The prognostic significance of lymph node metastasis and intrapancreatic perineural invasion in pancreatic cancer after curative resection

P < 0.02). In the group of patients with nodal metastasis, the 5-year survival rate for those without perineural invasion was 17%, while that for those with perineural invasion was 10%. The most favorable 5-year survival of 89% was observed in the subgroup of patients with stage I disease without perineural invasion. Thus, pancreatic adenocarcinoma categorized by the combination of these independent types of biological behavior showed 5-year survival rates ranging from very high to low, indicating that these two factors play an important role in the prognosis of this disease. (Received for publication on July 18, 1997; accepted on May 15, 1998)     

Impact of microscopic hepatic lymph node involvement on survival after resection of colorectal liver metastasis

BACKGROUND: Macroscopic hepatic lymph node involvement is usually a contraindication to hepatic resection. Only a few studies have investigated the impact of hepatic lymph node involvement on survival. The aim of this retrospective study was to assess microscopic hepatic lymph node involvement in resectable colorectal liver metastasis and outcomes in patients with such involvement. STUDY DESIGN: From January 1985 to December 2000, 156 patients underwent curative liver resection in association with systematic hepatic lymph node dissection for colorectal liver metastasis. A first analysis was performed to assess the association between hepatic lymph node metastasis and patients' characteristics. A second analysis assessed survival after resection of liver colorectal metastasis by using the Kaplan-Meier method. RESULTS: Twenty-three of the 156 patients (15%) had microscopically involved hepatic lymph nodes. No predictive factor of lymph node metastasis was identified. Multivariate analysis showed that lymph node metastasis, preoperative carcinoembryonic antigen level, number of metastases, and morbidity were factors influencing survival. The 3- and 5-year survival rates of patients with lymph node metastasis were 27% and 5%, respectively, compared with 56% and 43% without lymph node metastasis (p = 0.0001). CONCLUSIONS: During resection of liver colorectal metastasis, microscopic lymph node involvement occurred in 15% of the patients and was associated with a poor 5-year survival. Hepatic lymph node dissection should be performed systematically to select high-risk patients.     

Impact of lymph node metastasis on survival with early gastric cancer

The impact of lymph node metastasis on the survival of early gastric cancer (EGC) cases remains controversial. A retrospective study of 621 patients with EGC undergoing gastrectomy with lymphadenectomy during the period 1966–1993 was performed to evaluate the influence of node involvement on long-term outcomes. Lymph node metastasis was observed in 63 cases (10.1%). Two groups, EGC with and without node involvement, were compared with respect to long-term results and various clinicopathologic factors. The median observation period was 123 months. EGC cases without metastatic nodes had significantly better outcomes than those with node involvement in terms of overall survival as well as survival excluding deaths due to diseases unrelated to the primary EGC. Survival rates for EGC patients with node involvement did not, however, differ significantly according to the number of metastatic nodes. Three factors-submucosal invasion, large tumor size, and recurrence-were significantly related to lymph node metastasis. Age, sex, family history of malignancy, histologic type, and multiple occurrence of gastric cancer were unrelated to the prevalence of node involvement. The frequency of recurrence in EGC cases without node involvement was low (1.8%, 10 of 558). Recurrence was not, however, exceptional in those with metastatic nodes (9.5%, 6 of 63). EGC patients with lymph node metastasis, even with only a single positive node, constitute a high risk group for EGC recurrence.     

Solitary mediastinal lymph node recurrence after curative resection of colon cancer

We report two cases of solitary mediastinal lymph node recurrence after colon cancer resection. Both cases had para-aortic lymph node metastasis at the time of initial surgery and received adjuvant chemotherapy for 4 years in case 1 and 18 mo in case 2. The time to recurrence was more than 8 years in both cases. After resection of the recurrent tumor, the patient is doing well with no recurrence for 6 years in case 1 and 4 mo in case 2. Patients should be followed up after colon cancer surgery considering the possibility of solitary mediastinal lymph node recurrence if they had para-aortic node metastasis at the time of initial surgery.     

