AIM:To explore risk factors for lymph node metastases in early gastric cancer(EGC) and to confirm the appropriate range of lymph node dissection.METHODS:A total of 202 patients with EGC who underwent curative gastrect...AIM:To explore risk factors for lymph node metastases in early gastric cancer(EGC) and to confirm the appropriate range of lymph node dissection.METHODS:A total of 202 patients with EGC who underwent curative gastrectomy with lymphadenectomy in the Department of Surgery,Xinhua Hospital and Ruijin Hospital of Shanghai Jiaotong University Medical School between November 2003 and July 2009,were retrospectively reviewed.Both the surgical procedure and the extent of lymph node dissection were based on the recommendations of the Japanese gastric cancer treatment guidelines.The macroscopic type was classified as elevated(type Ⅰ or Ⅱa),flat(Ⅱb),or depressed(Ⅱc or Ⅲ).Histopathologically,papillary and tubular adenocarcinomas were grouped together as differentiated adenocarcinomas,and poorly differentiated and signet-ring cell adenocarcinomas were regarded as undifferentiated adenocarcinomas.Univariate and multivariate analyses of lymph node metastases and patient and tumor characteristics were undertaken.RESULTS:The lymph node metastases rate in patients with EGC was 14.4%.Among these,the rate for mucosal cancer was 5.4%,and 8.9% for submucosal cancer.Univariate analysis showed an obvious correlation between lymph node metastases and tumor location,depth of invasion,morphological classification and venous invasion(χ 2 = 122.901,P = 0.001;χ 2 = 7.14,P = 0.008;χ 2 = 79.523,P = 0.001;χ 2 = 8.687,P = 0.003,respectively).In patients with submucosal cancers,the lymph node metastases rate in patients with venous invasion(60%,3/5) was higher than in those without invasion(20%,15/75)(χ 2 = 4.301,P = 0.038).Multivariate logistic regression analysis revealed that the depth of invasion was the only independent risk factor for lymph node metastases in EGC [P = 0.018,Exp(B) = 2.744].Among the patients with lymph node metastases,29 cases(14.4%) were at N1,seven cases were at N2(3.5%),and two cases were at N3(1.0%).Univariate analysis of variance revealed a close relationship between the depth of invasion and lymph node metastases at pN 1(P = 0.008).CONCLUSION:The depth of invasion was the only independent risk factor for lymph node metastases.Risk factors for metastases should be considered when choosing surgery for EGC.展开更多
Objective: To develop and validate a radiomics-based predictive risk score(RPRS) for preoperative prediction of lymph node(LN) metastasis in patients with resectable non-small cell lung cancer(NSCLC).Methods: We retro...Objective: To develop and validate a radiomics-based predictive risk score(RPRS) for preoperative prediction of lymph node(LN) metastasis in patients with resectable non-small cell lung cancer(NSCLC).Methods: We retrospectively analyzed 717 who underwent surgical resection for primary NSCLC with systematic mediastinal lymphadenectomy from October 2007 to July 2016. By using the method of radiomics analysis, 591 computed tomography(CT)-based radiomics features were extracted, and the radiomics-based classifier was constructed. Then, using multivariable logistic regression analysis, a weighted score RPRS was derived to identify LN metastasis. Apparent prediction performance of RPRS was assessed with its calibration,discrimination, and clinical usefulness.Results: The radiomics-based classifier was constructed, which consisted of 13 selected radiomics features.Multivariate models demonstrated that radiomics-based classifier, age group, tumor diameter, tumor location, and CT-based LN status were independent predictors. When we assigned the corresponding score to each variable,patients with RPRSs of 0-3, 4-5, 6, 7-8, and 9 had distinctly very low(0%-20%), low(21%-40%), intermediate(41%-60%), high(61%-80%), and very high(81%-100%) risks of LN involvement, respectively. The developed RPRS showed good discrimination and satisfactory calibration (C-index: 0.785, 95% confidence interval(95% CI):0.780-0.790)Additionally, RPRS outperformed the clinicopathologic-based characteristics model with net reclassification index(NRI) of 0.711(95% CI: 0.555-0.867).Conclusions: The novel clinical scoring system developed as RPRS can serve as an easy-to-use tool to facilitate the preoperatively individualized prediction of LN metastasis in patients with resectable NSCLC. This stratification of patients according to their LN status may provide a basis for individualized treatment.展开更多
