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Danzinger S, Pöckl K, Kronawetter G, Pfeifer C, Behrendt S, Gscheidlinger P, Harrasser L, Mühlböck H, Dirschlmayer W, Schauer C, Reitsamer R, Uher H, Schönau K, Delmarko I, Singer CF. Axillary lymph node status and invasive lobular breast cancer : Analysis of the Clinical Tumor Register of the AGO Austria. Wien Klin Wochenschr 2023; 135:463-471. [PMID: 37010596 PMCID: PMC10497662 DOI: 10.1007/s00508-023-02162-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/10/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Invasive lobular carcinoma (ILC) represents the second most common type of invasive breast cancer (BC). Although ILC generally have good prognostic properties (positive estrogen receptor, ER, low tumor grade), they are generally diagnosed at a more advanced stage. The data on the axillary lymph node status in ILC compared to invasive ductal carcinoma (IDC) are considered controversial. Therefore, the aim of this study was to compare the pathological node stage (pN) between ILC and IDC in an Austria-wide register. METHODS Data of the Clinical Tumor Register (Klinisches TumorRegister, KTR) of the Austrian Association for Gynecological Oncology (AGO) were retrospectively analyzed. Patients with primary early BC, invasive lobular or ductal, diagnosed between January 2014 and December 2018, and primary surgery were included. A total of 2127 tumors were evaluated and compared in 2 groups, ILC n = 303, IDC n = 1824. RESULTS A total of 2095 patients were analyzed in the study. In the multivariate analysis, pN2 and pN3 were observed significantly more frequently in ILC compared with IDC (odds ratio, OR 1.93; 95% confidence interval, CI 1.19-3.14; p = 0.008 and OR 3.22; 95% CI: 1.47-7.03; p = 0.003; respectively). Other factors associated with ILC were tumor grades 2 and 3, positive ER, and pathological tumor stage (pT) 2 and pT3. In contrast, concomitant ductal carcinoma in situ, overexpression of the human epidermal growth factor receptor 2 (HER2), and a moderate and high proliferation rate (Ki67) were found less frequently in ILC. CONCLUSION The data show an increased risk of extensive axillary lymph node metastasis (pN2/3) in ILC.
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Affiliation(s)
- Sabine Danzinger
- Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Karin Pöckl
- Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Gerit Kronawetter
- Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Christian Pfeifer
- Department of Statistics, University of Innsbruck, Innsbruck, Austria
| | - Sandra Behrendt
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Patricia Gscheidlinger
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Lois Harrasser
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Helmut Mühlböck
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Walter Dirschlmayer
- Department of Obstetrics and Gynecology, Hospital Barmherzige Schwestern Ried, Ried im Innkreis, Austria
| | - Christian Schauer
- Department of Gynecology, Hospital Barmherzige Brüder Graz, Graz, Austria
| | - Roland Reitsamer
- Department of Gynecology, Paracelsus Medical University, University Hospital Salzburg, Landeskrankenhaus Salzburg, Salzburg, Austria
| | - Heidemarie Uher
- Department of Surgery, Breast Health Center, Hospital Landstraße, Vienna, Austria
| | - Kristina Schönau
- Department of General, Visceral and Tumor Surgery, Breast Health Center, Hospital Ottakring, Vienna, Austria
| | - Irmgard Delmarko
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Christian F. Singer
- Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
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Placke JM, Mertens D, Tasdogan A, Chorti E, Schadendorf D, Ugurel S, Roesch A, Stoffels I, Klode J. Multispectral optoacoustic tomography to differentiate between lymph node metastases and coronavirus-19 vaccine-associated lymphadenopathy. J Eur Acad Dermatol Venereol 2023; 37:907-913. [PMID: 36606548 DOI: 10.1111/jdv.18847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Worldwide mass vaccination for COVID-19 started in late 2020. COVID-19 vaccines cause benign hypermetabolic lymphadenopathies. Clinical stratification between vaccine-associated benign lymphadenopathies and malignant lymphadenopathies through ultrasound, MRI or FDG PET-CT is not feasible. This leads to unnecessary lymph node biopsies, excisions and even radical lymph node dissections. Therefore, to avoid unnecessary surgeries, we assessed whether noninvasive multispectral optoacoustic tomography (MSOT) enables a better differentiation between benign and malignant lymphadenopathies. PATIENTS AND METHODS All patients were vaccinated for COVID-19. We used MSOT to image deoxy- and oxyhaemoglobin levels in lymph nodes of tumour patients to assess metastatic status. MSOT imaging results were compared with standard ultrasound and pathological lymph node analysis. We also evaluated the influences of gender, age and time between vaccination and MSOT measurement of lymph nodes on the measured deoxy- and oxyhaemoglobin levels in patients with reactive lymph node changes. RESULTS Multispectral optoacoustic tomography was able to identify cancer-free lymph nodes in vivo without a single false negative (33 total lymph nodes), with 100% sensitivity and 50% specificity. A statistically significant higher deoxyhaemoglobin content was detected in patients with tumour manifestations in the lymph node (p = 0.02). There was no statistically significant difference concerning oxyhaemoglobin (p = 0.65). Age, sex and time between vaccination and MSOT measurement had statistically non-significant impact on deoxy- and oxyhaemoglobin levels in patients with reactive lymph nodes. CONCLUSION Here, we show that MSOT measurement is an advantageous clinical approach to differentiate between vaccine-associated benign lymphadenopathy and malignant lymph node metastases based on the deoxygenation level in lymph nodes.
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Affiliation(s)
- Jan-Malte Placke
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Delphine Mertens
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Alpaslan Tasdogan
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Eleftheria Chorti
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Selma Ugurel
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Alexander Roesch
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ingo Stoffels
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Joachim Klode
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Kustić D, Klarica Gembić T, Grebić D, Petretić Majnarić S, Nekić J. The role of different lymph node staging systems in predicting prognosis and determining indications for postmastectomy radiotherapy in patients with T1-T2pN1 breast carcinoma. Strahlenther Onkol 2020; 196:1044-1054. [PMID: 32710122 DOI: 10.1007/s00066-020-01669-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/06/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Based on the risk of locoregional recurrence (LRR), postmastectomy radiotherapy (PMRT) is recommended in T1-T2pN1 breast carcinoma (BC). We aimed to elucidate our institutional strategies underlying selection of these patients for PMRT. In the no-PMRT subset, we compared various lymph node (LN) staging systems' abilities to predict 5‑year overall and locoregional-free survival (OS/LRFS). METHODS We retrospectively enrolled 548 women with T1-T2pN1 BC undergoing mastectomy and axillary LN dissection. Depending on PMRT delivery, the participants were divided into the PMRT and no-PMRT groups. Predictors of OS/LRFS were calculated for the no-PMRT group only. Based on Cox regression modelling, the number of positive LNs (PLN), negative LNs (NLN), LN ratio (LNR), log odds of PLN (LODDS), and modified LNR (mLNR) were modelled, each respectively, with OS model covariates (age, grade III, lymphovascular invasion [LVI], tumor size, hormone receptor [HR] status) and LRFS model covariates (age, grade III, LVI). The C‑statistic, Akaike information criterion, and likelihood ratio χ2 of the models were compared. RESULTS Median follow-up was 60.5 (18-82), 61 (28-82), and 60 (18-80) months for the entire cohort, PMRT, and no-PMRT group, respectively. The PMRT and no-PMRT groups had comparable OS (p = 0.235). LRFS was better (p = 0.030) in the PMRT group comprising 105 subjects (19.16%) who were younger, more likely to have a higher-grade, HR-, HER2+ tumors, more PLNs, fewer NLNs, Ki-67 ≥ 20%, LVI, and extranodal extension (p ≤ 0.001). In the no-PMRT group, LNR-based OS/LRFS models exhibited superior prognostic performance. CONCLUSION In early-stage BC patients undergoing mastectomies, LN dissections and no PMRT, we propose LNR-based multivariable models to predict OS/LRFS with superior accuracy.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents, Hormonal/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Breast Neoplasms/drug therapy
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/secondary
- Chemotherapy, Adjuvant
- Combined Modality Therapy
- Female
- Follow-Up Studies
- Humans
- Lymph Node Excision
- Lymphatic Irradiation
- Lymphatic Metastasis/radiotherapy
- Mastectomy
- Middle Aged
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/radiotherapy
- Neoplasm Staging/methods
- Neoplasms, Hormone-Dependent/therapy
- Prognosis
- Proportional Hazards Models
- Radiotherapy, Adjuvant/methods
- Retrospective Studies
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Affiliation(s)
- Domagoj Kustić
- Department of Nuclear Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia.
| | | | - Damir Grebić
- Clinic for Surgery, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | | | - Jasna Nekić
- Department of Nuclear Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia
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Li D, Xu X, Yan D, Yuan S, Ni J, Lou H. Prognostic factors affecting survival and recurrence in patients with early cervical squamous cell cancer following radical hysterectomy. J Int Med Res 2020; 48:300060519889741. [PMID: 31889461 PMCID: PMC7607059 DOI: 10.1177/0300060519889741] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 10/30/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the clinical and histological features affecting the survival of patients with early cervical squamous cell cancer treated with radical hysterectomy. METHODS We retrospectively analyzed clinical and histological data for patients with stage IB-IIA cervical cancer treated by radical hysterectomy at Zhejiang Cancer Hospital from August 2008 to January 2013. RESULTS A total of 1435 patients were included in the study. Cox regression analysis identified tumor size >4 cm, lymphovascular space involvement (LVSI), lymph node ratio (LNR), and squamous cell carcinoma antigen (SCC-Ag) >2.65 ng/mL as independent prognostic risk factors. Among 1096 patients without high pathological risk factors, the 5-year local recurrence rates for SCC-Ag ≤2.65 and >2.65 ng/mL were 6.6% and 25.7%, respectively. Among 332 patients with lymph node positivity, the overall survival rates for LNR ≤0.19 and >0.19 were 87.8% and 55.6%, respectively. CONCLUSIONS LVSI, tumor size >4 cm, LNR >0.19, and SCC-Ag >2.65 ng/mL may predict a poor prognosis in patients with early cervical squamous cell cancer treated with radical hysterectomy. SCC-Ag >2.65 ng/mL may be a useful prognostic factor guiding the use of postoperative radiotherapy in patients without pathologic risk factors.
