Cancer Research and Treatment

Original Articles

Comparison of Long-term Oncological Outcome of Sentinel Lymph Node Mapping Methods (Dye-Only versus Dye and Radioisotope) in Breast Cancer Patients Following Neoadjuvant Chemotherapy: Jinyoung Byeon, Changjin Lim, Eunhye Kang, Ji-Jung Jung, Hong-Kyu Kim, Han-Byoel Lee, Hyeong-Gon Moon, Wonshik Han; Received December 30, 2024 Accepted April 13, 2025 Published online April 15, 2025; DOI: https://doi.org/10.4143/crt.2024.1253 [Accepted]

Abstract PDF: Purpose
Sentinel lymph node biopsy (SLNB) using dye and isotope (DUAL) is recommended over the dye-only (DYE) method after neoadjuvant chemotherapy (NCT) due to potentially lower false-negative rates. However, the long-term outcome of either method is unclear. We aimed to compare the long-term oncological outcomes of DYE versus DUAL SLNB methods in patients who received NCT.
Materials and Methods
In this retrospective cohort study, 893 patients who underwent SLNB following NCT and had pathologically negative lymph nodes were included. After propensity score matching for cT, cN, and pT stages, 280 patients were in the DYE group and 560 in the DUAL group. Indigo carmine was used for dye and Tc-99m antimony trisulfate for isotope mapping.
Results
Median follow-up was 75.6 months in the DYE group and 83.0 months in the DUAL group. Mean (±SD) number of harvested sentinel nodes was 6.7 (±3.4) and 6.7 (±3.8) in the DYE and DUAL groups (p=0.51). Five-year distant metastasis-free survival was 95.2% in DYE group and 93.3% in DUAL group (HR=1.45; 95% CI, 0.82–2.57; p=0.19). Disease-free survival (HR=0.97; 95% CI, 0.69–1.50; p=0.91) and overall survival (HR=0.98; 95% CI, 0.56–1.69; p=0.95) were not significantly different. Axillary recurrence rate was 1.8% and 2.5% in DYE and DUAL groups(p=0.64).
Conclusion
Long-term oncological outcomes did not significantly differ between DYE and DUAL SLNB methods. The dye-only method can be safely recommended for breast cancer patients who received NCT.

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Lung and Thoracic cancer

Differences in the Prognostic Impact between Single-Zone and Multi-Zone N2 Node Metastasis in Patients with Station-Based Multiple N2 Non–Small Cell Lung Cancer: Shia Kim, Geun Dong Lee, SeHoon Choi, Hyeong Ryul Kim, Yong-Hee Kim, Dong Kwan Kim, Seung-Il Park, Jae Kwang Yun; Cancer Res Treat. 2025;57(1):95-104. Published online July 22, 2024; DOI: https://doi.org/10.4143/crt.2024.120

Abstract PDF Supplementary Material PubReader ePub: Purpose
The International Association for the Study of Lung Cancer suggests further subdivision of pathologic N (pN) category in non–small-cell lung cancer (NSCLC) by incorporating the location and number of involved lymph node (LN) stations. We reclassified patients with the station-based N2b disease into single-zone and multi-zone N2b groups and compared survival outcomes between the groups.
Materials and Methods
This retrospective study included patients with pN2 NSCLC who underwent lobectomy from 2006 to 2019. The N2 disease was subdivided into four categories: single-station N2 without N1 (N2a1), single-station N2 with N1 (N2a2), multiple-station N2 with single zone involvement (single-zone N2b), and multiple-station N2 with multiple zone involvement (multi-zone N2b). LN zones included in the subdivision of N2 disease were upper mediastinal, lower mediastinal, aortopulmonary, and subcarinal.
Results
Among 996 eligible patients, 211 (21.2%), 394 (39.6%), and 391 (39.3%) were confirmed to have pN2a1, pN2a2, and pN2b disease, respectively. In multivariable analysis after adjustment for sex, age, pT category, and adjuvant chemotherapy, overall survival was significantly better with single-zone N2b disease (n=125, 12.6%) than with multi-zone N2b disease (n=266, 26.7%) (hazard ratio [HR], 0.67; 95% confidence interval [CI], 0.49 to 0.90; p=0.009) and was comparable to that of N2a2 disease (HR, 1.12; 95% CI, 0.83 to 1.49; p=0.46).
Conclusion
Prognosis of single-zone LN metastasis was better than that of multiple-zone LN metastasis in patients with N2b NSCLC. Along with the station-based N descriptors, zone-based descriptors might ensure optimal staging, enabling the most appropriate decision-making on adjuvant therapy for patients with pN2 NSCLC.

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Gastrointestinal cancer

Survival Benefit of Adjuvant Chemotherapy in Patients with Pancreatic Ductal Adenocarcinoma Who Underwent Surgery Following Neoadjuvant FOLFIRINOX: So Heun Lee, Dae Wook Hwang, Changhoon Yoo, Kyu-pyo Kim, Sora Kang, Jae Ho Jeong, Dongwook Oh, Tae Jun Song, Sang Soo Lee, Do Hyun Park, Dong Wan Seo, Jin-hong Park, Ki Byung Song, Jae Hoon Lee, Woohyung Lee, Yejong Park, Bong Jun Kwak, Heung-Moon Chang, Baek-Yeol Ryoo, Song Cheol Kim; Cancer Res Treat. 2023;55(3):956-968. Published online February 27, 2023; DOI: https://doi.org/10.4143/crt.2022.409

Abstract PDF Supplementary Material PubReader ePub

Purpose
The benefit of adjuvant chemotherapy following curative-intent surgery in pancreatic ductal adenocarcinoma (PDAC) patients who had received neoadjuvant FOLFIRINOX is unclear. This study aimed to assess the survival benefit of adjuvant chemotherapy in this patient population.
Materials and Methods
This retrospective study included 218 patients with localized non-metastatic PDAC who received neoadjuvant FOLFIRINOX and underwent curative-intent surgery (R0 or R1) between January 2017 and December 2020. The association of adjuvant chemotherapy with disease-free survival (DFS) and overall survival (OS) was evaluated in overall patients and in the propensity score matched (PSM) cohort. Subgroup analysis was conducted according to the pathology-proven lymph node status.
Results
Adjuvant chemotherapy was administered to 149 patients (68.3%). In the overall cohort, the adjuvant chemotherapy group had significantly improved DFS and OS compared to the observation group (DFS: median, 13.8 months [95% confidence interval (CI), 11.0 to 19.1] vs. 8.2 months [95% CI, 6.5 to 12.0]; p < 0.001; and OS: median, 38.0 months [95% CI, 32.2 to not assessable] vs. 25.7 months [95% CI, 18.3 to not assessable]; p=0.005). In the PSM cohort of 57 matched pairs of patients, DFS and OS were better in the adjuvant chemotherapy group than in the observation group (p < 0.001 and p=0.038, respectively). In the multivariate analysis, adjuvant chemotherapy was a significant favorable prognostic factor (vs. observation; DFS: hazard ratio [HR], 0.51 [95% CI, 0.36 to 0.71; p < 0.001]; OS: HR, 0.45 [95% CI, 0.29 to 0.71; p < 0.001]).
Conclusion
Among PDAC patients who underwent surgery following neoadjuvant FOLFIRINOX, adjuvant chemotherapy may be associated with improved survival. Randomized studies should be conducted to validate this finding.

Citations

Citations to this article as recorded by

The survival effect of neoadjuvant therapy and neoadjuvant plus adjuvant therapy on pancreatic ductal adenocarcinoma patients with different TNM stages: a propensity score matching analysis based on the SEER database
Hao Hu, Yang Xu, Qiang Zhang, Yuan Gao, Zhenyu Wu
Expert Review of Anticancer Therapy.2024; 24(6): 467. CrossRef
Neoadjuvant treatment of pancreatic ductal adenocarcinoma: Whom, when and how
Nebojsa Manojlovic, Goran Savic, Stevan Manojlovic
World Journal of Gastrointestinal Surgery.2024; 16(5): 1223. CrossRef
Case Study on Analysing the Early Disease Detection of Pancreatic Ductal Adenocarcinoma in Korean Association for Clinical Oncology
Sijithra Ponnarassery Chandran, N. Santhi
American Journal of Clinical Oncology.2024; 47(10): 475. CrossRef
Evaluating the benefits of adjuvant chemotherapy in patients with pancreatic cancer undergoing radical pancreatectomy after neoadjuvant therapy—a systematic review and meta-analysis
Jiahao Wu, Yike Zhang, Haodong Wang, Wenyi Guo, Chengqing Li, Yichen Yu, Han Liu, Feng Li, Lei Wang, Jianwei Xu
Frontiers in Oncology.2024;[Epub] CrossRef
Prognostic factors in localized pancreatic ductal adenocarcinoma after neoadjuvant therapy and resection: a systematic review and meta-analysis
Ammar A Javed, Alyssar Habib, Omar Mahmud, Asad Saulat Fatimi, Mahip Grewal, Nabiha Mughal, Jin He, Christopher L Wolfgang, Lois Daamen, Marc G Besselink
JNCI: Journal of the National Cancer Institute.2024;[Epub] CrossRef

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Breast cancer

Retrospective Cohort Study on the Long-term Oncologic Outcomes of Sentinel Lymph Node Mapping Methods (Dye-Only versus Dye and Radioisotope Mapping) in Early Breast Cancer: A Propensity Score-Matched Analysis: Changjin Lim, Eunhye Kang, Ji Gwang Jung, Jong-Ho Cheun, Hong-Kyu Kim, Han-Byoel Lee, Hyeong-Gon Moon, Wonshik Han; Cancer Res Treat. 2023;55(2):562-569. Published online September 26, 2022; DOI: https://doi.org/10.4143/crt.2022.871

Abstract PDF PubReader ePub: Purpose
In sentinel lymph node (SLN) biopsy (SLNB) during breast cancer surgery, SLN mapping using dye and isotope (DUAL) may have lower false-negative rates than the dye-only (DYE) method. However, the long-term outcomes of either method are unclear. We aimed to compare long-term oncological outcomes of DYE and DUAL for SLNB in early breast cancer.
Materials and Methods
This retrospective single-institution cohort study included 5,795 patients (DYE, 2,323; DUAL, 3,472) with clinically node-negative breast cancer who underwent SLNB and no neoadjuvant therapy. Indigo carmine was used for the dye method and Tc99m-antimony trisulfate for the isotope. To compare long-term outcomes, pathologic N0 patients were selected from both groups, and propensity score matching (PSM), considering age, pT category, breast surgery, and adjuvant treatment, was performed (1,441 patients in each group).
Results
The median follow-up duration was 8.7 years. The median number of harvested sentinel nodes was 3.21 and 3.12 in the DYE and DUAL groups, respectively (p=0.112). The lymph node–positive rate was not significantly different between the two groups in subgroups of similar tumor sizes (p > 0.05). Multivariate logistic regression revealed that the mapping method was not significantly associated with the lymph node–positive rate (p=0.758). After PSM, the 5-year axillary recurrence rate (DYE 0.8% vs. DUAL 0.6%, p=0.096), and 5-year disease-free survival (DYE 93.9% vs. DUAL 93.7%, p=0.402) were similar between the two groups.
Conclusion
Dye alone for SLNB was not inferior to dual mapping regarding long-term oncological outcomes in early breast cancer.

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Diagnostic Assessment of Deep Learning Algorithms for Frozen Tissue Section Analysis in Women with Breast Cancer: Young-Gon Kim, In Hye Song, Seung Yeon Cho, Sungchul Kim, Milim Kim, Soomin Ahn, Hyunna Lee, Dong Hyun Yang, Namkug Kim, Sungwan Kim, Taewoo Kim, Daeyoung Kim, Jonghyeon Choi, Ki-Sun Lee, Minuk Ma, Minki Jo, So Yeon Park, Gyungyub Gong; Cancer Res Treat. 2023;55(2):513-522. Published online September 6, 2022; DOI: https://doi.org/10.4143/crt.2022.055

Abstract PDF Supplementary Material PubReader ePub

Purpose
Assessing the metastasis status of the sentinel lymph nodes (SLNs) for hematoxylin and eosin–stained frozen tissue sections by pathologists is an essential but tedious and time-consuming task that contributes to accurate breast cancer staging. This study aimed to review a challenge competition (HeLP 2019) for the development of automated solutions for classifying the metastasis status of breast cancer patients.
Materials and Methods
A total of 524 digital slides were obtained from frozen SLN sections: 297 (56.7%) from Asan Medical Center (AMC) and 227 (43.4%) from Seoul National University Bundang Hospital (SNUBH), South Korea. The slides were divided into training, development, and validation sets, where the development set comprised slides from both institutions and training and validation set included slides from only AMC and SNUBH, respectively. The algorithms were assessed for area under the receiver operating characteristic curve (AUC) and measurement of the longest metastatic tumor diameter. The final total scores were calculated as the mean of the two metrics, and the three teams with AUC values greater than 0.500 were selected for review and analysis in this study.
Results
The top three teams showed AUC values of 0.891, 0.809, and 0.736 and major axis prediction scores of 0.525, 0.459, and 0.387 for the validation set. The major factor that lowered the diagnostic accuracy was micro-metastasis.
Conclusion
In this challenge competition, accurate deep learning algorithms were developed that can be helpful for making a diagnosis on intraoperative SLN biopsy. The clinical utility of this approach was evaluated by including an external validation set from SNUBH.

