Pathological Node Research Articles

Abstract 3359: Sensitive detection of locoregional MRD after head and neck cancer surgery

Abstract Background: Plasma cell-free DNA (cfDNA) has low sensitivity to detect locoregional molecular residual disease (MRD) immediately after surgery for limited-stage head and neck cancer. To enhance locoregional MRD sensitivity, we utilize a novel biofluid proximal to the primary tumor: the serosanguinous fluid collected by surgical drains inserted into the wound bed following regional lymph node dissection. We demonstrate that cancer-associated cfDNA in the surgical drain fluid (SDF) is a sensitive biomarker of locoregional MRD detection, risk stratification, and prognostication. Methods: We extracted DNA from 168 SDFs, 48 paired plasmas, and 44 tumor specimens collected 24 hours after surgery from 90 patients: 74 HPV (+) oropharyngeal cancers (OPC), 8 HPV (-) oral cancers, 2 thyroid cancers, and 6 benign neck pathologies. SDFs were also collected at 0, 6, 12, and 24 hours after surgery from 11 HPV (+) patients. We applied TaqMan qPCR to our specimens to quantify cell-free HPV (cf-HPV), a proxy for cancer-associated cfDNA in HPV (+) malignancies. We then measured the association between cf-HPV and extranodal extension (ENE), AJCC 8 staging, and established clinical and pathological risk criteria from 4 HPV (+) OPC clinical trials. We validated our findings using HPV next-generation sequencing. We also compared the predictive value of high-risk pathology with cf-HPV MRD for HPV (+) OPC recurrences. Lastly, we developed a second assay for cell-free BRAF V600E (cf-V600E) in thyroid cancer SDF. Results: Serially collected SDF revealed cf-HPV decreased continuously from 0 to 24 hours postoperative, and that the 24-hour timepoint stratified detectable versus undetectable persistent residual disease. At 24 hours, SDF was significantly more enriched with cf-HPV compared to plasma (P < 0.0001). In a subset of 9 patients, HPV genotype and detection in SDF were 100% concordant between NGS and PCR. Strikingly, SDF cf-HPV was 11-fold higher in pN2 patients versus pN1/N0 (P = 0.02) and 15-fold higher in cases with ENE (P = 0.003), suggesting SDF reflects aggressive nodal pathology and captures locoregional MRD. When we classified our patients according to established clinical and pathological risk criteria, we found significantly higher SDF cf-HPV among high-risk patients (AUC = 0.77). Crucially, in HPV (+) patients treated with surgery alone, SDF MRD detected 100% of locoregional recurrences, while plasma MRD and high-risk pathology detected 0%. Lastly, as proof of concept, we demonstrated SDF cf-V600E detection in the context of high-risk thyroid cancer. Conclusions: Surgical drain fluid cancer-associated cfDNA is a novel minimally invasive biomarker. Our SDF assay was strongly associated with high-risk criteria and detected locoregional relapse with 100% sensitivity compared to 0% in plasma. Our data suggest that SDF liquid biopsy is ultra-sensitive and has the potential to inform postoperative molecular-based risk stratification. Citation Format: Noah Earland, Ricardo J. Ramirez, Sophie P. Gerndt, Peter K. Harris, Andrew I. Hearn, Matthew Inkman, Jeffrey J. Szymanski, Nick Semenkovich, Benjamin M. Wahle, Zhongping Xu, Kevin Chen, Jin Zhang, Jose P. Zevallos, Aadel A. Chaudhuri. Sensitive detection of locoregional MRD after head and neck cancer surgery [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3359.

Axillary lymph node status and invasive lobular breast cancer : Analysis of the Clinical Tumor Register of the AGO Austria.

Invasive lobular carcinoma (ILC) represents the second most common type of invasive breast cancer (BC). Although ILC generally have good prognostic properties (positive estrogen receptor, ER, low tumor grade), they are generally diagnosed at amore advanced stage. The data on the axillary lymph node status in ILC compared to invasive ductal carcinoma (IDC) are considered controversial. Therefore, the aim of this study was to compare the pathological node stage (pN) between ILC and IDC in an Austria-wide register. Data of the Clinical Tumor Register (Klinisches TumorRegister, KTR) of the Austrian Association for Gynecological Oncology (AGO) were retrospectively analyzed. Patients with primary early BC, invasive lobular or ductal, diagnosed between January 2014 and December 2018, and primary surgery were included. Atotal of 2127 tumors were evaluated and compared in 2groups, ILC n = 303, IDC n = 1824. Atotal of 2095patients were analyzed in the study. In the multivariate analysis, pN2 and pN3 were observed significantly more frequently in ILC compared with IDC (odds ratio, OR 1.93; 95% confidence interval, CI 1.19-3.14; p = 0.008 and OR 3.22; 95% CI: 1.47-7.03; p = 0.003; respectively). Other factors associated with ILC were tumor grades2 and3, positive ER, and pathological tumor stage (pT) 2 and pT3. In contrast, concomitant ductal carcinoma in situ, overexpression of the human epidermal growth factor receptor2 (HER2), and amoderate and high proliferation rate (Ki67) were found less frequently in ILC. The data show an increased risk of extensive axillary lymph node metastasis (pN2/3) in ILC.

