Lymph Node Metastasis In Men Research Articles

Androgen Receptor Activation Induces Senescence in Thyroid Cancer Cells.

Thyroid cancer (TC) is the most common endocrine malignancy, with an approximately three-fold higher incidence in women. TCGA data indicate that androgen receptor (AR) RNA is significantly downregulated in PTC. In this study, AR-expressing 8505C (anaplastic TC) (84E7) and K1 (papillary TC) cells experienced an 80% decrease in proliferation over 6 days of exposure to physiological levels of 5α-dihydrotestosterone (DHT). In 84E7, continuous AR activation resulted in G1 growth arrest, accompanied by a flattened, vacuolized cell morphology, with enlargement of the cell and the nuclear area, which is indicative of senescence; this was substantiated by an increase in senescence-associated β-galactosidase activity, total RNA and protein content, and reactive oxygen species. Additionally, the expression of tumor suppressor proteins p16, p21, and p27 was significantly increased. A non-inflammatory senescence-associated secretory profile was induced, significantly decreasing inflammatory cytokines and chemokines such as IL-6, IL-8, TNF, RANTES, and MCP-1; this is consistent with the lower incidence of thyroid inflammation and cancer in men. Migration increased six-fold, which is consistent with the clinical observation of increased lymph node metastasis in men. Proteolytic invasion potential was not significantly altered, which is consistent with unchanged MMP/TIMP expression. Our studies provide evidence that the induction of senescence is a novel function of AR activation in thyroid cancer cells, and may underlie the protective role of AR activation in the decreased incidence of TC in men.

A protective factor against lymph node metastasis of papillary thyroid cancer: Female gender

ObjectivePapillary thyroid carcinoma (PTC) is the most common pathological type of thyroid cancer, with good prognosis, but the rate of lymph node metastasis (LNM) is high, and the difference between men and women is significant. Therefore, the related risk factors for LNM of PTC based on gender were examined in this study in order to draw attention to gender factor in PTC. MethodsWe retrospectively analyzed the clinicopathological data of 2103 patients with surgically confirmed PTC at the Fourth affiliated Hospital of Hebei Medical University West Side between January 2016 and December 2019. ResultsLNM was detected in 1124 of the 2103 cases of PTC. Logistic regression analysis showed that LNM was associated with age (p < 0.001, OR:0.547), gender (p < 0.001, OR:2.609), tumor diameter (p < 0.001, OR:2.995), bilaterality (p=0.003, OR:1.683), and extrathyroid extension (p < 0.001, OR:1.657). After propensity score matching, female gender (p < 0.001, OR: 0.393) remained an independent factor of LNM in patients with PTC. LNM in men was only associated with diameter (p < 0.001, OR: 3.246). LNM in woman was associated with menopausal history (p = 0.012, OR=0.684), reproductive history (p < 0.001, OR=0.360), abortion history (p = 0.011, OR=0.725), tumor diameter >1 cm (p < 0.001, OR=2.807), bilaterality (p =0.006, OR:1.728), and extrathyroid extension (p < 0.001, OR=1.879). ConclusionAlthough the invasion is high in female patients, the rate of LNM is significantly reduced due to the influence of sex hormones and reproductive factors. For female patients of childbearing age who were not pregnant and did not have children, it is suggested to take a positive attitude towards their lymph nodes.

Lymphovascular and perineural invasion are risk factors for inguinal lymph node metastases in men with T1G2 penile cancer.

To analyse the risk of inguinal lymph node (ILN) metastases in T1G2 penile cancer stratified by lymphovascular invasion (LVI), perineural invasion (PNI) and tumour size. Retrospective study of men with localised T1G2 penile cancer with non-palpable lymph nodes and no local recurrence during follow-up at six European institutional high-volume centres was performed. ILN involvement was defined as cancer detected during ultrasound-guided fine-needle aspiration cytology, core needle biopsy, dynamic sentinel lymph node biopsy, ILN dissection or inguinal recurrence during follow-up. Uni- and multivariable logistic regression analyses were performed. In the cohort of 554 men with T1G2 penile cancer, from 6 European institutions, ILN metastases were observed in 46/554 men (8%, 95% confidence interval (CI) 6-11%). Men with both, LVI- and PNI- primary cancers had the lowest risk of ILN involvement (6%) whereas men with LVI + or PNI + showed ILN metastases in 22% and 30%. In multivariable regression, men with LVI + or PNI + had higher odds for ILN metastases compared to men with LVI- and PNI- (OR 3.9, 95% CI 1.6-9.0, p value < 0.01) Tumour size was not associated with ILN risk (OR 1.01 95% CI 0.99-1.04, p = 0.17). Approximately, one out of ten men with T1G2 overall and one out of four men with either LVI + or PNI + still have ILN metastases despite being clinically node negative. Therefore, invasive ILN staging should strongly be recommended in T1G2 with LVI + or PNI + but importantly, must be discussed in patients with T1G2 with LVI- or PNI-.

