Resection Of Regional Nodes Research Articles

Clinicopathological Evaluation of Papillary Thyroid Microcarcinoma.

Clinicians sometimes encounter papillary thyroid microcarcinoma (PMC) that is less than 10 mm, associated with lymph node metastasis. In this study, we assessed PMC clinicopathologically to clarify risk factors for poor prognosis. Fifty-one patients who underwent thyroid surgery at Aichi Medical University from September 2009 to October 2016 were included. Patients were divided into two groups, pEX-positive (23 patients) and pEX-negative (28 patients), based on the pathological finding of thyroid capsule invasion. The former indicates that the tumor infiltrated the thyroid capsule and spreadto the neighboring tissue, and the latter indicates no capsule invasion. We analyzed factors such as patient characteristics, pathological findings, and serum levels of thyroid hormones in the two groups. No statistical differences were observed between the two groups in gender distribution or age at surgery. Preoperative cancer diagnoses were established for more patients in the pEX-positive group than in the pEX-negative group (n = 21 and 14, respectively; P = 0.004). The mean (±SD) pathological tumor diameter was 5.42 ± 2.77 in the pEX-negative group and 8.32 ± 1.61 in the pEX-positive group (P < 0.001). No significant differences in preoperative serum levels of free T3, free T4, thyroid-stimulating hormone, or thyroglobulin were observed between the two groups. The odds ratio for node positivity in tumors invading thyroid capsules (pEX-positive) compared to those with no capsule invasion (pEX-negative) was 13.20 (95% confidence interval, 3.45-50.42). Immunohistological staining for phosphatase and tensin homolog deleted from chromosome 10 (PTEN) and Akt (protein kinase B) revealed the facilitation of PTEN and suppression of Akt, which might indicate downregulation of the phosphoinositide 3-kinase-Akt (PI3K-Akt) cascade. In general, the prognosis of PMC is favorable. However, the prognosis is less favorable in patients with nodal metastasis or extrathyroidal invasion. It is controversial whether resection is required for proven PMCs. For PMCs associated with extrathyroidal invasion, regional lymph node resection with lobectomy should be performed due to the high risk for lymphatic spread. There might be a possibility that the natural progression of PMC seems to be controlled by the facilitation of PTEN. However, a tumor in the lateral peripheral region of the thyroid parenchyma might be associated with capsule invasion followed by lymphatic spread.

Effect of surgery on survival of patients with small-cell lung cancer undiagnosed before resection.

Standards of treatment for limited-stage small-cell lung cancer (SCLC) include chemoradiotherapy. The place of the surgery in this indication is still debated. The objective of this study was to evaluate the overall survival (OS) in patients who underwent surgery for an SCLC undiagnosed before resection in the University Hospital of Nancy, France. Secondarily, the impact of surgery on recurrence-free survival (RFS) was analyzed. All the patients who underwent lung resection in the Department of Thoracic Surgery, from 1991 to 2018, and a diagnosis of SCLC after surgery were included. OS and RFS were analyzed according to the resection type, postoperative staging, and lymph node extension. Sixty-one patients were included. The median OS was higher in patients with lobectomy than those with pneumonectomy (26 [8.4-208.7] vs. 12 [3.4-27.6] months, P < 0.001) in stage I compared to other stages (58 [8.4-208.7] vs. 17 [3.4-83.5] months, P = 0.002), and N0-1 than N2 (25 [3.6-208.7] vs. 15 [3.4-83.5] months, P = 0.01). RFS was also significantly higher after lobectomy than after pneumonectomy (17 [1.6-184.9] vs. 8 [0.5-17.6], P < 0.001), stage I than stages II-III (35 [5-184.9] vs. 11 [0.5-42.4], P < 0.001) and N0-1 compared to N2 (25 [1.6-184.9] vs. 9 [0.5-16.5] months, P = 0.006). In multivariate analysis, the only independent factor influencing the OS was the pneumonectomy (hazard ratios = 3.19; 95% confidence interval [1.46-6.98], P = 0.004). Surgical resection of stage I SCLC may lead to better OS and RFS. N1 patients should not automatically be excluded from surgery. Lobectomy with regional lymph node resection is the preferable choice of surgery.

Prognostic Value of Metastatic Lymph Node Ratio and Identification of Factors Influencing the Lymph Node Yield in Patients Undergoing Curative Colon Cancer Resection.

