Lymph Node Stage Research Articles

Abstract PS6-53: Higher clinical lymph node stage predicts worse survival in patients with breast cancer who achieve a pathologic complete response after neoadjuvant chemotherapy

Abstract Background: Despite patients with breast cancer who achieve a pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) generally demonstrate improved survival, some of these patients will develop breast cancer recurrence. Identification of factors associated with recurrence in patients with pCR after NAC would be helpful to optimize treatment strategies in breast cancer. In this study, we aim to particularly explore the factors associated with the prognosis of this patient population.Methods: Data of patients from three tertiary hospitals and treated with NAC between 2005 and 2019 were retrospectively collected. A pCR was defined as no invasive tumor in the breast and no tumor in the lymph node (ypT0/is, ypN0). Factors associated with pCR were analyzed using univariable and multivariable logistic regression analyses. Disease-free survival (DFS) and overall survival (OS) were analyzed using the Kaplan-Meier method. The prognostic value of clinicopathological factors regarding DFS and OS were determined by univariable and multivariable Cox regression analyses.Results: A total of 897 patients were used for the analysis, including 287 patients with a pCR and 610 patients without pCR. Clinical TNM stage, histological grade, estrogen receptor (ER) status, progesterone receptor (PR) status, human epidermal growth factor receptor 2 (HER2) status, Ki67, molecular subtype, NAC regimen and NAC cycles were associated with pCR status, with TNM stage and molecular subtype as independent predictors of pCR. Patients with a pCR had a superior DFS (pCR vs non-pCR, hazard ratio [HR] 0.26 (95% confidence interval [CI] 0.15-0.45, P<0.001) and OS (pCR vs non-pCR, hazard ratio [HR] 0.13 (95% confidence interval [CI] 0.05-0.35, P<0.001). In patients with pCR, clinical T stage, N stage and TNM stage were associated with DFS and OS, with higher N stage as an independent predictor of a worse DFS and OS.Conclusions:Clinical N stage of breast cancer is an independent predictor of worse DFS and OS in patients with a pCR after NAC. Possible this could support treatment escalation in this patient population in the future. Citation Format: Li-Yun Xie, Kun Wang, Yan-Xia Shi, Hai-Lu Chen, Jian-Hao Huang, Yang-Hang Fan, Si-Qi Qiu, Zhi-Yong Wu. Higher clinical lymph node stage predicts worse survival in patients with breast cancer who achieve a pathologic complete response after neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-53.

Management of Positive Cervical Lymph Nodes in Parotid Cancer

Objective: Assessment the management of positive cervical lymph nodes in parotid cancer. Associated clinical symptoms, histological types, regional lymph node stage (n stage), occult metastasis, neck dissection by level, recurrence, neck irradiation. Methods. We carried out a retrospective analysis of 43 patient’s pathological positive lymph nodes metastatic from parodied cancer, who underwent neck dissection. treated in years 2010-2020, we analyzed the following parameters: age, sex, pT-Status, tumour size, skin invasion, facial nerve palsy, tumour fixation, extraparotid extension, localization, grade, histology, Distribution of T classification was: T3 (60%), and T4 (40%). Results: Mean patient age was 52 years, the most common location of cervical Nodes Met. was level II (72%), then III (49%) then I (42%), then IV (40%) and V (19%). The incidence was highest among patients with (27.9%) mucoepidermoid carcinoma was most common, followed by (14.6%) carcinoma ex-pleomorphic adenoma (9.3%) with acinic cell carcinoma (7%) with squamous cell carcinoma, (11.6%) with adenoid cystic carcinoma, (7.0%) with adenocarcinoma, (7.4%) salivary duct carcinoma, When classified by histological grade, 35% of patients with low/intermediate-grade versus 65.0% high-grade ., Pre-operative fine needle aspiration (83.7%) patients, Post-surgical irradiation was performed in all 43 patients (100%). The resection status (R) was Negative margins R0. (93%), lymphovascular space invasion (44.2%) and (25.6%) had perineural invasion. Skin invasion in (14%) patients, and (4.7%) had regional nodal recurrence (7%) patients with pN1, vs (93%) patients with pN2. Pathologically positive lymph node 4 (range: 1–8 Nodes) lymph nodes harvest 29(range, 23–41 lymph nodes)., Conclusion: modified Radical Neck Dissection with additional radiotherapy should be carried out in patients. Nodes positive parotied cancer especially High histological stage, advanced stage, perineural invasion, positive operative edge, a fixed mass with extra parotid extension facial-nerve paralysis and tumor pain in partied cancer.

