Number Of Positive Nodes Research Articles

Artificial intelligence based personalized predictive survival among colorectal cancer patients

Background and ObjectiveColorectal cancer is a major health concern. It is now the third most common cancer and the fourth leading cause of cancer mortality worldwide. The aim of this study was to evaluate the performance of machine learning algorithms for predicting survival of colorectal cancer patients 1 to 5 years after diagnosis, and identify the most important variables. MethodsA sample of 1236 patients diagnosed with colorectal cancer and 118 predictor variables has been used. The outcome of interest was a binary variable indicating whether the patient survived the number of years in question or not. 20 predictor variables were selected using mutual information score with the outcome. We implemented 11 machine learning algorithms and evaluated their performance with a 5 by 2-fold cross-validation with stratified folds and with paired Student's t-tests. We compared the results with the Kaplan-Meier estimator and Cox's proportional hazard regression. ResultsUsing the 20 most important predictor variables for each of the survival years, the logistic regression algorithm achieved an area under the receiver operating characteristic curve of 0.850 (0.014 SD, 0.840-0.860 95 % CI) for the 1-year, and 0.872 (0.014 SD, 0.861-0.882 95% CI) for the 5-year survival prediction. Using only the 5 most important predictor variables, the corresponding values are 0.793 (0.020 SD, 0.778-0.807 95% CI) and 0.794 (0.011 SD, 0.785-0.802 95% CI). The most important variables for 1-year prediction were number of R residual, M distant metastasis, overall stage, probable recurrence within 5 years, and tumour length, whereas for 5-year prediction the most important were probable recurrence within 5 years, R residual, M distant metastasis, number of positive lymph nodes, and palliative chemotherapy. Biomarkers do not appear among the top 20 most important ones. For all survival intervals, the probability of the top model agrees with the Kaplan-Meier estimate, both in the interval of one standard deviation and in the 95% confidence interval. ConclusionsThe findings suggest that machine learning algorithms can predict the survival probability of colorectal cancer patients and can be used to inform the patients and assist decision-making in clinical care management. In addition, this study unveils the most essential variables for estimating survival short- and long-term among patients with Colorectal cancer.

Interim analysis of the prospective COTRIMS (Cologne Trial of Retroperitoneal Lymphadectomy in Metastatic Seminoma) trial.

409 Background: Radiation therapy or systemic chemotherapy with 3 cycles PEB represent the guideline recommended treatment options in marker negative clinical stage IIA/B seminoma. Despite a high cure rate of 90% to 94% and 82% to 90% in CS IIA and IIB, respectively, both therapeutic options are associated with significant long-term toxicities. It was the aim of our trial to evaluate the feasibility, oncological efficacy and treatment associated morbidity of primary nsRPLND in stage IIA/B seminoma. Methods: 30 patients with marker negative clinical stage IIA and IIB classical seminoma of the testis were recruited in the prospective trial. Primary goal was a relapse rate <20% within 2 years follow-up. Exclusion criteria were adjuvant carboplatin therapy for clinical stage I disease, extensive clinical stage IIb or clinical stage IIC disease, previous retroperitoneal surgery or radiation therapy, and positive tumor markers. All patients underwent nerve sparing RPLND with a modified template resection. None of the patients received adjuvant chemotherapy in the presence of positive lymph nodes. All patients underwent close follow-up with imaging studies and tumor markers at 3-month intervals during the first 2 years, at 6-month intervals in year 3 and annually thereafter. 10 pts had preoperative serum analysis of miR371. Results: Mean age was 34.2 (21-54) years. Mean follow-up is 29.4 (1-60) months and 32.5 (3-60) for those with a minimum follow-up of 3 months. All patients were treatment-naïve; 19 and 11 patients were diagnosed with stage IIA and IIB disease, respectively, at time of RPLND. 28 and 2 patients underwent open and robot assisted ns RPLND, respectively. Mean OR time was 131 (105-195) min, mean blood loss was < 150ml and the mean hospitalization time was 4.5 (3-9) days. We did not observe surgery associated complications > Clavien Dindo grade 3a. Mean number of dissected lymph nodes was 18 (7-57), the mean number of positive lymph nodes was 1.3 (1-2) and the mean diameter of positive nodes was 2.3 (0.8-4.1) cm. Histology of the resected lymph nodes revealed metastatic seminoma in 25 (80%) patients; 2 and 3 patients demonstrated embryonal carcinoma and benign disease, resp. 10 pts underwent serum analysis of miR371 preoperatively which predicted metastatic disease in 9/10 and benign histology in 1/1. 2/30 (6.7%) patients developed an outfield relapse 4 and 6 months postoperatively. Both patients were salvaged by systemic chemotherapy with 4 cycles PEB. Conclusions: NsRPLND results in a high cure rate at midterm follow-up and it is associated with a low frequency of treatment associated morbidities making this approach a feasible alternative to standard radiation therapy or systemic chemotherapy. MiR371p might be a useful marker to predict presence/absence of metastases in equivocal findings. Clinical trial information: DRKS00025384 .

