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Background: PanNETs are a rare group of pancreatic tumors that display heterogeneous histopathological and clinical behavior. Nodal disease has been established as one of the strongest predictors of patient outcomes in PanNETs. Lack of accurate preoperative assessment of nodal disease is a major limitation in the management of these patients, in particular those with small (< 2 cm) low-grade tumors. The aim of the study was to evaluate the ability of radiomic features (RF) to preoperatively predict the presence of nodal disease in pancreatic neuroendocrine tumors (PanNETs). Patients and Methods: An institutional database was used to identify patients with nonfunctional PanNETs undergoing resection. Pancreas protocol computed tomography was obtained, manually segmented, and RF were extracted. These were analyzed using the minimum redundancy maximum relevance analysis for hierarchical feature selection. Youden index was used to identify the optimal cutoff for predicting nodal disease. A random forest prediction model was trained using RF and clinicopathological characteristics and validated internally. Results: Of the 320 patients included in the study, 92 (28.8%) had nodal disease based on histopathological assessment of the surgical specimen. A radiomic signature based on ten selected RF was developed. Clinicopathological characteristics predictive of nodal disease included tumor grade and size. Upon internal validation the combined radiomics and clinical feature model demonstrated adequate performance (AUC 0.80) in identifying nodal disease. The model accurately identified nodal disease in 85% of patients with small tumors (< 2 cm). Conclusions: Non-invasive preoperative assessment of nodal disease using RF and clinicopathological characteristics is feasible. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the therapeutic effect of post‐operative radiotherapy (PORT) with respect to nodal status among patients with head and neck Merkel cell carcinoma (HNMCC). Methods: In this retrospective study, we queried Surveillance, Epidemiology, and End Results (SEER) dataset from 2000 through 2019. We included all adult patients who received primary surgical resection for histologically confirmed treatment naive HNMCC. Entropy balancing was used to reweight observations such that there was covariate balance between patients who received PORT and patients who received surgical resection alone. Doubly robust estimation was achieved by incorporating weights into a multivariable cox proportional hazards model. Planned post hoc subgroup analysis was performed to evaluate the impact of PORT by pathological node status. Results: Among 752 patients (mean age, 73.3 years [SD 10.8]; 64.2% male; 91.2% White; 41.9% node‐positive), 60.4% received PORT. Among node‐positive patients, we found that PORT was associated with improved overall survival (OS) (aHR, 0.55; 95% CI, 0.37–0.81; p = 0.003) and improved disease‐specific survival (DSS) (aHR, 0.57; 95% CI, 0.35–0.92; p = 0.022). Among node‐negative patients, we found that PORT was not associated with OS and was associated with worse DSS (aHR, 2.34; 95% CI, 1.30–4.23; p = 0.005). Conclusions: We found that PORT was associated with improved OS and DSS for node‐positive patients and worse DSS for node‐negative patients. For HNMCC treated with primary surgical resection, these data confirm the value of PORT for pathologically node‐positive patients and support the use of single modality surgical therapy for pathologically node‐negative patients without other adverse risk factors. Level of Evidence: 4 Laryngoscope, 134:3587–3594, 2024 [ABSTRACT FROM AUTHOR]

Objectives: Stereotactic body radiotherapy (SBRT) and/or single fraction stereotactic body radiosurgery (SRS) are effective treatment options for the treatment of oligometastatic disease of lymph nodes. Despite the encouraging local control rate, progression-free survival remains unfair due to relapses that might occur in the same district or at other sites. The recurrence pattern analysis after nodal local ablative RT (laRT) in oligometastatic patients is presented in this study. Methods: The pattern of failure of patients with nodal metastases who were recruited and treated with SBRT in the Destroy-1 or SRS in the Destroy-2 trials was investigated in this single-institution, retrospective analysis. The different relapsed sites following laRT were recorded. Results: Data on 190 patients who received SBRT or SRS on 269 nodal lesions were reviewed. A relapse rate of 57.2% (154 out of 269 nodal lesions) was registered. The pattern of failure was distant in 88 (57.4%) and loco-regional in 66 (42.6%) patients, respectively. The most frequent primary malignancies among patients experiencing loco-regional failure were genitourinary and gynaecological cancers. Furthermore, the predominant site of loco-regional relapse (62%) was the pelvic area. Only 26% of locoregional relapses occurred contra laterally, with 74% occurring ipsilaterally. Conclusions: The recurrence rates after laRT for nodal disease were more frequent in distant regions compared to locoregional sites. The most common scenarios for locoregional relapse appear to be genitourinary cancer and the pelvic site. In addition, recurrences often occur in the same nodal station or in a nodal station contiguous to the irradiated nodal site. Advances in knowledge: Local ablative radiotherapy is an effective treatment in managing nodal oligometastasis. Despite the high local control rate, the progression free survival remains dismal with recurrences that can occur both loco-regionally or at distance. To understand the pattern of failure could aid the physicians to choose the best treatment strategy. This is the first study that reports the recurrence pattern of a significant number of nodal lesions treated with laRT. [ABSTRACT FROM AUTHOR]

