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Node-positive Patients (node-positive + patient)
Selected AbstractsPrognostic value of laparoscopic ultrasound in patients with gastro-esophageal cancerDISEASES OF THE ESOPHAGUS, Issue 3-4 2001M. E. Flett Forty-four patients with gastro-esophageal tumors regarded as resectable by conventional staging underwent laparoscopic ultrasonography (LUS). Following LUS, seven were found to be irresectable and were managed by palliative therapies. Thirty-seven patients proceeded to surgical exploration and 36 were resected (R0 80%, R1 11%, and R2 9%). All patients were reviewed until death or for a minimum of 24 months. Patients undergoing resection had a 62% 1-year survival (median 17 months; confidence intervals, CI 6,28). LUS defined nodal status indicated a trend toward prolonged survival in the node-negative group, median 22 months (CI 5,39), compared with 13 months (CI 6,20) in the node-positive group. Disease-free survival was greater in LUS node-negative patients at 29 months (CI 23,35) compared with node-positive patients at 13 months (CI 5,21) P=0.0083. LUS staging allows prediction of the likelihood of recurrence of gastro-esophageal malignancies. This may prove useful for the appropriate allocation of patients to primary and adjuvant therapies. [source] Metastatic melanoma volume in sentinel nodes: objective stereology-based measurement predicts disease recurrence and survivalHISTOPATHOLOGY, Issue 7 2009Rikke Riber-Hansen Aims:, Sentinel lymph node (SLN) status is the most important prognostic factor in intermediate thickness melanoma. The amount of metastatic disease in positive SLNs varies greatly between patients, and this tumour burden appears to influence the prognosis of node-positive patients. The aim was to use objective stereological techniques to correlate accurately total SLN tumour burden with recurrence and patient survival. Methods and results:, SLNs from 327 patients were examined by complete step sectioning and immunohistochemistry. The total metastasis volume (TMV) of 156 positive SLNs from 99 patients (30.3%) was measured using stereological methods based on the 2D-nucleator and Cavalieri's principle. The maximum metastasis diameter was also measured. These two measurements were correlated with disease recurrence and patient survival. The mean TMV for SLN+ patients was 10.5 mm3 (median 0.05 mm3; range 0.0001,623.7 mm3). Median follow-up was 26.3 months. On multivariate analysis, TMV was an independent predictor of recurrence when corrected for primary tumour thickness (P = 0.001) and was a stronger prognosticator compared with the maximum metastasis diameter (P < 0.0001 versus P = 0.01). Conclusions:, Combining total step sectioning of SLNs with stereological assessment of metastases, we found metastasis volume to be a highly significant predictor of disease recurrence and survival. [source] Per-operative frozen section examination of pelvic nodes is unnecessary for the majority of clinically localized prostate cancers in the prostate-specific antigen eraINTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2000Yoshiyuki Kakehi Abstract Background: The incidence of unsuspected lymph node metastasis seems to be decreasing in the prostate-specific antigen (PSA) era. It remains controversial as to whether routine pelvic lymph node dissection and per-operative frozen section examination should be performed. In addition, it is still unclear whether an aggressive approach to local disease by surgery or irradiation confers survival benefits on stage D1 patients. Methods: Eighty-eight consecutive patients with clinically localized prostate cancer who underwent pelvic lymph node dissection prior to radical prostatectomy during the period between 1985 and 1998 were analyzed. The incidence of lymph node metastases after 1992 was compared with that before 1992. Sensitivity and specificity of frozen section examination was assessed. Progression-free survival and cause-specific survival curves of node-positive patients who underwent radical prostatectomy were estimated by the Kaplan,Meier method. Results: Six of 17 patients (35.3%) treated before 1992 and five of 71 patients (7.0%) treated after 1992 showed unsuspected lymph node metastasis (P = 0.0059). Eight of 11 node-positive patients underwent radical prostatectomy and two have so far demonstrated clinical progression and cancer death with a median follow-up period of 63 months. The 5 year progression-free rate and the cause-specific survival rate for these patients were 71.4 and 85.7%, respectively. Sensitivity of frozen section examination for micrometastasis and gross-metastasis cases, respectively, was 3/6 (50%) and 4/4 (100%), while specificity was 85/85 (100%). Conclusions: The incidence of unsuspected lymph node metastases has been significantly decreased in the PSA era. Frozen section examination of pelvic nodes can be omitted and radical prostatectomy is an acceptable choice of treatment in patients without macroscopically apparent nodal metastases. [source] Intraoperative labeling of sentinel lymph nodes with a combination of vital dye and radionuclide tracer , results in sentinel lymph node-positive patientsJOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 3 