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1.
S.D. Lee T.H. Kim D.Y. Kim J.Y. Baek S.Y. Kim H.J. Chang S.C. Park J.W. Park J.H. Oh K.H. Jung 《European journal of surgical oncology》2012
Purpose
To evaluate the prognostic effect of lymph node ratio (LNR) in patients with locally advanced rectal cancer who were treated with curative resection after preoperative chemoradiotherapy (CRT).Methods
Between October 2001 and December 2007, 519 patients who had undergone curative resection of primary rectal cancer after preoperative CRT were enrolled. Of these, 154 patients were positive for lymph node (LN) metastasis and were divided into three groups according to the LNR (≤0.15 [n = 80], 0.16–0.3 [n = 44], >0.3 [n = 30]) to evaluate the prognostic effect on overall survival (OS) and disease-free survival (DFS).Results
LNR (≤0.15, 0.16–0.3, and >0.3) was significantly associated with 5-year OS (90.3%, 75.1%, and 45.1%; p < 0.001) and DFS (66.7%, 55.8%, and 21.9%; p < 0.001) rates. In a multivariate analysis, LNR (≤0.15, 0.16–0.3, and >0.3) was a significant independent prognostic factor for OS (hazard ratios [HRs], 1, 3.609, and 8.197; p < 0.001) and DFS (HRs, 1, 1.699, and 3.960; p < 0.001). LNR had a prognostic impact on OS and DFS in patients with <12 harvested LNs, as well as in those with ≥12 harvested LNs (p < 0.05).Conclusion
LNR was a significant independent prognostic predictor for OS and DFS in patients with locally advanced rectal cancer who were treated with curative resection after preoperative CRT. 相似文献2.
Ji-Yoon Kim Mi-Ryeong Ryu Byung-Ock Choi Woo-Chan Park Se Jeong Oh Jong-Man Won Su-Mi Chung 《JOURNAL OF BREAST CANCER》2011,14(3):204-212
Purpose
This study evaluated the prognostic impact of the lymph node ratio (LNR; i.e., the ratio of positive to dissected lymph nodes) on recurrence and survival in breast cancer patients with positive axillary lymph nodes (LNs).Methods
The study cohort was comprised of 330 breast cancer patients with positive axillary nodes who received postoperative radiotherapy between 1987 and 2004. Ten-year Kaplan-Meier locoregional failure, distant metastasis, disease-free survival (DFS) and disease-specific survival (DSS) rates were compared using Kaplan-Meier curves. The prognostic significance of the LNR was evaluated by multivariate analysis.Results
Median follow-up was 7.5 years. By minimum p-value approach, 0.25 and 0.55 were the cutoff values of LNR at which most significant difference in DFS and DSS was observed. The DFS and DSS rates correlated significantly with tumor size, pN classification, LNR, histologic grade, lymphovascular invasion, the status of estrogen receptor and progesterone receptor. The LNR based classification yielded a statistically larger separation of the DFS curves than pN classification. In multivariate analysis, histologic grade and pN classification were significant prognostic factors for DFS and DSS. However, when the LNR was included as a covariate in the model, the LNR was highly significant (p<0.0001), and pN classification was not statistically significant (p>0.05).Conclusion
The LNR predicts recurrence and survival more accurately than pN classification in our study. The pN classification and LNR should be considered together in risk estimates for axillary LNs positive breast cancer patients. 相似文献3.