Background: Despite notable advances made in preoperative staging, unexpected nodal metastases after surgery are still significantly detected. In this study we aim to analyze the upstaging rate in patients with clinical stage I NSCLC without evidence of nodal disease in the preoperative staging who underwent lobectomy and radical lymphadenectomy. Methods: Patients who underwent lobectomy and systematic lymphadenectomy for clinical stage INSCLCwere evaluated. Exclusion criteria included the neoadjuvant treatment, incomplete resection and no adherence to preoperative guidelines. Results: A total of 297 patients were included in the study. 159 patients were female, and the median age was 68 (61 - 73). The variables that showed a significant correlation with the upstaging rate at the univariate analysis were the number of resected lymph nodes and micropapillar/solid adenocar-cinoma subtype. This result was confirmed in the multivariate analysis with a OR= 2.545 (95%CI 1.136-5.701; p=0.02) for the number of resected lymph nodes and a OR=2.717 (95%CI 1.256-5.875; p=0.01) for the high-grade pattern of adenocarcinoma. Conclusion: Our results showed that in a homogeneous cohort of patients with clinical stage I NSCLC, the number of resected lymph nodes and the histological subtype of adenocarcinoma can significantly be associated with nodal metastasis. [ABSTRACT FROM AUTHOR]

BackgroundDespite notable advances made in preoperative staging, unexpected nodal metastases after surgery are still significantly detected. In this study we aim to analyze the upstaging rate in patients with clinical stage I NSCLC without evidence of nodal disease in the preoperative staging who underwent lobectomy and radical lymphadenectomy.MethodsPatients who underwent lobectomy and systematic lymphadenectomy for clinical stage I NSCLC were evaluated. Exclusion criteria included the neoadjuvant treatment, incomplete resection and no adherence to preoperative guidelines.ResultsA total of 297 patients were included in the study. 159 patients were female, and the median age was 68 (61 - 73). The variables that showed a significant correlation with the upstaging rate at the univariate analysis were the number of resected lymph nodes and micropapillar/solid adenocar-cinoma subtype. This result was confirmed in the multivariate analysis with a OR= 2.545 (95%CI 1.136-5.701; p=0.02) for the number of resected lymph nodes and a OR=2.717 (95%CI 1.256-5.875; p=0.01) for the high-grade pattern of adenocarcinoma.ConclusionOur results showed that in a homogeneous cohort of patients with clinical stage I NSCLC, the number of resected lymph nodes and the histological subtype of adenocarcinoma can significantly be associated with nodal metastasis.

Simple Summary: Preoperative mediastinal staging plays a crucial role in determining the appropriate treatment strategy for patients with stage IIIA-N2 disease, but an optimal treatment strategy has yet to be established. Invasive mediastinal staging is indicated in approximately 30% of patients with suspected NSCLC. In general, if proven N2 disease is present, induction therapy is prioritized in order to downstage and achieve a better prognosis. In the absence of N2 disease, surgical resection with mediastinal lymphadenectomy is the most appropriate treatment option. Nevertheless, unforeseen N2 (uN2) disease, also called unexpected or surprise N2, can still be found during or after surgery despite current preoperative mediastinal staging showing N0 or N1 disease. As preoperative mediastinal staging improved over time, the prevalence of uN2 changed. The aim of this study is to determine the prevalence of true uN2 disease and its characteristics. A secondary objective is to identify its significance for long-term outcomes. Patients with unforeseen N2 (uN2) disease are traditionally considered to have an unfavorable prognosis. As preoperative and intraoperative mediastinal staging improved over time, the prevalence of uN2 changed. In this review, the current evidence on uN2 disease and its prevalence will be evaluated. A systematic literature search was performed to identify all studies or completed, published trials that included uN2 disease until 6 April 2023, without language restrictions. The Newcastle-Ottawa Scale (NOS) was used to score the included papers. A total of 512 articles were initially identified, of which a total of 22 studies met the predefined inclusion criteria. Despite adequate mediastinal staging, the pooled prevalence of true unforeseen pN2 (9387 patients) was 7.97% (95% CI 6.67–9.27%), with a pooled OS after five years (892 patients) of 44% (95% CI 31–58%). Substantial heterogeneity regarding the characteristics of uN2 disease limited our meta-analysis considerably. However, it seems patients with uN2 disease represent a subcategory with a similar prognosis to stage IIb if complete surgical resection can be achieved, and the contribution of adjuvant therapy is to be further explored. [ABSTRACT FROM AUTHOR]

