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 determine whether the number of examined lymph nodes(LNs) is correlated with the overall survival of gallbladder carcinoma(GBC) patients. METHODS Patients were collected from the Surveillance Epidemiology and E...AIM To determine whether the number of examined lymph nodes(LNs) is correlated with the overall survival of gallbladder carcinoma(GBC) patients. METHODS Patients were collected from the Surveillance Epidemiology and End Results database(2004-2013) and categorized by the number of LNs into six groups: 1 LN, 2 LNs, 3 LNs, 4 LNs, 5 LNs, and ≥ 6 LNs. Survival curves for overall survival were plotted with a KaplanMeier analysis. The log-rank test was used for univariate comparisons.RESULTS In a cohort of 893 patients, the median number of examined LNs was two for the entire cohort. The survival for the 1 LN group was significantly poorer than those of the stage Ⅰ and Ⅱ disease groups and for the entire cohort. By dichotomizing the number of LNs from 1 to 6, we found that the minimum number of LNs that should be examined was four for stage Ⅰ, four or five for stage Ⅱ, and six for stage ⅢA disease. Therefore, for the entire cohort, the number of examined LNs should be at least six, which is exactly consistent with the American Joint Committee on Cancer criteria.CONCLUSION The examination of higher numbers of LNs is associated with improved survival after resection surgery for N0 GBC. The guidelines for GBC surgery, which recommend that six LNs be examined at least, are statistically valid and should be applied in clinical practice widely.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
AIM: To elucidate the potential impact of examined lymph nodes (eLNs) on long-term survival of node-negative gastric cancer patients after curative surgery.
AIM:To investigate the long-term effect of the number of resected lymph nodes (LNs) on the prognosis of patients with node-negative gastric cancer.METHODS: Clinical data of 211 patients with gastric cancer, without no...AIM:To investigate the long-term effect of the number of resected lymph nodes (LNs) on the prognosis of patients with node-negative gastric cancer.METHODS: Clinical data of 211 patients with gastric cancer, without nodal involvement, were analyzed retrospectively after D2 radical operation. We analyzed the relationship between the number of resected LNs with the 5-year survival, the recurrence rate and the post-operative complication rate.RESULTS: The 5-year survival of the entire cohort was 82.2%. The total number of dissected LNs was one of the independent prognostic factors. Among patients with comparable depth of invasion, the larger the number of resected LNs, the better the survival (P<0.05). A cut-point analysis provided the possibility to detect a significant survival difference among subgroups. Patients had a better long-term survival outcomes with LN counts ≥15 for pT1-2, ≥20 for pT3-4, and ≥15 for the entire cohort. The overall recurrence rate was 29.4% within 5 years after surgery. There was a statistically significant, negative correlation between the number of resected LNs and the recurrence rate (P>0.01). The post-operative complication rate was 10.9% and was not signif icantly correlated with the number of dissected LNs (P>0.05).CONCLUSION: For node-negative gastric cancer, sufficient number of dissected LNs is recommended during D2 lymphadenectomy, to improve the long-term survival and reduce the recurrence. Suitable increments of the dissected LN count would not increase the post-operative complication rate.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
AIM:To investigate the effects of extended lymphadenectomy and postoperative chemotherapy on gastric cancer without lymph node metastasis.METHODS:Clinical data of 311 node-negative gastric cancer patients who underwen...AIM:To investigate the effects of extended lymphadenectomy and postoperative chemotherapy on gastric cancer without lymph node metastasis.METHODS:Clinical data of 311 node-negative gastric cancer patients who underwent potentially curative gastrectomy with more than 15 lymph nodes resected,from January 2002 to December 2006,were analyzed retrospectively.Patients with pT4 stage or distant metastasis were excluded.We analyzed the relationship between the D2 lymphadenectomy and the 5-year survival rate among different subgroups stratified by clinical features,such as age,tumor size,tumor location and depth of invasion.At the same time,the relationship between postoperative chemotherapy and the5-year survival rate among different subgroups were also analyzed.RESULTS:The overall 5-year survival rate of the entire cohort was 63.7%.The 5-year survival rate was poor in those patients who were:(1)more than 65 years old;(2)with tumor size larger than 4 cm;(3)with tumor located in the upper portion of the stomach;and(4)with pT3 tumor.The survival rate was improved significantly by extended lymphadenectomy only in patients with pT3 tumor(P=0.019),but not in other subgroups.Moreover,there was no significant difference in survival rate between patients with and without postoperative chemotherapy among all of the subgroups(P>0.05).CONCLUSION:For gastric cancer patients without lymph node metastasis,extended lymphadenectomy could improve the survival rate of those who have pT3-stage tumor.However,there was no evidence of a survival benefit from postoperative chemotherapy alone.展开更多
