Positive Lymph Node Ratio Research Articles

What Factors Are Associated With Regional Recurrence After Operative Treatment of Oral Squamous Cell Carcinoma?

A considerable proportion of oral squamous cell carcinoma (OSCC) recurrences involve the neck, which has a substantial impact on prognosis and is poorly understood.The purpose of this study was to analyze clinical and pathologic characteristics of regional recurrence of OSCC and identify possible risk factors. A single-center retrospective cohort study was designed to address the study purpose. All patients who were treated surgically for primary OSCC with or without adjuvant therapy between 2010 and 2015 were considered for inclusion with respect to predefined criteria, and demographic, clinical, and pathologic variables were collected. The lymph node status after primary OSCC treatment (pN) was defined as the predictor variable, and the occurrence of regional recurrence served as the primary outcome variable. Further variables of special interest were the histologic differentiation (G status) of the primary OSCC and the values of the lymph node ratio and log odds of positive lymph nodes. Descriptive, inferential, and appropriate time-dependent (Kaplan-Meier analysis, Cox regression model) statistics were computed. The level of statistical significance was set at P≤.05. The study sample was composed of 171 patients (70 women and 101 men; average age, 62.4years). Neck failure occurred in 18 patients (11%) either in combination with local recurrence (15patients) or in isolation (3 patients).Poor histologic differentiation of the primary tumor was identified as an independent risk factor for regional recurrence. Most neck recurrences manifested in previously unaddressed levels (IV and V). Regional recurrence of OSCC might be associated with specific clinicopathologic parameters of the primary tumor. The importance of these parameters for OSCC prognosis assessment and recurrence prediction should be elucidated in further studies.

The prognostic relevance of lymph node ratio in patients with oral squamous cell carcinoma treated with neoadjuvant therapy regimen and radical surgery

BackgroundThis study aims at investigating the prognostic significance of lymph node ratio (LNR) in a cohort of patients with oral squamous cell carcinomas (OSCC), treated with neoadjuvant radiochemotherapy followed by radical surgery. MethodsThe study included 171 treatment-naive patients with biopsy-proven primary OSCC, being reviewed retrospectively. All patients received a concomitant neoadjuvant radiochemotherapy (RCT) followed by radical surgery of the primary tumor and neck dissection based on the pretreatment staging results. The Kaplan–Meier survival analysis method was used to estimate the events of interest for overall survival (OS). Prognostic factors were identified through univariate and multivariate analysis. ResultsThe 5-year overall survival rate for all patients was 48 %. In univariate analysis, patient's age and data compiled from the histopathological examination as margin status, extracapsular spread, ypT, ypN, ypUICC, number of positive lymph nodes and lymph node ratio (LNR) had a statistically significant impact on overall survival. Multivariate analysis revealed an independent significant impact of patient age, ypT, margin status and LNR on OS. ypN showed no statistical significant impact on OS. ConclusionOur results show that LNR is an important predictor for OS in patients with OSCC that were treated with neoadjuvant radiochemotherapy and radical surgery.

Lymph node ratio has prognostic value related to the number of positive lymph nodes in patients with vulvar cancer.

We investigated the value of the number of positive lymph nodes (PLNs) and lymph node ratio (LNR) on survival of vulvar cancer patients. A total of 2332patients with vulvar squamous cell carcinoma were included from the SEER program. In multivariate analysis, the number of PLNs and LNR were independent prognostic indictors of survival outcomes, a higher number of PLNs and a higher LNR had poorer survival outcomes. An LNR >0.2 was associated with poor survival outcomes according to the number of PLNs. The LNR has prognostic value related to the number of PLNs and may allow a more accurate determination of the lymph node status of vulvar cancer patients.

Topoisomerase II alpha and microtubule-associated protein-tau as a predictive marker in axillary lymph node positive breast cancer.

