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PubMed1998

Lymph nodes and human tumors (review).

This review examines the crucial role of regional lymph nodes (RLN) in defense against tumor progression. RLN are one of the first major components of the immune system to come into contact with tumor cells or tumor-cell products and are important in the generation of tumor-directed immune responses. Involvement of RLN by tumor cells is a prognostic index of survival and a biological indicator of a more distant metastatic disease. Enlargement of lymph nodes as a consequence of the increase in the number of lymphoid cells, is a common finding in humans. These changes of cellular organization display the most decisive evidence of the existence of an immune response within a draining lymph node. The variety of cells mediating immune response to tumors are summarized briefly. The lymphocyte subpopulations involved reflect the nature of the response and may determine the outcome of the tumor-host interaction. The composition of the lymphocyte subpopulations can be recognized in tumor-draining lymph nodes by distinctive surface-membrane markers assessable by flow cytometry. In human patients with solid tumors limited quantification of the lymphocyte subpopulations within RLN has been carried out using this technique and the results indicated that an increase in B lymphocytes in tumor-reactive lymph nodes is marked in the adenocarcinomas (colon and breast) while in other tumors, such as melanoma and squamous cell carcinoma, this increase in B lymphocytes is less pronounced. The increased number of B lymphocytes in the reactive lymph nodes suggests the existence of an immune response involving interactions between T and B cells. B lymphocytes expression of CD80 appears to increase in some reactive lymph nodes to adenocarcinomas, possibly indicating the state of activation of CD80+ B cells, and their role as antigen-presenting cells. Any improvement in the antitumor activity of RLN would be important in the immunotherapy of cancer patients. The ability to generate a large number of tumor-reactive T lymphocytes is a critical requirement for adoptive immunotherapy. Tumor-draining lymph nodes (TDLN) are an excellent source of tumor-reactive T lymphocytes and the adoptive transfer of these cells is capable of mediating the regression of tumors established both in the lung and in the brain. Although cancers elicit a vigorous immune response during the early part of their growth, the immune response is soon downregulated, permitting progressive cancer growth. Furthermore, there are date suggesting the existence of immunosuppressive mechanisms within RLN in the antitumor response. However, there are no yet conclusive data concerning the characteristics of the response or its effectiveness.

Animals↗

PubMed2001

Risk factors for lymph node metastases and their prognostic significance in early gastric cancer (EGC) for the Italian Research Group for Gastric Cancer (IRGGC).

BACKGROUND: Lymph node metastases are present in only about 15% of patients with early gastric cancer (EGC) and for this reason, the majority of these patients do not require lymphadenectomy. In Japan, EGC patients undergo less invasive treatment (endoscopic mucosal resection, wedge resection, laparoscopy). However, the indications for and results of these types of treatment are still uncertain. METHODS: In a multicentre retrospective study, we analysed the clinicopathological data referring to 584 early gastric cancer patients who underwent D2 gastrectomy. A comparison was made between patients with and without lymph node metastases in relation to numerous pre- and postoperative variables. Long-term survival and risk factors for lymph node metastases were analysed. The primary aim was to compare our results with those of Western and Japanese authors; we also evaluated the possibility of identifying a subset of patients at low risk of lymph node metastases who may be candidates for endoscopic treatment. RESULTS: The incidence of lymph node metastasis was 14.4%. Univariate and multivariate analyses showed that submucosal infiltration, diffuse histotype, tumour size and Kodama Pen A type were all related to the presence of lymph node metastases. Patients with types I, IIa and IIb mucosal tumours did not present lymph node metastases. Postoperative mortality was 2.2%. Five-year survival in relation to lymph node groups was 95% in N0 patients, 77% in N1 patients and 60% in N2 patients (p = 0.0001, Japanese N-stage). The number of positive lymph nodes also had a prognostic value. Patients with three or fewer positive lymph nodes presented a better 5-year prognosis (83%) than those with more than three positive lymph nodes (48%) (p = 0.0001). CONCLUSIONS: Our study confirms that lymph node involvement is an extremely important prognostic factor. For this reason, the therapeutic strategy of our surgical units is as follows: 1) D2 gastrectomy is the standard treatment even in early gastric cancer (EGC); 2) endoscopic mucosal resection (EMR) could be considered first in types I, IIa and IIb tumours that are diagnosed as limited to the mucosal layer.

