Microscopic Lymph Node Metastases Research Articles

Intratumoral dihydropyrimidine dehydrogenase messenger RNA level reflects tumor progression in human colorectal cancer.

Determination of intratumoral dihydropyrimidine dehydrogenase (DPD) is of clinical interest because increased DPD levels can influence the tumor response to 5-fluorouracil-based chemotherapy through increased inactivation of the agent in tumor cells. DPD messenger RNA (mRNA) levels were evaluated in 80 consecutive patients undergoing surgery for primary colorectal cancer and 12 cases of liver metastasis. Higher DPD mRNA levels were associated with higher pathologic classification, corresponding to the T categories (r =.267; P =.003). The DPD mRNA level was statistically higher in tumors with microscopic lymph node metastasis than in those without (P =.002). Hence, the DPD mRNA level increased in accordance with Dukes' classification (r =.387; P =.0001). The DPD mRNA level of the liver metastasis from colorectal cancer was significantly higher than that of primary lesions (P =.002). In eight patients, the DPD mRNA level of the liver metastasis was significantly higher than that of the matched primary tumor (P =.017). Increases of the DPD mRNA level in cancerous tissue seem to reflect tumor progression. High DPD mRNA levels in liver metastasis and advanced colorectal cancer may have clinical importance for 5-fluorouracil-based chemosensitivity.

Expression of Matrix Metalloproteinase-9 and Bombesin/Gastrin-Releasing Peptide in Human Prostate Cancers and their Lymph Node Metastases

Neuroendocrine differentiation and subsequent excretion of neuropeptides have been demonstrated to be associated with progression of human prostate cancer. Among neuropeptides found to exist in the prostate, bombesin/gastrin-releasing peptide has been shown to upregulate matrix metalloproteinase-9 (MMP-9) in human prostate cancer cell lines. Expression levels of bombesin, MMP-9, and neuron-specific enolase were examined by immunohistochemistry in 41 cases of clinically organ-confined prostate cancers including 9 with microscopic lymph node metastases. Twenty-seven (64%) of the 41 radical prostatectomy specimens were positive for both MMP-9 and bombesin. Expression of these molecules was observed in almost the same population of the cancer cells. The remaining 14 cases were negative for both MMP-9 and bombesin. High-grade tumors (Gleason sum U 7) were more likely to express MMP-9 and bombesin (21/24 : 88%) than low-grade tumors (Gleason sum S 6) (7/17 : 41%). In eight of the nine cases with pathological lymph node metastases, expression of MMP-9 and bombesin was also noted in metastatic sites. Neuron-specific enolase was positive in 16 cases (39%) and not always associated with the expression of bombesin. Expression of bombesin and expression of MMP-9 are common in human prostate cancers and may be related to an aggressive phenotype.

悪性黒色腫の統計 悪性黒色腫の新ＴＮＭ分類と解説，ならびに新病期による統計 （１９９２〜１９９６年）

The TNM Classification of Malignant Tumours was revised by the International Union Against Cancer in 2002. The modifications include the addition of the presence/absence of ulceration, more detailed differentiation of tumor thickness, both microscopic and macroscopic regional lymph node metastasis, lung metastasis under distant metastasis, and abnormal LDH levels as prognostic factors, thereby considerably increasing the complexity of the classification system. In this paper, we comment on the new TNM Classification for malignant melanoma and present the results of a review of a statistical investigation of malignant melanoma (1992 to 1996) based on the new staging system. It was found that the survival rate generally corresponded to the extent of disease progression. [Skin Cancer (Japan) 2002; 17: 113-118]

Postoperative adjuvant therapy in early invasive cervical cancer patients with histopathologic high-risk factors.

