1
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Li Z, Li X, Guan S, Zhu G, Lin H, Wu H, Jia J, Guo Z, Cai Z, Zheng Q, Zhang H, Ruan F, Zheng X, Yang C, Xu Y, Ye J. Correlation Analysis Between Tumor Deposit and Clinicopathologic Characteristics and Prognosis of Gastric Cancer: A Multicenter Retrospective Study. Ann Surg Oncol 2024; 31:5984-5996. [PMID: 38814549 DOI: 10.1245/s10434-024-15508-1] [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: 10/31/2023] [Accepted: 05/09/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND The mechanism underlying the formation of gastric tumor deposits (TDs) is unclear. We aimed to explore the risk factors for the formation and prognostic value of TDs. METHODS This retrospective analysis included 781 locally advanced gastric cancer (LAGC) patients from four medical institutions in China, from June 2014 to June 2018. The risk factors for TD formation and prognostic value were determined through univariate and multivariate analyses. RESULTS Univariate analysis revealed that TD positivity was closely related to tumor diameter, Borrmann classification, differentiation degree, pT stage, pN stage, pTNM stage, and nerve and vascular invasion (p < 0.05). Multivariate logistic regression revealed that tumor diameter ≥ 5 cm (odds ratio [OR] 1.836, 95% confidence interval [CI] 1.165-2.894, p = 0.009) and vascular invasion (OR 2.152, 95% CI 1.349-3.433, p = 0.001) were independent risk factors for TD positivity. Multivariate Cox analysis revealed that TD positivity (OR 1.533, 95% CI 1.101-2.134, p = 0.011), tumor diameter ≥ 5 cm (OR 1.831, 95% CI 1.319-2.541, p < 0.001), pT4a stage (OR 1.652, 95% CI 1.144-2.386, p = 0.007), and vascular invasion (OR 1.458, 95% CI 1.059-2.008, p = 0.021) were independent risk factors for GC prognosis. The 5-year overall and disease-free survival of the TD-positive group showed significant effects among patients in the pT4a and pN3b stages (p < 0.05). CONCLUSIONS TDs are closely related to tumor diameter and vascular invasion in LAGC patients, and TD positivity is an independent prognostic factor for LAGC patients, especially those at pT4a and pN3b stages.
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Affiliation(s)
- Zhixiong Li
- Gastrointestinal Surgery Unit 1, The First Hospital of Putian City, Putian, 351100, Fujian, China
- Gastrointestinal Surgery Unit 2, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China
| | - Xinyu Li
- Department of Gastrointestinal Surgery, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, 362002, Fujian, China
| | - Shen Guan
- Department of Gastrointestinal Surgery, Clinical Oncology School of Fujian Medical University Fujian Cancer Hospital, Fuzhou, 350004, Fujian, China
| | - Guangwei Zhu
- Gastrointestinal Surgery Unit 2, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China
| | - Huimei Lin
- Department of Anorectal Surgery, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, 361021, Fujian, China
| | - Haiyan Wu
- Department of Pathology, The First Hospital of Putian City, Putian, 351100, Fujian, China
| | - Jing Jia
- Department of Gastrointestinal Surgery, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, 362002, Fujian, China
| | - Zipei Guo
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Zhiming Cai
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Qiajun Zheng
- Gastrointestinal Surgery Unit 2, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China
| | - Haoxiang Zhang
- Gastrointestinal Surgery Unit 2, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China
| | - Fangqiu Ruan
- Gastrointestinal Surgery Unit 2, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China
| | - Xu Zheng
- Gastrointestinal Surgery Unit 2, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China
| | - Chunkang Yang
- Department of Gastrointestinal Surgery, Clinical Oncology School of Fujian Medical University Fujian Cancer Hospital, Fuzhou, 350004, Fujian, China
| | - Yanchang Xu
- Gastrointestinal Surgery Unit 1, The First Hospital of Putian City, Putian, 351100, Fujian, China.
| | - Jianxin Ye
- Gastrointestinal Surgery Unit 2, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China.
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2
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Detterbeck FC, Ostrowski M, Hoffmann H, Rami-Porta R, Osarogiagbon RU, Donnington J, Infante M, Marino M, Marom EM, Nakajima J, Nicholson AG, van Schil P, Travis WD, Tsao MS, Edwards JG, Asamura H. The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for Revision of the Classification of Residual Tumor After Resection for the Forthcoming (Ninth) Edition of the TNM Classification of Lung Cancer. J Thorac Oncol 2024; 19:1052-1072. [PMID: 38569931 DOI: 10.1016/j.jtho.2024.03.021] [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: 02/10/2024] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION The goal of surgical resection is to completely remove a cancer; it is useful to have a system to describe how well this was accomplished. This is captured by the residual tumor (R) classification, which is separate from the TNM classification that describes the anatomic extent of a cancer independent of treatment. The traditional R-classification designates as R0 a complete resection, as R1 a macroscopically complete resection but with microscopic tumor at the surgical margin, and as R2 a resection that leaves gross tumor behind. For lung cancer, an additional category encompasses situations in which the presence of residual tumor is uncertain. METHODS This paper represents a comprehensive review of evidence regarding these R categories and the descriptors thereof, focusing on studies published after the year 2000 and with adjustment for potential confounders. RESULTS Consistent discrimination between complete, uncertain, and incomplete resection is revealed with respect to overall survival. Evidence regarding specific descriptors is generally somewhat limited and only partially consistent; nevertheless, the data suggest retaining all descriptors but with clarifications to address ambiguities. CONCLUSION On the basis of this review, the R-classification for the ninth edition of stage classification of lung cancer is proposed to retain the same overall framework and descriptors, with more precise definitions of descriptors. These refinements should facilitate application and further research.
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Affiliation(s)
- Frank C Detterbeck
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
| | - Marcin Ostrowski
- Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Hans Hoffmann
- Division of Thoracic Surgery, Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain
| | - Ray U Osarogiagbon
- Oncology Research Group, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee
| | | | - Maurizio Infante
- Department of Thoracic Surgery, Ospedale Borgo Trento, Verona, Italy
| | - Mirella Marino
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Edith M Marom
- Department of Diagnostic Imaging, The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Jun Nakajima
- Department of Thoracic Surgery, The University of Tokyo, Tokyo, Japan
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield NHS Hospitals, Guy's and St. Thomas' NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Paul van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem (Antwerp), Belgium
| | - William D Travis
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ming S Tsao
- Department of Pathology, The Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - John G Edwards
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals National Health Service Foundation Trust, Northern General Hospital, Sheffield, United Kingdom
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio School of Medicine, Tokyo, Japan
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3
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Tankel J, Spicer J, Chu Q, Fiset PO, Kidane B, Leighl NB, Joubert P, Maziak D, Palma D, McGuire A, Melosky B, Snow S, Bahig H, Blais N. Canadian Consensus Recommendations for the Management of Operable Stage II/III Non-Small-Cell Lung Cancer: Results of a Modified Delphi Process. Curr Oncol 2023; 30:10363-10384. [PMID: 38132389 PMCID: PMC10742991 DOI: 10.3390/curroncol30120755] [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: 10/31/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023] Open
Abstract
The treatment paradigm for patients with stage II/III non-small-cell lung cancer (NSCLC) is rapidly evolving. We performed a modified Delphi process culminating at the Early-stage Lung cancer International eXpert Retreat (ELIXR23) meeting held in Montreal, Canada, in June 2023. Participants included medical and radiation oncologists, thoracic surgeons and pathologists from across Quebec. Statements relating to diagnosis and treatment paradigms in the preoperative, operative and postoperative time periods were generated and modified until all held a high level of consensus. These statements are aimed to help guide clinicians involved in the treatment of patients with stage II/III NSCLC.
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Affiliation(s)
- James Tankel
- Department of Thoracic Surgery, McGill University Health Center, Montreal, QC H3G 1A4, Canada
| | - Jonathan Spicer
- Department of Thoracic Surgery, McGill University Health Center, Montreal, QC H3G 1A4, Canada
| | - Quincy Chu
- Department of Medical Oncology, Cross Cancer Institute, Edmonton, AB T6G 1Z2, Canada
| | - Pierre Olivier Fiset
- Department of Pathology, McGill University Health Center, Montreal, QC H3G 1A4, Canada
| | - Biniam Kidane
- Section of Thoracic Surgery, University of Manitoba & Cancer Care Manitoba, Winnipeg, MB R3A 1R9, Canada
| | - Natasha B. Leighl
- Division of Medical Oncology, Princess Margaret Cancer Center, Toronto, ON M5G 2C4, Canada
| | - Philippe Joubert
- Department of Pathology, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université, Laval, QC G1V 4G5, Canada
| | - Donna Maziak
- Department of Thoracic Surgery, Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada
| | - David Palma
- Department of Radiation Oncology, London Health Services Center, London, ON N6A 5A5, Canada
| | - Anna McGuire
- Department of Thoracic Surgery, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Barbara Melosky
- Department of Medical Oncology, BCCA, Vancouver, BC V5Z 4E6, Canada
| | - Stephanie Snow
- Department of Medical Oncology, Queen Elizabeth II Health Sciences Center, Halifax, NS B3H 3A7, Canada
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 3E4, Canada
| | - Normand Blais
- Department of Medical Oncology, Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 3E4, Canada
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4
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Fujikawa K, Omori T, Shinno N, Hara H, Yamamoto M, Yasui M, Matsuda C, Wada H, Nishimura J, Haraguchi N, Akita H, Ohue M, Miyata H. Tumor Deposit Is an Independent Factor Predicting Early Recurrence and Poor Prognosis in Gastric Cancer. J Gastrointest Surg 2023; 27:1336-1344. [PMID: 37014588 DOI: 10.1007/s11605-023-05668-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/11/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Accurate prognostic estimation is crucial; however, the prognostic value of tumor deposits in gastric cancer remains controversial. This study aimed to investigate their prognostic significance. METHODS Clinicopathological and prognostic data of 1012 gastric cancer patients who underwent R0 or R1 surgery from 2010 to 2017 at the Osaka International Cancer Institute were retrospectively reviewed. RESULTS Overall, 6.3% patients had tumor deposits, which were associated with Borrmann type, surgical procedure, type of gastrectomy, extent of lymphadenectomy, tumor size, histology, pT, pN, pM, pStage, lymphatic invasion, vascular invasion, preoperative chemotherapy, and postoperative chemotherapy. Tumor deposit-positive patients had worse 5-year disease-free survival (32.60% vs. 92.45%) and overall survival (41.22% vs. 89.37%) than tumor deposit-negative patients. Subgroup analysis regarding pStage II-III also showed significant differences between patients with and without tumor deposits for 5-year disease-free survival (34.15% vs. 80.98%) and overall survival (43.17% vs. 75.78%). Multivariable analysis showed that older age, undifferentiated histology, deeper tumor invasion, lymph node metastasis, distant metastasis, and presence of tumor deposits were significantly correlated with early tumor recurrence and shorter survival time; these factors were identified as independent prognostic factors. The 5-year disease-free survival of tumor deposit-positive patients was significantly worse than that of patients in the pStage III group and comparable to that of patients in the pT4, pN3, and pM1 groups. The 5-year overall survival of tumor deposit-positive patients was comparable to that of the pT4, pN3, pM1, and pStage III groups. CONCLUSIONS Tumor deposits are strong and independent predictors of tumor recurrence and poor survival.
