Adjuvant pelvic radiation is associated with improved survival and decreased disease recurrence in pelvic node-positive penile cancer after lymph node dissection: A multi-institutional study

Purpose

Few studies have examined the role of radiation therapy in advanced penile squamous cell carcinoma. We sought to evaluate the association of adjuvant pelvic radiation with survival and recurrence for patients with penile cancer and positive pelvic lymph nodes (PLNs) after lymph node dissection.

Risk factors for lymph node metastasis in clinically node-negative penile cancer patients

Objectives:   To analyze the effects of pathological T stage, grade, extent of surgery for primary tumor, and age group on the risk of developing lymph node metastasis in clinically node-negative penile cancer patients.
Methods:   We performed a retrospective analysis of 200 clinically node-negative penile cancer patients who were kept under surveillance, after treatment of the primary tumor in our institution. The primary outcome parameter was cytologically or histologically proven lymph node metastasis. Logistic regression analysis was used to compute odds ratios in univariate and multivariate settings.
Results:   Lymph node metastasis occurred in 31 patients at a median time of three months. Histological grade 3 and grade 2 tumors had a statistically significant increased odds ratio for lymph node metastasis, (7.1[ P  < 0.001] and 2.7 [ P  = 0.04], respectively), compared with grade 1 tumors. Although increasing pT stage was associated with increasing odds ratios, the differences were not statistically significant. Nor did the extent of surgery of the primary tumor or the age group significantly influence the risk of developing lymph node metastasis.
Conclusions:   Histological grade is the most significant parameter influencing the risk of lymph node metastasis in clinically node-negative penile cancer patients on surveillance. Patients with grade 3 and grade 2 tumors may benefit from elective inguinal lymphadenectomy.     

The risk factors for the presence of pelvic lymph node metastasis in penile squamous cell carcinoma patients with inguinal lymph node dissection

Objective

To evaluate factors in penile squamous cell carcinoma predictive of pelvic lymph node metastasis and survival.

Materials and methods

Data were collected and analyzed retrospectively in 146 patients with squamous cell carcinoma of penis who underwent bilateral inguinal lymph node dissection in our center between January 1998 and April 2011. Variables recorded included serum squamous cell carcinoma antigen, primary tumor p53 immunoreactivity, histological grade, pathological tumor stage, lymphatic or vascular invasion, absent/unilateral or bilateral inguinal lymph node involvement, number of metastatic inguinal lymph nodes, presence of extracapsular growth and lymph node density.

Results

Seventy patients had inguinal lymph node metastasis (LNM). Of these, 33 (47.1 %) had pelvic LNM. Primary tumor strong p53 expression, lymphatic or vascular invasion, involvement of more than two inguinal lymph nodes and 30 % or greater lymph node density were significant predictors of pelvic LNM. Primary tumor strong p53 expression (odds ratio [OR] 5.997, 95 % confidence intervals [CI] 1.615–22.275), presence of extracapsular growth (OR 2.209, 95 % CI 1.166–4.184), involvement of more than two inguinal lymph nodes (OR 2.494, 95 % CI 1.086–5.728) and pelvic lymph node involvement (OR 18.206, 95 % CI 6.807–48.696) were independent prognostic factors for overall survival.

Conclusions

Primary tumor expression of p53, lymphatic or vascular invasion, number of metastatic inguinal lymph nodes and lymph node density were all predictors of pathologic pelvic lymph node involvement. Patients with pelvic LNM had an adverse prognosis, with a 3-year overall survival rate of approximately 12.1 %. Pelvic lymph node dissection should be considered in these cases.     