Citations

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Detection of metastatic breast carcinoma in sentinel lymph node frozen sections using an artificial intelligence-assisted system
Chia-Ping Chang, Chih-Yi Hsu, Hsiang Sheng Wang, Peng-Chuna Feng, Wen-Yih Liang
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Value of frozen section to tailor surgical staging in apparent early-stage epithelial ovarian cancer
Stefano Di Berardino, Nicolò Bizzarri, Marianna Ciancia, Francesca Moro, Belen Padial Urtueta, Claudia Marchetti, Gian Franco Zannoni, Giovanni Scambia, Anna Fagotti
International Journal of Gynecological Cancer.2025; : 101746. CrossRef
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Shishun Fan, Huirui Zhang, Zhenyu Meng, Ang Li, Yuqing Luo, Yueping Liu
Journal of Clinical Pathology.2024; 77(8): 517. CrossRef
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Srijan Shukla, Nisha Hariharan
Annals of Surgical Oncology.2023; 30(9): 5314. CrossRef

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Genitourinary cancer

The Prognosis and the Role of Adjuvant Chemotherapy for Node-Positive Bladder Cancer Treated with Neoadjuvant Chemotherapy Followed by Surgery: Hyehyun Jeong, Kye Jin Park, Yongjune Lee, Hyung-Don Kim, Jwa Hoon Kim, Shinkyo Yoon, Bumsik Hong, Jae Lyun Lee; Cancer Res Treat. 2022;54(1):226-233. Published online May 6, 2021; DOI: https://doi.org/10.4143/crt.2021.365

Abstract PDF Supplementary Material PubReader ePub

Purpose
This study aims to evaluate the prognosis of pathologically node-positive bladder cancer after neoadjuvant chemotherapy, the role of adjuvant chemotherapy in these patients, and the value of preoperative clinical evaluation for lymph node metastases.
Materials and Methods
Patients who received neoadjuvant chemotherapy followed by partial/radical cystectomy and had pathologically confirmed lymph node metastases between January 2007 and December 2019 were identified and analyzed.
Results
A total of 53 patients were included in the study. The median age was 61 years (range, 34 to 81 years) with males comprising 86.8%. Among the 52 patients with post-neoadjuvant/pre-operative computed tomography results, only 33 patients (63.5%) were considered positive for lymph node metastasis. Sixteen patients (30.2%) received adjuvant chemotherapy (AC group), and 37 patients did not (no AC group). With the median follow-up duration of 67.7 months, the median recurrence-free survival (RFS) and the median overall survival (OS) was 8.5 months and 16.2 months, respectively. The 2-year RFS and OS rates were 23.3% and 34.6%, respectively. RFS and OS did not differ between the AC group and no AC group (median RFS, 8.8 months vs. 6.8 months, p=0.772; median OS, 16.1 months vs. 16.3 months, p=0.479). Thirty-eight patients (71.7%) experienced recurrence. Distant metastases were the dominant pattern of failure in both the AC group (91.7%) and no AC group (76.9%).
Conclusion
Patients with lymph node-positive disease after neoadjuvant chemotherapy followed by surgery showed high recurrence rates with limited survival outcomes. Little benefit was observed with the addition of adjuvant chemotherapy.

Citations

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A Predictive Nomogram for Development of Lymph Node Metastasis in Muscle-Invasive Bladder Cancer Following Neoadjuvant Therapy
Garrett K. Harada, Steven N. Seyedin, Olivia Heutlinger, Armon Azizi, Audree Hsu, Arash Rezazadeh, Michael Daneshvar, Greg E. Gin, Edward M. Uchio, Giovanna A. Giannico, Jeremy P. Harris, Aaron B. Simon, Jeffrey V. Kuo, Nataliya Mar
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G. Marcq, W. Kassouf, M. Roumiguié, B. Pradere, L.S. Mertens, S. Albisinni, A. Cimadamore, J. Yuen-Chun Teoh, M. Moschini, E. Laukhtina, A. Mari, F. Soria, A. Gallioli, F. del Giudice, D. d’Andrea, W. Krajewski, J.B. Beauval, E. Xylinas, D. Pouessel, P. S
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Influence of Neoadjuvant Chemotherapy on Survival Outcomes of Radical Cystectomy in Pathologically Proven Positive and Negative Lymph Nodes
Krystian Kaczmarek, Bartosz Małkiewicz, Karolina Skonieczna-Żydecka, Artur Lemiński
Cancers.2023; 15(19): 4901. CrossRef
Comparison of responses to neoadjuvant and adjuvant chemotherapies in muscle-invasive bladder cancer
Serhat Sekmek, Gökhan Ucar, Irfan Karahan, Dogan Bayram, Selin Aktürk Esen, Ismet Seven, Mehmet Ali Nahit Sendur, Dogan Uncu
African Journal of Urology.2023;[Epub] CrossRef

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Gastrointestinal Cancer

LASSO-Based Machine Learning Algorithm for Prediction of Lymph Node Metastasis in T1 Colorectal Cancer: Jeonghyun Kang, Yoon Jung Choi, Im-kyung Kim, Hye Sun Lee, Hogeun Kim, Seung Hyuk Baik, Nam Kyu Kim, Kang Young Lee; Cancer Res Treat. 2021;53(3):773-783. Published online December 29, 2020; DOI: https://doi.org/10.4143/crt.2020.974

Abstract PDF Supplementary Material PubReader ePub

Purpose
The role of tumor-infiltrating lymphocytes (TILs) in predicting lymph node metastasis (LNM) in patients with T1 colorectal cancer (CRC) remains unclear. Furthermore, clinical utility of a machine learning–based approach has not been widely studied.
Materials and Methods
Immunohistochemistry for TILs against CD3, CD8, and forkhead box P3 in both center and invasive margin of the tumor were performed using surgically resected T1 CRC slides. Three hundred and sixteen patients were enrolled and categorized into training (n=221) and validation (n=95) sets via random sampling. Using clinicopathologic variables including TILs, the least absolute shrinkage and selection operator (LASSO) regression model was applied for variable selection and predictive signature building in the training set. The predictive accuracy of our model and the Japanese criteria were compared using area under the receiver operating characteristic (AUROC), net reclassification improvement (NRI)/integrated discrimination improvement (IDI), and decision curve analysis (DCA) in the validation set.
Results
LNM was detected in 29 (13.1%) and 12 (12.6%) patients in training and validation sets, respectively. Nine variables were selected and used to generate the LASSO model. Its performance was similar in training and validation sets (AUROC, 0.795 vs. 0.765; p=0.747). In the validation set, the LASSO model showed better outcomes in predicting LNM than Japanese criteria, as measured by AUROC (0.765 vs. 0.518, p=0.003) and NRI (0.447, p=0.039)/IDI (0.121, p=0.034). DCA showed positive net benefits in using our model.
Conclusion
Our LASSO model incorporating histopathologic parameters and TILs showed superior performance compared to conventional Japanese criteria in predicting LNM in patients with T1 CRC.

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Breast cancer

Challenge for Diagnostic Assessment of Deep Learning Algorithm for Metastases Classification in Sentinel Lymph Nodes on Frozen Tissue Section Digital Slides in Women with Breast Cancer: Young-Gon Kim, In Hye Song, Hyunna Lee, Sungchul Kim, Dong Hyun Yang, Namkug Kim, Dongho Shin, Yeonsoo Yoo, Kyowoon Lee, Dahye Kim, Hwejin Jung, Hyunbin Cho, Hyungyu Lee, Taeu Kim, Jong Hyun Choi, Changwon Seo, Seong il Han, Young Je Lee, Young Seo Lee, Hyung-Ryun Yoo, Yongju Lee, Jeong Hwan Park, Sohee Oh, Gyungyub Gong; Cancer Res Treat. 2020;52(4):1103-1111. Published online June 30, 2020; DOI: https://doi.org/10.4143/crt.2020.337

Abstract PDF PubReader ePub

Purpose
Assessing the status of metastasis in sentinel lymph nodes (SLNs) by pathologists is an essential task for the accurate staging of breast cancer. However, histopathological evaluation of sentinel lymph nodes by a pathologist is not easy and is a tedious and time-consuming task. The purpose of this study is to review a challenge competition (HeLP 2018) to develop automated solutions for the classification of metastases in hematoxylin and eosin–stained frozen tissue sections of SLNs in breast cancer patients.
Materials and Methods
A total of 297 digital slides were obtained from frozen SLN sections, which include post–neoadjuvant cases (n = 144, 48.5%) in Asan Medical Center, South Korea. The slides were divided into training, development, and validation sets. All of the imaging datasets have been manually segmented by expert pathologists. A total of 10 participants were allowed to use the Kakao challenge platform for six weeks with two P40 GPUs. The algorithms were assessed in terms of the AUC (area under receiver operating characteristic curve).
Results
The top three teams showed 0.986, 0.985, and 0.945 AUCs for the development set and 0.805, 0.776, and 0.765 AUCs for the validation set. Micrometastatic tumors, neoadjuvant systemic therapy, invasive lobular carcinoma, and histologic grade 3 were associated with lower diagnostic accuracy.
Conclusion
In a challenge competition, accurate deep learning algorithms have been developed, which can be helpful in making frozen diagnosis of intraoperative sentinel lymph node biopsy. Whether this approach has clinical utility will require evaluation in a clinical setting

Citations

Citations to this article as recorded by

Detection of metastatic breast carcinoma in sentinel lymph node frozen sections using an artificial intelligence-assisted system
Chia-Ping Chang, Chih-Yi Hsu, Hsiang Sheng Wang, Peng-Chuna Feng, Wen-Yih Liang
Pathology - Research and Practice.2025; 267: 155836. CrossRef
Diagnostic Assessment of Deep Learning Algorithms for Frozen Tissue Section Analysis in Women with Breast Cancer
Young-Gon Kim, In Hye Song, Seung Yeon Cho, Sungchul Kim, Milim Kim, Soomin Ahn, Hyunna Lee, Dong Hyun Yang, Namkug Kim, Sungwan Kim, Taewoo Kim, Daeyoung Kim, Jonghyeon Choi, Ki-Sun Lee, Minuk Ma, Minki Jo, So Yeon Park, Gyungyub Gong
Cancer Research and Treatment.2023; 55(2): 513. CrossRef
Artificial intelligence and frozen section histopathology: A systematic review
Benjamin G. Gorman, Mark A. Lifson, Nahid Y. Vidal
Journal of Cutaneous Pathology.2023; 50(9): 852. CrossRef
Effectiveness of transfer learning for enhancing tumor classification with a convolutional neural network on frozen sections
Young-Gon Kim, Sungchul Kim, Cristina Eunbee Cho, In Hye Song, Hee Jin Lee, Soomin Ahn, So Yeon Park, Gyungyub Gong, Namkug Kim
Scientific Reports.2020;[Epub] CrossRef

8,525 View
207 Download
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Head/neck cancer

Nomogram for Predicting Central Lymph Node Metastasis in Papillary Thyroid Cancer: A Retrospective Cohort Study of Two Clinical Centers: Zheyu Yang, Yu Heng, Jianwei Lin, Chenghao Lu, Dingye Yu, Lei Tao, Wei Cai; Cancer Res Treat. 2020;52(4):1010-1018. Published online June 9, 2020; DOI: https://doi.org/10.4143/crt.2020.254

Abstract PDF PubReader ePub

Purpose
Central lymph node metastasis (CNM) are highly prevalent but hard to detect preoperatively in papillary thyroid carcinoma (PTC) patients, while the significance of prophylactic compartment central lymph node dissection (CLND) remains controversial as a treatment option. We aim to establish a nomogram assessing risks of CNM in PTC patients, and explore whether prophylactic CLND should be recommended.
Materials and Methods
One thousand four hundred thirty-eight patients from two clinical centers that underwent thyroidectomy with CLND for PTC within the period 2016–2019 were retrospectively analyzed. Univariate and multivariate analysis were performed to examine risk factors associated with CNM. A nomogram for predicting CNM was established, thereafter internally and externally validated.
Results
Seven variables were found to be significantly associated with CNM and were used to construct the model. These were as follows: thyroid capsular invasion, multifocality, creatinine > 70 μmol/L, age < 40, tumor size > 1 cm, body mass index < 22, and carcinoembryonic antigen > 1 ng/mL. The nomogram had good discrimination with a concordance index of 0.854 (95% confidence interval [CI], 0.843 to 0.867), supported by an external validation point estimate of 0.825 (95% CI, 0.793 to 0.857). A decision curve analysis was made to evaluate nomogram and ultrasonography for predicting CNM.
Conclusion
A validated nomogram utilizing readily available preoperative variables was developed to predict the probability of central lymph node metastases in patients presenting with PTC. This nomogram may help surgeons make appropriate surgical decisions in the management of PTC, especially in terms of whether prophylactic CLND is warranted.