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Affiliation(s)
- Kaoru Fujikawa
- Osaka International Cancer Institute, 3-1-69 Otemae, Tyuo-Ward, Osaka City, Osaka-Prefecture, Japan
| | - Takeshi Omori
- Osaka International Cancer Institute, 3-1-69 Otemae, Tyuo-Ward, Osaka City, Osaka-Prefecture, Japan.
| | - Naoki Shinno
- Osaka International Cancer Institute, 3-1-69 Otemae, Tyuo-Ward, Osaka City, Osaka-Prefecture, Japan
| | - Hisashi Hara
- Osaka International Cancer Institute, 3-1-69 Otemae, Tyuo-Ward, Osaka City, Osaka-Prefecture, Japan
| | - Masaaki Yamamoto
- Osaka International Cancer Institute, 3-1-69 Otemae, Tyuo-Ward, Osaka City, Osaka-Prefecture, Japan
| | - Masayoshi Yasui
- Osaka International Cancer Institute, 3-1-69 Otemae, Tyuo-Ward, Osaka City, Osaka-Prefecture, Japan
| | - Chu Matsuda
- Osaka International Cancer Institute, 3-1-69 Otemae, Tyuo-Ward, Osaka City, Osaka-Prefecture, Japan
| | - Hiroshi Wada
- Osaka International Cancer Institute, 3-1-69 Otemae, Tyuo-Ward, Osaka City, Osaka-Prefecture, Japan
| | - Junichi Nishimura
- Osaka International Cancer Institute, 3-1-69 Otemae, Tyuo-Ward, Osaka City, Osaka-Prefecture, Japan
| | - Naotsugu Haraguchi
- Osaka International Cancer Institute, 3-1-69 Otemae, Tyuo-Ward, Osaka City, Osaka-Prefecture, Japan
| | - Hirofumi Akita
- Osaka International Cancer Institute, 3-1-69 Otemae, Tyuo-Ward, Osaka City, Osaka-Prefecture, Japan
| | - Masayuki Ohue
- Osaka International Cancer Institute, 3-1-69 Otemae, Tyuo-Ward, Osaka City, Osaka-Prefecture, Japan
| | - Hiroshi Miyata
- Osaka International Cancer Institute, 3-1-69 Otemae, Tyuo-Ward, Osaka City, Osaka-Prefecture, Japan
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5
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Müller C, Taber S, Pfannschmidt J, Griff S. Extracapsular extension of pN2 lymph node metastases is not prognostically significant in surgically resected patients with non-small cell lung cancer. Innov Surg Sci 2023; 8:9-16. [PMID: 37842196 PMCID: PMC10576552 DOI: 10.1515/iss-2022-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 03/16/2023] [Indexed: 10/17/2023] Open
Abstract
Objectives In patients with non-small cell lung cancer (NSCLC) the pathologic lymph node status N2 is a heterogeneous entity, with different degrees of lymph node involvement representing different prognoses. It is speculated whether extra capsular nodal extension may help to define a subgroup with implications on long-term survival. Methods We retrospectively identified 118 patients with non-small cell lung cancer (65 men, 53 women), who were treated between 2013 and 2018 and found to have pathologic N2 lymph node involvement. In all patients lung resection with systematic mediastinal and hilar lymph node dissection was performed with curative intent. In N2 lymph node metastases capsules of affected lymph nodes were examined microscopically as to whether extracapsular extension was present. Results 51 patients (43 %) had extracapsular extension (ENE). Most of these patients (n=35) only had ENE in a single lymph node (69 %). The overall 5-year survival rate was 24.6 % and progression-free survival rate 17.8 %. In the multivariate analysis OS was worse for patients with multiple affected pN2 stations, concurrent N1 metastases, increasing age, and larger tumor size. For the percentage of lymph nodes affected with ENE (of total examined) only a non-significant trend towards worse OS could be observed (p=0.06). Conclusions Although we could not demonstrate significant prognostic differences between N2 extra capsular nodal involvement within our patient population, other analyses may yield different results. However, clinicians should continue performing thorough lymph nodes dissections in order to achieve local complete resection even in patients with extra capsular tumor spread.
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Affiliation(s)
- Christin Müller
- Department of Tissue Diagnostics, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Samantha Taber
- Department of Thoracic Surgery, Heckeshorn Lung Clinic – HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Joachim Pfannschmidt
- Department of Thoracic Surgery, Heckeshorn Lung Clinic – HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Sergej Griff
- Department of Tissue Diagnostics, HELIOS Klinikum Emil von Behring, Berlin, Germany
- Brandenburg Medical High School Theodor Fontane Neuruppin, Neuruppin, Germany
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6
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Zhou M, Yang W, Zou W, Yang J, Zhou C, Zhang Z, Wang Y, Zhang J, Wang Y, Li G, Zhang Z, Xia F. Prognostic significance of tumor deposits in radically resected gastric cancer: a retrospective study of a cohort of 1915 Chinese individuals. World J Surg Oncol 2022; 20:304. [PMID: 36138439 PMCID: PMC9502614 DOI: 10.1186/s12957-022-02773-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background Tumor deposits (TDs) have been identified as an independent prognostic factor in gastric cancer (GC). However, the associated clinicopathological factors and how to simply and reasonably incorporate TD into the TNM staging system remain undetermined. The aim of the current study was therefore to assess the significance of TD among radically resected GC patients. Methods We retrospectively reviewed 1915 patients undergoing radical resection between 2007 and 2012. The patients were classified into two groups according to TD status (absent vs. present), and the clinicopathologic characteristics, DFS, and OS were compared. Associations of TD presence with other clinicopathologic factors were evaluated by logistic regression analysis. Univariate and multivariate Cox regression analyses were performed to determine the prognostic factors for DFS and OS in the primary cohort. Propensity score matching (PSM) was performed to reduce the possibility of selection bias according to the presence of TD. External validation of previously proposed modified staging systems incorporating TD was conducted. Results The detection rate of TD was 10.5% (201/1915). The presence of TD was significantly related to unfavorable clinicopathologic variables, including advanced T and N categories. According to the multivariate Cox regression analysis, the presence of TD was identified as an independent prognostic factor for DFS and OS in the primary cohort (both P < 0.001). In the after-PSM cohort, TD presence also significantly shortened DFS and OS. In the external validation, one system that incorporated TD into the pTNM stage had the best performance. Conclusions The presence of TD was significantly associated with poor survival in radically resected GC patients. The incorporation of TD into the TNM staging system can further improve the predictive capability. A multicenter cohort with a large sample size is needed to determine the appropriate method of incorporation. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-022-02773-1.
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Affiliation(s)
- Menglong Zhou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, People's Republic of China
| | - Wang Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, People's Republic of China
| | - Wei Zou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, People's Republic of China
| | - Jianing Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, People's Republic of China
| | - Changming Zhou
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.,Department of Cancer Prevention, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China
| | - Zhiyuan Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, People's Republic of China
| | - Yaqi Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, People's Republic of China
| | - Jing Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, People's Republic of China
| | - Yan Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, People's Republic of China
| | - Guichao Li
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, People's Republic of China
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China. .,Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, People's Republic of China.
| | - Fan Xia
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China. .,Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, People's Republic of China.