The aims of this study were to investigate the correlation between topoisomerase II alpha (TOP2A), microtubule-associated protein-tau (MAP-tau) and other prognostic factors in breast cancer and to evaluate the predictive value of TOP2A and MAP-tau in breast cancer patients who received anthracycline and taxane-containing adjuvant chemotherapy. Seventy patients with axillary lymph node positive breast cancer who underwent curative surgery between January 2000 and December 2005 were evaluated retrospectively. The levels of protein expression of TOP2A and MAP-tau were assessed using immunohistochemistry. Among the 70 patients, 43 (61.4%) showed TOP2A overexpression and 30 (42.9%) showed MAP-tau positivity. TOP2A overexpression was associated with p53 positivity and high histological grade. MAP-tau positivity was associated with a lower positive lymph node ratio, lower proliferative activity, and hormone receptor positivity. Based on the TOP2A and MAP-tau expression, there was no significant difference in disease-free survival in the breast cancer patients who received anthracycline and taxane-containing adjuvant chemotherapy. We conclude that immunohistochemical analysis of TOP2A and MAP-tau protein expression may not predict the benefits of adjuvant anthracycline and taxane chemotherapy in axillary node positive breast cancer.

Application value of the different lymph node staging system predicting prognosis of advanced gallbladder carcinoma

Application value of the different lymph node staging system predicting prognosis of advanced gallbladder carcinoma

Barbed suture for pancreatic anastomosis during pancreaticoduodenectomy decreases incidence of clinically significant pancreatic fistula

Background: Pancreatic leak after pancreaticoduodonectomy maints to be a high cause of morbidity during pancreaticoduodenectomy, regardless of the technique. Barbed suture is being utilized in many clinical applications due to ease of use and potential higher burst strength during gastrointestinal anastomsis. To date, no studies have looked at the impace of utilizing barbed suture in pancreatic reconstruction during pancreaticoduodenecotmy. Methods: A retrospective analysis of a prospective database was reviewd off all pancreaticoduenectomy cases performed by a single surgeon from 2015–2017 at a tertiary care regional medical center. Pancreatic anastomosis was performed as a pancreaticojejunostomy in an end to side fashion, An outer layer of mattress vicryl suture was utilized first followed by inner running layer of barbed suture. No stent was utlized during anastomosis. Drain amylase was checked on POD 1 and 3. Fistula rates were recorded in accordance with the International Society of Grading of Pancreatic Fistutla descriptions. Results: A total of 32 consecutive pancreaticoduodenectomies were performed by a single surgeon. There was no difference in age, operative indication, pancreatic texture, and duct diameter between patients. 16 patients had elevated amylase levels (50%) Of these, 15/32 Grade A (46%), 1/32 Grade B (3%), 0/32 Grade C (0%). One patient required percutaneous drain placement on post operative day 14 which resolved leak. No patients required operative intervention for pancreatic fistula. Mean time to drain removal was 7 days. There were no deaths related to pancreatic fistula during the study period. Conclusion: Barbed suture utilization is a reliable and safe method of pancreaticojejunostomy creation during pancreaticoduodenectomy. This technique has a low incidence of clincally relevent pancreatic fistula and is easily producibleFigure 1Demographics, perioperative data, and complication data for minimally invasive pancreatectomyPDLPTotalDemographic dataTotal number of patients4357100 Male, No. (%)20 (46.5%)35 (61.4%)55 (55%) Female, No. (%)23 (53.5%)22 (38.6%)45 (45%)Age in years, median (range)67 (38–87)66 (40–74)66 (28–87)ASA score, No. (%) ASA II7 (16.3%)8 (17.0%)15 (15%) ASA III28 (65.1%)33 (70.2%)61 (61%) ASA IV5 (11.6%)6 (12.8%)11 (11%)BMI, median (range)26.6 (19.0–39.1)26.5 (16.8–68.6)26.5 (16.8–68.6)Perioperative data Case initiated robotically, No. (%)43 (100%)25 (43.9%)68 (68%) Convened to open9 (20.9%)6 (10.5%)15 (15%) Operative time, median (range)429.5 (290–571)206(131–375)295 (131–571) EBL in mL, median (range)500 (50–5000)200 (25–2000)325 (25–5000) Length of stay in days, median (range)8 (5–63)6 (3–20)6 (3–63) 90-day readmission, No. (%)15 (34.9%)12 (21.05%)27 (27%) 30-day mortality, No. (%)0 (0.0%)0 (0%)0 (0%) 90-day mortality, No. (%)1 (2.3%)2 (3.5%)3 (3%) Pancreatic fistula (Grade B/C)4 (9.3%)6 (10.5%)10 (10%)Oncological Factors Tumor size in mm, mean (range)28.7 (5–100)42.8 (4.2–80)36.7 (4.2–100) R0 resection, No. (%)31 (72.1%)40 (70.2%)71 (71%) R1 resection, No. (%)12 (27.9%)15 (26.3%)27 (27%) Lymph nodes harvested with specimen, mean (range)18.9 (5–39)11.2 (1–24)14.5 (1–39) Cases with positive lymph nodes, No. (%)30 (69.8%)26 (49.1%)56 (56%) Number of nodes positive, mean (range)3 (0–16)0.8 (0.0–4.0)1.7 (0–16) Positive lymph node ratio, mean (range)0.19 (0–0.76)0.09 (0–0.67)0.13 (0–0.76)Abbreviations: PD, pancreaticoduodenectomy; LP, left pancreatectomy; BMI, body mass index; EBL, estimated blood loss. Open table in a new tab . Abbreviations: PD, pancreaticoduodenectomy; LP, left pancreatectomy; BMI, body mass index; EBL, estimated blood loss.

