Number Of Pathological Lymph Nodes Research Articles

Abstract PO4-23-01: Imaging tailored axillary approach combined with radiotherapy eliminates axillary lymph node dissection in low-volume axillary disease after neoadjuvant chemotherapy

Abstract ABSTRACT Background Individualized treatment strategies are highlighted for breast cancer patients in the last decades. Therefore aggressive surgical approaches have begun to evolve towards minimally invasive tailored interventions. SLNB is widely used in patients who received neoadjuvant treatment (NAC) and axillary lymph node dissection (ALND) is recommended for patients with axillary residual disease after NAC. In our study, we investigated regional recurrence rates in patients with limited axillary residual disease after NAC who underwent imaging-guided (MR+USG) axillary surgery plus radiotherapy (RT) instead of ALND. Materials and Methods 139 patients whose clinical stages were T1-3 and N1 at the time of diagnosis, who had a clinically good or complete axillary response after neoadjuvant therapy, and who had axillary residue (≤3 pathological lymph nodes) with favorable response to NAC (>50% fibrotic changes) in the final pathological examination were included in the study. The tumor stage and the number of pathological lymph nodes were assessed by USG, MMG, MR, and PET-CT examination (The minimum number of lymph nodes to be removed was determined according to imaging findings). All patients underwent imaging-guided SLNB (blue dye) and imaging-guided palpable lymph node excision. The patients were re-evaluated with their final pathology results in the multidisciplinary councils for suitable further treatments, ALND or RT. Peripheral lymphatic radiotherapy was applied to patients whose radiology and pathology results were compatible and no further surgery was done. The patients whose radiologically detected number of positive nodes was inconsistent with the number of metastases in pathology examination and who were presumed to have the gross residual disease underwent ALND. These patients were excluded from the study. Results The median age was 47 years. The median number of lymph nodes excised was 4. The total number of excised lymph nodes was between 1-3 in 64 (46%) patients and between 4-6 in 62 (45%) patients. 13 (9%) patients had ≥7 lymph nodes. 1 metastatic lymph node was found in all patients with 1 positive lymph node according to imaging findings. Of 41 patients with 2 radiologically positive lymph nodes, 1 metastatic lymph node was found in 17 (41%) patients, 2 metastatic lymph nodes in 22 (53%), and 3 metastatic lymph nodes in 2 (5%) patients respectively. Radiology reported 3 positive lymph nodes in 22 patients, of which 1 metastatic lymph node was found in 8 (36%), 2 metastatic lymph nodes in 10 (45%), and 3 metastatic lymph nodes in 4 (18%). The median follow-up period was 44 months. One patient had breast recurrence at the 31st month and one patient had lymphatic recurrence in the supraclavicular area at the 39th month. Systemic recurrence was noted in 6 (4.3%) patients. No axillary recurrence occurred during the follow-up period. Conclusions Patients with pathological-suspicious ≤ 3 lymph nodes shown by imaging (USG, MR, and PET-CT) who responded to NAC but still have residual disease in the axilla can be safely treated with SLNB(blue dye)+imaging-guided axillary approach and adjuvant RT. This approach eliminates the need for ALND in patients with low-volume residual axillary disease. Table. Patient characteristics Citation Format: Mahmut Muslumanoglu, Baran Mollavelioglu, Selman Emiroglu, Hasan Karanlik, Mustafa Tukenmez, Kamuran Ibis, Aysel Bayram, Ravza Yılmaz, Neslihan Cabıoğlu, Abdullah Igci. Imaging tailored axillary approach combined with radiotherapy eliminates axillary lymph node dissection in low-volume axillary disease after neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-23-01.

Prognostic factors and survival of breast cancer in patients over 40 years of age

