Nonmetastatic Status Research Articles

PROFILE OF PROSTATE CANCER PATIENTS AT DR. MOEWARDI HOSPITAL PERIOD JANUARY 2017 – JANUARY 2022: RETROSPECTIVE STUDY

Objective: This study aims to know the profile of prostate cancer patients treated at Moewardi General Hospital from January 2017 to January 2022. Material & Methods: A retrospective study was conducted in prostate cancer patients who have or are undergoing therapy at Moewardi General Hospital from January 2017 to January 2022 using purposive sampling techniques. Results: From January 2017 to January 2022, 441 male patients were diagnosed with prostate cancer which is dominated able to go home alive, around 92.97%. The age of study subjects was overlooked of 70-80 years with a total of 182 people, dominated by self-employed as many as 420 people. The breakdown of PSA scores of 1-20 in as many as 247 people, Adeno Ca Prostate as many as 374 people with the majority of prostate Ca cases in subjects in non-metastatic status (359 people). The results of variable Rectal Toucher examination described results dominated by palpable prostate and hard as many as 437 people. Conclusion: The most important prognostic indicators in prostate cancer are the patient's age and general health at the time of diagnosis, the cancer stage, the level of pre-therapeutic PSA, and the Gleason score. A worse prognosis is associated with high levels of the disease, more advanced stages, younger age, and elevated levels of PSA. Keywords: Prostate cancer, patient’s age, PSA, male.

Consolidatory ablative stereotactic body radiation therapy after induction chemotherapy for unresectable pancreatic cancer: A single center experience.

Consolidatory radiotherapy in form of stereotactic body radiation therapy (SBRT) with an ablative dose following induction chemotherapy is emerging as a promising treatment scheme for unresectable pancreatic cancer. Outcomes of given treatment at a single center for contiguous patients with unresectable pancreatic cancer were evaluated to build the optimal treatment strategy. In this retrospective study, a total of 50 patients with unresectable pancreatic cancer who underwent induction chemotherapy and ablative dose SBRT were included. SBRT dose was 40-50 Gy in five fractions. Two strategies were adopted to adhere to the organs at risk (OAR) dose constraints: simultaneous integrated protection (SIP) technique and magnetic resonance (MR)-guided adaptive technique. Overall survival (OS) and local progression-free survival (LPFS) were calculated from the start date of SBRT. The median follow-up period for survivors was 21.1 months (range, 6.2-61.0 months). Eleven (22.0%) patients underwent resection after SBRT, which were all R0 resection. In patients with non-metastatic disease, the median OS was 26.5 months (range, 4.1-61.0 months), and the 1- and 3-year LPFS were 90.0% (95% confidence interval [CI], 72.0-96.7%) and 57.4% (95% CI, 31.7-76.4%), respectively. Patients with oligometastatic disease had inferior survival outcomes, but there was no survival difference among responders to induction chemotherapy. In the multivariable analysis, tumor size ≤4 cm, non-metastatic status, and good response to induction chemotherapy were associated with improved LPFS. In dosimetric analysis, GTV Dmin ≥50.5 Gy was the strongest prognosticator against local progression. Grade ≥3 adverse events occurred in two (4.0%) patients with non-adaptive RT, but none in patients with MR-guided adaptive RT. Ablative dose SBRT following induction chemotherapy is an effective strategy for selected patients with unresectable pancreatic cancer. The SIP technique and MR-guided adaptive RT were attributed to minimizing the risk of adverse events. Further studies are needed to identify the best candidates for consolidatory SBRT in unresectable pancreatic cancer.

Application of the Machine-Learning Model to Improve Prediction of Non-Sentinel Lymph Node Metastasis Status Among Breast Cancer Patients.