Objectives: Neoadjuvant therapy has been theorized to increase complexity of non–small cell lung cancer resections; however, specific factors that contribute to intraoperative challenges after induction therapy have not been well described. We aimed to characterize the effect of nodal involvement and nodal treatment response on surgical complexity after neoadjuvant therapy. Methods: We identified patients treated with neoadjuvant therapy followed by anatomic lung resection for cN + non–small cell lung cancer between 2010 and 2020. Patients were categorized according to clinical N1 versus N2 disease. To evaluate the effect of nodal response to therapy, thoracic radiologists measured clinically suspected and pathologically involved lymph nodes before and after induction therapy. Operative reports were reviewed to identify technical challenges specifically related to nodal disease. Categorical outcomes were compared using Fisher exact test. Results: One hundred twenty-four patients met inclusion criteria, among whom 107 (86.3%) were treated with neoadjuvant chemotherapy, whereas chemoradiation (n = 8) and targeted therapy (n = 9) were less common. In cases with N1 disease, 8/38 (21.0%) required proximal pulmonary arterial control, whereas this was necessary in only 2/88 (2.3%) of N2 cases (P = .001). Likewise, sleeve resection and arterioplasty were needed more frequently during resection of N1 disease (7/38, 18.4%) versus N2 disease (0/88, P

Objectives: To identify factors associated with concordance between World Health Organization (WHO) grade on cytological analysis (c-grade) and histopathological analysis (h-grade) of surgical specimen in patients with PanNETs and examine trends in utilization and accuracy of EUS-FNA in preoperatively predicting grade. Background: WHO grading system is prognostic in pancreatic neuroendo-crine tumors (PanNETs). The concordance between c-grade and h-grade is reported to be between 50% and 92%. Methods: A multicenter retrospective study was performed on patients undergoing resection for PanNETs at four high-volume centers between 2010 and 2019. Patients with functional or syndrome-associated tumors, and those receiving neoadjuvant therapy were excluded. Factors associated with concordance between c-grade and h-grade and trends of utilization of EUS-FNA were assessed. Results: Of 869 patients included, 517 (59.5%) underwent EUS-FNA; 452 (87.4%) were diagnostic of PanNETs and WHO-grade was reported for 270 (59.7%) patients. The concordance between c-grade and h-grade was 80.4% with moderate concordance (Kc = 0.52, 95% CI: 0.41–0.63). Significantly higher rates of concordance were observed in patients with smaller tumors (<2 vs. ≥2cm, 81.1% vs. 60.4%, P = 0.005). Highest concordance (98.1%) was observed in patients with small tumors undergoing assessment between 2015-2019 with a near-perfect concordance (Kc = 0.88, 95% CI: 0.61–1.00). An increase in the utilization of EUS-FNA (56.1% to 64.1%) was observed over the last 2 decades (P = 0.017) and WHO-grade was more frequently reported (44.2% vs. 77.6%, P < 0.001). However, concordance between c-grade and h-grade did not change significantly (P = 0.118). Conclusion: Recently, a trend towards increasing utilization and improved diagnostic accuracy of EUS-FNA has been observed in PanNETs. Concordance between c-grade and h-grade is associated with tumor size with near-perfect agreement when assessing PanNETs <2cm in size. [ABSTRACT FROM AUTHOR]

