AIM： To investigate whether serum vascular endothelial growth factor-C （SVEGF-C）, VEGF-C, and lymphatic vessel density （LVD） in tumor tissues are related to lymph node metastasis （LNM） and prognosis in gastric ...AIM： To investigate whether serum vascular endothelial growth factor-C （SVEGF-C）, VEGF-C, and lymphatic vessel density （LVD） in tumor tissues are related to lymph node metastasis （LNM） and prognosis in gastric cancer. METHODS： SVEGF-C levels of 80 gastric cancer patients and 20 healthy donors were examined using ELISA. VEGF-C expression and LVD were examined using immunohistochemical staining. Kaplan-Meier survival analysis was performed to determine their influence on the prognosis of the patients. RESULTS： The SVEGF-C level in gastric cancer patients （595.9 ± 201.0 ng/L） was significantly higher （P = 0.000） than controls （360.0 ± 97.4 ng/L）. Both SVEGF-C and LVD were significantly higher in poorly differentiated adenocarcinomas, T3 and T4, LNM, distant metastasis, and pTNM groups Ⅲ and Ⅳ （P = 0.000）. The sensitivity and specificity of SVEGF-C for predicting LNM were 82.8% and 81.8%, respectively （cut-off = 542.5 ng/L）. The positive expression rate of VEGF-C was significantly higher in cancerous than in normal tissues （65% vs 20%; P = 0.001）. VEGF-C expression up-regulation was significantly related to differentiation, depth of invasion, LNM, distant metastasis, and pTNM stage （P = 0.000）. LVD was 10.7 ± 3.1/200 HP in the experimental group vs 4.9 ± 1.3/200 HP in controls （P = 0.000）; LVD in cancerous tissues with and without LNM was 12.0 ± 2.7/200 HP vs 7.6 ± 0.5/200 HP, respectively （P = 0.000）. SVEGF-C and LVD were significantly higher in VEGF-C positive than in negative patients （P = 0.000）; SVEGF-C level was related to LVD （P = 0.000）. Kaplan-Meier survival analysis factors predicating poor prognosis were： SVEGF-C level （P = 0.001）, VEGF-C expression and LVD （both P = 0.000）. CONCLUSION： SVEGF-C level, VEGF-C and LVD are related to LNI and poor prognosis of patients with gastric cancer, SVEGF-C may be a biomarker for LNI in gastric cancer,展开更多
BACKGROUND Lymphatic basin dissection is a sentinel node biopsy method that is specific for gastric cancer.In this method,the dyed lymphatic system is dissected en bloc,and sentinel nodes are identified at the back ta...BACKGROUND Lymphatic basin dissection is a sentinel node biopsy method that is specific for gastric cancer.In this method,the dyed lymphatic system is dissected en bloc,and sentinel nodes are identified at the back table(ex vivo).Even with lymphatic basin dissection,blood flow to the residual stomach can be preserved,and functionpreserving curative gastrectomy can be performed.The oncological safety of function-preserving curative gastrectomy combined with lymphatic basin dissection has not yet been fully investigated.We hypothesized that the oncological safety of sentinel node navigation surgery(SNNS)is not inferior to that of the guidelines.AIM To investigate the life prognosis of SNNS for gastric cancer in comparison with guidelines surgery.METHODS This was a retrospective cohort study.Patients were selected from gastric cancer patients who underwent sentinel node biopsy from April 1999 to March 2016.Patients from April 1999 to August 2008 were from the Department of Surgery II,Kanazawa University Hospital,and patients from August 2009 to March 2016 were from the Department of Surgical Oncology,Kanazawa Medical University Hospital.Patients who were diagnosed with gastric cancer,which was preoperatively diagnosed as superficial type(type 0),5 cm or less in length,clinical T1-2 and node negative,and underwent various gastrectomies guided by sentinel node navigation were retrospectively collected.The overall survival(OS)and relapsefree survival(RFS)of these patients(SNNS group)were investigated.Patients with gastric cancer of the same stage and who underwent guidelines gastrectomy with standard nodal dissection were also selected as the control group.RESULTS A total of 239 patients in the SNNS group and 423 patients in the control group were included.Pathological nodal metastasis was observed in 10.5%and 10.4%of the SNNS and control groups,respectively.The diagnostic abilities of sentinel node biopsy were 84%and 98.6%for sensitivity and accuracy,respectively.In the SNNS group,81.6%of patients underwent modified gastrectomy or functionpreserving curative gastrectomy with lymphatic basin dissection,in which the extent of nodal dissection was further reduced compared to the guidelines.The OS rate in the SNNS group was 96.8%at 5 years and was significantly better than 91.3%in the control group(P=0.0014).The RFS rates were equal in both groups.After propensity score matching,there were 231 patients in both groups,and the cumulative recurrence rate was 0.43%at 5 years in the SNNS group and 1.30%in the control group,which was not statistically different.CONCLUSION The oncological safety of patients who undergo gastrectomy guided by sentinel node navigation is not inferior to that of the guidelines surgery.展开更多
OBJECTIVE To investigate the relationship between lymphatic vessel density and lymph node metastasis of invasive micropapillary carcinoma (IMPC) of the breast. METHODS The immunohistochemical study for vascular endoth...OBJECTIVE To investigate the relationship between lymphatic vessel density and lymph node metastasis of invasive micropapillary carcinoma (IMPC) of the breast. METHODS The immunohistochemical study for vascular endothelial growth factor-c (VEGF-C), VEGF Receptor-3 (VEGFR-3) and lymphatic vessel density of 51 cases of IMPC were performed, and lymph node metastases were examined by microscopic analysis of these cases. RESULTS In IMPC, VEGF-C was expressed in the cytoplasm and/or on the membrane of the tumor cells, and the expression of VEGF-C showed a positive correlation with lymph node metastasis (P<0.01). Lymphatic vessel density was determined by the number of micro-lymphatic vessels with VEGFR-3 positive staining. Lymphatic vessel density was positively correlated with VEGF-C expression (P<0.01) and lymph node metastasis (P<0.01). The percentage of IMPC in the tumor was not associated with the incidence of lymph node metastasis. The metastatic foci in lymph nodes were either pure or predominant micropapillary carcinoma. CONCLUSION The results suggested that VEGF-C overexpression stimulated tumor lymphangiogenesis, and the increased lymphatic vessel density may be the key factor that influenced lymph node metastasis of IMPC.展开更多
Objective: To identify the feasibility of the lymphatic mapping and sentinel node biopsy (SNB) in patients with breast cancer and to examine whether the characteristics of the sentinel lymph node (SLN) accurately pred...Objective: To identify the feasibility of the lymphatic mapping and sentinel node biopsy (SNB) in patients with breast cancer and to examine whether the characteristics of the sentinel lymph node (SLN) accurately predict the status of axillary node. Methods: 33 patients with breast cancer intraoperatively and postoperatively underwent a lymphatic mapping and the SNB using Patent Blue. Results: The SLNs were found in 30 of 33 patients (90.9%), the SLN accurately predicted the status of the axillary in 29 (96.7%). In one case the SLN was negative, but other axillary nodes were tumor positive. Conclusion: This study confirmed that the procedure of lymphatic mapping and SNB in the patients with breast cancer is feasibility, and that the histological characteristics of the SLN accurately predict the status of the axillary node. We believe that this technique might replace axillary lymph node dissection for breast cancer patients with negative axillae in the future.展开更多
