Pelvic Node Metastasis Research Articles

Lateral pelvic node dissection after neoadjuvant chemoradiation in rectal cancer with right internal iliac node metastasis but without regional node metastasis: A case report.

Introduction and importanceTotal mesorectal excision (TME) with lateral pelvic node dissection was routinely done in low clinical T3 rectal tumors below the peritoneal reflection as stated in the Japanese guidelines for colorectal cancer. Our institution follows the same practice in selected patients. This is our first reported case wherein a patient with rectal cancer underwent total mesorectal excision with lateral lymphadenectomy after neoadjuvant treatment with a positive lateral node on histopathology.Case presentationA 49 year old female rectal had rectal adenocarcinoma 4 cm FAV. Pelvic MRI revealed a low rectal tumor abutting the mesorectal fascia anteriorly, anal sphincters not involved, and confluent enlarged right iliac nodes. After neoadjuvant treatment, interval decrease in size of the rectal lesion and the right iliac nodes were noted. Patient underwent partial intersphincteric resection, lateral pelvic node dissection and protective loop ileostomy.Clinical discussionHistopathology revealed a rectal adenocarcinoma with one right internal iliac lymph node was positive for tumor involvement. Circumferential resection margin was 4.0 mm. Patient is currently on 4th cycle of adjuvant chemotherapy. Preoperative chemoradiation could not completely eradicate lateral pelvic node metastasis. Therefore, lateral pelvic node dissection should be considered if lateral pelvic lymph node metastasis is suspected even after neoadjuvant therapy.ConclusionUnlike TME, performance of a routine lateral lymphadenectomy in rectal cancer surgery varies by geographic location. Reports from Asian countries and our practice in our institution shows that it can be performed safely. This could improve the oncologic outcomes of patients especially if combined with neoadjuvant chemoradiotherapy.

Re-classification of uterine cervical cancer cases treated with radical hysterectomy based on the 2018 FIGO staging system

ObjectiveWe re-classified patients with stage IB–II disease (based on the 2008 system) and compared the outcomes with those obtained after using the 2018 International Federation of Gynecology and Obstetrics (FIGO) staging system. Materials and methodsWe reviewed the data of 154 patients with cervical cancer who underwent radical hysterectomy at our hospital during 2006–2016. Pathological, histological, and radiographic data were used to re-classify the cases based on the 2018 FIGO system. We compared these outcomes to those obtained after using the 2008 FIGO assignments. Overall survival (OS) was calculated from primary therapy initiation until death or the last follow-up examination. ResultsThe histological types were squamous cell carcinoma (108 cases) and others (46 cases). The 2008 FIGO system assignments were stage IB1, IB2, IIA1, IIA2, and IIB (87, 27, seven, five, and 28 patients, respectively). The new 2018 FIGO system assignments were stage IB1, IB2, IB3, IIA1, IIA2, IIB, and IIIC1 (52, 26, 16, six, three, 21, and 30 patients, respectively). Re-classification to stage IIIC1 disease was observed for previously assigned stage IB1, IB2, IIA1, IIA2, and IIB cases (10, seven, two, two, and nine cases, respectively). The median OS durations based on the 2018 FIGO system were 71.7, 61.1, and 62.3 months for patients with stage IB1, IB2, and IB3 (p = 0.04) disease, respectively. The new stage IB3/IIA2/IIB cases had longer OS than the old stage IB2/IIA2/IIB cases. A positive computed tomography (CT) finding of nodal involvement was observed in 37% of cases with pathological confirmation of pelvic lymph node (LN) involvement. Using CT to identify pelvic LN metastasis had a sensitivity of 37% and specificity of 93%. ConclusionThe 2018 FIGO staging system for cervical cancer after radical hysterectomy showed a better ability to differentiate survival outcomes. However, the image evaluation method should be reconsidered.

