BACKGROUND The diagnostic accuracy for detecting metastatic lymph nodes in colorectal cancer(CRC)remains suboptimal.To address this limitation,our study investigates the potential of gemstone spectral computed tomogra...BACKGROUND The diagnostic accuracy for detecting metastatic lymph nodes in colorectal cancer(CRC)remains suboptimal.To address this limitation,our study investigates the potential of gemstone spectral computed tomography imaging(GSI)to improve diagnostic accuracy in lymph node metastasis(LNM)assessment.AIM To extensively investigate the clinical utility of GSI in the preoperative assessment of CRC.METHODS The subject population included 200 patients with CRC who were admitted to Zibo Central Hospital from January 2022 to December 2023.All patients underwent dual-phase contrast-enhanced scans in the arterial and venous phases using GSI before surgical intervention.During the research,meticulous quantification was conducted regarding the number of patients with CRC with LNM as well as the exact count of metastatic lymph nodes.Moreover,for both metastatic and non-metastatic lymph nodes,the short diameter at the maximum crosssectional area(covering the axial,sagittal,and coronal planes),morphological features(including manifestations such as margin blurring,aggregation,and enhancement),and spectral parameters in the arterial and venous phases[specifically iodine concentration(IC),normalized IC(NIC),and the slope of the spectral curve(λHU)]were measured and recorded,and a comparative analysis was conducted.The diagnostic efficacy of each index with differences was systematically assessed using the receiver operating characteristic(ROC)curve.Concurrently,receiver operating characteristic curves were constructed for LNM screening based on the short diameter at the maximum cross-sectional area of lymph nodes and each spectral parameter in the arterial and venous phases.RESULTS The area under the curve of GSI for diagnosing LNM in patients with CRC can reach 0.897,with sensitivity,specificity,and accuracy of 92.59%,85.87%,and 89.50%,respectively.A total of 265 lymph nodes were analyzed from the 200 participants with CRC,with metastatic lymph nodes accounting for 56.60%.Compared with nonmetastatic lymph nodes,the short diameters of metastatic lymph nodes in the axial,sagittal,and coronal planes were significantly increased,whereas the IC values in the arterial and venous phases,the NIC value in the arterial phase,and theλHU values in the arterial and venous phases were significantly decreased.The short axial,sagittal,and coronal diameters,arterial-phase IC,venous-phase IC,arterial-phase NIC,arterial-phaseλHU,and venousphaseλHU for diagnosing metastatic lymph nodes demonstrated area under the curve values of 0.631,0.681,0.659,0.862,0.808,0.831,0.801,and 0.706,respectively.CONCLUSION GSI exhibits substantial clinical significance in the preoperative assessment of CRC.Among the parameters assessed,the arterial-phase IC demonstrates the most outstanding diagnostic performance,effectively improving the diagnostic efficacy for preoperative LNM in CRC.展开更多
BACKGROUND Accurate identification of tumor invasion depth and lymph node(LN)involve-ment in patients with colon cancer(CC)is critical for guiding treatment strategies.However,the preoperative prediction of tumor inva...BACKGROUND Accurate identification of tumor invasion depth and lymph node(LN)involve-ment in patients with colon cancer(CC)is critical for guiding treatment strategies.However,the preoperative prediction of tumor invasion depth and LN metastasis in CC remains challenging.As the intestinal tumor develops,the fat density in the mesentery increases.METHODS Patients,who were diagnosed with CC and underwent surgery,were included and divided into the training and validation cohorts.CT-T values of the mesen-tery were extracted from the CT images.Cutoff points were determined using the receiver operating characteristic(ROC)curve,and the area under the ROC curve was employed to assess the performance of the CT-T value for tumor invasion depth and LN status prediction.RESULTS Cutoff values of 11.83 and 17.17 were identified to discriminate T1/2 vs T3/4 and N0 vs N1/2,respectively.With a cutoff CT-T value of 11.83,the total diagnostic accuracy for T stage was 83.1%(81.5%for the training cohort and 86.2%for the validation cohort).With a cutoff CT-T value of 17.17,the total diagnostic accuracy for N stage was 77.3%(75.8%for the training cohort and 80.1%for the validation cohort),which was higher than that of CT-reported LN metastasis.CONCLUSION In this study,we explored an efficient method for predicting preoperative T and N stages using the tumor-contributed CT value of the mesentery in CC,which displayed superior predictive accuracy.展开更多