Objective: To study micrometastases in lymph nodes from patients with node-negative gastric carcinoma by routine histologic examination and discuss their prognostic significance and the relationship between micrometas...Objective: To study micrometastases in lymph nodes from patients with node-negative gastric carcinoma by routine histologic examination and discuss their prognostic significance and the relationship between micrometastases and each of the clinicopathologic factors. Methods: A total of 1245 perigastric lymph nodes from 105 patients with node-negative gastric carcinoma was immunohisto-chemically detected using a monoclonal antibody against low molecular weight cytokeratin AE1. The characteristics of the micrometastases, their related factors and effect on patients’ survival after surgery were analysed and tested with statistical methods. Results: Micrometastases were observed in 81 lymph nodes (6.5%) of 31 patients (29.5%). The incidence of lymph node micrometastases was significantly higher in the diffuse type (41.5%) than in the intestinal type gastric carcinoma (17.6%,P<0.01,x 2test). In addition, the presence of micrometastases was closely correlated with the size and invasion depth of the primary tumor, but had no relation to patient’s age, sex and the location of primary tumor. The patients with micrometastases had significantly worse prognosis shown by Log-rank test. Their five-year survival rate after surgery was 61.29%; for those without micrometastases the rate was 82.43%,P=0.0116. When the number of patient’s lymph nodes with micrometastases was three or more, the five-year survival rate of these patients was much lower (41.67%,P=0.0012). Conclusion: The detection of lymph node micrometastases is necessary to more accurately determine the prognosis and clinical staging of patients with node-negative gastric carcinoma by routine histologic examination. The presence of micrometastases may be regarded as one of the clues in adjuvant therapy of those patients.展开更多
Objective： To investigate the recurrent patterns and factors involved in node-negative advanced gastric cancer after curative resection. Patients and Methods： Clinicopathological characteristics and prognostic outco...Objective： To investigate the recurrent patterns and factors involved in node-negative advanced gastric cancer after curative resection. Patients and Methods： Clinicopathological characteristics and prognostic outcomes of 310 patients who had lymph node-negative advanced gastric adenocarcinoma and received curative resection between 2002 and 2006 were retrospectively evaluated. Results： Among the 300 patients, 15 （5.0%） had locoregional recurrence, 5 （1.7%） had lymph node recurrence, 27 （9.0%） had peritoneal seeding recurrence, and 21 （7.0%） had hematogenous metastasis. Using multivariate analysis, we found that the maximum tumor diameter （P=0.014）, histological type （P=0.001） and Borrmann type （P=0.033） were independent factors predicting the locoregional recurrence. Lymph node recurrence was significantly affected by lymph node dissection （P=0.029） and lymphovascular invasion （P=0.004）. Clinicopathological factors predicting the peritoneal seeding recurrence were the depth of invasion （P=0.001） and Borrmann type （P=0.002）. In addition, lymphovascular invasion （P=0.013） and histological type （P=0.001） were significantly associated with hematogenous metastasis. Conclusion： Node-negative advanced gastric cancer has a high amount of peritoneal seeding and hematogenous metastasis.展开更多
Objective： To investigate the expressions of plasminogen activator inhibitor type 1 （PAl-1）, C-erbB-2, VEGF and Ki-67 by immunohistostaining and then to evaluate the prognostic value of PAl-1 in node-negative breas...Objective： To investigate the expressions of plasminogen activator inhibitor type 1 （PAl-1）, C-erbB-2, VEGF and Ki-67 by immunohistostaining and then to evaluate the prognostic value of PAl-1 in node-negative breast cancer. Methods： The study included a retrospective series of 62 female patients with axillary lymph node-negative breast cancer. Expressions of PAl-1, C-erbB-2, VEGF and Ki-67 were determined by immunohistostaining on formalin-fixed paraffin-embedded tissue sections from these patients after a median follow-up of 69 months （range 22-117 months）. Correlations with well known clinicopathologic factors were assessed and multivariate survival analyses were performed. Results： High PAl-1 level was positively associated with high