Pattern Of Lymph Node Metastasis Research Articles

Invasion category-oriented lymph node metastases of cholangiocarcinoma and the prognostic impact.

It was speculated that intrahepatic cholangiocarcinoma (ICC) invasion would influence cancer progression, such as lymph node (LN) metastasis, and the efficacy of LN dissection (LND). The purpose of this study is to evaluate the LN metastatic pattern of intrahepatic cholangiocarcinoma, including the invasion category and prognosis after surgical resection, in order to explore effective LND. We analyzed a prospectively collected cohort for ICC with a previously reported invasion category: hilar type, showing invasion to the main or first branch of Glisson; peripheral type, showing no invasion to less than the third branch; and intermediate type, for all others. Data from a total of 180 patients who underwent surgical resection were analyzed (LN dissection in 142 (79%)). In single ICC, hilar type had a higher LN metastatic rate than the others (hilar; 23/45 (51%), intermediate; 7/25 (28%), peripheral; 1/34 (3%)). Although the survival with LN metastasis (LN+) was worse, single and hilar/intermediate ICC LN+ had a better survival than peripheral type LN+ (3-year OS: hilar/intermediate 30-37%, peripheral 0%). The most frequent LN metastatic region was the hepatico-duodenal ligament for all invasion categories, and the LN metastatic region was not related to the survival. In peripheral ICC, LND did not affect the survival. By contrast, hilar/intermediate ICC LN+ had a better survival than did peripheral ICC LN+, and the 3-year OS was ≥ 20%. LN metastasis depended on the ICC invasion category in addition to the tumor number, which affected patients' survival and the need for LND. In hilar-type disease, LN dissection may contribute to the survival.

Incidence and Pattern of Nodal Metastasis in Colon and Rectal Cancer: a Study of 1012 Cases from Thailand

Objective: Lymph node (LN) metastasis is a key to determine prognosis and adjuvant treatment for resectable colorectal cancer. This study aimed to determine and compare the incidence and pattern of LN metastasis between colon cancer and rectal cancer.Methods: Medical and pathological reports of patients with stage I-III colorectal adenocarcinoma undergoing oncological resection between 2009 and 2013 at the Faculty of Medicine Siriraj Hospital were reviewed. The incidence and pattern of LN metastasis related to tumor staging between colon cancer and rectal cancer were analyzed.Results: This study included 1012 cases (502 colon cancer and 510 rectal cancer). Compared with rectal specimens, colonic specimens had a larger tumor size (5.8 cm vs 5.0 cm; P<0.001), more T4 lesion (24% vs 6.3%; P<0.001) and more LNs harvested (24 vs 18; P<0.001). Nodal metastases were found in 552 specimens (54.5%). The rate of LN metastasis was 14.3% for T1 tumors, 25.6% for T2 tumors, 61.2% for T3 tumors, and 65.6% for T4 tumors. There was no significant difference in the overall rate of nodal metastasis between colon cancer and rectal cancer (52.6% vs 56.5%; P=0.22), but rectal cancer had more N2 staging (31% vs 22.5%; P=0.002). Rectal cancer yielded more median number of positive LN (4 vs 3; P=0.002) with a greater LN ratio (0.22 vs 0.12; P<0.001) than colon cancer. Based on the depth of tumor invasion, T3 rectal cancer had a significantly higher rate of LN metastasis (66.8% vs 55.7%; P=0.004) and a greater LN ratio (0.23 vs 0.10; P<0.001) than T3 colon cancer.Conclusion: Although colon cancer had a larger tumor size and a higher percentage of deeper invasion, rectal cancer were associated with a higher number of positive LN, more N2 status and a greater LN ratio - especially T3 lesion.

Prognostic score for survival with pulmonary carcinoids: the importance of associating clinical with pathological characteristics.