BACKGROUND The number of tumor deposits(TDs)does not play a part in the current tumor node metastasis staging.Negative lymph node(NLN)status is associated with the prognosis of colorectal cancer(CRC),but its clear rol...BACKGROUND The number of tumor deposits(TDs)does not play a part in the current tumor node metastasis staging.Negative lymph node(NLN)status is associated with the prognosis of colorectal cancer(CRC),but its clear role in N1c stage remains to be defined.AIM To evaluate the combination of TDs and NLNs as potential prognostic indicators in N1c CRC.METHODS We retrospectively identified 107 consecutive patients who had N1c CRC radically resected at China-Japan Friendship Hospital.The combination of TDs and NLNs was calculated by the formula NLNTD=NLN/(TD+1).Cutoff values of NLNs and NLNTD were determined using the R package“survminer”.Disease-free survival(DFS),overall survival(OS)and cancer-specific survival(CSS)were determined using the Kaplan-Meier method to assess the impact of NLNTD on prognosis.Results were compared using the log-rank test.RESULTS The median follow-up time was 63.17(45.33-81.37)months for DFS,with 33.64%(36/107)of patients experiencing recurrence during follow-up.Five-year DFS was 66.0%(57.3%-76.0%).There was no significant difference in prognosis between patients with>12 and≤12 NLNs(P=0.058)for DFS.Similar results were seen according to the number of TDs.The definition of NLNTD=NLN/(TD+1)with a cutoff value of 6 divided patients into two groups with different DFS(P=0.005).Five-year DFS for patients with NLNTD>6 was 73.5%(63.6%-85.0%),compared with 50.0%(35.7%-70.0%)for those with NLNTD≤6.These two groups had different prognosis without perineural invasion(P=0.012)or lymphovascular invasion(P=0.002)even neither(P=0.053).Similar results were seen for OS and CSS.CONCLUSION NLNTD could serve as important prognostic factor for outcomes in N1c CRC patients.These patients could be stratified for prognosis through NLNTD and the high-risk should be given more attention during treatment.展开更多
Imaging studies are a major component in the evaluation of patients for the screening,staging and surveillance of colorectal cancer.This review presents commonly encountered findings in the diagnosis and staging of pa...Imaging studies are a major component in the evaluation of patients for the screening,staging and surveillance of colorectal cancer.This review presents commonly encountered findings in the diagnosis and staging of patients with colorectal cancer using computed tomography(CT)colonography,magnetic resonance imaging(MRI),and positron emission tomography(PET)/CT colonography.CT colonography provides important information for the preoperative assessment of T staging.Wall deformities are associated with muscular or subserosal invasion.Lymph node metastases from colorectal cancer often present with calcifications.CT is superior to detect calcified metastases.Three-dimensional CT to image the vascular anatomy facilitates laparoscopic surgery.T staging of rectal cancer by MRI is an established modality because MRI can diagnose rectal wall laminar structure.N staging in patients with colorectal cancer is still challenging using any imaging modality.MRI is more accurate than CT for the evaluation of liver metastases.PET/CT colonography isvaluable in the evaluation of extra-colonic and hepatic disease.PET/CT colonography is useful for obstructing colorectal cancers that cannot be traversed colonoscopically.PET/CT colonography is able to localize synchronous colon cancers proximal to the obstruction precisely.However,there is no definite evidence to support the routine clinical use of PET/CT colonography.展开更多
Rational application of different forms of nitrogen（N） fertilizer for peanut（Arachis hypogaea L.） requires tracking the N supplied sources which are commonly not available in the differences among the three source...Rational application of different forms of nitrogen（N） fertilizer for peanut（Arachis hypogaea L.） requires tracking the N supplied sources which are commonly not available in the differences among the three sources：root nodule,soil and fertilizer.In this study,two kinds of peanut plants（nodulated variety（Huayu 22） and non-nodulated variety（NN-1）） were choosed and four kinds of N fertilizers：urea-N（CONH_2-N）,ammonium-N（NH_4~＋-N）,nitrate-N（NO_3^--N） and NH_4~＋ ＋NO_3^--N labeled by^（15）N isotope were applied in the