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Zhu L, Wang L, Gao Z, Zeng Y, Tao K, Wang Q, Li X, Zhang H, Shen Z, Zhou J, Shen K, Ye Y, Wu A. Examined lymph node numbers influence prognosis in rectal cancer treated with neoadjuvant therapy. CANCER PATHOGENESIS AND THERAPY 2023; 1:168-176. [PMID: 38327833 PMCID: PMC10846314 DOI: 10.1016/j.cpt.2023.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/25/2022] [Accepted: 01/02/2023] [Indexed: 02/09/2024]
Abstract
Background The number of lymph nodes examined (LNe) is often insufficient in patients with rectal cancer (RC) treated with neoadjuvant therapy; however, its prognostic value remains controversial. Thus, we retrospectively explored whether LNe had an influence on staging and prognosis and investigated whether there was a cut-off value for better prognosis in patients with RC treated with neoadjuvant therapy. Methods Data were collected from seven prospective hospital databases in China from July 2002 to May 2018. Binary logistic regression models were used to predict lymph node metastasis. The cut-off value for LNe was determined using X-tile 3.6.1. Survival outcomes and risk factors were analyzed using the log-rank test and Cox regression model. Results A total of 482 patients were included, of whom 459 had complete overall survival (OS) information. Using the percentile method, the total number of lymph nodes examined (TLNe) was 14-16 (40th-60th percentile), and the proportion of patients with lymph node metastasis reached a maximum of 48.1%. Cox multivariate analysis showed that the odds ratio (OR) remained the highest when TLNe was 14-16 (OR = 3.379, P = 0.003). The 3-year and 5-year OS were 85.4% and 77.8%, respectively. Negative lymph nodes examined (NLNe) of ≤6 was an independent risk factor for 3-year and 5-year OS (3-year OS 71.1% vs. 85.9%, P = 0.004; 5-year OS 66.3% vs. 74.3%, P = 0.035). Subgroup analysis for patients with ypN + showed that higher 3-year and 5-year OS were achieved when the TLNe was >10, 78.8% vs. 54.0% (P = 0.005), and 60.8% vs. 36.0% (P = 0.012), respectively. Patients with ypN0M0 had a higher 5-year OS when the TLNe was >19 (P = 0.055). Conclusion The TLNe and NLNe influenced the staging accuracy and demonstrated prognostic value in patients with RC treated with neoadjuvant therapy.
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Affiliation(s)
- Liyu Zhu
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing 100044, China
- Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing 100044, China
| | - Lin Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Zhidong Gao
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing 100044, China
- Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing 100044, China
| | - Yujian Zeng
- Yunnan Institute of Digestive Disease, Department of Gastrointestinal and Hernia Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Kaixiong Tao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Quan Wang
- Department of Gastrointestinal and Anal Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Xinming Li
- Department of Gastrointestinal and Anal Surgery, Huangshi Central Hospital, Huangshi, Hubei 435000, China
| | - Huanhu Zhang
- Department of Gastrointestinal Surgery, Weihai Municipal Hospital, Weihai, Shandong 264200, China
| | - Zhanlong Shen
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing 100044, China
- Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing 100044, China
| | - Jing Zhou
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing 100044, China
- Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing 100044, China
| | - Kai Shen
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing 100044, China
- Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing 100044, China
| | - Yingjiang Ye
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Aiwen Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
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Shi Y, Li X, Zhang X, Wang S, Pu J, Zhang L, Hu Z. Constructing and Validating a Prognosis Predictive Nomogram for Cancer-Specific Survival in Rectal Cancer Patients Receiving Preoperative Radiotherapy. J INVEST SURG 2022; 35:1526-1535. [PMID: 35618267 DOI: 10.1080/08941939.2022.2078021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background A predictive tool is required to identify the cancer-specific survival in rectal cancer (RC) patients who have opted to receive preoperative radiotherapy.Methods A database containing the data on RC patients' records of Surveillance, Epidemiology, and End Results (SEER) receiving surgery during 2000-2014 was selected. All patients received neoadjuvant radiotherapy (NR). The correlation of clinicopathological parameters was analyzed using the Chi-square test and the survival risk factors were analyzed using the Cox proportional hazards analysis (univariate and multivariate). Finally, the nomogram was developed and validated to visually represent an accurate prediction of the probability of 3- and 5-year cancer-specific survival (CSS) based on the screened variables of the cohort.Results 11,499 rectal cancer patients were included in our cohort. Patients' records were randomly allocated to either the development or validation cohorts based on an equal ratio (1:1). Performing the multivariate Cox regression analysis incorporating these variables in the development cohort determined 11 independent prognostic factors. Statistically significant differences were recorded among subgroups using log-rank tests, which confirmed the appropriateness and acceptability of factor stratifications. Then, the nomogram was constructed and its concordance index (C-index) values in the development cohort (0.720) and validation cohort (0.717) were evaluated to be higher (P<0.05) than those of the AJCC stage (0.631 and 0.633 respectively). Also, the 3-year AUC values of this nomogram were higher than those of the AJCC stage in both the development cohort (0.746 vs. 0.631) and the validation cohort (0.745 vs. 0.640). Using DCA curves, the predictive potential of the currently developed nomogram outperformed the conventional AJCC staging system.Conclusion The nomogram model might be a more reliable tool to predict prognosis accurately in rectal cancer patients receiving preoperative radiotherapy.
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Affiliation(s)
- Yunjie Shi
- Department of Anorectal Surgery, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Xinxing Li
- Department of General Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xukun Zhang
- Academy for Engineering and Technology, Fudan University, Shanghai, China
| | - Shengyun Wang
- Department of Emergency and Critical Care Medicine, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Jun Pu
- Department of Anesthesiology, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Lihua Zhang
- Academy for Engineering and Technology, Fudan University, Shanghai, China
| | - Zhiqian Hu
- Department of Anorectal Surgery, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China.,Department of General Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
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Zeman M, Skałba W, Szymański P, Hadasik G, Żaworonkow D, Walczak DA, Czarniecka A. Risk factors for long-term survival in patients with ypN+ M0 rectal cancer after radical anterior resection. BMC Gastroenterol 2022; 22:141. [PMID: 35346064 PMCID: PMC8961971 DOI: 10.1186/s12876-022-02226-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Regional lymph node metastases are the main adverse prognostic factor in patients with rectal cancer without distant metastases. There are discrepancies, however, regarding additional risk factors in the group of ypN + M0 patients. The purpose of the study was to assess clinical and pathological factors affecting long-term oncological outcomes in the group of ypN + M0 patients after radical rectal anterior resection.
