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
Accurate preoperative prediction of lymph node metastasis is crucial for developing clinical management strategies for patients with esophageal cancer.In this letter,we present our insights and opinions on a new nomog...Accurate preoperative prediction of lymph node metastasis is crucial for developing clinical management strategies for patients with esophageal cancer.In this letter,we present our insights and opinions on a new nomogram proposed by Xu et al.Although this research has great potential,there are still concerns re-garding the small sample size,limited consideration of biological complexity,subjective image segmentation,incomplete image feature extraction and statistical analyses.Furthermore,we discuss how to achieve more robust and accurate predictive performance in future research.展开更多
BACKGROUND Tissue hardness is closely related to disease pathophysiology.Shear-wave ela-stography(SWE)is a simple and noninvasive ultrasound technique that has been used to evaluate the presence of lymph node metastas...BACKGROUND Tissue hardness is closely related to disease pathophysiology.Shear-wave ela-stography(SWE)is a simple and noninvasive ultrasound technique that has been used to evaluate the presence of lymph node metastases and differentiate between benign and malignant tumors.AIM To investigate SWE usefulness in measuring lymph node hardness to predict metastasis presence or absence in surgically removed lymph nodes.METHODS This observational study obtained data from patients who underwent surgery for esophageal or gastric cancer at Nippon Medical School Hospital.The hardness of the surgically removed lymph nodes was measured using SWE.The lymph nodes with hardness values≥2.2 m/s were considered clinically positive for metastasis,whereas those with lower hardness values were considered clinically negative.The lymph nodes subsequently underwent pathological examination to determine the presence of metastasis,and the SWE results and pathological assessments were compared.RESULTS A total of 1077 lymph nodes were evaluated;18 and 15 cases of esophageal and gastric cancer were identified,respectively.The optimal cutoff value for lymph node size was calculated to be 5.1 mm,and the area under the curve value was 0.74(95%confidence interval:0.69-0.84).When limited to a lymph node larger than the cut off value,the SWE sensitivity and specificity for metastasis identification were 0.76 and 0.82,respectively.CONCLUSION SWE was useful in detecting lymph node metastases in the upper gastrointestinal tract.展开更多
Euphorbia helioscopia,a natural plant recognized for its anti-tumor properties,has been extensively investigated in various cancers.However,its therapeutic potential in gastric cancer with positive lymph node metastas...Euphorbia helioscopia,a natural plant recognized for its anti-tumor properties,has been extensively investigated in various cancers.However,its therapeutic potential in gastric cancer with positive lymph node metastasis remains underexplored.This study aimed to elucidate the role of E.helioscopia in treating gastric cancer with lymph node metastasis using an integrative approach that combined network pharmacology,molecular docking,and molecular dynamics simulations.Initially,shared target data between E.helioscopia and gastric cancer with positive lymph node metastasis were identified and systematically analyzed.Subsequently,molecular docking was conducted to validate the interactions between key components and targets.Finally,molecular dynamics simulations were employed,with binding free energy calculations performed using the MM-PBSA algorithm.The findings revealed that the primary bioactive compounds of E.helioscopia in this context included quercetin and luteolin,targeting core molecules such as EGFR and MMP9.Key pathways implicated in its mechanism of action included resistance to EGFR tyrosine kinase inhibitors,among others.Molecular docking demonstrated robust binding affinity between the active compounds and critical targets,with molecular dynamics and binding free energy analyses highlighting a particularly stable interaction between luteolin and MMP9.In conclusion,E.helioscopia exhibited a multi-component,multi-target,and multi-pathway therapeutic profile in treating gastric cancer with positive lymph node metastasis.These findings offered valuable theoretical insights supporting its potential clinical application in oncology.展开更多
BACKGROUND Gastrointestinal dual-contrast ultrasonography(DCUS)is characterized by its high resolution,sensitivity,and specificity.AIM To determine the accuracy of DCUS in predicting lymph node metastasis in middle-ag...BACKGROUND Gastrointestinal dual-contrast ultrasonography(DCUS)is characterized by its high resolution,sensitivity,and specificity.AIM To determine the accuracy of DCUS in predicting lymph node metastasis in middle-aged and elderly patients with gastric cancer(GC).METHODS A total of 100 middle-aged and elderly patients with GC admitted to the Fourth Affiliated Hospital of Soochow University(Dushu Lake Hospital,Suzhou,China)between April 2022 and April 2024 were selected.The baseline data and lymph node metastasis status were collected.DCUS combined with intravenous contrast technology was used to calculate the enhancement time(ET),time to peak(TTP),and slope of the ascending branch wash-in rate(WIR).These indicators were used in assessing lymph node metastasis in patients with GC.RESULTS Among 100 middle-aged and elderly patients with GC,35(35.00%)had lymph node metastases.GC patients with lymph node metastasis had a higher propor-tion of stage II TNM classification and higher WIR values than those without lymph node metastasis.The ET and TTP values were lower in patients with lymph node metastases,and all differences were statistically significant(P<0.05).The area under the curve values for ET,TTP,WIR,and combined diagnosis of GC lymph node metastasis using DCUS were all>0.7.Optimal assessment was achieved when the cutoff values for ET,TTP,and WIR were set at 16.32 seconds,10.67 seconds,and 7.02,res-pectively.CONCLUSION DCUS-mediated assessment of ET,TTP,and WIR can effectively predict and evaluate lymph node metastasis status in patients with GC,with higher sensitivity when used in combination.展开更多
BACKGROUND Lymph node metastasis(LNM)is a key prognostic factor in pancreatic cancer(PC).Accurate preoperative prediction of LNM remains challenging.Radiomics offers a noninvasive method to extract quantitative imagin...BACKGROUND Lymph node metastasis(LNM)is a key prognostic factor in pancreatic cancer(PC).Accurate preoperative prediction of LNM remains challenging.Radiomics offers a noninvasive method to extract quantitative imaging features that may aid in predicting LNM.AIM To investigate the potential value of a computed tomography(CT)-based radiomics model in prediction of LNM in PC.METHODS A retrospective analysis was performed on 168 pathologically confirmed PC patients who underwent contrast-enhanced-CT.Among them,107 cases had no LNM,while 61 cases had confirmed LNM.These patients were randomly divided into a training cohort(n=135)and a validation cohort(n=33).A total of 792 radiomics features were extracted,comprising 396 features from the arterial phase and another 396 from the portal venous phase.The Minimum Redundancy Maximum Relevance and Least Absolute Shrinkage and Selection Operator methods were used for feature selection and Radiomics model construction.The receiver operating characteristic curve was employed to assess the diagnostic potential of the model,and DeLong test was used to compare the area under the curve(AUC)values of the model.RESULTS Six radiomics features from the arterial phase and nine from the portal venous phase were selected.The Radscore model demonstrated strong predictive performance for LNM in both the training and test cohorts,with AUC values ranging from 0.86 to 0.94,sensitivity between 66.7% and 91.7%,specificity from 71.4% to 100.0%,accuracy between 78.8%and 91.1%,PPV ranging from 64.7% to 100.0%,and negative predictive value between 84.0% and 93.8%.No significant differences in AUC values were observed between the arterial and portal venous phases in either the training or test set.CONCLUSION The preoperative CT-based radiomics model exhibited robust predictive capability for identifying LNM in PC.展开更多
BACKGROUND Gastric cancer(GC)is frequently diagnosed at advanced stages,often with lymph node metastasis(LNM),which complicates prognosis.Swollen LNM(SLNM)in GC has been linked to poor outcomes,yet its prognostic valu...BACKGROUND Gastric cancer(GC)is frequently diagnosed at advanced stages,often with lymph node metastasis(LNM),which complicates prognosis.Swollen LNM(SLNM)in GC has been linked to poor outcomes,yet its prognostic value requires validation.AIM To evaluate the prognostic significance of SLNM in GC patients undergoing curative-intent gastrectomy.METHODS A retrospective analysis included 507 GC patients with LNM,categorized by SLNM status into positive(SLNM present)and negative(SLNM absent)groups.Survival outcomes were compared between groups,including propensity score matching and multivariate analysis to assess the role of SLNM as an independent prognostic factor.RESULTS One hundred and thirty-nine(27.4%)patients exhibited SLNM,associated with significantly lower 5-year overall survival(OS)compared to non-SLNM patients(13.6%vs 35.8%,P<0.001).After matching,SLNM-positive patients maintained worse OS rates(13.4%vs 21.2%,P=0.006).Multivariate analysis confirmed SLNM as an independent prognostic factor(hazard ratio=1.318,P=0.031).Additionally,T4 stage,N3 stage,and neoadjuvant chemotherapy independently influenced survival outcomes for SLNM-positive patients.Those who received neoadjuvant chemotherapy demonstrated better prognosis.CONCLUSION SLNM is an independent predictor of poor prognosis in GC.Neoadjuvant chemotherapy followed by D2 gastrectomy and adjuvant chemotherapy may offer survival benefits for patients with SLNM.展开更多
