Pathological Lymph Node Metastasis Research Articles

Prognostication of Overall Survival in Muscle Invasive Bladder Cancer: An Application of a Lymph Node Metastasis Nomogram

The purpose of this study was to determine if a previously developed nomogram predictive of developing pathologic lymph node metastasis after multiagent chemotherapy for clinical node-negative muscle invasive bladder cancer may also prognosticate overall survival (OS) in patients treated with definitive chemoradiotherapy (CRT). Using the National Cancer Database, we identified all patients with cN0 muscle invasive urothelial carcinoma of the bladder treated with definitive CRT from 2004 to 2020. Patient probability of occult nodal disease was assessed using a previous nomogram developed from those treated with multiagent chemotherapy alone followed by pathologic nodal assessment. Following a 70:30 training and testing data split, variables were assessed for association with OS using the log-rank test, with those with p < 0.05 deemed eligible for inclusion within a multivariate Cox proportional hazards model. Patients were then stratified as high-, medium-, or low-risk for death using the hazard function's prognostic index. The proportional hazards assumption was checked using Schoenfeld residuals and discrimination assessed using dynamic area under the receiver operating characteristics curves (AUC). Validation was assessed within the testing and a retrospectively collected institutional cohort of 15 patients treated from 2014 - 2020 with CRT. A total of 1047 patients were identified for this study with median age of 78 years (IQR = 70-83 years) and follow-up of 31.3 months (IQR = 16.0 - 56.6 months). Cox analysis revealed patient age (HR = 1.03; 95% CI = 1.02 - 1.04; p < 0.001), Charlson-Deyo Score, and predicted probability of developing future lymphadenopathy (HR = 4.47; 95% CI = 1.83 - 10.93; p = 0.001) were significantly associated with OS. Median OS for those identified as high, medium, and low risk for death on Cox analysis was 34.2 months (IQR = 21.3 - 40.6 months), 38.9 months (IQR = 31.4 - 47.2 months), and 77.8 months (IQR = 56.1 - 100.3 months), respectively (AUC range = 0.615 - 0.870) (p < 0.001). Similar discrimination was seen within the testing cohort as well with significant differences between median OS across each group (AUC range = 0.580 - 0.726) (p < 0.001). Notably, among patients within the institutional cohort, only one patient stratified as high (N = 1/2; 50.0%) or medium risk (N = 0/5; 0.0%) remained alive at time of final follow-up, whereas 88.9% (N = 7/8) of low-risk patients survived (p = 0.051). Similarly, significant differences in OS were again seen between risk groups, with a median OS of 51.3 months and 19.9 months for high- and medium-risk patients, respectively, while median OS for low-risk patients was not reached (p = 0.006). This study demonstrates the prognostic utility of a previously reported nomogram in predictions of OS. Investigation is warranted to explore how radiation and chemotherapy may offset worse OS in those at high risk for occult nodal disease progression.

Portomesenteric venous contact ≤180° and overall survival in resectable head and body pancreatic adenocarcinoma treated with upfront surgery

IntroductionUpfront surgery is the standard of care for resectable pancreatic cancer, defined as the absence of or ≤180° tumour contact with the portal/superior mesenteric vein. We hypothesized that portomesenteric venous tumour contact is prognostically unfavourable and aimed to assess whether it is associated with poorer survival compared with no venous contact in resectable head and body pancreatic cancer. MethodsThis single-centre retrospective study included patients undergoing upfront surgery for resectable head and body pancreatic cancer in 2010–2020 at Umeå University Hospital, Sweden. No venous contact was compared with portomesenteric venous contact of ≤180° based on preoperative imaging. Overall survival on an intention-to-treat basis was compared with Kaplan-Meier curves, a log-rank test and Cox proportional hazards models. ResultsThe final study cohort included 39 patients with portomesenteric venous tumour contact and 144 patients without venous tumour contact. Patients with venous tumour contact had a median overall survival of 15.3 months compared to 23.0 months (log rank P = 0.059). Portomesenteric venous tumour contact was an independent negative prognostic factor for survival in the multivariable Cox model (HR 1.68; 95% CI 1.11–2.55, P = 0.014) and was associated with higher rates of microscopically non-radical resections (R1) (50% vs 26.1%, P = 0.012) and pathological lymph node metastasis (76.7% vs 56.8%, P = 0.012). There was no difference in adjuvant chemotherapy receipt or postoperative complications between the groups. ConclusionsPortomesenteric venous tumour contact is associated with poorer overall survival and higher rates of R1 resections and lymph node metastasis in patients with resectable head and body pancreatic cancer treated with upfront surgery.