Methods
112 patients with ypN + M0 rectal cancer after neoadjuvant therapy and radical anterior resection were subject to a retrospective analysis. The effect of potential factors on survival was assessed with the use of Kaplan–Meier curves together with a log-rank test and multiple factor Cox proportional hazards model.
Results
In the multiple factor Cox analysis, adverse factors affecting disease-free survival (DFS) were: the use of angiotensin-converting enzyme inhibitors (ACEIs) (hazard ratio HR: 3.11, 95% CI 1.01–9.56, p = 0.047), presence of perineural invasion (HR: 7.27, 95% CI 2.74–19.3, p < 0.001) and occurrence of postoperative complications (HR: 6.79, 95% CI 2.09–22.11, p = 0.001), while a positive factor was the negative lymph node (NLN) count > 7 (HR: 0.33, 95% CI 0.12–0.88, p = 0.026). In the disease-specific survival (DSS) analysis, an adverse factor was the use of ACEIs (HR: 4.275, 95% CI 1.44–12.694, p = 0.009), while a positive effect was caused by NLN > 5 (HR: 0.22, 95% CI 0.082–0.586, p = 0.002).
Conclusions
The use of ACEIs may have a negative effect on long-term treatment outcomes in patients with ypN + M0 rectal cancer. In this group of patients, the NLN count seems to be an important prognostic factor, as well.
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Zhang M, Cui M, Zuo Q, Wang L, Wang J, Zhu L, Yan R, Lu N, Yan H, Zhang L. Construction and evaluation of prognostic models for esophageal cancer patients with distant and non-distant metastases: providing a reference process for clinical diagnosis and treatment. J Gastrointest Oncol 2021; 12:1241-1254. [PMID: 34532084 DOI: 10.21037/jgo-21-429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/19/2021] [Indexed: 12/24/2022] Open
Abstract
Background Although the current treatment for esophageal cancer has great technological progress, the 5-year survival rate of patients is not optimistic. About 70% of patients with esophageal cancer are at an advanced stage at first diagnosis. These patients are prone to distant metastasis, and the prognosis is poor. Therefore, understanding the risk factors for distant metastasis in patients with esophageal cancer, combined with the prognosis of the patient, can aid in choosing the optimal diagnosis and treatment plan. Ultimately, it will improve the patient's survival time and quality of life. This research aims to construct a model for the risk assessment of distant metastasis in patients with esophageal cancer and prognostic models for patients with distant and non-distant metastases. Methods The Surveillance Epidemiology and End Results (SEER) database was used to select patients with esophageal cancer from 2010 to 2015. The optimal cutoff point was selected for the age and tumor size variables using X-tile. The nomogram was constructed using R software (The R Foundation for Statistical Computing). Results Gender, grade, T stage, N stage, and tumor size were independent risk factors associated with distant metastasis in patients with esophageal cancer. The concordance index (C-index) of the nomogram prediction model for whether the patient will have distant metastasis was 0.609. Age, grade, T stage, N stage, and tumor size were independent risk factors affecting the prognosis without distant metastasis. The C-index of the nomogram prediction model for patients with distant metastases was 0.590. Age and T stage were independent risk factors affecting the prognosis of patients with distant metastases. The C-index of the nomogram prediction model was 0.543. The combination of radiotherapy, chemotherapy, and primary surgery yielded the best overall survival for both patients with distant metastases and patients with non-distant metastases. Conclusions A comprehensive assessment of the risk of distant metastasis in patients with esophageal cancer, combined with prognosis prediction, is necessary to provide patients with a reasonable treatment plan.
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Affiliation(s)
- Mingxin Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Medical University, Xi'an, China.,Department of Internal Medicine, The Second Clinical Medical College of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Manli Cui
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Qianqian Zuo
- Department of Oncology Geriatrics, The First Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Li Wang
- Department of Scientific Research, The Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Jia Wang
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Lin Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Rong Yan
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Ning Lu
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Honglin Yan
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Lingmin Zhang
- Department of Anesthesiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Yang H, Mei T. The prognostic value of lymph node ratio in patients with surgically resected stage I-III small-cell lung cancer: a propensity score matching analysis of the SEER database. Eur J Cardiothorac Surg 2021; 60:1212-1220. [PMID: 34195790 DOI: 10.1093/ejcts/ezab287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/12/2021] [Accepted: 05/13/2021] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES Due to the lack of prospective studies, the role of the lymph node ratio (LNR) in small-cell lung cancer (SCLC) remains unknown. This study aimed to assess the prognostic effect of LNR in surgically resected stage I-III SCLC patients. METHODS Clinical data of stage I-III (excluding N3 and NX) SCLC patients diagnosed between 1998 and 2016 were extracted from the Surveillance, Epidemiology and End Results database. Patients were divided into low-risk and high-risk subsets based on the LNR cut-off value of 0.15 using X-tile software. Propensity score matching analysis was employed to reduce bias in baseline characteristics. Kaplan-Meier analysis was performed to determine the overall survival (OS) and lung cancer-specific survival (LCSS). Cox regression analysis was performed to evaluate the effects of multiple variables. RESULTS A total of 978 patients were identified, of whom 669 (68.40%) had LNR ≤0.15. Patients with LNR ≤0.15 showed better OS (P < 0.001) and LCSS (P < 0.001) both before and after propensity score matching. Multivariable analyses of the matched population confirmed LNR as an independent prognostic factor. Patients with LNR >0.15 showed poorer OS [hazard ratio (HR) 1.55, 95% confidence interval (CI) 1.09-2.19; P = 0.015] and LCSS (HR 1.65, 95% CI 1.13-2.43; P = 0.010). Subgroup analyses revealed that LNR ≤0.15 was associated with favourable OS (P = 0.009 and 0.197, respectively) and LCSS (P = 0.010 and 0.169, respectively) in N1 and N2 patients. CONCLUSIONS LNR was determined as an independent predictor for surgically resected stage I-III SCLC, indicating that higher LNR is associated with reduced survival. The predictive value of LNR should to be further validated in prospective studies.
