Node Involvement Research Articles

Locally Advanced Cervical Cancer in a Patient with Epidermolysis Bullosa Treated with Concurrent Chemoradiotherapy and Electronic Brachytherapy

Purpose: The purpose of this report is to investigate the feasibility of combined modality treatment in a case of locally advanced cervical cancer in a patient with inherited epidermolysis bullosa as well as to suggest a protocol for cervical electronic brachytherapy. Materials and Methods: The patient was treated with image-guided external beam radiotherapy and concomitant chemotherapy to a dose of 45 Gy in 25 fractions with a simultaneously integrated boost of 55 Gy in involved lymph nodes. The maximal skin dose was 34.09 Gy. Intracavitary electronic brachytherapy was applied to the uterine cervix in 4 fractions of 7 Gy and contributed no dose to the skin. Results: The treatment was tolerated well with no early toxicity. During the 3-month period of follow-up, no adverse events of grade 2 or higher were detected, and no exacerbation of skin lesions was noted. Conclusions: This is the first report of treatment of cervical cancer in a patient with inherited epidermolysis bullosa where combined concurrent chemoradiotherapy and intracavitary electronic brachytherapy demonstrated feasibility and safety. The followed institutional protocol for treatment planning and delivery ensured low doses to organs and risk and reproducibility.

Aggressive characteristics of tumor deposits in colorectal cancer highlight the need for staging refinement in patients with 0-3 metastatic lymph nodes.

Accurate staging is essential for the optimal management of patients with colorectal cancer (CRC). The role of tumor deposits (TDs) in CRC staging has been contentious due to a lack of comprehensive understanding of their clinical and biological traits. In this retrospective study, we analyzed large data from 5718 CRC patients diagnosed between 2011 and 2022, ensuring rigorous data collection and long-term follow-up. Patients with positive TDs displayed aggressive clinical features. The risk factors for TDs varied among patients with different backgrounds of lymph node (LN) involvement, and the numbers of TDs and metastatic LNs showed a significantly positive correlation. TDs significantly impacted CRC prognosis, resulting in unfavorable outcomes irrespective of LN status. To delve into the biological characteristics of TDs, we performed transcriptome sequencing, immunohistochemistry, and Kaplan-Meier analyses on tissue samples from the additional CRC cohort and The Cancer Genome Atlas datasets. TDs exhibited aggressive biological phenotypes that were distinct from primary tumors and metastatic LNs, characterized by elevated signatures of epithelial-mesenchymal transition, angiogenesis, and immune suppression. Cox proportional hazards analysis was then applied to reassess the appropriate role of TDs within the TNM staging system, revealing that the prognostic weightiness of TDs in CRC corresponded to N2a rather than N1 in patients with 0-3 LN metastases. Overall, our comprehensive analysis showed that TDs, with their aggressive clinical and biological characteristics, could optimize the staging of CRC, highlighting the need to refine their role within the TNM staging system.

The Single-Cell Landscape of Peripheral and Tumor-infiltrating Immune Cells in HPV- HNSCC.

Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer worldwide. HPV-negative HNSCC, which arises in the upper airway mucosa, is particularly aggressive, with nearly half of patients succumbing to the disease within five years and limited response to immune checkpoint inhibitors compared to other cancers. There is a need to further explore the complex immune landscape in HPV-negative HNSCC to identify potential therapeutic targets. Here, we integrated two single-cell RNA sequencing datasets from 29 samples and nearly 300,000 immune cells to investigate immune cell dynamics across tumor progression and lymph node metastasis. Notable shifts toward adaptative immune cell populations were observed in the 14 distinct HNSCC-associated peripheral blood mononuclear (PBMCs) and 21 tumor-infiltrating immune cells (TICs) considering disease stages. All PBMCs and TICs revealed unique molecular signatures correlating with lymph node involvement; however, broadly, TICs increased ligand expression among effector cytokines, growth factors, and interferon-related genes. Pathway analysis comparing PBMCs and TICs further confirmed active cell signaling among Monocyte-Macrophage, Dendritic cell, Natural Killer (NK), and T cell populations. Receptor-ligand analysis revealed significant communication patterns shifts among TICs, between CD8+ T cells and NK cells, showing heightened immunosuppressive signaling that correlated with disease progression. In locally invasive HPV-negative HNSCC samples, highly multiplexed immunofluorescence assays highlighted peri-tumoral clustering of exhausted CD8+ T and NK cells, alongside their exclusion from intra-tumoral niches. These findings emphasize cytotoxic immune cells as valuable biomarkers and therapeutic targets, shedding light on the mechanisms by which the HNSCC sustainably evades immune responses.

