Risk Factors For Lymph Node Metastasis Research Articles

Risk factors for lymph node metastases in T1 colorectal cancer differ according to tumour morphology

Background: Tumour budding, lymphovascular invasion (LVI) and venous invasion (VI) are recognised risk factors for lymph node metastases (LNM) in early stage (T1) colorectal cancer (CRC). However, whether the importance of these factors varies according to tumour morphology is unknown. This study investigated the differential impact of risk factors for LNM in pedunculated and non-pedunculated T1 CRC.

A nomogram for predicting lymph node metastasis in early gastric cancer

Objective: To explore the independent risk factors of lymph node metastasis (LNM) in early gastric cancer, and to use nomogram to construct a prediction model for above LNM. Methods: A retrospective cohort study was conducted. Inclusion criteria: (1) primary early gastric cancer as stage pT1 confirmed by postoperative pathology; (2) complete clinicopathological data. Exclusion criteria: (1) patients with advanced gastric cancer, stump gastric cancer or history of gastrectomy; (2) early gastric cancer patients confirmed by pathology after neoadjuvant chemotherapy; (3) other types of gastric tumors, such as lymphoma, neuroendocrine tumor, stromal tumor, etc.; (4) primary tumors of other organs with gastric metastasis. According to the above criteria, 1633 patients with early gastric cancer who underwent radical gastrectomy at the Department of General Surgery of the Chinese PLA General Hospital First Medical Center from December 2005 to December 2020 were enrolled as training set, meanwhile 239 patients with early gastric cancer who underwent gastrectomy at the Department of General Surgery of the Chinese PLA General Hospital Fourth Medical Center from December 2015 to December 2020 were enrolled as external validation set. Risk factors of LNM in early gastric cancer were identified by using univariate and multivariate logistic regression analyses. A nomogram prediction model was established with significant factors screened by multivariate analysis. Area under the receiver operating characteristic curve (AUC) was used for assessing the predictive value of the model. Calibration curve was drawn for external validation. Results: Among 1633 patients in training set, the mean number of retrieved lymph nodes was 20 (13-28), and 209 patients (12.8%) had lymph node metastasis. Univariate analysis showed that gender, resection range, tumor location, tumor morphology, lymph node clearance, vascular invasion, lymphatic cancer thrombus, tumor length, tumor differentiation, microscopic presence of signet ring cells and depth of tumor invasion were associated with LNM (all P<0.05). Multivariate analysis revealed that females, tumor morphology as ulcer type, vascular invasion, lymphatic cancer thrombus, tumor length≥3 cm, deeper invasion of mucosa, and poor differentiation were independent risk factors for LNM in early gastric cancers (all P<0.05). Receiver operating characteristic curve indicated that AUC of training set was 0.818 (95%CI: 0.790-0.847) and AUC of external validation set was 0.765 (95%CI: 0.688-0.843). The calibration curve showed that the LNM probability predicted by nomogram was consistent with the actual situation (C-index: 0.818 in training set and 0.765 in external validation set). Conclusions: Females, tumor morphology as ulcer type, vascular invasion, lymphatic cancer thrombus, tumor length≥3 cm, deeper invasion of mucosa and poor differentiation are independent risk factors for LNM of early gastric cancer. The establishment of a nomogram prediction model for LNM in early gastric cancer has great diagnostic value and can provide reference for treatment selection.

Diffuse pattern, orbital invasion, perineural invasion and Ki-67 are associated with nodal metastasis in patients with eyelid sebaceous carcinoma

BackgroundMetastasis dominates the prognosis of eyelid sebaceous carcinoma (SC). This study aimed to explore risk factors for nodal metastasis and develop a nomogram to predict nodal metastasis in patients with...

Roles of DWI and T2-weighted MRI volumetry in the evaluation of lymph node metastasis and lymphovascular invasion of stage IB–IIA cervical cancer