P002 - Risk factors for inguinal lymph node metastases in men with T1G2 penile cancer: a multi centre collaborative study

P002 - Risk factors for inguinal lymph node metastases in men with T1G2 penile cancer: a multi centre collaborative study

Contemporary Incidence and Predictors of Occult Inguinal Lymph Node Metastases in Men With Clinically Node-negative (cN0) Penile Cancer

To (1) examine the contemporary incidence of occult inguinal LN metastases and (2) identify predictors of occult inguinal LN metastases to improve selection of cN0 patients for inguinal lymphadenectomy (ILND). We identified 590 men with cTany cN0 cM0 penile cancer who underwent partial/radical penectomy and ILND from 2006-2016 in the NCDB. Rates of pN+ disease were examined, and a multivariable regression model was constructed to identify features associated with pN+ disease. Tumors were ≤pT1 in 21%, pT2 in 43%, and pT3/pT4 in 24% of patients. A median of 15 (IQR 8-22) LNs were removed at ILND. The overall pN+ rate was 24% and did not vary over the study period. The pN+ rate, stratified by pT stage, varied from 18-33%. On multivariable analysis, only higher tumor grade (OR 2.16; P=0.02 for grade 2; OR 2.81; P=0.005 for grade 3-4, versus grade 1) and lymphovascular invasion (OR 3.12; P <0.001) were independently associated with pN+ disease, whereas pT stage was not. The contemporary rate of occult LN metastases in men with cN0 penile cancer remains high at approximately 24%. Our results suggest that high tumor grade and/or lymphovascular invasion are better determinants of lymph node involvement than primary tumor stage.

Diagnostic accuracy of 18F-fluciclovine PET/CT in primary lymph node staging of prostate cancer.

To determine preoperative diagnostic accuracy of 18F-fluciclovine PET/CT-scan in detection (or exclusion) of lymph node metastases (LNM) in men with prostate cancer (PCa) in comparison to the histopathological results of the extended pelvic lymph node dissection (e-PLND). A retrospective medical records-based cohort study, including 47 men with primary PCa who received 18F-fluciclovine PET/CT and subsequent e-PLND for lymph node staging. Incidence and number of visualized LNM, their locations and diameters on 18F-fluciclovine PET/CT were recorded in comparison to the histopathological results of the e-PLND as reference. Positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity and diagnostic accuracy of 18F-fluciclovine PET/CT were calculated on the basis of histopathology results after e-PLND. Forty-seven men were eligible for analysis. Median lymph node yield was 19 (range 10-70). A total of 996 lymph nodes were removed, and 59 metastases were found in 21 cases (45%). Preoperative PET was issued 'positive' in 11 men and in 9 of them (82%) this was histopathologically confirmed resulting in a PPV of 82% (95% CI, 51-96). On the contrary, PET was issued 'negative' in 36 cases, but in 12 of them (33%) metastases were detected in the e-PLND specimen, resulting in an NPV of 67% (95% CI, 50-80). The patient-based sensitivity was 43% (95% CI, 24-64) and the patient-based specificity rate was 92% (95% CI, 75-99), whereas overall diagnostic accuracy was established to be 70% in the present cohort. 18F-Fluciclovine PET/CT has a high specificity and positive predicted value for the presence of LNM in men with prostate cancer. However, the sensitivity and NPV seem to be limited to exclude the absence of LNM at a clinically acceptable level. Prospective evaluation is necessary to define patients who may benefit from 18F-fluciclovine PET/CT as a triage test for the indication for e-PLND.