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7
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Elsner F, Hoffmann M, Fahrioglu‐Yamaci R, Czyz Z, Feliciello G, Mederer T, Polzer B, Treitschke S, Rümmele P, Weber F, Wiesinger H, Robold T, Sziklavari Z, Sienel W, Hofmann H, Klein CA. Disseminated cancer cells detected by immunocytology in lymph nodes of
NSCLC
patients are highly prognostic and undergo parallel molecular evolution. J Pathol 2022; 258:250-263. [DOI: 10.1002/path.5996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/20/2022] [Accepted: 07/28/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Felix Elsner
- Chair of Experimental Medicine and Therapy Research University of Regensburg Regensburg Germany
- Institute of Pathology University of Regensburg Regensburg Germany
- Institute of Pathology University Hospital Erlangen Erlangen Germany
| | - Martin Hoffmann
- Division of Personalized Tumour Therapy Fraunhofer ITEM‐R Regensburg Germany
| | - Rezan Fahrioglu‐Yamaci
- Chair of Experimental Medicine and Therapy Research University of Regensburg Regensburg Germany
| | - Zbigniew Czyz
- Chair of Experimental Medicine and Therapy Research University of Regensburg Regensburg Germany
| | | | - Tobias Mederer
- Chair of Experimental Medicine and Therapy Research University of Regensburg Regensburg Germany
| | - Bernhard Polzer
- Division of Personalized Tumour Therapy Fraunhofer ITEM‐R Regensburg Germany
| | - Steffi Treitschke
- Division of Personalized Tumour Therapy Fraunhofer ITEM‐R Regensburg Germany
| | - Petra Rümmele
- Institute of Pathology University of Regensburg Regensburg Germany
- Institute of Pathology University Hospital Erlangen Erlangen Germany
| | - Florian Weber
- Institute of Pathology University of Regensburg Regensburg Germany
| | | | - Tobias Robold
- Department of Thoracic Surgery University Hospital Regensburg Regensburg Germany
| | - Zsolt Sziklavari
- Department of Thoracic Surgery Krankenhaus Barmherzige Brüder Regensburg Regensburg Germany
- Department of Thoracic Surgery Klinikum Coburg, Coburg Germany
| | - Wulf Sienel
- Department of Thoracic Surgery University of Munich Grosshadern Campus, Munich Germany
| | - Hans‐Stefan Hofmann
- Department of Thoracic Surgery University Hospital Regensburg Regensburg Germany
- Department of Thoracic Surgery Krankenhaus Barmherzige Brüder Regensburg Regensburg Germany
| | - Christoph A. Klein
- Chair of Experimental Medicine and Therapy Research University of Regensburg Regensburg Germany
- Division of Personalized Tumour Therapy Fraunhofer ITEM‐R Regensburg Germany
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8
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Nomura K, Nakai T, Nishina Y, Sakamoto N, Miyoshi T, Tane K, Samejima J, Aokage K, Kojima M, Sakashita S, Taki T, Miyazaki S, Watanabe R, Suzuki K, Tsuboi M, Ishii G. FDG uptake in PET is associated with the tumor microenvironment in metastatic lymph nodes and prognosis in N2 lung adenocarcinoma. Cancer Sci 2022; 113:1488-1496. [PMID: 35023268 PMCID: PMC8990723 DOI: 10.1111/cas.15266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/22/2021] [Accepted: 12/31/2021] [Indexed: 11/26/2022] Open
Abstract
Positron emission tomography is a useful technique for diagnosing lymph node (LN) metastasis. This study aimed to elucidate the association between fluorodeoxyglucose accumulation and the microenvironment in metastatic LNs in lung adenocarcinoma. We retrospectively analyzed 62 patients with surgically resected pathological N2 lung adenocarcinoma who underwent preoperative PET. The maximum standardized uptake value (SUVmax) in the metastatic LNs was measured. Lymph node specimens were immunohistochemically analyzed for CD8+, FoxP3+, and CD79a+ lymphocytes, CD204+ tumor‐associated macrophages (TAMs), and alpha‐smooth muscle actin‐positive cancer‐associated fibroblasts (αSMA+ CAFs). We compared the clinicopathologic and immunohistochemical characteristics between two groups with high and low LN SUVmax. Using novel 3D hybrid spheroid models, we investigated the change in invasiveness of cancer cells in the presence of CAFs. In the multivariate analyses, LN SUVmax was an independent prognostic factor. The overall survival in the LN SUVmax high group was significantly worse than in the low group (P = .034). In the LN SUVmax high group, metastatic cancer cell invasion of extranodal tissue was more frequent (P = .005) and the number of CD204+ TAMs and αSMA+ CAFs in metastatic LNs was significantly higher than in the low group (P < .001 and P = .002, respectively). Hybrid spheroid models revealed that cancer cells coexisting with CAFs were more invasive than those without CAFs. Our results indicated a strong association between LN SUVmax and poor prognosis in patients with N2 lung adenocarcinoma. Moreover, LN SUVmax was suggested to be associated with the presence of tumor‐promoting stromal cells in metastatic LNs.
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Affiliation(s)
- Kotaro Nomura
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.,Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.,Departments of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Tokiko Nakai
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Yukino Nishina
- Department of Integrated Biosciences, Laboratory of Cancer Biology, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Chiba, Japan.,Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | - Naoya Sakamoto
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.,Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | - Tomohiro Miyoshi
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Kenta Tane
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Joji Samejima
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Keiju Aokage
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Motohiro Kojima
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.,Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | - Shingo Sakashita
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.,Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | - Tetsuro Taki
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Saori Miyazaki
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Reiko Watanabe
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Kenji Suzuki
- Departments of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Masahiro Tsuboi
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Genichiro Ishii
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.,Department of Integrated Biosciences, Laboratory of Cancer Biology, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Chiba, Japan.,Division of Innovative Pathology and Laboratory Medicine, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Chiba, Japan
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9
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Ho TY, Chao CH, Chin SC, Ng SH, Kang CJ, Tsang NM. Classifying Neck Lymph Nodes of Head and Neck Squamous Cell Carcinoma in MRI Images with Radiomic Features. J Digit Imaging 2021; 33:613-618. [PMID: 31950301 DOI: 10.1007/s10278-019-00309-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The aim of this study is to develop a computer-aided diagnosis method to help classify medical images of neck lymph nodes in head and neck cancer patients. According to the current practice guidelines, the classification of lymph node status is critical for patient stratification before treatment. Take extra-nodal extension (ENE) of metastatic neck lymph nodes, the status of ENE has been considered a single factor affecting the decision of whether systemic treatment with toxicity should be given to patients with otherwise non-advanced cancer status. Medical imaging prior to surgery serves as tools for clinical staging and determining the extent of neck lymph node dissection during the tumor resection surgery. The information contained in these images may also help determine the status of ENE and thus stratify patients for more precise treatment. In the current practice, there has been not a reliable computer-aided tool for this task. In this study, we used open-source software to investigate radiomic features that help distinguish malignant from benign and ENE from non-ENE lymph nodes. We have identified 89 features that can differentiate malignant from benign and 4 features that can differentiate ENE from non-ENE lymph nodes. Furthermore, we fed the significant features to a multilayer perceptron neural network to predict malignancy and ENE of lymph nodes and achieved 84% and 77% of accuracy in each task, respectively.
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Affiliation(s)
- Tsung-Ying Ho
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chun-Hung Chao
- Department of Electrical Engineering, National Tsing Hua University, Hsinchu, Taiwan
| | - Shy-Chyi Chin
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Shu-Hang Ng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chung-Jan Kang
- Department of Otorhinolaryngology and Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Ngan-Ming Tsang
- Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fu-Hsing ST., Kwei-Shan, Linkou, Taoyuan, Taiwan.
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10
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Shih BCH, Jeon JH, Chung JH, Kwon HJ, Lee JH, Jung W, Hwang Y, Cho S, Kim K, Jheon S. Prognostic Significance of the Extranodal Extension of Regional Lymph Nodes in Stage III-N2 Non-Small-Cell Lung Cancer after Curative Resection. J Clin Med 2021; 10:jcm10153324. [PMID: 34362108 PMCID: PMC8347115 DOI: 10.3390/jcm10153324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 11/20/2022] Open
Abstract
The present study investigated the prognostic role of extranodal extension (ENE) in stage III-N2 non-small-cell lung cancer (NSCLC) following curative surgery. From January 2005 to December 2018, pathologic stage III-N2 disease was diagnosed in 371 patients, all of whom underwent anatomic pulmonary resection accompanied by mediastinal lymph node dissection. This study included 282 patients, after excluding 89 patients who received preoperative chemotherapy or incomplete surgical resection. Their lymph nodes were processed; after hematoxylin and eosin staining, histopathologic slides of the metastatic nodes were reviewed by a designated pathologist. Predictors of disease free survival (DFS), including age, sex, operation type, pathologic T stage, nodal status, visceral pleural invasion, perioperative treatment, and the presence of ENE, were investigated. Among the 282 patients, ENE was detected in 85 patients (30.1%). ENE presence was associated with advanced T stage (p = 0.034), N2 subgroups (p < 0.001), lymphatic invasion (p = 0.001), and pneumonectomy (p = 0.002). The multivariable analysis demonstrated that old age (p < 0.001), advanced T stage (p = 0.012), N2 subgroups (p = 0.005), and ENE presence (p = 0.005) were significant independent predictors of DFS. The DFS rate at five years was 21.4% in patients who had ENE and 43.4% in patients who did not have ENE (p < 0.001). The presence of ENE, coupled with tumor-node-metastasis staging, should be recognized as a meaningful prognostic factor in stage III-N2 NSCLC patients.
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Affiliation(s)
- Beatrice Chia-Hui Shih
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea; (B.C.-H.S.); (W.J.); (Y.H.); (S.C.); (K.K.); (S.J.)
| | - Jae Hyun Jeon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea; (B.C.-H.S.); (W.J.); (Y.H.); (S.C.); (K.K.); (S.J.)
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul 03080, Korea
- Correspondence: ; Tel.: +82-31-787-7146
| | - Jin-Haeng Chung
- Department of Translational Medicine, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea; (J.-H.C.); (H.J.K.)
- Department of Pathology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Hyun Jung Kwon
- Department of Translational Medicine, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea; (J.-H.C.); (H.J.K.)
- Department of Pathology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Jeong Hoon Lee
- Division of Biomedical Informatics, Seoul National University Biomedical Informatics, Seoul National University College of Medicine, Seoul 03080, Korea;
| | - Woohyun Jung
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea; (B.C.-H.S.); (W.J.); (Y.H.); (S.C.); (K.K.); (S.J.)
| | - Yoohwa Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea; (B.C.-H.S.); (W.J.); (Y.H.); (S.C.); (K.K.); (S.J.)
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Sukki Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea; (B.C.-H.S.); (W.J.); (Y.H.); (S.C.); (K.K.); (S.J.)
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Kwhanmien Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea; (B.C.-H.S.); (W.J.); (Y.H.); (S.C.); (K.K.); (S.J.)
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Sanghoon Jheon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea; (B.C.-H.S.); (W.J.); (Y.H.); (S.C.); (K.K.); (S.J.)
