Regional Node Involvement Research Articles

Diagnostic Accuracy of Computed Tomography and Clinical Examination in the Assessment of Mandibular Invasion of Oral Squamous Cell Carcinomas

Introduction: Computed tomography (CT) scan precisely shows soft and hard tissues in the same test hereby determines the lesion extension, involvement of regional node as well as of bone. Current study was aimed to evaluate the efficacy of clinical examination and CT to assess mandibular invasion in oral squamous cell carcinoma. Materials and methods: This cross-sectional study was conducted at Dhaka Dental College Hospital from July, 2016 to July, 2017 among conveniently selected 35 patients of histologically confirmed squamous cell carcinoma which was close to the mandible. The patients underwent proper clinical examination. CT scan was performed; preoperative staging and treatment plan was formulated according to the status of bone invasion. After mandibulectomy, the resected specimens were sent for histopathology. The findings from clinical examination and CT were then correlated with the gold standard, postoperative histopathology. Results: Clinical examination accurately detected 22 cases to have bone invasion and 8 cases with no bone invasion. It also gave 2 false positive and 3 false negative results. On the other hand CT accurately detected 24 cases to have bone invasion and 9 cases with no bone invasion. It provided one false positive and one false negative result. However, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of clinical examination were 88%, 80%, 91.67%, 72.73%, 85.71% respectively (p = 0.0002) and of CT were 96%, 90%, 96%, 90%, 94.28% respectively (p < 0.0001). Clinical examination and CT were found sensitive enough and have an acceptable range of specificity as primary investigative modalities. CT scan outperforms clinical examination in terms of sensitivity, specificity, NPV, and accuracy. Conclusion: CT scan imaging is the method of choice for planning treatment in advanced oral squamous cell carcinoma. This study reveals how a CT scan can provide additional diagnostic value to detect bone invasion. Update Dent. Coll. j: 2024; 14(2): 21-26

BRAF and NRAS Mutations and the Association with Prognosis of Acral Lentiginous and Nodular Melanomas in Indonesia.

Melanomas are rare yet the most aggressive skin cancer among Asians. Clinical presentation, risk factors, and the underlying molecular mechanisms are strikingly different from cutaneous melanoma in Caucasians. Mutation patterns of BRAF and NRAS genes were examined from DNAs derived from primary melanoma tumor tissues (fresh tissues or formalin-fixed paraffin-embedded samples) using pyrosequencing. A total of 63 patients consisting of acral lentiginous melanoma (N=22, 34.9%) and nodular melanoma (N=41, 65.1%) were included in this study. Most patients were diagnosed at Stage III-IV (N=49, 77.8%), Breslow thickness more than 4 mm (N=51, 80.9%), presence of ulceration (N=35, 55.6%), diameter larger than 6 mm (N=61, 96.8%), regional node infiltration (N=41, 77.8%). BRAF and NRAS mutations were found in 28 (44.4%) and 8 (12.7%), respectively. BRAF and NRAS mutations were significantly associated with older melanoma patients (OR = 6.075, 95%CI = 2.013-18.333 dan OR = 13.263, 95%CI = 1.518-115.901, respectively). BRAF mutations were associated with lower overall survival (Median survivals were 16.5 vs 31.4 months, Log-rank test P=0.001). NRAS mutations were not significantly associated with lower overall survival. In this study, melanoma patients are largely diagnosed at the late stages with ulceration and involvement of regional lymph nodes. BRAF mutations are associated with lower survival of cutaneous melanoma patients.

The Other Site of Rhabdomyosarcoma.