Clinical Impact of Pelvic Lymph Node Status in Locally Advanced Cervical Cancer Patients Treated by Concurrent Chemoradiation Therapy.

Objective:To explore the treatment outcomes of locally advanced cervical cancer (LACC) patients with pelvic lymph node enlargement (PLNE) or stage IIIC1 when compared with no PLNE and unknown PLN status (UNK). Materials and Methods:Retrospective cohort study was designed by matching with the ratio of 1:4:4 for patients with PLNE, no PLNE and UNK between 2003 and 2017. The main factor which was used to match was clinical staging. Results:All 360 LACC patients who treated as concurrent chemoradiation therapy (CCRT) were composed of 40 with PLNE, 160 with no PLNE and 160 with UNK. The majority of tumor histology (78.9%) was squamous cell carcinoma and 51.1% were diagnosed in stage IIB. Five-year progression free survival rates of patients with PLNE, no PLNE and UNK were 42.7%, 64.5% and 59.0%, respectively (P = 0.191), and corresponding with 5-year overall survival rates of 57.0%, 66.0% and 61.9% (P = 0.608). Patients with PLNE had local recurrence (LR) at 22.5%, compared with no PLNE at 11.3% and UNK at 11.9%. The most common site of LR for patients with PLNE was PLN with odds ratio of 19.7 when using no PLNE as reference (P < 0.001). There was no statistically significant difference between distant metastasis rates in PLN statuses of patients with PLNE, no PLNE and UNK at 20.6%, 30.0% and 26.3%, respectively. Conclusions:LACC patients with PLNE had a trend of poorer survival rates than patients with no PLNE, while treatment outcomes of patients with UNK were not inferior to no PLNE.

A case-control study on the relationship between the ratio of neutrophils to lymphocytes in malignant tumors and ventilator-associated pneumonia

To explore the relationship between ventilator-associated pneumonia (VAP) and neutrophil/lymphocyte ratio (NLR) before mechanical ventilation in patients with malignant tumors. A retrospective nested case-control study was conducted. Patients with malignant tumor treated by mechanical ventilation admitted to the Third Affiliated Hospital of Guizhou Medical University from February 2015 to February 2020 were enrolled. The patients with VAP were selected as the case group, and the matched non-VAP cases were selected according to 1:2 as the control group. The clinical data were collected, and the differences of each index between the two groups were compared. The influencing factors of VAP in patients with malignant tumor were analyzed by multivariate Logistic regression. During the study period, 1 271 patients with malignant tumors were treated with mechanical ventilation, of which 241 cases had VAP, and the incidence of VAP was 18.96%. There were 232 VAP patients in the case group matched 464 non-VAP patients in the control group. The clinical data of age, gender, hospitalization diagnosis, primary tumor, regional lymph node and distant metastasis (TNM) stage, acute physiology and chronic health evaluation II (APACHE II), complications, duration of mechanical ventilation, hemoglobin (Hb) and serum albumin (Alb) levels were balanced and comparable between the two groups, and the cluster nursing measures were consistent. Compared with the control group, although there was no significant difference in neutrophil count (NEU) and lymphocyte count (LYM) in the case group [NEU (×109/L): 3.81±1.07 vs. 3.64±1.05, LYM (×109/L): 2.06±0.59 vs. 2.15±0.62, both P > 0.05], NLR was significantly increased (2.07±1.05 vs. 1.89±0.96, P < 0.05), and the hospital stay was significantly longer (days: 24.84±3.81 vs. 13.19±3.98, P < 0.01). NLR, gender, age, APACHE II score, TNM stage, Hb, serum Alb and duration of mechanical ventilation were included in multivariate Logistic regression analysis. The results showed that patients with elevated NLR had higher risk of VAP [odds ratio (OR) = 1.187, 95% confidence interval (95%CI) was 1.015-1.387, P = 0.032]. In patients with VAP, NLR was negatively correlated with the time of mechanical ventilation before VAP (r = -0.327, P = 0.000), and positively correlated with the time of treatment with antibiotics after VAP (r = 0.559, P = 0.000). Elevated NLR in patients with malignant tumors who were on mechanical ventilation can significantly increase the risk of VAP and increase the difficulty of treatment.