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Affiliation(s)
- Dan Li
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shanxi, P.R. China
- Second Clinical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, P.R. China
| | - Xiaoxian Xu
- Department of Gynecologic Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, P.R. China
| | - Dingding Yan
- Department of Gynecologic Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, P.R. China
| | - Shuhui Yuan
- Department of Gynecologic Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, P.R. China
| | - Juan Ni
- Department of Gynecologic Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, P.R. China
| | - Hanmei Lou
- Department of Gynecologic Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, P.R. China
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Li X, Wang M, Wang M, Yu X, Guo J, Sun T, Yao L, Zhang Q, Xu Y. Predictive and Prognostic Roles of Pathological Indicators for Patients with Breast Cancer on Neoadjuvant Chemotherapy. J Breast Cancer 2019; 22:497-521. [PMID: 31897326 PMCID: PMC6933033 DOI: 10.4048/jbc.2019.22.e49] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 10/11/2019] [Indexed: 02/06/2023] Open
Abstract
Currently, neoadjuvant chemotherapy is a standard therapeutic strategy for breast cancer, as it can provide timely and individualized chemo-sensitivity information and is beneficial for custom-designing subsequent treatment strategies. To accurately select candidates for neoadjuvant chemotherapy, the association between various immunohistochemical biomarkers of primary disease and tumor response to neoadjuvant chemotherapy has been investigated, and results have shown that certain pathological indicators evaluated after neoadjuvant chemotherapy are associated with long-term prognosis. The Food and Drug Administration (FDA) has recommended that complete pathological response can be used as a surrogate endpoint for neoadjuvant chemotherapy, which is related to better prognosis. Considering that residual tumor persists in the majority of patients after neoadjuvant chemotherapy, the value of various pathological indicators of residual disease in predicting the long-term outcomes is being extensively investigated. This review summarizes and compares various predictive and prognostic indicators for patients who have received neoadjuvant chemotherapy, and analyzes their efficacy in different breast cancer subtypes.
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Affiliation(s)
- Xinyan Li
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Mozhi Wang
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Mengshen Wang
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Xueting Yu
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Jingyi Guo
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Tie Sun
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Litong Yao
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Qiang Zhang
- Department of Breast Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, Liaoning Province, China
| | - Yingying Xu
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
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Suzuki S, Shimoda M, Shimazaki J, Maruyama T, Oshiro Y, Nishida K, Kuroda J, Miyoshi K, Koike N, Harada N. Number of positive lymph nodes and lymphatic invasion are significant prognostic factors after pancreaticoduodenectomy for distal cholangiocarcinoma. Clin Exp Gastroenterol 2019; 12:255-262. [PMID: 31239748 PMCID: PMC6559140 DOI: 10.2147/ceg.s207333] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 05/02/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Early recurrence of distal cholangiocarcinoma (DCC) may result in a poorer prognosis. This study aimed to evaluate the clinicopathological factors that predict survival and recurrence in patients with DCC. Methods: Fifty-five patients with DCC who underwent pancreaticoduodenectomy between 2005 and 2015 were studied retrospectively. The following clinicopathological parameters were analyzed as predictors of disease-free survival (DFS) and overall survival (OS): sex, age, body mass index, presence of biliary tract decompression, macroscopic type, histological type, tumor size, TNM classification, lymph node metastasis ratio, number of positive lymph nodes (PLNs), lymphatic invasion, venous invasion, perineural invasion, proximal bile duct margin, dissected margin, portal system invasion, arterial system invasion, stage, and residual tumor. Results: Univariate analysis showed that contiguous extension of the primary tumor, PLN, lymphatic invasion, venous invasion, perineural invasion, and stage were significant prognostic factors for DFS and OS. Multivariate analysis revealed that PLN and lymphatic invasion were prognostic for DFS and OS (P<0.001). Significant differences in OS and DFS were found in analyses stratified by PLN (0, 1, 2 vs ≥3) and lymphatic invasion (0 vs 1, 2, 3). Conclusion: Among the clinicopathological parameters analyzed, PLN and lymphatic invasion were confirmed as prognostic factors for DCC.
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Affiliation(s)
- Shuji Suzuki
- Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, Ibaraki 300-0395, Japan
| | - Mitsugi Shimoda
- Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, Ibaraki 300-0395, Japan
| | - Jiro Shimazaki
- Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, Ibaraki 300-0395, Japan
| | - Tsunehiko Maruyama
- Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, Ibaraki 300-0395, Japan
| | - Yukio Oshiro
- Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, Ibaraki 300-0395, Japan
| | - Kiyotaka Nishida
- Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, Ibaraki 300-0395, Japan
| | - Jun Kuroda
- Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, Ibaraki 300-0395, Japan
| | - Kenta Miyoshi
- Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, Ibaraki 300-0395, Japan
| | - Nobusada Koike
- Department of Surgery, Hachioji Digestive Disease Hospital, Tokyo 192-0903, Japan
| | - Nobuhiko Harada
- Department of Surgery, Hachioji Digestive Disease Hospital, Tokyo 192-0903, Japan
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Vijaykumar DK, Agarwal R, Philip A, Pavithran K, Rajanbabu A, Goel G. Prognostic significance of residual nodal burden using lymph node ratio in locally advanced breast cancer after neoadjuvant chemotherapy. Indian J Cancer 2019; 56:228-235. [DOI: 10.4103/ijc.ijc_652_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Yoo J, Kim BS, Yoon HJ. Predictive value of primary tumor parameters using 18F-FDG PET/CT for occult lymph node metastasis in breast cancer with clinically negative axillary lymph node. Ann Nucl Med 2018; 32:642-648. [PMID: 30094546 DOI: 10.1007/s12149-018-1288-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 07/20/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study aimed to demonstrate the clinical significance of total lesion glycolysis (TLG) of primary breast cancer using 18F-FDG PET/CT to predict axillary lymph node (ALN) metastasis in invasive ductal breast cancer (IDC) with a clinically negative axillary lymph node (cN-ALN). METHODS 135 patients, newly diagnosed with IDC with CN-ALN between July 2016 and October 2017, were retrospectively enrolled. We estimated primary tumor PET/CT parameters including the maximum standard uptake value (SUVmax), metabolic tumor volume (MTV), and TLG, as well as clinicopathologic findings. All patients received breast surgery followed by pathologic axillary lymph node examination. RESULTS Of the 135 patients, 31 (23.0%) were diagnosed with pathologically proven metastatic ALN. In univariate analysis, SUVmax, MTV, and TLG of the primary breast tumor were correlated with metastatic ALN along with tumor size, lymphovascular invasion, CD34, and D2-40. On multivariate analysis, TLG (> 5.74, p = 0.009) had independent significance for predicting ALN metastasis in IDC with cN-ALN. CONCLUSION We demonstrated that TLG of primary tumors can be useful in predicting pathologic ALN metastasis in IDC patients with cN-ALN.
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Affiliation(s)
- Jang Yoo
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Bom Sahn Kim
- Department of Nuclear Medicine, Ewha Womans University School of Medicine, Seoul, South Korea.
| | - Hai-Jeon Yoon
- Department of Nuclear Medicine, Ewha Womans University School of Medicine, Seoul, South Korea
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Zhao X, Wei J, Li X, Yang H, Wang P, Cao S. Increasing negative lymph node count predicts favorable OS and DSS in breast cancer with different lymph node-positive subgroups. PLoS One 2018; 13:e0193784. [PMID: 29554092 PMCID: PMC5858777 DOI: 10.1371/journal.pone.0193784] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/16/2018] [Indexed: 11/18/2022] Open
Abstract
Adequate lymph node evaluation is recommended for optimal staging in patients with malignant neoplasms including breast cancer. However, the role of negative lymph nodes (LNs) remains unclear in breast cancer according to N substage (N1, N2, and N3). In this study, for the first time, we analyzed the prognostic significance of negative LNs in breast cancer patients. A critical relationship was observed between negative LN count and survival, independent of patient characteristics and other related molecular variables including estrogen receptor (PR) status, progesterone receptor (ER) status, human epidermal growth factor receptor 2 (HER2) status, depth of tumor invasion and degree of differentiation. This research is of great importance in providing more information about the prognosis of breast cancer by statistical analysis of negative lymph nodes and can serve as a useful supplement to the current pathological system.
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Affiliation(s)
- Xin Zhao
- Department of General Surgery, Tianjin First Central Hospital,Tianjin,China
| | - Jing Wei
- Department of Thoracic Surgery, Xuzhou Central Hospital, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou, China
| | - Xiaoxin Li
- Department of Pathology, Xuzhou Central Hospital, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou, China
| | - Haochang Yang
- College of Clinical Medicine, Binzhou Medical University, Yantai, China
| | - Pei Wang
- Department of Breast Surgery, Xuzhou Central Hospital, The Affiliated Xuzhou Hospital of Medical College of Southeast University,Xuzhou, China
- * E-mail: (SC); (PW)
| | - Susheng Cao
- Department of Breast Surgery, Xuzhou Central Hospital, The Affiliated Xuzhou Hospital of Medical College of Southeast University,Xuzhou, China
- * E-mail: (SC); (PW)
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Abstract
OBJECTIVES The optimal number of lymph nodes that need to be analyzed to reliably assess nodal status in distal pancreatectomy for adenocarcinoma is still unknown. METHODS Two hundred seventy-eight patients who underwent distal pancreatectomy for adenocarcinoma were retrieved from a retrospective French nationwide database. The relations between the number of analyzed lymph nodes and the nodal status of the tumor were studied. The beta-binomial law was used to estimate the probability of being truly node negative depending on the number of analyzed lymph nodes. Cox proportional hazard model was used for the survival analysis. RESULTS The median number of analyzed lymph nodes was 15. There was a positive correlation between the number of positive lymph nodes and the number of lymph nodes analyzed. The curve reached a plateau at approximately 25 lymph nodes. The beta binomial model demonstrated that an analysis of 21 negative lymph nodes shows a probability to be truly N0 at 95%. N+ status was associated with survival, but the number of lymph node analyzed was not. CONCLUSION At least 21 lymph nodes should be analyzed to ensure a reliable assessment of the nodal status, but this number may be hard to reach in distal pancreatectomy.
