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PubMed2006

Level IIb lymph node metastasis in elective neck dissection of oropharyngeal squamous cell carcinoma.

This study investigated the oncologic safety of preserving level IIb lymph nodes in ipsilateral and/or contralateral elective neck dissection (END) in patients with oropharyngeal squamous cell carcinoma (SCC). Fifty-one oropharyngeal SCC patients who underwent surgery as an initial treatment were reviewed. Twenty-one patients had clinically node negative necks (cN0) while 30 patients had ipsilateral clinically node positive necks (cN+). Of the cN0 patients, bilateral or ipsilateral END was performed in 15 and six patients, respectively. For the cN+ cases, ipsilateral therapeutic neck dissection with contralateral END was performed in 24 of 30 patients. In the cN0 patients, nodal metastasis to level IIb lymph nodes was not observed in any ipsilateral (21) or contralateral necks (15). Of the 24 cN+ patients who underwent contralateral END, two cases (8.3%) showed contralateral occult level IIb lymph node metastasis. Our data suggest that in cN0 oropharyngeal cancer patients, level IIb lymph nodes may be preserved in ipsilateral and contralateral neck dissection. However, caution is advised when preserving contralateral level IIb nodes in ipsilateral cN+ cases.

Adult↗

PubMedDate not supplied

Frequent gains of 20q and losses of 18q are associated with lymph node metastasis in intestinal-type gastric cancer.

BACKGROUND: The genetic aberrations associated with development and progression of gastric carcinomas (GCs) are poorly understood. The aim of this study was to identify chromosomal aberrations associated with the development and/or progression of intestinal-type GC. MATERIALS AND METHODS: Comparative genomic hybridization (CGH) analysis was applied to 36 intestinal-type GCs. We compared chromosomal aberrations detected by CGH analysis with clinicopathological parameters. RESULTS: Frequent gains of DNA copy number were found on 8q, 13q, 20q, 3q, 6q and losses were found on 17p, 18q in intestinal-type GCs. No significant differences were observed in the chromosomal aberrations between tumor stage, tumor location, peritoneal dissemination, liver metastasis or other distant metastasis. However, the frequencies of 20q12-13 gain and 18q21-22 loss were significantly higher in tumors with lymph node metastasis than in those without metastasis. CONCLUSION: Gains of 20q and losses of 18q may contribute to lymph node metastasis and the malignant phenotype in intestinal-type GCs.

Chromosome Aberrations↗

PubMedDate not supplied

The relationship of shape of tumor invasion to depth of invasion and cervical lymph node metastasis in squamous cell carcinoma of the tongue.

Several investigators have suggested that there is a strong correlation between tumor depth and lymph node involvement in tongue carcinoma. The purpose of this study was to investigate the relationship between the shape of tumor, tumor depth, and lymph node metastasis in tongue carcinoma. Fifty-four patients with T1 abd T2 tongue carcinomas who underwent surgical treatment were included in this study. Tumors were divided into four categories according to their shape of invasion: superficial, exophytic, endophytic, and a combination of endophytic and exophytic. Forty cases of endophytic and combination types were divided into two groups according to the shape of invasion: (1) reductive bottom of invasion (n = 17) and (2) expansive bottom of invasion (n = 23). Tumors with a reductive bottom of invasion showed a variety of tumor depths and had low lymph node involvement (4/17, 23.5%). However, tumors with an expansive bottom of invasion showed deeper invasion and a high incidence of lymph node metastasis (16/23, 69.6%). These results suggested that the macroscopic shape of invasion is a feature that may provide important information about the prognosis of the primary tumor especially in relation to cervical lymph node involvement.

Carcinoma, Squamous Cell↗

PubMed1992

[Preoperative administration of 5-FU emulsion for lymph nodes metastasis of pancreatic carcinoma].