Comprehensive analysis of prognostic value of lymph node staging classifications in patients with head and neck squamous cell carcinoma after cervical lymph node dissection

PurposeTo determine the optimal threshold of examined lymph node (ELN) number from cervical lymph node dissection for head and neck squamous cell carcinoma (HNSCC). Further to compare the prognostic value of multiple lymph node classification systems and to determine the most suitable scheme to predict survival. MethodsA total of 20991 HNSCC patients were included. Odds ratios (ORs) for negative-to-positive node stage migration and hazard ratios (HRs) for survival were fitted using the LOWESS smoother. Structural breakpoints were determined by the Chow test. The R square, C-index, likelihood ratio, and Akaike information criterion (AIC) were used to compare the prognostic abilities among AJCC N stage, number of positive lymph nodes (pN), positive lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS) stages. ResultsA minimal threshold ELN number of fifteen had the discriminatory capacities for both stage migration and survival. LODDS stages had the highest R square value (0.208), C-index (0.736) and likelihood ratio (2467) and the smallest AIC value (65874). LODDS stages also showed prognostic value in estimating patients with AJCC N0 stage. A novel staging system was proposed and showed good prognostic performance when stratified by different primary sites. ConclusionFifteen lymph nodes should be examined for HNSCC patients. LODDS stage allows better prognostic stratification, especially in N0 stage. The proposed staging system may serve as precise evaluation tools to estimate postoperative prognoses.

TBX1 Functions as a Tumor Activator in Prostate Cancer by Promoting Ribosome RNA Gene Transcription.

TBX1 belongs to an evolutionarily conserved family of transcription factors involved in organ development. TBX1 has been reported to have a hypermethylated cytosine guanine dinucleotide island around its second exon, which was related to prostate cancer (PCa) progression. However, the role and exact mechanism of TBX1 in PCa remains unknown. Using human prostate samples, online data mining and multiple in vitro and in vivo models, we examined the biological role and underlying mechanisms of TBX1 in PCa. TBX1 was highly expressed in PCa tissues, and high TBX1 expression was positively associated with Gleason score, pathological tumor stage, pathological lymph node stage, extraprostatic extension and disease/progression-free survival. In vitro and in vivo data demonstrated that TBX1 silencing inhibits PCa cell proliferation and colony formation and increases the cell population at the G0/G1 phase. The exogenous expression of TBX1 rescued these phenotypes. Mechanistically, TBX1 silencing suppressed the expression of 45S ribosomal RNA (rRNA), which was rescued by the exogenous expression of TBX1. TBX1 silencing inhibited the monomethylation of histone 3 lysine 4 (H3K4me1) binding with the non-coding intergenic spacer (IGS) regions of ribosomal DNA (rDNA) and the recruitment of upstream binding factor to the promoter and IGS regions of rDNA. The drug-induced enhancement of H3K4me1 counteracted the effect of TBX1 silencing. These findings indicate that TBX1 exerts its tumor activator function in PCa cells via epigenetic control, thereby promoting rRNA gene transcription. Thus, TBX1 may represent a prognostic biomarker and therapeutic target for PCa patients.

A Machine Learning-Based Investigation of Gender-Specific Prognosis of Lung Cancers.

Background and Objective: Primary lung cancer is a lethal and rapidly-developing cancer type and is one of the most leading causes of cancer deaths. Materials and Methods: Statistical methods such as Cox regression are usually used to detect the prognosis factors of a disease. This study investigated survival prediction using machine learning algorithms. The clinical data of 28,458 patients with primary lung cancers were collected from the Surveillance, Epidemiology, and End Results (SEER) database. Results: This study indicated that the survival rate of women with primary lung cancer was often higher than that of men (p < 0.001). Seven popular machine learning algorithms were utilized to evaluate one-year, three-year, and five-year survival prediction The two classifiers extreme gradient boosting (XGB) and logistic regression (LR) achieved the best prediction accuracies. The importance variable of the trained XGB models suggested that surgical removal (feature “Surgery”) made the largest contribution to the one-year survival prediction models, while the metastatic status (feature “N” stage) of the regional lymph nodes was the most important contributor to three-year and five-year survival prediction. The female patients’ three-year prognosis model achieved a prediction accuracy of 0.8297 on the independent future samples, while the male model only achieved the accuracy 0.7329. Conclusions: This data suggested that male patients may have more complicated factors in lung cancer than females, and it is necessary to develop gender-specific diagnosis and prognosis models.