结肠癌根治术中淋巴结清扫及其对预后的影响

淋巴结转移是结肠癌细胞转移的主要途径之一,亦是导致结肠癌病人根治术后复发和死亡的重要原因。根治性手术在进展期结肠癌综合治疗中起着关键作用,淋巴结清扫是结肠癌根治性手术的关键环节,淋巴结清扫范围包括肠旁、中间和主淋巴结。每例结肠癌根治术后标本至少应剪取12枚淋巴结。结肠癌根治术中合理规范的淋巴结清扫与术后足够数量的淋巴结剪取是结肠癌精确分期的依据,对于指导制定辅助治疗方案和评估预后具有重要意义。     

The role of paraaortic lymph node involvement on early recurrence and survival after macroscopic curative resection with extended lymphadenectomy for pancreatic carcinoma

BACKGROUND: Early recurrence of invasive pancreatic cancer is common even after curative resection. To establish appropriate selection criteria for radical surgery, it is essential to identify the patient population at risk for early recurrence. STUDY DESIGN: One hundred thirty-three of 136 patients who underwent potentially curative pancreatectomy for invasive ductal adenocarcinoma of the pancreas between 1999 and 2003 were divided into two groups: patients whose recurrence developed within 1 year after operation and those whose recurrence did not develop within 1 year. Clinicopathologic factors were retrospectively analyzed between these groups using univariate and multivariable methods. RESULTS: One postoperative death occurred, yielding an in-hospital mortality rate of 0.7% (of 136 patients). Eighty-one patients (61% of 133) were identified as having recurrent pancreatic carcinoma within a year. Paraaortic nodal involvement and positive washing cytology were independent predictors of early recurrence. The median survival time in 26 patients with paraaortic nodal involvement was 13 months, versus 30 months in 106 patients without paraaortic nodal involvement (p < 0.001). Paraaortic lymph node involvement was notably associated with elevated CA19-9 a month after operation (p = 0.03), larger tumor size (p = 0.02), and a positive surgical margin (p = 0.04). CONCLUSIONS: Sampling of paraaortic lymph nodes is recommended as a routine examination at laparotomy. When positive nodes are confirmed by frozen section, early recurrence and poor survival are inevitable, even after radical operation including extended lymphadenectomy.     

Relationship of cell type and lymph node metastasis to survival after resection of bronchial carcinoma.

In the completed adjuvant chemotherapy lung trials conducted by the Veterans Administration Surgical Group, the cell type was recorded in 2,341 of 2,349 curative resections; extent of lymph node involvement was known in all cases. Nodes were normal in 1,231 patients. Five- and ten-year survival computed by the life-table method was 33.7% and 20.4%, respectively. These rates were significantly greater than the 16.2% and 8.8% recorded in 1,118 patients whose nodes showed metastases. Among patients whose cell type was known, five-year survival in 484 with hilar node involvement was 17.4% and was not significantly different from 20.1% in 364 patients in whom only lobar nodes were involved. The survival was 8.9% in 268 patients with cancer in the mediastinal nodes; this was significantly worse than either of the aforementioned groups. A five-year survival of 26.8% in 1,482 patients with squamous cell carcinoma was greater than the 24.3% in 359 with adenocarcinoma and 22.4% in 500 with undifferentiated cell types, but the differences were not significant. Variations between these groups remained nonsignificant when nodes were normal and were of only borderline significance, at the 5% level, when they showed metastasis. When a curative resection has been accomplished, cell-type as classified in this study has little bearing on long-term survival, whereas the presence of node metastasis as well as its location is of the utmost importance.     

胰头癌淋巴结转移的临床研究

目的:探索胰头癌淋巴回流途径和淋巴结转移的特点,以指导胰腺癌根治术中的淋巴结清扫范围.方法:在46例胰头癌标本应用手术显微镜法寻找淋巴结,进行详细的分组,以明确各组淋巴结的转移状况,并进一步分析各组淋巴结的转移频率和相互关系.结果:46例胰头癌平均每例找到淋巴结41.8枚,证实32例伴有淋巴结转移,包括较小的淋巴结,转移率69.6%.第13、14、12、8、16组转移频率较高.6例胰腺钩突肿瘤仅发生14组淋巴结转移而不伴13或17组淋巴结转移.7例阳性的16组淋巴结均属16b1亚组,主要分布于腹主动脉、下腔静脉和左肾静脉围成的三角形区域内.结论:在胰头癌根治性切除时,即使是局限于胰腺内的小胰癌也应作广泛的淋巴结清扫.胰腺钩突肿瘤尤其要注意肠系膜上动静脉周围的淋巴结清扫.清扫腹主动脉周围淋巴结重点应在腹主动脉、下腔静脉和左肾静脉构成的三角形区域内.     

Prognostic significance of regional lymph node reaction after curative resection of advanced gastric cancer.

The prognosis of patients with advanced gastric cancer who undergo curative resection is still unsatisfactory. The relationship between prognosis and various factors such as stage, lymph node metastasis, serosal invasion and regional lymph node reaction (follicular hyperplasia and sinus histiocytosis) was evaluated. Of the factors studied, the only one that correlated well with survival was sinus histiocytosis. Lymph node metastasis was related weakly to prognosis. No correlation between prognosis and stage, serosal invasion or follicular hyperplasia was observed. Sinus histiocytosis may represent the morphological tumour-host immune reaction. Lymph node metastases or histological types were not related to regional lymph node reaction. These results suggest that sinus histiocytosis could be a useful prognostic factor for gastric cancer. Intensive postoperative follow-up for recurrence may be necessary even for patients with low-grade sinus histiocytosis in whom curative surgery is attempted.     

