Significance Of Nodes Research Articles

Re-consideration of Lymph Node Metastasis in Pancreatic Cancer Patients Following Radical Resection: A Retrospective Study.

Perioperative chemotherapy has become more common in patients with pancreatic cancer (PC), and the significance of lymph node (LN) metastasis and the role of surgical resection in PC have gradually evolved. In the present study, we reconsidered the significance of LN metastasis for patients with PC. We analyzed 142 PC patients who underwent radical resection at our hospital between September 2012 and December 2021. Patients were divided into three groups based on the performance of preoperative chemotherapy, as follows: up-front surgery (US, n=109), neoadjuvant chemotherapy (NAC, n=22), and conversion surgery (CS, n=11). The characteristics of patients with LN metastasis in the US group were clarified, and a prognostic analysis was performed. The prognostic impact of LN metastasis in the NAC/CS group was examined and compared to that in the US group. Multivariate analysis revealed that high CA19-9 levels, large tumor size, and positive lymphatic invasion were significantly associated with LN metastasis. LN metastasis and portal vein invasion were independent poor prognostic factors in multivariate analysis. Patients without LN metastasis in the NAC group tended to have a better prognosis than those in the US group; however, the prognosis of patients with LN metastasis was similar between the two groups. In the CS and US groups, the prognosis was comparable for patients with and without LN metastasis. LN metastasis is a notably poor prognostic factor for PC patients, even after NAC, and more aggressive perioperative treatments may be considered for these patients.

Impact of time-to-treatment on survival for early-stage non-small cell lung cancer in The Netherlands-a nationwide observational cohort study.

Varied outcomes on the relation between time-to-treatment and survival in early-stage non-small cell lung cancer (NSCLC) patients are reported. We examined this relation in a large multicentric retrospective cohort study and identified factors associated with extended time-to-treatment. We included 9,536 patients with clinical stage I-II NSCLC, diagnosed and treated in 2014-2019, from the Netherlands Cancer Registry that includes nation-wide data. Time-to-treatment was defined as the number of days between first outpatient visit for suspected lung cancer and start of treatment. The effect of extended time-to-treatment beyond the first quartile and survival was studied with Cox proportional hazard regression. Analyses were stratified for stage and type of therapy. Time-to-treatment was adjusted for multiple covariates including performance status and socioeconomic status. Factors associated with treatment delay were identified by multilevel logistic regression. Median time-to-treatment was 47 days [interquartile range (IQR): 34-65] for stage I and 46 days (IQR: 34-62) for stage II. The first quartile extended to 33 days for both stages. Risk of death increased significantly with extended time-to-treatment for surgical treatment of clinical stage II patients [adjusted hazard ratio (aHR) >33 days: 1.36, 95% confidence intervals (CI): 1.09-1.70], but not in stage II patients treated with radiotherapy or in stage I patients. Causes of prolonged time-to-treatment were multifactorial including diagnostic tests, such as endoscopic ultrasound (EUS) or endobronchial ultrasound (EBUS). Clinical stage II patients benefit from fast initiation of surgical treatment. Surprisingly this appears to be accounted for by patients who are clinically stage II but pathologically stage I. Further study is needed on characterizing these patients and the significance of lymph node- or distant micrometastasis in guiding time-to-treatment and treatment strategy.

NSKSD: Interdependent Network Dismantling via Nonlinear-Metric

Most networks are not isolated but interdependent in real applications. Studies on the dismantling of interdependent networks have motivated crucial and significant improvements to our understanding of fundamental network behaviors, i.e., function, robustness, structure characters, etc. The popular way to deal with such a dismantling problem is to extract the influential spreaders based on centrality measures. This brief proposes the node significance (NS) for individual node measures based on the novel sigmoid-like similarity calculation. A new index KSD is proposed to identify the top influential nodes, combining the different node centralities’ effects. Notably, we put forward two types of significance, i.e., the overlapping node significance (ONS) and the overlapping KSD (OKSD); both are set as benchmarks for computing the spreading capability of each node. Simulation results validate that our proposed NSKSD is much better than the state-of-the-art methods in terms of the efficient and effective dismantling of interdependent networks.