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Altundag K. Do cut-off values of lymph node ratio and presence of perineural invasion affect survival in breast cancer patients with pathologic N3a lymph node stage? Breast 2017; 35:218. [DOI: 10.1016/j.breast.2017.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/11/2017] [Indexed: 11/15/2022] Open
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Reply to Kadri Altundag: Do cut-off values of lymph node ratio and presence of perineural invasion affect survival in breast cancer patients with pathologic N3a lymph node stage? Breast 2017; 35:218-219. [DOI: 10.1016/j.breast.2017.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 05/11/2017] [Indexed: 11/17/2022] Open
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Yoo J, Kim BS, Chung J, Yoon HJ. Percentage change of primary tumor on 18F-FDG PET/CT as a prognostic factor for invasive ductal breast cancer with axillary lymph node metastasis: Comparison with MRI. Medicine (Baltimore) 2017; 96:e7657. [PMID: 28767583 PMCID: PMC5626137 DOI: 10.1097/md.0000000000007657] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
We evaluated the prognostic value of quantitative parameters using dual time point (DTP) F-FDG PET/CT (PET/CT) in invasive ductal breast cancer (IDC) with metastatic axillary lymph nodes (ALN) as compared with dynamic contrast-enhanced (DCE) and diffusion-weighted (DW) MRI.Seventy patients with IDC and metastatic ALN were retrospectively registered. Static PET parameters including maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG) of primary tumor, SUVmax of ALN (SUVALN), and percentage changes (Δ%) in those parameters were measured with DTP PET/CT. From DCE MRI, peak enhancement value, total tumor angio volume, and proportions of kinetic curve types on delayed-phases were investigated. The average apparent diffusion coefficient (ADCavg) was estimated on DWI. To demonstrate the prognostic value of quantitative imaging parameters for recurrence-free survival (RFS), univariate and multivariate analyses were performed using those parameters and clinicohistologic variables.All static PET parameters, %ΔSUVmax, %ΔMTV, and %ΔSUVALN on DTP PET/CT and ADCavg on DWI were significantly predictive for disease recurrence. Of clinicohistologic variables, pathologic tumor (pT) diameter, pathologic ALN stage, tumor grade, and hormonal status also were significantly prognostic. After multivariate analysis, %ΔSUVmax > 25.05 (P = .043), ADCavg ≤ 1016.55 (P = .020), pT diameter > 3 cm (P = .001), and ER negative status (P = .002) were independent prognostic factors for poor outcome.Only %ΔSUVmax of the primary tumor on PET/CT together with ADCavg, pT diameter, and ER status was an independent prognostic factor for predicting relapse in IDC with metastatic ALN. Percentage change of primary tumor on preoperative PET/CT may be a valuable imaging marker for selecting IDC patients that require adjunct treatment to prevent relapse.
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Affiliation(s)
- Jang Yoo
- Department of Nuclear Medicine, Ewha Womans University School of Medicine
- Sungkyunkwan University School of Medicine
| | - Bom Sahn Kim
- Department of Nuclear Medicine, Ewha Womans University School of Medicine
| | - Jin Chung
- Department of Radiology, Ewha Womans University, School of Medicine, Seoul, South Korea
| | - Hai-Jeon Yoon
- Department of Nuclear Medicine, Ewha Womans University School of Medicine
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Park K, Lee JH, Han HH, Mun SG, Kang S, Cha YJ, Koo JS, Kim MJ, Lee HS, Moon J, Cho NH. Nodal metastasis signatures in breast cancer. Pathol Res Pract 2016; 213:680-687. [PMID: 28476377 DOI: 10.1016/j.prp.2016.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/14/2016] [Accepted: 11/28/2016] [Indexed: 11/29/2022]
Abstract
Although the molecular taxonomy of invasive breast cancer is based on heterogeneous histologic types, pathologic nodal (pN) stage remains one of the most important independent prognostic factors. Although node-positive number (NPN) has been widely as an accepted staging algorithm of pN stage, the node-positive ratio (NPR) in totally resected axillary nodes has been considered as another reasonable indicator. We aimed to identify signatures to play a predictive role in nodal metastasis for analytic validation between the primary breast cancers with positive node metastasis and those with negative node metastasis. We validated expression profiles of surrogate candidates extracted from the prior 2D MALDI-TOF data for invasive breast cancer using fluorescence/silver in situ hybridization (FISH/SISH) and immunohistochemistry (IHC) in 151 primary breast cancers accompanied with 102 metastatic nodal tissues. Cox proportional hazards regression analyses indicated that event factors (recurrence or metastasis) were significantly more frequent in cases with CCDN1, c-myc gene amplification, IgHA2 low expression. CCDN1 gene amplification (OR: 5.702, p=0.0006), IgHA2 low expression (OR: 0.16, p=0.0184) remained significant factors for events on multivariate analyses. WDR+/ERK++ was significantly detected in higher pN stage (averaging 6.5 regional nodes or 43% of NPR), while seldom found in pN0-1. In conclusion, both overexpression of WDR1 and p-ERK in the primary breast cancer could play a role in the nodal signature over pN2-3.
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Affiliation(s)
- Kyeongmee Park
- Dept of Pathology, Inje University Sanggye Paik Hospital, Republic of Korea
| | - Joo Hyun Lee
- Dept of Pathology, Yonsei University College of Medicine, Republic of Korea; Brain Korea 21 Project for Medical Science, Republic of Korea
| | - Hyun Ho Han
- Dept of Pathology, Yonsei University College of Medicine, Republic of Korea; Brain Korea 21 Project for Medical Science, Republic of Korea
| | - Seong Gyeong Mun
- Dept of Pathology, Yonsei University College of Medicine, Republic of Korea; Brain Korea 21 Project for Medical Science, Republic of Korea
| | - Suki Kang
- Dept of Pathology, Yonsei University College of Medicine, Republic of Korea; Biomedical Institute, Yonsei University College of Medicine, Republic of Korea
| | - Youn Jin Cha
- Dept of Pathology, Yonsei University College of Medicine, Republic of Korea
| | - Ja-Seung Koo
- Dept of Pathology, Yonsei University College of Medicine, Republic of Korea
| | - Min Ju Kim
- Dept of Pathology, Gacheon Medical University, Republic of Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Republic of Korea
| | - Jieun Moon
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Republic of Korea
| | - Nam Hoon Cho
- Dept of Pathology, Yonsei University College of Medicine, Republic of Korea; Brain Korea 21 Project for Medical Science, Republic of Korea; Biomedical Institute, Yonsei University College of Medicine, Republic of Korea.
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15
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Quintyne KI, Woulfe B, Coffey JC, Merrigan A, Gupta RK. Lymph Node Ratio in Sentinel Lymph Node Biopsy Era: Are We Losing Prognostic Information? Clin Breast Cancer 2016; 17:117-126. [PMID: 27592541 DOI: 10.1016/j.clbc.2016.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/09/2016] [Accepted: 07/20/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND The number of involved axillary lymph nodes (LNs) found pathologically is regarded as a significant prognostic factor in early-stage breast cancer (EBC). Recently, there is speculation that LN ratio (LNR) may be a better surrogate at predicting cancer-specific outcome than number of involved LNs. This study investigated prognostic value of LNR, using predetermined cutoff values. METHODS Data included all women diagnosed with node-positive EBC between January 1, 2001, and December 31, 2010 (N = 553). Retrospective evaluation for clinical, demographic, and pathologic data was performed. Most had axillary node clearance (ANC) (548/553; 99.1%). Cohorts were divided by LNR risk groups (low: ≤ 0.20; intermediate: 0.21-0.65; high: >0.65). Proportional hazard modeling was undertaken to evaluate whether LNR was associated with overall survival (OS). RESULTS Median follow-up was 59.8 months. LNR distribution was as follows: low, 303/553 (54.8%); intermediate, 160/553 (28.9%); high, 90/553 (16.3%). Kaplan-Meier estimates for OS were stratified by LNR: low-risk group had better outcome for OS (P < .001). Overall 5- and 10-year OS was 63% and 58%, respectively. Number of positive LNs correlated with 10-year OS (66%, 48%, and 48% for patients with N1, N2, and N3 stage, respectively; P < .001). LNR also correlated with 5-year OS (69%, 48%, and 41% for low-, intermediate-, and high-risk groups, respectively; P < .001). Significantly, LNR on multivariate analysis also formed a prognostic model when combined with age, estrogen receptor status, PgR status and, HER2 status (P < .001). CONCLUSION The Findings support LNR as a predictor for OS in EBC. LNR should be considered an independent prognostic variable to current prognostic instruments already in use.
