Significance Of Node Involvement Research Articles

A look at current and potential treatment approaches for hormone receptor-positive, HER2-negative early breast cancer.

The heterogeneity of hormone receptor (HR)-positive, HER2-negative early breast cancers reinforces the importance of individualized, risk-adapted treatment approaches. Numerous factors contribute to the risk for recurrence, including clinical tumor features, individual biomarkers, and genomic risk. Current standard approaches for patients with HR-positive, HER2-negative, early stage disease focus on endocrine therapy and chemotherapy. The specific treatment regimen and duration of adjuvant therapy should be selected based on accurate risk assessment, tolerability of available therapies, and consideration for patient preferences. For patients with high-risk features, such as highly proliferative tumors, large tumor size, and significant nodal involvement, the risk for recurrence remains clinically significant despite appropriate adjuvant treatment with current standards of care. This has driven investigation into novel treatment approaches, including the addition of cyclin-dependent kinase 4 and 6 inhibitors to adjuvant endocrine therapy. Cyclin-dependent kinase 4 and 6 inhibition has demonstrated significant efficacy in patients with high-risk, HR-positive, HER2-negative, nonmetastatic breast cancer and now offers a new strategy to greatly improve outcomes in this difficult to treat patient population.; LAY SUMMARY: Hormone receptor (HR)-positive, HER2-negative early breast cancers are highly diverse and need to be managed differently for individual patients. The use of adjuvant endocrine therapy and chemotherapy should be driven by a patient's risk for recurrence, preferences, and risk for side effects. Patients with high-risk tumors have a persistently elevated risk for recurrence despite current standards of care. Emerging cyclin-dependent kinase 4 and 6 inhibitors are highly effective when added to endocrine therapy in high-risk, HR-positive early breast cancer and have the potential to improve patient outcomes in this difficult to treat patient population.

Risk factors and significance of lymph node involvement in serous borderline ovarian tumors

Borderline ovarian tumors represent a particular category of ovarian neoplasms characterized by a more favourable outcome, lower risk of recurrence and association of long term survival rates. Although in up to one third of cases lymph node metastases are present, they seem that they do not affect significantly the survival. The aim of the current paper is to identify the most important risk factors for lymph node invasion in serous borderline ovarian tumors and to study their influence on survival.

Lymph node yield following cholecystectomy for GB cancer; open versus laparoscopic surgery

Background: Surgery serves as the only curative treatment option for patients with GB cancer which has an incidence of approximately 1000 new cases a year within the UK. New evidence suggests that lymph node status serves as a key prognostic factor in the management of GB cancer. No standardised approach or uniform agreement to the extent of lymphadenectomy required for GB cancer management has been determined. The aim of this study was to review our own practice with regard to managing GB cancer, specifically looking at the extent of lymph node harvest when undertaking laparoscopic and open surgery. Material & Methods: A retrospective review of all patients who underwent curative surgery for GB cancer in one institution over 20 years was performed. Patients’ were identified by performing a search through the electronic hospital records using specific ICD10 code. Results: 20 patients were included. The diagnosis of GB cancer was an incidental finding in 14 patients. Surgery with curative intent for GB cancer was performed with open surgery in (n =10) 50% and Laparoscopic in 50% of the cases. All patients were diagnosed with adenocarcinoma on histology. The median lymph node harvest was higher in open surgery when compared to laparoscopic surgery median 6 (range 1-15) vs 2 ( range 0-11) respectively, P=0.009). Three patients also had adjuvant chemotherapy. Conclusion: In our experience open surgery for GB cancer resulted in a greater lymph node yield. However it is likely lymph node number with laparoscopic surgery could be similar in light of the significance of lymph node involvement and prognosis. Future prospective studies are likely to confirm this

Imaging characteristics of nasopharyngeal carcinoma for predicting distant metastasis