histologic grade of the tumors. Disease-free survival （DFS） was significantly shorter for the patients with moderate to intensive expression of PAl-1 than for those with negative （χ^2 = 25.46, P 〈 0.001; χ^2 = 23.07, P 〈 0.001） to mild expression （χ^2 = 19.75, P 〈 0.001; χ^2 = 17.40, P 〈 0.001）. Although on univariate analysis of the prognostic factors, tumor size, location of primary tumor and age as well as expressions of PAl-1, VEGF and Ki-67 were all significantly prognostic factors for DFS （P 〈 0.05）, PAl-1 was the only independent prognostic factor on multivariate analysis （P 〈 0.0001; hazard ratio [HR], 4.041; 95% confidence interval [CI], 1.928-8.468）. Conclusion： These results of the current study indicate that intermediate or high expression of PAl-1 represents a strong and independent unfavorable prognostic factor for the development of recurrence or metastases in axillary node-negative breast cancer.展开更多
The principal breast cancer treatment approach has long been surgical removal of the primary breast lesions and regional lymph nodes,particularly the axillary lymph nodes.However,the advent of minimally invasive diagn...The principal breast cancer treatment approach has long been surgical removal of the primary breast lesions and regional lymph nodes,particularly the axillary lymph nodes.However,the advent of minimally invasive diagnostic techniques,such as sentinel lymph node biopsy(SLNB),has markedly diminished the extent of surgery required for regional lymph nodes.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
Background: Sentinel lymph node (SLN) biopsy remains a cornerstone in the management of breast cancer, as it provides an accurate staging of the disease while minimizing the morbidity associated with complete axillary...Background: Sentinel lymph node (SLN) biopsy remains a cornerstone in the management of breast cancer, as it provides an accurate staging of the disease while minimizing the morbidity associated with complete axillary lymph node dissection. Advances in SLN detection have been very important in refining surgical techniques and improving patient outcomes. The purpose of the present study is to compare the effectiveness of radiocolloids, blue dyes, and fluorescent tracers in detecting the sentinel lymph node in breast cancer. Materials and Methods: Specifically, we analyzed the detection rate, accuracy, and safety profile of the techniques to outline the most reliable and clinically available. A comprehensive review was conducted, searching key databases, including PubMed, Scopus, and Web of Science, for studies published between 2010 and 2024. The review focused on studies that compared the performance of radiocolloids, blue dyes, and fluorescent tracers in the detection of sentinel lymph nodes in breast cancer patients. A total of 54 studies were included based on specific inclusion criteria. Results: Radiocolloids showed high detection rates in studies. Blue dyes have comparable results, but a small percentage of allergic reactions has been observed. Fluorescent tracers such as indocyanine green have improved visualization and accuracy, but their use requires specialized equipment and expertise. Combining radiocolloids with blue dyes or fluorescent tracers has improved detection rates in several studies. Cost and accessibility challenges have also been pointed out, particularly in low-resource settings. Conclusions: Radiocolloids have attained the status of gold standard in the detection of SLNs in breast cancer for their reliability and accuracy. While combined use with other tracers, like blue dyes or fluorescent agents, enhances overall detection performance, making it more holistic. As expected, further innovation and effort are required to improve accessibility and optimize the technique of sentinel lymph node biopsy worldwide.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
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
Background:Metastasis to the infraclavicular and supraclavicular lymph nodes(ISLNs)is an important factor that predicts poor survival in patients with breast cancer;however,pathological nodal staging does not traditio...Background:Metastasis to the infraclavicular and supraclavicular lymph nodes(ISLNs)is an important factor that predicts poor survival in patients with breast cancer;however,pathological nodal staging does not traditionally include ISLNs because of their non-routine surgical dissection.This study aimed to evaluate the prognostic impact of ISLN metastasis and propose a refined nodal staging system tailored for patients undergoing neoadjuvant chemotherapy(NAC).Methods:We retrospectively reviewed 1,072 patients with breast cancer with or without ISLN metastasis who received NAC at two institutions(Fujian cohort and Hebei cohort)from 2010 to 2022.We conducted detailed survival analysis to evaluate the diagnostic consistency and prognostic significance of ISLNs.Results:There were no survival differences among