J. Wind F.J.W. ten Kate J.J.S. Kiewiet S.M. Lagarde J.F.M. Slors J.J.B. van Lanschot W.A. Bemelman 《European journal of surgical oncology》2008
Aims
In colonic cancer the prognostic significance of extracapsular lymph node involvement (LNI) is not established and is therefore the objective of this study.Methods
Between January 1994 and May 2005, all patients who underwent resection for primary colonic cancer with lymph node metastasis were reviewed. All resected lymph nodes were re-examined to assess extracapsular LNI. In uni- and multivariate analysis disease-free survival (DFS) was correlated with various clinicopathologic factors.Results
One hundred and eleven patients were included. In 58 patients extracapsular LNI was identified. Univariate analysis revealed that pN-stage (5-year DFS pN1 vs. pN2: 65% vs. 14%, p < 0.001), extracapsular LNI (5-year DFS intracapsular LNI vs. extracapsular LNI: 69% vs. 41%, p = 0.003), and lymph node ratio (5-year DFS <0.176 vs. ≥0.176: 67% vs. 42%, p = 0.023) were significant prognostic indicators. Among these variables pN-stage (hazard ratio 3.5, 95% confidence interval [CI]: 1.72–7.42) and extracapsular LNI (hazard ratio 1.98, 95% CI: 1.00–3.91) were independent prognostic factors. Among patients without extracapsular LNI, those receiving adjuvant chemotherapy had a significantly better survival (p = 0.010). In contrast, chemotherapy did not improve DFS in patients with extracapsular LNI.Conclusion
Together with pN2 stage, extracapsular LNI reflects a particularly aggressive behaviour and has significant prognostic potential. 相似文献4.
The clinical outcome and prognostic factors after multi-visceral resection for advanced colon cancer
Aim
The value of multi-visceral resection (MVR) for treating primary advanced colon cancer infiltrating into the neighboring organs had been debated because of the high mortality.Methods
We reviewed 1288 patients who underwent curative resection for pT3–4 colon cancer without distant metastasis from 1994 to 2004.Results
Eighty four patients (6.5%) with colon cancer infiltrating into the neighboring organs (cT4) underwent MVR. The accuracy of the intra-operative decision for true invasion (pT4) was 35.7%. Major surgical morbidity occurred in 11 patients of the standard resection group (0.9%) and in 2 patients of the MVR group (2.3%) (p = 0.206). Most of the recurrence was distant metastasis (20 patients, 23.8%). Local recurrence was occurred in five patients (6.0%). The prognostic factors for recurrence and survival were pathologic tumor invasion (p = 0.033 and p = 0.016, respectively) and lymph node metastasis (p = 0.010 and p < 0.001, respectively).Conclusion
Multi-visceral resection was a safe and curative procedure as compared with standard resection for patients with advanced colon cancer. The cause of a poor prognosis in MVR was not local recurrence but distant metastasis. Pathologic tumor invasion and lymph node metastasis were the potential prognostic factors. 相似文献5.
J.W.T. Dekker K.C. Peeters H. Putter A.L. Vahrmeijer C.J.H. van de Velde 《European journal of surgical oncology》2010
Aims
Optimal staging in rectal cancer is indispensable for the decision on further treatment and estimation of prognosis. This study assesses the prognostic capacity of the metastatic lymph node ratio (LNR) in addition to the new TNM classification.Methods
LNR was determined, in stage III patients from the Dutch TME-trial. Six year median follow up data from the trial database were used to analyse the relation of LNR to overall survival (OS) and local recurrence (LR). The relation of LNR to lymph node yield was assessed and appropriate cut off values of LNR for clinical use were determined.Results
605 patients were analyzed. 278 underwent pre-operative radiotherapy. 82 patients developed a local recurrence and 289 distant metastases. LNR was an independent risk factor for OS, hazard ratio (HR) 2.10 (95% CI 1.35–3.27) (in addition to age >= 65 years, involved circumferential resection margin (CRM) and new TNM stage) and LR, HR 2.25 (95% CI 1.02–4.56) (in addition to pre-operative radiotherapy and involved CRM). LNR is predictive of OS and LR from a lymph node yield of more than one and more than five respectively. A LNR value of 0.60 offers the best cut off to identify high risk patients (5-years OS was 61 vs. 32%, HR 2.45 (95% CI 1.96–3.08) and 5-years LR rate 12.6 versus 16.3%, HR 1.65 (95% CI 1.03–2.64)).Conclusions
LNR is an independent risk factor for OS and LR in addition to the 7th edition of the TNM classification. It can aid in predicting prognosis and identifying patients that should be considered for adjuvant treatment. 相似文献6.