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul 03080, Korea
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11
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The Evolving Concept of Complete Resection in Lung Cancer Surgery. Cancers (Basel) 2021; 13:cancers13112583. [PMID: 34070418 PMCID: PMC8197519 DOI: 10.3390/cancers13112583] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/22/2021] [Accepted: 05/23/2021] [Indexed: 12/25/2022] Open
Abstract
Simple Summary In the surgical treatment of lung cancer, the complete removal of the portion of the lung where the cancer is and of the involved adjacent structures is of paramount importance to achieve long-term survival. The International Association for the Study of Lung Cancer (IASLC) proposed a definition of complete resection that included a well-defined type of removal of the regional lymph nodes as a fundamental step. The lymph nodes may contain cancer cells and, if left behind, cancer will soon progress. The IASLC also defined incomplete resection when there is any evidence of persistent cancer after the operation. It also defined an intermediate condition, uncertain resection, when no evidence of residual disease can be proved, but all the conditions of complete resection are not fulfilled. Four validations of the definitions have proved their prognostic value and, therefore, the definitions should be followed when a surgical resection of lung cancer is planned. Abstract Different definitions of complete resection were formulated to complement the residual tumor (R) descriptor proposed by the American Joint Committee on Cancer in 1977. The definitions went beyond resection margins to include the status of the visceral pleura, the most distant nodes and the nodal capsule and the performance of a complete mediastinal lymphadenectomy. In 2005, the International Association for the Study of Lung Cancer (IASLC) proposed definitions for complete, incomplete and uncertain resections for international implementation. Central to the IASLC definition of complete resection is an adequate nodal evaluation either by systematic nodal dissection or lobe-specific systematic nodal dissection, as well as the integrity of the highest mediastinal node, the nodal capsule and the resection margins. When there is evidence of cancer remaining after treatment, the resection is incomplete, and when all margins are free of tumor, but the conditions for complete resection are not fulfilled, the resection is defined as uncertain. The prognostic relevance of the definitions has been validated by four studies. The definitions can be improved in the future by considering the cells spread through air spaces, the residual tumor cells, DNA or RNA in the blood, and the determination of the adequate margins and lymphadenectomy in sublobar resections.
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12
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Nomura K, Aokage K, Nakai T, Sakashita S, Miyoshi T, Tane K, Samejima J, Suzuki K, Tsuboi M, Ishii G. Prognostic impact of extranodal extension in patients with pN1-N2 lung adenocarcinoma. J Cancer Res Clin Oncol 2021; 147:3699-3707. [PMID: 33811275 DOI: 10.1007/s00432-021-03608-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/17/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE Lymph node involvement is one of the important prognostic factors of patients with lung adenocarcinoma. In the tumor, node, and metastasis classification, lymph node involvement is categorized only according to the anatomical station and not the involvement pattern. The aim of this study was to investigate which morphological pattern of lymph node involvement affects the prognosis of patients with surgically resected lung adenocarcinoma. METHODS We retrospectively reviewed 168 consecutive patients who underwent surgical resection for primary lung adenocarcinoma with lymph node involvement. The morphological patterns of lymph node involvement (tumor area, number of metastatic lymph nodes, presence of necrosis, and extranodal extension) were histologically examined. The relationships between the patterns of lymph node involvement, clinicopathological features, and survival of patients were analyzed. RESULTS Eighty patients had N1 disease, and 88 patients had N2 disease. Univariate analysis revealed that invasive size, history of adjuvant chemotherapy, and presence of extranodal extension were significant prognostic factors in N1 patients, and vascular invasion, pleural invasion, presence of epidermal growth factor receptor mutation, history of adjuvant chemotherapy, and presence of extranodal extension were significant prognostic factors in N2 patients. In a bivariate analysis including other clinicopathological factors and patterns of lymph node involvement, the presence of extranodal extension was significantly associated with poor 3-year overall and recurrence-free survival of both N1 and N2 patients. CONCLUSIONS In patients who underwent surgical resection for lung adenocarcinoma with lymph node involvement, the extranodal extension was the most important prognostic factor among morphological lymph node involvement patterns.
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Affiliation(s)
- Kotaro Nomura
- Department of Pathology and Clinical Laboratories, National Cancer Center, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
- Departments of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Keiju Aokage
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Tokiko Nakai
- Department of Pathology and Clinical Laboratories, National Cancer Center, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Shingo Sakashita
- Department of Pathology and Clinical Laboratories, National Cancer Center, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Tomohiro Miyoshi
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Kenta Tane
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Joji Samejima
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Kenji Suzuki
- Departments of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Masahiro Tsuboi
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Genichiro Ishii
- Department of Pathology and Clinical Laboratories, National Cancer Center, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
- Division of Innovative Pathology and Laboratory Medicine, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center East, Kashiwa, Chiba, Japan.
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13
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Yun JK, Lee GD, Choi S, Kim HR, Kim YH, Park SI, Kim DK. The addition of radiotherapy to adjuvant chemotherapy has a combinatorial effect in pN2 non-small cell lung cancer only with extranodal invasion or multiple N2 metastasis. Lung Cancer 2021; 155:94-102. [PMID: 33765654 DOI: 10.1016/j.lungcan.2021.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/14/2021] [Accepted: 03/11/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The benefit of adjuvant therapy for heterogenous group of pathological N2 (pN2) non-small cell lung cancer (NSCLC) remains unclear. We evaluated the prognostic effect of adjuvant therapy after stratifying patients with pN2 according to subdivided N2 descriptors. MATERIALS AND METHODS We performed a retrospective analysis of clinical outcomes in patients with pN2 NSCLC who underwent upfront surgery. N2 descriptors were subdivided as single N2 metastasis without N1 involvement (pN2a1), single N2 with metastasis with N1 involvement (pN2a2), and multiple N2 metastasis (pN2b). RESULTS From 2005-2017, 838 patients with pN2 NSCLC underwent complete resection. There were 173 (21.0 %), 338 (40.3 %), and 324 (38.7 %) in the pN2a1, pN2a2, and pN2b groups. Patients who received chemoradiotherapy (CRTx; n = 389, 46.4 %) or chemotherapy (CTx; n = 204, 24.3 %) had similar prognoses, which were better than prognoses in patients who received with radiotherapy (RTx; n = 116, 13.8 %) or those who did not receive adjuvant therapy (n = 129, 15.4 %). According to the stratified multivariable Cox analysis, patients with pN2b stage in the CTx group had a significantly poor prognosis than those in the CRTx group (hazard ratio, 1.38; 95 % confidence interval, 1.03-1.98; p = 0.046). The difference in survival outcomes between the CRTx and CTx groups was significant in patients with extranodal invasion (ENI) (p = 0.011), but not in those without ENI (p = 0.527) CONCLUSIONS: Adjuvant CTx improves the overall and recurrence-free survival in patients with pN2 NSCLC undergoing upfront surgery with complete resection. RTx with adjuvant chemotherapy has a combinatorial effect on pN2 NSCLC only with ENI or multiple N2 metastasis.
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Affiliation(s)
- Jae Kwang Yun
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Geun Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Sehoon Choi
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Yong-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Seung-Il Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea.
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14
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Feng W, Li Y, Shen L, Zhang Q, Cai XW, Zhu ZF, Sun MH, Chen HQ, Fu XL. Clinical impact of the tumor immune microenvironment in completely resected stage IIIA(N2) non-small cell lung cancer based on an immunoscore approach. Ther Adv Med Oncol 2021; 13:1758835920984975. [PMID: 33488784 PMCID: PMC7804351 DOI: 10.1177/1758835920984975] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 12/11/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Completely resected stage IIIA(N2) non-small cell lung cancer (NSCLC)
comprises a heterogeneous population according to discrepancies in survival
prognosis. Accumulating evidence suggests that tumor-infiltrating
lymphocytes (TILs) are clinically significant, despite a lack of consensus
regarding the immunoscore (IS) in NSCLC. Here, we determined the prognostic
value of the immune microenvironment as an IS in a uniform cohort of
patients with completely resected stage IIIA(N2) NSCLC. Methods: Consecutive patients with pathologically confirmed stage IIIA(N2) NSCLC and
who underwent complete resection (2005–2012) were retrospectively reviewed.
Tissue microarrays (TMAs) were constructed from surgical paraffin-embedded
primary lung tumor specimen. For each case, two representative regions from
the tumor center (CT) and two from the invasive margin (IM) containing the
highest density of lymphocytes were selected. Densities of CD3+, CD45RO+,
and CD8+ lymphocytes were assessed using immunohistochemistry (IHC) by
specialized pathologists according to predefined scoring scales. Patients
were classified according to IS definition based on TIL type, density, and
distribution, and relationships between IS and prognosis were evaluated. Results: Patients (N = 288) with complete IHC-based TMA spots were
included. Univariate analyses showed that CD3+ T cell density was associated
with neither overall survival (OS) nor distant metastasis-free survival
(DMFS), whereas CD45RO+ T cell density in the IM was a significant
prognostic factor for DMFS (p = 0.02) and was predictive of
OS (p = 0.05). Combined CD45RO+ and CD8+ cell infiltration
in tumor regions (CT and IM) significantly improved IS prognostic impact.
Multivariate analyses revealed IS as an independent prognostic predictor for
both DMFS (p = 0.001) and OS
(p = 0.002). Conclusion: The proposed IS might provide valuable prognostic information, including
prediction of DMFS and OS in stage IIIA(N2) NSCLC patients. Larger patient
cohorts are needed to validate this IS classification, which might assist
with accurate risk stratification and treatment decisions.
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Affiliation(s)
- Wen Feng
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yuan Li
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Lei Shen
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Qin Zhang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xu-Wei Cai
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zheng-Fei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Meng-Hong Sun
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Hai-Quan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiao-Long Fu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 West Huaihai Road, Shanghai, 200030, China
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15
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Xu L, Su H, She Y, Dai C, Zhao M, Gao J, Xie H, Ren Y, Xie D, Chen C. Which N Descriptor Is More Predictive of Prognosis in Resected Non-small Cell Lung Cancer: The Number of Involved Nodal Stations or the Location-Based Pathological N Stage? Chest 2020; 159:2458-2469. [PMID: 33352193 DOI: 10.1016/j.chest.2020.12.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 11/29/2020] [Accepted: 12/02/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The eighth edition of nodal classification for non-small cell lung cancer (NSCLC) is defined only by the anatomical location of metastatic lymph nodes. RESEARCH QUESTION We sought to evaluate the prognostic significance and discriminatory capability of the number of involved nodal stations (nS) in a large Chinese cohort. STUDY DESIGN AND METHODS A total of 4,011 patients with NSCLC undergoing surgical resection between 2009 and 2013 were identified. The optimal cutoff values for nS classification were determined with X-tile software. Kaplan-Meier and multivariate Cox analysis were used to examine the prognostic performance of nS classification in comparison with location-based N classification. A decision curve analysis was performed to evaluate the standardized net benefit of nS classification in predicting prognosis. RESULTS All the patients were classified into four prognostically different subgroups according to the number of involved nodal stations: (1) nS0 (none positive), (2) nS1 (one involved station), (3) nS2 (two involved stations), and (4) nS ≥ 3 (three or more involved stations). The prognoses among all the neighboring categories of nS classification were statistically significantly different in terms of disease-free survival and overall survival. The multivariate Cox analysis demonstrated that nS was an independent prognostic factor of disease-free survival and overall survival. Patients with N1 or N2 stage disease could be divided into three prognostically different subgroups according to nS classification. However, the prognosis was similar between the N1 and N2 subgroups when patients were staged in the same nS category. The decision curve analysis showed that nS classification tended to have a higher predictive capability than location-based N classification. INTERPRETATION The nS classification could be used to provide a more accurate prognosis for patients with resected NSCLC. The nS is worth taking into consideration when defining nodal category in the forthcoming ninth edition of the staging system.