Adjuvant radiotherapy for positive lymph nodes of oesophageal squamous cell carcinoma: Can it earn promising benefits at long-term follow-up?

PurposeThe value of adjuvant radiotherapy for patients with positive lymph nodes after curative resection of oesophageal squamous cell carcinoma is controversial. This study aims to investigate its long-term benefits in a specific cohort. Patients and MethodsThe charts between 1990 and 2003 from patients with positive lymph nodes were retrospectively reviewed. Those subjects were divided into adjuvant radiotherapy and surgery alone groups, with two subgroups defined by radiation dose (cutoff value: 50Gy). Overall survival, disease-free survival and locoregional recurrence-free survival were compared between two groups, with predictive factors of overall survival analysed meanwhile. ResultsIn sum, 175 matched patients with 1:2 ratios for group balance were enrolled for final analysis. During the follow-up (median: 37.0 months), 143 (81.7%) deaths were recorded, with 70.6% of deaths from cancer progression. The median overall survival time (19.5, 4 to 172 months) was not significantly different between the two groups (18.9 vs. 20.0 months, P=0.179). However, the disease-free survival time was significantly shorter in the adjuvant radiotherapy group than that in the control group (median, 11.5 vs. 14.9 months; P=0.001), with the locoregional recurrence-free survival time impressively prolonged (median: 18.3 vs. 16.5 months; P=0.022). Age (P=0.030), number (P=0.005) and ratio (P=0.002) of positive lymph nodes were associated with overall survival, but radiation dose was not (P=0.204). ConclusionAdjuvant radiotherapy with low- or high-dose did not improve survival compared with surgery alone. However, radiotherapy was effective to control locoregional recurrence, and could be applied as salvage therapy when recurrence event occurred.

Prognostic factors of axillary lymph node-positive patients in clinical stage II and III breast cancer after neoadjuvant chemotherapy