Due to the impact of nodal metastasis on colon cancer prognosis, adequate regional lymph node resection and accurate pathological evaluation are required. The ratio of metastatic to examined nodes may bring an additional prognostic value to the actual staging system. This study analyzes the identification of factors influencing a high lymph node yield and its impact on survival. The lymph node ratio was determined in patients with fewer than 12 or at least 12 evaluated nodes. The study included patients after radical colon cancer resection in UICC stages II and III. For the lymph node ratio (LNR) analysis, node-positive patients were divided into four categories: i.e., LNR 1 (<0.05), LNR 2 (≥0.05; <0.2), LNR 3 (≥0.2; <0.4), and LNR 4 (≥0.4), and classified into two groups: i.e., those with <12 and ≥12 evaluated nodes. The study was conducted on 7012 patients who met the set criteria and were included in the data analysis. The mean number of examined lymph nodes was 22.08 (SD 10.64, median 20). Among the study subjects, 94.5% had 12 or more nodes evaluated. These patients were more likely to be younger, women, with a lower ASA classification, pT3 and pN2 categories. Also, they had no risk factors and frequently had a right-sided tumor. In the multivariate analysis, a younger age, ASA classification of II and III, high pT and pN categories, absence of risk factors, and right-sided location remained independent predictors for a lymph node yield ≥12. The univariate survival analysis of the entire cohort demonstrated a better five-year overall survival (OS) in patients with at least 12 lymph nodes examined (68% vs. 63%, p = 0.027). The LNR groups showed a significant association with OS, reaching from 75.5% for LNR 1 to 33.1% for LNR 4 (p < 0.001) in the ≥12 cohort, and from 74.8% for LNR2 to 49.3% for LNR4 (p = 0.007) in the <12 cohort. This influence remained significant and independent in multivariate analyses. The hazard ratios ranged from 1.016 to 2.698 for patients with less than 12 nodes, and from 1.248 to 3.615 for those with at least 12 nodes. The LNR allowed for a more precise estimation of the OS compared with the pN classification system. The metastatic lymph node ratio is an independent predictor for survival and should be included in current staging and therapeutic decision-making processes.

Removal of Bronchial Thrombus and Perioperative Anesthetic Management in a Cardiac Case: A Case Report

A 63-year-old male with a history of Rheumatic heart disease with post-balloon mitral valvuloplasty (BMV) presented with a carcinoid tumor of the right lower lobe, posted for lobectomy plus regional lymph node resection. Anesthetic challenges and management of this patient is well described here. A rare post-operative complication i.e, blood clots in the bronchus, resulting in hypoxia and desaturation was found during the extubation time. Handling such complications with a bronchoscope is also discussed in this case report.

Excitation coil for sentinel lymph node harvesting: design, digital twin and prototype.

A recently developed prototype (Laparoscopic Differential Magnetometer, in short LapDiffMag) identifies magnetic tracer accumulated inside sentinel lymph nodes (SLNs) during clinical laparoscopic procedures. The LapDiffMag relies on excitation of superparamagnetic iron oxide nanoparticles (SPIONs) and subsequent laparoscopic detection based on a nonlinear detection principle. The prototype uses an excitation coil to generate a magnetic field needed to activate SPIONs. This study reports on the process of developing a new excitation coil by describing the design choices based upon clinical requirements, by modeling delivered magnetic field using digital twin, and by comparing the magnetic fields of modeled and manufactured prototype. Digital twin technology was used to produce relevant and reliable data to demonstrate the safety and effectiveness of the excitation coil. The magnetic field originating from manufactured prototype was validated at two different heights above the excitation coil and have shown a good concordance to the data generated by its digital twin. Clinical Relevance- Current standard-of-care for a variety of tumor types consists of minimally invasive radical resection of primary tumor and regional lymph nodes (LNs). The newly introduced excitation coil will (after full validation) enable minimally invasive harvesting of sentinel LNs by means of magnetic tracer detection.

