BACKGROUND The accurate prediction of lymph node metastasis(LNM)is crucial for managing locally advanced(T3/T4)colorectal cancer(CRC).However,both traditional histopathology and standard slide-level deep learning ofte...BACKGROUND The accurate prediction of lymph node metastasis(LNM)is crucial for managing locally advanced(T3/T4)colorectal cancer(CRC).However,both traditional histopathology and standard slide-level deep learning often fail to capture the sparse and diagnostically critical features of metastatic potential.AIM To develop and validate a case-level multiple-instance learning(MIL)framework mimicking a pathologist's comprehensive review and improve T3/T4 CRC LNM prediction.METHODS The whole-slide images of 130 patients with T3/T4 CRC were retrospectively collected.A case-level MIL framework utilising the CONCH v1.5 and UNI2-h deep learning models was trained on features from all haematoxylin and eosinstained primary tumour slides for each patient.These pathological features were subsequently integrated with clinical data,and model performance was evaluated using the area under the curve(AUC).RESULTS The case-level framework demonstrated superior LNM prediction over slide-level training,with the CONCH v1.5 model achieving a mean AUC(±SD)of 0.899±0.033 vs 0.814±0.083,respectively.Integrating pathology features with clinical data further enhanced performance,yielding a top model with a mean AUC of 0.904±0.047,in sharp contrast to a clinical-only model(mean AUC 0.584±0.084).Crucially,a pathologist’s review confirmed that the model-identified high-attention regions correspond to known high-risk histopathological features.CONCLUSION A case-level MIL framework provides a superior approach for predicting LNM in advanced CRC.This method shows promise for risk stratification and therapy decisions,requiring further validation.展开更多
BACKGROUND Early screening,preoperative staging,and diagnosis of lymph node metastasis are crucial for improving the prognosis of gastric cancer(GC).AIM To evaluate the diagnostic value of combined multidetector compu...BACKGROUND Early screening,preoperative staging,and diagnosis of lymph node metastasis are crucial for improving the prognosis of gastric cancer(GC).AIM To evaluate the diagnostic value of combined multidetector computed tomography(MDCT)and gastrointestinal endoscopy for GC screening,preoperative staging,and lymph node metastasis detection,thereby providing a reference for clinical diagnosis and treatment.METHODS In this retrospective study clinical and imaging data of 134 patients with suspected GC who were admitted between January 2023 and October 2024 were initially reviewed.According to the inclusion and exclusion criteria,102 patients were finally enrolled in the analysis.All enrolled patients had undergone both MDCT and gastrointestinal endoscopy examinations prior to surgical intervention.Preoperative clinical staging and lymph node metastasis findings were compared with pathological results.RESULTS The combined use of MDCT and gastrointestinal endoscopy demonstrated a sensitivity of 98.53%,specificity of 97.06%,accuracy of 98.04%,positive predictive value of 98.53%,and negative predictive value of 97.06%for diagnosing GC.These factors were all significantly higher than those of MDCT or endoscopy alone(P<0.05).The accuracy rates of the combined approach for detecting clinical T and N stages were 97.06%and 92.65%,respectively,outperforming MDCT alone(86.76% and 79.41%)and endoscopy alone(85.29% and 70.59%)(P<0.05).Among 68 patients with confirmed GC,50(73.53%)were pathologically diagnosed with lymph node metastasis.The accuracy for detecting lymph node metastasis was 66.00%with endoscopy,76.00%with MDCT,and 92.00% with the combined approach,all with statistically significant differences(P<0.05).CONCLUSION The combined application of MDCT and gastrointestinal endoscopy enhanced diagnostic accuracy for GC,provided greater consistency in preoperative staging,and improved the detection of lymph node metastasis,thereby demonstrating significant clinical utility.展开更多
