AIM To assess whether elevated serum carcinoembryonic antigen(CEA) is in the inferior prognosis for pathological lymph node-negative(p N_0) gastric cancer(GC) patients who underwent D_2 gastrectomy.METHODS About 469 p...AIM To assess whether elevated serum carcinoembryonic antigen(CEA) is in the inferior prognosis for pathological lymph node-negative(p N_0) gastric cancer(GC) patients who underwent D_2 gastrectomy.METHODS About 469 p N0 GC patients,who received D^2 radical gastrectomy were retrospectively analyzed. The X-tile plots cut-off point for CEA were 30.02 ng/m L using minimum P-value from log-rank χ~2 statistics,and p N_0 GC patients were assigned to two groups: those more than 30.02 ng/m L(n = 48;CEA-high group) and those less than 30.02 ng/m L(n = 421;CEA-low group). Clinicopathologic characteristics were compared usingPearson's χ2 or Fisher's exact tests,and survival curves were so manufactured using the Kaplan-Meier method. Univariate and multivariate analysis were carried out using the logistic regression method.RESULTS The percentage of vessel carcinoma embolus(31.35% vs 17.1%) and advanced GC(T_(2-4b))(81.25% vs 65.32%) were higher in CEA-high group than CEA-low group. The CEA-positive patients had a significantly poorer prognosis than the CEA-nagetive patients in terms of overall survival(57.74% vs 90.69%,P < 0.05),and no different was found between subgroup of T category,differentiation,nerve invasion,and vessel carcinoma embolus(all P > 0.05). Multivariate survival analysis showed that CEA(OR = 4.924),and T category(OR = 2.214) were significant prognostic factors for stage p N0 GC(all P < 0.05). Besides,only T category(OR = 1.962) was an independent hazard factor in the CEA-high group(P < 0.05).CONCLUSION Those pretreatment serum CEA levels over 30.02 ng/m L on behalf of worse characteristics and unfavourable tumor behavior,and a poor prognosis for a nearly doubled risk of mortality in GC patients.展开更多
AIM: To elucidate the potential impact of examined lymph nodes (eLNs) on long-term survival of node-negative gastric cancer patients after curative surgery.
BACKGROUND The reliability of preoperative nodal diagnosis of advanced gastric cancer by multi-detector spiral computed tomography(MDCT)is still unclear.AIM To examine the diagnostic ability of MDCT more precisely by ...BACKGROUND The reliability of preoperative nodal diagnosis of advanced gastric cancer by multi-detector spiral computed tomography(MDCT)is still unclear.AIM To examine the diagnostic ability of MDCT more precisely by using data on intranodal pathological metastatic patterns.METHODS A total of 108 patients with advanced gastric cancer who underwent MDCT and curative gastrectomy at Kanazawa Medical University Hospital were enrolled in this study.The nodal sizes measured on computed tomography(CT)images were compared with the pathology results.A receiver-operating characteristic curve was constructed,from which the critical value(CV)was calculated by using the data of the first 69 patients retrospectively.By using the CV,sensitivity and specificity were calculated with prospectively collected data from 39 consecutive patients.This enabled a more precise one-to-one correspondence of lymph nodes between CT and pathological examination by using the size data of lymph node mapping.The intranodal pathological metastatic patterns were classified into the following four types:Small nodular,peripheral,large nodular,and diffuse.RESULTS Although all the cases were clinically suspected as having metastasis,81 had lymph node metastasis and 27 had no metastasis.The number of dissected,detected on CT,and metastatic nodes were,4241,897,and 801,respectively.The CV obtained from the receiver-operating characteristic was 7.6 mm for the long axis.The sensitivity was 91.4%and the specificity was 47.3%in the prospective phase.The large nodular and diffuse metastases were easy to diagnose becausemetastatic nodes with a large axis often exhibit these forms.CONCLUSION The ability of MDCT to contribute to a nodal diagnosis of advanced gastric cancer was examined prospectively with precise size data from node mapping,using a CV of 7.6 mm for the long axis that was calculated from the retrospectively collected data.The sensitivity was as high as 91%,and would be improved when referring to the enhanced patterns.However,its specificity was as low as 47%,because most of metastatic nodes in gastric cancer being small in size.The small nodular or peripheral type metastatic nodes were often small and considered difficult to diagnose.展开更多
