Regional Lymph Node Status Research Articles

Comparison of Four Lymph Node Stage Methods for Predicting the Prognosis of Distal Cholangiocarcinoma Patients After Surgery

BackgroundThe metastatic status of regional lymph nodes is an effective risk factor for the prognosis of distal cholangiocarcinoma (dCCA). But existing lymph node staging is not accurate enough and is susceptible to interference. This study aims to explore the predictive ability of the log odds of positive lymph nodes (LODDS) staging system of dCCA compared with existing lymph node staging systems.MethodsA total of 928 dCCA patients were selected from the Surveillance, Epidemiology, and End Results (SEER) database as the training cohort, and 207 dCCA patients from West China Hospital who underwent surgery were reviewed as the validation cohort. The least absolute shrinkage and selection operator (LASSO) and multivariate Cox regression were conducted to identify the most meaningful factors relevant to prognosis. The performance of four lymph node stage systems was compared by a model-based approach.ResultAge at diagnosis, pathological grade, American Joint Committee on Cancer (AJCC) tumor 7th T stage, tumor size, radiotherapy, chemotherapy, and lymph node stage system were independent prognostic factors. The model with the LODDS system had a better model fit with the highest C-index (0.679) and 1-/3-/5- area under the receiver operating characteristic curve (AUC) (0.739/0.671/0.658) as well as the lowest Akaike information criterion (AIC) (5,020.52). External validation results from 207 dCCA patients showed a C-index of 0.647 and 1-/3-/5-AUC of 0.740/0.683/0.589. Compared with the lymph node ratio (LNR), AJCC 8th N system, and 7th N system, the 5-year net reclassification improvement (NRI) of the LODDS system was 0.030 (95% CI: −0.079 to 0.147), 0.042 (95% CI: −0.062 to 0.139), and 0.040 (95% CI: −0.057 to 0.146), respectively. The integrated discrimination improvement (IDI) of LODDS improved compared with the LNR model (0.016; 95% CI: −0.001 to 0.036), AJCC 8th N system (0.020; 95% CI: 0.003–0.037), and AJCC 7th N system (0.019; 95% CI: 0.002–0.036). Decision curve analysis (DCA) also shows a greater net benefit of LODDS. In lymph node-negative patients, LODDS reveals a positive linear relationship with the hazard ratio (HR). The stage capacity of LODDS in a subgroup analysis stratified by examined lymph node number (ELNN) was consistent.ConclusionsThe LODDS lymph node stage system has superior predictive performance as compared with the LNR, AJCC 7th, and 8th lymph node stage systems. Meanwhile, LODDS has a more detailed staging ability and good stability.

Tumor glycolytic heterogeneity improves detection of regional nodal metastasis in patients with lung adenocarcinoma.

The diagnostic performance of 18F-FDG PET for detecting regional lymph node metastasis in resectable lung cancer is variable, and its sensitivity for adenocarcinoma is even lower. We aimed to evaluate the value of 18F-FDG PET-derived features in predicting pathological lymph node metastasis in patients with lung adenocarcinoma. We retrospectively analyzed pretreatment 18F-FDG PET-derived features of 126 lung adenocarcinoma patients who underwent curative surgery. A logistic regression model was used to analyze the association between study variables and pathological regional lymph node status obtained from the curative surgery. Furthermore, Cox regression analysis was used to test the effect of the study variables on survival outcomes, including disease-free survival (DFS) and overall survival (OS). The primary tumor entropy (OR = 1.7, p = 0.014) and visual interpretation of regional nodes via 18F-FDG PET (OR = 2.5, p = 0.026) independently predicted pathological regional lymph node metastasis. The areas under the receiver-operating-characteristic curves were 0.631, 0.671, and 0.711 for visual interpretation, primary tumor entropy, and their combination, respectively. Based on visual interpretation, a primary tumor entropy ≥ 3.0 improved the positive predictive value of positive visual interpretation from 51.2% to 63.0%, whereas an entropy < 3.0 improved the negative predictive value of negative visual interpretation from 75.3% to 82.6%. In cases with positive visual interpretation and low entropy, or negative visual interpretation and high entropy, the nodal metastasis rates were approximately 30%. In the survival analyses, the primary tumor entropy was also independently associated with DFS (HR = 2.7, p = 0.001) and OS (HR = 4.8, p = 0.001). Our preliminary results show that the primary tumor entropy may improve 18F-FDG PET visual interpretation in predicting pathological nodal metastasis in lung adenocarcinoma, and may also show a survival prognostic value. This versatile biomarker may facilitate tailored therapeutic strategies for patients with resectable lung adenocarcinoma.