Primary vs nodal site PET/CT response as a prognostic marker in oropharyngeal squamous cell carcinoma treated with intensity-modulated radiation therapy.

Positron emission tomography/computed tomography (PET/CT) in staging of advanced oropharyngeal squamous cell carcinoma (OPSCC) and at 3 months posttreatment (PETpost) is often utilized to assess response. The significance of lymph node vs primary site treatment response is incompletely understood. We reviewed 230 patients treated with radiation therapy. PETpost response was graded at primary and nodal sites and correlated with survival. Median age was 58, and 83% were p16-positive. Median follow-up was 24.3 months. Nodal response at PETpost predicted improved 2-year local recurrence-free survival (LRFS) (93% vs 72%, P =.004), 2-year disease-free survival (DFS) (80% vs 61.3%, P =.021), and 2-year overall survival (OS) (89% vs 83%, P =.051), while primary response only predicted improved 2-year LRFS (91% vs 76% P = .035). In OPSCC patients, both nodal and primary response at 3 months on PET/CT predicted for improved LRFS, but only nodal response predicted DFS and OS.

Isolated tumor cells in regional lymph nodes in patients with adenocarcinoma of the esophagogastric junction might represent part of true metastases

Regional lymph node metastases in patients with carcinoma of the esophagogastric junction (EGJ) are an important prognostic factor. According to the tumor, node, and metastasis classification, isolated tumor cells (ITCs) are single tumor cells or small clusters of tumor cells not exceeding 0.2 mm. Tumor clusters >0.2 mm are classified as metastases. The significance of lymph nodes with ITCs is unclear, although not contributing to the pN category. The aim of this study was to determine the prevalence of regional lymph nodes with ITCs on the primary hematoxylin and eosin-stained slide and to examine how often deeper sections reveal a true metastasis. The study included surgical specimens of 126 patients with adenocarcinoma of the EGJ. Lymph nodes with ITCs were identified. Additional sections were cut and stained with hematoxylin and eosin and with cytokeratin. All slides were evaluated for the presence of tumor cells, and it was determined whether the criteria for a metastasis were met on the additional sections. ITCs were detected in 59 (1.7%) of 3454 lymph nodes and in 41 (32.5%) of 126 patients. In 29 (49.2%) lymph nodes with ITCs on the primary slide, further sections resulted in a changed status from ITCs to a metastasis. In 7 (17.1%) of 41 patients, the pN category was changed. In patients with adenocarcinoma of the EGJ, the presence of ITCs in regional lymph nodes is a common observation. ITCs often represent part of a real metastasis. To obtain a pN category as accurate as possible, we strongly recommend thorough examination of regional lymph nodes with additional sections when ITCs are observed.

Semi-quantitative lymph node assessment of 18F-FDG PET/CT in locally advanced breast cancer: correlation with biological prognostic factors

The aim of this study was to analyse the correlation between dual-time-point (18)F-2-deoxy-2-fluoro-D-glucose (FDG) uptakes in lymph nodes assessed by positron emission tomography (PET)/CT and histopathological and immunohistochemical prognostic factors. Seventy-five women with locally advanced breast cancer were prospectively evaluated. PET/CT was requested in the initial staging previous to adjuvant chemotherapy (multicentre study). All of the patients underwent (18)F-FDG PET/CT with a dual-time-point acquisition. Both examinations were evaluated qualitatively and semi-quantitatively with calculation of maximum standardized uptake values (SUV(max)) in PET-1 (SUV-1) and in PET-2 (SUV-2) and the percentage variation of the SUV or retention index (RI) between PET-1 and PET-2 in lymph nodes with the greater (18)F-FDG uptake. The biological prognostic parameters such as the steroid receptor status, p53 and HER2 expression, proliferation rate (Ki-67) and grading were determined from tissue of the primary tumour. Metabolic and biological parameters were correlated using Spearman's rank-order correlation coefficient and Mann-Whitney U and Kruskal-Wallis tests. Negative receptor status was correlated with higher SUV-1, SUV-2 and RI in lymph nodes. The results were significant for progesterone receptor status. p53 over-expression and triple-negative status were associated with greater semi-quantitative parameters in lymph nodes. Higher tumoural grades were related with greater semi-quantitative parameters (p > 0.05). Biological factors of bad prognosis were correlated with higher semi-quantitative metabolic values in lymph nodes. Therefore these results appear to reveal biological significance of lymph node (18)F-FDG accumulation.

