Node Recurrence Research Articles

Pathological reevaluation of gastric neoplasms with differentiation into the fundic gland

Objectives In the original classification, oxyntic gland neoplasms (OGNs) are classified as carcinoma based on the submucosal (SM) involvement and differentiation into MUC5AC- and MUC6-positive cells. Some cases without structural or nuclear atypia or desmoplastic reaction (DR) in the SM layer, which is essential for typical carcinoma, are also categorized as carcinoma of OGNs. To address potential overdiagnoses, we conducted a histopathological review of OGNs to propose a clinically relevant reevaluation. Methods Forty-one OGNs diagnosed pathologically in our institution between 2010 and 2022 were included. We defined carcinoma based on the structural or nuclear atypia of the tumor cells and evaluated DR in cases of SM involvement. Furthermore, our novel classification was compared to the original one. Results Among 41 OGNs, 10 were classified as carcinoma and 31 as adenoma. Carcinoma had a significantly larger endoscopic and pathological tumor size (p = 0.03, p < 0.01) and more MUC5AC/MUC6 co-expression than adenoma (p < 0.01). All cases of SM involvement with DR were recognized in nine carcinoma (90%), and all 20 cases without DR were adenoma (65%). According to the original classification, 47% (14/30) of OGNs were categorized as noncurative endoscopic resection according to the Japanese guidelines, which recommended additional gastrectomy; however, no cases of lymph node metastasis and recurrence were observed. Conclusion Our definition of carcinoma could categorize all cases of SM involvement with DR and lymphatic invasion as carcinoma. This novel classification for OGNs may be possible to overcome the issue of overdiagnosis caused by the original classification.

Omission of elective neck irradiation in pT3-T4 oral squamous cell carcinoma with a pN0 neck: Impact on regional control and overall survival.

e18091 Background: Postoperative radiotherapy is commonly indicated for the treatment of locally advanced oral squamous cell carcinoma (OSCC). However, for patients with a pN0 neck following cervical lymph node dissection, the American Society of Clinical Oncology (ASCO) guidelines suggest that adjuvant radiotherapy to cervical lymphatic regions may be omitted. Despite this recommendation, limited evidence supports this approach. This study aims to evaluate the impact of omitting neck irradiation on survival and locoregional control in patients with pT3-T4N0 OSCC following elective neck dissection. Methods: In this retrospective, single-institution cohort study, we included patients with locally advanced OSCC (pT3-T4N0) who underwent surgery, including cervical lymph node dissection. These patients received adjuvant tumor bed radiotherapy (RT) without postoperative neck irradiation. Collected data between January 2009 and December 2019 encompassed demographics, medical history, tumor characteristics, treatment details, and follow-up outcomes. Results: Seventy-seven patients were analyzed, with a mean age of 64.86 years (±12.87). Of these, 61% were male (n=47) and 39% female (n=30). The mean follow-up period was 56.35 months (±36.13). The median number of lymph nodes retrieved was 33 on the right side and 32.5 on the left. Recurrences were observed in 20.8% of patients (n=16), with no cases of isolated lymph node recurrence identified. Of the recurrences, 62.5% occurred at the primary tumor site, while 12.5% were isolated distant metastases. Lymph node recurrence occurred in combination with tumor site recurrence in 2 patients and pulmonary metastases in 1 patient. The median overall survival was 4 years (range, 0–13 years). Overall survival rates were 88.2% (95% CI: 78.5–93.7) at 2 years and 77.6% (95% CI: 66.5–85.5) at 5 years. The median recurrence-free survival was also 4 years, with rates of 84.7% (95% CI: 74.1–91.2) at 2 years and 79.2% (95% CI: 67.2–87.3) at 5 years. Conclusions: This study supports the omission of postoperative neck irradiation in patients with pT3-T4N0 OSCC who require adjuvant treatment, provided that the lymph node yield from neck dissection meets established quality standards (e.g., 18 or more lymph nodes). Omitting neck irradiation in pN0 OSCC patients reduces irradiated target volumes and associated toxicities without compromising survival or locoregional control.

Galectin-3 suppresses CD8+ T cells function via myeloid-derived suppressor cells recruitment in cervical cancer.