The purpose of this study is to evaluate the efficacy of postoperative adjuvant therapy in preventing treatment failure after primary treatment with surgery in early invasive cervical cancer patients associated with the following histopathologic high-risk factors: lymph node metastasis (either macroscopic or microscopic), parametrial extension, lymphovascular permeation and depth of invasion > or =10 mm. Postoperative adjuvant concurrent chemoradiotherapy (PCCRT), postoperative adjuvant chemotherapy (PCT), or postoperative adjuvant radiotherapy (PRT) alone was administered to the 80 early invasive cervical cancers with at least one of the high-risk factors. Each of 61 patients received three to six cycles of chemotherapy at intervals of approximately 3 weeks. Twenty three patients were treated with PCCRT, 38 patients were treated with PCT alone, and 19 patients received PRT. The 5-year survival rates of patients with macroscopic lymph node metastasis were 66.7% and 35.7% in PCCRT and PRT, respectively. With microscopic lymph node metastasis, the 5-year survival rates were 83.3%, 60.0%, and 70.1% in PCCRT, PCT, and PRT, respectively. With parametrial extension, the 5-year survival rate was 58.1% in PCCRT. The 5-year survival rates of patients with lymphovascular permeation were 100%, 90.9%, and 66.7% in PCCRT, PCT, and PRT, respectively. With depth of invasion > or =10 mm, the 5-year survival rates were 100% and 91.3%, in PCCRT and PCT, respectively. PCCRT appears to be superior to PRT or PCT alone in early invasive cervical cancer patients with histopathologic high-risk factors.

A scoring function for target coverage in intensity modulated radiation therapy (IMRT) planning based on the probability of microscopic tumor extension and lymph node metastasis

Purpose: We developed a novel model implementing the concept that the relative importance of a given subvolume within a clinical target volume (CTV) depends on the probability of microscopic tumor extension and lymph node metastasis. This probability was derived from clinical pathological data and is expressed as a function of distance from the surface of gross tumor.

Survival after multimodality treatment for stage IIIC endometrial cancer

Objective: Our purpose was to review our results of multimodality treatment of lymph node metastasis in endometrial cancer (stage IIIC). Study Design: All patients underwent surgical staging for endometrial cancer with complete pelvic and aortic lymphadenectomy. All macroscopic nodal metastases were resected. Patients with microscopic nodal metastasis received adjuvant teletherapy, whereas those with macroscopic nodal metastasis received chemotherapy (carboplatin AUC 5 and paclitaxel 135 mg/m2 every 3 weeks for 6 courses) followed by teletherapy. Results: Twenty-one patients had stage IIIC disease, and one had stage IVB (inguinal nodal metastasis). Sixty-four percent of tumors were poorly differentiated. Fifty-five percent of patients had pelvic nodal metastasis only and 41% had macroscopic nodal metastasis. At a median follow-up of 3.8 years, 32% of patients had recurrence, all extrapelvic. Overall mean survival was 48 months and progression-free survival was 40 months. Overall survival for microscopic nodal metastasis was >60 months versus 35 months for macroscopic metastasis. Overall survival for pelvic nodal metastasis was 53 months versus 42 months for aorticinguinal metastasis. There were no complications from lymphadenectomy, a 22% chemotherapeutic toxicity, and a 14% radiation toxicity. Conclusion: Our surgical, chemotherapeutic, and radiation treatment protocol for stage IIIC endometrial cancer produced minimal toxicity and good survival. (Am J Obstet Gynecol 2001;184:1071-3.)

Long-term prognostic significance of HSP-70, c-myc and HLA-DR expression in patients with malignant melanoma