Background: Surgery following neoadjuvant chemotherapy (NAC) is increasingly utilized for breast cancer treatment with respect to downstage and recurrent risk reduction. However, there are some uncertainties about the solutions of adjuvant radiotherapy (design of RT field and indication in low-risk patients) in patients after NAC, especially in clinically node-positive patients. The objective of this study is to identify the risk factors of loco-regional recurrence (LRR), relapse and overall survival (OS) regarding tumor response post-NAC in this institution. Methods: From 2007 to 2015, 90 patients with newly diagnosed clinical stage II (n=44) or III (n=46) breast cancer and pathological positive lymph nodes who received chemotherapy followed by breast conserving surgery or mastectomy, adjuvant radiotherapy, and some with adjuvant systemic therapy were identified. All of them received anthracycline-based or taxane-based chemotherapy, external beam radiotherapy and systemic treatment including target or hormone therapy if indicated. Methods: The patient characteristics included clinical T/N stage, pathologic T/N stage, response after NAC, tumor grade, surgical margin, the presence or absence of lymphovascular invasion and extracapsular extension, the total number of lymph nodes dissection, the positive lymph nodes ratio (pLNR), tumor biomarker status [estrogen receptor (ER)/progesterone receptor (PR)/human epidermal growth factor receptor 2 (HER-2)], and adjuvant chemotherapy/target therapy or not. Univariate and multivariate analyses for risks of loco-regional recurrence (LRR), relapse (any local, regional or distant recurrence), and overall survival (OS) and the survival curves of LRR and relapse were performed. Results: After a median follow-up duration of 62 months (7–125 months), the multivariate analysis for risks of LRR showed that the status of clinical lymph nodes (cN2: HR =6.07, P=0.046; cN3: HR =30.22, P=0.001), response subgroups (stable disease: HR =3.01, P=0.047; progressive disease: HR =10.76, P<0.001), and pLNR (67–100%: HR =4.32, P=0.025) have statistical significance. The multivariate analysis for risks of relapse also showed that the status of clinical lymph nodes (cN1 micro/N1: HR =3.97, P=0.037; cN2: HR =4.06, P=0.053; cN3: HR =10.39, P=0.005), response subgroups (progressive disease: HR =3.73, P=0.008) and pLNR (67–100%: HR =3.02, P=0.032) have statistical significance. The multivariate analysis of OS only showed the tumor biomarker status of triple-negative breast cancer (TNBC) (HR =3.04, P=0.048) has statistical significance. Conclusions: In this study, we recorded poor therapeutic response, advanced clinically positive lymph nodes, and higher proportional positivity of dissected lymph nodes showing poor outcome regarding the loco-regional control and relapse-free survival among patients with positive axillary lymph nodes after NAC.

A Refined Staging Model for Resectable Pancreatic Ductal Adenocarcinoma Incorporating Examined Lymph Nodes, Location of Tumor and Positive Lymph Nodes Ratio.

Background: Nodal status and tumor site are prognostic factors for resectable pancreatic ductal adenocarcinoma (PDAC). Parameters for nodal status are diverse, and the number of examined lymph nodes (eNs) needed for good prognosis are uncertain. We try to modify staging system of resectable PDAC with parameters mentioned above by recursive partitioning analysis.Methods: Patients from the Surveillance, Epidemiology, and End Results (SEER) database were divided into training cohort and internal validation cohort, randomly. PDAC patients from Sun Yat-sen University Cancer Center were regarded as external validation cohort. The training cohort was used to refine staging model by recursive partitioning analysis, while the internal validation cohort and the external validation cohort were applied to assess discriminatory capacity of staging model. For parameters included in the modified model, their effects were studied.Results: The number of eNs, tumor site and tumor size were risk factors for positive nodal status. Lymph nodes ratio (LNR), tumor site, eNs and T stages of 8th the American Joint Committee on Cancer (AJCC) were selected to develop a refined model, dividing patients into 5 groups of different outcomes, preceding 8th AJCC classification. Besides, we found that (1) for small PDAC (diameter < 1cm), lymph node metastasis was rarely found; (2) enough eNs were needed to ensure better prognosis of node-negative patients; (3) tumors in the head of pancreas were prone to lymph nodes metastasis; (4) for node-positive patients, LNR was a better nodal parameter compared to positive lymph nodes (pNs).Conclusion: Our improved staging system helps to illuminate the interactions among tumor site, size and eNs.

Impact of number of positive lymph nodes and lymph node ratio on survival of women with node-positive breast cancer

Impact of number of positive lymph nodes and lymph node ratio on survival of women with node-positive breast cancer

P3.17-001 The Prognostic Analysis of Postoperative Radiotherapy for Esophageal Squamous Cell Carcinoma with Different Status of Lymph Node Metastasis