Peri-prostatic adipose tissue measurements using MRI predict prostate cancer aggressiveness in men undergoing radical prostatectomy.

To evaluate the effect of peri-prostatic adipose tissue (PPAT) measurements using preoperative MRI on the prediction of prostate cancer (PCa) aggressiveness in men undergoing radical prostatectomy (RP). We performed a retrospective study on 179 consecutive patients receiving RP from June 2016 to October 2018. Clinical characteristics were collected. PPAT measurements including peri-prostatic fat area (PPFA) and peri-prostatic fat area to prostate area (PA) ratio (PPFA/PA) were calculated by MRI. Multivariable logistic regression analysis was performed to identify independent predictors of PCa lymph node metastasis (LNM). The predictive performance was estimated through ROC curves. Nomograms were created based on the predictors. Pathologic Gleason score positively correlated with digital rectal examination (DRE), PSA, PPFA/PA, P504S, and Ki-67 (all P < 0.05). ROC curves revealed that high PPFA and high PPFA/PA were associated with LNM (both P < 0.05). Multivariate analysis revealed that high PPFA/PA, pathologic Gleason score, pT stage, and Ki-67 were independently predictive of LNM. The nomograms were created and the C-index was 0.945. PPFA/PA is an independent predictor for LNM along with Gleason score, pT stage, and Ki-67. PPFA/PA may help predict LNM in men undergoing RP, thus providing adjunctive information for therapeutic strategy and prognosis.

MP11-04 CONTEMPORARY INCIDENCE AND PREDICTORS OF OCCULT INGUINAL LYMPH NODE METASTASES IN MEN WITH CN0 PENILE CANCER

INTRODUCTION AND OBJECTIVE: Clinical practice guidelines recommend inguinal lymph node dissection (ILND) for men with clinically node-negative (cN0) penile cancer at increased risk of occult lymph node (LN) metastases. However, data regarding the incidence of occult LN metastases are limited to few studies that predated the introduction of contemporary cross-sectional imaging techniques. We therefore examined the contemporary incidence and predictors of occult inguinal LN metastases. METHODS: We identified 590 adult men with cTany cN0 cM0 squamous cell carcinoma of the penis who underwent partial/radical penectomy and ILND from 2006-2016 in the National Cancer Database. Rates of pN+ disease were examined stratified by tumor features, and a multivariable regression model was constructed to examine patient and clinical features associated with pN+ disease. RESULTS: Mean age was 61 (SD 12.5) years and median tumor size was 3.5 cm (IQR 2.5-4.8). Tumors were ≤pT1 in 126 (21%), pT2 in 256 (43%), and pT3/pT4 in 143 (24%) patients. Tumor grade was 1-2 in 409 (69%) and 3-4 in 160 (27%) of patients. A median of 15 (IQR 8-22) LNs were removed at ILND. The overall pN+ rate was 24% and did not vary over the study period (Figure 1). The pN+ rate, stratified by pT stage, varied from 18-33% (Table 1). On multivariable analysis, only higher tumor grade (OR 2.16;p=0.02 for grade 2; OR 2.81;p=0.005 for grade 3-4,versus grade 1) and lymphovascular invasion (OR 3.12;p<0.001) were independently associated with pN+ disease, whereas pT stage was not. CONCLUSIONS: Contemporary rates of occult LN metastases in men with cN0 penile cancer remain high at approximately 24%. Higher tumor grade and lymphovascular invasion were independently associated with pN+ disease, whereas pT stage was not.Source of Funding: None

68Ga-PSMA-11 PET has the potential to improve patient selection for extended pelvic lymph node dissection in intermediate to high-risk prostate cancer.