Galectin-3 suppresses CD8+ T cells function via myeloid-derived suppressor cells recruitment in cervical cancer.

The Added Value of Physical Examination for Breast Cancer Recurrence Detection in Women: A Systematic Review.

The Added Value of Physical Examination for Breast Cancer Recurrence Detection in Women: A Systematic Review.

Focal High-Grade Areas with a Tumor-in-Tumor Pattern: Another Feature of Pediatric DICER1-Associated Thyroid Carcinoma?

In the thyroid gland, during childhood or adolescence, DICER1-driven tumors include differentiated follicular thyroid carcinoma and, more rarely, poorly differentiated carcinoma. Herein, we describe the features of DICER1-associated thyroid carcinoma with the presence of high-grade areas within a differentiated tumor in four patients (median age 12.5 years, range 6–15 years), three of them carrying germline pathogenic variants of DICER1. A new tumor-in-tumor pattern characterized by intratumoral nodules with a higher histological grade (increased mitotic activity/Ki-67 and solid/trabecular/insular and/or microfollicular architecture) was detected in these DICER1-associated tumors. In two patients, the high-grade component also demonstrated the presence of CHEK2 p.(Tyr390Cys) likely pathogenic variants, suggesting a role for this gene and more generally for the ATM-CHECK2-TP53 pathway as a mechanism of malignant progression of DICER1-associated thyroid carcinomas. One of these two patients presented lymph node recurrence 8 months after surgery. An immunohistochemical study was also performed to explore the possible contribution of anti-DICER1 antibodies as well as thyroglobulin, Ki-67, p53, and PRAME in characterizing these tumors. DICER1 proved to be strongly expressed in mutated tumors compared to a control cohort (p < 0.001), deserving further validation to define its possible diagnostic role. Finally, well-demarcated ischemic-like areas with ghost cells embedded in a thick hyaline stroma (atrophic changes) were found within four tumors, whereas bunches of ectatic macrofollicles lined by flattened epithelium (involutional changes) were only detected in the background thyroid parenchyma of patients with germline DICER1 variants. These morphological features may alert pathologists to suspect a somatic and/or germline DICER1 alteration.

Retrospective comprehensive analysis of regional lymph node recurrence in breast cancer patients (REASON study)

BackgroundRandomized trials have progressively enabled the de-escalation of axillary surgery in breast cancer (BC) patients, reducing adverse events without compromising survival. Despite a not negligible rate of residual disease in the axilla after sentinel lymph node (SLN) procedure, the risk of regional lymph node recurrence (RLNR) is very low, due probably to multimodal adjuvant treatments. The characteristics of the small number of patients with RLNR remain poorly characterized and warrant further investigation, especially given their poor prognosis and the current context of ongoing studies exploring further de-escalation of axillary surgery.MethodsIn this retrospective and single institution study, we analyzed thoroughly a cohort of patients who experienced RLNR as first event between 2009 and 2020. MammaPrint and BluePrint analysis (MB) was performed in available primary invasive cancer tissues.ResultsForty patients, median age of 52, were analyzed. Disease-free interval was 8.7 years. Most of the patients (65%) had no special type BC. Majority (73%) had hormone receptor positive-HER2 negative (HR + /HER2−) BC, 13% triple negative (TNBC), 6% HER2 + , 8% ductal carcinoma in situ and 3% unknown. The median size of the primary tumor was 1.8 cm (range 0.3–7.0) and 57% had no initial LN involvement. Forty five percent had primary SLN procedure and 53% axillary LN dissection (ALND) of the patients received neo-/adjuvant chemotherapy, 63% endocrine therapy and 68% radiotherapy (50% only in breast). Sixty three percent had only RLNR and 38% had concomitant distant metastases. Among irradiated patients, 63% had some relapse in the radiation field. The MB analysis classified 70% of the analyzed cancers as low-risk luminal A (82% in HR + /HER2−), 15% high-risk luminal B, 10% high-risk basal type, and 5% high-risk HER2 type.ConclusionOur study confirms that patients treated with SLN do not show a higher risk of LRNR compared to ALND. LRNR is often diagnosed incidentally. Younger age, residual disease post-NAC, no regional radiation, stage II, and initial LN involvement were more represented, as well as patients with endocrine sensitive disease classified as low-risk luminal A by MB. Ongoing trials, including SOUND, INSEMA, and BOOG 2013-08, are further exploring axillary surgery de-escalation.