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Affiliation(s)
- Keith Ian Quintyne
- Community Oncology Department, National Cancer Control Programme (NCCP), Dublin, Ireland; Post-Graduate Department, Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
| | - Bernie Woulfe
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland; Stokes Institute, University of Limerick, Limerick, Ireland
| | - John C Coffey
- Post-Graduate Department, Graduate Entry Medical School, University of Limerick, Limerick, Ireland; Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - Anne Merrigan
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - Rajnish K Gupta
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland; Stokes Institute, University of Limerick, Limerick, Ireland
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Tsai J, Bertoni D, Hernandez-Boussard T, Telli ML, Wapnir IL. Lymph Node Ratio Analysis After Neoadjuvant Chemotherapy is Prognostic in Hormone Receptor-Positive and Triple-Negative Breast Cancer. Ann Surg Oncol 2016; 23:3310-6. [PMID: 27401442 DOI: 10.1245/s10434-016-5319-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Lymph node ratios (LNR), the proportion of positive lymph nodes over the number excised, both defined as ranges and single ratio values are prognostic of outcome. Little is known of the prognostic value of LNR after neoadjuvant chemotherapy (NAC) according to molecular subtype. METHODS From 2003 to 2014, patients who underwent definitive surgery after NAC were identified. LNR was calculated for node-positive patients who received axillary dissection or had at least 6 nodes removed. DFS was calculated using the Kaplan-Meier log rank test for yp N0-3 status, LNR categories (LNRC) ≤0.20 (low), 0.21-0.65 (intermediate), >0.65 (high), and single LNR values. RESULTS Of 428 NAC recipients, 263 were node negative and 165 (38.6 %) node positive: ypN1 = 97 (58.8 %), ypN2 = 43 (26.1 %), and ypN3 = 25 (15.2 %). Among node-positive cancers, the median number of LN removed was 14 (range, 6-51) and the median LNR was 0.22 (range, 0.03-1.0). Nodal stage was inversely associated with 5-year DFS: 91.5 % (ypN0), 74.5 % (ypN1), 49.8 % (ypN2), and 50.7 % (ypN3) (p < 0.001). LNRC was similarly inversely associated with DFS: 69.1 % (low), 71.4 % (intermediate), 49.3 % (high) (p < 0.001). Significant associations between LNRC and DFS were demonstrated in hormone receptor (HR)-positive and triple negative breast cancer (TNBC) subtypes, p = 0.02 and p = 0.003. A single-value LNR ≤ 0.15 in node-positive, HR-positive (94.1 vs 67.7 %; p = 0.04) and TNBC (94.1 vs 47.8 %; p = 0.001) groups was also significant. CONCLUSIONS Residual nodal disease after NAC, analyzed by LNRC or LNR = 0.15 cutoff value, is prognostic and can discriminate between favorable and unfavorable outcomes for HR-positive and TNBC cancers.
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Affiliation(s)
- Jacqueline Tsai
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Danielle Bertoni
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Melinda L Telli
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Irene L Wapnir
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
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Yamada S, Fujii T, Hirakawa A, Kanda M, Sugimoto H, Kodera Y. Lymph node ratio as parameter of regional lymph node involvement in pancreatic cancer. Langenbecks Arch Surg 2016; 401:1143-1152. [PMID: 27048402 DOI: 10.1007/s00423-016-1412-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 03/17/2016] [Indexed: 12/23/2022]
Abstract
PURPOSE To determine which indicators, anatomical nodal metastasis (Japan Pancreas Society, JPS), number of positive lymph nodes (PLN), or lymph node ratio (LNR), is the best means of assessing lymph node involvement in pancreatic cancer. METHODS This retrospective study analyzed 275 patients with pancreatic cancer treated at a single institution. Survival curves according to the JPS, PLN, or LNR were assessed by the Kaplan-Meier method. Prognostic value of each classification was explored by Cox regression analysis after adjustments for clinical factors. RESULTS Multivariate analysis showed that, relative to n0 in the JPS, hazard ratios (HR) in n1, n2, and n3 were 1.72, 1.73, and 2.75, respectively, with no difference in survival between n1 and n2. Relative to PLN of 0, the HR in the PLN categories of 1∼2, 3, and >3 were 1.39, 1.65, and 3.03, respectively. Relative to LNR of 0, the HR in the categories of 0 < LNR ≤ 0.1, 0.1 < LNR ≤ 0.2, and LNR > 0.2 were 1.27, 2.00, and 5.58, respectively. An incremental increase in the HR was observed as the LNR category progressed, and differences between the survivals were distinct when stratified by the LNR. CONCLUSIONS The LNR was an accurate predictor of survival among three assessment strategies and could be proposed as a candidate for use as N categories, pending validation studies.
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Affiliation(s)
- Suguru Yamada
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Tsutomu Fujii
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Akihiro Hirakawa
- Biostatistics Section, Center for Advanced Medicine and Clinical Research, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Mitsuro Kanda
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Hiroyuki Sugimoto
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
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18
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Fleming ND, Soliman PT, Westin SN, dos Reis R, Munsell M, Klopp AH, Frumovitz M, Nick AM, Schmeler K, Ramirez PT. Impact of Lymph Node Ratio and Adjuvant Therapy in Node-Positive Endometrioid Endometrial Cancer. Int J Gynecol Cancer 2015; 25:1437-44. [PMID: 26332387 PMCID: PMC4581897 DOI: 10.1097/igc.0000000000000510] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To determine if the ratio of positive to negative lymph nodes, or lymph node ratio (LNR), is a prognostic variable in patients with node-positive endometrial cancer and the impact of adjuvant therapy on survival. METHODS After institutional review board approval, a retrospective review of patients diagnosed as having stage IIIC endometrioid or mixed endometrioid endometrial cancer at a single institution from January 2000 through October 2011 was performed. Clinicopathologic and adjuvant treatment data were collected. Univariate and multivariate analysis were used to identify prognostic factors for progression-free (PFS) and overall survival. RESULTS One hundred twenty-four patients with stage IIIC1 (n = 64) and IIIC2 (n = 60) endometrial cancer were included in the analysis. Median age was 60 years (range, 25-84 years), and median follow-up was 49.4 months (range, 0.1-301.6 months). Age >70 years was identified as a prognostic factor for worse PFS (P = 0.0002) and overall survival (P = 0.0002) on multivariate analysis. Patients in this cohort receiving any adjuvant radiotherapy showed improved PFS (hazard ratio [HR], 0.34; 95% CI, 0.13-0.90; P = 0.03) compared with those receiving any adjuvant chemotherapy (HR, 2.33; 95% CI, 1.16-4.65; P = 0.02). In a subgroup analysis, patients with at least 10 nodes removed (n = 81) with an LNR greater than 50% had a PFS of 25.2 months compared with 135.6 months with an LNR of 50% or less (HR, 3.87; 95% CI, 1.15-13.04; P = 0.03). CONCLUSIONS Lymph node ratio may define a subgroup of stage IIIC endometrial cancers at increased risk for recurrence. Adjuvant radiotherapy was associated with decreased recurrence risk.
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Affiliation(s)
- Nicole D. Fleming
- Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Pamela T. Soliman
- Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Shannon N. Westin
- Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Ricardo dos Reis
- Department of Gynecologic Oncology, Hospital de Cancer de Barretos, Sao Paulo, Brazil
| | - Mark Munsell
- Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Ann H. Klopp
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Michael Frumovitz
- Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Alpa M. Nick
- Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Kathleen Schmeler
- Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
| | - Pedro T. Ramirez
- Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
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Turker I, Arslan UY, Yazici O, Uyeturk U, Oksuzoglu B, Budakoglu B, Özdemir N, Sonmez OU, Helvaci K, Esbah O, Bal O, Ekinci AS, Zengin N. Prognostic Factors in Operated Stage IIIC, Pathological N3a Breast Cancer Patients. ACTA ACUST UNITED AC 2015; 9:421-7. [PMID: 25759625 DOI: 10.1159/000366438] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The aim of this retrospective study was to evaluate the prognostic factors in patients operated for stage IIIC breast carcinoma who had > 10 positive axillary lymph nodes (pN3a). PATIENTS AND METHODS The medical records of 302 operated N3a breast cancer patients without distant metastasis followed up in 2 medical oncology clinics in Ankara between January 1998 and June 2013 were evaluated retrospectively. RESULTS The median age was 50 (21-83) years. The median follow-up time was 43 (5-191) months. The patients were divided into 4 subgroups according to hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status. There were 151 (50.0%) patients in the HR+/HER2- group, 80 (26.5%) patients in the HR+/HER2+ group, 42 (13.9%) patients in the HR-/HER2+ group, and 29 (9.6%) patients in the triple negative (TN) group. At the time of analysis, 155 (51.3%) patients had recurrent disease and 117 (38.7%) patients had died. The median disease-free survival (DFS) and overall survival (OS) times were 46.0 and 78.0 months, respectively. Both the DFS and OS in the HR+/HER2- group were longer than in the other groups (log-rank p = 0.034 and p = 0.016, respectively). Menopausal status, progesterone receptor (PgR) status, and lymph node ratio (LNR; defined as the number of positive lymph nodes compared to the total number of removed lymph nodes) were found to be independent prognostic factors (p = 0.019, p = 0.001, and p = 0.012, respectively). CONCLUSION Menopausal status, PgR status, and LNR were independent prognostic factors in operated N3a breast cancer patients, who are underrepresented in breast cancer trials.
