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Rouzier, Roman, Jean-Marc Extra, Mathieu Carton, Marie-Christine Falcou, Anne Vincent-Salomon, Alain Fourquet, Pierre Pouillart, and Edwige Bourstyn. "Primary Chemotherapy for Operable Breast Cancer: Incidence and Prognostic Significance of Ipsilateral Breast Tumor Recurrence After Breast-Conserving Surgery." Journal of Clinical Oncology 19, no. 18 (September 15, 2001): 3828–35. http://dx.doi.org/10.1200/jco.2001.19.18.3828.
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PURPOSE: To determine the incidence and the prognostic value of ipsilateral breast tumor recurrence (IBTR) in patients treated with primary chemotherapy and breast-conserving surgery. PATIENTS AND METHODS: Between January 1985 and December 1994, 257 patients with invasive T1 to T3 breast carcinoma were treated with primary chemotherapy, lumpectomy, and radiation therapy. The median follow-up time was 93 months. To evaluate the role of IBTR in metastase-free survival, a Cox regression multivariate analysis was performed using IBTR as a time-dependent covariate. RESULTS: The IBTR rates were 16% (± 2.4%) at 5 years and 21.5% (± 3.2%) at 10 years. Multivariate analysis showed that the probability of local control was decreased by the following independent factors: age ≤ 40 years, excision margin ≤ 2 mm, S-phase fraction more than 4%, and clinical tumor size more than 2 cm at the time of surgery. In patients with excision margins of more than 2 mm, the IBTR rates were 12.7% at 5 years and 17% at 10 years. Nodal status, age ≤ 40 years, and negative estrogen receptor status were predictors of distant disease in the Cox multivariate model with fixed covariates. The contribution of IBTR was highly significant (relative risk = 5.34) when added to the model, whereas age ≤ 40 years was no longer significant. After IBTR, 31.4% (± 7.0%) of patients developed metastases at 2 years and 59.7% (± 8.1%) at 5 years. Skin involvement, size at initial surgery, and estrogen receptor status were predictors of metastases after IBTR. CONCLUSION: IBTR is a strong predictor for distant metastases. There are implications for conservative surgery after downstaging of the tumor and therapy at the time of IBTR.
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Yang, Hong. "RA07.05: DIAGNOSTIC VALUE OF INTRAOPERATIVE ULTRASONOGRAPHY IN ASSESSING THORACIC RECURRENT LARYNGEAL NERVE LYMPH NODES IN PATIENTS WITH ESOPHAGEAL CANCER." Diseases of the Esophagus 31, Supplement_1 (September 1, 2018): 35. http://dx.doi.org/10.1093/dote/doy089.ra07.05.
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Abstract Background To evaluate the ability of intraoperative ultrasonography (IU) to detect recurrent laryngeal nerve (RLN) nodal metastases in esophageal cancer patients. Methods Sixty patients with esophageal cancer underwent IU, computed tomography (CT), and endoscopic ultrasonography (EUS) to assess for RLN nodal metastasis. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were compared. Results The sensitivities of IU, CT, and EUS in diagnosing right RLN nodal metastases were 71.4%, 14.3%, and 30.0%, respectively, and a significant difference among these three examinations was observed (c2 = 10.077, P = .006). The specificities of IU, CT, and EUS for diagnosing right RLN nodal metastasis were 67.4%, 97.8%, and 95.0%, respectively, and a significant difference was observed (c2 = 21.725, P < .001). No significant differences in either PPV or NPV were observed when diagnosing right RLN nodal metastases. For diagnosis of left RLN lymph nodal metastases, the sensitivities of IU, CT, and EUS were 91.7%, 16.7%, and 40.0% respectively. There was a significant difference among these diagnostic sensitivities (c2 = 14.067, P = .001). The specificities of IU, CT, and EUS for diagnosis of left RLN nodal metastases were 79.2%, 100%, and 82.5%, respectively and a significant difference was observed (c2 = 10.819, P = .004). No significant differences were observed in PPV or NPV for these examinations when diagnosing left RLN nodal metastases. Conclusion Intraoperative ultrasonography showed superior sensitivity compared with preoperative CT or EUS in detecting RLN lymph node metastasis in patients with thoracic esophageal cancer. Disclosure All authors have declared no conflicts of interest.
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Abu-Zaid, Ahmed, Ayman Azzam, Hindi Al-Hindi, and Tarek Amin. "Femoral Pathological Fracture as the First Clinical Manifestation of Papillary Thyroid Carcinoma in a Primigravida." Case Reports in Pathology 2013 (2013): 1–4. http://dx.doi.org/10.1155/2013/397361.
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Papillary thyroid carcinoma is the most common differentiated type of thyroid malignancy. It is largely a loco-regional disease with a high tendency to metastasize to regional cervical lymph nodes. Distant hematogenous metastases are very rare and primarily include lungs and bones. Distant bone metastases are present in approximately 1.7% of patients with differentiated thyroid malignancy. Sternum, ribs, and spine are the most frequent sites of osseous metastases. Up to our knowledge, we report the first occurrence of an extra nodal metastasis of papillary thyroid carcinoma to a femoral bone presenting as a pathological fracture in a 21-year-old 37-week primigravida. We report this case because of its unusual site of metastasis and atypical presentation during pregnancy. Moreover, we briefly elaborate on the management of such uncommon cases.
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Ide, Taketoshi, Takamichi Ito, Maiko Wada-Ohno, and Masutaka Furue. "Preoperative Screening CT and PET/CT Scanning for Acral Melanoma: Is it Necessary?" Journal of Clinical Medicine 10, no. 4 (February 17, 2021): 811. http://dx.doi.org/10.3390/jcm10040811.
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The efficacy of preoperative imaging for acral melanoma (AM) has not been fully evaluated. We examined the accuracy of imaging modalities in the detection of nodal and distant metastases in patients with AM. A retrospective review of 109 patients with AM was performed. All patients had no clinical signs suggestive of distant metastases, and underwent preoperative screening computed tomography (CT) and positron emission tomography (PET)/CT scans. Of 100 patients without lymphadenopathy, 17 patients were suspected of having nodal metastasis in CT and PET/CT, but only two of them were confirmed on histopathological analysis. On the other hand, 12 out of 83 negatively imaged patients showed histopathological signs of nodal metastasis; thus, the sensitivity and specificity of nodal detection were 14.3% and 82.6%, respectively. Regard to the detection of distant metastases, four patients were suspected of having metastasis, but this was later ruled out. The remaining 96 negatively imaged patients were confirmed to have no metastasis at the time of CT and PET/CT by the follow-up. In contrast, distant metastases were found by CT and PET/CT in four of nine patients (44.4%) with lymphadenopathy. Routine preoperative CT and PET/CT for AM patients without lymphadenopathy may not be warranted because of low sensitivity and specificity, but it can be considered for those with lymphadenopathy.
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Marchegiani, Giovanni, Luca Landoni, Stefano Andrianello, Gaia Masini, Sara Cingarlini, Mirko D’Onofrio, Riccardo De Robertis, et al. "Patterns of Recurrence after Resection for Pancreatic Neuroendocrine Tumors: Who, When, and Where?" Neuroendocrinology 108, no. 3 (November 27, 2018): 161–71. http://dx.doi.org/10.1159/000495774.
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Background/Aims: Pancreatic neuroendocrine tumors (pan-NENs) represent an increasingly common indication for pancreatic resection, but there are few data regarding possible recurrence after surgery. The aim of the study was to describe the frequency, timing, and patterns of recurrence after resection for pan-NENs with consequent implications for postoperative follow-up. Methods: We performed a retrospective analysis of pan-NENs resected between 1990 and 2015 at The Pancreas Institute, University of Verona Hospital Trust. Predictors of recurrence were assessed. Survival analysis was conducted using the Kaplan-Meier and conditional survival (CS) methods. Results: The cohort consisted of 487 patients with a median follow-up of 71 months. Recurrence developed in 12.3%: 54 (11.1%) liver metastases, 11 (2.3%) local recurrence, 10 (2.1%) nodal recurrence, and 8 (1.6%) metastases in other organs. Thirty-one (6.4%) died due to disease recurrence. Size > 21 mm, G3 grade, nodal metastasis, and vascular infiltration were independent predictors of overall recurrence. Recurrence occurred either during the first year of follow-up (n = 9), or after 10 years (n = 4). CS analysis revealed that nonfunctioning G1 pan-NEN ≤20 mm without nodal metastasis or vascular invasion had a negligible risk of developing recurrence. In the present series, after 5 years of follow-up without developing recurrence, tumor recurrence occurred only in the form of liver metastases. Conclusions: Recurrence of pan-NENs is rare and is predicted by tumor size, nodal metastasis, grading, and vascular invasion. Patients with G1 pan-NEN without nodal metastasis and vascular invasion may be considered cured by surgery. After 5 years without recurrence, follow-up should focus on excluding the development of liver metastases.
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Haidari, Selgai, Katharina Theresa Obermeier, Moritz Kraus, Sven Otto, Florian Andreas Probst, and Paris Liokatis. "Nodal Disease and Survival in Oral Cancer: Is Occult Metastasis a Burden Factor Compared to Preoperatively Nodal Positive Neck?" Cancers 14, no. 17 (August 31, 2022): 4241. http://dx.doi.org/10.3390/cancers14174241.
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The impact of neck involvement and occult metastasis (OM) in patients with oral squamous cell carcinoma (OSCC) favors an elective neck dissection. However, there are barely any existing data on survival for patients with OM compared with patients with positive lymph nodes detected preoperatively. This study aims to compare survival curves of patients suffering from lymph nodal metastases in a preoperatively N+ neck with those suffering from OM. In addition, clinical characteristics of the primary tumor were analyzed to predict occult nodal disease. This retrospective cohort study includes patients with an OSCC treated surgically with R0 resection with or without adjuvant chemoradiotherapy between 2010 and 2016. Minimum follow-up was 60 months. Kaplan–Meier analysis was used to compare the survival between patients with and without occult metastases and patients with N+ neck to those with occult metastases. Logistic regression was used to detect potential risk factors for occult metastases. The patient cohort consisted of 226 patients. Occult metastases occurred in 16 of 226 patients. In 53 of 226 patients, neck lymph nodes were described as suspect on CT imaging but had a pN0 neck. Higher tumor grading increased the chance of occurrence of occult metastasis 2.7-fold (OR = 2.68, 95% CI: 1.07–6.7). After 12, 24, 48 and 60 months, 82.3%, 73.8%, 69% and 67% of the N0 patients, respectively, were progression free. In the group with OM occurrence, for the same periods 66.6%, 50%, 33.3% and 33.3% of the patients, respectively, were free of disease. For the same periods, respectively, 81%, 63%, 47% and 43% of the patients in the N+ group but without OM remained disease free. The predictors for progression-free survival were a positive N status (HR = 1.44, 95% CI: 1.08–1.93) and the occurrence of OM (HR = 2.33, 95% CI: 1.17–4.64). The presence of occult metastasis could lead to decreased survival and could be a burdening factor requiring treatment escalation and a more aggressive follow-up than nodal disease detected in the preoperative diagnostic imaging.