Primary Malignant Melanoma of Vagina: A Clinicopathologic Analysis of 6 Cases

Abstract Introduction/Objective Primary malignant melanoma of vagina (PMMV) has a very high rate of recurrence and poor long-term survival. Less than 250 cases are reported in English literature to date, optimal treatments, risk factors, and prognostic predictors for PMMV are still subjects of debate. This study sought to evaluate the clinicopathologic features, initial management, and survival of 6 patients over 7 years follow-up in one institution. Methods/Case Report In this study, the clinical and pathologic features of 6 PMMV occurring in patients age 49 to 83 years were evaluated retrospectively. The mean age of the patients was 68.2 years, and all patients were postmenopausal women. At the time of diagnosis, all tumors were limited to the vagina. Results (if a Case Study enter NA) Vaginal bleeding, discharge and a tumor mass were the chief complaints. These patients were treated by pelvic exenteration, radical surgery and postoperative chemotherapy and/or radiotherapy. Follow-up was available in all patients ranging from 1 to 7 years. Two patients had metastases in other organs died at 16 and 34 months respectively. Two patients had distant recurrence at 1 to 2 years and are still alive. The other 2 patients have no evidence of disease over 2 years follow-up. Grossly, the tumors were mostly polypoid and ranged from 0.25 to 9.5 cm (mean, 5 cm) in maximum dimension. The depth of invasion ranged from 2.2 to 11 mm. A vertical growth phase was present in all tumors. S-100, HMB-45 and Melan-A were positive in 100% of cases tested. Depth of invasion, mitotic index of tumor cells, tumor size, age, menopausal status, pelvic lymph node metastasis and lymphocytic infiltration show no tendency towards progression-free survival. Patients with positive or indeterminate margin status demonstrated a higher risk of recurrence than did patients with negative margins. And adjuvant therapy was associated with progression-free survival. Conclusion In conclusion, PMMV is a rare disease, predominantly seen in women of postmenopausal age, and is associated with a poor prognosis. This study confirms S-100, HMB-45and Melan-A remains the most sensitive marker. Conventional predictors were of no prognostic value. Positive margin and adjuvant therapy were associated with progression-free survival. This report can facilitate the expansion of the phenotypic spectrum of gynecologic melanomas, and contribute to the prevention of misdiagnosis and inadequate treatment of PMMV.

Ultrastaging of ‘negative’ pelvic lymph nodes in patients with low- and intermediate-risk endometrioid endometrial cancer who developed non-vaginal recurrences

ObjectiveEvidence on micrometastases and isolated tumor cells as factors associated with non-vaginal recurrence in low- and intermediate-risk endometrial cancer is limited. The goal of our study was to investigate risk...

Association between single nucleotide polymorphisms of VEGF gene and pelvic lymph node metastasis in patients with early-stage cervical cancer

Cervical cancer patients in early-stage cervical cancer (ECC) were divided into pelvic lymph node (PLN) metastasis and non-PLN metastasis group. Single nucleotide polymorphism (SNP) genotyping for the VEGF gene was conducted and plasma VEGF levels were measured. Multivariate analysis was performed to assess the correlation between SNPs of the VEGF gene and PLN metastasis. We found that SNP of the VEGF rs2010963 was independently associated with PLN metastasis. GG and CG genotype had increased susceptibility to PLN metastasis compared with CC genotype, and moreover, OR was higher in GG genotype than in CG genotype. Plasma VEGF levels were lowest in CC genotype, intermediate in GC genotype and highest in GG genotype. In summary, the SNP of the VEGF rs2010963 affected susceptibility to PLN metastasis in patients with ECC, and GG and CG genotype had increased susceptibility compared with CC genotype. The potential mechanism was associated with elevated plasma VEGF levels. Impact Statement What is already known on this subject? The positive expression of vascular endothelial growth factor (VEGF) is correlated with higher risk of lymph node metastasis among cervical cancer patients, and VEGF levels of patients with pelvic lymph node (PLN) metastasis are significantly higher than those without PLN metastasis. Additionally, single nucleotide polymorphisms (SNPs) of the VEGF gene have been indicated to be correlated with individual susceptibility to tumours and expression and protein production of VEGF. What do the results of this study add? The SNP of the VEGF rs2010963 was independently associated with PLN metastasis in patients with early-stage cervical cancer (ECC). The GG and CG genotype of the VEGF rs2010963 had increased susceptibility to PLN metastasis compared with CC genotype. Plasma VEGF levels were lowest in the CC genotype, intermediate in the GC genotype and highest in the GG genotype. What are the implications of these findings for clinical practice and/or further research? The SNP of the VEGF rs2010963 affected susceptibility to PLN metastasis in patients with ECC, and the potential mechanism was associated with elevated plasma VEGF levels.

Stereotactic Body Radiation Therapy and Immunotherapy in Abdominal and Pelvic Lymph Node Metastases

