Stage Lymph Node Research Articles

Risk factors of lymph node metastasis in the splenic hilum of gastric cancer patients: a meta-analysis

BackgroundThe issue of whether or not splenic hilum lymph nodes (SHLN) should be excised in radical gastrectomy with D2 lymph node dissection remains controversial. In this study, we identified the clinicopathological features in patients with gastric cancer that could serve as predictive risk factors of SHLN metastasis.MethodsWe searched Medline, Embase, PubMed, and Web of Science databases from inception to May 2020 and consulted the related references. Overall, 15 articles evaluating a total of 4377 patients were included for study. The odds ratios (OR) of each risk factor and corresponding 95% confidence intervals (CI) were determined using the Revman 5.3 software.ResultsOur meta-analysis revealed tumor size greater than 5 cm (p < 0.01), tumor localization in the greater curvature (p < 0.01), diffuse type (Lauren’s classification) (p < 0.01), Borrmann types 3–4 (p < 0.01), poor differentiation and undifferentiation (p < 0.01), depth of invasion T3–T4 (p < 0.01), number of lymph node metastases N2–N3 (p < 0.01), distant metastasis M1 (p < 0.01), TNM stages 3–4 (p < 0.01), vascular invasion (p = 0.01), and lymphatic invasion (p < 0.01) as potential risk factors of SHLN metastasis. Moreover, positivity of Nos. 1, 2, 3, 4sa, 4sb, 4d, 6, 7, 9, 11, and 16 lymph nodes for metastasis was strongly associated with SHLN metastasis.ConclusionsTumor size, tumor location, Lauren’s diffuse type, Borrmann type, degree of differentiation, T stage, N stage, M stage, TNM stage, vascular invasion, lymphatic infiltration, and other positive lymph nodes are risk factors for SHLN metastasis.

Prognostic significance of lymph node yield in patients with synchronous colorectal carcinomas.

The National Comprehensive Cancer Network (NCCN) guidelines recommend examination of a minimum of 12 lymph nodes (LNs) for accurate staging of a single case of colorectal cancer. However, the guidelines do not support the examination of LNs in synchronous colorectal carcinoma (SCC). This study aimed to investigate the association between lymph node yield and the prognosis of SCC patients. Synchronous colorectal carcinoma patients were selected from the Surveillance, Epidemiology, and End Results (SEER) database over a 10-year interval (2004 to 2013). Systematic dichotomization for optimal cut-off point identification was performed using X-tile. The baseline for the two LNs groups generated was balanced using the propensity score matching (PSM) method. A total of 4616 patients met the inclusion criteria. The cut-off number for lymph node retrieved from a single patient was 15 and 12 for the first- and second-time diagnosis of SCC, respectively. Age, T category, N category, tumor grade, tumor site, tumor size, and radiation sequence were not balanced in the two groups. After adjusting the baseline in the two groups, the same results were observed. Age, T category, N category, tumor site had a partial effect on lymph node yield. There might be some biological characteristics of the tumor that influence lymph node yield. Retrieval of fewer than 15 LNs at the first time of SCC diagnosis indicates worse SCC prognosis. Because factors such as manner of surgical examination influence SCC prognosis, specimens should be preserved for at least 6 months to enable reevaluation should there be a need. Irb: IRB approval is not required because the SEER data are freely accessible.

Efficacy of the fat-dissociation method for nodal harvesting in gastric cancer.

BACKGROUNDThere is an increased need for accurate staging for gastric cancer treatment. Consequently, it is necessary to carefully examine all dissected lymph nodes for precise staging. Recently, the fat-dissociation method has been developed as a quick and accurate method for harvesting dissected lymph nodes of colorectal cancer cases.AIMTo investigate the usefulness of the fat-dissociation method for harvesting dissected lymph nodes of gastric cancer cases.METHODSFifty-six resected specimens from gastric cancer patients who underwent standard curative gastrectomy and lymph node dissection at our hospital were used. Group 2 lymph nodes were separated from each specimen, and the remaining adipose tissue containing the group 1 lymph nodes was used. Some resected specimens were subjected to the fat-dissociation method. One vial of Imofully® was dissolved in 50 mL of saline and injected into the tissue. The tissue was incubated for 1 h and the dissolved fat was removed. Subsequently, the nodes were identified, picked up with scissors, and mapped. The number of nodes in each lymphatic compartment and duration of lymph node harvest and mapping were compared.RESULTSThe fat-dissociation method was used for 24 samples, while the conventional dissection method was used for 32 samples. The total number of harvested lymph nodes was 45.9 in the fat dissociation group and 44.3 in the control group, and there was no significant difference between the two groups. There were also no significant differences in the number of lymph nodes between the two groups based on a comparison of the lymphatic compartments. However, the total median duration of the fat-dissociation method was 38.2 min, reflecting a reduced duration of approximately 60 min compared to the control group.CONCLUSIONBased on our results, the fat-dissociation method is effective in shortening the duration of lymph node harvest in gastric cancer surgery.