Aim Use of molecular markers indicative of the tumour oncogenic potential and host response may enhance our prognostic information for more effective treatment of melanoma patients. The roles of HSP-70 protein, c-myc oncogene and HLA-DR antigen expression were examined in melanoma patients and related to prognostic factors, recurrence rate and long-term survival. Methods Forty patients with tumours thicker than 1 mm were included in this study. All had elective node dissection and were followed for at least 7 years. Twenty-two had microscopic nodal metastases. Both primary melanoma tumour and lymph nodes were examined for the immunohistochemical expression of HSP-70 protein, c-myc oncogene and HLA-DR antigen.Results Eighteen patients had a recurrence (45%) and 23 patients survived overall (57.50%). Positive HSP-70 expression was observed in 52.50% of the primary melanomas and was associated with improved overall survival, especially in the patient group with tumours ≥1.5 mm (70%vs 26.70%, P=0.0159). C-myc oncogene was overexpressed in 47.50% and HLA-DR antigen in 42.50% of the primary melanomas, but no correlation with survival was observed. The expression profile of these molecular markers in the primary tumour did not predict the status of regional nodes. HLA-DR expression in lymph nodes was observed exclusively in the nodal tissue surrounding the metastatic melanoma tumour in five patients. Conclusions The immunohistochemical expression profile of HSP-70 but not of c-myc oncogene or HLA-DR antigen in the primary melanoma tumour could be of certain value in the identification of patients with graver prognosis who may benefit from more aggressive therapeutic strategies.

Impact of Histological Grade of Hepatocellular Carcinoma on the Outcome of Liver Transplantation

Histological grade of hepatocellular carcinoma (HCC) is an important prognostic factor affecting patient survival after orthotopic liver transplantation (OLT). Retrospective analysis. University-based teaching hospital. Of 952 OLTs performed between June 1991 and January 1999, 56 OLT recipients had histologically proven HCC in the explant liver. Of those, 53 patients with complete clinicopathologic data were analyzed. A single pathologist blinded to the outcome of each patient reviewed all histological specimens. Median follow-up was 709 days. Overall survival for patients with tumors sized 5 cm or less at 1, 3, and 5 years was 87%, 78%, and 71%, respectively (Kaplan-Meier). Univariate analysis revealed the size, number, and distribution of tumors; the presence of microscopic vascular invasion and lymph node metastasis; histological differentiation; and pTNM stage to be statistically significant factors affecting survival. Multivariate analysis revealed histological differentiation and pTNM stage to be the independent and statistically significant factors affecting survival (P =.002 and.03, respectively). When pTNM stage was excluded from multivariate analysis, histological differentiation and size remained the significant independent factors (P =.02 and.03, respectively). Three-year survival for patients with small (</=5 cm) tumor with well- to moderately differentiated and poorly differentiated HCC was 82% and 67%, respectively. Three-year survival for patients with large (>5 cm) tumor with well- to moderately differentiated and poorly differentiated HCC was 62.5% and 0%, respectively. In our retrospective experience, histological differentiation had a statistically significant effect on the prognosis of HCC after OLT. However, before altering the current OLT selection criteria for patients with HCC, prospective studies are required to confirm the impact of histological grade on clinical outcome.

Regional Nodal basin control is not compromised by previous sentinel lymph node biopsy in patients with melanoma

Regional nodal basin control is an important goal of lymphadenectomy in the management of melanoma patients with nodal disease. The purpose of this study was to determine if previous sentinel lymph node (SLN) biopsy compromises the ultimate regional nodal control achieved by subsequent therapeutic lymph node dissection in melanoma patients with microscopic lymph node metastases. A surgical melanoma database and hospital records were reviewed for 602 patients with primary cutaneous melanoma who underwent successful lymphatic mapping and SLN biopsy between 1991 and 1997. A total of 105 (17%) of 602 patients had histologically positive SLNs and were offered therapeutic lymphadenectomy; 101 (96%) underwent this procedure. Thirty-six patients (36%) developed recurrent melanoma at one or more sites. The median follow-up period was 30 months. Recurrence in the previously dissected nodal basin was observed in 10 patients (10%); none had recurrence at only that site. Nodal basin disease appeared after local/in-transit (n = 6) or distant (n = 1) failure in seven patients and, as a component of the first site of failure, simultaneously with local/in-transit (n = 2) or distant (n = 1) recurrence in three patients. Nodal basin failure after lymphadenectomy in patients who underwent previous biopsy of a histologically positive SLN is primarily a function of aggressive locoregional disease rather than of contamination from previous surgery. Because regional nodal control was comparable with that in other series, we conclude that SLN biopsy with selective lymphadenectomy does not compromise regional nodal basin control.