This study characterizes the efficacy and safety of stereotactic body radiation therapy (SBRT) with immunotherapy in the treatment of abdominal and pelvic lymph node metastases, based on a pooled analysis of three prospective phase I trials. While SBRT is frequently utilized for metastases, its role in the treatment of abdominal and pelvic lymphadenopathy remains unclear. We hypothesize that local control will remain excellent for nodal SBRT, even with prioritization of organ-at-risk (OAR) constraints resulting in undercoverage of target metastases and with omission of elective treatment of regional nodal basins.Patients with widely metastatic solid malignancies were enrolled on three Phase I trials between 2016 and 2020 (total 213 patients). Patients were treated with multisite SBRT (up to 4 sites). Metastases > 65cc were partially treated. Immunotherapy was administered either concurrently or sequentially. Immunotherapy regimens included pembrolizumab, ipilimumab with nivolumab, urelumab with nivolumab, or cabiralizumab with nivolumab. The study cohort included patients who underwent SBRT to at least one lymph node in the abdomen or pelvis, including the inguinal regions. Local control (LC) of irradiated metastases and regional control (RC) of the corresponding nodal basin were determined per RECIST 1.1 guidelines. Overall survival (OS) was calculated using the Kaplan-Meier method. For each irradiated lesion, the mean dose, V95%, and V100% to the ITV and PTV were recorded.A total of 39 patients (mean age 59.2 years) underwent SBRT to 56 abdominal or pelvic lymph node metastases with median follow-up of 16.2 months. The median prescription dose was 45 Gy in 3 fractions. Median lesion volume was 17.0cc. Lymph node sites included 24 para-aortic/retroperitoneal (43%), 9 pelvic (16%), 11 inguinal (20%), 10 gastrohepatic/porta hepatis (18%), and 2 other (4%). Across all patients, the 1-year LC was 90.4%. Even without elective treatment of the corresponding nodal basins, 1-year RC was 81.9% (with only one isolated regional failure without concomitant distant progression). Median OS was 25 months, while 1-year and 2-year OS were 69.9% and 53.2%, respectively. ITV mean dose, V95%, and V100% were 47.3 Gy, 95.3%, and 89.5%, respectively (reported as medians across all 56 metastases). PTV mean dose, V95%, and V100% were 45.5 Gy, 84.2%, and 75.0%, respectively. The overall incidence of grade 3+ toxicity was 10.3%. The incidence of grade 3 colitis was 2.6% and grade 3 hepatitis was 2.6%, with no grade 4-5 colitis/hepatitis events.In this pooled analysis of three prospective trials, SBRT to abdominal or pelvic lymph node metastases with immunotherapy is associated with acceptable toxicity and high rates of LC, even with target undercoverage to meet OAR constraints. This suggests a potential for this approach in clinical practice and study in future trials.

Do Radiotherapy Planning Factors Influence Para-Aortic Recurrence in IIIC1 Cervical Cancer Patients?

Patients with locally advanced cervical cancer are at higher risk of para-aortic lymph node recurrence, however, the addition of prophylactic para-aortic irradiation is still controversial. The aim of this study was to evaluate prognostic factors related to para-aortic recurrence in patients with cervical cancer and pelvic lymph node metastasis (2018 FIGO Stage IIIC1).A retrospective cohort analysis was conducted with patients with cervical cancer and pelvic lymph node metastasis (2018 FIGO Stage IIIC1), that were treated with primary or adjuvant chemoradiotherapy from 2007 to 2018 at a single tertiary cancer center. Clinical and pathological variables were evaluated, as well as radiological and radiotherapy planning factors. Kaplan-Meier method was used to calculate survival and survival comparison between groups with log-rank method. Statistically significant was defined as P ≤ 0.05.Seventy-two patients were included: 56 (77.8%) had primary chemoradiotherapy and 16 (22.2%) adjuvant chemoradiotherapy after radical hysterectomy and lymph node staging. 58 (80.5%) underwent 3D-conformal, 14 (19.5%) intensity-modulated radiotherapy, and 67 (93%) also had high dose rate vaginal brachytherapy. Only 1 patient did not receive concomitant chemotherapy. Staging PET-CT was available in 23 (31.9%) cases and the remaining ones were staged with MRI or CT scans, Surgical para-aortic staging was not performed. The median follow-up was 42 months (range, 5 to 144 months). Overall, 27 (37.5 %) patients recurred during follow-up, and 7 (26 %) had isolated para-aortic lymph-node recurrence. Distant metastasis and pelvic recurrence were found in 12 (45 %) and 8 (29 %) cases, respectively. Median overall survival, disease free survival, distant metastasis free survival, loco-regional free survival and para-aortic free survival were 56, 52, 52, 51 and 42 months, respectively. In univariate analysis, PET SUV in pelvic lymph nodes higher than 10.2 (P = 0.02) and positive lymph nodes in the left common iliac station (P = 0.05) were identified as predictive factors for isolated para-aortic recurrence. We also identified positive lymph node in the common iliac station as a predictor for distant recurrence (P = 0.002). Tumor size larger than 66 mm (P = 0.046) and positive lymph node in the left common iliac lymph node station (P = 0.02) as predictors for pelvic recurrence. Lymph node > 24 mm was the only prognostic factor associated with overall survival (P = 0.012).In this retrospective cohort, radiological and radiotherapy planning factors as high lymph node's PET SUV and proximal location of positive pelvic lymph nodes were prognostic for para-aortic recurrence in IIIC1 cervical cancer patients. Further prospective and randomized studies are required to validate those risk factors as well as to determine if prophylactic para-aortic irradiation would improve outcomes in these patients.P.J. Pinto: None. S.L. Favareto: None. C.F. Souza: None. G. Baiocchi: None. A.A. da Costa: None. A.C. Pellizon: None. C. Abrahao: None. D.G. Castro: None. G.R. Gondim: None. H. Ramos: None. E. Santos Neto: None. R.C. Fogaroli: None. M.G. Silva: None. M.J. Chen: None.