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Affiliation(s)
- Hao Yang
- Department of Respiratory and Critical Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Tonghua Mei
- Department of Respiratory and Critical Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
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Zeman M, Czarnecki M, Chmielik E, Idasiak A, Skałba W, Strączyński M, Paul PJ, Czarniecka A. The assessment of risk factors for long-term survival outcome in ypN0 patients with rectal cancer after neoadjuvant therapy and radical anterior resection. World J Surg Oncol 2021; 19:154. [PMID: 34020673 PMCID: PMC8140444 DOI: 10.1186/s12957-021-02262-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/11/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The main negative prognostic factors in patients with rectal cancer after radical treatment include regional lymph node involvement, lymphovascular invasion, and perineural invasion. However, some patients still develop cancer recurrence despite the absence of the above risk factors. The aim of the study was to assess clinicopathological factors influencing long-term oncologic outcomes in ypN0M0 rectal cancer patients after neoadjuvant therapy and radical anterior resection. METHODS A retrospective survival analysis was performed on a group of 195 patients. We assessed clinicopathological factors which included tumor regression grade, number of lymph nodes in the specimen, Charlson comorbidity index (CCI), and colorectal anastomotic leakage (AL). RESULTS In the univariate analysis, AL and CCI > 3 had a significant negative impact on disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS). After the division of ALs into early and late ALs, it was found that only patients with late ALs had a significantly worse survival. The multivariate Cox regression analysis showed that CCI > 3 was a significant adverse risk factor for DFS (HR 5.78, 95% CI 2.15-15.51, p < 0.001), DSS (HR 7.25, 95% CI 2.25-23.39, p < 0.001), and OS (HR 3.9, 95% CI 1.72-8.85, p = 0.001). Similarly, late ALs had a significant negative impact on the risk of DFS (HR 5.05, 95% CI 1.97-12.93, p < 0.001), DSS (HR 10.84, 95% CI 3.44-34.18, p < 0.001), and OS (HR 4.3, 95% CI 1.94-9.53, p < 0.001). CONCLUSIONS Late AL and CCI > 3 are the factors that may have an impact on long-term oncologic outcomes. The impact of lymph node yield on understaging was not demonstrated.
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Affiliation(s)
- Marcin Zeman
- The Oncologic and Reconstructive Surgery Clinic, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-100, Gliwice, Poland.
| | - Marek Czarnecki
- The Oncologic and Reconstructive Surgery Clinic, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-100, Gliwice, Poland
| | - Ewa Chmielik
- Tumor Pathology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-100, Gliwice, Poland
| | - Adam Idasiak
- II Clinic of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-100, Gliwice, Poland
| | - Władysław Skałba
- The Oncologic and Reconstructive Surgery Clinic, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-100, Gliwice, Poland
| | - Mirosław Strączyński
- The Oncologic and Reconstructive Surgery Clinic, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-100, Gliwice, Poland
| | - Piotr J Paul
- Tumor Pathology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-100, Gliwice, Poland.,Department of Pathology, Institute of Medical Sciences, University of Opole, Oleska 48, 45-052, Opole, Poland
| | - Agnieszka Czarniecka
- The Oncologic and Reconstructive Surgery Clinic, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-100, Gliwice, Poland
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Yao W, Lu N, Cui M, Wang J, Du Z, Zhang M. [Positive lymph node ratio ≥0.16 is an independent risk factor affecting the prognosis of patients with esophageal cancer]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:837-842. [PMID: 32895212 DOI: 10.12122/j.issn.1673-4254.2020.06.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate the value of positive lymph node ratio (LNR) in predicting the prognosis of patients with esophageal cancer. METHODS We retrieved the data of a total of 862 patients with esophageal cancer with complete clinical pathology data archived in SEER database in 2010 to 2015. The best cutoff point of LNR was selected using X-tile software. Univariate and multivariate COX proportional hazard models were used to assess the value of LNR in predicting the prognosis of patients after propensity score matching (PSM). RESULTS The best cut-off point of LNR determined using X-tile 3.6.1 software was 0.16. The patients with LNR < 0.16 and those with LNR≥0.16 showed significant differences in the number of positive lymph nodes, pathological type, T stage and M stage. After 1:1 propensity score matching, the two groups showed no significant difference in the clinical data or pathological parameters. Matched univariate and multivariate COX regression analyses showed that LNR, primary tumor site and M staging were all independent risk factors affecting the prognosis of patients, and among them LNR had the most significant predictive value (LNR < 0.16 vs LNR≥0.16: HR=1.827, 95% CI: 1.140-2.929; P=0.000). The median survival time of patients with LNR < 0.16 was 31 months (95%CI: 22.556-39.444 months), as compared with 16 months (95%CI: 12.989-19.011) in patient with LNR≥0.16 (Log Rank χ2=27.392, P < 0.0001). LNR had a better accuracy than N stage for assessing the patients' prognosis with an area under the ROC curve of 0.617 (95%CI: 0.567-0.666), as compared with 0.515 (95%CI: 0.463-0.565) of N stage (z=3.008, P=0.0026). CONCLUSIONS LNR≥0.16 is an independent risk factor affecting the prognosis of patients with esophageal cancer and has better prognostic value than N stage.