EARLY RECURRENCE OF CARCINOMA GALL BLADDER AFTER R0 RESECTION OF STAGE T1B-T3

Objective:The time to tumour recurrence after curative intent excision can predict the prognosis of hepatobiliary malignancies. As a result, we studied the risk factors for early recurrence of gallbladder cancer and related prognosis in patients with T1b–T3 gallbladder carcinoma who had received R0 resection. Material and Methods:Total of 18patients who underwent R0 resection for gall bladder carcinoma of stage T1b–T3 between March 2009 and Feb 2017at Hayatabad Medical Complex Peshawar Pakistan were included in the study. The exclusion and inclusion criteria were strictly followed.Logisticregressionmodelswereusedtoidentifytheriskfactorsforearlyrecurrence. Results:Atthetimeofradical surgery the type of resection consisted primarily of cholecystectomy with partial hepatic resection was (n=15, 83.3%). Resection of regional lymph nodes was performed routinely in all patients. Pathologically most patients had tumors at stage I&amp;II (n=13, 72.2%).Postoperatively5(27.7%) patients hadatleastonecomplication&amp;almost 2 (11.1%) individuals developed major complications,theoverallmorbiditywas 4(22.2%).Overall survival rate at1,3, and 5 years was 15(83.3%),11(61.1%) and6(33.3%)respectively. Total of 7(38.8%) patients experienced tumor recurrence after treatment, amongthem 4 (57.1%) developed a local recurrence, while 1(14.2%) developed distant recurrence and 2(28.5%) experienced both local and distant recurrence. The liver parenchyma 3(42.8%) was the most prevalent site of relapse. Conclusion: T3 stage, N1–N2 stage, poor differentiation and lymphovascular invasion were independent risk factors associated with early recurrence for patients with gall bladder carcinoma with stage T1b–T3 disease after R0 resection.

Synchronous gastric cancer and primary lymphoma of right adrenal gland: a case report

This report presents an extremely rare case of synchronous gastric cancer and primary adrenal diffuse large B-cell lymphoma (DLBCL). An 82-year-old man underwent computed tomography, which revealed a heterogeneous appearing and hypodense adrenal mass and a gastric mass with no enlarged lymph nodes in the neck, mediastinum, abdomen, and inguinal region. Upper gastrointestinal endoscopy revealed a protruding gastric tumor. The specimens obtained from endoscopic biopsy were histologically confirmed to be adenocarcinoma. The hormonal findings eliminated functional adrenal tumor. The patient underwent distal gastrectomy with regional lymph node resection for gastric cancer and incisional biopsy of the adrenal mass. Based on the pathological findings, diagnoses of mixed mucinous and tubular adenocarcinomas of the stomach and adrenal DLBCL were confirmed. Postoperation, the patient received rituximab combined with low-dose doxorubicin, cyclophosphamide, vincristine, and prednisone (R-miniCHOP). Six courses of R-miniCHOP were planned, but were completed in only one course at the patient’s request. The patient died 2 months after surgery.

Surgical resection of primary tumors improved the prognosis of patients with bone metastasis of non-small cell lung cancer: a population-based and propensity score-matched study.

BackgroundMost patients with lung cancer are in an advanced stage at the time of diagnosis due to occult onset. Bone is one of the most common sites of hematogenous metastasis of lung cancer. This study aimed to evaluate the impact of surgical resection of primary tumors on the prognosis of patients with bone metastasis of non-small cell lung cancer, using the Surveillance, Epidemiology, and End Results (SEER) database.MethodsA total of 9,804 patients with only bone metastasis were identified from the SEER database. Propensity score matching was used to reduce the selection bias. Cancer-specific survival (CSS) and overall survival (OS) were compared between patients with or without primary tumor resection. The Cox regression model was applied to evaluate multiple prognostic factors.ResultsAfter propensity score matching, 424 patients were selected for survival analysis. No statistically significant differences were found in age, sex, race, tumor location, histology, T stage, and N stage between patients with or without surgical resection of primary tumors. The prognosis of patients who underwent surgical resection of primary tumors was significantly better than that of patients who had not undergone surgery. The surgical resection of primary tumors was an independent prognostic factor. The prognosis of patients who underwent lobectomy/bilobectomy was significantly better compared to other surgical types. Regional lymph node resection during surgery also significantly improved the prognosis of the patients.ConclusionsFor patients with only bone metastasis, surgical resection of primary tumors could significantly improve prognosis. Lobectomy/bilobectomy with regional lymph node resection was the best surgical strategy.

Laparoscopic radical antegrade modular pancreatosplenectomy: preliminary experience with 10 cases