Citations

Citations to this article as recorded by

Risk nomogram for papillary thyroid microcarcinoma with central lymph node metastasis and postoperative thyroid function follow-up
Yuting Huang, Pengwei Lou, Hui Li, Yinhui Li, Li Ma, Kai Wang
Frontiers in Endocrinology.2024;[Epub] CrossRef
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Weihan Xiao, Xiaomin Hu, Chaoxue Zhang, Xiachuan Qin
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Yubo Sun, Wei Sun, Jingzhe Xiang, Hao Zhang
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An integrated nomogram combining deep learning, clinical characteristics and ultrasound features for predicting central lymph node metastasis in papillary thyroid cancer: A multicenter study
Luchen Chang, Yanqiu Zhang, Jialin Zhu, Linfei Hu, Xiaoqing Wang, Haozhi Zhang, Qing Gu, Xiaoyu Chen, Sheng Zhang, Ming Gao, Xi Wei
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Central and lateral neck involvement in papillary thyroid carcinoma patients with or without thyroid capsular invasion: A multi-center analysis
Zheyu Yang, Yu Heng, Jian Zhou, Lei Tao, Wei Cai
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Development and validation of nomograms for predicting the risk of central lymph node metastasis of solitary papillary thyroid carcinoma of the isthmus
Yonghao Li, Xuefei Gao, Tiantian Guo, Jing Liu
Journal of Cancer Research and Clinical Oncology.2023; 149(16): 14853. CrossRef
Development and validation of an individualized nomogram for predicting the high-volume (> 5) central lymph node metastasis in papillary thyroid microcarcinoma
X. Wei, Y. Min, Y. Feng, D. He, X. Zeng, Y. Huang, S. Fan, H. Chen, J. Chen, K. Xiang, H. Luo, G. Yin, D. Hu
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Preoperative Prediction of Central Cervical Lymph Node Metastasis in Fine-Needle Aspiration Reporting Suspicious Papillary Thyroid Cancer or Papillary Thyroid Cancer Without Lateral Neck Metastasis
Kai Zhang, Lang Qian, Jieying Chen, Qian Zhu, Cai Chang
Frontiers in Oncology.2022;[Epub] CrossRef
Relationship between subgroups of central and lateral lymph node metastasis in clinically node-negative papillary thyroid carcinoma
Jing Zhou, Da-Xue Li, Han Gao, Xin-Liang Su
World Journal of Clinical Cases.2022; 10(12): 3709. CrossRef
Hashimoto’s Thyroiditis Is Associated With Central Lymph Node Metastasis in Classical Papillary Thyroid Cancer: Analysis from a High-Volume Single-Center Experience
Bin Zeng, Yu Min, Yang Feng, Ke Xiang, Hang Chen, Zijing Lin
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Nomogram model based on preoperative serum thyroglobulin and clinical characteristics of papillary thyroid carcinoma to predict cervical lymph node metastasis
Qungang Chang, Jieming Zhang, Yaqian Wang, Hongqiang Li, Xin Du, Daohong Zuo, Detao Yin
Frontiers in Endocrinology.2022;[Epub] CrossRef
Ultrasound-based radiomics nomogram combined with clinical features for the prediction of central lymph node metastasis in papillary thyroid carcinoma patients with Hashimoto’s thyroiditis
Peile Jin, Jifan Chen, Yiping Dong, Chengyue Zhang, Yajun Chen, Cong Zhang, Fuqiang Qiu, Chao Zhang, Pintong Huang
Frontiers in Endocrinology.2022;[Epub] CrossRef
Lateral Involvement in Different Sized Papillary Thyroid Carcinomas Patients with Central Lymph Node Metastasis: A Multi-Center Analysis
Yu Heng, Zheyu Yang, Pengyu Cao, Xi Cheng, Lei Tao
Journal of Clinical Medicine.2022; 11(17): 4975. CrossRef
Risk factors and prediction models of lymph node metastasis in papillary thyroid carcinoma based on clinical and imaging characteristics
Yanyuan Deng, Jie Zhang, Jiao Wang, Jinying Wang, Junping Zhang, Lulu Guan, Shasha He, Xiudan Han, Wei Cai, Jixiong Xu
Postgraduate Medicine.2022;[Epub] CrossRef
A prognostic nomogram for papillary thyroid cancer lymph node metastasis based on immune score
Yihua Lu, Kai Qian, Mengjia Fei, Kai Guo, Yuan Shi, Zhuoying Wang
Frontiers in Endocrinology.2022;[Epub] CrossRef
Risk factors for central and lateral lymph node metastasis in papillary thyroid carcinoma
Ji Hyun Ahn, Hee Kyung Chang
Kosin Medical Journal.2022; 37(4): 311. CrossRef
Construction and validation of a nomogram for predicting cervical lymph node metastasis in classic papillary thyroid carcinoma
Y. Feng, Y. Min, H. Chen, K. Xiang, X. Wang, G. Yin
Journal of Endocrinological Investigation.2021; 44(10): 2203. CrossRef
Application of Machine Learning Algorithms to Predict Central Lymph Node Metastasis in T1-T2, Non-invasive, and Clinically Node Negative Papillary Thyroid Carcinoma
Jiang Zhu, Jinxin Zheng, Longfei Li, Rui Huang, Haoyu Ren, Denghui Wang, Zhijun Dai, Xinliang Su
Frontiers in Medicine.2021;[Epub] CrossRef
Preoperative Predictors of Lymph Node Metastasis in Colon Cancer
Yansong Xu, Yi Chen, Chenyan Long, Huage Zhong, Fangfang Liang, Ling-xu Huang, Chuanyi Wei, Shaolong Lu, Weizhong Tang
Frontiers in Oncology.2021;[Epub] CrossRef
Preoperatively Predicting the Central Lymph Node Metastasis for Papillary Thyroid Cancer Patients With Hashimoto’s Thyroiditis
Yu Min, Yizhou Huang, Minjie Wei, Xiaoyuan Wei, Hang Chen, Xing Wang, Jialin Chen, Ke Xiang, Yang Feng, Guobing Yin
Frontiers in Endocrinology.2021;[Epub] CrossRef
Reevaluation of Criteria and Establishment of Models for Total Thyroidectomy in Differentiated Thyroid Cancer
Zhenghao Wu, Yunxiao Xiao, Jie Ming, Yiquan Xiong, Shuntao Wang, Shengnan Ruan, Tao Huang
Frontiers in Oncology.2021;[Epub] CrossRef
Influencing Factors and Cumulative Risk Analysis of Cervical Lymph Node Metastasis of Papillary Thyroid Microcarcinoma
Yirong Yin, Xiang Xu, Liyan Shen, Wenjuan Zhao, Hongcui Diao, Chengqian Li
Frontiers in Oncology.2021;[Epub] CrossRef
A Specific Predicting Model for Screening Skip Metastasis From Patients With Negative Central Lymph Nodes Metastasis in Papillary Thyroid Cancer
Zheyu Yang, Yu Heng, Qiwu Zhao, Zichao Cao, Lei Tao, Weihua Qiu, Wei Cai
Frontiers in Endocrinology.2021;[Epub] CrossRef
Computed Tomography-Based Radiomics Model to Predict Central Cervical Lymph Node Metastases in Papillary Thyroid Carcinoma: A Multicenter Study
Jingjing Li, Xinxin Wu, Ning Mao, Guibin Zheng, Haicheng Zhang, Yakui Mou, Chuanliang Jia, Jia Mi, Xicheng Song
Frontiers in Endocrinology.2021;[Epub] CrossRef
Nomogram Including Elastography for Prediction of Contralateral Central Lymph Node Metastasis in Solitary Papillary Thyroid Carcinoma Preoperatively

Ning Li, Ju-hua He, Chao Song, Li-chun Yang, Hong-jiang Zhang, Zhi-hai Li
Cancer Management and Research.2020; Volume 12: 10789. CrossRef

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Establishment and Validation of a Nomogram for Nasopharyngeal Carcinoma Patients Concerning the Prognostic Effect of Parotid Lymph Node Metastases: Chao Lin, Xue-Song Sun, Sai-Lan Liu, Xiao-Yun Li, Nian Lu, Xin-Ling Li, Lin-Quan Tang, Ling Guo; Cancer Res Treat. 2020;52(3):855-866. Published online March 10, 2020; DOI: https://doi.org/10.4143/crt.2019.772

Abstract PDF PubReader ePub

Purpose
The prognosis of nasopharyngeal carcinoma (NPC) patients with parotid lymph node (PLN) metastasis remains unclear. This study was performed to investigate the prognostic significance and optimal staging category of PLN metastasis and develop a nomogram for estimating individual risk.
Materials and Methods
Clinical data of 7,084 non-metastatic NPC patients were retrospectively reviewed. Overall survival (OS) was the primary endpoint. A nomogram was established based on the Cox proportional hazards regression model. The accuracy and calibration ability of this nomogram was evaluated by C-index and calibration curves with bootstrap validation.
Result
Totally, 164/7,084 NPC patients (2.3%) presented with PLNs. Multivariate analyses showed that PLN metastasis was a negative prognostic factor for OS, progression-free survival (PFS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRFS). Patients with PLN metastasis had a worse prognosis than N3 disease. Five independent prognostic factors were included in the nomogram, which showed a C-index of 0.743. The calibration curves for probability of 3- and 5-year OS indicated satisfactory agreement between nomogram-based prediction and actual observation. All results were confirmed in the validation cohort.
Conclusion
NPC patient with PLN metastasis had poorer survival outcome (OS, PFS, DMFS, and LRFS) than N3 disease. We developed a nomogram to provide individual prediction of OS for patients with PLN metastasis.

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Risk factors analysis and nomogram for predicting recurrence in periocular basal cell carcinoma
Xincen Hou, Alexander C. Rokohl, Katharina Berndt, Senmao Li, Xiaojun Ju, Philomena A. Wawer Matos, Wanlin Fan, Ludwig M. Heindl
Canadian Journal of Ophthalmology.2025;[Epub] CrossRef
Advances in Nasopharyngeal Carcinoma Staging: from the 7th to the 9th Edition of the TNM System and Future Outlook
Binhao Wu, Xiaozhong Chen, Caineng Cao
Current Oncology Reports.2025; 27(3): 322. CrossRef
Analysis of patients with parotid recurrence after parotid-sparing IMRT for nasopharyngeal carcinoma: case series and review of the literature
Sezin Yuce Sari, Melek Tugce Yilmaz, Gozde Yazici, Sepideh Mohammadipour, Gokhan Ozyigit, Ibrahim Gullu, Mustafa Cengiz
Strahlentherapie und Onkologie.2024; 200(12): 1057. CrossRef
Nomogram Based on Liver Function Test Indicators for Survival Prediction in Nasopharyngeal Carcinoma Patients Receiving PD-1 Inhibitor Therapy
Lixia Liang, Yan Li, Yansui Hong, Tianxing Ji, Hao Chen, Zhifang Lin
Current Oncology.2023; 30(8): 7189. CrossRef
A Randomized Controlled Trial on Evaluation of Plasma Epstein-Barr Virus Biomarker for Early Diagnosis in Patients With Nasopharyngeal Carcinoma
Wen Liu, Huilan Li, Hui Sheng, Xiaohua Liu, Peidong Chi, Xueping Wang, Minjie Mao
Advances in Therapy.2020; 37(10): 4280. CrossRef
Prognosis prediction signature of seven immune genes based on HPV status in cervical cancer
Qianqian Xia, Hua Jin, Xing Zhang, Wenjing Yan, Dan Meng, Bo Ding, Jian Cao, Dake Li, Shizhi Wang
International Immunopharmacology.2020; 88: 106935. CrossRef

15,221 View
127 Download
4 Web of Science
6 Crossref

Pretreatment Lymph Node Metastasis as a Prognostic Significance in Cervical Cancer: Comparison between Disease Status: Soo Young Jeong, Hyea Park, Myeong Seon Kim, Jun Hyeok Kang, E Sun Paik, Yoo-Young Lee, Tae Joong Kim, Jeong Won Lee, Byoung-Gie Kim, Duk Soo Bae, Chel Hun Choi; Cancer Res Treat. 2020;52(2):516-523. Published online October 29, 2019; DOI: https://doi.org/10.4143/crt.2019.328

Abstract PDF Supplementary Material PubReader ePub

Purpose
Lymph node metastasis (LNM) is the most significant prognostic factor in cervical cancer that was recently incorporated into the International Federation of Gynecology and Obstetrics (FIGO) staging system. This study was performed to evaluate whether the prognostic significance of LNM differs according to disease status.
Materials and Methods
Patients with FIGO stage IB or higher cervical cancer who had pretreatment computed tomography and/or magnetic resonance imaging studies as well as long-term follow-up were enrolled in this retrospective study. The hazard ratio (HR) of Cox regression was used to determine the prognostic significance of LNM. The HRs were compared between the different tumor groups (based on stage, histology, tumor size, primary treatment, age, parametrium involvement, and lymphovascular space invasion).
Results
A total of 970 patients treated between January 1999 and December 2007 were included. The pretreatment LNM had prognostic significance in patients with stage IB1/IIA (HR for progression-free survival 2.10, p=0.001; HR for overall survival 1.99, p=0.005). However, the significance gradually decreased or disappeared with advancing stages. Similarly, the prognostic significance of the pretreatment LNM decreased with advancing disease status, including old age, parametrial involvement or lymphovascular space involvement. In contrast, the tumor size was associated with the prognostic significance of LNM with advancing status. The significance of the clinical LNM did not reflect the significance of the clinical stage. In contrast, the tumor size, parametrial involvement, and significance of the pathologic LNM reflected the clinical stage.
Conclusion
In patients with cervical cancer, pretreatment LNM on imaging has different clinical significance depending on the tumor status.