BACKGROUND One of the main characteristics of oral squamous cell carcinoma(OSCC)is that it metastasizes to cervical lymph nodes frequently with a high degree of local invasiveness.A primary feature of malignant tumors...BACKGROUND One of the main characteristics of oral squamous cell carcinoma(OSCC)is that it metastasizes to cervical lymph nodes frequently with a high degree of local invasiveness.A primary feature of malignant tumors is their penetration of neighboring tissues,such as lymphatic and blood arteries,due to the tumor cells'capacity to break down the extracellular matrix(ECM).Matrix metalloproteinases(MMPs)constitute a family of proteolytic enzymes that facilitate tissue remodeling and the degradation of the ECM.MMP-9 and MMP-13 belong to the group of extracellular matrix degrading enzymes and their expression has been studied in OSCC because of their specific functions.MMP-13,a collagenase family member,is thought to play an essential role in the MMP activation cascade by breaking down the fibrillar collagens,whereas MMP-9 is thought to accelerate the growth of tumors.Elevated MMP-13 expression has been associated with tumor behavior and patient prognosis in a number of malignant cases.AIM To assess the immunohistochemical expression of MMP-9 and MMP-13 in OSCC.METHODS A total of 40 cases with histologically confirmed OSCC by incisional biopsy were included in this cross-sectional retrospective study.The protocols for both MMP-9 and MMP-13 immunohistochemical staining were performed according to the manufacturer’s recommendations along with the normal gingival epithelium as a positive control.All the observations were recorded and Pearson’sχ²test with Fisher exact test was used for statistical analysis.RESULTS Our study showed no significant correlation between MMP-9 and MMP-13 staining intensity and tumor size.The majority of the patients were in advanced TNM stages(III and IV),and showed intense expression of MMP-9 and MMP-13.CONCLUSION The present study suggests that both MMP-9 and MMP-13 play an important and independent role in OSCC progression and invasiveness.Intense expression of MMP-9 and MMP-13,irrespective of histological grade of OSCC,correlates well with TNM stage.Consequently,it is evident that MMP-9 and MMP-13 are important for the invasiveness and progression of tumors.The findings may facilitate the development of new approaches for evaluating lymph node metastases and interventional therapy techniques,hence enhancing the prognosis of patients diagnosed with OSCC.展开更多
Objective: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
Gastric cancer(GC)remains a leading cause of cancer mortality.While the extent of nodal involvement is a well-known prognostic factor,the specific entity of swollen lymph node metastasis(SLNM),bulky nodal tumor deposi...Gastric cancer(GC)remains a leading cause of cancer mortality.While the extent of nodal involvement is a well-known prognostic factor,the specific entity of swollen lymph node metastasis(SLNM),bulky nodal tumor deposits detectable radiologically or pathologically,has received little attention in staging.Recent data from a study by Cui et al demonstrated that SLNM is an independent predictor of very poor survival in GC.Through robust data and rigorous propensitymatched analyses,SLNM emerged not merely as an anatomical finding but as an independent predictor of poor prognosis,even among patients undergoing curative resection.As precision oncology advances,the findings by Cui et al urge a fundamental rethinking of how SLNM is incorporated into clinical decisionmaking for GC management.In this editorial,we critically examine the prognostic significance of SLNM,challenge its omission from traditional staging frameworks,and advocate for its formal integration into preoperative risk stratification and treatment planning.Recognizing SLNM at diagnosis could unlock intensified neoadjuvant therapy strategies and optimize outcomes for a historically high-risk patient subgroup.展开更多
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 Anaplastic lymphoma kinase(ALK)gene fusion is a molecular subtype of nonsmall cell lung cancer,representing 4%-6%of lung adenocarcinomas.Axillary lymph node(ALN)metastasis from lung cancer is rare,and massi...BACKGROUND Anaplastic lymphoma kinase(ALK)gene fusion is a molecular subtype of nonsmall cell lung cancer,representing 4%-6%of lung adenocarcinomas.Axillary lymph node(ALN)metastasis from lung cancer is rare,and massive bleeding from such lesions is an even more unusual and life-threatening complication.This case demonstrates how localized radiotherapy can be used as an effective hemostatic and tumor-controlling measure when conventional interventions fail.CASE SUMMARY A 48-year-old male presented in October 2019 with ALK-positive lung adenocarcinoma and multiple metastases.He received multiple lines of ALK tyrosine kinase inhibitor therapy,whole-brain radiotherapy,stereotactic radiotherapy,chemotherapy,and