Survival outcomes in elderly Taiwanese women according to breast cancer subtype and lymph node status: A single-center retrospective study.
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ABSTRACT:
SUBMITTER: Lin KH
PROVIDER: S-EPMC8717987 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:This study aimed to evaluate the prognosis of breast cancer patients who received neoadjuvant chemotherapy and underwent sentinel lymph node biopsy (SLNB) alone as axillary surgery regardless of their clinical and pathological lymph node status. We reviewed the records of 1,795 patients from Asan Medical Center who were diagnosed with stage I-III breast cancer and received neoadjuvant chemotherapy during 2003-2014. We selected 760 patients who underwent SLNB alone as axillary surgery and divided these patients into four groups according to their clinical lymph node (cN) and pathological lymph node (pN) status: cN(-)pN(-) (n = 377), cN(-)pN(+) (n = 33), cN(+)pN(-) (n = 242), and cN(+)pN(+) (n = 108). We then compared axillary lymph node recurrence, locoregional recurrence (LRR), distant metastasis-free survival (DMFS), and overall survival (OS) among the four groups using Kaplan-Meier analysis. We compared prognosis between the cN(-)pN(-) and cN(+)pN(-) groups to determine whether SLNB alone is an adequate treatment modality even in patients with cN positive pathology before neoadjuvant therapy but SLNB-negative pathology after NAC. The 5-year axillary recurrence rates in the cN(-)pN(-) and cN(+)pN(-) groups were 1.4% and 2.9%, respectively, and there was no significant difference between the two groups (p = 0.152). The axillary recurrence and LRR rates were significantly different among the four groups, with the pN-negative groups (cN[-]pN[-], cN[+]pN[-]) showing lower recurrence rates. DMFS and OS were also significantly different among the four groups, with the cN negative groups (cN[-]pN[-], cN[-]pN[+]) showing improved survival rates. Our study findings suggest that SLNB alone was associated with lower LRR rates even in patients with cN positive pathology before neoadjuvant therapy but cN negative pathology after SLNB. Moreover, recurrence and survival rates differ significantly according to clinical and pathological lymph node status.
| S-EPMC8130919 | biostudies-literature
Project description:BackgroundLymph node metastasis (LNM) is associated with poor prognosis in patients with duodenal cancer (DC). However, the efficacy and optimal extent of lymph node (LN) dissection have not been thoroughly discussed.MethodsA total of 98 consecutive patients with DC who underwent surgical resection (pancreatoduodenectomy, n = 55; partial resection, n = 32; pancreas-sparing total duodenectomy, n = 9) were retrospectively analyzed. The LN stations located upstream of the lymphatic flow were defined as Np stations according to tumor location, whereas the others were defined as Nd stations. The association between the dissection of each LN station and survival outcome was investigated using the efficacy index (EI; percentage of metastases to lymph nodes in each station multiplied by the 5-year survival rate of metastatic cases).ResultsThe survival of patients with LNM at the Nd stations (n = 6) was significantly worse than that of patients with LNM only at the Np stations (n = 20) (relapse-free survival, median survival time [MST], 6.0 vs. 48.4 months, p < 0.001; overall survival, MST, 15.1 vs. 96.0 months, p < 0.001). Multivariate analysis identified LNM at Nd stations as an independent prognostic factor for overall survival (hazard ratio 9.92; p = 0.015). The Np stations had a high EI (range, 8.34-20.88), whereas the Nd stations had an EI of 0, regardless of the tumor location.ConclusionsLN dissection of the Np stations contributed to acceptable survival, whereas LNM of the Nd stations led to poor survival, possibly reflecting advanced tumor progression to systemic disease in patients with DC.