BackgroundPerforming axillary lymph node dissection (ALND) is the current standard option after a positive sentinel lymph node (SLN). However, whether 1–2 metastatic SLNs require ALND is debatable. The probability of metastasis in non-sentinel lymph nodes (NSLNs) can be calculated using nomograms. In this study, we developed an individualized model using machine-learning (ML) methods to select potential variables, which influence NSLN metastasis.Materials and MethodsCohorts of patients with early breast cancer who underwent SLN biopsy and ALND between 2012 and 2021 were created (training cohort, N 157 and validation cohort, N 58) for the development of the nomogram. Three ML methods were trained in the training set to create a strong predictive model. Finally, the multiple iterations of the least absolute shrinkage and selection operator regression method were used to determine the variables associated with NSLN status.ResultsFour independent variables (positive SLN number, absence of lymph node hilum, lymphovascular invasion (LVI), and total number of SLNs harvested) were combined to generate the nomogram. The area under the receiver operating characteristic curve (AUC) value of 0.759 was obtained in the entire set. The AUC values for the training set and the test set were 0.782 and 0.705, respectively. The Hosmer-Lemeshow test of the model fit accuracy was identified with p = 0.759.ConclusionThis study developed a nomogram that incorporates ultrasound (US)-related variables using the ML method and serves to clinically predict the non-metastatic status of NSLN and help in the selection of the appropriate treatment option.

Incidence of venous thromboembolism and discriminating capacity of Khorana score in lung cancer patients treated with immune checkpoint inhibitors.

Venous-thromboembolism (VTE) is increased in lung cancer patients (LCP) treated with immune-checkpoint inhibitors (ICIs) but risk factors are not identified and the Khorana Score (KS) is not validated. To assess VTE incidence and its clinical impact, to investigate potential clinical risk factors and KS performance in LCP. Retrospective analysis of LCP initiating ICIs treatment between June 2015 and November 2020 in a for-profit cancer center. 481 patients were included: 62% adenocarcinoma, 70% PDL1 + , 86% stage-IV-disease. Over a median follow-up of 9.8months, 47 VTE were observed: 28 pulmonary embolisms, 15 deep venous thromboses (distal n = 9, proximal n = 6), 3 inferior vena cava thromboses, 1 other VTE, no superficial or digestive vein thrombosis. Median time from ICIs' initiation to VTE was 180 (11-1277) days. Overall survival was significantly lower in patients who experienced VTE (42.5 vs. 86.8months, p = 0.006). In univariate analysis patients VTE was more frequent in metastatic patients (11.1% vs. 1.5%, p = 0.015) and lower in those treated with durvalumab (1.9% vs. 9.6%, p = 0.046). Logistic regression analysis showed that non-metastatic status (OR 0.13; 0.02-0.95, p = 0.04) and BMI (OR 1.07; 1.01-1.14, p = 0.028) were associated with VTE. The rate of VTE was the same in patients with a KS < or ≥ 2 (10.2% vs. 9.3%, p = 0.87). ICIs-treated LCP are at high risk of thromboembolism. VTE has a negative impact on survival. KS does not perform well in LCP. It is important to identify which VTE prediction models are available to be used in adult ambulatory lung cancer patients.

Prospective study to assess the role of FDG PET/CT in detecting systemic metastatic spread in rectal cancers with lateral pelvic lymph nodes

IntroductionThe utility of positron emission tomography (PET) in detecting additional M1 patients over conventional staging modalities is not known in rectal cancer patients with enlarged lateral pelvic nodes. MethodsProspective, single center, single-arm interventional study of consecutive rectal cancer patients that had baseline lateral pelvic nodes on MRI (>10 mm) between February 2017 to December 2018. Such patients underwent PET after confirming non-metastatic status on CT of thorax and abdomen. Primary outcome measure was additional M1 sites detected on PET. A 10% distant metastasis rate was expected with 80% confidence interval (CI) set at 5% as the lower limit. Results44 patients were included and the concordance between MRI and PET in detection of lateral nodes was 97.7% (43 patients). Additional sites of metastasis were detected in 5 patients (11.36%; 80% CI - 5.63%–20.6%), and there was a change in treatment plan in 7 (15.9%). The number needed to treat (NNT) for PET scans to detect additional metastatic sites and change treatment were 9 and 6 respectively. There was a change in treatment intent (curative to palliative) in 2 patients (4.5%, NNT – 22). ConclusionIn rectal cancer patients with LPLN, the use of FDG-PET-CT over conventional staging studies led to the detection of additional extra-pelvic metastasis in 11.4% and changed the treatment plan in 15.9%. This met the pre-defined threshold to endorse the use of PET-CT in patients that match the study characteristics.