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Development of cervical intraepithelial neoplasia and invasive cervical cancer due to oxidative stress
Amir Asotić, Memić Asotić, Muhamed Memić, Kerim Asotić, Amra Asotić
Sanamed.2024; 19(1): 39. CrossRef
Investigating and Analyzing Prognostic Factors and Their Impact on Recurrent Cervical Cancers
Ashish Uke, Shweta B Dahake, Anurag Luharia, Monika Luharia, Gaurav V Mishra, Chanrashekhar Mahakalkar
Cureus.2024;[Epub] CrossRef
Based on 3D-PDU and clinical characteristics nomogram for prediction of lymph node metastasis and lymph-vascular space invasion of early cervical cancer preoperatively
Shuang Dong, Yan-Qing Peng, Ya-Nan Feng, Xiao-Ying Li, Li-Ping Gong, Shuang Zhang, Xiao-Shan Du, Li-Tao Sun
BMC Women's Health.2024;[Epub] CrossRef
Recent Advances in Cervical Cancer Management: A Review on Novel Prognostic Factors in Primary and Recurrent Tumors
Angela Santoro, Frediano Inzani, Giuseppe Angelico, Damiano Arciuolo, Emma Bragantini, Antonio Travaglino, Michele Valente, Nicoletta D’Alessandris, Giulia Scaglione, Stefania Sfregola, Alessia Piermattei, Federica Cianfrini, Paola Roberti, Gian Franco Za
Cancers.2023; 15(4): 1137. CrossRef
Identification of lymph node metastasis in pre‐operation cervical cancer patients by weakly supervised deep learning from histopathological whole‐slide biopsy images
Qingqing Liu, Nan Jiang, Yiping Hao, Chunyan Hao, Wei Wang, Tingting Bian, Xiaohong Wang, Hua Li, Yan zhang, Yanjun Kang, Fengxiang Xie, Yawen Li, XuJi Jiang, Yuan Feng, Zhonghao Mao, Qi Wang, Qun Gao, Wenjing Zhang, Baoxia Cui, Taotao Dong
Cancer Medicine.2023; 12(17): 17952. CrossRef
Roles of DWI and T2-weighted MRI volumetry in the evaluation of lymph node metastasis and lymphovascular invasion of stage IB–IIA cervical cancer
Y. Wang, X. Chen, H. Pu, Y. Yuan, S. Li, G. Chen, Y. Liu, H. Li
Clinical Radiology.2022; 77(3): 224. CrossRef
Risk Factor Assessment of Lymph Node Metastasis in Patients With FIGO Stage IB1 Cervical Cancer
Mu Xu, Xiaoyan Xie, Liangzhi Cai, Yongjin Xie, Qiao Gao, Pengming Sun
Frontiers in Oncology.2022;[Epub] CrossRef
Intravoxel Incoherent Motion (IVIM) MR Quantification in Locally Advanced Cervical Cancer (LACC): Preliminary Study on Assessment of Tumor Aggressiveness and Response to Neoadjuvant Chemotherapy
Miriam Dolciami, Silvia Capuani, Veronica Celli, Alessandra Maiuro, Angelina Pernazza, Innocenza Palaia, Violante Di Donato, Giusi Santangelo, Stefania Maria Rita Rizzo, Paolo Ricci, Carlo Della Rocca, Carlo Catalano, Lucia Manganaro
Journal of Personalized Medicine.2022; 12(4): 638. CrossRef
The prognostic significance of pretreatment squamous cell carcinoma antigen levels in cervical cancer patients treated by concurrent chemoradiation therapy and a comparison of dosimetric outcomes and clinical toxicities between tomotherapy and volumetric
Yuan-Kai Cheng, Shih-Hsun Kuo, Heng-Hsuan Yen, Jing-Hu Wu, Yu-Chieh Chen, Ming-Yii Huang
Radiation Oncology.2022;[Epub] CrossRef
What MRI-based tumor size measurement is best for predicting long-term survival in uterine cervical cancer?
Njål Lura, Kari S. Wagner-Larsen, David Forsse, Jone Trovik, Mari K. Halle, Bjørn I. Bertelsen, Øyvind Salvesen, Kathrine Woie, Camilla Krakstad, Ingfrid S. Haldorsen
Insights into Imaging.2022;[Epub] CrossRef
Clinical value of MRI, serum SCCA, and CA125 levels in the diagnosis of lymph node metastasis and para-uterine infiltration in cervical cancer
Chao Ran, Jian Sun, Yunhui Qu, Na Long
World Journal of Surgical Oncology.2021;[Epub] CrossRef
A Novel Four-Gene Prognostic Signature as a Risk Biomarker in Cervical Cancer
Jun Wang, Hua Zheng, Yatian Han, Geng Wang, Yanbin Li, Cuida Meng
International Journal of Genomics.2020; 2020: 1. CrossRef

10,425 View
223 Download
14 Web of Science
12 Crossref

Impact of Regional Nodal Irradiation for Breast Cancer Patients with Supraclavicular and/or Internal Mammary Lymph Node Involvement: A Multicenter, Retrospective Study (KROG 16-14): Kyubo Kim, Yuri Jeong, Kyung Hwan Shin, Jin Ho Kim, Seung Do Ahn, Su Ssan Kim, Chang-Ok Suh, Yong Bae Kim, Doo Ho Choi, Won Park, Jihye Cha, Mison Chun, Dong Soo Lee, Sun Young Lee, Jin Hee Kim, Hae Jin Park, Wonguen Jung; Cancer Res Treat. 2019;51(4):1500-1508. Published online March 15, 2019; DOI: https://doi.org/10.4143/crt.2018.575

Abstract PDF Supplementary Material PubReader ePub

Purpose
The purpose of this study was to evaluate the treatment outcomes of radiotherapy (RT) for breast cancer with ipsilateral supraclavicular (SCL) and/or internal mammary (IMN) lymph node involvement.
Materials and Methods
A total of 353 patients from 11 institutions were included. One hundred and thirty-six patients had SCL involvement, 148 had IMN involvement, and 69 had both. All patients received neoadjuvant systemic therapy followed by breast-conserving surgery or mastectomy, and postoperative RT to whole breast/chest wall. As for regional lymph node irradiation, SCL RT was given to 344 patients, and IMN RT to 236 patients. The median RT dose was 50.4 Gy.
Results
The median follow-up duration was 61 months (range, 7 to 173 months). In-field progression was present in SCL (n=20) and/or IMN (n=7). The 5-year disease-free survival (DFS) and overall survival rates were 57.8% and 75.1%, respectively. On multivariate analysis, both SCL/IMN involvement, number of axillary lymph node ≥ 4, triple-negative subtype, and mastectomy were significant adverse prognosticators for DFS (p=0.022, p=0.001, p=0.001, and p=0.004, respectively). Regarding the impact of regional nodal irradiation, SCL RT dose ≥ 54 Gy was not associated with DFS (5-year rate, 52.9% vs. 50.9%; p=0.696) in SCL-involved patients, and the receipt of IMN RT was not associated with DFS (5-year rate, 56.1% vs. 78.1%; p=0.099) in IMN-involved patients.
Conclusion
Neoadjuvant chemotherapy followed by surgery and postoperative RT achieved an acceptable in-field regional control rate in patients with SCL and/or IMN involvement. However, a higher RT dose to SCL or IMN RT was not associated with the improved DFS in these patients.

Citations

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Clinical outcomes after post-operative radiotherapy for breast cancer patients presenting with ipsilateral supraclavicular metastasis: considerations on the cranial border of irradiation field
Xiaofang Wang, Xiaomeng Zhang, Li Zhang, Jin Meng, Wei Shi, Xingxing Chen, Zhaozhi Yang, Xin Mei, Xiaoli Yu, Zhen Zhang, Zhimin Shao, Xiaomao Guo, Jinli Ma
Breast Cancer.2025; 32(1): 144. CrossRef
Outcomes and Trends in Axillary Management of Stage cN3b Breast Cancer Patients
Julia M. Selfridge, Zachary Schrank, Chris B. Agala, David W. Ollila, Kristalyn K. Gallagher, Dana L. Casey, Philip M. Spanheimer
Annals of Surgical Oncology.2025; 32(3): 2070. CrossRef
Internal mammary regional management after neoadjuvant therapy in breast cancer
Zhao Bi, Chun-Hui Zheng, Tong-Yue Ren, Yong-Sheng Wang
International Journal of Surgery.2024;[Epub] CrossRef
Oncological outcomes in patients with residual triple-negative breast cancer after preoperative chemotherapy
Hyunki Park, Haeyoung Kim, Won Park, Won Kyung Cho, Nalee Kim, Tae Gyu Kim, Young-Hyuck Im, Jin Seok Ahn, Yeon Hee Park, Ji-Yeon Kim, Seok Jin Nam, Seok Won Kim, Jeong Eon Lee, Jonghan Yu, Byung Joo Chae, Sei Kyung Lee, Jai-Min Ryu
Radiation Oncology Journal.2024; 42(3): 210. CrossRef
Clinical audit of breast cancer patients treated with helical tomotherapy for irradiation of the internal mammary chain
Garima Shrivastav, Debanjali Datta, Tabassum Wadasadawala, Pallavi Rane, Subhajit Panda, Rima Pathak, Libin Scaria, Revathy Krishnamurthy, Rajiv Sarin
Journal of Radiotherapy in Practice.2023;[Epub] CrossRef
The optimal regional irradiation volume for breast cancer patients: A comprehensive systematic review and network meta-analysis of published studies
Wei-Xiang Qi, Lu Cao, Cheng Xu, Gang Cai, Jiayi Chen
Frontiers in Oncology.2023;[Epub] CrossRef
Contemporary Outcomes After Multimodality Therapy in Patients With Breast Cancer Presenting With Ipsilateral Supraclavicular Node Involvement
Kevin Diao, Lauren M. Andring, Carlos H. Barcenas, Puneet Singh, Huong (Carisa) Le-Petross, Valerie K. Reed, Jay P. Reddy, Elizabeth S. Bloom, Neelofur R. Ahmad, Lauren L. Mayo, George H. Perkins, Melissa P. Mitchell, Kevin T. Nead, Welela Tereffe, Benjam
International Journal of Radiation Oncology*Biology*Physics.2022; 112(1): 66. CrossRef
Locoregional Management and Prognostic Factors in Breast Cancer With Ipsilateral Internal Mammary and Axillary Lymph Node Involvement
Lauren M. Andring, Kevin Diao, Susie Sun, Miral Patel, Gary J. Whitman, Pamela Schlembach, Isadora Arzu, Melissa M. Joyner, Simona F. Shaitelman, Karen Hoffman, Michael C. Stauder, Benjamin D. Smith, Wendy A. Woodward
International Journal of Radiation Oncology*Biology*Physics.2022; 113(3): 552. CrossRef
Yesterday, Today and Tomorrow – Are We Any Closer to Knowing Which Patients Will Benefit from Adjuvant Internal Mammary Nodal Irradiation?
C.A. Johnson, J. Evans
Clinical Oncology.2022; 34(8): 534. CrossRef
Dynamics of circulating tumor DNA during postoperative radiotherapy in patients with residual triple-negative breast cancer following neoadjuvant chemotherapy: a prospective observational study
Haeyoung Kim, Yeon Jeong Kim, Donghyun Park, Woong-Yang Park, Doo Ho Choi, Won Park, Won kyung Cho, Nalee Kim
Breast Cancer Research and Treatment.2021; 189(1): 167. CrossRef
Cervical Lymph Node Involvement above the Supraclavicular Fossa in Breast Cancer: Comparison with Stage IIIC (KROG 18-02)
Jae Sik Kim, Kyubo Kim, Kyung Hwan Shin, Jin Ho Kim, Seung Do Ahn, Su Ssan Kim, Yong Bae Kim, Jee Suk Chang, Doo Ho Choi, Won Park, Tae Hyun Kim, Mison Chun, Jihye Cha, Jin Hee Kim, Dong Soo Lee, Sun Young Lee, Hae Jin Park
Journal of Breast Cancer.2020; 23(2): 194. CrossRef
Aggressive Surgical Excision of Supraclavicular Lymph Node Did Not Improve the Outcomes of Breast Cancer With Supraclavicular Lymph Node Involvement (KROG 16-14)
Kyubo Kim, Su Ssan Kim, Kyung Hwan Shin, Jin Ho Kim, Seung Do Ahn, Doo Ho Choi, Won Park, Sun Young Lee, Mison Chun, Jin Hee Kim, Yong Bae Kim, Jihye Cha, Hae Jin Park, Dong Soo Lee, Wonguen Jung
Clinical Breast Cancer.2020; 20(1): 51. CrossRef
Combined Therapy Can Improve the Outcomes of Breast Cancer with Isolated Supraclavicular Lymph Node Involvement

Tianyi Ma, Yan Mao, Haibo Wang
Cancer Management and Research.2020; Volume 12: 11857. CrossRef

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331 Download
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Nomogram Development and External Validation for Predicting the Risk of Lymph Node Metastasis in T1 Colorectal Cancer: Jung Ryul Oh, Boram Park, Seongdae Lee, Kyung Su Han, Eui-Gon Youk, Doo-Han Lee, Do-Sun Kim, Doo-Seok Lee, Chang Won Hong, Byung Chang Kim, Bun Kim, Min Jung Kim, Sung Chan Park, Dae Kyung Sohn, Hee Jin Chang, Jae Hwan Oh; Cancer Res Treat. 2019;51(4):1275-1284. Published online January 17, 2019; DOI: https://doi.org/10.4143/crt.2018.569

Abstract PDF Supplementary Material PubReader ePub

Purpose
Predicting lymph node metastasis (LNM) risk is crucial in determining further treatment strategies following endoscopic resection of T1 colorectal cancer (CRC). This study aimed to establish a new prediction model for the risk of LNM in T1 CRC patients.
Materials and Methods
The development set included 833 patients with T1 CRC who had undergone endoscopic (n=154) or surgical (n=679) resection at the National Cancer Center. The validation set included 722 T1 CRC patients who had undergone endoscopic (n=249) or surgical (n=473) resection at Daehang Hospital. A logistic regression model was used to construct the prediction model. To assess the performance of prediction model, discrimination was evaluated using the receiver operating characteristic (ROC) curves with area under the ROC curve (AUC), and calibration was assessed using the Hosmer-Lemeshow (HL) goodness-of-fit test.
Results
Five independent risk factors were determined in the multivariable model, including vascular invasion, high-grade histology, submucosal invasion, budding, and background adenoma. In final prediction model, the performance of the model was good that the AUC was 0.812 (95% confidence interval [CI], 0.770 to 0.855) and the HL chi-squared test statistic was 1.266 (p=0.737). In external validation, the performance was still good that the AUC was 0.771 (95% CI, 0.708 to 0.834) and the p-value of the HL chi-squared test was 0.040. We constructed the nomogram with the final prediction model.
Conclusion
We presented an externally validated new prediction model for LNM risk in T1 CRC patients, guiding decision making in determining whether additional surgery is required after endoscopic resection of T1 CRC.