主动脉旁淋巴结转移在可切除胰腺癌预后中的含意

胰腺癌病人手术切除后的生存曲线在1年内呈直线下降,而后下降相对缓慢.此类病人短的生存期可能与导致肿瘤快速复发的某种临床病理学因素是相一致的.     

胰头癌淋巴转移特点的探索和影响的因素

目的 探索胰头癌淋巴回流途径和淋巴结转移的特点，初步分析胰头癌淋巴结转移的相关因素．以指导胰腺癌根治术中的淋巴结清扫。方法 21例胰头癌标本应用手术显微镜法寻找淋巴结，并进行详细的分组。分析各组淋巴结的转移频率和相互关系。分析肿瘤大小、肿瘤组织学类型、术前血清肿瘤标志物与淋巴结转移的关系。结果 21例胰头癌平均每例找到淋巴结37．7枚，证实17例伴有淋巴结转移。第13、14、12和8组转移频率较高。4例胰腺钩突肿瘤仪发生14组淋巴结转移而不伴13或17组淋巴结转移。4例16组阳性的淋巴结均为16bl亚组．主要分布于腹主动脉、下腔静脉、左。肾静脉围成的三角形区域内。淋巴结转移与肿瘤大小、肿瘤组织学类型无关。伴有淋巴结转移的病人术前血清中CA50、CA24-2明显升高。结论 在胰头癌根治性切除时．即使是局限于胰腺内的小胰癌也应作广泛的淋巴结清扫。胰腺钩突肿瘤尤其要注意肠系膜上动静脉周围的淋巴结清扫。清扫腹主动脉周围淋巴结重点应在腹主动脉、下腔静脉和左肾静脉构成的三角形区域内。术前血清中CA50、CA24-2明显升高的病人术中更应注重淋巴结的清扫。     

孤立性淋巴结转移对胃癌预后的影响

目的探讨胃癌发生孤立性淋巴结转移对患者预后的影响。方法总结1995年1月至2003年12月间施行胃癌D2根治术的280例患者的临床资料．比较分析有淋巴结孤立性转移（孤立转移组）与无淋巴结转移（无转移组）两组患者的预后差异,进一步比较孤立转移组中跳跃性与非跳跃性淋巴结转移患者预后的差异：并进行预后因素分析。结果孤立转移组患者83例．无转移组患者197例。孤立转移组和无转移组术后5年生存率分别为623％和83．5％．差异有统计学意义（P〈0．05）。孤立性淋巴结转移是影响本组患者预后的独立因素之一（P〈0．01）。肿瘤浸润深度是胃癌孤立性淋巴结转移的独立危险因素（P〈0．05）。孤立转移组中跳跃性淋巴结转移者19例（22．9％）,跳跃性与非跳跃性淋巴结转移患者术后5年生存率分别为50．0％和66．1％．差异无统计学意义（P〉0．05）。结论发生孤立性淋巴结转移的胃癌患者预后较无淋巴结转移者差。施行D2根治术有助于跳跃性淋巴结转移的清扫．     

Metachronous common iliac lymph node metastasis after rectosigmoid colon cancer resection: A case report

Introduction and importanceMetastases to common iliac lymph nodes from cancer of the rectosigmoid are extremely rare. We report a patient with a right common iliac lymph node metastasis after rectosigmoid cancer resection.Case presentationThe patient is a 57-year-old woman diagnosed with rectosigmoid cancer (Stage IIIc) who underwent laparoscopic resection followed by 8 courses of adjuvant chemotherapy with capecitabine. Sixteen months after resection, an intra-abdominal mass and a left lung nodule were found on computed tomography scans, which were suspected to be recurrences. Exploratory laparoscopy showed that the abdominal lesion was an enlarged common iliac lymph node, which was completely excised. No other intraabdominal recurrences were found. Subsequently, a left upper lobe lung metastasis was resected thoracoscopically. However, multiple lung metastases developed four months after the lung resection, and systemic therapy was begun.Clinical discussionA lower incidence of lateral lymph node metastases from cancer in the rectosigmoid has been reported. Direct lymphatic pathways from the sigmoid colon or rectosigmoid to lateral lymph nodes have been suspected, which may be associated with the poor prognosis in this patient.ConclusionA metachronous metastasis to a common iliac lymph node from primary rectosigmoid cancer is reported. Common iliac lymph node metastases from rectosigmoid cancer might have more malignant potential, and should be treated in the same manner as peri-aortic lymph node metastases.     