Pancreatic ductal adenocarcinoma (PDAC) regional nodal disease at standard lymphadenectomy: is MRI accurate for identifying node-positive patients?

To determine the accuracy of qualitative and quantitative MRI features for the diagnosis of pathologic regional lymph nodes at standard lymphadenectomy in patients with pancreatic ductal adenocarcinoma (PDAC). All adult patients with pancreatic MRI performed from 2011 to 2021 within 3months of a pancreaticoduodenectomy were eligible for inclusion in this single-center retrospective cohort study. Regional nodes at standard lymphadenectomy were independently reviewed by two fellowship-trained abdominal radiologists for the following qualitative features: heterogeneous T2 signal, round shape, indistinct margin, peri-nodal fat stranding, and restricted diffusion greater than the spleen. Quantitative characteristics including primary tumor size, largest node short- and long-axes length, number of regional nodes, absolute apparent diffusion coefficient (ADC) values, and ADC node-to-spleen signal index were assessed. Analysis was at the patient-level with surgical pathology as the reference standard. Of 75 patients, 85% (64/75) were positive for regional nodal disease on histopathology. None of the qualitative variables evaluated on MRI was associated with pathologic nodes. Median primary tumor maximum diameter was slightly larger for patients with pathologic nodes compared to those without (18mm (10-42mm) vs 16mm (9-22mm), p = 0.027). None of the other quantitative features was associated with pathologic nodes. Radiologist opinion was not associated with pathologic nodes (p = 0.520). Interobserver agreement was fair (kappa = 0.257). Lymph node morphologic features and radiologist opinion using MRI are of limited value for diagnosing PDAC regional nodal disease. Improved diagnostic techniques are needed given the prognostic implications of pathologic lymph nodes in these patients. • Multiple lymph node morphologic features routinely assessed on MRI for malignancies elsewhere in the body are likely not applicable when assessing for pancreatic ductal adenocarcinoma nodal disease. • Interobserver agreement for the presence or absence of pancreatic ductal adenocarcinoma lymph node morphologic features on MRI is fair (kappa = 0.257). • Many more lymph nodes are resected at PDAC standard lymphadenectomy than are detectable on MRI, median 25 vs 5 (p < 0.001), suggesting improved diagnostic techniques are needed to identify PDAC nodal disease.

MP69-18 EVALUATING THE ROLE OF LYMPHVASCULAR INVASION AS AN INDICATOR FOR ADVERSE OUTCOMES IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA AND ITS HISTOLOGICAL SUBTYPES

You have accessJournal of UrologyCME1 Apr 2023MP69-18 EVALUATING THE ROLE OF LYMPHVASCULAR INVASION AS AN INDICATOR FOR ADVERSE OUTCOMES IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA AND ITS HISTOLOGICAL SUBTYPES Ivan Rakic, Matthew Davis, Nicholas Corsi, Alexander Stephens, Sohrab Arora, Nikola Rakic, Taylor Malchow, Chase Morrison, Rafe Affas, Akshay Sood, Craig Rogers, and Firas Abdollah Ivan RakicIvan Rakic More articles by this author , Matthew DavisMatthew Davis More articles by this author , Nicholas CorsiNicholas Corsi More articles by this author , Alexander StephensAlexander Stephens More articles by this author , Sohrab AroraSohrab Arora More articles by this author , Nikola RakicNikola Rakic More articles by this author , Taylor MalchowTaylor Malchow More articles by this author , Chase MorrisonChase Morrison More articles by this author , Rafe AffasRafe Affas More articles by this author , Akshay SoodAkshay Sood More articles by this author , Craig RogersCraig Rogers More articles by this author , and Firas AbdollahFiras Abdollah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003332.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Lymphvascular invasion (LVI) is recognized as an adverse prognostic factor in many cancers. However, its utility in upper tract urothelial carcinoma (UTUC) has not been well-defined. Our aim is to assess the prognostic ability of LVI in UTUC urothelial carcinoma (UC) and micropapillary urothelial carcinoma (MPUC) subtypes as a predictor of overall survival (OS) using a large North American cohort. METHODS: Our cohort included 9750 cM0 UTUC patients who underwent a radical nephroureterectomy (RNU), between 2004 and 2015, within the National Cancer Database (NCDB). The main variable of interest was LVI status, and its interaction with pathological nodal (pN) status. Kaplan-Meier curves were used to estimate the OS. Cox regression analysis tested the impact of LVI status on OS after accounting for covariates: age, sex, race, year of diagnosis, Charlson Comorbidity Index, income, treatment center type, insurance status, pathological tumor, and pN status. RESULTS: Mean (SD) age was 70.90±10.9 years. Overall, 14.4% had LVI, and 6.77% had pN+ (pN1-3) disease. The rate of advanced stage (pT3 or higher), and pN+ disease was 78.8%% and 18.1% in patients with LVI vs. 34.7% and 3.32% in patients without LVI. The histological subtypes were UC, pure squamous, sacromatoid/spindle cell carcinoma, and MPUC in respectively 49.8%, 0.608%, 0.708%, and 48.9% of patients. The mean (SD) follow-up was 42.9±35.3 months. In patients with UC at 5-years post-RNU, the OS rates were 60.2%, 29.9%, 28.9%, and 20.8% in patient with pN0 without LVI, pN0 with LVI, pN+ without LVI, and pN+ with LVI, respectively (p<0.001). In patients with MPUC at 5-years post-RNU, the OS rates were 65.3%, 40.2%, 54.7%, and 36.5% in patient with pN0 without LVI, pN0 with LVI, pN+ without LVI, and pN+ with LVI, respectively (p<0.001). On multivariable analysis, LVI was an independent predictor of less favorable OS outcomes, as those with LVI had a 1.82-fold higher risk of death (95% CI: 1.21-1.54, p<0.001), when compared to their counterpart without LVI. CONCLUSIONS: To the best of our knowledge, our report is the first to examine the impact of LVI on OS in a large North American nationwide cohort. Our results indicate that LVI is associated with less favorable survival outcomes in patient with UTUC who are treated surgically, and can be utilized for counseling after RNU and as a risk-stratification tool for future clinical trials. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e972 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ivan Rakic More articles by this author Matthew Davis More articles by this author Nicholas Corsi More articles by this author Alexander Stephens More articles by this author Sohrab Arora More articles by this author Nikola Rakic More articles by this author Taylor Malchow More articles by this author Chase Morrison More articles by this author Rafe Affas More articles by this author Akshay Sood More articles by this author Craig Rogers More articles by this author Firas Abdollah More articles by this author Expand All Advertisement PDF downloadLoading ...