Adjuvant Systemic Immunotherapies for Resected Stage III Melanoma: A Single-Centre Retrospective Clinical Practice Review.

Melanoma poses significant challenges due to its resistance to conventional therapies and increasing incidence rates. Stage III melanoma, characterised by regional lymph node involvement, has a high risk of recurrence despite surgical resection. Adjuvant immunotherapy, particularly using the PD-1 inhibitors pembrolizumab and nivolumab, has shown promising results in improving recurrence-free survival (RFS) and overall survival (OS) in Stage III melanoma patients. This retrospective analysis examined the effects of adjuvant pembrolizumab or nivolumab on patients with Stage III melanoma treated in a tertiary oncology centre. Of the 110 patients, 95 received pembrolizumab and 15 received nivolumab. The pembrolizumab completion rate was 62.1%, with 31.2% discontinuing due to disease progression or adverse effects. The nivolumab completion rate was lower at 40%, with 60% discontinuing due to toxicity or disease progression. Grade 3 or higher toxicities were observed in 17% of pembrolizumab and 53.3% of nivolumab patients. Disease progression occurred in 27.4% of pembrolizumab and 26.7% of nivolumab patients. Pembrolizumab showed a 12-month RFS of 78.9% and 24-month RFS of 77.6%, with an OS of 97.9% at 12 months. Nivolumab exhibited a 12-month RFS of 86.7% and 24-month RFS of 80%. RFS rates varied by disease stage and mutation status. Adjuvant pembrolizumab and nivolumab both demonstrate efficacy in improving RFS and OS in Stage III melanoma patients. Pembrolizumab has higher completion rates and fewer toxicities compared to nivolumab. Further studies are warranted to explore long-term outcomes and optimise treatment strategies.

The Application of Three-dimensional Shear Wave Elastography in the Detection of Inguinal Lymph Node Metastasis in Gynecological Malignancies

Background: Accurate assessment of lymph node involvement is essential for prognosis and guiding treatment decisions in gynecological cancers, as it directly influences therapeutic strategies and patient outcomes. However, conventional imaging techniques, such as ultrasound and computed tomography (CT), demonstrate limited accuracy in determining the nature of lymph nodes. This study implements three-dimensional shear wave elastography (3D-SWE), an innovative technique that quantifies the stiffness of inguinal lymph nodes (ILN) in patients with gynecological cancers. This approach offers a more comprehensive assessment of ultrasound elastography compared to traditional methods. Methods: This retrospective study evaluated 120 ILNs from patients with gynecological cancers who underwent conventional ultrasound (US), two-dimensional shear wave elastography (2D-SWE), and multiplanar 3D-SWE. The diagnostic performance was analyzed using receiver operating characteristic (ROC) methodology, enabling a comprehensive comparison of the sensitivity and specificity of 3D-SWE relative to conventional ultrasound and 2D-SWE. Pathology results from lymph node resections or biopsies served as the reference standard. Results: Final pathology confirmed 65 metastatic and 55 benign lymph nodes. The maximum (Emax) and average (Emean) elasticity values from 2D-SWE and 3D-SWE for malignant lymph nodes were significantly higher than those for benign lymph nodes (p < 0.0001). ROC analysis indicated that for identifying metastatic lymph nodes, the area under the curve (AUC) values were 0.798 for 2D-SWE Emax, and 0.828, 0.839, and 0.816 for the transverse, sagittal, and coronal planes of 3D-SWE Emax, respectively. The differences between these AUC values were not statistically significant (p > 0.05). Furthermore, Emax values consistently surpassed Emean values in terms of characterization accuracy across modalities. Although no significant differences were observed between 2D-SWE and 3D-SWE, the sagittal view Emax yielded the best AUC, indicating optimal diagnostic precision overall. Conclusions: 3D-SWE, particularly using the sagittal Emax parameter, effectively distinguishes benign lymph nodes from metastatic ones by quantitatively evaluating the stiffness of ILNs in relation to gynecological tumors. Serving as a dependable diagnostic method for lymph nodes, 3D-SWE may help reduce the necessity for invasive biopsy procedures in some cases.