Recurrence Prediction Score of the Localy Advance Breast Cancer in West Sumatera Province, Indonesia

Introduction: Breast cancer is the most common malignancy that occurs in women in the world, which is about 18% of cancer cases that occur in women. Every year there are 1 million new cases of breast cancer worldwide and nearly 60,000 patients die from this disease. Therefore, the authors want to find out more about the prognosis factors that play a role in influencing the survival of patients with locally advanced breast cancer in Padang city, West Sumatera Province Indonesia.&#x0D; Methods: This study is a retrospective case-control study of locally advanced breast cancer for patients in Padang city. The study was conducted at the Surgical Oncology Division of Dr. M Djamil Padang Hospital, Ropana Suri Hospital, Ibnu Sina Hospital and Siti Rahmah Padang Hospital from September 2018 to December 2018. The total number of samples for the two groups was 242 people. The sampling technique used was convenience sampling.&#x0D; Results: In this study 4 prognostic factors were found that had a significant effect on predicting breast cancer recurrence, namely histopathological type, stage, regional lymph and lymphovascular invasion with p &lt;0.05.&#x0D; Conclusion: Prognosis factors that influence breast cancer recurrence are histopathological type, stage, regional lymph node status and lymphovascular invasion. A scoring system is obtained that is good enough to predict the possibility of breast cancer recurrence.

Recurrence Prediction Score of the Localy Advance Breast Cancer in West Sumatera Province, Indonesia

Introduction: Breast cancer is the most common malignancy that occurs in women in the world, which is about 18% of cancer cases that occur in women. Every year there are 1 million new cases of breast cancer worldwide and nearly 60,000 patients die from this disease. Therefore, the authors want to find out more about the prognosis factors that play a role in influencing the survival of patients with locally advanced breast cancer in Padang city, West Sumatera Province Indonesia.&#x0D; Methods: This study is a retrospective case-control study of locally advanced breast cancer for patients in Padang city. The study was conducted at the Surgical Oncology Division of Dr. M Djamil Padang Hospital, Ropana Suri Hospital, Ibnu Sina Hospital and Siti Rahmah Padang Hospital from September 2018 to December 2018. The total number of samples for the two groups was 242 people. The sampling technique used was convenience sampling.&#x0D; Results: In this study 4 prognostic factors were found that had a significant effect on predicting breast cancer recurrence, namely histopathological type, stage, regional lymph and lymphovascular invasion with p &lt;0.05.&#x0D; Conclusion: Prognosis factors that influence breast cancer recurrence are histopathological type, stage, regional lymph node status and lymphovascular invasion. A scoring system is obtained that is good enough to predict the possibility of breast cancer recurrence.

Application of an indocyanine green surgical fluorescence imaging system in sentinel lymph node biopsy of acral malignant melanoma.

BackgroundRegional lymph node status is an independent influencing factor for the prognosis of acral malignant melanoma, and the accuracy of sentinel lymph node biopsy (SLNB) is directly related to the judgment of regional lymph node status. This study aimed to explore the application value of indocyanine green (ICG) surgical fluorescence imaging system in the SLNB of acral malignant melanoma.MethodsA total of 34 patients with acral malignant melanoma were admitted to the Department of Burn and Plastic Surgery in Jiangsu Provincial People’s Hospital from January 2020 to March 2020. Among these patients, 22 required SLNB. ICG and methylene blue (MB) were combined to intraoperatively trace the sentinel lymph nodes (SLNs). The total number of SLNs detected during the operation was counted. We compared the number, detection rate, as well as the detection rate and false negative rate of positive SLNs of SLNs detected by ICG, MB, and ICG combined with MB.ResultsA total of 56 SLNs were detected in the 22 patients, among which 55 were detected by ICG (98%), 41 were detected by MB (71%), and 56 (100%) were detected by ICG combined with MB, and the average number of SLNs were 2.5, 1.64, and 2.55, respectively. A total of nine SLNs were detected, of which nine were detected by ICG (100%), seven by MB (78%), and nine by ICG combined with MB (100%). Patients with negative SLNs had no recurrence at the 6-month follow-up.ConclusionsCompared with MB, the ICG fluorescent imaging system can improve the detection rate of SLNs in patients with acral malignant melanoma. Also, ICG combined with MB was superior to ICG alone.