5-FU oil emulsion (n = 5) or 5-FU dry syrup (n = 4), at a daily dose of 332mg for 7 days, was administered preoperatively to patient with periampullary carcinoma to evaluate the uptake of 5-FU to regional lymph nodes. In the group given 5-FU oil emulsion, the mean concentration of 5-FU was 293 +/- 97 ng/ml (mean +/- S.E.D), and that of the group given dry syrup was 72 +/- 20 ng/ml. Although no statistically significant difference was found, 5-FU seemed to reach the regional lymph nodes as an emulsion rather than as an aqueous solution. Preoperative administration of 5-FU emulsion might have some favorable effect on lymph node metastasis and lymph invasion of pancreatic carcinoma.

Administration, Oral↗

PubMed1990

Infiltration of dendritic cells in relation to tumor invasion and lymph node metastasis in human gastric cancer.

The infiltration of dendritic cells determined in 210 patients with gastric carcinoma was investigated from the standpoint of tumor invasion, lymph node metastasis, and prognosis. Dendritic cell infiltration was graded as "slight" and "marked." The 39% frequency in the marked infiltration group at the mucosal stage did not change in proportion to invasion into the deeper layers. The 5-year survival rate was 60.4% in patients with marked infiltration and 38.8% in those with slight infiltration, which was statistically different (P less than 0.01). The difference in survival rates was only statistically significant in those with cancer emerging from the serosa (P less than 0.001). There was a similar incidence of lymph node metastasis between the marked and slight infiltration groups in each grade of tumor invasion. However, marked infiltration of dendritic cells prevented widespread nodal involvement beyond the primary node in cases of advanced carcinoma (P less than 0.05). These findings indicate that infiltrating dendritic cells do not prevent the spread of tumor invasion but do prevent nodal involvement; therefore, for patients with a gastric cancer emerging from the serosa, the prognosis will be good.

Carcinoma↗

PubMed1997

Expression of bcl-2 protein in esophageal squamous cell carcinomas and its association with lymph node metastasis.

BACKGROUND: Recent studies on the role of bcl-2 in malignant tumors have suggested its prognostic significance. The goals of the current study were to determine any correlation between bcl-2 expression in esophageal squamous cell carcinoma and histopathology, lymph node metastasis, and clinical variables, and to assess its applicability as a parameter for prognosis. METHODS: Immunohistochemical staining for bcl-2 (clone 124) was performed on archival material from 105 esophageal squamous cell carcinomas. The results were compared among patient subgroups. RESULTS: bcl-2 was expressed in 58% of esophageal carcinomas, demonstrating positive correlations with a lack of keratinization and an early stage of disease. Lymph node metastasis was significantly less frequently observed in the subset of early stage carcinomas with bcl-2 staining. Univariate analysis revealed significantly longer disease free survival in patients with bcl-2 positive carcinomas than in those bcl-2 negative. bcl-2 expression did not have independent prognostic value in a multivariate survival analysis. CONCLUSIONS: bcl-2 is frequently expressed in esophageal carcinomas, and this expression is positively associated with nonkeratinization and an early stage, whereas it is negatively linked with lymph node metastasis and may indicate a favorable prognosis.

Carcinoma, Squamous Cell↗

PubMed1982

The influence of lymph node metastasis and ulceration of primary melanoma on germinal centers within draining lymph nodes: a histomorphometric study.

Microscopic counts and histoelectronic measurement of germinal centers in regional lymph nodes of melanoma patients showed a significant progressive increase in average number, as well as area, of germinal centers with occurrence of (adjacent) metastasis and presence of primary-tumor ulceration. The findings confirm in a quantitative manner the stage-dependent effect of progressive liberation of tumor antigen [10] on lymph node centers of humoral immune response.

Adult↗

PubMed2006

Serum CA 125 levels and lymph node metastasis in patients with endometrial cancer.

