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Tankel J, Nevo Y, Al Shehhi R, Sakalla R, Dehghani M, Spicer J, Najmeh S, Mueller C, Ferri L, Cools-Lartigue J. Impact of bulky loco-regional lymphadenopathy in esophageal adenocarcinoma on survival: a retrospective single center analysis. Dis Esophagus 2024:doae046. [PMID: 38862393 DOI: 10.1093/dote/doae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 04/11/2024] [Indexed: 06/13/2024]
Abstract
The relationship between 'bulky' locoregional lymphadenopathy and survival has not been investigated in the setting of esophageal adenocarcinoma (EAC). This study aimed to explore whether bulky regional lymphadenopathy at diagnosis affected survival outcomes in patients with EAC treated with neoadjuvant chemotherapy and en bloc resection. A single-center retrospective review of a prospectively maintained upper GI cancer surgical database was performed between January 2012 and December 2019. Patients with locally advanced EAC (cT2-3, N+, M0) treated with neoadjuvant docetaxel-based chemotherapy and transthoracic en bloc esophagogastrectomy were identified. Computed tomography scans from before the initiation of treatment were reviewed, and patients were stratified according to whether bulky loco-regional lymph nodes were present. This was defined as lymphadenopathy >2 cm in any axis. Overall survival was compared, and a Cox multivariate regression model was calculated. Two hundred twenty-five of the eight hundred seventy patients identified met the inclusion criteria. Forty-eight (21%) had bulky lymphadenopathy, leaving 177 allocated to the control group. More patients with bulky lymphadenopathy had ypN3 disease (18/48, 38% vs. 39/177, 20%, P = 0.025). Among patients with bulky lymphadenopathy, overall survival was generally worse (32.6 vs. 59.1 months, P = 0.012). However, among the 9/48 (19%) patients with bulky lymphadenopathy who achieved ypN- status survival outcomes were similar to those with non-bulky lymphadenopathy who also achieved lymph node sterilization. Poor differentiation (HR 1.8, 95% CI 1.0-2.9, P = 0.034), ypN+ (HR 1.9, 95% CI 1.1-3.6, P = 0.032), and bulky lymphadenopathy were independently associated with an increased risk of death (HR 1.7, 1.0-2.9, P = 0.048). Bulky regional lymphadenopathy is associated with a poor prognosis. Efforts to identify the ideal treatment regimen for these patients are urgently required.
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Affiliation(s)
- James Tankel
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Canada
| | - Yehonathan Nevo
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Canada
| | - Ruqaiya Al Shehhi
- Department of Radiology, Montreal General Hospital, McGill University Health Center, Montreal, Canada
| | - Rawan Sakalla
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Canada
| | - Mehrnoush Dehghani
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Canada
| | - Jonathan Spicer
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Canada
| | - Sara Najmeh
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Canada
| | - Carmen Mueller
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Canada
| | - Lorenzo Ferri
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Canada
| | - Jonathan Cools-Lartigue
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Canada
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Sugimura K, Miyata H, Kanemura T, Takeoka T, Sugase T, Yamamoto M, Shinnno N, Hara H, Omori T, Motoori M, Ohue M, Yano M. Clinical Impact of Metastatic Lymph Node Size on Therapeutic Effect and Prognosis in Patients with Esophageal Squamous Cell Carcinoma Who Underwent Preoperative Chemotherapy Followed by Esophagectomy. Ann Surg Oncol 2023; 30:4193-4202. [PMID: 37010661 DOI: 10.1245/s10434-023-13393-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/10/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Pretreatment metastatic lymph node (LN) size has been reported to be associated with prognosis in esophageal squamous cell carcinoma (ESCC). However, its relationship with response to preoperative chemotherapy or prognosis has not been clarified. We investigated the relationship between metastatic LN size and response to preoperative treatment, and prognosis in patients with metastatic esophageal cancer who underwent surgery. PATIENTS AND METHODS A total of 212 clinically node-positive patients who underwent preoperative chemotherapy followed by esophagectomy for ESCC were enrolled. Patients were stratified into three groups on the basis of the length of the short axis of the largest LN in pretreatment computed tomography images: < 10 mm (group A), 10-19 mm (group B), and ≥ 20 mm (group C). RESULTS Group A had 90 patients (42%), group B had 103 patients (49%), and group C had 19 patients (9%). Group C had significantly lower percent reduction in total metastatic LN size than groups A and B (22.5% versus 35.7%, P = 0.037). Group C had significantly more metastatic LNs based on histological examination than groups A and B (10.1 versus 2.4, P < 0.001). Group C patients whose LNs responded had significantly fewer metastatic LNs than nonresponders (5.1 versus 11.9, P = 0.042). Group C had significantly poorer overall survival than groups A and B (3-year survival, 25.4% versus 67.3%, P < 0.001). However, group C patients whose LNs responded had better survival than nonresponders (3-year survival, 57.1% versus 0%, P = 0.008). CONCLUSIONS Patients with large metastatic LNs have poor response and poor prognosis. However, if a response is obtained, long-term survival can be expected.
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Affiliation(s)
- Keijiro Sugimura
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan.
- Department of Surgery, Kansai Rosai Hospital, Amagasaki City, Hyogo, Japan.
| | - Hiroshi Miyata
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Kanemura
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Tomohira Takeoka
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Takahito Sugase
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Masaaki Yamamoto
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Naoki Shinnno
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hisashi Hara
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Takeshi Omori
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Masaaki Motoori
- Department of Surgery, Osaka General Medical Center, Osaka, Japan
| | - Masayuki Ohue
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Masahiko Yano
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
- Department of Surgery, Osaka Suita Municipal Hospital, Suita City, Osaka, Japan
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Kloft M, Ruisch JE, Raghuram G, Emmerson J, Nankivell M, Cunningham D, Allum WH, Langley RE, Grabsch HI. Prognostic Significance of Negative Lymph Node Long Axis in Esophageal Cancer: Results From the Randomized Controlled UK MRC OE02 Trial. Ann Surg 2023; 277:e320-e331. [PMID: 34520429 PMCID: PMC9831043 DOI: 10.1097/sla.0000000000005214] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To analyze the relationship between negative lymph node (LNneg) size as a possible surrogate marker of the host antitumor immune response and overall survival (OS) in esophageal cancer (EC) patients. BACKGROUND Lymph node (LN) status is a well-established prognostic factor in EC patients. An increased number of LNnegs is related to better survival in EC. Follicular hyperplasia in LNneg is associated with better survival in cancer-bearing mice and might explain increased LN size. METHODS The long axis of 304 LNnegs was measured in hematoxylin-eosin stained sections from resection specimens of 367 OE02 trial patients (188 treated with surgery alone (S), 179 with neoadjuvant chemotherapy plus surgery (C+S)) as a surrogate of LN size. The relationship between LNneg size, LNneg microarchitecture, clinicopathological variables, and OS was analyzed. RESULTS Large LNneg size was related to lower pN category ( P = 0.01) and lower frequency of lymphatic invasion ( P = 0.02) in S patients only. Irrespective of treatment, (y)pN0 patients with large LNneg had the best OS. (y)pN1 patients had the poorest OS irrespective of LNneg size ( P < 0.001). Large LNneg contained less lymphocytes ( P = 0.02) and had a higher germinal centers/lymphocyte ratio ( P = 0.05). CONCLUSIONS This is the first study to investigate LNneg size in EC patients randomized to neoadjuvant chemotherapy followed by surgery or surgery alone. Our pilot study suggests that LNneg size is a surrogate marker of the host antitumor immune response and a potentially clinically useful new prognostic biomarker for (y)pN0 EC patients. Future studies need to confirm our results and explore underlying biological mechanisms.
