Prognostic value of lymphovascular invasion in patients with esophageal squamous cell carcinoma
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Abstract:
Whether lymphovascular invasion (LVI) in esophageal squamous cell carcinoma (ESCC) should be considered an independent prognostic factor for survival is controversial. The aim of this report was to investigate the prognostic value of LVI for patients with ESCC.Between October 2010 and July 2011, 152 ESCC patients were retrospectively reviewed. All of the patients underwent curative resection as their primary treatment. Clinicopathological features and overall survival (OS) rate were investigated. Kaplan-Meier curves were used to calculate the OS rate, and the prognostic factors were identified by Cox regression model.Positive LVI was found in 49 (32.2%) patients. Patients with negative LVI had a significantly better 5-year OS rate than those with positive LVI (52.9% vs. 28.8%; P=0.000). The age, T stage, N stage, tumor differentiation, and LVI were demonstrated to be significant prognostic factors for OS through univariate analyses. LVI was confirmed as an independent prognostic factor for OS through multivariate survival analyses. Subgroup analyses revealed that LVI was associated with a decreased OS in node-negative patients, and no significant difference was observed in node-positive cases.Our study highlighted that LVI is an independent prognostic factor in patients with resectable ESCC. LVI may facilitate the stratification of patients with poor survival.Keywords:
Lymphovascular invasion
Univariate analysis
T-stage
Objective
To analyze the correlation of clinicopathological characteristics and maximum standardized uptake value (SUVmax) detected by 18F-FDG PET-CT in non-small cell lung cancer (NSCLC).
Methods
105 patients with NSCLC who underwent 18F-FDG PET-CT scan before surgical resection were reviewed retrospectively. Clinicopathological factors which might affect SUVmax were evaluated, including sex, age, smoking history, CEA level, tumor site, histological type, TNM stage, T factor, N factor, tumor size, lymphovascular invasion and pleural invasion features. Independent factors were identified by multiple regression analysis. The diagnostic efficiency and best cut-off point of SUVmax were calculated by the receiver operating characteristic curve.
Results
It was identified by the univariate analysis that the CEA level (P=0.002), tumor size (P<0.001), histological type (P<0.001), TNM stage (P<0.001), T factor (P<0.001), N factor (P<0.001), and lymphovascular invasion (P=0.001) were factors affecting SUVmax. While histological type (P=0.004), tumor size (P=0.036), N factor (P=0.043) were found to be significant independent factors according to multivariate regression analysis. The SUVmax of primary tumor was a predictor for lymphatic metastasis with the highest diagnostic accuracy at a cut-off value of 6.75, the sensitivity and specificity were 72.2 % and 81.6 %, respectively.
Conclusions
The SUVmax is correlated with histological type, tumor diameter, nodal status in NSCLC, and is higher in patients with non-adenocarcinoma, lager tumor and lymphatic metastasis. Furthermore, the probability of lymphatic metastasis could be predicted by SUVmax of the primary tumor.
Key words:
Carcinoma, non-small-cell lung; PET-CT; Deoxyglucose; Standardized uptake value; Pathology
Lymphovascular invasion
Univariate analysis
Standardized uptake value
T-stage
Primary tumor
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What's known on the subject? and What does the study add? In an array of urological and non-urological malignancies, lymphovascular invasion (LVI) is a pathological feature known to be associated with adverse outcomes for recurrence and survival. For some cancers, LVI has therefore been incorporated into American Joint Committee on Cancer TNM staging algorithms. This study presents an analysis of the impact of LVI in upper urinary tract urothelial carcinoma (UTUC) treated at our institution over a 20-year period. In addition to known associations with features of aggressive disease and overall survival, we were able to show that LVI-positive status upsets the TNM staging for UTUC. Namely, patients with superficial stage and LVI-positive disease have overall survival outcomes similar to those of patients with muscle-invasive LVI-negative carcinoma. Such evidence may support the addition of LVI to future TNM staging algorithms for UTUC.To assess the impact of lymphovascular invasion (LVI) on the prognosis of patients with upper urinary tract urothelial cell carcinoma (UTUC) treated with radical nephroureterectomy (RNU).The Columbia University Medical Center Urologic Oncology database was queried and 211 patients undergoing RNU for UTUC between 1990 and 2010 were identified. These cases were retrospectively reviewed, and the prognostic significance of relevant clinical and pathological variables was analysed using log-rank tests and Cox proportional hazards regression models. Actuarial survival curves were calculated using the Kaplan-Meier method.LVI was observed in 68 patients (32.2%). The proportion of LVI increased with advancing stage, high grade, positive margin status, concomitant carcinoma in situ, and lymph node metastases. The 5- and 10-year overall survival rates were 74.7% and 53.1% in the absence of LVI, and 35.7% and 28.6% in the presence of LVI, respectively. In multivariate analysis, age, race and LVI were independent predictors of overall survival.The presence of LVI on pathological review of RNU specimens was associated with worse overall survival in patients with UTUC. LVI status should be included in the pathological report for RNU specimens to help guide postoperative therapeutic options. With confirmation from large international studies, inclusion of LVI in the tumour-node-metastasis staging system for UTUC should be considered.
