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.
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 summarize the research progress of mucinous breast cancer (MBC). MethodsLiteratures about the recent studies of MBC were reviewed. ResultsMBC was one of special subtype of infiltrating breast cancer. According to the mucus ingredient in the ratio of the mass, MBC was divided into pure mucinous breast cancer (PMBC) and mixed mucinous breast cancer (MMBC). Compared to infiltrating ductal cancer-not otherwise specified (IDC-NOS), MBC showed higher positive expression rates of estrogen receptor (ER) and progestrogen receptor (PR), with reduced lymph node metastasis rate and better prognosis. PMBC had lower lymph node metastasis rate and better outcome than MMBC. ConclusionsThere is significant difference about clinical and pathological characteristics between MBC and IDC-NOS. Researches are generally believed that MBC is an uncommon breast neoplasm which is associated with a good prognosis.
Objective To explore the value of multidetector row helical CT （MDCT） in the diagnosis of lymph node metastasis in adenocarcinoma of esophaogastric junction （AEG）， and to study the pattern of lymph node metastasis of it. Methods The MDCT images of 60 patients with AEG who underwent operation in our hospital from Jan. 2011to Oct. 2012 were collected， in order to explore the value of MDCT in the diagnosis of lymph node metastasis in AEG， and to study the pattern of lymph node metastasis of it. Results With diameter upper 8 mm and the difference of the mean value of enhanced degree upper 70 Hu as the standard of lymph node metastasis， the Kappa value （0.819 and 0.718），sensitivity （83.1% and 91.8%）， and specificity （78.9% and 83.5%） were all optimal. The lymph node metastasis rate was significantly higher in serosa invasion group than those of non-invasion group （P＜0.05）. The metastatic area of lymphnodes mainly concentrated around cardia （No. 7， 8， and 9 group）， lesser curvature of the stomach， celiac axis， and hepato-gastric ligament （No. 10， 11， 12， and 14 group） with the metastasis rate of 83.8% and 82.3%， respectively. Conclusion MDCT is useful to confirm the features， location， and rules of lymph node metastasis in patients with AEG， which is helpful in accurately cleaning the lymph nodes.
Objective To summarize and analyze the different views on the lymph node metastasis and the extent of lymphadenectomy in gastric cancer.Methods The current domestic and foreign reports on lymph node metastasis and lymphadenectomy in gastric cancer were reviewed.Results Lymph node dissection of gastric cancer is based on clinical stage and the location of the tumor. Laparoscopic-assisted gastrectomy in treatment of gastric cancer is a safe， feasible， effective， and minimally invasive technique with good outcomes for patients. Sentinel lymph node（SLN） in the clinical assessment of early gastric cancer is feasible，besides with high accuracy and sensitivity. Lymphatic mapping is an effective， easy， and safe method to guide lymphadenectomy in gastric cancer. Evidence-based lymphadenectomy in gastric cancer provide a new perspective to the extent. Conclusions It is difficult to evaluate those methods exactly. Researchers over the world should learn from each other and explore further in order to develop guiding principles in the end.
ObjectiveTo explore the differences and similarities of the featurs of lymph node metatasis of abdominal esophageal carcinoma and cardiac cancer. MethodsPreoperative CT images of abdominal esophageal carcinomas and cardiac cancers were reviewed and analysed on lymph node size and preponderant distribution. ResultsShort diameter ≥10 mm of lymph node at CT was adopted as metastasis criterion. The detection rates of abdominal esophageal carcinomas and cardiac cancers were 73.5%（144/196） and 83.7% （170/203）, respectively. Thoracic lymph node metastasis rate of abdominal esophageal carcinomas was 11.1% （4/36） in 7 area, 27.8% （10/36） in 8 area, 8.3% （3/36） in 9 area, while celiac lymph node metastasis rate was 36.1% (13/36 ） in No.7 group, 19.4% （7/36） in No.1 group, and 11.1% （4/36） in No.2 group primarily. Lymph node metastasis rate of cardiac cancers was 17.9% （5/28） in No.1 group, 28.6% （8/28） in No.2 group, 39.3% （11/28 ） in No.3 group, and 25.0% （7/28） in No.4 group for the first stop lymph nodes, and 35.7% （10/28 ） in No.7 group for the second stop primarily. ConclusionAs metastasis criterion, short diameter ≥10 mm of lymph node at CT is feasible, but there exist certain falsepositive rate. Thoracic lymph node metastasis of abdominal esophageal carcinomas is mainly in the 7, 8, and 9 area, while celiac metastasis is mainly in No.7, No.1, and No.2 groups. Lymph node metastasis of cardiac cancers is in No.1, No.2, No.3, No.4, and No.7 group primarily.
