Quality Assurance Parameters and Predictors of Outcome for Ilioinguinal and Inguinal Dissection in a Contemporary Melanoma Patient Population

Background  

Regional lymph node dissection (RLND) is currently the most effective therapy for metastatic melanoma in groin lymph nodes. With thorough surgery, RLND lymph node (LN) retrieval numbers have a predictable distribution. Whether patients have inguinal or ilioinguinal dissection varies between institutions. This study was designed to provide LN retrieval parameters for inguinal and ilioinguinal LN dissections, and secondarily, to analyze known predictors for survival outcomes, including LN ratio, i.e., involved/total number LN removed.     

Detection of Lymph Node Involvement by Cytokeratin Immunohistochemistry is an Independent Prognostic Factor After Curative Resection of Esophageal Cancer

Background  

Involved lymph nodes (LN) are a negative prognostic factor in esophageal cancers. To assess the role of nodal micrometastases, we performed immunohistochemical analyses of LN after resection of node-negative esophageal cancers and correlated the results with survival.     

Regional Recurrence after Lymphadenectomy for Clinically Evident Lymph Node Metastases from Papillary Thyroid Cancer: A Cohort Study

Background  

The presence of lymph node (LN) metastases in papillary thyroid cancer (PTC) has limited prognostic utility for predicting disease-specific survival. Pathologic features of the LNs beyond their presence and location do not factor into the AJCC staging system. Most LN metastases are microscopic. The natural history of patients with PTC and clinically evident LN metastases (CELNM) has not been well characterized.     

Clinical Significance of Lymph Node Metastasis in Patients Undergoing Partial Hepatectomy for Hepatocellular Carcinoma

Background

There are few detailed clinical reports about perihepatic lymph node (LN) assessment of hepatocellular carcinoma (HCC). The purpose of the present study was to evaluate the incidence, site, and impact on survival of LN metastasis in patients with HCC amenable to curative liver resection and routine regional lymphadenectomy.

Methods

From January 2001 to June 2004, a total of 523 HCC patients undergoing curative hepatic resection and routine regional lymphadenectomy were included in this study. The incidence, site of LN metastasis in HCC patients, and its influence on survival were analyzed.

Results

A total of 3433 lymph nodes were dissected from the 523 patients enrolled in this study and examined by pathologists. Among these patients, LN metastasis was found in 39 (7.45%) patients. Hepatic pedicle, retropancreatic space, and common hepatic artery stations were conventionally removed. The incidence of LN metastasis in the hepatic pedicle station was higher than that in the other stations (p < 0.01) The overall cumulative survival rate was significantly worse for patients with LN metastasis than for those without LN metastasis (p < 0.01). The median survival time was 28 months among the patients with LN metastasis and 53 months among those without LN metastasis. Tumors had recurred in 82.05% (32/39) of patients with LN metastasis and in 57.64% (279/484) of those without LN metastasis (p < 0.01). Regional lymphadenectomy was considerably safe with a low intraoperative complication rate (0.95%).

Conclusions

Lymph node metastasis in patients with HCC is closely related to a lower survival rate. Regional lymph node dissection should always be performed to determine the precise stage of the disease. Hepatic resection with regional lymphadenectomy is a safe procedure in patients with HCC.     

Race and Correlations Between Lymph Node Number and Survival for Patients with Gastric Cancer

Background

There is ongoing debate whether extended lymphadenectomy improves survival in gastric cancer patients who undergo surgical resection. We previously observed that Korean–American patients had the highest overall survival in Los Angeles County. Our objective was to assess lymph node (LN) number and its impact on survival for Korean–American gastric cancer patients.

Methods

We utilized the National Cancer Institute’s Surveillance, Epidemiology, and End Results registry to identify Korean–Americans with gastric adenocarcinoma treated with curative-intent gastrectomy between 1988 and 2008. We grouped patients according to examined LN number (1–15 and 16+) and compared characteristics. We performed similar analysis for white patients.

Results

Out of 982 Korean–American patients with gastric adenocarcinoma, most patients had 1–15 examined LNs (60 %). When we compared LN groups, we observed higher overall survival in the 1–15 group than the 16+ group (5-year survival, 59 % vs 52 %, respectively; p?=?0.04). However, LN number was not prognostic of overall survival on stepwise Cox proportional hazards analysis. In contrast, LN number was prognostic for white patients.

