Presence Of Positive Nodes Research Articles

Retrospective analysis of treatment effects and prognostic factors associated with overall survival in patients with resected adenocarcinoma of the pancreas.

359 Background: The role of adjuvant chemotherapy in pancreas cancer has been well established. The role of radiation therapy however remains controversial. The ESPAC-1 study showed a possible deleterious effect for radiation on survival of patients with resected pancreas cancer, although the study was limited by lack of compliance and quality control. Methods: We performed a retrospective analysis of patients who underwent curative resection of their cancer of the pancreas over the last 2 decades at the Ohio State University. 333 patients with adenocarcinoma of the pancreas were identified from our database and 148 subjects were found with complete treatment information available. Thirty patients had no treatment after resection. Log-rank test was used to compare the overall survival (OS) of two groups of patients: treated with chemotherapy (C, N=68) or fluoropyrimidine-based chemoradiation (CRT, N=50). Demographics of the CT and CRT groups were balanced. Patient characteristics including age, sex, tumor size, tumor location, tumor grade, nodal status, margins (R0 vs. R1) and number of hospitalizations within a six-month period of discharge from the hospital after surgery were compared across all groups. The effect of these variables on OS was assessed using log-rank test. Results: The mOS for C (21.5 months, 95% CI; 13.5, 24.6) and CRT (16.8 months, 95% CI; 13.9, 23.1) were similar. There was no statistically significant difference observed for C vs. CRT (p>0.8). Out of all the characteristic variables tested (N= 148), only the presence of at least one positive lymph node vs. none had a statistically significant negative effect on survival (mOS of 12.20 months vs. 23.10 months; p=0.0053). Conclusions: In patients with resected adenocarcinoma of the pancreas, the addition of radiation does not seem to add benefit. The presence of positive lymph nodes is an adverse prognostic factor on overall survival.

Prognostic Significance of Lymphovascular Space Invasion and Nodal Involvement in Intermediate- and High-Risk Endometrial Cancer Patients Treated With Curative Intent Using Surgery and Adjuvant Radiotherapy

The aim of this study was to assess whether lymphovascular space invasion (LVSI) and nodal status provide adequate prognostic information in comparison with the entire set of traditional prognostic factors in intermediate- and high-risk endometrial cancer patients treated and staged with primary surgery and adjuvant radiotherapy. Three hundred twenty-four previously untreated high-intermediate- and high-risk endometrial cancer patients with FIGO (International Federation of Gynecology and Obstetrics) stage I to IIIC; endometrioid, serous, or clear cell histology; diagnosed between November 1995 and December 2006; who presented to Peter MacCallum Cancer Centre for adjuvant radiotherapy were included in these analyses. All traditionally recognized prognostic factors and newly created 4 pairs of combination of LVSI and nodal status were studied with respect to survival and patterns of failure. The median follow-up time was 4.8 years. Five-year failure-free survival for all patients according to FIGO stage I, II, and III were 87.4%, 89.0%, and 62.4 %, respectively. In multivariable analysis for relapse, positive LVSI had a hazard ratio of 4.9 (P = 0.000), which increased to 8.8 (P = 0.004) in the presence of positive nodes. For overall survival, only LVSI was significant, with a hazard ratio of 3.02 (P = 0.003). In particular, in the presence of LVSI and nodes, histological type, grade, and myometrial invasion were not significant prognosticators for relapse or overall survival. This model enables the separation of good prognosis patients even among poorly differentiated endometrioid, serous, and clear cell carcinoma patients and can be used in simplifying the staging of endometrial cancer and for selecting patients for high-risk endometrial cancer studies.

P3-07-40: Impact of the Sentinel Lymph Node Procedure on the Detection of Positive Lymph Nodes in Breast Cancer.

Abstract Introduction: The objective of the sentinel lymph node (SLN) procedure in breast cancer is to perform an accurate axillary staging and provide good local control, while sparing the patients the morbidity of an axillary lymph node dissection (ALND). Since its routine clinical use, questions have been raised concerning the upstaging of a subgroup of node-negative patients and an increase in the overall percentage of node-positive patients. The goal of our study was to investigate the impact of the SLN procedure on the detection of positive lymph nodes. Patients and methods: We included 1119 consecutive breast cancer patients from one center (2007-2009) who underwent primary surgery for a breast cancer smaller than 5 cm diameter without clinical involvement of axillary lymph nodes. 31 patients had a bilateral breast cancer. Logistic regression models were used to analyze the effect of various predictors on the presence of positive lymph nodes. First, we fitted univariable models for a number of predictors of which the relationship with lymph node involvement was to be expected. (multifocality, tumor location in the breast, tumor size, LVI, ER, PR, Her-2, tumor grade, age and histologic subtype). In a second stage, we fitted a multivariable model including the procedure (SLN biopsy or ALND) and the predictors that have been shown to be related to lymph node involvement in univariable analysis or for which this relationship has been suggested in the literature. The probability of finding positive lymph nodes was thus calculated in both groups correcting for relevant predictors of lymph node involvement. Results: The SLN biopsy group includes 830 patients, the ALND group 320. Tumors in the ALND group are larger (mean 26.65 mm versus 18.43mm) and more frequently multifocal (24.44% versus 8.19%). 33% of patients in the ALND group were lymph node positive, 28% in the SLN procedure group. Univariable and multivariable analyses revealed that LVI, tumor size and multifocality are the most significant predictors of lymph node involvement (table 1). The AUC for the multivariate model is 0.754. By comparing ALND en SLN biopsy an odds ratio (OR) of 0.7635 (95% confidence interval: 0.5334−1.0930) is observed, suggesting a higher probability of finding positive lymph nodes with SLN procedure. However, the difference between the procedures is not significant (p= 0.1404). Conclusion: For comparable tumors, the chance of detecting positive lymph nodes is not lower when applying SLN procedure compared to ALND. The results even point in the direction of a higher detection rate with SLN. However, care should be taken in making this conclusion given a non-significant result. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-07-40.

