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Heterogeneity exists in positive nodes (pN +) preoperative negative conventional staging (cN0M0) prostate cancer (PCa) men management. We performed a survey to investigate the current opinion on this issue in the European urological community. An acceptable awareness of pN + disease and management was found. pN + PCa was considered as a multifaceted category needing a risk-adapted approach. Expectant compared to immediate upfront management and new imaging modalities are increasingly considered. Introduction: The urological community's opinion over the management of men being found with pathologically positive nodes (pN +) following radical prostatectomy (RP) performed with curative intent after preoperative negative conventional staging (cN0M0) has never been assessed. This remains crucial, especially considering the advent of novel imaging modalities. Our aim was to investigate the current opinion on management of pN + cN0M0 prostate cancer (PCa) in the European urological community. Methods: Following validation, a 31-item survey, complying with the Cherries checklist, was distributed using a web link from December 2021 to April 2022 to 10 urological societies mailing list. Social media (Twitter, Facebook) were also used. Results: We received 253 replies. The majority were Urologists (96.8%), younger than 60 (90.5%); 5.2% did not have access to PET-scans; 78.9% believed pN + is a multifaceted category; 10-years CSS was marked as 71 to 95% by 17.5%. Gold standard management was stated not being ADT by 80.8% and being RT ±ADT by 52.3%. Early sRT ±ADT was considered an option vs. aRT ±ADT by 72.4%. In case of BCR 71% would perform and decide management based on PSMA-PET whilst 3.7% would not perform PSMA-PET. pN + management is still unclear for 77.1%. On multivariate analysis PSMAPET availability related to a lower and higher likelihood of considering aRT ±ADT as standard and of considering early salvage versus aRT respectively (P < .05). Conclusions: The Urological community has an acceptable awareness of pN + disease and management, although it may overestimate disease aggressiveness. The majority consider pN + PCa as a multifaceted category and rely on a riskadapted approach. Expectant compared to immediate upfront management and new imaging modalities are increasingly considered. [ABSTRACT FROM AUTHOR]

Background and purpose: Guidelines recommend that the axillary lymph node dissection can be omitted for T 1-2 breast cancer patients with 1-2 positive sentinel lymph nodes who undergo breast-conserving mastectomy and whole breast radiation. This study aimed to explore the independent prognostic factors for elderly breast cancer patients with 1-2 positive lymph nodes who underwent mastectomy and construct a nomogram to predict their survival following different axillary surgeries. Methods: T 1-2 invasive breast cancer patients with 1-2 positive nodes and mastectomy from 2010 to 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) program and divided into the training cohort (n=3 647) and the validation cohort (n=1 216). Univariate and multivariate Cox analyses were used to identify independent risk factors for overall survival (OS). The nomogram was constructed to predict 3- and 5-year OS, which was validated by the concordance index (C-index) and calibration curves. Results: A total of 4 863 patients were included with a 42 months median follow-up time. The nomogram was constructed by incorporating nine independent prognostic factors (age, race, marital status, grade, subtype, T stage, axillary surgery, radiation and chemotherapy) identified by multivariate Cox analysis (P

Background: In published radiotherapy trials, the failure rate in the control arm among patients with one to three positive nodes is high compared with that seen with modern adjuvant treatments. Therefore, the generalizability of the results has been questioned. The aim of the present study was to compare relative survival in breast cancer patients between two Swedish regions with screening mammography programs and adjuvant treatment guidelines similar with the exception of the indication of radiotherapy for patients with one to three positive nodes. Patients and methods: Between 1989 and 2006, breast cancer patients were managed very similarly in the west and southeast regions, except for indication for postoperative radiotherapy. In patients with one to three positive nodes, postmastectomy radiotherapy was generally given in the southeast region (89% of all cases) and generally not given in the west region (15% of all cases). For patients with one to three positive nodes who underwent breast-conserving surgery, patients in the west region had breast radiotherapy only, while patients in the southeast region had both breast and lymph nodes irradiated. Results: The 10-year relative survival for patients with one to three positive lymph nodes was 78% in the west region and 77% in the southeast region (P = 0.12). Separate analyses depending on type of surgery, as well as number of examined nodes, also revealed similar relative survival. Conclusion: Locoregional postoperative radiotherapy has well-known side-effects, but in this population-based study, there was little or no influence of this type of radiotherapy on survival when one to three lymph nodes were involved. [ABSTRACT FROM AUTHOR]

Background/aim: The lymph node status has high prognostic relevance in head and neck squamous cell carcinoma (HNSCC). This study aimed to address the hypothesis that the number of positive nodes and the nodal ratio have a prognostic impact on survival in HNSCC., Patients and Methods: A retrospective analysis of 221 patients with HNSCC and clinical N+ status who underwent a neck dissection during primary surgery or after definitive radio(chemo)therapy was performed. The possible influence of age, sex, TNM stage, number of positive nodes and nodal ratio on survival was analyzed by univariate and multivariate Cox models and log-rank tests., Results: On average, 30.1 lymph nodes were removed and 4.96 metastases were detected. The mean nodal ratio was 9.4%, the median nodal ratio was 5.3%. Multivariate analysis demonstrated a nodal ratio of ≥6-<12.5% [hazard ratio (HR)=2.33, 95% confidence interval (CI)=1.24-4.37; p=0.008] and of ≥12.5% (HR=2.86, 95% CI=1.40-5.84; p=0.004) compared to nodal ratio 0, number of positive nodes pN=1 compared to number of positive nodes=0 (HR=2.02, 95% CI=1.08-3.80. p=0.029), as well as N3 compared to N0 (HR=8.10, 95% CI=1.89-34.66; p=0.005), and Mx compared to M0 (HR of 2.76, 95% CI=1.59-4,79, p≤0.001) were of main importance for poor prognosis. Postoperative radio(chemo)therapy after surgery was associated with prolonged survival in multivariate analysis (HR=0.37, 95% CI=0.24-0.57; p≤0.001)., Conclusion: The nodal ratio and number of positive nodes seem to have a high prognostic impact in patients with HNSCC and can be of value in identifying patients at high risk who warrant more aggressive therapy., (Copyright © 2022 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Objective: The purpose of the present study was to identify prognostic factors in surgically treated patients with stage IB-IIB cervical cancers, who also presented with positive pelvic nodes.Method: The patient population consisted of 68 individuals presenting with stage IB-IIB cervical cancers and with histologically proven pelvic lymph nodes.Result: We found no association between the type of adjuvant therapy and patient outcome. Multivariate analysis revealed that non-squamous histology was an independent prognostic factor for disease-free and overall survival rates. In squamous cell carcinomas, the bilateral nature of the positive nodes was found to be a significant factor for disease-free survival rates. In non-squamous cell carcinomas, positive nodes of more than 2 cm in size were found to be a significant factor for disease-free survival rates.Conclusion: Non-squamous histology was an independent prognostic factor and chemoradiotherapy did not improve the survival outcomes of the patients in this study population. [ABSTRACT FROM AUTHOR]

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., (Copyright © 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

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.