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Type-oriented therapy for gastric cancer effective for lymph node metastasis: management of lymph node metastasis using activated carbon particles adsorbing an anticancer agent.

Activated carbon particles are taken selectively up by lymphatics when injected into the tissues and visualize regional lymph nodes colored black. Furthermore, carbon particles adsorb a large amount of the anticancer agent mitomycin C (MMC) on their surface and release the drug reversibly. Using these properties of activated carbon particles, we have applied it for lymph node dissection and chemotherapy of lymph node metastasis. After injection of carbon particles, regional lymph nodes of the stomach were found to be black; blackened lymph nodes extending widely from perigastric to para-aortic nodes were identified from other structures. Four hundred and twenty-four patients with gastric cancer were treated with this method for lymph node metastasis during 1984-1988. Involved nodes were generally colored in high incidence, about 70% of involved ones except for highly positive nodes, which was the same as noninvolved nodes. In highly positive nodes, the colored incidence was decreased to about 48%. The cumulative 5-year survival rate of the patients treated with this series was 74.6%, which was significantly higher than the figures without this method.

Carbon

[Experimental study of lymph node metastasis in thoracic esophageal carcinoma--regarding lymph node metastasis and changes in lymphatic flow by ultrafine charcoal in rabbit esophageal carcinoma model].

Esophageal carcinoma models were created by transplanting VX2 cells to rabbit esophagus endoscopically. By injecting finely divided activated charcoal into normal rabbit esophagus and tumor sites of esophageal carcinoma model, lymph flow was observed directly. Existence of lymph node metastasis was studied in detailed pathology. In 30 rabbits with upper esophageal carcinoma, lymph node metastasis was seen in 77%. Metastasis to bilateral intrathoracic paratracheal lymph node was seen in 50%, and also concentration of lymphatic flows from tumor site was seen. However, there were no metastasis and no lymph flow to abdominal lymph nodes. While, metastasis to cervical lymph nodes showed around 13%. Esophageal lymphatic flows were also seen reaching the cervical area along the esophagus. In 40 models with mid lower esophageal carcinoma, lymph node metastasis were seen in 88%. Metastasis to right and left thoracic paratracheal lymph nodes was 75% and 53%, respectively, and 25% of metastasis went to cardia lymph nodes. The lymph flows were going up and down around these lymph nodes, and reaching to lymph nodes at upper highest mediastinum or left gastric artery. The metastatic rate to the cervical lymph nodes was about 5%. There were no significant differences in lymphatic metastasis between right and left mediastinum. These findings suggest the necessity of radical dissection for both sides of the mediastinum.

Animals

[Clinico-pathologic evaluation of retroperitoneal lymph node metastasis in ovarian carcinoma].

Retroperitoneal lymph node dissection was performed in 18 cases of ovarian carcinoma. Of 18 patients, 8 (44.4%) patients had lymph node metastasis. It was found that 50.0% of patients with stage III and 100% of patients with stage IV had lymph node metastasis. Serous cystadenocarcinoma and poorly differentiated carcinoma were demonstrated to be the risk factors in lymph node metastasis. Lymph node metastasis was found to be significantly correlated with the volume of ascites, peritoneal cytology, or peritoneal dissemination. Patients without peritoneal dissemination or positive peritoneal cytology had no lymph node metastasis. Patients with bilateral ovarian tumors tended to have a higher incidence of lymph node metastasis than those with a unilateral ovarian tumor. The incidence of para-aortic lymph node metastasis was found to be higher than that of pelvic or inguinal lymph node metastasis. We concluded that in the clinical stage, serous cystadenocarcinoma, poorly differentiated epithelial carcinoma, ascites, peritoneal cytology, peritoneal dissemination and bilateral ovarian tumors were assumed to affect the incidence of retroperitoneal lymph node metastasis of ovarian carcinoma. It was suspected that the lymphatic spread of ovarian carcinoma had two routes: via ascites and peritoneal dissemination.

Ascitic Fluid

[DNA ploidy in submucosal cancer of the stomach and its relationship to lymph node metastasis].

The relationship between DNA ploidy and lymph node metastasis was determined in 40 cases of gastric cancer confined to the submucosa (with lymph node metastasis 20 cases and without 20 cases). The DNA ploidy patterns were classified as follows: Type D, Type A1 and Type A2. Of the 20 cases with lymph node metastasis, 1 was Type D, 7 were Type A1 and 12 were Type A2. The likelihood of lymph node metastasis was 12.5% (1/8) for Type D, 43.8% (7/16) for Type A1 and 75.0% (12/16) for Type A2. It is concluded that although gastric cancer confined to the submucosa is classified as early one, analysis of DNA content places such tumors with lymph node metastasis into the advanced cancer category.