BackgroundThe radical antegrade modular pancreatosplenectomy (RAMPS) which is a reasonable surgical approach for left-sided pancreatic cancer is emphasis on the complete resection of regional lymph nodes and tumor-free margin resection. Laparoscopic radical antegrade modular pancreatosplenectomy (LRAMPS) has been rarely performed, with only 49 cases indexed on PubMed. In this study, we present our experience of LRAMPS.MethodsFrom December 2018 to February 2020, 10 patients underwent LRAMPS for pancreatic cancer at our department. The data of the patient demographics, intraoperative variables, postoperative hospital stay, morbidity, mortality, pathologic findings and follow-up were collected.ResultsLRAMPS was performed successfully in all the patients. The median operative time was 235 min (range 212–270 min), with an EBL of 120 ml (range 100–200 ml). Postoperative complications occurred in 5 (50.0%) patients. Three patients developed a grade B pancreatic fistula. There was no postoperative 30-day mortality and reoperation. The median postoperative hospital stay was 14 days (range 9–24 days).The median count of retrieved lymph nodes was 15 (range 13–21), and four patients (40%) had malignant-positive lymph nodes. All cases achieved a negative tangential margin and R0 resection. Median follow-up time was 11 months (range 3–14 m). Two patients developed disease recurrence (pancreatic bed recurrence and liver metastasis) 9 months, 10 months after surgery, respectively. Others survived without tumor recurrence or metastasis.ConclusionsLRAMPS is technically safe and feasible procedure in well-selected patients with pancreatic cancer in the distal pancreas. The oncologically outcomes need to be further validated based on additional large-volume studies.

Short- and long-term outcomes following robotic and open resection for cholangiocarcinoma: a national cohort study

Presenter: Ahmad Hamad MD | The Ohio State University Background: Curative-intent surgical resection with porta hepatis lymphadenectomy provides the best chance for long-term survival for patients with cholangiocarcinoma. A robotic approach has been increasingly adopted by many surgeons at high volume centers, however its impact on perioperative and long-term outcomes are largely unknown. Methods: Patients with stages I-III cholangiocarcinoma who underwent surgical resection between 2004 and 2017 were queried from the National Cancer Database. Descriptive statistics and multivariate models were constructed to determine the association between surgical approach (robotic vs. open) and short- and long-term surgical and oncological outcomes including lymph node yield, surgical margins, length of stay, 30-day readmission after surgery, 90-day mortality, and overall survival (OS). Results: A total of 1,876 patients with cholangiocarcinoma who underwent open (n = 1810, 96.5%) and robotic-assisted (n = 66, 3.5%) resections were identified. Patients who underwent robotic-assisted surgery were older (68±12 years) compared to patients undergoing open surgery (64 ±11 years; P = 0.003); however, there was no difference in gender, race, insurance status, hospital volume or comorbidities (all P>0.05). Additionally, there was no difference in tumor size or grade between groups (all P>0.05). Performance of regional lymph node resection (Robotic: 45.5% vs. Open: 55.4%), median number of lymph nodes examined (Robotic: 2.06 ± 3.73 vs. Open: 2.29 ± 3.82), and positive lymph nodes (Robotic: 0.17 ± 0.46 vs. Open: 0.38 ± 1.01) also did not differ between groups (P>0.05). The incidence of non-R0 resection margin also was similar between groups (Robotic: 80.6% vs. Open: 81.7%; P = 0.76). Following surgery, patients who underwent a robotic-assisted resection had a shorter length of hospital stay (Robotic: 6 ± 5 days vs. Open: 9 ± 10 days, P = 0.019). There was no difference in 30-day readmission rates (Open: 7.7% vs. Robotic: 4.5%, P = 0.48) or 90-day mortality (Open: 7.0% vs. Robotic: 4.9%, P = 1.00) between the groups. Older age (HR 1.02, 95%CI 1.01-1.02; P < 0.001), patients with stage 2 disease (HR 1.77, 95%CI 1.52-2.06, p = 0.00), stage 3 disease (HR 1.93 95%CI 1.53-2.42, p = 0.00), and higher comorbidity (HR 1.24, 95%CI 1.05-1.47, p = 0.010) were associated with worse overall survival. Conclusion: This national cohort study demonstrates similar surgical and oncological outcomes between patients undergoing robotic-assisted surgery and open surgery for cholangiocarcinoma. Future studies should focus on a patient-centered approach in determining surgical approach for resection of cholangiocarcinoma.

Current Trends in the Quality Assessment of Colorectal Cancer Practice and Treatment in South Korea during 2012-2017.

PurposeColorectal cancer (CRC) is increasing in South Korea due to westernized eating habits and regular health check-ups. The Korean Health Insurance Review and Assessment Service (HIRA) has conducted a national quality assessment of the treatment of CRC. This study examined the quality assessment report of the Korean HIRA and analyzed the status of practice pattern and the epidemiology of CRC in South Korea.Materials and MethodsThe number of subjects was determined based on the number of surgical procedures in each institution during 2012–2017. The institution types were classified according to the number of beds and the composition of oncologic specialists. Twenty-one indicators for diagnosis, chemotherapy, radiotherapy, surgery, pathology, and mortality were analyzed and the inter-institutional variation for each indicator was calculated.ResultsAmong 21 evaluation indices, indicators related to medical records, receipt of chemotherapy with a high coefficient of variation of ≥ 0.1% were improved over 6 years until the survey in 2017. In the analysis of indices affecting surgical mortality, the regional lymph node resection and examination rate (p=0.022) showed a negative correlation with surgical mortality. Hospitalization stay (p < 0.001) and hospitalization cost (p=0.002) were positively correlated with surgical mortality.ConclusionThis study showed that the treatment quality and examination status for CRC in South Korea were appropriate for improving relevant medical records, receipt of chemotherapy, maintaining the quality of treatment, and mortality. These analyses could be the basis for developing an improved quality assessment program worldwide.