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Kandagatla, Pridvi, Lilias H. Maguire, and Karin M. Hardiman. "Biology of Nodal Spread in Colon Cancer: Insights from Molecular and Genetic Studies." European Surgical Research 59, no. 5-6 (2018): 361–70. http://dx.doi.org/10.1159/000494832.
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Colorectal cancer (CRC) lymph node metastases are common but their genetics and the mechanism whereby these metastases occur are not well understood. Here we present recent data regarding genetic heterogeneity in primary CRCs and their metastasis. In addition, we explain the different potential models describing the mechanisms of metastasis and the data supporting them. Multiple studies have also revealed a variety of prognostic molecular markers that are associated with lymph node metastasis in CRC. A better understanding of genetic heterogeneity and the mechanisms of metastasis is critical to predicting clinical response and resistance to targeted therapy.
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Kowalski, Luiz P., and Jesus E. Medina. "NODAL METASTASES." Otolaryngologic Clinics of North America 31, no. 4 (August 1998): 621–37. http://dx.doi.org/10.1016/s0030-6665(05)70076-1.
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Russell, Maria C., Yj Chiang, Barry W. Feig, George J. Chang, Miguel A. Rodriguez-Bigas, John Michael Skibber, Ryaz Chagpar, Janice N. Cormier, and Y. Nancy You. "Lymph node metastasis in patients with early pathologic T-stage rectal cancers: What does local excision leave behind?" Journal of Clinical Oncology 30, no. 4_suppl (February 1, 2012): 537. http://dx.doi.org/10.1200/jco.2012.30.4_suppl.537.
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537 Background: As the interest in local excision (LE) for rectal cancer increases, the risk of residual nodal disease and local failure must be considered. We utilized a nationwide cancer registry to establish incidence and predictors of nodal metastasis in early pathologic T stage rectal cancers. Methods: Early path T stage rectal cancers (1998-2007) were identified from the National Cancer Database (NCDB), including pT1-2 tumors in patients not receiving neoadjuvant therapy (NT), or ypT0-2 tumors after NT. Proctectomy was performed in 22,416 (74.7%) and LE in 7,589 (25.3%) without NT. After NT, 7,481 (96.1%) underwent proctectomy and 300 (3.9%) LE. Nodal metastasis rates were calculated from proctectomy patients. Factors associated with nodal metastases were analyzed among those with ≥12 nodes assessed. Results: The incidence of nodal positivity was 12.5% for pT1 and 26.8% for pT2 tumors. Among those with ≥12 nodes examined, these rates increased to 16.9% and 28.6% respectively. After receiving NT, nodal positivity rates were 8.6% for ypT0, 12.9% for ypT1, and 21.4% for ypT2 tumors. These rates increased to 13.5%, 16.9% and 28.3% respectively when ≥12 nodes examined. In multivariate analysis, female sex, age <50, higher T stage, higher histologic grade, mucinous/signet-ring features, and more than 12 nodes examined were all significantly associated with nodal metastases in both groups ( Table ). Conclusions: Among rectal cancers of early path T stages, the risk of nodal metastasis increases with higher path T stage and with greater number of nodes examined, regardless of receipt of NT. These findings must be carefully deliberated, given the current interests in expanding the role of LE based on pathologic T stage of rectal cancer. [Table: see text]
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Kumar, Praveen, Nishikant Avinash Damle, Sandeep Agarwala, Sada Nand Dwivedi, and Chandrasekhar Bal. "Individualized dosimetry in children and young adults with differentiated thyroid cancer undergoing iodine-131 therapy." Journal of Pediatric Endocrinology and Metabolism 33, no. 8 (August 27, 2020): 1031–44. http://dx.doi.org/10.1515/jpem-2020-0072.
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AbstractObjectivesThe amount of Iodine-131 to treat young patients with differentiated thyroid cancer (DTC) has not been established so far. The purpose of this study was to perform and compare blood dosimetry by “Hanscheid’s approach”and lesion dosimetry by “Maxon’s approach”.MethodsSeventy-one DTC patients ≤21 years were given diagnostic activity of 74 MBq 131I followed by whole-body scan (WBS) at 2 h (pre-void), 24 h, 48 h, and ≥72 h. Pre-therapy blood and lesion dosimetry were conducted to determine the absorbed doses to blood and lesions and to predict the therapeutic activity. The administered activities were varied from 1.11–5.55 GBq of 131I depending on disease extent. Post therapy dosimetries were again performed by acquiring WBS data at 24 h, 48 h, and ≥72 h.ResultsIn blood dosimetry, the difference between predicted therapy activity (PTA) and actual therapeutic activity (ATA) was statistically significant in remnant and lung lesions but insignificant in nodal metastases (p=0.287). In lesion dosimetry, the difference between PTA and ATA was statistically significant for lung metastasis patients; however, not significant in remnant (p=0.163) and nodal metastases (p=0.054). The difference between predicted and observed absorbed dose was insignificant in blood dosimetry whereas, significant in lesion dosimetry.ConclusionsThe PTA based on 0.3 Gy recommendations of Hanscheid et al. may be adequate for patients with remnant or nodal metastases but inadequate for lung metastases. Lesion dosimetry demonstrated that there is scope to decrease the 131I empiric ATA for remnant and nodal metastases; at the same time, there is scope to increase in lung metastasis patients.
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Rose, Peter G., Lee P. Adler, Michael Rodriguez, Peter F. Faulhaber, Fadi W. Abdul-Karim, and Floro Miraldi. "Positron Emission Tomography for Evaluating Para-aortic Nodal Metastasis in Locally Advanced Cervical Cancer Before Surgical Staging: A Surgicopathologic Study." Journal of Clinical Oncology 17, no. 1 (January 1999): 41. http://dx.doi.org/10.1200/jco.1999.17.1.41.
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PURPOSE: Positron emission tomographic (PET) scanning provides a novel means of imaging malignancies. This prospective study was undertaken to evaluate PET scanning in detecting para-aortic nodal metastasis in patients with locally advanced cervical carcinoma and no evidence of extrapelvic disease before planned surgical staging lymphadenectomy. MATERIALS AND METHODS: After 20 mCi of 2-[18F]fluoro-2-deoxy-d-glucose (FDG) were administered intravenously, the abdomen and pelvis were scanned. Continuous bladder irrigation was used to reduce artifact. Patients were classified by the presence or absence of FDG uptake in the primary tumor and in pelvic or para-aortic nodes. Para-aortic node metastases were classified as present or absent according to a standardized staging procedure. Pelvic node metastases were similarly classified in a subset of patients who underwent pelvic node resection. RESULTS: Thirty-two patients with stage IIB (n = 6), IIIB (n = 24), and IVA (n = 2) tumors were studied. Fluorodeoxyglucose was taken up by 91% of the cervical tumors. Six of eight patients with positive para-aortic node metastasis had PET scan evidence of para-aortic nodal metastasis. One of the two false-negatives had only one microscopic focus of metastatic cancer. In the para-aortic nodes, PET scanning had a sensitivity of 75%, a specificity of 92%, a positive predictive value of 75%, and a negative predictive value of 92%. Fluorodeoxyglucose para-aortic nodal uptake conferred a relative risk of 9.0 (95% confidence interval, 2.3 to 36.0) for para-aortic nodal metastasis. All 10 of 17 patients with metastasis were predicted by PET scanning (P < .001); five of these patients had abnormalities on computed tomographic scans. CONCLUSION: Cervical cancers have a high avidity for FDG. The use of PET-FDG scanning accurately predicts both the presence and absence of pelvic and para-aortic nodal metastatic disease.
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Wahl, Richard L., Barry A. Siegel, R. Edward Coleman, and Constantine G. Gatsonis. "Prospective Multicenter Study of Axillary Nodal Staging by Positron Emission Tomography in Breast Cancer: A Report of the Staging Breast Cancer With PET Study Group." Journal of Clinical Oncology 22, no. 2 (January 15, 2004): 277–85. http://dx.doi.org/10.1200/jco.2004.04.148.
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PurposeTo determine the accuracy of positron emission tomography with fluorine-18–labeled 2-fluoro-2-deoxy-d-glucose (FDG-PET) in detecting axillary nodal metastases in women with primary breast cancer.Patients and MethodsIn this prospective multicenter study, 360 women with newly diagnosed invasive breast cancer underwent FDG-PET. Images were blindly interpreted by three experienced readers for abnormally increased axillary FDG uptake. Imaging results from 308 assessable axillae were compared with axillary node pathology.ResultsFor detecting axillary nodal metastasis, the mean estimated area under the receiver operator curve for the three readers was 0.74 (range, 0.70 to 0.76). If at least one probably or definitely abnormal axillary focus was considered positive, the mean (and range) sensitivity, specificity, and positive and negative predictive values for PET were 61% (54% to 67%), 80% (79% to 81%), 62% (60% to 64%), and 79% (76% to 81%), respectively. False-negative axillae on PET had significantly smaller and fewer tumor-positive lymph nodes (2.7) than true-positive axillae (5.1; P < .005). Semiquantitative analysis of axillary FDG uptake showed that a nodal standardized uptake value (lean body mass) more than 1.8 had a positive predictive value of 90%, but a sensitivity of only 32%. Finding two or more intense foci of tracer uptake in the axilla was highly predictive of axillary metastasis (78% to 83% positive predictive value), albeit insensitive (27%).ConclusionFDG-PET has moderate accuracy for detecting axillary metastasis but often fails to detect axillae with small and few nodal metastases. Although highly predictive for nodal tumor involvement when multiple intense foci of tracer uptake are identified, FDG-PET is not routinely recommended for axillary staging of patients with newly diagnosed breast cancer.
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Rajab, Esa, Sharifah Nor Akmal, and Abdul Majid Nasir. "Glycogen-rich clear cell carcinoma in the tongue." Journal of Laryngology & Otology 108, no. 8 (August 1994): 716–18. http://dx.doi.org/10.1017/s0022215100127938.
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AbstractThe case of a minor salivary gland tumour, arising from the tongue, with nodal metastasis is presented. Biopsy of the tumour and fine-needle aspiration cytology of the neck swelling showed the presence of a clear cell carcinoma with evidence of nodal metastases. A commando operation was performed and the defect was reconstructed using a local tongue flap. The literature review indicated that the neoplasm was rare and its site of occurrence rather unusual.