LncRNA UCA1 maintains the low-tumorigenic and nonmetastatic status by stabilizing E-cadherin in primary prostate cancer cells.

Long noncoding RNAs (LncRNAs) have emerged as important players in cancer biology. Increasing evidence suggests that LncRNAs are frequently dysregulated in cancer and may function as oncogenes or tumor suppressors. Urothelial carcinoma associated 1 (UCA1), a LncRNA, firstly identified in bladder transitional cell carcinoma, seems to act as an oncogene in many different types of human cancers by promoting cell proliferation and migration. In this study, we revealed a novel biological function of UCA1, which was different from thatreported by previous studies, was responsible for maintaining the low-tumorigenic, nonmetastatic phenotypes in primary prostate epithelial cells. UCA1 could stabilize E-cadherin protein by preventing the interaction between E-cadherin and its E3 ligase MDM2, which suppressed MDM2-mediated ubiquitination and degradation of E-cadherin. In addition, we also found that UCA1 acted as a sponge of miR-296-3p, which targeted E-cadherin gene CDH1 messenger RNA at the posttranscription level. Taken together, these findings demonstrated that UCA1 had a new important role in effectively keeping E-cadherin at a high level through a dual mechanism, which maintained primary prostate cancer cells at the low-tumorigenic and nonmetastatic status.

Abstract P4-01-05: Circulating ensembles of tumor associated cells for detection of breast cancer

Abstract Background: Mammographic screening for breast cancer offers the possibility of reducing morbidity and mortality from the disease but has economic and safety implications. Thromboembolism is a well-recognized, potentially life-threatening complication of cancer. Detection and characterization of tumour emboli comprising Circulating Ensembles of Tumor Associated Cells (C-ETACs) has however remained largely unstudied, essentially due to the difficulties in their isolation. Here we present for the first time an observational study describing the prevalence of C-ETACs in breast cancer patients and in asymptomatic individuals using a novel, label and hypothesis free process. Methods:15 ml of peripheral blood was collected from 7075 female volunteers including 1582 previously diagnosed cases of breast cancer with definite radiological and histopathological evidence of disease of which 361 were non-metastatic, 792 were metastatic, 425 cases were recently diagnosed and treatment naïve and 1006 patients had received prior treatments. The control population comprised 5493 asymptomatic individuals with age-related increased risk of breast cancer. The control patients underwent mammography and had a BI-RADS category score of 1, consistent with absence of malignancy in the breast. Peripheral blood mononuclear cells from the study population were grown in an epigenetically active cell culture medium with paradoxical cytotoxicity that selectively kills normal cells and confers survival and growth advantage on apoptosis-resistant cells of tumorigenic origin and their emboli, viz., C-ETACs. C-ETACs are defined as clusters comprising Epcam+ and CK+ cells irrespective of CD45 expression. In a subset of 100 samples from breast cancer patients we confirmed that the isolated C-ETACs contained cells that were positive for GCDFP. Results: C-ETACs were detected in 1413 / 1582 cases of breast cancer giving a sensitivity of 89.3%. There were no statistically significant differences between metastatic vs non-metastatic status of the disease or prior treatment. Among the 5493 individuals with unremarkable mammography, C-ETACs were detected in 104 (1.89 %) individuals. These individuals are being followed up prospectively for manifestation of clinical or radiological signs of malignancy of the breast as well as in other organs. Conclusions: Our study shows that heterotypic C-ETACs are a common feature of breast cancer irrespective of type, stage and grade and are almost entirely absent in asymptomatic, mammographically normal individuals. Our results therefore identify a potential biomarker for breast cancer which is specific and sensitive and which satisfies the requirements for the non-invasive, radiation-free detection of breast cancer. As such, it is a candidate for development as a modality for population screening. Citation Format: Timothy Crook, Dadasaheb Akolkar, Pradip Fulmali, Revati Patil, Cynthe Sims, Pooja Fulmali, Vineet Datta, Sachin Apurwa, Ajay Srinivasan, Rajan Datar. Circulating ensembles of tumor associated cells for detection of breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-01-05.