Lymph node metastasis is a significant prognostic factor in patients with resected esophageal cancer. Although the role of postoperative radiotherapy has not been confirmed, a large number of studies have shown that postoperative radiotherapy can improve the local control and survival, especially for stage III and lymph node positive patients. This study retrospectively analyzed the prognostic factors of postoperative radiotherapy for locally advanced esophageal squamous cell carcinoma (ESCC), and evaluated the prognostic value of different status of lymph node metastasis. Data from 121 patients with locally advanced ESCC who underwent radical resection and received postoperative radiotherapy from 2006 to 2013 were reviewed retrospectively. OS and DFS were estimated using Kaplan-Meier. Univariate analysis and multivariate analysis were performed to investigate prognostic factors by the Log-rank test and the Cox regression model. The effects of different status of lymph node metastasis on OS and recurrence patterns were compared. The median DFS of all patients was 22.57 months, and median OS was 32.90 months. Multivariate analysis showed that Karnofsky Performance Status, length of tumor and positive lymph nodes ratio (LNR) were independent prognostic factors of DFS and OS. For patients with lymph nodes metastasis, LNR has better prognostic value for OS (AUC=0.673, P =0.04) compared with the number of positive lymph nodes (AUC=0.584 P=0.31). The median OS of patients with LNR≤ 15% and LNR>15% were 33.43 and 19.20 months, P =0.04. Patients without lymph node skip metastasis (NSM) had better OS than that with NSM, but the difference was not statistically significant. Among the patients with both LNR>15% and NSM, OS was significantly worse than other lymph node positive patients, with median OS of 14.33 vs. 32.50 months, P=0.02. The analysis of the treatment failure patterns showed that more distant metastases were observed in patients with LNR>15%, while more local and regional recurrences were observed with LNR≤15%. The status of lymph node metastasis was related to the prognosis of postoperative radiotherapy for locally advanced ESCC. LNR has better prognostic value for OS, treatment failure patterns varied in different LNR. The patients with both high LNR and NSM have significantly poorer prognosis.

Prognostic value of three different staging schemes based on pN, MLR and LODDS in patients with T3 esophageal cancer

Objective: To evaluate the prognostic value of three different staging schemes based on positive lymph nodes (pN), metastatic lymph nodes ratio (MLR) and log odds of positive lymph nodes (LODDS) in patients with T3 esophageal cancer. Methods: From 2007 to 2014, clinicopathological characteristics of 905 patients who were pathologically diagnosed as T3 esophageal cancer and underwent radical esophagectomy in Zhejiang Cancer Hospital were retrospectively analyzed. Kaplan-Meier curves and Multivariate Cox proportional hazards models were used to evaluate the independent prognostic factors. The values of three lymph node staging schemes for predicting 5-year survival were analyzed by using receiver operating characteristic (ROC) curves. Results: The 1-, 3- and 5-year overall survival rates of patients with T3 esophageal cancer were 80.9%, 50.0% and 38.4%, respectively. Multivariate analysis showed that MLR stage, LODDS stage and differentiation were independent prognostic survival factors (P<0.05 for all). ROC curves showed that the area under the curve of pN stage, MLR stage, LODDS stage was 0.607, 0.613 and 0.618, respectively. However, the differences were not statistically significant (P>0.05). Conclusions: LODDS is an independent prognostic factor for patients with T3 esophageal cancer. The value of LODDS staging system may be superior to pN staging system for evaluating the prognosis of these patients.

Lymph Node Metastasis in the Prognosis of Gastroenteropancreatic Neuroendocrine Tumors.

This study aimed to determine the prognostic use of the extent of lymph node (LN) involvement in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) by analyzing population-based data. Patients in the Surveillance, Epidemiology, and End Results registry were identified with histologically confirmed, surgically resected GEP-NETs. We divided patients into 3 lymph node ratio (LNR) groups based on the ratio of positive LNs to total LNs examined: 0.2 or less, greater than 0.2 to 0.5, and greater than 0.5. Disease-specific survival was compared according to LNR group. We identified 3133 patients with surgically resected GEP-NETs. Primary sites included the stomach (11% of the total), pancreas (30%), colon (32%), appendix (20%), and rectum (7%). Survival was worse in patients with LNRs of 0.2 or less (hazard ratio [HR], 1.5; 95% confidence interval [CI], 1.2-2.0), greater than 0.2 to 0.5 (HR, 2.0; 95% CI, 1.6-2.5), and greater than 0.5 (HR, 3.1; 95% CI, 2.5-3.9) compared with N0 patients. Ten-year disease-specific survival decreased as LNR increased from N0 (81%) to 0.2 or less (69%), greater than 0.2 to 0.5 (55%), and greater than 0.5 (50%). Results were consistent for patients with both low- and high-grade tumors from most primary sites. Degree of LN involvement is a prognostic factor at the most common GEP-NET sites. Higher LNR is associated with decreased survival.