AIM To assess clinical outcomes for submucosal (T1b) oesophageal adenocarcinoma (OAC) patients managed with either surgery or endoscopic eradication therapy.METHODS Patients found to have T1b OAC following endoscopic ...AIM To assess clinical outcomes for submucosal (T1b) oesophageal adenocarcinoma (OAC) patients managed with either surgery or endoscopic eradication therapy.METHODS Patients found to have T1b OAC following endoscopic resection between January 2008 to February 2016 at University College London Hospital were retrospectively analysed. Patients were split into low-risk and high-risk groups according to established histopathological criteria and were then further categorised according to whether they underwent surgical resection or conservative management. Study outcomes include the presence of lymphnode metastases, disease-specific mortality and overall survival. RESULTS A total of 60 patients were included; 22 patients were surgically managed (1 low-risk and 21 high-risk patients) whilst 38 patients were treated conservatively (12 low-risk and 26 high-risk). Overall, lymph node metastases (LNM) were detected in 10 patients (17%); six of these patients had undergone conservative management and LNM were detected at a median of 4 mo after endoscopic mucosal resection (EMR). All LNM occurred in patients with highrisk lesions and this represented 21% of the total high-risk lesions. Importantly, there was no statistically significant difference in tumor-related deaths between those treated surgically or conservatively (P = 0.636) and disease-specific survival time was also comparable between the two treatment strategies (P = 0.376).CONCLUSION T1b tumours without histopathological high-risk markers of LNM can be treated endoscopically with good outcomes. In selected patients, endoscopic therapy may be appropriate for high-risk lesions.展开更多
Objective To investigate the risk factors with lymph node metastatic recurrence in patients with N0 esophageal cancer after Ivor-Lewis Esophagectomy. Methods The subjects were 82 patients with pN0 esophagea cancer who...Objective To investigate the risk factors with lymph node metastatic recurrence in patients with N0 esophageal cancer after Ivor-Lewis Esophagectomy. Methods The subjects were 82 patients with pN0 esophagea cancer who underwent Ivor-Lewis esophagectomy from January 2001 to January 2005. By using RT-PCR,VEGF C mRNA was detected in tumor issues,and Mucin (MUC1) mRNA was detected in lymph nodes. The Kaplan-Meier method was used to calculate the survival展开更多
AIM:To reveal the clinicopathological features and risk factors for lymph node metastases in gastric cardiac adenocarcinoma of male patients.METHODS:We retrospective reviewed a total of 146male and female patients wit...AIM:To reveal the clinicopathological features and risk factors for lymph node metastases in gastric cardiac adenocarcinoma of male patients.METHODS:We retrospective reviewed a total of 146male and female patients with gastric cardiac adenocarcinoma who had undergone curative gastrectomy with lymphadenectomy in the Department of Surgery,Xin Hua Hospital and Rui Jin Hospital of Shanghai Jiaotong University Medical School between November2001 and May 2012.Both the surgical procedure and extent of lymph node dissection were based on the recommendations of Japanese gastric cancer treatment guidelines.Univariate and multivariate analyses of lymph node metastases and the clinicopathological features were undertaken.RESULTS:The rate of lymph node metastases in male patients with gastric cardiac adenocarcinoma was72.1%.Univariate analysis showed an obvious correlation between lymph node metastases and tumor size,gross appearance,differentiation,pathological tumor depth,and lymphatic invasion in male patients.Multivariate logistic regression analysis revealed that tumor differentiation and pathological tumor depth were the independent risk factors for lymph node metastases in male patients.There was an obvious relationship between lymph node metastases and tumor size,gross appearance,differentiation,pathological tumor depth,lymphatic invasion at pN1and pN2,and nerve invasion at pN3in male patients.There were no significant differences in clinicopathological features or lymph node metastases between female and male patients.CONCLUSION:Tumor differentiation and tumor depth were risk factors for lymph node metastases in male patients with gastric cardiac adenocarcinoma and should be considered when choosing surgery.展开更多