Rhabdomyosarcoma (RMS) is a rare malignant soft tissue sarcoma (STS), accounting for almost 50% of pediatric STSs. Due to its heterogeneity, RMS presents challenges in diagnosis and treatment, with prognosis varying depending on multiple factors. Tumors localized in the other site (OTH)-including the paraspinal, perianal, thoracic, abdominal, pelvic, and perineal regions-are generally classified as unfavorable. This study assesses the clinical features and prognoses of RMS in OTH locations depending on its site of origin. An explorative analysis of RMS cases from the SEER 17 database 2000-2020 was conducted. Patients of all ages with histologically confirmed RMS as primary malignant disease classified under OTH, were included. OTH was categorized in four granular site classifications. Overall survival (OS) and disease-specific survival (DSS) were analyzed using Kaplan-Meier estimators. Factors independently influencing survival, including a site classification model presented in this study, were identified through Cox regression analysis. Out of 4168 patients with RMS, 990 cases of RMS with the OTH site met the inclusion criteria. The median age was 16 years. The predominant histological subtypes were embryonal (33.0%) and alveolar (25.5%). Most tumors were ≥ 5 cm (median 9 cm) and located primarily in the pelvic region (41.5%). The 3-, 5-, and 10-year OS rates were 45.4% ± 3.332 (95% CI), 40.7 ± 3.332, and 38.6% ± 3.332, respectively, while DSS rates were 43.3% ± 3.136 (95% CI), 38.3% ± 3.136, and 35.1% ± 3.332. In the multivariate analysis age, histological type, site in a granular categorization, stage, regional lymph node examination, and regional lymph node involvement (pathologically proven) were independently associated with survival. Through both univariate and multivariate analyses, an OTH favorable group could be established. The OTH favorable group consists of the anal region, gallbladder and biliary tract, and breast. RMS in OTH shows significant differences in prognosis, putting the current categorization as unfavorable into question and making a more detailed classification necessary. Furthermore, pathological regional lymph node assessment is specifically in the OTH localization recommended.

Distant metastasis patterns among lung cancer subtypes and impact of primary tumor resection on survival in metastatic lung cancer using SEER database.

This research aimed to systematically uncover the metastatic characteristics and survival rates of lung cancer subtypes and to evaluate the impact of surgery at the primary tumor site on cancer-specific survival in DM lung cancer. We used the Surveillance, Epidemiology, and End Results (SEER) database (2010-2019) to identify primary lung cancers with DM at presentation (M1). Kaplan-Meier (KM) survival curves were generated and compared utilizing log-rank tests. Cox regression methods were employed to determine hazard ratios (HR) and 95% confidence intervals related to CSS factors. Inverse probability of treatment weighting (IPTW) was applied to reduce bias. We analyzed 77,827 M1 lung cancer cases, with 41.22% having DM at presentation. Bone metastasis was most common in ADC, ASC, SCC, LCC; brain in LCNEC; liver in SCLC. Lung was common in TC + AC and SCC. Long-term survival was best in TC + AC and worst in SCLC (p < 0.001). Male gender, age < 50, primary tumor site (main bronchus, lower lobe), large tumor diameter, ADC/SCLC/SCC pathology, and regional lymph node involvement were significant risk factors for multiorgan metastasis. Age ≥ 50, male, large tumor diameter, positive lymph nodes, and multiorgan metastases were associated with lower CSS. In contrast, radiotherapy, chemotherapy, systemic therapy, and surgery were associated with higher CSS rates. Primary tumor resection improved survival in lung cancer patients (excluding small cell lung cancer, SCLC) with single organ metastases (KM log rank p < 0.001, HR = 0.6165; 95% CI (0.5468-0.6951)), especially in brain (p < 0.001, HR = 0.6467; 95% CI (0.5505-0.7596)) and bone (p = 0.182, HR = 0.6289; p < 0.01), but not in liver or intrapulmonary metastases after IPTW. Significant differences in DM patterns and corresponding survival rates exist among lung cancer subtypes. Primary tumor resection improves survival in lung cancer patients (excluding small cell lung cancer, SCLC) with single organ metastases, with better outcomes in patients with brain and bone metastases, while no significant benefit was seen in patients with liver and intrapulmonary metastases.