To determine whether magnetic resonance imaging volumetry on T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) could be used to assess lymph node metastases (LNM) and lymphovascular invasion (LVSI) in resectable cervical cancer. Sixty-five consecutive patients with cervical cancer were enrolled retrospectively. Tumour size, including maximum transverse diameter, tumour length, and gross tumour volume (GTV), was evaluated on DWI and T2WI. Apparent diffusion coefficient (ADC) values were measured. Univariate, multivariate, and receiver operating characteristic (ROC) curve analyses were performed to determine whether tumour size and ADC could be used to assess LNM and LVSI. Tumour length on both T2WI and DWI, and T2WI-based and DWI-based GTVs could be used to assess LNM (p=0.002, 0.004, 0.001, and <0.001, respectively). Tumour length on T2WI, T2WI-based GTV, DWI-based GTV, and ADC value could be used assess LVSI (p=0.039, 0.038, 0.012, 0.039, respectively). Multivariate analyses showed both T2WI-based GTV (odds ratio [OR]=1.044; p=0.008) and DWI-based GTV (OR=1.941; p=0.019) were independent risk factors for LNM. T2WI-based GTV (OR=1.023, p=0.038) and DWI-based GTV (OR=3.275, p=0.008) were independent risk factors for LVSI. No statistically significant difference was identified between the area under the ROC curve (AUC) of the DWI-based GTV and the T2WI-based GTV (0.790 versus 0.775, p=0.113), or the tumour length on both T2WI (0.790 versus 0.734, p=0.185) and DWI (0.790 versus 0.737, p=0.333) for LNM. For LVSI, the AUC of DWI-based GTV was higher than T2WI-based GTV (0.720 versus 0.682, p=0.006). GTV on both T2WI and DWI could be used assess LNM and LVSI. DWI-based GTV might show the greatest potential for assessing LNM and LVSI in resectable cervical cancer.

The Construction and Development of a Clinical Prediction Model to Assess Lymph Node Metastases in Osteosarcoma.

Background: This study aimed to construct a clinical prediction model for osteosarcoma patients to evaluate the influence factors for the occurrence of lymph node metastasis (LNM).Methods: In our retrospective study, a total of 1,256 patients diagnosed with chondrosarcoma were enrolled from the SEER (Surveillance, Epidemiology, and End Results) database (training cohort, n = 1,144) and multicenter dataset (validation cohort, n = 112). Both the univariate and multivariable logistic regression analysis were performed to identify the potential risk factors of LNM in osteosarcoma patients. According to the results of multivariable logistic regression analysis, A nomogram were established and the predictive ability was assessed by calibration plots, receiver operating characteristics (ROCs) curve, and decision curve analysis (DCA). Moreover, Kaplan-Meier plot of overall survival (OS) was plot and a web calculator visualized the nomogram.Results: Five independent risk factors [chemotherapy, surgery, lung metastases, lymphatic metastases (M-stage) and tumor size (T-stage)] were identified by multivariable logistic regression analysis. What's more, calibration plots displayed great power both in training and validation group. DCA presented great clinical utility. ROCs curve provided the predictive ability in the training cohort (AUC = 0.805) and the validation cohort (AUC = 0.808). Moreover, patients in LNN group had significantly better survival than that in LNP group both in training and validation group.Conclusion: In this study, we constructed and developed a nomogram with risk factors, which performed well in predicting risk factors of LNM in osteosarcoma patients. It may give a guide for surgeons and oncologists to optimize individual treatment and make a better clinical decision.

Correlation between gastritis cystica profunda and the risk of lymph node metastasis in early gastric cancer.

In early gastric cancer (EGC) patients, lymph node metastasis (LNM) risk assessment is particularly important for the selection of surgical methods. In this study, we investigated the correlation between gastritis cystica profunda (GCP) and the risk of LNM in EGC. From January 2014 to December 2019, EGC patients who underwent curative radical gastrectomy were enrolled in this study. The clinicopathological features were analyzed, and the correlation between GCP and the risk of lymph node metastasis was assessed. Data for 180 EGC patients were analyzed, and 17.8% (32/180) had LNM. The incidence of LNM was 2.6% in the GCP-positive group and 21.8% in the GCP-negative group. Univariate analysis revealed that GCP, depth of tumor invasion, and lymphovascular invasion were the risk factors of LNM in EGC patients. Multiple regression analysis showed that GCP was associated with the risk of LNM in EGC patients (OR=0.097, 0.121, 0.100, p<0.05). The curve fitting results showed that there was a negative correlation between the GCP and LNM in EGC, which was consistent between different tumor sites, size, ulceration, differentiation types, depth of tumor invasion, lymphovascular invasion, and no significant interaction was found among these factors (p for interaction range 0.224-0.717). GCP is closely related to LNM in EGC. Preoperative assessment of whether EGC is combined with GCP is beneficial for the assessment of the risk of LNM.

Scoring Model Based on Nodal Metastasis Prediction Suggesting an Alternative Treatment to Total Gastrectomy in Proximal Early Gastric Cancer.