Impact of number of positive lymph nodes on prognostic stratification in renal cell carcinoma: Analysis of the National Cancer Database.

736 Background: Lymph node positivity in Renal Cell Carcinoma (RCC) is associated with worsened oncologic outcomes. However, the actual prognostic significance of node positivity 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 node positivity that distinguishes favorable risk 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 cases of RCC were queried in patients age ≥18. Patients with pathologic node positive disease and without synchronous metastasis were selected for analysis to minimize confounding from metastatic burden. Multivariable Cox Proportional-Hazards regression tested association between number of pathologically positive lymph nodes and all-cause mortality (ACM), adjusting for clinical and pathologic co-variables. Receiver Operator Characteristic (ROC) Curve analyses employing the concordance probability method evaluated performance of potential cut-points for pN2 node-positivity. Kaplan-Meier analyses (KMA) compared these thresholds against overall survival (OS) in non-metastatic Stage IV RCC. Results: 28,590 patients with above criteria were identified, of which 13.6% had pN1. On multivariable analyses, increased pathologic node positivity was associated with increased hazard of ACM (HR 1.19, 95% Confidence Interval [CI] 1.17-1.20, p<0.001). ROC mapping of all possible lymph node thresholds from ≥2 to ≥10, with stage IV as the highest point, showed comparable concordance probability among these cutoffs 0.26-0.33, AUC=0.656. On KMA, when threshold was set at ≥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 pathologic positive nodes, and pN2 as ≥3 pathologic positive nodes. 5-year OS for Stage III pN0 was 69.4% (95% CI 68.4-70.5), for Stage III pN1 was 41.4% (95% CI 39.0-43.8), for Stage III pN2 was 31.8% (95% CI 28.2-35.9%), and for non-metastatic Stage IV was (30.0%, 95% CI 28.2-32.0%). On multivariable analyses, pN2 exhibited 38% greater hazard of ACM (HR 3.31, 95% CI 2.24-2.54, p<0.001) compared to pN1 (HR 2.39, 95% CI 2.24-2.54, p<0.001). Conclusions: These findings represent one of the largest characterizations of impact of positive nodal counts on prognostic stratification in RCC. Pathologic node positivity could be stratified to pN1 and pN2, with pN2 conferring poor prognostic risk comparable to non-metastatic Stage IV pN0 disease. Although further validation studies are warranted, consideration should be given towards stratifying Stage III pN2 patients to a higher risk group.

Characterization of lymph node metastases in prostate cancer.