High Occurrence of Aberrant Lymph Node Spread on Magnetic Resonance Lymphography in Prostate Cancer Patients With a Biochemical Recurrence After Radical Prostatectomy

To investigate the pattern of lymph node spread in prostate cancer patients with a biochemical recurrence after radical prostatectomy, eligible for salvage radiotherapy; and to determine whether the clinical target volume (CTV) for elective pelvic irradiation in the primary setting can be applied in the salvage setting for patients with (a high risk of) lymph node metastases. The charts of 47 prostate cancer patients with PSA recurrence after prostatectomy who had positive lymph nodes on magnetic resonance lymphography (MRL) were reviewed. Positive lymph nodes were assigned to a lymph node region according to the guidelines of the Radiation Therapy Oncology Group (RTOG) for delineation of the CTV for pelvic irradiation (RTOG-CTV). We defined four lymph node regions for positive nodes outside this RTOG-CTV: the para-aortal, proximal common iliac, pararectal, and paravesical regions. They were referred to as aberrant lymph node regions. For each patient, clinical and pathologic features were recorded, and their association with aberrant lymph drainage was investigated. The distribution of positive lymph nodes was analyzed separately for patients with a prostate-specific antigen (PSA) <1.0 ng/mL. MRL detected positive aberrant lymph nodes in 37 patients (79%). In 20 patients (43%) a positive lymph node was found in the pararectal region. Higher PSA at the time of MRL was associated with the presence of positive lymph nodes in the para-aortic region (2.49 vs. 0.82 ng/mL; p= 0.007) and in the proximal common iliac region (1.95 vs. 0.59 ng/mL; p= 0.009). There were 18 patients with a PSA <1.0 ng/mL. Ten of these patients (61%) had at least one aberrant positive lymph node. Seventy-nine percent of the PSA-recurrent patients had at least one aberrant positive lymph node. Application of the standard RTOG-CTV for pelvic irradiation in the salvage setting therefore seems to be inappropriate.

1847 USE OF PERIOPERATIVE CHEMOTHERAPY IN PATIENTS TREATED WITH RADICAL CYSTECTOMY AND EXTENDED LYMPH NODE DISSECTION FOR UROTHELIAL CARCINOMA OF THE BLADDER AND THE EFFECT IN DOWNSTAGING AND SURVIVAL

You have accessJournal of UrologyBladder Cancer: Invasive1 Apr 20111847 USE OF PERIOPERATIVE CHEMOTHERAPY IN PATIENTS TREATED WITH RADICAL CYSTECTOMY AND EXTENDED LYMPH NODE DISSECTION FOR UROTHELIAL CARCINOMA OF THE BLADDER AND THE EFFECT IN DOWNSTAGING AND SURVIVAL Nathan R. Starke, Guilherme Godoy, Gilad E. Amiel, Guru Sonpavde, and Seth P. Lerner Nathan R. StarkeNathan R. Starke Houston, TX More articles by this author , Guilherme GodoyGuilherme Godoy Houston, TX More articles by this author , Gilad E. AmielGilad E. Amiel Houston, TX More articles by this author , Guru SonpavdeGuru Sonpavde Houston, TX More articles by this author , and Seth P. LernerSeth P. Lerner Houston, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1880AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite level I evidence, neoadjuvant chemotherapy (NACT) in patients with muscle-invasive bladder cancer is underutilized. The objective of this study was to evaluate the effect of NACT on DS and the impact of peri-operative CT in the survival outcomes of patients undergoing radical cystectomy (RC) and extended lymph node dissection (eLND) in our series. METHODS From March 1992 to June 2010, 412 patients treated by one of two surgeons in a single center with RC + eLND with or without chemotherapy were identified. 372 evaluable patients were included in the analyses. Data elements included age at RC, gender, clinical and pathologic stage and grade, presence of positive nodes, DS defined as pT-stage lower than cT-stage, use of chemotherapy, drug regimen and type, whether NACT, adjuvant chemotherapy (ACT) or salvage chemotherapy (SCT). Endpoints were presence of DS, cancer-specific survival and overall survival. Statistical analyses were performed using regression models with significant p < 0.05. RESULTS At the time of treatment, median age was 69 years (interquartile range [IQR], 59, 75), 83.5% were male, and median follow-up for patients alive was 51 months (IQR, 17, 73). The majority of patients had muscle invasive disease (pT2, pT3 and pT4 in 20.9%, 32.3% and 11.5%, respectively) and urothelial carcinoma histology (87.3%). NACT, ACT and SCT were used in 9.1%, 26.9%, and 6.6%, respectively. Cisplatin-based regimens were used in NACT and ACT in 75.0% and 80.6%, respectively. At the time of analysis, 175 patients had died, including 82 patients who died of disease. DS was significantly associated with use of NACT (p-values <0.021), independent of whether cisplatin was used or not. The use of any type of CT was independently associated with cancer-specific survival after controlling for age, pT-stage, and presence of positive lymph nodes (HR 2.52, 95%CI 1.51, 4.23, p<0.001). The type of CT was also significantly associated with cancer-specific survival, with reduced risk associated with ACT vs. NACT (HR 0.41, p=0.012), and SCT vs. NACT (HR 0.31, p=0.045). The use of CT was not independently associated with overall survival in any models controlling for age, pT-stage, presence of positive lymph nodes, and downstaging. CONCLUSIONS DS was significantly associated with use of NACT in our series, but without correlation with survival outcomes. The use of any of the CT modalities (NACT, ACT or SCT) was independently associated with cancer specific-survival, but not with overall survival. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e741 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nathan R. Starke Houston, TX More articles by this author Guilherme Godoy Houston, TX More articles by this author Gilad E. Amiel Houston, TX More articles by this author Guru Sonpavde Houston, TX More articles by this author Seth P. Lerner Houston, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