PurposeTotal gastrectomy (TG) with lymph node (LN) dissection is recommended for early gastric cancer (EGC) but is not indicated for endoscopic resection (ER). We aimed to identify patients who could avoid TG by establishing a scoring system for predicting lymph node metastasis (LNM) in proximal EGCs.Materials and MethodsBetween January 2003 and December 2017, a total of 1,025 proximal EGC patients who underwent TG with LN dissection were enrolled. Patients who met the absolute ER criteria based on pathological examination were excluded. The pathological risk factors for LNM were determined using univariate and multivariate logistic regression analyses. A scoring system for predicting LNM was developed and applied to the validation group.ResultsOf the 1,025 cases, 100 (9.8%) showed positive LNM. Multivariate analysis confirmed the following independent risk factors for LNM: tumor size >2 cm, submucosal invasion, lymphovascular invasion (LVI), and perineural invasion (PNI). A scoring system was created using the four aforementioned variables, and the areas under the receiver operating characteristic curves in both the training (0.85) and validation (0.84) groups indicated excellent discrimination. The probability of LNM in mucosal cancers without LVI or PNI, regardless of size, was <2.9%.ConclusionsOur scoring system involving four variables can predict the probability of LNM in proximal EGC and might be helpful in determining additional treatment plans after ER, functioning as a good indicator of the adequacy of treatments other than TG in high surgical risk patients.

Clinicopathological Findings Associated With Cervical Lymph Node Metastasis in Papillary Thyroid Microcarcinoma: A Retrospective Study in China.

ObjectiveThe incidence of papillary thyroid microcarcinoma (PTMC) has increased sharply during the past decades. Yet, whether or not nodal dissection should be performed remains controversial. This article aims to assess the high-risk factors associated with cervical lymph node metastasis (LNM) in patients with PTMC, which may potentially guide clinical management decision-making.MethodsMedical records of 449 PTMC patients who underwent thyroidectomy in our hospital from August 2016 to July 2017 were retrospectively reviewed. Clinical and pathological factors of the patients were anonymously extracted from the charts and analyzed.ResultThe patients were classified into two subgroups according to maximum tumor size measured through post-surgical pathology: smaller PTMC group (≤5 mm) and larger PTMC group (>5 mm). Larger tumor size was found to be associated with a higher rate of LNM (P = .001), particularly central lymph node metastasis (CLNM) (P = .001). Tumor size was also associated with extrathyroidal tumor extension (ETE) (P < .001), bilateral lesions (P = .015), and BRAFv600e mutation (P = .004). LNM was found to be more common in older patients (>55 y) (P = .030), and those with multifocal cancer (P < .001). In PTMC patients with unilateral lesions without ETE, tumor size was not significantly associated with LNM (P = .121).ConclusionsFor the PTMC population, tumor size was an independent risk factor for LNM, particularly for patients of old age (>55 y), and multifocality. However, in PTMC patients with unilateral lesions without extrathyroidal extension, tumor size was not related to the risk of LNM. These findings may potentially guide clinical decision-making in terms of cervical nodal dissection.

Treatment of Superficial Esophageal Cancer: An Update

Superficial esophageal squamous cell carcinoma (SESCC) is an esophageal squamous cell carcinoma confined to the mucosa or superficial submucosa. Recent Korean Guidelines recommend an endoscopic resection as the first-line treatment for SESCC without a distant or lymph node metastasis (LNM) after excluding those with an obvious submucosal invasion. Before endoscopic treatment of SESCC, Lugol chromoendoscopy or image-enhanced endoscopy is recommended to define the extent of the lesion, and endoscopic ultrasound is recommended to determine the T stage. The tumor size, macroscopic type of tumor, pathologic differentiation, depth of tumor, and lymphovascular invasion (LVI) are risk factors of LNM in SESCC. No additional treatment is necessary after an en bloc complete resection of SESCC invading no more than the lamina propria without LVI. Although the risk of LNM in a SESCC invading into muscularis mucosa without LVI is low, a close follow-up is recommended without additional treatment. On the other hand, additional treatment is recommended in the case of a tumor with submucosal invasion or an LVI positive or positive vertical resection margin. Adjuvant therapy includes esophagectomy or chemoradiotherapy (CRT), but it is unclear which treatment is better. The 5-year overall survival rates were reportedly 90-100% for esophagectomy and 75-85% for CRT. Nevertheless, patients with high-risk features including poorly differentiated histology, LVI positive, perineural invasion positive, T1b-SM2/T1b-SM3 cancer, and vertical resection margin positive need to be treated with an additional esophagectomy. Elderly patients, those with a physical condition and co-morbidities, and those with LNM or cancer-specific mortality require additional treatment after a non-curative endoscopic resection of SESCC.