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Affiliation(s)
- Maximilian Kloft
- Department of Pathology, GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Jessica E Ruisch
- Department of Pathology, GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Gayatri Raghuram
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
- Department of Pathology, Nottingham University Hospitals, Nottingham, UK
| | - Jake Emmerson
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Matthew Nankivell
- MRC Clinical Trials Unit at UCL, University College London, London, UK
| | - David Cunningham
- Gastrointestinal and Lymphoma Unit, Royal Marsden Hospital, London, UK; and
| | | | - Ruth E Langley
- MRC Clinical Trials Unit at UCL, University College London, London, UK
| | - Heike I Grabsch
- Department of Pathology, GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, Netherlands
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
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Omeroglu S, Gulmez S, Yazici P, Demir U, Guven O, Capkinoglu E, Uzun O, Senger AS, Polat E, Duman M. Clinical significance of the largest histopathological metastatic lymph node size for postoperative course of patients undergoing surgery for gastric cancer. Front Surg 2023; 10:1105189. [PMID: 36874461 PMCID: PMC9982115 DOI: 10.3389/fsurg.2023.1105189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023] Open
Abstract
Aim The aim of this study was to investigate the effect of the largest metastatic lymph node (MLN) size on postoperative outcomes of patients with stage II-III gastric cancer (GC). Methods A total of 163 patients with stage II/III GC who underwent curative surgery were included in this single-center retrospective study. The lymph nodes were counted, each lymph node was analyzed for metastatic involvement by histopathological examination, and the diameter of the largest metastatic lymph node was recorded. The severity of postoperative complications was assessed by Clavien-Dindo classification system. Two groups of 163 patients were defined according to ROC analysis with cut-off value of histopathologically maximum MLN diameter. A comparative analysis of demographic and clinicopathological characteristics of the patients and their postoperative outcomes were performed. Results The median hospital stay was significantly longer in patients with major complications compared to patients without major complications [18 days (IQR: 13-24) vs. 8 days (IQR: 7-11); (p < 0.001)]. The median MLN size was significantly larger in deceased patients compared to survived [1.3 cm (IQR: 0.8-1.6) vs. 0.9 cm (IQR: 0.6-1.2), respectively; (p < 0.001)]. The cut-off value of MLN size predicting mortality was found as 1.05 cm. MLN size ≥1.05 cm had nearly 3.5 times more negative impact on survival. Conclusions The largest metastatic lymph node size had a significant association with survival outcomes. Particularly, MLN size over 1.05 cm was associated with worse survival outcomes. However, the largest MLN was not shown to have any effect on major complications. Further prospective and large-scale studies are required to draw more precise conclusions.
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Affiliation(s)
- Sinan Omeroglu
- Department of General Surgery, University of Health Sciences Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Türkiye
| | - Selcuk Gulmez
- Department of Gastrointestinal Surgery, University of Health Sciences Kosuyolu High Specialization Education and Research Hospital, Istanbul, Türkiye
| | - Pinar Yazici
- Department of General Surgery, University of Health Sciences Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Türkiye
| | - Uygar Demir
- Department of General Surgery, University of Health Sciences Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Türkiye
| | - Onur Guven
- Department of General Surgery, University of Health Sciences Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Türkiye
| | - Emir Capkinoglu
- Department of General Surgery, University of Health Sciences Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Türkiye
| | - Orhan Uzun
- Department of Gastrointestinal Surgery, University of Health Sciences Kosuyolu High Specialization Education and Research Hospital, Istanbul, Türkiye
| | - Aziz Serkan Senger
- Department of Gastrointestinal Surgery, University of Health Sciences Kosuyolu High Specialization Education and Research Hospital, Istanbul, Türkiye
| | - Erdal Polat
- Department of Gastrointestinal Surgery, University of Health Sciences Kosuyolu High Specialization Education and Research Hospital, Istanbul, Türkiye
| | - Mustafa Duman
- Department of Gastrointestinal Surgery, University of Health Sciences Kosuyolu High Specialization Education and Research Hospital, Istanbul, Türkiye
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Omeroglu S, Gulmez S, Uzun O, Senger AS, Bostanci O, Guven O, Polat E, Duman M. Clinical significance of the histopathological metastatic largest lymph node size in colorectal cancer patients. Front Oncol 2023; 13:1120753. [PMID: 36950545 PMCID: PMC10027072 DOI: 10.3389/fonc.2023.1120753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/09/2023] [Indexed: 03/08/2023] Open
Abstract
Background The metastatic lymph nodes (MLN) are interpreted to be correlated with prognosis of the colorectal cancers (CRC). The present retrospective study aimed to investigate the clinical significance of the largest MLN size in terms of postoperative outcomes and its predictive value in the prognosis of the patients with stage III CRC. Methods Between May 2013 and December 2018, a total of 101 patients who underwent curative resection for stage III CRC retrospectively reviewed. All patients were divided into two groups regarding cut-off value (<1.05 cm and ≥1.05 cm) of maximum MLN diameter measured histopathologically. A comparative analysis of demographic and clinicopathological characteristics of the patients and their postoperative outcomes were performed. Results Two groups carried similar demographic data and preoperative laboratory variables except the lymphocyte count, hematocrit (HCT) ratio, hemoglobin level and mean corpuscular volume (MCV) value (p<0.05). The patients with MLN diameter ≥1.05 cm (n=46) needed more erythrocyte suspension and were hospitalized longer than the patients with a diameter <1.05 cm (n=55) (p=0.006 and 0.0294, respectively). Patients with MLN diameter < 1.05 cm had a significantly longer overall survival than patients with MLN diameter ≥ 1.05 cm (75,29 vs. 52,57 months, respectively). Regarding the histopathologic features, the patients with MLN diameter ≥1.05 cm had larger tumor size and higher number of MLN than those with diameter <1.05 cm (p=0.049 and 0.001). Conclusion The size of MLN larger than 1.05 cm may be predictive for a poor prognosis and lower survival of stage III CRC patients. The largest MLN size may be a proper alternative factor to the number of MLNs in predicting prognosis or in staging CRC patients.
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Affiliation(s)
- Sinan Omeroglu
- Department of General Surgery, University of Health Sciences Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Türkiye
- *Correspondence: Sinan Omeroglu,
| | - Selcuk Gulmez
- Department of Gastrointestinal Surgery, University of Health Sciences Kosuyolu High Specialization Education and Research Hospital, Istanbul, Türkiye
| | - Orhan Uzun
- Department of Gastrointestinal Surgery, University of Health Sciences Kosuyolu High Specialization Education and Research Hospital, Istanbul, Türkiye
| | - Aziz Serkan Senger
- Department of Gastrointestinal Surgery, University of Health Sciences Kosuyolu High Specialization Education and Research Hospital, Istanbul, Türkiye
| | - Ozgur Bostanci
- Department of General Surgery, University of Health Sciences Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Türkiye
| | - Onur Guven
- Department of General Surgery, University of Health Sciences Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Türkiye
| | - Erdal Polat
- Department of Gastrointestinal Surgery, University of Health Sciences Kosuyolu High Specialization Education and Research Hospital, Istanbul, Türkiye
| | - Mustafa Duman
- Department of Gastrointestinal Surgery, University of Health Sciences Kosuyolu High Specialization Education and Research Hospital, Istanbul, Türkiye
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Maeda C, Yamaoka Y, Shiomi A, Kagawa H, Hino H, Manabe S, Kato S, Hanaoka M, Notsu A. The Impact of Metastatic Lymph Node Size on Long-term Outcomes for pStage III Colon Cancer. CANCER DIAGNOSIS & PROGNOSIS 2022; 2:31-37. [PMID: 35400003 PMCID: PMC8962840 DOI: 10.21873/cdp.10073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/18/2021] [Indexed: 06/14/2023]
Abstract
AIM To clarify the impact of metastatic lymph node size on long-term outcomes in patients undergoing curative colectomy for pathological stage III colon cancer. PATIENTS AND METHODS This study enrolled patients who underwent curative colectomy for pStage III colon cancer between January 2013 and December 2015. All patients were divided into four groups based on the short-axis diameter of the largest MLN: Group A, <5 mm; Group B, ≥5 mm and <10 mm; Group C, ≥10 mm and <15 mm; Group D, ≥15 mm. RESULTS A total of 209 patients were analyzed. The 5-year recurrence-free survival rates of Groups A, B, C, and D were 82.3%, 74.6%, 74.5% and 60.7%, respectively. In multivariate analysis, Group D (hazard ratio=3.95; 95% confidence interval, 1.34-11.65; p=0.01) was independently associated with worse RFS. CONCLUSION Bulky MLNs might be a poor prognostic factor in node-positive colon cancer.