640 OUTCOMES OF PATIENTS WITH LYMPH NODE POSITIVE DISEASE FOLLOWING OPEN RADICAL RETROPUBIC PROSTATECTOMY FOR CLINICALLY LOCALIZED PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Advanced1 Apr 2011640 OUTCOMES OF PATIENTS WITH LYMPH NODE POSITIVE DISEASE FOLLOWING OPEN RADICAL RETROPUBIC PROSTATECTOMY FOR CLINICALLY LOCALIZED PROSTATE CANCER Ryan Dorin, Siamak Daneshmand, Jie Cai, and Gary Lieskovsky Ryan DorinRyan Dorin Los Angeles, CA More articles by this author , Siamak DaneshmandSiamak Daneshmand Los Angeles, CA More articles by this author , Jie CaiJie Cai Los Angeles, CA More articles by this author , and Gary LieskovskyGary Lieskovsky Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1542AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients undergoing radical prostatectomy for clinically localized prostate cancer are occasionally found to have lymph node (LN) metastases on pathological exam. We examined the clinical outcomes of this consecutive cohort of patients who underwent uniform open radical retropubic prostatectomy (RRP) with bilateral pelvic lymph node dissection (PLND) in the PSA era. METHODS We reviewed an IRB approved, prospectively maintained prostate cancer database and identified 2487 patients with clinically organ confined (cT1/cT2) prostate adenocarcinoma who underwent RRP and PLND between July 1988 and June 2008. Patients were excluded if they had undergone preoperative radiation (XRT) or androgen deprivation (ADT), or if their preoperative risk group was indefinable. RESULTS Median follow-up was 7.2 years (range 1–21 years), and a median of 16 LNs were removed per patient. There were 150 patients with LN+ disease (80 with 1 positive LN (+LN), 40 patients with 2 +LNs, and 30 patients with ≥3 +LNs). Estimated 10 year overall survival rates (OS), clinical recurrence free survival (CRFS) and biochemical recurrence free survival (BCRFS) were 86% and 74% (RR 2.2 p<0.001), 97% and 84% (RR 6.8, p<0.001), and 88% and 57% (RR 3.9, p<0.001) for patients with negative LNs and a single positive LN, respectively. Among LN+ patients, there was a significant difference in OS based on number of +LNs, with 75% of patients with ≤2 +LNs and 52% of patients with ≥3 +LNs alive at 10 years (RR 2.3, p= 0.0032), however there were no statistically significant differences in CRFS or BCRFS based on number of +LNs. Patients with ≤2 +LNs were less likely to receive adjuvant therapy, with 32% undergoing ADT and 39% undergoing XRT, while 57% of patients with ≥3 +LNs received ADT and 57% received XRT. There were 49 LN+ patients (33 with 1 +LN, 13 with 2 +LNs, and 3 with ≥3 +LNs) who did not undergo any adjuvant therapy, with 5 and 10 year BCRFS rates of 82% and 59%, and 5 and 10 year CRFS rates of 88% and 80%, respectively. CONCLUSIONS There is a low incidence of unexpected LN metastases in patients with clinically localized prostate cancer undergoing RP. The presence of positive LNs was a significant negative predictor of recurrence and survival, but the number of positive LNs was not, likely resulting from increased use of adjuvant therapies in patients with higher volume LN metastases. RRP with a thorough PLND appears to be curative in a subset of patients with low volume nodal disease. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e259 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryan Dorin Los Angeles, CA More articles by this author Siamak Daneshmand Los Angeles, CA More articles by this author Jie Cai Los Angeles, CA More articles by this author Gary Lieskovsky Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

