ObjectiveTo investigate the rule of lymph node metastasis and its relationship with prognosis in stage N1 thoracic esophageal squamous cell carcinoma. MethodsThe clinical and follow-up data of 121 stage N1 (1 to 2 lymph node metastases) thoracic esophageal squamous cell carcinoma patients, who underwent radical resection of esophageal carcinoma in our hospital from 2015 to 2017, were retrospectively analyzed. There were 104 (86.0%) males and 17 (14.0%) females with an average age of 64.9±8.3 years. ResultsThe early metastasis rates of the left upper paratracheal, right upper paratracheal, lower thoracic paraesophageal, paracardial, lesser curvature and greater curvature lymph nodes were 22.6%, 28.0%, 21.2%, 41.7%, 25.0% and 25.0%, respectively. The three-year survival rates in the group with and without left upper paratracheal lymph node metastasis were 8.3% and 34.9%, respectively (P=0.000). The three-year survival rates of the subcarinal lymph node metastasis group and the non-metastasis group were 10.5% and 36.3%, respectively (P=0.032). Multivariate Cox regression analysis showed that, left upper paratracheal lymph node metastasis (P=0.000) and subcarinal lymph node metastasis (P=0.010) were independent prognostic factors for early stage lymph node metastasis of esophageal squamous cell carcinoma. The three-year survival rates of patients with simple abdominal lymph node metastasis and those with simple thoracic lymph node metastasis were 51.1% and 25.0%, respectively (P=0.016). ConclusionThe lymph nodes of N1 stage thoracic esophageal squamous cell carcinoma are more likely to metastasize to left upper paratracheal lymph nodes, right upper paratracheal lymph nodes, lower thoracic paraesophageal lymph nodes, paracardial lymph nodes, lesser curvature of stomach and greater curvature of stomach lymph nodes. Lymph node metastases of left upper paratracheal and subcarinal are independent factors for the prognosis of patients with stage N1 thoracic esophageal squamous cell carcinoma. The prognosis of patients with simple abdominal lymph node metastasis is better than that of patients with simple thoracic lymph node metastasis.
ObjectiveTo explore the value on excision of subpyloric (No.6 group) lymph nodes of stomach by detection of metastatic rate and metastasis of lymph nodes of No.6 group and its subgroups. MethodsThe clinical data including complete information on No.6 group and its subgroups lymph nodes in 80 patients underwent gastrectomy and subpyloric lymph nodes dissection for gastric cancer from January 2006 to December 2009 were retrospectively analyzed. Referring to the right gastroepiploic vein, the No.6 lymph nodes were divided into three subgroups (No.6a, No.6b, and No.6c subgroup), and the relationship between the metastasis of No.6 lymph nodes and clinicopathologic features as well as the metastasis of No.7, No.8a， and No.9 lymph nodes were analyzed by logistic regression analysis. ResultsThe metastatic rate of No.6 group lymph nodes was 41.3% (33/80) and with 26.0% (108/415) of the resected lymph nodes involved. The metastatic rate of lymph nodes in No.6a subgroup (7.5%, 6/80) was significantly lower than that in No.6b (16.3%, 13/80) and No.6c subgroup (36.3%, 29/80), Plt;0.001. The metastasis of the resected lymph nodes in No.6a, No.6b, and No.6c subgroup was 25.0% (8/32), 17.6% (13/74), and 28.2% (87/309), respectively, and the difference was not significant (P=0.292). The metastasis of lymph nodes in No.6a subgroup was correlated to T stage (P=0.042) and N stage (P=0.006). The metastasis of lymph nodes in No.6b subgroup was correlated to N stage (P=0.002) and TNM stage (P=0.013). The metastasis of lymph nodes in No.6c subgroup was correlated to differentiation degree of tumor (P=0.008), T stage (P=0.003), N stage (P=0.000), and TNM stage (P=0.000). The logistic regression analysis showed that the metastasis of lymph nodes was correlated to the metastasis of No.8a lymph nodes (P=0.023) and N stage (P=0.002) in No.6 group, the metastasis of No.8a lymph nodes (P=0.018) in No.6a subgroup, N stage (P=0.005) in No.6b subgroup, and the metastasis of No.8a lymph nodes (P=0.016) and N stage (P=0.004) in No.6c subgroup. ConclusionAttentions should be paid to the complete dissection of subpyloric lymph nodes in gastric cancer surgery, especially for the lymph nodes of No.6a and No.6b subgroups.