field barrel experiment in Chengyang Experimental Station,Shandong Province,China,to determine the N supplied sources and N use efficiency over peanut growing stages.The results showed that intensities and amounts of N supply from the three sources were all higher at middle growing stages（pegging phase and podding phase）.The accumulated amounts of N supply from root nodule,soil and fertilizer over the growing stages were 8.3,5.3 and 3.8g m^（-2） in CONH_2-N treatment,which are all significantly higher than in the other three treatments.At seedling phase,soil supplied the most N for peanut growth,then root nodule controlled the N supply at pegging phase and podding phase,but soil mainly provided N again at the last stage（pod filling phase）.For the whole growing stages,root nodule supplied the most N（47.8 and 43.0%） in CONH_2-N and NH_4~＋-N treatments,whereas soil supplied the most N（41.7 and 40.9%） in NH_4~＋ ＋NO_3^--N and NO_3^--N treatments.The N use efficiency was higher at pegging phase and podding phase,while accumulated N use efficiency over the growing stages was higher in CONH_2-N treatment（42.2%） than in other three treatments（30.4%in NH_4~＋-N treatment,29.4%in NO_3^--N treatment,29.4%in NH_4~＋ ＋NO_3^--N treatment）.In peanut growing field,application of CONH_2-N is a better way to increase the supply of N from root nodule and improve the N use efficiency.展开更多
BACKGROUND Gastric cancer is an aggressive disease with frequent lymph node(LN)involvement.The NCCN recommends a D2 lymphadenectomy and the harvesting of at least 16 LNs.This threshold has been the subject of great de...BACKGROUND Gastric cancer is an aggressive disease with frequent lymph node(LN)involvement.The NCCN recommends a D2 lymphadenectomy and the harvesting of at least 16 LNs.This threshold has been the subject of great debate,not only for the extent of surgery but also for more appropriate staging.The reclassification of stage IIB through IIIC based on N3b nodal staging in the eighth edition of the American Joint Committee on Cancer(AJCC)staging system highlights the efforts to more accurately discriminate survival expectancy based on nodal number.Furthermore,studies have suggested that pathologic assessment of 30 or more LNs improve prognostic accuracy and is required for proper staging of gastriccancer.AIM To evaluate the long-term survival of advanced gastric cancer patients who deviated from expected survival curves because of inadequate nodal evaluation.METHODS Eligible patients were identified from the Surveillance,Epidemiology,and End Results database.Those with stage II-III gastric cancer were considered for inclusion.Three groups were compared based on the number of analyzed LNs.They were inadequate LN assessment(ILA,<16 LNs),adequate LN assessment(ALA,16-29 LNs),and optimal LN assessment(OLA,≥30 LNs).The main outcomes were overall survival(OS)and cancer-specific survival.Data were analyzed by the Kaplan-Meier product-limit method,log-rank test,hazard risk,and Cox proportional univariate and multivariate models.Propensity score matching(PSM)was used to compare the ALA and OLA groups.RESULTS The analysis included 11607 patients.Most had advanced T stages(T3=48%;T4=42%).The pathological AJCC stage distribution was IIA=22%,IIB=18%,IIIA=26%,IIIB=22%,and IIIC=12%.The overall sample divided by the study objective included ILA(50%),ALA(35%),and OLA(15%).Median OS was 24 mo for the ILA group,29 mo for the ALA group,and 34 mo for the OLA group(P<0.001).Univariate analysis showed that the ALA and OLA groups had better OS than the ILA group[ALA hazard ratio(HR)=0.84,95%confidence interval(CI):0.79-0.88,P<0.001 and OLA HR=0.73,95%CI:0.68-0.79,P<0.001].The OS outcome was confirmed by multivariate analysis(ALA HR=0.68,95%CI:0.64-0.71,P<0.001 and OLA:HR=0.48,95%CI:0.44-0.52,P<0.001).A 1:1 PSM analysis in 3428 patients found that the OLA group had better survival than the ALA group(OS:OLA median=34 mo vs ALA median=26 mo,P<0.001,which was confirmed by univariate analysis(HR=0.81,95%CI:0.75-0.89,P<0.001)and multivariate analysis:(HR=0.71,95%CI:0.65-0.78,P<0.001).CONCLUSION Proper nodal staging is a critical issue in gastric cancer.Assessment of an inadequate number of LNs places patients at high risk of adverse long-term survival outcomes.展开更多
