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Objective To analyze the risk factors of preoperative lymph node staging (N-stage) deficiency in gastric cancer and establish a preoperative assessment model to assist in predicting preoperative N-stage. Methods A retrospective method was used to analyze the clinicopathological data of 268 patients with gastric cancer. The patients routinely underwent preoperative thin-section enhanced CT to assess preoperative N-stage. Results The risk factors for preoperative N-stage deficiency were analyzed in combination with postoperative pathological findings. Multifactorial logistic regression analysis was performed to determine influencing factors, and Kaplan-Meier analysis was used to plot the survival curves of preoperative N-stage accurate group and deficiency group. The nomogram plot and ROC curves of the prediction model were drawn using the R package. AUC, 95%CI, sensitivity, and specificity were calculated. Results Age, BMI, poor differentiation, and Lauren's classification as diffuse were independent risk factors for preoperative N-stage deficiency in gastric cancer (P < 0.05). Prognostic survival was significantly worse in the preoperative N stage-inadequate group than that in the accurate group (P=0.041). The AUC area was 0.935, with a sensitivity of 85.9% and specificity of 96.9%. Conclusion Young age, high BMI, poor differentiation, and Lauren's classification as diffuse are independent risk factors for preoperative N-stage deficiency. The established preoperative assessment model based on age, BMI, differentiation degree, and Lauren's classification in this study has relatively high credibility.
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Objective To investigate the impact of lymph node metastasis on the survival of SCLC patients with M1a disease. Methods We retrospectively analyzed the medical records of 7027 SCLC patients with M1a disease from 2004 to 2015 in SEER database. The Kaplan-Meier method and log-rank test were used to estimate the OS in all N stage subgroups. Cox proportional hazard model was used to assess whether N stage was an independent risk factor for prognosis. Results The median OS of all patients was 7 months. Among all M1a patients, the patients without lymph node involvement (N0) had the best OS, followed by N1 stage patients; N2 and N3 stage patients had the worst OS (P < 0.001). Similarly, this trend was observed when M1a disease was subdivided into contralateral pulmonary nodules, malignant pleural effusion and malignant pericardial effusion. Multivariate analysis showed that lymph node metastasis was an independent prognostic factor for SCLC patients with M1a disease, and this result was also noticed in all subgroups of M1a disease. Conclusion Lymph node metastasis may affect the survival of SCLC patients with M1a disease, adding prognostic information. And it is recommended to further improve the N descriptor in the next version of TNM staging system.
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@#Objective To investigate the rule of lymph node metastasis and its relationship with prognosis in stage N1 thoracic esophageal squamous cell carcinoma. Methods The clinical and follow-up data of 121 stage N1 (1 to 2 lymph node metastases) thoracic esophageal squamous cell carcinoma patients, who underwent radical resection of esophageal carcinoma in our hospital from 2015 to 2017, were retrospectively analyzed. There were 104 (86.0%) males and 17 (14.0%) females with an average age of 64.9±8.3 years. Results The early metastasis rates of the left upper paratracheal, right upper paratracheal, lower thoracic paraesophageal, paracardial, lesser curvature and greater curvature lymph nodes were 22.6%, 28.0%, 21.2%, 41.7%, 25.0% and 25.0%, respectively. The three-year survival rates in the group with and without left upper paratracheal lymph node metastasis were 8.3% and 34.9%, respectively (P=0.000). The three-year survival rates of the subcarinal lymph node metastasis group and the non-metastasis group were 10.5% and 36.3%, respectively (P=0.032). Multivariate Cox regression analysis showed that, left upper paratracheal lymph node metastasis (P=0.000) and subcarinal lymph node metastasis (P=0.010) were independent prognostic factors for early stage lymph node metastasis of esophageal squamous cell carcinoma. The three-year survival rates of patients with simple abdominal lymph node metastasis and those with simple thoracic lymph node metastasis were 51.1% and 25.0%, respectively (P=0.016). Conclusion The lymph nodes of N1 stage thoracic esophageal squamous cell carcinoma are more likely to metastasize to left upper paratracheal lymph nodes, right upper paratracheal lymph nodes, lower thoracic paraesophageal lymph nodes, paracardial lymph nodes, lesser curvature of stomach and greater curvature of stomach lymph nodes. Lymph node metastases of left upper paratracheal and subcarinal are independent factors for the prognosis of patients with stage N1 thoracic esophageal squamous cell carcinoma. The prognosis of patients with simple abdominal lymph node metastasis is better than that of patients with simple thoracic lymph node metastasis.