1306 PERIPROSTATIC FAT PADS HARBOR LYMPH NODES AND LYMPH NODE METASTASES: IMPACT ON PATHOLOGICAL WORK UP

You have accessJournal of UrologyProstate Cancer: Localized1 Apr 20111306 PERIPROSTATIC FAT PADS HARBOR LYMPH NODES AND LYMPH NODE METASTASES: IMPACT ON PATHOLOGICAL WORK UP Lars Budäus, Hendrik Isbarn, Felix Chun, Sascha Ahyai, Margit Fisch, Roland Dahlem, Georg Salomon, Thorsten Schlomm, Alexander Haese, Thomas Steuber, Hans Heinzer, Hartwig Huland, and Markus Graefen Lars BudäusLars Budäus Hamburg, Germany More articles by this author , Hendrik IsbarnHendrik Isbarn Hamburg, Germany More articles by this author , Felix ChunFelix Chun Hamburg, Germany More articles by this author , Sascha AhyaiSascha Ahyai Hamburg, Germany More articles by this author , Margit FischMargit Fisch Hamburg, Germany More articles by this author , Roland DahlemRoland Dahlem Hamburg, Germany More articles by this author , Georg SalomonGeorg Salomon Hamburg, Germany More articles by this author , Thorsten SchlommThorsten Schlomm Hamburg, Germany More articles by this author , Alexander HaeseAlexander Haese Hamburg, Germany More articles by this author , Thomas SteuberThomas Steuber Hamburg, Germany More articles by this author , Hans HeinzerHans Heinzer Hamburg, Germany More articles by this author , Hartwig HulandHartwig Huland Hamburg, Germany More articles by this author , and Markus GraefenMarkus Graefen Hamburg, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1006AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Defatting of the periprostatic areas during radical prostatectomy (RP) is essential to expose the puboprostatic ligaments, endopelvic fascia and anterior surface of the dorsal vein complex. Lymph nodes are present in these areas in some individuals, but their incidence and involvement by metastases is unknown. We determined the necessity of obtaining pathological analyses of the fat pads from these areas. METHODS Between 7/2010 and 9/2010 a total of 402 men underwent RP at our institution by 8 surgeons. Periprostatic fat was resected in all cases, histological examination of these specimen was performed in 356 (88.5%). The relationship between presence of lymph nodes within the periprostatic fat pads and the total number of lymph nodes examined and the relationship between the presence of lymph node metastasis within the fat pads and metastasis in other lymph node regions was assessed by using the χ2 and t-test. RESULTS Lymph nodes within the periprostatic fat pads were detected in 20 (5.6%) of patients. Among these patients, tumor infiltration was found in 4 patients (1.2%). Three of these patients harbored lymph node metastases without any other lymph node metastasis during standard lymphadenectomy. Finally, no relationship was detected between the total number of lymph nodes removed and the detection of lymph nodes in the periprostatic fat pads (p=0.4). CONCLUSIONS Our analyzes demonstrate that lymph nodes can be detected in periprostatic fad pads, which are not routinely included in the pathological work up. Moreover, no relationship exists between the presence of lymph nodes within the periprostatic fat and the total number of lymph nodes yielded in other lymphatic fields. Similarly, no relationship exists between the presence of positive lymph nodes in the periprostatic fat pads and presence positive nodes within other lymph nodes. Therefore, despite the relatively low incidence of both findings, implementing routinely pathological work up of periprostatic fad pads yielded during RP, should be considered to guarantee adequate lymph node staging. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e523 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lars Budäus Hamburg, Germany More articles by this author Hendrik Isbarn Hamburg, Germany More articles by this author Felix Chun Hamburg, Germany More articles by this author Sascha Ahyai Hamburg, Germany More articles by this author Margit Fisch Hamburg, Germany More articles by this author Roland Dahlem Hamburg, Germany More articles by this author Georg Salomon Hamburg, Germany More articles by this author Thorsten Schlomm Hamburg, Germany More articles by this author Alexander Haese Hamburg, Germany More articles by this author Thomas Steuber Hamburg, Germany More articles by this author Hans Heinzer Hamburg, Germany More articles by this author Hartwig Huland Hamburg, Germany More articles by this author Markus Graefen Hamburg, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Breast cancer care compared with clinical Guidelines: an observational study in France