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Affiliation(s)
- Wenzhu Yao
- Xi'an Medical University, Xi'an 710032, China
| | - Ning Lu
- Department of Gastroenterology, First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China
| | - Manli Cui
- Department of Gastroenterology, First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China
| | - Jia Wang
- Department of Gastroenterology, First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China
| | - Zhaozhao Du
- Department of Gastroenterology, First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China
| | - Mingxin Zhang
- Department of Gastroenterology, First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China
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Kamel MG, Istanbuly S, Abd-Elhay FAE, Mohamed MYF, Huu-Hoai L, Sadik M, Dibas M, Huy NT. Examined and Positive Lymph Node Counts Are Associated with Mortality in Prostate Cancer: A Population-Based Analysis. Urol Int 2020; 104:699-709. [PMID: 32268338 DOI: 10.1159/000505410] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 12/11/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Prostate cancer (PCa) is the third leading cause of death from cancer in the United States. We aimed to disclose the prognostic values of examined (dissected) lymph node (ELN), negative lymph node (NLN), and positive (metastatic) lymph node (PLN) counts and lymph node (LNs) ratio in PCa patients. METHODS We extracted data of PCa patients diagnosed between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) program. We included patients with a histologically confirmed diagnosis having at least one ELN and with the PCa as the primary tumor only. RESULTS We have included 96,064 patients. Multivariable Cox proportional hazards regression modelsdisclosed that patients having more ELNs were associated with better survival. However, we demonstrated that patients having more PLNs were associated with worse survival. Additionally, older age, unmarried patients, with Gleason's score of 8-10, T4 and M1 stages and those who received chemotherapy and/or radiation but did not receive surgery were significantly associated with worse PCa survival. CONCLUSIONS We have disclosed several independent predictors affecting PCa patients including age, marital status, Gleason's score, T and N stages, having received therapy, surgery, and ELN and PLN counts. Moreover, we demonstrated that patients with lower ELN and higher PLN counts were a high-risk group. We strongly recommend adding the ELN and/or PLN counts into consideration during patient staging/treatment.
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Affiliation(s)
- Mohamed Gomaa Kamel
- Faculty of Medicine, Minia University, Minia, Egypt.,Online Research Club, Nagasaki, Japan
| | - Sedralmontaha Istanbuly
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | | | | | - Le Huu-Hoai
- Online Research Club, Nagasaki, Japan.,Saigon General Hospital, Ho Chi Minh, Vietnam
| | - Mohamed Sadik
- Online Research Club, Nagasaki, Japan.,Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt
| | - Mahmoud Dibas
- Online Research Club, Nagasaki, Japan.,Sulaiman Al Rajhi Colleges, Al Bukayriya, Saudi Arabia
| | - Nguyen Tien Huy
- Department of Clinical Product Development, Institute of Tropical Medicine (NEKKEN), School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan, .,Evidence Based Medicine Research Group & Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh, Vietnam,
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Yu L, Zhang XT, Guan SH, Cheng YF, Li LX. The Number of Negative Lymph Nodes is Positively Associated with Survival in Esophageal Squamous Cell Carcinoma Patients in China. Open Med (Wars) 2020; 15:152-159. [PMID: 32190739 PMCID: PMC7065439 DOI: 10.1515/med-2020-0023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 11/26/2019] [Indexed: 12/24/2022] Open
Abstract
Background There is a controversial relationship between the negative lymph nodes (NLNs) and survival in patients with esophageal squamous cell carcinoma (ESCC). This study investigates the implications of total number of NLNs on thoracic ESCC patient prognosis. Methods 579 thoracic ESCC patients were categorized into four groups (0-9, 10-14, 15-19 and ≥20 NLNs). Univariate analysis was done by the log-rank tests while multivariate analysis was undertaken using Cox regression models. Survival analysis was determined employing the Kaplan-Meier method. Results When the numbers of NLNs were 9 or less, 10 to 14, 15 to 19 and 20 or more, patients of 3-year survival rates were 21.7%, 40.0%, 61.2% and 77.5%, respectively (P<0.001). In the node-negative and node-positive subgroups, 3-year survival rates were 34.9% and 14.3%, 50.9% and 19.3%, 65.6% and 51.8%, 81.4% and 68.9% respectively (P<0.001). Gender, tumor length, tumor differentiation, T and N stage as well as the total NLNs were found to be significantly linked to survival rates. Multivariate analysis showed tumor length, T stage, N stage and total NLNs were independent prognostic factors for ESCC patients. Conclusion NLNs numbers is a significant independent prognostic indicator for thoracic ESCC patients' survival after curative esophagectomy.
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Affiliation(s)
- Lan Yu
- School of Medicine, Shandong University, Jinan 250012, China.,Cancer Prevention Center, Qingdao Central (Cancer) Hospital, The Second Affiliated Hospital of University Qingdao, Qingdao 266042, China
| | - Xiao-Tao Zhang
- Cancer Prevention Center, Qingdao Central (Cancer) Hospital, The Second Affiliated Hospital of University Qingdao, Qingdao 266042, China
| | - Shang-Hui Guan
- Department of Radiotherapy, Qilu Hospital of Shandong University, No 107, Wenhua West Road, Lixia District, Jinan 250012, Shandong, China
| | - Yu-Feng Cheng
- Department of Radiotherapy, Qilu Hospital of Shandong University, No 107, Wenhua West Road, Lixia District, Jinan 250012, Shandong, China
| | - Lin-Xi Li
- Queen Mary School, Medical college of Nanchang University, Nanchang 330088, China
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10
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Deng HY, Zhu XQ, Ding YY, Li JD, Yang J, Ke TF, Wang R, Chen Q, Hu J, Wang YY, Liao CD. Multislice spiral CT images combined with CEA and lymphocyte-to-neutrophil ratio predict recurrence and post-operative metastasis of rectal cancer. Mol Cell Probes 2019; 50:101502. [PMID: 31891748 DOI: 10.1016/j.mcp.2019.101502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/03/2019] [Accepted: 12/26/2019] [Indexed: 12/20/2022]
Abstract
To explore the early predictors of post-operative recurrence and metastasis of rectal cancer, analyse the associated risk, and construct a model. Retrospective collection. Four hundred patients with rectal cancer underwent surgical resection and pathological diagnosis from September 2013 to September 2014. During the post-operative period, the patients were tested by imaging examination, serum tumour markers, and routine blood follow-up for at least 3 years. Preoperative CT examination of tumour size, lymphocyte-to-neutrophil ratio, and CEA were significant biomarkers for predicting recurrence and/or metastasis of post-operative rectal cancer. The stratified threshold of the lesion size cut-off point in CT images of patients with rectal cancer was 18.75 cm3, the cut-off point value of the lymphocyte-to-neutrophil ratio was 0.33, and the CEA cut-off point value was 16.97 ng/ml. We used the cut-off point to perform stratified survival analysis to obtain two K-M curves and conduct a log-rank test. The Cox multivariate risk regression results were as follows: preoperative CT images of lesion size, lymphocyte-to-neutrophil ratio, and CEA. The AUC of the normogram model for the prediction of post-operative recurrence and metastasis of rectal cancer is 0.939. Preoperative CT examination of tumour size can predict post-operative recurrence and metastasis of rectal cancer and can be used to analyse its risk. The lymphocyte-to-neutrophil ratio and CEA can also predict post-operative tumour recurrence and metastasis risk.
