AIM:To assess the effects of neoadjuvant chemoradiotherapy(CRT) on the presence of extracapsular lymph node involvement(LNI) and its prognostic value in patients with resected esophageal cancer.METHODS:Two hundred and...AIM:To assess the effects of neoadjuvant chemoradiotherapy(CRT) on the presence of extracapsular lymph node involvement(LNI) and its prognostic value in patients with resected esophageal cancer.METHODS:Two hundred and ninety-eight patients with advanced esophageal cancer underwent esophagectomy between 1997 and 2006.One hundred and ninety patients(63.8%) were treated with neoadjuvant CRT prior to resection.A total of 986 metastatic LNs were examined.Survival of the patients was analyzed according to intra-and extra-capsular LNI.RESULTS:Five-year survival rate was 22.5% for the entire patient population.Patients with extracapsular LNI had a 5-year survival rate of 16.7%,which was comparable to the 15.8% in patients with infiltrated nodes of the celiac trunk(pM1lymph).In contrast to patients treated with surgery alone,neoadjuvant therapy resulted in signif icantly(P = 0.001) more patients with pN0/M0(51.6% vs 25.0%).In 17.6% of the patients with surgery alone vs 16.8% with neoadjuvant CRT,extracapsular LNI was detected.Neoadjuvant therapy does not reduce the occurrence of extracapsular LNI.CONCLUSION:Extracapsular LNI is an independent negative prognostic factor not influenced by neoadjuvant CRT.In a revised staging system for esophageal cancer,extracapsular LNI should be considered.展开更多
Whether regional lymph node involvement exerts significant effect on the prognosis still remains obscure for pancreatic neuroendocrine tumors.To clarify this association and identify predictors for lymph node involvem...Whether regional lymph node involvement exerts significant effect on the prognosis still remains obscure for pancreatic neuroendocrine tumors.To clarify this association and identify predictors for lymph node involvement,we studied the data of patients aged>18 years with regional lymph node involvement histologically confirmed pancreatic neuroendocrine tumors from 2004 to 2014 in the Surveillance,Epidemiology,and End Results database(http://seer.cancer.gov/about).We evaluated Lymph node involvement as a prognostic factor by Cox regression.We reduced 9 variables of demographic and tumor characteristics to 5 potential predictors using least absolute shrinkage and selection operator(LASSO)regression model.We further constructed a lymph node involvement model by logistic regression.The model was verified by the verification set,and the visual expression of the model was realized by a nomogram.A total of 1545 cases of pancreatic neuroendocrine tumors were included in our study.Lymph node positivity was significantly associated with disease-specific survival(P<0.001).Younger patients(P<0.05),patients with tumors in the pancreatic head(P<0.05),patients at high American Joint Committee on Cancer T stage(P<0.001),and patients of an undifferentiated status(P<0.05)showed a significantly higher possibility of developing lymph node involvement.The reliability of this model was verified by cross-validation between the training and testing set,and we obtained good discrimination and calibration power.This model also showed great performance in C-index and area under receiver operating characteristic curve.Lymph node positivity was an important negative prognostic predictor for pancreatic neuroendocrine tumor.We developed a lymph node involvement model based on the predictors including age,marital status,primary site,T status,and tumor grade.展开更多
To the Editor:Neoadjuvant chemotherapy(NAC)significantly improves the prognosis for patients with breast cancer with internal mammary lymph node(IMN)involvement,[1]but the locoregional treatment of IMNs including IMN ...To the Editor:Neoadjuvant chemotherapy(NAC)significantly improves the prognosis for patients with breast cancer with internal mammary lymph node(IMN)involvement,[1]but the locoregional treatment of IMNs including IMN dissection(IMND)and IMN boost irradiation(IMNB)has long been debated,[2]owing to the difficulty in surgical approaches and cardiopulmonary side effects caused by high-dose radiation.[3]To date,the surgical dissection of IMNs is rarely performed;thus,the data regarding survival outcome of IMND is quite limited.In terms of radiotherapy(RT),there is marked discrepancy in radiation dose to IMNs in patients with metastatic IMN following NAC.[4]In this study,we report our institutional experience in the locoregional treatment of metastatic IMN and its impact on prognosis in patients who have undergone NAC.展开更多