CARDIOTOXICITY FROM CHEMOTHERAPY IN ELDERLY PATIENTS: LIMITS AND NEW THERAPEUTIC FRONTIERS

CARDIOTOXICITY FROM CHEMOTHERAPY IN ELDERLY PATIENTS: LIMITS AND NEW THERAPEUTIC FRONTIERS

Neck Active Monitoring After Partial Laryngectomy for cT2N0M0 True Vocal Cord SCC: A 10-Year STROBE Analysis.

To evaluate 10-year nodal outcome of active monitoring of the neck for cT2N0M0 true vocal cord (TVC) squamous cell carcinoma (SCC) after frontline partial laryngectomy (PL). Retrospective observational study adhering to the STROBE guideline. French academic tertiary referral care center. Inception cohort of 81 isolated and untreated cT2N0M0 TVC SCC consecutively managed between 1983 and 2013 with frontline PL and active monitoring of the neck. 85% of patients were followed until death or for at least 10 years. Main endpoint was 10-year actuarial nodal control analysis. Secondary endpoints were the search for potential variables increasing the risk for nodal recurrence, management of nodal recurrence, and analysis of the oncologic consequences of nodal recurrence. The significance threshold was set at p < 0.005. The 10-year actuarial nodal control estimate was 90% with salvage treatment, yielding a 99% overall nodal control rate. On univariate analysis, none of the variables assessed significantly statistically increased the risk for nodal recurrence. The 10-year actuarial estimate of distant metastasis was 0% in patients with nodal control as compared with 35% in patients with nodal recurrence (p < 0.0001). The 10-year actuarial survival estimate was 0% in patients with nodal recurrence as compared with 67% in patients with nodal control (p < 0.0001). Among the 37 patients who died, uncontrolled SCC was the cause of death in 33% of patients who had a nodal recurrence and 3% of those who did not. Active monitoring of the neck for cT2N0M0 TVC SCC managed with PL, although not detrimental in terms of overall nodal control, is impaired by the negative oncological impact of nodal recurrence.

Postoperative Recurrence Pattern of Clinical Stage I Esophageal Cancer After Esophagectomy with Two- or Three-Field Lymph Node Dissection: Supplementary Analysis from JCOG0502.

Although recurrence after curative surgery for cT1bN0M0 clinical stage I (cStage I) esophageal squamous cell carcinoma (ESCC) is not rare, reports of recurrence analyses are sparse. Detailed data on optimal postoperative follow-up evaluation of cStage I ESCC are lacking. This study aimed to evaluate the frequency, characteristics, and predictors of postoperative recurrence in patients with cT1bN0M0 cStage I ESCC. The study analyzed 210 patients who underwent surgery for cT1bN0M0 cStage I ESCC and a follow-up computed tomography (CT) examination in the prospective multicenter study, JCOG0502. The study categorized the characteristics of postoperative recurrences such as the recurrence sites and whether regional/non-regional lymph nodes (LNs) and single/multiple organs were involved. Backward elimination was applied (p < 0.2) to identify postoperative recurrence predictors and obtained hazard ratios (HRs) based on Fine and Gray's model. Postoperative recurrence was experienced by 31 patients (14.8%) at one or more of the following sites: regional LNs (n = 18), non-regional LNs (n = 10), lung (n = 2); bone (n = 2), and liver, local recurrence, skin, pleura, pericardium, and other (n = 1 each). In four patients, the first recurrence developed in multiple organs. The median interval between trial registration and the first recurrence was 18.6 months. In multivariable analyses, pathologic nodal metastasis (hazard ratio [HR], 3.29; p = 0.003), tumor location in the upper-thoracic esophagus versus lower-thoracic esophagus (HR, 6.71; p = 0.013), and two-field lymphadenectomy (HR, 4.31; p = 0.001) were independently associated with the development of postoperative recurrence. The main postoperative recurrence sites of cT1bN0M0 ESCC are the LNs, but recurrence in non-regional LNs or distant organs is also quite common, indicating the importance of post-surgery systemic follow-up evaluation.