Case report: optimal tumor cytoreduction and octreotide with durable disease control in a patient with MEN-1 and Zollinger-Ellison syndrome\u2014over a decade of follow-up

BackgroundZollinger-Ellison syndrome (ZES) is a rare condition characterized by hypersecretion of gastrin by gastrinoma tumors leading to severe peptic ulcer disease with potential development of gastric carcinoid tumors. Herein, we report the clinical course of a 68-year-old patient with multiple endocrine neoplasia type 1 (MEN-1) who underwent several surgeries to ultimately undergo optimal tumor cytoreduction of locally advanced gastrinomas and symptomatic gastric carcinoids. The patient was subsequently maintained on octreotide long-acting release (LAR). This case report supports consideration for aggressive tumor cytoreduction and octreotide in similar patients with MEN-1-associated ZES for durable disease control and symptom management.Case presentationThe patient is a 68-year-old male with multiple endocrine neoplasia type 1 (MEN-1), diagnosed in 1993 after presenting with recurrent renal calculi and hypercalcemia. Soon thereafter, he presented with symptoms and elevated gastrin levels suggestive of ZES prompting abdominal exploration with partial resection of the duodenum to remove gastrinoma tumor nodules. Within 4 years of the operation, he represented with intractable hypergastrinemia despite optimal medical management with peak gastrin levels exceeding 29,000 pg/mL, in 2006. In January 2007, the patient returned to the operating room for resection of regional peripancreatic and perigastric lymph nodes and enucleation of pancreatic body and tail gastrinoma tumors. Although his gastrin level decreased to 5000 pg/mL with resultant improvement of symptoms, in less than 2 years, he developed disease progression with obstructive symptomatology from enlarging gastric carcinoids and rising gastrin levels. In May of 2008, he underwent pancreaticoduodenectomy and near-total gastrectomy. Since June of 2008, the patient shows no demonstrable progression of disease and remains asymptomatic on LAR octreotide (30 mgs). Gastrin levels have been well controlled (range, 100–624 pg/mL; current 114 pg/mL).ConclusionSuccess of this procedure in our case report highlights the potential role for optimal tumor cytoreduction and LAR octreotide to control disease progression in a patient with MEN-I and Zollinger-Ellison syndrome with locally advanced gastrinoma and secondary large gastric carcinoids.

P2.01-53 Surgical Resection of Primary Tumor Improve the Prognosis of Lung Cancer Patients with Bone Metastasis

Most of the lung cancer patients are in advanced stage at the time of diagnosis due to occult onset. Bone metastasis is one of the most common sites of hematogenous metastasis of lung cancer. This study used the Surveillance, Epidemiology, and End Results (SEER) database to evaluate the impact of surgical resection of primary tumor on the prognosis of lung cancer patients with bone metastasis. We identified 12578 lung patients with only bone metastasis from the Surveillance, Epidemiology, and End Results database. Propensity score matching was used to reduce the selection bias. Cancer–specific survival (CSS) were compared between patients with or without primary tumor resection. The Cox regression model was applied to evaluate multiple prognostic factors. The effects of different surgical extension and lymph node resection on prognosis were also analyzed. After propensity matching, a total of 458 patients were selected into survival analysis. There were no statistical differences in age, gender, race, tumor location, histology, T stage and N stage between patients with or without surgical resection of primary tumor. The prognosis of patients undergoing surgical resection of primary tumor was significantly better than that of patients who had not undergone surgery (five-year CSS rate: 2.7% vs. 23.4%, respectively, P<0.001). Multivariable analysis revealed that surgical resection of primary tumor was an independent prognostic factor (HR=0.518, 95% confidence interval [CI] 0.414 to 0.648, P<0.001). In addition, the prognosis of patients undergoing lobectomy/bilobectomy was significantly better than that of others(P<0.001). Furthermore, regional lymph node resection during the operation could significantly improve the prognosis of the patients (P<0.001). For lung cancer patients with only bone metastasis, surgical resection of primary tumor could significantly improve the prognosis. Lobectomy/bilobectomy with regional lymph node resection was the best surgical strategy.