Higher Lymph Node Metastasis Rate and Poorer Prognosis of Intestinal-Type Gastric Cancer Compared to Diffuse-Type Gastric Cancer in Early-Onset Early-Stage Gastric Cancer: A Retrospective Study

Background: The incidence of early-onset gastric cancer (GC) that was diagnosed at <50 years is increasing, but there is a knowledge gap on early-onset early-stage GC (EEGC) that was defined as early-onset GC limited to the mucosa or submucosa. Therefore, we comprehensively analysed the clinical features based on Lauren type.Methods: Logistic and Cox analyses were used to investigate risk factors for lymph node metastasis (LNM) and prognosis, respectively. Propensity score matching (PSM) was used to adjust confounding factors. Protein mass spectrometry analysis was used to explore the molecular mechanism of LNM.Result: Our study included 581 patients with EEGC from the Surveillance, Epidemiology, and End Results (SEER) database and 226 patients with EEGC from our own centre. We identified intestinal type, T1b stage, and tumour size (>3 cm) as risk factors for LNM using SEER and our own data. We also found that the prognosis of patients with intestinal-type EEGC was poorer than patients with diffuse-type EEGC, and T1b stage and positive LNM were hazard factors for survival. After analysing the expression of proteins between positive and negative LNM in the intestinal or diffuse type, we found no similar proteins between these groups. The differentially expressed genes (DEGs) in the intestinal type functioned as epithelial cell signalling in Helicobacter pylori. The DEGs in the diffuse type functioned in the tricarboxylic acid cycle (TCA cycle) and oxidative phosphorylation.Conclusion: For EEGC, our study was the first report to demonstrate that the intestinal type was a risk factor for LNM and survival compared to the diffuse type, and the oncogenic expression promoting the occurrence of LNM was different. These findings suggest that clinicians should pay more attention to intestinal-type EEGC than diffuse-type EEGC.

A Population-Based Study: How to Identify High-Risk T1–2 Esophageal Cancer Patients?

BackgroundDue to individualized conditions of lymph node metastasis (LNM) and distant metastasis (DM), the following therapeutic strategy and diagnosis of T1–2 esophageal cancer (ESCA) patients are varied. A prediction model for identifying risk factors for LNM, DM, and overall survival (OS) of high-risk T1–2 ESCA patients is of great significance to clinical practice.MethodsA total of 1,747 T1–2 ESCA patients screened from the surveillance, epidemiology, and end results (SEER) database were retrospectively analyzed for their clinical data. Univariate and multivariate logistic regression models were established to screen out risk factors for LNM and DM of T1-2 ESCA patients, while those of OS were screened out using the Cox regression analysis. The identified risk factors for LNM, DM, and OS were then subjected to the establishment of three nomograms, respectively. The accuracy of the nomograms was evaluated by depicting the calibration curve, and the predictive value and clinical utility were evaluated by depicting the clinical impact curve (CIC) and decision curve analysis (DCA), respectively.ResultsThe age, race, tumor grade, tumor size, and T-stage were significant factors for predicting LNM of T1–2 ESCA patients (p < 0.05). The age, T-stage, tumor grade, and tumor size were significant factors for predicting DM of T1–2 ESCA patients (p < 0.05). The age, race, sex, histology, primary tumor site, tumor size, N-stage, M-stage, and surgery were significant factors for predicting OS of T1–2 ESCA patients (p < 0.05). The C-indexes of the three nomograms constructed by these factors were 0.737, 0.764, and 0.740, respectively, suggesting that they were clinically effective.ConclusionsThe newly constructed nomograms can objectively and accurately predict the LNM, DM, and OS of T1–2 ESCA patients, which contribute to the individualized decision making before clinical management.