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Chakrabarti, Deep, Sumaira Qayoom, and Madan Lal Brahma Bhatt. "Parotid nodal metastases." Oral Oncology 139 (April 2023): 106339. http://dx.doi.org/10.1016/j.oraloncology.2023.106339.
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Wey, Elizabeth A., Andrew J. Britton, Joseph J. Sferra, Tim Kasunic, Linda R. Pepe, and Henry D. Appelman. "Gastroblastoma in a 28-Year-Old Man With Nodal Metastasis: Proof of the Malignant Potential." Archives of Pathology & Laboratory Medicine 136, no. 8 (August 1, 2012): 961–64. http://dx.doi.org/10.5858/arpa.2011-0372-cr.
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Gastroblastoma is a newly defined neoplasm of children and young adults with only 4 reported cases to date. Morphologically, the tumor is a mixture of epithelial structures and stromal elements with minimal cytologic atypia. In these 4 reported cases, there were no metastases or postresection recurrences. We report a case of gastroblastoma in a 28-year-old man with a histologic nodal metastasis and clinical distant metastases.
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Lindberg, James M., Dustin M. Walters, Edward B. Stelow, Reid B. Adams, and Todd W. Bauer. "The incidence and preoperative detection of nodal metastases in resected pancreatic neuroendocrine tumors." Journal of Clinical Oncology 30, no. 4_suppl (February 1, 2012): 178. http://dx.doi.org/10.1200/jco.2012.30.4_suppl.178.
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178 Background: Pancreatic neuroendocrine tumors (pNETs) are a heterogeneous group of rare malignancies in which surgical resection remains the only curative therapy. The optimal surgical approach (enucleation vs. pancreatectomy) is controversial. This study aims to determine the 1) incidence, 2) predictors, and 3) preoperative detection of lymph node (LN) metastases in resected pNETs to help guide surgical management. Methods: A retrospective review of prospectively collected data was performed for all patients with pancreatic neuroendocrine tumors who underwent surgical resection at the University of Virginia between 1991 and 2010. The electronic medical record, radiology reports and pathology reports were used to identify patient demographics, surgical procedure, tumor functional status, type, size, location, and LN status. Results: In all, 76 patients were identified. Most tumors were non-functioning (71%) with insulinomas (13%) and gastrinomas (5%) representing the largest groups of functioning pNETs. Nineteen tumors (25%) had LN metastases at the time of resection. LN-positive tumors were significantly larger than LN-negative tumors (4.0 ± 0.4 cm vs. 2.8 ± 0.2 cm, p=0.01). Five (11%) of 46 tumors ≤ 3 cm and one (14%) of 7 tumors ≤ 1 cm had LN metastases. There were no significant relationships between LN status and either tumor type or location (head/uncinate vs. body/tail). Of patients with LN-positive tumors, preoperative CT or MRI detected the LN metastases in only 19%. Conclusions: Twenty-five percent of pNETs are associated with LN metastasis. The only predictor of LN metastasis was tumor size, but even smaller tumors were associated with LN metastasis. The sensitivity of preoperative CT and MRI is quite poor in detecting LN metastasis. Thus, formal resection with lymphadenectomy should be considered the standard of care for pNETs. [Table: see text]
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David, Arnob Barua, Quazi Billur Rahman, Md Wares Uddin, Himel Chakma, Sajib Kumar Talukdhar, Mohiul Alam Siddique, and Mohammed Kamal Uddin. "Frequency of Skip Metastasis to the Cervical Lymph Nodes in Oral Squamous Cell Carcinoma." IAHS Medical Journal 4, no. 2 (October 30, 2022): 36–40. http://dx.doi.org/10.3329/iahsmj.v4i2.62521.
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Background: Oral Squamous Cell Carcinoma (OSCC) commonly spreads across regional lymph nodes. Presence or lack of metastasis to the cervical lymph nodes is an essential prognostic factor. The regional metastatic pattern to the cervical lymph nodes is defined as the orderly involvement of the successive anatomical lymph node levels. When the sequential order of involvement is lost and metastases are found at a lower level without involving the first echelon nodes or groups of intermediate nodes, then it is called skip metastases. Knowledge of Skip metastases will allow patients to prevent from receiving under and overt therapy. Current treatment of oral squamous cell carcinoma is primary resection followed by elective/therapeutic neck dissection. Regarding neck dissection, there is a dilemma that up to which level should be performed. Some prefer up to level III and some prefer up to level IV based on evidence of skip metastasis to level IV. This study conducted to find out the frequency of skip metastasis and its pattern according to the site, size and grading of primary oral squamous cell carcinoma.
Materials and methods: This was a cross sectional study performed in between August 2018 to September 2019 among 58 patients having histologically proven oral squamous cell carcinoma of tongue, buccal mucosa and retro molar trigone undergoing elective and therapeutic neck dissection. Cervical lymph nodes along with fibro-fatty tissue from patients underwent neck dissection except super selective neck dissection were fixed with 10% formalin in separate containers. The containers were marked with nodal level and sent to pathology department for histopathological examination.
Results: Out of 58 patients, 32 (55.2%) had cervical nodal metastasis on postoperative histopathology report, 26 (44.8%) patients had no nodal metastasis and 7 (12.1%) developed skip metastasis. Oral squamous cell carcinoma of tongue was found to be the most frequent site to develop skip metastasis to the cervical lymph node. Also, skip metastases were relatively higher in greater tumour grading and T-stages.
Conclusion: Chances of skip metastasis should be considered during treatment planning, especially for oral squamous cell carcinoma of the tongue. For the majority of cases with N0 neck, elective neck dissection up to level III should be performed. In case of carcinoma of Tongue, high-grade tumour and advanced T-stages, elective neck dissection should be performed up to level IV.
IAHS Medical Journal Vol 4(2), December 2021; 36-40
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Meler-Claramonte, Carla, Francesc Xavier Avilés-Jurado, Isabel Vilaseca, Ximena Terra, Paloma Bragado, Gemma Fuster, Xavier León León Vintró, and Mercedes Camacho. "Semaphorin-3F/Neuropilin-2 Transcriptional Expression as a Predictive Biomarker of Occult Lymph Node Metastases in HNSCC." Cancers 14, no. 9 (April 30, 2022): 2259. http://dx.doi.org/10.3390/cancers14092259.
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The expression of the semaphorin-3F (SEMA3F) and neuropilin-2 (NRP2) is involved in the regulation of lymphangiogenesis. The present study analyzes the relationship between the transcriptional expression of the SEMA3F-NRP2 genes and the presence of occult lymph node metastases in patients with cN0 head and neck squamous cell carcinomas. We analyzed the transcriptional expression of SEMA3F and NRP2 in a cohort of 53 patients with cN0 squamous cell carcinoma treated with an elective neck dissection. Occult lymph node metastases were found in 37.7% of the patients. Patients with occult lymph node metastases (cN0/pN+) had significantly lower SEMA3F expression values than patients without lymph node involvement (cN0/pN0). Considering the expression of the SEMA3F-NRP2 genes, patients were classified into two groups according to the risk of occult nodal metastasis: Group 1 (n = 34), high SEMA3F/low NRP2 expression, with a low risk of occult nodal involvement (14.7% cN0/pN+); Group 2 (n = 19), low SEMA3F or high SEMA3F/high NRP2 expression, with a high risk of occult nodal involvement (78.9% cN0/pN+). Multivariate analysis showed that patients in Group 2 had a 26.2 higher risk of lymph node involvement than patients in Group 1. There was a significant relationship between the transcriptional expression values of the SEMA3F-NRP2 genes and the risk of occult nodal metastases.
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Olivotto, Ivo A., Boon Chua, Sharon J. Allan, Caroline H. Speers, Stephen Chia, and Joseph Ragaz. "Long-Term Survival of Patients With Supraclavicular Metastases at Diagnosis of Breast Cancer." Journal of Clinical Oncology 21, no. 5 (March 1, 2003): 851–54. http://dx.doi.org/10.1200/jco.2003.11.105.
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Background: Patients with supraclavicular metastases at diagnosis of breast cancer were classified between 1987 and 2002 as having stage M1 breast cancer according to the tumor-node-metastasis (TNM) system. The 2003 edition of the TNM staging guidelines has classified such patients as having stage IIIC disease. To determine relative prognosis, we compared long-term survival in a population-based cohort of patients with isolated supraclavicular metastases (nodal-M1) to outcomes of patients with stage IIIB or M1 (other) disease at presentation. Materials and Methods: Among patients with breast cancer and known tumor stage referred to the British Columbia Cancer Agency from 1976 to 1985, 336 IIIB, 233 M1, and 51 nodal-M1 patients were identified. Actuarial overall and breast cancer–specific survival rates were determined to 20 years. Results: Overall survival at 20 years was 13.2% for nodal-M1 cases (95% confidence interval [CI], 5% to 26%), 9.4% for IIIB cases (95% CI, 6% to 14%), and 1.3% for M1 (other) cases (95% CI, 0.4% to 3.5%; log-rank P < .0005). Overall survival was similar between nodal-M1 and IIIB cases (P = .27). Breast cancer–specific survival at 20 years was 24.1% for nodal-M1 cases (95% CI, 13% to 37%), 30.2% for IIIB cases (95% CI, 23% to 38%), and 3.9% for M1 (other) cases (95% CI, 2% to 8%; log-rank P < .0005). Breast cancer–specific survival was significantly different for nodal-M1 cases compared with either IIIB or M1 (other) cases (P = .008 for both). Conclusion: Patients with supraclavicular metastases at diagnosis have significantly better outcomes than patients with M1 (other) disease and overall survival similar to patients with IIIB disease. Reclassification as stage IIIC is appropriate for patients with breast cancer who present with supraclavicular nodal metastases alone.
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Peintinger, Florentia, Roland Reitsamer, Marjolein L. Smidt, Thorsten Kühn, and Cornelia Liedtke. "Lymph Nodes in Breast Cancer - What Can We Learn from Translational Research." Breast Care 13, no. 5 (2018): 342–47. http://dx.doi.org/10.1159/000492435.
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Clinical observations about lack of survival benefit after extensive axillary surgery and biological discordance between primary breast tumors and axillary lymph nodes raise the question of the actual metastatic potential of axillary nodal disease. The exploration of intratumoral heterogeneity and detection of genomic differences between the primary and lymph nodes indicate some similarity between the number of mutations in synchronous axillary node metastases and those in the primary lesion, suggesting a favorable prognosis. The hematogenous route of metastasis needs to be considered in findings of different subclones between nodal and distant metastases. Modern tools such as whole-genome sequencing applied in multiple tumor areas may guide more precisely the extent of axillary surgery.