Background Patients with single station mediastinal lymph node （N2） non-small call lung ccancer （NSCLC） have a better prognosis than those with multilevel N2.The molecular factors which are involved in disease pro...Background Patients with single station mediastinal lymph node （N2） non-small call lung ccancer （NSCLC） have a better prognosis than those with multilevel N2.The molecular factors which are involved in disease progression remain largely unknown.The purpose of this study was to investigate gene expression differences between single station and multilevel N2 NSCLC and to identify the crucial molecular factors which are associated with progress and prognosis of stage N2 NSCLC.Methods Gene expression analysis was performed using Agilent 4x44K Whole Human Genome Oligo Microarray on 10 freshfrozen lymph node tissue samples from single station N2 and paired multilevel N2 NSCLC patients.Real-time reverse transcription （RT）-PCR was used to validate the differential expression of 14 genes selected by cDNA microarray of which four were confirmed.Immunohistochemical staining for these validated genes was performed on formalin-fixed,paraffinembedded tissue samples from 130 cases of stage N2 NSCLC arranged in a high-density tissue microarray.Results We identified a 14 gene expression signature by comparative analysis of gene expression.Expression of these genes strongly differed between single station and multilevel N2 NSCLC.Four genes （ADAM28,MUC4,CLDN1,and IGF2） correlated with the results of microarray and real-time RT-PCR analysis for the gene-expression data in samples from 56 NSCLC patients.Immunohistochemical staining for these genes in samples from 130 cases of stage N2 NSCLC demonstrated the expression of IGF2 and CLDN1 was negatively correlated with overall survival of stage N2 NSCLC.Conclusions Our results suggest that the expression of CLDN1 and IGF2 indicate a poor prognosis in stage N2 NSCLC.Further,CLDN1 and IGF2 may provide potential targeting opportunities in future therapies.展开更多
文摘BACKGROUND The diagnostic accuracy for detecting metastatic lymph nodes in colorectal cancer(CRC)remains suboptimal.To address this limitation,our study investigates the potential of gemstone spectral computed tomography imaging(GSI)to improve diagnostic accuracy in lymph node metastasis(LNM)assessment.AIM To extensively investigate the clinical utility of GSI in the preoperative assessment of CRC.METHODS The subject population included 200 patients with CRC who were admitted to Zibo Central Hospital from January 2022 to December 2023.All patients underwent dual-phase contrast-enhanced scans in the arterial and venous phases using GSI before surgical intervention.During the research,meticulous quantification was conducted regarding the number of patients with CRC with LNM as well as the exact count of metastatic lymph nodes.Moreover,for both metastatic and non-metastatic lymph nodes,the short diameter at the maximum crosssectional area(covering the axial,sagittal,and coronal planes),morphological features(including manifestations such as margin blurring,aggregation,and enhancement),and spectral parameters in the arterial and venous phases[specifically iodine concentration(IC),normalized IC(NIC),and the slope of the spectral curve(λHU)]were measured and recorded,and a comparative analysis was conducted.The diagnostic efficacy of each index with differences was systematically assessed using the receiver operating characteristic(ROC)curve.Concurrently,receiver operating characteristic curves were constructed for LNM screening based on the short diameter at the maximum cross-sectional area of lymph nodes and each spectral parameter in the arterial and venous phases.RESULTS The area under the curve of GSI for diagnosing LNM in patients with CRC can reach 0.897,with sensitivity,specificity,and accuracy of 92.59%,85.87%,and 89.50%,respectively.A total of 265 lymph nodes were analyzed from the 200 participants with CRC,with metastatic lymph nodes accounting for 56.60%.Compared with nonmetastatic lymph nodes,the short diameters of metastatic lymph nodes in the axial,sagittal,and coronal planes were significantly increased,whereas the IC values in the arterial and venous phases,the NIC value in the arterial phase,and theλHU values in the arterial and venous phases were significantly decreased.The short axial,sagittal,and coronal diameters,arterial-phase IC,venous-phase IC,arterial-phase NIC,arterial-phaseλHU,and venousphaseλHU for diagnosing metastatic lymph nodes demonstrated area under the curve values of 0.631,0.681,0.659,0.862,0.808,0.831,0.801,and 0.706,respectively.CONCLUSION GSI exhibits substantial clinical significance in the preoperative assessment of CRC.Among the parameters assessed,the arterial-phase IC demonstrates the most outstanding diagnostic performance,effectively improving the diagnostic efficacy for preoperative LNM in CRC.
