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Das vorrangig lymphogen metastasierende Plattenepithelkarzinom stellt die häufigste histologische Tumorentität bei Tumoren der oberen Luft- und Spei-sewege dar. Das Vorhandensein von Lymphknotenmetastasen korreliert mit einer deutlich verschlechterten Überlebensprognose. Der Lymphknotenstatus besitzt somit einen hohen prädiktiven Wert bei Patienten mit Plattenepithelkar-zinomen des Kopf-Hals-Bereichs, sodass die akkurate Detektion und Elimina-tion der Halslymphknotenmetastasen von elementarer Bedeutung sind. Eine wachsende Anzahl an Studien u.a. bei Patienten mit Mamma-, Rektum- und Blasenkarzinomen suggeriert, dass das Verhältnis der histologisch positiven Lymphknoten (Number of Positive Nodes) zu den insgesamt resezierten Lymphknoten, die sogenannte Nodal Ratio von prognostischer Relevanz ist. Ziel der vorliegenden Arbeit war es, zu überprüfen, inwiefern sich die beiden Parameter Nodal Ratio und Number of Positive Nodes zur Abschätzung der Prognose bei Patienten mit Plattenepithelkarzinomen des Kopf-Hals-Bereichs eignen und ob sie zusätzliche Informationen zur konventionellen TNM-Klassifikation liefern. Es erfolgte eine retrospektive Analyse von 221 Patienten mit Plattenepithel-karzinomen des Kopf-Hals-Bereichs und klinischem N+-Hals, die zwischen 1998 und 2009 eine Neck Dissection im Rahmen der chirurgischen Primärthe-rapie oder nach primärer (definitiver) Radio(chemo)therapie (R(CH)T) erhal-ten hatten. Die Überlebensanalyse inklusive der Fünf-Jahres-Überlebensraten erfolgte nach der Kaplan-Meier-Methode. Danach wurde der mögliche Ein-fluss von Alter, Geschlecht, Primärtherapie, postoperativer Behandlung, TNM-Stadium nach UICC 2010, Nodal Ratio und Number of Positive Nodes auf das Überleben mittels uni-und multivariater Methoden (Cox-Modell) getestet. Ein p-Wert p

Purpose of review To investigate the features and optimal management of pN+ cM0 prostate cancer (PCa) according to registry-based studies. Recent findings Up to 15% of PCa patients harbor lymph node invasion (pN+) at radical prostatectomy plus lymph node dissection. Nonetheless, the optimal management strategy in this setting is not well characterized. Summary We performed a systematic review including n = 13 studies. Management strategies comprised 13 536 men undergoing observation, 11 149 adjuvant androgen deprivation therapy (aADT), 7,075 adjuvant radiotherapy (aRT) +aADT and 705 aRT. Baseline features showed aggressive PCa in the majority of men. At a median follow-up ranging 48-134months, Cancer-related death was 5% and overall-mortality 16.6%. aADT and aRT alone had no cancer-specific survival or overall survival advantages over observation only and over not performing aRT, respectively. aADT plus aRT yielded a survival benefit compared to observation and aADT, which in one study, were limited to certain intermediate-risk categories. Age, Gleason, Charlson score, positive surgical margins, pathological stage, and positive nodes number, but not prostate specific antigen, were most relevant prognostic factors. Our work further confirmed pN+ PCa is a multifaceted disease and will help future research in defining its optimal management based on different risk categories to maximize survival and patient's quality of life.

Context Optimal management of prostate cancer (PCa) patients with lymph node invasion at radical prostatectomy and pelvic lymph node dissection still remains unclear. Objective To assess the effectiveness of postoperative treatment strategies for pathologically node-positive PCa patients. The secondary aim was to identify the most relevant prognostic factors to guide the management of pN1 patients. Evidence acquisition A systematic review was performed in January 2020 using Medline, Embase, and other databases. A total of 5063 articles were screened, and 26 studies including 12 537 men were selected for data synthesis and included in the current review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations. Evidence synthesis Ten-year biochemical recurrence (BCR)-free, clinical recurrence–free, cancer-specific (CSS), and overall (OS) survival rates ranged from 28% to 56%, 70% to 92%, 72% to 98%, and 60% to 87.6%, respectively. A total of seven, five, and six studies assessed the oncological outcomes of observation, adjuvant radiotherapy (aRT), or adjuvant androgen deprivation therapy (ADT), respectively. Initial observation followed by salvage therapies at the time of recurrence represents a safe option in selected patients with a low disease burden. The use of aRT with or without ADT might improve survival in men with locally advanced disease and a higher number of positive nodes. Risk stratification according to pathological Gleason score, number of positive nodes, pathological stage, and surgical margins status is the key to risk stratification and selection of the optimal postoperative therapy. Limitations of this systematic review are the retrospective design of the studies included and the lack of data on adverse events. Conclusions While the majority of men with pN1 disease would experience BCR after surgery, long-term disease-free survival has been reported in selected patients. Management options to improve oncological outcomes include observation versus adjuvant therapies such as aRT and/or ADT. Disease characteristics should be used to select the optimal postoperative management for pN1 PCa patients. Patient summary Finding node-positive prostate cancer after a radical prostatectomy often leads to high postoperative prostate-specific antigen levels and is overall a poor prognostic factor. However, this does not necessarily translate into poor survival for all men. Management can be tailored to the severity of disease and options include observation, androgen deprivation therapy, and/or radiotherapy.

// Lin Chen 1, * , Jinfeng Zhang 2, * , Jiayi Chen 3 , Lili Liu 1 , Lili Liang 1 , Zhiyi Shangguan 1 and Dandan Wang 1 1 Department of Radiation Therapy Technology Center, Harbin Medical University Cancer Hospital, Harbin, China 2 Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China 3 Department of Radiological Physics, Harbin Medical University Cancer Hospital, Harbin, China * These authors have contributed equally to this work Correspondence to: Dandan Wang, email: 407745429@qq.com Keywords: triple negative breast cancer, adjuvant radiotherapy, positive nodes, survival Received: July 10, 2016 Accepted: March 27, 2017 Published: April 18, 2017 ABSTRACT The efficacy of adjuvant radiotherapy for the treatment of triple negative breast cancer patients with varying numbers of positive lymph nodes is not clear. We assessed the association between adjuvant radiotherapy and survival in 943 T1/T2 triple negative breast cancer patients treated at our institute between 2008 and 2012. We determined that post-operative radiotherapy improved overall survival (OS), disease-free survival (DFS), and local recurrence-free survival (LRFS) in patients with ≥ 4 positive nodes ( p = 0.037, p = 0.035, and p = 0.012, respectively). Although Cox regression analysis demonstrated that radiotherapy was a significant prognostic factor in triple negative breast cancer with ≥ 4 positive nodes, post-operative radiotherapy had no clear effect on OS, DFS, or LRFS in patients with 1-3 positive nodes ( p = 0.849, p = 0.860, and p = 0.162, respectively). The prognosis (i.e., OS, DFS, and LRFS) of triple negative breast cancer patients without lymph node metastasis who underwent breast-conserving surgery and post-operative radiotherapy was similar to that of patients who underwent mastectomy alone ( p = 0.336, p = 0.537, and p = 0.978, respectively). Our findings demonstrate that post-operative radiotherapy is beneficial for T1/T2 triple negative breast cancer patients with ≥ 4 positive lymph nodes.