Colorectal cancer in the young: a possible role for immune surveillance?

Background: Younger patients with colorectal cancer (CRC) generally have better survival in spite of worse clinical and pathological features.

Methods: Twenty-six patients under 50 years operated for primary CRC were enrolled and matched 1:2:2 according to stage, tumor site and gender with 52 patients from 50 to 70 years and 52 patients over 70 years old.

Results: Patients under 50 years had a significantly longer overall, cancer specific and disease free survival (p?=?.001, p?=?.007 and p?=?.05, respectively). However, they had more frequently lymphovascular invasion (p?=?.006) and they more frequently developed metachronous CRC at follow-up (p?=?.03). Nevertheless, preoperative lymphocytes blood count/white blood count (LBC/WBC) ratio inversely correlated with age at operation (rho?=??.21, p?=?.04) and it predicted CRC recurrence with an accuracy of 70%, p?p?p?=?.0001 and p?=?.01, respectively).

Conclusions: Patients under 50 years had a significantly longer survival with a higher LBC/WBC ratio. These results could suggest a possible role of immunosurveillance in neoplastic control.     

Completeness of pathology reports in stage II colorectal cancer

Introduction: The completeness of the pathological examination of resected colon cancer specimens is important for further clinical management. We reviewed the pathological reports of 356 patients regarding the five factors (pT-stage, tumor differentiation grade, lymphovascular invasion, tumor perforation and lymph node metastasis status) that are used to identify high-risk stage II colon cancers, as well as their impact on overall survival (OS).

Methods: All patients with stage II colon cancer who were included in the first five years of the MATCH study (1 July 2007 to 1 July 2012) were selected (n?=?356). The hazard ratios of relevant risk factors were calculated using Cox Proportional Hazards analyses.

Results: In as many as 69.1% of the pathology reports, the desired information on one or more risk factors was considered incomplete. In multivariable analysis, age (HR: 1.07, 95%CI 1.04–1.10, p?p?=?.003) and well (HR 0.11, 95%CI 0.01–0.89, p?=?.038) differentiated tumors were significantly associated with OS.

Conclusions: Pathology reports should better describe the five high-risk factors, in order to enable proper patient selection for further treatment. Chemotherapy may be offered to stage II patients only in select instances, yet a definitive indication is still unavailable.     

Is there any Prognostically Different Subgroup among Patients with Stage IIIC (Any TN3M0) Breast Carcinoma?

Background We investigated whether there are prognostically different subgroups among patients with stage IIIC (anyTN3M0) breast carcinoma. Methods The file records of 348 female patients operated for stage IIIC breast carcinoma were reviewed. The endpoint was disease recurrence. Results Patients with a T1, T2 or T3 tumor had significantly better disease-free survival (DFS) compared to those with a T4 tumor. In the patient group with T1,2,3N3M0 disease, the DFS was significantly better in patients with between 10 and 15 metastatic axillary lymph nodes, compared to patients with 16 or more metastatic lymph nodes (p = 0.0360) and in patients with a nodal ratio ( number of metastatic lymph nodes divided by number of removed nodes) less than or equal to 0.80, compared to patients with a nodal ratio greater than 0.80 (p = 0.0003). In the patient subgroup with between 10 and 15 metastatic lymph nodes, those with a nodal ratio greater than 0.80 had significantly worse DFS, whereas in the patient subgroup with 16 or more metastatic lymph nodes the nodal ratio had no prognostic significance. The DFS of patients with 10 to 15 positive lymph nodes and a nodal ratio of up to 0.80 was significantly better than that of both the patients with 10 to 15 positive lymph nodes and a nodal ratio greater than 0.80 (p = 0.0002), and the patients with 16 or more positive lymph nodes (p = 0.0002); survival of the latter two patient groups was similar. Conclusions Patients with T1,2,3N3M0 disease can be divided into prognostically different subgroups according to the number of metastatic lymph nodes in the axilla and the nodal ratio; in this way, different patient subgroups may be offered different treatment strategies. An erratum to this article can be found at     