Robot-assisted neck dissection via retroauricular approach in head and neck cancer

Objective: To evaluate the effectiveness and safety of robot-assisted neck dissection via retroauricular approach for head and neck squamous cell carcinoma patients. Methods: A retrospective analysis was conducted on 22 patients with head and neck squamous cell carcinoma who underwent robot-assisted neck dissection via the retroauricular approach at Beijing United Family Hospital from March 2018 to August 2023. Among them, 6 were female and 16 were male, with an age range of 39-75 years. Preoperative staging showed N0 for 9 patients (41%), N1 for 12 patients (55%), and N2 for 1 patient (4%). The relevant clinical pathological and follow-up data were collected, and the effectiveness and safety of this surgical approach were analyzed. Kaplan Meier method was used to analyze the patient survival rate. Results: All patients were completed the robot-assisted neck dissection without conversion to open neck surgery, including the dissections of Ⅱ-Ⅳ regions in 11 patients, Ⅱ-Ⅲ regions in 8 patients, Ⅰ-Ⅳ regions in 2 patients, and Ⅰ-Ⅲ regions in 1 patient. The total number of dissected lymph nodes ranged from 7 to 69 (average 25.5), and the total number of metastatic lymph nodes ranged from 0 to 4 (average 1.4). The average total drainage volume was 145.8 ml. During the operation, one patient had pharyngocervical communication with the neck, which was sutured without postoperative pharyngeal fistula. After the operation, one patient developed a wound hematoma and improved after bedside drainage and hemostasis. The median follow-up time was 30 months. At the end of follow-up, one patient developed parapharyngeal lymph node recurrence, but no recurrence in the conventional neck dissection area. The 3-year neck control rate was 94.7% and the 3-year overall survival rate was 83.3%. The median satisfaction score for appearance was 10 points. Conclusion: Robot-assisted neck dissection via the retroauricular approach for head and neck squamous cell carcinoma can achieve good oncological and functional outcomes, with fewer postoperative complications and higher patient appearance satisfaction.

Survival determinants and toxicity of second-course radiotherapy for isolated nodal recurrences in breast cancer.

Isolated nodal recurrence (INR) after localized breast cancer is rare, with an incidence of less than 1%. Curative management typically includes surgical resection, often with axillary lymph node dissection (ALND), followed by regional nodal radiotherapy. However, evidence-based guidelines remain limited due to the rarity of this clinical scenario. The aim of this study was to evaluate survival determinants and the acute and long-term toxicities associated with second-course regional nodal irradiation as part of curative strategies for INR after localized breast cancer. This retrospective study included 11patients with localized breast cancer who developed ipsilateral, nonmetastatic INR between 2003 and 2019. All patients were treated with curative intent, including regional nodal irradiation. Overall survival (OS), cancer-specific survival (CSS), metastasis-free survival (MFS), local control, and treatment toxicities were analyzed. Survival probabilities were calculated using the Kaplan-Meier method, and Cox regression was used to assess prognostic factors. The 5‑year OS and CSS were 71.6%, while MFS was 62.3%. Inclusion of internal mammary chain (IMC) irradiation significantly improved OS, CSS, and MFS (p < 0.01). Triple-negative breast cancer (TNBC) INRs were associated with worse survival outcomes. Acute grade2 toxicities included radiodermatitis (36.4%), and late grade2 toxicities were limited to fibrosis (18.2%). No cardiac, pulmonary, or grade3 or higher toxicities were reported. This study highlights the favorable survival outcomes and safety profile of contemporary curative strategies for INRs following localized breast cancer, with a5-year OS rate exceeding historical benchmarks. Internal mammary chain irradiation appears to improve survival without increased toxicity. However, the poor prognosis associated with TNBC INR underscores the need for effective systemic therapies. Prospective multicenter trials are essential to validate these findings and optimize treatment protocols.

Elective clinical target volume in early squamous cell anal canal cancer: A systematic review and meta-analysis of the risk of recurrence in untreated upper pelvic and external iliac lymph nodes.