Aims: Breast cancer is the cancer with the highest incidence and mortality in women. There are differences in prognosis and survival between women over and under the age of 40. In this article, we aimed to examine breast cancer prognostic factors and survival results in people over the age of 40. Methods: 1187 patients aged 40 and over who underwent surgery at the Ondokuz Mayıs University Department of General Surgery between August 2005 and April 2019 and whose data were accessible were retrospectively examined. Data were obtained from the hospital automation system, the Ministry of Health’s online database, hospital archives, patients, and/or their relatives. They were classified separately in terms of type of surgery, axillary metastasis status (according to radiological status if axilla surgery is not performed), type of axilla surgery performed, pathological tumor size, number of pathological lymph nodes, pathological stage, lymphovascular and perineural invasion status, hormone receptor positivity, C-erb B2 and Ki-67 status, neoadjuvant treatment status, and molecular subgroup. Variables were analyzed individually for recurrence, mortality, and survival. Results found to be significant were subjected to multivariate analysis testing. Statistical significance was accepted as p<0.05. Results: As a result of multivariate analysis performed by excluding data that disrupted homogeneous distribution, perineural invasion, lymphovascular invasion, grade, and progesterone receptor status were determined to be independent prognostic factors in terms of recurrence. Lymphovascular invasion and progesterone receptor status were found to be independent prognostic factors for mortality. Conclusion: A lot of studies have been conducted, and criteria have been determined for breast cancer prognosis and survival. In our results, lymphovascular invasion and progesterone receptor status were found to be independent prognostic markers for both recurrence and mortality. More reliable results can be obtained with prospective study analyses.

The Significance of Preoperative Computed Tomography Features in the Prediction of Overall Survival in Gastric Cancer: A Retrospective Analysis.

Computed tomography (CT) is a frequently used modality for staging in the preoperative evaluation of gastric cancer (GC). Our aim was to interpret the importance of preoperative CT features in predicting overall survival (OS) in patients operated for GC. One hundred and one patients with GC (33 women, 68 men; range of age: 29-82 years, median age: 61 years) who had abdominal CT prior to surgical resection were included in the study retrospectively. Two radiologists evaluated CT scans to record the longest dimension of the tumor, the localization of the lesion, the attenuation values of the tumor in the arterial and venous phases (Hounsfield units), invasion depth of the lesion (T stage), and the number of pathological lymph nodes (LNs) (N stage). Postoperative pathological results including resection (R0, R1), T stage, N stage, grade, and histopathological subtype were documented. All CT-provided results and clinicopathological features associated with OS were analyzed by univariate, multivariate, and receiver operator characteristic analysis. Multivariate analysis revealed that none of the CT features were associated with the OS. After resection, the survival ratio was poor for the R1 and high-grade groups than for the R0 and low-grade groups (p=0.001 and p=0.005, respectively). N stage and the longest dimension of the tumor on CT imaging truly estimated R1 resection status (AUC, 0.697; sensitivity, 63%; and specificity, 88%, and AUC, 0.734; sensitivity, 18%; and specificity, 76%, respectively). R1 resection status is associated with poor OS in GC. CT features, including the tumor's longest dimension and the number of pathological LNs, can predict R1 resection status.

The Current Status of Ultrasonography and Fine-Needle Aspiration Citology for the Management of the Axilla in Breast Cancer

Objetive: to analyze whether ultrasonography with fine-needle aspiration cytology of an axillary suspicious node, in patients with breast cancer, could help to differentiate between patients with low involvement of the axilla (up to 2 nodes with macrometastasis) of those with high involvement of the axilla (more than 2 lymph nodes with macrometastasis). Material and methods: A total of 115 consecutive patients with breast cancer (up to 5 cm in diameter), with clinically negative axilla and pathologically positive axilla. All patients underwent preoperative axillary ultrasound and ultrasound-guided fine-needle aspiration cytology was performed in patients with suspicious nodes. In all patients with positive cytology, lymphadenectomy was performed. In all patients with negative ultrasound and cytology, sentinel lymph node biopsy was performed, and when it was positive, lymphadenectomy was performed. The number of pathological lymph nodes was evaluated after lymphadenectomy. Results: A total of 61 patients had positive axillary ultrasound and cytology. In 42 of them (69%), there were more than 2 pathological lymph nodes. There were 54 patients with negative axillary ultrasound and cytology. In 49 of them (90%), there were only 1 or 2 pathological lymph nodes. Axillary ultrasound and fine-needle aspiration cytology were able to identify 42 of the 47 patients (89%) with more than 2 pathological lymph nodes. Conclusion: ultrasound and ultrasound-guided fine-needle aspiration citology was able to identify, in a preoperative stage, those patients with high axillary involvement (more than 2 lymph nodes with macrometastasis). The latter are the patients who would benefit from lymphadenectomy of the axilla, ignoring the sentinel lymph node biopsy stage.