Lung carcinoids (LCs) are staged using the non-small-cell lung cancer tumour/node/metastasis staging system; the possibility of an LC-specific staging system is still being debated. The goal of our study was to construct a composite prognostic score for LC. From January 2002 to December 2014, data from 293 patients who underwent surgical treatment for LC in 7 research institutes were retrospectively analysed. A panel of established prognostic factors in addition to lymph node metastasis patterns (single/multiple N1-N2 station, skip metastasis, lobe specific), numbers of lymph nodes resected and the ratio between the numbers of metastatic lymph nodes and the numbers of lymph nodes resected (node ratio) were correlated to overall survival (OS) and disease-free survival (DFS). The log-hazard ratio (HR), obtained from the Cox model, was used to derive weighting factors for a continuous prognostic index, designed to identify differential outcome risks. The score was dichotomized according to maximally selected log-rank statistics. Pathological analysis showed typical carcinoids in 223 (76.1%) and atypical carcinoids in 70 (23.9%) patients; the tumour/node/metastasis pattern was stage I in 72.4%, stage II in 18.1%, stage III in 9.5% and stage IV in 0.03% cases. The median numbers of lymph nodes resected was 12 (range 0-53); hilar and mediastinal node metastases were identified in 14% and 6.8% of cases, respectively. Overall, the 5-year OS and 5-year DFS rates were 90.6% and 76.7%, respectively. At multivariable analysis, sex, age, pathological T stage and node ratio were significantly related to a better OS; age, histological type, pathological T stage and node ratio were related to DFS. These factors were used to generate the prognostic score, which showed statistically significant differences between the high-risk and low-risk groups: 5-year OS = 96.6% if score <3.1 vs 63.5% if score ≥3.1 [P < 0.0001; HR 17.56, 95% confidence interval (CI) 5.45-56.53]; 5-year DFS 92.3% if score <1.5 vs 52.5% if score ≥ 1.5 (P < 0.0001; HR 7.95, 95% CI 3.48-18.16). The proposed prognostic scores seem to be effective in predicting outcomes for patients with LCs.

Sentinel node theory helps tracking of primary lesions of cancers of unknown primary

BackgroundSentinel lymph node is the first stop of lymphatic spreading of cancer with known primary. The lymph node metastasis pattern of cancer of unknown primary (CUP) is unclear and has been presumed to follow the same pathway. To test this hypothesis, data of all 716 patients clinically diagnosed as CUP in our center were collected.MethodsDiagnoses of lymph node metastasis were established by 18F-FDG PET-CT and/or biopsy pathology. Three hundred and forty-seven cases meeting the criteria were divided into three groups: pathology-confirmed primary with invasive biopsy or surgery of the suspicious lesion (group A, n = 64), primary still unknown even with invasive biopsy or surgery of the suspicious lesion (group B, n = 204), and others with no suspicious lesion or lesions who had not been sampled due to medical or other reasons (group C, n = 79). We assessed the clinicopathological features between these groups, and the relationship between lymph node metastasis pattern and confirmed primary site.ResultsIn group A, the primary sites of 61 cases were compatible with sentinel node theory, resulting in a positive predictive value of 95%. No significant differences in age, sex, bone metastasis, or visceral metastasis observed between group A and group B, except that group A had a higher ratio of differentiated carcinoma (94% vs. 77%, P = 0.003).ConclusionTo our knowledge, this is the first evidence indicating that the majority of clinical CUP cases follow the sentinel node theory to spread in lymph nodes, which helps tracking the primary, especially for differentiated carcinoma.

A slowly-growing solitary skip lymph nodule of occult gastric cancer above the neck of pancreas: a case report

BackgroundSkip lymphatic metastasis (SK) is an exceptional and characteristic pattern of lymph node metastasis in gastric cancer (GC) with infrequent incidence. This is an extremely rare report of occult gastric cancer with solitary skip lymphatic metastasis as the initial and primary observation.Case presentationA 61-year-old woman, who complained of epigastric discomfort for several years, presented a solitary nodule upon pancreas neck examination by CT without performance on the primary lesion, even gastroscopy. During the preoperative 4-month follow-up, the nodule stayed stable without any therapy. The postoperative pathological examination confirmed the consistent diagnosis of gastric adenocarcinoma between the nodule and the stomach lesion, which was found by preoperative random biopsy of the mucosa.ConclusionsThis case highlights the concentration on vigilance to the SK of GC and a closer observation for intra-abdominal nodules, even radiological suspicion of a benign lesion.