A comparison of 18F-FDG PET-based radiomics and deep learning in predicting regional lymph node metastasis in patients with resectable lung adenocarcinoma: a cross-scanner and temporal validation study.

The performance of 18F-FDG PET-based radiomics and deep learning in detecting pathological regional nodal metastasis (pN+) in resectable lung adenocarcinoma varies, and their use across different generations of PET machines has not been thoroughly investigated. We compared handcrafted radiomics and deep learning using different PET scanners to predict pN+ in resectable lung adenocarcinoma. We retrospectively analyzed pretreatment 18F-FDG PET from 148 lung adenocarcinoma patients who underwent curative surgery. Patients were separated into analog (n = 131) and digital (n = 17) PET cohorts. Handcrafted radiomics and a ResNet-50 deep-learning model of the primary tumor were used to predict pN+ status. Models were trained in the analog PET cohort, and the digital PET cohort was used for cross-scanner validation. In the analog PET cohort, entropy, a handcrafted radiomics, independently predicted pN+. However, the areas under the receiver-operating-characteristic curves (AUCs) and accuracy for entropy were only 0.676 and 62.6%, respectively. The ResNet-50 model demonstrated a better AUC and accuracy of 0.929 and 94.7%, respectively. In the digital PET validation cohort, the ResNet-50 model also demonstrated better AUC (0.871 versus 0.697) and accuracy (88.2% versus 64.7%) than entropy. The ResNet-50 model achieved comparable specificity to visual interpretation but with superior sensitivity (83.3% versus 66.7%) in the digital PET cohort. Applying deep learning across different generations of PET scanners may be feasible and better predict pN+ than handcrafted radiomics. Deep learning may complement visual interpretation and facilitate tailored therapeutic strategies for resectable lung adenocarcinoma.

Clinical Significance of Radical Prostatectomy in Clinical Lymph Node Metastasis in Prostate Cancer.

This study aimed to investigate the role of radical prostatectomy (RP) among clinical nodal metastasis prostate cancer and whether histological confirmation of lymph node metastasis through surgery can help with treatment. After excluding patients with distant metastatic prostate cancer or neoadjuvant androgen deprivation therapy, 42 patients with clinical nodal metastasis who underwent RP at our institution were included in the study. We classified them as having or not having pathological lymph node metastasis. Clinicopathologic data were analyzed in this retrospective chart review. Kaplan-Meier analysis was used to calculate the estimated castration-resistant prostate cancer (CRPC)-free survival, biochemical recurrence (BCR)-free survival, and cancer-specific survival (CSS). There is no significant difference in age, presence of diabetes mellitus, hypertension, BCR time, CRPC time, overall survival, salvage RT rate, and initial prostate-specific antigen level between the two groups. However, there is a significant difference in the pathology N1 group in terms of pathological T stage, pathologic Gleason score, BCR rate, CRPC rate, and CSS. A multivariate Cox proportional hazard regression analysis was used to identify predictors of CRPC-free survival. Patients with pathological lymph node metastasis had a shorter CRPC-free survival [hazard ratio (HR) 4.87; 95% confidence interval (CI) 1.25-19.00, p = 0.02]. Radical prostatectomy can confirm lymph node metastasis. Although pathologic diagnosis has no effect on time to BCR and CPRC, because it affects BCR rate, CRPC rate, and CSS, an accurate pathological diagnosis obtained through surgery is beneficial in the treatment of clinical lymph node metastasis prostate cancer.

147. CHARACTERISTICS AND PREDICTORS OF EARLY POSTOPERATIVE RECURRENCE OF ESOPHAGEAL CANCER

Abstract Background Recurrence after radical esophageal cancer surgery is known to occur in 30–50% of cases, mostly within 2 years after surgery. This study aimed to clarify the characteristics of patients with early recurrence within 6 months after esophageal cancer surgery and the risk factors for early recurrence. Methods A total of 350 patients who underwent esophagectomy between January 2011 and August 2021 were included in this study. Patient background factors were compared among three groups: the early recurrence group with recurrence within 6 months after surgery, the late recurrence group with recurrence after 6 months after surgery, and the recurrence-free group. Multivariate logistic regression was used to analyze the association between various predictors and early postoperative recurrence. Results Postoperative recurrence occurred in 141 patients (40.1%). Recurrence within 6 months after surgery occurred in 65 patients, and recurrence after 6 months in 76 patients. The proportion of advanced clinical stage increased in patients with early postoperative recurrence. Significant differences between the three groups were found for CRP, SCC, Neutrophil, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio. Prognostic nutrition index、advanced lung cancer inflammation (BMI × Alb/NLR) were significantly less in patients with early postoperative recurrence. Multivariate analysis showed that clinical stage, pathological lymph node metastasis, and NLR were independent prognostic factors for early postoperative recurrence. Conclusions Preoperative NLR may be a valuable early postoperative recurrence factor for patients with esophageal cancer undergoing esophagectomy.