Adjuvant bleomycin, etoposide and cisplatin in pathological stage II non-seminomatous testicular cancer: the Indiana University experience

Two cycles of bleomycin, etoposide, and cisplatin (BEP) were evaluated as adjuvant chemotherapy for patients with pathological stage II non-seminomatous germ cell tumours. Between 1985 and 1995, 86 patients with pathological stage II non-seminomatous testicular cancer were treated with two cycles of BEP. At retroperitoneal lymph node dissection (RPLND) 49 patients (57%) had pathological stage II A (microscopic nodal metastases) and 37 (43%) had stage II B (gross nodal metastases). After RPLND, the patients received bleomycin, 30 units weekly for 8 weeks, etoposide (100 mg/m 2) and cisplatin (20 mg/m 2) each for 5 days every 28 days for two cycles as adjuvant chemotherapy. 4 patients were lost to follow-up. 10 patients (12%) developed granulocytopenic fever during their chemotherapy. Of the 82 evaluable patients all remained with no evidence of disease except for a single patient with a cervical nodal relapse of teratoma. This was resected and he remains disease free. Median follow-up has been 85 months (range: 42–173 months). In patients with fully resected stage II non-seminomatous germ cell tumour, two cycles of BEP were almost universally effective in preventing relapse.

Contemporary results of anatomic radical prostatectomy.

With current clinical practice, most newly diagnosed cases of prostate cancer are potentially life-threatening yet still curable. The anatomical (nerve-sparing) radical prostatectomy has dramatically improved the results of surgical treatment. Other new management options, including conformal (three-dimensional) external beam radiation therapy, radioactive seed implantation (brachytherapy), cryoablation, and hormonal therapy, may be useful in some patients, but they are all probably less effective than radical prostatectomy. Suitability for radical prostatectomy generally requires a clinically localized, potentially life-threatening tumor [as defined by Gleason grade, tumor stage, and serum prostate-specific antigen (PSA) level], a life expectancy of 10 years, and no serious co-morbid medical conditions. With contemporary radical prostatectomy, about 70% of men with clinically localized disease will be cured, depending on tumor grade, tumor stage, and the serum PSA level. Urinary continence and sexual potency can be preserved in most patients, but substantially better results have been reported from centers of excellence than from community-based series. Other complications occur in about 10% of patients and with greater frequency in older patients. The operative mortality rate is less than 0.5%. Neoadjuvant hormonal therapy does not appear to affect treatment failure rates in patients undergoing radical prostatectomy. Prostatectomy may be beneficial in patients with microscopic lymph node metastases. Postoperative adjuvant radiotherapy may also be beneficial for patients with adverse pathologic findings. Salvage radical prostatectomy after radiation failure is associated with a 10-fold higher risk of complications and limited prospects for cure. Prospective, randomized clinical trials are underway to compare the results of radical prostatectomy with other treatments. Currently, radical prostatectomy is considered the preferred treatment for men with localized disease and a 10-year life expectancy.

Pretreatment surgical staging of patients with cervical carcinoma: the case for lymph node debulking.

The routine use of extraperitoneal surgical staging prior to radiation therapy in patients with bulky or locally advanced cervical carcinoma remains controversial. A review was performed of 266 patients with cervical carcinoma who underwent extraperitoneal pelvic and paraaortic lymphadenectomy prior to receiving radiotherapy. Patients were divided into groups based on their lymph node status. Group A had negative lymph nodes; Group B had resected, microscopic lymph node metastases; Group C had macroscopically positive lymph nodes that were resectable at the time of surgery; and Group D had unresectable lymph nodes. All patients received standard radiotherapy utilizing external beam and brachy-therapy. Patients with lymph node metastases received extended field irradiation. Survival probabilities were computed by the Kaplan-Meier product limits method with statistical significance determined by the Mantel-Cox log rank test. Lymph node metastases were detected in 50% of patients. Five- and 10-year disease free survival rates were similar for all patients in Groups B and C. All patients in Group D recurred. There was a 10.5% incidence of severe radiation-related morbidity and a 1.1% incidence of treatment-related deaths. Pretreatment extraperitoneal staging of patients with bulky or locally advanced cervical carcinoma may afford a survival benefit via the debulking of macroscopically positive lymph nodes without significantly increasing treatment-related morbidity or mortality.

