Impact of total retrieved lymph nodes on staging and survival of patients with gastric cancer invading the subserosa

PurposeTo investigate the impact of total retrieved lymph nodes (tLNs) on staging and survival in patients with pT2b gastric cancer according to the nodal status.MethodsClinicopathological characteristics and prognostic outcomes of 392 patients with pT2b gastric cancer between 1980 and 2005 were retrospectively investigated based on the nodal status.ResultsThe number of metastatic lymph nodes (mLNs) was highly correlated with the number of tLNs (P < 0.001). The overall 5-year and 10-year survival rates were 39.0% (153/392) and 17.9% (70/392), respectively. The survival rates in patients with pN0 cancers did not differ significantly from that in patients with pN1 cancer when the tLNs were 25 or less. However, the survival rate in patients with N0 cancers was significantly greater than that in patients with pN1 cancers when the tLNs were more than 25 (64.3% vs. 36.9%, χ² = 4.339, P = 0.037). Moreover, both 5- and 10-year survival rates differed significantly among patients with pN1, pN2 and pN3 gastric cancer regardless of tLNs. Multivariate analysis revealed that age, tumor focus number, tumor location, and mLN, but not tLNs, were independent prognostic predictors in patients with pT2b gastric cancer.ConclusionsTo improve the accuracy of staging, no less than 15 tLNs should be pathologically examined in patients with pN1–3, and 25 tLNs for the patients with N0. More tLNs may not be associated with a better prognosis in pT2b disease because the extent of lymph node dissection is pre-defined for the operation.     

Consensus on the regional lymph nodes irradiation in breast cancer

Standard locoregional treatment of early-stage breast cancer currently consists of the conservative surgery and sentinel lymph node biopsy. In the event of positive sentinel node biopsy, an axillary level I–II lymphadenectomy should be carried out. However, recent publications have increasingly supported a tendency not to apply the surgical lymphadenectomy, but simultaneously, it has been developed a new role of regional radiotherapy, even if there is only 1–3 axillary lymph nodes involved. Given these new trends, radiation oncologists are facing the dilemma with regard to deciding about regional irradiation of breast cancer. For such purpose, The Spanish Group of Breast Cancer Radiation Oncology (GEORM as per its Spanish acronym) decided to reach a consensus to issue the respective guidelines for such types of cases. GEORM Managing Commission, gathering 13 members of different Spanish regional communities, issued a questionnaire including different clinical situations. These questions were set as key questions seeking responses, which were answered by 66 % out of the 75 members of the group. Following the response, the guidelines were drafted based on the replies to the mentioned questionnaire. All the respective issues were discussed by means of a virtual platform. In this article, we show the levels of consensus for different clinical situations, depending on the number of nodes involved and the type of surgical procedure performed on the axillary lymph nodes. The ongoing evolution of the oncological treatments obliges the radiation oncologists to take decisions without any existing clarifying evidence, and therefore, the consensus is necessary, which can assist in the decision-making process by the practitioners in such kinds of clinical situations.     

Experimental and clinical study on injection of neocarzinostatin into the duodenal sub-serosa as chemotherapy for the regional lymphatic system in pancreatoduodenal cancer

At the time of pancreatoduodenal cancer resection, Neocarzinostatin (NCS) was injected into the duodenal sub-serosa, as perioperative adjuvant chemotherapy for metastatic lymph nodes and cancer cells released into the lymphatic system. NCS content in the lymph nodes was measured after administration, and usefulness of the chemotherapy was investigated. Experiment: NCS (4,000 units) was administered into the duodenal sub-serosa of 18 adult mongrel dogs. NCS contents in the lymph nodes (those in the root of the mesentery and around the aorta) and pancreatic tissues were measured. NCS content in the pancreatic tissues decreased significantly 3 hours after administration, while that in the lymph nodes did not decreased even 3 hours later. Consequently, NCS is considered to be remain in the lymph nodes. Clinical findings: NCS (10,000 units) was administered into the duodenal sub-serosa in 18 resectable cases of pancreatoduodenal cancer. NCS content in the dissected lymph nodes was measured. The total number of dissected lymph nodes was 176, and the mean NCS content was 0.62 mu/g. The number of lymph nodes positive for metastasis was 14, and much content of NCS was observed in the specimens (mean NCS content: 1.25 mu/g). Examination according to site revealed the most content in the lymph nodes in pancreatic head closest to the site of administration, followed by the lymph nodes in the root of the mesentery and those in the hepatoduodenal ligament in the direction of lymphatic flow. Moreover, some distal lymph nodes also showed much content. NCS content in the lymph nodes showed time-related increase after administration, and significant correlation was observed within 2 hours.(ABSTRACT TRUNCATED AT 250 WORDS)     