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Prognostic Value and Staging Classification of Lymph Nodal Necrosis in Nasopharyngeal Carcinoma after Intensity-Modulated Radiotherapy: Yanru Feng, Caineng Cao, Qiaoying Hu, Xiaozhong Chen; Cancer Res Treat. 2019;51(3):1222-1230. Published online December 27, 2018; DOI: https://doi.org/10.4143/crt.2018.595

Abstract PDF PubReader ePub

Purpose
The aim of the present study was to evaluate the prognostic value of magnetic resonance imaging (MRI)‒determined lymph nodal necrosis (LNN) in nasopharyngeal carcinoma (NPC) and explore the feasibility of an N-classification system based on the 8th edition of the American Joint Committee on Cancer (AJCC) system.
Materials and Methods
The MRI scans of 616 patients with newly diagnosed stage T1-4N1-3M0 NPC who were treated with definitive intensity-modulated radiotherapy (IMRT) were reviewed.
Results
Multivariate analysis showed that LNN was an independent negative prognostic predictor of distant metastasis free survival (hazard ratio, 1.634; 95% confidence interval, 1.023 to 2.609; p=0.040) and overall survival (hazard ratio, 2.154; 95% confidence interval, 1.282 to 3.620; p=0.004). Patients of classification N1 disease with LNN were reclassified as classification N2, and classification N2 disease with LNN as classification N3 in the proposed N-classification system. Correlation with death and distant failure was significant, and the total difference between N1 and N3 was wider with the proposed system.
Conclusion
MRI-determined LNN is an independent negative prognostic factor for NPC. The proposed N classification system is powerfully predictive.

Citations

Citations to this article as recorded by

Identifying adverse nodal features associated with poor prognosis in stage IB nasopharyngeal carcinoma patients based on the 9th AJCC/UICC staging system: Implications for treatment intensification
Jing Zhong, Hongye Chen, Xinlan Chen, Ning Ma, Yuan Huang, Shaojun Lin, Jianji Pan, Yunbin Chen, Tianzhu Lu, Youping Xiao, Peng Shi, Hanchuan Xu, Qiaojuan Guo
Radiotherapy and Oncology.2025; 205: 110747. CrossRef
Advanced image-identified extranodal extension of retropharyngeal lymph nodes in the refinement of N classification for nasopharyngeal carcinoma
Wei Jiang, Gao-Yuan Wang, Guan-Jie Qin, Wu-Qi Zhang, Xiao-Dong Zhu, Ya-Qian Han, Feng Lei, Liang-Fang Shen, Kun-Yu Yang, Chun-Yan Cui, Ling-Long Tang, Yan-Ping Mao, Lei Chen, Rui Guo, Ling Li, Zheng Wu, Gui-Qiong Xu, Qin Zhou, Jing Huang, Shao-Hui Huang,
Cell Reports Medicine.2025; 6(2): 101942. CrossRef
Advances in Nasopharyngeal Carcinoma Staging: from the 7th to the 9th Edition of the TNM System and Future Outlook
Binhao Wu, Xiaozhong Chen, Caineng Cao
Current Oncology Reports.2025; 27(3): 322. CrossRef
Development and Validation of a Nomogram Based on the Different Grades of Cervical Lymph Node Necrosis to Predict Overall Survival in Patients with Lymph Node-Positive Locally Advanced Nasopharyngeal Carcinoma
Run-Zhi Wang, Li-Ru Zhu, Yao-Can Xu, Mei-Wen Chen, Zhong-Guo Liang, Kai-Hua Chen, Ling Li, Xiao-Dong Zhu
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Matted Lymph Nodes on MRI in Nasopharyngeal Carcinoma: Prognostic Factor and Potential Indication for Induction Chemotherapy Benefits
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Zetan Chen, Gang Wu, Xiangying Lin, Xiaopeng Huang, Shuai Zhang, Kaihua Chen, Zhongguo Liang, Xiaodong Zhu
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A prognostic nomogram incorporating tumor size and lymph node size for patients with nasopharyngeal carcinoma
Qi Yi, Jiazuo Cai, Yunen Lin, Zimei Hu, Jie Lin, Zhong Huang, Wei Liu, Ronghui Zheng, YaWei Yuan, Chengcong Chen
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Hao Xu, Ai Wang, Chi Zhang, Jing Ren, Peng Zhou, Jieke Liu
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Wenmiao Cao, Xiaoxin Li, Jianqi Yang, Enming Xing, Wenjuan Wu, Yizhi Ge, Buhai Wang
ORL.2023; 85(4): 195. CrossRef
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Yongfeng Piao, Caineng Cao, Yuanfan Xu, Shuang Huang, Feng Jiang, Ting Jin, Qifeng Jin, Yonghong Hua, Qiaoying Hu, Xiaozhong Chen
European Archives of Oto-Rhino-Laryngology.2022; 279(1): 353. CrossRef
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Baoqiu Liu, Mingxing Zhang, Yanqing Cao, Zhe Wang, Xicheng Wang
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Qi-Yong H. Ai, Kuo Feng Hung, Tiffany Y. So, Frankie K. F. Mo, Wing Tsung Anthony Chin, Edwin P. Hui, Brigette B. Y. Ma, Michael Ying, Ann D. King
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Efficacy of concurrent chemoradiotherapy plus Endostar compared with concurrent chemoradiotherapy in the treatment of locally advanced nasopharyngeal carcinoma: a retrospective study
Yuanxiu Yin, Ziyan Zhou, Zhiru Li, Mingjun Shen, Yating Qin, Chaolin Yang, Rensheng Wang, Min Kang
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Martin Dolezel, Marek Slavik, Tomas Blazek, Tomas Kazda, Pavel Koranda, Lucia Veverkova, Petr Burkon, Jakub Cvek
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Ying Bin, Zhen Meng, Lu-Lu Huang, Xue-Ying Hu, Jun-Mei Song, Yi-Ting Xie, Min Kang, Ren-Sheng Wang
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Influence of tumor necrosis on treatment sensitivity and long-term survival in nasopharyngeal carcinoma
Shao-Bo Liang, Lu-Si Chen, Xing-Li Yang, Dan-Ming Chen, Dong-Hui Wang, Chun-Yan Cui, Chuan-Bo Xie, Li-Zhi Liu, Xiang-Ying Xu
Radiotherapy and Oncology.2021; 155: 219. CrossRef
Establishment and validation of a novel nomogram to predict overall survival in nasopharyngeal carcinoma with lymph node metastasis
Wanpeng Li, Hanyu Lu, Huan Wang, Li Hu, Xicai Sun, Hongmeng Yu, Dehui Wang
Head & Neck.2021; 43(8): 2353. CrossRef
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MRI-based radiomics as response predictor to radiochemotherapy for metastatic cervical lymph node in nasopharyngeal carcinoma
Hao Xu, Jieke Liu, Ying Huang, Peng Zhou, Jing Ren
The British Journal of Radiology.2021;[Epub] CrossRef
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Man Xu, Jian Zang, Shanquan Luo, Jianhua Wang, Xuqi Li
BMJ Open.2021; 11(8): e045417. CrossRef
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Chi Leung Chiang, Qiaojuan Guo, Wai Tong Ng, Shaojun Lin, Tiffany Sze Wai Ma, Zhiyuan Xu, Youping Xiao, Jishi Li, Tianzhu Lu, Horace Cheuk Wai Choi, Wenqi Chen, Eric Sze Chun Chau, Peter Ho Yin Luk, Shao Hui Huang, Brian O’Sullivan, Jianji Pan, Anne Wing
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Xiaoshuang Niu, Fen Xue, Peiyao Liu, Chaosu Hu, Xiayun He
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Xi Chen, Xun Cao, Bingzhong Jing, Weixiong Xia, Liangru Ke, Yanqun Xiang, Kuiyuan Liu, Mengyun Qiang, Chixiong Liang, Jianpeng Li, Mingyong Gao, Wangzhong Li, Jingjing Miao, Guoying Liu, Zhuochen Cai, Shuhui Lv, Xiang Guo, Chaofeng Li, Xing Lv
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Axillary Lymph Node Dissection Does Not Improve Post-mastectomy Overall or Disease-Free Survival among Breast Cancer Patients with 1-3 Positive Nodes: Ji Hyeon Joo, Su Ssan Kim, Byung Ho Son, Seung Do Ahn, Jin Hong Jung, Eun Kyung Choi, Sei Hyun Ahn, Jong Won Lee, Hee Jeong Kim, Beom Seok Ko; Cancer Res Treat. 2019;51(3):1011-1021. Published online October 16, 2018; DOI: https://doi.org/10.4143/crt.2018.438

Abstract PDF Supplementary Material PubReader ePub

Purpose
Axillary lymph node dissection (ALND) may be avoidable for breast cancer patients with 1-2 positive lymph nodes (LN) after breast-conserving therapy. However, the effects of ALND after mastectomy remain unclear because radiation is not routinely used. Herein, we compared the benefits of post-mastectomy ALND versus sentinel node biopsy (SNB) alone for breast cancer patients with 1-3 metastatic LNs.
Materials and Methods
A total of 1,697 patients with pN1 disease who underwent mastectomy during 2000-2015 were identified from an institutional database. Outcomes were compared using the inverse probability of treatment weighted method.
Results
Patients who underwent SNB tended to have smaller tumors, a lower histology grade, a lower number of positive LNs, and better immunohistochemical findings. After correcting all confounding factors regarding patient, tumor, and adjuvant treatment, the SNB and ALND groups did not differ in terms of overall survival (OS) and disease-free survival (DFS), distant metastasis and locoregional recurrence. The 10-year DFS and OS rates were 83% and 84%, respectively, during a median follow-up period of 93 months.
Conclusion
ALND did not improve post-mastectomy survival outcomes among patients with N1 breast cancer, even after adjusting for all histopathologic and treatment-related factors.

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The Lymphatic Drainage Pattern of Internal Mammary Sentinel Lymph Node Identified by Small Particle Radiotracer (^99mTc-Dextran 40) in Breast: Xiao-Shan Cao, Guo-Ren Yang, Bin-Bin Cong, Peng-Fei Qiu, Yong-Sheng Wang; Cancer Res Treat. 2019;51(2):483-492. Published online June 11, 2018; DOI: https://doi.org/10.4143/crt.2018.062

Abstract PDF PubReader ePub

Purpose
The purpose of this study was to detect the lymphatic drainage pattern of internal mammary area and verify the concept of internal mammary sentinel lymph node (IM-SLN) in breast.
Materials and Methods
A small particle radiotracer (^99mTc-Dextran 40) was prepared and tested. ^99mTc-Dextran 40 was injected into intraparenchyma at the sound breast by a modified radiotracer injection technique. Subsequently, dynamic single-photon emission computed tomography (SPECT), computed tomography (CT), and SPECT/CT combination images were performed to identify the radioactive lymph vessels and internal mammary lymph nodes (IMLNs). The direction of lymph drainage and the location of the IMLNs were identified in the SPECT/CT imaging.
Results
The radiochemical purity of ^99mTc-Dextran 40 was > 95%. ^99mTc-Dextran 40 could drainage into first, second, and third lymph node and the radioactive lymph node could be detected by the γ detector in the animal experiment. After ^99mTc-Dextran 40 injecting into intraparenchyma, 50.0% cases (15/30) were identified the drainage lymphatic vessels and radioactive IMLNs by SPECT. The drainage lymphatic vessel was found from injection point to the first IMLN (IM-SLN) after 10.5±0.35 minutes radiotracer injection, and then ^99mTc-Dextran 40 was accumulated into the IM-SLN. The combination imaging of SPECT/CT showed the second IMLN received the lymph drainage from the IM-SLN. The lymphatic drainage was step by step in the internal mammary area.
Conclusion
The lymph was identified to drain from different regions of the breast to IM-SLN, and then outward from IM-SLN to other IMLN consecutively. It demonstrated the concept of the IM-SLN and provided more evidences for the application of internal mammary sentinel lymph node biopsy.