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Affiliation(s)
- Long Xu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hang Su
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yunlang She
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chenyang Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Mengmeng Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiani Gao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Huikang Xie
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yijiu Ren
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
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Moon DH, Choi JH, Yang HC, Kim MS, Lee JM, Lee GK, Jeon JH. Size and extranodal extension of metastatic lymph nodes in lung adenocarcinoma. J Thorac Dis 2020; 12:6514-6522. [PMID: 33282353 PMCID: PMC7711416 DOI: 10.21037/jtd-20-2039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background This study assessed the prognostic significance of metastatic lymph node size (MLNS) and extranodal extension (EN) in patients with node-positive lung adenocarcinoma (ADC). Methods Prognostic factors influencing survival were analyzed, including age, sex, extent of operation, T- and N-stage, size of tumor, postoperative chemotherapy, presence of EN, and MLNS (>7.0 vs. ≤7.0 mm). Results Three hundred seventy-five patients met the inclusion criteria were enrolled (mean age: 59.8±10.5 years). Increasing MLNS was significantly correlated with large tumor size (P=0.015), advanced N status (P<0.001), and presence of EN (P<0.001). In multivariable analysis, large tumor size [hazard ratio (HR) 1.135, 95% confidence interval (CI): 1.050 to 1.228, P<0.001], adjuvant chemotherapy (HR 0.582, 95% CI: 0.430 to 0.787, P<0.001), EN (HR 1.454, 95% CI: 1.029 to 2.055, P=0.034), and MLNS greater than 7 mm (HR 1.741, 95% CI: 1.238 to 2.447, P<0.001) were significant prognostic factors for survival. Patients were classified into 3 groups: Group A, MLNS ≤7.0 mm/EN (−); Group B, MLNS ≤7.0 mm/EN (+) or MLNS >7.0 mm/EN (−); and Group C, MLNS >7.0 mm/EN (+). The 5-year overall survival (OS) was 72.2%, 59.0%, and 38.5% in Groups A, B and C, respectively (P<0.001). Conclusions The MLNS and presence of EN could provide an important prognostic implication for patients with node-positive lung ADC.
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Affiliation(s)
- Duk Hwan Moon
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea.,Department of Thoracic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin-Ho Choi
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea
| | - Hee Chul Yang
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea
| | - Moon Soo Kim
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea
| | - Jong Mog Lee
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea
| | - Geon-Kook Lee
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea
| | - Jae Hyun Jeon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Chen D, Ding Q, Wang W, Wang X, Wu X, Mao Y, Chen C, Chen Y, Zhang Y. Characterization of Extracapsular Lymph Node Involvement and Its Clinicopathological Characteristics in Stage II-IIIA Lung Adenocarcinoma. Ann Surg Oncol 2020; 28:2088-2098. [PMID: 33015723 DOI: 10.1245/s10434-020-09154-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The prognostic impact and clinicopathological characteristics of extracapsular lymph node involvement (ECLNI) in patients with surgically resected lung adenocarcinoma (LUAD) remain unknown in the context of the eighth edition N classification. PATIENTS AND METHODS We retrospectively reviewed 279 patients with stage II-IIIA LUAD who underwent lobectomy and lymphadenectomy. The correlations of ECLNI presence and clinicopathological profiles were analyzed. We also assessed the impact of ECLNI on the postoperative survival of pN1 and pN2 LUAD patients. RESULTS ECLNI-positive status was more common in patients with high lymph node yield and in patients with multiple stations involved. The logistic regression model identified tumor spread through air spaces, micropapillary component, cribriform component, and nodal stage as predictive factors for ECLNI presence. LUAD patients with ECLNI presence had an increased risk of locoregional recurrence compared with those without (p < 0.001). Presence of ECLNI was confirmed as an independent risk factor for worse recurrence-free survival (RFS) (p < 0.001) and overall survival (OS) (p < 0.001) in the entire cohort. Among the 61 patients with ECLNI(+)pN2 disease, our analysis revealed that adjuvant radiation was a significant predictor of improved RFS and OS. In addition, ECLNI status provides additional precision in stratifying pN1 and pN2 patients with significantly different RFS and OS. CONCLUSIONS Our data suggest that ECLNI remains a strong prognosticator of unfavorable OS and RFS for LUADs in the context of the eighth edition N classification. Adjuvant radiation should be actively considered for pN1b and pN2 LUAD patients with ECLNI presence.
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Affiliation(s)
- Donglai Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qifeng Ding
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Wei Wang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaofan Wang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xuejie Wu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yiming Mao
- Department of Thoracic Surgery, Suzhou Kowloon Hospital Shanghai Jiaotong University School of Medicine, Suzhou, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
| | - Yongbing Chen
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China.
| | - Yongsheng Zhang
- Department of Pathology, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Clinical significance of extranodal extension in sentinel lymph node positive breast cancer. Sci Rep 2020; 10:14684. [PMID: 32895434 PMCID: PMC7477554 DOI: 10.1038/s41598-020-71594-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 08/18/2020] [Indexed: 01/09/2023] Open
Abstract
The precise stage of lymph node (LN) metastasis is a strong prognostic factor in breast cancers, and sentinel lymph node (SLN) is the first station of nodal metastasis. A number of patients have extranodal extension (ENE) in SLN, whereas the clinical values of ENE in SLN in breast cancers are still in exploration. The aim of our study was to evaluate the predictive and prognostic values of ENE in SLN in breast cancers, and to investigate the feasibility of ENE to predict non-SLN metastasis, nodal burden, disease free survival (DFS) and overall survival (OS) in clinical practice. 266 cases of primary invasive breast cancer (cT1-2N0 breast cancer) underwent SLN biopsy and axillary lymph node dissection (ALND) between 2008 and 2015 were extracted from the pathology database of Fudan University Shanghai Cancer Center. ENE in SLN was defined as extension of neoplastic cells through the lymph-nodal capsule into the peri-nodal adipose tissue, and was classified as no larger than 2 mm and larger than 2 mm group. The associations between ENE and clinicopathological features, non-SLN metastasis, nodal burden, DFS, and OS were analyzed. In the 266 patients with involved SLN, 100(37.6%) were positive for ENE in SLN. 67 (25.2%) cases had ENE no larger than 2 mm in diameter, and 33(12.4%) had ENE larger than 2 mm. Among the clinicopathological characteristics, the presence of ENE in SLN was associated with higher pT and pN stages, PR status, lympho-vascular invasion. Logistic regression analysis indicated that patients with ENE in SLN had higher rate of non-SLN metastasis (OR4.80, 95% CI 2.47–9.34, P < 0.001). Meanwhile, in patients with SLN micrometastasis or 1–2 SLNs involvement, ENE positive patients had higher rate of non-SLN metastasis, comparing with ENE negative patients (P < 0.001, P = 0.004 respectively). The presence of ENE in SLN was correlated with nodal burden, including the pattern and number of involved SLN (P < 0.001, P < 0.001 respectively), the number of involved non-SLN and total positive LNs (P < 0.001, P < 0.001 respectively). Patients with ENE had significantly higher frequency of pN2 disease (P < 0.001). For the disease recurrence and survival status, Cox regression analysis showed that patients with ENE in SLN had significantly reduced DFS (HR 3.05, 95%CI 1.13–10.48, P = 0.008) and OS (HR 3.34, 95%CI 0.74–14.52, P = 0.092) in multivariate analysis. Kaplan–Meier curves and log-rank test showed that patients with ENE in SLN had lower DFS and OS (for DFS: P < 0.001; and for OS: P < 0.001 respectively). Whereas no significant difference was found in nodal burden between ENE ≤ 2 mm and > 2 mm groups, except the number of SLN metastasis was higher in patients with ENE > 2 mm. Cox regression analysis, Kaplan–Meier curves and log-rank test indicated that the size of ENE was not an independent factor of DFS and OS. Our study indicated that ENE in SLN was a predictor for non-SLN metastasis, nodal burden and prognosis in breast cancers. Patients with ENE in SLN had a higher rate of non-SLN metastasis, higher frequency of pN2 disease, and poorer prognosis. Patients with ENE in SLN may benefit from additional ALND, even in SLN micrometastasis or 1–2 SLNs involvement patients. The presence of ENE in SLN should be evaluated in clinical practice. Size of ENE which was classified by a 2 mm cutoff value had no significant predictive and prognostic values in this study. The cutoff values of ENE in SLN need further investigation.
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Tan J, Yang B, Xu Z, Zhou S, Chen Z, Huang J, Gao H, Zheng S, Wen L, Han F. Tumor deposit indicates worse prognosis than metastatic lymph node in gastric cancer: a propensity score matching study. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:671. [PMID: 31930072 DOI: 10.21037/atm.2019.10.33] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background The prognostic value of tumor deposit (TD) in gastric cancer is controversial. This study aims to investigate the prognostic value of TD. Methods The consecutive patients diagnosed with gastric cancer from October 2007 to October 2012 were selected. The patients were divided by whether they suffered TD into two groups. The basic data were comparable between the two groups after propensity score matching (PSM), then survival analysis [overall survival (OS) and cancer-specific survival (CSS)] was applied in two groups. After that, all the patients were divided by pN staging and survival analysis were applied in each subgroup. At last, all patients were divided into TD group, pN1 stage group, pN2 stage group, pN3a, and pN3b stage group, OS and CSS were compared between them. Multivariable competing risk analyses tested association of TD with OS and CSS, before and after PSM. Results Eight hundred and three patients were concluded. After PSM, 137 patients with TD and 274 patients without TD were selected, the 5-year OS and CSS rates of patients with TD were significantly worse than patients without TD (OS: 19.7% vs. 42.0%, P<0.001; CSS: 22.6% vs. 45.6%, P<0.001). In all patients' survival analysis, the 5-year OS and CSS rates of TD group were comparable with pN3a group (OS: 19.7% vs. 25.3%, P=0.221, CSS: 22.6% vs. 30.1%, P=0.092) and pN3b group (OS: 19.7% vs. 19.6% P=0.349, CSS: 22.6% vs. 23.5%, P=0.452). Meanwhile, on multivariable cox regression analyses, the presence of TD significantly reduces the OS and CSS of patients in gastric cancer. Conclusions TD has a marked impact on the prognosis of gastric cancer. Even patients with TD had the same prognosis with pN3 stage.