243. COMPARISON BETWEEN THE THERAPEUTIC AND PROPHYLACTIC LYMPHADENECTOMY OF THE SUPRACLAVICULAR AREA FOR PATIENTS WITH ESOPHAGEAL CANCER

Abstract Backgrounds Lymphadenectomy of the supraclavicular area (SCA) for patients with esophageal cancer has still remained controversial. Some previous studies showed that it could not improve survival. In this study, we retrospectively investigated the results of therapeutic and prophylactic lymphadenectomy around SCA for patient with esophageal cancer. Methods From 2010 to 2015, the patients who underwent esophagectomy with 3-fields lymphadenectomy were enrolled in this study. Patients with cervical esophageal cancer and with pN3 were excluded. Clinical nodal metastasis was decided on CT findings. Efficiency of index for lymphadenectomy (EI) was calculated with nodal incidence multiplied by 3-year relapse free survival (3yRFS). Results A total of 514 patients was enrolled in this study. Therapeutic lymphadenectomy was performed in 47 patients, and prophylactic lymphadenectomy was performed in 467 patients. In the therapeutic lymphadenectomy group, nodal metastasis was found in 17 patients (36.2%) and 3yRFS of these patients was 34.3%, and EI was 12.4. Meanwhile, in the prophylactic group, nodal metastasis was found in 14 (3.0%) and 3yRFS of these patients was 35.7%, and EI was 1.1. Of 514 patients, 138 received neo-adjuvant treatments. In the neo-adjuvant group, EI of the therapeutic lymphadenectomy was 21.5, and that of the prophylactic lymphadenectomy was 2.7. In the upfront surgery group, EI of the therapeutic lymphadenectomy was 0, and that of the prophylactic lymphadenectomy was 0.6. Conclusion The 3yRFS of the patients with pathological nodal metastasis in the SCA was relatively good. However, EI in the prophylactic group was very low due to very low incidence of the pathological nodal metastasis in the SCA. Clinical significance of prophylactic lymphadenectomy of SCA is not clear based on our data.

42 Can Cross-Sectional Imaging Reliably Determine Pathological Staging of Right Sided Colon Cancers and Select Patients for More Radical Surgery or Neo-Adjuvant Treatment?

Abstract Aim Cross sectional imaging with CT scanning is the most commonly performed imaging modality to stage right sided colon cancers. There is increasing evidence for the use of neo-adjuvant chemotherapy in selected patients and debate about the role of complete mesocolic excision (CME) and central vascular ligation (CVL) in the management of locally advanced colon cancers. Predicted tumour stage and presence of nodal by CT is often used to select patients for neo-adjuvant chemotherapy and those that may benefit metastases from CME. This study aims to compare predicted radiological T and N staging with final pathological T and N staging in elective patients having potentially curative surgery for right sided colon cancer. Method Retrospective analysis of a prospectively gathered database of all patients who had undergone (true) right hemicolectomy between 02/01/13 and 21/05/20. Sensitivity, specificity, positive predictive value, and negative predictive value for CT scanning with regards pathological nodal metastases were calculated and analysed. Results The sensitivity and specificity of radiology staging for predicating nodal status were 76.4% and 65.5% respectively. The positive predictive value of CT staging for correctly identifying nodal metastases was 55.3%, with a negative predictive value of 77.3%. Conclusions This large series adds further evidence that CT, even when reviewed by expert GI radiologists, has limited accuracy at identifying lymph node metastases in colon cancer.

Sublobar resection in non-small cell lung cancer: patient selection criteria and risk factors for recurrence.