Elucidating the clinical-pathological factors and prognosis in breast cancer young surviving women who had a subsequent pregnant

Objective. To elucidate the impact of clinical-pathological factors on overall survival (OS) in patients who got pregnant after breast cancer treatment. Methods. Retrospective cohort of women age younger than 40 years with breast cancer history without active disease at diagnosis of postcancer pregnancy. Clinical-pathological factors were analized by age group and recent birth. Overall survival (OS) was evaluated from Kaplan-Meier method. The association between clinical-pathological factors and OS was examined using Cox proportional hazards method to estimate hazard ratio (HR) with 95% confidence intervals (CI). Results: A total of 14 patients were selected. Median age was 28.5 years (interquartile range, 26-35). Locally advanced stage (IIB-IIIB) was diagnosed in 64.3%. Patients lower than 35 years experienced more positive clinical lymph nodes (72.7%), grade 2 (63.6%) and ER/PgR-negative tumors (54.5% and 72.7%, respectively). The patients with ER-positive tumors showed an improvement non-significant at 5-year OS (87%; p = 0.097). In the bivariate analysis, patients with a higher number of pathological lymph nodes (pNs) had a 12% increase in the risk of death than those with lower number (HR = 1.12; 95% CI: 1.02 to 1.2). The multivariate model (after adjustment for number of pNs, age and tumor size) ascertained that the nodal status was the only independent predictor associated to a worse OS (HR = 1.15; 95% CI: 1.01 to 1.3). Conclusion. Pregnancy after cancer did not have a detrimental effect on survival. The patients < 35 years old group showed more unfavorable tumor features at diagnosis, which can largely explain a poorer prognosis. Nodal status was the most important prognostic factor that predicted the poor prognosis.

The Combination of T Stage and the Number of Pathologic Lymph Nodes Provides Better Prognostic Discrimination in Early-Stage Cervical Cancer With Lymph Node Involvement.

ObjectiveStage I and II cervical cancer with pelvic and/or para-aortic lymph node (LN) metastases are upstaged to stage IIIC under the new FIGO 2018 staging system, and radical chemoradiotherapy was recommended. But heterogeneity in outcome existed in this group of patients. We conducted this retrospective analysis to evaluate the heterogeneity of these patients and tried to provide a more detailed classification to reflect the prognosis and guide the treatment. We also evaluated the efficacy and toxicity of surgery followed by sequential chemoradiotherapy in this cohort.MethodsEarly-stage cervical cancer with LN involvement that had radical hysterectomy followed by sequential chemoradiotherapy were retrospectively analyzed. Survival analyses were conducted to identify the prognostic factors.ResultsA total of 242 patients were included in the study; 64 (26.4%) patients had treatment failure, and 51 (21.1%) died. Pathology, T stage, the number of pathologic LN (pLN), and neoadjuvant chemotherapy or not were independent prognostic factors for disease-free survival and overall survival (OS). Patients with T1N < 3 pLN had significantly better survival than T2N < 3 pLN/T1-2 N≥ 3 pLN, with failure rates of 11.6% and 35.8% in each group; and 5 year OS was 92% and 62%, respectively (P = 0.000). About 1.5% of the patients discontinued radiotherapy, and 14.1% had G3-4 hematological toxic effects during radiotherapy; 1.7% developed G2-3 lower limb edema, and 2.9% developed severe urinary toxicity.ConclusionNodal involvement alone is inadequate as the sole pathologic factor to predict survival in early-stage cervical cancer. The combination of tumor and node subcategory provides better prognostic discrimination.

The Indications for Elective Neck Dissection in T1N0M0 Oral Cavity Squamous Cell Carcinoma