Background:Lymphedema is a debilitating condition that frequently occurs after breast cancer treatment.Vas-cularized lymph node transfer(VLNT)is a promising approach to reduce lymphedema.This study used magnetic reson...Background:Lymphedema is a debilitating condition that frequently occurs after breast cancer treatment.Vas-cularized lymph node transfer(VLNT)is a promising approach to reduce lymphedema.This study used magnetic resonance lymphangiography(MRL)to assess lymphatic reconnections post-VLNT in patients with breast cancer-related lymphedema(BCRL).Methods:The clinical records of six female patients with unilateral upper limb BCRL who underwent VLNT(4 cases)or VLNT combined with breast reconstruction(2 cases)were retrospectively reviewed.All patients were examined using MRL preoperatively and at the 1-year follow-up.The morphological characteristics of the lymphatic network,dermal backflow patterns,and architecture of the lymph nodes were evaluated.Clinical outcomes,patient satisfaction,and complications were assessed.Results:At the 1-year follow-up,reduction in tissue edema and limb circumference was achieved in all six patients.In MRL,the implanted lymph nodes in the axillary region of the affected upper arm were enhanced and visualized in all six patients.Reconnected lymphatic vessels in the subcutaneous tissue associated with the implanted lymph nodes were observed in four patients.Decreased dermal backflow and lymphatic vessel dilation of the affected limbs were observed in all six patients.No disruption of the lymph flow in the donor area was detected.Conclusion:This is the first study to provide direct imaging evidence for the reconnection of afferent lymphatic channels between implanted lymph nodes and the recipient lymphatic system in patients with BCRL.Overall,our study demonstrates the mechanism and efficacy of VLNT in reducing lymphedema.展开更多
The principle of surgical treatment for gastric cancer is the radical resectioning although the suitable resecting range for different cases of gastric cancer is still being argued upon[1-9]. However, the diagnostic a...The principle of surgical treatment for gastric cancer is the radical resectioning although the suitable resecting range for different cases of gastric cancer is still being argued upon[1-9]. However, the diagnostic accuracy of early gastric cancer (EGC) without lymphatic metastasis has obviously improved with an improvement in the diagnostic technique and due to the accumulation of knowledge on the biological profiles of EG C[10-17]. The D2 lymph node excision was used as a regular operation to treat the EGC previously. But the concept for the EGC without lymphatic metastasis has gradually changed and the less invasive resections has been applied in some cases[18-20]. This study aimed at investigating the risk factors of lymphatic metastasis in EGC in order to find out the proofs for the suitable indications for less invasive operations such as endoscopic mucosal resectioning (EMR), laparoscopic and laparotomic resectioning.展开更多
Esophageal carcinoma(EC) is a highly lethal malignancywith a poor prognosis. One of the most important prognostic factors in EC is lymph node status. Therefore, lymphadenectomy has been recognized as a key that influe...Esophageal carcinoma(EC) is a highly lethal malignancywith a poor prognosis. One of the most important prognostic factors in EC is lymph node status. Therefore, lymphadenectomy has been recognized as a key that influences the outcome of surgical treatment for EC. However, the lymphatic drainage system of the esophagus, including an abundant lymph-capillary network in the lamina propria and muscularis mucosa, is very complex with cervical, mediastinal and celiac node spreading. The extent of lymphadenectomy for EC has always been controversial because of the very complex pattern of lymph node spreading. In this article, published literature regarding lymphatic spreading was reviewed and the current lymphadenectomy trends for EC are discussed.展开更多
BACKGROUND One of the main characteristics of oral squamous cell carcinoma(OSCC)is that it metastasizes to cervical lymph nodes frequently with a high degree of local invasiveness.A primary feature of malignant tumors...BACKGROUND One of the main characteristics of oral squamous cell carcinoma(OSCC)is that it metastasizes to cervical lymph nodes frequently with a high degree of local invasiveness.A primary feature of malignant tumors is their penetration of neighboring tissues,such as lymphatic and blood arteries,due to the tumor cells'capacity to break down the extracellular matrix(ECM).Matrix metalloproteinases(MMPs)constitute a family of proteolytic enzymes that facilitate tissue remodeling and the degradation of the ECM.MMP-9 and MMP-13 belong to the group of extracellular matrix degrading enzymes and their expression has been studied in OSCC because of their specific functions.MMP-13,a collagenase family member,is thought to play an essential role in the MMP activation cascade by breaking down the fibrillar collagens,whereas MMP-9 is thought to accelerate the growth of tumors.Elevated MMP-13 expression has been associated with tumor behavior and patient prognosis in a number of malignant cases.AIM To assess the immunohistochemical expression of MMP-9 and MMP-13 in OSCC.METHODS A total of 40 cases with histologically confirmed OSCC by incisional biopsy were included in this cross-sectional retrospective study.The protocols for both MMP-9 and MMP-13 immunohistochemical staining were performed according to the manufacturer’s recommendations along with the normal gingival epithelium as a positive control.All the observations were recorded and Pearson’sχ²test with Fisher exact test was used for statistical analysis.RESULTS Our study showed no significant correlation between MMP-9 and MMP-13 staining intensity and tumor size.The majority of the patients were in advanced TNM stages(III and IV),and showed intense expression of MMP-9 and MMP-13.CONCLUSION The present study suggests that both MMP-9 and MMP-13 play an important and independent role in OSCC progression and invasiveness.Intense expression of MMP-9 and MMP-13,irrespective of histological grade of OSCC,correlates well with TNM stage.Consequently,it is evident that MMP-9 and MMP-13 are important for the invasiveness and progression of tumors.The findings may facilitate the development of new approaches for evaluating lymph node metastases and interventional therapy techniques,hence enhancing the prognosis of patients diagnosed with OSCC.展开更多
Objective:Lymphatic metastasis is one of the leading causes of malignancy dispersion in various types of cancer.However,few anti-lymphangiogenic drugs have been approved for clinical use to date.Therefore,new therapie...Objective:Lymphatic metastasis is one of the leading causes of malignancy dispersion in various types of cancer.However,few anti-lymphangiogenic drugs have been approved for clinical use to date.Therefore,new therapies to block lymphangiogenesis are urgently required.Methods:Immunohistochemistry,immunofluorescence,Western blot,migration assays,and lymphangiogenesis and lymphatic metastasis assays were used.Results:Anlotinib,a receptor tyrosine kinase inhibitor,suppressed the rate of new metastatic lesions(31.82%in the placebo arm and 18.18%in the anlotinib arm)in patients with advanced lung adenocarcinoma who were enrolled in our ALTER-0303 study.D2-40+-lymphatic vessel density was strongly correlated with disease stage,metastasis,and poor prognosis in 144 Chinese patients with lung adenocarcinoma.In mice bearing A549EGFP tumors,tumor lymphatic vessel density,tumor cell migration to lymph nodes,and the number of distant metastatic lesions were lower in the anlotinib group than in the controls.Anlotinib inhibited the growth and migration of human lymphatic endothelial cells(hLECs)and lymphangiogenesisin vitro andin vivo.Treatment of hLECs with anlotinib downregulated phosphorylated vascular endothelial growth factor receptor 3(VEGFR-3).Conclusions:Anlotinib inhibits lymphangiogenesis and lymphatic metastasis,probably through inactivating VEGFR-3 phosphorylation.The results indicate that anlotinib may be beneficial for treatment in avoiding lymphangiogenesis and distant lymphatic metastasis in lung adenocarcinoma.(Trial registration:ALTER0303;NCT02388919;March 17,2015.)展开更多