1341 Not so Incidental: A Case of Incidentally Found Isolated Metastatic Melanoma of the Pancreas

INTRODUCTION: Metastatic lesions of the pancreas are uncommon, with reported frequencies of intrapancreatic metastases ranging from 4.5% to 11%, with isolated metastases around 2% of cases. Metastases from malignant melanoma is quite rare, with fewer then 200 cases reported in literature. CASE DESCRIPTION/METHODS: 79-year-old female who presented to ED in June 2018 with fever, dysuria, and dyspnea. Past medical history significant for prednisone dependent sarcoidosis, atrial fibrillation, and basal cell carcinoma. Labs showed elevated WBC and UA concern for UTI. She was admitted for treatment. CT scan was done due to dyspnea showing LLL consolidation. Incidentally, a new 2.6 × 1.8 cm mass within the pancreas neck was seen. At discharge she was referred to our facility for EUS and FNA. EUS showed a pancreatic mass abutting the superior mesenteric vein without invasion. Cytological analysis obtained by EUS-FNA (Figure 1) showed malignant melanoma with abundant melanin pigments (Figure 2). Positive for Sox-10, Melan A and HMB-45. Referral to medical oncology was made for further work-up. PET scan was preformed due to lack of previous melanoma history, showing no evidence of disease outside the pancreatic area (Figure 3). With no primary lesion identified further referrals to Dermatology and Ophthalmology, however these evaluations were negative for overt cutaneous or ocular melanoma. Colonoscopy was performed and showed no lesions. Due to the isolated lesion, deemed an appropriate candidate for resection. September 2018, partial pancreatectomy and regional lymph node resection completed. Pathology of the 4.5 cm pancreatic neck mass, in addition to celiac and portal lymph node, consistent with malignant melanoma. October 2018 started immunotherapy of Opdivo and Ipilumimab. Repeat PET scan showed nodule along right flank, superior to iliac crest, FDG avid, suspicious for melanoma and thought to be the sight of primary lesion. Tolerated immunotherapy well, but in December 2018, was admitted due to respiratory distress secondary to aspiration pneumonia, was transitioned to comfort cares due to worsening clinical status, passing away. DISCUSSION: This case is a unique presentation of an isolated metastatic pancreatic melanoma, found incidentally in an otherwise asymptomatic patient. With the widespread use of imaging, clinicians can expect an increasing number of “incidentalomas” being found, stressing the role of EUS-FNA in gaining a precise diagnosis which is critical in the overall prognosis and management of patients.

Use of immunotherapy for stage-III and IV melanoma and likelihood of regional and distant lymph node resection and surgical resection for distant metastasis.

9558 Background: Immunotherapy (IMT) for stages-III and IV melanoma has dramatically changed overall prognosis and treatment strategies. The aim of this study was to evaluate if use of IMT significantly changed the likelihood of regional/distant lymph node (LN) resection and surgical resection for distant metastases (DM) among patients with stages-III and IV melanoma, respectively, in the pre- and post-2011 era. Methods: The National Cancer Database (2004-2015) was used to evaluate the likelihood of regional/distant LN resection and surgical resection for DM among patients with stages-III and IV melanoma, respectively, with use of IMT. Multivariable stepwise with forward selection Poisson regression with robust standard errors was used to adjust for potential confounders (age, gender, race, year of diagnosis, Charlson-Deyo Score, facility type, facility location, insurance status, 2012 median income quartile, and 2013 urban/rural status). A stratified analysis was performed to evaluate differences among facility type. Results: There were 28,847 patients (median age 62 (IQR 53-73); 36.3% female) with stage-III melanoma and 14,443 patients (median age 66 (IQR 56-76); 31.7% female) with stage-IV melanoma. Overall, 24.3% (n = 7,018) and 17.0% (n = 2,459) with stage-III and IV melanoma, respectively, received IMT. The adjusted relative risk (aRR) of regional/distant LN resection among patients with stage-III melanoma was significantly higher with use of IMT (aRR 1.16, 95% CI 1.05–1.28, P = 0.004), while the aRR of surgical resection for DM was significantly lower with use of IMT for stage-IV melanoma (aRR 0.85, 95% CI 0.78–0.92, P &lt; 0.001). Stratified analysis demonstrated that the findings were principally reflective of academic/research hospitals. Conclusions: The higher likelihood of regional/distant LN resection in stage-III melanoma may be due to the curative role of surgery and preceded the post-MSLT-II era. Conversely, in stage-IV melanoma, surgery may be limited to resectable oligometastatic disease given the durable and systemic benefit of first-line IMT.