Elective clinical target volume in early squamous cell anal canal cancer: A systematic review and meta-analysis of the risk of recurrence in untreated upper pelvic and external iliac lymph nodes.

PSMA PET/CT findings in high-risk biochemical recurrence after local treatment of prostate cancer.

To describe PSMA PET/CT characteristics of patients with high-risk BCR. This was a retrospective analysis of patients with high-risk BCR prostate cancer (PSA ≥ 2ng/ml above nadir after radiation therapy [RT] or ≥1ng/ml after radical prostatectomy [RP] +/- RT) who underwent PET/CT from July 2021-March 2023. Patients with prior cytotoxic chemotherapy, androgen deprivation therapy (ADT) initiated >3months prior to PET/CT or positive conventional imaging within 3months of PET/CT were excluded. Neoadjuvant/adjuvant ADT completed ≥9months prior was allowed. Logistic regression, Pearson's Chi-squared, Wilcoxon rank sum and Fisher's exact tests were used for analysis. A total of 113 of 145 (77%) included patients in the analysis had ≥1 lesion on PSMA PET/CT. There was no difference in PSMA PET/CT positivity based on age, race, Gleason Grade at initial biopsy or PSA. Overall, 29 (20%) patients had lesions in the prostate/prostate bed only, 31 (21%) had lesions consistent with N1M0 disease and 53 (37%) had lesions consistent with M1 disease. For M1 patients, 21/53 (40%) had oligometastatic disease (1-3 lesions), and 32/53 (60%) had a higher burden (>3 lesions). Local recurrence was more common with RT and nodal recurrence with RP, with no difference in distant metastasis by initial treatment. Nearly 80% of patients with high-risk BCR after local treatment for prostate cancer with RP and/or RT will have positive findings on PSMA PET/CT. In addition to intensified systemic therapy, up to 55% of the patients may have benefitted from salvage local therapy, nodal pelvic radiation or metastasis-directed therapies for oligometastatic disease.

Complete Response Achieved by Gemcitabine+Cisplatin+Durvalumab Therapy for Lymph Node Recurrence of Intraductal Cholangiocarcinoma-A Case Report

The prognosis for unresectable or recurrent biliary tract cancer is generally unfavorable. However, recent reports suggest that combination therapy with immune checkpoint inhibitors may improve outcomes. We report the case of a 79-year-old woman with intrahepatic cholangiocarcinoma who underwent radical resection. Three months post-surgery, she developed a recurrence in an intra-abdominal lymph node. Treatment with 4 courses of gemcitabine+cisplatin+durvalumab(GCD)resulted in a complete response, with no measurable lesions detected on imaging. The patient continued treatment and was subsequently transitioned to durvalumab monotherapy. Although treatment was discontinued due to drug-induced pneumonia, she has remained relapse-free since. To our knowledge, this is the first reported case of a complete response to GCD therapy in biliary tract cancer.

Salvage metastasis-directed therapy versus elective nodal radiotherapy for oligorecurrent nodal prostate cancer metastases (PEACE V-STORM): a phase 2, open-label, randomised controlled trial.

Salvage metastasis-directed therapy versus elective nodal radiotherapy for oligorecurrent nodal prostate cancer metastases (PEACE V-STORM): a phase 2, open-label, randomised controlled trial.

Rare Upper Mediastinal Oligometastasis from Early Esophagogastric Adenocarcinoma: A Case Report.