To validate selection criteria for sublobar resection in patients with lung cancer with respect to recurrence, and to investigate predictors for recurrence in patients for whom the criteria are not suitable. Patients who underwent sublobar resection for lung cancer between July 2010 and December 2018 were retrospectively included. The criteria for curative sublobar resection were consolidation-to-tumor ratio ≤0.50 and size ≤3.0 cm in tumors with a ground-glass opacity (GGO) component (GGO group), and size of ≤2.0 cm and volume doubling time ≥400 days in solid tumors (solid group). Cox regression was used to identify predictors for time-to-recurrence (TTR) in tumors outside of these criteria (non-curative group). Out of 530 patients, 353 were classified into the GGO group and 177 into the solid group. In the GGO group, the 2-year recurrence rates in curative and non-curative groups were 2.1 and 7.7%, respectively (p = 0.054). In the solid group, the 2-year recurrence rates in curative and non-curative groups were 0.0 and 28.6%, respectively (p = 0.03). Predictors of 2-year TTR after non-curative sublobar resection were pathological nodal metastasis (hazard ratio [HR], 6.63; p = 0.02) and lymphovascular invasion (LVI; HR, 3.28; p = 0.03) in the GGO group, and LVI (HR, 4.37; p < 0.001) and fibrosis (HR, 3.18; p = 0.006) in the solid group. The current patient selection criteria for sublobar resection are satisfactory. LVI was a predictor for recurrence after non-curative resection. This result supports selection criteria of patients for sublobar resection. LVI may help predict recurrence after non-curative sublobar resection.

Survival Trends and Profiling of Gastric Mixed Adenoneuroendocrine Carcinoma (gMANEC) in the Current Era

Background: Gastric mixed adenoneuroendocrine carcinoma (gMANEC) is a histopathologic diagnosis with at least 30% each of exocrine and endocrine components. Although prognosis is thought to be driven by the relative exocrine or endocrine dominance, gMANEC has been clinically treated as gastric adenocarcinoma (gAC). The overall survival of gMANEC as compared to gastric neuroendocrine carcinoma (gNEC) or gAC remains undefined. Methods: Using the National Cancer Database, patients with gastric tumors were queried from 2004 to 2016 for gMANEC, gNEC, and gAC histologies. Demographic and clinicopathologic features were recorded. Univariate and multivariate Cox proportional hazards analyses were performed to delineate factors associated with overall survival (OS). Results: Overall, 404 patients diagnosed with gMANEC were identified. Patients had a median age 68 years, were majority male, and predominantly Caucasian. Gastric MANEC was more frequently poorly differentiated (73%vs 52% (gAC) vs 20% (gNEC), P &lt; .001) with lymphovascular invasion (57%vs 38%vs 27%, P &lt; .001) and lymph node involvement (59%vs 49%vs 36%, P &lt; .001); these factors were associated with worse OS on univariable analysis. Finally, tumors &gt;5 cm and lymph node involvement were independent predictors of worse survival. The median OS of patients with gMANEC was 41.5 months. Conclusion: Gastric MANEC and gAC have a similarly dismal prognosis and thus should be continued to treat like gAC. Pathologic nodal metastasis, tumor size and grade are useful prognostic factors.

High monoamine oxidase a expression predicts poor prognosis for prostate cancer patients

BackgroundMonoamine oxidase A (MAOA) is a mitochondrial enzyme that is involved in prostate tumorigenesis and cancer metastasis. The predictive power of the preoperative clinical and pathological indicators for prostate cancer(PC) remains to be improved. To enrich evidence regarding the value of MAOA as a prognostic biomarker in clinical practice, this study explored the significance of MAOA expression as a prognostic marker for patients with PC after radical prostatectomy-pelvic lymph node dissection (RP-PLND).MethodsMAOA expression was analyzed in 50 benign prostate tissues and 115 low-intermediate risk and 163 high-risk PC tissues using tissue immunohistochemistry (IHC). Propensity score matching, survival analysis and COX regression analysis were conducted to investigate the correlation between high MAOA expression and progression free survival (PFS) in PC patients.ResultsMAOA expression was increased in PC patients, especially in those with high risk PC and pathological lymph node (pLN) metastasis. High MAOA expression was significantly associated with PSA recurrence for both low-intermediate risk PC patients (log-rank test: P = 0.02) and high risk PC patients (log-rank test: P = 0.03). Cox regression analysis revealed that high MAOA expression was an adverse prognostic factor for both low-intermediate risk PC patients (hazard ratio [HR] 2.74, 95% confidence interval [CI] 1.26–5.92; P = 0.011) and high risk PC patients (HR 1.73, 95% CI 1.11–2.71; P = 0.016). High MAOA expression was also significantly associated with PSA recurrence in high risk PC patients developed into castration-resistant prostate cancer (CRPC) and were receiving abiraterone therapy (log-rank: P = 0.01).ConclusionsMAOA expression correlates with the malignant progression of PC. High MAOA expression may be a poor prognostic marker for patients with PC after RP-PLND. More careful follow up or potential of adjuvant hormonal therapy may be addressed for patients with high MAOA expression.