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Affiliation(s)
- Chikara Maeda
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Yusuke Yamaoka
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Akio Shiomi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Hiroyasu Kagawa
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Hitoshi Hino
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Shoichi Manabe
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Shunichiro Kato
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Marie Hanaoka
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Akifumi Notsu
- Division of Clinical Research Center, Shizuoka Cancer Center Hospital, Shizuoka, Japan
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Li Y, Du Q, Wei X, Guo Z, Lei T, Li Y, Han D, Wu X, Zhang K, Zhang T, Chen X, Dong J, Zhang B, Wei H, Zhang W, Pang Q, Wang P. A Clinical Scoring Model to Predict the Effect of Induction Chemotherapy With Definitive Concurrent Chemoradiotherapy on Esophageal Squamous Cell Carcinoma Prognosis. Front Oncol 2021; 11:703074. [PMID: 34912702 PMCID: PMC8666950 DOI: 10.3389/fonc.2021.703074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/10/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose The aim of the study was to compare the clinical outcomes of induction chemotherapy (IC) followed by definitive concurrent chemoradiotherapy (dCCRT) versus chemoradiotherapy alone in patients with esophageal squamous cell carcinoma (ESCC) on the basis of a clinical scoring model. Methods A retrospective review of 599 patients with ESCC treated with dCCRT at our institution from 2010 to 2019 was conducted. The patients were divided into two groups based on whether they received IC. A clinical scoring model was performed using the significant variables obtained from the multivariate analysis. The PFS and OS rates were estimated using the Kaplan–Meier method. Results During the study period, 182 patients receiving IC followed by dCCRT and 417 dCCRT alone were identified. No significant differences in the PFS and OS rates were observed between the IC group (P=0.532) and the non-IC group (P=0.078). A clinical scoring model was constructed based on independent prognostic factors with scores ranging from 0 to 10.4. The patients were divided into high- and low-risk groups by using the median score as the cutoff value. The PFS rate of patients receiving IC was higher than that of patients treated without IC (P=0.034), while there was no improvement in the OS rate (P=0.794) in the high-risk group. No significant differences in the PFS (P=0.207) or OS (P=0.997) rate were found between the two treatment groups in the low-risk group. Conclusions The addition of IC followed by dCCRT for patients with ESCC might be associated with better PFS rates based on a clinical scoring model but has no impact on OS rates. Further prospective studies are warranted for the validation of this model.
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Affiliation(s)
- Yang Li
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Qingwu Du
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Xiaoying Wei
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Zhoubo Guo
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Tongda Lei
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yanqi Li
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Dong Han
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Xiaoyue Wu
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Kunning Zhang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Tian Zhang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Xi Chen
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Jie Dong
- Department of Nutrition Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Baozhong Zhang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Hui Wei
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Wencheng Zhang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Qingsong Pang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Ping Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
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Kamarajah SK, Marson EJ, Zhou D, Wyn-Griffiths F, Lin A, Evans RPT, Bundred JR, Singh P, Griffiths EA. Meta-analysis of prognostic factors of overall survival in patients undergoing oesophagectomy for oesophageal cancer. Dis Esophagus 2020; 33:5843554. [PMID: 32448903 DOI: 10.1093/dote/doaa038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 03/25/2020] [Accepted: 04/17/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Currently, the American Joint Commission on Cancer (AJCC) staging system is used for prognostication for oesophageal cancer. However, several prognostically important factors have been reported but not incorporated. This meta-analysis aimed to characterize the impact of preoperative, operative, and oncological factors on the prognosis of patients undergoing curative resection for oesophageal cancer. METHODS This systematic review was performed according to PRISMA guidelines and eligible studies were identified through a search of PubMed, Scopus, and Cochrane CENTRAL databases up to 31 December 2018. A meta-analysis was conducted with the use of random-effects modeling to determine pooled univariable hazard ratios (HRs). The study was prospectively registered with the PROSPERO database (Registration: CRD42018157966). RESULTS One-hundred and seventy-one articles including 73,629 patients were assessed quantitatively. Of the 122 factors associated with survival, 39 were significant on pooled analysis. Of these. the strongly associated prognostic factors were 'pathological' T stage (HR: 2.07, CI95%: 1.77-2.43, P < 0.001), 'pathological' N stage (HR: 2.24, CI95%: 1.95-2.59, P < 0.001), perineural invasion (HR: 1.54, CI95%: 1.36-1.74, P < 0.001), circumferential resection margin (HR: 2.17, CI95%: 1.82-2.59, P < 0.001), poor tumor grade (HR: 1.53, CI95%: 1.34-1.74, P < 0.001), and high neutrophil:lymphocyte ratio (HR: 1.47, CI95%: 1.30-1.66, P < 0.001). CONCLUSION Several tumor biological variables not included in the AJCC 8th edition classification can impact on overall survival. Incorporation and validation of these factors into prognostic models and next edition of the AJCC system will enable personalized approach to prognostication and treatment.
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Affiliation(s)
- Sivesh K Kamarajah
- Northern Oesophagogastric Cancer Unit, Newcastle University NHS Foundation Trust Hospitals, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, University of Newcastle, Newcastle upon Tyne, UK
| | - Ella J Marson
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Dengyi Zhou
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Aaron Lin
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Richard P T Evans
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - James R Bundred
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Pritam Singh
- Department of Upper Gastrointestinal Surgery, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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9
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Hansen T, Nilsson M, Lindholm D, Sundström J, Hedberg J. Normal radiological lymph node appearance in the thorax. Dis Esophagus 2019; 32:1-6. [PMID: 30561570 DOI: 10.1093/dote/doy120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 10/18/2018] [Indexed: 12/11/2022]
Abstract
Modern treatment of esophageal cancer is multimodal and highly dependent on a detailed diagnostic assessment of clinical stage, which includes nodal stage. Clinical appraisal of nodal stage is highly dependent on knowledge of normal radiological appearance, information of which is scarce. We aimed to describe lymph node appearance on computed tomography (CT) investigations in a randomly selected cohort of healthy subjects. In a sample of the Swedish Cardiopulmonary bioimage study, which investigates a sample of the Swedish population aged 50-64 years, the CT scans of 426 subjects were studied in detail concerning intrathoracic node stations relevant in clinical staging of esophageal cancer. With stratification for sex, the short axis of visible lymph nodes was measured and the distribution of lymph node sizes was calculated as well as proportion of patients with visible nodes above 5 and 10 millimeters for each station. Probability of having any lymph node station above 5 and 10 millimeters was calculated with a logistic regression model adjusted for age and sex. In the 214 men (aged: 57.3 ± 4.1 years) and 212 women (aged: 57.8 ± 4.4 years) included in this study, a total of 309 (72.5%) had a lymph node with a short axis of 5 mm or above was seen in at least one of the node stations investigated. When using 10 mm as a cutoff, nodes were visible in 29 (6.81%) of the subjects. Men had higher odds of having any lymph node with short axis 5 mm or above (OR 3.03 95% CI 1.89-4.85, P < 0.001) as well as 10 mm or above (OR 2.31 95% CI 1.02-5.23, P = 0.044) compared to women. Higher age was not associated with propensity for lymph nodes above 5 or 10 millimeters in this sample. We conclude that, in a randomly selected cohort of patients between 50 and 64 years, almost 10% of the men and 4% of the women had lymph nodes above 10 millimeters, most frequently in the subcarinal station (station 107). More than half of the patients had nodes above 5 millimeters on CT and men were much more prone to have this finding. The probability of finding lymph nodes in specific stations relevant of esophageal cancer is now described.
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Affiliation(s)
| | - M Nilsson
- Department of Medical Sciences, and Uppsala University, Uppsala
| | - D Lindholm
- Division of Surgery, CLINTEC, Karolinska Institutet and Department of Upper Abdominal Surgery, Division of Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - J Sundström
- Division of Surgery, CLINTEC, Karolinska Institutet and Department of Upper Abdominal Surgery, Division of Cancer, Karolinska University Hospital, Stockholm, Sweden
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10
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Preoperative lymph node status on computed tomography influences the survival of pT1b, T2 and T3 esophageal squamous cell carcinoma. Surg Today 2018; 49:378-386. [PMID: 30467719 DOI: 10.1007/s00595-018-1741-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 11/11/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE The preoperative lymph node status is critical for tailoring optimal treatments for esophageal squamous cell carcinoma (ESCC). This study aimed to evaluate the prognostic impact of a diagnostic criterion based solely on the short-axis diameters of lymph nodes depicted on computed tomography (CT) in ESCC patients undergoing upfront esophagectomy. METHODS We retrospectively reviewed 246 pT1b-T3 ESCC patients undergoing upfront esophagectomy. Clinically positive lymph node metastasis (cN+) was defined as nodes with a short-axis diameter of at least 8 mm on CT. RESULTS Ninety-three patients had a cN+ status according to this criterion. The overall and recurrence-free survival rates were significantly lower in the cN+ group than in the cN- group (P < 0.001). The overall survival rate was markedly lower in the "pN2/3 and cN+" group than in the other groups (vs. pN0: P < 0.001, vs. pN1: P = 0.002, vs. "pN2/3 and cN-": P < 0.001). However, the overall survival rate of the "pN2/3 and cN-" group was similar to that of the pN0-1 groups. A multivariate analysis showed that cN+ (P = 0.002), major complications (P = 0.001), and pT3 (P = 0.021) were independently associated with a poor prognosis. CONCLUSION A diagnostic criterion based solely on the short-axis diameters of lymph nodes depicted on CT was useful for stratifying the survival in ESCC patients.