AIM: To determine the significance of increased serum direct bilirubin level for lymph node metastasis(LNM) in Chinese rectal cancer patients, after those with known hepatobiliary and pancreatic diseases were excluded...AIM: To determine the significance of increased serum direct bilirubin level for lymph node metastasis(LNM) in Chinese rectal cancer patients, after those with known hepatobiliary and pancreatic diseases were excluded.METHODS: A cohort of 469 patients, who were treated at the China-Japan Friendship Hospital, Ministry of Health(Beijing, China), in the period from January 2003 to June 2011, and with a pathological diagnosis of rectal adenocarcinoma, were recruited. They included 231 patients with LNM(49.3%) and 238 patients without LNM. Follow-up for these patients was taken through to December 31, 2012.RESULTS: The baseline serum direct bilirubin concentration was(median/inter-quartile range) 2.30/1.60-3.42 μmol/L. Univariate analysis showed that compared with patients without LNM, the patients with LNM had an increased level of direct bilirubin(2.50/1.70-3.42 vs 2.10/1.40-3.42, P = 0.025). Multivariate analysis showed that direct bilirubin wasindependently associated with LNM(OR = 1.602; 95%CI: 1.098-2.338, P = 0.015). Moreover, we found that:(1) serum direct bilirubin differs between male and female patients; a higher concentration was associated with poor tumor classification;(2) as the baseline serum direct bilirubin concentration increased, the percentage of patients with LNM increased; and(3) serum direct bilirubin was associated with the prognosis of rectal cancer patients and higher values indicated poor prognosis.CONCLUSION: Higher serum direct bilirubin concentration was associated with the increased risk of LNM and poor prognosis in our rectal cancers.展开更多
A double-blinded randomized controlled field trial based on parallel group design was conducted from January, 2018 to July, 2018 in Chercher Oda-Bultum Farmers Union beef Farm. The present study was conducted to evalu...A double-blinded randomized controlled field trial based on parallel group design was conducted from January, 2018 to July, 2018 in Chercher Oda-Bultum Farmers Union beef Farm. The present study was conducted to evaluate the roll of effective microbial supplementation to feed on the infection of Salmonella in the mesenteric and sub-iliac lymph nodes of beef cattle. In order to undertake the study, 130 beef cattle kept by the farm were used to establish a cohort. The study animals were randomly assigned to the treatment group (n = 100) and control group (n = 30). The feed of treatment group was mixed with EM at dose of 5× 10<sup>10</sup> cfu/day/head for 90, 100 and 115 days while that of the control group was mixed with molasses, which acts as placebo. Both the treatment and control were slaughtered and two lymph nodes were collected from each animal under strict sterile condition and processed for the isolation and identification of Salmonella using standard procedure. The occurrence of Salmonella was 70% (CI = 51% - 85%) in control group while it was 33% (CI = 24% - 43%) in treatment group. The difference in the proportion of Salmonella infection in the two group was significant (x<sup>2</sup> = 13.01;p = 0.000). The relative risk of Salmonella isolation in the control was 2.12 (1.41 - 3.20) compared to treatment group. The absolute and relative risk reduction in the treatment were 37% (CI = 17% - 57%) and 53% (CI = 29% - 69%), respectively. This preliminary study indicated that effective microbial supplementation of beef cattle feed reduced the occurrences of Salmonella in the lymph node of beef cattle, thereby potentially minimizing the economic and public health impacts of Salmonella infection. Then, it was recommended to use EM as prevention and control option in Salmonella carriage in cattle.展开更多
<strong>Background:</strong> <span style="font-family:""><span style="font-family:Verdana;">Clinicopathological and biological features are associated with neck lymph n...<strong>Background:</strong> <span style="font-family:""><span style="font-family:Verdana;">Clinicopathological and biological features are associated with neck lymph node metastasis (LNM) of hypopharyngeal squamous cell carcinoma (HSCC). However, there is no complete nomogram combining multiple factors that can be used to accurately predict the neck LNM status for HSCC patients. </span><b><span style="font-family:Verdana;">Purpose:</span></b><span style="font-family:Verdana;"> To guide the selection of surgical methods and radiotherapy areas for hypopharyngeal cancer. In this study, a nomogram was developed to combine these risk factors to predict neck LNM and guide the treatment of HSCC. </span><b><span style="font-family:Verdana;">Material and Methods: </span></b><span style="font-family:Verdana;">This retrospective study included 117 patients (training cohort, 64 patients;trial cohort, 53 patients). Biological characteristics of HSCC patients were assessed using immunohistochemical staining, and data of patient age, gender, and preoperative computed tomography (CT) scan reports were collected. Significant risk factors in univariate analysis were further identified to be independent variables in multivariate logistic regression analysis, which were then incorporated in and presented with a nomogram by using the rms package in R software. Receiver operating characteristic (ROC) curves and calibration curves were used to validate the discrimination and accuracy in the training and validation cohorts, respectively, and clinical usefulness was verified in decision curve analysis curves. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">All variables with P-values < 0.2 in the univariate analysis were selected for multivariate logistic regression analysis to further identify independent risk factors for neck LNM. In multivariate logistic regression analysis, variables with P-values < 0.2 were identified as independent risk factors and then used to construct the nomogram. In total, five independent predictors, including the maximum tumor diameter in CT, tumor cell differentiation, LNM status in CT, Stathmin1 expression level, and lymphatic vessel invasion were included in the nomogram. The area under the ROC curve (AUC) was 0.916 (95% confidence interval [CI], 0.833 - 1.000) and AUC of 0.928 (95% CI, 0.864</span></span><span style="font-family:Verdana;"> - </span><span style="font-family:""><span style="font-family:Verdana;">1.000) in internal validation and the external validation. </span><b><span style="font-family:Verdana;">Conclusions</span></b><span style="font-family:Verdana;">: Both the internal validation in the training cohort and the external validation in the validation cohort showed </span></span><span style="font-family:Verdana;">that </span><span style="font-family:Verdana;">the nomogram had good discrimination, accuracy, and excellent clinical usefulness. The nomogram based on clinicopathological and biological features developed in this study has strong predictive power and could be used to predict neck LNM of HSCC in clinical practice.</span>展开更多
The principle of surgical treatment for gastric cancer is the radical resectioning although the suitable resecting range for different cases of gastric cancer is still being argued upon[1-9]. However, the diagnostic a...The principle of surgical treatment for gastric cancer is the radical resectioning although the suitable resecting range for different cases of gastric cancer is still being argued upon[1-9]. However, the diagnostic accuracy of early gastric cancer (EGC) without lymphatic metastasis has obviously improved with an improvement in the diagnostic technique and due to the accumulation of knowledge on the biological profiles of EG C[10-17]. The D2 lymph node excision was used as a regular operation to treat the EGC previously. But the concept for the EGC without lymphatic metastasis has gradually changed and the less invasive resections has been applied in some cases[18-20]. This study aimed at investigating the risk factors of lymphatic metastasis in EGC in order to find out the proofs for the suitable indications for less invasive operations such as endoscopic mucosal resectioning (EMR), laparoscopic and laparotomic resectioning.展开更多
目的联合空间位置-临床-影像特征探讨可切除肺腺癌淋巴结转移的危险因素,并构建淋巴结转移预测模型。方法回顾性纳入2016年6月—2020年6月于南京医科大学第一附属医院接受胸部CT,并经手术确诊为有或无淋巴结转移的浸润性肺腺癌患者。根...目的联合空间位置-临床-影像特征探讨可切除肺腺癌淋巴结转移的危险因素,并构建淋巴结转移预测模型。方法回顾性纳入2016年6月—2020年6月于南京医科大学第一附属医院接受胸部CT,并经手术确诊为有或无淋巴结转移的浸润性肺腺癌患者。根据有无淋巴结转移,将患者分为阳性组与阴性组。收集患者的临床及影像学资料,采用单因素和多因素logistic回归分析可切除肺腺癌淋巴结转移的独立危险因素,并建立淋巴结转移的空间位置-临床-影像特征联合预测模型,将其与不包含空间位置特征的传统淋巴结转移预测模型进行对比。结果共纳入611例患者,阳性组333例,其中男172例、女161例,平均年龄(58.9±9.7)岁;阴性组278例,其中男127例、女151例,平均年龄(60.1±11.4)岁。单因素及多因素logistic回归分析显示,病灶距离肺门的空间位置关系、结节类型、胸膜改变、血清癌胚抗原(carcinoembryonic antigen,CEA)水平是淋巴结转移的独立危险因素,以此为基础构建的空间位置-临床-影像特征联合预测模型敏感性为91.67%,特异性为74.05%,准确性为87.88%,曲线下面积(area under the curve,AUC)为0.885。不包含空间位置特征的传统淋巴结转移预测模型敏感性为76.40%,特异性为72.10%,准确性为53.86%,AUC为0.827。两种预测方法的AUC差异有统计学意义(P=0.026)。与传统预测模型相比,空间位置-临床-影像特征联合预测模型的预测效能有显著提升。结论在可切除肺腺癌患者中,空间位置、实性密度、胸膜改变为宽基底凹陷以及血清CEA水平升高者发生淋巴结转移的风险更高。展开更多
目的探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)发生右侧喉返神经后方淋巴结(lymph nodes posterior to the right recurrent laryngeal nerve,LN-prRLN)转移的影响因素,并构建临床列线图预测模型,为LN-prRLN清扫决策提供参...目的探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)发生右侧喉返神经后方淋巴结(lymph nodes posterior to the right recurrent laryngeal nerve,LN-prRLN)转移的影响因素,并构建临床列线图预测模型,为LN-prRLN清扫决策提供参考依据。方法通过回顾性分析保定市第一中心医院普外科2021年1月至2023年12月期间收治的PTC患者的临床资料,其中行LN-prRLN清扫325例,根据是否出现LN-prRLN转移分为非转移组(269例)和转移组(56例)。通过比较2组患者临床病理特征方面的差异,分析探讨LN-prRLN转移的危险因素,然后以危险因素构建LN-prRLN转移的列线图预测模型并验证及评估模型效能。结果共纳入325患者,其中56例(17.23%)发生LN-prRLN转移。单因素分析结果显示:性别、腺外侵犯、右侧喉返神经前方淋巴结(ymph nodes anterior to right recurrent laryngeal nerve,LN-arRLN)转移、癌灶位置和侧颈区淋巴结转移(lateral lymph node metastasis,LLNM)与PTC发生LN-prRLN转移相关(P<0.05)。多因素logistic回归分析结果显示:男性[OR=3.878,95%CI为(1.192,12.615)]、有腺外侵犯[OR=2.836,95%CI为(1.036,7.759)]、有LNarRLN转移[OR=10.406,95%CI为(3.225,33.926)]、右侧癌灶[OR=5.632,95%CI为(1.812,17.504)]和有LLNM[OR=3.426,95%CI为(1.147,10.231)]是LN-prRLN转移的危险因素。基于以上危险因素构建的列线图预测模型的受试者工作特征曲线显示:曲线下面积为0.865,95%CI为(0.795,0.934),约登指数为0.729,敏感度为0.873,特异度为0.856,具有较高的预测价值。Bootstrap检验内部验证一致性指数为0.840,95%CI为(0.755,0.954)。校正曲线显示预测值靠近理想曲线,有较好的一致性,临床决策曲线分析显示该模型对PTC发生LN-prRLN转移的临床预测效果良好。结论男性、腺外侵犯、LN-arRLN转移、右侧癌灶和LLNM是PTC发生LN-prRLN转移的危险因素,基于以上危险因素构建的列线图预测模型有较高的区分度和校准度,有助于外科医生临床决策。展开更多