Radical prostatectomy with extended pelvic lymph node dissection (ePLND) is a curative treatment option for patients with clinically significant localised prostate cancer. The decision to perform an ePLND can be challenging because the overall incidence of lymph node metastasis is relatively low and ePLND is not free of complications. Using current clinical nomograms to identify patients with nodal involvement, approximately 75-85% of ePLNDs performed are negative. The aim of this study was to assess the added value of 68Ga-PSMA-11 PET in predicting lymph node metastasis in men with intermediate- or high-risk prostate cancer. 68Ga-PSMA-11 PET scans of 60 patients undergoing radical prostatectomy with ePLND were reviewed for qualitative (visual) assessment of suspicious nodes and assessment of quantitative parameters of the primary tumour in the prostate (SUVmax, total activity (PSMAtotal) and PSMA positive volume (PSMAvol)). Ability of quantitative PET parameters to predict nodal metastasis was assessed with receiver operating characteristics (ROC) analysis. A multivariable logistic regression model combining PSA, Gleason score, visual nodal status on PET and primary tumour PSMAtotal was built. Net benefit at each risk threshold was compared with five nomograms: MSKCC nomogram, Yale formula, Roach formula, Winter nomogram and Partin tables (2016). Overall, pathology of ePLND specimens revealed 31 pelvic metastatic lymph nodes in 12 patients. 68Ga-PSMA-11 PET visual analysis correctly detected suspicious nodes in 7 patients, yielding a sensitivity of 58% and a specificity of 98%. The area under the ROC curve for primary tumour SUVmax was 0.70, for PSMAtotal 0.76 and for PSMAvol 0.75. The optimal cut-off for nodal involvement was PSMAtotal > 49.1. The PET model including PSA, Gleason score and quantitative PET parameters had a persistently higher net benefit compared with all clinical nomograms. Our model combining PSA, Gleason score and visual lymph node analysis on 68Ga-PSMA-11 PET with PSMAtotal of the primary tumour showed a tendency to improve patient selection for ePLND over the currently used clinical nomograms. Although this result has to be validated, 68Ga-PSMA-11 PET showed the potential to reduce unnecessary surgical procedures in patients with intermediate- or high-risk prostate cancer.

Predictive Factors of Inguinal Lymph Node Metastasis in Men with Penile Cancer at Sanglah Hospital, Denpasar, Bali

Objective: to know the predictive factors of inguinal lymph node metastasis in men with penile cancer. Methods: this was a retrospective study on 65 patients with penile cancer in Sanglah Hospital, Denpasar, Bali from 2011 to 2015. Patients were included in analysis if they had undergone partial or total penectomy, and inguinal lymph-node dissection or excisional biopsy. Inguinal lymph node metastasis was defined as tumor positive node based on histopathology finding in patients who underwent inguinal lymph node dissection or excisional biopsy. Data retrieved from this study was analyzed by Chi Square and Kruskal-Wallis test. Results: a total of 65 patients diagnosed as penile cancer in Sanglah Hospital, Denpasar, Bali from 2011 to 2015. Mean age of these patients was 53.24 ± 13.42 years. The youngest age was 27 years old and the oldest was 86 years old. Fifteen patients were excluded for different reasons, remaining 50 patients for further analysis. From 50 patients included in analysis, 25 patient (50%) had inguinal lymph node metastasis. There were significant correlation between pathologic stage of the primary tumor (p=0.021), histologic grade (p=0.020), and vascular invasion (p=0.008) with the presence of inguinal lymph node metastasis. Based on pathologic stage of the primary tumor, only 1 of 7 patients (14%) with pT1 had inguinal lymph node metastasis compared with 10 of 24 patients (42%) with pT2, 10 of 15 patients (67%) with pT3, and 4 of 4 patients with pT4 (100%). Based on histologic grade, only 2 of 9 patients (22%) with grade I had inguinal lymph node metastasis compared with 18 of 36 patients (50%) with grade II, and 5 of 5 patients (100%) with grade III. Based on vascular invasion, only 15 of 38 patients (39%) without vascular invasion had inguinal lymph node metastasis compared with 10 of 12 patients (83%) with vascular invasion. No significant correlation was found between age and the presence of inguinal lymph node metastasis (p=0.829). Conclusion: pathologic stage of the primary tumor, histologic grade, and vascular invasion were predictive factors of inguinal lymph node metastasis in men with penile cancer.