耻骨后根治性前列腺切除治疗淋巴结转移前列腺癌的疗效分析

目的:探讨耻骨后根治性前列腺切除结合辅助内分泌治疗或局部外放疗治疗20例前列腺癌伴盆腔淋巴结转移的安全性和疗效。方法:术前对20例前列腺癌患者均行双侧足背淋巴管造影,对其中11例盆腔可疑淋巴结穿刺抽吸淋巴液,进行实时定量PCR(RT-PCR)检测淋巴液PSA mRNA和前列腺特异膜抗原(PSMA)mRNA的表达。20例均行耻骨后根治性前列腺切除和扩大盆腔淋巴结清扫,对其中3例切端阳性者待尿失禁控制后给予外放疗。结果:11例经RT-PCR检测淋巴结液PSA mRNA和PSMA mRNA阳性表达中均经病理证实为前列腺癌淋巴结转移。术中失血量中位数575 ml,术中输血5例。手术切缘阳性3例,漏尿和淋巴漏各2例,无尿失禁、血管损伤和直肠损伤病例。经中位数42个月随访,术后6~48个月生化复发12例,复发时间中位数12个月。术后12个月和48个月分别死亡2例。结论:术前淋巴管造影后穿刺抽吸淋巴结液,用RT-PCR方法检测淋巴液PSA mRNA和PSMA mRNA表达有助于术前确定前列腺癌盆腔淋巴结转移。采用耻骨后根治性前列腺切除和扩大淋巴结清扫结合辅助内分泌治疗,对切端阳性者给予局部外放射治疗是治疗前列腺癌伴盆腔淋巴结转移患者安全、有效的方法。但对Gleason 10分的盆腔淋巴结转移前列腺癌采用根治性前列腺切除应慎重。     

Extent of pelvic lymph node dissection in penile cancer may impact survival

Introduction

Current guidelines on management of penile carcinoma (PC) recommend ipsilateral pelvic lymph node dissection (PLND) in patients with inguinal lymph node metastasis (LNM) who meet specific criteria. The aim of this article was to assess outcomes in patients treated with bilateral PLND in the presence of unilateral metastatic pelvic nodes.

Methods

After IRB approval, four international centers contributed to this study. Men with PC and unilateral inguinal LNM and pelvic node metastases were retrospectively analyzed. Estimates of overall survival (OS) and cancer-specific survival were provided by the Kaplan–Meier method. Comparisons between subgroups were made using the log-rank test, and Cox regression analysis was used to adjust comparisons for covariates of interest.

Results

From 1978 to 2012, fifty-one men with unilateral inguinal LNM and positive pelvic nodes on PLND were identified. Thirty-eight (75 %) had ipsilateral and 13 (25 %) had bilateral PLND. Except the extent of the PLND, patients were comparable with respect to disease and therapeutic interventions. The Kaplan–Meier estimated median OS was significantly longer in the bilateral PLND patients (21.7 vs. 13.1, p = 0.051). On Cox regression analysis, bilateral PLND [HR 0.25, (95 % CI 0.10–0.64)], multiple pelvic node involvement [HR 2.12 (95 % CI 1.02–4.43)], neoadjuvant chemotherapy [HR 0.01, (95 % CI 0.02–0.44)] and adjuvant therapies [HR 0.16, (95 % CI 0.06–0.45)] (compared to no additional therapy) were independent predictors of OS.

Conclusions

Men with PC and pelvic node metastases may benefit from a bilateral PLND. This hypothesis requires further confirmation.

     

Role of lymph node density in predicting survival of patients with lymph node metastases after radical cystectomy: A multi-institutional study

Objectives:   To evaluate the prognostic role of different clinico-pathological parameters in node-positive patients treated by radical cystectomy.
Methods:   A retrospective multi-institutional study of 435 patients who underwent radical cystectomy between 1990 and 2005 was carried out. Of them, pathological lymph node (LN) metastases were found in 83 patients. Sixty of these 83 patients, whose clinical information and follow-up data were available, were included in the analysis. Twenty-five patients had undergone adjuvant chemotherapy, whereas 35 had not. A Cox proportional hazards model was used to determine the impact of the following clinico-pathological parameters on patient survival: number of resected LNs, number of positive LNs, LN density (defined as the ratio of the number of positive LNs divided by the total number of resected LNs) and adjuvant chemotherapy.
Results:   Median follow-up for surviving patients was 41 months (range 4–138) after surgery. The median survival time for all patients was 22 months (95% confidence interval, 15–42 months). At multivariate analysis, LN density of 25% or less, adjuvant chemotherapy and pure urothelial carcinoma were independently significant predictors of survival.
Conclusions:   Lymph node density predicts survival in patients with node-positive bladder cancer.     