| S-EPMC10797846 | biostudies-literature
Project description:Objective: This study aimed to investigate the effect of lymph node status on survival in large colon cancer. Methods: In the first cohort, patients diagnosed with non-metastatic colon cancer (N = 176,834) were identified from the Surveillance, Epidemiology, and End Results (SEER) database between January 1988 and December 2005. Further analyses were conducted in the other cohort (N = 855) from the Fudan University Shanghai Cancer Center (FUSCC) database. Results: In the SEER cohort, CSS differences increased as the tumor enlarged until a threshold tumor size group (tumor measuring 7-8 cm, P < 0.001) was reached, in which node positivity showed the maximum negative effect on CSS; multivariate Cox analyses showed that tumors measuring 7-8 cm presented a significant lower risk of cancer-specific mortality compared with those measuring 2-4 cm [hazard ratio (HR) = 1.087; 95% confidence interval (CI) = 1.014-1.165, P = 0.018]. In the FUSCC cohort, N0 tumors measuring 21-40 mm presented a higher risk of recurrence compared with those measuring 41-80 mm. Conclusions: Mortality risk of node positivity increased as tumor enlarged until a threshold tumor size (tumor size of 7-8 cm) was reached, mainly resulting from larger tumors without lymph node involvement being a surrogate for biologically indolent colon cancer of tumor recurrence. Our study could provide both researchers and clinicians a better understanding of colon cancer biology.
| S-EPMC6298250 | biostudies-literature
Project description:Objective Our objective was to explore the impact of tumor sites on lymph node (LN) status and prognosis in non-distant metastasis colon cancer after radical operation. Methods Surveillance, epidemiology, and end results (SEER) database was used to identify 124, 836 early-stage colon cancer patients between 1988 and 2010, treated with radical surgery with a known tumor site. Seven tumor sites were defined as ascending, hepatic, cecum, transverse, descending, splenic, and sigmoid colons by the anatomical location. The associations of tumor site and LN status, including adequate (≥12) LN harvest and LN positivity, were examined with logistic regression, adjusting for multiple covariates. Relative survival was compared in a flexible parametric model. Results The quartile number of LN examined gradually decreased from ascending to sigmoid colon cancer (P<0.001 for all patients, and T2, T3 and T4 stages). More numbers of LN examined and a higher proportion of LN positivity were retrieved in left-half colon cancer than in right-half colon cancer. Cumulative incidence of death (CID) was higher in patients with less LN examined except for the group of cecum colon cancer, but there was no significant difference between all groups (5-year CID: 18.99%~21.98% for LN count ≥ 12 and 23.01%~26.89% for LN count <12). Conclusions LN examined and LN positivity in colon cancer were important prognostic factors. There was no significant CDI difference between groups with different tumor sites. Current guidelines for extent of resection should take this into consideration so that and unnecessary treatment may be avoided.
| S-EPMC6584349 | biostudies-literature
Project description:BackgroundThe effectiveness of prophylactic lateral lymph node dissection (LLND) in treating patients with lower rectal cancer remains controversial and has not been clearly established. Therefore, we aimed to retrospectively analyze the survival impact of prophylactic LLND in patients with lower rectal cancer.MethodsData of 301 patients with lower rectal cancer (tumor's lower edge on the anal side of the peritoneal reflexion) with clinical T3 disease and negative preoperative lateral lymph node metastasis, who underwent radical resection (R0) at our hospital between April 2007 and March 2017, were included in this study. Patients who received preoperative chemotherapy or radiotherapy were excluded. The relapse-free survival (RFS) and overall survival (OS) rates were compared between the dissection (prophylactic LLND, n = 37) and non-dissection (no prophylactic LLND, n = 264) groups.ResultsSignificantly fewer men and younger patients were noted in the dissection group than in the non-dissection group. Post-surgery 3- and 5-year RFS rates were 69.6% and 66.8% in the dissection group and 75.1% and 72.5% in the non-dissection group, respectively (5-year post-surgery RFS, p = 0.58). In the dissection and non-dissection groups, the 5-year OS rates were 86.5% and 79.7%, respectively (p = 0.29), and the 5-year cancer-specific survival rates were 88.9% and 86.0%, respectively (p = 0.29), with no significant differences. Lateral lymph node recurrence was observed in one (2.7%) and 10 patients (3.8%) in the dissection and non-dissection groups, respectively, and there was no significant difference between the groups.ConclusionsIn this study, the effectiveness of prophylactic LLND was limited in patients with > T3 lower rectal cancer with no evidence of preoperative lymph node metastasis. Prophylactic LLND may not be necessary if there is no preoperative lymph node metastasis, even if the invasion depth is T3 or higher.