Most papillary thyroid carcinoma(PTC) patients have a good prognosis. However, lymph node metastasis(LNM), the most common manifestation of disease progression, is frequently associated with a poor prognosis.Neverthel...Most papillary thyroid carcinoma(PTC) patients have a good prognosis. However, lymph node metastasis(LNM), the most common manifestation of disease progression, is frequently associated with a poor prognosis.Nevertheless, few studies have focused on the underlying mechanisms of LNM. In the current study, we aimed to investigate the potential role of exosomal circRNAs that contribute to LNM in PTC. We identified 9 000 differentially expressed exosomal circRNAs in PTC patients with LNM, including 684 upregulated and 2 193 downregulated circRNAs. Functional enrichment analysis revealed that these differentially expressed circRNAs were primarily involved in a variety of molecular and signaling pathways correlated with PTC progression and LNM. Through bioinformatics analysis, we identified 14 circRNA-miRNA-mRNA networks related to LNM-associated signaling pathways in PTC. Moreover, both circTACC2-miR-7-EGFR and circBIRC6-miR-24-3p-BCL2L11 axes were verified for their potential involvement in PTC with LNM. Additionally, we identified four upregulated circRNA-related hub genes and eight hub genes correlated with downregulated circRNAs, some of which were validated as being potentially involved in LNM in PTC. Collectively, our findings provide a novel framework for an in-depth investigation of the function of dysregulated exosomal circRNAs and their potential as biomarkers in PTC patients with LNM.展开更多
Objective To analyze the risk factors for lymph node metastasis(LNM)in patients with stage pT1 lung adenocarcinoma to select a more appropriate surgical option.Methods In this retrospective study,294 patients with pos...Objective To analyze the risk factors for lymph node metastasis(LNM)in patients with stage pT1 lung adenocarcinoma to select a more appropriate surgical option.Methods In this retrospective study,294 patients with postoperative pathologically confirmed stage pT1 invasive lung adenocarcinoma were collected and divided into two groups according to whether they had mediastinal or hilar LNM.Patient tumor imaging,pathological features and gene mutations were analyzed,and risk factors that might predict LNM were derived via univariate and multivariate logistic analyses.LNM-related variables were screened by Boruta and least absolute shrinkage and selection operator regression analysis.Results Among the 294 patients,45(15.3%)had positive mediastinal or hilar lymph nodes.There were no significant differences between the two groups in terms of sex,age,or underlying disease.The difference in the percentage of solidity between the two groups was significant,with the higer percentage group showing a more significant difference.The results of multivariate logistic analysis revealed that a high percentage of solid components and wild-type epidermal growth factor receptor(EGFR)were risk factors for LNM.The nomogram for predicting LNM included the consolidation tumor ratio,tumor size,micropapillary and EGFR,with an area under the curve of 93.4%(95%CI:88.7–99.1)in the derivation cohort and 92.3%(95%CI:84.6–99.9)in the validation cohort.Conclusions A high proportion of solid components and wild-type EGFR were risk factors for pT1 stage lung adenocarcinoma,suggesting that the choice of lung segmentectomy needs to be evaluated and selected more cautiously.展开更多
Objective:The neglect of occult lymph nodes metastasis(OLNM)is one of the pivotal causes of early non-small cell lung cancer(NSCLC)recurrence after local treatments such as stereotactic body radiotherapy(SBRT)or surge...Objective:The neglect of occult lymph nodes metastasis(OLNM)is one of the pivotal causes of early non-small cell lung cancer(NSCLC)recurrence after local treatments such as stereotactic body radiotherapy(SBRT)or surgery.This study aimed to develop and validate a computed tomography(CT)-based radiomics and deep learning(DL)fusion model for predicting non-invasive OLNM.Methods:Patients with radiologically node-negative lung adenocarcinoma from two centers were retrospectively analyzed.We developed clinical,radiomics,and radiomics-clinical models using logistic regression.A DL model was established using a three-dimensional squeeze-and-excitation residual network-34(3D SE-ResNet34)and a fusion model was created by integrating seleted clinical,radiomics features and DL features.Model performance was assessed using the area under the curve(AUC)of the receiver operating characteristic(ROC)curve,calibration curves,and decision curve analysis(DCA).Five predictive models were compared;SHapley Additive exPlanations(SHAP)and Gradient-weighted Class Activation Mapping(Grad-CAM)were employed for visualization and interpretation.Results:Overall,358 patients were included:186 in the training cohort,48 in the internal validation cohort,and 124 in the external testing cohort.The DL fusion model incorporating 3D SE-Resnet34 achieved the highest AUC of 0.947 in the training dataset,with strong performance in internal and external cohorts(AUCs of 0.903 and 0.907,respectively),outperforming single-modal DL models,clinical models,radiomics models,and radiomicsclinical combined models(DeLong test:P<0.05).DCA confirmed its clinical utility,and calibration curves demonstrated excellent agreement between predicted and observed OLNM probabilities.Features interpretation highlighted the importance of textural characteristics and the surrounding tumor regions in stratifying OLNM risk.Conclusions:The DL fusion model reliably and accurately predicts OLNM in early-stage lung adenocarcinoma,offering a non-invasive tool to refine staging and guide personalized treatment decisions.These results may aid clinicians in optimizing surgical and radiotherapy strategies.展开更多
BACKGROUND Esophageal cancer(EC)is one of the most common malignancies worldwide,and lymph node(LN)metastasis remains one of the leading causes of EC recurrence.Metabolic disorders critically affect cancer progression...BACKGROUND Esophageal cancer(EC)is one of the most common malignancies worldwide,and lymph node(LN)metastasis remains one of the leading causes of EC recurrence.Metabolic disorders critically affect cancer progression,and lipid levels are closely associated with the occurrence of EC and several other tumor types.This study analyzed pretreatment lipid levels to determine their association with LN metastasis.AIM To dissect the possible mechanisms underlying LN metastasis and clarify the prognostic role of lipid profiles in EC.METHODS Serum lipid levels and clinicopathological information were retrospectively collected from 294 patients,and risk factors for LN metastasis were confirmed using a logistic regression model.Latent factors were explored using information from publicly accessible databases and immunofluorescence and immunohistochemical staining techniques.RESULTS High serum levels of low-density lipoprotein(LDL)cholesterol promote LN metastasis in EC,while high-density lipoprotein cholesterol has the opposite role.Information of a public database revealed that LDL receptors LRP5 and LRP6 are highly expressed in ECs,and LRP6 overexpression positively correlated with the infiltration of B lymphocytes and a poor prognosis.Immunofluorescence and immunohistochemical staining revealed that the expression of LRP6 and infiltrated B lymphocytes in patients with≥1 regional LN metastasis,containing N1-3(N+group)were significantly higher than those in the N0 group.LRP6 was also highly expressed in the B lymphocytes of the N+group.There was no difference in CXCL13 expression between the N+and N0 groups.However,CXCR5 expression was significantly higher in the N0 group than in the N+group.CONCLUSION High serum LDL levels can promote LN metastasis in EC,and the mechanisms may be related to LRP6 expression and the infiltration of B lymphocytes.展开更多
Lymph node metastasis(LNM)is a crucial risk factor influencing an unfavorable prognosis in specific cancers.Fundamental research illuminates our understanding of tumor behavior and identifies valuable therapeutic targ...Lymph node metastasis(LNM)is a crucial risk factor influencing an unfavorable prognosis in specific cancers.Fundamental research illuminates our understanding of tumor behavior and identifies valuable therapeutic targets.Nevertheless,the exploration of fundamental theories and the validation of clinical therapies hinge on preclinical experiments.Preclinical models,in this context,serve as the conduit connecting fundamental theories to clinical outcomes.In vivo models established in animals offer a valuable platform for comprehensively observing interactions between tumor cells and organisms.Using various experimental animals,including mice,diverse methods,such as carcinogen-induced tumorigenesis,tumor cell line or human tumor transplantation,genetic engineering,and humanization,have been used effectively to construct numerous models for tumor LNM.Carcinogen-induced models simulate the entire process of tumorigenesis and metastasis.Transplantation models,using human tumor cell lines or patient-derived tumors,offer a research platform closely mirroring the histology and clinical behavior of human tumors.Genetically engineered models have been used to delve into the mechanisms of primary tumorigenesis within an intact microenvironment.Humanized models are used to overcome barriers between human and murine immune systems.Beyond mouse models,various other animal models have unique advantages and limitations,all contributing to exploring LNM.This review summarizes existing in vitro and animal preclinical models,identifies current bottlenecks in preclinical research,and offers an outlook on forthcoming preclinical models.展开更多