Can adjuvant radiotherapy be omitted for oral cavity cancer patients who received neoadjuvant therapy and surgery? A retrospective cohort study.

Surgery and postoperative adjuvant therapy comprise the standard treatment for locally advanced resectable oral squamous cell carcinoma (LAROSCC), while preoperative neoadjuvant therapy is being explored without sufficient confirmation of improved survival. De-escalation regimens after neoadjuvant therapy, such as those omitting adjuvant radiotherapy, may provide comparable or better outcomes, suggesting rigorous assessment of adjuvant therapy outcomes is needed in LAROSCC patients. The authors thus performed this retrospective study in LAROSCC patients who received neoadjuvant therapy and surgery, to compare the outcomes for overall survival (OS) and locoregional recurrence-free survival (LRFS) between the adjuvant radiotherapy (radio) and nonradiotherapy (nonradio) cohorts. Patients diagnosed with LAROSCC who received neoadjuvant therapy and surgery were enrolled and divided into radio and nonradio cohorts to determine whether adjuvant radiotherapy could be omitted after neoadjuvant therapy and surgery. From 2008 to 2021, 192 patients were enrolled. No significant differences were found in OS or LRFS between the radio and nonradio patient cohorts. The 10-year estimated OS rates were 58.9 versus 44.1% in radio versus nonradio cohorts, while 10-year estimated LRFS rates were 55.4 versus 48.2%, respectively. For clinical stage III patients, 10-year OS rates were 62.3 versus 62.6% (radio vs. nonradio), and estimated 10-year LRFS rates were 56.5 versus 60.7% (radio vs. nonradio). Multivariate Cox regression modeling of postoperative variables showed pathologic response of primary tumor and pathologic regional lymph nodes staging were associated with survival, while the adjuvant radiotherapy exposure was not included in the model due to nonsignificance. These findings support further prospective evaluation of adjuvant radiotherapy omission, and suggest that de-escalation trials are warranted for LAROSCC surgery patients who received neoadjuvant therapy.

MP64-19 IMPACT OF NUMBER OF POSITIVE LYMPH NODES ON PROGNOSTIC STRATIFICATION IN RENAL CELL CARCINOMA: ANALYSIS OF THE NATIONAL CANCER DATABASE