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Objective: To retrospectively compare the prognosis between patients with locally advanced T and N stage nasopharyngeal carcinoma (NPC), to provide a reference for the clinical treatment of NPC. Methods: A total of 264 NPC cases from December 2011 to November 2017 visiting The General Hospital of Western Theater Command were pathologically diagnosed and retrospectively analyzed. Of these, 102 and 162 were locally advanced T and N stage, respectively. Results: The two groups 5-year overall survival (OS), progression-free survival (PFS), local relapse-free survival (LRFS), and distant metastasis-free survival (DMFS) were compared. These were 82.8% and 75.8% (P=0.271), 73.7% and 62.8% (P=0.043), 87.6% and 91.6% (P=0.646), 87.7% and 79.5% (P=0.066), respectively. Conclusions: The DMFS, OS and PFS decreased in patients with locally advanced N stage NPC, although there was no statistical difference. The significance of systemic and stratified treatment should be emphasized in patients with locally advanced N stage NPC in order to achieve a higher OS rate and reduce distant metastasis.
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Objective The aim of this study was to investigate the diagnostic value of the intravoxel incoherent motion (IVIM) for discriminating nonmetastatic from metastatic mediastinal lymph nodes in lung cancer.Methods IVIM was performed preoperatively on 66 patients with lung cancer during October 2015 to June 2016 in Capital Medical University Affiliated Beijing Chaoyang Hospital.Preoperative examination including the chest MRI scan,chest CT,head MRI,bone scan-ning and the cardiopulmonary function.None of the patients was undergone any kind of treatment about the cancer before the examinations,the neoadjuvant chemotherapy or radiation therapy,immunotherapy and gene targeted therapy were included.Measured the short axis diameter and the IVIM parameters of the mediastinal lymph nodes,apparent diffusion coefficient(ADC),diffusion coefficient(D),pseudo-diffusion coefficient(D *),and perfusion fraction(f).All the patients underwent the lobectomy or wedge resection and lymph node dissection or systematic sampling.By comparing the IVIM parameters of the nonmetastatic and metastatic mediastinal lymph nodes according to the pathological examination,draw the ROC curves to find the best cutoff value for diagnosis.And 42 cases were used to comparing the value of the MRI and CT in differential diagnosis.Results MRI measured 184 groups mediastinal lymph nodes,including 164 groups without metastasis,20 groups with metastasis.The ADC,D,D *,f values and short axis diameter of the nonmetastatic lymph nodes(n =164) were(2.880 ± 0.785) × 10-3 mm2/s,(0.670 ± 0.179) × 10-3 mm2/s,(0.383 ± 0.123) × 10-3 mm2/s,0.422 ± 0.119,(6.546 ± 1.932) mm,respectively,and (1.897 ±0.657) × 10-3 mm2/s,(0.472 ±0.210) × 10-3 mm2/s,(0.354 ±0.130) × 10-3 mm2/s,0.412 ±0.090,(7.510 ± 2.773) mm respectively for the metastatic lymph nodes (n =20).The ADC and D value of the nonmetastatic lymph nodes were significantly higher than the metastatic lymph nodes(P ＜0.01).While the other paraneters(D *,f,and short axis diameter) between the two groups did not show significantly different.Optimal cutoff values(area under the curve,sensitivity,and specificity) for distinguishing metastatic from nonmetastatic lymph nodes were as follows:ADC =1.890 × 10-3 mm2/s (0.871,92.7％,80.0％);and D =0.648 × 10-3mm2/s(0.740,70.0％,84.1％).Conclusion IVIM is useful to distinguish metastatic from nonmetastatic lymph nodes in lung cancer.The ADC and the D values are significant higher in metastatic lymph nodes,which more sensitive than the other parameters(D *,f,and short axis diameter).As a result,IVIM can be used in the N-stage diagnosis of lung cancer.