Analysis of regional lymph nodes in periprostatic fat following robot‐assisted radical prostatectomy

• To determine the incidence and significance of lymph nodes in the anterior prostatovesicular lymphofatty tissue. • One hundred and twenty patients with clinically localized prostate cancer underwent robot-assisted laparoscopic radical prostatectomy with excision of anterior prostatovesicular tissue at a single institution over a 6-month period. • Tissue was sent for pathological analysis. • Separate pelvic lymph node dissection was carried out in moderate-risk and high-risk patients. • A total of 20 out of 120 patients (16.7%) had lymph nodes in the anterior lymphofatty tissue. • Average lymph node number when present was 1.5 (one to three). • Pathological assessment of the lymph nodes revealed metastatic prostate cancer in 3 out of 120 (2.5%) patients, each of whom had adverse pathological features. • Patients with metastatic lymph nodes in the anterior tissue did not have cancer involvement of the pelvic lymph nodes. • Patients with lymph nodes found in the anterior lymphofatty tissue were slightly younger but were otherwise similar with respect to other demographics, prostate-specific antigen, biopsy Gleason score, clinical stage, pathological stage, pathological Gleason score, seminal vesicle invasion, and margin status. • Anterior lymphofatty tissue overlying the prostate occasionally contains lymph nodes that can harbour malignant disease and routine excision may eradicate regional tumour burden. • Of patients with nodes, 15% were found to have malignant involvement. • The long-term impact on progression-free and overall survival requires further study.

Present and future of sentinel lymph node biopsy in breast cancer staging

There is little, if any, doubt about the feasibility and clinical applicability of sentinel lymph node biopsy (SLNB) in the management of breast cancer patients. Prognostic signifi cance of lymph nodes is a major factor in the most used clinical and pathological staging system in breast cancer ‐ the tumour, node, metastasis (TNM) classifi cation system of the American Joint Committee on Cancer (AJCC) [1]. Since SLNB was described and began to be used in clinical practice in the early 1990s, many changes have been implemented from a technical point of view, especially those related to indications criteria. Most criteria for SLNB not initially considered as good staging methods have been reconsidered, and we now fi nd few absolute contraindications for the method. Changes in SLNB indications have defi ned three groups: initial indications that have not changed and are still absolute, initial absolute contraindications that have become indications or relative contraindications, and initial absolute contraindications that remain. In the fi rst group we fi nd ductal and lobular invasive breast carcinomas 2 cm, high grade, or when mastectomy is needed. In this issue of Clinical and Translational Oncology, Collado et al. [2] confi rm these selective criteria for SLNB indication in cases of intraductal tumours. They analyse 65 cases following these criteria and fi nd that the use of SLNB allows unnecessary lymphadenectomy to be avoided in half of the patients that require mastectomy, and they conclude that indication for SLNB in patients with intraductal carcinoma of the breast should be proportional to the infi ltration risk of the lesion. The second group shows the highest number of changes. Previous cosmetic breast surgery, even with implants use, or conservative surgery for breast cancer allows SLNB biopsy if it is necessary to stage a new tumour. This is supported by a dynamic concept of SLNB: sentinel node represents lymphatic drainage from a specifi c anatomic area and, if a previous surgical procedure has changed it, a new lymphatic net will develop in this basin with a “new representative” sentinel node. Breast cancer during pregnancy was also an initial contraindication for SLNB due to the use of radioactive tracers. Safety and feasibility studies have shown that

To be or not to be: Significance of lymph nodes on pretreatment CT in predicting survival of rectal cancer patients