Intra-Tumor Heterogeneity Revealed by Mass Spectrometry Imaging Is Associated with the Prognosis of Breast Cancer.

Simple SummaryThe coexistence of genetically distinct cancer cell clones, their phenotypic plasticity, and the presence of different constituents of the tumor microenvironment create intra-tumor heterogeneity, which affects cancer development and its response to therapy. We observed that a higher degree of phenotypic heterogeneity revealed by mass spectrometry imaging was associated with a favorable outcome in HER2-positive breast cancer. This phenomenon putatively reflects the presence of heterotypic components of the microenvironment, which could facilitate the response to anticancer treatment.Intra-tumor heterogeneity (ITH) results from the coexistence of genetically distinct cancer cell (sub)populations, their phenotypic plasticity, and the presence of heterotypic components of the tumor microenvironment (TME). Here we addressed the potential association between phenotypic ITH revealed by mass spectrometry imaging (MSI) and the prognosis of breast cancer. Tissue specimens resected from 59 patients treated radically due to the locally advanced HER2-positive invasive ductal carcinoma were included in the study. After the on-tissue trypsin digestion of cellular proteins, peptide maps of all cancer regions (about 380,000 spectra in total) were segmented by an unsupervised approach to reveal their intrinsic heterogeneity. A high degree of similarity between spectra was observed, which indicated the relative homogeneity of cancer regions. However, when the number and diversity of the detected clusters of spectra were analyzed, differences between patient groups were observed. It is noteworthy that a higher degree of heterogeneity was found in tumors from patients who remained disease-free during a 5-year follow-up (n = 38) compared to tumors from patients with progressive disease (distant metastases detected during the follow-up, n = 21). Interestingly, such differences were not observed between patients with a different status of regional lymph nodes, cancer grade, or expression of estrogen receptor at the time of the primary treatment. Subsequently, spectral components with different abundance in cancer regions were detected in patients with different outcomes, and their hypothetical identity was established by assignment to measured masses of tryptic peptides identified in corresponding tissue lysates. Such differentiating components were associated with proteins involved in immune regulation and hemostasis. Further, a positive correlation between the level of tumor-infiltrating lymphocytes and heterogeneity revealed by MSI was observed. We postulate that a higher heterogeneity of tumors with a better prognosis could reflect the presence of heterotypic components including infiltrating immune cells, that facilitated the response to treatment.

Analysis of Clinicopathological Factors Influencing Survival in Patients with Renal Cell Carcinoma and Venous Tumor Thrombus.

This study aimed to define patients with renal cell cancer and coexisting tumor thrombus in order to address concerns regarding survival and prognostic factors after radical surgery. Several prognostic factors for overall survival (OS) were assessed in patients treated surgically at five institutions from 2012 to 2018. Univariate and multivariate analyses were used to determine the independent risk factors of OS. A total of 142 patients were eligible for further analysis (mean age of 64.75 years, 56% males). Most patients presented with clear cell carcinoma (95%). The Mayo stage was predominantly 0–1 (88%). Distant visceral metastases at the time of diagnosis were present in 36 patients (25%), whereas nodal metastases were present in 24 patients (16.9%). During the follow-up period (mean of 32.5 months), the 3-year OS rate reached 68.2%. The majority of patients received no adjuvant treatment (n = 107). In a multivariable model predicting OS, regional lymph node status (p < 0.001), distant metastases (p = 0.009), tumor grade (p = 0.002), duration of hospitalization (p = 0.016), and Clavien–Dindo grade (p = 0.047) were identified as independent prognostic factors. A subgroup of patients with specific clinicopathological factors may benefit most from the radical surgery, including patients without regional lymph node or distant metastases and with low tumor grades, whereas short hospitalization and low Clavien–Dindo grades represent additional independent prognostic factors.

Correlation between Grading Histopathology and Sentinel Lymph Node Metastasis in Early Breast Cancer in University of Sumatera Utara Hospital