Prognostic Impact of the Number of Examined Lymph Nodes in Stage II Colorectal Adenocarcinoma: A Retrospective Study.

Background Evaluation of lymph node status is critical in colorectal carcinoma (CRC) treatment. However, as patients with node involvement may be incorrectly classified into earlier stages if the examined lymph node (ELN) number is too small and escape adjuvant therapy, especially for stage II CRC. The aims of this study were to assess the impact of the ELN on the survival of patients with stage II colorectal cancer and to determine the optimal number. Methods Data from the US Surveillance, Epidemiology, and End Results (SEER) database on stage II resected CRC (1988-2013) were extracted for mathematical modeling as ELN was available since 1988. Relationship between ELN count and stage migration and disease-specific survival was analyzed by using multivariable models. The series of the mean positive LNs, odds ratios (ORs), and hazard ratios (HRs) were fitted with a LOWESS (Locally Weighted Scatterplot Smoothing) smoother, and the structural break points were determined by the Chow test. An independent cohort of cases from 2014 was retrieved for validation in 5-year disease-specific survival (DSS). Results An increased ELN count was associated with a higher possibility of metastasis LN detection (OR 1.010, CI 1.009-1.011, p < 0.001) and better DSS in LN negative patients (OR 0.976, CI 0.975-0.977, p < 0.001). The cut-off point analysis showed a threshold ELN count of 21 nodes (HR 0.692, CI 0.667-0.719, p < 0.001) and was validated with significantly better DSS in the SEER 2009 cohort CRC (OR 0.657, CI 0.522-0.827, p < 0.001). The cut-off value of the ELN count in site-specific surgeries was analyzed as 20 nodes in the right hemicolectomy (HR 0.674, CI 0.638-0.713, p < 0.001), 19 nodes in left hemicolectomy (HR 0.691, CI 0.639-0.749, p < 0.001), and 20 nodes in rectal resection patients (HR 0.671, CI 0.604-0.746, p < 0.001), respectively. Conclusions A higher number of ELNs are associated with more-accurate node staging and better prognosis in stage II CRCs. We recommend that at least 21 lymph nodes be examined for accurate diagnosis of stage II colorectal cancer.

Abstract C101: A prognostic risk model for African American women with breast cancer: Implications for meaningful accrual in clinical trials

Abstract Background: Racial disparities in breast cancer outcomes appear to be widening in the US despite multiple advancements in breast cancer (BC) management. Although BC incidence rates are similar between European-American (EA) and African American (AA) women in the US, striking differences exist in age-adjusted mortality rates. Moreover, AAs only represent 5-10% of BC clinical trials is the US, and there is a dearth of studies that stratify outcomes by race. Unfortunately, there is no reliable way to identify AA BC patients at high risk of poor outcomes, which would require more aggressive treatment. In this study, we aimed to develop a prognostic model for AA women that will allow for a deeper segmentation and an accurate patient stratification into high and low risk subgroups to aid clinical decision making. Methods: We obtained protein data from The Cancer Proteome Atlas (TCPA) dataset, which consists of reverse phase protein array (RPPA) expression levels of 224 proteins measured from BC TCGA cohort. Protein expression information were available for a total of 754 BC patients (134 AA and 620 EA). Sequential forward selection alongside cross-validation was used to select proteins, fit into a random forest model, based on their combined accuracy in predicting patient prognosis. Models were evaluated on the combined cross validated test sets either univariately through the Kaplan-Meier log-rank test or via multivariate analysis after adjusting for stage, age, and positive lymph nodes through Cox regression model. Results: The selection process resulted in combination of four proteins that optimized prognostic prediction: bcl2- like protein (BAX), Inositol polyphosphate-4-phosphatase, type II (INPP4B), X-ray repair cross-complementing protein 1 (XRCC1) and Cleaved Poly (ADP-ribose) polymerase (c-PARP)). Alone, these proteins did not have significant prognostic value in AA BC patients [BAX (HR=0.676, p=0.6276), INPP4B (HR=0.9935, p=0.9772), XRCC1(HR=0.2613, p=0.1455), c-PARP (HR=0.6375, p=0.6186)]; within random forest, these variables were able to stratify high-risk group patients with 86% accuracy and Hazard Ratio (HR) of 5 (p &amp;lt;0.001). The model retained its significant prognostic ability (HR=10.741, p=0.0006) when controlling for clinicopathologic variables like stage, age, and positive lymph nodes. Finally, we retrained our model to risk stratify BC patients in the EA cohort; the magnitude of risk stratification was very low (HR=1.33) compared to AA cohort, confirming its prognostic role specifically in AA BC patients. Conclusions: Based on statistical modeling and ML-based approaches, our data show that assessment of expression of a quartet of biomarkers—BAX, XRCC1, INPP4B and c-PARP—can be used to robustly stratify AA BC patients into high- and low-risk categories. We believe our model plays an important prognostic role in AA BC patients and could inform clinicians to prioritize AA patients for appropriate clinical trials and also help patients make decisions about enrolling in such trials. Citation Format: Shristi Bhattarai, Sergey Klimov, Ritu Aneja. A prognostic risk model for African American women with breast cancer: Implications for meaningful accrual in clinical trials [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C101.