MicroRNA-130b Is a Unique Autophagy-Related Epigenetic Predictor of FLOT-Chemotherapy in Gastric Cancers.

Liquid biopsies have great potential for precision medicine as they provide information about primary and metastatic tumors using minimally invasive techniques. MicroRNAs (miRNAs) are promising biomarkers for detecting gastric cancer (GC). The aim of the study was to identify miR molecules associated with autophagy in gastric cancer (GC) cells, determine their expression levels in GC and FLOT-treated patients, and assess the efficacy of FLOT therapy in GC patients. Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) pathways were used to analyze cellular pathways. MicroRNAs were isolated from the tissues. The study found a connection between the expression of the let-7a-5p gene and the size of primary tumors. Bioinformatics analysis identified multiple targets and signaling pathways associated with this phenomenon. We observed an increase in the levels of miR-21-3p and hsa-miR-130b-3p with lymph node involvement. miR-21-3p is associated with the activation of molecular pathways induced by H. pylori in cases of coinfection. Patients with complete regression had higher levels of expression of hsamir- 130b-3p. The bioinformatics analysis allowed us to identify the most significant targets among microRNAs. Based on the presented data, it becomes clear that GC is heterogeneous and that the process of autophagy is complex. The association between hsa-miR-130b-3p and tumor response to therapy is particularly interesting.

Dysregulation of genes involved in the long-chain fatty acid transport in pancreatic ductal adenocarcinoma.

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive lethal malignancy with limited options for treatment and a 5-year survival rate of 11% in the United States. As for other types of tumors, such as colorectal cancer, aberrant de novo lipid synthesis and reprogrammed lipid metabolism have been suggested to be associated with PDAC development and progression. To identify the possible involvement of lipid metabolism in PDAC by analyzing in tumoral and non-tumoral tissues the expression level of the most relevant genes involved in the long-chain fatty acid (FA) import into cell. A gene expression analysis of FASN, CD36, SLC27A1, SLC27A2, SLC27A3, SLC27A4, SLC27A5, ACSL1, and ACSL3 was performed by qRT-PCR in 24 tumoral PDAC tissues and 11 samples from non-tumoral pancreatic tissues obtained via fine needle aspiration or via surgical resection. The genes were considered significantly dysregulated between the groups when the p value was < 0.05 and the fold change (FC) was ≤ 0.5 and ≥ 2. We found that three FA transporters and two long-chain acyl-CoA synthetases genes were significantly upregulated in the PDAC tissue compared to the non-tumoral tissue: SLC27A2 (FC = 5.66; P = 0.033), SLC27A3 (FC = 2.68; P = 0.040), SLC27A4 (FC = 3.13; P = 0.033), ACSL1 (FC = 4.10; P < 0.001), and ACSL3 (FC = 2.67; P = 0.012). We further investigated any possible association between the levels of the analyzed mRNAs and the specific characteristics of the tumors, including the anatomic location, the lymph node involvement, and the presence of metastasis. A significant difference in the expression of SLC27A3 (FC = 3.28; P = 0.040) was found comparing patients with and without lymph nodes involvement with an overexpression of this transcript in 17 patients presenting tumoral cells in the lymph nodes. Despite the low number of patients analyzed, these preliminary results seem to be promising. Addressing lipid metabolism through a broad strategy could be a beneficial way to treat this malignancy. Future in vitro and in vivo studies on these genes may offer important insights into the mechanisms linking PDAC with the long-chain FA import pathway.

Role of neck dissections in the management of carotid body tumors.