You have accessJournal of UrologyCME1 Apr 2023MP64-19 IMPACT OF NUMBER OF POSITIVE LYMPH NODES ON PROGNOSTIC STRATIFICATION IN RENAL CELL CARCINOMA: ANALYSIS OF THE NATIONAL CANCER DATABASE Luke Wang, Florin Vaida, Dhruv Puri, Sohail Dhanji, Franklin Liu, Jonathan Afari, Margaret Meagher, Kevin Hakimi, Mimi Nguyen, Cesare Saitta, Saeed Ghassemzadeh, Aastha Shah, Ryan Nasseri, Juan Javier-Desloges, James Murphy Mckay, and Ithaar Derweesh Luke WangLuke Wang More articles by this author , Florin VaidaFlorin Vaida More articles by this author , Dhruv PuriDhruv Puri More articles by this author , Sohail DhanjiSohail Dhanji More articles by this author , Franklin LiuFranklin Liu More articles by this author , Jonathan AfariJonathan Afari More articles by this author , Margaret MeagherMargaret Meagher More articles by this author , Kevin HakimiKevin Hakimi More articles by this author , Mimi NguyenMimi Nguyen More articles by this author , Cesare SaittaCesare Saitta More articles by this author , Saeed GhassemzadehSaeed Ghassemzadeh More articles by this author , Aastha ShahAastha Shah More articles by this author , Ryan NasseriRyan Nasseri More articles by this author , Juan Javier-DeslogesJuan Javier-Desloges More articles by this author , James Murphy MckayJames Murphy Mckay More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003322.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The prognostic significance of lymph node (LN) positivity in renal cell carcinoma (RCC) is poorly understood. Currently, American Joint Committee on Cancer (AJCC) Stage III RCC includes both node-positive pN1 and node-negative pN0 disease. We hypothesize that (1) there is a threshold in number of pathologic positive LN (pLN) that distinguishes favorable from poor risk nodal disease, and (2) current categorization of pN1 can be subdivided into pN1 and pN2 based this threshold. We tested our hypothesis using the National Cancer Database (NCDB). METHODS: From 2004-2019, all RCC were queried in patients age ≥18. pN1 RCC with no synchronous metastasis were selected to minimize confounding from metastatic burden. Multivariable Cox regression tested association between number of pLN and all-cause mortality (ACM). Receiver Operator Characteristic (ROC) Curve analyses employing concordance probability method and analysis of regression coefficients evaluated performance of potential cut-points for pN2. Kaplan-Meier analyses (KMA) compared these thresholds against overall survival (OS) in non-metastatic Stage IV RCC. RESULTS: 29,388 patients were identified; 3910 (13.3%) had pN1. On Cox regression, increased number of pLN was associated with increased hazard of ACM (HR 1.19, p<0.001). Analysis of estimated regression coefficients identified potential threshold at ≥3 pLN. ROC mapping of thresholds ≥2 to ≥10 showed stable concordance probability 0.26-0.33, AUC=0.656. On KMA, when threshold was ≥3, 5-year OS was no longer significantly different from non- metastatic Stage IV RCC as illustrated by overlapping confidence intervals. We designated pN1 as 1-2 pLN, and pN2 as ≥3 pLN. 5-year OS for Stage III pN0 was 69.4% (95% CI 68.4-70.5), for Stage III pN1 was 41.4% (39.0-43.8), for Stage III pN2 was 31.8% (28.2-35.9%), and for non-metastatic Stage IV was 30.0% (28.2-32.0%). pN2 exhibited 38% greater hazard of ACM (HR 3.31, p<0.001) compared to pN1 (HR 2.39, p<0.001). CONCLUSIONS: These findings show that original pN1 RCC could be stratified to pN1 and pN2, with pN2 conferring poor prognosis comparable to non-metastatic Stage IV pN0 disease. Although validation studies are warranted, consideration should be given towards stratifying Stage III pN2 patients to a higher risk group. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e888 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luke Wang More articles by this author Florin Vaida More articles by this author Dhruv Puri More articles by this author Sohail Dhanji More articles by this author Franklin Liu More articles by this author Jonathan Afari More articles by this author Margaret Meagher More articles by this author Kevin Hakimi More articles by this author Mimi Nguyen More articles by this author Cesare Saitta More articles by this author Saeed Ghassemzadeh More articles by this author Aastha Shah More articles by this author Ryan Nasseri More articles by this author Juan Javier-Desloges More articles by this author James Murphy Mckay More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement PDF downloadLoading ...

MP32-10 THE CANCER OF THE BLADDER RISK ASSESSMENT (COBRA) SCORE AND MORTALITY-SURVIVAL RELATIONSHIP IN PATIENTS WHO HAVE UNDERGONE RADICAL CYSTECTOMY IN THE TURKISH UROONCOLOGY ASSOCIATION DATABASE