Long-Term Outcomes of Cervical Cancer Patients With Complete Metabolic Response After Definitive Chemoradiotherapy

The utility of metabolic positron-emission tomography (PET) parameters in patients with cervical cancer who had complete metabolic response (CMR) after chemoradiotherapy (ChRT) is unclear. We investigated the importance of metabolic parameters measured with 18F-FDG-PET/CT for predicting progression-free survival (PFS) and overall survival (OS).The clinical data of 152 patients with biopsy-proven cervical cancer treated with definitive ChRT at our institution between November 2006 and August 2012 were retrospectively evaluated. The clinical data and PET parameters including standardized uptake value (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of 122 patients having CMR in post-treatment 18F-FDG-PET/CT delivered a median of 3.9 months after ChRT completion were analyzed. The PET parameters were measured for primary tumors (p) and metastatic lymph nodes (ln) separately.With a median follow-up of 8.4 years, 55 patients (45%) presented with disease a median of 19.7 months after ChRT. The cut-off values determined with receiver operating curve analysis for survival were 15.8, 48.7 cm³, 552.3, 8.7, 7.0 cm³, and 24.6 and for disease recurrence were 19.9, 49.8 cm³, 597.4, 9.1, 7.3 cm³, and 25.2 for SUVp, MTVp, TLGp, SUVln, MTVln, and TLGln, respectively. All metabolic PET parameters were significant prognostic factors for OS and PFS in univariate analysis. FIGO stage was predictive of both OS and PFS, while pelvic and/or para-aortic lymph node metastasis were predictive of OS only. In multivariate analysis, FIGO stage ≥IIB [HR = 2.53 (95% CI, 1.02-7.34), P = 0.04], MTVp ≥49.8 cm³ [HR = 4.13 (95% CI, 2.51-6.78), P < 0.001] and TLGp ≥597.4 [HR = 2.21 (95% CI, 1.06-4.61), P = 0.03] were predictive of worse OS. Advanced stage [HR = 4.11 (95% CI, 0.98-7.22) P = 0.05], presence of lymph node metastasis [HR = 1.48 (1.09-2.39), P = 0.04], higher TLGp [HR = 2.31 (95% CI, 1.14-4.68), P = 0.02] and larger MTVln [HR = 2.24 (1.05-4.74), P = 0.04] were significant factors for poor PFS rates.Advanced stage and higher TLGp values were significant predictors for poor survival and higher progression rates. Additional prognostic factors for worse OS were larger MTVp and lymph node metastasis and for disease progression, MTVln. We also found that most disease recurrences presented as distant metastasis, which suggests a need for effective systemic treatment.C. Onal: None. O. Guler: None. M. Reyhan: None. A. Yapar: None.

Implications of Isolated Para-Aortic Lymph Node Metastasis in Endometrial Cancer: A Large-Scale, Multicenter, and Retrospective Study

Objective: To systematically evaluate lymph node metastasis (LNM) patterns in patients with endometrial cancer (EC) who underwent complete surgical staging, which included systematic pelvic and para-aortic lymphadenectomy.Methods: Four thousand and one patients who underwent complete surgical staging including systematic pelvic and para-aortic lymphadenectomy for EC were enrolled from 30 centers in China from 2001 to 2019. We systematically displayed the clinical and prognostic characteristics of patients with various LNM patterns, especially the PLN-PAN+ [para-aortic lymph node (PAN) metastasis without pelvic lymph node (PLN) metastasis]. The efficacy of PAN+ (para-aortic lymph node metastasis) prediction with clinical and pathological features was evaluated.Results: Overall, 431 of the 4,001 patients (10.8%) showed definite LNM according to pathological diagnosis. The PAN+ showed the highest frequency (6.6%) among all metastatic sites. One hundred fourteen cases (26.5%) were PLN-PAN+ (PAN metastasis without PLN metastasis), 167 cases (38.7%) showed PLN+PAN-(PLN metastasis without PAN metastasis), and 150 cases (34.8%) showed metastasis to both regions (PLN+PAN+). There was also 1.9% (51/2,660) of low-risk patients who had PLN-PAN+. There are no statistical differences in relapse-free survival (RFS) and disease-specific survival (DSS) among PLN+PAN-, PLN-PAN+, and PLN+PAN+. The sensitivity of gross PLNs, gross PANs, and lymphovascular space involvement (LVSI) to predict PAN+ was 53.8 [95% confidence interval (CI): 47.6–59.9], 74.2 95% CI: 65.6–81.4), and 45.8% (95% CI: 38.7–53.2), respectively.Conclusion: Over one-fourth of EC patients with LMN metastases were PLN-PAN+. PLN-PAN+ shares approximate survival outcomes (RFS and DSS) with other LNM patterns. No effective clinical methods were achieved for predicting PAN+. Thus, PLN-PAN+ is a non-negligible LNM pattern that cannot be underestimated in EC, even in low-risk patients.

Using a new diagnostic tool to predict lymph node metastasis in advanced epithelial ovarian cancer leads to simple lymphadenectomy decision rules: A multicentre study from the FRANCOGYN group.