BACKGROUND Lymph node metastasis(LNM) of papillary thyroid carcinoma(PTC) has a certain regularity and occurs first to the central lymph node and then to the lateral lymph node. The pathway of PTC LNM can guide surgic...BACKGROUND Lymph node metastasis(LNM) of papillary thyroid carcinoma(PTC) has a certain regularity and occurs first to the central lymph node and then to the lateral lymph node. The pathway of PTC LNM can guide surgical prophylactic lymph node dissection(LND) for clinical surgeons.AIM To investigate the relationship between subgroups of central LNM and lateral LNM in unilateral clinically node-negative PTC(cN0-PTC).METHODS Data were collected for 1089 PTC patients who underwent surgical treatment at the Department of Endocrine and Breast Surgery of the First Hospital of Chongqing Medical University from January 2016 to December 2017. A total of 388 unilateral cN0-PTC patients met the inclusion criteria and were enrolled in this study. The clinical and pathological data for these 388 patients who underwent total thyroidectomy + central LND + lateral LND were retrospectively analyzed. The relationship between the central LNM and lateral LNM subgroups was investigated.RESULTS The coincidence rate of cN0-PTC was only 30.0%.Optimal scaling regression analysis showed that sex(57.1% vs 42.9%, P = 0.026), primary tumor size(68.8% vs 31.2%, P = 0.008), tumor location(59.7% vs 40.3%, P = 0.007), extrathyroid extension(ETE)(50.6% vs 49.9%, P = 0.046), and prelaryngeal LNM(57.1% vs 42.9%, P = 0.004) were significantly associated with ipsilateral level-II LNM. Their importance levels were 0.122, 0.213, 0.172, 0.110, and 0.227, respectively. Primary tumor size(74.6% vs 30.2%, P = 0.016), pretracheal LNM(67.5% vs 32.5%, P < 0.001), and paratracheal LNM(71.4% vs 28.6%, P < 0.001) were significantly associated with ipsilateral level-Ⅲ LNM. Their importance levels were 0.120, 0.408, and 0.351, respectively. Primary tumor size(72.1% vs 27.9%, P = 0.003), ETE(70.4% vs 29.6%, P = 0.016), pretracheal LNM(68.3% vs 31.7%, P=0.001), and paratracheal LNM(80.8% vs 19.2%, P < 0.001) were significantly associated with ipsilateral level-IV LNM. Their importance levels were 0.164, 0.146, 0.216, and 0.472, respectively.CONCLUSION The LNM pathway of thyroid cancer has a certain regularity. For unilateral cN0-PTC patients with a tumor diameter > 2 cm and pretracheal or ipsilateral paratracheal LNM, LND at ipsilateral level Ⅲ and level IV must be considered. When there is a tumor in the upper third of the thyroid with prelaryngeal LNM, LND at level II, level Ⅲ and level IV must be considered.展开更多
Recently, there has been controversy about the relationship between the number of lymph nodes removed and survival of patients diagnosed with lymph node-negative breast cancer. To assess this relationship, 603 cases o...Recently, there has been controversy about the relationship between the number of lymph nodes removed and survival of patients diagnosed with lymph node-negative breast cancer. To assess this relationship, 603 cases of lymph node-negative breast cancer with a median of 126 months of follow-up data were studied. Patients were stratified into two groups(Group A, 10 or fewer tumor-free lymph nodes removed; Group B, more than 10 tumor-free lymph nodes removed). The number of tumor-free lymph nodes in ipsilateral axillary resections as well as 5 other disease parameters were analyzed for prognostic value. Our results revealed that the risk of death from breast cancer was significantly associated with patient age, marital status, histologic grade, tumor size, and adjuvant therapy. The 5- and 10-year survival rates for patients with 10 or fewer tumor-free lymph nodes removed was 88.0% and 66.4%, respectively, compared with 69.2% and 51.1%, respectively, for patients with more than 10 tumor-free lymph nodes removed. For patients with 10 or fewer tumor-free lymph nodes removed, the adjusted hazard ratio(HR) for risk of death from breast cancer was 0.579(95% confidence interval, 0.492-0.687, P < 0.001), independent of patient age, marital status, histologic grade, tumor size, and adjuvant therapy. Our study suggests that the number of tumor-free lymph nodes removed is an independent predictor in cases of lymph node-negative breast cancer.展开更多
Introduction:We examined the pathology and safety outcomes associated with the extent of pelvic lymph node dissection in patients with high-risk prostate cancer undergoing radical prostatectomy.Materials and Methods:W...Introduction:We examined the pathology and safety outcomes associated with the extent of pelvic lymph node dissection in patients with high-risk prostate cancer undergoing radical prostatectomy.Materials and Methods:We retrospectively identified men with prostate cancer who underwent robot-assisted radical prostatectomy with pelvic lymph node dissection between May 2016 and September 2021.Cases were categorized using Current Procedural Terminology(CPT)codes(38571)for extended lymph node dissection and super-extended lymph node dissection(38572).Using logistic regression,we compared the groups on a number of factors,including recurrence.Results:Super-extended lymph node dissection had significantly higher median prostate-specific antigen and National Comprehensive Cancer Network risk classification prior to surgery.Significant differences were observed in the pathologic T stage and pathology grade group.Time on robot was significantly longer for the super-extended group,while estimated blood loss was lower.No differences were observed in length of stay or any complication-related variable.Super-extended had significantly higher node positivity(36.1%vs.7.6%,p<0.001)and recurrence.10.0%of super-extended cases had node positivity in the aortic bifurcation,the common iliac,or the pre-sacral chains that would have been missed with an extended dissection.2.2%of patients had node positivity in these chains only.Conclusions:Super-extended lymph node dissection is safe and feasible for patients with high-risk prostate cancer.Further research is needed to better understand its clinical benefit and to further inform optimal patient selection.展开更多