Carotid body tumors (CBTs) are rare neoplasms of the paraganglia at the carotid bifurcation. While typically benign, CBTs occasionally exhibit malignancy, metastasizing to nearby lymph nodes. Histopathologic analysis alone is insufficient to confirm malignancy, requiring metastases to non-neuroendocrine tissue for a definitive diagnosis. The role of selective neck dissections (SNDs) in detecting malignancy and guiding subsequent management remains uncertain. A retrospective case series through electronic chart review was performed on 21 patients undergoing CBT surgeries between 2002 and 2022 at a Canadian institution. SNDs were performed on all 21 patients. Data collection included patient demographics, genetic and laboratory testing results, preoperative imaging, intraoperative and postoperative complications, histologic analysis of neck SND and tumor specimen, and follow-up results. Of the 21 surgical resections, there were three cases (14.3%) of carotid artery injuries and six cases (28.6%) of nerve injuries. One patient (4.8%) experienced three intraoperative strokes. Three patients (14.3%) were found to have lymph node involvement, confirming malignancy, and underwent further treatment with radiotherapy. Interestingly, two patients with carotid injuries had malignant tumors, demonstrating a statistical significance between carotid injury and malignancy (OR 34.00, 95% CI: 1.48, 781.83, p = .041). SNDs are a useful adjunct in detecting malignancy during CBT surgeries. The incidence of malignancy in CBT is low but not negligible, and SND should be considered in patients to prevent inadvertent underdetection of metastatic disease. This study's 14.3% incidence of malignancy suggests that there may be a rationale for considering the universal implementation of SND during CBT resections. 4.

Prognostic Factors in Therapy Regimes of Breast Cancer Patients with Brain Metastases: A Retrospective Monocentric Analysis.

Background: Breast cancer patients who develop brain metastases have a high mortality rate and a massive decrease in quality of life. Approximately 10-15% of all patients with breast cancer (BC) and 5-40% of all patients with metastatic BC develop brain metastasis (BM) during the course of the disease. However, there is only limited knowledge about prognostic factors in the treatment of patients with brain metastases in breast cancer (BMBC). Therefore, we retrospectively analyzed data of BMBC patients from the University Hospital of Würzburg for treatment patterns to find characteristics associated with a better or worse prognosis. These findings should help to treat the ever-increasing collective of patients with BMBC better in the future. Methods: The clinical data of 337 patients with cerebral metastatic breast cancer (date of death between 2004 and 2021) treated at the Department of Gynecology and Obstetrics of the University Hospital Würzburg were retrospectively analyzed, with a focus on patients' survival. Results: The involvement of regional lymph nodes at initial diagnosis, the immunohistochemical subtype of TNBC at the onset of BMBC, and extracranial metastases at the time of BM diagnosis (bone, liver, lung metastases) were associated with a worse prognosis. In contrast, the immunohistochemical subtype of HER2/neu, the sole occurrence of a singular BM, the local surgical removal of BMs, and radiotherapy (especially stereotactic radiotherapy) were associated with prolonged survival. The number of therapies before the diagnosis of BMs also had a prognostic influence. Conclusions: Looking back at data is crucial for pinpointing risk elements affecting survival after a BM diagnosis. In our investigation, along with established factors like immunohistologic subtype, BM count, surgical excision, stereotactic irradiation, and type of extracranial metastasis, we also found that the number of therapies before BM diagnosis and the initial lymph node status were associated with patients' survival. Potentially, these factors could be included in prospective prognostic scores for evaluating brain metastasis survival rates, thereby aiding in making appropriate treatment suggestions for impacted patients.

Clinical and imaging features of co-existent pulmonary tuberculosis and lung cancer: a population-based matching study in China

BackgroundCo-existent pulmonary tuberculosis and lung cancer (PTB-LC) represent a unique disease entity often characterized by missed or delayed diagnosis. This study aimed to investigate the clinical and radiological features of patients diagnosed with PTB-LC.MethodsPatients diagnosed with active PTB-LC (APTB-LC), inactive PTB-LC (IAPTB), and LC alone without PTB between 2010 and 2022 at our institute were retrospectively collected and 1:1:1 matched based on gender, age, and time of admission. Symptoms and clinicopathological features were compared among the three groups of patients. Logistic regression was employed for risk factor analysis.ResultsCompared to LC or IAPTB-LC, patients with APTB-LC exhibited higher proportions of weight loss (p < 0.001) and fever (p < 0.001) at the time of diagnosis. Additionally, radiological features such as nodules (p = 0.007), tree-in-bud (p < 0.001), cavitation (p < 0.001), and calcification (p < 0.001) were significantly more prevalent in APTB-LC patients compared to the other groups. Patients with APTB-LC were more susceptible to lymph node involvement (p < 0.001) and distant metastasis (p = 0.006) compared to those with IAPTB-LC or LC alone. Additionally, in comparison to LC alone, patients with IAPTB-LC exhibited more complex symptoms, imaging features, and lymph node metastases. Logistic regression results indicated that factors such as BMI, fever, patchy shadow, cavitation, neck or supraclavicular lymph node metastasis, and liver injury favor the diagnosis of APTB-LC over LC alone. The pre-diagnostic model exhibited robust performance, achieving area under the curve (AUC) values of 0.864 in the training set and 0.830 in the test set.ConclusionOur results indicate that PTB-LC is a distinct disease characterized by complex clinicopathological features and a more aggressive nature. Based on our findings, we recommend conducting TB-related tests for LC patients who exhibit relevant risk factors or are identified as high-risk cases according to the pre-diagnostic model.