Aged↗

PubMed1980

Lymph node invasion and prognosis in nephroblastoma.

Five hundred and twelve children with Wilms' tumor Stages I, II, and III registered to the International Society of Pediatric Oncology (SIOP) nephroblastoma trial were analyzed as to the prognostic value of metastatic lymph node involvement. The lymph nodes of 300 patients were submitted for microscopic examination; malignant invasion was reported in 15%. The disease-free and the actuarial survival rates for patients with metastatic lymph node invasion were significantly worse than for those without metastatic lymph node involvement. Radical lymph node dissection neither improved the cure rate nor decreased the rate of abdominal recurrence in patients with lymph node metastases.

Adolescent↗

PubMed2006

[Technique investigation of endoscopic axillary lymph node dissection by liposuction].

OBJECTIVE: To study the technique of endoscopic axillary lymph node dissection by liposuction. METHODS: Endoscopic axillary lymph node dissection (E-ALND) after liposuction (group A) were performed on 45 patients with breast cancer from Dec. 2004 to Oct. 2005. It was compared with traditional ALND (group B). RESULTS: The average operation time of E-ALND was 108 min (60 - 190 min), it was longer than that in group B (P < 0.05). The total blood loss in group A was 152.82 ml (80 - 220 ml), it was less than that in group B significantly (P < 0.01). In group A, the mean lymph nodes harvested by endoscopy were 18 (8 - 34), the total postoperative lymph flow was 140.38 ml (60 - 180 ml), the duration of drainage was 6.91 d (6 - 15 d). The postoperation complication included axillary seromas 7 cases, epidermic blister 5 cases, operation area phlegmon 2 cases were found in group A. There was no significant difference between two groups in the total postoperative lymph flow, the duration of drainage and the number of dissected lymph nodes and postoperation complication. The incision of chest wall was smaller in group A, and patients by this surgery were satisfied with the cosmetic results. CONCLUSIONS: Endoscopic axillary lymph node dissection by liposuction could match the traditional lymphadenectomy. The technique should be further standardized.

Adult↗

PubMed1987

Spread of herpes simplex virus in lymph nodes after experimental infection of mice.

Herpes simplex virus was frequently isolated from ipsilateral popliteal lymph nodes after percutaneous inoculation of the dorsal face of the footpad, and from ipsi- and contralateral submandibular lymph nodes after percutaneous inoculation of the cheek or the orofacial area of mice. Virus was detected only on very rare occasion in nondraining lymph nodes (inguinal or axillary) or in contralateral popliteal lymph nodes, but was frequently isolated in contralateral lumbar lymph nodes after footpad inoculation. The presence of virus in lymph nodes paralleled or followed the invasion of ipsilateral sensory ganglia and was associated with dissemination of virus in contralateral sensory ganglia after unilateral inoculation. In older mice virus was detected only occasionally in lymph nodes and dissemination of virus in contralateral sensory ganglia was generally not observed. The results suggest that lymphatic spread may contribute to dissemination of virus in contralateral sensory ganglia after unilateral inoculation of mice.

Age Factors↗

PubMed2002

Elective lymph node dissection in patients with melanoma: systematic review and meta-analysis of randomized controlled trials.

HYPOTHESIS: Elective lymph node dissection does not improve survival in patients with melanoma without clinically detectable lymph node metastases. OBJECTIVE: To determine whether elective lymph node dissection in patients with melanoma without clinically detectable regional metastases decreases overall mortality. DESIGN: Systematic review and meta-analysis of randomized controlled trials comparing elective lymph node dissection with delayed lymphadenectomy at the time of clinical recurrence. SETTING: Randomized controlled trials available by February 2001. SUBJECTS: The included trials comprised 1533 participants. INTERVENTION: Elective lymph node dissection compared with delayed lymphadenectomy or no lymphadenectomy in patients with melanoma without clinically detectable regional metastases. MAIN OUTCOME MEASURE: Overall mortality in treatment groups as compared with control groups at the end of a 5-year follow-up period. RESULTS: Three randomized controlled trials met the inclusion criteria. The pooled odds ratio for overall mortality for the 3 trials was 0.86 (95% confidence interval, 0.68-1.09). Results are statistically nonsignificant, but they have potential clinical significance. CONCLUSIONS: This systematic review of randomized controlled trials comparing elective lymph node dissection with surgery delayed until the time of clinical recurrence shows no significant overall survival benefit for patients undergoing elective lymph node dissection. Trials included in this review, however, contain significant bias. The question is not answered for all patients, and the results do not exclude the possibility that some subgroups may benefit from elective lymph node dissection. Further research is required.