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99mTc-rituximab tracer injection for guiding internal mammary sentinel lymph nodes biopsy in primary breast cancer: A prospective observational study
Wenxin Chen, Yaodong Su, Hui Zhang, Yu Zhang, Lin Zhu, Mengbo Lin, Zhiyi Lin, Mingdian Yu, Shengping Yang, Yanmin Zhang
Frontiers in Oncology.2023;[Epub] CrossRef
Internal mammary lymph node metastasis in breast cancer patients based on anatomical imaging and functional imaging
Wei Wang, Pengfei Qiu, Jianbin Li
Breast Cancer.2022; 29(6): 933. CrossRef
The hypothesis of internal mammary lymph node drainage chain in breast cancer
Zhao Bi, Peng Chen, Xian-Rang Song, Yong-Sheng Wang
Future Oncology.2020; 16(21): 1489. CrossRef
Comparative research on 99mTc-Rituximab and 99mTc-sulfur colloid in sentinel lymph node imaging of breast cancer
Jing-Jie Zhang, Wan-Chun Zhang, Cai-Xia An, Xiao-Min Li, Le Ma
BMC Cancer.2019;[Epub] CrossRef

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Feasibility of Charcoal Tattooing of Cytology-Proven Metastatic Axillary Lymph Node at Diagnosis and Sentinel Lymph Node Biopsy after Neoadjuvant Chemotherapy in Breast Cancer Patients: Seho Park, Ja Seung Koo, Gun Min Kim, Joohyuk Sohn, Seung Il Kim, Young Up Cho, Byeong-Woo Park, Vivian Youngjean Park, Jung Hyun Yoon, Hee Jung Moon, Min Jung Kim, Eun-Kyung Kim; Cancer Res Treat. 2018;50(3):801-812. Published online August 17, 2017; DOI: https://doi.org/10.4143/crt.2017.210

Abstract PDF PubReader ePub

Purpose
Sentinel lymph node biopsy (SLNB) can be performed when node-positive disease is converted to node-negative status after neoadjuvant chemotherapy (NCT). Tattooing nodes might improve accuracy but supportive data are limited. This study aimed to investigate the feasibility of charcoal tattooing metastatic axillary lymph node (ALN) at presentation followed by SLNB after NCT in breast cancers.
Materials and Methods
Twenty patientswith cytology-proven node metastases prospectively underwent charcoal tattooing at diagnosis. SLNB using dual tracers and axillary surgery after NCT were then performed. The detection rate of tattooed node and diagnostic performance of SLNB were analyzed.
Results
All patients underwent charcoal tattooingwithout significant morbidity. Sentinel and tattooed nodes could be detected during surgery after NCT. Nodal pathologic complete response was achieved in 10 patients. Overall sensitivity, false-negative rate (FNR), negative predictive value, and accuracy of hot/blue SLNB were 80.0%, 20.0%, 83.3%, and 90.0%, respectively. Retrieving more nodes and favorable nodal response were associated with improved performance. The best accuracy was observed when excised tattooed node was calculated together (FNR, 0.0%). Cold/non-blue tattooed nodes of five patients were removed during non-sentinel axillary surgery but clinicopathological parameters did not differ compared to patients with hot/blue tattooed node detected during SLNB, suggesting the importance of the tattooing procedure itself to improve performance.
Conclusion
Charcoal tattooing of cytology-confirmed metastatic ALN at presentation is technically feasible and does not limit SLNB after NCT. The tattooing procedure without additional preoperative localization is advantageous for improving the diagnostic performance of SLNB in this setting.

Citations

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12,904 View
361 Download
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Risk Factors for a False-Negative Result of Sentinel Node Biopsy in Patients with Clinically Node-Negative Breast Cancer: Seung Ah Lee, Hak Min Lee, Hak Woo Lee, Ban Seok Yang, Jong Tae Park, Sung Gwe Ahn, Joon Jeong, Seung Il Kim; Cancer Res Treat. 2018;50(3):625-633. Published online July 31, 2017; DOI: https://doi.org/10.4143/crt.2017.089

Abstract PDF Supplementary Material PubReader ePub

Purpose
Although sentinel lymph node biopsy (SLNB) can accurately represent the axillary lymph node (ALN) status, the false-negative rate (FNR) of SLNB is the main concern in the patients who receive SLNB alone instead of ALN dissection (ALND).
Materials and Methods
We analyzed 1,886 patientswho underwent ALNDafter negative results of SLNB,retrospectively. A logistic regression analysis was used to identify risk factors associated with a falsenegative (FN) result. Cox regression model was used to estimate the hazard ratio of factors affecting disease-free survival (DFS).
Results
Tumor located in the upper outer portion of the breast, lymphovascular invasion, suspicious node in imaging assessment and less than three sentinel lymph nodes (SLNs) were significant independent risk factors for FN in SLNB conferring an adjusted odds ratio of 2.10 (95% confidence interval [CI], 1.30 to 3.39), 2.69 (95% CI, 1.47 to 4.91), 2.59 (95% CI, 1.62 to 4.14), and 2.39 (95% CI, 1.45 to 3.95), respectively. The prognostic factors affecting DFS were tumor size larger than 2 cm (hazard ratio [HR], 1.86; 95% CI, 1.17 to 2.96) and FN of SLNB (HR, 2.51; 95% CI, 1.42 to 4.42) in SLN-negative group (FN and true-negative), but in ALN-positive group (FN and true-positive), FN of SLNB (HR, 0.64; 95% CI, 0.33 to 1.25) did not affect DFS.
Conclusion
In patients with risk factors for a FN such as suspicious node in imaging assessment, upper outer breast cancer, less than three harvested nodes, we need attention to find another metastatic focus in non-SLNs during the operation. It may contribute to provide an exact prognosis and optimizing adjuvant treatments.

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Jing Si, Rong Guo, Huan Pan, Xiang Lu, Zhiqin Guo, Chao Han, Li Xue, Dan Xing, Wanxin Wu, Caiping Chen
Frontiers in Oncology.2022;[Epub] CrossRef
False-negative frozen section of sentinel nodes in early breast cancer (cT1-2N0) patients
Zhu-Jun Loh, Kuo-Ting Lee, Ya-Ping Chen, Yao-Lung Kuo, Wei-Pang Chung, Ya-Ting Hsu, Chien-Chang Huang, Hui-Ping Hsu
World Journal of Surgical Oncology.2021;[Epub] CrossRef
What Is High-risk Breast Cancer With Pathologically Negative Lymph Nodes for Regional Recurrence?
Sang-Won Kim, Won Kyung Cho, Doo Ho Choi, Haeyoung Kim, Oyeon Cho, Won Park, Mison Chun
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Validating the ACOSOG Z0011 Trial Result: A Population-Based Study Using the SEER Database
Jiwoong Jung, Byoung Hyuck Kim, Jongjin Kim, Sohee Oh, Su-jin Kim, Chang-Sup Lim, In Sil Choi, Ki-Tae Hwang
Cancers.2020; 12(4): 950. CrossRef
Retrospectively validating the results of the ACOSOG Z0011 trial in a large Asian Z0011-eligible cohort
Jiwoong Jung, Wonshik Han, Eun Sook Lee, So-Youn Jung, Jai Hong Han, Dong-Young Noh, Yumi Kim, Hee Jun Choi, Jeong Eon Lee, Seok Jin Nam, Jong Won Lee, Hee Jeong Kim, Eunhae Um, Joo Heung Kim, Seho Park, Young Up Cho
Breast Cancer Research and Treatment.2019; 175(1): 203. CrossRef
Preliminary study of contrast-enhanced ultrasound in combination with blue dye vs. indocyanine green fluorescence, in combination with blue dye for sentinel lymph node biopsy in breast cancer
Yidong Zhou, Yan Li, Feng Mao, Jing Zhang, Qingli Zhu, Songjie Shen, Yan Lin, Xiaohui Zhang, He Liu, Mengsu Xiao, Yuxin Jiang, Qiang Sun
BMC Cancer.2019;[Epub] CrossRef

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Which Patients with Isolated Para-aortic Lymph Node Metastasis Will Truly Benefit from Extended Lymph Node Dissection for Colon Cancer?: Sung Uk Bae, Hyuk Hur, Byung Soh Min, Seung Hyuk Baik, Kang Young Lee, Nam Kyu Kim; Cancer Res Treat. 2018;50(3):712-719. Published online July 14, 2017; DOI: https://doi.org/10.4143/crt.2017.100

Abstract PDF PubReader ePub

Purpose
The prognosis of patientswith colon cancer and para-aortic lymph node metastasis (PALNM) is poor. We analyzed the prognostic factors of extramesenteric lymphadenectomy for colon cancer patients with isolated PALNM.
Materials and Methods
We retrospectively reviewed 49 patients with PALNM who underwent curative resection between October 1988 and December 2009.
Results
In univariate analyses, the 5-year overall survival (OS) and disease-free survival (DFS) rates were higher in patients with ≤ 7 positive para-aortic lymph node (PALN) (36.5% and 27.5%) than in those with > 7 PALN (14.3% and 14.3%; p=0.010 and p=0.027, respectively), and preoperative carcinoembryonic antigen (CEA) level > 5 was also correlated with a lower 5-year OS and DFS rate of 21.5% and 11.7% compared with those with CEA ≤ 5 (46.3% and 41.4%; p=0.122 and 0.039, respectively). Multivariate analysis found that the number of positive PALN (hazard ratio [HR], 3.291; 95% confidence interval [CI], 1.309 to 8.275; p=0.011) was an independent prognostic factor for OS and the number of positive PALN (HR, 2.484; 95% CI, 0.993 to 6.211; p=0.052) and preoperative CEA level (HR, 1.953; 95% CI, 0.940 to 4.057; p=0.073) were marginally independent prognostic factors for DFS. According to our prognostic model, the 5-year OS and DFS rate increased to 59.3% and 53.3%, respectively, in patients with ≤ 7 positive PALN and CEA level ≤ 5.
Conclusion
PALN dissection might be beneficial in carefully selected patients with a low CEA level and less extensive PALNM.

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Akira Ouchi, Koji Komori, Sono Ito, Yusuke Kinugasa, Soichiro Ishihara, Akio Shiomi, Yukihide Kanemitsu, Takeshi Suto, Hiroki Takahashi, Yoichi Ajioka
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Shin Emoto, Yosuke Fukunaga, Manabu Takamatsu, Hiroshi Kawachi, Shuhei Sano, Tetsuro Tominaga, Toshiki Mukai, Tomohiro Yamaguchi, Toshiya Nagasaki, Takashi Akiyoshi, Tsuyoshi Konishi, Satoshi Nagayama, Masashi Ueno
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Michelle Zhiyun Chen, Yeng Kwang Tay, Swetha Prabhakaran, Joseph C Kong
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Qingwei Ren, Yanyan Chen, Xuejun Shao, Lanzhong Guo, Xinxin Xu
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Jun Woo Bong, Sanghee Kang, Pyoungjae Park
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Maurizio Zizzo, Maria Pia Federica Dorma, Magda Zanelli, Francesca Sanguedolce, Maria Chiara Bassi, Andrea Palicelli, Stefano Ascani, Alessandro Giunta
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Pengyue Zhao, Xingpeng Yang, Yang Yan, Jiaqi Yang, Songyan Li, Xiaohui Du
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Prognostic significance of enlarged paraaortic lymph nodes detected during left-sided colorectal cancer surgery: a single-center retrospective cohort study
Jaram Lee, Hyeong-min Park, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim
World Journal of Surgical Oncology.2021;[Epub] CrossRef
Risk factors for local recurrence and long term survival after minimally invasive intersphincteric resection for very low rectal cancer: Multivariate analysis in 161 patients
G.N. Piozzi, H. Park, T.H. Lee, J.S. Kim, H.B. Choi, S.J. Baek, J.M. Kwak, J. Kim, S.H. Kim
European Journal of Surgical Oncology.2021; 47(8): 2069. CrossRef
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Sung Chul Lee, Hee Cheol Kim, Woo Yong Lee, Seong Hyeon Yun, Yong Beom Cho, Jung Wook Huh, Yoon Ah Park, Jung Kyong Shin
Colorectal Disease.2021; 23(10): 2584. CrossRef
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Guglielmo Niccolò Piozzi, Seon Hahn Kim
Annals of Coloproctology.2021; 37(6): 351. CrossRef
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Hamid Dahmarde, Fateme Parooie, Morteza Salarzaei
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Junichi Sakamoto, Heita Ozawa, Hiroki Nakanishi, Shin Fujita, Norikatsu Miyoshi
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Long-term outcome and prognostic factors for patients with para-aortic lymph node dissection in left-sided colorectal cancer
Kota Sahara, Jun Watanabe, Atsushi Ishibe, Yusuke Suwa, Hirokazu Suwa, Mitsuyoshi Ota, Chikara Kunisaki, Itaru Endo
International Journal of Colorectal Disease.2019; 34(6): 1121. CrossRef

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Can We Skip Intraoperative Evaluation of Sentinel Lymph Nodes? Nomogram Predicting Involvement of Three or More Axillary Lymph Nodes before Breast Cancer Surgery: Soo Kyung Ahn, Min Kyoon Kim, Jongjin Kim, Eunshin Lee, Tae-Kyung Yoo, Han-Byoel Lee, Young Joon Kang, Jisun Kim, Hyeong-Gon Moon, Jung Min Chang, Nariya Cho, Woo Kyung Moon, In Ae Park, Dong-Young Noh, Wonshik Han; Cancer Res Treat. 2017;49(4):1088-1096. Published online January 25, 2017; DOI: https://doi.org/10.4143/crt.2016.473

Abstract PDF Supplementary Material PubReader ePub

Purpose
The American College of Surgeons Oncology Group Z0011 trial reported that complete dissection of axillary lymph nodes (ALNs) may not be warranted in women with clinical T1-T2 tumors and one or two involved ALNs who were undergoing lumpectomy plus radiation followed by systemic therapy. The present study was conducted to identify preoperative imaging predictors of ≥ 3 ALNs.
Materials and Methods
The training set consisted of 1,917 patients with clinical T1-T2 and node negative invasive breast cancer. Factors associated with ≥ 3 involved ALNs were evaluated by logistic regression analysis. The validation set consisted of 378 independent patients. The nomogram was applied prospectively to 512 patients who met the Z0011 criteria.
Results
Of the 1,917 patients, 204 (10.6%) had ≥ 3 positive nodes. Multivariate analysis showed that involvement of ≥ 3 nodes was significantly associated with ultrasonographic and chest computed tomography findings of suspicious ALNs (p < 0.001 each). These two imaging criteria, plus patient age, were used to develop a nomogram calculating the probability of involvement of ≥ 3 ALNs. The areas under the receiver operating characteristic curve of the nomogram were 0.852 (95% confidence interval [CI], 0.820 to 0.883) for the training set and 0.896 (95% CI, 0.836 to 0.957) for the validation set. Prospective application of the nomogram showed that 60 of 512 patients (11.7%) had scores above the cut-off. Application of the nomogram reduced operation time and cost, with a very low re-operation rate (1.6%).
Conclusion
Patients likely to have ≥ 3 positive ALNs could be identified by preoperative imaging. The nomogram was helpful in selective intraoperative examination of sentinel lymph nodes.

