Significance of the Extracapsular Spread of Metastatic Lymph Nodes in Papillary Thyroid Carcinoma

OBJECTIVES: The extracapsular spread (ECS) of metastatic lymph nodes is associated with aggressive tumor behavior, and is regarded as a major risk factor for local recurrence in patients with head and neck squamous cell carcinoma. However, the significance of ECS of metastatic lymph nodes has not been well established in well-differentiated thyroid carcinoma. The purpose of this study was to examine this question. METHODS: A retrospective review was performed of 335 patients with papillary thyroid carcinoma who underwent total thyroidectomy with lymph node dissection from April 2001 to December 2009. We analyzed various clinical characteristics, pathologic factors, and the size, number, and ECS of foci in metastatic lymph nodes. RESULTS: On pathologic review, 201 of the patients (56.6%) had lymph node metastasis. This was significantly related to age and tumor size. ECS was noted in 64 of these 201 patients (31.8%), and was significantly related to male gender, tumor size, presence of extrathyroidal extension, metastatic lymph node size, and focus size. Recurrence occurred in 13 patients (3.9%), and the presence of ECS was significantly related to recurrence. CONCLUSION: ECS of metastatic lymph nodes is an important prognostic factor for loco-regional recurrence in papillary thyroid carcinoma.

Patterns and prognostic value of lymph node metastasis of nasopharyngeal carcinoma based on 2013 updated consensus guidelines of neck node levels / 中国癌症杂志

Background and purpose:In 2013, the ofifcial journal of European Society of Radiotherapy &Oncology (ESTRO) -Radiotherapy & Oncology published the updated version of Consensus Guidelines of Delineation of the neck node levels for head and neck tumors, which contributed to the standardization of description of neck nodal metastasis, as well as reduction of treatment variations from various institutions. This study applied this updated guidelines to analyze the patterns of lymph node metastasis of nasopharyngeal carcinoma and explore the prognostic value of the radiologic characteristics of nodes, in order to provide evidence for future revision of N staging system. Methods:A total of 656 patients from Jan. 2009 to Dec. 2010 were retrospectively recruited to analysis. All were pathologically diagnosed as non-metastatic nasopharyngeal carcinoma, treated with intensity-modulated radiotherapy. All patients received a pretreatment MRI scan. We retrospectively reviewed the MRI imaging of 656 patients and mapped the lymph node metastasis using the 2013 International Consensus Guidelines.Results:Median follow-up was 46.9 months. Four-year local recurrence-free survival, nodal recurrence-free survival, distant metastasis-free survival, disease-free survival and overall survival was 91.3%, 95.1%, 87.7%, 78.5% and 92.8%, respectively. The most common metastatic node levels were levelⅡ (76.2%) and levelⅦa (65.1%), followed by levelⅢ (50.4%),Ⅴa(17.5%) andⅣa (11.7%). There was a very low incidence of node skipping (1.0%). Cervical nodal necrosis was observed in 46.4%of patients with positive nodes and extracapsular spread was noted in 74.4% of them. Univariate analysis showed that bilateral nodal involvement, greatest dimension of positive nodes (≥6 cm), central nodal necrosis, T stage and N stage were prognostic factors for disease-free survival and distant metastasis-free survival (P<0.05). Extracapsular spread showed a trend to correlate with poor distant metastasis-free survival (P=0.060). The involvement of lower neck levels (below the caudal border of cricoid cartilage) did not have a signiifcant impact on disease-free survival and distant metastasis-free survival. In multivariate analysis, T stage and greatest dimension of nodes (≥6 cm) were independent prognostic factors for distant metastasis-free survival (P<0.05). T stage, greatest dimension of nodes (≥6 cm) and central nodal necrosis were independent prognostic factors of disease-free survival (P<0.05).Conclusion:This study demonstrates the patterns of lymph node metastasis of nasopharyngeal carcinoma based on 2013 International Consensus Guidelines. Bilateral nodal involvement, greatest dimension of positive nodes and central nodal necrosis had prognostic values on disease-free survival and distant metastasis-free survival. In our study, the involvement of lower neck levels was not proved to be a prognostic factor for disease-free survival and distant metastasis-free survival.