Lymphnode metastasis patterns in primary sites of hypopharyngeal cancer: A retrospective analysis from multicenter data.

e18559 Background: Understanding the pattern of lymph node metastasis (LNM) in hypopharyngeal cancers (HPC) could help both surgeons and radiologists make decisions in the management of cervical lymph node. Our objective is to identify the pattern of nodal spread and the relationship between features of primary tumor and LNM in HPC. Methods: 244 newly diagnosed HPC patients during 2014 to 2017 were recruited from 3 specialized cancer hospitals in mainland China. All patients underwent head and neck magnetic resonance imaging(MRI) and received definitive radiotherapy ± concurrent chemotherapy. The features of primary tumor (tumor size, primary location, and extent of invasion) and the involvement of lymph nodes in each level were reassessed. According to the incidence of LNM, these levels were sequenced and sorted into drainage stations. Meanwhile, univariate and multivariate analysis was used to determine the risk factors for bilateral and regional lymph node metastasis. Results: The cohort consisted 195 piriform sinus cancers (PSC), 47 posterior wall cancers (PWC), 2 Post-cricoid cancers (PCC). 176 patients (72.1%) presented with MRI-detectable LNM. The overall LNM rates for level II-VI and retropharyngeal lymph nodes (RPLNs) were 59.0%, 52.9%, 14.3%, 1.6%, 2.9% and 14.7% respectively. Based on the prevalence of LNM in each level, we suppose that the lymphatic drainage of PSC was carried out in sequence along three stations: Level II &amp; III (61.0% &amp; 55.4%), Level IV &amp; RPLN (15.9% &amp; 10.3%), and Level V &amp; VI(1.5% &amp; 3.1%). While, for PWC the lymphatic drainage is carried out along two stations: Level II, III &amp; RPLN (48.9%,40.4% &amp; 34.0%), and Level IV-VI (6.4%, 0% and 2.1%). According to univariate analysis, primary subsite, posterior wall, post-cricoid and non-pyriform sinus invasion were correlated with bilateral LNM. The presence of RPLNs was correlated with larger tumor size(&gt;4cm), primary subsite, posterior wall and non-pyriform sinus invasion. In further multivariate analysis, posterior wall invasion was significantly correlated with bilateral LNM (P = 0.030, HR = 2.853 95%CI, 1.110-7.338). Tumor size &gt; 4cm(P = 0.017, HR = 2.545, 95%CI,1.180-5.488) and posterior wall invasion(P = 0.017, HR = 2.880 95%CI, 1.209-6.862) were correlated with RPLN metastasis. Conclusions: Different primary sites of HPC have different lymphnode metastasis patterns. Piriform sinus cancer tends to metastasize to the ipsilateral Level II&amp;III. Posterior wall cancer tends to metastasize bilaterally to Level II, III and RPLN.

Impact of 18F-FDG-PET/CT on the identification of regional lymph node metastases and delineation of the primary tumor in esophageal squamous cell carcinoma patients