Purpose To assess the extent to which pretreatment imaging of lymph nodes by computed tomography (CT) predicts survival of patients with rectal cancer. Materials and methods We retrospectively analyzed 70 patients with rectal cancer, who had pretreatment CT and curative surgery between December 1999 and October 2003. These patients were followed until December 2007, ensuring minimal follow-up time of 49 months. Two radiologists who reviewed the CT images on workstations had no prior access to clinical and treatment information regarding the selected patients. The parameters assessed for survival analysis were as follows: patient age, sex, CEA and CA199 level, preoperational therapy, tumor location, serosal invasion, largest diameters and numbers of lymph nodes on pretreatment CT. Kaplan–Meier survival curves, the log-rank test, and the multivariate Cox proportional hazards model were used to evaluate the prognostic value of the parameters. Results Using pretreatment CT as prognostic tool, we found that both size and number of lymph nodes correlated with the overall survival of patients with rectal cancer. The data proved that a diameter smaller than 8 mm for the largest lymph node was correlated with prolonged survival ( P < 0.001). Meanwhile, patients with more than 4 lymph nodes had a significantly worse disease-specific survival ( P = 0.042). Both parameters are independent prognostic factors (hazard ratio 4.910 and 3.563) and could predict the overall survival of rectal cancer patients. Conclusion The lymph node size and number, as determined by pretreatment CT, is an important clinical prognostic factor in patients with rectal cancer. The pretreatment CT findings could be used to predict survival and plan appropriate therapies.

Novel techniques in sentinel lymph node mapping and localization of nonpalpable breast lesions: the Moffitt experience.

The concept of lymphatic mapping has helped to redefine the clinical significance of lymph nodes with respect to breast cancer. The combination technique using both blue dye and radiocolloid is the most effective method of lymphatic mapping. The data in the literature support the concept that all patients undergoing lumpectomy or especially mastectomy should undergo lymphatic mapping if a diagnosis of invasive cancer is remotely possible. The low morbidity, high sensitivity, and specificity of mapping indicate its use for increasing numbers of patients thought initially not to be candidates for the procedure.

Prognostic features in patients with stage T1 breast carcinoma and a 0.5-cm or less lymph node metastasis. Significance of lymph node hilar tissue invasion.

Trends in surgical practice suggest that pathologists will encounter increased numbers of patients with small invasive ductal adenocarcinomas; small, if any, metastatic deposits in axillary lymph nodes (ALNs); and possibly fewer ALN specimens to examine. New prognostic histologic features may be needed in this environment. We studied histologic features of primary breast carcinoma and ALN metastasis from 86 patients who had stage T1 ductal carcinomas with only 1 ALN metastasis that was 0.5 cm or less and correlated these features with the development of distant metastases to evaluate their potential usefulness as prognostic indicators. The median follow-up period was 5.3 years. Distant metastases developed in 12 patients. Features significantly associated with 10-year distant metastases-free survival were lymph node hilar tissue invasion (HTI) and ALN metastasis size (stage N1a vs N1b). Tumor grade 1 vs grades 2 or 3 approached significance. The presence of HTI also was related significantly to a decreased 10-year distant metastases-free survival in the stage N1b group. Our study suggests that HTI, along with other well-known parameters, is a useful prognostic feature. In addition, it supports the opinion that ALN dissection may provide limited additional information for patients with grade 1, stage Tla, invasive ductal carcinomas. Additional studies are needed to confirm our findings.

The significance of lymph nodes (LN) dissection through median sternotomy for left lung cancer : M. Mitsuoka, A. Hayashi, S. Takamori, Y. Nagamatsu, T. Matsuo, T. Kakegawa. 1st. Department of Surgery, Kurume University School of Medicine, Kurume, Japan

The significance of lymph nodes (LN) dissection through median sternotomy for left lung cancer : M. Mitsuoka, A. Hayashi, S. Takamori, Y. Nagamatsu, T. Matsuo, T. Kakegawa. 1st. Department of Surgery, Kurume University School of Medicine, Kurume, Japan