基金Supported by Shanghai Jiaotong University Medical School for Scientific Research,No.09XJ21013Shanghai Health Bureau for Scientific Research,No.2010029Shanghai Science and Technology Commission for Scientific Research,No.124119a0300
文摘AIM:To explore risk factors for lymph node metastases in early gastric cancer(EGC) and to confirm the appropriate range of lymph node dissection.METHODS:A total of 202 patients with EGC who underwent curative gastrectomy with lymphadenectomy in the Department of Surgery,Xinhua Hospital and Ruijin Hospital of Shanghai Jiaotong University Medical School between November 2003 and July 2009,were retrospectively reviewed.Both the surgical procedure and the extent of lymph node dissection were based on the recommendations of the Japanese gastric cancer treatment guidelines.The macroscopic type was classified as elevated(type Ⅰ or Ⅱa),flat(Ⅱb),or depressed(Ⅱc or Ⅲ).Histopathologically,papillary and tubular adenocarcinomas were grouped together as differentiated adenocarcinomas,and poorly differentiated and signet-ring cell adenocarcinomas were regarded as undifferentiated adenocarcinomas.Univariate and multivariate analyses of lymph node metastases and patient and tumor characteristics were undertaken.RESULTS:The lymph node metastases rate in patients with EGC was 14.4%.Among these,the rate for mucosal cancer was 5.4%,and 8.9% for submucosal cancer.Univariate analysis showed an obvious correlation between lymph node metastases and tumor location,depth of invasion,morphological classification and venous invasion(χ 2 = 122.901,P = 0.001;χ 2 = 7.14,P = 0.008;χ 2 = 79.523,P = 0.001;χ 2 = 8.687,P = 0.003,respectively).In patients with submucosal cancers,the lymph node metastases rate in patients with venous invasion(60%,3/5) was higher than in those without invasion(20%,15/75)(χ 2 = 4.301,P = 0.038).Multivariate logistic regression analysis revealed that the depth of invasion was the only independent risk factor for lymph node metastases in EGC [P = 0.018,Exp(B) = 2.744].Among the patients with lymph node metastases,29 cases(14.4%) were at N1,seven cases were at N2(3.5%),and two cases were at N3(1.0%).Univariate analysis of variance revealed a close relationship between the depth of invasion and lymph node metastases at pN 1(P = 0.008).CONCLUSION:The depth of invasion was the only independent risk factor for lymph node metastases.Risk factors for metastases should be considered when choosing surgery for EGC.
基金supported by the National Key Research and Development Plan of China (No. 2017YFC1309100)the National Natural Scientific Foundation of China (No. 81771912, 81901910, and 81701782)the Provincial Science and Technology Plan Project of Guangdong Province (No. 2017B020227012)
文摘Objective: To develop and validate a radiomics-based predictive risk score(RPRS) for preoperative prediction of lymph node(LN) metastasis in patients with resectable non-small cell lung cancer(NSCLC).Methods: We retrospectively analyzed 717 who underwent surgical resection for primary NSCLC with systematic mediastinal lymphadenectomy from October 2007 to July 2016. By using the method of radiomics analysis, 591 computed tomography(CT)-based radiomics features were extracted, and the radiomics-based classifier was constructed. Then, using multivariable logistic regression analysis, a weighted score RPRS was derived to identify LN metastasis. Apparent prediction performance of RPRS was assessed with its calibration,discrimination, and clinical usefulness.Results: The radiomics-based classifier was constructed, which consisted of 13 selected radiomics features.Multivariate models demonstrated that radiomics-based classifier, age group, tumor diameter, tumor location, and CT-based LN status were independent predictors. When we assigned the corresponding score to each variable,patients with RPRSs of 0-3, 4-5, 6, 7-8, and 9 had distinctly very low(0%-20%), low(21%-40%), intermediate(41%-60%), high(61%-80%), and very high(81%-100%) risks of LN involvement, respectively. The developed RPRS showed good discrimination and satisfactory calibration (C-index: 0.785, 95% confidence interval(95% CI):0.780-0.790)Additionally, RPRS outperformed the clinicopathologic-based characteristics model with net reclassification index(NRI) of 0.711(95% CI: 0.555-0.867).Conclusions: The novel clinical scoring system developed as RPRS can serve as an easy-to-use tool to facilitate the preoperatively individualized prediction of LN metastasis in patients with resectable NSCLC. This stratification of patients according to their LN status may provide a basis for individualized treatment.