Objective: To determine the infection rates of mesenteric and mediastinal lymph nodes in relation to Linguatula serrata(L. serrata) nymphs. Methods: In the present study, mesenteric and mediastinal lymph nodes of 200 ...Objective: To determine the infection rates of mesenteric and mediastinal lymph nodes in relation to Linguatula serrata(L. serrata) nymphs. Methods: In the present study, mesenteric and mediastinal lymph nodes of 200 sheep with different sex and age that were slaughtered in a Shahrekord slaughterhouse were collected. The lymph nodes were examined macroscopically and for histopathological examination, tissue samples were taken from the gross lesions processed routinely by paraffin method and stained with hematoxylin and eosin. Results: Out of 200 examined sheep, the mesenteric lymph nodes in 18 sheep(9%) and the mediastinal lymph nodes of 9 sheep(4.5%) were infected by L. serrata nymphs. The infection rate increased with age, but no significant difference was observed between males and females or the two types of lymph nodes(P > 0.01). Different nonspecific gross and macroscopic lesions were seen in infected lymph nodes. L. serrata nymph sections were observed in some histopathological slides. Conclusions: It is concluded that the sheep may play an important role in linguatulosis of final hosts and human beings in this region.展开更多
Objective The aim of the study was to study the correlation between the clinicopathological parameters of lung adenocarcinoma and lymph node metastasis and identify the risk factors of lymph node metastasis.Methods Th...Objective The aim of the study was to study the correlation between the clinicopathological parameters of lung adenocarcinoma and lymph node metastasis and identify the risk factors of lymph node metastasis.Methods The data of 258 patients with postoperative lung adenocarcinoma(mainly based on their pathological data)were collected and analyzed,and their basic information was counted.Results Maximum tumor diameter was found to be an independent risk factor for lymph node metastasis.The larger the maximum diameter of the tumor in patients with lung adenocarcinoma,the higher the likelihood of lymph node metastasis.Solid predominant adenocarcinoma with mucin production is as an independent risk factor for superior mediastinal and subcarinal lymph node metastasis.Primary adenocarcinomas in the lower lobe of the lung may have a higher rate of lymph node metastasis than those in the upper lobe.Conclusion The known pathological subtypes of lung adenocarcinoma can be used for the prediction of lymph node metastasis in various regions and guide the dissection of lymph nodes that would improve patients’prognosis.展开更多
Ductal breast cancer is a clinically heterogeneous disease;we investigate the correlation between tumor size, comedo necrosis, number of cell mitoses and axillary lymph node metastasis in ductal breast cancer. In this...Ductal breast cancer is a clinically heterogeneous disease;we investigate the correlation between tumor size, comedo necrosis, number of cell mitoses and axillary lymph node metastasis in ductal breast cancer. In this study, 104 ductal breast cancer specimens were collected and divided into 3 groups: T1 group (tumor size ≤ 2 cm), T2 group (2 5.0 cm). Among those specimens, 95 cases were diagnosed with invasive ducted carcinoma, and 9 cases were ductal carcinoma in-situ (DCIS). Results show that T3 group has a higher rate of axillary lymph node metastasis than T2 group and T1 group;T2 group has a higher rate of lymph node metastasis than T1 group. The patients with the number of cell mitoses (≥10) were also has a higher rate of axillary lymph node metastasis (P = 0.0139) than the patients with the number of cell mitoses (<10). No significance was found between comedo necrosis lesions and axillary lymph node metastasis, though the frequency of comedo necrosis lesions in patients with axillary lymph node metastasis was higher than those in non-metastatic patients. It is concluded that the tumor size and the number of cell mitoses were risk factors for axillary lymph node involvement in ductal breast cancer.展开更多
BACKGROUND Lymph node status is a critical prognostic factor in gastric cancer(GC),but stage migration may occur in pathological lymph nodes(pN)staging.To address this,alternative staging systems such as the positive ...BACKGROUND Lymph node status is a critical prognostic factor in gastric cancer(GC),but stage migration may occur in pathological lymph nodes(pN)staging.To address this,alternative staging systems such as the positive lymph node ratio(LNR)and log odds of positive lymph nodes(LODDS)were introduced.AIM To assess the prognostic accuracy and stratification efficacy of three nodal staging systems in GC.METHODS A systematic review identified 12 studies,from which hazard ratios(HRs)for overall survival(OS)were summarized.Sensitivity analyses,subgroup analyses,publication bias assessments,and quality evaluations were conducted.To enhance comparability,data from studies with identical cutoff values for pN,LNR,and LODDS were pooled.Homogeneous stratification was then applied