Factors that Influence 12 or More Harvested Lymph Nodes in Early-Stage Colorectal Cancer

Background  The number of lymph nodes required for accurate staging is a critical component in early-stage (stage A and B) colorectal cancer (CRC). Current guidelines demand at least 12 lymph nodes to be retrieved. Results of previous studies were contradictory in factors, which influenced the number of harvested lymph nodes. This study was designed to determine the factors that influence the number of harvested lymph nodes (≥12) in early-stage CRC in a single institution. Methods  Between 2003 and 2007, data on patients who underwent surgery for early-stage CRC were analyzed retrospectively. Data for a total of 470 patients were collected and all the tumor-bearing specimens were fixed with node identification performed. Several possible factors that influence 12 or more harvested lymph nodes were investigated and classified into four aspects: (1) operating surgeon, (2) examining pathologist, (3) patient (age, sex, and body mass index), and (4) disease (maximal length of tumor, length of specimen, tumor localization, tumor cell differentiation, Dukes stage, type of resection, and type of tumor). Results  A total of 289 patients (61.5%) with 12 or more harvested lymph nodes and 181 patients (38.5%) with < 12 lymph nodes were analyzed. The results demonstrate that within a single institution the maximal length of tumor, tumor localization, and depth of tumor invasion according to Dukes stage were independent influencing factors of 12 or more harvested lymph nodes. Maximal length of tumor was associated with more harvested lymph nodes (P < 0.001). Neither the operating surgeon nor the examining pathologist had significant influence on the number of harvested lymph nodes. Conclusions  The number of harvested lymph nodes was highly variable in patients who underwent resection of early-stage CRC. Neither the operating surgeon nor the examining pathologist had significant influence on the number of harvested lymph nodes. Therefore, from the viewpoint of the surgeons, disease itself is the most important factor influencing the number of harvested lymph nodes.     

Can Retroperitoneal Lymph Node Dissection (RPLND) be feasibly performed to prolong survival in Renal Cell Carcinoma (RCC) with limited lymph node involvement? An Analysis of Recurrence Patterns

IntroductionThe therapeutic benefit of performing a lymph node dissection (LND) in patients with renal cell carcinoma (RCC) has been controversial. In prior studies, it was thought that a low event rate for nodal metastases affected the ability to draw any conclusions. Here, we opted to select patients that had low burden 1 or 2 nodes positive to study survival outcomes and recurrence patterns based on limited LND or extended LND with a template retroperitoneal lymph node dissection (RPLND).MethodsWe used our single institutional database from 2000 and 2019 and identified 45 patients that had only 1 or 2 nodes positive on final pathology without any other systemic disease. These patients all underwent nephrectomy with limited LND or a template RPLND on the ipsilateral side.ResultsWe identified 23 patients in the limited LND and 22 in the template RPLND group. Thirty-one patients included in the study had 1 positive lymph node and 14 patients had 2 positive lymph nodes. For patients undergoing a limited LND, a median 4 (IQR 1–11) lymph nodes were resected and for those undergoing template RPLND, 18 (IQR: 13–23) lymph nodes were resected. On Kaplan-Meier analysis, a difference was noted in overall survival (P = 0.04) when comparing limited LND to template RPLND. We also mapped out patterns of recurrence and found that 6 patients had retroperitoneal lymph node recurrences after a limited LND in the ipsilateral node packet. On univariate analysis, pathologic stage was a major factor for survival, but did not remain as significant with the inclusion of template RPLND status and Charlson Comorbidity Index in multivariate analysis.ConclusionWe identified specific patients that had RCC with limited lymph node involvement. We found that a select number of patients had durable improvement in survival outcomes with template RPLND. In examining the recurrence patterns, a greater number of patients may have derived benefit for an initial template RPLND.     