An accurate prediction of negative lymph node metastasis with consideration of glucose metabolism in early-stage non-small cell lung cancer.

We aimed to identify risk factors in lymph node metastasis in early-stage non-small cell lung cancer (NSCLC) and predict lymph node metastasis. A total of 416 patients with clinical stage IA2-3 NSCLC who underwent lobectomy and lymph node dissection between July 2016 and December 2020 at National Cancer Center Hospital East were included. Multivariable logistic regression was performed to develop a model for predicting lymph node metastasis. Leave-one-out cross-validation was performed to evaluate the developing prediction model, and sensitivity, specificity, and concordance statistics were calculated to evaluate its diagnostic performance. The formula for calculating the probability of pathological lymph node metastasis included SUVmax of the primary tumor and serum CEA level. The concordance statistics was 0.7452. When the cutoff value associated with the risk of incorrectly predicting pathological lymph node metastasis was 7.2%, the diagnostic sensitivity and specificity for predicting metastasis were 96.4% and 38.6%, respectively. We created a prediction model for lymph node metastasis in NSCLC by combining the SUVmax of the primary tumor and serum CEA levels, which showed a particularly strong association. This model is clinically useful as it successfully predicts negative lymph node metastasis in patients with clinical stage IA2-3 NSCLC.

Survival outcomes of laparoscopic versus open radical hysterectomy in early cervical cancer with incidentally identified high-risk factors

ObjectivePreviously, we suggested that patients with cervical cancer (CC) with tumors ≤2 cm on preoperative magnetic resonance imaging (MRI) are safe candidates for laparoscopic radical hysterectomy (LRH). Here, we aim to investigate whether LRH deteriorates the prognosis of patients with incidentally identified high-risk factors; lymph node metastasis (LNM) or parametrial invasion (PMI). MethodsWe identified patients with 2009 FIGO stage IB1 CC who underwent Type C LRH or open radical hysterectomy (ORH) at three tertiary hospitals between 2000 and 2019. Those with a tumor ≤2 cm on preoperative MRI who were not suspicious of LNM or PMI preoperatively were included, while those who were indicated to receive adjuvant treatment but did not actually receive it were excluded. Survival outcomes were compared between the LRH and ORH groups in the overall population, then narrowed down to those with LNM, and then to those with PMI. ResultsIn total, 498 patients were included: 299 in the LRH group and 199 in the ORH group. The LRH and ORH groups showed similar 3-year progression-free survival (PFS) (94.0% vs. 93.6%; P = 0.615) and 5-year overall survival (OS) rates (97.2% vs. 96.8%; P = 0.439). On pathologic examination, 49 (9.8%) and 16 (3.2%) patients had LNM and PMI, respectively, and 10 (2.0%) had both. In the LNM subgroup, 5-year PFS rate was not significantly different between the LRH and ORH groups (73.2% vs. 91.7%; P = 0.169). In the PMI subgroup, no difference in PFS was observed between the two groups (P = 0.893). ConclusionsLRH might not deteriorate recurrence and mortality rates in CC patients with tumors ≤2 cm when adjuvant treatment is appropriately administered, even if pathologic LNM and PMI are incidentally identified.

Salvage radiotherapy is effective in patients with PSMA-PET-negative biochemical recurrence- results of a retrospective study

Background/PurposeThe present study aimed to assess whether SRT to the prostatic fossa should be initiated in a timely manner after detecting biochemical recurrence (BR) in patients with prostate cancer, when no correlate was identified with prostate-specific membrane antigen positron emission tomography (PSMA-PET). Materials and MethodsThis retrospective, multicenter analysis included 1222 patients referred for PSMA-PET after a radical prostatectomy due to BR. Exclusion criteria were: pathological lymph node metastases, prostate-specific antigen (PSA) persistence, distant or lymph node metastases, nodal irradiation, and androgen deprivation therapy (ADT). This led to a cohort of 341 patients. Biochemical progression-free survival (BPFS) was the primary study endpoint. ResultsThe median follow-up was 28.0 months. The 3-year BPFS was 71.6% in PET-negative cases and 80.8% in locally PET-positive cases. This difference was significant in univariate (p = 0.019), but not multivariate analyses (p = 0.366, HR: 1.46, 95%CI: 0.64–3.32). The 3-year BPFS in PET-negative cases was significantly influenced by age (p = 0.005), initial pT3/4 (p < 0.001), pathology scores (ISUP) ≥ 3 (p = 0.026), and doses to fossa > 70 Gy (p = 0.027) in univariate analyses. In multivariate analyses, only age (HR: 1.096, 95%CI: 1.023–1.175, p = 0.009) and PSA-doubling time (HR: 0.339, 95%CI: 0.139–0.826, p = 0.017) remained significant. ConclusionTo our best knowledge, this study provided the largest SRT analysis in patients without ADT that were lymph node-negative on PSMA-PET. A multivariate analysis showed no significant difference in BPFS between locally PET-positive and PET-negative cases. These results supported the current EAU recommendation to initiate SRT in a timely manner after detecting BR in PET negative patients.