Value of intravoxel incoherent motion for assessment of lymph node status and tumor response after chemoradiation therapy in locally advanced rectal cancer

ObjectiveTo assess the role of region of interest (ROI) selection of intravoxel incoherent motion (IVIM) for predicting lymph node metastases (LNM) and tumor response after chemoradiation therapy (CRT) in locally advanced rectal cancer. Materials and methodsSeventy-nine patients with biopsy-proven rectal adenocarcinoma who underwent pre- and post-CRT MRI and surgery were prospectively enrolled. The exclusion criteria included nonresectable and/or metastatic disease and loss of follow-up. Pathological stage was determined using ypTNM stage and tumor regression grade. Slow diffusion coefficient (D), fast diffusion coefficient (D*), perfusion-related diffusion fraction (f), apparent diffusion coefficient (ADC) and their percentage changes (Δ%) were evaluated by two readers using whole-volume, single-slice and small samples ROI methods. Risk factors including carcinoembryonic antigen, post-CRT T-staging, extramural venous invasion and IVIM parameters were evaluated through multivariate analyses. Areas under the receiver operating characteristic curves (AUCs) were calculated to evaluate diagnostic performance. Duration of follow-up was two-year. Recurrence-free survival of patients with LNM and tumor response was estimated using Kaplan-Meier analysis. ResultsInterobserver agreement were good for pre- and post-CRT three ROI methods (intraclass correlation coefficient [ICC], 0.581–0.953). Whole-volume ROI-derived Δ%D was an independent risk factor for LNM, non-pathological complete response (non-pCR) and poor response (odds ratio, 0.940, 0.952, 0.805, respectively; all p < 0.001). Whole-volume ROI-derived Δ%D showed best AUC of 0.810, 0.851 and 0.903 for LNM, non-pCR and poor response (cutoff value, 31.8%, 54.5%, 52.8%, respectively). Patients with post-CRT LNM showed reduction in 2-year recurrence-free survival (hazard ratio, 3.253). ConclusionsWhole-volume ROI-derived Δ%D provided high diagnostic performance for evaluating post-CRT LNM and tumor response. Patients with post-CRT LNM showed earlier recurrence.

Intraglandular dissemination is a risk factor for lymph node metastasis in papillary thyroid carcinoma: a propensity score matching analysis.

Intraglandular dissemination is one of the metastatic pathways of papillary thyroid carcinoma (PTC). However, few studies have assessed the impact of intraglandular dissemination among patients with PTC. The purpose of this study was to investigate the potential correlation between intraglandular dissemination and various clinicopathological parameters in PTC patients. We retrospectively collected the data of 1,043 consecutive PTC patients in Wuhan Union Hospital from 1 June 2020 to 1 May 2021. The patients were divided into 2 groups according to the presence or absence of intraglandular dissemination. A propensity score matching (PSM) analysis with a matching ratio of 1:2 and a caliper value of 0.05 was used to compare the clinicopathological differences between groups. Logistic regression analysis was performed to quantify the association between intraglandular dissemination and cervical lymph node (LN) metastasis. In total, 117 and 204 PTC patients with and without intraglandular dissemination, respectively, were successfully matched. The LN metastasis rate of PTC patients with intraglandular dissemination (88%) was significantly higher than that of patients without intraglandular dissemination (67.2%; P<0.001). The number of metastatic LNs in patients with and without intraglandular dissemination also varied greatly, at 9.62 (SD =7.92) and 3.33 (SD =4.23), respectively. Intraglandular dissemination was associated with an increased risk of LN metastasis in both the unmatched patients [odds ratio (OR), 3.19; 95% confidence interval (CI): 1.74 to 5.86; P<0.001] and the matched subset (OR, 4.00; 95% CI: 1.98 to 8.05; P<0.001). No statistically significant differences were found in age, gender, tumor size, histological subtypes, extrathyroidal extension, or presence of Hashimoto's thyroiditis (HT) (all P values >0.05). Intraglandular dissemination is a risk factor for LN metastasis in PTC, which suggests a need for more thorough LN dissection and closer follow-up in these patients. This finding may provide reliable reference data for the risk stratification of patients with PTC.

Systemic Immune-Inflammatory Index as a Predictor of Lymph Node Metastasis in Endometrial Cancer.

