AIM: To investigate a link between lymph node yield and systemic inflammatory response in colon cancer. METHODS: A prospectively maintained database was interrogated. All patients undergoing curative colonic resection...AIM: To investigate a link between lymph node yield and systemic inflammatory response in colon cancer. METHODS: A prospectively maintained database was interrogated. All patients undergoing curative colonic resection were included. Neutrophil lymphocyte ratio(NLR) and albumin were used as markers of SIR. In keeping with previously studies, NLR ≥ 4, albumin < 35 was used as cut off points for SIR. Statistical analysis was performed using 2 sample t-test and χ~2 tests where appropriate.RESULTS: Three hundred and two patients were included for analysis. One hundred and ninety-five patients had NLR < 4 and 107 had NLR ≥ 4. There was no difference in age or sex between groups. Patients with NLR of ≥ 4 had lower mean lymph node yields than patients with NLR < 4 [17.6 ± 7.1 vs 19.2 ± 7.9(P = 0.036)]. More patients with an elevated NLR had node positive disease and an increased lymph node ratio(≥ 0.25, P = 0.044). CONCLUSION: Prognosis in colon cancer is intimately linked to the patient’s immune response. Assuming standardised surgical technique and sub specialty pathology, lymph node count is reduced when systemic inflammatory response is activated.展开更多
AIM To evaluate the prognostic value of the number of retrieved lymph nodes(LNs) and other prognostic factors for patients with distal cholangiocarcinomas, and to determine the optimal retrieved LNs cut-off number.MET...AIM To evaluate the prognostic value of the number of retrieved lymph nodes(LNs) and other prognostic factors for patients with distal cholangiocarcinomas, and to determine the optimal retrieved LNs cut-off number.METHODS The Surveillance, Epidemiology and End Results database was used to screen for patients with distal cholangiocarcinoma. Patients with different numbers of retrieved LNs were divided into three groups by the X-tile program. X-tile from Yale University is a useful tool for outcome-based cut-point optimization. The Kaplan-Meier method and Cox regression analysis were utilized for survival analysis.RESULTS A total of 449 patients with distal cholangiocarcinoma met the inclusion criteria. The Kaplan-Meier survival analysis for all patients and for N1 patients revealed no significant differences among patients with different retrieved LN counts in terms of overall and cancerspecific survival. In patients with node-negative distal cholangiocarcinoma, patients with four to nine retrieved LNs had a significantly better overall(P = 0.026) and cancer-specific survival(P = 0.039) than others. In the subsequent multivariate analysis, the number of retrieved LNs was evaluated to be independently associated with survival. Additionally, patients with four to nine retrieved LNs had a significantly lower overall mortality risk [hazard ratio(HR) = 0.39; 95% confidence interval(CI): 0.20-0.74] and cancer causespecific mortality risk(HR = 0.32; 95%CI: 0.15-0.66) than other patients. Additionally, stratified survival analyses showed persistently better overall and cancerspecific survival when retrieving four to nine LNs in patients with any T stage of tumor, a tumor between 20 and 50 mm in diameter, or a poorly differentiated or undifferentiated tumor, and in patients who were ≤ 70-years-old. CONCLUSION The number of retrieved LNs was an important independent prognostic factor for patients with nodenegative distal cholangiocarcinoma. Additionally, patients with four to nine retrieved LNs had better overall and cancer-specific survival rates than others, but the reason and mechanism were unclear. This conclusion should be validated in future studies.展开更多
Lymphadenectomy of colorectal cancer is a decisive factor for the prognostic and therapeutic staging of the patient. For over 15 years, we have asked ourselves if the minimum number of 12 examined lymph nodes (LNs) wa...Lymphadenectomy of colorectal cancer is a decisive factor for the prognostic and therapeutic staging of the patient. For over 15 years, we have asked ourselves if the minimum number of 12 examined lymph nodes (LNs) was sufficient for the prevention of understaging. The debate is certainly still open if we consider that a limit of 12 LNs is still not the gold standard mainly because the research methodology of the first studies has been criticized. Moreover many authors report that