Diagnosis and treatment of pelvic lymph node metastasis in bladder cancer

BACKGROUND AND METHODS: Bipedal lymphography and percutaneous fine needle aspiration biopsy (FNAB) of pelvic lymph node was done in 200 patients with bladder cancer. RESULTS: A diagnosis of metastasis to the pelvic lymph node was obtained by this method in 34 patients. Of these 34 patients, only 12 (35%) were positive or suspected of having pelvic lymph node metastasis by computed tomography. Sixteen patients (47%) had unequivocally positive or highly suspicious lymphogram and 18 patients (53%) had normal lymphogram. Seventy-eight cases, including eight FNAB-positive cases, were treated by radical cystectomy and regional lymph node dissection. Sensitivity, specificity, positive predictive value and negative predictive value of FNAB were 57, 100, 100 and 91%, respectively. Thirteen FNAB-positive M0 patients could be treated by multimodality therapy and evaluated after neoadjuvant therapy by repeated lymphography and FNAB. All were changed to N0 by FNAB after neoadjuvant therapy. In eight patients treated by total cystectomy and lymph node dissection, four had down staged to pN0 but four had one positive node. In five follow-up cases without surgery, one had recurrent pelvic lymph node metastasis 35 months later. Cause-specific survival of these patients was 76% at 5 years and 57% at 8 years. CONCLUSIONS: Pretreatment diagnosis of pelvic lymph node metastasis and multimodality therapy may improve the prognosis of regional lymph node-positive bladder cancer. Because it is difficult to diagnose pN1 using FNAB, radical operation should be performed even if neoadjuvant therapy is effective and down staging is obtained.     

Comparison of different lymph node staging schemes in prostate cancer patients with lymph node metastasis

International Urology and Nephrology - In addition to standard TNM N staging, lymph node ratio (LNR) and log odds of metastatic lymph node (LODDS) staging methods have been developed for cancer...     

Intra-arterial infusion chemotherapy for penile carcinoma with deep inguinal lymph node metastasis

From July 1994 to January 1999, three patients with penile squamous cell carcinoma with deep inguinal lymph node metastases without distant metastases were treated with multimodality treatment including intra-arterial infusion chemotherapy mainly with monthly courses of cisplatin, methotrexate and bleomycin. One patient achieved a complete response and 2 achieved a partial response. It appears to be reasonable to presume that intra-arterial chemotherapy has a beneficial effect in the management of penile cancer with fixed metastatic inguinal lymph nodes, but a larger number of patients and longer follow-up are required to confirm these results.     

早期胃癌淋巴结转移的危险因素分析

目的探讨早期胃癌病人淋巴结转移的危险因素,以期为临床治疗方案的选择提供依据。方法回顾性分析我院2010年1月至2013年12月期间收治的早期胃癌病人的临床病理特征与淋巴结转移规律关系。结果共89例早期胃癌病人纳入研究分析,所有病人淋巴结转移率为14.6%(13/89)。肿瘤大体类型分为隆起型、表浅型、凹陷型,其淋巴结转移率分别为10.0%、5.6%及22.0%,各型间淋巴结转移率差异有统计学意义(P =0.000);黏膜内癌与黏膜下癌淋巴结转移率分别为4.9%(2/41)及22.9%(11/48),二者间差异有统计学意义(P =0.016);高分化良好型早期胃癌无淋巴结转移,中分化及低分化早期胃癌淋巴结转移分别为10.3%(3/29)、18.5%(10/54),差异有统计学意义(P =0.000);6例病人伴有脉管癌栓,其中4例发生淋巴结转移。Logistic 回归多因素分析结果显示：肿瘤大体类型、分化程度、浸润深度及脉管癌栓对淋巴结转移具有显著性影响(P <0.05),其比值比(OR)值分别为4.7、3.2、15.1和5.7。病人性别、年龄、肿瘤部位等与淋巴结转移无相关性。结论早期胃癌病人淋巴结转移率低,其转移与否同肿瘤大体类型、浸润深度、分化程度以及脉管癌栓密切相关。     