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11
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Goense L, Ruurda JP, Carter BW, Fang P, Ho L, Meijer GJ, van Hillegersberg R, Hofstetter WL, Lin SH. Prediction and diagnosis of interval metastasis after neoadjuvant chemoradiotherapy for oesophageal cancer using 18F-FDG PET/CT. Eur J Nucl Med Mol Imaging 2018; 45:1742-1751. [PMID: 29663014 PMCID: PMC6097755 DOI: 10.1007/s00259-018-4011-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/06/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE During neoadjuvant chemoradiotherapy for oesophageal cancer, or in the interval prior to surgery, some patients develop systemic metastasis. This study aimed to evaluate the diagnostic performance of 18F-FDG PET/CT for the detection of interval metastasis and to identify predictors of interval metastases in a large cohort of oesophageal cancer patients. METHODS In total, 783 consecutive patients with potentially resectable oesophageal cancer who underwent chemoradiotherapy and pre- and post-treatment 18F-FDG PET/CT between 2006 and 2015 were analyzed from a prospectively maintained database. Diagnostic accuracy measures were calculated on a per-patient basis using histological verification or clinical follow-up as a reference standard. Multivariable logistic regression analysis was performed to determine pre-treatment predictors of interval metastasis. A prediction score was developed to predict the probability of interval metastasis. RESULTS Of 783 patients that underwent 18F-FDG PET/CT restaging, 65 (8.3%) were found to have interval metastasis and 44 (5.6%) were deemed to have false positive lesions. The resulting sensitivity and specificity was 74.7% (95% CI: 64.3-83.4%) and 93.7% (95% CI: 91.6-95.4%), respectively. Multivariable analysis revealed that tumor length, cN status, squamous cell tumor histology, and baseline SUVmax were associated with interval metastasis. Based on these criteria, a prediction score was developed with an optimism adjusted C-index of 0.67 that demonstrated accurate calibration. CONCLUSIONS 18F-FDG PET/CT restaging detects distant interval metastases in 8.3% of patients after chemoradiotherapy for oesophageal cancer. The provided prediction score may stratify risk of developing interval metastasis, and could be used to prioritize additional restaging modalities for patients most likely to benefit.
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Affiliation(s)
- Lucas Goense
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA. .,Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. .,Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Brett W Carter
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Penny Fang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Linus Ho
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Gert J Meijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | | | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Steven H Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
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12
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Yano M, Miyata H, Sugimura K, Motoori M, Omori T, Fujiwara Y, Miyoshi N, Yasui M, Ohue M, Akita H, Tomokuni A, Takahashi H, Kobayashi S, Sakon M. 18F-fluorodeoxyglucose positron emission tomography/computed tomography for the prediction of survival in patients with advanced esophageal cancer who have undergone neoadjuvant chemotherapy. Mol Clin Oncol 2018; 8:434-440. [PMID: 29456850 DOI: 10.3892/mco.2018.1546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 12/29/2017] [Indexed: 11/06/2022] Open
Abstract
Neoadjuvant chemotherapy (NAC) is a promising treatment strategy for advanced esophageal cancer. However, measures of NAC response assessment and prognostic prediction have not yet been established. The aim of this study was to evaluate the usefulness of combined 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT). A total of 77 patients with stage IB-IV esophageal cancer who were treated with NAC followed by curative resection were retrospectively analyzed. PET/CT was performed before and after NAC and 56 patients were clinical responders. The pretreatment maximal standardized uptake value (pre-SUVmax), post-SUVmax and %SUVmax were 11.3±5.8, 5.1±4.8 and 49.0±35.1%, respectively, for the main tumors (T) and 4.3±2.8, 2.5±1.9 and 67.0±39.6%, respectively, for the metastatic nodes (N). Among the preoperatively available factors, clinical response (P=0.018), post-SUVmax-N (P=0.0001) and %SUVmax-T (P=0.0031) were significant prognostic factors by univariate analysis. The multivariate analysis identified post-SUVmax-N as the only significant prognostic predictor (P=0.0254). Patients with a post-SUVmax-N of <3.0 exhibited significantly fewer pathological metastatic nodes and better disease-free survival compared with patients with a post-SUVmax-N >3.0. Therefore, post-SUVmax-N may be a useful prognostic predictor in patients with advanced esophageal cancer who are treated with NAC followed by surgery.
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Affiliation(s)
- Masahiko Yano
- Department of Gastroenterological Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Osaka 537-8511, Japan
| | - Hiroshi Miyata
- Department of Gastroenterological Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Osaka 537-8511, Japan
| | - Keijiro Sugimura
- Department of Gastroenterological Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Osaka 537-8511, Japan
| | - Masaaki Motoori
- Department of Gastroenterological Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Osaka 537-8511, Japan
| | - Takeshi Omori
- Department of Gastroenterological Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Osaka 537-8511, Japan
| | - Yoshiyuki Fujiwara
- Department of Gastroenterological Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Osaka 537-8511, Japan
| | - Norikatsu Miyoshi
- Department of Gastroenterological Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Osaka 537-8511, Japan
| | - Masayoshi Yasui
- Department of Gastroenterological Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Osaka 537-8511, Japan
| | - Masayuki Ohue
- Department of Gastroenterological Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Osaka 537-8511, Japan
| | - Hirofumi Akita
- Department of Gastroenterological Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Osaka 537-8511, Japan
| | - Akira Tomokuni
- Department of Gastroenterological Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Osaka 537-8511, Japan
| | - Hidenori Takahashi
- Department of Gastroenterological Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Osaka 537-8511, Japan
| | - Shogo Kobayashi
- Department of Gastroenterological Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Osaka 537-8511, Japan
| | - Masato Sakon
- Department of Gastroenterological Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Osaka 537-8511, Japan
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13
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Tsuchihashi K, Yoshihiro T, Aikawa T, Nio K, Takayoshi K, Yokoyama T, Fukata M, Arita S, Ariyama H, Shimizu Y, Yoshida Y, Torisu T, Esaki M, Odashiro K, Kusaba H, Akashi K, Baba E. Metastatic esophageal cancer presenting as shock by injury of vagus nerve mimicking baroreceptor reflex: A case report. Medicine (Baltimore) 2017; 96:e8987. [PMID: 29245271 PMCID: PMC5728886 DOI: 10.1097/md.0000000000008987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Neurogenic shock is generally typified by spinal injury due to bone metastases in cancer patients, but continuous disturbance of the vagus nerve controlling the aortic arch baroreceptor can cause shock by a reflex response through the medulla oblongata. PATIENT CONCERNS A 43-year-old woman with dysphagia presented to our hospital. Computed tomography showed a primary tumor adjacent to and surrounding half the circumference of the descending aorta, and multiple cervical lymph node metastases, including a 55 × 35-mm lymph node overlapping the root of the left vagus nerve. Squamous esophageal cancer (T4bN3M1, stage IV) was diagnosed. Whereas shock status initially appeared soon after left cervical pain, suggesting pain-induced neutrally-mediated syncope, sustained bradycardia and hypotension occurred even after alleviation of pain by opioids. DIAGNOSIS Disturbance of the left vagus nerve associated with the aortic arch baroreceptor by a large left cervical lymph node metastasis was considered as the cause of shock, pathologically mimicking the baroreceptor reflex. INTERVENTIONS Systemic steroid administration was performed, and radiotherapy for both the primary site and lymph node metastasis was started 2 days after initiating steroid treatment. OUTCOMES Four days after initiating steroid administration, hypotension and bradycardia were improved and stable. LESSONS Disturbance of the vagus nerve controlling the aortic arch baroreceptor should be kept in mind as a potential cause of neurogenic shock in cancer patients, through a pathological reflex mimicking the baroreceptor reflex.
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Affiliation(s)
- Kenji Tsuchihashi
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences
| | - Tomoyasu Yoshihiro
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences
| | - Tomomi Aikawa
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences
| | - Kenta Nio
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences
| | - Kotoe Takayoshi
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences
| | - Taku Yokoyama
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences
| | - Mitsuhiro Fukata
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences
| | - Shuji Arita
- Department of Comprehensive Clinical Oncology, Faculty of Medical Sciences
| | - Hiroshi Ariyama
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences
| | | | - Yuichiro Yoshida
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takehiro Torisu
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Motohiro Esaki
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keita Odashiro
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences
| | - Hitoshi Kusaba
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences
| | - Koichi Akashi
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences
| | - Eishi Baba
- Department of Comprehensive Clinical Oncology, Faculty of Medical Sciences
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14
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Mine S, Watanabe M, Imamura Y, Okamura A, Kurogochi T, Sano T. Clinical Significance of the Pre-therapeutic Nodal Size in Patients Undergoing Neo-Adjuvant Treatment Followed by Esophagectomy for Esophageal Squamous Cell Carcinoma. World J Surg 2017; 41:184-190. [PMID: 27468743 DOI: 10.1007/s00268-016-3675-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The clinical significance of pre-therapeutic nodal size in patients with esophageal squamous cell carcinoma (ESCC) is not clear. We investigated whether nodal size was correlated with survival in patients undergoing neo-adjuvant treatment followed by esophagectomy for ESCC. METHODS In 2009-2013, 222 patients who underwent neo-adjuvant treatment followed by esophagectomy for ESCC were enrolled in this retrospective study. Nodal size was measured along the short axis of the largest node using pre-therapeutic CT images. Patients were then stratified based on this short axis, and nodal size was correlated with clinicopathological factors and survival. RESULTS Patients with larger nodes were likely to have deeper cT, higher cN status, and poorer survival. Among the clinical factors cT, cN, cM, and nodal size, only cT and nodal size were independent prognostic factors in multivariate analysis [hazard ratio (HR) 2.0, 95 % confidence interval (CI) 1.1-3.5, p = 0.025 and HR 1.5, 95 % CI 1-2.3, p = 0.036, respectively]. In addition, nodal size was significantly associated with hematological recurrence (p = 0.007), but not lymphatic relapse (p = 0.272). CONCLUSIONS The short axis of the largest node before neo-adjuvant treatment in patients with ESCC is a prognostic factor.