targeted agents over 4 years and 7 months.In February 2024,rapid enlargement and rupture of a left ALN metastasis caused massive bleeding.Interventional and surgical hemostasis were not feasible.Localized radiotherapy was initiated at 15 Gray in 5 fractions,later increased to a total of 39 Gray in 13 fractions,resulting in rapid bleeding control and partial tumor response.The patient subsequently received chemotherapy,and the axillary lesion healed without recurrent bleeding.However,three months later,he developed severe pneumonia with mixed bacterial,mycobacterial,and fungal infections and died despite intensive care.CONCLUSION Radiotherapy can effectively control bleeding and achieve local tumor control in ALK-positive lung cancer with ruptured ALN metastasis when other treatments are ineffective.展开更多
Dear Editor,Esophageal cancer(EC)is a malignant tumor originating from esophageal epithelium and remains a leading cause of cancer incidence and mortality worldwide1,2.According to the 2020 World Health Organization s...Dear Editor,Esophageal cancer(EC)is a malignant tumor originating from esophageal epithelium and remains a leading cause of cancer incidence and mortality worldwide1,2.According to the 2020 World Health Organization statistics,there were approx-imately 604,000 new EC cases and 544,000 EC-related deaths globally with China reporting approximately 320,000 new cases and 300,000 deaths,mainly from esophageal squamous cell carcinoma(ESCC)3.Although there has been progress in the treatment of EC,the long-term prognosis of patients with R0 resection and lymph node-positive disease contin-ues to be suboptimal4.A retrospective analysis performed by our center suggested that the median overall survival(OS)of lymph node-positive patients with EC who received postoper-ative adjuvant radiotherapy(PART)was 29 months compared to 21 months for surgery alone with 3-year survival rates of 43%and 36%,respectively,indicating a potential survival ben-efit of PART5.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
The article by Yuan et al accessed the clinicopathologic and prognostic significance of the patterns of lymph node(LN)metastasis in upper and lower gastric cancer(GC).In this article,we will analyze both the strengths...The article by Yuan et al accessed the clinicopathologic and prognostic significance of the patterns of lymph node(LN)metastasis in upper and lower gastric cancer(GC).In this article,we will analyze both the strengths and limitations of this paper.The study’s methodology seems appropriate and proper statistical analyses were applied to identify significant variables.The authors applied the Cox regression model to identify independent risk factors and Kaplan-Meier survival curves to assess prognosis.The researchers found notable differences in cli-nicopathologic variables between patients with upper and lower GC.Addi-tionally,they identified specific LN stations more prone to metastasis in different Siewert classifications of GC.Despite the study’s detailed analysis,it would have been beneficial to explore whether there were survival differences among upper GC patients based on the Siewert classification.Furthermore,the study should have addressed potential confounding factors that might have influenced the results.A more comprehensive analysis could have been achieved by comparing survival outcomes based on LN metastasis patterns.Overall,this article is relevant and provides valuable insights into the significance of LN metastasis patterns in upper GC patients.展开更多
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
This letter comments on a study on lipid metabolism,immunity,and lymph node metastasis in esophageal cancer,a clinically relevant topic given lipid-immune crosstalk in tumor progression,to be published by the World Jo...This letter comments on a study on lipid metabolism,immunity,and lymph node metastasis in esophageal cancer,a clinically relevant topic given lipid-immune crosstalk in tumor progression,to be published by the World Journal of Gastrointestinal Surgery.Key concerns include the following:Lack of detailed lipid parameter data[especially low-density lipoprotein(LDL)distribution]to contextualize LDL-metastasis associations,unclear criteria for selecting LDL receptors/LDL receptor-related protein family genes and unexplained exclusion of broader lipid metabolism genes,and a disconnect between the proposed LDL-B lymp-hocyte regulatory hypothesis and literature emphasizing cholesterol’s impact on T cells.We therefore suggest that future research should supplement lipid data,clarify gene selection rationale,and provide direct evidence for LDL-B lympho-cyte interplay,in order to enhance reliability in understanding esophageal cancer lipid-immune regulation.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