Esophagogastric junction (EGJ) adenocarcinoma is an aggressive cancer with poor prognosis. Metastasis to the upper mediastinal lymph nodes is rare, with reported rates of 3.8% to 6.1%. This case report highlights the diagnostic and therapeutic challenges of oligometastatic recurrence in EGJ adenocarcinoma, emphasizing the role of surgery in selected cases. A 63-year-old male underwent proximal gastrectomy for a Siewert type 2 poorly differentiated EGJ adenocarcinoma. Postoperative histopathology confirmed the diagnosis of stage 1 cancer. At 30 months, contrast-enhanced computed tomography (CT) scan detected a right paratracheal lymph node recurrence. Subsequent follow-up CT and positron emission tomography (PET) scan revealed progressive enlargement of the same lymph node with negative PET uptake. Owing to strong clinical and radiological suspicion of oligometastasis, thoracoscopic lymphadenectomy was performed with the patient in the left lateral decubitus position under one-lung ventilation. The postoperative histopathological examination confirmed metastatic adenocarcinoma. The patient was discharged uneventfully on postoperative day 5 and prescribed with adjuvant tegafur-gimeracil-oteracil (S-1). He remained asymptomatic during ongoing surveillance. This case highlights the challenges in diagnosing oligometastatic recurrence of EGJ adenocarcinoma, particularly when typical imaging signs are absent. It also demonstrates the importance of a multidisciplinary treatment approach, including careful surveillance and timely intervention. Surgery is one of the options for oligometastasis.

The Prognostic Role of Magnetic-Resonance-Imaging-Detected Corpus Invasion in Patients with Cervical Carcinoma Who Underwent Definitive or Adjuvant Pelvic Radiotherapy.

In patients undergoing a radical hysterectomy, uterine corpus invasion worsens cervical cancer prognosis. However, the prognostic role of the invasion in locally advanced stages remains elusive. Due to the inadequacy of typical corpus biopsies, corpus invasion is diagnosed using magnetic resonance imaging (MRI). In this study, we investigated the prognostic role of MRI-detected uterine corpus invasion in patients undergoing radiotherapy for cervical cancer. This retrospective analysis involved 259 patients without extrapelvic metastases, diagnosed with FIGO 2009 stages IB-IVA cervical carcinoma from January 2011 to December 2020. The corpus invasion extent was classified as exocervical-confined (group 1), endocervical (group 2), or uterine corpus invasion (group 3). The rates of overall survival, cancer-specific survival, locoregional recurrence, para-aortic lymph node recurrence, and extrapelvic metastases after pelvic radiotherapy were analyzed. Kaplan-Meier and Cox regression analyses were used to determine recurrence-associated risks. Optimal risk stratification was predicted using a receiver operating characteristic curve with the area under the curve. Groups 1, 2, and 3 included 66.0%, 18.9%, and 15.1% of patients, respectively. The 5-year para-aortic lymph node recurrence rates were 6.3%, 17.2%, and 34.2% (p < 0.001). Uterine corpus invasion was an independent factor for overall survival, cancer-specific survival, locoregional recurrence, extrapelvic metastases, and para-aortic lymph node recurrence. Including uterine corpus invasion in the risk stratification led to higher areas under the curve for overall survival, cancer-specific survival, locoregional recurrence, extrapelvic metastases, and para-aortic lymph node recurrence than using single parameters. In cervical cancer, following pelvic radiotherapy, uterine corpus invasion is a significant prognostic factor. More-aggressive treatments such as extended-field radiotherapy, adjuvant chemotherapy, and immune checkpoint inhibitors as an alternative to standard pelvic radiotherapy with concurrent chemotherapy may be considered in these patients.

Combined Spatial and Dosimetric Recurrence Pattern Analysis in Head and Neck Squamous Cell Carcinoma Following Postoperative (Chemo)radiotherapy