Regional Lymph Node Metastasis of Scalp Angiosarcoma: A Detailed Clinical Observation Study of 40 Cases.

The incidence of lymph node metastasis (LNM) of angiosarcomas is reported to be less than 15%, and elective neck management has not been indicated. This study evaluated the incidence and pattern of regional LNM in patients with scalp angiosarcomas using the clinical data of its full course to understand time-event sequences of scalp angiosarcomas. This retrospective study included all consecutive cases of pathology-confirmed angiosarcomas and analyzed 40 cases of scalp angiosarcomas. The survival plots were estimated using the Kaplan-Meier method, and the results are presented mainly in a descriptive manner. The overall survival rate for the patients was 35.8% at 2years. In contrast to previous reports, regional LNM was observed in more than half of the patients (52.5%) with scalp angiosarcoma. Meanwhile, a direct spread to distant organs occurred in only 27.5% of the patients. Regional LNM could predict clinical manifestation of systemic disease within 3 to 6months. No differences in survival rates between patients with and without LNM were observed in this series. Occurrence of LNM seemed to be correlated with a high mitotic rate of primary tumors, but not with tumor grade or tumor dimension. The first-echelon lymph nodes from scalp angiosarcoma were peri-parotid, post-auricular, and level 2 lymph nodes. For a localized scalp angiosarcoma, it seems reasonable for initial curative surgery to include prophylactic evaluation of regional lymph nodes for pathologic nodal staging, prognosis estimation, and the decision for systemic treatments.

The Prognostic Value of One-Step Nucleic Acid Amplification (OSNA) and Immunohistochemistry (IHC) in Ex Vivo Sentinel Lymph Nodes in Stage I &amp; II Colonic Cancer Patients - A Multicenter Cohort Study

Colorectal cancer (CRC) is the third most common cancer worldwide with nearly 1,4 million newly diagnosed patients each year, accounting for 8% of all cancer related deaths.

Comparison of Laparoscopy and Laparotomy for Para-Aortic Lymphadenectomy in Women With Presumed Stage I-II High-Risk Endometrial Cancer.

Objective: To compare laparoscopic surgery to laparotomy for harvesting para-aortic lymph nodes in presumed stage I–II, high-risk endometrial cancer patients.Methods: Patients with histologically proven endometrial cancer, presumed stage I-II with high-risk tumor features who had undergone hysterectomy, bilateral salpingoophorectomy, or pelvic and para-aortic lymphadenectomy by either laparoscopy or laparotomy in Samsung Medical Center from 2005 to 2017 were retrospectively investigated. The primary outcome was para-aortic lymph node count. Secondary outcomes were pelvic lymph node count, perioperative events, and postoperative complications.Results: A total of 90 patients was included (35 for laparotomy, 55 for laparoscopy) for analysis. The mean (±SD) para-aortic lymph node count was 10.66 (±7.596) for laparotomy and 10.35 (±5.848) for laparoscopy (p = 0.827). Mean pelvic node count was 16.8 (±6.310) in the laparotomy group and 16.13 (±7.626) in the laparoscopy group (p = 0.664). Lower estimated blood loss was shown in the laparoscopy group. There was no difference in perioperative outcome between the groups. Additional multivariate analysis showed that survival outcome was not affected by surgical methods in presumed stage I-II, high-risk endometrial cancer patients.Conclusions: Study results demonstrate comparable para-aortic lymph node count with less blood loss in laparoscopy over laparotomy. In women with presumed stage I-II, high-risk endometrial cancer, laparoscopy is a valid treatment modality.