基金Supported by National Natural Science Foundation of China,No.82303785and Medical Scientific Research Foundation of Guangdong Province,No.A2024096.
文摘BACKGROUND Accurate identification of tumor invasion depth and lymph node(LN)involve-ment in patients with colon cancer(CC)is critical for guiding treatment strategies.However,the preoperative prediction of tumor invasion depth and LN metastasis in CC remains challenging.As the intestinal tumor develops,the fat density in the mesentery increases.METHODS Patients,who were diagnosed with CC and underwent surgery,were included and divided into the training and validation cohorts.CT-T values of the mesen-tery were extracted from the CT images.Cutoff points were determined using the receiver operating characteristic(ROC)curve,and the area under the ROC curve was employed to assess the performance of the CT-T value for tumor invasion depth and LN status prediction.RESULTS Cutoff values of 11.83 and 17.17 were identified to discriminate T1/2 vs T3/4 and N0 vs N1/2,respectively.With a cutoff CT-T value of 11.83,the total diagnostic accuracy for T stage was 83.1%(81.5%for the training cohort and 86.2%for the validation cohort).With a cutoff CT-T value of 17.17,the total diagnostic accuracy for N stage was 77.3%(75.8%for the training cohort and 80.1%for the validation cohort),which was higher than that of CT-reported LN metastasis.CONCLUSION In this study,we explored an efficient method for predicting preoperative T and N stages using the tumor-contributed CT value of the mesentery in CC,which displayed superior predictive accuracy.
基金Supported by the National High Level Hospital Clinical Research Funding,No.2023-NHLHCRF-BQ-32 and No.2023-NHLHCRFYYPPLC-ZR-13National Key Research and Development Program of China,No.2024YFE0198300Beijing Municipal Natural Science Foundation,No.7222316.
文摘BACKGROUND The number of tumor deposits(TDs)does not play a part in the current tumor node metastasis staging.Negative lymph node(NLN)status is associated with the prognosis of colorectal cancer(CRC),but its clear role in N1c stage remains to be defined.AIM To evaluate the combination of TDs and NLNs as potential prognostic indicators in N1c CRC.METHODS We retrospectively identified 107 consecutive patients who had N1c CRC radically resected at China-Japan Friendship Hospital.The combination of TDs and NLNs was calculated by the formula NLNTD=NLN/(TD+1).Cutoff values of NLNs and NLNTD were determined using the R package“survminer”.Disease-free survival(DFS),overall survival(OS)and cancer-specific survival(CSS)were determined using the Kaplan-Meier method to assess the impact of NLNTD on prognosis.Results were compared using the log-rank test.RESULTS The median follow-up time was 63.17(45.33-81.37)months for DFS,with 33.64%(36/107)of patients experiencing recurrence during follow-up.Five-year DFS was 66.0%(57.3%-76.0%).There was no significant difference in prognosis between patients with>12 and≤12 NLNs(P=0.058)for DFS.Similar results were seen according to the number of TDs.The definition of NLNTD=NLN/(TD+1)with a cutoff value of 6 divided patients into two groups with different DFS(P=0.005).Five-year DFS for patients with NLNTD>6 was 73.5%(63.6%-85.0%),compared with 50.0%(35.7%-70.0%)for those with NLNTD≤6.These two groups had different prognosis without perineural invasion(P=0.012)or lymphovascular invasion(P=0.002)even neither(P=0.053).Similar results were seen for OS and CSS.CONCLUSION NLNTD could serve as important prognostic factor for outcomes in N1c CRC patients.These patients could be stratified for prognosis through NLNTD and the high-risk should be given more attention during treatment.