Oral cavity squamous cell carcinoma complicated by internal jugular vein thrombosis

Head and neck squamous cell carcinoma (SCC) encompasses various cancers from the upper aerodigestive tract. Initial presentation often includes regional nodal involvement (40% in stage IVA or B) and distant metastases (up to 10%). Facial edema is a frequent clinical issue with multiple causes, such as allergic reactions, trauma, venous thrombosis, infections, and both benign and malignant conditions. An extremely rare condition is tumor thrombosis of the internal jugular vein (IJV), typically reported in differentiated thyroid cancer cases. We present a diagnosed case of SCC of the left lower alveolus in a 54-year-old female who presented with diffuse facial swelling and stridor two years post-diagnosis. Further evaluation through clinical examination and imaging studies revealed partial thrombosis of the right IJV. The patient underwent an emergency tracheostomy and was treated with intravenous heparin, which effectively managed the local symptoms. This case report highlights the clinical features, diagnostic methods, treatment modalities, and favorable prognosis associated with the long-term effects of untreated head and neck cancers.

Sentinel lymph node biopsy for early stage vulvar squamous cell carcinoma

Background Patients with regional lymph node involvement from squamous cell carcinoma (SCC) of the vulva have a 48% 5-year relative survival. Recently, sentinel lymph node (SLN) biopsy has become a viable alternative to inguinofemoral lymphadenectomy. We sought to identify risk factors for predicting a positive SLN in patients with vulvar SCC. Methods A retrospective review of 29 patients with vulvar SCC was performed from 2016 to 2021 at a tertiary care center. Clinicopathologic data were collected in addition to SLN status, including number of lymph nodes removed. Results The average depth of invasion was 7.9 mm, average tumor size was 1.8 cm, 3 of 23 patients had perineural invasion, and 4 of 23 patients had lymphovascular invasion. One patient who did not map on lymphoscintigraphy and five patients with recurrent vulvar SCC were excluded from final analysis. The average number of SLNs removed was two. One patient had a positive SLN: the depth of invasion was 17 mm, tumor size was 5.1 cm, and lymphovascular invasion was present. Conclusions Most patients with early stage vulvar SCC had a negative SLN biopsy. Further study is needed to determine the patient subset that could avoid SLN biopsy altogether.

Predictive models and biomarkers for survival in stage III breast cancer: a review of clinical applications and future directions

Stage III breast cancer, characterized by locally advanced tumors and potential regional lymph node involvement, presents a formidable challenge to both patients and healthcare professionals. Accurate prediction of survival outcomes is crucial for guiding treatment decisions and optimizing patient care. This publication explores the potential clinical utility of predictive tools, encompassing genetic markers, imaging techniques, and clinical parameters, to improve survival outcome predictions in stage III breast cancer. Multimodal approaches, integrating these tools, hold the promise of delivering more precise and personalized predictions. Despite the inherent challenges, such as data standardization and genetic heterogeneity, the future offers opportunities for refinement, driven by precision medicine, artificial intelligence, and global collaboration. The goal is to empower healthcare providers to make informed treatment decisions, ultimately leading to improved survival outcomes and a brighter horizon for individuals facing this challenging disease.

Evaluation and Comparison of the Dose Received by the Mandible, Maxilla, and Teeth in Two Methods of Three-dimensional Conformal Radiation Therapy and Helical Tomotherapy.