Medulloblastoma has a global impact on health related quality of life: Findings from an international cohort.

BackgroundUnderstanding the global impact of medulloblastoma on health related quality of life (HRQL) is critical to characterizing the broad impact of this disease and realizing the benefits of modern treatments. We evaluated HRQL in an international cohort of pediatric medulloblastoma patients.MethodsSeventy‐six patients were selected from 10 sites across North America, Europe, and Asia, who participated in the Medulloblastoma Advanced Genomics International Consortium (MAGIC). The Health Utilities Index (HUI) was administered to patients and/or parents at each site. Responses were used to determine overall HRQL and attributes (ie specific subdomains). The impact of various demographic and medical variables on HRQL was considered—including molecular subgroup.ResultsThe majority of patients reported having moderate or severe overall burden of morbidity for both the HUI2 and HUI3 (HUI2 = 60%; HUI3 = 72.1%) when proxy‐assessed. Self‐care in the HUI2 was rated as higher (ie better outcome) for patients from Western versus Eastern sites, P = .02. Patients with nonmetastatic status had higher values (ie better outcomes) for the HUI3 hearing, HUI3 pain, and HUI2 pain, all P < .05. Patients treated with a gross total resection also had better outcomes for the HUI3 hearing (P = .04). However, those who underwent a gross total resection reported having worse outcomes on the HUI3 vision (P = .02). No differences in HRQL were evident as a function of subgroup.ConclusionsBy examining an international sample of survivors, we characterized the worldwide impact of medulloblastoma. This is a critical first step in developing global standards for evaluating long‐term outcomes.

Intermittent bicalutamide in recurrent non-metastatic castrate sensitive prostate cancer: A single institution experience.

307 Background: Despite radical treatment, a proportion of men with prostate cancer will develop localized recurrence. Intermittent LHRH analogue (LHRHa) therapy has shown equivalence to long-term hormone manipulation with reduced toxicity. The non-steroidal competitive androgen receptor antagonist, bicalutamide, offers disease control with a further reduced toxicity profile. We report our institution’s experience of intermittent bicalutamide therapy (IBT) in recurrent non-metastatic castrate sensitive disease. Methods: Patients with biochemical recurrence and non-metastatic status on conventional imaging treated with IBT April 2016-November 2017 are reported. Previous LHRHa in the radical setting was allowed if testosterone recovery had occurred. For inclusion, one full course of IBT therapy had to be completed and treatment break commenced. Dose was 150mg with all other treatment decisions were at clinician discretion. Results: 103 men were identified with 4 were excluded due to insufficient data or failure to start treatment break. Mean age at initial diagnosis was 64.5yrs and, at commencement of IBT, 71.7. Mean overall time on IBT was 47months (20 and 27 months on and off treatment respectively). The longest recorded time on IBT was 153 months. 1 patient completed 8cycles of IBT. Mean number of cycles was 2.8 (range 1-8). Mean length of treatment break reduced with successive cycles of therapy measuring less than time on treatment after cycle 4. Of 39 patients with follow up therapies recorded, 77% received continuous bicalutamide as second line therapy. Conclusions: IBT offers a valid alternative to intermittent LHRHa therapy in recurrent non-metastatic castrate sensitive prostate cancer with the advantage of an improved toxicity profile benefiting patients. Further work to assess long-term outcomes in this patient population is warranted.[Table: see text]