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Affiliation(s)
- Shinji Mine
- Department of Gastroenterological Surgery, Cancer Institute Hospital, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan. .,Department of Esophageal and Gastroenterological Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Masayuki Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Hospital, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yu Imamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Akihiko Okamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Takanori Kurogochi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Takeshi Sano
- Department of Gastroenterological Surgery, Cancer Institute Hospital, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
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15
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Chi YK, Chen Y, Li XT, Sun YS. Prognostic significance of the size and number of lymph nodes on pre and post neoadjuvant chemotherapy CT in patients with pN0 esophageal squamous cell carcinoma: a 5-year follow-up study. Oncotarget 2017; 8:61662-61673. [PMID: 28977894 PMCID: PMC5617454 DOI: 10.18632/oncotarget.18665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 04/28/2017] [Indexed: 01/24/2023] Open
Abstract
The prognosis of patients with esophageal cancer improves by using neoadjuvant chemotherapy (NAC). More patients obtain pathological N0 staging (pN0) after surgery. The heterogeneity of prognosis of these patients poses a great challenge of customizing therapeutic strategies for individual patients. The signs of lymph nodes on both pre and post NAC computer tomography (CT) scan can provide more information for evaluation. Therefore, we investigated a new approach to lymph node (LN)-survival analysis by using pre-/post-NAC CT in pN0 esophageal cancer. 79 patients undergone curative resection after NAC obtained pN0 staging. The long and short axis diameter of maximal lymph node (MaxLN) and LN number on pre-/post-NAC CT scans were recorded and assessed for predicting survival by univariate and multivariate survival analysis. The prognosis of patients with esophageal cancer was correlated with the LN size and number on pre-/post-NAC CT. The LN number on pre-NAC CT and short-axis diameter of MaxLN on post-NAC CT remained the independent predictor of overall survival. By using these two factors as classification criterion, N0b group included patients with LN number>4 on pre-NAC CT or short-axis diameter of MaxLN >7 mm on post-NAC CT and the rest patients were included in N0a group. N0a group had a significantly better overall survival than N0b group (5-year survival rate: 75.2% vs. 32.6%). The size and number of lymph node on pre-/post-NAC CT were reliable and important prognostic factors in patients with pN0 esophageal cancer. This new criterion could distinguish these patients into N0a and N0b, according to different prognosis.
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Affiliation(s)
- Yong-Kun Chi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Ying Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Xiao-Ting Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Ying-Shi Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
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16
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A Prognostic Scoring Model for the Utility of Induction Chemotherapy Prior to Neoadjuvant Chemoradiotherapy in Esophageal Cancer. J Thorac Oncol 2017; 12:1001-1010. [PMID: 28351804 DOI: 10.1016/j.jtho.2017.03.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/14/2017] [Accepted: 03/19/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The aim of this study was to identify patients with esophageal cancer who may benefit from induction chemotherapy (IC) before neoadjuvant chemoradiotherapy (nCRT) on the basis of a prognostic scoring model. METHODS Between 1998 and 2015, 535 patients with esophageal cancer who underwent nCRT were included for analysis, including 218 patients who received IC before nCRT (IC group) and 317 patients who did not receive IC (non-IC group). A prognostic scoring model was developed to predict disease-free survival (DFS) on the basis of a Cox proportional hazards model. RESULTS The median follow-up time was 63.5 months (range 8.0-178.5) for survivors. The 5-year DFS rates were similar between the IC and non-IC groups (53.7% vs. 45.1%, p = 0.196). Multivariate analysis determined that histologic grade, tumor location, baseline positron emission tomography maximum standard uptake value, and lymph node size were independent prognostic factors for DFS. A prognostic scoring system was constructed by using these four factors, with the total score ranging from 0 to 6.2. When the median value was used as a cutoff, low-risk (≤3.5) and high-risk (>3.5) groups were identified. In the high-risk group, patients who received IC had a nonsignificantly higher pathologic complete response rate (p = 0.272) and a significantly better DFS (p = 0.03) than patients who did not receive IC. After propensity score matching, the high-risk group demonstrated a significantly improved DFS with IC, a benefit that was not observed in the low-risk group. CONCLUSIONS On the basis of the prognostic scoring model, the addition of IC to nCRT may provide a DFS benefit in high-risk patients with a risk score higher than 3.5. Prospective validation is warranted.
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17
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Thoracic lymph node delineation at dose-reduced (1 mSv) dose-modulated contrast enhanced MDCT: a retrospective pilot study. Radiol Med 2016; 121:644-51. [DOI: 10.1007/s11547-016-0645-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/18/2016] [Indexed: 11/27/2022]
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18
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Role of neoadjuvant treatment in clinical T2N0M0 oesophageal cancer: results from a retrospective multi-center European study. Eur J Cancer 2016; 56:59-68. [PMID: 26808298 DOI: 10.1016/j.ejca.2015.11.024] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 11/08/2015] [Accepted: 11/29/2015] [Indexed: 11/23/2022]
Abstract
AIMS The aims of this study were to compare short- and long-term outcomes for clinical T2N0 oesophageal cancer with analysis of (i) primary surgery (S) versus neoadjuvant therapy plus surgery (NS), (ii) squamous cell carcinoma and adenocarcinoma subsets; and (iii) neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy. METHODS Data were collected from 30 European centres from 2000 to 2010. Among 2944 included patients, 355 patients (12.1%) had cT2N0 disease; 285 (S) and 70 (NS), were compared in terms of short- and long-term outcomes. Propensity score matching analyses were used to compensate for differences in baseline characteristics. RESULTS No significant differences between the groups were shown in terms of in hospital morbidity and mortality. Nodal disease was observed in 50% of S-group at the time of surgery, with 20% pN2/N3. Utilisation of neoadjuvant therapy was associated with significant tumour downstaging as reflected by increases in pT0, pN0 and pTNM stage 0 disease, this effect was further enhanced with neoadjuvant chemoradiotherapy. After adjustment on propensity score and confounding factors, for all patients and subset analysis of squamous cell and adenocarcinoma, neoadjuvant therapy had no significant effect upon survival or recurrence (overall, loco-regional, distant or mixed) compared to surgery alone. There were no significant differences between neoadjuvant chemotherapy and chemoradiotherapy in short- or long-term outcomes. CONCLUSION The results of this study suggest that a surgery alone treatment approach should be recommended as the primary treatment approach for cT2N0 oesophageal cancer despite 50% of patients having nodal disease at the time of surgery.
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19
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TAKENO SHINSUKE, YAMASHITA SHINICHI, YAMAMOTO SATOSHI, TAKAHASHI YOSHIAKI, MOROGA TOSHIHIKO, KAWAHARA KATSUNOBU, SHIROSHITA TOYOO, YAMANA IPPEI, MAKI KENJI, YAMASHITA YUICHI. Number of metastasis-positive lymph node stations is a simple and reliable prognostic factor following surgery in patients with esophageal cancer. Exp Ther Med 2012; 4:1087-1091. [PMID: 23226779 PMCID: PMC3494111 DOI: 10.3892/etm.2012.705] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 07/27/2012] [Indexed: 12/31/2022] Open
Abstract
The aim of this study was to evaluate the utility of lymph node metastasis classification based on the number of positive stations in patients undergoing surgical management of esophageal cancer. Of 257 patients who underwent curative esophagectomy, 126 patients with lymph node involvement underwent assessment of nodal metastasis mode according to the 7th edition of the TNM classification (UICC), and the Japanese Guidelines for the Clinical and Pathological Studies on Carcinoma of the Esophagus. Lymph node metastasis mode was divided into single station (S) and multi-station (M) groups. The S group was subclassified into single-node-single-station (SS) or multi-node-single-station (MS), and the M group was subclassified into multi-station in pN1 (2 metastasis positive nodes; MM-pN1) or multi-station in pN2 or 3 (MM-pN2,3) by TNM classification, multi-station-single-area (MMS) or multi-station-multi-areas (MMM). The correlation between prognosis and lymph node metastasis mode was assessed. A total of 47 patients were classified as S (MS, n=11; SS, n=36), and 79 patients were classified as M (MM-pN1, n=12; MM-pN2,3, n=67; MMM, n=55; MMS, n=24). Prognosis was poorer among the M- than in the S-classified patients (p=0.0035), whereas prognosis was not significantly different between the subgroups. In conclusion, lymph node metastasis classification based on the number of metastasis-positive stations is a useful predictor of prognosis in patients undergoing surgical management of esophageal cancer. This system relies on a simple classification method that combines the Japanese classification based on lymphatic spread and the TNM classification based on the number of positive lymph nodes.