The aim of this study was to evaluate the correlation of preoperative serum CA 125 levels and lymph node metastasis in patients with endometrial cancer. Preoperative levels of serum CA 125 were determined in 64 patients with endometrial cancer treated with total abdominal hysterectomy with a lymph node dissection as initial therapy. Lymph node status, determined by histopathology, was correlated with both normal and elevated CA 125 levels, determined preoperatively. A serum CA 125 level of >30 IU/ml was considered elevated. There were five patients (7.8%) with pelvic or paraaortic lymph node metastases and 59 patients (92.2%) without nodal metastases. In all five patients with lymph node metastases, serum CA 125 was within normal limits. Preoperative serum CA 125 levels were above normal in eight lymph node-negative patients. In the remaining group of 51 node-negative patients, serum CA 125 levels were within normal limits. Among the five lymph node-positive patients, four had endometrioid and one had serous papillary cancer. One patient had histologic grade 2 tumor and four patients had histologic grade 3. Preoperative serum CA 125 levels do not offer any information for predicting lymph node metastasis in patients with endometrial cancer.

Aged↗

PubMed1997

[Investigation into mediastinal lymph node metastasis of lung cancer and rationale for decision of the extent of mediastinal dissection].

UNLABELLED: From the study on the regional lymphatic drainage and investigation into mediastinal lymph node metastasis of lung cancer, we have decided the extent of mediastinal dissection as follows; 1) For right lung cancer, as the routine procedure, extended systematic ipsilateral mediastinal dissection including the left tracheobronchial region, the anterior and the posterior ipsilateral mediastinum through a conventional thoracotomy. 2) For left lung cancer, as the routine procedure, systematic bilateral mediastinal dissection through a median sternotomy. 3) For the patients with advanced lymph node metastasis (the highest mediastinal or the cervical node involvement) or direct extension into the upper mediastinum of cancer in any side of the lungs, the lower half of modified radical neck dissection combined with systematic bilateral mediastinal dissection through a cervical collar incision and median sternotomy. RESULTS: 1. The noteworthy location and incidences of mediastinal lymph node involvement were as follows; 1) Among 34 patients of right lung cancer with pN2-3 M0 disease, in 5 patients the anterior mediastinal node involvement and in 6 patients (18%) the contralateral tracheobronchial node involvement were found by the pathological investigation at surgery. 2) The incidences of contralateral mediastinal node involvement at median sternotomies were 20% of 15 patients of the left upper lobe primary and 57% of 7 patients of the left lower lobe primary. 2. Postoperative survival rates calculated with Kaplan-Meier method; 1) The five-year survival rates were 67% in 22 patients with pT1-2N2M0; 72% in 20 patients with pT1-2N2-3 alpha (one level) M0 and 65% in 13 patients with pT1-2N2-3 alpha (multi level) M0. 2) The five-year survival rate of 8 patients with N3 gamma whose cancer were diagnosed as cN0-3 alpha preoperatively and resected completely was 60%. In conclusion, these results encourage us to continue this study because we can believe that our systematic mediastinal dissection beyond the anatomical difficulties would bring better prognoses in the patients with pN2-3 disease.

Humans↗

PubMed1997

[A comparative study on p53 gene mutation in primary human Dukes C colon cancer with that in matched lymph node metastasis].