BACKGROUND Reliable preoperative detection of lymph node metastasis(LNM)in pancreatic cancer remains elusive:Conventional computed tomography(CT)underestimates micrometastases,and carbohydrate antigen 19-9 is hampered...BACKGROUND Reliable preoperative detection of lymph node metastasis(LNM)in pancreatic cancer remains elusive:Conventional computed tomography(CT)underestimates micrometastases,and carbohydrate antigen 19-9 is hampered by low specificity.The neutrophil-albumin ratio(NAR)simultaneously reflects systemic inflammation and nutritional depletion,but its contribution to LNM prediction in pancreatic cancer is unexplored.We hypothesised that integrating NAR with multiphase CT findings would significantly improve the accuracy of preoperative LNM assessment in patients undergoing curative-intent resection.AIM To determine whether preoperative NAR plus multi-phase CT reliably predicts nodal metastasis in pancreatic cancer.METHODS In this single-centre retrospective cohort study(February 2022 to February 2025,Ordos Central Hospital,China),129 consecutive patients undergoing curative pancreatic resection were histologically classified as LNM+(n=61)and LNM-(n=68).Preoperative NAR and platelet-albumin ratio(PAR)were calculated;optimal cut-offs were determined with X-tile.Multi-phase CT images were re-reviewed by two blinded radiologists.Independent predictors of nodal metastasis were identified by multivariate logistic regression,and model performance was evaluated with receiver operating characteristic(ROC)analysis.RESULTS Between the two cohorts,univariate comparison revealed significant divergence in age,tumour diameter,concomitant hemangioma thrombosis,PAR,NAR,and CT-detected nodal status(P<0.05).Subsequent multivariate modelling identified hemangioma thrombosis,PAR above 6.35,NAR exceeding 0.13,and radiologically positive lymph nodes as independent predictors of nodal metastasis(P<0.05).ROC evaluation indicated that the NAR-plus-CT-nodes model(model 1)reached an area under the curve(AUC)of 0.758,whereas the fourvariable composite(model 3)achieved the best performance with an AUC of 0.830(95%CI:0.753-0.890),sensitivity 83.61%,and specificity 67.65%.CONCLUSION The model 3(NAR>0.13,PAR>6.35,CT nodal positivity,hemangioma thrombosis)provides robust,clinically actionable preoperative identification of pancreatic cancer patients at high risk of LNM.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
基金Supported by Chongqing Medical Scientific Research Project(Joint Project of Chongqing Health Commission and Science and Technology Bureau),No.2023MSXM060.
文摘BACKGROUND The accurate prediction of lymph node metastasis(LNM)is crucial for managing locally advanced(T3/T4)colorectal cancer(CRC).However,both traditional histopathology and standard slide-level deep learning often fail to capture the sparse and diagnostically critical features of metastatic potential.AIM To develop and validate a case-level multiple-instance learning(MIL)framework mimicking a pathologist's comprehensive review and improve T3/T4 CRC LNM prediction.METHODS The whole-slide images of 130 patients with T3/T4 CRC were retrospectively collected.A case-level MIL framework utilising the CONCH v1.5 and UNI2-h deep learning models was trained on features from all haematoxylin and eosinstained primary tumour slides for each patient.These pathological features were subsequently integrated with clinical data,and model performance was evaluated using the area under the curve(AUC).RESULTS The case-level framework demonstrated superior LNM prediction over slide-level training,with the CONCH v1.5 model achieving a mean AUC(±SD)of 0.899±0.033 vs 0.814±0.083,respectively.Integrating pathology features with clinical data further enhanced performance,yielding a top model with a mean AUC of 0.904±0.047,in sharp contrast to a clinical-only model(mean AUC 0.584±0.084).Crucially,a pathologist’s review confirmed that the model-identified high-attention regions correspond to known high-risk histopathological features.CONCLUSION A case-level MIL framework provides a superior approach for predicting LNM in advanced CRC.This method shows promise for risk stratification and therapy decisions,requiring further validation.