Surgical staging and high dose rate brachytherapy for endometrial cancer: Limiting external radiotherapy to node-positive tumors

To evaluate the efficacy and morbidity of surgical staging and high dose rate brachytherapy for women with stage I-IIIA endometrial cancer. Sixty consecutive patients underwent surgical staging consisting of total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal cytology, bilateral pelvic lymphadenectomy, periaortic lymphadenectomy, and omentectomy. High dose rate brachytherapy was delivered postoperatively in three fractions for a total of 2100 cGy. Only patients with nodal metastasis received external radiotherapy. Twenty-two tumors (37%) were considered high-risk uterine disease because of deep invasion (stage IC), cervical involvement (stage II), positive peritoneal cytology (stage IIIA), or poor differentiation (grade 3). Lymph node metastases were detected in five patients. There was no surgical mortality, and morbidity from surgery and high dose rate brachytherapy was minimal. At a median follow-up of 3 years, there has been one recurrence. The conventional practice of postoperative external radiotherapy was altered in 23 of 60 patients (38%): 22 women with high-risk uterine factors did not receive external radiotherapy, and one patient with low-risk uterine factors (less than 50% myometrial invasion, grade 2) received external radiotherapy because of microscopic pelvic lymph node metastasis. Surgical staging and high dose rate brachytherapy without external radiotherapy for stage I-IIIA endometrial cancer were associated with minimal morbidity and produced excellent survival.

Malignant mesonephric neoplasms of the uterine cervix. A report of eight cases, including four with a malignant spindle cell component.

Eight mesonephric adenocarcinomas of the uterine cervix, four of which had a malignant spindle-cell component, occurred in women aged 34 to 71 (median 43, mean 54.5) years, bringing to 14 the number of cervical mesonephric carcinomas in the literature. The tumors with a malignant spindle-cell component ("malignant mesonephric mixed tumors") are, with one possible exception, the first reported examples at this site. The patients, almost all of whom presented with vaginal bleeding, underwent hysterectomy; five also had a pelvic lymph node dissection. The tumors were all stage IB, although microscopic lymph node metastases were found in two cases. Gross examination revealed an invasive cervical mass in each case. On microscopic examination, seven tumors were adjacent to mesonephric hyperplasia, which in five cases was florid and focally atypical; in the remaining case, occasional non-neoplastic mesonephric tubules were found only within the tumor. The adenocarcinomas typically exhibited a variety of patterns, including a ductal pattern resembling endometrioid adenocarcinoma, a small tubular pattern, a retiform pattern, a solid pattern, and a sex-cord-like pattern. These disparate patterns frequently caused diagnostic difficulty. The spindle-cell component generally resembled endometrial stromal sarcoma or a nonspecific spindle-cell sarcoma; one tumor also contained multiple foci of osteosarcoma and another, a single chondroid focus. Immunohistochemical staining for a variety of antigens failed to reveal a distinctive profile, although all the carcinomas were immunoreactive for vimentin. Follow-up in six cases revealed three patients to be alive without evidence of recurrence at postoperative intervals of 2 to 3 years. Recurrent tumor developed in a fourth patient 1 year after hysterectomy; she was treated with chemotherapy and was alive and free of disease at 2 years. Another patient had intra-abdominal recurrences (including liver metastases) at 9 and 11 years and was alive with tumor at 13 years. Death at 8.5 months in a final patient was probably due to an independent stage IIc ovarian clear-cell carcinoma. These and prior observations in the literature suggest that malignant mesonephric tumors of the cervix may be more indolent than their müllerian counterparts, from which they should be distinguished. Mesonephric carcinomas in this site should also be distinguished from florid mesonephric hyperplasia, with which they are usually associated.