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Arya, Suvarcha, Vipin Arora, Harish Chand Taneja, and Priyanka Gogoi. "Evaluation of epithelial mesenchymal transition markers snail and slug as predictor of nodal metastasis in oral squamous cell carcinoma." International Journal of Otorhinolaryngology and Head and Neck Surgery 6, no. 12 (November 24, 2020): 2183. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20204953.
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<p><strong>Background: </strong>Presence of regional neck node metastasis in head and neck cancer is a major determinant of overall survival. In patients presenting with neck node metastasis, there is a fifty percent decrease in overall survival, irrespective of the treatment modality. Tumor, nodes, metastases staging system, based on the anatomical extent of disease is used to predict patient prognosis and need for adjuvant treatment. Advent of immune based therapy has led to development of new molecular markers which can predict the disease aggressiveness by predicting lymph node and distal metastasis. Epithelial mesenchymal transition<strong> (</strong>EMT) in cancer is thought to convert the stable epithelial cells to mesenchymal cells that acquire properties of invasion with regional and distal metastasis.</p><p><strong>Methods:</strong> In the current study we evaluated the expression of EMT markers snail and slug in oral squamous cell carcinoma with and without neck node metastasis in 86 patients.</p><p><strong>Results:</strong> In this study, snail positivity was observed in 72 cases (83.72%), slug positivity was observed in 52 cases (60.46%) and either of the two expressions was observed in 77 cases (89.53%). Found that snail was significantly associated with clinical nodal status (p=0.037) and post-op histopathological nodal status (p=0.003). Also found that slug was significantly associated with clinical nodal status (p<0.001), post-op histopathological nodal status (p=0.001) and perineural invasion (p=0.003).</p><p><strong>Conclusions:</strong> Snail and slug positivity correlates with clinical and post-op histopathological nodal status and thus can be used as a predictor of nodal metastasis in oral squamous cell carcinoma.</p>
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Mosquera, Catalina, Haily Vora, and Timothy Louis Fitzgerald. "Novel nomogram combining depth of invasion and size to predict the benefit of regional lymphadenectomy for appendiceal neuroendocrine tumors (A-NET)." Journal of Clinical Oncology 34, no. 4_suppl (February 1, 2016): 389. http://dx.doi.org/10.1200/jco.2016.34.4_suppl.389.
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389 Background: The need for regional lymphadenectomy for A-NET is predicated on the risk of nodal metastasis. Although depth of invasion is predictive of nodal metastases in other gastrointestinal NET, current guideline recommendations for A-NET are based solely upon size. Methods: Patients with A-NET from 1988-2012 were identified within the SEER registry. Depth of invasion was defined as limited to lamina propria (LP), invading or through muscularis propria (MP), and through serosa (TS). Results: A total of 1,024 patients met inclusion criteria, with majority being female (55.7%), white (86.8%), and node-negative (81.1%). On univariate analysis, risk of nodal metastases was associated with size ( < 1 cm 1.9%, 1-2 cm 19.7%, 2-4 cm 32.5%, and > 4 cm 37.2%), depth of invasion (LP 4.1%, MP 17.4% and TS 44.3%) and extent of surgery (appendectomy 8.7% vs colectomy 31.9%), p < 0.0001. On multivariate analysis, size ( < 1 cm vs 1-2 cm HR 8.80, vs 2-4 cm HR 15.68, and vs > 4 cm HR 15.16), depth of invasion (LP vs TS HR 6.67) and extent of surgery (appendectomy vs colectomy HR 2.98), continued to be associated with nodal involvement, p < 0.0001. When only patients with colectomy were considered results were similar on both univariate and multivariate analyses. On univariate survival analysis, size [ < 1cm 95.6%, 1-2cm 94.9%, 2-4cm 88.4%, and > 4cm 73.7% 5-year disease-specific survival (5-y DSS)], depth of invasion (LP 96.9%, MP 93.2%, and TS 77.1% 5-y DSS), extent of surgery (appendectomy 94.4% and colectomy 87.1%), and N stage (N0 94.7% and N1 77.7%) predicted survival, p < 0.002. In a Cox regression model, extent of surgery and N stage continued to predict survival. A nomogram was created to predict the risk of nodal metastases, AUC = 0.83. Conclusions: This simple nomogram, which incorporates size and tumor extension, accurately predicts the risk for regional nodal metastases in appendiceal NET. In addition to providing valuable information on risk for regional nodal metastases, depth of invasion independently predicts survival.
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Zhou, Hengbo, Pin-ji Lei, and Timothy P. Padera. "Progression of Metastasis through Lymphatic System." Cells 10, no. 3 (March 12, 2021): 627. http://dx.doi.org/10.3390/cells10030627.
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Lymph nodes are the most common sites of metastasis in cancer patients. Nodal disease status provides great prognostic power, but how lymph node metastases should be treated is under debate. Thus, it is important to understand the mechanisms by which lymph node metastases progress and how they can be targeted to provide therapeutic benefits. In this review, we focus on delineating the process of cancer cell migration to and through lymphatic vessels, survival in draining lymph nodes and further spread to other distant organs. In addition, emerging molecular targets and potential strategies to inhibit lymph node metastasis are discussed.
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Weiss, Aaron R., Elizabeth R. Lyden, James R. Anderson, Douglas S. Hawkins, Sheri L. Spunt, David O. Walterhouse, Suzanne L. Wolden, et al. "Histologic and Clinical Characteristics Can Guide Staging Evaluations for Children and Adolescents With Rhabdomyosarcoma: A Report From the Children's Oncology Group Soft Tissue Sarcoma Committee." Journal of Clinical Oncology 31, no. 26 (September 10, 2013): 3226–32. http://dx.doi.org/10.1200/jco.2012.44.6476.
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Purpose To simplify the recommended staging evaluation by correlating tumor and clinical features with patterns of distant metastasis in newly diagnosed patients with embryonal rhabdomyosarcoma (ERMS) or alveolar rhabdomyosarcoma (ARMS). Patients and Methods Patient data from the Intergroup Rhabdomyosarcoma Study Group and the Children's Oncology Group over two periods were analyzed: 1991 to 1997 and 1999 to 2004. We used recursive partitioning analyses to identify factors (including histology, age, regional nodal and distant metastatic status, tumor size, local invasiveness, and primary site) that divided patients into subsets with the most different rates of metastatic disease. Results Of the 1,687 patients analyzed, 5.7% had lung metastases, 4.8% had bone involvement, and 6% had bone marrow (BM) involvement. Rhabdomyosarcoma (RMS) without local invasion (T1) had a low rate of metastasis for all distant sites, especially ERMS (0% bone, 0% BM). ARMS with local invasion (T2) had a higher rate of metastasis for all distant sites (13% lung, 18% bone, 23% BM). ERMS, T2 also had a higher rate of metastatic lung involvement (9%). The likelihood of bone or BM involvement increased in the presence of lung metastases (41% with, 6% without). Regional nodal metastases (N1) predicted a high rate of metastasis in all distant sites (14% lung, 14% bone, 18% BM). A staging algorithm was developed. Conclusion Staging studies in childhood RMS can be tailored to patients' presenting characteristics. Bone marrow aspirate and biopsy and bone scan are unnecessary in at least one third of patients with RMS.
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Choi, Audrey H., Matthew Surrusco, Samuel Rodriguez, Khaled Bahjri, Naveen Solomon, Carlos Garberoglio, Sharon Lum, and Maheswari Senthil. "Extranodal Extension on Sentinel Lymph Node Dissection: Why should we Treat it Differently?" American Surgeon 80, no. 10 (October 2014): 932–35. http://dx.doi.org/10.1177/000313481408001004.
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American College of Surgeons Oncology Group Z0011 concluded that axillary lymph node dissection (ALND) may be avoided in selected patients with breast cancer with limited axillary nodal metastasis on sentinel lymph node dissection (SLND). However, patients with extranodal extension (ENE) were excluded to the follow existing standard of care, which is completion ALND. The significance of ENE detected on SLND is not well defined. Our objective was to determine the impact of ENE found on SLND on nonsentinel lymph node (NSLN) metastasis, recurrence, and overall mortality. We evaluated patients with breast cancer treated at a tertiary cancer center from 2005 to 2012. SLND was performed in 655 patients. Of those, 478 of 655 (73.0%) patients had no SLN metastases, 124 of 655 (18.9%) had SLN metastases without ENE (SLN-ENE), and 53 of 655 (8.1%) had SLN metastases with ENE (SLN1ENE). Of patients undergoing ALND, NSLN metastasis was detected in 37 of 84 (44.0%) of patients in the SLN-ENE group and 26 of 45 (57.8%) patients in the SLN1ENE group ( P = 0.14). On adjusted analyses, ENE was associated with increased disease recurrence (odds ratio [OR], 5.48; 95% confidence interval [CI], 1.23 to 24.48; P = 0.03) as well as increased overall mortality (OR, 8.16; 95% CI, 1.72 to 38.63; P = 0.01). In conclusion, ENE is associated with increased overall axillary nodal burden, disease recurrence, and overall mortality.
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Ito, Hiroaki, Haruhiro Inoue, Noriko Odaka, Hitoshi Satodate, Michitaka Suzuki, Shumpei Mukai, Yusuke Takehara, Tomokatsu Omoto, and Shin-ei Kudo. "Comparison of Clinicopathological Characteristics in the Patients with Cardiac Cancer with or without Esophagogastric Junctional Invasion: A Single-Center Retrospective Cohort Study." International Journal of Surgical Oncology 2013 (2013): 1–7. http://dx.doi.org/10.1155/2013/189459.
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Background. This study addresses clinicopathological differences between patients with gastric cardia and subcardial cancer with and without esophagogastric junctional invasion.Methods. We performed a single-center, retrospective cohort study. We studied patients who underwent curative surgery for gastric cardia and subcardial cancers. Tumors centered in the proximal 5 cm of the stomach were classed into two types, according to whether they did (Ge) or did not (G) invade the esophagogastric junction.Results. A total of 80 patients were studied; 19 (73.1%) of 26 Ge tumors and 16 (29.6%) of 54 G tumors had lymph nodes metastases. Incidence of nodal metastasis in pT1 tumors was significantly higher in the Ge tumor group. No nodal metastasis in cervical lymph nodes was recognized. Only two patients with Ge tumors had mediastinal lymph node metastases. Incidence of perigastric lymph node metastasis was significantly higher in those with Ge tumors. Ge tumors tended to be staged as progressive disease using the esophageal cancer staging manual rather than the gastric cancer staging manual.Conclusion. Because there are some differences in clinicopathological characteristics, it is thought to be adequate to distinguish type Ge from type G tumor.