Intra-operative assessment of sentinel lymph nodes for breast cancer surgery: An update

Lymph node (LN) involvement is the strongest prognostic factor in operable breast cancer (BC). Therefore, accurate assessment of LN status is essential for management of BC patients. The introduction of sentinel LN approach reduced the need for extensive axillary surgery to achieve accurate staging. However, positive sentinel LN as determined on postoperative histological examination often leads to a second axillary operation to ensure an accurate staging and that positive non-sentinel LNs are removed. Although preoperative assessment of LN has improved significantly, its accuracy remains insufficient to avoid further axillary surgery and is not sufficient to predict the status of the LN. Therefore, intraoperative evaluation of the sentinel LN to determine the need for completing lymph node dissection in case of metastasis can provide an important approach to guide BC management decision making. This article reviews the techniques available and under development for intraoperative detection of sentinel LN metastasis in BC surgery. The key features of each technique are described in detail, emphasising the benefits offered by label-free optical techniques: minimal sample preparation, high spatial resolution, and immediate on-site implementation. Optical techniques have the potential to provide a cost-effective and accurate intraoperative platform for the assessment of SLN within the operating theatre.     

Immune response to cancer and its regulation in regional lymph nodes

Regional draining lymph nodes (LNs) play a pivotal role in initiating immune responses. However, the presence of metastases may compromise their normal immunological function. Preclinical studies indicate that despite metastases, early tumor-draining LNs are still a rich source of sensitized T cells. Recently, we found that dendritic (DC)-tumor fusion hybrids were capable of stimulating therapeutic T-cell generation in the LN. However, this response is regulated by a tumor-specific suppression mechanism(s). Reversal of these dysfunctions would help the success of immunotherapy.     

Suppressor cells in the pelvic lymph nodes regional to bladder cancer.

Regional lymph node cells from some patients with locally advanced bladder carcinoma were found to inhibit the reactivity of normal and autologous peripheral blood lymphocytes in mixed leukocyte culture. The data suggest that suppressor cells are generated in draining lymph nodes of these patients by a high concentration of tumor-derived products and may have suppressive influence on host immunologic defense mechanisms.     

Follicular hyperplasia of the regional lymph nodes in stomach cancer and its prognostic significance

Degree of follicular hyperplasia of regional lymph nodes (LFH) in patients with gastric tumors (T1-4N0M0) was evaluated versus 5-year survival, age, tumor size, depth of invasion and histologic pattern. Stage II-III LFH was found to have a favorable prognosis. Tumor size proved a factor influencing the degree. No apparent relationship between age, depth of invasion and degree of tumor cell differentiation, on the one hand, and LFH stage, on the other, was established.     

Prognostic significance of metastatic involvement of regional lymph nodes in lung cancer

The study was concerned with a retrospective evaluation of the results of treatment of 1400 patients with operable epidermoid lung cancer. The prognostic significance of regional lymph node involvement in combination with such tumor parameters as site, size, degree of differentiation and gross pattern of primary tumor was evaluated.     

Concanavalin A-inducible suppressor cells in regional lymph nodes of cancer patients.

Regional tumor-draining lymph nodes of 11 of 14 patients with urological tumors and one of four controls studied contained suppressor cell precursors that could be activated by concanavalin A (Con A) to suppress the proliferative response of autologous lymphocytes to Con A. In contrast, no suppression of lymphocyte proliferation by lymph node cells that were not activated with Con A was observed in four patients tested. The suppressive effect was not due to decreased viability or increased release of cold thymidine by Con A-activated cells nor to alteration in the time course of the proliferative response of Con A-activated cells. Mitomycin C treatment of lymph node cells 24 hr after activation did not abrogate their suppressive activity. Peak suppression was observed after 72 hr in culture. The amount of suppression measured could be maximized by treatment of suppressor cells with mitomycin C 24 hr after activation and by washing the cells immediately before pulse labeling with tritiated thymidine. The concentration of Con A required to produce peak suppression varied from patient to patient with optimal doses ranging from 5 to 25 microgram/ml.     