to date both in the United States and Europe the number “12” target is uncommon, not adequate, or accessible only in highly specialised centres. It should however be noted that both the pressing nature of the debate and the dissemination of guidelines have been responsible for a trend that has allowed for a general increase in the number of LNs examined. There are different variables that can affect the retrieval of LNs. Some, like the surgeon, the surgery, and the pathology exam, are without question modifiable; however, other both patient and disease-related variables are non-modifiable and pose the question of whether the minimum number of examined LNs must be individually assigned. The lymph nodal ratio, the sentinel LNs and the study of the biological aspects of the tumor could find valid application in this field in the near future.展开更多
Lymph node involvement is one of the most important prognostic indicators of carcinoma of the digestive tract.Although the therapeutic impact of lymphadenectomy has not been proven and the number of retrieved nodes ca...Lymph node involvement is one of the most important prognostic indicators of carcinoma of the digestive tract.Although the therapeutic impact of lymphadenectomy has not been proven and the number of retrieved nodes cannot be considered a measure of successful cancer surgery,an adequate lymph node count should be guaranteed to accurately assess the N-stage through the number of involved nodes,lymph node ratio,number of negative nodes,ratio of negative to positive nodes,and log odds,i.e.,the log of the ratio between the number of positive lymph nodes and the number of negative lymph nodes in digestive carcinomas.As lymphadenectomy is not without complications,sentinel node mapping has been used as the rational procedure to select patients with early digestive carcinoma in whom nodal dissection may be omitted or a more limited nodal dissection may be preferred.However,due to anatomical and technical issues,sentinel node mapping and nodal basin dissection are not yet the standard of care in early digestive cancer.Moreover,in light of the biological,prognostic and therapeutic impact of tumor budding and tumor deposits,two epithelial-mesenchymal transition-related phenomena that are involved in tumor progression,the role of staging and surgical procedures in digestive carcinomas could be redefined.展开更多
目的探讨阴性淋巴结数目(NLNC)对胃印戒细胞癌(GSRC)患者预后的影响及构建G S R C患者的预后预测模型。方法基于SEER数据库收集GSRC患者2101例,随机分为建模组和验证组,检验临床病理特征与GSRC预后的关系。多因素Cox比例风险回归模型分...目的探讨阴性淋巴结数目(NLNC)对胃印戒细胞癌(GSRC)患者预后的影响及构建G S R C患者的预后预测模型。方法基于SEER数据库收集GSRC患者2101例,随机分为建模组和验证组,检验临床病理特征与GSRC预后的关系。多因素Cox比例风险回归模型分析影响总生存的独立危险因素并建立预后预测模型。一致性指数(C-index)、校准曲线、净分类指数(NRI)、综合判别指数(IDI)和临床决策曲线(DCA)对列线图进行准确性和临床适用性评估。结果所有患者按照7:3比例划分,建模组1473例,验证组628例。NLNC>10是GSRC患者预后的保护因素(HR=0.578,95%CI:0.504~0.662),根据多因素Cox比例风险回归模型筛选的变量建立Nomogram图,建模组和验证组的C-index分别为0.737(95%CI:0.720~0.753)和0.724(95%CI:0.699~0.749),区分度良好,校准曲线显示模型的一致性较高。NRI=17.77%,连续NRI=36.34%,IDI=4.2%,表明该模型较传统模型是正向收益,DCA决策曲线远离基准线表明模型临床适用性好。结论NLNC增加是GSRC患者预后的有利因素。本研究建立的列线图相对准确,可预测GSRC患者的预后。展开更多
目的探讨术前中性粒细胞计数(NE)、淋巴细胞计数(LY)、血小板计数(PLT)、中性粒细胞与淋巴细胞比值(NLR)及血小板与淋巴细胞比值(PLR)与声门上型喉癌颈淋巴结转移的关系。方法回顾性分析2017年1月1日至2020年8月31日于临沂市人民医院行...目的探讨术前中性粒细胞计数(NE)、淋巴细胞计数(LY)、血小板计数(PLT)、中性粒细胞与淋巴细胞比值(NLR)及血小板与淋巴细胞比值(PLR)与声门上型喉癌颈淋巴结转移的关系。方法回顾性分析2017年1月1日至2020年8月31日于临沂市人民医院行手术治疗的87例声门上型喉癌患者的临床资料,根据术后病理结果分为颈淋巴结转移组37例(转移组)和无颈淋巴结转移组50例(对照组)。比较两组患者的年龄、性别、分化程度、T分期等临床资料和血常规指标(NE、LY、PLT、NLR及PLR)。对两组间存在差异的血常规指标进行受试者工作(ROC)曲线分析确定其最佳临界值。按照ROC曲线分析结果中最佳临界值对两组间存在差异的血常规指标进行赋值,赋值后行多因素Logistic回归分析。结果两组患者的年龄及性别、分化程度、T分期构成比等一般临床资料比较差异均无统计学意义(P>0.05);转移组和对照组患者的NE[(4.65±0.19)×10^(9)/L vs(3.86±0.14)×10^(9)/L]、PLT[252.11(229.00,279.50)×10^(9)/L vs 226.22(189.00,252.00)×10^(9)/L]、NLR[2.36(1.94,2.72)vs 1.77(1.40,2.06)]及PLR[(129.01±5.91)vs(103.95±4.38)]比较,转移组明显高于对照组,差异均有统计学意义(P<0.05);转移组患者的LY为2.03(1.74,2.37)×10^(9)/L,略低于对照组的2.30(1.78,2.45)×10^(9)/L,但差异无统计学意义(P>0.05);根据ROC曲线分析确定NE、PLT、NLR及PLR的最佳临界值分别为3.98、224.50、1.93、116.12;赋值后进行多因素Logistic回归分析,结果显示NLR≥1.93(OR:7.385,95%CI:1.544~35.331)及PLT≥224.50(OR:6.733,95%CI:1.531~29.597)是声门上型喉癌发生淋巴结转移的独立危险因素(P<0.05)。结论声门上型喉癌患者术前NLR和PLT显著升高与其颈淋巴结转移相关;NLR和PLT对评估声门上型喉癌颈淋巴结转移具有潜在的临床应用价值。展开更多