Allan Ramos-Esquivel Melissa Juárez Ileana González Juan Porras Luis Rodriguez 《Journal of gastrointestinal cancer》2014,45(2):133-136
Purpose
Recently, the positive lymph node ratio (LNR) is considered a new prognostic parameter on survival and time to progression for patients with colon cancer. The aim of this study was to determine the prognostic impact of the LNR as an independent factor for overall survival (OS) and disease-free survival (DFS) in patients with colon cancer regardless of their clinical stage.Methods
We retrospectively identified 85 consecutive patients diagnosed with colon adenocarcinoma treated in our centre during 2010. We categorized patients according to a LNR cutoff of 0.25. Three-year OS and DFS were determined according to the Kaplan–Meier method. A Cox proportional model was used to assess the influence of other prognostic variables on each outcome.Results
After median follow-up of 34.8 months, neither median OS nor DFS has been reached by any of the subgroups. Nevertheless, patients with a LNR?≥?0.25 exhibited a higher risk of death (hazard ratio, 3.10; 95 % confidence interval (CI), 1.38–7.01; log-rank test: p?=?0.006) and a shorter interval without progression (hazard ratio, 6.59; 95 % CI, 1.96–22.15; log-rank test: p?=?0.002.) than patients with LNR?<?0.25. After adjusting for prespecifed variables, the impact of a LNR?≥?0.25 was independently associated with OS (hazard ratio, 2.8; 95 % CI, 1.01–7.73; p?=?0.04) and DFS (hazard ratio, 7.07; 95 % CI, 1.23–40.45; p?=?0.03).Conclusions
LNR was independently associated with OS and DFS in patients with colon adenocarcinoma regardless of its clinical stage. 相似文献7.
Ling-Long Tang Ying Sun Yan-Ping Mao Yong Chen Wen-Fei Li Lei Chen Li-Zhi Liu Ai-Hua Lin Li Li Jun Ma 《Radiotherapy and oncology》2014
Background and purpose
The development of improved diagnostic and therapeutic techniques has revolutionized the management of nasopharyngeal carcinoma (NPC). The purpose of this study is to revaluate the prognostic value of parapharyngeal extension in NPC in the IMRT era.Material and methods
We retrospectively reviewed data from 749 biopsy-proven non-metastatic NPC patients. All patients were examined with magnetic resonance imaging (MRI) and received intensity-modulated radiotherapy (IMRT) as the primary treatment.Results
The incidence of parapharyngeal extension was 72.1%. A significant difference was observed in the disease-free survival (DFS; 70.3% vs. 89.1%, P < 0.001), distant metastasis-free survival (DMFS; 79.3% vs. 92.0%, P < 0.001), and local relapse-free survival (LRFS; 92.8% vs. 99.0%, P = 0.002) of patients with and without parapharyngeal extension. Parapharyngeal extension was an independent prognostic factor for DFS and DMFS in multivariate analysis (P = 0.001 and P = 0.015, respectively), but not LRFS. The difference between DMFS in patients with or without parapharyngeal space extension was statistically significant in patients with cervical lymph node metastasis (P < 0.001).Conclusions
In the IMRT era, parapharyngeal extension remains a poor prognosticator for DMFS in NPC, especially in patients with positive lymph node metastasis. Additional therapeutic improvements are required to achieve a favorable distant control in NPC with parapharyngeal extension. 相似文献8.