The management of the clinically node-negative neck in T1 oral cavity squamous cell carcinoma (SCC) is controversial. The purpose of this study was to investigate tumor characteristics of surgically managed patients with T1N0 oral cavity SCC and determine the possible benefits of elective neck dissection (END). A retrospective cohort study was conducted assessing outcomes for patients with stage I oral SCC at Waikato Hospital, New Zealand, between 2008 and 2018. Clinical staging was based on the American Joint Committee on Cancer Cancer Staging Manual, 8th Edition. Patients with T1N0 SCC either had an END or had the neck observed. These data were used to determine the rate of occult nodal disease, recurrence rate, and survival. Data collected included patient demographics, location, tumor characteristics including differentiation, depth of invasion (DOI), perineural invasion (PNI), lymphovascular invasion, closest histologic margin, management of the neck, the number of pathologic lymph nodes, adjuvant treatment, recurrence, and survival. A total of 70 patients were included in the study (40 male, 30 female; age range 30 to 91; mean age 65years). Twenty-seven (38.6%) patients underwent END, whereas 43 patients (61.4%) were observed. Occult nodal metastases were diagnosed in 6 of 27 (22.2%) patients who underwent END. Regional relapse occurred in 7 of 43 (16.3%) patients who were observed. Risk factors for nodal disease included increasing DOI ≥ 3mm (P=.049), poor tumor differentiation (P=.003), and presence of PNI (P=.002). Negative prognostic factors for overall survival included male gender (P=.02, hr=3.55, CI for HR (1.18, 10.65)), presence of PNI (P=.001, hr=4.52, CI for HR (1.77, 11.57)), and locoregional recurrence (P<.005, hr=6.55, CI for HR (2.69, 15.98)). Six of the 7 tumors that relapsed in the neck after observation had a primary tumor DOI < 3mm. There is little data published for management outcomes of the node-negative neck in stage I oral squamous cell carcinoma. Given salvage neck dissection carries a poorer prognosis, END should be recommended for all T1N0 oral SCC with DOI ≥ 3mm. In cases of DOI < 3mm undergoing primary ablation only, a staging neck dissection as a second procedure should be considered in the presence of poor tumor differentiation or PNI on final histology.

“Rectal cancer survival: A retrospective analysis of MRI features and their association with prognosis”

PurposeTo assess rectal cancer aggressiveness using magnetic resonance (MR) imaging features and to investigate their relationship with patient prognosis. Materials and methodsClinical information and Pelvic MR scans of 106 consecutive patients with primary rectal cancer (RC) were analyzed. Clinical symptoms, age, sex, tumor location, and patient´s survival were recorded. The variables investigated by MR were: depth or mural/extramural tumor involvement, distance to mesorectal margin, lymph node involvement, vascular, peritoneal or sphincter complex infiltration. The association between imaging features and disease-free survival (DFS) was also assessed using a Kaplan-Meier model. Differences between survival curves were tested for significance using the Mantel-Cox LogRank test. ResultsThe final study population was 106 patients (65 males, 41 females). The median age was 69.5 years (range, 39-92 years). No significant differences were found between death risk and sex, age or tumor location (p>0,05). However, the relative risk (RR) of tumor mortality increased significantly with the presence of the variables: vascular infiltration (×5), T4 tumors (× 4.57), N2 lymph node involvement (more than 3 affected nodes × 4.11) and mesorectal fascia involvement (× 3,77). ConclusionTumor extension, number of pathological lymph nodes, mesorectal fascia involvement and vascular infiltration values obtained on initial MR imaging staging showed a significant difference for disease-free survival in RC at six years of control.

Development and Validation of a Risk Model for Breast Cancer–Related Lymphedema

Approximately 1 in 5 patients with breast cancer who undergo axillary lymph node dissection will develop lymphedema. To appropriately triage and monitor these patients for timely diagnosis and treatment, robust risk models are required. To evaluate the prognostic value of mammographic breast density in estimating lymphedema severity. This prognostic study collected data from July 16, 2018, to March 3, 2020, from the electronic health records of patients of the Cancer Rehabilitation and Survivorship Program at the Princess Margaret Cancer Centre in Toronto, Ontario, Canada. Participants included women who had completed curative treatment for a first diagnosis of breast cancer and who were referred to the program. Also included were a sample of patients in the general breast oncology population who were receiving follow-up care at the center during the same period but who were not referred to the program. All patients attended follow-up appointments at the Princess Margaret Cancer Centre from January 1, 2016, to May 1, 2018. The cohort was randomly split 2:1 to group patients into a training cohort and a validation cohort. Participant demographic and clinical characteristics included age, sex, body mass index (BMI), medical history, cancer characteristics, and cancer treatment. Spearman correlation coefficient between measured and predicted volume of lymphedema was calculated. Area under the curve (AUC) values were generated for predicting the occurrence of at least mild lymphedema (volume, >200 mL) and severe lymphedema (volume, >500 mL) at the time of initial lymphedema diagnosis. A total of 373 female patients (median [interquartile range] age, 52.3 [45.9-60.1] years) were eligible for this analysis. Multivariate linear regression identified 3 patient factors (age, BMI, and mammographic breast density), 1 cancer factor (number of pathological lymph nodes), and 1 treatment factor (axillary lymph node dissection) as independent prognostic variables. In validation testing, Spearman correlation revealed a statistically significant moderate correlation (coefficient, 0.42; 95% CI, 0.26-0.56; P < .001) between measured volume and predicted volume of lymphedema. The AUC values were 0.72 (95% CI, 0.60-0.83) for predicting the occurrence of mild lymphedema and 0.83 (95% CI, 0.74-0.93) for severe lymphedema. This prognostic study found that patients with low breast density appeared to be at a higher risk of developing severe lymphedema. The finding suggests that by combining breast density with established risk factors a multivariate linear regression model could be used to predict the development of lymphedema and provide volumetric estimates of lymphedema severity in patients with breast cancer.