380 Background: Unlike lymph node (LN) staging in other malignancies, prostate cancer nodal staging does not characterize or quantify the LN tumor burden. Detailed characterization of LN metastases may provide improved prognostic information, which could assist in post-surgical management decisions. Methods: Clinical and pathologic information was retrospectively collected via electronic medical record from 66 patients with pathologically confirmed LN involvement after radical prostatectomy with pelvic lymph node dissection performed by a single surgeon. Tissue slides of all positive LNs were re-evaluated by a single pathologist in accordance with our institutional review board protocol. Poisson regression analyses and Cox proportional-hazard regression were performed to evaluate the association of risk factors with the number of positive nodes and the association of LN characteristics with biochemical recurrence (BCR)-free survival. Results: Median number of positive LNs per patient was 2 (IQR 1-3). Mean % positive LNs per patient was 8.9 (SD10.4). Mean cumulative size of all tumor deposits in all positive LNs per patient was 5.0mm (SD 4.8). Average % surface area of LN involved by tumor was 28%. 48 (73%) patients were alive without disease at median follow-up time of 38 months (IQR 26-50 months). Higher pre-surgery PSA, clinical stage T3-T4 versus T1-2, extraprostatic extension (EPE), seminal vesical involvement (SVI), and lymphovascular invasion (LVI) were significantly associated with higher incidence rate of nodal positivity. Larger mean size of largest LN deposits, mean size of total LN deposits, and mean % surface area of LN involved were significantly associated with worse BCR-free survival. There was no significant association for number of positive nodes, LN anatomical compartments, extranodal extension (ENE), span of ENE, and distance of ENE from LN capsule. Higher pre-surgery PSA and post-surgery Gleason grade were significantly associated with worse BCR-free survival. Conclusions: Our data shows that LN tumor burden is associated with worse BCR-free survival. Anatomical LN compartments and quantification of ENE did not show significant association with BCR. [Table: see text]

Lymph node stain after radical resection of rectal cancer mainly increased the harvest of mini lymph node: A randomized controlled trial

The lymph node status plays an important role in rectal cancer, which depends on adequate lymph node harvest. Lymph node stain techniques increase the lymph node harvest. The aim of this prospective study is to investigate which subgroups of lymph nodes harvested were increased mostly. From May 2020 to May 2022, 172 stage II-III rectal cancer patients were randomized to methylene blue (MB) stained group or unstained group to retrieve the lymph nodes. Methylene blue solution was injected into the inferior mesenteric artery, we dissected lymph nodes by palpation and sight. The lymph nodes were divided into 3 groups depending on the anatomy (main lymph nodes, superior rectal and perirectal lymph nodes (SPLNs), and pericolic lymph nodes located beyond 10cm proximal to the tumor), and 3 groups depending on the short diameter of the nodes (big: ≥ 5mm, small: 5-2mm, mini: ≤ 2mm). The number of lymph nodes harvested with MB was significantly higher (22.0 (14.8, 32.0) vs 14.5 (11.0, 22.0); p < 0.001) without difference in positive patients or number of positive nodes. The positive rate of the big node was 3.5%, the small node was 1.9%, and the mini node was 0.2%. In the subgroup analysis, the median number of mini lymph nodes in the MB-stained group was significantly more than that of the unstained group (median (IQR): 9.0 (6.0, 14.0) vs 4.0 (2.0,6.0), p < 0.001); and the median number of SPLNs in the MB-stained group were significantly more than that of the unstained group (median (IQR): 15.0 (9.0, 19.0) vs 10.0 (6.0, 13.3), p < 0.001); these differences were existing in both patients with and without neoadjuvant treatments. Intra-arterial injection of MB can significantly increase the number of lymph nodes harvested in rectal cancers, especially those mini lymph nodes. However, methylene blue staining did not significantly increase the number of positive lymph nodes and the proportion of patients with more than 12 lymph nodes, or affect lymph node staging accuracy after radical resection of rectal cancer.

Impact of the 21-gene expression assay on treatment decisions and clinical outcomes in breast cancer with one to three positive lymph nodes.

To assess the practice patterns of the recurrence score (RS) based on the 21-gene expression assay on adjuvant chemotherapy recommendations and survival outcomes in estrogen receptor-positive (ER+)/HER2- breast cancer (BC) with one to three positive lymph nodes (N1). We included patients with T1-2N1M0 and ER+/HER2- BC diagnosed between 2010 and 2015 in the Surveillance, Epidemiology, and End Results Oncotype DX Database. Breast cancer-specific survival (BCSS) and overall survival (OS) were assessed. We included 35,137 patients in this study. There were 21.2% of patients who had RS testing in 2010, which was significantly increased to 36.8% in 2015 (P < 0.001). Performance of the 21-gene testing was associated with older age, lower tumor grade, T1 stage, lower number of positive lymph nodes, and progesterone receptor-positive disease (all P < 0.05). In those without 21-gene testing, age was the main factor significantly related to the receipt of chemotherapy, whereas RS was the main factor significantly related to chemotherapy receipt in those with 21-gene testing. The probability of chemotherapy receipt in those without 21-gene testing was 64.1% and was decreased to 30.8% in those with 21-gene testing. On multivariate prognostic analysis, the performance of 21-gene testing was associated with better BCSS (P < 0.001) and OS (P < 0.001) compared with those without 21-gene testing. Similar results were found after propensity score matching. The 21-gene expression assay is frequently and increasingly used for chemotherapy decision-making in ER+/HER2- BC with N1 disease. Performance of the 21-gene testing is associated with improved survival outcomes. Our study supports the routine use of 21-gene testing in the clinical practice of this population.