The role of sleeve resections in advanced nodal disease

Objective: The aim of this study was to compare the short-term and long-term results of sleeve resections depending on limited nodal disease (N0/N1, LND) and advanced nodal disease (N2/N3, AND) for non-small cell lung cancer (NSCLC) at a single institution. Methods: We retrospectively reviewed our prospective database of all NSCLC patients undergoing sleeve resections between January 1999 and December 2008. Patients’ characteristics, morbidity, mortality, locoregional recurrence, distant recurrence, and survival were analyzed corresponding to LND and AND. Results: The indication was NSCLC for 170 sleeve resections (LND: n = 120; AND: n = 50) out of 213 consecutive sleeve resections. Both groups were statistically equal with regard to age (LND 61.8 ± 12.4 vs AND 60.8 ± 9.6 years), gender, co-morbidities, type of sleeve resection (bronchial vs bronchovascular), number of dissected lymph nodes (LND 40.0 ± 12.4 vs AND 36.7 ± 14.0), histology and completeness of resection (LND 96.7% vs AND 98.0%), respectively. More patients had induction chemotherapy in AND group (p = 0.049). The short-term results were equal on the subject of morbidity rate (LND: 34.2%, AND: 44.0%), secondary pneumonectomy (LND: 1.7%, AND: 4.0%), and mortality rate (LND: 5.0%, AND: 6.0%), respectively. LND was associated with a better 5-year-survival rate (LND: 67%; AND: 42%) and mean survival (LND: 80.8 months; AND: 37.7 months; p = 0.014). In the long-term follow-up, more distant metastases were detected in AND group (26.0% vs 14.2%, p = 0.079) in contrast to identical locoregional recurrence (LND: 1.7%; AND: 0%). In the event of metastazing, the mean time to the development of distant metastases was similar (LND: 19.1 months; AND: 12.4 months; p = 0.2). Conclusions: Lymph node involvement is a negative prognostic factor concerning long-term survival. Sleeve resections in AND do not result in higher morbidity and mortality. But even in AND, sleeve resections are associated with promising long-term survival and extraordinary local control of the disease as a result of high complete resection rates. High rate of distant failure warrants further investigation for the systemic control of the disease.     

Lymph Node Tumor Volumes in Patients Undergoing Sentinel Lymph Node Biopsy for Cutaneous Melanoma

Background: Regional lymph node tumor volumes in patients undergoing sentinel lymph node (SN) biopsy (SNB) for treatment of cutaneous melanoma have not been described. The objectives of this study were to describe the lymph node tumor volumes typically seen in this population and to correlate tumor volumes with tumor thickness and positive SN characteristics.Methods: Review of a consecutive series of patients with clinically localized cutaneous melanoma who underwent SNB of nonpalpable regional lymph node basins followed by complete lymphadenectomy (LND) was performed. Multiple lymph node sections from positive SNs and nonsentinel nodes (NSNs) in LND specimens were examined microscopically. Individual tumor deposit diameters were measured using an ocular micrometer. Aggregate tumor volumes were calculated for SN and LND specimens. Tumor volumes and SN and LND positivity rates were correlated with tumor thickness, the number of positive SNs, and the presence of multiple SN tumor deposits.Results: SNB procedures were performed for 149 melanomas in 189 regional nodal basins. The mean tumor depth was 2.48 mm. The mean number of SNs/basin was 2.1. Thirty-two of 149 SNB procedures (21.5%) revealed a total of 34 nodal basins with at least one positive SN. The median tumor volume in positive SNs was 4.7 mm³ (range, 0.1-3618 mm³; mean, 209 mm³). The median aggregate tumor volume in positive LND specimens was 4.9 mm³ (range, 0.1-3618 mm³; mean, 224 mm³). Six basins (17.6%) contained at least one positive NSN. The regional node aggregate tumor volume correlated weakly with tumor thickness (Pearsons correlation coefficient = .302, P = .0934). NSN positivity was not predicted by tumor thickness, American Joint Committee on Cancer tumor stage, number of positive SNs, or number of metastatic deposits within SNs.Conclusions: Most melanoma-positive SNs contain minute tumor volumes. Tumor thickness and patterns of SN metastases may not be predictive of tumor burden or the presence of positive NSNs.     