DNA, Neoplasm

[Study of para-aortic lymph node metastasis for advanced gastric cancer on consecutive lymph node slices].

Para-aortic lymph nodes (No. 16) from 21 patients with advanced gastric cancer who underwent extensive lymph node dissection, were sliced consecutively at intervals of 50 mu to study minute metastasis of No. 16 lymph nodes. Twenty-six of 30 metastatic lymph nodes had minute involvement, in which carcinoma cells were detected in marginal sinus of lymph node, microscopically. The rate of the metastases to No. 16 lymph nodes was 19% among N0-3 cases by conventional method (not consecutive slices). On the contrary, the percentage of metastasis to No. 16 lymph nodes by consecutive slices was 33% among N0-3 cases. Therefore, No. 16 nodes are involved in metastasis at high rate at operation and the extensive lymph node dissection including No. 16 nodes (R4) will be recommended to prevent lymph node recurrence caused by such a minute metastasis.

Aorta

Postoperative chemoradiotherapy in Wilms tumor with concurrent lung and lymph node metastasis.

BACKGROUND: An effective treatment strategy is essential for metastatic Wilms tumor (WT) management. To improve prognostic accuracy, this study examined metastatic patterns and key prognostic factors. METHODS: Children diagnosed with WT from 2010 to 2021 were identified from the SEER database. All patients underwent chemotherapy and surgical resection. Metastatic patterns, metastasis-related predictors, and prognostic factors were evaluated. RESULTS: Of the 1040 patients analyzed, 226 (21.7%) experienced lung metastasis, 31 (3.0%) liver metastasis, 6 (0.6%) bone metastasis, and 220 (21.2%) regional lymph node metastasis. Distant metastasis was associated with a higher incidence of lymph node metastasis (OR = 1.506, 95% CI 1.346-1.685, p < 0.001). Age 3-17 years (OR = 1.933, 95% CI 1.406-2.680, p < 0.001), left-sided (OR = 1.383, 95% CI 1.016-1.890, p = 0.040), bilateral (OR = 2.303, 95% CI 1.215-4.243, p = 0.009), and tumor size &#x2265;135 mm (OR = 2.020, 95% CI 1.481-2.749, p < 0.001) were identified as predictors of metastasis. Both lymph node (p < 0.001) and lung metastasis (p < 0.001) were high-risk factors for WT. Radiotherapy provided long-term survival benefits for the metastatic population (p = 0.027), while postoperative chemotherapy showed better outcomes than preoperative or other strategies (p < 0.001). Further analysis demonstrated that the concurrent lung and lymph node metastasis group benefited more from postoperative chemoradiotherapy, with HRs of 0.226 (p = 0.028) for overall survival and 0.255 (p = 0.048) for cancer-specific survival. CONCLUSION: WT with concurrent lung and lymph node metastasis represents a distinct and aggressive metastatic phenotype associated with a significantly poor prognosis. Postoperative chemoradiotherapy may provide superior survival benefits for this high-risk population.

Humans

The risk of lymph node metastasis in colorectal polyps with invasive adenocarcinoma.

One hundred fifty-one patients with colorectal polyps containing invasive adenocarcinoma treated by resection were studied to determine the incidence of lymph node metastasis and whether lymph node metastasis was related to the depth of invasion. Other variables evaluated included size and configuration of the polyp, grade of adenocarcinoma, presence or absence of lymphovascular invasion, and degree of differentiation. In patients with sessile polyps, the incidence of lymph node metastasis was 10 percent. Eighty percent of these lesions had lymphovascular invasion. For pedunculated polyps, the overall incidence of lymph node metastasis was 6 percent. However, there was no incidence of lymph node metastasis when the depth of invasion was limited to the head, neck, and stalk of the polyp (Levels 1, 2, and 3). Only when the depth of invasion reached to the base of the stalk (Level 4) was the risk of lymph node metastasis high (27 percent). The other risk factors were not associated with lymph node metastasis. We concluded that the most significant risk factor for lymph node metastasis in patients with invasive carcinoma in a polyp was invasion into the submucosa of the bowel wall (Level 4).

Adenocarcinoma

Effects of incision and irradiation on regional lymph node metastasis in carcinoma of the hamster tongue.