BackgroundGreat variability in breast cancer (BC) treatment practices according to patient, tumour or organisation of care characteristics has been reported but the relation between these factors is not well known. In two French regions, we measured compliance with Clinical Practice Guidelines for non-metastatic BC care management and identified factors associated with non-compliance at clinical and organisational levels.MethodsEligible patients had invasive unilateral BC without distant metastases and at least two contacts with one of the two regional healthcare systems (2003-2004) in the first year after diagnosis. Medical data were collected from patient medical records in all public and private hospitals (99 hospitals).The care process was defined by 20 criteria: clinical decisions for treatment and therapeutic procedures. Each criterion was classified according to level of compliance ("Compliant", "Justifiable" and "Not Compliant") and factors of non-compliance were identified (mixed effect logistic regression).Results926 women were included. Non-compliance with clinical decisions for treatment was associated with older patient age (OR 2.1; 95%CI: 1.3-3.6) and region (OR 3.0; 95%CI: 1.2-7.4). Non-compliance with clinical decisions for radiotherapy was associated with lymph node involvement or the presence of peritumoural vascular invasion (OR 1.5; 95%CI: 1.01-2.3) and non-compliance with overall treatment (clinical decisions for treatment + therapeutic procedures) was associated with the presence of positive lymph nodes (OR 2.0; 95%CI: 1.2-3.3), grade III versus grade I (OR 2.9; 95%CI: 1.4-6.2), and one region of care versus another (OR 3.5; 95%CI: 1.7-7.1). Finally, heterogeneity of compliance in overall treatment sequence was identified between local cancer units (p < 0.05).ConclusionThis study provides interesting insights into factors of non-compliance in non-metastatic BC management and could lead to quality care improvements.

Aktuelle TNM-Klassifikationssysteme für das Nebennierenkarzinom

Adrenocortical carcinoma (ACC) is a rare malignancy and often difficult to diagnose. It was only in 2003 that the UICC proposed the first TNM classification for ACC. However, an analysis based on data from the German ACC Registry revealed several shortcomings of this classification; in particular, the outcome of patients with UICC stage II and III was not significantly different. Therefore, the European Network for the Study of Adrenal Tumours (ENSAT) developed a revised staging system, the superiority of which was recently confirmed in an independent American cohort. In the ENSAT classification, stage I (tumors ≤ 5 cm) and II (tumors < 5 cm) are non-infiltrating tumors without positive lymph nodes and distant metastases. Stage III is defined by the presence of positive lymph nodes, infiltration of surrounding tissue, or venous tumor thrombus. Stage IV is restricted to patients with distant metastasis. Since the ENSAT classification better reflects patient prognosis than the UICC classification, its use for future clinical and research purposes is recommended. Furthermore, exact documentation of the resection status is essential for optimal decisions on treatment.

Role of level VI lymph nodes metastasis in cervical metastasis of patients with papillary thyroid cancer

To study the features of level VI lymph node metastasis in papillary thyroid cancer (PTC) and the distribution of metastatic lymph nodes in the neck levels, and to provide evidences for the treatments of cervical metastasis in patients with PTC. Ninety-seven PTC cases were reviewed retrospectively. The tumors in all cases were limited to one side lobe. Of them, 72 patients were cN0 and 25 patients were cN+; 32 patients with tumors ≤ 1 cm and 65 patients with tumors > 1 cm. Pathological examinations of frozen biopsies of level III and IV lymph nodes were taken in the operation. The extent of lymph node dissection depending on pathological examination results of level III and IV lymph nodes and the size and location of the tumor. For the patients with metastatic lymph nodes in level III and IV, the modified neck dissection including level VI was performed. Ipsilateral VI lymph node dissection was performed for the patients with tumors ≤ 1 cm and bilateral VI lymph node dissection for the patients with tumors > 1 cm or with extra-thyroidal invasion. In 97 patients, 122 sides of VI lymph node dissection were performed. Positive nodes in level VI were found in 45.1% (55/122) patients. The positive rates of nodes metastases in level VI were 45.8% (33/72) for 72 patients with cN0 and 76.0% (19/25) for 25 patients with cN+ respectively, with a significant difference statistically (χ(2) = 6.790, P = 0.009). Positive rates of node metastases in level VI were 65.0% (13/20) in 10 patients with extra-thyroidal invasion and 41.2% (42/102) in 77 patients without extra-thyroidal invasion respectively, with a significant difference statistically (χ(2) = 3.833, P = 0.047). Positive rate of node metastasis in level VI was 43.8% (14/32) in 32 patients with tumors ≤ 1cm. Of 65 patients with tumors > 1cm, ipsilateral and bilateral node metastasis rates were 69.2% (45/65) and 23.1% (15/65) respectively, with a significant difference statistically (χ(2) = 5.843, P = 0.016). Cervical lymph node metastasis in level VI can occur at early stage of PTC. The patients with extra-thyroidal invasion were prone to have lymph node metastasis in level VI. Ipsilateral positive nodes in level VI can exist in the patients with tumors ≤ 1 cm, while bilateral positive nodes in level VI can occur in the patients with tumors > 1 cm. The cervical lymph node metastasis of PTC may take place in level VI alone or in level VI and in lateral neck levels simultaneously. Pathological examinations of frozen biopsies of level III and IV lymph nodes should be taken for PTC patients, when the presence of positive lymph node, the modified neck dissection including level VI should be performed.