Head-to-head comparison of lymph node density and number of positive lymph nodes in stratifying the outcome of patients with lymph node-positive prostate cancer submitted to radical prostatectomy and extended lymph node dissection

ObjectiveThe aim of this study was to compare the predictive ability of lymph node density (LND) and number of positive lymph nodes in patients with prostate cancer and lymph node invasion.Materials and methodsWe included 568 patients with lymph node invasion treated with radical prostatectomy and extended pelvic lymph node dissection between January 1990 and July 2011 at a single center. The Kaplan-Meier method and multivariable Cox regression models tested the association between the number of positive lymph nodes or LND and cancer-specific survival (CSS). The predictive accuracy of a baseline model was assessed using Harrell's concordance index and then compared with that of a model including either the number of positive nodes or LND.ResultsThe median number of positive lymph nodes was 2, whereas the median LND was 11.1%. At 5, 8, and 10 years, CSS rates were 92.5%, 83.9%, and 82.8%, respectively. At multivariable analyses, number of positive lymph nodes and LND, considered as continuous variables, were independent predictors of CSS (all P≤0.01). A 30% LND cutoff was found to be highly predictive of CSS (P = 0.004), and a cutoff of 2 positive nodes was confirmed to be a strong predictor of CSS (P = 0.02). The number of positive nodes and LND similarly, continuous or dichotomized, increased the accuracy for CSS predictions (0.68–0.69 vs. 0.61 of baseline model). LND cutoff of 30% increased the discrimination the most (0.69; +0.083).ConclusionsThe number of positive lymph nodes and LND showed comparable discriminative power for long-term CSS predictions. A cutoff of 30% LND might be suggested for the selection of patients candidate for adjuvant systemic therapy, because it increased the model's discrimination the most.     

Modern Chemotherapy Mitigates Adverse Prognostic Effect of Regional Nodal Metastases in Stage IV Colorectal Cancer

Background

In colorectal cancer, the involvement of regional lymph nodes with metastasis is an established prognostic factor. The impact of the number of positive nodes on patient outcome with stage IV disease is not well defined.

Methods

A retrospective review was performed of 1,421 patients at two tertiary referral centers with stage IV colorectal cancer who underwent primary tumor resection. Associations between regional nodes, lymph node ratio (LNR), and overall survival (OS) from date of diagnosis were analyzed.

Results

The number of positive regional nodes and LNR correlated with multiple sites of metastases (p?<?0.001). Survival was significantly associated with the number of positive nodes and LNR, with a median OS of 43 months with negative nodes, compared to 20 months with ≥7 positive nodes (p?<?0.001). The number of regional nodal metastases correlated with OS among 400 patients undergoing resection of liver metastases (p?=?0.005) but lost prognostic significance in the subset of 223 patients who underwent hepatectomy with perioperative oxaliplatin- or irinotecan-based chemotherapy (p?=?0.48).

Conclusions

In stage IV colorectal cancer, an increasing number of positive regional nodes and LNR correlate with multiple sites of metastases and poorer survival. The number of metastatic regional lymph nodes loses prognostic significance with modern chemotherapy in patients undergoing resection of liver metastases.     