Background:Patients with gastric cancer(GC)are prone to lymph node metastasis(LNM),which is an important factor for recurrence and poor prognosis of GC.Nowadays,more and more studies have confirmed that exosomes can p...Background:Patients with gastric cancer(GC)are prone to lymph node metastasis(LNM),which is an important factor for recurrence and poor prognosis of GC.Nowadays,more and more studies have confirmed that exosomes can participate in tumor lymphangiogenesis.An in-depth exploration of the pathological mechanism in the process of LNM in GC may provide effective targets and improve the diagnosis and treatment effect.Materials and Methods:We used sequencing analysis of collected serum to screen out exo-miRNA related to LNM in GC.ELISA,qRT-PCR,Western Blot,RNA pull-down assay,Transwell assay,animal experiments,and other experiments were used to verify the results.Results:In this study,we screened out miR-224-3p related to GC progression and LNM in a vascular endothelial growth Factor C(VEGFC)-independent manner.We found that exo-miR-224-3p derived from GC cells could enter human lymphatic endothelial cells(HLECs)and promote the tube formation and migration of HLECs.In addition,it was revealed that miR-224-3p could bind to the 3′UTR region of GSK3B mRNA.Then,we proved that inhibiting the expression of GSK3B could suppress the phosphorylation ofβ-catenin and promote the transcription of PROX1,thus leading to tumor lymphangiogenesis.Furthermore,it was also found that hnRNPA1 mediated the sorting of miR-224-3p into exosomes,and the high expression of PKM2 promoted the secretion of exomiR-224-3p.Conclusions:Our discovery of the exo-miR-224-3p/GSK3B/β-catenin/PROX1 axis may provide a new direction for the clinical treatment of GC.展开更多
BACKGROUND Early gastric cancer(EGC)is a common malignant tumor of the digestive system,and its lymph node metastasis and survival prognosis have been concerning.By retrospectively analyzing the clinical data of EGC p...BACKGROUND Early gastric cancer(EGC)is a common malignant tumor of the digestive system,and its lymph node metastasis and survival prognosis have been concerning.By retrospectively analyzing the clinical data of EGC patients,we can better under-stand the status of lymph node metastasis and its impact on survival and prog-nosis.AIM To evaluate the prognosis of EGC patients and the factors that affect lymph node METHODS The clinicopathological data of 1011 patients with EGC admitted to our hospital between January 2015 and December 2023 were collected in a retrospective cohort study.There were 561 males and 450 females.The mean age was 58±11 years.The patient underwent radical gastrectomy.The status of lymph node metastasis in each group was determined according to the pathological examination results of surgical specimens.The outcomes were as follows:(1)Lymph node metastasis in EGC patients;(2)Analysis of influencing factors of lymph node metastasis in EGC;and(3)Analysis of prognostic factors in patients with EGC.Normally distributed measurement data are expressed as mean±SD,and a t test was used for comparisons between groups.The data are expressed as absolute numbers or percentages,and the chi-square test was used for comparisons between groups.Rank data were compared using a nonparametric rank sum test.A log-rank test and a logistic regression model were used for univariate analysis.A logistic stepwise regression model and a Cox stepwise regression model were used for multivariate analysis.The Kaplan-Meier method was used to calculate the survival rate and construct survival curves.A log-rank test was used for survival analysis.RESULTS Analysis of influencing factors of lymph node metastasis in EGC.The results of the multifactor analysis showed that tumor length and diameter,tumor site,tumor invasion depth,vascular thrombus,and tumor differentiation degree were independent influencing factors for lymph node metastasis in patients with EGC(odds ratios=1.80,1.49,2.65,5.76,and 0.60;95%CI:1.29–2.50,1.11–2.00,1.81–3.88,3.87-8.59,and 0.48-0.76,respectively;P<0.05).Analysis of prognostic factors in patients with EGC.All 1011 patients with EGC were followed up for 43(0–13)months.The 3-year overall survival rate was 97.32%.Multivariate analysis revealed that age>60 years and lymph node metastasis were independent risk factors for prognosis in patients with EGC(hazard ratio=9.50,2.20;95%CI:3.31-27.29,1.00-4.87;P<0.05).Further analysis revealed that the 3-year overall survival rates of gastric cancer patients aged>60 years and≤60 years were 99.37%and 94.66%,respectively,and the difference was statistically significant(P<0.05).The 3-year overall survival rates of patients with and without lymph node metastasis were 95.42%and 97.92%,respectively,and the difference was statistically significant(P<0.05).CONCLUSION The lymph node metastasis rate of EGC patients was 23.64%.Tumor length,tumor site,tumor infiltration depth,vascular cancer thrombin,and tumor differentiation degree were found to be independent factors affecting lymph node metastasis in EGC patients.Age>60 years and lymph node metastasis are independent risk factors for EGC prognosis.展开更多
BACKGROUND Lymph node metastasis is a specific type of metastasis in hepatic alveolar echinococcosis(AE).Currently,there is a scarcity of describing the clinical characteristics and lymph node metastasis rules of pati...BACKGROUND Lymph node metastasis is a specific type of metastasis in hepatic alveolar echinococcosis(AE).Currently,there is a scarcity of describing the clinical characteristics and lymph node metastasis rules of patients with hepatic AE combined with lymph node metastasis and its mechanism and management are still controversial.Radical hepatectomy combined with regional lymph node dissection is a better treatment.AIM To analyse the clinical features of hepatic AE combined with lymph node metastasis to explore its treatment and efficacy.METHODS A total of 623 patients with hepatic AE admitted to the First Affiliated Hospital of Xinjiang Medical University from 1 January 2012 to 1 January 2022 were retrospectively analysed.Fifty-five patients with combined lymph node metastasis were analysed for their clinical data,diagnosis and treatment methods,follow-up efficacy,and characteristics of lymph node metastasis.Finally,we comparatively analysed the lymph node metastasis rates at different sites.Categorical variables are expressed as frequencies and percentages,and the analysis of difference was performed using theχ2 test.The Bonferroni method was used for pairwise comparisons when statistical differences existed between multiple categorical variables.RESULTS A lymph node metastasis rate of 8.8%(55/623)was reported in patients with hepatic AE,with a female predilection(69.1%)and a statistically significant sex difference(χ2=8.018,P=0.005).Of the 55 patients with lymph node metastasis,72.7%had a parasite lesion,neighbouring organ invasion,and metastasis stage of P3N1M0 and above,of which 67.3%,78.2%,and 34.5%of hepatic AE lesions invaded the bile ducts,blood vessels,and distant metastases,respectively.Detection rates of lymph node metastasis of 16.4%,21.7%,and 34.2%were reported for a preoperative abdominal ultrasound,magnetic resonance imaging,and computed tomography examinations.All patients were intraoperatively suspected with enlarged lymph nodes and underwent radical hepatectomy combined with regional lymph node dissection.After surgery,a routine pathological examination was conducted on the resected lymph nodes.A total of 106 positive lymph nodes were detected in six groups at various sites,including 51 single-group metastasis cases and four multi-group metastasis cases.When the metastasis rates at different sites were statistically analysed,we observed that the metastasis rate in the para-hepatoduodenal ligament lymph nodes was significantly higher than that of the other sites(χ^(2)=128.089,P=0.000<0.05).No statistical difference was observed in the metastasis rate between the five other groups.Clavien-Dindo grade IIIa complication occurred in 14 cases,which improved after administering symptomatic treatment.Additionally,lymph node dissection-related complications were not observed.Recurrence after 2 years was observed in one patient.CONCLUSION Lymph node metastasis is a rare form of metastasis in hepatic AE,which is more frequent in women.Parahepatoduodenal ligament lymph nodes are commonly observed.Radical hepatectomy combined with regional lymph node dissection is a safe,effective,and feasible treatment for liver AE combined with lymph node metastasis.展开更多