The effects of incision and irradiation on regional lymph node metastasis in DMBA-induced squamous cell carcinomas of the hamster tongue are reported. Metastasis to the submandibular lymph nodes was confirmed histologically in 48.0% of the animals. The incidence of lymph node metastasis was significantly increased (65.9%) after repeated incisions of tongue carcinomas. Three gray whole-body irradiation also increased the rate of metastasis from 31.0% to 46.3%. Higher incidences of lymphatic vessel invasion after incision and concomitant lymph node metastasis in the lymphatic invasion-positive group indicated a stepwise relationship leading to an increase in lymph node metastasis after incision. Because of the high incidence of metastases and close resemblance to human carcinomas in the tumor cell deposition and establishment of metastatic foci, DMBA-induced tongue carcinoma with invasion may serve as an experimental model of human oral carcinomas.

9,10-Dimethyl-1,2-benzanthracene

[Study of para-aortic lymph node metastasis of gastric cancer subjected to superextensive lymph node dissection].

Para-aortic lymph nodes (n4), were dissected out to the technical extreme (superextensive lymph node dissection) from 129 gastric cancer cases, and were subjected to the histological study for metastasis. Following observations led us to the conclusions in reference to the significance of n4 node dissections on curability of surgery. 1) Among 25 cases with n4(+) metastasis n3 was free [n3(-)] in 11 cases (44.0%). 2) ps(+) cancer presented high rate of n4(+) (31.5%). 3) n4(+) occurred irrespective of the location of the cancer, with particularly high rate of occurrence among CMA and cancers. 4) The rate of the metastasized lymph nodes to the total number of the n4 lymph nodes, was found low (34.9%) in cases with n3(-), and high (90.1%) with n3(+). 5) The cumulative survival rate of the cases with n4(+) was found significantly high with n3(-), as compared to n3(+) cases. The lymphatic drainage from the stomach seems more direct and/or more abundant to the n4 than to the n3 nodes. Such observation coincides with our experience that the n4 nodes are involved in metastasis in earlier timing and in higher incidence than n3 nodes. These results warn the present evaluation of curability in which the n4 node dissection is not performed. It is our opinion that the thorough dissection extended to the n4 nodes (superextensive lymph node dissection) is warranted, particularly in order to improve the curability of n3(-)-n4(+) cases.

Aorta, Abdominal

[Clinical characteristics and prognosis of renal cell carcinoma. Statistical evaluation of possible determinants for distant metastasis, venous tumor thrombi, and lymph node metastasis].

To clarify the recent clinical characteristics of renal cell carcinomas and to evaluate possible determinants for metastasis and venous tumor thrombi, the authors reviewed data from 99 renal cell carcinoma patients treated at Nagoya University Hospital between 1980 and 1989. According to Robson's classification, stage I tumors were found in 48 patients, stage II in 9, stage III in 16, and stage IV in 26. Incidentally detected tumors appeared to be on the increase in recent years. Grade 1 tumors were significantly associated with low-stage tumors and expansive growth. Univariate and multivariate analyses using a logistic regression model demonstrated that venous tumor thrombi and histological grade were significantly related to distant metastasis. Univariate analysis revealed relative risks of 4.7 for venous tumor thrombus presence (pV1b-pV2 vs. pV0-pV1a, p = 0.005) and 8.5 for histological grade (grades 2 and 3 vs. grade 1, p = 0.04). Local invasion (pT3 vs. pT2a-pTb: a relative risk of 7.5, p = 0.0009) and infiltration pattern (INF beta and INF gamma vs. INF alpha: a relative risk of 11.5, p = 0.002). were associated with venous tumor thrombi. Local invasion (pT3 vs. pT2a-pT2b: a relative risk of 6.6, p = 0.03) was the only significant determinant for lymph node metastasis. The 5-year actuarial survival rate was 60.0% for all 99 patients. The 5-year survival rates for stage I and II tumors were, respectively, 91.8% and 64.8%.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma, Renal Cell

Lymph node metastasis in resectable esophageal cancer.

The prognostic significance of lymph node metastasis was analyzed in 41 patients with locally resectable epidermoid carcinoma of the esophagus. The 5-year survival rate was 50.9% if no metastases or only single node metastasis was present and 29.8% when the lymph node metastasis was confined to one anatomic compartment. All patients with metastasis to two nodes died within 4 years of operation, and all with involvement of three nodes or more died within 3 years. Even with no metastases or single node metastasis, three of 22 patients (13.6%) died of recurrence or metastasis or a combination of the two. Although nodal dissection may be beneficial for selected patients, our results indicate that the survival period is short in the presence of a small number of lymph node metastases, even if the local disease is resectable and despite nodal dissection. Cure is unlikely when cervical or abdominal nodes are involved, and a conservative approach may be indicated for such patients.