Salvage abdominoperineal resection following combined chemotherapy and radiotherapy for epidermoid carcinoma of the anus

Background: Up to one-third of patients with anal epidermoid cancer will fail initial chemoradiotherapy (CT-RT) or have local recurrence after treatment. This study evaluates the Memorial Sloan-Kettering Cancer Center (MSKCC) experience with salvage abdominoperineal resection (APR) in these patients. Methods: Thirty-eight patients who underwent salvage APR following 5-fluorouracil (5-FU), mitomycin C, and radiotherapy over the past 12 years were analyzed by retrospective review. Survival was calculated by the Kaplan-Meier method and comparisons by log-rank analysis. Results: The indications for APR were recurrent disease after CT-RT in 14 patients and persistent disease in 24 patients. Median follow-up time and survival were 47 and 41 months, respectively. The actuarial 5-year survival was 44%. Twenty-three patients had recurrent disease after APR. Inguinal lymphadenopathy at initial presentation (p<0.05), fixation of tumor to the pelvic sidewall (p<0.01), and pathologic involvement of the perirectal fat (p<0.01) adversely affected survival. Age, gender, initial response to CT-RT, initial stage of the primary tumor, histologic levator muscle involvement, status of perirectal lymph nodes, and extent of lymphadenectomy did not affect survival. Conclusions: Salvage APR can be expected to yield a moderate number of long-term survivors, but the high rate of disseminated failure suggests the need for additional postoperative treatment. Presented at the 46th Annual Cancer Symposium of the Society of Surgical Oncology, Los Angeles, California, March 18–21, 1993.     

Lymph node dissection during radical nephrectomy: A Canadian multi-institutional analysis

ObjectivesTo determine the association between lymph node dissection (LND) at the time of radical nephrectomy and survival in a large, multi-institutional cohort using a propensity score matching design.Subjects and MethodsThe Canadian Kidney Cancer information system was used to identify patients undergoing radical nephrectomy for nonmetastatic renal cell carcinoma. Associations between LND with overall survival , recurrence free survival and cancer specific survival were determined using various propensity score techniques in the overall cohort and in patients with varying probabilities of pN1. Cox models were used to determine association of lymph node removed with outcomes.ResultsOf the 2,699 eligible patients, 812 (30%) underwent LND. Of the LND patients, 88 (10.8%) had nodal metastases. There was no association between LND and improved overall survival, recurrence free survival or cancer specific survival using various propensity score techniques (stratification by propensity score quintile, matched pairs, inverse treatment probability weighting and adjusted for propensity score quintile). There was no association between LND and a therapeutic benefit in patients with increased threshold probabilities of nodal metastases. Increased number of lymph nodes removed was not associated with improved survival outcomes.ConclusionsLND at the time of radical nephrectomy for renal cell carcinoma is not associated with improved outcomes. There was no benefit in patients at high risk for nodal metastases, and the number of nodes removed did not correlate with survival. Further studies are needed to determine which high risk patients may benefit from LND.     

The impact of surgeon and pathologist on lymph node retrieval in colorectal cancer and its impact on survival for patients with Dukes' stage B disease

Objective An adequate lymph node harvest is necessary for accurate Dukes’ stage discrimination in colorectal cancer. The aim of this study is to identify the effect of variables, including the individual surgeon and pathologist, on lymph node harvest in a single institution. Method Three hundred and eighty one consecutive patients had resection for colorectal cancer, in a single unit. Factors influencing lymph node retrieval, including individual surgeon and reporting pathologist, were subjected to uni‐ and multivariate analysis. Actuarial survival of all patients with Dukes’ stage B and C disease was then calculated and survival compared between Dukes’ stage B and C at differing levels of lymph node harvest. Results The unit median lymph node harvest was 13 nodes/patient (95% CI 13.1–14.5). There was no difference in lymph node harvest between specialist colorectal surgeons and the pooled results of four nonspecialist consultant surgeons. However, there was a significant difference between reporting pathologists (P < 0.001). On univariate analysis, operation type, operative urgency, Dukes’ stage, T‐stage, reporting pathologist and use of neoadjuvant therapy in rectal cancer, were found to significantly affect lymph node retrieval. On multivariate analysis, operation type, T‐stage, reporting pathologist and neoadjuvant therapy in rectal cancer remained significant variables. Patients with one or more lymph node metastasis had greater nodal harvests than those without (median 15 vs 12 P = 0.02). Survival of patients with Dukes’ stage B disease was found to improve as lymph node harvest increased. Conclusion Overall lymph node harvest, in this unit, varied according to the reporting pathologist but not operating surgeon. As lymph node harvest increased to 15 per patient, the probability of identifying a metastatic node increased.     

