Objective To evaluate the potential of specific mRNA marker keratin 19(K19) to detect micrometastasis by reverse transcriptase polymerase chain reaction (RT-PCR) .Methods One hundred and ninty four regional lymph nodes harvested from 6 cases of benign diseases, 4 cases of breast carcinoma, 5 cases of gastric carcinoma and 12 cases of colorectal carcinoma patients were examined by conventional pathology and amplifying tissue specific K19 mRNA by RT-PCR separately, then the two methods were compared with each other. Results None of the 34 lymph nodes which were pathological metastasis-negative from benign diseases expressed K19 mRNA by RT-PCR, all of the 28 regional lymph nodes which were pathological metastasis-positive from malignant cases showed trains of K19 mRNA by RT-PCR. Of the 132 lymph nodes which were pathological metastasis-negative from malignant cases, 11 lymph nodes were detected with micrometastasis by genetic diagnosis.Conclusion Genetic diagnosis of lymph node micrometastasis is more sensitive than conventional pathology and has diagnostic value and merits further study.
ObjectiveTo explore the safety, effectiveness, and cosmetic advantage of endoscopic thyroidectomy for differentiated thyroid cancer in the cT1N0 stage. MethodsThe clinical data of 148 patients underwent thyroidectomy for the cT1N0 differentiated thyroid cancer in the First Affiliated Hospital of PLA General Hospital and the PLA General Hospital from September 2010 to September 2013 were analyzed retrospectively, including 36 patients by total endoscopic thyroidectomy (TET group), 41 patients by endoscopic-assisted thyroidectomy (EAT group), and 71 patients by open thyroidectomy (OT group). The intraoperative status, early complications, late complications, and cosmetic result were compared among these three groups. ResultsAll the procedures were accomplished successfully.①In the intraoperative status: The operation time of the TET group was significantly longer than that of the EAT group(P < 0.05)or OT group (P < 0.05), drainage on the first day after operation in the TET group was significantly more than that in the EAT(P < 0.05)or OT group (P < 0.05), the intraoperative bleeding of the TET group or EAT group was significantly less than that of the OT group (P < 0.05), there were no statistical significances in the total number of lymph nodes dissection and number of positive lymph nodes among three groups (P > 0.05).②In the early complications: The postoperative pain score of the TET group was significantly lower than that of the EAT group (P < 0.05)or OT group (P < 0.05), there were no statistical significances in the postoperative bleeding, seroma, infection, transient recurrent laryngeal nerve paralysis, or transient hypoparathyroidism among three groups (P > 0.05).③In the late complications: there was no statistical significance in the perpetual recurrent laryngeal nerve paralysis, perpetual hypoparathyroidism, or thyroid cancer relapse among three groups (P > 0.05).④The best cosmetic result was obtained by the patients underwent TET as compared with the patients underwent EAT(P < 0.05)or OT (P < 0.05). ConclusionsEndoscopic procedure has the same effectiveness and safety with open procedure for differentiated thyroid cancer in the cT1N0 stage, but endoscopic procedure has a better cosmetic result than that open procedure. Compared with EAT, TET has more advantages in the cosmetic result.
Objective To investigate the expression of cerb B2 and CathepsinD in gastric carcinoma and its correlation with the biological behavior of gastric carcinoma (GC). MethodsThe expression was studied by immunohistochemical technique. The expression of cerb B2 and CathepsinD were analyzed with their relation to histologic types, depth of invasion, growth pattern, lymph node metastasis and prognosis of gastric carcinoma. ResultsThirtynine of the 102 gastric carcinoma specimens (38.24%) were positive for cerb B2 and correlated with depth of invasion (P＜0.05) and lymph node metastasis (P＜0.05); eightythree of the 102 gastric carcinoma specimens (81.37%) were positive for CathepsinD and correlated with depth of invasion (P＜0.05), growth pattern (P＜0.05), lymph node metastasis (P＜0.05) and blood vessels cancer embolus (P＜0.05). Prognosis of patients with gastric carcinoma with positive expression of cerb B2 or CathepsinD was poor. The 5year survival rate was significantly lower in gastric carcinoma patients with positive expression of cerb B2 or CathepsinD. Conclusion cerb B2 and CathepsinD are highly related to growth, invasion, metastasis and prognosis of gastric carcinoma.