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Affiliation(s)
- SHINSUKE TAKENO
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka City, Fukuoka
- Department of Surgery II, Oita University Faculty of Medicine, Oita,
Japan
| | | | - SATOSHI YAMAMOTO
- Department of Surgery II, Oita University Faculty of Medicine, Oita,
Japan
| | - YOSHIAKI TAKAHASHI
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka City, Fukuoka
| | - TOSHIHIKO MOROGA
- Department of Surgery II, Oita University Faculty of Medicine, Oita,
Japan
| | - KATSUNOBU KAWAHARA
- Department of Surgery II, Oita University Faculty of Medicine, Oita,
Japan
| | - TOYOO SHIROSHITA
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka City, Fukuoka
| | - IPPEI YAMANA
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka City, Fukuoka
| | - KENJI MAKI
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka City, Fukuoka
| | - YUICHI YAMASHITA
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka City, Fukuoka
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Tokunaga M, Sugisawa N, Tanizawa Y, Bando E, Kawamura T, Terashima M. The impact of preoperative lymph node size on long-term outcome following curative gastrectomy for gastric cancer. Ann Surg Oncol 2012; 20:1598-603. [PMID: 23117474 DOI: 10.1245/s10434-012-2699-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Indexed: 01/11/2023]
Abstract
BACKGROUND Multidetector-row computed tomography (MDCT) is widely used to predict pathological nodal status. However, an appropriate nodal size cutoff value to predict pathological nodal status has not been determined, and the impact of preoperative lymph node size on long-term outcomes is unclear. METHODS This study included 137 gastric cancer patients with nodal involvement who underwent R0 gastrectomy between September 2002 and December 2006. Lymph nodes with a short-axis diameter of 10 mm or more as measured by MDCT were regarded as metastasized. An appropriate cutoff value with a high positive predictive value (PPV) and high specificity also was identified, and the subsequent clinicopathological characteristics and long-term outcomes were investigated. RESULTS A cutoff value of 15 mm was found to be appropriate for grouping patients into large (≥15 mm) and small (<15 mm) lymph node metastasis (LLNM and SLNM) groups, with a high PPV (98.6 %) and specificity (99.8 %). There were no differences in clinicopathological characteristics between the groups except for pathological nodal status. In the LLNM group, the 5-year survival rate was 55 %, which was significantly lower than in the SLNM group (73.2 %; P = 0.008). After stratification by tumor depth, the same trend was observed in patients with pT3 disease (46.8 % vs. 72.7 %; P = 0.015) and those with pT4 disease (14.3 % vs. 64.8 %; P = 0.035). CONCLUSIONS Gastric cancer patients with lymph nodes measuring 15 mm or more preoperatively have worse long-term outcomes. These patients would therefore be suitable candidates for future clinical trials investigating the efficacy of neoadjuvant chemotherapies.
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Affiliation(s)
- Masanori Tokunaga
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, Japan.
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Preoperative staging of clinically node-negative esophageal cancer by the combination of 18F-fluorodeoxyglucose positron emission tomography and computed tomography (FDG–PET/CT). Esophagus 2012. [DOI: 10.1007/s10388-012-0342-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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22
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Kuroda J, Yoshida M, Kitajima M, Yanagisawa A, Matsubara T, Yamaguchi T, Osamura Y, Ohta K, Kubota K, Beck Y, Yamashita Y. Utility of preoperative chemoradiotherapy for advanced esophageal carcinoma. J Gastroenterol Hepatol 2012; 27 Suppl 3:88-94. [PMID: 22486878 DOI: 10.1111/j.1440-1746.2012.07078.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The most effective treatment would be neoadjuvant chemoradiotherapy (NACRT) plus surgery with three-field lymphadenectomy, if tolerability and complications are acceptable. The aim of this prospective study was to evaluate the tolerability of NACRT+ systematic three-field lymphadenectomy. METHODS A total of 127 cases of advanced esophageal carcinoma were objected, among which 32 had NACRT, being the cases suspected to cT3-T4 or, < cT3 with multiple lymph node metastasis. ≥ T2 of 95 cases were treated by surgery alone (NACRT [-] case). The effect of NACRT was evaluated by histological examination and corrected with the clinicopathologic factors, including postoperative prognosis. After reports JCOG9907, we treated eight cases with neoadjuvant chemotherapy at stages II and III. We examined Musashi-1 staining for these eight cases. RESULTS Histological good response to NACRT group showed good prognosis. Lymph node metastasis is a predictive factor for prognosis. In this additional study, Musashi-1 was positive after neoadjuvant chemotherapy in three cases. The histological response was grade 1 in all of them and recurrence was observed within a short period of time. Two cases of grade 3 were negative staining to Musashi-1 and showed no recurrence. CONCLUSIONS This study shows that NACRT plus surgery with three-field lymphadenectomy is a feasible therapeutic approach for the cases with multiple lymph node metastases. Prognosis was significantly better in cases with marked histological improvement. It is important to find the predictive factors of histological improvement. Musashi-1 might be a candidate maker for histological response and prognosis, and further studies are needed to prove it.
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Affiliation(s)
- Junko Kuroda
- Department of Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan.
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Yan C, Zhu ZG, Yan M, Zhang H, Pan ZL, Chen J, Xiang M, Chen MM, Liu BY, Yin HR, Lin YZ. Size of the largest lymph node visualized on multi-detector-row computed tomography (MDCT) is useful in predicting metastatic lymph node status of gastric cancer. J Int Med Res 2010; 38:22-33. [PMID: 20233510 DOI: 10.1177/147323001003800103] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
This study was designed to investigate whether the size of the largest lymph node (long-axis diameter [LAD] and short-axis diameter [SAD]) visualized using multi-detector-row computed tomography (MDCT) was useful for predicting the metastatic lymph node (MLN) status of gastric cancer. A retrospective analysis of 305 gastric cancer patients who underwent pre-operative MDCT was performed, followed by a prospective study in 61 gastric cancer patients to determine the diagnostic effectiveness of LAD and SAD. In the retrospective study, the accuracy of LAD and SAD for predicting the MLN status of gastric cancer was 51.1% and 45.9%, respectively. In the prospective study, the accuracy of LAD and SAD measurement and the traditional MDCT method of counting MLNs was 52.5%, 49.2% and 57.4%, respectively; the differences were not significant. In conclusion, the size of the largest lymph node in terms of LAD and SAD visualized on MDCT was useful for predicting the MLN status of gastric cancer, with accuracy comparable to the traditional MDCT method of counting the total number of MLNs detected.