High Expression of Delta-Like Ligand 4 Predicts Poor Prognosis After Curative Resection for Pancreatic Cancer

Background

Delta-like ligand 4 (DLL4)-Notch signaling plays a key role in tumor angiogenesis, but its prognostic value in patients with pancreatic ductal adenocarcinoma (PDAC) remains unclear. Our aim was to determine whether high DLL4 expression is correlated with poor prognosis after curative resection for PDAC.

Methods

Surgical specimens obtained from 89 patients with PDAC were immunohistochemically assessed for DLL4 and vascular endothelial growth factor receptor 2 (VEGFR-2) expression. Prognostic significance of DLL4 expression was evaluated by Kaplan–Meier method and Cox regression. The correlations of DLL4 expression with VEGFR-2 expression, tumor stage, and lymph node metastasis were examined by chi-square test and multivariate logistic regression.

Results

There were 38 (42.7%) and 51 patients who showed high and low DLL4 expression, respectively. Survival curves showed that patients with low DLL4 expression had a significantly better survival than those with high DLL4 expression (P < .001). Multivariate survival analysis demonstrated that high DLL4 expression was independently associated with both reduced overall survival (hazard ratio [HR] 2.24; 95% confidence interval [95% CI] 1.14–4.38) and reduced progression-free survival (HR 2.37; 95% CI 1.22–4.60). Multivariate logistic regression analyses showed that high DLL4 expression was independently associated with both advanced tumor stage (odds ratio [OR] 6.84; 95% CI 2.42–9.36) and lymph node metastasis (OR 3.27; 95% CI 1.04–10.34). We also found a positive correlation between DLL4 and VEGFR-2 expression (P < .001).

Conclusions

High DLL4 expression is significantly associated with poor prognosis for surgically resected PDAC, advanced tumor stage, and lymph node metastasis. Application of adjuvant therapy targeting DLL4-Notch signaling may improve prognosis.

     

Impact of acute kidney injury on renal allograft survival

Background: Acute kidney injury (AKI) is one of the major determinants of graft survival in kidney transplantation (KTx). Renal Transplant recipients are more vulnerable to develop AKI than general population. AKI in the transplant recipient differs from community acquired, in terms of risk factors, etiology and outcome. Our aim was to study the incidence, risk factors, etiology, outcome and the impact of AKI on graft survival.

Methods: A retrospective analysis of 219 renal transplant recipients (both live and deceased donor) was done.

Results: AKI was observed in 112 (51.14%) recipients, with mean age of 41.5?±?11.2 years during follow-up of 43.2?±?12.5 months. Etiologies of AKI were infection (47.32%), rejection (26.78%), calcineurin inhibitor (CNI) toxicity (13.39%), and recurrence of native kidney disease (NKD) (4.46%). New Onset Diabetes After Transplant (NODAT) and deceased donor transplant were the significant risk factors for AKI. During follow-up 70.53% (p?=?.004) of AKI recipients progressed to chronic kidney disease (CKD) in contrast to only 11.21% (p?=?.342) of non AKI recipients. Risk factors for CKD were AKI within first year of transplant (HR: 7.32, 95%CI: 4.37–15.32, p?=?.007), multiple episodes of AKI (HR: 6.92, 95%CI: 3.92–9.63, p?=?.008), infection (HR: 3.62, 95%CI: 2.8–5.75, p?=?.03) and rejection (HR: 9.92 95%CI: 5.56–12.36, p?=?.001).