Factores pronósticos del hepatocarcinoma en el hígado no cirrótico tras su resección: presentación de 51 casos

Background Clinical presentation, treatment and prognosis of hepatocellular carcinoma depend on presence or absence of cirrhosis. In the literature there are few reports of hepatocellular carcinoma in non-cirrhotic patients. Objective To describe a consecutive series of resected patients with hepatocellular carcinoma in non-cirrhotic liver and to identify prognostic factors of recurrence and survival. Material and methods Between 1990 and 2006, 51 patients were operated on. Data were retrospectively analysed from a prospectively collected database. Single and multivariate analyses were performed to identify factors associated with survival and disease-free survival. Results Thirty-three patients were male, median age 49.8 years. A major hepatectomy was performed in 72%. Morbidity was 43% and mortality was 0%. One-, two- and three-year survival rates were 90%, 75% and 67%, respectively. One-, two- and three-year disease-free survival rates were 65%, 41% and 37%, respectively. Presence of vascular invasion and of positive nodes was statistically significant for survival in univariate analysis but had no statistical significance in multivariate analysis. Conclusions Major hepatic resection is a safe treatment for hepatocellular carcinoma in non-cirrhotic patients. Both vascular invasion and presence of positive nodes were associated with poor survival. However, neither of them represented an independent variable.

Prognostic factors after resection of hepatocellular carcinoma in the non-cirrhotic liver: Presentation of 51 cases

BackgroundClinical presentation, treatment and prognosis of hepatocellular carcinoma depend on the presence or absence of cirrhosis. In the literature there are few reports of hepatocellular carcinoma in non-cirrhotic patients. ObjectiveTo describe a consecutive series of resected patients with hepatocellular carcinoma in non-cirrhotic liver and to identify prognostic factors of recurrence and survival. Material and methodsBetween 1990 and 2006, 51 patients were operated on. Data were collected retrospectively until 2001 and prospectively from then on. The results of surgery were assessed. Single and multivariate analyses were performed to identify factors associated with survival and disease-free survival. ResultsThirty-three patients were male, median age 49.8 years. A major hepatectomy was performed in 72%. Morbidity was 43% and mortality was 0%. One-, two- and three-year survival rates were 90%, 75%, and 67%, respectively. One-, two- and three-year disease-free survival rates were 65%, 41%, and 37%, respectively. Presence of vascular invasion and of positive nodes was statistically significant for survival in univariate analysis but had no statistical significance in multivariate analysis. ConclusionsMajor hepatic resection is a safe treatment for hepatocellular carcinoma in noncirrhotic patients. Both vascular invasion and presence of positive nodes were associated with poor survival. However, neither of them represented an independent variable.

How many nodes are needed to stage a neck? A critical appraisal

Reliable staging of the neck is an important factor for the estimation of prognosis of head and neck cancer patients. A total of 608 patients with oral squamous cell carcinomas treated from March 1975 to December 2000 were enrolled. In radical neck dissection (RND) group, the number of lymph nodes ranged from 6 to 116; while in selective neck dissection (SND) group, from 1 to 87 (P < 0.001). In SND group, the number of metastatic nodes ranged from 0 to 8 nodes, while in RND group, from 0 to 47 (P < 0.001). The number of dissected lymph nodes correlates with the presence of positive nodes (P = 0.001). In RND group, this correlation is described by the equation Y = -0.0117X (2) + 1.7262X. Factors affecting neck metastasis were number of dissected nodes (P < 0.001), lymphatic embolization (P = 0.044) and neural invasion (P = 0.030). In SND group, this equation is Y = -0.012X (2) + 1.5102X; the number of dissected nodes (P = 0.002) and lymphatic embolization (P = 0.001) were significant for metastasis finding. For patients with tumors at stages I and II, a significant impact on survival and neck recurrence rates were observed. In conclusion, we report the importance of the number of retrieved nodes in likelihood of positive cervical node finding. Node yield is an important factor in oral cancer staging, and, more important, in early stage carcinomas, it is associated with survival and recurrence rates.

Prognostic value of lymph node metastases and lymph node ratio in esophageal squamous cell carcinoma

Aims Although the positive lymph node (LN) metastasis in patients with thoracic esophageal squamous cell carcinoma carcinoma (SCC) has been reported to be a risk factor to reduce long-term survival, only a few studies have so far evaluated the lymph node metastasis among this group of patients. The purpose of this study was to evaluate the impact of lymph node positivity and ratio on survival of esophageal SCC. Methods All patients undergoing esophagectomy at the Forth Hospital of Hebei Medical University between January 1986 and December 2002 were reviewed. Survival curves were estimated using the Kaplan-Meier method. Results Of 1325 patients with invasive cancer, had squamous cell cancer of the esophagus. Median overall survival (OS) of the entire group was 36.7 months and 5-year OS was 39.3%. The most significant prognostic factor for overall survival was the presence of positive LN ( P < 0.01). Additionally, patients with zero involved LN had a 5-year survival of 49.1%, while patients with 1–3 positive LN and >3 positive LN had 5-year survival of 19.5% and 11.0%, respectively ( P < 0.01). Finally, an increasing ratio of positive to examined LN was linearly associated with a worsening 5-year survival, patients with <25%, 25%–50% and >50% positive LN had 5-year survival of 47.53%, 14.6% and 8.9%, respectively ( P < 0.01). Conclusion Increasing number of positive LN in patients with esophageal cancer and increasing ratio of metastatic to examine LN portend a poor prognosis. These factors should play an important role in predicting prognosis of patients.