AIM. To explore the role of the matrix metalloproteinase-9 （MMP-9） polymorphism in colorectal cancer （CRC） in a northeast Chinese population.METHODS： Genotyping of MNP-9-1562C〉T and 279R〉Q polymorphisms was car...AIM. To explore the role of the matrix metalloproteinase-9 （MMP-9） polymorphism in colorectal cancer （CRC） in a northeast Chinese population.METHODS： Genotyping of MNP-9-1562C〉T and 279R〉Q polymorphisms was carried out on blood samples from 137 colorectal cancer patients and 199 controls using polymerase chain reaction-restriction fragment length polymorphism （PCR-RFLP）. Multivariate logistic regression models were used to calculate adjusted odds ratios （OR） and 95% confidence intervals （95% CI）.RESULTS： The distribution of IVllVlP-9 -2562C〉T and 279 R〉Q genotype was not significantly associated with the risk of CRC. However, the risk of Ilymph node metastasis of CRC was increased in patients with the -1562T allele （OR = 2.601; 95% CI = 1.160-5.835; P = 0.022）. The frequency of MMP-9 279RR ＋ RQ genotype was higher than the QQ genotype among CRC patients younger than sixty years old （OR = 0.102, 95% CI = 0.013-0.812; P = 0.012）.CONCLUSION： Our results indicated that the MMP-9- 1562C〉T polymorphism affects lymph node metastasis of CRC. In addition, the MMP-9 279R allele may lead to a younger age of onset of colorectal cancer.展开更多
The principal breast cancer treatment approach has long been surgical removal of the primary breast lesions and regional lymph nodes,particularly the axillary lymph nodes.However,the advent of minimally invasive diagn...The principal breast cancer treatment approach has long been surgical removal of the primary breast lesions and regional lymph nodes,particularly the axillary lymph nodes.However,the advent of minimally invasive diagnostic techniques,such as sentinel lymph node biopsy(SLNB),has markedly diminished the extent of surgery required for regional lymph nodes.展开更多
Objective： Although many clinical studies on skip lymphatic metastasis in non-small cell lung cancer have been reported, the risk factors for skip lymphatic metastasis are still controversy and debatable. This study ...Objective： Although many clinical studies on skip lymphatic metastasis in non-small cell lung cancer have been reported, the risk factors for skip lymphatic metastasis are still controversy and debatable. This study investigated, by multivariate logistic regression analysis, the clinical features of skip metastasis to mediastinal lymph nodes （N2） in non-small cell lung cancer 0NISCLC） patients. Methods： We collected the clinicopathological data of 256 pN2-NSCLC patients who underwent lobectomy plus systemic lymph node dissection in Fujian Medical University Union Hospital. The cases in the present study were divided into two groups： skip metastasis （N2 skip＋） and non- skip metastasis （N2 skip-）. A retrospective analysis of clinical pathological features of two groups was performed, rib determine an independent factor, multivariate logistic regression analysis was used to identify possible risk factors. Results： A total of 256 pN2-NSCLC patients were recruited. The analysis results showed that gender, pathologic types, surgery, pleural involvement, smoking history, age, tumor stages, and differentiation were not statistical significant factors impacting on skip metastasis in pN2-NSCLC （P〉0.05）, whereas tumor size was an independent factor for skip metastasis （P=0.02）. Conclusions： The rate of skip lymphatic metastasis increases in pN2-NSCLC patients, in accompany with an increased tumor size.展开更多
AIM: To explore risk factors of lymphatic metastasis (LM) in gallbladder cancer, and their potential to complement unsatisfactory radiological detection.
Objective： This study aims to investigate the clinicopathologic significance of lymphatic vessel invasion （LVI） labeled by D2-40 monoclonal antibody in esophageal squamous cell carcinoma （ESCC）. Methods： Immunoh...Objective： This study aims to investigate the clinicopathologic significance of lymphatic vessel invasion （LVI） labeled by D2-40 monoclonal antibody in esophageal squamous cell carcinoma （ESCC）. Methods： Immunohistochemical assay was used to detect the expression of D2-40 and LVI in 107 ESCC patients. Then, the correlation between the clinicopathologic feature and the overall survival time of the patients was analyzed. Results： The lymph node metastasis rates were 70% and 21% in the LVI-positive and LVI-negative groups, respectively. The nodal metastasis rate was higher in the LVI-positive group than in the LVI-negative group. Multivariate regression analysis showed that LVI was related to nodal metastasis （P〈0.001）. The median survival time of the patients was 26 and 43 months in the LVI-positive and LVI-negative groups, respectively. Mthough univariate regression analysis showed significant difference between the two groups （P=0.014）, multivariate regression analysis revealed that LVI was not an independent prognostic factor for overall survival in the ESCC patients （P=0.062）. Lymphatic node metastasis （P=0.031）, clinical stage （P=0.019）, and residual tumor （P=0.026） were the independent prognostic factors. Conclusion： LVI labeled by D2-40 monoclonal antibody is a risk factor predictive of lymph node metastasis in ESCC patients.展开更多
AIM: To evaluate whether serum and tumor indoleamine 2,3-dioxygenase activities can predict lymphatic invasion (LI) or lymph node metastasis in colorectal carcinoma.METHODS: The study group consisted of 44 colorectal ...AIM: To evaluate whether serum and tumor indoleamine 2,3-dioxygenase activities can predict lymphatic invasion (LI) or lymph node metastasis in colorectal carcinoma.METHODS: The study group consisted of 44 colorectal carcinoma patients. The patients were re-grouped according to the presence or absence of LI and lymph node metastasis. Forty-three cancer-free subjects without any metabolic disturbances were included into the control group. Serum neopterin was measured by enzyme linked immunosorbent assay. Urinary neopterin and biopterin, serum tryptophan (Trp) and kynurenine (Kyn) concentrations of all patients were determined by high performance liquid chromatography. Kyn/Trp was calculated and its correlation with serum neopterin was determined to estimate the serum indoleamine 2,3-dioxygenase activity. Tissue sections from the studied tumors were re-examined histopathologically and were stained by immunohistochemistry with indoleamine-2,3-dioxygenase antibodies.RESULTS: Neither serum nor urinary neopterin was significantly different between the patient and control groups (both P > 0.05). However, colorectal carcinoma patients showed a significant positive correlation between the serum neopterin levels and Kyn/Trp (r = 0.450, P < 0.01). Urinary biopterin was significantly higher in cancer cases (P < 0.05). Serum Kyn/Trp was significantly higher in colorectal carcinoma patients (P < 0.01). Lymphatic invasion was present in 23 of 44 patients, of which only 12 patients had lymph node metastasis. Eleven patients with LI had no lymph node metastasis. Indoleamine-2,3-dioxygenase intensity score was significantly higher in LI positive cancer group (44.56% ± 6.11%) than negative colorectal cancer patients (24.04% ± 6.90%), (P < 0.05). Indoleamine 2,3-dioxygenase expression correlated both with the presence of LI and lymph node metastasis (P < 0.01 and P < 0.05, respectively). A significant difference between the accuracy of diagnosis by using either total indoleamine-2,3-dioxygenase immunostaining score or of lymph node metastasis was found during the evaluation of cancer patients.CONCLUSION: Indoleamine-2,3-dioxygenase expression may predict the presence of unrecognized LI and lymph node metastasis and may be included in the histopathological evaluation of colorectal carcinoma cases.展开更多