Relationship of Preoperative Serum Uric Acid Level with Survival in Colorectal Cancer

To investigate the prognostic significance of uric acid level in colorectal cancer in addition to conventional factors in terms of survival. Observational Study. At the University of Health Sciences, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey, between January 2012 and December 2019. Methodology: A total of selected 332 patients, who underwent surgery for colorectal cancer between 2012 and 2019, were retrospectively reviewed. Patients with a history of neoadjuvant therapy due to rectal cancer, GUT disease, renal failure, stage 4 disease, emergency surgery and severe preoperative infection, were excluded from the study. Peripheral blood samples were collected about a week before the operation. Serum uric acid (SUA) values were measured and recorded. Results: The patients comprised 198 males and 134 females with a mean age 62.2 ±11.7 years (14-91) years in total. Conventional surgery was performed in 228 patients, and laparoscopy in 104 patients. Uric acid level, number of pathological lymph nodes, number of pathological lymph nodes/total number of lymph nodes (LNO), perineural invasion, type of surgery and disease stage were found to be factors affecting the prognosis (p <0.05). Uric acid cut off value of 5.3 or higher was found to be statistically significant in terms of survival. Serum uric acid (SUA) value measured preoperatively was found to be a prognostic factor for colorectal cancer. Key Words: Serum uric acid (SUA), Colon cancer, Rectal cancer, Prognostic factor.

Rol de la ecografía y punción con aguja fina en el manejo de la axila en pacientes con cáncer mamario, en la era posterior al ACOSOG Z0011

ObjectiveTo determine whether ultrasound and ultrasound-guided fine-needle aspiration in patients with breast cancer who meet the ACOSOG Z0011 selection criteria can identify those with high axillary involvement (more than 2 lymph nodes with macrometastases). Material and methodsA total of 115 consecutive patients with breast cancer (up to 5cm in diameter), with clinically negative axilla and pathologically positive axilla. All patients underwent preoperative axillary ultrasound. Ultrasound-guided fine-needle aspiration cytology was performed in patients with suspicious nodes on ultrasound. In all patients with positive cytology, lymphadenectomy was performed. In all patients with negative ultrasound and cytology, sentinel lymph node biopsy was performed, and when it was positive, lymphadenectomy was performed. The number of pathological lymph nodes was evaluated after lymphadenectomy. ResultsA total of 61 patients had positive ultrasound and axillary cytology. In 42 of them (69%), there were more than 2 pathological lymph nodes. There were 54 patients with negative ultrasound and axillary cytology. In 49 of them (90%), there were only 1 or 2 pathological lymph nodes. Axillary ultrasound and fine-needle aspiration cytology were able to identify 42 of the 47 patients (89%) with more than 2 pathological lymph nodes. ConclusionIn patients with breast cancer who meet the ACOSOG Z0011 selection criteria, ultrasound and ultrasound-guided fine-needle aspiration can accurately identify those with high axillary involvement (more than 2 lymph nodes with macrometastasis), which would benefit from lymphadenectomy.