patients with ISLN involvement across different assay method-ologies and patient cohorts.Among 887 patients in the Fujian cohort,238 patients(26.8%)with positive ISLNs had significantly inferior 3-year progression-free survival(PFS,75.9%vs.90.4%,P<0.001)and overall survival(OS,90.6%vs.95.9%,P<0.001).After adjusting for potential confounders,ISLN involvement persisted as an independent predictor of both PFS and OS.We propose a refined axillary classification that combines pathologi-cal axillary staging post-NAC with ISLN involvement,revealing 3-year PFS rates of 95.3%,87.6%,73.4%,and 64.5%for the respective four groups defined by this refined classification combining axillary stage and ISLN status.Conclusions:Involvement of the ISLNs was associated with a worse prognosis,underscoring their prognostic value.This finding highlights the potential of ISLN status to influence decisions regarding adjuvant treatment in patients with breast cancer.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
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
BACKGROUND The National Comprehensive Cancer Network guidelines recommend adjuvant chemotherapy(ACT)for patients with stage II colon cancer who have undergone curative surgery when fewer than 12 lymph nodes(LNs)are re...BACKGROUND The National Comprehensive Cancer Network guidelines recommend adjuvant chemotherapy(ACT)for patients with stage II colon cancer who have undergone curative surgery when fewer than 12 lymph nodes(LNs)are retrieved.This study seeks to further examine the requirement for ACT in individuals who had 12 or more LNs harvested.AIM To investigate if stage II colon cancer patients with 12 or more LNs retrieved benefit from ACT.METHODS This retrospective cohort study included individuals diagnosed with stage II colon cancer who underwent surgery between 2008 and 2017 from the Surveillance,Epidemiology,and End Results(SEER)registry and a Chinese multicenter database.All patients had at least 12 LNs retrieved.The key endpoint was overall survival(OS).Cox regression analysis was performed to assess independent OS predictors.Propensity score matching controlled for confounders,and Kaplan-Meier analysis evaluated the impact of ACT on survival.RESULTS A total of 32742 patients with stage II colon cancer from the SEER cohort and 3153 patients from the Chinese cohort were included.The average number of LNs retrieved was 20.0(15.0,26.0)in the SEER cohort and 18.0(15.0,22.0)in the Chinese cohort.No-ACT remained an independent risk factor in both cohorts(hazard ratio=1.589,95%confidence interval:1.485-1.700 and hazard ratio=1.865,95%confidence interval:1.465-2.375,respectively).In the SEER cohort,patients in the ACT group consistently demonstrated better 5-year OS rates both before and after propensity score matching(79.4%vs 66.1%and 79.4%vs 69.4%,both P<0.0001).Similarly,these findings were further validated in the Chinese cohort(91.2%vs 82.1%and 90.0%vs 82.8%,both P<0.0001).ACT improved prognosis even in T3 and grade 1/2 patients.CONCLUSION This research,based on two large population-based cohorts,demonstrates that stage II colon cancer patients with 12 or more LNs retrieved can still benefit from ACT.展开更多
Background:3-field lymph node dissection(3FL)frequently lead to much more perioperative complications than 2-field lymph node dissection(2FL).This study was designed as a non-inferiority trial to evaluate whether 3FL ...Background:3-field lymph node dissection(3FL)frequently lead to much more perioperative complications than 2-field lymph node dissection(2FL).This study was designed as a non-inferiority trial to evaluate whether 3FL could be omitted without compromising overall survival(OS)and disease-free survival(DFS)in the patients with resectable thoracic esophageal squamous cell cancer(ESCC)and negative right recurrent laryngeal nerve lymph nodes(RRLN-LNs).Methods:cT1b-3N0-1M0 thoracic ESCC patients were managed in 3 arms during open or minimally invasive McKeown esophagectomy according to the results of frozen section examination for RRLN-LNs:if positive,direct 3FL(RRLN[+]-3FL);if negative,2FL(RRLN[-]-2FL)or 3FL(RRLN[-]-3FL)by randomization.Results:Based on frozen section,of the 829 finally recruited patients,121(13.6%)had positive RRLN-LNs and direct 3FL(RRLN[+]-3FL);766 had negative RRLN-LNs and were randomized into the RRLN[-]-2FL(386 cases)or RRLN[-]-3FL(380 cases)group.The cervical LN metastasis rate in the RRLN[+]-3FL group(28.9%)was significantly higher than that in the RRLN[-]-3FL group(8.3%)(P<0.001).The 5-year OS and DFS were 72.2%and 65.1%in the RRLN[-]-3FL group and 68.8%and 62.8%in the RRLN[-]-2FL group(OS,P=0.163;DFS,P=0.378),versus 50.3%and 41.2%in the RRLN[+]-3FL group(both P<0.001),respectively.Conclusions:Additional cervical lymphadenectomy can be avoided in the patients with middle or lower thoracic ESCC and negative RRLN-LNs by frozen section treated by upfront surgery.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.