Simple Summary: The clinically relevant information that guides further surgical management of the axilla in women with breast cancer is the distinction between non-significant (N0–N1) versus significant (≥N2) lymph node metastases. In women with newly diagnosed breast cancer, MRI is increasingly used to determine the local extent of disease in the breast. The aim of our retrospective study on 414 patients who underwent routine breast MRI for local staging of the breast was to determine whether an abbreviated protocol for regional lymph node staging is sufficient to identify patients with significant nodal disease. Our results demonstrated that a single 3 min coronal T1-weighted sequence, acquired with the system's built-in body coil, covering the chest wall, axilla, and supra- and infraclavicular region, helped rule out the presence of significant nodal disease with a NPV of 98.8% [97.0–100%]. False-positive findings were mostly caused by patients with positive, but non-significant, lymph node metastases (N1). Background: The detection of regional lymph node metastases (LNM), in particular significant LNM (≥N2), is important to guide treatment decisions in women with breast cancer. The purpose of this study was to determine whether a coronal pulse sequence as part of pre-operative breast MRI is useful to identify women without significant LNM. Material: Retrospective study between January 2017 and December 2019 on 414 consecutive women with breast cancer who underwent pre-operative breast MRI on a 1.5 T system. For lymph node (LN) staging, a coronal pre-contrast non-fat-suppressed T1-weighted TSE sequence was acquired with the system's built-in body coil, covering the chest wall; acquisition time 3:12 min. Two radiologists rated the likelihood of LNM on a 3-point scale (absent/possible/present). Validation was obtained by histology from sentinel LN biopsy, axillary LN dissection, and/or PET/CT. Results: 368/414 women were staged to have no or non-significant LNM (pN0 in 282/414, pN1 in 86/414), and significant LNM (≥pN2) in 46/414. For identification of women with significant LNM, MRI was true-positive in 42/46, false-negative in 4/46, true-negative in 327/368, and false-positive in 41/83, the latter mostly caused by women with N1-disease (38/41), yielding an NPV and PPV for significant LNM of 98.8% [95%-CI: 97.0–100%] and 50.6% [43.1–58.1%], respectively. Conclusions: A 3 min coronal T1-weighted pulse sequence covering the chest wall as part of pre-operative breast MRI is useful to rule out significant LNM with high NPV. Where MRI staging is positive for significant LNM, additional work-up is indicated to improve the distinction of N1 and N2 disease. [ABSTRACT FROM AUTHOR]

Introduction: Papillary thyroid carcinoma (PTC) accounts for the majority of thyroid malignancies; risk of PTC recurrence over a 30‐year period is approximately 30%, of which 70% occur as nodal metastases. Patients with nodal disease who are treated with therapeutic dissection are at higher risk for recurrence, but optimal nodal yield has not been defined. We aim to determine variables predictive of nodal recurrence of PTC within the first 5 years of surgery, with a focus on lymph node ratio (LNR), to inform clinical decision‐making. Methods: Retrospective chart review identified 41 patients with nodal recurrence of PTC and 284 without nodal recurrence following thyroid surgery from 2000 to 2015. Cohorts were compared with regards to clinical history, surgical findings, and tumor characteristics. Results: The fraction of the patients who underwent therapeutic central or lateral lymph node dissection was significantly higher in the nodal recurrence cohort. Maximum tumor size, presence of extrathyroidal extension, largest lymph node focus, LNR, postoperative thyroglobulin level, and administration of postoperative radioactive iodine were significantly increased in the PTC nodal recurrence group. LNR greater than 0.3 held the highest level of significance as a binary cutoff and captured the larger proportion of patients in the nodal recurrence cohort (68.3%). Conclusion: This study demonstrates characteristics to help assess risk of nodal recurrence of PTC and suggests LNR of lower than 0.3 is optimal to reduce risk of recurrence. The next steps include cohort studies to validate findings and weight variable analysis to optimize the extent of surgical therapeutic dissection. Level of Evidence: 4 Laryngoscope, 132:1883–1887, 2022 [ABSTRACT FROM AUTHOR]