ObjectiveThe aim of this study was to develop a new diagnostic tool to predict lymph node metastasis (LNM) in patients with advanced epithelial ovarian cancer undergoing primary cytoreductive surgery.Materials and methodThe FRANCOGYN group’s multicenter retrospective ovarian cancer cohort furnished the patient population on which we developed a logistic regression model. The prediction model equation enabled us to create LNM risk groups with simple lymphadenectomy decision rules associated with a user-friendly free interactive web application called shinyLNM.Results277 patients from the FRANCOGYN cohort were included; 115 with no LNM and 162 with LNM. Three variables were independently and significantly (p<0.05) associated with LNM in multivariate analysis: pelvic and/or para-aortic LNM on CT and/or PET/CT (p<0.00), initial PCI ≥ 10 and/or diaphragmatic carcinosis (p = 0.02), and initial CA125 ≥ 500 (p = 0.02). The ROC-AUC of this prediction model after leave-one-out cross-validation was 0.72. There was no difference between the predicted and the observed probabilities of LNM (p = 0.09). Specificity for the group at high risk of LNM was 83.5%, the LR+ was 2.73, and the observed probability of LNM was 79.3%; sensitivity for the group at low-risk of LNM was 92.0%, the LR- was 0.24, and the observed probability of LNM was 25.0%.ConclusionThis new tool may prove useful for improving surgical planning and provide useful information for patients.

Lateral pelvic lymph nodes for rectal cancer: A review of diagnosis and management.

The current status and future prospects for diagnosis and treatment of lateral pelvic lymph node (LPLN) metastasis of rectal cancer are described in this review. Magnetic resonance imaging (MRI) is recommended for the diagnosis of LPLN metastasis. A LPLN-positive status on MRI is a strong risk factor for metastasis, and evaluation by MRI is important for deciding treatment strategy. LPLN dissection (LPLD) has an advantage of reducing recurrence in the lateral pelvis but also has a disadvantage of complications; therefore, LPLD may not be appropriate for cases that are less likely to have LPLN metastasis. Radiation therapy (RT) and chemoradiation therapy (CRT) have limited effects in cases with suspected LPLN metastasis, but a combination of preoperative CRT and LPLD may improve the treatment outcome. Thus, RT and CRT plus selective LPLD may be a rational strategy to omit unnecessary LPLD and produce a favorable treatment outcome.

Feasibility of Predicting Pelvic Lymph Node Metastasis Based on IVIM-DWI and Texture Parameters of the Primary Lesion and Lymph Nodes in Patients with Cervical Cancer

To investigate the feasibility and value of intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) and texture parameters of primary lesions and lymph nodes for predicting pelvic lymph node metastasis in patients with cervical cancer. A total of 143 patients with cervical cancer confirmed by surgical pathology were analyzed retrospectively and 125 patients were enrolled in primary lesions study, 83 patients and 134 lymph nodes were enrolled in lymph nodes study. Patients and lymph nodes were randomly divided into training group and test group at a ratio of 2: 1. The IVIM-DWI parameters and 3D texture features of primary lesions and lymph nodes of all patients were measured. The least absolute shrinkage and selection operator algorithm, spearman's correlation analysis, independent two-sample t-test and Mann-Whitney U-test were used to select texture parameters. Multivariate Logistic regression analysis and receiver operating characteristic curves were used to model and evaluate diagnostic performances. In primary lesions study, model 1 was constructed by combining f value, original_shape_Sphericity and original_firstorder_Mean of primary lesions. In lymph nodes study, model 2 was constructed by combining short diameter, circular enhancement and rough margin of lymph nodes. Model 3 was constructed by combining ADC, f value and original_glszm_Small Area Emphasis of lymph nodes. The areas under curve of model 1, 2 and 3 in training group and test group were 0.882, 0.798, 0.907 and 0.862, 0.771, 0.937 respectively. Models based on IVIM-DWI and texture parameters of primary lesions and lymph nodes both performed well in diagnosing pelvic lymph node metastasis of cervical cancer and were superior to morphological features of lymph nodes. Especially, parameters of lymph nodes showed higher diagnostic efficiency and clinical significance.

Comparison of survival outcomes with or without Para-aortic lymphadenectomy in surgical patients with stage IB1-IIA2 cervical cancer in China from 2004 to 2016

BackgroundCurrent opinions on whether surgical patients with cervical cancer should undergo para-aortic lymphadenectomy at the same time are inconsistent. The present study examined differences in survival outcomes with or without para-aortic lymphadenectomy in surgical patients with stage IB1-IIA2 cervical cancer.MethodsWe retrospectively compared the survival outcomes of 8802 stage IB1-IIA2 cervical cancer patients (FIGO 2009) who underwent abdominal radical hysterectomy + pelvic lymphadenectomy (n = 8445) or abdominal radical hysterectomy + pelvic lymphadenectomy + para-aortic lymphadenectomy (n = 357) from 37 hospitals in mainland China.ResultsAmong the 8802 patients with stage IB1-IIA2 cervical cancer, 1618 (18.38%) patients had postoperative pelvic lymph node metastases, and 37 (10.36%) patients had para-aortic lymph node metastasis. When pelvic lymph nodes had metastases, the para-aortic lymph node simultaneous metastasis rate was 30.00% (36/120). The risk of isolated para-aortic lymph node metastasis was 0.42% (1/237). There were no significant differences in the survival outcomes between the para-aortic lymph node unresected and resected groups. No differences in the survival outcomes were found before or after matching between the two groups regardless of pelvic lymph node negativity/positivity.ConclusionPara-aortic lymphadenectomy did not improve 5-year survival outcomes in surgical patients with stage IB1-IIA2 cervical cancer. Therefore, when pelvic lymph node metastasis is negative, the risk of isolated para-aortic lymph node metastasis is very low, and para-aortic lymphadenectomy is not recommended. When pelvic lymph node metastasis is positive, para-aortic lymphadenectomy should be carefully selected because of the high risk of this procedure.