MP61-02 DETAILED CADAVERIC ANALYSIS FOR PERIVESICAL LYMPH NODES WITH POTENTIAL IMPLICATIONS IN BLADDER CANCER

INTRODUCTION AND OBJECTIVE: Perivesical lymph nodes were added to the 8 edition of AJCC staging for bladder cancer. In pN+ patients, positive perivesical lymph nodes are associated with even worse overall survival. These nodes are inconsistently evaluated at the time of radical cystectomy (RC) and can be difficult to differentiate from perivesical fat. Currently, no studies have detailed the presence or anatomic location of perivesical lymph nodes. The objective was to provide a detailed anatomic evaluation of perivesical lymph nodes. METHODS: Six unembalmed cadavers with no prior pelvic malignancy or surgery were utilized. An open RC was performed on all specimens with wide resection of perivesical tissue and meticulous care to separate the pelvic lymph nodes (e.g.obturator, external iliac) from the specimen. The specimens were fixed in a previously validated lymph node revealing solution for 6 hours. Perivesical tissue dissection in 2 mm slices was performed. Lymph node identification and examination were performed by a board-certified pathologist. Perivesical lymph node size and location in relation to bladder wall was recorded. RESULTS: Gross lymph nodes were identified in the perivesical tissue in 50% (3/6) of the specimens, with a total of 6 lymph nodes identified. The mean lymph node size was 7.5 mm (2-16 mm). The mean distance from bladder wall was 9 mm (3-15 mm). Ten potential anatomic locations for perivesical nodes were developed: urachal, anterior bladder wall, posterior peritoneum, periprostatic/bladder neck, bilateral peripedicle, bilateral periseminal vesicle, bilateral lateral bladder wall. Nodes were identified in the: Right peripedicle (2 nodes), left lateral bladder wall (2 nodes), posterior peritoneum (1 node), anterior bladder wall (1 node) (Table). On histologic analysis, 4 of the 6 (66%) grossly identified lymph nodes had confirmed lymphoid tissue. CONCLUSIONS: In a cadaveric model with meticulous dissection, gross and histologically-confirmed lymph nodes were identified in the perivesical space in half of patients. When present, patients had an average of two nodes that were distributed around the bladder and within 15mm of the bladder wall. This data, as well as the inclusion of perivesical lymph nodes in AJCC staging, argues for thorough evaluation of the RC specimen for perivesical lymph nodes.Source of Funding: None

Evaluation and Recommendation of the 8th Edition of American Joint Committee on Cancer (AJCC) Staging System for Intrahepatic Cholangiocarcinoma (ICC) in 820 Patients from the Surveillance, Epidemiology, and End Results (SEER) Database

BackgroundThe AJCC made four changes to T category in the 8th AJCC stage for ICC, but this is a topic of debate. MethodsData from 820 patients with ICC were extracted from the SEER database. Survival analysis of the 8th AJCC stage was examined. ResultsTo verify the four T staging changes by survival analysis: prognosis of patients with tumor size > 5 cm was poorer than that with tumor size ≤ 5 cm (P < 0.05); in N0M0 cohort, there was no significant difference in survival between solitary tumor with vascular invasion and multiple tumors (P = 0.092), tumor perforating the visceral peritoneum with and without involving local extrahepatic structures by direct invasion (P = 0.470), and tumor with and without periductal invasion (PI) (P = 0.220). The prognosis of patients with ≥ 4 positive lymph nodes was relatively poor compared with 1–3 positive lymph nodes (P = 0.037) and similar to patients with stage IV (8th AJCC, P = 0.585). ConclusionThis study found that there was no significant difference in survival between tumor perforating the visceral peritoneum with and without involving local extrahepatic structures by direct invasion, whereas other T staging changes were effective. The inclusion of the number of positive lymph nodes in the 8th AJCC stage may improve prognostic discrimination in ICC patients.

Long-term efficacy and adverse reactions of intensity-modulated radiotherapy for patients with nasopharyngeal carcinoma in non-endemic northwest China