BACKGROUND: Breast cancer is a malignancy in breast tissue from the duct or lobar epithelium. American Joint Committee on Cancer has specified important prognostic factors such as primary tumor size, regional lymph node status, and distant metastasis. Axillary lymph node status has been one of the most reliable prognostic factors in early breast cancer in women. Axillary lymph node dissection is an old method to identify metastasis in axillary lymph nodes and started being replaced by sentinel lymph node biopsy (SLNB). SLNB has been introduced as a minimal invasive procedure, but in Indonesia, this procedure cannot be done due to technology limitation. Grading tumor is one of the predictor factors that can predict lymph node metastasis. This predictor factor has been associated with sentinel lymph node metastasis significantly. AIM: According to this, we conduct this study to analyze the correlation between grading histopathology in breast cancer with sentinel lymph node metastasis to lower false-negative rate in SLNB using methylene blue dye. MATERIALS AND METHODS: In this study, we included 51 patients that qualified using inclusion and exclusion criteria. Then, sentinel lymph node metastasis and grading histopathology data were retrieved from the patient’s medical record. This data are analyzed using SPSS with Chi-square test. RESULTS: The most type of breast cancer in this study is invasive ductal carcinoma was found in 40 patients (78.4%). There are 22 of 51 patients (51.6%) with metastasis to sentinel lymph node, have Grade 3 in histopathologic findings. CONCLUSIONS: The statistical evaluation showed that there is significant correlation between grading histopathology and SLNB with p = 0.001.

Ratiometric Raman nanotags enable intraoperative detection of metastatic sentinel lymph node

Sentinel lymph node (SLN) imaging and biopsy has been advocated as an important technique to evaluate the metastatic status of regional lymph nodes and determine subsequent surgical procedure for many cancers, yet there is no reliable means to provide accurate and rapid diagnosis of metastatic SLN during surgery. Here we develop a new approach, named “Ratiometric Raman dual-nanotag strategy”, that using folic acid functionalized targeted and nontargeted gap-enhanced Raman tags (FA-GERTs and Nt-GERTs) to detect metastatic SLN based on Raman imaging combined with classical least square data processing methods. By using this strategy, with built-in self-calibration for signal correction, rather than absolute intensity-dependent signal readout, we realize the visualization and prompt intraoperative diagnosis of metastatic SLN with a high accuracy of 87.5 % when the cut-off value of ratio (FA-GERTs/Nt-GERTs) set at 1.255. This approach may outperform the existing histopathological assessment in diagnosing SLN metastasis and is promising for guiding surgical procedure in the future.

Adequacy of Surgical Pathology Reports of Colorectal Carcinoma and Its Significance.

IntroductionColorectal cancer is the fifth most common cancer in the world. For loco-regionally confined disease surgery is the definitive treatment. An adequate surgical pathology report is mandatory for the selection of adjuvant therapy. The objective of this study is to analyze whether adequate information is provided or not in the surgical pathology reports of colorectal carcinoma as according to College of American Pathologists (CAP) guidelines.MethodThis is a cross-sectional study carried out in the Department of Clinical Oncology, Jinnah Postgraduate Medical Center (JPMC) Karachi, tertiary care hospital in Pakistan. The duration of the study was from February 2020 to January 2021. A total of 153 surgical pathology reports issued by 11 different hospital-based laboratories after definitive surgery was assessed to look at its concordance rate with the checklist adapted from the CAP guidelines.ResultsOut of 153 surgical pathology reports, clinical information was provided in 72.5% of reports. Details of tumor extension were present in 88.2%, tumor margin in 75%, surgical procedure in 79%, and tumor deposits in 39.2% of reports. Macroscopic details including tumor perforation and evaluation of mesorectum were documented in 51.6% and 53.5% of the reports respectively. Details regarding perineural invasion along with lymphovascular invasion were present in 81.6% and 93% of the reports, respectively. The treatment effect was documented in only 25% of reports and regional lymph node status has been described in 85% of reports. Parameters described in all surgical pathology reports were: tumor site, tumor type, histologic type, and histologic grade. The pathological stage of the disease was documented in 91.5% of the reports.ConclusionThis study concluded that surgical pathology reports of the majority of pathology laboratories were not fully adhered to the checklist provided by the CAP guidelines. This will affect post-operative management along with the prediction of disease prognosis.

Incidence of adnexal involvement among patients with clinical stage I endometrioid endometrial adenocarcinoma