To determine the imaging characteristics of nasopharyngeal carcinoma (NPC) that may be associated with increased risk of distant metastasis. A total 164 patients with NPC were reviewed retrospectively. Patients were divided into the metastatic group (n=110) or the non-metastatic group (n=54). Non-metastatic was defined as no evidence of distant metastasis during at least 5 years of follow-up. Pretreatment images of the primary tumour and nodal involvement were analysed. Statistical analyses were performed to identify the factors that may predict distant metastasis. The statistically significant sites of tumour extension in the metastatic group included: skull base bone (p<0.001), cervical spine (C-spine; p=0.012), parapharyngeal space (p=0.003), pterygopalatine fossae (PPF; p=0.004), prevertebral space (p<0.001), masticator space (p=0.006), carotid space (p=0.001), and intracranial extension (p=0.004). Statistically significant nodal involvement included bilateral involvement (p=0.04), size 3-6 cm (p=0.011), >10 pathological nodes (p<0.001), level IB (p=0.013), IIB (p=0.011), III (p=0.001), IV (p<0.001), VB (p=0.001), and supraclavicular (p=0.003) and intraparotid nodes (p=0.004). The mean number of significant involvement factors was significantly higher in the metastatic group (3.46±2.24 tumour extension sites and 5.04±2.51 nodal involvement factors) than in the non-metastatic group (p<0.001). NPC patients with local extension at more than three sites and with more than five nodal involvement factors should be screened for distant metastasis.

Significance of lymph node involvement in local recurrence of colorectal cancer.

There are few data on lymphatic spread concomitant to local recurrence (LR) of colorectal cancer (CRC). The objectives of this study were to determine variables associated with lymphatic spread, to analyze the distribution of LN+, and understand the underlying mechanisms. A total of 76 patients underwent resection of LR of CRC between January 2007 and December 2018 at Institut cancérologique de l'Ouest and were retrospectively reviewed. Twenty-five (32.9%) patients had lymph node (LN) involvement with LR. Lymphatics from the mesocolon-rectum and aorto-iliac compartments were involved in 21%, 20.3% and 18.1%, 20.3% for pelvic and retroperitoneal LRs, respectively. In multivariate analysis, the only predictive factor for LN invasion (LN+) was a primary positive LN status (odds ratio, 5.3; P = .007). Despite a trend toward a worse median overall survival in the LN+ group, the difference was not significant in comparison with the LN- group (46 vs. 57 months; P = 0.31) or with the LN- plus LN not assessed groups (46 months vs not reached; P = .07). LN invasion with LR from CRC is a frequent occurrence without significant impact on survival. The only predictive factor is a primary positive nodal status.

Cytoreduction plus hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis in colorectal cancer patients: a single-center cohort study

BackgroundIn this study, we report our experience of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) in patients with peritoneal carcinomatosis (PC) from colorectal cancer (CRC), focusing on the factors affecting survival.MethodsAll patients with surgically treated PC from colorectal cancer and with no involvement of other organs referred to our institute from March 2005 to December 2017 were included in the analysis.ResultsThirty-eight patients underwent CRS-HIPEC, and all had a completeness of cytoreduction score of 0 (CC0). The median operating time was 645 min (interquartile range [IQR] 565–710). Five patients (13.1%) had Clavien-Dindo grade > 2 postoperative complications. Median overall survival (OS) was 60 months. In the Cox regression for OS, calculated on the CRS-HIPEC group, the peritoneal cancer index (PCI) > 6 (hazard ratio [HR] 4.48, IQR 1.68–11.9, P = 0.003) and significant nodal involvement (N2) (HR 3.89, IQR 1.50–10.1, P = 0.005) were independent prognostic factors. Median disease-free survival (DFS) was 16 months. Only N2 (HR 2.44, IQR 1.11–5.36, P = 0.027) was a significantly negative prognostic factor for DFS in multivariate analysis.ConclusionsCRS-HIPEC can substantially improve survival. However, patients with high PCI (PCI > 6) and significant nodal involvement (N2) may not benefit from the procedure.

Impact of affected lymph nodes on long-term outcome after surgical therapy of alveolar echinococcosis.

