Risk Of Lymph Node Metastasis Research Articles

Evidence for the extent and oncological benefit of lymphadenectomy in gastric cancer

The oncological standard for curative treatment of non-metastasized gastric cancer is surgical resection with systematic D2 lymphadenectomy. Early stage carcinomas (pT1a) with circumscribed prerequisites are an exception as they can be endoscopically resected; however, by infiltration of invasive gastric cancer into submucosal layers (pT1b) the risk for lymph node metastases is up to 25-28%. Due to the lack of screening programs in the western world, most gastric cancers are diagnosed in an advanced stage and the treatment is multimodal with perioperative multiple chemotherapy and increasingly more also with immunotherapy. Nevertheless, despite multidisciplinary treatment strategies, the benefits of surgical resection and an adequate systematic lymphadenectomy are still independent prognostic factors for long-term survival; however, the classification and extent of the lymphadenectomy are regularly updated, especially as a result of the spread of minimally invasive operations, and in addition are internationally evaluated differently. In the context of perioperative morbidity and oncological outcome this includes the approach with respect to individual lymph node stations, especially lymph node stations 10 and 12a and in addition the classification D1-D3. Furthermore, continuous modifications, particularly from Asia, such as sentinel lymph node resection underline the pursuit of improvements. The multitude of alterations in the context of multidisciplinary treatment concepts and the international heterogeneity make the evaluation of the value of individual surgical aspects noticeably more difficult.

Smac/DIABLO protein acts as an independent prognostic factor in oral squamous cell carcinoma

Oral squamous cell carcinoma (OSCC) poses significant health risks with increasing incidence and mortality rates. In this context, there is an urgent need to explore novel biomarkers to enhance therapeutic strategies and improve survival. Understanding apoptotic evasion in cancer pathogenesis, this pioneering study aims to investigate the correlation between a pro-apoptotic protein Smac/DIABLO and patient prognosis within the OSCC cohort. Immunohistochemistry (IHC) was employed to analyze Smac/DIABLO protein expression and correlate with clinicopathological and prognostic factors during a long-term follow-up. Smac/DIABLO low expression was associated with worse overall survival (OS), relapse-free survival (RFS), disease-specific survival (DSS), and an increase in risk of lymph node metastasis (LNM) in univariate analyses. Furthermore, multivariate analyses confirmed Smac/DIABLO as an independent prognostic factor, predicting poorer OS [Hazard Ratio (HR) = 3.6 (95% CI 1.7–7.6), p < 0.001], RFS [HR = 2.9 (95% CI 1.4–5.6), p = 0.003], DSS [HR = 6.7 (95% CI 2.7–16.7), p < 0.001], and increased likelihood of LNM [Odds Ratio (OR) = 4.8 (95% CI 1.4–15.9), p = 0.011]. Patients with positive Smac/DIABLO expression exhibited three times higher survival probability. Low proapoptotic protein Smac/DIABLO expression significantly influences prognostic predictions and strongly correlates with poor OSCC outcomes. Future studies involving Smac-mimetic drugs in OSCC are needed to evaluate their pro-apoptotic potential in cancer cells.

Impact of age stratification on risk of lymph node metastasis in T1 oral tongue squamous cell carcinomas patients

BackgroundThe objective of this study is to assess the association between age and lymph nodes metastasis (LNM) in T1 oral tongue squamous cell carcinomas (OTSCC) patients. MethodsPatients with T1 OTSCC were extracted from the SEER database between 2005 and 2014. Univariate and multivariate logistic regression models were produced to recognize the association between age and risk factors of LNM. ResultsA total of 3535 patients were analyzed. Younger patients more frequently presented with LNM compared to their older peers (P < 0.01). In multivariate analyses, older age was associated with a significantly lower risk of LNM. Compared to patients aged 12–39-years-old, the hazard ratios for patients aged 40–49, 50–59, 60–69, 70–79 and 80–101 years old were 0.999 (95 % confidence interval [CI] 0.684–1.461), 0.863 (95 % CI 0.611–1.219), 0.972 (95 % CI 0.687–1.373), 0.667 (95 % CI 0.452–0.983), and 0.395 (95 % CI 0.241–0.646), respectively. Subgroups analysis shows that the effect of older age was significantly associated with a lower risk of LNM in Caucasian female who harbored moderately differentiated disease. ConclusionOur study demonstrates that younger patients with T1 OTSCC had a higher risk of LNM than their old peers, especially for tumors with poor differentiation. More accurate assessments of LNM and prophylactic neck dissection or prophylactic adjuvant radiation therapy to neck will be imperative for reducing recurrence in younger T1 OTSCC.