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Objective To improve the non?surgical N staging system for esophageal carcinoma ( EC) . Methods A retrospective analysis was performed in 501 patients newly diagnosed with esophageal squamous cell carcinoma who received radiotherapy in our hospital from 2009 to 2013. The impacts of the supraclavicular lymph nodes and mediastinal lymph nodes on the overall survival ( OS) rate were analyzed. The original non?surgical N staging system was improved and the proposed N staging system was evaluated. The OS rates were calculated using the Kaplan?Meier method and analyzed using the log?rank test. The univariate and multivariate analyses were performed using the log?rank test and Cox regression model, respectively. Results The 3?and 5?year sample sizes were 404 and 205, respectively. In all patients, the 1?, 3?, and 5?year OS rates were 64?9%, 26?5%, and 18?3%, respectively;the 1?, 3?, and 5?year distant metastasis?free ( DMF) rates were 86?2%, 68?9%, and 67?3%, respectively;the 1?, 3?, and 5?year local control rates were 72?7%, 53?1%, and 43?6%, respectively. The univariate analysis showed that the incidence, 3?year OS rate, and 3?year DMF rate of supraclavicular lymph node metastases in patients with cervical and upper?thoracic EC were significantly higher than those in patients with middle?thoracic and lower?thoracic EC ( 25?7% vs. 14?2%, P=0?034;24?2% vs. 11?5%, P=0?016;84?8% vs. 69?2%, P=0?007) . The multivariate analysis also showed that the number of metastatic lymph nodes was an independent prognostic factor for the OS and DMF rates in patients ( P= 0?000;P= 0?007 ) . Conclusions It is reasonable to classify upper?thoracic EC with supraclavicular lymph node metastasis into stage N1 diseases. The proposed N staging system with the factor of the number of metastatic lymph nodes is more scientific and objective than the original N staging system.
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Breast cancer staging, in particular N-stage changed most significantly due to the advanced technique of sentinel lymph node biopsy two decades ago. Pathologists have more thoroughly examined and scrutinized sentinel lymph node and found increased number of small volume metastases. While pathologists use the strict criteria from the Tumor Lymph Node Metastasis (TNM) Classification, studies have shown poor reproducibility in the application of American Joint Committee on Cancer and International Union Against Cancer/TNM guidelines for sentinel lymph node classification in breast cancer. In this review article, a brief history of TNM with a focus on N-stage is described, followed by innate problems with the guidelines, and why pathologists may have difficulties in assessing lymph node metastases uniformly. Finally, clinical significance of isolated tumor cells, micrometastasis, and macrometastasis is described by reviewing historical retrospective data and significant prospective clinical trials.
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Breast Neoplasms , Breast , Classification , Joints , Lymph Nodes , Neoplasm Metastasis , Neoplasm Micrometastasis , Prospective Studies , Retrospective Studies , Sentinel Lymph Node BiopsyABSTRACT
BACKGROUND: Carcinoma of buccal mucosa is the most common cancer of the oral cavity in India. Treatment of oral cancer poses unique reconstructive challenges, owing to the dynamic architecture of the oral cavity. Despite current progress in various treatment modalities, over the past 50 years survival rates have not improved drastically. Although, philosophy on treatment of buccal mucosa carcinoma remains well‑established, due to the relative paucity of reported data, retrospective reviews of institutional experiences are of prime importance. This study provides a detailed insight on this site specific cancer of the oral cavity in the Indian population. AIM: The aim of this study is to analyze our experience with the management of carcinoma of buccal mucosa; associated clinical presentation, outcomes and prognostic factors. SETTINGS AND DESIGN: A retrospective chart review was performed of all cases of primary buccal mucosa carcinoma treated surgically between years 2008 and 2012 in SDM Craniofacial Unit, Karnataka, India. MATERIALS AND METHODS: All cases were analyzed based on patient characteristics, clinical presentation, surgical and adjuvant therapy rendered and treatment outcomes. A retrospective chart review was carried out using the hospital’s data base for the same. STATISTICAL ANALYSIS USED: Kaplan‑Meier methods were used for analyzing disease free survival (DFS). Univariate analysis of prognostic factors was performed with log rank test. RESULTS: The significant variables in univariate analysis were: Overall stage, T‑stage (T1/T2 vs. T3/T4) and nodal status (N0 vs. N+). We found that staging, tumor size and nodal status were significant prognostic factors for DFS. CONCLUSION: The strong influence of overall disease stage, tumor size, nodal status, final histopathological report and habits of tobacco/betel quid chewing, on prognosis; emphasizes the importance of early diagnosis and prevention of carcinoma of buccal mucosa in the Indian population.