Objective To retrospectively analyze the characteristics of nasopharyngeal carcinoma, long-term efficacy, adverse reactions of intensity-modulated radiotherapy (IMRT) in non-endemic northwest China and summarize the experience of IMRT in the treatment of nasopharyngeal carcinoma in the past decade. Methods Clinical data of 658 patients newly diagnosed with nasopharyngeal carcinoma without distant metastasis admitted to First affiliated hospital from January 2006 to December 2016 were retrospectively analyzed. All patients were treated with IMRT. The survival analysis was performed by Kaplan-Meier method. The multivariate analysis was conducted with Cox’s regression model. Results In non-endemic northwest China, a large proportion of patients were newly diagnosed with locally advanced nasopharyngeal carcinoma, and a majority of them were pathologically characterized as differentiated subtypes. The 5-year overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS) and distant metastasis-free survival (DMFS) rates were 75.7%, 70.1%, 91.2%, 97.0% and 81.0%, respectively. Multivariate analysis showed that age, pathological type, nasopharyngeal tumor volume>23 cm3 and neck lymph node metastasis complicated with necrosis were the factors of poor prognosis of DFS (all P<0.05). Age, pathological type, neck lymph node metastasis complicated with necrosis were the factors of poor prognosis of OS (all P<0.05). N stage and neck lymph node metastasis complicated with necrosis were the factors of poor prognosis of DMFS (both P<0.05). Conclusions Similar clinical efficacy has been achieved in terms of IMRT for nasopharyngeal carcinoma in non-endemic northwest China compared with that in endemic area. Induction chemotherapy combined with concurrent radiochemotherapy can provide clinical benefits for patients with locally advanced nasopharyngeal carcinoma in non-endemic area. Key words: Nasopharyngeal neoplasm/intensity-modulated radiotherapy; Non-endemic area; Prognosis

Abstract P3-01-21: Functional duality of NUAK2 in breast cancer metastases

Abstract Background: Breast cancer patients with lymph nodes metastasis were proven to have more aggressive biologically phenotypes. This study was aimed to find different biomarker ectopic expression between breast cancer patients' metastatic lymph nodes and primary cancer, and to explore the potential molecular mechanisms. Method: From our previous research, we selected the pairing samples from primary breast cancer with their early stage lymph node metastasis to carry out differential gene expression profiling. Genes with high expression level in sentinel lymph node metastasis were obtained. Then according to the findings of CRISPR/Cas9 screening and the results in relevant literature and online public database, we decided to investigate the role of NUAK2 in our further research. In vitro and in vivo analyses were carried out to determine the potential mechanisms of NUAK2 in lymph node metastases and prognosis. Results NUAK2 belongs to the AMP-activated protein kinase (AMPK) family, with its members controling protein metabolism, polarity, and overall cellular homeostasis actin cytoskeleton organization. The effect of NUAK2 variant expression in breast cancer metastases remains unknown. In this study, it was found that the expression level of NUAK2 was significantly higher in 5 paired metastatic lymph node than that in primary cancer, using Affymetrix GeneChip® Human Transcriptome Array 2.0. From online public database, higher NUAK2 expression level was markedly associated with better metastasis-free survival in breast cancer patients. The effects of NUAK2 on proliferation were investigated by CCK-8 and IncuCyte ZOOM™ assay, respectively. The results demonstrated that knockdown NUAK2 was able to significantly inhibit the proliferation of breast cancer cells. However, for cancer metastases, it was demonstrated that knock-down of NUAK2 significantly accelerated the migration of breast cancer cells, while overexpression of NUAK2 notably inhibited breast cancer cell migration. When promoting proliferation of breast cancer cells, NUAK2 might involve signal pathways of cell cycle. As for the anti-metastasis function, it would regulate cell adhesion, cell motility and microenvironment. Conclusion: Our in vitro study demonstrated that NUAK2 has shown reverse effects of tumor cell proliferation and invasion. The interaction of NUAK2 and cancer cells could be an important role in cell proliferation involved in cell cycle signal pathway, and modulate cell mobility by inducing cell-cell detachment. Its molecular mechanism of dual effect in breast cancer need further investigation. Citation Format: Wang Jia, XUE Jingyan, Hou Jianjing, Xiu Bingqiu, Li Lun, Chi Yayun, Wu Jiong. Functional duality of NUAK2 in breast cancer metastases [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-01-21.

Prognostic impact of lymph node status in patients after total pancreatectomy for pancreatic ductal adenocarcinoma: A strobe-compliant study.