PurposeIn patients undergoing chemoradiation for esophageal squamous cell carcinoma (ESCC), the extent of elective nodal irradiation (ENI) is still discussed controversially. This study aimed to analyze patterns of lymph node metastases and their correlation with the primary tumor using 18F‑fludeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scans.Methods102 ESCC patients with pre-treatment FDG-PET/CT scans were evaluated retrospectively. After exclusion of patients with low FDG uptake and patients without FDG-PET-positive lymph node metastases (LNM), 76 patients were included in the final analysis. All LNM were assigned to 16 pre-defined anatomical regions and classified according to their position relative to the primary tumor (above, at the same height, or below the primary tumor). In addition, the longitudinal distance to the primary tumor was measured for all LNM above or below the primary tumor. The craniocaudal extent (i.e., length) of the primary tumor was measured using FDG-PET imaging (LPET) and also based on all other available clinical and imaging data (endoscopy, computed tomography, biopsy results) except FDG-PET (LCT/EUS).ResultsSignificantly more LNM were identified with 18F‑FDG-PET/CT (177 LNM) compared to CT alone (131 LNM, p < 0.001). The most common sites of LNM were paraesophageal (63% of patients, 37% of LNM) and paratracheal (33% of patients, 20% of LNM), while less than 5% of patients had supraclavicular, subaortic, diaphragmatic, or hilar LNM. With regard to the primary tumor, 51% of LNM were at the same height, while 25% and 24% of lymph node metastases were above and below the primary tumor, respectively. For thirty-three LNM (19%), the distance to the primary tumor was larger than 4 cm. No significant difference was seen between LCT/EUS (median 6 cm) and LPET (median 6 cm, p = 0.846)Conclusion18F‑FDG-PET can help to identify subclinical lymph node metastases which are located outside of recommended radiation fields. PET-based involved-field irradiation might be the ideal compromise between small treatment volumes and decreasing the risk of undertreatment of subclinical metastatic lymph nodes and should be further evaluated.

Papillary Carcinoma of Thyroid Nodule if Located in Isthmus Is Associated with Greater Disease Progression: a Systematic Review and Meta-analysis

The aim of this study was to evaluate the clinicopathologic characteristics and pattern of lymph node (LN) metastasis in papillary thyroid cancer (PTC) located in the isthmus. A systematic review of the relevant electronic databases was conducted between January 2000 and December 2019, including Pubmed, Web of Science, and the China Journal Net. Outcomes of interest included gender, age, tumor size, multifocality, capsule invasion, extrathyroidal extension, and lymph node metastasis. We calculated the pooled odds ratios (ORs) with 95% confidence intervals (CIs) for each study using a random or fixed effect model. Nine studies with a total of 4541 patients were included. Patients with isthmic PTC were 565 (12.4%). Our meta-analysis revealed that there was a significant association between the isthmus location and multifocality (OR = 1.50; 95% CI = 1.18–1.90), capsule invasion (OR = 1.53; 95% CI = 1.17–1.99), extrathyroidal extension (ETE) (OR = 1.95; 95% CI = 1.34–2.86), and central LN metastasis (OR = 1.53; 95% CI = 1.17–1.99). For patients with solitary nodule, our meta-analysis illustrated that there was a significant association between the isthmus location and ETE (OR = 1.65; 95% CI = 1.11–2.46), and central LN metastasis (OR = 2.50; 95% CI = 1.82–3.44). However, the meta-analysis suggested that there was no correlation between the isthmus location and lateral LN involvement (OR = 1.04; 95% CI = 0.58–1.87). PTCs located in the isthmus were associated with multifocality, capsule invasion, ETE, and more likely to involve the central lymph node.

Diagnostic Accuracy of Ultrasound for the Evaluation of Lateral Compartment Lymph Nodes in Papillary Thyroid Carcinoma.