Conclusion: Renal transplant recipients have high risk for AKI and it hampers long-term graft survival.     

Does the Extent of Operation Influence the Prognosis in Patients With Melanoma Metastatic to Inguinal Nodes?

Background: The role of pelvic lymphadenectomy in melanoma metastatic to the superficial inguinal region remains controversial. Some researchers advocate aggressive surgical management,whereas others feel that outcome depends more on extent of disease rather than extent of treatment.We reviewed our recent experience to investigate possible therapeutic effects of extended surgery.Methods: We performed a retrospective clinical and pathological review of 227 consecutive patients having superficial (SLND) or combined inguinal lymphadenectomy (CLND) for cutaneous melanoma.Results: A total of 174 SLNDs and 53 CLNDs were performed. Overall 5-year survival for node-positive patients was 39%. Survival for patients with positive superficial nodes was 40%; for those with positive deep nodes it was 35% (P = ns). In node-positive patients, number and size of involved lymph nodes and the presence of extranodal spread, failure to receive adjuvant therapy, and tumor ulceration were associated with poorer prognosis. Extent of surgery was not associated with differential survival, although CLND patients had worse pathological features. Subgroup analysis showed no significant survival difference between SLND and CLND.Conclusions: Some patients with deep nodal involvement apparently are cured by CLND. However, it is the biology of the disease and not the extent of surgery that primarily governs outcome. Patients with clinical or radiological evidence of pelvic nodal disease without evidence of systemic disease should have a CLND, but we find no evidence to support CLND if the pelvic nodes are clinically and radiologically negative.     

Predictors of adequate lymph node dissection in patients with non–muscle invasive bladder cancer undergoing radical cystectomy and effect on survival

IntroductionRadical cystectomy (RC) is the standard of care for refractory high-risk non-muscle invasive bladder cancer (NMIBC). We aim to identify predictors of adequate lymph node dissection (LND) in a cohort of NMIBC patients undergoing RC, as well as its impact on clinical outcomes.MethodsThe National Cancer Database was queried for patients who underwent RC for urothelial cell carcinoma for clinical stage Tis/a/1 N0M0 disease between 2004 and 2013. Patients were stratified by LND: none, inadequate (<10) or adequate (≥10 nodes). Factors associated with LND were analyzed. Inverse-probability weighted propensity score matching was used to assess the impact of adequate LND on overall survival.ResultsThe final cohort of 3,226 patients had a median follow-up of 39.0 months, had a mean age of 65.3 years, was 70% male, and was 81% Caucasian. Overall, 16.6% received no LND, 28.5% inadequate LND, and 55.0% adequate LND. Treatment at an academic facility, Charlson-Deyo Comorbidity score of 1, and later year of treatment were significantly associated with adequate LND. Overall survival was significantly higher with adequate LND compared to a matched-cohort of inadequate LND patients (68.7% vs. 60.6% at 5 years, P < 0.01).ConclusionsNearly half of NMIBC patients undergoing RC do not receive an adequate LND, despite an association with increased overall survival. Treatment at an academic facility was associated with increased likelihood of adequate LND. Initiatives to improve adequate LND in this population may be warranted.     

Who is Responsible for Inadequate Lymph Node Retrieval after Colorectal Surgery: Surgeon or Pathologist ?

Background : Many factors have been described influencing survival of patients with colorectal cancer. The most important prognostic factor is lymph node involvement. The National Comprehensive Cancer Network indicates that at least 12 lymph nodes (LN12) must be retrieved for proper staging and treatment planning. The surgeon and the pathologist influence the number of retrieved lymph nodes.

Methods : We retrospectively reviewed all patients with diagnosis and subsequent surgery for colorectal cancer from January 2004 to January 2010 at Gulhane Military Medical Academy in Ankara, Turkey. We investigated the relationship between LN12 and the independent variables of tumour size, lymph node involvement, metastasis, age, gender, surgeon, pathologist, surgical specimen length, tumour stage, and localization. Statistical analysis utilized the Shapiro-Wilk test, interquartile range, Mann-Whitney test, chi-square and chi-square likelihood ratio tests, and Kruskal-Wallis non-parametric variance analysis.