A prospective randomized controlled trial comparing laparoscopic versus open Whipple’s procedure for periampullary malignancy

Background: Laparoscopic surgery in cases of periampullary region malignancies has been emerging as a preferable alternative to open pancreatoduodenectomy due to their benefits such as early mobilization and shorter duration of hospital stay. We conducted this study to determine whether laparoscopic approach is comparable to open pancreatoduodenectomy in terms of hospital stay, blood loss, complications, pathological radicality with oncological safety and overall postoperative short-term outcomes.Methods: This was a single-center, non-stratified, balanced allocation, open-label, parallel-group randomized control study in which patients who had undergone Whipple’s procedure were included. Patients were randomized after confirmation of non-metastatic status into either the laparoscopy (N=15) or open surgery group (N=15). The primary outcome variable was duration of postoperative hospital stays. Secondary outcomes were duration of surgery, blood loss, complication rates (using definitions of the international study group of pancreatic surgery) and pathological radicality of resection.Results: Pain in abdomen was the predominant complaint which was seen in 12 (80%) and 10 (66%) patients each. The other common symptoms were weight loss, vomiting and jaundice. Surgical site infection, mean blood loss and mean operative duration was significantly lower in laparoscopic group (P&lt;0.05). Mean tumor size was more in open group. Mortality was comparable in both the groups.Conclusions: Laparoscopic pancreatoduodenectomy offers significant benefit in terms of hospital stay, surgical site infection, mean blood loss, mean operative duration and mean interval of duration receiving chemo/radiotherapy as compared to open surgery in cases of periampullary region malignancy.

Three inflammation-related genes could predict risk in prognosis and metastasis of patients with breast cancer.

BackgroundCurrent predictive model is not developed by inflammation‐related genes to evaluate clinical outcome of breast cancer patients.MethodsWith mRNA expression profiling, we identified 3 mRNAs with significant expression between 15 normal samples and 669 breast cancer patients. Using 7 cell lines and 150 paraffin‐embedded specimens, we verified the expression pattern by bio‐experiments. Then, we constructed a three‐mRNA model by Cox regression method and approved its predictive accuracy in both training set (n = 1095) and 4 testing sets (n = 703).ResultsWe developed a three‐mRNA (TBX21, TGIF2, and CYCS) model to stratify patients into high‐ and low‐risk subgroup with significantly different prognosis. In training set, 5‐year OS rate was 84.5% (78.8%‐90.5%) vs 73.1% (65.9%‐81.2%) for the low‐ and high‐risk group (HR = 1.573 (1.090‐2.271); P = 0.016). The predictive value was similar in four independent testing sets (HR>1.600; P < 0.05). This model could assess survival independently with better predictive power compared with single clinicopathological risk factors and any of the three mRNAs. Patients with both low‐risk values and any poor prognostic factors had more favorable survival from nonmetastatic status (HR = 1.740 (1.028‐2.945), P = 0.039). We established two nomograms for clinical application that integrated this model and another three significant risk factors to forecast survival rates precisely in patients with or without metastasis.ConclusionsThis model is a dependable tool to predict the disease recurrence precisely and could improve the predictive accuracy of survival probability for breast cancer patients with or without metastasis.

Earlier use of androgen receptor-axis-targeted drugs may improve overall survival in patients with non-metastatic castration-resistant prostate cancer.