ObjectiveTo evaluate the lymphatic tracing effects of nano-carbon particles for radical gastrectomy. MethodsTotally eighty-six cases of gastric cancer patients were randomly divided into experimental group (n=43) and control group (n=43). In the experimental group, nanocarbon was injected into the subserosa around the tumor for lymphatic tracing before operation, while no tracer was given in the control group. Then the number of lymph nodes dissected, operation time, and postoperative complications of patients were compared. ResultsThe number of lymph nodes dissected in patients of experimental group was 30.20±11.63 (17-45), which was significantly more than that of control group 〔22.47±7.60 (15-31)〕, Plt;0.05. The blacken rate of lymph nodes in patients of the experimental group was 74.56% (1 260/1 690). Of 302 metastatic lymph nodes, the blacken rate of metastatic lymph nodes was 61.26% (185/302), which was significantly higher than the nonblacken rate of metastatic lymph nodes (38.74%, 117/302), Plt;0.05. The operation time of patients in experimental group 〔(3.51±0.43) h〕 was not different from that in control group 〔(3.49±0.51) h〕, Pgt;0.05. The postoperative complications of patients in two groups was not different and no local or systemic adverse reaction occurred in patients of experimental group. ConclusionSubserosal injection of nanocarbon particles around the tumor is safe and can provide the guidance to lymph node dissection in radical gastrectomy.
Objective To investigate the lymph node micrometastasis and its clinicopathologic features on 5-year disease free survival rate for patients with pT1—3N0 gastric cancer. Methods One hundred and twenty patients with stage pT1—3N0 gastric tumors were included, and 2 106 lymph nodes were harvested and examined in all the specimens. There were 9－28 lymph nodes with average 18 lymph nodes from each patient. All the lymph nodes were negative by HE staining. The CK20 expression of lymph nodes was tested by immunohistochemistry. The relationships between clinicopathologic features or CK positive expression and 5-year disease free survival were analyzed. Results The positive expression rate of CK20 was 9.07% (191/2 106) in lymph nodes and 26.67% (32/120) in patients with pT1—3N0 gastric cancer by immunohistochemistry. Eleven cases were with micriometastasis, 21 cases were isolated tumor cells (ITC). The average postoperative follow-up was 66.35 (range 24—121) months. Five-year disease free survival rates were 87.4%, 78.3%, and 40.9% for the lymph node negative, ITC, and micrometastasis groups, respectively. Five-year disease free survival rate in the micrometastasis group was lower than that in the lymph node negative group (P=0.000) and ITC group (P=0.046). However, there was no significant difference between the lymph node negative group and ITC group （P=0.253）. Multivariate analysis identified tumor diameter (P=0.011), depth of tumor invasion (P=0.043), and lymphatic vessel invasion (P=0.002) were related with CK20 positive expression. There was no significant relationship between the pathologic parameters and the 5-year disease free survival rates. Lymph node micrometastasis of gastric cancer was detected in 11 patients who should belong to stage pN1(Mi), the restage rate was 9.17%. While the lymph node negative (88 patients) and ITC (21 patients) were recorded pN0(i-) and pN0(i+), respectively, and were not recommended restage (stage pN0). Conclusion Patients with stage pT1—3N0 gastric cancer and micrometastasis in lymph node are with high-risk and low 5-year disease free survival rate, for whom adjuvant therapies may be justified and effective.
Barrett’s esophagus is considered an important risk factor for the pathogenesis of esophageal adenocarcinoma. Treatment strategies for diseases from high-grade dysplasia （HGD） to adenocarcinoma are different. The recurrence rates of endoscopic treatment and anti-reflux surgery are comparatively higher. Abnormal lesions of the esophagus can be completely resected by esophagectomy for the treatment of HGD to adenocarcinoma, and treatment outcomes are confirmed.But appropriate surgical strategies and lymph node dissection scopes should be chosen according to different cancer staging.Lymph node metastasis is a major factor in determining prognosis.
To investigate the relationship between clinicopathological features and lymph node metastasis in the primary gastric cancer and affer the basis for deciding appropriate extent of lymph node dissection, a total of 192 patients who underwent curative gastrectomy and lymph node dissection for gastric cancer were analyzed retrospectively. Result: The total rate of lymph node metastasis was 60.4%, with 28.9% of the resected lymph nodes involved. The lymph node metastasis of C, M, A region and the whole stomach were 64.6%, 57.7%, 59.1% and 90.9% respectively. The rates of the lymph node metastasis increased successively in carcinoma of early, middle and late stages (Ｐ＜0.05), the rate of the infiltrative tumor (Borr Ⅲ，Ⅳ) being 76.5% which was significantly higher than that of the circumscribed tumor (Borr Ⅰ，Ⅱ) (43.2%)。 Relating with the tumor size ＜4cm in diameter showed lesser rate, while 4-8 cm and ＞8cm in diameter showed increasingly higher metastaticrate (Ｐ＜0.01). As a result, we should decide the appropriate extent of lymph node dissection during the operation on the basis of clinicopathological stages, type of Borrmann’s, site and maximum diameter of gastric cancer along with the state of lymph node metastasis in carcinoma of different region of the stomach.