AIM: To observe the regulatory effect of Chinese herbal medicine on peritoneal lymphatic stomata and its significance in treating ascites in liver fibrosis model mice. METHODS: Two Chinese herbal composite prescriptio...AIM: To observe the regulatory effect of Chinese herbal medicine on peritoneal lymphatic stomata and its significance in treating ascites in liver fibrosis model mice. METHODS: Two Chinese herbal composite prescriptions were used separately to treat the carbon tetrachloride-induced mouse model of liver fibrosis. The histo-pathologic changes of the liver sections (HE and VG stainings) were observed. The peritoneal lymphatic stomata was detected by scanning electron microscopy and computer image processing. The changes of urinary volume and sodium ion concentration were measured. RESULTS: In the model group, lots of fibrous tissue formed in liver and extended into the hepatic lobules to separate them incompletely. In the treated and prevention groups, the histo-pathologic changes of liver was rather milder, only showed much less fibrous tissue proliferation in the hepatic lobules. The peritoneal lymphatic stomata enlarged with increased density in the experimental groups (diameter: PA, 3.07 +/- 0.69 microm; PB, 2.82 +/- 0.37 microm; TA, 3.25 +/- 0.82 microm and TB, 2.82 +/- 0.56 microm; density: PA, 7.11 +/- 1.90 stomata.1000 microm(-2); PB, 8.76 +/- 1.45 stomata.1000 microm(-2); TA, 6.55 +/- 1.44 stomata.1000 microm(-2)and TB, 8.76+/-1.79 stomata.1000 microm(-2)), as compared with the model group (diameter: 2.00+/-0.52 microm density: 4.45+/-1.05 stomata.1000 microm(-2)). After treatment, the urinary volume and sodium ion excretion increased in the experimental groups (PA, 231.28+/-41.09 mmol.L(-1); PB, 171.69 +/- 27.48 mmol.L(-1) and TA, 231.44 +/- 34.12 mmol.L(-1)), which were significantly different with those in the model group (129.33 +/- 36.75 mmol.L(-1)). CONCLUSION: Chinese herbal medicine has marked effects in alleviating liver fibrosis, regulating peritoneal lymphatic stomata, improving the drainage of ascites from peritoneal cavity and causing increase of urinary volume and sodium ion excretion to reduce the water and sodium retention, and thus have favorable therapeutic effect in treating ascites.展开更多
BACKGROUND Lymph node status is a critical prognostic factor in gastric cancer(GC),but stage migration may occur in pathological lymph nodes(pN)staging.To address this,alternative staging systems such as the positive ...BACKGROUND Lymph node status is a critical prognostic factor in gastric cancer(GC),but stage migration may occur in pathological lymph nodes(pN)staging.To address this,alternative staging systems such as the positive lymph node ratio(LNR)and log odds of positive lymph nodes(LODDS)were introduced.AIM To assess the prognostic accuracy and stratification efficacy of three nodal staging systems in GC.METHODS A systematic review identified 12 studies,from which hazard ratios(HRs)for overall survival(OS)were summarized.Sensitivity analyses,subgroup analyses,publication bias assessments,and quality evaluations were conducted.To enhance comparability,data from studies with identical cutoff values for pN,LNR,and LODDS were pooled.Homogeneous stratification was then applied to generate Kaplan-Meier(KM)survival curves,assessing the stratification efficacy of three staging systems.RESULTS The HRs and 95%confidence intervals for pN,LNR,and LODDS were 2.16(1.72-2.73),2.05(1.65-2.55),and 3.15(2.15-4.37),respectively,confirming all three as independent prognostic risk factors for OS.Comparative analysis of HRs demonstrated that LODDS had superior prognostic predictive power over LNR and pN.KM curves for pN(N0,N1,N2,N3a,N3b),LNR(0.1/0.2/0.5),and LODDS(-1.5/-1.0/-0.5/0)revealed significant differences(P<0.001)among all prognostic stratifications.Mean differences and standard deviations in 60-month relative survival were 27.93%±0.29%,41.70%±0.30%,and 26.60%±0.28%for pN,LNR,and LODDS,respectively.CONCLUSION All three staging systems are independent prognostic factors for OS.LODDS demonstrated the highest specificity,making it especially useful for predicting outcomes,while pN was the most effective in homogeneous stratification,offering better patient differentiation.These findings highlight the complementary roles of LODDS and pN in enhancing prognostic accuracy and stratification.展开更多
Background: Sentinel lymph node (SLN) biopsy remains a cornerstone in the management of breast cancer, as it provides an accurate staging of the disease while minimizing the morbidity associated with complete axillary...Background: Sentinel lymph node (SLN) biopsy remains a cornerstone in the management of breast cancer, as it provides an accurate staging of the disease while minimizing the morbidity associated with complete axillary lymph node dissection. Advances in SLN detection have been very important in refining surgical techniques and improving patient outcomes. The purpose of the present study is to compare the effectiveness of radiocolloids, blue dyes, and fluorescent tracers in detecting the sentinel lymph node in breast cancer. Materials and Methods: Specifically, we analyzed the detection rate, accuracy, and safety profile of the techniques to outline the most reliable and clinically available. A comprehensive review was conducted, searching key databases, including PubMed, Scopus, and Web of Science, for studies published between 2010 and 2024. The review focused on studies that compared the performance of radiocolloids, blue dyes, and fluorescent tracers in the detection of sentinel lymph nodes in breast cancer patients. A total of 54 studies were included based on specific inclusion criteria. Results: Radiocolloids showed high detection rates in studies. Blue dyes have comparable results, but a small percentage of allergic reactions has been observed. Fluorescent tracers such as indocyanine green have improved visualization and accuracy, but their use requires specialized equipment and expertise. Combining radiocolloids with blue dyes or fluorescent tracers has improved detection rates in several studies. Cost and accessibility challenges have also been pointed out, particularly in low-resource settings. Conclusions: Radiocolloids have attained the status of gold standard in the detection of SLNs in breast cancer for their reliability and accuracy. While combined use with other tracers, like blue dyes or fluorescent agents, enhances overall detection performance, making it more holistic. As expected, further innovation and effort are required to improve accessibility and optimize the technique of sentinel lymph node biopsy worldwide.展开更多
The article by Yuan et al accessed the clinicopathologic and prognostic significance of the patterns of lymph node(LN)metastasis in upper and lower gastric cancer(GC).In this article,we will analyze both the strengths...The article by Yuan et al accessed the clinicopathologic and prognostic significance of the patterns of lymph node(LN)metastasis in upper and lower gastric cancer(GC).In this article,we will analyze both the strengths and limitations of this paper.The study’s methodology seems appropriate and proper statistical analyses were applied to identify significant variables.The authors applied the Cox regression model to identify independent risk factors and Kaplan-Meier survival curves to assess prognosis.The researchers found notable differences in cli-nicopathologic variables between patients with upper and lower GC.Addi-tionally,they identified specific LN stations more prone to metastasis in different Siewert classifications of GC.Despite the study’s detailed analysis,it would have been beneficial to explore whether there were survival differences among upper GC patients based on the Siewert classification.Furthermore,the study should have addressed potential confounding factors that might have influenced the results.A more comprehensive analysis could have been achieved by comparing survival outcomes based on LN metastasis patterns.Overall,this article is relevant and provides valuable insights into the significance of LN metastasis patterns in upper GC patients.展开更多