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Affiliation(s)
- Hui-Yuan Deng
- The Third Affiliated Hospital of Kunming Medical University, Radiology Department of Yunnan Cancer Hospital, Kunming, 650118, Yunnan, China
| | - Xiang-Qing Zhu
- The 920th Hospital of Joint Logistics Support Force, Kunming, 650032, Yunnan, China
| | - Ying-Ying Ding
- The Third Affiliated Hospital of Kunming Medical University, Radiology Department of Yunnan Cancer Hospital, Kunming, 650118, Yunnan, China
| | - Jin-Dan Li
- The Third Affiliated Hospital of Kunming Medical University, Radiology Department of Yunnan Cancer Hospital, Kunming, 650118, Yunnan, China
| | - Jun Yang
- The Third Affiliated Hospital of Kunming Medical University, Radiology Department of Yunnan Cancer Hospital, Kunming, 650118, Yunnan, China
| | - Teng-Fei Ke
- The Third Affiliated Hospital of Kunming Medical University, Radiology Department of Yunnan Cancer Hospital, Kunming, 650118, Yunnan, China
| | - Rui Wang
- The Third Affiliated Hospital of Kunming Medical University, Radiology Department of Yunnan Cancer Hospital, Kunming, 650118, Yunnan, China
| | - Qiang Chen
- Faculty of Animal Science and Technology, Yunnan Agricultural University, Kunming, 650201, Yunnan, China
| | - Jing Hu
- Department of Medical Oncology, The First People's Hospital of Yunnan Province, Kunming, 650032, Yunnan, China
| | - Yan-Ying Wang
- The 920th Hospital of Joint Logistics Support Force, Kunming, 650032, Yunnan, China
| | - Cheng-de Liao
- The Third Affiliated Hospital of Kunming Medical University, Radiology Department of Yunnan Cancer Hospital, Kunming, 650118, Yunnan, China.
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11
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Prognostic value of negative lymph node count in patients with jejunoileal neuroendocrine tumors. JOURNAL OF BIO-X RESEARCH 2019. [DOI: 10.1097/jbr.0000000000000045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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12
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Elhusseiny KM, Abd-Elhay FAE, Kamel MG, Abd El Hamid Hassan HH, El Tanany HHM, Hieu TH, Tieu TM, Low SK, Hou V, Dibas M, Huy NT. Examined and positive lymph nodes counts and lymph nodes ratio are associated with survival in major salivary gland cancer. Head Neck 2019; 41:2625-2635. [PMID: 30905082 DOI: 10.1002/hed.25742] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 10/22/2018] [Accepted: 03/05/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND We aimed to investigate the prognostic role of examined (dissected) lymph nodes (ELNs), negative LNs (NLNs), and positive (metastatic) LNs (PLNs) counts and LN ratio (LNR = PLNs/ELNs×100) in patients with major salivary gland cancer (SGC). METHODS Data were retrieved for major SGC patients diagnosed between 1988 and 2011 from Surveillance, Epidemiology, and End Results program. RESULTS We have included 5446 patients with major SGC. Most patients had parotid gland cancer (84.61%). Patients having >18 ELNs, >4 PLNs, and >33.33% LNR were associated with a worse survival. Moreover, older age, male patients, grade IV, distant stage, unmarried patients, submandibular gland cancer, and received chemotherapy but not received surgery were significantly associated with a worse survival. CONCLUSIONS We demonstrated that patients with >18 ELNs and >4 PLNs counts, and >33.33% LNR were high-risk group patients. We strongly suggest adding the ELNs and PLNs counts and/or LNR into the current staging system.
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Affiliation(s)
- Khaled Mosaad Elhusseiny
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt.,Online Research Club (http://www.onlineresearchclub.org/
| | | | - Mohamed Gomaa Kamel
- Online Research Club (http://www.onlineresearchclub.org/.,Faculty of Medicine, Minia University, Minia, Egypt
| | - Heba Hassan Abd El Hamid Hassan
- Online Research Club (http://www.onlineresearchclub.org/.,Faculty of Pharmacy, Modern University for Technology and Information, Cairo, Egypt
| | | | - Truong Hong Hieu
- Online Research Club (http://www.onlineresearchclub.org/.,University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Thuan Minh Tieu
- Online Research Club (http://www.onlineresearchclub.org/.,McMaster University, Hamilton, Ontario, Canada
| | - Soon Khai Low
- Online Research Club (http://www.onlineresearchclub.org/.,School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Selangor, Malaysia
| | - Vincent Hou
- Online Research Club (http://www.onlineresearchclub.org/.,McMaster University, Hamilton, Ontario, Canada
| | - Mahmoud Dibas
- Online Research Club (http://www.onlineresearchclub.org/.,Sulaiman Al Rajhi Colleges, Al Bukayriya, Saudi Arabia
| | - Nguyen Tien Huy
- Evidence Based Medicine Research Group, Ton Duc Thang University, Ho Chi Minh City, 70000, Vietnam.,Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, 70000, Vietnam.,Department of Clinical Product Development, Institute of Tropical Medicine (NEKKEN), School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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13
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Dawson H, Kirsch R, Messenger D, Driman D. A Review of Current Challenges in Colorectal Cancer Reporting. Arch Pathol Lab Med 2019; 143:869-882. [DOI: 10.5858/arpa.2017-0475-ra] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Pathologic assessment of colorectal cancer resection specimens plays an important role in postsurgical management and prognostication in patients with colorectal cancer. Challenges exist in the evaluation and reporting of these specimens, either because of difficulties in applying existing guidelines or related to newer concepts.
Objective.—
To address challenging areas in colorectal cancer pathology and to provide an overview of the literature, current guidelines, and expert recommendations for the handling of colorectal cancer resection specimens in everyday practice.
Data Sources.—
PubMed (US National Library of Medicine, Bethesda, Maryland) literature review; reporting protocols of the College of American Pathologists, the Royal College of Pathologists of the United Kingdom, and the Japanese Society for Cancer of the Colon and Rectum; and classification manuals of the American Joint Committee on Cancer and the Union for International Cancer Control.