NET guidelines for white patients may not fit Asian patients

IntroductionPancreatic neuroendocrine tumors (pNETs) are slow growing, malignant tumors that show different survival outcomes by race. Current size-based guidelines were largely developed in White patients. Our aim was to investigate tumor size and incidence of lymph node metastasis (LNM) between White and Asian pNET patients to evaluate generalizability of established guidelines. MethodsUsing the National Cancer Database (NCDB), we conducted a multi-institutional analysis of patients with low grade, resected, nonfunctional, sporadic, non-metastatic pNETs. Chi-squared tests were implemented to determine correlation between PTS and LMN incidence as well as race and LMN incidence. A logistic regression model was utilized to determine correlation between LMN, tumor size, and race. Overall survival was assessed using the Kaplan-Meier method. ResultsA total of 4977 pNET patients (205 Asian and 4772 White) were included in our analysis. Asian patients presented with smaller tumors (3.0 ​cm vs 3.9 ​cm, p ​= ​0.029) but when grouped by size, there was no difference in the distribution (p ​= ​0.77). White patients demonstrated a higher incidence of lymph node metastasis at presentation compared to Asian patients (27 ​% vs 19 ​%, p ​= ​0.013), a higher likelihood of an R0 resection (95.3 ​% vs. 89.3 ​%, p ​< ​0.0001).Within both populations, tumor size (<2 ​cm, 2–3 ​cm, and ≥3 ​cm) positively correlated with incidence of LNM (11.5 ​%, 24.6 ​%, and 39.1 ​%). No difference of LNM was seen between racial cohorts at PTS <3 ​cm, however, Asian patients were less likely to exhibit LNM at PTS ≥3 ​cm (28.2 ​% and 39.5 ​%, p ​= ​0.04). Overall survival was not significantly different between racial groups (p ​= ​0.92). ConclusionSize based surgical resection guidelines for pancreatic neuroendocrine tumors based on a predominantly White patient population may not be generalizable to the Asian population. Within this population, we found the risk of lymph node metastasis did not increase at similar rates with increasing primary tumor size.

Lymph node metastasis risk factors in T2 colorectal cancer.

This study evaluates risk factors for lymph node metastasis (LNM) in T2 colorectal cancer to refine patient selection for endoscopic resection. We reviewed records from consecutive patients who had undergone curative surgical resection of T2 colorectal cancerat our institution in Japan between April 2001 and December 2021. Data on conventional clinicopathologic variables were retrieved from the pathology reports at the time of surgery. The clinicopathological features included patient age, sex, tumor diameter, morphology, tumor location, lymphatic invasion, vascular invasion, tumor differentiation, carcinoembryonic antigen and carbohydrate antigen 19-9 levels, number of lymph node dissections, presence of adenoma component, and LNM. Among the patients (338 men, 320 women), 170 (25.8%) exhibited LNM. Multivariate logistic regression identified three independent risk factors for LNM: lymphatic invasion (odds ratio [OR], 32.6; 95% confidence interval [CI], 17.3-61.4; p < 0.0001), female sex (OR, 1.70; 95% CI, 1.10-2.62; p = 0.02), and elevated carcinoembryonic antigen levels (OR, 2.56; 95% CI, 1.10-5.96; p = 0.03). Lymphatic invasion, female sex, and high carcinoembryonic antigen levels significantly increase the risk of LNM in T2 colorectal cancer.

Estimation of invasion depth of early colorectal cancer using Endoscopic ultrasonography and Magnifying chromoendoscopy: a meta-analysis.