Association of the Actin-Binding Protein Transgelin with Lymph Node Metastasis in Human Colorectal Cancer

Metastatic dissemination of primary tumors is responsible for 90% of colorectal cancer (CRC) deaths. The presence of positive lymph nodes, which separates stage I/II from stage III CRC, is a particularly key factor in patient management. Here, we describe results of a quantitative proteomic survey to identify molecular correlates of node status. Laser capture microdissection and two-dimensional difference gel electrophoresis were used to establish expression profiles for 980 discrete protein features in 24 human CRC specimens. Protein abundances were determined with a median technical coefficient of variation of 10%, which provided an ability to detect small differences between cancer subtypes. Transgelin, a 23-kDa actin-binding protein, emerged as a top-ranked candidate biomarker of node status. The area under the receiver operating characteristic curve for transgelin in predicting node status was 0.868 (P = .002). Significantly increased frequency of moderate- and high-level transgelin expression in node-positive CRC was also seen using semiquantitative immunohistochemistry to analyze 94 independent CRC specimens on tissue microarrays (P = .036). Follow-up studies in CRC cell lines demonstrated roles for transgelin in promoting invasion, survival, and resistance to anoikis. Transgelin localizes to the nucleus of CRC cells, and its sequence and properties suggest that it may participate in regulation of the transcriptional program associated with the epithelial-to-mesenchymal transition.

140P THE ROLE OF THORACIC SURGERY IN TREATMENT OF PULMONARY METASTASIS

Background The problem of surgical treatment of pulmonary metastasis is still alive, it is accepted in the world as a curative way of treatment of pulmonary metastasis. But the problem lies in the Czech Republic that only a few oncologists accept it as one of the most effective ways of treatment. Prognostic factors for pulmonary metastasectomies are complete resection, disease free interval, the amount and size of the metastasis, tumor double time, histology of the primary tumor and biologic aggressiveness of the tumor. Methods The effect of the surgery is based on exact diagnostic investigation (X-ray, HRCT, PET-CT) and on the proper selection of patients based on the contol of the primary tumor, no metastasis in other localizations, the possibility of complete resection, good cardiopulmonal condition of the patient, no other better way of treatment and low-operative risk. As contraindications are mostly considered low pulmonary function, impossibility of complete resection and the presence of many tiny metastasis. According to the size, number and side is chosen the right access to the pulmonary cavity and the proper surgery is performed. The importance of mediastinal lymphadenectomy was not defined yet. The presence of positive lymphnodes is not a good prognostic factor for long-time survival rate. Results The authors will present the results of pulmonary metastasectomies in the last ten years on over 100 patients performed in our department. Most of the surgeries were performed by atypic resection with safety margin, also some lobectomies and enclueations. No pneumonectomy was performed. Mediastinal lymphadenectomy was performed at carcinomas. Conclusions Pulmonary metastasectomy can be when performed by a experienced surgeon and after an exact indication, a way of secure, effective and potentially curative treatment .

Limited prognostic value of the 2004 International Union Against Cancer staging classification for adrenocortical carcinoma

Adrenocortical carcinoma (ACC) is a rare malignancy, and it was only in 2004 that the International Union Against Cancer (UICC) defined TNM criteria and published the first staging classification. However, to date, the prognostic value of the proposed classification has not been evaluated. The German ACC Registry comprising 492 patients was searched for patients who were diagnosed between 1986 and 2007 with detailed information on primary diagnosis and a minimum follow-up of 6 months. Patients were assigned to UICC tumor stage, and disease-specific survival (DSS) was assessed. In addition, the contribution of potential risk factors for DSS was evaluated. In total, 416 patients with a mean follow-up of 36 months met the inclusion criteria (stage I, n=23 patients; stage II, n=176 patients; stage III, n=67 patients; stage IV, n=150 patients). Kaplan-Meier analysis revealed a stage-dependent DSS. However, DSS in patients with stage II ACC did not differ significantly from DSS in patients with stage III ACC (hazard ratio, 1.38; 95% confidence interval, 0.89-2.16). Furthermore, patients who had stage IV ACC without distant metastases had an improved DSS compared with patients who had metastatic disease (P=.004). An analysis of different potential risk factors for defining stage III ACC revealed important roles in DSS for tumor infiltration in surrounding tissue, venous tumor thrombus (VTT), and positive lymph nodes; whereas tumor invasion in adjacent organs carried a prognosis similar to that of infiltration in surrounding tissue only. The 2004 UICC staging classification for ACC has significant limitations. On the basis of the current analysis, a revised classification with superior prognostic accuracy is proposed (the European Network for the Study of Adrenal Tumors classification). In this system, stage III ACC is defined by the presence of positive lymph nodes, infiltration of surrounding tissue, or VTT; and stage IV ACC is restricted to patients with distant metastasis.