基金Supported by Department of General,Visceral and Cancer Surgery,Center for Integrated Oncology (CIO) Kln Bonn and the Hoff`sche Stiftung
文摘AIM:To assess the effects of neoadjuvant chemoradiotherapy(CRT) on the presence of extracapsular lymph node involvement(LNI) and its prognostic value in patients with resected esophageal cancer.METHODS:Two hundred and ninety-eight patients with advanced esophageal cancer underwent esophagectomy between 1997 and 2006.One hundred and ninety patients(63.8%) were treated with neoadjuvant CRT prior to resection.A total of 986 metastatic LNs were examined.Survival of the patients was analyzed according to intra-and extra-capsular LNI.RESULTS:Five-year survival rate was 22.5% for the entire patient population.Patients with extracapsular LNI had a 5-year survival rate of 16.7%,which was comparable to the 15.8% in patients with infiltrated nodes of the celiac trunk(pM1lymph).In contrast to patients treated with surgery alone,neoadjuvant therapy resulted in signif icantly(P = 0.001) more patients with pN0/M0(51.6% vs 25.0%).In 17.6% of the patients with surgery alone vs 16.8% with neoadjuvant CRT,extracapsular LNI was detected.Neoadjuvant therapy does not reduce the occurrence of extracapsular LNI.CONCLUSION:Extracapsular LNI is an independent negative prognostic factor not influenced by neoadjuvant CRT.In a revised staging system for esophageal cancer,extracapsular LNI should be considered.
基金This work was supported by the Zhejiang Natural Sciences Foundation of China(No.LY18H160007,LY17H160029,Q17H160042,LQ16H160003)the Zhejiang Medical Innovative Discipline Construction Project-2016.
文摘Whether regional lymph node involvement exerts significant effect on the prognosis still remains obscure for pancreatic neuroendocrine tumors.To clarify this association and identify predictors for lymph node involvement,we studied the data of patients aged>18 years with regional lymph node involvement histologically confirmed pancreatic neuroendocrine tumors from 2004 to 2014 in the Surveillance,Epidemiology,and End Results database(http://seer.cancer.gov/about).We evaluated Lymph node involvement as a prognostic factor by Cox regression.We reduced 9 variables of demographic and tumor characteristics to 5 potential predictors using least absolute shrinkage and selection operator(LASSO)regression model.We further constructed a lymph node involvement model by logistic regression.The model was verified by the verification set,and the visual expression of the model was realized by a nomogram.A total of 1545 cases of pancreatic neuroendocrine tumors were included in our study.Lymph node positivity was significantly associated with disease-specific survival(P<0.001).Younger patients(P<0.05),patients with tumors in the pancreatic head(P<0.05),patients at high American Joint Committee on Cancer T stage(P<0.001),and patients of an undifferentiated status(P<0.05)showed a significantly higher possibility of developing lymph node involvement.The reliability of this model was verified by cross-validation between the training and testing set,and we obtained good discrimination and calibration power.This model also showed great performance in C-index and area under receiver operating characteristic curve.Lymph node positivity was an important negative prognostic predictor for pancreatic neuroendocrine tumor.We developed a lymph node involvement model based on the predictors including age,marital status,primary site,T status,and tumor grade.
基金National Natural Science Foundation of China(No.82273399)Natural Science Foundation of Guangdong Province(No.2022A1515012229)National Natural Science Foundation of China(No.82372742)
文摘To the Editor:Neoadjuvant chemotherapy(NAC)significantly improves the prognosis for patients with breast cancer with internal mammary lymph node(IMN)involvement,[1]but the locoregional treatment of IMNs including IMN dissection(IMND)and IMN boost irradiation(IMNB)has long been debated,[2]owing to the difficulty in surgical approaches and cardiopulmonary side effects caused by high-dose radiation.[3]To date,the surgical dissection of IMNs is rarely performed;thus,the data regarding survival outcome of IMND is quite limited.In terms of radiotherapy(RT),there is marked discrepancy in radiation dose to IMNs in patients with metastatic IMN following NAC.[4]In this study,we report our institutional experience in the locoregional treatment of metastatic IMN and its impact on prognosis in patients who have undergone NAC.