Interfacial Curvature as a Potential Index for Prognosis of Colon Adenocarcinoma.

Tumor invasion and metastasis are complex interfacial mechanical processes between the tumor and its surrounding tissue, with the interfacial curvature of tumor playing an important role in cancer progression. In this study, the potential role of interfacial curvature in the prognosis of patients with colon adenocarcinoma is investigated. The front edge interfacial curvature of adenocarcinoma from biopsies of patients in different tumor, lymph node, and metastasis (TNM) stages are calculated and compared, and prognosis assessment is conducted using Kaplan-Meier and Cox proportional hazards regression analyses. Results reveal that patients with larger interfacial curvature of adenocarcinoma are more likely to belong to higher TNM stages. Concomitantly, in the same TNM stage, patients with increased adenocarcinoma interfacial curvature show worse prognosis with higher recurrence and lower survival rates. Besides, interfacial curvature is an independent prognostic factor for cause-specific survival and relapse-free survival among all selected patients. Mechanical models of colon adenocarcinoma invasion and metastasis are established to better understand the close association between interfacial curvature and tumor progression. The results together with hematoxylin and eosin staining indicate that metastasis in stages T3N0M0 and T3N1M0 may be linked to large interfacial curvatures. Therefore, interfacial curvature may serve as a potential index for predicting prognosis in patients with colon adenocarcinoma.

Adjuvant contralateral neck irradiation for oral cavity cancer - A systematic review and meta-analysis

IntroductionWhether contralateral neck irradiation should be administered for oral cavity cancer is a critical question because patients receiving bilateral neck irradiation experience more adverse effects. Patients not receiving contralateral neck irradiation are at risk of contralateral neck recurrence of oral cavity cancer Materials and MethodsMeta-analysis and subgroup analysis were performed for the rates of contralateral neck recurrence of oral cavity cancer in patients receiving no contralateral neck radiation. We aimed to identify the patient group suitable for contralateral neck radiotherapy omission. The PRISMA guideline was used for this study. We extracted data including the first author, country, sample size, numbers of patients receiving ipsilateral neck radiotherapy and experiencing contralateral neck recurrence, participant characteristics, and details of cancer types ResultsThe rate of contralateral neck recurrence is extremely low, 3.4% (95% confidence interval: 2.2%–5.4%). Isolated contralateral neck recurrence occurred in 18 of 524 patients receiving radiotherapy to the primary tumor site with or without ipsilateral irradiation. The subgroup analysis was conducted to investigate pathological lymph node stage and subsite. Subgroup analysis showed that the N2–3 group was more likely to exhibit recurrence in contralateral neck than the N0–1 group was (14.4% versus 1.5%, p = 0.0008). In addition, the contralateral neck recurrence rate was 6.3% (95% CI = 2.3%–13.1%) and 2.8% (95% CI = 1.5%–4.8%), in the tongue cancer patient group and the non-tongue cancer patient group, respectively. Meta-regression showed that the rate of contralateral recurrence was not different between both groups (p = 0.08). Only 2 exhibited isolated contralateral neck recurrence (5.1%) in pN0–1 tongue cancer patient. Most of them (>90%) are lateralized. ConclusionIn conclusion, the omission of contralateral irradiation is reasonable in pN0–1, well lateralized oral cavity cancer.

Upregulation of BIRC5 plays essential role in esophageal squamous cell carcinoma.

Esophageal squamous cell carcinoma (ESCC) is one of the most common cancers in the world, the detection and prognosis of which are still unsatisfactory. Thus, it is essential to explore the factors that may identify ESCC and evaluate the prognosis of ESCC patients. Both protein and mRNA expression levels of BIRC5 are upregulated in ESCC group rather than non-ESCC group (standardized mean difference > 0). BIRC5 mRNA expression is related to the age, tumor location, lymph node stage and clinical stage of ESCC patients (p < 0.05). BIRC5 expression makes it feasible to distinguish ESCC from non-ESCC (area under the curve > 0.9), and its high expression is related to poor prognosis of ESCC patients (restrictive survival time difference = -0.036, p < 0.05). BIRC5 may play an important role in ESCC by influencing the cell cycle pathway, and CDK1, MAD2L and CDC20 may be the hub genes of this pathway. The transcription factors-MAZ and TFPD1 -are likely to regulate the transcription of BIRC5, which may be one of the factors for the high expression of BIRC5 in ESCC. The current study shows that upregulation of BIRC5 may have essential clinical value in ESCC, and contributes to the understanding of the pathogenesis of ESCC.