文摘AIM To determine whether the number of examined lymph nodes(LNs) is correlated with the overall survival of gallbladder carcinoma(GBC) patients. METHODS Patients were collected from the Surveillance Epidemiology and End Results database(2004-2013) and categorized by the number of LNs into six groups: 1 LN, 2 LNs, 3 LNs, 4 LNs, 5 LNs, and ≥ 6 LNs. Survival curves for overall survival were plotted with a KaplanMeier analysis. The log-rank test was used for univariate comparisons.RESULTS In a cohort of 893 patients, the median number of examined LNs was two for the entire cohort. The survival for the 1 LN group was significantly poorer than those of the stage Ⅰ and Ⅱ disease groups and for the entire cohort. By dichotomizing the number of LNs from 1 to 6, we found that the minimum number of LNs that should be examined was four for stage Ⅰ, four or five for stage Ⅱ, and six for stage ⅢA disease. Therefore, for the entire cohort, the number of examined LNs should be at least six, which is exactly consistent with the American Joint Committee on Cancer criteria.CONCLUSION The examination of higher numbers of LNs is associated with improved survival after resection surgery for N0 GBC. The guidelines for GBC surgery, which recommend that six LNs be examined at least, are statistically valid and should be applied in clinical practice widely.
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.
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.
基金Supported by (in part) The Follow-up Office established by the Department of Oncology,Affiliated Union Hospital of Fujian Medical University,Fuzhou,Fujian Province,China
文摘AIM:To investigate the long-term effect of the number of resected lymph nodes (LNs) on the prognosis of patients with node-negative gastric cancer.METHODS: Clinical data of 211 patients with gastric cancer, without nodal involvement, were analyzed retrospectively after D2 radical operation. We analyzed the relationship between the number of resected LNs with the 5-year survival, the recurrence rate and the post-operative complication rate.RESULTS: The 5-year survival of the entire cohort was 82.2%. The total number of dissected LNs was one of the independent prognostic factors. Among patients with comparable depth of invasion, the larger the number of resected LNs, the better the survival (P<0.05). A cut-point analysis provided the possibility to detect a significant survival difference among subgroups. Patients had a better long-term survival outcomes with LN counts ≥15 for pT1-2, ≥20 for pT3-4, and ≥15 for the entire cohort. The overall recurrence rate was 29.4% within 5 years after surgery. There was a statistically significant, negative correlation between the number of resected LNs and the recurrence rate (P>0.01). The post-operative complication rate was 10.9% and was not signif icantly correlated with the number of dissected LNs (P>0.05).CONCLUSION: For node-negative gastric cancer, sufficient number of dissected LNs is recommended during D2 lymphadenectomy, to improve the long-term survival and reduce the recurrence. Suitable increments of the dissected LN count would not increase the post-operative complication rate.
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.
文摘AIM:To investigate the effects of extended lymphadenectomy and postoperative chemotherapy on gastric cancer without lymph node metastasis.METHODS:Clinical data of 311 node-negative gastric cancer patients who underwent potentially curative gastrectomy with more than 15 lymph nodes resected,from January 2002 to December 2006,were analyzed retrospectively.Patients with pT4 stage or distant metastasis were excluded.We analyzed the relationship between the D2 lymphadenectomy and the 5-year survival rate among different subgroups stratified by clinical features,such as age,tumor size,tumor location and depth of invasion.At the same time,the relationship between postoperative chemotherapy and the5-year survival rate among different subgroups were also analyzed.RESULTS:The overall 5-year survival rate of the entire cohort was 63.7%.The 5-year survival rate was poor in those patients who were:(1)more than 65 years old;(2)with tumor size larger than 4 cm;(3)with tumor located in the upper portion of the stomach;and(4)with pT3 tumor.The survival rate was improved significantly by extended lymphadenectomy only in patients with pT3 tumor(P=0.019),but not in other subgroups.Moreover,there was no significant difference in survival rate between patients with and without postoperative chemotherapy among all of the subgroups(P>0.05).CONCLUSION:For gastric cancer patients without lymph node metastasis,extended lymphadenectomy could improve the survival rate of those who have pT3-stage tumor.However,there was no evidence of a survival benefit from postoperative chemotherapy alone.
文摘Objective: To study micrometastases in lymph nodes from patients with node-negative gastric carcinoma by routine histologic examination and discuss their prognostic significance and the relationship between micrometastases and each of the clinicopathologic factors. Methods: A total of 1245 perigastric lymph nodes from 105 patients with node-negative gastric carcinoma was immunohisto-chemically detected using a monoclonal antibody against low molecular weight cytokeratin AE1. The characteristics of the micrometastases, their related factors and effect on patients’ survival after surgery were analysed and tested with statistical methods. Results: Micrometastases were observed in 81 lymph nodes (6.5%) of 31 patients (29.5%). The incidence of lymph node micrometastases was significantly higher in the diffuse type (41.5%) than in the intestinal type gastric carcinoma (17.6%,P<0.01,x 2test). In addition, the presence of micrometastases was closely correlated with the size and invasion depth of the primary tumor, but had no relation to patient’s age, sex and the location of primary tumor. The patients with micrometastases had significantly worse prognosis shown by Log-rank test. Their five-year survival rate after surgery was 61.29%; for those without micrometastases the rate was 82.43%,P=0.0116. When the number of patient’s lymph nodes with micrometastases was three or more, the five-year survival rate of these patients was much lower (41.67%,P=0.0012). Conclusion: The detection of lymph node micrometastases is necessary to more accurately determine the prognosis and clinical staging of patients with node-negative gastric carcinoma by routine histologic examination. The presence of micrometastases may be regarded as one of the clues in adjuvant therapy of those patients.