Lymphovascular invasion
Upper urinary tract
T-stage
Surgical margin
Ureteral neoplasm
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In patients with stage II colorectal cancer (CRC) the number of surgically retrieved lymph nodes (LNs) is associated with prognosis, resulting in a minimum of 10-12 retrieved LNs being recommended for this stage. Current guidelines do not provide a recommendation regarding LN yield in T1 CRC. Studies evaluating LN yield in T1 CRC suggest that such high LN yields are not feasible in this early stage, and a lower LN yield might be appropriate. We aimed to validate the cut-off of 10 retrieved LNs on risk for recurrent cancer and detection of LN metastasis (LNM) in T1 CRC, and explored whether this number is feasible in clinical practice.Patients diagnosed with T1 CRC and treated with surgical resection between 2000 and 2014 in thirteen participating hospitals were selected from the Netherlands Cancer Registry. Medical records were reviewed to collect additional information. The association between LN yield and recurrence and LNM respectively were analyzed using 10 LNs as cut-off. Propensity score analysis using inverse probability weighting (IPW) was performed to adjust for clinical and histological confounding factors (i.e., age, sex, tumor location, size and morphology, presence of LNM, lymphovascular invasion, depth of submucosal invasion, and grade of differentiation).In total, 1017 patients with a median follow-up time of 49.0 months (IQR 19.6-81.5) were included. Four-hundred five patients (39.8%) had a LN yield ≥ 10. Forty-one patients (4.0%) developed recurrence. LN yield ≥ 10 was independently associated with a decreased risk for recurrence (IPW-adjusted HR 0.20; 95% CI 0.06-0.67; P = 0.009). LNM were detected in 84 patients (8.3%). LN yield ≥ 10 was independently associated with increased detection of LNM (IPW-adjusted OR 2.27; 95% CI 1.39-3.69; P = 0.001).In this retrospective observational study, retrieving < 10 LNs was associated with an increased risk of CRC recurrence, advocating the importance to perform an appropriate oncologic resection of the draining LNs and diligent LN search when patients with T1 CRC at high-risk for LNM are referred for surgical resection. Given that both gastroenterologists, surgeons and pathologists will encounter T1 CRCs with increasing frequency due to the introduction of national screening programs, awareness on the consequences of an inadequate LN retrieval is of utmost importance.
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T-stage
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The aim of this study was to evaluate the local recurrence and distant metastasis rates for urothelial carcinoma of the bladder after radical cystectomy and to identify the predictive factors for local recurrence and distant metastasis. The study population was 347 consecutive patients treated with radical cystectomy for urothelial carcinoma of the bladder at our institution. Local recurrence, distant metastasis, and both local and distant recurrence rates were 49 (14.1%) months, 96 (27.7%) months, and 17 (4.9%) months, respectively. The mean follow-up times to recurrence were 14.37 ± 13.25 months (range, 2-60 months) and 14.43 ± 15.72 months (range, 2-109 months) for local recurrence and distant metastasis, respectively (p = 0.808). The mean post-recurrence disease-specific survival (PRDSS) times for local, distant, and both local and distant recurrences were 17.82 ± 3.18 months, 4.16 ± 0.39 months, and 11.41 ± 2.73 months, respectively (p < 0.001). The predictive factors for local recurrence and distant metastasis were stage and nodal involvement (p < 0.001). Sex, grade, lymphovascular invasion (LVI), carcinoma in situ (CIS), and lymph node density (LND; 10% cut-off value) were not predictors for recurrence in the results of the multivariate analysis. The current study demonstrated that stage and pathological nodal involvement were independent predictors of local recurrence and distant metastasis. The results of this study suggest that the early diagnosis and intervention of invasive bladder cancer cases may decrease the number of high stage and lymph node positive cases that have a high risk of local and distant recurrences. The adjuvant treatment options in the presence of risk factors for recurrence may improve survival outcomes.
Lymphovascular invasion
Distant metastasis
T-stage
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Lymphovascular invasion
T-stage
Neoadjuvant Therapy
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A study of the main prognostic factors and of the overall survival rate of gastric cancer (GC) is presented. It covered 895 cases diagnosed histopathologically in the province of Zaragoza (Spain) over a ten-year period (1980-1989). The analysis of the survival rate was carried out according to the Kaplan-Meier method and the Mantel-Haenszel test. The average overall survival rate of the sample was 6.5 months and the five-year survival rate was 16.5%. Lauren's intestinal histological type is associated with a better prognosis (a five-year survival rate of 25%) than the diffuse type (15%). The survival rate with regard to gastric wall invasion ranges from 78% for T1 tumors to 8% for T4 tumors (p < 0.0001). There are significant differences in survival rate between the TNM classification stages, ranging from a five-year survival rate of 77% for Stage I to 0% for Stage IV.
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Lymphovascular invasion
Univariate analysis
T-stage
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Lymphovascular invasion
Upper urinary tract
T-stage
Ureteral neoplasm
Nephrology
Surgical margin
Urothelial cancer
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Lymphovascular invasion
T-stage
Univariate analysis
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