Gastric cancer(GC)remains a leading cause of cancer mortality.While the extent of nodal involvement is a well-known prognostic factor,the specific entity of swollen lymph node metastasis(SLNM),bulky nodal tumor deposi...Gastric cancer(GC)remains a leading cause of cancer mortality.While the extent of nodal involvement is a well-known prognostic factor,the specific entity of swollen lymph node metastasis(SLNM),bulky nodal tumor deposits detectable radiologically or pathologically,has received little attention in staging.Recent data from a study by Cui et al demonstrated that SLNM is an independent predictor of very poor survival in GC.Through robust data and rigorous propensitymatched analyses,SLNM emerged not merely as an anatomical finding but as an independent predictor of poor prognosis,even among patients undergoing curative resection.As precision oncology advances,the findings by Cui et al urge a fundamental rethinking of how SLNM is incorporated into clinical decisionmaking for GC management.In this editorial,we critically examine the prognostic significance of SLNM,challenge its omission from traditional staging frameworks,and advocate for its formal integration into preoperative risk stratification and treatment planning.Recognizing SLNM at diagnosis could unlock intensified neoadjuvant therapy strategies and optimize outcomes for a historically high-risk patient subgroup.展开更多
文摘AIM： To investigate whether serum vascular endothelial growth factor-C （SVEGF-C）, VEGF-C, and lymphatic vessel density （LVD） in tumor tissues are related to lymph node metastasis （LNM） and prognosis in gastric cancer. METHODS： SVEGF-C levels of 80 gastric cancer patients and 20 healthy donors were examined using ELISA. VEGF-C expression and LVD were examined using immunohistochemical staining. Kaplan-Meier survival analysis was performed to determine their influence on the prognosis of the patients. RESULTS： The SVEGF-C level in gastric cancer patients （595.9 ± 201.0 ng/L） was significantly higher （P = 0.000） than controls （360.0 ± 97.4 ng/L）. Both SVEGF-C and LVD were significantly higher in poorly differentiated adenocarcinomas, T3 and T4, LNM, distant metastasis, and pTNM groups Ⅲ and Ⅳ （P = 0.000）. The sensitivity and specificity of SVEGF-C for predicting LNM were 82.8% and 81.8%, respectively （cut-off = 542.5 ng/L）. The positive expression rate of VEGF-C was significantly higher in cancerous than in normal tissues （65% vs 20%; P = 0.001）. VEGF-C expression up-regulation was significantly related to differentiation, depth of invasion, LNM, distant metastasis, and pTNM stage （P = 0.000）. LVD was 10.7 ± 3.1/200 HP in the experimental group vs 4.9 ± 1.3/200 HP in controls （P = 0.000）; LVD in cancerous tissues with and without LNM was 12.0 ± 2.7/200 HP vs 7.6 ± 0.5/200 HP, respectively （P = 0.000）. SVEGF-C and LVD were significantly higher in VEGF-C positive than in negative patients （P = 0.000）; SVEGF-C level was related to LVD （P = 0.000）. Kaplan-Meier survival analysis factors predicating poor prognosis were： SVEGF-C level （P = 0.001）, VEGF-C expression and LVD （both P = 0.000）. CONCLUSION： SVEGF-C level, VEGF-C and LVD are related to LNI and poor prognosis of patients with gastric cancer, SVEGF-C may be a biomarker for LNI in gastric cancer,
基金This study was approved by the ethics committee of Kanazawa University Hospital and Kanazawa Medical University(Trial Number R093,M288)ICG mapping was approved by the ethics committee of Kanazawa Medical University(Trial NumberM404).
文摘BACKGROUND Lymphatic basin dissection is a sentinel node biopsy method that is specific for gastric cancer.In this method,the dyed lymphatic system is dissected en bloc,and sentinel nodes are identified at the back table(ex vivo).Even with lymphatic basin dissection,blood flow to the residual stomach can be preserved,and functionpreserving curative gastrectomy can be performed.The oncological safety of function-preserving curative gastrectomy combined with lymphatic basin dissection has not yet been fully investigated.We hypothesized that the oncological safety of sentinel node navigation surgery(SNNS)is not inferior to that of the guidelines.AIM To investigate the life prognosis of SNNS for gastric cancer in comparison with guidelines surgery.METHODS This was a retrospective cohort study.Patients were selected from gastric cancer patients who underwent sentinel node biopsy from April 1999 to March 2016.Patients from April 1999 to August 2008 were from the Department of Surgery II,Kanazawa University Hospital,and patients from August 2009 to March 2016 were from the Department of Surgical Oncology,Kanazawa Medical University Hospital.Patients who were diagnosed with gastric cancer,which was preoperatively diagnosed as superficial type(type 0),5 cm or less in length,clinical T1-2 and node negative,and underwent various gastrectomies guided by sentinel node navigation were retrospectively collected.The overall survival(OS)and relapsefree survival(RFS)of these patients(SNNS group)were investigated.Patients with gastric cancer of the same stage and who underwent guidelines gastrectomy with standard nodal dissection were also selected as the control group.RESULTS A total of 239 patients in the SNNS group and 423 patients in the control group were included.Pathological nodal metastasis was observed in 10.5%and 10.4%of the SNNS and control groups,respectively.The diagnostic abilities of sentinel node biopsy were 84%and 98.6%for sensitivity and accuracy,respectively.In the SNNS group,81.6%of patients underwent modified gastrectomy or functionpreserving curative gastrectomy with lymphatic basin dissection,in which the extent of nodal dissection was further reduced compared to the guidelines.The OS rate in the SNNS group was 96.8%at 5 years and was significantly better than 91.3%in the control group(P=0.0014).The RFS rates were equal in both groups.After propensity score matching,there were 231 patients in both groups,and the cumulative recurrence rate was 0.43%at 5 years in the SNNS group and 1.30%in the control group,which was not statistically different.CONCLUSION The oncological safety of patients who undergo gastrectomy guided by sentinel node navigation is not inferior to that of the guidelines surgery.
基金This work was supported by the National Natural Science Foundation of China (No.30470667) the Project was sponsored by SRF for ROCS, SEM (No. 2003-2005), and Tianjin Medical University Foundation for Introduction of the Talented Man (No.2003- 2005).
文摘OBJECTIVE To investigate the relationship between lymphatic vessel density and lymph node metastasis of invasive micropapillary carcinoma (IMPC) of the breast. METHODS The immunohistochemical study for vascular endothelial growth factor-c (VEGF-C), VEGF Receptor-3 (VEGFR-3) and lymphatic vessel density of 51 cases of IMPC were performed, and lymph node metastases were examined by microscopic analysis of these cases. RESULTS In IMPC, VEGF-C was expressed in the cytoplasm and/or on the membrane of the tumor cells, and the expression of VEGF-C showed a positive correlation with lymph node metastasis (P<0.01). Lymphatic vessel density was determined by the number of micro-lymphatic vessels with VEGFR-3 positive staining. Lymphatic vessel density was positively correlated with VEGF-C expression (P<0.01) and lymph node metastasis (P<0.01). The percentage of IMPC in the tumor was not associated with the incidence of lymph node metastasis. The metastatic foci in lymph nodes were either pure or predominant micropapillary carcinoma. CONCLUSION The results suggested that VEGF-C overexpression stimulated tumor lymphangiogenesis, and the increased lymphatic vessel density may be the key factor that influenced lymph node metastasis of IMPC.
基金a grant from CIDA(Canadian International Development Agency).
