journal reading - preoperative lymp node
-
Upload
rambopratama -
Category
Documents
-
view
216 -
download
0
Transcript of journal reading - preoperative lymp node
-
8/20/2019 journal reading - preoperative lymp node
1/19
Widya Sakti Pratama
-
8/20/2019 journal reading - preoperative lymp node
2/19
Background
• Approximately 2.7% to 10% ofpatients it! "## !a$e lymp! nodemetastasis
• mpro$ed sur$i$al in patients it! "##!o underent "P&'(
• Patients it! only nodal metastasis
!o undergo a &' dissection atnep!rectomy may !a$e dura)ledisease*free sur$i$al
-
8/20/2019 journal reading - preoperative lymp node
3/19
+aterial and +et!od
• "etrospecti$ely data)ase for patients it!"## it!out distant metastasis !ounderent radical or partial nep!rectomy
it! ,p-any p'0*1 +0 and it!out ,p-anyp'x +0 "P&'( )eteen 1// and 2012
• Symptom c!aracteriation as recordedas local or systemic
• A nomogram as de$eloped to predictt!e pro)a)ility of lymp! node metastasis
-
8/20/2019 journal reading - preoperative lymp node
4/19
-
8/20/2019 journal reading - preoperative lymp node
5/19
+aterial and +et!od
• systemic systems o fe$er3
o nig!t seats
o 4atigue
o eig!t loss greater t!an 10 pounds
• &ocal Symptomso 4lank paino5ematuria respiratory or gastrointestinal
complain
-
8/20/2019 journal reading - preoperative lymp node
6/19
• #linically positi$e &'s ,c'1 ere
de6ned as retroperitoneallymp!adenopat!y greater t!an 1 cm oncross sectional imaging or enlarged &'sat surgery
• radiograp!ic information
– -umor
– &' sie
– -umor necrosis
– -!rom)us
– location
-
8/20/2019 journal reading - preoperative lymp node
7/19
Statistical Analysis
• Analysis in patients !o underent"P&'( to determine signi6cantco$ariates )eteen t!ose it! p'1
and p'0
• A nomogram as de$eloped topredict t!e pro)a)ility of &'
metastasis in patients !ounderent "P&'(
-
8/20/2019 journal reading - preoperative lymp node
8/19
Statistical Analysis
• utcome measures – $erall Sur$i$al
– #ancer Speci6c Sur$i$al
–
"ecurrence 4ree Sur$i$al• $erall Sur$i$al and #ancer Speci6c Sur$i$al
calculated in mont!s from t!e date ofsurgery to t!e date of last follo up or deat!
• "ecurrence free sur$i$al calculated inmont!s from t!e date of surgery to t!e dateof local and8or distant recurrence
-
8/20/2019 journal reading - preoperative lymp node
9/19
-
8/20/2019 journal reading - preoperative lymp node
10/19
"9S:&-
• We identi6ed 13270 patients it!renal cell carcinoma it!out distantmetastasis !o !ad ,;
-
8/20/2019 journal reading - preoperative lymp node
11/19
• ;
-
8/20/2019 journal reading - preoperative lymp node
12/19
-
8/20/2019 journal reading - preoperative lymp node
13/19
(iscussion
• Patients it! "## it!out distantmetastasis !o ere selected for"P&'( local symptoms3 9#? PS 1
or greater3 c'1 stage and increased&(5 ere independent predictors of&' metastasis
-
8/20/2019 journal reading - preoperative lymp node
14/19
• Patients it! clinically negati$e )utpat!ologically positi$e &'s ,c'0p'1!ad )etter S3 #SS and "4S t!an
patients it! clinically andpat!ologically positi$e &'s ,c'1p'1.
-
8/20/2019 journal reading - preoperative lymp node
15/19
-
8/20/2019 journal reading - preoperative lymp node
16/19
-
8/20/2019 journal reading - preoperative lymp node
17/19
-
8/20/2019 journal reading - preoperative lymp node
18/19
#onclusions
• &ocal symptoms3 9#? PS3 c' stageand lactate de!ydrogenase ereindependent predictors of lymp! node
metastasis in patients !o underentretroperitoneal lymp! node dissection
• Predicti$e nomogram !ad >/%
discrimination and performed ellit! internal $alidation
-
8/20/2019 journal reading - preoperative lymp node
19/19
#onclusions
• Patients it! clinically negati$e )utpat!ologically positi$e &'s representa small su)set of t!ose it! "## ,7%
in t!is co!ort
• -!e incidence of clinically positi$e)ut pat!ologically negati$e &'s
,7% is not insigni6cant