to generate Kaplan-Meier(KM)survival curves,assessing the stratification efficacy of three staging systems.RESULTS The HRs and 95%confidence intervals for pN,LNR,and LODDS were 2.16(1.72-2.73),2.05(1.65-2.55),and 3.15(2.15-4.37),respectively,confirming all three as independent prognostic risk factors for OS.Comparative analysis of HRs demonstrated that LODDS had superior prognostic predictive power over LNR and pN.KM curves for pN(N0,N1,N2,N3a,N3b),LNR(0.1/0.2/0.5),and LODDS(-1.5/-1.0/-0.5/0)revealed significant differences(P<0.001)among all prognostic stratifications.Mean differences and standard deviations in 60-month relative survival were 27.93%±0.29%,41.70%±0.30%,and 26.60%±0.28%for pN,LNR,and LODDS,respectively.CONCLUSION All three staging systems are independent prognostic factors for OS.LODDS demonstrated the highest specificity,making it especially useful for predicting outcomes,while pN was the most effective in homogeneous stratification,offering better patient differentiation.These findings highlight the complementary roles of LODDS and pN in enhancing prognostic accuracy and stratification.展开更多
BACKGROUND Gastric cancer is the leading cause of cancer-related deaths worldwide.Early gastric cancer(EGC)is often associated with the risk of lymph node metastasis,which influences treatment decisions.Despite the us...BACKGROUND Gastric cancer is the leading cause of cancer-related deaths worldwide.Early gastric cancer(EGC)is often associated with the risk of lymph node metastasis,which influences treatment decisions.Despite the use of enhanced computed tomography,the prediction of lymph node involvement remains challenging.AIM To investigate the risk factors for lymph node metastasis and invasion depth in patients with EGC.METHODS In total,210 patients with pathologically diagnosed EGC were included in this study.Univariate and multivariate statistical analyses were used to predict risk factors for lymph node metastasis and invasion depth in patients with EGC.RESULTS Among the 210 patients,27(12.9%)had lymph node metastases.Of the 117 patients with submucosal gastric cancer,24(20.5%)had lymph node metastases.Both univariate and multivariate analyses indicated that the depth of invasion in EGC was a risk factor for lymph node metastasis in these patients.Additionally,pathological type was identified as a risk factor for cancer cell invasion in patients with EGC.CONCLUSION EGC invasion depth,not tumor type,size,age,sex,or location,predicts lymph node spread.Tumor type,not size,age,sex,or location,predicts cancer cell invasion.展开更多
This study was conducted by determination or mutative p53 gene expression in 32 casesof submucosa early gastric cancer. The relationship of p53 gene mutation and tumorlgenesis andprogress or gastric cancer was evaluat...This study was conducted by determination or mutative p53 gene expression in 32 casesof submucosa early gastric cancer. The relationship of p53 gene mutation and tumorlgenesis andprogress or gastric cancer was evaluated based on the cllnlco-pathological characteristics of early gastric cancer. Results showed that positive rate or P53 Protein expression was 34. 8% in early gastriccancer and p53 mutation related to the hlstology, location or tumor and lymph node metastasis (P <0. 05). Our research suggested that p53 gene ed,resslon closely related to the prognosis of early gastric cancer, and carcinogenesls I,athways may be different according to the positions of stomach.展开更多
Background:Pathological complete response(pCR)of axillary lymph nodes(ALNs)is frequently achieved in patients with clinically node-positive breast cancer after neoadjuvant chemotherapy(NAC),and ALN status is an import...Background:Pathological complete response(pCR)of axillary lymph nodes(ALNs)is frequently achieved in patients with clinically node-positive breast cancer after neoadjuvant chemotherapy(NAC),and ALN status is an important prognostic factor for breast cancer patients.This study aims to develop a new predictive clinical model to assess the ALN pCR rate after NAC.Methods:This was a retrospective series of 467 patients who had biopsy-proven positive ALNs at diagnosis and underwent ALN dissection from 2007 to 2014 at the National Cancer Center/Cancer Hospital of the Chinese Academy of Medical Sciences.We analyzed the clinicopathologic features of the patients and developed a nomogram to predict the probability of ALN pCR.A multivariable logistic regression stepwise model was used to construct a nomogram to predict ALN pCR in node-positive patients.The adjusted area under the receiver operating characteristic curve(AUC)was calculated to quantify the ability to rank patients by risk.Internal validation was performed using the 50/50 hold-out validation method.The nomogram was externally validated with prospective cohorts of 167 patients from 2016 to 2018 at the Cancer Hospital of the Chinese Academy of Medical Sciences and 114 patients from 2018 to 2020 at Beijing Tiantan Hospital.Results:In this retrospective study,115(24.6%)patients achieved ALN pCR after NAC.Multivariate analysis showed that clinical tumor stage(Odds ratio[OR]:0.321,95%confidence interval[CI]:0.121-0.856;P=0.023);primary tumor response(OR:0.189;95%CI:0.123-0.292;P<0.001),and estrogen receptor status(OR:0.530,95%CI:0.304-0.925;P=0.025)were independent predictors of ALN pCR.The nomogram was constructed based on the result of multivariate analysis.In the internal validation of performance of nomogram,the AUCs for the training and test sets were 0.719 and 0.753,respectively.The nomogram was validated in external cohorts with AUCs of 0.720,which demonstrated good discriminatory power in these data sets.Conclusion:We developed a nomogram to predict the likelihood of axillary pCR in node-positive breast cancer patients after NAC.The predictive model performed well in multicenter prospective external validation.This practical tool could provide information to surgeons regarding whether to perform additional ALN dissection after NAC.Trial registration:ChiCTR.org.cn,ChiCTR1800014968.展开更多