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Affiliation(s)
- Ibrahim Turker
- Medical Oncology Department, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Ulku Y Arslan
- Medical Oncology Department, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Ozan Yazici
- Medical Oncology Department, Ankara Numune Training and Research Hospital, Turkey
| | - Ummugul Uyeturk
- Medical Oncology Department, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Berna Oksuzoglu
- Medical Oncology Department, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Burcin Budakoglu
- Medical Oncology Department, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Nuriye Özdemir
- Medical Oncology Department, Ankara Numune Training and Research Hospital, Turkey
| | - Ozlem U Sonmez
- Medical Oncology Department, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Kaan Helvaci
- Medical Oncology Department, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Onur Esbah
- Medical Oncology Department, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Oznur Bal
- Medical Oncology Department, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Ahmet S Ekinci
- Medical Oncology Department, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Nurullah Zengin
- Medical Oncology Department, Ankara Numune Training and Research Hospital, Turkey
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Jayasinghe UW, Pathmanathan N, Elder E, Boyages J. Prognostic value of the lymph node ratio for lymph-node-positive breast cancer- is it just a denominator problem? SPRINGERPLUS 2015; 4:121. [PMID: 25815246 PMCID: PMC4366431 DOI: 10.1186/s40064-015-0865-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 01/29/2015] [Indexed: 11/15/2022]
Abstract
Purpose To examine the prognostic value of lymph node ratio (LNR) for patients with node-positive breast cancer with varying numbers of minimum nodes removed (>5, > 10 and > 15 total node count). Methods This study examined the original histopathological reports of 332 node-positive patients treated in the state of New South Wales (NSW), Australia between 1 April 1995 and 30 September 1995. The LNR was defined as the number of positive lymph nodes (LNs) over the total number of LNs removed. The LNR cutoffs were defined as low-risk, 0.01–0.20; intermediate-risk, 0.21– 0.65; and high-risk, LNR >0.65. Results The median follow-up was 10.3 years. In multivariate analysis, LNR was an independent predictor of 10-year breast cancer specific survival when > 5 nodes were removed. However, LNR was not an independent predictor when > 15 nodes were removed. In a multivariate analysis the relative risk of death (RR) decreased from 2.20 to 1.05 for intermediate-risk LNR and from 3.07 to 2.64 for high-risk while P values increased from 0.027 to 0.957 for intermediate-risk LNR and 0.018 to 0.322 for high-risk with the number of nodes removed increasing from > 5 to > 15. Conclusions Although LNR is important for patients with low node denominators, for patients with macroscopic nodal metastases in several nodes following an axillary dissection who have more than 15 nodes dissected, the oncologist can be satisfied that prognosis, selection of adjuvant chemotherapy and radiotherapy fields can be based on the numerator of the positive nodes. Electronic supplementary material The online version of this article (doi:10.1186/s40064-015-0865-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Upali W Jayasinghe
- Westmead Breast Cancer Institute, Westmead, New South Wales Australia ; Faculty of Medicine, University of New South Wales, Sydney, New South Wales Australia
| | | | - Elisabeth Elder
- Westmead Breast Cancer Institute, Westmead, New South Wales Australia
| | - John Boyages
- Macquarie University Cancer Institute, Macquarie University, North Ryde, New South Wales Australia
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Kiriyama M, Ebata T, Aoba T, Kaneoka Y, Arai T, Shimizu Y, Nagino M. Prognostic impact of lymph node metastasis in distal cholangiocarcinoma. Br J Surg 2015; 102:399-406. [PMID: 25611179 DOI: 10.1002/bjs.9752] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/13/2014] [Accepted: 11/18/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND The aim of the study was to investigate the prognostic impact of lymph node metastasis in cholangiocarcinoma using three different classifications. METHODS Patients who underwent pancreaticoduodenectomy for distal cholangiocarcinoma in 24 hospitals in Japan between 2001 and 2010 were included. Survival was calculated by means of the Kaplan-Meier method and differences between subgroups were assessed with the log rank test. The Cox proportional hazards model was used to identify independent predictors of survival. χ(2) scores were calculated to determine the cut-off value of the number of involved nodes, lymph node ratio (LNR) and total lymph node count (TLNC) for discriminating survival. RESULTS Some 370 patients were included. The median (range) TLNC was 19 (3-59). Nodal metastasis occurred in 157 patients (42·4 per cent); the median (range) number of involved nodes and LNR were 2 (1-19) and 0·11 (0·02-0·80) respectively. Four or more involved nodes was associated with a significantly shorter median survival (1·3 versus 2·2 years; P = 0·001), as was a LNR of at least 0·17 (1·4 versus 2·3 years; P = 0·002). Involvement of nodes along the common hepatic artery, present in 21 patients (13·4 per cent), was also associated with a shorter survival (median 1·3 versus 2·1 years; P = 0·046). Multivariable analysis among 157 node-positive patients identified the number of involved nodes as an independent prognostic factor (risk ratio 1·87; P = 0·002). CONCLUSION The number of involved nodes was a strong predictor of survival in patients with distal cholangiocarcinoma.
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Affiliation(s)
- M Kiriyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Fleming ND, Frumovitz M, Schmeler KM, dos Reis R, Munsell MF, Eifel PJ, Soliman PT, Nick AM, Westin SN, Ramirez PT. Significance of lymph node ratio in defining risk category in node-positive early stage cervical cancer. Gynecol Oncol 2015; 136:48-53. [PMID: 25451695 PMCID: PMC4430191 DOI: 10.1016/j.ygyno.2014.11.010] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/08/2014] [Accepted: 11/11/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The ratio of positive to negative lymph nodes, or lymph node ratio (LNR), is an important prognostic factor in several solid tumors. The objective of this study was to determine if LNR can be used to define a high-risk category of patients with node-positive early stage cervical cancer. METHODS We performed a retrospective review of patients diagnosed with node-positive stage I or II cervical cancer who underwent radical hysterectomy and pelvic +/- para-aortic lymphadenectomy at MD Anderson from January 1990 to December 2011. Univariate and multivariate analyses were used to identify prognostic factors for progression-free (PFS) and overall survival (OS). RESULTS Ninety-five patients met the inclusion criteria and were included in the analysis. Median total nodes removed were 19 (range 1-58), and median number of positive nodes was 1 (range 1-12). Fifty-eight patients (61%) received radiation with concurrent cisplatin and 27 patients (28%) received radiotherapy alone. Twenty-one (22%) patients recurred. On multivariate analysis, a LNR > 6.6% was associated with a worse PFS (HR = 2.97, 95% CI 1.26-7.02, p = 0.01), and a LNR > 7.6% with a worse OS (HR = 3.96, 95% CI 1.31-11.98, p = 0.01). On multivariate analysis, positive margins were associated with worse PFS (p = 0.001) and OS (p = 0.002), and adjuvant radiotherapy (p = 0.01) with improved OS. CONCLUSIONS LNR appears to be a useful tool to identify patients with worse prognosis in node-positive early stage cervical cancer. LNR may be used in addition to pathologic risk factors to tailor adjuvant treatment in this population.
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Affiliation(s)
- Nicole D Fleming
- Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, United States.
| | - Michael Frumovitz
- Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, United States
| | - Kathleen M Schmeler
- Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, United States
| | - Ricardo dos Reis
- Department of Gynecologic Oncology, Hospital de Cancer de Barretos, Sao Paulo, Brazil
| | - Mark F Munsell
- Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, United States
| | - Patricia J Eifel
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, United States
| | - Pamela T Soliman
- Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, United States
| | - Alpa M Nick
- Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, United States
| | - Shannon N Westin
- Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, United States
| | - Pedro T Ramirez
- Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, United States
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Ataseven B, Kümmel S, Weikel W, Heitz F, Holtschmidt J, Lorenz-Salehi F, Kümmel A, Traut A, Blohmer J, Harter P, du Bois A. Additional prognostic value of lymph node ratio over pN staging in different breast cancer subtypes based on the results of 1,656 patients. Arch Gynecol Obstet 2014; 291:1153-66. [PMID: 25367604 DOI: 10.1007/s00404-014-3528-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 10/22/2014] [Indexed: 12/01/2022]
Abstract
PURPOSE Although the impact of lymph node ratio (LNR: ratio of metastatic to resected LNs) in breast cancer (BC) has been investigated, its prognostic value in molecular subtypes remains unclear. Our aim was to evaluate the impact of LNR compared to pN-stage in BC subtypes. PATIENTS/METHODS We analyzed the impact of LNR and pN-stage on disease-free (DFS) and overall survival (OS) in 1,656 patients with primary BC who underwent primary axillary surgery (removal of ≥10 LNs) between 1998 and 2011. The cut-off points for LNR were previously published. Using immunohistochemical parameters tumors were grouped in luminalA, luminalB/HER2-, luminalB/HER2+, HER2+ and triple negative (TNBC). RESULTS For the entire cohort 5/10-year DFS and OS rates were 88/77% and 88/75%, respectively. LNR and pN-stage were independent prognostic parameters for DFS/OS in multivariate analysis in the entire cohort and each molecular subgroup (p < 0.001). However, increasing LNR seemed to discriminated 10-year DFS slightly better than pN-stage in luminalA (intermediate/high LNR 65/44% versus pN2/pN3 71/53%), luminalB/HER2- (intermediate/high LNR 48/24% versus pN2/pN3 41/42%), and TNBC patients (intermediate/high LNR 49/24% versus pN2/pN3 56/33%). CONCLUSIONS LNR is an important prognostic parameter for DFS/OS and might provide potentially more information than pN-stage in different molecular subtypes.
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Affiliation(s)
- B Ataseven
- Department of Gynecology and Gynecologic Oncology, Evangelische Huyssens-Stiftung, Kliniken Essen-Mitte, Essen, Germany,
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van Wely BJ, de Wilt JHW, Francissen C, Teerenstra S, Strobbe LJA. Meta-analysis of ultrasound-guided biopsy of suspicious axillary lymph nodes in the selection of patients with extensive axillary tumour burden in breast cancer. Br J Surg 2014; 102:159-68. [DOI: 10.1002/bjs.9663] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 04/15/2014] [Accepted: 09/01/2014] [Indexed: 11/07/2022]
Abstract
Abstract
Background
Recent studies show that not all patients with breast cancer and positive axillary lymph nodes need additional axillary surgery. A systematic review and meta-analysis of the literature was performed to test the hypothesis that ultrasound-guided biopsy of suspicious nodes can be a useful tool to identify patients with extensive axillary tumour burden.
Methods
PubMed and Embase were searched to identify articles reporting on ultrasound-guided techniques to stage the axilla of patients with breast cancer. The emphasis was to study the number of positive nodes found after axillary lymph node dissection (ALND) following a positive ultrasound-guided biopsy or a positive sentinel lymph node biopsy (SLNB). Information regarding the number of positive nodes thus had to be available. Results were tested for heterogeneity and a meta-analysis was performed.
Results
A total of 894 articles were identified, and 115 were selected based on title and abstract information by two independent reviewers. After extensive review, 18 articles were eligible for analysis. Eight studies reported sufficient data to perform a meta-analysis comparing 532 patients with a positive ultrasound-guided biopsy with 248 patients with a negative ultrasound-guided biopsy but a positive SLNB. The number of involved nodes was significantly higher in patients in whom axillary metastasis was detected by ultrasound-guided biopsy (P < 0·001). No heterogeneity in the observed effect was found (I2 = 22 per cent, P = 0·26).