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Predicting three or more metastatic nodes using contrast-enhanced lymphatic US findings in early breast cancer
Zihan Niu, Yunxia Hao, Yuanjing Gao, Jing Zhang, Mengsu Xiao, Feng Mao, Yidong Zhou, Ligang Cui, Yuxin Jiang, Qingli Zhu
Insights into Imaging.2024;[Epub] CrossRef
Individualized prediction of non-sentinel lymph node metastasis in Chinese breast cancer patients with ≥ 3 positive sentinel lymph nodes based on machine-learning algorithms
Xiangli Xie, Yutong Fang, Lifang He, Zexiao Chen, Chunfa Chen, Huancheng Zeng, Bingfeng Chen, Guangsheng Huang, Cuiping Guo, Qunchen Zhang, Jundong Wu
BMC Cancer.2024;[Epub] CrossRef
Gail model and fifth edition of ultrasound BI‐RADS help predict axillary lymph node metastasis in breast cancer—A multicenter prospective study
Lu‐Ying Gao, Hai‐Tao Ran, You‐Bin Deng, Bao‐Ming Luo, Ping Zhou, Wu Chen, Yu‐Hong Zhang, Jian‐Chu Li, Hong‐Yan Wang, Yu‐Xin Jiang
Asia-Pacific Journal of Clinical Oncology.2023;[Epub] CrossRef
Nomogram based on multiparametric analysis of early‐stage breast cancer: Prediction of high burden metastatic axillary lymph nodes
Ling Li, Jing Zhao, Yu Zhang, Zhanyu Pan, Jin Zhang
Thoracic Cancer.2023; 14(35): 3465. CrossRef
Stratification of Axillary Lymph Node Metastasis Risk with Breast MRI in Breast Cancer
Jieying Chen, Xiaolian Su, Tingting Xu, Qifeng Luo, Lin Zhang, Guangyu Tang
Future Oncology.2022; 18(15): 1849. CrossRef
ACR Appropriateness Criteria® Imaging of the Axilla
Huong T. Le-Petross, Priscilla J. Slanetz, Alana A. Lewin, Jean Bao, Elizabeth H. Dibble, Mehra Golshan, Jessica H. Hayward, Charlotte D. Kubicky, A. Marilyn Leitch, Mary S. Newell, Christine Prifti, Matthew F. Sanford, John R. Scheel, Richard E. Sharpe,
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Avoiding unnecessary intraoperative sentinel lymph node frozen section biopsy of patients with early breast cancer
Jongwon Kang, Tae-Kyung Yoo, Ahwon Lee, Jun Kang, Chang Ik Yoon, Bong Joo Kang, Sung Hun Kim, Woo Chan Park
Annals of Surgical Treatment and Research.2022; 102(5): 241. CrossRef
A nomogram for predicting three or more axillary lymph node involvement before breast cancer surgery
Young-Joon Kang, Jung Hyun Park, Young Wook Ju, Kyoung-Eun Kim, Yumi Kim, Eunshin Lee, Han-Byoel Lee, Dong-Young Noh, Wonshik Han
Scientific Reports.2022;[Epub] CrossRef
Accurate Evaluation of Feature Contributions for Sentinel Lymph Node Status Classification in Breast Cancer
Angela Lombardi, Nicola Amoroso, Loredana Bellantuono, Samantha Bove, Maria Colomba Comes, Annarita Fanizzi, Daniele La Forgia, Vito Lorusso, Alfonso Monaco, Sabina Tangaro, Francesco Alfredo Zito, Roberto Bellotti, Raffaella Massafra
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Is Routine Intraoperative Frozen Section Analysis of Sentinel Lymph Nodes Necessary in Every Early-Stage Breast Cancer?
Bhoowit Lerttiendamrong, Nattanan Treeratanapun, Voranaddha Vacharathit, Kasaya Tantiphlachiva, Phuphat Vongwattanakit, Sopark Manasnayakorn, Mawin Vongsaisuwon
Breast Cancer: Targets and Therapy.2022; Volume 14: 281. CrossRef
Predictive nomogram based on serum tumor markers and clinicopathological features for stratifying lymph node metastasis in breast cancer
Sheng-Kai Geng, Shao-Mei Fu, Hong-Wei Zhang, Yi-Peng Fu
BMC Cancer.2022;[Epub] CrossRef
Prediction of axillary nodal burden in patients with invasive lobular carcinoma using MRI
Su Min Ha, Jung Min Chang, Soo-Yeon Kim, Su Hyun Lee, Eun Sil Kim, Yeon Soo Kim, Nariya Cho, Woo Kyung Moon
Breast Cancer Research and Treatment.2021; 186(2): 463. CrossRef
Predicting of Sentinel Lymph Node Status in Breast Cancer Patients with Clinically Negative Nodes: A Validation Study
Annarita Fanizzi, Domenico Pomarico, Angelo Paradiso, Samantha Bove, Sergio Diotaiuti, Vittorio Didonna, Francesco Giotta, Daniele La Forgia, Agnese Latorre, Maria Irene Pastena, Pasquale Tamborra, Alfredo Zito, Vito Lorusso, Raffaella Massafra
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Sentinel Lymph Node Metastasis on Clinically Negative Patients: Preliminary Results of a Machine Learning Model Based on Histopathological Features
Annarita Fanizzi, Vito Lorusso, Albino Biafora, Samantha Bove, Maria Colomba Comes, Cristian Cristofaro, Maria Digennaro, Vittorio Didonna, Daniele La Forgia, Annalisa Nardone, Domenico Pomarico, Pasquale Tamborra, Alfredo Zito, Angelo Virgilio Paradiso,
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The new perspective of PET/CT for axillary nodal staging in early breast cancer patients according to ACOSOG Z0011 trial PET/CT axillary staging according to Z0011
Eunjung Kong, Jungeun Choi
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V. Madekivi, P. Boström, A. Karlsson, R. Aaltonen, E. Salminen
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External validation of a prognostic model based on total tumor load of sentinel lymph node for early breast cancer patients
Antonio Piñero-Madrona, Francisco Ripoll-Orts, José Ignacio Sánchez-Méndez, Asunción Chaves-Benito, Maximiliano Rodrigo Gómez-de la Bárcena, Ana Calatrava-Fons, Salomón Menjón-Beltrán, Vicente Peg-Cámara
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Axillary Nodal Evaluation in Breast Cancer: State of the Art
Jung Min Chang, Jessica W. T. Leung, Linda Moy, Su Min Ha, Woo Kyung Moon
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Can We Identify or Exclude Extensive Axillary Nodal Involvement in Breast Cancer Patients Preoperatively?
Martijn Leenders, Gaëlle Kramer, Kamar Belghazi, Katya Duvivier, Petrousjka van den Tol, Hermien Schreurs
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Computer-aided prediction model for axillary lymph node metastasis in breast cancer using tumor morphological and textural features on ultrasound
Woo Kyung Moon, I-Ling Chen, Ann Yi, Min Sun Bae, Sung Ui Shin, Ruey-Feng Chang
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The Evolution of the Current Indications for Sentinel Lymph Node Biopsy in Breast Cancer
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Axillary Lymph Node to Primary Breast Tumor Standardized Uptake Value Ratio from FDG-PET/CT Imaging for Predicting the Necessity for Nodal Dissection in Primary Breast Tumors
Han-kyul Shin, Min Kyoon Kim, Sung Jun Park, Ju Won Seok, Hee-Chul Shin
Journal of Breast Disease.2017; 5(2): 76. CrossRef

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Prognostic Value of Axillary Nodal Ratio after Neoadjuvant Chemotherapy of Doxorubicin/Cyclophosphamide Followed by Docetaxel in Breast Cancer: A Multicenter Retrospective Cohort Study: Se Hyun Kim, Kyung Hae Jung, Tae-Yong Kim, Seock-Ah Im, In Sil Choi, Yee Soo Chae, Sun Kyung Baek, Seok Yun Kang, Sarah Park, In Hae Park, Keun Seok Lee, Yoon Ji Choi, Soohyeon Lee, Joo Hyuk Sohn, Yeon-Hee Park, Young-Hyuck Im, Jin-Hee Ahn, Sung-Bae Kim, Jee Hyun Kim; Cancer Res Treat. 2016;48(4):1373-1381. Published online March 23, 2016; DOI: https://doi.org/10.4143/crt.2015.475

Abstract PDF Supplementary Material PubReader ePub

Purpose
The purpose of this study is to investigate the prognostic value of lymph node (LN) ratio (LNR) in patients with breast cancer after neoadjuvant chemotherapy.
Materials and Methods
This retrospective analysis is based on the data of 814 patientswith stage II/III breast cancer treated with four cycles of doxorubicin/cyclophosphamide followed by four cycles of docetaxel before surgery. We evaluated the clinical significance of LNR (3 categories: low 0-0.20 vs. intermediate 0.21-0.65 vs. high 0.66-1.00) using a Cox proportional regression model.
Results
A total of 799 patients underwent breast surgery. Pathologic complete response (pCR, ypT0/isN0) was achieved in 129 patients (16.1%) (hormone receptor [HR] +/human epidermal growth factor receptor 2 [HER2] –, 34/373 [9.1%]; HER2+, 45/210 [21.4%]; triple negative breast cancer, 50/216 [23.1%]). The mean numbers of involved LN and retrieved LN were 2.70 (range, 0 to 42) and 13.98 (range, 1 to 64), respectively. The mean LNR was 0.17 (low, 574 [71.8%]; intermediate, 170 [21.3%]; high, 55 [6.9%]). In univariate analysis, LNR showed significant association with a worse relapse-free survival (3-year relapse-free survival rate 84.8% in low vs. 66.2% in intermediate vs. 54.3% in high; p < 0.001, log-rank test). In multivariate analysis, LNR did not show significant association with recurrence after adjusting for other clinical factors (age, histologic grade, subtype, ypT stage, ypN stage, lymphatic or vascular invasion, and pCR). In subgroup analysis, the LNR system had good prognostic value in HR+/HER2– subtype.
Conclusion
LNR is not superior to ypN stage in predicting clinical outcome of breast cancer after neoadjuvant chemotherapy. However, the prognostic value of the LNR system in HR+/HER2– patients is notable and worthy of further investigation.