Current insights on PSMA PET/CT in intermediate-risk prostate cancer: a literature review.

The purpose of this systematic review was to evaluate the role of PSMA PET/CT in intermediate-risk prostate cancer (PCa) patients, to determine whether it could help improve treatment strategy and prognostic stratification. A systematic literature search up to May 2024 was conducted in the PubMed, Embase and Scopus databases. Articles with mixed risk patient populations, review articles, editorials, letters, comments, or case reports were excluded. The quality of the papers was assessed by using the CASP criteria. The literature search returned 1111 studies; however, 1105 articles were excluded, and therefore 6 full-text papers were retrieved for the final analysis. Three out of six papers focused on the utility of SUVmax in identifying high ISUP grade in patients with intermediate-risk PCa. The latest three papers discussed the controversial role of PSMA PET/CT in predicting the lymph node involvement, mainly in the case of favorable subset. PSMA PET has completely changed the management of patients with PCa; indeed its role is still undefined in patients with intermediate-risk disease. Future perspective is to investigate larger cohorts of intermediate-risk PCa patients, to fully recognize the added value offered by PSMA PET in this category of subjects.

PET/CT-based target volume definition in involved-site radiotherapy for treatment of early-stage nodal follicular lymphoma.

Recent advancements in imaging, particularly 18F-fluorodeoxyglucose positron-emission tomography-computed tomography (FDG-PET/CT), have improved the detection of involved lymph nodes, thus influencing staging accuracy and potentially treatment outcomes. This study is apost hoc analysis of the GAZAI trial data to evaluate the impact of FDG-PET/CT versus computed tomography (CT) alone on radiation target volumes for involved-site radiotherapy (IS-RT) in early-stage follicular lymphoma (FL). All patients in the GAZAI trial underwent pretherapeutic FDG-PET/CT examinations, which were subject to central quality control. Lymph nodes with pathological metabolism were assessed for CT morphology. Differential regional involvement and the impact on radiation target volume for IS-RT were compared between PET/CT-based to solely CT-based staging. In 54patients with PET-positive lymph nodes after initial surgery, 170 involved lymph nodes were identified in total. FDG-PET/CT identified additionally involved lymph nodes not detected by CT in 61% of the patients, leading to asignificant change in radiation treatment fields for 30% of the cohort. Only 58% of all involved lymph nodes exhibited pathological CT morphology. The findings were robust across different Deauville score thresholds and CT morphological metrics. The findings confirm the essential role of FDG-PET/CT in accurately defining the radiation volume for treatment of early-stage follicular lymphomas with radiotherapy. These results support the integration of FDG-PET/CT into the standard diagnostic pathway and its inclusion in the service catalogue of statutory health insurance, emphasizing its importance for optimal treatment planning and the potential impact on patient outcomes.

Clinical characteristics of lymphoma patients presenting with fever of unknown origin misdiagnosed with connective tissue diseases.