文摘Objective: To identify the feasibility of the lymphatic mapping and sentinel node biopsy (SNB) in patients with breast cancer and to examine whether the characteristics of the sentinel lymph node (SLN) accurately predict the status of axillary node. Methods: 33 patients with breast cancer intraoperatively and postoperatively underwent a lymphatic mapping and the SNB using Patent Blue. Results: The SLNs were found in 30 of 33 patients (90.9%), the SLN accurately predicted the status of the axillary in 29 (96.7%). In one case the SLN was negative, but other axillary nodes were tumor positive. Conclusion: This study confirmed that the procedure of lymphatic mapping and SNB in the patients with breast cancer is feasibility, and that the histological characteristics of the SLN accurately predict the status of the axillary node. We believe that this technique might replace axillary lymph node dissection for breast cancer patients with negative axillae in the future.
基金supported by the National Natural Science Foundation of China(grant nos.81372080 and 82302822)Shanghai Municipal Key Clinical Specialty(grant no.shslczdzk00901)Shanghai Sailing Program(grant no.21YF1424000).
文摘Background:Lymphedema is a debilitating condition that frequently occurs after breast cancer treatment.Vas-cularized lymph node transfer(VLNT)is a promising approach to reduce lymphedema.This study used magnetic resonance lymphangiography(MRL)to assess lymphatic reconnections post-VLNT in patients with breast cancer-related lymphedema(BCRL).Methods:The clinical records of six female patients with unilateral upper limb BCRL who underwent VLNT(4 cases)or VLNT combined with breast reconstruction(2 cases)were retrospectively reviewed.All patients were examined using MRL preoperatively and at the 1-year follow-up.The morphological characteristics of the lymphatic network,dermal backflow patterns,and architecture of the lymph nodes were evaluated.Clinical outcomes,patient satisfaction,and complications were assessed.Results:At the 1-year follow-up,reduction in tissue edema and limb circumference was achieved in all six patients.In MRL,the implanted lymph nodes in the axillary region of the affected upper arm were enhanced and visualized in all six patients.Reconnected lymphatic vessels in the subcutaneous tissue associated with the implanted lymph nodes were observed in four patients.Decreased dermal backflow and lymphatic vessel dilation of the affected limbs were observed in all six patients.No disruption of the lymph flow in the donor area was detected.Conclusion:This is the first study to provide direct imaging evidence for the reconnection of afferent lymphatic channels between implanted lymph nodes and the recipient lymphatic system in patients with BCRL.Overall,our study demonstrates the mechanism and efficacy of VLNT in reducing lymphedema.
基金Scientific Research Foundation for Returned Overseas Chinese Scholars,Slate Education Commission(1997-832)
文摘The principle of surgical treatment for gastric cancer is the radical resectioning although the suitable resecting range for different cases of gastric cancer is still being argued upon[1-9]. However, the diagnostic accuracy of early gastric cancer (EGC) without lymphatic metastasis has obviously improved with an improvement in the diagnostic technique and due to the accumulation of knowledge on the biological profiles of EG C[10-17]. The D2 lymph node excision was used as a regular operation to treat the EGC previously. But the concept for the EGC without lymphatic metastasis has gradually changed and the less invasive resections has been applied in some cases[18-20]. This study aimed at investigating the risk factors of lymphatic metastasis in EGC in order to find out the proofs for the suitable indications for less invasive operations such as endoscopic mucosal resectioning (EMR), laparoscopic and laparotomic resectioning.
文摘Esophageal carcinoma(EC) is a highly lethal malignancywith a poor prognosis. One of the most important prognostic factors in EC is lymph node status. Therefore, lymphadenectomy has been recognized as a key that influences the outcome of surgical treatment for EC. However, the lymphatic drainage system of the esophagus, including an abundant lymph-capillary network in the lamina propria and muscularis mucosa, is very complex with cervical, mediastinal and celiac node spreading. The extent of lymphadenectomy for EC has always been controversial because of the very complex pattern of lymph node spreading. In this article, published literature regarding lymphatic spreading was reviewed and the current lymphadenectomy trends for EC are discussed.
文摘BACKGROUND One of the main characteristics of oral squamous cell carcinoma(OSCC)is that it metastasizes to cervical lymph nodes frequently with a high degree of local invasiveness.A primary feature of malignant tumors is their penetration of neighboring tissues,such as lymphatic and blood arteries,due to the tumor cells'capacity to break down the extracellular matrix(ECM).Matrix metalloproteinases(MMPs)constitute a family of proteolytic enzymes that facilitate tissue remodeling and the degradation of the ECM.MMP-9 and MMP-13 belong to the group of extracellular matrix degrading enzymes and their expression has been studied in OSCC because of their specific functions.MMP-13,a collagenase family member,is thought to play an essential role in the MMP activation cascade by breaking down the fibrillar collagens,whereas MMP-9 is thought to accelerate the growth of tumors.Elevated MMP-13 expression has been associated with tumor behavior and patient prognosis in a number of malignant cases.AIM To assess the immunohistochemical expression of MMP-9 and MMP-13 in OSCC.METHODS A total of 40 cases with histologically confirmed OSCC by incisional biopsy were included in this cross-sectional retrospective study.The protocols for both MMP-9 and MMP-13 immunohistochemical staining were performed according to the manufacturer’s recommendations along with the normal gingival epithelium as a positive control.All the observations were recorded and Pearson’sχ²test with Fisher exact test was used for statistical analysis.RESULTS Our study showed no significant correlation between MMP-9 and MMP-13 staining intensity and tumor size.The majority of the patients were in advanced TNM stages(III and IV),and showed intense expression of MMP-9 and MMP-13.CONCLUSION The present study suggests that both MMP-9 and MMP-13 play an important and independent role in OSCC progression and invasiveness.Intense expression of MMP-9 and MMP-13,irrespective of histological grade of OSCC,correlates well with TNM stage.Consequently,it is evident that MMP-9 and MMP-13 are important for the invasiveness and progression of tumors.The findings may facilitate the development of new approaches for evaluating lymph node metastases and interventional therapy techniques,hence enhancing the prognosis of patients diagnosed with OSCC.
基金This work was supported by grants from the National Natural Science Foundation of China(Grant No.81802296)Natural Science Foundation of Tianjin(Grant No.18JCQNJC82500)Tianjin Municipality Science and Technology Commission Projects(Grant No.12ZCDZSY15600).
文摘Objective:Lymphatic metastasis is one of the leading causes of malignancy dispersion in various types of cancer.However,few anti-lymphangiogenic drugs have been approved for clinical use to date.Therefore,new therapies to block lymphangiogenesis are urgently required.Methods:Immunohistochemistry,immunofluorescence,Western blot,migration assays,and lymphangiogenesis and lymphatic metastasis assays were used.Results:Anlotinib,a receptor tyrosine kinase inhibitor,suppressed the rate of new metastatic lesions(31.82%in the placebo arm and 18.18%in the anlotinib arm)in patients with advanced lung adenocarcinoma who were enrolled in our ALTER-0303 study.D2-40+-lymphatic vessel density was strongly correlated with disease stage,metastasis,and poor prognosis in 144 Chinese patients with lung adenocarcinoma.In mice bearing A549EGFP tumors,tumor lymphatic vessel density,tumor cell migration to lymph nodes,and the number of distant metastatic lesions were lower in the anlotinib group than in the controls.Anlotinib inhibited the growth and migration of human lymphatic endothelial cells(hLECs)and lymphangiogenesisin vitro andin vivo.Treatment of hLECs with anlotinib downregulated phosphorylated vascular endothelial growth factor receptor 3(VEGFR-3).Conclusions:Anlotinib inhibits lymphangiogenesis and lymphatic metastasis,probably through inactivating VEGFR-3 phosphorylation.The results indicate that anlotinib may be beneficial for treatment in avoiding lymphangiogenesis and distant lymphatic metastasis in lung adenocarcinoma.(Trial registration:ALTER0303;NCT02388919;March 17,2015.)