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Affiliation(s)
- Jianan Tan
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Bin Yang
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Zhimeng Xu
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510000, China
| | - Shengning Zhou
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Zhitao Chen
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Jing Huang
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Han Gao
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Senyou Zheng
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Liqiang Wen
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Fanghai Han
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
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Liang Y, Wu L, Liu L, Ding X, Wang X, Liu H, Meng J, Xu R, He D, Liang H. Impact of extranodal tumor deposits on prognosis and N stage in gastric cancer. Surgery 2019; 166:305-313. [PMID: 31221435 DOI: 10.1016/j.surg.2019.04.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 04/14/2019] [Accepted: 04/23/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Extranodal tumor deposits have been reported to be associated with a poor prognosis in many malignancies and are also included in the tumor, node, and metastasis staging system for colorectal cancer. METHODS We reviewed retrospectively a total of 2,344 gastric cancer patients who underwent gastrectomy with curative intent at the Tianjin Medical University Cancer Institute and Hospital (Hexi District, Tianjin, China) and the First Affiliated Hospital of Hainan Medical University (Longhua District, Haikou, China). Patients were categorized into 2 groups based on extranodal tumor deposit status: a positive group, including those with extranodal tumor deposits, and a negative group composed of those with no extranodal tumor deposits. Clinicopathologic factors were correlated with extranodal tumor deposits, and their individual prognoses were analyzed. In addition, a pathologically modified node classification system was proposed by incorporating the extranodal tumor deposit status into the 8th ed of the N staging system. The superiority of prognostic prediction between the modified node classification and node stage was compared. RESULTS A total of 645 (27.5%) patients had extranodal tumor deposits. The presence of extranodal tumor deposits was associated with a larger tumor size, Borrmann type III and IV, a deeper depth of invasion, and an advanced node stage. In the multivariate analysis, extranodal tumor deposits were an independent prognostic factor for gastric cancer patients after curative resection. Gastric cancer patients with extranodal tumor deposits demonstrated a lesser 5-year overall survival than those with no extranodal tumor deposits (31.9% vs 61.4%, P < .001). With the strata analysis, statistically significant prognostic differences between the two groups were only observed in patients at the N0-N2 stage. The modified node classification was found to be more appropriate for predicting the overall survival of gastric cancer patients after curative resection than node stage, and the -2 log likelihood of the modified node classification (16,042.890) was smaller than the value of node stage (16,150.811). CONCLUSION Extranodal tumor deposits in gastric cancer patients indicate aggressive characteristics and a poorer prognosis of gastric cancer. We maintain that extranodal tumor deposits should be incorporated into the N staging system to enhance the accuracy of the prognostic prediction of patients with gastric cancer.
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Affiliation(s)
- Yuexiang Liang
- Department of Gastrointestinal Oncology, The First Affiliated Hospital of Hainan Medical University, Longhua District, Haikou, China
| | - Liangliang Wu
- Department of Gastric Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center For Cancer, Hexi District, Tianjin, China
| | - Lijie Liu
- Department of Gastrointestinal Oncology, The First Affiliated Hospital of Hainan Medical University, Longhua District, Haikou, China
| | - Xuewei Ding
- Department of Gastric Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center For Cancer, Hexi District, Tianjin, China
| | - Xiaona Wang
- Department of Gastric Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center For Cancer, Hexi District, Tianjin, China
| | - Hongmin Liu
- Department of Gastric Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center For Cancer, Hexi District, Tianjin, China
| | - Jin Meng
- Department of Gastrointestinal Oncology, The First Affiliated Hospital of Hainan Medical University, Longhua District, Haikou, China
| | - Ronghua Xu
- Department of Gastrointestinal Oncology, The First Affiliated Hospital of Hainan Medical University, Longhua District, Haikou, China
| | - Donglei He
- Department of Gastrointestinal Oncology, The First Affiliated Hospital of Hainan Medical University, Longhua District, Haikou, China
| | - Han Liang
- Department of Gastric Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center For Cancer, Hexi District, Tianjin, China.
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Kim CW, Kim J, Park Y, Cho DH, Lee JL, Yoon YS, Park IJ, Lim SB, Yu CS, Kim JC. Prognostic Implications of Extranodal Extension in Relation to Colorectal Cancer Location. Cancer Res Treat 2018; 51:1135-1143. [PMID: 30514068 PMCID: PMC6639205 DOI: 10.4143/crt.2018.392] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 11/18/2018] [Indexed: 12/13/2022] Open
Abstract
Purpose Extranodal extension (ENE) is closely associated with the aggressiveness of both colon and rectal cancer. This study evaluated the clinicopathologic significance and prognostic impact of ENE in separate populations of patients with colon and rectal cancers. Materials and Methods The medical records of 2,346 patients with colorectal cancer (CRC) who underwent curative surgery at our institution between January 2003 and December 2011 were clinically and histologically reviewed. Results ENE was associated with younger age, advanced tumor stage, lymphovascular invasion (LVI), and perineural invasion (PNI) in both colon and rectal cancer. ENE rates differed significantly in patients with right colon (36.9%), left colon (42.6%), and rectal (48.7%) cancers (right vs. left, p=0.037; left vs. rectum, p=0.009). The 5-year disease-free survival (DFS) rate according to ENE status and primary tumor site differed significantly in patients with ENE-negative colon cancer (80.5%), ENE-negative rectal cancer (77.4%), ENE-positive colon cancer (68.6%), and ENE-positive rectal cancer (64.2%) (p<0.001). Multivariate analysis showed that advanced tumor stage, ENE, LVI, PNI, and absence of adjuvant chemotherapy were independently prognostic of reduced DFS in colon and rectal cancer patients. Conclusion ENE is closely associated with the aggressiveness of colon and rectal cancers, with its frequency increasing from the right colon to the left colon to the rectum. ENE status is a significant independent predictor of DFS in CRC patients irrespective of tumor location. ENE might be more related with distally located CRC.
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Affiliation(s)
- Chan Wook Kim
- Department of Surgery, Institute of Innovative Cancer Research, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jihun Kim
- Department of Pathology, Institute of Innovative Cancer Research, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yangsoon Park
- Department of Pathology, Institute of Innovative Cancer Research, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hyung Cho
- School of Life Science, Kyungpook National University, Daegu, Korea
| | - Jong Lyul Lee
- Department of Surgery, Institute of Innovative Cancer Research, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Sik Yoon
- Department of Surgery, Institute of Innovative Cancer Research, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Ja Park
- Department of Surgery, Institute of Innovative Cancer Research, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seok-Byung Lim
- Department of Surgery, Institute of Innovative Cancer Research, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Sik Yu
- Department of Surgery, Institute of Innovative Cancer Research, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Cheon Kim
- Department of Surgery, Institute of Innovative Cancer Research, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Luchini C, Veronese N, Nottegar A, Cheng M, Kaneko T, Pilati C, Tabbò F, Stubbs B, Pea A, Bagante F, Demurtas J, Fassan M, Infante M, Cheng L, Scarpa A. Extranodal extension of nodal metastases is a poor prognostic moderator in non-small cell lung cancer: a meta-analysis. Virchows Arch 2018; 472:939-947. [PMID: 29392400 DOI: 10.1007/s00428-018-2309-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 12/29/2017] [Accepted: 01/22/2018] [Indexed: 01/10/2023]
Abstract
Extranodal extension (ENE) of nodal metastasis is defined as the extension of metastatic cells through the nodal capsule into the perinodal tissue. This morphological parameter, recently proposed as an important prognostic factor in different types of malignancy, has not been included in the TNM staging system for non-small cell lung cancer (NSCLC). In this systematic review with meta-analysis, we weighted the prognostic role of ENE in patients with lymph node-positive NSCLC. Two independent authors searched SCOPUS and PubMed through 28 February 2017. Prospective and retrospective studies on NSCLC, comparing patients with presence of ENE (ENE+) ENE+) vs. only intranodal extension (ENE-) and including data regarding prognosis, were considered as eligible. Data were summarized using risk ratios (RR) for the number of deaths/recurrences, and hazard ratios (HR) with 95% confidence intervals (CI) for time-dependent risk related to ENE+, adjusted for potential confounders. We identified 13 studies, including 1709 patients (573 ENE+ and 1136 ENE-) with a median follow-up of 60 months. ENE was associated with a significantly increased risk of mortality of all causes (RR = 1.39, 95% CI: 1.18-1.65, P < 0.0001, I2 = 70%; HR = 1.30, 95% CI: 1.01-1.67, P = 0.04, I2 = 0%) and of disease recurrence (RR = 1.32, 95% CI: 1.04-1.68, P = 0.02, I2 = 42%; HR = 1.93, 95% CI: 1.53-2.44, P < 0.0001, I2 = 0%). We conclude that in NSCLC, requirements for assessment of ENE should be included in gross sampling and ENE status should be included in the pathology report. Inclusion of ENE status in oncology staging systems will allow further assessment of its role as prognostic parameter.
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Affiliation(s)
- Claudio Luchini
- Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Piazzale Scuro, 10, 37134, Verona, Italy.