BACKGROUND Gastric cancer is one of the most common malignant tumors in the digestive system,ranking sixth in incidence and fourth in mortality worldwide.Since 42.5%of metastatic lymph nodes in gastric cancer belong t...BACKGROUND Gastric cancer is one of the most common malignant tumors in the digestive system,ranking sixth in incidence and fourth in mortality worldwide.Since 42.5%of metastatic lymph nodes in gastric cancer belong to nodule type and peripheral type,the application of imaging diagnosis is restricted.AIM To establish models for predicting the risk of lymph node metastasis in gastric cancer patients using machine learning(ML)algorithms and to evaluate their pre-dictive performance in clinical practice.METHODS Data of a total of 369 patients who underwent radical gastrectomy at the Depart-ment of General Surgery of Affiliated Hospital of Xuzhou Medical University(Xuzhou,China)from March 2016 to November 2019 were collected and retro-spectively analyzed as the training group.In addition,data of 123 patients who underwent radical gastrectomy at the Department of General Surgery of Jining First People’s Hospital(Jining,China)were collected and analyzed as the verifi-cation group.Seven ML models,including decision tree,random forest,support vector machine(SVM),gradient boosting machine,naive Bayes,neural network,and logistic regression,were developed to evaluate the occurrence of lymph node metastasis in patients with gastric cancer.The ML models were established fo-llowing ten cross-validation iterations using the training dataset,and subsequently,each model was assessed using the test dataset.The models’performance was evaluated by comparing the area under the receiver operating characteristic curve of each model.RESULTS Among the seven ML models,except for SVM,the other ones exhibited higher accuracy and reliability,and the influences of various risk factors on the models are intuitive.CONCLUSION The ML models developed exhibit strong predictive capabilities for lymph node metastasis in gastric cancer,which can aid in personalized clinical diagnosis and treatment.展开更多
In this editorial,we comment on the article by Wang et al published in the recent issue of the World Journal of Gastroenterology in 2023.We focused on identifying risk factors for lymph node metastasis(LNM)in superfic...In this editorial,we comment on the article by Wang et al published in the recent issue of the World Journal of Gastroenterology in 2023.We focused on identifying risk factors for lymph node metastasis(LNM)in superficial esophageal squamous cell carcinoma(SESCC)patients and how to construct a simple and reliable clinical prediction model to assess the risk of LNM in SESCC patients,thereby helping to guide the selection of an appropriate treatment plan.The current standard treatment for SESCC is radical esophagectomy with lymph node dissection.However,esophagectomy is associated with considerable morbidity and mortality.Endoscopic resection(ER)offers a safer and less invasive alternative to surgical resection and can enable the patient's quality of life to be maintained while providing a satisfactory outcome.However,since ER is a localized treatment that does not allow for lymph node dissection,the risk of LNM in SESCC limits the effectiveness of ER.Understanding LNM status can aid in determining whether patients with SESCC can be cured by ER without the need for additional esophagectomy.Previous studies have shown that tumor size,macroscopic type of tumor,degree of differentiation,depth of tumor invasion,and lymphovascular invasion are factors associated with LNM in patients with SESCC.In addition,tumor budding is commonly associated with LNM,recurrence,and distant metastasis,but this topic has been less covered in previous studies.By comprehensively evaluating the above risk factors for LNM,useful evidence can be obtained for doctors to select appropriate treatments for SESCC patients.展开更多
BACKGROUND Advanced rectal cancer with submesenteric lymph node metastasis is a common complication of advanced rectal cancer,which has an important impact on the treatment and prognosis of patients.AIM To investigate...BACKGROUND Advanced rectal cancer with submesenteric lymph node metastasis is a common complication of advanced rectal cancer,which has an important impact on the treatment and prognosis of patients.AIM To investigate the clinical and pathological characteristics of inferior mesenteric artery(IMA)root lymph node metastases in patients with rectal cancer.The findings of this study provided us with fresh medical information that assisted us in determining the appropriate treatment for these patients.METHODS Our study searched PubMed,Google Scholar,and other databases and searched the relevant studies and reports on the risk factors of IMA root lymph node metastasis of rectal cancer published in the self-built database until December 31,2023.After data extraction,the Newcastle-Ottawa scale was used to evaluate the quality of the included literature,and RevMan5.3 software was used for meta-analysis and heterogeneity testing.The fixed effect modules without heterogeneity were selected to combine the effect size,and the random effect modules with heterogeneity were selected to combine the effect size.The cause of heterogeneity was found through sensitivity analysis,and the data of various risk factors were combined to obtain the final effect size,odds ratio(OR)value,and 95%confidence interval(CI).Publication bias was tested by drawing funnel plots.RESULTS A total of seven literature were included in this study.By combining the OR value of logistic multivariate regression and the 95%CI of various risk factors,we concluded that the risk factors for lymph node metastasis in the IMA region of rectal cancer were as follows:Preoperative carcinoembryonic antigen(CEA)>5 ng/mL(OR=0.32,95%CI:0.18-0.55,P<0.05),tumor located above peritoneal reflexive(OR=3.10,95%CI:1.78-5.42,P<0.05),tumor size≥5 cm(OR=0.36,95%CI:0.22-0.57,P<0.05),pathological type(mucinous adenocarcinoma/sig-ring cell carcinoma)(OR=0.23,95%CI:0.13-0.41,P<0.05),degree of tumor differentiation(low differentiation)(OR=0.17,95%CI:0.10-0.31,P<0.05),tumor stage(T3-4 stage)(OR=0.11,95%CI:0.04-0.26,P<0.05),gender and age were not risk factors for IMA root lymph node metastasis in rectal cancer(P>0.05).CONCLUSION Preoperative CEA level,tumor location,tumor size,tumor pathologic type,tumor differentiation,and T stage were correlated with IMA root lymph node metastasis.展开更多
Objective:The assessment of lateral lymph node metastasis(LLNM)in patients with papillary thyroid carcinoma(PTC)holds great significance.This study aims to develop and evaluate a deep learning-based automatic pipeline...Objective:The assessment of lateral lymph node metastasis(LLNM)in patients with papillary thyroid carcinoma(PTC)holds great significance.This study aims to develop and evaluate a deep learning-based automatic pipeline system(DLAPS)for diagnosing LLNM in PTC using computed tomography(CT).Methods:A total of 1,266 lateral lymph nodes(LLNs)from 519 PTC patients who underwent CT examinations from January 2019 to November 2022 were included and divided into training and validation set,internal test set,pooled external test set,and prospective test set.The DLAPS consists of an auto-segmentation network based on RefineNet model and a classification network based on ensemble model(ResNet,Xception,and DenseNet).The performance of the DLAPS was compared with that of manually segmented DL models,the clinical model,and Node Reporting and Data System(Node-RADS).The improvement of radiologists’diagnostic performance under the DLAPS-assisted strategy was explored.In addition,bulk RNA-sequencing was conducted based on 12 LLNs to reveal the underlying biological basis of the DLAPS.Results:The DLAPS yielded good performance with area under the receiver operating characteristic curve(AUC)of 0.872,0.910,and 0.822 in the internal,pooled external,and prospective test sets,respectively.The DLAPS significantly outperformed clinical models(AUC 0.731,P<0.001)and Node-RADS(AUC 0.602,P<0.001)in the internal test set.Moreover,the performance of the DLAPS was comparable to that of the manually segmented deep learning(DL)model with AUCs ranging 0.814−0.901 in three test sets.Furthermore,the DLAPSassisted strategy improved the performance of radiologists and enhanced inter-observer consistency.In clinical situations,the rate of unnecessary LLN dissection decreased from 33.33%to 7.32%.Furthermore,the DLAPS was associated with the cell-cell conjunction in the microenvironment.Conclusions:Using CT images from PTC patients,the DLAPS could effectively segment and classify LLNs non-invasively,and this system had a good generalization ability and clinical applicability.展开更多
Objective After endoscopic resection of colorectal cancer with submucosal invasion(pT1 CRC),additional surgical treatment is recommended if deep submucosal invasion(DSI)is present.This study aimed to further elucidate...Objective After endoscopic resection of colorectal cancer with submucosal invasion(pT1 CRC),additional surgical treatment is recommended if deep submucosal invasion(DSI)is present.This study aimed to further elucidate the risk factors for lymph node metastasis(LNM)in patients with pT1 CRC,especially the effect of DSI on LNM.Methods Patients with pT1 CRC who underwent lymph node dissection were selected.The Chi-square test and multivariate logistic regression were used to analyze the relationship between clinicopathological characteristics and LNM.The submucosal invasion depth(SID)was measured via 4 methods and analyzed with 3 cut-off values.Results Twenty-eight of the 239 patients presented with LNM(11.7%),and the independent risk factors for LNM included high histological grade(P=0.003),lymphovascular invasion(LVI)(P=0.004),intermediate to high budding(Bd 2/3)(P=0.008),and cancer gland rupture(CGR)(P=0.008).Moreover,the SID,width of submucosal invasion(WSI),and area of submucosal invasion(ASI)were not significantly different.When one,two,three or more risk factors were identified,the LNM rates were 1.1%(1/95),12.5%(7/56),and 48.8%(20/41),respectively.Conclusion Indicators such as the SID,WSI,and ASI are not risk factors for LNM and are subjective in their measurement,which renders them relatively inconvenient to apply in clinical practice.In contrast,histological grade,LVI,tumor budding and CGR are relatively straightforward to identify and have been demonstrated to be statistically significant.It would be prudent to focus on these histological factors rather than subjective measurements.展开更多
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.