文摘Imaging studies are a major component in the evaluation of patients for the screening,staging and surveillance of colorectal cancer.This review presents commonly encountered findings in the diagnosis and staging of patients with colorectal cancer using computed tomography(CT)colonography,magnetic resonance imaging(MRI),and positron emission tomography(PET)/CT colonography.CT colonography provides important information for the preoperative assessment of T staging.Wall deformities are associated with muscular or subserosal invasion.Lymph node metastases from colorectal cancer often present with calcifications.CT is superior to detect calcified metastases.Three-dimensional CT to image the vascular anatomy facilitates laparoscopic surgery.T staging of rectal cancer by MRI is an established modality because MRI can diagnose rectal wall laminar structure.N staging in patients with colorectal cancer is still challenging using any imaging modality.MRI is more accurate than CT for the evaluation of liver metastases.PET/CT colonography isvaluable in the evaluation of extra-colonic and hepatic disease.PET/CT colonography is useful for obstructing colorectal cancers that cannot be traversed colonoscopically.PET/CT colonography is able to localize synchronous colon cancers proximal to the obstruction precisely.However,there is no definite evidence to support the routine clinical use of PET/CT colonography.
基金supported by the Youth Scientific Research Foundation of Shandong Academy of Agricultural Sciences, China(2014QNM27)the Applying Basic Research Project of Qingdao,Shandong Province,China(14-2-4-90-jch)+3 种基金the Modern Agricultural Industry Technology System,China (SDAIT-05-021-04)the National Key Technology R&D Program of China(2014BAD11B04)the Key Innovation of Science and Technology Project of Shandong Academy of Agricultural Sciences,China(2014CXZ06-22014CXZ11-2)
文摘Rational application of different forms of nitrogen（N） fertilizer for peanut（Arachis hypogaea L.） requires tracking the N supplied sources which are commonly not available in the differences among the three sources：root nodule,soil and fertilizer.In this study,two kinds of peanut plants（nodulated variety（Huayu 22） and non-nodulated variety（NN-1）） were choosed and four kinds of N fertilizers：urea-N（CONH_2-N）,ammonium-N（NH_4~＋-N）,nitrate-N（NO_3^--N） and NH_4~＋ ＋NO_3^--N labeled by^（15）N isotope were applied in the field barrel experiment in Chengyang Experimental Station,Shandong Province,China,to determine the N supplied sources and N use efficiency over peanut growing stages.The results showed that intensities and amounts of N supply from the three sources were all higher at middle growing stages（pegging phase and podding phase）.The accumulated amounts of N supply from root nodule,soil and fertilizer over the growing stages were 8.3,5.3 and 3.8g m^（-2） in CONH_2-N treatment,which are all significantly higher than in the other three treatments.At seedling phase,soil supplied the most N for peanut growth,then root nodule controlled the N supply at pegging phase and podding phase,but soil mainly provided N again at the last stage（pod filling phase）.For the whole growing stages,root nodule supplied the most N（47.8 and 43.0%） in CONH_2-N and NH_4~＋-N treatments,whereas soil supplied the most N（41.7 and 40.9%） in NH_4~＋ ＋NO_3^--N and NO_3^--N treatments.The N use efficiency was higher at pegging phase and podding phase,while accumulated N use efficiency over the growing stages was higher in CONH_2-N treatment（42.2%） than in other three treatments（30.4%in NH_4~＋-N treatment,29.4%in NO_3^--N treatment,29.4%in NH_4~＋ ＋NO_3^--N treatment）.In peanut growing field,application of CONH_2-N is a better way to increase the supply of N from root nodule and improve the N use efficiency.
