A gynecologic oncology pathologist evaluated all cases. Patients with tumors of low malignant potential and mucinous carcinomas metastatic to the ovary from other primary sites were excluded. Patients with primary mucinous ovarian carcinomas were identified (n=107). All patients underwent primary surgery. At time of surgery, 93 patients (87%) had tumors that grossly appeared to be confined to the ovary, and 14 patients (13%) had evidence of extraovarian disease. Of the 93 patients with tumors that grossly appeared to be confined to the ovary at surgical exploration, 51 (55%) underwent lymphadenectomy (n=27 pelvic and paraaortic, n=19 pelvic only, n=5 paraaortic only). Of these 51 patients, none had metastatic disease to the pelvic or paraaortic lymph nodes. In addition, there were no significant differences in progression-free survival and overall survival rates between the patients who underwent lymphadenectomy and those who did not. There were no cases of isolated lymph node metastases among women with primary mucinous carcinoma grossly confined to the ovary, suggesting that routine lymphadenectomy may be omitted in these patients. III.

Relationship Between Age and Axillary Lymph Node Involvement in Women With Breast Cancer

Relationship Between Age and Axillary Lymph Node Involvement in Women With Breast Cancer

Predictors of Axillary Lymph Node Involvement in Women with T3 Breast Cancers: Analysis of 1988–2003 SEER Data

We investigated characteristics associated with axillary lymph node (LN) status in patients with T3 breast cancers and hypothesized that LN status is an independent predictor of survival. Characteristics associated with axillary LN metastasis among women with T3 breast cancers were identified from the 1988-2003 Surveillance, Epidemiology, and End Results (SEER) database. The primary outcome was breast cancer-specific mortality. Cox models were used to calculate adjusted hazard ratios (aHR) and 95% confidence intervals (CI). A total of 12,778 patients with T3 breast cancers were analyzed (8201 LN+, 3695 LN-, 882 unknown). LN+ patients were more likely to be <50 y, married, and have ER+/PR+, grade 3 invasive ductal cancers (P<0.01 for each). Most patients underwent mastectomy (87.4%). Post-mastectomy radiation was more commonly used in LN+ patients (P<0.01). LN+ patients had higher breast cancer-specific mortality (36.2% versus 16.4%, P<0.01) and were more likely to die during the follow-up period (aHR = 2.87, 95% CI: 2.62-3.15) compared with LN- patients. Analysis of the SEER database indicated that several patient and tumor characteristics predict a higher likelihood of axillary LN involvement in patients with T3 breast cancers. LN status was an independent predictor of survival in women with T3 breast cancers.

Relationship Between Age and Axillary Lymph Node Involvement in Women With Breast Cancer

To study the relation between the presence of axillary lymph node (LN) involvement and age in breast cancer. The breast cancer database of the University Hospitals Leuven contains complete data on 2,227 patients with early breast cancer consecutively treated between 2000 and 2005. A multivariate piecewise logistic regression model was used to analyze LN involvement in relation to age at diagnosis. A similar analysis was then performed on a large, independent, population-based database from the Eindhoven Cancer Registry to investigate whether the effects of the Leuven model could be replicated. We observed a piecewise effect of age. That is, women up to 70 years of age were less likely to have positive LNs with increasing age (odds ratio per 10-year increase, 0.87). In contrast, older women were more likely to have positive LNs with increasing age. However, for older women, the effect of age interacted with tumor size (P = .0044), suggesting that increasing age is associated with increased risk of LN involvement, mainly in small tumors. These findings were replicated in the Eindhoven Cancer Registry database. Axillary LN involvement varies with age at diagnosis; its probability decreases with increasing age up to the age of approximately 70 years, but increases again thereafter. However, this increase is mainly seen in smaller tumors and suggests a different behavior of small breast cancers in older adult patients. We hypothesize that decreased immune defense mechanisms, related with aging, may play a role in earlier invasion into LNs.

QS259. Predictors of Axillary Lymph Node Involvement in Women With T3 Breast Cancers: Analysis of 1988-2003 SEER Data

QS259. Predictors of Axillary Lymph Node Involvement in Women With T3 Breast Cancers: Analysis of 1988-2003 SEER Data

Early invasive cervical cancer: MRI and CT predictors of lymphatic metastases in the ACRIN 6651/GOG 183 intergroup study

Purpose To compare MRI, CT, clinical exam and histopathological analysis for predicting lymph node involvement in women with cervical carcinoma, verified by lymphadenectomy. Methods A 25-center ACRIN/GOG study enrolled 208 patients with biopsy-proven invasive cervical cancer for MRI and CT prior to attempted curative radical hysterectomy. Each imaging study was interpreted prospectively by one onsite radiologist, and retrospectively by 4 independent offsite radiologists, all blinded to surgical, histopathological and other imaging findings. Likelihood of parametrial and uterine body involvement was rated on a 5-point scale. Tumor size measurements were attempted in 3 axes. Association with histologic lymph node involvement, scored as absent, pelvic only and common iliac or paraaortic, was evaluated using Cochran–Mantel Haenszel statistics, univariate and multivariate logistic regression, generalized estimating equations, accuracy statistics and ROC analysis. Results Lymphatic metastases were found in 34% of women; 13% had common iliac nodal metastases, and 9% had paraortic nodal metastases. Based on the retrospective multi-observer re-reads, the average AUC for predicting histologic lymph node involvement based on tumor size was higher for MRI versus CT, although formal statistic comparisons could not be conducted. Multivariate analysis showed improved model fit incorporating predictors from MRI, but not from CT, over and above the initial clinical and biopsy predictors, although the increase in discriminatory ability was not statistically significant. Conclusion MRI findings may help predict the presence of histologic lymph node involvement in women with early invasive cervical carcinoma, thus providing important prognostic information.