To evaluate the diagnostic accuracy of ultrasound (US) assessing the lateral compartment lymph node metastasis in patients with primary papillary thyroid carcinoma (PTC), and to demonstrate the incidence and patterns of the lateral lymph node metastasis. We retrospectively reviewed 198 patients with primary PTC who underwent thyroidectomy in addition to modified lateral neck dissections (MLND) involving level II to level V due to clinically positive lateral neck disease. A skilled and experienced single operator performed all US examinations. Surgical pathology results were accepted as the reference method and sensitivity, specificity, and diagnostic accuracy of US in detecting metastatic lymph nodes established using level-by-level analysis. In the study cohort, 10.1% of the patients had lateral compartment lymph node metastases without any central compartment involvement. For the lateral compartment, 48.5% had level II, 74.7% had level III, 64.6% had level IV, and 29.3% of the patients had level V metastasis. None of the patients had isolated level V metastasis. The sensitivity, specificity, and diagnostic accuracy of US in identifying lateral lymph compartment metastasis ranged from 87% to 91.4%, 92% to 98.6% 92.4% to 96%, respectively. However, the sensitivity (74.7%) and diagnostic accuracy (76.2%) of US significantly decreased for the central compartment while specificity (90%) remained similar. US performed by a skilled operator has an excellent diagnostic accuracy for the evaluation of lateral cervical lymph nodes in primary PTC; thus, might enable precise tailoring of the management strategies. Moreover, the high incidence of level V involvement favors MLND over selective approaches.

Understanding the pattern of lymph node metastasis for trans-segmental thoracic esophageal cancer to develop precise delineation of clinical target volume for radiotherapy.

This study was conducted to explore the lymph node metastasis (LNM) pattern of thoracic esophageal cancer (TEC) depending upon the location of the primary tumor and provide a reference for the design of clinical target volume (CTV). The data of patients who underwent radical esophagectomy and three-field lymph node dissection at Fujian Cancer Hospital from 2006 to 2010 were retrospectively analyzed. We segmented the esophagus according to the anatomical landmarks on computed tomography (CT) and defined the transsegmental and mono-segmental esophageal carcinoma. The LNM pattern in trans-segmental and monosegmental esophageal cancer was explored and the CTV delineation was determined based on LNM pattern. A total of 852 patients were included in this study. The top five sites of LNM for upper-middle TEC were cervical, upper and middle paraesophageal, and zone 1, 2, 4 regions. The most common sites of LNM for lower-middle TEC were cervical and middle paraesophageal, group 3, 7, and zone 7 regions. The top five sites of LNM for middle-upper TEC were cervical, middle paraesophageal, zone 1, 7, and group 7 regions. The most common sites of LNM for middle-lower TEC were cervical, middle paraesophageal, zone 7, and group 2, 7 regions. The top five sites of LNM for TEC involving all the segments were cervical, middle paraesophageal, zone 7, group 2 and 7 regions. LNM pattern of trans-segmental and mono-segmental TEC varies depending upon the primary tumor location. The irradiation field must be designed according to the primary tumor location.

Erratum: Is there really no difference of mediastinal lymph node metastasis pattern between esophageal adenocarcinoma and squamous cell carcinoma?

Erratum: Is there really no difference of mediastinal lymph node metastasis pattern between esophageal adenocarcinoma and squamous cell carcinoma?

Intraparotid and cervical lymph nodes metastasis in primary parotid gland carcinoma-impact on clinical outcome.

The aim of this study was to investigate the prognostic value of evaluation of intraparotid and cervical lymph node metastases in primary parotid cancer. A retrospective medical chart review and histopathologic evaluation of all patients surgically treated for primary parotid cancer during the period 1993 to 2010 was performed. The presence and ratio of intraparotid and cervical lymph node metastases were assessed and determined as primary predictor variables. Overall survival (OS) and disease-free survival (DFS) were defined as primary outcome variables. In total, 50 patients were included. The presence of pathologic cervical lymph nodes (P=.005) and a high cervical lymph node ratio (LNR) (P=.0001) had a significant association with worse OS. Worse DFS was found in patients with a high cervical LNR (P=.001) and intraparotid lymph node metastases (P=.029). In high-grade carcinoma, a high LNR showed worse DFS (P=.05). A high cervical LNR (P=.012) and resection margin status (P=.002) were identified as independent prognostic markers for OS and the presence of intraparotid lymph nodes for DSS (P=.05). Evaluation of patterns of lymph node metastases provides additional prognostic value in patients with primary parotid gland cancer.

Colorectal cancer treated by resection and extended lymphadenectomy: patterns of spread in left- and right-sided tumours.