2006Wolfgang Pfützner Sentinel-Lymphknoten; Melanom; Metastasierung; Diagnostik Summary Background: Sentinel lymph node biopsy enhances the accuracy of tumor staging in patients with malignant melanoma and can help select candidates for regional lymphadenectomy. There are two techniques for identifying the sentinel lymph node: intradermal injection of a radionuclide tracer or of a blue dye. We evaluated both methods to determine how they can be best utilized to locate a sentinel lymph node. Patients and methods: In a retrospective study, 323 patients with melanoma (tumor thickness , 0.75 mm) who underwent sentinel lymph node biopsy after both radionuclide and blue dye injection were evaluated. The labeling of lymph nodes showing micrometastasis by histopathological examination was determined. Results: 63 patients showed sentinel lymph nodes with micrometastasis. All of these nodes (100 %) were labeled with radionuclide tracer, but only 90 % with blue dye. In 5 patients, only radionuclide labeling identified the histopathologically-positive lymph node. In 36 patients, several sentinel lymph nodes were identified, with the histopathologically-positive nodes usually showing a higher radioactive signal intensity than the negative ones. Conclusion: Since in some patients histopathologically-positive lymph nodes are only labeled by radionuclide tracer, radionuclide labeling is indispensable for locating sentinel lymph nodes. In contrast, labeling with blue dye represents a supplementary method, which can simplify the recognition of the sentinel lymph node during surgery. Zusammenfassung Hintergrund: Die Entnahme des Sentinel-Lymphknotens erlaubt eine genauere Aussage über das Tumorstadium bei Patienten mit malignem Melanom und eine Auswahl der Patienten, bei denen eine therapeutische Dissektion der regionären Lymphknoten indiziert ist. Es existieren zwei Methoden,den Sentinel-Lymphknoten zu lokalisieren: Intradermale Injektion eines Radionuklidtracers oder eines blauen Farbstoffes. Wir prüften die Wertigkeit beider Methoden und stellten die Frage, welche Empfehlungen zum Einsatz dieser Verfahren beim Auffinden des Sentinel-Lymphknotens gegeben werden können. Patienten und Methodik: In eine retrospektiven Studie wurden 323 Patienten mit einem Melanom (Tumordicke , 0,75 mm) evaluiert, bei denen zur Entfernung des Sentinel-Lymphknotens sowohl eine Radionuklid- als auch eine Farb-stoffmarkierung erfolgte. Es wurde untersucht, welche Markierung die Lymph-knoten aufwiesen, bei denen sich in der histopathologischen Begutachtung Mikrometastasen fanden. Ergebnisse: 63 Patienten zeigten Sentinel-Lymphknoten mit Mikrometastasen, von denen alle (100 %) radionuklidmarkiert waren, jedoch nur 90 % auch eine Farbstoffmarkierung aufwiesen. Bei 5 Patienten wurde der histopathologisch positive Lymphknoten nur durch die Radionuklidmarkierung entdeckt. Mehrere Sentinel-Lymphknoten fanden sich bei 36 Patienten,wobei die histopatho-logisch positiven zumeist eine höhere radioaktive Impulsrate aufwiesen als die negativen Lymphknoten. Schlussfolgerung: Da bei bestimmten Personen histologisch positive Lymph-knoten ausschliesslich radioaktiv markiert sind, ist die Radionuklidmarkierung bei der Lokalisation des Sentinel-Lymphknoten unverzichtbar. Die Farbstofffärbung dagegen stellt eine ergänzende Methode dar, die das intraoperative Auffinden des Sentinel-Lymphknotens erleichtern kann. [source] Lymph node counts, rates of positive lymph nodes, and patient survival for colon cancer surgery in Ontario, Canada: A population-based study,JOURNAL OF SURGICAL ONCOLOGY, Issue 6 2006Luke Bui MD Abstract Background and Objectives This study assessed lymph node counts, lymph node status (positive or negative), and survival among patients undergoing colon cancer surgery in Ontario, Canada. Methods We obtained data from the Ontario Cancer Registry on 960 patients who underwent a major colon cancer resection in years 1991,1993. Patients and hospitals were ranked by lymph node count to correlate lymph node counts and lymph node status. For node-negative patients we assessed the influence of patient, hospital, and tumor factors on lymph node counts and survival. Results The rate of node-positive patients was similar among the lymph node count groups. For example, the odds ratio of a patient being node positive if the lymph node count was 10,36 versus 1,3 was 1.0 (CI 0.6,1.6, P,=,0.42). Among node-negative patients, survival was improved for patients with a high (10,36) versus low (1,3) lymph node count (HR 0.6, CI 0.4,1.0, P,=,0.03). No patient, hospital, or tumor factors predicted both a higher lymph node count and improved survival. Conclusions In this population-based study of patients undergoing colon cancer surgery, higher lymph node counts did not correlate with increased rates of node-positive status. J. Surg. Oncol. 