Comparison of treatment strategies for resectable locally advanced primary mucinous adenocarcinoma of the lung.

Primary pure mucinous adenocarcinoma (PMA) is a rare type of lung cancer with unique clinical and prognostic features. Previous studies have shown that PMA have more early-stage cancer compared with other adenocarcinoma (ADC) subtypes. The clinicopathological features and optimal treatment strategies of resectable locally advanced mucinous adenocarcinoma lack evidence and require further study. In this study, we collected information from patients with stage III-N2 PMA who underwent radical surgery between 2004 and 2016 from the Surveillance, Epidemiology, and End Results (SEER) database. The clinicopathological parameters, treatments, overall survival (OS), and cancer-specific survival (CSS) were evaluated. Of 242,699 eligible lung adenocarcinoma patients, 124 with PMA and 3405 with other ADCs of stage III-N2 received radical surgery were identified. Compared with other ADCs, PMA tended to appear more in the lower lobes, with higher degree of differentiation, less early T stage, and more positive lymph nodes numbers. Patients with PMA had significantly worse survival than other ADCs (OS=45.0 vs. 57.1 months, p= 0.005, CSS=51.8 vs. 65.5months, p= 0.017). We explored the benefit population of postoperative radiotherapy (PORT) and found that the population with ≤7 positive lymph nodes could benefit from PORT, and OS was significantly improved (41.2 vs. 69.3 months, p= 0.034). For patients with >7 positive lymph nodes, PORT did not provide a survival benefit, while chemotherapy improved OS (10.9 vs. 23.3 months, p= 0.041). Multivariate analysis showed that race, tumor location, number of positive lymph nodes, and PORT were independent prognostic factors in patients with postoperative III-N2 lung PMA. The prognosis of patients with resectable III-N2 primary lung PMA was significantly worse than that of other ADCs, and PORT was an independent prognostic factor. Patients with ≤7 positive lymph nodes could benefit from PORT and those with >7 positive lymph nodes could benefit from chemotherapy.

Intrathoracic Robotic-Sewn Anastomosis During Ivor Lewis Esophagectomy for Cancer: Back to Basics?

BackgroundTo assess the feasibility, clinical utility, and safety of intrathoracic robotic-sewn esophageal anastomosis (IrEA) during Ivor Lewis esophagectomy for adenocarcinoma of the lower third of the esophagus, or cancer at the gastro-esophageal junction type I (Siewert classification). MethodsA protocol for completely robotic Ivor Lewis esophagectomy (CrIE) and intrathoracic robotic-sewn anastomosis (IrEA) was established at the authors’ institutions from January 2015 through December 2019. Overall surgery-related postoperative complications were analyzed. Overall survival and disease-free survival analysis were performed using standard methods. ResultsThe study population consisted of 40 patients. Median operative time was 320 min (sd 62, range 235–500 min), and conversion to open rate was 0%. Anastomotic leak rate was 10%. The mean number of examined lymph nodes (ELN) was 19 (IQR 11–29), and the mean number of positive lymph nodes (PLN) was 3 (IQR 0–5). Short- and long-term surgical and oncological outcomes were comparable at a medium follow-up of 37 months. The median overall survival was 48 months while the mean disease-free survival was 29 months. ConclusionThis pilot series, in which an intrathoracic robotic-sewn anastomosis (IrEA) was performed during CrIE, demonstrated the safety and feasibility of this approach. Compared to the current standard of care at a high-volume center, IrEA was associated with better postoperative surgical outcomes and similar oncological outcomes to those reported worldwide today. These results call for further validation in a prospective and controlled setting to be fully incorporated into clinical practice.