ObjectiveTo investigate the metastatic status and risk factors of axillary non-sentinel lymph node (NSLN) in breast cancer patients with 1–2 positive sentinel lymph nodes (SLN), and to provide theoretical basis for exemption of axillary lymph node dissection (ALND) in these patients. Methods A retrospective analysis was performed on 54 patients diagnosed with breast cancer who underwent sentinel lymph node biopsy (SLNB) and confirmed to have 1–2 positive sentinel lymph nodes (SLNS) and received ALND in the Department of Thyroid and Breast Surgery of Tongling People’s Hospital from January 2018 to April 2023. The patients were divided into NSLN metastatic group (17 cases) and NSLN non-metastatic group (37 cases) according to whether there was metastasis. Chi-square test was used to compare the basic information and clinicpathological features of the two groups. The independent risk factors for axillary NSLN metastasis were screened out by multivariate binary logistic regression model. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of independent risk factors combined with axillary NSLN metastasis. Results There were 54 cases with 1–2 metastasis of SLN, 17 cases with axillary NSLN metastasis (31.5%). The incidence of axillary NSLN metastasis in patients with tumor at T1 stage (maximum diameter ≤2 cm) was only 14.3% (4/28), however, the metastatic rate of axillary NSLN in patients with tumor in T2–T3 stage (maximum diameter >2 cm) was as high as 50.0% (13/26). The axillary NSLN metastasis rate was only 21.2% (7/33) with 1 SLN metastasis, while the axillary NSLN metastasis rate was 47.6% (10/21) with 2 SLN metastasis. Univariate analysis showed that T stage (tumor diameter >2 cm), 2 SLN metastases, number of SLN >5 and tumor with vascular embolus were more likely to develop axillary NSLN metastases (P<0.05). Multivariate binary logistic regression analysis showed that T stage (tumor diameter >2 cm) and 2 SLN metastases were independent risk factors for axillary NSLN metastasis in breast cancer patients, the area under ROC curve of combined prediction of axillary NSLN metastasis by the two was 0.747, 95%CI was (0.657, 0.917), sensitivity was 0.765 and specificity was 0.649. Conclusions The combination of tumor T stage and the number of SLN metastases can better predict axillary NSLN metastasis in breast cancer patients. ALND is recommended for breast cancer patients with T stage (tumor diameter >2 cm) and 2 SLN metastases to reduce the risk of residual axillary NSLN metastasis.
Objective To summarize the research progress on diagnostic criteria of lymph node metastasis in medullary thyroid carcinoma (MTC), and the indication and scope of lateral cervical lymph node dissection (LCLND). Method By searching PubMed and CNKI databases, the related guidelines and literature about the diagnosis and treatment of lateral cervical lymph node metastasis in MTC in recent years were obtained and reviewed. Results The metastatic rate of lateral cervical lymph nodes in MTC patients was high. The indication of LCLND was both consensus and controversy. The LCLND of MTC was also controversial, and the focus of controversy mainly focused on the survival rate, recurrence rate, distant metastasis and postoperative complications of patients receiving prophylactic LCLND. Different imaging methods had their own advantages and disadvantages in diagnosing lymph node metastasis of MTC. Nuclear medicine was effective but expensive. Fine needle puncture was also an effective method for the diagnosis of lymph node metastasis of MTC. At present, calcitonin level, tumor size and lymph node metastasis were still important indicators for evaluating MTC for prophylactic LCLND, but the application of related indications had not been unified. Many scholars recommended comprehensive consideration of various indicators to evaluate whether MTC carried out preventive LCLND. Conclusions The LCLND of MTC needs to be further explored and standardized on the basis of the existing consensus. The focus of prophylactic LCLND should be to improve the survival rate of patients while reducing complications as much as possible.