文摘Objective： To investigate the recurrent patterns and factors involved in node-negative advanced gastric cancer after curative resection. Patients and Methods： Clinicopathological characteristics and prognostic outcomes of 310 patients who had lymph node-negative advanced gastric adenocarcinoma and received curative resection between 2002 and 2006 were retrospectively evaluated. Results： Among the 300 patients, 15 （5.0%） had locoregional recurrence, 5 （1.7%） had lymph node recurrence, 27 （9.0%） had peritoneal seeding recurrence, and 21 （7.0%） had hematogenous metastasis. Using multivariate analysis, we found that the maximum tumor diameter （P=0.014）, histological type （P=0.001） and Borrmann type （P=0.033） were independent factors predicting the locoregional recurrence. Lymph node recurrence was significantly affected by lymph node dissection （P=0.029） and lymphovascular invasion （P=0.004）. Clinicopathological factors predicting the peritoneal seeding recurrence were the depth of invasion （P=0.001） and Borrmann type （P=0.002）. In addition, lymphovascular invasion （P=0.013） and histological type （P=0.001） were significantly associated with hematogenous metastasis. Conclusion： Node-negative advanced gastric cancer has a high amount of peritoneal seeding and hematogenous metastasis.
基金Research Programme of the Shanghai Municipal Science and Technology Commission(No.06DZ19505)
文摘Objective： To investigate the expressions of plasminogen activator inhibitor type 1 （PAl-1）, C-erbB-2, VEGF and Ki-67 by immunohistostaining and then to evaluate the prognostic value of PAl-1 in node-negative breast cancer. Methods： The study included a retrospective series of 62 female patients with axillary lymph node-negative breast cancer. Expressions of PAl-1, C-erbB-2, VEGF and Ki-67 were determined by immunohistostaining on formalin-fixed paraffin-embedded tissue sections from these patients after a median follow-up of 69 months （range 22-117 months）. Correlations with well known clinicopathologic factors were assessed and multivariate survival analyses were performed. Results： High PAl-1 level was positively associated with high histologic grade of the tumors. Disease-free survival （DFS） was significantly shorter for the patients with moderate to intensive expression of PAl-1 than for those with negative （χ^2 = 25.46, P 〈 0.001; χ^2 = 23.07, P 〈 0.001） to mild expression （χ^2 = 19.75, P 〈 0.001; χ^2 = 17.40, P 〈 0.001）. Although on univariate analysis of the prognostic factors, tumor size, location of primary tumor and age as well as expressions of PAl-1, VEGF and Ki-67 were all significantly prognostic factors for DFS （P 〈 0.05）, PAl-1 was the only independent prognostic factor on multivariate analysis （P 〈 0.0001; hazard ratio [HR], 4.041; 95% confidence interval [CI], 1.928-8.468）. Conclusion： These results of the current study indicate that intermediate or high expression of PAl-1 represents a strong and independent unfavorable prognostic factor for the development of recurrence or metastases in axillary node-negative breast cancer.
基金supported by grants from the National Natural Science Foundation of China(Grant Nos.81672638 and W2421095)National Natural Science Foundation of Shandong Province(Grant No.ZR2024LMB011)Collaborative Academic Innovation Project of Shandong Cancer Hospital(Grant No.GF003)。
文摘The principal breast cancer treatment approach has long been surgical removal of the primary breast lesions and regional lymph nodes,particularly the axillary lymph nodes.However,the advent of minimally invasive diagnostic techniques,such as sentinel lymph node biopsy(SLNB),has markedly diminished the extent of surgery required for regional lymph nodes.