Using three-dimensional conformal radiation treatment (3D-CRT) and helical tomotherapy (HT), this study examines and contrasts the dosage received by the mandible, maxilla, and teeth. Sixteen patients with head-and-neck cancer (H and NC) were the subject of treatment planning at the Seyyed Al-Shohada Hospital in Isfahan, Iran. This study examined target coverage quality, exposure of healthy tissue, and radiation delivery effectiveness. In terms of a number of measures, including D2%, D50%, Dmean, V95%, conformity index (CI), and homogeneity index (HI) for the planning target volume (PTV) and D2%, D98%, Dmean, V95%, CI, and HI for the nodal PTV, HT showed considerable gains over 3D-CRT. The brainstem, D1cc, and D10cc received considerably lower maximum dosages in HT. Measurements of the right and left cochleas (Dmean, V55, and Dmax) revealed decreases in HT, with Dmean revealing the most significant variations. The Dmean and Dmax values for HT significantly decreased in constrictors as well. In terms of several HT-related indicators, the larynx, optic chiasm, optic nerves, oral cavity, mandible, thyroid, and parotid glands all showed considerable decreases. The findings of the comparison of the two treatment approaches revealed that the HT method was more than 50% more effective than the 3D-CRT method in sustaining organs at risk (OARs) and the target volume dose. In general, dosimetric coverage, homogeneity, conformity indices, and the absence of cold and hot patches showed that HT produced targets with greater accuracy than 3D-CRT. In addition, HT outperformed 3D-CRT in protecting important structures (OARs). HT as a result has the potential to be a more effective method of treatment for those with H and NC and involvement of regional lymph nodes.

Desmoplastic Melanoma

Desmoplastic melanoma is a rare fibrosing variant of melanoma. It typically affects elderly patients but can occasionally affect young or middle-aged individuals. Desmoplastic melanoma is relevant as a diagnostic pitfall for pure tumor variants' distinct histopathologic and clinical features. The latter includes a lower regional lymph node involvement frequency and a more favorable prognosis among thick melanomas. Classic cases of desmoplastic melanoma tend to carry a high mutation burden. Patients with metastases from those tumors tend to respond favorably to novel immunotherapies.

Exploring Pediatric Vertebral, Sacral, and Pelvic Osteosarcomas through the NCDB: Demographics, Treatment Utilization, and Survival Outcomes.

Retrieve data from the National Cancer Database (NCDB) to examine information on the epidemiological prevalence, treatment strategies, and survival outcomes of pediatric vertebral, sacral and pelvic osteosarcomas. We reviewed NCDB data from 2008 to 2018, concentrating on vertebral, sacral, and pelvic osteosarcomas in children 0 to 21 years. Our analysis involved logistic and Poisson regression, Kaplan-Meier survival estimates, and Cox proportional hazards models. The study population included 207 patients. For vertebral osteosarcomas, 62.5% of patients were female, and 78.1% were white. Regional lymph node involvement predicted 80 times higher mortality hazard (p = 0.021). Distant metastasis predicted 25 times higher mortality hazard (p = 0.027). For sacral and pelvic osteosarcomas, 58.3% of patients were male, and 72% were white. Patients with residual tumor were 4 times more likely to have prolonged LOS (p = 0.031). No residual tumor (HR = 0.53, p = 0.03) and radiotherapy receipt (HR = 0.46, p = 0.034) were associated with lower mortality hazards. Distant metastasis predicted 3 times higher mortality hazard (p < 0.001). Hispanic ethnicity was linked to lower resection odds (OR = 0.342, p = 0.043), possibly due to language barriers affecting patient understanding and care decisions. In conclusion, our examination of NCDB offers a thorough exploration of demographics, treatment patterns, and results, highlighting the importance of personalized approaches to enhance patient outcomes.

Current Role of PET CT in Staging and Management of Penile Cancers.

Penile cancer (PeCa) is a rare urological malignancy characterized by significant geographical variations in both incidence and mortality rates. Due to its rarity and the consequent lack of randomized trials, current management is based on retrospective studies and small prospective trials. In addition, both the diagnostic pathways and treatment strategies exhibit substantial heterogeneity, differing significantly between less-developed and well-developed countries. The prognosis of PeCas is determined by the presence and extent of regional lymph node (LN) involvement. Therefore, the early detection and treatment of LN metastasis is paramount to ensure better outcomes. In recent decades, overall survival of PeCas has increased, mainly due to advancements in imaging techniques and risk stratification. We aim to provide an overview of the current role of PET CT imaging in the management of patients with PeCa.