Recognizing and diagnosing lymphoma in patients with fever of unknown origin (FUO) can be challenging, and misdiagnosis is not uncommon. To improve understanding of the clinical characteristics of lymphoma patients presenting with FUO who were misdiagnosed with autoimmune diseases. A retrospective, observational study of 140 consecutive patients with FUO and lymphoma presenting to a tertiary center between January 2017 and December 2023. Patients were divided into those who were correctly diagnosed and those misdiagnosed as connective tissue diseases (CTD) and the clinical features compared. Of 140 lymphoma patients with FUO, 21 patients (15.0%) were misdiagnosed as CTD. The median time between symptom onset and diagnosis was significantly longer in the misdiagnosed group than in the non-misdiagnosed group (11.0 (IQR 6.0, 22.5) months vs. 4.0 (2.5, 9.0) months; p = 0.001). The misdiagnosed group had significantly less lymph node and bone marrow involvement and more skin rashes than the non-misdiagnosed group (47.6% vs. 70.6%, p = 0.039; 23.8% vs. 47.9%, p = 0.040; 47.6% vs. 25.2%, p = 0.036), as well as significantly lower ESR (p = 0.026) and hsCRP (p = 0.049). The misdiagnosed group had higher frequency of ANA/ANCA (57.1% vs. 27.7%; p = 0.008) and anti-phospholipid antibody (42.9% vs. 6.1%; p = 0.008) positivity. The distribution of lymphoma subtypes was different between groups (p = 0.058). Lymphoma patients with an atypical presentation and FUO suggesting inflammatory systemic disease are easily misdiagnosed. Autoantibody positivity is not rare in lymphoma patients with an atypical presentation and FUO, so close follow-up and repeated histopathological examination may be helpful to establishing a correct diagnosis.

Prognostic and Predictive Values of F-18 FDG PET/CT Volumetric Parameters in Small Cell Lung Cancer

Introduction: Volumetric parameters of the 18F-FDG PET/CT can contribute to the treatment decision in high risk patients. In the present study, we aimed to examine the predictive, prognostic, and clinical value of PET/CT by using the two volumetric parameters: metabolic tumor volume (MTV) and total lesion glycolysis (TLG), SUVmax to concurrently evaluate survival data in patients diagnosed with small cell lung cancer (SCLC). Methods: 244 patients with SCLC, who underwent 18F-FDG PET/CT imaging for staging purpose were enrolled. Primary tumor SUVmax, MTV (40-70%) and TLG (40-70%) obtained from PET/CT were documented. Results: All lesions (n=244) showed 18F-FDG uptake, mean SUVmax of 19.74±8.71 [range (min – max) = 3.80 - 58.80]. SUVmax was significantly higher in tumors with diameters &gt; 2 cm compared to those with diameters ≤ 2 cm (p=0.000). The mean survival time was significantly shorter in patients with tumor diameter greater than 2 cm, locoregional LN involvement, distant nodal metastasis, or distant organ metastasis (p=0.019, p

High-risk habitat radiomics model based on ultrasound images for predicting lateral neck lymph node metastasis in differentiated thyroid cancer

BackgroundThis study aims to evaluate the predictive usefulness of a habitat radiomics model based on ultrasound images for anticipating lateral neck lymph node metastasis (LLNM) in differentiated thyroid cancer (DTC), and for pinpointing high-risk habitat regions and significant radiomics traits.MethodsA group of 214 patients diagnosed with differentiated thyroid carcinoma (DTC) between August 2021 and August 2023 were included, consisting of 107 patients with confirmed postoperative lateral lymph node metastasis (LLNM) and 107 patients without metastasis or lateral cervical lymph node involvement. An additional cohort of 43 patients was recruited to serve as an independent external testing group for this study. Patients were randomly divided into training and internal testing group at an 8:2 ratio. Region of interest (ROI) was manually outlined, and habitat analysis subregions were defined using the K-means method. The ideal number of subregions (n = 5) was determined using the Calinski-Harabasz score, leading to the creation of a habitat radiomics model with 5 subregions and the identification of the high-risk habitat model. Area under the curve (AUC) values were calculated for all models to assess their validity, and predictive model nomograms were created by integrating clinical features. The internal and external testing dataset is employed to assess the predictive performance and stability of the model.ResultsIn internal testing group, Habitat 3 was identified as the high-risk habitat model in the study, showing the best diagnostic efficacy among all models (AUC(CRM) vs. AUC(Habitat 3) vs. AUC(CRM + Habitat 3) = 0.84(95%CI:0.71–0.97) vs. 0.90(95%CI:0.80-1.00) vs. 0.79(95%CI:0.65–0.93)). Moreover, integrating the Habitat 3 model with clinical features and constructing nomograms enhanced the predictive capability of the combined model (AUC = 0.95(95%CI:0.88-1.00)). In this study, an independent external testing cohort was utilized to assess the model’s accuracy, yielding an AUC of 0.88 (95%CI: 0.78–0.98).ConclusionThe integration of the High-Risk Habitats (Habitat 3) radiomics model with clinical characteristics demonstrated a high predictive accuracy in identifying LLNM. This model has the potential to offer valuable guidance to surgeons in deciding the necessity of LLNM dissection for DTC.Clinical trial numberNot applicable.