Neck circumference correlates with tumor size and lateral lymph node metastasis in men with small papillary thyroid carcinoma

Background/AimsObesity is correlated with numerous diseases, including thyroid cancer, but the clinical significance of obesity with regard to the clinical characteristics of thyroid cancer remains unclear. Neck circumference is an index of upper-body adipose tissue distribution.MethodsIn total, 401 patients with papillary thyroid carcinoma (PTC) measuring ≤ 2 cm were included. Neck circumference was measured horizontally at the level just below the thyroid cartilage on preoperative neck computed tomographic images.ResultsNeck circumference correlated significantly with tumor size in men (p = 0.001) but not in women (p = 0.930). Body mass index (BMI) did not significantly correlate with tumor size in either sex. Neck circumference was significantly larger in men with lateral lymph node (LN) metastasis than in those without (p = 0.004). Neck circumference and BMI did not differ significantly in women according to other factors such as tumor size, multifocality, extrathyroid extension, and LN metastasis. Tumor size and the prevalence of lateral LN metastasis in men tended to increase in the middle/large neck circumference subgroup compared with those in the low neck circumference subgroup. Multivariate logistic regression analysis revealed that neck circumference (p = 0.009) was a predictor for the presence of lateral LN metastasis in men. BMI was not a predictive factor for lateral LN involvement in either sex.ConclusionsNeck circumference, an indicator of central or visceral obesity but not BMI, may be associated with some prognostic factors in men with small PTC.

767 PATHOLOGICAL AND ONCOLOGIC OUTCOMES FOR MEN WITH POSITIVE LYMPH NODES AT RADICAL PROSTATECTOMY: 30-YEAR EXPERIENCE FROM A SINGLE INSTITUTION

You have accessJournal of UrologyProstate Cancer: Advanced II1 Apr 2012767 PATHOLOGICAL AND ONCOLOGIC OUTCOMES FOR MEN WITH POSITIVE LYMPH NODES AT RADICAL PROSTATECTOMY: 30-YEAR EXPERIENCE FROM A SINGLE INSTITUTION Phillip Pierorazio, Jeffrey Mullins, Ashley Ross, Edward Schaeffer, Alan Partin, Misop Han, Patrick Walsh, and Trinity Bivalacqua Phillip PierorazioPhillip Pierorazio Baltimore, MD More articles by this author , Jeffrey MullinsJeffrey Mullins Baltimore, MD More articles by this author , Ashley RossAshley Ross Baltimore, MD More articles by this author , Edward SchaefferEdward Schaeffer Baltimore, MD More articles by this author , Alan PartinAlan Partin Baltimore, MD More articles by this author , Misop HanMisop Han Baltimore, MD More articles by this author , Patrick WalshPatrick Walsh Baltimore, MD More articles by this author , and Trinity BivalacquaTrinity Bivalacqua Baltimore, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.854AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Lymph node (LN) metastases at radical prostatectomy (RP) are a poor prognostic indicator with regards to oncologic outcomes. We report the 30-year experience of single institution with regard to LN metastases in men with clinically localized prostate cancer. METHODS The Johns Hopkins Radical Prostatectomy Database (1982-2011) was queried for men with node-positive adenocarcinoma of the prostate (N+PC). 505 (2.5%) of 19,633 men were identified. Survival analysis was completed using the Kaplan-Meier method and proportional hazard regression models were created to identify predictors of outcome in this cohort. RESULTS Median age was 59.5 years (range 38-76) and the majority of patients were Caucasian (452, 89.5%). Median PSA was 10.1 ng/mL (0.4-129), only 153 (30.3%) and 79 (15.6%) had clinical stage T2b and T2c/T3 respectively; 162 (32.1%), 232 (45.9%), 56 (11.1%), 38 (7.7%) and 4 (0.8%) men had Gleason 2-6, 7, 8, 9 and 10 at biopsy. At pathologic evaluation, 26 (5.1%), 275 (54.5%), 85 (16.9%), 115 (22.9%) and 2 (0.4%) had Gleason 2-6, 7, 8, 9 and 10 respectively. Median total and positive nodes were 13.2 (1-41) and 1.7 (1-12) respectively. 135 patients had a dominant nodule localized to one side of the prostate; in these patients 80 (59.3%) demonstrated positive LN on the ipsilateral side, 28 (20.7%) had contralateral positive LN and 15 (11.1%) had bilateral positive LN. 15-year biochemical-recurrence free, metastases-free and cancer-specific survival were 7.1%, 41.5% and 57.5% respectively. Predictors of biochemical-recurrence, metastastes and death from prostate cancer in multivariable analysis included Gleason sum at RP and percent of positive LN; notably total LN dissected did not predict outcome. CONCLUSIONS In this highly-selected RP cohort, men with N+PC at RP can experience a durable long-term metastases-free and cancer-specific survival. Predictors of survival include Gleason sum and percentage of positive LN. While total number of LN dissected did not predict outcome, upwards of 30% of men with N+PC will have positive LN contralateral to the primary prostatic lesion highlighting the importance of a thorough, bilateral pelvic LN dissection. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e313 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Phillip Pierorazio Baltimore, MD More articles by this author Jeffrey Mullins Baltimore, MD More articles by this author Ashley Ross Baltimore, MD More articles by this author Edward Schaeffer Baltimore, MD More articles by this author Alan Partin Baltimore, MD More articles by this author Misop Han Baltimore, MD More articles by this author Patrick Walsh Baltimore, MD More articles by this author Trinity Bivalacqua Baltimore, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Occult Breast Cancers Manifesting as Axillary Lymph Node Metastasis in Men: A Two-Case Report