Prediction of lymph node metastasis of well-differentiated rectal neuroendocrine tumours using multiple diagnostic modalities.

The preoperative prediction of lymph node metastasis of well-differentiated rectal neuroendocrine tumours is highly desirable and useful in defining surgical indication more accurately. We aimed to evaluate lymph node metastasis in rectal neuroendocrine neoplasms using multiple imaging modalities. The clinical records and radiological images of 70 patients with well-differentiated rectal neuroendocrine tumours who received treatment at the University of Tokyo Hospital between 2010 and 2022 were retrospectively analysed. The relationship between evaluation by multiple imaging modalities and pathological lymph node metastasis was analysed. The receiver operating characteristic curves showed that a maximum lymph node diameter ≥4 mm on computed tomography and ≥8 mm on magnetic resonance imaging were the optimal predictive factors for lymph node metastasis. Accumulation in the lymph nodes on somatostatin receptor scintigraphy (P = 0.058) and Delle's findings on colonoscopy (P = 0.014) were also significant predictors of pathological lymph node positivity, and combination of multiple modalities was useful. Pathologically, lymphatic (P = 0.0030)/venous (P = 0.0007) invasion were risk factors for lymph node metastasis. In addition to pathological risk factors, a combination of multiple radiological imaging modalities is useful for predicting lymph node metastasis in well-differentiated rectal neuroendocrine tumours.

PD09-09 SURVIVAL BENEFITS OF ADJUVANT CHEMOTHERAPY FOR POSITIVE SOFT TISSUE SURGICAL MARGINS FOLLOWING RADICAL CYSTECTOMY IN BLADDER CANCER WITH EXTRAVESICAL EXTENSION

You have accessJournal of UrologyCME1 Apr 2023PD09-09 SURVIVAL BENEFITS OF ADJUVANT CHEMOTHERAPY FOR POSITIVE SOFT TISSUE SURGICAL MARGINS FOLLOWING RADICAL CYSTECTOMY IN BLADDER CANCER WITH EXTRAVESICAL EXTENSION Prithvi Murthy, Shreyas Naidu, Facundo Davaro, Philippe Spiess, Logan Zemp, Michael Poch, Rohit Jain, Aram Vosoughi, Alice Yu, Wade Sexton, Scott Gilbert, and Roger Li Prithvi MurthyPrithvi Murthy More articles by this author , Shreyas NaiduShreyas Naidu More articles by this author , Facundo DavaroFacundo Davaro More articles by this author , Philippe SpiessPhilippe Spiess More articles by this author , Logan ZempLogan Zemp More articles by this author , Michael PochMichael Poch More articles by this author , Rohit JainRohit Jain More articles by this author , Aram VosoughiAram Vosoughi More articles by this author , Alice YuAlice Yu More articles by this author , Wade SextonWade Sexton More articles by this author , Scott GilbertScott Gilbert More articles by this author , and Roger LiRoger Li More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003240.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Locally advanced muscle invasive bladder cancer is an aggressive disease entity that requires multimodal therapy. However, the benefits of adjuvant chemotherapy (AC) in patients with a positive soft-tissue surgical margin (STSM) are relatively unknown. We sought to define survival benefits in this cohort in our institutional bladder cancer database. METHODS: We performed a retrospective review of all patients undergoing radical cystectomy for urothelial carcinoma of the bladder at Moffitt Cancer Center from 2004-2020 with gross extravesical (≥pT3b) disease irrespective of neoadjuvant chemotherapy (NAC) use or pathologic lymph node metastases. Overall survival estimates were obtained using the Kaplan-Meier method with log-rank test and the Cox-proportional hazards model was used to identify predictors of overall survival. AC was defined by any chemotherapy use within 90 days of cystectomy, regardless of STSM status. RESULTS: 441 patients with pT3b disease or worse and adjuvant chemotherapy data were identified. Baseline clinicodemographic information are listed in Table 1. Positive STSM (HR 1.90, 1.42-2.53, 95% CI, p<0.001) and AC use (HR 0.63, 0.47-0.84, 95% CI, p=0.002) were significantly associated with poorer overall survival when adjusted for pathologic T-stage, N-stage, performance status and NAC use. On subgroup analysis, as shown in Figure 1, the use of AC in patients with a positive STSM improved median OS from 6 months [4-8, 95% CI] to 16 months [11-53, 95% CI] (p<0.01). In patients with a negative soft-tissue surgical margin, the median survival with AC was 22 months [17-37, 95% CI] compared to 16 months [14-20, 95% CI] without (p=0.14). ECOG performance status, NAC use, rates of pathologic nodal involvement, and LVI did not differ by AC use in the entire cohort or based on STSM status. CONCLUSIONS: Adjuvant chemotherapy may particularly benefit patients with positive STSM following radical cystectomy for gross extravesical disease. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e243 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Prithvi Murthy More articles by this author Shreyas Naidu More articles by this author Facundo Davaro More articles by this author Philippe Spiess More articles by this author Logan Zemp More articles by this author Michael Poch More articles by this author Rohit Jain More articles by this author Aram Vosoughi More articles by this author Alice Yu More articles by this author Wade Sexton More articles by this author Scott Gilbert More articles by this author Roger Li More articles by this author Expand All Advertisement PDF downloadLoading ...