J.Y. Deng H. Liang D. Sun Y. Pan R.P. Zhang B.G. Wang H.J. Zhan 《European journal of surgical oncology》2009
Aims
We conducted a retrospective case–control study to compare the prognostic differences of lymph node-positive gastric cancer patients between dissected lymph nodes (DLNs) < 15 group and DLNs ≥ 15 group.Methods
A retrospective study of 323 lymph node-positive gastric patients who underwent potentially curative resection for gastric cancer was analyzed to identify the prognostic differences between DLNs < 15 group and DLNs ≥ 15 group. Of these patients, 49 patients with <15 DLNs were matched with 147 patients with ≥15 DLNs according to gender, age, location of primary tumor, and type of gastrectomy.Results
Patients with n1 lymph node metastasis (according to JCGC), serosal involvement, ratio of positive lymph nodes less than 25%, or without adjuvant chemotherapy in ≥15 DLN group had comparatively longer median survival than patients with homologous clinicopathologic variables in <15 DLN group, respectively. Patients with n1 stage lymph node metastasis, serosal involvement, non-intestinal Lauren classification, or without adjuvant chemotherapy in <15 DLN group had higher recurrence rate than patients with homologous clinicopathologic variables in ≥15 DLN group, respectively. In addition, we demonstrated that patients with more than n1 stage lymph node metastasis in <15 DLN group had higher rate of peritoneal dissemination than those with more than n1 lymph node metastasis in ≥15 DLN group.Conclusions
DNL ≥15 was an important factor to improve the prognosis of lymph node-positive gastric cancer patients after potential curative resection. 相似文献9.
Martijnse IS Dudink RL Kusters M Rutten HJ Nieuwenhuijzen GA Wasowicz-Kemps DK 《European journal of surgical oncology》2012,38(3):252-258
Introduction
Lymph node involvement is one of the most important prognostic factors in rectal cancer. After neoadjuvant treatment the number of retrieved lymph nodes is often reported to be low which impairs reliable tumour staging. This study examines the effect of patent blue staining on the number of harvested lymph nodes and evaluates whether a higher number of retrieved lymph nodes is of prognostic significance.Patients and methods
Between March 2007 and December 2010, 295 consecutive patients with locally advanced rectal cancer following neoadjuvant treatment were included. Specimens were either not stained (NB), injected with patent blue into the mesorectum (MB) or directly into the inferior mesenteric artery (AB). Data were retrieved from a prospective database.Results
The number of evaluated lymph nodes was significantly higher in the stained specimens: mean 6.8 in the NB group (n = 89), 11.5 in the MB group (n = 86) and 17.4 in the AB group (n = 106) (p < 0.001). The percentage of patients with a minimum of 12 lymph nodes increased from 15.5% (NB) to 44.2% (MB) to 74.5% (AB) (p < 0.001). The three-year cancer specific survival for the lymph node ratio (LNR) was 95% (0), 94.4% (0.01–0.1), 80.1% (0.11–0.4) and 63.7% (0.41–1).Conclusion
The use of patent blue in patients who underwent rectal cancer surgery after neoadjuvant treatment significantly enhanced lymph node harvest. Injection into the inferior mesenteric artery was most effective. This relatively simple and generally applicable method can help to improve lymph node detection which lowers the LNR and allows adequate tumour staging. 相似文献10.
B. Posteraro R. Persiani V. Dall'Armi A. Biondi D. Arzani F. Sicoli S. Bonassi D. D'Ugo W. Ricciardi S. Boccia 《European journal of surgical oncology》2014
Background
Survival of patients after curative surgical resection for gastric cancer (GC) remains poor, thus emphasizing the need for better definition of prognostic factors to improve the long-term course of disease.Methods
From 1999 to 2009, 110 patients had curative-intent gastrectomy for adenocarcinoma. Clinicopathological features, Helicobacter pylori infection, dietary habits and lifestyle, and the presence of proinflammatory gene polymorphisms were evaluated.Results
At the end of follow-up, 55 deaths had occurred, 48 of them due to GC, whereas the median overall survival (OS) and disease-free survival (DFS) were 62 and 51 months, respectively. From the Kaplan–Meier analysis and log-rank test, statistically significant differences in OS and DFS were found for tumor site (only for DFS), tumor size, lymph node metastasis ratio (NR), and tumor-node-metastasis stage, but not for age, comorbidity, H. pylori infection, cigarette smoking, and IL1B or TNFA polymorphisms. Multivariable Cox regression analysis revealed NR was an independent prognostic factor for OS and DFS. Cardia tumor and patient age 65 years or older were also independent prognostic factors for OS and DFS.Conclusions
Tumor-related factors remain strongest predictors of survival in GC patients after surgery. Particularly, NR was an effective feature in identifying patients at high risk for adverse outcome. 相似文献11.