The Role of Pelvic Lymphadenectomy in Organ-sparing Treatment of Muscule-invasive Bladder Cancer

The Role of Pelvic Lymphadenectomy in Organ-sparing Treatment of Muscule-invasive Bladder Cancer

Interreader agreement in evaluation of 68Ga-PSMA PET/CT at the time of initial staging: comparison of the three evaluation criteria in the pretreatment risk groups.

The aim of this study was to assess the interreader agreement in evaluation 68Ga-prostate-specific membrane antigen (PSMA) PET/CT according to three current criteria European association of nuclear medicine, PROMISE with miTNM, and PSMA-RADS in newly diagnosed prostate cancer (PC) patients. The images of 101 patients who had been diagnosed with PC and underwent 68Ga-PSMA PET/CT at the time of initial staging were evaluated according to the three interpretation criteria by two nuclear medicine specialists. Local tumor, pelvic lymph node metastasis and distant metastasis were evaluated separately. Abdominal lymph nodes, bone and visceral organ metastases were additionally evaluated as subregions of distant metastatic sites. Patients were evaluated in subgroups Gleason score ≥8 or prostate-specific antigen ≥20 ng/mL as the high-risk group (HR) and prostate-specific antigen ≤ 20 ng/mL and Gleason score <8 as the low-risk group (LR). To measure interreader agreement for each judgment site Cohen's Kappa statistic coefficient (κ) was calculated. All three criteria European association of nuclear medicine, PROMISE with miTNM and PSMA-RADS exhibit substantial and almost perfect agreement between the readers in all sites except for PSMA-RADS in bone and visceral metastasis (κ = 0.495, κ = 0.506, respectively). According to the risk groups, a remarkable difference in interreader agreement for bone metastasis for all three criteria (especially in PSMA-RADS) between the HR and LR patients was detected. In low-risk patients especially PSMA-RADS criteria leads to increased interreader reporting differences. While evaluating 68Ga-PSMA PET/CT images it should be considered that pretreatment risk levels of PC patients could affect the interreader agreement.

HPV16 E6-specific T cell response and HLA-A alleles are related to the prognosis of patients with cervical cancer

BackgroundT cell epitopes are polypeptide fragments presented to T cell receptors by MHC molecules encoded by human leukocyte antigen (HLA) genes after antigen-presenting cell processing, which is the basis for the study of antigen immune mechanism and multi-epitope vaccine. This study investigated T cell response to HPV16 E6 and E7 in patients with cervical squamous cell carcinoma (CSCC). Also, the HLA-A allele distribution was compared among patients and evaluated as a factor to predict prognosis in these patients.Materials and methodsThis study recruited a total of 76 patients with International Federation of Gynaecology and Obstetrics (FIGO) stage IIB–IIIB CSCC. Mononuclear cells were isolated from the peripheral blood before any treatment and then enzyme-linked immunosorbent spot (ELISpot) assay was employed to measure the E6 and E7-specific T cell response. HLA‐A alleles were typed using Sanger sequencing‐based typing techniques with DNA extracted from the peripheral blood. The correlation between the T cell responses, HLA‐A allele distribution and patient prognosis were analysed using the Kaplan–Meier method, univariate and multivariate Cox proportional hazard models.ResultsThe frequency of HPV E6-specific T cell responses in patients with pelvic lymph node metastasis was lower than that in patients without metastasis (P = 0.022). The 5-year overall survival (OS) rates of patients were 87.5% for those responding to multiple overlapping peptides, 72.7% for those responding to 1–2 overlapping peptides and 47.7% for non-responders (P = 0.032). Cox regression analysis indicated that the presence of HLA*A02:07 was independently associated with worse OS (hazard ratio [HR] 3.042; 95% confidence interval [CI] 1.348–6.862; P = 0.007), while concurrent chemoradiation therapy (CCRT) was independently associated with better OS (HR 0.475; 95% CI 0.232–0.975; P = 0.042).ConclusionThe results of our study demonstrated that the level of HPV16 E6-specific T cell response and HLA*A02:07 were correlated with prognosis in patients with advanced CSCC.