Objective To improve esophageal lymph node staging and investgate an ideal esophageal lymph node metastasis staging method. Methods The clinical pathological data and followup data of the 236patients who had undergone thoracic esophagectomy with at least 6 lymph nodes (LN) removed from January 1985 to December 1989 were analyzed retrospectively. Cox proportional hazard model was used to screen risk factors, and Logrank test was applied to perform survival analysis according to lymph node metastasis staging (number, distance and extent). Results The 10-year follow-up rate was 92.3%（218/236）. The overall 1-year, 5-year and 10-year survival rates were 80.2%, 43.1% and 34.2% respectively. One hundred and twelve (47.4%) patients had LN metastasis, and their 5-year survival rates were lower than that of patients without LN metastasis (14.8% vs. 66.6%; χ2=77.18, P=0.000). Cox regression analysis showed that besides depth of invasion, differentiation grade and LN metastasis, the number, distance and extent of LN metastasis were the independent risk factors which could influence prognosis. A further analysis was given via univariate Logrank test. When grouped according to the number of LN metastasis, there were significant differences in overall survival rates (χ2=96.00,P=0.000), but no significant difference was found in survival rates between N2 and N3 group(Pgt;0.05). When grouped according to the distance of LN metastasis, there were significant differences in overall survival rates (χ2=79.29, P=0.000), but no significant difference was found in survival rates among S1, S2 and S3 group(Pgt;0.05). When grouped according to the extent of LN metastasis (0, 1, and ≥2 fields), there were significant differences in overall survival rates (χ2=87.47, P=0.000), and so were the survival rates among groups (χ2=5.14, P=0.023). Conclusion Revising the current Nclassification of TNM staging of esophageal cancer according to the extent of LN metastasis(0, 1, and ≥2 fields) is more reasonable, and can reflect the prognosis of patients with esophageal cancer after esophagectomy better.
Objective To establish the optimal morphological criteria combined with fibrinogen level for evaluation of lymph node metastasis in colorectal cancer. Methods A consecutive series of 690 patients who underwent curative surgery for colorectal cancer, were examined by abdominopelvic enhanced multi-slice spiral computed tomography (MSCT) scan. If regional lymph nodes appeared, the maximal long-axis diameter (MLAD), maximal short-axis diameter (MSAD), and axial ratio (MSAD/MLAD) were recorded. At each lymph node size cut-off value, the following were calculated: accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Moreover, preoperative plasma level of fibrinogen was retrospectively examined to identify metastatic or inflammatory lymph node combined with MSCT image. Both modalities, MSCT plus fibrinogen and MSCT alone, were compared based on the pathologic findings. Results The study population consisted of 100 patients with regional lymph nodes show. No significant difference was found between metastatic and inflammatory lymph nodes in imaging characteristics (Pgt;0.05). The best cut-off value of MSAD was 6 mm for lymph node metastasis with the sensitivity of 46.8%, specificity of 68.4%, accuracy of 55.0%, PPV of 70.7% and NPV of 44.1%. The best cut-off value of MLAD was 8 mm with the sensitivity of 43.5%, specificity of 63.2%, accuracy of 51.0%, PPV of 65.9% and NPV of 40.7%. Using hyperfibrinogenemia (FIB ≥3.5 g/L) to identify small metastatic lymph node, of which MSAD lt;6 mm or MLAD lt;8 mm, showed statistical diagnostic value (Kappa=0.256, P=0.047). Compared with MSAD (6 mm) alone, MSAD (6 mm) combined with hyperfibrinogenemia had a higher sensitivity (79.0% vs. 46.8%, Plt;0.001), but a similar accuracy (66.0% vs. 55.0%, Pgt;0.05) and a lower specificity (44.7% vs. 68.4%, P=0.037). MLAD (8 mm) combined with hyperfibrinogenemia led to a greater diagnostic value in sensitivity (80.6% vs. 43.5%, Plt;0.001) and accuracy (66.0% vs. 51.0%, P=0.031) than MLAD (8 mm) alone, with a no-significantly decreasing specificity (42.1% vs. 63.2%, Pgt;0.05). Conclusions This present study recommend MSAD ≥6 mm or MLAD ≥8 mm as the optimal criteria for preoperative N staging in colorectal cancer. Moreover, the sensitivity and even accuracy could be improved by combining hyperfibrinogenemia for lymph node metastasis identification.
【Abstract】 Objective To research the significance on expression of vascular endothelial growth factor-C (VEGF-C) in human breast carcinoma, benign diseases and normal mammary gland by self-constructed tissue chips and research its relationship to regional lymph node metastasis. Methods The tissue chips containing specimens of breast carcinoma, breast benign disease and normal mammary gland were designed and constructed. The expression of VEGF-C in the specimens was detected by the tissue chips and immunohistochemical method, and researched the relationship of the expression of VEGF-C in breast cancer with regional lymph node metastasis. Results The positive rates of VEGF-C in the centre and borderline of carcinoma and distant mammary gland （the distance from the tumor’s bouncary ＞3 cm） were 69.4%（68 /98）, 69.1%（67 /97） and 52.9%（36 /68）, respectively， but not in benign disease and normal mammary gland specimens. The positive rates of VEGF-C in the centre and borderline of carcinoma in lymph node metastasis group 〔75.0%（51/68）， 76.1%(51/67)〕 were significantly higher than that of no metastasis group 〔25.0%（17/68），23.9%(16/67)〕, P＜0.05. The positive rates of VEGF-C in the centre and borderline of carcinoma and distant mammary gland were no correlation with size, type and clinical stage of tumor. Conclusion The tissue chips is high efficiency and well quality control in multiple factor investigation. There are overexpression of VEGF-C in primary breast cancer, and that may play an important role in lymph node metastasis.
ObjectiveTo summarize the current advancement of adenocarcinoma of the esophagogastric junction (AEG) and improve the knowledge and cognition about AEG and find a feasible treatment strategy.Method Relevant literatures about current advancement of AEG published domestically and abroad recently were collected and reviewed. Results AEG had obvious differences from other parts of stomach tumors in anatomy, physiology, and pathology. The study of AEG in definition, biology origin, classification, lymph node metastasis and other aspects had basically reached a consensus. But for the surgical approach, the extent of resection, lymph node dissection or the way of the digestive tract reconstruction was controversial for a long time. Conclusions AEG as a kind of independent disease is increasing hazard to human health．By far, the most effective treatment is surgical resection, and how to choose the surgical method needs to be further researched.