A.E. Braat R.A. Pol J.W.A. Oosterhuis J.E. de Vries W.E. Mesker R.A.E.M. Tollenaar 《European journal of surgical oncology》2014
Aim
Investigate the prognostic impact and clinical relevance of the sentinel node (SN)-procedure in colon carcinoma.Patients and methods
Between May 2002 and January 2004, the SN-procedure was performed in 55 patients that underwent elective resection for clinically non-advanced colon carcinoma. A control group of 110 patients was identified from a cohort between January 2000 and April 2002. All lymph nodes were analysed by conventional haematoxylin–eosin staining. All negative SNs underwent in-depth analysis using immunohistochemical-staining and automated microscopy with the Ariol-system. Patients with positive lymph nodes were offered adjuvant chemotherapy. All patients were routinely monitored at 6-month intervals and follow-up was more than 5 years.Results
The SN was successfully identified in 98% of the patients, with 94% sensitivity. In-depth analysis with immunohistochemistry and automated microscopy (Ariol-system) upstaged 3 and 4 patients respectively. When only node-negative patients were analysed, overall 5-year-survival was significantly better in the SN group (91% vs. 76%, p = 0.04). Cancer-specific-mortality was even 0% (vs. 8%, p = 0.08). Disease-free-survival was significantly improved to 96% (vs. 77%, p < 0.01).Conclusions
This study describes the prognostic impact of the SN-procedure in colon carcinoma after 5-year-follow-up. Only one patient had recurrent disease after a negative SN procedure (disease-free-survival 96%). These results indicate that the SN-procedure is of prognostic relevance and might be useful to select patients for adjuvant chemotherapy. Patients that are lymph node negative after an SN-procedure have an excellent prognosis and do not need adjuvant treatment. 相似文献12.
Prognostic value of lymph node metastases and lymph node ratio in esophageal squamous cell carcinoma
Y.P. Liu L. Ma S.J. Wang Y.N. Chen G.X. Wu M. Han X.L. Wang 《European journal of surgical oncology》2010
Aims
Although the positive lymph node (LN) metastasis in patients with thoracic esophageal squamous cell carcinoma carcinoma (SCC) has been reported to be a risk factor to reduce long-term survival, only a few studies have so far evaluated the lymph node metastasis among this group of patients. The purpose of this study was to evaluate the impact of lymph node positivity and ratio on survival of esophageal SCC.Methods
All patients undergoing esophagectomy at the Forth Hospital of Hebei Medical University between January 1986 and December 2002 were reviewed. Survival curves were estimated using the Kaplan-Meier method.Results
Of 1325 patients with invasive cancer, had squamous cell cancer of the esophagus. Median overall survival (OS) of the entire group was 36.7 months and 5-year OS was 39.3%. The most significant prognostic factor for overall survival was the presence of positive LN (P < 0.01). Additionally, patients with zero involved LN had a 5-year survival of 49.1%, while patients with 1–3 positive LN and >3 positive LN had 5-year survival of 19.5% and 11.0%, respectively (P < 0.01). Finally, an increasing ratio of positive to examined LN was linearly associated with a worsening 5-year survival, patients with <25%, 25%–50% and >50% positive LN had 5-year survival of 47.53%, 14.6% and 8.9%, respectively (P < 0.01).Conclusion
Increasing number of positive LN in patients with esophageal cancer and increasing ratio of metastatic to examine LN portend a poor prognosis. These factors should play an important role in predicting prognosis of patients. 相似文献13.