文摘BACKGROUND Early screening,preoperative staging,and diagnosis of lymph node metastasis are crucial for improving the prognosis of gastric cancer(GC).AIM To evaluate the diagnostic value of combined multidetector computed tomography(MDCT)and gastrointestinal endoscopy for GC screening,preoperative staging,and lymph node metastasis detection,thereby providing a reference for clinical diagnosis and treatment.METHODS In this retrospective study clinical and imaging data of 134 patients with suspected GC who were admitted between January 2023 and October 2024 were initially reviewed.According to the inclusion and exclusion criteria,102 patients were finally enrolled in the analysis.All enrolled patients had undergone both MDCT and gastrointestinal endoscopy examinations prior to surgical intervention.Preoperative clinical staging and lymph node metastasis findings were compared with pathological results.RESULTS The combined use of MDCT and gastrointestinal endoscopy demonstrated a sensitivity of 98.53%,specificity of 97.06%,accuracy of 98.04%,positive predictive value of 98.53%,and negative predictive value of 97.06%for diagnosing GC.These factors were all significantly higher than those of MDCT or endoscopy alone(P<0.05).The accuracy rates of the combined approach for detecting clinical T and N stages were 97.06%and 92.65%,respectively,outperforming MDCT alone(86.76% and 79.41%)and endoscopy alone(85.29% and 70.59%)(P<0.05).Among 68 patients with confirmed GC,50(73.53%)were pathologically diagnosed with lymph node metastasis.The accuracy for detecting lymph node metastasis was 66.00%with endoscopy,76.00%with MDCT,and 92.00% with the combined approach,all with statistically significant differences(P<0.05).CONCLUSION The combined application of MDCT and gastrointestinal endoscopy enhanced diagnostic accuracy for GC,provided greater consistency in preoperative staging,and improved the detection of lymph node metastasis,thereby demonstrating significant clinical utility.
文摘BACKGROUND One of the main characteristics of oral squamous cell carcinoma(OSCC)is that it metastasizes to cervical lymph nodes frequently with a high degree of local invasiveness.A primary feature of malignant tumors is their penetration of neighboring tissues,such as lymphatic and blood arteries,due to the tumor cells'capacity to break down the extracellular matrix(ECM).Matrix metalloproteinases(MMPs)constitute a family of proteolytic enzymes that facilitate tissue remodeling and the degradation of the ECM.MMP-9 and MMP-13 belong to the group of extracellular matrix degrading enzymes and their expression has been studied in OSCC because of their specific functions.MMP-13,a collagenase family member,is thought to play an essential role in the MMP activation cascade by breaking down the fibrillar collagens,whereas MMP-9 is thought to accelerate the growth of tumors.Elevated MMP-13 expression has been associated with tumor behavior and patient prognosis in a number of malignant cases.AIM To assess the immunohistochemical expression of MMP-9 and MMP-13 in OSCC.METHODS A total of 40 cases with histologically confirmed OSCC by incisional biopsy were included in this cross-sectional retrospective study.The protocols for both MMP-9 and MMP-13 immunohistochemical staining were performed according to the manufacturer’s recommendations along with the normal gingival epithelium as a positive control.All the observations were recorded and Pearson’sχ²test with Fisher exact test was used for statistical analysis.RESULTS Our study showed no significant correlation between MMP-9 and MMP-13 staining intensity and tumor size.The majority of the patients were in advanced TNM stages(III and IV),and showed intense expression of MMP-9 and MMP-13.CONCLUSION The present study suggests that both MMP-9 and MMP-13 play an important and independent role in OSCC progression and invasiveness.Intense expression of MMP-9 and MMP-13,irrespective of histological grade of OSCC,correlates well with TNM stage.Consequently,it is evident that MMP-9 and MMP-13 are important for the invasiveness and progression of tumors.The findings may facilitate the development of new approaches for evaluating lymph node metastases and interventional therapy techniques,hence enhancing the prognosis of patients diagnosed with OSCC.