17P Impact of adjuvant chemoradiotherapy on survival outcome compared to other treatment modalities for cervical cancer stage IIIc

Cervical cancer is very common among females. Surgery, chemotherapy and radiotherapy are different treatment options for cervical cancer. In 2018, the FIGO staging system has implemented lymph node status in the staging criteria but didn’t consider the number of positive lymph nodes. The current guidelines recommends primary chemoradiotherapy to treat the advanced stages but combined treatment regimens for node positive cervical cancer remains controversial, so this study aims to evaluate the survival outcome of different treatment modalities with further stratification by the positive lymph node number. We used Surveillance, Epidemiology, and End Results (SEER) database to extract the data of 3146 patients with node positive cervical cancer diagnosed from 2000 to 2018, they were treated with different approaches: adjuvant chemoradiotherapy, adjuvant radiotherapy, surgery without systemic treatment, adjuvant chemotherapy and primary chemoradiotherapy. We divided patients into four groups according to the number of involved lymph nodes: one node, two to three nodes, four to 10 nodes, more than 10 nodes. We used SPSS for data analysis. The overall 5-year survival outcome was higher for adjuvant chemoradiotherapy compared to adjuvant radiotherapy, surgery, primary chemoradiotherapy and adjuvant chemotherapy (68.7%, 63.4%, 59.1%, 47.5%, 40.7% ; P-value >0.00). Out of adjuvant chemoradiotherapy showed better 5-year overall survival outcome in patients with one lymph node involvement 73.1% and in patients with 2-3 positive lymph nodes 63.9%. These results highlighted adjuvant chemo-radiotherapy as the treatment of choice for node cervical cancer stage IIIc, surgery and adjuvant chemoradiotherapy has have qiuet similar survival outcome. We also recommend the number of positive lymph nodes to be implemented in the upcoming FIGO system as a predictor for survival outcome and a factor for the treatment plan. Further evaluation is necessary to weigh the benefit versus side effects of the best regimen for each patient.

Impact of number of positive lymph nodes on prognostic stratification in renal cell carcinoma: Analysis of the National Cancer Database

Impact of number of positive lymph nodes on prognostic stratification in renal cell carcinoma: Analysis of the National Cancer Database

Effect of resection margin status on recurrence pattern and survival in distal pancreatectomy for left-sided pancreatic ductal adenocarcinoma.

675 Background: The association of resection margin status with recurrence and survival after pancreatectomy for pancreas ductal adenocarcinoma (PDAC) remains controversial. The aim of this study was to identify the effect of R1 resection on recurrence pattern and survival after distal pancreatectomy for left-sided PDAC. Methods: Patients who underwent distal pancreatectomy for PDAC at two high-volume institutions between January 2010 and December 2017 were retrospectively reviewed. Perioperative characteristics, pathological outcomes, recurrence pattern and survival data were collected to compare R0 resection and R1 resection. Results: Among 558 patients who underwent distal pancreatectomy for PDAC, 158 patients (28.3%) showed R1 resection margin. R1 patients were associated with large tumor size (3.3 cm vs. 3.7 cm, p= 0.006) and lower number of positive lymph nodes (1.3 vs. 2.0, p= 0.001). Median overall survival (37.3 months vs. 20.1 months, p&lt; 0.001) and recurrence-free survival (14.6 months vs. 6.9 months, p&lt; 0.001) significantly differed between the R0 and R1 groups. Disease recurrence patterns were not statistically different between the two groups ( p = 0.182). Among the recurrence patterns, peritoneal carcinomatosis had the shortest recurrence-free survival (5.6 months, p &lt; 0.05) and overall survival (13.6 months, p &lt; 0.05) compared with all other recurrence patterns. Conclusions: R1 resection margin after distal pancreatectomy was associated with poor survival and early recurrence. There is no significant difference in recurrence pattern between R0 and R1. Among the recurrence patterns, peritoneal carcinomatosis showed the worst prognosis.