文摘Accurate preoperative prediction of lymph node metastasis is crucial for developing clinical management strategies for patients with esophageal cancer.In this letter,we present our insights and opinions on a new nomogram proposed by Xu et al.Although this research has great potential,there are still concerns re-garding the small sample size,limited consideration of biological complexity,subjective image segmentation,incomplete image feature extraction and statistical analyses.Furthermore,we discuss how to achieve more robust and accurate predictive performance in future research.
基金This study was approved by the Ethics Committee of Nippon Medical School Hospital(No.B-2022-582).
文摘BACKGROUND Tissue hardness is closely related to disease pathophysiology.Shear-wave ela-stography(SWE)is a simple and noninvasive ultrasound technique that has been used to evaluate the presence of lymph node metastases and differentiate between benign and malignant tumors.AIM To investigate SWE usefulness in measuring lymph node hardness to predict metastasis presence or absence in surgically removed lymph nodes.METHODS This observational study obtained data from patients who underwent surgery for esophageal or gastric cancer at Nippon Medical School Hospital.The hardness of the surgically removed lymph nodes was measured using SWE.The lymph nodes with hardness values≥2.2 m/s were considered clinically positive for metastasis,whereas those with lower hardness values were considered clinically negative.The lymph nodes subsequently underwent pathological examination to determine the presence of metastasis,and the SWE results and pathological assessments were compared.RESULTS A total of 1077 lymph nodes were evaluated;18 and 15 cases of esophageal and gastric cancer were identified,respectively.The optimal cutoff value for lymph node size was calculated to be 5.1 mm,and the area under the curve value was 0.74(95%confidence interval:0.69-0.84).When limited to a lymph node larger than the cut off value,the SWE sensitivity and specificity for metastasis identification were 0.76 and 0.82,respectively.CONCLUSION SWE was useful in detecting lymph node metastases in the upper gastrointestinal tract.
基金The Gansu Province University Industrial Support Plan(Grant No.2023CYZC-05)the Cuiying Technology Innovation Project of Lanzhou University Second Hospital(Grant No.CY2022-MS-B04)+1 种基金the Doctoral Students Training Research Fund of Lanzhou University Second Hospital(Grant No.YJS-BD-32)the Gansu Province Drug Regulatory Science Research Project in 2024(Grant No.2024GSMPA032).
文摘Euphorbia helioscopia,a natural plant recognized for its anti-tumor properties,has been extensively investigated in various cancers.However,its therapeutic potential in gastric cancer with positive lymph node metastasis remains underexplored.This study aimed to elucidate the role of E.helioscopia in treating gastric cancer with lymph node metastasis using an integrative approach that combined network pharmacology,molecular docking,and molecular dynamics simulations.Initially,shared target data between E.helioscopia and gastric cancer with positive lymph node metastasis were identified and systematically analyzed.Subsequently,molecular docking was conducted to validate the interactions between key components and targets.Finally,molecular dynamics simulations were employed,with binding free energy calculations performed using the MM-PBSA algorithm.The findings revealed that the primary bioactive compounds of E.helioscopia in this context included quercetin and luteolin,targeting core molecules such as EGFR and MMP9.Key pathways implicated in its mechanism of action included resistance to EGFR tyrosine kinase inhibitors,among others.Molecular docking demonstrated robust binding affinity between the active compounds and critical targets,with molecular dynamics and binding free energy analyses highlighting a particularly stable interaction between luteolin and MMP9.In conclusion,E.helioscopia exhibited a multi-component,multi-target,and multi-pathway therapeutic profile in treating gastric cancer with positive lymph node metastasis.These findings offered valuable theoretical insights supporting its potential clinical application in oncology.
文摘BACKGROUND Gastrointestinal dual-contrast ultrasonography(DCUS)is characterized by its high resolution,sensitivity,and specificity.AIM To determine the accuracy of DCUS in predicting lymph node metastasis in middle-aged and elderly patients with gastric cancer(GC).METHODS A total of 100 middle-aged and elderly patients with GC admitted to the Fourth Affiliated Hospital of Soochow University(Dushu Lake Hospital,Suzhou,China)between April 2022 and April 2024 were selected.The baseline data and lymph node metastasis status were collected.DCUS combined with intravenous contrast technology was used to calculate the enhancement time(ET),time to peak(TTP),and slope of the ascending branch wash-in rate(WIR).These indicators were used in assessing lymph node metastasis in patients with GC.RESULTS Among 100 middle-aged and elderly patients with GC,35(35.00%)had lymph node metastases.GC patients with lymph node metastasis had a higher propor-tion of stage II TNM classification and higher WIR values than those without lymph node metastasis.The ET and TTP values were lower in patients with lymph node metastases,and all differences were statistically significant(P<0.05).The area under the curve values for ET,TTP,WIR,and combined diagnosis of GC lymph node metastasis using DCUS were all>0.7.Optimal assessment was achieved when the cutoff values for ET,TTP,and WIR were set at 16.32 seconds,10.67 seconds,and 7.02,res-pectively.CONCLUSION DCUS-mediated assessment of ET,TTP,and WIR can effectively predict and evaluate lymph node metastasis status in patients with GC,with higher sensitivity when used in combination.
基金Supported by National Natural Science foundation of China,No.82202135,No.82371919,No.82372017,and No.82171925China Postdoctoral Science Foundation,No.2023M741808+4 种基金Young Elite Scientists Sponsorship Program by China Association of Chinese Medicine,No.2024-QNRC2-B16Jiangsu Provincial Key Research and Development Program,No.BE2023789Young Elite Scientists Sponsorship Program by Jiangsu Association for Science and Technology,No.JSTJ-2023-WJ027Project funded by Nanjing Postdoctoral Science Foundation,Natural Science Foundation of Nanjing University of Chinese Medicine,No.XZR2023036Foundation of Excellent Young Doctor of Jiangsu Province Hospital of Chinese Medicine,No.2023QB0112.
文摘BACKGROUND Lymph node metastasis(LNM)is a key prognostic factor in pancreatic cancer(PC).Accurate preoperative prediction of LNM remains challenging.Radiomics offers a noninvasive method to extract quantitative imaging features that may aid in predicting LNM.AIM To investigate the potential value of a computed tomography(CT)-based radiomics model in prediction of LNM in PC.METHODS A retrospective analysis was performed on 168 pathologically confirmed PC patients who underwent contrast-enhanced-CT.Among them,107 cases had no LNM,while 61 cases had confirmed LNM.These patients were randomly divided into a training cohort(n=135)and a validation cohort(n=33).A total of 792 radiomics features were extracted,comprising 396 features from the arterial phase and another 396 from the portal venous phase.The Minimum Redundancy Maximum Relevance and Least Absolute Shrinkage and Selection Operator methods were used for feature selection and Radiomics model construction.The receiver operating characteristic curve was employed to assess the diagnostic potential of the model,and DeLong test was used to compare the area under the curve(AUC)values of the model.RESULTS Six radiomics features from the arterial phase and nine from the portal venous phase were selected.The Radscore model demonstrated strong predictive performance for LNM in both the training and test cohorts,with AUC values ranging from 0.86 to 0.94,sensitivity between 66.7% and 91.7%,specificity from 71.4% to 100.0%,accuracy between 78.8%and 91.1%,PPV ranging from 64.7% to 100.0%,and negative predictive value between 84.0% and 93.8%.No significant differences in AUC values were observed between the arterial and portal venous phases in either the training or test set.CONCLUSION The preoperative CT-based radiomics model exhibited robust predictive capability for identifying LNM in PC.
基金Supported by The Shandong Provincial Medical and Health Science and Technology Youth Project,China,No.202304081355The Weifang Youth Medical Talent Lift Project,Chinaand The Science and Technology Development Project of Affiliated Hospital of Shandong Second Medical University,China,No.2023FYQ004.