Elective Surgical Procedures↗

PubMed1990

[Lymphatic afferents and efferents of lymph nodes of the Barety's space. Anatomic review in adults].

Lymph nodes of the Barety's space (LNLB) often involved in lung diseases are known under various names for a long time ago by pathologists. Our study involves 360 cadavers of adult subjects. The injection of a dye was performed by direct catheterization of a pulmonary segment. L.N.L.B. were directly or indirectly coloured (inter connected ganglionary network) more often from the lobes of the right lung, but from the lobes of the left lung too. From L.N.L.B. the lymphatic flow discharges in the venous confluent of the neck in the right side; in 1/4 of the cases a mediastinal efferent joints the left venous confluent too. From the lower lymph nodes of the space efferents can go to lymph nodes which are located right along the arch of the azygos vein (and then to the thoracic duct) and in the left side the group of left suprabronchial lymph nodes (then either to the thoracic duct in the mediastinum, or to the recurrent chain to the neck). At last, it seems that inside the lymph nodes themselves, lymphatic flows exist, the topography and the nature of which change according to the area interested by the injection.

Adult↗

PubMed2000

Prognosis and surgical management of patients with palpable inguinal lymph node metastases from melanoma.

BACKGROUND: The appropriate management of melanoma metastatic to inguinal lymph nodes remains controversial. The aim of this study was to identify disease- and treatment-related factors that influence the outcome of patients undergoing therapeutic groin dissection for clinically detectable melanoma lymph node metastases. METHODS: A retrospective analysis was performed on data collected from the case records of patients who had a therapeutic inguinal lymph node dissection performed between 1984 and 1998. RESULTS: Some 132 patients were suitable for inclusion. Sixty patients had superficial inguinal lymph node dissection (SLND) and 72 had combined superficial inguinal and pelvic lymph node dissection (CLND). There was no difference in postoperative morbidity or major lymphoedema between SLND and CLND. The overall survival rate was 34 per cent at 5 years. On univariate analysis, age (P = 0.003), the number of involved superficial lymph nodes (P = 0.001) and the presence of extracapsular spread (P = 0.003) were found to have a significant impact on survival. The presence or absence of pelvic lymph node metastases in patients who had CLND was a significant prognostic factor for survival (5-year survival 19 versus 47 per cent; P = 0.015). CONCLUSION: The prognosis of patients with clinically detectable melanoma metastases to the groin is variable and related to the biological characteristics of each case. CLND provided additional prognostic information and optimal regional control with no increased morbidity compared with SLND.

Adult↗

PubMed1995

Different T-cell activation by streptozotocin and Freund's adjuvant in popliteal lymph node (PLN).

A popliteal lymph node (PLN) test was further validated for predictive screening of autoimmunity-inducing drugs. Autoimmune-like T-cell activation of streptozotocin (STZ) was compared with the effect of Freund's complete adjuvant (FCA), injected locally into the foot pad of BALB/c mice. Early cell activation in enlarged PLN was monitored by flow cytometry. Injection of both STZ and FCA markedly increased the absolute PLN cell number as well as specific T-helper (CD4+), T-suppressor/cytotoxic (CD8+), and B (Ig+) subsets. However, quantitative analysis of early T-cell activation revealed important differences between STZ-induced PLN reaction and FCA-related lymphoproliferation. At 72 h, the number of cells stained with anti-early activation marker (EAM+; CD69+) increased over 10 times in STZ-enlarged nodes and only 3 times in the FCA-inflamed nodes. Furthermore, different cytometric profiles were noted for STZ-activated and FCA-activated cells stained with anti-interleukin-2 receptor (IL-2R) (CD25+). The data suggest the applicability of early cytometric screening of enlarged PLN for predictive analysis detection of chemicals inducing an autoimmune-like reaction.