OBJECTIVE: To study the relationship between metastasis of colon cancer and the mutation of p53 gene. METHODS: PCR-SSCP was used to analyse exon 5-9 of the p53 gene in 73 cases of Dukes C human primary cancer and 40 cases of matched lymph node metastasis. RESULTS: Mutations were identified in 27 of 73 primary cancers (37%) and 19 of 40 lymph node metastasis (47.5%) with the overall incidence of p53 mutation being 44%. In 21 of 40 cases in which both primary and metastatic cancers were analysed by SSCP, we found no p53 mutations in both lesions. While the same exon and exactly the same mutated band pattern could be seen both in primary and metastatic cancers in another 12 cases (30%). In addition, the agreement of p53 mutation status in primary cancer to the lymph node metastases was lost in the remaining 7 cases (17.5%). All of the 7 cases were confirmed to have base substitution mutations by DNA direct sequencing. In 5 of 7 individuals, the point mutations were detected only in lymph node metastases but not in the primary cancers and in 2 of 7 cases, two exons were found to have mutations in lymph node metastases while only one or no mutation was identified in the primary cancers. CONCLUSION: Most p53 mutations occurred before metastasis and p53 mutations persist throughout the final stage of the progression and metastasis in colon cancer. Furthermore, the metastasis of colon cancer is accompanied by the emergence of new mutation in p53 gene or metastasis is selected against the p53 mutation, which suggests that the mutations in p53 gene may be related to the metastasis of colon cancer.

Aged↗

PubMed2003

Serum vascular endothelial growth factor-C level in patients with primary nonsmall cell lung carcinoma: a possible diagnostic tool for lymph node metastasis.

BACKGROUND: The authors measured circulating vascular endothelial growth factor-C (VEGF-C) and vascular endothelial growth factor (VEGF) levels in patients with primary nonsmall cell lung carcinoma and assessed its usefulness as a diagnostic tool for determining lymph node metastasis. METHODS: Ninety-two patients with nonsmall cell lung carcinoma and 58 patients with benign tumors of the lung were included in the current study, as well as 42 healthy control patients. Circulating VEGF-C and VEGF levels were assessed by enzyme-linked immunosorbent assay. RESULTS: Serum VEGF-C concentration was higher in patients with lung carcinoma than in patients with benign tumors or in healthy control patients. Patients with lymph node metastasis revealed higher serum VEGF-C and VEGF concentrations than those without. The median level of VEGF-C and VEGF according to lymphatic vessel invasion and venous invasion was higher in the group with invasion than in the group without. These differences were most significant among patients with VEGF-C with lymphatic vessel invasion (P = 0.0066 vs. P = 0.026) and in patients with VEGF with venous invasion (P = 0.19 vs. P = 0.011). Serum VEGF-C levels reached a sensitivity of 79% and a specificity of 72% with a cutoff value of 1756.0 pg/mL, whereas VEGF levels reached 68% sensitivity and 70% specificity at 327.8 pg/mL. If 92 patients were divided into 4 groups according to the combination of VEGF-C and VEGF levels, the positive predictive value was 84.2%, the negative predictive value was 95.8%, and accuracy was 93.1%. CONCLUSIONS: Circulating VEGF-C levels may provide additional information for distinguishing between the absence and presence of lymph node metastasis in patients with lung carcinoma.

Adult↗

PubMed2006

Patterns of regional head and neck lymph node metastasis in primary conjunctival malignant melanoma.

OBJECTIVE: To correlate patterns of regional lymph node metastasis with the site of origin in primary conjunctival malignant melanoma. DESIGN: Retrospective analysis (1990-2003) of clinical data. SETTING: Two London tertiary referral centres. PARTICIPANTS: 12 patients presenting with regional metastases after failed local treatment for conjunctival malignant melanoma. RESULTS: 6 cases predominantly involving the temporal conjunctiva metastasised to the pre-auricular lymph nodes. Two cases predominantly involving the nasal conjunctiva metastasised to the submandibular nodes. Of the two cases with purely multifocal disease, one metastasised to the pre-auricular nodes and another to both submandibular and parotid nodes. One primary conjunctival malignant melanoma had its origin in temporal conjunctiva but metastasised to submandibular nodes, and another case originating from nasal conjunctiva metastasised to pre-auricular nodes. CONCLUSIONS: Temporal conjunctival melanotic lesions tend to metastasise clinically to pre-auricular lymph nodes and nasal conjunctival melanotic lesions metastasise to the submandibular lymph nodes. Patterns appear consistent with laboratory-based anatomically mapped lymphatic drainage basins of the conjunctiva.