Diagnostic Accuracy of 68Ga-PSMA-11 PET for Pelvic Nodal Metastasis Detection Prior to Radical Prostatectomy and Pelvic Lymph Node Dissection

The presence of pelvic nodal metastases at radical prostatectomy is associated with biochemical recurrence after prostatectomy. To assess the accuracy of prostate-specific membrane antigen (PSMA) 68Ga-PSMA-11 positron emission tomographic (PET) imaging for the detection of pelvic nodal metastases compared with histopathology at time of radical prostatectomy and pelvic lymph node dissection. This investigator-initiated prospective multicenter single-arm open-label phase 3 imaging trial of diagnostic efficacy enrolled 764 patients with intermediate- to high-risk prostate cancer considered for prostatectomy at University of California, San Francisco and University of California, Los Angeles from December 2015 to December 2019. Data analysis took place from October 2018 to July 2021. Imaging scan with 3 to 7 mCi of 68Ga-PSMA-11 PET. The primary end point was the sensitivity and specificity for the detection pelvic lymph nodes compared with histopathology on a per-patient basis using nodal region correlation. Each scan was read centrally by 3 blinded independent central readers, and a majority rule was used for analysis. A total of 764 men (median [interquartile range] age, 69 [63-73] years) underwent 1 68Ga-PSMA-11 PET imaging scan for primary staging, and 277 of 764 (36%) subsequently underwent prostatectomy with lymph node dissection (efficacy analysis cohort). Based on pathology reports, 75 of 277 patients (27%) had pelvic nodal metastasis. Results of 68Ga-PSMA-11 PET were positive in 40 of 277 (14%), 2 of 277 (1%), and 7 of 277 (3%) of patients for pelvic nodal, extrapelvic nodal, and bone metastatic disease. Sensitivity, specificity, positive predictive value, and negative predictive value for pelvic nodal metastases were 0.40 (95% CI, 0.34-0.46), 0.95 (95% CI, 0.92-0.97), 0.75 (95% CI, 0.70-0.80), and 0.81 (95% CI, 0.76-0.85), respectively. Of the 764 patients, 487 (64%) did not undergo prostatectomy, of which 108 were lost to follow-up. Patients with follow-up instead underwent radiotherapy (262 of 379 [69%]), systemic therapy (82 of 379 [22%]), surveillance (16 of 379 [4%]), or other treatments (19 of 379 [5%]). This phase 3 diagnostic efficacy trial found that in men with intermediate- to high-risk prostate cancer who underwent radical prostatectomy and lymph node dissection, the sensitivity and specificity of 68Ga-PSMA-11 PET were 0.40 and 0.95, respectively. This academic collaboration is the largest known to date and formed the foundation of a New Drug Application for 68Ga-PSMA-11. ClinicalTrials.gov Identifiers: NCT03368547, NCT02611882, and NCT02919111.

Deep Inguinal Lymph Node Metastases Can Predict Pelvic Lymph Node Metastases and Prognosis in Penile Squamous Cell Carcinoma.

ObjectivesTo evaluate the relationship between deep inguinal lymph node metastasis (ILNM) and pelvic lymph node metastasis (PLNM) and explore the prognostic value of deep ILNM in penile squamous cell carcinoma (PSCC).Materials and MethodsThe records of 189 patients with ILNM treated for PSCC were analysed retrospectively. Logistic regression models were used to test for predictors of PLNM. Cox regression was performed in univariable and multivariable analyses of cancer-specific survival (CSS). CSS was compared using Kaplan-Meier analyses and log rank tests.ResultsPLNM were observed in 53 cases (28.0%). According to logistic regression models, only deep ILNM (OR 9.72, p<0.001) and number (≥3) of metastatic inguinal lymph nodes (ILNs) (OR 2.36, p=0.03) were independent predictors of PLNM. The incidences of PLNM were 18% and 19% with negative deep ILNM and extranodal extension (ENE); and 76% and 42% with positive deep ILNM and ENE, respectively. The accuracy of deep ILNM, ENE, bilateral involvement and number (≥3) of ILNMs for predicting PLNM were 81.0%, 65.6%, 63.5% and 67.2%, respectively. The CSS was significantly different in patients with positive and negative deep ILNM (median 1.7 years vs not reached, p<0.01). Patients who presented with deep ILNM had worse CSS (median 3.8 years vs not reached, p<0.01) in those with negative PLNs.ConclusionsDeep ILNM is the most accurate factor for predicting PLNM in PSCC according to our data. We recommend that patients with deep ILNM should be referred for pelvic lymph node dissection. Involvement of deep ILNs indicates poor prognosis. We propose that patients with metastases of deep ILNs may be staged as pN3.