Conclusion
Patients with breast cancer in whom axillary metastases are detected by ultrasound-guided biopsy have significantly more involved nodes than SLNB-positive patients. This finding enables further preoperative tailoring of axillary treatment in breast cancer.
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Affiliation(s)
- B J van Wely
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - J H W de Wilt
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - C Francissen
- Department of Surgery, Geldersche Vallei Hospital, Ede, The Netherlands
| | - S Teerenstra
- Section of Biostatistics, Department of Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - L J A Strobbe
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
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The Association between Survival and the Pathologic Features of Periampullary Tumors Varies over Time. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2014; 2014:890530. [PMID: 25104878 PMCID: PMC4102018 DOI: 10.1155/2014/890530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 06/15/2014] [Indexed: 02/07/2023]
Abstract
Introduction. Several histopathologic features of periampullary tumors have been shown to be correlated with prognosis. We evaluated their association with mortality at multiple time points. Methods. A retrospective chart review identified 207 patients with periampullary adenocarcinomas who underwent pancreaticoduodenectomy between January 1, 2001 and December 31, 2009. Clinicopathologic features were assessed, and the data were analyzed using univariate and multivariate methods. Results. In univariate analysis, perineural invasion had a strong association with 1-year mortality (OR 3.03, CI 1.42–6.47), and one lymph node (LN) increase in the LN ratio (LNR) equated with a 5-fold increase in mortality. In contrast, LN status (OR 6.42, CI 3.32–12.41) and perineural invasion (OR 5.44, CI 2.81–10.52) had the strongest associations with mortality at 3 years. Using Cox proportional hazards, perineural invasion (HR 2.61, CI 1.77–3.85) and LN status (HR 2.69, CI 1.84–3.95) had robust associations with overall mortality. Recursive partitioning analysis identified LNR as the most important risk factor for mortality at 1 and 3 years. Conclusions. Overall mortality was closely related to the LNR within the first year, while longer follow-up periods demonstrated a stronger association with perineural invasion and overall LN status. Therefore, the current staging for periampullary tumors may need to be updated to include the LNR.
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Abstract
Many of the surgical quality measures currently in use are not disease specific. For thyroid cancer, mortality and even recurrence are difficult to measure since mortality is rare and recurrence can take decades to occur. Therefore, there is a critical need for quality indicators in thyroid cancer surgery that are easily measured and disease specific. Here we will review recent research on two potential quality indicators in thyroid cancer surgery. The uptake percentage on postoperative radioactive iodine scans indicates the completeness of resection. Another measure, the lymph node ratio, is the proportion of metastatic nodes to the total number of nodes dissected. This serves as a more global measure of quality since it indicates not only the completeness of lymph node dissection but also the preoperative lymph node evaluation and decision-making. Together, these two quality measures offer a more accurate, disease-specific oncologic indicator of quality that can help guide quality assurance and improvement.
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Hua YH, Hu QY, Piao YF, Tang Q, Fu ZF. Effect of number and ratio of positive lymph nodes in hypopharyngeal cancer. Head Neck 2014; 37:111-6. [PMID: 24347492 DOI: 10.1002/hed.23574] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 09/09/2013] [Accepted: 12/10/2013] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The number and ratio of positive lymph nodes are important prognostic factors in gastric cancer, but there is little data reported in hypopharyngeal cancer. METHODS Medical data from 81 patients with hypopharyngeal cancer undergoing radical hypopharyngectomy and cervical lymph node dissection were reviewed. RESULTS The median survival time was 84, 54, 30, and 13 months in patients with N0, N1, N2, and N3, respectively, and 84, 51, and 17 months with positive lymph node ratios (N ratio) 0, <10%, and >10%, respectively. Of the 24 N1 patients, the 20 patients that had an N ratio <10% had a better prognosis than the 4 patients with an N ratio >10%. Similar data was seen for the N2 patients. Tumor (T) classification, adjuvant therapy, and N ratio were independent prognostic factors in multivariate analysis. CONCLUSION The positive lymph node ratio is complementary to the current N classification system.
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Affiliation(s)
- Yong-hong Hua
- Head and Neck Cancer Center, Zhejiang Cancer Hospital, Hangzhou, China
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Wang LP, Wang HY, Cao R, Zhu C, Wu XZ. Proposal of a new classification for stage III colorectal cancer based on the number and ratio of metastatic lymph nodes. World J Surg 2013. [PMID: 23385643 DOI: 10.1007/s00268013-1940-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The objective of this retrospective study was to determine whether the current staging system for stage III colorectal cancer (CRC) is appropriate and to assess the value of the metastatic lymph node ratio (LNR) in predicting the prognosis of patients with stage III CRC. METHODS From 2000 to 2006 inclusively, 245 patients with stage III CRC underwent curative resection. The follow-up was closed in March 2012. Kaplan-Meier survival curves and log-rank tests were used for the survival analysis. RESULTS Survival time of patients with T3N1M0 was significantly better than that for patients in other subgroups of stage IIIB and similar to that of patients with stage IIIA disease. The greatest survival difference was found with 0.30 as the LNR cutoff point for patients with current stage III CRC. Survival time of patients with LNR ≤ 0.30 was significantly better than that of those with LNR > 0.30. rN1 included stage III patients with LNR ≤ 0.30, and rN2 included patients with LNR > 0.30. Survival time of patients with T4aN1(rN2)M0 staging was significantly worse than that for patients with T4aN1(rN1)M0 staging and similar to that of patients with stage IIIC CRC. CONCLUSIONS We propose an algorithm to incorporate LNR into the current American Joint Committee on Cancer staging system. In it the patients with T3N1M0 are excluded from the current stage IIIB and included in the stage IIIA group. Also, patients with T4aN1(rN2)M0 are excluded from the current stage IIIB group and included in the stage IIIC group.
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Affiliation(s)
- Li-Ping Wang
- Department of Zhong-Shan-Men In-patient, Tianjin Medical University Cancer Institute and Hospital, Huan-Hu-Xi Road, He-Xi District, Tianjin 300171, China
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Wiznia LE, Lannin DR, Evans SB, Hofstatter EW, Horowitz NR, Killelea BK, Tsangaris TN, Chagpar AB. The number of lymph nodes dissected in breast cancer patients influences the accuracy of prognosis. Ann Surg Oncol 2013; 21:389-94. [PMID: 24132625 DOI: 10.1245/s10434-013-3308-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Recent trials have suggested that axillary node dissection may not be warranted in some breast cancer patients with one to two positive nodes. Given that lymph node ratio (LNR; number of positive lymph nodes divided by the total examined) has been shown to be a significant prognostic factor, we sought to determine whether the number of nodes removed in this low risk population predicted survival. METHODS The National Cancer Database is a comprehensive clinical surveillance resource capturing 70% of newly diagnosed malignancies in the United States; 309,216 breast cancer patients diagnosed between 1998 and 2005, with tumors ≤5 cm and one to two positive nodes, formed the cohort of interest. RESULTS Median age at diagnosis was 57 (range 18-90) years. Median tumor size was 2 (range 0.1-5) cm; 215,382 patients (69.7%) had one positive node, and 93,834 (30.3%) had two. The median number of lymph nodes examined was 11 (range 1-84). Patients were categorized into low (≤0.2), medium (0.21-0.65), or high (>0.65) LNR groups, with 228,822 (74%), 55,797 (18%), and 24,597 (8%) patients in each of these categories, respectively. Median follow-up was 54.1 months. Median overall survival (OS) for low, intermediate, and high LNR was 66.1, 61.1, and 56.5 months, respectively (p < 0.001). In a Cox model controlling for clinicopathologic and therapy covariates, LNR category remained a significant predictor of OS (p < 0.001). CONCLUSIONS LNR is an independent predictor of OS in a low-risk population with one to two positive nodes and tumors ≤5 cm. Therefore, the number of lymph nodes excised may influence prognostic stratification.
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Affiliation(s)
- Lauren E Wiznia
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA,
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30
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Wang LP, Wang HY, Cao R, Zhu C, Wu XZ. Proposal of a new classification for stage III colorectal cancer based on the number and ratio of metastatic lymph nodes. World J Surg 2013; 37:1094-102. [PMID: 23385643 DOI: 10.1007/s00268-013-1940-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The objective of this retrospective study was to determine whether the current staging system for stage III colorectal cancer (CRC) is appropriate and to assess the value of the metastatic lymph node ratio (LNR) in predicting the prognosis of patients with stage III CRC. METHODS From 2000 to 2006 inclusively, 245 patients with stage III CRC underwent curative resection. The follow-up was closed in March 2012. Kaplan-Meier survival curves and log-rank tests were used for the survival analysis. RESULTS Survival time of patients with T3N1M0 was significantly better than that for patients in other subgroups of stage IIIB and similar to that of patients with stage IIIA disease. The greatest survival difference was found with 0.30 as the LNR cutoff point for patients with current stage III CRC. Survival time of patients with LNR ≤ 0.30 was significantly better than that of those with LNR > 0.30. rN1 included stage III patients with LNR ≤ 0.30, and rN2 included patients with LNR > 0.30. Survival time of patients with T4aN1(rN2)M0 staging was significantly worse than that for patients with T4aN1(rN1)M0 staging and similar to that of patients with stage IIIC CRC. CONCLUSIONS We propose an algorithm to incorporate LNR into the current American Joint Committee on Cancer staging system. In it the patients with T3N1M0 are excluded from the current stage IIIB and included in the stage IIIA group. Also, patients with T4aN1(rN2)M0 are excluded from the current stage IIIB group and included in the stage IIIC group.