Impact of lymph node metastasis on the pattern of failure and survival in oral carcinomas

BACKGROUND: Carcinomas of the oral cavity present a high risk for neck metastases that decrease the disease control and survival. METHODS: A total of 106 patients with squamous cell carcinoma of the oral cavity who had metastatic neck nodes were studied. The impact of neck metastasis and treatment modalities on outcome was assessed. RESULTS: Thirty-eight patients developed neck recurrence or distant metastasis. The 5-year survival, neck recurrence-free, and distant metastases-free rates were 56%, 84%, and 77%, respectively. Univariate analyses showed extranodal spread (ENS), number of positive nodes, and adjuvant chemotherapy were predictors for survival. In multivariate analysis, ENS and postoperative radiotherapy were of borderline significance. There was no prognostic factor for neck control. The presence of ENS and lower levels of positive nodes and no chemotherapy were associated with high distant failure rates. CONCLUSIONS: To prevent distant metastases, patients with ENS should be considered for adjuvant chemotherapy.     

Predictive factors for lymph node metastasis in early gastric cancer with lymphatic invasion after endoscopic resection

Background

Lymph node (LN) metastasis is found in only about 5–10% of the patients who undergo additional surgery after non-curative endoscopic resection. Lymphatic invasion after endoscopic submucosal dissection (ESD) is regarded as non-curative resection due to risk of reginal LN metastasis. This study was aimed to identify clinicopathologic predictive factors for LN metastasis in early gastric cancer (EGC) with lymphatic invasion after endoscopic resection.

Methods

Among a total of 2036 patients who underwent endoscopic resection for EGC at Samsung Medical Center from April 2000 to May 2011, 146 patients were diagnosed with lymphatic invasion. And 123 patients who had gastrectomy with LN dissection due to presence of lymphatic invasion as one of the non-curative factors were included in this study. Demographics, endoscopic tumor findings, histological findings, surgical findings with pathologic reports, and follow-up data were collected from the patient’s medical records. Pathological re-evaluation of resected specimens was performed.

Results

Among a total of 123 patients, LN metastases were found in seven patients (5.7%). The univariate analysis revealed that the LN metastasis was significantly more frequent in patients with certain morphology of lymphatic invasion that shows adhesion to endothelium of lymphatic tumor emboli (p?=?0.016), higher number of lymphatic tumor emboli in whole section (p?<?0.001) and papillary adenocarcinoma component (p?=?0.024). In multivariate analysis, the number of lymphatic tumor emboli [OR 93.5, 95% CI (2.62–3330.81)] and the presence of papillary adenocarcinoma component [OR 552.5, 95% CI (1.20–254871.81)] were identified as independent predictors of LN metastasis in patients with lymphatic invasion after endoscopic resection.

Conclusions

The number of lymphatic tumor emboli and the presence of papillary adenocarcinoma component were significant predictors for LN metastasis in patients with lymphatic invasion after endoscopic resection.

     

Disease-specific survival after radical lymphadenectomy for penile cancer: Prediction by lymph node count and density

ObjectiveTo investigate the value of removed lymph node (LN) count and LN density (LND) for predicting disease-specific survival (DSS) rate following radical lymphadenectomy in patients with penile cancer.MethodsWe retrieved data from 146 patients who were surgically treated between 2002 and 2012. receiver-operating characteristic curve analysis was used to calculate the optimal cutoff value of LN count and LND for predicting DSS rate. LND was analyzed as a categorical variable by grouping patients with pN+tumors into 2 categories. Multivariate Cox regression analysis was used to test the effect of various variables on DSS rate based on collinearity in various models.ResultsMedian follow-up was 42 months. Overall, 75 patients (51.4%) had pN0 disease, and 71 patients (48.6%) had pN+disease. The optimal cutoff value of LN count and LND were 16% and 16%, respectively. Among patients with pN0 tumors, the number of LNs removed (≥16 LNs) was an independent significant predictor of DSS rate in univariate and multivariate analyses (all P<0.05). Stratifying pN+ patients as above versus below the LND threshold demonstrated significant differences in 5-year DSS: 81.2% versus 24.4% (P < 0.001). In multivariate models including known prognostic factors, LND was a statistically significant independent predictor of DSS rate (hazard ratio = 4.31 and 3.96 for above vs. below the LND threshold, respectively).ConclusionsThe removal of at least 16 LNs was associated with a significantly longer DSS rate in patients with pN0 penile cancer. Additionally, an LND above 16% is an independent predictor of DSS rate in patients with pN+tumors. Further independent validation is required to determine the clinical usefulness of LN count and LND in this patient population.