Multivisceral Resection for Locally Advanced Gastric Cancer

The role of multivisceral resection, in the setting of locally advanced gastric cancer, is still debated. Previous studies have reported a higher risk for perioperative morbidity and mortality, with limited objective benefit in terms of survival. Conversely, recent studies have shown the feasibility of enlarged resections and the potential advantage of extended resection for clinical stage T4b gastric adenocarcinoma with good long-term results. To analyze the role of multivisceral resection for locally advanced gastric cancer with particular attention to the brief and long-term results and to the prognostic value of clinical and pathologic factors. Prospective multicenter study using data from between January 1, 1995, and December 31, 2008. Seven Italian surgery centers. A total of 2208 patients underwent curative resections for gastric carcinoma at the centers. Among them, 206 patients presented with a clinical T4b carcinoma. One hundred twelve underwent a combined resection of the adjacent organs with a gastrectomy owing to suspicion or direct invasion of these organs by the gastric cancer. Clinical and pathologic variables were prospectively collected and the feasibility and efficacy of multivisceral resection for locally advanced clinical T4b gastric cancer were assessed. Postoperative mortality and complication rates of patients who underwent a gastrectomy with a combined resection of the involved organs were 3.6% and 33.9%, respectively. Pathologic factors revealed that the nodal involvement was present in about 89.3% of patients and the mean (SD) number of pathologic lymph nodes was 14.8 (16.6). The overall 5-year survival rate was 27.2%. The completeness of resection and lymph node invasion represent independent prognostic parameters at multivariate analysis. Our study indicates that patients undergoing extended resections experience acceptable postoperative morbidity and mortality rates, and an en bloc multivisceral resection should be performed in patients when a complete resection can be realistically obtained and when lymph node metastasis is not evident.

Single-port laparoscopic right hemicolectomy: the learning curve.

Single-port laparoscopic colectomy is described as a new technique in colorectal surgery. The initial case reports show the safety and feasibility, but the learning curve for this technique is unknown. Between July 2009 and September 2010, 20 consecutive patients with an indication for right hemicolectomy underwent a single-port laparoscopic approach without bias in selection. The only exclusion criterion was a prior midline laparotomy. The patients were followed up for 30 days. Chart review was completed for up to 35 months to assess long-term morbidity and mortality rates. The median age was 65 years (range, 59-88 years). Ninety percent of patients were men. The median body mass index was 28 kg/m(2) (range, 20-35 kg/m(2)). Seventy-five percent of patients had significant comorbidities with an American Society of Anesthesiologists class of 3 or 4. The estimated blood loss was 25 mL (range, 25-250 mL). The median number of pathologic lymph nodes for patients diagnosed with adenocarcinoma was 16 (range, 8-23). There was one conversion to hand-assisted laparoscopic (case 6) and one to open colectomy (case 9) because of the inability to achieve safe vessel ligation. The median hospital stay was 4.5 days (range, 3-7 days). The length of stay for the first 10 patients was 5.1 days, and it was 3.9 days for the last 10 patients (P = .045). There were no significant postoperative complications within 30 days. The mean operative time for the first 10 cases was 198 minutes (range, 148-272 minutes), and it was 123 minutes (range, 98-150 minutes) for the subsequent 10 cases (P = .0001). All intraoperative complications (minor bleeding) occurred within the first 10 patients, with no significant bleeding recorded for the last 10 cases. Single-port laparoscopic right hemicolectomy can be safely performed in patients who are candidates for conventional or hand-assisted right hemicolectomy with very low intraoperative and postoperative complication rates. The 30-day morbidity rate remained low with this technique. The higher technical difficulty compared with conventional laparoscopy is reflected in the longer initial operative times. The learning curve for a surgeon with advanced laparoscopic skills and adequate procedure numbers seems to be short, requiring approximately 10 cases to decrease operative times to baseline. The role and feasibility of broad adaptation for single-incision laparoscopy in colorectal surgery need to be further evaluated in larger case series and trials.