Whether tumour side affects the anatomical extent and distribution of lymph node metastasis in colon cancer is unknown. The impact of tumour side on the anatomical pattern of lymphatic spread in colon cancer was assessed. Patients with stage III colon cancer from a Japanese multi-institutional database who underwent extensive (D3) lymphadenectomy, which is similar in concept to complete mesocolic excision with central venous ligation, were divided into groups with right- and left-sided tumours. Based on location, mesenteric lymph nodes were categorized as paracolic (L1), intermediate (L2) or central (L3). The Kaplan-Meier method was used to evaluate disease-free survival (DFS) and overall survival (OS), and multivariable Cox models were used to evaluate the association between anatomical lymph node level, metastatic pattern and outcome. A total of 4034 patients with stage III colon cancer (right 1618, left 2416) were included. Unadjusted OS was worse in patients with right colon cancer (hazard ratio 1·23, 95 per cent c.i. 1·08 to 1·40; P = 0·002), but DFS was similar. Right-sided tumours more frequently invaded L3 nodes than left-sided lesions (8·5 versus 3·7 per cent; P < 0·001). The proportion of patients with a skipped pattern of lymphatic spread was higher in right than in left colon cancer (13·7 versus 9·0 per cent; P < 0·001). In multivariable analysis, invasion of L3 nodes was associated with worse OS in left but not in right colon cancer. The presence of skipped metastasis was associated with worse DFS in left, but not right, colon cancer. There are significant differences in the pattern of lymph node invasion between right- and left-sided stage III colon cancer, and in their prognostic significance, suggesting that tumour side may dictate the operative approach.

ASO Author Reflections: Pattern and Frequency of Lymph Node Metastasis in Scalp Angiosarcoma.

ASO Author Reflections: Pattern and Frequency of Lymph Node Metastasis in Scalp Angiosarcoma.

Mediastinal Up-Staging During Surgery in Non–Small-Cell Lung Cancer: Which Mediastinal Lymph Node Metastasis Patterns Better Predict The Outcome? A Multicenter Analysis

BackgroundUnexpected N2 involvement occurs in approximately 10% to 20% of patients with non–small-cell lung cancer (NSCLC) and patients’ prognostic factors remain unclear. The aim of this study was to evaluate prognostic factors in these patients. MethodsFrom January 2002 to December 2012, we retrospectively analyzed data of 550 patients with NSCLC with preoperative negative, but pathologic positive N2 involvement, who underwent anatomical lung resection and hilo-mediastinal lymphadenectomy, obtained from 6 institutions. An established prognostic factor panel and N2-type involvement were correlated to overall (OS), cancer-specific (CSS), and disease-free survival (DFS) using multivariate Cox Regression model. The following lymph node patterns were analyzed: number of resected nodes (#RNs), metastatic nodes (#MNs), ratio between #MNs and #RNs (NR), N2 subgroups proposed for the eighth TNM edition, and lobe-specific versus nonspecific metastasis. ResultsRegarding our cohort, 419 patients were staged IIIA (T1-2N2), 131 IIIB (T3-4 N2), 113 pT1, 306 pT2, 94 pT3, and 37 pT4; 5-year OS, DFS, and CSS were 34.1%, 20.1%, and 64.6%, respectively. Independent prognostic factor for OS, in the multivariable analysis, were as follows: NR <17% (P = .009), proposed N2 classification subgroups (P = .014), age <66 (P < .001), and pT (P = .005); for DFS: NR <17% (P = .003), adjuvant treatment (P = .026), and pT (P = .026); and for CSS: NR <17% (P = .008), grading (P = .001), and adjuvant treatment (P < .001). ConclusionOur study confirms that adjuvant therapy is fundamental and NR, in patients with unexpected N2 involvement, has a strong prognostic factor. In particular, a NR cutoff value of 17% could predict OS, DFS, and CSS in patients with NSCLC.