| S-EPMC8157696 | biostudies-literature
Project description:BackgroundLymph node involvement is recognized as a prognostic factor for patients with gallbladder cancer. However, the N stage varied from different editions of the American Joint Committee on Cancer (AJCC) TNM Classification. Our objective was to investigate the impact of lymph node involvement on overall survival in elderly patients with non-metastatic gallbladder adenocarcinoma.MethodsPatients older than 65 years with non-metastatic gallbladder adenocarcinoma were identified from the SEER data. We used Cox proportional hazard regression analysis to select the independent risk factor. A nomogram was built to identify the 1-, 3-, and 5-years' prognostic impact. Univariate and multivariate models were used to examine the correlation of overall survival (OS) with the number of metastatic nodes.ResultsA total of 1,654 patients (706 with and 948 without nodal involvement) were included. Cox proportional hazard regression analyses found that age, gender, tumor size, lymph node involvement, and surgical options were risk factors for the prognosis and were integrated into the nomogram. After adjustment, OS was compromised for patients who receive surgery with nodal involvement [hazard ratio (HR), 2.238; P < 0.01]. Furthermore, after adjustment the presence of more than two metastatic lymph nodes was associated with decreased OS (HR, 3.305; P < 0.01).ConclusionsOur results suggest that lymph node involvement is associated with compromised survival in elderly patients. A nomogram was developed to predict the prognosis of gallbladder cancer. A change point of more than two metastatic lymph nodes seems to carry prognostic significance, calling for closer monitoring of elderly patients with gallbladder cancer with involvement of increased number of lymph nodes.
| S-EPMC11300228 | biostudies-literature
Project description:MethodsA total of 100 cervical cancer patients undergoing laparoscopic surgery with SLN biopsy were included. Indocyanine green, carbon nanoparticles (CNPs), and a combination of both were used during surgeries. Detection rates, sensitivity, negative predictive value (NPV) of SLN biopsy, and related factors were analyzed.ResultsThe overall and bilateral SLN detection rates were 92% (92/100) and 74% (74/100), respectively. Combined tracers had higher bilateral SLN detection rates than CNPs alone (p=0.005). Menopause and lymph node metastasis were associated with lower overall and bilateral SLN detection rates (p < 0.05). SLN biopsy sensitivity and NPV for lymph node metastasis in patients with at least one detected SLN were 81.8% (9/11) and 97.3% (72/74), respectively. Among those with bilateral detected SLNs, higher sensitivity and NPV of 87.5% (7/8) and 98.3% (57/58) were observed, respectively. SLN algorithm can ensure that all patients with lymph node metastasis are detected by SLN biopsy.ConclusionSLN biopsy appears to be safe and effective for specific cervical cancer patients with high detection rates and NPV in laparoscopic surgery, especially for those with detected bilateral SLNs and undergoing the SLN algorithm. Selecting suitable patients for SLN mapping has prospects for clinical application.