Objectives: Evaluate the incidence and pathological factors associated with isolated adnexal involvement among patients with clinical stage I endometrioid endometrial adenocarcinoma undergoing hysterectomy. Methods: Patients without a history of another tumor diagnosed between 2010 and 2015 with clinical stage I endometrioid endometrial adenocarcinoma who underwent hysterectomy with bilateral salpingo-oophorectomy with known tumor grade, size, status of lymphovascular invasion (LVSI), peritoneal cytology and regional lymph nodes were selected from the National Cancer Database. Patients with adnexal metastases as the only site of intraperitoneal extra-uterine tumor spread were identified. Predictors of isolated adnexal involvement were identified with logistic regression. Overall survival (OS) of patients with and without adnexal involvement was compared with the log-rank test following generation of Kaplan-Meier curves. Results: A total of 17911 patients who met the inclusion criteria were identified; 161 (0.9%) had adnexal metastases. Incidence of adnexal metastases was lower for patients with grade 1 (0.6%) tumors compared to those with grade 2 (1%) and grade 3 (1.7%) tumors, p<0.001. Patients with adnexal metastases were more likely to have LVSI (50.3% vs 15.8%, p<0.001), positive peritoneal cytology (28.6% vs 5.2%, p<0.001) and positive lymph nodes (23.6% vs 3.7%, p<0.001). Incidence of adnexal metastasis was highest among patients with tumors ≥4 cm (1.6%) compared to those with tumors 2-4 cm (0.5%) and <2 cm (0.4%), p<0.001. Rate of adnexal metastasis among women <50 years was higher (2% vs 0.8%, p<0.001). By multivariate analysis, presence of positive peritoneal cytology (OR 4.90, 95% CI: 3.39, 7.07), LVSI (OR 3.01, 95% CI: 2.10, 4.31), lymph node metastasis (OR 2.85, 95% CI: 1.88, 4.32), tumor size >4 cm (OR 2.71, 95% CI: 1.47, 5.00) and age <50 years (OR 2.72, 95% CI: 1.85, 4.02) but not tumor grade were associated with adnexal metastasis. Three year OS rate for patients with adnexal involvement was 83% compared to 94.6% for those without, p<0.001 Conclusions: Isolated adnexal involvement is rare among patients with clinical stage I endometrioid endometrial adenocarcinoma, and correlated with worse overall survival. Presence of LVSI and positive peritoneal cytology were the strongest predictors of adnexal involvement. Evaluate the incidence and pathological factors associated with isolated adnexal involvement among patients with clinical stage I endometrioid endometrial adenocarcinoma undergoing hysterectomy. Patients without a history of another tumor diagnosed between 2010 and 2015 with clinical stage I endometrioid endometrial adenocarcinoma who underwent hysterectomy with bilateral salpingo-oophorectomy with known tumor grade, size, status of lymphovascular invasion (LVSI), peritoneal cytology and regional lymph nodes were selected from the National Cancer Database. Patients with adnexal metastases as the only site of intraperitoneal extra-uterine tumor spread were identified. Predictors of isolated adnexal involvement were identified with logistic regression. Overall survival (OS) of patients with and without adnexal involvement was compared with the log-rank test following generation of Kaplan-Meier curves. A total of 17911 patients who met the inclusion criteria were identified; 161 (0.9%) had adnexal metastases. Incidence of adnexal metastases was lower for patients with grade 1 (0.6%) tumors compared to those with grade 2 (1%) and grade 3 (1.7%) tumors, p<0.001. Patients with adnexal metastases were more likely to have LVSI (50.3% vs 15.8%, p<0.001), positive peritoneal cytology (28.6% vs 5.2%, p<0.001) and positive lymph nodes (23.6% vs 3.7%, p<0.001). Incidence of adnexal metastasis was highest among patients with tumors ≥4 cm (1.6%) compared to those with tumors 2-4 cm (0.5%) and <2 cm (0.4%), p<0.001. Rate of adnexal metastasis among women <50 years was higher (2% vs 0.8%, p<0.001). By multivariate analysis, presence of positive peritoneal cytology (OR 4.90, 95% CI: 3.39, 7.07), LVSI (OR 3.01, 95% CI: 2.10, 4.31), lymph node metastasis (OR 2.85, 95% CI: 1.88, 4.32), tumor size >4 cm (OR 2.71, 95% CI: 1.47, 5.00) and age <50 years (OR 2.72, 95% CI: 1.85, 4.02) but not tumor grade were associated with adnexal metastasis. Three year OS rate for patients with adnexal involvement was 83% compared to 94.6% for those without, p<0.001 Isolated adnexal involvement is rare among patients with clinical stage I endometrioid endometrial adenocarcinoma, and correlated with worse overall survival. Presence of LVSI and positive peritoneal cytology were the strongest predictors of adnexal involvement.