Impact of increasing lymph node yield on staging, morbidity and survival after esophagectomy for esophageal adenocarcinoma

Background: Extended lymphadenectomy during esophagectomy for esophageal cancer may increase survival, but also increase morbidity. This study analyses the influence of lymph node yield after transthoracic esophagectomy for esophageal adenocarcinoma on the number of positive lymph nodes, pathological N-stage, complications and survival.

Breast Cancer Mode of Detection in a Population-Based Cohort

ObjectiveTo evaluate how breast cancers come to clinical attention (mode of detection [MOD]) in a population-based cohort, determine the relative frequency of different MODs, and characterize patient and tumor characteristics associated with MOD. Patients and MethodsWe used the Rochester Epidemiology Project to identify women ages 40 to 75 years with a first-time diagnosis of breast cancer from May 9, 2017, to May 9, 2019 (n=500) in a 9-county region in Minnesota. We conducted a retrospective medical record review to ascertain the relative frequency of MODs, evaluating differences between screening mammography vs all other MODs by breast density and cancer characteristics. Multiple logistic regression was conducted to examine the likelihood of MOD for breast density and stage of disease. ResultsIn our population-based cohort, 162 of 500 breast cancers (32.4%) were detected by MODs other than screening mammography, including 124 (24.8%) self-detected cancers. Compared with women with mammography-detected cancers, those with MODs other than screening mammography were more frequently younger than 50 years of age (P=.004) and had higher-grade tumors (P=.007), higher number of positive lymph nodes (P<.001), and larger tumor size (P<.001). Relative to women with mammography-detected cancers, those with MODs other than screening mammography were more likely to have dense breasts (odds ratio, 1.87; 95% CI, 1.20 to 2.92; P=.006) and advanced cancer at diagnosis (odds ratio, 3.58; 95% CI, 2.29 to 5.58; P<.001). ConclusionOne-third of all breast cancers in this population were detected by MODs other than screening mammography. Increased likelihood of nonmammographic MODs was observed among women with dense breasts and advanced cancer.

Development of a postoperative nomogram to predict overall survival in gastric cancer using variables the AJCC recommends for collection and registration.

468 Background: The American Joint Committee on Cancer (AJCC) has increasingly recognized the need for individual risk prediction model for the era of tailored therapy. This study aimed to develop a postoperative gastric cancer nomogram for prediction of overall survival (OS). Methods: The nomogram was developed using data of 4,990 patients with primary gastric cancer who underwent macroscopically complete resection (residual tumor: R0 or R1) at Shizuoka Cancer Center (Shizuoka, Japan), and it was created with a multivariable Cox proportional hazard regression model. Fifteen pathological or host-related variables (age, sex tumor location, tumor size, macroscopic type, histology, depth (pT), number of positive nodes (pN), number of negative nodes, location of positive nodes, lymphovascular invasion, lavage cytology (CY), tumor margin, serum CEA and serum CA19-9) were collected. They are recommended to collect and register by the AJCC. The model was validated internally using measures of discrimination (Harrell’s C-index), calibration and decision curve analysis. A stage-specific subset survival analysis of the three risk groups (low, intermediate, high) calculated using the nomogram was performed. Results: In the development procedure, multivariable analysis for OS selected 11 variables for constructing the nomogram. The developed nomogram showed good discrimination, with a C-index of 0.812; that of the American Joint Committee on Cancer (AJCC) pathological stage was 0.756. The nomogram performed well in the calibration and decision curve analyses. A stage-specific subset survival analysis of the three risk groups calculated using the nomogram also showed the superiority of nomogram-prediction when compared to AJCC ordinal staging. Conclusions: This new postoperative risk model accurately predicts OS in gastric cancer and can be used for patient counseling in clinical practice and clinical trial eligibility determination.

Prognostic factors for pulmonary carcinoid with positive lymph node after surgical resection: a SEER database study.