To evaluate the role of androgen receptor-axis-targeted drugs (ARAT) in non-metastatic castration-resistant prostate cancer (nmCRPC) versus mCRPC. Chemotherapy-naive patients (n = 114) with CRPC who had no metastasis at the time of diagnosis were included in this retrospective study. All patients were treated with ARAT at Jikei University and its affiliated hospitals from July 2014 to March 2017. The patients were stratified into nmCRPC (n = 81) and mCRPC (n = 33) groups according to their metastatic status at ARAT induction. The primary outcome measure was difference in overall survival (OS) between groups from the time of CRPC diagnosis. The patients were compared for progression-free survival (PFS) and prostate-specific antigen (PSA) response. The predictors of OS were explored by a multivariate Cox model. The baseline demographics did not differ significantly between the groups. The median observation period from the diagnosis of CRPC was 24.5 months (range: 3-135) and 20 months (range: 1-66) in nmCRPC and mCRPC groups, respectively. The nmCRPC group demonstrated better OS from the time of diagnosis of CRPC in Kaplan-Meier analysis than mCRPC group (86 months vs 40 months; P = 0.004), with similar results obtained for PFS (P = 0.048) and PSA response (P = 0.0014). Multivariate analysis demonstrated non-metastatic status, low PSA, and long PSA doubling time (PSADT) at ARAT induction as the significant predictors of longer OS (P = 0.044, 0.0001, and 0.026, respectively). Early use of ARAT may improve OS, PFS, and PSA response in CRPC. Larger, prospective studies will be required to confirm our findings.

Multicenter prospective study of switching from GnRH agonists to GnRH antagonist for patients with early stage of castration resistant prostate cancer as a second-line hormonal therapy.

183 Background: It was reported that GnRH antagonist could extend progression free survival for prostate cancer patients significantly longer than GnRH agonist in a first line hormonal therapy. However, the usefulness of switching from GnRH agonist to GnRH antagonist as a second hormonal therapy remains obscure. We performed a multicentral prospective study to investigate whether the switching from GnRH agonist to GnRH antagonist (degalerix) for patients with castration resistant prostate cancer (CRPC) as the 2nd line hormonal therapy was effective. Methods: 37 patients who were pathologically diagnosed as prostatic adenocarcinoma and developed CRPC after 1st line hormonal therapy with GnRH agonist plus anti-androgens were enrolled. After confirming anti-androgen withdrawal syndrome, they were treated with switching from GnRH agonists to degalerix. The primary endpoint was PSA response (PSA decline or up to 10% over baseline PSA). Secondary endpoints were the time to 25% PSA increase from the baseline (PSA response time), PSA progression free survival (PPFS), the time to treatment failure, cancer specific survival, radiographic PFS (rPFS), and safety. Results: Mean age was 76 years old, super high risk; 20 cases (54.1%), high risk; 11 cases (29.7%), intermediate risk; 5 cases (13.5%), low risk; one case (2.7%). PSA responder rate was 24.3% (9 cases). In responders, the median PSA response time was 5.75 months, the median PPFS was 1.77 months, and rPFS rate at 3 months was 96%. Regarding safety, only 2 cases (5.4%) showed G3 of AE. The PSA response had no relationship with the change of serum testosterone, LH nor FSH. Conclusions: The effectiveness of switching from GnRH agonist to GnRH antagonist showed to be limited. Although no predictive factor of the switching was recognized, some long-term responders were seen. We expect the possibility of switching to GnRH antagonist for patients in the early stage of CRPC, especially non-metastatic status. Clinical trial information: UNKNOWN.

Pemphigus vulgaris antigen mRNA quantification for the staging of sentinel lymph nodes in head and neck cancer

Background:Molecular diagnosis has been proposed to enhance the intra-operative diagnosis of sentinel lymph node (SLN) invasion in head and neck squamous cell carcinoma (HNSCC). Although cytokeratin (CK) mRNA quantification with real-time reverse transcriptase-PCR (QRT–PCR) has produced encouraging results, the more discriminating markers remain to be identified.Methods:Pemphigus vulgaris antigen (PVA), squamous cell carcinoma antigen (SCCA), and CK17 mRNA were quantified using QRT–PCR, and the results were compared with an extensive histopathological examination of the entire SLNs on 78 SLNs harvested from 22 patients with HNSCC.Results:SCCA and CK17 quantification showed significantly higher mRNA values for macrometastases (MAs) than for either negative or isolated tumour cell (ITC) SLNs (P<0.01). Pemphigus vulgaris antigen allowed the discrimination of all MAs and micrometastases from both negative and ITC SLNs (P<0.001). For the neck staging of patients, considering metastatic vs non-metastatic status, receiver-operating characteristic curve analysis found areas under the curve of 93.8, 97.9, and 100% for CK17, SCCA, and PVA, respectively. With PVA, a cutoff value of 562 copies per 100 ng of cDNA permitted the correct distinction between patients with positive as opposed to negative neck nodes in all cases.Conclusion:PVA seems to be a highly promising marker for accurate intra-operative SLN staging in HNSCC by QRT–PCR.