Tumor collagen framework from bright-field histology images predicts overall survival of breast carcinoma patients

Within the tumor microenvironment, specifically aligned collagen has been shown to stimulate tumor progression by directing the migration of metastatic cells along its structural framework. Tumor-associated collagen signatures (TACS) have been linked to breast cancer patient outcome. Robust and affordable methods for assessing biological information contained in collagen architecture need to be developed. We have developed a novel artificial neural network (ANN) based approach for tumor collagen segmentation from bright-field histology images and have tested it on a set of tissue microarray sections from early hormone receptor-positive invasive ductal breast carcinoma stained with Sirius Red (1 core per patient, n = 92). We designed and trained ANNs on sets of differently annotated image patches to segment collagen fibers and extracted 37 features of collagen fiber morphometry, density, orientation, texture, and fractal characteristics in the entire cohort. Independent instances of ANN models trained on highly differing annotations produced reasonably concordant collagen segmentation masks and allowed reliable prognostic Cox regression models (with likelihood ratios 14.11–22.99, at p-value < 0.05) superior to conventional clinical parameters (size of the primary tumor (T), regional lymph node status (N), histological grade (G), and patient age). Additionally, we noted statistically significant differences of collagen features between tumor grade groups, and the factor analysis revealed features resembling the TACS concept. Our proposed method offers collagen framework segmentation from bright-field histology images and provides novel image-based features for better breast cancer patient prognostication.

Dataset for the reporting of nephrectomy specimens for Wilms' tumour treated with preoperative chemotherapy: recommendations from the International Society of Paediatric Oncology Renal Tumour Study Group.

Datasets for histopathological reporting of many cancer types are developed by the International Collaboration on Cancer Reporting (ICCR), and are used in order to ensure standardised and uniformly accepted reporting as one of the essential requirements for comparison across patient populations in evaluating and validating pathological prognostic and predictive factors. Wilms' tumours are rare, and international reporting guidelines have not yet been published by the ICCR. The assessment of Wilms' tumours differs according to the treatment approach. The Children's Oncology Group, whose approach is followed mainly in North America, advocates primary surgery, and the International Society of Paediatric Oncology Renal Tumour Study Group (SIOP-RTSG), whose approach is followed in most countries around the world, uses preoperative chemotherapy as a first step, resulting in different subclassifications, staging criteria, and histopathological prognostic factors. This dataset is developed for the countries and institutions following the SIOP-RTSG approach, and it contains core (required) and non-core (recommended) elements, based on the results of the previous SIOP-RTSG studies, which are incorporated in the latest SIOP-RTSG UMBRELLA 2016 Study protocol. The core elements include clinical information, additional specimen submitted, macroscopic tumour site and appearance, tumour focality, tumour dimensions, macroscopic extent of invasion, block identification key, histological tumour type, histological tumour grade and risk group assessment, microscopic extent of invasion, lymphovascular invasion, resection margin status, regional lymph node status, histologically confirmed distant metastases, and pathological staging (SIOP staging system). The dataset should improve communication for patient care and prognostic determination of the old and new histopathological features.

Extracapsular extension and tumor implants in lymph nodes with canine mammary carcinoma metastasis: Study of the impact on survival

Regional lymph node status impacts survival in dogs with malignant mammary tumors. However, few studies have evaluated extracapsular extension and tumor implants in regional lymph node metastases in dogs with mammary carcinoma. Therefore, 84 cases of mammary carcinomas with metastases in inguinal and/or axillary lymph nodes from female dogs of different breeds and a total of 139 metastatic lymph nodes were evaluated by routine histological staining. Clinical and pathological characteristics of primary tumors as well as the presence of extracapsular extension and tumor implants in the lymph nodes were analyzed, in addition to survival. One to 5 lymph nodes were evaluated in each case. Extracapsular extension and tumor implants were present in 17.9% and 39.3% of cases, respectively. The simultaneous presence of extracapsular extension and tumor implants were associated with an increased risk of death (hazard ratio 10.46). In addition, “special type carcinomas”, high histological grade (grade III), and presence of extracapsular extension associated with tumor implants were related to a worse prognosis and shorter survival times (p < 0.05). Based on these results, we highlight the importance of identifying extracapsular extension and tumor implants in dogs with metastatic mammary carcinomas, as they are associated with a higher risk of death and shorter survival.