Impact of Proteins MCM7 and P16 on Oral Cancer Patient Prognosis

6000 new cases and 3800 deaths caused by head & neck cancer are reported every year in Poland. Most often patients are diagnosed in advanced stages of the disease. In those cases qualification to the treatment method can be difficult and has to be personalized. MCM7 protein is a marker of proliferation. P16 protein plays a pivotal role in cell cycle progression, cell aging and the development of cancer. In addition, there are reports showing that MCM7 and P16 are a good indicators of oncoprotein E7 activity in HPV 16 virus-infected cells. They can be used to distinguish head and neck tumors of viral etiology. The aim of the study is to evaluate prognostic significance of proteins MCM7 and P16 on oral cancer patients. The study included 129 patients, suffering from squamous cell carcinoma of mouth floor (C04) or anterior parts of tongue (C02), treated in the Lower Silesian Oncology Center in the years 1996-2011. 39 (30%) patients were diagnosed in stage II, 37 (29%) in stage III and 53 (41%) in stage IVa. All patients underwent microscopically radical resection of the primary tumor with simultaneous resection of regional lymph nodes and postoperative radiotherapy. MCM7 and P16 proteins expression was evaluated using a immunoreactivity Remmele scale (IRS). In all 129 patients MCM7 and P16 proteins expression was observed. 43 (33%) patients with a high expression of the p16 IRS≥8 protein and MCM7 IRS≥4 were isolated as a group of potential viral etiology of the disease. We observed statistically significant differences in survival between groups of patients with different expression of MCM7 and p16 in tumor cells (Table 1).Abstract 3508; Table 1The percentage of 5-year locoregional recurrence-free survival (LRFS), disease-free survival (DFS), disease specific survival (DSS) and overall survival (OS) of patients based on the level of MCM7 and p16 expression in cells of squamous cell carcinomaIRSNumer of patients5 year LRFS p=0,0135 year DFS p=0,00295 year DSS p=0,00275 year OS p=0,079p16≥8 i MCM7<42289%85%85%67%p16<8 i MCM7<42782%78%82%58%p16≥8 i MCM7≥44378%73%73%53%p16<8 i MCM7≥43760%50%50%43% Open table in a new tab The survival of patients with potential HPV viral etiology of the disease, characterized by high expression of the proteins p16 (IRS≥8) and MCM7 (IRS≥4), was worse than in the group of patients with low expression MCM7. It was also significantly better than among those with low percentage of p16 and high expression MCM7.

Influence of the MCM7 Protein Expression on Oral Cancer Patient Prognosis, Using Different Methods of the Measurement

MCM7 (Minichromosome maintenance 7, DNA replication licensing factor 7) thanks to its close relationship with DNA replication is a good marker of proliferation. That's why, we can assume there is a correlation between the degree of MCM7 expression and cancer aggressiveness. The aim of the study is to investigate how expression of MCM7 protein is associated with a prognosis in oral cancer patients using different methods of the measurement. The study included 129 patients, suffering from squamous cell carcinoma of mouth floor (C04) or malignant neoplasm of other and unspecified parts of tongue (C02), treated in the Lower Silesian Oncology Center in the years 1996-2011. 39 (30%) patients were diagnosed in stage II, 37 (29%) in stage III and 53 (41%) in stage IVa. All patients underwent microscopically radical resection of the primary tumor with simultaneous resection of regional lymph nodes and adjuvant radiotherapy. MCM7 protein expression was evaluated using a immunoreactivity Remmele scale (IRS), the percentage of stained cells (MCM7%) and the intensity of the color reaction (INT). In all 129 patients MCM7 protein expression was observed. The parameters of MCM7 protein expression (Table 1): INT, MCM7% and IRS in univariate analysis, significantly affected the patient outcome. However, the best correlating expression parameter with the chance of cure turned out to be INT. INT was the only parameter that had a statistically significant impact on OS. Another advantage was easier method of INT evaluation in comparison to MCM7% and IRS scoring.Abstract 2922; Table 1The percentage of 5-year locoregional recurrence-free survival (LRFS), disease-free survival (DFS), disease specific survival (DSS) and overall survival (OS) of patients based on the expression of MCM7 protein in cells of squamous cell carcinoma5-year LRFS5-year DFS5-year DSS5-year OSMCM7%≤25%88%85%85%65%>25%71%64%65%50%p-value0,0260,0120,0160,062MCM7 INT186%80%83%61%277%70%70%57%359%54%54%37%p-value0,0050,0050,0060,041MCM7 IRS<486%81%83%63%≥469%62%62%48%p-value0,0170,0090,00540,052 Open table in a new tab The level of MCM7 expression in the cells of squamous cell carcinoma of mouth floor or body of the tongue is a prognostic factor. All parameters – MCM7%, MCM7 INT and MCM7 IRS – had a significant influence on the survival of cancer patients. However, the most advantageous method was assessment of the MCM7 INT expression.