J.P. Van Damme S. Schmitz J.P. Machiels C. Galant V. Grégoire B. Lengelé M. Hamoir 《European journal of surgical oncology》2010
Objectives
The primary objectives of this study were to analyse the outcome of patients diagnosed with head and neck soft tissue sarcomas (HNSTS) and to identify relevant prognostic factors. As well as this, we compared the prognostic value of two staging systems proposed by the American Joint Committee on Cancer (AJCC) and the Memorial Sloan-Kettering Cancer Center (MSKCC).Methods
From 07/1988 to 01/2008, the charts of 42 adult patients were retrospectively reviewed. Potential prognostic factors were analysed according to overall survival (OS), disease-free survival (DFS) and disease-specific survival (DSS).Results
At 5 years, OS was 57%, DFS 47% and DSS 72%. On univariate analysis, statistically significant prognostic factors were for OS, distant or lymph node metastasis at diagnosis (p = 0.032), for DFS, margins after surgery (p = 0.007), for DSS, regional or distant metastasis at diagnosis (p = 0.002), initial AJCC and MSKCC stage (p = 0.018 and p = 0.048) and margins after surgery (p = 0.042). On multivariate analysis, margins remained statistically significant for DFS (p = 0.039) when there was a trend with the initial AJCC stage (p = 0.054) for OS. The AJCC staging system was of more prognostic value than the MSKCC staging system.Conclusions
Achieving clear margins after surgery is vital for improved local control and the best chance of survival. Adjuvant chemotherapy and radiotherapy were not shown to provide additional benefit. To better identify prognostic factors, it seems essential to set up national and international databases allowing multicenter registration for those patients. 相似文献14.
J.-H. Chen C.-W. Wu S.-S. Lo A.F.-Y. Li M.-C. Hsieh K.-H. Shen W.-Y. Lui 《European journal of surgical oncology》2007
Aims
Pyloric stenosis usually presents with symptoms, and this may lead patients to consult their physician. We evaluate whether distal gastric cancer patients with pyloric stenosis had a better outcome than those without.Methods
A total of 551 distal gastric cancer patients who received curative subtotal gastrectomy between January 1988 and December 2003 at Taipei Veterans General Hospital were analyzed. Among them, 174 patients were sorted into the pyloric stenosis group according to obstructive symptoms. Their clinicopathological features, survival and prognostic factors were evaluated.Results
The 5-year overall and disease-free survival rate of distal third gastric adenocarcinoma for the pyloric stenosis group was significantly lower than those without pyloric stenosis. Multivariate analysis revealed the pyloric stenosis group had deeper cancer invasion (relative to pT1, RR of pT2 3.1, p = 0.009; pT3 6.1, p < 0.001; pT4 16.5, p < 0.001), and more lymph node metastasis (RR 3.6; p = 0.001). The pyloric stenosis group had a tendency to lymph node metastasis toward the hepatoduodenal ligament, but this did not reach statistical difference. However, the pyloric stenosis group had significantly higher lymph node metastasis in the retropancreatic region (5.17% vs. 0.53%; p = 0.001).Conclusions
Distal gastric cancers with pyloric stenosis have worse biological behavior than those without, and consequently have a poor outcome. 相似文献15.