基金Supported by Domestic Support from Young and Middle-aged key personnel Training program for provincial Health planning Students,No.2017-ZQN-18provincial Youth Health Science Research project,No.2014-2-8 and No.2017-1-13National key Clinical Specialty Construction project,No.2013-2016
文摘AIM To assess whether elevated serum carcinoembryonic antigen(CEA) is in the inferior prognosis for pathological lymph node-negative(p N_0) gastric cancer(GC) patients who underwent D_2 gastrectomy.METHODS About 469 p N0 GC patients,who received D^2 radical gastrectomy were retrospectively analyzed. The X-tile plots cut-off point for CEA were 30.02 ng/m L using minimum P-value from log-rank χ~2 statistics,and p N_0 GC patients were assigned to two groups: those more than 30.02 ng/m L(n = 48;CEA-high group) and those less than 30.02 ng/m L(n = 421;CEA-low group). Clinicopathologic characteristics were compared usingPearson's χ2 or Fisher's exact tests,and survival curves were so manufactured using the Kaplan-Meier method. Univariate and multivariate analysis were carried out using the logistic regression method.RESULTS The percentage of vessel carcinoma embolus(31.35% vs 17.1%) and advanced GC(T_(2-4b))(81.25% vs 65.32%) were higher in CEA-high group than CEA-low group. The CEA-positive patients had a significantly poorer prognosis than the CEA-nagetive patients in terms of overall survival(57.74% vs 90.69%,P < 0.05),and no different was found between subgroup of T category,differentiation,nerve invasion,and vessel carcinoma embolus(all P > 0.05). Multivariate survival analysis showed that CEA(OR = 4.924),and T category(OR = 2.214) were significant prognostic factors for stage p N0 GC(all P < 0.05). Besides,only T category(OR = 1.962) was an independent hazard factor in the CEA-high group(P < 0.05).CONCLUSION Those pretreatment serum CEA levels over 30.02 ng/m L on behalf of worse characteristics and unfavourable tumor behavior,and a poor prognosis for a nearly doubled risk of mortality in GC patients.
基金Supported by A grant from the National Basic Research Pro-gram of China(973 Program),No.2010CB529301
文摘AIM: To elucidate the potential impact of examined lymph nodes (eLNs) on long-term survival of node-negative gastric cancer patients after curative surgery.
文摘BACKGROUND The reliability of preoperative nodal diagnosis of advanced gastric cancer by multi-detector spiral computed tomography(MDCT)is still unclear.AIM To examine the diagnostic ability of MDCT more precisely by using data on intranodal pathological metastatic patterns.METHODS A total of 108 patients with advanced gastric cancer who underwent MDCT and curative gastrectomy at Kanazawa Medical University Hospital were enrolled in this study.The nodal sizes measured on computed tomography(CT)images were compared with the pathology results.A receiver-operating characteristic curve was constructed,from which the critical value(CV)was calculated by using the data of the first 69 patients retrospectively.By using the CV,sensitivity and specificity were calculated with prospectively collected data from 39 consecutive patients.This enabled a more precise one-to-one correspondence of lymph nodes between CT and pathological examination by using the size data of lymph node mapping.The intranodal pathological metastatic patterns were classified into the following four types:Small nodular,peripheral,large nodular,and diffuse.RESULTS Although all the cases were clinically suspected as having metastasis,81 had lymph node metastasis and 27 had no metastasis.The number of dissected,detected on CT,and metastatic nodes were,4241,897,and 801,respectively.The CV obtained from the receiver-operating characteristic was 7.6 mm for the long axis.The sensitivity was 91.4%and the specificity was 47.3%in the prospective phase.The large nodular and diffuse metastases were easy to diagnose becausemetastatic nodes with a large axis often exhibit these forms.CONCLUSION The ability of MDCT to contribute to a nodal diagnosis of advanced gastric cancer was examined prospectively with precise size data from node mapping,using a CV of 7.6 mm for the long axis that was calculated from the retrospectively collected data.The sensitivity was as high as 91%,and would be improved when referring to the enhanced patterns.However,its specificity was as low as 47%,because most of metastatic nodes in gastric cancer being small in size.The small nodular or peripheral type metastatic nodes were often small and considered difficult to diagnose.