文摘BACKGROUND Gastric cancer(GC)is frequently diagnosed at advanced stages,often with lymph node metastasis(LNM),which complicates prognosis.Swollen LNM(SLNM)in GC has been linked to poor outcomes,yet its prognostic value requires validation.AIM To evaluate the prognostic significance of SLNM in GC patients undergoing curative-intent gastrectomy.METHODS A retrospective analysis included 507 GC patients with LNM,categorized by SLNM status into positive(SLNM present)and negative(SLNM absent)groups.Survival outcomes were compared between groups,including propensity score matching and multivariate analysis to assess the role of SLNM as an independent prognostic factor.RESULTS One hundred and thirty-nine(27.4%)patients exhibited SLNM,associated with significantly lower 5-year overall survival(OS)compared to non-SLNM patients(13.6%vs 35.8%,P<0.001).After matching,SLNM-positive patients maintained worse OS rates(13.4%vs 21.2%,P=0.006).Multivariate analysis confirmed SLNM as an independent prognostic factor(hazard ratio=1.318,P=0.031).Additionally,T4 stage,N3 stage,and neoadjuvant chemotherapy independently influenced survival outcomes for SLNM-positive patients.Those who received neoadjuvant chemotherapy demonstrated better prognosis.CONCLUSION SLNM is an independent predictor of poor prognosis in GC.Neoadjuvant chemotherapy followed by D2 gastrectomy and adjuvant chemotherapy may offer survival benefits for patients with SLNM.
基金National Natural Science Foundation of China (Grant No. 81800698)Jiangsu Provincial Medical Key Discipline Cultivation Unit (Grant No. JSDW202241)+1 种基金Research Project of Jiangsu Commission of Health (Grant No. H2023053)Zhenjiang Science and the Technology Planning Project (Grant Nos. SH2023006and SH2023008)。
文摘Most papillary thyroid carcinoma(PTC) patients have a good prognosis. However, lymph node metastasis(LNM), the most common manifestation of disease progression, is frequently associated with a poor prognosis.Nevertheless, few studies have focused on the underlying mechanisms of LNM. In the current study, we aimed to investigate the potential role of exosomal circRNAs that contribute to LNM in PTC. We identified 9 000 differentially expressed exosomal circRNAs in PTC patients with LNM, including 684 upregulated and 2 193 downregulated circRNAs. Functional enrichment analysis revealed that these differentially expressed circRNAs were primarily involved in a variety of molecular and signaling pathways correlated with PTC progression and LNM. Through bioinformatics analysis, we identified 14 circRNA-miRNA-mRNA networks related to LNM-associated signaling pathways in PTC. Moreover, both circTACC2-miR-7-EGFR and circBIRC6-miR-24-3p-BCL2L11 axes were verified for their potential involvement in PTC with LNM. Additionally, we identified four upregulated circRNA-related hub genes and eight hub genes correlated with downregulated circRNAs, some of which were validated as being potentially involved in LNM in PTC. Collectively, our findings provide a novel framework for an in-depth investigation of the function of dysregulated exosomal circRNAs and their potential as biomarkers in PTC patients with LNM.
文摘Objective To analyze the risk factors for lymph node metastasis(LNM)in patients with stage pT1 lung adenocarcinoma to select a more appropriate surgical option.Methods In this retrospective study,294 patients with postoperative pathologically confirmed stage pT1 invasive lung adenocarcinoma were collected and divided into two groups according to whether they had mediastinal or hilar LNM.Patient tumor imaging,pathological features and gene mutations were analyzed,and risk factors that might predict LNM were derived via univariate and multivariate logistic analyses.LNM-related variables were screened by Boruta and least absolute shrinkage and selection operator regression analysis.Results Among the 294 patients,45(15.3%)had positive mediastinal or hilar lymph nodes.There were no significant differences between the two groups in terms of sex,age,or underlying disease.The difference in the percentage of solidity between the two groups was significant,with the higer percentage group showing a more significant difference.The results of multivariate logistic analysis revealed that a high percentage of solid components and wild-type epidermal growth factor receptor(EGFR)were risk factors for LNM.The nomogram for predicting LNM included the consolidation tumor ratio,tumor size,micropapillary and EGFR,with an area under the curve of 93.4%(95%CI:88.7–99.1)in the derivation cohort and 92.3%(95%CI:84.6–99.9)in the validation cohort.Conclusions A high proportion of solid components and wild-type EGFR were risk factors for pT1 stage lung adenocarcinoma,suggesting that the choice of lung segmentectomy needs to be evaluated and selected more cautiously.
基金supported by the National Natural Science Foundation of China(No.82272845)the Natural Science Foundation of Shandong(No.ZR2023ZD26).
文摘Objective:The neglect of occult lymph nodes metastasis(OLNM)is one of the pivotal causes of early non-small cell lung cancer(NSCLC)recurrence after local treatments such as stereotactic body radiotherapy(SBRT)or surgery.This study aimed to develop and validate a computed tomography(CT)-based radiomics and deep learning(DL)fusion model for predicting non-invasive OLNM.Methods:Patients with radiologically node-negative lung adenocarcinoma from two centers were retrospectively analyzed.We developed clinical,radiomics,and radiomics-clinical models using logistic regression.A DL model was established using a three-dimensional squeeze-and-excitation residual network-34(3D SE-ResNet34)and a fusion model was created by integrating seleted clinical,radiomics features and DL features.Model performance was assessed using the area under the curve(AUC)of the receiver operating characteristic(ROC)curve,calibration curves,and decision curve analysis(DCA).Five predictive models were compared;SHapley Additive exPlanations(SHAP)and Gradient-weighted Class Activation Mapping(Grad-CAM)were employed for visualization and interpretation.Results:Overall,358 patients were included:186 in the training cohort,48 in the internal validation cohort,and 124 in the external testing cohort.The DL fusion model incorporating 3D SE-Resnet34 achieved the highest AUC of 0.947 in the training dataset,with strong performance in internal and external cohorts(AUCs of 0.903 and 0.907,respectively),outperforming single-modal DL models,clinical models,radiomics models,and radiomicsclinical combined models(DeLong test:P<0.05).DCA confirmed its clinical utility,and calibration curves demonstrated excellent agreement between predicted and observed OLNM probabilities.Features interpretation highlighted the importance of textural characteristics and the surrounding tumor regions in stratifying OLNM risk.Conclusions:The DL fusion model reliably and accurately predicts OLNM in early-stage lung adenocarcinoma,offering a non-invasive tool to refine staging and guide personalized treatment decisions.These results may aid clinicians in optimizing surgical and radiotherapy strategies.
文摘BACKGROUND Esophageal cancer(EC)is one of the most common malignancies worldwide,and lymph node(LN)metastasis remains one of the leading causes of EC recurrence.Metabolic disorders critically affect cancer progression,and lipid levels are closely associated with the occurrence of EC and several other tumor types.This study analyzed pretreatment lipid levels to determine their association with LN metastasis.AIM To dissect the possible mechanisms underlying LN metastasis and clarify the prognostic role of lipid profiles in EC.METHODS Serum lipid levels and clinicopathological information were retrospectively collected from 294 patients,and risk factors for LN metastasis were confirmed using a logistic regression model.Latent factors were explored using information from publicly accessible databases and immunofluorescence and immunohistochemical staining techniques.RESULTS High serum levels of low-density lipoprotein(LDL)cholesterol promote LN metastasis in EC,while high-density lipoprotein cholesterol has the opposite role.Information of a public database revealed that LDL receptors LRP5 and LRP6 are highly expressed in ECs,and LRP6 overexpression positively correlated with the infiltration of B lymphocytes and a poor prognosis.Immunofluorescence and immunohistochemical staining revealed that the expression of LRP6 and infiltrated B lymphocytes in patients with≥1 regional LN metastasis,containing N1-3(N+group)were significantly higher than those in the N0 group.LRP6 was also highly expressed in the B lymphocytes of the N+group.There was no difference in CXCL13 expression between the N+and N0 groups.However,CXCR5 expression was significantly higher in the N0 group than in the N+group.CONCLUSION High serum LDL levels can promote LN metastasis in EC,and the mechanisms may be related to LRP6 expression and the infiltration of B lymphocytes.
基金supported by the Fundamental Research Funds for the Central Universities(Wuhan University,Clinical Medicine+X,No.2042024YXB017)the Hubei Province Chinese Medicine Research Project(No.ZY2023Q015)+2 种基金the National Natural Science Foundation of China(No.61904057)the Natural Science Foundation of Hubei Province(No.2023AFB665)the Medical Young Talents Program of Hubei Province,Wuhan Young Medical Talents Training Project,China.