Introduction magnifying chromoendoscopy (MCE) and Endoscopic ultrasonograpty (EUS) are often used as diagnostic tools to estimate the depth of invasion in early colorectal cancers (CRCs). The aim of this study was to compare MCE with EUS in distinguishing between slight submucosal invasion (invasion depth <1000μm) and massively submucosal invasion in patients with early CRCs, since slight submucosal invasion is currently considered as an indication for endoscopic resection and submucosal cancer with massively submucosal invasion should be surgically treated due to an increased risk of lymph node metastasis. Methods For this meta-analysis, relevant studies were identified from PubMed, Embase and the Cochrane Library databases between the time of the establishment and April 2023.Data on the yield of tumors were extracted, pooled, and analyzed by stata15.0 software. The sensitivity, specificity, positive likelihood ratio and negative likelihood ratio in differentiating massive submucosal invasion from slight submucosal invasion were calculated for both diagnostic modalities. Results Twenty-six studies involving 1,2586 lesions were included: sixteen were studies on MCE and 7 were studies on EUS and 3 were studies on both MCE and EUS. The pooled sensitivity of MCE was 0.78(95%CI 0.72-0.83), the specificity was 0.95（0.95%CI 0.91-0.97）, the positive likelihood ratio was 15.4（0.95%CI 8.7-27.4) and the negative likelihood ratio was 0.23（0.95%CI 0.18-0.30).The pooled sensitivity of EUS was 0.88(95%CI 0.81-0.93), the specificity was 0.87（0.95%CI 0.80-0.91）, the positive likelihood ratio was 6.7（0.95%CI 4.4-10.3) and the negative likelihood ratio was 0.13（0.95%CI 0.08-0.23). Conclusion The sensitivity tended to be higher in EUS than MCE for early CRCs with massively submucosal invasion, whereas the specificity was significantly lower in EUS than in MCE.

Therapeutic strategies for ypT1 rectal cancer after neoadjuvant chemoradiotherapy: a retrospective cohort study

PurposeThe optimal treatment of ypT1 rectal cancer after neoadjuvant chemoradiotherapy (nCRT) remains controversial. This study aimed to determine whether local excision is non-inferior to radical surgery and whether adjuvant chemotherapy (ACT) would improve survival in patients with ypT1 rectal cancer after nCRT.MethodsWe enrolled 1212 and 91 patients with ypT1 rectal cancer underwent nCRT followed by radical surgery from the SEER database (2004–2018) and the Zhejiang Cancer Hospital (ZJCH) (2010–2022), respectively. Another 62 patients underwent LE were also identified from SEER registries. Propensity score matching was performed to balance baseline characteristics between patients in different treatment groups.ResultsRegional nodal metastasis was histopathologically detected in 257 patients (20.7%) within the SEER cohort, showing a significant association with poor cancer-specific survival (CSS) and overall survival (OS). Consistent findings were also observed in the ZJCH cohort. After 1:1 propensity score matching (60 pairs), no significant differences were observed between the extended resection and local excision groups in CSS (hazard ratio [HR] 0.88, P = 0.785) and OS (HR 0.81, P = 0.450). Patients with regional nodal metastases were more likely to receive ACT, while no apparent survival benefit was observed with additional ACT after PSM adjusting (187 pairs). Notwithstanding, for individuals younger than 50 years, ACT might provide a survival benefit in CSS (HR 0.25, P = 0.033) and OS (HR 0.30, P = 0.022).ConclusionAlthough patients with ypT1 rectal cancer have a non-negligible risk for nodal metastasis, oncologic outcomes of local excision following nCRT seem to be comparable to radical surgery. ACT could not effectively improve prognosis in patients with ypT1 tumors, except for those younger than 50 years of age.

Value of Computed Tomography Scan for Detecting Lymph Node Metastasis in Early Esophageal Squamous Cell Carcinoma.