Objective To investigate the diagnostic significance of fine needle aspiration cytology (FNAC) combined with BRAFV600E gene detection in the diagnosis of cervical lymph node metastasis of thyroid cancer. Methods Atotal of 140 patients with suspected cervical lymph node metastasis of thyroid cancer were collected as the research objects, and all patients were given ultrasound-guided FNAC and detection of BRAFV600E gene. The significance of the diagnosis was analyzed according to the gold standard after pathological examination. Results All the 140 patients underwent surgical treatment. For FNAC, the sensitivity was 63.6% (84/132), the specificity was 100% (8/8), the accuracy was 65.7% (92/140), the positive predictive value was 100% (84/84), and the negative predictive value was 14.3% (8/56). For detection of BRAFV600E gene, the sensitivity was 84.8% (112/132), the specificity was 100% (8/8), the accuracy was 85.7% (120/140), the positive predictive value was 100% (112/112), and the negative predictive value was 28.5% (8/28). For FNAC combined with BRAFV600E gene detection, the sensitivity was 90.9% (120/132), the specificity was 100% (8/8), the accuracy was 91.4% (128/140), the positive predictive value was 100% (120/120), and the negative predictive value was 40.0% (8/20). The area under curve of receiver operating characteristic for FNAC, detection of BRAFV600E gene, and FNAC combined with BRAFV600E gene detection were 0.818, 0.924, and 0.955, respectively. Conclusion FNAC combine with BRAFV600E gene detection improves the accuracy of neck lymph node metastasis in patients with thyroid cancer, which is worthyof performed.
ObjectiveTo analyze the characteristics and risk factors of lymph node metastasis in thoracic esophageal squamous cell carcinoma (ESCC).MethodsThe clinical data of 407 patients with ESCC who underwent radical resection of esophageal carcinoma from December 2012 to October 2018 in our hospital were retrospectively analyzed. There were 390 males and 17 females with a median age of 63 (38-82) years. Esophageal lesions were found in 26 patients of upper thoracic segment, 190 patients of middle thoracic segment and 191 patients of lower thoracic segment. ResultsAmong the patients, 232 (57.0%) were found to have cervical, thoracic and/or abdominal lymph node metastasis. The lymphatic metastasis rates of cervical, upper, middle, lower mediastinal nodes and abdominal nodes were 0.7%, 8.8%, 21.4%, 16.7% and 37.1%, respectively. The adjacent lymph node metastasis alone occurred in 50.0% patients, and the multistage or skip lymph node metastasis accounted for 29.3% and 20.7%, respectively. Multivariate analysis showed that the length of esophageal lesion, T stage, degree of tumor differentiation, vascular cancer embolus and nerve invasion were independent risk factors for lymph node metastasis.ConclusionThe rates of lymph node metastasis are similar in the upper, middle and lower thoracic ESCC. The main pattern of lymph node metastasis is the adjacent lymph node metastasis, followed by multistage and skip lymph node metastases. The length of esophageal lesion, T stage, degree of tumor differentiation, vascular cancer embolus and nerve invasion are independent factors for lymph node metastasis. The operation and dissection range should be selected according to the location of tumor and the characteristics of the lesion.
ObjectiveTo analyze the expression and significance of NF-κBp65 and autophagy-related proteins Beclin1 and p62 in patients with papillary thyroid carcinoma (PTC).MethodsOne hundred and sixty cases of PTC patients' tumor tissue specimens and paracancerous tissue specimens in our hospital from March 2013 to February 2015 were collected, and 90 cases of cervical lymph node metastasis tissue specimens of the above patients were collected. The expressions of NF-κBp65, Beclin1 and p62 in PTC tissues, metastatic lymph node tissues and paracancerous tissues were detected by immunohistochemical method, and the relationship between the above indexes and the clinicopathological characteristics and prognosis of PTC patients was analyzed.ResultsThe positive rates of expression of NF-kappa Bp65 and p62 in PTC tissues and metastatic lymph node tissues were higher than those in paracancerous tissues (P<0.05). The expression rate of Beclin1 in PTC tissues and metastatic lymph node tissues was lower than that in paracancerous tissues (P<0.05). The positive rate of NF-κBp65 expression in PTC tissues was not related to the clinicopathological characteristics of patients (P>0.05). The expression of p62 decreased with the increase of tumor differentiation (P<0.05). The expression of Beclin1 in patients with stage Ⅲ+Ⅳ and lymph node metastasis were lower than those in patients with stage Ⅰ+Ⅱ and without lymph node metastasis (P<0.05), while the expression of p62 was opposite. Spearman correlation analysis showed that the expression of Beclin1 and p62 in PTC tissues was negatively correlated (r=–0.656, P<0.01). In metastatic lymph node tissues, the expression of Beclin1 and p62 was also negatively correlated (r=–0.562, P<0.01). The 3-year survival rates of patients with positive expression of p62 and NF-κBp65 in PTC tissues were lower than that of patients with negative expression (P<0.05). The 3-year survival rate of patients with positive expression of Becrin1 was higher than that of negative expression (P<0.05). TNM stage, lymph node metastasis, NF-κBp65 and p62 were independent risk factors for PTC prognosis, and Beclin1 was protective factor.ConclusionsNF-κBp65 and p62 are highly expressed in PTC tissues and lymph node metastasis tissues, while Beclin1 is poorly expressed, which could be used as independent prognostic factors for PTC patients. In addition, Beclin1 and p62 are related to PTC biological behavior and may become potential indicators for PTC diagnosis.