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Affiliation(s)
- Li-Ping Wang
- Department of Zhong-Shan-Men In-patient, Tianjin Medical University Cancer Institute and Hospital, Huan-Hu-Xi Road, He-Xi District, Tianjin 300171, China
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Lawn AM, Frampton AE, Krell J, Waheed S, Stacey-Clear A. Lymph node ratio can further stratify prognosis in subpopulations of breast cancer patients with axillary nodal metastases. Future Oncol 2013; 9:1425-31. [DOI: 10.2217/fon.13.154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Evaluation of: Dings PJ, Elferink MA, Strobbe LJ, de Wilt JH. The prognostic value of lymph node ratio in node-positive breast cancer: a Dutch nationwide population-based study. Ann. Surg. Oncol. 20(8), 2607–2614 (2013). Breast cancer (BC) is the most common cancer in women worldwide and affects one in eight women in the UK at some point in their lifetime. Advances in treatment have led to greatly improved survival rates. Management of axillary lymph node (LN) metastases has been a controversial but evolving area of BC therapy. Positive LN status is of vital importance in determining long-term outcomes. Recent studies have shown that it is not only the absolute number of involved LNs, but also the ratio of metastatic to examined LNs (or LN ratio [LNR]) that confers prognostic information. In the evaluated article, a population-wide study was performed to elucidate the influence of LNR on mortality risk in Dutch BC patients. LNR was an independent prognostic factor, but was not better than current tumor, node, metastasis pathological nodal staging. It was, however, able to discriminate subpopulations within pathological nodal categories. In this article we examine the use of LNR in BC.
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Affiliation(s)
- Anneliese M Lawn
- Department of Breast Surgery, St Georges’ Hospital NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - Adam E Frampton
- Department of Surgery & Cancer, Imperial Centre for Translational & Experimental Medicine, Imperial College, Hammersmith Hospital campus, Du Cane Road, London, W12 0NN, UK
| | - Jonathan Krell
- Department of Surgery & Cancer, Imperial Centre for Translational & Experimental Medicine, Imperial College, Hammersmith Hospital campus, Du Cane Road, London, W12 0NN, UK
| | - Shamaela Waheed
- Department of Breast & Endocrine Surgery, East Surrey Hospital, Canada Avenue, Redhill, Surrey, RH1 5RH, UK
| | - Adam Stacey-Clear
- Department of Breast & Endocrine Surgery, East Surrey Hospital, Canada Avenue, Redhill, Surrey, RH1 5RH, UK
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Is there different correlation with prognostic factors between “non-mass” and “mass” type invasive ductal breast cancers? Eur J Radiol 2013; 82:1404-9. [DOI: 10.1016/j.ejrad.2013.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 02/17/2013] [Accepted: 03/04/2013] [Indexed: 11/17/2022]
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Koca E, Kuzan TY, Dizdar O, Babacan T, Sahin I, Ararat E, Altundag K. Outcomes of locally advanced breast cancer patients with ≥ 10 positive axillary lymph nodes. Med Oncol 2013; 30:615. [PMID: 23729267 DOI: 10.1007/s12032-013-0615-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 05/17/2013] [Indexed: 11/30/2022]
Abstract
Breast cancers with 10 or more positive lymph nodes at the time of diagnosis are staged as pathological N3a (pN3a) and they have poor prognosis. Recent studies showed five-year disease-free survival (DFS) and overall survival (OS) rates of N3a disease as 43-66 and 58-81 %, respectively. We herein present outcomes of our patients with stage pN3a breast cancer. Among 2,578 patients diagnosed with invasive breast carcinoma at Hacettepe University Hospital between 2002 and 2012, 218 patients (8.4 %) had pN3a disease and were included and analyzed retrospectively in this study. Patients with internal mammary, infraclavicular, and supraclavicular node metastasis or distant metastasis at initial diagnosis were excluded. Demographic features, tumor characteristics, treatment regimens, and patient outcomes in terms of DFS and OS were analyzed. Lymph node ratio was defined as the ratio of positive to total removed lymph nodes. The median age was 49. Most common histological subtype was ductal carcinoma (82.1 %). About 82.6 % of patients had stage T2/T3 cancers and 47.7 % (104) had grade III cancers. Estrogen and progesterone receptors were positive in 133 (61 %) and 121 (55.5 %) patients, respectively. HER2 status was known for 213 patients and was positive in 87 (39.9 %) patients. A total of 27 (12.6 %) patients had triple-negative tumors. Lymphovascular invasion, extracapsular extension, and perineural invasion were present in 106 (48.6 %), 105 (48.2 %), 20 (9.2 %) cases, respectively. A total of 18 patients (8.3 %) received neoadjuvant and 200 patients (91.7 %) received adjuvant chemotherapy, mostly with anthracycline- (95 %) and taxane (60 %)-containing regimens. A total of 210 patients (96.3 %) received radiotherapy. Median follow-up was 39.5 months. A total of 96 patients relapsed on follow-up and 64 patients died. Nineteen of the relapses were locoregional and 77 were distant relapses. The 5-year DFS rate was 46.2 % and the OS rate was 69.8 %. In multivariate Cox regression analysis, grade III disease (HR 1.899, 95 % CI 1.196-3.017, P = 0.007), perineural invasion (HR 2.519, 95 % CI 1.341-4.731, P = 0.004), and lymph node ratio (≥ 0.9 vs. <0.9) (HR 2.290, 95 % CI 1.368-3.835, P = 0.002) were significantly associated with DFS, and grade III disease (HR 2.679, 95 % CI 1.500-4.782, P = 0.001) and lymph node ratio (≥ 0.9 vs. <0.9) (HR 2.182, 95 % CI 1.211-3.932, P = 0.009) were significantly associated with OS. Patients with pN3a disease in our cohort have comparable survival rates with other reports in the literature. Within this high risk group of patients, those with grade III disease, perineural invasion, and lymph node ratio ≥ 0.9 seem to confer poorer prognosis.
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Affiliation(s)
- Emre Koca
- Hacettepe University Cancer Institute, Ankara, Turkey
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Dings PJM, Elferink MAG, Strobbe LJA, de Wilt JHW. The Prognostic Value of Lymph Node Ratio in Node-Positive Breast Cancer: A Dutch Nationwide Population-Based Study. Ann Surg Oncol 2013; 20:2607-14. [DOI: 10.1245/s10434-013-2932-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Indexed: 12/16/2022]
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Bai LS, Chen C, Gong YP, Wei W, Tu Y, Yao F, Li JJ, Wang LJ, Sun SR. Lymph Node Ratio is More Predictive than Traditional Lymph Node Stratification in Lymph Node Positive Invasive Breast Cancer. Asian Pac J Cancer Prev 2013; 14:753-7. [DOI: 10.7314/apjcp.2013.14.2.753] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Duraker N, Batı B, Çaynak ZC, Demir D. Lymph Node Ratio May Be Supplementary to TNM Nodal Classification in Node-positive Breast Carcinoma Based on the Results of 2,151 Patients. World J Surg 2013; 37:1241-8. [DOI: 10.1007/s00268-013-1965-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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37
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The lymph node ratio has limited prognostic significance in melanoma. J Surg Res 2013; 179:10-7. [DOI: 10.1016/j.jss.2012.08.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 07/30/2012] [Accepted: 08/24/2012] [Indexed: 11/19/2022]
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Schneider DF, Chen H, Sippel RS. Impact of lymph node ratio on survival in papillary thyroid cancer. Ann Surg Oncol 2012; 20:1906-11. [PMID: 23263904 DOI: 10.1245/s10434-012-2802-8] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND In papillary thyroid cancer, the role of lymph node dissection remains controversial, and staging systems consider metastatic lymph nodes as a binary entity. The purpose of this study was to determine a threshold lymph node ratio (LNR) that impacted disease-specific mortality (DSM). METHODS We utilized the surveillance, epidemiology, and end results (SEER) database to analyze adult patients who underwent thyroidectomy with lymph node dissection. A LNR (metastatic lymph nodes to total lymph nodes) was calculated after eliminating patients with less than three nodes collected. Kaplan-Meier estimates for DSM were plotted for LNRs and compared by the log rank test. The Cox proportional hazards model was used to evaluate LNR with other known clinical and pathologic determinants of prognosis. RESULTS A total of 10,955 cases contained data on lymph nodes. Median follow-up time was 25 months (range 0-59 months), and the mean LNR was 0.28 ± 0.37. After comparing Kaplan-Meier survival estimates and overall DSM rates, we found that a LNR ≥0.42 best divided those with lymph node metastasis based on DSM (p < 0.01). Those with a LNR ≥0.42 experienced a DSM rate of 1.72 % while those with a LNR <0.42 had a DSM rate of 0.65 % (p < 0.01). In addition, patients with a LNR ≥0.42 experienced a 77 % higher DSM rate compared to those with metastatic lymph nodes as a whole. When considered with other known determinants of prognosis, we found that LNR was strongly associated with DSM (hazard ratio 4.33, 95 % confidence interval 1.68-11.18, p < 0.01). CONCLUSIONS LNR is a strong determinant of DSM, and a threshold LNR of 0.42 can be used to risk-stratify patients with metastatic lymph nodes.
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Affiliation(s)
- David F Schneider
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA
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Wang F, He W, Qiu H, Wang X, Guo G, Chen X, Rong Y, Zhou F, Yin C, Yuan Z, Xia L. Lymph Node Ratio and pN Staging Show Different Superiority As Prognostic Predictors Depending on the Number of Lymph Nodes Dissected in Chinese Patients With Luminal A Breast Cancer. Clin Breast Cancer 2012; 12:404-11. [DOI: 10.1016/j.clbc.2012.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 05/16/2012] [Accepted: 07/09/2012] [Indexed: 12/18/2022]
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Yang C, Liu F, Li S, Li W, Zhai L, Ren M, Li Y, Lang R, Fan Y, Zhang X, Fu L. Lymph Node Ratio. Int J Surg Pathol 2012; 20:546-54. [PMID: 22736300 DOI: 10.1177/1066896912451323] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
St. Gallen 2005 expert consensus guideline modified its criteria for the risk category of breast cancer (BC) patients by integrating a combination of lymph nodes with metastasis (positive lymph nodes [PLNs]) and HER-2/neu status of tumor. Recently, some studies have shown that lymph node ratio (LNR), defined as the ratio of axillary lymph nodes with tumor metastasis to the total lymph nodes dissected, was a better independent prognostic indicator than PLN and should be considered as an alternative to the status of regional lymph nodes in the staging of breast cancer (pN). In the current study, the authors retrospectively reviewed 1095 primary BC patients with PLN and assessed the prognostic effect of LNR measured by relapse-free survival and overall survival to explore the feasibility of LNR and HER-2/neu status in stratifying the risk category of BC. Our results indicate that although by univariate analysis and when assessed as single covariate in multivariate analysis, both PLN and LNR were independent prognostic factors, PLN lost its significance when combined with LNR as covariates. A cutoff value of LNR = 0.30 was identified to show high accuracy in separating patients based on their survivals. The risk categories defined by LNR combined with HER-2/neu status were compatible to those defined by the PLN in combination with HER-2/neu status. LNR was a strong prognostic predictor of node-positive BC patients, superior to PLN. It should be considered as a new factor to couple with HER-2/neu status in defining risk category of BC patients.