The Effects of the Factors Related to the Patient and the Disease on the Performance of Ablation Therapy in Patients with Differentiated Thyroid Cancer who have Received I-131 Ablation Therapy

Objective: To investigate whether the factors related to the patient and the disease have any effect on the success of ablation therapy in patients with differentiated thyroid cancer who have received I-131 ablation therapy.Material and Methods: All the patients with differentiated thyroid cancer were referred for I-131 ablation therapy after thyroidectomy between July 2007 and September 2009. The patients had at least six months of follow-up. Age, gender, type of tumor, presence of capsule invasion, size of tumor, number of the tumors, localization of the tumor, invasion of thyroid capsule, lymph/vessel invasion, presence of metastatic lymph nodes, type of surgery, preablation values of thyroglobulin (Tg), AntiTg, TSH, surveys for the evaluation of metastatic disease, (thyroid and bone scintigraphy, neck and abdominal ultrasonography, chest and brain computerized tomography), administered dose, postablation I-131 whole body scan (WBS) and diagnostic I-131 WBS, neck USG, values of Tg and AntiTg at the 6th month were recorded. The presence of residual thyroid activity on the 6th month diagnostic I-131 WBS image was accepted as the criterion for ablation success.Results: 191 patients with differentiated thyroid cancer were assessed in this study. The overall success rate of the first ablation therapy was 74.3%. The success rate of the ablation therapy was 66% and 75% in metastatic group and non-metastatic group, respectively. Except the significant correlation between the number of pathologic lymph nodes and the success of ablation (p=0.025), there was no other significant correlation between the patient/disease related factors and the success of ablation therapy.Conclusion: Significant correlation between the number of the pathologic lymph nodes and the ablation therapy performance can also be due to statistical error because of the limited sample size. There was no significant correlation between other patient/disease related prognostic factors and the success of ablation therapy.Conflict of interest:None declared.

P-0197 Common VEGF Gene Polymorphisms are Not Associated With Relapse-Free Survival in Colorectal Cancer Patients

ABSTRACT Introduction The formation of new blood vessels, a phenomenon known as angiogenesis, is essential for tumor growth and development of metastases. The most important regulator of this process is vascular endothelial growth factor (VEGF). Several common polymorphisms in the VEGF-gene have been associated with different VEGF expression, production and plasma levels according to allele status. It was demonstrated that these genetic variants also have influence on susceptibility, development of metastases as well as survival in various types of cancer. Therefore, these variants could have an impact on relapse-free survival of patients with colorectal cancer (CRC). Methods To test this hypothesis, VEGF genotypes of the +936 C>T, -2578 C>A and -634 G>C polymorphisms were determined in genomic DNA extracted from peripheral blood of 433 Caucasian patients with histologically proven CRC. The different genotypes were analyzed by a fluorogenic exonuclease assay (TaqMan™). Results 159 patients (37%) developed metastases, relapsed or died during a follow-up of maximum 10 years (Mean follow-up time 58±34 months, median 55 months). In a cox regression model including the different VEGF genotypes, age at diagnosis, tumor grade, tumor size, stage (AJCC), number of lymph nodes evaluated, number of pathologic lymph nodes and administration of adjuvant 5-FU containing chemotherapy we were not able to detect a correlation between these polymorphisms and relapse-free survival. The relative risk (RR) for the +936 C>T SNP was 0.889 (95% CI: 0.619-1.279, p=0.527), for the -2578 C>A SNP 1.062 (95% CI: 0.780-1.446, p=0.704) and for the -634 G>C SNP 1.162 (95% CI: 0.846-1.595, p=0.355). Conclusion We conclude that the investigated polymorphisms show no association with relapse-free survival for Caucasians suffering from colorectal cancer.

The number of pathologic lymph nodes involved is still a significant prognostic factor even after neoadjuvant chemoradiotherapy in esophageal squamous cell carcinoma

The correlation between the number of pathologic metastatic LNs in patients with esophageal squamous cell carcinoma (ESCC) after neoadjuvant chemoradiotherapy (NACRT) and surgical outcome has rarely been reported. We evaluated the correlation between the number of pathologic metastatic lymph nodes (LNs) and the surgical outcome in ESCC after NACRT. Eighty-eight patients with ESCC who underwent NACRT followed by surgery were evaluated. The clinical response of NACRT was evaluated and surgical specimens of the primary tumor and resected LNs were analyzed clinicopathologically. Fewer pathologic metastatic LNs was associated with better survival. According to the number of metastatic LNs, the difference in the median survival was the largest between the groups when patients were divided into those with 2 and 3 metastatic LNs (χ(2) : 13.694, P < 0.001). With regard to clinical factors, the initial N status prior to treatment had the most significant impact on survival by a univariate analysis (P = 0.064), and the number of pathologic metastatic LNs was a risk factor for poor survival, with a hazard ratio of 5.128 (95% C.I.: 1.438-18.285, P = 0.012) by a multivariate analysis. Of the various factors, the number of pathologic metastatic LNs was the strongest indicator to predict the patients' survival.