文摘Lymph node metastasis(LNM)is a crucial risk factor influencing an unfavorable prognosis in specific cancers.Fundamental research illuminates our understanding of tumor behavior and identifies valuable therapeutic targets.Nevertheless,the exploration of fundamental theories and the validation of clinical therapies hinge on preclinical experiments.Preclinical models,in this context,serve as the conduit connecting fundamental theories to clinical outcomes.In vivo models established in animals offer a valuable platform for comprehensively observing interactions between tumor cells and organisms.Using various experimental animals,including mice,diverse methods,such as carcinogen-induced tumorigenesis,tumor cell line or human tumor transplantation,genetic engineering,and humanization,have been used effectively to construct numerous models for tumor LNM.Carcinogen-induced models simulate the entire process of tumorigenesis and metastasis.Transplantation models,using human tumor cell lines or patient-derived tumors,offer a research platform closely mirroring the histology and clinical behavior of human tumors.Genetically engineered models have been used to delve into the mechanisms of primary tumorigenesis within an intact microenvironment.Humanized models are used to overcome barriers between human and murine immune systems.Beyond mouse models,various other animal models have unique advantages and limitations,all contributing to exploring LNM.This review summarizes existing in vitro and animal preclinical models,identifies current bottlenecks in preclinical research,and offers an outlook on forthcoming preclinical models.
基金supported by grants from the National Natural Science Foundation of China(Nos.82072664,81974374,82173125,82103677).
文摘Background:Patients with gastric cancer(GC)are prone to lymph node metastasis(LNM),which is an important factor for recurrence and poor prognosis of GC.Nowadays,more and more studies have confirmed that exosomes can participate in tumor lymphangiogenesis.An in-depth exploration of the pathological mechanism in the process of LNM in GC may provide effective targets and improve the diagnosis and treatment effect.Materials and Methods:We used sequencing analysis of collected serum to screen out exo-miRNA related to LNM in GC.ELISA,qRT-PCR,Western Blot,RNA pull-down assay,Transwell assay,animal experiments,and other experiments were used to verify the results.Results:In this study,we screened out miR-224-3p related to GC progression and LNM in a vascular endothelial growth Factor C(VEGFC)-independent manner.We found that exo-miR-224-3p derived from GC cells could enter human lymphatic endothelial cells(HLECs)and promote the tube formation and migration of HLECs.In addition,it was revealed that miR-224-3p could bind to the 3′UTR region of GSK3B mRNA.Then,we proved that inhibiting the expression of GSK3B could suppress the phosphorylation ofβ-catenin and promote the transcription of PROX1,thus leading to tumor lymphangiogenesis.Furthermore,it was also found that hnRNPA1 mediated the sorting of miR-224-3p into exosomes,and the high expression of PKM2 promoted the secretion of exomiR-224-3p.Conclusions:Our discovery of the exo-miR-224-3p/GSK3B/β-catenin/PROX1 axis may provide a new direction for the clinical treatment of GC.
文摘BACKGROUND Early gastric cancer(EGC)is a common malignant tumor of the digestive system,and its lymph node metastasis and survival prognosis have been concerning.By retrospectively analyzing the clinical data of EGC patients,we can better under-stand the status of lymph node metastasis and its impact on survival and prog-nosis.AIM To evaluate the prognosis of EGC patients and the factors that affect lymph node METHODS The clinicopathological data of 1011 patients with EGC admitted to our hospital between January 2015 and December 2023 were collected in a retrospective cohort study.There were 561 males and 450 females.The mean age was 58±11 years.The patient underwent radical gastrectomy.The status of lymph node metastasis in each group was determined according to the pathological examination results of surgical specimens.The outcomes were as follows:(1)Lymph node metastasis in EGC patients;(2)Analysis of influencing factors of lymph node metastasis in EGC;and(3)Analysis of prognostic factors in patients with EGC.Normally distributed measurement data are expressed as mean±SD,and a t test was used for comparisons between groups.The data are expressed as absolute numbers or percentages,and the chi-square test was used for comparisons between groups.Rank data were compared using a nonparametric rank sum test.A log-rank test and a logistic regression model were used for univariate analysis.A logistic stepwise regression model and a Cox stepwise regression model were used for multivariate analysis.The Kaplan-Meier method was used to calculate the survival rate and construct survival curves.A log-rank test was used for survival analysis.RESULTS Analysis of influencing factors of lymph node metastasis in EGC.The results of the multifactor analysis showed that tumor length and diameter,tumor site,tumor invasion depth,vascular thrombus,and tumor differentiation degree were independent influencing factors for lymph node metastasis in patients with EGC(odds ratios=1.80,1.49,2.65,5.76,and 0.60;95%CI:1.29–2.50,1.11–2.00,1.81–3.88,3.87-8.59,and 0.48-0.76,respectively;P<0.05).Analysis of prognostic factors in patients with EGC.All 1011 patients with EGC were followed up for 43(0–13)months.The 3-year overall survival rate was 97.32%.Multivariate analysis revealed that age>60 years and lymph node metastasis were independent risk factors for prognosis in patients with EGC(hazard ratio=9.50,2.20;95%CI:3.31-27.29,1.00-4.87;P<0.05).Further analysis revealed that the 3-year overall survival rates of gastric cancer patients aged>60 years and≤60 years were 99.37%and 94.66%,respectively,and the difference was statistically significant(P<0.05).The 3-year overall survival rates of patients with and without lymph node metastasis were 95.42%and 97.92%,respectively,and the difference was statistically significant(P<0.05).CONCLUSION The lymph node metastasis rate of EGC patients was 23.64%.Tumor length,tumor site,tumor infiltration depth,vascular cancer thrombin,and tumor differentiation degree were found to be independent factors affecting lymph node metastasis in EGC patients.Age>60 years and lymph node metastasis are independent risk factors for EGC prognosis.
基金Supported by Natural Science Foundation of Xinjiang Uygur Autonomous Region,China,No.2022D01D17.
文摘BACKGROUND Lymph node metastasis is a specific type of metastasis in hepatic alveolar echinococcosis(AE).Currently,there is a scarcity of describing the clinical characteristics and lymph node metastasis rules of patients with hepatic AE combined with lymph node metastasis and its mechanism and management are still controversial.Radical hepatectomy combined with regional lymph node dissection is a better treatment.AIM To analyse the clinical features of hepatic AE combined with lymph node metastasis to explore its treatment and efficacy.METHODS A total of 623 patients with hepatic AE admitted to the First Affiliated Hospital of Xinjiang Medical University from 1 January 2012 to 1 January 2022 were retrospectively analysed.Fifty-five patients with combined lymph node metastasis were analysed for their clinical data,diagnosis and treatment methods,follow-up efficacy,and characteristics of lymph node metastasis.Finally,we comparatively analysed the lymph node metastasis rates at different sites.Categorical variables are expressed as frequencies and percentages,and the analysis of difference was performed using theχ2 test.The Bonferroni method was used for pairwise comparisons when statistical differences existed between multiple categorical variables.RESULTS A lymph node metastasis rate of 8.8%(55/623)was reported in patients with hepatic AE,with a female predilection(69.1%)and a statistically significant sex difference(χ2=8.018,P=0.005).Of the 55 patients with lymph node metastasis,72.7%had a parasite lesion,neighbouring organ invasion,and metastasis stage of P3N1M0 and above,of which 67.3%,78.2%,and 34.5%of hepatic AE lesions invaded the bile ducts,blood vessels,and distant metastases,respectively.Detection rates of lymph node metastasis of 16.4%,21.7%,and 34.2%were reported for a preoperative abdominal ultrasound,magnetic resonance imaging,and computed tomography examinations.All patients were intraoperatively suspected with enlarged lymph nodes and underwent radical hepatectomy combined with regional lymph node dissection.After surgery,a routine pathological examination was conducted on the resected lymph nodes.A total of 106 positive lymph nodes were detected in six groups at various sites,including 51 single-group metastasis cases and four multi-group metastasis cases.When the metastasis rates at different sites were statistically analysed,we observed that the metastasis rate in the para-hepatoduodenal ligament lymph nodes was significantly higher than that of the other sites(χ^(2)=128.089,P=0.000<0.05).No statistical difference was observed in the metastasis rate between the five other groups.Clavien-Dindo grade IIIa complication occurred in 14 cases,which improved after administering symptomatic treatment.Additionally,lymph node dissection-related complications were not observed.Recurrence after 2 years was observed in one patient.CONCLUSION Lymph node metastasis is a rare form of metastasis in hepatic AE,which is more frequent in women.Parahepatoduodenal ligament lymph nodes are commonly observed.Radical hepatectomy combined with regional lymph node dissection is a safe,effective,and feasible treatment for liver AE combined with lymph node metastasis.