The necessity of computed tomography (CT) scan for detecting potential lymph node metastasis (LNM) in early esophageal squamous cell carcinoma (ESCC) before endoscopic and surgical treatments is under debate. Patients with histologically proven ESCC limited to the mucosa or submucosa were examined retrospectively. Diagnostic performance of CT for detecting LNM was analyzed by comparing original CT reports with pathology reports. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated. A total of 625 patients from three tertiary referral hospitals were included. The rate of pathologically confirmed LNM was 12.5%. Based on original CT reports, the sensitivity, specificity, accuracy, PPV, and NPV of CT to determine LNM in T1 ESCC were 41.0%, 83.2%, 77.9%, 25.8%, and 90.8% respectively. For mucosal cancers (T1a), these parameters were 50.0%, 81.7%, 80.9%, 6.8%, and 98.4%, respectively. For submucosal cancers (T1b), they were 40.0%, 85.0%, 75.0%, 43.0%, and 83.3%, respectively. Additionally, the diagnostic performance of CT for LNM was relatively better for ESCC in the lower esophagus. Pathologically, 69.2% of patients with LNM did not exhibit lymphovascular invasion (LVI), and the sensitivity of CT for recognizing LNM in these patients (33.3%) was lower than those with LVI (58.3%). Computed tomography can detect nearly half of the LNM cases in early ESCC with high specificity. The performance of CT further improved in LNM cases with LVI. Therefore, we conclude that routine preoperative CT for the assessment of potential LNM risk in patients with early ESCC is necessary.

Enhanced Risk Stratification for Sentinel Lymph Node Biopsy in Head and Neck Melanoma Using the Merlin Assay (CP-GEP).

Sentinel lymph node biopsy (SLNB) for head and neck melanomas involves complex challenges due to intricate lymphatic networks and delicate anatomic structures. The Merlin Assay (CP-GEP), merging clinicopathologic data with gene expression profiling, offers a non-invasive method to identify patients who have a low risk for nodal metastasis, potentially sparing these low-risk patients from surgical procedures. This study evaluated 250 clinically node-negative patients with stage I, II, or III melanoma from the Mayo Clinic and University Hospitals Cleveland Medical Center who had tumors in the head and neck region diagnosed between 2004 and 2021. All the patients underwent SLNB. The Merlin Assay, using the CP-GEP model, combines patient age at diagnosis, Breslow thickness, and gene expression of eight specific genes from the primary tumor to predict the risk of nodal metastasis. The SLNB positivity rate was 14% overall, and CP-GEP predicted a possible 40.8% reduction in SLNB procedures with a negative predictive value (NPV) of 98%. For 215 SLNB-negative patients (5-year recurrence-free survival [RFS] of 76.9%, distant metastasis-free survival [DMFS] of 84.3%, and melanoma-specific survival [MSS] of 90.6%), CP-GEP improved risk stratification by identifying 100 patients as low risk with 5-year RFS of 86.1%, DMFS of 92.7%, and MSS of 95.3%. Among 167 T1-T2 patients, the SLNB positivity rate was 8.4%, and CP-GEP achieved an SLNB reduction rate of 56.3% with an NPV of 98.9%. The Merlin Assay effectively categorizes head and neck melanoma patients by risk, enabling more accurate clinical decision-making regarding SLNB and follow-up evaluation, especially for early-stage melanoma patients.

Construction of a risk prediction model for axillary lymph node metastasis in breast cancer based on gray-scale ultrasound and clinical pathological features.

This study aimed to develop a model to predict the risk of axillary lymph node (ALN) metastasis in breast cancer patients, using gray-scale ultrasound and clinical pathological features. A retrospective analysis of 212 breast cancer patients who met the inclusion criteria from January 2011 to December 2021 was carried out. Clinical and pathological characteristics, including age, tumor size, pathological type, molecular subtype, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and proliferation cell nuclear antigen (Ki-67), were examined. Preoperative ultrasound examinations were performed, and ultrasound radiomics features of breast cancer lesions were extracted using Pyradiomics software. The data was divided into training (70%) and testing (30%) sets. A predictive model for axillary lymph node metastasis (ALNM) was established by combining clinical and ultrasound features. The diagnostic performance of the model was evaluated using receiver operating characteristic (ROC) curves and five-fold cross-validation. The rate of lymph node metastasis was 41.51%. Using LASSO algorithm, 17 features linked to ALN metastasis were extracted from a comprehensive databank of 8 clinical features and 1314 ultrasound radiomic attributes. Of these, four were clinical-pathological features (tumor size, tumor type, age, and expression levels of the Ki-67 protein), and 13 were radiomic features. And the following features exhibited both high weights and correlation coefficients: tumor size (R=0.29, weight=0.071), tumor type (R=-0.24, weight=-0.048), wavelet-LH_glcm_Imc1 (R=0.28, weight=0.029363), wavelet-LH_glszm_SZNUN (R=-0.20, weight=-0.028507), and squareroot_ firstorder_ Minimum (R= -0.25, weight= -0.059). The ROC area under the curve for the model in the training and testing sets was 0.882 (95% CI: 0.830-0.935) and 0.853 (95% CI: 0.762-0.945), respectively. The predictive model demonstrated a sensitivity of 87.5% on the training set and 79.2% on the test set, with corresponding specificities of 75.0% and 77.5%, accuracy of 80.4% and 78.1%, respectively. When evaluated using 5-fold cross-validation, the model achieved an average test set area under the curve (AUC) of 0.799 and a training set AUC of 0.852. The clinical-radiomic model has the potential to predict axillary lymph node metastasis in breast cancer.