BackgroundAdvancements in nodal staging for head and neck squamous cell carcinoma (HNSCC) have prompted radiotherapy de-escalation trials to reduce irradiation of electively treated neck regions, with the goal of improving treatment tolerability. While volumetric de-escalation has shown promise in definitive radiotherapy of HNSCC, limited data exist regarding its safety in the postoperative treatment setting. This study aimed to assess dose-level-specific locoregional recurrence patterns following standard postoperative (chemo)radiotherapy in a mixed HNSCC cohort to inform risk-adaptive radiotherapy strategies.Materials and methodsWe retrospectively reviewed 203 HNSCC patients (75% HPV-negative, 25% HPV-positive) treated with curative intent postoperative (chemo)radiotherapy from 2017 to 2021. Recurrence imaging was co-registered with planning CT, and recurrent tumor volumes were dosimetrically compared to the target volume dose and spatially analyzed using a center-of-mass-based approach. We classified five recurrence types: A (central high-dose), B (peripheral high-dose), C (central intermediate- or low-dose), D (peripheral intermediate- or low-dose), and E (extraneous dose).ResultsWith a median follow-up of 39.7 months, the three-year local, regional, and distant control of HPV-negative HNSCC were 84%, 87%, and 87%, respectively. Of 56 recurrences, 17 were local, 13 regional, 3 locoregional, 9 combined local/regional with concomitant distant failure, and 14 distant only. Of 40 analyzed recurrences, we identified 47.5% as type A/B, 5% as type C/D intermediate-dose, and 20% as type E, half of which were secondary cancers. Among the 27.5% (11/40) type C/D low-dose recurrences in the elective target volume, 15% (6/40) were true nodal failures, resulting in an overall elective neck failure rate of 3% (6/203).ConclusionThe predominance of high-dose recurrences suggests that biological tumor resistance is a key driver of treatment failure, highlighting the necessity to refine postoperative risk stratification and integrate tumor biology into dose escalation decisions. The low incidence of isolated nodal recurrences in electively treated neck regions supports the feasibility of volumetric de-escalation of postoperative radiotherapy. This approach might not only be feasible for HPV-associated oropharyngeal cancers but also for HPV-negative tumors, provided that accurate nodal staging has been conducted.

Patterns of Initial Lymph Node Involvement and Recurrence in Patients With Maxillary Sinus Squamous Cell Carcinoma.

Determining whether to treat the elective cervical lymph node (LN) area remains a dilemma in maxillary sinus squamous cell carcinoma (SCC). This study analyzed the patterns of initial LN involvement and recurrence to guide treatment strategies. We retrospectively reviewed 119 patients with maxillary sinus SCC treated between 2005 and 2023. Patients received definitive concurrent chemoradiotherapy, neoadjuvant therapy followed by local treatment, or upfront surgery with or without adjuvant radiotherapy. Among 119 patients, 28 (23.5%) had clinical LN involvement at diagnosis, primarily at ipsilateral neck levels I and II. Regional failure occurred in 18 (19.8%) cN0 and 9 (32.1%) cN+ patients, with ipsilateral level II being the most common site. Contralateral failures were frequent in cN+ patients. Distant metastases occurred in 17 patients (14.3%), predominantly in the lungs. Understanding LN involvement and recurrence patterns can refine radiation field design and follow-up strategies in maxillary sinus SCC.

A dynamic nomogram for predicting abdominal lymph node recurrence in patients with esophageal carcinoma

Patients with middle and lower thoracic esophageal carcinoma (TEC) after surgery are prone to develop abdominal lymph node recurrence (LNR). However, questions remain regarding the indications for postoperative abdominal radiotherapy. We aimed to identify the risk factors for abdominal LNR and to develop a dynamic nomogram for predicting abdominal LNR. We reviewed 1004 patients with middle and lower TEC treated with three-field lymph node dissection between January 2010 and December 2020 at two clinical centers. Risk factors for abdominal LNR were identified using least absolute shrinkage and selection operator (LASSO) logistic regression analysis. A dynamic nomogram was then developed. Performance was evaluated using receiver operating characteristic (ROC) curve , calibration curve and decision curve analysis. The rates of abdominal LNR in the training, internal test and external test cohorts were 25.91%, 23.40% and 23.98%, respectively. A dynamic nomogram was developed to predict the abdominal LNR in patients with middle and lower TEC. The main predictors included tumor location, pathologic N stage and number of preoperative abdominal LNM. The AUC of the training, internal test, and external test cohorts were 0.767 (95%CI 0.7263–0.8079), 0.763 (95%CI 0.7002–0.8258) and 0.802 (95%CI 0.7419–0.8629), respectively. Furthermore, The calibration curves and DCA analysis indicated a favorable fit and significant clinical applicability of the nomogram. The dynamic nomograms is available at https://prediction-of-abdiminal-lymph-node-metastasis-in-tec.shinyapps.io/DynNomapp/. Tumor location, pathologic N stage and number of preoperative abdominal LNM were identified as risk factors for predicting abdominal LNR. The online dynamic nomograms showed good prediction performance and convenient clinical application, which may help clinicians identify patients who require adjuvant abdominal radiotherapy.