Occult breast cancer is a type of breast cancer without any symptoms on the breasts or any abnormalities upon radiologic examination such as mammography. In males, there are few cases of breast cancer, the rate of diagnosis of occult breast cancer is very low, and little is known about this disease. We experienced two cases of occult breast cancers manifesting as axillary lymph node metastasis in men. They had a palpable lesion on axillary area several years ago and had not seen a doctor about it. As such there was no abnormality on evaluations for cancer except for axillary lymph node showing signs of carcinoma (primary or metastatic) on biopsy and estrogen receptor-positive and progesterone receptor-positive on immunohistochemistry. The patients were diagnosed with occult breast cancer, and treatments were performed. Herein, we report the rare cases of occult breast cancers in men.

Vascular endothelial growth factor gene polymorphisms in thyroid cancer

Vascular endothelial growth factor (VEGF) is a potent stimulator for angiogenesis. It has been implicated in growth and metastasis of thyroid cancer. Three functional single nucleotide polymorphisms (SNPs) of VEGF (-2578C/A, -634G/C, and +936C/T) are known to be related with VEGF expression. We conducted a case-control study to evaluate the genetic effects of these three functional SNPs on the development of thyroid cancer and lymph node metastasis. A total of 332 cases and 261 controls were recruited for this study. The genotypes were determined by the TaqMan 5'-nuclease assay. Hardy-Weinberg equilibrium (HWE) was tested for each SNP, and genetic effects were evaluated by the chi(2)-test and multiple logistic regression. We used Bonferroni correction to account for multiple testing, and a two-tailed P value <0.017 was considered statistically significant. All three SNPs were in HWE. The A allele of -2578C/A (i.e. SNP rs699947) increased a risk for thyroid cancer (adjusted OR=136, 95% CI=1.02-1.81, P=0.039). Haplotype analysis yielded a less significant result (an empirical P value of 0.07). There was a tendency of increasing the frequency of the risk allele from controls, patients without lymph node metastasis to patients with lymph node metastasis (P(trend)=0.019). Further analysis showed that the genetic effect was only in men (adjusted OR=1.97, 95% CI=1.16-3.37, P=0.013) but not in women (adjusted OR=1.15, 95% CI=0.81-1.62, P=0.435). The other two SNPs did not show significant results. The A allele of the SNP rs699947 increased the risk of thyroid cancer development and regional lymph node metastasis in men.