In a prospective, multicenter study, the 31-GEP identified patients at increased risk of tumor recurrence and added significant prognostic value to AJCC staging

Cutaneous melanoma (CM) guidelines base management decisions on a patient’s American Joint Committee on Cancer (AJCC) tumor stage. However, limitations in staging accuracy suggest additional tools could improve risk-aligned patient management decisions. The 31-gene expression profile (GEP) test identifies patients with CM with low (Class 1A), intermediate (Class 1B/2A), or high (Class 2B) risk for sentinel lymph node (SLN) positivity, recurrence, metastasis, and death. In this multicenter, prospective study, we validated the 31-GEP for risk of recurrence and demonstrated the added value of 31-GEP to AJCC staging. Patients were included in the prospective CONNECTION study if they were tested with the 31-GEP from 2018 to the present (n=876). Survival was estimated using Kaplan-Meier analysis and 31-GEP stratification tested with the log-rank test. Cox regression was performed to identify predictors of recurrence. ANOVA was used to compare Cox models for the most accurate recurrence prediction. Patients with a Class 1A result had significantly higher 3-year recurrence-free survival than those with a Class 1B/2A or Class 2B result (98.5% vs. 80.8% vs. 63.0%, p&lt;0.001). The 31-GEP had higher sensitivity (75.0% vs. 37.5%) and negative predictive value (98.6% vs. 96.9%) than AJCC staging. Multivariable analysis demonstrated that Class 1B/2A (hazard ratio, HR=3.12, p=0.037) and Class 2B (HR=5.91, p=0.002) were significant predictors of recurrence in addition to stage IB (HR=4.02, p=0.02), IIA (HR=6.06, p=0.006), IIC (HR=17.14, p&lt;0.001), and III (HR=8.84, p&lt;0.001). Stage IIB (HR=4.63, p=0.057) was not significant. Comparing a staging-only model to a 31-GEP+staging model showed that adding 31-GEP to staging significantly improved prediction accuracy over staging alone (ANOVA: c2=10.58, p=0.005). In this prospective study, the 31-GEP stratified risk of recurrence, was a significant predictor of recurrence, and added significant predictive value to AJCC staging. The 31-GEP identifies patients at high risk of recurrence who should be managed more intensely, and adding 31-GEP to staging allows better risk-aligned care decisions, which can lead to improved patient outcomes.

Accurate prediction of the lymph node status in ampullary duodenal carcinoma: potential guidance for clinical management

PurposeThis study aimed to identify the risk factors associated with ampullary duodenal carcinoma (a-DC) and develop a clinical model to dynamically and accurately predict the risk of lymph node metastasis (LNM) in a-DC patients.MethodsData from 4077 patients (2004–2020) were extracted from the Surveillance, Epidemiology, and End Results database to form a training cohort, while 173 cases (2010–2020) from Zhejiang Provincial People’s Hospital in China were used as an external validation cohort. A reliable LASSO-logistic method was employed to identify independent risk factors for a-DC LNM, and a nomogram was developed based on these factors to assess the risk of a-DC LNM. The nomogram was evaluated using the Akaike information criterion, misclassification error, area under the curve, and likelihood ratio test. Finally, the nomogram’s accuracy and generalizability were externally validated..ResultsAfter screening using LASSO and logistic regression four variables were identified as independent risk factors for a-DC LNM: sex (P < 0.001), tumor size (P < 0.001), grade (P < 0.001), and tumor extension (P < 0.001). The area under the curve of the nomogram was 74.8% in the training group and 88.9% in the external validation group. The calibration curves demonstrated that the LNM predictions made by the nomogram were in satisfactory agreement with the actual observed LNM. Additionally, the decision curve analysis curves indicated effective clinical utility of the nomogram.ConclusionsA nomogram based on the LASSO-logistic analysis was constructed to predict a-DC LNM, demonstrating good performance and clinical application value.