文摘BACKGROUND Gastric cancer is one of the most common malignant tumors in the digestive system,ranking sixth in incidence and fourth in mortality worldwide.Since 42.5%of metastatic lymph nodes in gastric cancer belong to nodule type and peripheral type,the application of imaging diagnosis is restricted.AIM To establish models for predicting the risk of lymph node metastasis in gastric cancer patients using machine learning(ML)algorithms and to evaluate their pre-dictive performance in clinical practice.METHODS Data of a total of 369 patients who underwent radical gastrectomy at the Depart-ment of General Surgery of Affiliated Hospital of Xuzhou Medical University(Xuzhou,China)from March 2016 to November 2019 were collected and retro-spectively analyzed as the training group.In addition,data of 123 patients who underwent radical gastrectomy at the Department of General Surgery of Jining First People’s Hospital(Jining,China)were collected and analyzed as the verifi-cation group.Seven ML models,including decision tree,random forest,support vector machine(SVM),gradient boosting machine,naive Bayes,neural network,and logistic regression,were developed to evaluate the occurrence of lymph node metastasis in patients with gastric cancer.The ML models were established fo-llowing ten cross-validation iterations using the training dataset,and subsequently,each model was assessed using the test dataset.The models’performance was evaluated by comparing the area under the receiver operating characteristic curve of each model.RESULTS Among the seven ML models,except for SVM,the other ones exhibited higher accuracy and reliability,and the influences of various risk factors on the models are intuitive.CONCLUSION The ML models developed exhibit strong predictive capabilities for lymph node metastasis in gastric cancer,which can aid in personalized clinical diagnosis and treatment.
文摘In this editorial,we comment on the article by Wang et al published in the recent issue of the World Journal of Gastroenterology in 2023.We focused on identifying risk factors for lymph node metastasis(LNM)in superficial esophageal squamous cell carcinoma(SESCC)patients and how to construct a simple and reliable clinical prediction model to assess the risk of LNM in SESCC patients,thereby helping to guide the selection of an appropriate treatment plan.The current standard treatment for SESCC is radical esophagectomy with lymph node dissection.However,esophagectomy is associated with considerable morbidity and mortality.Endoscopic resection(ER)offers a safer and less invasive alternative to surgical resection and can enable the patient's quality of life to be maintained while providing a satisfactory outcome.However,since ER is a localized treatment that does not allow for lymph node dissection,the risk of LNM in SESCC limits the effectiveness of ER.Understanding LNM status can aid in determining whether patients with SESCC can be cured by ER without the need for additional esophagectomy.Previous studies have shown that tumor size,macroscopic type of tumor,degree of differentiation,depth of tumor invasion,and lymphovascular invasion are factors associated with LNM in patients with SESCC.In addition,tumor budding is commonly associated with LNM,recurrence,and distant metastasis,but this topic has been less covered in previous studies.By comprehensively evaluating the above risk factors for LNM,useful evidence can be obtained for doctors to select appropriate treatments for SESCC patients.
文摘BACKGROUND Advanced rectal cancer with submesenteric lymph node metastasis is a common complication of advanced rectal cancer,which has an important impact on the treatment and prognosis of patients.AIM To investigate the clinical and pathological characteristics of inferior mesenteric artery(IMA)root lymph node metastases in patients with rectal cancer.The findings of this study provided us with fresh medical information that assisted us in determining the appropriate treatment for these patients.METHODS Our study searched PubMed,Google Scholar,and other databases and searched the relevant studies and reports on the risk factors of IMA root lymph node metastasis of rectal cancer published in the self-built database until December 31,2023.After data extraction,the Newcastle-Ottawa scale was used to evaluate the quality of the included literature,and RevMan5.3 software was used for meta-analysis and heterogeneity testing.The fixed effect modules without heterogeneity were selected to combine the effect size,and the random effect modules with heterogeneity were selected to combine the effect size.The cause of heterogeneity was found through sensitivity analysis,and the data of various risk factors were combined to obtain the final effect size,odds ratio(OR)value,and 95%confidence interval(CI).Publication bias was tested by drawing funnel plots.RESULTS A total of seven literature were included in this study.By combining the OR value of logistic multivariate regression and the 95%CI of various risk factors,we concluded that the risk factors for lymph node metastasis in the IMA region of rectal cancer were as follows:Preoperative carcinoembryonic antigen(CEA)>5 ng/mL(OR=0.32,95%CI:0.18-0.55,P<0.05),tumor located above peritoneal reflexive(OR=3.10,95%CI:1.78-5.42,P<0.05),tumor size≥5 cm(OR=0.36,95%CI:0.22-0.57,P<0.05),pathological type(mucinous adenocarcinoma/sig-ring cell carcinoma)(OR=0.23,95%CI:0.13-0.41,P<0.05),degree of tumor differentiation(low differentiation)(OR=0.17,95%CI:0.10-0.31,P<0.05),tumor stage(T3-4 stage)(OR=0.11,95%CI:0.04-0.26,P<0.05),gender and age were not risk factors for IMA root lymph node metastasis in rectal cancer(P>0.05).CONCLUSION Preoperative CEA level,tumor location,tumor size,tumor pathologic type,tumor differentiation,and T stage were correlated with IMA root lymph node metastasis.
基金supported by the Taishan Scholar Project(No.ts20190991,No.tsqn202211378)the Key R&D Project of Shandong Province(No.2022CXPT023)+1 种基金the General Program of National Natural Science Foundation of China(No.82371933)the Medical and Health Technology Project of Shandong Province(No.202307010677)。
文摘Objective:The assessment of lateral lymph node metastasis(LLNM)in patients with papillary thyroid carcinoma(PTC)holds great significance.This study aims to develop and evaluate a deep learning-based automatic pipeline system(DLAPS)for diagnosing LLNM in PTC using computed tomography(CT).Methods:A total of 1,266 lateral lymph nodes(LLNs)from 519 PTC patients who underwent CT examinations from January 2019 to November 2022 were included and divided into training and validation set,internal test set,pooled external test set,and prospective test set.The DLAPS consists of an auto-segmentation network based on RefineNet model and a classification network based on ensemble model(ResNet,Xception,and DenseNet).The performance of the DLAPS was compared with that of manually segmented DL models,the clinical model,and Node Reporting and Data System(Node-RADS).The improvement of radiologists’diagnostic performance under the DLAPS-assisted strategy was explored.In addition,bulk RNA-sequencing was conducted based on 12 LLNs to reveal the underlying biological basis of the DLAPS.Results:The DLAPS yielded good performance with area under the receiver operating characteristic curve(AUC)of 0.872,0.910,and 0.822 in the internal,pooled external,and prospective test sets,respectively.The DLAPS significantly outperformed clinical models(AUC 0.731,P<0.001)and Node-RADS(AUC 0.602,P<0.001)in the internal test set.Moreover,the performance of the DLAPS was comparable to that of the manually segmented deep learning(DL)model with AUCs ranging 0.814−0.901 in three test sets.Furthermore,the DLAPSassisted strategy improved the performance of radiologists and enhanced inter-observer consistency.In clinical situations,the rate of unnecessary LLN dissection decreased from 33.33%to 7.32%.Furthermore,the DLAPS was associated with the cell-cell conjunction in the microenvironment.Conclusions:Using CT images from PTC patients,the DLAPS could effectively segment and classify LLNs non-invasively,and this system had a good generalization ability and clinical applicability.
基金supported by a grant from the National Key Research and Development Program of China(No.2023YFC2507406).
文摘Objective After endoscopic resection of colorectal cancer with submucosal invasion(pT1 CRC),additional surgical treatment is recommended if deep submucosal invasion(DSI)is present.This study aimed to further elucidate the risk factors for lymph node metastasis(LNM)in patients with pT1 CRC,especially the effect of DSI on LNM.Methods Patients with pT1 CRC who underwent lymph node dissection were selected.The Chi-square test and multivariate logistic regression were used to analyze the relationship between clinicopathological characteristics and LNM.The submucosal invasion depth(SID)was measured via 4 methods and analyzed with 3 cut-off values.Results Twenty-eight of the 239 patients presented with LNM(11.7%),and the independent risk factors for LNM included high histological grade(P=0.003),lymphovascular invasion(LVI)(P=0.004),intermediate to high budding(Bd 2/3)(P=0.008),and cancer gland rupture(CGR)(P=0.008).Moreover,the SID,width of submucosal invasion(WSI),and area of submucosal invasion(ASI)were not significantly different.When one,two,three or more risk factors were identified,the LNM rates were 1.1%(1/95),12.5%(7/56),and 48.8%(20/41),respectively.Conclusion Indicators such as the SID,WSI,and ASI are not risk factors for LNM and are subjective in their measurement,which renders them relatively inconvenient to apply in clinical practice.In contrast,histological grade,LVI,tumor budding and CGR are relatively straightforward to identify and have been demonstrated to be statistically significant.It would be prudent to focus on these histological factors rather than subjective measurements.