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Sakanaka, Katsuyuki, Yuichi Ishida, and Takashi Mizowaki. "A Case Report of Locally Advanced Anal Cancer with Solitary Cutaneous Nodular Metastasis in the Ipsilateral Labia Majora Treated with Definitive Chemoradiotherapy." Case Reports in Oncology 12, no. 3 (September 19, 2019): 721–27. http://dx.doi.org/10.1159/000503171.
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Cutaneous metastasis from anal cancer is rare at the initial diagnosis. There is a dearth of information on definitive treatment for anal cancer with cutaneous metastasis. We report the case of a 63-year-old female with locally advanced anal cancer and solitary cutaneous nodular metastasis in the right labia majora identified at the initial diagnosis that was successfully treated with definitive chemoradiotherapy. She arrived at our hospital with complaints of an enlarging perineal itching nodule. Genital and rectal examination detected an anal tumor with perineal and rectal invasion. The biopsy specimen indicated it was a squamous cell carcinoma that was accompanied by right inguinal and external iliac lymph nodal metastases and solitary cutaneous nodular metastasis in the ipsilateral labia majora. She was diagnosed with anal cancer, clinical T3N1M1, stage IV (UICC-TNM 7th). She had good performance status and effective organ function. She received definitive chemoradiotherapy with irradiation fields that included the primary tumor, pelvic lymph nodal metastases, and solitary cutaneous genital metastasis. After completing the planned treatment, all tumors vanished without recurrences at 42 months after treatment. In conclusion, patients with locally advanced anal cancer may suffer genital cutaneous metastasis that develops with lymphatic drainage from the anus to the inguinal lymph nodes. Anal cancer with solitary genital cutaneous nodular metastasis can be considered as a local-regional disease and can be treated with chemoradiotherapy. Chemoradiotherapy achieved a cure in our case.
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Bansal, Nidhi, Arnav Kr Roychoudhury, and Harshi Dhingra. "THYMIC CARCINOMA - A RARE CASE REPORT." Medicine and Pharmacy Reports 91, no. 2 (April 26, 2018): 238–41. http://dx.doi.org/10.15386/cjmed-887.
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Introduction. Thymic carcinoma is a rare, invasive mediastinal neoplasm with a tendency to metastasize. They constitute a heterogeneous group of tumors that present differently in terms of both behavior and prognosis. Case report. We present a case of thymic carcinoma in a 55-year-old male patient known to suffer from Myasthenia gravis, whose chief complaints were fatigability, ptosis and coughing. All electromyography studies were done along with excision biopsy to reach the definitive diagnosis. Results and conclusion. The histopathological diagnosis of Thymic carcinoma-Lymphoepithelial variant was established. Though no definite staging system exists for the thymic carcinoma, prognosis of the patient was ascertained by using Weissferdt-Moran system, Masaoka and Tsuchiya TNM staging systems. Involvement of the pleural and the pericardial structures leads to poor prognosis, though no distant metastases or lymph nodal metastasis were evident.
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Rutkowski, Piotr, Monika Jurkowska, Aleksandra Gos, Andrzej Tysarowski, Wanda Michej, Tomasz Switaj, Wirginiusz Dziewirski, et al. "Correlations of molecular alterations in clinical stage III cutaneous melanoma with clinical-pathological features and patients outcome." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): 8548. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.8548.
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8548 Background: To evaluate frequency and type of oncogenic BRAF/NRAS mutations in cutaneous melanoma with clinically detected nodal metastases (stage IIIB,C) in relation to clinicopathologic features and outcome. Methods: We analyzed 221 patients after therapeutic lymphadenectomy-LND (1995-2010) not treated with tyrosine kinase inhibitors and performed molecular characterization of nodal metastases in terms of BRAF/NRAS genes (analyzed by sequencing of respective coding sequences). Median follow-up time was 53 months. Results: BRAF mutations were detected in 139 (63%) cases (127–V600E, 8–V600K, 4-others), mutually exclusive NRAS mutations in 35(15.8%) cases (mainly Q61R and Q61K). BRAF mutation presence correlated with patients' younger age(median 52 vs 60 years for BRAF+ vs. BRAF-, p<0.05), metastases in axillary basin (p<0.05) and less involved nodes (median 3 vs. 4; p<0.05). 5-year overall survival (OS) was 35% and 45% (calculated from date of LND and primary tumor excision, respectively); 5-year recurrence-free survival RFS (from LND) – 29%. We have not found correlation between mutational status and RFS or OS (calculated from date of LND and primary tumor excision) – for BRAF mutated-melanomas prognosis was the same as wild-type melanoma patients(p=0.26) with even trend for better OS for non-V600E mutants. Negative prognostic factors (in univariate and multivariate analysis) for OS and RFS were: male gender (p<0.01), metastatic lymph nodes>1 (p<0.001), nodal metastases extracapsular extension (p<0.001). The interval from diagnosis of first-ever melanoma to regional nodal metastasis (median-10 months) was not significantly different between BRAF-mutant and BRAF wild-type patients (p=0.29). Conclusions: BRAF/NRAS mutational status is not prognostic marker in stage III melanoma patients with macroscopic nodal involvement, what may have implication for potential adjuvant therapy. BRAF status had no impact on disease-free interval from diagnosis of primary melanoma to nodal metastases. Our first-ever comprehensive molecular analysis of clinical stage III melanomas revealed that BRAF-mutants show characteristic clinicopathologic features.
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Tantraworasin, Apichat, Somcharoen Saeteng, Nirush Lertprasertsuke, Nuttapon Arayawudhikule, Choosak Kasemsarn, and Jayanton Patumanond. "Completely Resected N0 Non-Small Cell Lung Cancer: Prognostic Factors Affecting Long-Term Survival." ISRN Surgery 2013 (August 29, 2013): 1–7. http://dx.doi.org/10.1155/2013/175304.
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Background. Although early stage non-small cell lung cancer (NSCLC) has an excellent outcome and correlated with good long-term survival, up to 15 percent of patients still relapse postoperatively and die. This study is conducted to identify prognostic factors that may affect the long-term survival in completely resected N0 NSCLC. Methods. Medical records of 124 patients with completely resected N0 NSCLC were retrospectively reviewed. Prognostic factors affecting long-term survival were analyzed by the Kaplan-Meier method and Cox proportional hazards analysis. Results. Overall five-year survival rate was 48 percent. Multivariable analysis revealed stage of disease, tumor necrosis, tumor recurrence, brain metastasis, adrenal metastases, and skin metastases as significant prognostic factors affecting long-term survival. The hazard ratio (HR) of tumor necrosis, tumor recurrence, brain metastasis, adrenal metastases, and skin metastases was 2.0, 2.3, 7.6, 4.1, and 8.3, respectively, and all P values were less than 0.001. Conclusions. Our study shows stage of disease, tumor necrosis, tumor recurrence, brain metastasis, adrenal metastasis, and skin metastasis as the independent prognostic factors of long-term survival in pathological N0 NSCLC. Early stage NSCLC patients without nodal involvement or presented with tumor necrosis should benefit from adjuvant chemotherapy, and sites of metastasis could predict the long-term survival as described.
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Johnson, Benny, Zhaohui Jin, Michael G. Haddock, Christopher Leigh Hallemeier, James A. Martenson, Rory L. Smoot, David W. Larson, Eric J. Dozois, David M. Nagorney, and Axel Grothey. "A curative intent trimodality approach for advanced isolated abdominal nodal metastasis in metastatic colorectal cancer: Update of a single-institutional experience." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): 3556. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.3556.
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3556 Background: To define and update survival rates and relapse patterns in patients (pts) with isolated advanced abdominal nodal metastasis secondary to colorectal cancer (CRC), treated with curative intent using aggressive trimodality therapy. Methods: Fifty-seven pts with isolated advanced abdominal lymph node metastasis (retroperitoneal and mesenteric) secondary to colorectal cancer received trimodality therapy defined as chemotherapy delivered in conjunction with external beam radiotherapy (EBRT) followed by lymphadenectomy and intraoperative radiotherapy (IORT). Infusional 5-FU was the most common radiosensitizer used (66%, 38 pts). The median dose of EBRT was 50 Gy & the median dose of intraoperative radiotherapy was 12.5 Gy. End points included distant metastasis, toxicities, local failure within EBRT field, recurrence within the intraoperative radiotherapy field, and survival. Results: 49% of pts were male, median age 50.5 yrs. All patients had ECOG ≤ 1. 27 pts had primary right sided colon cancer, 16 left sided colon cancer and 14 rectal primaries. Median time from initial CRC diagnosis to development of abdominal lymph node metastatic disease was 24 months (95% CI, 23.5-45.1 months). 84% (48 pts) had paraaortic nodal metastases, 12% (7 pts) had mesenteric nodal metastases, and 3% (2 pts) had both. With a median follow up of 89.4 months, the median overall survival and 5-year estimated survival rate were 53.2 months (95% CI, 46.4-78.8 months) and 42%, respectively. Median progression free survival was 19.3 months (95% CI, 15.6-32.8 months). 21 (37%) pts never developed distant disease. Outcome was not affected by disease sidedness, rectal primary, or mutational profile. Treatment was well tolerated without any grade 3/4 toxicities. Conclusions: The use of trimodality therapy including EBRT with radiosensitizing chemotherapy, lymphadenectomy and IORT produces sustainable long-term survival in selected metastatic CRC pts presenting with isolated retroperitoneal/mesenteric nodal relapse.
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Jiang, Ping, Jing Cai, Xiaoqi He, Hongbo Wang, Weihong Dong, Yuan Zhang, Juergen Dunst, Kay C. Willborn, Bangxing Huang, and Zehua Wang. "Identification of risk factors associated with pelvic lymph node metastasis in patients with stage IB1 cervical cancer." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e18005-e18005. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e18005.
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e18005 Background: Evaluation the distribution of nodal metastases in the stage IB1 cervical cancer and the risk factors associated with pelvic lymph node metastasis (LNM) at each anatomic location. Methods: 728 patients with stage IB1 cervical cancer who underwent radical hysterectomies and systemic pelvic lymphadenectomies from January 2008 to December 2017 were retrospectively studied. All removed pelvic lymph nodes were pathologically examined, and the risk factors for LNM at the obturator, internal iliac, external iliac, and common iliac regions were evaluated by univariate and multivariate logistic regression analyses. Results: 20,134 lymph nodes were analysed with the average number of 27.80 (± SD 9.43) lymph nodes per patient. Nodal metastases were present in 266 (14.6%) patients. The obturator was the most common site for nodal metastasis (42.5%) followed by the internal iliac nodes (20.3%) and the external iliac nodes (19.9%), while the common iliac (9.8%) and parametrial (7.5%) nodes were the least likely to be involved. Tumor size more than 2 cm, histologically proven lymphovascular space involvement (LVSI) and parametrial invasion correlated independently significantly with the higher risk of the lymphatic metastasis. Obesity (BMI≥25) was independently significantly negatively correlated with the risk of lymphatic metastases. All the positive common iliac nodes were found in patients with tumors greater than 2 cm. The multivariate analysis showed that tumor size greater than 3 cm was associated with a 16.6-fold increase in the risk for common iliac LNM. Interestingly, tumor size was not an independent risk factor for pelvic LNM in the lower regions, i.e., the obturator, internal iliac and external iliac areas, where LVSI was the most significant predictor for LNM. In addition, parametrial invasion was related to external and internal iliac LNM; deep stromal invasion and age less than 50 years were associated with obturator LNM. Conclusions: The incidence of lymph node metastasis in patients with stage IB1 cervical cancer is low but prognostically relevant. The data offer the opportunity for tailored individual treatment in selected patients with small tumors and obesity.