文摘AIM To assess clinical outcomes for submucosal (T1b) oesophageal adenocarcinoma (OAC) patients managed with either surgery or endoscopic eradication therapy.METHODS Patients found to have T1b OAC following endoscopic resection between January 2008 to February 2016 at University College London Hospital were retrospectively analysed. Patients were split into low-risk and high-risk groups according to established histopathological criteria and were then further categorised according to whether they underwent surgical resection or conservative management. Study outcomes include the presence of lymphnode metastases, disease-specific mortality and overall survival. RESULTS A total of 60 patients were included; 22 patients were surgically managed (1 low-risk and 21 high-risk patients) whilst 38 patients were treated conservatively (12 low-risk and 26 high-risk). Overall, lymph node metastases (LNM) were detected in 10 patients (17%); six of these patients had undergone conservative management and LNM were detected at a median of 4 mo after endoscopic mucosal resection (EMR). All LNM occurred in patients with highrisk lesions and this represented 21% of the total high-risk lesions. Importantly, there was no statistically significant difference in tumor-related deaths between those treated surgically or conservatively (P = 0.636) and disease-specific survival time was also comparable between the two treatment strategies (P = 0.376).CONCLUSION T1b tumours without histopathological high-risk markers of LNM can be treated endoscopically with good outcomes. In selected patients, endoscopic therapy may be appropriate for high-risk lesions.
文摘Objective To investigate the risk factors with lymph node metastatic recurrence in patients with N0 esophageal cancer after Ivor-Lewis Esophagectomy. Methods The subjects were 82 patients with pN0 esophagea cancer who underwent Ivor-Lewis esophagectomy from January 2001 to January 2005. By using RT-PCR,VEGF C mRNA was detected in tumor issues,and Mucin (MUC1) mRNA was detected in lymph nodes. The Kaplan-Meier method was used to calculate the survival
基金Supported by Shanghai Jiaotong University Medical School for Scientific Research,Grants No.09XJ21013Shanghai Health Bureau for Scientific Research,Grants No.2010029 and 2010057+1 种基金Shanghai Science and Technology Commission for Scientific Research,Grants No.124119a0300Shanghai Municipal Education Commission,Grants No.12Y2034
文摘AIM:To reveal the clinicopathological features and risk factors for lymph node metastases in gastric cardiac adenocarcinoma of male patients.METHODS:We retrospective reviewed a total of 146male and female patients with gastric cardiac adenocarcinoma who had undergone curative gastrectomy with lymphadenectomy in the Department of Surgery,Xin Hua Hospital and Rui Jin Hospital of Shanghai Jiaotong University Medical School between November2001 and May 2012.Both the surgical procedure and extent of lymph node dissection were based on the recommendations of Japanese gastric cancer treatment guidelines.Univariate and multivariate analyses of lymph node metastases and the clinicopathological features were undertaken.RESULTS:The rate of lymph node metastases in male patients with gastric cardiac adenocarcinoma was72.1%.Univariate analysis showed an obvious correlation between lymph node metastases and tumor size,gross appearance,differentiation,pathological tumor depth,and lymphatic invasion in male patients.Multivariate logistic regression analysis revealed that tumor differentiation and pathological tumor depth were the independent risk factors for lymph node metastases in male patients.There was an obvious relationship between lymph node metastases and tumor size,gross appearance,differentiation,pathological tumor depth,lymphatic invasion at pN1and pN2,and nerve invasion at pN3in male patients.There were no significant differences in clinicopathological features or lymph node metastases between female and male patients.CONCLUSION:Tumor differentiation and tumor depth were risk factors for lymph node metastases in male patients with gastric cardiac adenocarcinoma and should be considered when choosing surgery.
基金Supported by the National Specific Research Project for Health and Welfare of ChinaNo.200902002-1+3 种基金the Research Fund of Beijing Municipal Science and Technology CommissionNo.Z111107067311021Beijing NOVA ProgrammeNo.Z131107000413067
文摘AIM: To determine the significance of increased serum direct bilirubin level for lymph node metastasis(LNM) in Chinese rectal cancer patients, after those with known hepatobiliary and pancreatic diseases were excluded.METHODS: A cohort of 469 patients, who were treated at the China-Japan Friendship Hospital, Ministry of Health(Beijing, China), in the period from January 2003 to June 2011, and with a pathological diagnosis of rectal adenocarcinoma, were recruited. They included 231 patients with LNM(49.3%) and 238 patients without LNM. Follow-up for these patients was taken through to December 31, 2012.RESULTS: The baseline serum direct bilirubin concentration was(median/inter-quartile range) 2.30/1.60-3.42 μmol/L. Univariate analysis showed that compared with patients without LNM, the patients with LNM had an increased level of direct bilirubin(2.50/1.70-3.42 vs 2.10/1.40-3.42, P = 0.025). Multivariate analysis showed that direct bilirubin wasindependently associated with LNM(OR = 1.602; 95%CI: 1.098-2.338, P = 0.015). Moreover, we found that:(1) serum direct bilirubin differs between male and female patients; a higher concentration was associated with poor tumor classification;(2) as the baseline serum direct bilirubin concentration increased, the percentage of patients with LNM increased; and(3) serum direct bilirubin was associated with the prognosis of rectal cancer patients and higher values indicated poor prognosis.CONCLUSION: Higher serum direct bilirubin concentration was associated with the increased risk of LNM and poor prognosis in our rectal cancers.