Objectives: Neoadjuvant chemoradiation has been shown to improve survival in locally advanced esophageal and gastroesophageal junction cancer. The purpose of our study was to examine the effects of posttreatment persistent lymph node (LN) disease on overall survival (OS) and recurrence in patients with esophageal adenocarcinoma after neoadjuvant chemoradiation as well as the effect of LN harvest and the potential benefit of adjuvant chemotherapy. Methods: The records of patients who underwent esophagectomy in our hospital from January 2005 until December 2016 were analyzed. Our study group consisted of 509 patients. Results: Patient groups were created based on pathologic staging after esophagectomy (ypT N) as 22.0% of patients were ypT0 N0, 46.2% had incomplete response only at the primary tumor level (ypT + N0), and 31.8% had at least 1 metastatic lymph node (ypTx N+). Median OS was 58.3 months. The ypTx N+ group was divided into ypTx N1 and ypTx N2 or N3 subgroups based on the number of metastatic lymph nodes. The OS between the 2 groups was not significantly different (median OS, 37.6 vs 29.8 months; P = .097). The disease-free survival did show a statistically significant difference (median disease-free survival, 27.6 vs 13.7 months; P = .007). The LN harvest was not found to be significantly associated with OS. However, administration of adjuvant chemotherapy was a significant prognosticator for increased OS (hazard ratio, 0.590; P = .043). Conclusions: Our results demonstrate that residual LN disease after neoadjuvant chemoradiation is associated with increased mortality. Adjuvant chemotherapy, but not number of LNs resected, was correlated with increased OS in this subset of patients.

Some studies showed that the increase of tumor size has a negative effect on survival in colon cancers. Our study aims to assess the effects of tumor volume on lymph node positivity and prognosis in stage pT3 colon cancers. All patients who underwent surgery for colon cancer in our clinic were evaluated retrospectively. The study included 213 patients who were diagnosed with colon adenocarcinoma and reported as pathologic. Preoperative abdomen computed tomography scans were used for measurements of tumor volume. Tumor volumes were compared according to the pathological lymph node involvement. Cut-off values were determined with ROC analysis. The cases were divided into groups according to the determined cut-off value and data compared. Mean tumor volume was found to be higher in the lymph node-positive group (p=0.01). The higher number of removed lymph nodes and lymph node positivity was detected more in cases that were above the cut-off value (p=0.003 and p=0.004, respectively). The mean survival time was 37.3±1.3 months. There was no correlation between tumor volume and the overall survival time (p=0.21). According to data comparison of the lymph node positivity, Kaplan-Meier analysis showed that the increase of the N stage reduces the 5-year survival rate (for the N0, N1, N2 stages, 60%, 52%, 35%, respectively). Tumor volume is correlated with lymph node involvement. It has been shown that increasing the N stage has a negative effect on prognosis. Our study showed that tumor volume has no significant impact on survival but may have an indirect effect on prognosis. [ABSTRACT FROM AUTHOR]

Aim: To describe treatment patterns among patients with stage III melanoma who underwent surgical excision in years 2011–2016, and assess outcomes among patients who subsequently received systemic adjuvant therapy versus watch-and-wait. Methods: Chart review of 380 patients from 17 melanoma centers in North America, South America and Europe. Results: Of 129 (34%) patients treated with adjuvant therapy, 85% received interferon α-2b and 56% discontinued treatment (mostly due to adverse events). Relapse-free survival was significantly longer for patients treated with adjuvant therapy versus watch-and-wait (hazard ratio = 0.63; p < 0.05). There was considerable heterogeneity in adjuvant treatment schedules and doses. Similar results were found in patients who received interferon-based adjuvant therapy. Conclusion: Adjuvant therapies with better safety/efficacy profiles will improve clinical outcomes in patients with stage III melanoma.

Background: This systematic review and meta-analysis seek to evaluate the prevalence of nodal disease in rectal cancer patients with pathological complete responses (pCR) after neoadjuvant chemoradiotherapy (ypT0N+). Methods: This study conformed to the PRISMA guidelines. A search was performed on major databases to identify relevant articles. Meta-analyses of pooled proportions were performed on rectal cancer with pCR and ypT0N+. Meta-regression was undertaken to identify sources of heterogeneity, and the Newcastle-Ottawa Scale (NOS) was employed to assess the risk of bias. Results: A total of 18 studies were included, totaling 7568 patients. The overall risk of bias was low, since all studies scored 6 and above out of 9 on the NOS. Preoperatively, the pooled proportions of patients with T3/T4 tumors and clinically positive nodal disease were 84.08% (95% CI 74.19 to 91.99%) and 52.14% (95% CI 35.02 to 69.00%) respectively. The prevalence of pCR in the whole pool was 18.52% (95% CI 13.31 to 24.35%; I2 = 93.85%; P = 0.00), and meta-regression showed a significantly negative relationship with patient age (β = − 0.03, 95% CI − 0.03 to − 0.02; P = 0.00). The pooled prevalence of ypT0N+ was 4.61% (95% CI 2.41 to 7.28%; I2 = 52.27%; P = 0.01), and meta-regression demonstrated a significantly positive relationship with male gender (β = 1.06, 95% CI 1.00 to 1.12; P = 0.04). Conclusion: There is a small risk of ypN+ in patients with pCR after neoadjuvant CRT and surgery for rectal cancer. However, further research is warranted to establish these findings and to identify predictive factors for this specific group of patients. [ABSTRACT FROM AUTHOR]