基金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Gastric cancer(GC)remains a leading cause of cancer mortality.While the extent of nodal involvement is a well-known prognostic factor,the specific entity of swollen lymph node metastasis(SLNM),bulky nodal tumor deposits detectable radiologically or pathologically,has received little attention in staging.Recent data from a study by Cui et al demonstrated that SLNM is an independent predictor of very poor survival in GC.Through robust data and rigorous propensitymatched analyses,SLNM emerged not merely as an anatomical finding but as an independent predictor of poor prognosis,even among patients undergoing curative resection.As precision oncology advances,the findings by Cui et al urge a fundamental rethinking of how SLNM is incorporated into clinical decisionmaking for GC management.In this editorial,we critically examine the prognostic significance of SLNM,challenge its omission from traditional staging frameworks,and advocate for its formal integration into preoperative risk stratification and treatment planning.Recognizing SLNM at diagnosis could unlock intensified neoadjuvant therapy strategies and optimize outcomes for a historically high-risk patient subgroup.
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 the National Natural Science Foundation of China,No.82303833the Open Research Fund of Hubei Key Laboratory of Precision Radiation Oncology,No.2024ZLJZFL002the Science Foundation of Union Hospital,No.2024ZLJZFL016.
文摘BACKGROUND Anaplastic lymphoma kinase(ALK)gene fusion is a molecular subtype of nonsmall cell lung cancer,representing 4%-6%of lung adenocarcinomas.Axillary lymph node(ALN)metastasis from lung cancer is rare,and massive bleeding from such lesions is an even more unusual and life-threatening complication.This case demonstrates how localized radiotherapy can be used as an effective hemostatic and tumor-controlling measure when conventional interventions fail.CASE SUMMARY A 48-year-old male presented in October 2019 with ALK-positive lung adenocarcinoma and multiple metastases.He received multiple lines of ALK tyrosine kinase inhibitor therapy,whole-brain radiotherapy,stereotactic radiotherapy,chemotherapy,and targeted agents over 4 years and 7 months.In February 2024,rapid enlargement and rupture of a left ALN metastasis caused massive bleeding.Interventional and surgical hemostasis were not feasible.Localized radiotherapy was initiated at 15 Gray in 5 fractions,later increased to a total of 39 Gray in 13 fractions,resulting in rapid bleeding control and partial tumor response.The patient subsequently received chemotherapy,and the axillary lesion healed without recurrent bleeding.However,three months later,he developed severe pneumonia with mixed bacterial,mycobacterial,and fungal infections and died despite intensive care.CONCLUSION Radiotherapy can effectively control bleeding and achieve local tumor control in ALK-positive lung cancer with ruptured ALN metastasis when other treatments are ineffective.
基金supported by the National Natural Science Foundation of China(Grant No.82172567)the Key R&D Plan of Jiangxi Province(Grant No.2021BBG71006)the Key Project of Science and Technology Innovation of Health Commission of Jiangxi Province(Grant Nos.2023ZD005 and 2024ZD008).
文摘Dear Editor,Esophageal cancer(EC)is a malignant tumor originating from esophageal epithelium and remains a leading cause of cancer incidence and mortality worldwide1,2.According to the 2020 World Health Organization statistics,there were approx-imately 604,000 new EC cases and 544,000 EC-related deaths globally with China reporting approximately 320,000 new cases and 300,000 deaths,mainly from esophageal squamous cell carcinoma(ESCC)3.Although there has been progress in the treatment of EC,the long-term prognosis of patients with R0 resection and lymph node-positive disease contin-ues to be suboptimal4.A retrospective analysis performed by our center suggested that the median overall survival(OS)of lymph node-positive patients with EC who received postoper-ative adjuvant radiotherapy(PART)was 29 months compared to 21 months for surgery alone with 3-year survival rates of 43%and 36%,respectively,indicating a potential survival ben-efit of PART5.
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.