P-241 Metastatic lymph node ratio as an addition to the nodal evaluation of TNM staging: A new sight for prevention of stage migrations

TNM staging is a routine grading system for gastric cancer, but the survival of gastric cancer gets better with early diagnoses and a better management with the correlation of oncology and general surgery departments. Making additions to TNM classification is important in terms of clarifying surveillance and preventing stage migrations. The purpose of this study was to evaluate the metastatic lymph node ratios in locally advanced gastric cancer patients who have undergone curative gastrectomy with D2 dissection. From January 2011 to December 2015, 341 patients were diagnosed with gastric adenocarcinoma and 226 patients underwent curative gastrectomy in our hospital. As curative gastrectomies with R0 resection and patients without distant metastasis were included in the study, palliative surgeries, R1-R2 resections, emergent surgeries and surgeries with insufficient lymph node dissection are excluded. From 226 patients, 193 patients whose tumor was not T1 and whose both preoperative and postoperative data were present were included in the study. In particular, lymph node metastasis was not present in 81 patients. The ratio between the number of metastatic lymph nodes and total number of dissected lymph nodes was analysed to evaluate their influences on the disease outcome. Patients were divided into three groups according to the ratio (NR) between metastatic lymph nodes and total nodes dissected. The number of metastatic lymph nodes ranged from 0 to 43 (mean, 6.77±4.82) and the number of dissected total lymph nodes ranged from 15 to 93 (mean 27.13±6.91). There was no significant correlation between numbers of metastatic and dissected lymph nodes (p:0.142). Survival of patients at 5 years regardless of their stage was 54.1%, with a median survival of 23.24±4.18 months. According to regional nodal status (N) of the 8th edition of the AJCC, patients with N0 (n=81), pN1 (n=24), pN2 (n=31) and pN3 (n=67) showed survival rates at 5 years of 81.7%, 75.0%, 45.2% and 40.3%, respectively (p=0.009). Patients were stratified into NR0 (ratio 0%), NR1 (ratio 1-49%) and NR2 (ratio >50%). Their survival rates at 5 years were 81.7%, 53.5% and 36.1%, respectively (p=0.008). Metastatic lymph node ratio is an independent prognostic factor in survival regardless of the number dissected in the surgical process. The metastatic lymph node ratio has a more beneficial effect on disease-free and overall survival than the number of metastatic lymph nodes. If D2 dissection is done, metastatic lymph node ratio should be added to pathological TNM staging for a better foresight and for the prevention of stage migrations.

ARTIFICIAL INTELLIGENCE, VIRTUAL REALITY AND ROBOTICS IN COLORECTAL SURGERY USING MASTER-CLASS TECHNOLOGICAL INNOVATIONS

ARTIFICIAL INTELLIGENCE, VIRTUAL REALITY AND ROBOTICS IN COLORECTAL SURGERY USING MASTER-CLASS TECHNOLOGICAL INNOVATIONS

Prognostic factors in colorectal cancer

Aim: to evaluate prognostic factors in colorectal cancer.Material and methods: published data (publications in PubMed, Scopus, eLIBRARY databases) and own results of treatment of 47 patients with T2-4N0-2M0 colon cancer in 2017–2018. The following prognostic factors were studied: metastasis in regional lymph nodes, tumor site, CEA level, KRAS and BRAF mutation status, microsatellite instability, MUSASHI2, p53, VEGF.Results: a correlation between tumor progression and the status of regional lymph nodes demonstrated significant differences (p = 0.038): in N0, the risk of progression was 3.8%, in N1 — 14.9%, in N2 — 43.6%. Statistical processing of the results did not reveal significant differences between groups of patients without and with cancer generalization by their age, gender, tumor site, type of lymph node dissection, T stage, differentiation of adenocarcinoma, levels of CEA, mutations of KRAS, MSI, p53, MUSASHI2, VEGF. We used these prognostic factors to determine biological features of the tumor, its aggressiveness and treatment approaches.Conclusions: the status of regional lymph nodes remains the main factor in determining the prognosis of a colon tumor and in the medical therapy appointment. Molecular genetic factors are currently of great importance for determining tactics in personalized medical treatment.

Deep learning analysis of the primary tumour and the prediction of lymph node metastases in gastric cancer.