You have accessJournal of UrologyCME1 Apr 2023MP32-10 THE CANCER OF THE BLADDER RISK ASSESSMENT (COBRA) SCORE AND MORTALITY-SURVIVAL RELATIONSHIP IN PATIENTS WHO HAVE UNDERGONE RADICAL CYSTECTOMY IN THE TURKISH UROONCOLOGY ASSOCIATION DATABASE Hasan Tavukçu, Ilker Tinay, Volkan Izol, Sümer Baltaci, Kerem Teke, Evren Süer, Uğur Yücetaş, Sertaç Yazici, Serkan Akan, Bahadir Şahin, and Members Of Urooncology Hasan TavukçuHasan Tavukçu More articles by this author , Ilker TinayIlker Tinay More articles by this author , Volkan IzolVolkan Izol More articles by this author , Sümer BaltaciSümer Baltaci More articles by this author , Kerem TekeKerem Teke More articles by this author , Evren SüerEvren Süer More articles by this author , Uğur YücetaşUğur Yücetaş More articles by this author , Sertaç YaziciSertaç Yazici More articles by this author , Serkan AkanSerkan Akan More articles by this author , Bahadir ŞahinBahadir Şahin More articles by this author , and Members Of UrooncologyMembers Of Urooncology More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003265.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Cancer of the Bladder Risk Assessment (COBRA) Score is observed as a practical and useful method that can be used to predict survival in patients who have undergone radical cystectomy. We also aimed to evaluate survival by using COBRA score in the bladder cancer patient group in our country. METHODS: A total of 910 patients who had undergone radical cystectomy were included in the Turkish Urooncology Association database. Patients were classified according to tumor stage and lymph node (TLN) involvement; Mortality rates and survival were analyzed according to both TLN classification and COBRA score. RESULTS: The mean age of the patients was 63.94±9.55 years, of which 450 (49.5%) were male and 460 (50.5%) were female; while 279 (30.7%) had lymph node involvement, 631 (69.3%) did not. Cancer specific mortality and overall mortality rates were found to be significantly higher in patients with lymph node involvement (p:0.000*, p:0.042*). There is a statistically significant difference between the COBRA scores and the survival rates in terms of cancer specific mortality according to TLN classification (p:0.000; p<0.05). Survival rate of group with pathological T3-T4 Node (+) were significantly lower than the other groups (p<0.05). Survival rate of group with <T2 Node (-) is significantly higher than the other groups (p<0.05). Only those with a COBRA score of 6 had a lower mortality rate than those with a COBRA score of 5. In the Cox regression analysis for cancer-related death, a one-unit increase in the COBRA score increases the cancer-related death rate 1.54-fold (HR:1.540; 95% CI:1.402-1.691) (p<0.05). When the COBRA score is compared to 0, the highest risk is seen in COBRA 5. If the COBRA score is 5, the risk of cancer-related death increases 14.63 times (HR:14.627; 95% CI:7.041-30.385) (p<0.05); this is followed by the COBRA 6 score. (Table)Table: Cox regression analysis results for cancer-related death. CONCLUSIONS: The COBRA score can be used as a practical prognostic tool in radical cystectomy patients. As the COBRA score increases, the prognosis worsens, and our results are consistent with the first validated study. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e444 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hasan Tavukçu More articles by this author Ilker Tinay More articles by this author Volkan Izol More articles by this author Sümer Baltaci More articles by this author Kerem Teke More articles by this author Evren Süer More articles by this author Uğur Yücetaş More articles by this author Sertaç Yazici More articles by this author Serkan Akan More articles by this author Bahadir Şahin More articles by this author Members Of Urooncology More articles by this author Expand All Advertisement PDF downloadLoading ...

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 ...

PD15-01 SURVIVAL IN ADJUVANT VS SALVAGE RADIATION THERAPY IN PATHOLOGICAL NODE POSITIVE PROSTATE CANCER PATIENTS: A MULTICENTRIC STUDY

PD15-01 SURVIVAL IN ADJUVANT VS SALVAGE RADIATION THERAPY IN PATHOLOGICAL NODE POSITIVE PROSTATE CANCER PATIENTS: A MULTICENTRIC STUDY

Relationship between molecular markers and lymphadenectomy and lymphovascular space invasion in endometrial cancer.

Relationship between pathologic parameters, surgical parameters, or lymph node status with oncologic outcomes is not fully elucidated in endometrial cancer (EC). We want to investigate the molecular classification of uterine cancer in the Turkish population and its relationship between lymphadenectomy and lymph node metastasis. In this study, 100 patients' clinical and pathologic data diagnosed with EC were analyzed. Pathologic and molecular parameters were investigated and compared them with clinical parameters. According to the molecular analysis, 16 patients (16%) had p53 mutation, 3 patients (3%) were classified as POLE mutant group, 38 (38%) patients in the MSI group, and the remaining 43 patients (43%) into the no specific mutation profile (NSMP) group. Lymph node metastasis rate was significantly higher in copy number high (CNH) group compared to the others. In the CNH group, 29 of 437 (6.6%) dissected lymph nodes had metastasis. The median OS was the highest in the POLE group (72months) and lowest in the CNH group (36months). Endometrial cancer patients showed significantly different overall and disease-free survival according to the molecular subtypes and it was consistent with the literature, Lymph node metastasis risk was the highest in CNH group. MSI status is important for the lymph node metastasis risk but not all abnormalities, especially PMS2 and MLH1 expression changes showed the highest risk.