Clinical Characteristics and Outcomes of Pediatric Systemic Anaplastic Large Cell Lymphoma.

Anaplastic large cell lymphomas (ALCLs) present unique challenges due to their clinical and genetic heterogeneity. This study investigated the clinical characteristics of children diagnosed with systemic ALCL. Retrospective data from 14 pediatric patients diagnosed with systemic ALCL at Valme University Hospital were studied. Demographic, clinical, and treatment data were collected and statistically analyzed. The mean age at diagnosis was 8.5 years, with a male predominance (78.6%). Cutaneous presentation occurred in 35.7% of cases, with characteristic rapidly growing subcutaneous nodules. B symptoms were present in 57.1% of patients, while 100% exhibited nodal involvement. Visceral and bone marrow involvement was observed in 71.4% and 7.1% of patients, respectively. Central nervous system (CNS) involvement was absent. Anaplastic lymphoma kinase (ALK) rearrangement was positive in all cases. Anthracycline-based chemotherapy resulted in 100% 5- and 10-year overall survival rates. Systemic ALCL in children often presents with advanced-stage disease, with cutaneous involvement in a significant proportion of cases. Prompt recognition of skin lesions is vital to expedite diagnosis and treatment initiation, ultimately improving patient outcomes. This study underscores the importance of vigilance and early intervention in managing pediatric ALCL.

Evidence for the extent and oncological benefits of lymphadenectomy in colon and rectal cancer : Anarrative review based on meta-analyses

Lymphadenectomy for rectal cancer is clearly defined by total mesorectal excision (TME). The analogous surgical strategy for the colon, the complete mesocolic excision (CME), follows the same principles of dissection in embryologically predefined planes. This narrative review initially identified key issues related to lymphadenectomy of rectal and colon cancer. The subsequent search was based on PubMed and focused on meta-analyses. The endpoints for rectal cancer were the benefit of high tie versus low tie and the indications for lateral pelvic lymphadenectomy. For colon cancer the evidence for CME, for the longitudinal extent of resection, for the dissection of infrapyloric and gastroepiploic lymph nodes, for the number of lymph nodes and for the sentinel lymph node technique were used as endpoints. An oncological benefit of the high tie cannot be derived from the current data. Lateral pelvic lymphadenectomy should only be selectively performed after chemoradiotherapy (CRT) in cases of remaining lymph nodes with suspected metastases. In most studies CME proved to be oncologically superior, especially in stageIII. The longitudinal extent of resection should be at least 10 cm in both directions if the principles of CME are observed. Infrapyloric and gastroepiploic lymph node involvement is to be expected in 0.7-22% of cases, depending on patient selection, which justifies dissection, particularly in carcinomas of both flexure and the transverse colon. The minimum number of lymph nodes to be removed cannot be clearly derived from the available studies. Precisely performed CME and an optimal pathological work-up are important. The sentinel lymph node technique cannot currently be used as acriterion for limiting the extent of resection. Both TME and CME are reliable standards for the lymphadenectomy in colorectal carcinomas. A lymphadenectomy that goes beyond this is reserved for selected cases and is partly the subject of currently ongoing studies.

The Necessity of Lymphadenectomy for Non-Small Cell Lung Cancer Smaller Than 6 mm in Solid Size.

This study aimed to evaluate the necessity of lymph node sampling for specific non-small cell lung cancer (NSCLC). Patients with small-size (≤2 cm) NSCLC who underwent surgical resection between 2009 and 2022 were retrospectively screened. The characteristics of patients with nodal metastasis were demonstrated. For selected patients, the perioperative and long-term outcomes with and without lymphadenectomy were compared. Of the 2713 patients enrolled in this study, 75 (2.76 %) had involvement of nodules with a minimum solid size of 6 mm. No patient with pure ground glass opacity (0/945) had nodal metastasis, whereas 14 patients with part-solid nodules (14/1260, 1.11 %) and 61 patients with solid nodules (61/508, 12.01 %) had nodal involvement. Patients who had NSCLC with solid components smaller than 6 mm (n=1588) had no nodal metastasis. Of these patients, 339 underwent sublobar resection without lymphadenectomy (SRN0), 1056 received sublobar resection with lymphadenectomy (SRN1), and 190 received lobectomy with lymphadenectomy (LRN1). The patients with SRN0 had a shorter operating time, less volume of drainage, a lower incidence of chylothorax (0 % vs 0.6 % vs. 2.1 %; P = 0.012) and air leakage, as well as a shorter postoperative hospital stay (3 vs. 4 vs. 4 days; P < 0.001) than those with SRN1 or LRN1. The 5-year recurrence-free survival was 100 % for the patients with SRN0, 99.2 % for those with SRN1, and 98.5 % for those with LRN1 (P = 0.370). Lymphadenectomy may be unnecessary for NSCLC smaller than 6 mm in solid size. Sublobar resection without lymphadenectomy had favorable effects on postoperative complications and fast recovery with no compromise of long-term outcomes.