文摘AIM: To investigate a link between lymph node yield and systemic inflammatory response in colon cancer. METHODS: A prospectively maintained database was interrogated. All patients undergoing curative colonic resection were included. Neutrophil lymphocyte ratio(NLR) and albumin were used as markers of SIR. In keeping with previously studies, NLR ≥ 4, albumin < 35 was used as cut off points for SIR. Statistical analysis was performed using 2 sample t-test and χ~2 tests where appropriate.RESULTS: Three hundred and two patients were included for analysis. One hundred and ninety-five patients had NLR < 4 and 107 had NLR ≥ 4. There was no difference in age or sex between groups. Patients with NLR of ≥ 4 had lower mean lymph node yields than patients with NLR < 4 [17.6 ± 7.1 vs 19.2 ± 7.9(P = 0.036)]. More patients with an elevated NLR had node positive disease and an increased lymph node ratio(≥ 0.25, P = 0.044). CONCLUSION: Prognosis in colon cancer is intimately linked to the patient’s immune response. Assuming standardised surgical technique and sub specialty pathology, lymph node count is reduced when systemic inflammatory response is activated.
基金Supported by the National Natural science Foundation of China,No.81301975the Chongqing Natural Science Foundation,No.cstc2016jcyj A016
文摘AIM To evaluate the prognostic value of the number of retrieved lymph nodes(LNs) and other prognostic factors for patients with distal cholangiocarcinomas, and to determine the optimal retrieved LNs cut-off number.METHODS The Surveillance, Epidemiology and End Results database was used to screen for patients with distal cholangiocarcinoma. Patients with different numbers of retrieved LNs were divided into three groups by the X-tile program. X-tile from Yale University is a useful tool for outcome-based cut-point optimization. The Kaplan-Meier method and Cox regression analysis were utilized for survival analysis.RESULTS A total of 449 patients with distal cholangiocarcinoma met the inclusion criteria. The Kaplan-Meier survival analysis for all patients and for N1 patients revealed no significant differences among patients with different retrieved LN counts in terms of overall and cancerspecific survival. In patients with node-negative distal cholangiocarcinoma, patients with four to nine retrieved LNs had a significantly better overall(P = 0.026) and cancer-specific survival(P = 0.039) than others. In the subsequent multivariate analysis, the number of retrieved LNs was evaluated to be independently associated with survival. Additionally, patients with four to nine retrieved LNs had a significantly lower overall mortality risk [hazard ratio(HR) = 0.39; 95% confidence interval(CI): 0.20-0.74] and cancer causespecific mortality risk(HR = 0.32; 95%CI: 0.15-0.66) than other patients. Additionally, stratified survival analyses showed persistently better overall and cancerspecific survival when retrieving four to nine LNs in patients with any T stage of tumor, a tumor between 20 and 50 mm in diameter, or a poorly differentiated or undifferentiated tumor, and in patients who were ≤ 70-years-old. CONCLUSION The number of retrieved LNs was an important independent prognostic factor for patients with nodenegative distal cholangiocarcinoma. Additionally, patients with four to nine retrieved LNs had better overall and cancer-specific survival rates than others, but the reason and mechanism were unclear. This conclusion should be validated in future studies.
文摘Lymphadenectomy of colorectal cancer is a decisive factor for the prognostic and therapeutic staging of the patient. For over 15 years, we have asked ourselves if the minimum number of 12 examined lymph nodes (LNs) was sufficient for the prevention of understaging. The debate is certainly still open if we consider that a limit of 12 LNs is still not the gold standard mainly because the research methodology of the first studies has been criticized. Moreover many authors report that to date both in the United States and Europe the number “12” target is uncommon, not adequate, or accessible only in highly specialised centres. It should however be noted that both the pressing nature of the debate and the dissemination of guidelines have been responsible for a trend that has allowed for a general increase in the number of LNs examined. There are different variables that can affect the retrieval of LNs. Some, like the surgeon, the surgery, and the pathology exam, are without question modifiable; however, other both patient and disease-related variables are non-modifiable and pose the question of whether the minimum number of examined LNs must be individually assigned. The lymph nodal ratio, the sentinel LNs and the study of the biological aspects of the tumor could find valid application in this field in the near future.