Expression profile and prognostic values of GATA family members in kidney renal clear cell carcinoma

To investigate the possible diagnostic and prognostic biomarkers of kidney renal clear cell carcinoma (KIRC), an integrated study of accumulated data was conducted to obtain more reliable information and more feasible measures. Using the Tumor Immune Estimation Resource (TIMER), University of Alabama at Birmingham Cancer Data Analysis Portal (UALCAN), Human Protein Atlas (HPA), Kaplan-Meier plotter database, Gene Expression Profiling Interactive Analysis (GEPIA2) database, cBioPortal, and Metascape, we analyzed the expression profiles and prognoses of six members of the GATA family in patients with KIRC. Compared to normal samples, KIRC samples showed significantly lower GATA2/3/6 mRNA and protein expression levels. KIRC's pathological grades, clinical stages, and lymph node metastases were closely related to GATA2 and GATA5 levels. Patients with KIRC and high GATA2 and GATA5 expression had better overall survival (OS) and recurrence-free survival (RFS), while those with higher expression of GATA3/4/6 had worse outcomes. The role and underlying mechanisms of the GATA family in cell cycle, cell proliferation, metabolic processes, and other aspects were evaluated based on Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) enrichment analyses. Furthermore, we found that infiltrating immune cells were highly correlated with GATA expression profiles. These results showed that GATA family members may serve as prognostic biomarkers and therapeutic targets for KIRC.

Is Systemic Inflammatory Response Index (SIRI) a Reliable Tool for Prognosis of Gastric Cancer Patients Without Neoadjuvant Therapy?

The systemic inflammatory response index (SIRI), which depends on peripheral neutrophil, monocyte, and lymphocyte count, was found as an effective prognostic indicator for various malignancies. This study aims to investigate the predictive value of preoperative SIRI in the prognosis of gastric cancer patients without neoadjuvant therapy. The patients who underwent gastric cancer surgery in Marmara University Hospital's General Surgery Department between 2019 and 2021 were analyzed retrospectively. SIRI was calculated from preoperative peripheral blood samples' neutrophil, lymphocyte, and monocyte count. The optimal cut-off value for SIRI was calculated by the receiver operating characteristics (ROC) curve and was found to be 1.35. The clinicopathological outcomes and overall survival (OS) were analyzed under two groups according to the SIRI values lower or higher than 1.35. The number of eligible patients was 199. The median follow-up time was 25 (1-56) months. The higher SIRI was associated with male gender (p = 0.044), lower serum albumin (0.002) level, and Clavien-Dindo (CD) Grade III and higher complications (p = 0.018). However, there was no significant difference between the groups regarded pathological tumor, nodes, and metastases (TNM) stages, histological grade, and Lauren Type. In addition, OS and stage-specific OS were similar between the groups. SIRI may be a valuable and effective predictive indicator for postoperative morbidity. The prognostic performance of SIRI on long-term OS is still controversial. Further investigations are needed into this topic.

Imaging nodal volume and survival in oral tongue cancer with cervical lymph node metastasis

ObjectivesOral tongue cancer is the most prevalent type of oral cavity cancer and presents the worst prognosis. With the use of TNM staging system, only the size of primary tumor and lymph node are considered. However, several studies have considered the primary tumor volume as a possible significant prognostic factor. Our study, therefore, aimed to explore the role of nodal volume from imaging as a prognostic implication. MethodsMedical records and imaging (either from Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) scan) of 70 patients diagnosed with oral tongue cancer with cervical lymph node metastasis between January 2011 and December 2016 were retrospectively reviewed. The pathological lymph node was identified, and nodal volume was measured using the Eclipse radiotherapy planning system and was further analysed for its prognostic implications, particularly on overall survival, disease-free survival, and distant metastasis-free survival. ResultsFrom A Receiver Operating Characteristic (ROC) curve analysis, the optimal cut-off value of the nodal volume was 3.95 cm3, to predict the disease prognosis, in terms of overall survival and metastatic-free survival (p ≤ 0.001 and p = 0.005, respectively), but not the disease-free survival (p = 0.241). For the multivariable analysis, the nodal volume, but not TNM staging, was a significant prognostic factor for distant metastasis. ConclusionsIn patients with oral tongue cancer and cervical lymph node metastasis, the presence of an imaging nodal volume of ≥3.95 cm3 was a poor prognostic factor for distant metastasis. Therefore, the lymph node volume may have a potential role to adjunct with the current staging system to predict the disease prognosis. Level of Evidence2b.

Metabolic tumour and nodal response to neoadjuvant chemotherapy on FDG PET-CT as a predictor of pathological response and survival in patients with oesophageal adenocarcinoma