基金Program for New Century Excellent Talents in University, NCET-06-0296
文摘AIM. To explore the role of the matrix metalloproteinase-9 （MMP-9） polymorphism in colorectal cancer （CRC） in a northeast Chinese population.METHODS： Genotyping of MNP-9-1562C〉T and 279R〉Q polymorphisms was carried out on blood samples from 137 colorectal cancer patients and 199 controls using polymerase chain reaction-restriction fragment length polymorphism （PCR-RFLP）. Multivariate logistic regression models were used to calculate adjusted odds ratios （OR） and 95% confidence intervals （95% CI）.RESULTS： The distribution of IVllVlP-9 -2562C〉T and 279 R〉Q genotype was not significantly associated with the risk of CRC. However, the risk of Ilymph node metastasis of CRC was increased in patients with the -1562T allele （OR = 2.601; 95% CI = 1.160-5.835; P = 0.022）. The frequency of MMP-9 279RR ＋ RQ genotype was higher than the QQ genotype among CRC patients younger than sixty years old （OR = 0.102, 95% CI = 0.013-0.812; P = 0.012）.CONCLUSION： Our results indicated that the MMP-9- 1562C〉T polymorphism affects lymph node metastasis of CRC. In addition, the MMP-9 279R allele may lead to a younger age of onset of colorectal cancer.
基金supported by grants from the National Natural Science Foundation of China(Grant Nos.81672638 and W2421095)National Natural Science Foundation of Shandong Province(Grant No.ZR2024LMB011)Collaborative Academic Innovation Project of Shandong Cancer Hospital(Grant No.GF003)。
文摘The principal breast cancer treatment approach has long been surgical removal of the primary breast lesions and regional lymph nodes,particularly the axillary lymph nodes.However,the advent of minimally invasive diagnostic techniques,such as sentinel lymph node biopsy(SLNB),has markedly diminished the extent of surgery required for regional lymph nodes.
文摘Objective： Although many clinical studies on skip lymphatic metastasis in non-small cell lung cancer have been reported, the risk factors for skip lymphatic metastasis are still controversy and debatable. This study investigated, by multivariate logistic regression analysis, the clinical features of skip metastasis to mediastinal lymph nodes （N2） in non-small cell lung cancer 0NISCLC） patients. Methods： We collected the clinicopathological data of 256 pN2-NSCLC patients who underwent lobectomy plus systemic lymph node dissection in Fujian Medical University Union Hospital. The cases in the present study were divided into two groups： skip metastasis （N2 skip＋） and non- skip metastasis （N2 skip-）. A retrospective analysis of clinical pathological features of two groups was performed, rib determine an independent factor, multivariate logistic regression analysis was used to identify possible risk factors. Results： A total of 256 pN2-NSCLC patients were recruited. The analysis results showed that gender, pathologic types, surgery, pleural involvement, smoking history, age, tumor stages, and differentiation were not statistical significant factors impacting on skip metastasis in pN2-NSCLC （P〉0.05）, whereas tumor size was an independent factor for skip metastasis （P=0.02）. Conclusions： The rate of skip lymphatic metastasis increases in pN2-NSCLC patients, in accompany with an increased tumor size.
文摘AIM: To explore risk factors of lymphatic metastasis (LM) in gallbladder cancer, and their potential to complement unsatisfactory radiological detection.
基金supported by the Science and Technology Development Planning of Shandong Provincethe China Postdoctoral Science Fund (Grant No.2012GGE27088 andNo.2011M500531)
文摘Objective： This study aims to investigate the clinicopathologic significance of lymphatic vessel invasion （LVI） labeled by D2-40 monoclonal antibody in esophageal squamous cell carcinoma （ESCC）. Methods： Immunohistochemical assay was used to detect the expression of D2-40 and LVI in 107 ESCC patients. Then, the correlation between the clinicopathologic feature and the overall survival time of the patients was analyzed. Results： The lymph node metastasis rates were 70% and 21% in the LVI-positive and LVI-negative groups, respectively. The nodal metastasis rate was higher in the LVI-positive group than in the LVI-negative group. Multivariate regression analysis showed that LVI was related to nodal metastasis （P〈0.001）. The median survival time of the patients was 26 and 43 months in the LVI-positive and LVI-negative groups, respectively. Mthough univariate regression analysis showed significant difference between the two groups （P=0.014）, multivariate regression analysis revealed that LVI was not an independent prognostic factor for overall survival in the ESCC patients （P=0.062）. Lymphatic node metastasis （P=0.031）, clinical stage （P=0.019）, and residual tumor （P=0.026） were the independent prognostic factors. Conclusion： LVI labeled by D2-40 monoclonal antibody is a risk factor predictive of lymph node metastasis in ESCC patients.
基金Supported by Gazi UniversityScientific Research Projects DivisionNo.01/2007-62
文摘AIM: To evaluate whether serum and tumor indoleamine 2,3-dioxygenase activities can predict lymphatic invasion (LI) or lymph node metastasis in colorectal carcinoma.METHODS: The study group consisted of 44 colorectal carcinoma patients. The patients were re-grouped according to the presence or absence of LI and lymph node metastasis. Forty-three cancer-free subjects without any metabolic disturbances were included into the control group. Serum neopterin was measured by enzyme linked immunosorbent assay. Urinary neopterin and biopterin, serum tryptophan (Trp) and kynurenine (Kyn) concentrations of all patients were determined by high performance liquid chromatography. Kyn/Trp was calculated and its correlation with serum neopterin was determined to estimate the serum indoleamine 2,3-dioxygenase activity. Tissue sections from the studied tumors were re-examined histopathologically and were stained by immunohistochemistry with indoleamine-2,3-dioxygenase antibodies.RESULTS: Neither serum nor urinary neopterin was significantly different between the patient and control groups (both P > 0.05). However, colorectal carcinoma patients showed a significant positive correlation between the serum neopterin levels and Kyn/Trp (r = 0.450, P < 0.01). Urinary biopterin was significantly higher in cancer cases (P < 0.05). Serum Kyn/Trp was significantly higher in colorectal carcinoma patients (P < 0.01). Lymphatic invasion was present in 23 of 44 patients, of which only 12 patients had lymph node metastasis. Eleven patients with LI had no lymph node metastasis. Indoleamine-2,3-dioxygenase intensity score was significantly higher in LI positive cancer group (44.56% ± 6.11%) than negative colorectal cancer patients (24.04% ± 6.90%), (P < 0.05). Indoleamine 2,3-dioxygenase expression correlated both with the presence of LI and lymph node metastasis (P < 0.01 and P < 0.05, respectively). A significant difference between the accuracy of diagnosis by using either total indoleamine-2,3-dioxygenase immunostaining score or of lymph node metastasis was found during the evaluation of cancer patients.CONCLUSION: Indoleamine-2,3-dioxygenase expression may predict the presence of unrecognized LI and lymph node metastasis and may be included in the histopathological evaluation of colorectal carcinoma cases.
基金the National Natural Science Foundation of China,No.39970934Scientific Researches by Science Coinmittee of Hangzhou+2 种基金State Administration of Traditional Chinese Medicine,No.97Z031Zhejiang Provincial Administration of Traditional Chinese Medicineexcellent young talented person by Chinese Ministry of Health and Analysis and Testing fundation of Zhejiang Province.