Prognostic factors and role with chemotherapy (CT) and radiotherapy (RT) remain unclear for patients of pulmonary carcinoid (PC) with positive lymph node after surgery. PC patients who underwent surgery and with positive lymph node between 2000 and 2016 were identified from the SEER database. Univariate and multivariate cox regression analysis were used to identify independent risk factors for overall survival (OS). A total of 552 patients were identified. Multivariate analysis indicated that age (≤ 70/ > 70) (HR = 0.32, 95% CI 0.21-0.50; P < 0.001), histologic type (typical carcinoid [TC]/atypical carcinoid [AC]) (HR = 0.53, 95% CI 0.36-0.78, P = 0.001), number of positive lymph nodes (n ≥ 3/n = 1-2) (HR = 1.91, 95% CI 1.26-2.90; P = 0.002), and treatment mode (surgery + RT/surgery alone) (HR = 1.75, 95% CI 1.09-2.81; P 0.02) were independent prognostic factors for OS. In subgroup analysis according to histological type, prognostic factors were similar between AC and TC, except surgery + RT being negative prognostic factor for TC but AC. No significant difference in OS was observed between the surgery alone and surgery + CT in any subgroup of patients. Age > 70, histological type of AC, positive lymph nodes ≥ 3, and surgery + RT were likely to be negative prognostic factors for OS. Addition CT to surgery did not appear to provide additional OS benefit.

Appendiceal goblet cell carcinoma has marginal advantages from perioperative chemotherapy: a population-based study with an entropy balancing analysis

PurposeThe aim is to clarify the use of perioperative chemotherapy in resectable goblet cell carcinoma (GCC).MethodsA retrospective study was carried out based on the Surveillance, Epidemiology, and End Results study. The population was divided: into patients who received only radical surgery (group A) and those who received radical surgery plus chemotherapy (group B). An entropy balancing was carried out to correct the imbalance between the two groups. Two models were generated. Model 1 contained only high-risk patients: group B and a “virtual” group A with similar characteristics. Model 2 included only low-risk patients: group A and “virtual” group B with identical attributes. The efficacy of entropy balancing was evaluated with the d value. The overall survival was compared and reported with Hazard Ratio (HR) within a confidence interval of 95% (95 CI).ResultsThe groups A and B were imbalanced for tumor size (d = 0.392), T (d = 1.128), N (d = 1.340), M (d = 1.456), mean number of positive lymph nodes (d = 0.907), and LNR (d = 0.889). Before the balancing, the risk of death was higher in group B than in A (4.3; 2.5 to 7.4). After reweighting, all large differences were eliminated (d < 0.200). In high-risk patients, the risk of death was higher in patients who underwent surgery alone than those who received perioperative chemotherapy (HR 0.5; 0.2 to 1.3) without statistical significance (p = 0.187). In low-risk patients, the risk of death was similar (HR 1.1; 0.3 to 3.3).ConclusionPerioperative chemotherapy could provide some marginal advantages to high-risk patients.

Rate of occult neck nodal metastasis in primary and salvage laryngectomy.

Rate of occult neck nodal metastasis in primary and salvage laryngectomy.

Mammographic assessment of breast density as a tool for predicting the response to neoadjuvant therapy in breast cancer patients.

Breast cancer (BC) is the most frequently diagnosed cancer and the leading cause of cancer-related death among women worldwide. For locally advanced diseases and high-risk tumors, neoadjuvant therapy (NAT) is the treatment of choice. Some studies show that mammographic density (MD) tumor margins and the presence of microcalcifications play a prognostic role in BC patients. Hence, the objective of this retrospective study was to assess if MD could predict the response to NAT among different molecular subtypes of BC patients undergoing NAT at The "Prof. Dr I. Chiricuta" Oncology Institute of Cluj-Napoca, Romania (IOCN). Furthermore, the association between MD, tumor margins and the presence of microcalcifications with clinico-pathological data was analyzed. Eighty-four breast cancer patients diagnosed and treated at IOCN were included in this study. The morphological characteristics of the tumors were framed according to the BIRADS lexicon. The presence or absence of microcalcifications was also assessed. First, the significance of associations between breast density, margins and microcalcifications and clinico-pathological parameters of the patients were tested with Fisher or Fisher-Freeman-Halton Exact Test. Next, using multinomial logistic regression, we modelled the associations between the pathological response measured by Miller Payne and Residual cancer burden (RCB) systems and the BI-RADS. Variables having significant univariate tests were selected as candidates for the multivariable analysis (adjusted model). Breast densities were significantly associated with the age of the patients (p=0.01), number of positive lymph nodes (p=0.037), margins (p=0.002) and combined categories of Miller-Payne (p=0.034) and RCB pathological response (p=0.021). Margins was significantly associated with ki67 proliferation index (p=0.029), estrogen receptor (ER) (p=0.007), progesterone receptor (PR) (p=0.019), molecular subtype (p<0.001) and the number of clinically observed positive lymph nodes at diagnosis (p=0.019). In our cohort, BC patients with lower MD had higher odds of achieving pCR following NAT, suggesting the role of MD as a clinical prognostic marker. Larger multicenter studies are warranted to validate the prognostic value of MD, which could aid in patients stratification based on their likelihood to respond to NAT.