Preliminary study of cervical lymph node extracapsular spread direction of oral squamous cell carcinoma / 实用口腔医学杂志

Objective:To study the direction of cervical node extracapsular spread(ECS)of oral squamous cell carcinoma(OSCC). Methods:57 cases of OSCC were treated by combined radical operation.The relationship between ECS and T stage,tumor thick-ness,differentiation degree of OSCC,lymph node size and the ECS direction in each lymph node level were statistically analysed. Results:ECS was found in 30 of the 57 cases,and in 78 of the 174 metastasis positive lymph nodes.29 ECS nodes in levelⅠ,the frequency of the shallow side was 26,the deep side 13(P=0.000 3).But the difference in other levels was not statistically signifi-cant(P>0.05).It was not statistically significant between the incidence of ECS and T stage;it was statistically significant between the incidence of ECS and tumor thickness(P<0.05),tumor differentiation degree(P<0.05)and the lymph node size(P<0.01). Conclusion:ECS of OSCC on the shallow side is more than that in the deep side of lymph nodes in levelⅠ.ECS is positively corre-lated with the tumor thickness of OSCC,metastasied lymph node size;negatively related to the differentiation degree of OSCC.

Expression of Matrix Metalloproteinase-2,-9 and Extracapsular Spread of Cervical Node Metastasis in the Head and Neck Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cervical lymph node metastasis is the most important prognostic factor in head and neck squamous cell carcinoma (HNSCC). Further, it is important to predict extracapsular spread (ECS) before treatment, because ECS makes prognosis worse. It has been well established that matrix metalloproteinases (MMPs) expression correlates with cervical lymph node metastasis, but studies on its involvement in extracapsular spread are not enough. The aim of this study was to investigate the correlationship between extracapsular spread of cervical lymph node metastasis and expression of matrix metalloproteinases in the primary sites of head and neck cancer and metastatic cervical lymph nodes. SUBJECTS AND METHOD: An immunohistochemical study was carried out using monoclonal antibodies to MMP-2, MMP-9 on tissue obtained from 46 patients with head and neck cancer who underwent a surgery of primary tumor removal and neck dissection. We evaluated correlations between the expressions of MMP-2, MMP-9 in the primary tumor and ECS of metastatic lymph nodes, and that between expressions of MMP-2, MMP-9 in the metastatic lymph nodes and ECS. RESULTS: The result showed that while there is no significant correlation between expressions of MMP-2, MMP-9 in primary tumor and ECS of cervical lymph nodes, expressions of the MMPs in the positive lymph nodes and ECS of the lymph nodes have significant relationships. CONCLUSION: Expression of MMP-2,-9 may play a pivotal role in extracapsular spread beyond lymphatic metastasis and in the progression of HNSCC.

Prognostic Significance of Extracapsular Spread in Metastatic Lymph Node of Head and Neck Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUND: Lymph node metastasis in head and neck squamous cell carcinoma has been interpretated as a poor prognostic factor. However, N staging system which depends on the size and numbers of the metastatic lymph node has been reported to be insufficient as a prognostic factor. OBJECTIVES: To determine the value of extracapsular spread of metastatic lymph node as a prognostic factor and to evaluate the relationship of extracapsular spread and N staging system of metastatic lymph node. MATERIALS AND METHODS: From January 1990 to December 1993, 109 patients who received neck dissection for metastatic lymph node of head and neck squamous cell carcinoma were retrospectively studied for the presence of extracapsular spread according to N staging and compared the survival rates between the N staging system and the presence of extracapsular spread. RESULTS: Histopathologically, there were 17 cases(15.6%) of N0, 56 cases(51.4%) of N1, 25 cases(22.9%) of N2, and 11 cases(10.1%) of N3. Extracapsular spread in N1 was 30.4%, 64.0% in N2, and 90.9% in N3. Three year overall survival rate for N0 was 58%, 69% for N1, 48% for N2, 27% for N3, and 69% for 49 cases without extracapsular spread and 46% in 43 cases with extracapsular spread. CONCLUSION: Presence of extracapsular spread in metastatic lymph node of head and neck squamous cell carcinoma seems to have a significant value as a prognostic factor.

The relationship between invasion pattern and extracapsular spread in lymph node metastasis from squamous cell carcinoma of tongue / 实用口腔医学杂志

Objective: To study the relationship between different patterns of invasion and extracapsular spread in lymph node metastasis from squamous cell carcinoma of tongue. Methods: Pattern of invasion described by Anneroth was used to evaluate the malignance grade of tongue cancer and immunohistochemical and HE staining were used to detect the extracapsular spread in successive cases of tongue cancer with radical neck dissection. Results: Lymph node metastasis was observed in 0/5 of the cases with pattern I invasion,3/8 pattern II,5/6 pattern III and 1/1 pattern Ⅳ. Extracapsular spread occurred as totally or partly replacement of the lymph node by the tumourcells. The tumour cells infiltrated between lymph nodes, perinodal fibroadipose tissue or sternocleidmastoid muscle in the form of cell cluster or isolated cell. Conclusion: Pattern of invasion is a significant factor for evaluating the malignance grading of tongue cancer. Radical neck dissection should be used to treat the tongue cancer with pattern III or IV invasion.