Sentinel lymph node biopsy for staging penile cancer

Eighteen sentinel lymph node biopsies were performed in 10 patients with invasive squamous carcinoma of the penis. Five of 15 biopsies associated with inguinal lymphadenopathy and 2 of 3 biopsies associated with palpably normal inguinal nodes were positive. Among 7 ipsilateral regional lymphadenectomies undertaken because of a positive biopsy, additional lymph node metastases were uncovered in only 1 instance. Among 5 patients with negative biopsies bilaterally, none had other superficial inguinal lymph node metastases and all but one have remained free of tumor (mean follow-up 26 months). These data support the possibility that the sentinel lymph node is often the first site of regional lymphatic metastasis in penile cancer.     

腹腔镜直肠癌根治术侧方淋巴结清扫术

对腹膜反折以下cT3或N＋的直肠癌行侧方淋巴结清扫术可减少局部复发率及提高生存率。该术式采用五孔法完成,按日本学组提出的三间隙原则进行清扫：①分离保护输尿管及下腹神经,清扫下腹神经丛及下腹神经与髂总动脉、髂内动脉之间的第二间隙淋巴结;②清扫髂内外动脉间及闭孔内的第三间隙淋巴脂肪组织;③切除髂内血管及盆丛神经。应视肿瘤部位、浸润深度以及侧方淋巴结肿大情况,选择性行单或双侧清扫。腹腔镜下完成侧方淋巴结清扫具有视野好、狭小间隙操作方便、出血少等优势,是一种安全可行的手术方式。     

Risk factors predictive of lymph node metastasis in depressed early gastric cancer

BACKGROUND: This study was conducted to identify risk factors predictive of regional lymph node metastasis in depressed early gastric cancer and further to establish an objective criterion useful to indicate additional surgical treatment in cases in which submucosal tumor extension becomes evident by endoscopic mucosal resection (EMR). METHODS: Data from 276 patients surgically treated for depressed early gastric cancer were collected, and the relationship between the patient and tumor characteristics, and the lymph node metastasis was retrospectively evaluated by multivariate analysis. RESULTS: In the multivariate logistic regression model, female sex, a larger tumor size (20 mm or more), submucosal invasion, and presence of lymphatic vessel involvement were found to be independent risk factors for lymph node metastasis. Among 145 patients with submucosally invasive carcinoma, no lymph node metastasis was observed in patients who showed none of the other three risk factors, whereas 14.3% and 23.3% of patients with one and two of these factors had lymph node metastasis, respectively. The lymph node metastasis rate was calculated to be 86.7% in patients who had all three factors. CONCLUSIONS: Submucosal invasion, female sex, tumor size of 20 mm or more, and lymphatic vessel involvement were significantly and independently related to the presence of lymph node metastasis in depressed early gastric cancer. The positive number of the latter three risk factors is a simple criterion to indicate additional surgical treatment in cases with submucosal invasion revealed first by EMR.     

More lymph node dissection improves survival in patients with newly diagnosed lymph node-positive penile cancer

International Urology and Nephrology - For patients with lymph node-positive (LN+) penile cancer, the optimal extent of lymph node dissection (LND) is currently not established. We aimed to reveal...