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Perveen, Rahima, Jasmin Ferdous, Sharmin Quddus, and Tapati Mandal. "Solitary Liver Metastasis from Follicular Variant Papillary Thyroid Carcinoma: A Case Report." Bangladesh Journal of Nuclear Medicine 22, no. 2 (February 1, 2021): 146–49. http://dx.doi.org/10.3329/bjnm.v22i2.51768.
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Papillary and follicular thyroid carcinomas, together known as differentiated thyroid carcinomas (DTC), are among the most curable of cancers. Distant metastases are rare events at the onset of DTC. Sites of metastases from follicular thyroid cancer (FTC) are usually osseous, and those from papillary thyroid cancer (PTC) metastasize to regional nodal basins and the lungs. Visceral metastases are rare, but the involvement of multiple sites has been reported so far. Liver metastases from differentiated thyroid carcinoma (LMDTC) are rare.We present the case of a patient with follicular variant of papillary thyroid carcinoma (FVPTC) unusually involving the liver.
Bangladesh J. Nuclear Med. 22(2): 146-149, Jul 2019
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Ahmed, Sadaf, Montasir Junaid, Sohail Awan, Maliha Kazi, Hareem Khan, and Sohail Halim. "Frequency of Cervical Nodal Metastasis in Early-Stage Squamous Cell Carcinoma of the Tongue." International Archives of Otorhinolaryngology 22, no. 02 (June 6, 2017): 136–40. http://dx.doi.org/10.1055/s-0037-1603626.
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Introduction Oral cavity carcinoma is an aggressive tumor, with the tongue being one of the most common subsites of involvement. Surgery is a gold standard method of dealing with advanced-stage tumors. However, for early-stage carcinomas of the tongue, the management remains controversial. Several studies have indicated that early-stage cancers have a high chance of occult cervical node metastasis, which, if left untreated, can greatly affect the prognosis. Certain parameters can help identify patients with occult cervical node metastases, and can avoid unnecessary neck dissection in node negative patients. Tumor thickness is one such objective parameter. Objective To estimate the frequency of cervical lymph node metastasis in patients with early-stage, node-negative (N0) squamous cell carcinoma of the tongue. Methods In-patient hospital data was reviewed from January 2013 until March 2014, and 78 patients who underwent primary resection of the tumor and neck dissection for biopsy-proven, early stage squamous cell carcinoma of the tongue were included. Data such as tumor thickness, tumor differentiation and presence of occult nodal metastasis in the surgical specimen were gathered from the histopathology reports. The frequency of subclinical cervical lymph node metastasis in patients with early-stage squamous cell carcinoma of the tongue was estimated. Results A total of 69% of the patients with tumor thicknesses > 5 mm had tumor metastases in the neck nodes, while 100% of the patients with tumor thicknesses < 5 mm had no neck nodal metastasis. Conclusion A tumor thickness > 5 mm is significantly associated with subclinical metastasis, and prophylactic neck dissection is warranted in such cases.
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Lee, C. C., M. B. Faries, L. A. Wanek, and D. L. Morton. "Improved survival following lymphadenectomy for nodal metastasis from an unknown primary melanoma." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 8515. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.8515.
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8515 Background: It is not possible to identify a primary site in 10–20% of melanoma patients presenting with palpable nodal metastases. The explanation for this phenomenon is unknown but could reflect an endogenous antimelanoma immune response that causes complete regression of the primary melanoma. If so, then these patients should have a better survival than patients whose primary melanoma has been identified. Methods: We reviewed our 13,000-patient prospective melanoma database (1971–2005) to identify patients managed with regional lymphadenectomy for palpable nodal metastases from unknown primary melanoma (MUP) or known primary cutaneous melanoma (MKP). Multivariate analysis was performed to identify prognostic factors significant for survival. MUP and MKP patients were then matched by significant covariates. Overall survival (OS) was estimated by Kaplan-Meier method and compared by log-rank analysis. Results: Among 1571 patients with palpable nodal metastases who underwent regional lymphadenectomy, multivariate analysis identified 5 significant covariates: age (HR=1.294, P=0.0017), sex (HR=1.335, P=0.0004), nodal tumor burden (HR=1.256, P<0.0001), decade of diagnosis (HR=0.989, P=0.0131), and unknown/known primary (HR=1.507; 95% CI=1.220 to 1.862; P=0.0001). Five-year OS was significantly higher for the 262 MUP patients than 1309 MKP patients (55±6% vs. 44±3%; P=0.0021). Computerized matching of MUP and MKP patients by four significant covariates (age, sex, nodal tumor burden, and decade of diagnosis) yielded 221 matched pairs. Median OS and 5-year OS rates were 165 months and 58±7%, respectively, for MUP as compared with 34 months and 40±6%, respectively, for MKP (P=0.0008). Conclusions: Our results strongly support the effectiveness of lymphadenectomy for nodal metastasis from MUP. Risk of death dropped significantly when regional lymphadenectomy was performed for metastases from MUP as compared with MKP. This result is compatible with an immunologic rejection of the primary melanoma due to a strong host antitumor immune response. Immunologic studies to identify cell-mediated and antibody components of this response are underway. No significant financial relationships to disclose.
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Kurisunkal, Vineet, Ashish Gulia, Puri Ajay, and Bharat Rekhi. "Lymph node metastasis in extremity chondrosarcomas." South Asian Journal of Cancer 09, no. 01 (January 2020): 01–03. http://dx.doi.org/10.4103/sajc.sajc_84_19.
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Abstract Bacground: Primary bone sarcomas mainly metastasize through haematogenous route and rarely through lymph nodes due to paucity of lymphatic channels in the bone (1). Nodal spread in chondrosarcoma is extremely rare and there are two reported cases in literature including one previously published by our institute (3, 5). Aims and Objectives: We present a series of chondrosarcoma cases (primary tumour located in the scapula, proximal femur, proximal humerus and pelvis), presenting with lymph node metastasis, treated at our institute. We assessed the oncological outcome of these cases and the impact of nodal metastasis on survival. Materials and Methods: Between January 2006 and December 2015, 243 patients of extremity and pelvic chondrosarcoma were operated at our institute. These cases were retrieved from a prospectively maintained database. Four (1.6%) of these patients developed lymph node metastasis. Clinical and radiological details of these cases were retrieved from electronic medical records and case files. Histopathology of the primary chondrosarcoma lesion and nodal metastasis was reconfirmed by a pathologist specializing in sarcomas. Conclusion: Lymph node metastasis though extremely rare in primary osseous chondrosarcoma, definitely affects their survival adversely. The rarity of the occurrence of lymph node metastasis in primary osseous tumors, especially chondrosarcoma highlights the need for multi institutional studies to pool knowledge and evaluate the prognostic significance and etiopathogenesis of lymph node metastasis in primary bone chondrosarcoma.
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Eveno, C., D. Goárá, D. Tzanis, P. Dartigues, F. Dumont, L. Benhaim, M. Ducreux, and D. Elias. "Retroperitoneal dissemination of colorectal ovarian metastases: Basis for rationale use of lymphadenectomy." Journal of Clinical Oncology 29, no. 4_suppl (February 1, 2011): 535. http://dx.doi.org/10.1200/jco.2011.29.4_suppl.535.
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535 Background: Retroperitoneal lymph nodes are a common site of metastases in primary ovarian cancers and primary peritoneal carcinoma, therefore pelvic and paraaortic lymphadenectomy are recommended. Colorectal ovarian metastases are mostly associated to peritoneal carcionomatosis (PC), which treatment is based on complete cytoreductive surgery (CCRS) associated to intraperitoneal chemotherapy (IPC). The aim of this study was to compare the rate of nodal (pelvic, paraaortic) recurrences, between 2 groups of patients (pts) operated on PC with ovarian metastases (OM) or without OM. Methods: From January 1994 to December 2009, all consecutive women who underwent CCRS plus IPC, were selected from a prospective database. Demographics, tumor characteristics, surgical procedures and chemotherapy, were analyzed and compared. Results: One hundred and five pts were identified; 63 (60%) had ovarian metastasis (synchronous or metachronous). Groups were comparable for all variables, except for the median peritoneal cancer index which was lower in the OM group (9 vs.10.5, p<.05). Nodal recurrences were diagnosed in 19 pts (18%), in paraaortic nodes in 14 pts (74%), pelvic nodes in 7 pts (36%), both in 2 pts (10%) and were associated to other relapse in 15 pts (80%). All these nodal recurrences occurred in the OM group (30% vs. 0, p<.001). After a median follow-up of 74 months (10-196), 3-year overall survival rate was greater in pts without nodal recurrences (71 vs 41 %, p=0.37) and at the end of the study, there was significantly more patients died of disease in case of nodal recurrence (24/44 vs 5/19, p=.04). Conclusions: Nearly one third of patients with ovarian metastases experienced paraaortic and pelvic nodes recurrences. This may due to the specific pattern of lymphatic spread of ovary, well known in primary carcinomas. Therefore, systematic lymphadenectomy should be studied in patients with colorectal ovarian metastases treated in curative intent. No significant financial relationships to disclose.
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Turner, S. J., G. J. Morgan, C. E. Palme, and M. J. Veness. "Metastatic cutaneous squamous cell carcinoma of the external ear: a high-risk cutaneous subsite." Journal of Laryngology & Otology 124, no. 1 (September 24, 2009): 26–31. http://dx.doi.org/10.1017/s0022215109991101.