ObjectiveTo investigate the mediastinal lymph node metastasis of cT1a-cN0M0 lung adenocarcinoma, so as to provide a theoretical basis for intraoperative lymph node dissection in patients with early stage lung adenocarcinoma.MethodsClinicopathological features of lung adenocarcinoma patients who received operation in our hospital from 2017 to 2018 were collected. A total of 667 patients including 241 male and 426 female patients at age of 59 (16, 87) years were included. There were 234 patients with pure ground glass nodules, 98 patients with ground glass-predominant tumor, 199 patients with consolidation-predominant tumor and 136 patinets with solid tumor in the study. Postoperative N1 lymph node metastasis occurred in 30 patients and N2 lymph node metastasis occurred in 52 patients.ResultsThe result of univariate analysis showed that male (P=0.014), higher carcino-embryonic antigen levels (P<0.001), larger nodal diameter (P<0.001), larger consolidation tumor ratio (P<0.001), smaller tumor disappearance ratio (P<0.001), solid nodules (P<0.001), cavitary sign (P=0.005), lobulation sign (P=0.002), spicule sign (P=0.003), pleural indentation sign (P=0.001), bronchus sign (P=0.025) were risk factors for mediastinal lymph node metastasis. In terms of pathology, the N2 positive group had larger size of pathological tissue (P<0.001), more N1 lymph node metastasis (P<0.001), higher pathology T stage (P<0.001), more spread through air space (P=0.001), more pleural invasion (P<0.001), and more lymphovascular invasion (P<0.001). Multivariate analysis showed that lymphovascular invasion (OR=6.9, 95%CI 2.3-20.7, P=0.001), larger consolidation tumor ratio (OR=109.6, 95%CI 3.8-3 124.3, P=0.006), cavitary sign (OR=3.1, 95%CI 1.1-8.3, P=0.028) and N1 lymph node metastasis (OR=15.7, 95%CI 6.7-36.4, P<0.001) were independent risk factors for mediastinal lymph node metastasis.ConclusionFor lung adenocarcinoma, mediastinal lymph node metastasis will not occur in ground glass nodule and ground glass-predominant tumor patients. The probability of mediastinal lymph node metastasis increases with the increase of solid components and presence of cavitary sign. Therefore, different types of lymph node resection can be considered for patients with different imaging findings.
ObjectiveTo explore the risk factors of lymph node metastasis in patients with colorectal cancer, and construct a risk prediction model to provide reference for clinical diagnosis and treatment.MethodsThe clinicopathological data of 416 patients with colorectal cancer who underwent radical resection of colorectal cancer in the Department of Gastrointestinal Surgery of the Second Affiliated Hospital of Nanchang University from May 2018 to December 2019 were retrospectively analyzed. The correlation between lymph node metastasis and preoperative inflammatory markers, clinicopathological factors and tumor markers were analyzed. Logistic regression was used to analyze the risk factors of lymph node metastasis, and R language was used to construct nomogram model for evaluating the risk of colorectal cancer lymph node metastasis before surgery, and drew a calibration curve and compared with actual observations. The Bootstrap method was used for internal verification, and the consistency index (C-index) was calculated to evaluate the accuracy of the model.ResultsThe results of univariate analysis showed that factors such as sex, age, tumor location, smoking history, hypertension and diabetes history were not significantly related to lymph node metastasis (all P>0.05). The factors related to lymph node metastasis were tumor size, T staging, tumor differentiation level, fibrinogen, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), fibrinogen/albumin ratio (FAR), fibrinogen/prealbumin ratio (FpAR), CEA, and CA199 (all P<0.05). The results of logistic regression analysis showed the FpAR [OR=3.630, 95%CI (2.208, 5.968), P<0.001], CA199 [OR=2.058, 95%CI (1.221, 3.470), P=0.007], CEA [OR=2.335, 95%CI (1.372, 3.975), P=0.002], NLR [OR=2.532, 95%CI (1.491, 4.301), P=0.001], and T staging were independent risk factors for lymph node metastasis. The above independent risk factors were enrolled to construct regression equation and nomogram model, the area under the ROC curve of this equation was 0.803, and the sensitivity and specificity were 75.2% and 73.5%, respectively. The consistency index (C-index) of the nomogram prediction model in this study was 0.803, and the calibration curve showed that the result of predicting lymph node metastasis was highly consistent with actual observations.ConclusionsFpAR>0.018, NLR>3.631, CEA>4.620 U/mL, CA199>21.720 U/mL and T staging are independent risk factors for lymph node metastasis. The nomogram can accurately predict the risk of lymph node metastasis in patients with colorectal cancer before surgery, and provide certain assistance in the formulation of clinical diagnosis and treatment plans.