J.P. Klussmann T. Ponert R.P. Mueller H.P. Dienes O. Guntinas-Lichius 《European journal of surgical oncology》2008
Aim
To assess the metastatic topography of intraparotideal and neck lymph nodes in parotid cancer and its influence on tumour recurrence and survival.Methods
The lymph node spread of 142 patients with primary parotid carcinoma treated from 1986 to 2006 was analysed. Disease-free survival (DFS) and overall survival (OS) were calculated. The role of the metastatic pattern as prognostic factors were univariately and multivariately analysed.Results
A lateral, total or radical parotidectomy was performed in 19, 80 and 43 patients, respectively. A radical/radical-modified or selective neck dissection was performed in 68 and 74 patients, respectively. Eighty-seven neck dissection specimens were negative (pN0). Twelve patients had intraparotideal and cervical lymph node involvement (pPar+/pN+). In 24 patients only intraparotideal metastases were detected (pPar+/pN0). 19 patients only had cervical nodal involvement (pPar−/pN+). Twenty-five patients had occult locoregional lymph metastases (cN0/pN+). The median follow-up was 24.4 months. The disease-free survival rate was 81% at 5 years, and 62% at 10 years. By univariate analysis, R+ (p = 0.001), pT (p = 0.019), lymphangiosis carcinomatosa (p = 0.019), pN+ (p = 0.042), and extracapsular spread (p = 0.046) were prognostic for disease-free survival. Multivariate analysis revealed R+ as independent risk factor (p = 0.046). In pN+ patients, involvement of parotid lymph nodes (p = 0.013), nodes in neck level I (p < 0.0001) and IV (p = 0.005) were univariate risk factors. Multivariate analysis showed lymph node metastases in level I as independent risk factor (p = 0.022).Conclusion
Total parotidectomy and radical-modified neck dissection is recommended as surgical treatment of parotid cancer and should be analysed in a prospective trial. 相似文献16.
E.S. van der Zaag C.J. Buskens N. Kooij H. Akol H.M. Peters W.H. Bouma W.A. Bemelman 《European journal of surgical oncology》2009
Aim
To compare the predictive value of sentinel lymph node (SN) mapping between patients with colon and rectal cancer.Patients and methods
An ex vivo SN procedure was performed in 100 patients with colon and 32 patients with rectal cancer. If the sentinel node was negative, immunohistochemical analyses using two different antibodies against cytokeratins (Cam5.2 and CK 20) and one antibody against BerEp-4 were performed to detect occult tumour cells. Isolated tumour cells (<0.2 mm) were discriminated from micrometastases (0.2–2 mm).Results
An SN was identified in 117 patients (89%), and accurately predicted nodal status in 106 patients (accuracy 91%). Both sensitivity and negative predictive value were higher in colon carcinomas than in rectal carcinomas (83% versus 57%, p = 0.06 and 93% versus 65%, p = 0.002 respectively). In patients with extensive lymph node metastases the SN procedures were less successful. Eleven of the 13 unsuccessful SN procedures were performed in patients with rectal cancer who had pre-operative radiotherapy. After immunohistochemical analysis 21 of the 73 N0 patients had occult tumour cells in their SN; eight patients had micrometastases and 13 patients had isolated tumour cells.Conclusion
SN mapping accurately predicts nodal status in patients with colonic cancer. Immunohistochemical analysis demonstrates micrometastatic disease in eight out of 73 N0 patients, with a true upstaging rate of 11%. SN mapping is less reliable in patients with rectal cancer after pre-operative radiotherapy. 相似文献17.
Aims
The purpose of this prospective study was to assess the results and the relevance of radioisotope guided pelvic lymph node dissection (PLND) in loco-regional staging in patients with clinically localized prostate cancer.Methods
A total of 100 patients with prostate cancer underwent radioisotope guided PLND. Eighty-seven patients were candidates for retropubic radical prostatectomy and 13 underwent radiotherapy. The 72 first patients received 2× 0.3 ml of 30 MBq-nanocolloid-99mTc and the next 28 patients received 2× 0.3 ml of 100 MBq. Sentinel lymph nodes (SLNs) were detected intraoperatively with a gamma probe.Results
A median number of three SLNs was removed per patient. SLNs were located outside obturator fossa in more than two thirds of patients. Lymph node involvement was observed in 12% of patients. Fifty percent of the LNM were outside obturator fossa;41.6% of lymph node metastases (LNM) were lying at the first centimeters of the hypogastric artery. Eleven of the 13 LNM were detected in the SLN. The two non-SLN (NSLN) involved nodes were found in two patients who failed the sentinel lymph node procedure. Each of 12 patients had pre-operative PSA above 10 ng/ml and Gleason score ≥7.Conclusions
Limited PLND to obturator fossa is clearly insufficient for accurate lymph node staging in patients with prostate cancer. SLN procedure could be an alternative for pelvic lymph node staging with an excellent sensitivity in patients with unfavorable prognostic factors (PSA >10 ng/ml; biopsy Gleason score >6). 相似文献18.