Endoscopic ultrasound with tissue acquisition of lymph nodes in patients with potentially resectable intrahepatic cholangiocarcinoma.

Background and study aims Lymph node (LN) involvement is a poor prognostic factor for patients with intrahepatic cholangiocarcinoma (iCCA). The aim of this study was to evaluate the yield and impact on clinical decision making of endoscopic ultrasound with tissue acquisition (EUS-TA) of LNs in patients with potentially resectable iCCA. Patients and methods In this multicenter cohort study, patients with potentially resectable iCCA and preoperative EUS between 2010 and 2020 were retrospectively included. The impact of EUS-TA was defined as the percentage of patients who did not undergo surgical exploration due to pathologically confirmed positive LNs found with EUS-TA. Results A total of 56 patients underwent EUS, with 91% of patients to target suspicious LNs on imaging. EUS-TA of LNs confirmed malignancy in 21 LNs among 19 patients (34%). In 17 patients (30%), surgical exploration was withheld due to nodal involvement. Finally, 24 patients (43%) underwent surgical exploration among whom positive regional LNs were identified in six patients (25%). Conclusions In patients with potentially resectable iCCA and suspicious LNs on cross-sectional imaging, EUS-TA confirmed LN involvement in 30% of patients. Surgical exploration was withheld mostly because of extraregional LN involvement and regional LN involvement in patients with high surgical risk.

Portal Venous Tumor Thrombosis and Visceral Organ Metastasis without Skeletal Involvement in mCRPC: Adverse Prognostic Indicators on Dual Tracer PET/CT and Clinical Outcome after 177Lu-PSMA-617 PRLT and Cabazitaxel Therapy

AbstractProstate cancer involving visceral organs are occurrences in the later disease course, usually following regional nodal and skeletal involvement, and are refractory to conventional treatment. A 61-year-old male patient presented with locally advanced disease at presentation, which progressed on androgen deprivation therapy and systemic therapy with involvement of the visceral organs (lungs and liver). Portal venous tumor thrombosis involving the right and main branch was also observed on contrast-enhanced computed tomography (CECT) and magnetic resonance imaging (MRI), which showed intense uptake on 68Ga-labeled prostate-specific membrane antigen positron emission tomography/computed tomography (68Ga-PSMA-11 PET/CT) and 18F-fluorodeoxyglucose PET/CT (18F-FDG-PET/CT). Post-177Lu-PSMA-617 radioligand therapy (PRLT) showed mixed response on tumor marker and imaging analysis with survival of 6 months after 177Lu-PSMA radioligand therapy. The high Gleason score, visceral organ metastasis, and increased metabolic activity on FDG were the adverse prognostic factors in the described patient.

Chondrosarcoma of the Mobile Spine in the Elderly: A National Cancer Database Study

BackgroundThe current research on geriatric patients with spinal chondrosarcoma is limited. This study aimed to investigate the demographics, patterns of care, and survival of geriatric patients with chondrosarcoma of the mobile spine. MethodsThe National Cancer Database was queried from 2008 to 2018 for geriatric patients (60-89 years) with chondrosarcoma of the mobile spine. The primary outcome of this study was overall survival (OS). The secondary outcome was treatment utilization patterns. Survival analyses were conducted using log-rank tests and Cox proportional hazards regressions. Logistic regression models were utilized to assess correlations between baseline variables and treatment utilization. ResultsThe database retrieved 122 patients. While 43.7% of the patients presented with tumors exceeding 5cm in size, the incidence of regional lymph node involvement or distant metastases was relatively low, affecting only 5% of the patients. Furthermore, 22.3% of the patients had tumors graded as 3-4. The five-year OS rate was 52.9% (95% confidence interval 42-66.6). The mortality risk was significantly associated with age, tumor grade and stage, and treatment plan. Most patients (79.5%) underwent surgery, while 35.9% and 4.2% were treated with radiotherapy and chemotherapy, respectively. Age, race, comorbidities, geographical region, tumor stage, and healthcare facility type significantly correlated with treatment utilization. ConclusionSurgical resection significantly lowered the mortality risk in geriatric patients with spinal chondrosarcomas. Demographic and geographical factors significantly dictated treatment plans. Further studies are required to assess the role of radiotherapy and chemotherapy in treating these patients in the modern era.