Animals↗

PubMed2007

Morbidity and mortality of laparoscopy-assisted gastrectomy with extraperigastric lymph node dissection for gastric cancer.

Gastrectomy with extraperigastric lymph node dissection has not been generally acceptable because of increased morbidity and mortality in some Western countries. Recently, many surgeons have become interested in laparoscopic gastric surgery for malignant disease as well as benign lesions because laparoscopic surgery itself has been shown to have many advantages over open surgery. The aims of this study are to evaluate the incidence and nature of operative morbidity and mortality after laparoscopy-assisted gastrectomy (LAG) with extraperigastric lymph node dissection with respect to surgical experience and to identify factors predictive of complications and death. We reviewed the surgical outcomes of LAG with extraperigastric lymph node dissection in 140 consecutive gastric cancer patients. Clinicopathologic characteristics, operative outcomes, and postoperative morbidities and mortalities were compared after dividing the 140 patients into early (1-70) and late (71-140) groups. And risk factors for morbidity and mortality were identified by multivariate logistic regression analysis. The overall operative morbidity and mortality rates were 18.6% and 0.7%, respectively. Thirty postoperative complications occurred in 26 patients. The minor surgical complication rate in the late group was significantly lower than that in the early group (P = 0.0349). According to univariate and multivariate analyses to evaluate the independent predictor of a higher operative morbidity rate, no factor was significantly associated with operative morbidity. We conclude that LAG with extraperigastric lymph node dissection is a technically feasible and acceptable surgical modality for gastric cancer and low morbidity and mortality rates for this procedure can be accomplished by experienced laparoscopic gastric surgeons at large-volume hospitals.

Female↗

PubMed1990

[Surgical treatment of iatrogenic lesions of the accessory nerve following lymph node excision].

Excision of lymph nodes on the lateral margin of the sterno-cleido-mastoid muscle may result in damage to the accessory nerve. Most commonly the branch to the trapezius is involved. The treatment in five cases of iatrogenic lesions is described. Contrary to the widespread assumption that these lesions are irreversible, there was significant improvement in all cases.

Accessory Nerve Injuries↗

PubMed1988

[Roentgeno-anatomical study of inguinal, pelvic and lumbar lymph nodes].

Clinical anatomy of the inguinal, pelvic and lumbar lymph nodes was studied in 89 autopsies on adult males. The data on the life-time lymphographic and post mortem examination of the lymph nodes were compared. It was demonstrated that the retroperitoneal lymph nodes in an adult male include 4-20 right-side, 8-16 left-side external and common iliac, 3-13 right-side lumbar, 3-29 left-side and 0-8 intermediate lumbar nodes. It is important that the skeleton-related topography and number of lymph nodes, and the relationship between these parameters and age should be taken into account in making primary and differential diagnosis of various relevant lesions.

Adult↗

PubMed2003

How many lymph nodes are necessary to stage early and advanced adenocarcinoma of the sigmoid colon and upper rectum?

The lymph-node yields in specimens resected for colorectal adenocarcinoma show considerable variations, raising the question whether the minimum lymph-node number recommended by the UICC (International Union Against Cancer) for pN0 classification represents an appropriate quality standard for specimen work-up. The number of pericolic lymph nodes recovered from 568 archival surgical colorectal carcinoma specimens located in the sigmoid or upper rectum showed a highly statistically significant correlation with both the pT category and the presence of metastases ( P<0.0005). The median lymph-node yield in standardized (i.e., resembling in size surgically removed cancer specimens) tumor-free specimens obtained during autopsies was 13 lymph nodes, compared with 20.5 when diverticula were present and more than 30 in specimens with chronic inflammation or from patients with systemic infections. In 48 pT2 and pT3 carcinoma specimens prospectively dissected in the same way, median numbers of 18 (pT2) and 23 (pT3) lymph nodes were detected (range between 8 and 39 nodes). The lymph-node numbers recommended in previous studies and by the UICC often seem to be too low to declare a specimen free of metastases. Although the great variation in lymph-node counts requires the recovery of all lymph nodes for pN0 classification, recommendations considering the pT status and additional factors like diverticula and inflammatory changes can be useful as a quality standard for specimen work up.