Prognostic performance of three lymph node staging schemes for patients with Siewert type II adenocarcinoma of esophagogastric junction

The prognostic performance of different lymph node staging schemes for adenocarcinoma of esophagogastric junction (AEG) remains controversial. The objective of the present study was to compare the prognostic efficacy of the number of lymph node metastases (LNMs), the positive lymph node ratio (LNR) and the log odds of positive lymph nodes (LODDS). Patients diagnosed with Siewert type II AEG were included from the Surveillance, Epidemiology, and End Results database. Harrell’s C-index statistic, Schemper’s proportion of explained variation (PEV), the Akaike information criterion (AIC) and restricted cubic spine analyses were adopted to assess the predictive accuracy of LNM, LNR and LODDS. A total of 1302 patients with post-surgery Siewert type II AEG were included. LNM, LNR and LODDS all showed significant prognostic value in the multivariate Cox regression analyses. LODDS performed higher predictive accuracy than LNM and LNR, with relatively higher C-index, higher Schemper’s PEV value and lower AIC value. For patients with no nodes involved, LODDS still performed significantly discriminatory utility. LODDS showed more accurate prognostic performance than LNM and LNR for post-surgery Siewert type II AEG, and it could help to detect survival heterogeneity for patients with no positive lymph nodes involved.

Prospective Evaluation of Associations between Cancer-Related Pain and Perineural Invasion in Patients with Resectable Pancreatic Adenocarcinoma

IntroductionPerineural invasion is a unique characteristic of pancreatic adenocarcinoma biology and is present in the majority of resected pathologic specimens. The purpose of this study was to understand the relationships between preoperative pain and perineural invasion in patients with pancreatic adenocarcinoma. MethodsFifty-two chemotherapy naive patients undergoing resection for pancreatic adenocarcinoma from 2012 to 2014 completed a previously validated Brief Pain Inventory survey for preoperative clinical pain scoring. Preoperative pain was correlated with multiple clinicopathologic features. ResultsPreoperative pain was not associated with pathologic cancer stage, lymph node status, lymph node positivity ratio, resection margin status, or tumor location within the pancreas. In the subgroup of pancreatic head cancers, pain interference with affect was associated with the absence of perineural invasion (p = 0.02). Patients with stage I cancer had higher pain interference scores than those with stage II cancer (p = 0.02). ConclusionsPreoperative pain does not predict the presence of perineural invasion or other pathologic prognostic factors in patients with resectable pancreatic adenocarcinoma. Higher pain scores in pancreatic head cancers correlated with absence of perineural invasion and early cancer stage. The effects of preoperative pain on quality and interference of daily life deserve further investigation in larger prospective studies involving patients with pancreatic cancer.

Pathologic lymph node ratio is a predictor of esophageal carcinoma patient survival: a literature-based pooled analysis.

The positive lymph node ratio (LNR) has been suggested as a predictor of survival in patients with esophageal carcinoma (EC). However, existed evidences did not completely agree with each other. We sought to examine whether LNR was associated with overall survival (OS). Electronic database was searched for eligible literatures. The primary outcome was the relationship between LNR and OS, which was presented as hazard ratio (HR) with 95% confidence intervals (CIs). All statistical analyses were performed using STATA 11.0 software. A total of 18 relevant studies which involved 7,664 cases were included. Patients with an LNR of 0.3 or greater had an increased risk of death compared to those with an LNR of less than 0.3(HR = 2.33; 95% CI 2.03-2.68; P<0.01). Similarly, patients with an LNR greater than 0.5 was also associated with a decreased OS(HR = 1.95; 95% CI 1.52-2.50; P<0.01). No publication bias was found. This meta-analysis confirmed that LNR was a significant predictor of survival in patients with EC and should be considered in prognostication.

The importance of log odds of positive lymph nodes for locoregional recurrence in oral squamous cell carcinoma