ObjectiveTo compare effectiveness and safety of video-assisted thoracic surgery (VATS) and thoracotomy in lymph node (LN) dissection for lung cancer. MethodsA comprehensive search of PubMed, Ovid Medline, EMbase, Web of Science, ScienceDirect, the Cochrane Library, Scopus and Google Scholar was performed to identify studies (from January 1990 to July 2015) comparing VATS with thoracotomy in LN dissection. The data were analyzed by RevMan 5.3 software. Quality of literature was evaluated by Newcastle-Ottawa scale or Jadad scale. ResultsFifty-one articles met the inclusion criteria involved 7 127 patients in the VATS group and 9 217 patients in the thoracotomy group. Thirty-eight articles were of good quality and the remaining thirteen were medium. Meta-analysis showed that fewer N1 LN stations in the VATS group (95% CI -0.23 to -0.04, P=0.005), although VATS harvested more left-side LNs (95% CI 0.51 to 3.22, P=0.007). The number of total LNs (95% CI -1.81 to 0.28, P=0.15), total LN stations (95% CI -0.34 to 0.15, P=0.44), N2 LNs (95%CI -1.77 to 0.79, P=0.45), N2 LN stations (95% CI -0.22 to 0.16, P=0.78), N1 LNs (95% CI -0.95 to 0.11, P=0.12), and right-side LNs (95% CI -1.52 to 2.23, P=0.71) harvested in the two groups were not significantly different. ConclusionIn the surgical treatment of lung cancer, VATS can achieve the same efficacy of LN dissection as thoracotomy. This conclusion still needs to be further proved by more high-quality and large-scale RCTs.
Objective To identify micrometastasis in regional lymph nodes of gastric cancer by quantitative real-time reverse transcription-PCR (qRT-PCR) assay and to evaluate the clinical significance of micrometastasis. Methods To study 320 lymph nodes collected from January 2010 to June 2010， 281 of which were from 40 patients with gastric cancer who had undergone a standard gastrectomy with lymphadenectomy， and other 39 of which were from 10 patients with gastroduodenal ulcer. Made CEA， CK-19， and CK-20 as primers， and used qRT-PCR assay in addition to hematoxylin and eosin staining to detect the micrometastasis， and to analyze the clinicopathologic characteristics.Results Totally， micrometastasis were detected by qRT-PCR assay in 31 (15.34%，31/202) lymph nodes of 28 (70.00%， 28/40) patients. Thirty-nine lymph nodes from 10 patients with gastroduodenal ulcer were negative by qRT-PCR and HE staining. The degree of differentiation， depth of gastric mural invasion， and clinical stage had statistically significant correlation with the incidence of lymph node micrometastasis (P＜0.05). Conclusions qRT-PCR assay is a sensitive and speci?c method to detect lymph node micrometastasis in gastric cancer patients，and it has importantly clinical significance in evaluating clinical staging，prognosis and treatment prescription.
Objective To investigate the effects of vascular endothelial growth factor C (VEGF-C) gene modified lymph nodes on promoting proliferation of lymphatic endothelial cells in the surrounding tissues. Methods Thirty-six Sprague Dawley rats, weighing 200.1-271.5 g, were randomly divided into 2 groups (n=18). After the in situ axillary lymph nodes transplantation models were established in both groups, 1.5 × 108 PFU Ad-VEGF-C-Flag and Ad-Flag were injected into the transplanted lymph nodes in experimental group and control group, respectively. At 3 days after injection, the axillary lymph nodes were harvested to observe the expression of Flag; at 1, 2, and 4 weeks after injection, the axillary lymph nodes and the surrounding tissues were harvested to observe the expression of Prxo-1 protein and to calculate the fluorescence density; at 2 and 4 weeks after injection, the absorbance (A) value of treated blood at 620 nm was calculated to observe lymphatic back-flow function improvement; the rats without treatment served as normal control group, and the rats with in situ axillary lymph nodes transplantation model served as blank control group. Results At 3 days after injection, the expression of Flag could be detected in experimental group and control group. The fluorescence density of Prox-1 protein in experimental group increased at 1, 2, and 4 weeks, and it was significantly higher than that in control group (P lt; 0.05). The A values of normal control group and blank control group were 0.539 ± 0.020 and 0.151 ± 0.007, respectively. The A values of experimental group and control group were 0.170 ± 0.011 and 0.168 ± 0.010 at 2 weeks, and 0.212 ± 0.016 and 0.197 ± 0.006 at 4 weeks, which were significantly lower than those of normal control group (P lt; 0.05), but no significant difference was found when compared with blank control group, and between the experimental group and control group (P gt; 0.05). Conclusion The VEGF-C gene modified lymph nodes can stimulate the proliferation of lymphatic endothelial cells in the surrounding tissues. However, it has no improved effect on lymphatic back-flow function in the affected limb.