A Nomogram for Staging of Exclusive Nonobturator Lymph Node Metastases in Men with Localized Prostate Cancer

A Nomogram for Staging of Exclusive Nonobturator Lymph Node Metastases in Men with Localized Prostate Cancer

A Nomogram for Staging of Exclusive Nonobturator Lymph Node Metastases in Men with Localized Prostate Cancer

ObjectivesSome patients with localized prostate cancer are at risk of nonobturator lymph node invasion (NOLNI) and may require an extended pelvic lymph node dissection (ePLND). We explored the rate of exclusive NOLNI and developed a nomogram to predict it. Material and methodsWe mapped all ePLND specimens according to their anatomic location (obturator, external iliac, internal iliac lymph nodes) and assessed the location-specific rate of LNI in 565 patients. A multivariate logistic regression-based nomogram predicting NOLNI was then internally validated with 200 bootstrap resamples. ResultsOverall, 11.1% (63 of 565) had LNI and 21 (3.7%) had exclusive NOLNI. The nomogram predicting exclusive NOLNI was 80.2% accurate. The nomogram’s negative predictive value was 99%, when it predicted 0–10% probability of NOLNI. This approach could allow the omission of an ePLND in 350 of 565 (61.9%) patients and still correctly stage 85.8% of NOLNI cases. ConclusionsOur nomogram-based approach offers the possibility of identifying men who are at virtually zero risk of exclusive NOLNI. In these men, an ePLND may be safely avoided.

Hyperlipidaemia is positively correlated with lymph node metastasis in men with early gastric cancer.

Although increased dietary fat or cholesterol has been reported to be a risk factor for the development of certain cancers, the effect of serum lipid levels on tumour metastasis is not clearly understood. The association between lymph node metastasis and preoperative serum levels of total cholesterol (TC) and triglyceride (TG) as well as various pathological findings for tumours was examined in 353 patients with early gastric cancer who underwent gastrectomy with classical lymphadenectomy. The rate of lymph node metastasis was significantly higher in patients with early gastric cancer who had hypercholesterolaemia (TC 220 mg/dl or greater) or hypertriglyceridaemia (TG 150 mg/dl or greater). The tendency was more prominent in men, and multivariate analysis showed that hypertriglyceridaemia was an independent risk factor for nodal metastasis in men, in addition to pathological invasion to the submucosal layer or to lymphatic vessels. In contrast, neither hypercholesterolaemia nor hypertriglyceridaemia showed a significant association with nodal status in women with early gastric cancer. Raised serum lipid levels might favour the development of lymph node metastasis in men with early-stage gastric cancer. In patients with early gastric cancer serum lipid levels should be checked before operation, and the use of minimal local treatments must be considered carefully in male patients with hyperlipidaemia.

PROGNOSTIC FACTORS FOR SURVIVAL OF PATIENTS WITH PATHOLOGICAL GLEASON SCORE 7 PROSTATE CANCER: DIFFERENCES IN OUTCOME BETWEEN PRIMARY GLEASON GRADES 3 AND 4

We evaluated differences in clinical and pathological outcomes between Gleason 3 + 4 and 4 + 3 prostate cancer. The radical prostatectomy whole mounted specimens from 263 men with pathological Gleason 7 tumors were identified. Gleason 3 + 4 and 4 + 3 tumors were compared in regard to pathological variables and outcome. Significance of clinical and pathological data on progression-free survival was analyzed. Of the tumors 34% had a primary Gleason grade of 4, and were more likely than those with primary grade 3 to have seminal vesicle involvement (34% versus 18%, p = 0.006), a higher pathological stage (pT3 55% versus 42%, N+ 13% versus 3%, 0.001), extraprostatic extension (58% versus 38%, 0.001) and higher median preoperative prostate specific antigen (PSA) (13.5 versus 9.0 ng./ml., respectively <0.001). Mean followup plus or minus standard deviation was 6.8 +/- 1.9 years. The overall 10-year crude, cancer specific and progression-free survival rates were 83%, 99% and 58%, respectively. Primary Gleason grade was significantly associated with progression-free (risk ratio 1.6, 95% confidence interval 1.08 to 2.5, p = 0.02) but not crude and cancer-specific survival. Univariately, primary Gleason grade 4 was associated with progression-free survival, as were percent Gleason 4, seminal vesicle invasion, lymph node involvement, pT stage, margin status, DNA ploidy, preoperative PSA, cancer volume and extent of extraprostatic extension. Multivariately, only preoperative PSA (p <0.001), seminal vesicle invasion (<0.001) and DNA ploidy (0.002) were associated with progression-free survival. Primary Gleason grade and percent Gleason 4 were not identified as independently associated with progression-free survival. In patients with Gleason 7 score prostate cancer primary Gleason grade 3 and 4 cancers are different in pathological parameters and prognosis. However, primary Gleason grade does not provide any additional information than other known prognostic factors, such as preoperative PSA, seminal vesicle invasion and DNA ploidy.