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AbstractIntroduction:Patients with cutaneous squamous cell carcinoma of the external ear may develop metastatic spread to the nearby ipsilateral parotid and/or upper cervical lymph nodes. The literature suggests that the external ear is a high-risk subsite for such tumours, due to nodal metastasis and its associated morbidity and mortality.Methods:Between 1980 and 2007, 43 patients with a diagnosis of metastatic cutaneous squamous cell carcinoma of the external ear were treated with surgery alone, surgery plus adjuvant radiotherapy, or radiotherapy alone.Results:Patients comprised 39 men and four women. Their median age at diagnosis was 72 years, with a median follow up of 35 months. The median size of the primary lesion was 21 mm, with a median thickness of 7 mm. Fifteen patients presented concurrently with nodal metastases. Thirty patients developed parotid metastases (with positive cervical nodes in six patients), while 13 developed cervical metastases only. Eight patients underwent surgery alone, 32 underwent surgery plus adjuvant radiotherapy, and three received radiotherapy alone. At the last follow up, 15 patients had relapsed and nine had died of their disease, with a median survival after relapse of 5.5 months.Conclusion:Patients with metastatic cutaneous squamous cell carcinoma of the external ear have a relatively poor outcome, with a significant number of patients experiencing nodal relapse and death after treatment.
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Fujikawa, Hirohito, Kentaro Sakamaki, Taiichi Kawabe, Tsutomu Hayashi, Toru Aoyama, Takehiro Wakasugi, Shinichi Hasegawa, et al. "Prediction of nodal metastasis in clinical T1 gastric cancer." Journal of Clinical Oncology 32, no. 3_suppl (January 20, 2014): 21. http://dx.doi.org/10.1200/jco.2014.32.3_suppl.21.
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21 Background: Clinical T1 gastric cancer sometimes metastasizes to regional lymph nodes. Standard surgery is D2 gastrectomy for clinical T1N+ gastric cancer patients, however, clinical detection of nodal metastasis by Computed Tomography is unreliable, with only 4% sensitivity in our previous study. The present study aimed to predict pathological nodal metastases in clinical T1 gastric cancer. Methods: Patients were selected from the prospective database of Kanagawa Cancer Center between Oct 2000 and Oct 2007 based on the following criteria; (1) histologically proven adenocarcinoma of the stomach, (2) patients were diagnosed with clinical T1 by gastrointestinal endoscopy, (3) patients received radical surgery with D1 or more lymphadenectomy as a primary treatment. First, univariate logistic-regression model was used to select risk factors for prediction of pathological nodal metastasis by analyzing clinical factors of tumor location, clinical depth (cT1a or cT1b), macroscopic type, maximal tumor diameter, and pathological type. Then, the optimal cut-off value and predictive accuracy was determined by ROC curve using significant factors selected in logistic regression. Results: A total of 511 patients were entered into this study. Among these, pathological N+ was observed in 46 patients (9.0%). Clinical depth (p=0.002), tumor diameter (p<0.001) and pathological type (p=0.002) were significant risk factors for pathological nodal metastasis. Using these factors in multivariate logistic regression, the AUC was calculated to be 0.75. Cut-off value was different depending on the histology and clinical depth; 7.9 cm for differentiated type and 4.8 cm for undifferentiated type in cT1a and 4.3 cm for differentiated type and 1.1 cm for undifferentiated type in cT1b. Using these criteria, sensitivity and specificity for prediction of pathological nodal metastasis were 67.4% and 71.6%, respectively. Conclusions: Pathological nodal metastasis in clinical T1 gastric cancer was predictable by clinical depth, pathological type, and tumor size, however, specificity was not so high. D2 surgery is highly recommended for clinical T1 when the tumors satisfy these criteria.
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Perera, Dilmi, Ronald Ghossein, Niedzica Camacho, Yasin Senbabaoglu, Venkatraman Seshan, Juan Li, Nancy Bouvier, et al. "Genomic and Transcriptomic Characterization of Papillary Microcarcinomas With Lateral Neck Lymph Node Metastases." Journal of Clinical Endocrinology & Metabolism 104, no. 10 (June 25, 2019): 4889–99. http://dx.doi.org/10.1210/jc.2019-00431.
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Abstract Context Most papillary microcarcinomas (PMCs) are indolent and subclinical. However, as many as 10% can present with clinically significant nodal metastases. Objective and Design Characterization of the genomic and transcriptomic landscape of PMCs presenting with or without clinically important lymph node metastases. Subjects and Samples Formalin-fixed paraffin-embedded PMC samples from 40 patients with lateral neck nodal metastases (pN1b) and 71 patients with PMC with documented absence of nodal disease (pN0). Outcome Measures To interrogate DNA alterations in 410 genes commonly mutated in cancer and test for differential gene expression using a custom NanoString panel of 248 genes selected primarily based on their association with tumor size and nodal disease in the papillary thyroid cancer TCGA project. Results The genomic landscapes of PMC with or without pN1b were similar. Mutations in TERT promoter (3%) and TP53 (1%) were exclusive to N1b cases. Transcriptomic analysis revealed differential expression of 43 genes in PMCs with pN1b compared with pN0. A random forest machine learning–based molecular classifier developed to predict regional lymph node metastasis demonstrated a negative predictive value of 0.98 and a positive predictive value of 0.72 at a prevalence of 10% pN1b disease. Conclusions The genomic landscape of tumors with pN1b and pN0 disease was similar, whereas 43 genes selected primarily by mining the TCGA RNAseq data were differentially expressed. This bioinformatics-driven approach to the development of a custom transcriptomic assay provides a basis for a molecular classifier for pN1b risk stratification in PMC.
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Urzal, Cecília, Rita Sousa, Vítor Baltar, Paulo Correia, Eugénia Cruz, and Daniel Pereira da Silva. "Factores Preditivos de Metastização Ganglionar Retroperitoneal no Cancro do Endométrio." Acta Médica Portuguesa 27, no. 1 (January 8, 2014): 82. http://dx.doi.org/10.20344/amp.4115.
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<strong>Introduction:</strong> It has been suggested that a complete staging may be safely omitted in endometrial carcinoma patients at low risk for lymph node metastasis. The purposes of our study were to explore the prognostic significance of pathologic factors for pelvic and paraaortic nodal spread and to validate the Mayo algorithm in order to identify patients in whom lymphadenectomy may be avoided.<br /><strong>Material and Methods:</strong> We conducted a retrospective review including 208 patients, regarding the evaluation of pathologic variables and nodal metastases. Statistical analysis was performed using the chi-square test, the Fisher exact test and the Student’s t-test.<br /><strong>Results:</strong> Myometrial invasion > 50% (p < 0.001), cervical invasion (p = 0.001), lymphovascular space invasion (p = 0.003) and positive peritoneal cytology (p = 0.03) were significant predictors of retroperitoneal lymph node dissemination. Pelvic lymph node metastases were predictive of positive paraaortic lymph nodes (p < 0.001).<br /><strong>Discussion:</strong> The Mayo algorithm identified patients without pelvic or paraaortic nodal metastases with a 98.4% negative predictive value (61/62). Myometral invasion ≤ 50% and absence of cervical and lymphovascular invasion presented a negative predictive value of 98.8% (79/80).<br /><strong>Conclusion:</strong> Although the Mayo criteria predict a very low likelihood of retroperitoneal nodal metastases, the combination of myometral invasion ≤ 50% and absence of cervical or lymphovascular invasion would have safely avoided lymphadenectomy in a larger number of women.
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Uriev, L., I. Maslovsky, F. Barak, and D. Ben-Dor. "Size of Metastatic Lymph Nodes." Case Reports in Pathology 2013 (2013): 1–3. http://dx.doi.org/10.1155/2013/648219.
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We present a case and review of the literature of well-differentiated sigmoid adenocarcinoma with numerous metastases into pericolic lymph nodes. All positive lymph nodes were small. The authors concluded that there is no clear correlation between nodal size and the likelihood of metastasis in the lymph node, and the status of small lymph nodes must receive special attention by clinicians and pathologists.
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Yong, Tuck Leong, Nezor Houli, Graham Starkey, Mehrdad Nikfarjam, Robert Jones, Michael Fink, V. Muralidharan, Marcos Perini, and Chris Christophi. "Patterns of Lymph Node Recurrence in Colorectal Cancer Liver Metastases after Surgery: A Retrospective Longitudinal Study." Cancer and Clinical Oncology 6, no. 2 (October 8, 2017): 35. http://dx.doi.org/10.5539/cco.v6n2p35.
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Background: Hepatic resection is the standard treatment for resectable colorectal cancer liver metastases. There is evidence that lymphatics play a role in disease recurrence post-surgery. The aim of this retrospective study is to assess patterns of lymph node recurrence after liver resection. Methods: Patients who had liver resection for colorectal cancer metastasis between 1 January 2010 and 31 December 2015 at 2 institutions in Melbourne, Australia were included. Data was collected from databases located at the 2 surgical centres.Results: Seventy-four patients were included in the study. Follow-up period was for a mean of 31.4 months. Lymph node recurrence was seen in 39.2% of patients during follow-up. Initial recurrence sites after hepatectomy was mainly in visceral-site only. Lymph node recurrences became more prominent during subsequent Recurrence Stages (RS) (RS1 – 22.4%, RS2 – 50.0%, RS3 – 50.0%, RS4 – 71.4%, RS5 – 66.7%, and RS6 – 0%). No predictive factor showed statistically significant relation to development of nodal recurrence. Conclusion: Lymph node recurrences after hepatic resection for liver metastases usually occur subsequent to a visceral-site only metastasis. There is no predictive factor as to which nodal group would be involved due to the complexity of liver lymphatic drainage.
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Saba, Nabil F., Kelly R. Magliocca, Sungjin Kim, Susan Muller, Zhengjia Chen, Carrie Eggers, Vanessa H. Phelan, et al. "Acetylated tubulin and risk of nodal metastases in squamous cell carcinoma of the head and neck (SCCHN)." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): 5560. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.5560.
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5560 Background: We previously established that AT expression predicts for response to chemotherapy in SCCHN (Saba et al, AACR 2010 meeting abstr 3744). We wanted to further examine the relation of AT expression and nodal metastases in SCCHN. Methods: We assessed AT expression in archival tissue specimens from primary SCCHN cases with (50 cases) and without (53 cases) lymph node metastases (NM) using standard immunohistochemistry (IHC). Clinical characteristics of patients were retrieved from the department of pathology under the guidelines of the institutional review board (IRB). IHC staining for AT was scored based on intensity and percentage of tumor cells stained: 0 = no staining, 1+ = weak, 2+ = moderate, 3+ = moderate to high, 4+ = high and a weighted index (WI) was calculated as percent stain x stain intensity. Wilcoxon two-sample test and Kruskal-Wallis test were used to estimate the relationships of the WI with nodal metastasis, node status, primary tumor location, grade, and stage. Log-rank test was used to examine the difference in OS and DFS among four groups based on quartiles of the WI. A Cox proportional hazard model was employed to estimate the adjusted effect of WI on OS and DFS. Results: A higher AT expression was associated with nodal metastasis (p=0.0155) and higher stage (p=0.0311). A lower AT expression was associated with oral cavity primary (p=0.0107). After adjusting for age, gender, race, and smoking status, a lower AT expression was significantly associated with better DFS in the subset of patients with NM by multivariate analysis (HR=1.008; 95% CI=1.002- 1.014; p=0.0123). Among patients with no NM there was a marginally significant difference in OS among four different groups based on quartiles of AT expression (p=0.0765). Conclusions: High AT expression is associated with nodal metastases in SCCHN and may be a marker of poor prognosis in patients with node positive disease. The value of AT as a prognostic marker in SCCHN needs to be better defined. This work is supported by a SPORE CDP Grant P50 CA128613-03 to NFS.