Conclusions

Although examined LN number may impact survival for white patients, outcomes of Korean–American gastric cancer patients were independent of LN number. Our data suggest that survival of Korean–American gastric cancer patients are comparable with outcomes from East Asian hospitals and may be independent of surgical technique.     

Discordance Between Conventional and Detailed Lymph Node Analysis in Resected Biliary Carcinoma at or Above the Cystic Duct: Are We Understaging Patients?

Background

Analysis of portal lymph node (LN) metastases following resection of biliary carcinomas at or above the cystic duct (BC) is used to select patients for adjuvant therapy, but no guidelines exist and LN yield is low. Some consider analysis of 7 LNs necessary for accurate staging. Conventional LN analysis may understage patients.

Methods

Portal LNs from 38 node-negative patients following resection of BC from 2000 to 2008 were re-examined in detail for occult metastases (OM) using a modified Weaver protocol. Outcomes measured were discordance in LN positivity and patient survival.

Results

On detailed examination, 5 of 38 patients had OM. There was no difference in survival between patients with and without OM (24 vs 17 months; p = .382). There was no association between OM and patient demographics or adverse tumor characteristics. The median LN yield was 3. Of the 27 patients with <7 LNs retrieved, 1 had OM, compared with 4 of 11 patients with ≥7 LNs retrieved (p = .030). OM in these well-staged patients were associated with reduced survival (9 vs 41 months; p = .032).

Conclusions

There is discordance between conventional and detailed LN analysis in resected BC. LN yield ≥7 was associated with OM. The presence of OM may be associated with decreased survival. Conventional LN analysis may understage patients with resected BC.     

How Does the Number of Resected Lymph Nodes Influence TNM Staging and Prognosis for Esophageal Carcinoma?

Background  

It is proposed by International Union Against Cancer (UICC) and American Joint Committee on Cancer (AJCC) that at least 6 lymph nodes (LN) should be removed during resection of esophageal cancer for an accurate N classification. However, large series evidence is needed. The aim of this study is to assess the impact of total number of removed LNs during esophagectomy on UICC-TNM staging and long-term survival.     

The Impact of <Superscript>18</Superscript>F-Fluorodeoxyglucose Positron Emission Tomography Positive Lymph Nodes on Postoperative Recurrence and Survival in Resectable Thoracic Esophageal Squamous Cell Carcinoma

Background  

Induction therapy is not always beneficial for all patients. Therefore, it is important to identify the patients with a high rate of recurrence. The occurrence of lymph node metastases (LNMs) strongly influences the postoperative survival in patients with esophageal cancer. We investigated the usefulness of an LN evaluation by initial ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in prediction of postoperative recurrence for patients with resectable esophageal squamous cell carcinoma (ESCC).     

Lobular In-Situ Neoplasia on Breast Core Needle Biopsy: Imaging Indication and Pathologic Extent Can Identify Which Patients Require Excisional Biopsy

Background  

The surgical management of lobular in-situ neoplasia (LN) identified by core needle biopsy (CNB) is currently variable. Our institution has routinely excised LN on CNB since 2003, allowing for an unbiased assessment of upgrade rates.     

Neither Preoperative Computed Tomography nor Intra-Operative Examination can Predict Metastatic Lymph Node in the Hepatic Pedicle in Patients with Colorectal Liver Metastasis

Background  

In patients operated on for colorectal liver metastasis (CRLM), metastatic lymph node (LN) of the hepatic pedicle is a major prognostic factor. Efficiency of preoperative computed tomography (CT) and intraoperative examination for the diagnosis of metastatic LN of hepatic pedicle is prospectively evaluated.     

The role of lymph-node dissection in the treatment of upper urinary tract cancer: a multi-institutional study

OBJECTIVES

To determine the role of lymph‐node (LN) dissection in patients undergoing surgery for upper urinary tract (UUT) cancer.

PATIENTS AND METHODS

We reviewed the clinicopathological data from 312 patients with UUT cancer treated predominantly by nephroureterectomy. The relationship between clinical characteristics and cancer‐specific survival (CSS) was analysed, focusing on node‐related information.