文摘BACKGROUND Gastric cancer is an aggressive disease with frequent lymph node(LN)involvement.The NCCN recommends a D2 lymphadenectomy and the harvesting of at least 16 LNs.This threshold has been the subject of great debate,not only for the extent of surgery but also for more appropriate staging.The reclassification of stage IIB through IIIC based on N3b nodal staging in the eighth edition of the American Joint Committee on Cancer(AJCC)staging system highlights the efforts to more accurately discriminate survival expectancy based on nodal number.Furthermore,studies have suggested that pathologic assessment of 30 or more LNs improve prognostic accuracy and is required for proper staging of gastriccancer.AIM To evaluate the long-term survival of advanced gastric cancer patients who deviated from expected survival curves because of inadequate nodal evaluation.METHODS Eligible patients were identified from the Surveillance,Epidemiology,and End Results database.Those with stage II-III gastric cancer were considered for inclusion.Three groups were compared based on the number of analyzed LNs.They were inadequate LN assessment(ILA,<16 LNs),adequate LN assessment(ALA,16-29 LNs),and optimal LN assessment(OLA,≥30 LNs).The main outcomes were overall survival(OS)and cancer-specific survival.Data were analyzed by the Kaplan-Meier product-limit method,log-rank test,hazard risk,and Cox proportional univariate and multivariate models.Propensity score matching(PSM)was used to compare the ALA and OLA groups.RESULTS The analysis included 11607 patients.Most had advanced T stages(T3=48%;T4=42%).The pathological AJCC stage distribution was IIA=22%,IIB=18%,IIIA=26%,IIIB=22%,and IIIC=12%.The overall sample divided by the study objective included ILA(50%),ALA(35%),and OLA(15%).Median OS was 24 mo for the ILA group,29 mo for the ALA group,and 34 mo for the OLA group(P<0.001).Univariate analysis showed that the ALA and OLA groups had better OS than the ILA group[ALA hazard ratio(HR)=0.84,95%confidence interval(CI):0.79-0.88,P<0.001 and OLA HR=0.73,95%CI:0.68-0.79,P<0.001].The OS outcome was confirmed by multivariate analysis(ALA HR=0.68,95%CI:0.64-0.71,P<0.001 and OLA:HR=0.48,95%CI:0.44-0.52,P<0.001).A 1:1 PSM analysis in 3428 patients found that the OLA group had better survival than the ALA group(OS:OLA median=34 mo vs ALA median=26 mo,P<0.001,which was confirmed by univariate analysis(HR=0.81,95%CI:0.75-0.89,P<0.001)and multivariate analysis:(HR=0.71,95%CI:0.65-0.78,P<0.001).CONCLUSION Proper nodal staging is a critical issue in gastric cancer.Assessment of an inadequate number of LNs places patients at high risk of adverse long-term survival outcomes.
基金Thiswork was supported by grants from National Natural Science Foundation of China （No. 30801377, No. 81000899, No. 81201649） and Tianjin Municipal Science and Technology Commission Key Application Research Project （No. 11JCZDJC 18900）.
文摘Background Patients with single station mediastinal lymph node （N2） non-small call lung ccancer （NSCLC） have a better prognosis than those with multilevel N2.The molecular factors which are involved in disease progression remain largely unknown.The purpose of this study was to investigate gene expression differences between single station and multilevel N2 NSCLC and to identify the crucial molecular factors which are associated with progress and prognosis of stage N2 NSCLC.Methods Gene expression analysis was performed using Agilent 4x44K Whole Human Genome Oligo Microarray on 10 freshfrozen lymph node tissue samples from single station N2 and paired multilevel N2 NSCLC patients.Real-time reverse transcription （RT）-PCR was used to validate the differential expression of 14 genes selected by cDNA microarray of which four were confirmed.Immunohistochemical staining for these validated genes was performed on formalin-fixed,paraffinembedded tissue samples from 130 cases of stage N2 NSCLC arranged in a high-density tissue microarray.Results We identified a 14 gene expression signature by comparative analysis of gene expression.Expression of these genes strongly differed between single station and multilevel N2 NSCLC.Four genes （ADAM28,MUC4,CLDN1,and IGF2） correlated with the results of microarray and real-time RT-PCR analysis for the gene-expression data in samples from 56 NSCLC patients.Immunohistochemical staining for these genes in samples from 130 cases of stage N2 NSCLC demonstrated the expression of IGF2 and CLDN1 was negatively correlated with overall survival of stage N2 NSCLC.Conclusions Our results suggest that the expression of CLDN1 and IGF2 indicate a poor prognosis in stage N2 NSCLC.Further,CLDN1 and IGF2 may provide potential targeting opportunities in future therapies.