Adult↗

PubMed2006

Molecular factors of 5-fluorouracil metabolism in colorectal cancer: analysis of primary tumor and lymph node metastasis.

Thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD) and thymidine phosphorylase (TP) are predictive markers for tumor response to 5-fluorouracil-based therapies. To determine whether gene expression values measured in primary cancer tissue would be useful for prediction of response of lymph node metastases, the expressions of these genes were quantitatively analyzed in 35 pairs of primary colorectal cancer (CRC) and corresponding lymph node metastases using real-time PCR. DPD and TP mRNA levels were significantly lower in the primary colorectal tumor and lymph node metastases compared with the normal adjacent stroma tissue (p<0.01), whereas TS mRNA levels were significantly higher in the primary tumor and lymph node metastases than in the normal adjacent tissue (p<0.001). Median gene expression levels of TP and TS did not differ significantly between primary colorectal tumor and corresponding lymph node metastasis but median DPD gene expression levels in the lymph node metastases were significantly higher compared to matched primary colorectal tumors (p=0.015). There was a significant correlation for DPD, TP and TS gene expression levels between primary colorectal tumor specimens and the matched lymph node metastasis. These results suggest that biopsies of the tumor of origin may be valid for determining predictive markers for chemotherapy response in patients with metastatic CRC.

Aged↗

PubMed2003

Elevated serum epidermal growth factor receptor level is correlated with lymph node metastasis in lung cancer.

BACKGROUND: Using an enzyme immunoassay for epidermal growth factor receptor (EGFR), we investigated whether serum EGFR levels could be used as predictors of the development and extent of lung cancer. METHODS: The study included 106 lung cancer patients and 16 patients with nonmalignant thoracic disease. Serum samples were collected before clinical treatment. RESULTS: There was no difference between serum EGFR levels in patients with lung cancer (21.275 +/- 22.035 fm/ml) in comparison with those in nonmalignant-disease controls (22.630 +/- 7.330 fm/ml; P = 0.8083). However, lung cancer patients with lymph node metastasis (23.515 +/- 20.065 fm/ml) had significantly higher EGFR levels compared with those in patients without lymph node metastasis (16.390 +/- 10.970 fm/ml; P = 0.0228). The serum EGFR levels were similar in samples from lung cancer patients with various pathological subtypes. There was no difference in the prognosis between the lung cancer group with normal EGFR levels (<850 ng/ml) and the group with elevated EGFR levels (>850 ng/ml). CONCLUSION: Serum EGFR levels may serve as a marker that can be used as an indicator of lymph node metastasis in lung cancer. However, there was no difference between levels in patients with lung cancer and those in nonmalignant-disease controls, indicating that the measurement of serum EGFR levels was of limited value in the detection of lung cancer.

Aged↗

PubMedDate not supplied

Exfoliative tumor clearance following radiotherapy estimated by comparing radioresponse between primary esophageal cancer and its lymph node metastasis.

BACKGROUND/AIMS: We estimated the capacity for exfoliative mechanical clearance which could occur in shrinkage of esophageal tumors following radiotherapy; both mechanical clearance and phagocytotic biological clearance of another clearance mechanism could participate in primary diseases located on outer tissue surfaces, whereas only biological clearance can participate in lymph node metastases surrounded by normal tissues which prevent mechanical clearance. METHODOLOGY: Twenty-one patients with primary esophageal cancer and lymph node metastasis both treated by radiotherapy with the same dose were reviewed. The extent of tumor shrinkage was estimated by measuring the size on computed tomography scans before and after radiotherapy. The capacity for biological clearance plus mechanical clearance (primary disease) or biological clearance alone (lymph node metastasis) was defined as the slope of a tumor shrinkage curve. The capacity for mechanical clearance was estimated by intra-patient subtraction. RESULTS: Extent of tumor shrinkage was consistently greater in primary disease than in lymph node metastasis for each patient, showing significant correlation in extent of shrinkage between them. The capacity was smaller for mechanical clearance than for biological clearance as a whole, showing no correlation between them. CONCLUSIONS: Mechanical clearance is highly likely to participate extra in the shrinkage of tumors located on outer tissue surfaces; therefore, these tumors will normally respond more highly than parenchymal tumors.