The role of endoscopic ultrasonography for diagnosis of residual rectal neuroendocrine tumor.

Endoscopic ultrasonography (EUS) is useful for assessing the depth and regional lymph node involvement in rectal neuroendocrine tumors (NETs). However, evidence regarding the effectiveness of EUS in identifying residual lesions in patients with incompletely resected NET is limited. We aimed to evaluate the efficacy of EUS in identifying residual rectal NETs and the clinical outcomes of salvage endoscopic treatment. We retrospectively reviewed the records of patients who were transferred to Chosun University Hospital and received salvage treatment for incompletely resected rectal NETs between January 2012 and October 2021. This study included 68 incompletely resected rectal NET, of which 59 were margin-positive and 9 were margin-indeterminate. EUS detection (odds ratio (OR), 8.44; 95% confidence interval (CI), 1.18-41.35) and visual detection (OR, 7.00; 95% CI, 1.50-47.48) were associated with residual lesion in patients with incompletely resected NET. EUS detection of residual lesions showed a sensitivity of 94%, specificity of 71%, positive predictive value of 88%, negative predictive value of 83%, and accuracy of 87%. All patients underwent salvage treatment with band-ligation endoscopic mucosal resection (58.8%) and endoscopic submucosal dissection (41.2%). Residual NETs were diagnosed in 47 of 68 patients (69.1%), and no recurrence was noted during the follow-up period of 51.8 ± 22.9months. EUS is a more sensitive method than visual detection for evaluating residual rectal NETs. Salvage endoscopic treatment for incompletely resected NETs is safe and effective.

Outcome of children and young adults with localized extremity rhabdomyosarcoma treated on Children's Oncology Group trials.

10006 Background: Extremity rhabdomyosarcoma (RMS) accounts for 15-20% of patients with localized RMS. The long-term survival and associated prognostic factors of extremity RMS patients treated on the contemporary Children’s Oncology Group (COG) trials have not been reported. Methods: Patients with localized extremity RMS enrolled on the D9602, D9803, ARST0331 and ARST0531 COG trials were analyzed. The Kaplan-Meyer method estimated event-free (EFS) and overall survival (OS). The Log-rank test and Cox regression were used to estimate the prognostic significance of age at diagnosis, sex, race, tumor site &amp; size, IRS group, stage, histology, FOXO1 fusion status, anaplasia, lymph node involvement, delayed primary excision (DPE) and radiation on survival. Results: We identified 159 patients with localized extremity RMS; 108 (68%) were &lt; 10 years at diagnosis, 84(53%) had primary tumor &gt; 5 cm, and 35 (22%) and 98 (62%) had IRS group II and III disease. Histology was alveolar in 106 (67%), and 43 (27%) had regional lymph node involvement on imaging or pathology. Seventeen were treated on low-risk (LR) studies D9602 (N = 10) and ARST0331 (N = 7), whereas 142 were treated on intermediate-risk (IR) trials D9803 (N = 85) and ARST0531 (N = 57). Eighty patients (50%) underwent primary surgical excision and 121 (76%) received radiotherapy. DPE was attempted in 60 patients (38%), resulting in an R0 (microscopically negative) margin in 48 (80%). Relapse/progression occurred in 52 patients: metastatic 26 (50%), local 22 (42%), and combined 3(6%). The 5-year EFS and OS of the whole cohort were 62.6% (95% CI: 54%-71.2%) and 78.7%% (95%CI: 71.4%-85.9%). LR patients treated on D9602 and ARST0331 trials had comparable 5-year EFS (70% vs. 71.4%, p-0.90) and OS (90% vs. 85.7%, p-0.54), respectively, while IR patients had significantly better 5-year EFS (68.9% vs. 51%, p-0.023) and OS (86.2% vs. 64.4%, p-0.007) on D9803 trial than ARST0531 trial. The 5-year EFS and OS of IRS group III patients with DPE with R0 margins were comparable to IRS group II patients (70.4% vs. 66.6%) &amp; (86.5% vs. 84.6%), respectively. On univariable analysis, age at diagnosis and sex were associated with EFS, while age at diagnosis, sex, tumor size, IRS group, stage and fusion status were associated with OS (p &lt; 0.05). None of the analyzed factors demonstrated independent statistical association with EFS, whereas female sex was the only factor independently associated with OS [Hazard ratio (HR): 0.4, 95% CI 0.20-0.85)]. Conclusions: IR localized extremity RMS patients treated on ARST0531 had suboptimal outcome. Survival of IRS group III patients with R0 DPE was comparable to IRS group II patients. Females with localized extremity RMS had better OS than males. Clinical trial information: NCT00354835 ; NCT00003958 ; NCT00075582 ; NCT00002995 .