- ARC-Net Research Center, University and Hospital Trust of Verona, Verona, Italy.
| | - Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy
- Institute for Clinical Research and Education in Medicine (IREM), Padua, Italy
| | | | - Monica Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Takuma Kaneko
- Department of Molecular Pathology, Tohoku University School of Medicine, Sendai, Japan
| | - Camilla Pilati
- Personalized Medicine, Pharmacogenomics, Therapeutic Optimization, Université Paris Descartes, Paris, France
| | - Fabrizio Tabbò
- Department of Oncology, University of Turin, Turin, Italy
| | - Brendon Stubbs
- Health Service and Population Research Department, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Antonio Pea
- Department of Surgery, University and Hospital Trust of Verona, Verona, Italy
| | - Fabio Bagante
- Department of Surgery, University and Hospital Trust of Verona, Verona, Italy
| | - Jacopo Demurtas
- Primary Care Department, LHT South-East Tuscany, Grosseto, Italy
| | - Matteo Fassan
- ARC-Net Research Center, University and Hospital Trust of Verona, Verona, Italy
| | | | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Aldo Scarpa
- Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Piazzale Scuro, 10, 37134, Verona, Italy
- ARC-Net Research Center, University and Hospital Trust of Verona, Verona, Italy
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Prognostic Impact of Extracapsular Lymph Node Invasion on Survival in Non-small-Cell Lung Cancer: A Systematic Review and Meta-analysis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1116:27-36. [PMID: 29956198 DOI: 10.1007/5584_2018_238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The extracapsular tumor extension (ECE) of nodal metastasis is an important prognostic factor in different types of malignancies. However, there is a lack of recent data in patients with non-small-cell lung cancer (NSCLC). In addition, the TNM staging system does not include ECE status as a prognostic factor. This systematic review and meta-analysis has been conducted to summarize and pool existing data to determine the prognostic role of ECE in patients with lymph node-positive NSCLC. Two authors performed an independent search in PubMed using a predefined keyword list, without language restrictions with publication date since 1990. Prospective or retrospective studies reporting data on prognostic parameters in subjects with NSCLC with positive ECE or with only intracapsular lymph node metastasis were retrieved. Data were summarized using risk ratios (RR) for the survival with 95% confidence intervals (CI). The data was analyzed using Mix 2 (ref: Bax L: MIX 2.0 - Professional software for meta-analysis in Excel. Version 2.015. BiostatXL, 2016. https://www.meta-analysis-made-easy.com ). There 2,105 studies were reviewed. Five studies covering a total of 828 subjects met the inclusion criteria and were included in the meta-analysis. Two hundred and ninety-eight (35.9%) patients were categorized as ECE+, of whom 54 (18.1%) survived at the end of follow-up. In the ECE-negative group, 257 patients (48.4%) survived by the end of follow-up. Thus, ECE status is associated with a significantly decreased survival rate: pooled RR 0.45 (95% CI 0.35-0.59), Q (4) = 4.06, P value = 0.39, and I 2 = 68.00% (95 CI 0.00-79.55%). In conclusion, ECE has a significant impact on survival in NSCLC patients and should be considered in diagnostic and therapeutic decisions in addition to the current TNM staging. Postoperative radiotherapy may be an option in ECE-positive pN1 NSCLC patients.
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Extranodal extension status is a powerful prognostic factor in stage III colorectal cancer. Oncotarget 2017; 8:61393-61403. [PMID: 28977872 PMCID: PMC5617432 DOI: 10.18632/oncotarget.18223] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 04/12/2017] [Indexed: 01/07/2023] Open
Abstract
Purpose The present study aimed to evaluate the clinicopathologic characteristics of patients with extranodal extension (ENE) and the prognostic implications of ENE in stage III colorectal cancer (CRC). Results ENE was more frequent in younger patients and those with rectal cancer, higher T stage, higher N stage, lymphovascular invasion (LVI), and perineural invasion (PNI). Five-year disease-free survival (DFS) and overall survival (OS) were lower in patients with ENE-positive than in those with ENE-negative tumors (DFS, 66.4% vs. 80.1%; and OS, 74.8% vs. 85.6%, respectively; P < 0.001 both). In multivariate analysis, pathologic stage, the presence of ENE, LVI, PNI, and no adjuvant chemotherapy were significant independent prognostic factors for DFS and OS. There were no statistically significant differences in DFS and OS between ENE-positive stage IIIB tumors and ENE-negative stage IIIC tumors. Materials and Methods The records of 1,948 stage III CRC patients who underwent curative surgery between January 2003 and December 2010 were retrospectively reviewed. Conclusions The presence of ENE is independently and significantly associated with lower DFS and OS rates after curative resection for stage III CRC. ENE status should be considered in both the pathologic report and CRC staging system.
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Clinicopathologic Significance of Extranodal Tumor Extension in Colorectal Adenocarcinoma with Regional Lymph Node Metastasis. Gastroenterol Res Pract 2016; 2016:5620765. [PMID: 27195006 PMCID: PMC4853953 DOI: 10.1155/2016/5620765] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/30/2016] [Accepted: 03/31/2016] [Indexed: 11/17/2022] Open
Abstract
Background. This study investigated the clinicopathologic significance of extranodal tumor extension in colorectal adenocarcinoma with lymph node metastasis. Method. Included were 419 patients who underwent curative resection for primary colorectal adenocarcinoma. Results. Extranodal tumor extension was observed more frequently in tumors with ulceroinfiltrative gross type (p = 0.026), higher histologic grade (p = 0.012), high grade tumor budding (p = 0.003), vascular invasion (p < 0.001), perineural invasion (p = 0.015), tumor deposit (p < 0.001), high ratio of metastatic/total lymph nodes (p < 0.001), and high pN stage (p < 0.001). Overall survival was significantly different between an extranodal tumor extension (−) group and an extranodal tumor extension (+) group for both N1 (p = 0.022) and N2 homogeneous staging (p = 0.007). Both overall (p = 0.002) and disease-free survival (p = 0.001) were significantly different between the two groups in an N1a homogeneous group and overall survival was significantly different (p = 0.016) in an N2b homogeneous group. Conclusion. Our study demonstrated that extranodal tumor extension was a useful prognostic factor for colorectal adenocarcinoma with lymph node metastasis, especially in homogeneous pN staging groups.
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Cao Q, Zhang B, Zhao L, Wang C, Gong L, Wang J, Pang Q, Li K, Liu W, Li X, Wang P, Wang P. The impact of positive nodal chain ratio on individualized multimodality therapy in non-small-cell lung cancer. Tumour Biol 2015; 36:4617-25. [PMID: 25623115 DOI: 10.1007/s13277-015-3109-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 01/14/2015] [Indexed: 12/25/2022] Open
Abstract
This study aimed to analyze the prognostic significance of the positive nodal chain ratio (NCR) in non-small-cell lung cancer (NSCLC). A total of 208 pIIIa-N2 NSCLC patients who underwent complete surgical resections with a systematic nodal dissection were enrolled. The median values of NCR and the positive lymph node ratio (LNR) were used to grouping patients. The differences of overall survival (OS) and disease-free survival (DFS) between the different groups were compared. The median values of NCR and LNR were 0.31 and 0.45, respectively. The patients were separated into group A (NCR ≤0.45 and LNR ≤0.31; 91 cases), group B (NCR ≤0.45 and LNR >0.31 or NCR >0.45 and LNR ≤0.31; 51 cases), and group C (NCR >0.45 and LNR >0.31; 66 cases) according to their combined LCR and LNR values. Groups A, B, and C exhibited significantly different prognoses (5-year OS: 43.7, 25.2, and 12.3 %, respectively, p < 0.0001; 5-year DFS: 30.4, 23.3, and 8.6 %, respectively, p < 0.0001). Multivariate analyses revealed that this novel grouping method based on the combination of NCR and LNR was an independent prognostic factor for 5-year OS and 5-year DFS in pIIIa-N2 NSCLC. In group C, patients who received no postoperative treatment, adjuvant chemotherapy alone, or chemoradiotherapy exhibited different 5-year OS rates (0.0, 11.6, and 37.5 %, respectively, p = 0.003) and 5-year DFS rates (0.0, 7.5, and 25.0 %, respectively, p = 0.009). Therefore, postoperative chemoradiotherapy may significantly improve the prognosis of patients displaying NCR >0.45 and LNR >0.31. NCR combined with LNR may be more effective to guide individualized multimodality therapy including postoperative chemoradiotherapy for pIIIa-N2 NSCLC.
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Affiliation(s)
- Qinchen Cao
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
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Wu MH, Shen WT, Gosnell J, Duh QY. Prognostic significance of extranodal extension of regional lymph node metastasis in papillary thyroid cancer. Head Neck 2014; 37:1336-43. [DOI: 10.1002/hed.23747] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2014] [Indexed: 11/07/2022] Open
Affiliation(s)
- Ming-Hsun Wu
- Department of Surgery; National Taiwan University Hospital; Taipei Taiwan
| | - Wen T. Shen
- Department of Surgery; University of California San Francisco; San Francisco California
| | - Jessica Gosnell
- Department of Surgery; University of California San Francisco; San Francisco California
| | - Quan-Yang Duh
- Department of Surgery; University of California San Francisco; San Francisco California
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Xiong S, Zheng Y, Jiang P, Liu R, Liu X, Qian J, Gu J, Chang L, Ge D, Chu Y. PA28gamma emerges as a novel functional target of tumour suppressor microRNA-7 in non-small-cell lung cancer. Br J Cancer 2013; 110:353-62. [PMID: 24281003 PMCID: PMC3899764 DOI: 10.1038/bjc.2013.728] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/12/2013] [Accepted: 10/23/2013] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND MicroRNA-7 (miR-7) has been reported to be a tumour suppressor gene. However, whether it has a role in the growth of non-small-cell lung cancer (NSCLC) and what is its target involved in the tumour growth is still under investigation. METHODS NSCLC tissue sample, NSCLC cell lines and tissue microarray were investigated in this study. Total RNA, miRNA and protein were used for RT-PCR and western blot analysis. Immunohistochemistry was performed in tissues microarray. Cell culture and intervention experiments were performed in vitro and in vivo. Bioinformatics prediction, western blot and luciferase assay were identified the target of miR-7. RESULTS In this study, we found that the expression of miR-7 was significantly downregulated not only in NSCLC cell lines, but also in human NSCLC tissues compared with the matched adjacent tissues. Restoration of its expression through miR-7 mimics in A549 and H1299 NSCLC cells inhibited cell proliferation, colony formation, and cell-cycle progression in vitro. More importantly, the tumorigenicity in nude mice was reduced after administration of miR-7 in vivo. In advance, through bioinformatic analysis, luciferase assay and western blot, we identified a novel target of miR-7, PA28gamma (a proteasome activator) to be enrolled in the regulation with tumour. PA28gamma mRNA and protein levels are markedly upregulated in NSCLC cell lines and tumour samples, exhibiting a strong inverse relation with that of miR-7. In addition, knockdown of PA28gamma induced similar effects as overexpression of miR-7 in NSCLC cells. Furthermore, miR-7 overexpression or silencing of PA28gamma reduced the cyclinD1 expression at mRNA and protein level in NSCLC cell lines. CONCLUSION All these findings strongly imply that the overexpression of PA28gamma resulted from miR-7 downexpression in NSCLC has an important role in promoting cancer cell progress and consequently results in NSCLC growth. Thus, strategies targeting PA28gamma and/or miR-7 may become promising molecular therapies in NSCLC treatment.