Purpose: The nodal status is a strong predictor for clinical outcome in patients with penile cancer. We aimed to evaluate the association between preoperative plasma IGFBP2 levels and nodal status in patients with penile squamous cell carcinoma (PSCC).Methods: This retrospective study enrolled 56 penile cancer patients who underwent penectomy between 2015 and 2017. Preoperative plasma IGFBP2 levels were detected by enzyme linked immunosorbent assay, which was analyzed in association with clinicopathological parameters (age, body mass index, pathological grade, phimosis, histological subtype, tumor stage, and nodal status). Univariable and Multivariable Cox regression analysis was conducted to identify the prognostic factors that influence disease free survival in PSCC. CCK8 assay and clonogenic assay were used to evaluate the cell viability and tumorigenic potential of PSCC cell line, respectively; wound healing assay, and transwell invasion assay were conducted to evaluate the effect of IGFBP2 depletion on cell migration and invasion in PSCC cells; IGFBP2 protein expression was analyzed by Western blotting.Results: Plasma IGFBP2 levels were markedly higher in preoperative PSCC than those in healthy male subjects (P = 0.0007). Penectomy led to a significant reduction of plasma IGFBP2 levels in PSCC patients (P = 0.0098). Preoperative plasma IGFBP2 levels were significantly associated with nodal status of PSCC (P < 0.0001). At the cutoff value of 486.2 ng/ml, preoperative plasma IGFBP2 produced a sensitivity of 80.8% and a specificity of 86.7% to discriminate nodal metastasis. Preoperative plasma IGFBP2 levels could serve as independent prognostic factor for disease free survival in PSCC (P = 0.001). Further, knockdown of IGFBP2 expression suppressed cell growth, inhibited clonogenesis, and attenuated cell migration and invasion in Penl1 cells; depletion of IGFBP2 expression attenuated the levels of p-AKT and p-ERK1/2, while increased the expression of p16 and cleaved caspase-3 in Penl1 cells. Silencing IGFBP2 also led to a considerable decline of MMP2/9 levels in culture supernatant of Penl1 cells.Conclusion: Higher preoperative plasma IGFBP2 was closely associated with nodal metastasis, which might serve as a useful diagnostic and prognostic biomarker for clinical management of PSCC. IGFBP2 might play an important role in the malignant progression of PSCC. Therapeutic strategies targeting IGFBP2-related signaling pathways may have a therapeutic benefit in PSCC patients. [ABSTRACT FROM AUTHOR]

Objective: Esthesioneuroblastoma is an uncommon malignancy of the sinonasal tract arising from the olfactory epithelium. Surgical management of the primary site, often via an endoscopic approach, with or without adjuvant radiation, is often curative. There is growing but ultimately limited data regarding management of the neck and the risk of nodal metastases. In this study, we examine the incidence and patterns of esthesioneuroblastoma-related cervical nodal metastases using the Surveillance, Epidemiology, and End Results (SEER) database.Methods: The SEER registry was queried for all patients with esthesioneuroblastomas diagnosed between 1973 and 2012. Patient data was then analyzed with respect to age, sex, race, modified Kadish stage, grade, survival functions, and nodal disease including specific nodal basins.Results: Three hundred and eighty-one cases of esthesioneuroblastoma with information on nodal metastases were identified. The overall cervical nodal metastasis rate was 8.7%. Level II metastases were most common (6.6%). A total of 4.5% of cases presented with multiple positive nodal basins. Male sex (P = 0.009) and higher tumor grade (P = 0.009) correlated with the presence of level II metastases. There was no association of primary tumor site to the presence of nodal metastases (P > 0.05). The presence of nodal disease significantly predicted poorer overall (P = 0.001) and disease-specific survival (P = 0.017).Conclusion: The incidence of nodal metastases in esthesioneuroblastoma at diagnosis is rare, and elective management of the neck remains controversial. Primary tumor site does not appear to predict metastases at specific nodal basins. Higher tumor grade may be a harbinger of eventual nodal metastases.Level Of Evidence: NA Laryngoscope, 129:1025-1029, 2019. [ABSTRACT FROM AUTHOR]