Analysis of multiple factors influencing the survival of patients with advanced gastric cancer.

The aim of this study was to investigate the main factors influencing the survival of patients with advanced gastric cancer. The clinicopathological data of 120 patients with advanced gastric cancer were analyzed retrospectively, and clinical and pathological data were collected. Tumor tissue staging and grading were re-evaluated, and 5-year overall survival was followed up. The classified data were described by percentages, and the continuous data were described by standard deviations or medians. Univariate analysis was performed using the χ2 test or rank-sum test, followed by Kaplan-Meier survival analysis to calculate the median survival time and 5-year cumulative survival. A multivariate Cox regression model was used to evaluate the independent risk factors affecting survival. The test level was α = 0.05. Patients were followed up for 0 to 60 months, the 5-year overall survival rate was 36.2%, and the median survival time was 53.0 ± 1.461 months. K-M and log-rank test results revealed that tumor location, degree of differentiation, depth of invasion, regional lymph node involvement, and postoperative tumor stage were correlated with a decreased 5-year survival rate (P < 0.05). A multivariate Cox risk regression model was used to analyze the degree of histological differentiation (HR = 1.441; 95% CI = 1.049-1.979; P = 0.024), regional lymph node (HR = 1.626; 95% CI = 1.160-2.279; P = 0.005), and pTNM stage (HR = 2.266; 95% CI = 1.335-3.847; P = 0.002), which are independent risk factors for poor survival. Tumor location (P = 0.191), invasion depth (P = 0.579) and tumor size (P = 0.324) were not found to be independent risk factors. The degree of tumor differentiation, regional lymph node metastasis and postoperative pathological stage were found to be independent risk factors for 5-year overall survival in patients with advanced gastric cancer. Standardized and reasonable lymph node dissection and accurate postoperative pathological staging were very important.

The Role of Axillary Lymph Node Dissection versus Sentinel Lymph Node Dissection in Breast Cancer Patients with Clinical N2b-N3c Disease Who Receive Adjuvant Radiotherapy.