A novel prognostic factor TIPE2 inhibits cell proliferation and promotes apoptosis in pancreatic ductal adenocarcinoma (PDAC).

Background: Tumor necrosis factor (TNF)-alpha-induced protein 8-like 2 (TIPE2 or TNFAIP8L2) is a newly discovered negative immune regulator. Studies have shown that TIPE2 causes significant malignant biological effects and is differentially expressed in various malignant tumors. However, the expression and roles of TIPE2 in pancreatic ductal adenocarcinoma (PDAC) are largely unknown.Materials and Methods: The expression of TIPE2 in PDAC tissues was assessed by immunohistochemistry, qPCR and western blot analysis and related clinicopathological parameters including survival time were analyzed. After overexpression of TIPE2, cell proliferation and apoptosis analysis were conducted, and the associated underlying molecular mechanism was also explored.Results: In the present study, TIPE2 was upregulated in early PDAC tissues, and TIPE2 expression decreased as the tumor progressed (P<0.001). TIPE2 expression was negatively associated with tumor size, TNM stage and metastasis of lymph nodes. Furthermore, as an independent risk factor, TIPE2 could be used to predict the survival of patients with PDAC (P=0.035). TIPE2 overexpression significantly suppressed the viability, proliferation and induced apoptosis of PDAC cells by inhibiting survivin and increasing the activity of caspase3/7.Conclusions: For the first time, this study demonstrated that TIPE2 is an independent prognostic factor in PDAC. TIPE2 inhibited the proliferation and induced apoptosis via regulating survivin/caspase3/7 signaling pathway. These results indicated that TIPE2 is a potential biomarker for predicting the prognosis of PDAC patients and plays a pivotal role in the progression of PDAC.

The Prognostic Role of Β-Catenin Subcellular Localization in Hepatocellular Carcinoma of Egyptian Patients

Background: Hepatocellular carcinoma (HCC) is one of the most common cancers in Egypt with fatal outcome. The molecular pathogenesis of this type of cancer is so complex involving interaction of several signaling pathways. Among those is Wingless (WNT)/β-catenin signaling pathway, which is frequently activated in HCC. Objectives: To investigate the relationship of different localization patterns of β-catenin in relation to different histopathologic parameters in Egyptian HCC cases. Patients and methods: One hundred and twenty-one (121) HCC specimens were subjected for β-catenin evaluation by immunohistochemistry. Results: The studied HCC cases showed β-catenin membranous expression in 47/121 (38.8%) of cases, while nucleocytoplasmic localization was observed in 31/121 (25.6%). Most of HCC cases that showed single tumor mass presentation exhibited negative nucleocytoplasmic expression pattern (79.2%, P=0.02). Membranous pool of β-catenin was associated with adverse prognostic factors like increased positivity among high-grade cases (P=0.04), higher H score value in cases having lymphovascular invasion, positive lymph node and higher (advanced) TMN stages (P = 0.01, 0.00, 0.00 &0.03 respectively). Conclusion: HCC cases showed heterogeneous β-catenin expression pattern. Membranous β-catenin localization was associated with aggressive prognostic parameters of HCC.

Evaluation of ERG Expression in Prostate Adenocarcinoma and Its Prognostic Impact in Patients Survival Rate.