Does N ratio affect survival in D1 and D2 lymph node dissection for gastric cancer?

To identify whether there could have been changes in survival if lymph node ratio (N ratio) had been used. We assessed 334 gastric adenocarcinoma cases retrospectively between 2001 and 2009. Two hundred and sixteen patients out of 334 were included in the study. Patients were grouped according to disection1 (D1) or dissection 2 (D2) dissection. We compared the estimated survival and actual survival determined by Pathologic nodes (pN) class and N ratio, and SPSS 15.0 software was used for statistical analysis. Ninety-six (44.4%) patients underwent D1 dissection and 120 (55.6%) had D2 dissection. When groups were evaluated, 23 (24.0%) patients in D1 and 21 (17.5%) in D2 had stage migration (P = 0.001). When both D1 and D2 groups were evaluated for number of pathological lymph nodes, despite the fact that there was no difference in N ratio between D1 and D2 groups, a statistically significant difference was found between them with regard to pN1 and pN2 groups (P = 0.047, P = 0.044 respectively). In D1, pN0 had the longest survival while pN3 had the shortest. In D2, pN0 had the longest survival whereas pN3 had the shortest survival. N ratio is an accurate staging system for defining prognosis and treatment plan, thus decreasing methodological errors in gastric cancer staging.

Extent of extracapsular spread: a critical prognosticator in oral tongue cancer.

Extracapsular spread (ECS) of metastatic squamous cell carcinoma of the head and neck to regional lymph nodes is the most reliable predictor of poor treatment outcomes. Recently, the authors have shown that ECS is significantly associated with higher rates of locoregional recurrence, distant metastasis, and decreased survival in patients with squamous cell carcinoma of the oral tongue (SCCOT). The purpose of this review was to determine if the degree of ECS impacts distant metastasis rates and survival. Two hundred sixty-six patients treated for SCCOT with surgery +/- adjuvant radiotherapy from 1980-1995 were reviewed. The setting was a tertiary referral center. The extent of ECS on histopathologic review of involved lymph nodes was measured from the capsular margin to the farthest perinodal extension in mm. Extent of ECS and the number of pathologic lymph nodes with or without ECS were analyzed for disease-free interval, survival rates, and distant metastases. No differences in the survival of patients with ECS of </= 2 mm or > 2 mm was found (P = 0.92). Patients with both ECS and multiple positive lymph nodes had decreased overall survival (P = 0.0003), disease-specific survival (P = 0.0005), and a shorter disease-free interval (P = 0.019) when compared with those with a single positive lymph node with ECS. Those with multiple ECS+ lymph nodes had the worst prognosis (P = 0.001). Based on these findings, the authors recommended that all patients with SCCOT with ECS or multiple positive lymph nodes with or without ECS on pathologic review be considered for clinical trials that intensify regional and systemic adjuvant therapy.

Rectal endosonography in inflammatory bowel disease: differential diagnosis and prediction of remission.

There are few and conflicting data on EUS features of the rectal wall in Crohn's disease (CD) and ulcerative colitis (UC). The aim of our study was to determine whether rectal EUS could first differentiate between CD and UC, and secondly predict remission in CD. During a 14 month period we prospectively and blindly studied several parameters on rectal EUS (total wall thickness, mucosal appearance, submucosal thickness, number of enlarged vessels in the submucosa and number of pathological lymph nodes around the rectum and sigmoid colon) in 20 normal subjects, 26 patients with UC, 39 patients with CD, and four with infectious colitis. Comparisons were made between normal controls, patients with acute UC and those with acute CD, as well as between acute flare-ups and quiescent forms of CD and UC in the same patients. Normal subjects showed some features which were significantly different from those in CD or UC patients. A greater number of pathological lymph nodes was characteristic for acute UC, whereas the number of enlarged vessels was increased in acute CD. Quiescent CD showed a lower amount of wall thickening than acute CD. No significant alterations of the five parameters were found in quiescent UC compared to acute UC. This study suggests that EUS could be helpful in differentiating acute UC from CD, and to predict remission in CD.