H.T. Niu T. Xu Y.B. Zhang D.Q. Pang Z.L. Zhang S. Wu B. Cheng Y. Wang J.W. Chang G. Sun 《European journal of surgical oncology》2008
Aims
We present the characteristics and outcomes of a large Chinese series of patients treated with radical cystectomy and pelvic lymphadenectomy for invasive cancer of the bladder. Our aim is to determine the significant independent prognostic factors that determine this outcome.Methods
The records of 356 patients with invasive bladder cancer, operated at three Chinese medical institutes between 1995 and 2004, were reviewed. Of the 356 patients, 324 (91.0%) were TCC, 24 (6.7%) were adenocarcinoma, eight (2.3%) were squamous carcinoma. The incidence of pelvic lymph node involvement was 22.8%. The mean (SD, range) follow-up of the 356 patients was 54.89 (31.66, 3–137) months. Multivariate analysis was used to assess the clinical and pathological variables affecting disease-free survival (DFS).Results
The 1-, 2- and 5-year DFS rates were 87%, 75% and 48%, respectively. In multivariate analysis, tumor configuration (RR = 1.62, p = 0.012), multiplicity (RR = 1.41, p = 0.036), histological subtype (RR = 2.17, p < 0.001), tumor stage (RR = 2.50, p < 0.001), tumor grade (RR = 2.40, p < 0.001), node status (RR = 2.51, p < 0.001), neoadjuvant chemotherapy (RR = 0.46, p = 0.016) had independent significance for survival on multivariate analysis.Conclusions
The results of this series show that radical cystectomy and pelvic lymphadenectomy provide durable local control and DFS in patients with invasive bladder cancer. Multivariates affect the prognosis after radical cystectomy for invasive bladder cancer. The treatment of invasive bladder cancer in China is still in need of improvement and normalization. 相似文献19.
I. Meattini I. Desideri C. Saieva G. Francolini V. Scotti P. Bonomo D. Greto M. Mangoni J. Nori L. Orzalesi M. Fambrini S. Bianchi L. Livi 《European journal of surgical oncology》2014
Background
The tumor status of the axillary lymph nodes is one of the most important prognostic factors in women with early breast cancer (BC). Sentinel lymph node (SLN) biopsy has become the standard staging procedure for patients with invasive BC, largely replacing axillary lymph nodes dissection (ALND). The exact impact on prognosis of SLN tumor burden is still object of controversy. The aim of this study was to correlate the tumor burden in the SLN with the outcome in a large cohort of women.Patients and methods
1040 consecutive patients with clinical stage I–III invasive BC were prospectively collected on our Institutional BC database from January 2001 to January 2007. Patients were stratified into the following four groups based on the tumor burden of the SLN: macrometastases, tumor deposit ≥2 mm; micrometastases, tumor deposit ≥0.2 mm and <2 mm; isolated tumor cells (ITC), isolated tumor cells or tumor deposit <0.2 mm; negative, in case of patients with no evidence of tumor.Results
At a median follow-up of 8.5 years, the tumor burden of SLN metastases resulted significant predictor of DFS (P < 0.0001) and OS (P = 0.042). Multivariate analysis showed that the tumor burden of SLN metastases and Ki 67 proliferative index maintained the statistical significance.Conclusion
Patients with SLN micrometastases or ITC, do not seem to have a worse DFS or OS compared with SLN negative cases. There is a significant decrease in DFS and OS in patients with macrometastatic disease in the SLN. 相似文献20.
Agnieszka Zolciak-Siwinska Norbert Piotrkowicz Joanna Jonska-Gmyrek Maria Nicke-Psikuta Wojciech Michalski Maryla Kawczyńska Michał Bijok Krzysztof Bujko 《Radiotherapy and oncology》2013