A nomogram of inflammatory indexes for preoperatively predicting the risk of lymph node metastasis in colorectal cancer

PurposeTo investigate the independent risk factors associated with the development of lymph node metastasis (LNM) in patients with colorectal cancer (CRC), focusing on preoperative systemic inflammatory indicators, and to construct a corresponding risk predictive model.Materials and MethodsThe clinical data of 241 patients with CRC who underwent surgery after the first diagnosis between January 2012 and December 2017 at our hospital were reviewed. A best logistic regression model was constructed by Lasso regression for multivariate analysis, from which a Nomogram was derived. Using bootstrap to conduct internal validation. The model’s predictive performance and clinical practicability were evaluated using the receiver operating characteristic curve (ROC) curve, calibration curve, and decision curve analysis (DCA). External validation was conducted using retrospective data from 170 patients who underwent surgery between January 2020 and May 2022 at another hospital.ResultsCross-validation indicated smoking history, neutrophil–lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), fibrinogen-albumin ratio (FAR), and fecal occult blood (FOB) as variables with non-zero coefficients. These factors were included in the logistic regression, and multivariate analysis confirmed that smoking history, NLR, LMR, FAR, and FOB were independent risk factors (P < 0.05). The ROC and calibration curve of the original model and external validation indicated strong predictive power of the model. DCA suggested the model’s favorable clinical utility.ConclusionsThe model constructed in this study has robust predictive performance and clinical utility for the preoperative determination of CRC LMN, offering significant for clinical decision-making in patients with CRC.

Stratification of risk for lymph node metastasis and long-term oncologic outcomes in patients initially treated by endoscopic resection for rectal neuroendocrine tumors

Background and AimsThe treatment of rectal neuroendocrine tumors (NETs) is determined by the risk of lymph node (LN) metastasis. We aimed to stratify the risk of LN metastasis according to the number of risk factors and evaluate the long-term outcomes of patients initially treated endoscopically for rectal NETs. MethodsWe retrospectively analyzed 441 patients initially treated with endoscopy for rectal NETs; those who had at least one of the risk factors for LN metastasis were defined as high-risk patients. We stratified LN metastasis rates according to the number of risk factors. The 5-year overall survival (OS) and recurrence-free survival (RFS) were compared between the high- and low-risk groups. ResultsPathologic size (odds ratio [OR], 1.208; 95% confidence interval [CI], 1.062–1.374; P=0.001), (+) resection margin invasion (OR, 2.897; 95% CI, 1.057–7.936; P=0.039), and angiolymphatic invasion (OR, 22.155; 95% CI, 7.563–64.904; P=0.001) were risk factors for LN metastasis. The rate of LN metastasis increased as the number of risk factors increased (P=0.001). The 5-year RFS rates were 98.7% and 99% in the high- and low-risk groups, with no significant difference (P=0.966). The 5-year OS rates were 100% and 99.5% in the high- and low-risk groups, with no significant difference (P=0.571). ConclusionsThe risk of LN metastasis increased significantly when the number of risk factors increased in patients with rectal NETs. Patients who initially underwent endoscopic resection for rectal NETs showed a favorable long-term oncologic outcome if salvage treatments were performed, depending on the stratification of their risk factors.

A comprehensive overview of gastric cancer management from a surgical point of view

