• Asian Pacific Journal of Cancer Prevention
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• 제15권21호
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• pp.9233-9239
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• 2014

Background: We aimed to evaluate the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) expression discordance in matched pairs of primary breast cancer and lymph node metastasis specimens and determine the effect of discordance on prognosis. Materials and Methods: Among all patients diagnosed with lymph node metastases from 2004 to 2007, primary tumors and paired lymph node metastases were resected from 209 patients. The status of ER, PR, and HER2 expression was analyzed immunohistochemically in 200, 194, and 193 patients, respectively. Discordance was correlated with prognosis. Results: Biomarker discordance between primary tumors and paired lymph node metastases was 25.0% (50/200) for ER status, 28.9% (56/194) for PR status, and 14.0% (27/193) for HER2 status. ER positivity was a significant independent predictor of improved survival when analyzed in primary tumors and lymph node metastases. Patients with PR-positive primary tumors and paired lymph node metastases displayed significantly enhanced survival compared to patients with PR-positive primary tumors and PR-negative lymph node metastases. Patients with ER- and PR-positive primary tumors and paired lymph node metastases who received endocrine therapy after surgery displayed significantly better survival than those not receiving endocrine therapy. Similalry treated patients with PR-negative primary tumors and PR-positive paired lymph node metastases also displayed better survival than those not receiving endocrine therapy. Conclusions: Biomarker discordance was observed in matched pairs of primary tumors and lymph node metastases. Such cases displayed poor survival. Thus, it is important to reassess receptor biomarkers used for lymph node metastases.

• Asian Pacific Journal of Cancer Prevention
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• 제13권1호
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• pp.251-254
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• 2012

Purpose: To explore the relationship between auxiliary lymph node metastasis and clinical features, and to identify the factors that affect metastasis occurrence. Methods: A total of 164 cases of primary breast cancer were selected to investigate features such as age, concomitant chronic disease and pathologic diagnosis. Immunohistochemistry was used to detect the expression of the estrogen receptor (ER) and CerbB-2. Logistic regression was employed to analyze the factors that affect the incidence of lymph node metastases. Results: The incidence of lymph node metastases was 46.3% among elderly patients with breast cancer. Based on logistic regression, chronic disease, scale of tumor, age, and ER expression affected the occurrence of lymph node metastases; the ORs were 3.05, 2.18, 0.34, and 3.83, respectively. Between different pathologic diagnoses and the risk factors, the OR scores were 12.7 and 8.02, respectively, for aggressive ductal carcinoma and aggressive lobular carcinoma auxiliary lymph node metastases. Conclusion: The incidence of lymph node metastases is affected by chronic disease, scale of tumor, age, ER expression and pathologic diagnosis.

• Asian Pacific Journal of Cancer Prevention
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• 제15권24호
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• pp.10607-10611
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• 2015

Background: HER2 expression in the primary tumor and its lymph node metastases vary in gastric cancer, reflecting intratumoral heterogeneity. This finding also suggests that proliferation of a different clone in metastatic nodes is possible. In the current study, we aimed to determine the cause of discordance in HER-2 expression in the primary tumor and lymph node metastases for patients with gastric cancer. Materials and Methods: Eighty-one patients with gastric cancer who had undergone radical gastrectomy and were found to have lymph node metastasis upon pathological examination were included. Histopathological samples were obtained from biopsies obtained during patient gastrectomies and lymph node dissection. HER2 status was evaluated by both immunohistochemistry (IHC) and silver in situ hybridization (SISH). Results: Sixty-four (79%) patients were SISH (-), while 17 (21%) were SISH (+) in the primary tumor. However, in metastatic lymph nodes, HER2 status was SISH positive in 5 (28.3%) of the 64 SISH (-) primary tumor specimens. One of the 17 SISH (+) primary tumors was SISH (-) in the metastatic lymph nodes. Thus, SISH results for HER2 in both primary tumors and lymph node metastases were comparable, showing a concordance of 92.5%. In total, six patients demonstrated discordance between the primary tumor and lymph node metastases. The prevalence of HER2 discordance was significantly higher for patients in the pN2 and N3 stages (p=0.007). Although discordant patients had worse survival rates than concordant patients, the differences were not significant (p>0.05).Conclusions: Our study indicates that the frequency of concordance in HER2 status, as determined by IHC or SISH, is high in primary tumors and their corresponding lymph node metastases for patients with gastric cancer. If there is a discrepancy in HER2 status, its evaluation by both IHC and SISH may be useful for detecting patients who would benefit from trastuzumab, and it would therefore help guide decision-making processes in administering treatment.