文摘AIM: To observe the regulatory effect of Chinese herbal medicine on peritoneal lymphatic stomata and its significance in treating ascites in liver fibrosis model mice. METHODS: Two Chinese herbal composite prescriptions were used separately to treat the carbon tetrachloride-induced mouse model of liver fibrosis. The histo-pathologic changes of the liver sections (HE and VG stainings) were observed. The peritoneal lymphatic stomata was detected by scanning electron microscopy and computer image processing. The changes of urinary volume and sodium ion concentration were measured. RESULTS: In the model group, lots of fibrous tissue formed in liver and extended into the hepatic lobules to separate them incompletely. In the treated and prevention groups, the histo-pathologic changes of liver was rather milder, only showed much less fibrous tissue proliferation in the hepatic lobules. The peritoneal lymphatic stomata enlarged with increased density in the experimental groups (diameter: PA, 3.07 +/- 0.69 microm; PB, 2.82 +/- 0.37 microm; TA, 3.25 +/- 0.82 microm and TB, 2.82 +/- 0.56 microm; density: PA, 7.11 +/- 1.90 stomata.1000 microm(-2); PB, 8.76 +/- 1.45 stomata.1000 microm(-2); TA, 6.55 +/- 1.44 stomata.1000 microm(-2)and TB, 8.76+/-1.79 stomata.1000 microm(-2)), as compared with the model group (diameter: 2.00+/-0.52 microm density: 4.45+/-1.05 stomata.1000 microm(-2)). After treatment, the urinary volume and sodium ion excretion increased in the experimental groups (PA, 231.28+/-41.09 mmol.L(-1); PB, 171.69 +/- 27.48 mmol.L(-1) and TA, 231.44 +/- 34.12 mmol.L(-1)), which were significantly different with those in the model group (129.33 +/- 36.75 mmol.L(-1)). CONCLUSION: Chinese herbal medicine has marked effects in alleviating liver fibrosis, regulating peritoneal lymphatic stomata, improving the drainage of ascites from peritoneal cavity and causing increase of urinary volume and sodium ion excretion to reduce the water and sodium retention, and thus have favorable therapeutic effect in treating ascites.
基金the Clinical Medical Team Introduction Program of Suzhou,No.SZYJTD201804.
文摘BACKGROUND Lymph node status is a critical prognostic factor in gastric cancer(GC),but stage migration may occur in pathological lymph nodes(pN)staging.To address this,alternative staging systems such as the positive lymph node ratio(LNR)and log odds of positive lymph nodes(LODDS)were introduced.AIM To assess the prognostic accuracy and stratification efficacy of three nodal staging systems in GC.METHODS A systematic review identified 12 studies,from which hazard ratios(HRs)for overall survival(OS)were summarized.Sensitivity analyses,subgroup analyses,publication bias assessments,and quality evaluations were conducted.To enhance comparability,data from studies with identical cutoff values for pN,LNR,and LODDS were pooled.Homogeneous stratification was then applied to generate Kaplan-Meier(KM)survival curves,assessing the stratification efficacy of three staging systems.RESULTS The HRs and 95%confidence intervals for pN,LNR,and LODDS were 2.16(1.72-2.73),2.05(1.65-2.55),and 3.15(2.15-4.37),respectively,confirming all three as independent prognostic risk factors for OS.Comparative analysis of HRs demonstrated that LODDS had superior prognostic predictive power over LNR and pN.KM curves for pN(N0,N1,N2,N3a,N3b),LNR(0.1/0.2/0.5),and LODDS(-1.5/-1.0/-0.5/0)revealed significant differences(P<0.001)among all prognostic stratifications.Mean differences and standard deviations in 60-month relative survival were 27.93%±0.29%,41.70%±0.30%,and 26.60%±0.28%for pN,LNR,and LODDS,respectively.CONCLUSION All three staging systems are independent prognostic factors for OS.LODDS demonstrated the highest specificity,making it especially useful for predicting outcomes,while pN was the most effective in homogeneous stratification,offering better patient differentiation.These findings highlight the complementary roles of LODDS and pN in enhancing prognostic accuracy and stratification.
文摘Background: Sentinel lymph node (SLN) biopsy remains a cornerstone in the management of breast cancer, as it provides an accurate staging of the disease while minimizing the morbidity associated with complete axillary lymph node dissection. Advances in SLN detection have been very important in refining surgical techniques and improving patient outcomes. The purpose of the present study is to compare the effectiveness of radiocolloids, blue dyes, and fluorescent tracers in detecting the sentinel lymph node in breast cancer. Materials and Methods: Specifically, we analyzed the detection rate, accuracy, and safety profile of the techniques to outline the most reliable and clinically available. A comprehensive review was conducted, searching key databases, including PubMed, Scopus, and Web of Science, for studies published between 2010 and 2024. The review focused on studies that compared the performance of radiocolloids, blue dyes, and fluorescent tracers in the detection of sentinel lymph nodes in breast cancer patients. A total of 54 studies were included based on specific inclusion criteria. Results: Radiocolloids showed high detection rates in studies. Blue dyes have comparable results, but a small percentage of allergic reactions has been observed. Fluorescent tracers such as indocyanine green have improved visualization and accuracy, but their use requires specialized equipment and expertise. Combining radiocolloids with blue dyes or fluorescent tracers has improved detection rates in several studies. Cost and accessibility challenges have also been pointed out, particularly in low-resource settings. Conclusions: Radiocolloids have attained the status of gold standard in the detection of SLNs in breast cancer for their reliability and accuracy. While combined use with other tracers, like blue dyes or fluorescent agents, enhances overall detection performance, making it more holistic. As expected, further innovation and effort are required to improve accessibility and optimize the technique of sentinel lymph node biopsy worldwide.
文摘The article by Yuan et al accessed the clinicopathologic and prognostic significance of the patterns of lymph node(LN)metastasis in upper and lower gastric cancer(GC).In this article,we will analyze both the strengths and limitations of this paper.The study’s methodology seems appropriate and proper statistical analyses were applied to identify significant variables.The authors applied the Cox regression model to identify independent risk factors and Kaplan-Meier survival curves to assess prognosis.The researchers found notable differences in cli-nicopathologic variables between patients with upper and lower GC.Addi-tionally,they identified specific LN stations more prone to metastasis in different Siewert classifications of GC.Despite the study’s detailed analysis,it would have been beneficial to explore whether there were survival differences among upper GC patients based on the Siewert classification.Furthermore,the study should have addressed potential confounding factors that might have influenced the results.A more comprehensive analysis could have been achieved by comparing survival outcomes based on LN metastasis patterns.Overall,this article is relevant and provides valuable insights into the significance of LN metastasis patterns in upper GC patients.
文摘Gastric cancer(GC)remains a leading cause of cancer mortality.While the extent of nodal involvement is a well-known prognostic factor,the specific entity of swollen lymph node metastasis(SLNM),bulky nodal tumor deposits detectable radiologically or pathologically,has received little attention in staging.Recent data from a study by Cui et al demonstrated that SLNM is an independent predictor of very poor survival in GC.Through robust data and rigorous propensitymatched analyses,SLNM emerged not merely as an anatomical finding but as an independent predictor of poor prognosis,even among patients undergoing curative resection.As precision oncology advances,the findings by Cui et al urge a fundamental rethinking of how SLNM is incorporated into clinical decisionmaking for GC management.In this editorial,we critically examine the prognostic significance of SLNM,challenge its omission from traditional staging frameworks,and advocate for its formal integration into preoperative risk stratification and treatment planning.Recognizing SLNM at diagnosis could unlock intensified neoadjuvant therapy strategies and optimize outcomes for a historically high-risk patient subgroup.