Diagnostic accuracy of magnetic resonance imaging to evaluate axillary lymph node status in breast cancer patients receiving neoadjuvant chemotherapy.

Axillary lymph node status is an important prognostic factor for breast cancer patients. This study aimed to assess the accuracy of MRI in assessing the axillary nodal status in breast cancer patients receiving neo-adjuvant chemotherapy (NACT). Data were retrospectively collected for 88 patients between 2011 and 2016 from the hospital records. All patients had baseline MRI, followed by the end of neoadjuvant chemotherapy MRI. Patient demographics, cancer type, grade, stage, receptor status, and the number of positive lymph nodes identified on the baseline and preoperative MRI were recorded. The imaging results were compared to post-operative histopathological lymph node findings. The median patient age of the patients was 54 years (32-77 years). There were 67 (76.1%) patients with histologically proven positive axillary lymph nodes on baseline MRI. The overall conversion from abnormal to normal axillary nodes following chemotherapy (ypN0) was 38.8% (26 patients out of 67). The sensitivity and specificity of MRI for predicting axillary status was 68.85 and 85.71%, respectively, with an overall MRI diagnostic accuracy of 73.07%. MRI has low sensitivity and diagnostic accuracy in predicting axillary nodal status in breast cancer patients receiving neoadjuvant chemotherapy. Given the low NPV of MRI of the axilla, a negative MRI does not obviate the need for definitive axillary surgery. In its current state, MRI cannot obviate the need for axillary surgery in patients receiving NACT. Long: short axis ratio (L: S) of the axillary lymph node is not a good predictor of axillary metastases.

Survival after Ivor Lewis versus McKeown esophagectomy for cancer: propensity score matched analysis.

It is unknown whether Ivor Lewis (IL) or McKeown (McK) esophagectomy is preferred in patients with potentially curable esophageal or gastro-esophageal junction (GEJ) cancer. Patients with mid- and distal esophageal and GEJ cancer without distant metastases who underwent IL or McK esophagectomy in the Netherlands between 2015 and 2017, were selected from the Netherlands Cancer Registry. Patients were propensity score matched for sex, age, American Society of Anesthesiologist classification, comorbidity, tumor type, tumor location, clinical stage, neoadjuvant treatment and year of diagnosis. The primary outcome was a 3-year relative survival (RS). Secondary outcome parameters were number of lymph nodes examined, number of positive lymph nodes, radical resection rate, tumor regression grade, post-operative complications and mortality. A total of 1627 patients who underwent IL (n = 1094) or McK (n = 533) esophagectomy were included. Patient and tumor characteristics were balanced after propensity score matching, leaving 658 patients to be compared. The 3-year RS was 54% after IL and 50% after McK esophagectomy, P = 0.140. The median number of lymph nodes examined, median number of positive lymph nodes, radical resection rate and tumor regression grade were comparable between both groups. Recurrent laryngeal nerve palsy (2 vs. 5%, P = 0.006) occurred less frequently after IL esophagectomy. No differences were observed in post-operative anastomotic leakage rate, pulmonary complication rate and mortality rates. There was no statistically significant difference in the 3-year RS between IL and McK esophagectomy. Based on these results, both IL and McK esophagectomy can be performed in patients with mid to distal esophageal and GEJ cancer.