Objectives2-deoxy-2[18F]Fluoro-d-glucose (FDG) PET-CT has an emerging role in assessing response to neoadjuvant therapy in oesophageal cancer. This study evaluated FDG PET-CT in predicting pathological tumour response (pTR), pathological nodal response (pNR) and survival.MethodsCohort study of 75 patients with oesophageal or oesophago-gastric junction (GOJ) adenocarcinoma treated with neoadjuvant chemotherapy then surgery at Guy’s and St Thomas’ NHS Foundation Trust, London (2017–2020). Standardised uptake value (SUV) metrics on pre- and post-treatment FDG PET-CT in the primary tumour (mTR) and loco-regional lymph nodes (mNR) were derived. Optimum SUVmax thresholds for predicting pathological response were identified using receiver operating characteristic analysis. Predictive accuracy was compared to PERCIST (30% SUVmax reduction) and MUNICON (35%) criteria. Survival was assessed using Cox regression.ResultsOptimum tumour SUVmax decrease for predicting pTR was 51.2%. A 50% cut-off predicted pTR with 73.5% sensitivity, 69.2% specificity and greater accuracy than PERCIST or MUNICON (area under the curve [AUC] 0.714, PERCIST 0.631, MUNICON 0.659). Using a 30% SUVmax threshold, mNR predicted pNR with high sensitivity but low specificity (AUC 0.749, sensitivity 92.6%, specificity 57.1%, p = 0.010). pTR, mTR, pNR and mNR were independent predictive factors for survival (pTR hazard ratio [HR] 0.10 95% confidence interval [CI] 0.03–0.34; mTR HR 0.17 95% CI 0.06–0.48; pNR HR 0.17 95% CI 0.06–0.54; mNR HR 0.13 95% CI 0.02–0.66).ConclusionsMetabolic tumour and nodal response predicted pTR and pNR, respectively, in patients with oesophageal or GOJ adenocarcinoma. However, currently utilised response criteria may not be optimal. pTR, mTR, pNR and mNR were independent predictors of survival.Key Points• FDG PET-CT has an emerging role in evaluating response to neoadjuvant therapy in patients with oesophageal cancer.• Prospective cohort study demonstrated that metabolic response in the primary tumour and lymph nodes was predictive of pathological response in a cohort of patients with adenocarcinoma of the oesophagus or oesophago-gastric junction treated with neoadjuvant chemotherapy followed by surgical resection.• Patients who demonstrated a response to neoadjuvant chemotherapy in the primary tumour or lymph nodes on FDG PET-CT demonstrated better survival and reduced rates of tumour recurrence.

Checkpoint inhibitor-induced immune-related sarcoidosis-like reaction

Immune checkpoint inhibitors are associated with a wide spectrum of immune-related adverse events (AE) of different severity. Immune-related sarcoidosis-like reactions are relatively rare but clinically important AEs. These abnormalities, due to the appearance of active pathological lymph nodes or nodules in other organs on radiographs, can be falsely interpreted as tumor progression or stabilization and thus affect treatment strategy, leading to unreasonably early therapy discontinuation or its unnecessary continuation. So far there were no convincing criteria for differentiation between sarcoidosis-like reaction and sarcoidosis, oncologist should be aware of this reaction and include it in the differential diagnosis in patient with suspected disease progression who are treated with immune checkpoint inhibitors.

The Application of the Proposed Sydney System for Reporting Lymph Node Cytopathology: A Five-Year Experience of an Academic Institution in South India

Introduction: Fine needle aspiration biopsy (FNAB) is a routinely used investigation in the evaluation of lymph node pathologies. However, there exists a lack of uniformity in cytopathology reporting owing to the nonavailability of standard guidelines. Recently, a novel system for reporting lymph node cytopathology has been proposed. The present study aimed to analyze the utility of the proposed system in cytopathology reporting in our institution. Materials: FNABs of lymph nodes performed over a period of 5 years were categorized as per the proposed Sydney system. The diagnoses on cytopathology were correlated with histopathologic diagnoses to assess the diagnostic accuracy. The rate of malignancy (ROM) for each category was calculated. Results: A total of 747 lymph node FNABs were included in the study. Histopathology was available in 262 cases. ROM in categories I–V was 26.3%, 7.2%, 76.9%, 82.3%, and 100.0%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of FNAB when considering category L3 to represent benign cytopathology were 84.2%, 97.5%, 97.1%, and 86.2%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of FNAB when considering category L3 to represent malignant cytopathology were 92.56%, 95.08%, 94.9%, and 92.8%, respectively. Conclusion: The study substantiates the usefulness of the proposed Sydney system in lymph node cytopathology in enhancing better communication between clinicians and cytopathologists. The use of ancillary techniques like immunocytochemistry and flow cytometry will aid in arriving at a more precise diagnosis.

Malignant sublingual gland tumors: A single-center retrospective analysis of 79 patients.

To analyze and summarize the clinicopathological features, risk factors for cervical nodal metastasis, and prognostic factors of malignant sublingual gland tumors (MSLGT). Patients diagnosed with MSLGT were retrospectively reviewed from January 2005 to December 2017 at Shanghai Ninth Hospital. The clinicopathological features were summarized, and the correlations between clinicopathological parameters, cervical nodal metastasis, and local-regional recurrence were evaluated using the Chi-square test. Kaplan-Meier method and Cox regression analysis were performed to assess the survival and independent prognostic factors. Seventy-nine patients were included, and the 5-year overall survival and disease-free survival rates was 85.7% and 71.7%, respectively. Gender and clinical tumor stage were risk factors for cervical nodal metastasis. Tumor size and pathological lymph node (LN) stage were independent prognostic factors for adenoid cystic carcinoma (ACC) of the sublingual gland; while age, pathological LN stage, and distant metastasis were prognostic factors for patients with non-ACC of the sublingual gland. Patients with higher clinical stage were more likely to undergo tumor recurrence. Malignant sublingual gland tumors are rare, and neck dissection should be performed in male MSLGT patients with higher clinical stage. Among patients with both ACC and non-ACC MSLGT patients, pN+ indicate a poor prognosis.