PurposeThis study assessed the predictive value of the preoperative systemic immune-inflammatory index (SII) for lymph node metastasis (LNM) in endometrial cancer (EC) patients.MethodsWe retrospectively included 392 EC patients between January 2013 and January 2019. Data on clinical indicators including age, body mass index (BMI), menopause, serum inflammatory immune index, serum tumor markers, history of diabetes and hypertension, stage, histological type, and myometrial invasion (MI) were collected. The association between clinical indicators and LNM was evaluated.ResultsThe results indicated that neutrophil (NE), monocyte (MO) counts, SII, cancer antigen 125 (CA125), cancer antigen 153 (CA153), cancer antigen 199 (CA199), and the expression of estrogen receptor (ER) and Ki67 were higher in EC patients with LNM than in those without LNM (P<0.05). Lymph vascular space invasion (LVSI) was also associated with LNM (P<0.05). Consequently, the SII, CA125, CA153 and LVSI were found to be independent risk factors for LNM, and a nomogram including these indicators was performed. The ROC curve analysis showed that compared with a single index, the combination of the SII, CA125, CA153 and LVSI significantly improved the efficiency of diagnosing LNM in EC patients (AUC=0.865, P < 0.001). Moreover, the SII was significantly associated with age, menopause, and FIGO stage (P < 0.05). Further logistic regression analysis suggested that elevated serum SII was an independent risk factor for MI and progression to a higher pathological grade in young premenopausal EC patients. In addition, elevated SII was an independent risk factor for advanced EC progression in age ≥55 or postmenopausal EC patients.ConclusionAn elevated SII is an independent risk factor for LNM in patients with EC. In addition, the SII can be used as a predictor of MI and higher pathological grade in young premenopausal EC patients.

A nomogram to predict risk of lymph node metastasis in early gastric cancer

Lymph node (LN) metastasis is known as one of the most important prognostic factors for early gastric cancer (EGC) patients. Patients without LNM normally have better prognosis. However, there is no evaluation criteria to accurately assess the possibility of LN metastasis. Therefore, this study aims to establish an effective nomogram for prognosis prediction. In this study, 285 EGC patients from January 2010 to December 2015 were enrolled. Pearson’s Chi-Square (χ2) test (including continuity correction when appropriate) and logistics regression analyses was used to identify the risk factors for LN metastasis. The independent risk factors identified were then incorporated in a nomogram model. The predictive accuracy and discriminative ability of the nomogram were evaluated by receiver operating characteristic curve (ROC) and calibration curve. LN metastasis occurred in 59 (20.7%) EGC patients. And most of these patients were submucosal cancers (48/59). Chi-square test indicated lymphovascular emboli, carbohydrate antigen 19-9 (CA19-9), ulcer, tumor size, tumor infiltration and histological grade were the risk factors, and multivariate logistics analyses confirmed all these six factors were independent risk factors of LN metastasis, which were selected to construct the nomogram. The nomogram proved well calibrated and had good discriminative ability (C-index value: 0.842). The proposed nomogram could result in more-accurate risk prediction for EGC patients.

Risk Factors of Lymph Node Metastasis and Its Prognostic Significance in Early Gastric Cancer: A Multicenter Study.

BackgroundEarly gastric cancer (EGC) is invasive gastric cancer that invades no deeper than the submucosa, regardless of lymph node metastasis (LNM). It is mainly treated by surgery. Recently, the resection range of EGC has been minimized, but cancer recurrence and overall survival in some patients should be given high status. LNM is an important indicator of prognosis and treatment in gastric cancer. The law of the number and location of metastatic lymph nodes in EGC is not yet clear. Therefore, we aimed to identify the risk factors of LNM in radically resected EGC and guide treatment.MethodsThe clinicopathological factors of 611 patients with EGC were retrospectively analyzed in six hospitals between January 2010 and December 2016. The relationship between clinicopathological factors and LNM, as well as their prognostic significance, were analyzed by univariate and multivariate analyses.ResultsThe rate of LNM was 20.0% in the 611 EGC patients. The depth of invasion, differentiation type, tumor diameter, morphological ulceration, and lymphovascular invasion were independent risk factors for LNM (P<0.05) by logistic regression analysis. Tumor location in the proximal third of the stomach and morphological ulceration were significant factors for group 2 LNM. Moreover, the 5-year survival rate was 94.9% for patients with no positive nodes, 88.5% for patients with 1-2 positive nodes, 64.3% for patients with 3-6 positive nodes, and 41.8% for patients with >6 metastatic nodes. Interestingly, the 7-year risk of relapse diminished for patients with no LNM or retrieved no less than 15 lymph nodes.ConclusionsFifteen lymph node dissection and D2 radical operation are the surgical options in case of high risk factors for LNM. Extended lymph node dissection (D2+) is recommended for morphological ulceration or disease located in the proximal third of the stomach due to their high rate of group 2 LNM. Furthermore, LNM is a significant prognostic factor of EGC. Moreover, lymph nodes can also play a significant role in the chemotherapeutic and radiotherapy approach for non-surgical patients with EGC.