文摘BACKGROUND One of the main characteristics of oral squamous cell carcinoma(OSCC)is that it metastasizes to cervical lymph nodes frequently with a high degree of local invasiveness.A primary feature of malignant tumors is their penetration of neighboring tissues,such as lymphatic and blood arteries,due to the tumor cells'capacity to break down the extracellular matrix(ECM).Matrix metalloproteinases(MMPs)constitute a family of proteolytic enzymes that facilitate tissue remodeling and the degradation of the ECM.MMP-9 and MMP-13 belong to the group of extracellular matrix degrading enzymes and their expression has been studied in OSCC because of their specific functions.MMP-13,a collagenase family member,is thought to play an essential role in the MMP activation cascade by breaking down the fibrillar collagens,whereas MMP-9 is thought to accelerate the growth of tumors.Elevated MMP-13 expression has been associated with tumor behavior and patient prognosis in a number of malignant cases.AIM To assess the immunohistochemical expression of MMP-9 and MMP-13 in OSCC.METHODS A total of 40 cases with histologically confirmed OSCC by incisional biopsy were included in this cross-sectional retrospective study.The protocols for both MMP-9 and MMP-13 immunohistochemical staining were performed according to the manufacturer’s recommendations along with the normal gingival epithelium as a positive control.All the observations were recorded and Pearson’sχ²test with Fisher exact test was used for statistical analysis.RESULTS Our study showed no significant correlation between MMP-9 and MMP-13 staining intensity and tumor size.The majority of the patients were in advanced TNM stages(III and IV),and showed intense expression of MMP-9 and MMP-13.CONCLUSION The present study suggests that both MMP-9 and MMP-13 play an important and independent role in OSCC progression and invasiveness.Intense expression of MMP-9 and MMP-13,irrespective of histological grade of OSCC,correlates well with TNM stage.Consequently,it is evident that MMP-9 and MMP-13 are important for the invasiveness and progression of tumors.The findings may facilitate the development of new approaches for evaluating lymph node metastases and interventional therapy techniques,hence enhancing the prognosis of patients diagnosed with OSCC.
文摘Background: Sentinel lymph node (SLN) biopsy remains a cornerstone in the management of breast cancer, as it provides an accurate staging of the disease while minimizing the morbidity associated with complete axillary lymph node dissection. Advances in SLN detection have been very important in refining surgical techniques and improving patient outcomes. The purpose of the present study is to compare the effectiveness of radiocolloids, blue dyes, and fluorescent tracers in detecting the sentinel lymph node in breast cancer. Materials and Methods: Specifically, we analyzed the detection rate, accuracy, and safety profile of the techniques to outline the most reliable and clinically available. A comprehensive review was conducted, searching key databases, including PubMed, Scopus, and Web of Science, for studies published between 2010 and 2024. The review focused on studies that compared the performance of radiocolloids, blue dyes, and fluorescent tracers in the detection of sentinel lymph nodes in breast cancer patients. A total of 54 studies were included based on specific inclusion criteria. Results: Radiocolloids showed high detection rates in studies. Blue dyes have comparable results, but a small percentage of allergic reactions has been observed. Fluorescent tracers such as indocyanine green have improved visualization and accuracy, but their use requires specialized equipment and expertise. Combining radiocolloids with blue dyes or fluorescent tracers has improved detection rates in several studies. Cost and accessibility challenges have also been pointed out, particularly in low-resource settings. Conclusions: Radiocolloids have attained the status of gold standard in the detection of SLNs in breast cancer for their reliability and accuracy. While combined use with other tracers, like blue dyes or fluorescent agents, enhances overall detection performance, making it more holistic. As expected, further innovation and effort are required to improve accessibility and optimize the technique of sentinel lymph node biopsy worldwide.
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supported by the Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors(Fujian Medical University)and Clinical Research Center for Radiology and Radiotherapy of Fujian Province(Digestive,Hematological and Breast Malignancies).
文摘Background:Metastasis to the infraclavicular and supraclavicular lymph nodes(ISLNs)is an important factor that predicts poor survival in patients with breast cancer;however,pathological nodal staging does not traditionally include ISLNs because of their non-routine surgical dissection.This study aimed to evaluate the prognostic impact of ISLN metastasis and propose a refined nodal staging system tailored for patients undergoing neoadjuvant chemotherapy(NAC).Methods:We retrospectively reviewed 1,072 patients with breast cancer with or without ISLN metastasis who received NAC at two institutions(Fujian cohort and Hebei cohort)from 2010 to 2022.We conducted detailed survival analysis to evaluate the diagnostic consistency and prognostic significance of ISLNs.Results:There were no survival differences among patients with ISLN involvement across different assay method-ologies and patient cohorts.Among 887 patients in the Fujian cohort,238 patients(26.8%)with positive ISLNs had significantly inferior 3-year progression-free survival(PFS,75.9%vs.90.4%,P<0.001)and overall survival(OS,90.6%vs.95.9%,P<0.001).After adjusting for potential confounders,ISLN involvement persisted as an independent predictor of both PFS and OS.We propose a refined axillary classification that combines pathologi-cal axillary staging post-NAC with ISLN involvement,revealing 3-year PFS rates of 95.3%,87.6%,73.4%,and 64.5%for the respective four groups defined by this refined classification combining axillary stage and ISLN status.Conclusions:Involvement of the ISLNs was associated with a worse prognosis,underscoring their prognostic value.This finding highlights the potential of ISLN status to influence decisions regarding adjuvant treatment in patients with breast cancer.