文摘BACKGROUND Lymph node metastasis(LNM) of papillary thyroid carcinoma(PTC) has a certain regularity and occurs first to the central lymph node and then to the lateral lymph node. The pathway of PTC LNM can guide surgical prophylactic lymph node dissection(LND) for clinical surgeons.AIM To investigate the relationship between subgroups of central LNM and lateral LNM in unilateral clinically node-negative PTC(cN0-PTC).METHODS Data were collected for 1089 PTC patients who underwent surgical treatment at the Department of Endocrine and Breast Surgery of the First Hospital of Chongqing Medical University from January 2016 to December 2017. A total of 388 unilateral cN0-PTC patients met the inclusion criteria and were enrolled in this study. The clinical and pathological data for these 388 patients who underwent total thyroidectomy + central LND + lateral LND were retrospectively analyzed. The relationship between the central LNM and lateral LNM subgroups was investigated.RESULTS The coincidence rate of cN0-PTC was only 30.0%.Optimal scaling regression analysis showed that sex(57.1% vs 42.9%, P = 0.026), primary tumor size(68.8% vs 31.2%, P = 0.008), tumor location(59.7% vs 40.3%, P = 0.007), extrathyroid extension(ETE)(50.6% vs 49.9%, P = 0.046), and prelaryngeal LNM(57.1% vs 42.9%, P = 0.004) were significantly associated with ipsilateral level-II LNM. Their importance levels were 0.122, 0.213, 0.172, 0.110, and 0.227, respectively. Primary tumor size(74.6% vs 30.2%, P = 0.016), pretracheal LNM(67.5% vs 32.5%, P < 0.001), and paratracheal LNM(71.4% vs 28.6%, P < 0.001) were significantly associated with ipsilateral level-Ⅲ LNM. Their importance levels were 0.120, 0.408, and 0.351, respectively. Primary tumor size(72.1% vs 27.9%, P = 0.003), ETE(70.4% vs 29.6%, P = 0.016), pretracheal LNM(68.3% vs 31.7%, P=0.001), and paratracheal LNM(80.8% vs 19.2%, P < 0.001) were significantly associated with ipsilateral level-IV LNM. Their importance levels were 0.164, 0.146, 0.216, and 0.472, respectively.CONCLUSION The LNM pathway of thyroid cancer has a certain regularity. For unilateral cN0-PTC patients with a tumor diameter > 2 cm and pretracheal or ipsilateral paratracheal LNM, LND at ipsilateral level Ⅲ and level IV must be considered. When there is a tumor in the upper third of the thyroid with prelaryngeal LNM, LND at level II, level Ⅲ and level IV must be considered.
基金supported by a grant from the National Natural Science Foundation of China (No. 81172165)
文摘Recently, there has been controversy about the relationship between the number of lymph nodes removed and survival of patients diagnosed with lymph node-negative breast cancer. To assess this relationship, 603 cases of lymph node-negative breast cancer with a median of 126 months of follow-up data were studied. Patients were stratified into two groups(Group A, 10 or fewer tumor-free lymph nodes removed; Group B, more than 10 tumor-free lymph nodes removed). The number of tumor-free lymph nodes in ipsilateral axillary resections as well as 5 other disease parameters were analyzed for prognostic value. Our results revealed that the risk of death from breast cancer was significantly associated with patient age, marital status, histologic grade, tumor size, and adjuvant therapy. The 5- and 10-year survival rates for patients with 10 or fewer tumor-free lymph nodes removed was 88.0% and 66.4%, respectively, compared with 69.2% and 51.1%, respectively, for patients with more than 10 tumor-free lymph nodes removed. For patients with 10 or fewer tumor-free lymph nodes removed, the adjusted hazard ratio(HR) for risk of death from breast cancer was 0.579(95% confidence interval, 0.492-0.687, P < 0.001), independent of patient age, marital status, histologic grade, tumor size, and adjuvant therapy. Our study suggests that the number of tumor-free lymph nodes removed is an independent predictor in cases of lymph node-negative breast cancer.
文摘Introduction:We examined the pathology and safety outcomes associated with the extent of pelvic lymph node dissection in patients with high-risk prostate cancer undergoing radical prostatectomy.Materials and Methods:We retrospectively identified men with prostate cancer who underwent robot-assisted radical prostatectomy with pelvic lymph node dissection between May 2016 and September 2021.Cases were categorized using Current Procedural Terminology(CPT)codes(38571)for extended lymph node dissection and super-extended lymph node dissection(38572).Using logistic regression,we compared the groups on a number of factors,including recurrence.Results:Super-extended lymph node dissection had significantly higher median prostate-specific antigen and National Comprehensive Cancer Network risk classification prior to surgery.Significant differences were observed in the pathologic T stage and pathology grade group.Time on robot was significantly longer for the super-extended group,while estimated blood loss was lower.No differences were observed in length of stay or any complication-related variable.Super-extended had significantly higher node positivity(36.1%vs.7.6%,p<0.001)and recurrence.10.0%of super-extended cases had node positivity in the aortic bifurcation,the common iliac,or the pre-sacral chains that would have been missed with an extended dissection.2.2%of patients had node positivity in these chains only.Conclusions:Super-extended lymph node dissection is safe and feasible for patients with high-risk prostate cancer.Further research is needed to better understand its clinical benefit and to further inform optimal patient selection.