Alveolar echinococcosis (AE) is a life-threatening helminthic disease. In humans, AE mostly affects the liver; the regional hepatic lymph nodes may be involved, indicating dissemination of AE from the liver. To achieve complete removal of the disease, enlarged hepatic lymph nodes may be resected during surgical treatment. We evaluated the frequency of affected lymph nodes by conventional microscopic and immunohistochemical analyses including detection of small particles of Echinococcus multilocularis (spem). Furthermore, we analyzed the association of resection of enlarged and affected lymph nodes with long-term outcome after surgical therapy of patients who underwent surgery with curative intent. We identified 43 patients who underwent hepatic surgery with curative intent with lymph node resection for AE. We analyzed the cohort for the manifestation of the parasite in the resected lymph nodes by conventional histology and by immunohistochemistry and compared these data with the further course of AE. Microscopically infected lymph nodes (laminar layer visible) were found in 7 out of these 43 patients (16%). In more than three quarters (25/32) of all specimens investigated, lymph nodes showed spems when stained with antibody against Em2G11, a monoclonal antibody specific for the Em2 antigen of the Echinococcus multilocularis metacestode. Most frequently, lymph nodes were resected due to enlargement. The median size of microscopically affected lymph nodes was 2cm (range, 1.2 to 2.5cm), the median size of immunohistochemically and non-affected lymph nodes was 1.3cm each (range, "small" to 2.3 or 2.5cm, respectively). Median follow-up was 8years for all patients, 5years for patients with lymph node resection, and 4years for patients with infested lymph nodes. Overall, recurrent disease was seen in ten patients (10/109; 9%) after a median period of 1.5years (range, 4months to 4years). None of the seven patients with conventionally microscopically affected lymph nodes suffered from recurrent disease. One patient with negative resected nodes and one patient with spems showed recurrent disease after 4 and 35months, respectively. Lymph node involvement in AE is frequent, particularly when evaluated by immunohistochemical examination of lymph nodes with the monoclonal antibody Em2G11. Affected lymph nodes tend to be larger in size. Lymph node involvement is not associated with recurrent disease and therefore warrants further analysis of the biological significance of lymph node involvement.

Uso do corante azul de metileno a 2% na localização do linfonodo axilar em cadelas (Canis familiaris – Linnaeus, 1758)

A biopsia de linfonodo sentinela (LS) é cada vez mais utilizada para a determinação do estadiamento clínico tumoral. O acometimento de linfonodos em animais com doença oncológica possui forte valor prognóstico no tumor da glândula mamária. Em medicina veterinária faltam diretrizes bem estabelecidas para a avaliação do LS. O objetivo deste estudo foi avaliar a eficácia do corante azul de metileno a 2% na identificação do linfonodo axilar em cadelas com lesões mamárias. Para tanto, foram utilizadas 101 cadelas, portadoras de lesões mamárias, submetidas à mastectomia radical unilateral ou bilateral. Antes do início da cirurgia, aplicou-se, por via intradérmica, na área ao redor da mama torácica cranial, solução de azul de metileno a 2% estéril. O corante foi eficaz na identificação do linfonodo axilar em 76,27% das cadeias mamárias. Obtiveram-se estruturas coradas em azul, semelhantes a linfonodos em 78,81% dos casos. Dessas estruturas, 96,77% foram confirmadas ao exame histopatológico como linfonodos. Dada a importância prognóstica do comprometimento de linfonodos em alguns tumores, a avaliação do LS deve ser incorporada à rotina clínica, de modo a permitir um estadiamento mais preciso das cadelas com neoplasia mamária.

Prognostic significance of lymph node involvement in periampullary cancer

Prognostic significance of lymph node involvement in periampullary cancer

Assessment of nodal status for perihilar cholangiocarcinoma location, number, or ratio of involved nodes.

Surgical treatment of perihilar cholangiocarcinoma (PCC) is the treatment of choice that can achieve long term results. Unfortunately the presence of lymph node metastases is frequent and it is one of the major negative prognostic factors in patients submitted to surgery. In literature there are few data about the prognostic significance of location, number and ratio of involved nodes. Moreover guidelines about the extent of lymph node dissection are not available. In this commentary the data of literature about prognostic significance of lymph node involvement are described and analysed.

NUT Midline Carcinoma: A Case Report with a Novel Translocation and Review of the Literature

NUT midline carcinoma (NMC) is a rare, genetically defined, highly lethal undifferentiated carcinoma occurring in the midline location of the neck, head or mediastinum. We present the case of a 23 year-old otherwise healthy Chinese male immigrant who presented with complaints of sore throat and right sided neck mass. The initial treatment was for likely EBV infection with streptococcal superinfection. Although continued investigation was pursued shortly after initial presentation, the mass had enlarged and become necrotic with significant nodal involvement. The mass was diagnosed as an NMC tumor with a novel three-way translocation t(9;15;19; q34;q13;p13.1). Despite aggressive treatment, the patient's condition progressed rapidly and he died within 3 months of initial diagnosis. Standard therapeutic interventions have been ineffective in the treatment of NMC. Earlier diagnosis could allow characterization of the natural progression of this entity, and allow more time for intervention or development of novel therapies, potentially related to molecular targets. This continues to require a high index of suspicion and early imaging with cytogenetic and immunohistochemical confirmation.