Overall expression of beta-catenin outperforms its nuclear accumulation in predicting outcomes of colorectal cancers

To examine the expression of beta-catenin in colorectal cancer and look for association with other clinico-pathological parameters. Tumor samples from 163 cases of colorectal cancer (CRC) who had undergone primary colectomy between May, 1998 and November, 2002 with complete follow-up data for either 5 years or until death were recruited for a beta-catenin immunohistochemical study. The percentage of immunoreacted tumor cells was defined as overall staining density (OSD) and percentage of cells having nuclear localization was counted as nuclear staining density (NSD). Univariate exploration used log-rank test and multivariate survival analysis used Cox's hazard regression model. Beta-catenin immunoreactivity was detected in 161 samples (98.8%), of which 131 cases had nuclear staining. High OSD (> or = 75%), detected in 123 cases (75.5%), was significantly associated with earlier clinical staging (P < 0.01), lower nodal status (P = 0.02), non-metastatic status (P < 0.01) and better differentiation (P = 0.02). Multivariate analysis found that high OSD was independently associated with better survival [Cox's hazard ratio 0.51, 95% confidence interval (CI) 0.31-0.83]. Although high NSD (> or = 75%) was correlated with high pre-operative serum CEA (P = 0.03), well differentiation (P < 0.01), and increased staining intensity (P < 0.01), the parameter was not significantly associated with survival. Unlike previous reports, the study did not find a predictive value of nuclear beta-catenin in CRC. Instead, the overall expression of beta-catenin in CRC showed an association with better differentiation and earlier staging. Moreover, the parameter also independently predicted superior survival.

Morphological characteristics of lateral pelvic lymph nodes in rectal carcinoma

Macroscopic and imaging indicators for lymph node metastasis have been documented not in lateral pelvic lymph nodes but in mesorectal lymph nodes in patients with rectal carcinoma. We conducted this study to uncover morphological characteristics of lateral pelvic lymph nodes in patients with rectal carcinoma. Fifty-eight patients with locally advanced rectal carcinoma who had total mesorectal excision and lateral pelvic lymph node dissection were studied. Total number of lateral pelvic lymph nodes evaluated was 462, with 538 mesorectal lymph nodes being used for comparison. Factors of lymph nodes evaluated were size (long- and short-axes diameters), shape (ovoid and irregular), and heterogeneity of internal structure. Receiver operating characteristic (ROC) curve analysis was used to compare the diagnostic accuracy of each factor. Lateral pelvic lymph node at non-metastatic status appeared to be longer (4.5 vs 3.5 mm) and thinner (2.2 vs 2.6 mm) than mesorectal lymph nodes. ROC curve analysis, for discriminating non-metastatic and metastatic lateral pelvic lymph nodes, revealed that a short-axis diameter appeared to be the most prominent factor with highest area under curve (0.907) and was more reliable than either long-axis diameter (0.811) or shape (0.527) other than internal structure (1.00). A short-axis diameter was an independent risk factor for metastasis by multivariate analysis with an odds ratio of 1.29 (p < 0.0001, 95% confident interval, 1.22-1.36). The most reliable cut-off value was 4 mm with 96% of sensitivity, 68% of specificity, and 82% of overall accuracy. Lateral pelvic lymph nodes tended to be longer and thinner than mesorectal lymph nodes at non-metastatic status. A short-axis diameter of 4 mm or larger was the prominent indicator of metastasis in lateral pelvic lymph nodes.