Presence Of Extranodal Extension Research Articles

Extranodal Extension in Lymph Node–Positive Prostate Cancer

Evaluation of extranodal tumor extension may provide prognostic information for patients with epithelial malignancies. However, its importance for the patient who has prostate cancer with regional lymph node metastasis requires further investigation and clarification. This study was performed to evaluate the prognostic significance of extranodal extension (ENE) in a large series of node-positive patients. The study group included 212 node-positive patients who were treated by bilateral pelvic lymphadenectomy, radical retropubic prostatectomy, and androgen deprivation between 1987 and 1992 at the Mayo Clinic. ENE was defined as cancer perforating through the lymph node capsule into perinodal tissue. Nodal cancer volume was measured by the grid method. Univariate and multivariate risk ratios (RR) for distant metastasis-free and cancer-specific survival were estimated using the Cox proportional model. The mean follow-up was 6.3 years (median, 6.1 years). Distant metastasis-free and cancer-specific survival at 5 years for all patients was 91% and 95%, respectively. ENE was found in 126 of 212 patients (59%). The presence of ENE was not significantly associated with distant metastasis-free (RR = 1.6; 95% confidence interval [CI], 0.7 to 3.9) or cancer-specific survival (RR = 2.2; 95% CI, 0.7 to 6.8). Among 98 patients with a single positive node, there was no significant difference in distant metastasis or cancer-specific survival according to the presence of ENE (P =.88 and P =.36, respectively). After adjusting for Gleason score, DNA ploidy, and ENE, only nodal cancer volume was significantly associated with adverse distant metastasis-free (RR = 1.9; 95% CI, 1.5 to 2.8) and cancer-specific survival (RR = 1.4; 95% CI, 1.1 to 1.9). Our data indicate that the presence of ENE is not associated with unfavorable survival in patients with node-positive prostate cancer treated by radical retropubic prostatectomy, bilateral pelvic lymphadenectomy, and androgen deprivation therapy. In contrast, nodal cancer volume was predictive of distant metastasis-free survival and cancer-specific survival.

Follow-Up Strategies in the Postirradiated Breast: Techniques Involved in the Detection of Local Recurrences Following Breast Conservation Therapy

: Our goal was to delineate parameters involved in the detection of local recurrences of cancer after breast conservation therapy, and to further define standardized follow-up strategies for surveillance of the breast after irradiation. We retrospectively evaluated 152 patients treated with breast conservation therapy who had received a median of 86 months of consecutive clinical and radiographic follow-up at the University of Texas M. D. Anderson Cancer Center from 1978 to 1989. All mammograms were reevaluated by a single radiologist (B. S. J who had no knowledge of the physical or pathologic findings. Local recurrences were found in 13 patients (9%), with a mean time to recurrence of 51 months (median time, 37 months). Age, tumor size, margin status, nuclear grade, estrogen receptor status, nodal status, and the presence of ex-tranodal extension were similar in patients with or without local recurrence. The primary method of detection was physical examination in 10 of the 13 patients (77%); only 3 occult local recurrences were detected by mammography alone. The 13 patients with local recurrences underwent an aver-age number of 14 physical examinations and 5 mammograms in the follow-up period prior to the detection of local recurrence. Our data suggested that, in patients with early stage breast cancer, the incidence of local recurrence after breast conservation therapy is relatively low. Most local recurrences occurred 2 years after breast conservation therapy and were detected by physical examinations. Yearly diagnostic mammograms after breast conservation therapy are sufficient and may complement thorough physical examinations. A new baseline mammogram to evaluate the treated breast at 6 months, after irradiation changes have stabilized, may be useful for future mammogram comparisons.?