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Affiliation(s)
- Cuicui Yang
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Fangfang Liu
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Shuai Li
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Weidong Li
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Lili Zhai
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Meijing Ren
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Yaqing Li
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Ronggang Lang
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Yu Fan
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Xinmin Zhang
- Temple University Hospital, Philadelphia, PA, USA
| | - Li Fu
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
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Bhamidipati CM, Stukenborg GJ, Thomas CJ, Lau CL, Kozower BD, Jones DR. Pathologic lymph node ratio is a predictor of survival in esophageal cancer. Ann Thorac Surg 2012; 94:1643-51. [PMID: 22621876 DOI: 10.1016/j.athoracsur.2012.03.078] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 03/16/2012] [Accepted: 03/21/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND A ratio between pathologic and examined lymph nodes may have predictive relevance in esophageal cancer. We sought to determine the prognostic value of lymph node ratio (LNR) compared with TNM and N stage using the seventh edition American Joint Commission on Cancer and International Union Against Cancer criteria. METHODS We abstracted data from 347 consecutive patients undergoing esophagectomy for esophageal cancer between 1999 and 2010 at our institution. Patients were stratified into surgery alone or induction therapy followed by surgery. Kaplan-Meier and Cox proportional hazard models estimated the survival function using LNR as a continuous variable or categorized into 0, more than 0.0 to less than 0.1, 0.1 to less than 0.2, 0.2 to less than 0.3, and 0.3 or greater. The influence of LNR on survival was assessed by the Wald χ(2) statistic and survival plots. RESULTS A total of 173 patients (49.9%) underwent induction therapy. The pathologic complete response rate was 55 of 173 (32%). The median number of examined nodes in surgery alone was 14 (interquartile range, 8 to 21), and induction was 12 (interquartile range, 7 to 17). Patients with nodal disease (n = 137) had a median LNR of 0.2 with equivalent survival regardless of induction therapy. Examination of LNR as a continuous variable demonstrated that LNR is an independent predictor of survival in both groups. After categorization, LNR contributed more toward estimating survival than pN stage in both groups. CONCLUSIONS Lymph node ratio is an independent predictor of survival in patients undergoing esophagectomy for esophageal cancer. The LNR makes a greater contribution in estimating overall survival than pN stage, regardless of the utilization of induction therapy.
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Affiliation(s)
- Castigliano M Bhamidipati
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA 22908-0679, USA
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Huebner M, Kendrick M, Reid-Lombardo KM, Que F, Therneau T, Qin R, Donohue J, Nagorney D, Farnell M, Sarr M. Number of lymph nodes evaluated: prognostic value in pancreatic adenocarcinoma. J Gastrointest Surg 2012; 16:920-6. [PMID: 22421988 DOI: 10.1007/s11605-012-1853-2] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 02/20/2012] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The impact of the number of lymph node (LN) evaluated pathologically on accurate staging is unknown. Our primary aim was to determine a minimum number of evaluated LN needed to provide accurate staging of pancreatic cancer. METHODS Four hundred ninety-nine patients underwent a curative pancreatectomy for pancreatic adenocarcinoma cancer from 1981-2007. The probability of understaging a patient as N0 was estimated based on the number of LN evaluated. The prognostic value of LN ratio (LNR) was assessed. RESULTS Survival for node-negative (pN0) patients with <11 LN examined was worse than for pN0 patients with ≥11 LNs with a hazard ratio (95 % CI) of 1.33 (1.1-1.7, p = 0.01) with 3-year survivals of 32 vs. 50%, respectively. Three-year survival for pN1 patients with <11 nodes evaluated was similar to pN1 patients with ≥11 nodes (25 vs. 30%). LNR ≥ 0.17 predicted worse survival with hazard ratio of 1.76 (1.3-2.4, p = 0.001) than LNR < 0.17; 3-year survivals were 37 vs. 19%. CONCLUSION Patients with "N0" disease with <11 LN evaluated pathologically have worse survival, suggesting that metastatic nodes were missed by evaluating too few nodes. For pN1 patients, LNR stratifies survival of patient cohorts more accurately. Adequate staging of pancreatic cancer requires pathologic evaluation of ≥11 LNs.
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Affiliation(s)
- Marianne Huebner
- Department of Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
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Rubovszky G, Horváth Z, Tóth E, Láng I, Kásler M. Significance of histomorphology of early triple-negative breast cancer. Pathol Oncol Res 2012; 18:823-31. [PMID: 22415664 DOI: 10.1007/s12253-012-9510-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 02/20/2012] [Indexed: 01/03/2023]
Abstract
UNLABELLED Triple-negative breast cancer (TNBC) is a heterogeneous disease. Possibly genetic characterisation provides the most appropriate information on tumour biology and prognosis, but it is only limitedly available in clinical practice. The aim of this investigation was to explore what additional prognostic information could be gained from detailed histomorphologic report. PATIENTS AND METHOD patients were selected retrospectively operated from 2005 to 2009 in one institution and charts were revised. Beyond age, tumour and nodal status, histologic grade and therapy, the additional pathologic characteristics were also involved in analysis: necrosis, lymphocytic infiltration, peritumoural vascular invasion (PVI), perineural invasion, DCIS extent and grade, perinodal spread, mitotic activity index (MAI). RESULTS 295 early TNBC were involved. In univariate survival analysis with a mean follow-up of 3.57 years the tumour size, the nodal status, type of operation (conservation or mastectomy), irradiation, PVI and perinodal spread proved to be significantly connected with both disease free survival (DFS) and breast cancer specific overall survival (BSOS), and necrosis and chemotherapy with BSOS. Necrosis analysed together with lymphocytic infiltrate showed greater predicting power. In multivariate analysis nodal metastasis, necrosis positive/lymphacytic infiltration negative status and lack of irradiation has significant negative impact on DFS (p = <0.0001 HR:1.98 [1.4-2.77], p = <0.017 HR:2.1 [1.1-3.8], p = <0.001 HR:0.25 [0.11-0.57], respectively) and BSOS (p = <0.0001 HR:2.47 [1.8-3.4], p = <0.017 HR:3.7 [1.6-8.2], p = <0.0017 HR:0.24 [0.1-0.58], respectively). For DFS perivascular invasion also showed significant effect (p = <0.042 HR:2.5 [1.0-6.0]). Nodal status was the strongest prognostic parameter but other histomorphologic parameters can be used for prognosis prediction.
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Han TJ, Kang EY, Jeon W, Kim SW, Kim JH, Kim YJ, Park SY, Kim JS, Kim IA. The prognostic value of the nodal ratio in N1 breast cancer. Radiat Oncol 2011; 6:131. [PMID: 21978463 PMCID: PMC3198692 DOI: 10.1186/1748-717x-6-131] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 10/06/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the nodal ratio (NR) has been recognized as a prognostic factor in breast cancer, its clinical implication in patients with 1-3 positive nodes (N1) remains unclear. Here, we evaluated the prognostic value of the NR and identified other clinico-pathologic variables associated with poor prognosis in these patients. METHODS We analyzed 130 patients with N1 invasive breast cancer who were treated at Seoul National University Bundang Hospital from March 2003 to December 2007. Disease-free survival (DFS), locoregional recurrence-free survival (LRRFS), and distant metastasis-free survival (DMFS) were compared according to the NR with a cut-off value of 0.15. RESULTS We followed patients' recovery for a median duration of 59 months. An NR > 0.15 was found in 23.1% of patients, and a median of 18 nodes were dissected per patient (range 1-59). The NR was statistically independent from other prognostic variables, such as patient age, T stage, extent of surgery, pathologic factors in the chi square test. On univariate analysis, patients with a NR > 0.15 had significantly lower 5-year LRRFS (88.7% vs. 97.9%, p = 0.033) and 5-year DMFS (81.3% vs. 96.4%, p = 0.029) and marginally lower 5-year DFS (81.3% vs. 94.0%, p = 0.069) than those with a NR ≤0.15, respectively. Since the predictive power of the NR was found to differ with diverse clinical and pathologic variables, we performed adjusted analysis stratified by age, pathologic characteristics, and adjuvant treatments. Only young patients with a NR > 0.15 showed significantly lower DFS (p = 0.027) as well as those presenting an unfavorable pathologic profile such as advanced T stage (p = 0.034), histologic grade 3 (p = 0.034), positive lymphovascular invasion (p = 0.037), involved resection margin (p = 0.007), and no chemotherapy (p = 0.014) or regional radiotherapy treatment (p = 0.039). On multivariate analysis, a NR > 0.15 was significantly associated with lower DFS (p = 0.043) and DMFS (p = 0.012), but not LRRFS (p = 0.064). CONCLUSIONS A NR > 0.15 was associated with an increased risk of recurrence, especially in young patients with unfavorable pathologic profiles.
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Affiliation(s)
- Tae Jin Han
- Department of Radiation Oncology, Seoul National University, Bundang Hospital, 166 Gumiro Seongnamsi Kyeonggido, 463-707, Korea
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