文摘A double-blinded randomized controlled field trial based on parallel group design was conducted from January, 2018 to July, 2018 in Chercher Oda-Bultum Farmers Union beef Farm. The present study was conducted to evaluate the roll of effective microbial supplementation to feed on the infection of Salmonella in the mesenteric and sub-iliac lymph nodes of beef cattle. In order to undertake the study, 130 beef cattle kept by the farm were used to establish a cohort. The study animals were randomly assigned to the treatment group (n = 100) and control group (n = 30). The feed of treatment group was mixed with EM at dose of 5× 10<sup>10</sup> cfu/day/head for 90, 100 and 115 days while that of the control group was mixed with molasses, which acts as placebo. Both the treatment and control were slaughtered and two lymph nodes were collected from each animal under strict sterile condition and processed for the isolation and identification of Salmonella using standard procedure. The occurrence of Salmonella was 70% (CI = 51% - 85%) in control group while it was 33% (CI = 24% - 43%) in treatment group. The difference in the proportion of Salmonella infection in the two group was significant (x<sup>2</sup> = 13.01;p = 0.000). The relative risk of Salmonella isolation in the control was 2.12 (1.41 - 3.20) compared to treatment group. The absolute and relative risk reduction in the treatment were 37% (CI = 17% - 57%) and 53% (CI = 29% - 69%), respectively. This preliminary study indicated that effective microbial supplementation of beef cattle feed reduced the occurrences of Salmonella in the lymph node of beef cattle, thereby potentially minimizing the economic and public health impacts of Salmonella infection. Then, it was recommended to use EM as prevention and control option in Salmonella carriage in cattle.
文摘<strong>Background:</strong> <span style="font-family:""><span style="font-family:Verdana;">Clinicopathological and biological features are associated with neck lymph node metastasis (LNM) of hypopharyngeal squamous cell carcinoma (HSCC). However, there is no complete nomogram combining multiple factors that can be used to accurately predict the neck LNM status for HSCC patients. </span><b><span style="font-family:Verdana;">Purpose:</span></b><span style="font-family:Verdana;"> To guide the selection of surgical methods and radiotherapy areas for hypopharyngeal cancer. In this study, a nomogram was developed to combine these risk factors to predict neck LNM and guide the treatment of HSCC. </span><b><span style="font-family:Verdana;">Material and Methods: </span></b><span style="font-family:Verdana;">This retrospective study included 117 patients (training cohort, 64 patients;trial cohort, 53 patients). Biological characteristics of HSCC patients were assessed using immunohistochemical staining, and data of patient age, gender, and preoperative computed tomography (CT) scan reports were collected. Significant risk factors in univariate analysis were further identified to be independent variables in multivariate logistic regression analysis, which were then incorporated in and presented with a nomogram by using the rms package in R software. Receiver operating characteristic (ROC) curves and calibration curves were used to validate the discrimination and accuracy in the training and validation cohorts, respectively, and clinical usefulness was verified in decision curve analysis curves. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">All variables with P-values < 0.2 in the univariate analysis were selected for multivariate logistic regression analysis to further identify independent risk factors for neck LNM. In multivariate logistic regression analysis, variables with P-values < 0.2 were identified as independent risk factors and then used to construct the nomogram. In total, five independent predictors, including the maximum tumor diameter in CT, tumor cell differentiation, LNM status in CT, Stathmin1 expression level, and lymphatic vessel invasion were included in the nomogram. The area under the ROC curve (AUC) was 0.916 (95% confidence interval [CI], 0.833 - 1.000) and AUC of 0.928 (95% CI, 0.864</span></span><span style="font-family:Verdana;"> - </span><span style="font-family:""><span style="font-family:Verdana;">1.000) in internal validation and the external validation. </span><b><span style="font-family:Verdana;">Conclusions</span></b><span style="font-family:Verdana;">: Both the internal validation in the training cohort and the external validation in the validation cohort showed </span></span><span style="font-family:Verdana;">that </span><span style="font-family:Verdana;">the nomogram had good discrimination, accuracy, and excellent clinical usefulness. The nomogram based on clinicopathological and biological features developed in this study has strong predictive power and could be used to predict neck LNM of HSCC in clinical practice.</span>
基金Scientific Research Foundation for Returned Overseas Chinese Scholars,Slate Education Commission(1997-832)
文摘The principle of surgical treatment for gastric cancer is the radical resectioning although the suitable resecting range for different cases of gastric cancer is still being argued upon[1-9]. However, the diagnostic accuracy of early gastric cancer (EGC) without lymphatic metastasis has obviously improved with an improvement in the diagnostic technique and due to the accumulation of knowledge on the biological profiles of EG C[10-17]. The D2 lymph node excision was used as a regular operation to treat the EGC previously. But the concept for the EGC without lymphatic metastasis has gradually changed and the less invasive resections has been applied in some cases[18-20]. This study aimed at investigating the risk factors of lymphatic metastasis in EGC in order to find out the proofs for the suitable indications for less invasive operations such as endoscopic mucosal resectioning (EMR), laparoscopic and laparotomic resectioning.