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Affiliation(s)
- C Yan
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Chao YK, Wu YC, Liu YH, Tseng CK, Chang HK, Hsieh MJ, Chu Y, Liu HP. Distant nodal metastases from intrathoracic esophageal squamous cell carcinoma: Characteristics of long-term survivors after chemoradiotherapy. J Surg Oncol 2010; 102:158-62. [DOI: 10.1002/jso.21588] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Lee PC, Port JL, Paul S, Stiles BM, Altorki NK. Predictors of long-term survival after resection of esophageal carcinoma with nonregional nodal metastases. Ann Thorac Surg 2009; 88:186-92; discussion 192-3. [PMID: 19559222 DOI: 10.1016/j.athoracsur.2009.03.079] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 03/24/2009] [Accepted: 03/25/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with esophageal carcinoma and celiac, cervical, or other nonregional nodal metastases generally have a poor prognosis after surgical resection. Factors predicting long-term survival are unclear. The goal of this study was to analyze factors predicting long-term survival in this subset of patients. METHODS We conducted a retrospective review of a prospective database over a 20-year period to identify patients with resected esophageal carcinoma with nonregional lymph node metastases. Medical records were reviewed and risk factors were analyzed. RESULTS Sixty-seven patients underwent esophagectomy for M1a or M1b disease from 1987 to 2007. Esophagectomy was transthoracic in 62 patients and transhiatal in 5. The median number of lymph nodes harvested was 36. Sites of nodal metastases were the following: recurrent nodal chain in 42 patients, celiac in 20, both recurrent and celiac in 4, and paratracheal in 1. Median length of follow-up was 66 months. The 5-year overall survival for the entire cohort was 25%. The 5-year overall survival was significantly higher with earlier T-status, (pathologic tumor [pT]1/T2 vs pT3/T4; 62% vs 15%, p = 0.006). Thirteen patients who had nonregional nodal metastases without involvement of regional nodes (pN0) had a significant improvement in 5-year survival (67% vs 15%; p < 0.001). Patients with squamous cell carcinomas had higher 5-year survival compared with those with adenocarcinomas (42% vs 14%; p = 0.009). Patients treated with induction chemotherapy had prolonged 5-year survival (41%, p = 0.06) compared with those treated with adjuvant chemotherapy (11%) or no therapy (20%). Multivariate analysis demonstrated that chemotherapy treatment, squamous cell type, and early T stage (pT1/T2) are significant positive predictors of survival. CONCLUSIONS Surgical resection for patients with esophageal cancer associated with nonregional nodal metastases results in 25% survival at five years. Squamous histology, earlier T status, and perioperative chemotherapy are independent positive predictors of long-term survival.
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Affiliation(s)
- Paul C Lee
- Department of Cardiothoracic Surgery, Division of Thoracic Surgery, New York Presbyterian Hospital - Weill Cornell Medical College, New York, New York 10021, USA
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Cheze-Le Rest C, Metges JP, Teyton P, Jestin-Le Tallec V, Lozac'h P, Volant A, Visvikis D. Prognostic value of initial fluorodeoxyglucose-PET in esophageal cancer: a prospective study. Nucl Med Commun 2008; 29:628-35. [PMID: 18528185 DOI: 10.1097/mnm.0b013e3282f81423] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Esophageal cancer outcome greatly depends on the pathological stage. Our objectives were to assess prognosis on the basis of the initial fluorodeoxyglucose (FDG)-PET scan, focusing on the correlation between overall survival and FDG uptake in the primary, as well as the presence of FDG-positive lymph nodes or distant metastases. METHODS Fifty-two esophageal cancer patients undergoing FDG-PET as part of initial routine staging procedure before treatment were included. The maximum standardized uptake value (SUV max) was determined in each primary lesion and the number of abnormalities including primary, lymph nodes, or distant metastases was recorded. Correlation with overall survival was performed using Kaplan-Meier method and Cox regression analysis was used to assess the prognostic value of PET parameters. RESULTS Half of the patients were planned for initial curative surgery (52%). Using univariate survival analysis, either surgery, SUV max >9, two or more PET abnormalities or the presence of FDG-positive nodes were significant overall survival prognostic predictors. After multivariate analysis, only SUV max >9 and FDG-positive lymph nodes were found as independent predictors of poor outcome. CONCLUSION In this prospective study, FDG-PET was found to provide prognostic information supporting a new indication for initial FDG-PET examination in esophageal cancer.
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The number of metastatic lymph nodes and the ratio between metastatic and examined lymph nodes are independent prognostic factors in esophageal cancer regardless of neoadjuvant chemoradiation or lymphadenectomy extent. Ann Surg 2008; 247:365-71. [PMID: 18216546 DOI: 10.1097/sla.0b013e31815aaadf] [Citation(s) in RCA: 315] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate whether the number of lymph nodes metastasis (LNMs) and the ratio between metastatic and examined lymph nodes (LNs) are better prognostic factors when compared with traditional staging systems in patients with esophageal carcinoma. SUMMARY BACKGROUND DATA The accuracy of the 6th UICC/TNM classification is suboptimal, especially when not taking into account neoadjuvant therapy and lymphadenectomy extent. METHODS For 536 patients who underwent curative en bloc esophagectomy, in whom 51.5% (n = 276) received neoadjuvant chemoradiation, LNMs were classified according to the 6th UICC/TNM classification and systems based on the number (< or =4 and >4) or the ratio (< or =0.2 and >0.2) of LNMs. Survival of the respective stages, predictors of survival, and influence of both chemoradiation and number of examined LNs were studied. RESULTS After a median follow-up of 50 months, the 5-year survival rates were 47% for the entire population, significantly poorer for patients with >4 LNMs (8% vs. 53%, P < 0.001) or a ratio of LNMs >0.2 (22% vs. 54%, P < 0.001). After adjustment for confounding variables, a number of LNMs >4 and a ratio of LNMs >0.2 were the only predictors of poor prognosis. The prognostic role of both the number and the ratio of LNMs was maintained whether patients received neoadjuvant chemoradiation or not. Moreover, LN ratio is shown to be more accurate for inadequately staged patients (<15 examined LNs), whereas the number of LNMs is pertinent for adequately staged patients (> or =15 examined LNs). CONCLUSION Staging systems for esophageal cancer that use the number (< or =4 or >4) and the ratio (< or =0.2 or >0.2) of LNMs have greater prognostic importance than the current staging systems because of the good stratification of the groups and their clinical utility, taking into account neoadjuvant therapy and lymphadenectomy extent.
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Large Metastatic Lymph Node Size, Especially More Than 2 cm: Independent Predictor of Poor Prognosis in Node-Positive Gastric Carcinoma. World J Surg 2007; 32:262-6. [DOI: 10.1007/s00268-007-9158-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dhar DK, Hattori S, Tonomoto Y, Shimoda T, Kato H, Tachibana M, Matsuura K, Mitsumoto Y, Little AG, Nagasue N. Appraisal of a revised lymph node classification system for esophageal squamous cell cancer. Ann Thorac Surg 2007; 83:1265-72. [PMID: 17383324 DOI: 10.1016/j.athoracsur.2006.12.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Revised: 11/29/2006] [Accepted: 12/04/2006] [Indexed: 12/26/2022]
Abstract
BACKGROUND Node-positive patients with esophageal carcinoma constitute a heterogeneous population with a variable prognosis, which the current staging system insufficiently addresses. To that end, 863 patients with a curative resection for esophageal squamous cell carcinoma were analyzed to evaluate a useful and simple nodal classification system. METHODS Along with standard conventional clinicopathologic factors, data for metastatic lymph node (MLN) number, metastatic to examined LN ratio (MLN ratio), and MLN size were evaluated. The greatest microscopic dimension of the metastatic tumor inside the largest MLN (MLN size) was measured on histopathologic slides. Patients with MLNs were classified into n1 (< 9 mm) and n2 (> or = 9 mm) groups, according to size of MLNs (n-stage). RESULTS The paratracheal LNs most frequently contained the largest MLN and among them the right recurrent laryngeal LNs were the most common site (81.8%). Patients were stratified into significant groups by all the nodal criteria. In multivariable analysis, MLN size n-stage and MLN ratio N-stage were the best independent predictors for disease-free and overall survival, respectively. In the disease-free survival, MLN ratio N-stage subcategories were divided into prognostic groups according to the n-stage. A combined nodal staging strategy combining the n-stage and N-stage had the strongest prognostic value and was used for the tumor-node-metastasis classification with distinct separation of patients into prognostic groups. CONCLUSIONS Results of this study indicate that the MLN size may serve as an accurate metric to classify node-positive patients and a combination of the MLN ratio and size may have synergism in classifying node-positive patients into prognostically homogenous groups.
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Aiko S, Yoshizumi Y, Ishizuka T, Sakano T, Kumano I, Sugiura Y, Maehara T. Reduction rate of lymph node metastasis as a significant prognostic factor in esophageal cancer patients treated with neoadjuvant chemoradiation therapy. Dis Esophagus 2007; 20:94-101. [PMID: 17439591 DOI: 10.1111/j.1442-2050.2006.00624.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Tumor regression is used widely as a measure of tumor response following radiation therapy or chemoradiation therapy (CRT). In cases of esophageal cancer, a different pattern of tumor shrinkage is often observed between primary tumors and metastatic lymph nodes (MLNs). Regression of MLNs surrounded by normal tissue may be a more direct measure of the response to CRT than regression of a primary tumor as exfoliative mechanical clearance does not participate in shrinkage of MLNs. In this study we evaluated the significance of the reduction rate (RR) of MLNs as a prognostic factor in esophageal cancer patients treated with neoadjuvant CRT. Forty-two patients with marked MLNs were selected from 93 patients with esophageal carcinoma who had received neoadjuvant CRT. The RRs of the primary tumor and the MLNs were calculated from computed tomography scans. In 20 patients, surgical resection was carried out following CRT. Univariate analysis was used to determine which of the following variables were related to survival: size of the primary tumor and MLNs; RRs of both lesions; degree of lymph node (LN) metastasis; clinical stage; and surgical resection. Multivariate analysis was then performed to assess the prognostic relevance of each variable. The primary tumor was larger than the MLNs in 69% of patients before CRT and in 40% of patients after CRT. In 79% of the patients, the RR of the primary tumor was greater than the RR of the MLNs. The results of the univariate analyses showed that a high RR of the MLNs and surgical resection after CRT were associated with significantly improved survival. The multivariate analysis demonstrated that the RR of MLNs had the strongest influence on survival. The RR of LN metastasis should be evaluated as an important prognostic predictor in patients with marked LN metastasis of esophageal cancer treated with CRT.