In order to identify influencing factors for retrieval of lymph nodes, multiple linear regression was performed. In order to identify the direction and extent of effects of these influencing factors, logistic regression was performed. OR (Odds Ratio) and 95% CI (Confidence Interval) of the OR were calculated.

Results : There were 223 study patients, 134 with colon cancer and 89 with rectal cancer. There was no statistical significance in terms of age, gender, cancer type and postoperative tumour size, number of metastatic lymph nodes > 4, or LN12 (p > 0.05). Statistical significance was found between surgeons and LN12, the number of operations and LN12 (p < 0.001), and pathologists and LN12 (p = 0.049).

Conclusions : Harvesting an adequate number of lymph nodes is crucial for patients with colorectal cancer in terms of staging and planning further treatment modalities such as adjuvant chemotherapy. Multidisciplinary collaboration between surgeons and pathologists is vital for optimal patient outcomes.     

Low lean tissue mass can be a predictor of one-year survival in hemodialysis patients

Purpose: Nutritional status has a significant impact on the outcomes in the dialysis population. The aim of this study was to evaluate the association between body composition and a one-year survival of hemodialysis patients.

Methods: Forty-eight patients with chronic kidney disease stage V treated with hemodialysis for more than three months were included. Body composition was assessed by bioimpedance spectroscopy (Body Composition Monitor, Fresenius Medical Care). Blood samples for serum creatinine, serum albumin, serum prealbumin, high sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-6), insulin-like growth factor 1(IGF-1) concentrations were taken before the midweek dialysis session.

Results: Over the course of a one-year observation, seven patients died. We observed a significantly lower lean tissue index (LTI) (p?=?.013) and higher IL-6 (p?=?.032) and hsCRP levels (p?=?.011) among the patients who died. The remaining biochemical markers did not differ between these two groups. Kapplan–Meier analysis revealed a worse survival rate in patients with sarcopenia (lower than the 10th percentile for their age and gender) in comparison with those with normal LTI. However, it was not of statistical significance (p?=?.055). LTI inversely correlated with age and IL-6 and positively with IGF-1.

Conclusions: Sarcopenia defined as decreased LTI, is a relatively common condition among patients undergoing maintenance hemodialysis, it can also be associated with a lower one-year survival rate. Decreased lean tissue mass can be associated with old age, lower IGF-1 levels and higher IL-6 levels. Body composition assessment may provide prognostic data for hemodialysis patients.     

Prognostic significance of prostaglandin E2 production in fresh tissues of head and neck cancer patients

Background. Immunosuppressive prostaglandins may play a role in the biologic behavior of head and neck cancer. Increased levels of prostaglandin E₂ (PGE₂) have been measured in squamous cell carcinoma of the head and neck (SCCHN). Methods. To address this question, tissue levels of PGE₂ were measured in tumor tissues, normal mucosa, and lymph nodes of 37 patients undergoing tumor resections. Tissue specimens were placed in culture media, and levels of PGE₂ released into the supernatant were measured by radioimmunoassay. Results. Tissue levels of PGE₂ were significantly greater in tumor and normal mucosal tissues compared to lymph nodes (p = 0.0003). There was no difference between metastatic and tumor-free lymph nodes. Although tumor tissue levels of PGE₂ were not associated with tumor stage, increased levels of PGE₂ were associated with increased 2-year disease-free survival (p = 0.02). Conclusions. Although PGE₂ may have adverse effects on local immune function in tumor tissues, improved survival of patients with increased local PGE₂ production may be indicative of an enhanced immunologic response to the tumor which has a favorable impact on outcome. © 1995 Jons Wiley & Sons, Inc.