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Breast Cancer Patients With Positive Apical or Infraclavicular/Ipsilateral Supraclavicular Lymph Nodes Should Be Excluded in the Application of the Lymph Node Ratio System
Zhe Wang, Wei Chong, Huikun Zhang, Xiaoli Liu, Yawen Zhao, Zhifang Guo, Li Fu, Yongjie Ma, Feng Gu
Frontiers in Cell and Developmental Biology.2022;[Epub] CrossRef
The prognostic role of lymph node ratio in breast cancer patients received neoadjuvant chemotherapy: A dose-response meta-analysis
Jinzhao Liu, Yifei Li, Weifang Zhang, Chenhui Yang, Chao Yang, Liang Chen, Mingjian Ding, Liang Zhang, Xiaojun Liu, Guozhong Cui, Yunjiang Liu
Frontiers in Surgery.2022;[Epub] CrossRef
Prognostic implications of regression of metastatic axillary lymph nodes after neoadjuvant chemotherapy in patients with breast cancer
Yul Ri Chung, Ji Won Woo, Soomin Ahn, Eunyoung Kang, Eun-Kyu Kim, Mijung Jang, Sun Mi Kim, Se Hyun Kim, Jee Hyun Kim, So Yeon Park
Scientific Reports.2021;[Epub] CrossRef
Using a novel T-lymph node ratio model to evaluate the prognosis of nonmetastatic breast cancer patients who received preoperative radiotherapy followed by mastectomy
Yang Wang, Yuanyuan Zhao, Song Liu, Weifang Tang, Hong Gao, Xucai Zheng, Shikai Hong, Shengying Wang
Medicine.2017; 96(42): e8203. CrossRef
The genetic variants in the PTEN/PI3K/AKT pathway predict susceptibility and CE(A)F chemotherapy response to breast cancer and clinical outcomes
Xiang Li, Ruishan Zhang, Zhuangkai Liu, Shuang Li, Hong Xu
Oncotarget.2017; 8(12): 20252. CrossRef
Prognostic Significance of Inner Quadrant Involvement in Breast Cancer Treated with Neoadjuvant Chemotherapy
Ji Hyun Chang, Wan Jeon, Kyubo Kim, Kyung Hwan Shin, Wonshik Han, Dong-Young Noh, Seock-Ah Im, Tae-You Kim, Yung-Jue Bang
Journal of Breast Cancer.2016; 19(4): 394. CrossRef

12,034 View
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The Expression of Carbonic Anhydrase (CA) IX/XII and Lymph Node Metastasis in Early Breast Cancer: Keun-Yong Eom, Min Hye Jang, So Yeon Park, Eun Young Kang, Sung Won Kim, Jee Hyun Kim, Jae-Sung Kim, In Ah Kim; Cancer Res Treat. 2016;48(1):125-132. Published online March 3, 2015; DOI: https://doi.org/10.4143/crt.2014.243

Abstract PDF PubReader ePub

Purpose
The aim of study was to test by immunohistochemical (IHC) staining whether carbonic anhydrase (CA) 9 and 12 have an effect on sentinel lymph node (SLN) metastasis in early breast cancer and to find clinicopathologic factors associated with SLN metastasis.
Materials and Methods
Between June 2003 and June 2011, medical records of 470 patients diagnosedwith breast cancer with pT1-2, pN0-2, and M0 were reviewed. Of these 470, 314 patients who underwent SLN biopsy±axillary dissection were subjects of this study. Using tissue microarray, IHC staining for CA9 and CA12 was performed. Clinicopathologic factors such as patient age, tumour size, lymphatic invasion, hormone receptor status, and the Ki-67 labeling index were analysed together.
Results
The mean age of all patients was 51.7 years. The mean number of harvested SLN was 3.62, and 212 patients (67.5%) had negative SLN. Lymphatic invasion, the Ki-67 labelling index of primary tumours, and CA9 staining of stromal cells, were independent risk factors for SLN metastasis in the multivariate analysis. In 33 patients (10.5%) without the three risk factors, no patient had SLN metastasis. In 80 patients without lymphatic invasion of primary tumours or CA9 staining of stromal cells, only four patients (5%) had positive SLN.
Conclusion
CA9 staining of stromal cells is an independent risk factor for SLN metastasis as well as lymphatic invasion and a low Ki-67 labelling index of primary tumours in patients with early breast cancer. IHC staining of primary tumours for CA12was not associatedwith SLN metastasis.

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Correspondences

Reply to Commentary on “Clinical Characteristics and Adequate Treatment of Familial Adenomatous Polyposis Combined with Desmoid Tumors”: Jin Cheon Kim; Cancer Res Treat. 2015;47(2):341-341. Published online February 26, 2015; DOI: https://doi.org/10.4143/crt.2015.050

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Commentary on “Clinical Characteristics and Adequate Treatment of Familial Adenomatous Polyposis Combined with Desmoid Tumors”: Edoardo Virgilio, Francesca Di Gregorio, Genoveffa Balducci; Cancer Res Treat. 2015;47(2):339-340. Published online February 26, 2015; DOI: https://doi.org/10.4143/crt.2015.038

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Case Report

A Unique Case of Erdheim-Chester Disease with Axial Skeleton, Lymph Node, and Bone Marrow Involvement: Jin Lim, Ki Hwan Kim, Koung Jin Suh, Kyung Ah Yoh, Jin Young Moon, Ji Eun Kim, Eun Youn Roh, In Sil Choi, Jin-Soo Kim, Jin Hyun Park; Cancer Res Treat. 2016;48(1):415-421. Published online February 26, 2015; DOI: https://doi.org/10.4143/crt.2014.160

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Erdheim-Chester disease is a rare non-Langerhans–cell histiocytosis with bone and organ involvement. A 76-year-old man presented with low back pain and a history of visits for exertional dyspnea. We diagnosed him with anemia of chronic disease, cytopenia related to chronic illness, chronic renal failure due to hypertension, and hypothyroidism. However, we could not determine a definite cause or explanation for the cytopenia. Multiple osteosclerotic axial skeleton lesions and axillary lymph node enlargement were detected by computed tomography. Bone marrow biopsy revealed histiocytic infiltration, which was CD68-positive and CD1a-negative. This report describes an unusual presentation of Erdheim-Chester disease involving the bone marrow, axial skeleton, and lymph nodes.

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Original Articles

Overexpression of Plasminogen Activator Inhibitor-1 in Advanced Gastric Cancer with Aggressive Lymph Node Metastasis: Yun-Suhk Suh, Jieun Yu, Byung Chul Kim, Boram Choi, Tae-Su Han, Hye Seong Ahn, Seong-Ho Kong, Hyuk-Joon Lee, Woo Ho Kim, Han-Kwang Yang; Cancer Res Treat. 2015;47(4):718-726. Published online February 2, 2015; DOI: https://doi.org/10.4143/crt.2014.064

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Purpose
The purpose of this study is to investigate differentially expressed genes using DNA microarray between advanced gastric cancer (AGC) with aggressive lymph node (LN) metastasis and that with a more advanced tumor stage but without LN metastasis.
Materials and Methods
Five sample pairs of gastric cancer tissue and normal gastric mucosa were taken from three patients with T3N3 stage (highN) and two with T4N0 stage (lowN). Data from triplicate DNA microarray experiments were analyzed, and candidate genes were identified using a volcano plot that showed ≥ 2-fold differential expression and were significant by Welch's t test (p < 0.05) between highN and lowN. Those selected genes were validated independently by reverse- transcriptase–polymerase chain reaction (RT-PCR) using five AGC patients, and tissue- microarray (TMA) comprising 47 AGC patients.
Results
CFTR, LAMC2, SERPINE2, F2R, MMP7, FN1, TIMP1, plasminogen activator inhibitor-1 (PAI- 1), ITGB8, SDS, and TMPRSS4 were commonly up-regulated over 2-fold in highN. REG3A, CD24, ITLN1, and WBP5 were commonly down-regulated over 2-fold in lowN. Among these genes, overexpression of PAI-1 was validated by RT-PCR, and TMA showed 16.7% (7/42) PAI-1 expression in T3N3, but none (0/5) in T4N0 (p=0.393).
Conclusion
DNA microarray analysis and validation by RT-PCR and TMA showed that overexpression of PAI-1 is related to aggressive LN metastasis in AGC.

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Using the Lymph Node Ratio to Evaluate the Prognosis of Stage II/III Breast Cancer Patients Who Received Neoadjuvant Chemotherapy and Mastectomy: San-Gang Wu, Qun Li, Juan Zhou, Jia-Yuan Sun, Feng-Yan Li, Qin Lin, Huan-Xin Lin, Xun-Xing Gaun, Zhen-Yu He; Cancer Res Treat. 2015;47(4):757-764. Published online December 8, 2014; DOI: https://doi.org/10.4143/crt.2014.039

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Purpose
This study was conducted to investigate the prognostic value of lymph node ratio (LNR) in stage II/III breast cancer patients who undergo mastectomy after neoadjuvant chemotherapy.
Materials and Methods
Clinical and pathological data describing stage II/III breast cancer patients were included in this retrospective study. The primary outcomes were locoregional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS).
Results
Among 277 patients, there were 43 ypN0, 64 ypN1, 89 ypN2, and 81 ypN3 cases. Additionally, there were 43, 57, 92 and 85 cases in the LNR 0, 0.01-0.20, 0.21-0.65, and > 0.65 groups, respectively. The median follow-up was 49.5 months. Univariate analysis showed that both ypN stage and LNR were prognostic factors of LRFS, DMFS, DFS, and OS (p < 0.05). Multivariate analysis showed that LNR was an independent prognostic factor of LRFS, DMFS, DFS, and OS (p < 0.05), while ypN stage had no effect on prognosis (p > 0.05).
Conclusion
The integrated use of LNR and ypN may be suitable for evaluation the prognosis of stage II/III breast cancer patients who undergo mastectomy after neoadjuvant chemotherapy.

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Prospective Evaluation of the Feasibility of Sentinel Lymph Node Biopsy in Breast Cancer Patients with Negative Axillary Conversion after Neoadjuvant Chemotherapy: Hy-De Lee, Sung Gwe Ahn, Seung Ah Lee, Hak Min Lee, Joon Jeong; Cancer Res Treat. 2015;47(1):26-33. Published online August 29, 2014; DOI: https://doi.org/10.4143/crt.2013.208

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Purpose
Tumor response to neoadjuvant chemotherapy (NAC) may adversely affect the identification and accuracy rate of sentinel lymph node biopsy (SLNB). This study was conducted to evaluate the feasibility of SLNB in node-positive breast cancer patients with negative axillary conversion after NAC. Materials and Methods Ninety-six patients with positive nodes at presentation were prospectively enrolled. 18Fluorodeoxyglucose-positron emission tomography (18F-FDG PET) and ultrasonography were performed before and after NAC. A metastatic axillary lymph node was defined as positive if it was positive upon both 18F-FDG PET and ultrasonography, while it was considered negative if it was negative upon both 18F-FDG PET and ultrasonography. Results After NAC, 55 cases (57.3%) became clinically node-negative, while 41 cases (42.7%) remained node-positive. In the entire cohort, the sentinel lymph node (SLN) identification and false-negative rates were 84.3% (81/96) and 18.4% (9/49), respectively. In the negative axillary conversion group, the results of SLNB showed an 85.7% (48/55) identification rate and 16.7% (4/24) false-negative rate. Conclusion For breast cancer patients with clinically positive nodes at presentation, it is difficult to conclude whether the SLN accurately represents the metastatic status of all axillary lymph nodes, even after clinically negative node conversion following NAC.

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A Distribution Weighted Prognostic Scoring Model for Node Status in Advanced Rectal Cancer: Kwang-Hee Yeo, Ho Hyun Kim, Dong-Yi Kim, Young-Jin Kim, Jae-Kyun Ju; Cancer Res Treat. 2014;46(1):41-47. Published online January 15, 2014; DOI: https://doi.org/10.4143/crt.2014.46.1.41

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PURPOSE
There are various lymph node-based staging systems. Nevertheless, there is debate over the use of parameters such as the number of involved lymph nodes and the lymph node ratio. As a possible option, the distribution of metastatic lymph nodes may have a prognostic significance in rectal cancer. This study is designed to evaluate the impact of distribution-weighted nodal staging on oncologic outcome in rectal cancer.
MATERIALS AND METHODS
From a prospectively maintained colorectal cancer database of our institution, a total of 435 patients who underwent a curative low anterior resection for mid and upper rectal cancer between 1995 and 2004 were enrolled. Patients were divided into 3 groups according to the location of apical metastatic nodes. A location-weighted prognostic score was calculated by a scoring model using a logistic regression test for location based-statistical weight to number of lymph nodes. All cases were categorized in quartiles from lymph node I to lymph node IV using this protocol.
RESULTS
The location of lymph node metastasis was an independent factor that was associated with a poor prognostic outcome (p<0.001). Based on this result, the location-weighted-nodal prognostic scoring model did not show lesser significant results (p<0.0001) in both overall survival and cancer-free survival analyses.
CONCLUSION
The location of apical nodes among the metastatic nodes does not have a lesser significant impact on oncologic result in patients with advanced rectal cancer. A location-weighted prognostic scoring model, which considered the numbers of involved lymph nodes as the rate of significance according to the location, may more precisely predict the survival outcome in patients with lymph node metastasis.

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Annals of Saudi Medicine.2015; 35(1): 23. CrossRef

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Case Report

Poorly Differentiated Neuroendocrine Carcinoma in a Perigastric Lymph Node from an Unknown Primary Site: Hee Seung Lee, Hye-Suk Han, Sung-Nam Lim, Hyun-Jung Jeon, Ho-chang Lee, Ok-Jun Lee, Hyo Young Yun, Ki Hyeong Lee, Seung Taik Kim; Cancer Res Treat. 2012;44(4):271-274. Published online December 31, 2012; DOI: https://doi.org/10.4143/crt.2012.44.4.271

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Neuroendocrine carcinomas from an unknown primary site are uncommon. The authors report on a case of neuroendocrine carcinoma in a perigastric lymph node (LN) with no primary site. A 52-year-old male patient with early gastric adenocarcinoma underwent treatment by endoscopic submucosal dissection, and, six months later, findings on a computed tomographic scan of the abdomen revealed a LN enlargement measuring 2.0 cm in the perigastric region. The patient underwent subtotal gastrectomy and regional LN dissection under a suggestive preoperative diagnosis of gastric adenocarcinoma with LN metastasis. However, microscopically, no residual tumor was found in the stomach, and the perigastric LN showed poorly differentiated neuroendocrine carcinoma (PDNEC). After an extensive workup, no primary site was identified. The patient also received four cycles of etoposide and cisplatin. Despite its extremely rare incidence, this case suggests that PDNEC of an unknown primary site is limited to a single site, and that resection should be considered in combination with chemotherapy.

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