文摘Lymph node involvement is one of the most important prognostic indicators of carcinoma of the digestive tract.Although the therapeutic impact of lymphadenectomy has not been proven and the number of retrieved nodes cannot be considered a measure of successful cancer surgery,an adequate lymph node count should be guaranteed to accurately assess the N-stage through the number of involved nodes,lymph node ratio,number of negative nodes,ratio of negative to positive nodes,and log odds,i.e.,the log of the ratio between the number of positive lymph nodes and the number of negative lymph nodes in digestive carcinomas.As lymphadenectomy is not without complications,sentinel node mapping has been used as the rational procedure to select patients with early digestive carcinoma in whom nodal dissection may be omitted or a more limited nodal dissection may be preferred.However,due to anatomical and technical issues,sentinel node mapping and nodal basin dissection are not yet the standard of care in early digestive cancer.Moreover,in light of the biological,prognostic and therapeutic impact of tumor budding and tumor deposits,two epithelial-mesenchymal transition-related phenomena that are involved in tumor progression,the role of staging and surgical procedures in digestive carcinomas could be redefined.
文摘目的探讨阴性淋巴结数目(NLNC)对胃印戒细胞癌(GSRC)患者预后的影响及构建G S R C患者的预后预测模型。方法基于SEER数据库收集GSRC患者2101例,随机分为建模组和验证组,检验临床病理特征与GSRC预后的关系。多因素Cox比例风险回归模型分析影响总生存的独立危险因素并建立预后预测模型。一致性指数(C-index)、校准曲线、净分类指数(NRI)、综合判别指数(IDI)和临床决策曲线(DCA)对列线图进行准确性和临床适用性评估。结果所有患者按照7:3比例划分,建模组1473例,验证组628例。NLNC>10是GSRC患者预后的保护因素(HR=0.578,95%CI:0.504~0.662),根据多因素Cox比例风险回归模型筛选的变量建立Nomogram图,建模组和验证组的C-index分别为0.737(95%CI:0.720~0.753)和0.724(95%CI:0.699~0.749),区分度良好,校准曲线显示模型的一致性较高。NRI=17.77%,连续NRI=36.34%,IDI=4.2%,表明该模型较传统模型是正向收益,DCA决策曲线远离基准线表明模型临床适用性好。结论NLNC增加是GSRC患者预后的有利因素。本研究建立的列线图相对准确,可预测GSRC患者的预后。
文摘目的探讨术前中性粒细胞计数(NE)、淋巴细胞计数(LY)、血小板计数(PLT)、中性粒细胞与淋巴细胞比值(NLR)及血小板与淋巴细胞比值(PLR)与声门上型喉癌颈淋巴结转移的关系。方法回顾性分析2017年1月1日至2020年8月31日于临沂市人民医院行手术治疗的87例声门上型喉癌患者的临床资料,根据术后病理结果分为颈淋巴结转移组37例(转移组)和无颈淋巴结转移组50例(对照组)。比较两组患者的年龄、性别、分化程度、T分期等临床资料和血常规指标(NE、LY、PLT、NLR及PLR)。对两组间存在差异的血常规指标进行受试者工作(ROC)曲线分析确定其最佳临界值。按照ROC曲线分析结果中最佳临界值对两组间存在差异的血常规指标进行赋值,赋值后行多因素Logistic回归分析。结果两组患者的年龄及性别、分化程度、T分期构成比等一般临床资料比较差异均无统计学意义(P>0.05);转移组和对照组患者的NE[(4.65±0.19)×10^(9)/L vs(3.86±0.14)×10^(9)/L]、PLT[252.11(229.00,279.50)×10^(9)/L vs 226.22(189.00,252.00)×10^(9)/L]、NLR[2.36(1.94,2.72)vs 1.77(1.40,2.06)]及PLR[(129.01±5.91)vs(103.95±4.38)]比较,转移组明显高于对照组,差异均有统计学意义(P<0.05);转移组患者的LY为2.03(1.74,2.37)×10^(9)/L,略低于对照组的2.30(1.78,2.45)×10^(9)/L,但差异无统计学意义(P>0.05);根据ROC曲线分析确定NE、PLT、NLR及PLR的最佳临界值分别为3.98、224.50、1.93、116.12;赋值后进行多因素Logistic回归分析,结果显示NLR≥1.93(OR:7.385,95%CI:1.544~35.331)及PLT≥224.50(OR:6.733,95%CI:1.531~29.597)是声门上型喉癌发生淋巴结转移的独立危险因素(P<0.05)。结论声门上型喉癌患者术前NLR和PLT显著升高与其颈淋巴结转移相关;NLR和PLT对评估声门上型喉癌颈淋巴结转移具有潜在的临床应用价值。