• Asian Pacific Journal of Cancer Prevention
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• 제17권9호
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• pp.4503-4506
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• 2016

Background: Lymph node and distant metastases are known as the prognostic factor in renal cell carcinoma (RCC). Clinical parameters are needed to predict metastases preoperatively. The aim of this study was to assess clinical predictive factors for lymph node and distant metastases. Materials and Methods: We collected RCC data from January 1995 until December 2015 at Cipto Mangunkusumo hospital in Jakarta. We only reviewed data that had renal cell carcinoma histopathology by operation or biopsy. Clinical information such as patient age, gender, hemoglobin (Hb), erythrocyte sedimentation rate (ESR), and tumor size (clinical T stage) were reviewed and analyzed by Chi-squre and logistic regression to establish clinical predictive value. Results: A total of 102 patients were reviewed. There were 32 (31.4%) with lymph node metastases and 27 (26.5%) with distant metastases. Age, Hb and clinical T staging were associated with nodal metastases. However, only Hb and clinical T staging were found to be associated with distant metastases. By logistic regression, we found T3-4 in clinical T-stage to be the only predictor of nodal metastases (OR 5.14; 1.87 - 14.09) and distant metastases (OR 3.42; 1.27 - .9.23). Conclusions: Clinical T-stages of T3 and T4 according to The AJCC TNM classification could be used as independent clinical predictive factors for lymph node or distant metastases in patients with RCC.

• Asian Pacific Journal of Cancer Prevention
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• 제14권6호
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• pp.3825-3830
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• 2013

More studies are needed to clarify treatments and prognosis of early esophageal squamous cell carcinoma (ESCC). This retrospective study was designed to review the outcome of surgical treatment for early ESCC, evaluate the results of a left thoracotomy for selected patients with early ESCC, and identify factors affecting lymph node metastases and survival. The clinicopathological data of 228 patients with early ESCC who underwent transthoracic esophagectomy with lymphadenectomy without preoperative adjuvant treatment were reviewed. The ${\chi}^2$ test or Fisher's exact test were used to detect factors related to lymph node metastasis. Univariate and multivariate analyses were performed to identify prognostic factors. There were 152 males and 76 females with a median age of 55 years. Two hundred and eight patients underwent a left thoracotomy, and the remaining 20 patients with lymph nodes in the upper mediastinum more than 5 mm in short-axis diameter by computed tomography scan underwent a right thoracotomy. No lymph node metastasis was found in the 18 patients with carcinoma in situ, while lymph node metastases were detected in 1.6% (1/62) of patients with mucosal tumours and 18.2% (27/148) of patients with submucosal tumours. Only 7 patients showed upper mediastinal lymph node metastases in the follow-up. The 5- and 10-year overall survival rates were 81.4% and 70.1%, respectively. Only histologic grade (P<0.001) and pT category (P=0.001) significantly correlated with the presence of lymph node metastases. In multivariate analysis, only histologic grade (P=0.026) and pT category (P=0.008) were independent prognostic factors. A left thoracotomy is acceptable for selected patients with early ESCC. Histologic grade and pT category affected the presence of lymph node metastases and were independent prognostic factors for early ESCC.

• 대한영상의학회지
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• 제84권6호
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• pp.1403-1407
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• 2023

방광암의 림프절 전이는 방광의 림프순환에서 처음과 두 번째로 거쳐 가는 외/내 장골, 폐쇄림프절과 총장골림프절에서 주로 일어난다. 방광암에서 횡격막을 넘어서 일어나는 전이는 드물고, 두경부로의 전이는 예후가 좋지 않으며 생존율도 낮다. 방광요로상피암 환자에서 뼈나 그 외에 고형장기로의 전이 없이 목 피부의 염증성 변화와 함께 림프절전이를 동반하는 것은 드문 증례이므로 이에 보고하고자 한다.

• Radiation Oncology Journal
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• 제15권4호
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• pp.321-329
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• 1997