Background: With an expectation of excellent locoregional control, ongoing efforts to de-intensify therapy for patients with human papillomavirus-associated squamous cell oropharyngeal cancer necessitate a better understanding of the metastatic risk for patients with this disease. The objective of this study was to determine what factors affect the risk of metastases in patients with squamous cell cancers of the oropharynx.Methods: Under a shared use agreement, 547 patients from Radiation Therapy Oncology Group 0129 and 0522 with nonmetastatic oropharyngeal squamous cell cancers who had a known p16 status and smoking status were analyzed to assess the association of clinical features with the development of distant metastases. The analyzed factors included the p16 status, sex, T stage, N stage, age, and smoking history.Results: A multivariate analysis of 547 patients with a median follow-up of 4.8 years revealed that an age ≥ 50 years (hazard ratio [HR], 3.28; P = .003), smoking for more than 0 pack-years (HR, 3.09; P < .001), N3 disease (HR, 2.64; P < .001), T4 disease (HR, 1.63; P = .030), and a negative p16 status (HR, 1.60; P = .044) were all factors associated with an increased risk of distant disease.Conclusions: Age, smoking, N3 disease, T4 disease, and a negative p16 status were associated with the development of distant metastases in patients with squamous cell cancers of the oropharynx treated definitively with concurrent chemoradiation. [ABSTRACT FROM AUTHOR]

Introduction: Lymph node involvement and the number of positive nodes is a significant prognosticator in oral cavity cancers and current staging system does not incorporate it as an integral part.Material and Methods: This was a retrospective study of oral cavity cancer patients who were operated during the time period of 2009-2017. The data was collected and analysed to assess the impact of increase in the number of positive nodes on survival and its comparison of survival statistics to current AJCC staging.Results: A total of 1431 patients were included in this study and 32.5% of these patients had a node positive disease. Nodal positivity was a significant prognosticator on multivariate analysis. Number of positive nodes was modelled with restricted cubic spline function and it showed progressive worsening of survival functions with increase in number. On Kaplan Meier analysis there was a better separation of curves when number of positive nodes was used and Akaike information criterion (AIC) showed that it was a better prognosticator than existing AJCC staging.Conclusion: Number of positive nodes is a significant prognosticator of prognosis and hence should be considered in the AJCC staging system. [ABSTRACT FROM AUTHOR]

Lymph node dissection (LND; PLND: pelvic LND) is an essential component of radical cystectomy (RC) for bladder cancer (BC). However, the optimal anatomical extent of LND and its potential therapeutic role are still controversial: as we will explain, the extent of LND dissection is a predictor of survival and local recurrence but what is an adequate extension is still unclear. Moreover, there is large uncertainty about the role of surgery in patients with clinically-positive nodes. In this review we will provide a synthesis of the available evidence on this highly debated topic. Overall, the studies presented in this work support the idea that extended lymphadenectomy could provide optimal diagnostic and possibly therapeutic results in cN- patients. In cN+ patients, post chemotherapy surgery may be considered especially in subjects who have a good response to CHT, although definitive evidence is still needed. Finally, the final results of randomized trials are eagerly awaited to draw definitive conclusions of the role of PLND in BC.