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Affiliation(s)
- S Aiko
- National Defense Medical College, Surgery II, Saitama, Japan.
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Dhar DK, Yoshimura H, Kinukawa N, Maruyama R, Tachibana M, Kohno H, Kubota H, Nagasue N. Metastatic lymph node size and colorectal cancer prognosis. J Am Coll Surg 2005; 200:20-8. [PMID: 15631916 DOI: 10.1016/j.jamcollsurg.2004.09.037] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2004] [Revised: 09/14/2004] [Accepted: 09/21/2004] [Indexed: 12/17/2022]
Abstract
BACKGROUND Colorectal cancer patients with lymph node metastasis constitute a heterogeneous population with variable prognoses. In this study, my colleagues and I propose a simpler lymph node (LN) staging system for colorectal cancer. STUDY DESIGN Four-hundred and twenty-three consecutive colorectal cancer patients were studied. Of these, 36 were excluded because another carcinoma was present. The remaining 387 patients entered the TNM staging analysis. In the survival analysis, 76 patients with distant metastasis were excluded and the remaining 311 patients (LN(-) = 204 and LN(+) = 107) were studied. The diameter of the largest metastatic LN (MLN) was measured on histopathological slides. After examination of various cutpoints and survival outcomes, patients with MLNs were classified into n1 (< or = 9 mm) and n2 (> or = 10 mm) groups, according to size of MLNs (n-stage). RESULTS Using disease-free survival (DFS) and overall survival (OS) as outcomes, patients were separated into significant prognostic groups by MLN size (univariate, p < 0.0001) (5-year survival, DFS: n0 = 91.5%, n1 = 62.2%, and n2 = 34.4%; OS: n0 = 85.1%, n1 = 63.5%, and n2 = 42.5%) and International Union Against Cancer/American Joint Committee on Cancer (UICC/AJCC) (N-stage) (univariate, p < 0.0001) (5-year survival, DFS: N0 = 91.5%, N1 = 60.5%, and N2 = 36.8%; OS: N0 = 85.1%, N1 = 65.3%, and N2 = 38.0%). But in patients with fewer than 15 LNs examined (n = 31), only the new nodal stage stratified patients into significant groups (OS: p = 0.003 and DFS: p = 0.001). Only the UICC/AJCC N-stage subcategories were further split into significant prognostic groups by MLN size (UICC/AJCC N1: DFS, p = 0.048 and OS, p = 0.11; N2: DFS, p = 0.04 and OS, p = 0.04). n-stage was an independent important factor both in the DFS and OS in multivariable analysis. CONCLUSIONS MLN size is a strong prognostic variable in colorectal carcinoma. This new metric may help clinicians treating colorectal cancer patients, but additional studies are required before clinical application.
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Affiliation(s)
- Dipok Kumar Dhar
- Department of Digestive and General Surgery, Shimane University, Izumo 693-8501, Japan
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Sharma A, Fidias P, Hayman LA, Loomis SL, Taber KH, Aquino SL. Patterns of lymphadenopathy in thoracic malignancies. Radiographics 2004; 24:419-34. [PMID: 15026591 DOI: 10.1148/rg.242035075] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
There are different lymphatic drainage pathways in the thorax that are relevant in the staging of lung cancer, breast cancer, lymphoma, esophageal cancer, and malignant mesothelioma. To properly search for metastatic spread, it is important to carefully evaluate the specific nodal stations that drain the thoracic structures from which a primary tumor originates. Because size criteria have limitations in the prediction of nodal status, pathologic confirmation is essential for accurate staging. Computed tomography (CT) is useful in helping the surgeon or interventional radiologist determine the most appropriate approach for nodal sampling. Fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) has an increasing role in detection of diseased lymph nodes that appear normal at CT alone, particularly when FDG PET images are fused with CT images. However, the role of radiologic imaging extends beyond initial staging and the guidance of interventions to include posttreatment assessment and the detection of recurrent disease. Therefore, at all levels of cancer imaging, it is essential to identify the relevant lymph node regions and their relations to the primary tumor.
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Affiliation(s)
- Amita Sharma
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Founders 202, Boston, MA 02114, USA.
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Abstract
Esophageal cancer is one of the most lethal of all neoplasms. During the last two decades, there have been significant changes in the epidemiology and treatment of esophageal cancer. The incidence of adenocarcinoma is increasing whereas that of squamous cancer is decreasing. Surgery, the mainstay of treatment of esophageal cancer, has been used with neoadjuvant chemoradiotherapy to improve prognosis in patients with localized disease. Accurate staging is essential for selection of the best mode of therapy and to predict prognosis. In addition, with widespread use of neoadjuvant therapy, accurate assessment of response to therapy has become very important because responders have better a prognosis than nonresponders. Anatomical imaging methods, such as computed tomography and endoscopic ultrasonography, that are commonly used to evaluate esophageal cancer have shortcomings in demonstrating the true extent of disease and in assessing or predicting response to therapy. Positron emission tomography (PET) with 2-[(18)F]fluoro-2-deoxy-d-glucose (FDG) has been shown to be a useful adjunct to anatomical imaging methods. For initial staging of esophageal cancer, the combination of PET and endoscopic ultrasonography with fine-needle aspiration biopsy has been suggested to be the most effective strategy. For restaging and monitoring response to therapy, FDG-PET has been shown to be superior to conventional imaging. The incidence of gastric cancer is decreasing worldwide, but it is also a highly lethal cancer. Similar to esophageal cancer, noninvasive staging of this cancer is unsatisfactory. Approximately one-third of the patients thought to have limited disease and to be candidates for surgery by conventional staging methods, are found to have advanced disease at surgery. Only a few published studies have evaluated gastric cancer with FDG-PET. These studies suggest that FDG-PET may be useful in evaluating gastric cancers of intestinal type and nonmucinous tumors.
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Affiliation(s)
- Farrokh Dehdashti
- Division of Nuclear Medicine, Edward Mallinckrodt Institute of Radiology and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63110, USA
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Dhar DK, Kubota H, Kinukawa N, Maruyama R, Kyriazanos ID, Ohno S, Nagasue N. Prognostic significance of metastatic lymph node size in patients with gastric cancer. Br J Surg 2004; 90:1522-30. [PMID: 14648731 DOI: 10.1002/bjs.4354] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Patients with gastric cancer that has metastasized to the lymph nodes are a heterogeneous population with a variable prognosis. Stratification of these patients into prognostic groups is necessary for optimal adjuvant therapy. METHODS The study comprised 715 patients who had undergone curative resection of a gastric neoplasm. Lymph nodes were sectioned, stained with haematoxylin and eosin, and the diameter of the largest metastatic lymph node (MLN) was measured. Patients with metastatic nodes were divided into groups n1 and n2 according to the size of the MLN. The cut-off level was set at 7 mm by a two-sample log rank test; patients in group n1 had a MLN size of 7 mm or less and those in group n2 had a MLN of 8 mm or more. RESULTS Patients were stratified into significant prognostic groups by both the Union International Contra la Cancrum (UICC) node (N) stage and MLN size (n group). The UICC N-stage subcategories were further divided into prognostic groups according to MLN size (n group). On multivariate analysis the MLN size remained independently significant in terms of overall and disease-free survival rates, and the UICC N stage was not significant, independently of the n group. Node-positive patients with fewer than 15 lymph nodes removed at operation could also be stratified into prognostic groups by the n group. Stratification according to the TNM stage and by MLN size was superior to existing UICC TNM staging. CONCLUSION This new method may help clinicians to design a more appropriate treatment strategy for patients with gastric cancer.
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Affiliation(s)
- D K Dhar
- Second Department of Surgery, Shimane Medical University, Izumo, Japan
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Demeester SR. Lymph node involvement in esophageal adenocarcinoma: if you see one, have you seen them all? J Thorac Cardiovasc Surg 2003; 126:947-9. [PMID: 14566230 DOI: 10.1016/s0022-5223(03)00732-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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