S427 Predictors for Lymph Node Metastasis and Survival of Patients With T1b Esophageal Adenocarcinoma Treated With Surgery and Endoscopic Therapy: An Analysis of Surveillance, Epidemiology, and End Results Database

Introduction: There have been a few population-based studies to compare the long-term outcomes of patients those received surgery versus with endotherapy (ET) for T1b esophageal adenocarcinoma (EAC). In this study, we aimed to determine the risk factors of lymph node metastasis (LNM) and evaluate the long-term survival of patients with T1b EAC who underwent ET or surgery. Methods: We used the Surveillance Epidemiology and End Result database to identify patients with T1b histologically confirmed EAC diagnosed between 2004-2018. Patients were grouped based on whether they received ET (n=185) or surgery (n=935). Prevalence of LNM at initial diagnosis was analyzed. Multivariate logistic regression was performed to identify factors associated with LNM and endoscopic therapy. A Cox proportional hazards model was performed to examine the association of treatment options and survival after controlling for potential confounders. Results: Overall, 16% of cases had LNM at the time of diagnosis. The risk factors for LNM included lesion size ≥20 mm (OR 1.7, 95%CI 1.2-2.4) and poor tumor differentiation (OR 1.6, 95%CI 1.2-2.3). The use of ET increased progressively, from 0.8% in 2008 to 1.6% in 2018. ET was more commonly performed in patients with age >65 yr (OR 2.7, 95%CI 1.5-4.6), tumor size ≤20mm (OR 2.1, 95%CI 1.3-3.7), recent year of diagnosis (2008-2018 vs 2004-2007; OR 3.1, 95%CI 1.7-5.7) and those without LNM. Three-year overall survival was higher in surgery group than in the ET group (65.4% vs 54.4%, p = 0.04). Of 946 patients with T1bN0M0 EAC, 177 underwent ET and 769 had radical surgery. After adjusting for patient and tumor specific factors, patients with T1bN0M0 EAC treated by ET had a worse overall survival outcome (HR 1.4, 95% CI 1.06-1.97, P=0.01) compared to those received surgery. ET and surgery resulted in statistically equivalent in esophageal cancer mortality [HR 0.98, 95%CI 0.62-1.56, P=0.96]. Conclusion: In T1b EAC, tumor size ≥20mm and poor differentiation are the significant risk factors for LNM. Cancer specific survival in patients with T1bN0M0 EAC treated with ET appears to be similar to those treated with surgery. We found that patients who have significant coexisting conditions such as older age, are less likely to undergo surgery, as reflected in our study that older patients were more likely to have ET, which could partly explain higher overall mortality in ET group.Figure 1.: A: In a multivariate Cox proportional hazards model, adjusted for clinical and tumor-related factors, ET was associated with increased cumulative hazard (HR 1.4, 95% CI 1.06-1.97) compared to surgery. B: No difference was noted in cancer specific survival between the treatment groups when adjusted for age, sex, race, tumor size, tumor differentiation, and year of diagnosis.

Prognostic Radiological Tools for Clinical Stage IA Pure Solid Lung Cancer.

In this study, we analyzed prognostic radiological tools and surgical outcomes for radiologically pure solid adenocarcinomas (AD) and squamous cell carcinoma (SQ) in clinical stage IA. We retrospectively investigated 130 patients who underwent surgical resections. We assessed the predictive risk factors for recurrence and pathological lymph node metastasis (LNM). There was no statistical difference in recurrence free survival (RFS) or cancer-specific survival (CSS) between AD and SQ groups (p = 0.642 and p = 0.403, respectively). In the whole cohort, tumor size on lung window and mediastinal settings, and tumor disappearance ratio using high-resolution computed tomography (HRCT) were not prognostic parameters (p = 0.127, 0.066, and 0.082, respectively). The maximal standardized uptake value (SUVmax) using positron emission tomography-CT was associated with recurrence (p = 0.016). According to the receiver operating characteristic curve, the cut-off value of SUVmax for recurrence was 4.6 (p = 0.016). The quantitative continuous variables using any radiological tools were not associated with LNM. However, tumor diameter on mediastinal setting ≥8 mm with SUVmax ≥2.4 could be a risk factor for LNM. Pure solid AD and SQ were equivalent for the RFS and CSS. SUVmax was useful to predict recurrence. The tumor diameter on a mediastinal setting and SUVmax were useful in predicting pathological LNM.

Influencing Factors and Cumulative Risk Analysis of Cervical Lymph Node Metastasis of Papillary Thyroid Microcarcinoma.