Laparoscopic Pelvic Lymph Node Dissection for Prostate Cancer

Pelvic lymphadenectomy unquestionably is still the most accurate method to identify the presence or absence of lymphatic extension of prostate cancer. Lymphatic spread follows the lymph channels that leave the prostate posteriorly and then spread primarily to a lymphatic field of drainage that includes the perivesical, hypogastric, obturator, presacral, and presciatic lymph nodes. The obturator nodes are commonly the first site of meta~tasis.~' The risk of nodal involvement is increased with larger tumor volume and local periprostatic spreadlo; however, when only the histopathologic grade of the tumor is used, no method is precise in detecting positive pelvic lymph nodes with increasing Gleason score.2,18,22,28 At present, no imaging modality can identify accurately lymphatic involvement with prostate cancer. The role of CT scan in evaluating lymph node involvement is limited, with an accuracy rate of only 65%.3 In addition, microscopic nodal metastases cannot be demonstrated by CT scan in patients with advanced disease of the prostate (stages B,, C, or D).15,32 Unless the nodes are grossly enlarged, CT scan imaging of the prostate is limited as a staging tool for prostate cancer. The value of ultrasonography and magnetic resonance imaging for pelvic lymph node involvement is similar to that of CT scan, with a reported accuracy of 84% to 89%:~~~ Pedal lymphangiography, Color reproduction in this article courtesy of a grant by Tap Pharmaceuticals, Inc.

Clinicopathologic study of patients with Borrmann type IV gastric carcinoma.

Between 1979 and 1993, 665 Japanese patients with advanced gastric cancer underwent surgery at our hospital. These patients were divided into two groups, consisting of 102 patients with Borrmann type IV carcinoma, and the remaining 563 patients with all other types of gastric carcinoma, which were then compared clinicopathologically. In the patients with Borrmann type IV carcinoma, 77.4% of the lesions demonstrated poorly differentiated adenocarcinoma, and 99 patients were classified as Stage III or IV. The resection rate was 87.2% (89/102) with only 39 curative operations despite the fact that 70 total gastrectomies were performed. The incidence of peritoneal dissemination (29.4%) and serosal invasion (97.0%) was significantly higher in these patients. Microscopic lymph node metastasis was positive in 86.5%. The 5-year survival rate was 23.4% in the patients with a curative operation and 5.0% in those with a noncurative operation (p < 0.01). Peritoneal dissemination was most frequently noted in the recurrence patterns. We conclude that early detection and a curative operation are both essential to improve the prognosis of patients with Borrmann type IV gastric cancer. The addition of a potent postoperative chemotherapy regimen is also recommended.

POORLY DIFFERENTIATED ADENOCARCINOMA AND SIGNET RING CELL CARCINOMA OF THE LARGE INTESTINE

Poorly differentiated adenocarcinomas or signet ring cell carcinomas (poorly differentiated group) are relatively rare in the large intestine compared to well or moderately differentiated adenocarcinomas (differentiated group). We compared the poorly differentiated group with the differentiated group to elucidate clinicopathological features of the poorly differentiated group. Among 292 resected patients with colorectla carcinoma, 28 (10%) patients had tumor belonged to the poorly differentiated group. The incidence of a primary tumor locating in the proximal colon was higher in the poorly differentiated group than that in the differentiated group. The incidences of microscopic lymph node metastasis, peritoneal dissemination and macroscopic invasion to the adjacent organs were significantly (p<0.05) higher in the poorly differentiated group than these in the differentiated group. Particularly, the rate of n4(+) cases was markedly higher in the poorly differentiated group. The prognosis of the poorly differentiated group was significantly (p<0.05) worse than that of the other thought the tumors were resected curatively or lymph node metastasis was n(-), nl(+) or n2(+). We conclude that the poorly differentiated adenocar-cinomas are biologically more malignant than the differentiated adenocarcinomas. Thus, multimodified therapies are necessary in order to improve the prognosis of the poorly differentiated adenocarcinoma, if curative resection is possible.