Positive Surgical Margins in Soft Tissue Following Radical Cystectomy for Bladder Cancer and Cancer Specific Survival

We evaluated risk factors for positive soft tissue surgical margins and the impact of soft tissue surgical margins on metastatic progression and disease specific survival in patients treated with radical cystectomy for bladder cancer. A total of 1,589 patients who underwent radical cystectomy for primary urothelial cancer at our institution were included in the study. Several variables were analyzed including gender, age, use of perioperative chemotherapy, tumor stage, tumor grade, presence of carcinoma in situ, pathological vascular invasion, bladder pathology, status of soft tissue surgical margins, lymph node status, number of lymph nodes removed and number of positive lymph nodes. End points were freedom from progression to metastases and disease specific survival. Positive soft tissue surgical margins were detected in 67 patients (4.2%). Risk factors for positive soft tissue surgical margins were female gender (p = 0.04), pathological stage, vascular invasion in the radical cystectomy specimen, lymph node metastases (all p < or = 0.001) and median number of positive lymph nodes (p = 0.002). In addition, nonpure transitional cell carcinoma histology (p = 0.001) was associated with positive soft tissue surgical margins. In the 5 years after cystectomy, rates of disease specific survival for the negative and positive soft tissue surgical margin groups were 72% (95% CI 69-75) and 32% (95% CI 19-54), respectively. On multivariate analysis disease specific death was associated with tumor stage, positive soft tissue surgical margins, vascular invasion, presence of positive lymph nodes, number of nodes removed and number of positive nodes. Risk factors for positive soft tissue surgical margins are female gender, locally advanced cancer, presence of vascular invasion and mixed histology. Patients with positive soft tissue surgical margins have poor prognosis, and positive soft tissue surgical margins were found to be independently associated with disease specific death.

Dissection of the submuscular recess (sublevel IIb) in squamous cell cancer of the upper aerodigestive tract: Prospective study and systematic review of the literature

Selective neck dissection is commonly used to clear occult neck metastases in the N0 neck. The aim of this study was to identify the incidence of occult metastases in lymph nodes of sublevel IIb (submuscular recess; SMR) in upper aerodigestive tract squamous cell carcinoma in the setting of clinically and radiologically staged N0 necks and to perform a systematic review of the literature on the incidence of metastases in this setting. We conducted a prospective study of 50 neck dissections and systematic review of the literature. (A) Prospective study: Tissue dissected out from the SMR was sent separately for histopathologic analysis. Between 0 and 7 nodes were harvested from sublevel IIb. One patient had a metastatic node in sublevel IIb with extracapsular spread in the ipsilateral neck. No other positive nodes were detected. Sixteen necks showed occult metastases at other levels. (B) Systematic review: The review identified 14 articles with 903 necks suitable for inclusion. The overall incidence of metastatic disease at this sublevel in the context of an N0 neck from any site is 2.0% (18 of 903). The incidence of occult metastatic disease in sublevel IIb for oral cavity, oropharyngeal, and laryngeal cancer is 3.9% (11 of 279), 5.2% (5 of 96), and 0.4% (1 of 230) patients, respectively. Contralateral positive nodes (0.9%) and isolated metastases (0.3%) at this sublevel were rare. Nodal metastases are uncommon in the SMR even in the presence of positive nodes in adjacent sublevel IIa. There appears to be no advantage in performing contralateral SMR dissection in N0 necks and in laryngeal primaries.

Dissection of level IIb in squamous cell cancer of the upper aerodigestive tract: prospective study and systematic review of the literature

Objectives. Selective neck dissection is commonly used to clear occult metastases in the N0 neck. The aim of this study is to identify the incidence of micrometastases in level IIb nodes in patients with upper aerodigestive tract squamous cell carcinoma with clinically and radiologically staged N0 necks and to perform a systematic review of the literature on the incidence of metastases in this setting.Methods. Thirty‐eight patients were selected and 50 neck dissection (ND) specimens were examined prospectively. Tissue dissected from level IIb was sent separately for histo‐pathological analysis. All the relevant literature in the English language was systematically reviewed.Results. On average, 2.9 ± 0.4 nodes (range 0–10) were harvested. One patient had a metastatic node in level IIb with extracapsular spread in the ipsilateral neck. No other positive nodes were detected. There was an incidental finding of a deposit of papillary thyroid carcinoma. Sixteen of the 50 NDs showed micrometastases at other levels, predominantly in level IIa (75%). The systematic review identified 11 papers with 704 patients suitable for inclusion. The overall incidence of metastatic disease at level IIb in the context of an N0 neck from any site is 2.3% (16/704). 3.5% (11/312) of oral cavity cancer metastasise to level IIb and none of the 244 patients with laryngeal cancer had level IIb metastatic nodes.Conclusions. Nodal metastasis is rare in the level IIb even in the presence of positive nodes in adjacent level IIa. There appears to be no advantage in performing contralateral level IIb dissection in N0 necks.