Abdomen

[Imprint cytodiagnosis of lymph node metastasis in resected lung cancer].

The cytological examination of lymph node imprints is a rapid and useful method for diagnosis of lymph node metastasis. We applied this technique for the diagnosis of regional lymph node metastasis of resected lung cancer, and compared its diagnostic value with histological examination. The accuracy rate of imprint cytology is 97.3%, and the sensitivity rate is 100%. We conclude that imprint cytology of lymph node for diagnosis of cancer metastasis is highly accurate and simple, and its diagnostic value may be equal to that of routine histological examination.

Adenocarcinoma

Surgical approach to early gastric cancer with lymph node metastasis.

The clinicopathology of our series of patients (n = 486) with early gastric cancer was reviewed with special reference to metastasis to the regional lymph nodes. The incidence of lymph node metastasis was 15.8% (19/120) in patients with the protruded type of carcinoma and 11.7% (42/360) in patients with the depressed type of carcinoma. It was especially high in carcinomas of the IIa + IIc type of the former group. The incidence of lymph node involvement was higher in the group with larger tumors (greater than 30 mm) than in the group with smaller tumors (less than or equal to 30 mm). Metastatic lesions were detected in as many as 25.0% (16/64) of the cases with large tumors (greater than or equal to 50 mm); however, of the 46 cases with small tumors (less than 10 mm), 1 case had metastases to the nodes of group 1. There were 4 cases of m-cancer with metastasis to group 1 lymph nodes. Skip metastasis to group 2 lymph nodes was discovered in 4 cases. From these results, we feel that the standard operation for early gastric cancer is R2-gastrectomy including the complete removal of group 1 and 2 lymph nodes. R1-gastrectomy or local resection is thought to be sufficient for m-cancer with a lesion smaller than 10 mm in maximum diameter.

Adenocarcinoma

[Immunohistochemical study of the extracellular matrix in non-small cell lung cancer: relation to lymph node metastasis and prognosis].

The distribution of type IV collagen and laminin in the basement membrane (BM), and fibronectin in the peritumoral stroma of 112 lung cancers (62 adenocarcinomas, 50 squamous cell carcinomas) was studied using immunohistochemical techniques to compare with tumor size, lymph node metastasis and prognosis. In normal lung tissues, type IV collagen and laminin stainings were continuously linear in bronchial BM, blood vessel BM, around bronchial gland and along alveolar septa. Immunoreactivity of fibronectin was shown in BM and stroma. In lung cancers, type IV collagen and laminin stainings were observed in continuous or discontinuous pattern around carcinoma cells, and partially unrecognizable. Staining patterns were divided into continuous (C) and discontinuous (D). And fibronectin patterns were divided into weakly and strongly positive. In relation between staining pattern and lymph node metastasis, in adenocarcinomas, C pattern of type IV collagen staining without lymph node metastasis occurred in 73.9% and with metastasis in 26.1%, on the other hand, D pattern without lymph node metastasis occurred in 25.6% and with metastasis in 74.4%. The correlation was statistically significant (p less than 0.01). And also, in squamous cell carcinomas, C pattern without lymph node metastasis seen in 71.4% and with metastasis in 28.6%, on the other hand, D pattern without lymph node metastasis seen in 27.6% and with metastasis in 72.4%. The correlation was statistically significant (p less than 0.01). But staining pattern of fibronectin didn't correlate to lymph node metastasis. In comparison between C and D patterns, C pattern was associated with longer survival than D pattern (p less than 0.01). In lung cancers without lymph node metastasis, C pattern tended to be higher in 5-year-survival than D pattern, but not significant. These findings suggest that staining pattern of type IV collagen and laminin might be correlated to cancer metastasis and useful to estimate the prognosis.

Adenocarcinoma

Enhancing effect of clamping of the portal vein on the effectiveness of antitumor agents against lymph node metastasis.

An experimental study was made on the suppressive effect on lymph node metastasis of an antitumor agent administered during the clamping of the portal vein. When mitomyaneously clamped, a higher concentration of the drug was detected in the mesenteric lymph nodes compared to the conventional intravenous administration. The growth of mesenteric lymph node metastasis was markedly suppressed by the combined use of mitomycin-C and portal vein clamping. These results suggest that the procedure applied in the present study directs a high concentration of antitumor preparations to the lymph nodes in the portal vein region, and thus is a good method for the suppression of lymph node metastasis.

Animals

Epithelioid sarcoma: an analysis of 22 cases indicating the prognostic significance of vascular invasion and regional lymph node metastasis.