Lymph node metastasis (LNM) in gastric cancer is a prognostic factor and has implications for the extent of lymph node dissection. The lymphatic drainage of the stomach involves multiple nodal stations with different risks of metastases. The aim of this study was to develop a deep learning system for predicting LNMs in multiple nodal stations based on preoperative CT images in patients with gastric cancer. Preoperative CT images from patients who underwent gastrectomy with lymph node dissection at two medical centres were analysed retrospectively. Using a discovery patient cohort, a system of deep convolutional neural networks was developed to predict pathologically confirmed LNMs at 11 regional nodal stations. To gain understanding about the networks' prediction ability, gradient-weighted class activation mapping for visualization was assessed. The performance was tested in an external cohort of patients by analysis of area under the receiver operating characteristic (ROC) curves (AUC), sensitivity and specificity. The discovery and external cohorts included 1172 and 527 patients respectively. The deep learning system demonstrated excellent prediction accuracy in the external validation cohort, with a median AUC of 0·876 (range 0·856-0·893), sensitivity of 0·743 (0·551-0·859) and specificity of 0·936 (0·672-0·966) for 11 nodal stations. The imaging models substantially outperformed clinicopathological variables for predicting LNMs (median AUC 0·652, range 0·571-0·763). By visualizing nearly 19 000 subnetworks, imaging features related to intratumoral heterogeneity and the invasive front were found to be most useful for predicting LNMs. A deep learning system for the prediction of LNMs was developed based on preoperative CT images of gastric cancer. The models require further validation but may be used to inform prognosis and guide individualized surgical treatment.

Prognostic value of regional lymph node involvement in patients with metastatic colorectal cancer: palliative versus curative resection

BackgroundApproximately 20% of patients with colorectal cancer are initially diagnosed with stage IV disease. This study aims to examine the role of regional lymph node (LN) status in metastatic colorectal cancer (mCRC) with respect to clinicopathologic features and survival outcomes.MethodsWe investigated 1147 patients diagnosed with mCRC and had undergone surgical resection of the primary CRC. A total of 167 patients were placed in the LN-negative (LN−) group and another 980 in the LN-positive (LN+) group.ResultsLN+ patients exhibited a significantly higher rate of T4 tumors (p = 0.008), poorly differentiated adenocarcinoma (p < 0.001), lymphovascular invasion (p < 0.001), and perineural invasion (p < 0.001) than those in the LN− group. LN− patients had a significantly higher rate of lung metastasis (p < 0.001), whereas the rate of peritoneal seeding (p < 0.001) and systemic node metastasis (p < 0.001) was both significantly higher in the LN+ group. The 5-year overall survival (OS) in the LN+ group was significantly poorer than that in the LN− group (LN− vs. LN+ 23.2% vs. 18.1%; p = 0.040). In patients with curative resection, the 5-year OS rate has no significant difference between the two groups (LN− vs. LN+ 19.5% vs. 24.3%; p = 0.890).ConclusionsMetastatic CRC patients with LN+ who underwent primary tumor resection may present with more high-risk pathological features, more peritoneal seeding, and systemic node metastasis, but less lung metastasis than LN− patients. LN+ patients had poorer long-term outcomes compared with that in LN− patients. Nevertheless, with curative resection, LN+ patients could have similar survival outcomes as LN− patients.

PET/CT in breast cancer staging is useful for evaluation of axillary lymph node and distant metastases

IntroductionBreast cancer outcome is dependent on disease stage. The aim of the study was to assess the role of PET/CT in the evaluation of axillary lymph node and distant metastases in women with newly diagnosed primary breast cancer. Materials and methodsWe assessed, among patients with newly diagnosed primary breast cancer, associations of [18F] fluorodeoxyglucose (FDG) uptake (maximum standardized uptake value [SUVmax]) with clinical variables of the primary tumor, including regional nodal status and the presence of distant metastases. ResultsOf 324 patients, 265 (81.8%) had focal uptake of FDG that corresponded with the cancerous lesion, and 21 (6.5%) had no FDG-avid findings. The remaining 38 patients had diffuse or nonspecific uptake of FDG. Among patients with a focal uptake of FDG (n = 265), the mean tumor size was 2.6 ± 1.9 (range 0.5–13.5), and the mean SUVmax was 5.3 ± 4.9 (range 1.2–25.0). In 83 patients (25.6%), PET/CT demonstrated additional suspected foci in the same breast. FDG-avid lymphadenopathy was observed in 156 patients (48.1%). Further assessment of lymph node involvement was available for 55/156 patients (axillary lymph node dissection [n = 21]; core needle biopsy [n = 34]) and confirmed axillary lymph node metastases in 47 (85.5%)). Thirteen patients (4.0%) had FDG-avid supraclavicular lymph nodes and six (1.9%) had FDG-avid internal mammary lymph nodes. Distant FDG-avid lesions were detected in 33 patients (10.2%). ConclusionPET/CT is a useful diagnostic tool for staging breast cancer patients, but its use should be limited to specific clinical situations; further evaluation is needed.