2006;93:439,445. © 2006 Wiley-Liss, Inc. [source] Association between extent of axillary lymph node dissection and patient, tumor, surgeon, and hospital factors in patients with early breast cancerJOURNAL OF SURGICAL ONCOLOGY, Issue 2 2003David W. Petrik MD Abstract Background and Objectives Axillary lymph node dissection (ALND) in patients with breast cancer is crucial for accurate staging, provides excellent regional tumor control, and is included in the standard of care for the surgical treatment of breast cancer. However, the extent of ALND varies, and the extent of dissection and the number of lymph nodes that comprise an optimal axillary dissection are under debate. Despite conflicting evidence, several studies have shown that improved survival is correlated with more lymph nodes removed in both node-negative and node-positive patients. The purpose of this study is to determine which patient, tumor, surgeon, and hospital characteristics are associated with the number of nodes excised in early breast cancer patients. Methods A random sample of 938 women with node-negative breast cancer was drawn from the Ontario Cancer Registry and the data supplemented with chart reviews. The extent of axillary dissection was studied by examining the number of nodes examined in relation to the patient, tumor, surgeon, and hospital factors. Results The mean number of lymph nodes excised was 9.8 (SD = 4.8; range, 1,31), and 49% of patients had ,10 nodes excised. Lower patient age was associated with the excision of more lymph nodes (,10 nodes: 63% of patients <40 years vs. 38% of patients ,80 years). Surgeon academic affiliation and surgery in a teaching hospital were highly correlated with each other and were significantly associated with the excision of ,10 nodes. The number of nodes excised was not associated with any tumor factors, nor with the breast operation performed. These results were confirmed with multivariable models. Conclusions Even though the number of lymph nodes found in the pathologic specimen can be influenced by factors other than surgical technique (e.g., number of nodes present, specimen handling, and pathologic examination), this study shows significant variation of this variable and an association with several patient and surgeon/hospital factors. This variation and the association with survival warrant further study and effort at greater consistency. J. Surg. Oncol. 2003;82:84,90. © 2003 Wiley-Liss, Inc. [source] Treatment of the axilla in early breast cancer: past, present and futureANZ JOURNAL OF SURGERY, Issue 12 2001Boon Chua Background:, The optimal treatment of the axilla in early breast cancer is controversial. The present study reviews the pattern and predictors of regional recurrence (RR) and prognosis after RR in patients with early breast cancer treated by conservative surgery and radiotherapy (CS + RT). Implications of the results on current practice and future directions are explored. Methods:, Between 1979 and 1994, 1158 patients with stage I or II breast cancer were treated with CS + RT at Westmead Hospital. Two groups of patients were compared: 782 patients who underwent axillary dissection (axillary surgery group) and 229 patients who received radiotherapy (axillary RT group) as the only axillary treatment. At least 10 lymph nodes were dissected in 82% of the axillary surgery group. Of the women in the RT group, 90% received RT to the axilla and supraclavicular fossa (SCF) only and 10% also received RT to the internal mammary chain (IMC). Results:, With a median follow-up period of 79 months for the axillary surgery group and 111 months for the axillary RT group, 27 patients developed a RR (2.8% and 2.2%, respectively). Seven patients (0.9%) in the axillary surgery group and three patients (1.3%) in the axillary RT group developed a RR in the axilla (P, not significant). Of the patients with SCF recurrences, 14 (1.8%) were in the axillary surgery group and one (0.4%) in the axillary RT group (P, not significant). One patient in the axillary surgery group developed concurrent axillary and SCF recurrences, while a patient in the axillary RT group developed an IMC recurrence. Twenty (74%) of the 27 patients with a RR developed a concurrent or subsequent distant relapse (30% and 44%, respectively). In the pathologically node-positive patients, the axillary recurrence rate was higher in those who had less than five nodes removed (17%) than those who had 10 or more nodes removed (0%; P = 0.01). The SCF recurrence rate was higher in patients with four or more positive axillary nodes (9.5%) than in those with 0,3 positive nodes (1.5%; P = 0.003). Conclusion:, Adequate treatment of the axilla by surgery or RT alone is associated with a low rate of RR. The incidence of distant relapse was substantial in patients who developed a RR, which gives emphasis to the importance of optimizing local,regional control. [source] Vascular and Biology 03BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue S1 2002C. Parr Background: Hepatocyte growth factor (HGF) elicits a number of functions that are tumourigenic and known to enhance the metastatic potential of tumour cells. HGF is produced as pro-HGF and requires proteolytic activation, by HGF activator, to evoke a biological response. The HGF inhibitors, HAI-1 and HAI-2, suppress the conversion of pro-HGF, through their interaction with HGF activator. This study quantitated the expression of HGF, its receptor and its inhibitors in breast cancer. Methods: Breast cancer tissues from patients (n = 97) were obtained with background normal tissues. RNA was extracted from these tissues, and HGF, c-Met, HAI-1 and HAI-2 expression was quantified using