Adenocarcinoma↗

PubMed2005

Neoadjuvant methotrexate, vinblastine, doxorubicin and cisplatin for histologically proven lymph node positive bladder cancer.

PURPOSE: We gained insight into the effect of neoadjuvant chemotherapy and subsequent surgery in patients with bladder cancer with tumor positive lymph nodes. MATERIALS AND METHODS: A total of 52 patients with histologically proven positive lymph nodes (by lymph node dissection or aspiration cytology) were treated with chemotherapy and post-chemotherapy surgery in case of partial or complete response. We evaluated response in the primary tumor and lymph nodes, long-term clinical outcome, and clinicopathological features potentially predictive of survival. RESULTS: Complete response, partial response and stable/progressive disease were attained in 29%, 57% and 14%, and resulted in a 5-year survival of 42%, 19% and 0%, respectively. Objective response (HR 4.1), especially complete response (HR 8.0), was independently associated with survival. The prognostic values of lymph node status and bladder tumor status after methotrexate, vinblastine, doxorubicin and cisplatin were evaluated separately. A tumor negative bladder combined with tumor negative nodes were associated with improved survival (HR 4.4) as was a tumor negative lymph node region in the presence of residual bladder disease (HR 2.8). All patients with post-chemotherapy tumor positive nodes died within 2 years. In resected specimens residual disease was found in 4 of 15 clinically complete responders while no tumor could be detected in 3 of 29 clinically assessed as partial responders. CONCLUSIONS: Response to chemotherapy is associated with improved survival, and our data suggest that lymph node status after methotrexate, vinblastine, doxorubicin and cisplatin is more important than local tumor status in this aspect. In the absence of reliable noninvasive methods, post-chemotherapy surgery in this series was the most adequate method of response evaluation and in limited partial responders led to long-term progression-free survival.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2002

Detection of occult metastases in lymph nodes from patients with colorectal carcinoma by reverse transcriptase-polymerase chain reaction.

OBJECTIVE: To detect occult metastases in lymph nodes from patients with colorectal carcinoma and its clinical significance. METHODS: The metastases in 260 lymph nodes from 39 histologically verified colorectal cancer patients were studied by both hematoxylin-eosin (HE) staining and cytokeratin-20 (CK20) specific RT-PCR. Ten normal lymph nodes were served as negative controls, and HT29 colon cancer cell line and 5 colorectal cancer specimens as positive controls. RESULTS: Ten normal lymph nodes were CK20-negative, HT29 cells and 5 tumor specimens were all CK20-positive. All 29 lymph nodes from 16 patients which confirmed metastases by HE staining exhibited CK20 positive expression; an additional 28 lymph nodes from 5 patients with no histologically detectable metastases expressed CK20 mRNA, i.e. presence of metastases. The difference of the positivity was significant (11.1% vs 21.9%, P < 0.01). According to the HE staining, the cases of Dukes' A, B, C and D were 3, 20, 12 and 4, respectively. In the 20 patients of Dukes' B stage, 5 of them had CK20-positive lymph nodes. CONCLUSION: CK20-specific RT-PCR is a highly sensitive, specific and simple method for detecting occult metastases in lymph nodes. The detection of CK20 mRNA expression in lymph nodes is recommended to precisely determine tumor stage and postoperative adjuvant therapy for patients with colorectal cancer, and further studies should be done in future to confirm the findings.

Adult↗

PubMed2004

Tumor micrometastases in mesorectal lymph nodes and their clinical significance in patients with rectal caner.