The optimal number of examined lymph nodes (ELN) for staging and impact of nodal status on survival following total pancreatectomy (TP) for pancreatic ductal adenocarcinoma (PDAC) is unclear. The aim of this study was to evaluate the prognostic impact of different lymph node status after TP for PDAC.The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients who underwent TP for PDAC from 2004 to 2015. We calculated overall survival (OS) of these patients using Kaplan-Meier analysis and Cox proportional hazards model.Overall, 1291 patients were included in the study, with 869 node-positive patients (49.5%). A cut-off points analysis revealed that 19, 19, and 13 lymph nodes best discriminated OS for all patients, node-negative patients, and node-positive patients, respectively. Higher number of ELN than the corresponding cut-off points was an independent predictor for better prognosis [all patients: hazard ratios (HR) 0.786, P = .002; node-negative patients: HR 0.714, P = .043; node-positive patients: HR 0.678, P < .001]. For node-positive patients, 1 to 3 positive lymph nodes (PLN) correlated independently with better survival compared with those with 4 or more PLN (HR 1.433, P = .002). Moreover, when analyzed in node-positive patients with less than 13 ELN, neither the number of PLN nor lymph node ratio (LNR) was associated with survival. However, when limited node-positive patients with at least 13 ELN, univariate analyses showed that both the number of PLN and LNR were associated with survival, whereas multivariate analyses demonstrated that only number of PLN was consistently associated with survival (HR 1.556, P = .004).Evaluation at least 19 lymph nodes should be considered as quality metric of surgery in patients who underwent TP for PDAC. For node-negative patients, a minimal number of 19 lymph nodes is adequate to avoid stage migration. For node-positive patients, PLN is superior to LNR in predicting survival after TP, predominantly for those with high number of ELN.

MAP7 promotes migration and invasion and progression of human cervical cancer through modulating the autophagy

BackgroundMicrotubule-associated proteins 7(MAP7) was reported to be engaged into the function of neuronal function. The function of MAP7 in human cervical cancer (CC) was unknown. We aimed to uncover the function and mechanism of MAP7 on CC.MethodsWe applied qRT-PCR, western blot and immunochemistry to detect the expression difference between normal tissue and CC. In vitro, we establish MAP7 stable knocking down and overexpression cell lines and investigated the function and underlying mechanism of MAP7 in CC.ResultsBoth mRNA and protein of MAP7 were upregulated in CC compared with the normal tissue. MAP7 was correlated with the clinical stage and tumor size and lymph node metastasis. MAP7 promotes the invasion and migration of CC cell lines. We next detected EMT pathway and autophagy associated pathway. MAP7 promotes the EMT through modulating the autophagy.ConclusionTaken above, our results showed that MAP7 promotes the migration and invasion and EMT through modulating the autophagy.

Near-Infrared Labeling of EGFR+ Cells Can Allow Differentiation between Benign and Metastatic Lymph Nodes.