Surgical results of lung cancer with sarcoid reaction in regional lymph nodes

BACKGROUND: There have been few reports of sarcoid reaction in the regional lymph nodes associated with lung cancer. The purpose of this study was to analyze the surgical results of lung cancer with sarcoid reaction. METHODS: Of 1733 lung cancer patients undergoing surgical treatment in our institute from 1990 to 2004, we reviewed 22 patients (1.3%) with sarcoid reaction in the regional lymph nodes of lung cancer. RESULTS: On pre-operative computed tomography (CT), mediastinal lymph node swelling was detected in 19 patients (86%) as clinical N3 disease (c-N3) in six or as c-N2 in 13, while three patients were classified as c-N0. To these 19 patients, lymph node status was histologically checked by mediastinoscopy in four patients, sternotomy approach in two and open mini-thoracotomy in 13. Because the sampling-biopsy nodes showed no tumor metastasis, radical surgery was promptly performed. However, four patients (18%) were finally judged to have pathological lymph node positive disease. Five patients were in pathological stage (p-stage) IA, nine in p-stage IB, five in p-stage IIB, two in p-stage IIIA, and one in stage IIIB. The overall 3-, and 5-year survival rates of these patients were 85.2 and 77.7%, respectively, with no significant difference compared to those of the remaining patients without sarcoid reaction. CONCLUSIONS: Because lung cancer patients with sarcoid reaction in the regional lymph nodes frequently show mediastinal lymph node swelling on CT, radical resection should be performed after confirming the node status by appropriate sampling biopsy. It seems that surgical results of lung cancers with sarcoid reaction in the regional nodes are not prognostically different from those without sarcoid reaction.     

Limited capability of regional lymph nodes to eradicate metastatic cancer cells

The capacity of lymph nodes to eradicate cancer is a controversial issue. The purpose of this study was to determine the interplay between tumor growth and host resistance at early stages of lymph node metastasis. A metastasis model was made in the rat mesenteric lymph node, and migration of cancer cells was visualized in vivo. The lymph node was removed for histologic analysis and cytokine measurement. Migrant cancer cells were initially arrested in the marginal sinus. After an initial increase, the number of cancer cells in the marginal sinus declined until 48 hours after inoculation. Germinal centers and lymphoid cells in the medulla proliferated before 48 hours. ED3(+) macrophages incorporated apoptotic cancer cells, but significant cancer proliferation occurred after 4 days. Lymph nodes depleted of macrophages were massively invaded by cancer cells. Tumor necrosis factor alpha and interleukin (IL)-1beta in the nodes transiently increased after 1 hour and 3 hours, respectively, and were expressed in ED3(+) and ED2(+) macrophages, respectively. These changes were followed by a transient increase in IL-2. Interferon-gamma and IL-12 did not increase during the early stages of metastasis, but they decreased after 48 hours. In conclusion, the marginal sinus constitutes a mechanical barrier against cancer cell passage. Early pathological manifestations in the regional lymph node are consistent with those in cancer patients with improved survival. Parasinus macrophages play a role in the transient antimetastatic capability of the node, and cytokines secreted by these cells increased at the early stages of metastasis. Deterioration of cytokine induction may be responsible for subsequent cancer proliferation.     

Lymphoid subpopulation changes in regional lymph nodes in squamous head and neck cancer.

Lymph nodes from 10 normal patients and regional lymph nodes (RLN) from 19 patients with squamous cancer of the head and neck were evaluated as to their lymphoid subpopulations. In comparison to normal lymph nodes, RLN from cancer patients demonstrated a marked increase in the proportion of cells with membrane immunoglobulin, the receptor for the third component of complement, and the receptor for the Fc portion of immunoglobulin G. The increased Fc receptor cells were not Fc-bearing thymus-derived lymphocytes, inasmuch as they separated with the non-sheep erythrocyte-lymphocyte rosette-forming population. The overall thymus-derived lymphocyte percentage in RLN was proportionally decreased. A transition from the normal lymph node composition to the altered lymphocyte profile seen in RLN was demonstrated on moving from distal lymph nodes to RLN within the lymphatic drainage of a tumor. Lymph nodes involved with tumor also showed the pattern of bursa equivalent cell population increases.