RESULTS

In all, 166 patients had LN dissection while 146 did not (pNx). Multivariate analysis showed that T stage, grade and pN status were significant variables for CSS. The difference in survival between the pN0 and pNx groups remained significant in a multivariate analysis. The median (range) number of LNs removed was 6 (1–65). There was no significant difference in CSS between the 72 patients with fewer than six LNs removed and the 78 with six or more removed.

CONCLUSIONS

LN dissection is important for postoperative stratification of patients with UUT cancer because node‐positive disease was one of the variables with a significant adverse effect on survival. In addition, the significant difference in survival between the pN0 and pNx groups might indicate a therapeutic benefit of LN dissection, although removing more LNs did not uniformly increase the probability of CSS.     

Number of Lymph Nodes Evaluated: Prognostic Value in Pancreatic Adenocarcinoma

Introduction  

The impact of the number of lymph node (LN) evaluated pathologically on accurate staging is unknown. Our primary aim was to determine a minimum number of evaluated LN needed to provide accurate staging of pancreatic cancer.     

Survival Impact of Lymphadenectomy Stratified by Nodal Metastatic Probability in Endometrial Cancer

Background

Our objective was to identify a subgroup of patients with early-stage endometrial cancer in whom lymphadenectomy was associated with enhanced survival based on the stratification of lymph node (LN) metastasis probability provided by a previously developed nomogram.

Methods

Data from the Surveillance, Epidemiology, and End Results database for 66,210 patients with histologically proven endometrial cancer were analyzed. For each patient, the LN metastasis probability according to the previously developed nomogram was calculated. Patients were clustered into quintiles according to their LN metastasis probability. The cancer related survival in each quintile group was calculated using Kaplan–Meier analysis and compared based on whether patients underwent lymphadenectomy.

Results

Except for the second quintile group, the specific survival rate systematically decreased when the predicted LN probability increased. In the five quintile groups, the 5-year specific survival rate was significantly higher in the patients who did not undergo lymphadenectomy compared with those who underwent lymphadenectomy and had ≥10 or <10 LNs removed.

Conclusions

Our results suggest the pejorative outcome associated with a higher risk of LN metastasis is not counterbalanced by the lymphadenectomy.     

The prognostic significance of nodal disease burden in patients with lymph node metastases from renal cell carcinoma

Objectives

To assess the relationship between nodal disease burden and overall survival (OS) among patients with lymph node (LN) metastases from renal cell carcinoma (RCC)

Combination of Ex Vivo Sentinel Lymph Node Mapping and Methylene Blue-Assisted Lymph Node Dissection in Gastric Cancer: A Prospective and Randomized Study

Background  

Exact lymph node (LN) staging is crucial for prognosis estimation and treatment stratification in gastric cancer. Recently, a new concept for improving LN harvest and the accuracy of LN staging was introduced. It combines methylene blue-assisted lymph node dissection (MBLND) with a new ex vivo sentinel lymph node (evSLN) mapping technique. The purpose of this study was to investigate these techniques in a prospective and randomized manner.     

Poor Prognosis of Advanced Gastric Cancer with Metastatic Suprapancreatic Lymph Nodes

Background

Whether gastrectomy with D2 lymphadenectomy improves survival of patients with advanced gastric cancer (AGC) remains controversial. Few studies have described the pathological features of AGC with metastatic suprapancreatic lymph nodes (LN), which are the target of D2 lymphadenectomy. This study therefore aims to clarify the prognosis and clinical pathological features including the number and location of metastatic LN in AGC with metastatic suprapancreatic LN.

Methods

406 patients with AGC, who underwent gastrectomy with D2 lymphadenectomy from 1982 to 2007 at Oita University, were reviewed retrospectively with regard to presence or absence of metastatic suprapancreatic LN. The pathological factors associated with AGC with metastatic suprapancreatic LN were examined by univariate and multivariate analysis.

Results

Of 362 patients with AGC, 78 had suprapancreatic LN metastasis (21.5 %), differing significantly in terms of presence of vascular invasion and having a larger number of metastatic perigastric LN in comparison with only metastatic perigastric LN on univariate analysis. According to multivariate analysis, they were associated with presence of vascular invasion and a large number of total metastatic LN (more than two; N2≤). The overall 5-year survival rate of the AGC with perigastric LN metastasis (station 1–7) group was 37.9 % and of the AGC with suprapancreatic LN metastasis group was 12.8 %. There were significant differences in each group (P < 0.05).