Conclusions.—
This review has addressed issues and challenges affecting quality of colorectal cancer pathology reporting. High-quality pathology reporting is essential for prognostication and management of patients with colorectal cancer.
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Affiliation(s)
- Heather Dawson
- From the Institute of Pathology, University of Bern, Bern, Switzerland (Dr Dawson); Pathology and Laboratory Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada (Drs Dawson and Kirsch); the Department of Colorectal Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom (Dr Messenger); and Pathology and Laboratory Medicine, Western Univer
| | - Richard Kirsch
- From the Institute of Pathology, University of Bern, Bern, Switzerland (Dr Dawson); Pathology and Laboratory Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada (Drs Dawson and Kirsch); the Department of Colorectal Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom (Dr Messenger); and Pathology and Laboratory Medicine, Western Univer
| | - David Messenger
- From the Institute of Pathology, University of Bern, Bern, Switzerland (Dr Dawson); Pathology and Laboratory Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada (Drs Dawson and Kirsch); the Department of Colorectal Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom (Dr Messenger); and Pathology and Laboratory Medicine, Western Univer
| | - David Driman
- From the Institute of Pathology, University of Bern, Bern, Switzerland (Dr Dawson); Pathology and Laboratory Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada (Drs Dawson and Kirsch); the Department of Colorectal Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom (Dr Messenger); and Pathology and Laboratory Medicine, Western Univer
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14
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Lin JY, Bai DS, Zhou BH, Chen P, Qian JJ, Jin SJ, Jiang GQ. Positive relationship between number of negative lymph nodes and duration of gallbladder cancer cause-specific survival after surgery. Cancer Manag Res 2018; 10:6961-6969. [PMID: 30588101 PMCID: PMC6300379 DOI: 10.2147/cmar.s187857] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Although the prognostic implications of negative lymph nodes (NLNs) has been reported for a variety of tumors, little information has been published about the NLNs in gallbladder cancer (GBC). Patients and methods In this study, clinicopathological characteristics and survival times of patients who had undergone surgery for GBC were collected from the Surveillance, Epidemiology, and End Results Program-registered TNM stage database and analyzed. Univariate and multivariate Cox proportional hazards models were used to identify the predictors of survival. Results It was found that a cutoff of one to two NLNs is optimal when assessing the association with survival, survival rates being consistently better with two or more NLNs than with fewer than two. This optimal cutoff value of 2 was identified as an independent prognostic factor by univariate and multivariate analyses (all P<0.001). Specifically, patients with two or more NLNs had better 5-year gallbladder cancer cause-specific survival than those with fewer than NLNs examined for stage I/II, stage III/IV, and all TNM stages (all P<0.001). Conclusion Our findings indicate that the number of NLNs is an independent prognostic factor after GBC surgery, and, together with the number of positive lymph nodes, this will provide better prognostic information than the number of positive lymph nodes alone.
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Affiliation(s)
- Jin-Yong Lin
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China, .,Department of Hepatobiliary Surgery, The Second Clinical College, Dalian Medical University, Dalian, China
| | - Dou-Sheng Bai
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China,
| | - Bao-Huan Zhou
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China, .,Department of Hepatobiliary Surgery, The Second Clinical College, Dalian Medical University, Dalian, China
| | - Ping Chen
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China,
| | - Jian-Jun Qian
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China,
| | - Sheng-Jie Jin
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China,
| | - Guo-Qing Jiang
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China,
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15
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Wei Z, Yu Z, Li H, Peng W, Zhang J, Zhang Y, Song W, Liu J, Yang W, Wang T. The appropriate number of negative lymph nodes dissection for nonmetastatic penile cancer. Andrologia 2018; 51:e13154. [PMID: 30255596 DOI: 10.1111/and.13154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/01/2018] [Accepted: 08/21/2018] [Indexed: 11/28/2022] Open
Abstract
Negative lymph nodes status has been attached more attention as a prognostic indicator for nonmetastatic penile cancer. We aimed to identify the appropriate number of negative lymph nodes dissection for nonmetastatic penile cancer using the Surveillance, Epidemiology and End Results database. A total of 1,470 nonmetastatic patients with penile squamous cell carcinoma were identified during 2004 and 2013. All patients were categorised according to different risk levels and lymphadenectomy. Univariate and multivariate Cox regression analyses were performed to evaluate the relationship between prognostic risk factors and cancer-specific survival. The optimal cut-off value of negative lymph nodes dissection was determined using the X-Tile program. A total of 1,470 patients were categorised into low- (pT1G1), intermediate- (pT1G2) or high-risk (pT1G3 and all higher stages) groups. In multivariate Cox analysis, lymphadenectomy improved the cancer-specific survival for patients in high-risk group (p = 0.014). Further, the optimal cut-off value of negative lymph nodes dissection for high-risk patients was 5 and patients with >5 negative lymph nodes had a higher cancer-specific survival (χ2 = 9.3676, p < 0.05). Therefore, lymphadenectomy improved survival for high-risk penile cancer and the removal of more than five negative lymph nodes was correlated with higher cancer-specific survival for high-risk patients who underwent lymphadenectomy.
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Affiliation(s)
- Zhewen Wei
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhe Yu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Peng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junfeng Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen Song
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weimin Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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16
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Shen F, Cui J, Cai K, Pan H, Bu H, Yu F. Prognostic accuracy of different lymph node staging systems in rectal adenocarcinoma with or without preoperative radiation therapy. Jpn J Clin Oncol 2018; 48:625-632. [PMID: 29788392 DOI: 10.1093/jjco/hyy070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 05/04/2018] [Indexed: 12/23/2022] Open
Abstract
Background and objective A variety of different lymph node (LN) staging systems have been developed to describe the lymph node status accurately. We aim to compare the prognostic accuracy of American Joint Committee on Cancer seventh N stage relative to negative number of lymph node (nLN), lymph node ratio (LNR) and log odds of metastatic lymph nodes (LODDS) in rectal adenocarcinoma (RC). Methods A total of 19 167 Stage II-III rectal cancer patients who underwent surgical resection of rectal adenocarcinoma were identified from Surveillance, Epidemiology and End Results database. Akaike's Information Criterion (AIC) and the Harrell's concordance index (c statistic) were used to evaluate the relative discriminative power of the different LN staging systems. Results Of the 19 167 patients, 10 958 received preoperative radiotherapy (pre-RT cohort) and 8209 patients were treated with surgical resection directly (SURG cohort). When assessed using categorical cutoff values, LNR has a somewhat better prognostic accuracy both in pre-RT (c-index: 0.62; AIC: 2988.6) and SURG groups (c-index: 0.60; AIC: 3359.8). Further analysis based on different total number of lymph node (TNLN) suggested that when less than 10 lymph nodes were retrieved, LNR exhibited significant superiority (pre-RT: c-index: 0.597, AIC: 1006.8; SURG: c-index: 0.560, AIC: 810.5). When analyzed as a continuous variable, the LODDS system performed the best and was not impacted by TNLN. Conclusion When assessed as a categorical variable, LNR was the most powerful method to predict survival for Stage II-III RC patients with limited TNLN. Rather, LODDS was the most accurate staging system regardless of the TNLN when LN status was modeled as continuous variable.