Number of involved lymph nodes is important in the prediction of prognosis for primary duodenal adenocarcinoma

BackgroundThe significance of lymph node involvement regarding the prognosis of primary duodenal adenocarcinoma remains controversial. This study aims to evaluate the prognostic accuracy of nodal metastasis using the seventh edition American Joint Committee on Cancer staging system in patients with primary duodenal adenocarcinoma. MethodsBetween 1993 and 2010, 36 patients who had undergone surgical resection for primary duodenal adenocarcinoma at the Kaohsiung Veterans General Hospital were retrospectively reviewed. ResultsThe median disease-free survival for all patients was 19 months and the median overall survival was 21 months. Lymph node metastases were found in 26 (72%) of the patients, and 14 patients (39%) patients had in excess of three positive lymph nodes (N2). Patients with N2 disease had significantly reduced overall survival, as compared to patients with three or fewer positive lymph nodes (N1; p = 0.036). In univariate analysis, factors including age >75 years, body weight loss, tumor size ≤4 cm, N2 disease and lymph node ratio >0.4 predicted shorter overall survival. Multivariate analysis demonstrated that N2 and lymph node ratio >0.4 are significant risk factors associated with overall survival (p = 0.026 and p = 0.042 respectively). N2 is also the only independent predictive factor for disease-free survival (p = 0.023). ConclusionSubdivision of metastatic lymph nodes into N1 and N2 improves predictive ability. The seventh edition American Joint Committee on Cancer staging system is applicable in the present study with regard to the prediction of the prognosis for primary duodenal adenocarcinoma.

Approaches to classification and management of histologically ambiguous/ borderline / primary cutaneous melanocytic tumours

Because naevi and melanomas are tumours which exhibit considerable morphological heterogeneity, many histological features are common to both groups of tumours. As a consequence, the pathological diagnosis of some melanocytic tumours can be difficult. For some atypical tumours that do not display clear-cut features of malignancy, it may be difficult or impossible to exclude a diagnosis of melanoma and such tumours are sometimes referred to as ‘histologically ambiguous' or ‘borderline' tumours or as ‘melanocytic tumours of uncertain malignant potential' (MELTUMP). While not diagnoses <i>per se</i>, these terms are useful for conveying the diagnostic uncertainty to both the treating clinician and the patient. Examples of such tumours include some cases that show some resemblance to Spitz naevi, blue naevi, deep penetrating naevi and possible naevoid melanomas. We recommend that a second opinion be sought from one or more experienced colleagues when there is uncertainty about whether a primary melanocytic tumour is benign or malignant. If diagnostic uncertainty persists, the evidence for or against the various differential diagnostic considerations should be presented in the pathology report and a ‘most likely' or ‘favoured' diagnosis given. Recent studies have suggested that molecular testing of the primary tumour using techniques such as comparative genomic hybridisation or fluorescence <i>in situ</i> hybridisation may assist in establishing a diagnosis of melanoma if multiple chromosomal aberrations are identified. However, these tests are not widely available at present and require further independent validation. Complete excision of the lesion is probably mandatory, but plans for further management should be formulated on case-by-case basis. The safest course of action will usually be to manage the tumour as if it were a melanoma (taking into account the tumour's thickness and other prognostic variables); however, this may not always be appropriate, particularly if it is located on the face. In some cases, the clinician may consider conveying the diagnostic uncertainty to the patient and presenting them with management choices so that they can decide whether they wish to be managed aggressively (as for a melanoma) or conservatively. Whilst a sentinel lymph node biopsy may be considered on the basis of the primary tumour characteristics, the clinical significance of lymph node involvement for these tumours is not yet clear, but it probably does not have the same prognostic implications as nodal involvement from an unequivocal ‘conventional' melanoma.

Histologically Ambiguous (“Borderline”) Primary Cutaneous Melanocytic Tumors: Approaches to Patient Management Including the Roles of Molecular Testing and Sentinel Lymph Node Biopsy