Lymph node metastatic patterns and the development of multidisciplinary treatment for esophageal cancer.

Abundant lymphatic flow and the anatomical location of the esophagus can result in the widespread distribution of lymph node metastasis of esophageal cancer from the cervical to the abdominal field. Historically, the Japan Esophageal Society and American Joint Committee on Cancer offer two different classifications of lymph node group location surrounding the esophagus. The location of sentinel lymph nodes in midthoracic esophageal cancer reflects the variety of lymphatic drainage routes. In fact, in cT1N0 esophageal cancer, pathological lymph node metastasis has been observed from the cervical to the abdominal field, and the locations were shown to be closely linked to the primary tumor location in advanced stages. While the impact of histology on the distribution of LN metastasis has been extensively debated, a recent prospective study on esophagogastric junction cancer found that metastatic patterns did not differ by histology. Thoracic duct lymph nodes were defined as one of the regional lymph node stations in the mediastinum. Although lymph node metastasis around the thoracic duct has occasionally been observed, the oncologic impact of thoracic duct lymph node dissection has not been fully elucidated. To eradicate tumors locoregionally, three-field lymph node dissection, a strategy for extended lymph node clearance, has been established. In esophagectomy, three-field lymph node dissection is defined as a procedure for complete regional cervico-thoraco-abdominal lymph node dissection. However, its therapeutic efficacy must be evaluated based on the balance between oncological outcomes and possible added surgical risk. To further improve survival, multidisciplinary treatment consisting of surgery, chemotherapy, and radiotherapy has been established worldwide as a standard treatment for esophageal cancer. Now that neoadjuvant therapy followed by esophagectomy is the standard, adding adjuvant therapy including immunotherapy could be a promising treatment option. The ideal combination of various multidisciplinary treatment approaches and extensive LN dissection need to be established to improve the oncological outcomes for EC patients.

Artificial intelligence-based computer-aided diagnosis system supports diagnosis of lymph node metastasis in esophageal squamous cell carcinoma: A multicenter study

BackgroundThis study aimed to develop an artificial intelligence-based computer-aided diagnosis system (AI-CAD) emulating the diagnostic logic of radiologists for lymph node metastasis (LNM) in esophageal squamous cell carcinoma (ESCC) patients, which contributed to clinical treatment decision-making. MethodsA total of 689 ESCC patients with PET/CT images were enrolled from three hospitals and divided into a training cohort and two external validation cohorts. 452 CT images from three publicly available datasets were also included for pretraining the model. Anatomic information from CT images was first obtained automatically using a U-Net-based multi-organ segmentation model, and metabolic information from PET images was subsequently extracted using a gradient-based approach. AI-CAD was developed in the training cohort and externally validated in two validation cohorts. ResultsThe AI-CAD achieved an accuracy of 0.744 for predicting pathological LNM in the external cohort and a good agreement with a human expert in two external validation cohorts (kappa = 0.674 and 0.587, p < 0.001). With the aid of AI-CAD, the human expert's diagnostic performance for LNM was significantly improved (accuracy [95% confidence interval]: 0.712 [0.669–0.758] vs. 0.833 [0.797–0.865], specificity [95% confidence interval]: 0.697 [0.636–0.753] vs. 0.891 [0.851–0.928]; p < 0.001) among patients underwent lymphadenectomy in the external validation cohorts. ConclusionsThe AI-CAD could aid in preoperative diagnosis of LNM in ESCC patients and thereby support clinical treatment decision-making.