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Affiliation(s)
- Feng Shen
- Department of Colorectal Surgery, Tongde Hospital of Zhejiang Province, Hangzhou Zhejiang, China
| | - Junhui Cui
- Department of Colorectal Surgery, Tongde Hospital of Zhejiang Province, Hangzhou Zhejiang, China
| | - Ke Cai
- Department of Colorectal Surgery, Tongde Hospital of Zhejiang Province, Hangzhou Zhejiang, China
| | - Haiqiang Pan
- Department of Colorectal Surgery, Tongde Hospital of Zhejiang Province, Hangzhou Zhejiang, China
| | - Heqi Bu
- Department of Colorectal Surgery, Tongde Hospital of Zhejiang Province, Hangzhou Zhejiang, China
| | - Feng Yu
- Department of Colorectal Surgery, Tongde Hospital of Zhejiang Province, Hangzhou Zhejiang, China
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17
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He WZ, Xie QK, Hu WM, Kong PF, Yang L, Yang YZ, Jiang C, Yin CX, Qiu HJ, Zhang HZ, Zhang B, Xia LP. An increased number of negative lymph nodes is associated with a higher immune response and longer survival in colon cancer patients. Cancer Manag Res 2018; 10:1597-1604. [PMID: 29950897 PMCID: PMC6014727 DOI: 10.2147/cmar.s160100] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background The purpose of the present study was to examine the relationship among the number of negative lymph nodes (LNs), the local and systemic immune response, and survival in patients with colon cancer. Patients and methods One thousand one hundred and fifty-seven patients with colon cancer who underwent surgery at Sun Yat-sen University Cancer Center between 2009 and 2014 were included. We examined negative LNs in relation to the local and systemic immune response, including percentage carcinoma, neutrophil and lymphocyte infiltration, Crohn's-like reaction, neutrophil to lymphocyte ratio, platelets, and C-reactive protein (CRP). Disease-free survival and overall survival were also examined. We performed subgroup analysis based on the distribution of negative LNs. Results An increased number of negative LNs was associated with greater neutrophil invasion (p=0.001), more lymphocyte invasion (p=0.001), and more Crohn's-like reaction (p=0.001). No significant correlation was observed between negative LNs and the neutrophil to lymphocyte ratio. More than 12 negative LNs were associated with increased platelets and CRP levels. A higher number of negative LNs was independently associated with longer disease-free survival in stage I+II patients (p=0.004) and stage III patients (p=0.015), while negative LNs were also independent prognostic factors in stage IV patients (p=0.007). Conclusion Our study suggests that negative LNs are indicators of the immune response and are associated with a better prognosis in patients with colon cancer.
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Affiliation(s)
- Wen-Zhuo He
- VIP Region, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Qian-Kun Xie
- VIP Region, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Wan-Ming Hu
- Department of Pathology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China.,Department of Pathology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, People's Republic of China.,Department of Pathology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Peng-Fei Kong
- VIP Region, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Lin Yang
- VIP Region, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Yuan-Zhong Yang
- Department of Pathology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Chang Jiang
- VIP Region, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Chen-Xi Yin
- VIP Region, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Hui-Juan Qiu
- VIP Region, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Hui-Zhong Zhang
- Department of Pathology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Bei Zhang
- VIP Region, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Liang-Ping Xia
- VIP Region, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China
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18
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What Is the Minimum Number of Examined Lymph Nodes After Neoadjuvant Therapy in Rectal Cancer? J Gastrointest Surg 2018; 22:1068-1076. [PMID: 29468556 DOI: 10.1007/s11605-018-3717-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 02/08/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND To date, no guidelines have standardized the number of examined lymph nodes (eLNs) after neoadjuvant treatment. This study investigated the minimum number of eLNs required for patients with rectal cancer (RC) who received neoadjuvant treatment. MATERIAL AND METHODS This study was based on data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database. We included 2173 patients with RC who received neoadjuvant therapy. Restricted cubic spline was used to analyze the association between eLNs and lymph node metastasis (LNM). RESULTS The number of eLNs was an independent predictive factor for the presence of LNM (odds ratio 1.033; 95% confidence interval 1.020-1.046; P < 0.001). When the number of eLN ≤ 16, 10 and 11 eLNs had the highest rates of positive LNM. Analysis of the restricted cubic spline method found that when number of eLNs was < 10, the LNM rate increased rapidly, but this increase was not so obviously when there were > 10 eLNs. CONCLUSIONS Among RC patients who receive neoadjuvant therapy, the minimum number of eLNs may be 10 to ensure pathological quality.