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.
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.
基金Supported by Shanxi Special Projects of the Central Government Guiding Local Science and Technology Development of China,No.YDZJSX2021B016Shanxi Cancer Hospital Doctoral Master’s Guide and Companion Flying Fund,No.SD2023010.
文摘BACKGROUND The National Comprehensive Cancer Network guidelines recommend adjuvant chemotherapy(ACT)for patients with stage II colon cancer who have undergone curative surgery when fewer than 12 lymph nodes(LNs)are retrieved.This study seeks to further examine the requirement for ACT in individuals who had 12 or more LNs harvested.AIM To investigate if stage II colon cancer patients with 12 or more LNs retrieved benefit from ACT.METHODS This retrospective cohort study included individuals diagnosed with stage II colon cancer who underwent surgery between 2008 and 2017 from the Surveillance,Epidemiology,and End Results(SEER)registry and a Chinese multicenter database.All patients had at least 12 LNs retrieved.The key endpoint was overall survival(OS).Cox regression analysis was performed to assess independent OS predictors.Propensity score matching controlled for confounders,and Kaplan-Meier analysis evaluated the impact of ACT on survival.RESULTS A total of 32742 patients with stage II colon cancer from the SEER cohort and 3153 patients from the Chinese cohort were included.The average number of LNs retrieved was 20.0(15.0,26.0)in the SEER cohort and 18.0(15.0,22.0)in the Chinese cohort.No-ACT remained an independent risk factor in both cohorts(hazard ratio=1.589,95%confidence interval:1.485-1.700 and hazard ratio=1.865,95%confidence interval:1.465-2.375,respectively).In the SEER cohort,patients in the ACT group consistently demonstrated better 5-year OS rates both before and after propensity score matching(79.4%vs 66.1%and 79.4%vs 69.4%,both P<0.0001).Similarly,these findings were further validated in the Chinese cohort(91.2%vs 82.1%and 90.0%vs 82.8%,both P<0.0001).ACT improved prognosis even in T3 and grade 1/2 patients.CONCLUSION This research,based on two large population-based cohorts,demonstrates that stage II colon cancer patients with 12 or more LNs retrieved can still benefit from ACT.
基金supported by National Science and Technology Sup-port Program(grant number:NKTRDP-2015BAI12B08-01).
文摘Background:3-field lymph node dissection(3FL)frequently lead to much more perioperative complications than 2-field lymph node dissection(2FL).This study was designed as a non-inferiority trial to evaluate whether 3FL could be omitted without compromising overall survival(OS)and disease-free survival(DFS)in the patients with resectable thoracic esophageal squamous cell cancer(ESCC)and negative right recurrent laryngeal nerve lymph nodes(RRLN-LNs).Methods:cT1b-3N0-1M0 thoracic ESCC patients were managed in 3 arms during open or minimally invasive McKeown esophagectomy according to the results of frozen section examination for RRLN-LNs:if positive,direct 3FL(RRLN[+]-3FL);if negative,2FL(RRLN[-]-2FL)or 3FL(RRLN[-]-3FL)by randomization.Results:Based on frozen section,of the 829 finally recruited patients,121(13.6%)had positive RRLN-LNs and direct 3FL(RRLN[+]-3FL);766 had negative RRLN-LNs and were randomized into the RRLN[-]-2FL(386 cases)or RRLN[-]-3FL(380 cases)group.The cervical LN metastasis rate in the RRLN[+]-3FL group(28.9%)was significantly higher than that in the RRLN[-]-3FL group(8.3%)(P<0.001).The 5-year OS and DFS were 72.2%and 65.1%in the RRLN[-]-3FL group and 68.8%and 62.8%in the RRLN[-]-2FL group(OS,P=0.163;DFS,P=0.378),versus 50.3%and 41.2%in the RRLN[+]-3FL group(both P<0.001),respectively.Conclusions:Additional cervical lymphadenectomy can be avoided in the patients with middle or lower thoracic ESCC and negative RRLN-LNs by frozen section treated by upfront surgery.