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Parshin, V. S., A. A. Veselova, V. S. Medvedev, S. A. Ivanov, and A. D. Kaprin. "LEVELS I–VII FOLLOWING THYROIDECTOMY FOR PAPILLARY THYROID CANCER." Siberian journal of oncology 19, no. 5 (October 29, 2020): 76–81. http://dx.doi.org/10.21294/1814-4861-2020-19-5-76-81.
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Introduction. Cervical lymph node metastases can occur not only in patients when they are first diagnosed with papillary thyroid cancer but also in patients who have undergone thyroidectomy. Objective. The aim of this study was to assess the potential utility of neck ultrasound in diagnosing cervical lymph node metastases (levels I–VII) in patients who underwent surgical treatment for papillary thyroid cancer.Material and Methods. B-mode sonography of all nodal levels in the neck was performed using a linear array transducer in the frequency range of 7.5–13 MHz, power mapping and panoramic scan to locate regional lymph node metastases. All lymph nodes removed during reoperations were submitted for histological evaluation. Sonographic examinations of cervical lymph nodes of the levels I–VII were performed in 2875 patients who had undergone thyroidectomy in different regions of the Russian Federation. The patients were admitted to our clinic to receive radioactive iodine therapy. All neck levels were assessed by ultrasound.Results. Sonography revealed cervical lymph node metastases in 267 (9.2 %) of 2875 patients with papillary thyroid cancer who had undergone thyroidectomy. Nodal metastasis in level VI only occurred in 70 (2.4 %) patients, in levels II–III–IV only in 150 (5.21 %), in level VB only in 32 (1.11 %), and at the same time in level VI and in levels II–III–IV in 15 (0.52 %) patients. There were no metastases in levels I, VA, VII of the neck. Solitary metastases to all levels were found in 7.5 %, multiple metastases in 1.2 %, and conglomerates in 0.6 % of cases. Solitary metastases in level VI were noted in 56 (1.9 %), in levels II–III–IV in 125 (4.3 %), and in level VB in 29 (1.0 %) patients. Multiple metastases in level VI were detected in 11 (0.38 %), in levels II–III–IV in 21 (0.73 %), and in level VB in 3 (0.1 %) patients. Median metastasis size was 2.1 ± 1.6 cm.Conclusion. Post-thyroidectomy patients were found to have cervical lymph node metastases. Ultrasound scanning of the neck should be considered a key examination if there are cicatricial changes as it enables to identify metastasis and to determine its location. The maximal number of metastases was noted in levels II–III–IV. Cervical lymph node metastases occurred less frequently in the central level and level VB. The predominant metastatic pattern was solitary. There was an essential difference in metastatic spread to cervical lymph nodes between postthyroidectomy patients and patients who were first diagnosed with papillary thyroid cancer.
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Wing Yuen, Anthony Po, Chiu Ming Ho, William Ignace Wei, and Lai Kun Lam. "Analysis of recurrence after surgical treatment of advanced laryngeal carcinoma." Journal of Laryngology & Otology 109, no. 11 (November 1995): 1063–67. http://dx.doi.org/10.1017/s0022215100132037.
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AbstractThe pattern of recurrences after surgical treatment of 276 patients with stage T3 and T4 laryngeal carcinoma was reviewed. Nodal recurrence was the commonest site and occurred mainly in patients with supraglottic and transglottic carcinoma. Distant metastasis was the second commonest site of recurrence, and the most distant metastases developed without locoregional recurrence. Local recurrence alone was uncommon in patients treated with primary surgery.
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Heimann, Ruth, and Samuel Hellman. "Clinical Progression of Breast Cancer Malignant Behavior: What to Expect and When to Expect it." Journal of Clinical Oncology 18, no. 3 (February 1, 2000): 591. http://dx.doi.org/10.1200/jco.2000.18.3.591.
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PURPOSE: Seemingly localized breast cancer is a heterogeneous mix of truly localized cancers and cancers with occult metastases. Our purpose is to determine the parameters of metastatic proclivity for the different clinical presentations of operable breast cancer and to present quantitative prognostic information useful to both doctors and patients. PATIENTS AND METHODS: A series of regionally treated breast cancer patients was analyzed to determine the likelihood and time of the appearance of clinical metastases for different clinical subgroups. Patients operated on at the University of Chicago from 1927 to 1987 for clinically regionally localized breast cancer, who received no systemic therapy as a part of their initial treatment, were included. Overall survival and distant disease-free survival in this mature series are analyzed. RESULTS: Metastagenicity, the metastatic proclivity of a tumor, increases with both tumor size and nodal involvement. This is also true for virulence, which is the rate at which these metastases appear. Each clinical group has a cured population, even those with extensive nodal involvement. A table provides a tool for determining the proportion of risk expended in each clinical group as a function of the distant disease-free survival. Whereas the likelihood of metastasis increases with tumor size and nodal involvement, the time to their appearance decreases. CONCLUSIONS: Breast cancer metastagenicity and virulence are heterogeneous even within clinically similar groups of operable breast cancer patients. Tumor progression is correlated with increasing tumor size and nodal involvement. Markers are needed to identify individual tumor virulence and metastagenicity.
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Kamura, T., N. Tsukamoto, N. Tsuruchi, T. Kaku, T. Saito, N. To, H. Nakano, and K. Akazawa. "Histopathologic prognostic factors in stage IIb cervical carcinoma treated with radical hysterectomy and pelvic-node dissection — an analysis with mathematical statistics." International Journal of Gynecologic Cancer 3, no. 4 (1993): 219–25. http://dx.doi.org/10.1046/j.1525-1438.1993.03040219.x.
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Of 107 patients with stage IIb cervical cancer who underwent laparotomy, 82 (77%) could be treated with radical hysterectomy (RAH) and pelvic-node dissection (PND). The remaining 25 patients were unsuitable for radical surgery because of para-aortic lymph node metastases, direct cancer invasion into the bladder muscle, and/or fixed enlarged pelvic lymph nodes (PLN): Such patients were treated with radiation therapy after laparotomy. Fifty-nine of RAH patients were given postoperative pelvic radiation because they had PLN metastases, parametrial invasion, and/or full thickness cervical stromal invasion. The overall 5-year survival of the patients undergoing RAH was significantly better than that of those who could not be treated with RAH (P< 0.001). In the RAH patients, parametrial invasion, which clinically defines stage IIb, was found only in 45%. Univariate analysis of histopathologic prognostic factors revealed that PLN metastasis, parametrial invasion, adenocarcinoma, and lymph-vascular space invasion significantly affected survival of the RAH patients (P< 0.05). Multivariate analysis using Cox's proportional hazards regression model, however, selected only PLN metastasis as a strong prognostic factor (P< 0.001). Concerning PLN metastasis patients with two or more positive nodal groups vs. 49%,P< 0.0001). The logistic regression analysis revealed that tumor diameter, parametrial invasion and lymph-vascular space invasion were independently correlated with PLN metastases in two or more nodal groups. The present data suggest that (i) the patients with massive pelvic extension of cancer cannot be cured by radiation therapy alone, (ii) the strong determinant of the prognosis of the patients undergoing RAH and PND is PLN metastasis. Therefore, for these patients with poor prognosic factors, other treatment modalities should be considered. From the present study it seems that planning RAH and PND for patients with stage IIb disease might make it possible to select poor prognostic subgroups, who have extra cervical extension or PLN metastases in two or more groups, and be useful in individualizing treatment.
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Robson, N. L. K., V. H. Oswal, and L. M. Flood. "Radiation therapy of laryngeal cancer: A twenty year experience." Journal of Laryngology & Otology 104, no. 9 (September 1990): 699–703. http://dx.doi.org/10.1017/s0022215100113660.
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AbstractThis paper reviews a 20 year experience of radiation treatment of 286 laryngeal cancers and presents results with a minimum five year follow-up. All cases presented had glottic or supraglottic squamous cell carcinomas with no clinical evidence of nodal metastasis. A policy of primary radiotherapy, with surgery for salvage of treatment failures, produced control of primary disease and prevention of metastases superior to most other regimes documented in the literature.
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Rabbani, Farhang, Joel Sheinfeld, Hesam Farivar-Mohseni, Antonio Leon, Michael J. Rentzepis, Victor E. Reuter, Harry W. Herr, et al. "Low-Volume Nodal Metastases Detected at Retroperitoneal Lymphadenectomy for Testicular Cancer: Pattern and Prognostic Factors for Relapse." Journal of Clinical Oncology 19, no. 7 (April 1, 2001): 2020–25. http://dx.doi.org/10.1200/jco.2001.19.7.2020.
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PURPOSE: To determine the incidence, pattern, and predictive factors for relapse in patients with low-volume nodal metastases (stage pN1) at retroperitoneal lymphadenectomy (RPLND) and identify who may benefit from chemotherapy in the adjuvant or primary setting. PATIENTS AND METHODS: Fifty-four patients with testicular nonseminomatous germ cell tumor had low-volume retroperitoneal metastases (pathologic stage pN1, 1997 tumor-node-metastasis classification) resected at RPLND, 50 of whom were managed expectantly without adjuvant chemotherapy. The dissection was bilateral in 12 and was a modified template in 38 patients. Retroperitoneal metastases were limited to microscopic nodal involvement in 14 patients. Follow-up ranged from 1 to 106 months (median, 31.4 months). RESULTS: Eleven patients (22%) suffered a relapse at a median follow-up of 1.8 months (range, 0.6 to 28 months). The most frequent form of recurrence was marker elevation in nine (18%) patients. Persistent marker elevation after orchiectomy and before retroperitoneal lymphadenectomy was a significant independent predictor of relapse (relative risk, 8.0; 95% confidence interval, 2.3 to 27.8; P = .001). Four of five (80%) patients with elevated markers (alpha-fetoprotein alone in three, alpha-fetoprotein and beta human chorionic gonadotropin in one) suffered a relapse, compared with seven of 45 (15.6%) patients with normal markers. CONCLUSION: Clinical stage I and IIA patients with normal markers who have low-volume nodal metastases have a low incidence of relapse and can be managed by observation only if compliance can be assured. In contrast, patients with elevated markers before retroperitoneal lymphadenectomy have a high rate of relapse and should be considered for primary chemotherapy.