Despite advancements in medical care, surgical technologies, and the development of novel treatments over the past decade, the prognosis for patients with gastric cancer (GC) has only modestly improved. This is primarily due to the fact that the majority of patients are diagnosed at advanced stages or present with metastatic disease. Radical resection remains the cornerstone of potentially curative treatment, yet the overall 5-year survival rate remains below 35%. The management of GC varies globally, influenced by factors such as geographical disparities, patient comorbidities and performance status, surgical approaches, and available medical resources. Multidisciplinary collaboration and a multimodal treatment approach are essential for optimizing patient outcomes. Surgeons must stay updated on emerging surgical concepts and make informed decisions regarding patient selection, timing of intervention, and the adoption of appropriate surgical techniques to improve both quality of life and prognosis. This review aims to provide a surgical perspective on the management of GC across all stages, highlighting the importance of a comprehensive treatment approach. Endoscopic resection may be a viable option for early GC in patients with minimal risk of lymph node metastasis, particularly in elderly patients with high surgical risk or severe comorbidities. For advanced GC, neoadjuvant therapy followed by surgery could be a promising strategy to improve patient outcomes. Conversion surgery offers a potential survival benefit for patients who respond to treatment with tumor downstaging. The treatment of peritoneal carcinomatosis remains challenging; however, hyperthermic intraperitoneal chemotherapy combined with complete cytoreductive surgery or pressurized intraperitoneal aerosolized chemotherapy may prolong survival or improve quality of life in highly selected patients.

Clinical Management of Patients with Colorectal Intramucosal Carcinoma Compared to High-Grade Dysplasia and T1 Colorectal Cancer.

In the colorectum, intramucosal carcinoma (IMC), like high-grade dysplasia (HGD), should be resected endoscopically. We were interested to understand how real-world treatment of IMC cases compares to management of HGD and T1 colorectal cancer (CRC). A multicenter cohort study was conducted. Through pathology databases, all patients diagnosed between 2010-2019 with HGD, IMC or T1 CRC polyps at three hospitals in a regional Canadian center were identified. The primary outcome was the proportion of surgical management of IMC compared to HGD after complete endoscopic resection. Secondary outcomes were the proportion of synchronous advanced neoplasia (SAN) and the adjusted hazard ratios (aHR) for metachronous advanced neoplasia (MAN) in the three groups among patients eligible for follow-up. We identified 753 patients with IMC or HGD on a first pathology diagnosis, including 601 after complete endoscopic resection. Patients with IMC were more likely to undergo surgery after complete endoscopic resection compared to patients with HGD (10.5% [6/57] vs 0% [0/544], p<0.001). 455 patients had follow-up endoscopy and pathology (mean age 67.1y, 42.2% female, median follow-up 3.4y): 269 with HGD, 60 with IMC, 126 with T1 CRC. Proportions of SAN were 24.2%, 26.7% and 25.4% (p=0.908). Compared to HGD, patients with IMC and T1 CRC had similar MAN risks (aHR 0.82 [0.43-1.59] and aHR 1.16 [0.66-2.05], respectively). No lymph nodes were positive (0/363) and no metastasis occurred among patients with IMC. Patients diagnosed with colorectal IMC were more likely to undergo surgery after complete endoscopic resection than when HGD was diagnosed, although they were not at increased risk of SAN or MAN in this study and the known risk of nodal metastasis with colorectal IMC is small (0-2%). Unless a patient diagnosed with IMC is particularly concerned with this small risk, complete endoscopic resection should be considered definitive treatment for IMC and should not be followed by surgery.

Analysis of Risk Factors and Risk Prediction for Cervical Lymph Node Metastasis in Thyroid Papillary Carcinoma.

To analyze the risk factors of cervical lymph node metastasis (LNM) of thyroid papillary carcinoma (PTC) and construct the prediction model. Clinical data of 1105 patients with pathologically confirmed PTC in our hospital from February 2019 to May 2024 were retrospectively analyzed, and randomly divided into a training set and validation set according to the proportion of 7:3. With cervical central LNM (CLNM) and lateral LNM (LLNM) as outcome variables respectively, ultrasound characteristics were analyzed and C-TIRADS scores were performed Combined with the general situation of the patient, preoperative serum thyroglobulin (Tg) level, BRAFV600E (hereinafter referred to as BRAF) gene mutation and other characteristics of the patient, analysis was conducted to determine the independent risk factors for cervical CLNM and LLNM of PTC, and establish Nomogram prediction models. The test data set is used to validate the model. The area under the ROC curve (AUC) and the decision curve analysis (DCA) were used to evaluate the prediction efficiency of the model. The analysis shows that male, age < 55 years old, tumor diameter ≥ 1 cm, capsular invasion, positive serum thyroglobulin (Tg), BRAF gene mutation type and C-TIRADS score are independent risk factors for cervical CLNM in PTC (P < 0.05). Tumor diameter ≥ 1 cm, capsular invasion, tumor located at the upper pole and presence of CLNM are independent risk factors for LLNM in PTC. Based on the above risk factors, Nomogram prediction models for CLNM and LLNM are constructed respectively. The AUC of the CLNM prediction model is 91.5%. LLNM model is 96.1%. Ultrasound indicators, C-TIRADS score combined with BRAF gene status, Tg and clinical indicators of patients have important value in predicting cervical CLNM and LLNM in PTC. The Nomogram prediction models constructed based on the above indicators can effectively predict the risk of LNM in PTC.