HomeRadiology: Imaging CancerVol. 2, No. 1 PreviousNext Research HighlightsFree AccessNear-Infrared Labeling of EGFR+ Cells Can Allow Differentiation between Benign and Metastatic Lymph NodesAdeline N. BoettcherAdeline N. BoettcherAdeline N. BoettcherPublished Online:Jan 31 2020https://doi.org/10.1148/rycan.2020194014MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Take-Away Points■ Major focus: Improving ex vivo identification of benign and metastatic lymph nodes for solid tumor staging.■ Key result: Panitumumab-IRDye800CW (anti-EGFR) imaging of resected lymph nodes from patients with solid tumors enhanced ex vivo classification of benign and metastatic lymph nodes.■ Impact: This imaging methodology can increase efficiency and accuracy of lymph node characterization and can be further developed for in vivo imaging during resection surgeries to easily visualize metastatic lymph nodes.Standard staging of head and neck squamous cell carcinomas is performed by histopathologic assessment of resected lymph nodes from the neck. Metastatic or benign status of resected lymph nodes can be used in the tumor, node, metastasis (TNM) staging system to stage patient tumors. Proper staging of tumors is critical for determining the optimal treatment plan. Current practice requires assessing as many as possible collected lymph nodes for staging. Lymph nodes are typically analyzed by hematoxylin-eosin (H-E) staining to detect differences in tissue architecture for benign or metastatic classification, which can be a time-consuming and subjective process. Nishio et al describe the use of panitumumab-IRDye800CW (anti–epidermal growth factor receptor [EGFR]) as a near-infrared fluorescently labeled agent to selectively label metastatic lymph nodes during ex vivo evaluation.In this single-center, nonrandomized, phase I study, 22 patients underwent surgical resection of primary tumors, as well as either a unilateral or bilateral neck dissection. Panitumumab-IRDye800CW was infused into patients 1–5 days prior to surgery with an average dose of 0.67 mg/kg (range, 0.26–1.05 mg/kg). Resected lymph nodes were subjected to closed-field fluorescence imaging, as well as standard H-E staining, to determine the sensitivity and specificity of fluorescent EGFR labeling. Nishio et al quantified two imaging parameters: (a) mean fluorescence intensity (MFI) and (b) signal-to-background (SBR) and compared these results to histopathologic findings of the lymph nodes. Metastatic lymph nodes had significantly higher MFI and SBR than benign lymph nodes. Taking both MFI and SBR into account, metastatic lymph nodes could be identified with high sensitivity (84.6%), specificity (94.0%), negative predictive value (99.3%), and an acceptable positive predictive value (36.2%).In all, using panitumumab-IRDye800CW to label metastatic lymph nodes could reduce the total number of lymph nodes required for histologic determination of benign or metastatic status. Additionally, regular implementation of the described anti-EGFR labeling approach could help to increase standardization and efficacy of lymph node identification.Highlighted ArticleNishio, N, van den Berg NS, van Keulen S, et al. Optical molecular imaging can differentiate metastatic benign lymph nodes in head and neck cancer. Nat Commun 2019;10:5044. doi: https://doi.org/10.1038/s41467-019-13076-7Highlighted ArticleNishio, N, van den Berg NS, van Keulen S, et al. Optical molecular imaging can differentiate metastatic benign lymph nodes in head and neck cancer. Nat Commun 2019;10:5044. doi: https://doi.org/10.1038/s41467-019-13076-7 Crossref, Medline, Google ScholarArticle HistoryPublished online: Jan 31 2020 FiguresReferencesRelatedDetailsRecommended Articles USPIO-enhanced MRI for Nodal Staging in Patients with Head and Neck CancerRadiology: Imaging Cancer2022Volume: 4Issue: 5Advances in Diagnosis and Multidisciplinary Management of Oropharyngeal Squamous Cell Carcinoma: State of the ArtRadioGraphics2019Volume: 39Issue: 7pp. 2055-2068Application of N Descriptors Proposed by the International Association for the Study of Lung Cancer in Clinical StagingRadiology2021Volume: 300Issue: 2pp. 450-457CT-based Radiomic Signatures for Predicting Histopathologic Features in Head and Neck Squamous Cell CarcinomaRadiology: Imaging Cancer2020Volume: 2Issue: 3Impact of 18F-DCFPyL PET on Staging and Treatment of Unfavorable Intermediate or High-Risk Prostate CancerRadiology2022Volume: 304Issue: 3pp. 600-608See More RSNA Education Exhibits AJCC 2018 Head and Neck Cancer Staging Manual: Get Prepared for the ENT Tumor BoardDigital Posters2018Cystic Cervical Lymph Nodes: A Systematic Approach and Useful Imaging Features for their DifferentiationDigital Posters2020Esophageal Cancer: Role of Imaging in Primary Staging and Assessment of Response to Neoadjuvant TherapyDigital Posters2018 RSNA Case Collection Synovial sarcoma of neckRSNA Case Collection2020Multiple Endocrine Neoplasia Type 1 SyndromeRSNA Case Collection2021Horner syndrome in neuroblastomaRSNA Case Collection2020 Vol. 2, No. 1 Metrics Altmetric Score PDF download

Prognostic significance of lymph node count in high-risk node-negative colon carcinoma.

the prognostic value of the number of lymph nodes isolated (< 12 versus ≥ 12) in the surgical specimen continues to be controversial. In this study, the impact of isolating fewer or more than 12 lymph nodes in stage II colon cancer with a high-risk biologic phenotype was analyzed, such as the presence of perineural invasion. all cases of stage II disease (T3-4N0M0) with perineural invasion (PNI+) were retrospectively identified from a prospective database of patients undergoing surgery for colon cancer. The cohort was divided into two groups depending on the number of lymph nodes isolated (< 12 vs ≥ 12). Apart from clinical and surgical data, the patterns of recurrence, overall (OS) and disease-free survival (DFS) at five and ten years were analyzed. sixty patients met the inclusion criteria, 31.7 % had < 12 lymph nodes isolated and 68.3 % had more than 12 isolated. There were no clinical or surgical differences between the two groups. OS at five and ten years was significantly lower in the patients with < 12 lymph nodes isolated (84.2 %, 62.7 % vs 94.6 % and 91.6 %, p = 0.01). DFS at five and ten years was 51 % vs 86.5 %, respectively (p = 0.005). the number of lymph nodes isolated (with a cutoff of 12) in stage II colon cancer with PNI+ has prognostic value and should therefore be borne in mind when planning adjuvant chemotherapy.

Proposal of the minimal number of retrieved regional lymph nodes for accurate staging of distal bile duct cancer and clinical validation of the three-tier lymph node staging system (AJCC 8th edition).