Histología e inmunohistoquímica de los carcinomas de mama en pacientes intervenidas de más de 70 años de edad

ObjectiveWe retrospectively analyzed tumoral characteristics (histology and immunohistochemistry) in a group of elderly patients (≥ 70 years old) after surgery between 2003 and 2005, and compared these characteristics with those of younger patients. Material and methodsWe studied the characteristics of 483 breast carcinomas diagnosed sfrom 2003 to 2005 in the Gynecology Service of the 12 de Octubre Hospital in Madrid. Of these, 153 (31.7%) corresponded to patients aged 70 years old or older. Data were analyzed using the SPSS 12.0 program, and the groups were compared using chi-square analysis (or Fisher’s test when required). Quantitative data were expressed as mean±standard deviation and median with interquartile range. ResultsIn our patients aged 70 years or older, diagnosis after mammography was less frequent. In situ and microinvasive carcinomas were less frequent and the mean size of invasive carcinomas was larger. These findings can be explained by the lack of mammographic screening. No other histological or immuno-histochemical differences were found in comparison with younger patients and no differences were found in axillary lymph node involvement in women with axillary dissection. ConclusionsTreatment in elderly patients should be individually tailored according to the biological characteristics of the tumor, comorbidity, and life expectancy. Age per se should not be considered a predictive factor of worse outcome.

Fluorodeoxyglucose positron emission tomography with sentinel lymph node biopsy for evaluation of axillary involvement in breast cancer

This study analysed the value of [(18)F]fluorodeoxyglucose positron emission tomography (FDG-PET) in detecting axillary lymph node involvement in women with breast cancer. In the first 150 women in this prospective study, axillary lymph node dissection (ALND) was performed regardless of the PET results. In a second group (125 women) FDG-PET was complemented with sentinel lymph node biopsy (SLNB) only in those who did not have pathological axillary uptake. The sensitivity and specificity of FDG-PET in detecting axillary involvement was 84.5 and 98.5 per cent respectively in the whole series of 275 patients, with two false-positive and 22 false-negative results. False-negative results were associated with some intrinsic tumour characteristics. In 21 women, PET revealed pathological uptake, suggesting involvement of the internal mammary lymph node chain. Whole-body PET identified a second synchronous tumour in five asymptomatic patients and haematogenous metastases in two patients. The high positive predictive value of PET (98.4 per cent) suggests that FDG uptake in the axilla could be an indication for full ALND without previous SLNB.

Parity in Relation to Risk of Axillary Lymph Node Involvement in Women with Breast Cancer

Objective: To investigate the association between parity and axillary lymph node involvement (ALNI) at breast cancer diagnosis. Methods: One surgeon has reviewed all breast cancer cases in Malmö, Sweden, diagnosed 1961–1991. This study includes the 3,472 women who had a first-time diagnosis of unilateral invasive breast cancer, and who had undergone axillary dissection. Information was collected regarding date of birth, date of diagnosis, age at diagnosis, menopausal status, tumour size, histological type, tumour location, type of surgery, stage (ALNI), and parity. Parity was investigated in relation to ALNI using logistic regression analysis, adjusted for potential confounders, yielding odds ratios (OR) with 95% confidence intervals (CI). The analyses were repeated in different strata with regard to birth-years cohort, age at diagnosis, and period of diagnosis. Results: High parity was associated with ALNI, the adjusted OR for ALNI among women with 4 or more children was 1.56 (1.13–2.15). This association was stronger in comparatively old women (≧67.45 years), OR 1.78 (1.10–2.88). Considering parity a continuous variable, the OR for ALNI among all women was 1.06 (1.01–1.12). Conclusions: We conclude that women with 4 or more children had an increased risk of ALNI at breast cancer diagnosis.

Predictive model of axillary lymph node involvement in women with small invasive breast carcinoma: axillary metastases in breast carcinoma.

Axillary lymph node involvement (ALNI) remains the most accurate predictive factor for recurrence risk and survival in patients with invasive breast carcinoma (IBC) and is an essential element in therapeutic decisions. However, axillary dissection (AD) is responsible for several side effects and is now discussed in small IBC. The objective of this study was to define a predictive model of ALNI by using clinical and histologic variables available before surgery. The authors studied 795 cases of IBC (T0, T1, T2 < or = 4 cm; N0; M0) treated between 1980 and 1997 by conservative surgery and radiation therapy. All cases had axillary dissection with at least 10 lymph nodes removed. A stepwise logistic regression analysis was performed to build a predictive model of ALNI. The authors then used the jackknife resampling technique to produce unbiased estimates of the probabilities of ALNI along with their confidence intervals. The global ALNI rate was 25.7%. The final predictive model included clinical tumor size, location, and histologic subtype and grade as variables independently associated with ALNI. The estimated probability of ALNI varied from 6% to 45%, according to case characteristics for these variables. These results show that the omission of AD in surgical procedures for these tumors is debatable. Even when ALNI rates were low, the superior bounds of the confidence intervals could be high. Consequently, we do not recommend to omit AD in women whose estimated risks are higher than 25%. Women with a risk of ALNI lower than 25% could benefit from the sentinel lymph node procedure with, likewise, a limited risk of false-negative.