基金Supported by Faculty of Veterinary Medicine,Shahrekord University(Grant No:2012/333)
文摘Objective: To determine the infection rates of mesenteric and mediastinal lymph nodes in relation to Linguatula serrata(L. serrata) nymphs. Methods: In the present study, mesenteric and mediastinal lymph nodes of 200 sheep with different sex and age that were slaughtered in a Shahrekord slaughterhouse were collected. The lymph nodes were examined macroscopically and for histopathological examination, tissue samples were taken from the gross lesions processed routinely by paraffin method and stained with hematoxylin and eosin. Results: Out of 200 examined sheep, the mesenteric lymph nodes in 18 sheep(9%) and the mediastinal lymph nodes of 9 sheep(4.5%) were infected by L. serrata nymphs. The infection rate increased with age, but no significant difference was observed between males and females or the two types of lymph nodes(P > 0.01). Different nonspecific gross and macroscopic lesions were seen in infected lymph nodes. L. serrata nymph sections were observed in some histopathological slides. Conclusions: It is concluded that the sheep may play an important role in linguatulosis of final hosts and human beings in this region.
文摘Objective The aim of the study was to study the correlation between the clinicopathological parameters of lung adenocarcinoma and lymph node metastasis and identify the risk factors of lymph node metastasis.Methods The data of 258 patients with postoperative lung adenocarcinoma(mainly based on their pathological data)were collected and analyzed,and their basic information was counted.Results Maximum tumor diameter was found to be an independent risk factor for lymph node metastasis.The larger the maximum diameter of the tumor in patients with lung adenocarcinoma,the higher the likelihood of lymph node metastasis.Solid predominant adenocarcinoma with mucin production is as an independent risk factor for superior mediastinal and subcarinal lymph node metastasis.Primary adenocarcinomas in the lower lobe of the lung may have a higher rate of lymph node metastasis than those in the upper lobe.Conclusion The known pathological subtypes of lung adenocarcinoma can be used for the prediction of lymph node metastasis in various regions and guide the dissection of lymph nodes that would improve patients’prognosis.
文摘Ductal breast cancer is a clinically heterogeneous disease;we investigate the correlation between tumor size, comedo necrosis, number of cell mitoses and axillary lymph node metastasis in ductal breast cancer. In this study, 104 ductal breast cancer specimens were collected and divided into 3 groups: T1 group (tumor size ≤ 2 cm), T2 group (2 5.0 cm). Among those specimens, 95 cases were diagnosed with invasive ducted carcinoma, and 9 cases were ductal carcinoma in-situ (DCIS). Results show that T3 group has a higher rate of axillary lymph node metastasis than T2 group and T1 group;T2 group has a higher rate of lymph node metastasis than T1 group. The patients with the number of cell mitoses (≥10) were also has a higher rate of axillary lymph node metastasis (P = 0.0139) than the patients with the number of cell mitoses (<10). No significance was found between comedo necrosis lesions and axillary lymph node metastasis, though the frequency of comedo necrosis lesions in patients with axillary lymph node metastasis was higher than those in non-metastatic patients. It is concluded that the tumor size and the number of cell mitoses were risk factors for axillary lymph node involvement in ductal breast cancer.
基金the Clinical Medical Team Introduction Program of Suzhou,No.SZYJTD201804.
文摘BACKGROUND Lymph node status is a critical prognostic factor in gastric cancer(GC),but stage migration may occur in pathological lymph nodes(pN)staging.To address this,alternative staging systems such as the positive lymph node ratio(LNR)and log odds of positive lymph nodes(LODDS)were introduced.AIM To assess the prognostic accuracy and stratification efficacy of three nodal staging systems in GC.METHODS A systematic review identified 12 studies,from which hazard ratios(HRs)for overall survival(OS)were summarized.Sensitivity analyses,subgroup analyses,publication bias assessments,and quality evaluations were conducted.To enhance comparability,data from studies with identical cutoff values for pN,LNR,and LODDS were pooled.Homogeneous stratification was then applied to generate Kaplan-Meier(KM)survival curves,assessing the stratification efficacy of three staging systems.RESULTS The HRs and 95%confidence intervals for pN,LNR,and LODDS were 2.16(1.72-2.73),2.05(1.65-2.55),and 3.15(2.15-4.37),respectively,confirming all three as independent prognostic risk factors for OS.Comparative analysis of HRs demonstrated that LODDS had superior prognostic predictive power over LNR and pN.KM curves for pN(N0,N1,N2,N3a,N3b),LNR(0.1/0.2/0.5),and LODDS(-1.5/-1.0/-0.5/0)revealed significant differences(P<0.001)among all prognostic stratifications.Mean differences and standard deviations in 60-month relative survival were 27.93%±0.29%,41.70%±0.30%,and 26.60%±0.28%for pN,LNR,and LODDS,respectively.CONCLUSION All three staging systems are independent prognostic factors for OS.LODDS demonstrated the highest specificity,making it especially useful for predicting outcomes,while pN was the most effective in homogeneous stratification,offering better patient differentiation.These findings highlight the complementary roles of LODDS and pN in enhancing prognostic accuracy and stratification.