Background & Objective:Some certain markers, including prostatic specific antigen (PSA), are being used to screen prostate cancer (PC), but none of them have sufficient sensitivity and specificity for evaluation of prognosis. Currently, genetic variants have found their place in the prognosis of PC. ETS-related gene (ERG) expression and its intensity have contradictory evidence regarding ERG expression with PC incidence or associating outcome. Our purpose was to survey the relationship of ERG expression and its intensity with PC and relative clinical outcome.Methods:We studied the immunohistochemichal (IHC) expression of ERG in 101 radical prostatectomy specimens with PC of different histologic grades. All samples were chosen from pathology department of Sina hospital in Tehran-Iran from 2011 to 2018. Positive ERG expression and its association with Gleason score, preoperative PSA, metastasis status, stage and grade of tumors was evaluated.Results:In total, ERG expression was observed in 42 cases (41.58%) and of these, 7 (16.66%) were categorized as weak, 13 (30.95%) moderate and 22(52.38%) as strong. There was no significant correlation between ERG expression and age, preoperative PSA, Gleason score, lymph node involvement, metastatic pattern, stage, and grade of the tumor (P>0.05). ERG expression frequency in the two groups of survived and expired patients was 42.85% and 0%, respectively; despite the noticeable difference, it was not statistically significance (P=0.264). Conclusion:Evaluation of ERG expression and its intensity may have no essential role as an acceptable prognostic factor in Iranian’s population for anticipating whether PC itself or the outcomes accompanied. This relation is vigorously under the influence of geographical/ethnical features.

Polymeric immunoglobulin receptor (PIGR) exerts oncogenic functions via activating ribosome pathway in hepatocellular carcinoma.

Objective: This report aimed to investigate the potential mechanism of polymeric immunoglobulin receptor (PIGR) in promoting cancer development in hepatocellular carcinoma (HCC).Methods: PIGR expression was investigated in Gene Expression Omnibus (GEO), Oncomine, The Cancer Genome Atlas (TCGA) and The Human Protein Atlas (HPA) databases. Relationships between PIGR and HCC survival and clinico-pathological features were conducted in TCGA. RNAseq of PIGR overexpression and knockdown samples in Bel-7404 cells were performed for identifying potential mechanisms.Results: PIGR was significantly overexpressed in tumors compared to nontumors and in HCC serum peripheral blood mononuclear cells (PBMC) than in healthy individuals (all p < 0.05). In TCGA, PIGR was highly altered in 14% HCC patients. PIGR upregulation was significantly associated with poor disease-free survival (p < 0.05). More patients recurred/progressed in PIGR altered group compared to unaltered group (p < 0.01). PIGR was significantly higher in HCC patients with incomplete cirrhosis (p < 0.001) and established cirrhosis (p < 0.05). Fewer patients had N0 lymph node stage in PIGR altered group than those in the unaltered group (p < 0.05). PIGR RNAseq revealed that ribosome signaling was the common pathway in PIGR overexpression and PIGR knockdown samples. RNAseq analysis indicated that RPL10, RPL10A, RPL12, RPL19, RPL36, RPL38, RPL41, RPL6, RPL8, RPS12, RPS14, RPS15A, RPS2, RPS27A and RPSA were significantly upregulated in PIGR overexpression group and downregulated in PIGR underexpression group (all p < 0.05).Conclusions: Aberrant PIGR was associated with HCC recurrence, and PIGR stimulated ribosome pathway might be a potential mechanism.

Relevance of CD4+ and CD8+ tumor-infiltrating lymphocytes and Foxp3 as prognostic factors in papillary thyroid carcinoma

Background There is increasing evidence supporting the prognostic significance of tumor-infiltrating lymphocytes as CD4, CD8, and forkhead box P3 (Foxp3)-expressing regulatory T cells in different cancers, however, their significance in thyroid cancer remains uncertain. Aims We investigated the expression of CD4, CD8, and Foxp3 in papillary thyroid carcinoma (PTC) and assessed its prognostic implications. Study design It is a retrospective study carried out on 43 PTC cases that were retrieved from archives of pathology lab of Oncology Center, Mansoura University, Egypt. Materials and methods Immunostaining for CD4, CD8, and Foxp3 was done. Results We found that CD4/CD8 expression was significantly higher among patients with higher lymph-node stage and more extranodal extension (P=0.038 and 0.043, respectively). Disease-free survival was found to be shorter among patients with high CD4/CD8 ratio compared with patients with low ratio (P=0.014). As regards Foxp3, there was a difference in its expression between neoplastic and nonneoplastic tissues. Both disease-free survival and overall survival were found to be shorter among patients with positive Foxp3 in tumor and tumor-infiltrating lymphocytes compared with patients with negative Foxp3 in both. Conclusions CD4/CD8 ratio and Foxp3 could be used as predictive markers and as a target therapy for PTC.