The minimal required number of retrieved lymph nodes (MNRLNs) to enable accurate staging of distal bile duct (DBD) adenocarcinoma remains unclear. The three-tier 8th N staging system of the American Joint Committee on Cancer (AJCC) for DBD adenocarcinoma has been recently released. The present study is aimed at proposing the MNRLNs for accurate staging and validating the 8th N stage. Between 1991 and 2015, patients with pathologically confirmed DBD adenocarcinoma who underwent pancreatoduodenectomy were enrolled. MNRLN was calculated via a log-rank test based on cut-off values. The concordance index (C-index) was utilized to compare the discrimination capability of the two- and three-tier N stages. A total of 780 patients were enrolled. Lymph node (LN) positivity and 5-year overall survival (5-YOS) rates stabilized and significant survival differences between node-negative and -positive patients were observed when≥12 LNs were retrieved. 5-YOS rates between each 8th N stage significantly differ (N0 vs. N1, P=0.037; N1 vs. N2, P=0.003). The C-index of the 8th N stage was higher than that of the 7th (0.59 vs. 0.57). For accurate staging, at least 12 LNs should be retrieved. The three-tier N staging system is valid for clinical practice and has a more accurate prognostic predictability than the two-tier system.

The expression and clinical significance of kinesin superfamily proteins 18A in bladder cancer tissues

Objective To investigate the expression level of kinesin superfamily proteins 18A (KIF18A) in bladder cancer tissues and its correlation with clinicopathological features. Methods The clinical data, bladder cancer tissues and adjacent normal tissues samples of 63 patients who underwent radical cystectomy in our hospital from October 2016 to December 2018 were collected. To the normal tissue of the cancer side as a control, to detect the level of KIF18A expression in bladder cancer tissue, according to staining results, bladder cancer patients were divided into KIF18A low expression group and KIF18A high expression group, using the chi-square test or Fisher precision test to compare the clinical and pathological characteristics between the groups, Analysis of the correlation between the degree of expression of KIF18A in bladder cancer tissue and clinical pathological characteristics. Results The high expression rate of KIF18A in bladder cancer tissues was 55.6% (35/63) and the low expression rate was 44.4% (28/63). The high expression rate of KIF18A in normal tissues was 28.6% (18/63) and the low expression rate was 71.4% (45/63). KIF18A expression in bladder cancer was significantly different from that in adjacent normal tissues (χ2=9.412, P 0.05), age (χ2=0.268, P>0.05), the tumor diameter (χ2=0.121, P>0.05), N staging (lymph node involvement staging χ2=4.882, P>0.05), M staging (distant metastasis staging χ2=1.690, P>0.05). T staging (tumor invasion staging χ2=9.264, P<0.05) and pathological grading (χ2=5.119, P<0.05) was significantly related to the high expression rate of KIF18A. Conclusion KIF18A is up-regulated in bladder cancer, and its high expression is positively correlated with T stage and pathological grade. Key words: Bladder cancer; Kinesin superfamily proteins; Kinesin superfamily proteins 18A; Clinicopathologic features

Selective lymph node dissection for clinical T1 stage non-small cell lung cancer.

BackgroundMore and more pulmonary nodules are detected by CT scan, and postoperative pathology reveals many lymph nodes without metastasis. The purpose of this study was to investigate the characteristics of T1 stage lymph node metastasis in non-small cell lung cancer (NSCLC) and to explore the indications for selective lymph node dissection (SLND).MethodsA total of 841 patients with stage T1 of NSCLC were performed lobectomy and systemic lymphadenectomy. We analyzed the types of lymph node metastases and the relationship between lymph node metastasis and pulmonary pleural invasion, thrombosis of vascular carcinoma and tumor size in all patients.ResultsAmong them, 257 cases of tumor in the right upper lobe (RUL) and 186 cases in the left upper lobe (LUL), and no metastasis was found in the inferior mediastinal lymph nodes. Tumor metastases occurred in subcarinal lymph nodes, with hilar and/or mediastinal lymph node metastasis. Among the 171 cases with right lower lobe (RLL) tumors and the 151 cases with left lower lobe (LLL) tumors, patients with superior lymph node metastasis were all associated with hilar and/or subcarinal lymph node metastasis. Among the 76 cases with right middle lobe (RML) tumors, no metastasis with inferior mediastinal lymph node was observed. Lymph node metastasis is much easier in patients with pulmonary pleural invasion or thrombosis of vascular cancer. The larger the tumor diameter, the greater the possibility of lymph node metastasis.ConclusionsSLND is a feasible treatment for clinical T1 stage NSCLC under the guidance of intraoperative frozen results of lobe-specific lymph nodes.

Oncologic outcome after completing or abandoning (radical) hysterectomy in patients with cervical cancer and intraoperative detection of lymph node positivity; ABRAX (ABandoning RAd hyst in cerviX cancer)

BackgroundThe management of patients with intraoperative detection of lymph node involvement remains controversial. The most significant aspect is the decision regarding the completion of the cervical procedure, such as hysterectomy,...