文摘目的联合空间位置-临床-影像特征探讨可切除肺腺癌淋巴结转移的危险因素,并构建淋巴结转移预测模型。方法回顾性纳入2016年6月—2020年6月于南京医科大学第一附属医院接受胸部CT,并经手术确诊为有或无淋巴结转移的浸润性肺腺癌患者。根据有无淋巴结转移,将患者分为阳性组与阴性组。收集患者的临床及影像学资料,采用单因素和多因素logistic回归分析可切除肺腺癌淋巴结转移的独立危险因素,并建立淋巴结转移的空间位置-临床-影像特征联合预测模型,将其与不包含空间位置特征的传统淋巴结转移预测模型进行对比。结果共纳入611例患者,阳性组333例,其中男172例、女161例,平均年龄(58.9±9.7)岁;阴性组278例,其中男127例、女151例,平均年龄(60.1±11.4)岁。单因素及多因素logistic回归分析显示,病灶距离肺门的空间位置关系、结节类型、胸膜改变、血清癌胚抗原(carcinoembryonic antigen,CEA)水平是淋巴结转移的独立危险因素,以此为基础构建的空间位置-临床-影像特征联合预测模型敏感性为91.67%,特异性为74.05%,准确性为87.88%,曲线下面积(area under the curve,AUC)为0.885。不包含空间位置特征的传统淋巴结转移预测模型敏感性为76.40%,特异性为72.10%,准确性为53.86%,AUC为0.827。两种预测方法的AUC差异有统计学意义(P=0.026)。与传统预测模型相比,空间位置-临床-影像特征联合预测模型的预测效能有显著提升。结论在可切除肺腺癌患者中,空间位置、实性密度、胸膜改变为宽基底凹陷以及血清CEA水平升高者发生淋巴结转移的风险更高。
文摘目的探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)发生右侧喉返神经后方淋巴结(lymph nodes posterior to the right recurrent laryngeal nerve,LN-prRLN)转移的影响因素,并构建临床列线图预测模型,为LN-prRLN清扫决策提供参考依据。方法通过回顾性分析保定市第一中心医院普外科2021年1月至2023年12月期间收治的PTC患者的临床资料,其中行LN-prRLN清扫325例,根据是否出现LN-prRLN转移分为非转移组(269例)和转移组(56例)。通过比较2组患者临床病理特征方面的差异,分析探讨LN-prRLN转移的危险因素,然后以危险因素构建LN-prRLN转移的列线图预测模型并验证及评估模型效能。结果共纳入325患者,其中56例(17.23%)发生LN-prRLN转移。单因素分析结果显示:性别、腺外侵犯、右侧喉返神经前方淋巴结(ymph nodes anterior to right recurrent laryngeal nerve,LN-arRLN)转移、癌灶位置和侧颈区淋巴结转移(lateral lymph node metastasis,LLNM)与PTC发生LN-prRLN转移相关(P<0.05)。多因素logistic回归分析结果显示:男性[OR=3.878,95%CI为(1.192,12.615)]、有腺外侵犯[OR=2.836,95%CI为(1.036,7.759)]、有LNarRLN转移[OR=10.406,95%CI为(3.225,33.926)]、右侧癌灶[OR=5.632,95%CI为(1.812,17.504)]和有LLNM[OR=3.426,95%CI为(1.147,10.231)]是LN-prRLN转移的危险因素。基于以上危险因素构建的列线图预测模型的受试者工作特征曲线显示:曲线下面积为0.865,95%CI为(0.795,0.934),约登指数为0.729,敏感度为0.873,特异度为0.856,具有较高的预测价值。Bootstrap检验内部验证一致性指数为0.840,95%CI为(0.755,0.954)。校正曲线显示预测值靠近理想曲线,有较好的一致性,临床决策曲线分析显示该模型对PTC发生LN-prRLN转移的临床预测效果良好。结论男性、腺外侵犯、LN-arRLN转移、右侧癌灶和LLNM是PTC发生LN-prRLN转移的危险因素,基于以上危险因素构建的列线图预测模型有较高的区分度和校准度,有助于外科医生临床决策。