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19
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You L, Guo X, Huang Y. Correlation of Cancer Stem-Cell Markers OCT4, SOX2, and NANOG with Clinicopathological Features and Prognosis in Operative Patients with Rectal Cancer. Yonsei Med J 2018; 59:35-42. [PMID: 29214774 PMCID: PMC5725361 DOI: 10.3349/ymj.2018.59.1.35] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/08/2017] [Accepted: 10/03/2017] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To investigate the association of cancer stem-cell markers [octamer-binding transcription factor 4 (OCT4), sex determining region Y-box 2 (SOX2), and Nanog homebox (NANOG)] expression with clinicopathological properties and overall survival (OS) in operative rectal cancer (RC) patients receiving adjuvant therapy. MATERIALS AND METHODS 153 patients with primary RC receiving surgery were enrolled. Tumor tissue and paired adjacent normal tissue sample were collected, and OCT4, SOX2, and NANOG expressions were assessed by immunofluorescent staining. The median follow-up duration was 5.2 years, and the last follow-up date was August 2016. RESULTS Tumor tissue OCT4 (p<0.001), SOX2 (p=0.003), and NANOG (p<0.001) expressions were higher than those in adjacent tissue. OCT4 expression was positively correlated with pathological grade (R=0.185, p=0.022), tumor size (R=0.224, p=0.005), and N stage (R=0.170, p=0.036). NANOG expression was positively associated with tumor size (R=0.169, p=0.036). Kaplan-Meier suggested that OCT4⁺ was associated with worse OS compared with OCT4? (p<0.001), while no association of SOX2 (p=0.121) and NANOG expressions (p=0.195) with OS was uncovered. Compared with one or no positive marker, at least two positive markers were associated with shorter OS (p<0.001), while all three positive markers were correlated with worse OS compared with two or less positive markers (p<0.001). Multivariate Cox's analysis revealed that OCT4⁺ (p<0.001) and N stage (p=0.046) were independent factors for shorter OS. CONCLUSION Tumor tissue OCT4 expression was correlated with poor differentiation, tumor size, and N stage, and it can serve as an independent prognostic biomarker in operative patients with RC receiving adjuvant therapy.
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Affiliation(s)
- Liuping You
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xin Guo
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yuenan Huang
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
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Lu H, Guo R, Yang H, Wang H, Liang X, Hu Z, Li X. The prognostic value of negative lymph node count for patients with cervical cancer after radical surgery. Oncotarget 2017; 9:2810-2818. [PMID: 29416813 PMCID: PMC5788681 DOI: 10.18632/oncotarget.23596] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 12/15/2017] [Indexed: 12/13/2022] Open
Abstract
Negative lymph node (NLN) count has been recognized as a prognostic indicator in various cancers. However, the relationship between NLN count and the prognosis of cervical cancer is still unknown. In this study, 10, 500 cervical cancer patients after radical surgery were selected from Epidemiology and End Results Program (SEER) data. Clinicopathological characteristics were collected for analysis, including year of diagnosis, age, race, grade, primary site, FIGO stage and cause specific survival (CSS). Univariate and multivariate Cox proportional hazards model was used to assess risk factors for survival of patients. X-tile plots identified 6 as the optimal cutoff value of NLN count to divide patients into high and low risk subsets in terms of CSS (χ2 = 183.95, P < 0.001). The rate of 5-year CCS of cervical cancer patients was improved with an increase in NLN count from 0 to 23 (all P < 0.001). NLN count was validated as an independently prognostic factor by the multivariate Cox analysis (HR: 1.571, 95% CI: 1.370~1.801, P < 0.001). Subgroup analysis showed that NLN count was a prognosis factor in FIGO stage I (χ2=35.023, P < 0.001), stage II (χ2 = 12.910, P < 0.001), stage III + IV (χ2 = 9.732, P = 0.002) and unknown stage (χ2 = 16.654, P < 0.001). Conclusively, this study demonstrated the NLN count was an independent prognostic factor for cervical cancer patients.
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Affiliation(s)
- Hao Lu
- Department of General Surgery, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Rong Guo
- The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Haotian Yang
- Therapeutics Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Woolloongabba, QLD, Australia.,School of Biomedical Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Haolu Wang
- Therapeutics Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Woolloongabba, QLD, Australia
| | - Xiaowen Liang
- Therapeutics Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Woolloongabba, QLD, Australia
| | - Zhiqian Hu
- Department of General Surgery, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Xinxing Li
- Department of General Surgery, Changzheng Hospital, The Second Military Medical University, Shanghai, China
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Lee SY, Kim CH, Kim YJ, Kim HR. Prognostic significance of the distribution of lymph node metastasis in rectal cancer after neoadjuvant chemoradiation. J Surg Oncol 2017; 117:514-522. [DOI: 10.1002/jso.24871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 09/09/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Soo Young Lee
- Department of Surgery; Chonnam National University Hwasun Hospital and Medical School; Hwasun Korea
| | - Chang Hyun Kim
- Department of Surgery; Chonnam National University Hwasun Hospital and Medical School; Hwasun Korea
| | - Young Jin Kim
- Department of Surgery; Chonnam National University Hwasun Hospital and Medical School; Hwasun Korea
| | - Hyeong Rok Kim
- Department of Surgery; Chonnam National University Hwasun Hospital and Medical School; Hwasun Korea
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Zhao Q, Chen S, Feng JF. A novel inflammation-based prognostic index for patients with esophageal squamous cell carcinoma: neutrophil lymphocyte ratio/albumin ratio. Oncotarget 2017; 8:103535-103542. [PMID: 29262582 PMCID: PMC5732748 DOI: 10.18632/oncotarget.21989] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 09/23/2017] [Indexed: 12/15/2022] Open
Abstract
Background We initially proposed a novel inflammation-based prognostic index, named neutrophil lymphocyte ratio/albumin ratio (NLR/Alb), for predicting the postoperative survival in esophageal squamous cell carcinoma (ESCC). Materials and methods A retrospective study of 329 cases with resectable ESCC was included. The optimal cut-off values were evaluated by X-tile program. The 5-year cancer-specific survival (CSS) was calculated by Kaplan–Meier method. Cox regression analyses were performed to evaluate the prognostic factors. Results The optimal cut-off value was 0.1 for NLR/Alb according to the X-tile program. There was a significantly better 5-year CSS in patients with NLR/Alb ≤ 0.1 than patients with NLR/Alb > 0.1 (39.1% vs. 11.0%, P < 0.001). According to multivariate analyses, NLR/Alb (P = 0.001) was an independent prognostic factor. Conclusions The NLR/Alb is a novel and usefull predictive factor in patients with ESCC.
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Affiliation(s)
- Qiang Zhao
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou, P.R.China.,Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology, Hangzhou, P.R. China
| | - Sheng Chen
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou, P.R.China.,Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology, Hangzhou, P.R. China
| | - Ji-Feng Feng
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou, P.R.China.,Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology, Hangzhou, P.R. China
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