Editorial Comment to "Can the Briganti 2019 nomogram be modified to predict lymph node metastasis risk in patients with prostate cancer detected with in-bore biopsy?"

Editorial Comment to "Can the Briganti 2019 nomogram be modified to predict lymph node metastasis risk in patients with prostate cancer detected with in-bore biopsy?"

Comparative prediction of lymph node metastasis in pT1 colorectal cancer among Western and Japanese guidelines.

Additional surgery with lymph node (LN) dissection is recommended for pT1 colorectal carcinoma (CRC) resected by endoscopy, based on pathological risk factors for LN metastasis (LNM), according to guidelines by the Japanese Society for Cancer of the Colon and Rectum (JSCCR), National Comprehensive Cancer Network (NCCN), and European Society for Medical Oncology (ESMO). We retrospectively analyzed 560 consecutive patients with T1 CRC who underwent endoscopic resection alone (n=190) or initial or additional surgery with LN dissection (n=370) between 1992 and 2017 at Hiroshima University Hospital. Patients were classified into LNM low- and high-risk groups according to guidelines by the JSCCR, NCCN, and ESMO as follows. Patients without any specified pathological LNM risk factor were included in the LNM low-risk group, while the high-risk group comprised all other patients. We analyzed the LNM predictive ability of each guideline. The LNM high-risk rate, sensitivity, specificity, positive and negative predictive values, accuracy of LNM risk, and AUC for LNM predictive ability were 82%, 100%, 19%, 9%, 100%, 26% and 0.596 in the JSCCR guidelines; 52%, 98%, 52%, 15%, 99%, 56%, and 0.749 in the NCCN; and 54%, 98%, 50%, 15%, 99%, 54%, and 0.743 in the ESMO, respectively. The JSCCR guidelines could diagnose LNM in all cases but had the highest false-positive rate. It is important to reduce unnecessary additional surgeries for pT1 CRCs after ER.

Variation in the detection of lymphovascular invasion in T1 colorectal cancer and its impact on treatment: A nationwide Dutch study.

Lymphovascular invasion (LVI) plays an important role in determining the risk of lymph node metastasis (LNM) in T1 colorectal cancer (CRC) patients and influencing treatment decisions and patient outcomes. This study evaluated how the detection of LVI varies between Dutch laboratories and investigated its impact on the treatment and oncological outcomes of T1 CRC patients. Pathology reports and clinical data of T1 CRC patients who underwent local resection between 2015 and 2019 were obtained from the Dutch nationwide pathology databank (Palga cohort, n=5513). Data on the standard of LVI diagnosis (H&E/Immunohistochemistry) were not available. We categorized laboratories as low, average, or high detectors and evaluated the impact of LVI detection practice on the surgical resection rate and the proportion of LNM-negative (LNM-) surgeries. In the second part of the study, we used the Dutch T1 CRC Working Group cohort (n=1268) to evaluate the impact of LVI detection practice on cancer recurrences during follow-up. Multivariable logistic regression analyses and Cox proportional hazard regression were used to study the association between LVI detection practice and the outcomes. In the PALGA cohort, the proportion of surgical resections after local resection of a T1 CRC was significantly higher among patients diagnosed by laboratories with a high LVI detection rate (high vs. low: adjusted OR [aOR] 1.87; 95% confidence interval [CI] 1.52-2.31) as was the proportion of LNM-surgeries (aOR 1.73; 95% CI 1.39-2.15). In the second cohort, no significant difference was observed in cancer recurrences among patients diagnosed in laboratories with high detection rates compared with low detection rates (aHR 2.23; 95% CI 0.94-5.23). These findings suggest that a high detection rate of LVI does not improve oncological outcomes and may expose more patients to unnecessary oncological surgery, emphasizing the need for standardization of LVI diagnosis.