Twenty-two cases of epithelioid sarcoma seen and/or treated at Memorial Hospital are presented. With the exception of one tumor which occurred in the neck, all the sarcomas arose in the upper (15 cases) or lower extremities (6 cases). Ten originated in the hand. At the time of initial treatment, 14/22 patients were between 20 and 40 years of age. The tumor most commonly presented as a nodular lesion and involved dermis, subcutaneous tissue, fascia and tendons, and when it recurred (13 cases) it tended to grow proximally along tendons and fascial planes. Of special interest was the finding of vascular invasion in surgical specimens removed from 5 patients. Four of these represented recurrent tumor, and in two cases the vascular invasion was massive. Two of these patients also demonstrated tumor emboli in pulmonary vessels and cardiac involvement at autopsy. Metastasis to regional lymph nodes occurred in eight cases (42%). Follow-up ranging from 2 to 34 years (average of 8 years) was obtained for 19 cases (86%). Eleven patients are alive with disease or died as a result of their sarcoma (58% of the follow-up group). Adverse prognostic factors included recurrence after initial local excision, vascular invasion and lymph node metastasis. All of the patients with intravenous extension of tumor and 6 of 8 patients with lymph node involvement died with pulmonary metastases. Our data suggest that cure may best be achieved by amputation or by an exceptionally wide en bloc excision as early as possible, depending upon the location and extent of the original tumor.

Adolescent

Lymph node metastasis and retroperitoneal lymphadenectomy in ovarian cancer.

While clinicians are devoting themselves to the study of the behaviour of ovarian cancer as well as to the search for more effective therapeutic modalities, little attention has been paid to an important route of metastasis in this group of diseases: retroperitoneal spread through the lymphatic pathway. The purpose of this report is to present a 5-year experience of a prospective study on lymph node metastasis in patients with ovarian cancer through retroperitoneal lymphadenectomy at the Peking Union Medical College Hospital. From June 1982 through May 1987, retroperitoneal lymph node dissection was performed in 105 cases of ovarian cancer. Seventy-seven (73.3%) were histologically diagnosed as cancer of epithelial origin, and 28 (26.7%) as germ-cell tumours. The overall incidence of retroperitoneal positive nodes was 54.3% (57/105). The incidence of positive pelvic nodes was 46.7% (49/105), and that of positive para-aortic nodes was 37.5% (30/80). In 69 patients who underwent systemic lymphadenectomy, 39 were found to have glandular involvement; in these 39 patients both aortic and pelvic nodes were positive in 19 cases (48.7%), aortic nodes were positive and pelvic nodes negative in 7 cases (18.0%), and pelvic nodes were positive and aortic nodes negative in 13 cases (33.3%). Preoperative lymphography was performed in 30 cases. The positive and negative correspondence rates with the pathological findings were both 83.3%. In 38 cases in which the primary cancer originated in the left ovary, 17 (44.7%) were found to have positive pelvic nodes, whereas in 25 cases with primary cancer arising in the right ovary only 2 (8%) had metastasis of the ipsilateral pelvic nodes. The lymph nodes obtained from 22 patients with positive nodes and sufficient preoperative chemotherapy were carefully examined under the microscope for the effects of the drugs. Some cellular degeneration of the lymph node metastasis was observed in only one of the 15 cases of epithelial cancer, and no response at all was noted in three cases of immature teratoma. Cellular degeneration accompanied by extensive necrosis was demonstrated in the metastatic tumours of the lymph nodes in all four cases of endodermal sinus tumour. Seventy-two patients were followed-up for at least 2 1/2 years. The rate of complete remission was 46.7% (14/30) in patients with negative nodes, but only 33.3% (14/42) in those with positive nodes. However, the difference was not statistically significant.

Antineoplastic Combined Chemotherapy Protocols

Regional lymph node metastasis in renal cell carcinoma: incidence, distribution and its relation to other pathological findings.

Extended ipsilateral lymphadenectomy performed on 102 patients with renal cell carcinoma revealed 21 patients (21%) having regional lymph node metastasis. Of the 21 patients, 6 (6%) had single-node metastasis and 15 (15%) multiple-node metastasis. PT, pV, pM, cell type and grade were all correlated with regional node metastasis. The metastatic lymph node foci were distributed along the pathways of normal lymphatic drainage. The recurrence of the disease was correlated with lymph node metastasis, indicating that metastasis is one of the prognostic factors. The very close correlation of node metastasis with vein invasion suggests that removal at least of the ipsilateral lymph node might be necessary when removal of a thrombus in the renal vein or vena cava is indicated.

Carcinoma, Renal Cell