It is well recognized that the pathologic diagnosis of melanocytic tumors can sometimes be difficult. For some atypical melanocytic tumors that do not display clear-cut features of malignancy, it may be difficult or impossible to exclude a diagnosis of melanoma; this includes those showing some resemblance to Spitz nevi, blue nevi, deep penetrating nevi, and possible nevoid melanomas. When there is uncertainty about whether a primary melanocytic tumor is a nevus or a melanoma, we recommend that a second opinion be sought from one or more experienced colleagues. If diagnostic uncertainty persists, the evidence for or against the various differential diagnostic considerations should be presented in the pathology report and a "most likely" or "favored" diagnosis given. Molecular testing of the primary tumor by using techniques such as comparative genomic hybridization or fluorescence in situ hybridization may assist in establishing a diagnosis of melanoma if multiple chromosomal aberrations are identified. However, these tests require further independent validation and are not widely available at present. Complete excision of the lesion is probably mandatory, but plans for further management should be formulated on a case-by-case basis. While the safest course of action will usually be to manage the tumor as if it were a melanoma (taking into account the tumor's thickness and other prognostic variables), this may not always be appropriate, particularly if it is located in a cosmetically sensitive site such as the face. In some cases, it may be appropriate for the surgical oncologist to convey the diagnostic uncertainty to patients and to present them with management choices so that they can decide whether they wish to be managed aggressively (as for a melanoma) or conservatively. While a sentinel lymph node biopsy may be recommended on the basis of the primary tumor characteristics, the clinical significance of lymph node involvement for these tumors is not yet clear, and it may not have the same prognostic implications as nodal involvement from an unequivocal "conventional" melanoma.

Histologically ambiguous ("borderline") primary cutaneous melanocytic tumors: approaches to patient management including the roles of molecular testing and sentinel lymph node biopsy.

It is well recognized that the pathologic diagnosis of melanocytic tumors can sometimes be difficult. For some atypical melanocytic tumors that do not display clear-cut features of malignancy, it may be difficult or impossible to exclude a diagnosis of melanoma; this includes those showing some resemblance to Spitz nevi, blue nevi, deep penetrating nevi, and possible nevoid melanomas. When there is uncertainty about whether a primary melanocytic tumor is a nevus or a melanoma, we recommend that a second opinion be sought from one or more experienced colleagues. If diagnostic uncertainty persists, the evidence for or against the various differential diagnostic considerations should be presented in the pathology report and a most likely or favored diagnosis given. Molecular testing of the primary tumor by using techniques such as comparative genomic hybridization or fluorescence in situ hybridization may assist in establishing a diagnosis of melanoma if multiple chromosomal aberrations are identified. However, these tests require further independent validation and are not widely available at present. Complete excision of the lesion is probably mandatory, but plans for further management should be formulated on a case-by-case basis. While the safest course of action will usually be to manage the tumor as if it were a melanoma (taking into account the tumor's thickness and other prognostic variables), this may not always be appropriate, particularly if it is located in a cosmetically sensitive site such as the face. In some cases, it may be appropriate for the surgical oncologist to convey the diagnostic uncertainty to patients and to present them with management choices so that they can decide whether they wish to be managed aggressively (as for a melanoma) or conservatively. While a sentinel lymph node biopsy may be recommended on the basis of the primary tumor characteristics, the clinical significance of lymph node involvement for these tumors is not yet clear, and it may not have the same prognostic implications as nodal involvement from an unequivocal conventional melanoma.

Lymph Node Metastases in Diffuse Malignant Peritoneal Mesothelioma

Improved survival has been reported for diffuse malignant peritoneal mesothelioma (DMPM) treated by surgical cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC). The significance of lymph node involvement in this disease is still poorly understood. Prospectively collected clinical data on 83 consecutive patients with DMPM undergoing surgical cytoreduction and closed-abdomen HIPEC with cisplatin and doxorubicin were reviewed. Clinically suspicious lymph nodes were submitted to pathological examination. The impact of nodal involvement on survival was assessed by multivariate analysis; 14 clinicopathological control variables were tested. For the overall series, median follow-up was 52 months (range 1-126 months) and 5-year overall survival (OS) was 49.5%. Lymph nodes were submitted to pathological examination in 38 patients, being positive in 11 and negative in 27. Lymph nodes were not clinically suspicious and not sampled in 45 patients. Iliac (n = 7) and paracolic (n = 2) nodes were the most commonly involved nodes. OS was 18.0% for patients with pathologically positive nodes and 82.5% for those with pathologically negative nodes (P = 0.0024). On multivariate analysis, pathologically negative (versus positive/not assessed) nodes [hazard ratio (HR) = 2.81; 95% confidence interval (CI) = 1.12-7.05; P = 0.027], epithelial subtype (HR = 2.93; CI = 1.24-6.95; P = 0.015), mitotic count <or=5/50 high-power microscopic fields (HPF) (HR = 5.34; CI = 1.96-14.54; P = 0.001), and completeness of cytoreduction (HR = 2.06; CI = 1.19-3.56; P = 0.001) correlated with increased OS. Positive nodes (versus negative/not assessed) did not significantly correlate with survival. Pathologically negative nodes (as compared with pathological positive and not assessed), along with pathological and biological features, independently correlated with increased survival following comprehensive treatment. This suggests the need for careful node sampling when performing surgical cytoreduction for DMPM patients.