Aged↗

PubMedDate not supplied

PD-ECGF, bFGF, and VEGF expression in non-small cell lung carcinomas and their association with lymph node metastasis.

The angiogenic factors PD-ECGF, bFGF and VEGF were determined immunohistochemically in 168 non-small cell lung carcinomas to investigate whether the expression of these parameters is correlated with lymph node metastasis of patients. The expressions of the above mentioned factors was indeed associated with lymph node metastasis, but the results were not statistically significant. However, a combination of the factors PD-ECGF, bFGF and VEGF significantly improved the prognostic information. The number of tumors with lymph node involvement increased with the number of angiogenic factors. Only 43% of the patients had-lymph node involvement when all factors were negative whereas 77% showed metastasis when all factors were positive (one factor positive: 53%, two factors positive: 68). This result is statistically significant (p = 0.002, test for trend).

Adenocarcinoma↗

PubMed1991

Early mucosal gastric cancer with extra-perigastric (n2) lymph node metastasis.

During the 10 years from 1977 to 1986, a total of 314 cases of early gastric cancer were resected. Of these, 43 (14%) had lymph node metastases, with 6 cases of mucosal (m-) cancer and 37 of submucosal (sm-) cancer. Among the patients with positive lymph node metastases, 37 (86%) had metastases in the Group 1 regional lymph nodes. Eight patients had metastases in the Group 2 lymph nodes, and these involved 2 cases of m-cancer and 6 of sm-cancer. Lymph node metastasis is generally believed to occur in only about 3% of m-cancer, and then mainly in the Group 1 lymph nodes. Here, 2 rare cases of early gastric m-cancer with positive extra-gastric lymph node metastasis are reviewed in detail, with special attention to the surgical management.

Aged↗

PubMed1998

Expression of p53 and p21 proteins in oral squamous cell carcinoma: correlation with lymph node metastasis and response to chemoradiotherapy.

p53 protein, a product of the p53 cancer suppressor gene, and p21 protein, a cyclin-dependent kinase inhibitor, were immunohistochemically investigated in 150 oral squamous cell carcinomas (SCCs) and the relationship between their expression and clinicopathological findings were evaluated. The positivity for p53 and p21 proteins was not correlated with the T-stage, mode of tumor cell invasion or tumor cell differentiation. However, the expression of p53 and p21 proteins was correlated with lymph node metastasis. Of 62 SCCs with regional lymph node metastasis, 45 SCCs (72.6%) were positive for p53 while 45 (52.9%) of 88 SCCs without metastasis expressed p53 protein (p < 0.02). In addition, p21 protein was observed in 25 (38.5%) and 18 (21.2%) SCCs with and without metastasis, respectively (p < 0.05). Furthermore, p53 protein was inversely correlated with the histopathological effect of inductive chemoradiotherapy; the rate of chemoradiotherapy-induced lethal degeneration (56.7%) in p53-negative SCCs was significantly higher than that (28.9%) in p53-positive SCCs (p < 0.005). However, no clear difference in the effect was observed between p21-positive and p21-negative SCCs. Finally, the 5-year-survival rate was highest in p53(-)-p21(+) (80.0%) followed by 76.3% in p53(-)-p21(-), 65.9% in p53(+)-p21(+) and 65.4% in p53(+)-21p(-) SCCs. These results indicate that although the expression of p21 protein is only weakly correlated with the clinico-histopathological findings, p53 protein is a useful prognostic marker and that inductive chemoradiotherapy can be successfully planned by immunohistochemical examination of p53 protein.

Adult↗