Radiomics nomogram integrating intratumoural and peritumoural features to predict lymph node metastasis and prognosis in clinical stage IA non-small cell lung cancer: a two-centre study

To investigate the value of a radiomics nomogram integrating intratumoural and peritumoural features in predicting lymph node metastasis and overall survival (OS) in patients with clinical stage IA non-small-cell lung cancer (NSCLC). This study retrospectively enrolled 199 patients (training cohort: 71 patients from Affiliated Tumour Hospital of Nantong University; internal validation cohort: 46 patients from Affiliated Tumour Hospital of Nantong University; external validation cohort: 82 patients from the public database). CT radiomics models were constructed based on four volumes of interest: gross tumour volume (GTV), gross and 3 mm peritumoural volume (GPTV3), gross and 6 mm peritumoural volume (GPTV6), and gross and 9 mm peritumoural volume (GPTV9). The optimal radiomics signature was further combined with independent clinical predictors to develop a nomogram. Univariable and multivariable Cox regression analysis were applied to determine the relationship between factors and OS. GPTV6 radiomics yielded better performance than GTV, GPTV3, and, GPTV9 radiomics in the training (area under the curve [AUC], 0.81), internal validation (AUC, 0.79), and external validation cohorts (AUC, 0.71), respectively. The nomogram integrating GPTV6 radiomics and spiculation improved predictive ability, with AUCs of 0.85, 0.80, and 0.74 in three cohorts, respectively. Pathological lymph node metastasis, nomogram-predicted lymph node metastasis, and pleural indentation were independent risk predictors of OS (p<0.05). The nomogram integrating GPTV6 radiomics features and independent clinical predictors performed well in predicting lymph node metastasis and prognosis in patients with clinical stage IA NSCLC.

Artificial intelligence-based radiomics for the prediction of nodal metastasis in early-stage lung cancer

We aimed to investigate the value of computed tomography (CT)-based radiomics with artificial intelligence (AI) in predicting pathological lymph node metastasis (pN) in patients with clinical stage 0–IA non-small cell lung cancer (c-stage 0–IA NSCLC). This study enrolled 720 patients who underwent complete surgical resection for c-stage 0–IA NSCLC, and were assigned to the derivation and validation cohorts. Using the AI software Beta Version (Fujifilm Corporation, Japan), 39 AI imaging factors, including 17 factors from the AI ground-glass nodule analysis and 22 radiomics features from nodule characterization analysis, were extracted to identify factors associated with pN. Multivariate analysis showed that clinical stage IA3 (p = 0.028), solid-part size (p < 0.001), and average solid CT value (p = 0.033) were independently associated with pN. The receiver operating characteristic analysis showed that the area under the curve and optimal cut-off values of the average solid CT value relevant to pN were 0.761 and -103 Hounsfield units, and the threshold provided sensitivity, specificity, and negative predictive values of 69%, 65%, and 94% in the entire cohort, respectively. Measuring the average solid-CT value of tumors for pN may have broad applications such as guiding individualized surgical approaches and postoperative treatment.

Association of Ki-67 expression in radical cystectomy specimens of infiltrating urothelial carcinoma with histopathological parameters

Urothelial carcinoma is the most common neoplasm of urinary bladder. Antigen Ki-67 is a nuclear protein that is necessary for cellular proliferation. The aim of this study was to determine the association of expression of Ki-67 with histopathological parameters in radical cystectomy specimens of histologically diagnosed cases of infiltrating urothelial carcinoma. This is a cross-sectional study conducted among 36 cases of infiltrating urothelial carcinoma collected from Department of Pathology, Bangabandhu Sheikh Mujib Medical University. Histopathological parameters i.e. morphologic variants, stage (pT), lympho-vascular invasion, perineural invasion and lymph node metastasis were assessed. Ki-67 immunohistochemistry were performed. Mean ±SD age of the patients was 58.9±13.8 years. Among the morphological variants, 64% cases were microscopically arranged in papillary pattern. Eighteen (50%) patients underwent surgical intervention at stage pT2. Lympho-vascular invasion, perineural invasion and lymph node metastasis were identified in 12 (33.3%), 9 (25%) and 13 (48.1%) of the cases, respectively. Among the morphological parameters, Ki-67 shows association with pathological stages and lymph node metastasis. The use of Ki-67 immunomarker along with grading and staging may provide significant prognostic information in urothelial carcinoma of the urinary bladder. BSMMU J 2022; 15(3): 186-191