Conclusions

Patients with AGC with metastatic suprapancreatic LN had a large number of total metastatic LN and poor prognosis, suggesting that it may be a systemic disease.     

Prognostic Impact of Lymph Node Retrieval and Ratio in Gastric Cancer: a U.S. Single Center Experience

Introduction

Increased lymph node (LN) retrieval for gastric cancer has been associated with improved overall survival (OS). This study examines the impact of number of examined LN (eLN) and lymph node ratio.

Methods

Patients referred for surgical care of gastric cancer were stratified by number of eLN, positive LNs (LN+), and lymph node ratio (LN+/eLN). Clinicopathologic factors were compared; OS and disease-free survival (DFS) were the primary endpoints.

Results

From 1997 to 2012, 222 patients, median age 67 (range, 17–92)?years, were analyzed. Of 220 (99 %) explored, 164 (74 %) underwent resection. Median OS was 22 (range, 0.3–140)?months. Perineural and lymphovascular invasion and poor differentiation adversely affected OS, p?<?0.05. A median 14 eLN (range, 0–45), with median 1 LN+ (range, 0–31), was observed. There were no OS or DFS differences when comparing the eLN groups. Both OS and DFS were impacted by LN+. Lymph node ratio demonstrated worse median OS with increasing ratio: 49 months (0) to 37 months (0.01–0.2), 27 months (0.21–0.5), and 12 months (>0.5), p?<?0.0001. DFS was similar: 35 months (0), decreasing to 22 months (0.01–0.2), 13 months (0.21–0.5), and 7 months (>0.5), p?<?0.0001.

Conclusion

Number of eLN did not impact survival, while LN+ adversely affected survival. Lymph node ratio may predict prognosis better than number of eLN or LN+ in gastric cancer.     

Soluble VEGF receptor 1 promotes endothelial injury in children and adolescents with lupus nephritis

Background  

Endothelial cell injury plays a key role in the pathogenesis of lupus nephritis (LN) and atherosclerosis. The aim of this study was to identify factors involved in the process of endothelial damage in children and adolescents with LN.     

Cervical Lymph Node Dissection for Clinically Submucosal Carcinoma of the Thoracic Esophagus

Background

The purposes of this study were to clarify the risk factors for supraclavicular lymph node (SCLN) metastasis and the survival benefit from cervical lymph node (LN) dissections in patients with clinically submucosal (cT1b) carcinoma of the thoracic esophagus.

Methods

A total of 86 patients with this disease who underwent esophagectomy with 3-field lymph node dissection were retrospectively reviewed. Multivariate logistic regression and Cox proportional hazard model were used to identify the independent risk factors for SCLN metastasis and prognostic factors, respectively. An index calculated by multiplying the frequency of metastasis at nodal basin and the 5-year overall survival rate of patients with metastasis at that basin were used to assess the therapeutic outcomes.

Results

A total of 40 patients (47 %) were found to have pathological LN metastasis. Also, 13 patients (15 %) had cervical LN metastasis: 6 and 7 with carcinoma of the upper and mid-thoracic esophagus, respectively. SCLN metastasis was found in 6 patients (7 %); however, there was no independent risk factor for SCLN metastasis. The 5-year overall survival rate was 72.5 %. Cervical LN metastasis was an independent prognostic factor (p = .04; odds ratio 2.55; 95 % confidence interval 1.03–6.31); however, there was no significant difference in survival between patients with SCLN metastasis and those without (p = .06). The calculated index of estimated benefit from cervical LN dissections was 6.9, following upper mediastinal LN of 15.6 and perigastric LN of 8.3.

Conclusions

We could not identify risk factors to predict SCLN metastasis. Cervical LN dissection should not be omitted in patients with cT1b carcinoma, especially of the upper and mid-thoracic esophagus.     

Role of surgical approach on lymph node dissection yield and survival in patients with upper tract urothelial carcinoma

Objectives

With increasing utilization of robot-assisted surgery in urologic oncology, robotic nephroureterectomy (RNU) is becoming the surgical modality of choice for patients with upper tract urothelial carcinoma (UTUC). The role of surgical approach on lymph node dissection (LND) and lymph node (LN) yield is unclear, and potential therapeutic effects are unknown. Here we analyze the effects of surgical approach on LN yield, performance of LND, and overall survival (OS).