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Affiliation(s)
- S Xiong
- 1] Department of Immunology and Key Laboratory of Molecular Medicine of Ministry of Education, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China [2] Biotherapy Research Center of Fudan University, Shanghai, People's Republic of China [3] Department of Hematology/Oncology, The Second Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Y Zheng
- 1] Department of Immunology and Key Laboratory of Molecular Medicine of Ministry of Education, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China [2] Biotherapy Research Center of Fudan University, Shanghai, People's Republic of China
| | - P Jiang
- Department of Immunology and Key Laboratory of Molecular Medicine of Ministry of Education, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - R Liu
- 1] Department of Immunology and Key Laboratory of Molecular Medicine of Ministry of Education, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China [2] Biotherapy Research Center of Fudan University, Shanghai, People's Republic of China
| | - X Liu
- Department of Immunology and Key Laboratory of Molecular Medicine of Ministry of Education, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - J Qian
- Department of Immunology and Key Laboratory of Molecular Medicine of Ministry of Education, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - J Gu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - L Chang
- Department of Immunology and Key Laboratory of Molecular Medicine of Ministry of Education, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - D Ge
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Y Chu
- 1] Department of Immunology and Key Laboratory of Molecular Medicine of Ministry of Education, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China [2] Biotherapy Research Center of Fudan University, Shanghai, People's Republic of China
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Characteristics of Lymph Node Metastases Defining the Outcome After Radical Cystectomy of Urothelial Bladder Carcinoma. Jpn J Clin Oncol 2012; 42:1066-72. [DOI: 10.1093/jjco/hys136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Place de la radiothérapie médiastinale postopératoire dans les cancers pulmonaires non à petites cellules. Cancer Radiother 2011; 15:514-7. [DOI: 10.1016/j.canrad.2011.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 06/15/2011] [Indexed: 11/21/2022]
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Relapse in resected lung cancer revisited: does intensified follow up really matter? A prospective study. World J Surg Oncol 2009; 7:87. [PMID: 19909550 PMCID: PMC2784765 DOI: 10.1186/1477-7819-7-87] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2009] [Accepted: 11/12/2009] [Indexed: 12/01/2022] Open
Abstract
Background beside the well known predominance of distant vs. loco-regional relapse, several aspects of the relapse pattern still have not been fully elucidated. Methods prospective, controlled study on 88 patients operated for non-small cell lung cancer (NSCLC) in a 15 months period. Stage IIIA existed in 35(39.8%) patients, whilst stages IB, IIA and IIB existed in 10.2%, 4.5% and 45.5% patients respectively. Inclusion criteria: stage I-IIIA, complete resection, systematic lymphadenectomy with at least 6 lymph node groups examined, no neoadjuvant therapy, exact data of all aspects of relapse, exact data about the outcome of the treatment. Results postoperative lung cancer relapse occurred in 50(56.8%) patients. Locoregional, distant and both types of relapse occurred in 26%, 70% and 4% patients respectively. Postoperative cancer relapse occurred in 27/35(77.1%) pts. in the stage IIIA and in 21/40(52.55) pts in the stage IIB. In none of four pts. in the stage IIA cancer relapse occurred, unlike 22.22% pts. with relapse in the stage IB. The mean disease free interval in the analysed group was 34.38 ± 3.26 months. The mean local relapse free and distant relapse free intervals were 55 ± 3.32 and 41.62 ± 3.47 months respectively Among 30 pts. with the relapse onset inside the first 12 month after the lung resection, in 20(66.6%) pts. either T3 tumours or N2 lesions existed. In patients with N0, N1 and N2 lesions, cancer relapse occurred in 30%, 55.6% and 70.8% patients respectively Radiographic aspect T stage, N stage and extent of resection were found as significant in terms of survival. Related to the relapse occurrence, although radiographic aspect and extent of resection followed the same trend as in the survival analysis, only T stage and N stage were found as significant in the same sense as for survival. On multivariate, only T and N stage were found as significant in terms of survival. Specific oncological treatment of relapse was possible in 27/50(54%) patients. Conclusion the intensified follow up did not increase either the proportion of patients detected with asymptomatic relapse or the number of patients with specific oncological treatment of relapse.
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Moretti L, Yu DS, Chen H, Carbone DP, Johnson DH, Keedy VL, Putnam JB, Sandler AB, Shyr Y, Lu B. Prognostic factors for resected non-small cell lung cancer with pN2 status: implications for use of postoperative radiotherapy. Oncologist 2009; 14:1106-15. [PMID: 19897534 DOI: 10.1634/theoncologist.2009-0130] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND For non-small cell lung cancer (NSCLC) patients with pN2 status, the use of postoperative radiotherapy (PORT) remains controversial. Here, we investigated the association between different clinicopathological features and postoperative therapy and local control and survival in patients with resected pN2 NSCLC. METHODS We retrospectively analyzed 83 patients with pN2 NSCLC who underwent resection at Vanderbilt University Medical Center between 1994 and 2004. The relationship between 10 prognostic factors-gender, age at diagnosis, histology, tumor size, number of nodal stations involved, positive node number, surgical margin, extracapsular extension (ECE), and use of postoperative chemotherapy and PORT-and 2-year local recurrence-free survival (LRFS), distant recurrence-free survival (DRFS), recurrence-free survival (RFS), and overall survival (OS) rates was evaluated. Univariate and multivariate analyses were conducted using the Kaplan-Meier method and Cox proportional hazards ratios, respectively. RESULTS On univariate analysis, PORT was significantly associated with greater LRFS, RFS, and OS rates, whereas chemotherapy was associated with a trend toward a higher OS rate. Negative surgical margins were predictive of a higher OS rate, and negative ECE was associated with higher LRFS and RFS rates. On multivariate analysis, only PORT and negative ECE were associated with a higher LRFS rate. On subgroup analysis, in negative ECE patients, PORT was significantly associated with a higher OS rate. CONCLUSIONS PORT is associated with a higher OS rate for patients with resected pN2 NSCLC with negative ECE but not with positive ECE. The absence of ECE may serve as a useful prognostic variable in the selection of pN2 NSCLC patients for PORT and warrants further investigation in randomized clinical trials.
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MESH Headings
- Adenocarcinoma/pathology
- Adenocarcinoma/radiotherapy
- Adenocarcinoma/surgery
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Non-Small-Cell Lung/radiotherapy
- Carcinoma, Non-Small-Cell Lung/surgery
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/secondary
- Carcinoma, Squamous Cell/surgery
- Female
- Humans
- Lung Neoplasms/pathology
- Lung Neoplasms/radiotherapy
- Lung Neoplasms/surgery
- Male
- Middle Aged
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/radiotherapy
- Neoplasm Recurrence, Local/surgery
- Neoplasm Staging
- Pneumonectomy
- Postoperative Care
- Prognosis
- Retrospective Studies
- Survival Rate
- Treatment Outcome
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Affiliation(s)
- Luigi Moretti
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Pantarotto JR, Piet AH, Vincent A, van Sörnsen de Koste JR, Senan S. Motion Analysis of 100 Mediastinal Lymph Nodes: Potential Pitfalls in Treatment Planning and Adaptive Strategies. Int J Radiat Oncol Biol Phys 2009; 74:1092-9. [DOI: 10.1016/j.ijrobp.2008.09.031] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Revised: 07/27/2008] [Accepted: 09/28/2008] [Indexed: 12/25/2022]
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Bell AM, DeYoung BR, Weydert J. Extranodal extension in metastatic non-small cell lung cancer. Chest 2008; 132:2058-9; author reply 2059-60. [PMID: 18079250 DOI: 10.1378/chest.07-1852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Response. Chest 2007. [DOI: 10.1016/s0012-3692(15)52498-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Senan S. Staging nodal disease in non-small cell lung cancer: implications for radiation therapy. J Thorac Oncol 2007; 2:585-7. [PMID: 17607111 DOI: 10.1097/jto.0b013e31807a2fbe] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Chang YL, Wu CT, Lee YC. Surgical treatment of synchronous multiple primary lung cancers: Experience of 92 patients. J Thorac Cardiovasc Surg 2007; 134:630-7. [PMID: 17723810 DOI: 10.1016/j.jtcvs.2007.06.001] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Revised: 05/27/2007] [Accepted: 06/05/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVES According to our previous study, the concurrent detection of p53 and epidermal growth factor receptor mutations significantly improves the clonality assessment and impact management of patients with multiple primary lung cancer. Nevertheless, the treatment, outcome, and safety of patients with this complex disease remain controversial. This series of cases detail our experiences with surgical resections in 92 patients during the past 16 years. METHODS A database of 1651 patients was evaluated for unilateral and bilateral synchronous multiple primary lung cancers. The relationships among the location of tumors, number of tumors, tumor size, tumor histology, vascular invasion, regional lymph node metastasis, extranodal extension, type of surgery, mortality, and survival were analyzed. RESULTS The 5-year survival for all synchronous multiple primary lung cancers was 35.3%. The overall surgical mortality was 1.1%. Notably, lymph node metastasis, extranodal extension, vascular invasion, tumors with adenosquamous carcinoma or different histology, and poor survival were observed. Multivariate analysis showed that only the occurrence of lymph node metastasis remained a statistically significant prognostic factor. The 5-year survivals were 15.5% [corrected] and 52.5% [corrected] for patients with and without lymph node metastasis, respectively (P < .001). CONCLUSION An aggressive surgical approach is safe and justified in patients with synchronous multiple primary lung cancers and node-negative diseases. The status of this particular form of non-small cell lung cancers might be considered in the conventional TNM staging system for more accurate prediction of patient prognosis.
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Affiliation(s)
- Yih-Leong Chang
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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