AIM: To investigate the number, size, and status of lymph nodes within the mesorectum and to explore the prognostic significance of lymph node micrometastases in patients with rectal cancer. METHODS: Thirty-one patients with rectal cancer undergone total mesorectal excision between October 2001 and October 2002 were included. Mesorectal nodes retrieved from the resected specimens were detected with a combination of haematoxylin and eosin (HE) staining and immunohistochemistry (IHC). The relations between lymph node metastases, micrometastases and postoperative recurrence were analyzed. RESULTS: A total of 548 lymph nodes were harvested, with 17.7+/-8.2 nodes per case. The average number of metastatic nodes in HE-positive patients and micrometastatic nodes in IHC-positive patients was 5.2+/-5.1 per case and 2.2+/-1.3 per case, respectively. The mean size of all nodes and metastatic nodes was 4.1+/-1.8 mm and 5.2+/-1.7 mm in diameter, respectively. The mean size of micrometastatic nodes was 3.9+/-1.4 mm in diameter. The size of the majority of mesorectal nodes (66.8%), metastatic nodes (52.6%), and micrometastatic nodes (79.5%) was less than 5 mm in diameter. During a median follow-up period of 24.6+/-4.7 mo, 5 patients (16.7%) had recurrence, of them 2 died and 3 survived. Another case died of tumor unrelated cause and was excluded. All 5 recurrent cases had 3 or more nodes involved, and one of them developed only lymph node micrometastases. The mean number of both metastatic and micrometastatic nodes per case differed significantly between the recurrent and non-recurrent groups (P<0.01 and P = 0.01, respectively). CONCLUSION: The majority of lymph nodes, metastatic, and micrometastatic lymph nodes within the mesorectum are smaller than 5 mm in diameter. The nodal status and the number of lymph nodes involved with tumor metastases and micrometastases are related to the rapid postoperative recurrence.

Adult↗

PubMed2001

Extranodal extension of axillary metastasis of invasive breast carcinoma as a possible predictor for the total number of positive lymph nodes.

INTRODUCTION: By the implementation of the sentinel node procedure in the treatment of breast carcinoma routine axillary lymph node, dissection can be abandoned in patients with a tumour-negative sentinel node. When the sentinel node is positive there are two options; an axillary dissection or radiotherapy of the axilla. In the latter case one is not informed about the total number of positive lymph nodes which can be of importance for the choice of adjuvant chemotherapy. In this paper we analyse whether it is possible to use histological parameters of a lymph-node metastasis to predict the number of tumour-cell-containing nodes. METHODS: Four hundred and ninety-eight patients treated for invasive breast cancer at our department from 1991 to 1996 were investigated to see whether extranodal extension of axillary metastases had a significant predictive value for the number of positive lymph nodes. Extranodal extension was scored as: no extranodal extension (NEE) and extranodal extension (EE); the latter was subdivided in minimal extranodal extension (MEE) or extensive extranodal extension (EEE). RESULTS: Of 498 patients, 230 patients had axillary involvement. NEE was seen in 83 (36.1%) patients and 147 (63.9%) had EE. Subdivision of this latter group revealed 77 patients with MEE (52%), 65 patients with EEE (45%) and five patients not further specified (3%). The number of positive nodes for the EE-group (6.9+/-0.5) was significant higher compared with the NEE-group (2.1+/-0.2) (P<0.001). The number of positive nodes was also significantly higher for the EEE-group compared to the MEE-group, 10.6+/-0.8 vs 4.0+/-0.4 (P<0.001). The predictive value for > or =4 positive axillary lymph nodes was 84.6% for EEE, 58.5% for EE and only 14.5% for NEE. These differences were significant (P<0.001). CONCLUSIONS: The presence of extranodal extension in axillary lymph-node metastases can be a good predictor for the expected number of positive nodes. This histological parameter could be of value to determine the kind of adjuvant chemotherapy after a positive sentinel-node biopsy with only radiotherapy of the axilla and no further axillary lymph-node dissection.

Adult↗

PubMed1981

Lymph node metastases in cancer of the thoracic esophagus.

Curettage of lymph nodes in 36 patients with cancer of the thoracic esophagus was performed in the bilateral supraclavicular, right intrathoracic and abdominal regions. The overall metastatic ratio in lymph nodes was 52.8 percent (19 of 36). It was particularly high in the right supraclavicular nodes (26.7 percent), the paracardial (27.8 percent) nodes, and nodes of the arch of the left gastric artery (19.4 percent) and the celiac axis (16.7 percent). Metastatic lesions were limited to the intrathoracic lymph nodes in 1 of 19 patients with positive nodal metastasis and were accompanied by metastases of the supraclavicular or abdominal nodes in the other 18 patients. In eight (88.9 percent) of nine patients in whom intrathoracic nodal metastases were confirmed, the supraclavicular or abdominal lymph nodes were involved by metastatic lesions. On the other hand, jumping metastasis to the neck or the abdominal lymph nodes without intrathoracic involvement was observed in 27.8 percent.

Carcinoma↗

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