Open Surgical Revision of Laparoscopic Pelvic Lymphadenectomy for Staging of Prostate Cancer: The Impact of Laparoscopic Learning Curve

We attempt to clarify the impact of the learning curve on the first 30 laparoscopic pelvic lymphadenectomies performed at our institute. Open surgical revision of the area of laparoscopic dissection was performed at radical retropubic prostatectomy. The mean number of obturator and iliac lymph nodes removed laparoscopically was 8.7 and 8.8 from the right and left sides, respectively. The mean number of residual obturator and iliac lymph nodes removed at open operation was 3.2 and 3 from the right and left sides, respectively. The amount of residual lymph node tissue after laparoscopic lymphadenectomy progressively decreased with time, especially after the first 20 cases. A microscopic pelvic lymph node metastasis was found at open operation in patients 6, 14 and 15, who had false-negative results at laparoscopy. Due to the learning curve effect, the first 30 patients who undergo laparoscopic pelvic lymphadenectomy should be assessed again by an open operation at radical retropubic prostatectomy.

A CLINICOPATHOLOGICAL STUDY ON GASTRIC CANCER WITH ESOPHAGEAL INVASION IN THE CARDIAC REGION

One hundred and thirty-one gastric cancers in the cardiac region surgically treated at the department from 1980 to 1992 were classified into two groups: CE-cancers and C-cancers. In this study the clinicopathological charactaristics and therapeutic results of them were studied. Among the clinicopathological charactaristics, there were significant differences between them in gross type of the tumor, tumor size, microscopic depth, vessel invasion, microscopic lymph node metastasis, infiltrative growth, and microscopic stage. These findings suggest that there were more advanced cases in CE-cancers than C-cancers. Curative resection rate was significantly higher in C-cancers, and cummulative five-years survival rate was better in C-cancers (64.1%) than CE-cancers (34.8%). Cummulative survival rate of CE-cancers was studied in length of esophageal invasion, length of oral width, lymph node metastasis, tumor size, and microscopic depth. It was suggested that the grade of lymph node metastasis chiefly affected the prognosis of CE-cancers.

Pelvic and Para-aortic Lymphadenectomy for Surgical Staging of High-Risk Endometrioid Adenocarcinoma of the Endometrium

The objective of this study was to analyze the results of pelvic and para-aortic lymphadenectomy in high-risk patients with endometrioid adenocarcinoma of the endometrium and no clinical or gross surgical evidence of extrauterine metastases. From August 1987 to October 1992, 50 patients with high-risk endometrioid adenocarcinoma of the endometrium had pelvic and para-aortic lymphadenectomy performed. The median number of lymph nodes removed was 18. No preoperative radiotherapy was administered. Pelvic lymph node metastases (20.0%) and para-aortic lymph node metastases (16.0%) were the most common sites of extrauterine metastases diagnosed. Eight patients (80.0%) with pelvic lymph node metastases also had para-aortic metastases. All 8 patients with para-aortic lymph node metastases had pelvic lymph node metastases. Pelvic lymphadenopathy was diagnosed on surgical exploration in 30% of patients with pelvic lymph node metastases, and para-aortic lymphadenopathy was present in 50% with para-aortic metastases. Six of 46 patients (13.0%) without pelvic or para-aortic lymphadenopathy had microscopic lymph node metastases. Palpation of the pelvic and para-aortic lymph node areas alone is inadequate in identifying patients with lymph node metastases. The addition of routine pelvic and para-aortic lymphadenectomy to TAH/BSO will identify subclinical lymph node metastases in a significant number of patients who may benefit from individualized postoperative therapy.