ObjectivesLog odds of positive lymph nodes (LODDS) has been demonstrated as a very promising staging model for multiple cancer sites, as it avoids singularity and predicts prognosis significantly better than conventional nodal staging and lymph node ratio. However, published studies on the influence of LODDS for patients with OSCC are very seldom. Material and methodsRetrospective chart review of 499 patients with treatment-naive oral squamous cell carcinoma. Exclusion criteria were neoadjuvant chemoradiotherapy, T4b classification, perioperative death, unresectable disease, synchronous malignancy, follow-up < 3 months and inadequate information to correctly determine nodal yield. Statistical analysis was performed using univariate and multivariate analysis. ResultsA significant correlation was found between locoregional recurrence and pathologic T classification (p=0.030), pathologic N classification p=0.013), extracapsular spread (p=0.034), grading (p=0.021), number of positive lymph nodes (p=0.042), lymph node ratio (p=0.009), LODDS (p=0.007) and treatment strategy (p=0.039). Multivariate analysis indicated lymph node ratio (p=0.029) and LODDS (p=0.015) as independent indicators for locoregional recurrence. Within the analyzed models, Nagelkerke R2 index and Someŕs D showed the strongest discrimination ability for LODDS. ConclusionFor patients with oral squamous cell carcinoma, log odds of positive lymph nodes and lymph node ratio are independent indicators for locoregional recurrence. LODDS predicts locoregional recurrence better than conventional nodal staging system, lymph node ratio and the number of positive lymph nodes.

Comparative Quantitative Lymph Node Assessment in Localized Esophageal Cancer Patients After R0 Resection With and Without Neoadjuvant Chemoradiation Therapy

IntroductionThe effects of neoadjuvant chemoradiation therapy on lymph node retrieval during esophagectomy for patients with esophageal cancer are unclear. The aim of this study was to quantify lymph node retrieval after R0 esophagectomy and to assess its impact on overall survival in induction therapy patients. MethodsOne hundred seventy-four consecutive patients underwent esophagectomy with or without induction therapy from 2008 to 2015 for esophageal cancer. Total lymph nodes, positive lymph nodes, and lymph node ratios were compared between two groups of patients: those treated with either upfront surgery or those treated with neoadjuvant chemoradiation therapy followed by surgery. Comparisons were made using Student’s t test. Overall survival was obtained and compared using Kaplan Meier survival curves. ResultsTotal lymph node counts were less in the induction therapy group (p = 0.027), while positive lymph node counts and lymph node ratios did not differ between groups (p = 0.262 and p = 0.310, respectively). In the neoadjuvant chemoradiation followed by surgery group, overall survival was significantly shorter for patients who had any positive lymph nodes in the pathologic specimen (p = 0.0065). ConclusionsTotal lymph node counts were significantly lower in the induction therapy group, while positive lymph node counts and lymph node ratios did not differ from the upfront surgery group. Although overall survival was not different between groups, it was decreased within the induction therapy cohort among those who had any positive lymph nodes retrieved at surgery. This study confirms that unstratified gross lymph node counts do not substantially relate to prognosis in the heterogeneous population of locally advanced esophageal cancer patients who may or may not have had neoadjuvant chemoradiation.

The value of N staging with the positive lymph node ratio, and splenectomy, for remnant gastric cancer: A multicenter retrospective study.

Surgery for remnant gastric cancer (RGC) frequently fails to obtain the >15 lymph nodes necessary for tumor-node-metastasis (TNM) staging. We aimed to evaluate the utility of the recently developed tumor-ratio-metastasis (TRM) staging system. We also examined the pattern of lymph node metastasis and the role of prophylactic splenectomy in RGC. Between May 2003 and December 2012, data from 170 patients who underwent surgery for RGC were retrospectively analyzed. RGC arising after previous benign disease (n = 46) was associated with retrieval of more lymph nodes (27.3 vs 10.0; P < 0.001), and a lower rate of retrieving ≤15 lymph nodes (15.6% vs 77.4%, P < 0.001), than after previous malignant disease (n = 122). The 5 year survival rate according to TNM staging was 75% in stage I, 77.1% in stage II, and 23.5% in stage III, whereas by TRM staging it was 75%, 81.6%, and 23.2%, respectively. Overall survival was not different between the splenectomy and non-splenectomy groups at each stage (P = 0.751, 0.723, 0.151, and 0.706 for stage I, II, III, and IV, respectively). The analyses did not identify a survival benefit from prophylactic splenectomy or show an improvement in staging with the TRM system for RGC.

Prognostic impact of the number of positive lymph nodes and lymph node ratio on the outcome of patients after resection of pancreatic adenocarcinoma

Prognostic impact of the number of positive lymph nodes and lymph node ratio on the outcome of patients after resection of pancreatic adenocarcinoma