For breast cancer with advanced regional lymph node involvement, axillary lymph node dissection (ALND) remains the standard of care for staging and treating the axilla despite the presence of undissected lymph nodes. The benefit of ALND in this setting is unknown. We sought to describe national patterns of care of axillary surgery and its association with overall survival (OS) among women with cN2b-N3c breast cancer who receive adjuvant radiotherapy. We identified female patients with cN2b-N3c breast cancer from 2012 to 2017 from the National Cancer Database. Clinical and demographic information were analyzed using Wilcoxon rank sum and χ2 tests. Predictors of receipt of ALND and predictors of death were identified with multivariable logistic regression modeling. Inverse probability of treatment weighting was implemented to adjust for differences in treatment cohorts. The Kaplan-Meier method was used to evaluate OS. We identified 7167 patients. Of these, 922 (13%) received SLNB and 6254 (87%) received ALND; 7% were cN2b, 19% cN3a, 24% cN3b, 19% cN3c, and 31% cN3, not otherwise specified. Predictors of receipt of ALND were age 50-69 years [odds ratio (OR) 1.3, p < 0.01], cN3a (OR 7.6, p < 0.01), cN3b (OR 2.8, p < 0.01), and cN3c (OR 4.2, p < 0.01). Predictors of death included cN3c (OR 1.9, p < 0.01), age 70-90 years (OR 1.5, p = 0.01), and positive surgical margins (OR 1.5, p < 0.01). After cohort balancing, ALND was not associated with improved OS when compared with SLNB (HR 0.99, p = 0.91). ALND in patients with advanced nodal disease was not associated with improved survival compared with SLNB for women who receive adjuvant radiotherapy.

A Cost-Effective Model for Predicting Recurrent Gastric Cancer Using Clinical Features.

This study used artificial intelligence techniques to identify clinical cancer biomarkers for recurrent gastric cancer survivors. From a hospital-based cancer registry database in Taiwan, the datasets of the incidence of recurrence and clinical risk features were included in 2476 gastric cancer survivors. We benchmarked Random Forest using MLP, C4.5, AdaBoost, and Bagging algorithms on metrics and leveraged the synthetic minority oversampling technique (SMOTE) for imbalanced dataset issues, cost-sensitive learning for risk assessment, and SHapley Additive exPlanations (SHAPs) for feature importance analysis in this study. Our proposed Random Forest outperformed the other models with an accuracy of 87.9%, a recall rate of 90.5%, an accuracy rate of 86%, and an F1 of 88.2% on the recurrent category by a 10-fold cross-validation in a balanced dataset. We identified clinical features of recurrent gastric cancer, which are the top five features, stage, number of regional lymph node involvement, Helicobacter pylori, BMI (body mass index), and gender; these features significantly affect the prediction model's output and are worth paying attention to in the following causal effect analysis. Using an artificial intelligence model, the risk factors for recurrent gastric cancer could be identified and cost-effectively ranked according to their feature importance. In addition, they should be crucial clinical features to provide physicians with the knowledge to screen high-risk patients in gastric cancer survivors as well.

A rare clinical case of diagnosis and treatment of metastases of Merkel carcinoma in the right inguinal lymph nodes without an identified primary focus

Introduction. Merkel’s carcinoma is a neuroendocrine malignant epithelial skin tumor, rapidly progressive, prone to local recurrence and metastasis to regional lymph nodes and internal organs. The etiology and pathogenesis of Merkel’s carcinoma are still an insufficiently studied issue. Because of its rare occurrence, only single observations of Merkel’s carcinoma metastasis without an identified primary focus, most often with regional lymph node involvement, have been described in the world literature.Clinical case. This article presents a clinical case of metastatic lesion of inguinal lymph nodes with microinvasion into femoral artery in Merkel’s carcinoma without identified primary focus. After a comprehensive examination and onco-consilium the patient underwent surgical treatment in the scope of cytoreductive excision of the inguinal lymph node conglomerate on the right side and artery prosthesis with an autovenous graft. According to the routine postoperative pathomorphologic and immunohistochemical studies, the diagnosis of Merkel’s carcinoma metastasis was finally confirmed.Conclusion. Identification and description of such clinical cases are practically significant and can serve for formation of certain algorithms for treatment of Merkel’s carcinoma both with local manifestations and in progressive forms. Patients with Merkel’s carcinoma should be discussed in oncological consiliums, as treatment may include surgical stage, including biopsy of sentinel lymph nodes, adjuvant radiotherapy, chemotherapy and immunotherapy in case of tumor dissemination.