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PURPOSE: The 7th edition UICC/AJCC TNM classification for gastric cancer has several changes from the previous edition. Especially, the classification of the number of lymph node metastases (LNM) is reorganized. According to the new TNM system, N stage was categorized to N0 (no LNM), N1 (1~2 LNM), N2 (3~6 LNM), N3 (7 or more LNM). The aim of our study was to compare the prognostic significance of the new (7th) UICC/AJCC N stage with the old (6th). METHODS: From 2000 to 2005 a total of 425 patients who underwent curative resections with D2 and with 15 or more lymph nodes retrieved were studied retrospectively. RESULTS: According to the 7th UICC/AJCC N stage, the 5-year cumulative survival rates (5YSR) of N0, N1, N2, N3 were 96.0%, 79.2%, 58.5% and 24.3%, respectively (P<0.001). Using univariate analysis, the N stage of 7th and 6th UICC/AJCC TNM classification, 7th UICC/AJCC T stage, differentiation of tumor, type of gastrectomy (subtotal and total gastrectomy), size of primary tumor (< or =5, 5<< or =10, 10<) were associated with 5YSR. However, Cox regression multivariate analysis showed the 7th UICC/AJCC N stage to bean independent factor for predicting the 5YSR instead of the 6th UICC/AJCC N stage (P<0.001, hazard ratio (HR) 1.859, 95% confidence interval (CI) 1.576~2.194), including depth of tumor invasion (P<0.001, HR 1.673, 95% CI 1.351~2.073). CONCLUSION: The new (7th) UICC/AJCC N stage is a more reliable prognostic factor of gastric cancer than the old (6th) N stage.
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Humans , Gastrectomy , Lymph Nodes , Multivariate Analysis , Neoplasm Metastasis , Retrospective Studies , Stomach Neoplasms , Survival RateABSTRACT
One hundred and thirty five patients with carcinoma of the nasopharyx were treated by radiation therapy in the Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University between August 1977 and July 1987. Of the 30 patients omitted: 8 had distant metastases at initial diagnosis or during radiotherapy; 18 patients refused or did not received a full course of radiation therapy, and four had not been confirmed histologically. The remaining 105 patients were analyzed to determine the incidence and patter of distant metastases. Diagnosis of distant metastases was made based on clinical signs and radiography, even though histologic confirmation was not made. Twenty-six patients developed distant metastases after definite irradiation of nasopharyx and neck, an incidence rate of 24.8%. The common sites of distant metastases were, in descending order, bone, lung, liver, and brain. There was a strong correlation between Ho's N stage and distant metastases rate. But sex, age, histologic subtype (squamous cell and undifferentiated cell), AJC T and N stage, treatment modalities (radiotherapy alone and radiotherapy combined with chemotherapy) were not significant. Of those patients who developed distant metastases, 80.8% were discovered within 2 years of their radical radiotherapy. The prognosis for nasopharyngeal carcinoma patients developing distant metastases was poor: median survival was nine months and 80% of those patients died within two years of the initial diagnosis of distant metastasis.