Management of retroperitoneal lymph nodes in the treatment of ovarian cancer

The mechanisms and clinical significance of lymph node involvement in ovarian cancer have been revealed since the International Federation of Gynaecology and Obstetrics (FIGO) introduced a new clinical staging including retroperitoneal lymph node status. The multiple directions of the lymph drainage pathway in ovarian cancer have been recognized. The incidence and pattern of lymph node involvement depends on the extent of disease progression and the histological type. Thus, it is difficult to specify a single node as the sentinel node. As a surgical approach, systemic lymphadenectomy is necessary to obtain accurate clinical stage, and it has obvious diagnostic value. Nevertheless, a recent large randomized trial in patients with advanced ovarian cancer revealed that systemic lymphadenectomy had no impact on survival compared with removing only macroscopic lymph nodes. Other factors, such as chemosensitivity, histological grade, and the size of residuals have also influenced survival in ovarian cancer. From the viewpoint of adverse effects and survival benefit, the efficacy of lymphadenectomy remains controversial. Therefore, further accumulation of clinical data is needed to establish the indications for lymph node dissection; when this procedure is done, it should be performed by experienced gynecologic oncologists at selected institutions.

Reasons for Failure to Identify Positive Sentinel Nodes in Breast Cancer Patients With Significant Nodal Involvement

Reasons for Failure to Identify Positive Sentinel Nodes in Breast Cancer Patients With Significant Nodal Involvement

Role of proteomics in personalized medicine.

Vignette 1: current practice A 45-year-old female presents at a clinic with a complaint of shortness of breath. After a thorough cardiovascular evaluation that reveals no evidence of heart disease, a computed tomography (CT) scan of the thorax reveals several large nodules in the right lung. An endoscopically-obtained tissue biopsy is taken and fixed in formalin for morphological analysis by a pathologist. Under a microscope, the pathologist examines the tissue section that has been stained with hematoxylin and eosin. Based on experience, the pathologist classifies the tissue as a poorly differentiated adenocarcinoma of the lung. A subsequent staging imaging study is performed revealing likely significant nodal involvement. Based on years of clinical correlations and clinical trials, this patient begins a treatment regimen including chemotherapy. The oncologist communicates to the patient that a range of patient responses to the proposed chemotherapies has been observed, from good to poor response. Patient concerns over the side effects of therapy are balanced against the hope of a good response. At present, based on morphological assessments, the type of response cannot be predicted.

Significance of lymph node metastasis in patients with diffuse malignant peritoneal mesothelioma

Background Diffuse malignant peritoneal mesothelioma (DMPM) is a rare and invariably fatal neoplasm. Some studies have shown that cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) achieved an improved survival, as compared to historical controls. However, the significance of lymph node involvement in this disease has never been well defined. Methods One hundred patients with DMPM underwent CRS and PIC at the Washington Hospital Center. The inclusion criteria for surgery consisted of histological diagnosis of DMPM, age <80 years and good performance status. All data were collected prospectively. Lymph node status, seven clinical variables and eight treatment-related prognostic factors were analyzed for survival. Results Seven patients were lymph node positive and they all died of their disease within 2 years after the surgery. The remaining 93 patients had 5- and 7-year survival of 50% and 43%, respectively. Univariate analysis showed that gender ( p < 0.001), peritoneal cancer index ( p = 0.009), lymph node status ( p < 0.001), extra-abdominal invasion ( p = 0.026), histological type ( p < 0.001), intraoperative blood loss ( p = 0.035), completeness of cytoreduction ( p < 0.001), intraperitoneal chemotherapy regimen ( p = 0.041), and redo cytoreductive surgery ( p = 0.022) were significant for survival. Multivariate analysis demonstrated that female gender, lymph node metastasis not detected, epithelial type, and adequate cytoreduction were independently associated with an improved survival. Conclusions CRS and PIC showed an improved survival for DMPM, as compared to historical controls. Lymph node status along with three other prognostic variables was significant in the multivariate analysis.