Evaluation of clinicopathological parameters and its relation with immunohistochemical expressions in breast carcinoma: A hospital based cross-sectional observational study

Introduction: Knowhow of HER-2/neu proto-oncogene amplification and/or over expression and presence of hormone (estrogen and progesterone) receptors in tumour tissue is one of the most crucial checkpoints in the therapy of breast cancer. The present study aimed to evaluate various clinicopathological parameters in the mastectomy specimens and to probe for any relation with its immunohistochemical expressions. Materials and Methods: Detailed clinical examination of the breast and the lump was done and presence of any axillary or cervical lymph nodes was also noted. After clinical examination, tumour size from the mastectomy specimen was recorded; number of lymph nodes was noted. The modified radical mastectomy samples after surgical removal, were fixed in formalin and sent for histopathological examination where tissue processing and staining with haematoxylin & eosin was done. Post mastectomy grading of the malignant breast lesion was done. Immunostaining of the HER-2 protein, Estrogen receptors (ER) & Progesterone receptors (PR) was performed for all specimens. Results: The present study showed a significant inverse association between ER and PR expression and higher tumour grades, axillary lymph node metastases and stage. HER-2/neu overexpression is significantly associated with clinicopathlogical parameters like younger age group, increased tumour size, higher tumour grades, and higher clinical staging. Significant association was seen between tumour size and lymph node metastases implying that lymph node metastasis increases with larger tumour size. Keywords: Breast Carcinoma, HER2/Neu receptor, Estrogen Receptor, Progesterone Receptor.

Completion of radical hysterectomy does not improve survival of patients with cervical cancer and intraoperatively detected lymph node involvement: ABRAX international retrospective cohort study.

The management of cervical cancer patients with intraoperative detection of lymph node involvement remains controversial. Since all these patients are referred for (chemo)radiation after the surgery, the key decision is whether radical hysterectomy should be completed as originally planned, taking into account an additional morbidity associated with extensive surgical dissection prior to adjuvant treatment. The ABRAX study investigated whether completing a radical uterine procedure is associated with an improved oncological outcome of such patients. We performed retrospective analyses of 515 cervical cancer patients (51 institutions, 19 countries) who were referred for primary curative surgery between 2005 and 2015 (stage IA-IIB, common tumour types) in whom lymph node involvement was detected intraoperatively. Patients were stratified according to whether the planned uterine surgery was completed (COMPL group, N=361) or abandoned (ABAND group, N=154) to compare progression-free survival. Definitive chemoradiation was given to 92.9% patients in the ABAND group and adjuvant (chemo)radiation or chemotherapy to 91.4% of patients in the COMPL group. The risks of recurrence (hazard ratio [HR] 1.154, 95% confidence intervals [CI] 0.799-1.666, P=0.45), pelvic recurrence (HR 0.836, 95% CI 0.458-1.523, P=0.56), or death (HR 1.064, 95% CI 0.690-1.641, P=0.78) were not significantly different between the two groups. No subgroup showed a survival benefit from completing radical hysterectomy. Disease-free survival reached 74% (381/515), with a median follow-up of 58 months. Prognostic factors were balanced between the two groups. FIGO stage and number of pelvic lymph nodes involved were significant prognostic factors in the whole study cohort. We showed that the completion of radical hysterectomy does not improve survival in patients with intraoperatively detected lymph node involvement, regardless of tumour size or histological type. If lymph node involvement is confirmed intraoperatively, abandoning uterine radical procedure should be considered, and the patient should be referred for definitive chemoradiation. NCT04037124.

CD8+ T-cell lymphocytes infiltration predict clinical outcomes in Wilms' tumor.