Objective To explore regularity of lymph node metastasis and analyze its relation between lymph node metastasis and histological features and its immunohistochemical markers of gastric cancer, and to provide evidence for selection of reasonable operation. Method The clinical data of 160 patients with gastric cancer who underwent D2, D3 or D3+ from August 2013 to May 2016 in the Second Hospital of Lanzhou University were retrospectively studied, and the relation between the lymph node metastasis and the pathological features and the immunohistochemical markers in the different location of gastric cancer was analyzed. Results ① The rate of lymph node metastasis in the early gastric cancer was significantly lower than that in the advanced gastric cancer (P<0.05), which in the T4 stage was significantly higher than that in the T1–T3 stages (P<0.05), in the poorly differentiated gastric cancer was significantly higher than that in the well differentiated gastric cancer (P<0.05), or in the Borrmann type Ⅲ+Ⅳ (infiltrative type) was significantly higher than that in the Borrmann type Ⅰ+Ⅱ (topical type,P<0.05), but which wasn’t associated with the gender, tumor location, or tumor diameter (P>0.05). ② The lymph node metastasis occurred mainly in the first and the second stations for the well differentiated gastric cardia cancer, which not only occurred in the first and the second stations, but also occurred in the No.13 lymph node for the poorly differentiated gastric cardia cancer; which occurred mainly in the first and the second stations and occasionally occurred in the No.12 lymph node for the well differentiated gastric body cancer, which not only occurred in the first and the second stations, but also occurred in the No.12, No.13 and No.14 lymph nodes for the poorly differentiated gastric body cancer; which occurred in the No.11, No.12 and No.13 lymph nodes for the part of well differentiated gastric antrum cancer, which even occurred in the No.15 and No.16 lymph nodes for the part of poorly differentiated gastric antrum cancer. ③ The expression positive rates of the TopoⅡα, Villin, Ki-67, CK-8, and CK-18 proteins in the poorly differentiated gastric cancer were significantly higher than those in the well differentiated gastric cancer (P<0.05), which of the P-gp, GST-π, and c-erbB-2 proteins in the poorly differentiated gastric cancer were significantly lower than those in the well differentiated gastric cancer (P<0.05). The expression positive rates of the TopoⅡα, P-gp, Villin, Ki-67, CK-8, and CK-18 proteins in the gastric cancer with lymph node metastasis were significantly higher than those in the gastric cancer without lymph node metastasis (P<0.05), whereas there were no relation between the expression positive rates of the GST-π and c-erbB-2 proteins and the lymph node metastasis of gastric cancer (P>0.05). ④ The different location of gastric cancer wasn’t associated with the gender, gross type, clinical stage, T stage, degree of differentiation, Borrmann type, or tumor diameter. Conclusions In advanced gastric cancer, depth of tumor invasion reached T4, poor degree of differentiation, and Borrmann infiltration type of gastric cancer, lymph node metastasis rates are higher. For gastric cardia cancer patients with well differentiation, standard D2 should be performed, D2+No.13 should be performed for poor differentiation. For gastric body cancer patients with well differentiation, D2+No.12 should be performed, D3 should be performed for poor differentiation. For gastric antrum cancer patients with differentiation degree or not, D3 should be performed, selective dissection of No.15 or No.16 lymph node should be performed for poor differentiation. Combined detection of TopoⅡα, Villin, Ki-67, CK-8, CK-18, P-gp, GST-π, and c-erbB-2 immunohistochemical markers might be helpful to improve accuracy of lymph node metastasis and evaluate degree of malignancy and prognosis of patients with gastric cancer.