Resection of the upper paracervical lymphovascular tissue should be an integral part of a pelvic sentinel lymph node algorithm in early stage cervical cancer

ObjectiveTo investigate the prevalence of lymph nodes and lymph node metastases (LNMs) in the upper paracervical lymphovascular tissue (UPLT) in early stage cervical cancer. MethodsIn this prospective study consecutive women with stage IA1-IB1 cervical cancer underwent a pelvic lymphadenectomy including identification of sentinel nodes (SLNs) as part of a nodal staging procedure in conjunction with a robotic radical hysterectomy (RRH) or robotic radical trachelectomy (RRT). Indocyanine green (ICG) was used as tracer. The UPLT was separately removed and defined as “SLN-parametrium” and, as all SLN tissue, subjected to ultrastaging and immunohistochemistry. Primary endpoint was prevalence of lymph nodes and metastatic lymph nodes in the UPLT. Secondary endpoints were complications associated with removal of the UPLT. ResultsOne hundred and forty-five women were analysed. Nineteen (13.1%) had pelvic LNMs, all identified by at least one metastatic SLN. In 76 women (52.4%) at least one UPLT lymph node was identified. Metastatic UPLT lymph nodes were identified in six women of which in three women (2.1% of all women and 15.8% of node positive women) without lateral pelvic LNMs. Thirteen women had lateral pelvic SLN LNMs with either no (n = 5) or benign (n = 8) UPLT lymph nodes. No intraoperative complications occurred due to the removal of the UPLT. ConclusionRemoval of the UPLT should be an integral part of the SLN concept in early stage cervical cancer.

PD57-01 PREDICTING EARLY BIOCHEMICAL PROGRESSION IN PROSTATE CANCER PATIENTS STAGED WITH PSMA PET AND MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy IV (PD57)1 Sep 2021PD57-01 PREDICTING EARLY BIOCHEMICAL PROGRESSION IN PROSTATE CANCER PATIENTS STAGED WITH PSMA PET AND MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING Dennie Meijer, Pim van Leeuwen, Maarten Donswijk, Thierry Boellaard, Ivo Schoots, Henk van der Poel, Harry Hendrikse, Daniela Oprea-Lager, and André Vis Dennie MeijerDennie Meijer More articles by this author , Pim van LeeuwenPim van Leeuwen More articles by this author , Maarten DonswijkMaarten Donswijk More articles by this author , Thierry BoellaardThierry Boellaard More articles by this author , Ivo SchootsIvo Schoots More articles by this author , Henk van der PoelHenk van der Poel More articles by this author , Harry HendrikseHarry Hendrikse More articles by this author , Daniela Oprea-LagerDaniela Oprea-Lager More articles by this author , and André VisAndré Vis More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002091.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The aim of this study was to point out predictors for early oncological outcome in patients who opt for robot-assisted laparoscopic radical prostatectomy (RARP) for localized prostate cancer (PCa) including conventional prognostic variables as well as multiparametric magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen (PSMA) positron emission tomography (PET) imaging. METHODS: This observational study included 500 patients who underwent RARP and extended pelvic lymph node dissection (ePLND). Outcome measurement was biochemical progression of disease, defined as any post-operative PSA ≥0.2 ng/mL. A Cox-regression analysis was performed to assess predictors for biochemical progression, including initial prostate-specific antigen (PSA)-value, biopsy Grade Group (GG), T-stage on mpMRI, and lymph node status on PSMA PET imaging (miN0 vs. miN1). RESULTS: The median total follow-up of all included patients was 12.8 months (IQR 6.6-22.3). When assessing biochemical progression after surgery, initial PSA-value (per doubling; OR 1.24 (95%CI 1.08-1.43), p=0.003), biopsy GG ≥4 vs. GG 1-2 (OR 2.33 (95%CI 1.47-3.69), p<0.001), T-stage on mpMRI (rT3a vs. rT2: OR 2.04 (95%CI 1.30-3.20), p=0.002; ≥rT3b vs. rT2: OR 4.87 (95%CI 3.24-7.32), p<0.001) and miN1 on PSMA PET imaging (OR 2.16 (95%CI 1.46-3.20), p<0.001) were independent predictors of biochemical progression of disease. Moreover, the number of pelvic lymph node metastases on PSMA PET was significantly associated with biochemical progression: one pelvic lymph node metastasis vs. no metastatic disease resulted in an OR 2.60 (95%CI 1.57-4.31), p<0.001; two pelvic lymph node metastases or more on PSMA PET vs. no metastatic disease resulted in an OR 4.61 (95%CI 2.84-7.48), p<0.001. CONCLUSIONS: Initial PSA-value, biopsy GG ≥4, ≥rT3 disease on mpMRI and miN1 disease on PSMA PET were predictors for early biochemical progression after RARP. Furthermore, the number of pelvic lymph node metastases on staging PSMA PET was associated with biochemical progression. Identifying patients with an increased risk of biochemical progression after surgery may have implications for patient counseling in radical treatment decisions and on patient selection for modern (neo-)adjuvant and systematic treatments. Source of Funding: No funding was received for conducting this study. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1009-e1009 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dennie Meijer More articles by this author Pim van Leeuwen More articles by this author Maarten Donswijk More articles by this author Thierry Boellaard More articles by this author Ivo Schoots More articles by this author Henk van der Poel More articles by this author Harry Hendrikse More articles by this author Daniela Oprea-Lager More articles by this author André Vis More articles by this author Expand All Advertisement Loading ...