The abundance and location of CD8+ tumor-infiltrating lymphocytes demonstrate important facets of the anticancer immune response. CD8-expressing lymphocytes have been used in immunotherapy for multiple cancers. This study aims to determine the association between the abundance and localization of CD8+ tumor-infiltrating lymphocytes and clinical outcomes of Wilms' tumor. This retrospective study employed 42 pediatric patients diagnosed with Wilms' tumor. CD8+ tumor-infiltrating lymphocyte counts were calculated based on the mean percentage of stroma occupied by CD8+ lymphocytes at the center and the invasive border of the tumor using immunohistochemistry. CD8+ tumor-infiltrating lymphocyte counts were significantly higher in the center and the invasive border of the early-stage tumor samples. CD8+ tumor-infiltrating lymphocytes in the invasive border and tumor center positively correlated with tumor invasion, regional lymph node invasion, histological type, metastasis, and stage of the tumor. A high CD8+ tumor-infiltrating lymphocyte scores at the invasive margin of the tumor correlated with low tumor recurrence. Low CD8+ tumor-infiltrating lymphocyte scores in the two tumor regions correlated with poor prognosis and shorter disease-free survival. Overall, these findings show that patients with high CD8+ tumor-infiltrating lymphocytes are associated with better clinical outcomes. Therefore, measuring the abundance of CD8+ tumor-infiltrating lymphocytes may be useful in predicting response to cancer immunotherapies.

THE EXPRESSION OF HER-2 AND GALECTIN-3 IN COLORECTAL ADENOCARCINOMA AND THEIR RELATIONSHIP WITH CLINICOPATHOLOGICAL PARAMETERS

Colorectal carcinoma (CRC) is the third most common cancer among worldwide. Data from WHO GLOBOCAN in 2018 show there were 1.8 million cases of CRC in the world, with mortality rates 861,000. Histopathology of tumor show 90% of CRC is adenocarcinoma and predominantly in men. Some proteins that are thought to play a role in tumor development are HER2 and Galectin-3. Correlation between expression of Human Epidermal Growth Factor Receptor 2 (HER2) and Galectin-3 with clinicopathology aspect are expected to help determine treatment options. The aim of this study was to investigate the correlation between expression levels of HER-2 and Galectin-3 in vary clinicopathological aspect of colorectal adenocarcinoma. Cross sectional study was conducted in 40 samples of colorectal adenocarcinoma in dr. Kariadi Central General Hospital from 1st January 2018 until 31st December 2018. Samples were analyzed regarding the expression of HER2 and Galectin-3 by immunohistochemical staining of paraffin-embedded material. Coexpression of HER-2, Galectin-3 and the clinicopathological parameters (gender, age, location, depth of invasion, lymph nodes metastase, distant metastase and stage) were analyzed using Chi square test and Spearmans correlation test. Positive HER-2 expression was found on 5% of samples, while strong expresion of Galectin-3 was found on 12.5% of samples. There was no significant correlation between HER-2 and Galectin-3 expression and clinicopathology aspect.

The Prognostic Value of 18F-Fluorodeoxyglucose PET/CT in the Initial Assessment of Primary Tracheal Malignant Tumor: A Retrospective Study.

ObjectiveTo investigate the potential value of 18F-fluorodeoxyglucose (FDG) PET/CT in predicting the survival of patients with primary tracheal malignant tumors.Materials and MethodsAn analysis of FDG PET/CT findings in 37 primary tracheal malignant tumor patients with a median follow-up period of 43.2 months (range, 10.8–143.2 months) was performed. Cox proportional hazards regression analyses were used to assess the associations between quantitative 18F-FDG PET/CT parameters, other clinic-pathological factors, and overall survival (OS). A risk prognosis model was established according to the independent prognostic factors identified on multivariate analysis. A survival curve determined by the Kaplan-Meier method was used to assess whether the prognosis prediction model could effectively stratify patients with different risks factors.ResultsThe median survival time of the 37 patients with tracheal tumors was 38.0 months, with a 95% confidence interval of 10.8 to 65.2 months. The 3-year, 5-year and 10-year survival rate were 54.1%, 43.2%, and 16.2%, respectively. The metabolic tumor volume (MTV), total lesion glycolysis (TLG), maximum standardized uptake value, age, pathological type, extension categories, and lymph node stage were included in multivariate analyses. Multivariate analysis showed MTV (p = 0.011), TLG (p = 0.020), pathological type (p = 0.037), and extension categories (p = 0.038) were independent prognostic factors for OS. Additionally, assessment of the survival curve using the Kaplan-Meier method showed that our prognosis prediction model can effectively stratify patients with different risks factors (p < 0.001).ConclusionThis study shows that 18F-FDG PET/CT can predict the survival of patients with primary tracheal malignant tumors. Patients with an MTV > 5.19, a TLG > 16.94 on PET/CT scans, squamous cell carcinoma, and non-E1 were more likely to have a reduced OS.