Comparison of antegrade robotic assisted VS laparoscopic inguinal lymphadenectomy for penile cancer

BackgroundMinimally invasive modifications of inguinal lymphadenectomy (IL), including laparoscopic IL (LIL) and robotic-assisted IL (RAIL), have been utilized for penile cancer. Comparative study is necessary to guide the decision about which minimally invasive technique to select for IL. Therefore we compared RAIL with LIL performed via an antegrade approach in terms of perioperative outcomes.MethodsWe conducted a retrospective study of 43 patients who underwent RAIL (n = 20) or LIL (n = 23) for penile cancer from 2016 to 2020. The key surgical procedures and techniques are described. Complications were graded by the Clavien-Dindo classification, and operative time, estimated blood loss (EBL), lymph nodal yield, nodal positivity, postoperative drain duration, and disease recurrence during follow-up were assessed. Categorical variables were compared using chi-squared whereas continuous variables were compared by t-tests.ResultsThe operative time for RAIL was significantly shorter than that of LIL (median 83 vs 95 min). Significantly less blood loss was reported with RAIL than with LIL (median 10 vs 35 ml). Lymph node yield, pathological positive nodes, the hospital stay, postoperative drain duration, postoperative complications and recurrence were similar for RAIL and LIL.ConclusionsFor patients with penile cancer, perioperative outcomes of RAIL and LIL were similar, but there was less blood loss, a shorter operative time for robotic cases.

Lymph Node Metastases in Surgically Resected Solitary Ground-Glass Opacities: A Two-Center Retrospective Cohort Study and Pooled Literature Analysis.

An increasing body of evidence supports the noninferiority of sublobar resection compared with lobectomy in terms of survival for patients with early-stage lung cancer with ground-glass opacities (GGOs). However, few studies have focused on the incidence of lymph node (LN) metastases in these patients. We aimed to analyze N1 and N2 lymph node involvement in patients with non-small cell lung cancer (NSCLC) with GGO components stratified with different consolidation tumor ratio (CTR). We performed two-center studies by retrospectively reviewing a total of 864 patients with NSCLC with semisolid or pure GGO manifestation (diameter≤3cm). Clinicopathologic features and outcomes were analyzed. We also reviewed 35 studies to characterize the patient with NSCLC population with the GGO manifestation. In both cohorts, there was no LN involvement for pure GGO NSCLC, while solid predominant GGO exhibited a relatively high LN involvement rate. On the basis of a pooled literature analysis, the incidence of pathologic mediastinal LN was 0% and 3.8% for pure and semisolid GGOs, respectively. GGO NSCLCs with CTR≤0.5 also had rare LN involvement (0.1%). From two cohorts and pooled literature analysis, LN involvement was not observed in patients with pure GGO, and very few patients with semisolid GGO NSCLC with CTR ≤0.5 had LN involvement, revealing that it may be unnecessary to perform lymphadenectomy for pure GGOs, while mediastinal lymph node sampling (MLNS) is enough for semisolid GGOs with CTR ≤0.5. For the patients with GGO CTR >0.5, mediastinal lymphadenectomy (MLD) or MLNS should be considered.

Clinical, cytological and ultrasonographic features of incidental thyroid cancer in a hospital‐based study in vietnam

Thyroid nodules are common diseases of the endocrine system, with a 5% prevalence rate in the general population. This study aimed to identify prevalence, clinical, cytological and ultrasonographic features of incidental thyroid cancer and its associated factors in Vietnam. This cross-sectional descriptive study consisted of 208 patients with incidental thyroid nodules detected by ultrasound at the Endocrinology Department, Bach Mai Hospital, Hanoi, Vietnam between November 2019 and August 2020. Clinical information, sonography characteristics of thyroid nodules, results of fine-needle aspiration biopsy (FNAB), postoperative pathology and lymph node metastasis were collected. A multiple logistic regression model was used to estimate factors associated with thyroid cancer. A total of 272 thyroid nodules (from 208 participants) were included in this study. The mean age was 47.2± 12.0 (years). The rate of incidental thyroid cancer patients detected was 17.3%. Nodules <1 cm in size were significantly more prevalent for malignant nodules. The size of more than half of thyroid cancer nodules was 0.50-0.99 cm. Postoperative pathology of all nodules with Bethesda V and VI was papillary thyroid cancer which was consistent with cytological results. 33.3% of thyroid cancer patients have lymph node metastasis. The regression model showed that thyroid cancer was more likely to occur at a younger age (≤ 45 years vs. >45 years, OR 2.8; 95% CI: 1.3-6.1), taller-than-wide nodules (OR 6.8; 95% CI: 2.3-20.2) and hypo-echoic nodules (OR 5.2; 95% CI: 1.7-15.9). The study showed that the prevalence of incidental thyroid cancers was 17.3%, of which 100% was papillary carcinoma. People under the age of 45 and the presence of ultrasound characteristics, such as taller-than-wide and hypoechoic nodules increased risk for malignancy.