Introduction: Rectal resection after neoadjuvant chemoradiotherapy is the standard of care for rectal cancer. Non-operative management of rectal cancer is the new frontier. Selection of these patients is based on the absence of mucosal disease after neoadjuvant therapy. The question that is quintessential is whether absence of mucosal disease means absence of nodal disease. Aim: To see the correlation between absence of mucosal disease and mesorectal disease in rectal resections after neoadjuvant therapy for rectal cancer. Materials and Methods: A retrospective study was done on 479 patients of locally advanced carcinoma rectum from 2008 to 2015. All patients received neoadjuvant therapy which was mainly long course radiation therapy with 5040cGy over duration of 28 days with concurrent chemotherapy. Some patients underwent neoadjuvant chemotherapy. After an interval of approximately 6 weeks they underwent curative surgery. The patients who had complete pathological response were analysed in this study. Results: Out of the 479 patients, 76 patients were found to have no disease in the rectal wall. Only 1 patient (1.3%) had node positive disease without having any rectal disease (T0N1). The rest had no tumour either in the rectum or the mesorectal nodes. Thus, 75 patients had a pathological complete response (15.6%). Conclusion: In patients with rectal cancer undergoing neoadjuvant chemoradiotherapy followed by radical resection, absence of tumour in the rectum correlates well with absence of disease in the mesorectum and absence of nodal disease. Thus, absence of mucosal disease can be taken as marker of complete response to neoadjuvant therapy.

Despite notable advances made in preoperative staging, unexpected nodal metastases after surgery are still significantly detected. Given the promising role of neoadjuvant targeted treatments, the definition of novel predictive factors of nodal metastases is an extremely important issue. In this study we aim to analyze the upstaging rate in patients with early stage NSCLC without evidence of nodal disease in the preoperative staging who underwent lobectomy and radical lymphadenectomy. Patients who underwent lobectomy and systematic lymphadenectomy for early stage LUAD without evidence of nodal disease at the preoperative staging using NGS analysis for actionable molecular targets evaluation after surgery were evaluated. Exclusion criteria included the neoadjuvant treatment, incomplete resection and no adherence to preoperative guidelines. A total of 359 patients were included in the study. 172 patients were female, and the median age was 68 (61–72). The variables that showed a significant correlation with the upstaging rate at the univariate analysis were the ALK rearrangement, the number of resected lymph nodes and the diameter of the tumor. This result was confirmed in the multivariate analysis, with an OR of 8.052 (CI95% 3.123–20.763, p = 0.00001) for ALK rearrangement, 1.087 (CI95% 1.048–1.127, p = 0.00001) for the number of resected nodes and 1.817 (CI95% 1.214–2.719, p = 0.004) for cT status. Our results showed that in a homogeneous cohort of patients with clinical node early stage LUAD the ALK rearrangement, the number of resected lymph nodes and the tumor diameter can significantly predict nodal metastasis. [ABSTRACT FROM AUTHOR]

Objectives: Research on endometrial cancer (EC) has demonstrated an association between increasing tumor size and poor outcomes, including increase in nodal disease and advanced stage at diagnosis. However, the implications of overall uterine weight (UW) at the time of hysterectomy for EC are unknown. The aim of this study is to investigate if increasing UW is associated with poor prognosis, specifically regarding lymph node metastasis (LNM), lymphovascular space invasion (LVSI), and stage. Materials and Methods: This is a retrospective cohort study of patients undergoing robotic-assisted surgical management of EC at two institutions. Patients with a preoperative diagnosis of complex atypical hyperplasia (CAH) or EC were included. All patients underwent surgical staging including hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and when feasible, para-aortic lymphadenectomy. Patients were categorized based on UW on final pathology report, into one of six groups: < 50 grams, 51-100 grams, 101-150 grams, 151-200 grams, 201-250 grams, and > 250 grams. The rate of lymph node involvement, LVSI, and stage were then analyzed for each group. Chi-Square and t-test were used for statistical analysis. Results: From 2013-2017, 161 patients were identified. Twenty-seven patients were excluded due to final pathology diagnosis other than EC. Of the remaining 134 patients, 103 had LVSI, 96 had LNM and 116 had stage reported. There were 120 (89.6%) endometrioid, four (2.9%) papillary serous, three (2.2%) clear cell, three (2.2%) carcinosarcoma, three (2.2%) undifferentiated, and one (0.7%) endometrial stromal sarcoma histologies. Among the entire cohort, the incidence of LNM was 19.8% and LVSI was 12.6%. Increasing UW was associated with increase in LVSI (p = 0.003), LN metastasis (p = 0.000), and stage (p = 0.010). On further analysis, the cohort was examined as two separate groups, UW < 200 vs. > 200 grams. UW > 200 grams is associated with significant increase in LVSI (p = 0.045) and LNM (p = 0.0005). There were no LNM in patients with UW < 100 grams. Conclusions: Increasing UW at the time of hysterectomy for EC is associated with increase in LVSI, LN metastasis, and stage. [ABSTRACT FROM AUTHOR]