文摘The article by Yuan et al accessed the clinicopathologic and prognostic significance of the patterns of lymph node(LN)metastasis in upper and lower gastric cancer(GC).In this article,we will analyze both the strengths and limitations of this paper.The study’s methodology seems appropriate and proper statistical analyses were applied to identify significant variables.The authors applied the Cox regression model to identify independent risk factors and Kaplan-Meier survival curves to assess prognosis.The researchers found notable differences in cli-nicopathologic variables between patients with upper and lower GC.Addi-tionally,they identified specific LN stations more prone to metastasis in different Siewert classifications of GC.Despite the study’s detailed analysis,it would have been beneficial to explore whether there were survival differences among upper GC patients based on the Siewert classification.Furthermore,the study should have addressed potential confounding factors that might have influenced the results.A more comprehensive analysis could have been achieved by comparing survival outcomes based on LN metastasis patterns.Overall,this article is relevant and provides valuable insights into the significance of LN metastasis patterns in upper GC patients.
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.
基金Supported by Fujian Provincial Science and Technology Innovation Joint Fund Project,No.2024Y9555Fujian Provincial Natural Science Foundation Project,No.20241011124.
文摘This letter comments on a study on lipid metabolism,immunity,and lymph node metastasis in esophageal cancer,a clinically relevant topic given lipid-immune crosstalk in tumor progression,to be published by the World Journal of Gastrointestinal Surgery.Key concerns include the following:Lack of detailed lipid parameter data[especially low-density lipoprotein(LDL)distribution]to contextualize LDL-metastasis associations,unclear criteria for selecting LDL receptors/LDL receptor-related protein family genes and unexplained exclusion of broader lipid metabolism genes,and a disconnect between the proposed LDL-B lymp-hocyte regulatory hypothesis and literature emphasizing cholesterol’s impact on T cells.We therefore suggest that future research should supplement lipid data,clarify gene selection rationale,and provide direct evidence for LDL-B lympho-cyte interplay,in order to enhance reliability in understanding esophageal cancer lipid-immune regulation.
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.
文摘BACKGROUND Reliable preoperative detection of lymph node metastasis(LNM)in pancreatic cancer remains elusive:Conventional computed tomography(CT)underestimates micrometastases,and carbohydrate antigen 19-9 is hampered by low specificity.The neutrophil-albumin ratio(NAR)simultaneously reflects systemic inflammation and nutritional depletion,but its contribution to LNM prediction in pancreatic cancer is unexplored.We hypothesised that integrating NAR with multiphase CT findings would significantly improve the accuracy of preoperative LNM assessment in patients undergoing curative-intent resection.AIM To determine whether preoperative NAR plus multi-phase CT reliably predicts nodal metastasis in pancreatic cancer.METHODS In this single-centre retrospective cohort study(February 2022 to February 2025,Ordos Central Hospital,China),129 consecutive patients undergoing curative pancreatic resection were histologically classified as LNM+(n=61)and LNM-(n=68).Preoperative NAR and platelet-albumin ratio(PAR)were calculated;optimal cut-offs were determined with X-tile.Multi-phase CT images were re-reviewed by two blinded radiologists.Independent predictors of nodal metastasis were identified by multivariate logistic regression,and model performance was evaluated with receiver operating characteristic(ROC)analysis.RESULTS Between the two cohorts,univariate comparison revealed significant divergence in age,tumour diameter,concomitant hemangioma thrombosis,PAR,NAR,and CT-detected nodal status(P<0.05).Subsequent multivariate modelling identified hemangioma thrombosis,PAR above 6.35,NAR exceeding 0.13,and radiologically positive lymph nodes as independent predictors of nodal metastasis(P<0.05).ROC evaluation indicated that the NAR-plus-CT-nodes model(model 1)reached an area under the curve(AUC)of 0.758,whereas the fourvariable composite(model 3)achieved the best performance with an AUC of 0.830(95%CI:0.753-0.890),sensitivity 83.61%,and specificity 67.65%.CONCLUSION The model 3(NAR>0.13,PAR>6.35,CT nodal positivity,hemangioma thrombosis)provides robust,clinically actionable preoperative identification of pancreatic cancer patients at high risk of LNM.
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.