Patterns of Cervical Lymph Node Metastasis and Relatively Risk Factors in Locally Advanced Supraglottic Squamous Cell Carcinoma

Patterns of Cervical Lymph Node Metastasis and Relatively Risk Factors in Locally Advanced Supraglottic Squamous Cell Carcinoma

Papillary Thyroid Cancers of the Thyroid Isthmus: The Pattern of Nodal Metastasis and the Significance of Extrathyroidal Extension.

Cancers of the thyroid isthmus are less frequent compared with the lobar cancers yet have their own unique clinicopathological characteristics. Herein, we sought to examine the isthmic papillary thyroid carcinomas (PTCs) for the pattern of and risk factors for nodal metastasis and the significance of extrathyroidal extension (ETE). The medical records of 3138 patients diagnosed with solitary PTC who had undergone surgery were retrospectively reviewed. Of these, 122 isthmic PTCs were matched to common lobar PTCs at a ratio of 1:3 for age, sex, and nodule size. Patient demographics, surgical findings, and pathology reports were analyzed. Isthmic PTCs comprised 4.6% of all PTCs and had more lymphatic invasion (22.1% vs. 13.4%, p = 0.021), ETE (73.0% vs. 57.1%, p = 0.002), and perithyroidal and prelaryngeal node metastasis (18.0% vs. 9.0%, p = 0.006) compared with lobar PTCs. However, there were no significant differences in the rate of central and lateral node metastasis between the two groups. ETE was identified not to be a risk factor for isthmic PTCs for central and lateral node metastasis, in contrast to lobar PTCs in which ETE was a significant risk factor (odds ratio 3.18, 95% confidence interval [CI] 1.89-5.34; and 4.72, 95% CI 1.04-21.41). The rates of central and lateral node metastasis of isthmic PTCs are comparable with that of lobar PTCs despite a higher rate of ETE in the isthmic counterpart. Although the extent of surgery for isthmic PTCs remains to be investigated, careful dissection of perithyroidal and prelaryngeal nodes may be necessary for isthmic PTCs.

Extent of Peritoneal Resection for Peritoneal Metastases: Looking Beyond a Complete Cytoreduction.

Completeness of cytoreduction is one of the most important prognostic factors impacting outcomes of cytoreductive surgery (CRS). To what extent the surrounding normal peritoneum needs to be removed is not known. We hypothesized that the extent of peritoneal resection should be different for different tumors and performed this study to find evidence to support this rationale. To determine the extent of resection of surrounding tissue for any tumor, the mechanisms of tumor development and spread, tumor morphology, the possibility of finding disease in the surrounding normal tissue, and the pattern of lymph node metastases should be known. Surgical resections also depend on patterns of recurrence and the impact of varying extent of resection on survival. We performed a review of literature pertaining to pathways and patterns of peritoneal cancer spread to determine the scientific basis for the extent of peritonectomy. We also reviewed studies comparing less and more extensive peritoneal resection. There is no consensus on the extent of lymphadenectomy required for most PM. Based on this review, we provide recommendations for the extent of peritoneal resection and the extent of lymph node dissection that should be performed for some common peritoneal tumors and identify areas that require further research. We propose that a systematic method of synoptic reporting of pathological specimens of CRS should be developed to capture information regarding the disease distribution within the peritoneal cavity and morphology of PM from different tumors. This can in future be used to establish standard guidelines for such resections.