목적 : 두경부 암 환자에서 경부 림프절 전이 가능성이 높아지는 것은 원발병소의 해부학적위치 및 특성, 원발병소의 크기 즉 병기와 조직병리학적 종류 따라 영향을 받는다. 두경부 암 환자에서 경부 림프절의 전이 양상은 다른 나라에서 분석, 연구되어 있고, 현재 두경부 암 환자 치료와 처치를 이를 기조로 하여 사용한다. 그러나, 두경부 암 환자에 대한 경부 림프절 전이에 대한 우리나라 환자의 통계는 없어 이번 통계를 시행하게 되었다. 대상 및 방법 : 1981년 11월부터 1995년 12월까지 본 병원 방사선 종양학과에 내원한 환자중초사가 가능한 997명을 대상으로 하였다. 조사는 방사선 종양학과에 내원시 면밀한 경부 촉진과향께 컴퓨터 단층 촬영영상 상에서 확인을 하였다. 환자는 크게 경부 림프절 전이가 있는 군과 전이가 없는 군으로 나누었고, 경부 림프절의 병기는 미국 암 연합회에서 추천한 방식에 의하였다. 원발병소의 위치 및 주위로의 침윤 등은 면밀한 관찰과 촉진, 컴퓨터 단층 촬영 영상, 수술소견 및 조직병리학 소견을 참조하였다. 결 과 :방사선 종양학과에 방사선 치료를 위해 내원한 997명 중 416명$(42\%)$에서 경부 림프절 전이를 뽀였고, 581명$(58\%)$에서 전이를 보이지 않았다. 경부 림프절 전이를 보인 림프절의 병기분포를 관찰한 결과 다음과 같았다. Hl : 106$(25.5\%)$, N2a 100$(24\%)$, N2b :68$(16.4\%)$, N2c : 69$(16.6\%)$, N3 :73$(15\%)$. 두경부 암 환자에서 원발병소의 빈도는 다음과 같다. 후두암 : 283$(28.5\%)$, 부비동암 : 152$(18\%)$, 구인두암: 144$(14.5\%)$, 비인강암: In$(12\%)$, 구강암 :92$(9\%)$, 하인두암:71$(7\%)$, 타액선암:$58(6\%)$, 미지원발부위암:31$(3\%)$, 피부암: $14(2\%)$. 두경부 암 환자 중 가장 경부 림프절 전이가 높은 원발병소는 비인강암$(71\%)$으로 나타났고, 다음은 하인두암$(69\%)$, 구인두암$(64\%)$, 구강암$(39\%)$ 순이었다. 경부 림프절 전이를 보였던, 416명 중에서는 구인두암 92명$(22\%)$, 비인강암 8f명$(21\%)$, 후두암 79명$(19\%)$의 순이였다. 병리조직학적으로 가장 빈도가 높을 것은 편평상피암증으로 전체 환자 중 $65.4\%$을 차지하였고, 다음은 악성 림프종이 109명으로 $11\%$였다. 결론 : 두경부 암 환자에서 경부 림프절 전이의 양상이 외국 통계와 비교 매우 유사하게 나타났으며, 원발병소의 해부학적 특성에 따라 경부 림프절 전이가 좌우되며 원발병소의 병기가 진행됨에 따라 경부 림프절 전이 빈도도 증가 되며 또한 경부 림프절의 병기도 증가되는 것을 관찰 할 수 있었다.

• International journal of thyroidology
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• 제11권2호
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• pp.117-122
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• 2018

Metastases to regional cervical lymph nodes occur frequently in patients with thyroid cancer. The appropriate management of regional lymph node is important to achieve good disease control and to classify risk stratification for adjuvant radioactive iodine. However, there are some occasions that neck dissection is difficult and embarrassing in thyroid cancer. Especially, extensive or unusual nodal metastases bring challenges and makes neck dissection more difficult. Carotid artery management is one of the most difficult procedure in neck dissection. The management of patients who have persistent or recurrent cervical metastasis involving the carotid artery has been controversial and treatment dilemma to the surgeon. Metastasis of well differentiated thyroid cancer to the retropharyngeal lymph nodes is rare but occasionally encountered. The complete surgical excision is usually recommended for retropharyngeal lymph node metastasis of well differentiated thyroid cancer. An extensive mediastinal dissection in advanced differentiated thyroid carcinoma is occasionally required. This paper will review recent reports of management of advanced nodal metastasis of thyroid cancer and share the author's personal experience.

• 한국임상수의학회:학술대회논문집
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• 한국임상수의학회 2009년도 추계학술대회
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• pp.235-235
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• 2009

• Asian Pacific Journal of Cancer Prevention
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• 제14권1호
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• pp.583-587
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• 2013

This study aimed to investigate tumor microvessel density (MVD) and lymphatic vessel density (LVD) using the Chalkley method as predictive markers for the risk of axillary lymph node metastasis and their relationship to other clinicopathological parameters in primary breast cancer cases. Forty two node-positive and eighty node-negative breast cancers were immunostained for CD34 and D2-40. MVD and LVD were counted by the Chalkley method at x400 magnification. There was a positive significant correlation of the MVD with the tumor size, coexisting ductal carcinoma in situ (DCIS) and lymph node metastases (P<0.05). In multivariate analysis, the MVD (2.86-4: OR 5.87 95%CI 1.05-32; >4: OR 20.03 95%CI 3.47-115.55), lymphovascular invasion (OR 3.46, 95% CI 1.13-10.58), and associated DCIS (OR 3.1, 95%CI 1.04-9.23) independently predicted axillary lymph node metastasis. There was no significant relationship between LVD and axillary lymph node metastasis. However, D2-40 was a good lymphatic vessel marker to enhance the detection of lymphatic invasion compared to H and E staining. In conclusion, MVD by the Chalkley method, lymphovascular invasion and associated DCIS can be additional predictive factors for axillary lymph node metastases in breast cancer. No relationship was identified between LVD and clinicopathological variables, including axillary lymph node metastasis.