PRRT as an alternative method of treatment in patient with glucagonoma syndrome: A case report

Introduction: Glucagonoma is a rare pancreatic neuroendocrine tumor derived from alpha-cells of the islet of Langerhans. Due to oversecretion of glucagon it is associated with a characteristic paraneoplastic phenomenon, called glucagonoma syndrome, which consists of necrolytic migratory erythema (NME), weight loss, diabetes mellitus, diarrhea, normochromic normocytic anemia, deep vein thrombosis or pulmonary embolism and neuropsychiatric disturbances. Treatment modalities include surgical removal of tumor, somatostatin analogs and peptide receptor radionuclide therapy (PRRT). Case report: We present a case of 61-year-old woman diagnosed with glucagonoma in April 2012. Initially, body-caudal pancreatomy and resection of regional lymph nodes were performed. Five months after surgery, a PET-CT scan detected pathological mass with expression of somatostatin receptors in pancreatic body and metastases to regional lymph nodes. What is more, since April 2014 the patient had complained about persistent pruritus of the entire body. At present, due to the nonsurgical pancreatic mass and metastases she is treated with somatostatin analogs and PRRT. During this therapy the pruritus had decreased and currently there is no sign of cutaneous disease. Moreover, reduction of tumor size was obtained. Conclusions: PRRT may reduce tumor size and by reducing bothersome symptoms substantially improve the quality of life in patients with SSTR-positive tumors

What's the Best Way to Treat GE Junction Tumors? Approach Like Gastric Cancer.

The debate as to the optimal classification, staging, and treatment of gastroesophageal junction (GEJ) tumors wages on, and one must acknowledge that there is no "one-size-fits-all" approach. However, in this review we are charged with defending the position that all GEJ tumors are best treated like gastric cancer. We submit that, as stated, this is not a defensible position and that a clear definition of terms is warranted. Given the rarity of squamous cell carcinoma and the dramatic rise in incidence of adenocarcinoma of the GEJ in the West, we define GEJ "tumors" to mean adenocarcinomas of the GEJ. Furthermore, on the basis of their location, pathogenesis, and biologic behavior, we submit that few would argue with the contention that Siewert type I GEJ tumors are best treated like distal esophageal cancer and that Siewert type III GEJ tumors are best treated like gastric cancer. The real debate concerns the management of Siewert type II GEJ tumors, which arise immediately at the esophagogastric junction. Thus, for the purposes of this review, we have taken the liberty of redefining the question as what's the best way to treat adenocarcinomas of the true GEJ (i.e., Siewert type II tumors), and we submit that these tumors are in fact best treated like gastric cancer. This approach ensures that patients receive those therapies needed for the locoregional and systemic control of their disease together with a surgical procedure that optimizes complete tumor and regional lymph node resection while limiting morbidity.

Epitheloid Hemangioendothelioma of the Submandibular Region

Objective: To present an uncommon cause for a submandibular mass and review of the literature.&#x0D; Methods:&#x0D; Design: Case Report&#x0D; Setting: Tertiary Government Hospital&#x0D; Patient: One&#x0D; Results: A 25-year-old lady presented with a painless chronic submandibular swelling. Ultrasound identified a solid mass, following which an uncomplicated core biopsy was performed obtaining an accurate pre-operative histopathological diagnosis. Pre-operative arterial embolization of this vascular mass led to a relatively bloodless wide local excision. Radiological imaging for distant metastases was negative.&#x0D; Conclusion: Epitheloid Hemangioendothelioma is an uncommon cause for a submandibular mass. A malignant vascular soft tissue tumor with morphologic characteristics similar to carcinomas, melanomas and epitheloid sarcomas, it has a high rate of metastasis and morbidity when it affects the soft tissues and viscera. Immunohistochemistry provides clues to differentiation, and recommended treatment consists of a surgical wide local excision with regional lymph node resection. As there are no established standard therapeutic protocols for this disease due to its rarity, an individual case-by-case approach and follow-up needs to be undertaken.&#x0D; Keywords: epitheloid hemangioendothelioma, malignant vascular tumor, submandibular mass