ObjectiveTo explore the influencing factors and cumulative risk of lymph node metastasis (LNM) in papillary thyroid microcarcinoma (PTMC) patients.Methods607 patients confirmed PTMC pathologically after thyroidectomy were enrolled in this retrospective study. The rate of LNM was calculated. Different clinicopathological characteristics were compared in PTMC patients with and without LNM and in different subgroups of LNM, respectively. Correlation between clinicopathological characteristics and LNM was analyzed and the cumulative risk of LNM according to different clinicopathological characteristics was calculated.Results(1) There were 228 cases (37.56%) of PTMC combined with LNM. Compared with the non-lymph node metastasis group, the proportion of age <55 years, male, multiple foci, bilateral foci, diameter>0.5cm, extracapsular invasion, HT and intermediate-to-high risk stratification for recurrence of the LNM group was significantly increased (all p<0.05);(2) Multivariate logistic regression analysis showed that age <55years, male, multiple foci, diameter>0.5cm,HT were independently positively correlated with LNM (all p <0.05); (3) Subgroup analysis showed that women aged <55 years combined with HT and aged≥55 years combined with BMI≥25 kg/m2 were independently positively associated with LNM; (4) With the increase of the tumor diameter, the cumulative risk of LNM in group of age <55 years, males, and multiple foci increased gradually, and was higher than those of age≥55 years, females and single foci, respectively. (5) Among the 228 cases of LNM, the proportion of lymph nodes (LN) >5 and the positive rate of LN were both higher in male group than that in the female group. The proportion of multiple foci and HT in LLNM group was higher than that in CLNM group (all P<0.05).ConclusionAge <55 years, males, multiple foci, diameter >0.5cm and HT were independent risk factors of LNM; HT was an independent risk factor for LNM in female <55 years old, and BMI≥25 kg/m2 was an independent risk factor for LNM in female ≥55 years old; The increase of tumor diameter in age <55 years, males, multiple foci, and bilateral foci increased the cumulative risk of LNM, respectively; The number of LNM and the positive rate of LNM were both higher in male, and patients with multiple foci or HT were more likely to develop into LLNM.

Clinical and Molecular Characterizations of Papillary Thyroid Cancer in Children and Young Adults: A Multicenter Retrospective Study.

Background: Papillary thyroid carcinoma (PTC) is a rare malignancy in children and young adults (CAYA). It often presents with aggressive disease patterns and advanced stages, which are clinically distinct from those in adult patients. In this study, we sought to characterize and better understand the clinical variants of PTC in CAYA and explore the underlying mechanisms. Methods: CAYA patients (age ≤18 years) diagnosed with PTC between June 2006 and June 2018 were retrospectively recruited from five hospitals. Demographic information, pathological data, and follow-up status were recorded. Tumor samples obtained from 20 children (mean age 15.15 years) and 10 adults (mean age 38.80 years) underwent comprehensive whole transcriptome sequencing. Differentially expressed genes (DEGs), mutational landscape, and immune infiltration were analyzed. Results: A total of 217 CAYA-PTC patients (162 females and 55 males) with an average age of 14.38 ± 3.53 years (range 2-18) were included. Lymph node metastasis (LNM) was observed in 85.71%, of which 57.60% were in the lateral cervical compartment. Disease recurred in 28 of 217 (12.90%) patients with a median follow-up of 4.76 years. Multivariate logistic regression analysis revealed that age, bilateral disease, extrathyroidal extension, and coexisting Hashimoto's thyroiditis (co-HT) were independent risk factors for LNM, while co-HT was the only risk factor for recurrence. Using whole transcriptome sequencing of PTC tissues, we identified 301 DEGs. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses showed that differences in immune mediators played important roles, based on the distributions of mutation frequencies, types, and expression levels between CAYA and adult patients. Based on the integrated data sets, we identified significantly mutated immune genes, cluster of differentiation 24 (CD24), coagulation factor 12 (F12), coagulation factor 5 (F5), integrin subunit alpha 3 (ITGA3), and retinoic acid early transcript 1L (RAET1L), which were then verified by immunohistochemistry. Furthermore, resting mast cells, resting natural killer cells, plasma cells, and regulatory T cells were different in the CAYA-PTC group and correlated with the expression of immune checkpoints. Conclusions: There are considerable variabilities that may contribute to the different clinical presentations between CAYA and adult PTC patients, among which the decrease in protective immune cells may be a factor. Collectively, our results add to the possible biological mechanisms involved in CAYA-PTC.