PERINEURAL INVASION AND SEMINAL VESICLE INVOLVEMENT PREDICT PELVIC LYMPH NODE METASTASIS IN MEN WITH LOCALIZED CARCINOMA OF THE PROSTATE

Purpose We evaluate the contribution of *perineural invasion and seminal vesicle biopsy results in predicting pelvic lymph node metastases in men with T1 or T2 adenocarcinoma of the prostate. Materials and Methods A total of 212 men with localized prostate cancer were evaluated for serum prostate specific antigen (PSA), clinical stage, Gleason score and the presence of *perineural invasion. Each patient had undergone seminal vesicle biopsies and a laparoscopic pelvic lymph node dissection before definitive therapy. The pretreatment prognostic values, presence of perineural invasion and seminal vesicle involvement were compared to the results of the laparoscopic pelvic lymph node dissection. Differences in proportions were tested using the Pearson chi-square test. The effect of multiple variables was tested using a stepwise logistic regression analysis. Results PSA ranged from 1.6 to 190 ng./ml. (median 11), and 52% of patients had Gleason score 7 or greater and 67.5% had clinical stage T2b or greater disease. Of the 212 patients 37 (17.5%) had *perineural invasion, 43 (20.3%) seminal vesicle involvement and 21 (10%) positive node dissections. A PSA greater than 20 ng./ml. (20 versus 6.8%, p = 0.006), Gleason score 7 or greater (15.5 versus 3.9%, p = 0.005), clinical stage T2b or greater (14 versus 0.6%, p = 0.004), presence of perineural invasion (27 versus 6%, p = 0.0001) and seminal vesicle involvement (32.6 versus 4.1%, p <0.0001) influenced nodal findings. However, in the logistic regression model only the positive seminal vesicle biopsy (p = 0.0006), presence of perineural invasion (p = 0.04) and PSA greater than 20 ng./ml. (p = 0.044) were significant variables. Of the 21 men with positive node dissections 18 (85.7%) had a positive seminal vesicle biopsy or perineural invasion. Separation of patients into a high risk group defined by a positive seminal vesicle biopsy or *perineural invasion, or a low risk group defined as the absence of these features yielded a significant association with nodal involvement (28 versus 2%, p <0.0001). A separate analysis of the patients with a negative seminal vesicle biopsy demonstrated that only perineural invasion (19 versus 2%, p = 0.0002) and PSA greater than 20 ng./ml. (12 versus 2%, p = 0.01) conferred a greater risk of nodal metastases. A logistic regression analysis in the negative seminal vesicle biopsy group discarded all of the variables other than perineural invasion as significant. Conclusions A positive seminal vesicle biopsy is the most significant predictor of pelvic lymph node metastases in men with T1 or T2 prostate cancer. Perineural invasion is also an independent predictor of nodal disease. Patients with either of these features should undergo pelvic lymph node dissection before receiving definitive therapy.

Pelvic lymphadenectomy can be omitted in selected patients with carcinoma of the prostate: development of a system of patient selection

Objectives. The prevalence of pelvic lymph node metastases in men with clinically localized prostate cancer has decreased dramatically over the past decade, possibly due to efforts at early detection. With a significantly lower incidence of pelvic node involvement, it may be possible to identify a segment of patients for whom pelvic lymph node dissection (PLND) may be omitted. This study was conducted to develop a method to select patients for whom PLND could be omitted. Methods. We analyzed serum prostate-specific antigen (PSA), clinical stage, biopsy Gleason score, and final pathologic stage in 481 men with clinically localized prostate cancer. These variables were compared to the risk of positive pelvic lymph nodes. Results. Logistic regression analysis determined that combining all three variables provided the best determination of final pathologic stage. A series of probability curves have been created to estimate the risk of positive lymph nodes in a given patient. Based on the distribution of patients in this study and using these probability functions, PLND could be avoided in up to 50% of patients with localized prostate cancer diagnosed by contemporary methods. Conclusions. In properly selected patients, pelvic lymphadenectomy can be omitted in the staging and treatment of localized prostate cancer.