Neoadjuvant Chemotherapy for T3 Tumors in the Era of Precision Medicine-Biology Is Still King.

Clinical T3 (cT3) breast cancer (BC) presents a challenge for achieving cosmetically acceptable breast conservation, and neoadjuvant chemotherapy (NAC) is commonly used for cytoreduction in these high-risk cancers. MammaPrint® risk-of-recurrence and BluePrint® molecular subtyping genomic signatures have demonstrated high accuracy in predicting chemotherapy benefits. Here, we examined the utility of MammaPrint/BluePrint for predicting pathological Complete Response (pCR) rates to NAC among 404 patients diagnosed with cT3 early-stage BC. The association of genomic subtype and clinical features with the likelihood of pCR was evaluated by multivariate logistic regression. Differences in pCR rates between genomic risk categories were evaluated by a two-sided proportional z-test and stratified by nodal status. MammaPrint/BluePrint subtyping was associated with significantly higher odds ratios (ORs) for pCR in MammaPrint High-Risk/BluePrint Basal-Type (OR = 3.06, 95% CI: 1.15-8.19, p = 0.025) and HER2-Type (OR = 6.27, 95% CI: 2.19-19.38, p = 0.001) compared to BluePrint Luminal-Type. Of the 209 patients with hormone receptor-positive, HER2-negative disease, 6.7% achieved pCR, and MammaPrint High-Risk was associated with a significantly higher pCR rate (9.3%) compared to MammaPrint Low-Risk cancers (0%), regardless of nodal involvement (p = 0.036). These data show that for patients with MammaPrint Low-Risk, cT3 tumors are less likely to have clinically impactful cytoreduction from NAC, regardless of nodal involvement.

Is Mandard tumor regression grade scoring sufficient for locally advanced rectal cancer?

Objective: Neoadjuvant chemotherapy (NACT) has become the standard of care for locally advanced rectal cancer. To evaluate the effectiveness of NACT, the Mandard tumor regression grade (TRG) has been widely studied. However, research has yielded mixed results regarding the correlation between TRG and lymph node involvement post-treatment, as well as its impact on overall survival (OS). This study aims to investigate the association between TRG and lymph node involvement and to explore its relationship with disease-free survival (DFS). Material and Methods: This study included 50 patients newly diagnosed with advanced rectal cancer, treated at the Ege University Medical Oncology outpatient clinic between June 2016 and June 2023. Patients were categorized into two groups based on Mandard’s classification: TRG 1+2 (good response) and TRG 3+4+5 (poor response). Since no patients achieved complete response corresponding to TRG 5, this grade was excluded from the analysis. Statistical analyses were performed using SPSS version 28.0. Results: No significant correlation was found between TRG and ypT stage. However, a significant correlation was observed between TRG and both ypN stage and overall disease stage, with TRG III-IV groups demonstrating significantly higher ypN stages and disease stages (p = 0.013). The number of lymph nodes involved was significantly greater in the TRG III-IV group. The complete response rate was significantly lower in the TRG III-IV group compared to the TRG I-II group (p = 0.011). No significant association was found between TRG and other clinical characteristics (p &gt; 0.05). Conclusion: Our findings suggest that TRG is associated with lymph node involvement, indicating that the tumor’s response to chemoradiation parallels that of lymph node metastases. However, no significant relationship was observed between TRG and ypT stage, DFS, or OS. These results highlight the need for additional prognostic components within the TRG system. While the Mandard TRG system remains convenient and reliable, further understanding of the tumor’s multilayered structure and morphology may enhance its prognostic utility.