Patterns and risk factors of lymph node metastasis in locally advanced supraglottic squamous cell carcinoma

Objective To investigate the pattern of lymph node metastasis (LNM) in patients with locally advanced (T3, T4) laryngeal squamous cell carcinoma (LALSC) and provide reference for the delineation of clinical target volume. Methods Clinical data of 272 patients with LALSC treated in our hospital from 2000 to 2017 were retrospectively analyzed. All patients underwent bilateral neck dissection (at least level Ⅱ-Ⅳ). The LNM ratio of each node level was calculated. The risk factors of LNM were identified by univariate and multivariate logistic regression analyses. Results LNM was found in 156 of 272 patients (57.1%). According to the location of primary lesions, all patients were divided into group A (n=72; unilateral without midline involvement), group B (n=86; unilateral with midline involvement) and group C (n=114; giant or central). In group A, the LNM ratio at ipsilateral level Ⅱ, Ⅲ and Ⅳ was 36.3%, 26.4% and 6.9%, whereas 13.9%, 8.3% and 1.4% at the contralateral level, respectively. In group B, the LNM ratio at ipsilateral level Ⅱ, Ⅲ and IV was 1.9%, 29.1% and 11.6%, whereas 18.6%, 14.0% and 1.2% at the contralateral level, respectively. In group C, the LNM ratio at the left neck level Ⅱ, Ⅲ and Ⅳ was 24.6%, 23.7% and 2.6%, whereas 21.9%, 26.3% and 6.1% at the right neck, respectively. Bilateral LNM ratio did not significantly differ between group A and group B/C (15.3%, 25.0%, P=0.093). Ipsilateral level Ⅲ metastasis (OR=2.929, 95%CI 1.041-8.245, P=0.042) and clinical N stage (OR=0.082, 95%CI 0.018-0.373, P=0.001) were associated with contralateral LNM. Ipsilateral level Ⅱ(P=0.043) or Ⅲ(P=0.009) metastasis were risk factors of the ipsilateral level Ⅳ metastasis. Conclusions Neck levels Ⅱ and Ⅲ are the high-risk LNM regions, whereaslevels Ⅳ and V are the low-risk areas. Ipsilateral level Ⅱ or Ⅲ metastases are the risk factors of ipsilateral level Ⅳ and contralateral cervical LNM. Contralateral neck LNM rarely occurs in cN0 stage patients. Key words: Locally advanced laryngeal cancer; Squamous cell carcinoma; Lymph node metastasis; Risk factor

Comparison of Clinicopathological Profile of Oral Squamous Cell Carcinoma between Younger and Older Indian Adults

Introduction: The relative incidence of Oral Squamous Cell Carcinoma (OSCC) seems to be increasing in young subjects and there is still no consensus regarding its pathogenesis, clinicopathological characteristics and prognosis in this population. Aim: The study aimed at evaluating the clinicopathological features of OSCC in younger patients and to determine any characteristic specific to this population in contrast to the older subjects. Materials and Methods: This was a single centre prospective study, conducted on 187 radical resection specimens of OSCC, between April 2015 and April 2020, at MS Ramaiah Medical College and Hospitals, Bengaluru. Of the study population 18.7% were young patients (≤40 years) and 81.3% were older patients. The clinical features and tumour characteristics were evaluated and the tumours were staged according to American Joint Committee on Cancer (AJCC) staging system. The characteristics in young patients (≤40 years) were compared to those of older patients. SPSS Version 18.0 software was used for statistical analysis. Chi-square test was used to determine any significant difference in the categorical variables. Results: Of the 187 patients, included in the study, 18.7%were young with a mean age of 36.8 years and male: female ratio of 1.3:1. Risk factor usage was present in 85.7% and family history of OSCC was present in 5.7% of the patients. Buccal mucosa was the commonest tumour site (54.3%) (significant p-value 0.031). Most patients presented at advanced TNM (Tumour Node Metastasis) stage (77.2%) and lymph node metastasis, extranodal extension and Worst Pattern Of Invasion (WOPI) were respectively present in 40%, 14.2% and 8.6% of the cases. Conclusion: Family antecedent of OSCC was higher in the young patients. Risk factor exposure and tumour characteristics like commonest anatomic site, morphology, differentiation and perineural invasion are relatively similar between the two age groups. Lymphovascular invasion, extranodal extension, WOPI, lymph node metastasis and presentation at advanced TNM stage were relatively more frequent, though not statistically significant, in the young suggesting a possibility of OSCC being more biologically aggressive in this population.