a real-time quantitative PCR (RTQ-PCR) techniques. Results: Levels of HGF and its receptor were found to be significantly higher in breast cancer than normal background tissues. The level of HAI-1 and 2 was also seen to be higher in tumour tissues. The mean results (copy number mL,1) are given in the Table below: In addition, patients with progressive diseases had a higher level of HGF (62.7 copies mL,1), than those with stable disease (43.8 copies mL,1), over a 5-year follow-up period. Furthermore, tumour tissues from node-positive patients expressed lower HAI-2 levels (341.3 copies mL,1), than the node-negative breast cancer tissues (1021.5 copies mL,1). Conclusions: This study has shown that the quantity of HGF, c-Met, HAI-1 and HAI-2 expressed in breast cancer tissues was significantly higher than that of background breast samples, and that the level of HGF is associated with progressive disease. [source] Lymphatic mapping and sentinel lymph node biopsy in the detection of early metastasis from sweat gland carcinoma,CANCER, Issue 9 2003Paul N. Bogner M.D. Abstract BACKGROUND Several subtypes of sweat gland carcinoma have been found to demonstrate a propensity to metastasize systemically and to regional lymph nodes. The predictive value and benefit of sentinel lymph node (SLN) biopsy have been established in numerous other malignancies, but to the authors' knowledge there is little literature published to date regarding the use of SLN biopsy in patients with sweat gland carcinoma. In the current study, the authors demonstrated the utility of SLN biopsy in detecting subclinical metastases of sweat gland carcinoma, which may result in early treatment. METHODS The authors identified five patients with malignant eccrine tumors in whom SLN biopsy was performed at the study institution. Clinical and histopathologic data were reviewed. RESULTS The five study cases included two cases of aggressive digital papillary adenocarcinoma (both occurring on upper extremity digits), two cases of hidradenocarcinoma (occurring on the knee and foot, respectively), and an eccrine carcinoma (occurring on the scalp). In each biopsy-established case, there was no clinical evidence of metastatic disease, and a wide local excision or amputation was performed with concurrent SLN biopsy. Four of 18 SLNs in 3 of the 5 patients (60%) were found to be positive for metastatic carcinoma, as identified in hematoxylin and eosin stains and/or cytokeratin immunohistochemical stains. All three lymph node-positive patients subsequently underwent regional lymphadenectomy and were found to have no evidence of additional metastases. CONCLUSIONS The results of the current study demonstrate that SLN biopsy detects subclinical metastases from sweat gland carcinomas to regional lymph nodes. SLN mapping and biopsy at the time of resection can provide useful information with which to guide early treatment. Further studies are necessary to determine whether this procedure results in a survival benefit in patients with sweat gland carcinomas. Cancer 2003;97:2285,9. © 2003 American Cancer Society. DOI 10.1002/cncr.11328 [source] What factors affect lymph node yield in surgery for rectal cancer?COLORECTAL DISEASE, Issue 5 2004C. C. Thorn Abstract Objective The detection of lymph node metastases is of vital importance in patients undergoing excisional surgery for rectal cancer as it provides important prognostic information and facilitates decision-making with regards to adjuvant therapy. It has been suggested that patients in whom only a small number of nodes are present in the excised specimen have a worse prognosis, presumably due to inadequate lymphadenectomy and consequent understaging of the disease. The aim of this study was to determine which factors affect the yield of lymph nodes. Methods This was a retrospective study of patients who had undergone a resection for histologically proven adenocarcinoma of the rectum. The total number of lymph nodes identified in the excised specimen was recorded in each case. A multivariate analysis was performed to ascertain whether this number was significantly influenced by any of several variables. Results A total of 167 patients were studied (M:F ratio 107 : 60, median age 70 years). The median number of lymph nodes contained within the resected specimen was 16 (interquartile range 10,21). On univariate analysis a significantly higher yield of lymph nodes was obtained with tumours in the middle third of the rectum (P = 0.007), larger tumours (P < 0.001), more locally advanced tumours according to both pT staging (P = 0.001) and Dukes' staging (P = 0.020), an increased number of involved nodes (P = 0.003) and examination by a specialist histopathologist (P = 0.003). On multivariate analysis the only significant variables were tumour size (P = 0.021), number of positive nodes (P = 0.007) and histopathologist (P = 0.021). Conclusions The number of lymph nodes identified within the excised specimen in patients undergoing resection of a rectal cancer positively correlates with the size of the tumour and is also dependent on the examining histopathologist. In addition, in node-positive patients the number of involved nodes increases with increasing lymph node yield. [source] | |||||||||||||||||||