| S-EPMC8064774 | biostudies-literature
Project description:BackgroundThis study identified predictors of favorable overall survival (OS) for stage III colon cancer patients who had only one lymph node (LN) metastasis (N1a).MethodsVariables, including preoperative carcinoembryonic antigen (CEA) level, LN sampling status, and the choices of postoperative adjuvant chemotherapy, were recorded. Prognostic significance was determined using the log-rank test and multivariate Cox regression analysis.ResultsThe median 42-month follow-up period included 363 eligible patients. Among them, 230 (63.3%) received only 5-flurouracil (5-FU) adjuvant chemotherapy; 76 (20.9%) underwent oxaliplatin-based regimens; and 57 (15.7%) chose surgery alone. The 5-year survival rate of these evaluated patients was 75%, 63%, and 77%, respectively (P = 0.823). Multivariate analysis revealed that normal preoperative CEA level (≦5 ng/mL) and adequate LN sampling (LN ≧ 12) were significant predictors for higher 5-year OS (P < 0.001; P = 0.007, respectively). However, the use of postoperative adjuvant chemotherapy in these N1a colon cancer patients did not significantly affect their 5-year OS.ConclusionsA preoperative CEA level of less than or equal to 5 ng/mL, and curative surgery with an adequate lymphadenectomy determined a favorable OS outcome in stage III colon cancer with only one LN metastasis.
| S-EPMC4575069 | biostudies-literature
Project description:BackgroundSome studies have shown that prophylactic lateral neck dissection (pLND) may be beneficial for patients with papillary thyroid carcinoma (PTC); however, none of the Western guidelines currently recommends this procedure. Since 2007, the decision to perform pLND at our institution has been made on a case-by-case basis with different risk factors in mind. In this study, we investigated the significance and indications of pLND in patients with PTC.MethodsWe identified patients at stage N0 or N1a and M0 with PTC who underwent surgery from 2007 to 2017. We compared lateral compartment recurrence-free survival (RFS) and distant RFS between patients who did and did not undergo pLND (pLND and non-pLND groups).ResultspLND was performed in 494/3177 (15.5%) patients with PTC (tumor size [T] ≥2 cm, cN0 or N1a, M0). Overall, no significant difference in lateral compartment RFS was detected between the pLND and non-pLND groups. On multivariate analysis, T ≥ 3 cm and positive extrathyroidal extension were independent predictors for recurrence to the lateral compartment. In the subset analysis of T ≥ 3 cm with positive extrathyroidal extension (n = 127), the lateral compartment RFS rate of the pLND group was significantly better (p < 0.01) than that of the non-pLND group (p < 0.01). In this subset, pLND reduced recurrence to the lateral compartment by 20.7% during the 5-year follow-up. However, pLND did not improve distant RFS.ConclusionspLND significantly improved lateral node RFS in patients having PTC ≥3 cm with significant extrathyroidal extension. For such patients, pLND at initial surgery may be considered to avoid second surgery.
| S-EPMC7406979 | biostudies-literature
Project description:BACKGROUND:To study metastasis to the infra-pyloric (no. 6) lymph nodes and their subgroups and the related risk factors of gastric cancer patients. METHODS:Gastric cancer patients who underwent gastrectomy with complete postoperative pathological information on the no. 6 lymph node station and its subgroups from January 1, 2008, to December 31, 2011, were included. The clinicopathological characteristics and survival outcomes were analyzed. RESULTS:A total of 121 patients were included; they had 6.1?±?7.7 positive lymph nodes, and 35.1?±?14.2 lymph nodes were examined. The overall lymph node positivity rate was 67.8% (82/121) with a positivity rate of 28.1% (34/121) for the no. 6 lymph nodes. The metastasis rate was 6.6% for the no. 6a nodes, 6.6% for the no. 6b nodes, and 21.5% for the no. 6c nodes. Also, no. 8a (OR?=?1.329, p?=?0.017) and no. 9 (OR?=?1.250, p?=?0.022) nodal positivity and lower third tumor location (OR?=?1.278, p?=?0.001) were independent risk factors for no. 6 lymph nodal metastasis. There was a significant survival difference between patients with positive and negative no. 6 lymph nodes and patients with metastasis to other lymph node stations (p?<? 0.001). CONCLUSIONS:Patients with no. 6 lymph node metastasis have poor survival outcomes. Complete infra-pyloric lymphadenectomy is necessary and crucial for gastric cancer patients.
| S-EPMC6011414 | biostudies-literature