文摘BACKGROUND Gastric cancer is the leading cause of cancer-related deaths worldwide.Early gastric cancer(EGC)is often associated with the risk of lymph node metastasis,which influences treatment decisions.Despite the use of enhanced computed tomography,the prediction of lymph node involvement remains challenging.AIM To investigate the risk factors for lymph node metastasis and invasion depth in patients with EGC.METHODS In total,210 patients with pathologically diagnosed EGC were included in this study.Univariate and multivariate statistical analyses were used to predict risk factors for lymph node metastasis and invasion depth in patients with EGC.RESULTS Among the 210 patients,27(12.9%)had lymph node metastases.Of the 117 patients with submucosal gastric cancer,24(20.5%)had lymph node metastases.Both univariate and multivariate analyses indicated that the depth of invasion in EGC was a risk factor for lymph node metastasis in these patients.Additionally,pathological type was identified as a risk factor for cancer cell invasion in patients with EGC.CONCLUSION EGC invasion depth,not tumor type,size,age,sex,or location,predicts lymph node spread.Tumor type,not size,age,sex,or location,predicts cancer cell invasion.
文摘This study was conducted by determination or mutative p53 gene expression in 32 casesof submucosa early gastric cancer. The relationship of p53 gene mutation and tumorlgenesis andprogress or gastric cancer was evaluated based on the cllnlco-pathological characteristics of early gastric cancer. Results showed that positive rate or P53 Protein expression was 34. 8% in early gastriccancer and p53 mutation related to the hlstology, location or tumor and lymph node metastasis (P <0. 05). Our research suggested that p53 gene ed,resslon closely related to the prognosis of early gastric cancer, and carcinogenesls I,athways may be different according to the positions of stomach.
基金This research was supported by grants from the National Key Research and Development Program of China(No.2019YFE0110000)the CAMS Innovation Fund for Medical Sciences(CIFMS)(Nos.2016-I2M-1-001,2017-I2M-3-004)+3 种基金the National Natural Science Foundation of China(No.82072097)the Youth Research Fund of Beijing Tiantan Hospital(No.2017-YQN-09)the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(Nos.2018PT32013,2017PT32001,and 2016ZX310178)the Beijing Hope Run Special Fund of Cancer Foundation of China(No.LC2020A18)。
文摘Background:Pathological complete response(pCR)of axillary lymph nodes(ALNs)is frequently achieved in patients with clinically node-positive breast cancer after neoadjuvant chemotherapy(NAC),and ALN status is an important prognostic factor for breast cancer patients.This study aims to develop a new predictive clinical model to assess the ALN pCR rate after NAC.Methods:This was a retrospective series of 467 patients who had biopsy-proven positive ALNs at diagnosis and underwent ALN dissection from 2007 to 2014 at the National Cancer Center/Cancer Hospital of the Chinese Academy of Medical Sciences.We analyzed the clinicopathologic features of the patients and developed a nomogram to predict the probability of ALN pCR.A multivariable logistic regression stepwise model was used to construct a nomogram to predict ALN pCR in node-positive patients.The adjusted area under the receiver operating characteristic curve(AUC)was calculated to quantify the ability to rank patients by risk.Internal validation was performed using the 50/50 hold-out validation method.The nomogram was externally validated with prospective cohorts of 167 patients from 2016 to 2018 at the Cancer Hospital of the Chinese Academy of Medical Sciences and 114 patients from 2018 to 2020 at Beijing Tiantan Hospital.Results:In this retrospective study,115(24.6%)patients achieved ALN pCR after NAC.Multivariate analysis showed that clinical tumor stage(Odds ratio[OR]:0.321,95%confidence interval[CI]:0.121-0.856;P=0.023);primary tumor response(OR:0.189;95%CI:0.123-0.292;P<0.001),and estrogen receptor status(OR:0.530,95%CI:0.304-0.925;P=0.025)were independent predictors of ALN pCR.The nomogram was constructed based on the result of multivariate analysis.In the internal validation of performance of nomogram,the AUCs for the training and test sets were 0.719 and 0.753,respectively.The nomogram was validated in external cohorts with AUCs of 0.720,which demonstrated good discriminatory power in these data sets.Conclusion:We developed a nomogram to predict the likelihood of axillary pCR in node-positive breast cancer patients after NAC.The predictive model performed well in multicenter prospective external validation.This practical tool could provide information to surgeons regarding whether to perform additional ALN dissection after NAC.Trial registration:ChiCTR.org.cn,ChiCTR1800014968.
